BACKGROUND Renal cell carcinoma(RCC)is treated with surgical resection as the gold standard,as it is notoriously resistant to systemic therapy.Advancements with targeted therapies contribute to declining mortality,but...BACKGROUND Renal cell carcinoma(RCC)is treated with surgical resection as the gold standard,as it is notoriously resistant to systemic therapy.Advancements with targeted therapies contribute to declining mortality,but metastatic RCC(mRCC)survival remains poor.One possible factor is treatment at academic centers,which employ advanced providers and novel therapies.This study compared outcomes of mRCC in patients treated at academic/research facilities compared to those treated at non-academic centers.AIM To compare survival outcomes of mRCC and their various etiologies between academic and non-academic centers.METHODS The National Cancer Database was used to identify mRCC patients including all histology subtypes and stage IV disease.Descriptive statistics and Kaplan-Meier curves measured survival outcomes for user file facility types sorted into a binary academic/research and non-academic research variable.Multivariate logistic regression and Cox proportional hazard testing generated odds ratio and hazard ratio.Data was analyzed using Statistical Package for the Social Sciences version 29.0 using a significance level of P<0.05.RESULTS Overall,academic facility patients experienced greater 5-year and 10-year overall survival than non-academic facility patients.Treatment at non-academic facilities was associated with increased odds of death that persisted even after controlling for age,tumor size,sex,and distance traveled to treatment center.In comparison,nonacademic facility patients also experienced greater risk of hazard.CONCLUSION Patients with mRCC treated at academic/research facilities experienced increased survival compared to patients treated at non-academic facilities,were more likely to be younger,carry private insurance,and come from a large metropolitan area.They also were significantly more likely to receive surgery and adjuvant immunotherapy.展开更多
Increased mortality rates in chronic obstructive pulmonary disease(COPD)patients with heart failure(HF)are believed to be driven by various factors,including disparities in access to healthcare services and shifting d...Increased mortality rates in chronic obstructive pulmonary disease(COPD)patients with heart failure(HF)are believed to be driven by various factors,including disparities in access to healthcare services and shifting dynamics of the population characteristics.In this study,we examined the racial and ethnic disparities in the clinical outcomes of HF in COPD patients in the United States,analyzing data from the Nationwide Inpatient Sample database.The database was searched retrospectively from 2016 to 2022 to identify COPD and HF patients by International Classification of Diseases-10 codes.A total of 2445545 individuals were included of which 76%were Whites,16%were Blacks,5%Hispanics and 3%others.Whites were significantly older than other populations(P<0.001),and a significantly higher proportion of Blacks were females compared to other racial groups.Regarding clinical outcomes,Black COPD patients with HF had the lowest mortality rates while it was similar between Whites and Hispanics(P<0.001).Compared to Whites,the adjusted odds ratio was significantly lower for Blacks,0.797[95%confidence interval(CI):0.783-0.812;P<0.001]and Hispanics,0.956(95%CI:0.932-0.981;P=0.001).Other racial groups had significantly higher mortality compared to Whites,with an adjusted odds ratio of 1.131(95%CI:1.099-1.164;P<0.001).Individuals from other racial groups had significantly longer hospital stay,and hospitalization cost adjusted for inflation.Cardiac arrest was the strongest predictor(P<0.001)for in-hospital mortality in all racial groups.展开更多
BACKGROUND In severe cases of coronary artery disease,percutaneous coronary intervention provide promising results.The stent used could be a drug-eluting stent(DES)or a titanium-nitride-oxide coated stent(TiNOS).AIM T...BACKGROUND In severe cases of coronary artery disease,percutaneous coronary intervention provide promising results.The stent used could be a drug-eluting stent(DES)or a titanium-nitride-oxide coated stent(TiNOS).AIM To compare the 5-year effectiveness and safety of the two stent types.METHODS The following systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines,and PubMed/MEDLINE,Scopus,and Cochrane Central were searched from inception till August 2023.Primary outcomes were major adverse cardiac events(MACE),cardiac death,myocardial infarction(MI),cardiac death or MI,and ischemia-driven total lesion revascularization(ID-TLR).RESULTS Four randomized controlled trials(RCT),which analyzed a sum total of 3045 patients with acute coronary syndrome(ACS)after a median follow-up time of 5 years were included.Though statistically insignificant,an increase in the ID-TLR was observed in patients receiving TiNOSs vs DESs.In addition,MI,cardiac death and MI,and definite stent thrombosis(DST)were significantly decreased in the TiNOS arm.Baseline analysis revealed no significant results with meta-regression presenting non-ST elevated MI(NSTEMI)as a statistically significant covariate in the outcome of MACE.CONCLUSION TiNOS was found to be superior to DES in terms of MI,cardiac death or MI,and DST outcomes,however,the effect of the two stent types on ID-TLR and MACE was not significant.A greater number of studies are required to establish an accurate comparison of patient outcomes in TiNOS and DES.展开更多
Background:The therapeutic effectiveness of interleukin-6 receptor inhibitor in critically ill hospitalized patients with coronavirus disease 2019(COVID-19)is uncertain.Methods:To evaluate the efficacy and safety of t...Background:The therapeutic effectiveness of interleukin-6 receptor inhibitor in critically ill hospitalized patients with coronavirus disease 2019(COVID-19)is uncertain.Methods:To evaluate the efficacy and safety of the outcome as recovery or death of tocilizumab for severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)infection,we conducted a randomized,double-blinded,placebo-controlled phase 2 trial in critically ill COVID-19 adult patients.The patients were randomly assigned in a 4:1 ratio to receive standard medical treatment plus the recommended dose of either tocilizumab or the placebo drug.Randomization was stratified.The primary outcome was the recovery or death after administration of tocilizumab or a placebo drug.The secondary outcomes were clinical recovery or worsening of the patients’symptoms and inflammatory markers and discharge from the hospital.Results:Of 190 patients included in this study,152 received tocilizumab,and 38 received a placebo.The duration of hospital stay of the interventional group was 12.9±9.2,while the placebo group had a more extended hospital stay(15.6±8.8).The mortality ratio for the primary outcome,ie,mortality or recovery in the tocilizumab group was 17.8%;p=0.58 by log-rank test).The mortality ratio in the placebo group was 76.3%;p=0.32 by log-rank test).The inflammatory markers in the tocilizumab group significantly declined by day 16 compared to the placebo group.Conclusions:The use of tocilizumab was associated with decreased mortality,earlier improvement of inflamma-tory markers,and reduced hospital stay in patients with severe COVID-19.展开更多
文摘BACKGROUND Renal cell carcinoma(RCC)is treated with surgical resection as the gold standard,as it is notoriously resistant to systemic therapy.Advancements with targeted therapies contribute to declining mortality,but metastatic RCC(mRCC)survival remains poor.One possible factor is treatment at academic centers,which employ advanced providers and novel therapies.This study compared outcomes of mRCC in patients treated at academic/research facilities compared to those treated at non-academic centers.AIM To compare survival outcomes of mRCC and their various etiologies between academic and non-academic centers.METHODS The National Cancer Database was used to identify mRCC patients including all histology subtypes and stage IV disease.Descriptive statistics and Kaplan-Meier curves measured survival outcomes for user file facility types sorted into a binary academic/research and non-academic research variable.Multivariate logistic regression and Cox proportional hazard testing generated odds ratio and hazard ratio.Data was analyzed using Statistical Package for the Social Sciences version 29.0 using a significance level of P<0.05.RESULTS Overall,academic facility patients experienced greater 5-year and 10-year overall survival than non-academic facility patients.Treatment at non-academic facilities was associated with increased odds of death that persisted even after controlling for age,tumor size,sex,and distance traveled to treatment center.In comparison,nonacademic facility patients also experienced greater risk of hazard.CONCLUSION Patients with mRCC treated at academic/research facilities experienced increased survival compared to patients treated at non-academic facilities,were more likely to be younger,carry private insurance,and come from a large metropolitan area.They also were significantly more likely to receive surgery and adjuvant immunotherapy.
文摘Increased mortality rates in chronic obstructive pulmonary disease(COPD)patients with heart failure(HF)are believed to be driven by various factors,including disparities in access to healthcare services and shifting dynamics of the population characteristics.In this study,we examined the racial and ethnic disparities in the clinical outcomes of HF in COPD patients in the United States,analyzing data from the Nationwide Inpatient Sample database.The database was searched retrospectively from 2016 to 2022 to identify COPD and HF patients by International Classification of Diseases-10 codes.A total of 2445545 individuals were included of which 76%were Whites,16%were Blacks,5%Hispanics and 3%others.Whites were significantly older than other populations(P<0.001),and a significantly higher proportion of Blacks were females compared to other racial groups.Regarding clinical outcomes,Black COPD patients with HF had the lowest mortality rates while it was similar between Whites and Hispanics(P<0.001).Compared to Whites,the adjusted odds ratio was significantly lower for Blacks,0.797[95%confidence interval(CI):0.783-0.812;P<0.001]and Hispanics,0.956(95%CI:0.932-0.981;P=0.001).Other racial groups had significantly higher mortality compared to Whites,with an adjusted odds ratio of 1.131(95%CI:1.099-1.164;P<0.001).Individuals from other racial groups had significantly longer hospital stay,and hospitalization cost adjusted for inflation.Cardiac arrest was the strongest predictor(P<0.001)for in-hospital mortality in all racial groups.
文摘BACKGROUND In severe cases of coronary artery disease,percutaneous coronary intervention provide promising results.The stent used could be a drug-eluting stent(DES)or a titanium-nitride-oxide coated stent(TiNOS).AIM To compare the 5-year effectiveness and safety of the two stent types.METHODS The following systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines,and PubMed/MEDLINE,Scopus,and Cochrane Central were searched from inception till August 2023.Primary outcomes were major adverse cardiac events(MACE),cardiac death,myocardial infarction(MI),cardiac death or MI,and ischemia-driven total lesion revascularization(ID-TLR).RESULTS Four randomized controlled trials(RCT),which analyzed a sum total of 3045 patients with acute coronary syndrome(ACS)after a median follow-up time of 5 years were included.Though statistically insignificant,an increase in the ID-TLR was observed in patients receiving TiNOSs vs DESs.In addition,MI,cardiac death and MI,and definite stent thrombosis(DST)were significantly decreased in the TiNOS arm.Baseline analysis revealed no significant results with meta-regression presenting non-ST elevated MI(NSTEMI)as a statistically significant covariate in the outcome of MACE.CONCLUSION TiNOS was found to be superior to DES in terms of MI,cardiac death or MI,and DST outcomes,however,the effect of the two stent types on ID-TLR and MACE was not significant.A greater number of studies are required to establish an accurate comparison of patient outcomes in TiNOS and DES.
基金was obtained from the research ethical committee of Lahore General Hospital,hav-ing approval number 00-144-20(ClinicalTrials.gov ID:NCT04560205)。
文摘Background:The therapeutic effectiveness of interleukin-6 receptor inhibitor in critically ill hospitalized patients with coronavirus disease 2019(COVID-19)is uncertain.Methods:To evaluate the efficacy and safety of the outcome as recovery or death of tocilizumab for severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)infection,we conducted a randomized,double-blinded,placebo-controlled phase 2 trial in critically ill COVID-19 adult patients.The patients were randomly assigned in a 4:1 ratio to receive standard medical treatment plus the recommended dose of either tocilizumab or the placebo drug.Randomization was stratified.The primary outcome was the recovery or death after administration of tocilizumab or a placebo drug.The secondary outcomes were clinical recovery or worsening of the patients’symptoms and inflammatory markers and discharge from the hospital.Results:Of 190 patients included in this study,152 received tocilizumab,and 38 received a placebo.The duration of hospital stay of the interventional group was 12.9±9.2,while the placebo group had a more extended hospital stay(15.6±8.8).The mortality ratio for the primary outcome,ie,mortality or recovery in the tocilizumab group was 17.8%;p=0.58 by log-rank test).The mortality ratio in the placebo group was 76.3%;p=0.32 by log-rank test).The inflammatory markers in the tocilizumab group significantly declined by day 16 compared to the placebo group.Conclusions:The use of tocilizumab was associated with decreased mortality,earlier improvement of inflamma-tory markers,and reduced hospital stay in patients with severe COVID-19.
