Sensitivity of fecal immunochemical test and risk factors for interval colorectal cancer in a French population

BackgroundColorectal cancer (CRC) screening using fecal immunochemical testing (FIT) aims to detect pre-symptomatic colorectal lesions and reduce CRC mortality.AimsThe objectives of this study were to determine the FIT sensitivity for diagnosis of CRC, the impact of diagnostic circumstances on treatment and survival, and risk factors for interval cancer (IC).MethodsThis population-based study evaluated the 2016–2017 CRC screening campaign in Finistère, France. CRCs were classified according to diagnostic circumstances: screen-detected CRC (SD-CRC), CRC with delayed diagnosis, IC after negative FIT (FIT-IC), post-colonoscopy CRC, CRC in non-responders and CRC in the excluded population.ResultsThis study included 909 CRCs: 248 SD-CRCs (6% of positive FIT) and 60 FIT-ICs (0.07% of negative FIT). The FIT sensitivity for CRC was 80.5% (CI95%: 76.1–84.9) at the threshold of 30 µg hemoglobin/g feces used in France. In multivariate analysis, proximal (OR:6.73) and rectal locations (OR:7.52) were associated with being diagnosed with FIT-IC rather than SD-CRC. The FIT positivity threshold maximizing the sum of sensitivity and specificity was found to be 17 µg/g, with 14 additional CRCs diagnosed compared to the current threshold.ConclusionsOur study confirms the good sensitivity of FIT. A decrease of the FIT detection threshold could optimize sensitivity.     

Evaluation of a risk score based on dietary and lifestyle factors to target a population at risk in colorectal cancer screening

BackgroundThe aim of our study was to assess three risk scores to predict lesions, advanced neoplasia (high-risk adenomas and colorectal cancer (CRC)) and CRC in individuals who participate to colorectal cancer screening.MethodsThe data of dietary and lifestyle risk factors were carried out during 2 mass screening campaigns in France (2013–2016) and the FOBT result was collected until December 2018. The colonoscopy result in positive FOBT was recovered. Three risk scores (Betés score, Kaminski score and adapted-HLI) were calculated to detect individuals at risk of lesions.ResultsThe Betés score had an AUROC of 0.63 (95% CI, [0.61–0.66]) for lesions, 0.65 (95% CI, [0.61–0.68]) for advanced neoplasia and 0.65 (95% CI, [0.58–0.72]) for predicting screen-detected CRC.The adapted HLI score had an AUROC of 0.61 (95% CI, [0.58–0.65]) for lesions, 0.61 (95% CI, [0.56–0.65]) for advanced neoplasia and 0.55 (95% CI, [0.45–0.65]) for predicting screen-detected CRC.The Kaminski score had an AUROC of 0.65 (95% CI, [0.63–0.68]) for lesions, 0.65 (95% CI, [0.61–0.68]) for advanced neoplasia and 0.69 (95% CI, [0.62–0.76]) for predicting screen-detected CRC.ConclusionA simple questionnaire based on CRC risk factors could help general practitioners to identify participants with higher risk of significant colorectal lesions and incite them to perform the fecal occult blood test.     

In-Hospital Outcomes with Transfemoral Versus Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Peripheral Arterial Disease

BackgroundThere is a paucity of data regarding outcomes with transfemoral (TF) versus transapical (TA) access for transcatheter aortic valve replacement (TAVR) in patients with peripheral artery disease (PAD).MethodsWe queried the national inpatient sample database (NIS) (2012−2013) to identify patients with PAD who underwent TAVR. We conducted a propensity matching analysis using 25 clinical variables to compare TF-TAVR versus TA-TAVR. The main outcome was in-hospital mortality.ResultsThe analysis included 22,349 patients who underwent TAVR, among those 6692 (29.9%) had PAD. In the matched cohort, in-hospital mortality was similar between TF-TAVR and TA-TAVR groups (4.8% vs. 5.1%, OR 0.95; 95%CI 0.74–1.21). TF-TAVR was associated with lower rates of cardiogenic shock (OR 0.64; 95%CI 0.50–0.82), use of mechanical circulatory support (OR 0.56; 95%CI 0.42–0.75), acute kidney injury (OR 0.76; 95%CI 0.67–0.86), hemodialysis (OR 0.51; 95%CI 0.36–0.71), major bleeding (OR 0.72; 95%CI 0.64–0.80), blood transfusion (OR 0.65; 95%CI 0.58–0.73), discharge to a skilled nursing facility (OR 0.61; 95%CI 0.54–0.68) as well as shorter length of hospital stay (8.13 ± 6.76 vs. 10.11 ± 7.80 days) compared with TA-TAVR. However, TF-TAVR was associated with higher rate of vascular complications (11.7% vs. 3.7%, OR 3.40; 95%CI 2.63–4.38), complete heart block (OR 1.52; 95%CI 1.23–1.87), and pacemaker insertion (OR = 1.58; 95%CI: 1.28–1.94). There was no difference between both groups in the rate of cerebrovascular accidents (OR 1.26; 95%CI 0.93–1.72).ConclusionIn this observational analysis from a large national database, there was no difference in in-hospital mortality between TF-TAVR and TA-TAVR among patients with PAD. Further studies are encouraged to identify the optimal access for TAVR in patients with PAD.     

Factors associated with participation in colorectal cancer screening in Korea: the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV)

Purpose

Despite the Government’s National Cancer Screening Program for colorectal cancer (CRC), the number of individuals participating in screening in Korea is low. Therefore, the aim of this study was to identify associations between relevant risk factors and the uptake of screening in Korea.

Methods

The Health Interview Survey sub-dataset derived from the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV) was used to evaluate participation in CRC screening and factors associated with attendance in individuals aged ≥50. Those that completed the questionnaire and not previously diagnosed with CRC were enrolled (8,042 subjects). Multi-dimensional covariates were considered as potential predictors for CRC screening in multivariate analyses.

Results

A total of 33.2% complied with the CRC screening recommendations. The following were associated with participation: age (aged 70 or older [ref], aged 70 or over; odds ratio (OR) 1.81, 95% confidence interval (CI) 1.54–2.14), marital status (OR 1.43, 95%CI 1.23–1.66), urban-dwelling (OR 1.16, 95%CI 1.02–1.32), education level (elementary school or less [ref], high school (OR 1.29, 95%CI 1.09–1.53), university or higher (OR 1.53, 95%CI 1.23–1.91)), household income (fourth quartile [ref], first quartile (OR 1.29, 95%CI 1.07–1.56)), private health insurance (OR 1.38, 95%CI 1.21–1.58), smoking (OR 1.35, 95%CI 1.43–1.60), self-reported depression (OR 0.79, 95%CI 0.68–0.92), and number of chronic diseases (0–3 [ref], ≥4 (OR 1.41, 95%CI 1.22–1.62)).

Conclusion

To improve participation in CRC screening, appropriate strategies must be directed toward vulnerable populations, such as those with low socioeconomic status.     

Sleep disturbances and risk of falls in an old Chinese population-Rugao Longevity and Ageing Study

BackgroundTo explore the relationship between sleep disturbances and falls in an elderly Chinese population.MethodsData from 1726 individuals aged 70–87 years from the Rugao Longevity and Ageing Study were used. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep variables. Outcomes were falls ≥1 time per year and falls ≥2 times per year.ResultsA total of 22.7% of the participants experienced ≥1 fall, and 9.8% experienced ≥2 falls per year. Poor sleep quality was associated with ≥1 fall (OR 1.08, 95% CI 1.05–1.12; OR 1.27, 95% CI 1.14–1.41) and ≥2 falls (OR 1.08, 95% CI 1.03–1.14; OR 1.28, 95% CI 1.10–1.48), with an increase per PSQI score and SD PSQI score, respectively. In addition, sleep quality, sleep latency, sleep efficiency, and sleep disturbance subcomponents were associated with an increased risk of ≥1 fall with ORs of 1.44 (95% CI, 1.21–1.72), 1.23 (95%CI,1.09–1.40), 1.12 (95%CI, 1.01–1.23) and 1.70 (95% CI,1.35–2.14), respectively, and were associated with an increased risk of ≥2 falls with ORs 1.54 (95%CI, 1.22–1.96), 1.21(95%CI, 1.02–1.44), 1.17 (95% CI 1.02–1.33), and 1.78 (95%CI, 1.31–2.44), respectively. Further, participants slept ≤5 h per night had an increased risk of ≥1 fall (OR 2.34; 95%CI, 1.59–3.46) and ≥2 falls (OR 2.19; 95%CI, 1.30–3.69).ConclusionsPoor sleep quality and several subcomponent sleep symptoms were consistently associated with increased risk of falls ≥1 time and ≥2 times in Chinese elderly. The identification of sleep disturbances may help identify high-risk Chinese elders who may benefit from fall prevention education.     

Colorectal cancer surveillance in Portuguese families with lynch syndrome: a cohort study

Purpose

Lynch syndrome (LS) is associated with a high risk of colorectal cancer (CRC). The aim of this study was to assess the cumulative risk for the development of colorectal adenomas or carcinomas in a LS CRC surveillance program and to audit the quality of the endoscopic procedures.

Methods

We evaluated 147 asymptomatic LS mutation carriers, without previous CRC, in a surveillance program with colonoscopy every 12–18 months, between 2005 and 2016. Data was obtained by retrospective review of colonoscopy reports and hospital clinical files. The main outcome was assessed using Kaplan–Meier curves. Logistic regression was used to study the risk of developing adenomas.

Results

Patients were under surveillance for 1092 observation years (mean, 7.7 years/patient). Most exams presented adequate bowel preparation (83.5%) and 99.2% achieved cecal intubation. The estimated risk for adenomas at age 60 was 75.6% in men (95%CI, 60.5–88.3) and 65.5% in women (95%CI, 50.8–79.7). Male gender (OR 2.4; 95%CI, 1.2–4.9; p?=?0.018) and age at start of surveillance >?40 years (OR 3.7; 95%CI, 1.8–7.7; p?<?0.001) were independent risk factors for adenoma detection. CRC was diagnosed in 11 patients with an estimated cumulative risk at age 60 of 18.4% (95%CI, 9.2–34.8%); 72.7% of CRC were classified as stage I; no patient died from CRC.

Conclusion

A colonoscopic surveillance program in LS patients allowed the detection of adenomas in a large group of mutation carriers and diagnosis of early-stage carcinomas. Our findings may help other teams to adopt similar strategies or to refer patients early to specialized centers.

     

Loss of independence as a metric for racial disparities in lower extremity amputation for diabetes: A National Surgery Quality Improvement Program (NSQIP) analysis

IntroductionThis study assessed the association between race/ethnicity and amputation with mortality and loss of independence (LOI) for diabetic gangrene.MethodsWe analyzed the American College of Surgeons National Surgery Quality Improvement Program database from 2016 to 2019. Chi-squared tests were performed to evaluate differences in baseline characteristics and complications. Multivariable logistic regression was performed to model LOI and 30-day mortality.Results5250 patients with diabetes underwent lower extremity amputation as treatment for gangrene. Hispanic patients were more likely to undergo below the knee amputation (BKA) (P = 0.006). Guillotine amputation (GA) was associated with age > 65 (P < 0.0001), independent functional status prior to admission (P < 0.0001), and mortality (OR 1.989, 95%CI 1.29–3.065), but was not associated with LOI. Mortality was less frequent in Black patients (OR 0.432, 95%CI 0.207–0.902), but loss of independence (LOI) was more frequent in Black patients (OR 1.373, 95%CI 1.017–1.853). Hispanic patients were less likely to experience LOI (OR 0.575, 95%CI 0.477–0.693).ConclusionsLOI and mortality provide contrasting perspectives on outcomes following lower extremity amputation. Further assessment of risk factors may illuminate healthcare disparities.     

Syncope in the German Nationwide inpatient sample – Syncope in atrial fibrillation/flutter is related to pulmonary embolism and is accompanied by higher in-hospital mortality

AimsSyncope is a common phenomenon in the general population. Although most of the causes are of benign origin, some comorbidities are accompanied by high mortality.We aimed to compare the in-hospital mortality of patients with syncope related to different comorbities and investigate the impact of syncope in patients with atrial fibrillation/flutter (AF).MethodsThe nationwide inpatient sample of Germany of the years 2011–2014 was used for this analysis. Patients with syncope (ICD-code R55) were stratified by presence of selected comorbidities. Additionally, AF patients with and without syncope were compared. Incidence of syncope and in-hospital mortality were calculated. Syncope as a predictor of adverse outcome in AF patients was investigated.ResultsIn total, 1,628,859 hospitalizations of patients with syncope were identified; incidence was 504.6/100,000 citizens/year with case-fatality rate of 1.6%. Patients with syncope revealed frequently comorbidities as AF, heart failure and pneumonia. In-hospital mortality was high in syncope patients with pulmonary embolism (PE, 13.0%), pneumonia (12.8%), myocardial infarction (MI, 9.7%) and stroke (8.5%).We analysed 1,106,019 hospitalizations (52.9% females, 54.9% aged > 70 years) of patients with AF (2011–2014). Among these, 23,694 (2.1%) were coded with syncope and 0.7% died. Syncope had no significant impact on in-hospital mortality (OR 1.04, 95%CI 0.92–1.17, P = .503) independently of age, sex and comorbidities, but was associated with PE (OR 1.83, 95%CI 1.42–2.36, P < .001), MI (OR 1.68, 95%CI 1.48–1.90, P < .001), stroke (OR 1.66, 95%CI 1.42–1.94, P < .001) and pneumonia (OR 1.26, 95%CI 1.16–1.37, P < .001).ConclusionsSyncope is a frequent cause for referrals in hospitals. While the overall in-hospital mortality rate is low (<2%), syncope in coprevalence with PE, pneumonia, MI and stroke showed a mortality rate > 8%. Syncope in AF patients had no independent impact on in-hospital mortality.     

Factors associated with non-presentation in a multidisciplinary team meeting for colon cancer: A matched retrospective cohort study in a French area

BackgroundSurvival of patients with colon cancer has increased in recent years due to advances in treatment and the implementation of multidisciplinary team meetings (MDTm). However, the organization of MDTm can be improved. The objectives of this work were to characterize patients with colon cancer who were not presented in MDTm and to analyse the reasons for their non-presentation.MethodsThe study was based on a retrospective cohort including patients with colon cancer diagnosed between 2014 and 2016. Risk factors for non-presentation in MDTm were investigated after 1:1 matching on age, gender and tumour location, using multivariate analysis.Resultsamongst 1616 patients diagnosed with colon cancer, 20.5% were not presented in MDTm. The most common reasons for non-presentation were ‘advanced age or poor general condition’ (22.6%) and ‘superficial tumour’ (20.5%), while 20.8% of non-presentation remained unexplained. Non-presentation in MDTm was associated with ECOG PS of 2 (OR 0.51, 95%CI 0.32–0.81, p = 0.005), best supportive care (OR 0.05, 95%CI 0.00–0.38, p = 0.016) and early death (OR 0.09, 95%CI 0.04–0.19, p<0.001). By contrast, patients with symptomatic tumours were more likely to be presented in MDTm than patients participating in mass screening (OR 2.16, 95%CI 1.09–4.32, p = 0.028). Presentation was significantly associated with diagnosis by a digestive surgeon (OR 2.16, 95%CI 1.22–3.92, p = 0.01) and a high UICC stage.ConclusionsThis study identified factors associated with non-presentation in a multidisciplinary team meeting for colon cancer such as an advanced age or a superficial tumour, paving the way for targeted improvements.     

Neuraminidase inhibitors are effective and safe in reducing influenza complications: meta-analysis of randomized controlled trials.

BackgroundThere is scarce evidence verifying the impact of neuraminidase inhibitors (NAIs) in reducing influenza complications. The aim was to evaluate the available evidence from randomized-controlled trials (RCT) regarding the efficacy and safety of NAIs in reducing influenza complications.MethodsA systematic search of the literature was performed in the Cochrane Library, PubMed and Web of Science databases (2006–2019). Eligibility criteria were RCT that enrolled patients of any age or clinical severity with seasonal influenza (H₁N₁, H₃N_2, or B) or influenza-like syndrome and receiving NAIs comparing to placebo therapy.ResultsEighteen RCTs (9004 patients) were included: nine focused on oral oseltamivir, six on inhaled zanamivir, and three on intravenous peramivir. Administration of NAIs therapy significantly decreased the time to clinical resolution (median difference: -17.7 hours; and total influenza-related complications (OR: 0.64, 95%CI: 0.51–0.82). In addition, NAIs significantly decreased acute otitis media complication (OR: 0.50, 95%CI: 0.31–0.82) and need for antibiotic treatment (OR: 0.64, 95%CI: 0.46–0.90); and showed a trend towards a reduced occurrence of pneumonia (OR: 0.44, 95%CI: 0.10–2.00), bronchitis (OR: 0.80, 95%CI: 0.43–1.48), sinusitis (OR: 0.73, 95%CI: 0.40–1.32), asthma exacerbations (OR: 0.57, 95%CI: 0.28–1.16), and hospitalizations (OR: 0.57, 95%CI: 0.24–1.38). The overall proportion of AEs tend to increase with NAIs treatment (OR: 1.16, 95%CI: 0.92–1.47). Use of NAIs was associated with a significant increase of nausea and vomiting (OR: 1.61, 95%CI: 1.04–2.50) and a decrease on diarrhea (OR: 0.81, 95%CI: 0.65–1.00).ConclusionsNAIs are effective in reducing time to clinical resolution, total influenza-related complications, otitis media, and need of antibiotic administration. Reductions on mortality, pneumonia, asthma exacerbations or hospitalization rates only did demonstrate a trend benefit in favor of NAIs. The only significant AE is the increased occurrence of nausea and vomiting.     

Impact of care pathway adherence on recovery following distal pancreatectomy within an enhanced recovery program

BackgroundIn bowel surgery, adherence to enhanced recovery program (ERP) has been associated with improved recovery. The objective of this study was to evaluate the impact of adherence to ERP elements on outcomes, and identify factors associated with successful recovery following distal pancreatectomy (DP).MethodsData for 376 patients who underwent DP managed within an ERP including 16 perioperative elements were reviewed. Primary endpoint was successful recovery, a composite outcome defined as length of hospital stay≤7 days, no severe complications nor readmissions.ResultsPatients had a mean (SD) overall adherence of 76 (14)%. Overall, 166 (44%) patients had a successful recovery. There was a positive association between overall adherence and successful recovery (OR 1.19, 95%CI 1.08–1.31 for every additional element, p = 0.001), while an inverse relationship was found with comprehensive complication index (8% reduction, 95%CI -15 to −2%, p = 0.011). Adherence to postoperative phase interventions had the greatest impact on recovery (OR 1.29, 95%CI 1.13–1.47 for every additional postoperative element; p < 0.001). At multivariable regression, early termination of IV fluids was the only ERP element associated with successful recovery (OR 2.80, 95%CI 1.73–4.54; p < 0.001).ConclusionIncreased adherence to ERP elements was associated with successful early recovery and reduction of postoperative complication severity.     

Thirty-Day Readmissions After Chronic Total Occlusion Percutaneous Coronary Intervention in the United States: Insights From the Nationwide Readmissions Database

BackgroundSeveral studies have investigated early readmissions after percutaneous coronary interventions (PCIs). However, studies investigating 30-day readmission following PCI for chronic total occlusion (CTO) are lacking.MethodsThe National-Readmission-Database (NRD) was queried to identify patients undergoing elective CTO PCI between January 1, 2016 and December 31, 2016. We assessed the incidence, predictors, and cost of 30-day readmissions.ResultsA total of 30,579 CTO PCIs were identified in the NRD. After excluding patients who had acute myocardial infarction (n = 14,852), the final cohort included 15,907 patients. In this group of patients, 254 patients (1.5%) expired during their index admission and, 1600 patients (10%) had an unplanned readmission within 30 days. Cardiac causes constituted 54.2% of all causes of readmission. During the readmission, 15.8% of patients had coronary angiography, 8.4% underwent PCI, and 0.9% underwent bypass grafting. Independent predictors of 30-day readmission included baseline characteristics [age (OR 0.99, 95%CI 0.98–0.99), female (OR 1.14, 95%CI 1.01–1.28), lung disease (OR 1.36, 95%CI 1.20–1.55), heart failure (OR 1.42, 95%CI 1.24–1.62), anemia (OR 1.30, 95%CI 1.12–1.50), vascular disease (OR 1.18, 95%CI 1.03–1.35), history of stroke (OR 1.50, 95%CI 1.28–1.76) and the presence of a defibrillator (OR 1.68, 95%CI 1.39–2.03)], and procedural complications [acute kidney injury (OR 1.55, 95%CI 1.33–1.80) and gastrointestinal bleeding (OR 1.67, 95%CI 1.03–2.71)].ConclusionsOne-tenth of patients undergoing CTO PCI are readmitted within 30-days, mostly for cardiac causes. The majority undergo angiography but <10% receive revascularization. Certain patient and procedural characteristics independently predicted 30-day readmission.     

The impact of frailty on the postoperative outcomes of patients undergoing cholecystectomy: propensity score matched analysis of 2011–2017 US hospitals

BackgroundFrailty is an aggregate variable that encompasses debilitating geriatric conditions, which potentially affects postoperative outcomes. In this study, we evaluate the relationship between clinical frailty and post-cholecystectomy outcomes using a national registry of hospitalized patients.Methods2011–2017 National Inpatient Sample database was used to identify patients who underwent cholecystectomy. Patients were stratified using the Johns Hopkins ACG frailty definition into binary (frailty and no-frailty) and tripartite frailty (frailty, prefrailty, no-frailty) indicators. The controls were matched to study cohort using 1:1 propensity score-matching and postoperative outcomes were compared.ResultsPost-match, using the binary term, frail patients (n = 40,067) had higher rates of mortality (OR 2.07 95%CI 1.90–2.25), length of stay, costs, and complications. In multivariate, frailty was associated with higher mortality (aOR 2.06 95%CI 1.89–2.24). When using tripartite frailty term, prefrail (n = 35,595) and frail (n = 4472) patients had higher mortality (prefrailty: OR 2.04 95%CI 1.86–2.23; frailty: OR 2.49 95%CI 1.99–3.13), length of stay, costs, and complications. In multivariate, prefrailty and frailty were associated with higher mortality (prefrailty: aOR 2.02 95%CI 1.84–2.21; frailty: aOR 2.54 95%CI 2.02–3.19).ConclusionThis study shows the presence of frailty (and prefrailty) is an independent risk factor of adverse postoperative outcomes in patients undergoing cholecystectomy.     

The impact of upper gastrointestinal surgical volume on short term pancreaticoduodenectomy outcomes for pancreatic adenocarcinoma in the SEER-Medicare population

BackgroundPatients undergoing pancreaticoduodenectomy (PD) at low volume PD hospitals with high volume for other complex operations have comparable outcomes to high volume PD centers. We evaluated the impact of upper gastrointestinal operations (UGI) hospital volume on the outcomes of elderly, high risk patients undergoing PD.MethodsPatients >65 years old who underwent PD for pancreatic adenocarcinoma were identified from SEER-Medicare (2008–2015). Four volume cohorts were created using PD tertiles and UGI median: low (1st tertile PD), mixed-low (2nd tertile PD, low UGI), mixed-high (2nd tertile PD, high UGI) and high (3rd tertile PD). Multivariable logistic and negative binomial regression assessed short-term complications.ResultsIn total, 2717 patients were identified with a median age of 74.5 years. Patients treated at low, mixed-low and mixed-high volume hospitals, versus high volume, had higher risk of short-term complications, including major complications (low: OR 1.441, 95%CI 1.165–1.783; mixed-low: OR 1.374, 95%CI 1.085–1.740; mixed-high: OR 1.418, 95%CI 1.098–1.832) and 90-day mortality (low: OR 2.16, 95%CI 1.454–3.209; mixed-low: OR 2.068, 95%CI 1.347–3.175; mixed-high: OR 1.96, 95%CI 1.245–3.086).ConclusionPatients with pancreatic adenocarcinoma who are older and more medically complex benefit from undergoing surgery at high volume PD centers, independent of the operative experience of that center.     

The Relationship between Particulate Matter (PM10) and Hospitalizations and Mortality Of Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Abstract

Background: Numerous studies have reported variable associations between ambient particulate matter (PM) and chronic obstructive pulmonary disease (COPD) hospitalizations and mortality. Objective: To conduct a systematic study assessing the associations between hospitalizations and mortality from COPD and ambient PM₁₀ (particulate matter with aerodynamic diameters ≤ 10 μm, PM₁₀). Methods: Systematic searches were conducted in 6 common electronic databases. A meta-analysis was performed to estimate the odds ratio (OR) to evaluate the relationship between PM₁₀ and COPD hospitalizations and mortality. Publication bias and heterogeneity of samples were tested by Begg funnel plot and Egger test, respectively. Study findings were analyzed using random-effect model and fixed-effect model. Results: The search yielded 31 studies suitable for the meta-analysis during the period from Jan 1, 2000 to Oct 31, 2011. A 10μg/m³ increase in PM₁₀ was associated with a 2.7% (95%CI = 1.9%-3.6%) increase in COPD hospitalizations with an OR of 1.027 (95%CI: 1.019–1.036), and a 1.1% (95%CI: 0.8%–1.4%) increase in COPD mortality with an OR of 1.011 (95%CI: 1.008–1.014). Conclusions: Ambient PM₁₀ is associated with increased COPD hospitalizations and mortality. Further research is needed to elucidate whether this association is causal and to clarify its mechanisms.     

Non-HACEK gram negative bacilli endocarditis: Analysis of a national prospective cohort.

BackgroundInfective endocarditis (IE) due to non-HACEK bacilli (Haemophilus species, Actinobacillus, Cardiobacterium, Eikenella, or Kingella) is uncommon and poorly described. The objectives of this study were to describe non-HACEK Gram-Negative Bacilli (GNB) IE cases and compare characteristic of IE produced by Enterobacterales and non-fermenting (NF) GNB.MethodsFrom January 2008 to December 2018, 3910 consecutive patients with definitive IE diagnosis, defined with Modified Duke criteria, either clinical or pathological criteria (e.g. demonstration of non-HACEK GNB in valve culture)were prospectively included.ResultsA total of 104 IE cases were caused by non-HACEK GNB (2.6%). Compared to IE due to other microorganisms (excluding HACEK GNB), patients with non-HACEK GNB IE presented with higher age (71 years [IQR 62–78] vs 68 years [IQR: 57–77]; p = 0.026), higher proportion of women (52% vs 31.5%, p < 0.001), higher Charlson Index (5 [IQR: 4–8] vs 4 [IQR 3–7], p = 0.003) and higher in-hospital mortality (36.5% vs 27.1%, p = 0.034). Enterobacterales cases were more frequently associated with genitourinary focus (32.8% vs 5.0%, p = 0.001). NFGNB endocarditis more frequently affected right valves (20.0% vs. 6.3%, p = 0.033), had more common healthcare-related acquisition (67.5% vs. 43.7%, p = 0.030) and venous catheter as focus (40.0% vs. 17.2%, p = 0.019). In the multivariant model, factors related with hospital mortality were: age (OR 1.05, 95%CI 1.00–1.09, p = 0.042), prosthetic valve (OR 2.31, 95%CI 0.90–5.88, p = 0.080), and not performing surgery when indicated (OR 3.60, 95%CI 1.17–11.05, p = 0.025).Patients treated with quinolone combination had lower mortality (OR 0.29; 95%CI 0.09–0.96; p = 0.043).ConclusionNon-HACEK GNB IE is a rare infection characterized by affecting elderly patients with high comorbidity, nosocomial acquisition and unfavorable outcome. Age, prosthetic valve and not performing surgery when indicated are associated with mortality.     

Periprocedural Myocardial Injury and Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Replacement

Background/purposePPMI and CAD are common in patients undergoing TAVR. Despite several studies evaluating their interaction as well as the influence these factors play on outcomes, there remains no consensus. We sought to evaluate the impact of peri-procedural myocardial injury (PPMI) and incidental coronary artery disease (iCAD) on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).Methods/materialsWe analyzed prospective data from 400 patients undergoing TAVI for severe aortic stenosis between 2008 and 2018 to determine rates of PPMI (troponin 15× the upper limit of normal) and iCAD (≥50% stenosis) and their impact on long-term mortality.ResultsMean age was 83 ± 6 years; 45% were female. PPMI was observed in 65% (254/400). On multivariable logistic regression analysis, higher left ventricular ejection fraction (LVEF) (OR 1.04, 95%CI 1.01–1.06, p = 0.002), and first generation valves (OR 3.00, 95%CI 1.75–5.15, p < 0.001) were independently associated with PPMI, while oral anticoagulation was inversely associated (OR 0.48, 95%CI 0.28–0.82, p = 0.007). PPMI was not associated with 30-day, 1-year or long-term mortality. After excluding previous bypass grafting, iCAD was observed in 40% (129/324). In patients with iCAD, PCI was associated with reduced long-term mortality compared to medical management in adjusted analysis (OR 0.37, 95%CI 0.16–0.88, p = 0.03).ConclusionsPPMI and iCAD in patients undergoing TAVR are common. PPMI is associated with older generation valves and higher LVEF rather than traditional cardiovascular risk factors. In our study, PPMI was not associated with long-term mortality. However, in patients with iCAD, PCI was associated with reduced long-term mortality compared to medical management.     

The risk of developing a mismatch repair deficient colorectal cancer after undergoing cholecystectomy

Objectives: Mismatch repair deficient (dMMR) colorectal cancer (CRC) is caused by inactivation of the MMR DNA repair system, most commonly via epigenetic inactivation of the MLH1 gene, and these tumors occur most frequently in the right colon. The objective was to determine whether cholecystectomy (CCY) increases the risk of a dMMR CRC by comparing CCY incidence in patients with dMMR CRC and proficient MMR (pMMR) CRC to unaffected controls.

Materials and methods: All patients diagnosed with CRC in Iceland from 2000 to 2009 (n?=?1171) were included. They had previously been screened for dMMR by immunohistochemistry (n?=?129 were dMMR). Unaffected age- and sex-matched controls (n?=?17,460) were obtained from large Icelandic cohort studies. Subjects were cross-referenced with all pathology databases in Iceland to establish who had undergone CCY. Odds ratios were calculated using unconditional logistic regression.

Results: Eighteen (13.7%) dMMR CRC cases and 90 (8.7%) pMMR CRC cases had undergone CCY compared to 1532 (8.8%) controls. CCY-related odds ratios (OR) were 1.06 (95% CI 0.90–1.26, p?=?.577) for all CRC, 1.16 (95% CI 0.66–2.05 p?=?.602) for dMMR CRCand 1.04 (95% CI 0.83–1.29, p?=?.744) for pMMR CRC. Furthermore, OR for dMMR CRC was 0.51 (95% CI 0.16–1.67, p?=?.266), 2.04 (95% CI 0.92–4.50, p?=?.080) and 1.08 (95% CI 0.40–2.89, p?=?.875)?<10 years, 10–20 years and?>20 years after a CCY, respectively.

Conclusions: There was no evidence of increased risk of developing dMMR CRC after CCY although a borderline significantly increased 2-fold risk was observed 10–20 years after CCY. Larger studies are warranted to examine this further.