Gut bacterial communities of diarrheic patients with indications of Clostridioides difficile infection

Gut bacterial communities of diarrheic patients with indications of Clostridioides difficile infection

We present bacterial 16S rRNA gene datasets derived from stool samples of 44 patients with diarrhea indicative of a Clostridioides difficile infection.
After processing of paired-end sequencing data, reads were merged, quality-filtered, primer sequences removed, reads truncated to 400 bp and dereplicated.
The bacterial community profiles are based on operational taxonomic unit (OTU, defined at 97% genetic identity) frequency in stool samples of 44 patients with diarrhea indicative of C. difficile infection and 35 asymptomatic control individuals (n=79).
Occurrence of diarrhea in patents is indicated by plus (patient exhibited diarrhea) and minus (no diarrhea), results from microbiological diagnosis of C. difficile infection (C. d. m. t.) are shown below (plus, positively tested for C. difficile; minus, negatively tested for C. difficile).
Full size image Non-metric multidimensional scaling (NMDS) based on weighted Unifrac12 was used to display the bacterial community structure in 79 stool samples at same sequencing effort (10.000 reads per sample).
Full size image We present bacterial 16S rRNA gene datasets derived from stool samples of 44 patients with diarrhea indicative of a Clostridioides difficile infection.
After processing of paired-end sequencing data, reads were merged, quality-filtered, primer sequences removed, reads truncated to 400 bp and dereplicated.
The bacterial community profiles are based on operational taxonomic unit (OTU, defined at 97% genetic identity) frequency in stool samples of 44 patients with diarrhea indicative of C. difficile infection and 35 asymptomatic control individuals (n=79).
Occurrence of diarrhea in patents is indicated by plus (patient exhibited diarrhea) and minus (no diarrhea), results from microbiological diagnosis of C. difficile infection (C. d. m. t.) are shown below (plus, positively tested for C. difficile; minus, negatively tested for C. difficile).
Full size image Non-metric multidimensional scaling (NMDS) based on weighted Unifrac12 was used to display the bacterial community structure in 79 stool samples at same sequencing effort (10.000 reads per sample).

Impact of anesthetic agents on overall and recurrence-free survival in patients undergoing esophageal cancer surgery: A retrospective observational study

Impact of anesthetic agents on overall and recurrence-free survival in patients undergoing esophageal cancer surgery: A retrospective observational study

The patients were divided into two groups according to the anesthetics administered during surgery: volatile anesthesia (VA) or intravenous anesthesia with propofol (TIVA).
TIVA during esophageal cancer surgery was associated with better postoperative survival rates compared with volatile anesthesia.
Therefore, we performed a retrospective study to assess the relationship of anesthesia with overall and recurrence-free survival rates in patients following esophageal cancer surgery.
These data suggest a significantly lower overall survival rate in the VA group compared with the TIVA group (P < 0.001, Fig. Despite these limitations, if the relationship between anesthetics and recurrence and survival after cancer surgery is indeed causal, our results may have an important clinical implication for esophageal cancer management. The patients were divided into two groups according to the anesthetics administered during surgery: volatile anesthesia (VA) or intravenous anesthesia with propofol (TIVA). TIVA during esophageal cancer surgery was associated with better postoperative survival rates compared with volatile anesthesia. Therefore, we performed a retrospective study to assess the relationship of anesthesia with overall and recurrence-free survival rates in patients following esophageal cancer surgery. These data suggest a significantly lower overall survival rate in the VA group compared with the TIVA group (P < 0.001, Fig. Despite these limitations, if the relationship between anesthetics and recurrence and survival after cancer surgery is indeed causal, our results may have an important clinical implication for esophageal cancer management.

Neutrophil-lymphocyte Ratio Plus Prognostic Nutritional Index Predicts the Outcomes of Patients with Unresectable Hepatocellular Carcinoma After Transarterial Chemoembolization

Neutrophil-lymphocyte Ratio Plus Prognostic Nutritional Index Predicts the Outcomes of Patients with Unresectable Hepatocellular Carcinoma After Transarterial Chemoembolization

A receiver-operating characteristic (ROC) analysis was used to classify patients as follows: NLR-PNI 0 group (NLR ≤ 2.2 and PNI > 46), NLR-PNI 1 group (NLR > 2.2 or PNI ≤ 46) and NLR-PNI 2 group (NLR > 2.2 and PNI ≤ 46).
Regarding 1-, 3-, and 5-year survival, the NLR-PNI score had superior discriminative abilities (i.e., higher area under the ROC curve), compared with either the NLR or PNI alone, and patients in the NLR-PNI 0, 1, and 2 groups had median survival times of 33 (95% confidence interval: 22.8–43.2), 14 (10.9–17.1), and 6 (9.9–14.1) months, respectively.
However, studies have also shown that not all patients with unresectable HCC benefit from TACE.
A new inflammation-based score system, the NLR-PNI score, was then generated by combining the NLR score with the PNI score.
Full size image This study included 793 patients with unresectable HCC who had undergone TACE during the study period and for whom complete data were available.
Overall, 54.2% of the patients received >1 TACE treatment (range: 1–9).
(A) Overall survive; (B) NLR; (C) PNI; (D) NLR-PNI score.
As the prognostic values of the NLR and PNI are stable in patients with early-stage HCC, we evaluated whether a combination of these scores could optimize the selection of patients who would benefit from TACE among a patient subgroup with varying tumour burdens and variable predicted survival outcomes.
Our results indicated that the combined NLR-PNI score could better reflect the systemic inflammatory response for patients with HCC after TACE, compared with either score alone.
After dividing our patients into three groups according to NLR-PNI scores, we found that those with high combined scores had progressively worse outcomes relative to those with lower scores, and these differences were largely significant.

Challenges of incentivising patient centred care

Challenges of incentivising patient centred care

Although the definition is still somewhat contested, patient centred care incorporates aspects of the patient experience, such as communication, shared decision making, and the way services are designed, accessed, and delivered, including integration of care.1 Patient experience has also become seen as integral to quality of care,2 leading to calls internationally for measurement and incentive structures to be realigned to place a greater focus on patient reported information.
Patient reported information is that which is gathered directly from patients or their families and carers, either as a narrative or through survey questions.

The responses to the “cancer drugs scandal” must fully involve patients—an essay by Tessa Richards

The responses to the “cancer drugs scandal” must fully involve patients—an essay by Tessa Richards

After finding that most new cancer drugs appear to confer little clinical benefit, The BMJ’s Tessa Richards reflects on her cancer journey and argues that decision making in cancer must improve, to involve patients at every level The struggle to cope with debilitating side effects As a patient and patient advocate I repeatedly hear, read, and observe stories of bravery, disillusion, and despair.
A couple of years ago I was invited to a meeting convened by an oncologist who specialises in dealing with the abdominal side effects of cancer treatment.
Inadequate discussions about treatment Undeniably, many new cancer treatments are highly effective, and the issue for patients is often getting access to them.
The focus is on scan and test results and treatment options.
Consensus on “recommended” treatment may be reached with little or no reference to patients’ goals, hopes, fears, or preferences at the current stage in their cancer journey.
They included: immediate surgery (deemed very risky); adjuvant chemotherapy, with a view to shrinking the tumour a bit prior to surgery; joining a phase I clinical trial (I was advised to “chase this option fast” but weeks later was told that I didn’t fit the eligibility criteria); undergoing a second course of abdominal radiotherapy (my first was more than 10 years ago); and taking a long used, but notoriously hard to tolerate, “holding” drug for adrenal cancer, called mitotane.
Evidence on the likely outcomes of pursuing these options was not clear.
She seemed flummoxed: “I don’t know the palliative care doctors,” she said.
Patients surely have a right to question doctors, explore options, and have personal views on “best” treatment.
“Guinea pig” status, as described in a recent lacerating article by Paul Wicks (another member of The BMJ’s patient panel), is not acceptable.23 It’s also important to extend and open up the debate among researchers and health professionals about the nature and drivers of the eye wateringly high level of avoidable waste in the biomedical research enterprise.2425 There are “scandals” here including bias, error, non-publication, and fraud, which have a direct bearing on the “cancer drugs scandal.” Patient and public awareness of the issues—and their input—can help in a collective drive to tackle these problems, just as patient input is vital in assessing the value of healthcare.26 Implementing the call for #PatientsIncluded in medical conferences will help on both fronts.27 But no campaign can deliver what most patients seek—and it’s not a patient right.