BACKGROUND Despite advances in detection and treatments,biliary tract cancers continue to have poor survival outcomes.Currently,there is limited data investigating the significance of socioeconomic status,race/ethnici...BACKGROUND Despite advances in detection and treatments,biliary tract cancers continue to have poor survival outcomes.Currently,there is limited data investigating the significance of socioeconomic status,race/ethnicity,and environmental factors in biliary tract cancer survival.Data from the Surveillance,Epidemiology,and End Results database for biliary and gallbladder adenocarcinomas were extracted from 1975 to 2016.Socioe-conomic data included smoking,poverty level,education,adjusted household income,and percentage of foreign-born persons and urban population.Survival was calculated with Cox proportional hazards models for death in the 5-year period following diagnosis.RESULTS Our study included 15883 gallbladder,11466 intrahepatic biliary,12869 extrahepatic biliary and 7268 ampulla of Vater adenocarcinoma cases.When analyzing county-specific demographics,patients from counties with higher incomes were associated with higher survival rates[hazard ratio(HR)=0.97,P<0.05].Similarly,counties with a higher percentage of patients with a college level education and counties with a higher urban population had higher 5-year survival rates(HR=0.96,P=0.002 and HR=0.97,P=0.004,respectively).CONCLUSION Worse survival outcomes were observed in lower income counties while higher income and education level were associated with higher 5-year overall survival among gallbladder and biliary malignancies.展开更多
Background and aims:Ingested sharp objects pose increased risks of adverse events compared with other foreign bodies.We conducted the largest systematic review to date of sharp wooden object ingestions to elucidate pa...Background and aims:Ingested sharp objects pose increased risks of adverse events compared with other foreign bodies.We conducted the largest systematic review to date of sharp wooden object ingestions to elucidate patterns in clinical presentation and guide management practices.Methods:Cochrane Library,Google Scholar,Ovid MEDLINE,Ovid Embase,PubMed,Scopus,and Web of Science Core Collection databases were searched for cases of adults who ingested sharp wooden objects.Descriptive statistics were reported for risk factors,clinical presentations,laboratory and imaging findings,adverse events,and treatments.Results:Analysis of 479 cases showed that most patients were unaware of ingestion(74.8%)and toothpicks were the most common ingested item(92.5%).Male sex(70.1%),substance use(9.4%),and edentulousness(6.1%)were risk factors.Common symptoms included abdominal pain(83.7%)and fever(36.7%).Imaging identified the object in 48.1%of cases,with computed tomography being the most sensitive(54.7%).Objects were commonly found in the gastrointestinal tract(79.3%).They were consistently found in the gastrointestinal tract when patients were aware of ingestion or imaging showed an intraluminal/transluminal location.Endoscopy visualized the objects 76.1%of the time,with successful removal in 88.8%of cases;4.7%of patients required surgery following endoscopic removal.Adverse events included perforation(87.5%)and abscess(33.0%),with a mortality rate of 5.0%.Conclusions:Ingestion of sharp wooden objects presents heterogeneously and can lead to serious complications.Endoscopic removal is safe and effective.We propose a clinical algorithm to guide physicians in diagnosing and managing suspected sharp wooden object ingestion.展开更多
文摘BACKGROUND Despite advances in detection and treatments,biliary tract cancers continue to have poor survival outcomes.Currently,there is limited data investigating the significance of socioeconomic status,race/ethnicity,and environmental factors in biliary tract cancer survival.Data from the Surveillance,Epidemiology,and End Results database for biliary and gallbladder adenocarcinomas were extracted from 1975 to 2016.Socioe-conomic data included smoking,poverty level,education,adjusted household income,and percentage of foreign-born persons and urban population.Survival was calculated with Cox proportional hazards models for death in the 5-year period following diagnosis.RESULTS Our study included 15883 gallbladder,11466 intrahepatic biliary,12869 extrahepatic biliary and 7268 ampulla of Vater adenocarcinoma cases.When analyzing county-specific demographics,patients from counties with higher incomes were associated with higher survival rates[hazard ratio(HR)=0.97,P<0.05].Similarly,counties with a higher percentage of patients with a college level education and counties with a higher urban population had higher 5-year survival rates(HR=0.96,P=0.002 and HR=0.97,P=0.004,respectively).CONCLUSION Worse survival outcomes were observed in lower income counties while higher income and education level were associated with higher 5-year overall survival among gallbladder and biliary malignancies.
文摘Background and aims:Ingested sharp objects pose increased risks of adverse events compared with other foreign bodies.We conducted the largest systematic review to date of sharp wooden object ingestions to elucidate patterns in clinical presentation and guide management practices.Methods:Cochrane Library,Google Scholar,Ovid MEDLINE,Ovid Embase,PubMed,Scopus,and Web of Science Core Collection databases were searched for cases of adults who ingested sharp wooden objects.Descriptive statistics were reported for risk factors,clinical presentations,laboratory and imaging findings,adverse events,and treatments.Results:Analysis of 479 cases showed that most patients were unaware of ingestion(74.8%)and toothpicks were the most common ingested item(92.5%).Male sex(70.1%),substance use(9.4%),and edentulousness(6.1%)were risk factors.Common symptoms included abdominal pain(83.7%)and fever(36.7%).Imaging identified the object in 48.1%of cases,with computed tomography being the most sensitive(54.7%).Objects were commonly found in the gastrointestinal tract(79.3%).They were consistently found in the gastrointestinal tract when patients were aware of ingestion or imaging showed an intraluminal/transluminal location.Endoscopy visualized the objects 76.1%of the time,with successful removal in 88.8%of cases;4.7%of patients required surgery following endoscopic removal.Adverse events included perforation(87.5%)and abscess(33.0%),with a mortality rate of 5.0%.Conclusions:Ingestion of sharp wooden objects presents heterogeneously and can lead to serious complications.Endoscopic removal is safe and effective.We propose a clinical algorithm to guide physicians in diagnosing and managing suspected sharp wooden object ingestion.
