1,721,082 research outputs found
IMPACT OF LIFESTYLE FACTORS ON SCREENING-DETECTED COLORECTAL NEOPLASIA
Full text linkBackground and aims: The detection and removal of precancerous lesions through colorectal cancer (CRC) screening, and the intervention on modifiable risk factors for CRC - such as smoking habits, physical activity, red meat consumption and alcohol intake - represent the two possible ways for reducing CRC incidence and mortality. The aim of this project was to investigate whether lifestyle factors, gender, family history and daily low-dose Aspirin use are important factors in predicting endoscopy findings at a first round screening level and whether they can have a significant impact on the natural history of the disease in screened patients during their follow-up (second round screening level).
Patients and methods: Me and my work team identified and selected a study population of 870 men and women of age 50-74 years who underwent a screening colonoscopy at the European Institute of Oncology (IEO) between the years 2007-2009 after a positive Fecal Occult Blood Test (FOBT+). We set up a telephone questionnaire in order to retrieve information on smoking habits, BMI, physical activity, diet, alcohol consumption, family history and usage of low-dose Aspirin at the time of the first colonoscopy. All patients were then interviewed by me by telephone. Ninety-five individuals were not interviewed for various reasons, making the final population size n=775. Patients who could answer the questionnaire were similar to the unreached individuals in terms of outcome of the first colonoscopy.
Results: At first colonoscopy, we observed 415 patients presenting with a high-risk neoplasia (i.e. 3 or more adenomas or at least one adenoma bigger than 10 mm / with villous component / with high-grade dysplasia or invasive tumor). At the univariate analysis, gender, family history, physical activity, smoking habits, alcohol intake, fruit and vegetable intake and daily low-dose Aspirin were associated with the prevalence of high-risk neoplasia. Using a “Spike at zero function”, we showed that light drinkers (<5 grams per day) seemed to have a lower risk of high-risk neoplasia compared to non-drinkers. We concluded that a proportion of non-drinkers might avoid alcohol because of some health conditions linked to the endpoint of interest. At a multivariable level, all those factors remained statistically significantly associated with the outcome of interest. We therefore combined the information of lifestyle factors, gender, family history and daily low-dose Aspirin use to obtain a reliable individual risk score (i.e. linear predictor) and build a nomogram.
The second colonoscopy visit date was fixed in advanced at the time of first colonoscopy, based on the outcome of the first colonoscopy, following a typical example of Doctor’s care scheme of examinations. After adjusting for the severity of the outcome of the first colonoscopy and for the time from first to second colonoscopy, we obtained a statistically significant association between the linear predictor and the risk of high-risk neoplasia detected at the second colonoscopy.
We then applied homogeneous Markov Models to simultaneously model the disease process over time. The effect of the linear predictor on the transitions – from one disease stage to the other – resulted statistically significant. Moreover, as the linear predictor increased, the probability of getting better decreased. In other words, the worse the lifestyle, the lower the probability for the intestinal mucosa to heal. On the other hand, the estimated parameter for the effect of linear predictor on the aggravation transition resulted positive: the worse the lifestyle, the higher the probability to find new high-risk polyps.
Conclusions: Lifestyle should be considered in the planning of population CRC screenings, because the identification of different risk groups can lead to more tailored screening policies, and accordingly to more efficient and cost-effective interventions
Reply to the letter to the editor 'Erroneous conclusions about the association between light alcohol drinking and the risk of cancer: comments on Bagnardi et al.'s meta-analysis, by S.-K. Myung'
Full text linkFetal cardiac parameters for prediction of twin-to-twin transfusion syndrome.
No full textTo assess myocardial performance index measured by conventional Doppler (MPI) and by tissue Doppler imaging (MPI') at 18 weeks' gestation in monochorionic diamniotic twins for the prediction of twin-to-twin transfusion syndrome (TTTS).This was a single-center observational study of 100 uncomplicated monochorionic diamniotic twin pregnancies attending the twin pregnancy clinic at the University Hospital Spedali Civili of Brescia from 2009 to 2012. MPI and MPI' were obtained from the left (LV) and right (RV) ventricles of each twin at around 18 weeks of gestation (range, 17 + 1 to 19 + 4 weeks) and fortnightly thereafter. Cases which later developed TTTS formed the study group, and the remaining controls were subdivided into those continuing as uncomplicated pregnancies and those which later developed selective intrauterine growth restriction (sIUGR). Data were analyzed by receiver-operating characteristics curve analysis and univariate and multivariable logistic regression.Of the 100 pregnancies, 88 were controls (84 uncomplicated and four developed sIUGR) and 12 developed TTTS. RV-MPI and LV-MPI, and LV-MPI' were significantly higher in future TTTS recipients than in controls, while RV-MPI' was significantly lower in donors. RV-MPI and LV-MPI and LV-MPI' were found to be predictive indicators in pregnancies that had not yet developed TTTS. Their negative predictive values were > 90\%, and their specificities > 80\%. The best performing index was LV-MPI', with a sensitivity of 91.7\% and specificity of 88.6\%.Before diagnosis of TTTS, the cardiac function (as assessed by MPI and MPI') of the future donor twin is not grossly abnormal, but that of the recipient is abnormal. We identified cardiac indices predictive of the subsequent development of TTTS, and suggest a possible role of these indices in planning the follow-up of monochorionic diamniotic twin pregnancies
Comparing granulocyte colony–stimulating factor filgrastim and pegfilgrastim to its biosimilars in terms of efficacy and safety: A meta-analysis of randomised clinical trials in breast cancer patients
No full textBACKGROUND:
Granulocyte colony-stimulating factors (G-CSFs) are widely used to prevent neutropenia in cancer patients undergoing myelosuppressive chemotherapy. Several biosimilar medicines of G-CSF are now available, with their development involving a step-wise series of comparisons to demonstrate similarity to reference biologics. Randomised clinical trials (RCTs) are considered confirmatory, and for G-CSF biosimilars, patients with breast cancer (BC) undergoing myelosuppressive chemotherapy are the most sensitive population in which to confirm similarity. This meta-analysis aimed to compare the clinical efficacy and safety of approved or proposed G-CSF biosimilars (filgrastim or pegfilgrastim) with reference G-CSF in patients with BC.
METHODS:
A Medline literature search up to March 2017 identified RCTs comparing biosimilar G-CSF to reference in BC patients. The primary efficacy end-point was mean difference in duration of severe neutropenia (DSN). Secondary efficacy end-points were differences in depth of absolute neutrophil count (ANC) nadir, time to ANC recovery and incidence of febrile neutropenia. Safety analyses included calculation of risk ratios for bone pain events, myalgia events and serious adverse events. Random effect models were fitted to obtain the pooled estimates of the mean difference for continuous outcomes and the risk ratio for dichotomous outcomes and their corresponding 95% confidence intervals (CIs).
FINDINGS:
Eight eligible RCTs were included in this meta-analysis. Overall difference in DSN between reference and biosimilar medicines was not statistically significant (0·06 d [95% CI -0·05, 0·17]). The analysis of secondary efficacy end-points showed no significant differences between reference biologics and biosimilar medicines, as well as the analysis of bone pain events, myalgia events and serious adverse events.
INTERPRETATION:
This meta-analysis showed no significant differences in clinical efficacy and safety between biosimilar and reference G-CSF in BC patients
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Gene-smoking interaction on colorectal adenoma and cancer risk : review and meta-analysis
No full textThe etiology of colorectal cancer is complex and multifactorial. Tobacco smoke has been found to be associated both with colorectal adenoma and cancer development. It was hypothesized that tobacco smoking could interact with genetic factors, providing different risk estimates according to different genetic predisposition. We reviewed and summarized by a meta-analytic approach the evidence from the literature on the interaction of smoking with the five most studied gene polymorphisms (GSTM1, GSTT1, mEH3, mEH4, NAT2). We calculated pooled Odds Ratios for each gene-smoking combination by random effects models, and provided a pooled P-value for gene-smoking interaction. Heterogeneity among studies was evaluated by the Q statistic and I2. Overall, 27 case-control studies or nested case-control studies are included in this review: 12 presented data on GSTM1 polymorphism, eight on GSTT1, seven on mEH3, mEH4, and 10 on NAT2. We found a weak suggestion of an antagonistic effect of mEH3 low or medium metabolizer with smoking on colorectal adenoma risk (pooled P-value for the interaction: 0.02): smokers carriers of mEH3 low or medium metabolizer had slightly lower risk (Odds Ratio; 95% Confidence Interval: 1.6; 1.2-2.1) than smokers with mEH3 high metabolizer (1.8; 1.4-2.4). A non-significant positive interaction between GSTT1 null genotype and smoking was suggested for colorectal adenoma risk. None of the other common genetic polymorphisms involved in tobacco carcinogens metabolism seemed to modify the smoking-related risk of colorectal adenoma or cancer. © 2009 Elsevier B.V. All rights reserved
Cigarette smoking and adenomatous polyps : a meta-analysis
No full textBackground & Aims: Through the past 2 decades, a consistent association between cigarette smoking and colorectal adenomatous polyps, recognized precursor lesions of colorectal cancer, has been shown. We performed a meta-analysis to provide a quantitative pooled risk estimate of the association, focusing on the different characteristics of the study populations, study designs, and clinical feature of the polyps. Methods: We performed a comprehensive literature search of studies linking cigarette smoking and adenomas. We used random effects models to evaluate pooled relative risks and performed dose-response, heterogeneity, publication bias, and sensitivity analyses. Results: Forty-two independent observational studies were included in the analysis. The pooled risk estimates for current, former, and ever smokers in comparison with never smokers were 2.14 (95% confidence interval [CI], 1.86-2.46), 1.47 (95% CI, 1.29-1.67), and 1.82 (95% CI, 1.65-2.00), respectively. The association was stronger for high-risk adenomas than for low-risk adenomas. Studies in which all controls underwent full colonoscopy showed a higher risk compared with studies in which some or all controls underwent partial colon examination. Conclusions: This meta-analysis provides strong evidence of the detrimental effect of cigarette smoking on the development of adenomatous polyps. Smoking is important for both formation and aggressiveness of adenomas
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