Trends in age- and sex-specific lung cancer mortality in Europe and Northern America: Analysis of vital registration data from the WHO Mortality Database between 2000 and 2017

Background: In the context of new targeted therapies and immunotherapy as well as screening modalities for lung cancer patients, detailed mortality trends in Europe and Northern America are unknown. Methods: Time-trend analysis using vital registration data of Northern America and Europe from the WHO Mortality Database (years 2000/2017). To assess improvements in lung cancer mortality, we performed a population-averaged Poisson autoregressive analysis. The average annual percent change (AAPC) was used as a summary measure of overall and country-specific trends in mortality. Second, we studied time trends of lung cancer incidence and smoking prevalence rates. Findings: In the total population of 872·5 million people between 2015 and 2017, the average annual age-standardised mortality from lung cancer was 54·6 deaths per 100 000, with substantial differences across countries. Lung cancer was reported as the primary cause of death in 5·4 cases per 100 deaths. The age-standardised mortality rate decreased constantly (AAPC –1·5%) between 2000 and 2017. While mortality in men dropped annually by an average of −2·3%, mortality in women decreased by an average of −0·3%. This slight decline was driven exclusively by the USA. In contrast, 21 out of 31 countries registered a significant increase in female lung cancer mortality between 2000 and 2017, with Spain (AAPC 4·1%) and France (AAPC 3·6%) leading the list. Interpretation: Despite overall decreases in lung cancer mortality trends, female mortality remained unchanged or increased significantly in all countries except the USA. National mortality outcomes reflect variabilities in tobacco control, screening, therapeutic advances, and access to health care

Validation of the 8th lung cancer TNM classification and clinical staging system in a German cohort of surgically resected patients

The updated 8th edition of the tumor, node, metastases (TNM) classification system for non-small cell lung cancer (NSCLC) attempts to improve on the previous 7th edition in predicting outcomes and guiding management decisions. This study sought to determine whether the 8th edition was more accurate in predicting long-term survival in a European population of surgically treated NSCLC patients

Assoziationen zwischen zerebralen Mikroblutungen und Lipiden bei Patienten mit einem ersten ischämischen Schlaganfall

Background: Cerebral microbleeds (CMBs) are magnetic resonance imaging (MRI) markers of cerebral small vessel disease (SVD) and are a risk factor for ischemic stroke, hemorrhagic stroke, and poor functional outcome after stroke. Although dyslipidemia is associated with ischemic stroke, its relationship to CMBs is unclear. In this study, which is a substudy of the Berlin Cream&amp;Sugar; study, we sought to determine whether CMBs in first-time ischemic stroke patients were associated with various measures of dyslipidemia. Methods: This substudy included all patients enrolled in the Berlin Cream&amp;Sugar; study between January 2009 and October 2015, who had received necessary imaging for evaluation of CMBs. 3 – 7 days after ischemic stroke, baseline serum lipid parameters (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and TG levels) were measured, and patients were administered oral TG tolerance tests (OTTT) and oral glucose tolerance tests (OGTT). Results: A total of 291 subjects were included in this substudy (median age 64.5 years, standard deviation [SD] ± 13 years; median National Institutes of Health Stroke Scale [NIHSS] 1, interquartile range [IQR] 0-2). Of these, 28 (9.6%) were found to have one or more CMB. Compared to patients with low TC (<165 mg/dl), patients with midrange TC (165-198 mg/dl) had an adjusted odds ratio [OR] of 0.20 (95% confidence interval [CI] 0.10 - 0.76) for CMBs (p=0.018); for patients with the highest tertile of TC (>198 mg/dl) the adjusted OR was 0.32 (95% CI 0.09 – 1.10, p=0.070). Additionally, in post hoc analysis, CMBs were independently associated with increasing severity of white matter hyperintensities (WMHs), based on Wahlund score (Wahlund 0-3: reference; Wahlund 4-10: adjusted OR 6.1; 95% CI 1.8 - 21.2; p= 0.004; Wahlund >10: adjusted OR 10.8; 95% CI 2.9 - 39.4; p<0.01) and with the lowest tertial of glomerular filtration rate (GFR), (GFR >92.2 ml/min/1.73 m²: reference; m²GFR<75.5 ml/min/1.73 m²: adjusted OR 7.4; 95% CI 1.6 - 33.9; p=0.01) . Conclusion: Low TC, WMH severity, and poorer renal function were associated with CMBs in our cohort of first time ischemic stroke patients. Neither fasting TGs nor any measure of TG metabolism based on the OTTT were significantly associated with CMBs. Further studies may investigate the association between CMBs and renal function and TC level. Our results do not, however, suggest that further investigation of TG or TG metabolism would be a fruitful field for further research.Einleitung: Zerebrale Mikroblutungen (engl.: cerebral microbleeds, CMBs) sind ein Kernspintomographie Marker für eine Erkrankung der kleinen Hirngefäße (engl.: small vessel disease, SVD) und stellen ein Risikofaktor für einen hämorrhagischen Schlaganfall, einen ischämischen Schlaganfall, sowie für ein schlechtes funktionelles Endergebnis nach Schlaganfall dar. Obwohl eine Dyslipidämie mit dem Risiko eines ischämischen Schlaganfalls assoziiert ist, bleibt die Assoziation mit CMBs umstritten. Das primäre Ziel der vorliegenden Substudie der Berliner Cream&amp;Sugar; Studie, war es, den Zusammenhang zwischen CMBs und Dyslipidämie bei Patienten mit einem ersten ischämischen Schlaganfall zu untersuchen. Methoden: In diese Substudie wurden alle Patienten einbezogen, die in die Berliner Cream&amp;Sugar; Studie zwischen Januar 2009 und Oktober 2015 eingeschlossen wurden und für die kernspintomographischer T2*-gewichteter Gradientenechosequenzen vorlagen. 3 – 7 Tagen nach dem Schlaganfall wurden zirkulierende Lipidparameter (Gesamtcholesterin [engl.: total cholesterin, TC], Lipoprotein niederer Dichte [engl.: low density lipoprotein, LDL-C], Lipoprotein hoher Dichte [engl., high density lipoprotein, HDL-C] und TG) bestimmt und ein oraler Triglyzerid- Toleranz-Test (OTTT) und ein oraler Glukose-Toleranz-Test (OGTT) wurden durchgeführt. Ergebnisse: 291 Patienten konnten in dieser Substudie berücksichtigt werden (Durchschnittsalter 64.5 Jahre, SD ± 13; Durchschnitts- National Institutes of Health Stroke Scale [NIHSS] 1, IQR 0-2). CMBs wurden bei insgesamt 28 Patienten festgestellt (9.6%). Das Vorliegen von CMBs war signifikant seltener bei Patienten mit mittleren TC-Spiegeln (165-198 mg/dl), verglichen mit Patienten mit den niedrigsten TC-Spiegeln (<165 mg/dl) (adjustiertes Odds Ratio [OR] 0.20; 95% Konfidenzinterval [engl. confidence interval, CI] 0.10 - 0.76; p=0.018); bei Patienten mit den höchsten TC- Spiegeln (>198 mg/dl) war das adjustiertes OR 0.32 (95% CI 0.09 – 1.10, p=0.070). Zusätzlich zeigten sich statistisch signifikante Zusammenhänge zwischen CMBs und Ausprägung der Hyperintensitäten der weißen Hirnsubstanz (engl. White matter hyperintensities, WMHs) (Wahlund 0-3: Referenz; Wahlund 4-10: adjustiertes OR 6.1; 95% CI 1.8 - 21.2; p= 0.004; Wahlund >10: adjustiertes OR 10.8; 95% CI 2.9 - 39.4; p<0.01) und dem untersten Tertial von glomerulären Filtrationsrate (GFR >92.2 ml/min/1.73 m²: Referenz; GFR<75.5 ml/min/1.73 m²: adjustiertes OR 7.4; 95% CI 1.6 - 33.9; p=0.01). Schlussfolgerung: Zusammenfassend stellten wir fest, dass niedrige TC- Spiegeln, WMH Schwere sowie reduzierte Nierenfunktion mit CMBs signifikant assoziieren. Weder nüchterne TC-Spiegeln noch die von uns untersuchten Parameter des TG Stoffwechsels waren mit dem Vorliegen von CMBs assoziiert. Weitere Studien könnten die Rollen von TC-Spiegeln und Nierenfunktion in der Entstehung von CMBs untersuchen. Anhand unserer Ergebnisse können wir jedoch keine weiteren Untersuchungen des Zusammenhangs zwischen CMBs und TG-Spiegeln / TG Metabolismus empfehlen

Depression and Anxiety Management in Parkinson Disease

ABSTRACT: BACKGROUND: Depression and anxiety are common but underrecognized and undertreated nonmotor symptoms of Parkinson disease (PD) due to their diagnostic criteria overlapping with other PD symptoms, limited randomized controlled studies in this specific population, and the need for multidisciplinary expertise. The purpose of this article is to offer evidence-based solutions for managing comorbid depression and anxiety in patients with PD through a case study analysis. CASE STUDY: A case study is used to illustrate the somatic manifestations of anxiety in PD that leads to diagnostic challenge and multidisciplinary management. MANAGEMENT CONSIDERATIONS: The appropriate use of screening tools, pharmacological and nonpharmacological management, and education are important interventions to consider when treating depression and anxiety in PD. CONCLUSION: Effective management requires accurate assessments, individualized treatment modalities, and patient education. Nurses who are knowledgeable about the effects and management of mood disorders in PD can play an integral role in the multidisciplinary team approach for assessment, patient and caregiver education, and treatment plan implementation