Real-world practice patterns and outcomes in Veterans with relapsed/refractory diffuse large B-cell lymphoma

Aim: To describe practices and outcomes in veterans with relapsed/refractory diffuse large B-cell lymphoma. Patients & methods: Using Veteran Affairs Cancer Registry System and electronic health record data, we identified relapsed/refractory diffuse large B-cell lymphoma patients completing second-line treatment (2L) in 2000–2016. Treatments were classified as aggressive/nonaggressive. Analyses included descriptive statistics and the Kaplan–Meier estimation of progression-free survival and overall survival. Results: Two hundred and seventy patients received 2L. During median 9.7-month follow-up starting from 2L, 470 regimens were observed, averaging 2.7 regimens/patient: 219 aggressive, 251 nonaggressive. One hundred and twenty-one patients proceeded to third-line, 50 to fourth-line and 18 to fifth-line treatment. Median progression-free survival in 2L was 5.2 months. Median overall survival was 9.5 months. Forty-four patients (16.3%) proceeded to bone marrow transplant. Conclusion: More effective, less toxic treatments are needed and should be initiated earlier in treatment trajectory.

Aromatase Inhibitors and Risk of Arthritis and Carpal Tunnel Syndrome among Taiwanese Women with Breast Cancer: A Nationwide Claims Data Analysis

Tamoxifen or aromatase inhibitor (AI) therapy may prevent breast cancer recurrence, however, adverse effects may lead to treatment discontinuation. Evidence regarding the occurrence of AI-associated musculoskeletal problems among Asians is scarce. We identified women with breast cancer-initiating tamoxifen or AIs from the Taiwan National Health Insurance Research Database (2007-2012). Using multivariable cause-specific hazard models, we examined the association between endocrine therapy and the risk of any arthritis and carpal tunnel syndrome, adjusting for age, prior cancer treatment, and other health status factors. Among 32,055 eligible women with breast cancer (mean age = 52.6 ± 11.5 years), 87.4% initiated tamoxifen, 3.9% initiated anastrozole, 8.0% initiated letrozole, and 0.7% initiated exemestane. AI users had a higher 1-year cumulative incidence for any arthritis (13.0% vs. 8.2%, p < 0.0001) and carpal tunnel syndrome (1.4% vs. 0.8%, p = 0.008). Compared to tamoxifen users, AI users had a higher risk of any arthritis [adjusted hazard ratio (aHR) = 1.21, 95%CI = 1.09-1.34] and carpal tunnel syndrome (aHR = 1.68, 95%CI = 1.22-2.32). No significant difference was observed in the risks of any arthritis and carpal tunnel syndrome across different AIs. Taxane use was not associated with any arthritis (aHR = 0.92, 95%CI = 0.81-1.05) or carpal tunnel syndrome (aHR = 0.97, 95%CI = 0.67-1.40) compared to other chemotherapies. Taiwanese women with breast cancer-initiating AIs had an increased risk of arthritis and carpal tunnel syndrome compared to those who initiated tamoxifen.

Comparison of underwater and conventional endoscopic mucosal resection for removing sessile colorectal polyps: a propensity-score matched cohort study

Background and study aims  Endoscopic mucosal resection (EMR) is a standard method for removing sessile colorectal polyps ≥ 10 mm. Recently, underwater EMR (UEMR) has been introduced as a potential alternative. However, the effectiveness and safety of UEMR compared with conventional EMR is un clear. Patients and methods  In this 1:1 propensity score (PS) matched retrospective cohort study, we compared the en bloc resection rates, procedure time, intraprocedural and delayed bleeding rates, and incidence of muscle layer injury. We also performed subgroup analyses by sizes of polyps (< 20 mm and ≥ 20 mm). Results  Among 350 polyps in 315 patients from August 2012 to November 2017, we identified 121 PS-matched pairs. Mean polyp size was 16.8 mm. With similar en bloc resection rates (EMR: 82.6 % vs. UEMR: 87.6 %, rate difference: 5.0, 95 % confidence interval [95 % CI]: - 4 to 13.9 %), UEMR demonstrated a shorter resection time (10.8 min vs. 8.6 min, difference: - 2.2 min, 95 % CI: - 4.1 to - 0.3 min) and a lower intraprocedural bleeding rate (15.7 % vs. 5.8 %, rate difference: - 9.9 %, 95 % CI: - 17.6 to - 2.2 %). Incidence of delayed bleeding and muscle layer injury were low in both groups. For polyps < 20 mm, effectiveness and safety outcomes were similar in both groups. For polyps ≥ 20 mm (42 PS-matched pairs), the UEMR group has a comparable en bloc resection rate with shorter procedure time and superior safety outcomes Conclusions  UEMR achieved an en bloc resection rate comparable to conventional EMR with less intraprocedural bleeding and a shorter procedure time.

Assessing the effect of oral activated vitamin D on overall survival in hemodialysis patients: a landmark analysis

BACKGROUND

Patients with end stage renal disease have a high all-cause and cardiovascular mortality. Secondary hyperparathyroidism and vitamin D deficiency are considered part of the mechanism for the excess mortality observed. We aimed to evaluate the relationship between vitamin D use and all-cause mortality.

METHODS

In this retrospective cohort study, we included all incident patients who started hemodialysis in Taiwan between 2001 and 2009. Patients were followed from landmark time, i.e., the 360th day from hemodialysis initiation, through the end of 2010 or death. We evaluated the association between activated vitamin D use or not before landmark time and all-cause mortality using conditional landmark analysis with Cox regression. We used group-based trajectory model to categorize high-dose versus average-dose users to evaluate dose-response relationships.

RESULTS

During the median follow-up of 1019 days from landmark time, vitamin D users had a lower crude mortality rate than non-users (8.98 versus 12.93 per 100 person-years). Compared with non-users, vitamin D users was associated with a lower risk of death in multivariate Cox model (HR 0.91 [95% CI, 0.87-0.95]) and after propensity score matching (HR 0.94 [95% CI, 0.90-0.98]). High-dose vitamin D users had a lower risk of death than conventional-dose users, HR 0.75 [95% CI, 0.63-0.89]. The association of vitamin D treatment with reduced mortality did not alter when we re-defined landmark time as the 180th day or repeated analyses in patients who underwent hemodialysis in the hospital setting.

CONCLUSIONS

Our findings supported the survival benefits of activated vitamin D among incident hemodialysis patients.

Trastuzumab-Related Cardiotoxic Effects in Taiwanese Women: A Nationwide Cohort Study

Importance

Trastuzumab is an essential medicine per the World Health Organization Model List, but its cardiac safety information in Asian women is limited.

Objective

To estimate the rate and the risk of heart failure (HF) and/or cardiomyopathy (CM) in Asian women undergoing trastuzumab treatment.

Design

This cohort study used the Taiwanese National Health Insurance Research Database (NHIRD), a nationwide claim database covering more than 99% of the entire Taiwanese population, to identify 23 006 women with incident breast cancer (BC) who received chemotherapy from 2006 to 2009. We grouped women per their initial treatment regimens and found 1066 new trastuzumab users. We matched trastuzumab users with nonusers by year of BC diagnosis and propensity score (PS) with the caliper widths at 0.25 standard deviation of PS (up to 4 nonusers per trastuzumab user). The study lasted from January 2006 to December 2013 with a median follow-up of 5.29 years and a landmark design to avoid immortal time bias.

Exposure

Trastuzumab.

Main Outcomes and Measures

To estimate HF and/or CM rates and time to HF and/or CM, we employed a cause-specific hazard model. Trastuzumab exposure was a time-dependent variable, while cumulative courses of chemotherapy agents with known cardiotoxic effects (including anthracyclines, taxanes, and cyclophosphamide) were defined as time-dependent covariates in the analysis model. We also performed 6 sensitivity analyses.

Results

In this cohort of 23 006 women (mean age, 50.99 years), the crude incidence of HF and/or CM was 4.03% in trastuzumab users and 2.88% in nonusers. The median time to HF and/or CM was 456 days in trastuzumab users and 966 days in nonusers. The 1-year cumulative hazard ratio was 1.86 (95% CI, 1.08-3.19). The sensitivity analyses yielded similar results.

Conclusions and Relevance

Compared with the published results, the trastuzumab-related HF and/or CM rate was 5-fold lower in Taiwanese women with breast cancer. Nonetheless, our cohort had a similar trastuzumab-related HF and/or CM risk. Our study provides critical cardiac safety information of trastuzumab for Asian women with BC under current treatment guidelines and label information.

A self-protected colorless WDM-PON with 2.5 Gb/s upstream signal based on RSOA

In this investigation, we propose and demonstrate a colorless wavelength division multiplexed passive optical network (WDM-PON) at 2.5 Gb/s using reflective semiconductor optical amplifier (RSOA)-based optical networking units (ONUs); together with a self-protected architecture against fiber fault. In the optical line terminal (OLT), we use an array of self-seeding Fabry-Perot laser diodes (FP-LDs) to provide single-longitudinal-mode (SLM) continuous wave (CW) optical sources for the external injection to the RSOA-based ONUs. The self-survivable function for protecting the fiber fault in the distributed fibers and the proposed network performance are investigated and discussed.

Randomization of heavily damaged regions in annealed low energy Ge+-implanted (0 0 1)Si

Apparent growth of amorphous layers during low temperature annealing was observed in low energy Ge(+)-implanted (001)Si by high-resolution transmission electron microscopy. The occurrence of abnormal growth is due to the randomization of heavily damaged regions beneath the original amorphous/crystalline interfaces. The randomization process is attributed to the strain, incurred by the presence of a high density of large Ge atoms in the heavily damaged Si substrate, relaxation to lower the free energy of the systems. The randomization upon annealing may be fruitfully applied to minimize the transient enhanced diffusion in shallow junction formation.

Diffractive optical element designed by use of an irregular etching-depth sequence

In fabricating a diffractive optical element the ratio of the etching depth between the (n - 1)th and the nth mask is usually 1/2. We found that the diffraction efficiency of a diffractive optical element can be improved by as much as 7.8% if the above ratio (1/2) is not kept constant. For achieving this improvement the difference between the desired and the actual diffraction pattern is also used as an objective function for phase quantization.

An ultra-precision XYTheta(Z) piezo-micropositioner. II. Experiment and performance

For pt I see ibid., vol. 46, no. 4 (July 1999). The performance of an ultra-precision three dimensional micropositioner using the built-in multilayer piezoelectric actuators and sensors is presented. The compact design utilizes the monolithic mechanism to achieve translation in the X- and Y-axes and rotation in the theta(Z) axis with high stiffness and high damping. Hysteresis, nonlinearity, and drift of piezoelectric effects are improved by incorporating the sensors in a feedback control. Experiments demonstrate that the micropositioner is capable of a 10 nm resolution over the travel range of 17.8 mum in the X- and Y-axes and a 0.15 murad resolution over the range of 585 murad in the theta(Z) axis. The crossaxis interferences are within 1.14% of the full range. The results agree well with predictions by theoretical models.

An ultra-precision XYtheta(Z) piezo-micropositioner. I. Design and analysis

A novel three degree-of-freedom micropositioner was developed for deep ultraviolet lithography applications. The design of the micropositioner utilizes the monolithic flexural mechanism with built-in multilayer piezoelectric actuators and sensors to achieve translations in the X- and Y-axes and rotation in the theta(Z)-axis. The compact design aims at high resolution, high stiffness, and extremely low crosstalk interference. Parametric analyses of harmonic and forced vibrations are conducted to solve the derived dynamic models for the near optimum geometry of the micropositioner. Furthermore, the error budget analysis is conducted to minimize the effects of the geometric tolerance, material variation, and hysteresis errors.

Risk factors for human T-cell lymphotropic virus types I and II (HTLV-I and -II) in blood donors: the Retrovirus Epidemiology Donor Study. NHLBI Retrovirus Epidemiology Donor Study

In the United States, blood donors have been routinely screened for human T-cell lymphotropic virus (HTLV) since 1988. HTLV-I and -II seropositive blood donors have been identified through confirmatory testing at five participating blood centers and frequency-matched seronegative controls provided information on potential HTLV sociodemographic, parenteral, and sexual risk factors during structured interviews. After adjustment, low educational attainment; accidental needlesticks or cuts; prior blood transfusion; > or = 7 sex partners; and a sex partner from an HTLV-I endemic area were significantly associated with both HTLV-I and -II. Gender did not modify the odds ratios (OR) in the final logistic regression models, despite apparent male-female differences in gender-specific bivariable analysis. Injection drug use (IDU) or having sex with an IDUs were significant risks for HTLV-II, but not for HTLV-I. The OR for donors who had IDU sex partners was 20.6 times higher than those who did not. For IDUs, the OR was increased 10.5 times over nonusers. Abortion was a significant HTLV-II risk factor for women. Our findings indicate that IDU and sex with IDUs are important risk factors for HTLV-II transmission, even among low-risk populations such as blood donors.

Post-renal transplant erythrocytosis

Erythrocytosis is a relatively common phenomenon following renal transplantation. It is not only associated with some special clinical conditions, but also increases the risk of thromboembolism. We therefore studied the clinical manifestations and possible risk factors of erythrocytosis in our renal-transplant patients. Study of 175 patients showed that erythrocytosis, defined as Hct > or = 50%, was found in 17 patients (9.7%), 14 males and 3 females. Among these 17 patients, 13 received cadaveric grafts and the other 4 living-related grafts. True erythrocytosis, defined as erythrocytosis with elevated red blood cell (RBC) mass, was found in 7 patients. Relative erythrocytosis, defined as erythrocytosis with normal RBC mass, was found in the other 10 patients. Six patients developed acquired renal cysts of the native or graft kidneys during the post transplant period. The incidence of acquired renal cysts in the erythrocytosis group was significantly higher than that in the non-erythrocytosis group. The clinical and demographic characteristics were similar in terms of age, gender, serum albumin, and serum creatinine in the erythrocytosis and non-erythrocytosis groups. The incidences of abnormal liver function, and hypertension were similar between the 2 groups. Seventeen of the 161 patients (10.6%) receiving cyclosporine regimen developed erythrocytosis, but none of the 14 patients receiving non-cyclosporine regimen developed erythrocytosis (p > 0.05). Only one patient with true erythrocytosis had an elevated serum erythropoietin (EPO) level and no thromboembolic complications occurred in the erythrocytosis group. We conclude that: (1) the incidence of erythrocytosis in our transplant patients was 9.7%; (2) a higher incidence of acquired renal cysts was found in the erythrocytosis group; (3) most of the patients with erythrocytosis had a normal serum EPO level; (4) no thromboembolic complications occurred in our patients.