Survival Analysis of Demographic Factors Associated With 5+ Year Survival of Pancreatic Carcinoma.

Background Although pancreatic cancer incidence is low at 13.1 per 100,000 people, this cancer is difficult to treat and carries a poor 5-year survival rate. Additionally, pancreatic cancer survival rates vary disproportionately based on age and race. The objective of this study was to evaluate the association between 5-year survival of pancreatic cancer and the basic demographic factors age, race, and sex. Methods Data were retrieved from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 database, spanning from 2000-2017, using SEER*Stat. SPSS was used to calculate descriptive statistics for vital status, age, race, and sex. Odds ratios with confidence intervals were calculated using Epi Info. Case data were used to conduct survival analysis by age, race, and sex using OriginPro. Results Out of a total of 118,581 cases, 79.3% were White (n = 106,887), 12.5% were Black (n = 16,866), 7.4% were Asian or Pacific Islander (n = 9,960), 0.6% were American Indian/Alaskan Native (n = 792), and 0.2% were unknown race (n = 321). The odds ratio (OR) of dying before reaching 5+ survival was lowest for the Asian or Pacific Islander group (OR = 0.70, 95% CI: 0.66 - 0.74), followed by the group of Black patients (OR = 1.07, 95% CI: 1.02 - 1.13), the White patients group (OR = 1.12, 95% CI: 1.08 - 1.17), and the American Indian/Alaskan Native group (OR = 1.12, 95% CI: 0.89 - 1.40). The largest age group was 65-69 years old, comprising 14.7% (n = 19,866) of the dataset. Probability of 5+ year survival for pancreatic cancer patients was highest for the age group 15-19 years (n = 74). In general, 5+ year survival probability declined with age. Risk of death before reaching 5+ year pancreatic cancer survival was slightly higher in men (OR = 1.03, 95% CI: 1.00 - 1.07), who comprised 50.9% (n = 68,628) of the dataset. Discussion Findings from this study corroborate differences by age, race, and sex discussed in the literature. Differences in survival rates by race depart from some findings in literature documenting no significant differences in treatment outcome by race. Controlling for age in a future study in both race and sex survival probability analyses may be helpful. Further, stratifying by sex in survival probability analysis by race would be illuminating. In addition to survival analysis, regression modeling would be a useful next step.

The Reverse Sural Artery Flap: A Reliable and Versatile Flap for Wound Coverage of the Distal Lower Extremity and Hindfoot.

The reverse sural artery flap is a distally based fasciocutaneous or adipofascial flap used for wound coverage of the distal one-third of the lower extremity, ankle, and posterior heel. The flap harvest can be performed without sacrificing major arteries of the lower extremity. It can be elevated and mobilized with relative ease and a short operative time. It provides a good alternative to free tissue transfer in complex lower-extremity wounds with exposed bone, tendon, or hardware. The surgeon must be familiar with the management of venous congestion to improve the success of the flap.

The Geographic Distribution of Liver Cancer in Canada Does Not Associate with Cyanobacterial Toxin Exposure.

BACKGROUND: The incidence of liver cancer has been increasing in Canada over the past decade, as has cyanobacterial contamination of Canadian freshwater lakes and drinking water sources. Cyanotoxins released by cyanobacteria have been implicated in the pathogenesis of liver cancer. OBJECTIVE: To determine whether a geographic association exists between liver cancer and surrogate markers of cyanobacterial contamination of freshwater lakes in Canada. METHODS: A negative binomial regression model was employed based on previously identified risk factors for liver cancer. RESULTS: No association existed between the geographic distribution of liver cancer and surrogate markers of cyanobacterial contamination. As predicted, significant associations existed in areas with a high prevalence of hepatitis B virus infection, large immigrant populations and urban residences. DISCUSSION AND CONCLUSIONS: The results of this study suggest that cyanobacterial contamination of freshwater lakes does not play an important role in the increasing incidence of liver cancer in Canada.

The influence of NICE guidance on the uptake of laparoscopic surgery for colorectal cancer.

BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) did not recommend laparoscopic surgery for colorectal cancer in 2000, but updated its guidance in 2006. We investigated the uptake of laparoscopic surgery for colorectal cancer before and after NICE guidance in 2000 and 2006. METHODS: Using hospital episode statistics (HES) data for men and women in England, the annual percentages of open and laparoscopic resections for colorectal cancer were calculated between 1997 and 2007. RESULTS: A total of 182,191 patient spells containing a diagnosis of colorectal cancer plus either a procedure code for surgical resection of the large bowel and/or a laparoscopic procedure were identified: 177,537 (97.4%) were for open resection; 4193 (2.3%) for laparoscopic surgery; and for 461 (0.3%) the procedure was unclear. The annual number of open procedures performed remained stable, whereas the numbers of laparoscopic resections increased steadily. CONCLUSIONS: Despite NICE guidance in 2000 recommending open surgery for colorectal cancer, there was a continuous increase in the laparoscopic approach in England, starting 3 years before the modified guidance supporting this technique. Whether NICE guidance was an effective deterrent and the guidelines protected patients cannot be determined from this retrospective study, but a similar staged approach for the adoption of other complex laparoscopic procedures is recommended.

Interaction between transcription factor, basal transcription factor 3, and the NH2-terminal domain of human estrogen receptor alpha.

The estrogen receptor (ER), like other members of the nuclear receptor superfamily, possesses two separate transcriptional activation functions, AF-1 and AF-2. Although a variety of coactivators and corepressors of AF-2 have been identified, less is known of the mechanism of action of AF-1. We have used the yeast two-hybrid system to isolate a cDNA coding for a protein that binds specifically to the AF-1 region of human ERalpha. This cDNA codes for the transcription factor basal transcription factor 3 (BTF3). The specificity of the interaction between BTF3 and ERalpha has been confirmed in vivo and in vitro. Transient transfection experiments reveal that overexpression of BTF3 modulates the transcriptional response of reporter genes to ERalpha. BTF3 interacts with ERalpha that has been activated either by 17beta-estradiol (ligand-dependent activation) or by epidermal growth factor (ligand-independent activation). The effects of BTF3 on the reporter genes requires the presence of ERalpha containing an active AF-1 function. BTF3 may be a component of the mechanism by which the AF-1 function of ERalpha stimulates gene transcription.

Geographic analysis of diabetes prevalence in an urban area.

The objective of this research is to identify the sociodemographic, environmental, and lifestyle factors associated with the geographic variability of Diabetes Mellitus (DM) prevalence in the City of Winnipeg, Manitoba in Canada. An ecological regression study design was employed for this purpose. The study population included all prevalent cases of DM in 1998 for Winnipeg. Predictor and outcome data were aggregated for analysis using two methods. First, the spatial scan statistic was used to aggregate study data into highly probable diabetes prevalence clusters. Secondly, predictor and outcome data were aggregated to existing administrative health areas. Analysis of variance and spatial and non-spatial linear regression techniques were used to explore the relationship between predictor and outcome variables. The results of the two methods of data aggregation on regression results were compared. Mapping and statistical analysis revealed substantial clustering and small-area variations in the prevalence of DM in the City of Winnipeg. The observed variations were associated with variations in socioeconomic, environmental and lifestyle characteristics of the population. The two methods of data aggregation used in the study generated very similar results in terms of identifying the geographic location of DM clusters and of the population characteristics ecologically correlated to those clusters. High rates of DM prevalence are strongly correlated with indicators of low socioeconomic status, poor environmental quality and poor lifestyles. This analysis further illustrates what a useful tool the spatial scan statistic can be when used in conjunction with ecological regression to explore the etiology of chronic disease.