Chemotherapy-induced oral mucositis management: A retrospective analysis of MuGard, Caphosol, and standard supportive care measures

Background

Oral mucositis, a common complication of several different anticancer therapies, causes significant morbidity in cancer patients. It is characterized by the destruction of the mucosa throughout the gastrointestinal tract including the oral cavity. Limited data exist regarding the treatment of established oral mucositis with oral mucoadhesive hydrogel (MuGard) or supersaturated calcium phosphate oral rise (Caphosol) compared to standard topical therapies.

Objectives

To evaluate the effects of MuGard and Caphosol compared to standard topical therapy in the treatment of established oral mucositis.

Methods

A retrospective chart review was performed including adults receiving MuGard, Caphosol, and/or standard topical therapy for the treatment of established oral mucositis while admitted to a community teaching hospital. A post hoc propensity score was used to match patients receiving newer agents (Mugard/Caphosol) to those receiving standard topical therapy (ST).

Results

One hundred and forty-seven patients were included for analysis (125 ST, 15 MuGard, 7 Caphosol). From this population, 14 patients in each group were matched. The primary endpoint of median change in average daily pain score at days 3 and 7, compared to baseline, demonstrated no difference between matched groups at day 3 (ST 0, MuGard/Caphosol 0.18, p = 0.830) or day 7 (ST 0, MuGard/Caphosol 0.8, p = 0.494). No differences were noted between groups in opioid usage, oral mucositis symptom duration or progression, or incidence of documented infection.

Conclusion

MuGard and Caphosol did not demonstrate any benefits compared to standard topical therapy at reducing pain scores or increasing mucosal recovery in the treatment of oral mucositis.

Gender and socioeconomic inequalities in the implementation of the Basque programme for multimorbid patients

Background

The aim of our study was to increase awareness of the relevance of the implemented programmes to inequity of access and inequality of health by analyzing the impact of a patient-centred strategy for multimorbid patients.

Methods

This retrospective study compared the 2014 multimorbid patient group (intervention group) with its 2012 analogue (control group), before the Department of Health of the Basque Country launched the strategy for managing disease chronicity. Inequalities in healthcare access were represented by differences in the inclusion of patients in the programme and in contacts with primary care (PC) services by gender and socioeconomic status (measured by deprivation index by census track). Likewise, differences in hospital care represented inequalities in health outcomes. Generalized linear models were used to analyze relationships among variables. A propensity score by a genetic matching approach was used to minimize possible selection bias.

Results

At baseline, women had less probability of being eligible for the programme. No clear patterns were seen in resource consumption in PC. The probability of hospitalization was higher for men and increased according to socioeconomic status. The implementation of the programme yielded more contacts with PC services in all groups and a reduction in hospitalizations, especially among men and the most socioeconomically deprived patients.

Conclusion

The patient-centred, integrated-care intervention launched by the Department of Health of the Basque Country might have reduced some gender and socioeconomic inequalities in health outcomes, as it avoided more hospitalizations in subgroups that presented with more episodes of decompensation in the reference year.

Avaliação clínica dos sintomas de pacientes com câncer de cabeça e pescoço

Objetivo: avaliar os sintomas mais frequentes apresentados pelos pacientes com câncer de cabeça e pescoço e fatores associados.Metodologia: trata-se de um estudo transversal realizado com 77 pacientes do serviço de cirurgia de cabeça e pescoço do Instituto Nacional de Câncer (Brasil). Foi utilizado o Memorial Symptom Assessment Scale (MSAS), adaptado ao Brasil. Foi avaliada a prevalência dos sintomas, bem como sua associação com variáveis demográficas e clínicas por meio dos testes de qui- quadrado e de ANOVA.Resultados: os sintomas mais prevalentes foram boca seca (62,5 %), tristeza (60 %), preocupações (53,75 %), nervosismo (48,75 %) e tosse (46,25 %). Quanto à faixa etária, identificou-se diferença nos sintomas físicos de baixa frequência (PHYS-L), com maior queixa entre os jovens (p < 0,01). Na escala global (TMSAS) houve queixa maior dos pacientes ambulatoriais comparados aos internados (p = 0,05). Houve, ainda, queixa maior de sintomas de baixa frequência entre pacientes sem metástase (p = 0,05).Conclusão: considerando-se a ocorrência de múltiplos sintomas no paciente oncológico, é necessário ter métodos que sejam capazes de avaliar, de forma mais ampla, os sintomas. Dessa forma, o enfermeiro terá melhor compreensão da complexidade dos grupos de sintomas, permitindo aperfeiçoar as intervenções clínicas no processo de enfermagem.

Evaluating Monetary-Based Benefit-Sharing as a Mechanism to Improve Local Human Development and its Importance for Impact Assessment of Hydropower Plants in Brazil

Although hydropower companies and governments have promoted monetary-based Benefit-Sharing Mechanisms alone as a vector of local development for flooded municipalities, it is not possible to identify this evidence in the scientific literature. The present work investigates the quantitative influence of Financial Compensation on Human Development Indexes (HDI) in flooded municipalities over 2000–2010. The econometric analysis shows that there are no statistically significant results related to the quantities of Financial Compensation and the development variables. The findings reinforce that Financial Compensation itself could not be considered the only input to improve development processes. Management frameworks should be considered since they can provide a broader view of the affected areas, including elements such as participatory processes, adaptation management, formal and legal guidelines and stakeholder engagement. Specially in the Brazilian case, the Impact Assessment procedures and their products could provide detailed data and criteria to municipalities to manage the inflow resources.

General practitioner endorsement of mail-out colorectal cancer screening: The perspective of nonparticipants

Despite the health and economic benefits associated with mail-out colorectal cancer (CRC) screening, participation in programs across the world is suboptimal. A letter from the recipient’s general practitioner (GP) endorsing program participation has been shown to have a consistent, but modest, effect on screening uptake; however, the mechanisms by which GP endorsement is effective have not been investigated. The purpose of the present study was to evaluate the potential utility of GP endorsement letters or SMS in the context of facilitating bowel cancer screening in previous nonparticipants and to identify mechanisms underlying responses. A cross-section of nonparticipants in the Australian National Bowel Cancer Screening Program (N = 110) was randomly assigned to view a letter or SMS from a GP endorsing participation via an online survey. Ordinal responses reflecting effectiveness of, and influences on, GP endorsement were collected along with open questions regarding other potential endorsers. Percentages, means, and 95% confidence intervals were calculated and compared. Fifty-two percent of the sample agreed that GP endorsement would encourage their future participation. Responses did not differ between SMS and letter formats. Trust in the GP had significantly more influence on response to GP endorsement than the credibility or medical knowledge. Other health professionals and cancer survivors were commonly suggested as alternative sources of endorsement. Interventions to improve CRC screening participation could benefit from the routine implementation of GP endorsement from GPs, other trusted health professionals, or cancer survivors, particularly by encouraging people who forget or procrastinate over collecting a stool sample.

Global and Multidimensional Symptom Assessments in Patients Presenting Abdominal Neoplasms

Objective: To evaluate symptoms among patients with abdominal cancer and associated factors. Materials and methods: A cross-sectional study with 100 patients. The prevalence of symptoms was evaluated through the Memorial Symptom Assessment Scale (MSAS) and its association with demographic and clinical variables using chi-square and ANOVA tests. Results: The most prevalent symptoms were weight loss (64.0 %), pain (56.0 %), dry mouth (50.0 %), “I do not look more myself” (48.0 %) and lack of energy (45.0 %). There was a significant difference between sex and high-frequency (PHYS-H) (p = 0.001) and low-frequency (PHYS-L) physical symptoms (p = 0.004), and for general scale (TMSAS) (p = 0.002); (p = 0.001), general range (p = 0.027) and borderline significance for the global scale (GDI) (p = 0.051); high-frequency physical symptoms (p = 0.022), low-frequency physical symptoms (p = 0.034) and the overall scale (p = 0.034). There was one major complaint regarding the severity of high-frequency physical symptoms in patients with liver cancer (p = 0.018). Conclusion: Symptoms of physical and psychological aspects in cancer patients were associated with gender, race, marital status and tumor location. There is a need for tools to assess symptoms and enable health professionals to intervene more effectively.

Epidemiology of acute kidney injury and associated factors among patients with malignancy: Analysis of hospital inpatient database in Shanghai, China

Objective:

This study aimed to understand the incidence of acute kidney injury in cancer patients, to figure out which clinical factors could increase the risks of acute kidney injury, and then to assess the effect of acute kidney injury on in-hospital mortality, length of stay, and hospital cost.

Methods:

This study was designed as a retrospective cohort study based on the hospital inpatient database in Zhongshan Hospital, Shanghai, China. Patients with malignancy and admitted to the hospital between 1 October 2014 and 30 September 2015 were recruited. Data on demographics, comorbidities, and clinical records were exported for analysis. Acute kidney injury was diagnosed using KDIGO (Kidney Disease: Improving Global Outcomes) criteria and stratified into community-acquired and hospital-acquired acute kidney injury. Multivariate model and survival analysis were applied to discover the influencing factors of acute kidney injury among cancer patients.

Results:

Of the 26,914 eligible cancer admissions, 3326 acute kidney injury cases were identified with an incidence of 12.4%. Of them, 2961 patients located in acute kidney injury stage 1 and another 365 cases developed to stage 2–3. The highest rates were localized to renal cancer (27.3%), multiple myeloma (24.1%), and leukemia (23.9%). Patients with older age and hematologic cancer shared a higher acute kidney injury incidence. Pre-existing chronic kidney disease (adjusted odds ratio = 7.14), heart failure (adjusted odds ratio = 4.20), surgery/chemotherapy (adjusted odds ratio = 0.99/2.28), hyponatremia (adjusted odds ratio = 2.84), hypokalemia (adjusted odds ratio = 2.42), and hyperuricemia (adjusted odds ratio = 2.62) were the major factors associated with acute kidney injury. In-hospital mortality for acute kidney injury patients was 5.1% as compared with those without acute kidney injury (0.8%). Survival analysis reveals that the risk of death was higher among patients with hospital-acquired acute kidney injury (adjusted hazard ratio = 4.50) and severe acute kidney injury stage (adjusted hazard ratio = 2.68/3.91). Furthermore, the length of stay (13.5 days) and hospital cost (45,066 CNY) were significantly greater in patients with community-acquired acute kidney injury.

Conclusion:

Acute kidney injury was common in cancer patients and associated with an ominous outcome. Pre-existing comorbidities, electrolyte disturbances, and abnormal biochemical were the predicting factors for acute kidney injury incidence. Better monitoring of electrolytes, identification of high-risk patients, and early acute kidney injury diagnosis should be considered as a priority during anti-cancer treatment.

Perspectives of ferrocenyl chalcones: synthetic scaffolds toward biomedical and materials science applications

Ferrocene and its derivatives constitute versatile and interesting scaffolds for the global chemical enterprise due to its multiple applications that range from biomedical to materials science. Ferrocenyl derivatives are the leading compounds in our research for the syntheses and characterization as well as their potential biological applications. Among them, our recent focus has been in ferrocenyl chalcones as a framework for further derivatization. The proposed modifications consist on the incorporation of heterocyclic moieties into the ferrocenyl chalcone core. This can be afforded either by introducing a heterocyclic aromatic moiety as a substituent or functionalizing the α-β unsaturated system. Another modification explored is the formation of ammonium or pyridinium salts to increase water solubility. Studied ferrocenyl chalcones exhibit remarkable stability, physical, and electrochemical properties. These factors have led the approaches for them to be precursors of biologically active compounds (cancer, bacteria, malaria, and neurobiological diseases). Moreover, other potential applications include molecular materials, redox-sensors, and polymers. Our goal in this mini review is to highlight the chemistry of ferrocene derivatives with particular prominence to those ferrocenyl chalcones studied in our laboratory and their applications. Moreover, we are providing a background on ferrocene, chalcones, and ferrocenyl chalcones, emphasizing the methodologies with preeminent yields.

Determination of Aflatoxin M1 concentration in volunteers from rural and urban areas of Cochabamba-Bolivia

Aflatoxins are produced by toxigenic strains of Aspergillus fungi and include the subtypes: B1, B2, G1, and G2. Once ingested, aflatoxin is metabolized to aflatoxin M1 found in the urine. Because of the importance of aflatoxins on human health, we analyzed 550 urine samples collected from farmers and city volunteers from Cochabamba. The level of aflatoxin M1 was determined using the Helica Aflatoxin M1 ELISA Kit specific for urine. 216 volunteer farmers had an aflatoxin M1 range of 0.02-1.21 ng/ml, while 334 urine city volunteers had a range of 0.03-1.27 ng/ml, indicating a risk for exposure to aflatoxin contamination for both populations.

Inhibitory effects of nobiletin and its major metabolites on lung tumorigenesis

The present study demonstrated that the oral administration of nobiletin significantly inhibited lung carcinogenesis in mice, and these chemopreventive effects could be attributed to its metabolites that showed potent anti-cancer effects.

Quantification of CYFRA 21-1 and a CYFRA 21-1–anti-CYFRA 21-1 autoantibody immune complex for detection of early stage lung cancer

Population-based screening of stage 0–I lung cancer is crucial for saving lives. The CIC/CYFRA 21-1 ratio allows the detection of stage I lung cancer with 76.0% sensitivity and 87.5% specificity.

2-Dicyanomethylenethiazole based NIR absorbing organic nanoparticles for photothermal therapy and photoacoustic imaging

TPTHM NPs are candidates for PAI/PTT agents due to their NIR absorption, good biocompatibility, high photostability and photothermal conversion efficiency (38%).

A 25-year trend in gastrointestinal cancers in northern Iran (1991-2016)

BACKGROUND

Identifying the incidence of cancer helps in planning and prioritizing resources for its screening, prevention, treatment and diagnosis. This study aimed at investigating a 25-year trend in gastrointestinal cancer in northern Iran during 1991-2016.

METHODS

This research was a trend analysis. The study population was one thousand five hundred and thirty-five cancer patients referring to Shahid Rajai Hospital in Babolsar, northern Iran, as the only center for radiotherapy in the North of Iran, during 1991-2016. SPSS version 22 was used for entering data and t-test, ᵡ2 and ANOVA were used for analyzing data in the significant level of ≤0.05.

RESULTS

The highest incidence of stomach cancer was 111 (35%) in 2011 and the lowest incidence was 44 (16.3%) in 1996, The highest frequency of esophageal cancer was reported 137(56.1%) cases in 1991 and the lowest frequency was 78 (26.3%) cases in 2016, while the highest incidence of colorectal cancer was 109 (36.7%) cases in 2016 and its lowest frequency was 32 (16.3%) in 1996. There was also a significant difference in the frequency of gastrointestinal cancers in different studied years (p <0.001).

CONCLUSION

The trends in the incidence of stomach and colorectal cancers in northern Iran were increasing while esophageal cancer was decreasing.

Cytotoxic, anti-mitotic and cytogenetic effects of the leaves and stems of Olax subscorpioidea Oliv. (Olacaceae) against Artemia salina nauplii and Allium cepa meristematic cells

The search for novel, safe and effective anticancer agents has been a continuous and recurring objective in cancer research. Olax subscorpioidea is a medicinal plant used for ethnomedicinal treatment of cancer in Nigeria. In this study, we investigated the cytotoxic, anti-mitotic and cytogenetic effects of methanol extracts of the leaves and stems of O. subscorpioidea. The cytotoxic activities were evaluated against brine shrimps (Artemia salina) nauplii and Allium cepa roots, while anti-mitotic and cytogenetic effects were assessed on Allium cepa meristematic cells. Cytotoxicity assays showed that the extracts demonstrated potent cytotoxic activities, having LC50 values of 10.7 and 45.2 µg/mL against brine shrimps and IC50 values in the range of 47.03 – 81.93 µg/mL on A. cepa roots. These activities were comparable to that of potassium dichromate and methotrexate used as positive control in each of the assays. Anti-mitotic results indicated that at a concentration of 10 µg/mL, the extracts demonstrated percentage mitotic inhibition (% M.I) of 35.95 – 70.12%, with greater or similar anti-mitotic effects to methotrexate at a concentration of 125 µg/mL, % M.I of 39.04 – 40.64%. Cytogenetic investigation revealed that the extracts showed chromosomal aberrations that were not considerably different from those observed in the negative control group. The current findings suggest that the plant extracts may contain cytotoxic and anti-mitotic compounds. Further research to investigate these extracts in more sophisticated test systems and to isolate and characterize their active principles is ongoing.

Polysaccharides fromNostoc communeVaucher activate macrophagesviaNF-κB and AKT/JNK1/2 pathways to suppress colorectal cancer growthin vivo

NVPS activate macrophagesviaNF-κB and AKT/JNK1/2 pathways to suppress colorectal cancer growthin vivo.

A dual-aptamer-based biosensor for specific detection of breast cancer biomarker HER2 via flower-like nanozymes and DNA nanostructures

A dual-aptamer electrochemical biosensor based on flower-like nanozymes and DNA nanostructures was fabricated for detection of breast cancer biomarker HER2.

SATB1 promotes epithelial-mesenchymal transition via Notch signaling pathway in colorectal cancer

Epithelial-mesenchymal transition (EMT) is essential for initiation of colorectal cancer (CRC) metastasis, but the diver proteins of EMT remain unclear. Special AT-rich sequence-binding protein 1 (SATB1) was found to be overexpressed in CRC cell lines, and its expression level was positively correlated with CRC progression. Strikingly, EMT process was regulated by SATB1, as SATB1 overexpression upregulated E-cadherin and SATB1 knockdown inhibited N-cadherin cell models. Mechanistically, SATB1 promoted EMT-mediated CRC metastasis via activation of Notch signaling pathway. Taken together, SATB1 plays a vital role in CRC metastasis and may act as a novel prognostic biomarker and a promising therapeutic target for CRC.

Improved tumor targeting and penetration by a dual-functional poly(amidoamine) dendrimer for the therapy of triple-negative breast cancer

A dual-functional drug delivery system based on the conjugation of PAMAM dendrimer with EBP-1 and TAT peptide was established for the therapy of triple-negative breast cancer.

DOX-assisted functionalization of green tea polyphenol nanoparticles for effective chemo-photothermal cancer therapy

Green tea polyphenol nanoparticles with chemotherapeutic and photothermal performance exhibited effective anti-tumor effects in vivo with intravenous injection.

Photodetection of DNA mismatches by dissymmetric Ru(ii) acridine based complexes

Favored radiative deactivation processes in dissymmetric Ru(ii) complexes enable photodetection of DNA mismatches.

Design, synthesis and biological evaluation of novel 2,4-diaminopyrimidine derivatives as potent antitumor agents

Two series of 2-aminopyrimidine derivatives possessing triazolopiperazine or 1,4,8-triazaspiro[4.5]decan-3-one scaffolds were designed, synthesized and evaluated for their biological activity.

Simultaneous detection of carcinoembryonic antigen and neuron-specific enolase in human serum based on time-resolved chemiluminescence immunoassay

We developed a novel, effective, reliable and convenient TRCLIA method for the simultaneous detection of CEA and NSE in serum.

Branched mannans from the mushroom Cantharellus cibarius enhance the anticancer activity of natural killer cells against human cancers of lung and colon

Cantharellus cibarius branched mannans increase natural killer cells NK92 viability and proliferation and enhance their cytotoxicity against lung and colon cancer cells A549 and LS180, at the same time they do not affect lung and colon epithelial cells NL20 and CCD841 CoN.

Costs and Their Predictors in Transsphenoidal Pituitary Surgery

BACKGROUND

Contemporary surgical approaches to pituitary pathologies include transsphenoidal microsurgical and, more recently, endoscopic techniques. Data reporting direct costs in transsphenoidal pituitary surgery are limited.

OBJECTIVE

To examine direct costs (including overall total, hospital/facility, and physician payments) of microscopic and endoscopic pituitary surgery and evaluate predictors of differential costs in transsphenoidal pituitary surgery using a national database.

METHODS

The Truven MarketScan® database 2010-2014 (IBM, Armonk, New York) was queried and patients undergoing microscopic and/or endoscopic transsphenoidal pituitary surgery identified. Mean costs and predictors of differential costs were analyzed using analysis of variance and generalized linear models. Beta-coefficients (β) assessed relative contributions of independent predictors.

RESULTS

Mean overall total ($34 943.13 [SD ± 19 074.54]) and hospital/facility ($26 505.93 [SD ± 16 819.52]) payments were higher in endoscopic compared to microscopic surgeries (both P < .001). Lengths of hospital stay (LOS) were similar between groups. Predictors of overall total and hospital/facility payments were similar including surgical technique, age, geographical region, comorbidity index, postoperative surgical and medical complications, and LOS with LOS being the most significant predictor (β = 0.27 and β = 0.29, respectively). Mean physician payments ($4549.24 [SD ± 3956.27]) were similar in microscopic and endoscopic cohorts (P = .26). Predictors of physician payments included age, health plan, geographical region, postoperative surgical complications, and LOS with health plan being the most significant predictor (β = –0.21).

CONCLUSION

Higher overall total and hospital/facility costs are associated with endoscopic transsphenoidal pituitary surgery compared to microsurgery. In contrast, physician reimbursements are similar between techniques. Whereas LOS was the strongest predictor of overall total and hospital/facility costs, health plan was the strongest predictor of differential physician reimbursements.

Retrospective Cohort Study: Ledipasvir-Sofosbuvir With/Without Ribavirin for Chronic Hepatitis C Post–Liver Transplant in a Real-World Population

Background: Liver damage caused by hepatitis C virus (HCV) is the number one indication for liver transplantation in the United States and Europe. Patients with a detectable HCV level at time of transplant will universally develop a recurrent infection, which can lead to increased morbidity and mortality. Objective: To assess the sustained virologic response rate post end-of-treatment (SVR) in HCV-infected, post–liver transplant patients at the University of Washington Medical Center (UWMC) treated with ledipasvir-sofosbuvir (LDV/SOF). Methods: This retrospective, cohort study of HCV-positive, genotype 1 or 4 infected, post–liver transplant patients treated with LDV/SOF was conducted at a large academic medical center affiliated clinic. Patients treated with 12 weeks of LDV/SOF with or without ribavirin were included in the 12-week group, and patients treated with 24 weeks of LDV/SOF without ribavirin were included in the 24-week group. Results: Twenty-nine patients with recurrent HCV post–liver transplant receiving 12 weeks of LDV/SOF with or without ribavirin and 32 patients receiving 24 weeks of LDV/SOF alone were assessed. SVR was achieved by 100% (29/29) of patients in the 12-week group and 100% (32/32) of patients in the 24-week group. Conclusion: Post–liver transplant patients at UWMC treated with LDV/SOF for recurrent HCV achieved high rates of SVR.

Propensity Score Estimation Using Classification and Regression Trees in the Presence of Missing Covariate Data

Data mining and machine learning techniques such as classification and regression trees (CART) represent a promising alternative to conventional logistic regression for propensity score estimation. Whereas incomplete data preclude the fitting of a logistic regression on all subjects, CART is appealing in part because some implementations allow for incomplete records to be incorporated in the tree fitting and provide propensity score estimates for all subjects. Based on theoretical considerations, we argue that the automatic handling of missing data by CART may however not be appropriate. Using a series of simulation experiments, we examined the performance of different approaches to handling missing covariate data; (i) applying the CART algorithm directly to the (partially) incomplete data, (ii) complete case analysis, and (iii) multiple imputation. Performance was assessed in terms of bias in estimating exposure-outcome effects among the exposed, standard error, mean squared error and coverage. Applying the CART algorithm directly to incomplete data resulted in bias, even in scenarios where data were missing completely at random. Overall, multiple imputation followed by CART resulted in the best performance. Our study showed that automatic handling of missing data in CART can cause serious bias and does not outperform multiple imputation as a means to account for missing data.

Breast Cancer Genetics: Relevance to Oncology Practice

Our knowledge of genetic mechanisms involved in cancer initiation, promotion, and progression recently bas expanded. In order to benefit from this expansion and to apply genetic discoveries to current protocols for prevention, screening, diagnosis, treatment, prognosis, and monitoring for minimal residual disease, a working knowledge must be developed of the genetic principles, oncogenes, tumor suppressor genes, and genetic models of carcinogenesis. Genetic susceptibility testing for cancer soon will be introduced into oncology practice through established familial risk counseling programs, and the oncologist must be prepared to address the medical, ethical, legal, economic, psychological, and social issues that accompany this testing.

Merits and caveats of propensity scores to adjust for confounding

Proper adjustment for confounding is essential when estimating the effects of treatments or risk factors on health outcomes in observational data. To this end, various statistical methods have been developed. In the past couple of years, the use of propensity scores (PSs) to control for confounding has increased. Proper understanding of this method is necessary to critically appraise research in which it is applied. In this article, we provide an overview of PS methods, explaining their concept, advantages and possible disadvantages. Furthermore, the use of PS matching, PS adjustment and PS weighting is illustrated using data from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) cohort of dialysis patients.