BACKGROUND Esophageal carcinoma presents as 2 types,esophageal adenocarcinoma(EAC)and esophageal squamous cell carcinoma(ESCC)with the frequency of both changing in the United States(US).AIM To investigate EAC/ESCC in...BACKGROUND Esophageal carcinoma presents as 2 types,esophageal adenocarcinoma(EAC)and esophageal squamous cell carcinoma(ESCC)with the frequency of both changing in the United States(US).AIM To investigate EAC/ESCC incidence time trends among the 3 main US racial groups and investigate trends in US EAC survival by ethnicity.METHODS Twenty-five years(1992-2016)of data from SEER 13 program was analyzed to compare incidence trends in EAC and ESCC between non-Hispanic whites(nHW),non-Hispanic Blacks(nHB)and Hispanics(Hisp)using SEERStat®.In addition,SEER 18 data,from 1975-2015,on EAC in the US was analyzed to evaluate racial disparities in incidence and survival using SEERStat®and Ederer II method.RESULTS In the 3 major US ethnic groups,age-adjusted incidence of ESCC has declined while EAC has continued to rise from 1992-2016.Of note,in Hisp,the EAC incidence rate increased while ESCC decreased from 1992 to 2016,resulting in EAC as the predominant esophageal cancer subtype in this group since 2011,joining nHW.Furthermore,although ESCC remains the predominant tumor in nHB,the difference between ESCC and EAC has narrowed dramatically over 25 years.EAC survival probabilities were worse in all minority groups compared to nHw.CONCLUSION Hisp have joined nHW as US ethnic groups more likely to have EAC than ESCC.Of note,EAC incidence in nHB is increasing at the highest rate nationally.Despite lower EAC incidence in all minority groups compared to nHW,these populations have decreased survival compared to nHW.展开更多
BACKGROUND Life expectancy in patients with Duchenne muscular dystrophy(DMD)has improved due to advances in medical care.DMD patients develop progressive spinal deformity after loss of ambulatory function and onset of...BACKGROUND Life expectancy in patients with Duchenne muscular dystrophy(DMD)has improved due to advances in medical care.DMD patients develop progressive spinal deformity after loss of ambulatory function and onset of wheelchair dependence for mobility.There is limited published data on the effect of spinal deformity correction on long-term functional outcomes,quality of life(QoL),and satisfaction in DMD patients.AIM To investigate the long-term functional outcomes following spinal deformity correction in DMD patients.METHODS This was a retrospective cohort study from 2000-2022.Data was collected from hospital records and radiographs.At follow-up,patients completed the muscular dystrophy spine questionnaire(MDSQ).Statistical analysis was performed by linear regression analysis and ANOVA to analyse clinical and radiographic factors significantly associated with MDSQ scores.RESULTS Forty-three patients were included with mean age 14.4 years at surgery.Spinopelvic fusion was performed in 41.9%of patients.Mean surgical time was 352.1 min and mean blood loss was 36%of estimated total blood volume.Mean hospital stay was 14.1 d.Postoperative complications occurred in 25.6%of patients.Mean preoperative scoliosis was 58°,pelvic obliquity 16.4°,thoracic kyphosis 55.8°,lumbar lordosis 11.1°,coronal balance 3.8 cm,and sagittal balance+6.1 cm.Mean surgical correction of scoliosis was 79.2%and of pelvic obliquity was 80.8%.Mean follow-up was 10.9 years(range:2-22.5).Twenty-four patients had died at follow-up.Sixteen patients completed the MDSQ at mean age 25.4 years(range 15.2-37.3).Two patients were bed-ridden and 7 were on ventilatory support.Mean MDSQ total score was 38.1.All 16 patients were satisfied with the results of spinal surgery and would choose surgery again if offered.Most patients(87.5%)reported no severe back pain at follow-up.Factors significantly associated with functional outcomes(MDSQ total score)included greater duration of post-operative follow-up,age,scoliosis postoperatively,correction of scoliosis,increased lumbar lordosis postoperatively,and greater age at loss of independent ambulation.CONCLUSION Spinal deformity correction in DMD patients leads to positive long-term effects on QoL and high patient satisfaction.These results support spinal deformity correction to improve long-term QoL in DMD patients.展开更多
文摘BACKGROUND Esophageal carcinoma presents as 2 types,esophageal adenocarcinoma(EAC)and esophageal squamous cell carcinoma(ESCC)with the frequency of both changing in the United States(US).AIM To investigate EAC/ESCC incidence time trends among the 3 main US racial groups and investigate trends in US EAC survival by ethnicity.METHODS Twenty-five years(1992-2016)of data from SEER 13 program was analyzed to compare incidence trends in EAC and ESCC between non-Hispanic whites(nHW),non-Hispanic Blacks(nHB)and Hispanics(Hisp)using SEERStat®.In addition,SEER 18 data,from 1975-2015,on EAC in the US was analyzed to evaluate racial disparities in incidence and survival using SEERStat®and Ederer II method.RESULTS In the 3 major US ethnic groups,age-adjusted incidence of ESCC has declined while EAC has continued to rise from 1992-2016.Of note,in Hisp,the EAC incidence rate increased while ESCC decreased from 1992 to 2016,resulting in EAC as the predominant esophageal cancer subtype in this group since 2011,joining nHW.Furthermore,although ESCC remains the predominant tumor in nHB,the difference between ESCC and EAC has narrowed dramatically over 25 years.EAC survival probabilities were worse in all minority groups compared to nHw.CONCLUSION Hisp have joined nHW as US ethnic groups more likely to have EAC than ESCC.Of note,EAC incidence in nHB is increasing at the highest rate nationally.Despite lower EAC incidence in all minority groups compared to nHW,these populations have decreased survival compared to nHW.
文摘BACKGROUND Life expectancy in patients with Duchenne muscular dystrophy(DMD)has improved due to advances in medical care.DMD patients develop progressive spinal deformity after loss of ambulatory function and onset of wheelchair dependence for mobility.There is limited published data on the effect of spinal deformity correction on long-term functional outcomes,quality of life(QoL),and satisfaction in DMD patients.AIM To investigate the long-term functional outcomes following spinal deformity correction in DMD patients.METHODS This was a retrospective cohort study from 2000-2022.Data was collected from hospital records and radiographs.At follow-up,patients completed the muscular dystrophy spine questionnaire(MDSQ).Statistical analysis was performed by linear regression analysis and ANOVA to analyse clinical and radiographic factors significantly associated with MDSQ scores.RESULTS Forty-three patients were included with mean age 14.4 years at surgery.Spinopelvic fusion was performed in 41.9%of patients.Mean surgical time was 352.1 min and mean blood loss was 36%of estimated total blood volume.Mean hospital stay was 14.1 d.Postoperative complications occurred in 25.6%of patients.Mean preoperative scoliosis was 58°,pelvic obliquity 16.4°,thoracic kyphosis 55.8°,lumbar lordosis 11.1°,coronal balance 3.8 cm,and sagittal balance+6.1 cm.Mean surgical correction of scoliosis was 79.2%and of pelvic obliquity was 80.8%.Mean follow-up was 10.9 years(range:2-22.5).Twenty-four patients had died at follow-up.Sixteen patients completed the MDSQ at mean age 25.4 years(range 15.2-37.3).Two patients were bed-ridden and 7 were on ventilatory support.Mean MDSQ total score was 38.1.All 16 patients were satisfied with the results of spinal surgery and would choose surgery again if offered.Most patients(87.5%)reported no severe back pain at follow-up.Factors significantly associated with functional outcomes(MDSQ total score)included greater duration of post-operative follow-up,age,scoliosis postoperatively,correction of scoliosis,increased lumbar lordosis postoperatively,and greater age at loss of independent ambulation.CONCLUSION Spinal deformity correction in DMD patients leads to positive long-term effects on QoL and high patient satisfaction.These results support spinal deformity correction to improve long-term QoL in DMD patients.
