Competing mortality risks among women aged 50–79 years when diagnosed with invasive breast cancer,Queensland, 1997–2012

BackgroundUnderstanding the burden of competing (non-breast cancer) mortality is important for the growing number of breast cancer survivors. We quantity these patterns, and the impact of two leading non-cancer causes of death, within ten years of breast cancer diagnosis.MethodsPopulation based cancer registry study of 23,809 women aged 50–79 diagnosed with first primary breast cancer in Queensland, Australia, 1997 to 2012 with additional data linkage to identify individual non-cancer mortality causes. Flexible parametric competing-risks models were used to estimate the crude and adjusted probabilities of death.ResultsWhile overall mortality increased with age at diagnosis, this effect was strongest for non-cancer (such as cardiovascular and cerebrovascular disease) mortality. Women diagnosed with advanced breast cancer had a higher crude probability of breast cancer death (23.1% versus 4.5% for localised) but similar probability of competing mortality (11.6% versus 11.3%). Within each category of spread of disease, the probability of breast-cancer deaths remained relatively constant with age, while the probability of competing deaths increased. The 10-year probability of dying from breast cancer was 3.7%, 4.2% and 5.6% among women with localised disease aged 50 to 59, 60–69 and 70–79 respectively, but 3.1%, 7.8% and 22.9% for competing mortality. Increasing age, advanced disease and being unpartnered were independently associated with increased risk of breast cancer and competing deaths.ConclusionsPromotion of improved health behaviors after a cancer diagnosis and development of individualized strategies for clinical management should be prioritized as part of optimal care for breast cancer survivors.     

Influence of etching with erbium, chromium:yttrium–scandium–gallium–garnet laser on microleakage of class V restoration

The aim of this in vitro study was to evaluate some parameters of dental etching when irradiated with an erbium, chromium:yttrium–scandium–gallium–garnet (Er,Cr:YSGG) laser. One-hundred sound human third molars were selected and randomly distributed into ten groups (n = 10). The class V cavities of group 1 (control) were prepared with a bur and etched with 37% phosphoric acid, while groups G2 to G10, were prepared with laser (5 W, 88.46 J/cm², 90/70% air/water) and etched with the following powers: G3 and G4, 0.25 W; G5 and G6, 0.5 W; G7 and G8, 0.75 W; G9 and G10, 1 W. Group G2 received no laser etching. Prior to restoration, G2, G4, G6, G8 and G10 received acid etching. After restoration, all samples were submitted to a microleakage test. According to statistical analysis (Kruskal–Wallis and Dunn’s tests), G10 presented the lowest microleakage values (P<0.05). The other groups showed no differences between them. Etching with Er,Cr:YSGG laser (1 W) followed by phosphoric acid was effective in reducing the microleakage of class V restorations.     

Abnormal expression of Col X, PTHrP, TGF-β, bFGF, and VEGF in cartilage with Kashin–Beck disease

The purpose of the current study was to investigate the abnormal expression of Col X, PTHrP, TGF-β, bFGF, and VEGF in cartilage from patients with Kashin–Beck disease (KBD) to understand the pathogenesis of chondronecrosis in KBD. Articular cartilage and growth plate cartilage collected were divided into four groups: control children (8 samples, 5 cases), KBD children (19 samples, 9 cases), control adults (8 samples, 6 cases), and KBD adults (16 samples, 15 cases). The presence of PTHrP, TGF-β₁, bFGF, VEGF, and collagen X in articular cartilage and in growth plate cartilage was analyzed by immunohistochemistry. Articular cartilage and growth plate were each divided in three zones, and the rate of positive cells was counted by light microscope for cytoplasmic and pericellular staining. Results showed that (1) in KBD children, Col X expression was lower in the deep zone of growth plate cartilage than in normal children; in articular cartilage of KBD adults, however, collagen X expression was higher in the middle zone compared to the controls; (2) staining for bFGF, PTHrP, TGF-β₁, and VEGF in KBD adult patients was prominent in the chondrocyte clusters and the eroded surface of articular cartilage, and the percentage of chondrocyte staining was significantly higher than in control samples (t = 3.64–10.34, df = 12 for children and 19 for adults, P = 0.002–0.0001); and (3) the enhanced PTHrP, TGF-β₁, and VEGF staining in the deep and middle zone of KBD articular cartilage correlated with the high incidence of chondronecrosis in the middle zone (48.5% ± 10.2%) and deep zone (70.6% ± 27.0%) of adult KBD cartilage. In conclusion, Col X expression was reduced in areas of chondrocyte necrosis in the deep zone of KBD articular cartilage, indicating changes in terminal chondrocyte differentiation. PTHrP, TGF-β₁, and VEGF expression was significantly altered and indicated degenerative changes in KBD cartilage, which initially resemble those occurring in osteoarthritis, but lead eventually to chondronecrosis, an event not observed in osteoarthritis.     

Hospitalisations with burns in children younger than five years in Portugal, 2011–2015

IntroductionPaediatric population still represents a high burden of hospitalisations among burns inpatients. Children under five years old have a distinct aetiology distribution comparing to other age groups, representing in Portugal a fifth of all hospitalisations with burns. We aimed to describe the demographic and clinical burden of burns requiring hospitalization, as well as hospitalization charges, among this age group in Portugal.MethodsWe performed a retrospective study including inpatients younger than five years-old and discharged between 2011 and 2015 in a public Portuguese hospital with a main or secondary diagnosis of burns (ICD-9-CM: 940.xx-949.xx). Clinical and demographics characteristics were assessed, as well as hospital reimbursement charges.ResultsA total of 1217 hospitalisations with burns were found, with a hospitalization rate of 54.6 hospitalisations/100,000 inhabitants/year, higher among boys. Ninety percent of them were due to hot liquid or objects. There were three in-hospital deaths. There was a median length of stay of 9 days and a mean hospitalization reimbursed charge of 3073 Euros (4918 I$). Non-rural: rural hospitalization rate ratio was of 0.42:1. Évora and Bragança were the districts with higher hospitalization rate with 116 and 107, respectively.DiscussionThis Portuguese nation-wide study on hospitalisations with burns highlights that 90% of all burns were due to hot liquid or object and a major impact of patients younger than 2 years old in this age group. Urban vs rural difference in hospitalization rate should also be considered for further health inequalities’ studies. As conclusion, ongoing attention needs to be dedicated to paediatric burn prevention and safety cost-effective strategies, particularly in relation to scalds, to further reduce the incidence of burn hospitalisations in children and the associated hospital costs.     

Churg–Strauss syndrome with severe granulomatous angiitis and crescentic glomerulonephritis, which developed during therapy with a leukotriene receptor antagonist

A 77-year-old Japanese female developed Churg–Strauss syndrome (CSS), showing fever and numbness in bilateral hands. She was being treated for bronchial asthma with combination inhalant of corticosteroid with beta₂-agonist, and an oral leukotriene receptor antagonist (LTRA), montelukast, for 15 months. She presented fever up to 38°C with microscopic hematuria and proteinuria, serum creatinine level of 0.7 mg/dl, and C-reactive protein of 11 mg/dl. After referral to our hospital, eosinophilia and high myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) level were observed together with hematuria and proteinuria; renal biopsy examination was performed to clarify the disorder. Renal biopsy specimens showed necrotizing crescent formation, severe granulomatous angiitis in an interlobular artery, and interstitial eosinophilic infiltration. It was noted that nearly intact glomeruli were infiltrated with eosinophils. After treatment with oral prednisolone at initial dose of 40 mg (1 mg/kg body weight), urinary findings rapidly became normal with mild elevation of serum creatinine to 1.5 mg/dl and trace level of serum C-reactive protein in 1 month. Because she was previously treated with montelukast without oral corticosteroid, linkage between CSS and LTRA was highly suspected.     

Henoch–Schönlein purpura with hypocomplementemia

Background

Abnormalities of the complement system in Henoch–Schönlein purpura (HSP) have been reported, but how this abnormality in the complement system impacts on the prognosis of HSP remains unknown.

Methods

We retrospectively studied patients hospitalized for HSP in the Children’s Hospital Affiliated to Soochow University between October 2010 and May 2011. Patients with HSP and hypocomplementemia were the cases, and those without hypocomplementemia were the HSP controls. Another group of children (n?=?50) with upper respiratory tract infections, but without HSP acted as negative controls.

Results

A total number of 338 HSP patients were included in this study (n?=?53 cases, n?=?285 controls). In the cases, C3 and C4 levels decreased in 29 patients, C3 was low in 6, and C4 in 18. Complement levels returned to normal within 3 months in all HSP patients except one. Case group patients had higher levels of serum IgG and arthralgia, as well as positive titers of antistreptolysin-O. Rates of abdominal pain, gastrointestinal bleeding, Henoch–Schönlein purpura nephritis (HSPN), and serum IgA and IgM levels were similar in the two HSP groups.

Conclusion

Hypocomplementemia associated with HSP is a transient phenomenon. The incidence of significant sequelae such as HSPN between patients with and without hypocomplementemia does not differ.

     

Dubin–Johnson syndrome with cholecystolithiasis and choledocholithiasis

INTRODUCTIONDubin–Johnson syndrome (DJS) is unusual during common medical work. Moreover, cholecystolithiasis and choledocholithiasis involvement has not been reported.PRESENTATION OF CASEWe describe a case of DJS complicated by cholecystolithiasis and choledocholithiasis. A 49-year-old man accepted by outpatient complained with intermittent cramping pain in right upper abdomen. It is diagnosed as cholecystolithiasis and choledocholithiasis. We found the dark greenish liver when the operation was performed. Liver biopsy confirms the DJS.DISCUSSIONIt is the firstly reported case DJS related to the cholecystolithiasis and choledocholithiasis.CONCLUSIONCholecystolithiasis and choledocholithiasis may develop in DJS. DJS is possible a reason for cholecystolithiasis and choledocholithiasis, not just likely a chance occurrence.     

Computed tomography–evaluated features of spinal degeneration: prevalence,intercorrelation, and association with self-reported low back pain

Background contextAlthough the role of radiographic abnormalities in the etiology of nonspecific low back pain (LBP) is unclear, the frequent identification of these features on radiologic studies continues to influence medical decision making.PurposeThe primary purposes of the study were to evaluate the prevalence of lumbar spine degeneration features, evaluated on computed tomography (CT), in a community-based sample and to evaluate the association between lumbar spine degeneration features. The secondary purpose was to evaluate the association between spinal degeneration features and LBP.Study designThis is a cross-sectional community-based study that was an ancillary project to the Framingham Heart Study.SampleA subset of 187 participants were chosen from the 3,529 participants enrolled in the Framingham Heart Study who underwent multidetector CT scan to assess aortic calcification.Outcome measuresSelf-report measures: LBP in the preceding 12 months was evaluated using a Nordic self-report questionnaire. Physiologic measures: Dichotomous variables indicating the presence of intervertebral disc narrowing, facet joint osteoarthritis (OA), spondylolysis, spondylolisthesis, and spinal stenosis and the density (in Hounsfield units) of multifidus and erector spinae muscles were evaluated on CT.MethodsWe calculated the prevalence of spinal degeneration features and mean density of multifidus and erector spinae muscles in groups of individuals with and without LBP. Using the χ² test for dichotomous and t test for continuous variables, we estimated the differences in spinal degeneration parameters between the aforementioned groups. To evaluate the association of spinal degeneration features with age, the prevalence of degeneration features was calculated in four age groups (less than 40, 40–50, 50–60, and 60+ years). We used multiple logistic regression models to examine the association between spinal degeneration features (before and after adjustment for age, sex, and body mass index [BMI]) and LBP, and between all degeneration features and LBP.ResultsIn total, 104 men and 83 women, with a mean age (±standard deviation) of 52.6±10.8 years, participated in the study. There was a high prevalence of intervertebral disc narrowing (63.9%), facet joint OA (64.5%), and spondylolysis (11.5%) in the studied sample. When all spinal degeneration features as well as age, sex, and BMI were factored in stepwise fashion into a multiple logistic regression model, only spinal stenosis showed statistically significant association with LBP, odds ratio (OR) (95% confidence interval [CI]): 3.45 [1.12–10.68]. Significant association was found between facet joint OA and low density of multifidus (OR [95% CI]: 3.68 [1.36–9.97]) and erector spinae (OR [95% CI]: 2.80 [1.10–7.16]) muscles.ConclusionsDegenerative features of the lumbar spine were extremely prevalent in this community-based sample. The only degenerative feature associated with self-reported LBP was spinal stenosis. Other degenerative features appear to be unassociated with LBP.     

Arterial hypertension during treatment with triptorelin in a child with Williams–Beuren syndrome

Background

Arterial hypertension (AHT) is a common finding in children with Williams–Beuren syndrome (WBS). Although cardiovascular and renal abnormalities can explain the AHT in some patients with WBS, its etiology is not fully understood and most cases are considered idiopathic.

Case-diagnosis/treatment

The case is reported of a 10-year-old girl with WBS who developed severe AHT during treatment with triptorelin, a long-lasting gonadotropin-releasing hormone (GnRH) analog, administered because of early normal puberty. Comprehensive diagnostic studies ruled out other known causes of AHT associated with WBS. After discontinuation of triptorelin, the blood pressure remained within the normal range for her age and height with no antihypertensive treatment on long-term follow-up. To the best of the authors’ knowledge, this is the first report of AHT associated with triptorelin administration in a child with WBS.

Conclusions

Clinicians should be aware of the possibility, although rare, of AHT developing during triptorelin administration in childhood, specifically in patients at increased risk of AHT, such as those with WBS.     

Wyburn–Mason Syndrome Variant Treated with Stereotactic Radiosurgery

Classical Wyburn–Mason syndrome consists of unilateral arteriovenous malformations affecting the retina, midbrain, and visual pathways in the brain, and the facial structures. An unusual case of Wyburn–Mason syndrome with bilateral manifestations and without retinal involvement is described. A 19-year-old girl presented at the age of 5 with a left hemiparesis and aphasia following intracerebral hemorrhage in the right internal capsule and basal ganglia. Angiography demonstrated left sylvian, right frontoparietal, and right thalamic arteriovenous malformations (AVMs). In addition to multiple intracranial AVMs, she had multiple telangiectatic lesions scattered over her body. Ophthalmological examination was normal except for left orbital bruit. Two years later, with moderate clinical improvement, she had proton beam radiosurgery for her multiple AVMs. Due to lack of beneficial effect, repeat radiosurgery with more appropriate dose is under consideration. A review of the literature revealed that our presenting case represents one of the few reported cases of atypical Wyburn–Mason syndrome with bilateral manifestations and without retinal involvement. To our knowledge, ours represent the first reported case for which radiosurgery had been offered as a treatment modality.     

Successful treatment of Epstein–Barr virus–associated primary central nervous system lymphoma due to post-transplantation lymphoproliferative disorder,with ibrutinib and third-party Epstein–Barr virus–specific T cells

Primary central nervous system lymphoma (PCNSL) occurring following organ transplantation (post-transplantation lymphoproliferative disorder [PTLD]) is a highly aggressive non-Hodgkin lymphoma. It is typically treated with high-dose methotrexate-based regimens. Outcomes are dismal and clinical trials are lacking. It is almost always Epstein–Barr virus (EBV) associated. Two patients (CA1-2) presented with EBV-associated PCNSL after renal transplant. CA1 was on hemodialysis and had prior disseminated cryptococcus and pseudomonas bronchiectasis, precluding treatment with methotrexate. CA2 was refractory to methotrexate. Both were treated off-label with the first-generation Bruton's tyrosine kinase inhibitor ibrutinib for 12 months. Cerebrospinal fluid penetration at therapeutic levels was confirmed in CA1 despite hemodialysis. Both patients entered remission by 2 months. Sequencing confirmed absence of genetic aberrations in human leukocyte antigen (HLA) class I/II and antigen-presentation/processing genes, indicating retention of the ability to present EBV-antigens. Between Weeks 10 and 13, they received third-party EBV-specific T cells for consolidation with no adverse effects. They remain in remission ≥34 months since therapy began. The strength of these findings led to an ongoing phase I study (ACTRN12618001541291).