To evaluate if the obesity paradox, wherein obesity portends worse overall prognosis for a disease but improved outcomes for patients receiving immunotherapy, exists for patients receiving bacillus Calmette-Guérin (BCG) in a contemporary cohort.
We performed an Institutional Review Board-approved database review to identify patients with non-muscle-invasive bladder cancer (NMIBC) completing at least an induction course of BCG. Clinicopathological variables collected included body mass index (BMI), medications, and diabetes mellitus (DM). Outcomes of interest included recurrence-free (RFS), progression-free (PFS), cancer-specific (CSS), and overall survival (OS). Univariate and multivariate modelling were used to evaluate the association between outcomes and clinical factors.
A total of 579 patients (median follow-up 4.6years) received BCG induction for NMIBC; 90% had high-grade disease (47.2% clinical stage T1). In all, 75.7% of patients were overweight or obese and 18% had DM. Aspirin, statins, metformin and β-blockers were used in 34%, 42%, 11%, and 29% of patients, respectively. Overweight and obese patients had improved PFS, CSS and OS. DM was associated with worse RFS. Medications of interest had no association with outcomes.
Elevated BMI is associated with improved outcomes in patients with NMIBC treated with BCG immunotherapy. Patients with DM are at increased risk of recurrence. These findings support a potential obesity paradox in bladder cancer. Evaluation of the underlying mechanism and the role of global patient assessment, counselling, and risk factor modification are warranted.
Elevated BMI is associated with improved outcomes in patients with NMIBC treated with BCG immunotherapy. Patients with DM are at increased risk of recurrence. These findings support a potential obesity paradox in bladder cancer. Evaluation of the underlying mechanism and the role of global patient assessment, counselling, and risk factor modification are warranted.The SARS-CoV-2 (COVID-19) pandemic continues to affect many lives globally. Patients with cancer undergoing potentially immunosuppressive therapies appear to be at particular risk for the disease and its complications. Here, we describe the experience of patients with cancer within Kaiser Permanente, a large, integrated health system in Northern California. ML348 Between February 25, 2020, and June 8, 2020, 4,627 patients were diagnosed with COVID-19, of whom 33 had active cancer treatment within 180 days and 214 had a history of cancer. Patients with active cancer treatment had a statistically higher risk of requiring noninvasive ventilation (odds ratio [OR], 2.57; confidence interval [CI], 1.10-6.01), and there was a nonsignificant trend toward higher risk of death (OR, 2.78; CI, 0.92-8.43). Those with a history of cancer had comparable outcomes to those without cancer. These data demonstrate an increased risk of complications from COVID-19 for patients with active cancer treatment.Nonalcoholic fatty liver disease (NAFLD) is a public health crisis and the most common chronic liver disease in the US with a current prevalence of 25% in US adults and rising.1-3 NAFLD results from the accumulation of fat within hepatocytes in patients without a history of heavy alcohol use or other causes (e.g., medication, hepatitis C). NAFLD is a spectrum of disease ranging from simple steatosis (NAFL) to steatohepatitis (NASH), fibrosis, and cirrhosis. NAFLD is associated with risk for hepatocellular carcinoma, need for liver transplantation, type 2 diabetes, chronic kidney disease, and cardiovascular disease.1,4 Risk for these complications increases with the degree of fibrosis.2,5 Identifying advanced fibrosis previously required expensive and invasive liver biopsy, but recently several biomarkers and scoring systems can reliably establish risk for advanced fibrosis. The fibrosis-4 (FIB-4) index is a well-validated tool that uses common clinical information (patient age, ALT, AST, and platelet count) to estimate risk of advanced fibrosis (low, indeterminate, and high) in patients with hepatic steatosis.5-7.Halogen bonding, parallel to hydrogen bonding, was introduced into the catalytic cycloaddition of carbon dioxide into epoxide (CCE) reactions. A series of halogen-bond donor (XBD) catalysts of N-iodopyridinium halide featured with N-I bond were synthesized and evaluated in CCE reactions. The optimal XBD catalyst, 4-(dimethylamino)-N-iodopyridinium bromide ([DMAPI]Br), under screened conditions at 100 °C, ambient pressure, and 1 mol % catalyst loading, realized 93 % conversion of styrene oxide into cyclic carbonate in 6 h. The substrate scope was successfully extended with excellent yields (mostly ≥93 %) and quantitative selectivity (more than 99 %). 1 H NMR spectroscopy of the catalyst [DMAPI]Br on substrate epoxide certified that the N-I bond directly coordinated with the epoxide oxygen. A plausible mechanism of halogen-bonding catalysis was proposed, in which the DMAPI cation functioned as halogen-bond donor to activate the epoxide, and the counter anion bromide attacked the methylene carbon to initiate the ring-opening of the epoxide. CCE reactions promoted by N-iodopyridinium halide, exemplify a first case of halogen-bonding catalysis in epoxide activation and CO2 transformation.Photodynamic therapy (PDT) is an effective treatment option for the treatment of superficial basal cell carcinoma (sBCC). Recent publications have demonstrated that PDT with 7.8% 5-aminolaevulinic acid nanoemulsion-based gel (BF-200 ALA-PDT) is an effective and safe alternative for the treatment of sBCC). To investigate the efficacy and safety of 7.8% 5-aminolaevulinic acid nanoemulsion-based gel (BF-200 ALA)-PDT for the treatment of sBCC. A non-controlled, open-label single centre study was conducted. Patients received one PDT cycle with two PDT sessions one-week apart. In case that clinical-dermoscopy evaluation of treatment outcome revealed remaining lesions, a second PDT cycle was performed. The clinical results at the dermoscopy and fluorescence diagnosis level were histologically confirmed in all patients. Treatment response was evaluated 3, 6, and 12 months after last PDT session. A total of 31 patients (12 men and 19 women), with a median age of 63.74 years were included in this study. 3-month after PDT-session, 23/31 patients were complete responders (74.ML348
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