Epidemiology of Mpox Outbreaks and Implications for Surveillance in Imo State, Nigeria

Mpox disease is caused by a double-stranded DNA virus, genus Orthopoxvirus of the family Poxviridae. The incubation period is usually 6 to 13 days but can range from 5 to 21 days while symptoms and signs may persist for 2 to 5 weeks. Although, the clinical features are usually less severe when compared to the deadly smallpox, the disease can be fatal with case fatality rate between 1% and 10%. In Imo State, Nigeria, there has been a changing epidemiology of the disease in the last 6 years and the frequency and geographic distribution of cases have progressively increased. This study aims to conduct a review of the disease epidemiology between 2017 and 2023 and implications for surveillance in Imo State. Surveillance data from the Surveillance Outbreak Response and Management System (SORMAS) was extracted between January 2017 and December 2023 across the 27 Local Government Areas (LGAs) of Imo State. A line list of 231 suspected cases was downloaded into an excel template and analyzed using SPSS® version 20 software. Analysis was done using descriptive statistics and associations were tested using Fischer’s exact at 0.05 level of significance. Of the 231 suspected cases, 57.1% (132) were males, 42.9% (99) were females and the modal age group was between the ages of 0 - 4 (32.5%). Eight (8) LGAs (districts) accounted for 71% (n = 164) of all the suspected cases. 21.2% (49) were confirmed positive, 27 males (55.1%) and 22 females (44.9%) (p > 0.05). Modal age group was 20 - 24 (22.4%, n = 11), 18% (9) were children under 14 years, p > 0.05. Case fatality rate was 8% (n = 4). There was no significant association between mortality and age group. Five (5) LGAs accounted for about 60% (29) of all confirmed cases. These LGAs contribute only 20% to the total population in the State. Only 5.6% and 4% of suspected and confirmed cases, respectively, had knowledge of contact with an infectious source. The study described the epidemiology of Mpox outbreaks between 2017 and 2023 and the findings have significant implications on detection and outbreak response activities.

Molecular Epidemiology and Clinical Characteristics of Hand, Foot and Mouth Disease in North Sichuan Region, China, 2018-2023: A Descriptive Study

Background: Hand, foot and mouth disease (HFMD) remains an important public health problem in China. Many studies on the epidemiological characteristics of HFMD have been reported, but studies in North Sichuan region have been neglected. Methods: HFMD-related enterovirus infected cases were clinically confirmed and underwent real-time RT-PCR (rRT-PCR) from May 2018 to October 2023 in Guangyuan Central Hospital. Results: During 2018-2023, other EV (437 cases, 81.08%) was the most predominant serotype followed by CV-A16 (94 cases, 17.44%), EV-A71 (8 cases, 1.48%) was the least predominant serotype. Peak infections occurred in July and October. There were no significant differences in gender, age and serotypes. HFMD was concentrated in children under 47 months of age, with the highest incidence in children aged 12 - 23 months and the highest proportion of other EV infections in the whole age group. COVID-19 did not cause significant changes in gender, age and serotype. Overall, there was a significant increase in the proportion of children aged 12 - 23 months infected with CV-A16, and an increase in the proportion of children aged over 36 months infected with other EVs. Conclusions: The incidence of HFMD caused by EV-A71 has decreased significantly, and other EVs have become the main pathogens of HFMD in North Sichuan region in recent years. In the prevention and control of CV-A16, more attention should be paid to children aged 12 - 23 months and the dominant serotype should be closely monitored. Our study highlights the importance of developing of new diagnostic reagents and vaccines for the prevention and control of enterovirus infection. This study for the first time provides insights into district interventions to local conditions.

Measurement,associations,patterns,and promotion:Unveiling vital areas in physical activity epidemiology

Physical activity(PA)epidemiology first emerged as a new field of study around the 1950s with publication of seminal investigations on London civil servants1 and has continued to evolve as a scientific discipline to present time.This subdiscipline of epidemiology studies the frequencies,distributions,and dynamics of PA and its impact on human health,morbidity,and mortality.Research over the past 75 years has demonstrated numerous health benefits of PA.Based on these research findings,the World Health Organization recommends adults aged 18-64 years engage in at least 150-300 min of moderate-intensity aerobic PA per week,or at least 75-150 min of vigorous-intensity aerobic PA per week,or a combination of both intensities.

Epidemiology and current management of cerebrovascular disease in China

The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.In connection with the previous section,this fifth section of the report continues the dissection on the manage-ment of cardiovascular diseases(CVD).Cerebrovascular disease is the leading cause of death and loss of healthy life among Chinese residents.Based on the results of GBD 2019,from 1990 to 2019,the years of life lost due to premature death caused by stroke showed a decreasing trend,while the years lived with disability still increased continuously.At present,national mortal-ity surveillance system can provide national and provincial representative annual death data on cerebrovascular disease,but the national representative data on some other important epidemiological indicators(such as incidence,prevalence,disability rate,and case fatality rate)are scarce in China.With the construction of large cohort population and extension of follow-up time,re-search on stroke-related risk factors is increasing,providing a basis for the prevention and control of risk factors.Due to limited large-scale population-based intervention studies,there is a lack of epidemiological evidence to transform into feasible interven-tion strategies and measures.In recent years,great progress in endovascular treatment for basilar-artery occlusion has been achieved in China,but there is still much room for improvement of guideline-based anticoagulant treatment and lipid-lowering treatment,as well as standardized diagnosis and treatment among patients with ischemic stroke.

Epidemiology and current management of cardiovascular disease in China

The Annual Report on Cardiovascular Health and Diseases in China(2022) intricate landscape of cardiovascular health in China. This is the fourth section of the report with a specific focus on epidemiology and current management of cardiovascular disease(CVD) in China. This section of the report highlights the epidemiological trends of CVD in China. It reveal a concerning rise in prevalence, with approximately 330 million affected individuals, including significant numbers with stroke, coronary artery disease(CAD), heart failure, and other conditions. CVD stands as the primary cause of mortality among both urban and rural populations, accounting for nearly half of all deaths in 2020. Mortality rates are notably higher in rural areas compared to urban centers since 2009. While age-standardized mortality rates have decreased, the absolute number of CVD deaths has increased, primarily due to population aging. Ischemic heart disease, hemorrhagic and ischemic strokes are the leading causes of CVD-related deaths. Notably, the burden of atherosclerotic cardiovascular disease has risen substantially, with atherosclerotic cardiovascular disease-related deaths increasing from 1990 to 2016. The incidence of ischemic stroke and ischemic heart disease has shown similar increasing trends over the past three decades. CAD mortality, particularly acute myocardial infarction, has been on the rise, with higher mortality rates observed in rural areas since 2016. The prevalence of CAD has increased significantly, with over 11 million patients identified in 2013. Studies assessing hospital performance in managing acute coronary syndrome reveal gaps in adherence to guideline-recommended strategies, with disparities in care quality across hospitals. However, initiatives like the China Patient-centered Evaluative Assessment of Cardiac Events(PEACE)-Retrospective AMI Study and the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS) project aim to improve patient outcomes through enhanced care protocols. Moreover, advancements in medical technology, such as quantitative flow ratio-guided lesion selection during percutaneous coronary intervention, show promise in improving clinical outcomes for patients undergoing intervention.

Heart failure in China:epidemiology and current management

The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascularhealth in China.In connection with the previous section,this sixth section of the report offers a comprehensive analysis of heart failure(HF)in China.HF is one of the most important cardiovascular disease in the 21st century.Its mortality is equivalent to that of cancer.It is an important public health problem that seriously affects the health of Chinese residents.In recent years,with the deepeningof understanding,the change of treatment principles,the innovation of treatment methods and the update of treatment guidelines,the in-hospital mortality of HF patients has declined,and the long-term prognosis is also improving.However,there are stilldifferences in the management level of HF among different hospitals in China.How to improve the standardized diagnosis andtreatment level of HF in China remains an important challenge.

Epidemiology of EGFR Mutation in Adenocarcinoma NSCLC Patients in India: A Systematic Review and Meta-Analysis

Studies reporting the Indian prevalence of Epidermal Growth Factor Receptor (EGFR) mutation are mostly single centers with small sample sizes. This systematic review and meta-analysis summarized the available evidence of EGFR mutation epidemiology in Indian patients with adenocarcinoma (ADC) Non-Small Cell Lung Cancer (NSCLC). We conducted a structured literature search in PubMed, and EMBASE databases from January 2004 through October 2019. The primary outcome of interest was prevalence of EGFR mutation by gender, smoking status, and mutation subtype. The review included 34 studies. EGFR mutation prevalence was 39.5% in patients with ADC, and significantly higher in females, non-smokers, and patients with exon 19 deletions. The EGFR mutation frequency in Indian patients with ADC was higher than reported in Caucasians but at a lower range of that reported in East Asians. These findings support the use of EGFR mutation testing to guide choice of treatment.

A 10-year review and epidemiology of animal bite cases in Gerash city, south of Iran: A retrospective cross-sectional study

Objective:To determine the temporal trend and epidemiology of animal bite cases in Gerash City,Iran.Methods:This retrospective cross-sectional study analyzed 630 cases of people with animal bites between 2011 and 2021 in Gerash City.The collected data were analyzed using Chi-square test.Results:The mean age of victims was(30.9±17.5)years.80.54%Of victims were male,39.70%were self-employed,and 64.60%were adults(≥18 years).Most cases of bites occurred in 2019(91 cases),2020(74 cases)and 2021(87 cases),and most of the bites were related to the upper limbs(62.70%).Most of the wounds were superficial(78%),most of the biting animals were domestic animals(91.74%),and most of the victims had Iranian nationality(97.62%).Conclusions:Given the increasing trend of animal bites in Gerash City,health authorities should carry out basic measures such as education and awareness among the public,especially at-risk groups such as adult males.Additionally,since most cases of bites are due to dogs,it seems necessary to plan for vaccination of dogs,especially those with owners.

Ruptured Ectopic Pregnancy: Epidemiology and Management in the General Surgery Department of the Ignace Deen National Hospital, Conakry University Hospital

Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Hospital. Methodology: This was a retrospective, descriptive study lasting two years (January 1, 2020 to December 31, 2022), carried out in the general surgery and gyneco-obstetrics departments of the Ignace Deen national hospital, Conakry University Hospital. We included all patients with a ruptured ectopic pregnancy who received surgical treatment during the study period. Results: We collected 13,524 cases of surgical interventions in the two services, among them, we recorded 89 cases or 0.66% GEUR. The average age of the patients was 24.26 years. Brides were the most represented with 80.96% of cases. Women practicing a liberal profession were 51.69% (n = 46) and housewives 26.97% (n = 24). Clinically, amenorrhea was noted in all patients, i.e. 100%, abdominal-pelvic pain in 95.2% (n = 85) of cases, metrorrhagia in 94.08% (n = 84), abdominal-pelvic sensitivity in 97.44% (n = 87) of cases and anemia in 85.39% of cases. The GEUR was ampullary in 69.66% (n = 62) cases. Salpingectomy was performed in 90.72% (n = 81). The surgical outcomes were satisfactory in 98.87% (n = 88) of cases. We recorded one case of surgical site infection. We have not recorded any deaths. The average length of hospitalization was 4 days. Conclusion: GEUR is relatively high in our context. A good understanding of the prognostic factors of GEUR, awareness and family planning could reduce GEUR.

Epidemiology of work-related hand and wrist injuries in a referral center: A descriptive study

BACKGROUND Occupational hand and wrist injuries(OHWIs)account for 25%of work-related accidents in low-and middle-income countries.In Colombia,more than 500000 occupational accidents occurred in 2021,and although the rate declined to less than 5%in 2020 and 2021,at least one in four accidents involved a hand or wrist injury.AIM To describe the OHWIs in workers seen at the emergency room at a second-level hospital in Colombia.METHODS An observational study was performed using data from workers who experienced OHWIs and attended a second-level hospital,between June,2020 and May,2021.The overall frequency of OHWIs,as well as their distribution by sociodemo-graphic,clinical,and occupational variables,are described.Furthermore,association patterns between sex,anatomical area(fingers,hand,wrist),and type of job were analyzed by correspondence analysis(CA).RESULTS There were 2.101 workers treated for occupational accidents,423(20.3%)were cases of OHWIs,which mainly affected men(93.9%)with a median age of 31 years and who worked mainly in mining(75.9%).OHWIs were more common in the right upper extremity(55.3%)and comprised different types of injuries,such as contusion(42.1%),laceration(27.9%),fracture(18.7%),and crush injury(15.6%).They primarily affected the phalanges(95.2%),especially those of the first finger(25.7%).The CAs showed associations between the injured anatomical area and the worker’s job that differed in men and women(explained variance>90%).CONCLUSION One out of five workers who suffered occupational accidents in Cundinamarca,Columbia had an OHWI,affecting mainly males employed in mining.This occupational profile is likely to lead to prolonged rehabilitation,and permanent functional limitations.Our results might be useful for adjusting preventive measures in cluster risk groups.

Prospective study of hepatitis B and D epidemiology and risk factors in Romania:A 10-year update

BACKGROUND The global burden of hepatitis D virus(HDV)infection represents a major medical challenge and a public health crisis worldwide.However,there is a lack of accurate data on the epidemiology and risk factors for HDV.Hepatitis B virus(HBV)and HDV coinfection causes the most severe form of viral hepatitis,leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection,including the need for liver transplantation and death.AIM To investigate the epidemiology,natural history,risk factors and clinical management of HBV and HDV coinfection in Romanian patients.METHODS This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in Romania.All consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were enrolled.Patients with acute hepatitis or incomplete data were excluded.Of the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period,963 met the inclusion criteria.Testing for anti-HDV antibodies and HDV RNA was performed for all participants.Demographic and risk factor data were collected by investigators using medical charts and patient questionnaires.All data were stored in an anonymized online database during the study.RESULTS The prevalence of HBV was 3.8%;among these patients,the prevalence of HBV/HDV coinfection was 33.1%.The median age of the study population was 54.0 years,and it consisted of 55.1%men.A higher prevalence of HBV/HDV coinfection was observed in patients 50–69 years old.Patients with HBV/HDV coinfection were significantly older than those with HBV monoinfection(P=0.03).Multivariate multiple regression analysis identified female gender(P=0.0006),imprisonment(P<0.0001),older age at diagnosis(P=0.01)and sexual contact with persons with known viral hepatitis(P=0.0003)as significant risk factors for HDV.CONCLUSION This study shows that HDV infection among those with HBV remains endemic in Romania and updates our understanding of HDV epidemiology and associated risk factors.It emphasizes the need for systematic screening for HDV infection and collaborative initiatives for controlling and preventing HBV and HDV infection.

Epidemiology and prognostic nomogram for locally advanced gastric signet ring cell carcinoma:A population-based study

BACKGROUND Gastric signet ring cell carcinoma(GSRC)represents a specific subtype of gastric cancer renowned for its contentious epidemiological features,treatment principles,and prognostic factors.AIM To investigate the epidemiology of GSRC and establish an improved model for predicting the prognosis of patients with locally advanced GSRC(LAGSRC)after surgery.METHODS The annual rates of GSRC incidence and mortality,covering the years 1975 to 2019,were extracted from the Surveillance,Epidemiology,and End Results(SEER)database to explore the temporal trends in both disease incidence and mortality rates using Joinpoint software.The clinical data of 3793 postoperative LAGSRC patients were collected from the SEER database for the analysis of survival rates.The Cox regression model was used to explore the independent prognostic factors for overall survival(OS).The risk factors extracted were used to establish a prognostic nomogram.RESULTS The overall incidence of GSRC increased dramatically between 1975 and 1998,followed by a significant downward trend in incidence after 1998.In recent years,there has been a similarly optimistic trend in GSRC mortality rates.The trend in GSRC showed discrepancies based on age and sex.Receiver operating characteristic curves,calibration curves,and decision curve analysis for 1-year,3-year,and 5-year OS demonstrated the high discriminative ability and clinical utility of this nomogram.The area under the curve indicated that the performance of the new model outperformed that of the pathological staging system.CONCLUSION The model we established can aid clinicians in the early prognostication of LAGSRC patients,resulting in improved clinical outcomes by modifying management strategies and patient health care.

Current Epidemiology of Intracranial Metastases in Two University Teaching Reference Hospitals of the Town of Yaounde, Cameroon: Analysis of 35 Cases Recorded in the Neurosurgery Departments

Background: The incidence of intracranial metastases (ICMET) has been steadily rising, and its frequency with respect to primary brain tumours is relatively high. Objective: The objectives of this study were to elucidate the current epidemiology and describe the clinical, diagnostic and therapeutic features of ICMET in Yaounde. Method and findings: A descriptive cross-sectional study was done in the neurosurgery departments of the General and Central Hospitals of Yaounde during the period from January 2016 to December 2022. We included all medical booklets of patients admitted for a tumoral intracranial expansive process with our target population being patients with histological evidence of ICMET, and did a retrospective inclusion of data using a pre-established technical form aimed at collecting sociodemographic data, clinical data, paraclinical data, and the treatment procedures. Analysis was done using the SPSS statistical software. A total of 614 cases of intracranial tumors were included among whom 35 presented histological evidence of ICMET. This gives a frequency of 5.7%. The sex ratio was 0.94, the mean age was 55.68 +/- 14.4 years, extremes 28 and 86 years and the age range 50 - 59 was affected in 28.57% of cases. The clinical presentation included signs of raised intracranial pressure (headache, blurred vision, vomiting) in 26 cases (74.3%), motor deficit 48.6%, seizures 17.1%. The mode of onset was metachronous in 71.4% and synchronous in 28.6%. The imaging techniques were cerebral CT scan in 82.9%, cerebral MRI in 40%, TAP scan in 22.9%. The metastatic lesions were supratentorial in 94.3% and single in 62.9%. The primary cancers found were breast cancer (31.4%), lung cancer (25.7%), prostate cancer (17.1%), thyroid cancer (5.7%), colon cancer (2.9%), and melanoma (2.9%). The therapeutic modalities were total resection (68.6%), radiotherapy (37.1%). Conclusion: Intracranial metastases are relatively frequent. There is a female sex predominance and the age group 50 - 59 years is the most affected. Brain metastases mostly occur in patients with a history of known primary tumor. The clinical signs mainly include signs of raised intracranial pressure, motor deficit, seizures and mental confusion. Cerebral CT Scan is the main imaging technique used. Most of the lesions are single and supratentorially located. The primary cancers most represented include breast cancer, lung cancer and prostate cancer. Surgery is the main treatment procedure. The adjuvant treatment (radiotherapy, chemotherapy) was limited.

Updates on global epidemiology,risk and prognostic factors of gastric cancer

Gastric cancer(GC)is defined as the primary epithelial malignancy derived from the stomach,and it is a complicated and heterogeneous disease with multiple risk factors.Despite its overall declining trend of incidence and mortality in various countries over the past few decades,GC remains the fifth most common malignancy and the fourth leading cause of cancer-related death globally.Although the global burden of GC has shown a significant downward trend,it remains severe in certain areas,such as Asia.GC ranks third in incidence and mortality among all cancer types in China,and it accounts for nearly 44.0%and 48.6%of new GC cases and GC-related deaths in the world,respectively.The regional differences in GC incidence and mortality are obvious,and annual new cases and deaths are increasing rapidly in some developing regions.Therefore,early preventive and screening strategies for GC are urgently needed.The clinical efficacies of conventional treatments for GC are limited,and the developing understanding of GC pathogenesis has increased the demand for new therapeutic regimens,including immune checkpoint inhibitors,cell immunotherapy and cancer vaccines.The present review describes the epidemiology of GC worldwide,especially in China,summarizes its risk and prognostic factors,and focuses on novel immunotherapies to develop therapeutic strategies for the management of GC patients.

Epidemiology of animal bite injuries in North of Fars province in Iran

Objective:To investigate the epidemiological situation of animal bites in Rostam city of Fars province.Methods:This is a cross-sectional study.Cases of animal bites registered in health centers of Rostam city of Fars province from the beginning of 2014 to 2020 were analyzed using the census method.The tool for collecting information was the portal of the Ministry of Health and the registration offices of people who were referred to the rabies center.Results:A total of 628 cases of animal bites registered in health centers of Rostam city of Fars province from the beginning of 2014 to 2020.The mean age of the injured was(31.3±20.2)years.Of the total injured cases,414(65.9%)were male,and 491(78.2%)lived in villages.Most of the cases were bitten by dogs(n=420,66.8%)and the upper limb was involved in 280(55.2%)cases.In addition,an increasing trend was observed in the incidence of animal bites from 2015 to 2020.Conclusions:The incidence of animal bites in Rostam City is high,and most of the cases occur in rural areas.Considering the injuries caused by animal bites,the risk of rabies transmission,and the high costs of vaccination and serum therapy,it is necessary to hold control,educational,and vaccination programs.

Epidemiology and early screening strategies for colorectal cancer in China

China ranks the first worldwide in the number of new colorectal cancer(CRC) cases and CRC-related deaths. The increasing incidence of early-onset CRC in recent years highlights the challenges related to CRC screening and prevention. High-quality colonoscopy is the universally used gold standard for CRC screening. Risk assessment combined with a two-step screening strategy based on colonoscopy and non-invasive examinations was proven to be highly effective. However, systematic use of well-established risk factors associated with CRC, beyond age, could better identify those who might harbor advanced colorectal neoplasia, improve the diagnostic yield of current screening modalities, and optimize the selection of individuals who might benefit most from preventive strategies.“Personalization” and “Standardization” are the future development directions of CRC screening, from the initiation of screening in those at high risk for CRC to follow-up after treatment, which are the key to ensure the screening efficiency.

Breast cancer: Epidemiology, risk factors and screening

Breast cancer is a global health concern with a significant impact on the well-being of women. Worldwide, the past several decades have witnessed changes in the incidence and mortality of breast cancer. Additionally,epidemiological data reveal distinct geographic and demographic disparities globally. A range of modifiable and non-modifiable risk factors are established as being associated with an increased risk of developing breast cancer.This review discusses genetic, hormonal, behavioral, environmental, and breast-related risk factors. Screening plays a critical role in the effective management of breast cancer. Various screening modalities, including mammography,ultrasound, magnetic resonance imaging(MRI), and physical examination, have different applications, and a combination of these modalities is applied in practice. Current screening recommendations are based on factors including age and risk, with a significant emphasis on minimizing potential harms to achieve an optimal benefits-to-harms ratio. This review provides a comprehensive insight into the epidemiology, risk factors, and screening of breast cancer. Understanding these elements is crucial for improving breast cancer management and reducing its burden on affected individuals and healthcare systems.

The global epidemiology of upper and lower gastrointestinal bleeding in general population:A systematic review

BACKGROUND Gastrointestinal bleeding(GIB)is a common and potentially life-threatening clinical event.To date,the literature on the long-term global epidemiology of GIB has not been systematically reviewed.AIM To systematically review the published literature on the worldwide epidemiology of upper and lower GIB.METHODS EMBASE®and MEDLINE were queried from 01 January 1965 to September 17,2019 to identify population-based studies reporting incidence,mortality,or casefatality rates of upper GIB(UGIB)or lower GIB(LGIB)in the general adult population,worldwide.Relevant outcome data were extracted and summarized(including data on rebleeding following initial occurrence of GIB when available).All included studies were assessed for risk of bias based upon reporting guidelines.RESULTS Of 4203 retrieved database hits,41 studies were included,comprising a total of around 4.1 million patients with GIB worldwide from 1980–2012.Thirty-three studies reported rates for UGIB,four for LGIB,and four presented data on both.Incidence rates ranged from 15.0 to 172.0/100000 person-years for UGIB,and from 20.5 to 87.0/100000 person-years for LGIB.Thirteen studies reported on temporal trends,generally showing an overall decline in UGIB incidence over time,although a slight increase between 2003 and 2005 followed by a decline was shown in 5/13 studies.GIB-related mortality data were available from six studies for UGIB,with rates ranging from 0.9 to 9.8/100000 person-years,and from three studies for LGIB,with rates ranging from 0.8 to 3.5/100000 person-years.Casefatality rate ranged from 0.7%to 4.8%for UGIB and 0.5%to 8.0%for LGIB.Rates of rebleeding ranged from 7.3%to 32.5%for UGIB and from 6.7%to 13.5%for LGIB.Two main areas of potential bias were the differences in the operational GIB definition used and inadequate information on how missing data were handled.CONCLUSION Wide variation was seen in estimates of GIB epidemiology,likely due to high heterogeneity between studies however,UGIB showed a decreasing trend over the years.Epidemiological data were more widely available for UGIB than for LGIB.

Treatment trends of muscle invasive bladder cancer: Evidence from the Surveillance, Epidemiology, and End Results database, 1988 to 2013

Objective:Guidelines for muscle-invasive bladder cancer(MIBC)recommend that patients receive neoadjuvant chemotherapy with radical cystectomy as treatment over radical cystectomy alone.Though trends and practice patterns of MIBC have been defined using the National Cancer Database,data using the Surveillance,Epidemiology,and End Results(SEER)program have been poorly described.Methods:Using the SEER database,we collected data of MIBC according to the American Joint Commission on Cancer.We considered differences in patient demographics and tumor charac-teristics based on three treatment groups:chemotherapy(both adjuvant and neoadjuvant)with radical cystectomy,radical cystectomy,and chemoradiotherapy.Multinomial logistic regression was performed to compare likelihood ratios.Temporal trends were included for each treatment group.Kaplan-Meier curves were performed to compare cause-specific sur-vival.A Cox proportional-hazards model was utilized to describe predictors of survival.Results:Of 16728 patients,10468 patients received radical cystectomy alone,3236 received chemotherapy with radical cystectomy,and 3024 received chemoradiotherapy.Patients who received chemoradiotherapy over radical cystectomy were older and more likely to be African American;stage III patients tended to be divorced.Patients who received chemotherapy with radical cystectomy tended to be males;stage II patients were less likely to be Asian than Caucasian.Stage III patients were less likely to receive chemoradiotherapy as a treatment op-tion than stage II.Chemotherapy with radical cystectomy and chemoradiotherapy are both un-derutilized treatment options,though increasingly utilized.Kaplan-Meier survival curves showed significant differences between stage II and III tumors at each interval.A Cox proportional-hazards model showed differences in gender,tumor stage,treatment modality,age,andmarital status.Conclusion:Radical cystectomy alone is still the most commonly used treatment for muscle-invasive bladder cancer based on temporal trends.Significant disparities exist in those who receive radical cystectomy over chemoradiotherapy for treatment.

Epidemiology and outcome of individuals with intraductal papillary neoplasms of the bile duct

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a rare distinct subtype of precursor lesions of biliary carcinoma.IPNB is considered to originate from luminal biliary epithelial cells,typically displays mucin-hypersecretion or a papillary growth pattern,and results in cystic dilatation[1].IPNB develops anywhere in the intrahepatic and extrahepatic biliary tracts,and can occur in various pathological stages from low-grade dysplasia to invasive carcinoma.IPNBs have similar phenotypic changes in the occurrence and development of all subtypes,and the prognosis is significantly better than that of traditional(nonpapillary)cholangiocarcinoma.AIM To evaluate the clinicopathological features of IPNB to provide evidence-based guidance for treatment.METHODS Invasive IPNB,invasive intraductal papillary mucinous neoplasm of the pancreas(IPMN),and traditional cholangiocarcinoma data for affected individuals from 1975 to 2016 were obtained from the Surveillance,Epidemiology,and End Results(SEER)database.Annual percentage changes(APCs)in the incidence and incidence-based(IB)mortality were calculated.We identified the independent predictors of overall survival(OS)and cancer-specific survival(CSS)in indivi duals with invasive IPNB.RESULTS The incidence and IB mortality of invasive IPNB showed sustained decreases,with an APC of-4.5%(95%CI:-5.1%to-3.8%)and-3.3%(95%CI:-4.1%to-2.6%)(P<0.001),respectively.Similar decreases in incidence and IB mortality were seen for invasive IPMN but not for traditional cholangiocarcinoma.Both OS and CSS for invasive IPNB were better than for invasive IPMN and traditional cholangiocarcinoma.A total of 1635 individuals with invasive IPNB were included in our prognosis analysis.The most common tumor sites were the pancreaticobiliary ampulla(47.9%)and perihilar tract(36.7%),but the mucin-related subtype of invasive IPNB was the main type,intrahepatically(approximately 90%).In the univariate and multivariate Cox regression analysis,age,tumor site,grade and stage,subtype,surgery,and chemotherapy were associated with OS and CSS(P<0.05).CONCLUSION Incidence and IB mortality of invasive IPNB trended steadily downward.The heterogeneity of IPNB comprises site and the tumor’s mucin-producing status.