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Zheng C, Zha X, Cai S, Cui J, Li Q, Ye Z. Interval-based sparse ensemble multi-class classification algorithm for terahertz data. Heliyon 2024; 10:e27743. [PMID: 38509892 PMCID: PMC10950663 DOI: 10.1016/j.heliyon.2024.e27743] [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: 08/25/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
Terahertz time-domain spectroscopy (THz-TDS) has been widely used for food and drug identification. The classification information of a THz spectrum usually does not exist in the whole spectral band but exists only in one or several small intervals. Therefore, feature selection is indispensable in THz-based substance identification. However, most THz-based identification methods empirically intercept the low-frequency band of the THz absorption coefficients for analysis. In order to adaptively find out important intervals of the THz spectra, an interval-based sparse ensemble multi-class classifier (ISEMCC) for THz spectral data classification is proposed. In ISEMCC, the THz spectra are first divided into several small intervals through window sliding. Then the data of training samples in each interval are extracted to train some base classifiers. Finally, a final robust classifier is obtained through a nonnegative sparse combination of these trained base classifiers. With l 1 -norm, two objective functions that based on Mean Square Error (MSE) and Cross Entropy (CE) are established. For these two objective functions, two iterative algorithms based on the Alternating Direction Method of Multipliers (ADMM) and Gradient Descent (GD) are built respectively. ISEMCC transforms the problem of interval feature selection and decision-level fusion into a nonnegative sparse optimization problem. The sparse constraint ensures only a few important spectral segments are selected. In order to verify the performance of the proposed algorithm, comparative experiments on identifying the origin of Bupleurum and the harvesting year of Tangerine peel are carried out. The base classifiers used by ISEMCC are Support Vector Machine (SVM) and Decision Tree (DT). The experimental results demonstrate that the proposed algorithm outperforms six typical classifiers, including Random Forest (RF), AdaBoost, RUSBoost, ExtraTree, and the two base classifiers, in terms of classification accuracy.
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Affiliation(s)
- Chengyong Zheng
- School of Mathematics and Computational Science, Wuyi University, Jiangmen, 529000, China
| | - Xiaowen Zha
- School of Mathematics and Computational Science, Wuyi University, Jiangmen, 529000, China
| | - Shengjie Cai
- Shenzhen Kangguan Technology Co., LTD, Shenzhen, 518129, China
| | - Jing Cui
- Guangdong Jiangmen Chinese Traditional Medicine College, Jiangmen, 529020, China
| | - Qian Li
- Terahertz Technology Application (Guangdong) Co., Ltd, Guangzhou, 510700, China
| | - Zhijing Ye
- Faculty of Innovation Engineering, Macau University of Science and Technology, Taipa, Macau
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Kanaka S, Matsuda A, Yamada T, Yokoyama Y, Matsumoto S, Takahashi G, Sonoda H, Ohta R, Uehara K, Shinji S, Iwai T, Takeda K, Sekiguchi K, Kuriyama S, Miyasaka T, Yoshida H. Oncologic investigation of the interval from stent placement to surgery in patients with obstructive colorectal cancer. Surg Today 2024:10.1007/s00595-024-02818-w. [PMID: 38526561 DOI: 10.1007/s00595-024-02818-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/08/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Self-expandable metallic stent (SEMS) placement is widely used as a bridge to surgery (BTS) procedure for obstructive colorectal cancer. However, evidence regarding the optimal interval between SEMS placement and elective surgery is lacking. METHODS We retrospectively collected data from patients with BTS between January 2013 and October 2021. Inverse probability treatment-weighted propensity score analyses were used to compare short- and long-term outcomes between the short-interval (SI) and long-interval (LI) groups, using a cutoff of 20 days. RESULTS In total, 138 patients were enrolled in this study (SI group, n = 63; LI group, n = 75). In the matched cohort, the patients' backgrounds were well balanced. The incidence of Clavien-Dindo grade ≥ II postoperative complications was not significantly different between the SI and LI groups (19.0% vs. 14.0%, P = 0.47). There were no significant differences between the SI and LI groups in the 3-year recurrence-free survival (68.0% vs. 76.4%, P = 0.73) or 3-year overall survival rates (86.0% vs. 90.6%, P = 0.72). CONCLUSIONS A longer interval did not deteriorate the oncological outcomes. Individual perioperative management with an appropriate interval to improve the patient's condition is required to ensure safe surgery.
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Affiliation(s)
- Shintaro Kanaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yasuyuki Yokoyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-Cho, Nakahara-Ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Satoshi Matsumoto
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Goro Takahashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Hiromichi Sonoda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Ryo Ohta
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-Cho, Nakahara-Ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Kay Uehara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Seiichi Shinji
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Takuma Iwai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Kohki Takeda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Kumiko Sekiguchi
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-Cho, Nakahara-Ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Sho Kuriyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Toshimitsu Miyasaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
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Jiang SJ, Diaconescu AC, McEwen DP, McEwen LN, Chang AC, Lin J, Reddy RM, Lynch WR, Bonner S, Lagisetty KH. Factors affecting timing of surgery following neoadjuvant chemoradiation for esophageal cancer. Heliyon 2023; 9:e23212. [PMID: 38144324 PMCID: PMC10746453 DOI: 10.1016/j.heliyon.2023.e23212] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/26/2023] Open
Abstract
Background Neoadjuvant chemoradiation with esophagectomy is standard management for locally advanced esophageal cancer. Studies have shown that surgical timing following chemoradiation is important for minimizing postoperative complications, however in practice timing is often variable and delayed. Although postoperative impact of surgical timing has been studied, less is known about factors associated with delays. Materials and methods A retrospective review was performed for 96 patients with esophageal cancer who underwent chemoradiation then esophagectomy between 2018 and 2020 at a single institution. Univariable and stepwise multivariable analyses were used to assess association between social (demographics, insurance) and clinical variables (pre-operative weight, comorbidities, prior cardiothoracic surgery, smoking history, disease staging) with time to surgery (≤8 weeks "on-time" vs. >8 weeks "delayed"). Results Fifty-one patients underwent esophagectomy within 8 weeks of chemoradiation; 45 had a delayed operation. Univariate analysis showed the following characteristics were significantly different between on-time and delayed groups: weight loss within 3 months of surgery (3.9 ± 5.1 kg vs. 1.5 ± 3.6 kg; P = 0.009), prior cardiovascular disease (29% vs. 49%; P = 0.05), prior cardiothoracic surgery (4% vs. 22%; P = 0.01), history of ever smoked (69% vs. 87%; P = 0.04), absent nodal metastasis on pathology (57% vs. 82%; P = 0.008). Multivariate analysis demonstrated that prior cardiothoracic surgery (OR 8.924, 95%CI 1.67-47.60; P = 0.01) and absent nodal metastasis (OR 4.186, 95%CI 1.50-11.72; P = 0.006) were associated with delayed surgery. Conclusions Delayed esophagectomy following chemoradiotherapy is associated with prior cardiothoracic surgery and absent nodal metastasis. Further investigations should focus on understanding how these factors contribute to delays to guide treatment planning and mitigate sources of outcome disparities.
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Affiliation(s)
- Shannon J. Jiang
- Washington University in St. Louis, Department of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Andrada C. Diaconescu
- University of Alabama at Birmingham, Department of Surgery, 1720 University Blvd, Birmingham, AL, 35294, USA
| | - Dyke P. McEwen
- University of Michigan, Department of Pharmacology, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Laura N. McEwen
- University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Andrew C. Chang
- University of Michigan, Department of Surgery, Section of Thoracic Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Jules Lin
- University of Michigan, Department of Surgery, Section of Thoracic Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Rishindra M. Reddy
- University of Michigan, Department of Surgery, Section of Thoracic Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - William R. Lynch
- University of Michigan, Department of Surgery, Section of Thoracic Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Sidra Bonner
- University of Michigan, Department of Surgery, Section of General Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Kiran H. Lagisetty
- University of Michigan, Department of Surgery, Section of Thoracic Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
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Uccella S, Bosco M, Mezzetto L, Garzon S, Maggi V, Giacopuzzi S, Antonelli A, Pinali L, Zorzato PC, Festi A, Polati E, Montemezzi S, De Manzoni G, Franchi MP, Veraldi GF. Major vessel resection for complete cytoreduction in primary advanced and recurrent ovarian malignancies: A case series and systematic review of the literature - pushing the boundaries in oncovascular surgery. Gynecol Oncol 2023; 179:42-51. [PMID: 37922861 DOI: 10.1016/j.ygyno.2023.10.021] [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: 08/02/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Oncovascular surgery (the removal of major blood vessels infiltrated by cancer) is challenging but can be key to achieve complete cytoreduction in patient with advanced ovarian cancer. The aim of this study was to review the literature on oncovascular surgery in ovarian cancer and to report the details of all the cases performed at our institution. METHODS We retrospectively reviewed the database of ovarian cancer patients who underwent debulking surgery at the Department of Obstetrics and Gynecology of Verona University between January 2021 and 2023. Patients with at least one major vessel resection during cytoreduction were identified. We then systematically review the literature searching Pubmed and Embase from inception to January 2023 to report all cases of surgery for ovarian cancer with concomitant major vessel resection. RESULTS Five patients with advanced/recurrent ovarian cancer underwent major vascular resection at our institution. Vascular involvement was preoperatively identified in all cases and no case of vascular resection was performed after accidental injury. The major vessels removed were the inferior vena cava (n = 2), the common iliac veins (n = 2), the external iliac arteries (n = 2), the left common iliac artery (n = 1), and the left external iliac vein (n = 1). All patients underwent other non-gynecological cytoreductive procedures prior to vessel removal and had R0 obtained. Three (60%) patients experienced one or more postoperative complications. The literature search identified a total of seven cases of major vessels resection in ovarian cancer surgery. A single or multiple major vessels were removed in two (28.6%) and five (72.4%) cases, respectively. All the seven patients underwent vascular reconstruction. Four (57.1%) patients reported postoperative complications. Overall, 66.7% of the 12 total identified patients were free from disease at the last follow-up [median 15.5 months (range 5-25)]. CONCLUSIONS Oncovascular surgery is feasible in selected patients with ovarian cancer, provided that a multidisciplinary approach with customized care is available.
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Affiliation(s)
- Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Luca Mezzetto
- Unit of Vascular Surgery, Azienda Ospedaliera Universitaria Integrata, University of Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Veronica Maggi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Giacopuzzi
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Lucia Pinali
- Radiology Department, Verona University Hospital, Verona, Italy
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Anna Festi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Enrico Polati
- Department of Anaesthesia and Intensive Care B, University of Verona, DAI Emergenza e Terapie Intensive, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | | | - Giovanni De Manzoni
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | - Massimo P Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Gian Franco Veraldi
- Unit of Vascular Surgery, Azienda Ospedaliera Universitaria Integrata, University of Verona, Italy
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Giannopoulos S, Makhecha K, Madduri S, Garcia F, Baumgartner TC, Stefanidis D. What is the ideal timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis? Surg Endosc 2023; 37:8764-8770. [PMID: 37567978 DOI: 10.1007/s00464-023-10332-2] [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: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Acute cholecystitis (AC) is one of the most prevalent diseases in clinical practice. Poor surgical candidates may benefit from early percutaneous cholecystostomy (PC) drainage followed by interval cholecystectomy (IC), which is the definitive treatment. The optimal timing between the PC drainage and the IC has not been identified. This study aimed to investigate how the duration between PC and IC affects perioperative outcomes and identify the optimal IC timing to minimize complications. METHODS This retrospective cohort study included all adult patients diagnosed with AC who underwent PC followed by IC at a single institution center between 2014 and 2022. Patients with a history of hepatobiliary surgery, stones in the common bile duct, cirrhosis, active malignancy, or prolonged immunosuppression were excluded. The analysis did not include cases with major concurrent procedures during cholecystectomy, previously aborted cholecystectomies, or failure of the PC drain to control the inflammation. Linear and logistic regression models were used to analyze the impact of the interval between PC and IC on intra- and perioperative outcomes. RESULTS One hundred thirty-two patients (62.1% male) with a mean age of 64.4 ± 15 (mean ± SD) years were diagnosed with AC (25% mild, 47.7% moderate, 27.3% severe). All patients underwent PC followed by IC after a median of 64 [48-91] days. Longer ICU stay was associated with longer time intervals between PC and IC (Coef 105.98, p < 0.001). No significant variations were detected in the intraoperative and perioperative outcomes between patients undergoing IC within versus after 8 weeks from PC placement. However, a higher percentage of patients with delayed IC (after 8 weeks) were discharged home (96.4% vs. 83.7%; p = 0.019). CONCLUSIONS Patients may benefit from undergoing IC after the 8-week cutoff after PC. However, very long periods between PC and IC procedures may increase the risk of longer ICU stay.
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Affiliation(s)
- Spyridon Giannopoulos
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Keith Makhecha
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Sathvik Madduri
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Felix Garcia
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Timothy C Baumgartner
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA.
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Neithiya T, Patra AP, Shaha KK, Harichandrakumar KT. Nomogram based Postmortem- interval estimation compared with the Actual death-interval in Tropical environmental conditions. J Forensic Leg Med 2023; 100:102598. [PMID: 37820500 DOI: 10.1016/j.jflm.2023.102598] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Estimating an accurate postmortem interval (PMI) is essential for death investigators to confirm the offence timing and suspects' alibis. Compared to traditional methods, the Nomogram-based method is claimed to estimate nearly accurate PMI, but most of such studies are based on the Western population. Adequate data for bodies exposed to tropical climate of India and the Indian subcontinent are not available. AIM To assess the accuracy and goodness-of-fit of Nomogram based PMI estimation in bodies exposed to Indian climatic conditions after death. MATERIAL AND METHODS This is a 3-year-long study on 200 bodies with known death times. The exact PMI was recorded from direct sources: family members, police and hospital records. Before autopsy, the ambient temperature, body weight, length, and rectal temperature were measured, and the details of clothing, sex, and age, were used on a nomogram to calculate the PMI (tN). One-way ANOVA correlation and Mann-Whitney U test were used to compare the variables. Linear regression analysis was used to establish the relationship between the rectal temperature (Tr) and nomogram estimated PMI (tN) and the known PMI(t). The consistency and agreement between the tN and t were measured using Intra-class correlation coefficient (ICC). Bland-Altman (BA) plot was used to compare the level of agreement between direct(t) and nomograms method PMIs. RESULTS Nomogram-based PMI estimation showed a statistically significant strong relationship with rectal temperature (R 0.77, R2 0.74, adjusted R2 0.76, t-stat 25.83 p < 0.000) and exhibited a relatively consistent agreement with the known death interval (ICC 0.935). Regressing the tN over t showed that the nomogram method can predict PMI with 95 % accuracy. The BA plot between Direct and Nomogram methods exhibited a consistent agreement in PMI estimation though the limits of agreement (LoA) were wide: range 39.09-121.18 min. CONCLUSION The accuracy and reliability of the Nomogram method in PMI estimation is high and recommended for the South Indian population. However, the presence of systematic differences between tN and t can't be ruled out due to wider LoA in BA plot. Hence, these findings highlight the need for further investigation and potential refinement of the PMI estimation methods to enhance accuracy and reduce discrepancies.
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Affiliation(s)
- T Neithiya
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
| | - Ambika Prasad Patra
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
| | - Kusa Kumar Shaha
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
| | - K T Harichandrakumar
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
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Yan H, Wei S, Sui Y, Lu S, Zhang W, Feng X, Liu Y, Zhang T, Ruan W, Xia J, Lin W, Ley B, Auburn S, Li S, Li J, Wang D. Analysis of the relapse of imported Plasmodium vivax and Plasmodium ovale in five provinces of China. Malar J 2023; 22:209. [PMID: 37443070 DOI: 10.1186/s12936-023-04642-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The global battle against malaria is facing formidable challenges, particularly in controlling Plasmodium vivax and Plasmodium ovale, whose cases have not been reduced as effectively as Plasmodium falciparum because of their relapse. This study investigates the current situation and underlying factors contributing to relapse or recrudescence of imported cases of P. vivax and P. ovale, and seeks to provide a reference for reducing relapse or recrudescence in malaria-free areas and offers a scientific basis for designing strategies to prevent imported re-transmission. METHODS This study analysed imported P. vivax and P. ovale in Anhui, Zhejiang, Henan, Hubei, and Guangxi provinces during 2014-2021 by retrospective analysis. A case-control study was conducted on patients who experienced relapse or recrudescence. RESULTS From 2014 to 2021, 306 cases of P.vivax and 896 cases of P.ovale were included in the study, while 75 cases had relapse or recrudescence, including 49 cases of P. ovale (65.33%) and 26 cases of P. vivax (34.67%). Within less than 5 weeks after returning to the country, 122 cases of P. vivax (39.87%, 122/306) and 265 cases of P. ovale (29.58%, 265/896) occurred. Within less than 53 weeks, the ratio of P. vivax was 94.77% (290/306), and that of P. ovale was 89.96% (806/896). Among the cases experiencing relapse or recrudescence, only 1 case of P. vivax (1/26 3.85%) and 3 cases of P. ovale (3/49 6.12%) occurred within less than 5 weeks after the first onset, whereas 21 cases of P. vivax (21/26 80.77%) and 42 cases of P. ovale (42/49 85.71%) occurred within less than 53 weeks after the first onset. The difference in relapse or recrudescence due to different drugs and medication regimens and medical activities at various levels of medical institutions was statistically significant. CONCLUSION In areas where malaria has been eliminated, routine health screening in a scientific time frame for people returning from at-risk areas can effectively improve the efficiency of preventing re-transmission, thereby reducing prevention costs and disease burden. Preventing patients from self-treating and strengthening medication regulations in health facilities are key measures to reduce relapse or recrudescence.
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Affiliation(s)
- Hui Yan
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Shujiao Wei
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Yuan Sui
- Brown School, Washington University, St. Louis, MO, USA
| | - Shenning Lu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology (National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention), 200025, Shanghai, China
| | - Weiwei Zhang
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Xiangyang Feng
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Ying Liu
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, 450016, China
| | - Tao Zhang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, 230601, China
| | - Wei Ruan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Jing Xia
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Wen Lin
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Shizhu Li
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Chinese Center for Tropical Diseases Research, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jun Li
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China.
| | - Duoquan Wang
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Chinese Center for Tropical Diseases Research, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Gan R, Huang X, Zhao J, Zhang Q, Huang C, Li Y. Time interval between hCG administration and oocyte retrieval and ART outcomes: an updated systematic review and meta-analysis. Reprod Biol Endocrinol 2023; 21:61. [PMID: 37400840 DOI: 10.1186/s12958-023-01110-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023] Open
Abstract
RESEARCH QUESTION To explore whether prolonged hCG-ovum pickup interval improves assisted reproductive technology outcomes. DESIGN CENTRAL, CNKI, Cochrane Systematic Reviews, EMBASE, MEDLINE, PUBMED, and Web of Science up to May 13 2023 were searched for studies reporting associations between hCG-ovum pickup intervals and assisted reproductive technology outcomes. Intervention types included short (≤ 36 h) and long (> 36 h) hCG-ovum pickup intervals in assisted reproductive technology cycles. All outcomes were based upon only fresh embryo transfers. Primary outcome is defined as the clinical pregnancy rate. Data were pooled using random-effects models. Heterogeneity was assessed using the I 2 statistics. RESULTS Twelve studies were included in the meta-analysis, including five retrospective cohort studies, one prospective cohort study, and six randomized or quasi-randomized controlled trials. The short and long interval groups had similar oocyte maturation rates, fertilization rate and high-quality embryo rate (OR, 0.69; 95% CI, 0.45-1.06; I 2 = 91.1%, OR, 0.88; 95% CI, 0.77-1.0; I 2 = 44.4% and OR, 1.05; 95% CI, 0.95-1.17; I 2 = 8.6%, respectively). The clinical pregnancy rates in the long retrieval group were significantly higher than in the short retrieval group (OR, 0.66; 95% CI, 0.45-0.95; I 2 = 35.4%). The groups had similar miscarriage and live birth rates (OR, 1.92; 95% CI, 0.66-5.60; I 2 = 0.0% and OR, 0.50; 95% CI, 0.24-1.04; I 2 = 0.0%, respectively). CONCLUSIONS The clinical pregnancy rates can be increased by prolonging the hCG-ovum pickup interval, which would help us develop more reasonable time schedules for fertility centers and patients. META-ANALYSIS REGISTRATION PROSPERO CRD42022310006 (28 Apr 2022).
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Affiliation(s)
- Runxin Gan
- Reproductive Medicine Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
- Clinical Research Center for Women's, Reproductive Health in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
| | - Xi Huang
- Reproductive Medicine Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
- Clinical Research Center for Women's, Reproductive Health in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
| | - Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
- Clinical Research Center for Women's, Reproductive Health in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
| | - Qiong Zhang
- Reproductive Medicine Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
- Clinical Research Center for Women's, Reproductive Health in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
| | - Chuan Huang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410000, China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China.
- Clinical Research Center for Women's, Reproductive Health in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China.
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Cambray M, González-Viguera J, Losa F, Martínez-Villacampa M, Frago R, Mata F, Castellví J, Guinó E. Determining the optimal interval between neoadjuvant radiochemotherapy and surgery in rectal cancer: a retrospective cohort study. Int J Colorectal Dis 2023; 38:154. [PMID: 37261511 DOI: 10.1007/s00384-023-04457-y] [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] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION In locally advanced rectal cancer, the optimal interval between completion of neoadjuvant radiochemotherapy (RT-ChT) and surgical resection remains unclear due to contradictory data on the benefits of extending this interval. Therefore, the aim of this retrospective study was to determine the impact of this interval on outcomes in patients treated for rectal cancer at our center. METHODS We retrospectively reviewed 382 consecutive patients treated for stage II/III rectal cancer between October 1, 2012, and December 31, 2017. We evaluated four different cut-off points (56, 63, 70, and 77 days) to determine which had the greatest impact on treatment outcomes. RESULTS The median time between completion of RT-ChT and surgery was 67.2 days (range, 28-294). Intervals > 8 weeks (56 days) were associated with worse therapeutic outcomes. Specifically, an interval ≥ 77 days was associated with a significant decrease in overall survival (OS; 84% vs. 70%; p = 0.004), which is why we selected this interval for the comparative analysis. Several outcome variables were significantly better in the short interval (< 77 days) group, including margin involvement (5.2% vs. 13.9%; p = 0.01), sphincter preservation (78% vs. 59.3%; p = 0.003), and distant dissemination (22.6% vs. 32.5%; p = 0.04). No significant between-group differences were found in complete/nearly complete response rates (19.2% vs. 24.4%; p = 0.3). Time to surgery was statistically significant on both the univariate and multivariate analyses. CONCLUSIONS Our findings suggest that surgery should not be delayed more than 8 weeks (56 days) after neoadjuvant treatment. An interval > 8 weeks should only be considered in patients who demonstrate a good response to neoadjuvant RT-ChT.
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Affiliation(s)
- Maria Cambray
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier González-Viguera
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Ferran Losa
- Medical Oncology Department, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
- Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Ricard Frago
- General and Digestive Surgery Department, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Fernando Mata
- General and Digestive Surgery Department, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Jordi Castellví
- General and Digestive Surgery Department, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Elisabet Guinó
- Data Analytics Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
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10
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Aslanov K, Atici AE, Karaman D, Bozkurtlar E, Yegen ŞC. Optimal waiting period to surgical treatment after neoadjuvant chemoradiotherapy for locally advanced rectum cancer: a retrospective observational study. Langenbecks Arch Surg 2023; 408:210. [PMID: 37227524 DOI: 10.1007/s00423-023-02930-4] [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: 03/18/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The optimal waiting period after neoadjuvant treatment in patients with locally advanced rectal cancers is still controversial. The literature has different results regarding the effect of waiting periods on clinical and oncological outcomes. We aimed to investigate the effects of these different waiting periods on clinical, pathological, and oncological outcomes. METHODS Between January 2014 and December 2018, a total of 139 consecutive patients with locally advanced rectal adenocarcinoma, who were treated in the Department of General Surgery at the Marmara University Pendik Training and Research Hospital, were enrolled in the study. The patients were split into three groups according to waiting time for surgery after neoadjuvant treatment: group 1 (n = 51) included patients that have 7 weeks and less (≤ 7 weeks) time interval, group 2 (n = 45) 8 to 10 weeks (8-10 weeks), group 3 (n = 43) 11 weeks and above (11 weeks ≤). Their database records, which were entered prospectively, were analyzed retrospectively. RESULTS There were 83 (59.7%) males and 56 (40.3%) females. The median age was 60 years, and there was no statistical difference between the groups regarding age, gender, BMI, ASA score, ECOG performance score, tumor location, and preoperative CEA values. Also, we found no significant differences regarding operation times, intraoperative bleeding, length of hospital stay, and postoperative complications. According to the Clavien-Dindo (CD) classification, severe early postoperative complications (CD 3 and above) were observed in 9 patients. The complete pathological response (pCR, ypT0N0) was observed in 21 (15.1%) patients. The groups had no significant difference regarding 3-year disease-free and 3-year overall survival (p = 0.3, p = 0.8, respectively). Local recurrence was observed in 12 of 139 (8.6%) patients and distant metastases occurred in 30 of 139 (21.5%) patients during the follow-up period. There was no significant difference between the groups in terms of both local recurrence and distant metastasis (p = 0.98, p = 0.43, respectively). CONCLUSION The optimal time for postoperative complications and sphincter-preserving surgery in patients with locally advanced rectal cancer is 8-10 weeks. The different waiting periods do not affect disease-free and overall survival. While long-term waiting time does not make a difference in pathological complete response rates, it negatively affects the TME quality rate.
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Affiliation(s)
- Khayal Aslanov
- Department of General Surgery, Pendik Education and Research Hospital, Faculty of Medicine, Marmara University, 34899, Pendik, Istanbul, Turkey
| | - Ali Emre Atici
- Department of General Surgery, Pendik Education and Research Hospital, Faculty of Medicine, Marmara University, 34899, Pendik, Istanbul, Turkey.
| | - Damlanur Karaman
- Department of Pathology, Pendik Education and Research Hospital, Faculty of Medicine, Marmara University, 34899, Pendik, Istanbul, Turkey
| | - Emine Bozkurtlar
- Department of Pathology, Pendik Education and Research Hospital, Faculty of Medicine, Marmara University, 34899, Pendik, Istanbul, Turkey
| | - Şevket Cumhur Yegen
- Department of General Surgery, Pendik Education and Research Hospital, Faculty of Medicine, Marmara University, 34899, Pendik, Istanbul, Turkey
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11
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Fusano M, Bencini PL, Toffanetti JN, Galimberti MG. Time interval between pulse dye laser treatments of port-wine stains: 30 years of experience. J COSMET LASER THER 2023; 25:33-37. [PMID: 37289942 DOI: 10.1080/14764172.2023.2222946] [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: 01/15/2023] [Revised: 05/14/2023] [Accepted: 06/04/2023] [Indexed: 06/10/2023]
Abstract
Port-wine stains (PWS) are frequently refractory to laser treatments. The aim of this study is to evaluate the role of treatment interval time. From 1990, 216 patients underwent Pulsed Dye Laser sessions. The laser sessions were scheduled at a minimum interval of 4 weeks to a maximum of 48 weeks. Clinical outcomes were assessed 8 weeks after the last laser session. Better results were obtained with 8 weeks interval time between therapy session, and high efficacies were also found for intervals of 4, 6 and 10 weeks. For greater interval instead, the effectiveness is significantly lower.
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Affiliation(s)
- Marta Fusano
- Departement of Dermatology, Istituto di Chirurgia E Laserchirurgia in Dermatologia (I.C.L.I.D), Milano, Italy
| | - Pier Luca Bencini
- Departement of Dermatology, Istituto di Chirurgia E Laserchirurgia in Dermatologia (I.C.L.I.D), Milano, Italy
| | | | - Michela Gianna Galimberti
- Departement of Dermatology, Istituto di Chirurgia E Laserchirurgia in Dermatologia (I.C.L.I.D), Milano, Italy
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12
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Imaz JA, Garcia SC, González LA. The time elapsed between assessments of blood metabolome and live weight affects associations between the abundance of metabolites and growth rate in beef cattle. Metabolomics 2023; 19:51. [PMID: 37184621 DOI: 10.1007/s11306-023-02015-9] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION This study aimed to assess the associations between the relative abundance (RA) of blood metabolites and growth rate (i.e., live weight change, LWC) calculated using different intervals of time between live weight (LW) measurements from the metabolome assessment. METHODS Grazing beef cattle were raised for 56 days and blood samples from each animal were taken on day 57. Live weight was continuously measured using an automatic in-paddock weighing scale. The RA of plasma metabolites were determined using proton nuclear magnetic resonance (NMR). Live weight data were filtered for outliers and one LW record was selected every 1, 7, 14, 21, 28, 35, 42, 49 and 56 days before the metabolome assessment (LWC1 to LWC56, respectively). Live weight change was then re-calculated for each interval between LW data selected. RESULTS Associations between LWC calculations and the RA of metabolites were greatly affected by the interval of time between LW data selected. Thus, the number of significant associations decreased from 9 for LWC1 to 5 for LWC35 whereas no significant associations were found for LWC56 (P > 0.05). There were 7 metabolites negatively associated with LWC1 including leucine, 2-hydroxybutyrate, valine, creatinine, creatine, phenylalanine and methylhistidine; however, correlations were positive for 2 lipids. The strength of the correlation coefficients decreased as the length of the interval between LW measures increased although this reduction was greater for some metabolites such as leucine compared to others such as lipids. Our findings suggest that the time frame in which a particular response variable, such as LWC, is measured and metabolomic samples are taken could largely impact associations and thus conclusions drawn. CONCLUSIONS Depending on the variable to be explored, rapid changes in cattle metabolome may not be reflected in correlations if they are not assessed close in time. Our findings suggest that LWC should be measured for a period shorter than 28 days before the metabolome assessment as the number of significant associations decreases when LWC is measured for longer periods.
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Affiliation(s)
- José Augusto Imaz
- Sydney Institute of Agriculture, School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Sydney, NSW, 2570, Australia.
- Department of Regional NSW, Primary Industries, Menangle, Sydney, NSW, Australia.
| | - S C Garcia
- Sydney Institute of Agriculture, School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Sydney, NSW, 2570, Australia
- Dairy Research Foundation, Sydney, Australia
| | - L A González
- Sydney Institute of Agriculture, School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Sydney, NSW, 2570, Australia
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Kassie SY, Ngusie HS, Demsash AW, Alene TD. Spatial distribution of short birth interval and associated factors among reproductive age women in Ethiopia: spatial and multilevel analysis of 2019 Ethiopian mini demographic and health survey. BMC Pregnancy Childbirth 2023; 23:275. [PMID: 37087447 PMCID: PMC10122344 DOI: 10.1186/s12884-023-05610-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 04/14/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Short Birth Interval negatively affects the health of both mothers and children in developing countries. Studies conducted in Ethiopia on the spatial variation and determinants of individual and community-level factors about short birth intervals were limited. Thus, this study was intended to assess the spatial variation of the short birth interval and its determinants in Ethiopia. METHODS This study is a secondary analysis of the Ethiopian Demographic and Health Survey (mini EDHS 2019). A total of 1784 reproductive-age women were included in the analysis. The global spatial autocorrelation (Global Moran's I) and the Getis-Ord statistics tool were used to detect the presence of clustering and the high/low hotspot areas of SBI respectively. Ordinary kriging was used to interpolate short birth intervals, and spatial scan statistics were employed to identify spatial clusters with high and low SBI. A multilevel multivariable model was used to identify predictors of a short birth interval. RESULTS The prevalence of SBI was 62.89% (95%CI: 59.3, 69.7) in Ethiopia. High clustering of SBI was observed in all parts of Somali, in Afar (zones 1, 3, 4, &5), Oromia (Guje, Bale, & West Harerge), and northern Tigray. The most likely significant primary cluster was observed in the Somali region. Women who lived in the primary cluster were 24% more likely to have a short birth interval than those who lived outside the window. In the multilevel mixed-effect analysis age 25-34 [(AOR = 0.40, 95% CI: 0.35, 0.45)], 35-49 [(AOR = 0.44, 95% CI: 0.38, 0.51)], Muslim religion follower [(AOR = 3.5, 95% CI: 2.7, 4.69)], no formal education [(AOR = 0.5, 95% CI: 0.37, 0.70)], primary education[(AOR = 0.4, 95%CI: 0.28, 0.53)], and secondary education [(AOR = 0.3, 95% CI: 0.24, 0.48)], middle [(AOR: 1.3, 95% CI: 1.2, 1.52)], rich wealth status [(AOR: 1.4, 95% CI: 1.3, 1.68)], female sex children [(AOR: 1.2, 95% CI: 1.09, 1.42)], and two or fewer ideal number of children [(AOR = 0.2, 95% CI: 0.25, 0.32)] were found to be significant predictors of SBI. CONCLUSION Overall, SBI was high and significantly clustered across the region of Ethiopia. Age, religion, education, wealth status, the sex of the indexed child, and the ideal number of children were found to be significantly associated with short birth intervals. Hence, the government should design a health promotion strategy and public health awareness in the identified hotspot areas of SBI and should scale up family planning and the wealth status of reproductive-age women.
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Affiliation(s)
- Sisay Yitayih Kassie
- Department of Health informatics, College of Health Sciences, Mettu University, P.O.Box:318, Mettu, Ethiopia.
| | - Habtamu Setegn Ngusie
- Department of Health informatics, School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Addisalem Workie Demsash
- Department of Health informatics, College of Health Sciences, Mettu University, P.O.Box:318, Mettu, Ethiopia
| | - Tilahun Dessie Alene
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Suh JW, Oh HK, Lee J, Yang IJ, Ahn HM, Kim DW, Kang SB, Shin R, Heo SC, Lee DW, Park SC, Sohn DK, Oh JH, Kim MJ, Park JW, Ryoo SB, Jeong SY, Park KJ; Seoul Colorectal Research Group (SECOG). Safety of early surgery after self-expandable metallic stenting for obstructive left-sided colorectal cancer. Surg Endosc 2023. [PMID: 36717427 DOI: 10.1007/s00464-023-09891-1] [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: 10/05/2022] [Accepted: 01/15/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Self-expanding metallic stenting (SEMS) is usual for the temporary resolution of obstructive left-sided colorectal cancer (CRC) as a bridge to elective surgery. However, there is no consensus regarding adequate time intervals from stenting to radical surgery. The aim of this study was to identify the optimal time interval that results in favorable short- and long-term outcomes. METHODS Data on patients with obstructive left-sided CRC who underwent elective radical surgery after clinically successful SEMS deployment in five tertiary referral hospitals from 2004 to 2016 were analyzed, retrospectively. An inverse probability treatment-weighted propensity score analysis was used to minimize bias. Postoperative short- and long-term outcomes were compared between two groups: an early surgery (within 8 days) group and delayed surgery (after 8 days) group. RESULTS Of 311 patients, 148 (47.6%) underwent early and 163 (52.4%) underwent delayed surgery. The median surgery interval was 9.0 days. After adjustment, the groups had similar patient and tumor characteristics. In terms of short-term outcomes, there was no difference in hospitalization length or postoperative complications. No deaths were observed. With a median follow-up of 71.0 months, no significant difference was observed between the groups in 5-year overall survival (early vs. delayed surgery: 79.6% vs. 71.3%, P = 0.370) and 5-year disease-free survival (early vs. delayed surgery: 59.1% vs. 60.4%, P = 0.970). CONCLUSIONS In obstructive left-sided CRC, the time interval between SEMS and radical surgery did not significantly influence short- and long-term outcomes. Therefore, early surgery after SEMS could be suggested if there is no reason to postpone surgery for preoperative medical optimization.
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15
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Zhangbo Y, Zheng C, Hui W. Contact network analysis of COVID-19 Delta variant outbreak in urban China -based on 2,050 confirmed cases in Xi'an, China. BMC Public Health 2022; 22:2408. [PMID: 36550467 PMCID: PMC9772588 DOI: 10.1186/s12889-022-14882-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of this paper is to study how the Delta variant spread in a China city, and to what extent the non-pharmaceutical prevention measures of local government be effective by reviewing the contact network of COVID-19 cases in Xi'an, China. METHODS We organize the case reports of the Shaanxi Health Commission into a database by text coding and convert them into a network matrix. Then we construct a dynamic contact network for the corresponding analysis and calculate network indicators. we analyze the cases' dynamic contact network structure and intervals between diagnosis time and isolation time by using data visualization, network analysis method, and Ordinary Least Square (OLS) regression. RESULTS The contact network for this outbreak in Xi'an is very sparse, with a density of less than 0.0001. The contact network is a scale-free network. The average degree centrality is 0.741 and the average PageRank score is 0.0005. The network generated from a single source of infection contains 1371 components. We construct three variables of intervals and analyze the trend of intervals during the outbreak. The mean interval (interval 1) between case diagnosis time and isolation time is - 3.9 days. The mean of the interval (interval 2) between the infector's diagnosis time and the infectee's diagnosis time is 4.2 days. The mean of the interval (interval 3) between infector isolation time and infectee isolation time is 2.9 days. Among the three intervals, only interval 1 has a significant positive correlation with degree centrality. CONCLUSIONS By integrating COVID-19 case reports of a Chinese city, we construct a contact network to analyze the dispersion of the outbreak. The network is a scale-free network with multiple hidden pathways that are not detected. The intervals of patients in this outbreak decreased compared to the beginning of the outbreak in 2020. City lockdown has a significant effect on the intervals that can affect patients' network centrality. Our study highlights the value of case report text. By linking different reports, we can quickly analyze the spread of the epidemic in an urban area.
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Affiliation(s)
- Yang Zhangbo
- grid.43169.390000 0001 0599 1243School of Humanities and Social Science, Xi’an Jiaotong University, Xi’an, China ,grid.43169.390000 0001 0599 1243Institute for Empirical Social Science Research, Xi’an Jiaotong University, Xi’an, China
| | - Chen Zheng
- grid.43169.390000 0001 0599 1243School of Humanities and Social Science, Xi’an Jiaotong University, Xi’an, China
| | - Wang Hui
- grid.43169.390000 0001 0599 1243School of Management, Xi’an Jiaotong University, No.28 Xianningxi Road, Xi’an, 710049 China
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16
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Huang B, Deng Y, Liu Z, Zhu X, Su Y, Gu D, Li Z, Fang W, Pennathur A, Luketich JD, Xiang J, Chen H, Wu Q, Xu W, Zhang J. Oesophagectomy following noncurative endoscopic resection for oesophageal carcinoma: does interval matter? Eur J Cardiothorac Surg 2022; 63:6967434. [PMID: 36594564 DOI: 10.1093/ejcts/ezac565] [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] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/21/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Oesophagectomy was always recommended after noncurative endoscopic resection (ER). And the optimal time interval from ER to oesophagectomy remains unclear. This study was to explore the effect of interval on pathologic stage and prognosis. METHODS We included 155 patients who underwent ER for cT1N0M0 oesophageal cancer and then received subsequent oesophagectomy from 2009 to 2019. Overall survival and disease-free survival (DFS) were analysed to find an optimal cut-off of interval from ER to oesophagectomy. In addition, pathologic stage after ER was compared to that of oesophagectomy. Logistic regression model was built to identify risk factors for pathological upstage. RESULTS The greatest difference of DFS was found in the groups who underwent oesophagectomy before and after 30 days (P = 0.016). Among total 155 patients, 106 (68.39%) received oesophagectomy within 30 days, while 49 (31.61%) had interval over 30 days. Comparing the pathologic stage between ER and oesophagectomy, 26 patients had upstage and thus had worse DFS (hazard ratio = 3.780, P = 0.042). T1b invasion, lymphovascular invasion and interval >30-day group had a higher upstage rate (P = 0.014, P < 0.001 and P < 0.001, respectively). And they were independent risk factors for pathologic upstage (odds ratio = 3.782, 4.522 and 2.844, respectively). CONCLUSIONS It was the first study exploring the relationship between time interval and prognosis in oesophageal cancer. The longer interval between noncurative ER and additional oesophagectomy was associated with a worse DFS, so oesophagectomy was recommended performed within 1 month after ER. Older age, T1b stage, lymphovascular invasion and interval >30 days were significantly associated with pathologic upstage, which is related to the worse outcome too.
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Affiliation(s)
- Binhao Huang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China.,Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yangqing Deng
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Zhichao Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Xiuzhi Zhu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuceng Su
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Dantong Gu
- Department of Biostatistics, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Arjun Pennathur
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hezhong Chen
- Department of Thoracic Surgery, Changhai Hospital Affiliated to The Second Military Medical University, Shanghai, China
| | - Qingquan Wu
- Department of Thoracic Surgery, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jie Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China.,Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Tsou YK, Pan KT, Lee MH, Lin CH. Endoscopic salvage therapy after failed biliary cannulation using advanced techniques: A concise review. World J Gastroenterol 2022; 28:3803-3813. [PMID: 36157537 PMCID: PMC9367240 DOI: 10.3748/wjg.v28.i29.3803] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/15/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) begins with successful biliary cannulation. However, it is not always be successful. The failure of the initial ERCP is attributed to two main aspects: the papilla/biliary orifice is endoscopically accessible, or it is inaccessible. When the papilla/biliary orifice is accessible, bile duct cannulation failure can occur even with advanced cannulation techniques, including double guidewire techniques, transpancreatic sphincterotomy, needle-knife precut papillotomy, or fistulotomy. There is currently no consensus on the next steps of treatment in this setting. Therefore, this review aims to propose and discuss potential endoscopic options for patients who have failed ERCP due to difficult bile duct cannulation. These options include interval ERCP, percutaneous-transhepatic-endoscopic rendezvous procedures (PTE-RV), and endoscopic ultrasound-assisted rendezvous procedures (EUS-RV). The overall success rate for interval ERCP was 76.3% (68%-79% between studies), and the overall adverse event rate was 7.5% (0-15.9% between studies). The overall success rate for PTE-RV was 88.7% (80.4%-100% between studies), and the overall adverse event rate was 13.2% (4.9%-19.2% between studies). For EUS-RV, the overall success rate was 82%-86.1%, and the overall adverse event rate was 13%-15.6%. Because interval ERCP has an acceptably high success rate and lower adverse event rate and does not require additional expertise, facilities, or other specialists, it can be considered the first choice for salvage therapy. EUS-RV can also be considered if local experts are available. For patients in urgent need of biliary drainage, PTE-RV should be considered.
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Affiliation(s)
- Yung-Kuan Tsou
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kuang-Tse Pan
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Mu Hsien Lee
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Cheng-Hui Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Kitamura K, Makino A, Matsui T, Takasato Y, Sugiura S, Ito K. A 60-minute dosing interval is safer than a 30- or 40-minute interval in oral food challenge. Allergol Int 2022; 71:230-235. [PMID: 34887191 DOI: 10.1016/j.alit.2021.11.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/30/2021] [Accepted: 11/01/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The interval between antigen ingestion may influence the safety of oral food challenge tests (OFCs), especially in patients with severe food allergies. METHODS This retrospective chart review of OFCs eliciting objective reactions to wheat, egg, and milk that were performed between April 2012 and January 2021 evaluated an equivalent number of low-dose OFCs performed at 30-, 40-, or 60-min intervals. To avoid the influence of the potential allergy severity of the patients, the prediction scores of all intervals were matched. We evaluated the total symptom score (TS), total ingested dose, and the proportions of severe reactions (TS ≥ 30) and adrenaline use. RESULTS We analyzed 945 OFCs (wheat, n = 186; egg, n = 561; milk, n = 198). The 60-min OFC had significantly lower TS than the 30- and 40-min OFC methods in wheat (p < 0.001 and p = 0.003, respectively), egg (p < 0.001 for both), and milk (p < 0.001 and p = 0.018, respectively). The total dose in the 60-min method was significantly lower than in the 30-min method (p < 0.001 for all). The proportion of severe reaction (TS ≥ 30) in the 60-min method was significantly lower than that in the 30-min method for the egg and milk OFCs (p = 0.001 and p < 0.001, respectively). There was no difference in the rates of adrenaline injection. CONCLUSIONS The 60-min interval is safer than 30- or 40-min intervals in wheat, egg, and milk OFCs in patients with a low threshold dose for food allergy.
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Affiliation(s)
- Katsumasa Kitamura
- Department of Allergy, Allergy and Immunology Center, Aichi Children's Health and Medical Center, Aichi, Japan.
| | - Atsushi Makino
- Department of Allergy, Allergy and Immunology Center, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Teruaki Matsui
- Department of Allergy, Allergy and Immunology Center, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Yoshihiro Takasato
- Department of Allergy, Allergy and Immunology Center, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Shiro Sugiura
- Department of Allergy, Allergy and Immunology Center, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Komei Ito
- Department of Allergy, Allergy and Immunology Center, Aichi Children's Health and Medical Center, Aichi, Japan
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Nath B, Gaikwad HS, Nagpal K. Continuation of Copper T in Immediate Postplacental, Immediate Postabortal and Interval Period of Insertion. J Obstet Gynaecol India 2022; 72:38-46. [PMID: 35125737 DOI: 10.1007/s13224-021-01497-8] [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: 01/05/2021] [Accepted: 05/05/2021] [Indexed: 02/03/2023] Open
Abstract
AIM Copper containing IUCDs are one of most effective mode of contraception for birth spacing. We conducted this prospective observational study to suggest a possible better period of insertion of IUCDs with cost-saving benefits. METHODS All married women in the reproductive age group desirous of Copper-T 375 IUD insertion in either immediate postplacental (PP), immediate postabortal (PA) or interval (INT) period were recruited. The women were asked to return for scheduled follow-up visits at 6 weeks, 6 months and 12 months. They were advised to visit family planning clinic any time if they experienced pelvic pain, discharge per vaginum, unusual bleeding or missed periods. At each visit, women were interviewed for any side effects they have experienced and were asked to elaborate. Pelvic pain was assessed from visual analogue scale. Continuation rate was measured at the end of one year. RESULTS Women in INT group (90.14%) had the highest continuation rate followed by PP (83.18%) and PA (80%) groups. Women in PP (AOR = 3.37, 95% CI 1.17-9.72) and PA (AOR = 4.53, 95% CI 1.33-14.04) groups had higher odds of discontinuation compared to INT group after adjusting for age, parity, working and education status. There was a significant difference between the groups when cumulative expulsion was considered (p = 0.045), but none when cumulative removal (p = 0.107) was taken into account. CONCLUSION The continuation rate remained high in women who had insertion in the interval period compared to immediate postplacental and postabortal periods.
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Ellerby Z, Wagner C, Broomell SB. Capturing richer information: On establishing the validity of an interval-valued survey response mode. Behav Res Methods 2021. [PMID: 34494219 DOI: 10.3758/s13428-021-01635-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/18/2021] [Indexed: 11/14/2022]
Abstract
Obtaining quantitative survey responses that are both accurate and informative is crucial to a wide range of fields. Traditional and ubiquitous response formats such as Likert and visual analogue scales require condensation of responses into discrete or point values—but sometimes a range of options may better represent the correct answer. In this paper, we propose an efficient interval-valued response mode, whereby responses are made by marking an ellipse along a continuous scale. We discuss its potential to capture and quantify valuable information that would be lost using conventional approaches, while preserving a high degree of response efficiency. The information captured by the response interval may represent a possible response range—i.e., a conjunctive set, such as the real numbers between 3 and 6. Alternatively, it may reflect uncertainty in respect to a distinct response—i.e., a disjunctive set, such as a confidence interval. We then report a validation study, utilizing our recently introduced open-source software (DECSYS), to explore how interval-valued survey responses reflect experimental manipulations of several factors hypothesised to influence interval width, across multiple contexts. Results consistently indicate that respondents used interval widths effectively, and subjective participant feedback was also positive. We present this as initial empirical evidence for the efficacy and value of interval-valued response capture. Interestingly, our results also provide insight into respondents’ reasoning about the different aforementioned types of intervals—we replicate a tendency towards overconfidence for those representing epistemic uncertainty (i.e., disjunctive sets), but find intervals representing inherent range (i.e., conjunctive sets) to be well-calibrated.
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21
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Couturier A, Kodjikian L, Baillif S, Conart JB, Dot C, Delyfer MN, Matonti F, Caillaux V, Bousquet E, Robinet A, Massé H, Uzzan J, Mrejen S, Semoun O. [Treatment of exudative age-related macular degeneration: Consensus of French experts for first-line treatment selection and the importance of long-term risk/benefit ratio]. J Fr Ophtalmol 2021; 44:937-946. [PMID: 34147276 DOI: 10.1016/j.jfo.2021.01.001] [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: 01/15/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.
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Affiliation(s)
- A Couturier
- Université de Paris, service d'ophtalmologie, assistance publique hôpitaux de Paris, hôpital Lariboisière, Paris, France
| | - L Kodjikian
- Service d'ophtalmologie, hôpital universitaire Croix-Rousse, hospices Civils de Lyon, université Lyon I, Lyon, France; CNRS UMR 5510 Mateis, Villeurbanne, France
| | - S Baillif
- Service d'ophtalmologie, hôpital universitaire Pasteur 2, université Côte d'Azur, Nice, France
| | - J-B Conart
- Service d'ophtalmologie, CHRU Nancy, Vandoeuvre-lès-Nancy, France; Institut de la Vision, Inserm, UMR_S 968, CNRS, Sorbonne Université, Paris, France
| | - C Dot
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, 69003 Lyon, France; École du Val de Grâce, Paris, France
| | - M-N Delyfer
- Service d'ophtalmologie, centre hospitalier universitaire de Bordeaux, université de Bordeaux, Inserm, Bordeaux population health research centre, team LEHA, UMR 1219, 33000 Bordeaux, France
| | - F Matonti
- Centre Monticelli Paradis, Aix Marseille Univ, CNRS, INT, Inst Neurosci Timone, 433, bis rue Paradis, 13008 Marseille, France
| | - V Caillaux
- Centre explore vision Paris, Rueil Malmaison, France; Service d'ophtalmologie, assistance publique hôpitaux de Paris, hôpital Lariboisière, Paris, France
| | - E Bousquet
- OphtalmoPôle de Paris, hôpital Cochin, assistance publique hôpitaux de Paris, université de Paris, Paris, France
| | - A Robinet
- Centre ophtalmologique ophtasiam, clinique Pasteur-Lanrose, Brest, France
| | - H Massé
- Service d'ophtalmologie, centre hospitalier universitaire de Nantes, Nantes, France
| | - J Uzzan
- Clinique Mathilde, Rouen, France
| | - S Mrejen
- Centre d'Imagerie et de Laser, Paris, France
| | - O Semoun
- Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, université Paris Est Créteil, 40, avenue de Verdun, 94000 Créteil, France; Centre ophtalmologique du Panthéon, Paris, France.
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Zhang Q, Liang J, Chen J, Mei S, Wang Z. Predictive Factors for Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer. Asian Pac J Cancer Prev 2021; 22:1607-1611. [PMID: 34048192 PMCID: PMC8408379 DOI: 10.31557/apjcp.2021.22.5.1607] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Indexed: 01/04/2023] Open
Abstract
Background: An accurate assessment of potential pathologic complete response(pCR) following neoadjuvant chemoradiotherapy(NCRT) is important for the appropriate treatment of rectal cancer. However, the factors that predict the response to neoadjuvant chemoradiotherapy have not been well defined. Therefore, this study analyzed the predictive factors on the development of pCR after neoadjuvant chemoradiation for rectal cancer. Methods: From January 2008 to January 2018, a total of 432 consecutive patients from a single institution patients who underwent a long-course neoadjuvant chemoradiotherapy were reviewed in this study. The clinicopathological features were analyzed to identify predictive factors for pathologic complete response in rectal cancer after neoadjuvant chemoradiation. Results: The rate of pathologic complete response in rectal cancer after neoadjuvant chemoradiation was 20.8%, patients were divided into the pCR and non-pCR groups. The two groups were well balanced in terms of age, gender, body mass index, ASA score, tumor stage, tumor differentiation, tumor location, surgical procedure, chemotherapy regimen and radiation dose. The multivariate analysis revealed that a pretreatment carcinoembryonic antigen (CEA) level of ≤5 ng/mL and an interval of ≥8 weeks between the completion of chemoradiation and surgical resection were independent risk factors of an increased rate of pCR. Conclusions: Pretreatment carcinoembryonic antigen (CEA) level of ≤5 ng/mL and an interval of ≥8 weeks between the completion of chemoradiation and surgical resection are predictive factors for pathologic complete response in rectal cancer after neoadjuvant chemoradiation. Using these predictive factors, we can predict the prognosis of patients and develop adaptive treatment strategies. A wait-and-see policy might be possible in highly selective cases.
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Affiliation(s)
- Qi Zhang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jianan Chen
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Zheng Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
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Bégin P, Gagnon R, Leduc JM, Paradis B, Renaud JS, Beauchamp J, Rioux R, Carrier MP, Hudon C, Vautour M, Ouellet A, Bourget M, Bourdy C. Accuracy of rating scale interval values used in multiple mini-interviews: a mixed methods study. Adv Health Sci Educ Theory Pract 2021; 26:37-51. [PMID: 32378151 DOI: 10.1007/s10459-020-09970-1] [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: 08/29/2019] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
When determining the score given to candidates in multiple mini-interview (MMI) stations, raters have to translate a narrative judgment to an ordinal rating scale. When adding individual scores to calculate final ranking, it is generally presumed that the values of possible scores on the evaluation grid are separated by constant intervals, following a linear function, although this assumption is seldom validated with raters themselves. Inaccurate interval values could lead to systemic bias that could potentially distort candidates' final cumulative scores. The aim of this study was to establish rating scale values based on rater's intent, to validate these with an independent quantitative method, to explore their impact on final score, and to appraise their meaning according to experienced MMI interviewers. A 4-round consensus-group exercise was independently conducted with 42 MMI interviewers who were asked to determine relative values for the 6-point rating scale (from A to F) used in the Canadian integrated French MMI (IFMMI). In parallel, relative values were also calculated for each option of the scale by comparing the average scores concurrently given to the same individual in other stations every time that option was selected during three consecutive IFMMI years. Data from the same three cohorts was used to simulate the impact of using new score values on final rankings. Comments from the consensus group exercise were reviewed independently by two authors to explore raters' rationale for choosing specific values. Relative to the maximum (A = 100%) and minimum (F = 0%), experienced raters concluded to values of 86.7% (95% CI 86.3-87.1), 69.5% (68.9-70.1), 51.2% (50.6-51.8), and 29.3% (28.1-30.5), for scores of B, C, D and E respectively. The concurrent score approach was based on 43,412 IFMMI stations performed by 4345 medical school applicants. It provided quasi-identical values of 87.1% (82.4-91.5), 70.4% (66.1-74.7), 51.2% (47.1-55.3) and 31.8% (27.9-35.7), respectively. Qualitative analysis explained that while high scores are usually based on minor details of relatively low importance, low scores are usually attributed for more serious offenses and were assumed by the raters to carry more weight in the final score. Individual drop or increase in final MMI ranking with the use of new scale values ranged from - 21 to + 5 percentiles, with the average candidate changing by ± 1.4 percentiles. Consulting with experienced interviewers is a simple and effective approach to establish rating scale values that truly reflects raters' intent in MMI, thus improving the accuracy of the instrument and contributing to the general fairness of the process.
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Affiliation(s)
- Philippe Bégin
- Faculty of Medicine, Université de Montréal, Montreal, Canada.
- CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Robert Gagnon
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | | | | | - Jacinthe Beauchamp
- Faculty of Medicine, Université Sherbrooke, Sherbrooke, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Moncton, Canada
| | - Richard Rioux
- Faculty of Social Science, Université du Québec à Montréal, Montreal, Canada
| | | | - Claire Hudon
- Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Marc Vautour
- Faculty of Medicine, Université Sherbrooke, Sherbrooke, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Moncton, Canada
| | - Annie Ouellet
- Faculty of Medicine, Université Sherbrooke, Sherbrooke, Canada
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Hou CH, Chen KJ, Lee JS, Lin KK, Pu C. Effect of the time interval between cataract surgery for both eyes on mental health outcome: a cohort study of 585,422 patients. BMC Ophthalmol 2021; 21:110. [PMID: 33648477 PMCID: PMC7919071 DOI: 10.1186/s12886-021-01876-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cataract surgeries can improve mental health outcomes. However, previous studies have not investigated whether the time interval between cataract surgeries for 2 eyes affects mental health outcomes. METHODS We used the whole-population National Health Insurance (NHI) claims data from Taiwan to conduct a cohort study. Patients who received cataract surgeries for both eyes were identified (n = 585,422). The mental health inpatient and outpatient consultations received by these patients were analyzed, with different time intervals (< 3, 3 to 6, 6 to 12, and > 12 months) between the surgeries. Negative binominal regression was performed to estimate the interaction of the first eye surgery with the time interval. RESULTS The number of mental health consultations was lowest among patients with a time interval of < 3 months (1.783-1.743, P < .001), and a negative dose response effect was observed, such that a longer time interval corresponded to a lower reduction in the number of mental health consultations. For patients with a time interval of > 12 months, the predicted number of mental health consultations increased from 1.674 to 1.796 (P < .001). CONCLUSIONS Given a patient expected to receive surgeries for both eyes within 1 year, scheduling both surgeries within a short time interval may be beneficial for maximizing the effects of cataract surgery in reducing the number of mental health consultations.
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Affiliation(s)
- Chiun-Ho Hou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, 155 Linong Street. Sec 2, Peitou, Taipei, Taiwan.,Department of Ophthalmology, Change Gung Memorial Hospital, Xiamen, People's Republic of China.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ken-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jiahn-Shing Lee
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ken-Kuo Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Christy Pu
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, 155 Linong Street. Sec 2, Peitou, Taipei, Taiwan.
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Dockree S, Brook J, James T, Shine B, Impey L, Vatish M. Pregnancy-specific reference intervals for C-reactive protein improve diagnostic accuracy for infection: A longitudinal study. Clin Chim Acta 2021; 517:81-85. [PMID: 33647266 DOI: 10.1016/j.cca.2021.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Infections are a major cause of maternal mortality. C-reactive protein (CRP), a commonly-used inflammatory marker, is widely used to inform diagnosis, but the upper limit of normal in pregnancy is uncertain. We have defined trimester-specific reference intervals for CRP and evaluated their diagnostic accuracy for infection. MATERIALS AND METHODS Development cohort: longitudinal study of pregnant women to determine 95% reference intervals. Evaluation cohort: diagnostic accuracy study to evaluate these intervals in 50 women with suspected intrauterine infection. RESULTS In these 322 healthy pregnant women, CRP was substantially higher than in most non-pregnant populations. CRP was similar in each trimester, with an upper reference limit of 19 mg/L. CRP increased linearly with body mass index (p < 0.0001). The sensitivity and specificity of CRP for diagnosing chorioamnionitis were 73% and 86%, respectively. The overall diagnostic accuracy using the pregnancy-specific reference interval was significantly better than that of the existing standard (p = 0.03). CONCLUSIONS CRP is a widely-used clinical tool in pregnancy, and a pregnancy-specific reference interval should be used to optimise diagnostic accuracy. Chorioamnionitis was used as an example of a localised infection with well-defined outcomes, but pregnancy-specific RIs for CRP should be considered in any clinical setting including pregnant women.
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Affiliation(s)
| | - Jennifer Brook
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK.
| | - Tim James
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK.
| | - Brian Shine
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK.
| | | | - Manu Vatish
- Nuffield Department of Women's and Reproductive Health, University of Oxford, UK.
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Andrianakis A, Moser U, Kiss P, Holzmeister C, Andrianakis D, Tomazic PV, Wolf A, Graupp M. Comparison of two different intratympanic corticosteroid injection protocols as salvage treatments for idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 2021; 279:609-618. [PMID: 33591388 DOI: 10.1007/s00405-021-06676-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/14/2020] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to investigate the effect of interval length and total count of intratympanic steroid (ITS) injections in salvage treatment of patients with idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS This retrospective case-control study included 64 patients with ISSNHL, who were treated with ITS injections as salvage therapy at a tertiary referral centre. From September 2019 to December 2020, 32 patients received up to four injections every 2-4 days (revised-protocol group). These patients were 1:1 matched to patients, who received up to three injections at 1-week intervals between January 2014 and August 2019 (initial-protocol group). Hearing outcomes of the two groups were compared. RESULTS Both ITS salvage treatment protocols resulted in a statistically significant hearing improvement (p < 0.05). The initial-protocol declined hearing thresholds by 12 ± 11.7 dB (p < 0.001, d = 1, P = 99%). Mean hearing function was improved by 13.4 ± 19.1 dB in the revised-protocol group [p < 0.001, d = 0.7, P = 98%]. A clinically significant hearing improvement (> 10 dB) was seen in 18 patients (58.1%) in the initial-protocol group and in 14 patients (41.9%) in the revised-protocol group. A comparison of the hearing outcomes between protocol groups revealed no statistically significant differences (p > 0.05). CONCLUSION These results indicate that a shorter injection interval does not lead to better hearing outcomes in ITS salvage treatment for ISSNHL. Moreover, fewer ITS injections may reduce costs, physical/mental stress of the patients and lower the risk of persistent tympanic perforations.
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Affiliation(s)
- Alexandros Andrianakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Ulrich Moser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Peter Kiss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Clemens Holzmeister
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Damianos Andrianakis
- Institute of Mathematics and Scientific Computing, University of Graz, Graz, Austria
| | - Peter Valentin Tomazic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria.
| | - Axel Wolf
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Matthias Graupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
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Chen YH, Zhu XY, Liu XQ. Acute and life-threatening complications in patients with anorexia nervosa: A case report and literature study. Nutrition 2021; 87-88:111204. [PMID: 33744639 DOI: 10.1016/j.nut.2021.111204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/08/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 11/27/2022]
Abstract
Anorexia nervosa (AN) is characterized by a strong fear of weight gain and body image disorders and is classified as a mental illness that can cause direct damage to one's mental health and body. Many individuals with AN tend to commit suicide. Additionally, the disease can lead to chronic undernutrition and low body weight, adversely affecting each body system, exacerbating systemic medical complications, especially acute life-threatening complications. Therefore, AN has the highest mortality and disability rates among all mental diseases. There is a basic clinical need to identify and address the acute and critical complications of this disease as soon as possible. However, the current literature has a poor description of the acute and critical complications of AN and lacks a systematic review. We report a case of a patient with AN and severe hypokalemia, significant Q-T interval prolongation, stomach dilation, and intestinal obstruction who recovered after conservative treatment. The defecation method we used, to our knowledge, has not been previously reported in the literature. We also briefly review the various acute and life-threatening complications of AN.
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Affiliation(s)
- Yun-Hu Chen
- Department of Internal Medicine, Taicang Hospital affiliated with Nanjing University of Traditional Chinese Medicine, Suzhou, China.
| | - Xing-Yu Zhu
- Department of Clinical Pharmacy, Taicang Hospital affiliated with Nanjing University of Traditional Chinese Medicine, Suzhou, China
| | - Xue-Qian Liu
- Department of Emergency Medicine, Taicang Hospital affiliated with Nanjing University of Traditional Chinese Medicine, Suzhou, China
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28
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Snast I, Lapidoth M, Kaftory R, Nosrati A, Hodak E, Mimouni D, Solomon-Cohen E, Levi A. Does interval time between pulsed dye laser treatments for port-wine stains influence outcome? A systematic review and meta-analysis. Lasers Med Sci 2021; 36:1909-1916. [PMID: 33580846 DOI: 10.1007/s10103-021-03264-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/26/2020] [Accepted: 01/31/2021] [Indexed: 01/12/2023]
Abstract
The pulsed dye laser (PDL) is the standard treatment for port-wine stains (PWS). Maximal improvement occurs after multiple treatment sessions; however, the optimal treatment interval has yet to be determined. The aim of this study was to review whether there is an association between PDL treatment interval and outcome of PWS. Six databases were searched by three reviewers for publications investigating treatment of PWS with PDL. The 75% improvement rates (75IR) were extracted for quantitative analysis. Meta-regression was used to investigate the association between treatment intervals and 75IR. The systematic review included 1 RCT and 33 cohort studies (7 prospective cohorts and 26 retrospective cohorts), with a total of 3777 patients. The pooled 75IR was 37% (95% CI 29-45%; I2 = 95%). Light Fitzpatrick skin type (p = 0.04), facial anatomic location (p = 0.01), and young age (p = 0.008) were associated with 75IR. In an unadjusted (p = 0.42) and multivariable adjusted (p = 0.98) meta-regression, no association was found between time interval between treatments and 75IR. These results persisted in a sensitivity analysis of studies with a mean patient age of ≤ 1. The majority of included studies were heterogeneous and retrospective. Based on cohort studies of low-to-moderate quality, time intervals between PDL treatments are not associated with PWS outcome.
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Affiliation(s)
- Igor Snast
- Division of Dermatology, Laser Unit, Rabin Medical Center Hospital, 39 Jabotinsky St, 4941492, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Lapidoth
- Division of Dermatology, Laser Unit, Rabin Medical Center Hospital, 39 Jabotinsky St, 4941492, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kaftory
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Nosrati
- Division of Dermatology, Laser Unit, Rabin Medical Center Hospital, 39 Jabotinsky St, 4941492, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Division of Dermatology, Laser Unit, Rabin Medical Center Hospital, 39 Jabotinsky St, 4941492, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Mimouni
- Division of Dermatology, Laser Unit, Rabin Medical Center Hospital, 39 Jabotinsky St, 4941492, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Solomon-Cohen
- Division of Dermatology, Laser Unit, Rabin Medical Center Hospital, 39 Jabotinsky St, 4941492, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assi Levi
- Division of Dermatology, Laser Unit, Rabin Medical Center Hospital, 39 Jabotinsky St, 4941492, Petah Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Jiang D, Chen Y, Guo T. Lasting Effects of Using Distraction to Manage Responses to Unpleasant Pictures: Electrophysiological Evidence. Biol Psychol 2020; 156:107952. [PMID: 32961303 DOI: 10.1016/j.biopsycho.2020.107952] [Citation(s) in RCA: 2] [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: 08/08/2019] [Revised: 07/25/2020] [Accepted: 09/08/2020] [Indexed: 11/22/2022]
Abstract
Distraction is a widely used form of emotion regulation. Most studies have focused on the influence of distraction on the processing of aversive stimuli during distraction regulation, however, few studies investigated the impact on responses to aversive stimuli when they are re-presented later. This study examined whether processing of unpleasant pictures could be modulated by previous distraction and whether this modulation was associated with the intervals between regulation and re-exposure. Participants were presented with unpleasant images and asked to attend to or distract themselves from the images. After a 5- or 30-minute interval, the participants were re-exposed to the same images in an oddball task. Event-related potential measurements revealed that compared with the previous attention condition, the P3 amplitudes were significantly larger in the 30-min interval group, but not in the 5-min interval group under the previous distraction condition, and that the late positive potential amplitudes were significantly larger in the 30-min interval group, but tended to be smaller in the 5-min interval group. These findings suggest that the effects of distraction were diminished or disappeared after a 5-min interval and reversed after a 30-min interval. This pattern suggests that caution should be exercised in the use of distraction strategies to reduce negative emotions, particularly in cases in which unpleasant images may reappear in everyday life.
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Zhang Y, Ma Y, Fang Z, Hu S, Li Z, Zhu L, Jin L. Performing ICSI within 4 hours after denudation optimizes clinical outcomes in ICSI cycles. Reprod Biol Endocrinol 2020; 18:27. [PMID: 32290842 PMCID: PMC7155264 DOI: 10.1186/s12958-020-00587-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 04/02/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The study aimed to investigate whether and how general and partial time intervals between processes, from human chorionic gonadotrophin (HCG) trigger to intracytoplasmic sperm injection (ICSI), affected the laboratory and reproductive outcomes in ICSI cycles. METHODS This was a retrospective data analysis of 3602 women who underwent ICSI treatment cycles using partner or donor sperms, performed at Reproduction Medicine Center of Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology (Wuhan, China) between October 2016 and September 2018. The clinical pregnancy rate was the major outcome in the study. The fertilization and available embryo rates were secondary outcomes. RESULTS Data from 3602 consecutive fresh ICSI cycles was analysed. Multivariate linear regression and logistic regression analysis of factors related to fertilization and clinical pregnancy rates showed that fertilization rate (P = 0.001) and clinical pregnancy rate (P = 0.037) were significantly associated with denudation (DN)-ICSI interval. Long DN-ICSI interval was associated with higher rate of fertilization than short DN-ICSI interval but significantly decreased clinical pregnancy rate when the interval is over 4 h (P < 0.05). CONCLUSIONS DN-ICSI time interval can act as an independent predictor for clinical outcomes in ICSI cycles. The optimal time for ICSI is within 4 h after oocyte denudation for excellent laboratory and reproductive outcomes in ICSI cycles.
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Affiliation(s)
- Yini Zhang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China
| | - Yongzhuang Ma
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zishui Fang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China
| | - Shiqiao Hu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China
| | - Zhou Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China
| | - Lixia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China.
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China.
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Planellas Giné P, Cornejo Fernández L, Salvador Rosés H, Buxó Pujolras M, Farrés Coll R, Hernandez Yague X, Canals Subirats E, Gil Garcia J, Rodríguez Hermosa JI, Codina Cazador A. Delaying surgery by more than 10 weeks after long-course neoadjuvant radiotherapy in locally advanced rectal cancer patients improves pathologic complete response. Updates Surg 2020; 72:453-461. [PMID: 32232742 DOI: 10.1007/s13304-020-00747-0] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND We currently do not know the optimal time interval between the end of chemoradiotherapy and surgery. Longer intervals have been associated with a higher pathological response rate, worse pathological outcomes and more morbidity. The aim of this study was to evaluate the effect and safety of the current trend of increasing time interval between the end of chemoradiotherapy and surgery (< 10 weeks vs. ≥ 10 weeks) on postoperative morbidity and pathological outcomes. This study analyzed 232 consecutive patients with locally advanced rectal cancer treated with long-course neoadjuvant chemoradiotherapy from January 2012 to August 2018. 125 patients underwent surgery before 10 weeks from the end of chemoradiotherapy (Group 1) and 107 patients underwent surgery after 10 or more weeks after the end of chemoradiotherapy (Group 2). Results have shown that wait for ≥ 10 weeks did not compromise surgical safety. Pathological complete response and tumor stage was statistically significant among groups. The effect of wait for ≥ 10 weeks before surgery shown higher tumor regression than the first group (Group 1, 12.8% vs Group 2, 31.8%; p < 0.001). On multivariate analysis, wait for ≥ 10 weeks was associated with pathological compete response. Patients from the second group were four time more likely to achieve pathologic complete response than patients from the first group (OR, 4.27 95%CI 1.60-11.40; p = 0.004). Patients who undergo surgery after ≥ 10 weeks of the end of chemoradiotherapy are four time more likely to achieve complete tumor remission without compromise surgical safety or postoperative morbidity.
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Affiliation(s)
- Pere Planellas Giné
- Section of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital of Girona, France Avenue s/n, 17007, Girona, Spain.
- Girona Biomedical Research Foundation (IdIBGI), Girona, Spain.
| | | | - Helena Salvador Rosés
- Section of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital of Girona, France Avenue s/n, 17007, Girona, Spain
| | | | - Ramon Farrés Coll
- Section of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital of Girona, France Avenue s/n, 17007, Girona, Spain
- Girona Biomedical Research Foundation (IdIBGI), Girona, Spain
| | - Xavier Hernandez Yague
- Section of Oncology, Institut Catala de Oncologia, "Doctor Josep Trueta", University Hospital, Girona, Spain
| | - Eugeni Canals Subirats
- Section of Radiotherapy, Institut Catala de Oncologia, "Doctor Josep Trueta", University Hospital, Girona, Spain
| | - Júlia Gil Garcia
- Section of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital of Girona, France Avenue s/n, 17007, Girona, Spain
- Girona Biomedical Research Foundation (IdIBGI), Girona, Spain
| | - Jose Ignacio Rodríguez Hermosa
- Section of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital of Girona, France Avenue s/n, 17007, Girona, Spain
- Girona Biomedical Research Foundation (IdIBGI), Girona, Spain
| | - Antoni Codina Cazador
- Section of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital of Girona, France Avenue s/n, 17007, Girona, Spain
- Girona Biomedical Research Foundation (IdIBGI), Girona, Spain
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Yang X, He BJ, Sun SQ, Feng JX, Li JX. [Clinical effect of acupoint thread-embedding therapy at different intervals in the intervention of metabolic syndrome]. Zhen Ci Yan Jiu 2020; 45:62-5. [PMID: 32144911 DOI: 10.13702/j.1000-0607.1806816] [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] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the clinical effect of acupoint thread-embedding therapy at different intervals in the treatment of metabolic syndrome, and to find the optimal treatment interval. METHODS A total of 70 patients with metabolic syndrome were randomly divided into treatment group 1 (n=35)and treatment group 2(n=35). Both groups were given acupoint thread-embedding therapy at Zhongwan (CV12), bilateral Liangmen (ST21), bilateral Huaroumen (ST24), bilateral Tianshu (ST25), bilateral Daimai (GB26), Guanyuan (CV4), bilateral Dachangshu (BL25), bilateral Pishu (BL20), bilateral Zusanli (ST36), bilateral Yinlingquan (SP9), and bilateral Fenglong (ST40), and the treatment interval was 7 d for treatment group 1 and 14 d for treatment group 2. Each course of treatment was 42 d, and both groups were treated for 2 courses. Waist circumfe-rence (WC), hip circumference (HC), waist-hip ratio (WHR), body mass index (BMI), serum triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), and glycosylated hemoglobin (Hb1Ac) were measured before and after treatment to analyze clinical outcome, and adverse reactions were recorded. RESULTS After treatment, both groups had significant reductions in WC, HC, WHR, BMI, TG, LDL-C, FPG and Hb1Ac (P<0.05) and a significant increase in HDL-C (P<0.05). Compared with treatment group 1, treatment group 2 had significant increases in WC, WHR, BMI, TG, LDL-C, FPG and Hb1Ac (P<0.05) and a significant reduction in HDL-C (P<0.05). There was no significant difference in the incidence rate of adverse reactions between the two groups (P>0.05). CONCLUSION Under the premise of ensuring efficacy and safety, an interval of 7 d is the optimal interval for acupoint thread-embedding therapy in the clinical intervention of metabolic syndrome.
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Affiliation(s)
- Xuan Yang
- Department of Acupuncture and Moxibustion, The Fourth People's Hospital of Shaanxi Province, Xi'an 710043, China
| | - Bian Jiang He
- Department of Acupuncture and Moxibustion, The Fourth People's Hospital of Shaanxi Province, Xi'an 710043, China
| | - Sheng Qi Sun
- Department of Gastroenterology, The Fourth People's Hospital of Shaanxi Province, Xi'an 710043, China
| | - Jun Xin Feng
- Department of Acupuncture and Moxibustion, The Fourth People's Hospital of Shaanxi Province, Xi'an 710043, China
| | - Ji Xue Li
- Department of Acupuncture and Moxibustion, The Fourth People's Hospital of Shaanxi Province, Xi'an 710043, China
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Kuo YH, Chien YW, Chen PR, Feng CL, Li CC, Chien CR. Impact of the interval between neoadjuvant concurrent chemoradiotherapy and esophagectomy in the modern era: a population-based propensity-score-matched retrospective cohort study in Asia. World J Surg Oncol 2019; 17:222. [PMID: 31856840 PMCID: PMC6923901 DOI: 10.1186/s12957-019-1712-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/06/2019] [Accepted: 09/20/2019] [Indexed: 11/26/2022] Open
Abstract
Background Neoadjuvant concurrent chemoradiotherapy (nCCRT) is one of the standard-of-care options for locally advanced esophageal squamous cell carcinoma (LA-ESqCC). The optimal interval between nCCRT and esophagectomy is unknown. Methods We constructed a propensity-score-matched [1:1 for long (8–12 weeks) vs short (4–7 weeks) intervals] cohort of LA-ESqCC patients who were diagnosed from 2011 to 2015 and treated with nCCRT via the Taiwan Cancer Registry and related databases. We compared the hazard ratios (HRs) of death using a robust variance estimator. We also evaluated alternative covariables, outcomes, and interval definitions. Results Our study population included 80 patients for each group; groups were balanced with respect to the observed covariables. There was no significant difference for the HR of death [1.22; 95% confidence interval 0.78–1.91, P = 0.39] when the long interval group was compared to the short interval group. There were also no significant differences when alternative covariables, outcomes, or interval definitions were evaluated. Conclusions In this population-based study in modern Asia, we found that for LA-ESqCC patients treated with nCCRT and esophagectomy, overall survival was similar for either long or short intervals between nCCRT and esophagectomy. Randomized controlled trials are needed to verify this finding.
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Affiliation(s)
- Yao-Hung Kuo
- Department of Radiation Oncology, E-Da Hospital, Kaohsiung, Taiwan.,College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pin-Ru Chen
- Department of Chest Surgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chun-Lung Feng
- Division of Gastroenterology and Hepatology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chia-Chin Li
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan. .,Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan. .,Department of Medical Research, China Medical University Hsinchu Hospital, Hsinchu, Taiwan. .,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
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Samadder NJ, Neklason D, Snow A, Samowitz W, Cessna MH, Rowe K, Sandhu I, Boucher K, Pappas L, Smith KR, Wong J, Curtin K, Provenzale D, Burt RW. Clinical and Molecular Features of Post-Colonoscopy Colorectal Cancers. Clin Gastroenterol Hepatol 2019; 17:2731-2739.e2. [PMID: 30930275 DOI: 10.1016/j.cgh.2019.02.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Post-colonoscopy colorectal cancers (PCCRCs) may arise from missed lesions or due to molecular features of tumors that allow them to grow rapidly. We aimed to compare clinical, pathology, and molecular features of PCCRCs (those detected within 6-60 months of colonoscopy) and detected CRCs (those detected within 6 months of a colonoscopy). METHODS Within a population-based cross-sectional study of incident CRC cases in Utah (from 1995 through 2009), we identified PCCRCs (those cancers that developed within 5 years of a colonoscopy) and matched the patients by age, sex, and hospital site to patients with detected CRC. Archived specimens were retrieved and tested for microsatellite instability (MSI), CpG island methylation, and mutations in KRAS and BRAF. There were 2659 cases of CRC diagnosed within the study window; 6% of these (n = 159) were defined as PCCRCs; 84 of these cases had tissue available and were matched to 84 subjects with detected CRC. RESULTS Higher proportions of PCCRCs than detected CRCs formed in the proximal colon (64% vs 44%; P = .016) and were of an early stage (86% vs 69%; P = .040). MSI was observed in 32% of PCCRCs compared with 13% of detected CRCs (P = .005). The other molecular features were found in similar proportions of PCCRCs and detected CRCs. In a multivariable logistic regression, MSI (odds ratio, 4.20; 95% CI, 1.58-11.14) was associated with PCCRC. There was no difference in 5-year survival between patients with PCCRCs vs detected CRCs. CONCLUSION In this population-based cross-sectional study of incident CRC cases in Utah, we found PCCRCs to be more likely to arise in the proximal colon and demonstrate MSI, so PCCRCs and detected CRC appear to have different features or processes of tumorigenesis. Additional studies are needed to determine if post-colonoscopy cancers arise through a specific genetic pathway.
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Affiliation(s)
- N Jewel Samadder
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Gastroenterology), University of Utah, Salt Lake City, Utah; Department of Medicine (Gastroenterology), Mayo Clinic, Phoenix, Arizona.
| | - Deb Neklason
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Genetic Epidemiology), University of Utah, Salt Lake City, Utah
| | - Angela Snow
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Wade Samowitz
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Melissa H Cessna
- Department of Pathology and Biorepository, Intermountain Healthcare, Salt Lake City, Utah
| | - Kerry Rowe
- Department of Medicine, Intermountain Healthcare, Salt Lake City, Utah
| | - Iqbal Sandhu
- Department of Bioinformatics, Intermountain Healthcare, Salt Lake City, Utah
| | - Kenneth Boucher
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Lisa Pappas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ken Robert Smith
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jathine Wong
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Karen Curtin
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Genetic Epidemiology), University of Utah, Salt Lake City, Utah
| | - Dawn Provenzale
- Department of Medicine (Gastroenterology), Duke University, Durham, North Carolina; VA Cooperative Studies Program Epidemiology Center, Departments of Medicine (Gastroenterology) and Clinical Genomics, Mayo Clinic, Phoenix, Arizona
| | - Randall W Burt
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Gastroenterology), University of Utah, Salt Lake City, Utah; Department of Oncological Sciences, University of Utah, Salt Lake City, Utah
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Kim JW, Jung KW, Kwon JG, Lee JB, Park JK, Bang KB, Tae CH, Oh JH. What Is Appropriate Upper Endoscopic Interval Among Dyspeptic Patients With Previously Normal Endoscopy? A Multicenter Study With Bayesian Change Point Analysis. J Neurogastroenterol Motil 2019; 25:544-550. [PMID: 31587546 PMCID: PMC6786439 DOI: 10.5056/jnm19063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/21/2019] [Revised: 07/08/2019] [Accepted: 07/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background/Aims Appropriate interval for performing follow-up endoscopy among dyspeptic patients without abnormal findings on previous endoscopy is unclear. We analyzed the multicenter-collected data from the Korean Society of Neurogastroenterology and Motility. Methods We collected clinical data of the patients who visited the gastroenterology department and underwent 2 or more sessions of upper endoscopy during 2012–2017 at 6 university hospitals in Korea. Patients with endoscopic interval between 90 days and 760 days were included. For those with multiple endoscopic sessions, only the first 2 were analyzed. Positive outcome was defined as adenoma or cancer in the upper gastrointestinal tract. To identify the point of change and estimate the properties of the stochastic process before and after the change, we used Bayesian regression with Metropolis-Hastings algorithm. Results There were 1595 patients. Mean age was 58.8 years (standard deviation, 12.8). Median interval of endoscopy was 437 days (standard deviation, 153). On follow-up endoscopy, there were 12 patients (0.75%) who had neoplasia (4 with gastric cancer and 8 with gastric adnoma). As with the prior hypothesis, we presumed the change point (CP) of increase in frequency of organic lesion as 360 days. After random-walk Metropolis-Hastings sampling with Markov-Chain Monte Carlo iterations of 5000, the CP was 560 days (95% credible interval, 139–724). Estimated average of frequency of dysplastic lesions increased by a factor of 4.4 after the estimated CP. Conclusion To rule out dysplastic lesions among dyspeptic patients who had previously normal endoscopy, a 2-year interval could be offered as follow-up interval for repeat upper endoscopy.
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Affiliation(s)
- Jong Wook Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Joong Goo Kwon
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jung Bok Lee
- Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Kyu Park
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Korea
| | - Ki Bae Bang
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Chungcheongnam-do, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jung Hwan Oh
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Riche M, Mathon B, Mokhtari K, Carpentier A, Amelot A. Cylindroma spine metastasis: Long-term follow-up is required. Neurochirurgie 2019; 66:45-49. [PMID: 31634508 DOI: 10.1016/j.neuchi.2019.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/08/2019] [Revised: 09/21/2019] [Accepted: 09/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adenoid cystic carcinoma (ACC), or cylindroma, is a rare malignancy believed to arise from epithelial cells of salivary glands. It is a slow-growing but aggressive tumor with a propensity for perineural invasion. Metastases are common to the lung, but rare to the spine. The natural history of ACC spine metastases is unknown and progression is unpredictable. METHODS (1) A case report was described for a patient diagnosed with spine ACC metastasis of the T6/T7 vertebrae. (2) A literature search was conducted on Medline via PubMed and the Cochrane databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify articles from 1973 to March 2019 using following keywords: adenoid cystic carcinoma, cylindroma, metastasis, salivary glands. RESULTS/CASE REPORT We report an unusual case of spine ACC metastasis of the T6/T7 vertebrae in a patient suffering from progressive radiculopathy and thoracic pain. Based on these findings, the patient underwent T6/T7 laminectomy. The diagnosis was confirmed by the pathology results. The primary parotid tumor had been resected 35 years before spine metastasis. A review of literature encompassing 40 years identified 16 patients treated for ACC spine metastases. Mean time to spine metastases was 4.1 years after primary treatment of ACC. Spine metastases were isolated, without local recurrence at the neck. CONCLUSION This case highlights the critical importance of long follow up of ACC patients, due to late spine metastases. Diagnosis spinal metastasis of salivary carcinoma should be considered, to guide management, especially in clinical follow-up.
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Affiliation(s)
- M Riche
- Department of Neurosurgery, groupe hospitalier universitaire de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - B Mathon
- Department of Neurosurgery, groupe hospitalier universitaire de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne-University, UPMC, University Paris 06, 75013 Paris, France
| | - K Mokhtari
- Department of Neuro-pathology, La Pitié-Salpétrière Hospital, 75013 Paris, France; Sorbonne-University, UPMC, University Paris 06, 75013 Paris, France
| | - A Carpentier
- Department of Neurosurgery, groupe hospitalier universitaire de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne-University, UPMC, University Paris 06, 75013 Paris, France
| | - A Amelot
- Department of Neurosurgery, groupe hospitalier universitaire de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne-University, UPMC, University Paris 06, 75013 Paris, France.
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Pastorino U, Sverzellati N, Sestini S, Silva M, Sabia F, Boeri M, Cantarutti A, Sozzi G, Corrao G, Marchianò A. Ten-year results of the Multicentric Italian Lung Detection trial demonstrate the safety and efficacy of biennial lung cancer screening. Eur J Cancer 2019; 118:142-148. [PMID: 31336289 DOI: 10.1016/j.ejca.2019.06.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Multicentric Italian Lung Detection (MILD) trial demonstrated that prolonged low-dose computed tomography (LDCT) screening could achieve a 39% reduction in lung cancer (LC) mortality. We have here evaluated the long-term results of annual vs. biennial LDCT and the impact of screening intensity on overall and LC-specific mortality at 10 years. PATIENTS AND METHODS Between 2005 and 2018, the MILD trial prospectively randomised the 2376 screening arm participants to annual (n = 1190) or biennial (n = 1186) LDCT, for a median screening period of 6.2 years and 23,083 person-years of follow-up. The primary outcomes were 10-year overall and LC-specific mortality, and the secondary end-points were the frequency of advanced-stage and interval LCs. RESULTS The biennial LDCT arm showed a similar overall mortality (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.57-1.12) and LC-specific mortality at 10 years (HR 1.10, 95% CI 0.59-2.05), as compared with the annual LDCT arm. Biennial screening saved 44% of follow-up LDCTs in subjects with negative baseline LDCT, and 38% of LDCTs in all participants, with no increase in the occurrence of stage II-IV or interval LCs. CONCLUSIONS The MILD trial provides original evidence that prolonged screening beyond five years with biennial LDCT can achieve an LC mortality reduction comparable to annual LDCT, in subjects with a negative baseline examination.
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Affiliation(s)
- U Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| | - N Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - S Sestini
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Silva
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - F Sabia
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Boeri
- Tumor Genomics Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - A Cantarutti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - G Sozzi
- Tumor Genomics Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - A Marchianò
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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Khater A, Hamed E, Roshdy S, Elnahas W, Farouk O, Senbel A, Fathi A, Eldamshety O, Abdallah A. A New Concept of Interval TRAM for Immediate Breast Reconstruction in Obese Women. Indian J Surg Oncol 2019; 10:280-285. [PMID: 31168248 DOI: 10.1007/s13193-018-0866-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/01/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022] Open
Abstract
Performing pedicled TRAM in obese women carries risk of flap loss or native breast envelop necrosis. Our technique depends on performing total flap delay at the same setting with mastectomy with flap suture in situ to be followed 1 week later by flap transfer. This study included 24 operable women who were candidates for skin sparing or modified radical mastectomy. In one case, delay was only done and followed by mastectomy and flap transfer. In later experience, delay plus mastectomy was done first and followed later by flap transfer. Operative data and postoperative complications were recorded. The mean BMI was 37 ± 2.75. The mean total operative time was 200 ± 20.37. The mean total hospital stay was 9.1 ± 3.35 days. The mean total volume of blood loss was 380 ± 82.33 ml. Breast envelop necrosis was encountered in four cases; three of them were replaced by the TRAM skin. There was no total flap loss while partial loss was recorded in five cases. Fat necrosis occurred in eight cases. Most of mastectomy bed and abdominal complications were in average. Most of cases showed satisfactory esthetic outcome. Our new concept of "Interval TRAM" enables safe immediate breast reconstruction with pedicled TRAM in obese women and ensures presence of a skin pack up for the native breast envelop skin. We recommend this technique in every obese female who undergoes skin sparing mastectomy with immediate pedicled TRAM flap reconstruction.
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Affiliation(s)
- Ashraf Khater
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Egypt, Gomhoria Street, Mansoura, 35511 Egypt
| | - EmadEldeen Hamed
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Egypt, Gomhoria Street, Mansoura, 35511 Egypt
| | - Sameh Roshdy
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Egypt, Gomhoria Street, Mansoura, 35511 Egypt
| | - Waleed Elnahas
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Egypt, Gomhoria Street, Mansoura, 35511 Egypt
| | - Omar Farouk
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Egypt, Gomhoria Street, Mansoura, 35511 Egypt
| | - Ahmed Senbel
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Egypt, Gomhoria Street, Mansoura, 35511 Egypt
| | - Adel Fathi
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Egypt, Gomhoria Street, Mansoura, 35511 Egypt
| | - Osama Eldamshety
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Egypt, Gomhoria Street, Mansoura, 35511 Egypt
| | - Ahmed Abdallah
- Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of Medicine, Mansoura University, Egypt, Gomhoria Street, Mansoura, 35511 Egypt
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Morikawa M, Umazume T, Hosokawa-Miyanishi A, Watari H, Kobayashi T, Seki H, Saito S. Relationship between antithrombin activity and interval from diagnosis to delivery among pregnant women with early-onset pre-eclampsia. Int J Gynaecol Obstet 2019; 145:62-69. [PMID: 30714139 DOI: 10.1002/ijgo.12780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/27/2018] [Revised: 09/18/2018] [Accepted: 01/25/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the cutoff of antithrombin activity for predicting the interval from diagnosis of early-onset pre-eclampsia to delivery. METHODS At Hokkaido University Hospital, Japan, data were retrospectively assessed on antithrombin activity measured at both diagnosis of pre-eclampsia and delivery among women with singleton pregnancy and pre-eclampsia (defined by combined gestational hypertension and proteinuria) between 2009 and 2017. The timing of delivery was determined by maternal and fetal well-being. RESULTS Among 2904 singleton deliveries, antithrombin activity was measured for 94 (3.2%) women diagnosed with pre-eclampsia. The median (range) interval was significantly longer for 38 (40%) women with early-onset than for 56 (60%) women with late-onset pre-eclampsia (6.5 [0-27] vs 1 [0-29] days, respectively; P<0.001). In the early-onset group, median antithrombin activity at diagnosis was significantly lower for 19 women with an interval of less than 7 days (72% [60%-92%]) than for 19 women with a longer interval (≥7 days) (84% [59%-110%]; P=0.012). Antithrombin activity of 78% at diagnosis of early-onset pre-eclampsia was optimal for predicting a delivery interval of less than 7 days. CONCLUSION A cutoff of 78% antithrombin activity at diagnosis of early-onset pre-eclampsia might be used as a predictor of delivery within 7 days.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ami Hosokawa-Miyanishi
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takao Kobayashi
- Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Hiroyuki Seki
- Center for Maternal Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Graduate School of Medicine, Toyama, Japan
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Peng L, Liu JQ, Xu C, Huang XD, Tang LL, Chen YP, Sun Y, Ma J. The prolonged interval between induction chemotherapy and radiotherapy is associated with poor prognosis in patients with nasopharyngeal carcinoma. Radiat Oncol 2019; 14:9. [PMID: 30654815 PMCID: PMC6335732 DOI: 10.1186/s13014-019-1213-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 09/11/2018] [Accepted: 01/08/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Induction chemotherapy (IC) now is gaining recognition for the treatment of nasopharyngeal carcinoma (NPC). The current study was conducted to examine the association between prognosis and the interval between IC and radiotherapy (RT) in NPC patients. METHODS Patients with newly diagnosed, non-metastatic NPC who were treated with IC followed by RT from 2009 to 2012 were identified from an inpatient database. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS) and locoregional recurrence-free survival (LRFS) were compared between those with interval ≤ 30 and > 30 days by Kaplan-Meier and log-rank analyses; Cox modeling was used for multivariable analysis. RESULTS A total of 668 patients met inclusion criteria with median follow-up of 64.4 months. Patients were categorized by interval: 608 patients with interval ≤ 30 days, and 60 with interval > 30 days. The 5-year OS, DFS, DMFS and LRFS rates were 86.6, 78.2, 88.0 and 89.8% for patients with interval ≤ 30 days, respectively, and 69.2, 64.5, 71.2 and 85.1% for patients with interval > 30 days, respectively. The prolonged interval was a risk factor for OS, DFS and DMFS with adjusted hazard ratios (95% confidence intervals) were 2.44 (1.48-4.01), 1.99 (1.27-3.11) and 2.62 (1.54-4.47), respectively. CONCLUSIONS Prolonged interval > 30 days was associated with a significantly higher risk of distant metastasis and death in NPC patients. Efforts should be made to avoid prolonged interval between IC and RT to minimize the risk of treatment failure.
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Affiliation(s)
- Liang Peng
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Jin-Qi Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Cheng Xu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Xiao-Dan Huang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Ling-Long Tang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Yu-Pei Chen
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.
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Engel C, Vasen HF, Seppälä T, Aretz S, Bigirwamungu-Bargeman M, de Boer SY, Bucksch K, Büttner R, Holinski-Feder E, Holzapfel S, Hüneburg R, Jacobs MAJM, Järvinen H, Kloor M, von Knebel Doeberitz M, Koornstra JJ, van Kouwen M, Langers AM, van de Meeberg PC, Morak M, Möslein G, Nagengast FM, Pylvänäinen K, Rahner N, Renkonen-Sinisalo L, Sanduleanu S, Schackert HK, Schmiegel W, Schulmann K, Steinke-Lange V, Strassburg CP, Vecht J, Verhulst ML, de Vos Tot Nederveen Cappel W, Zachariae S, Mecklin JP, Loeffler M. No Difference in Colorectal Cancer Incidence or Stage at Detection by Colonoscopy Among 3 Countries With Different Lynch Syndrome Surveillance Policies. Gastroenterology 2018; 155:1400-1409.e2. [PMID: 30063918 DOI: 10.1053/j.gastro.2018.07.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Patients with Lynch syndrome are at high risk for developing colorectal cancer (CRC). Regular colonoscopic surveillance is recommended, but there is no international consensus on the appropriate interval. We investigated whether shorter intervals are associated with lower CRC incidence and detection at earlier stages by comparing the surveillance policies in Germany, which evaluates patients by colonoscopy annually, in the Netherlands (patients evaluated at 1-2-year intervals), and Finland (patients evaluated at 2-3-year intervals). METHODS We collected data from 16,327 colonoscopic examinations (conducted from 1984 through 2015) of 2747 patients with Lynch syndrome (pathogenic variants in the MLH1, MSH2, or MSH6 genes) from the German HNPCC Consortium, the Dutch Lynch Syndrome Registry, and the Finnish Lynch Syndrome Registry. Our analysis included 23,309 person-years of cumulative observation time. Time from the index colonoscopy to incident CRC or adenoma was analyzed using the Kaplan-Meier method; groups were compared using the log-rank test. We performed multivariable Cox regression analyses to identify factors associated with CRC risk (diagnosis of CRC before the index colonoscopy, sex, mutation, age, and presence of adenoma at the index colonoscopy). RESULTS The 10-year cumulative CRC incidence ranged from 4.1% to 18.4% in patients with low- and high-risk profiles, respectively, and varied with age, sex, mutation, and prior detection of CRC or adenoma. Observed colonoscopy intervals were largely in accordance with the country-specific recommendations. We found no significant differences in cumulative CRC incidence or CRC stage at detection among countries. There was no significant association between CRC stage and time since last colonoscopy. CONCLUSIONS We did not find a significant reduction in CRC incidence or stage of detection in Germany (annual colonoscopic surveillance) than in countries with longer surveillance intervals (the Netherlands, with 1-2-year intervals, and Finland, with 2-3-year intervals). Overall, we did not find a significant association of the interval with CRC risk, although age, sex, mutation, and prior neoplasia were used to individually modify colonoscopy intervals. Studies are needed to develop and validate risk-adapted surveillance strategies and to identify patients who benefit from shorter surveillance intervals.
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Affiliation(s)
- Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany.
| | - Hans F Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Toni Seppälä
- Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Stefan Aretz
- Institute of Human Genetics, University of Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | | | - Sybrand Y de Boer
- Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Karolin Bucksch
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | | | - Elke Holinski-Feder
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Stefanie Holzapfel
- Institute of Human Genetics, University of Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | - Robert Hüneburg
- Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Maarten A J M Jacobs
- Department of Gastroenterology and Hepatology, Free University Medical Centre, Amsterdam, The Netherlands
| | - Heikki Järvinen
- Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Matthias Kloor
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Cooperation Unit Applied Tumour Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Cooperation Unit Applied Tumour Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan J Koornstra
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Mariette van Kouwen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alexandra M Langers
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paul C van de Meeberg
- Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Monika Morak
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Gabriela Möslein
- Center for Hereditary Tumors, HELIOS Klinikum Wuppertal, University Witten-Herdecke, Wuppertal, Germany
| | - Fokko M Nagengast
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kirsi Pylvänäinen
- Department of Education and Research, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Nils Rahner
- Institute of Human Genetics, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Silvia Sanduleanu
- Department of Gastroenterology and Hepatology, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - Hans K Schackert
- Department of Surgical Research, Technische Universität Dresden, Dresden, Germany
| | - Wolff Schmiegel
- Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Karsten Schulmann
- Department of Internal Medicine, Hematology and Oncology, Klinikum Arnsberg, Arnsberg, Germany
| | - Verena Steinke-Lange
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Christian P Strassburg
- Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Juda Vecht
- Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
| | - Marie-Louise Verhulst
- Department of Gastroenterology and Hepatology, Maxima Medical Centre, Eindhoven, The Netherlands
| | | | - Silke Zachariae
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Jukka-Pekka Mecklin
- Departments of Education and Research and Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland; Sports and Health Sciences, Jyväskylä University, Jyväskylä, Finland
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
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Hayashi K, Mitani S, Taniguchi H, Yasui H, Muro K, Mori K, Gotoda T, Yamazaki K. Panitumumab Provides Better Survival Outcomes Compared to Cetuximab for Metastatic Colorectal Cancer Patients Treated with Prior Bevacizumab within 6 Months. Oncology 2018; 96:132-139. [PMID: 30359979 DOI: 10.1159/000493321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/11/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Anti-epithelial growth factor receptor (EGFR) antibodies cetuximab (Cmab) and panitumumab (Pmab) have shown survival benefit for metastatic colorectal cancer (mCRC) patients. This study aimed to compare Pmab and Cmab according to the interval between bevacizumab discontinuation and anti-EGFR antibody initiation (bevacizumab-free interval; BFI). METHODS We retrospectively evaluated mCRC patients who received Cmab or Pmab in combination with irinotecan at two institutions. Inclusion criteria were histologically confirmed mCRC, with KRAS exon 2 wild-type tumor, refractory or intolerant to fluoropyrimidines, oxali platin, and irinotecan. RESULTS One-hundred-seventy-eight patients fulfilled the eligibility criteria. Among them, there was no significant difference in overall survival (OS) and progression-free survival (PFS) between the Pmab (n = 44) and Cmab groups (n = 134). Of 132 patients with BFI < 6 months, the median OS was 13.3 and 11.5 months in the Pmab (n = 39) and Cmab (n = 93) groups, respectively (p = 0.043). The median PFS was 5.8 and 4.9 months in the Pmab and Cmab groups, respectively (p = 0.055). Multivariate analysis for OS confirmed the superiority of Pmab. CONCLUSION Pmab showed more favorable outcomes in patients treated with bevacizumab within the last 6 months. The interval between prior bevacizumab and subsequent anti-EGFR therapy may be useful for determining the optimal anti-EGFR therapy.
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Affiliation(s)
- Kaori Hayashi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Nagaizumi-Cho, Japan.,Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Seiichiro Mitani
- Department of Clinical Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Hiroya Taniguchi
- Department of Clinical Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Hirofumi Yasui
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Nagaizumi-Cho, Japan
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Keita Mori
- Shizuoka Cancer Center, Clinical Research Center, Clinical Research Promotion Unit, Nagaizumi-Cho, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Nagaizumi-Cho,
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Qin Q, Xu H, Liu J, Zhang C, Xu L, Di X, Zhang X, Sun X. Does timing of esophagectomy following neoadjuvant chemoradiation affect outcomes? A meta-analysis. Int J Surg 2018; 59:11-18. [PMID: 30261331 DOI: 10.1016/j.ijsu.2018.09.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 07/30/2018] [Revised: 09/05/2018] [Accepted: 09/19/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The optimal timing of esophagectomy after neoadjuvant chemoradiation treatment (nCRT) remains unclear. Here, a meta-analysis was conducted to determine whether prolonged interval between nCRT and surgery can affect the outcomes in esophageal cancer. MATERIALS AND METHODS The databases PubMed, Embase, Web of Science, and Cochrane were systematically searched for studies reporting the outcomes in esophageal cancer according to the length of interval between nCRT and surgery. The primary outcome was rate of pathologic complete response (pCR), and the secondary outcomes included R0 resection rate, incidence of anastomotic leak, postoperative mortality, and two or five-year overall survival (OS). The intervals were classified into dichotomous (≤7-8 weeks and >7-8 weeks) for the pooled analysis, and a combined relative risk (RR) was calculated. RESULTS A total of 13 studies involving 15,086 patients were analyzed. The overall results indicated that an interval longer than 7-8 weeks between the end of nCRT and the surgery was significantly associated with an improved pCR rate (RR, 1.13; 95% confidence interval [CI], 1.05-1.21; P = 0.001). However, it was related to a higher 30-day surgical mortality (RR, 1.51; 95% CI, 1.19-1.92; P = 0.0006). The subgroup analyses only detected a significant association of the extended interval with pCR and the surgical mortality rate in adenocarcinoma patients. Moreover, an increased time interval resulted in a lower 2-year (RR, 0.94; 95% CI, 0.90-0.98; P = 0.002) and 5-year OS (RR, 0.88; 95% CI, 0.82-0.95; P = 0.0009). No association with R0 resection rate or anastomotic complication resulting from delayed resection was detected. CONCLUSIONS Although increasing the time interval from nCRT to esophagectomy was associated with significantly higher pathologic complete response rates in esophageal cancer, delaying the surgery might be disadvantageous for the long-term survival.
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Affiliation(s)
- Qin Qin
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huazhong Xu
- Department of Neurosurgery, Sir Run Run Shaw Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Jia Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chi Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liping Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoke Di
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaowen Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Rinnan Å, Savorani F, Engelsen SB. Simultaneous classification of multiple classes in NMR metabolomics and vibrational spectroscopy using interval-based classification methods: iECVA vs iPLS-DA. Anal Chim Acta 2018; 1021:20-27. [PMID: 29681281 DOI: 10.1016/j.aca.2018.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/01/2017] [Revised: 01/30/2018] [Accepted: 03/12/2018] [Indexed: 11/18/2022]
Abstract
Interval based chemometric algorithms have proven to be very powerful for spectral alignments, spectral regressions and spectral classifications. The interval-based methods may not only improve the performance, but also reduce model complexity and enhance the spectral interpretation. Extended Canonical Variate Analysis (ECVA) is a powerful method for multiple group classifications of multivariate data and can easily be extended to an interval approach, iECVA. This study outlines the iECVA method and compares its performance to interval Partial Least Squares Discriminant Analysis (iPLS-DA) on three spectroscopic datasets from Nuclear Magnetic Resonance (NMR), Near Infrared (NIR) and Infrared (IR) spectroscopy, respectively. The results invariantly show that the interval-based classification methods greatly enhance the interpretability of the models by identifying important spectral regions, which facilitate interpretation and biomarker discovery. Although the results for the two methods are similar regarding the number of misclassifications and identified important regions, the model complexity of the PLS-DA proved to consistently lower than the ECVA. The Matlab source codes for both iECVA and iPLS-DA are made freely available at www. MODELS life.ku.dk.
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Affiliation(s)
- Åsmund Rinnan
- Chemometrics and Analytical Technology, Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark.
| | - Francesco Savorani
- Chemometrics and Analytical Technology, Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark
| | - Søren Balling Engelsen
- Chemometrics and Analytical Technology, Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark
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Bhatt MN, Ghio M, Sadri L, Sarkar S, Kasotakis G, Narsule C, Sarkar B. Percutaneous Cholecystostomy in Acute Cholecystitis-Predictors of Recurrence and Interval Cholecystectomy. J Surg Res 2018; 232:539-46. [PMID: 30463770 DOI: 10.1016/j.jss.2018.06.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Percutaneous cholecystostomy (PC) tube is a preferred option in acute cholecystitis for patients who are high risk for cholecystectomy (CCY). There are no evidence-based guidelines for patient care after PC. We identified the predictors of disease recurrence and successful interval CCY. METHODS A retrospective review of 145 PC patients between 2008 and 2016 at a tertiary hospital was performed. Primary outcomes included mortality, readmissions, hospital and intensive care unit length of stay (LOS), disease recurrence, and interval CCY. RESULTS There were 96 (67%) calculous and 47 (33%) acalculous cholecystitis cases. Seventy-two (49%) had chronic and 73 (51%) had acute prohibitive risks as an indication for PC. There were 54 (37%) periprocedural complications, which most commonly were dislodgements. Twenty-six (18%) patients had a recurrence at a median time of 65 days. Calculous cholecystitis (odds ratio [OR] 3.44, P = 0.038) and purulence in the gallbladder (OR 3.77, P = 0.009) were predictors for recurrence. Forty-one (28%) patients underwent interval CCY. Patients with acute illness were likely to undergo interval CCY (OR 6.67, P = 0.0002). Patients with acalculous cholecystitis had longer hospital LOS (16 versus 8 days) and intensive care unit LOS (2 versus 0 days), and higher readmission rates (OR 2.42, P = 0.02). Thirty-day mortality after PC placement was 9%. Patients receiving interval CCY were noted to have increased survival compared to PC alone. However, this should not be attributed to interval CCY alone in absence of randomization in this study. CONCLUSIONS Calculous cholecystitis and purulence in the gallbladder are independent predictors of acute cholecystitis recurrence. Acute illness is a strong predictor of successful interval CCY. The association of interval CCY and prolonged survival in patients with PC as noted in this study should be further assessed in future prospective randomized trials.
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Wu H, Fang C, Huang L, Fan C, Wang C, Yang L, Li Y, Zhou Z. Short-course radiotherapy with immediate or delayed surgery in rectal cancer: A meta-analysis. Int J Surg 2018; 56:195-202. [PMID: 29807169 DOI: 10.1016/j.ijsu.2018.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 02/27/2018] [Revised: 04/12/2018] [Accepted: 05/21/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The safety and efficacy of preoperative short-course radiotherapy had been verified in rectal cancer. However, the timing of surgery after radiation had not been well defined. Thus, we performed this meta-analysis to compare the interval time of surgery after short-course radiotherapy in rectal cancer: immediate surgery (<4 weeks) vs delayed surgery (>4 weeks). METHODS We searched the PubMed, EMBASE, MEDLINE, and Cochrane Library database. The primary endpoints were survival rates and pathological outcomes, and the second endpoints included sphincter preservation rate, R0 resection rate and postoperative complications. RevMan 5.3 was used to calculate pooled risk ratio (RRs) and 95% confidence interval (CIs). RESULTS In total, 5 eligible studies including 1244 participants were identified. The delayed surgery group had a markedly higher pathological complete response rate [RR = 15.71, 95% CI (2.10, 117.30), P = 0.007] and downstaging rate [RR = 2.63, 95% CI (1.77, 3.90), P < 0.00001], a higher proportion of patients with adjuvant pathologic stage 0 + I disease [RR = 1.49, 95% CI (1.23, 1.81), P < 0.0001] and a lower incidence of postoperative complications [RR = 0.81, 95% CI (0.70, 0.95), P = 0.008] than did the immediate surgery group, but the survival rate, sphincter preservation rate and R0 resection rate were similar between the two groups. CONCLUSION Based on better pathologic outcomes and fewer postoperative complications, we recommended short-course radiotherapy with delayed surgery for more than 4 weeks.
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Affiliation(s)
- Haoyan Wu
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Chao Fang
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Libin Huang
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Chuanwen Fan
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Cun Wang
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Yuan Li
- Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Department of Pediatric Surgery, West China Hospital and State Key Laboratory of Biotherapy, Chengdu, China
| | - Zongguang Zhou
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China.
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Anteneh Y, Stellmacher T, Zeleke G, Mekuria W, Gebremariam E. Dynamics of land change: insights from a three-level intensity analysis of the Legedadie-Dire catchments, Ethiopia. Environ Monit Assess 2018; 190:309. [PMID: 29696501 DOI: 10.1007/s10661-018-6688-1] [Citation(s) in RCA: 3] [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: 06/01/2017] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
Earlier studies on land change (LC) have focused on size and magnitude, gains and losses, or land transfers between categories. Therefore, these studies have failed to simultaneously show the complete LC processes. This paper examines LCs in the Legedadie-Dire catchments in Oromia State, Ethiopia, using land-category maps with intensity analysis (IA) at three points in time. We comprehensively analyze LC to jointly encompass the rate, intensity, transition, and process. Thirty-meter US Geological Survey (USGS) Landsat imagery from 1986, 2000, and 2015 (< 10% cloud) is processed using TerrSet-LCM and ArcGIS. Six categories are identified using a maximum likelihood classification technique: settlement, cultivation, forest, water, grassland, and bare land. Then, classified maps are superimposed on the images to statistically examine changes with an IA. Considerable changes are observed among categories, except for water, between 1986-2000 and 2000-2015. Overall land change occurred quickly at first and then slowly in the second time interval. The total land area that exhibited change (1st ≈ 54% and 2nd ≈ 51%) exceeded the total area of persistence (1st ≈ 46% and 2nd ≈ 49%) across the landscape. Cultivation and human settlements were the most intensively increased categories, at the expense of grassland and bare ground. Hence, when grassland was lost, it tended to be displaced by cultivation more than other categories, which was also true with bare land. Annual intensity gains were active for forest but minimal for cultivation, implying that the gains of forest were associated with in situ reforestation practices and that the gains in cultivation were caused by its relatively large initial area under a uniform intensity concept. This study demonstrates that IA is valuable for investigating LC across time intervals and can help distinguish dormant vs. active and targeted vs. avoided land categories.
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Affiliation(s)
- Yilikal Anteneh
- Geography and Environmental Studies, Arba Minch University (AMU), P.O. Box: 21, Arba Minch, Ethiopia.
| | - Till Stellmacher
- Center for Development Research (ZEF), University of Bonn, Bonn, Germany
| | - Gete Zeleke
- Water and Land Resource Center (WLRC), P. O. Box: 3880, Addis Ababa, Ethiopia
| | - Wolde Mekuria
- International Water Management Institute (IWMI), P.O. Box 5689, Addis Ababa, Ethiopia
| | - Ephrem Gebremariam
- Ethiopian Institute of Architecture, Building Construction, and City Development (EiABC), Addis Ababa University (AAU), P.O. Box: 518, Addis Ababa, Ethiopia
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Gupta P, Gupta MM, Sharma R. Intrauterine Copper Device (CuT380A) as a Contraceptive Method in the Indian Context: Acceptability, Safety and Efficacy Depending on the Timing of Insertion. J Obstet Gynaecol India 2018; 68:129-135. [PMID: 29662283 DOI: 10.1007/s13224-017-1079-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/14/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022] Open
Abstract
Background Ideal time of Intrauterine copper device (IUCD) insertion either to space or limit births in Indian women should be known to check fertility effectively and safely. We therefore aimed to compare various IUCD related clinical factors to assess its acceptability, safety and efficacy in immediate postpartum vaginal insertion, intra-caesarean insertion, delayed postpartum insertion and interval insertion at a tertiary-care centre in India. Methods It was a retrospective analysis of prospectively collected data from July 2013 to July 2014. Data was reviewed about maternal age, socioeconomic status, education, occupation and parity of a total of 1631 eligible mothers and was compared between postpartum group and interval group. Data about spontaneous expulsion rate of IUCD, proportion of patients not able to feel thread, reasons for removal and failure rate of IUCD up to a follow-up period of 6 months was also collected in these women and compared among immediate vaginal insertion, intra-caesarean insertion, delayed postpartum insertion and interval insertion. Results Majority of women were between 20 and 35 years of age group, literate, multiparous, unemployed and belonged to middle/lower socio-economic strata in both postpartum and interval groups. Spontaneous expulsion rates were 1.84, 0.84, 2.83 and 1.63%; proportions of patients not able to feel thread were 3.07, 8.73, 4.45 and 1.63%; and removal rates were 7.99, 6.48, 7.69 and 3.47% in immediate vaginal, intra-caesarean, delayed postpartum and interval insertion groups, respectively. Failure was seen in only one case of delayed postpartum insertion. Conclusion IUCD was more acceptable among young, literate and multiparous women as a contraceptive method. Immediate postpartum period was the safest and most efficacious time for IUCD insertion with least expulsion rate, maximum continuation rate and no failure and, therefore, should be encouraged by adequate counseling of mothers.
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Affiliation(s)
- Purnima Gupta
- 1Department of Obstetrics and Gynaecology, Gandhi Medical College and Associated Sultania Zanana Hospital, Bhopal, Madhya Pradesh India
| | - Madhavi Mathur Gupta
- 2Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Rachna Sharma
- 2Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Chakraverty S, Sahoo BK, Rao TD, Karunakar P, Sapra BK. Modelling uncertainties in the diffusion-advection equation for radon transport in soil using interval arithmetic. J Environ Radioact 2018; 182:165-171. [PMID: 29258052 DOI: 10.1016/j.jenvrad.2017.12.007] [Citation(s) in RCA: 6] [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: 12/26/2016] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 06/07/2023]
Abstract
Modelling radon transport in the earth crust is a useful tool to investigate the changes in the geo-physical processes prior to earthquake event. Radon transport is modeled generally through the deterministic advection-diffusion equation. However, in order to determine the magnitudes of parameters governing these processes from experimental measurements, it is necessary to investigate the role of uncertainties in these parameters. Present paper investigates this aspect by combining the concept of interval uncertainties in transport parameters such as soil diffusivity, advection velocity etc, occurring in the radon transport equation as applied to soil matrix. The predictions made with interval arithmetic have been compared and discussed with the results of classical deterministic model. The practical applicability of the model is demonstrated through a case study involving radon flux measurements at the soil surface with an accumulator deployed in steady-state mode. It is possible to detect the presence of very low levels of advection processes by applying uncertainty bounds on the variations in the observed concentration data in the accumulator. The results are further discussed.
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Affiliation(s)
- S Chakraverty
- Department of Mathematics, National Institute of Technology Rourkela, Odisha, 769008, India.
| | - B K Sahoo
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai, 400 094, India.
| | - T D Rao
- Department of Mathematics, National Institute of Technology Rourkela, Odisha, 769008, India.
| | - P Karunakar
- Department of Mathematics, National Institute of Technology Rourkela, Odisha, 769008, India.
| | - B K Sapra
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai, 400 094, India.
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Widdice LE, Unger ER, Panicker G, Hoagland R, Callahan ST, Jackson LA, Berry AA, Kotloff K, Frey SE, Harrison CJ, Pahud BA, Edwards KM, Mulligan MJ, Sudman J, Bernstein DI. Antibody responses among adolescent females receiving two or three quadrivalent human papillomavirus vaccine doses at standard and prolonged intervals. Vaccine 2018; 36:881-889. [PMID: 29306506 DOI: 10.1016/j.vaccine.2017.12.042] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/21/2017] [Accepted: 12/07/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The originally recommended dosing schedule, 0, 2, 6 months, for the 3-dose quadrivalent human papillomavirus vaccine (4vHPV) was often not followed, resulting in longer than recommended intervals between doses and interest in the effect of prolonged intervals. Recent two-dose recommendations require investigations into the effect of delaying dose 2. METHODS This multi-site, prospective study enrolled healthy 9-17 year old girls (n = 1321) on the day of or within 28 days following a third dose of 4vHPV vaccination. Antibody titers to 4vHPV types were measured at one and six months post-dose 3 from all participants and post-dose 2 from participants who were on time for dose 3. To compare antibody responses, participants were categorized into groups: second and third doses on time (control group); on-time dose 2, substantially late dose 3 (group 2); substantially late dose 2, on-time dose 3 (group 3); both doses substantially late (group 4). Analyses compared age-adjusted geometric mean titers (GMTs) at one-month and six-months post-dose 3, effect of delaying the second dose, and two versus three doses as well as post-dose 2 GMTs, stratified by age. RESULTS Compared to on-time dosing, one-month post-dose 3 GMTs were non-inferior in groups 2, 3, and 4 and were superior in group 2. Six month post-dose 3 GMTs were superior in groups 2, 3, and 4 for each genotype, except HPV 18 in group 3. Age-adjusted post does 2 titers were significantly lower than post-dose 3 titers when dose 2 was on time but were significantly higher when dose 2 was substantially late. Participants ≥15 years old had no difference in post-dose 2 titers compared to <15 year olds when dose 2 was substantially delayed. CONCLUSIONS Prolonged intervals between doses do not appear to diminish and may enhance antibody response to 4vHPV. ClinicalTrials.gov (NCT00524745).
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Affiliation(s)
- Lea E Widdice
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, United States.
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Gitika Panicker
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Rebecca Hoagland
- Cota Enterprises, Inc., 16570 46th Street, McLouth, KS 66054, United States.
| | - S Todd Callahan
- Division of Adolescent and Young Adult Health, Vanderbilt University, 719 Thompson Lane, Suite 36300, Nashville, TN 37204, United States.
| | - Lisa A Jackson
- Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, United States.
| | - Andrea A Berry
- Division of Infectious Disease and Tropical Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, United States.
| | - Karen Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, United States.
| | - Sharon E Frey
- Division of Infectious Diseases, Allergy and Immunology, Saint Louis University, 1100 S. Grand Boulevard, St. Louis, MO 63104, United States.
| | - Christopher J Harrison
- Division of Pediatric Infectious Diseases, Children's Mercy - Kansas City, 2401 Gillham Road, MO 64108, United States.
| | - Barbara A Pahud
- Division of Pediatric Infectious Diseases, Children's Mercy - Kansas City, 2401 Gillham Road, MO 64108, United States.
| | - Kathryn M Edwards
- Division of Pediatric Infectious Diseases, Vanderbilt Vaccine Research Program, D7227 Medical Center North, Vanderbilt University School of Medicine, Nashville, TN 37232, United States.
| | - Mark J Mulligan
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court, Suite 200, Decatur, GA 30030, United States.
| | - Jon Sudman
- Kaiser Permanente Georgia, 200 Crescent Centre Parkway, Lower Level, Tucker, GA 30084, United States.
| | - David I Bernstein
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 6014, Cincinnati, OH 45229, United States.
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