Does Dosage or Duration of Concurrent Oral Corticosteroid Influence Elevated Risk of Postoperative Complications After Total Joint Arthroplasty?

BackgroundThis report seeks to clarify whether the dosage and duration of preoperative concurrent corticosteroid use influence postoperative complications after primary total joint arthroplasty (TJA).MethodsThis retrospective single institutional study enrolled 1128 primary TJA cases, including 905 total hip arthroplasties and 223 total knee arthroplasties at a minimum 6 months of follow-up. Mean follow-up period was 51.9 ± 34.1 months (range 6-146). Of all joints, 120 joints (10.6%) were associated with chronic concurrent oral corticosteroid use. Multivariate analysis was performed to identify whether chronic concurrent oral corticosteroid use elevated the risk of postoperative complications including surgical site infection/periprosthetic joint infection, delayed wound healing, periprosthetic fracture, and implant loosening. For chronic concurrent oral corticosteroid user, we determined whether the dosage and duration of preoperative concurrent corticosteroid use influenced postoperative complications and have an effective threshold for postoperative complications using receiver operating characteristic curve analysis.ResultsThe multivariate analysis revealed that American Society of Anesthesiologist Physical Status 3 was an independent risk factor for postoperative complications, while concurrent oral corticosteroid use was not an independent risk factor. When we compared joints with (n = 13) and without (n = 107) postoperative complications in chronic concurrent oral corticosteroid user, there was no statistical difference in the dosage (P = .97) and duration (P = .69) between the 2 groups. Area under the curve values for the oral corticosteroid dosages and duration were 0.482 and 0.549, respectively.ConclusionThis study revealed that neither dosage nor duration of concurrent oral corticosteroid use was predictive of postoperative complications after TJA. American Society of Anesthesiologist Physical Status 3 is a major factor in postoperative complications after TJA.     

胰腺囊性肿瘤恶性风险预测模型研究

目的 明确与恶性胰腺囊性肿瘤（PCN）相关的术前危险因素，建立准确的预测模型，并予以验证。方法 纳入2013年1月至2020年5月复旦大学附属华东医院经术后病理检查证实的114例PCN病例，分为模型组（n=80）和验证组（n=34）。回顾性分析模型组术前的临床资料并探索与恶性PCN相关的影响因素，建立PCN恶性风险预测模型，绘制受试者工作特征（ROC）曲线和校正曲线评价模型，最后基于验证组数据对模型进行临床验证。结果 单因素回归分析提示临床症状、CA19-9水平升高、中性粒细胞淋巴细胞比值（NLR）、淋巴细胞单核细胞比值（LMR）、肿瘤最大直径、胰管扩张和实性成分与恶性PCN显著相关，进一步行多因素回归分析确定了NLR≥2.146、CA19-9水平升高、胰管扩张是恶性PCN的独立预测因素。基于多因素回归分析结果建立恶性PCN预测模型，绘制模型的ROC曲线，计算AUC为0.921（95%CI 0.863~0.979），Youden指数最大时取得最佳临界预测值为0.203，此时相对应的特异度为83.3%，敏感度为92.9%，准确率为85%。同时校正曲线显示模型具有较好的拟合度，最后代入验证组数据显示模型预测准确率为82.4%，特异度81.2%，敏感度100%。结论 CA19-9水平升高、NLR升高以及胰管扩张是恶性PCN的高危因素，基于此建立的恶性胰腺囊性肿瘤的预测模型具有较好的准确率，可为今后的临床诊疗提供辅助参考。     

Risk stratification in breast cancer screening: Cost-effectiveness and harm-benefit ratios for low-risk and high-risk women

In mammography screening programmes, women are screened according to a one-size-fits-all principle. Tailored screening, based on risk levels, may lead to a better balance of benefits and harms. With microsimulation modelling, we determined optimal mammography screening strategies for women at lower (relative risk [RR] 0.75) and higher (RR 1.8) than average risk of breast cancer, eligible for screening, using the incremental cost-effectiveness ratio (ICER) of current uniform screening in the Netherlands (biennial [B] 50-74) as a threshold ICER. Strategies varied by interval (annual [A], biennial, triennial [T]) and age range. The number of life-years gained (LYG), breast cancer deaths averted, overdiagnosed cases, false-positive mammograms, ICERs and harm-benefit ratios were calculated. Optimal risk-based screening scenarios, below the threshold ICER of €8883/LYG, were T50-71 (€7840/LYG) for low-risk and B40-74 (€6062/LYG) for high-risk women. T50-71 screening in low-risk women resulted in a 33% reduction in false-positive findings, a similar reduction in costs and improved harm-benefit ratios compared to the current screening schedule. B40-74 in high-risk women led to an increase in screening benefit, compared to current B50-74 screening, but a relatively higher increase in false-positive findings. In conclusion, optimal screening consisted of a longer interval and lower stopping age than current uniform screening for low-risk women, and a lower starting age for high-risk women. Extending the interval for women at lower risk from biennial to triennial screening reduced harms and costs while maintaining most of the screening benefit.     

Patterns in metabolite profile are associated with risk of more aggressive prostate cancer: A prospective study of 3,057 matched case–control sets from EPIC

Metabolomics may reveal novel insights into the etiology of prostate cancer, for which few risk factors are established. We investigated the association between patterns in baseline plasma metabolite profile and subsequent prostate cancer risk, using data from 3,057 matched case–control sets from the European Prospective Investigation into Cancer and Nutrition (EPIC). We measured 119 metabolite concentrations in plasma samples, collected on average 9.4 years before diagnosis, by mass spectrometry (AbsoluteIDQ p180 Kit, Biocrates Life Sciences AG). Metabolite patterns were identified using treelet transform, a statistical method for identification of groups of correlated metabolites. Associations of metabolite patterns with prostate cancer risk (OR_1SD) were estimated by conditional logistic regression. Supplementary analyses were conducted for metabolite patterns derived using principal component analysis and for individual metabolites. Men with metabolite profiles characterized by higher concentrations of either phosphatidylcholines or hydroxysphingomyelins (OR_1SD = 0.77, 95% confidence interval 0.66–0.89), acylcarnitines C18:1 and C18:2, glutamate, ornithine and taurine (OR_1SD = 0.72, 0.57–0.90), or lysophosphatidylcholines (OR_1SD = 0.81, 0.69–0.95) had lower risk of advanced stage prostate cancer at diagnosis, with no evidence of heterogeneity by follow-up time. Similar associations were observed for the two former patterns with aggressive disease risk (the more aggressive subset of advanced stage), while the latter pattern was inversely related to risk of prostate cancer death (OR_1SD = 0.77, 0.61–0.96). No associations were observed for prostate cancer overall or less aggressive tumor subtypes. In conclusion, metabolite patterns may be related to lower risk of more aggressive prostate tumors and prostate cancer death, and might be relevant to etiology of advanced stage prostate cancer.