Genome-Wide Association Study of Retinopathy in Individuals without Diabetes

10.1371/journal.pone.0054232PLoS ONE82

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Medical Expenditure and Family Satisfaction Between Hospice and General Care in Terminal Cancer Patients in Taiwan

As the number of terminal cancer patients increases, several care models have been adopted to provide better care quality and reduce medical expenditure. This study compared inpatient medical expenditure and family satisfaction in a hospice ward (HW) and general ward (GW) for terminal cancer patients in Taiwan. Methods: We enrolled terminal cancer patients who were admitted and died during the same admission period in a tertiary care hospital in Taiwan from January 2003 to December 2005. These patients were allocated into three groups: inpatient care in HW alone; inpatient care in GW alone; and inpatient care in mixed group (initially in GW, then transferred to HW). Inpatient medical expenditure and family satisfaction were compared between the three groups. Results: A total of 1942 patients were recruited and allocated into HW (n = 292), GW (n = 1511) and mixed (n = 139) groups. The average medical expenditure per person or per inpatient day was lower in the HW than the GW or mixed group. Subjects who had ever been admitted to the intensive care unit or received cardiopulmonary resuscitation in the GW or mixed groups required more expenditure on medical care than that in the HW group. Daily medical expenditure in the HW group also was much lower than that in the GW and mixed groups, based on length of stay and cancer type. The family satisfaction score was significantly higher in the mixed and/or HW group than the GW group. Conclusion: For terminal cancer patients, hospice care can improve family satisfaction while reducing medical expenditure in Taiwan

Subject characteristics by study site.

*<p>Sample size of cohort used for primary analysis.</p>†<p>Presented as mean (standard deviation).</p>‡<p>Random glucose. HTN: Current use of blood pressure medication or systolic/diastolic blood pressure ≥140/90. AGES: Age, Gene/Environment Susceptibility-Reykjavik Study. ARIC: Atherosclerosis Risk in Communities study. BMES: Blue Mountains Eye Study. CHS: Cardiovascular Health Study. MESA: Multi-Ethnic Study of Atherosclerosis. RS: Rotterdam Study.</p

Regional association plot of SNP rs10486302 on chromosome 7 for Singapore Asian Indians.

<p>This figure is the regional association plot of SNP rs10486302 on chromosome 7 that reached gene-wide significance (p&lt;4.9×10⁻⁴) in the testing of transferability of the discovery SNP, rs12155400, to other SNPs in the histone deacetylase 9 gene in a cohort of Singapore Asian Indians without diabetes or hypertension. The lead and surrounding SNPs are color coded according to the pair-wise linkage disequilibrium (LD) with the lead SNP (presented as a diamond) on a scale of r² from 0 to 1. Estimated recombination rates reflect the local LD structure in the 500kb buffer around the index SNP and plotted based on values from HapMap II Han Chinese of Beijing China (HCT)/Japanese in Tokyo, Japan (JPT) populations.</p

Regional association plot of SNP rs213276 on chromosome 7 for African Americans.

<p>This figure is the regional association plot of SNP rs213276 on chromosome 7 that reached gene-wide significance (p&lt;5.2×10⁻⁵) in the testing of transferability of the discovery SNP, rs12155400, to other SNPs in the histone deacetylase 9 gene in a cohort of African Americans without diabetes or hypertension. The lead and surrounding SNPs are color coded according to the pair-wise linkage disequilibrium (LD) with the lead SNP (presented as a diamond) on a scale of r² from 0 to 1. Estimated recombination rates reflect the local LD structure in the 500 kb buffer around the index SNP and plotted based on values from HapMap II Yoruba in Ibadan, Nigeria (YRI) population.</p

Regional association plot of SNP rs12155400 on chromosome 7 for Caucasians.

<p>This figure is the regional association plot of SNP rs12155400 on chromosome 7 that reached genome-wide significance in the meta-analysis of GWAS results in participants of European ancestry without diabetes or hypertension. The lead and surrounding SNPs are color coded according to the pair-wise linkage disequilibrium (LD) with the lead SNP (presented as a diamond) on a scale of r² from 0 to 1. Estimated recombination rates reflect the local LD structure in the 500 kb buffer around the index SNP and plotted based on values from HapMap II Centre d’Etude du Polymorphisme Humain collection samples from a Utah (CEU) population.</p

The association between SNP rs12155400 on chromosome 7 and various micro- and macrovascular diseases.

*<p>The Wellcome Trust Case Control Consortium 2.</p>†<p>The Heart and Vascular Health Study.</p>#<p>No results.</p>‡<p>Chronic Kidney Diseases Genetics Consortium. MAF: Minor Allele Frequency. SE: Standard Error. UACR: Urinary Albumin to Creatinine Ratio. eGFRcrea: estimated Glomerular Filtration Rate using creatinine.</p

Distribution of retinopathy lesions.

*<p>defined as the presence of microaneurysms or dot-blot hemorrhages excluding individuals with self-report of diabetes or fasting blood glucose ≥126 mg/dL [7.0 mmol/L]) and individuals with secondary causes of retinopathy (e.g. branch or central retinal vein occlusions, late age-related macular degeneration) and other retinopathy phenotypes including exudates without microaneurysms or dot-blot hemorrhages and pre-retinal or vitreous hemorrhages. RS defined diabetes as a random glucose &gt; = 11.1 mmol/L, diabetic medication or self-reported history. HTN: Current use of blood pressure medication or systolic/diastolic blood pressure ≥140/90. AGES: Age, Gene/Environment Susceptibility-Reykjavik Study. ARIC: Atherosclerosis Risk in Communities study. BMES: Blue Mountains Eye Study. CHS: Cardiovascular Health Study. MESA: Multi-Ethnic Study of Atherosclerosis. RS: Rotterdam Study. NA: Not Available.</p