Insomnia,Fatigue, and Depression: Theoretical and Clinical Implications of a Self-reinforcing Feedback Loop in Cancer

Introduction:Insomnia is emerging as a modifiable major risk factor for mental and physical problems, including cancer, and it may contribute to cancer-related fatigue and depression. Since both fatigue and depression may favor insomnia as well, we may hypothesize a self-reinforcing feedback loop among these factors in cancer.Methods:With the aim of discussing this hypothesis, PubMed, PsycINFO, and Embase electronic databases were searched for literature published according to the PRISMA method with several combinations of terms such as “insomnia” and “cancer” and “fatigue” and “depression”. On this basis, we conducted a narrative review about theoretical aspects of insomnia in the context of cancer and about its role in cancer-related fatigue and depression.Results:Twenty-one papers were selected according to inclusion/exclusion criteria. Insomnia is frequent in cancer, and it is associated with cancer-related comorbid conditions such as emotional distress, depressive symptoms, and cancer-related fatigue. The hyperactivation of stress and inflammatory systems, which sustain insomnia, may contribute to cancer-related depression and fatigue. A deleterious feedback loop may be created, and it may perpetuate not only insomnia but also these cancer-related comorbid conditions.Conclusion:Although the understanding of the causal relationship between insomnia/ depression/fatigue in individuals with cancer is limited, we may hypothesize that these symptoms can exacerbate and maintain each other. When insomnia is established in cancer, it may lead to a vicious cycle with fatigue and depression and may contribute to adverse cancer outcomes. Interventions targeting insomnia could provide a promising approach not only for insomnia but also for cancer-related symptoms among cancer patients.     

Research advances of N6‐methyladenosine in diagnosis and therapy of pancreatic cancer

BackgroundN6‐methyladenosine (m6A) is the addition of a methyl group on the N6 position of adenosine and is the most prevalent and abundant epigenetic modification in eukaryote mRNA. m6A marks are added to mRNA by the m6A methyltransferase complex (“writers”), removed by m6A demethylases (“erasers”), and recognized by m6A‐binding proteins (“readers”). Recent evidence has shown that the m6A modification plays a crucial role in the pathogenic mechanism and malignant progression of pancreatic cancer, with roles in cell survival, proliferation, migration, invasion, tumor metastasis, and drug resistance.MethodsLiterature was searched in Pubmed and Web of Science for the following keywords: “N6‐methyladenosine”, “pancreatic cancer”, “epigenetic modification”, “immunotherapy”.ResultsAmong classical m6A regulators, while METTL3, METTL14, WTAP, FTO, YTHDF2, IGF2BP1–3, hnRNPC, and NKAP are upregulated in pancreatic cancer, METTL16 and ALKBH5 are downregulated in pancreatic cancer. m6A modification has been investigated in pancreatic cancer therapy.ConclusionDysregulated m6A and its related factors in pancreatic cancer cells and patients indicate their potential values as novel biomarkers in pancreatic cancer diagnosis and targeted therapy.     

The Effect of Concussion History on Lower Extremity Injury Risk in College Athletes: A Systematic Review and Meta-Analysis

IntroductionCollegiate athletes who suffer a concussion may possess prolonged impairments even after clearance for return-to-participation, which may place them at an increased risk of lower extremity injury.ObjectiveTo conduct a systematic review and meta-analysis of studies examining risk of lower extremity musculoskeletal injury following a concussion in collegiate athletes.MethodsA literature search was performed using the following databases: PubMed, CINAHL, SPORTDiscus. The following search terms were used to identify relevant articles, [“concussion” OR “brain injury” OR “mild traumatic brain injury” OR “mTBI”] AND [“lower extremity injury” OR “musculoskeletal injury”]. Articles were included if they were published between January 2000 and July 2021 and examined collegiate athletes’ risk of sustaining a lower extremity musculoskeletal injury following a concussion. Methodological quality of included studies was performed with a modified Downs and Black Checklist. The primary outcome of interest was the risk of sustaining a lower extremity musculoskeletal injury following a concussion. A random effects meta-analysis was conducted in which a summative relative risk (RR) for sustaining a lower extremity injury in athletes with and without a history of concussion was calculated.ResultsSeven studies met the eligibility criteria to be included in the systematic review. There were 348 athletes in the concussion group and 482 control athletes in the included studies. Most of the studies were of good or excellent quality. Five of the seven studies were able to be included in the meta-analysis. College athletes who suffered a concussion possessed a 58% greater risk of sustaining a lower extremity musculoskeletal injury than those who did not have a history of a concussion (RR = 1.58[1.30, 1.93]).ConclusionsLower extremity injury risk is potentially increased in college athletes following a concussion compared to those without a history of a concussion. Further research is needed to investigate the mechanism behind this increased risk. Clinical assessments throughout the concussion return-to-play protocol may need to be improved in order to detect lingering impairments caused by concussions.Level of Evidence1     

Intra-abdominal hypertension and increased acute kidney injury risk: a systematic review and meta-analysis

ObjectiveThe present meta-analysis aimed to determine the relationship between intra-abdominal hypertension (IAH) and an increased prevalence of acute kidney injury (AKI) and identify the associated risk factors in various patient populations, regardless of whether they were admitted to an intensive care unit.MethodsWe used three databases for the following search terms: “IAH,” “abdominal compartment syndrome,” “AKI,” “acute kidney failure,” and others. The articles retrieved were compared to identify appropriate studies published until 7 May 2020. The main outcome was AKI.ResultsSix studies with 344 individuals were included. The patients were divided into two main groups: the IAH and non-IAH groups. Compared with patients without IAH, patients with IAH had a higher risk of AKI (odds ratio = 2.57, 95% confidence interval: 1.55–4.26). In the subgroup and meta-regression analyses, body mass index, age, the presence or absence of burns, and cardiac surgery did not affect the risk of AKI.ConclusionIAH was associated with AKI risk, and this association was not influenced by age, body mass index, the presence or absence of burns, or cardiac surgery.     

The Quality of Life of People with Solid Cancer is Less Worse than Other Diseases with better Prognosis,Except in the Presence of Depression

Background:Suffering from Solid Cancer (SC) may adversely impact the Health-related Quality of Life (H-QoL). The aims of this study are to measure the H-QoL in a sample of people suffering from SC and to clarify the role of the co-occurrence of depressive episodes. Results were compared with a healthy control group and with groups of other disorders.Methods:In 151 patients with SC (mean±sd age 63.1±11.5; female 54.3%), H-QoL was assessed by SF-12, depressive episodes were identified by PHQ-9. The attributable burden of SC in impairing H-QoL was calculated as the difference between SF-12 score of a community sex and age ¼ matched healthy control group and that of the study sample. The attributable burden of SC was compared with other chronic diseases using specific diagnostic groups drawn from case-control studies that used the same database for selecting control samples.Results:H-QoL in people with SC was significantly worse than in the healthy control group (p<0.0001). The attributable burden in worsening the H-QoL due to SC was similar to those of severe chronic diseases, but lower than Multiple Sclerosis (p<0.0001) or Fibromyalgia (p<0.00001). Having a depressive episode was a strong determinant of decreasing H-QoL, regardless of the severity of cancer.Conclusion:The findings confirm a strong impact of SC but showed that H-QoL in SC was higher than in chronic diseases with better “quoad vitam” outcome. Since depression was a strong determinant, its prevention, early detection and therapy are the main objectives that must be reached in cancer patients.     

Unattended compared to traditional blood pressure measurement in patients with rheumatoid arthritis: a randomised cross-over study

BackgroundHypertension is characterised by a high prevalence, low awareness and poor control among rheumatoid arthritis (RA) patients. Correct blood pressure (BP) measurement is highly important in these subjects. The “unattended” BP measurement aims to reduce the “white-coat effect,” a phenomenon associated with cardiovascular risk. Data on “unattended” BP measurement in RA and its impact on hypertensive organ damage are very limited.MethodsBP was measured in the same patient both traditionally (“attended” BP) and by the “unattended” protocol (3 automated office BP measurements, at 1-min intervals, after 5 min of rest, with patient left alone) by a randomised cross-over design. Patients underwent clinical examination, 12-lead electrocardiography and trans-thoracic echocardiography to evaluate cardiac damage.ResultsSixty-two RA patients (mean age 67 ± 9 years, 87% women) were enrolled. Hypertension was diagnosed in 79% and 66% of patients according to ACC/AHA and ESC/ESH criteria, respectively. Concordance correlation coefficients between the two techniques were 0.55 (95%, CI 0.38–0.68) for systolic BP and 0.73 (95%, CI 0.60–0.82) for diastolic BP. “Unattended” (121.7/68.6 mmHg) was lower than “attended” BP (130.5/72.8 mmHg) for systolic and diastolic BP (both p < .0001). Among the two techniques, only “unattended” systolic BP showed a significant association with left ventricular mass (r = 0.11; p = .40 for “attended” BP; r = 0.27; p = .036 for unattended BP; difference between slopes: z = 3.92; p = .0001).ConclusionsIn RA patients, “unattended” BP is lower than traditional (“attended”) BP and more closely associated with LV mass. In these patients, the “unattended” automated BP measurement is a promising tool which requires further evaluation.

KEY MESSAGES

• “Unattended” automated blood pressure registration, aimed to reduce the “white-coat effect” is lower than “attended” value in rheumatoid arthritis patients.
• “Unattended” blood pressure is more closely associated with left ventricular mass than “attende” registration.

     

The roles and mechanisms of circular RNAs related to mTOR in cancers

BackgroundCircular RNAs (circRNAs) are stable molecules with covalently closed structures that have an irreplaceable role in the occurrence, progression, and even treatment of plenty of cancers. Mammalian/mechanistic target of rapamycin (mTOR) is a key regulator in cancers and plays several biological functions, such as proliferation, migration, invasion, autophagy, and apoptosis.MethodsAll data were collected through PubMed and CNKI, using terms including “circRNA,” “mTOR,” “caner,” “signaling pathway,” “biomarker,” “diagnosis,” “treatment.” Articles published in Chinese and English were included.ResultsIn this review, the expression, function, and mechanism of circRNA‐associated mTOR in cancers were described. CircRNA‐associated‐mTOR can regulate the progression and therapy of a variety of cancers in multiple signaling pathways, such as phosphatidylinositol‐3‐kinase (PI3K)/protein kinase B (Akt)/mTOR, mitogen‐activated protein kinase (MAPK)/mTOR, and AMP‐activated protein kinase (AMPK)/mTOR axis. These cancers including esophageal carcinoma (circLPAR3, ciRS‐7), gastric cancer (circNRIP1, hsa_circ_0010882, hsa_circ_0000117, hsa_circ_0072309, and circST3GAL6), colorectal cancer (hsa_circ_0000392, hsa_circ_0084927, hsa_circ_0104631, and circFBXW7), liver cancer (circC16orf62, hsa_circ_100338, hsa_circ_0004001, hsa_circ_0004123, hsa_circ_0075792, hsa_circ_0079299, and hsa_circ_0002130), pancreatic cancer (circ‐IARS and circRHOBTB3), renal carcinoma (ciRS‐7), bladder cancer (circUBE2K), prostate cancer (circMBOAT2 and circ‐ITCH), ovarian cancer (circEEF2, circRAB11FIP1, circMYLK, and circTPCN), endometrial cancer (hsa_circ_0002577 and circWHSC1), lung cancer (circHIPK3, hsa_circ_0001666), thyroid cancer (hsa_circ_0007694 and hsa_circ_0008274), glioma (circGFRA1, circ‐MAPK4, circPCMTD1, and hsa_circ_0037251), osteosarcoma (circTCF25), leukemia (circ‐PRKDC), and breast cancer (hsa_circ_0000199, circUBAP2, and circWHSC1).     

Clinical Characteristics and Treatment Outcome of Central Nervous System Nocardiosis: A Systematic Review of Reported Cases

BackgroundThe clinical spectrum of systemic nocardiosis encompasses pulmonary and disseminated disease. Central nervous system (CNS) involvement is an important feature of disseminated disease with significant mortality and high relapse rate, especially in those with suppressed cell-mediated immunity. This systematic review aimed to evaluate the epidemiology, clinical features, diagnosis, therapeutic interventions, and outcome in patients with CNS nocardiosis.MethodsA literature search was performed in major databases (PubMed, Google Scholar, and Scopus) by using distinct keywords: “CNS disease,” “Nocardia,” “meningitis,” “brain abscess,” “disseminated disease,” and “Cotrimoxazole.” We included all patients ≥18 years with CNS nocardiosis reported between January 2000 and December 2020.ResultsA total of 129 papers were included in the final analysis. The mean age of patients was 55 ± 16 years, and the majority were male (70.8%). Nocardia farcinica was the commonest species (39.6%), followed by Nocardia nova (5.9%). Thirty-four percent of the patients were found to be immunocompetent. Corticosteroid use was the most common predisposing factor (55.8%). Among neuroimaging findings, brain abscess was most common (86.9%), followed by leptomeningeal enhancement (12.1%). The overall case-fatality rate in CNS disease was 22.8%. On multivariate analysis, patients who underwent surgery (OR 2.4, 95% CI 0.99–4.11, p value 0.046) had better survival than those treated with antimicrobial therapy alone. Immunodeficient state (OR 0.32, 95% CI 0.15–0.90, p value 0.019) was independently associated with poor outcome.ConclusionCNS nocardiosis carries significant mortality, especially in immunodeficient patients. We advocate the use of surgery combined with antimicrobials to improve clinical outcome.     

Hematological changes associated with COVID‐19 infection

BackgroundThe unresolved COVID‐19 pandemic considerably impacts the health services in Iraq and worldwide. Consecutive waves of mutated virus increased virus spread and further constrained health systems. Although molecular identification of the virus by polymerase chain reaction is the only recommended method in diagnosing COVID‐19 infection, radiological, biochemical, and hematological studies are substantially important in risk stratification, patient follow‐up, and outcome prediction.AimThis narrative review summarized the hematological changes including the blood indices, coagulative indicators, and other associated biochemical laboratory markers in different stages of COVID‐19 infection, highlighting the diagnostic and prognostic significance.MethodsLiterature search was conducted for multiple combinations of different hematological tests and manifestations with novel COVID‐19 using the following key words: “hematological,” “complete blood count,” “lymphopenia,” “blood indices,” “markers” "platelet" OR "thrombocytopenia" AND "COVID‐19," "coronavirus2019," "2019‐nCoV," OR "SARS‐CoV‐2." Articles written in the English language and conducted on human samples between December 2019 and January 2021 were included.ResultsHematological changes are not reported in asymptomatic or presymptomatic COVID‐19 patients. In nonsevere cases, hematological changes are subtle, included mainly lymphocytopenia (80.4%). In severe, critically ill patients and those with cytokine storm, neutrophilia, lymphocytopenia, elevated D‐dimer, prolonged PT, and reduced fibrinogen are predictors of disease progression and adverse outcome.ConclusionMonitoring hematological changes in patients with COVID‐19 can predict patients needing additional care and stratify the risk for severe course of the disease. More studies are required in Iraq to reflect the hematological changes in COVID‐19 as compared to global data.     

COVID‐19 in HIV‐positive patients: A systematic review of case reports and case series

IntroductionCoronavirus disease 2019 (COVID‐19) and acquired immune deficiency syndrome (AIDS) are two viral diseases for which there are currently no definitive treatments. Nowadays, because of the health system''s focus on the COVID‐19 epidemic, the control of human immunodeficiency virus (HIV) has received less attention. In this review, we will discuss the characteristics of COVID‐19 in HIV‐positive patients.Material and MethodsUsing the PRISMA guideline, the databases of Scopus, PubMed, and Web of Science were searched systematically from January 1, 2019 to February 24, 2021. The following keywords were used: “Human Immunodeficiency Virus,” “acquired immune deficiency syndrome,” “HIV,” “AIDS,” “COVID‐19,” “severe acute respiratory syndrome coronavirus 2,” “novel coronavirus,” “SARS‐CoV‐2,” “nCoV disease,” “SARS2,” and “2019‐nCoV disease.”ResultsTwenty‐one percent of studies were conducted in the USA (n = 13), 16% in China (n = 10), and 13% in Italy (n = 8), respectively. The majority of the patients were men (74.3%). Tenofovir disoproxil fumarate was used in 47.4% of patients, emtricitabine in 58.4%, and lamivudine in 34.8% to treat HIV. Symptoms of HIV patients with COVID‐19 included coughing (81.3%), fever (62.8%), and dyspnea (60%). Hydroxychloroquine (39.34%) and azithromycin (36.58%) were the common treatment options for COVID‐19. The total death rate in HIV‐positive patients with COVID‐19 was about 9%.ConclusionIn the current systematic review, we demonstrated that HIV‐positive patients co‐infected with COVID‐19 have high comorbidity of hypertension and diabetes mellitus. HIV/COVID‐19 co‐infection might have negatively influenced the HIV treatment and diagnosis, which indicates the need to regularly screen HIV patients in the COVID‐19 pandemic.     

Patient-Physician Communication in Acute Myeloid Leukemia and Myelodysplastic Syndrome

Introduction:An effective communication is an integral part of the patient-physician relationship. Lack of a healthy patient-physician relationship leads to a lower level of patient satisfaction, scarce understanding of interventions and poor adherence to treatment regimes. Patients need to be involved in the therapeutic process and the assessment of risks and perspectives of the illness in order to better evaluate their options. Physicians, in turn, must convey and communicate information clearly in order to avoid misunderstandings and consequently poor medical care. The patient-physician relationship in cancer care is extremely delicate due to the complexity of the disease. In cancer diagnosis, the physician must adopt a communicative approach that considers the psychosocial factors, needs and patient’s preferences for information,which in turn all contribute to affect clinical outcomes. Search Strategy and Methods : This review was conducted using the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA) statement. We included studies on the importance of physician-patient communication in Acute Myeloid Leukaemia and Myelodysplastic Syndrome care. We searched PubMed, Web of Sciences, Scopus, Google scholar for studies published from December 1 ^st , 2020 up to March 1 ^st , 2021. Using MeSH headings, we search for the terms “Physician and patient communication AND Acute Myeloid leukemia” or “Myelodysplastic syndrome” or “Doctor” or “Clinician”, as well as variations thereof . Purpose of the Review : This review examines the progress in communication research between patient and physician and focuses on the impact of communication styles on patient-physician relationshipin hematologic cancers, including Acute Myeloid Leukaemia and Myelodysplastic Syndromes.     

Effect of Blood Groups on Clinical Presentations and Treatment Outcomes in Immune Thrombotic Thrombocytopenic Purpura Patients with Severe ADAMTS13 Deficiency: A Multi-Center Experience

IntroductionThrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by accumulation of ultra-large von Willebrand factor (vWF) due to the significantly reduced activity ADAMTS13. Limited studies have been published examining the blood group as an epidemiological factor that can contribute to development of TTP. It has been suggested that due to low vWF levels, the distribution of the “O” blood group among TTP patients may be lower than anticipated compared to the blood group distribution rates in the normal population. The aim of this study was to explore the relationship between blood groups and the clinical outcome of immune TTP (iTTP).MethodsThirty patients with iTTP with severe ADAMTS13 deficiency were enrolled. Data collection commenced in January 2011 and was completed by June 2020. It was analyzed whether there was a difference between the blood groups in terms of frequency of iTTP, response to treatment, frequency of relapse, and clinical and laboratory results.Results and ConclusionsThe distribution of group “A” among patients with iTTP was higher than expected. Although not statistically significant, patients with blood group “O” required more TPE for the treatment and relapse rate was statistically higher than other blood groups. Mortality rate in all patients was 6.7%. Although blood group “A” is a risk factor for iTTP, the frequency of relapse is higher in the blood group “O.”Key Words: ADAMTS13, ABO blood group, Thrombotic thrombocytopenic purpura     

The utility of SARS‐CoV‐2 nucleocapsid protein in laboratory diagnosis

BackgroundThe Coronavirus Disease 2019 (COVID‐19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which has now become a global pandemic owing to its high transmissibility. The SARS‐CoV‐2 nucleocapsid protein tests are playing an important role in screening and diagnosing patients with COVID‐19, and studies about the utility of SARS‐CoV‐2 nucleocapsid protein tests are increasing now.MethodsIn this review, all the relevant original studies were assessed by searching in electronic databases including Scopus, Pubmed, Embase, and Web of Science. “SARS‐CoV‐2”, “COVID‐19”, “nucleocapsid protein”, and “antigen detection” were used as keywords.ResultsIn this review, we summarized the utility of SARS‐CoV‐2 nucleocapsid protein in laboratory diagnosis. Among the representative researches, this review analyzed, the sensitivity of SARS‐CoV‐2 nucleocapsid protein detection varies from 13% to 87.9%, while the specificity could almost reach 100% in most studies. As a matter of fact, the sensitivity is around 50% and could be higher or lower due to the influential factors.ConclusionIt is well suggested that SARS‐CoV‐2 nucleocapsid protein is a convenient method with a short turnaround time of about half an hour, and the presence of N antigen is positively related to viral transmissibility, indicating that SARS‐CoV‐2 N protein immunoassays contribute to finding out those infected people rapidly and segregating them from the uninfected people.     

Broad application prospects of bone turnover markers in pediatrics

BackgroundBone turnover markers (BTMs) have been studied for application in clinical medicine. However, BTMs in children are challenging, and few studies explore these BTMs in children. The application of BTMs is complicated mainly due to pre‐analytical factors, variable reference intervals of age‐ and sex‐related BTMs for adolescents and children in different regions and laboratories. Therefore, laboratory testing of BTMs is critical for understanding pediatric bone development and metabolism, which provides additional information about bone development and diseases.MethodsLiterature search was conducted using the MeSH term “child” combined with the terms that bone turnover markers such as “osteocalcin,” “Procollagen type I N‐terminal propeptide,” “procollagen type I C‐terminal propeptide,” “osteocalcin,” “N‐terminal cross‐linked telopeptide,” and “C‐terminal cross‐linked telopeptide,” Several databases including Web of Science, Google Scholar, and PubMed were searched to obtain the relevant studies.ResultsBTMs represent the combined effects of skeletal development, growth, and remodeling in children, which can be used in clinical pediatrics to assist in the diagnosis and prognosis of bone metabolic disorders.ConclusionBTMs are clearly helpful for diagnosis and monitoring of bone growth and development as well as bone metabolic disorders.     

Top studies of 2021 relevant to primary care: From the PEER team

ObjectiveTo summarize 10 high-quality studies or guidelines from 2021 that have strong relevance to physicians in comprehensive family practice.Selecting the evidenceRoutine literature surveillance of abstracts in high-impact journals and EvidenceAlerts was completed by the PEER (Patients, Experience, Evidence, Research) team, a group of health care professionals with a research interest in evidence-based medicine and primary care. Abstracts were screened, selected, and ranked by the PEER team.Main messageThe articles from 2021 that are most likely to impact primary care practice discuss the following topics: empagliflozin for heart failure with preserved ejection fraction; semaglutide for weight loss; stopping antidepressants in primary care; inhaled budesonide for COVID-19; acetylsalicylic acid for preeclampsia prevention; quarter-dose blood pressure medications for hypertension; aggressive blood pressure control for elderly patients; kangaroo care for low-birth-weight infants; footwear for knee osteoarthritis; and delayed antibiotics for pediatric respiratory infections. Two “honourable mention” studies are also briefly reviewed.ConclusionResearch from 2021 produced several high-quality studies in cardiovascular care but also addressed a variety of conditions relevant to primary care including weight loss, depression, and COVID-19.

Each year, an overwhelming number of medical articles are published, making it challenging for family physicians to keep up to date on the literature. We have summarized our selection of the top 10 articles from 2021, along with 2 “honourable mentions,” that we believe will offer value for physicians in comprehensive family practice.     

An Overview of the International Literature on Health-Related Quality of Life,Mental Health and Psychosocial Issues in People with Cancer

Background:Cancer is one of the most important leading causes of death worldwide. Early detection, screening and diagnosis have been demonstrated to significantly improve patients’ survival rates and increase awareness of the benefit of prompt therapies and healthy lifestyles. In this context, Health-related Quality of Life (HRQoL) and several psychosocial difficulties are of relevance as prognostic factors for the trajectory of the diseases of people living with cancer.Methods:This Special Issue aims to present a set of systematic reviews and research studies focusing on several psychosocial aspects in people suffering from hematologic and solid cancer.Results:Three systematic reviews regard HRQoL, the quality of patient-physician communication, depression and other stress-related difficulties, respectively. One review pointed out the difficulties in diagnosing depression in the elderly with solid cancer; another one regards the risk of cancer in severe mental illnesses, such as schizophrenia, bipolar disorders, and severe depressive disorders. One additional review regards HRQoL in people with cancer in the present era of COVID-19 pandemic. Furthermore, some research studies pointed out the usefulness of a validated instrument to assess satisfaction with care in the oncology field, as well as of the self-reinforcing feedback loop to improve fatigue, insomnia and depression in people with cancer. Other two research studies evaluate, respectively, the attributable burden in worsening HRQoL in people suffering both from cancer and depression and the Type D personality as a risk factor for stress-related difficulties in women with breast cancer.Conclusion:This Special Issue is a contribution to enhance future research mainly about such interventions useful to assess and improve HRQoL and overall well-being in people with cancer.     

Role of lung ultrasound for the etiological diagnosis of acute lower respiratory tract infection (ALRTI) in children: a prospective study

Objective and designOur prospective study assesses the role of detailed lung ultrasound (LUS) features to discriminate the etiological diagnosis of acute lower respiratory tract infection (ALRTI) in children.MethodologyWe analyzed patients aged from 1 month to 17 years admitted between March 2018 and April 2020 who were hospitalized for ALRTI. For all patients, history, clinical parameters, microbiological data, and lung ultrasound data were collected. Patients were stratified into three main groups (“bacterial”, “viral”, “atypical”) according to the presumed microbial etiology and LUS findings evaluated according to the etiological group. Nasopharyngeal swabs were obtained from all patients. A qualitative diagnostic test developed by Nurex S.r.l. was used for identification of bacterial and fungal DNA in respiratory samples. The Seegene Allplex™ Respiratory assays were used for the molecular diagnosis of viral respiratory pathogens. In addition, bacterial culture of blood and respiratory samples were performed, when indicated.ResultsA total of 186 children with suspected ALRTI (44% female) with an average age of 6 were enrolled in the study. We found that some ultrasound findings as size, number and distribution of consolidations, the position and motion of air bronchograms, pleural effusions and distribution of vertical artifacts significantly differ (p < 0.05) in children with bacterial, viral and atypical ALRTI.ConclusionOur study provides a detailed analysis of LUS features able to predict the ALRTI ethology in children. These findings may help the physicians to better manage a child with ALRTI and to offer personalized approach, from diagnosis to treatment and follow-up.     

Comparison of the Impact of “Fast Decline” in Residual Renal Function and “Initial Anuria” on Long-Term Outcomes in CAPD Patients

♦ Background: Residual renal function (RRF) is pivotal to long-term outcomes, while rapid RRF decline (RRFD) is associated with mortality risk for continuous ambulatory peritoneal dialysis (CAPD) patients. This study was conducted to compare the impact of “initial anuria” and rapid RRFD on the long-term prognosis of CAPD patients.♦ Method: According to the timing of anuria and the slope of RRFD, a total of 255 incident CAPD patients were divided into 3 groups. For the “anuria” group, anuria was detected from CAPD initiation and persisted for > 6 months (n = 27). Based on the median of the RRFD slope, the other 228 non-anuric patients were divided into a “slow decliner” group (n = 114), and a “rapid decliner” group (n = 114). The maximal observation period was 120 months.♦ Results: Logistic regression tests indicated that the “anuria” group was associated with previous hemodialysis > 3 months (odds ratio [OR]: 8.52, 95% confidence interval [CI]: 3.12 – 23.28), and female (OR: 0.29, 95% CI: 0.09 – 0.90), while the “fast decliner” group with higher Davies co-morbidity scores (DCS) (OR: 1.52; 95% CI: 1.08 – 2.14), body mass index (BMI) (OR: 1.12; 95% CI: 1.04 – 1.21), and male (OR: 1.12; 95% CI: 1.04 – 1.21). After adjusting for DCS, the “fast decliner” group (hazard ratio [HR]: 0.37; 95% CI: 0.17 – 0.80) showed a better outcome than that of the “anuria” group (reference = 1). Both baseline RRF (β = -0.24; p < 0.001) and DCS (β = -3.76; p < 0.001) showed inverse linear correlations to the slope of RRFD. From the Cox proportional analyses, higher baseline RRF (HR: 0.92; 95% CI: 0.88 –.97) and higher slope of RRFD (slower decline in RRF) (HR: 0.90; 95% CI: 0.85 – 0.96) were independent factors for less mortality risk in patients with DCS = 0. However, only a higher slope of RRFD (HR: 0.97; 95% CI: 0.94 – 0.99) was significant for better survival in CAPD patients with DCS > 0.♦ Conclusion: Compared to the baseline RRF, CAPD patients with co-morbidities that rapidly deteriorate RRFD are more crucially associated with long-term mortality risk.