Acute kidney injury in ovarian cancer patients undergoing cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy

Background: Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) prolongs survival in patients with metastatic peritoneal disease. We look at the incidence of acute kidney injury (AKI) in patients who have received cisplatin during CRS-HIPEC in the treatment of peritoneal carcinomatosis from an ovarian primary, and identify possible peri-operative risk factors.

Methods: Between 2005 and 2013, we performed CRS-HIPEC on 47 patients with ovarian primaries and peritoneal metastasis. Retrospective data were collected on the patient’s demographics, treatment details and outcomes. Renal impairment was graded according to the NCI-CTCAE 3.0 criteria.

Results: There were 47 patients, with a median age of 50 (24–74) years. The median baseline creatinine was 53?μmol/L (23–102) and median baseline albumin of 39?g/L (13–45). All underwent pre-operative chemotherapy for a median of six cycles (0–22) with a median of 15?days between chemotherapy and surgery. They received intra-operative cisplatin at a temperature of 40?°C for 60?min at a median dose of 90?mg/kg. 19 (40.4%) experienced post-operative AKI, of which 5 (8.5%) developed grade 3 and 4 impairment. Two (4.3%) required long-term dialysis. Univariate analysis showed that risk factors for AKI included age, baseline creatinine, baseline estimated glomerular filtration rate, pre-operative albumin, number of cycles of pre-operative carboplatin, time interval between pre-operative chemotherapy and CRS-HIPEC and volume of blood transfusions.

Conclusions: Identification of risk factors for AKI post-CRS-HIPEC helps improve pre-operative patient selection and optimisation, facilitate tailoring of chemotherapy, and foster closer peri-operative monitoring and fluid management in at-risk patients.     

Optimal treatment increased survival of hepatocellular carcinoma patients detected with community‐based screening

Background and Aim: The early detection of hepatocellular carcinoma (HCC) and opportunity to select appropriate treatment are important benefits of HCC screening. Our aim in the present study was to investigate the survival rate, prognostic factors and treatment effects in HCC patients of community‐based screening. Methods: Community‐based ultrasound (US) screening for HCC in adults with platelet counts (< 150 × 10³/mm³) and/or alpha fetoprotein (AFP) > 20 ng/mL was conducted in 2002 and 2004. As per the Barcelona Clinic Liver Cancer (BCLC) stage, 90 cases of intermediate or earlier stage HCC were detected and 88 cases had sufficient information for analysis (49 men and 39 women, aged 65.8 ± 9.6 years). The tumor diameter was mostly less than 5 cm (76.1%). The follow up was continued until June 2008. Results: The 4‐year overall survival rate was 46.8%. Old age (≥ 70 years) (P = 0.046), later stage of HCC (intermediate vs earlier) (P = 0.012), low platelet count (< 100 × 10³/mm³) (P = 0.013) and refusal of modern treatment (P = 0.026) were independent poor prognostic factors. Curative treatment increased survival in patients of all ages. Both curative treatment and transcatheter arterial embolization (TAE) increased survival in cases of intermediate HCC. However, treatment benefits were not found for patients with (very) early stage HCC. Conclusions: Early detection and prompt treatment of HCC leads to increased survival. For elderly patients this benefit was seen only for early stage cases receiving curative treatment. Differences between treatment types for patients with (very) early stage HCC might emerge with a longer follow‐up period.     

Low accuracy of the national reporting system of acute hepatitis C infection in Taiwan, 1995–2004

Background and Aim: This study attempted to clarify accuracy of acute hepatitis C (AHC) and its clinical characteristics. Methods: We reviewed 632 reported cases from national surveillance data of the Taiwan Center for Disease Control between 1995 and 2004, and reclassified diagnoses. A definite case was defined as alanine aminotransferase (ALT) > 10 × the upper limit of normal (ULN) with seroconversion of anti‐hepatitis C virus antibody (anti‐HCV). A probable case was defined as (i) seroconversion of anti‐HCV and/or elevated ALT levels; or (ii) anti‐HCV(+) but titers increased (from < 40 S/CO to ≥ 40 S/CO) and ALT > 10 × the ULN. A suspected case was defined as initial anti‐HCV(+) and ALT level > 10 × the ULN and/or jaundice. Excluded cases were defined as ALT levels less than 10 × ULN with initial positive anti‐HCV Ab. Results: A total of 310 (49%) cases were confirmed as AHC; these included 95 (15%) definite and 215 (34%) probable cases. Higher incidence rates and accuracy of AHC were demonstrated in the southern area significantly if compared with northern, eastern and central areas, respectively (all P < 0.05). On comparison between blood centers and hospitals, more AHC cases were found in Southern Taiwan than in other areas (157/73 vs 24/40, P < 0.001), younger mean age (33.3 ± 11.1 vs 49.3 ± 16.4, P < 0.001), lower ALT levels (263.1 ± 200.9 vs 1264.2 ± 706.8, P < 0.001) and male predominance (191/39 vs 46/18, P = 0.046). Conclusions: This study showed our reporting system over‐estimated the AHC diagnosis, which is also a common issue worldwide. Greater efforts are needed to establish appropriate reporting systems, as well as more supplemental methods to distinguish between prevalent and incident cases.     

A systematic review of physiological reactivity to stimuli in autism

Objective: The prevalence of abnormal behavioural responses to a variety of stimuli among individuals with autism has led researchers to examine whether physiological reactivity (PR) is typical in this population. This article reviewed studies assessing PR to sensory, social and emotional, and stressor stimuli in individuals with autism. Methods: Systematic searches of electronic databases identified 57 studies that met our inclusion criteria. Studies were analysed to determine: (a) participant characteristics; (b) physiological measures used; (c) PR to sensory, social and emotional or stressor stimuli; (d) the relation between PR and behavioural or psychological variables and (e) baseline physiological activity. A novel measure of methodological quality suitable for use with non-randomized, non-interventional, psychophysiological studies was also developed and applied. Results: Individuals with autism were found to respond differently than typically developing controls in 78.6%, 66.7% and 71.4% of sensory, social and emotional, and stressor stimulus classes, respectively. However, this extant literature is characterized by variable and inconsistent findings, which do not appear to be accounted for by varying methodological quality, making it difficult to determine what specific factors differentiate individuals with autism who present with atypical PR from those who do not. Conclusions: Despite this uncertainty, individual differences in PR are clearly present in autism, suggesting additional research is needed to determine the variables relating to PR among those with ASD and to examine the possible existence of physiological subtype responders in the population.     

Early cognitive development in children born to women with epilepsy: A prospective report

Purpose: In this prospective study the early cognitive development of children born to women with epilepsy (n = 198) was assessed and compared to a group of children representative of the general population (n = 230). Methods: The children were assessed when younger than the age of 2 years using the Griffiths Mental Development Scales, either in their local participating hospital or in their home. The assessments were completed by an assessor who was blinded to whether the child’s mother had epilepsy and to antiepileptic drug type. Results: Children exposed to sodium valproate had a statistically significant increased risk of delayed early development in comparison to the control children. Linear regression analysis showed a statistically significant effect of sodium valproate exposure on the child’s overall developmental level that was not accounted for by confounding variables. Delayed early development is also noted for children within an ad hoc group of less commonly utilized antiepileptic drugs, although conclusions cannot be drawn due to the size of this group (n = 13). Children exposed to either carbamazepine or lamotrigine in utero did not differ significantly in their overall developmental ability. Differences noted in specific developmental areas for these two groups were not statistically significant after the control for confounders such as socioeconomic status and maternal IQ. Discussion: Women with epilepsy should be informed of the risks posed to their potential offspring prior to pregnancy to allow for informed decisions regarding treatment. Children exposed in utero to antiepileptic drugs should be monitored throughout childhood to allow for early intervention when necessary.     

Expression of mitotic checkpoint proteins BUB1B and MAD2L1 in salivary duct carcinomas

J Oral Pathol Med (2010) 39 : 349–355 Objective: Defects in the mitotic checkpoint lead to aneuploidy and might facilitate tumorigenesis. However, the ploidy status in salivary duct carcinoma (SDC) has been reported to play limited role in prediction of prognosis. Thus, we need more reliable markers to reflect the rapid tumor progression in SDCs. We aimed here to investigate the expression of mitotic checkpoint proteins benzimidazole 1 homolog beta (BUB1B) and mitosis arrest‐deficient 2 like 1 (MAD2L1) in SDCs and to determine their possible role as surrogate prognostic markers. Methods: We analyzed the clinical courses, pathologic findings and immunohistochemical profiles of mitotic checkpoint proteins (BUB1B and MAD2L1) in 27 pathologically confirmed SDCs. The expression status of BUB1B and MAD2L1 was compared with clinicopathologic factors and other molecular markers, such as TGF‐beta, c‐erb‐B2, androgen receptor, vascular endothelial growth factor, and epidermal growth factor receptor, for prognostic significance. Results: High BUB1B expression was detected in 25.9% of subjects, and high MAD2L1 expression was in 55.6% of subjects. However, survival analysis revealed that mitotic checkpoint expression did not have prognostic significance in SDCs, nor did the other studied markers. Rather, the clinical variable of N classification at diagnosis (in N+ status, hazard ratio 5.19, 95% CI 1.26–21.32 for disease‐free survival and hazard ratio 7.18, 95% CI 1.09–46.99 for overall survival) was strongly associated with survival and prognosis based on the Cox proportional hazard model. Conclusions: Mitotic checkpoint proteins appeared to play a limited role in predicting prognosis in SDCs. Further study is required to elucidate the exact role of mitotic checkpoint proteins in SDCs.     

A comparative study of biweekly disposable contact lenses: silicone hydrogel versus hydrogel

Background: Our aim was to compare the clinical performance of a biweekly (second generation) silicone hydrogel lens and a biweekly hydrogel lens worn for daily wear modality. Methods: We used a double‐masked study, in which non‐presbyopic, asymptomatic and adapted soft lens wearers were recruited. Subjects wore a silicone hydrogel lens in one eye and a hydrogel lens in the other (lens types and eyes were randomly assigned) for one month. Lenses were replaced every two weeks. Contact lens fitting, pre‐lens tear film thinning time, vision, corneal integrity and lens deposits were assessed before and every fortnight after delivery of new lenses. A questionnaire was used to compare the subjective performance of the two lens types. Results: Thirty of the 33 subjects completed the study. There were no significant differences in lens fitting (centration and movement), pre‐lens tear film thinning time, vision or corneal integrity between the two lens types. Statistically, there was no significant difference in lens deposits between the two lens types but silicone hydrogel lenses tended to have more Grade 3 to 4 lipid deposits than hydrogel lenses. Subjects found no significant differences between the two lens types in terms of vision and comfort. Preference for silicone hydrogel lenses increased from 33 at the first after‐care visit to 50 per cent at the second after‐care visit. Conclusion: This short‐term study demonstrates that the performance of silicone hydrogel and hydrogel lenses is comparable but the former tends to build up more lipid deposits than the latter. We did not find better performance in terms of ocular integrity of silicone hydrogel lenses compared to the hydrogel lenses, probably because the subjects were adapted asymptomatic contact lens wearers before commencing the study. Contact lens wearers having hypoxia‐related problems are likely to benefit from using silicone hydrogel lenses, as these lenses provide at least three times more oxygen than conventional hydrogel lenses.