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Oncology Letters Sep 2023Anaplastic thyroid cancer (ATC) is a very rare disease with a poor prognosis and with no established effective drug therapy. The present study aimed to report the...
Anaplastic thyroid cancer (ATC) is a very rare disease with a poor prognosis and with no established effective drug therapy. The present study aimed to report the outcomes of lenvatinib single-agent therapy as an initial drug treatment in ATC, and to investigate its safety and efficacy. This retrospective cohort study included 56 patients with unresectable primary ATC, of whom 36 were treated with lenvatinib and 12 with weekly paclitaxel, and 8 patients who refused any drug treatment who received palliative care. The average survival in the lenvatinib group was 5.8 months, which was significantly longer than 2.0 months in the paclitaxel group (P=0.005). The efficacy of lenvatinib in the 36 patients with ATC, whose primary tumors were unresectable, was evaluated. The response rate was 33% and the median overall survival time was 5.0 months. A safety review indicated that lenvatinib should be used under the careful observation of local findings. Two patients, who showed a reduction with lenvatinib, underwent conversion surgery, which prolonged the prognosis in terms of avoiding events, such as asphyxia, fistula and hemorrhage due to tumor growth; however, the surgical margins were positive, indicating that complete remission was impossible even if surgical resection was performed. Therefore, starting with lenvatinib treatment and identifying a therapeutic drug based on genomic analysis is an acceptable treatment strategy for ATC while halting the disease progression.
PubMed: 37614659
DOI: 10.3892/ol.2023.14002 -
Frontiers in Medicine 2023Benign airway stenosis (BAS), namely airway narrowing caused by a variety of benign lesions, can lead to varying degrees of breathing difficulties and even death due to...
INTRODUCTION
Benign airway stenosis (BAS), namely airway narrowing caused by a variety of benign lesions, can lead to varying degrees of breathing difficulties and even death due to asphyxia. This study aimed to elucidate the clinical characteristics of BAS, including etiology, treatment and pathology, by analyzing the clinical data of BAS patients.
METHODS
A retrospective analysis was conducted using the clinical data of 617 BAS cases from January 2017 to December 2022. The pathological characteristics of the tissues were assessed by hematoxylin-eosin (H&E) and Masson's staining. Besides, protein expression levels were determined by immunohistochemistry (IHC).
RESULTS
A total of 617 patients were included (333 females [53.97%] and 284 males [46.03%]), with an average age of 48.93 ± 18.30 (range 14-87). Tuberculosis ( = 306, 49.59%) and trauma ( = 179, 29.02%) were the two leading etiologies of BAS, followed by airway foreign bodies (FB, = 74, 11.99%), external compression ( = 25, 4.05%) and other etiologies ( = 33, 5.35%). Among 306 tuberculous tracheobronchial stenosis (TBTS) cases, most were females ( = 215, 70.26%), and TBTS mainly occurred in the left main bronchus ( = 97, 31.70%), followed by the right middle bronchus ( = 70 cases, 22.88%). The majority of TBTS patients ( = 259, 84.64%) were treated by interventional therapy. The condition of 179 BAS patients was ascribed to trauma, such as tracheal intubation ( = 92, 51.40%), tracheotomy ( = 69, 38.56%), injury ( = 15, 8.38%) and surgery ( = 3, 1.68%), which mostly took place in the trachea ( = 173, 96.65%). TAS patients mainly received interventional therapy ( = 168, 93.85%) and stent implantation ( = 47, 26.26%). The granulation tissues of BAS primarily featured inflammation, proliferation and fibrosis. IHC indicated the up-regulated expressions of transforming growth factor-β1 (TGF-β1), α-smooth muscle actin (α-SMA), collagen type I protein (COL-I) and vimentin, and the down-regulated expression of E-cadherin, which indicated fibrosis and epithelial-mesenchymal transition (EMT).
CONCLUSION
Tuberculosis was the main etiology, and trauma was the secondary etiology. The granulation tissues of BAS were characterized by inflammation, fibrosis and probably EMT. Comprehensive interventional therapy is an effective method of treating BAS.
PubMed: 37547601
DOI: 10.3389/fmed.2023.1202309 -
Journal of Forensic and Legal Medicine Nov 2023A young woman was buried in a sitting position in sandy soil in a shallow grave. PMCT showed filling of the upper airways with radio-opaque material consistent with...
A young woman was buried in a sitting position in sandy soil in a shallow grave. PMCT showed filling of the upper airways with radio-opaque material consistent with soil, with autopsy dissection confirming the presence of soil in the mouth, pharynx, upper oesophagus, larynx, trachea and main bronchi. Death was due to upper airway occlusion by soil. Live burial as a type of homicide is extremely rare. Issues that need to be clarified include whether the victim was alive at the time of burial, the level of consciousness/awareness of the process, whether restraints or drugs were used and the speed with which death occurred. Possible mechanisms of death include smothering, choking and positional/compression asphyxia.
Topics: Female; Humans; Forensic Medicine; Larynx; Autopsy; Homicide; Mouth; Asphyxia; Soil; Burial
PubMed: 37950991
DOI: 10.1016/j.jflm.2023.102617 -
Pediatric Research Jul 2023An ancillary study of the High-Dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial for neonates with hypoxic-ischemic encephalopathy (HIE) and treated with... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
An ancillary study of the High-Dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial for neonates with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia examined the hypothesis that neonates randomized to receive erythropoietin (Epo) would have a lower seizure risk and burden compared with neonates who received placebo.
METHODS
Electroencephalograms (EEGs) from 7/17 HEAL trial centers were reviewed. Seizure presence was compared across treatment groups using a logistic regression model adjusting for treatment, HIE severity, center, and seizure burden prior to the first dose. Among neonates with seizures, differences across treatment groups in median maximal hourly seizure burden were assessed using adjusted quantile regression models.
RESULTS
Forty-six of 150 (31%) neonates had EEG seizures (31% in Epo vs 30% in placebo, p = 0.96). Maximal hourly seizure burden after the study drug was not significantly different between groups (median 11.4 for Epo, IQR: 5.6, 18.1 vs median 9.7, IQR: 4.9, 21.0 min/h for placebo).
CONCLUSION
In neonates with HIE treated with hypothermia who were randomized to Epo or placebo, we found no meaningful between-group difference in seizure risk or burden. These findings are consistent with overall trial results, which do not support Epo use for neonates with HIE undergoing therapeutic hypothermia.
IMPACT
In the HEAL trial of erythropoietin (Epo) vs placebo for neonates with encephalopathy presumed due to hypoxic-ischemic encephalopathy (HIE) who were also treated with therapeutic hypothermia, electrographic seizures were detected in 31%, which is lower than most prior studies. Epo did not reduce the proportion of neonates with acute provoked seizures (31% in Epo vs 30% in placebo) or maximal hourly seizure burden after the study drug (median 11.4, IQR 5.6, 18.1 for Epo vs median 9.7, IQR 4.9, 21.0 min/h for placebo). There was no anti- or pro-convulsant effect of Epo when combined with therapeutic hypothermia for HIE.
Topics: Infant, Newborn; Humans; Hypoxia-Ischemia, Brain; Hypothermia; Seizures; Erythropoietin; Asphyxia; Hypothermia, Induced
PubMed: 36470964
DOI: 10.1038/s41390-022-02398-w -
European Journal of Obstetrics,... Aug 2023A lack of consistent professional guidance on when to intervene during emergence (buttocks and anus visible at the introitus to birth of the head) in vaginal breech... (Review)
Review
PROBLEM
A lack of consistent professional guidance on when to intervene during emergence (buttocks and anus visible at the introitus to birth of the head) in vaginal breech birth (VBB).
BACKGROUND
Hypoxia and asphyxia are common complications of VBB, especially due to umbilical cord compression around the time of emergence.
AIM
To gain insight into VBB time management trends, the evidence behind these practices and how they may have influenced outcomes.
METHODS
Literature review of obstetric textbooks published between 1960 and 2000 contained in the Wellcome Collection and Royal College of Obstetricians and Gynaecologists Library in London.
FINDINGS
90 textbooks were reviewed. Recommendations for 'safe' intervals between birth of the umbilicus and the head ranged from 5 to 20 min. Many sources focused only on the time required to deliver the head, with 'up to 10 min' being the most common interval described. The review found no mention of cord compression causing concern earlier in breech births than once the umbilicus itself is delivered, nor any evidence to support the recommendations.
DISCUSSION
These findings demonstrate a long-term pattern across the second half of the 20th century, whereby birth attendants were urged not to rush emergence nor delay intervention but were given little clear guidance on optimal timings.
CONCLUSION
Clear, evidence-based guidance should be provided in breech training materials to avoid unnecessary hypoxic injuries, and this guidance should be rigorously evaluated.
Topics: Pregnancy; Female; Humans; Delivery, Obstetric; Breech Presentation; Time Management; Parturition; Administration, Intravaginal
PubMed: 37390754
DOI: 10.1016/j.ejogrb.2023.06.015 -
Medicina Sep 2023Neonatal hypoxic ischemic encephalopathy (HIE) is a type of injury caused by lack of oxygen in the brain during the neonatal period. It is a clinical syndrome clearly... (Review)
Review
Neonatal hypoxic ischemic encephalopathy (HIE) is a type of injury caused by lack of oxygen in the brain during the neonatal period. It is a clinical syndrome clearly recognizable in term and premature newborns secondary to asphyxia at the time of delivery. HIE is estimated to occur at a frequency of 1-3 for each 1000 alive newborns per year in developed countries. In countries of low or medium income, the incidence is up to 10-20 times higher, equivalent to 1-8 alive newborns per each 1000. The social and economic impact has been estimated near US$ 50.2 million per year of life adjusted to disability. At the same time, it is estimated in 7, the number of patients needed to treat with corporal cooling therapy (CCT)to prevent one case of death or severe disability. The etiology is multifactorial and includes prenatal, perinatal and postnatal factors. The diagnosis is based in the inability to support spontaneous breath at the time of delivery requiring assisted ventilation, Apgar less than 5 at 5 and 10 minutes, altered level of consciousness, neonatal reflexes and muscle tone. This article is a review of the stablished and emergent therapeutic strategies based on the pathophysiological disease process.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Hypoxia-Ischemia, Brain; Brain; Consciousness; Hypothermia, Induced
PubMed: 37714119
DOI: No ID Found -
BMC Pregnancy and Childbirth Dec 2023Multiple pregnancies carry an increased risk of maternal and perinatal complications, notably prematurity. Few studies have evaluated the risk factors for preterm births... (Review)
Review
OBJECTIVE
Multiple pregnancies carry an increased risk of maternal and perinatal complications, notably prematurity. Few studies have evaluated the risk factors for preterm births in multiple pregnancies within the Thai population. This study aims to ascertain maternal and perinatal outcomes and identify factors linked to preterm births in multiple pregnancies.
METHODS
This study was carried out at Khon Kaen University, Faculty of Medicine, Department of Obstetrics and Gynecology in Thailand. We reviewed the medical records of women with multiple pregnancies who delivered at a gestational age of more than 20 weeks between January 1, 2012 and December 31, 2021. We excluded patients with incomplete data or those for whom data were missing.
RESULTS
Out of 21,400 pregnancies, 427 were multiple pregnancies, constituting approximately 1.99%. Over the ten-year period, 269 multiple pregnancies (65.1%) resulted in preterm births. Of these, 173 (64.3%) were monochorionic twins, and 96 (35.7%) were dichorionic twins. Monochorionic twins had a notably higher rate of preterm delivery (AOR, 2.06; 95%CI 1.29-3.30). Vaginal delivery was observed in 7.9% of the cases, while cesarean sections were performed for both twins in 91.5% of cases. In 0.5% of the cases, only the second twin was delivered by cesarean section. In terms of neonatal outcomes, 160 infants (19.4%) weighed less than 1,500 g at birth, and there were 78 perinatal deaths (9.4%). Birth asphyxia was noted in 97 cases (20.2%) among monochorionic twins and in 28 cases (8.1%) for dichorionic twins.
CONCLUSION
The prevalence of multiple pregnancies was 1.99%, with 65.1% resulting in preterm births. Neonatal complications were notably more frequent in monochorionic twins. Monochorionic placenta and antepartum complications emerged as significant risk factors for preterm birth.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Infant; Premature Birth; Pregnancy, Twin; Cesarean Section; Retrospective Studies; Thailand; Pregnancy, Multiple; Pregnancy Outcome
PubMed: 38110899
DOI: 10.1186/s12884-023-06186-0 -
Translational Pediatrics Jun 2023In the present study, we aimed to detect microRNA-210 (miR-210) expression in the peripheral blood of neonates with asphyxia and determine the correlation between...
BACKGROUND
In the present study, we aimed to detect microRNA-210 (miR-210) expression in the peripheral blood of neonates with asphyxia and determine the correlation between miR-210 and clinical manifestations and indicators related to pathological changes. Further, we performed Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of the potential target genes of miR-210 to examine their related diseases and network interactions.
METHODS
In total, 27 neonates with asphyxia were included in the asphyxia group and 26 healthy neonates were included in the normal group. Quantitative real-time polymerase chain reaction was performed to measure miR-210 expression in the peripheral blood. Furthermore, the correlation between miR-210 expression and asphyxia-related clinical indicators was determined, and the receiver operating characteristic curve analysis of miR-210 was conducted. Moreover, GO and KEGG analyses were conducted to identify the target genes of miR-210. Lastly, the association between miR-210 target genes and autism and epilepsy was elucidated and network interaction analysis was performed to determine the involvement of the target genes of miR-210 in neurological or cardiovascular diseases.
RESULTS
miR-210 was highly expressed in the peripheral blood of neonates with asphyxia. Furthermore, the mode of normal delivery, cord potential of hydrogen, and Apgar scores were elevated in these neonates. Additionally, we identified 142 miR-210 target genes, which were associated with both neurodevelopmental and cardiovascular diseases. These genes were associated with the metabolic, cancer, and phosphatidylinositol3-kinase/serine/threonine kinase and mitogen-activated kinase-like protein pathways. Furthermore, 102 miR-210 target genes were associated with autism and epilepsy.
CONCLUSIONS
High miR-210 expression in the peripheral blood of neonates with asphyxia may be associated with anoxic cerebral injury. The miR-210 target genes are associated with neurodevelopmental and cardiovascular diseases and autism and epilepsy.
PubMed: 37427073
DOI: 10.21037/tp-23-106 -
PloS One 2023The casts of Pompeii bear witness to the people who died during the Vesuvius 79 AD eruption. However, studies on the cause of death of these victims have not been...
The casts of Pompeii bear witness to the people who died during the Vesuvius 79 AD eruption. However, studies on the cause of death of these victims have not been conclusive. A previous important step is the understanding of the post-depositional processes and the impact of the plaster in bones, two issues that have not been previously evaluated. Here we report on the anthropological and the first chemical data obtained from the study of six casts from Porta Nola area and one from Terme Suburbane. A non-invasive chemical analysis by portable X-ray fluorescence was employed for the first time on these casts of Pompeii to determine the elemental composition of the bones and the plaster. Elemental profiles were determined providing important data that cross-referenced with anthropological and stratigraphic results, are clearly helpful in the reconstruction of the perimortem and post-mortem events concerning the history of these individuals. The comparative analyses carried out on the bone casts and other collections from burned bones of the necropolis of Porta Nola in Pompeii and Rome Sepolcreto Ostiense, and buried bones from Valencia (Spain), reveal the extent of high temperature alteration and post-depositional plaster contamination. These factors make bioarchaeological analyses difficult but still allow us to support asphyxia as the likely cause of death.
Topics: Humans; Animals; Splints; Anthropology; Asphyxia; Chromatography, Gas; Drug Contamination; Lepidoptera; Nitroarginine
PubMed: 37610984
DOI: 10.1371/journal.pone.0289378 -
BMC Medicine Nov 2023Maternal pre-gestational diabetes (PGDM), gestational diabetes mellitus (GDM), and overweight/obesity have been associated with increased risks of offspring...
BACKGROUND
Maternal pre-gestational diabetes (PGDM), gestational diabetes mellitus (GDM), and overweight/obesity have been associated with increased risks of offspring neurodevelopmental conditions (NDCs) including autism, intellectual disability (ID), and attention deficit/hyperactivity disorder (ADHD). Less is known about whether and how obstetric and neonatal complications (e.g., preterm birth, neonatal asphyxia) could mediate these associations.
METHODS
In this Swedish register-based cohort study, we examined complications during pregnancy, delivery, and the neonatal period as potential mediators of the relationships between maternal metabolic conditions and offspring NDCs. We quantified the extent to which these obstetric and neonatal factors could mediate the associations of maternal metabolic conditions with offspring NDCs by applying parametric regression models for single mediation analyses and weighting-based methods for multiple mediation analyses under counterfactual frameworks.
RESULTS
The study sample included 2,352,969 singleton children born to 1,299,692 mothers from 1987-2010 who were followed up until December 31, 2016, of whom 135,832 children (5.8%) were diagnosed with at least one NDC. A substantial portion of the association between maternal PGDM and children's odds of NDCs could be explained by the combined group of obstetric and neonatal complications in the multiple mediation analysis. For instance, these complications explained 44.4% of the relationship between maternal PGDM and offspring ID risk. The proportion of the relationship between maternal overweight/obesity and children's risk of NDCs that could be explained by obstetric and neonatal complications was considerably smaller, ranging from 1.5 to 8.1%. Some complications considered on their own, including pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities, could explain at least 10% of the associations between maternal PGDM and offspring NDCs. Complications during the neonatal period showed a stronger joint mediating effect for the relationship between PGDM and offspring NDCs than those during pregnancy or delivery.
CONCLUSIONS
Obstetric and neonatal complications could explain nearly half of the association between maternal PGDM and offspring risk of NDCs. The mediating effects were more pronounced for complications during the neonatal period and for specific complications such as pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities. Effective preventive strategies for offspring NDCs should holistically address both the primary metabolic issues related to PGDM and the wide array of potential complications, especially those in the neonatal period.
Topics: Pregnancy; Child; Female; Infant, Newborn; Humans; Overweight; Cohort Studies; Premature Birth; Asphyxia; Diabetes, Gestational; Obesity
PubMed: 37936224
DOI: 10.1186/s12916-023-03116-x