Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Clinical Outcome Results of Stand Alone Anchored Spacer for Anterior Cervical Discectomy and Fusion

Background Data: Anterior cervical discectomy and fusion (ACDF) became the classic operation in treating degenerative cervical spondylosis. The application of anterior cervical plate helped fusion and stabilization; however, there were many reports of the complications, such as dysphagia and the possibility of adjacent segment degeneration that may develop after anterior cervical approach. Purpose: The aim of this study is to assess the outcome of the standalone anchored cervical spacers in anterior cervical discectomy and fusion. Study Design: This is a retrospective study included 30 patients suffering from degenerative cervical disc disease. The outcome measures were: the visual analogue score, Cobb’s angles for sagittal and segmental alignment, the Japanese orthopedic association score, Nurick score for myelopathic patients and the occurrence of postoperative dysphagia. Patients and Methods: 30 patients were included in this study. All these patients had an anterior approach for cervical discectomy. A standalone anchored cervical spacer was used for this purpose. All patients were regularly assessed through the follow up period of two years post surgical intervention. Results: The study included 30 patients, 22 patients had single level, and 8 patients had two levels cervical discectomy. Postoperative improvement of radicular pain VAS were statistically significant (9.0 to 1.67) as well as the improvement in Cobb’s angle (1.39±5.69 to 6.78±3.83) were statistically significant (P=0.001). Postoperative improvement in the JOA Score was significant (7.12 to 14.65). Nurick score for myelopathy improvement was statistically significant (2.6 to 0.83). Postoperative improvement in the fused levels’ height was statistically significant (p=0.001) Conclusion: Stand-alone anchored spacer has a good result regarding relief of symptoms, fusion, and is simple to insert with less post-operative dysphagia. (2018ESJ156

Slotted Antenna Array with Enhanced Radiation Characteristics for 5G 28 GHz Communications

This paper presents a 1 × 4 linear antenna array working at 28 GHz for 5G communication systems. The proposed array employs four rectangular slotted antenna elements fed by a 1 × 4 T-power divider. An artificial magnetic conductor (AMC) layer is placed below the array for increasing the radiation intensity and improving overall array gain. The measured impedance bandwidth of the proposed array with (|S11| < −10 dB) is extended from 25.36 to 26.03 GHz (with a bandwidth of 0.67 GHz) and from 26.75 to 28.81 GHz (with a bandwidth of 2.06 GHz). The proposed array design exhibits a measured gain value that varies between 11.8 dBi and 13.1 dBi within the operating bands and reaches 13.1 dBi at 28 GHz. The proposed array achieves a radiation efficiency of 83.05%, and a front-to-back ratio ranging between 15 and 20 dB across the operating frequency band. The array is fabricated and tested with good matching between the simulated and tested outcomes. The improved performance of the array makes it a suitable candidate for 5G new radio (NR) communications

Unraveling Therapeutic Opportunities and the Diagnostic Potential of microRNAs for Human Lung Cancer

Lung cancer is a major public health problem and a leading cause of cancer-related deaths worldwide. Despite advances in treatment options, the five-year survival rate for lung cancer patients remains low, emphasizing the urgent need for innovative diagnostic and therapeutic strategies. MicroRNAs (miRNAs) have emerged as potential biomarkers and therapeutic targets for lung cancer due to their crucial roles in regulating cell proliferation, differentiation, and apoptosis. For example, miR-34a and miR-150, once delivered to lung cancer via liposomes or nanoparticles, can inhibit tumor growth by downregulating critical cancer promoting genes. Conversely, miR-21 and miR-155, frequently overexpressed in lung cancer, are associated with increased cell proliferation, invasion, and chemotherapy resistance. In this review, we summarize the current knowledge of the roles of miRNAs in lung carcinogenesis, especially those induced by exposure to environmental pollutants, namely, arsenic and benzopyrene, which account for up to 1/10 of lung cancer cases. We then discuss the recent advances in miRNA-based cancer therapeutics and diagnostics. Such information will provide new insights into lung cancer pathogenesis and innovative diagnostic and therapeutic modalities based on miRNAs

Randomized Phase II Trial of Carboplatin-Paclitaxel Versus Carboplatin-Paclitaxel-Trastuzumab in Uterine Serous Carcinomas That Overexpress Human Epidermal Growth Factor Receptor 2/neu

Purpose Uterine serous carcinoma is a rare, aggressive variant of endometrial cancer. Trastuzumab is a humanized monoclonal antibody that targets human epidermal growth factor receptor 2 (HER2)/neu, a receptor overexpressed in 30% of uterine serous carcinoma. This multicenter, randomized phase II trial compared carboplatin-paclitaxel with and without trastuzumab in patients with advanced or recurrent uterine serous carcinoma who overexpress HER2/neu. Methods Eligible patients had primary stage III or IV or recurrent HER2/neu-positive disease. Participants were randomly assigned to receive carboplatin-paclitaxel (control arm) for six cycles with or without intravenous trastuzumab (experimental arm) until progression or unacceptable toxicity. The primary end point was progression-free survival, which was assessed for differences between treatment arms via one-sided log-rank tests. Results From August 2011 to March 2017, 61 patients were randomly assigned. Forty progression-free survival-related events occurred among 58 evaluable participants. Among all patients, median progression-free survival was 8.0 months (control) versus 12.6 months (experimental; P = .005; hazard ratio [HR], 0.44; 90% CI, 0.26 to 0.76). Similarly, median progression-free survival was 9.3 (control) versus 17.9 (experimental) months among 41 patients with stage III or IV disease undergoing primary treatment (P = .013; HR, 0.40; 90% CI, 0.20 to 0.80) and 6.0 (control) versus 9.2 months (experimental), respectively, among 17 patients with recurrent disease (P = .003; HR, 0.14; 90% CI, 0.04 to 0.53). Toxicity was not different between treatment arms, and no unexpected safety signals emerged. Conclusion Addition of trastuzumab to carboplatin-paclitaxel was well tolerated and increased progression-free survival. These encouraging results deserve further investigation to determine their impact on overall survival in patients with advanced or recurrent uterine serous carcinoma who overexpress HER2/neu.AbbVie; Amgen; Astellas Pharma; Astex Pharmaceuticals; AstraZeneca; Boehringer Ingelheim; Bristol-Myers Squibb; Eisai; Endocyte; Exelixis; Incyte; Merck; PharmaMar; Prima BioMed; Genentech; Tesaro; Iovance Biotherapeutics; Agenus; inVentiv Health Clinical; TRACON Pharmaceuticals; Immunogen; Stemcentrx; INC Research; PRA Intl; Janssen Research and Development; Ajinomoto; Clovis Oncology; Serono; ERGOMED Clinical Research; Array BioPharma; Regeneron Pharmaceuticals; BiPar/Sanofi-Aventis6 month embargo; published online: 27 March 2018This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]