Clinical characteristics and incidences of benign and malignant insulinoma using a national inpatient database in Japan

2021 ◽  
Author(s):  
Kayo Ikeda Kurakawa ◽  
Akira Okada ◽  
Katsunori Manaka ◽  
Takaaki Konishi ◽  
Taisuke Jo ◽  
...  
Keyword(s):  
Adult Population ◽  
Patient Characteristics ◽  
Therapeutic Interventions ◽  
Neuroendocrine Neoplasm ◽  
Background Characteristics ◽  
Japanese Adult ◽  
Diagnosis Procedure Combination ◽  
Malignant Insulinoma ◽  
Number Of Patients ◽  
Inpatient Database

Abstract Context Insulinoma is the most common pancreatic functional neuroendocrine neoplasm, yet little information on recent clinical practice in patients with insulinoma, especially malignant insulinoma, is available. Objective To clarify the characteristics and practice patterns in patients with insulinoma using a national inpatient database. Methods Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified patients with insulinoma admitted between 2010 and 2018. We compared background characteristics and therapeutic interventions between patients with benign and malignant insulinoma. We also estimated the incidence of insulinoma using the number of patients with newly diagnosed insulinoma in 2012. Results We identified 844 patients with benign insulinoma and 102 patients with malignant insulinoma. Patients with malignant insulinoma were younger (median, 55.5 vs. 66.0 years, P < 0.001) and less likely to be female (55.9% vs. 65.3%, P = 0.061) than patients with benign insulinoma. Analysis of therapeutic interventions revealed that patients with malignant insulinoma more frequently received medications (71.6% vs. 49.6%, P < 0.001) but less frequently underwent pancreatic surgery (57.8% vs. 72.0%, P = 0.003). Older patients were a smaller proportion of those undergoing surgery and a larger proportion of those managed with medications without surgery (P < 0.001). The incidence of insulinoma was estimated to be 3.27 (95% confidence interval, 2.93–3.61) persons per million Japanese adult population per year. Conclusions The present study using a nationwide database had a larger sample size than previous studies and revealed definitive differences in patient characteristics and therapeutic patterns between benign and malignant insulinoma.

scholarly journals Bayesian adaptive design of early-phase clinical trials for precision medicine based on cancer biomarkers

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shinjo Yada
Keyword(s):  
Neural Network ◽  
Clinical Trials ◽  
Precision Medicine ◽  
Early Phase ◽  
Patient Specific ◽  
Specific Gene ◽  
Cancer Type ◽  
Background Characteristics ◽  
Number Of Patients ◽  
Early Phase Clinical Trials

Abstract Cancer tissue samples obtained via biopsy or surgery were examined for specific gene mutations by genetic testing to inform treatment. Precision medicine, which considers not only the cancer type and location, but also the genetic information, environment, and lifestyle of each patient, can be applied for disease prevention and treatment in individual patients. The number of patient-specific characteristics, including biomarkers, has been increasing with time; these characteristics are highly correlated with outcomes. The number of patients at the beginning of early-phase clinical trials is often limited. Moreover, it is challenging to estimate parameters of models that include baseline characteristics as covariates such as biomarkers. To overcome these issues and promote personalized medicine, we propose a dose-finding method that considers patient background characteristics, including biomarkers, using a model for phase I/II oncology trials. We built a Bayesian neural network with input variables of dose, biomarkers, and interactions between dose and biomarkers and output variables of efficacy outcomes for each patient. We trained the neural network to select the optimal dose based on all background characteristics of a patient. Simulation analysis showed that the probability of selecting the desirable dose was higher using the proposed method than that using the naïve method.

scholarly journals AB0237 INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH RITUXIMAB AND ANTI-TNF INHIBITOR

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1144.2-1144
Author(s):  
N. Zehraoui ◽  
R. Benaziez.Boutaleb ◽  
H. Hafirassou ◽  
F. Mechid ◽  
N. Bahaz ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Best Practice ◽  
Biological Therapy ◽  
Patient Characteristics ◽  
Inadequate Response ◽  
Tnf Inhibitor ◽  
Clinical Rheumatology ◽  
Number Of Patients ◽  
Serious Infections ◽  
Comparative Risk

Background:Biological therapies have significantly improved the management of rheumatoid arthritis (RA). These molecules are very effective, but are known for their specific risks, especially infectious. It depends on several factors including the type of molecule used.Objectives:The objective of our study is to compare the rate of infection in RA patients treated with rituximab and anti-TNFα.Methods:Prospective, observational, monocentric study. Were included RA patients (ACR / EULAR 2010 criteria) treated with rituximab and anti-TNFα (adalimumab, infliximab and Etanercept) after inadequate response to DMARDs.Demographic characteristics, comorbidities, association with methotrexate and corticosteroids were collected and compared for each group.The number, type and severity of the infections in both cases were noted.SPSS (Statistical Package for Social Science) was used for data analysis.Results:40 RA patients treated with rituximab and 31 patients who received anti-TNFα were included.Patient characteristics and Comparison of rate of infection in RA patients between the two groups are summarized in Table 1Table 1.ParametersRituximabAnti-TNFαpNumber of patients4031Average age (years)56,2846,060,01Sexratio0,140,110,7Average duration of evolution (years)15,8313,740,3Patients under corticosteroid (%)97,587,10,08Average corticosteroid dose6,415,480,3patients under methotrexate (%)37,545,20,5Diabetes (%)2016,10,7Patients with infection (%)32,551,60,1Number of infections18240,4Number of serious infections500,04Conclusion:The rate of infections in patients with RA treated with rituximab or anti-TNF was similar. However, the infections observed were more serious in patients with RA treated with rituximabReferences:[1]Fabiola Atzeni MD PhD and al. Infections and Biological Therapy in Patients with Rheumatic Diseases. IMAJ . VOL 18. march-APRIL 2016.[2]Huifeng Yun and al. Comparative Risk of Hospitalized Infection Associated with Biologic Agents in Rheumatoid Arthritis Patients Enrolled in Medicare. ARTHRITIS & RHEUMATOLOGY. Vol. 68, No. 1, January 2016, pp 56–66.[3]Manjari Lahiri and al. Risk of infection with biologic antirheumatic therapies in patients with rheumatoid arthritis. Best Practice & Research Clinical Rheumatology (2015) 1-16.Disclosure of Interests:None declared

Cancer and COVID-19: A proposed mechanism with therapeutic interventions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3135-3135
Author(s):  
Yan Leyfman ◽  
Nancy Emmanuel ◽  
Aleksey Tentler ◽  
Jared Cappelli ◽  
Timothy K Erick ◽  
...  
Keyword(s):  
Respiratory Illness ◽  
Organ Damage ◽  
Multiple Organ ◽  
Therapeutic Interventions ◽  
Actual Number ◽  
Data Registry ◽  
Number Of Patients ◽  
Increased Risk ◽  
Life Threatening ◽  
Active Cancer

3135 Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel betacoronavirus that causes the respiratory illness coronavirus disease 2019 (COVID-19). COVID-19 ranges in severity from an asymptomatic viral infection to life-threatening cases of pneumonia, acute respiratory distress syndrome (ARDS), multi-organ damage and sepsis. Cancer patients are at an increased risk of severe SARS-CoV-2 infection due to their immunocompromised status. We propose a mechanism by which SARS-CoV-2 infection causes multiple organ damage through IL-6-mediated inflammation and hypoxia-induced cellular metabolic alterations leading to cell death. Hypoxia is also induced by malignancy due to alterations in metabolism, resulting in greater IL-6 secretion. Methods: To highlight the possible effect of active cancer on the likelihood of hypoxia in COVID-19, we analyzed the correlation between cancer status and the severity of COVID-19 from the COVID-19 and Cancer Consortium data registry. For cancer status, we looked at progressive cancer and remission of cancer only -- those being the two extremes of presence and absence of uncontrolled cancer. Similar to prior studies, the severity of COVID-19 was used as an indication of hypoxia. Results: We observed a 24% positive deviation between expected and actual number of patients with actively progressing cancer who had hypoxic COVID-19 (moderate to severe), and a 26.9% negative deviation between expected and actual number of patients with active cancer who had no hypoxia with COVID-19 (p<0.0001). Conversely, for patients with cancer in remission, there was only a +5.8% and -5.1% deviation between expected and actual number of patients who did not have hypoxia and who had hypoxia, respectively. Conclusions: These results suggest that in the presence of poorly controlled malignancy, there is an increased likelihood of hypoxia in patients with COVID-19, thereby exacerbating downstream cytokine release syndrome and contributing to prolonged systemic inflammatory injury. Appreciating this pathway, future therapies can be developed to target the pathogenesis of both diseases and prevent progression, as seen with mesenchymal stem cells, which demonstrated a 91% overall survival and 100% survival in patients younger than 85 years old at one month after a single treatment.[Table: see text]

scholarly journals Neoadjuvant peptide receptor radionuclide therapy and modified multivisceral transplantation for an advanced small intestinal neuroendocrine neoplasm: an updated case report

2017 ◽  
Vol 2 (4) ◽  
pp. 247-253
Author(s):  
Ashley K. Clift ◽  
Henk Giele ◽  
Srikanth Reddy ◽  
Rubens Macedo ◽  
Adil Al-Nahhas ◽  
...  
Keyword(s):  
Radionuclide Therapy ◽  
Surgical Techniques ◽  
Peptide Receptor Radionuclide Therapy ◽  
Neuroendocrine Neoplasm ◽  
Peptide Receptor ◽  
Multivisceral Transplantation ◽  
First Case ◽  
Mesenteric Root ◽  
Number Of Patients ◽  
Small Intestinal

AbstractSmall intestinal neuroendocrine neoplasms (SI-NEN) frequently metastasise to regional lymph nodes, and surgery is the mainstay of therapy for such patients. However, despite the possible use of advanced surgical techniques, the resection of both primary and locoregional diseases is not always attainable. Intestinal and multivisceral transplantation has been performed in a small number of patients with conventionally nonresectable, slow-growing tumours threatening the mesenteric root but has remained controversial. The use of donor skin in “sentinel flaps” in transplantation theoretically offers advantages in tailoring immunosuppression and monitoring for rejection. We represent (with extended follow-up) the first case of a patient with inoperable extensive mesenteric metastases from SI-NEN, who underwent neoadjuvant peptide receptor radionuclide therapy before a modified multivisceral transplant with a concomitant vascularised sentinel forearm flap. At 48 months after transplantation, our patient remained at full physical activity with no evidence of disease recurrence on either tumour biochemistry or radiological imaging.

scholarly journals Effects of Smoking and Shared Epitope on the Production of Anti-Citrullinated Peptide Antibody in a Japanese Adult Population

2014 ◽  
Vol 66 (12) ◽  
pp. 1818-1827 ◽  
Author(s):  
Chikashi Terao ◽  
Koichiro Ohmura ◽  
Katsunori Ikari ◽  
Takahisa Kawaguchi ◽  
Meiko Takahashi ◽  
...  
Keyword(s):  
Shared Epitope ◽  
Adult Population ◽  
Japanese Adult ◽  
Peptide Antibody ◽  
Citrullinated Peptide

scholarly journals Management of asymptomatic hypoglycemia with 40% oral dextrose gel in near term at-risk infants to reduce intensive care need and promote breastfeeding

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Fabio Meneghin ◽  
Martina Manzalini ◽  
Miriam Acunzo ◽  
Irene Daniele ◽  
Petrina Bastrenta ◽  
...  
Keyword(s):  
At Risk ◽  
Intensive Care ◽  
Glucose Infusion ◽  
Oral Feeding ◽  
Therapeutic Interventions ◽  
Secondary Outcome ◽  
Control Group ◽  
Intravenous Glucose ◽  
Number Of Patients ◽  
Near Term

Abstract Background Neonatal hypoglycemia is a common disorder especially in at-risk infants and it can be associated with poor long-term neurological outcomes. Several therapeutic interventions are suggested, from the implementation of breastfeeding to the glucose intravenous administration. Oral dextrose gel massaged into the infant’s inner cheek is a recent treatment option of asymptomatic hypoglycemia, after which oral feeding is encouraged. This approach seems to reduce the admission of infants to neonatal intensive care unit (NICU) so favouring maternal bonding and breastfeeding success at discharge. Methods In our ward, we prospectively compared a group of near-term neonates, (Gr2, n = 308) at risk for hypoglycemia, treated with an innovative protocol based on the addition of 40% oral dextrose gel (Destrogel, Orsana®,Italy) administered by massaging gums and cheek with historical matching newborns (Gr1, n = 389) treated with a formerly used protocol, as control group. The primary outcome was occurrence of NICU admission and the requirement of intravenous glucose administration; while discharge with full breastfeeding was the secondary outcome. Results In Gr1, 39/389 (10%) infants presented with asymptomatic hypoglycemia, 19/39 were transferred to the NICU, and 14/39 required intravenous glucose treatment. In Gr2, among the 30/308 infants with asymptomatic hypoglycemia managed according to the new protocol, 3/30 were transferred to the NICU and received intravenous glucose infusion. The mean duration of hospitalization respectively was 6.43 (± 6.36) and 3.73 ± 1.53 days (p <  0.001). At discharge, 7.7% of the infants in Gr1 and 30% of the infants in Gr2 were exclusively breastfed (p = 0.02). Considering Gr1 vs Gr2, the number of patients that were transferred to NICU was 19 (48.7%) vs 3 (10%) (p = 0.001) and the number of infants that needed intravenous glucose infusion was 14 (35.9%) vs 3 (10%) (p = 0.01), respectively. Conclusions In our population of near term infants, the introduction of 40% oral dextrose gel to the protocol, helped in the safe management of asymptomatic hypoglycemia and, at the same time, implemented breastfeeding.

scholarly journals Stereoacuity after Successful Occlusion Therapy in Children with Anisometropic Amblyopia

2021 ◽  
Vol 62 (11) ◽  
pp. 1539-1546
Author(s):  
Sang Wook Lee ◽  
Eun Hye Jung
Keyword(s):  
Patient Characteristics ◽  
Visual Development ◽  
Post Treatment ◽  
Control Group ◽  
Normal Children ◽  
Factors Affecting ◽  
Anisometropic Amblyopia ◽  
Factors Associated ◽  
Number Of Patients ◽  
The Mean

Purpose: To compare the stereoacuity between patients with anisometropic amblyopia who were treated and achieved normal visual acuity (VA) and normal children and evaluate the factors associated with stereoacuity.Methods: We retrospectively reviewed the records of 37 pediatric patients with anisometropic amblyopia who recovered to normal VA with glasses and occlusion treatment (amblyopia group) and 34 normal children (control group). The Worth 4-dot test, Lang II test, Titmus test, and TNO test were performed to measure stereoacuity. Clinical characteristics were compared between the two groups, and factors affecting stereoacuity outcomes were also analyzed in the amblyopic group.Results: The mean age at diagnosis of amblyopia was 5.3 ± 1.4 years, and the mean VAs at diagnosis were 0.41 ± 0.24 and 0.06 ± 0.07 in amblyopic and fellow eyes, respectively. The mean duration of occlusion was 19.00 ± 9.44 months, and VA of amblyopic eyes improved to 0.04 ± 0.04 after occlusion treatment. The patient characteristics did not differ significantly between the two groups, except for the final VA of the amblyopic eye. The final mean logarithm of minimal angle of resolution VA of the amblyopic eye in the amblyopia group was significantly worse than that in the control group. The number of patients with normal stereoacuity was significantly lower in the amblyopia group than in the control group on Lang II, Titmus, and TNO tests. Factors associated with poor stereoacuity were severe amblyopia in the Lang II test and poor post-treatment VA of the amblyopic eye in the Titmus test.Conclusions: Stereoacuity was worse in the amblyopia group than in the control group, despite normal visual development. The depth of amblyopia and post-treatment VA were associated with stereoacuity outcomes. Thus, VA improvement should be closely monitored in the amblyopic eye to obtain good stereoacuity.

scholarly journals Transfer of human proinsulin gene into Cucumber (Cucumis sativus L.) via agrobacterium method

Genetika ◽  
2017 ◽  
Vol 49 (2) ◽  
pp. 717-728
Author(s):  
Kameh Abookazemi ◽  
Javaran Jalali ◽  
Mehdi Mohebodini ◽  
Akbar Vaseghi
Keyword(s):  
Transgenic Plants ◽  
Molecular Farming ◽  
Adult Population ◽  
Advanced Technology ◽  
High Rate ◽  
35S Promoter ◽  
Dot Blot ◽  
Hormone Production ◽  
Human Proinsulin ◽  
Number Of Patients

Nowadays, approximately 5.8% in adult population around the world are suffering by diabetes. It can be caused by an increase in risk factors such as being overweight. Also it has been estimated that the number of patients will be doubled in near future and the demands for insulin hormone will be growing up by 3 to 4 % annually. Therefore, it?s necessary to develop new methods for hormone production with high rate of capacity in future. By advanced technology of transgenic DNA, the transgenic plants are introduced as an attractive system for expression and production of many kinds of pharmaceutical proteins. In this study, we investigated transfer of Human Proinsulin Gene into the Cucumber (Cucumissativus L.). Transgenic cucumber could be a great prospect for future source of eatable insulin pharmaceutical drugs to be taken by patients.Agrobacterium tumefaciensstrain LBA4404 carrying proinsulin genes with CaMV 35S promoter was used for the transformation purpose. The transgenic plants were analyzed by PCR, RT-PCR, SDS-PAGE, Dot blot and Electrochemiluminescence techniques. Production of proinsulin in cucumber could be a great prospect in molecular farming of human proinsulin.

scholarly journals Peculiarities of the disease and prevalence of chronic cystitis among the female population of Ukraine in the regional aspect

2021 ◽  
Vol 26 (4) ◽  
pp. 212-219
Author(s):  
N.O. Saidakova ◽  
V.P. Stus ◽  
N.V. Havva ◽  
V.І. Grodzinsky
Keyword(s):  
Growth Rate ◽  
Adult Population ◽  
High Growth ◽  
High Growth Rate ◽  
Chronic Cystitis ◽  
Female Population ◽  
Regional Aspect ◽  
Number Of Patients ◽  
Southeastern Region ◽  
Intensive Growth

The study uses data from state and industry official statistics for 2008-2017. Absolute and relative indicators of morbidity and prevalence of chronic cystitis among the female population of Ukraine, its regions and areas were analyzed taking into account two five-year periods for comparative assessment of the nature and intensity of dynamic processes. It is revealed that the number of patients with chronic cystitis (СC) registered in Ukraine is at the expense of women, which are 3-3.5 times more in number than men, with their characteristic more intensive growth (for 10 years by 3.6% against 0.4% among the adult population in the country). The first three places in the structure belong to the Southeastern region, Kyiv, Western region, the next – Central, Southern, Northeastern regions. Levels of the prevalence of the disease among women (100 thousand) are higher than the average in Ukraine and have a high growth rate (for 10 years by 13.5% from 232.2 to 263.6 against 9.3% from 171.5 to 187.5, respectively). Typical for Ukraine persistent increase in patients with the first diagnosis of chronic cystitis (0.8%, 2.1% and 2.8%, respectively, in the first, second periods and 10 years to 15112 in 2017) is also formed by this category (women's growth was 3.4%, 12.4%, and 5.0%, respectively, to 11.295). A similar situation was also identified in the analysis of the level of morbidity (per 100 thousand). In Ukraine, its growth rate for the last five years was 9.6% against 1.8% for the previous year, for 10 years – 11.9%, and the value reached 43.4 in 2017 against 38.8 in 2008. Among women, its levels are higher than the average in Ukraine (in 2017 – 59.2 against 56.1 in 2008), and the increase was more intense (by 6.2% and 11.3% over the periods; for 10 years – by 11.98%).

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