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Hendriks MMC, Schweren KSA, Kleij A, Berrevoets MAH, de Jong E, van Wijngaarden P, Ammerlaan HSM, Vos AN, van Assen S, Slieker K, Gisolf EH, Netea MG, Ten Oever J, Kouijzer IJE. Low-risk Staphylococcus aureus bacteremia patients do not require routine diagnostic imaging: A multicenter retrospective cohort study. Clin Infect Dis 2024:ciae187. [PMID: 38576380 DOI: 10.1093/cid/ciae187] [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: 12/21/2023] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Risk stratification to categorize patients with Staphylococcus aureus bacteremia (SAB) as low- or high-risk for metastatic infection may direct diagnostic evaluation and enable personalized management. We investigated the frequency of metastatic infections in low-risk SAB patients, their clinical relevance, and whether omission of routine imaging is associated with worse outcomes. METHODS We performed a retrospective cohort study in seven Dutch hospitals among adult patients with low-risk SAB, defined as hospital-acquired infection without treatment delay, absence of prosthetic material, short duration of bacteremia, and rapid defervescence. The primary outcome was the proportion of patients whose treatment plan changed due to detected metastatic infections, as evaluated by both the actual therapy administered and by linking a retrospectively adjudicated diagnosis to guideline-recommended treatment. Secondary outcomes were 90-day relapse-free survival, and factors associated with performing of diagnostic imaging. RESULTS Of 377 patients included, 298 (79%) underwent diagnostic imaging. In 15 of these 298 patients (5.0%) imaging findings during patient admission had been interpreted as metastatic infections that should extend duration of treatment. Using the final adjudicated diagnosis, 4 patients (1.3%) had clinically relevant metastatic infection. In a multilevel multivariable logistic regression analysis, 90-days relapse-free survival was similar between patients without imaging and those who underwent imaging (81.0% versus 83.6%; aOR 0.749 (95% CI 0.373-1.504). CONCLUSION Our study advocates risk stratification for the management of patients with SAB. Prerequisites are follow-up blood cultures, bedside ID consultation, along with critically reviewing disease evolution. Using this approach, routine imaging could be omitted in low-risk patients.
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Affiliation(s)
- M M C Hendriks
- Department of Internal Medicine and Radboud center for infectious diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K S A Schweren
- Department of Internal Medicine and Radboud center for infectious diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A Kleij
- Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | - E de Jong
- Amphia Hospital, Breda, the Netherlands
| | | | | | - A N Vos
- Treant, Emmen, the Netherlands
| | | | - K Slieker
- Bernhoven Hospital, Uden, the Netherlands
| | - E H Gisolf
- Rijnstate Hospital, Arnhem, the Netherlands
| | - M G Netea
- Department of Internal Medicine and Radboud center for infectious diseases, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - J Ten Oever
- Department of Internal Medicine and Radboud center for infectious diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I J E Kouijzer
- Department of Internal Medicine and Radboud center for infectious diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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Moll M, Nechvile E, Kirisits C, Komina O, Pajer T, Kohl B, Miszczyk M, Widder J, Knocke-Abulesz TH, Goldner G. Radiotherapy in localized prostate cancer: a multicenter analysis evaluating tumor control and late toxicity after brachytherapy and external beam radiotherapy in 1293 patients. Strahlenther Onkol 2024:10.1007/s00066-024-02222-w. [PMID: 38488901 DOI: 10.1007/s00066-024-02222-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: 11/30/2023] [Accepted: 02/25/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND AND PURPOSE Comparing oncological outcomes and toxicity after primary treatment of localized prostate cancer using HDR- or LDR-mono-brachytherapy (BT), or conventionally (CF) or moderately hypofractionated (HF) external beam radiotherapy. MATERIALS AND METHODS Retrospectively, patients with low- (LR) or favorable intermediate-risk (IR) prostate cancer treated between 03/2000 and 09/2022 in two centers were included. Treatment was performed using either CF with total doses between 74 and 78 Gy, HF with 2.4-2.6 Gy per fraction in 30 fractions, or LDR- or HDR-BT. Biochemical control (BC) according to the Phoenix criteria, and late gastrointestinal (GI), and genitourinary (GU) toxicity according to RTOG/EORTC criteria were assessed. RESULTS We identified 1293 patients, 697 with LR and 596 with IR prostate cancer. Of these, 470, 182, 480, and 161 were treated with CF, HF, LDR-BT, and HDR-BT, respectively. For BC, we did not find a significant difference between treatments in LR and IR (p = 0.31 and 0.72). The 5‑year BC for LR was between 93 and 95% for all treatment types. For IR, BC was between 88% in the CF and 94% in the HF group. For CF and HF, maximum GI and GU toxicity grade ≥ 2 was between 22 and 27%. For LDR-BT, we observed 67% grade ≥ 2 GU toxicity. Maximum GI grade ≥ 2 toxicity was 9%. For HDR-BT, we observed 1% GI grade ≥ 2 toxicity and 19% GU grade ≥ 2 toxicity. CONCLUSION All types of therapy were effective and well received. HDR-BT caused the least late toxicities, especially GI.
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Affiliation(s)
- Matthias Moll
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- Department of Radiation Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | | | - Christian Kirisits
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Oxana Komina
- Department of Radiation Oncology, Klinik Hietzing, Vienna, Austria
| | - Thomas Pajer
- Department of Radiation Oncology, Klinik Hietzing, Vienna, Austria
| | - Bettina Kohl
- Department of Radiation Oncology, Klinik Hietzing, Vienna, Austria
| | - Marcin Miszczyk
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- IIIrd, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102, Gliwice, Poland
| | - Joachim Widder
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | - Gregor Goldner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Huang H, Liu Y, Ni S, Wang X, Liu S. The frequency of risk pathological characteristics in clinically low-risk papillary thyroid microcarcinoma suitable for active surveillance. Eur Arch Otorhinolaryngol 2024; 281:1559-1564. [PMID: 38153557 DOI: 10.1007/s00405-023-08420-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/16/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE Active surveillance has emerged as an initial management strategy for patients with low-risk papillary thyroid microcarcinoma (PTMC). The main objective of this research was to investigate the frequency of risk pathological characteristics among patients with clinically low-risk PTMC who are suitable for Active Surveillance. METHODS A retrospective review was conducted on patients who underwent lobectomy for PTMC between January 2013 and December 2018. Patients with bilateral tumors, macroscopic multifocal tumors, macroscopic extrathyroidal extension (ETE), clinical lymph node metastases, macroscopic extranodal extension (ENE), distant metastases, a history of neck radiation or familial thyroid cancer were excluded. Pathological characteristics were collected from the postoperative pathological results. Aggressive variants, multifocality, ETE, lymphovascular invasion (LVI), perineural invasion (PNI), metastatic lymph nodes (LNs) ≥ 5, and ENE were defined as risk characteristics. RESULTS The study included 4923 patients, of whom 1229 (25.0%) were male. The mean age was 43 years. A total of 2250 patients (45.7%) exhibited risk characteristics. Among them, 15 patients presented with aggressive variants, and 1813 patients (36.8%) had ETE. Multifocality, LVI, and PNI were observed in 551 (11.2%), 21 (0.4%), and 40 (0.8%) patients, respectively. A total of 139 patients (2.8%) had five or more metastatic LNs, and ENE was identified in 140 patients. Notably, 172 patients (3.5%) fulfilled the criteria for completion thyroidectomy, as they had aggressive variants, LVI, or five or more metastatic LNs. CONCLUSIONS Nearly half of the patients diagnosed with clinically low-risk PTMC exhibited risk pathological characteristics, and a small proportion of patients met the criteria for completion thyroidectomy.
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Affiliation(s)
- Hui Huang
- Department of Head and Neck Surgical Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Yunhe Liu
- Department of Head and Neck Surgical Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Song Ni
- Department of Head and Neck Surgical Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Xiaolei Wang
- Department of Head and Neck Surgical Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, China.
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Cao L, Lin C, Liu Y, Sui C, Li Z, Chen L, Guan W, Tao L, Tao T, Wang M, Wang F. Clinical characteristics and prognostic analysis of postoperative recurrence or metastasis of low-risk gastrointestinal stromal tumors. World J Surg Oncol 2024; 22:65. [PMID: 38395931 PMCID: PMC10885449 DOI: 10.1186/s12957-024-03339-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. This study aimed to investigate the clinical characteristics and prognosis of postoperative recurrence or metastasis in patients with low-risk stromal tumors, in order to take individualized postoperative management and treatment for patients with low-risk GISTs with relatively high recurrence. METHODS We retrospectively analyzed the clinicopathological and follow-up data of patients with GISTs who underwent surgical resection in Nanjing Drum Tower Hospital from March 2010 to December 2021. A total of 282 patients with low-risk GISTs were included, none of whom were treated with imatinib. Univariate and multivariate Cox analysis and survival curves were used to explore the relationship between clinical features and recurrence or metastasis in patients with low-risk GISTs. RESULTS Of the 282 patients with low-risk GISTs who met inclusion criteria, 14 (4.96%) had recurrence or metastasis. There was a correlation between tumor size, primary site, resection type, Ki67 index, neutrophil lymphocyte ratio (NLR) and CD34 expression and postoperative recurrence or metastasis of GISTs (P < 0.05). Subsequently, multifactorial analysis showed that tumor primary site, tumor size, and Ki67 index were independent risk factors affecting postoperative recurrent or metastasis in patients with low-risk GISTs (P < 0.05). Ultimately, According to Kaplan-Meier analysis, non-gastric primary tumors, larger tumors, and high Ki67 index were significantly associated with poor progression-free survival ( PFS ). CONCLUSIONS Tumor location, tumor size and Ki-67 were independent risk factors for postoperative recurrence and metastasis in patients with low-risk GISTs. Based on the 2008 modified NIH recurrence risk grading system, combined with the above three factors, it can be used to evaluate the prognosis of patients with low-risk GISTs and provide personalized postoperative review and follow-up management recommendations.
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Affiliation(s)
- Lianlian Cao
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Lin
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu Liu
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chao Sui
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhaoping Li
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Li Chen
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wenxian Guan
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Liang Tao
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Tingting Tao
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
| | - Meng Wang
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
| | - Feng Wang
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Yoon JH, Choi W, Park JY, Hong AR, Kim HK, Kang HC. Active Surveillance for Low-Risk Papillary Thyroid Carcinoma as an Acceptable Management Option with Additional Benefits: A Comprehensive Systematic Review. Endocrinol Metab (Seoul) 2024; 39:152-163. [PMID: 38417830 PMCID: PMC10901657 DOI: 10.3803/enm.2023.1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/17/2023] [Accepted: 11/23/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGRUOUND Active surveillance (AS) has been introduced as a management strategy for low-risk papillary thyroid carcinoma (PTC) due to its typically indolent nature. Despite this, the widespread adoption of AS has encountered several challenges. The aim of this systematic review was to evaluate the safety of AS related to disease progression and its benefits compared with immediate surgery (IS). METHODS Studies related to AS in patients with low-risk PTC were searched through the Ovid MEDLINE, Embase, Cochrane Library, and KoreaMed databases. Studies on disease progression, surgical complication, quality of life (QoL), and cost-effectiveness were separately analyzed and narratively synthesized. RESULTS In the evaluation of disease progression, the proportions of cases with tumor growth ≥3 mm and a volume increase >50% were 2.2%-10.8% and 16.0%-25.5%, respectively. Newly detected lymph node metastasis was identified in 0.0%-1.4% of patients. No significant difference was found between IS and delayed surgery in surgical complications, including vocal cord paralysis and postoperative hypoparathyroidism. AS was associated with better QoL than IS. Studies on the cost-effectiveness of AS reported inconsistent data, but AS was more cost-effective when quality-adjusted life years were considered. CONCLUSION AS is an acceptable management option for patients with low-risk PTC based on the low rate of disease progression and the absence of an increased mortality risk. AS has additional benefits, including improved QoL and greater QoL-based cost-effectiveness.
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Affiliation(s)
- Jee Hee Yoon
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Wonsuk Choi
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ji Yong Park
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - A Ram Hong
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Barbui T, Carobbio A, De Stefano V, Alvarez-Larran A, Ghirardi A, Carioli G, Fenili F, Rossi E, Ciceri F, Bonifacio M, Iurlo A, Palandri F, Benevolo G, Pane F, Ricco A, Carli G, Caramella M, Rapezzi D, Musolino C, Siragusa S, Rumi E, Patriarca A, Cascavilla N, Mora B, Cacciola E, Calabresi L, Loscocco GG, Guglielmelli P, Gesullo F, Betti S, Ramundo F, Lunghi F, Scaffidi L, Bucelli C, Cattaneo D, Vianelli N, Bellini M, Finazzi MC, Tognoni G, Rambaldi A, Vannucchi AM. Ropeginterferon phase 2 randomized study in low-risk polycythemia vera: 5-year drug survival and efficacy outcomes. Ann Hematol 2024; 103:437-442. [PMID: 38060001 DOI: 10.1007/s00277-023-05577-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
In patients with low-risk polycythemia vera, exposure to low-dose Ropeginterferon alfa-2b (Ropeg) 100 µg every 2 weeks for 2 years was more effective than the standard treatment of therapeutic phlebotomy in maintaining target hematocrit (HCT) (< 45%) with a reduction in the need for phlebotomy without disease progression. In the present paper, we analyzed drug survival, defined as a surrogate measure of the efficacy, safety, adherence, and tolerability of Ropeg in patients followed up to 5 years. During the first 2 years, Ropeg and phlebotomy-only (Phl-O) were discontinued in 33% and 70% of patients, respectively, for lack of response (12 in the Ropeg arm vs. 34 in the Phl-O arm) or adverse events (6 vs. 0) and withdrawal of consent in (3 vs. 10). Thirty-six Ropeg responders continued the drug for up to 3 years, and the probability of drug survival after a median of 3.15 years was 59%. Notably, the primary composite endpoint was maintained in 97%, 94%, and 94% of patients still on drug at 3, 4, and 5 years, respectively, and 60% of cases were phlebotomy-free. Twenty-three of 63 Phl-O patients (37%) failed the primary endpoint and were crossed over to Ropeg; among the risk factors for this failure, the need for more than three bloodletting procedures in the first 6 months emerged as the most important determinant. In conclusion, to improve the effectiveness of Ropeg, we suggest increasing the dose and using it earlier driven by high phlebotomy need in the first 6 months post-diagnosis.
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Affiliation(s)
- Tiziano Barbui
- FROM, Fondazione Per La Ricerca Ospedale Di Bergamo ETS, Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.
| | - Alessandra Carobbio
- FROM, Fondazione Per La Ricerca Ospedale Di Bergamo ETS, Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Valerio De Stefano
- Dipartimento Di Scienze Radiologiche Ed Ematologiche, Sezione Di Ematologia, Università Cattolica del Sacro Cuore-Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Arianna Ghirardi
- FROM, Fondazione Per La Ricerca Ospedale Di Bergamo ETS, Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Greta Carioli
- FROM, Fondazione Per La Ricerca Ospedale Di Bergamo ETS, Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Francesca Fenili
- FROM, Fondazione Per La Ricerca Ospedale Di Bergamo ETS, Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Elena Rossi
- Dipartimento Di Scienze Radiologiche Ed Ematologiche, Sezione Di Ematologia, Università Cattolica del Sacro Cuore-Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Ciceri
- Unità Operativa Di Ematologia E Trapianto Midollo Osseo, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimiliano Bonifacio
- Dipartimento Di Ingegneria Per La Medicina Di Innovazione, Sezione Di Biomedicina Di Innovazione, Università Di Verona, Verona, Italy
- Dipartimento Di Medicina, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | - Alessandra Iurlo
- UOC Ematologia, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seragnoli", Bologna, Italy
| | - Giulia Benevolo
- SC Ematologia U, A.O.U. Città Della Salute E Della Scienza, Turin, Italy
| | - Fabrizio Pane
- UOC Di Ematologia E Trapianti Di Midollo, Azienda Ospedaliera Universitaria Federico II Di Napoli, Naples, Italy
- Dipartimento Di Medicina Clinica E Chirurgia, Università Di Napoli Federico II, Naples, Italy
| | - Alessandra Ricco
- U.O. Ematologia Con Trapianto Azienda Ospedaliera Universitaria "Consorziale Policlinico" Di Bari, Bari, Italy
| | - Giuseppe Carli
- UOC Ematologia, Azienda ULSS 8 Berica Ospedale San Bortolo Di Vicenza, Vicenza, Italy
| | - Marianna Caramella
- Divisione Ematologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Davide Rapezzi
- Divisione Di Ematologia, Azienda Ospedaliera S. Croce E Carle Di Cuneo, Cuneo, Italy
| | - Caterina Musolino
- UOC Ematologia, Azienda Ospedaliera Universitaria Policlinico "G Martino", Messina, Italy
| | - Sergio Siragusa
- Divisione Ematologia, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Palermo, Italy
| | - Elisa Rumi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Divisione Di Ematologia, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | - Andrea Patriarca
- SCDU Ematologia, Azienda Ospedaliero Universitaria Maggiore Della Carità, Novara, Italy
| | - Nicola Cascavilla
- UO Ematologia IRCCS "Casa Sollievo Della Sofferenza", San Giovanni Rotondo, Italy
| | - Barbara Mora
- Hematology, Ospedale Di Circolo, ASST Sette Laghi, Varese, Italy
| | - Emma Cacciola
- UO Di Emostasi/Ematologia Centro Federato FCSA, Dipartimento Di Scienze Mediche, Chirurgiche E Tecnologie Avanzate "G. F. Ingrassia, Azienda Ospedaliera Universitaria Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Laura Calabresi
- CRIMM, Azienda Ospedaliera Universitaria Careggi, Dipartimento Di Medicina Sperimentale E Clinica, Università Di Firenze, Florence, Italy
| | - Giuseppe Gaetano Loscocco
- CRIMM, Azienda Ospedaliera Universitaria Careggi, Dipartimento Di Medicina Sperimentale E Clinica, Università Di Firenze, Florence, Italy
| | - Paola Guglielmelli
- CRIMM, Azienda Ospedaliera Universitaria Careggi, Dipartimento Di Medicina Sperimentale E Clinica, Università Di Firenze, Florence, Italy
| | - Francesca Gesullo
- CRIMM, Azienda Ospedaliera Universitaria Careggi, Dipartimento Di Medicina Sperimentale E Clinica, Università Di Firenze, Florence, Italy
| | - Silvia Betti
- Dipartimento Di Scienze Radiologiche Ed Ematologiche, Sezione Di Ematologia, Università Cattolica del Sacro Cuore-Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Ramundo
- Dipartimento Di Scienze Radiologiche Ed Ematologiche, Sezione Di Ematologia, Università Cattolica del Sacro Cuore-Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesca Lunghi
- Unità Operativa Di Ematologia E Trapianto Midollo Osseo, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi Scaffidi
- Dipartimento Di Medicina, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | - Cristina Bucelli
- UOC Ematologia, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Cattaneo
- UOC Ematologia, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Vianelli
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seragnoli", Bologna, Italy
| | - Marta Bellini
- UOC Ematologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Chiara Finazzi
- UOC Ematologia, ASST Papa Giovanni XXIII, Bergamo, Italy
- Dipartimento Di Oncologia Ed Emato-Oncologia, Università Degli Studi Di Milano, Milan, Italy
| | - Gianni Tognoni
- Centro Di Coordinamento Nazionale Dei Comitati Etici, Agenzia Italiana del Farmaco, Rome, Italy
| | - Alessandro Rambaldi
- UOC Ematologia, ASST Papa Giovanni XXIII, Bergamo, Italy
- Dipartimento Di Oncologia Ed Emato-Oncologia, Università Degli Studi Di Milano, Milan, Italy
| | - Alessandro Maria Vannucchi
- CRIMM, Azienda Ospedaliera Universitaria Careggi, Dipartimento Di Medicina Sperimentale E Clinica, Università Di Firenze, Florence, Italy
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Spinner C, Huber LRB. How Much is too Much? High Utilization of Prenatal Care and Its Impact on Primary Cesarean Birth Among Women in the United States. Matern Child Health J 2024:10.1007/s10995-023-03887-y. [PMID: 38261276 DOI: 10.1007/s10995-023-03887-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Nationally, cesarean birth is one of the most performed surgical procedures, yet cesarean births have been linked to an increased risk of delivery complications. Prenatal care (PNC) and education are possible strategies to reduce the number of cesarean births. However, there is scant research assessing the impact of these strategies on safely reducing primary cesarean births. This study evaluates the association between the adequacy of PNC utilization and primary cesarean birth. METHODS The analysis used 2018 birth certificate data, and the sample included nulliparous women with no reported pregnancy or delivery complications (N = 729,140). Logistic regression was used to model the association between the adequacy of PNC utilization and delivery method, as well as identify other factors associated with the delivery method. RESULTS Among women with a primary cesarean birth, 36.2% had received adequate plus PNC. After adjustment, there was no significant association between women receiving inadequate, intermediate, or adequate PNC and primary cesarean birth. However, women who received adequate plus PNC had an increased odds of having a primary cesarean birth compared to women with no PNC (OR, 1.23; 95% CI, 1.18-1.28). DISCUSSION Findings from this study highlight the need to further understand the role of PNC and its potential impact on the delivery method. Within the patient-provider relationship, healthcare providers have the unique opportunity to provide education and inform patients of the risks and benefits of all delivery options. Thus, there is an increased opportunity to safely reduce primary cesarean births.
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Affiliation(s)
- Chelse Spinner
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, North Carolina, 28223, USA.
| | - Larissa R Brunner Huber
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, North Carolina, 28223, USA
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Yoon JH, Choi W, Park JY, Hong AR, Kim HK, Kang HC. Active Surveillance for Low-Risk Papillary Thyroid Carcinoma as an Acceptable Management Option with Additional Benefits: A Comprehensive Systematic Review. Endocrinol Metab (Seoul) 2024:EnM.2024.1794. [PMID: 38253475 DOI: 10.3803/enm.2024.1794] [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: 07/28/2023] [Accepted: 11/23/2023] [Indexed: 01/24/2024] Open
Abstract
Background Active surveillance (AS) has been introduced as a management strategy for low-risk papillary thyroid carcinoma (PTC) due to its typically indolent nature. Despite this, the widespread adoption of AS has encountered several challenges. The aim of this systematic review was to evaluate the safety of AS related to disease progression and its benefits compared with immediate surgery (IS). Methods Studies related to AS in patients with low-risk PTC were searched through the Ovid MEDLINE, Embase, Cochrane Library, and KoreaMed databases. Studies on disease progression, surgical complication, quality of life (QoL), and cost-effectiveness were separately analyzed and narratively synthesized. Results In the evaluation of disease progression, the proportions of cases with tumor growth ≥3 mm and a volume increase >50% were 2.2%-10.8% and 16.0%-25.5%, respectively. Newly detected lymph node metastasis was identified in 0.0%-1.4% of patients. No significant difference was found between IS and delayed surgery in surgical complications, including vocal cord paralysis and postoperative hypoparathyroidism. AS was associated with better QoL than IS. Studies on the cost-effectiveness of AS reported inconsistent data, but AS was more cost-effective when quality-adjusted life years were considered. Conclusion AS is an acceptable management option for patients with low-risk PTC based on the low rate of disease progression and the absence of an increased mortality risk. AS has additional benefits, including improved QoL and greater QoL-based cost-effectiveness.
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Affiliation(s)
- Jee Hee Yoon
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Wonsuk Choi
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ji Yong Park
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - A Ram Hong
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Farmakis IT, Kaier K, Hobohm L, Mohr K, Valerio L, Barco S, Konstantinides SV, Binder H. Healthcare resource utilisation and associated costs after low-risk pulmonary embolism: pre-specified analysis of the Home Treatment of Pulmonary Embolism (HoT-PE) study. Clin Res Cardiol 2024:10.1007/s00392-023-02355-5. [PMID: 38170252 DOI: 10.1007/s00392-023-02355-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Pulmonary embolism (PE) and its sequelae impact healthcare systems globally. Low-risk PE patients can be managed with early discharge strategies leading to cost savings, but post-discharge costs are undetermined. PURPOSE To define healthcare resource utilisation and overall costs during follow-up of low-risk PE. METHODS We used an incidence-based, bottom-up approach and calculated direct and indirect costs over 3-month follow-up after low-risk PE, with data from the Home Treatment of Patients with Low-Risk Pulmonary Embolism (HoT-PE) cohort study. RESULTS Average 3-month costs per patient having suffered low-risk PE were 7029.62 €; of this amount, 4872.93 € were associated with PE, accounting to 69.3% of total costs. Specifically, direct costs totalled 3019.33 €, and of those, 862.64 € (28.6%) were associated with PE. Anticoagulation (279.00 €), rehospitalisations (296.83 €), and ambulatory visits (194.95 €) comprised the majority of the 3-month direct costs. The remaining costs amounting to 4010.29 € were indirect costs due to loss of productivity. CONCLUSION In a patient cohort with acute low-risk PE followed over 3 months, the majority of costs were indirect costs related to productivity loss, whereas direct, PE-specific post-discharge costs were low. Effective interventions are needed to reduce the burden of PE and associated costs, especially those related to productivity loss.
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Affiliation(s)
- Ioannis T Farmakis
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Katharina Mohr
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany.
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Lama A, Gude F, Toubes ME, Casal A, Ricoy J, Rábade C, Rodríguez-Núñez N, Cao-Ríos A, Calvo U, Valdés L. Usefulness of a predictive model to hospitalize patients with low-risk community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2024; 43:61-71. [PMID: 37938500 DOI: 10.1007/s10096-023-04683-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION A high proportion of patients with low-risk community-acquired pneumonia (CAP) (classes I-III of the Pneumonia Severity Index) are hospitalized. The purpose of this study was to determine whether validated severity scales are used in clinical practice to make admission decisions, identify the variables that influence this decision, and evaluate the potential predictive value of these variables. MATERIALS AND METHODS A prospective, observational study of patients ≥ 18 years of age with a diagnosis of low-risk CAP hospitalized or referred from the Emergency Department to outpatient consultations. A multivariate logistic regression predictive model was built to predict the decision to hospitalize a patient. RESULTS The study population was composed of 1,208 patients (806 inpatients and 402 outpatients). The severity of CAP was estimated in 250 patients (20.7%). The factors that determined hospitalization were "abnormal findings in complementary studies" (643/806: 79.8%; due to respiratory failure in 443 patients) and "signs of clinical deterioration" [64/806 (7.9%): hypotension (16/64, 25%); hemoptoic expectoration (12/64, 18.8%); tachypnea (10/64, 15.6%)]. In total, ambulatory management was not contraindicated in 24.7% of hospitalized patients (199). The predictive model built to decide about hospitalization had a good power of discrimination (AUC 0.876; 95%CI: 0.855-0.897). CONCLUSIONS Scales are rarely used to estimate the severity of CAP at the emergency department. The decision to hospitalize or not a patient largely depends on the clinical experience of the physician. Our predictive model showed a good power to discriminate the patients who required hospitalization. Further studies are warranted to validate these results.
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Affiliation(s)
- Adriana Lama
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Francisco Gude
- Concepción Arenal Primary Care Centre Grupo de Métodos de Investigación, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Unidad de Epidemiología Clínica Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - María Elena Toubes
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Ana Casal
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana S/N, 15706, Santiago de Compostela, Spain.
| | - Jorge Ricoy
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Carlos Rábade
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Ana Cao-Ríos
- Concepción Arenal Primary Care Centre Grupo de Métodos de Investigación, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Unidad de Epidemiología Clínica Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Uxío Calvo
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana S/N, 15706, Santiago de Compostela, Spain
- Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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Kolar T, Bunc M, Jelenc M, Terseglav S, Kotnik A, Lakič N. Minimally invasive surgical aortic valve replacement versus transfemoral transcatheter aortic valve implantation in low-risk octogenarians : Observational, retrospective and single-center study. Wien Klin Wochenschr 2023; 135:703-711. [PMID: 36239806 DOI: 10.1007/s00508-022-02094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/09/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of this study was to compare short-term and mid-term outcomes in low-risk octogenarian population treated with transfemoral transcatheter aortic valve implantation (tf-TAVI) or minimally invasive aortic valve replacement (mini-AVR) for severe aortic stenosis. METHODS In this single-center, retrospective cohort study we gathered data on low-risk (Society of Thoracic Surgeons [STS] score < 4%) octogenarians before and after tf-TAVI and mini-AVR performed between January 2013 and May 2019; follow-up was completed in May 2022. Short-term outcomes were hospital length of stay, in-hospital all-cause mortality and other major postoperative outcomes. Mid-term clinical outcomes were 1‑year and 3‑year all-cause mortality. Propensity score-based matching was performed. RESULTS In total 106 patients were matched, resulting in 53 pairs. In-hospital complications were similar between the matched groups of patients with the exception of mild and moderate paravalvular leak (mini-AVR vs. tf-TAVI: mild PVL: 3.8% vs. 45.3%, p < 0.001; moderate PVL: 0% vs. 3.8%, p = 0.4952) and of postprocedural acute kidney injury that was more frequent in mini-AVR group (mini-AVR vs. tf-TAVI: 22.6% vs. 5.7%; p = 0.023). Hospital length of stay (p = 0.239) and in-hospital mortality (p = 0.495) did not differ between groups. The 1-year and 3‑year all-cause mortality Kaplan-Meier estimates were similar between mini-AVR and tf-TAVI. CONCLUSION In the present study on low-risk octogenarians, transfemoral TAVI and minimally invasive AVR showed comparable short-term and mid-term results. Both procedures are deemed safe and effective. Larger RCTs will be required to determine which low-risk patients will benefit most from TAVI.
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Affiliation(s)
- Tadeja Kolar
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
- Department of cardiovascular surgery, University Clinical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
| | - Matjaž Bunc
- Department of cardiology, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Matija Jelenc
- Department of cardiovascular surgery, University Clinical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Simon Terseglav
- Department of cardiology, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Aleša Kotnik
- Department of cardiovascular surgery, University Clinical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Nikola Lakič
- Department of cardiovascular surgery, University Clinical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
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Mugavin J, Room R, Callinan S, MacLean S. How do people drink alcohol at a low-risk level? Health Sociol Rev 2023; 32:311-326. [PMID: 37162256 DOI: 10.1080/14461242.2023.2209090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Abstract
Reducing the risks associated with drinking is an ongoing public health goal. Approximately two-fifths of Australian adults consume alcohol within low-risk guidelines, yet little is known about their drinking patterns or practices. In this paper, we use social practice theory to consider low-risk drinking at home as a routinised social practice with material, meaning and competence dimensions. We analysed open-text survey responses from 252 Australian adults (30-65, 89% female) who were considered low-risk drinkers. A low-risk drinking occasion was typically closely linked to other practices such as eating dinner or connecting with family or friends. Drinking alcohol, even in small amounts, was associated with enjoyment. Being attuned to bodily sensations and applying some self-imposed rules were competencies that allowed low-risk drinkers to avoid intoxication. Low-risk drinking practices entail some elements that can inform health promotion, including encouraging efforts to limit drinking to times of the day (e.g. during meals) and to attend to bodily feelings of sufficiency. The study also shows how low-risk drinking is entangled with gendered and age-related norms about drinking, and facilitated by rarely being in 'intoxigenic' environments. These factors are imbricated with individual decisions in our respondents' capacity to consume alcohol moderately.
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Affiliation(s)
- Janette Mugavin
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Sarah Callinan
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
| | - Sarah MacLean
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Wang X, Diao Z, Liu Z, Qi P, Wang Z, Cang T, Chu Y, Zhao H, Zhang C, Xu H, Di S. Development of S-penthiopyrad for bioactivity improvement and risk reduction from the systemic evaluation at the enantiomeric level. Environmental Pollution 2023; 333:122012. [PMID: 37307862 DOI: 10.1016/j.envpol.2023.122012] [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: 03/24/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/14/2023]
Abstract
For the purpose of screening high-efficiency and low-risk green pesticides, a systematic study on fungicide penthiopyrad was conducted at the enantiomeric level. The bioactivity of S-(+)-penthiopyrad (median effective concentration (EC50), 0.035 mg/L) against Rhizoctonia solani was 988 times higher than R-(-)-penthiopyrad (EC50, 34.6 mg/L), which would reduce 75% usage of rac-penthiopyrad under the same efficacy. Furthermore, their antagonistic interaction (toxic unit (TUrac), 2.07) indicated the existence of R-(-)-penthiopyrad would reduce the fungicidal activity of S-(+)-penthiopyrad. AlphaFold2 modeling and molecular docking illustrated that S-(+)-penthiopyrad had the higher binding ability with the target protein than R-(-)-penthiopyrad, showing higher bioactivity. For model organism Danio rerio, S-(+)-penthiopyrad (median lethal concentrations (LC50), 3.02 mg/L) and R-(-)-penthiopyrad (LC50, 4.89 mg/L) were both less toxic than rac-penthiopyrad (LC50, 2.73 mg/L), and the existence of R-(-)-penthiopyrad could synergistically enhance the toxicity of S-(+)-penthiopyrad (TUrac, 0.73), using S-(+)-penthiopyrad would reduce at least 23% toxicity to fish. The enantioselective dissipation and residues of rac-penthiopyrad were tested in three kinds of fruits, and their dissipation half-lives ranged from 1.91 to 23.7 d. S-(+)-penthiopyrad was dissipated preferentially in grapes, which was R-(-)-penthiopyrad in pears. On the 60th d, the residue concentrations of rac-penthiopyrad in grapes were still higher than its maximum residue limit (MRL), but the initial concentrations were lower than their MRL values in watermelons and pears. Thus, more tests in different cultivars of grapes and planting environments should be encouraged. Based on the acute and chronic dietary intake risk assessments, the risks in the three fruits were all acceptable. In conclusion, S-(+)-penthiopyrad is a high-efficiency and low-risk alternative to rac-penthiopyrad.
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Affiliation(s)
- Xinquan Wang
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products/ Key Laboratory of Detection for Pesticide Residues and Control of Zhejiang, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou, 310021, PR China; Agricultural Ministry Key Laboratory for Pesticide Residue Detection, Hangzhou, 310021, PR China
| | - Ziyang Diao
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products/ Key Laboratory of Detection for Pesticide Residues and Control of Zhejiang, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou, 310021, PR China; Agricultural Ministry Key Laboratory for Pesticide Residue Detection, Hangzhou, 310021, PR China; College of Food Science & Engineering, Hainan University, No. 158 Renmin Avenue, Haikou, 570100, PR China
| | - Zhenzhen Liu
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products/ Key Laboratory of Detection for Pesticide Residues and Control of Zhejiang, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou, 310021, PR China; Agricultural Ministry Key Laboratory for Pesticide Residue Detection, Hangzhou, 310021, PR China
| | - Peipei Qi
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products/ Key Laboratory of Detection for Pesticide Residues and Control of Zhejiang, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou, 310021, PR China; Agricultural Ministry Key Laboratory for Pesticide Residue Detection, Hangzhou, 310021, PR China
| | - Zhiwei Wang
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products/ Key Laboratory of Detection for Pesticide Residues and Control of Zhejiang, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou, 310021, PR China; Agricultural Ministry Key Laboratory for Pesticide Residue Detection, Hangzhou, 310021, PR China
| | - Tang Cang
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products/ Key Laboratory of Detection for Pesticide Residues and Control of Zhejiang, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou, 310021, PR China; Agricultural Ministry Key Laboratory for Pesticide Residue Detection, Hangzhou, 310021, PR China
| | - Yanyan Chu
- School of Medicine and Pharmacy, Ocean University of China/ Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao, 266200, China
| | - Huiyu Zhao
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products/ Key Laboratory of Detection for Pesticide Residues and Control of Zhejiang, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou, 310021, PR China; Agricultural Ministry Key Laboratory for Pesticide Residue Detection, Hangzhou, 310021, PR China
| | - Chenghui Zhang
- College of Food Science & Engineering, Hainan University, No. 158 Renmin Avenue, Haikou, 570100, PR China
| | - Hao Xu
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products/ Key Laboratory of Detection for Pesticide Residues and Control of Zhejiang, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou, 310021, PR China; Agricultural Ministry Key Laboratory for Pesticide Residue Detection, Hangzhou, 310021, PR China
| | - Shanshan Di
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products/ Key Laboratory of Detection for Pesticide Residues and Control of Zhejiang, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou, 310021, PR China; Agricultural Ministry Key Laboratory for Pesticide Residue Detection, Hangzhou, 310021, PR China.
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Kuo SH, Tseng LM, Chen ST, Sagara Y, Chang YC, Yeh HT, Kuo YL, Hung CC, Lu TP, Lee YH, Toi M, Huang CS. Radiotherapy versus low-dose tamoxifen following breast-conserving surgery for low-risk and estrogen receptor-positive breast ductal carcinoma in situ: an international open-label randomized non-inferiority trial (TBCC-ARO DCIS Trial). BMC Cancer 2023; 23:865. [PMID: 37710198 PMCID: PMC10500726 DOI: 10.1186/s12885-023-11291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/11/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Radiotherapy (RT) following breast-conserving surgery (BCS) is mainly used to decrease the rate of ipsilateral breast tumor recurrence (IBTR) in women with breast ductal carcinoma in situ (DCIS). Recent studies have demonstrated that low-dose tamoxifen significantly reduces IBTR in breast DCIS. Here, we aim to determine whether the administration of low-dose tamoxifen is non-inferior to RT in preventing IBTR in patients with low-risk characteristics of breast DCIS. METHODS/DESIGN This is a prospective, international, open-label, randomized, non-inferiority trial. Patients with low-risk clinicopathologic features (> 40 years old, low risk of breast cancer susceptibility gene (BRCA) 1 and BRCA2 mutations, mammographically detected unicentric and non-mass lesions, low- or intermediate-grade without comedo or necrosis, measuring < 2.5 cm with margins ≥ 3 mm, and estrogen receptor-positive status) of DCIS who underwent BCS will be randomized at a 1:1 ratio to either receive tamoxifen (5 mg/day) for 5 years or undergo RT with conventional fractions (50 Gy in 25 fractions) or hypofractionations (40.05 Gy in 15 fractions). Randomization will be stratified by the Taiwan Breast Cancer Consortium. As approximately 5% of patients cannot tolerate the side effects of low-dose tamoxifen and will receive RT, we estimate that 405 patients will be randomized to a low-dose tamoxifen arm and 405 patients to the RT arm, according to a non-inferiority margin within 5% of IBTR difference and 90% β-power noticing non-inferiority. The primary endpoints are breast tumor recurrence, including ipsilateral, regional, contralateral, and distant recurrence of breast DCIS or invasive cancer. The secondary endpoints are overall survival and adverse effects of RT and tamoxifen. Translational studies will also be conducted for this trial. DISCUSSION This is the first non-inferiority trial on breast DCIS. This study will provide an important recommendation for clinical physicians on whether to use low-dose adjuvant tamoxifen for patients with low-risk breast DCIS who do not want to receive adjuvant RT. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT04046159, Registered on April 30, 2019.
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Affiliation(s)
- Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Radiation Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan
- Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ling-Ming Tseng
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shou-Tung Chen
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yasuaki Sagara
- Department of Breast Surgical Oncology, Hakuaikai Social Cooperation, Sagara Hospital, Kagoshima, Japan
| | | | - Hsien-Tang Yeh
- Department of Surgery, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Yao-Lung Kuo
- Division of Breast Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chih-Chiang Hung
- Department of Surgery, Division of Breast Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tzu-Pin Lu
- Department of Public Health, National, Institute of Epidemiology and Preventive Medicine, Taiwan University, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Pathology, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Masakazu Toi
- Tokyo Metropolitan Cancer and Infectious Disease Centre, Komagome Hospital, Tokyo, Japan
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Rd, Taipei, Taiwan.
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Winter MC, Tidy JA, Singh K, Sarwar N, Aguiar X, Seckl MJ. Efficacy analysis of single-agent carboplatin AUC4 2-weekly as second-line therapy for methotrexate-resistant (MTX-R) low risk gestational trophoblastic neoplasia (GTN). Gynecol Oncol 2023; 175:66-71. [PMID: 37327541 DOI: 10.1016/j.ygyno.2023.05.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Approximately one-third of patients with low-risk Gestational Trophoblastic Neoplasia (WHO 0-6) develop methotrexate-resistance (MTX-R). In the UK, subsequent treatment with either actinomycin-D (ActD) or multi-agent combination chemotherapy has depended on whether the hCG was above or below an hCG threshold. To reduce exposure to combination chemotherapy (CC), over the years the UK service has raised this threshold as well as using single-agent carboplatin AUC6 3-weekly at MTX-R instead of CC. Updated results for carboplatin demonstrate an 86% complete hCG response (hCG CR) but associated with haematological dose-limiting toxicity. METHODS In 2017, single-agent carboplatin became the national standard second-line treatment following MTX-R at hCG of >3000 IU/L. Carboplatin was changed to two-weekly AUC4 scheduling and continued until normal hCG plus 3 consolidation cycles. For patients failing to respond, CC (Etoposide-Actinomycin-D or EMA-CO) was introduced. RESULTS 22 evaluable patients with a median hCG at MTX-R of 10,147 IU/L (IQR 5527-19,639) received carboplatin AUC4 2-weekly (median no. of cycles = 6, IQR 2-8). Of these, 36% achieved a hCG CR. All 14 non-CR patients were cured with subsequent CC; 11 and 2 patients with 3rd line and 4th line CC respectively and 1 patient following 5th line CC and hysterectomy. Overall survival remains 100%. CONCLUSION Carboplatin is not sufficiently active in the second-line treatment of low-risk MTX-resistant GTN. New strategies are required to increase hCG CR and spare more toxic CC regimens.
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Affiliation(s)
- Matthew C Winter
- Sheffield Centre for Trophoblastic Disease, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Whitham Road, Sheffield S10 2SJ, UK; Department of Oncology and Metabolism, The University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK.
| | - John A Tidy
- Sheffield Centre for Trophoblastic Disease, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Whitham Road, Sheffield S10 2SJ, UK
| | - Kam Singh
- Sheffield Centre for Trophoblastic Disease, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Whitham Road, Sheffield S10 2SJ, UK
| | - Naveed Sarwar
- Gestational Trophoblastic Tumour Centre, Charing Cross Hospital Campus of Imperial College London, Fulham Palace Rd, London W6 8RF, UK
| | - Xianne Aguiar
- Gestational Trophoblastic Tumour Centre, Charing Cross Hospital Campus of Imperial College London, Fulham Palace Rd, London W6 8RF, UK
| | - Michael J Seckl
- Gestational Trophoblastic Tumour Centre, Charing Cross Hospital Campus of Imperial College London, Fulham Palace Rd, London W6 8RF, UK
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Aslaner Ak M, Gedük A, Acar İH, Polat MG, Sunu C, Bolaman AZ, Hacıbekiroğlu T, Güvenç B, Ertop Ş. Long-Term Efficacy of Erythropoiesis-Stimulating Agents in Patients with Low-Risk or Intermediate-1-Risk Myelodysplastic Syndrome: Multicenter Real-Life Data. Turk J Haematol 2023; 40:92-100. [PMID: 36799095 PMCID: PMC10240155 DOI: 10.4274/tjh.galenos.2023.2022.0437] [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: 09/30/2022] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
Objective This study was undertaken to evaluate the long-term clinical efficacy of epoetin alfa and darbepoetin alfa in patients with myelodysplastic syndrome (MDS) in a real-life setting. Materials and Methods A total of 204 patients with low-risk or intermediate-1-risk MDS who received epoetin alfa or darbepoetin alfa were included. Hemoglobin levels and transfusion needs were recorded before treatment and at 12 months, 24 months, 36 months, and 48 months of treatment. Results At the 36-month (p=0.025) and 48-month (p=0.022) visits, epoetin alfa yielded significantly higher hemoglobin levels compared to darbepoetin alfa. Transfusion needs were also significantly lower with epoetin alfa compared to darbepoetin alfa at 24 months (p=0.012) and in the low-risk group compared to the intermediate-risk group at 24 months (p=0.018), 36 months (p=0.025), and 48 months (p<0.001). Treatment response rates at the 24-month, 36-month, and 48-month visits in the epoetin alfa (43.0%, 33.6%, and 27.1%), darbepoetin alfa (29.9%, 22.7%, and 16.5%), low-risk (39.3%, 30.0%, and 26.0%), and intermediate-risk (29.6%, 24.1%, and 11.1%) groups were lower than those obtained at 12 months, and the values differed significantly for the 36-month and 48-month visits with values ranging from p<0.05 to p<0.001. Conclusion This real-life long-term ESA extension study investigated the clinical efficacy of epoetin alfa and darbepoetin alfa for up to 48 months, revealing that treatment efficacy reached a plateau starting from the 24th month of therapy with a continuing decrease in treatment response rates regardless of treatment type, risk status, or gender. Nonetheless, significantly higher hemoglobin levels and marked improvement in transfusion needs were evident in epoetin-treated patients compared to darbepoetin-treated patients and in the low-risk group compared to the intermediate-risk group.
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Affiliation(s)
- Müzeyyen Aslaner Ak
- Zonguldak Bülent Ecevit University Faculty of Medicine, Department of Hematology, Zonguldak, Türkiye
| | - Ayfer Gedük
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Türkiye
| | - İbrahim Halil Acar
- Çukurova University Faculty of Medicine, Department of Hematology, Adana, Türkiye
| | - Merve Gökçen Polat
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Türkiye
| | - Cenk Sunu
- Sakarya Training and Research Hospital, Clinic of Hematology, Sakarya, Türkiye
| | - Ali Zahit Bolaman
- Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Türkiye
| | - Tuğba Hacıbekiroğlu
- Sakarya Training and Research Hospital, Clinic of Hematology, Sakarya, Türkiye
| | - Birol Güvenç
- Çukurova University Faculty of Medicine, Department of Hematology, Adana, Türkiye
| | - Şehmus Ertop
- Zonguldak Bülent Ecevit University Faculty of Medicine, Department of Hematology, Zonguldak, Türkiye
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Fastenau J, Jain K, Popovic A, Kovac E. Review of Active Surveillance in Underrepresented and High-Risk Populations: Feasibility and Safety. Curr Urol Rep 2023:10.1007/s11934-023-01158-5. [PMID: 36995563 DOI: 10.1007/s11934-023-01158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to investigate the current use and effectiveness of active surveillance (AS) for clinical low-risk prostate cancer (PCa) in men considered to be "high-risk" based on the factors of race, genetics, healthcare access, and socioeconomic status. RECENT FINDINGS Advances in molecular biomarkers and imaging have improved the detection, risk stratification, and treatment of PCa. Still, overdiagnosis and overtreatment of indolent disease remain a concern. AS is therefore the preferred option for clinical low-risk disease. Yet, because of the variability in PCa presentation based on the aforementioned environmental and genetic factors, the question remains: Is active surveillance a safe option for everyone? Provider hesitancy should not necessarily exclude high-risk men from participating in AS. Rather, clinicians should employ shared decision-making, sound clinical judgment, and stringent follow-up in order to effectively counsel AS candidates and optimize AS-related outcomes in "high-risk" individuals.
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Affiliation(s)
- John Fastenau
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, 07103, USA
| | - Kunj Jain
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, 07103, USA
| | - Aleksandar Popovic
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, 07103, USA
| | - Evan Kovac
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, 07103, USA.
- Cancer Institute of New Jersey, Newark, NJ, USA.
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Parker VL, Cushen BF, Hills A, Kandiah K, Palmer JE, Singh K, Hancock BW, Tidy JA, Winter MC. Flat-dose versus weight or body surface area-based methotrexate dosing in low-risk gestational trophoblastic neoplasia. Gynecol Oncol 2023; 169:34-40. [PMID: 36495594 DOI: 10.1016/j.ygyno.2022.11.025] [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: 07/30/2022] [Revised: 11/03/2022] [Accepted: 11/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Single-agent methotrexate (MTX) is commonly used as first-line treatment for low-risk gestational trophoblastic neoplasia (LR-GTN), although no international consensus exists on the optimal treatment regimen to maximise complete hCG response (CR) and minimise relapse rates. Current regimens differ in the route of administration, dose scheduling, and use of flat-dose, body surface area (BSA)- or weight-based dosing. In the UK a methotrexate-folinic acid (MTX-FA) 8-day 50 mg intramuscular flat-dose regimen is used, with 15 mg oral folinic acid rescue. In LR-GTN patients, we aim to determine the effect of MTX dose adjustment by BSA and weight upon chemotherapy response and disease relapse. METHODS Between January 1973 and August 2020, 935 LR-GTN patients treated with first-line MTX-FA were identified from a single UK specialist trophoblastic centre. Of these, 364 were included, of which 178 (49%) had a CR to first-line MTX-FA. Subgroup analyses were performed upon: (i) patients who changed chemotherapy due to MTX toxicity (n = 33); and (ii) patients with a FIGO score of 5-6 (n = 85). Logistic regression analysis explored the relationship between BSA or weight adjusted MTX dosing and: (i) CR to first-line chemotherapy; (ii) incidence of disease relapse. Linear regression analyses assessed the correlation of BSA and weight with the number of MTX-FA cycles required to achieve CR. RESULTS In LR-GTN patients, BSA and weight adjusted MTX-FA dosing did not influence CR to first-line chemotherapy or the incidence of disease relapse. The number of MTX cycles required to achieve CR was not associated with BSA or weight. These findings were maintained in a subgroup analysis of FIGO 5-6 patients. The incidence of MTX toxicity was not influenced by BSA or weight. CONCLUSIONS In the treatment of LR-GTN, dose individualisation using BSA or weight is not required, and fixed dosing continues to be preferred as the UK standard.
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Assayag F, Georges JL, Chabay S, Lancien S, Flaujac C, Azarian R, de Villepin EG, Tapiéro S, Livarek B, Koukabi M, Maurizot A. [Home treatment of low-risk pulmonary embolism patients : Efficacy and safety of an outpatient program including the general practitioner]. Ann Cardiol Angeiol (Paris) 2022; 71:245-251. [PMID: 35940966 DOI: 10.1016/j.ancard.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
AIM Outpatient treatment (OT) of patients with low-risk pulmonary embolisms (PE) is recommended. A multidisciplinary OT program including the general practitioner (GP) has been implemented at Versailles hospital in 2019. The objectives of the study were to assess the feasibility, safety and acceptability of the program. MATERIAL AND METHODS The feasibility of, and the inclusion criteria for OT were defined from a retrospective cohort study of PE patients carried out in 2018. In the prospective study, consecutive patients consulting in the emergency department between 2019 and 2021 with confirmed PE were eligible for OT if they had sPESI and HESTIA scores equal to 0, normal troponin and NT-pro-BNP levels, and no right ventricular dilation on imaging. PEs associated with COVID were excluded. The OT program included 4 appointments within 3 months, including 2 with the GP. Events (death, recurrence of PE or venous thromboembolism, bleeding, rehospitalisation) were collected at 3-month follow-up. RESULTS In the retrospective study, 19% of the 138 PE patients seen in the emergency department were eligible for OT. No complication occurred at Day 90. In the prospective study, 313 consecutive patients with confirmed PE in the emergency department were included, 66 (21%) were eligible for OT. Overall, 43 patients (14%) received OT (39 eligible) and 27 patients eligible for OT were hospitalised (92% because of pulmonary infarction). At 3-month follow-up, there were no death, no recurrence of thromboembolism, and one patient has been early hospitalised for COVID; 3 female patients treated with rivaroxaban had minor bleeding (heavy menstrual bleeding). The satisfaction rate of general practitioner was 95%. CONCLUSIONS This study confirms the feasibility and safety of our OT program for low-risk EP patients, centered on the general practitioner. It reduces the time spent in the emergency department, reduces hospitalisations and strengthens the city-hospital link for care.
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Affiliation(s)
- Franck Assayag
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France; Service d'accueil des urgences, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France.
| | - Jean-Louis Georges
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Simon Chabay
- Unité de Médecine Vasculaire, Service de Cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Solène Lancien
- Service d'accueil des urgences, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Claire Flaujac
- Laboratoire de biologie médicale - secteur d'hémostase, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Reza Azarian
- Service de pneumologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Eve Galouzeau de Villepin
- Service d'accueil des urgences, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Stéphanie Tapiéro
- Unité de Médecine Vasculaire, Service de Cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Bernard Livarek
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Mehrsa Koukabi
- Service d'accueil des urgences, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Aurélien Maurizot
- Unité de Médecine Vasculaire, Service de Cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
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20
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Xie Z, Peng Z, Zou Y, Xiao H, Li B, Zhou Q, Chen S, Xu L, Shen J, Mo Y, Peng S, Kuang M, Long J, Feng ST. Non-invasive diagnosis strategy of hepatocellular carcinoma in low-risk population. BMC Cancer 2022; 22:709. [PMID: 35761201 PMCID: PMC9238050 DOI: 10.1186/s12885-022-09812-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Aims With prevalence of hepatocellular carcinoma (HCC) in low-risk population (LRP), establishing a non-invasive diagnostic strategy becomes increasingly urgent to spare unnecessary biopsies in this population. The purposes of this study were to find characterisics of HCC and to establish a proper non-invasive method to diagnose HCC in LRP. Methods A total of 681 patients in LRP (defined as the population without cirrhosis, chronic HBV infection or HCC history) were collected from 2 institutions. The images of computed tomography (CT) and magnetic resonance imaging (MRI) were manually analysed. We divided the patients into the training cohort (n = 324) and the internal validating cohort (n = 139) by admission time in the first institution. The cohort in the second institution was viewed as the external validation (n = 218). A multivariate logistic regression model incorporating both imaging and clinical independent risk predictors was developed. C-statistics was used to evaluate the diagnostic performance. Results Besides the major imaging features of HCC (non-rim enhancement, washout and enhancing capsule), tumor necrosis or severe ischemia (TNSI) on imaging and two clinical characteristics (gender and alpha fetoprotein) were also independently associated with HCC diagnosis (all P < 0.01). A clinical model (including 3 major features, TNSI, gender and AFP) was built to diagnose HCC and achieved good diagnostic performance (area under curve values were 0.954 in the training cohort, 0.931 in the internal validation cohort and 0.902 in the external cohort). Conclusions The clinical model in this study developed a satisfied non-invasive diagnostic performance for HCC in LRP. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09812-w.
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Affiliation(s)
- Zonglin Xie
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhenpeng Peng
- Department of Radiology, the First Affiliated Hospital, Sun Yat-Sen University, Yuexiu Distinct, 58 Zhongshan Road 2, Guangzhou, 500018, China
| | - Yujian Zou
- Department of Radiology, The Affiliated Dongguan Hospital, Southern Medical University, Dongguan, China
| | - Han Xiao
- Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bin Li
- Clinical Trial Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qian Zhou
- Clinical Trial Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shuling Chen
- Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lixia Xu
- Department of Oncology, the First Affiliated Hospital, Sun Yat-Sen University, Yuexiu Distinct, 58 Zhongshan Road 2, Guangzhou, 500018, China
| | - Jingxian Shen
- Department of Medical Imaging, Sun Yat-Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yunxian Mo
- Department of Medical Imaging, Sun Yat-Sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Sui Peng
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Clinical Trial Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Kuang
- Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianting Long
- Department of Oncology, the First Affiliated Hospital, Sun Yat-Sen University, Yuexiu Distinct, 58 Zhongshan Road 2, Guangzhou, 500018, China.
| | - Shi-Ting Feng
- Department of Radiology, the First Affiliated Hospital, Sun Yat-Sen University, Yuexiu Distinct, 58 Zhongshan Road 2, Guangzhou, 500018, China.
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21
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Dowling NA, Youssef GJ, Greenwood C, Merkouris SS, Suomi A, Room R. The Identification of Low-risk Gambling Limits for Specific Gambling Activities. J Gambl Stud 2022; 38:559-590. [PMID: 34061293 DOI: 10.1007/s10899-021-10036-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 11/30/2022]
Abstract
An emerging literature has identified optimal low-risk gambling limits in an effort to reduce gambling-related harm. Concerns have, however, been raised about the construction of aggregate low-risk limits that are applied to all gambling activities and there is support from gambling experts and the general public in Australia for the identification of low-risk limits for specific gambling activities. The study's aim was to identify and evaluate a set of empirically-based activity-specific limits (gambling frequency, gambling expenditure, gambling expenditure as a proportion of gross personal income, session expenditure, session duration) in a secondary analysis of Social and Economic Impact Studies of Gambling in Tasmania and the 2014 Survey on Gambling, Health and Wellbeing in the ACT. Balancing sensitivity and specificity, limits were identified for all gambling activities: EGMs (10 times per year, AUD$300/year, 0.63-1.04% of personal income, AUD$35 per session, 40 min/session), horse/dog racing (0.55% of personal income), instant scratch tickets (AUD$45/year), lotteries (0.45% of personal income), keno (4-13 times/year, AUD$45-$160/year), casino table games (AUD$345/year, 0.36-0.76% of personal income), bingo (AUD$150/year, 0.49% of personal income, AUD$17/session, 90 min/session), and sports/other event betting (14 times/year, AUD$400/year, 0.55-0.86% of personal income). These limits were exceeded by one-quarter to one-half of gamblers on these specific activities and were generally good predictors of gambling-related harm in subgroups of gamblers participating in these gambling activities and in the overall gambling sample. The limits provide gamblers, regulators, prevention workers, and researchers with simple rules of thumb in prevention efforts to reduce gambling-related harm in specific contexts.
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Affiliation(s)
- N A Dowling
- School of Psychology, Deakin University, Geelong, VIC, 3220, Australia.
- Melbourne Graduate School of Education, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - G J Youssef
- School of Psychology, Deakin University, Geelong, VIC, 3220, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - C Greenwood
- School of Psychology, Deakin University, Geelong, VIC, 3220, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - S S Merkouris
- School of Psychology, Deakin University, Geelong, VIC, 3220, Australia
| | - A Suomi
- Research School of Population Health, The Australian National University, Canberra, ACT, 2600, Australia
- Institute of Child Protection Studies, The Australian Catholic University, Watson, ACT, 2612, Australia
| | - R Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, 3086, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, 106 91, Stockholm, Sweden
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22
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Magro PL, Sousa-Uva M. In low-risk patients aged >70-75 with severe aortic stenosis, is transcatheter superior to surgical aortic valve replacement in terms of reported cardiovascular composite outcomes and survival? Interact Cardiovasc Thorac Surg 2022; 34:40-44. [PMID: 34999806 PMCID: PMC8923392 DOI: 10.1093/icvts/ivab218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/16/2021] [Accepted: 07/02/2021] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: In low-risk patients aged >70-75 with severe aortic stenosis, is transcatheter superior to surgical aortic valve replacement in terms of reported composite outcomes and survival? More than 73 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The only low-risk randomized control trial to date [Nordic Aortic Valve Intervention (NOTION)] regarding an elderly population did not show a statistically significant difference between the 2 approaches regarding the composite endpoint of death, stroke or myocardial infarction. A subgroup analysis of elderly patients in the 2 main low-risk randomized control trials did not yield statistically different results from those of the overall population; the results indicated the superiority of transcatheter aortic valve implantation regarding the composite of death, stroke or rehospitalization at 1 year [The Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis (PARTNER 3)] and non-inferiority regarding a composite of death or stroke at 2 years [Medtronic Evolut Transcatheter Aortic Valve Replacement in Low-Risk Patients (Evolut LR)]. The results from lower evidence studies are largely consistent with these findings. Overall, there is no compelling evidence indicating that older age should be an isolated criterion for the choice between transcatheter aortic valve replacement and surgical aortic valve replacement in otherwise low-risk patients. The superiority of either technique regarding the aforementioned composite short-term outcomes in this particular subgroup of patients is unclear.
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Affiliation(s)
- Pedro Lamares Magro
- Department of Cardiothoracic Surgery, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Miguel Sousa-Uva
- Department of Cardiothoracic Surgery, Hospital de Santa Cruz, Carnaxide, Portugal
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Triguero A, Pedraza A, Pérez-Encinas M, Mata-Vázquez MI, Vélez P, Fox L, Gómez-Calafat M, García-Delgado R, Gasior M, Ferrer-Marín F, García-Gutiérrez V, Angona A, Gómez-Casares MT, Cuevas B, Martínez C, Pérez R, Raya JM, Guerrero L, Murillo I, Bellosillo B, Hernández-Boluda JC, Sanz C, Álvarez-Larrán A. Low-risk polycythemia vera treated with phlebotomies: clinical characteristics, hematologic control and complications in 453 patients from the Spanish Registry of Polycythemia Vera. Ann Hematol 2022; 101:2231-2239. [PMID: 36042023 PMCID: PMC9584989 DOI: 10.1007/s00277-022-04963-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/17/2022] [Indexed: 12/05/2022]
Abstract
Hematological control, incidence of complications, and need for cytoreduction were studied in 453 patients with low-risk polycythemia vera (PV) treated with phlebotomies alone. Median hematocrit value decreased from 54% at diagnosis to 45% at 12 months, and adequate hematocrit control over time (< 45%) was observed in 36%, 44%, and 32% of the patients at 6, 12, and 24 months, respectively. More than 5 phlebotomies per year in the maintenance phase were required in 19% of patients. Worsening thrombocytosis, age > 60 years, and microvascular symptoms constituted the main indications for starting cytoreduction. Median duration without initiating cytoreduction was significantly longer in patients younger than 50 years (< 0.0001). The incidence rate of thrombosis under phlebotomies alone was 0.8% per year and the estimated probability of thrombosis at 10 years was 8.5%. The probability of arterial thrombosis was significantly higher in patients with arterial hypertension whereas there was a trend to higher risk of venous thrombosis in cases with high JAK2V617F allele burden. Rates of major bleeding and second primary neoplasm were low. With a median follow-up of 9 years, survival probability at 10 years was 97%, whereas the probability of myelofibrosis at 10 and 20 years was 7% and 20%, respectively. Progression to acute myeloid leukemia was documented in 3 cases (1%). Current management of low-risk PV patients is associated with low rate of thrombosis and long survival. New treatment strategies are needed for improving hematological control and, in the long term, reducing progression to myelofibrosis.
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Affiliation(s)
| | | | | | | | | | - Laura Fox
- Hospital Universitario Vall d'Hebron, Hematología Experimental, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | | | | | - Anna Angona
- ICO Girona-Hospital Josep Trueta, Girona, Spain
| | | | | | | | - Raúl Pérez
- Hospital Universitario Clínico Virgen de La Arrixaca, Murcia, Spain
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Bakkar S, Al-Omar K, Donatini G, Aljarrah Q, Papavramidis TS, Materazzi G, Miccoli P. Postoperatively determined high-risk histopathologic features in papillary thyroid carcinoma initially eligible for thyroid lobectomy: a game changer. Endocrine 2021; 74:611-615. [PMID: 34110601 DOI: 10.1007/s12020-021-02788-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Recent clinical practice guidelines consider thyroid lobectomy a viable alternative for low-risk papillary thyroid carcinoma PTC measuring 1-4 cm in size. We aimed to assess the likelihood of finding postoperatively determined high-risk histopathologic features that would lead to the recommendation of completion thyroidectomy. METHODS A retrospective review of patients who underwent total thyroidectomy for PTC measuring 1-4 cm in size between Jan 2012 and Jan 2018 was conducted. Patients with pre-operative high-risk characteristics were excluded: history of radiation exposure, positive family history, clinically suspicious cervical lymphadenopathy, and gross extrathyroidal extension (ETE). A hypothetical group of 245 patients remained eligible for lobectomy. The pathology specimens from the cancer-containing lobes were evaluated for high-risk features: aggressive histology, capsular and/or vascular invasion, microscopic ETE, and multifocality. A subgroup analysis was performed with 2 cm being the cut-off size. RESULTS The average age was 39 years with 73% being females. Mean cancer size was 16 mm. Evaluation of the cancer-containing lobe for high-risk features revealed: aggressive histology (33%), ETE (12%), capsular invasion (33%), vascular invasion (17%), and ipsilateral multifocality (30%). The cumulative risk of having ≥1 high-risk feature mandating completion thyroidectomy was 59%. The risk was considerably higher for lesions ≤2 cm compared to larger lesions (64% vs.48%; p = 0.049; RR = 1.3). CONCLUSIONS A considerable proportion of patients initially eligible for lobectomy have high-risk features that only become evident at pathology. Therefore, a comprehensive approach is advocated to determine the extent of surgery for PTC incorporating patient preferences regarding risks and benefits.
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Affiliation(s)
- Sohail Bakkar
- Department of General and Specialized Surgery, Faculty of Medicine, the Hashemite University, Zarqa, 13133, Jordan.
| | - Khaled Al-Omar
- Department of General and Specialized Surgery, Faculty of Medicine, the Hashemite University, Zarqa, 13133, Jordan
| | - Gianluca Donatini
- Department of General and Endocrine Surgery, University of Poitiers, CHU Poitiers, Poitiers, France
| | - Qusai Aljarrah
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Theodosios S Papavramidis
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki (AUTH), Thessaloniki, 5462, Greece
| | - Gabriele Materazzi
- Department of Surgical, Medical, Pathology, and Critical Care, The University of Pisa, Pisa, 56124, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Pathology, and Critical Care, The University of Pisa, Pisa, 56124, Italy
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How J, Hobbs G. Management Issues and Controversies in Low-Risk Patients with Essential Thrombocythemia and Polycythemia Vera. Curr Hematol Malig Rep 2021; 16:473-482. [PMID: 34478054 DOI: 10.1007/s11899-021-00649-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] [Accepted: 06/02/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Essential thrombocythemia (ET) and polycythemia vera (PV) are the most common myeloproliferative neoplasms (MPNs). Treatment of ET and PV is based on the risk for subsequent thrombosis. High-risk patients, defined as older than 60, JAK2 V617F-positive patients, or patients with a history of prior thrombosis, merit cytoreduction to control blood counts, whereas a watchful waiting paradigm is utilized in low-risk patients. However, low-risk patients have a host of other specific management issues that arise during their disease course. This review will discuss the most common management issues specific to the care of low-risk patients, including anti-platelet therapy dosing, pregnancy, and indications for early cytoreduction. RECENT FINDINGS Although low-dose aspirin is well established in PV, its indications and dosing regimens are less clear in ET. Recent evidence has supported twice daily low-dose aspirin in ET and observation alone in very low-risk ET patients. Pregnancy is not contraindicated in MPNs, and we recommend aspirin throughout pregnancy with consideration for prophylactic postpartum anticoagulation. High phlebotomy needs, symptom burden, and extreme thrombocytosis are common reasons for initiation of cytoreduction in low-risk patients, although we typically do not start cytoreduction for an isolated high platelet count alone. Recent data has also demonstrated a potential disease-modifying effect of interferons in MPNs, with some experts now advocating the early use of interferon in low-risk patients, although more mature data is needed before practice guidelines change. We evaluate the literature to inform clinical decision-making regarding these controversies, including most recent data that has challenged the "watchful waiting" paradigm. Our discussion provides guidance on common clinical scenarios seen in low-risk ET and PV patients, who face a myriad of complex management decisions in their care.
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Affiliation(s)
- Joan How
- Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson, Office 138, Boston, MA, 02114, USA.,Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Gabriela Hobbs
- Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson, Office 138, Boston, MA, 02114, USA.
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Liu L, Mathias A, Kwong T, Worster A, Kavsak PA. Clinical chemistry score misses fewer deaths as compared to troponin T alone in a United States emergency department population. Clin Biochem 2021; 95:91-92. [PMID: 34129860 DOI: 10.1016/j.clinbiochem.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/10/2021] [Indexed: 01/17/2023]
Affiliation(s)
- Li Liu
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States.
| | - Andrew Mathias
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Tai Kwong
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Andrew Worster
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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Relph S, Guo Y, Harvey ALJ, Vieira MC, Corsi DJ, Gaudet LM, Pasupathy D. Characteristics associated with uncomplicated pregnancies in women with obesity: a population-based cohort study. BMC Pregnancy Childbirth 2021; 21:182. [PMID: 33673827 PMCID: PMC7934497 DOI: 10.1186/s12884-021-03663-2] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately one in five pregnant women have obesity. Obesity is associated with an increased risk of antenatal, intrapartum, and perinatal complications, but many women with obesity have uncomplicated pregnancies. At a time where maternity services are advocating for women to make informed choices, knowledge of the chance of having an uncomplicated (healthy) pregnancy is essential. The objective of this study was to calculate the rate of uncomplicated pregnancy in women with obesity and evaluate factors associated with this outcome. METHODS This prospective cohort study was conducted using the Ontario birth registry dataset in Canada (703,115 women, April 2012-March 2017). The rate of uncomplicated or complicated composite pregnancy outcomes (hypertensive disorders of pregnancy, gestational diabetes, preterm birth, neonate small- or large- for gestational age at birth, congenital anomaly, fetal death, antepartum bleeding or preterm prelabour membrane rupture) were calculated for women with and without obesity. Associations between uncomplicated pregnancy and maternal characteristics were explored in a population of women with obesity but without other pre-existing co-morbidities (e.g., essential hypertension) or obstetric risks identified in the first trimester (e.g., multiple pregnancy), using log binomial regression analysis. RESULTS Of the studied Ontario maternity population (body mass index not missing) 17·7% (n = 117,236) were obese. Of these 20·6% had pre-existing co-morbidities or early obstetric complicating factors. Amongst women with obesity but without early complicating factors, 58·2% (n = 54,191) experienced pregnancy without complication; this is in comparison to 72·7% of women of healthy weight and no early complicating factors. Women with obesity and no early pregnancy complicating factors are more likely to have an uncomplicated pregnancy if they are multiparous, younger, more affluent, of White or Black ethnicity, of lower weight, with normal placental-associated plasma protein-A and/or spontaneously conceived pregnancies. CONCLUSIONS The study demonstrates that over half of women with obesity but no other pre-existing medical or early obstetric complicating factors, proceed through pregnancy without adverse obstetric complication. Care in lower-risk settings can be considered as their outcomes appear similar to those reported for low-risk nulliparous women. Further research and predictive tools are needed to inform stratification of women with obesity.
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Affiliation(s)
- Sophie Relph
- Department of Women and Children's Health, King's College London, 10th Floor, St Thomas' Hospital, Westminster Bridge Road, London, UK.
| | - Yanfang Guo
- Better Outcomes Registry & Network Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada.,OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Alysha L J Harvey
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Matias C Vieira
- Department of Women and Children's Health, King's College London, 10th Floor, St Thomas' Hospital, Westminster Bridge Road, London, UK.,Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, 101 Alexander Fleming st, Cidade Universitaria, Campinas, SP, Brazil
| | - Daniel J Corsi
- Better Outcomes Registry & Network Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada.,OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Laura M Gaudet
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada.,Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, King's College London, 10th Floor, St Thomas' Hospital, Westminster Bridge Road, London, UK.,Discipline of Obstetrics, Gynaecology and Neonatology, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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Yu S, Huh HJ, Lee KW, Park JB, Kim SJ, Huh W, Jang HR, Kwon GY, Moon HH, Kang ES. Pre-Transplant Angiotensin II Type 1 Receptor Antibodies and Anti-Endothelial Cell Antibodies Predict Graft Function and Allograft Rejection in a Low-Risk Kidney Transplantation Setting. Ann Lab Med 2021; 40:398-408. [PMID: 32311853 PMCID: PMC7169631 DOI: 10.3343/alm.2020.40.5.398] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/13/2019] [Revised: 02/17/2020] [Accepted: 03/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Non-HLA antibodies, anti-angiotensin II type 1 receptor antibodies (anti-AT1R) and anti-endothelial cell antibodies (AECA), are known to play a role in allograft rejection. We evaluated the role of both antibodies in predicting post-transplant outcomes in low-risk living donor kidney transplantation (LDKT) recipients. Methods In 94 consecutive LDKT recipients who were ABO compatible and negative for pre-transplant HLA donor-specific antibodies, we determined the levels of anti-AT1Rs using an enzyme-linked immunosorbent assay and the presence of AECAs using a flow cytometric endothelial cell crossmatch (ECXM) assay with pre-transplant sera. Hazard ratio (HR) was calculated to predict post-transplant outcomes. Results Pre-transplant anti-AT1Rs (≥11.5 U/mL) and AECAs were observed in 36 (38.3%) and 22 recipients (23.4%), respectively; 11 recipients had both. Pre-transplant anti-AT1Rs were a significant risk factor for the development of acute rejection (AR) (HR 2.09; P=0.018), while a positive AECA status was associated with AR or microvascular inflammation only (HR 2.47; P=0.004) throughout the follow-up period. In particular, AECA (+) recipients with ≥11.5 U/mL anti-AT1Rs exhibited a significant effect on creatinine and estimated glomerular filtration rate (P<0.001; P=0.028), although the risk of AR was not significant. Conclusions Pre-transplant anti-AT1Rs and AECAs have independent negative effects on post-transplant outcomes in low-risk LDKT recipients. Assessment of both antibodies would be helpful in stratifying the pre-transplant immunological risk, even in low-risk LDKT recipients.
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Affiliation(s)
- Shinae Yu
- Department of Laboratory Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyo Won Lee
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.,Organ Transplantation Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Berm Park
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.,Organ Transplantation Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Joo Kim
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.,Organ Transplantation Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wooseong Huh
- Organ Transplantation Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Ryoun Jang
- Organ Transplantation Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ghee Young Kwon
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Hwan Moon
- Department of Surgery Kosin University Gospel Hospital, Medical College of Kosin University, Busan, Korea
| | - Eun-Suk Kang
- Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea.,Organ Transplantation Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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McDow AD, Roman BR, Saucke MC, Jensen CB, Zaborek N, Jennings JL, Davies L, Brito JP, Pitt SC. Factors associated with physicians' recommendations for managing low-risk papillary thyroid cancer. Am J Surg 2020; 222:111-118. [PMID: 33248684 DOI: 10.1016/j.amjsurg.2020.11.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/09/2020] [Revised: 10/27/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The 2015 American Thyroid Association endorsed less aggressive management for low-risk papillary thyroid cancer (LR-PTC). We aimed to identify factors influencing physicians' recommendations for LR-PTC. METHODS We surveyed members of three professional societies and assessed respondents' recommendations for managing LR-PTC using patient scenarios. Multivariable logistic regression models identified clinical and non-clinical factors associated with recommending total thyroidectomy (TT) and active surveillance (AS). RESULTS The 345 respondents included 246 surgeons and 99 endocrinologists. Physicians' preference for their own management if diagnosed with LR-PTC had the strongest association with their recommendation for TT and AS (TT: OR 12.3; AS: OR 7.5, p < 0.001). Physician specialty and stated patient preference were also significantly associated with their recommendations for both management options. Respondents who received information about AS had increased odds of recommending AS. CONCLUSIONS Physicians' recommendations for LR-PTC are strongly influenced by non-clinical factors, such as personal treatment preference and specialty.
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Affiliation(s)
- Alexandria D McDow
- Division of Surgery Oncology, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 537, Indianapolis, IN, 46202, USA.
| | - Benjamin R Roman
- Division of Head and Neck, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
| | - Megan C Saucke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792, USA.
| | - Catherine B Jensen
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792, USA.
| | - Nick Zaborek
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792, USA.
| | - Jamia Linn Jennings
- Wisconsin Department of Health Services, 1 West Wilson Street, Madison, WI, 53703, USA.
| | - Louise Davies
- The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, USA and The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Juan P Brito
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Susan C Pitt
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792, USA.
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Haeusler GM, Gaynor L, Teh B, Babl FE, Orme LM, Segal A, Mechinaud F, Bryant PA, Phillips B, Lourenco RDA, Slavin MA, Thursky KA. Home-based care of low-risk febrile neutropenia in children-an implementation study in a tertiary paediatric hospital. Support Care Cancer 2020; 29:1609-1617. [PMID: 32740894 DOI: 10.1007/s00520-020-05654-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/24/2020] [Accepted: 07/24/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Home-based management of low-risk febrile neutropenia (FN) is safe, improves quality of life and reduces healthcare expenditure. A formal low-risk paediatric program has not been implemented in Australia. We aimed to describe the implementation process and evaluate the clinical impact. METHOD This prospective study incorporated three phases: implementation, intervention and evaluation. A low-risk FN implementation toolkit was developed, including a care-pathway, patient information, home-based assessment and educational resources. The program had executive-level endorsement, a multidisciplinary committee and a nurse specialist. Children with cancer and low-risk FN were eligible to be transferred home with a nurse visiting daily after an overnight period of observation for intravenous antibiotics. Low-risk patients were identified using a validated decision rule, and suitability for home-based care was determined using disease, chemotherapy and patient-level criteria. Plan-Do-Study-Act methodology was used to evaluate clinical impact and safety. RESULTS Over 18 months, 292 children with FN were screened: 132 (45%) were low-risk and 63 (22%) were transferred to home-based care. Compared with pre-implementation there was a significant reduction in in-hospital median LOS (4.0 to 1.5 days, p < 0.001) and 291 in-hospital bed days were saved. Eight (13%) patients needed readmission and there were no adverse outcomes. A key barrier was timely screening of all patients and program improvements, including utilising the electronic medical record for patient identification, are planned. CONCLUSION This program significantly reduces in-hospital LOS for children with low-risk FN. Ongoing evaluation will inform sustainability, identify areas for improvement and support national scale-up of the program.
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Affiliation(s)
- Gabrielle M Haeusler
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,University of Melbourne, Parkville, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. .,The Paediatric Integrated Cancer Service, Parkville, Victoria, Australia. .,Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia. .,Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Lynda Gaynor
- The Paediatric Integrated Cancer Service, Parkville, Victoria, Australia.,Hospital In The Home Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Benjamin Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Emergency Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lisa M Orme
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ahuva Segal
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Francoise Mechinaud
- Unité d'hématologie immunologie pédiatrique, Hopital Robert Debré, APHP Nord Université de Paris, Paris, France
| | - Penelope A Bryant
- Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Hospital In The Home Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, New South Wales, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, 3010, Australia.,Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Karin A Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, 3010, Australia.,Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,NHMRC National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Sabnis HS, Minson KA, Monroe C, Allen K, Metts JL, Cooper TM, Woods WG, Castellino SM, Keller FG. A strategy to reduce cumulative anthracycline exposure in low-risk pediatric acute myeloid leukemia while maintaining favorable outcomes. Leuk Res 2020; 96:106421. [PMID: 32683126 DOI: 10.1016/j.leukres.2020.106421] [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: 05/12/2020] [Revised: 06/26/2020] [Accepted: 07/10/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Advances in risk stratification have improved the 3-year disease-free survival (DFS) and overall survival (OS) of low-risk pediatric acute myeloid leukemia (LR-AML) to approximately 70 % and 85 % respectively. LR-AML is defined by favorable cytogenetic/molecular features and/or optimal early response to therapy. However, cumulative anthracycline exposure in contemporary Children's Oncology Group (COG) regimens approach a doxorubicin equivalent exposure of 540 mg/m2; with rates of non-infection related left ventricular systolic dysfunction (LVSD) approaching 15 %. This is a major cause of toxicity in these patients and precludes the further use of anthracyclines in the relapsed setting; therefore, strategies that reduce cardiotoxicity while maintaining excellent outcomes are needed. PATIENTS AND METHODS Twenty-seven pediatric patients with LR-AML were treated with an anthracycline-reduced approach (Aflac-AML regimen) between 2011 and 2016. Patients received four courses of therapy including three high-dose cytarabine containing courses and a cumulative doxorubicin equivalent exposure of 390 mg/m2, a 28 % reduction in anthracycline dosing compared to current COG regimens. RESULTS The 3-year DFS and OS was 70.0 % and 85.5 % respectively, from end of Induction I (first chemotherapy cycle) with a median follow-up of 3.2 years. These survival outcomes are comparable to current LR-AML regimens. Only two patients developed non-infection related LVSD during therapy and more importantly, none developed LVSD after completion of therapy. CONCLUSION These findings suggest that LR-AML outcomes can be maintained using a reduced anthracycline chemotherapy regimen, resulting in lower cardiac toxicity. This new chemotherapy backbone is now being tested prospectively (NCT04326439) to further validate its use in pediatric LR-AML.
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Enikeev D, Morozov A, Taratkin M, Barret E, Kozlov V, Singla N, Rivas JG, Podoinitsin A, Margulis V, Glybochko P. Active Surveillance for Intermediate-Risk Prostate Cancer: Systematic Review and Meta-analysis of Current Protocols and Outcomes. Clin Genitourin Cancer 2020; 18:e739-e753. [PMID: 32768356 DOI: 10.1016/j.clgc.2020.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Current guidelines allow active surveillance for intermediate-risk prostate cancer patients but do not provide comprehensive recommendations for selection. We performed a systematic review and meta-analysis of outcomes for active surveillance in intermediate- and low-risk groups. METHODS We performed a systematic literature search of intermediate-risk localized prostate cancer patients undergoing active surveillance using 3 literature search engines (Medline, Web of Science, and Scopus) over the past 10 years. The primary outcome was the percentage of patients who remain under surveillance. Secondary outcomes included cancer-specific survival, overall survival, and metastasis-free survival. For articles including both low- and intermediate-risk patients undergoing active surveillance, comparisons between the two groups were made. RESULTS The proportion of patients who remained on active surveillance was comparable between the low- and intermediate-risk groups after 10 and 15 years' follow-up (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.83-1.14; and OR, 0.86; 95% CI, 0.65-1.13). Cancer-specific survival was worse in the intermediate-risk group after 10 years (OR, 0.47; 95% CI, 0.31-0.69) and 15 years (OR, 0.34; 95% CI, 0.2-0.58). The overall survival rate showed no statistical difference at 5 years' follow-up (OR, 0.84; 95% CI, 0.45-1.57) but was worse in the intermediate-risk group after 10 years (OR, 0.43; 95% CI, 0.35-0.53). Metastases-free survival did not significantly differ after 5 years (OR, 0.55; 95% CI, 0.2-1.53) and was worse in the intermediate-risk group after 10 years (OR, 0.46; 95% CI, 0.28-0.77). CONCLUSION Active surveillance could be offered to patients with intermediate-risk prostate cancer. However, they should be informed of the need for regular monitoring and the possibility of discontinuation as a result of a higher rate of progression. Available data indicate that 5-year survival rates between intermediate- and low-risk patients do not differ; 10-year survival rates are worse. To assess the long-term effectiveness and safety of active surveillance, it is necessary to develop unified algorithms for patient selection and management, and to prospectively conduct studies with long-term surveillance.
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Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Vasiliy Kozlov
- Department of Public Health and Healthcare, Sechenov University, Moscow, Russia
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Alexey Podoinitsin
- Moscow Regional Research and Clinical Institute MONIKI n.a. M.F. Vladimirskiy, Moscow, Russia
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Wyler von Ballmoos MC, Reardon MJ. Commentary: What pooling data tells us, or not, about using TAVR in the population at low surgical risk for mortality. Cardiovasc Revasc Med 2020:S1553-8389(20)30260-8. [PMID: 32499123 DOI: 10.1016/j.carrev.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 11/15/2022]
Affiliation(s)
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, United States of America.
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, Bataille V, Bastholt L, Dreno B, Fargnoli MC, Forsea AM, Frenard C, Harwood CΑ, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Malvehy J, Del Marmol V, Middleton MR, Moreno-Ramirez D, Pellecani G, Peris K, Saiag P, van den Beuken-van Everdingen MHJ, Vieira R, Zalaudek I, Eggermont AMM, Grob JJ; European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC). European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention. Eur J Cancer 2020; 128:60-82. [PMID: 32113941 DOI: 10.1016/j.ejca.2020.01.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 12/19/2022]
Abstract
Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in the white populations, accounting for 20% of all cutaneous malignancies. Factors implicated in cSCC etiopathogenesis include ultraviolet radiation exposure and chronic photoaging, age, male sex, immunosuppression, smoking and genetic factors. A collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organisation of Research and Treatment of Cancer (EORTC) was formed to update recommendations on cSCC classification, diagnosis, risk stratification, staging and prevention, based on current literature, staging systems and expert consensus. Common cSCCs are typically indolent tumors, and most have a good prognosis with 5-year cure rates of greater than 90%, and a low rate of metastases (<4%). Further risk stratification into low-risk or high-risk common primary cSCC is recommended based on proposed high-risk factors. Advanced cSCC is classified as locally advanced (lacSCC), and metastatic (mcSCC) including locoregional metastatic or distant metastatic cSCC. Current systems used for staging include the American Joint Committee on Cancer (AJCC) 8th edition, the Union for International Cancer Control (UICC) 8th edition, and Brigham and Women's Hospital (BWH) system. Physical examination for all cSCCs should include total body skin examination and clinical palpation of lymph nodes, especially of the draining basins. Radiologic imaging such as ultrasound of the regional lymph nodes, magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography-computed tomography (PET-CT) scans are recommended for staging of high-risk cSCC. Sentinel lymph node biopsy is currently not recommended. Nicotinamide, oral retinoids, and topical 5-FU have been used for the chemoprevention of subsequent cSCCs in high-risk patients but are not routinely recommended. Education about sun protection measures including reducing sun exposure, use of protective clothing, regular use of sunscreens and avoidance of artificial tanning, is recommended.
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Summers G, Tierney B, Crotzer D. Survival outcomes of minimally invasive versus open radical hysterectomy for low-risk, early-stage cervical cancer. Int J Gynaecol Obstet 2020; 149:380-381. [PMID: 32077088 DOI: 10.1002/ijgo.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/07/2019] [Accepted: 02/18/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Garth Summers
- The University of Nebraska Medical Center, Midwest Gynecology Oncology, Creighton University, Omaha, NE, USA
| | - Brent Tierney
- The University of Nebraska Medical Center, Midwest Gynecology Oncology, Creighton University, Omaha, NE, USA
| | - David Crotzer
- The University of Nebraska Medical Center, Midwest Gynecology Oncology, Creighton University, Omaha, NE, USA
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Mašić S, Pezelj I, Krušlin B. PROSTATE-SPECIFIC ANTIGEN (PSA) VALUES IN PATIENTS WITH LOW- AND HIGH-RISK PROSTATIC ADENOCARCINOMA. Acta Clin Croat 2019; 58:12-15. [PMID: 34975192 PMCID: PMC8693563 DOI: 10.20471/acc.2019.58.s2.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Prostatic adenocarcinoma (PC) comprises around 19% of malignancies in Croatian male population. On the basis of PSA value, Gleason score, grading group and clinical stage, PC can be classified into low- and high-risk groups which is significant for different therapeutic regimens and prognostic outcomes. In this retrospective study, we analyzed the difference in preoperative PSA value in a group of 272 patients who underwent radical prostatectomy and were diagnosed with PC adenocarcinoma in our institution in a period from January 1st, 2018 untill December 31st, 2018. Subsequently, they were divided into low- and high-risk prostatic adenocarcinoma groups. Our results demonstrated positive correlation in preoperative PSA values between the groups and therefore support the use of PSA as one of the parameters in defining low- and high-risk prostatic adenocarcinoma categories.
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Ze Y, Zhang X, Shao F, Zhu L, Shen S, Zhu D, Bi Y. Active surveillance of low-risk papillary thyroid carcinoma: a promising strategy requiring additional evidence. J Cancer Res Clin Oncol 2019; 145:2751-9. [PMID: 31571010 DOI: 10.1007/s00432-019-03021-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/05/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Papillary thyroid carcinoma (PTC), the most common malignant tumor of the thyroid, has been criticized as overtreated by some researchers in recent years. Active surveillance (AS) was first proposed at Kuma Hospital in 1993, and popularized in other institutes ever since. We provide a brief review of low-risk PTC active monitoring studies to date, and discuss the advantages of AS and limitations of existing studies. RESULTS Most papillary thyroid microcarcinomas do not show significant growth or new lymph node metastasis in a 10-year AS period. Patients who undergo delayed surgery during AS generally have a good prognosis. Tumor progression correlates with age, calcification pattern, and Ki-67 positivity. Serum thyroid stimulating hormone concentration and pregnancy might also influence tumor progression in some studies. CONCLUSION Active surveillance for low-risk PTC has shown its safety and feasibility in certain populations. In the future, it is warranted to determine valuable tumor progression predictors and most suitable PTC patients for AS.
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Gnanapragasam VJ, Barrett T, Thankapannair V, Thurtle D, Rubio-Briones J, Domínguez-Escrig J, Bratt O, Statin P, Muir K, Lophatananon A. Using prognosis to guide inclusion criteria, define standardised endpoints and stratify follow-up in active surveillance for prostate cancer. BJU Int 2019; 124:758-767. [PMID: 31063245 DOI: 10.1111/bju.14800] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To test whether using disease prognosis can inform a rational approach to active surveillance (AS) for early prostate cancer. PATIENTS AND METHODS We previously developed the Cambridge Prognostics Groups (CPG) classification, a five-tiered model that uses prostate-specific antigen (PSA), Grade Group and Stage to predict cancer survival outcomes. We applied the CPG model to a UK and a Swedish prostate cancer cohort to test differences in prostate cancer mortality (PCM) in men managed conservatively or by upfront treatment in CPG2 and 3 (which subdivides the intermediate-risk classification) vs CPG1 (low-risk). We then applied the CPG model to a contemporary UK AS cohort, which was optimally characterised at baseline for disease burden, to identify predictors of true prognostic progression. Results were re-tested in an external AS cohort from Spain. RESULTS In a UK cohort (n = 3659) the 10-year PCM was 2.3% in CPG1, 1.5%/3.5% in treated/untreated CPG2, and 1.9%/8.6% in treated/untreated CPG3. In the Swedish cohort (n = 27 942) the10-year PCM was 1.0% in CPG1, 2.2%/2.7% in treated/untreated CPG2, and 6.1%/12.5% in treated/untreated CPG3. We then tested using progression to CPG3 as a hard endpoint in a modern AS cohort (n = 133). During follow-up (median 3.5 years) only 6% (eight of 133) progressed to CPG3. Predictors of progression were a PSA density ≥0.15 ng/mL/mL and CPG2 at diagnosis. Progression occurred in 1%, 8% and 21% of men with neither factor, only one, or both, respectively. In an independent Spanish AS cohort (n = 143) the corresponding rates were 3%, 10% and 14%, respectively. CONCLUSION Using disease prognosis allows a rational approach to inclusion criteria, discontinuation triggers and risk-stratified management in AS.
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Affiliation(s)
- Vincent J Gnanapragasam
- Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, UK.,Cambridge Urology Translational Research and Clinical Trials Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | - David Thurtle
- Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK
| | | | | | - Ola Bratt
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Par Statin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kenneth Muir
- Department of Public Health and Epidemiology, University of Manchester, Manchester, UK
| | - Artitaya Lophatananon
- Department of Public Health and Epidemiology, University of Manchester, Manchester, UK
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Nguyen TPL, Edwards H, Do TND, Finlayson K. Effectiveness of a theory-based foot care education program (3STEPFUN) in improving foot self-care behaviours and foot risk factors for ulceration in people with type 2 diabetes. Diabetes Res Clin Pract 2019; 152:29-38. [PMID: 31082445 DOI: 10.1016/j.diabres.2019.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/12/2019] [Accepted: 05/03/2019] [Indexed: 01/13/2023]
Abstract
AIMS To evaluate the effectiveness of a theory-based foot care education intervention program (3STEPFUN) for people with type 2 diabetes at low risk of developing a foot ulcer. METHODS A controlled, pre-test/ post-test quasi-experimental design was used. From 119 participants, 60 participants in the control group received usual care and a foot care brochure. Those in the intervention group received (1) a small group intensive education and hands-on skills session; (2) a foot care kit and documents; and (3) three regular booster follow-up phone calls over 6 months. Generalised Estimating Equations models were undertaken to examine the impact of the intervention on outcomes over time. RESULTS The intervention group had significantly improved outcomes compared to the control group over 6 months in the following aspects: improved preventive foot care behaviour (p = 0.001); and decreased prevalence of foot risk factors for ulceration (i.e. dry skin, corns/ callus) (OR: 0.04, 95% CI 0.01 - 0.13, p < 0.001). CONCLUSIONS The study's findings provide evidence of 3STEPFUN on improving foot self-care behaviour and preventing minor foot problems. Further study with formal RCT design and longer follow-up time to examine the effects on decreasing foot ulcer incidence is recommended.
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Affiliation(s)
- Thi Phuong Lan Nguyen
- School of Nursing, Faculty of Health, Queensland University of Technology, Australia; Ho Chi Minh City University of Medicine and Pharmacy, Viet Nam.
| | - Helen Edwards
- Faculty of Health, Queensland University of Technology, Australia
| | | | - Kathleen Finlayson
- School of Nursing, Faculty of Health, Queensland University of Technology, Australia
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Ilboudo M, Zohoncon TM, Traore IMA, Traore EMA, Kande A, Obiri-Yeboah D, Djigma FW, Gyebre YMC, Simpore J. Implication of low risk human papillomaviruses, HPV6 and HPV11 in laryngeal papillomatosis in Burkina Faso. Am J Otolaryngol 2019; 40:368-371. [PMID: 30799210 DOI: 10.1016/j.amjoto.2019.02.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Laryngeal papillomatosis is the most common benign tumor of the larynx of children. It is characterized by the development of exophytic proliferative lesions in the mucosa of the airways. Human papillomavirus (HPV) has been recognized as a causal agent among which HPV types 6 and 11 are the most frequently implicated. This disease affects the vocal cords and other important functions of the child. The difficulty of treatment is related to the high recurrence of papilloma growth after surgical removal. The objective of this study was to describe the implication of HPV6 and HPV11 in cases of laryngeal papillomatosis histologically confirmed in Ouagadougou. MATERIALS AND METHODS This was a descriptive cross-sectional study based on histologically diagnosed archival tissue; obtained in the last ten years (2007 to 2017) in the anatomy and cyto-pathology laboratories in Burkina Faso. These fixed and paraffin-embedded tissues were deparaffinized with xylene before HPV DNA extraction; then HPV6 and HPV 11 were identified by real-time multiplex PCR. RESULTS The prevalence of low-risk HPV infection (HPV-LR) was 54.84% in histologically confirmed laryngeal papillomatosis in Ouagadougou. Among the HPV-LR positive samples, HPV6 and HPV11 genotype prevalence's were respectively 41.17% and 35.3% while the HPV6 / HPV11 co-infection was 23.53%. CONCLUSIONS The results show the implication of HPV6 and HPV11 in laryngeal papillomatosis in Burkina Faso with a high prevalence.
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Affiliation(s)
- Maïmouna Ilboudo
- Laboratory of Molecular Biology and Genetics (LABIOGENE), University of Ouaga I Professor Joseph KI-ZERBO, 03 BP 7021, Ouagadougou 03, Burkina Faso; Pietro Annigoni Biomolecular Research Center (CERBA), 01 BP 364, Ouagadougou 01, Burkina Faso
| | - Théodora Mahoukèdè Zohoncon
- Laboratory of Molecular Biology and Genetics (LABIOGENE), University of Ouaga I Professor Joseph KI-ZERBO, 03 BP 7021, Ouagadougou 03, Burkina Faso; Pietro Annigoni Biomolecular Research Center (CERBA), 01 BP 364, Ouagadougou 01, Burkina Faso
| | - Ina Marie Angèle Traore
- Laboratory of Molecular Biology and Genetics (LABIOGENE), University of Ouaga I Professor Joseph KI-ZERBO, 03 BP 7021, Ouagadougou 03, Burkina Faso; Pietro Annigoni Biomolecular Research Center (CERBA), 01 BP 364, Ouagadougou 01, Burkina Faso
| | - Esther Mah Alima Traore
- Laboratory of Molecular Biology and Genetics (LABIOGENE), University of Ouaga I Professor Joseph KI-ZERBO, 03 BP 7021, Ouagadougou 03, Burkina Faso; Pietro Annigoni Biomolecular Research Center (CERBA), 01 BP 364, Ouagadougou 01, Burkina Faso
| | - Ali Kande
- Laboratory of Molecular Biology and Genetics (LABIOGENE), University of Ouaga I Professor Joseph KI-ZERBO, 03 BP 7021, Ouagadougou 03, Burkina Faso; Pietro Annigoni Biomolecular Research Center (CERBA), 01 BP 364, Ouagadougou 01, Burkina Faso
| | - Dorcas Obiri-Yeboah
- University of Cape Coast, School of Medical Sciences, Department of Microbiology and Immunology, University Post Office, Ghana
| | - Florencia W Djigma
- Laboratory of Molecular Biology and Genetics (LABIOGENE), University of Ouaga I Professor Joseph KI-ZERBO, 03 BP 7021, Ouagadougou 03, Burkina Faso; Pietro Annigoni Biomolecular Research Center (CERBA), 01 BP 364, Ouagadougou 01, Burkina Faso
| | - Yvette Marie Chantal Gyebre
- University of Ouaga I Professor Joseph KI-ZERBO, 03 BP 7021, University Hospital Yalgado OUEDRAOGO, Ouagadougou 03, Burkina Faso
| | - Jacques Simpore
- Laboratory of Molecular Biology and Genetics (LABIOGENE), University of Ouaga I Professor Joseph KI-ZERBO, 03 BP 7021, Ouagadougou 03, Burkina Faso; Pietro Annigoni Biomolecular Research Center (CERBA), 01 BP 364, Ouagadougou 01, Burkina Faso.
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Yao W, Li K, Dong KR, Zheng S, Xiao XM. Long-term prognosis of low-risk neuroblastoma treated by surgery alone: an experience from a single institution of China. World J Pediatr 2019; 15:148-152. [PMID: 30446974 DOI: 10.1007/s12519-018-0205-z] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/19/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Low-risk neuroblastomas have favorable biologic characteristics. Children Oncology Group (COG) proposed that surgical resection of the primary tumor was sufficient. We evaluated the long-term prognosis of surgery alone for patients with low-risk neuroblastoma in China. METHODS A total of 34 patients with low-risk neuroblastoma were treated in our center between Jan 2009 and Dec 2013. The medical records of these patients were reviewed. RESULTS The primary lesion was located in the adrenal gland in 19 patients, the retroperitoneum in 5, the posterior mediastinum in 9 and the neck in 1. The tumor diameters and volumes were 1.80-10.0 cm (average 5.5 ± 2.3 cm) and 1.28-424.10 cm3 (average 58.81 ± 92.00 cm3), respectively. The stages of the patients were as follows: stage I in 25, stage II in 7, and stage IVs in 2. All patients were in the low-risk group according to COG risk stratification criteria. No patients showed MYCN amplification. The primary tumors of all patients were completely resected. Nine adrenal tumors were completely resected by laparoscopy. All patients were successfully followed for 66-115 (average 89.71 ± 16.17) months. Recurrence was observed in 4 patients. In addition to one local recurrence, another three recurrences were metastases. The lesions were effectively controlled in all patients with recurrences. All patients survived, including 28 cases of tumor-free survival; the 4-year overall and event-free survival rates were both 100%. CONCLUSIONS Surgery alone is a safe and effective treatment strategy for low-risk neuroblastoma. Recurrent lesions may be controlled and treated by rescue chemotherapy and surgery.
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Affiliation(s)
- Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.,National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China. .,National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China.
| | - Kui-Ran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.,National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.,National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xian-Min Xiao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.,National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
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Ancel J, Rault E, Fernandez MP, Huissoud C, Savidan A, Gaire C, Dupont C, Rudigoz RC. When can obstetric risk be predicted? J Gynecol Obstet Hum Reprod 2018; 48:179-186. [PMID: 30580069 DOI: 10.1016/j.jogoh.2018.12.006] [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: 05/24/2018] [Revised: 12/06/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of the study was to assess the chronology of the appearance of perpartum obstetric risk factors (POR) in order to define the best moment to evaluate the type of management to which women will be oriented. We have secondarily studied the extent to which inappropriate medical interventions play a role in the genesis of some complications in the deliveries of women who are in principle at low risk. MATERIALS AND METHODS We conducted a prospective cohort study from January 1 to June 30, 2015 at the Croix-Rousse Hospital of Lyon, a level III maternity, and the Valence Hospital Center, a level II maternity, including all women giving birth at 24 to 42 weeks of gestation at hospital. The women were divided into two groups : one with no known perpartum obstetric risk (POR-) and the other with at least one obstetrical perpartum risk factor (POR+), defined at three different stages (at the last pregnancy monitoring consultation, at the onset of labor at the admission in the delivery room, and at the end of labor just before expulsive efforts). We observed medical interventions and foeto-maternal complications in each group. A non-simple delivery was a delivery involving a medical intervention, or a maternal or neonatal complication, or any combination of these. A secondary retrospective analysis of the practices and management was made for women initially considered POR- at the onset of labor but who had a non-simple delivery to assess adherence to current guidelines according to an audit schedule. RESULTS Among 1975 women, we identified 32% women as POR- at end of pregnancy, 21% at start of labor and 20% at end of labor. Among the POR- women at start of labor, 16% had a non-simple delivery. 35% of these non-simple deliveries might perhaps have been avoided by closer adherence to current recommendations. Nonetheless 54% of these women still had an unpredictable and inevitable non-simple delivery that in some cases required an extremely rapid intervention. CONCLUSION Determining and predicting pregnant women who will need additional resources in addition to the usual obstetric and neonatal care is difficult. This identification should be made at the admission for delivery and this risk should be reassessed during labor. There are no women at zero risk of intervention. Therefore, delivery in demedicalized units should not take place in isolated or distant free-standing facilities.
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Affiliation(s)
- Julie Ancel
- Service de gynécologie obstétrique CH de la Croix Rousse, France.
| | - Emmanuel Rault
- Service de gynécologie obstétrique CH de Valence, France
| | | | - Cyril Huissoud
- Service de gynécologie obstétrique CH de la Croix Rousse, France
| | - Anne Savidan
- Service de gynécologie obstétrique CH de Valence, France
| | - Coralie Gaire
- Service de gynécologie obstétrique CH de Valence, France
| | | | - R C Rudigoz
- Service de gynécologie obstétrique CH de la Croix Rousse, France
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Mangili G, Cioffi R, Danese S, Frigerio L, Ferrandina G, Cormio G, Rabaiotti E, Scarfone G, Gadducci A, Bergamini A, Pisano C, Candiani M. Does methotrexate (MTX) dosing in a 8-day MTX/FA regimen for the treatment of low-risk gestational trophoblastic neoplasia affect outcomes? The MITO-9 study. Gynecol Oncol 2018; 151:449-452. [PMID: 30266260 DOI: 10.1016/j.ygyno.2018.09.025] [Citation(s) in RCA: 10] [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: 08/01/2018] [Revised: 09/15/2018] [Accepted: 09/21/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare clinical outcomes of patients diagnosed with low-risk gestational trophoblastic neoplasia (GTN) receiving intramuscular methotrexate 50 mg total dose/day versus 1 mg/kg/day in a 8-day methotrexate/folinic acid (MTX/FA) regimen. METHODS This retrospective, multicenter study included 176 patients: 99 (56%) receiving methotrexate 50 mg total dose/day on days 1, 3, 5, 7 alternated with FA 7,5 mg on days 2, 4, 6, 8, every 14 days (group A); and 77 patients (44%), receiving methotrexate 1 mg/kg/day on days 1, 3, 5, 7 alternated with FA 7,5 mg on days 2, 4, 6, 8, every 14 days (group B). Patients' characteristics and outcomes were compared by univariate analysis. RESULTS Forty-five patients (25.6%) developed resistance to MTX and received a second-line treatment, 7 (4%) received a third-line treatment and 8 (4.5%) relapsed after initial remission. There was no difference between group A and B patients in the average number of chemotherapy cycles required to achieve remission (5.7 ± 2.6 vs 6.3 ± 2.3, p = 0.106). The 2 treatment groups showed comparable rates of MTX resistance (28.3% vs 22.1%, p = 0.387) and relapse (3% vs 6.5%, p = 0.300). There was no difference in the incidence of treatment toxicity of any CTCAE grade between group A and B patients (16.2% vs 15.2%, p = 0.999). Subgroup analysis stratifying patients by weight (<50 kg, ≥60 kg, ≥70 kg, ≥80 kg) confirmed these results. CONCLUSION The 2 MTX schedules showed comparable efficacy in the treatment of low-risk GTN with an acceptable rate of toxicity.
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Affiliation(s)
- Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Cioffi
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Saverio Danese
- Obstetrics and Gynecology Unit, Ospedale S. Anna, Turin, Italy
| | - Luigi Frigerio
- Obstetrics and Gynecology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS -Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, Istituto Tumori "Giovanni Paolo II", University of Bari, Italy
| | - Emanuela Rabaiotti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna Scarfone
- Obstetrics and Gynecology Unit, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Angiolo Gadducci
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmela Pisano
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Dabi Y, Willecocq C, Ballester M, Carcopino X, Bendifallah S, Ouldamer L, Lavoue V, Canlorbe G, Raimond E, Coutant C, Graesslin O, Collinet P, Bricou A, Huchon C, Daraï E, Haddad B, Touboul C. Identification of a low risk population for parametrial invasion in patients with early-stage cervical cancer. J Transl Med 2018; 16:163. [PMID: 29898732 PMCID: PMC6001133 DOI: 10.1186/s12967-018-1531-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/30/2018] [Indexed: 12/11/2022] Open
Abstract
Background Recent studies have challenged radical procedures for less extensive surgery in selected patients with early-stage cervical cancer at low risk of parametrial invasion. Our objective was to identify a subgroup of patients at low risk of parametrial invasion among women having undergone surgical treatment. Methods Data of 1447 patients with cervical cancer treated between 1996 and 2016 were extracted from maintained databases of 10 French University hospitals. Patients with early-stage (IA2–IIA) disease treated by radical surgery including hysterectomy and trachelectomy, were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariate analysis, was used to account for the influence of multiple variables. Results Out of the 263 patients included for analysis, on final pathology analysis 28 (10.6%) had parametrial invasion and 235 (89.4%) did not. Factors significantly associated with parametrial invasion on multivariate analysis were: age > 65 years, tumor > 30 mm in diameter measured by MRI, lymphovascular space invasion (LVSI) on pathologic analysis. Among the 235 patients with negative pelvic lymph nodes, parametrial disease was seen in only 7.6% compared with 30.8% of those with positive pelvic nodes (p < 0.001). In a subgroup of patients presenting tumors < 30 mm, negative pelvic status and no LVSI, the risk of parametrial invasion fell to 0.6% (1/173 patients). Conclusion Our analysis suggests that there is a subgroup of patients at very low risk of parametrial invasion, potentially eligible for less radical procedures. Electronic supplementary material The online version of this article (10.1186/s12967-018-1531-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yohann Dabi
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France.,Faculté de Médecine de Créteil UPEC - Paris XII, Créteil, France
| | - Claire Willecocq
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France.,Faculté de Médecine de Créteil UPEC - Paris XII, Créteil, France
| | - Marcos Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Hopital Nord, APHM, Marseilles, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Lobna Ouldamer
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France
| | - Vincent Lavoue
- CRLCC Eugène-Marquis, Service de Gynécologie, CHU de Rennes, Université de Rennes 1, Rennes, France
| | - Geoffroy Canlorbe
- Department of Gynaecology and Obstetrics, Pitié Salpetrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Charles Coutant
- Centre de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Pierre Collinet
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Jean-Verdier University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Cyrille Huchon
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France.,Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78103, Poissy, France
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Bassam Haddad
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France.,Faculté de Médecine de Créteil UPEC - Paris XII, Créteil, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France. .,Faculté de Médecine de Créteil UPEC - Paris XII, Créteil, France. .,Inserm U965 Laboratory, Angiogenèse et Recherche Translationnelle, Paris, France.
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45
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Joyce NM, Tully E, Kirkham C, Dicker P, Breathnach FM. Perinatal mortality or severe neonatal encephalopathy among normally formed singleton pregnancies according to obstetric risk status:" is low risk the new high risk?" A population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2018; 228:71-75. [PMID: 29909266 DOI: 10.1016/j.ejogrb.2018.06.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the capacity of the current system of obstetric risk stratification at the outset of pregnancy to predict severe adverse perinatal outcome. STUDY DESIGN This retrospective cohort study of singleton pregnancies over a five year period (2009-2013) was performed at the Rotunda Hospital, Dublin, Ireland. High-risk or low-risk status was assigned retrospectively to a large consecutive cohort of women with a normally-formed singleton pregnancy on the basis of factors analyzed at the first prenatal hospital visit. The incidence of severe perinatal morbidity and mortality were compared between high- and low-risk groups to determine the predictive utility of risk stratification at the outset of pregnancy for severe perinatal morbidity. RESULTS During the study period, 41,044 patients registered for prenatal care. 25,702;(63%) were deemed low-risk and 15,342;(37%) high-risk. Low-risk women were statistically more likely to be nulliparous (p < 0.0001) and to have a spontaneous or operative vaginal delivery (p < 0.0001). High-risk women were more likely to be multiparous and to undergo Caesarean delivery (p < 0.0001). The perinatal mortality rate was 3.8 per-1000 in low-risk pregnancies and 6.1 per-1000 in the a priori high-risk group (p = 0.012). The incidence of severe neonatal encephalopathy (NNE) was 1.8 and 0.65 per-1000 in the low and high-risk groups respectively (p = 0.0025). CONCLUSION Where low-risk status is assigned at registration, neonatal encephalopathy is more prevalent. This data is relevant for the design of prenatal care models and demonstrates that assignment of low obstetric risk on the basis of maternal or pre-pregnancy factors alone may erroneously be interpreted as conferring low-risk status to the fetus.
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Affiliation(s)
- Niamh M Joyce
- RCSI Rotunda, Royal College of Surgeons in Ireland, RCSI Unit, Rotunda Hospital, Parnell Square, Dublin 1, Ireland.
| | - Elizabeth Tully
- RCSI Rotunda, Royal College of Surgeons in Ireland, RCSI Unit, Rotunda Hospital, Parnell Square, Dublin 1, Ireland
| | - Colin Kirkham
- The Rotunda Hospital, Parnell Square, Dublin 1, Ireland
| | - Patrick Dicker
- RCSI Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland
| | - Fionnuala M Breathnach
- RCSI Rotunda, Royal College of Surgeons in Ireland, RCSI Unit, Rotunda Hospital, Parnell Square, Dublin 1, Ireland
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Abstract
The incidence of thyroid cancer has increased, mainly due to the incidental finding of low-risk papillary thyroid cancers (PTC). These malignancies grow slowly, and are unlikely to cause morbidity and mortality. New understanding about the prognosis of tumor features has led to reclassification of many tumors within the low-risk thyroid category, and to the development of a new one "very low-risk tumors." Alternative less aggressive approaches to therapy are now available including active surveillance and minimally invasive interventions. In this narrative review, we have summarized the available evidence for the management of low-risk PTC.
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Affiliation(s)
- Nicole M Iñiguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
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47
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Asami M, Yamaji K, Aoki J, Tanimoto S, Watanabe M, Horiuchi Y, Furui K, Kato N, Hara K, Tanabe K. Association of Dyslipidemia and Sex With Coronary Artery Calcium Assessed by Coronary Computed Tomography Angiography. Int Heart J 2017; 58:695-703. [PMID: 28966320 DOI: 10.1536/ihj.16-481] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous studies reporting that statin increases coronary artery calcium (CAC) were conducted exclusively on patients with statin as a prevention, regardless of the presence or absence of dyslipidemia. The impact of sex on CAC has not been fully evaluated. We aimed to determine the association of dyslipidemia and sex with CAC using 320-row multi-detector computed tomography (MDCT).Of the 356 consecutive patients who underwent coronary MDCT, 251 patients were enrolled, after excluding those with prior stenting and/or coronary bypass grafting or images showing motion artifacts. The primary outcome measures were the percent calcium volume (PCV) and percent atheroma volume (PAV) per coronary vessel.Multivariable analyses indicated that PCV was significantly higher in dyslipidemia patients without statins than in the subjects without dyslipidemia [partial regression coefficient (PRC): 2.59, 95% confidence interval (CI): 0.83 to 4.34, P = 0.004]. In contrast, PCV was similar in dyslipidemia patients taking statins and those without dyslipidemia (PRC: -1.09, 95% CI: -2.82 to 0.65, P = 0.22). There was no significant difference in PCV between men and women, although women exhibited a significantly lower PAV (PRC: -2.87, 95% CI: -4.54 to -1.20, P = 0.001).In low-risk patients, these results could be translated into hypotheses, which should be tested in future prospective studies. Furthermore, there was no significant difference in CAC between men and women, but women had lower PAV than men.
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Affiliation(s)
| | | | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital
| | | | | | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital
| | - Koichi Furui
- Division of Cardiology, Mitsui Memorial Hospital
| | - Nahoko Kato
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
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48
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Affiliation(s)
- Con Aroney
- Cardiology Services, Holy Spirit Northside Hospital, Brisbane, Qld, Australia; Medicine, University of Queensland, Brisbane, Qld, Australia.
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49
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Ito Y, Miyauchi A, Oda H. Low-risk papillary microcarcinoma of the thyroid: A review of active surveillance trials. Eur J Surg Oncol 2017; 44:307-315. [PMID: 28343733 DOI: 10.1016/j.ejso.2017.03.004] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [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: 10/13/2016] [Revised: 12/01/2016] [Accepted: 03/09/2017] [Indexed: 12/15/2022] Open
Abstract
Papillary microcarcinoma (PMC) of the thyroid is defined as papillary thyroid carcinoma (PTC) measuring ≤1 cm. Many autopsy studies on subjects who died of non-thyroidal diseases reported latent small thyroid carcinoma in up to 5.2% of the subjects. A mass screening study for thyroid cancer in Japanese adult women detected small thyroid cancer in 3.5% of the examinees. This incidence was close to the incidence of latent thyroid cancer and more than 1000 times the prevalence of clinical thyroid cancer in Japanese women reported at that time. The question of whether it was correct to treat such PMCs surgically then arose. In 1993, according to Dr. Miyauchi's proposal, Kuma Hospital initiated an active surveillance trial for low-risk PMC as defined in the text. In 1995, Cancer Institute Hospital in Tokyo, Japan, started a similar observation trial. The accumulated data from the trials at these two institutions strongly suggest that active surveillance (i.e., observation without immediate surgery) can be the first-line management for low-risk PMC. Although our data showed that young age and pregnancy might be risk factors of disease progression, we think that these patients can also be candidates for active surveillance, because all of the patients who showed progression signs were treated successfully with a rescue surgery, and none of them died of PTC. In this review, we summarize the data regarding the active surveillance of low-risk PMC as support for physicians and institutions that are considering adopting this strategy.
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Affiliation(s)
- Y Ito
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - A Miyauchi
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan.
| | - H Oda
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
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50
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Porcaro AB, Cavicchioli F, De Luyk N, Mattevi D, Corsi P, Sebben M, Tafuri A, Processali T, Inverardi D, Cacciamani G, De Marchi D, Balzarro M, Cerruto MA, Brunelli M, Novella G, Siracusano S, Artibani W. Clinical Factors Predicting Tumour Upgrading in Patients Under Active Surveillance and Elected to Active Treatment after Disease Reclassification or Progression. Urol Int 2017; 99:186-193. [PMID: 28196367 DOI: 10.1159/000457966] [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: 10/20/2016] [Accepted: 01/24/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate clinical factors associated with tumour upgrading (UPG) in low-intermediate risk patients who progressed while under active surveillance (AS) and underwent delayed radical prostatectomy. MATERIAL AND METHODS The evaluated factors included prostate specific antigen (PSA), prostate volume, PSA density and number of biopsy positive cores (BPC). Multivariate logistic regression by the forward step Wald procedure was used. RESULTS The study evaluated 24 patients who had UPG in 13 cases (54.2%). Independent factors associated with tumour UPG included PSA (OR 2.1; p = 0.047) and BPC (OR 2; p = 0.042). CONCLUSIONS Clinical factors associated with UPG were identified in patients who were under AS for with low-intermediate risk disease. Preoperative PSA levels and number of BPC were independent factors associated with UPG in a contemporary cohort of patients who progressed under AS and underwent delayed active treatment.
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Affiliation(s)
- Antonio Benito Porcaro
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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