Magnetic resonance elastography as a preoperative assessment for predicting intrahepatic recurrence in patients with hepatocellular carcinoma

PURPOSE

Magnetic resonance elastography (MRE) is a noninvasive tool for diagnosing hepatic fibrosis with high accuracy. We investigated the preoperative clinical and imaging predictors of intrahepatic recurrence after curative resection of hepatocellular carcinoma (HCC), and evaluated MRE as a predictor of intrahepatic recurrence.

METHODS

We retrospectively evaluated 80 patients who underwent preoperative contrast-enhanced magnetic resonance imaging (MRI) with two-dimensional MRE and curative resection for treatment-naïve HCC between May 2019 and December 2021. Liver stiffness (LS) was measured on the elastograms, and the optimal cutoff of LS for predicting intrahepatic recurrence was obtained using receiver operating characteristic (ROC) analysis. An LS above this cutoff was defined as MRE-recurrence. Preoperative imaging features of the tumor were assessed on MRI, including features in the Liver Imaging Reporting and Data System and microvascular invasion (MVI). Recurrence-free survival (RFS) rates were estimated using the Kaplan-Meier method, and differences were compared using the log-rank test. Using a Cox proportional hazards model, we conducted a multivariable analysis to investigate the factors affecting recurrence-free survival.

RESULTS

During a median follow-up period of 32 months (range, 4-52 months), thirteen patients (16.3%) developed intrahepatic recurrence. ROC analysis determined an LS cutoff of ≥4.35 kPa to define MRE-recurrence. The 4-year RFS rate was significantly higher in patients without MRE-recurrence than in those with MRE-recurrence (93.4% vs. 48.9%; p = 0.001). In multivariable analysis, MRE-recurrence (Hazard ratio [HR], 5.9; 95% confidence interval [CI], 1.5-23.1) and MVI (HR, 3.4; 95% CI, 1.0-11.3) were independent predictors of intrahepatic recurrence.

CONCLUSIONS

Patients without MRE-recurrence had significantly higher RFS rates than those with MRE-recurrence. MRE-recurrence and MVI were independent predictors of intrahepatic recurrence in patients after curative resection for HCC.

Using GPT-4 for LI-RADS feature extraction and categorization with multilingual free-text reports

BACKGROUND AND AIMS

The Liver Imaging Reporting and Data System (LI-RADS) offers a standardized approach for imaging hepatocellular carcinoma. However, the diverse styles and structures of radiology reports complicate automatic data extraction. Large language models hold the potential for structured data extraction from free-text reports. Our objective was to evaluate the performance of Generative Pre-trained Transformer (GPT)-4 in extracting LI-RADS features and categories from free-text liver magnetic resonance imaging (MRI) reports.

METHODS

Three radiologists generated 160 fictitious free-text liver MRI reports written in Korean and English, simulating real-world practice. Of these, 20 were used for prompt engineering, and 140 formed the internal test cohort. Seventy-two genuine reports, authored by 17 radiologists were collected and de-identified for the external test cohort. LI-RADS features were extracted using GPT-4, with a Python script calculating categories. Accuracies in each test cohort were compared.

RESULTS

On the external test, the accuracy for the extraction of major LI-RADS features, which encompass size, nonrim arterial phase hyperenhancement, nonperipheral 'washout', enhancing 'capsule' and threshold growth, ranged from .92 to .99. For the rest of the LI-RADS features, the accuracy ranged from .86 to .97. For the LI-RADS category, the model showed an accuracy of .85 (95% CI: .76, .93).

CONCLUSIONS

GPT-4 shows promise in extracting LI-RADS features, yet further refinement of its prompting strategy and advancements in its neural network architecture are crucial for reliable use in processing complex real-world MRI reports.

[Pre- and post-diagnosis body mass index in association with colorectal cancer death in a prospective cohort study]

Objective: To evaluate the association between pre-and post-diagnosis body mass index (BMI) and risk of colorectal cancer (CRC) death. Methods: The cohort consisted of 3, 057 CRC patients from Shanghai who were diagnosed from Jan. 1, 2009 to Dec. 31, 2011 and aged from 20 to 74 years. The pre- and post-diagnosis BMI and clinical and lifestyle factors were collected at baseline. Death information was collected using record linkage with the Shanghai Cancer Registry and telephone confirmation during follow-up by the end of 2019. The Cox proportional regression model was used to estimate HR with 95% CI. Results: Analysis by multivariable Cox model showed no association between pre-diagnosis BMI and death risk in both male and female patients. Male patients with a post-diagnosis underweight BMI had an elevated risk of death compared to those in normal weight (HR=1.69, 95% CI: 1.21-2.37), especially in early stage cases. Overweight patients (HR=0.74, 95% CI: 0.61-0.89) and patients with obesity class Ⅰ (HR=0.63, 95% CI: 0.45-0.89)had better survival with decreased risks of death, especially in advanced stage cases. The decreased death risk in patients with obesity class Ⅱ was not significant (HR=0.57, 95% CI: 0.24-1.39). The P(trend) value for decreased risk of death with increased BMI in female patients was statistically significant (P<0.001), and the overweight and obesity class Ⅰ categories had better survival in advanced stage(HR(overweight)=0.62, 95% CI: 0.42-0.93; HR(obesity class Ⅰ)=0.39, 95% CI: 0.16-0.98). Both male and female patients with post-diagnosis BMI loss >2.0 kg/m(2) had an increased death risk when compared with those with stable BMI (change≤1.0 kg/m(2)) between pre- and post-diagnosis. BMI gain after diagnosis did not change death risk. Conclusions: Post-diagnosis BMI in the overweight or obesity class Ⅰ groups might be conducive to prolonging male CRC patients' survival, while underweight might result in poor prognosis. Keeping weight and avoiding excessive weight loss should be suggested for all CRC patients after diagnosis.

Bevacizumab biosimilar candidate TAB008 compared to Avastin® in patients with locally advanced, metastatic EGFR wild-type non-squamous non-small cell lung cancer: a randomized, double-blind, multicenter study

BACKGROUND

Bevacizumab (Avastin®) is a monoclonal antibody targeting the vascular endothelial growth factor (VEGF). Used alone or in combination with chemotherapy and/or immunotherapy, Avastin® has shown promising efficacy in many cancers. This study compared the efficacy and safety of TAB008 with Avastin® sourced from the EU (bevacizumab-EU), in patients with non-squamous non-small cell lung cancer (nsNSCLC).

METHOD

In this randomized, double-blind, multicenter, phase III similarity study, treatment naïve for metastatic lung cancer., EGFR wild-type, locally advanced, metastatic, or recurrent non-squamous, non-small cell, lung cancer (nsNSCLC) patients were enrolled and randomized (1:1) into TAB008 or Avastin® groups. Patients received TAB008 or Avastin® 15 mg/kg intravenously plus paclitaxel/carboplatin for 4-6 cycles followed by TAB008 or Avastin® 7.5 mg/kg until disease progression, unacceptable toxicity or death. The primary endpoint compared the objective response rate (ORR) within 6 cycles as read by an independent radiological review committee (IRRC). Secondary endpoints compared disease control rate (DCR) Within 6 cycles, duration of response (DoR), progression-free survival (PFS), a year overall survival rate (OSR), overall survival (OS), safety, immunogenicity, and steady-state pharmacokinetics.

RESULTS

A total of 549 nsNSCLC patients were enrolled (277 in TAB008 group and 272 in Avastin® group). In the full analysis set, ORRs were 55.957% for TAB008 and 55.720% for Avastin®, and the ORR ratio was 1 (90% CI 0.89-1.14), well within the predefined equivalence margin of 0.75-1.33. No significant differences were found in DCR within 6 cycles (95.703% vs 95.367%, p = 0.8536), DoR (8.17 vs 7.3 months, p = 0.3526), PFS (9.10 vs. 7.97 months, p = 0.9457), 1 year overall survival rate (66.2% vs 68%, p = 0.6793), or OS (20.4 vs 17.6 months, p = 0.6549). Serious adverse events (SAEs) occurred in 37.55% (104/277) of patients in the TAB008 group and 34.32% (93/271) in the Avastin® group. Anti-drug antibodies were reported in 3 of 277 (1.08%) TAB008 patients, and 5 of 271 (1.85%) Avastin® patients, neutralizing antibody (Nab) was positive in 1 patient on Avastin®, which became negative upon follow-up. The steady-state trough concentrations (Cssmin) were 106.13 μg/mL in TAB008 group and 96.03 μg/mL in Avastin® groups, with the treatment group ratio of LS geometric means fully contained within the bioequivalence limits of 80.00-125.00% (90% CI was 101.74-120.05%).

CONCLUSIONS

TAB008 is similar to Avastin® in terms of efficacy, safety, and pharmacokinetic parameters, with comparable immunogenicity.

TRIAL REGISTRATION

ClinicalTrials.gov number; NCT05427305.

[Repeated stellate ganglion blockade for the treatment of ventricular tachycardia storm in patients with nonischemic cardiomyopathy: a new therapeutic option for patients with malignant arrhythmias]

Objectives: This study sought to describe our institutional experience of repeated percutaneous stellate ganglion blockade (R-SGB) as a treatment option for drug-refractory electrical storm in patients with nonischemic cardiomyopathy (NICM). Methods: This prospective observational study included 8 consecutive NICM patients who had drug-refractory electrical storm and underwent R-SGB between June 1, 2021 and January 31, 2022. Lidocaine (5 ml, 1%) was injected in the vicinity of the left stellate ganglion under the guidance of ultrasound, once per day for 7 days. Data including clinical characteristics, immediate and long-term outcomes, and procedure related complications were collected. Results: The mean age was (51.5±13.6) years. All patients were male. 5 patients were diagnosed as dilated cardiomyopathy, 2 patients as arrhythmogenic right ventricular cardiomyopathy and 1 patient as hypertrophic cardiomyopathy. The left ventricular ejection fraction was 37.8%±6.6%. After the treatment of R-SGB, 6 (75%) patients were free of electrical storm. 24 hours Holter monitoring showed significant reduction in ventricular tachycardia (VT) episodes from 43.0 (13.3, 276.3) to 1.0 (0.3, 34.0) on the first day following R-SGB (P<0.05) and 0.5 (0.0, 19.3) after whole R-SGB process (P<0.05). There were no procedure-related major complications. The mean follow-up was (4.8±1.1) months, and the median time of recurrent VT was 2 months. Conclusion: Minimally invasive R-SGB is a safe and effective method to treat electrical storm in patients with NICM.

[Clinical characteristics and long-term follow-up results of radiofrequency ablation for the treatment of ventricular tachycardia in patients with arrhythmogenic left ventricular cardiomyopathy]

Objective: To investigate the acute and long-term outcome of catheter ablation for the treatment of ventricular tachycardia (VT) in patients with arrhythmogenic left ventricular cardiomyopathy (ALVC). Methods: This retrospective, cross-sectional study enrolled ALVC patients undergoing radiofrequency ablation for the treatment of VT at the First Affiliated Hospital of Nanjing Medical University from January 2011 to December 2018 and collected their clinical characteristics and intraoperative electrophysiological examination. Patients were followed up every 6 months after radiofrequency ablation until August 2021. Echocardiographic results and VT recurrence post radiofrequency ablation were analysed. Results: Totally 12 patients were enrolled (mean age: (42±15) years, 11 males(11/12)). The mean of left ventricular end diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF) were (51±5)mm and (65±5)%, respectively. Twelve VTs were induced in 10 patients during the electrophysiological study, and the mean tachycardia cycle length was (293±65) ms. Three-dimensional substrate mapping revealed the diseased area at endocardial site in one patient, at epicardial sites in the other 11 patients (involved endocardial sites in 2 cases) with the basal part near the mitral annulus being the predilection for the substrate (10/11). After the catheter ablation at the endocardial and epicardial sites respectively, the complete procedure endpoint was achieved in all patients (VT cannot be induced post ablation). The median follow-up time was 65 (25, 123) months. One patient was lost to follow-up, and the other 11 patients survived without VT. No significant cardiac function deterioration was detected by the echocardiographic examination ((51±5)mm vs. (52±5)mm, P>0.05 for LVDd, (65±5)% vs. (60±6)%, P>0.05 for LVEF) at the end of follow-up. Conclusion: After radiofrequency ablation, the complete procedure endpoint is achieved in ALVC patients, and the catheter ablation provides long-term ventricular tachycardia control during the long-term follow-up.

Pembrolizumab versus chemotherapy for patients with esophageal squamous cell carcinoma enrolled in the randomized KEYNOTE-181 trial in Asia

BACKGROUND

In the randomized phase III KEYNOTE-181 study, pembrolizumab prolonged overall survival (OS) compared with chemotherapy as second-line therapy in patients with advanced esophageal cancer and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥10. We report a post hoc subgroup analysis of patients with esophageal squamous cell carcinoma (ESCC) enrolled in KEYNOTE-181 in Asia, including patients from the KEYNOTE-181 China extension study.

PATIENTS AND METHODS

Three hundred and forty Asian patients with advanced/metastatic ESCC were enrolled in KEYNOTE-181, including the China cohort. Patients were randomly assigned 1 : 1 to receive pembrolizumab 200 mg every 3 weeks for ≤2 years or investigator's choice of paclitaxel, docetaxel, or irinotecan. OS, progression-free survival, response, and safety were analyzed without formal comparisons. OS was evaluated based on PD-L1 CPS expression level.

RESULTS

In Asian patients with ESCC, median OS was 10.0 months with pembrolizumab and 6.5 months with chemotherapy [hazard ratio (HR), 0.63; 95% CI 0.50-0.80; nominal P < 0.0001]. Median progression-free survival was 2.3 months with pembrolizumab and 3.1 months with chemotherapy (HR, 0.79; 95% CI 0.63-0.99; nominal P = 0.020). Objective response rate was 17.1% with pembrolizumab and 7.1% with chemotherapy; median duration of response was 10.5 months and 7.7 months, respectively. In patients with PD-L1 CPS <1 tumors (pembrolizumab versus chemotherapy), the HR was 0.99 (95% CI 0.56-1.72); the HR (95% CI) for death was better for patients with PD-L1 CPS cut-offs >1 [CPS ≥1, 0.57 (0.44-0.75); CPS ≥5, 0.56 (0.41-0.76); CPS ≥10, 0.53 (0.37-0.75)]. Treatment-related adverse events were reported in 71.8% of patients in the pembrolizumab group and 89.8% in the chemotherapy group; grade 3-5 events were reported in 20.0% and 44.6%, respectively.

CONCLUSIONS

Pembrolizumab monotherapy demonstrated promising efficacy in Asian patients with ESCC, with fewer treatment-related adverse events than chemotherapy. PD-L1 CPS ≥1 is an appropriate cut-off and a predictive marker of pembrolizumab efficacy in Asian patients with ESCC.

Ejection dynamics in native aortic valve stenosis using echocardiography: can it be helpful?

Background

The assessment of aortic stenosis (AS) severity has a major impact on the management of affected patients. Ejection dynamics, including acceleration time (AT), ejection time (ET), and acceleration time/ejection time ratio (AT/ET) measured using doppler echocardiography are established in the evaluation of prosthetic aortic valve stenosis with high sensitivity and specificity. However, their clinical utility in native AS has not been well described.

Purpose

The aim of this systematic review was to evaluate the diagnostic accuracy of ejection dynamics to identify severe AS and to assess whether ejection dynamics can differentiate low flow, low gradient severe AS from pseudo-severe AS.

Methods

We conducted a systematic review of Medline, Embase, and Web of Science from database inception until January 2021. We included observational studies and randomized controlled trials (RCTs) in which the diagnostic accuracy of ejection dynamics by doppler echocardiography for severe AS was compared with standard echocardiographic diagnostic criteria including peak velocity, mean pressure gradient, aortic valve area, and dimensionless index. Studies were eligible if they included AS of at least mild severity. Two authors independently screened and extracted data.

Results

We included 12 studies in the review (RCT=1, observational=11) with a total of 5182 participants. There was significant inconsistency in outcome measurement and reporting of results therefore a meta-analysis was not suitable. We used narrative synthesis to report our results. All included studies used standard echocardiographic criteria to ascertain the presence of severe AS. Mean age was 72 years and 53% of the participants were male. 1983 participants (38.3%) were classified as having severe AS. AT &gt;94–109ms had sensitivity of 74–92% and specificity of 72–89% at identifying severe AS. AT/ET &gt;0.34–0.35 showed sensitivity of 67–77% and specificity of 68–100%. Only one study compared low-flow, low-gradient AS with pseudo-severe AS, showing that an AT &gt;100ms had sensitivity 62%, specificity 76%; and AT/ET &gt;0.33, sensitivity 65%, specificity 84%. Data for ET showed insufficient consistency and diagnostic accuracy.

Conclusions

AT and AT/ET may be useful to corroborate the presence of severe AS. However, more research is needed to understand whether these parameters add incremental prognostic value to standard echocardiographic measures of AS severity.

Funding Acknowledgement

Type of funding sources: None. Summary of evidence search and selection

Effect of prevalent atrial fibrillation on cardiovascular outcomes in patients with chronic kidney disease

Background

The global increase in incidence and prevalence of chronic kidney disease (CKD) is associated with a parallel rise in co-morbid atrial fibrillation (AF). Concurrent presence of both conditions increases clinical complexity and may portend poor outcomes in this population.

Purpose

The aim of our study was to assess the impact of prevalent AF on mortality and cardiovascular outcomes in patients with CKD.

Methods

Consecutive patients with CKD (Stages 2 to 5) attending the Nephrology outpatient clinics in our health district between Jan 2007-Dec 2017 were retrospectively evaluated. Detailed appraisal of patient demographics, anthropometrics, clinical co-morbidities (including aetiology, stage and management of CKD) and pharmacotherapeutics was undertaken. These patients were followed for up to ten years for the composite outcomes of all-cause death and major adverse cardiovascular events (MACE). We excluded patients with incomplete clinical data and patients with concomitant medical co-morbidity limiting lifespan to &lt;6 months.

Results

2008 patients (63.61±17.17 yrs; 55.7% men) were assessed. The mean eGFR was 37.53±21.88 mL/min/m2. Patients with prevalent AF (n=440, 22%) were older (p&lt;0.01), with lower eGFR (p&lt;0.01) and higher rates of renal replacement therapy (p&lt;0.01). They also had a greater burden of coronary disease (p&lt;0.01), heart failure (p&lt;0.01), stroke (p&lt;0.01), obstructive sleep apnoea (p&lt;0.01), chronic obstructive pulmonary disease (p&lt;0.01), anaemia (p&lt;0.01) and obesity (p&lt;0.01). Over the mean follow-up period of 44.04±34.96 months, 832 patients met the composite outcome (410 all-cause death, 422 MACE). On log rank tests, prevalent AF was a predictor of the composite outcome (Figure 1; p&lt;0.01) and remained an independent predictor of all-cause death and MACE on multivariate analysis (HR 1.65; 95% CI 1.24–2.21, p&lt;0.01).

Conclusions

Prevalent AF is an independent predictor of all-cause death and MACE in patients with CKD.

Figure 1. Kaplan Meier Curve

Funding Acknowledgement

Type of funding source: None

Gd-EOB-DTPA MRI for focal nodular hyperplasia-like lesions in pediatric cancer survivors

OBJECTIVES

To investigate the hepatobiliary enhancement patterns of gadoxetic acid (Gd-EOB-DTPA) MRI and the temporal evolution of focal nodular hyperplasia (FNH)-like lesions in pediatric cancer survivors.

METHODS

We retrospectively included pediatric cancer survivors who had new liver lesions detected during surveillance imaging and who were diagnosed with FNH-like lesions by Gd-EOB-DTPA MRI without the aid of a hepatobiliary phase. The hepatobiliary enhancement patterns of FNH-like lesions were categorized as homogeneous hyperintense/isointense, heterogeneous hyperintense, and ring-like enhancement. Temporal changes in the FNH-like lesions were evaluated by follow-up Gd-EOB-DTPA MRI. Statistical analyses included one-way analysis of variance and Spearman's rank correlation test.

RESULTS

A total of 132 radiologically diagnosed FNH-like lesions in 18 patients showed the three different hepatobiliary enhancement patterns: homogeneous hyperintense/isointense (n = 65, 49%), heterogeneous hyperintense (n = 24, 18%), and ring-like enhancement (n = 43, 33%). A weak positive correlation was found between the lesion size and the hepatobiliary enhancement pattern (p = 0.015). Follow-up MRI showed alterations in the size and number of 55 FNHs in 8 patients, including stable size (n = 15, 27%), increased size (n = 17, 31%), decreased size (n = 11, 20%), disappearance (n = 12, 22%), and 74 new lesions (5 patients, 63%).

CONCLUSIONS

FNH-like lesions in pediatric cancer survivors showed three different hepatobiliary enhancement patterns and various temporal changes. Recognition of the radiological characteristics of FNH-like lesions may avoid unnecessary invasive procedures and reduce patients/parents' anxiety.

KEY POINTS

• FNH-like lesions in pediatric cancer survivors showed three different hepatobiliary enhancement patterns. The most common was homogeneous hyperintense/isointense, followed by heterogeneous hyperintense, and ring-like enhancement. • FNH-like lesions in pediatric cancer survivors can show various temporal changes during follow-up.

P1709 Left atrial strain: a novel prognostic marker in patients with chronic kidney disease

Funding Acknowledgements

Nil

Background and objectives

Patients with chronic kidney disease (CKD) are at increased risk of adverse cardiovascular events that are underestimated by traditional risk stratification algorithms. We sought to determine clinical and echocardiographic predictors of adverse outcomes in CKD patients.

Methods

Stage 3 and 4 CKD patients without previous cardiac disease underwent a comprehensive transthoracic and stress echocardiogram, with left ventricular (LV) and left atrial (LA) strain analysis. Participants were followed for the primary end point of a composite of all-cause death and major adverse cardiovascular events (MACE). The secondary end point was a composite of cardiovascular death and MACE.

Results

243 patients (male 63%; mean age 59.2 ± 14.4 years) were followed for a median of 3.9 ± 2.7 years. 69 patients met the primary endpoint and 58 the secondary end point. Age (p &lt; 0.01), history of diabetes mellitus (p &lt; 0.01), indexed LV mass(LVMI) (p &lt; 0.01), LV global longitudinal strain(GLS) (p &lt; 0.01), indexed LA volume(LAVI) (p &lt; 0.01), E/e’ ratio (p &lt; 0.01) and LA strain (LAs) (p &lt; 0.01) were independent predictors of death and MACE. On Cox proportional hazards regression analysis, LAs (p &lt; 0.01) was the only independent predictor for the primary end point in a model accounting for age, diabetes mellitus, LVMI, LVGLS, E/e’ and LAVI. LAs remained an independent predictor for the secondary end point.

Conclusions

LAs is an independent predictor of death and MACE in CKD patients, in whom the predominant cardiac abnormality is diastolic impairment. LAs is a prognostic biomarker, reflecting alterations in diastolic function in CKD.

Abstract P1709 Figure. Kaplan Meier curve of LAs

Effect of oviposition by Bactrocera dorsalis on the antioxidant activity of orange juice

Among fruits and fruit products, oranges and orange juice are the most widely consumed worldwide. However, the effects of pest infestation of oranges on the quality of orange juice are not yet known. To evaluate the effect of the oriental fruit fly Bactrocera dorsalis on the antioxidant activity of orange juice, we measured changes in the vitamin C (Vc) concentration, total phenol content, and antioxidant activity of orange juice after the introduction of fruit fly eggs. Ten days after the eggs were introduced (larvae removed), the concentration of Vc in orange juice was 18.65 µg/mL, which was 9.16 µg/mL lower than that measured in healthy orange juice. In addition, the total phenol content decreased by 46.519 mg Gallic Acid Equivalents (GAE)/g to 9.748 mg GAE/g. Furthermore, the free-radical scavenging activity decreased from 22.297% to 5.393%. Correlation analysis indicated significant correlations between Vc concentration, total phenol content, and antioxidant activity of orange juice after B. dorsalis infestation. The decrease in Vc concentration, total phenol content and free-radical scavenging activity indicated that B. dorsalis changed the quality of orange juice by affecting the antioxidant activity of the juice after the oranges were infested.

Tea consumption and risk of fractures: an updated meta-analysis

This meta-analysis included 16 studies, involving seven cohort studies and nine case-control studies, and the results indicated that tea consumption may be associated with a reduced the risk of fractures.

INTRODUCTION

Regarding relationship of tea consumption with the risk of fractures remains controversial. We performed a meta-analysis to elucidate the association between tea consumption and the risk of fractures.

METHODS

Relevant articles were identified up to March 2019 by searching PubMed, Web of Science, and Embase databases. The pooled relative risks (RRs) with 95% confidence intervals (CIs) were computed utilizing fixed or random effects model based on heterogeneity.

RESULTS

Altogether 16 studies (seven cohort and nine case-control studies) were included in this meta-analysis, involving 772,707 participants with 37,166 fracture cases. The RRs (95% CIs) of fracture for the highest versus lowest category of tea consumption were 0.86 (0.78-0.94). Subgroup analysis indicated significant associations in cohort studies (0.90 (0.86-0.94)) and case-control studies (0.77 (0.69-0.85)).

CONCLUSIONS

The current meta-analysis indicates that tea consumption may be associated with a reduced the risk of fractures.

Concurrent weekly single cisplatin vs triweekly cisplatin alone with radiotherapy for treatment of locally advanced cervical cancer: a meta-analysis

Background

Radiotherapy (RT) concurrent with cisplatin (CDDP) is the standard regimen used for treatment of locally advanced cervical carcinoma. In this meta-analysis, we compared the weekly and triweekly single CDDP concomitant chemoradiation regimens for treatment of cervical cancer with respect to compliance, recurrence, survival, and acute adverse effects.

Materials and methods

A systematic search for relevant studies was conducted in PubMed, Cochrane Library, EMBASE, and Medline databases. Fixed- or random-effects model was used for pooled analysis. The end points were overall survival, recurrence, compliance, and acute adverse effect reported as odds ratios (ORs) and 95% CIs.

Results

Six randomized trials and two retrospective studies qualified the inclusion criteria. The regimen of triweekly CDDP alone concurrent with RT showed better compliance (OR, 0.49; 95% CI, 0.29–0.83; P=0.009). No significant difference was observed between the 2 arms with respect to recurrence, survival, and acute adverse effects (all P>0.05). However, triweekly CDDP regimen was associated with significantly lower incidence of local recurrence (OR, 1.83; 95% CI: 1.12–3.01; P=0.02), while weekly CDDP regimen was associated with a lower risk of leucopenia (OR, 0.30; 95% CI: 0.10–0.92; P=0.03).

Conclusion

Triweekly single platinum chemotherapy plus concurrent RT was superior to weekly CDDP regimen with respect to local recurrence and treatment compliance in patients with locally advanced cervical carcinoma.

Effects of lactic acid bacteria and smectite after aflatoxin B1 challenge on the growth performance, nutrient digestibility and blood parameters of broilers

This study aimed to investigate the effect of lactic acid bacteria (LAB) and smectite on the growth performance, nutrient digestibility and blood parameters of broilers that were fed diets contaminated with aflatoxin B₁ (AFB₁ ). A total of 480 newly hatched male Arbor Acres broilers were randomly allocated into four groups with six replicates of 20 chicks each. The broilers were fed diets with the AFB₁ (40 μg/kg) challenge or without (control) it and supplemented with smectite (3.0 g/kg) or LAB (4.0 × 10¹⁰  CFU/kg) based on the AFB₁ diet. The trial lasted for 42 days. The results showed that during days 1-42 of AFB₁ challenge, the feed intake (FI) and body weight gain (BWG) were depressed (p < .05). The inclusion of LAB and smectite increased (p < .05) the BWG by 71.58 and 41.89 g/bird, respectively, which reached the level of the control diet (p ≥ .05), but there were no differences (p ≥ .05) in performance between LAB and smectite. LAB and smectite also increased (p < .05) the apparent total tract digestibility of the crude protein. Regarding the blood parameters, AFB₁ decreased (p < .05) the levels of red blood cell count, haematocrit, mean corpuscular volume, haemoglobin, albumin and total protein. In the meantime, the AFB₁ increased (p < .05) leucocyte counts, urea nitrogen, cholesterol, total bilirubin, creatinine, glutamic-pyruvic transaminase, glutamic oxaloacetic transaminase and alkaline phosphatase. By contrast, LAB and smectite affected (p < .05) these parameters in the opposite direction. It can be concluded that after the AFB₁ challenge, LAB and smectite have similar effects on the growth and health of the broilers, suggesting that LAB could be an alternative against AFB₁ in commercial animal feeds.

[Analysis of the patterns of female breast cancer incidence in Shanghai, 2003-2012]

Objective: To analyze the patterns of female breast cancer and their incidence in Shanghai during 2003-2012, and to compare them with international data. Methods: The data of female breast cancer cases diagnosed between 2003 and 2012 were collected from the Shanghai Cancer Registry. The record of cancer cases included the patient's name, gender, date of birth, permanent and residential address, diagnosis site or name, histological type, date of first diagnosis, diagnostic basis and diagnostic stage, etc. Data source of cancer incidence of World, Developed Countries, Developing Countries, East Asia and China in 2012 sourced from GLOBOCAN 2012 database of the WHO International Agency for Research on Cancer (IARC); and the data of USA during 2008-2012 was collected from SEER 18 database from Surveillance, Epidemiology, and End Results Program of the National Cancer Institute (NCI). Incidence indicators of Shanghai female breast cancer were calculated, including the average cases, median age, average age, proportion, crude rate, age-specific rate and age-standardized rate. Results: During 2003-2012, 41 991 new cases of female breast cancer were diagnosed in Shanghai, with an average of 4 199 cases per year, accounting for 17.23% among total new female cancer cases, ranking first in female cancer incidence in Shanghai during 2003-2012, with a crude incidence rate of 60.90 per 100 000 and an age-standardized incidence rate of 33.90 per 100 000. During 2008-2012, an average 4 528 new cases of female breast cancer was diagnosed per year in Shanghai, with 16.97% among total female cancer cases. The median age was 56 years old and the mean age was 57.73 years old. The crude rate was 64.23 per 100 000 and the age-standardized rate was 35.00 per 100 0000, which was higher than those of China (22.1 per 100 000), Eastern Areas (27.0 per 100 000) and Developing Counties (31.3 per 100 000), and lower than that of World (43.1 per 100 000), and Yellow Race Population of USA (68.77 per 100 000). During 2003-2007, on average, 3 869 new cases of female breast cancer were diagnosed per year in Shanghai, accounting for 17.54% of total female cancer cases. The median age was 53 years old and the mean age was 56.44 years old. The crude rate was 57.42 per 100 000 and the age-standardized rate was 32.69 per 100 000. There was a continuing peak stage spanned 25 years old from 50 to 74 years old, during 2008-2012. Compared with those of 2003-2007, the beginning age group of the continuing peak stage was delayed for 5 years old and the ending age group was delayed for 10 years old. Conclusion: The age-standardized incidence rate in Shanghai was higher than those of China, Eastern Areas and Developing Counties, and lower than that of World, and that of Yellow Race Population of USA; Compared with 2003-2007, the crude rate and age-standardized rate increased, the median age, mean age and the beginning and ending age group of the continuing peak stage were delayed.

The α-β circular scanning with large range and low noise

A circular-route scanning method called α-β circular scanning is proposed and realized using sinusoidal signals with a constant phase difference of π/2. Experiments show that the circular scanning range of α-β circular scanning is 57% greater than the rectangular scanning range of raster scanning within an effective optical field of view. Moreover, the scanning speed is improved by 7.8% over raster scanning because the whole sine signal is utilized in α-β circular scanning whereas the flyback area of the saw-tooth signal needs to be discarded in raster scanning. The maximum scanning acceleration decreases by a factor of 44, drastically decreasing the high noise, which should considerably elongate the lifetime of the galvanometers while inhibiting internal vibration. The proposed α-β circular scanning technique could be used in scanning imaging, optical tweezers and laser-beam fabrication.

Effectiveness of Nurse Counselling in Discouraging the Use of the infant Walkers

Infant walkers are widely used by caregivers in Singapore despite being recognized as a household hazard. The study determined the effectiveness of nurse counselling in dissuading caregivers from using the walker. Caregivers of children 4 months of age were recruited and divided into the intervention group (nurse's advice and illustrated pamphlets), a conventional group (questionnaire alone) and a control group (without any intervention in a separate polyclinic). The percentage of the caregivers, who used the walkers in each group when their child was 9 months old, was taken as a surrogate indicator of effectiveness of nurse's intervention. The study analyzed 708 caregivers. Fewer caregivers (62.7% intervention vs. 80.4% questionnaire alone vs. 83.0% control) used the walker after nurse's advice with illustrated pamphlets. 8% of the users reported walker-related injuries (n=43). Nurses' counselling could be a simple yet effective method to discourage the use of walkers. Asia Pac J Public Health 2004; 16(2): 104-108.

Breast cancer incidence and mortality: trends over 40 years among women in Shanghai, China

BACKGROUND

Breast cancer incidence rates are increasing among Asian women, likely due to the changes in risk factors caused by globalization. Trends in breast cancer rates among Chinese women may differ from other Asian regions due to the implementation of a nationwide family planning program and resulting changes in women's reproductive practices. Appraisal of cancer trends can direct cancer control and public health planning, but relevant studies in China are scarce due to a lack of long-term data. We sought to evaluate secular time trends in breast cancer incidence and mortality using 40 years of cancer registry data for women in urban Shanghai.

MATERIALS AND METHODS

Data on invasive breast cancer incidence and mortality were collected by the Shanghai Cancer Registry. Age-standardized rates (ASRs) for incidence and mortality were calculated using the Segi/Doll 1960 world standard population. Age, period, and birth cohort effects were evaluated using age-period-cohort (APC) Poisson regression models. Overall linear trends, interpreted as the estimated annual percentage change (EAPC), were derived from the net drift in age-drift models.

RESULTS

A total of 53 885 breast cancer cases and 17 235 breast cancer-specific deaths were documented among women in urban Shanghai between 1 January 1973 and 31 December 2012. Breast cancer incidence and mortality ASRs increased by 141.2% and 26.6%, respectively. Significant age, cohort, and period effects were identified in both incidence and mortality APC models; cohort effects were pronounced. Overall, a substantial increase in breast cancer incidence (EAPC = 2.96%/year) and a moderate increase in breast cancer mortality (EAPC = 0.87%/year) was observed. A notable downward trend in mortality was identified among younger women born after 1960.

CONCLUSIONS

Forty years of cancer registry data document a tremendous increase in incidence and a slight increase in mortality for breast cancer among women in Shanghai. Effective, appropriate, and affordable breast cancer prevention and control strategies are urgently needed in China.

Digital Subtraction Cystography for Detection of Communicating Holes of Spinal Extradural Arachnoid Cysts

Objective

The purpose of this study was to demonstrate the usefulness of digital subtraction cystography to identify communicating holes between a spinal extradural arachnoid cyst (SEAC) and the subarachnoid space prior to cyst removal and hole closure.

Materials and Methods

Six patients with SEAC were enrolled in this retrospective study. Digital subtraction cystography and subsequent CT myelography were performed for every patient. The presence and location of the communicating holes on cystography were documented. We evaluated the MRI characteristics of the cysts, including location, size, and associated spinal cord compression; furthermore, we reviewed cystographic images, CT myelograms, procedural reports, and medical records for analysis. If surgery was performed after cystography, intraoperative findings were compared with preoperative cystography.

Results

The location of the communicating hole between the arachnoid cyst and the subarachnoid space was identified by digital subtraction cystography in all cases (n = 6). Surgical resection of SEAC was performed in 4 patients, and intraoperative location of the communicating hole exactly corresponded to the preoperative identification.

Conclusion

Fluoroscopic-guided cystography for SEAC accurately demonstrates the presence and location of dural defects. Preoperative digital subtraction cystography is useful for detection of a communicating hole between a cyst and the subarachnoid space.

Limited human-to-human transmission of avian influenza A(H7N9) virus, Shanghai, China, March to April 2013

In April 2013, two members of one family were successively confirmed as cases of avian influenza A(H7N9) virus infection in Shanghai, China. Respiratory specimens from the two cases and their close contacts were tested using real-time reverse-transcription (RT)-PCR. Paired serum specimens from contacts were tested by haemagglutination inhibition assay and microneutralisation test. The index patient developed severe pneumonia. Her husband presented with pneumonia shortly thereafter. Both cases had highly similar clinical features and infection with A(H7N9) virus was confirmed in both cases by genetic analysis. Phylogenetic analysis revealed a high level of similarity between the sequences from the two patients and environmental samples collected from wet markets in Minhang and Changning districts. Six samples from the Changning wet market were confirmed as A(H7N9) positive. Of 27 close contacts, one developed mild respiratory symptoms and another tested positive for A(H7N9) antibodies, but both were negative by real-time RT-PCR. The other 25 close contacts of both cases were A(H7N9) negative. Limited human-to-human transmission of the virus most likely occurred in the family cluster. However, other close contacts did not test positive for the virus, suggesting limited potential for extensive human-to-human transmission of the virus.