Lung cancer survival and sex-specific patterns in Portugal: A population-based analysis

INTRODUCTION

In Portugal, lung cancer (LC) is the first cause of cancer-related death and of death and disability combined. This study aims to analyze the overall survival (OS) and relative survival (RS) of patients diagnosed with LC in 2009-2011 by socio-demographic and tumor characteristics, and analyze sex-specific patterns.

METHODS

We estimated 5-year OS using the Kaplan-Meier method and 5-year net survival through the RS framework. Cox regression modeling was used to determine the hazard ratio (HR) of death associated with each independent variable.

FINDINGS

For the 11,523 cases analyzed, median 5-year OS was 264 days (95% confidence interval [CI]: 254.8-273.2), the cumulative OS was 13.6% and RS was 15.1%. Males had a lower median survival (237 days; 95% CI: 228.2-245.7) compared to females (416 days; 95% CI: 384.4-447.6) (p < 0.0001) and lower 5-year RS proportions (12.1% vs. 24.9%). RS progressively decreased with age (41.7% for age-group <40 to 7.2% for ≥80) and stage (66.6% for stage I to 2.4% for stage IV). As predictors of decreased survival, we identified male gender, increasing age >50, histologic types (squamous cell carcinoma, non-small cell lung cancer not otherwise specified, other unspecified and small cell lung cancer), and increasing stage. Compared to women, the risk of death in men was 37.7% higher (HR = 1.386; 95% CI: 1.295-1.484).

CONCLUSIONS

The differences between OS and RS were small, reflecting the high lethality of LC. Male gender and older age are factors related to poor prognosis. Histology also plays a role in survival prognosis and varies with gender, but the factor related to the worst survival is stage. Although the study reflects data from a decade ago, and major changes occurred in diagnosis, staging and treatment, particularly for advanced disease, as LC mortality is strongly correlated with late stage diagnosis, all efforts should be made to secure early diagnosis and improve survival prospects.

A review: Circadian Rhythm Dysfunction and Bipolar Disorder

Introduction

Circadian rhythm (CR) dysfunction is a prominent feature in bipolar disorder (BD) and sleep disturbances are characteristic, although not essential to the diagnosis.

Objectives

To review the literature regarding the CR dysfunction and its impact on the onset and clinical course of BD.

Methods

We conducted a MEDLINE search using bipolar disorder, circadian rhythm and sleep as keywords, selecting studies written in English.

Results

CR dysfunction is a trait marker of BD. It’s known that during depressive episodes insomnia is present, with difficulty falling asleep/ maintaining sleep and early awakening. Regarding mania, decreased need for sleep is a critical marker. During the euthymic period significant alterations in sleep pattern have been described. It’s also known that changes in the sleep pattern occur prior to those in mood patterns, indicating that sleep dysregulation may trigger the onset of mood episodes or relapses. Therefore, CR disruption may be associated with the pathophysiology of BD and some factors have already been identified: irregularity of the sleep-wake rhythm, eveningness chronotype, abnormality of melatonin secretion, vulnerability of clock genes and the irregularity of social zeitgeber.

Conclusions

Disturbances of sleep are pervasive, and an essential feature of BD, worse during mood episodes, but still present during euthymic periods. It remains to determine whether circadian rhythm dysfunction is a trait marker or mood state dependent. Further studies are warranted to clarify this association.

Disclosure

No significant relationships.

Quality of life, work ability and oral health among patients with chronic liver diseases

BACKGROUND

This study aimed to explore the associations between health-related quality of life and work ability with the oral health status of patients with chronic liver disease.

MATERIAL AND METHODS

A cross-sectional study included 150 patients with chronic liver disease, consecutively seen at University Hospital, Salvador, Brazil. Oral health was evaluated by the Decayed, Missing, and Filled Teeth (DMFT) index and by the presence of gingivitis and periodontitis. Salivary flow was "reduced" when <1.0 mL/min. Health-related quality of life was evaluated by using the 36-Item Short Form Health Survey questionnaire (SF-36); work ability was evaluated by the Work Ability Index questionnaire.

RESULTS

All health-related quality of life indicators were systematically lower among the 99 patients with reduced salivary flow than among the 51 patients with normal salivary flow. Physical Functioning, Role-Physical, and Physical Component Summary scores were strongly correlated (P < 0.005 or less) with the number of Missing Teeth and with DMFT index. Reduced salivary flow was associated (P < 0.05) with poor work ability. Patients with poor or moderate work ability presented higher (P < 0.001) means of the DMFT index than those with good or excellent work ability.

CONCLUSIONS

Patients with chronic liver disease who present poor oral health presented low health-related quality of life and poor work ability. These findings reinforce the need of these patients for specialized stomatological care.

Post-transplant Lymphoproliferative Disorder: A Single-Center Experience

BACKGROUND

Post-transplant lymphoproliferative disorder (PTLD) is the second most common neoplasia after adult kidney transplantation (KT).

METHODS

We retrospectively analyzed 8 adult patients who underwent KT in our center, diagnosed with PTLD between 2001 and 2014.

RESULTS

Six patients were men. The median age at presentation was 43 years and the median time since transplantation was 7.3 years. Three patients had previously received anti-thymocyte globulin/OKT3, and all were taking calcineurin inhibitors (CNI) at diagnosis. The monomorphic type was the most common, with diffuse large B-cell lymphoma as the origin. The most frequent presentation was fever. Four in five patients had Epstein-Barr-related PTLD. All patients received various regimens of immunosuppression reduction (IR), with 4 converting CNI to mTOR inhibitor (imTOR). Subsequent treatment (when needed) was chemotherapy, radiotherapy, and surgery. The maximum follow-up time was 6.7 years, with a 50% mortality rate that occurred at a median time of 3.5 months (2 died with functioning kidney). All 4 patients who were in remission at the end of follow-up had CNI conversion to imTOR, and none lost the allograft.

CONCLUSIONS

Despite the small number of cases, our results confirm the high PTLD impact in overall and allograft survival. Our PTLD type distribution is in accord with the literature. First-line PTLD treatment is IR, but the best method is still unknown; our results may suggest a beneficial effect of CNI conversion to imTOR.

Critical care transition programs and the risk of readmission or death after discharge from ICU

PURPOSE

Critical care transition programs have been widely implemented to improve the safety of patient discharge from ICU, but have undergone limited evaluation. We sought to evaluate implementation of a critical care transition program on patient readmission to ICU (72 h) and mortality (14 days).

METHODS

Interrupted time series analysis of 32,234 consecutive adult patients discharged alive from medical-surgical ICUs in eight hospitals in two cities between January 1, 2002 and January 1, 2012. A multidisciplinary ICU provider team (physician, nurse, respiratory therapist) that serially evaluated each patient after ICU discharge was implemented in three hospitals in one city (study group), but not the five hospitals in the other city (control group). Temporal changes were examined using multivariable, segmented linear regression models.

RESULTS

After implementation of the program, there was an immediate non-significant decrease in the absolute proportion of patients readmitted to ICU in the study group (-0.4%, 95% CI -1.7 to +1.0%) and a non-significant increase in the absolute proportion of patients readmitted to ICU in the control group (+1.0%, 95% CI -0.3 to +2.2%). Subsequently, there were non-significant changes in the absolute proportion of patients readmitted to ICU in both the study (+0.1% per quarter; 95% CI, -0.1 to +0.2%) and control (-0.1 per quarter; 95% CI, -0.2 to +0.1%) groups over time. No significant changes were observed in mortality. The results were stable across patient subgroups.

CONCLUSIONS

Implementation of a critical care transition program was not associated with patient readmission to ICU or mortality.

Correlations between radiometric analysis of Quaternary deposits and the chronology of prehistoric settlements from the southeastern Brazilian coast

Natural gamma radiation measurements of sand deposits were carried out in order to study the chronology of prehistoric colonization of the Brazilian coast during the Holocene. The method employs thorium, uranium and potassium as tracers of the geological provenance of Quaternary deposits, where artificial shellmounds are found. The so-called sambaquis are archaeological settlements, characteristic of fisher-gatherers, specialized in the exploitation of shellfish. Our results show a considerable positive correlation between the formation of coastal deposits, based on cross plots of eTh/eU and eTh/K, and the antiquity of its prehistoric human occupation.

Pharmacological management of osteoporosis and concomitant calcium supplementation in a Portuguese urban population: the EpiPorto study (2005-2007)

INTRODUCTION

We aimed to describe the pharmacological management of osteoporosis in the general population, with emphasis on the inclusion of calcium supplementation.

METHODS

We interviewed 1511 participants in an evaluation of a cohort of Portuguese adults. Antiresorptive therapy and calcium supplementation in the previous year were recorded. Socio-demographic characterisation included education, occupation, marital status and source of medical care. The participants' osteoporosis history and menopause age were noted. Dietary calcium intake was quantified using a food frequency questionnaire and a calcaneus quantitative ultrasound was conducted.

RESULTS

Antiresorptive drugs had been used by 11.4% of women and 1.2% of men in the previous year. Bisphosphonates were the most referred subgroup (88% of all therapies), followed by raloxifen, and calcitonin. Overall, 43% of women reported using calcium in combination with bone-sparing drugs. Combination therapy was more frequent among older women (> or =70 years old: 63%), those with the highest educational level (>12 schooling years: 49%), blue-collar occupations (55%) and private healthcare (43%). Women with longer postmenopausal periods (>10 years: 42%) and those with the highest spontaneous calcium intakes (highest tertile: 44%) reported combination therapy more frequently.

CONCLUSION

Although treatment with bone-sparing drugs is frequent, the management of osteoporosis does not systematically include the recommended calcium supplementation.

Limits for the central production of Theta+ and Xi(--)pentaquarks in 920-GeV pA collisions

We have searched for Theta+(1540) and Xi(--)(1862) pentaquark candidates in proton-induced reactions on C, Ti, and W targets at midrapidity and square root of s = 41.6 GeV. In 2 x 10(8) inelastic events we find no evidence for narrow (sigma approximately 5 MeV) signals in the Theta+ --> pK0(S) and Xi(--) --> Xi- pi- channels; our 95% C.L. upper limits (UL) for the inclusive production cross section times branching fraction B dsigma/dy/(y approximately 0) are (4-16) mub/N for a Theta+ mass between 1521 and 1555 MeV, and 2.5 mub/N for the Xi(--). The UL of the yield ratio of Theta+/Lambda(1520) < (3-12)% is significantly lower than model predictions. Our UL of B Xi(--)/Xi(1530)0 < 4% is at variance with the results that have provided the first evidence for the Xi(--).

Prognostic significance of Lauren and Ming classifications and other pathologic parameters in gastric carcinoma

One hundred seventy-two patients with gastric carcinoma were studied (111 men and 61 women). Mean age was 54.0 +/- 11.2 years, and the overall five-year survival rate was 37.5%. There were four carcinomas in situ and one double carcinoma; the remaining 167 were classified as intestinal (112), diffuse (48), and atypical (7), according to Lauren; and as expanding (96) and infiltrative (71), according to Ming. Both classifications had prognostic significance; that of Lauren's could not be ascribed to sex and age of patients, to location of tumors, or to extent of disease, but appeared to be associated with the histologic pattern of regional lymph nodes. The prognostic significance of Ming's classification did not seem to depend upon sex and age of patients, location of tumors, or lymphoid response, but appeared to be partially related with extent of disease. The concurrent use of both classification did not provide further prognostic information.

Prognostic significance of Lauren and Ming classifications and other pathologic parameters in gastric carcinoma

One hundred seventy-two patients with gastric carcinoma were studied (111 men and 61 women). Mean age was 54.0 +/- 11.2 years, and the overall five-year survival rate was 37.5%. There were four carcinomas in situ and one double carcinoma; the remaining 167 were classified as intestinal (112), diffuse (48), and atypical (7), according to Lauren; and as expanding (96) and infiltrative (71), according to Ming. Both classifications had prognostic significance; that of Lauren's could not be ascribed to sex and age of patients, to location of tumors, or to extent of disease, but appeared to be associated with the histologic pattern of regional lymph nodes. The prognostic significance of Ming's classification did not seem to depend upon sex and age of patients, location of tumors, or lymphoid response, but appeared to be partially related with extent of disease. The concurrent use of both classification did not provide further prognostic information.

Prognostic significance of Lauren and Ming classifications and other pathologic parameters in gastric carcinoma

One hundred seventy-two patients with gastric carcinoma were studied (111 men and 61 women). Mean age was 54.0 +/- 11.2 years, and the overall five-year survival rate was 37.5%. There were four carcinomas in situ and one double carcinoma; the remaining 167 were classified as intestinal (112), diffuse (48), and atypical (7), according to Lauren; and as expanding (96) and infiltrative (71), according to Ming. Both classifications had prognostic significance; that of Lauren's could not be ascribed to sex and age of patients, to location of tumors, or to extent of disease, but appeared to be associated with the histologic pattern of regional lymph nodes. The prognostic significance of Ming's classification did not seem to depend upon sex and age of patients, location of tumors, or lymphoid response, but appeared to be partially related with extent of disease. The concurrent use of both classification did not provide further prognostic information.