Population-based survival analysis of primary spinal chordoma in the US from 2000 to 2020.

PURPOSE: Chordomas are rare malignant tumors that occur primarily in the axial skeleton. We seek to analyze trends affecting five-year overall survival (5y OS) among patients with primary spinal chordomas (PSC) of the vertebrae and sacrum/pelvis. METHODS: The Surveillance, Epidemiology, and End Results (SEER) Program was used to identify patients with PSC (ICD-O-3 histology codes 9370/3, 9371/3, and 9372/3) of the spine or sacrum/pelvis. Multivariate and univariate survival analyses were conducted to assess demographic, disease, or treatment characteristic trends. RESULTS: Eight-hundred-ninety-six patients diagnosed with PSC were identified. Patients 0-54 years at diagnosis had improved 5y OS compared to those either 55-69 years (HR = 1.78; p = 0.046) or those between 70 and 85 + years (HR = 3.92; p < 0.001). Histology impacted 5y OS: Cox regression demonstrated variance among the three histologies assessed (p < 0.001), while univariate analysis demonstrated patients with dedifferentiated chordoma (1.0% of cohort; 33.3% [1.9,64.7]) and chondroid chordoma (2.0% of cohort; 52.5% [26.1,78.9]) had decreased 5y OS compared to those with general chordoma (72.2% [68.8,75.6]; p < 0.001). Nonmarried patients had decreased 5y OS on univariate analysis (65.2% [59.4,71.0] versus 76.2% [72.0,80.4]), with widowed patients being the primary driver of this on subanalysis. Treatment with gross total resection was associated with increased 5y OS (HR = 0.22, p < 0.001), as was treatment with radiotherapy (HR = 0.69, p = 0.030). CONCLUSION: Patient age and marital status were significant demographic factors associated with changes in 5y OS among those with PSC. PSC histology is a potentially important prognostic factor in the management of disease.

Water, Sanitation, and Cholera in Sub-Saharan Africa.

Improvements in water and sanitation should reduce cholera risk though the associations between cholera and specific water and sanitation access measures remain unclear. We estimated the association between eight water and sanitation measures and annual cholera incidence access across sub-Saharan Africa (2010-2016) for data aggregated at the country and district levels. We fit random forest regression and classification models to understand how well these measures combined might be able to predict cholera incidence rates and identify high cholera incidence areas. Across spatial scales, piped or "other improved" water access was inversely associated with cholera incidence. Access to piped water, septic or sewer sanitation, and septic, sewer, or "other improved" sanitation were associated with decreased district-level cholera incidence. The classification model had moderate performance in identifying high cholera incidence areas (cross-validated-AUC 0.81, 95% CI 0.78-0.83) with high negative predictive values (93-100%) indicating the utility of water and sanitation measures for screening out areas that are unlikely to be at high cholera risk. While comprehensive cholera risk assessments must incorporate other data sources (e.g., historical incidence), our results suggest that water and sanitation measures could alone be useful in narrowing the geographic focus for detailed risk assessments.

RNA-Seq combined with population-level analysis reveals important candidate genes related to seed size in flax (Linum usitatissimum L.).

Seed size is a key determinant of crop yields. Understanding the regulatory mechanisms of seed size is beneficial for improving flax seed yield. In this study, the development of large flax seeds lagged behind that of small seeds, and 1,751 protein-coding genes were differentially expressed in early seeds, torpedo-stage embryos, and endosperms of CIli2719 and Z11637 using RNA sequencing. Homologous alignment revealed that 129 differentially expressed genes (DEGs) in flax were homologous with 71 known seed size-related genes in Arabidopsis thaliana and rice (Oryza sativa L.). These DEGs controlled seed size through multiple processes and factors, among which phytohormone pathways and transcription factors were the most important. Moreover, 54 DEGs were found to be associated with seed size and weight in a DEG-based association study. Nucleotide diversity (π) analysis of seed size-related candidate DEGs by homologous alignment and association analysis showed that the π values decreased significantly during flax acclimation from oil to fiber flax, suggesting that some seed size-related candidate genes were selected in this acclimation process. These results provide important resources and genetic foundation for further research on seed size regulation and seed improvement in flax.

Surgeon factors are strongly correlated with who receives a sleeve gastrectomy versus a Roux-en-Y gastric bypass.

BACKGROUND: Sleeve gastrectomy (SG) has replaced Roux-en-Y gastric bypass (RYGB) as the most common bariatric operation. While SG constitutes ∼70% of all bariatric volume, we hypothesize that the distribution of SG versus RYGB varies widely at the level of the surgeon and that surgeon rather than patient factors are the primary driver of the procedure performed. OBJECTIVES: To determine the distribution of bariatric procedures performed at the surgeon level. SETTING: Population-level analysis using the Statewide Planning and Research Cooperative System (SPARCS) for New York State (2004-2014). METHODS: Identified surgeons performing SG and RYGB using billing codes. Logistic regression performed to determine the impact of surgeon, patient, and hospital factors on receiving a RYGB. RESULTS: Of the 142 surgeons who perform >5 bariatric operations per year, 32 (22.5%) performed a SG in ≥95% of their bariatric cases in the year 2014. In logistic regression, diabetes (odds ratio [OR] 1.45; P < .001) and gastroesophageal reflux disease (OR 1.36; P < .001) were associated with receiving a RYGB. However, the most correlated factor was whether the surgeon had a RYGB case volume >66th percentile in the preceding year (OR 33.8; P < .001). In pseudo-R2 analysis, 83% of the power of the regression could be explained by surgeon factors alone. CONCLUSIONS: While the percentage of SG in this cohort closely matches the national average, there is wide variation at the surgeon level with a significant proportion predominantly performing a single procedure. Surgeon factors are more strongly correlated with procedure selection compared to patient or hospital factors.

In-hospital mortality in older patients after ventricular assist device implantation: A national cohort study.

OBJECTIVES: To assess baseline patient characteristics and identify factors associated with in-hospital mortality after ventricular assist device (VAD) placement. METHODS: Cross-sectional study using the National Inpatient Sample database from January 2010 to December 2014. Analyses were performed with sample weights provided by the National Inpatient Sample, which are reported ± the standard error of the mean. RESULTS: Weighted samples yielded 15,021 ± 1111 patients who received a VAD. The mean age at time of implantation was 56.6 years. Most recipients were white (59.9%) and male (75.0%). Among older patients, in-hospital mortality increased from 17.2% to 48.2% when 1 or more high-risk interventions (cardiac surgery, prolonged mechanical ventilation, hemodialysis, or extracorporeal membrane oxygenation) preceded VAD placement (P < .001). In comparison, in-hospital mortality in younger patients increased from 11.1% to 29.4% when 1 or more of these same procedures preceded VAD placement. The mortality difference associated with these procedures was 19% greater in older patients compared with younger patients (95% confidence interval [CI], 9%-28%). In-hospital mortality among VAD recipients was associated with age older than 65 years (odds ratio [OR], 1.76; 95% CI, 1.29-2.40), female sex (OR, 1.27; 95% CI, 0.97-1.67), and at least 1 high-risk intervention preceding VAD (OR, 5.52; 95% CI, 4.27-7.13). CONCLUSIONS: Older patients who underwent 1 or more intensive treatments before VAD placement had a nearly 50% inpatient mortality and were unlikely to receive a cardiac transplantation. Refining patient selection might help better align VAD with those most likely to benefit.