Epidemiology of suicide in an Iowa cohort.

OBJECTIVES: Suicide is an ongoing public health problem in the United States. The purpose of this epidemiologic investigation was to characterize and identify populations at risk of suicide, which in turn may lead to targeted intervention and improvements in suicide prevention. STUDY DESIGN: This is a descriptive analysis of 657 suicide decedents autopsied by the University of Iowa Hospitals and Clinics between 7/1/2003 and 6/30/2018 (180 months, 15 years). METHODS: Data were obtained via autopsy report abstraction. Chi-squared tests were used for categorical variables and Wilcoxon rank-sum tests were used for continuous variables. Statistical analyses were conducted using SAS 9.3. RESULTS: Decedents were primarily white (88.2%) and male (75.7%). Average age was 43 years. Suicides were more likely to occur at a residence (69.3%), earlier in the week, and in the late night to early morning hours. Suicides were most likely to occur in spring and least likely to occur in winter. The most common method was a firearm (44.6%), most often a handgun (61.3% of firearm suicides). Less than one-half (42.8%) of decedents communicated intent to end their life. Approximately one-quarter (22.1%) of suicides were without a known identified life stressor or a known inciting event, a phenomenon that was markedly more common among men. CONCLUSIONS: More than one-half of decedents left no communication of intent to commit suicide, and one-quarter-more commonly men-had no known life stressor or other specifically identified motivating factor. While women were more likely to have a known mental health condition, prior contact with mental health care, or prior suicidal behavior, we found that, statistically speaking, the typical profile of a completed suicide is a white male who used a firearm in his place of residence. Future studies should seek to further elucidate factors leading to suicide in this at-risk population.

Sequential Apparent Diffusion Coefficient for Assessment of Tumor Progression in Patients with Low-Grade Glioma.

BACKGROUND AND PURPOSE: Early and accurate identification of tumor progression in patients with low-grade gliomas is challenging. We aimed to assess the role of quantitative ADC analysis in the sequential follow-up of patients with low-grade gliomas as a potential imaging marker of tumor stability or progression. MATERIALS AND METHODS: In this retrospective study, patients with a diagnosis of low-grade glioma with at least 12 months of imaging follow-up were retrospectively reviewed. Two neuroradiologists independently reviewed sequential MR imaging in each patient to determine tumor progression using the Response Assessment in Neuro-Oncology criteria. Normalized mean ADC (ADCmean) and 10th percentile ADC (ADC10) values from FLAIR hyperintense tumor volume were calculated for each MR image and compared between patients with stable disease versus tumor progression using univariate analysis. The interval change of ADC values between sequential scans was used to differentiate stable disease from progression using the Fisher exact test. RESULTS: Twenty-eight of 69 patients who were evaluated met our inclusion criteria. Fifteen patients were classified as stable versus 13 patients as having progression based on consensus reads of MRIs and the Response Assessment in Neuro-Oncology criteria. The interval change of ADC values showed greater concordance with ultimate lesion disposition than quantitative ADC values at a single time point. The interval change in ADC10 matched the expected pattern in 12/13 patients with tumor progression (overall diagnostic accuracy of 86%, P <.001). On average, the ADC10 interval change predicted progression 8 months before conventional MR imaging. CONCLUSIONS: The interval change of ADC10 values can be used to identify progression versus stability of low-grade gliomas with a diagnostic accuracy of 86% and before apparent radiologic progression on conventional MR imaging.

Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma: case-matched analysis.

INTRODUCTION: This is a case-matched analysis of patients undergoing laparoscopic versus open hepatectomy for hepatocellular carcinoma (HCC), with specific regard to margin status and survival. METHODS: Laparoscopic cases were matched with open controls by cirrhosis and tumor size (within 10%). Data were evaluated by logistic regression using the generalized estimating equation method. Mixed linear regression models were used to assess operative duration in the groups. Overall and disease-free survival were compared using a Cox proportional frailty model. RESULTS: Twenty laparoscopic cases were matched to 56 open resections. Thirty patients (39%) developed recurrence and 13 patients (17%) died, including one (1.3%) death within 30 days. There were no significant differences in age, gender, cirrhosis or tumor size. Paired univariate and multivariate analyses showed cases of laparoscopic resection had similar rates of transfusion and positive margins compared with open resection. Operative duration was similar in laparoscopic (mean 161 +/- 37 min) and open (mean 165 +/- 53 min) groups. The adjusted odds of length of stay > or = 6 days was significantly lower in patients with laparoscopic resection [odds ratio (OR) = 0.07, 95% confidence interval (CI) = 0.02-0.27]. Both unadjusted and adjusted analyses showed no significant association between type of resection and overall or disease-free survival. DISCUSSION: Neither margin status, nor recurrence, nor survival was significantly different between the two cohorts. Laparoscopic resection for malignancy is safe, with a similar operative time as open hepatectomy. If tumor location is amenable, laparoscopic resection for HCC is a reasonable alternative to open resection with the added benefits of improved cosmesis and sooner discharge home.