Correlation of Neutrophil to Lymphocyte Ratio and Absolute Neutrophil Count With Outcomes With PD-1 Axis Inhibitors in Patients With Advanced Non–Small-Cell Lung Cancer

Introduction

Programmed death-1 (PD-1) axis inhibitors have become standard therapy in advanced non–small-cell lung cancer (NSCLC). Response might be delayed and pseudo-progression occasionally occurs in patients who eventually benefit from treatment. Additional markers beyond programmed death ligand 1 (PD-L1) expression are needed to assist in patient selection, response evaluation, and treatment decisions.

BRAF Mutant Lung Cancer: Programmed Death Ligand 1 Expression,Tumor Mutational Burden,Microsatellite Instability Status,and Response to Immune Check-Point Inhibitors

Introduction

The efficacy of immune checkpoint inhibitors (ICPi) in BRAF mutant NSCLC is unknown.

Intraductal papillary mucinous neoplasms: Does a family history of pancreatic cancer matter?

Background/ObjectivesThe purpose of this study is to compare surgically resected intraductal papillary mucinous neoplasms (IPMNs) in patients with and without a family history of pancreatic cancer to gain insight into differences that may suggest the need for differential management.MethodsA retrospective review of patients who underwent resection of an IPMN at the Massachusetts General Hospital (1990–2011) was conducted. Three hundred and twenty-four patients of whom 45 (13.9%) had a family history of pancreatic cancer were identified. Patients with (PFH) and without (NFH) a family history of pancreatic cancer were compared.ResultsThere were no differences in demographic characteristics between groups. Extra-pancreatic malignancies diagnosed prior to the IPMN were more common in those with a PFH (35.6% vs 20.1%, p = 0.03). There were no differences in IPMN characteristics between groups including no difference in the presence of invasive disease (p = 0.55). Concurrent pancreatic ductal adenocarcinomas were more common in those with a PFH (11.1% vs 2.9%, p = 0.02). The survival in the PFH group was marginally lower than the NFH group, a difference found to be attributable to the higher prevalence of extra-pancreatic malignancies.ConclusionCharacteristics of surgically resected IPMNs are not different between patients with and without a family history of pancreatic cancer. Most importantly, the incidence of invasive disease is not different, suggesting that these lesions may not be more aggressive when they occur in the presence of a family history of pancreatic cancer.     

Effects of bromocriptine on catecholamine metabolism in subjects with borderline arterial hypertension

Effects of bromocriptine on hemodynamics and catecholamine exchange were evaluated in patients with borderline arterial hypertension with respect to their family history. The agent was shown to be able to bring down blood pressure and decrease plasma catecholamine levels. With this, platelet monoamine oxidase activity was increased in persons with a family history of hypertensive disease.     

Assessment of rabies exposure risk among Israeli travelers

BACKGROUND: The decision whether or not to administer rabies pre-exposure prophylaxis (PEP) to travelers visiting endemic areas is a complex one. Paramount for making that decision is knowledge of the risk of animal bites during travel. This study attempts to estimate the risk of bites in travelers, and study the action they took before and after the incident. METHODS: Travelers presenting for pre-travel immunizations during the period of August through December 2004, who planned a travel of >or= 1 month's duration were retrospectively identified, contacted and interviewed by a structured questionnaire. These travelers did not receive specific advice concerning rabies. RESULTS: The study cohort comprised of 815 travelers (median age=25), of who 13 (1.6%) were injured by a potentially rabid animal (mainly, dog=6; monkey=4). The incidence of potential rabies exposure was found to be of 2.66 per 1000 travelers per month. Those injured had significantly longer trips than the non-injured (6.9+/-3.8 vs. 4+/-5.0 months, p=0.037); notably, the injuries occurred after a median of 5 weeks from departure. Although seven travelers noted blood at the site of injury, only four (31%) of the injured sought medical attention following the exposure, and all four received post-exposure prophylaxis. CONCLUSIONS: An injury by potentially rabid animals is not rare among long-term travelers. As the injury may occur early in the itinerary, rabies PEP should be considered for this population. Educational efforts are required in light of the lack of understanding of the dismal consequences of rabies among travelers.     

Long-term Reflux-Related Symptoms After Bariatric Surgery: Comparison of Sleeve Gastrectomy Versus Laparoscopic Adjustable Gastric Banding

Background

Long-term pulmonary reflux-related symptoms following laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) have not been reported.

Methods

We designed a retrospective analysis of consecutive patients who underwent LAGB or LSG between January 2000 and December 2010. All patients provided detailed history and physical examination. We assessed both early and late reflux-related symptoms. All patients underwent spirometry and chest X-ray (CXR).

Results

The analysis included 307 patients who underwent either LAGB (n = 193) or LSG (n = 114). Mean age was 43 ± 12 and 46 ± 11 years, respectively; 144 (76.6 %) and 83 (73 %) were female, respectively. Similar rates of previous pulmonary disease were noted in both LAGB and LSG groups (10.9 vs. 10.5 %, respectively). However, more patients with sleep apnea were in the LSG group (13.2 vs. 6.2 %, p = 0.03). The mean interval between surgery and the onset of pulmonary symptoms was longer in patients who underwent LAGB (72 ± 22 months) than for those who had LSG (36 ± 24 months; p = 0.03). The overall complication rate was higher in the LAGB (7.3 %) than in LSG (4.4 %) group. LSG patients had significantly lower rates of morning cough (12.3 vs. 59.6 %, p = 0.001) and postprandial cough (10.5 vs. 58 %, p = 0.001) compared to the LAGB patients. Two cases of pneumonia occurred in each group. The mortality rate was zero in both groups.

Conclusion

Both surgeries are considered safe and without major reflux-related symptoms. There is a lower incidence of cough with LSG than with LAGB.     

Are we doing our best to educate travelers about the risks of acute mountain sickness? An on-site prospective study in the Himalayas

Background.  Acute mountain sickness (AMS) affects almost half of those ascending to heights over 3,000 m. The knowledge and practices concerning AMS have not been adequately studied.
Methods.  We conducted a prospective on-site study in the Himalayas. Between July and October 2004, we approached a convenience sample of trekkers during or after their ascent to high altitudes and provided them with detailed questionnaires regarding knowledge of and personal experience with AMS.
Results.  One hundred ninety-two travelers (of whom 106 were Israelis and 86 Western Europeans) participated in the study. One hundred thirty travelers (68%) had received any written/oral information about AMS prior to their departure. The most common source of information among Israeli travelers was the travel clinic (65%), compared to only 9% among Europeans. Overall, 89% were found to have good "basic knowledge" about symptoms of AMS (defined as headache plus ≥2 of the following: fatigue, dizziness, nausea, insomnia). Travelers who had received information about AMS prior to their trip were significantly more knowledgeable about symptoms of AMS ( p = 0.0001), and treatment options, such as oxygen, medications, and rest ( p = 0.023, p = 0.024, p = 0.011, respectively). Only 2% of the Israelis versus 16% of the Europeans ( p = 0.0004) knew that O₂ was a treatment option. Forty-seven percent suffered from AMS, which in 50% began at 3,000 m. About 33 of 90 (37%) of those who suffered AMS symptoms had acetazolamide with them, but only 14 actually used it as treatment.
Conclusions.  Knowledge of AMS among climbers to high altitudes should be fostered, with specific emphasis on practical advice.     

Correlates of measures of voluntary force with the functional state of the motor system

Oscillation spectra were analyzed for prolonged isometric force recorded in healthy subjects of three age groups. Changes in the distributions of spectral components of the oscillations in force were noted, along with differences in the distributions of spectral density as exhaustion developed in the age groups. The amplitude-frequency ranges of changes in the spectral densities of oscillations in force characterized the activity at the suprasegmental and segmental levels of the motor system which support the voluntary control and automatic regulation of posture during the performance of movements. Correlates of the functional state of the motor system are discussed in terms of the voluntary and involuntary components of control. A significant increase in activity in the central structures of the movement control system was seen with the development of exhaustion, along with decreases in the frequency range of the activity of subcortical structures with age. __________ Translated from Rossiiskii Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 91, No. 5, pp. 488–501, May, 2005.