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Chen Z, Zhao X, He R, Li H, Fu S, Zhang K, Gu M, Zhou S. The impact of insurance status on in-hospital mortality in patients with hyperglycaemic crisis: A propensity score matching analysis. J Eval Clin Pract 2023; 29:1395-1401. [PMID: 37574779 DOI: 10.1111/jep.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
AIM This study was designed to determine the associations between insurance status and clinical outcomes among patients with hyperglycaemic crisis. METHODS Overall, 1668 patients with hyperglycaemic crisis were recruited from the Chongqing Medical University Medical Data Science Academy's big data platform. In-hospital mortality, length of stay and complications (i.e., hypoglycaemia, hypokalemia, pulmonary infection, multiple systemic organ failure, acute kidney injury and deep venous thrombosis) were assessed. Propensity score matching analysis was used to reduce the confounding bias, and univariate and multivariate logistic regression were used to estimate the effect of insurance status on mortality in patients with hyperglycaemic crisis. RESULTS After matching one uninsured patient to two insured patients with a calliper of 0.02, the uninsured group suffered a higher burden of in-hospital mortality than the insured group (16.9% vs. 9.8%); the insured status (odds ratio = 0.216, 95% confidence interval = 0.079-0.587) was a potential protect factor for in-hospital mortality of patients with hyperglycaemic crisis in the multivariate logistic regression analysis. CONCLUSIONS Insurance status is associated with the outcomes of hospitalisation for hyperglycaemic crisis; uninsured patients with hyperglycaemic crisis face a higher risk of mortality in China.
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Affiliation(s)
- Zhen Chen
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu Zhao
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui He
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Li
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shimin Fu
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kebiao Zhang
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Manping Gu
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Sumei Zhou
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Qiu Z, Qi W, Wu Y, Li L, Li C. Insurance status impacts survival of hepatocellular carcinoma patients after liver resection. Cancer Med 2023; 12:17037-17046. [PMID: 37455560 PMCID: PMC10501234 DOI: 10.1002/cam4.6339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND This study intends to examine the effect of public insurance status on survival outcomes of HCC patients after liver resection in China. METHODS We divided 2911 HCC patients after liver resection included in our study into the Urban Employed-based Medical Insurance group (UEBMI group, n = 1462) and the non-Urban Employed-based Medical Insurance group (non-UEBMI group, n = 1449). A propensity score matching (PSM) analysis was used to control confounding factors. Overall survival (OS) was estimated by Kaplan-Meier curves and Cox proportional hazard models based on variables screened by Lasso regression. Competing risk analysis was used to analyze cancer-specific survival (CSS). RESULTS UEBMI group had more male patients (p = 0.031), patients in the UEBMI group were older (p < 0.001) and had lower Charlson Comorbidity Index scores (CCI score, p < 0.001). Meanwhile, patients in the UEBMI group had better liver function (albumin-bilirubin grade I [ALBI I], p < 0.001) and lower tumor burden (α-fetoprotein [AFP], p = 0.009; Barcelona Clinic Liver Cancer stage [BCLC], p = 0.026; Milan criteria, p < 0.001; tumor size, p < 0.001; microvascular invasion [MVI], p = 0.030; portal vein tumor thrombosis [PVTT], p = 0.002). More patients in the UEBMI group received laparoscopic surgery (p = 0.024) and adjuvant transarterial chemoembolization (TACE, p < 0.001). After PSM, patients in the two matched groups had similar characteristics. Patients with recurrent HCC in the UEBMI were more likely to receive curative therapy (p < 0.001) and less likely to receive supportive care (p < 0.001). HCC patients after liver resection in the non-UEBMI group had a worse OS before (p < 0.0001) and after PSM (p = 0.002). [Correction added on August 16, 2023 after first online publication. The p value has been updated in the preceding sentence.] In our Lasso-Cox risk regression model, public health insurance status was an independent factor linked with OS (non-UEBMI vs. UEBMI, hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 1.12-1.46; p < 0.001). In the competing risk analysis, patients in the UEBMI group had a lower cumulative incidence of CSS before (p < 0.001) and after PSM (p = 0.001), and public insurance status of HCC patients after liver resection remained independently associated with CSS (non-UEBMI vs. UEBMI; HR:1.36; 95% CI: 1.18-1.58; p < 0.001). CONCLUSIONS Underinsured HCC patients after liver resection had worse survival outcomes. Less access to care for underinsured patients may explain the difference in survival, but the corresponding conclusions need to be further explored.
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Affiliation(s)
- Zhancheng Qiu
- Division of Liver Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Weili Qi
- Division of Liver Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Youwei Wu
- Division of Liver Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Lingling Li
- Department of Information Management CenterWest China Hospital, Sichuan UniversityChengduChina
| | - Chuan Li
- Division of Liver Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
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Li D, Lei HK, Shu XL, Zhang X, Tu HL, Wang F, Wang YW, Wang Y, Sui JD. Association of public health insurance with cancer-specific mortality risk among patients with nasopharyngeal carcinoma: a prospective cohort study in China. Front Public Health 2023; 11:1020828. [PMID: 37333541 PMCID: PMC10272587 DOI: 10.3389/fpubh.2023.1020828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Objective Health insurance programs are effective in preventing financial hardship in patients with cancer. However, not much is known about how health insurance policies, especially in Southwest China with a high incidence of nasopharyngeal carcinoma (NPC), influence patients' prognosis. Here, we investigated the association of NPC-specific mortality with health insurance types and self-paying rate, and the joint effect of insurance types and self-paying rate. Materials and methods This prospective cohort study was conducted at a regional medical center for cancer in Southwest China and included 1,635 patients with pathologically confirmed NPC from 2017 to 2019. All patients were followed up until May 31, 2022. We determine the cumulative hazard ratio of all-cause and NPC-specific mortality in the groups of various insurance kinds and the self-paying rate using Cox proportional hazard. Results During a median follow-up period of 3.7 years, 249 deaths were recorded, of which 195 deaths were due to NPC. Higher self-paying rate were associated with a 46.6% reduced risk of NPC-specific mortality compared to patients with insufficient self-paying rate (HR: 0.534, 95% CI: 0.339-0.839, p = 0.007). For patients covered by Urban and Rural Residents Basic Medical Insurance (URRMBI), and for patients covered by Urban Employee Basic Medical Insurance, each 10% increase in the self-paying rate reduced the probability of NPC-specific death by 28.3 and 25%, respectively (UEBMI). Conclusion Results of this study showed that, despite China's medical security administration improved health insurance coverage, NPC patients need to afford the high out-of-pocket medical costs in order to prolong their survival time.
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Affiliation(s)
- Dan Li
- School of Medicine, Chongqing University, Chongqing, China
| | - Hai-Ke Lei
- Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiao-Lei Shu
- Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Xin Zhang
- Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Hong-Lei Tu
- Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Feng Wang
- Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Yu-Wei Wang
- Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Ying Wang
- Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Jiang-Dong Sui
- Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China
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Liu H, Bai Y, Li F, Tian Z. Combined serum CXCL8, CXCL9 and CXCL13 tests for the prediction of microvascular invasion in hepatocellular carcinoma. Biomark Med 2023; 17:265-272. [PMID: 37218545 DOI: 10.2217/bmm-2023-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Aim: This work is to explore the predictive and diagnostic value of chemokine C-X-C motif ligand 8 (CXCL8), CXCL9 and CXCL13 combined detections for microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. Materials & methods: A total of 82 HCC patients with MVI were recruited as the MVI group and 154 patients with non MVI were recruited as the non MVI group. Results: In HCC patients with MVI, CXCL8, CXCL9, CXCL13 levels were significantly elevated. Child-Pugh scores and serum α-fetoprotein level had positive correlation with CXCL8, CXCL9 and CXCL13 levels. The serum levels of CXCL8, 9 and 13 were effective in predicting MVI in HCC patients. Conclusion: CXCL8, CXCL9 and CXCL13 levels in HCC patients are valuable parameters in the prediction of MVI.
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Affiliation(s)
- Hong Liu
- Department of General Surgery, Fifth People's Hospital, No. 1215 Guangrui Road, Liangxi District, Wuxi, Jiangsu, 214007, China
| | - Yang Bai
- Department of Hepatobiliary Surgery, the 904th Hospital of Joint Logistic Support Force of PLA, No. 101 Xingyuan North Road, Wuxi, Jiangsu, 214044, China
| | - Fuli Li
- Department of General Surgery, Fifth People's Hospital, No. 1215 Guangrui Road, Liangxi District, Wuxi, Jiangsu, 214007, China
| | - Zhiqiang Tian
- Department of General Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, Jiangsu, 214000, China
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Paskeh MDA, Ghadyani F, Hashemi M, Abbaspour A, Zabolian A, Javanshir S, Razzazan M, Mirzaei S, Entezari M, Goharrizi MASB, Salimimoghadam S, Aref AR, Kalbasi A, Rajabi R, Rashidi M, Taheriazam A, Sethi G. Biological impact and therapeutic perspective of targeting PI3K/Akt signaling in hepatocellular carcinoma: Promises and Challenges. Pharmacol Res 2023; 187:106553. [PMID: 36400343 DOI: 10.1016/j.phrs.2022.106553] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Cancer progression results from activation of various signaling networks. Among these, PI3K/Akt signaling contributes to proliferation, invasion, and inhibition of apoptosis. Hepatocellular carcinoma (HCC) is a primary liver cancer with high incidence rate, especially in regions with high prevalence of viral hepatitis infection. Autoimmune disorders, diabetes mellitus, obesity, alcohol consumption, and inflammation can also lead to initiation and development of HCC. The treatment of HCC depends on the identification of oncogenic factors that lead tumor cells to develop resistance to therapy. The present review article focuses on the role of PI3K/Akt signaling in HCC progression. Activation of PI3K/Akt signaling promotes glucose uptake, favors glycolysis and increases tumor cell proliferation. It inhibits both apoptosis and autophagy while promoting HCC cell survival. PI3K/Akt stimulates epithelial-to-mesenchymal transition (EMT) and increases matrix-metalloproteinase (MMP) expression during HCC metastasis. In addition to increasing colony formation capacity and facilitating the spread of tumor cells, PI3K/Akt signaling stimulates angiogenesis. Therefore, silencing PI3K/Akt signaling prevents aggressive HCC cell behavior. Activation of PI3K/Akt signaling can confer drug resistance, particularly to sorafenib, and decreases the radio-sensitivity of HCC cells. Anti-cancer agents, like phytochemicals and small molecules can suppress PI3K/Akt signaling by limiting HCC progression. Being upregulated in tumor tissues and clinical samples, PI3K/Akt can also be used as a biomarker to predict patients' response to therapy.
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Affiliation(s)
- Mahshid Deldar Abad Paskeh
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Fatemeh Ghadyani
- Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mehrdad Hashemi
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Alireza Abbaspour
- Cellular and Molecular Research Center,Qazvin University of Medical Sciences, Qazvin, Iran
| | - Amirhossein Zabolian
- Resident of department of Orthopedics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salar Javanshir
- Young Researchers and Elite Club, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mehrnaz Razzazan
- Medical Student, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sepideh Mirzaei
- Department of Biology, Faculty of Science, Islamic Azad University, Science and Research Branch, Tehran, Iran
| | - Maliheh Entezari
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | | | - Shokooh Salimimoghadam
- Department of Biochemistry and Molecular Biology, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Amir Reza Aref
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Translational Sciences, Xsphera Biosciences Inc. 6, Tide Street, Boston, MA 02210, USA
| | - Alireza Kalbasi
- Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Romina Rajabi
- Faculty of Veterinary Medicine, Islamic Azad University, Science and Research Branch, Tehran, Iran.
| | - Mohsen Rashidi
- Department Pharmacology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; The Health of Plant and Livestock Products Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Afshin Taheriazam
- Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Department of Orthopedics, Faculty of medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Gautam Sethi
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore; NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore.
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Sempokuya T, Warner J, Azawi M, Nogimura A, Wong LL. Current status of disparity in liver disease. World J Hepatol 2022; 14:1940-1952. [PMID: 36483604 PMCID: PMC9724102 DOI: 10.4254/wjh.v14.i11.1940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022] Open
Abstract
Disparities have emerged as an important issue in many aspects of healthcare in developed countries and may be based on race, ethnicity, sex, geographical location, and socioeconomic status. For liver disease specifically, these potential disparities can affect access to care and outcome in viral hepatitis, chronic liver disease, and hepatocellular carcinoma. Shortages in hepatologists and medical providers versed in liver disease may amplify these disparities by compromising early detection of liver disease, surveillance for hepatocellular carcinoma, and prompt referral to subspecialists and transplant centers. In the United States, continued efforts have been made to address some of these disparities with better education of healthcare providers, use of telehealth to enhance access to specialists, reminders in electronic medical records, and modifying organ allocation systems for liver transplantation. This review will detail the current status of disparities in liver disease and describe current efforts to minimize these disparities.
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Affiliation(s)
- Tomoki Sempokuya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Josh Warner
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Muaataz Azawi
- Division of Gastroenterology and Hepatology, Sanford Center for Digestive Health, Sioux Falls 57105, SD, Uruguay
| | - Akane Nogimura
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Aichi, Japan
- Division of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Aichi, Japan
| | - Linda L Wong
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States
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Li Y, Ji M, Xu H, Yang F, Yang Z, Shen L. CircRNA_0040705 promotes the progression of hepatocellular carcinoma. IUBMB Life 2022; 74:408-418. [PMID: 35080329 DOI: 10.1002/iub.2598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/25/2021] [Accepted: 01/02/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Circular RNAs (circRNAs) are involved in cancer progression. Nonetheless, the role and mechanism of circ_0040705 in hepatocellular carcinoma (HCC) are unclear. METHODS The aberrantly expressed circRNAs and microRNAs (miRNAs) in HCC tissues were screened by bioinformatics. Circ_0040705, miR-557, SRY-box transcription factor 2 (SOX2), E-cadherin, and N-cadherin expressions were determined using quantitative real-time polymerase chain reaction (qRT-PCR) or Western blot. Cell counting kit-8 (CCK-8), 5-Ethynyl-2'-deoxyuridine (EdU), Transwell experiments were utilized to examine the changes in HCC cell growth, migration and invasion after circ_0040475 was overexpressed or knocked down. Lung metastasis assay was used to validate the effects of circRNA_0040705 on the lung metastasis of HCC cells in vivo. Binding sequences between circ_0040705 and miR-557, and between miR-557 and SOX2 were verified using dual-luciferase reporter gene experiments. RESULTS The expression levels of circ_0040705 and SOX2 mRNA were markedly increased in HCC tissues but miR-557 expression was down-regulated. Circ_0040705 overexpression enhanced the growth, migration, invasion, and the expressions of E-cadherin and N-cadherin of HCC cells, and promoted lung metastasis in vivo whereas circ_0040705 knockdown exerted the opposite effects in HCC cells. Circ_0040705 worked as a sponge for miR-557 to down-modulate miR-557 expression, and miR-557 could specifically down-modulate SOX2 expression. CONCLUSION Circ_0040705 facilitates HCC cell growth, migration, and invasion by down-modulating miR-557 expression and up-modulating SOX2 expression.
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Affiliation(s)
- Yanxia Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Mengyao Ji
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Huang Xu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Fan Yang
- Department of Oncology and Intervention, General Hospital of TISCO, Taiyuan, Shanxi Province, China
| | - Zhiyong Yang
- Department of Oncology and Intervention, General Hospital of TISCO, Taiyuan, Shanxi Province, China
| | - Lei Shen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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