Background: Recent studies suggest that serum lipids are associated with pegylated interferon-alpha (PEG-IFN-a) treatment response in chronic hepatitis C patients. However, the role of serum lipids in influencing the outcome of HBV treatment is not well understood. This study aims to investigate the association of serum lipids with the response to interferon-alpha treatment for chronic hepatitis B (CHB) patients. Methods: We dynamically measured 11 clinical serum lipid parameters of 119 hepatitis B e antigen (HBeAg)positive CHB patients, including 53 patients who achieved sustained response (SR) and 66 patients who achieved non-response (NR) induced by PEG-IFN-a treatment for 48 weeks. Results: The dynamic analysis showed that the baseline serum total cholesterol (TCHO) level was higher in the NR group than that in the SR group (P=0.004). Moreover, the correlation analysis demonstrated a significant positive correlation between TCHO and hepatitis B surface antigen (HBsAg) at baseline (P=0.009). In addition, CHB patients with high baseline TCHO levels exhibited higher HBV DNA, HBsAg, HBeAg and hepatitis B e antibody (HBeAb) levels during early treatment periods (weeks 0, 4, 12 and 24) than those with the low TCHO levels. Furthermore, the logistic regression analysis identified that baseline serum TCHO was a risk factor for NR achievement (OR=4.94; P=0.047). Conclusions: Our results indicated that serum TCHO was associated with PEG-IFN-a therapeutic response in HBeAg-positive CHB patients which suggested that serum TCHO could be useful as an auxiliary clinical factor to predict poor efficacy of PEG-IFN-a therapy.
Objective: To understand how the different data collections methods of the Alberta Health Services Infection Prevention and Control Program (IPC) and the National Surgical Quality Improvement Program (NSQIP) are affecting reported rates of surgical site infections (SSIs) following total hip replacements (THRs) and total knee replacements (TKRs). Design: Retrospective cohort study. Setting: Four hospitals in Alberta, Canada. Patients: Those with THR or TKR surgeries between September 1, 2015, and March 31, 2018. Methods: Demographic information, complex SSIs reported by IPC and NSQIP were compared and then IPC and NSQIP data were matched with percent agreement and Cohen’s κ calculated. Statistical analysis was performed for age, gender and complex SSIs. A P value <.05 was considered significant. Results: In total, 7,549 IPC and 2,037 NSQIP patients were compared. The complex SSI rate for NSQIP was higher compared to IPC (THR: 1.19 vs 0.68 [P = .147]; TKR: 0.92 vs 0.80 [P = .682]). After matching, 7 SSIs were identified by both IPC and NSQIP; 3 were identified only by IPC, and 12 were identified only by NSQIP (positive agreement, 0.48; negative agreement, 1.0; κ = 0.48). Conclusions: Different approaches to monitor SSIs may lead to different results and trending patterns. NSQIP reports total SSI rates that are consistently higher than IPC. If systems are compared at any point in time, confidence on the data may be eroded. Stakeholders need to be aware of these variations and education provided to facilitate an understanding of differences and a consistent approach to SSI surveillance monitoring over time.
Background Amyloid light-chain amyloidosis (AL amyloidosis) is commonly associated with multiple myeloma. However, the clinical characteristics and prognosis of symptomatic and smoldering multiple myeloma with AL amyloidosis are not particularly clear. Methods Patients with symptomatic and smoldering multiple myeloma in the Peking University First Hospital registry from 2010 to 2018 were studied. The clinical and laboratory information was collected from first presentation to death or until the last available clinical follow-up. The patients’ survival and outcomes were analyzed, and the relationship between the clinical parameters and survival was also assessed. Results Compared with symptomatic multiple myeloma patients without AL amyloidosis, patients with AL amyloidosis had higher incidence of BNP≧700pg/mL ( P <0.001), ALP>187.5IU/L ( P =0.032) and ALB<25g/L ( P <0.001). Similarly, compared with smoldering multiple myeloma patients without AL amyloidosis, patients with AL amyloidosis had higher incidence of BNP≧700pg/mL ( P =0.030) and Alb<25g/L ( P =0.024). The existence of AL amyloidosis, especially those with the heart involvement, was related to shorter long-term survival of symptomatic and smoldering multiple myeloma according to univariate analyses. Renal involvement and gastrointestinal tract involvement had an impact on the prognosis of smoldering multiple myeloma but not on the symptomatic multiple myeloma. Cox regression model for overall survival detected BNP≧700pg/mL in symptomatic multiple myeloma having independent poorer prognostic significance (HR=2.455, P =0.004). Interestingly, BNP at diagnosis was significantly correlated with cardiac amyloidosis (r=0.496, P <0.001). Cox regression model for overall survival detected the presence of AL amyloidosis in smoldering multiple myeloma having independent poorer prognostic significance (HR=8.741, P =0.002). Conclusion AL amyloidosis is an independent poor prognostic factor for not only symptomatic multiple myeloma but also smoldering multiple myeloma. It is mainly because of involvement of important organs, especially the heart. AL amyloidosis probably has a greater impact on the prognosis of smoldering multiple myeloma than on the symptomatic multiple myeloma.
Background: In Alberta, Canada, surgical site infections (SSIs) following total hip and knee replacements (THRs and TKRs) are reported using the infection prevention and control (IPC) surveillance system, which surveys all THRs and TKRs using the NHSN definitions; and the National Surgical Quality Improvement Program (NSQIP), which uses different definitions and sampling strategies. Deterministic matching of patient data from these sources was used to examine the overlap and discrepancies in SSI reporting. Methods: A retrospective multisite cohort study of IPC and NSQIP superficial, deep, and organ-space THR/TKR SSI data collected 30 days postoperatively from September 1, 2015, to March 31, 2018 was undertaken. To identify patients with procedures captured by both IPC and NSQIP, data were cleaned, duplicates removed, and patients matched 1:1 using year of birth, procedure facility, type, side, date, and time. Positive and negative agreement were assessed, and the Cohen κ values were calculated. The definitions and data capture methods used by both IPC and NSQIP were also compared. Results: There were 7,549 IPC and 2,037 NSQIP patients, respectively, with 1,798 matched patients: IPC (23.8%) and NSQIP (88.3%). Moreover, 17 SSIs were identified by both IPC and NSQIP, including 9 superficial and 8 complex by IPC and 6 superficial and 11 complex by NSQIP. Also, 7 SSIs were identified only by IPC, of which 5 were superficial, and 36 SSIs were identified only by NSQIP, of which 28 were superficial (positive agreement, 0.44; negative agreement, 0.99; κ = .43). Excluding superficial SSIs, 7 SSIs were identified by both IPC and NSQIP; 3 were identified only by IPC; and 12 were identified only by NSQIP (positive agreement, 0.48; negative agreement, 1.00; κ = 0.48). Conclusions: THR/TKR SSI rates reported by IPC and NSQIP were not comparable in this matched dataset. NSQIP identifies more superficial SSIs. Variations in data capture methods and definitions accounted for most of the discordance. Both surveillance systems are critically involved with improving patient outcomes following surgery. However, stakeholders need to be aware of these variations, and education should be provided to facilitate an understanding of the differences and their interpretation. Future work should explore other surgical procedures and larger data sets.Funding: NoneDisclosures: None
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