Blood transfusion during liver cancer surgery associated with increased risk of cancer recurrence

Agencies
June 3, 2019

Jun 3: In a study, researchers have claimed that receiving blood transfusion during liver cancer surgery (hepatocellular carcinoma) increases the risk of cancer recurrence and dying prematurely.

The risk was markedly increased even when only a small amount of blood was transfused, researchers said.

The study is being presented at the 'European Society of Anaesthesiology' in Vienna, Austria (1-3 June).

Findings showed that transfusion of one to four units of blood increased the risk of cancer recurrence by 23 per cent and death by 55 per cent compared to matched controls.

"Our findings from a large cohort highlighted a significant association between red blood cell transfusions and the risk of cancer recurrence as well as a dose-response relationship between the number of transfusions and death after curative surgery for liver cancer," said Dr Ying-Hsuan Tai from Taipei Medical University Shuang Ho Hospital in Taiwan who led the research.

"The reason why blood transfusions substantially worsen cancer prognosis remains unclear, but it is likely to be related to the suppressive effects on the immune system," Dr Tai added.

Hepatocellular carcinoma (HCC) is the fifth most common form of cancer worldwide and the third most common cause of cancer-related deaths. It occurs frequently in people with cirrhosis (scarring of the liver) due to previous damage from hepatitis B or C virus, or long-term alcohol abuse. Surgery to remove cancer and a margin of healthy tissue that surrounds it (resection) is a curative treatment for people with early-stage liver cancers who have a normal liver function.

In this study, Tai and colleagues investigated the effect of perioperative blood transfusion on cancer prognosis following HCC resection in 1,469 patients without lymph node involvement or metastasis undergoing surgery between 2005 and 2016.

Researchers assessed postoperative disease-free survival and overall survival up to September 2018. Using statistical modelling (a technique called the inverse probability of treatment weighting) they were able to match patients who had equivalent age and health conditions when comparing their outcomes.

Almost one in three patients (30 per cent; 447 patients) received one to four units of allogeneic (from another individual) blood during or within seven days of surgery, while more than one in 10 (12 per cent; 179 patients) were given more than four units.

During a median 45 month follow-up, analyses showed that cancer was 23 per cent more likely to recur in patients who received a transfusion (1-4 units) compared to those not given a transfusion.

While those who received more than four units faced an 18 per cent greater risk of recurrence compared with those who received none.

Compared to those not given a transfusion, patients given 1-4 units of blood were 55 per cent more likely to die from any cause, while those receiving four or more units had almost double the risk of death.

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Agencies
May 10,2020

Washington D.C., May 9: Do the middle age feel much stressful now, and seems to have changed over time, if compared to the life in the 90s? Well, this recent study indicates that it might be true.

The study has signalled to the fact that life may become more stressful majorly for middle-aged people than it was in the 1990s. The researchers reached this analysis even before the novel coronavirus started sweeping the globe.

A team of researchers led by Penn State found that across all ages, there was a slight increase in daily stress in the 2010s compared to the 1990s. But when researchers restricted the sample to people between the ages of 45 and 64, there was a sharp increase in daily stress.

"On average, people reported about 2 percent more stressors in the 2010s compared to people in the past," said David M. Almeida, professor of human development and family studies at Penn State.

"That's around an additional week of stress a year. But what really surprised us is that people at mid-life reported a lot more stressors, about 19 percent more stress in 2010 than in 1990. And that translates to 64 more days of stress a year."

Almeida said the findings were part of a larger project aiming to discover whether health during the middle of Americans' lives has been changing over time.

"Certainly, when you talk to people, they seem to think that daily life is more hectic and less certain these days," Almeida said.

For the study, the researchers collected data from 1,499 adults in 1995 and 782 different adults in 2012.

Almeida said the goal was to study two cohorts of people who were the same age at the time the data was collected but born in different decades. All study participants were interviewed daily for eight consecutive days.

During each daily interview, the researchers asked the participants about their stressful experiences throughout the previous 24 hours.

They asked questions related to arguments with family or friends or feeling overwhelmed at home or work, so and so. The participants were also asked how severe their stress was and whether those stressors were likely to impact other areas of their lives.

"We were able to estimate not only how frequently people experienced stress, but also what those stressors mean to them," Almeida said.

"For example, did this stress affect their finances or their plans for the future. And by having these two cohorts of people, we were able to compare daily stress processes in 1990 with daily stress processes in 2010," Almeida added.

After analyzing the data, the researchers found that participants reported significantly more daily stress and lower well-being in the 2010s compared to the 1990s.

Additionally, participants reported a 27 percent increase in the belief that stress would affect their finances and a 17 percent increase in the belief that stress would affect their future plans.

Almeida said he was surprised not that people were more stressed now than in the 90s, but at the age group that was mainly affected.

"We thought that with economic uncertainty, life might be more stressful for younger adults. But we didn't see that. We saw more stress for people at mid-life," Almeida said.

"And maybe that's because they have children who are facing an uncertain job market while also responsible for their own parents. So it's this generational squeeze that's making stress more prevalent for people at mid-life," he concluded.

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News Network
March 6,2020

Mar 6: The spread of the new coronavirus is shining the spotlight on a little-discussed gender split: men wash their hands after using the bathroom less than women, years of research and on-the-ground observations show.

Health officials around the world advise that deliberate, regular handwashing is one of the best weapons against the virus which causes a flu-like respiratory illness that can kill and has spread to around 80 countries.

The Centers for Disease Control and Prevention's online fact sheet "Handwashing: A corporate activity," cites a 2009 study that finds "only 31% of men and 65% of women washed their hands" after using a public restroom.

Social media comments about men's handwashing lapses forced an august British institution to caution visitors about bathroom behaviour this week.

After author Sathnam Sanghera complained on Twitter about "grown," "educated" men in the British Library toilets not washing their hands, the library responded, putting up additional signs reminding patrons to wash their hands in men's and women's bathrooms.

Thanks to "visitor feedback," a spokesman told Reuters, "we have increased further the number of posters in public toilets so that visitors are reminded of the importance of good hygiene at exactly the point where they can wash their hands."

Men and women approach handwashing after using the restroom differently, according to multiple surveys and field studies.

"Women wash their hands significantly more often, use soap more often, and wash their hands somewhat longer than men," according to a 2013 Michigan State University field study conducted by research assistants who observed nearly 4,000 people in restrooms around East Lansing, Michigan.

The study found 14.6% of men did not wash their hands at all after using the bathroom and 35.1% wet their hands but did not use soap, compared to 7.1% and 15.1% of women, respectively.

"If you stand in the men's bathroom at work, and watch men leave, they mostly don't wash their hands if they used the urinal," said one New York City public relations executive, who did not want to be identified for fear of alienating his colleagues.

Since the virus's spread, he's seen an uptick in men's handwashing at work, he noted. "I, for the record, do wash my hands all the time," he added.

Female medical staff in critical care units "washed their hands significantly more often than did their male counterparts after patient contact," a 2001 study published in the American Journal of Infection Control found.

Middle-aged women with some college education had the highest level of knowledge about hand hygiene, a survey published in 2019 by BMC Public Health, an open access public health journal, found.

Early information about coronavirus infection in China shows that men may be more susceptible to the disease. Just over 58% of the more than 1,000 COVID-19 patients reported in China through Jan. 29, 2020, were male, research published in the New England Journal of Medicine shows.

Researchers have not linked the difference to hand hygiene.

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Agencies
June 10,2020

Early treatment with the antiviral drug remdesivir has been found to reduce viral load and prevent lung disease in macaques infected with SARS-CoV-2 that causes COVID-19, according to a study.

The findings, published in the journal Nature on Tuesday, support the early use of remdesivir treatment in patients with COVID-19 to prevent progression to pneumonia.

Researchers from the National Institutes of Health in the US noted that remdesivir has broad antiviral activity and has been shown to be effective against infections with SARS-CoV and MERS-CoV in animal models.

The drug is being tested in human clinical trials for the treatment of COVID-19, they said.

Researcher Emmie de Wit and colleagues investigated the effects of remdesivir treatment in rhesus macaques, a recently established model of SARS-CoV-2 infection.

Two sets of six macaques were inoculated with SARS-CoV-2.

One group was treated with remdesivir 12 hours later -- close to the peak of virus reproduction in the lungs -- and these macaques received treatment every 24 hours until six days after inoculation.

In contrast to the control group, the researchers found that macaques that received remdesivir did not show signs of respiratory disease, and had reduced damage to the lungs.

Viral loads in the lower respiratory tract were also reduced in the treated animals; viral levels were around 100 times lower in the lower-respiratory tract of remdesivir-treated macaques 12 hours after the first dose, they said.

The researchers said that infectious virus could no longer be detected in the treatment group three days after initial infection, but was still detectable in four out of six control animals.

Despite this virus reduction in the lower respiratory tract, no reduction in virus shedding was observed, which indicates that clinical improvement may not equate to a lack of infectiousness, they said.

Dosing of remdesivir in the rhesus macaques is equivalent to that used in humans, the researchers noted.

They cautioned that it is difficult to directly translate the timing of treatment used in corresponding disease stages in humans, because rhesus macaques normally develop only mild disease.

However, researchers said the results indicate that remdesivir treatment of COVID-19 should be initiated as early as possible to achieve the maximum treatment effect.

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