Preoperative oral care and effect on postoperative complications after major cancer surgery

Background

Improving patients' oral hygiene is an option for preventing postoperative pneumonia that may be caused by aspiration of oral and pharyngeal secretions. Whether preoperative oral care by a dentist can decrease postoperative complications remains controversial. A retrospective cohort study was undertaken to assess the association between preoperative oral care and postoperative complications among patients who underwent major cancer surgery.

Methods

The nationwide administrative claims database in Japan was analysed. Patients were identified who underwent resection of head and neck, oesophageal, gastric, colorectal, lung or liver cancer between May 2012 and December 2015. The primary outcomes were postoperative pneumonia and all-cause mortality within 30 days of surgery. Patient background was adjusted for with inverse probability of treatment weighting using propensity scoring.

Results

Of 509 179 patients studied, 81 632 (16·0 per cent) received preoperative oral care from a dentist. A total of 15 724 patients (3·09 per cent) had postoperative pneumonia and 1734 (0·34 per cent) died within 30 days of surgery. After adjustment for potential confounding factors, preoperative oral care by a dentist was significantly associated with a decrease in postoperative pneumonia (3·28 versus 3·76 per cent; risk difference − 0·48 (95 per cent c.i. −0·64 to−0·32) per cent) and all-cause mortality within 30 days of surgery (0·30 versus 0·42 per cent; risk difference − 0·12 (−0·17 to −0·07) per cent).

Conclusion

Preoperative oral care by a dentist significantly reduced postoperative complications in patients who underwent cancer surgery.

Fully Printed Wearable Vital Sensor for Human Pulse Rate Monitoring using Ferroelectric Polymer

The ability to monitor subtle changes in vital and arterial signals using flexible devices attached to the human skin can be valuable for the detection of various health conditions such as cardiovascular disease. Conventional Si device technologies are being utilised in traditional clinical systems; however, its fabrication is not easy owing to the difficulties in adapting to conventional processes. Here, we present the development of a fully printed, wearable, ferroelectric-polymer vital sensor for monitoring the human pulse wave/rate on the skin. This vital sensor is compact, thin, sufficiently flexible, and conforms to the skin while providing high pressure sensitivity, fast response time, superior operational stability, and excellent mechanical fatigue properties. Moreover, the vital sensor is connected to a communication amplifier circuit for monitoring the pulse waves with a wireless sensing system. This sensor system can realise the development of new healthcare devices for wearable sensor applications.

A Printed Organic Amplification System for Wearable Potentiometric Electrochemical Sensors

Electrochemical sensor systems with integrated amplifier circuits play an important role in measuring physiological signals via in situ human perspiration analysis. Signal processing circuitry based on organic thin-film transistors (OTFTs) have significant potential in realizing wearable sensor devices due to their superior mechanical flexibility and biocompatibility. Here, we demonstrate a novel potentiometric electrochemical sensing system comprised of a potassium ion (K⁺) sensor and amplifier circuits employing OTFT-based pseudo-CMOS inverters, which have a highly controllable switching voltage and closed-loop gain. The ion concentration sensitivity of the fabricated K⁺ sensor was 34 mV/dec, which was amplified to 160 mV/dec (by a factor of 4.6) with high linearity. The developed system is expected to help further the realization of ultra-thin and flexible wearable sensor devices for healthcare applications.

Abstract P1-05-05: Hyperthermia regulates transporter expression via ROS production and enhances the cytotoxicity of doxorubicin

Introduction: Hyperthermia (HT) is a non-invasive cancer therapy. Treatment temperature between 41°C to 44°C has no cytotoxic damage in normal cells, however shows cytotoxicity in cancer cells because of the underdeveloped vascular system. HT often used with other cancer therapy such as radiation therapy and chemotherapy. However mechanism of synergistic effect using these therapies remains unclear. Compared to 37°C, 42°C is mild heat stress for cells, thus superoxide anion is released from tissue. Superoxide anion is produced by mitochondrial electron transport chain. Reactive oxygen species (ROS), produced by mild heat stress, can be released from mitochondria. We have previously reported that ATP-binding cassette sub-family G member 2 (ABCG2) expression was suppressed by increasing mitochondrial ROS, and induction of the cancer specific porphyrin accumulation. ABCG2 is a transporter of doxorubicin (DOX), therefore we hypothesized that synergistic effect of HT and chemotherapy would be induced by down-regulation of ABCG2 expression via intracellular ROS increase. In this study, we investigated if cytotoxic effect of breast cancer cell using DOX can be enhance by HT via intracellular ROS increase.

Materials and methods: The murine breast cancer cell line, 4T1E was incubated at 37°C or 42°C for 1h. Intracellular ROS generation after HT treatment was detected by electron spin resonance (ESR). Twenty four hours after HT treatment, cells were incubated in medium containing 0, 0.1 and 1 μM DOX for 24 h. Cell viability was measured using the Cell Counting Kit 8, a water-soluble tetrazolium-8 based colorimetric assay. ABCG2 expression in whole cells was analyzed by Western blotting.

Results and discussion: ESR signal peak with HT treatment became high as compared to without HT treatment, indicating intracellular ROS level was increased by HT treatment. Cell viability and ABCG2 expression were decreased by DOX exposure and by HT treatment. The enhancement of HT treatment effect by DOX is considered to be result of down-regulation of ABCG2 expression by ROS. When cells were exposed to DOX with 5-aminolevulinic acid (ALA), cell viability reduced further. Since it is known that porphyrin is introduced by ALA and is transported by ABCG2, we speculate that ALA worked as a competitive inhibitor of DOX excretion transporter to enhance cell death. ESR signal peak in ALA treatment cells was higher than that in non-ALA treatment cells. Significant increase in cellular damage by HT treatment was shown by adding ALA, but not without ALA. Moreover, cell death induced by HT and ALA treatment was suppressed by adding N-acetylcysteine (NAC), which is an antioxidant. These results suggest that cellular damage of HT treatment is due to ROS production induced by ALA.

Conclusion: HT treatment involved intracellular ROS production and down-regulated the expression of ABCG2 protein. HT treatment also enhanced the cell damage by DOX. Cell death by DOX was enhanced by combination with HT and ALA treatment, possibly via intracellular ROS generation, and was suppressed by additing antioxidant.

Citation Format: Terasaki A, Kurokawa H, Terasaki M, Ito H, Matsui H, Ichioka E, Tsushima Y, Manaka-Iguchi A, Bando H, Hara H. Hyperthermia regulates transporter expression via ROS production and enhances the cytotoxicity of doxorubicin [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-05-05.

Comparison of up-front treatments for newly diagnosed immune thrombocytopenia -a systematic review and network meta-analysis

Corticosteroids such as prednisolone and dexamethasone have been established as up-front therapy for the treatment of newly diagnosed immune thrombocytopenia. Recent studies have indicated that other treatments such as rituximab or thrombopoietin receptor agonist can also be effective choices. We performed a systematic review and network meta-analysis to establish a clinically meaningful hierarchy of efficacy and safety of treatments for newly diagnosed primary immune thrombocytopenia in adults. Randomized controlled trials evaluating medical treatments for newly diagnosed immune thrombocytopenia were included. Reviewers independently extracted data and assessed the risk of bias. The main outcome was the sustained response (platelet count >30×10⁹/L for 3–6 months after completion of treatments), while overall response (platelet count >30×10⁹/L for 2–4 weeks after initiation of the up-front treatment) and therapy-related adverse events were the secondary endpoints. A total of 21 randomized controlled trials (1898 patients) were included in this study. Our main findings were a significantly better sustained response in the recombinant human thrombopoietin+dexamethasone and rituximab+dexamethasone arms compared to those of conventional therapies (prednisolone and dexamethasone monotherapy). Moreover, recombinant human thrombopoietin+dexamethasone and +prednisolone improved early overall response compared to prednisolone, dexamethasone, and rituximab-containing regimens. Therapy-related adverse events showed similar profiles and were tolerable in all treatment arms. Regimens containing recombinant human thrombopoietin agonist may be beneficial up-front therapies in addition to the conventional corticosteroid monotherapies. Future head-to-head trials including these regimens and rituximab-containing treatments are necessary in order to overcome the limitations of the small number in our study and determine the most suitable initial therapies for newly diagnosed immune thrombocytopenia.

Direct measurement of site-specific rates of reactions of H with C3H8, i-C4H10, and n-C4H10

We measured the rates of abstraction of a hydrogen atom from specific sites in propane C₃H₈, 2-methyl propane (i-C₄H₁₀), and butane (n-C₄H₁₀); the sites are a primary hydrogen of C₃H₈ and i-C₄H₁₀ and a secondary hydrogen of n-C₄H₁₀. The excellent reproducibility of conditions of a diaphragm-less shock tube enabled us to conduct comparative measurements of the evolution of H atoms in three mixtures-(i) 0.5 ppm C₂H₅I + Ar, (ii) 0.5 ppm C₂H₅I + 50-100 ppm alkane as C₃H₈ or i-C₄H₁₀ or n-C₄H₁₀ + Ar, and (iii) the same concentrations of alkane + Ar without C₂H₅I-in the temperature range 1000-1200 K and at a pressure of 2.0 bars. The net profile of rise and decay of H atoms in the C₂H₅I + alkane mixture was derived on subtracting the absorbance of (iii) from that of (ii). Measurements of the mixture (iii) are important because the absorption of alkanes at 121.6 nm is not negligible. In the temperature range 1000-1100 K, the rate of decomposition of C₂H₅I was evaluated directly on analyzing the exponential growth of H atoms in the mixture (i). The rate of decomposition of C₂H₅I is summarized as ln(k/s^-1) = (33.12 ± 1.4) - (25.23 ± 1.5) 10³/T (T = 1000-1100 K, P = 2.0 bars); the broadening factor F(T) in the Lindemann-Hinshelwood formula was evaluated in the fall-off region. The site-specific rates of H + (C₃-C₄) alkanes are summarized as follows: H + C₃H₈ → H₂ + 1-C₃H₇, ln(k_1a) = -(21.34 ± 0.86) - (5.39 ± 0.93)10³/T, H + i-C₄H₁₀ → H₂ + i-C₄H₉, ln(k_2a) = -(20.50 ± 1.36) - (6.14 ± 0.13)10³/T, H + n-C₄H₁₀ → H₂ + 2-C₄H₉, ln(k_3b) = -(21.37 ± 1.15) - (4.83 ± 1.26)10³/T. The present experimental results are compared with published results from quantum-chemical calculations of potential-energy surfaces and transition-state theory. The present experiments are consistent with those calculations for the reaction rates for the attack at the primary site for H + C₃H₈ and H + i-C₄H₁₀, but for the attack at the secondary site of n-C₄H₁₀, our results are substantially smaller than the computational prediction, which might indicate a hindrance by the C-H bonds of the primary sites that serves to decrease the rate of abstraction from the secondary site of n-C₄H₁₀. The influence on the total rates of reactions H + alkane and the group additivity rule are discussed.

Association between hospital volume and in-hospital mortality following radiofrequency ablation for hepatocellular carcinoma

Background

Radiofrequency ablation (RFA) is a minimally invasive treatment for hepatocellular carcinoma (HCC). There is increasing evidence of an association between increasing hospital volume and lower postoperative mortality for many surgical procedures, but this is difficult to establish with minimally invasive treatments, where postoperative mortality is low. The aim of this study was to investigate the relationship between hospital volume and in-hospital mortality following RFA using a Japanese nationwide database.

Methods

Data from the Diagnostic Procedure Combination database were analysed from 1 July 2010 to 31 March 2012. Multivariable logistic regression was used to analyse the relationship between hospital volume and in-hospital mortality following RFA, with adjustment for patient background.

Results

Some 36 675 patients with HCC were identified in the database. The overall in-hospital mortality rate from RFA was 0·31 per cent. In-hospital mortality was significantly higher in low-volume than high-volume hospitals (odds ratio 2·57, 95 per cent c.i. 1·61 to 4·09; P < 0·001). Higher in-hospital mortality was significantly associated with older age and a higher Charlson Co-morbidity Index score.

Conclusion

RFA for HCC was associated with acceptably low mortality in Japan, but in-hospital mortality following RFA was affected by hospital procedural volume.

Efficacy of Dexamethasone for Acute Primary Immune Thrombocytopenia Compared to Prednisolone: A Systematic Review and Meta-analysis

Corticosteroids have been established as first-line therapy in acute primary immune thrombocytopenia (ITP), and the clinical guidelines recommend either dexamethasone (Dex) or prednisolone (PSL). The types and dosages of corticosteroids, however, have not yet been determined, because previous randomized control trials (RCTs) comparing Dex and PSL showed controversial results in terms of efficacy. To understand and interpret all available evidence, we conducted a systematic review and meta-analysis of RCTs. The main outcome measure was the incidence of sustained response (SR; platelet count >30 × 10 ⁹ /L for 6 months without concomitant treatments after the completion of the final therapies). Eight RCTs (totaling 704 patients) were included in this study. The incidence of SR showed no significant difference, while it was significantly higher in the Dex arm when used with posttherapy (more than one course of Dex or tapering corticosteroids added; risk ratio [RR], 1.82; 95% confidence interval [CI], 1.38-2.41; p  < 0.01). A single course of Dex showed no significant difference. The overall response (platelet >30 × 10 ⁹ /L) at day 28 was significantly improved in the Dex arm (RR, 1.11; 95% CI, 1.01-1.22; p  = 0.03) and Dex with posttherapy suppressed long-term relapse (RR of nonevent, 1.32; 95% CI, 1.10-1.59; p  < 0.01). There were significantly fewer adverse events in the Dex arm (RR, 0.45; 95% CI, 0.37-0.55; p  < 0.01). Use of Dex with posttherapy instead of PSL may be more beneficial as the initial therapy. Studies comparing Dex with other new strategies are essential to determine the most suitable therapeutic regimens for acute ITP.

Economic Evaluation of Implant-Supported Overdentures in Edentulous Patients: A Systematic Review

PURPOSE

Edentulous patients benefit significantly from implant-supported overdenture prostheses. The purpose of this systematic review was to evaluate the cost-effectiveness of implant-supported overdentures (IODs) for edentulous patients.

MATERIALS AND METHODS

The search was limited to studies written in English and included an electronic and manual search through MEDLINE (Ovid, 1946 to November 2015), Embase (Ovid, 1966 to November 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (to November 2015), and PubMed (to November 2015). Two investigators extracted the data and assessed the studies independently. No meta-analysis was conducted due to the high heterogeneity within the literature.

RESULTS

Of the initial 583 selected articles, 10 studies involving 802 participants were included. Of these, 6 studies had a high risk of bias and the rest had an unclear risk of bias. Implant-supported prostheses were more cost-effective when compared to conventional dentures and fixed implant-supported prostheses. Overdentures supported by two implants and magnet attachment were reported as cost-effective.

CONCLUSION

Implant-supported overdentures are a cost-effective treatment for edentulous patients. More clinical studies with appropriate scientific vigor are required to further assess the cost-effectiveness of implant-supported overdentures.

Epidural analgesia is infrequently used in patients with acute pancreatitis : a retrospective cohort study

BACKGROUNDS AND AIMS

Epidural analgesia is an option for pain control in patients with acute pancreatitis. The aim of this study is to describe characteristics, morbidity and mortality of patients with acute pancreatitis treated with epidural analgesia.

PATIENTS AND METHODS

Data was extracted from a national inpatient database in Japan on patients hospitalized with acute pancreatitis between July 2010 and March 2013. A total of 44,146 patients discharged from acute care hospitals were included in this retrospective cohort study. The patient background, timing and duration of epidural analgesia, complications (epidural hematoma or abscess), surgery (for cholelithiasis / cholecystitis or complications) and mortality were verified.

RESULTS

Epidural analgesia was used in 307 patients (0.70 %). The mean age was 64.0 years (standard deviation, 15.4 years) and 116 (37.8%) of the patients were female. The median duration of epidural analgesia was four days (interquartile range, 3-5 days). No patient underwent surgery for epidural hematoma or abscess. Six (2.0%) patients died during hospitalization. Most likely causes of death were pulmonary embolism, multiple organ failure, sepsis, and methicillin-resistant staphylococcus aureus enterocolitis. The responsible physician for 250 of the patients (81.4%) was a gastroenterological surgeon. Epidural analgesia was started on the day of surgery in 278 (90.6%) patients.

CONCLUSION

Epidural analgesia is rarely used in patients with acute pancreatitis. None of the patients included in the study required surgery for epidural hematoma or abscess. Further research to evaluate the efficacy and safety of epidural analgesia in patients with acute pancreatitis is warranted.