Search

Background: Neuroendocrine tumors (NET) are a rare group of epithelial neoplasms present in the gastrointestinal tract (GI) (67.5%) and bronchopulmonary tree (25.3–30%), and in 15% of cases, their primary sites cannot be identified. Although endoscopic screening, improvements in pathological techniques, and early detection have shown improvements in NET survival rates, the prognosis of advanced, metastatic, and poorly differentiated NET is very poor. In this study, we aimed to evaluate the effect of gastrointestinal and pancreatic (GEPs) NETs’ grade on overall survival. Method: We searched observational studies describing the overall survival or prognostic factors of primary GEP NETs from May 2011–May 2021 following the PRISMA guidelines. Studies describing the effect of primary grade 3 GEP NETs on overall survival were included. A meta-analysis was performed, and a pooled hazard ratio and their 95% confidence interval (95% CI) were obtained. Forest plots were created using random effects models and a sensitivity analysis was performed to account for the heterogeneity. Results: Seven studies with 7692 confirmed patients were included. In our meta-analysis, grade 3 GEP NETs were associated with higher odds of poor survival (pooled HR: 2.73; 95% CI: 1.36–5.47; p = 0.005), with a 92% heterogeneity between studies (p < 0.0001). To account for this heterogeneity, a sensitivity analysis was performed by removing two outlying studies (Fathi et al. and Foubert et al.) on funnel plots. The results after the sensitivity analysis did not change and still showed a significant association of grade 3 with a poor survival (pooled HR: 4.53; 95% CI: 3.54–5.78; p < 0.00001), with no heterogeneity between studies (p = 0.72; I2 = 0%). Conclusions: Our meta-analysis found that grade 3 GEP NETs are associated with poor survival and additional future studies are needed to identify other risk factors associated with poor survival in GEP NETs to improve their mortality.

Introduction: Tobacco use is one of the most significant risk factors for stroke. Besides traditional cigarettes and combustible products, the use of e-cigarettes and electronic nicotine delivery products has been widespread among young adults in the recent era. Furthermore, the trend of vaping has increased over the last decade. However, the relationship between e-cigarettes and stroke is largely unknown. The aim of this study was to evaluate the prevalence and identify the relationship between e-cigarette smoking and stroke. Methods: A cross-sectional study was performed using the NHANES database of the US population. Adults with a history of smoking were considered in our study and divided into three groups, e-cigarette users, traditional, and dual smokers. The Chi-squared test, Wilcoxon rank-sum test, and multivariable logistic regression analysis were used to identify the prevalence and association of e-cigarette consumption and stroke. Results: Out of a total of 266,058 respondents from 2015 to 2018, we found 79,825 respondents who smoked e-cigarettes (9.72%) or traditional (29.37%) or dual smoking (60.91%). Stroke prevalence among e-cigarette smokers was 1.57%. Stroke was more prevalent among traditional smokers than among e-cigarette smokers. (6.75% vs. 1.09%; p < 0.0001) E-cigarette smokers had early onset of stroke in comparison with traditional smokers. (median age: 48 vs. 59 years; p < 0.0001). Among females with stroke, the prevalence of e-cigarette use was higher in comparison with traditional smoking (36.36% vs. 33.91%; p < 0.0001). Among the stroke population, the prevalence of e-cigarette use was higher among Mexican-Americans (21.21% vs. 6.02%) and other Hispanics (24.24% vs. 7.70%) compared with traditional smoking (p < 0.0001). The regression analysis found higher odds of stroke history among e-cigarette users than traditional smokers [aOR: 1.15; 95% CI: 1.15–1.16)]. Conclusion: Though stroke was more prevalent in traditional smokers, the incidence of stroke was early-in-onset and was strongly associated with e-cigarette use compared to traditional smokers. We have also identified vascular effects of e-cigarettes components as possible triggers for the stroke.

Background: It is vital to provide evidence-based research documentation to guide policy decision-making. There is a limited number of studies that participate in dental policy evidence-based research. Case Description: Texas is one of the states with limited dental service coverage for its Medicaid Beneficiaries. The recent senate bill 87R 1152 proposes expansion of dental preventive service to disability status Medicaid Beneficiaries. It is vital to understand how effective the extensive dental service under Medicaid coverage is through evidence-based research. True causal analysis of such public policies by utilizing observational data is only feasible through limited identification strategies. The current paper identifies that. Practical Implication: Through the identified research plan and conceptual framework, it can be established if extensive Medicaid dental service coverages effectively prevent dental disease burden in Texas.

Waste seaweed that is collected at coastal regions of maritime provinces in Canada is creating ecological problems as it promotes an anoxic event, which produces nearly zero dissolved oxygen in water along with hydrogen sulfide emission. The work done in this study attempts to address this issue by producing a coal-like solid hydrochar and nutritious liquid slurry (processed water) by employing a rather recent thermo-chemical process called hydrothermal carbonization (HTC) on the seaweed. The HTC was carried out in a batch reactor system for three different reaction temperatures, 180 °C, 200 °C, 220 °C, and three different reaction times, 30, 60, and 120 min. Each of the produced hydrochars was characterized by different analytical methods. The effects of the process conditions on the yield and the properties of the hydrochar and process water were examined. The hydrochar produced at 220 °C and 120 min showed the highest carbon content (48.5%) and heating value (18.93 MJ/kg). The energy density and carbon to nitrogen (C/N) ratio in the hydrochar increased significantly as compared to raw seaweed. Moreover, HTC reduced the ash yield and volatile compounds of the seaweed. Thus, hydrochar can be used as a fuel for direct combustion, in soil remediation, or in carbon sequestration applications.