Hepatitis C infection and renal cell carcinoma:A systematic review and meta-analysis

AIM To investigate the association between hepatitis C virus(HCV) infection and risk of renal cell carcinoma(RCC).METHODS A literature search was performed from inception until February 2016.Studies that reported relative risks,odd ratios,hazard ratios or standardized incidence ratio comparing the risk of RCC among HCV-infected participants vs those without HCV infection were included.Participants without HCV infection were used as comparators.Pooled odds ratios and 95%CI were calculated using a random-effect,generic inverse variance method.RESULTS Seven observational studies were with 196826 patients were included in the analysis to assess the risk of RCC in patients with HCV.A significantly increased risk of RCC among participants with HCV infection was found with a pooled RR of 1.86(95%CI:1.11-3.11).The association between RCC and HCV was marginally insignificant after a sensitivity analysis limited only to studies with adjusted analysis,with a pooled RR of 1.50(95%CI:0.93-2.42).CONCLUSION Our study demonstrated a potential association between HCV infection and RCC.Further studies of RCC surveillance in patients with HCV are required.     

Sarcomatoid Carcinoma of the Lung: The Mayo Clinic Experience in 127 Patients

Background

Pulmonary sarcomatoid carcinoma (PSC) is an unusual form of non–small-cell lung cancer (NSCLC). Because of its rarity and heterogeneity, the treatment and prognosis of PSC have not been clearly described.

Outcomes and risk factors of ventilator-associated pneumonia in neonates

Background:Ventilator-associated pneumonia (VAP) in neonates has been associated with high mortality and poor outcome.This study aimed to compare the incidence,risk factors,and outcomes of VAP and nonVAP conditions in neonates.Methods:We performed a prospective cohort study in a neonatal intensive care unit (NICU) in Thailand from January 2014 to December 2014.All neonatal patients who were ventilated more than 48 hours were enrolled.Results:There were 128 enrolled patients.The median (inter quartile range) gestational age and birthweight were 35 (30.2,37.8) weeks and 2380 (1323.8,3020.0) g.There were 17 VAP patients (19 episodes) and 111 non-VAP ones.The VAP rate was 13.3％ or 10.1 per 1000 ventilator days.According to the multivariate analysis,a birthweight less than 750 g [adjusted odds ratio (aOR)=10.75,95％ confidence interval (CI)=2.35-49.16;P=0.002] and sedative medication use (aOR=4.00,95％ CI=1.23-12.50;P=0.021)were independent risk factors for VAP.Compared with the non-VAP group,the median difference in the VAP group yielded a significantly longer duration of NICU stay (18 days,P=0.001),total length of hospital stay (16 days,P=0.002) and higher hospital costs ($5113,P=0.001).The inhospital mortality rate in the VAP and non-VAP groups was 17.6％ and 15.3％ (P=0.73),respectively.Conclusions:A neonatal birthweight less than 750 g and sedative medication use were independent risk factors for VAP.Our VAP patients experienced a longer duration of both NICU and hospital stay,and incurred higher hospitalization costs.     

Soft Plastic Bag Instead of Hard Plastic Container for Long-term Storage of Breast Milk

Objective

To compare the fat content and contamination of expressed breast milk (EBM) before and after storage (30 d) in hard polypropylene containers (HC) and soft polyethylene bags (SB) containers.

Methods

Ninety specimens of EBM were collected into HC and separated into two HC and two SB. The fat content of each specimen of EBM in HC and SB was measured and cultures were performed. The specimens in the second HC and SB containers were kept frozen for 30 d before thawing and then measuring the fat content and performing cultures.

Results

The means ± SD of the fat content of fresh and thawed EBM in HC were 2.98?±?0.97 and 2.66?±?0.88 g/100 ml, respectively, with a loss of 0.32 g/100 ml (p?<?0.001). The means ± SD of the fat content of fresh and thawed EBM in SB were 3.06?±?1.00 and 2.77?±?0.91 g/100 ml, respectively, with a mean loss of 0.29 g/100 ml during storage (p?<?0.001). The loss of fat content during frozen storage did not differ significantly between the two types of containers (p?=?0.53). All bacterial cultures of fresh and thawed EBM in HC and SB showed only nonpathogenic organisms.

Conclusions

SB can replace HC for the long-term storage of frozen EBM of up to 30 d without deleterious effects on fat loss or contamination.     

Effectiveness and safety of intravenous iloprost for severe persistent pulmonary hypertension of the newborn

Objective

The aims of this study were to determine the effectiveness (oxygenation), safety (hemodynamic status) and short term outcomes of intravenous iloprost (IVI) administration as a rescue therapy in severe persistent pulmonary hypertension of the newborn (PPHN).

Design

Retrospective medical records review.

Setting

Tertiary neonatal intensive care unit at Songklanagarind Hospital, Songkhla Province, Hat Yai, Thailand.

Participants

Newborns who received IVI as an adjunctive therapy for treatment of severe PPHN, as defined by an oxygen index (OI) of >20 and without response to conventional therapies.

Main Outcome Measures

The change of OI and alveolar-arterial oxygen difference before and after commencement of IVI.

Results

33 neonates with severe PPHN at a median gestation of 39 weeks and a baseline OI of 40 (range, 21–101) received IVI. The median OI and alveolar-arterial oxygen difference had a statistically significant decrease after 2 hours of treatment and continued to decline thereafter (P<0.05). All infants received one or more inotropic medications and volume expanders to provide blood pressure support with no statistically significant difference of blood pressure and heart rate before and after IVI treatment. The mortality rate was 15.2%, all of them had initially severe hypoxemia with a median OI of 53.6.

Conclusions

IVI may be effective in improving oxygenation and should be considered as a rescue therapy for infants with severe PPHN, especially in a limited resource environment with no inhaled nitric oxide available. Systemic hypotension may be a cause for concern.