Assessment of Postmastectomy Radiation Therapy Receipt by Age and Association With Outcomes in Women With Breast Cancer.

PURPOSE: Postmastectomy radiation therapy (PMRT) reduces locoregional recurrence (LRR) and improves overall survival (OS) in patients with breast cancer. Young age has been recognized as a risk factor for LRR. The primary objective of this study was to determine if recommendations for PMRT differed among patients younger than 50 years as compared to women aged 50 years or older. METHODS: We reviewed medical records of patients with breast cancer who underwent mastectomy with or without PMRT from 2010 through 2018. Univariable and multivariable models were used to estimate the association of age with PMRT. RESULTS: Of 2471 patients, 839 (34%) were <50 years; 1632 (66%) were ≥50 years. Patients <50 years had a higher percentage of grade 3 tumors, hormone receptor (HR) negative and/or Her-2/neu positive tumors, clinical stage T2/T3 tumors, and nodal involvement. Compared with patients ≥50 years, patients <50 years were more likely to undergo PMRT (OR 1.57; P = .001) and regional node irradiation (RNI) to the internal mammary nodes. Advanced clinical and pathologic stage, invasive tumor histology, the presence of lymphovascular invasion, and treatment with systemic chemotherapy were predictors of PMRT receipt for patients <50 years (P < .05). PMRT was associated with improved OS and recurrence free survival (RFS) among all patients (P < .01). CONCLUSION: Patients <50 years were more likely to undergo PMRT and to receive RNI to the internal mammary nodes but were also more likely to have other risk factors for recurrence that would warrant a PMRT recommendation. PMRT improved OS and RFS for all patients.

Assessment of the Cepheid 3-gene Host Response Fingerstick Blood Test (MTB-HR) on rapid diagnosis of tuberculosis.

ABSTRACTThe World Health Organization has identified high-priority target product profiles for new TB diagnostics which include rapid biomarker-based, non-sputum-based diagnostic testing, using an easily accessible sample. The Cepheid 3-gene Host Response Fingerstick Blood Prototype Test (MTB-HR) quantifies relative mRNA levels of a 3-gene signature (GBP5, DUSP3, and KLF2) from a whole-blood sample on the GeneXpert platform. The objective of the present study was to evaluate the performance of the MTB-HR to distinguish between active tuberculosis (ATB), latent Mycobacterium tuberculosis infection (LTBI), other pulmonary diseases, and healthy volunteers at a tertiary care centre. Among 653 participants enrolled in this study, 192 were diagnosed as having ATB, and the remaining 461 were classified as non-ATB, including 137 cases of LTBI, 224 cases of other pulmonary diseases, and 100 healthy volunteers. The corresponding AUCs of the MTB-HR in distinguishing untreated ATB from non-ATB, LTBI, other pulmonary diseases, and healthy volunteers were 0.814 (95% CI, 0.760-0.868, sensitivity 76.1%, specificity 71.6%), 0.739 (95% CI, 0.667-0.812, sensitivity 59.7%, specificity 78.1%), 0.825 (95% CI, 0.770-0.880, sensitivity 82.1%, specificity 65.6%), 0.892 (95% CI, 0.839-0.945, sensitivity 76.1%, specificity 88.0%), respectively. When only samples with TAT of less than 1 h were included, the AUC of the MTB-HR in distinguishing untreated ATB from non-ATB was largest, 0.920 (95% CI, 0.822-1.000, sensitivity 81.3%, specificity 87.7%). In conclusion, the MTB-HR assay shows potential as a rapid, blood-based screening and triage test for ATB, especially for untreated ATB, with the advantage of increased diagnostic yield since blood is more readily available.

Impact of Sociodemographic Disparities and Insurance Status on Survival of Patients with Early-Onset Colorectal Cancer.

BACKGROUND: Low socioeconomic status (SES) has been linked to worse survival in patients with colorectal cancer (CRC); however, the impact of SES on early-onset CRC remains undescribed. MATERIALS AND METHODS: Retrospective analysis of data from the National Cancer Database (NCDB) between 2004 and 2016 was conducted. We combined income and education to form a composite measure of SES. Logistic regression and χ2 testing were used to examine early-onset CRC according to SES group. Survival rates and Cox proportional hazards models compared stage-specific overall survival (OS) between the SES groups. RESULTS: In total, 30,903 patients with early-onset CRC were identified, of whom 78.7% were White; 14.5% were Black. Low SES compared with high SES patients were more likely to be Black (26.3% vs. 6.1%) or Hispanic (25.3% vs. 10.5%), have T4 tumors (21.3% vs. 17.8%) and/or N2 disease (13% vs. 11.1%), and present with stage IV disease (32.8% vs. 27.7%) at diagnosis (p < .0001, all comparisons). OS gradually improved with increasing SES at all disease stages (p < .001). In stage IV, the 5-year survival rate was 13.9% vs. 21.7% for patients with low compared with high SES. In multivariable analysis, SES (low vs. high group; adjusted hazard ratio [HRadj ], 1.35; 95% confidence interval [CI], 1.26-1.46) was found to have a significant effect on survival (p < .0001) when all of the confounding variables were adjusted. Insurance (not private vs. private; HRadj , 1.38; 95% CI, 1.31-1.44) mediates 31% of the SES effect on survival. CONCLUSION: Patients with early-onset CRC with low SES had the worst outcomes. Our data suggest that SES should be considered when implementing programs to improve the early detection and treatment of patients with early-onset CRC. IMPLICATIONS FOR PRACTICE: Low socioeconomic status (SES) has been linked to worse survival in patients with colorectal cancer (CRC); however, the impact of SES on early-onset CRC remains undescribed. In this retrospective study of 30,903 patients with early-onset CRC in the National Cancer Database, a steady increase in the yearly rate of stage IV diagnosis at presentation was observed. The risk of death increased as socioeconomic status decreased. Race and insurance status were independent predictors for survival. Implementation of programs to improve access to care and early diagnostic strategies among younger adults, especially those with low SES, is warranted.

Will polycentric cities cause more CO2 emissions? A case study of 232 Chinese cities.

From 2000 to 2010 China experienced rapid economic development and urbanization. Many cities in economically developed areas have developed from a single-center status to polycentricity. In this study, we used exploratory spatial data analysis (ESDA) to identify the population centers, which identified 232 cities in China as having urban centers. COMP was used to represent urban agglomeration, and POLYD (representing how far is the city's sub-centers to the main center), POLYC (representing the number of a city's centers), and POLYP (representing the population distributed between the main center and the sub-centers) were used to indicate urban polycentricity. Night light data were used to determine the CO2 emissions from various cities in China. A mixed model was used to study the impact of urban aggregation and polycentric data on the CO2 emission efficiency in 2000 and 2010. The study found that cities with higher compactness were distributed in coastal areas, and the cities with higher multicentricity were distributed in the Yangtze River Delta and Shandong Province. The more compact the city was, the less conducive it was to improving CO2 emission efficiency. Polycentric development of the city was conducive to improving the CO2 emission efficiency, but the number of urban centers had no significant relationship with the CO2 emission efficiency. Our research showed that the compactness and multicentricity of the city had an impact on the CO2 emission efficiency and provided some planning suggestions for the low carbon development of the city.

Circulating Short-Chain Fatty Acids Are Positively Associated with Adiposity Measures in Chinese Adults.

Epidemiological studies suggest a positive association between obesity and fecal short-chain fatty acids (SCFAs) produced by microbial fermentation of dietary carbohydrates, while animal models suggest increased energy harvest through colonic SCFA production in obesity. However, there is a lack of human population-based studies with dietary intake data, plasma SCFAs, gut microbial, and anthropometric data. In 490 Chinese adults aged 30-68 years, we examined the associations between key plasma SCFAs (butyrate/isobutyrate, isovalerate, and valerate measured by non-targeted plasma metabolomics) with body mass index (BMI) using multivariable-adjusted linear regression. We then assessed whether overweight (BMI ≥ 24 kg/m2) modified the association between dietary-precursors of SCFAs (insoluble fiber, total carbohydrates, and high-fiber foods) with plasma SCFAs. In a sub-sample (n = 209) with gut metagenome data, we examined the association between gut microbial SCFA-producers with BMI. We found positive associations between butyrate/isobutyrate and BMI (p-value < 0.05). The associations between insoluble fiber and butyrate/isobutyrate differed by overweight (p-value < 0.10). There was no statistical evidence for an association between microbial SCFA-producers and BMI. In sum, plasma SCFAs were positively associated with BMI and that the colonic fermentation of fiber may differ for adults with versus without overweight.

A Population-Based Study of Factors Associated with Postpartum Contraceptive Use by Birth Interval Length.

OBJECTIVE: The purpose of this study was to evaluate factors associated with postpartum contraceptive use among women with short and moderate-to-long birth intervals using population-based data from the Pregnancy Risk Assessment and Monitoring System. METHODS: Because only Mississippi and Tennessee include a question about birth interval length on their Pregnancy Risk Assessment and Monitoring System survey, this analysis was limited to women from those states who reported information on this variable (N = 2198). Demographic, lifestyle, and reproductive data, including information on postpartum contraceptive use, were obtained from surveys and birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Nearly 90% of women reported currently using a form of contraception during the postpartum period. In the unadjusted model, among women with short birth intervals, there was no association between alcohol consumption during pregnancy and postpartum contraceptive use (OR 1.03, 95% CI 0.15-7.31); however, smoking during pregnancy was associated with a decreased odds of postpartum contraceptive use (OR 0.70, 95% CI 0.25-1.96). Among women with moderate-to-long birth intervals, alcohol use during pregnancy was associated with a decreased odds (OR 0.71, 95% CI 0.28-1.80) and smoking during pregnancy was associated with an increased odds (OR 1.18, 95% CI 0.60-2.30) of postpartum contraceptive use. Regardless of birth interval length, women with no health insurance had a decreased odds of postpartum contraceptive use when compared with women with health insurance (short birth interval: OR 0.89, 95% CI 0.32-2.49 and moderate-to-long birth interval: OR 0.85, 95% CI 0.52-1.39). Among women with short birth intervals, non-Hispanic black women had a decreased odds of postpartum contraceptive use (OR 0.14, 95% CI 0.03-0.64) and women who were unmarried or had a history of preterm delivery had an increased odds of postpartum contraceptive use (unmarried: OR 5.81, 95% CI 1.26-26.69 and preterm delivery: OR 4.19, 95% CI 1.42-12.37, respectively) after adjustment for confounders. Among women with moderate-to-long birth intervals, individuals who identified as Hispanic/mixed race/other had a statistically significant decreased odds of postpartum contraceptive use after adjustment (OR 0.43, 95% CI 0.18-0.99). CONCLUSIONS: Findings underscore the importance of postpartum medical visits for all women, regardless of birth interval length. Certain groups of women may need additional counseling regarding the importance of using contraceptives to prevent another closely spaced or unintended pregnancy.

Acute Ingestion of a Mixed Flavonoid and Caffeine Supplement Increases Energy Expenditure and Fat Oxidation in Adult Women: A Randomized, Crossover Clinical Trial.

This randomized, double-blinded, crossover study measured the acute effect of ingesting a mixed flavonoid-caffeine (MFC) supplement compared to placebo (PL) on energy expenditure (EE) and fat oxidation (FATox) in a metabolic chamber with premenopausal women (n = 19, mean ± SD, age 30.7 ± 8.0 year, BMI 25.7 ± 3.4 kg/m2). The MFC supplement (658 mg flavonoids, split dose 8:30, 13:00) contained quercetin, green tea catechins, and anthocyanins from bilberry extract, and 214 mg caffeine. Participants were measured twice in a metabolic chamber for a day, four weeks apart, with outcomes including 22 h EE (8:30-6:30), substrate utilization from the respiratory quotient (RQ), plasma caffeine levels (16:00), and genotyping for the single-nucleotide polymorphism (SNP) rs762551. Areas under the curve (AUC) for metabolic data from the MFC and PL trials were calculated using the trapezoid rule, with a mixed linear model (GLM) used to evaluate the overall treatment effect. The 22 h oxygen consumption and EE were significantly higher with MFC than PL (1582 ± 143, 1535 ± 154 kcal/day, respectively, p = 0.003, trial difference of 46.4 ± 57.8 kcal/day). FATox trended higher for MFC when evaluated using GLM (99.2 ± 14.0, 92.4 ± 14.4 g/22 h, p = 0.054). Plasma caffeine levels were significantly higher in the MFC versus PL trial (5031 ± 289, 276 ± 323 ng/mL, respectively, p < 0.001). Trial differences for 22 h EE and plasma caffeine were unrelated after controlling for age and body mass (r = -0.249, p = 0.139), and not different for participants with the homozygous allele 1, A/A, compared to C/A and C/C (p = 0.50 and 0.56, respectively). In conclusion, EE was higher for MFC compared to PL, and similar to effects estimated from previous trials using caffeine alone. A small effect of the MFC on FATox was measured, in contrast to inconsistent findings previously reported for this caffeine dose. The trial variance for 22 h EE was not significantly related to the variance in plasma caffeine levels or CYP1A2*1F allele carriers and non-carriers.

Sex Disparity in Severity of Lung Lesions in Newly Identified Tuberculosis Is Age-Associated.

Background: The age-associated characteristic of computed tomography (CT) images of tuberculosis (TB) and the reason for male bias in TB are still not clear. Methods: We compared the CT images, clinical inflammatory indices and sputum bacterial counts between 594 non-smoking men and women with newly diagnosed TB with matched large span of ages from 15 to 92 years old. Logistic regression analyses were used to identify the cavity-associated factors of men and women, separately and in combination. Results: Sputum bacterial counts, ratio of cavities, lung injury scores, and level of C reactive protein were significantly higher in men than in women with ages from 15 to 74, but not in cases older than 75. In CT images, thick walled cavity, cicatricial emphysema and parenchymal bands were present in men at ages of 15-74 more than matched women. Ratios of cases with lobular emphysema and pleural effusion were higher in men after age of 56. While ratios of cases with parenchymal bands, calcification, pleural effusion, pleural thickening, lobular emphysema and bronchovascular distortion increased with aging, those of centrilobular nodules, micronodules and tree in bud decreased with aging in men. Erythrocyte sedimentation rate (ESR) increased with aging, but no differences were found between men and women in ESR or T-SPOT TB tests. Higher complement C4 and lower body mass index in men and positive result in anti-TB antibody test in women were strongly associated with the presence of cavity. Conclusions: The sex bias in TB is age-associated. TB prevention, treatment and research should take differences of sex and age into account.

Interbirth Interval and Pregnancy Complications and Outcomes: Findings from the Pregnancy Risk Assessment Monitoring System.

INTRODUCTION: Although the definition of a short interbirth interval has been inconsistent in the literature, Healthy People 2020 recommends that women wait at least 18 months after a live birth before attempting their next pregnancy. In the United States, approximately 33% of pregnancies are conceived within 18 months of a previous birth. Pregnancies that result from short interbirth intervals can pose serious risks. The objective of this study was to determine the association between interbirth interval and understudied pregnancy complications and outcomes, including small for gestational age (SGA) infants, premature rupture of membranes (PROM), preterm PROM (PPROM), placenta previa, and gestational diabetes, using Pregnancy Risk Assessment and Monitoring System data from Mississippi and Tennessee. METHODS: This study collected self-reported information from 2212 women on interbirth interval (≤18 months, ie, short; 19-35 months, ie, intermediate; and ≥36 months, ie, long; referent), PPROM, placenta previa, and gestational diabetes. SGA and PROM data were obtained from birth certificates. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs. RESULTS: After adjustment, there were no strong associations between interbirth interval and PPROM, gestational diabetes, or SGA infants. However, women with shorter intervals had increased odds of PROM (short: OR, 3.54; 95% CI, 1.22-10.23 and intermediate: OR, 4.09; 95% CI, 1.28-13.03) and placenta previa (short: OR, 2.58; 95% CI, 1.10-6.05 and intermediate: OR, 1.69; 95% CI, 0.94-3.05). DISCUSSION: The study's findings provide further support for encouraging women to space their pregnancies appropriately. Moreover, findings underscore the need to provide women with family planning services so that closely spaced pregnancies and unintended pregnancies can be avoided. Additional studies of the role of interbirth interval on these understudied pregnancy complications and outcomes are warranted.

Factors associated with pregnancy intention among women who have experienced a short birth interval: findings from the 2009 to 2011 Mississippi and 2009 Tennessee Pregnancy Risk Assessment Monitoring System.

PURPOSE: One-third of all pregnancies in the United States are conceived within 18 months of a prior live birth. Preventing unintended pregnancies may help to decrease the prevalence of pregnancies with these short interpregnancy intervals. However, data on factors associated with pregnancy intention among women who have had short birth intervals are sparse. Pregnancy Risk Assessment Monitoring System data were used to further evaluate these associations. METHODS: Because only Mississippi and Tennessee Pregnancy Risk Assessment Monitoring System include a survey question about birth interval length, this analysis was limited to women from those states who recently had a short birth interval (n = 384). Pregnancy intention and demographic, lifestyle, and reproductive data were obtained from surveys and birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Nearly 76% of women with short birth intervals reported their pregnancy as unintended. Women who were non-Hispanic black or consumed alcohol during pregnancy had statistically significant increased odds of reporting the pregnancy with a short birth interval as being unintended (OR = 3.98; 95% CI: 1.73-9.16 and OR = 10.56; 95% CI: 1.80-61.83, respectively). CONCLUSIONS: Although all women should be counseled on postpartum contraceptive use, findings suggest that important subpopulations of women may benefit from more targeted counseling during prenatal care visits and the immediate postpartum hospital stay regarding the importance of using contraception to not only better space pregnancies but also prevent unintended pregnancies.

Prevalence, risk factors, management, and treatment outcomes of first-line antituberculous drug-induced liver injury: a prospective cohort study.

PURPOSE: Antituberculosis drug-induced liver injury (ATDILI) is one of the most deleterious side effects associated with chemotherapy against tuberculosis (TB). In this study, our objective was to determine the incidence, risk factors, and management of ATDILI and analyze its impact on the treatment outcome in patients receiving standard anti-TB chemotherapy. METHODS: A prospective cohort study of ATDILI prevalence was conducted in 938 enrolled patients of the 1426 TB cases in Shanghai from March 2011 to September 2012. Patients were followed up until February 2014. Univariate and multivariate logistic regression analyses were used to determine the risk factors of ATDILI. Successful therapeutic outcome, rates of drug resistance conversion, sputum smear/culture conversion, and lung cavity closure were analyzed. RESULTS: Hepatitis B surface antigen/hepatitis B e antigen-positive hepatitis B carriers, complicated with systemic lupus erythematosus, albumin ≤ 25 g/L, and chronic alcoholism were independent risk factors for ATDILI. Of the 121 cases with ATDILI (incidence rate of 12.9%), 84 (69.4%) used modified anti-TB therapy after recovery of liver function. Compared with the non-ATDILI group, patients with ATDILI exhibited remarkably decreased lung cavity closure rate (84.6% vs. 93.0%, P < 0.001) along with significantly reduced sputum smear/culture conversion rate (85.4% vs. 94.0%, P < 0.001). CONCLUSIONS: Our findings indicated that 12.9% patients developed ATDILI during standard anti-TB therapy, resulting in poor therapeutic outcome. Hepatitis B carriers with systemic lupus erythematosus, albumin ≤ 25 g/L, and chronic alcoholism manifested increased risks for ATDILI. Copyright © 2016 John Wiley & Sons, Ltd.

A coordination complex system for generic, ultrafast, and sensitive multimode fluorescent staining of biomolecules.

Gel electrophoresis staining methodologies documented thus far are largely utilized in a biomolecule context-dependent manner. We report herein the development of a generic, ultrafast, and sensitive multimode fluorescent system for the efficient identification of DNA, RNA, and proteins. Interaction between a positively charged, planar ligand-based coordination complex with partner biomolecule leads to aggregation-induced fluorescence quenching and allows for the image contrast generation within one minute. Alternatively, successive reactions of the biomolecule-loaded gel with cation and ligand, in either order of sequence, provide an equally effective staining efficacy. Image contrast reversal is accomplished through a facile washing or photobleaching procedure. The versatility in the applicable target species and signal generation modes provides a hint at the design of novel staining structures and potentially enables the high-throughput readout of biomolecules.