Long-Term Survival in Patients with Cancers: A SEER-based analysis

Objectives: Long-term survival is an important endpoint in management of different malignancies which is rarely assessed due to unfeasibility of follow-up for long duration of time. In this study, we explored real-world data on cancer’s long-term survival using historical records from the Surveillance, Epidemiology, and End Results (SEER) Program. Besides reporting the 5-year relative survival, we analyzed the 10- and 20- year survival rates for different types of cancers. Additionally, survival trends as a function of time, age, and tumor type were reviewed and reported. Methods: We used SEER*Stat (version 8.3.6.1) for data acquisition from the SEER 9 Regs (Nov 2019 Submission) database. Data of patients diagnosed with cancer between 1975 and 2014 were retrieved and included in the analysis. Results: For patients diagnosed with any malignant disease (n = 4,412,024), there was a significant increase in median overall survival over time (p<0.001). The 20-, 10-, and 5-year survival rates were higher in solid tumors compared to hematological malignancies (50.8% vs. 38%, 57% vs. 47.4%, and 62.2% vs. 57.4%, respectively). The highest 20-year relative survival rates were observed in thyroid cancer (95.2%), germ cell and trophoblastic neoplasms (90.3%), melanoma (86.8%), Wilms’ tumor (86.2%), and prostate cancer (83.5%). Conclusions: Long-term follow-up data were suggestive of high 20-year relative survival rates for most tumor types. Relative survival showed an improving trend over time especially in solid tumors. Keywords: Survival; Neoplasms; SEER Program; Prognosis; United States

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

COVIDiSTRESS diverse dataset on psychological and behavioural outcomes one year into the COVID-19 pandemic

During the onset of the COVID-19 pandemic, the COVIDiSTRESS Consortium launched an open-access global survey to understand and improve individuals’ experiences related to the crisis. A year later, we extended this line of research by launching a new survey to address the dynamic landscape of the pandemic. This survey was released with the goal of addressing diversity, equity, and inclusion by working with over 150 researchers across the globe who collected data in 48 languages and dialects across 137 countries. The resulting cleaned dataset described here includes 15,740 of over 20,000 responses. The dataset allows cross-cultural study of psychological wellbeing and behaviours a year into the pandemic. It includes measures of stress, resilience, vaccine attitudes, trust in government and scientists, compliance, and information acquisition and misperceptions regarding COVID-19. Open-access raw and cleaned datasets with computed scores are available. Just as our initial COVIDiSTRESS dataset has facilitated government policy decisions regarding health crises, this dataset can be used by researchers and policy makers to inform research, decisions, and policy. © 2022, The Author(s).U.S. Department of Education, ED: P031S190304; Texas A and M International University, TAMIU; National Research University Higher School of Economics, ВШЭThe COVIDiSTRESS Consortium would like to acknowledge the contributions of friends and collaborators in translating and sharing the COVIDiSTRESS survey, as well as the study participants. Data analysis was supported by Texas A&M International University (TAMIU) Research Grant, TAMIU Act on Ideas, and the TAMIU Advancing Research and Curriculum Initiative (TAMIU ARC) awarded by the US Department of Education Developing Hispanic-Serving Institutions Program (Award # P031S190304). Data collection by Dmitrii Dubrov was supported within the framework of the Basic Research Program at HSE University, RF

Orbital melanocytoma: When a tumor becomes a relieving surprise

Purpose: Melanocytomas are rare pigmented tumors that arise form melanocytes and have been reported in the central nervous system. Orbital melanocytomas “also known as blue nevus” are rarely reported. The occurrence of choroidal melanoma and orbital melanocytomas has never been described. Observations: This is a case of orbital melanocytoma in a 34 year old female who presented with left proptosis and ecchymosis. She has the right eye enucleated to treat a large choroidal melanoma, 6 years earlier. Orbital metastasis was suspected. After orbital imaging and systemic evaluation, incisional biopsy was planned yet the mass could be totally excised and it turned out to be melanocytoma. The condition was not associated with nevus of Ota and the patient is not known to have any predisposing condition for melanocytic lesions. Conclusion and importance: Melanocytoma and malignant melanoma share the same cell of origin. The benign course, the well differentiated cells, absence of anaplasia and the positive reaction to Human Melanoma Black-45 (HMB-45) and S-100 proteins established the diagnosis of the former. Such diagnosis was a relief for this one eyed patient.(HMB-45:human melanoma black-45). Keywords: Orbit, Melanocytoma, Choroidal melanoma, HMB-45, S-10

Broadband PM6Y6 coreshell hybrid composites for photocurrent improvement and light trapping

Abstract Our research focuses on enhancing the broadband absorption capability of organic solar cells (OSCs) by integrating plasmonic nanostructures made of Titanium nitride (TiN). Traditional OSCs face limitations in absorption efficiency due to their thickness, but incorporating plasmonic nanostructures can extend the path length of light within the active material, thereby improving optical efficiency. In our study, we explore the use of refractory plasmonics, a novel type of nanostructure, with TiN as an example of a refractory metal. TiN offers high-quality localized surface plasmon resonance in the visible spectrum and is cost-effective, readily available, and compatible with CMOS technology. We conducted detailed numerical simulations to optimize the design of nanostructured OSCs, considering various shapes and sizes of nanoparticles within the active layer (PM6Y6). Our investigation focused on different TiN plasmonic nanostructures such as nanospheres, nanocubes, and nanocylinders, analyzing their absorption spectra in a polymer environment. We assessed the impact of their incorporation on the absorbed power and short-circuit current (Jsc) of the organic solar cell

Save the hearing, an ear surgery training project program to combat deafness in developing countries

Abstract Background Hearing loss is one of the most common health problems affecting people in the developing countries so our aim of the “Save The Hearing Project” was to combat deafness by training local doctors for ear surgery in order to treat their local patients with low cost as possible. The project was done as ear surgery campaigns in peripheral areas in Egypt, Yemen, and other countries, to train young ENT specialists and to treat patients there. Our plan was put according to the frequency of different causes of deafness as shown by previous surveys. We used the previous local and evidence-based researches to make our protocols of management of different diseases. These protocols were further evaluated during our work. The project has five stages. The first stage included management of sudden sensory neural hearing loss (SSNHL), otitis media with effusion (OME), and local anesthesia for the ear surgery—cartilage tympanoplasty and ossiculoplasty. The second stage included mastoidectomy cholesteatoma surgery and otoendoscopy. The third stage included more advanced surgery as stapedectomy and tympanosclerosis. The fourth stage included combating SNHL mainly through audiology and rehabilitation program, beside referral for cochlear implants to specialized centers. The fifth stage was only a plan for doing stem cell research in management of hearing loss. Results Our teams did about 42 campaigns only and the data of 31 were recorded. There were 259 attendants, 70 had hands on training, and 35 were well trained and became trainers. We did 270 tympanoplasties, 52 mastoidectomies, and cholesteatoma surgery beside 16 operations of stage III. Conclusion Training an ear surgeon is a tedious and long process, but it is at the end very fruitful and useful for the community. Most causes of HL are preventable. We think that our project plan to combat HL is very suitable to be applied in developing countries in Africa and the Middle East

Changes in peritoneal membrane with different peritoneal dialysis solutions: Is there a difference?

Background/Purpose: The peritoneal membrane of long-term peritoneal dialysis (PD) patients is characterized by morphological and microvascular changes. It is said that lactate-based peritoneal dialysate is implicated in the development of these changes. The aim of this study is to compare the effects of long-term exposure to glucose-based, lactate-buffered (Dianeal), and biocompatible bicarbonate/lactate-buffered, low glucose degradation product (Physioneal) peritoneal solutions on the peritoneal membrane. Methods: Thirty-nine incident PD patients were randomized into two groups: 19 patients with Dianeal dialysate (Group A) and 20 with biocompatible Physioneal dialysate (Group B). All patients used automated PD for a median of 31 months in Group A and 32 months in Group B. Three biopsies at one occasion only were taken from the peritoneal membrane at the end of the study. All samples were collected and fixed in accordance with a standardized protocol, and a histopathologist blinded to the clinical status and PD solutions allocated to the patients carried out the analysis. Results: The commonest change observed was peritoneal fibrosis, seen in 35 out of 39 cases (89.7%); it was moderate to severe in 28 cases (71.8%) and mild in 11 (28.2%) cases. This was followed by loss of mesothelial cells (22 cases, 56.4%), elastosis (20 cases, 51.3%), increased blood vessels (15 cases, 38.5%), thick-walled blood vessels (10 cases, 25.6%), and finally chronic inflammation and mesothelial cell hyperplasia (7 cases, 17.9%, and 6 cases, 15.4%, respectively). Of the patients with blood vessel abnormalities, 22 (88.0%) exhibited significant fibrosis and only three (12.0%) did not. Of those without blood vessel changes, only six (42.9%) patients exhibited similar degree of fibrosis (p < 0.01). The prevalence of vascular changes, moderate to severe fibrosis, as well as mesothelial cell abnormalities increased as the duration of PD increased. The prevalence of fibrosis, mesothelial cell loss, and vascular abnormalities increased significantly with diabetes mellitus (p < 0.001). Conclusion: There was no difference in the effects of long-term exposure to glucose-based, lactate-buffered, and biocompatible bicarbonate/lactate-buffered, low glucose degradation product peritoneal solutions on the peritoneal membrane. Risk factors other than PD dialysate composition need to be considered when assessing peritoneal membrane adequacy. The factors that were proved to be significant in our study are duration of end-stage renal disease, diabetes mellitus, and time on PD. 背景 / 目的: 在接受長期腹膜透析 (PD) 的病人間，腹膜會出現若干的形態學與微血管變化，這些變化被認為與採用乳酸鹽腹膜透析液有關。本研究旨在比較兩種透析液的長期暴露—乳酸鹽緩衝之 Dianeal®、與生物相容之 Physioneal® 對病人腹膜的影響。 方法: 共 39 位剛開始接受 PD 的病人被分為兩組：19 人接受 Dianeal 透析液 (A 組)、20 人接受生物相容之 Physioneal 透析液 (B 組)，所有病人接受的均為自動化 PD (APD)。研究結束時，我們對病人腹膜進行了活組織檢驗。 結果: 在 A 組及 B 組之間，間皮細胞消失分別發生於 52.6% 及 60.0% 的病人，間皮細胞增生則分別發生於 21.1% 及 15.0% 的病人 (p > 0.05)；嚴重間質纖維化分別發生於 42.1% 及 45.0% 的病人，中度間質纖維化則分別發生於 31.6% 及 25.0% 的病人 (p > 0.05)。在 A 組及 B 組的病人之間，彈性組織變性 (elastosis) 達到 “3+” 的比率分別為 15.8% 及 20.0%，達到 “2+” 的比率分別為 15.8% 及 15.0% (p > 0.05)；異常微血管增加則分別出現於 42.1% 及 35.0% 的病人 (p > 0.05)。在糖尿病患者之間、及接受 PD 較久的病人之間，腹膜病理性變化的比率均有所增加 (p < 0.001)。 結論: 長期採用以上兩種腹膜透析液於 PD 病人中，並未導致不同的腹膜變化。然而，以下因素則可能導致不同的腹膜變化：末期腎病、糖尿病、及 PD 的持續時間