A Randomized Controlled Trial to Compare Peripherally Inserted Central Catheter Tunnel Lengths in Adult Patients With Cancer.

BACKGROUND: Evidence is insufficient on the effect of tunnel lengths on tunneled peripherally inserted central catheter (PICC) placement in adult patients with cancer. OBJECTIVES: The primary objective was to explore whether there is an optimal PICC tunnel length to reduce the risk of PICC-related complications. The secondary objective was to compare patients' pain and comfort levels during catheter placement with different tunnel lengths. METHODS: Two hundred patients were randomly assigned to groups based on PICC tunnel length. Data collected included baseline characteristics, catheter-related characteristics, PICC-related complications, and patients' pain and comfort levels. FINDINGS: Patients with 4 cm, 5 cm, and 6 cm PICC tunnel lengths had a longer catheter dwell time and fewer PICC-related complications. No significant differences were found among all groups regarding patients' pain and comfort levels. The results suggest that a tunneled PICC is safe and effective. A tunnel length longer than 4 cm is recommended for tunneled PICC placement.

Identifying the impact of the Zone Insertion MethodTM (ZIMTM): A randomized controlled trial.

BACKGROUND: In 2011, Dawson proposed the Zone Insertion MethodTM (ZIMTM) to identify the optimal peripherally inserted central catheters (PICCs) insertion site in the upper arm. However, data on the effectiveness and safety of the ZIMTM in guiding PICC placement in Chinese population is limited. METHODS: In this randomized controlled trial, 120 cancer patients were randomly assigned to the upper portion of the red zone (RZ), the green zone (GZ) and the lower portion of the yellow zone (YZ) groups (at a 1:1:1 ratio). The aim was to compare the degree of patient comfort and the incidence of major PICC complications among the three insertion zones based on the ZIMTM in a Chinese Cancer Center. (Clinical Trials. Gov number, ChiCTR1900024111). RESULTS: A total of 118 catheters were inserted in 118 patients (2 patients were lost to follow-up). After the 1-month follow-up, patients randomly assigned to the YZ group had a higher degree of comfort with a lower score than those assigned to the other two zone groups: 30.21±3.16 in the YZ group versus 31.65±2.51 in the RZ group and 31.59±2.92 in the GZ group (P=.046). The incidence of thrombosis (10/40, 25%) and occlusion (4/40, 10%) in the RZ, which were significantly higher than those in the other two zone groups (χ2 =7.368, P=.02; χ2 =5.778, P =.03), whereas the risk in the GZ group was similar to that in the YZ group. The incidence of contact dermatitis in the GZ group was significantly higher than that of the other two zone groups (χ2=12.873, P=.001). CONCLUSIONS: This study found that the lower portion of YZ seems to be another suitable PICC insertion site for a higher degree of comfort and a lower risk of occlusion and thrombosis, which broadens the choice of PICC insertion sites in the upper arm for clinical practice.

Application and effect evaluation of multidisciplinary team management model: On central venous access device associated skin impairment based on Delphi method.

OBJECTIVE: To establish a multidisciplinary management model based on Delphi method to guide nursing practice and reduce the incidence of CVAD-associated Skin Impairment (CASI) in tumor patients. METHODS: On the basis of literature review and focus group interview, the initial item pool of CASI management model for cancer patients was determined. The Delphi method was used to conduct two rounds of letter consultation with 36 authoritative and representative experts to determine the content and weight of indicators of CASI multidisciplinary management model for cancer patients. RESULTS: Most of the research group were experts with bachelor degree or above. More than 90% of experts have worked for more than 10 years; Areas of expertise include oncology care, venous therapy, wound stomatology, and dermatology. The recovery rate of the two rounds of expert correspondence questionnaire was 100%. The authority coefficient of experts was 0.898, indicating a good degree of authority. Kendall's harmony coefficients were 0.193 and 0.250, with statistically significant differences (p < 0.001). After two rounds of expert letter consultation, a multidisciplinary management model of CASI for cancer patients was initially formed, which included 15 first-level prevention indexes and 38 second-level prevention indexes of CASI for cancer patients. There were 9 first-level indexes and 16 second-level indexes of CASI treatment in tumor patients. CONCLUSION: Cancer patients based on Delphi method to construct CASI multidisciplinary management model has high reliability and scientificity, multidisciplinary management model in the management of patients with tumor CASI exploration will provide new methods for central venous catheter nursing and the new way of thinking, will also be intravenous fluids will provide a scientific basis for professional development and quality improvement and practical experience.

Age, Gender and Geographic Differences in Global Health Burden of Cirrhosis and Liver Cancer due to Nonalcoholic Steatohepatitis.

Objective: Recently, Nonalcoholic Steatohepatitis (NASH) has become a major contributor to cirrhosis and liver cancer. Therefore, the Global Burden of Disease (GBD) 2017 was used to comprehensively analyze the global, regional, and national burden of cirrhosis and liver cancer due to NASH between 1990 and 2017. Methods: Data for cirrhosis and liver cancer due to NASH were extracted from the GBD study 2017. Socio-demographic Index (SDI) in 2017 was cited as indicators of socioeconomic status. ARIMA model was established to forecast the future health burden. Kruskal-Wallis test and Pearson linear correlation were adopted to evaluate the gender disparity and association with socioeconomic level. Results: From 1990-2017, the global disability-adjusted life years (DALYs) numbers of liver cancer due to NASH increased from 0.71 million to 1.46 million. The age-standardized DALYs rates of liver cancer due to NASH were negatively associated with SDI levels (r=0.-409, p<0.001). Geographically, Australasia experienced the largest increase in the burden of liver cancer due to NASH, with the age-standardized DALYs rate increasing by 143.54%. The global prevalence number of liver cancer due to NASH peaked at 60-64 years in males and at 65-69 years in females. Globally, the burden was heavier in males compared with females. Male-female-ratio of age-standardized DALYs rates in liver cancer due to NASH were positively related to SDI (r=0.303, P=0.011). Conclusion: The global burden of NASH-associated liver cancer has increased significantly since 1990, with age, gender and geographic disparity. Public awareness of liver diseases due to NASH should be emphasized.

Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025.

Diabetes mellitus is a leading cause of mortality and reduced life expectancy. We aim to estimate the burden of diabetes by type, year, regions, and socioeconomic status in 195 countries and territories over the past 28 years, which provide information to achieve the goal of World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases in 2025. Data were obtained from the Global Burden of Disease Study 2017. Overall, the global burden of diabetes had increased significantly since 1990. Both the trend and magnitude of diabetes related diseases burden varied substantially across regions and countries. In 2017, global incidence, prevalence, death, and disability-adjusted life-years (DALYs) associated with diabetes were 22.9 million, 476.0 million, 1.37 million, and 67.9 million, with a projection to 26.6 million, 570.9 million, 1.59 million, and 79.3 million in 2025, respectively. The trend of global type 2 diabetes burden was similar to that of total diabetes (including type 1 diabetes and type 2 diabetes), while global age-standardized rate of mortality and DALYs for type 1 diabetes declined. Globally, metabolic risks (high BMI) and behavioral factors (inappropriate diet, smoking, and low physical activity) contributed the most attributable death and DALYs of diabetes. These estimations could be useful in policy-making, priority setting, and resource allocation in diabetes prevention and treatment.

The prognostic landscape of adaptive immune resistance signatures and infiltrating immune cells in the tumor microenvironment of uveal melanoma.

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults and has a high mortality rate. Tumor microenvironment (TME) is crucial in controlling and influencing the behavior of malignant tumors. Thus, illustrating the prognostic values of adaptive immune resistance signatures and infiltrating immune cells in the TME of UM may provide scientific rationales for immunotherapy. In this study, the gene expression data of 80 primary UM and 103 primary skin cutaneous melanoma (SKCM) samples with relevant clinical information were obtained from The Cancer Genome Atlas (TCGA) database. The TME was analyzed by the xCell, EPIC, ESTIMATE and TIMER algorithms. The relationships and prognostic values of immune infiltrates and mutated genes were further investigated. We found that primary UM and primary SKCM exhibited distinct TMEs. Higher levels of infiltrating stromal and immune cells in UM were related to more aggressive biology and poor prognosis. Increased CD8+ T cell level, as well as several adaptive immune resistance markers, was a predictive factor of poor prognosis in UM. Furthermore, some common mutations of UM were associated with its TME. This study analyzed the immune landscape of adaptive immune resistance signatures and infiltrating immune cells in the TME of UM. Identification of these immune-related biomarkers may thus enable the prediction of prognosis and the selection of optimal immunotherapy strategies in UM.

Epidemiology and Survival Outcomes for Eyelid Primary Malignant Melanoma: An Analysis of 1397 Cases in the SEER Database.

PURPOSE: There has not been a recent population-based study regarding the epidemiological trend and survival of eyelid primary malignant melanoma (PMM). Our study aims to evaluate the updated incidence trends and discuss the factors affecting the survival outcomes of eyelid PMM. METHODS: A total of 1397 eyelid PMM cases diagnosed between 1975 and 2016 were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) database. Age-adjusted incidence rates and annual percent changes (APC) were calculated. Kaplan-Meier and Cox proportional hazards regression models were used to calculate survival outcomes and identify potential prognostic factors. RESULTS: The overall age-adjusted incidence of eyelid PMM rose from 0.039 (95% confidence interval [CI], 0.012-0.088) in 1975 to 0.103 (95% CI, 0.070-0.143) per 100 000 population in 2016, with significant APC of 1.313% (p < 0.001). Male subjects showed a higher average age-adjusted incidence rate than female subjects (p < 0.001). Survival analyses showed that 5-year accumulative overall survival (OS) and disease-specific survival (DSS) for patients with eyelid PMM were 70.5% and 90.6%. Additionally, 10-year OS and DSS were 51.8% and 86.1%, respectively. Analyses of Kaplan-Meier survival curves with the log-rank test revealed that older age, White race, nodular melanoma, higher American Joint Committee on Cancer (AJCC) stage (II to IV), advanced stage, distant metastasis, and no-surgery treatment were associated with lower OS and DSS rates. Age, histology, AJCC stage, and stage at diagnosis were found to be independent predictors of OS and DSS in multivariate models. CONCLUSION: The incidence of eyelid PMM increased with significant APC and male predominance. Age, histology, AJCC stage, and stage at diagnosis might be independent predictors of prognosis, emphasizing the importance of improved diagnosis of eyelid PMM.

A randomised, controlled trial comparing the long-term effects of peripherally inserted central catheter placement in chemotherapy patients using B-mode ultrasound with modified Seldinger technique versus blind puncture.

OBJECTIVE: To compare the effects of peripherally inserted central venous catheter (PICC) placement using B-mode ultrasound with the modified Seldinger technique (BUMST) versus the blind puncture. METHODS: One hundred chemotherapy patients were recruited to participate in a randomised, controlled trial in Guangzhou, China. Fifty were assigned to the experimental group (using BUMST), and 50 were assigned to the control group (blind puncture). Demographic and background data, data related to PICC placement, complications after PICC placement, the patients' degree of comfort (determined via a questionnaire), and patients' costs for PICC maintenance were collected to compare the effects of the two methods. T-tests and chi-square tests were used to analyse the data; p < 0.05 was accepted as statistically significant. RESULTS: Nighty-eight of the 100 PICCs were successfully inserted (50 in the experimental group and 48 in the control group). Compared with the control group, the experimental group had a lower rate of unplanned catheter removal (4.0% vs. 18.7%; p = 0.02), a lower incidence of mechanical phlebitis (0% vs. 22.9%; p < 0.001), a lower incidence of venous thrombosis (0% vs. 8.3%; p = 0.037), and a higher incidence of catheter migration (32% vs. 2.1%; p < 0.001). Compared with the control group, the experimental group experienced significantly less severe contact dermatitis (p = 0.038), had improved comfort at 1 week, 1 month, 2 months, and 3 months after PICC placement (p < 0.001), and had lower costs for PICC maintenance at 2 months, 3 months and when the catheter was removed (p < 0.05). CONCLUSIONS: Using B-mode ultrasound with MST for PICC placement reduced complications and patients' costs for PICC maintenance and improved patients' degree of comfort; thus, this procedure should be more widely used. The clinical trial registration number: ChiCTR-TRC-12002749.