Evidence suggests superiority of breast conserving surgery (BCS) plus radiation over mastectomy alone for treatment of early stage breast cancer. Whether the superiority of BCS plus radiation is ...related to the surgical approach itself or to the addition of adjuvant radiation therapy following BCS remains unclear.
We conducted a retrospective cohort study of women with breast cancer diagnosed from 1994-2012. Data regarding patient and tumor characteristics and treatment specifics were captured electronically. Kaplan-Meier survival analyses were performed with inverse probability of treatment weighting to reduce selection bias effects in surgical assignment.
Data from 5335 women were included, of which two-thirds had BCS and one-third had mastectomy. Surgical decision trends changed over time with more women undergoing mastectomy in recent years. Women who underwent BCS versus mastectomy differed significantly regarding age, cancer stage/grade, adjuvant radiation, chemotherapy, and endocrine treatment. Overall survival was similar for BCS and mastectomy. When BCS plus radiation was compared to mastectomy alone, 3-, 5-, and 10-year overall survival was 96.5% vs 93.4%, 92.9% vs 88.3% and 80.9% vs 67.2%, respectively.
These analyses suggest that survival benefit is not related only to the surgery itself, but that the prognostic advantage of BCS plus radiation over mastectomy may also be related to the addition of adjuvant radiation therapy. This conclusion requires prospective confirmation in randomized trials.
Aims. We aim to constrain the structural variations within the HST-1 region downstream of the radio jet of M 87, in general as well as in connection to the episodes of activity at very high energy ...(VHE). Methods. We analyzed and compared 26 VLBI observations of the M 87 jet, obtained between 2006 and 2011 with the Very Long Baseline Array (VLBA) at 1.7 GHz and the European VLBI Network (EVN) at 5 GHz. Results. HST-1 is detected at all epochs; we model-fitted its complex structure with two or more components, the two outermost of which display a significant proper motion with a superluminal velocity around ~4 c. The motion of a third feature that is detected upstream is more difficult to characterize. The overall position angle of HST-1 has changed during the time of our observations from −65° to −90°, while the structure has moved by over 80 mas downstream. Our results on the component evolution suggest that structural changes at the upstream edge of HST-1 can be related to the VHE events.
Abstract The debate over the effects of the timing of surgical spinal decompression after traumatic spinal cord injury (tSCI) has remained unresolved for over a century. The aim of the current study ...was to perform a systematic review and quality-adjusted meta-analysis of studies evaluating the effects of the timing of spinal surgery after tSCI. Studies were searched for through the MEDLINE(®) database (1966 to August 2012) and a 15-item, tailored scoring system was used for assessing the included studies' susceptibility to bias. Random effects and quality effects meta-analyses were performed. Models were tested for robustness using one way and criterion-based sensitivity analysis and funnel plots. Results are presented as weighted mean differences (WMDs) and odds ratios (ORs) with 95% confidence intervals (CIs). A total of 18 studies were analyzed. Heterogeneity was evident among the studies included. Quality effects models showed that - when compared with "late" surgery - "early" spinal surgery was significantly associated with a higher total motor score improvement (WMD: 5.94 points, 95% CI:0.74,11.15) in seven studies, neurological improvement rate (OR: 2.23, 95% CI:1.35,3.67) in six studies, and shorter length of hospital stay (WMD: -9.98 days, 95% CI:-13.10,-6.85) in six studies. However, one way and criterion-based sensitivity analyses demonstrated a profound lack of robustness among pooled estimates. Funnel plots showed significant proof of publication bias. In conclusion, despite the fact that "early" spinal surgery was significantly associated with improved neurological and length of stay outcomes, the evidence supporting "early" spinal surgery after tSCI lacks robustness as a result of different sources of heterogeneity within and between original studies. Where the conduct of a surgical, randomized controlled trial seems to be an unfeasible undertaking in acute tSCI, methodological safeguards require the utmost attention in future cohort studies. (Prospero registration number: PROSPERO CRD42012003182. See also http://www.crd.york.ac.uk/NIHR_PROSPERO/ ).
Study objective Rapid sequence intubation performed by nonphysicians such as paramedics or nurses has become increasingly common in many countries; however, concerns have been stated in regard to the ...safe use and appropriateness of rapid sequence intubation when performed by these health care providers. The aim of our study is to compare rapid sequence intubation success and adverse events between nonphysician and physician in the out-of-hospital setting. Methods A systematic literature search of key databases including MEDLINE, EMBASE, and the Cochrane Library was conducted. Eligibility, data extraction, and assessment of risk of bias were assessed independently by 2 reviewers. A bias-adjusted meta-analysis using a quality-effects model was conducted for the primary outcomes of overall intubation success and first-pass intubation success and for adverse events when possible. Results Eighty-three studies were included in the meta-analysis. There was a 2% difference in successful intubation proportion for physicians versus nonphysicians, 99% (95% confidence interval CI 98% to 99%) versus 97% (95% CI 95% to 99%). A 10% difference in first-pass rapid sequence intubation success was noted between physicians versus nonphysicians, 88% (95% CI 83% to 93%) versus 78% (95% CI 65% to 89%). For airway trauma, bradycardia, cardiac arrest, endobronchial intubation, hypertension, and hypotension, lower prevalences of adverse events were noted for physicians. However, nonphysicians had a lower prevalence of hypoxia and esophageal intubations. Similar proportions were noted for pulmonary aspiration and emesis. Nine adverse events estimates lacked precision, except for endobronchial intubation, and 4 adverse event analyses showed evidence of possible publication bias. Consequently, no reliable evidence exists for differences between physicians and nonphysicians for adverse events. Conclusion This analysis shows that physicians have a higher rapid sequence intubation first-pass and overall success, as well as mostly lower rates of adverse events for rapid sequence intubation in the out-of-hospital setting. Nevertheless, for all success and adverse events no firm conclusion for a difference could be drawn because of lack of precision of meta-analytic estimates or selective reporting. First-pass success could be an area in which to focus quality improvement strategies for nonphysicians.
We report that a ferroelectric-like metallic state with reduced anisotropy of polarization is created by the doping of conduction electrons into BaTiO3, on the bases of x-ray/electron diffraction and ...infrared spectroscopic experiments. The crystal structure is heterogeneous in nanometer-scale, as enabled by the reduced polarization anisotropy. The enhanced infrared intensity of soft phonon along with the resistivity reduction suggests the presence of unusual electron-phonon coupling, which may be responsible for the emergent ferroelectric structure compatible with metallic state.
We present an investigation into how well the properties of the accretion flow on to a supermassive black hole may be coupled to those of the overlying hot corona. To do so, we specifically measure ...the characteristic spectral index, Γ, of a power-law energy distribution, over an energy range of 2-10 keV, for X-ray selected, broad-lined radio-quiet active galactic nuclei (AGN) up to z ∼ 2 in Cosmic Evolution Survey (COSMOS) and Extended Chandra Deep Field South (E-CDF-S). We test the previously reported dependence between Γ and black hole mass, full width at half-maximum (FWHM) and Eddington ratio using a sample of AGN covering a broad range in these parameters based on both the Mg ii and Hα emission lines with the later afforded by recent near-infrared spectroscopic observations using Subaru/Fibre Multi Object Spectrograph. We calculate the Eddington ratios, λEdd, for sources where a bolometric luminosity (L
Bol) has been presented in the literature, based on spectral energy distribution fitting, or, for sources where these data do not exist, we calculate L
Bol using a bolometric correction to the X-ray luminosity, derived from a relationship between the bolometric correction and L
X/L
3000. From a sample of 69 X-ray bright sources (>250 counts), where Γ can be measured with greatest precision, with an estimate of L
Bol, we find a statistically significant correlation between Γ and λEdd, which is highly significant with a chance probability of 6.59× 10−8. A statistically significant correlation between Γ and the FWHM of the optical lines is confirmed, but at lower significance than with λEdd indicating that λEdd is the key parameter driving conditions in the corona. Linear regression analysis reveals that Γ = (0.32 ± 0.05) log10λEdd + (2.27 ± 0.06) and Γ = (−0.69 ± 0.11) log10(FWHM/km s−1) + (4.44 ± 0.42). Our results on Γ-λEdd are in very good agreement with previous results. While the Γ-λEdd relationship means that X-ray spectroscopy may be used to estimate black hole accretion rate, considerable dispersion in the correlation does not make this viable for single sources, however could be valuable for large X-ray spectral samples, such as those to be produced by eROSITA.
Background
Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current ...literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates.
Objectives
To conduct a systematic review of the literature and meta‐regression to explore the global incidence of CDMR.
Search strategy
PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019.
Selection criteria
Observational studies that report CDMR data were included. We excluded non‐English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors.
Data collection and analysis
Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality‐effects meta‐regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants.
Main results
We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation.
Conclusions
An appropriate reporting of CDMR should be a key priority in maternal health policies and practices.
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Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.
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Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.
Type 2 diabetes mellitus (DM) and cancer are common diseases that are frequently diagnosed in the same individual. An association between the two conditions has long been postulated. Here, we review ...the epidemiological evidence for increased risk of cancer, decreased cancer survival, and decreased rates of cancer screening in diabetic patients. The risk for several cancers, including cancers of the pancreas, liver, colorectum, breast, urinary tract, and endometrium, is increased in patients with DM. In a pooled risk analysis weighting published meta-analytic relative risk (RR) for individual cancer by differences in their incidence rates, we found a population RR of 0.97 (95% CI, 0.75-1.25) in men and 1.29 (95% CI, 1.16-1.44) in women. All meta-analyses showed an increased relative risk for cancer in diabetic men, except studies of prostate cancer, in which a protective effect was observed. The relationship between diabetes and cancer appears to be complex, and at present, a clear temporal relationship between the two conditions cannot be defined. DM also impacts negatively on cancer-related survival outcomes and cancer screening rates. The overwhelming evidence for lower cancer screening rates, increased incidence of certain cancers, and poorer prognosis after cancer diagnosis in diabetic patients dictates a need for improved cancer care in diabetic individuals through improved screening measures, development of risk assessment tools, and consideration of cancer prevention strategies in diabetic patients. Part two of this review focuses on the biological and pharmacological mechanisms that may account for the association between DM and cancer.
Malaria causes significant morbidity and mortality worldwide. There are several preventive measures that are currently employed, including insecticide-treated nets (ITNs, including long-lasting ...insecticidal nets and insecticidal-treated bed nets), indoor residual spraying (IRS), prophylactic drugs (PD), and untreated nets (UN). However, it is unclear which measure is the most effective for malaria prevention. We therefore undertook a network meta-analysis to compare the efficacy of different preventive measures on incidence of malaria infection.
A systematic literature review was undertaken across four medical and life sciences databases (PubMed, Cochrane Central, Embase, and Web of Science) from their inception to July 2016 to compare the effectiveness of different preventive measures on malaria incidence. Data from the included studies were analysed for the effectiveness of several measures against no intervention (NI). This was carried out using an automated generalized pairwise modeling (GPM) framework for network meta-analysis to generate mixed treatment effects against a common comparator of no intervention (NI).
There were 30 studies that met the inclusion criteria from 1998-2016. The GPM framework led to a final ranking of effectiveness of measures in the following order from best to worst: PD, ITN, IRS and UN, in comparison with NI. However, only ITN (RR: 0.49, 95% CI: 0.32-0.74) showed precision while other methods PD (RR: 0.24, 95% CI: 0.004-15.43), IRS (RR: 0.55, 95% CI: 0.20-1.56) and UN (RR: 0.73, 95% CI: 0.28-1.90) demonstrating considerable uncertainty associated with their point estimates.
Current evidence is strong for the protective effect of ITN interventions in malaria prevention. Even though ITNs were found to be the only preventive measure with statistical support for their effectiveness, the role of other malaria control measures may be important adjuncts in the global drive to eliminate malaria.
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