Scott W. Bloom

Value of the pretreatment albumin to globulin ratio in predicting long-term mortality in breast cancer patients

BACKGROUND Prior studies have demonstrated the prognostic value of pretreatment serum albumin in different types of cancer. The aim of this study was to assess the predictive value of the albumin to globulin ratio (AGR) on survival in breast cancer patients. METHODS This retrospective study used an unselected cohort of 354 breast cancer patients who had documented total protein and albumin levels prior to chemotherapy. Survival status was obtained from our cancer registry. Survival analysis, stratified by AGR tertiles, was used to evaluate the prognostic value of AGR. RESULTS Patients in the highest AGR tertiles (AGR > 1.45) had a lower 5-year mortality rate compared with those in the middle (AGR 1.21 to 1.45) and the lowest (AGR < 1.21) tertiles (6% vs. 18% and 32%, P < .001). After adjusting for confounding variables, AGR remained a significant predictor of mortality (P < .002). Moreover, after excluding the patients with albumin levels less than 3.6, the AGR remained a significant predictor of survival (P .0018). CONCLUSIONS Pretreatment AGR is an independent, significant predictor of long-term mortality in breast cancer patients, even in patients with normal albumin levels.

The value of the pretreatment neutrophil lymphocyte ratio vs. platelet lymphocyte ratio in predicting the long-term survival in colorectal cancer

BACKGROUND The neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) have been well studied as inflammatory markers and predictors for outcomes in colorectal cancer patients. Our aim was to determine the predictive value of both above ratios in colorectal cancer patients. METHODS This is a longitudinal retrospective study of a prospectively maintained database, included 580 patients, who had a complete blood count recorded before treatment (surgery or chemotherapy). We excluded patients presented with obstruction, infection, active hematological disease or those receiving steroid. The primary outcome (4-year cancer-related mortality) was obtained from our cancer registry. RESULTS The 4-year cancer-related mortality rate in the 3rd tertile of NLR was 37% in comparison with 13% and 19% in lower tertiles, P value < 0.001. Similarly the 3rd tertile of PLR was 32% with 18% and 19% in lower tertiles, P value < 0.0005. In the multivariate survival analyses, elevated NLR was associated with higher mortality (a hazard ratio of 2.31(1.4-3.8) for the highest tertile and 5% increase in mortality for each unit increase in NLR, p < 0.001). Similarly, elevated NLR was a significant predictor for a worse disease-free survival. However, PLR was not significant predictor of mortality when adjusted for other confounding variables. CONCLUSION Elevated pretreatment NLR is an independent predictor of both worse overall and disease free survival in colorectal cancer, whereas PLR was not after adjusting for confounding variables.

Value of albumin-globulin ratio as a predictor of all-cause mortality after non-ST elevation myocardial infarction.

Low albumin and the albumin–globulin ratio (AGR) were associated with vascular adverse events. Our study explores the AGR as a predictor of mortality after non-ST-segment elevation myocardial infarction (NSTEMI). In an observational study of 570 NSTEMI patients admitted to a tertiary center between 2004 and 2006, patients were stratified into equal tertiles according to AGR. The primary outcome was 4-year all-cause mortality. The 4-year mortality rates in the first, second, and third AGR tertiles were 88 (47%) of 189, 48 (25%)of 190 , and 19 (10%) of 191, respectively (P < .0001). After adjusting for 20 confounding variables, AGR first tertile (AGR <1.12) had a higher mortality versus second tertile (hazard ratio [HR] 2.6, P < .001). Likewise, the AGR second tertile had higher mortality versus the third tertile (AGR ≥1.34; HR 2.3, P = .004). The albumin–globulin ratio is a significant independent predictor of long-term mortality after NSTEMI in patients with normal serum albumin levels. Further studies are needed to explain the underlying mechanisms.

Assessing the value of the SimPraxis laparoscopic cholecystectomy trainer.

Junior-level surgical residents appeared to benefit the most from SimPraxis™ laparoscopic cholecystectomy simulation training.

Identification of Risk Factors for Cervical Spine Injury from Pediatric Trauma Registry

Background: Cervical spine injuries are rare in children. Our goal is to establish guidelines for cervical spine clearance that are practical for our pediatric population, and, in the process, to reduce the risk of radiation exposure from unnecessary advanced imaging. Methods: We retrospectively reviewed the records from the registries of two pediatric trauma centers from the past 11 years (January 2002 to June 2013). Patients aged 1 month to 17 years, who had a CT scan of the cervical spine due to trauma indication for possible cervical spine injury, were evaluated. Results: Three risk factors were identified as being significant for the presence of a cervical spine injury. Patients who sustained a cervical spine injury were more likely to be male (p = 0.0261), were more severely injured with a higher injury severity score (ISS 16.39 ± 15.79 injured vs. 8.7 ± 9.4 uninjured), and presented with neck tenderness (p = 0.0001). Conclusion: In our study, significant cervical spine injury is related to male gender, higher ISS and neck tenderness.