BackgroundNoninvasive ventilation (NIV) is being used increasingly in patients who have a “do not intubate” (DNI) order. However, the impact of NIV on the clinical and health-related quality of life (HRQOL) in the emergency setting is not known, nor is its effectiveness for relieving symptoms in end-of-life care.ObjectiveThe aim of this prospective study was to determine the outcome and HRQOL impact of regular use of NIV outcomes on patients with a DNI order who were admitted to the emergency room department (ED). Methods: Eligible for participation were DNI-status patients who receive NIV for acute or acute-on-chronic respiratory failure when admitted to the ED of a tertiary care, university-affiliated, 600-bed hospital between January 2014 and December 2014. Patients were divided into 2 groups: (1) those whose DNI order related to a decision to withhold therapy and (2) those for whom any treatment, including NIV, was provided for symptom relief only. HRQOL was evaluated only in group 1, using the 12-item Short Form Health Survey (SF-12). Long-term outcome was evaluated 90 days after hospital discharge by means of a telephone interview.ResultsDuring the study period 1727 patients were admitted to the ED, 243 were submitted to NIV and 70 (29%) were included in the study. Twenty-nine (41%) of the 70 enrollees received NIV for symptom relief only (group2). Active cancer [7% vs 35%, p = 0,004] and neuromuscular diseases [0% vs. 17%] were more prevalent in this group. NIV was stopped in 59% of the patients in group 2 due to lake of clinical benefit. The in-hospital mortality rate was 37% for group 1 and 86% for group 2 0,001). Among patients who were discharged from hospital, 23% of the group 1 and all patients in group 2 died within 90 days. Relative to baseline, no significant decline in HRQOL occurred in group 1 by 90 days postdischarge.ConclusionThe survival rate was 49% among DNI-status patients for whom NIV was used as a treatment in ED, and these patients did not experience a decline in HRQOL throughout the study. NIV did not provide significant relief of symptoms in more than half the patients who receive it for that purpose.

The treatment landscape of metastatic renal cell carcinoma (mRCC) has changed in the last decade with improvements in overall survival. Overall survival ranges from 57 months in good-to-intermediate prognosis patients to 19 months in poor prognosis patients. The most frequent sites of metastasis are the lungs, bone, distant lymph nodes, liver, adrenal, and brain. Cutaneous metastases are rare and represent an end-stage disease with a worse prognosis. Studying long-term survivors of mRCC can help clinicians to identify potential predictors of response to targeted therapy and define the best treatment sequences in this setting. In this case, we report a 59-year-old man with a good mRCC prognosis who is alive 156 months after the diagnosis of mRCC, 108 months with cutaneous metastases. The patient underwent five treatment lines, with good tolerance and quality of life. This therapeutic sequence was based on new treatment options and new evidence concerning mRCC.

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.conducted with separate interview guides designed for each participant group. Questions related to the use of VCs in the future, accessing technology, waiting times and communicating issues, wider worries or fears. Participants rated their experiences from 1-5 (1 being low and 5 being high). Interviews were recorded with verbal consent and transcribed verbatim. Data was thematically analysed using NVivo12.Results: A total of 36 patients and 10 clinicians participated. Themes were acceptance, time, technology, purpose of clinic, communication, equipment, benefits and choice. Participants were accepting of the VC with 80.5% of patients (n¼29/36) and 90% of clinicians (n¼9/10) supporting future use. Both groups agreed that VCs are not suited to everyone and the use of the VC should be individualised for the patient based on several criteria including patient preference, reason for consultation and patient characteristics. The average satisfaction rating of the VC was higher among patients (4.45/5) than clinicians (3.75/5), with many clinicians suggesting that support setting up video clinics may improve the score. Conclusions:The study showed the promising use of VCs in the future. Recommendations were suggested to optimise the patient and clinician experience. These include implementing a patient triage system to advise which patients should have a virtual consultation, providing enhanced training and equipment to staff and ensuring the chosen method of VC provided is individualised to the patient's needs.Legal entity responsible for the study: The authors.

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same period were collected for this case-control study. All patients had measured laboratory data including total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, apolipoprotein B, and apolipoprotein A-I. A total of 434 consecutive patients pathologically diagnosed gastric cancer were prospectively enrolled between December 2013 to March 2017, and 3053 controls from Health Promotion Center who received health examination during the same period were collected for casecontrol. All patients had measured laboratory data including total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, apolipoprotein B, and apolipoprotein A-I.Results: After adjusting for age and gender, lower HDL level (< 40 mg/dL, adjusted OR ¼1.629, 95% CI¼1.252e2.119), higher LDL levels (LDL¼100-129 mg/dL: adjusted OR¼1.742; LDL¼130-160: adjusted OR¼1.857; LDL160: adjusted OR¼1.663), and lower apolipoprotein A-I level (< 178 mg/dL, adjusted OR¼1.795, 95% CI¼1.190e 2.710) were significantly associated with an increased risk of gastric cancer. After adjusting multivariate factors including age, gender, Helicobacter pylori infection, body mass index, smoking status, alcohol drinking status and family history of gastric cancer, higher LDL level (LDL¼100-129 mg/dL: adjusted OR¼1.655; LDL¼130-160: adjusted OR¼1.787) and lower apolipoprotein B (adjusted OR¼1.381, 95% CI¼1.034e1.848) were identified as significant factors for gastric cancer. In subgroup analysis of gastric cancer patients, triglyceride level was inversely correlated with advanced cancer stage and poor differentiation. Conclusion:Low serum HDL level, high LDL level, low apolipoprotein A-I and lower apolipoprotein B level were significantly associated with increased risk of gastric cancer, and low triglyceride level was correlated with advanced cancer stage and poorer differentiation.Legal entity responsible for the study: The authors.