High snail expression predicts a poor prognosis in breast invasive ductal carcinoma patients with HER2/EGFR-positive subtypes.

BACKGROUND: High Snail expression is known as a poor prognostic factor in breast cancer. However, its prognostic impact for breast cancer with different molecular subtypes is still controversial. METHODS: Snail expression was examined by immunohistochemistry in tissue microarray slides of 85 corresponding tumor-adjacent normal (CTAN) and 247 breast invasive ductal carcinoma (IDC) tissues. Multivariable Cox regression analysis was used to assess the impact of Snail expression on survival rate by different molecular subtypes of breast IDC patients. RESULTS: The level of Snail expression in IDC tumor tissues was significantly higher than that in CTAN tissues. Moreover, high Snail expression had direct impacts on poor disease specific survival (DSS) and disease-free survival (DFS) in breast IDC patients with human epidermal growth factor receptor 2 (HER2)-positive and human epidermal growth factor receptor (EGFR)-positive statuses as well as the HER2 intrinsic subtype. Additionally, breast IDC patients with a combination of three prognostic factors, including high Snail expression and HER2-positive and EGFR-positive statuses, had much poor DSS and DFS with a statistically significant linear trend. CONCLUSION: High Snail expression could predict a poor prognosis for breast IDC patients with HER2/EGFR-positive subtypes.

[Factors Related to the Unplanned 90-Day Readmission Rate Among Elderly at a Geriatric Medicine Center].

BACKGROUND: Unplanned readmissions increase healthcare utilization rates and healthcare costs. The Taiwan Healthcare Indicator Series regards the rate of hospital readmission as an important indicator of inpatient-care quality. The elderly face a higher risk of unplanned readmission due to elderly-specific health and disease characteristics such as deteriorating body functions and the relatively high incidence of complications after the treatment of acute diseases. PURPOSE: To explore the factors that relate to the unplanned readmission of elderly within 90 days of discharge at a geriatric medical center. METHODS: We retrospectively reviewed the medical records of inpatients aged ≥65 years who had been admitted between January 2013 and December 2014. Related factors that affected the rate of unplanned readmission within 90 days of discharge were screened and analyzed using the chi-squared test and logistic regression analysis. RESULTS: The 90-day unplanned readmission rate was 20.3%. Factors that were found to relate to unplanned readmissions were: emergency room admission (88.7%), lack of regular outpatient follow-up (60.4%), cerebrovascular incidents (43.4%), osteoporosis (32.1%), gastrointestinal diseases (45.3%), and a hemoglobin level < 10.0 mg/dL (35.8%). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of the present study may help the healthcare team better understand the factors that affect unplanned readmission in the elderly. We suggest that these teams provide timely health education for elderly, integrative healthcare for chronic diseases, and appropriate nutritional supplements in order to reduce unplanned readmissions.