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Fulltext Nifedipine maintenance tocolysis and perinatal outcome: an individual participant data meta-analysis

van Vliet E, Dijkema GH, Schuit E, Heida KY, Roos C, van der Post J, et al.

BJOG, 2016 Oct;123(11):1753-60.
PMID: 27550838 DOI: 10.1111/1471-0528.14249

BACKGROUND: Preterm birth is the leading cause of neonatal mortality and morbidity in developed countries. Whether continued tocolysis after 48 hours of rescue tocolysis improves neonatal outcome is unproven.
OBJECTIVES: To evaluate the effectiveness of maintenance tocolytic therapy with oral nifedipine on the reduction of adverse neonatal outcomes and the prolongation of pregnancy by performing an individual patient data meta-analysis (IPDMA).
SEARCH STRATEGY: We searched PubMed, Embase, and Cochrane databases for randomised controlled trials of maintenance tocolysis therapy with nifedipine in preterm labour.
SELECTION CRITERIA: We selected trials including pregnant women between 24 and 36(6/7) weeks of gestation (gestational age, GA) with imminent preterm labour who had not delivered after 48 hours of initial tocolysis, and compared maintenance nifedipine tocolysis with placebo/no treatment.
DATA COLLECTION AND ANALYSIS: The primary outcome was perinatal mortality. Secondary outcome measures were intraventricular haemorrhage (IVH), necrotising enterocolitis (NEC), infant respiratory distress syndrome (IRDS), prolongation of pregnancy, GA at delivery, birthweight, neonatal intensive care unit admission, and number of days on ventilation support. Pre-specified subgroup analyses were performed.
MAIN RESULTS: Six randomised controlled trials were included in this IPDMA, encompassing data from 787 patients (n = 390 for nifedipine; n = 397 for placebo/no treatment). There was no difference between the groups for the incidence of perinatal death (risk ratio, RR 1.36; 95% confidence interval, 95% CI 0.35-5.33), intraventricular haemorrhage (IVH) ≥ grade II (RR 0.65; 95% CI 0.16-2.67), necrotising enterocolitis (NEC) (RR 1.15; 95% CI 0.50-2.65), infant respiratory distress syndrome (IRDS) (RR 0.98; 95% CI 0.51-1.85), and prolongation of pregnancy (hazard ratio, HR 0.74; 95% CI 0.55-1.01).
CONCLUSION: Maintenance tocolysis is not associated with improved perinatal outcome and is therefore not recommended for routine practice.
TWEETABLE ABSTRACT: Nifedipine maintenance tocolysis is not associated with improved perinatal outcome or pregnancy prolongation.

Matched MeSH terms: Infant, Newborn, Diseases/mortality; Premature Birth/mortality; Perinatal Mortality
The association between the behavior rating inventory of executive functioning and cognitive testing in children diagnosed with a brain tumor

de Vries M, de Ruiter MA, Oostrom KJ, Schouten-Van Meeteren AYN, Maurice-Stam H, Oosterlaan J, et al.

Child Neuropsychol, 2018 08;24(6):844-858.
PMID: 28693404 DOI: 10.1080/09297049.2017.1350262

Pediatric brain tumor survivors (PBTS) suffer from cognitive late effects, such as deteriorating executive functioning (EF). We explored the suitability of the Behavior Rating Inventory of Executive Function (BRIEF) to screen for these late effects. We assessed the relationship between the BRIEF and EF tasks, and between the BRIEF-Parent and BRIEF-Teacher, and we explored the clinical utility. Eighty-two PBTS (8-18 years) were assessed with EF tasks measuring attention, cognitive flexibility, inhibition, visual-, and working memory (WM), and with the BRIEF-Parent and BRIEF-Teacher. Pearson's correlations between the BRIEF and EF tasks, and between the BRIEF-Parent and BRIEF-Teacher were calculated. The BRIEF-Parent related poorly to EF tasks (rs < .26, ps > .01), but of the BRIEF-Teacher the WM-scale, Monitor-scale, Behavioral-Regulation-Index, and Meta-cognition-Index, and Total-score (rs > .31, ps < .01) related significantly to some EF tasks. When controlling for age, only the WM scale and Total score related significantly to the attention task (ps < .01). The inhibit scales of the BRIEF-Parent and BRIEF-Teacher correlated significantly (r = .33, p < .01). Children with clinically elevated scores on BRIEF scales that correlated with EF tasks performed worse on all EF tasks (ds 0.56-1.23, ps < .05). The BRIEF-Teacher Total and Index scores might better screen general EF in PBTS than the BRIEF-Parent. However, the BRIEF-Teacher is also not specific enough to capture separate EFs. Solely relying on the BRIEF as a screening measure of EFs in BPTS is insufficient. Questionnaires and tasks give distinctive, valuable information.

Matched MeSH terms: Brain Neoplasms/mortality
Association of nut intake with risk factors, cardiovascular disease, and mortality in 16 countries from 5 continents: analysis from the Prospective Urban and Rural Epidemiology (PURE) study

de Souza RJ, Dehghan M, Mente A, Bangdiwala SI, Ahmed SH, Alhabib KF, et al.

Am J Clin Nutr, 2020 07 01;112(1):208-219.
PMID: 32433740 DOI: 10.1093/ajcn/nqaa108

BACKGROUND: The association of nuts with cardiovascular disease and deaths has been investigated mostly in Europe, the USA, and East Asia, with few data available from other regions of the world or from low- and middle-income countries.
OBJECTIVE: To assess the association of nuts with mortality and cardiovascular disease (CVD).
METHODS: The Prospective Urban Rural Epidemiology study is a large multinational prospective cohort study of adults aged 35-70 y from 16 low-, middle-, and high-income countries on 5 continents. Nut intake (tree nuts and ground nuts) was measured at the baseline visit, using country-specific validated FFQs. The primary outcome was a composite of mortality or major cardiovascular event [nonfatal myocardial infarction (MI), stroke, or heart failure].
RESULTS: We followed 124,329 participants (age = 50.7 y, SD = 10.2; 41.5% male) for a median of 9.5 y. We recorded 10,928 composite events [deaths (n = 8,662) or major cardiovascular events (n = 5,979)]. Higher nut intake (>120 g per wk compared with <30 g per mo) was associated with a lower risk of the primary composite outcome of mortality or major cardiovascular event [multivariate HR (mvHR): 0.88; 95% CI: 0.80, 0.96; P-trend = 0.0048]. Significant reductions in total (mvHR: 0.77; 95% CI: 0.69, 0.87; P-trend <0.0001), cardiovascular (mvHR: 0.72; 95% CI: 0.56, 0.92; P-trend = 0.048), and noncardiovascular mortality (mvHR: 0.82; 95% CI: 0.70, 0.96; P-trend = 0.0046) with a trend to reduced cancer mortality (mvHR: 0.81; 95% CI: 0.65, 1.00; P-trend = 0.081) were observed. No significant associations of nuts were seen with major CVD (mvHR: 0.91; 95% CI: 0.81, 1.02; P-trend = 0.14), stroke (mvHR: 0.98; 95% CI: 0.84, 1.14; P-trend = 0.76), or MI (mvHR: 0.86; 95% CI: 0.72, 1.04; P-trend = 0.29).
CONCLUSIONS: Higher nut intake was associated with lower mortality risk from both cardiovascular and noncardiovascular causes in low-, middle-, and high-income countries.

Matched MeSH terms: Cardiovascular Diseases/mortality*
Differences in late cardiovascular mortality following acute myocardial infarction in three major Asian ethnic groups

de Carvalho LP, Gao F, Chen Q, Hartman M, Sim LL, Koh TH, et al.

Eur Heart J Acute Cardiovasc Care, 2014 Dec;3(4):354-62.
PMID: 24598820 DOI: 10.1177/2048872614527007

the purpose of this study was to investigate differences in long-term mortality following acute myocardial infarction (AMI) in patients from three major ethnicities of Asia.

Matched MeSH terms: Cardiovascular Diseases/mortality; Myocardial Infarction/mortality; Hospital Mortality
Changes of perinatal statistics in a semiurban setup between two time periods in Malaysia

al-Mohdzar SA, Haque E, Abdullah WA

Asia Oceania J Obstet Gynaecol, 1993 Dec;19(4):401-5.
PMID: 8135673

Hospital University Sains Malaysia (HUSM) functions as the state referral centre and the only hospital for the state of Kelantan that can offer neonatal intensive care service. The deliveries in HUSM with grand multiparity, late booking and problems of late referrals resembles a hospital serving a semiurban rather than an urban community. A comparison between the year 1989 and 1991 showed marked improvement of perinatal mortality rate from 41.32 to 24.88, which is significantly better than the improvement achieved from 1987 to 1989 (46.0 to 41.32). This was possible due to a marked fall in the early neonatal mortality rate from 10.02 in 1989 to 5.45 in 1991 and fall in the stillbirth rate from 31.61 to 19.53.

Matched MeSH terms: Infant Mortality/trends*
Fulltext An overview of atypical bacterial in congenital pneumonia

Zurina Zainuddin, Zainab Jumai Kassim, Siti Norbaya Masri, Putri Yubbu, Norlijah Othman, Zainab Jumai Kassim

Malaysian Journal of Paediatrics and Child Health, 2018;24(2):1-13.
MyJurnal

Congenital pneumonia is one of the common causes of respiratory distress at birth with significant morbidity and mortality in infants. Estimates show that neonatal pneumonia including congenital pneumonia contributes to between 750 000 and 1.2 million neonatal deaths every year which accounts for 10% global child mortality. Etiological agents are many and vary but atypical bacterial causes are few. The commonest cause for atypical bacteria is Ureaplasma urealyticum. Congenital pneumonia is often clinically difficult to diagnose owing to poor specificity of clinical signs, with similarities in radiologic presentation with other respiratory conditions of the newborn. Isolation of causative organism (s) by culture from nasopharyngeal aspirates or tracheal aspirates obtained within 8 hours of life is the gold standard of its diagnosis. However, this technique is elaborate and time consuming in identifying atypical bacteria. Development of a more sensitive modality such as polymerase chain reaction (PCR) has dramatically altered the microbiological diagnosis of congenital pneumonia.

Matched MeSH terms: Child Mortality
Motorcycle-related spinal injury: crash characteristics

Zulkipli ZH, Abdul Rahmat AM, Mohd Faudzi SA, Paiman NF, Wong SV, Hassan A

Accid Anal Prev, 2012 Nov;49:237-44.
PMID: 23036400 DOI: 10.1016/j.aap.2011.12.011

This study presents an analysis of crash characteristics of motorcyclists who sustained spinal injuries in motorcycle crashes. The aim of the study is to identify the salient crash characteristics that would help explain spinal injury risks for motorcyclists. Data were retrospectively collected from police case reports that were archived at MIROS from year 2005 to 2007. The data were categorized into two subcategories; the first group was motorcycle crashes with spinal injury (case) and the second group was motorcycle crashes without spinal injury (control). A total of 363 motorcyclists with spinal injury and 873 motorcyclists without spinal injury were identified and analyzed. Descriptive analysis and multivariate analysis were performed in order to determine the odds of each characteristic in contributing to spinal injury. Single vehicle crash, collision with fixed objects and crash configuration were found to have significant influence on motorcyclists in sustaining spinal injury (p<0.05). Although relatively few than other impact configurations, the rear-end impacted motorcyclist shows the highest risk of spinal injury. Helmets have helped to reduce head injury but they did not seem to offer corresponding protection for the spine in the study. With a growing number of young motorcyclists, further efforts are needed to find effective measures to help reduce the crash incidents and severity of spinal injury. In sum, the study provides some insights on some vital crash characteristics associated with spinal injury that can be further investigated to determine the appropriate counter-measures and prevention strategies to reduce spinal injury.

Matched MeSH terms: Accidents, Traffic/mortality; Spinal Cord Injuries/mortality; Spinal Injuries/mortality
Maternal and child health in urban Sabah, Malaysia: a comparison of citizens and migrants

Zulkifli SN, U KM, Yusof K, Lin WY

Asia Pac J Public Health, 1994;7(3):151-8.
PMID: 7794653 DOI: 10.1177/101053959400700302

This paper describes selected maternal and child health indicators based on a cross-sectional study of citizens and migrants in Sabah, Malaysia. A total of 1,515 women were interviewed from a multi-stage random sample of households in eight urban centers. Among the 1,411 women in the sample who had experienced a pregnancy before, 76% were local citizens and 24% were migrants. There were statistically significant differences between citizens and migrants in ethnicity, religion, education, household income, and access to treated water supply and sanitary toilet facilities. Significantly fewer migrants practiced any form of contraception and obtained any antenatal care during any pregnancy. Furthermore, citizens tended to initiate care as early as three months but migrants as late as seven months. Despite these differences, only the infant mortality rate, and not pregnancy wastage, was statistically significantly higher among migrants. Pregnancy interval was also similar between the two groups. The influence of several socioeconomic factors on pregnancy wastage and infant mortality was explored.

Matched MeSH terms: Infant Mortality*
Fulltext Population 70 million: a consideration of health aspects

Zulkifli SN, Yusof K

Med J Malaysia, 1985 Jun;40(2):62-79.
PMID: 3834289

A 70 million population for Malaysia by the year 2010 has been officially targetted for in the Mid-Term Review of the Fourth Malaysia Plan, 1981-1985. In response to this, a preliminary investigation was undertaken into the health aspects of population growth. For this exercise, infant mortality rate was used as the health indicator. From trends seen vis-a-vis population growth, it appears that thus far, population growth has not been associated negatively with health (as measured by IMR). In recognition of the relevance of the medical, economic and education factors to health, trends in Malaysia's population ratio, per capita GNP and rates of school enrolment were also drawn; the selection of these as proxies being based on completeness of time-serial records. Although statistical regressions established the high correlation between medical doctors.population ratio and school enrolment rate with IMR, the limitations in this analysis did not permit any reliable inferences. In view of the difficulties in projections of trends, a comparison of health and related variables was carried out for several countries with high populations as near to 70 million as were available. The characteristics associated with low mortality and high life expectancy (health indices) were identified as low population growth, high literacy and high per capita GNP; this being stated with explicit qualifications. Other determinants of health were also discussed in brief, and the need for careful planning in the distribution of human and material resources was noted.

Matched MeSH terms: Mortality
Fulltext Perinatal mortality: selected data from a survey

Zulkifli SN, Yusof K

Med J Malaysia, 1986 Dec;41(4):292-9.
PMID: 3670150

This paper describes the findings of a survey on perinatal cases in Kuala Lumpur. Information on the deceased infants and their deliveries were documented as well as selected social, demographic and anthropometric data on the mothers. This includes quality of the home environment in terms of presence of basic amenities. It was evident that the lower classes were better represented in the sample.
This paper also highlights a major problem in retrospective studies, that of successfully tracing eligible respondents. There were also cases of non-cooperation. Another problem which emerged, and one common to many developing countries, was the incompleteness of birth weight records.

Matched MeSH terms: Infant Mortality*
Fulltext TIOtropium Safety and Performance In Respimat® (TIOSPIRTM ): Analysis of Asian cohort of COPD patients

Zhong N, Moon HS, Lee KH, Mahayiddin AA, Boonsawat W, Isidro MG, et al.

Respirology, 2016 Nov;21(8):1397-1403.
PMID: 27490162 DOI: 10.1111/resp.12856

BACKGROUND AND OBJECTIVE: The TIOtropium Safety and Performance In Respimat (TIOSPIR) trial showed similar safety and exacerbation efficacy profiles for tiotropium Respimat and HandiHaler in patients with COPD. The TIOSPIR results for patients in Asia are presented here.
METHODS: TIOSPIR evaluated once-daily tiotropium Respimat 5 and 2.5 µg with HandiHaler 18 µg in patients with COPD. Primary endpoints included time to death and time to first COPD exacerbation. Safety and exacerbation efficacy profiles were determined for the Asian region, and for Asia (all treatment arms pooled) versus the rest of the world (RoW).
RESULTS: In Asia (n = 2356), time to death was similar for Respimat 5 and 2.5 µg versus HandiHaler 18 µg (hazard ratio (HR) (95% CI): 0.96 (0.67, 1.38) and 1.23 (0.87, 1.73)). Risk of COPD exacerbation was similar for Respimat 5 µg, but increased for 2.5 µg versus HandiHaler 18 µg (HR (95% CI): 0.99 (0.85, 1.15) and 1.17 (1.00, 1.35)). Time to death in Asia and RoW was similar (HR (95% CI): 1.15 (0.99, 1.35)). Time to first COPD exacerbation was longer (HR (95% CI): 0.84 (0.78, 0.89)) and exacerbation rates were lower in Asia, but severe exacerbations were more frequent than in the RoW. Risk of major adverse cardiovascular events was similar for both regions.
CONCLUSION: Similar safety and exacerbation efficacy profiles were observed for tiotropium Respimat 5 µg and HandiHaler 18 µg in patients with COPD from Asia, analogous to the global analysis. Asian patients had lower risk of, and fewer exacerbations overall, but a higher proportion of severe exacerbations than in the RoW.

Matched MeSH terms: Mortality
Fulltext Nutritional characteristics and clinical outcomes of critically ill patients with and without diabetes mellitus: a single-center prospective observational study in Malaysia

Zheng-Yii Lee, Ibrahim Noor Airini, Osama Hamdy, Mohd-Yusof Barakatun-Nisak

Malaysian Journal of Medicine and Health Sciences, 2020;16(106):116-121.
MyJurnal

Introduction: This study aimed to compare the nutritional characteristics and clinical outcomes among critically ill patients with diabetes (DM) and without diabetes (WDM). Methods: Mechanically ventilated, critically ill patients who were admitted into the intensive care unit (ICU) within 48 hours and remained in ICU 72 hours were prospec- tively recruited and followed for up to 12 days. They were stratified to DM or WDM, depending on their diabetes status at ICU admission and comparison were made for nutritional characteristics and clinical outcomes including 60-day mortality. Results: A total of 154 patients were included with 73 (47.4%) DM patients. In comparison to WDM, patients with DM were older, more severely ill, had higher nutritional risk and body mass index, presented with a higher blood glucose level, and required more insulin. DM was fed relatively earlier but had lower energy adequacy. They experienced more frequent EN interruption. Both groups had comparable ICU and hospital stay, ventilation support duration and mortality. In multivariable logistic regression, no association was found between diabetes status and for ICU and hospital mortality. However, There was a trend towards an increase in 60-day mor- tality in DM patients (Odds Ratio: 2.220, 95% Confidence Interval: 0.764-6.452; p=0.143). Conclusion: Critically ill patients with DM had higher nutritional risks, were fed relatively earlier, but with frequent EN interruption leading to lower energy adequacy than patients WDM. Diabetes status does not affect clinical outcomes.

Matched MeSH terms: Hospital Mortality
Thyroid hormones and mortality risk in euthyroid individuals: the Kangbuk Samsung health study

Zhang Y, Chang Y, Ryu S, Cho J, Lee WY, Rhee EJ, et al.

J Clin Endocrinol Metab, 2014 Jul;99(7):2467-76.
PMID: 24708095 DOI: 10.1210/jc.2013-3832

CONTEXT: Hyperthyroidism and hypothyroidism, both overt and subclinical, are associated with all-cause and cardiovascular mortality. The association between thyroid hormones and mortality in euthyroid individuals, however, is unclear.
OBJECTIVE: To examine the prospective association between thyroid hormones levels within normal ranges and mortality endpoints.
SETTING AND DESIGN: A prospective cohort study of 212 456 middle-aged South Korean men and women who had normal thyroid hormone levels and no history of thyroid disease at baseline from January 1, 2002 to December 31, 2009. Free T4 (FT4), free T3 (FT3), and TSH levels were measured by RIA. Vital status and cause of death ascertainment were based on linkage to the National Death Index death certificate records.
RESULTS: After a median follow-up of 4.3 years, 730 participants died (335 deaths from cancer and 112 cardiovascular-related deaths). FT4 was inversely associated with all-cause mortality (HR = 0.77, 95% confidence interval 0.63-0.95, comparing the highest vs lowest quartile of FT4; P for linear trend = .01), and FT3 was inversely associated cancer mortality (HR = 0.62, 95% confidence interval 0.45-0.85; P for linear trend = .001). TSH was not associated with mortality endpoints.
CONCLUSIONS: In a large cohort of euthyroid men and women, FT4 and FT3 levels within the normal range were inversely associated with the risk of all-cause mortality and cancer mortality, particularly liver cancer mortality.

Matched MeSH terms: Mortality*; Neoplasms/mortality
Fulltext Comprehensive genomic and immunological characterization of Chinese non-small cell lung cancer patients

Zhang XC, Wang J, Shao GG, Wang Q, Qu X, Wang B, et al.

Nat Commun, 2019 04 16;10(1):1772.
PMID: 30992440 DOI: 10.1038/s41467-019-09762-1

Deep understanding of the genomic and immunological differences between Chinese and Western lung cancer patients is of great importance for target therapy selection and development for Chinese patients. Here we report an extensive molecular and immune profiling study of 245 Chinese patients with non-small cell lung cancer. Tumor-infiltrating lymphocyte estimated using immune cell signatures is found to be significantly higher in adenocarcinoma (ADC, 72.5%) compared with squamous cell carcinoma (SQCC, 54.4%). The correlation of genomic alterations with immune signatures reveals that low immune infiltration was associated with EGFR mutations in ADC samples, PI3K and/or WNT pathway activation in SQCC. While KRAS mutations are found to be significantly associated with T cell infiltration in ADC samples. The SQCC patients with high antigen presentation machinery and cytotoxic T cell signature scores are found to have a prolonged overall survival time.

Matched MeSH terms: Carcinoma, Non-Small-Cell Lung/mortality; Carcinoma, Squamous Cell/mortality
A randomized controlled trial of levosimendan to reduce mortality in high-risk cardiac surgery patients (CHEETAH): Rationale and design

Zangrillo A, Alvaro G, Pisano A, Guarracino F, Lobreglio R, Bradic N, et al.

Am Heart J, 2016 Jul;177:66-73.
PMID: 27297851 DOI: 10.1016/j.ahj.2016.03.021

OBJECTIVE: Patients undergoing cardiac surgery are at risk of perioperative low cardiac output syndrome due to postoperative myocardial dysfunction. Myocardial dysfunction in patients undergoing cardiac surgery is a potential indication for the use of levosimendan, a calcium sensitizer with 3 beneficial cardiovascular effects (inotropic, vasodilatory, and anti-inflammatory), which appears effective in improving clinically relevant outcomes.
DESIGN: Double-blind, placebo-controlled, multicenter randomized trial.
SETTING: Tertiary care hospitals.
INTERVENTIONS: Cardiac surgery patients (n = 1,000) with postoperative myocardial dysfunction (defined as patients with intraaortic balloon pump and/or high-dose standard inotropic support) will be randomized to receive a continuous infusion of either levosimendan (0.05-0.2 μg/[kg min]) or placebo for 24-48 hours.
MEASUREMENTS AND MAIN RESULTS: The primary end point will be 30-day mortality. Secondary end points will be mortality at 1 year, time on mechanical ventilation, acute kidney injury, decision to stop the study drug due to adverse events or to start open-label levosimendan, and length of intensive care unit and hospital stay. We will test the hypothesis that levosimendan reduces 30-day mortality in cardiac surgery patients with postoperative myocardial dysfunction.
CONCLUSIONS: This trial is planned to determine whether levosimendan could improve survival in patients with postoperative low cardiac output syndrome. The results of this double-blind, placebo-controlled randomized trial may provide important insights into the management of low cardiac output in cardiac surgery.

Matched MeSH terms: Cardiac Output, Low/mortality; Cardiac Surgical Procedures/mortality; Postoperative Complications/mortality
Four-protein signature accurately predicts lymph node metastasis and survival in oral squamous cell carcinoma

Zanaruddin SN, Saleh A, Yang YH, Hamid S, Mustafa WM, Khairul Bariah AA, et al.

Hum Pathol, 2013 Mar;44(3):417-26.
PMID: 23026198 DOI: 10.1016/j.humpath.2012.06.007

The presence of lymph node (LN) metastasis significantly affects the survival of patients with oral squamous cell carcinoma (OSCC). Successful detection and removal of positive LNs are crucial in the treatment of this disease. Current evaluation methods still have their limitations in detecting the presence of tumor cells in the LNs, where up to a third of clinically diagnosed metastasis-negative (N0) patients actually have metastasis-positive LNs in the neck. We developed a molecular signature in the primary tumor that could predict LN metastasis in OSCC. A total of 211 cores from 55 individuals were included in the study. Eleven proteins were evaluated using immunohistochemical analysis in a tissue microarray. Of the 11 biomarkers evaluated using receiver operating curve analysis, epidermal growth factor receptor (EGFR), v-erb-b2 erythroblastic leukemia viral oncogene homolog 2 (HER-2/neu), laminin, gamma 2 (LAMC2), and ras homolog family member C (RHOC) were found to be significantly associated with the presence of LN metastasis. Unsupervised hierarchical clustering-demonstrated expression patterns of these 4 proteins could be used to differentiate specimens that have positive LN metastasis from those that are negative for LN metastasis. Collectively, EGFR, HER-2/neu, LAMC2, and RHOC have a specificity of 87.5% and a sensitivity of 70%, with a prognostic accuracy of 83.4% for LN metastasis. We also demonstrated that the LN signature could independently predict disease-specific survival (P = .036). The 4-protein LN signature validated in an independent set of samples strongly suggests that it could reliably distinguish patients with LN metastasis from those who were metastasis-free and therefore could be a prognostic tool for the management of patients with OSCC.

Matched MeSH terms: Carcinoma, Squamous Cell/mortality; Mouth Neoplasms/mortality
A severe outbreak of orf involving the buccal cavity of goats

Zamri-Saad M, al-Ajeeli KS, Ibrahim AL

Trop Anim Health Prod, 1992 Aug;24(3):177-8.
PMID: 1304665
Matched MeSH terms: Ecthyma, Contagious/mortality; Goat Diseases/mortality
Definitive concurrent chemoradiotherapy in cervical cancer--a University of Malaya Medical Centre experience

Zamaniah WI, Mastura MY, Phua CE, Adlinda A, Marniza S, Rozita AM

Asian Pac J Cancer Prev, 2014;15(20):8987-92.
PMID: 25374241

BACKGROUND: The efficacy of concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer is well established. We aimed to investigate the long-term efficacy of definitive concurrent chemoradiotherapy for cervical cancer in the University of Malaya Medical Centre.
MATERIALS AND METHODS: A cohort of 60 patients with FIGO stage IB2-IVA cervical cancer who were treated with definitive concurrent chemoradiotherapy with cisplatin followed by intracavitary brachytherapy or external beam radiotherapy (EBRT) boost between November 2001 and May 2008 were analysed. Patients were initially treated with weekly intravenous cisplatin (40 mg/m2) concurrent with daily EBRT to pelvis of 45-50 Gy followed by low dose rate brachytherapy or EBRT boost to tumour. Local control rate, progression free survival, overall survival and treatment related toxicities graded by the RTOG criteria were evaluated.
RESULTS: The mean age was 56. At the median follow-up of 72 months, the estimated 5-year progression-free survival (PFS) (median PFS 39 months) and the 5-year overall survival (OS) (median OS 51 months) were 48% and 50% respectively. The 5-year local control rate was 67.3%. Grade 3-4 late gastrointestinal and genitourinary toxicity occurred in 9.3% of patients.
CONCLUSIONS: The 5-year PFS and the 5-year OS in this cohort were lower than in other institutions. More advanced stage at presentation, longer overall treatment time (OTT) of more than fifty-six days and lower total dose to point A were the potential factors contributing to a lower survival.

Matched MeSH terms: Uterine Cervical Neoplasms/mortality; Neoplasm Recurrence, Local/mortality
Fulltext Acute appendicitis in pregnancy: a diagnostic and management challenge

Zainur Rashid, Z., Sulaiha, S.A., Azmi, M.N.

International Medical Journal Malaysia, 2014;13(1):77-80.
MyJurnal

Acute appendicitis is the most common extra-uterine surgical emergency encountered during pregnancy, but an accurate diagnosis is still an enigma. Anatomical shifting of the appendix by the enlarging uterus makes the clinical and sonographic diagnosis difficult. Prompt diagnosis and treatment are essential to prevent perforation, which increases the risk of fetal and maternal death. Surgical intervention, either by an open laparotomy or laparoscopy is the most appropriate treatment for appendicitis. This article reviews the epidemiology, clinical diagnosis, investigation, complications and treatment of acute appendicitis in pregnancy.

Matched MeSH terms: Maternal Mortality
Suicide patterns in children and adolescents: a review from a pediatric institution in England

Zainum K, Cohen MC

Forensic Sci Med Pathol, 2017 Jun;13(2):115-122.
PMID: 28349246 DOI: 10.1007/s12024-017-9860-y

Suicide is a catastrophic event to both families and communities yet it is potentially preventable. This study aims to determine incidence and patterns of suicide in children and young adolescents in our region, raise awareness of this entity as a potentially preventable cause of death in this age group, and identify its possible associated risk factors. We retrospectively reviewed suicide cases presenting as sudden unexpected death in children and adolescents that underwent coronial post-mortems at our institution. This is the largest pathological review of completed suicide in children and young adolescents within a single institution in the United Kingdom. We identified 23 suicide cases during a 12 year period from 2003 to 2015, in which 18 cases (78%) were male and 5 cases (22%) were female. The age range was from 8 to 16 years (mean age 12.82 +/- 2.52 SD). With the exception of one case, all of the victims were Caucasian. The majority, 19 cases (81%), were found dead inside their place of residence, 15 of whom were discovered in their own bedrooms. Twenty-one cases (91%) died from neck compression due to hanging; 6 cases (26%) had used the cord of a dressing gown and 5 (22%) opted to use a belt as the ligature. Two cases (9%) that died from multiple-drug toxicity were female. In 7 cases (30.5%) there was evidence of self-harm and in 3 cases (13%) there was a history of previous suicide attempts. Petechial hemorrhages were found at autopsy in more than half of hanging victims and only three cases (14%) displayed dual distribution of post-mortem hypostasis (back and legs). Seven victims (30.5%) left some form of suicide message to family members and friends, 2 of which wrote the message on their arm. Parental separation, conflict with parents, and depression, were common amongst decedents prior to committing suicide. Substance abuse was uncommon in suicide within our cases. Valuable information is available from thorough review of suicide data in children and young adolescents from a single institution. Pathologists and clinicians can play crucial roles in identifying potential risk factors that may contribute to prevent future deaths.

Matched MeSH terms: Asphyxia/mortality; Poisoning/mortality; Neck Injuries/mortality

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