To characterize colorectal cancer (CRC) in octogenarians as compared with younger patients.METHODSA single-center, retrospective cohort study which included patients diagnosed with CRC at the age of 80 years or older ...To characterize colorectal cancer (CRC) in octogenarians as compared with younger patients.METHODSA single-center, retrospective cohort study which included patients diagnosed with CRC at the age of 80 years or older between 2008-2013. A control group included consecutive patients younger than 80 years diagnosed with CRC during the same period. Clinicopathological characteristics, treatment and outcome were compared between the groups. Fisher’s exact test was used for dichotomous variables and χ<sup>2</sup> was used for variables with more than two categories. Overall survival was assessed by Kaplan-Meier survival analysis, with the log-rank test. Cancer specific survival (CSS) and disease-free survival were assessed by the Cox proportional hazards model, with the Fine and Gray correction for non-cancer death as a competing risk.RESULTSThe study included 350 patients, 175 patients in each group. Median follow-up was 40.2 mo (range 1.8-97.5). Several significant differences were noted. Octogenarians had a higher proportion of Ashkenazi ethnicity (64.8% vs 47.9%, P < 0.001), a higher rate of personal history of other malignancies (22.4% vs 13.7%, P = 0.035) and lower rates of family history of any cancer (36.6% vs 64.6%, P < 0.001) and family history of CRC (14.4% vs 27.3%, P = 0.006). CRC diagnosis by screening was less frequent in octogenarians (5.7% vs 20%, P < 0.001) and presentation with performance status (PS) of 0-1 was less common in octogenarians (71% vs 93.9%, P < 0.001). Octogenarians were more likely to have tumors located in the right colon (45.7% vs 34.3%, P = 0.029) and had a lower prevalence of well differentiated histology (10.4% vs 19.3%, P = 0.025). They received less treatment and treatment was less aggressive, both in patients with metastatic and non-metastatic disease, regardless of PS. Their 5-year CSS was worse (63.4% vs 77.6%, P = 0.009), both for metastatic (21% vs 43%, P = 0.03) and for non-metastatic disease (76% vs 88%, P = 0.028).CONCLUSIONOctogenarians presented with several distinct characteristics and had worse outcome. Further research is warranted to better define this growing population.展开更多
Objective: We employed a multidisciplinary approach incorporating theoretical ideas, clinical experience,psychology, physiology, traditional Chinese medicine(CM), modern practice of CM, and oncology to explore the eff...Objective: We employed a multidisciplinary approach incorporating theoretical ideas, clinical experience,psychology, physiology, traditional Chinese medicine(CM), modern practice of CM, and oncology to explore the effect of patients’ repression of negative emotions and traumatic events on breast cancer(BC) pathogenesis.Methods: BC female patients, older than 18 years of age, with available pathology reports who were treated at Rabin Medical Center were recruited. All participants completed questionnaires regarding medical history, behavioral tendencies, negative emotions, trauma, symptoms, and pathology(from a CM perspective). Data on tumor characteristics were collected from the pathology reports. The associations were examined using hierarchical binary logistic regressions.Results: A total of 155 BC patients were enrolled. The median age was 52 years, with a range of 26–79;95% were mothers;28% had estrogen receptor(ER)-negative BC, 52% had progesterone receptor(PR)-negative BC, 48% had human epidermal growth factor receptor 2-negative BC, and antigen Ki-67 ≥ 20%was reported for 52% of tumors. Statistically significant associations were found between the emotional markers(sense of motherhood failure, and lack of self-fulfillment), avoidance behavior, and physical symptoms that are related to emotional repression based on CM. Significant associations were also found between variables associated with physical symptoms of emotional repression, which involves the production and accumulation of non-substantial phlegm(i.e., ‘‘high-lipid Qi-like microscopic phlegm"),avoidance behavior which unconsciously uses ‘‘high-lipid Qi-like microscopic phlegm" in order to achieve emotional repression, and tumor parameters including tumor grade, PR status, and Ki-67.Patients with higher levels of ‘‘high-lipid Qi-like microscopic phlegm" were more likely to have tumors with worse prognosis(PR-negative, higher grade, and higher Ki-67).Conclusion: We demonstrated a relationship between emotional parameters, behavioral tendencies, CM parameters, and oncologic parameters in BC. Additional research is warranted to explore these associations and their relevance to clinical practice.展开更多
BACKGROUND In recent years survival of patients with metastatic colorectal cancer(mCRC),though still limited,has improved significantly;clearly,when the disease becomes refractory to standard regimens,additional treat...BACKGROUND In recent years survival of patients with metastatic colorectal cancer(mCRC),though still limited,has improved significantly;clearly,when the disease becomes refractory to standard regimens,additional treatment options are needed.Studies have shown that mitomycin C(MMC),an antitumor antibiotic,and capecitabine,a precursor of 5-fluorouracil,may act synergistically in combination.The efficacy of MMC/capecitabine has been demonstrated in the first-line setting,but only a few small studies have tested it in the advanced-line setting,with contradictory results.received a median of 2 MMC/capecitabine cycles(range 0.5-9.0).Thirty-four patients(28.6%)experienced grade≥3 toxicity,including 2(1.7%)with grade 4;there was no drug-related mortality.The objective response rate was 0.8%,and the disease control rate,24.4%.Median progression-free survival(PFS)was 2.1 mo(range 0.2-20.3),and median overall survival,4.8 mo(range 0.2-27.5).The 6-month overall survival rate was 44%;8.7%of patients remained progression-free.Factors associated with longer PFS were lower gamma-glutamyl transferase level(P=0.030)and primary tumor location in the left colon(P=0.017).Factors associated with longer overall survival were lower gamma-glutamyl transferase level(P=0.022),left-colon tumor location(P=0.044),low-to-moderate histological grade(P=0.012),Eastern Cooperative Oncology Group performance status 0-1(P=0.036),and normal bilirubin level(P=0.047).CONCLUSION MMC/capecitabine is an active,available,and relatively safe regimen for use beyond standard lines of therapy in mCRC.Several clinical and laboratory parameters can identify patients more likely to benefit.展开更多
BACKGROUND Although the association of attention deficit hyperactivity disorder(ADHD)with psychiatric disorders is well known,its association with somatic diseases is unclear.Only few studies have investigated the gas...BACKGROUND Although the association of attention deficit hyperactivity disorder(ADHD)with psychiatric disorders is well known,its association with somatic diseases is unclear.Only few studies have investigated the gastrointestinal(GI)morbidity in adult patients with ADHD.AIM To measure gastrointestinal comorbidity and its burden on healthcare in young adults with ADHD.METHODS The cohort included subjects aged 17-35 years recruited to the Israel Defense Forces in 2007-2013,33380 with ADHD and 355652 without(controls).The groups were compared for functional and inflammatory conditions of the gastrointestinal tract and clinic and specialist visits for gastrointestinal symptoms/disease during service(to 2016).Findings were analyzed by generalized linear models adjusted for background variables.RESULTS Compared to controls,the ADHD group had more diagnoses of functional gastrointestinal disorders(referred to as FGID),namely,dyspepsia[odds ratio(OR):1.48,95%confidence interval(CI):1.40-1.57,P<0.001],chronic constipation(OR:1.64,95%CI:1.48-1.81,P<0.001),and irritable bowel syndrome(OR:1.67,95%CI:1.56-1.80,P<0.001)but not of organic disorders(inflammatory bowel disease,celiac disease).They had more frequent primary care visits for gastrointestinal symptoms[rate ratio(RR):1.25,95%CI:1.24-1.26,P<0.001]and referrals to gastrointestinal specialists(RR:1.96,95%CI:1.88-2.03,P<0.001)and more episodes of recurrent gastrointestinal symptoms(RR:1.29,95%CI:1.21-1.38,P<0.001).Methylphenidate use increased the risk of dyspepsia(OR:1.49,95%CI:1.28-1.73,P<0.001)and constipation(OR:1.42,95%CI:1.09-1.84,P=0.009).CONCLUSION ADHD in young adults is associated with an excess of FGID and increased use of related health services.Research is needed to determine if an integrative approach treating both conditions will benefit these patients and cut costs.展开更多
Many patients with hepatocellular carcinoma are diagnosed with large tumours at an advanced stage.In addition,conditions such as liver fibrosis,cirrhosis,portal hypertension,viral load,and portal vein thrombosis due t...Many patients with hepatocellular carcinoma are diagnosed with large tumours at an advanced stage.In addition,conditions such as liver fibrosis,cirrhosis,portal hypertension,viral load,and portal vein thrombosis due to either non-neoplastic or portal vein tumour thrombus limit the indications for surgical management to a select subset of individuals(1).展开更多
Background:The vast majority of patients with cholangiocarcinoma(CC)have advanced disease at diagnosis and are candidates for palliative treatment only.The robustness of the randomized controlled trials regarding the ...Background:The vast majority of patients with cholangiocarcinoma(CC)have advanced disease at diagnosis and are candidates for palliative treatment only.The robustness of the randomized controlled trials regarding the treatment of CC are assessed.Methods:A systematic review of all randomized control trials(RCT)of treatments for both intra-and extrahepatic CC between 2010 and 2020 was performed.The survival-inferred fragility index(SIFI;the minimum number of reassignments of the best survivors between arms that would overturn the statistical outcomes)was calculated.In addition,the gain,or loss,in survival in RCTs was evaluated by the restricted mean survival time(RMST)difference.Finally,the level of spin i.e.,misrepresentation of study outcomes,was measured in inconclusive studies to assess distorted reporting strategies.Results:Out of 6,167 studies retrieved,11 could be retained for full text revision(7 with both intra-and extrahepatic CC,3 with peri-hilar CC,and 1 with peri-hilar or distal CC).Only 3 studies included resected patients(2 with both intra-and extrahepatic CC and 1 with peri-hilar or distal CC).Nine studies investigated systemic chemotherapy(including 3 after surgical resection),one study evaluated photodynamic therapy,and another investigated the use of an endoscopically inserted stent in the biliary tract.The median SIFI was−2[interquartile range(IQR):−6.25,−0.25]across all studies.Overall,the median RMST difference was 0.56 months(IQR:0.10,0.95).Finally,for inconclusive studies,the level of spin was high,moderate,and low in respectively 12.5%,25%,and 62.5% of the studies.Conclusions:RCTs of CC showed a low degree of robustness with a frequent proportion of associated spin.展开更多
文摘To characterize colorectal cancer (CRC) in octogenarians as compared with younger patients.METHODSA single-center, retrospective cohort study which included patients diagnosed with CRC at the age of 80 years or older between 2008-2013. A control group included consecutive patients younger than 80 years diagnosed with CRC during the same period. Clinicopathological characteristics, treatment and outcome were compared between the groups. Fisher’s exact test was used for dichotomous variables and χ<sup>2</sup> was used for variables with more than two categories. Overall survival was assessed by Kaplan-Meier survival analysis, with the log-rank test. Cancer specific survival (CSS) and disease-free survival were assessed by the Cox proportional hazards model, with the Fine and Gray correction for non-cancer death as a competing risk.RESULTSThe study included 350 patients, 175 patients in each group. Median follow-up was 40.2 mo (range 1.8-97.5). Several significant differences were noted. Octogenarians had a higher proportion of Ashkenazi ethnicity (64.8% vs 47.9%, P < 0.001), a higher rate of personal history of other malignancies (22.4% vs 13.7%, P = 0.035) and lower rates of family history of any cancer (36.6% vs 64.6%, P < 0.001) and family history of CRC (14.4% vs 27.3%, P = 0.006). CRC diagnosis by screening was less frequent in octogenarians (5.7% vs 20%, P < 0.001) and presentation with performance status (PS) of 0-1 was less common in octogenarians (71% vs 93.9%, P < 0.001). Octogenarians were more likely to have tumors located in the right colon (45.7% vs 34.3%, P = 0.029) and had a lower prevalence of well differentiated histology (10.4% vs 19.3%, P = 0.025). They received less treatment and treatment was less aggressive, both in patients with metastatic and non-metastatic disease, regardless of PS. Their 5-year CSS was worse (63.4% vs 77.6%, P = 0.009), both for metastatic (21% vs 43%, P = 0.03) and for non-metastatic disease (76% vs 88%, P = 0.028).CONCLUSIONOctogenarians presented with several distinct characteristics and had worse outcome. Further research is warranted to better define this growing population.
文摘Objective: We employed a multidisciplinary approach incorporating theoretical ideas, clinical experience,psychology, physiology, traditional Chinese medicine(CM), modern practice of CM, and oncology to explore the effect of patients’ repression of negative emotions and traumatic events on breast cancer(BC) pathogenesis.Methods: BC female patients, older than 18 years of age, with available pathology reports who were treated at Rabin Medical Center were recruited. All participants completed questionnaires regarding medical history, behavioral tendencies, negative emotions, trauma, symptoms, and pathology(from a CM perspective). Data on tumor characteristics were collected from the pathology reports. The associations were examined using hierarchical binary logistic regressions.Results: A total of 155 BC patients were enrolled. The median age was 52 years, with a range of 26–79;95% were mothers;28% had estrogen receptor(ER)-negative BC, 52% had progesterone receptor(PR)-negative BC, 48% had human epidermal growth factor receptor 2-negative BC, and antigen Ki-67 ≥ 20%was reported for 52% of tumors. Statistically significant associations were found between the emotional markers(sense of motherhood failure, and lack of self-fulfillment), avoidance behavior, and physical symptoms that are related to emotional repression based on CM. Significant associations were also found between variables associated with physical symptoms of emotional repression, which involves the production and accumulation of non-substantial phlegm(i.e., ‘‘high-lipid Qi-like microscopic phlegm"),avoidance behavior which unconsciously uses ‘‘high-lipid Qi-like microscopic phlegm" in order to achieve emotional repression, and tumor parameters including tumor grade, PR status, and Ki-67.Patients with higher levels of ‘‘high-lipid Qi-like microscopic phlegm" were more likely to have tumors with worse prognosis(PR-negative, higher grade, and higher Ki-67).Conclusion: We demonstrated a relationship between emotional parameters, behavioral tendencies, CM parameters, and oncologic parameters in BC. Additional research is warranted to explore these associations and their relevance to clinical practice.
基金The study was reviewed and approved by the Rabin Medical Center Institutional Review Board(Approval No.0639-19-RMC).
文摘BACKGROUND In recent years survival of patients with metastatic colorectal cancer(mCRC),though still limited,has improved significantly;clearly,when the disease becomes refractory to standard regimens,additional treatment options are needed.Studies have shown that mitomycin C(MMC),an antitumor antibiotic,and capecitabine,a precursor of 5-fluorouracil,may act synergistically in combination.The efficacy of MMC/capecitabine has been demonstrated in the first-line setting,but only a few small studies have tested it in the advanced-line setting,with contradictory results.received a median of 2 MMC/capecitabine cycles(range 0.5-9.0).Thirty-four patients(28.6%)experienced grade≥3 toxicity,including 2(1.7%)with grade 4;there was no drug-related mortality.The objective response rate was 0.8%,and the disease control rate,24.4%.Median progression-free survival(PFS)was 2.1 mo(range 0.2-20.3),and median overall survival,4.8 mo(range 0.2-27.5).The 6-month overall survival rate was 44%;8.7%of patients remained progression-free.Factors associated with longer PFS were lower gamma-glutamyl transferase level(P=0.030)and primary tumor location in the left colon(P=0.017).Factors associated with longer overall survival were lower gamma-glutamyl transferase level(P=0.022),left-colon tumor location(P=0.044),low-to-moderate histological grade(P=0.012),Eastern Cooperative Oncology Group performance status 0-1(P=0.036),and normal bilirubin level(P=0.047).CONCLUSION MMC/capecitabine is an active,available,and relatively safe regimen for use beyond standard lines of therapy in mCRC.Several clinical and laboratory parameters can identify patients more likely to benefit.
文摘BACKGROUND Although the association of attention deficit hyperactivity disorder(ADHD)with psychiatric disorders is well known,its association with somatic diseases is unclear.Only few studies have investigated the gastrointestinal(GI)morbidity in adult patients with ADHD.AIM To measure gastrointestinal comorbidity and its burden on healthcare in young adults with ADHD.METHODS The cohort included subjects aged 17-35 years recruited to the Israel Defense Forces in 2007-2013,33380 with ADHD and 355652 without(controls).The groups were compared for functional and inflammatory conditions of the gastrointestinal tract and clinic and specialist visits for gastrointestinal symptoms/disease during service(to 2016).Findings were analyzed by generalized linear models adjusted for background variables.RESULTS Compared to controls,the ADHD group had more diagnoses of functional gastrointestinal disorders(referred to as FGID),namely,dyspepsia[odds ratio(OR):1.48,95%confidence interval(CI):1.40-1.57,P<0.001],chronic constipation(OR:1.64,95%CI:1.48-1.81,P<0.001),and irritable bowel syndrome(OR:1.67,95%CI:1.56-1.80,P<0.001)but not of organic disorders(inflammatory bowel disease,celiac disease).They had more frequent primary care visits for gastrointestinal symptoms[rate ratio(RR):1.25,95%CI:1.24-1.26,P<0.001]and referrals to gastrointestinal specialists(RR:1.96,95%CI:1.88-2.03,P<0.001)and more episodes of recurrent gastrointestinal symptoms(RR:1.29,95%CI:1.21-1.38,P<0.001).Methylphenidate use increased the risk of dyspepsia(OR:1.49,95%CI:1.28-1.73,P<0.001)and constipation(OR:1.42,95%CI:1.09-1.84,P=0.009).CONCLUSION ADHD in young adults is associated with an excess of FGID and increased use of related health services.Research is needed to determine if an integrative approach treating both conditions will benefit these patients and cut costs.
文摘Many patients with hepatocellular carcinoma are diagnosed with large tumours at an advanced stage.In addition,conditions such as liver fibrosis,cirrhosis,portal hypertension,viral load,and portal vein thrombosis due to either non-neoplastic or portal vein tumour thrombus limit the indications for surgical management to a select subset of individuals(1).
文摘Background:The vast majority of patients with cholangiocarcinoma(CC)have advanced disease at diagnosis and are candidates for palliative treatment only.The robustness of the randomized controlled trials regarding the treatment of CC are assessed.Methods:A systematic review of all randomized control trials(RCT)of treatments for both intra-and extrahepatic CC between 2010 and 2020 was performed.The survival-inferred fragility index(SIFI;the minimum number of reassignments of the best survivors between arms that would overturn the statistical outcomes)was calculated.In addition,the gain,or loss,in survival in RCTs was evaluated by the restricted mean survival time(RMST)difference.Finally,the level of spin i.e.,misrepresentation of study outcomes,was measured in inconclusive studies to assess distorted reporting strategies.Results:Out of 6,167 studies retrieved,11 could be retained for full text revision(7 with both intra-and extrahepatic CC,3 with peri-hilar CC,and 1 with peri-hilar or distal CC).Only 3 studies included resected patients(2 with both intra-and extrahepatic CC and 1 with peri-hilar or distal CC).Nine studies investigated systemic chemotherapy(including 3 after surgical resection),one study evaluated photodynamic therapy,and another investigated the use of an endoscopically inserted stent in the biliary tract.The median SIFI was−2[interquartile range(IQR):−6.25,−0.25]across all studies.Overall,the median RMST difference was 0.56 months(IQR:0.10,0.95).Finally,for inconclusive studies,the level of spin was high,moderate,and low in respectively 12.5%,25%,and 62.5% of the studies.Conclusions:RCTs of CC showed a low degree of robustness with a frequent proportion of associated spin.
