The Influence of Histologic Grade on Outcomes of Elderly Women With Early Stage Breast Cancer Treated With Breast Conserving Surgery With or Without Radiotherapy

BackgroundTwo large randomized trials, CALGB 9343 and PRIME II, support omission of radiotherapy after breast conserving surgery (BCS) in elderly women with favorable-risk early stage breast cancer intending to take endocrine therapy. However, patients with grade 3 histology were underrepresented on these trials. We hypothesized that high-grade disease may be unsuitable for treatment de-escalation and report the oncologic outcomes for elderly women with favorable early stage breast cancer treated with BCS with or without radiotherapy.Materials and MethodsThe Surveillance, Epidemiology, and End Results database was queried for women between 70 and 79 years of age with invasive ductal carcinoma diagnosed between 1998 and 2007. This cohort was narrowed to women with T1mic-T1c, N0, estrogen receptor-positive, invasive ductal carcinoma treated with BCS with or without external beam radiation (EBRT). The primary endpoints were 5- and 10-year cause-specific survival (CSS). Univariate and multivariate analyses were performed. Propensity-score matching of T-stage, year of diagnosis, and age was utilized to reduce selection bias while comparing treatment arms within the grade 3 subgroup.ResultsA total of 12,036 women met inclusion criteria, and the median follow-up was 9.4 years. EBRT was omitted in 22% of patients, including 21% with grade 3 disease. Patients in the EBRT cohort were slightly younger (median, 74 vs. 75 years; P < .01) and had fewer T1a tumors (11% vs. 13%; P = .02). Histologic grades 1, 2, and 3 comprised 36%, 50%, and 14% of the cohort, respectively, and there were no differences in EBRT utilization by grade. Utilization of EBRT decreased following the publication of the CALGB trial in 2004 decreasing from 82% to 85% in 1998 to 2000 to 73% to 75% in 2005 to 2007 (P < .01). Unadjusted outcomes showed that in grade 1 disease, there were no differences in CSS with or without EBRT at 5 (99%) and 10 years (95%-96%). EBRT was associated with an improvement in CSS in grade 2 histology at 5 years (97% vs. 98%) and 10 years (92% vs. 95%) (P = .004). The benefit was more pronounced in grade 3 disease with CSS increasing from 93% to 96% at 5 years and from 87% to 92% at 10 years (P = .02) with EBRT. In the grade 3 subgroup, propensity-score matching confirmed EBRT was associated with superior CSS compared with surgery alone (hazard ratio, 0.58; 95% confidence interval, 0.34-0.98; P = .043).ConclusionIn this database analysis, omission of radiotherapy after BCS in elderly women with favorable-risk, early stage, grade 3 breast cancer was associated with inferior CSS. Further prospective data in this patient population are needed to confirm our findings and conclusions.     

品管圈活动在降低住院患者口服药漏发率中的研究

目的 探索品管圈活动在降低住院患者口服药漏发率中应用效果.方法 运用品管圈的管理方法,找出住院患者口服药漏发原因,进行分析、讨论、制定改进措施及效果评价.结果 开展品管圈活动前住院患者口服药漏发率为15.99%,目标值为6.95%,活动后降至1.72%,病人满意度由原来的82%上升至95%,差异有统计学意义(P<0.01).结论 开展品管圈活动,优化发药流程,改善不规范护理行为,能有效降低住院患者口服药漏发率,减少药物浪费,确保患者服药到口,保证用药安全,提高患者满意度.     

Frequency of surgical resection after starting neoadjuvant chemoradiotherapy in patients with esophageal cancer: A population-based cohort study

BackgroundNeoadjuvant chemoradiotherapy (nCRT) for resectable esophageal cancer is accompanied by the risk of treatment-related toxicity. The aim of this population-based cohort study was to provide insight in patients who do not proceed to surgical resection after starting nCRT.MethodsPatients who started nCRT for primary esophageal cancer diagnosed in 2015 and 2016 were selected from the nationwide population-based cancer registry. Outcome measurements included omission from surgical resection, reasons for omission of surgical resection, mortality during nCRT (≤90 days after ending nCRT) and 1-year overall survival. Multivariable logistic regression analyses were performed to identify predictive factors for omission of surgical resection.ResultsA total of 1521 patients were included, of whom 215 (14.1%) did not undergo surgical resection after starting nCRT. Age (OR:1.04, 95%CI:1.01–1.06), BMI (OR:0.95, 95%CI:0.90–0.99), WHO performance status (WHO 1: OR:1.62, 95%CI:1.16–2.62 and WHO 2: OR:3.53, 95%CI:1.68–7.41) and clinical N status (cN2: OR:1.57, 95% CI:1.04–2.37 and cN3: OR:2.52, 95%CI:1.14–5.55) were significantly associated with omission from surgery. The most frequently reported reasons for omission from surgery were disease progression (44.3%) and physical functioning (22.8%). During nCRT or within the subsequent waiting period to surgery, 38 patients (2.5%) deceased. One year overall survival of the patients who underwent nCRT followed by surgical resection was 94.9%, and 73.5% in the patients who did not undergo surgical resection following nCRT.ConclusionsOne in 7 patients who started nCRT for esophageal cancer do not proceed to surgical resection and have a decreased one year overall survival compared to patients who do proceed to surgical resection. Mortality during nCRT is considerable.     

The Outcome After Restorative Proctocolectomy With or Without Defunctioning Ileostomy

Purpose Controversy exists regarding the safety for omission of diverting ileostomy in restorative proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative proctocolectomy in a consecutive series of patients by comparing postoperative complications, functional results, and quality of life in patients with and without diverting ileostomy. Methods Data regarding demographics, length of stay, surgical characteristics, and complications were reviewed and recorded according to the presence (n= 1,725) or absence (n = 277) of a diverting ileostomy at the time of pelvic pouch surgery. Criteria for omission of ileostomy included: stapled anastomosis, tension-free anastomosis, intact tissue rings, good hemostasis, absence of airleaks, malnutrition, toxicity, anemia, and prolonged consumption of steroids. Functional outcome and quality of lifeindicators were prospectively recorded and compared. Results Patients in the ileostomy group had greater body surface area and older mean age at time of surgery, were taking greater doses of steroids preoperatively, and required more blood transfusions at the time of surgery compared with the one-stage (P < 0.05). There were no differences between the two groups in septic complications (P > 0.05). Early postoperative ileus was more common in the one-stage group (P < 0.001). There were no differences between the groups in quality of life and functional outcomes. Conclusions For carefully selected patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis, omission of diverting ileostomy is a safe procedure that does not lead to an increase inseptic complications or mortality. Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion, provided that certain selection factors are considered. Presented at the meeting of The American Society of Colon and Rectal Surgeons, Chicago, Illinois, June 3 to 7 2002.     

Sound omission related brain responses in children

Action is an important way for children to learn about the world. Recent theories suggest that action is inherently accompanied by the sensory prediction of its effects. Such predictions can be revealed by rarely omitting the expected sensory consequence of the action, resulting in an omission response that is observable in the EEG. Although prediction errors play an important role in models of learning and development, little is known about omission-related brain responses in children.This study used a motor-auditory omission paradigm, testing a group of 6–8-year-old children and an adult group (N = 31 each). In an identity-specific condition, the sound coupled to the motor action was predictable, while in an identity unspecific condition the sound was unpredictable.Results of a temporal principal component analysis revealed that sound-related brain responses underlying the N1-complex differed considerably between age groups. Despite these developmental differences, omission responses (oN1) were similar between age groups. Two subcomponents of the oN1 were differently affected by specific and unspecific predictions.Results demonstrate that children, independent from the maturation of sound processing mechanisms, can implement specific and unspecific predictions as flexibly as adults. This supports theories that regard action and prediction error as important drivers of cognitive development.     

三峡库区兴山县健康监测点居民死亡漏报调查

目的了解三峡库区人群健康监测点居民死亡人口漏报情况,为库区疾病预防控制提供科学依据。方法采用分层整群抽样方法,对三峡库区兴山县疾病监测点2008年1月1日至12月31日发生的全部死亡人口进行调查。结果报告死亡率为4.72‰,死亡人口漏报率为38.61%,校正死亡率7.68‰。结论目前三峡库区兴山县疾病监测点居民死亡漏报情况非常严重,应加强对居民死亡报告管理的力度,特别是增强乡、村医务人员的报告意识。     

彩超在阑尾病变中的应用探讨

目的对彩超在阑尾病变中的应用进行探讨。方法应用彩色多普勒超声诊断仪,对265例阑尾炎患者进行术前检查。结果超声检查符合率84.52%（224/265）,漏诊19例占7.15%,误诊25例占9.43%。结论超声在阑尾病变的诊断及鉴别诊断中价值很高,超声医生如果掌握阑尾的解剖变异、具备临床综合分析判断能力,必定会减少漏误诊,更好地服务临床。     

Omission bias and vaccine rejection by parents of healthy children: Implications for the influenza A/H1N1 vaccination programme

2009 H1N1 influenza A (“swine flu”) vaccine has been offered to healthy UK children aged 6 months–5 years since December 2009, though around 50% of parents plan to reject the vaccine. This study examined whether such parents exhibit omission bias (preference for errors arising from inaction over errors arising from action). One-hundred and forty-two parents completed an online questionnaire in which they rated (a) probability of occurrence, (b) symptoms and (c) duration of a hypothetical disease and a hypothetical vaccine adverse event (VAE). Almost all attributes were rated significantly less favourably when relating to VAE than to disease (p < 0.01 for 17 of 22 outcomes), despite the attributes being objectively identical. These data suggest that any vaccine is at a disadvantage in many parents’ consciousness in comparison with the infection itself, and that minor safety concerns could have disproportionately detrimental effects on vaccine uptake. Behavioural science offers strategies to ameliorate the impact of this bias and these should be explored further.     

Effects of autoshaping procedures on 3H-8-OH-DPAT-labeled 5-HT1a binding and 125I-LSD-labeled 5-HT2a binding in rat brain

Effects of experience with Pavlovian autoshaping procedures on lever-press autoshaping conditioned response (CR) performance and 3H-8-OH-DPAT-labeled binding of 5-HT(1a) receptors as well as 125I-LSD-labeled binding of 5-HT(2a) receptors were evaluated in four groups of male Long-Evans hooded rats. Two groups of rats (Group Paired High CR and Group Paired Low CR) received Pavlovian autoshaping procedures wherein the presentation of a lever (conditioned stimulus, CS) was followed by the response-independent presentation of food (unconditioned stimulus, US). Rats in Group Paired High CR (n=12) showed more rapid CR acquisition and higher asymptotic levels of lever-press autoshaping CR performance relative to rats in Group Low CR (n=12). Group Omission (n=9) received autoshaping with an omission contingency, such that performing the lever-press autoshaping CR resulted in the cancellation the food US, while Group Random (n=9) received presentations of lever CS and food US randomly with respect to one another. Though Groups Omission and Random did not differ in lever-press autoshaping CR performance, Group Omission showed significantly lower levels of 3H-8-OH-DPAT-labeled 5-HT(1a) binding in post-synaptic areas (frontal cortex, septum, caudate putamen), as well as significantly higher plasma corticosterone levels than Group Random. In addition, Group Random showed higher levels of 3H-8-OH-DPAT-labeled 5-HT(1a) binding in pre-synaptic somatodendritic autoreceptors on dorsal raphe nucleus relative to each of the other three groups. Autoradiographic analysis of 125I-LSD-labeled 5-HT(2a) receptor binding revealed no significant differences between Groups Paired High CR and Paired Low CR or between Groups Omission and Random in any brain regions.