1
|
An Analysis of Positron Emission Tomography Maximum Standard Uptake Value Among Patients With Head and Neck Cancer Receiving Photon and Proton Radiation. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00428-0. [PMID: 38499254 DOI: 10.1016/j.ijrobp.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/23/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE One main advantage of proton therapy versus photon therapy is its precise radiation delivery to targets without exit dose, resulting in lower dose to surrounding healthy tissues. This is critical, given the proximity of head and neck tumors to normal structures. However, proton planning requires careful consideration of factors, including air-tissue interface, anatomic uncertainties, surgical artifacts, weight fluctuations, rapid tumor response, and daily variations in setup and anatomy, as these heterogeneities can lead to inaccuracies in targeting and creating unwarranted hotspots to a greater extent than photon radiation. In addition, the elevated relative biological effectiveness at the Bragg peak's distal end can also increase hot spots within and outside the target area. METHODS AND MATERIALS The purpose of this study was to evaluate for a difference in positron emission tomography (PET) standard uptake value (SUV) after definitive treatment, between intensity modulated proton therapy (IMPT) and intensity modulated photon therapy (IMRT). In addition, we compared the biologic dose between PET areas of high and low uptake within the clinical target volume-primary of patients treated with IMPT. This work is assuming that the greater SUV may potentially result in greater toxicities. For the purposes of this short communication, we are strictly focusing on the SUV and do not have correlation with toxicity outcomes. To accomplish this, we compared the 3- and 6-month posttreatment fluorodeoxyglucose PET scans for 100 matched patients with oropharyngeal cancer treated definitively without surgery using either IMPT (n = 50) or IMRT (n = 50). RESULTS Our study found a significant difference in biologic dose between the high- and low-uptake regions on 3-month posttreatment scans of IMPT. However, this difference did not translate to a significant difference in PET uptake in the clinical target volume-primary at 3 and 6 months' follow-up between patients who received IMPT versus IMRT. CONCLUSIONS Studies have proposed that proton's greater relative biological effectiveness at the Bragg peak could lead to tissue inflammation. Our study did not corroborate these findings. This study's conclusion underscores the need for further investigations with ultimate correlation with clinical toxicity outcomes.
Collapse
|
2
|
Radiotherapy (RT) for Cutaneous Adnexal Carcinoma (CAC): 49 Patients Treated at a Single Institution Over 2 Decades. Int J Radiat Oncol Biol Phys 2023; 117:e607-e608. [PMID: 37785828 DOI: 10.1016/j.ijrobp.2023.06.1978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Cutaneous adnexal carcinomas (CACs) are a heterogenous group of rare skin cancers. Management strategies are extrapolated from the treatment of more common skin cancers, and case series describing patients treated with radiotherapy (RT) for CAC are limited to <15 patients. We reviewed our institutional experience to better understand the characteristics and outcomes of patients with CAC treated with RT. MATERIALS/METHODS Patients diagnosed with CAC and treated RT from 2000-2020 were identified using the following keywords: adnexal, microcystic, apocrine, eccrine, sebaceous, sweat gland, syringoma, mucinous, tubular, porocarcinoma, hidradenocarcinoma, and cylindrocarcinoma. Patient, cancer, and treatment characteristics were assessed by retrospective record review. Time to overall survival (OS), locoregional recurrence (LRR), distant metastasis (DM), and progression free survival (PFS) were evaluated using Kaplan-Meier methods. RESULTS Forty-nine patients with a median age of 65 years (IQR 53-82) were identified. Most were white (90%) men (59%) harboring tumors on the head and neck (80%). The most common subtypes of CAC were adnexal adenocarcinoma (39%), sebaceous carcinoma (35%) and microcystic adnexal carcinoma (10%). Patients were treated for de novo cancer (n = 35) or after recurrence (n = 14). Among de novo cases, 9 (26%) were treated with definitive RT, 22 (63%) were treated with surgery and adjuvant RT, and 4 (11%) with palliative RT. Per UICC system, de novo stage at time of RT was I in 2 (6%), II in 9 (26%), III in 12 (34%), IVA in 10 (29%), and IVB in 2 (6%). Median OS was 44 months and median follow-up of surviving patients was 41 months (IQR 17-75). De novo patients treated with definitive RT received a median dose of 70 Gy (IQR 60-73 Gy) and experienced 2-year rates of PFS, LRR, and DM of 30%, 55%, and 40%, respectively. All LRR events occurred within the irradiated volume. De novo patients treated with surgery and adjuvant RT received a median dose of 60 Gy (IQR 60-64 Gy) and experienced 2-year rates of PFS, LRR, and DM of 77%, 13%, and 10%, respectively. All LRR events occurred outside the irradiated volume. Among patients treated at recurrence, most (93%) underwent surgery and adjuvant RT. Per UICC system, their stage at time of RT was II in 2 (15.4%), III in 4 (30.8%), and IVA in 7 (53.8%). Recurrent patients treated with surgery and adjuvant RT received a median dose of 60 Gy (IQR 60-66 Gy) and experienced 2-year rates of PFS, LRR, and DM of 30%, 58%, and 29%, respectively. Three of 4 evaluable patients treated with palliative RT exhibited stable disease or tumor response. CONCLUSION In the largest single institution analysis to date, RT was primarily used for CAC patients as an adjuvant treatment. LRR was less frequent and less likely to occur within irradiated volume in patients selected for surgery and adjuvant RT than those selected for definitive RT or at time of recurrence.
Collapse
|
3
|
Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer. Laryngoscope 2023; 133:1138-1145. [PMID: 35801573 PMCID: PMC10547133 DOI: 10.1002/lary.30279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Limited data is available to guide non-surgical management of Stage T4 larynx and hypopharynx cancer patients who have inoperable disease or refuse surgery. We aim to review the nonoperative management of T4 laryngeal and hypopharyngeal cancer and report the long-term therapeutic and functional outcomes. METHODS We reviewed the nonoperative management of T4 laryngeal (n = 44) and hypopharyngeal (n = 53) cancer from 1997 to 2015 and performed a univariate analysis (UVA). RESULTS The 2-/5-year OS rates were 73%/38% for larynx patients and 52%/29% for hypopharynx patients. Locoregional failure (LRF) occurred in 25% and 19% of larynx and hypopharynx patients, respectively. On UVA of the larynx subset, N3 nodal status and non-intensity-modulated radiation therapy were negatively associated with OS; treatment with radiation therapy alone impacted disease-free survival; and age >70 was associated with LRF. On UVA of the hypopharynx subset, only T4b status significantly impacted OS. In the larynx and hypopharynx groups, 68% and 85% received a percutaneous endoscopic gastrostomy (PEG) tube and 32% and 40% received a tracheostomy tube, respectively. At the last follow-up visit, 66% of our larynx cohort had neither tracheostomy or PEG placed and 40% of our hypopharynx cohort had neither. CONCLUSION We report better than previously noted outcomes among T4 larynx and hypopharynx patients who have unresectable disease or refuse surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1138-1145, 2023.
Collapse
|
4
|
Salmonella enteritidis abdominal aorta mycotic aneurysm presented with acute cholestatic jaundice: A case report and literature review. Trop Biomed 2023; 40:23-28. [PMID: 37356000 DOI: 10.47665/tb.40.1.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Mycotic aneurysm is one of the extra-intestinal manifestations of Salmonella Enteritidis infection. The diagnosis of this condition is challenging owed to its variation in clinical presentations. We presented a case of a 54-year-old man with underlying diabetes mellitus and chronic smokers presented with acute right flank pain and fever associated with mild jaundice. The initial laboratory investigations suggested features of obstructive jaundice and urinary tract infection. The contrast enhancing computed tomography of the abdomen revealed the presence of saccular mycotic aneurysm located at the infrarenal abdominal aorta. The blood culture grew Salmonella Enteritidis which was susceptible to ceftriaxone, trimethoprim-sulfamethoxazole, ciprofloxacin, ampicillin, and amoxicillin-clavulanic acid. Intravenous ceftriaxone was initiated, and he underwent open surgery and artery repair at day 8 of admission. He responded well to the treatment given and subsequently discharged home after completed three weeks of intravenous ceftriaxone.
Collapse
|
5
|
Complementary and alternative medicine for children with sickle cell disease: A systematic review. Blood Rev 2023; 59:101052. [PMID: 36775794 DOI: 10.1016/j.blre.2023.101052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is a popular alternative to opioid and other analgesics in sickle cell disease (SCD). We review the effectiveness, prevalence, and factors associated with CAM use in the pediatric SCD population. METHODS The review protocol was created based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted in MEDLINE, Embase, Cochrane Library, PubMed, and Web of Science. RESULTS Twenty-four studies were examined. The prevalence of CAM use in pediatric patients with SCD ranged from 36 to 84.5%. Common inpatient CAM interventions were yoga, virtual reality, and acupuncture, which decreased pain scale scores. Outpatient CAMs were consisted of cognitive behavioral therapy, massage therapy, and guided-imagery, which increased pain tolerability and decreased pain scale scores. CONCLUSIONS CAM modalities can decrease pain scale scores. However, the impact of specific CAM modalities on emergency department visits, hospitalizations, and school absences were inconclusive.
Collapse
|
6
|
Evaluation of Proton Therapy Reirradiation for Patients With Recurrent Head and Neck Squamous Cell Carcinoma. JAMA Netw Open 2023; 6:e2250607. [PMID: 36689229 PMCID: PMC9871797 DOI: 10.1001/jamanetworkopen.2022.50607] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/09/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Use of proton therapy reirradiation (PT-ReRT) for head and neck cancer is increasing; however, reports are heterogenous and outcomes can be difficult to interpret. Objective To evaluate outcomes and toxic effects following PT-ReRT in a uniform and consecutive cohort of patients with head and neck squamous cell carcinoma. Design, Setting, and Participants This retrospective cohort study included patients with recurrent primary head and neck squamous cell carcinoma who were treated with PT-ReRT from January 1, 2013, to December 31, 2020, at a single institution. Patient, clinical, and treatment characteristics were obtained, and multidisciplinary review was performed to record and grade early and late toxic effects. Exposures Proton therapy reirradiation. Main Outcomes and Measures Follow-up was defined from the start of PT-ReRT. The Kaplan-Meier method was used for outcomes of interest, including local control (LC), locoregional control, distant metastatic control, progression-free survival, and overall survival (OS). Cox proportional hazards regression modeling was used to assess associations of covariates with OS. Results A total of 242 patients (median [range] age, 63 [21-96] years; 183 [75.6%] male) were included. Of these patients, 231 (95.9%) had a Karnofsky performance status score of 70 or higher, and 145 (59.9%) had at least a 10-pack-year smoking history. Median (range) follow-up was 12.0 (5.8-26.0) months for all patients and 24.5 (13.8-37.8) months for living patients. A total of 206 patients (85.1%) had recurrent disease vs second primary or residual disease. The median (range) interval between radiation courses was 22 (1-669) months. Median PT-ReRT dose was 70 cobalt gray equivalents (CGE) for the fractionated cohort and 44.4 CGE for the quad shot cohort. For the fractionated cohort, the 1-year LC was 71.8% (95% CI, 62.8%-79.0%) and the 1-year OS was 66.6% (95% CI, 58.1%-73.8%). For the quad shot cohort, the 1-year LC was 61.6% (95% CI, 46.4%-73.6%) and the 1-year OS was 28.5% (95% CI, 19.4%-38.3%). Higher Karnofsky performance status scores (hazard ratio [HR], 0.50; 95% CI, 0.25-0.99; P = .046) and receipt of salvage surgery prior to PT-ReRT (HR, 0.57; 95% CI, 0.39-0.84; P = .005) were associated with improved OS, whereas receipt of quad shot (HR, 1.97; 95% CI, 1.36-2.86; P < .001) was associated with worse OS. There were a total of 73 grade 3 and 6 grade 4 early toxic effects. There were 79 potential grade 3, 4 grade 4, and 5 grade 5 late toxic effects. Conclusions and Relevance The findings of this cohort study suggest that, compared with previous reports with photon-based reirradiation, patients are living longer with aggressive PT-ReRT; however, surviving patients remain at risk of early and late complications.
Collapse
|
7
|
Toxicity Profiles and Survival Outcomes Among Patients With Nonmetastatic Oropharyngeal Carcinoma Treated With Intensity-Modulated Proton Therapy vs Intensity-Modulated Radiation Therapy. JAMA Netw Open 2022; 5:e2241538. [PMID: 36367724 PMCID: PMC9652753 DOI: 10.1001/jamanetworkopen.2022.41538] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE Patients with oropharyngeal carcinoma (OPC) treated with radiotherapy often experience substantial toxic effects, even with modern techniques such as intensity-modulated radiation therapy (IMRT). Intensity-modulated proton therapy (IMPT) has a potential advantage over IMRT due to reduced dose to the surrounding organs at risk; however, data are scarce given the limited availability and use of IMPT. OBJECTIVE To compare toxic effects and oncologic outcomes among patients with newly diagnosed nonmetastatic OPC treated with IMPT vs IMRT with or without chemotherapy. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients aged 18 years or older with newly diagnosed nonmetastatic OPC who received curative-intent radiotherapy with IMPT or IMRT at a single-institution tertiary academic cancer center from January 1, 2018, to December 31, 2021, with follow-up through December 31, 2021. EXPOSURES IMPT or IMRT with or without chemotherapy. MAIN OUTCOMES AND MEASURES The main outcomes were the incidence of acute and chronic (present after ≥6 months) treatment-related adverse events (AEs) and oncologic outcomes, including locoregional recurrence (LRR), progression-free survival (PFS), and overall survival (OS). Fisher exact tests and χ2 tests were used to evaluate associations between toxic effects and treatment modality (IMPT vs IMRT), and the Kaplan-Meier method was used to compare LRR, PFS, and OS between the 2 groups. RESULTS The study included 292 patients with OPC (272 [93%] with human papillomavirus [HPV]-p16-positive tumors); 254 (87%) were men, 38 (13%) were women, and the median age was 64 years (IQR, 58-71 years). Fifty-eight patients (20%) were treated with IMPT, and 234 (80%) were treated with IMRT. Median follow-up was 26 months (IQR, 17-36 months). Most patients (283 [97%]) received a dose to the primary tumor of 70 Gy. Fifty-seven of the patients treated with IMPT (98%) and 215 of those treated with IMRT (92%) had HPV-p16-positive disease. There were no significant differences in 3-year OS (97% IMPT vs 91% IMRT; P = .18), PFS (82% IMPT vs 85% IMRT; P = .62), or LRR (5% IMPT vs 4% IMRT; P = .59). The incidence of acute toxic effects was significantly higher for IMRT compared with IMPT for oral pain of grade 2 or greater (42 [72%] IMPT vs 217 [93%] IMRT; P < .001), xerostomia of grade 2 or greater (12 [21%] IMPT vs 68 [29%] IMRT; P < .001), dysgeusia of grade 2 or greater (16 [28%] IMPT vs 134 [57%] IMRT; P < .001), grade 3 dysphagia (4 [7%] IMPT vs 29 [12%] IMRT; P < .001), mucositis of grade 3 or greater (10 [53%] IMPT vs 13 [70%] IMRT; P = .003), nausea of grade 2 or greater (0 [0%] IMPT vs 18 [8%] IMRT; P = .04), and weight loss of grade 2 or greater (22 [37%] IMPT vs 138 [59%] IMRT; P < .001). There were no significant differences in chronic toxic effects of grade 3 or greater, although there was a significant difference for chronic xerostomia of grade 2 or greater (6 IMPT [11%] vs 22 IMRT [10%]; P < .001). Four patients receiving IMRT (2%) vs 0 receiving IMPT had a percutaneous endoscopic gastrostomy tube for longer than 6 months. CONCLUSIONS AND RELEVANCE In this study, curative-intent radiotherapy with IMPT for nonmetastatic OPC was associated with a significantly reduced acute toxicity burden compared with IMRT, with few chronic toxic effects and favorable oncologic outcomes, including locoregional recurrence of only 5% at 2 years. Prospective randomized clinical trials comparing these 2 technologies and of patient-reported outcomes are warranted.
Collapse
|
8
|
Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. THE LANCET. RESPIRATORY MEDICINE 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
Collapse
|
9
|
Outcomes and Toxicities of Nonmedullary Thyroid Tumors Treated with Proton Beam Radiation Therapy. Int J Part Ther 2022; 9:20-30. [PMID: 36060412 PMCID: PMC9415751 DOI: 10.14338/ijpt-22-00005.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Proton therapy is an emerging therapy for several malignancies owing to its favorable therapeutic ratio. There are very limited data on the use of proton therapy in the management of thyroid carcinoma. Our objective was to review the safety, feasibility, and outcomes of proton therapy for patients with thyroid cancer treated to the head and neck. Methods From our institution's proton database from 2012 to 2021, we identified 22 patients with thyroid cancer treated with proton beam therapy. We evaluated outcomes and toxicities. Results Median follow-up was 26 months. Of the 22 patients, 50% were female. The mean age was 65 years. Three patients had anaplastic cancer; 13, papillary carcinoma; 2, follicular carcinoma; and 2, poorly differentiated carcinoma. Forty-six percent had T4 disease. Primary targets were the central neck compartment, level VI, and upper mediastinum. Radiation dose was 60 GyRBE adjuvantly, and 70 GyRBE for gross disease (range, 6000-7600 GyRBE). Eight patients underwent upfront adjuvant radiation, and 3 received definitive radiation for unresectable disease upfront. Eleven patients received either salvage or palliative radiation. Fifty-nine percent of patients had extrathyroidal extension, and 64% of patients had gross disease in the neck before treatment. Fifty percent of patients had metastatic disease before treatment. Sixteen patients received concurrent chemotherapy, 63% of these patients received doxorubicin. For all patients, 1-year local regional recurrence (LRR) was 0%, and overall survival (OS) was 90%. Acute grade 3+ toxicities occurred in 27% of patients, the most frequent being dermatitis (27%). Three patients required a percutaneous endoscopic gastrostomy tube after radiation therapy (RT), 2 owing to progression. There were no grade 4+ toxicities. Conclusions Proton therapy for thyroid cancer appears feasible and effective with minimal toxicities. Prospective studies comparing proton therapy with intensity-modulated RT, to evaluate the clinical efficacy of using proton therapy to reduce toxicities in patients undergoing radiation for thyroid cancer, are warranted.
Collapse
|
10
|
Impact of endoscopic sinus surgery on Eustachian tube dysfunction in patients with chronic rhinosinusitis: systematic review and meta-analysis. RHINOLOGY ONLINE 2022. [DOI: 10.4193/rhinol/22.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Eustachian tube dysfunction (ETD) has been associated with inflammatory conditions (1). Many studies have identified a high prevalence of ETD in patients with chronic rhinosinusitis (CRS) (2). However, there is a paucity of higher-level evidence assessing the impact of endoscopic sinus surgery (ESS) on patients with ETD concurrent disease. Methods: Systematic review and meta-analysis of non-randomised studies on the impact of ESS on ETD in patients with CRS, based on the eustachian tube dysfunction questionnaire (ETDQ-7) scores. PRISMA guidelines were followed according to a priori study protocol (PROSPERO Registration number: CRD42021245677). A random-effects model was employed. Results: 21 results were obtained using our search strategy. Four studies met our inclusion criteria. 501 patients were identified in the included studies. The prevalence of ETD in CRS patients in our review was 55.1%. Pooled estimates showed a statistically significant reduction in ETDQ-7 scores. Conclusions: The evidence to date suggests there is a high prevalence of concurrent ETD in CRS patients, the symptoms of which improved following ESS for CRS in this patient group. However, the current evidence base is comprised of uncontrolled case series. High-quality, randomised controlled studies with long-term follow-up are lacking.
Collapse
|
11
|
Efficient Neutron Irradiation Procedure for Uniform Dopant Distributions in Silicon Doping. JOURNAL OF NUCLEAR ENGINEERING AND RADIATION SCIENCE 2022. [DOI: 10.1115/1.4054005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Neutron Transmutation Doping (NTD) is one of the several techniques used for n-type doping with good homogeneity. NTD performances were investigated in this work within a project funded by the Academy of Scientific Research and Technology (ASRT), Egypt, for the "production of doped Silicon Wafers for Solar Panels and Basic Electronics," 2015-2018. The Egypt second research reactor (ETRR-2) has two irradiation positions for silicon doping using NTD. The two positions can accommodate silicon ingots with large diameters up to six inches. One crucial parameter that affects the quality of the product is the distribution of the dopant in the irradiated ingot. The irradiation facility provides the option of rotating the sample during irradiation for flattening the radial distribution of the dopant.
Since the neutron flux is not flat along the irradiation position due to leakage and the effect of control rods, the generated dopant will be not flat along the axial direction. To overcome this problem, this paper proposed an irradiation procedure to smooth the dopant distribution along the axial direction. Such procedure can be applied for NTD facilities that has not an acceptable axial neutron flux distribution in silicon doping process. The procedure is based on loading the irradiation position by two ingots staked end to end and, at the middle of the irradiation duration, the two ingots swap their places. This strategy was verified by MCNP calculations and experimentally.
Collapse
|
12
|
259 Effect of Telegram Videos on Anatomy Education Among 2nd Year Medical Students, University of Khartoum, 2021. Br J Surg 2022. [PMCID: PMC9383538 DOI: 10.1093/bjs/znac039.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aim
COVID-19 had major effect on the health and medical education. In order to oblige with the social distancing and quarantine, universities shifted to online learning. This study aimed to assess the effect of online education on anatomy DR (dissection room) teaching by the use of telegram software.
Method
This was a cross-sectional, prospective interventional study, which was carried out among 2nd year medical students in University of Khartoum. Students undertook initial tests on the heart and anterior abdominal wall modules. Telegram videos, prepared by the author, on the anatomy of the heart and the anterior abdominal wall were distributed to students. Students took a second test after watching the videos. A total number of 41 students attended heart sessions and 40 students attended the anterior abdominal wall sessions were included.
Results
The pre-test mean score for the heart and abdomen modules were 4.56 ± 2.335 and 6.15 ± 2.94, respectively. The post-tests means were 9.98 ± 2.877 and 8.95 ± 3.14, respectively. 90% and 75% of the students were satisfied with these videos, respectively.
Conclusions
This study revealed that Telegram videos as a method of online teaching had a positive effect on the students' performance, which was evidenced by the significant improvement in student's scores after watching the videos. Additionally, most of the students were satisfied with the videos and give positive feedback.
Collapse
|
13
|
Severe Hypophosphatemia Following Ferric Carboxymaltose in a Patient With Inflammatory Bowel Disease. Cureus 2021; 13:e20452. [PMID: 35047286 PMCID: PMC8760031 DOI: 10.7759/cureus.20452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/05/2022] Open
Abstract
Inflammatory bowel disease is a chronic inflammatory condition that affects the large and small bowel, which includes Crohn’s disease (CD) and ulcerative colitis (UC). Iron deficiency anemia (IDA) is one of the most common complications in people with inflammatory bowel disease. The treatment of choice is intravenous iron infusion. There is a lack of awareness of side effects of intravenous iron (Ferinject) such as hypophosphatemia, which can prolong hospital admission. We present the case of a patient with iron deficiency anemia and vitamin D deficiency who developed severe hypophosphatemia after intravenous injection of ferric carboxymaltose (Ferinject). In this case presentation, our aim is to increase the awareness of prescribers about the risk of developing low phosphate levels after Ferinject and the need to monitor serum phosphate levels.
Collapse
|
14
|
Proton beam radiation therapy treatment for head and neck cancer. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
|
15
|
Impact of End-Stage Renal Disease on Postoperative Outcomes of Total Knee Arthroplasty Patients with Minimum 2-Year Surveillance. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
16
|
Expression of Estrogen and Progesterone Receptors in a Tailgut Cyst with Carcinoid Tumor. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Tailgut cysts (TC) are congenital lesions that arise in the presacral space. They originate from the embryonic hindgut and usually present between the ages of 30-60, with female predominance. TCs are usually asymptomatic or can present with lower back, perianal or pelvic pain. Malignant transformation of a TC is a rare complication, with adenocarcinoma being the most common, followed by carcinoid tumor. About thirty cases of carcinoid tumors arising in a TC have been reported in the literature so far with a slight female predominance (1.5:1).
Methods/Case Report
We describe a 40-year-old Hispanic woman with a 9-year history of cyclic pelvic pain related to her menstrual cycles. She was diagnosed with adenomyosis and underwent hysterectomy that did not completely resolve her symptoms. Follow-up serial imaging showed a growing complex-cystic presacral mass, which was eventually excised. Grossly, there was a 3.6×3.1×2.5 cm multiloculated cystic mass filled with mucoid material. Microscopically, there were multiple cystic spaces lined by benign squamous and mucinous columnar epithelium and surrounded by smooth muscle cells. A 6-mm carcinoid tumor was found within a cyst wall and confirmed by positive synaptophysin and chromogranin staining with a Ki-67 proliferation index of <2%. Estrogen and progesterone receptor immunostains were positive in the epithelial cyst linings and the stromal cells but not in the carcinoid tumor cells.
Results (if a Case Study enter NA)
NA
Conclusion
We conclude that the diagnosis of TC should be considered in the differential of gynecologic patients with unresolved cyclic pelvic pain and that estrogen and progesterone could have an important role in the pathogenesis of TCs. Furthermore, estrogen receptors can be a therapeutic target in patients with this entity.
Collapse
|
17
|
893 Consenting for Appendicectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Appendicitis denotes to the inflammation of the appendix with over 50,000 cases in the UK per year. The treatment of choice is appendicectomy and this is one of the most common operations in the UK.
There are nil NICE or King’s College Hospital (KCH) guidance available on consenting for appendicectomy. Thus, guidance from Guy’s and St Thomas’ and Whittingham Health was used as reference and the consent forms at KCH were analysed for all appendicectomies over 2 months. A retrospective observational audit (Cycle 1) was conducted between Dec 2018 – Jan 2019 consisting of 34 patients. It assessed whether common complications were documented clearly and any possible complications.
This audit identified that consenting for diagnostic laparoscopy/appendicectomy did not cover many serious complications and was overall inadequate. One of the most common and serious complications was ileus/SBO (occurred in 9%) and was not consented for in 88% of patients. 12% of patients had a normal appendix and this was not consented in 100% of these patients.
Later, posters and teaching sessions were created to optimise the consent process for appendicectomy.
This was re-audited (Cycle 2) again between June 2019 – July 2019 with 49 patients to identify whether a positive change was identified. It identified that an 12% increase in consenting for ileus/SBO, 10% increase in conversion to open and 47% of individuals started consenting for hernia repair.
This work is vital as inadequate consenting can destroy doctor-patient relationship and result in litigation and we encourage clear consenting guideline for appendicectomies across trusts.
Collapse
|
18
|
890 Bilateral Acetabular Fractures Induced by An Epilepticseizure In a Paediatric Patient: A Unique Case Andits Management. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic–clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected, and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra- pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.
Collapse
|
19
|
The effect of short radiation treatment breaks on chemo-radiotherapy for oropharyngeal cancers. Head Neck 2021; 43:3796-3809. [PMID: 34585792 DOI: 10.1002/hed.26879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/26/2021] [Accepted: 09/08/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Numerous studies and guidelines suggest an outcome detriment from radiation treatment breaks (rTBs) and the need for compensatory dosing in patients with head and neck cancer. METHODS In a consecutive cohort of 521 patients with oropharyngeal squamous cell carcinoma (OPSCC), we investigated the impact of rTBs and prolongation of overall treatment time (OTT) on OS, DFS, LRC, and cancer recurrence using competing risk and multivariate analyses. RESULTS Neither OTT prolongation by ≤2 days nor rTBs of ≤3 days were associated with detriments to clinical outcomes. Consecutive breaks of ≥3 days were also not significantly associated with detriment to clinical outcomes. There was significantly increased competing mortality in those with longer breaks. CONCLUSIONS In OPSCC patients treated with definitive concurrent chemoradiotherapy, there is no significant association between disease failure and total rTBs of ≤3 consecutive or scattered days. Further investigation is needed for longer breaks.
Collapse
|
20
|
Role of α- and β-adrenergic signaling in phenotypic targeting: significance in benign and malignant urologic disease. Cell Commun Signal 2021; 19:78. [PMID: 34284799 PMCID: PMC8290582 DOI: 10.1186/s12964-021-00755-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/28/2021] [Indexed: 01/17/2023] Open
Abstract
The urinary tract is highly innervated by autonomic nerves which are essential in urinary tract development, the production of growth factors, and the control of homeostasis. These neural signals may become dysregulated in several genitourinary (GU) disease states, both benign and malignant. Accordingly, the autonomic nervous system is a therapeutic target for several genitourinary pathologies including cancer, voiding dysfunction, and obstructing nephrolithiasis. Adrenergic receptors (adrenoceptors) are G-Protein coupled-receptors that are distributed throughout the body. The major function of α1-adrenoceptors is signaling smooth muscle contractions through GPCR and intracellular calcium influx. Pharmacologic intervention of α-and β-adrenoceptors is routinely and successfully implemented in the treatment of benign urologic illnesses, through the use of α-adrenoceptor antagonists. Furthermore, cell-based evidence recently established the antitumor effect of α1-adrenoceptor antagonists in prostate, bladder and renal tumors by reducing neovascularity and impairing growth within the tumor microenvironment via regulation of the phenotypic epithelial-mesenchymal transition (EMT). There has been a significant focus on repurposing the routinely used, Food and Drug Administration-approved α1-adrenoceptor antagonists to inhibit GU tumor growth and angiogenesis in patients with advanced prostate, bladder, and renal cancer. In this review we discuss the current evidence on (a) the signaling events of the autonomic nervous system mediated by its cognate α- and β-adrenoceptors in regulating the phenotypic landscape (EMT) of genitourinary organs; and (b) the therapeutic significance of targeting this signaling pathway in benign and malignant urologic disease. Video abstract.
Collapse
|
21
|
Antibiotics to modify sickle cell disease vaso-occlusive crisis? Blood Rev 2021; 50:100867. [PMID: 34304939 DOI: 10.1016/j.blre.2021.100867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023]
Abstract
Despite the availability of hydroxyurea, the clinical use of the medication among patients with sickle cell disease (SCD) remains low in the United States. Given the high healthcare utilization cost, SCD requires new therapeutic approaches. Recent studies demonstrated bacterial overgrowth and dysbiosis-related intestinal pathophysiological changes in SCD. Intestinal microbes regulate neutrophil ageing. Aged and activated neutrophils contribute to the pathogenesis of vaso-occlusive crisis (VOC) in SCD. In this paper, we will review the pre-clinical and clinical data on how antibiotics might reduce the intestinal microbial density and influence the course of VOC. Based on these observations, we will discuss rationales for and potential challenges to antibiotic-based therapeutic approaches that may modify the clinical course of VOC in SCD.
Collapse
|
22
|
Outcomes and prognostic factors of major salivary gland tumors treated with proton beam radiation therapy. Head Neck 2021; 43:1056-1062. [PMID: 33606323 DOI: 10.1002/hed.26563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Proton beam radiation therapy (PBRT) has dosimetric advantages compared to photon radiation therapy for the treatment of major salivary gland tumors (MSGTs). METHODS Patients with non-metastatic MSGTs treated at a single proton therapy center from October 2013 to October 2018 were retrospectively reviewed. RESULTS Sixty-eight patients with MSGTs were included and the most common site and histology were the parotid gland (75.0%) and adenoid cystic carcinoma (22.1%), respectively. The 3-year rates of locoregional control, progression-free survival, and overall survival were 95.1% (95% CI: 89.9%-100.0%), 80.7% (70.2%-92.7%), and 96.1% (95% CI: 90.9%-100.0%), respectively. CONCLUSION In a large cohort of MSGTs treated with PBRT, the rates of locoregional control were high in short-term follow-up and treatment was well tolerated.
Collapse
|
23
|
Health 4.0: On the Way to Realizing the Healthcare of the Future. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2020; 8:211189-211210. [PMID: 34976565 PMCID: PMC8675545 DOI: 10.1109/access.2020.3038858] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/30/2020] [Indexed: 06/14/2023]
Abstract
Health 4.0 establishes a new promising vision for the healthcare industry. It creatively integrates and employ innovative technologies such as the Internet of Health Things (IoHT), medical Cyber-Physical Systems (medical CPS), health cloud, health fog, big data analytics, machine learning, blockchain, and smart algorithms. The goal is to deliver improved, value-added and cost-effective healthcare services to patients and enhance the effectiveness and efficiency or the healthcare industry. Health 4.0 (adapted from the Industry 4.0 principles) changes the healthcare business model to enhance the interactions across the healthcare clients (the patients), stakeholders, infrastructure, and value chain. This effectively will improve the quality, flexibility, productivity, cost-effectiveness, and reliability of healthcare services in addition to increasing patients' satisfaction. However, building and utilizing healthcare applications that follow the Health 4.0 concept is a non-trivial and complex endeavor. In addition, advanced potential applications based on Health 4.0 capabilities are not yet being investigated. In this paper we define the main objectives of Health 4.0 and discuss advanced potential Health 4.0 applications. To have a clear understanding of these applications, we categorize them in 4 groups based on the primary beneficiary of these applications. Thus we have patient targeted applications, applications supporting healthcare professionals, resource management applications and high-level healthcare systems management applications. In addition, as we studied the different applications, we realized that these is a certain collection of services that these most of them need regardless of their goals or business context. Services supporting data collection and transfer, security and privacy, reliable operations are some examples. As a result we propose creating a service-oriented middleware framework to offers the common services to the applications developers and facilitate the integration of different services to build applications under the Health 4.0 umbrella.
Collapse
|
24
|
A phase 3 study (COSMIC-313) of cabozantinib in combination with nivolumab and ipilimumab in patients with previously untreated advanced renal cell carcinoma of intermediate or poor risk. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
25
|
Split High-Dose Cisplatin: An Alternate High-Dose Cisplatin Administration Schedule for Definitive Chemoradiation in Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
26
|
|
27
|
Clinical Outcomes and Toxicities in Oropharyngeal Cancer (OPC) Patients Treated with Proton Therapy: A Single Institutional Experience. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
28
|
Concurrent Diffuse Large B-Cell Lymphoma and Epstein-Barr Virus-Associated Smooth Muscle Tumour in the Small Bowel of an HIV-Positive Adult-a Case Report and Review of the Literature. J Gastrointest Cancer 2020; 50:572-577. [PMID: 29297137 DOI: 10.1007/s12029-017-0046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
29
|
Increased Prevalence of Cestode Infection Associated with History of Deworming among Primary School Children in Ethiopia. Am J Trop Med Hyg 2019; 101:641-649. [PMID: 31333166 DOI: 10.4269/ajtmh.19-0284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Mass deworming of school-aged children with anthelmintics has been recognized as an effective approach for reducing the burden of soil-transmitted helminth (STH) infections. However, the consequences of this intervention on nontargeted parasite populations sharing the same gastrointestinal niche are unclear. We conducted a cross-sectional survey among three primary schools in Sululta town, Ethiopia, to examine the association between students' histories of deworming treatment in the past 6 months and the prevalence of cestode and protozoan infections. An interviewer-led questionnaire administered to parents provided information on sociodemographic factors, and deworming status was ascertained from school records. Stool samples were collected from 525 children for microscopic examination. The independent associations of "any cestode" (positive either for Hymenolepis nana or Taenia spp. eggs) and "any protozoan" (positive either for Giardia lamblia or Entamoeba histolytica/Entamoeba dispar) with history of deworming were examined using logistic regression. Overall, 25.9% of children were infected with at least one intestinal parasite of which H. nana was the most common. In multivariate analyses, deworming in the past 6 months was positively associated with increased odds of both "any protozoan" and "any cestode" infections; the latter reached statistical significance (AOR = 1.83, 95% CI: 0.69-4.86, P = 0.220, AOR = 3.82, 95% CI: 1.17-12.73, P = 0.029, respectively). If this observed association is causal, a greater understanding of interspecies interactions within the gastrointestinal niche may elucidate possible consequences of mass deworming treatments against STHs on coexisting nontargeted parasites.
Collapse
|
30
|
Efficacy of multimodality treatment in survival patterns among patients with endometrial carcinoma stage III. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy436.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
Surgery versus combined radiotherapy and chemotherapy: Survival patterns among patients with laryngeal squamous cell carcinoma stage III and IV. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy438.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
32
|
The development of a staphylococcus aureus four antigen vaccine for use prior to elective orthopedic surgery. Hum Vaccin Immunother 2018; 15:358-370. [PMID: 30215582 DOI: 10.1080/21645515.2018.1523093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Staphylococcus aureus (S. aureus) is a challenging bacterial pathogen which can cause a range of diseases, from mild skin infections, to more serious and invasive disease including deep or organ space surgical site infections, life-threatening bacteremia, and sepsis. S. aureus rapidly develops resistance to antibiotic treatments. Despite current infection control measures, the burden of disease remains high. The most advanced vaccine in clinical development is a 4 antigen S. aureus vaccine (SA4Ag) candidate that is being evaluated in a phase 2b/3 efficacy study in patients undergoing elective spinal fusion surgery (STaphylococcus aureus suRgical Inpatient Vaccine Efficacy [STRIVE]). SA4Ag has been shown in early phase clinical trials to be generally safe and well tolerated, and to induce high levels of bactericidal antibodies in healthy adults. In this review we discuss the design of SA4Ag, as well as the proposed clinical development plan supporting licensure of SA4Ag for the prevention of invasive disease caused by S. aureus in elective orthopedic surgical populations. We also explore the rationale for the generalizability of the results of the STRIVE efficacy study (patients undergoing elective open posterior multilevel instrumented spinal fusion surgery) to a broad elective orthopedic surgery population due to the common pathophysiology of invasive S. aureus disease and commonalties of patient and procedural risk factors for developing postoperative S. aureus surgical site infections.
Collapse
|
33
|
Allergy-related disorders (ARDs) among Ethiopian primary school-aged children: Prevalence and associated risk factors. PLoS One 2018; 13:e0204521. [PMID: 30252916 PMCID: PMC6155548 DOI: 10.1371/journal.pone.0204521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/10/2018] [Indexed: 12/29/2022] Open
Abstract
Background There has been a noticeable increase in the prevalence of allergy-related disorders (ARDs) in the modern era. Urbanization is believed to be a major environmental risk factor for the onset of ARDs but data from low- to middle-income countries is limited. Objective Our purpose was to assess the prevalence of ARDs and atopy among a population of rural Ethiopian school children and identify environmental and lifestyle factors associated with such disorders. Methods We performed a cross-sectional study on 541 school-children. An interviewer-led questionnaire administered to the mothers of each participant provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were based on the International Study of Asthma and Allergies in Children (ISAAC) core allergy and environmental questionnaire. Skin prick test for common allergens German cockroach (Blattella germanica) and dust mite (Dermatophagoides) was performed to define atopy. Multiple logistic regression analyses were performed to determine the odds ratio between ARDs and atopy with specific environmental and lifestyle habits. Results 541 children responded to the survey questions: the majority of participants were female (60.3%) and aged 10–15 years-old. The prevalence of any ARD was 27%, while the rates of ever-having eczema, rhinitis, and wheeze was found to be 16.8%, 9.6%, and 8.6% respectively. Only 3.6% (19 school-children) tested positive for any skin sensitization. Analysis of associated factors for ARDs found that a family history of allergic disorders (AOR: 2.80; p-value<0.01), use of insecticides (AOR: 2.05; p-value<0.01), and wearing open-toed shoes (AOR: 2.19; p-value = 0.02) were all significantly associated factors. Insecticide use, river-bathing, and infection with intestinal parasites were found to be significantly associated factors for atopy. Other potential risk factors such as frequent use of soap, bacterial infection, and household crowding had no statistical significance. Conclusion Our study suggests that the prevalence of skin sensitization and ARDs in rural populations of developing countries is still relatively low. We identified several possible risk factors for further investigation. Overall, the significance of identified risk factors appears to indicate that genetic predisposition and exposure to environmental pollution are more important to the etiology of ARDs and atopy than specific lifestyle behaviors.
Collapse
|
34
|
UHR RFID ring resonator-based tag antenna with photonic bandgap structure for metallic objects. JOURNAL OF FUNDAMENTAL AND APPLIED SCIENCES 2018. [DOI: 10.4314/jfas.v9i3s.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
35
|
Vaccine development to prevent Staphylococcus aureus surgical-site infections. Br J Surg 2017; 104:e41-e54. [PMID: 28121039 DOI: 10.1002/bjs.10454] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/27/2016] [Accepted: 11/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Staphylococcus aureus surgical-site infections (SSIs) are a major cause of poor health outcomes, including mortality, across surgical specialties. Despite current advances as a result of preventive interventions, the disease burden of S. aureus SSI remains high, and increasing antibiotic resistance continues to be a concern. Prophylactic S. aureus vaccines may represent an opportunity to prevent SSI. METHODS A review of SSI pathophysiology was undertaken in the context of evaluating new approaches to developing a prophylactic vaccine to prevent S. aureus SSI. RESULTS A prophylactic vaccine ideally would provide protective immunity at the time of the surgical incision to prevent initiation and progression of infection. Although the pathogenicity of S. aureus is attributed to many virulence factors, previous attempts to develop S. aureus vaccines targeted only a single virulence mechanism. The field has now moved towards multiple-antigen vaccine strategies, and promising results have been observed in early-phase clinical studies that supported the recent initiation of an efficacy trial to prevent SSI. CONCLUSION There is an unmet medical need for novel S. aureus SSI prevention measures. Advances in understanding of S. aureus SSI pathophysiology could lead to the development of effective and safe prophylactic multiple-antigen vaccines to prevent S. aureus SSI.
Collapse
|
36
|
Retrospektiver Vergleich der CT-gesteuerten Knochenbiopsie mit einem Handbohrer und einem elektrischen Bohrer. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
37
|
A smart storage optimisation technique on the cloud. INTERNATIONAL JOURNAL OF GRID AND UTILITY COMPUTING 2017. [DOI: 10.1504/ijguc.2017.085912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
38
|
A smart storage optimisation technique on the cloud. INTERNATIONAL JOURNAL OF GRID AND UTILITY COMPUTING 2017. [DOI: 10.1504/ijguc.2017.10006826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
39
|
Impact of prior treatment on patients with relapsed multiple myeloma treated with carfilzomib and dexamethasone vs bortezomib and dexamethasone in the phase 3 ENDEAVOR study. Leukemia 2017; 31:115-122. [PMID: 27491641 PMCID: PMC5220137 DOI: 10.1038/leu.2016.186] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/22/2016] [Indexed: 01/15/2023]
Abstract
The randomized phase 3 ENDEAVOR study (N=929) compared carfilzomib and dexamethasone (Kd) with bortezomib and dexamethasone (Vd) in relapsed multiple myeloma (RMM). We performed a subgroup analysis from ENDEAVOR in patients categorized by number of prior lines of therapy or by prior treatment. Median progression-free survival (PFS) for patients with one prior line was 22.2 months for Kd vs 10.1 months for Vd, and median PFS for patients with ⩾2 prior lines was 14.9 months for Kd vs 8.4 months for Vd. For patients with prior bortezomib exposure, the median PFS was 15.6 months for Kd vs 8.1 months for Vd, and for patients with prior lenalidomide exposure the median PFS was 12.9 months for Kd vs 7.3 months for Vd. Overall response rates (Kd vs Vd) were 81.9 vs 65.5% (one prior line), 72.0 vs 59.7% (⩾2 prior lines), 71.2 vs 60.3% (prior bortezomib) and 70.1 vs 59.3% (prior lenalidomide). The safety profile in the prior lines subgroups was qualitatively similar to that in the broader ENDEAVOR population. In RMM, outcomes are improved when receiving treatment with carfilzomib compared with bortezomib, regardless of the number of prior therapy lines or prior exposure to bortezomib or lenalidomide.
Collapse
|
40
|
A comparison between fresh euploid embryo transfer at late day 5 versus day 6. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
41
|
Preparation of Pt/MWCNTs Catalyst by Taguchi Method for Electrooxidation of Nitrite. JOURNAL OF ANALYTICAL CHEMISTRY 2016. [DOI: 10.1134/s1061934816020040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
42
|
Cytotoxic immune responses in the lungs correlate to disease severity in patients with hantavirus infection. Eur J Clin Microbiol Infect Dis 2016; 35:713-21. [PMID: 26873376 PMCID: PMC4819462 DOI: 10.1007/s10096-016-2592-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/19/2016] [Indexed: 12/14/2022]
Abstract
Hantavirus infections may cause severe and sometime life-threatening lung failure. The pathogenesis is not fully known and there is an urgent need for effective treatment. We aimed to investigate the association between pulmonary viral load and immune responses, and their relation to disease severity. Bronchoscopy with sampling of bronchoalveolar lavage (BAL) fluid was performed in 17 patients with acute Puumala hantavirus infection and 16 healthy volunteers acting as controls. Lymphocyte subsets, granzyme concentrations, and viral load were determined by flow cytometry, enzyme-linked immunosorbent assay (ELISA), and quantitative reverse transcription polymerase chain reaction (RT-PCR), respectively. Analyses of BAL fluid revealed significantly higher numbers of activated CD8+ T cells and natural killer (NK) cells, as well as higher concentrations of the cytotoxins granzymes A and B in hantavirus-infected patients, compared to controls. In patients, Puumala hantavirus RNA was detected in 88 % of BAL cell samples and correlated inversely to the T cell response. The magnitude of the pulmonary cytotoxic lymphocyte response correlated to the severity of disease and systemic organ dysfunction, in terms of need for supplemental oxygen treatment, hypotension, and laboratory data indicating renal failure, cardiac dysfunction, vascular leakage, and cell damage. Regulatory T cell numbers were significantly lower in patients compared to controls, and may reflect inadequate immune regulation during hantavirus infection. Hantavirus infection elicits a pronounced cytotoxic lymphocyte response in the lungs. The magnitude of the immune response was associated with disease severity. These results give insights into the pathogenesis and possibilities for new treatments.
Collapse
|
43
|
PVA-Coumarin Films: Materials for Optical Applications. JOURNAL OF COMPOSITES AND BIODEGRADABLE POLYMERS 2015; 3:41-45. [DOI: 10.12974/2311-8717.2015.03.02.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Pure Poly(vinylacohol) (PVA) and PVA-coum films with different concentrations were prepared by a casting technique. Optical absorption and mechanical properties were measured. The UV–Vis absorption spectra gave the same band positions but the absorption intensity increases with increasing coumarin concentration. The dependence of the absorption coefficient on the photon energy has been determined and the energy gaps and band tails were calculated. The topography of the surface was measured by atomic force microscope (AFM). It was found that Young’s modulus, the strength at the break and the band tail increase while the optical gaps for PVA-coum films decrease. RMS roughness of the surface for prepared films decreases as the coumarin concentration is increased. The obtained results illustrated that this material has promising applications in optical industries.
Collapse
|
44
|
Assessment of the Impact of Secondhand Smoking On Children’s Mental Health; an Egyptian Study. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31927-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
45
|
Nitrate detection activity of Cu particles deposited on pencil graphite by fast scan cyclic voltammetry. JOURNAL OF ANALYTICAL CHEMISTRY 2014. [DOI: 10.1134/s1061934815010037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
46
|
Electroreduction of nitrate ions at a platinum-copper electrode in an alkaline medium: Influence of sodium inositol phytate. Electrochim Acta 2014. [DOI: 10.1016/j.electacta.2014.05.128] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
47
|
A review of child abuse and the role of the dental team in South Africa. SADJ : JOURNAL OF THE SOUTH AFRICAN DENTAL ASSOCIATION = TYDSKRIF VAN DIE SUID-AFRIKAANSE TANDHEELKUNDIGE VERENIGING 2014; 69:250-256. [PMID: 26548199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
48
|
Image enhancement using MCNP5 code and MATLAB in neutron radiography. Appl Radiat Isot 2014; 89:30-6. [PMID: 24583508 DOI: 10.1016/j.apradiso.2014.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
This work presents a method that can be used to enhance the neutron radiography (NR) image for objects with high scattering materials like hydrogen, carbon and other light materials. This method used Monte Carlo code, MCNP5, to simulate the NR process and get the flux distribution for each pixel of the image and determines the scattered neutron distribution that caused image blur, and then uses MATLAB to subtract this scattered neutron distribution from the initial image to improve its quality. This work was performed before the commissioning of digital NR system in Jan. 2013. The MATLAB enhancement method is quite a good technique in the case of static based film neutron radiography, while in neutron imaging (NI) technique, image enhancement and quantitative measurement were efficient by using ImageJ software. The enhanced image quality and quantitative measurements were presented in this work.
Collapse
|
49
|
Dissimilar catalytic trails of nitrate reduction on Cu-modified Pt surface immobilized on H+ conducting solid polymer. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.molcata.2013.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
50
|
Simulation and modeling efforts to support decision making in healthcare supply chain management. ScientificWorldJournal 2014; 2014:354246. [PMID: 24683333 PMCID: PMC3934656 DOI: 10.1155/2014/354246] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 11/16/2013] [Indexed: 11/18/2022] Open
Abstract
Recently, most healthcare organizations focus their attention on reducing the cost of their supply chain management (SCM) by improving the decision making pertaining processes' efficiencies. The availability of products through healthcare SCM is often a matter of life or death to the patient; therefore, trial and error approaches are not an option in this environment. Simulation and modeling (SM) has been presented as an alternative approach for supply chain managers in healthcare organizations to test solutions and to support decision making processes associated with various SCM problems. This paper presents and analyzes past SM efforts to support decision making in healthcare SCM and identifies the key challenges associated with healthcare SCM modeling. We also present and discuss emerging technologies to meet these challenges.
Collapse
|