Racial Differences in Hospital Stays among Patients Undergoing Craniotomy for Tumour Resection at a Single Academic Hospital

BACKGROUND: Racial differences in American patients undergoing brain tumour surgery remain poorly characterized within urban medical centres. Our objective was to assess racial differences in operative brain tumour patients at a single academic hospital in Los Angeles, California. METHODS: We reviewed medical records of adult patients undergoing craniotomy for tumour resection from March 2013 to January 2017 at UCLA Medical Centre. Patients were categorized as Asian, Hispanic, Black, or White. Racial cohorts were matched on demographic variables for comparisons. Our primary outcome was post-operative length of stay (LOS). Secondary outcomes included hospital mortality and discharge disposition. RESULTS: In this study, 462 patients identified as Asian (15.1%), Hispanic (8.7%), Black (3.9%), or White (72.3%). After cohort matching, non-White patients had elevated risk of prolonged LOS [odds ratio (OR)=2.62 (1.44, 4.76)]. No differences were observed in hospital mortality or non-routine discharge. Longer LOS was positively correlated with non-routine discharge [r(pb) (458)=0.41, p<0.001]. Black patients with government insurance had average LOS 2.84 days shorter than Black patients with private insurance (p=0.04). Among Hispanics, government insurance was associated with non-routine discharge [OR=4.93 (1.03, 24.00)]. CONCLUSION: Racial differences manifested as extended LOS for non-White patients, with comparable rates of hospital mortality and non-routine discharge across races. Prolonged LOS loosely reflected complicated clinical course with greater risk of adverse discharge disposition. Private insurance coverage predicted markedly lower risk of non-routine discharge for Hispanic patients, and LOS of three additional days among Black patients. Further research is needed to elucidate the basis of these differences.

Risk of Brain Tumor Induction from Pediatric Head CT Procedures: A Systematic Literature Review

Head computed tomography (CT) is instrumental for managing patients of all ages. However, its low dose radiation may pose a low but non-zero risk of tumor induction in pediatric patients. Here, we present a systematic literature review on the estimated incidence of brain tumor induction from head CT exams performed on children and adolescents. MEDLINE was searched using an electronic protocol and bibliographic searches to identify articles related to CT, cancer, and epidemiology or risk assessment. Sixteen studies that predicted or measured head CT-related neoplasm incidence or mortality were identified and reviewed. Epidemiological studies consistently cited increased tumor incidence in pediatric patients (ages 0–18) exposed to head CTs. Excess relative risk of new brain tumor averaged 1.29 (95% confidence interval, 0.66–1.93) for pediatric patients exposed to one or more head CTs. Tumor incidence increased with number of pediatric head CTs in a dose-dependent manner, with measurable excess incidence even after a single scan. Converging evidence from epidemiological studies supported a small excess risk of brain tumor incidence after even a single CT exam in pediatric patients. However, refined epidemiological methods are needed to control for confounding variables that may contribute to reverse causation, such as patients with pre-existing cancer or cancer susceptibility. CT remains an invaluable technology that should be utilized so long as there is clinical indication for the study and the radiation dose is as small as reasonably achievable.

Genomic and Molecular Characterization of Brain Tumors in Asian and Non-Asian Patients of Los Angeles: A Single Institution Analysis

BACKGROUND: Worldwide, approximately 2% of new cancers are of the brain. Five-year survival rates among brain cancer patients have been reported as a little over a third. Differences in clinical outcomes between brain tumor patients of different races remain poorly understood. METHODS: A retrospective chart review was performed on brain tumor resection patients≥18 years old. Demographics, treatment variables, and survival outcomes were collected. Primary outcomes were length of stay, recurrence rate, progression-free survival (PFS), and overall survival (OS). RESULTS: A total of 452 patients were included in analysis. Females and males had nearly a 1:1 ratio (n=242 and n=220, respectively). Mean age was 54.8 years (SD: 14.5 range: 18–90). Females composed 69% (n=48) of Asian patients; males constituted 31% (n=22). Mean age of the Asian patients was 55.9 years (SD: 14.6 range: 26–89). Asian-only cohort tumor pathologies included glioblastoma (GBM) (n=14), high-grade glioma (n=7), low-grade glioma (n=4), meningioma (n=38), and metastases (n=7). Of the 185 meningioma patients, non-Asian patients comprised 79% of the group (n=146). Of the 65 GBM patients in total, non-Asian patients made up 89% of the GBM cohort (n=58). There were no statistically significant differences between these groups of both cohorts in recurrence (p=0.1580 and p=0.6294, respectively), PFS (p=0.9662 and p=0.4048, respectively), or OS (p=0.3711 and p=0.8183, respectively). CONCLUSION: Studies evaluating the survival between patients of different racial backgrounds against several tumor varieties are rare. Patients of certain racial backgrounds may need additional consideration when being attended to despite the same mutational composition as their counterparts. Repeated studies using national databases may yield more conclusive results.

HER2 Status and Its Heterogeneity in Gastric Carcinoma of Vietnamese Patient

BACKGROUND: Human epidermal growth factor receptor 2 (HER2) is related to the pathogenesis and poor outcome of numerous types of carcinomas, including gastric carcinoma. Gastric cancer patients with HER2 positivity have become potential candidates for targeted therapy with trastuzumab. METHODS: We investigated 208 gastric cancer specimens using immunohistochemistry (IHC), fluorescence in situ hybridization and dual in situ hybridization (ISH). We also investigated the concordance between IHC and ISH. The correlation between HER2 status and various clinicopathological findings was also investigated. RESULTS: In total, 15.9% (33/208) and 24.5% (51/208) of gastric cancers showed HER2 gene amplification and protein overexpression, respectively. A high level of concordance between ISH and IHC analyses (91.3%, κ = 0.76) was found. A significant correlation between HER2 status and intestinal-type (p < .05) and differentiated carcinomas (p < .05) was also noted. The HER2 heterogeneity was high in gastric cancers; we found 68.8% phenotypic heterogeneity and 57.6% genotypic heterogeneity. Heterogeneity in HER2 protein expression and gene amplification showed a close association with diffuse histologic type and IHC 2+. CONCLUSIONS: HER2 protein overexpression and gene amplification were detected in 24.5% and 15.9% of gastric cancer specimens, respectively. Intestinal-type showed a higher level of HER2 protein overexpression and gene amplification than diffuse type. HER2 status also showed a significant relationship with well- and moderately-differentiated carcinomas. The ratio of phenotypic and genotypic heterogeneity of HER2 was high in gastric carcinomas and was associated with HER2 IHC 2+ and diffuse histologic type.

Apply Nested-RT-PCR technique to identify bcr/abl fusion gene in the chronic myelogenous leukemia

Background: Bcr/abl fusion gene plays an important role in diagnosing and treating chronic myelogenous leukemia. Objective: to detect fusion genes: b3a2, b2a2, b3a3, b2a3 and e1a2 in patients with chronic myelogenous leukemia by using Nested RT - PCR technique. Subjects and methods: Peripheral blood samples were analyzed by Nested RT - PCR assay from 30 adult patients. Results: 28/30 patients showed bcr/abl fusions gene; among them 20/30 patients showed b3a2 fusions gene, 5/30 patients showed b2a2 fusions gene, 2/30 patients showed co-expression of the b3a2 and b2a2. 1/30 showed e1a2; 2/30 patients showed negative fusion gene. Count of leukocytes and platelets of patients with b3a2 fusion genes were 311.3 G/l and 597.5 G/l, respectively and of patients with b2a2 fusion genes were 136.7 G/l and 333 G/l, respectively. Conclusion: Most of patients showed b3a2 fusion gene, while remaining showed b2a2 transcripts or the co-expression of the b3a2, only one case showed e1a2 fusion gene, two patients showed negative fusion gene. There was no case which showed b3a3 or b2a3 fusion gene. Nested RT assay should be used to determine bcr/abl fusion genes for patients with chronic myelogenous leukemia\r\n', u'\r\n', u'

Hepatitis screen by ultrasound should or should not

Hepatitis screen by ultrasound should or should not

Ultrasonic diagnosis and prognosis of abdominal aortic aneurysm

Ultrasound (US) is a good screening modality to confirm or exclude aneurysm, especially abdominal aortic aneurysm (AAA). Transesophageal echocardiography (TEE) provides information for thoracic aneurysm except in the area of proximal (blind spot). In HCM, ultrasound and colour Doppler US in 10 years (1986-1987) are still the best screening modality of imaging diagnosis for detecting aortic aneurysm in preclinical stage, play a significant role in modifying the patient's prognosis.

Ultrasonic diagnosis of digestive tumor

A retrospective study on 40 cases of digestive tumor diagnosed by combination of ultrasound, X-ray and laparoscopy in which the ultrasound and anapathology play a role as screen has shown that the sensitivity and accuracy of ultrasound in the detection of digestive tumors was 97.05% and 87.50%, respectively. However, it should combine the ultrasound with other imaging diagnosis to obtain the higher accuracy

Ultrasound image of the amoebic hepatic abscess during the internal treatment

The ultrasound images of the amoebic hepatic abscess during the internal treatment were studied to evaluate the disease's progress and the response to the available guideline of treatment. The ultrasound's features and the distribution of the abscess focuses in 55 patients with the amoebic hepatic abscess during the treatment (6 months - 10 years) were evaluated. The conclusion: the diagnosis should base on the ultrasound, clinical features and needle aspiration as the guidance of the ultrasound.

The ultrasound image of amebic hepatic abscess during the internal treatment

55 cases of amoebic hepatic abscess diagnosed basing on the clinic, ultrasound B-mode and Doppler in 1998 in Hå ChÝ Minh medical center. The duration of disease was 6-10 days. Of which 10 cases were monitored continuously until the disease free. There was no specific image of amebic hepatic abscess on the ultrasound. Most of abscess focused in the right liver. The size of abscess was reduced gradually as duration of the treatment. The conclusion: the ultrasound helps the needle aspiration of the complicated diseases and monitors the response of the treatment.