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The aim of this study was to describe the impact of marginalization on DLBCL overall survival (OS) within the Canadian setting. We conducted a population-based retrospective cohort study of adult patients with newly diagnosed DLBCL in Ontario between 1 January 2005 and 31 December 2017 receiving a rituximab-containing chemotherapy regimen with curative intent followed until 1 March 2020. Our primary exposure of interest was the Ontario Marginalization Index (ON-Marg). The primary outcome was 2-year OS, accounting for patient age, sex, cancer characteristics, comorbidity burden, and rural dwelling status. While two-year overall survival was inferior for individuals in the most deprived marginalization quintile (70.4% Q5 vs. 76.0% Q1), after adjustment for relevant covariates neither the composite ON-Marg nor any of its dimensions had a significant effect. Within the Canadian context, among patients who receive chemotherapy, marginalization may not have a significant association with overall survival when accounting for key patient covariates, lending support for preserved outcomes. [ABSTRACT FROM AUTHOR]

The association between obesity and survival in non-Hodgkin lymphoma is unclear. Using the Ontario Cancer Registry we conducted a retrospective analysis of incident cases of aggressive-histology B-cell lymphoma treated with a rituximab-containing regimen with curative intent between 2008–2016. 6246 patients were included. On multivariable analysis the rate of all-cause mortality was lower for the overweight body mass index (BMI 25–29.9 kg/m2) (HR 0.85; 95%CI 0.77–0.95) and obese BMI (≥30 kg/m2) (HR 0.75; 95%CI 0.67–0.85) groups compared to the normal weight group (18.5–24.9 kg/m2). Binomial logistic regression analysis revealed a lower odds ratio (OR) of admission to hospital during treatment in the overweight (OR 0.84; 95%CI 0.75–0.95) compared to normal weight BMI group. In the largest cohort to date of aggressive-histology B-cell lymphoma patients treated with rituximab, increased BMI is associated with a survival advantage, and the magnitude of this effect increases from overweight to obese BMI. [ABSTRACT FROM AUTHOR]

Objective:Water-based exercises have been used in the rehabilitation of people with stroke, but little is known about the impact of this treatment on balance. This study examined the effect of water-based exercises compared to land-based exercises on the balance of people with sub-acute stroke. Methods:In this single-blind randomized controlled study, 32 patients with first-time stroke discharged from inpatient rehabilitation at West Park Healthcare Centre were recruited. Participants were randomized into W (water-based + land;n = 17) or L (land only;n = 15) exercise groups. Both groups attended therapy two times per week for six weeks. Initial and progression protocols for the water-based exercises (a combination of balance, stretching, and strengthening and endurance training) and land therapy (balance, strength, transfer, gait, and stair training) were devised. Outcomes included the Berg Balance Score, Community Balance and Mobility Score, Timed Up and Go Test, and 2 Minute Walk Test. Results:Baseline characteristics of groups W and L were similar in age, side of stroke, time since stroke, and wait time between inpatient discharge and outpatient therapy on all four outcomes. Pooled change scores from all outcomes showed that significantly greater number of patients in the W-group showed improvement post-training compared to the L-group (p < 0.05). More patients in W-group showed change scores exceeding the published minimal detectable change scores. Discussion:A combination of water- and land-based exercises has potential for improving balance. The results of this study extend the work showing benefit of water-based exercise in chronic and less-impaired stroke groups to patients with sub-acute stroke. [ABSTRACT FROM PUBLISHER]

A fetus of Chinese descent presented with ultrasound features of anemia at 20 weeks’ gestation. Father had low a mean corpuscular volume (MCV) level. Multiplex gap-polymerase chain reaction (gap-PCR) excluded common α-thalassemia (α-thal) deletions and mutations and PCR sequencing of the α1- and α2-globin genes were negative. The fetus had a normal karyotype. Array comparative genomic hybridization (aCGH) showed a single copy loss of 189.87 kb in chromosome 11p15.4, involving the whole β-globin gene cluster, inherited from the father. Multiplex ligation-dependent probe amplification (MLPA) confirmed the deletion included the ε-globin gene, confirming the diagnosis of heterozygous (εγδβ)0-thalassemia [(εγδβ)0-thal], also inherited from the father. The fetus had a worsening anemic conditionin uteroand required a transfusion at 26 weeks’ gestation, raising the hemoglobin (Hb) level from 5.3 to 12.6g/dL. A cesarean-section was subsequently performed at 32 weeks’ gestation because of reduced fetal movements, and a 1650g baby girl with good Apgar scores was delivered. Hemoglobin at birth was 12.8g/dL, gradually dropping to 6.8 g/dL, requiring three neonatal transfusions. Her condition gradually stabilized after 2 months with Hb stable at 8.0 g/dL. Family screening by MLPA showed that the paternal grandmother carried the same deletion. The deletion in this case is distinct and is the reported first case. The deletion transmitted across three successive generations with great phenotypic variation. The final adult phenotype of (εγδβ)0-thal is usually mild, therefore, with accurate prenatal diagnosis this condition is salvageable byin uteroand early neonatal transfusions, preventing adverse pregnancy and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Hydrops fetalis is commonly due to Hb Bart’s (γ4) disease in South East Asia. Here, we report an unusual case of hydrops fetalis due to congenital dyserythropoietic anemia (CDA) associated with compound heterozygosity forKrüppel-like factor 1(KLF1) gene mutations. Fetal cardiomegaly was first detected on routine mid-trimester scan in a pregnant woman with normal mean corpuscular volume (MCV) and Rhesus positive status. The fetus subsequently developed hydrops fetalis, and cordocentesis showed severe fetal anemia with a hemoglobin (Hb) level of 3.4 g/dL. Common causes of fetal anemia including Hb Bart’s disease, parvovirus infection, and red cell antibodies were excluded. In view of the marked increase in erythroblasts at various stages of erythropoiesis, the diagnosis of CDA was suspected. We screened the couple for previously reportedKLF1gene mutations, showing that the mother was heterozygous for the c.525_526insCGGCGCC, p.Gly176Argfs*179 mutation, and her husband heterozygous for c.1012C>A, p.Pro338Thr mutation. The fetus was a compound heterozygote for these two KLF1 mutations. After counseling, repeated intrauterine transfusions were given at 27, 29, and 34 weeks’ gestation; the hydrops fetalis was resolved. The baby was delivered at 34 weeks’ gestation and required monthly blood transfusions but was otherwise thriving. Bone marrow aspiration at 10 months of age showed the features of ineffective erythropoiesis, compatible with CDA. In conclusion, hydrops fetalis can rarely be due to CDA associated with a compound heterozygous mutation forKLF1gene mutations, and be managed by repeated intrauterine transfusions. Our present report adds to the wide clinical spectrum of KLF1 mutations. [ABSTRACT FROM AUTHOR]

In this first Asian study, the decision outcomes (decision conflict, decision regret, and anxiety) of 262 pregnant women offered noninvasive prenatal test (NIPT) for high-risk Down screening results were assessed. Decision conflict was experienced by 3.5% and level of decisional regret low (mean score 15.7, 95%CI 13.2-18.3). All 13 cases of decisional regret were NIPT acceptors. Elevated anxiety was experienced by 55.9% at the time of decision making about NIPT and persistent in 30.3%. Insufficient knowledge about NIPT was associated with elevated anxiety at decision making (p = .011) and with decisional regret (p = .016). Decisional regret was associated with prolonged anxiety (p = .010). [ABSTRACT FROM AUTHOR]

We here report an unusual case of Hb Bart’s (γ4) disease. Thalassemia screening of a couple showed that the wife was an α0-thalassemia (α0-thal) carrier and her husband’s mean corpuscular volume (MCV) was normal. Chorionic villus sampling (CVS) was performed at 13 weeks’ gestation for positive Down syndrome screening and chromosomal study of the cultured CVS showed a normal karyotype. Ultrasound examination at 22 weeks’ gestation showed fetal cardiomegaly and raised middle cerebral artery peak systolic velocity. Cordocentesis confirmed fetal anemia and showed Hb Bart’s disease. Multiplex gap-polymerase chain reaction (gap-PCR) for α-thal deletions on DNA extracted from the CVS showed the presence of a homozygous α0-thal − −SEA(Southeast Asian) deletion. The husband was found to be a carrier of the α+-thal −α3.7(rightward) deletion. Non paternity was excluded by fluorescent PCR using short tandem repeat (STR) markers on chromosomes 13, 18 and 21. Ade novoterminal deletion of chromosome 16 was excluded by array comparative genomic hybridization (aCGH). Detection of uniparental disomy (UPD), using STR markers on chromosome 16 showed maternal uniparental isodisomy from 16pter to 16p13.2, and uniparental heterodisomy from 16p13.13 to 16qter. [ABSTRACT FROM PUBLISHER]

Cetuximab (Erbitux) and panitumumab (Vectibix) are monoclonal antibodies to the EGFR. They are used as monotherapy or in combination with cytotoxic chemotherapy and increase both progression-free survival and overall survival in patients with wild-type RAS metastatic colorectal cancer. The most common side effects of therapy are dermatological, including skin (acneiform) rash, pruritus and hair changes. Despite their clinical activity, cost-effectiveness of the two drugs should be addressed in a discussion of their usage in everyday care. This study provides an up-to-date review of the clinical efficacy and cost-effectiveness of anti-EGFR inhibitors. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 36-year-old woman who was in her first pregnancy. The patient was found to have high concentration of chromosome 6 using a maternal plasma foetal DNA test. A caesarean section was also performed at 34 weeks due to the suboptimal foetal growth with oligohydramnios.

Current practice guidelines are unclear regarding the role of secondary prophylaxis of febrile neutropenia in advanced-stage Hodgkin lymphoma despite several small retrospective studies that demonstrate the omission of growth factors to be a safe and economic practice. We used a decision-analytic model to compare secondary prophylaxis with granulocyte colony-stimulating factor (G-CSF) to no G-CSF with the onset of severe neutropenia for a hypothetical cohort of patients with advanced-stage Hodgkin lymphoma treated with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). There was a net benefit of 0.017 years and 0.037 quality-adjusted life years for no G-CSF use in severe neutropenia. On microsimulation (10 000 trials), 96% of the simulations showed that the no G-CSF strategy is preferred to the use of G-CSF. This finding was robust across a wide range of sensitivity analyses. Our analysis suggests that G-CSF not be used as secondary prophylaxis of febrile neutropenia in advanced-stage Hodgkin lymphoma. [ABSTRACT FROM AUTHOR]

Background . Certain frequently used Chinese herbal medicines commonly used for weight control, may contain toxic Aristolochia species, which have been associated with severe nephropathy and urothelial cancer in humans and animals. The toxic entities in Aristolochia species are aristolochic acid-I (AA-I) and aristolochic acid-II (AA-II). There is a lack of systematic information about the aristolochic acid content of Aristolochia species and related genera, including those in Chinese materia medica that are used in the treatment of overweight individuals. Objectives . To determine the content of AA-I and AA-II of commonly used Chinese herbal medicines (raw herbs and manufactured products) including species of Aristolochia and related genera. Methods . Twenty-one raw herbs and seven manufactured herbal products were purchased from herbal wholesalers and traditional Chinese medicinal herb retailers in Melbourne, Australia in September 2003, after the supply of known aristolochic acid-containing herbs and products had been banned in Australia. Six additional raw herbs were sourced from a herbal teaching museum. These were purchased in 2001, before the prohibition. The contents of aristolochic acids of each was determined by high pressure liquid chromatography (HPLC), and confirmed by liquid chromatography–mass spectrometry (LC–MS). Results . Of the samples tested, four of the raw herbs purchased before the ban and two manufactured products purchased after the ban, were found to contain aristolochic acids (16–1002 ppm). Conclusions . Several Chinese raw herbs and some commercially available manufactured herbal products contain aristolochic acids. The confusion in Chinese nomenclature for related raw herbs, and imprecise labelling of manufactured products may contribute to the inadvertent use of toxic herbal species in Chinese medicine practice. Additional measures are needed to ensure the safety of consumers of Chinese herbal medicines. [ABSTRACT FROM AUTHOR]

The article focuses on the outcomes of women choosing extended non-invasive prenatal testing (NIPT). Topics discussed include women from five public hospitals across Hong Kong aged 18 year carrying a singleton pregnancy found to be at increased risk of Down's syndrome; mentions a conventional screening combined a first-trimester maternal biochemistry with a foetal nuchal translucency; and also mentions eligible women opting for NIPT chose one type of report and filled in a questionnaire.

A low level of PAPP-A predicts adverse fetal outcomes. As Chinese pregnant women have a higher level of PAPP-A, the predictive performance of PAPP-A and its optimal cutoff value might be different. This study aims to establish a PAPP-A cutoff value in the Chinese population that identifies adverse fetal outcomes. We retrospectively analysed 4936 spontaneous singleton pregnancies of Chinese women who underwent first-trimester combined Down’s screening in our unit from March 2010 to January 2014 and had delivery information available. A composite adverse fetal outcome encompassed intrauterine fetal loss (including miscarriages and stillbirths), and live births either before 32 weeks or weighing less than −2 standard deviation (SD) for gestation. The area under the curve of the receiver-operator characteristic curve for prediction of the composite adverse outcome using PAPP-A was 0.626 (95% CI =0.612–0.640,p < 0.0001). PAPP-A ≤ 0.23 multiples of median (MoM) identified 0.6% of Chinese pregnant women to be at significant risk of adverse fetal outcome (positive likelihood ratio 11.2, positive predictive value 21.4%) despite a low sensitivity (5.1%, 95% CI =1.9–10.8). The negative predictive value was high (97.7%). The commonly used cutoff of 0.4 MoM was associated with a positive likelihood ratio of 3.7 only. A prospective study is warranted. [ABSTRACT FROM PUBLISHER]