Hot disc of the Swift J0243.6+6124 revealed by Insight-HXMT

We report on analysis of observations of the bright transient X-ray pulsar (XRP) Swift J0243.6+6124 obtained during its 2017-2018 giant outburst with Insight-HXMT, NuSTAR, and Swift observatories. We focus on the discovery of a sharp state transition of the timing and spectral properties of the source at super-Eddington accretion rates, which we associate with the transition of the accretion disc to a radiation pressure dominated state, the first ever directly observed for magnetized neutron star. This transition occurs at slightly higher luminosity compared to already reported transition of the source from sub- to supercritical accretion regime associate with onset of an accretion column. We argue that this scenario can only be realized for comparatively weakly magnetized neutron star, not dissimilar to other ultra-luminous X-ray pulsars, which accrete at similar rates. Further evidence for this conclusion is provided by the non-detection of the transition to the propeller state in quiescence which strongly implies compact magnetosphere and thus rules out magnetar-like fields

Utilization of pain medications and its effect on quality of life, health care utilization and associated costs in individuals with chronic back pain

Raj Desai, Young Rock Hong, Jinhai Huo Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL 32610, USA Purpose: Pain medications are widely prescribed to treat chronic back pain (CBP). However, the effect of using pain medications on individuals with CBP has received very little attention. Objective: The aim of this study was to determine the patterns of pharmacological treatment in the population with CBP and assess its impact on quality of life, health care utilization and associated costs in USA. Patients and methods: Retrospective, cross-sectional data obtained from the Medical Expenditure Panel Survey (MEPS), from 2011 to 2015, were utilized for this study. Pharmacological treatment for CBP was categorized into three mutually exclusive categories: 1) opioids only, 2) nonsteroidal anti-inflammatory drugs (NSAIDs) only, 3) opioids and NSAIDs (combination). The effect of the use of these treatments was also evaluated. Results: A total of 5,203 individuals with CBP were identified. Of these, 2,568 (49.4%) utilized opioids only, 1,448 (27.8%) utilized NSAIDs only and 1,187 (22.8%) utilized both pain medications. Lower health-related quality-of-life scores on both the Short Form Health Survey-12 version 2 (SF-12v2) components (mental component summary score: 44.42 vs 46.67, P<0.001; physical component summary score: 35.34 vs 40.11, P<0.001) were observed for the opioid-only group compared to the NSAID-only group. In addition, individuals utilizing opioids only had greater utilization of inpatient services, office-based services, outpatient services and emergency room visits along with higher related health care costs. Conclusion: Future researchers need to investigate the long-term risks and benefits of opioids, and policy makers should evaluate the prescribing guidelines to aim for a more patient-centered care. Keywords: opioids, NSAIDs, quality of life, health care resource utilization, cos

Systematic review and a meta-analysis of hospital and surgeon volume/outcome relationships in colorectal cancer surgery

© Journal of Gastrointestinal Oncology. All rights reserved. Background: Numerous hospitals worldwide are considering setting minimum volume standards for colorectal surgery. This study aims to examine the association between hospital and surgeon volume on outcomes for colorectal surgery. Methods: Two investigators independently reviewed six databases from inception to May 2016 for articles that reported outcomes according to hospital and/or surgeon volume. Eligible studies included those in which assessed the association hospital or surgeon volume with outcomes for the surgical treatment of colon and/or rectal cancer. Random effects models were used to pool the hazard ratios (HRs) for the association between hospital/surgeon volume with outcomes. Results: There were 47 articles pooled (1,122,303 patients, 9,877 hospitals and 9,649 surgeons). The metaanalysis demonstrated that there is a volume-outcome relationship that favours high volume facilities and high volume surgeons. Higher hospital and surgeon volume resulted in reduced 30-day mortality (HR: 0.83; 95% CI: 0.78-0.87, P < 0.001 & HR: 0.84; 95% CI: 0.80-0.89, P < 0.001 respectively) and intra-operative mortality (HR: 0.82; 95% CI: 0.76-0.86, P < 0.001 & HR: 0.50; 95% CI: 0.40-0.62, P < 0.001 respectively). Post-operative complication rates depended on hospital volume (HR: 0.89; 95% CI: 0.81-0.98, P < 0.05), but not surgeon volume except with respect to anastomotic leak (HR: 0.59; 95% CI: 0.37-0.94, P < 0.01). High volume surgeons are associated with greater 5-year survival and greater lymph node retrieval, whilst reducing recurrence rates, operative time, length of stay and cost. The best outcomes occur in high volume hospitals with high volume surgeons, followed by low volume hospitals with high volume surgeons. Conclusions: High volume by surgeon and high volume by hospital are associated with better outcomes for colorectal cancer surgery. However, this relationship is non-linear with no clear threshold of effect being identified and an apparent ceiling of effec

Altered amplitude of low-frequency fluctuation and regional cerebral blood flow in females with primary dysmenorrhea: a resting-state fMRI and arterial spin labeling study

Ya-Nan Zhang,1 Jian-Wei Huo,1 Yi-Ran Huang,2 Ying Hao,3 Zi-Yue Chen41Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, People&rsquo;s Republic of China; 2School of Acupuncture-Moxibustion &amp; Tuina, Beijing University of Chinese Medicine, Beijing, 100029, People&rsquo;s Republic of China; 3Beijing International Center for Mathematical Research, Peking University, Beijing 100871, People&rsquo;s Republic of China; 4Department of Acupuncture and Moxibustion, Yanshan Hospital, Beijing 102500, People&rsquo;s Republic of ChinaPurpose: The current study aimed to explore the central mechanism of primary dysmenorrhea (PD) by investigating the alterations in resting state amplitude of low-frequency fluctuation (ALFF) and regional cerebral blood flow (CBF) between PD patients and healthy controls (HCs).Patients and methods: A total of 34 female subjects including 20 PD patients and 14 HCs underwent resting-state functional magnetic resonance imaging (rs-fMRI) and arterial spin labeling technique (ASL) MRI during menstrual phase. Subsequently, the differences in ALFF and CBF were compared in the two groups. The visual analog scores for pain (VAS-P) and for anxiety (VAS-A) were applied to assess cramping pain and related symptoms in PD patients. Finally, Pearson&rsquo;s correlation analysis was performed to analyze relationships between the neuroimaging findings and clinical characteristics.Results: Compared to HCs, PD patients had decreased ALFF in the right cerebellum posterior lobe, right middle temporal gyrus, right parahippocampal gyrus, right hippocampus, right brainstem and left parietal lobe. In addition, elevated CBF values were observed in the right inferior frontal gyrus, right precentral gyrus, and right superior temporal gyrus. There was no significant correlation between ALFF, CBF values and clinical characteristics including onset age of dysmenorrhea, VAS-A, and VAS-P in PD patients.Conclusion: The preliminary alterations of ALFF and CBF values in PD patients were observed in different pain-related brain regions, which were involved in multiple dimensions of pain and pain modulation. The combination of rs-fMRI and ASL MRI might provide complementary information for a better understanding of the central mechanism in PD.Keywords: primary dysmenorrhea, resting state functional magnetic resonance imaging, amplitude of low frequency fluctuation, arterial spin labeling, cerebral blood flo

Laryngeal Squamous Cell Carcinoma Survival in the Context of Human Papillomavirus: A Systematic Review and Meta-analysis.

BACKGROUND: Head and neck (H&N) squamous cell carcinoma (SCC) is a significant contributor to worldwide mortality and morbidity. Human papillomavirus (HPV) has been linked with H&N cancer and HPV-positive H&N SCC have been shown to have better survival outcomes. OBJECTIVE: To evaluate the effect of human papillomavirus (HPV) on laryngeal carcinoma (LSCC) survival outcomes and prognosis. METHOD: A systematic review and meta-analysis were performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. LSCC was confirmed based on histopathology, and HPV status was confirmed by either polymerase chain reaction, immunohistochemistry, and/or in-situ hybridization. RESULTS: There were 1214 studies which were identified, of which 14 studies were eligible for our review. A total of 2,578 cases of LSCC were included in analysis with 413 (16.0%) HPV-positive. Overall survival (OS) was not significant for HPV-positive LSCC in first five years (year one: OR 1.44 p=0.13; year two: OR 1.24 p=0.30; year three: OR 1.01 p=0.97; year four: OR 1.13 p=0.63; year five: OR 1.01 p=0.98). Disease-free survival (DFS) was similarly not significant for HPV-positive LSCC (year one: OR 1.08 p=0.68; year two: OR 1.22, p=0.31; year three: OR 1.13, p=0.69; year four: OR 0.93, p=0.80 and year five: OR 1.42, p=0.30). When studies are sub-divided into global regions, Chinese studies had better HPV-positive survival compared to North American studies in year five (OR 1.84 vs OR 0.46, p=0.04). CONCLUSION: This is the first study of its kind to evaluate the survival impact of HPV-positive LSCC patients. Unlike oropharyngeal cancer, HPV status does not make a difference to OS or DFS in LSCC. This supports data that HPV is not a prognostic factor in squamous carcinoma of the larynx