Fujian Medical University Cancer Hospital, Fuzhou, China Fujian Medical University Union Hospital, Fuzhou, China. [email protected]. The authors report no conflicts of interest.
Background: Hospital wastewater (HWW) promotes the spread of carbapenem resistance genes (CRGs). Aeromonas carry a large number of CRGs in HWW, they may play a role as a suitable reservoir for CRGs, while resistomes in HWW are still poorly characterized regarding carbapenem resistant Aeromonas . Thus, the aim of the study was to evaluate the molecular epidemiological characteristics of carbapenem resistant Aeromonas in HWW. Methods: A total of 33 carbapenem resistant Aeromonas were isolated from HWW. Antimicrobial susceptibility testing and polymerase chain reaction (PCR) were used to assess the antimicrobial resistance profiles. Molecular typing was performed using enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) and multilocus sequence typing (MLST). The horizontal transmission mode of bla KPC was explored through conjugation and transformation experiments. The stability of bla KPC -IncP-6 plasmids was assessed through plasmid stability and in vitro competition test. The PCR mapping method was used to investigate the structural diversity of bla KPC . Results: The detection rates of bla KPC and cphA in Aeromonas were 97.0% and 39.4% respectively. Aeromonas caviae were grouped into 13 clusters by ERIC-PCR and 12 STs by MLST. Aeromonas veronii were grouped into 11 clusters by ERIC-PCR and 4 STs by MLST. 56.3% bla KPC were located on mobilizable IncP-6 plasmids. bla KPC -IncP-6 plasmid showed high stability and low cost fitness. Conclusion: Carbapenem resistant Aeromonas from HWW mainly carried bla KPC , which exhibited great structural diversity. Aeromonas might serve as reservoirs for bla KPC and bla KPC might spread mainly through transformation in HWW. Keywords: hospital wastewater, carbapenem resistance, Aeromonas , IncP-6, bla KPC
Objective Rectal neuroendocrine tumors (R-NETs) usually invade the submucosa, and so complete resection is difficult. The treatment of choice for R-NETs ≤10 mm in size is endoscopic resection, but there is still controversy concerning the best endoscopic method. This study evaluated the efficacy and safety of ligation-assisted endoscopic submucosal resection combined with endoscopic ultrasonography (ESMR-LUS) for treatment of R-NETs.Methods We retrospectively analyzed the data of 101 patients with R-NETs ≤10 mm in size who underwent ESMR-LUS (n = 48) or conventional ligation-assisted endoscopic submucosal resection (ESMR-L; n = 53) between May 2019 and September 2021 at the 900th Hospital of Joint Logistics Support Force. Complete resection rate, pathological complete resection rate, procedure time, and adverse events were compared between the two groups of patients.Results The endoscopic complete resection rate was slightly higher in the ESMR-LUS group than in the ESMR-L group (100 vs. 96.2%, p = .496). The pathological complete resection rate was also slightly higher in the ESMR-LUS group (97.9 vs. 88.7%, p = .152), these findings, though statistically non-significant, have practical clinical significance. Margin involvement was less common in ESMR-LUS patients than in ESMR-L patients (1 vs. 6). Involvement of the lateral resection margin was found one patient in the ESMR-LUS group versus two patients in the ESMR-L group, and deep resection margin involvement in no patient in the ESMR-LUS group versus four patients in the ESMR-L group. Mean procedure time was longer in the ESMR-LUS group than in the ESMR-L group (11.08 ± 1.89 min vs. 9.38 ± 2.09 min, p = .061). Immediate bleeding occurred in two patients in the ESMR-LUS group vs. seven patients in the ESMR-L group. Two patients in the ESMR-L group also suffered perforation; both patients were successfully treated by endoscopy.Conclusions ESMR-LUS appears to be a safe and effective technique for removal of small rectal NETs confined to the submucosal layer without metastasis. Further studies are warranted to compare the efficacy and safety of different methods.
Background: Immune function is recognized as an important prognostic indicator in gastric cancer (GC). The relationship between the lymphocyte-monocyte ratio (LMR) and tumor-associated macrophage (TAM) has received far less attention. Methods: A total of 401 patients from a prospective trial (NCT02327481) were enrolled in this study. The relationships between the LMR, TAM, and clinicopathologic variables were analyzed using a Kaplan-Meier log-rank survival analysis, and multivariate Cox regression models were used to identify associations with recurrence-free survival (RFS) and overall survival (OS). The discriminatory power of the prognostic models for both RFS and OS were compared. The decision curve analysis was performed to compare the clinical utility of the prognostic models. Results: High LMR was observed in 81.5% of the 401 GC patients, and high TAM infiltration was observed in 45.9% of the patients. In a multivariate Cox analysis of all patients, LMR and TAM were both independent prognostic factors for RFS and OS. Patients with high TAM expression had similar mean LMR levels than patients with low TAM expression. Moreover, LMR appeared to lose its prognostic significance in patients with high TAM expression levels. Finally, the model that included the TAM had better predictive capability and clinical utility for both RFS and OS. Conclusions: Although LMR and TAM are both independent predictors of RFS and OS in resectable GC patients, LMR seem to attenuate its prognostic significance in patients with high TAM expression. This information may be helpful in the clinical management of patients with GC. Further external studies are warranted to confirm this hypothesis.
Randomized trials have compared hypofractionated (11-24 fractions) and standard fractionated (25-40 fractions) breast radiation after breast conserving surgery and have found no differences in local control, overall survival, or cosmetic outcome. We hypothesize that the perception amongst US physicians of the risk of late toxicity with hypofractionated radiation therapy has hindered the use of hypofractionated radiation therapy. The purpose of this study is to use population-based data to understand the real-world toxicity and tumor control in early stage breast cancer patients receiving either hypofractionated or standard fractionated radiation therapy. We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to identify early stage breast cancer patients diagnosed between 2000 and 2009 who were treated with breast conserving therapy. Using Medicare claims data, we identified a cohort of hypofractionated and a cohort of standard fractionated radiation therapy patients. We then identified radiation-related toxicities, including cardiac toxicities (myocardial infarction, coronary artery disease, valvular disease, conduction disorders, congestive heart failure, cardiomyopathy, and pericardial disease), breast-specific toxicities, hematologic toxicities, plexopathies, radiation pneumonitis, and upper extremity fractures. Additionally, we examined the rates of local tumor control and secondary malignancies. Each toxicity was determined by the presence of its ICD-9 diagnosis code or HCPCS code within the Medicare claims data. The association between radiation fractionation and the endpoints of toxicity and local tumor control was determined with cumulative incidence analysis and Fine-Gray regression. Our study population consisted of 23,125 women with early stage breast cancer who received breast conserving surgery followed by either hypofractionated (n=1,497) or standard fractionated (n=21,628) radiation therapy. Women in the hypofractionation cohort were older and had greater comorbidity than those in the standard fractionation cohort. On univariate analysis, we found that hypofractionation was associated with a low but slightly increased rate of local tumor recurrence (3.1% vs 1.5%, p=0.05) compared to standard fractionation. This remained significant on multivariate analysis (SDHR 1.72, p=0.05). All other toxicity endpoints were nonsignificant on both univariate and multivariate analysis. In a real-world cohort of older women with early stage breast cancer treated with breast conserving therapy, hypofractionated radiation therapy has equivalent rates of treatment-related toxicity in comparison to standard fractionated radiation therapy.
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