Background. Several prognostic factors have been used to guide therapy for colon cancer (CC). However, the relationship between CC laterality (sidedness) and prognosis remains under investigation. Objectives. To assess the effect of laterality on CC presentation and survival, using a Surveillance, Epidemiology, and End Results (SEER) population-based cohort. Methods. A retrospective cohort study using data from the SEER program (2007-2015). Results. Of the 163,980 patients with CC, 85,779 (52.3%) presented with right-sided CC (RCC) and 78,201 (47.7%) with left-sided CC (LCC). Stage distributions were as follows: stage I, 24.1%; stage II, 27.3%; stage III, 28.2%; and stage IV, 20.4%. In an adjusted modified Poisson regression approach for risk ratio (RR), patients with LCCs were more likely to be male (RR = 1.14; 95% CI 1.12-1.15, p<0.001). As compared to stage I, stage II cancers (RR = 0.88, 95% CI 0.87-0.90, p<0.001) were less likely to be LCC. Stage IV CC was slightly less likely to be left-sided (RR = 0.98, 95% CI 0.98, 0.96-1.00, p = 0.028). The median overall survival (OS) for RCC was 87 months. The median OS for LCC was not established, as more than half of the patients diagnosed with LCC were still living at the time of the analysis. In adjusted Cox proportional Hazard model, individuals with stage I, III, and IV LCCs had superior OS as compared to those with matched-stage RCC (adjusted HR = 0.87; 95% CI 0.85-0.88, p<0.001). However, OS was worse among those with stage II disease who presented with LCC (adjusted Hazard ratio [aHR] = 1.06; 95% CI 1.02-1.11, p = 0.004). CC-specific survival (CSS) was superior for LCC versus RCC for stages III and IV but worse for II. Conclusions. In this population-cohort study, LCC is associated with superior OS and CSS survival. The overall survival advantage was attributed to stage I, III, and IV disease. Individuals presenting with stage II disease exhibit superior survival if the CC is right-sided.
Background: Cardiovasculareventshavebeenreportedinthesettingofcoronavirus disease-19(COVID-19).Ithasbeenhypothesizedthatsystemicinflammationmayaggravate arrhythmias or trigger new-onset conduction abnormalities. However, the specifictypeanddistributionofelectrocardiographicdisturbancesinCOVID-19as wellastheirinfluenceonmortalityremaintobefullycharacterized. Methods: Electrocardiograms (ECGs) were obtained from 186 COVID-19-positive patientsatalargetertiarycarehospitalinNorthernNevada.Thefollowingarrhythmiaswereidentifiedbycardiologists:sinusbradycardia,sinustachycardia,atrialfibrillation (A-Fib), atrial flutter, multifocal atrial tachycardia (MAT), premature atrial contraction (PAC), premature ventricular contraction (PVC), atrioventricular block (AVB),andrightbundlebranchblock(RBBB).ThemeanPRinterval,QRSduration, andcorrectedQTintervalweredocumented.Fisher'sexacttestwasusedtocompare the ECG features of patients who died during the hospitalization with those who survived.TheinfluenceofECGfeaturesonmortalitywasassessedwithmultivariable logistic regression analysis.Results: A-Fib,atrialflutter,andST-segmentdepressionwerepredictiveofmortality.In addition,themeanventricularratewashigheramongpatientswhodiedascompared to those who survived. The use of therapeutic anticoagulation was associated with reducedoddsofdeath;however,thisassociationdidnotreachstatisticalsignificance. Conclusion:The underlying pathogenesis of COVID-19-associated arrhythmias remains to be established, but we postulate that systemic inflammation and/or hypoxiamayinducepotentiallylethalconductionabnormalitiesinaffectedindividuals.ThisisanopenaccessarticleunderthetermsoftheCreativeCommonsAttribution-NonCommercial-NoDerivsLicense,whichpermitsuseanddistributionin anymedium,providedtheoriginalworkisproperlycited,theuseisnon-commercialandnomodificationsoradaptationsaremade. ©2021TheAuthors.Annals of Noninvasive ElectrocardiologypublishedbyWileyPeriodicalsLLC.
BACKGROUND The presence of small air bubbles and foam are an impediment to a successful colonoscopy. They impair an endoscopist’s view and diminish the diagnostic accuracy of the study. This has been particularly noted to be of concern with the switch to lower volume polyethylene glycol (PEG) and bisacodyl combination preparation. AIM To evaluate the effect of oral simethicone addition to bowel preparation on intraluminal bubbles reduction during colonoscopy. METHODS Described is a prospective, randomized, multi-center, double-blinded, placebo-controlled study to evaluate the use of premixed simethicone formulation with split-regimen, low-volume PEG-bisacodyl combination bowel preparation for 168 outpatients undergoing screening, surveillance, and diagnostic colonoscopies. Primary outcome includes evaluation of bubbles during colonoscopy graded using the Intraluminal Bubbles Scale. Secondary outcomes include evaluation of the Boston Bowel Preparation Scale (BBPS), total number of polyps, polyp size differentiation, polyp laterality, adenoma detection, mass detection, cecal insertion time, withdrawal time, and patient-reported adverse events. RESULTS Higher Intraluminal Bubbles grades III and IV (less than 75% of the mucosa cleared of bubbles/foam requiring intervention with simethicone infused wash) were detected in the placebo group [Simethicone n = 4/84 vs Placebo n = 20/84 ( P = 0.007)]. BBPS total score was 7.42 [standard deviation (SD) = ± 1.51] in the simethicone group and 7.28 (SD = ± 1.44) in the placebo group ( P = 0.542) from a total of 9. Significantly higher number of adenomas were detected in the simethicone group ( P = 0.001). CONCLUSION The addition of simethicone to bowel preparation is well advised for its anti-foaming properties. The results of this study suggest that addition of oral simethicone can improve bowel wall visibility.
Background No data are available on sex disparities in prevalence and survival for primary malignant cardiac tumors ( PMCT ). This study aimed to compare male and female PMCT prevalence and long‐term survival rates. Methods and Results We utilized the Surveillance, Epidemiology, and End Results ( SEER ) 18 database from the National Cancer Institute for all PMCT s diagnosed between 1973 and 2015. From a total of 7 384 580 cases of cancer registered in SEER , we identified 327 men and 367 women with PMCT s. The majority (78%) of patients were white. Sarcoma was the most common type of PMCT in both men and women (≈60%). Individuals diagnosed with lymphoma exhibited better survival than those with other types of PMCT s. Men were diagnosed at a younger age than women; however, there was no significant difference in overall survival between the sexes. Men diagnosed with PMCT between the ages of 51 and 65 years demonstrated prolonged survival compared with those diagnosed at younger or older ages. There was no difference in survival rates among women based on age at diagnosis. Conclusions PMCT s are rare in both men and women. Tumors tend to be diagnosed at an earlier age in men compared with women, but there is no sex disparity in survival rate. Sarcoma is the most common type of PMCT , and lymphoma is associated with the highest survival rate among both sexes.
BACKGROUND Immune checkpoint inhibitors (ICIs) are novel therapeutic agents used for various types of cancer. ICIs have revolutionized cancer treatment and improved clinical outcomes among cancer patients. However, immune-related adverse effects of ICI therapy are common. Cardiovascular immune-related adverse events (irAEs) are rare but potentially life-threatening complications. AIM To estimate the incidence of cardiovascular irAEs among patients undergoing ICI therapy for various malignancies. METHODS We conducted this systematic review and meta-analysis by searching PubMed, Cochrane CENTRAL, Web of Science, and SCOPUS databases for relevant interventional trials reporting cardiovascular irAEs. We performed a single-arm meta-analysis using OpenMeta [Analyst] software of the following outcomes: Myocarditis, pericardial effusion, heart failure, cardiomyopathy, atrial fibrillation, myocardial infarction, and cardiac arrest. We assessed the heterogeneity using the I 2 test and managed to solve it with Cochrane’s leave-one-out method. The risk of bias was performed with the Cochrane’s risk of bias tool. RESULTS A total of 26 studies were included. The incidence of irAEs follows: Myocarditis: 0.5% [95% confidence interval (CI): 0.1%-0.9%]; Pericardial effusion: 0.5% (95%CI: 0.1%-1.0%); Heart failure: 0.3% (95%CI: 0.0%-0.5%); Cardiomyopathy: 0.3% (95%CI: -0.1%-0.6%); atrial fibrillation: 4.6% (95%CI: 1.0%-14.1%); Myocardial infarction: 0.4% (95%CI: 0.0%-0.7%); and Cardiac arrest: 0.4% (95%CI: 0.1%-0.8%). CONCLUSION The most common cardiovascular irAEs were atrial fibrillation, myocarditis, and pericardial effusion. Although rare, data from post market surveillance will provide estimates of the long-term prevalence and prognosis in patients with ICI-associated cardiovascular complications.
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