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1.
J Cancer Res Clin Oncol ; 146(1): 67-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786738

RESUMO

PURPOSE: Marital status has been demonstrated as an independent prognostic factor in many cancer types. The impact of marital status on non-small cell lung cancer (NSCLC) survival has not been assessed at the population level. Here, we used the surveillance, epidemiology and end results (SEER) database, a US national cancer registry, to address this issue. METHODS: All patients diagnosed with NSCLC from 2004 to 2009 were identified in the SEER database (version 8.3.2, updated at April 14, 2016). Those with incomplete clinicopathological information were excluded. The tumor, node, metastasis (TNM) staging was based on the criteria of the American Joint Committee on Cancer (AJCC) 6th edition. We used propensity-score matching analysis to balance baseline characteristics between the patients who were married and those who were not married. The impact of marital status on cancer-specific survival was analyzed with Cox proportional-hazards regression. RESULT: A total of 72, 984 NSCLC patients (41, 095 married patients, 56.3%) were enrolled in this study. After propensity-score matching, 25, 617 patients in the married group were 1:1 matched with patients in the unmarried group. Being unmarried was found to be associated with significantly decreased cancer-specific survival (hazard ratio (HR): 1.142, 95% CI: 1.119-1.166, p < 0.001). Among the unmarried group, patients who were single had worse cancer-specific survival (median survival 12 months, 95% CI: 11.37-12.63 months) than those who were divorced (median survival 15 months, 95% CI: 14.24-15.76 months, p < 0.001) or widowed (median survival 15 months, 95% CI: 14.25-15.76 months, p < 0.001). CONCLUSION: This study shows that marital status is an independent prognostic factor for cancer-specific survival in NSCLC patients. Patients who were married had better cancer-specific survival compared to the unmarried ones.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/mortalidade , Neoplasias Pulmonares/mortalidade , Estado Civil/estatística & dados numéricos , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/terapia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Sistema de Registros , Programa de SEER , Estados Unidos/epidemiologia
2.
Heart Lung Circ ; 29(1): e10-e11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31858979
3.
Breast J ; 26(1): 92-99, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31854067

RESUMO

The medical literature has been growing exponentially, and its size has become a barrier for physicians to locate and extract clinically useful information. As a promising solution, natural language processing (NLP), especially machine learning (ML)-based NLP is a technology that potentially provides a promising solution. ML-based NLP is based on training a computational algorithm with a large number of annotated examples to allow the computer to "learn" and "predict" the meaning of human language. Although NLP has been widely applied in industry and business, most physicians still are not aware of the huge potential of this technology in medicine, and the implementation of NLP in breast cancer research and management is fairly limited. With a real-world successful project of identifying penetrance papers for breast and other cancer susceptibility genes, this review illustrates how to train and evaluate an NLP-based medical abstract classifier, incorporate it into a semiautomatic meta-analysis procedure, and validate the effectiveness of this procedure. Other implementations of NLP technology in breast cancer research, such as parsing pathology reports and mining electronic healthcare records, are also discussed. We hope this review will help breast cancer physicians and researchers to recognize, understand, and apply this technology to meet their own clinical or research needs.

4.
Mol Nutr Food Res ; 63(24): e1900612, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31703241

RESUMO

SCOPE: Vegetarian diets confer health benefits to many cardiometabolic diseases, although whether and how gut microbiota in vegetarians contributes to host metabolism remains unclear. Thus, the aim is to explore the possible links between the gut microbiota and circulating gut microbiota-host co-metabolites among vegetarians and omnivores. METHODS AND RESULTS: Fecal and serum samples from 36 adults following a vegan, lacto-ovo vegetarian, or omnivorous diet are collected. A 16S rRNA gene, metagenome, metatranscriptome, and metabolome integrated multi-omics approach is adopted to profile fecal microbial composition and functionality and circulating gut microbiota-host co-metabolites. 16S rRNA gene and metagenomic sequencing suggest a significant difference in gut microbial composition between the two vegetarian groups and the omnivorous group at the family, genus, and species level. Metabolomic analysis reveals that circulating branched-chain amino acids (BCAAs)-valine, leucine, and isoleucine-are significantly lower in the two vegetarian groups than those in the omnivorous group. In line with the lower concentrations of BCAAs, metatranscriptomic analysis shows that the gut microbial pathway for the degradation of BCAAs is significantly upregulated among vegetarians compared with the omnivores. CONCLUSIONS: The results indicate that gut microbiota plays an important role in the modulation of circulating BCAAs among vegetarians.

5.
J Card Surg ; 34(12): 1498-1504, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31654595

RESUMO

BACKGROUND: The management strategy for secondary mitral regurgitation (MR) during aortic valve surgery for aortic regurgitations (ARs) remains controversial. This study aimed to compare the outcomes between mitral valve annuloplasty (MVP) and no intervention for managing 2+ or 3+ MR among severe patients with AR. METHODS: Eighty-seven eligible patients with complete echocardiographic follow-up were included, with 51 patients in the MVP group and 36 in the No-MVP group. The MVP group had a larger left atrial (LA) diameter (44.2 ± 6.6 vs 49.4 ± 7.6 mm; P = .001) and a higher proportion of 3+ MR (33.3% vs 76.5%; P < .001) than the No-MVP group. After 1:1 propensity-score matching, the patients treated with and without MVP were balanced on 14 preoperative characteristics. RESULTS: There was one in-hospital death in each group. In the propensity-score matched cohort, there was no statistically significant difference between the two groups in the cumulative incidence of residual 2+ MR during a follow-up of 26.4 ± 14.8 months (P = .64). The No-MVP group was associated with a more significant change in the left ventricular end-diastolic dimension (18.1 ± 7.9 vs 13.7 ± 8.7 mm; P = .02), while the changes in the LA diameter, left ventricular end-systolic dimension, and left ventricular ejection fraction were similar between the two groups. CONCLUSIONS: The severity of MR and the LA size may impact surgeons' decisions. MVP does not seem to add extra benefits to the outcomes, and it may be associated with worse left ventricular remodeling.

6.
JCO Clin Cancer Inform ; 3: 1-9, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31419182

RESUMO

PURPOSE: Quantifying the risk of cancer associated with pathogenic mutations in germline cancer susceptibility genes-that is, penetrance-enables the personalization of preventive management strategies. Conducting a meta-analysis is the best way to obtain robust risk estimates. We have previously developed a natural language processing (NLP) -based abstract classifier which classifies abstracts as relevant to penetrance, prevalence of mutations, both, or neither. In this work, we evaluate the performance of this NLP-based procedure. MATERIALS AND METHODS: We compared the semiautomated NLP-based procedure, which involves automated abstract classification and text mining, followed by human review of identified studies, with the traditional procedure that requires human review of all studies. Ten high-quality gene-cancer penetrance meta-analyses spanning 16 gene-cancer associations were used as the gold standard by which to evaluate the performance of our procedure. For each meta-analysis, we evaluated the number of abstracts that required human review (workload) and the ability to identify the studies that were included by the authors in their quantitative analysis (coverage). RESULTS: Compared with the traditional procedure, the semiautomated NLP-based procedure led to a lower workload across all 10 meta-analyses, with an overall 84% reduction (2,774 abstracts v 16,941 abstracts) in the amount of human review required. Overall coverage was 93%-we are able to identify 132 of 142 studies-before reviewing references of identified studies. Reasons for the 10 missed studies included blank and poorly written abstracts. After reviewing references, nine of the previously missed studies were identified and coverage improved to 99% (141 of 142 studies). CONCLUSION: We demonstrated that an NLP-based procedure can significantly reduce the review workload without compromising the ability to identify relevant studies. NLP algorithms have promising potential for reducing human efforts in the literature review process.

7.
Environ Int ; 126: 228-233, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30822651

RESUMO

Human-induced climate change has accelerated in recent decades, causing adverse health effects. However, the impact of the changing climate on neurological disorders in the older population is not well understood. We applied time-varying Cox proportional hazards models to estimate the associations between hospital admissions for dementia and the mean and variability of summer and winter temperatures in New England. We estimated seasonal temperatures for each New England zip code using a satellite-based prediction model. By characterizing spatial differences and temporal fluctuations in seasonal temperatures, we observed a lower risk of dementia-associated hospital admissions in years when local temperatures in either summer (hazard ration [HR] = 0.98; 95% confidence interval [CI]: 0.96, 1.00) or winter (HR = 0.97; 95% CI: 0.94, 0.99) were higher than average, and a greater risk of dementia-associated admissions for older adults living in zip codes with higher temperature variations. Effect modifications by sex, race, age, and dual eligibility were considered to examine vulnerability of population subgroups. Our results suggest that cooler-than-average temperatures and higher temperature variability increase the risk of dementia-associated hospital admissions. Thus, climate change may affect progression of dementia and associated hospitalization costs.


Assuntos
Mudança Climática , Demência/epidemiologia , Hospitalização/estatística & dados numéricos , Temperatura Ambiente , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , New England/epidemiologia , Estações do Ano
8.
Biomark Med ; 13(6): 437-443, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30808201

RESUMO

Aim: To evaluate the association between galectin-3 and arterial stiffness among hemodialysis patients. Methods: We enrolled 311 patients (median age: 61 years) with a median hemodialysis time of 90 months and a mean galectin-3 concentration of 29.78 ng/ml. Ninety-six (30.7%) had arterial stiffness diagnosed by the pulse-wave velocity over 10 m/s. Results: Galectin-3 was significantly associated with dialysis vintage, calcium, phosphorus and low-density lipoprotein. After adjustment for multiple cardiovascular risk factors, galectin-3 was independently associated with the pulse-wave velocity (partial r = 0.130; p = 0.035). This effect was still significant after additional adjustment for mean arterial pressure and single-pool Kt/V (partial r = 0.139; p = 0.014). Conclusion: Galectin-3 is independently associated with arterial stiffness among hemodialysis patients.

11.
J Vasc Surg ; 69(1): 64-73, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29914839

RESUMO

OBJECTIVE: Significant research efforts have been made to improve the safety and efficacy of endovascular aneurysm repair (EVAR) in treating abdominal aortic aneurysm. This study aimed to examine the trends of perioperative outcomes of EVAR in the recent decade using a national validated database. METHODS: Patients who underwent EVAR for intact abdominal aortic aneurysm between 2006 and 2015 were identified from the National Surgical Quality Improvement Program and divided into early (2006-2010) and late (2011-2015) periods. The primary outcome of the study was 30-day mortality. Secondary outcomes included operative time, length of hospital stay, and 30-day major complications (renal, cardiopulmonary, and wound infection). RESULTS: A total of 30,076 patients were identified, with 11,539 in the early period and 18,537 in the late period. The 30-day mortality was kept at a low level in both periods (1.2% vs 1.2%; P = .98), whereas both the mean operation time (155.5 ± 72.6 minutes vs 141.9 ± 73.7 minutes; P < .001) and length of hospital stay (3.24 ± 5.32 days vs 2.81 ± 4.30 days; P < .001) were decreased in the late period. The 30-day major complication rate was reduced by 19.6% (5.1% vs 4.1%; P < .0001), with decreased renal failure (1.4% vs 1.0%; P = .003), cardiopulmonary complications (2.2% vs 1.7%; P = .006), and wound complications (2.5% vs 1.8%; P < .001). All the decreasing trends of mortality, any 30-day complication, and each type of major complication were statistically significant. Being treated in the late period was independently associated with decreased 30-day major complications (odds ratio, 0.75; 95% confidence interval, 0.65-0.87; P < .001), and this effect was confirmed in the propensity score-matched cohort (odds ratio, 0.76; 95% confidence interval, 0.66-0.90; P < .001). CONCLUSIONS: Although the 30-day mortality remains similar, postoperative complications in EVAR have decreased significantly during the recent decade. The continuous improvement in endograft technology and surgical skills has resulted in decreased operative time, marked reduction in surgical complications, and shorter hospital length of stay after endovascular repair.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/tendências , Procedimentos Endovasculares/tendências , /tendências , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Competência Clínica , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Incidência , Curva de Aprendizado , Tempo de Internação/tendências , Masculino , Duração da Cirurgia , Segurança do Paciente , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
12.
J Surg Res ; 229: 223-229, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29936994

RESUMO

BACKGROUND: Quadricuspid aortic valve (QAV) is a rare and poorly understood congenital cardiac abnormality. This study aims to evaluate the clinical features and surgical outcomes of dysfunctional QAV. METHODS: From January 2011 to May 2017, 36 (mean age 50.7 ± 11.9 y, 19 males) of a total of 3855 patients who underwent aortic valve surgery were identified as having dysfunctional QAV (frequency 0.9%). All patients presented moderate or severe aortic regurgitation, and nine patients (25.0%) had concomitant aortic stenosis. The ascending aortic diameter was over 40 mm in seven patients (19.4%) and over 45 mm in two patients (5.6%). The most common QAV morphology was type B (n = 12, 33.3%) according to the Hurwitz-Roberts classification. RESULTS: All patients underwent aortic valve replacement and two required concomitant ascending aortic replacement. The mean follow-up time was 20.6 ± 14.2 mo. There was no early or late postoperative mortality or major complications. Pathological analysis of dilated ascending aorta demonstrated a relatively normal appearance. The ascending aorta did not grow after surgery (37.3 ± 4.1 mm versus 36.1 ± 2.5 mm, P = 0.084). Both the end-diastolic (58.1 ± 7.0 mm versus 50.0 ± 6.3 mm, P < 0.001) and end-systolic (37.7 ± 6.7 mm versus 32.8 ± 6.0 mm, P < 0.001) left ventricular dimensions were significantly decreased. CONCLUSIONS: Aortic insufficiency is the predominant pathology in dysfunctional QAV patients. The incidence and extent of aortic dilation is not significant in QAV and not associated with aortic valve phenotypes. Short- and mid-term surgical outcomes were found to be satisfactory in this study.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Implante de Prótese de Valva Cardíaca/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta/diagnóstico por imagem , Aorta/patologia , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/epidemiologia , Insuficiência da Valva Aórtica/etiologia , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/epidemiologia , Dilatação Patológica/etiologia , Ecocardiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
15.
J Thorac Cardiovasc Surg ; 155(3): 1109-1115.e1, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29223846

RESUMO

OBJECTIVE: Pulmonary artery sarcoma is an exceedingly rare malignancy. There is a lack of consensus regarding its diagnosis and treatment. We reviewed our experience in the surgical management of pulmonary artery sarcoma over an 11-year period. METHODS: From January 2005 to February 2016, 12 patients with pulmonary artery sarcoma (age 51 ± 14 years, 5 male) underwent surgical treatment at our center. Nine patients (75%) exhibited pulmonary trunk involvement on computed tomography angiography. Six patients (50%) were initially misdiagnosed with pulmonary embolism. RESULTS: Ten patients underwent pulmonary endarterectomy, and 3 of these patients required additional unilateral pneumonectomy. The remaining 2 patients underwent exploratory thoracotomy. One patient (8.3%) died in the hospital. The median length of postoperative intensive care unit and hospital stay were 1 day (range, 1-15 days) and 8 days (range, 5-21 days), respectively. The median postoperative survival of the total series was 18 months. Patients who received postoperative combined chemo- and radiotherapy were associated with improved survival compared with those who had isolated adjuvant therapy or surgery alone (median survival 28 vs 8 months, P = .042). CONCLUSIONS: Although pulmonary artery sarcoma has a very poor prognosis, surgical treatment offers a chance for symptom relief and better long-term outcome. Aggressive postoperative adjuvant treatment may be necessary to improve survival.


Assuntos
Embolectomia , Endarterectomia , Artéria Pulmonar/cirurgia , Sarcoma/cirurgia , Neoplasias Vasculares/cirurgia , Adulto , Idoso , Biópsia , Quimiorradioterapia Adjuvante , Quimioterapia Adjuvante , Angiografia por Tomografia Computadorizada , Embolectomia/efeitos adversos , Embolectomia/mortalidade , Endarterectomia/efeitos adversos , Endarterectomia/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Pneumonectomia , Complicações Pós-Operatórias/mortalidade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Radioterapia Adjuvante , Fatores de Risco , Sarcoma/diagnóstico por imagem , Sarcoma/mortalidade , Sarcoma/secundário , Toracotomia , Fatores de Tempo , Resultado do Tratamento , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/mortalidade , Neoplasias Vasculares/patologia , Adulto Jovem
16.
Interact Cardiovasc Thorac Surg ; 26(2): 210-215, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29049790

RESUMO

OBJECTIVES: Sinus of Valsalva aneurysms (SVAs) are rare and are often complicated by aortic insufficiency (AI). Treating AI is important for achieving good long-term results in patients with SVA. Here, we have summarized our experience with the surgical management of patients with SVA with concomitant AI. METHODS: Patients who were diagnosed with SVA and underwent surgical treatment between January 2008 and May 2016 were included. Clinical characteristics, including age, gender, SVA anatomy and concurrent anomalies, were analysed. The surgical strategies, intraoperative results and early and late outcomes were evaluated. RESULTS: A total of 178 patients (age 37.4 ± 13.1 years, 114 men) were identified. Eighty-seven (48.9%) patients had at least 2+ AI preoperatively. Patients with AI had a significant higher incidence of right coronary SVA with concomitant ventricular septal defects (80.5% vs 54.9%, P < 0.001). Concurrent aortic valve surgery was performed in 70 patients with 63 valve replacements and 7 valve repairs. The other 17 patients underwent SVA repair only. The mean follow-up time was 44.4 ± 33.8 months. During the follow-up, no patients who underwent valve replacement experienced perivalvular leakage, whereas 7 patients who underwent aortic valve repair had trivial-to-mild AI and 3 of the 17 patients who underwent SVA repair only presented with moderate AI. CONCLUSIONS: Various surgical techniques can be utilized to manage concomitant AI without compromising short-term outcomes. Valve replacement yields good long-term results. According to our experience, valve repair, especially valve-sparing procedures performed by experienced surgeons, could be an acceptable option when managing concomitant AI in young patients.


Assuntos
Aneurisma Aórtico/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Seio Aórtico/cirurgia , Adolescente , Adulto , Idoso , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seio Aórtico/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
17.
J Thorac Dis ; 9(9): 3148-3153, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29221290

RESUMO

Background: It is recommended that dilated ascending aortas (≥45 mm) should be replaced at the time of aortic valve replacement (AVR) for bicuspid aortic valve (BAV). The risk of progressive sinus of Valsalva dilatation after AVR and ascending aorta replacement is less clear. Methods: We identified 156 patients (age 56.2±10.8 years, 46 females) who underwent AVR and ascending aorta replacement in our institution from 2010-2014, 124 (79%) of whom had BAV. Aortic root and ascending aorta sizes were determined from preoperative and the most recent echocardiograms. The mean follow-up time was 34.4±22.3 months, and 97% of patients completed the follow-up. Results: The operative mortality rate was 1.3%. During a follow-up of up to 75.2 months, there were no late reoperations for aortic root dissection or rupture. The mean preoperative aortic root diameters in the tricuspid aortic valve (TAV) and BAV groups were 42.2±5.4 and 37.5±5.4 mm, respectively (P=0.69). After operation, most of the patients had reduced aortic root sizes, as the mean postoperative root diameters in the TAV and BAV groups were 39.6±5.2 and 35.7±5.1 mm, respectively (P=0.99). Conclusions: To avoid the risks associated with aortic root replacement, it is reasonable to spare the aortic roots in the setting of AVR and ascending aorta replacement for BAV with a dilated ascending aorta and relatively normal sinuses of Valsalva.

19.
J Thorac Dis ; 9(6): E547-E550, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28740694

RESUMO

Thoracic aortic aneurysm with subsequent dissection is a very rare but dangerous complication of Behcet's disease, which is a systemic syndrome that can involve blood vessels of all sizes. Surgical experience in dealing with this complication in patients with Behcet's disease has been limited. We report a 20-year-old patient with Behcet's disease who presented with a giant dissecting thoracic aortic aneurysm. The patient was successfully treated with an aortic root and arch replacement using a frozen elephant trunk technique. Timely surgical intervention and appropriate long-term medical management are important for these patients.

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