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Gebrael G, Meza L, Li X, Zengin Z, Sayegh N, Ebrahimi H, Tripathi N, Castro D, Mercier B, Barragan-Carrillo R, Li H, Chehrazi-Raffle A, Swami U, Tripathi A, Agarwal N, Maughan BL, Pal SK. Impact of Synchronous versus Metachronous Metastasis on Outcomes in Patients with Metastatic Renal Cell Carcinoma Treated with First-line Immune Checkpoint Inhibitor-based Combinations. Eur Urol Focus 2024:S2405-4569(24)00050-6. [PMID: 38580524 DOI: 10.1016/j.euf.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND AND OBJECTIVE The impact of time of metastasis onset with respect toprimary renal cell carcinoma (RCC) diagnosis on survival outcomes is not well characterized in the era of immune checkpoint inhibitor (ICI)-based combinations. Herein, we assessed differences in clinical outcomes between synchronous and metachronous metastatic RCC (mRCC). METHODS Data for patients with mRCC treated with first-line ICI-based combination therapies between 2014 and 2023 were retrospectively collected. Patients were categorized as having synchronous metastasis if present within 3 mo of RCC diagnosis; metachronous metastasis was defined as metastasis >3 mo after primary diagnosis. Time to treatment failure (TTF), overall survival (OS), and the disease control rate (DCR) were assessed. KEY FINDINGS AND LIMITATIONS Our analysis included 223 eligible patients (126 synchronous and 97 metachronous). Median TTF did not significantly differ between the synchronous and metachronous groups (9 vs 19.8 mo; p = 0.063). Median OS was significantly shorter in the synchronous group (28.0 vs 50.9 mo; p = 0.001). Similarly, patients with synchronous metachronous metastasis (58.7% vs. 78.4%; p = 0.002). On multivariable analyses, synchronous metastasis remained independently associated with worse OS and DCR. CONCLUSIONS AND CLINICAL IMPLICATIONS In this hypothesis-generating study, patients with mRCC with synchronous metastasis who were treated with first-line ICI-based combinations have a poorer OS and worse DCR than those with metachronous mRCC. If these results are externally validated, time to metastasis could be included in prognostic models for mRCC. PATIENT SUMMARY Our study demonstrates that patients treated with current first-line immunotherapies, who present with metastasis at the initial diagnosis of kidney cancer have worse overall survival compared to those who develop metastasis later. These results can help physicians and patients understand life expectancy.
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Affiliation(s)
- Georges Gebrael
- Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Luis Meza
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Xiaochen Li
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Zeynep Zengin
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Nicolas Sayegh
- Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Hedyeh Ebrahimi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Nishita Tripathi
- Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Daniela Castro
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Benjamin Mercier
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Regina Barragan-Carrillo
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Haoran Li
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Cancer Center, Westwood, KS, USA
| | - Alexander Chehrazi-Raffle
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Umang Swami
- Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Abhishek Tripathi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Neeraj Agarwal
- Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Benjamin L Maughan
- Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Aboras SI, Megahed AA, El-Yazbi F, Maher HM. Utility of sustainable ratio derivative spectrophotometry for the concurrent assay of synergistic repurposed drugs for COVID-19 infections; Insilico pharmacokinetics proof. BMC Chem 2024; 18:50. [PMID: 38454503 PMCID: PMC10921645 DOI: 10.1186/s13065-024-01147-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
The cutting-edge combination of fluvoxamine (FVM) and ivermectin (IVM) has been presented as a proposed dosage form for the treatment of COVID-19 infections in early diagnosed patients. The main objective of this work is to develop simple, sensitive, and efficient methods for the synchronous quantification of FVM and IVM without any prior separation. Four green UV-methods were employed for the synchronous quantification, namely: Fourier functions convolution of absorption spectra, FFAS, Fourier functions convolution of derivative spectra of absorption curves, FFDS, Fourier function convolution of ratio spectra of absorption curves, FFRS and the dual-wavelength method, DWM. FFRS and DWM approaches can be able to reconcile the two components' significantly interfering spectrum presented in this commixture. Good linearity was checked in the range of 5-40, and 2.5-25 μg/mL for the FVM, and IVM, respectively. All approaches developed have been recommended in compliance with ICH principles. Furthermore, the approaches' greenness was predestined by "National Environmental Method Index" (NEMI), "Analytical GREEnness metric (AGREE)", the "Analytical Eco-Scale", and the "Green Analytical Procedure Index" (GAPI). In addition, spider diagram was utilized for the assessment of the greenness index of the solvent used. Beside greenness, the sustainability of our methods was investigated using the HEXAGON tool. Continuing the constant pursuit of greenness, drug-drug interactions (DDIs) between FVM & IVM were predicted by insilico tools to ensure the safety of the suggested mixture as a preliminary step before invitro and in vivo studies. Because they were deemed sustainable, affordable, and successful, the suggested UV-methods may be used for routine quality control investigations of the indicated formulations FVM & IVM.
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Affiliation(s)
- Sara I Aboras
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, University of Alexandria, Al-mesallah, Alexandria, 21521, Egypt.
| | - Ahmed A Megahed
- Al-Basra Health Unit, Alamriya Medical Area, Ministry of Health, Alexandria, Egypt
| | - Fawzy El-Yazbi
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, University of Alexandria, Al-mesallah, Alexandria, 21521, Egypt
| | - Hadir M Maher
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, University of Alexandria, Al-mesallah, Alexandria, 21521, Egypt
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Altukhaim S, George D, Nagaratnam K, Kondo T, Hayashi Y. Enhancement of sense of ownership using virtual and haptic feedback. Sci Rep 2024; 14:5140. [PMID: 38429357 PMCID: PMC10907564 DOI: 10.1038/s41598-024-55162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
Accomplishing motor function requires multimodal information, such as visual and haptic feedback, which induces a sense of ownership (SoO) over one's own body part. In this study, we developed a visual-haptic human machine interface that combines three different types of feedback (visual, haptic, and kinesthetic) in the context of passive hand-grasping motion and aimed to generate SoO over a virtual hand. We tested two conditions, both conditions the three set of feedback were synchronous, the first condition was in-phase, and the second condition was in antiphase. In both conditions, we utilized passive visual feedback (pre-recorded video of a real hand displayed), haptic feedback (balloon inflated and deflated), and kinesthetic feedback (finger movement following the balloon curvature). To quantify the SoO, the participants' reaction time was measured in response to a sense of threat. We found that most participants had a shorter reaction time under anti-phase condition, indicating that synchronous anti-phase of the multimodal system was better than in-phase condition for inducing a SoO of the virtual hand. We conclude that stronger haptic feedback has a key role in the SoO in accordance with visual information. Because the virtual hand is closing and the high pressure from the balloon against the hand creates the sensation of grasping and closing the hand, it appeared as though the person was closing his/her hand at the perceptual level.
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Affiliation(s)
- Samirah Altukhaim
- Biomedical Science and Biomedical Engineering, School of Biological Sciences, University of Reading, Whiteknights, Reading, RG6 6AY, UK
- Physiotherapy Group in Stroke Unit, Alamiri Hospital, Kuwait, Kuwait
| | - Daniel George
- Biomedical Science and Biomedical Engineering, School of Biological Sciences, University of Reading, Whiteknights, Reading, RG6 6AY, UK
| | - Kiruba Nagaratnam
- Stroke Unit, Royal Berskhire Hospital, London Road, Reading, RG1 5AN, UK
| | - Toshiyuki Kondo
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, 2-24-16, Naka-Cho, Koganei, Tokyo, Japan
| | - Yoshikatsu Hayashi
- Biomedical Science and Biomedical Engineering, School of Biological Sciences, University of Reading, Whiteknights, Reading, RG6 6AY, UK.
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Azik H, Omri N, Kamil M, Miki H, Shay G, Roy M, Yuval F, Barak R, Ben S, Yariv S, Reuven BD, Gilad AE. Analysis of clinical characteristics, treatment patterns, and outcome of patients with bilateral testicular germ cell tumors. Discov Oncol 2024; 15:30. [PMID: 38321336 PMCID: PMC10847073 DOI: 10.1007/s12672-024-00874-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION Bilateral testicular germ cell tumor (BGCT) is a rare disease, occasionally considered to be more aggressive than unilateral germ cell tumors (GCT) in some reports. Among BGCT, a synchronous disease might be diagnosed at a higher stage than a metachronous disease, resulting in lower cancer-specific survival. Hence, our study aimed to perform a comparative analysis between unilateral testicular GCT, bilateral synchronous GCT, and bilateral metachronous GCT, aiming to verify the possibility that BGCT is diagnosed with a higher stage and may require more aggressive management. MATERIAL AND METHODS In our multicenter retrospective study we reviewed medical records of 40 patients with BGCT (24 metachronous and 16 synchronous). Clinical characteristics, pathological features of the primary and secondary tumors, adjuvant treatments (chemotherapy and radiotherapy)and sperm quality were evaluated as well as cancer-specific survival and overall survival. A cohort of one-to-one matched patients with unilateral GCT were used to determine risk factors for developing BGCT. RESULTS Patients with BGCT were slightly younger compared to those with unilateral GCT and had more advanced disease. Despite similar T-stage distribution between the two groups, nodal involvement was nearly twofold more frequent in patients with BGCT disease (42% vs 22%, p = 0.056). Additionally, although similar histological subtypes distribution at presentation among the two groups, the synchronous disease was diagnosed with a higher local T-stage (OR = 3.4), higher proportions of patients with elevated serum BHCG levels, and more frequent nodal involvement (OR = 2.2). This was later translated into an 18% higher disease-specific mortality rate. The median time to develop a contralateral tumor was 92 months. Pathological local T-stage (T2-T3) of the primary tumor predicted a shorter time interval to a diagnosis of a second contralateral tumor (HR 0.92, P < 0.05). CONCLUSION BGCT presents at a younger age and potentially with more advanced disease. Synchronous BGCT is diagnosed at a later stage compared to metachronous BGCT and has higher disease-specific mortality. Metachronous tumors might have a long time interval for the development of a contralateral neoplasm. The main predictor of developing an early metachronous disease is a high primary T stage.
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Affiliation(s)
- Hoffman Azik
- Urology Department, Rambam Health Care Campus, Haifa, Israel.
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel.
| | - Nativ Omri
- Urology Department, Rambam Health Care Campus, Haifa, Israel
| | - Malshy Kamil
- Urology Department, Rambam Health Care Campus, Haifa, Israel
| | - Haifler Miki
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
- Urology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Golan Shay
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
- Urology Department, Rabin Medical Center, Pethach Tikva, Israel
| | - Mano Roy
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
- Urology Department, Sourasky Medical Center, Tel Aviv, Israel
| | - Freifeld Yuval
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
- Urology Department, Carmel Medical Center, Haifa, Israel
| | - Rosenzweig Barak
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
- Urology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Shalom Ben
- Urology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Stabholz Yariv
- Urology Department, Sourasky Medical Center, Tel Aviv, Israel
| | | | - Amiel E Gilad
- Urology Department, Rambam Health Care Campus, Haifa, Israel
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
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Huguet F, Riou O, Pasquier D, Modesto A, Quéro L, Michalet M, Bordron A, Schipman B, Orthuon A, Lisbona A, Vendrely V, Jaksic N. Radiation therapy of the primary tumour and/or metastases of digestive metastatic cancers. Cancer Radiother 2024; 28:66-74. [PMID: 37806823 DOI: 10.1016/j.canrad.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/27/2023] [Accepted: 04/07/2023] [Indexed: 10/10/2023]
Abstract
Metastatic gastrointestinal cancer is not an uncommon situation, especially for pancreatic, gastric, and colorectal cancers. In this setting, few data are available on the impact of the treatment of the primary tumour. Oligometastatic disease is associated with longer survival in comparison with more advanced disease. Metastasis-directed therapy, such as stereotactic body radiotherapy, seems related to better outcomes, but the level of evidence is low. In most tumour locations, prospective data are very scarce and inclusion in ongoing trials is strongly recommended.
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Affiliation(s)
- F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, DMU Orphé, Sorbonne université, Paris, France; Laboratory of Cancer Biology and Therapeutics, centre de recherche Saint-Antoine, U938, Inserm, Paris, France.
| | - O Riou
- Institut de recherche en cancérologie de Montpellier, U1194, Inserm, université de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, ICM, institut régional du cancer de Montpellier, Montpellier, France
| | - D Pasquier
- Service d'oncologie radiothérapie, centre Oscar-Lambret, Lille, France; Université de Lille, CNRS, école centrale de Lille, UMR 9189 - CRIStAL, Lille, France
| | - A Modesto
- Département de radiothérapie, institut universitaire du cancer de Toulouse, Toulouse, France; Centre de recherche du cancer de Toulouse, UMR 1037, Inserm, université Toulouse-III Paul-Sabatier, Toulouse, France
| | - L Quéro
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP Nord, DMU Icare, Paris, France; Université Paris Cité, U1160, Inserm, Paris, France
| | - M Michalet
- Institut de recherche en cancérologie de Montpellier, U1194, Inserm, université de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, ICM, institut régional du cancer de Montpellier, Montpellier, France
| | - A Bordron
- Département de radiothérapie, centre hospitalier universitaire de Brest, Brest, France
| | - B Schipman
- Institut de cancérologie de Bourgogne, Dijon, France
| | - A Orthuon
- Institut de cancérologie de Bourgogne, Dijon, France
| | - A Lisbona
- Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - V Vendrely
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - N Jaksic
- Institut de cancérologie et radiothérapie Brétillien, Saint-Malo, France
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Timurtaş E, Selçuk H, Uğur Canöz E, Inceer M, Batar S, Demirbüken İ, Polat MG. Synchronous and asynchronous telerehabilitation methods produce similar benefits in individuals with non-specific neck pain. Arch Orthop Trauma Surg 2024; 144:559-566. [PMID: 37812269 DOI: 10.1007/s00402-023-05083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/18/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Evidence exists on clinical benefits of synchronous and asynchronous telerehabilitation for patients with non-specific neck pain (NSNP); however, limited studies are comparing synchronous and asynchronous telerehabilitation (TR) programs in this population. The aim of this study was to estimate the relative effectiveness of an 8-week synchronous or asynchronous TR in improving pain, functional disability, kinesiophobia, and mobility in patients with NSNP. MATERIALS AND METHODS This was a randomized, controlled clinical trial carried out on 60 individuals with NSNP. Participants were randomly assigned to synchronous TR group (n = 30) or asynchronous TR group (n = 30) that received the same exercise program for 8 weeks. Pain measured by Numeric Pain Rating Scale (NPRS), disability measured by Neck Disability Index (NDI), kinesiophobia measured by Tampa Scale of Kinesiophobia (TSK), and cervical range of motion were used as outcome measures. Assessments were performed at baseline, 4th week, 8th week, and 16th week. RESULTS The analysis showed a significant effect of time and significant interaction between group and time in NPRS, NDI, TSK, and cervical mobility scores (p < 0.05), yet the group effect was not significant (p > 0.05). There were no significant differences between the groups at all time points (p > 0.05) except for cervical right lateral flexion at 8th week (p = 0.036). CONCLUSION Telerehabilitation technologies are expanding at a rapid rate, and it is essential to understand the outcomes produced using these technologies in health conditions. This study showed that synchronous and asynchronous telerehabilitation produces similar results in patients with NSNP, supporting that either method can be used interchangeably.
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Affiliation(s)
- Eren Timurtaş
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Halit Selçuk
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey.
| | - Ekin Uğur Canöz
- Department of Physiotherapy, Vocational School of Health Services, Fenerbahçe University, Istanbul, Turkey
| | - Mehmet Inceer
- Patient Centered Solutions, IQVIA, Montreal, QC, Canada
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Suat Batar
- Department of Orthopedics and Traumatology, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - İlkşan Demirbüken
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Mine Gülden Polat
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
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Khalifa J, Lévy A, Sauvage LM, Thureau S, Darréon J, Le Péchoux C, Lerouge D, Pourel N, Antoni D, Blais E, Martin É, Marguerit A, Giraud P, Riet FG. Radiotherapy in the management of synchronous metastatic lung cancer. Cancer Radiother 2024; 28:22-35. [PMID: 37574329 DOI: 10.1016/j.canrad.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/02/2023] [Indexed: 08/15/2023]
Abstract
Metastatic lung cancer classically portends a poor prognosis. The management of metastatic lung cancer has dramatically changed with the emergence of immune checkpoint inhibitors, targeted therapy and due to a better understanding of the oligometastatic process. In metastatic lung cancers, radiation therapy which was only used with palliative intent for decades, represents today a promising way to treat primary and oligometastatic sites with a curative intent. Herein we present through a literature review the role of radiotherapy in the management of synchronous metastatic lung cancers.
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Affiliation(s)
- J Khalifa
- Department of Radiation Oncology, institut Claudius-Regaud/IUCT-Oncopole, Toulouse, France; U1037, Inserm, CRCT, Toulouse, France.
| | - A Lévy
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Université Paris-Saclay, Molecular Radiotherapy and Therapeutic Innovation lab, Inserm U1030, 94805 Villejuif, France
| | - L-M Sauvage
- Department of Radiation Oncology, institut Curie, Paris, France
| | - S Thureau
- Department of Radiation Oncology, centre Henri-Becquerel, Rouen, France; QuantIf-Litis EA4108, université de Rouen, Rouen, France
| | - J Darréon
- Department of Radiation Oncology, institut Paoli-Calmettes, Marseille, France
| | - C Le Péchoux
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Gustave-Roussy, 94805 Villejuif, France
| | - D Lerouge
- Department of Radiation Oncology, centre François-Baclesse, Caen, France
| | - N Pourel
- Department of Radiation Oncology, institut Sainte-Catherine, Avignon, France
| | - D Antoni
- Department of Radiation Oncology, institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - E Blais
- Department of Radiation Oncology, polyclinique Marzet, Pau, France
| | - É Martin
- Department of Radiation Oncology, centre Georges-François-Leclerc, Dijon, France
| | - A Marguerit
- Department of Radiation Oncology, institut de cancérologie de Montpellier, Montpellier, France
| | - P Giraud
- Department of Radiation Oncology, hôpital européen Georges-Pompidou, Paris, France; Université Paris Cité, Paris, France
| | - F-G Riet
- Department of Radiation Oncology, centre hospitalier privé Saint-Grégoire, Saint-Grégoire, France
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Hu N, Yan G, Tang MW, Wu YH, Xiang YN, Lei PG. Synchronous Double Primary Malignant Tumors and their Possible Shared Genes: A Rare Clinical Entity. Curr Med Imaging 2024; 20:e15734056258908. [PMID: 38087432 DOI: 10.2174/0115734056258908230920063040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/27/2023] [Accepted: 08/28/2023] [Indexed: 12/18/2023]
Abstract
Objective This study sought to analyze the 18F-FDG PET/CT and contrast-enhanced computed tomography (CT) images of synchronous colorectal cancer (CRC) and renal clear cell carcinoma (ccRCC) and identify the shared genes between these two types of cancer through bioinformatic analysis. Methods A retrospective analysis was conducted on a patient with synchronous CRC and ccRCC who underwent 18F-FDG PET/CT and contrast-enhanced CT before treatment. Databases were analyzed to identify differentially expressed genes between CRC and ccRCC, and co-expression genes were extracted for RCC and CRC. Results 18F-FDG PET/CT revealed intense metabolic activity in the primary colorectal lesion (SUVmax 13.2), while a left renal mass (diameter = 35 mm) was observed with no significant uptake. Contrast-enhanced CT during the arterial phase showed heterogeneous intense enhancement of the renal lesion, and the lesion washed out earlier than in the renal cortex in the nephrographic and excretory phases, indicating ccRCC. The histopathological results confirmed synchronous double primary malignant tumors. Our bioinformatic analysis results showed that synchronous occurrence of CRC and ccRCC may correlate with simultaneous expression of Carbonic Anhydrase 9 (CA9), integrin-binding sialoprotein (IBSP), and Fibrinogen γ chain (FGG). Conclusion 18F-FDG PET/CT combined with contrast-enhanced CT is an effective diagnostic tool in evaluating synchronous CRC and RCC. By analyzing this clinical case and conducting bioinformatic analysis, we improved our current understanding of the mechanisms underlying synchronous tumors.
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Affiliation(s)
- Na Hu
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Gang Yan
- Department of Nuclear Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Mao-Wen Tang
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yu-Hui Wu
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yi-Ning Xiang
- Department of Pathology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Ping-Gui Lei
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Kantiwal P, Agrawal D, Laxmi Prasad G, Gahlot N, Elhence A. Unusual presentation of adamantinoma with synchronous involvement of entire-lengths of the tibia and fibula in an elderly man: A case report. Int J Surg Case Rep 2024; 114:109101. [PMID: 38141510 PMCID: PMC10800343 DOI: 10.1016/j.ijscr.2023.109101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Adamantinoma is a rare primary low-grade malignant bone tumor with a median age of 20 to 30 years with a specific predilection to the lower 2/3rd shaft of the tibia. We present an unusual presentation of a giant adamantinoma with synchronous involvement of almost entire lengths of the tibia and fibula and extensive to the skin in a geriatric man. CASE PRESENTATION An elderly male patient in their late 50s presented to us with a grossly deformed left leg with a fungating mass over the left leg for 5 years. X-rays showed a lytic sclerotic lesion with a honeycomb appearance involving the entire length of the tibia and fibula. Magnetic Resonance Imaging showed a heterogeneous altered signal intensity (T1 isointense and T2 heterogeneous hyper-intense lesion) large lobulated lesion involving the entire length of the leg with lytic destruction of the entire tibia and fibula and associated remodeling. The histopathological examination revealed an Invasive tumor composed of both epithelial and mesenchymal elements. On immunohistochemistry, tumor cells were positive for D240 and negative for CD31. After confirming the diagnosis of adamantinoma of tibia and fibula radical resection of the tumor was planned and performed in the form of above-knee amputation. The patient was disease-free at 18 months of the latest follow-up and walking with the above knee prosthesis comfortably without any assistance. CLINICAL DISCUSSION Two morphological patterns of adamantinoma on MRI have been described, a solitary lobulated focus and a pattern of multiple small nodules in one or more foci. Our case has demonstrated the second type of morphology. Histologically, this case presented with "classical basaloid type epithelial cells embedded in osteofibrous dysplasia-like stroma." CONCLUSION The diagnosis of adamantinoma was based on the clinical-radiological findings and histo-morphology, and should be confirmed by immunohistochemistry for demonstrating epithelial cells. Ultra-structural analysis and Cytogenetic studies may be required in the cases of unusual presentation of these tumors. Wide local resection is the preferred treatment.
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Affiliation(s)
- Prabodh Kantiwal
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India.
| | - Divya Agrawal
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - G Laxmi Prasad
- Kims Sunshine Hospital, Begumpet, Hyderabad, Telangana 500016, India
| | - Nitesh Gahlot
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhay Elhence
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India
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10
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AlGhamdi FK, Altoijry A, AlQahtani A, Aldossary MY, AlSheikh SO, Iqbal K, Alayadhi WA. Synchronous carotid endarterectomy and coronary artery bypass graft: Four case reports. World J Clin Cases 2023; 11:8581-8588. [PMID: 38188208 PMCID: PMC10768504 DOI: 10.12998/wjcc.v11.i36.8581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/19/2023] [Accepted: 12/13/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND One of the major perioperative complications for coronary artery bypass graft (CABG) is stroke. The risk of perioperative stroke after CABG is approximately 2%. Carotid stenosis (CS) is considered an independent predictor of perioperative stroke risk in CABG patients. The optimal management of such patients has been a source of controversy. One of the possible surgical options is synchronous carotid endarterectomy (CEA) and CABG. Here, we have presented 4 cases of successful synchronous CEA and CABG. CASE SUMMARY Our center's experience with 4 cases of significant carotid artery stenosis, which were successfully managed with combined CEA and CABG, are detailed. The first case was a female who presented for CABG after a ST-elevation myocardial infarction. She had right internal carotid artery (ICA) occlusion and 90% left ICA stenosis. The second case was a male who was electively admitted for CABG. It was discovered that he had left ICA occlusion and 90% right ICA stenosis. The third case was a male with a history of stroke, two months prior to admission. He presented with non-ST-elevation myocardial infarction. Preoperatively, it was discovered that he had > 90% right ICA stenosis. The final case was a male who was electively admitted for CABG. It was discovered that he had bilateral > 90% ICA stenosis. We have also reviewed the current evidence and guidelines for managing CS in patients undergoing CABG. CONCLUSION Our case series demonstrated that synchronous CEA and CABG was safe. A multicenter study with additional patients is needed. It is necessary for clinicians to screen for CS in high-risk patients with features.
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Affiliation(s)
| | | | - Abdulrahman AlQahtani
- King Fahad Cardiac Center, King Saud University Medical City, Riyadh 11322, Saudi Arabia
| | - Mohammed Yousef Aldossary
- Department of General Surgery, King Saud University, Riyadh 11322, Saudi Arabia
- Department of Surgery, Dammam Medical Complex, Dammam 32245, Saudi Arabia
| | | | - Kaisor Iqbal
- Department of Surgery, King Saud University, Riyadh 11322, Saudi Arabia
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11
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Bizzarri N, Imterat M, Fruscio R, Giannarelli D, Perrone AM, Mancari R, Traut A, Rosati A, du Bois A, Ferrari D, De Iaco P, Ergasti R, Ataseven B, Bianchi T, Di Stanislao M, Perri MT, Heitz F, Concin N, Fanfani F, Vizza E, Scambia G, Harter P, Fagotti A. Lymph node staging in grade 1-2 endometrioid ovarian carcinoma apparently confined to the ovary: Is it worth? Eur J Cancer 2023; 195:113398. [PMID: 37890354 DOI: 10.1016/j.ejca.2023.113398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE The aim of this study was to assess the disease-free survival (DFS) and overall survival (OS) of patients with grade 1-2 endometrioid ovarian carcinoma apparently confined to the ovary, according to surgical staging. METHODS Multicenter, retrospective, observational cohort study. Patients with endometrioid ovarian carcinoma, surgical procedure performed between May 1985 and December 2019, stage pT1 N0/N1/Nx, grade 1-2 were included. Patients were stratified according to lymphadenectomy (defined as removal of any lymph node versus no lymph node assessment), and subgroup analyses according to tumor grade were performed. Kaplan-Meier curves and cox regression analyses were used to perform survival analyses. RESULTS 298 patients were included. 199 (66.8 %) patients underwent lymph node assessment. Of these, 166 (83.4 %) had unilateral/bilateral pelvic and para-aortic/caval lymphadenectomy. Eleven (5.5 %) patients of those who underwent lymph node assessment showed pathologic metastatic lymph nodes (FIGO stage IIIA1). Twenty-seven patients (9.1 %) had synchronous endometrioid endometrial cancer. After a median follow up of 45 months (95 %CI:37.5-52.5), 5-year DFS and OS of the entire cohort were 89.8 % and 96.2 %, respectively. Age ≤ 51 years (HR=0.24, 95 %CI:0.06-0.91; p = 0.036) and performance of lymphadenectomy (HR=0.25, 95 %CI: 0.07-0.82; p = 0.022) represented independent protective factors toward risk of death. Patients undergoing lymphadenectomy had better 5-year DFS and OS compared to those not receiving lymphadenectomy, 92.0 % versus 85.6 % (p = 0.016) and 97.7 % versus 92.8 % (p = 0.013), respectively. This result was confirmed after exclusion of node-positive patients. When stratifying according to tumor grade (node-positive excluded), patients with grade 2 who underwent lymphadenectomy had better 5-year DFS and OS than those without lymphadenectomy (93.0 % versus 83.1 %, p = 0.040 % and 96.5 % versus 90.6 %, p = 0.037, respectively). CONCLUSION Staging lymphadenectomy in grade 2 endometrioid ovarian carcinoma patients was associated with improved DFS and OS. Grade 1 and grade 2 might be considered as two different entities, which could benefit from different approach in terms of surgical staging. Prospective studies, including molecular profiles are needed to confirm the survival drivers in this rare setting.
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Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Majdi Imterat
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Gynaecologic Oncology, Hadassah Medical Centers, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Robert Fruscio
- Fondazione IRCCS San Gerardo dei Tintori, UOC Ginecologia, Università di Milano-Bicocca, Milano, Italy
| | - Diana Giannarelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Facility of Epidemiology and Biostatistics, Rome, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rosanna Mancari
- Gynecologic Oncology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andrea Rosati
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Debora Ferrari
- Fondazione IRCCS San Gerardo dei Tintori, UOC Ginecologia, Università di Milano-Bicocca, Milano, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Raffaella Ergasti
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Beyhan Ataseven
- Bielefeld University, Medical School and University Medical Center East Westphalia-Lippe, Klinikum Lippe, Academic Department of Gynecology, Gynecologic Oncology and Obstetrics, Detmold, Germany
| | - Tommaso Bianchi
- Fondazione IRCCS San Gerardo dei Tintori, UOC Ginecologia, Università di Milano-Bicocca, Milano, Italy
| | - Marco Di Stanislao
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Teresa Perri
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nicole Concin
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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12
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Zhou S, Wang J, Li M, Yang Y, Zhang H, Chen D. Bilateral and synchronous male breast cancer: a case report. Int J Clin Exp Pathol 2023; 16:352-356. [PMID: 38059175 PMCID: PMC10695746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 07/12/2023] [Indexed: 12/08/2023]
Abstract
Genetic mutational characterization of synchronous bilateral male breast cancer (BC) has been poorly reported due to its rarity. Herein, we present a 55-year-old male patient who was diagnosed with bilateral breast cancer (BBC) and harbored different gene mutations. The diagnosis of synchronous bilateral breast cancer (SBBC) was made using ultrasonography, magnetic resonance imaging (MRI), mammography and core-needle biopsy. Subsequently, bilateral modified radical mastectomies were performed, and histopathologic examination revealed invasive ductal carcinoma. To further investigate the genetic profile of the patient, the biopsy tissue from both breasts and a blood sample were subjected to targeted next generation sequencing (NGS). The genomic profile of the left breast (LB) sample revealed two copy number variations (CNVs), amplification of MCL1 and DAXX, while the right breast (RB) sample showed no obvious mutation. We are reporting this case along with its clinicopathologic findings and genetic investigations, since SBBS occurs extremely rarely, especially in men. The heterogeneity in gene mutations observed in this case may suggest a different pathogenesis and the need for different therapy strategies.
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Affiliation(s)
- Shaoqiang Zhou
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical UniversityKunming 650032, Yunnan, P. R. China
| | - Jiankui Wang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical UniversityKunming 650032, Yunnan, P. R. China
| | - Ming Li
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical UniversityKunming 650032, Yunnan, P. R. China
| | - Yinju Yang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical UniversityKunming 650032, Yunnan, P. R. China
| | - Hushan Zhang
- The Medical Department, 3D Medicines Inc.Shanghai 201114, P. R. China
| | - Dedian Chen
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical UniversityKunming 650032, Yunnan, P. R. China
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13
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Lin YJ, Chen HX, Zhang FX, Hu XS, Huang HJ, Lu JH, Cheng YZ, Peng JS, Lian L. Features of synchronous and metachronous dual primary gastric and colorectal cancer. World J Gastrointest Oncol 2023; 15:1864-1873. [DOI: 10.4251/wjgo.v15.i11.1864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/15/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Studies evaluating the characteristics of dual primary gastric and colorectal cancer (CRC) (DPGCC) are limited.
AIM To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous cancers in patients with DPGCC.
METHODS From October 2010 to August 2021, patients with DPGCC were retrospectively reviewed. The patients with DPGCC were divided into two groups (synchronous and metachronous). We compared the overall survival (OS) between the groups using Kaplan-Meier survival methods. Univariate and multivariate analyses were performed using Cox’s proportional hazards model to identify the independent prognostic factors for OS.
RESULTS Of the 76 patients with DPGCC, 46 and 30 had synchronous and metachronous cancers, respectively. The proportion of unresectable CRC in patients with synchronous cancers was higher than that in patients with metachronous cancers (28.3% vs 3.3%, P = 0.015). The majority of the second primary cancers had occurred within 5 years. Kaplan-Meier survival analysis showed that the patients with metachronous cancers had a better prognosis than patients with synchronous cancers (P = 0.010). The patients who had undergone gastrectomy (P < 0.001) or CRC resection (P < 0.001) had a better prognosis than those who had not. In the multivariate analysis, synchronous cancer [hazard ratio (HR) = 6.8, 95% confidence interval (95%CI): 2.0-22.7, P = 0.002)] and stage III-IV gastric cancer (GC) [HR = 10.0, 95%CI: 3.4-29.5, P < 0.001)] were risk prognostic factor for OS, while patients who underwent gastrectomy was a protective prognostic factor for OS [HR = 0.2, 95%CI: 0.1-0.6, P = 0.002].
CONCLUSION Regular surveillance for metachronous cancer is necessary during postoperative follow-up. Surgical resection is the mainstay of therapy to improve the prognosis of DPGCC. The prognosis appears to be influenced by the stage of GC rather than the stage of CRC. Patients with synchronous cancer have a worse prognosis, and its treatment strategy is worth further exploration.
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Affiliation(s)
- Yi-Jia Lin
- Department of General Surgery (Gastrointestinal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Hua-Xian Chen
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Feng-Xiang Zhang
- Department of General Surgery (Gastrointestinal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Xian-Sheng Hu
- Department of General Surgery (Gastrointestinal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Hai-Juan Huang
- Follow-up office, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Jian-Hua Lu
- Follow-up office, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Ye-Zi Cheng
- Department of General Surgery (Gastrointestinal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Jun-Sheng Peng
- Department of General Surgery (Gastrointestinal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Lei Lian
- Department of General Surgery (Gastrointestinal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
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Merseburger AS, Agarwal N, Bhaumik A, Lefresne F, Karsh LI, Pereira de Santana Gomes AJ, Soto ÁJ, Given RW, Brookman-May SD, Mundle SD, McCarthy SA, Uemura H, Chowdhury S, Chi KN, Bjartell A. Apalutamide plus androgen deprivation therapy in clinical subgroups of patients with metastatic castration-sensitive prostate cancer: A subgroup analysis of the randomised clinical TITAN study. Eur J Cancer 2023; 193:113290. [PMID: 37708629 DOI: 10.1016/j.ejca.2023.113290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Whether disease burden in patients with metastatic castration-sensitive prostate cancer (mCSPC) predicts treatment outcomes is unknown. We assessed apalutamide treatment effect in TITAN patients with mCSPC by disease volume, metastasis number and timing of metastasis presentation. METHODS These protocol-defined and post hoc analyses of the phase III randomised TITAN study evaluated clinical outcomes in patients receiving 240 mg/day apalutamide (n = 525) or placebo (n = 527) plus androgen-deprivation therapy (ADT). Subgroups were defined by volume (high: visceral and ≥1 bone metastases or ≥4 bone lesions with ≥1 beyond vertebral column/pelvis), development of metastases per conventional imaging (synchronous: at initial diagnosis; metachronous: after localised disease) and oligometastases (≤5 bone-only metastases) or polymetastases (>5 in bone ± other locations or ≤5 in bone plus other locations). Overall survival (OS), radiographic or second progression-free survival, and time to prostate-specific antigen progression or castration resistance were assessed using Cox proportional hazards models. RESULTS Of 1052 patients, 63%, 81%, 54%, 27%, 5.7%, and 8.0% had high-volume, synchronous, synchronous/high-volume, synchronous/low-volume, metachronous/high-volume, and metachronous/low-volume disease, respectively. The OS benefit favoured apalutamide plus ADT versus ADT alone in synchronous/high-volume (hazard ratio = 0.68 [95% confidence interval: 0.53-0.87]; p = 0.002), synchronous/low-volume (0.65 [0.40-1.05]; p = 0.08), metachronous/high-volume (0.69 [0.33-1.44]; p = 0.32) and metachronous/low-volume (0.22 [0.09-0.55]; p = 0.001) subgroups. Apalutamide improved other clinical outcomes regardless of subgroup, with similar safety profiles. Most favourable outcomes were observed in oligometastatic disease. CONCLUSION TITAN patients derived a robust benefit with apalutamide plus ADT regardless of disease volume and timing of metastasis presentation without differences in safety, supporting early apalutamide intensification in mCSPC. CLINICAL TRIAL REGISTRATION NCT02489318.
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Affiliation(s)
- Axel S Merseburger
- University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Suite 5726, Salt Lake City, UT 84112, USA.
| | - Amitabha Bhaumik
- Janssen Research & Development, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Florence Lefresne
- Janssen Research & Development, 1400 McKean Road, Spring House, PA 19477, USA.
| | - Laurence I Karsh
- The Urology Center of Colorado, 2777 Mile High Stadium Circle, Denver, CO 80211, USA.
| | | | - Álvaro Juárez Soto
- Hospital Universitario de Jerez de la Frontera, Ronda de Circunvalación s/n, 11407 Jerez de la Frontera, Cádiz, Spain.
| | - Robert W Given
- Urology of Virginia, Eastern Virginia Medical School, 825 Fairfax Ave., Suite 310, Norfolk, VA 23507, USA.
| | - Sabine D Brookman-May
- Janssen Research & Development, 1400 McKean Road, Spring House, PA 19477, USA; Ludwig-Maximilians-University, Geschwister-Scholl-Platz 1, D-80539 München, Germany.
| | - Suneel D Mundle
- Janssen Research & Development, 700 US Highway 202 S, Raritan, NJ 08869, USA.
| | - Sharon A McCarthy
- Janssen Research & Development, 700 US Highway 202 S, Raritan, NJ 08869, USA.
| | - Hirotsugu Uemura
- Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan.
| | - Simon Chowdhury
- Guy's, King's, and St Thomas' Hospitals, Great Maze Pond, London SE1 9RT, UK; Sarah Cannon Research Institute, 93 Harley St, Marylebone, London W1G 6AD, UK.
| | - Kim N Chi
- BC Cancer and Vancouver Prostate Centre, 600 West 10th Avenue, Vancouver V5Z 1L3, British Columbia, Canada.
| | - Anders Bjartell
- Skåne University Hospital, Lund University, Jan Waldenströms gata 5, plan 2, 20502 Malmö, Sweden.
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Bahbahani B, Khan RN, Ahmed I, Al-Rabiy FN, Baqer M, Al-Terki A. Rare renaissance: Quadruple synchronous renal cell tumors in one kidney - A case report. Urol Case Rep 2023; 51:102574. [PMID: 37811540 PMCID: PMC10551615 DOI: 10.1016/j.eucr.2023.102574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Multifocality in renal tumors is a rare occurrence, but not unheard of. Commonly the different foci correspond to the same histological pathology, however co-existence with other renal lesions, including both malignant and benign tumors, have also been reported. Here we present a 57-year-old male, ex-smoker who exhibited four distinct histological tumors in an ipsilateral kidney; multilocular cystic clear cell renal cell carcinoma (RCC) of low malignant potential, clear cell papillary RCC, renal oncocytoma, and renomedullary interstitial cell tumor. To our knowledge this is the first time these four tumors were found in the same patient, let alone the same kidney.
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Affiliation(s)
- Basmah Bahbahani
- Urology Unit – Al Amiri Hospital, PO Box 4077, Safat, 13041, Kuwait
| | - Rehan Nasir Khan
- Urology Unit – Al Amiri Hospital, PO Box 4077, Safat, 13041, Kuwait
| | - Iftikhar Ahmed
- Urology Unit – Al Amiri Hospital, PO Box 4077, Safat, 13041, Kuwait
| | | | - Mohsen Baqer
- Pathology Unit – Al Amiri Hospital, PO Box 4077, Safat, 13041, Kuwait
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Nagpal SK, Khabra K, Ross G, Kirby AM. Ten-Year Outcomes of Stereotactic Body Radiotherapy for Oligometastatic Breast Cancer: Does Synchronous Oligometastatic Breast Cancer Benefit? Clin Oncol (R Coll Radiol) 2023; 35:736-743. [PMID: 37684189 DOI: 10.1016/j.clon.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
AIMS The benefit of stereotactic body radiotherapy (SBRT) in metachronous oligometastatic breast cancer (OMBC) has previously been described and its use in current clinical practice is established. The role of SBRT in the management of synchronous OMBC remains uncertain. The aim of this study was to compare outcomes of SBRT-treated synchronous OMBC with those of SBRT-treated metachronous OMBC. MATERIALS AND METHODS This was a retrospective analysis of consecutive extracranial OMBC patients treated with SBRT at a single institution between 2011 and 2022. Kaplan-Meier methods were used to calculate progression-free survival (PFS), overall survival, local control and distant control. Log-rank tests were used to test any differences. Cox regression was used for univariate and multivariate analyses to identify predictive factors. Toxicity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 5. RESULTS In total, 74 OMBC patients with 113 lesions were analysed. The median follow-up was 20 months (range 0-98). Seventy per cent of patients presented metachronously and 30% synchronously. 30 Gy in three fractions was most commonly prescribed, resulting in a median biologically effective dose (BED at α/β = 10) of 60 Gy (range 35.7-112.5 Gy). Forty-nine per cent of patients switched systemic therapy post-SBRT (median time to switch: 14 months, range 0-79). Two patients (2%) experienced grade 3 acute toxicities with no grade ≥4 toxicities. At 2 years overall survival was 92.4% and PFS 39.0%, local control 85.9% and distant control 37.0%. For metachronous and synchronous disease, respectively, 2-year local control rates were 86.5% and 85.8% and PFS rates were 35.3% and 48.3%. The median PFS of metachronous and synchronous disease were 18 months and 17 months, respectively (P = 0.86). Predictive factors on multivariate analysis were treated site for overall survival, change in systemic therapy post-SBRT for PFS and BED for local control. CONCLUSION Our data confirm SBRT as a well-tolerated treatment for OMBC with excellent local control rates regardless of metachronous or synchronous presentation. There is no suggestion that survival outcomes are inferior for synchronous disease. Further prospective studies are required to validate this finding.
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Affiliation(s)
- S K Nagpal
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
| | - K Khabra
- Research Data and Statistics Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - G Ross
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - A M Kirby
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
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Vu KV, Trong NV, Khuyen NT, Huyen Nga D, Anh H, Tien Trung N, Trung Thong P, Minh Duc N. Synchronous rectal adenocarcinoma and intestinal mantle cell lymphoma: A case report. World J Clin Cases 2023; 11:5772-5779. [PMID: 37727717 PMCID: PMC10506007 DOI: 10.12998/wjcc.v11.i24.5772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/18/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Mantle cell lymphoma (MCL) of the gastrointestinal tract is a rare malignancy, accounting for about 0.2% of malignant colorectal tumors. MCL synchronous with rectal adenocarcinoma is extremely rare. We know of only a few cases reported in the literature. We describe the case of a patient with synchronous rectal adenocarcinoma and intestinal MCL. CASE SUMMARY A 63-year-old man was admitted to our hospital due to abdominal pain and hematochezia over the past month. The patient was diagnosed with middle rectal cancer cT2N0M0 and underwent surgery. However, we found a large tumor in the small intestine during surgery. The patient underwent total mesorectal excision for rectal cancer and resectioning of the ileal segment containing the large mass. Pathology and immunohistochemistry revealed the presence of both rectal adenocarcinoma and pathognomonic MCL stage IIE presenting as multiple lymphomatous polyposis. The patient subsequently underwent RDHAP/RCHOP chemotherapy and was maintained with rituximab. A Positron Emission Tomography and Computed Tomography (PET/CT) scan showed that the disease responded well to treatment without tumor-increased metabolism in the gastrointestinal tract. CONCLUSION Synchronous rectal adenocarcinoma and intestinal MCL presenting as multiple lymphomatous polyposis are extremely rare. MCL is often discovered fortuitously when rectal cancer is diagnosed. The coexistence of these tumors poses treatment challenges.
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Affiliation(s)
- Kim-Van Vu
- Department of General Surgery, Vietnam National Cancer Hospital, Ha Noi 100000, Viet Nam
- Department of Practical Surgery, Hanoi Medical University, Ha Noi 100000, Viet Nam
| | - Nguyen-Van Trong
- Department of Oncology, Hanoi Medical University, Ha Noi 100000, Viet Nam
| | - Nguyen-Thi Khuyen
- Pathology and Molecular Biology Center, Vietnam National Cancer Hospital, Ha Noi 100000, Viet Nam
| | - Do Huyen Nga
- Department of Hematologic Oncology, Vietnam National Cancer Hospital, Ha Noi 100000, Viet Nam
| | - Hoang Anh
- Department of General Surgery, Vietnam National Cancer Hospital, Ha Noi 100000, Viet Nam
- Department of Practical Surgery, Hanoi Medical University, Ha Noi 100000, Viet Nam
| | - Nguyen Tien Trung
- Department of General Surgery, Vietnam National Cancer Hospital, Ha Noi 100000, Viet Nam
| | - Pham Trung Thong
- Department of General Surgery, Vietnam National Cancer Hospital, Ha Noi 100000, Viet Nam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Viet Nam
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18
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A. Okiyeh Y, Boukhannous I, El Moudane A, Ahmed J, Aurtz Tombet C, Barki A. Rectorrhagia revealing synchronous colonic adenocarcinoma and papillary renal cell carcinoma type 1, an exceptional case report. Urol Case Rep 2023; 49:102434. [PMID: 37303817 PMCID: PMC10248790 DOI: 10.1016/j.eucr.2023.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/13/2023] [Indexed: 06/13/2023] Open
Abstract
Colorectal cancer (CRC) is the most prevalent type of cancer affecting the gastrointestinal tract. The synchronous occurrence of CRC and renal cell carcinoma is rare, and even rarer when the renal cell carcinoma is of papillary origin, with only two cases reported in the literature. The synchronous detection of colon cancer and other primary tumors has been extensively studied and reported in the literature, either falling within the framework of well-defined clinical syndromes such as Lynch syndrome or occurring sporadically. This article aims to report and expose a literature review of the synchrony of colorectal cancer and renal carcinoma.
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Affiliation(s)
- Yacoub A. Okiyeh
- Department of Urology, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Morocco
| | - Ibrahim Boukhannous
- Department of Urology, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Morocco
| | - Anouar El Moudane
- Department of Urology, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Morocco
| | - Jdaini Ahmed
- Department of Urology, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Morocco
| | - Craig Aurtz Tombet
- Department of Urology, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Morocco
| | - Ali Barki
- Department of Urology, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Morocco
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19
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Al Marwani M, Alamri N, Allebdi A. Synchronous bilateral breast cancer with different histology. Radiol Case Rep 2023; 18:2491-2497. [PMID: 37214322 PMCID: PMC10196912 DOI: 10.1016/j.radcr.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 05/24/2023] Open
Abstract
Synchronous bilateral breast cancer is a rare clinical entity. And due to both an improved prognosis and growing life expectancy on early detection, we have brought interest in case of patient with synchronous breast cancer. This study reports a case of synchronous bilateral breast cancer in an asymptomatic 70-year-old woman with a positive family history of breast cancer. This woman was diagnosed through radiological screenings, including mammograms, ultrasonography, and magnetic resonance imaging (MRI). On histopathologic examination of the core biopsy, the left breast mass was a Nottingham grade I invasive carcinoma of no particular type. The right breast mass was a Nottingham grade I invasive carcinoma with a mucinous component. After lumpectomies ultrasonography of the surgical specimens confirmed a small biopsy-proven invasive ductal cancer hypoechoic mass in the left breast, with an irregular margins and proven mucinous cancer mass in the right breast. The case was finally diagnosed as synchronous bilateral breast cancer of different pathologic types (ductal and mucinous).
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20
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Jongbloed M, Bartolomeo V, Steens M, Dursun S, van de Lisdonk T, De Ruysscher DKM, Hendriks LEL. Treatment outcome of patients with synchronous oligometastatic non-small cell lung cancer in the immunotherapy era: Analysis of a real-life intention-to-treat population. Eur J Cancer 2023; 190:112947. [PMID: 37451182 DOI: 10.1016/j.ejca.2023.112947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
The standard first-line treatment for non-oncogene driven metastatic non-small cell lung cancer (NSCLC) is an immune checkpoint inhibitor (ICI) based strategy. Although guidelines increasingly advise adding local radical treatment (LRT) to patients with synchronous oligometastatic (sOMD) NSCLC responding to systemic therapy, this recommendation is based on the studies without ICI. Furthermore, the majority of published oligometastatic studies were not on an intention-to-treat basis, resulting in selection bias. Moreover, staging Positron Emission Tomography-Computed Tomography (PET-CT) and brain imaging were often not mandatory and definitions of oligometastatic were heterogeneous. Therefore, this study focused on a single centre retrospective series, including all adequately staged patients with sOMD NSCLC according to the European Organisation for Research and Treatment of Cancer definition (maximum of 5 metastases in 3 organs) that were treated with induction (chemo)-ICI and compared outcomes to those treated with chemotherapy only, with and without LRT. The primary end-points were median progression-free survival (PFS) and overall survival (OS) for patients treated with induction (chemo)-ICI versus chemotherapy. Out of 68 included patients, 38 (56%) eventually received LRT. With a median follow-up of 26.7 months, the median PFS was 19.0 months for (chemo)-ICI (n = 18) versus 6.8 for chemotherapy-only (n = 50) (HR 0.5, p = 0.03), the median OS was 19.3 versus 15.7 months, respectively (HR 0.8, p = 0.4). In patients having received LRT, median PFS was 19.0 months for (chemo)-ICI versus 8.3 for chemotherapy-only (HR 0.6, p = 0.2). In conclusion, an ICI-based systemic treatment is feasible and may result in superior survival outcomes. This should be investigated in prospective trials. Strategies to improve response rates to systemic treatment are also needed.
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Affiliation(s)
- M Jongbloed
- Department of Pulmonary Diseases, GROW - School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - V Bartolomeo
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical Surgical, Diagnostic and Pediatric Sciences, Pavia University, Pavia, Italy; Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center, GROW-School for Oncology and Reproduction (GROW), Maastricht, the Netherlands
| | - M Steens
- Department of Pulmonary Diseases, GROW - School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - S Dursun
- Department of Pulmonary Diseases, GROW - School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - T van de Lisdonk
- Department of Pulmonary Diseases, Catharina Hospital, Eindhoven, the Netherlands
| | - D K M De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center, GROW-School for Oncology and Reproduction (GROW), Maastricht, the Netherlands
| | - L E L Hendriks
- Department of Pulmonary Diseases, GROW - School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands.
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21
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Janeva S, Krabbe E, Parris TZ, Nasic S, Sundquist M, Karlsson P, Audisio RA, Olofsson Bagge R, Kovács A. Clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancer. Breast Cancer Res 2023; 25:36. [PMID: 37024949 PMCID: PMC10080895 DOI: 10.1186/s13058-023-01632-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/02/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND When ipsilateral multifocal primary breast cancer (IMBC) is detected, standard routine is to evaluate the largest tumor with immunohistochemistry (IHC). As all foci are not routinely characterized, many patients may not receive optimal adjuvant treatment. Here, we assess the clinical relevance of examining at least two foci present in patients with IMBC. METHODS Patients diagnosed and treated for IMBC at Sahlgrenska University Hospital (Gothenburg, Sweden) between 2012 and 2017 were screened. In total, 180 patients with ≥ 2 invasive foci (183 specimens) were assessed with IHC and included in this study. Expression of the estrogen (ER) and progesterone (PR) receptors, Ki67, HER2, and tumor grade were used to determine the molecular surrogate subtypes and discordance among the foci was recorded. An additional multidisciplinary team board was then held to re-assess whether treatment recommendations changed due to discordances in molecular surrogate subtype between the different foci. RESULTS Discordance in ER, PR, HER2, and Ki67 was found in 2.7%, 19.1%, 7.7%, and 16.9% of invasive foci, respectively. Discordance in the molecular surrogate subtypes was found in 48 of 180 (26.7%) patients, which resulted in therapy changes for 11 patients (6.1%). These patients received additional endocrine therapy (n = 2), chemotherapy (n = 3), and combined chemotherapy and trastuzumab (n = 6). CONCLUSION Taken together, when assessing at least two tumor foci with IHC, regardless of shared morphology or tumor grade between the different foci, 6.1% of patients with IMBC were recommended additional adjuvant treatment. A pathologic assessment using IHC of all foci is therefore recommended to assist in individualized treatment decision making.
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Affiliation(s)
- Slavica Janeva
- Department of Surgery, Sahlgrenska Breast Center, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
- Department of Clinical Pathology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ellen Krabbe
- Department of Surgery, Kungälv Hospital, Region Västra Götaland, Kungälv, Sweden
| | - Toshima Z Parris
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Sundquist
- Department of Surgery, Kalmar County Hospital, Kalmar, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Riccardo A Audisio
- Department of Surgery, Sahlgrenska Breast Center, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska Breast Center, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anikó Kovács
- Department of Clinical Pathology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Pathology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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22
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Jia MM, Yang B, Ding C, Yao YR, Guo J, Yang HB. Synchronous multiple primary malignant neoplasms in breast, kidney, and bilateral thyroid: A case report. World J Clin Cases 2023; 11:1513-1520. [PMID: 36926403 PMCID: PMC10011999 DOI: 10.12998/wjcc.v11.i7.1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/02/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Multiple primary malignant neoplasms (MPMNs) are rare, while synchronous MPMNs (SMPMNs) are even less common. Owing to the progression of medical technology and the extension of life expectancy, its incidence is gradually increasing.
CASE SUMMARY Although reports of breast and thyroid dual cancers are common, cases of an additional diagnosis of kidney primary cancer within the same individual are rare.
CONCLUSION We present a case of simultaneous MPMN of three endocrine organs, reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.
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Affiliation(s)
- Miao-Miao Jia
- Department of General Surgery, Shanxi Bethune Hospital/General Surgery Department, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Bin Yang
- Department of General Surgery, Shanxi Bethune Hospital/General Surgery Department, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Chao Ding
- Department of General Surgery, Shanxi Bethune Hospital/General Surgery Department, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Ya-Rong Yao
- Department of General Surgery, Shanxi Bethune Hospital/General Surgery Department, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Jun Guo
- Department of General Surgery, Shanxi Bethune Hospital/General Surgery Department, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Hai-Bo Yang
- Department of General Surgery, Shanxi Bethune Hospital/General Surgery Department, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
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Kazi M, Patkar S, Patel P, Kunte A, Desouza A, Saklani A, Goel M. Simultaneous resection of synchronous colorectal liver metastasis: Feasibility and development of a prediction model. Ann Hepatobiliary Pancreat Surg 2023; 27:40-48. [PMID: 36168272 PMCID: PMC9947373 DOI: 10.14701/ahbps.22-043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Backgrounds/Aims Timing of resection for synchronous colorectal liver metastasis (CRLM) has been debated for decades. The aim of the present study was to assess the feasibility of simultaneous resection of CRLM in terms of major complications and develop a prediction model for safe resections. Methods A retrospective single-center study of synchronous, resectable CRLM, operated between 2013 and 2021 was conducted. Upper limit of 95% confidence interval (CI) of major complications (≥ grade IIIA) was set at 40% as the safety threshold. Logistic regression was used to determine predictors of morbidity. Prediction model was internally validated by bootstrap estimates, Harrell's C-index, and correlation of predicted and observed estimates. Results Ninety-two patients were operated. Of them, 41.3% had rectal cancers. Major hepatectomy (≥ 4 segments) was performed for 25 patients (27.2%). Major complications occurred in 20 patients (21.7%, 95% CI: 13.8%-31.5%). Predictors of complications were the presence of comorbidities and major hepatectomy (area under the ROC curve: 0.692). Unacceptable level of morbidity (≥ 40%) was encountered in patients with comorbidities who underwent major hepatectomy. Conclusions Simultaneous bowel and CRLM resection appear to be safe. However, caution should be exercised when combining major liver resections with bowel resection in patients with comorbid conditions.
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Affiliation(s)
- Mufaddal Kazi
- Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Shraddha Patkar
- Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India,Homi Bhabha National Institute, Mumbai, India,Corresponding author: Shraddha Patkar, MS, MCh Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai 400012, India Tel: +91-2224177000, E-mail: ORCID: https://orcid.org/0000-0001-8489-6825
| | - Prerak Patel
- Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Aditya Kunte
- Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Ashwin Desouza
- Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Avanish Saklani
- Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Mahesh Goel
- Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
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Aboshabana R, Elmansi H, El-Enany N. Investigation of facile spectroscopic approaches for rapid calycosin determination in invitro biological samples and pharmaceuticals; application to the content uniformity of capsules. Spectrochim Acta A Mol Biomol Spectrosc 2023; 286:121904. [PMID: 36228490 DOI: 10.1016/j.saa.2022.121904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Calycosin, the major bioactive isoflavonoid inAstragali Radix and an important anti-viral drug with a variety of pharmacological actions, is being determined by five different spectroscopic methods. Two spectrophotometric methods have been investigated including measuring the absorption spectra at λmax = 270 nm and the first derivative spectra at λ = 288 nm for methods I and II, respectively. For the first time; the native fluorescence of calycosin is measured without adding any reagents. The fluorescence intensity was measured at 340 nm after excitation at 282 nm in method III. The fourth method involves the direct measuring of a first derivative spectrofluorimetric emission peak at 292 nm. In method V synchronous fluorescence spectra were recorded in methanol at Δλ = 70 nm. The linear range for the fluorescence-based methods was 0.05-1.0 µg/mL and for the UV-based methods was 0.5-10.0 µg/mL. The methods were validated per International Council of Harmonization (ICHQ2R1) guidelines. The limits of detection were found to be down to 0.11 and 0.12 µg/mL for the spectrophotometric methods, and 15.0, 18.0,16.0 ng/ mL, for the spectrofluorimetric approaches respectively, representing the high sensitivity. Accordingly, this permitted the quantitation of calycosin in spiked human plasma samples with satisfactory percentage recoveries (94.50.-102.50 %). The methods were utilized for calycosin analysis in different matrices including plasma and capsules with high precision and accuracy.
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Affiliation(s)
- Rasha Aboshabana
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Heba Elmansi
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.
| | - Nahed El-Enany
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt; Department of Pharmaceutical Chemistry, Faculty of Pharmacy, New Mansoura University, New Mansoura 7723730, Egypt
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25
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Al-Mansour M, Saif SA, Alharbi Z, Alhwaity AS, Almasrahi A, Alnejadi W, Hussain S, Aga SS, Khan MA, Almufti R, Absi A. The Outcomes of Diffuse Large B-cell Lymphoma Patients with Synchronous and Early Central Nervous System Involvement: A Single-Center Experience. Asian Pac J Cancer Prev 2023; 24:623-631. [PMID: 36853313 PMCID: PMC10162608 DOI: 10.31557/apjcp.2023.24.2.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Diffuse large B cell lymphoma (DLBCL) is the most commonly diagnosed subtype of non-Hodgkin's lymphoma (NHL). R-CHOP has significantly improved clinical outcomes in patients with DLBCL, however, its indication in the prevention of CNS relapse and recurrence is still inconsistent. Moreover, prophylactic methotrexate and/or cytarabine have been used prophylactically for DLBCL patients is at high risk of CNS relapse and to treat CNS DLBCL, however, their efficacy remains unclear. METHODS The aim of our retrospective study was to determine the incidence of CNS in-volvement in patients with DLBCL and to describe its risk factors and survival outcomes. RESULTS A total of 406 patients with DLBCL were identified, and 17 (4.2%) of DLBCL patients had CNS involvement i.e. 9 (2.2 %) at diagnosis and 8 (~2%) at relapse. The patients were younger, had advanced stage, high CNS-IPI, and had extra nodal involvement. Seven out of the 17 patients who survived received chemotherapy and a prophylactic methotrexate. Considering the CNS-IPI, of the 146 patients with high CNS-IPI at presentation, 18 received the prophylactic HDMTX and 3 (16.7%) of them had CNS relapse. Two (1.6%) out of 128 who did not receive the prophylactic HDMTX had CNS relapse. On the other hand, of the 223 patients with intermediate CNS-IPI, 25 received the prophylactic HDMTX and 2 (8%) of them had CNS relapse and in 198 patients who did not receive the prophylactic HDMTX, 2 (1.01%) had CNS relapse. The 5-year progression-free survival and overall survival rates for the entire cohort were 73% and 84%, respectively. The median OS for those who had CNS involvement was 17 months and the 2-year OS was 40%. CONCLUSION CNS involvement in DLBCL has a poor prognosis, thus, aggressive CNS-directed therapy should be considered, especially in young patients.
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Affiliation(s)
- Mubarak Al-Mansour
- Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Saif Ahmed Saif
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Ziyad Alharbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Abdulrhman Salem Alhwaity
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Ahmed Almasrahi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Waleed Alnejadi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Sarah Hussain
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Syed Sameer Aga
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Muhammad Anwar Khan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Roula Almufti
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Ahmed Absi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
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Imazu Y, Matsuo Y, Hokuto D, Yasuda S, Yoshikawa T, Kamitani N, Yoshida C, Sasaki T, Sho M. Distinct role of tumor-infiltrating lymphocytes between synchronous and metachronous colorectal cancer. Langenbecks Arch Surg 2023; 408:72. [PMID: 36720759 DOI: 10.1007/s00423-023-02815-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/18/2023] [Indexed: 02/02/2023]
Abstract
PURPOSE Tumor-infiltrating lymphocytes (TILs) may influence the prognosis of colorectal liver metastasis (CRLM). We assessed the prognostic value of evaluating TILs in the primary and metastatic sites of synchronous CRLM as well as metachronous CRLM. METHODS We examined 90 patients who underwent curative primary and liver metastasis resection for colorectal cancer. CD8+ TILs (cytotoxic T cells) or CD45RO+ TILs (memory T cells) in both primary and metastatic sites were simultaneously evaluated by immunohistochemistry. RESULTS Fifty-one patients had synchronous CRLM, and 39 patients had metachronous CRLM. In synchronous cases, the overall survival (OS) was significantly worse in patients with low CD8+ or CD45RO+ TILs in a metastatic site than in those with high CD8+ or CD45RO+ TILs (P = 0.017 and P = 0.005, respectively). Multivariate analysis showed that age ≥ 65 years (P = 0.043), maximum tumor size ≥ 30 mm (P = 0.003), primary N2-3 (P = 0.019), and low CD8+ TILs in metastatic site (P = 0.046) were independent poor prognostic factors. In contrast, in metachronous cases, OS was significantly worse in patients with low CD45RO+ TILs in a primary site than in those with high CD45RO+ TILs (P = 0.021). CD45RO+ TILs in a primary site (P = 0.044) were determined to be independent prognostic factor on multivariate analysis. CONCLUSIONS The immune microenvironment between synchronous and metachronous CRLM might be different, and these differences may affect its prognosis.
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Affiliation(s)
- Yuki Imazu
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yasuko Matsuo
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Daisuke Hokuto
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Satoshi Yasuda
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Takahiro Yoshikawa
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Naoki Kamitani
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Chieko Yoshida
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Toshihide Sasaki
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
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Alzahrani HA, Shati AA, Bawahab MA, Alamri AA, Hassan B, Patel AA, Ahmad MT, El Maksoud WA, Alsaleem MA. Students' perception of a synchronous versus synchronous distance learning during COVID-19 pandemic in a medical college, southwestern region of Saudi Arabia. BMC Med Educ 2023; 23:53. [PMID: 36691003 PMCID: PMC9870191 DOI: 10.1186/s12909-023-04034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/16/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND COVID-19 preventive measures required a drastic shift to online teaching-learning in most of countries. Institutions used different combinations of live online lectures (synchronous) requiring students to attend the class in real-time, as well as recorded lectures uploaded by the instructors to be accessed by students as per their own convenience (asynchronous). We undertook this study to assess and compare the perceptions of students regarding their learning experiences in the synchronous versus asynchronous mode of instruction using their teaching-learning during the compulsory online mode of instruction at the peak of the COVID-19 pandemic. METHODOLOGY This cross-sectional questionnaire-based study received responses from 122 final-year medical students studying at the College of Medicine, King Khalid University, Abha, Saudi Arabia. An online 5-point Likert scale-based questionnaire was used to collect data regarding experience and perception towards synchronous and asynchronous learning. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A P-value less than 0.05 was considered significant. RESULT All the students found both synchronous and asynchronous learning to be equally satisfying, enjoyable and comfortable. No statistically significant difference was found when both the methods were analyzed for enhancement of knowledge. The students opined that asynchronous learning helped them manage their time better whereas synchronous learning encouraged more interaction during the live lectures. CONCLUSION Overall, the students' perceptions regarding both synchronous and asynchronous online learning were positive. As both methods have their advantages/limitations, a mix of both synchronous and asynchronous methods may be adopted depending upon the content of the topic and the desired learning outcomes.
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Affiliation(s)
- Hassan A. Alzahrani
- Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
- Department of Medical Education, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mohammed A. Bawahab
- Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Abdulaziz A. Alamri
- Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Bahaeldin Hassan
- Department of Medical Education, College of Medicine, King Khalid University, Abha, Saudi Arabia
- Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ayyub A. Patel
- Department of Medical Education, College of Medicine, King Khalid University, Abha, Saudi Arabia
- Department of Biochemistry, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mohammad Tauheed Ahmad
- Department of Medical Education, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Walid Abd El Maksoud
- Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mohammed A. Alsaleem
- Department of Family and Community Medicine, College of Medicine, King Khalid University Abha, Abha, Saudi Arabia
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Goh SM, Wu YC, Lee RWK. A Presentation of Synchronous Ovarian and Endometrial Endometrioid Adenocarcinoma From a Case of Suspected Ruptured Ectopic Pregnancy. J Med Cases 2023; 14:31-35. [PMID: 36755996 PMCID: PMC9881485 DOI: 10.14740/jmc4011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
A 32-year-old woman of child-bearing age who initially underwent surgical laparoscopy for suspected ruptured ectopic pregnancy with elevated serum β-human chorionic gonadotropin (hCG) levels was unexpectedly found to have histologically diagnosed synchronous ovarian and endometrial endometrioid adenocarcinoma. She subsequently underwent another full completion staging surgery and adjuvant chemotherapy as she was unsuitable for fertility-sparing surgery. An elevated serum β-hCG level accompanied by clinical signs of acute abdominal pain, per vaginal bleeding, ultrasound features of abdominal free fluid in the pelvis and an adnexal mass warrants a high clinical suspicion for a ruptured ectopic pregnancy. However, it is important to recognize ovarian malignancy as a rare but differential diagnosis to suspected ectopic pregnancy in patients with acute abdomen. Fertility-sparing surgery may be considered for young patients seeking fertility, without compromising patient survival in women without synchronous gynecological cancers.
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Affiliation(s)
- Siak Ming Goh
- Department of Minimally invasive Surgery Unit, Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore,Corresponding Author: Siak Ming Goh, Department of Minimally invasive Surgery Unit, Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Yanlin Carly Wu
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 119074, Singapore
| | - Ryan Wai Kheong Lee
- Department of Minimally invasive Surgery Unit, Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
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Salehiabar M, Ghaffarlou M, Mohammadi A, Mousazadeh N, Rahimi H, Abhari F, Rashidzadeh H, Nasehi L, Rezaeejam H, Barsbay M, Ertas YN, Nosrati H, Kavetskyy T, Danafar H. Targeted CuFe 2O 4 hybrid nanoradiosensitizers for synchronous chemoradiotherapy. J Control Release 2023; 353:850-863. [PMID: 36493951 DOI: 10.1016/j.jconrel.2022.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/08/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
Multifunctional nanoplatforms based on novel bimetallic nanoparticles have emerged as effective radiosensitizers owing to their potential capability in cancer cells radiosensitization. Implementation of chemotherapy along with radiotherapy, known as synchronous chemoradiotherapy, can augment the treatment efficacy. Herein, a tumor targeted nanoradiosensitizer with synchronous chemoradiotion properties, termed as CuFe2O4@BSA-FA-CUR, loaded with curcumin (CUR) and modified by bovine serum albumin (BSA) and folic acid (FA) was developed to enhance tumor accumulation and promote the anti-cancer activity while attenuating adverse effects. Both copper (Cu) and iron (Fe) were utilized in the construction of these submicron scale entities, therefore strong radiosensitization effect is anticipated by implementation of these two metals. The structure-function relationships between constituents of nanomaterials and their function led to the development of nanoscale materials with great radiosensitizing capacity and biosafety. BSA was used to anchor Fe and Cu ions but also to improve colloidal stability, blood circulation time, biocompatibility, and further functionalization. Moreover, to specifically target tumor sites and enhance cellular uptake, FA was conjugated onto the surface of hybrid bimetallic nanoparticles. Finally, CUR as a natural chemotherapeutic agent was encapsulated into the developed bimetallic nanoparticles. With incorporation of all abovementioned stages into one multifunctional nanoplatform, CuFe2O4@BSA-FA-CUR is produced for synergistic chemoradiotherapy with positive outcomes. In vitro investigation revealed that these nanoplatforms bear excellent biosafety, great tumor cell killing ability and radiosensitizing capacity. In addition, high cancer-suppression efficiency was observed through in vivo studies. It is worth mentioning that co-use of CuFe2O4@BSA-FA-CUR nanoplatforms and X-ray radiation led to complete tumor ablation in almost all of the treated mice. No mortality or radiation-induced normal tissue toxicity were observed following administration of CuFe2O4@BSA-FA-CUR nanoparticles which highlights the biosafety of these submicron scale entities. These results offer powerful evidence for the potential capability of CuFe2O4@BSA-FA-CUR in radiosensitization of malignant tumors and opens up a new avenue of research in this area.
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Affiliation(s)
- Marziyeh Salehiabar
- Zanjan Pharmaceutical Biotechnology Research Center, Zanjan University of Medical Sciences, Zanjan, Iran; Joint Ukraine-Azerbaijan International Research and Education Center of Nanobiotechnology and Functional Nanosystems, Drohobych, Ukraine
| | | | - Ali Mohammadi
- Zanjan Pharmaceutical Biotechnology Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Navid Mousazadeh
- Zanjan Pharmaceutical Biotechnology Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossein Rahimi
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Abhari
- Department of Radiology, School of Paramedical Sciences, Zanjan University of Medical Sciences, Zanjan 45139- 56184, Iran
| | - Hamid Rashidzadeh
- Zanjan Pharmaceutical Biotechnology Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Leila Nasehi
- Department of Medical Laboratory, School of Paramedical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hamed Rezaeejam
- Department of Radiology, School of Paramedical Sciences, Zanjan University of Medical Sciences, Zanjan 45139- 56184, Iran
| | - Murat Barsbay
- Hacettepe University, Department of Chemistry, Beytepe, Ankara 06800, Türkiye
| | - Yavuz Nuri Ertas
- ERNAM-Nanotechnology Research and Application Center, Erciyes University, Kayseri 38039, Türkiye; Department of Biomedical Engineering, Erciyes University, Kayseri 38039, Türkiye
| | - Hamed Nosrati
- Zanjan Pharmaceutical Biotechnology Research Center, Zanjan University of Medical Sciences, Zanjan, Iran; Joint Ukraine-Azerbaijan International Research and Education Center of Nanobiotechnology and Functional Nanosystems, Drohobych, Ukraine.
| | - Taras Kavetskyy
- Joint Ukraine-Azerbaijan International Research and Education Center of Nanobiotechnology and Functional Nanosystems, Drohobych, Ukraine; Department of Materials Engineering, The John Paul II Catholic University of Lublin, 20-950 Lublin, Poland; Drohobych Ivan Franko State Pedagogical University, 82100 Drohobych, Ukraine.
| | - Hossein Danafar
- Zanjan Pharmaceutical Biotechnology Research Center, Zanjan University of Medical Sciences, Zanjan, Iran; Joint Ukraine-Azerbaijan International Research and Education Center of Nanobiotechnology and Functional Nanosystems, Drohobych, Ukraine.
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Suen P, Assaad M, Mishiyev D, Narula N, Xue W, Chalhoub M. Rare capture: The detection of synchronous diffuse large B-cell lymphoma and lung adenocarcinoma diagnosed by effusion cytology. Respir Med Case Rep 2023; 43:101852. [PMID: 37124057 PMCID: PMC10131125 DOI: 10.1016/j.rmcr.2023.101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/13/2023] [Indexed: 05/02/2023] Open
Abstract
The diagnosis of two primary synchronous malignancies in a single pleural effusion cytology specimen is exceedingly rare. We describe, to the best of our knowledge, the first reported case of lung adenocarcinoma and suspected relapse of Diffuse Large B-Cell Lymphoma (DLBCL) diagnosed from a solitary effusion sample.
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Affiliation(s)
- Phyllis Suen
- Department of Pulmonary and Critical Care, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
- Corresponding author.
| | - Marc Assaad
- Department of Internal Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
| | - Danil Mishiyev
- Department of Internal Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
| | - Naureen Narula
- Department of Pulmonary and Critical Care, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
| | - Wei Xue
- Department of Pathology and Laboratory Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
| | - Michel Chalhoub
- Department of Pulmonary and Critical Care, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
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Haddadi S, Touati R, Namaoui Y. [What to do in front of the association between colonic adenocarcinoma and lymphoma ?]. Ann Pathol 2023; 43:34-38. [PMID: 36064675 DOI: 10.1016/j.annpat.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/12/2018] [Accepted: 08/24/2022] [Indexed: 01/25/2023]
Abstract
Synchronous presentation of a colonic adenocarcinoma and lymphoma is extremely rare. We describe here, the sixth observation of a marginal zone B-cell lymphoma, which was incidentally diagnosed in a 77-year-old patient, who was operated for adenocarcinoma of hepatic flexure. This case shows the importance to be aware of this rare association and highlights the dilemma of its management.
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Affiliation(s)
- Saïd Haddadi
- Service de chirurgie générale, hôpital central de l'Armée, Mohamed Seghir Nekkache, Ain Naâdja BP 244, Kouba 16205, Alger, Algérie.
| | - Rezki Touati
- Service de chirurgie générale, hôpital central de l'Armée, Mohamed Seghir Nekkache, Ain Naâdja BP 244, Kouba 16205, Alger, Algérie
| | - Yasmine Namaoui
- Service d'anatomie cytologie pathologiques, hôpital central de l'Armée, Mohamed Seghir Nekkache, Ain Naâdja BP 244, 16205 Kouba, Alger, Algérie
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Photopoulos P, Tsonos C, Stavrakas I, Triantis D. Remote and In-Person Learning: Utility Versus Social Experience. SN Comput Sci 2023; 4:116. [PMID: 36573208 PMCID: PMC9769479 DOI: 10.1007/s42979-022-01539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
The massive transition from in-person to remote teaching increased the impact of technology on the everyday life of the universities. Without the face-to-face component, learning and teaching became a completely different experience for students and teachers. Recording the attitudes and perceptions of the undergraduate students on the new situation became necessary for the faculties to support them effectively. This research collected quantitative and qualitative data from 336 students of all the years of studies. The students preferred in-person teaching and reported higher engagement, learning, and understanding during classroom teaching. More senior students, who had developed face-to-face ties with their colleagues before the pandemic, found it easier to continue their interactions remotely. They were interested in matching learning with the duties and needs at the particular period of their life, despite their beliefs concerning the effectiveness of in-person teaching. The first-year students found it challenging to develop relationships remotely, and they were the most frustrated. Overall, students in the first years of their studies perceived remote teaching as dissatisfactory compared to the more senior students. Similar to other publications, the respondents of this study challenged the effectiveness of remote teaching and the concomitant transition from in-person to remote social relationships.
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Affiliation(s)
- Panos Photopoulos
- Department of Electrical and Electronic Engineering, University of West Attica, Athens, Greece
| | - Christos Tsonos
- Department of Physics, University of Thessaly, Lamia, Greece
| | - Ilias Stavrakas
- Department of Electrical and Electronic Engineering, University of West Attica, Athens, Greece
| | - Dimos Triantis
- Department of Electrical and Electronic Engineering, University of West Attica, Athens, Greece
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Lu SN, Huang C, Li LL, Di LJ, Yao J, Tuo BG, Xie R. Synchronous early gastric and intestinal mucosa-associated lymphoid tissue lymphoma in a Helicobacter pylori-negative patient: A case report. World J Clin Cases 2022; 10:12447-12454. [PMID: 36483796 PMCID: PMC9724545 DOI: 10.12998/wjcc.v10.i33.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/03/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mucosa-associated lymphoid tissue (MALT) lymphoma occurs largely in the digestive tract, with the stomach being the most commonly affected organ, followed by the small intestine, large intestine, and esophagus. It is rarely found in both the stomach and colon. Helicobacter pylori (H. pylori) infection is strongly associated with gastric MALT lymphoma, although there is a small number of H. pylori-negative gastric MALT lymphomas. Diagnosis of MALT lymphoma is challenging because of nonspecific symptoms and diverse presentations of endoscopic findings.
CASE SUMMARY We report a case of an asymptomatic patient who during screening endoscopy and was found to have stromal tumor-like submucosal uplift lesions in the stomach body and polypoid lesions in the rectum. After endoscopic resection, the patient was diagnosed with multiple early simultaneous gastrointestinal MALT lymphomas.
CONCLUSION This study may help improve our understanding of MALT lymphomas and multifocal lesions treated using early endoscopy.
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Affiliation(s)
- Sheng-Nian Lu
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Cheng Huang
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Ling-Li Li
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Lian-Jun Di
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Jin Yao
- Pathology Department, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Bi-Guang Tuo
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Rui Xie
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
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Baek HS, Kim SW, Lee ST, Park HS, Seo SY. Silent advanced large cell neuroendocrine carcinoma with synchronous adenocarcinoma of the colon: A case report. World J Gastrointest Oncol 2022; 14:2266-2272. [PMID: 36438698 PMCID: PMC9694276 DOI: 10.4251/wjgo.v14.i11.2266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/31/2022] [Accepted: 10/12/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Large cell neuroendocrine carcinoma (LCNEC) accounts for about 0.25% of colorectal cancer patients. Furthermore, synchronous LCNEC and adenocarcinoma coexistence in the colon is very rare. LCNEC are usually aggressive and have a poor prognosis. Usually, colorectal LCNEC patients complain of abdominal symptoms such as pain, diarrhea or hematochezia because it is often diagnosed as an advanced disease that accompanies metastatic lesions.
CASE SUMMARY We describe a case of relatively asymptomatic synchronous LCNEC and colon adenocarcinoma. A 62-year-old male patient visited our hospital due to anemia detected by a local health check-up. He did not complain of melena, hematochezia or abdominal pain. Physical examination was unremarkable and his abdomen was soft, nontender and nondistended with no palpable mass. Laboratory tests revealed anemia with hemoglobin 5.1 g/dL. Colonoscopy revealed an ulcerofungating lesion in the ascending colon and about a 1.5 cm-sized large sessile polyp in the sigmoid colon. Endoscopic biopsy of the ascending colon lesion revealed the ulcerofungating mass that was LCNEC and endoscopic mucosal resection at the sigmoid colon lesion showed a large polypoid lesion that was adenocarcinoma. Multiple liver, lung, bone and lymph nodes metastasis was found on chest/abdominal computed tomography and positron emission tomography. The patient was diagnosed with advanced colorectal LCNEC with liver, lung, bone and lymph node metastasis (stage IV) and synchronous colonic adenocarcinoma metastasis. In this case, no specific symptom except anemia was observed despite the multiple metastases. The patient refused systemic chemotherapy and was discharged after transfusion.
CONCLUSION We report a case of silent LCNEC of the colon despite the advanced state and synchronous adenocarcinoma.
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Affiliation(s)
- Hyeon Seok Baek
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si 56445, Jeollabuk-do, South Korea
| | - Sang Wook Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si 56445, Jeollabuk-do, South Korea
| | - Soo Teik Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si 56445, Jeollabuk-do, South Korea
| | - Ho Sung Park
- Department of Pathology, Jeonbuk National University Medical School, Jeonju-si 56445, Jeollabuk-do, South Korea
| | - Seung Young Seo
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si 56445, Jeollabuk-do, South Korea
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Wu H, Yang R, Huang M, Wei Y, Dong G, Jin H, Zeng Y, Yang Y. Slice spectra approach to synchronous Two-dimensional correlation spectroscopy analysis for milk adulteration discriminate. Spectrochim Acta A Mol Biomol Spectrosc 2022; 278:121332. [PMID: 35550992 DOI: 10.1016/j.saa.2022.121332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/16/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
The discrimination approach of adulterated milk was proposed combined synchronous two-trace two-dimensional (2T2D) correlation slice spectra at the characteristic wavebands of adulterant in milk with multivariate method. Two common adulterants, melamine and urea, were analyzed to demonstrate useful by the method. 2T2D (near infrared) NIR slice spectra at characteristic wavebands of adulterant were extracted from the synchronous 2T2D correlation spectra, and were input to construct the N-way partial least squares discriminant analysis (NPLS-DA) models. One-dimensional (1D) spectroscopy featuring all the present components in the samples combined with partial least squares discriminant analysis (PLS-DA) was also evaluated for comparison. The results indicated that for one kind of adulterant in model, prediction accuracies of slice spectral models were both 100% for melamine-adulterated and urea-adulterated samples discrimination. Moreover, for two kinds of adulterants in model, prediction accuracies of slice spectral models were 90.57% and 100% for melamine-adulterated and urea-adulterated discrimination, respectively, which was better than those of 1D whole models based on PLS-DA (only 81.13% and 98.15%, respectively). The comparison informs that the 2T2D slice spectra extracted at the characteristic wavebands of adulterant highlighted the adulterant spectral features and was obviously advantage to improve the discrimination accuracy. Meanwhile, the complexity of slice spectra is significantly reduced compared with the whole matrix of synchronous 2T2D correlation spectra.
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Affiliation(s)
- Haiyun Wu
- College of Engineering and Technology, Tianjin Agricultural University, Tianjin 300392, China
| | - Renjie Yang
- College of Engineering and Technology, Tianjin Agricultural University, Tianjin 300392, China.
| | - Mingyue Huang
- College of Engineering and Technology, Tianjin Agricultural University, Tianjin 300392, China
| | - Yong Wei
- College of Engineering and Technology, Tianjin Agricultural University, Tianjin 300392, China.
| | - Guimei Dong
- College of Engineering and Technology, Tianjin Agricultural University, Tianjin 300392, China
| | - Hao Jin
- College of Engineering and Technology, Tianjin Agricultural University, Tianjin 300392, China
| | - Yanan Zeng
- College of Engineering and Technology, Tianjin Agricultural University, Tianjin 300392, China
| | - Yanrong Yang
- College of Engineering and Technology, Tianjin Agricultural University, Tianjin 300392, China
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Pan B, Xu Y, Zhou Y, Yao R, Zhou X, Xu Y, Ren X, Xiao M, Zhu Q, Kong L, Mao F, Lin Y, Zhang X, Shen S, Sun Q. Long-term survival of screen-detected synchronous and metachronous bilateral non-palpable breast cancer among Chinese women: a hospital-based study (2003-2017). Breast Cancer Res Treat 2022; 196:409-422. [PMID: 36166112 PMCID: PMC9581860 DOI: 10.1007/s10549-022-06747-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/11/2022] [Indexed: 12/05/2022]
Abstract
Purpose Screen-detected unilateral non-palpable breast cancer (NPBC) shows favorable prognosis, whereas bilateral breast cancer (BBC), especially synchronous BBC (SBBC) manifests worse survival than unilateral breast cancer (BC). It remains unclear whether screen-detected bilateral NPBC has compromised survival and requires intensified treatment or favorable prognosis and needs de-escalating therapy.
Methods From 2003 to 2017, 1,075 consecutive NPBC patients were retrospectively reviewed. There were 988 patients with unilateral NPBC (UniNPBC), and 87 patients with ipsilateral NPBC + any contralateral BC [(N + AnyContra) PBC], including 32 patients with bilateral NPBC (BiNPBC) and 55 patients with ipsilateral NPBC + contralateral palpable cancer [(N + Contra) PBC]. Median follow-up time was 91 (48–227) months. Clinicopathological characteristics were compared between UniNPBC and BBC, whereas relapse-free survival (RFS) and overall survival (OS) among BBC subgroups. RFS and OS factors of BBC were identified. Results Compared to UniNPBC, patients with screen-detected bilateral BC had more invasive (85.1%, 74.8%), ER negative (26.4%, 17.1%), PR negative (36.8%, 23.5%), triple-negative (21.6%, 8.5%) BC as well as less breast conserving surgery (17.2%, 32.4%), radiotherapy (13.8%, 32.0%) and endocrine therapy (71.3%, 83.9%). 10 year RFS and OS rates of (N + AnyContra) PBC (72.8%, 81.5%), (N + Contra) PBC (60.6%, 73.9%), and synchronous (N + Contra) PBC (58.1%, 70.1%) were significantly compromised compared to UniNPBC (91.0%, 97.2%). RFS factors of BBC included pN3 (p = 0.048), lymphovascular invasion (p = 0.008) and existence of contralateral palpable interval BC (p = 0.008), while the OS relevant factor was pN3 (p = 0.018). Conclusion Screen-detected bilateral NPBC including SynBiNPBC and MetaBiNPBC showed good prognosis as UniNPBC so that the therapy of BiNPBC could be de-escalated and optimized according to UniNPBC. Contrarily, screen-detected ipsilateral NPBC with contralateral palpable BC [(N + Contra) PBC] manifested unfavorable survival worse than UniNPBC and synchronous (N + Contra) PBC had the worst survival among all subgroups, implying that these were actually bilateral interval BC and required intensified treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06747-5.
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Affiliation(s)
- Bo Pan
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Ying Xu
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Ru Yao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Xingtong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Yali Xu
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Xinyu Ren
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Mengsu Xiao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Lingyan Kong
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Songjie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
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Di Maida F, Grosso AA, Sforza S, Mari A, Lambertini L, Nardoni S, Cocci A, Siena G, Masieri L, Tuccio A, Carini M, Minervini A. Surgical Management of Synchronous, Bilateral Renal Masses: A 1-decade Referral Center Experience. Eur Urol Focus 2022; 8:1309-17. [PMID: 35123928 DOI: 10.1016/j.euf.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/01/2021] [Accepted: 01/14/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Management and decision-making in patients with bilateral renal masses are controversial. OBJECTIVE To report our experience of surgical management in patients with bilateral renal masses undergoing surgery at a high-volume center. DESIGN, SETTING, AND PARTICIPANTS We retrospectively collected data from patients treated with partial nephrectomy (PN) or radical nephrectomy for bilateral renal masses at a single referral institution between June 2008 and June 2019. Patient- and tumor-related features, timing (one vs two stage), and surgical approach (open vs robotic) were analyzed. SURGICAL PROCEDURE A one- versus two-stage strategy was adopted according to the opportunity to perform at least one PN using a clampless or selective-clamping approach, in order to avoid acute kidney injury. MEASUREMENTS Operative time, warm ischemia time, and intra- and postoperative complications were recorded. Histopathological results and tumor histology were assessed. RESULTS AND LIMITATIONS Overall, 41 patients were included. The median age was 67 yr and the median preoperative estimated glomerular filtration rate (eGFR) was 84 ml/min/1.73 m2. The median Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 8 (interquartile range [IQR] 7-8) for both sides. In 17 (42%) patients, a simultaneous approach was chosen, with a pure robotic approach in 11/17 cases, while among the 24 (58.6%) patients treated with a two-stage strategy, 15 (62.5%) were treated with a robotic approach on both sides. Intraoperative complications and postoperative major (CDC ≥3) complications were recorded in 7.3% and 4.9% of cases, respectively. The overall positive surgical margins rate was 2.4%. At a median follow-up of 42 (IQR 18-59) mo, the median eGFR was 73 (IQR 64-80) ml/min/1.73 m2, while disease-free survival and cancer-specific mortality were 90.2% and 7.3%, respectively. CONCLUSIONS Our experience underlines that both simultaneous and staged surgical treatment of patients with bilateral renal masses are feasible and safe if grounded on proper patient selection. PATIENT SUMMARY Management of patients with bilateral renal masses is challenging, given the heterogeneity of clinical scenarios and the need to optimize the timing of treatment to achieve maximal functional preservation while ensuring oncological efficacy.
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Xu Y, Zhang Y, Zheng CZ, Li C, Guo T, Xu Y. Thermal ablation versus hepatic resection for colorectal cancer with synchronous liver metastases: a propensity score matching study. Eur Radiol 2022; 32:6678-6690. [PMID: 35999370 DOI: 10.1007/s00330-022-09080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/09/2022] [Accepted: 08/03/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Several studies have compared the efficacy of hepatic resection (HR) and thermal ablation (TA) for unresectable tumors; however, results remain inconsistent. Most cohorts in previous studies were heterogeneous groups of synchronous colorectal liver metastases (CRLM) and extrahepatic metastases. This retrospective study aimed to compare the therapeutic efficacy between TA and HR in synchronous CRLM without extrahepatic metastases. METHODS Cases with initially synchronous CRLM without extrahepatic metastases between January 2007 and December 2018 were enrolled. Of the 448 cases, 346 received HR and 102 TA. Propensity score matching with a 1:1 ratio was used to improve the comparability between the HR and TA groups. Technical success, complications, disease-free survival (DFS), and overall survival (OS) were compared before and after matching. RESULTS All patients achieved technical success. Major complication rates in the HR and TA groups were, respectively, 36.7% and 8.8% (p < 0.001). Before matching, the 5-year OS and DFS (p = 0.004 and p = 0.020, respectively) were significantly higher in the HR group than in the TA group. After matching, no significant difference in the 5-year OS and DFS was found between the groups (p = 0.770 and p = 0.939, respectively). Local tumor progression rate was significantly higher in the TA group both before (p = 0.027) and after (p = 0.029) matching. CONCLUSIONS For patients with CRC with synchronous CRLM, TA and HR provide comparable OS and DFS. TA is preferable if complete ablation is predicted. KEY POINTS • Thermal ablation and hepatic resection provide comparable overall survival and disease-free survival. • Thermal ablation is a safe and effective treatment for patients with colorectal cancer with synchronous liver metastases and has a lower major complication rate and higher repeatability than hepatic resection. • Thermal ablation is preferable if complete ablation is predicted.
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Affiliation(s)
- Yun Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an road, 270, Shanghai, 200032, People's Republic of China
| | - Yuqin Zhang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an road, 270, Shanghai, 200032, People's Republic of China
| | - Charlie Zhilin Zheng
- Mechanical & Aerospace Engineering, University of California, 7400 Boelter Hall Los Angeles, Los Angeles, CA, 90095, USA
| | - Cong Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an road, 270, Shanghai, 200032, People's Republic of China
| | - Tian'an Guo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an road, 270, Shanghai, 200032, People's Republic of China
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an road, 270, Shanghai, 200032, People's Republic of China.
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Oetter N, Möst T, Weber M, Buchbender M, Rohde M, Foerster Y, Bauerschmitz C, Röschmann N, Adler W, Rau A, Meyerolbersleben M, Kesting M, Lutz R. COVID-19 pandemic and its impact on dental education: digitalization - progress or regress? Example of an online hands-on course. BMC Med Educ 2022; 22:591. [PMID: 35915461 PMCID: PMC9340732 DOI: 10.1186/s12909-022-03638-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Due to the SARS-CoV-2 pandemic and the accompanying contact restrictions, a new challenge arose for dental education. Despite the limited overall situation, it must be ensured that, in addition to theoretical content, practical skills in particular continue to be taught. Therefore, the aim of this study was to develop and implement an online hands-on course for dental students that ensures practical training, even during the pandemic. METHODS The newly developed course was held from April 2020 to March 2021. A total of six groups (each consisting of approximately 40-50 students) took part in the course. The participating students were in their 3rd, 4th or 5th year of study. The course taught theoretical basics (via an online platform) and promoted the learning of practical/surgical techniques on models such as bananas, pork bellies, or chicken thighs with live demonstrations (via ZOOM) and interactive post-preparation by students at home (and in a rotating small group of 3-7 students on site). Student self-evaluation (at the beginning and end of the course) and course evaluation were performed using questionnaires. The learning success was analyzed (through self-evaluations) using Wilcoxon signed-rank tests (significance level alpha = 0.05). RESULTS Concerning students´ self-evaluations, the theoretical knowledge, general surgical skills (such as surgical instrument handling), and specific surgical skills (such as performing a kite flap) improved during the course, with significant results (p < 0.001 for each). About 60% of the students rated the course overall as excellent (grades 9 or 10 on a Likert scale of 1 to 10). The technical implementation of the course was rated with a median of 9 (= very good, on a Likert scale of 1 to 10). 38.5% described the applicability of the skills learned for their later professional life as extremely good. CONCLUSIONS The results of this work suggest that, within the limitations of this study, the introduced concept of an online hands-on course could be an appropriate form of teaching practical dental skills, even during a pandemic. Further research is needed in the field of digital education for dental students.
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Affiliation(s)
- Nicolai Oetter
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany.
| | - Tobias Möst
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Manuel Weber
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Mayte Buchbender
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Maximilian Rohde
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Yannick Foerster
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Charlotte Bauerschmitz
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Nico Röschmann
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Werner Adler
- Department of Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 6, 91054, Erlangen, Germany
| | - Andrea Rau
- Department of Oral and Cranio-Maxillofacial Surgery, University of Greifswald, University Hospital Greifswald, Ferdinand-Sauerbruch-Straße DZ 7, 17475, Greifswald, Germany
| | - Marion Meyerolbersleben
- Institute for Innovation in Learning, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU), Dr.-Mack-Straße 77, 90762, Fürth, Germany
| | - Marco Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
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Pesaturo KA, Cho HJ, Castaneda AT, Reilly NV, Verbetsky CA. Teach BIG: A framework-based approach to online teaching and learning. Curr Pharm Teach Learn 2022; 14:933-937. [PMID: 36055701 DOI: 10.1016/j.cptl.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/03/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Cultivating a rich, engaging learning atmosphere in the online environment can be challenging for even the most seasoned educators. Technologies are rapidly advancing, traditional classroom teaching strategies are integrating into the online arena, and students and faculty are evolving to meet the demands of their new learning environments. PERSPECTIVE One method to enhance teaching and learning in the online environment is the framework-based approach, summarized here as teach "BIG." Teach "BIG" stands for a three-pronged method that incorporates creating balance, increasing engagement, and giving resources for success. IMPLICATIONS Incorporation of the techniques described here can enhance online teaching in the didactic, hybrid, and experiential settings. While these are not all-inclusive means, the teach "BIG" approach may provide a foundation upon which to build successful online educational programs.
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Affiliation(s)
- Kimberly A Pesaturo
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, 1215 Wilbraham Road, Springfield, MA 01119, United States.
| | - Hae Jin Cho
- Department of Pharmacotherapy, College of Pharmacy, The University of North Texas Health Science Center at Fort Worth, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107, United States.
| | - Andre T Castaneda
- College of Pharmacy, The University of North Texas Health Science Center at Fort Worth, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107, United States
| | - Neil V Reilly
- College of Pharmacy and Health Sciences, Western New England University, 1215 Wilbraham Road, Springfield, MA 01119, United States
| | - Christina A Verbetsky
- College of Pharmacy and Health Sciences, Western New England University, 1215 Wilbraham Road, Springfield, MA 01119, United States
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Piątkowski J, Garsta E, Śmigielski G, Markiet K, Wasąg B, Ciarka A, Mikaszewski B. Synchronous bilateral multifocal basal cell adenomas of the parotid gland-a case report. BMC Oral Health 2022; 22:314. [PMID: 35906614 PMCID: PMC9336062 DOI: 10.1186/s12903-022-02339-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background Bilateral parotid gland tumors account for up to 3% of cases. In this group, the vast majority are Warthin’s tumors. However, bilateral presentations of other parotid gland tumor entities is also possible, an example of which is a basal cell adenoma (BCA). Bilateral BCA is extremely rare, which could cause misdiagnosing it as a Warthin tumor. Case presentation The current study reports the unique case of a 48-year-old woman who presented with a 6-month history of slowly growing masses located bilaterally in the parotid region, surgically treated with 5-year follow-up (no recurrence, normal facial nerve function). Magnetic resonance imaging (MRI) revealed three lesions: two in the superficial and deep lobes of the right parotid gland, and one in the superficial lobe of the left parotid gland. A total parotidectomy with facial nerve preservation was performed on the right side, and superficial parotidectomy on the left side 6 months later. Histopathological examination confirmed that all three tumors were BCAs. Molecular analysis didn’t show any strong, potential of unknown clinical significance in the studied sample. Conclusions Multifocal bilateral lesions of the parotid gland are usually Warthin tumors. Detailed preoperative diagnostics including MRI and histopathological examination is essential to avoid misdiagnosing BCA and Warthin tumors. To our best knowledge, no case of synchronous bilateral multifocal basal cell adenomas of the parotid gland has been reported in English literature so far.
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Affiliation(s)
- Jakub Piątkowski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego Street, 80-214, Gdańsk, Poland
| | - Ewa Garsta
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego Street, 80-214, Gdańsk, Poland
| | - Grzegorz Śmigielski
- Department of Otolaryngology, University Clinical Centre Gdańsk, 17 Smoluchowskiego Street, 80-214, Gdańsk, Poland
| | - Karolina Markiet
- 2nd Department of Radiology, Faculty of Health Sciences, Medical University of Gdańsk, 17 Smoluchowskiego Street, 80-214, Gdańsk, Poland
| | - Bartosz Wasąg
- Department of Biology and Medical Genetics, Faculty of Medicine, Medical University of Gdańsk, 1 Dębinki Street, 80-211, Gdańsk, Poland
| | - Aleksandra Ciarka
- Department of Patomorphology, University Clinical Centre Gdańsk, 17 Smoluchowskiego Street, 80-214, Gdańsk, Poland
| | - Bogusław Mikaszewski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego Street, 80-214, Gdańsk, Poland.
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El-Awady M, Elmansi H, Belal F, Shabana RA. Insights on the Quantitative Concurrent Fluorescence-Based Analysis of Anti-COVID-19 Drugs Remdesivir and Favipiravir. J Fluoresc 2022; 32:1941-1948. [PMID: 35771341 PMCID: PMC9244323 DOI: 10.1007/s10895-022-02998-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
Abstract
We hereby introduce a sensitive fast straightforward spectrofluorometric method for the estimation of remdesivir and favipiravir. The two drugs are prescribed in some regimens to treat COVID‐19 pandemic disease, which is caused by SARS‐CoV‐2. The method is based on the first derivative synchronous spectrofluorimetry approach for the measurement of remdesivir and favipiravir. This was accomplished at 251 nm and 335 nm respectively using the first derivative order at delta lambda of 140 nm. A linear response with a correlation coefficient 0.9994 was achieved between the concentration and the derivative amplitudes in the ranges of 20.0–100.0 ng ml−1 and 40.0–100.0 ng ml−1 for remdesivir and favipiravir, respectively. The methods were validated for different parameters as stated by the pharmacopeial rules and were applied successfully for estimation of the studied drugs in their synthetic mixtures and in spiked human plasma samples. No significant difference was observed between the proposed and comparison methods as revealed from the analysis of data.
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Affiliation(s)
- Mohamed El-Awady
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt.,Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Delta University for Science and Technology, International Coastal Road, Gamasa 11152, Mansoura, Egypt
| | - Heba Elmansi
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt.
| | - Fathalla Belal
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt
| | - Rasha Abo Shabana
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt
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Xu S, Chai N, Tang X, Linghu E, Lu Z, Wang S, Li B. Outcomes of simultaneous endoscopic submucosal dissection for synchronous multiple gastric neoplastic lesions: a retrospective comparative study. Surg Endosc 2022; 36:4014-4024. [PMID: 34713340 DOI: 10.1007/s00464-021-08722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 08/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Simultaneous endoscopic submucosal dissection (ESD) is occasionally used in synchronous multiple gastric neoplastic lesions (SMGL). Therefore, we aim to evaluate the safety and efficacy of simultaneous ESD for SMGL compared with ESD for single lesions. METHODS A total of 1058 patients who received ESD from November 2006 to September 2019 were retrospectively evaluated in this study, including 997 single gastric epithelial lesions treated by single ESD (unifocal group) and 125 SMGL from 61 patients treated by simultaneous ESD (multifocal group). RESULTS The mean procedure time was 49.2 ± 41.30 min and 89.5 ± 66.33 min in unifocal group and multifocal group, respectively (p < 0.001). There was no significant difference in postoperative stenosis rate (1.0% vs. 0.0%, p = 1.000), intraoperative bleeding (endoscopic resection bleeding-c3 grade) rate (0.5% vs. 1.6%, p = 0.696), postoperative bleeding rate (1.3% vs. 0.0%, p = 0.461), and perforation rate (0.9% vs. 1.6%, p = 0.449) between the two groups. In addition, en block resection rate (p = 0.825), complete resection rate (p = 0.856) and curative resection rate (p = 0.709) were comparable between the two groups. During the follow-up, the local recurrence rate per patient: p = 0.363; per lesion: p = 0.235) was not significantly different between the two groups, however, the cumulative incidence of metachronous lesions after treatment was significantly higher in the multifocal group than the other group (10.0% vs. 3.2%, p = 0.004). CONCLUSIONS Simultaneous ESD is safe and effective in the treatment of SMGL. However, separate ESD is recommended for SMGL with longer procedure time. Besides, the metachronous gastric neoplastic lesions should be paid attention to during follow-up.
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Affiliation(s)
- Shanshan Xu
- Nankai University School of Medicine, Nankai University, Tianjin, 300071, China.,Department of Gastroenterology and Hepatology, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Ningli Chai
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Xiaowei Tang
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Enqiang Linghu
- Nankai University School of Medicine, Nankai University, Tianjin, 300071, China. .,Department of Gastroenterology and Hepatology, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
| | - Zhongsheng Lu
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Shasha Wang
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Bao Li
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
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Sresuganthi JR, Nallamuthu A, Boominathan P. Comparison of Client-Led A synchronous and Clinician-Led Synchronous Online Methods for Evaluation of Subjective Vocal Measures in Teachers: A Feasibility Study. J Voice 2022:S0892-1997(22)00127-8. [PMID: 35641382 DOI: 10.1016/j.jvoice.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND COVID-19 has transformed face to face teaching in classrooms to online and hybrid modes. Increased vocal intensity/ pitch to call attention of students and transact in the online class, inappropriate posture (head, neck & upper trunk) while using the laptop and other online tools cause vocal loading leading to voice related concerns in teachers. Tele voice assessment is a feasible alternative means to seek professional help in the current situation and possibly in the future too. Client-led asynchronous and clinician-led synchronous voice recordings for clinical vocal measures among school teachers were compared in this study. METHOD Twenty-five school teachers (21 females & four males) from Chennai consented to the study. Information of voice use, its impact on the day-to-day situations, self-perception of vocal fatigue, and their recorded voice sample (phonation & speaking) were obtained online (asynchronous mode). Within a period of ten days, the clinician-led synchronous session was planned on a mutually convenient time for obtaining voice samples through zoom call. The voice samples obtained were compared for clinical measures and perceptual voice evaluation. RESULTS Participants reported of vocal symptoms and increased vocal fatigue scores. The maximum phonation time values obtained through synchronous mode were lesser when compared to asynchronous mode. Also, variability was noted in the perceptual vocal measures of voice samples obtained through synchronous mode. During synchronous voice recording & evaluation, the background noise, internet stability, audio enhancement feature, and microphone placement & quality could be monitored, and immediate feedback was provided. Additionally, the asynchronous recording can be supplemented for synchronous recording, with clear instructions & demonstration. CONCLUSION This study explored the feasibility of using synchronous and asynchronous voice recording for voice analysis in school teachers. The findings could serve as a base to understand the advantages and challenges of using client-led asynchronous and clinician-led synchronous methods for estimating vocal measures.
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Affiliation(s)
| | - Aishwarya Nallamuthu
- Department of Speech Language & Hearing Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India.
| | - Prakash Boominathan
- Department of Speech Language & Hearing Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India
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45
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Ueda Y, Makino Y, Tochigi T, Ota Y, Hidaka H, Nakamura T, Beppu K, Ohuchida J, Odate S, Terasaka S, Nishida T, Yoshida M, Kimura R, Marutsuka K, Otomo N. A rare case of synchronous multiple primary malignancies of breast cancer and diffuse large B-cell lymphoma that responded to multidisciplinary treatment: a case report. Surg Case Rep 2022; 8:99. [PMID: 35585439 PMCID: PMC9117581 DOI: 10.1186/s40792-022-01456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple primary malignancies of breast cancer and diffuse large B-cell lymphoma (DLBCL) are rare. Here, we report a case of advanced breast cancer and DLBCL managed with multidisciplinary therapy preceded by surgery with a successful outcome. CASE PRESENTATION During a medical examination, a 71-year-old woman was diagnosed with a right breast mass, enlarged lymph nodes throughout the body, and a splenic tumor. The results of the clinical examination and imaging were suggestive of widely spread breast cancer with lymph node metastasis and malignant lymphoma with systemic metastasis. The histological evaluation of the biopsied breast tissue revealed human epidermal growth factor receptor 2 (HER2)-positive breast cancer, whereas the histological evaluation of the excised inguinal lymph node revealed DLBCL. 18F-FDG PET/computed tomography was performed, and it was determined that both breast cancer and DLBCL were in an advanced stage. Thus, mastectomy was performed, and the axillary lymph nodes showed mixed metastasis of breast cancer and DLBCL. Soon after, the R-CHOP therapy was initiated (375-mg/m2 rituximab, 2-mg/m2 vincristine, 50-mg/m2 doxorubicin, 750-mg/m2 cyclophosphamide, and 125-mg methylprednisolone). After irradiation of the spleen, trastuzumab was administered for 1 year. CONCLUSIONS We experienced a case of combined breast cancer and DLBCL, which was difficult to treat because both were in advanced stages. Thorough staging of the malignancy and discussion by a multidisciplinary team are necessary to determine the optimal treatment strategy.
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Affiliation(s)
- Yuichi Ueda
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan.
| | - Yuko Makino
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
| | - Taro Tochigi
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
| | - Yoshikazu Ota
- Medical City Tobu Hospital, 3633-1 Tateno, Miyakonojo, Miyazaki, 885-0035, Japan
| | - Hideki Hidaka
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
| | - Takeshi Nakamura
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
| | - Kiichiro Beppu
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
| | - Jiro Ohuchida
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
| | - Seiichi Odate
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
| | - Soshi Terasaka
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
| | - Takahiro Nishida
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan.,Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Masaki Yoshida
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
| | - Ryuichiro Kimura
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
| | - Kousuke Marutsuka
- Department of Diagnostic Pathology, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
| | - Naoki Otomo
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Miyazaki, 880-8510, Japan
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Iglesias TG, Affeld MF, Zuniga A, Olmos R, Baudrand RF, San Francisco IF. Synchronous bilateral laparoscopic adrenalectomy: Surgical technique and perioperative results of a 13-years' experience. Actas Urol Esp 2022; 46:245-251. [PMID: 35260373 DOI: 10.1016/j.acuroe.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/21/2021] [Accepted: 05/02/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Laparoscopic surgery is the standard approach for the treatment of adrenal glands. Bilateral synchronous adrenalectomy is rarely performed, and evidence about this procedure is limited. Our objective is to report our 13-year experience with synchronous laparoscopic bilateral adrenalectomy, evaluating its feasibility, safety, and perioperative outcomes. PATIENTS AND METHODS A total of 23 consecutive patients undergoing synchronous bilateral laparoscopic adrenalectomy between 2007 and 2020 in a single academic center were included. Variables evaluated were operative time, estimated blood loss, conversion to open surgery, postoperative complications, mortality, and postoperative length of stay. RESULTS Mean operative time was 189.3 ± 48.9 min. Mean estimated blood loss was 163.0 ± 201.3 mL. There were no conversions to open surgery. Five patients had postoperative complications, three of those were major. No patient died in the perioperative period. Median postoperative length of stay was three days (range 1-30). At pathology analysis, 15 patients had bilateral adrenal hyperplasia, 2 unilateral adrenal hyperplasia and a contralateral benign tumor, 1 unilateral adrenal hyperplasia and a normal contralateral gland, 1 unilateral adenoma, 3 bilateral pheochromocytomas and 1 bilateral myelolipoma. CONCLUSION Synchronous bilateral laparoscopic adrenalectomy is a feasible and safe technique. A multidisciplinary and experienced team involving anesthesiologists and endocrinologists is required.
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Affiliation(s)
- T G Iglesias
- Departamento de Urología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M F Affeld
- Departamento de Urología, Hospital Intercultural de Nueva Imperial, Nueva Imperial, Chile
| | - A Zuniga
- Departamento de Urología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Program of Adrenal Diseases, CETREN UC, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Olmos
- Program of Adrenal Diseases, CETREN UC, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento of Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R F Baudrand
- Program of Adrenal Diseases, CETREN UC, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento of Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - I F San Francisco
- Departamento de Urología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Program of Adrenal Diseases, CETREN UC, Pontificia Universidad Católica de Chile, Santiago, Chile.
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47
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Hsiao TH, Wu CC, Tseng HH, Chen JH. Synchronous but separate neuroendocrine tumor and high-grade dysplasia/adenoma of the gall bladder: A case report. World J Clin Cases 2022; 10:2322-2329. [PMID: 35321155 PMCID: PMC8895191 DOI: 10.12998/wjcc.v10.i7.2322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/22/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gall bladder neuroendocrine tumors (GB-NETs) are rare, accounting for less than 0.5% of all NETs. They usually lack specific symptoms and are difficult to diagnose preoperatively. In most cases, GB-NETs are incidentally found after cholecystectomy for large polyps or cholelithiasis, causing acute or chronic cholecystitis. The coexistence of GB-NET and GB adenocarcinoma is very rare.
CASE SUMMARY We report a case of synchronous but separate GB-NET and adenoma with high-grade dysplasia in a patient who had undergone surgery for a progressively growing GB polypoid lesion. To the best of our knowledge, simultaneous separation of NETs and cancer in the GB has not been reported.
CONCLUSION Coexistent GB carcinoid tumor and adenocarcinoma is rare. A surveillance program is needed for these large GB polyps.
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Affiliation(s)
- Tsung-Hsien Hsiao
- Division of Gastroenterology and Hepatology, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Chao-Chuan Wu
- Department of Surgery, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Hui-Hwa Tseng
- Department of Pathology, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Jiann-Hwa Chen
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
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Wan M, Zhao D, Liu W, Xu X, Zheng B, Xiao S, Sun Y, Wang W. Clinical characteristics and prognosis of patients with hypopharyngeal cancers with multiple primary cancers: A propensity score matched analysis. Am J Otolaryngol 2022; 43:103297. [PMID: 34894448 DOI: 10.1016/j.amjoto.2021.103297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/05/2021] [Accepted: 11/28/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE This study aimed to identify the clinical characteristics of hypopharyngeal squamous cell carcinoma (HPSCC) patients with multiple primary cancers (MPCs) and to compare differences between patients with metachronous and synchronous MPCs. MATERIAL AND METHODS This study included 219 patients with HPSCC treated at our center between 2008 and 2020; the clinical characteristics and prognosis of 66 patients with MPCs were analyzed. Propensity score matching (PSM) was used to balance the factors between patients with synchronous and metachronous MPCs. RESULTS Sixty-six patients with HPSCC (66/219, 30.1%) experienced MPCs, of which 29 were synchronous and 37 were metachronous. The esophagus (n = 39, 59.1%), lung (n = 10, 15.2%), and oropharynx (n = 4, 6.1%) were the three most common sites of MPCs in both the synchronous and metachronous groups. More patients with synchronous MPCs were stage T1-2 (82.8% vs. 59.5%, P = 0.041) compared to those with metachronous MPCs. Among the 24 pairs of patients after PSM, patients with metachronous MPCs had higher 3-year progression-free survival (PFS) (52.5% vs. 16.3%, P < 0.001) and overall survival (OS) (58.5% vs. 22.1%, P = 0.001) than those with synchronous cancers. Multivariate Cox analysis showed that patients with synchronous MPCs had shorter PFS (HR 4.45, 95% CI 1.819-10.885, P = 0.001) and OS (HR 3.918, 95% CI 1.591-9.645, P = 0.003). CONCLUSION MPCs are common among patients with HPSCC, and patients with metachronous MPCs had better survival than those with synchronous MPCs. Clinicians should be aware of the possibility of MPCs in patients with HPSCC and optimize treatment to improve outcomes.
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Meerveld-Eggink A, Graafland N, Wilgenhof S, Van Thienen JV, Lalezari F, Grant M, Szabados B, Abu-Ghanem Y, Kuusk T, Boleti E, Blank CU, Haanen JBAG, Powles T, Bex A. Primary Renal Tumour Response in Patients Treated with Nivolumab and Ipilimumab for Metastatic Renal Cell Carcinoma: Real-world Data Assessment. EUR UROL SUPPL 2022; 35:54-8. [PMID: 35024632 DOI: 10.1016/j.euros.2021.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Following CARMENA and SURTIME, patients with metastatic renal cell carcinoma (mRCC) and International Metastatic RCC Database Consortium (IMDC) intermediate and poor risk receive systemic therapy with the primary tumour (primary) in place, with the option of deferred cytoreductive nephrectomy (CN) in responding patients. We retrospectively analysed the safety and efficacy of first-line nivolumab/ipilimumab in 71 primary mRCC patients (42.3% IMDC poor risk; 43.6% with more than three metastatic sites). The baseline mean primary diameter was 9.3 cm and median follow-up was 11.5 mo. Of 69 patients with at least one follow-up computed tomography scan, 23 (33.3 %) had a partial response (PR) of the primary after a median of 4.8 mo, which was associated with a 91.3% overall response rate at metastatic sites (MSs) and absence of progressive disease, irrespective of the IMDC risk. The complete response (CR) rate at MSs (n = 7 [10.1%]) is similar to the CR rate in CheckMate 214. Thirteen deferred CNs were performed (18.8%) after a median of 13 mo, rendering four patients disease free. Only 4.3% of primaries progressed; grade 3–4 immune-related adverse events occurred in 31.9%. Irrespective of the IMDC risk, patients with a PR in the primary had a 1-yr overall survival rate of 89% versus 67% in those without (p = 0.012). Patient summary Patients with metastatic kidney cancer receiving immunotherapy with nivolumab and ipilimumab had superior response at metastatic sites and better survival irrespective of International Metastatic RCC Database Consortium (IMDC) risk.
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50
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Abdel Moneim MM. Green & Sensitive pH-dependent Spectrofluorimetric Assay of Tamsulosin Hydrochloride and Tadalafil in their New Combined Formulation for Benign Prostatic Hyperplasia: Application to Spiked Human Plasma. J Fluoresc 2022; 32:1581-1590. [PMID: 35576092 PMCID: PMC9270271 DOI: 10.1007/s10895-022-02938-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
Sensitive and green spectrofluorimetric methods were utilized for Tamsulosin Hydrochloride (TAM) and Tadalafil (TDL) assessment in bulk and their newly available combined mixture for benign prostatic hyperplasia and erectile dysfunction. The technique relies on measuring native fluorescence of TAM in 0.1 N HCl at 324 nm and TDL in 0.1 N NaOH at 348 nm due to their different fluorimetric behavior in acidic and basic media where TAM has no fluorescence in basic medium and vice versa. To achieve better regression, the spectra were derivatized allowing determination of TAM at 314 nm and TDL at 320 and 380 nm (peak to peak) by applying third and first derivative, respectively. In addition, pH-dependent "constant-wavelength synchronous" spectrofluorimetry was applied where TAM and TDL were determined at 218 nm in acidic medium and at 268 nm in basic medium, respectively. Finally, derivatizing the latter emission spectra allowed determination of TAM and TDL at 232 nm and at 262 and 278 nm (peak to peak), respectively. Acidic and basic emission spectra where scanned at λexc = 225 nm (for TAM assay) and at λexc = 247 nm (for TDL assay), respectively. Fluorescence-concentration plots were linear and the proposed methods were used for analysis of TAM and TDL combined laboratory prepared formulation. These procedures are green, sensitive and of low cost which make them suitable for quality control analysis of the two drugs. In addition, the high selectivity of the proposed methods was tested by successfully applying them for TAM and TDL assay in plasma samples.
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Affiliation(s)
- Mona M. Abdel Moneim
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
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