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This study aimed to assess how the postoperative medial arch height influenced postoperative patient-reported clinical outcomes after surgery for stage Ⅱ acquired adult flatfoot deformity.A total of 30 feet of 30 patients (7 males, 23 females) who underwent surgery for stage Ⅱ acquired adult flatfoot deformity and could be followed up for at least 2 years were included. The average age at surgery was 60.0 (standard deviation, 13.0) years, and the average follow-up period was 40 (standard deviation, 15.4) months. Among them, 16 patients underwent lateral column lengthening and 14 patients did not. Patient-reported clinical outcomes were evaluated using the Self-Administered Foot Evaluation Questionnaire. Radiographic alignment was evaluated by the talonavicular coverage angle, lateral talo-1st metatarsal angle, medial cuneiform height, medial cuneiform to 5th metatarsal height, and calcaneal pitch. The correlation between postoperative Self-Administered Foot Evaluation Questionnaire and radiographic alignment was assessed with Pearson's correlation analysis.Self-Administered Foot Evaluation Questionnaire and radiographic alignment significantly improved postoperatively in all patients (P 0.0001). In patients with severe deformity who needed lateral column lengthening, lateral talo-1st metatarsal angle was negatively and medial cuneiform to 5th metatarsal height was positively correlated with physical functioning Self-Administered Foot Evaluation Questionnaire subscales (r = -0.56 and 0.55), and medial cuneiform height was positively correlated with physical functioning, social functioning and general health Self-Administered Foot Evaluation Questionnaire subscales (r = 0.70, 0.55 and 0.73, respectively).Postoperative medial arch height could influence physical functioning, social functioning, and general health in patients with severe stage II adult-acquired flatfoot deformity.

Borderline ovarian tumor is a tumor with pathomorphological characteristics, biological behavior and prognosis between benign and malignant tumors. Preoperative diagnosis of ovarian cancer is usually based on imaging and tumor markers. Because of the early diagnosis and good prognosis of borderline ovarian tumors, fertility preserving surgery can be selected for patients with borderline ovarian tumors who have not completed fertility. Compared with radical surgery, fertility preserving surgery has a higher recurrence rate, but most of them are not malignant, which will not affect the overall survival rate, and the postoperative fertility rate is also very good. Patients with borderline ovarian tumors, especially those with BOT stage II or above, should get pregnant as soon as possible and be followed up closely for a long time.

Burkitt lymphoma (BL) is a rare, mature, fast-growing and highly aggressive B-cell neoplasm. It has a high-proliferation rate with distinctive genetic changes in the C-MYC oncogene. Treatment usually requires intense and frequent chemotherapy regimens with central nervous system prophylaxis as the usual regimens used for other non-Hodgkin’s lymphoma yield poor survival in BL. This report discusses a patient who was diagnosed with a stage II, high-grade BL who received one cycle of intense chemotherapy and refused further treatment. That patient remained in complete remission in his last follow-up; 7 years from diagnosis without requiring other therapies for his lymphoma.

PURPOSE To investigate the efficacy of gefitinib as an adjuvant therapy for non–small-cell lung cancer patients with EGFR mutation. PATIENTS AND METHODS IMPACT (WJOG6410L; University Hospital Medical Information Network Clinical Trials Registry: UMIN000006252 ), a randomized, open-label, phase III study, included patients with completely resected pathologic stage II-III non–small-cell lung cancer harboring EGFR mutations (exon 19 deletion or L858R) during September 2011 to December 2015. Patients were randomly assigned to receive gefitinib (250 mg once daily) for 24 months or cisplatin (80 mg/m2 on day 1) plus vinorelbine (25 mg/m2 on days 1 and 8; cis/vin) once every 3 weeks for four cycles. The primary end point was disease-free survival (DFS). RESULTS Overall, 234 patients were randomly assigned. Among 232 eligible patients (116 each; excluding two who withdrew consent), the median DFS was 35.9 and 25.1 months in the gefitinib and cis/vin groups, respectively. However, Kaplan-Meier curves crossed around 4 years after surgery with no statistically significant difference (stratified log-rank P = .63; hazard ratio by stratified Cox proportional hazards model = 0.92; 95% CI, 0.67 to 1.28). Overall survival (OS) was also not different (stratified log-rank P = .89; hazard ratio = 1.03; 95% CI, 0.65 to 1.65), with the 5-year OS rates being 78.0% and 74.6% in the gefitinib and cis/vin groups, respectively. Treatment-related deaths occurred in 0 and three patients in the gefitinib and cis/vin groups, respectively. CONCLUSION Although adjuvant gefitinib appeared to prevent early relapse, it did not prolong DFS or OS. However, similar DFS and OS may justify adjuvant gefitinib in the selected patient subsets, especially those deemed ineligible for platinum-doublet adjuvant therapy; however, this was not a noninferiority trial.

It is crucial to have an adequate-size unobstructed branch pulmonary artery architecture to achieve an ideal cavopulmonary circulation. Branch pulmonary artery distortion, stenosis, or hypoplasia is a common problem following the stage I Norwood procedure for infants with hypoplastic left heart syndrome regardless of the shunt type. This technical review describes the surgical principle and techniques of the extensive hilum to hilum branch pulmonary artery reconstruction at the time of stage II palliation, bidirectional cavopulmonary shunt in infants with hypoplastic left heart syndrome.

Background Few studies have compared the survival outcomes of stages II and IIIA rectal cancer patients who did not receive neoadjuvant treatment. This study aimed to compare oncologic outcomes between 2 groups. Patients and Methods This study analyzed stage II or IIIA rectal cancer patients who underwent radical operation without neoadjuvant treatment between 1996 and 2013. The 3:1 propensity score analysis was used to adjust for several variables. After propensity score matching, 364 stage II rectal cancer, and 172 stage IIIA rectal cancer patients were analyzed. Results There were no significant differences in 5-year overall survival or disease-free survival rates between the 2 groups. When stage II rectal cancer was subdivided into stages IIA, IIB, and IIC, the 5-year DFS and OS rates of stage IIIA rectal cancer patients were similar to those of stage IIA cancer patients. Moreover, stage IIIA rectal cancer patients showed a statistically significantly better survival rates than stage IIC rectal cancer patients. Conclusion Stage IIIA group showed similar survival outcomes compared to stage IIA and IIB group and significantly better outcomes than stage IIC group. Thus, it should be considered to classify stage IIIA as a subgroup of stage II rather than as a subgroup of stage III rectal cancer. It should be also be considered to change to determine whether to do adjuvant treatment according to stage II rectal cancer.

Objective There is evidence that colorectal cancer screening using faecal haemoglobin is less effective in women than men. The faecal haemoglobin concentrations were therefore examined in women and men with screen-detected colorectal cancer. Setting Scottish Bowel Screening Programme, following the introduction of a faecal immunochemical test from November 2017, to March 2020. Methods Data were collated on faecal haemoglobin concentrations, pathological stage and anatomical site of the main lesion in participants who had colorectal cancer detected. The data in women and men were compared. Results For the faecal haemoglobin concentrations studied (>80 µg Hb/g faeces), the distributions indicated lower concentrations in women. Marked differences were found between women and men diagnosed with colorectal cancer. The median faecal haemoglobin concentration for women ( n = 720) was 408 µg Hb/g faeces compared to 473 µg Hb/g faeces for men ( n = 959) ( p = 0.004) and 50.6% of the results were >400 µg Hb/g faeces in women; in men, this was 57.8%. The difference in faecal haemoglobin concentrations in women and men became less statistically significant as stage advanced from stages I–IV. For right-sided, left-sided and rectal colorectal cancer, a similar gender difference persisted in all sites. Differences in faecal haemoglobin between the genders were significant for left-sided cancers and stage I and approached significance for rectal cancers and stage II, but all sites and stages showed lower median faecal haemoglobin concentrations for women. Conclusions To minimise gender inequalities, faecal immunochemical test-based colorectal cancer screening programmes should evaluate a strategy of using different faecal haemoglobin concentration thresholds in women and men.

OBJECTIVES The prognostic role of the epidermal growth factor receptor (EGFR) mutation remains controversial, especially in early-stage lung adenocarcinoma with a solid appearance. We evaluated the oncological outcomes of clinical stage I (c-stage I) radiologically invasive lung adenocarcinoma by EGFR mutation status. METHODS Between 2008 and 2013, the data from 463 surgically resected c-stage I radiologically invasive, i.e. solid-dominant lung adenocarcinomas subjected to EGFR mutant analysis, were evaluated. Oncological outcomes were assessed using multivariable Cox regression analysis. Recurrence-free survival (RFS) was estimated using Kaplan–Meier analysis and the log-rank test. RESULTS A total of 229 (49%) samples harboured the EGFR-mutant adenocarcinoma. Overall, the 5-year RFS did not differ significantly between the EGFR-mutant and EGFR wild-type groups (67.3% vs 64.9%; P = 0.639). However, among the clinical T1c/T2a tumour subset (n = 177), a multivariable Cox hazard model revealed that radiologically pure-solid tumour (P = 0.024), EGFR-mutant (P = 0.027) and pathological stage II/III (P CONCLUSIONS Among the c-stage I radiologically invasive lung adenocarcinomas, the EGFR mutation-positive type was correlated with an increased risk of recurrence in the c-T1c/T2a radiologically pure-solid tumour subset. When considering the prognostic value of EGFR mutations in early-stage lung adenocarcinoma, it is necessary to stratify them based on the presence of a ground-glass opacity component.

Basic parameters of walking were studied in 105 patients with the initial stages of coxarthrosis. The walking function was examined using the GAITRite® electronic system. It was revealed that the initial walking disorders in the form of a slight asymmetry of walking parameters are present already in patients with stage I coxarthrosis. The cause for the changes in the quality of walking in patients with stage I of the disease is exclusively adaptive changes, when the patient makes the movements more cautious to avoid provocation of pain. In patients with stage II of the disease, the symmetry of walking parameters is lower than in patients with stage I, besides, the duration of support increases with time, which indicates a physiological correction of walking. Deterioration in the quality of walking is caused not only by behavioral changes, but also by motor disorders due to changes in the affected joint function.

Background: Lateral column lengthening (LCL), originally described by Evans, is an established procedure to correct stage II adult acquired flatfoot deformity (AAFD). However, the relative position between the facets is violated, and other problems may include nonunion, malunion, and calcaneocuboid (CC) joint subluxation. Herein, we report a modified extra-articular technique of LCL with hockey-stick osteotomy, which preserves the subtalar joint as a whole, increases bony apposition to enhance healing ability, and preserves the insertion of the calcaneofibular ligament to stabilize the posterior fragment to promote adduction of the forefoot. Methods: We retrospectively recruited 24 patients (26 feet) with stage II AAFD who underwent extra-articular LCL. The mean age was 55.7 ± 15.7 years, and the mean follow-up period was 33.4 ± 12.1 months. Associated procedures of spring ligament repair/reconstruction and posterior tibial tendon plication or flexor digitorum longus transfer were routinely performed and may also include a Cotton osteotomy, heel cord lengthening, or hallux valgus correction. Clinical and radiographic outcomes at the final follow-up were compared with the preoperative assessments. Results: All patients achieved calcaneus union within 3 months of operation. The VAS pain score improved from 5.3 ± 0.75 preoperatively to 1.2 ± 0.79 at the final follow-up ( P < .001), and the AOFAS Ankle-Hindfoot Scale from 63.5 ± 8.5 to 85.8 ± 4.8 points ( P < .001). The radiographic measurements significantly improved in terms of the preoperative vs final angles of 8.9 ± 5.3 vs 15.2 ± 3.6 degrees for calcaneal pitch ( P < .001), 20.5 ± 9.2 vs 4.9 ± 4.8 degrees for Meary angle ( P < .001), 46.5 ± 5.2 vs 41.9 ± 3.2 degrees for lateral talocalcaneal angle ( P < .001), 23.9 ± 8.5 vs 3.9 ± 3.1 degrees for talonavicular coverage angle ( P < .001), and 18.2 ± 9.2 vs 7.3 ± 5.0 degrees for talus-first metatarsal angle ( P = .002). The CC joint subluxation percentage was 7.0% ± 5.4% preoperatively compared with 8.5% ± 2.4% at the final follow-up ( P = .101). No case showed progression of CC joint arthritis or CC joint subluxation (>15% CC joint subluxation percentage). One case showed transient sural nerve territory paresthesia, and 1 had pin tract infection. Three cases had lateral foot pain, which could be relieved by custom insoles. Conclusion: Modified extra-articular LCL as part of AAFD correction is a feasible alternative technique without subtalar joint invasion and may be associated with less CC joint subluxation compared with the Evans osteotomy. Level of Evidence: Level IV, retrospective case series.

Background Retrospective studies suggest that watch-and-wait is a safe alternative to total mesorectal excision in selected patients with a clinical complete response after chemoradiotherapy. Objective This study aimed to determine the proportion of patients with rectal cancer who may benefit from watch-and-wait. Design This study is a retrospective analysis of data from prospectively maintained databases. Setting This study was conducted at a comprehensive cancer center. Patients Consecutive patients with stage II or III rectal adenocarcinoma who were treated with total neoadjuvant therapy using induction chemotherapy between 2012 and 2019 under the care of the same surgeon were included. Intervention Induction-type total neoadjuvant therapy consisted of 8 cycles of leucovorin-fluorouracil-oxaliplatin or 5 cycles of capecitabine-oxaliplatin before chemoradiotherapy. Patients with a clinical complete response were offered watch-and-wait, and patients with residual tumor were offered total mesorectal excision. Main outcomes and measures Tumor response was assessed with a digital rectal examination, endoscopy, and MRI. Patient characteristics and recurrence-free survival were compared between the watch-and-wait group and the total mesorectal excision group. Results A total of 88 patients were included in the analysis. One (1%) died during neoadjuvant therapy. Fifty-five patients (62.5%) had an incomplete clinical response and underwent surgery, 10 (18%) of the 55 developed distant metastasis, and 3 (5%) developed local recurrence. The remaining 32 patients (36.3%) had a clinical complete response and underwent watch-and-wait. On average, patients in the watch-and-wait group were older and had smaller, more distal tumors compared with patients in the surgery group. The median radiation dose, number of chemotherapy cycles, rate of adverse events, and length of follow-up did not differ substantively between the total mesorectal excision group and the watch-and-wait group. In the watch-and-wait group, 2 (6%) patients developed tumor regrowth, and one of them had distant metastasis. Recurrence-free survival was significantly higher in the watch-and-wait group. Limitations Generalizability, sample size, and follow-up duration were limitations of this study. Conclusions Approximately one-third of patients with stage II or III rectal cancer can benefit from a watch-and-wait approach with the aim of preserving the rectum if treated with induction-type total neoadjuvant therapy and followed by an experienced multidisciplinary team. See Video Abstract at http://links.lww.com/DCR/B688. Conservacin de rganos en pacientes con cncer de recto tratados con terapia neoadyuvante total ANTECEDENTES:Estudios retrospectivos sugieren que observar y esperar es una alternativa segura a la escision mesorrectal total en pacientes seleccionados con una respuesta clinica completa despues de la quimiorradioterapia.OBJETIVO:Determinar la proporcion de pacientes con cancer de recto que pueden beneficiarse de observar y esperar.DISENO:Analisis retrospectivo de datos de bases de datos mantenidas de forma prospectiva.ESCENARIO:Centro Oncologico Integral.PACIENTES:Pacientes consecutivos con adenocarcinoma de recto en estadio II o III tratados con TNT utilizando quimioterapia de induccion entre 2012 y 2019 bajo el cuidado del mismo cirujano.INTERVENCION:La terapia neoadyuvante total de tipo induccion consistio en ocho ciclos de leucovorin-fluorouracilo-oxaliplatino o cinco ciclos de capecitabina-oxaliplatino antes de la quimiorradioterapia. A los pacientes con una respuesta clinica completa se les ofrecio observar y esperar, y a los pacientes con tumor residual se les ofrecio la escision mesorrectal total.PRINCIPALES RESULTADOS Y MEDIDAS:La respuesta del tumor se evaluo con un tacto rectal, endoscopia y resonancia magnetica. Se compararon las caracteristicas de los pacientes y la supervivencia libre de recurrencia entre el grupo de observacion y espera y el grupo de escision mesorrectal total.RESULTADOS:Se incluyo en el analisis a un total de 88 pacientes. Uno (1%) murio durante la terapia neoadyuvante. Cincuenta y cinco pacientes (62.5%) tuvieron una respuesta clinica incompleta y se sometieron a cirugia; 10 (18%) de los 55 desarrollaron metastasis a distancia y 3 (5%) desarrollaron recidiva local. Los 32 pacientes restantes (36.3%) tuvieron una cCR (respuesta clinica completa) y se sometieron a observar y esperar. En promedio, los pacientes del grupo de observacion y espera eran mayores y tenian tumores mas pequenos y distales en comparacion con el grupo de cirugia. La dosis mediana de radiacion, el numero de ciclos de quimioterapia, la tasa de eventos adversos y la duracion del seguimiento no difirieron sustancialmente entre el grupo de escision mesorrectal total y el grupo de observacion y espera. En el grupo de observacion y espera, 2 (6%) pacientes desarrollaron recrecimiento del tumor y uno de ellos tuvo metastasis a distancia. La supervivencia libre de recurrencia fue significativamente mayor en el grupo de observacion y espera.LIMITACIONES:Generalizabilidad, tamano de la muestra, duracion del seguimiento.CONCLUSIONES:Aproximadamente un tercio de los pacientes con cancer de recto en estadio II o III pueden beneficiarse de un abordaje de observacion y espera con el objetivo de preservar el recto si se tratan con terapia neoadyuvante total de tipo induccion y son seguidos por un equipo multidisciplinario experimentado. Consulte Video Resumen en http://links.lww.com/DCR/B688.

Background: Adjuvant chemotherapy demonstrated a clear benefit in resected non-small cell lung cancer (NSCLC) with nodal disease (stages II-III), and a minimal benefit in tumors >4 cm (stage II, TNM 8th edition). Pleural invasion (PL), classified as visceral pleural invasion (VPI, which includes PL1 and PL2, and parietal pleural invasion (PL3), is an established negative prognostic factor. However, whether PL should influence the decisional algorithm of postoperative chemotherapy is controversial. Methods: A survival analysis of NSCLC patients who underwent radical surgery between 2010 and 2015 included in the SEER database was performed. Tumor stage and size, number of examined and positive nodes, histology, PL, and treatment data were extracted. Propensity score matching was performed. The benefit of chemotherapy was analyzed in two subgroups: standard of care (SOC), including patients with positive nodes or tumors ≥ 4 cm; non-SOC, including patients with tumors < 4 cm and negative nodes. Results: Records of 30,858 patients were extracted. 11,708 patients were included in the propensity score-matched analysis. In the SOC subgroup, including 8089 patients, all pleural invasion degrees were associated with progressively increased risk for death and shorter overall survival (OS), independently from chemotherapy administration. However, chemotherapy significantly improved the median OS regardless of the extent of PL. In the non-SOC subgroup, including 3619 patients, only PL3 was associated with increased mortality. The administration of chemotherapy did not improve survival outcomes. Conclusion: Chemotherapy should be strongly recommended in patients in the SOC-subgroup with pleural invasion. VPI is not associated with unfavorable prognosis in the non-SOC subgroup.

Introduction: We conducted this study to reflect a single-center experience with the use of neoadjuvant systemic chemotherapy for the management of women with operable breast cancer.Methods: We conducted a retrospective chart review on all women presenting with operable, stage II-III, breast cancer and were scheduled for neoadjuvant systemic chemotherapy at Suez Canal University Hospital. The primary outcome of this study was to estimate the proportion of patients with operable breast cancer who become eligible for breast conservative surgery (CBS) after neoadjuvant systemic chemotherapy.Results: A total of 147 patients were included. Before the initiation of chemotherapy, only 66 (44.9%) patients were indicated for breast conservative surgery (CBS). A total of 40 (50.6%) new patients, out of the 81 patients who were ineligible before chemotherapy, became eligible for breast conservative surgery after neoadjuvant chemotherapy (95% CI 39.3 – 61.9%). On the other hand, nine (13.6%) patients became ineligible for breast conservative surgery after neoadjuvant chemotherapy. Out of the 98 eligible patients for breast conservative surgery after chemotherapy, 72 (73.5%) patients underwent the surgery and the remaining 26 patients chose total modified radical mastectomy (MRM). A total of 55 (76.4%) patients achieved pathological complete response pCR. One woman (0.1%) experienced relapse at the 3rd year of follow-up and three women (2%) experienced relapse at the 5th year of follow-up. The difference between patients who underwent breast conservative surgery and total mastectomy was not statistically significant (p =0.22 and 0.07, respectively).Conclusion: Neoadjuvant chemotherapy can play a crucial role in increasing the rate of eligibility for breast conservative surgery among women with operable, stage II-III, breast cancer.

Purpose The purpose of this study was to clarify the clinical features and outcomes of patients with recurrence after esophagectomy following neoadjuvant chemotherapy (NAC) related to the timing of recurrence. Methods We reviewed 240 consecutive patients who underwent NAC followed by esophagectomy for clinical stage II/III esophageal squamous cell carcinoma between 2009 and 2014. We compared the clinical features and survival after recurrence among groups of patients stratified by the timing of recurrence diagnosis and identified the risk factors for early recurrence (ER). Results Recurrence was identified within 1 year in 61 patients and after 1 year in 23 patients. Significant differences were observed between the patients with recurrence within 1 year (early recurrence; ER) and those with recurrence after 1 year (late recurrence; LR). The ER patients had more advanced tumors and higher pretreatment serum squamous cell antigen (SCC-Ag) levels and less experienced downstaging than patients without recurrence (no recurrence; NR). Overall survival was significantly worse for the ER patients than for the LR patients. Multivariate analysis revealed that cN2-3, increased serum SCC-Ag levels, and clinical response to NAC were independent predictors of ER. Conclusion The ER patients had distinctive clinical features from the LR and NR patients. Extensive lymph node metastasis, an elevated SCC-Ag, and inadequate response to NAC were identified as predictors of ER.

BACKGROUND AND OBJECTIVES: Watch-and-wait is variably adopted by surgeons and the impact of this on outcomes is unknown. We compare the disease-free survival and organ preservation rates of locally advanced rectal cancer patients treated by expert colorectal surgeons at a comprehensive cancer center. METHODS: This study included retrospective data on patients diagnosed with stage II/III rectal adenocarcinoma from January 2013 to June 2017 who initiated neoadjuvant therapy (either with chemoradiation, chemotherapy, or a combination of both) and were treated by an expert colorectal surgeon. RESULTS: 444 locally advanced rectal cancer patients managed by 5 surgeons were included. Tumor distance from the anal verge, type of neoadjuvant therapy, and organ preservation rates varied by treating surgeon. There was no difference in disease-free survival after stratifying by the treating surgeon (p=0.2). On multivariable analysis, neither the type of neoadjuvant therapy nor the treating surgeon was associated with disease-free survival. CONCLUSIONS: While neoadjuvant therapy type and organ preservation rates varied among surgeons, there were no meaningful differences in disease-free survival. These data suggest that amongst expert colorectal surgeons, differing thresholds for selecting patients for watch-and-wait do not affect survival.

Objectives The aim of this retrospective cross-sectional study was to estimate the association of HIV-1 infection under highly active antiretroviral treatment (HAART) on the clinical parameters of periodontitis. Materials and methods A total of 205 patients were divided in two groups: 74 HIV + and 131 HIV − . Periodontal probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and visible supragingival biofilm (VSB) were recorded. The association of HIV-1 infection with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm in non-adjacent teeth was estimated using binary logistic regression models. Results The variables HIV-1 infection (OR = 5.53, p 50 years old (OR = 6.29, p = 0.002, 95% CI: 1.94–20.42)], and VSB (OR = 23.68, p

BACKGROUND: To investigate the clinical experience and discuss the use of vacuum sealing drainage (VSD) combined with free anterolateral femoral flap grafting to treat pediatric foot and ankle soft tissue traumas. METHODS: This was a retrospective analysis of 16 pediatric patients with foot and ankle soft tissue traumas treated with free anterolateral femoral flap grafting from January 2015 to January 2018. After successful debridement and VSD, the clinical efficacy of the procedure was evaluated by observing parameters such as the color, shape, and texture of the flap on the receptor site. RESULTS: All patients were followed up for 23–32 months after surgery. Of the 16 patients, six had a flat flap appearance, while the remaining ten patients required flap repair surgery 6–9 months after the procedure. Eight of these ten patients had a satisfactory repair, and the remaining two patients had further repair surgery 9–10 months after the flap grafting. The postoperative results of all patients were satisfactory; no local infection, good flap survival, soft texture, glossy elasticity, and flat appearance. Statistical results showed only one case of local necrosis at the distal end of the flap, and the wound healed at stage II after redebridement and dressing change. CONCLUSIONS: VSD combined with free anterolateral femoral flap grafting is an easy and reliable operation with a good prognosis and excellent clinical utility and feasibility for treating pediatric patients with foot and ankle soft tissue traumas.

The Bukit Timah Granite (BTG) formation is widely distributed in the central and northern parts of Singapore Island. The BTG rocks in the formation vary from granite to granodiorite. Several hybrid rocks and dykes are also present in the BTG. The granite is in various states of fracturing and weathering, ranging from residual soils to intact, unweathered fresh rock. This paper presents some mechanical and physical properties of Singapore BTG rocks, based on data from the Factual Geotechnical Reports of more than 200 boreholes from Downtown Line stage II (DTL2) sites of Cashew, Hillview, Bukit Panjang and Beauty World. The variations of the parameters, including the unconfined compressive strength (UCS), the point-load strength index (Is50), the Cerchar abrasivity index (CAI), and the slake-durability index are derived from laboratory tests on samples from borelogs of different depths. The empirical correlations between the UCS and Is50 and between the CAI and the strength parameters (UCS and Is50) are derived and validated against the commonly adopted equations. Statistical information, including the average values, the standard deviations, and the coefficients of variation, are provided for these parameters. These statistics provide a useful reference for numerical simulations and future projects involving BTG rocks.

Objective To investigate three‐dimensional distribution of bone‐resorptive lesions based on the three‐pillar classification and its effect on the disease progression of osteonecrosis of the femoral head (ONFH). Methods A total of 194 femoral head CT images from 117 patients diagnosed with ARCO stage II and III ONFH were retrospectively reviewed from April 2014 to February 2019. Three‐dimensional structures of the femoral head and the bone‐resorptive lesions were reconstructed. Using the three‐pillar classification and coronal plane of the femoral head, we divided each femoral head into six regions to observe the location characteristics of bone‐resorption lesions, and explore the destruction of different areas of the femoral head by the bone‐resorptive lesions. Then the hips were divided into two groups based on whether they contained bone‐resorption lesions and compared the difference of stage II and stage III between the two groups. Results The regional distribution revealed 39 (27.27%), 55 (38.46%), six (4.20%), 23 (16.08%), 17 (11.89%) and three (2.10%) bone‐resorptive lesions in regions I, II, III, IV, V and VI respectively. The lateral pillar, AL (I + IV), contained 44.76% of the lesions, central pillar, C (II + V), 48.95%, and medial pillar, M (III + VI), 6.29%. Moreover, there were 81.82% bone‐resorption lesions in anterolateral pillar, AL (I + II + IV), and 18.18% in posteromedial pillar, PM (III + V + VI). In all ONFH hips, the lateral pillar of 81(88.04%) femoral heads were affected, the central pillar of 84 (91.30%) femoral heads were affected, and the medical pillar of 29 (31.52%) femoral heads were affected. The ratio of ARCO stage III in the group with bone‐resorption lesions was significantly higher than that of the group without bone‐resorption lesions (76.09% vs 30.39%, P, The bone‐resorption lesions are mainly distributed in the lateral, central pillar of the femoral head, and the lateral and central pillar of the femoral head with bone‐resorption lesions is usually involved. Furthermore, the result suggested that the bone‐resorption lesions might accelerate the progression of ONFH.

Summary. Glaucoma takes one of the fi rst places among the causes of blindness and visual impairment in the population of developed countries, including Ukraine. The low-pressure glaucoma (LPG) is from 3.5% to 66% in the structure of all types of glaucoma. Until now, there is no consensus in the literature on the mechanisms of the patho genesis as well as precise criteria for diagnosis and differential diagnosis of this disease. LPG is currently incomplete studied form of the disease, which gives a high percentage of irreversible blindness and presents a socially signifi cant problem of modern ophthalmology. In recent years, the increasing use of therapy is aimed at supporting trophic processes (neuroprotection) in order to prolong the stabilization period. One of the directions of modern ophthalmology in the treatment of low-pressure glaucoma is the search for agents (pharmacological, physical, etc.) that can inhibit foreign negative shifts and activation of lipid peroxidation in the cellular structures of the optic nerve and retina.Aim: to study and evaluation of the effi cacy of neuroprotective therapy in the treatment of low-pressure glaucoma patients.Materials and methods. 40 patients (80 eyes) with low-pressure glaucoma were included in the study. All patients were divided into 2 groups depending on the stage of the disease. The comparison group consisted of 15 patients (30 eyes) without LPG and with anomalies of refraction (myopia up to 3.0 Dptr). All studied groups were equal in age and sex. In addition to the comprehensive ophthalmic examination in dynamics, analysis of subjective sensations, changes of the tear production, indicators of tear fi lm stability, Lipkof test, OPI test, performed electrophysiological research (determination of visual cortical potential) and electroretinogram.The period of dynamic supervision for patients was 6 months. The assessment of the ophthalmic status was carried out on the fi rst visit (primary screening), on the second visit (after 1 month), and on the third visit (after 5–6 months).All patients in the main group carried out a ten session’s Piler-light course therapy a day. Bioptron-Piler-light was obtained from the use of green fi lter of the BIOPTRON (Zepter Group, Swiss). Light applications were performed through closed eyelids from a distance of 30 cm for 10 minutes. One month after the fi rst session, an ophthalmic status assessment was performed. Neuroprotective therapy was prescribed after Piler-light course therapy and included cytocholine sodium 2%, cyanocobalamin 0.05% and 0.2% sodium hyaluronate in eye drops (OMK2, FARMIGEA SpA, Roma, Italy, LLC “SAFFARMA”) in daily three-fold instillations during four months.Results. The analysis of the study results showed that after Piler-light course therapy there was a positive dynamics and improvement of clinical-functional parameters in low-pressure glaucoma patients. Electrophysiological parameters and perimeter data were improved. There was a possible widening of the vision, reducing the number of scotomas, improving the MD and reducing the PSD index, both in the initial and in the advanced stage of the disease.Subsequent use during four months eye drops, which included cytocholine sodium 2%, cyanocobalamin 0.05%, and 0.2% sodium hyaluronate, led to further improvement of electrophysiological parameters. An increase in the amplitude of electroretinogram has been found, which has been shown to improve the functional activity of photoreceptors.Indicators of the amplitude of the visual-induced potentials increased on the background of treatment, especially at the initial stage of low-pressure glaucoma patients. Indicators of latency complexes decreased and tended to normalize. This indicated an improvement in the conduction of nerve fi bers and on the active neuroprotective effect of eye drops on the neuro-receptor apparatus of visual analyzer.The analysis of diagnostic tests showed signs of instability of the tear fi lm, infl ammation of the surface of the eye, and changes in the main tear production in all low-pressure glaucoma patients at a screening visit. The results confi rmed the fact that the main positions of the violation of the tear production in the pathogenesis of dry eye disease in these patients.After the treatment course, improvement of all diagnostic tests was observed in patients with stage I of low-pressure glaucoma and in patients with stage II of this disease. It was determined that the tear fi lm stability test improved by 35.1% and 34.1% (p

Familial exudative vitreoretinopathy (FEVR) is a rare hereditary retinal disease characterized by polymorphism of clinical manifestations and varied prognoses. Diagnosing FEVR is particularly difficult when it manifests itself at an early age. Purpose: to analyze the clinical manifestations of FEVR in the first year of a child’s life. Material and methods . 69 children with FEVR were observed at the Helmholtz National Medical Research Center of Eye Diseases from January 2012 to February 2020. Results . 15 children (2 girls and 13 boys, 22 % of all those observed) showed ophthalmic changes in their first year. The age of the patients revealing the first clinical signs ranged from 1 week to 8 months (the median was 4 months). 4 eyes (15 %) were found to have stage I of the disease, 9 (33 %) — stage II, 4 (15 %) — stage III, 7 (26 %) — stage IV, and 3 (11 %) — stage V. Stages III to V associated with bad functional prognosis were found in half of the cases (52 %), the earliest symptoms were detected at the age of 3 weeks. Conclusions. While FEVR is a severe and potentially progressive disease, its diagnosis during the 1st year of life is important and requires improvement. Early diagnosis is complicated by the fact that the etiological and pathogenetic aspects of the disease are underresearched, which makes it necessary to focus on studying the factors contributing to the development and progression of FEVR.

Objective We previously described the hybrid comprehensive stage II operation as an alternate surgical procedure for a subset of patients with single ventricle congenital heart disease with adequate native ascending aortic outflow. Here we provide a clinical update on the 4 patients who have undergone this procedure. Methods After undergoing a hybrid approach to the stage I Norwood palliation, the hybrid comprehensive stage II procedure was performed with an incision to the main pulmonary artery (PA), dilation of the ductal stent, creation of a stented baffle between the branch PAs, and a bidirectional Glenn connection. With this approach, dissection of the distal arch and creation of a Damus-Kaye-Stansel anastomosis was avoided. A standard Fontan procedure was planned after the usual period of growth. Results The first patient, who had trisomy 21 and elevated PA pressures, died postoperatively due to left PA thrombosis. The subsequent 3 patients survived the procedure and remain clinically well. All have required catheterizations for reintervention on their stented intrapulmonary baffles and ductal arches, and all have undergone successful completion of their Fontan procedures. Conclusions The hybrid comprehensive stage II is a feasible, less complex alternative to the conventional comprehensive stage II operation in a subset of patients with single ventricle physiology. Early postoperative anticoagulation therapy to avoid PA thrombosis is recommended, and restenting of the ductal arch is anticipated. Although the long-term consequences of separate outflow tracts supplying the upper and lower body is unknown, the 3 surviving patients with this circulation are doing well with their Fontan circulation at midterm follow-up.

A specimen of rainbow trout Parasalmo mykiss (female aged 3.1+, 40 cm long and weighing 1006 g, with gonads at maturity stage II) was caught for the first time on the Kunashir Island (southern Kuril Islands) in Lake Valentina on February 26, 2019, during ice fishing. The appearance of this individual is probably associated with the colonization of the fish of this species that reproduce in the rivers of the neighboring Hokkaido Island.

Background/aim We evaluated the predictive value of candidate serum biomarkers for recurrence in stage II and III colorectal cancer (CRC) after curative surgery. Patients and methods A total of 33 and 120 patients with CRC with or without recurrence at 5 years after curative surgery were included in the training set and the validation set, respectively. Possible serum biomarkers were examined for associations with CRC recurrence using receiver operating characteristics (ROC) curve analysis. Results In the training set, the expression levels of the 14 biomarkers were compared according to recurrence. Among them, five biomarkers that had significantly different expression levels were validated in 60 patients with recurrence at 5 years after curative surgery and 60 patients without. Multivariate analysis showed that natural log-transformed values of carcinoembryonic antigen (CEA), cyclin-dependent kinase regulatory subunit 2 (CKS2), 2'-5'-oligoadenylate synthetase 2 (OAS2), and autophagy-related gene 5 (ATG5) in preoperative serum were significantly related to recurrence. ROC analysis showed that these biomarkers were able to discriminate patients with recurrence from those without (area under the curve=0.828, 95% confidence interval=0.755-0.990). Conclusion Preoperative serum levels of CEA, CKS2, OAS2 and ATG5 were independent risk factors for recurrence. A combination of serum CEA, CKS2, OAS2 and ATG5 predicted tumor recurrence well in patients with stage II and III CRC.

Background. Osteoporosis (OP) and its consequences is a pivotal medical and social problem. Rheumatic diseases especially rheumatoid arthritis (RA) is considered a key factor in the development of secondary OP. At the same time, patients with RA also have traditional risk factors (RF) for OP, as well as the adverse effects of drugs on bone metabolism. Consideration of the full spectrum in each patient with RA plays an important role in the individualized assessment of the risk of OP and the rational management.The aim. To analyze the most significant RF of OP in a cohort of patients with verified RA observed by primary care specialists.Materials and methods. Medical cards of 100 patients with determined RA (ACR / EULAR criteria) who were observed at out-patient clinics were studied. Along with the analysis of the clinical manifestations of RA, the registration of OP RF, both traditional and disease-related, was carried out with an analysis of the prevalence of RF in the investigated cohort.Results. The RA cohort under study was dominated by patients with erosive arthritis, disease duration of more than 5 years, RF and/or ACCP positivity, moderate activity, functional class 2–3. Based on the available instrumental data, systemic OP was diagnosed in 33% of patients, while DXA-densitometry was performed only in 5% of patients with osteoporotic fractures. Among the traditional RF, the most significant were female sex, age higher than 50 years, BMI less than 20 kg/m2 . The frequency of registration of these RF was significantly higher in the subgroup of patients with confirmed OP. Of the disease-associated RF, the most common were the following: duration of RA more than 5 years, activity of 2–3 degrees, high titer of RF and ACCP, X-ray stage II and higher, long term systemic GC use.Conclusions. In real practice, the diagnosis of OP in primary care in patients with RA is based on the available instrumental methods, preferably on standard radiography of bones and joints, which leads to underestimation and/or late diagnosis of OP. Patients with RA have a wide range of traditional and specific OP RFs, the assessment of which is important for determining the risk of fractures and timely prevention of OP complications.

Hepatocellular carcinoma (HCC) progresses fast and has a poor prognosis, but the growth rate in different TNM stages is not clear. The present study was to estimate the growth rate of HCC with different TNM stages at diagnosis.Baseline demographics and tumor characteristics were analyzed for 10145 patients in Surveillance, Epidemiology, and End Results (SEER) Program-registered HCC. Multiple linear regression models were used for age adjustment with patient race, sex, marital status, and HCC grade.The age at diagnosis was younger in Caucasians and males. The adjusted average age of patients with stage I HCC was 65.26 years. The adjusted age of patients with stage II, IIIA, IIIB, and IIIC was -0.17, -0.25, -0.29, and -0.55 adjusted-year younger compared with patients with stage I HCC (all P 0.001). The adjusted average age of patients with T1 was 65.26 years. The age adjustment was -0.17, -0.26, and -0.55 respectively (all P 0.001) for T2, T3 or T4 tumors without distant metastases.These findings demonstrated that the more advanced the HCC stage at diagnosis, the younger the age at diagnosis and the faster the HCC growth from tumor occurrence.

BACKGROUND Practice guidelines recommend neoadjuvant chemoradiation (NCR) for locally advanced rectal cancer (LARC). We examined guideline adherence in a healthcare system serving a region with socioeconomic disparities and poor cancer outcomes. METHODS Retrospective analysis of factors associated with guideline adherence. RESULTS 63.1% of stage II/III LARC patients received NCR. Factors associated with adherence included white race (OR = 2.15, p = 0.024), private insurance (OR = 2.70, p = 0.005), employed status (OR = 2.30, p = 0.031), age at diagnosis (OR = 0.74, p = 0.032), appropriate local staging (OR = 9.17, p < 0.0001), and diagnosis later in the study period (OR per 1 year = 1.20, p = 0.006). By multivariate analysis, private insurance (OR = 2.51, p = 0.023), younger age (OR per 10 years = 0.72, p = 0.048) and appropriate local staging (OR = 6.67, p

Donation-based markets have been implemented by many online platforms, such as live streaming platforms. In these markets, producers provide services without mandatory charges, and customers enjoy the services and voluntarily donate money to the producers. The donation is split between the producers and platform with a pre-agreed fraction. To gain insights into the market operation, we use a two-stage game to capture the sequential decision process between the platform and producers. In Stage I, the platform decides a donation-split-fraction (DSF), i.e., the fraction of donation kept by the producers. In Stage II, producers decide whether to participate in the platform and (if yes) how to choose their service attributes considering the DSF as well as the producers’ and customers’ preferences. We prove that the Stage II game is a potential game with a counter-intuitive equilibrium result: although a larger DSF leads to more producer participation and a better match between the producers’ choices and the customers’ preferences, it does not necessarily lead to more total donation. The Stage I problem, nevertheless, is challenging to solve analytically due to its non-convexity. To gain insights regarding the optimal DSF that maximizes the platform’s payoff, we characterize both its upper-bound and lower-bound. We show numerically that the platform’s optimal payoff always decreases with the mismatch between the producers’ and customers’ preferences. Finally, we conduct a case study with the dataset from Twitch and demonstrate the approach of computing the platform’s optimal DSF without the producers’ inherent preferences.

Objective To characterize kidney function in patients with exstrophy-epispadias complex (EEC) at time of presentation for adult urologic care. Materials and Methods This was a retrospective analysis of 23 patients (ages 18-57) with EEC who presented to a single tertiary care center from 2001-2020. Kidney function was evaluated based on calculated eGFR and presence of hydronephrosis on imaging. UDS data was used to evaluate the bladder. Results Patients had undergone a variety of different surgical techniques for exstrophy or epispadias repair prior to presentation to an adult urologist. We found that 10 of the 23 patients had evidence of CKD Stage II or higher at the time of presentation and 7 patients had evidence of hydronephrosis on imaging. There was urodynamics data available for 14 patients, of which 8 patients showed poor (≤15 ml/cmH2O) or intermediate (15-20 ml/cmH2O) bladder compliance. Conclusion In conclusion, some patients with EEC have evidence of kidney dysfunction at time of presentation to an adult urologist. It is important to consider this when caring for patients with EEC as adults.

Objective To demonstrate the feasibility and the simplified surgical techniques of intraabdominal suturing and knot–tying in robotic transvaginal natural orifice transluminal endoscopic surgery (RV–NOTES) sacrocolpopexy. Materials and Methods We report on two patients with symptomatic stage II apical pelvic organ prolapse who underwent a new technique of RV–NOTES sacrocolpopexy. Case one: A 69-year-old G2P2002 with a history of two prior vaginal deliveries presented with a vaginal bulge and pressure symptoms. She was initially fitted for a pessary but was unsatisfied and elected to proceed with surgical intervention. Case two: A 50-year-old G2P0011 female with a history of one prior vacuum-assisted vaginal delivery presented with symptoms of vaginal mass and bleeding due to an endometrial polyp. She was noted to have stage 2 apical prolapse and opted for transvaginal sacrocolpopexy. Results Both patients were observed overnight and discharged home twelve hours after surgery on postoperative day 1, after completing a voiding trial. For both patients, the postoperative course was unremarkable, and they only required one day of pain medications. At the three–week follow–up visit, they endorsed no postoperative pain or complications, and the POP-Q stage was noted to be 0. Patients had telemedicine visits at eight weeks postoperatively, at which time they had returned to their regular activities and denied symptoms of vaginal bulge or pressure. Conclusion Robotic assisted transvaginal NOTES sacrocolpopexy is a feasible and an alternative to traditional laparoscopic NOTES sacrocolpopexy.

AIM : This study aimed to investigate the effectiveness of the application of a combination of the preparation of micronized purified flavonoid fraction (MPFF) and elastic compression in patients with acquired lymphostasis. MATERIALS AND METHODS : Sixty patients with stage II secondary lower limb lymphedema according to М. Foeldi were included. The patients were divided into two groups through randomization with the envelope method. The first group (n = 30) was subjected to a conservative treatment (MPFF, 1000 mg/day) coupled with elastic compression (3rd class compression stockings). The second group was given compressive therapy (third-class compression stockings). The patients were physically examined through the measurement of the circumference of the limb at different levels. RESULTS : In the first group, the circumference of the lower third of the shin decreased by 8.15% (p = 0.005) after 1 month and by the end of treatment – by 10.6% (p < 0.001), of the middle third of shin – by 3.15% (p = 0.001) and 4.78% (p < 0.001), and of the upper third–by 4.08% (p < 0.001) and 5.99% (p < 0.001). By the end of the observation period (3 months), the circumference of the lower third of the shin in the second group (29.68 ± 4.67 cm) was significantly greater than that in the first group (26.65 ± 2.92 cm, p = 0.035). No adverse reactions were observed in the MPFF group. CONCLUSIONS : The volume of the lower limbs of patients with acquired lymphedema decreased after using a combination of MPFF and elastic compression to a larger extent than after the isolated use of elastic compression. Patients taking MPFF had a positive clinical effect without adverse reactions. Therefore, MPFF could be used in the pharmacotherapy of secondary lymphedema of the lower limbs.

Introducción: las úlceras por presión (UPP) son un problema de salud pública e impacto social, por ello presentamos algunos factores para su prevención en pacientes sometidos a cirugía de columna, en un hospital de tercer nivel. Objetivo: identificar factores de riesgo para el desarrollo de úlceras por presión (UPP) en el agente de cuidado sometido a cirugía de columna en posicionamiento decúbito prono en un hospital de tercer nivel. Material y métodos: estudio cuantitativo, prospectivo y longitudinal, realizado en una institución de tercer nivel, con una n de 20 pacientes. Análisis estadístico descriptivo. Resultados: el porcentaje de género para el estudio fue 50 % para masculino y 50 % para femenino, el predominio de edad fue entre 40 a 59 años con un 60 %, peso y talla representan un factor determinante, las UPP que se desarrollaron con mayor prevalencia en los agentes de cuidado fueron estadio I en un 72% y estadio II en 28%, relacionadas con el tiempo quirúrgico y la presión entre dos planos ejercida durante el procedimiento quirúrgico, por último, los dispositivos terapéuticos representan en el 100% de los casos un factor de riesgo determinante para la aparición de UPP. Conclusión: Es importante que el profesional de enfermería en conjunto con el equipo multidisciplinario del área neuroquirúrgica lleve a cabo las intervenciones de cuidado necesarias para su orevención, pues los factores de riesgo asociados con el desarrollo de UPP son: peso, talla, horas de cirugía y el tipo de superficie de apoyo empleada. Palabras clave: úlcera por presión, paciente quirúrgico, cirugía de columna, factores de riesgo, superficies de apoyo.

Background Peak severity of acute kidney injury (AKI) is associated with mortality in hospitalized pediatric patients. Other factors associated with AKI, such as number of AKI events, severity of AKI events and time spent in AKI, may also have associations with mortality. Characterization of these events could help to evaluate patient outcomes. Methods Pediatric inpatients ( Results A total of 184 297 inpatient encounters met study criteria [male 51.7%, age 7.8 years (interquartile range 2.5–13.8) and mortality 0.56%]. Hospital length of stay was 1.9 days (IQR 0.37, 4.8 days), 15.4% had an intensive care unit admission and 12.2% underwent mechanical ventilation. AKI occurred in 5.6% (n = 10 246) of admissions [Stage 1, 4.5% (n = 8310); Stage 2, 1.3% (n = 2363); Stage 3, 0.77% (n = 1423)] and repeat AKI events occurred in 1.92% (n = 3558). AKI was associated with mortality (odds ratio 6.0, 95% confidence interval 4.8–7.6; P < 0.001) and increasing severity (KDIGO maximum stage) was associated with increased mortality. Multiple AKI events were also associated with mortality (P < 0.001). Duration of AKI was associated with mortality (P < 0.001) but AKI velocity was not (P > 0.05). Conclusions AKI occurs in 5.6% of the pediatric inpatient population and multiple AKI events occur in ∼30% of these patients. Maximum KDIGO stage is most strongly associated with mortality. Multiple AKI events and AKI duration should also be considered when evaluating patient outcomes.

Introduction Tubercular bacterial meningitis continues to be an important cause of morbidity (especially neurologic handicap) in children from resource-poor countries. The present study was planned to assess the clinical and radiological presentation in cases of tubercular meningitis as well as to study the factors associated with mortality. Methodology This study was done over a period of 12 months on children between 5 years and 13 years with suspected TBM. Staging of tubercular meningitis was done according to RNTCP Pediatric TB guideline 2019. Result The study was conducted on a total of 47 pediatric patients with TBM. Mean age of children in present study was 8.77 ± 2.5 years. Our study documented male preponderance for TBM. Severe thinness was observed in 38.3% patients with TBM. Only 59.6% patients were immunized against tuberculosis and history of contact was documented in 40.5% patients. Maximum children belonged to stage I of TBM (59.6%) followed by stage III and stage II in 34% and 6.4% patients respectively. Montoux test positivity was observed in 14.9% patients only. CSF CBNAAT was positive in 6.4% patients. The most common finding was meningeal enhancement seen in 27.7% of patients followed by tuberculomas in 10.6%.Chest X ray was abnormal in 44.7% patients. In present study mortality was observed in 11 (23.4%) cases. Out of various risk factors, mortality was significantly associated with nutritional status and stage of TBM (p Conclusion TBM is associated with high morbidity and mortality in children especially in India where Burden of TB is high. Our study emphasized on the risk factors associated with mortality in children with TBM and need for early diagnosis and appropriate treatment.

Characterization of the degradation of scotopic electroretinography recordings from patients in various stages of ADNIV reveal photoreceptors may sustain early insult and reveals a unique time frame for potential therapeutic intervention. PURPOSE: To characterize the changes found in the electroretinography (ERG) recordings of Autosomal Dominant Neovascular Inflammatory Vitreoretinopathy (ADNIV) patients and correlate with clinical stages of the disease. METHODS: Retrospective chart review. Bright and dim flash full-field scotopic, photopic, and 30 Hz flicker ERGs were obtained according to international standards. The scotopic ERGs were further processed to analyze the oscillatory potential (OP). The patient described in the case report underwent full ERG testing; five patients composed the archival case series data and included scotopic ERG recordings. RESULTS: Stage I ADNIV is characterized by a decrease in the b-wave amplitude on scotopic flash ERG and the disappearance of late OPs; however, the a-wave amplitude is normal. In stage II, attenuation of early OPs and the c-wave are observed in scotopic ERG recordings, but both a- and b-wave amplitudes are unchanged. For patients in stage III, there is a continued decline of both a- and b-wave amplitudes in scotopic ERG recordings. There was a loss of recordable scotopic ERG response in patients with stage IV disease. CONCLUSIONS: ERG may be valuable in determining optimal timing for therapeutic intervention and response prior to loss of recordable retinal function in CAPN5 vitreoretinopathy.

Purpose: Adjuvant chemotherapy is recommended after curative surgery in patients with colon cancer of high-risk stage II and stage III. However, a considerable number of patients cannot complete the scheduled adjuvant treatment for various reasons. This study investigates the hindering factors to the adherence to adjuvant chemotherapy and their impact on long-term survival.Methods: A retrospective study was conducted for patients with colon cancer and had curative resection from 2009 to 2014. Among patients with pathologic stage II and III, stage II with low-risk features, double primary cancers, R2 resection cases were excluded. Patients were grouped into three groups: no-adjuvant therapy, adjuvant therapy for less than 3 months, and more than 3 months. Factors for withdrawal and the oncologic outcome were analyzed.Results: Of 571 patients, adjuvant chemotherapy was recommended in 403. One hundred and sixteen patients (28.8%) did not receive adjuvant chemotherapy, 78 (19.4%) withdrew within 3 months, and 209 (51.9%) maintained for more than 3 months. Factors for not receiving adjuvant chemotherapy or withdrawing within 3 months were older than 70 and American Society of Anesthesiologists class 3 or higher. Main reasons for discontinuation before 3 months were chemotoxicity and patient’s refusal. The long-term oncologic outcome of the patients who received adjuvant chemotherapy for more than 3 months was significantly better than others.Conclusion: No-adjuvant therapy or receiving them for lesser than 3 months is significantly affected by the patient’s performance status and social support, which coincides with a poor oncologic outcome. Social support and rehabilitation system may help to improve the survival outcome.

Background Arteriovenous malformation (AVM) which is a high-blood-flow lesion with connections between arteries and veins without an intervening capillary bed, is difficult to manage. The ear is the second most common site of extracranial AVM. However, studies regarding the management of this condition remain lacking. The purpose of this study was to share managing experiences in our center and to investigate the treatment effect through a retrospective analysis of cases. Methods Among 265 patients with AVM treated in our vascular anomalies center between January 2008 and January 2021, 10 patients with auricular AVM were included in the study to investigate the lesion distribution, clinical stage, and treatment methods by performing a retrospective evaluation. Results Among 10 patients, five patients had AVMs distributed in the upper half of the ear, one patient in the lower half of the ear, and four patients in whole ear, respectively. Seven patients had Schobinger stage II, and three had stage III. One patient received surgical treatment only, four patients received sclerotherapy only, and five patients received both surgical treatment and sclerotherapy. The posttreatment status was checked as controlled in two patients, improved in seven patients, persistent in one patient. There were no worsening patients. Conclusion Auricular AVM is a disease that is difficult to manage by one specific department, thus requiring a collaborative management effort from multidisciplinary team.

Objective The American Joint Committee on Cancer tumor node metastasis (TNM) staging system eighth edition (TNM-8) for differentiated thyroid cancer (DTC) has been introduced as a replacement for tumor node metastasis staging system seventh edition (TNM-7). We present the first study from a Middle Eastern population comparing these 2 versions of the TNM staging system. Methods We compared TNM-8 with TNM-7 in 701 patients with DTC seen during a 3-year period with a median age of 37 years (6-83) and a female-to-male ratio of 558 (79.6%) to 143 (20.4%). Results The number (%) of patients within each stage in TNM-7 and TNM-8, respectively, are as follows: stage I = 503 (71.6%) and 583 (83.2%), stage II = 52 (7.4%) and 81 (11.4%), stage III = 53 (7.6%) and 6 (0.9%), and stage IV = 93 (13.2%) and 31 (4.6%). Overall, 172 patients (24.5%) were downstaged in TNM-8 compared to that in TNM-7, as follows: 26, 30, and 24 patients from stages II, III, and IV in TNM-7 to stage I in TNM-8; 23 and 32 patients from TNM-7 stages III and IV to TNM-8 stage II; 6 patients from stage IVa in TNM-7 to stage III in TNM-8; and 31 patients from stage IVc in TNM-7 to stage IVb in TNM-8. TNM-7 and TNM-8 predicted the long-term outcome well (median follow-up, 7.9 years), but Kaplan-Meier analysis showed better separation of cancer-specific survival in TNM-8 compared to TNM-7. Conclusions Compared with TNM-7, TNM-8 approximately downstaged a quarter of DTC patients and was more robust in separating the outcome of different stages over time.

Background Outcomes in ampullary cancer (AC) may differ by pathologic subtype. No guidelines exist for the administration of adjuvant therapy (AT). We sought to evaluate the effect of subtype and AT on survival. Methods An institutional review of patients undergoing resection for AC from 2008-17 was performed. Recurrence-free (RFS) and overall survival (OS) were assessed by Kaplan-Meier and Cox proportional hazards modeling. Results Of 53 patients, two-thirds (62%) were stage III. Histologic subtype was evenly split between intestinal and pancreatobiliary (43% and 40%). Half of patients received AT. RFS and OS were 25 (95% CI 16–32) and 41 (CI 22–60) months, respectively, without significant difference by subtype. Stage II/III disease was associated with worse OS (HR 3.7, P = 0.03), which was improved with receipt of AT (HR 0.44, P Conclusion Stage is the primary determinant of survival in AC, which may be improved with AT.

In the historical dimension in Ukraine, family medicine (SM) was founded as a pilot project in the Lviv region in 1987. In 1992, after the successful introduction of the elements of the SM, a decision was made to reorganize the district service in the SM. This process was designed for several years and its implementation was planned in 5 stages: Stage I - UT (local therapist) perform the functions of doctors whose specialization is as close as possible to therapy; Stage II - UT replace doctors of narrower specialties; Stage III - UT provide not only primary health care (PTD), but also monitor patients with chronic diseases; Stage IV - UT provide obstetric and gynecological care, and pregnant women seek help from a family doctor; Stage V - complete retraining of UT, who must become qualified general practitioners - family medicine (GP-SM). The introduction of obstetric and gynecological services in the medical department was planned at stage IV, this process was long-awaited and provided, first of all, the training of family doctors in obstetric and gynecological technologies and skills. And only in 2002, the sectoral Order of the Ministry of Health of Ukraine No. 503 of 28.12.2002 «On the improvement of outpatient obstetric and gynecological care in Ukraine» for the first time defined the features of the functions of a family doctor to provide obstetric and gynecological care, and the Order of the Ministry of Health of Ukraine dated 15.07.2011 No. 417 “On the organization of outpatient obstetric and gynecological care in Ukraine”, the functions of the GP-SM on obstetric and gynecological care were expanded. However, taking into account the results of the analysis, the integration of obstetric and gynecological services at the PHC level is extremely imperfect, which makes it inaccessible to the population, ineffective in the preventive direction, unattainable for organizing the treatment process in cases of gynecological diseases. In addition, there are legal conflicts between the sectoral order on PMP No. 504 «On the approval of the procedure for the provision of primary health care», which does not define examination and instrumental obstetric and gynecological technologies for GP-SM, and the designated clinical protocols approved by orders of the Ministry of Health of Ukraine which do not contribute to the integration of obstetric and gynecological services at the PHC level.

New findings What is the central question of this study? To what extent does testosterone influence hemoglobin formation during male puberty? What is the main finding and its importance? In boys, testosterone might be responsible for about 65% of the increase in hemoglobin mass during puberty. The underlying mechanisms are assumed to be twofold: (i) indirectly, mediated by the increase in LBM, and (ii) directly by immediate testosterone effects on erythropoiesis. Thereby, an increase in testosterone by 1ng/ml is associated with an increase in Hbmass by ∼65g. These processes are likely to determine endurance performance in adulthood. Abstract The amount of hemoglobin during puberty is related to endurance performance in adulthood. During male puberty, testosterone stimulates erythropoiesis and could therefore be used as a marker for later endurance performance. This cross-sectional study aimed to determine the relationship between serum testosterone concentration and hemoglobin mass (Hbmass) in both male and female children and adolescents and to evaluate the possible influences of altitude and training. Three-hundred thirteen differently trained boys and girls aged from 9 to 18 years and living at altitudes of 1000m and 2600m above sea level entered the study. The stage of sexual maturation was determined according to the classification of Tanner. Testosterone was measured by ELISA. Hbmass was determined by CO-rebreathing. Hemoglobin concentration did not change during maturation in girls and was 11% higher during puberty in boys, while Hbmass was elevated by 33% in Tanner stage V compared to stage II in girls (373±88g vs 498±77g) and by 95% in boys, (428±95g vs 832±143g) respectively. This difference can most likely be attributed to indirect testosterone influences through an increase in LBM and to direct testosterone effects on erythropoiesis, which increase the Hbmass by ∼65g per 1ng/ml. Altitude and training statuses were not associated with testosterone, but with an increase in Hbmass (altitude by 1.1g/kgLBM, training by 0.8 g/kgLBM). Changes in Hbmass are closely related to testosterone levels during male puberty. Further studies will show whether testosterone and Hbmass during childhood and adolescence can be used as diagnostic tools for endurance talents. This article is protected by copyright. All rights reserved.

Background Kentucky has one of the highest rectal cancer incidences in the United States. High poverty rates have led to poor insurance coverage and inadequate access to care. The treatment of locally advanced rectal cancer utilizes a multimodal regimen requiring regular access to expert care. The rate of receipt of neoadjuvant therapy in Kentucky is unknown. Objective This study aimed to evaluate the rate and factors associated with the receipt of neoadjuvant therapy for localized advanced rectal cancer in Kentucky and the effect on overall survival. Design This is a retrospective database review. Settings This study was conducted by utilizing the Kentucky Cancer Registry at an academic center. Patients All patients diagnosed with stage II/III rectal adenocarcinoma from 2005 to 2015 in the Commonwealth of Kentucky were included. Main outcome measures The primary outcomes measured were the factors associated with nonreceipt of neoadjuvant therapy and overall survival. Results Of 1896 patients, only 46.8% received neoadjuvant therapy. Factors associated with not receiving neoadjuvant therapy included older age, female sex, low education level, high poverty level, and treatment at nonacademic centers. Survival analysis demonstrated significantly improved survival in patients receiving neoadjuvant therapy compared with other treatment regimens. Limitations This study was limited by the retrospective nature of the review and by unmeasured confounders. Conclusions Our study was the first to evaluate the factors behind the low rates of neoadjuvant therapy for locally advanced rectal cancer in Kentucky. Neoadjuvant therapy in this population is beneficial for survival; efforts should be made in policy and education with focus on older patients, female patients, and treatment at nonacademic centers. Centralization of rectal cancer care improves outcomes, but we must be aware of the effect it may have on disparate populations with poor access. See Video Abstract at http://links.lww.com/DCR/B596. Terapia neoadyuvante en el manejo del cncer de recto en estadio ii / iii un estudio retrospectivo en una poblacin dispar y el efecto en la supervivencia ANTECEDENTES:El estado de Kentucky tiene una de las mayores incidencias de cancer de recto en los EE. UU. Debido a una alta tasa de pobreza, el porcentaje de la poblacion que cuenta con seguro de salud, es muy limitado, y por lo tanto el acceso a una atencion de alto nivel es muy bajo. El tratamiento del cancer de recto localmente avanzado, es multidisciplinario, lo que exige acceso y disponibilidad a un grupo experto. Se desconoce la tasa de pacientes que reciben terapia neoadyuvante en Kentucky.OBJETIVO:Establecer la tasa y los factores asociados con el uso de terapia neoadyuvante en el tratamiento del cancer de recto localmente avanzado en Kentucky, y su efecto en la supervivencia global.DISENO:Revision retrospectiva de una base de datos.ESCENARIO:Este estudio se llevo a cabo utilizando el Registro de Cancer de Kentucky en un centro academico.PACIENTES:Se incluyen todos los pacientes diagnosticados con adenocarcinoma de recto, de la Mancomunidad (Commonwealth) de Kentucky, en estadio II / III entre 2005 y 2015.PRINCIPALES MEDIDAS DE RESULTADO:Establecer los factores asociados con el hecho de no recibir terapia neoadyuvante; y establecer la supervivencia global.RESULTADOS:De 1896 pacientes evaluados, solo el 46,8% recibio terapia neoadyuvante. Los factores asociados, para no haber recibido terapia neoadyuvante fueron: la edad avanzada, sexo femenino, bajo nivel educativo, alto nivel de pobreza y tratamiento en centros no academicos. El analisis de la supervivencia mostro una supervivencia significativamente mejor en los pacientes que recibieron terapia neoadyuvante en comparacion con otros esquemas de tratamiento.LIMITACIONES:Revision retrospectiva, factores de confusion no medidos.CONCLUSIONES:Nuestro estudio ha sido el primero en evaluar los factores determinantes de las bajas tasas de terapia neoadyuvante para el tratamiento del cancer de recto localmente avanzado en Kentucky. La terapia neoadyuvante mejora y favorece la supervivencia en esta poblacion, por lo tanto se deben hacer esfuerzos en las politicas de salud, asi como en educacion, enfocados a los pacientes mayores, pacientes femeninas y tratamiento en centros no academicos. El centralizar la atencion del cancer de recto, mejora los resultados, pero debemos ser conscientes del efecto que puede tener en poblaciones desiguales economicamente, con acceso deficiente a la posibilidad de recibir atencion de alto nivel. Consulte Video Resumen en http://links.lww.com/DCR/B596.

Complete upfront resection of pediatric gastrointestinal lymphomas is recommended over biopsy whenever feasible, but either approach may have adverse sequelae. We sought to compare gastrointestinal and oncological outcomes of pediatric gastrointestinal lymphomas who underwent attempted upfront resection or biopsy of the presenting bowel mass. We retrospectively reviewed charts of children with gastrointestinal lymphomas treated on LMB89 and LMB96 protocols from 2000 to 2019 who underwent upfront gastrointestinal surgery, and compared resection and biopsy groups. Of 33 children with abdominal lymphomas, 20 had upfront gastrointestinal surgery—10 each had resection or biopsy. Patients with attempted upfront resections had fewer postoperative gastrointestinal complications compared to biopsies (10% vs. 60%, p = 0.057), but longer time to chemotherapy initiation (median 11.5 vs. 4.5 days, p

Background and purpose This study was conducted to evaluate the longitudinal impact of postmastectomy radiation therapy (PMRT) on persistent severe lymphedema (PSL) using arm volume measurements by an infrared optoelectronic volumetry. Materials and methods Of the patients who underwent mastectomy between 2008 and 2016, we included 330 patients with secondary arm lymphedema. Percentage of excessive volume (PEV) of the arm were serially assessed using an optoelectronic volumetry 1, 3, 6, 12, 18, 24, 36, and 48 months after the lymphedema diagnosis (Tlymh_Dx). We defined PSL as 2 or more episodes of PEV ≥ 20%. Risk factors for PSL were evaluated using stepwise regression analyses. Results Patients who received PMRT (n = 202, 61.2%) were more likely to have larger extent of axillary node dissection (AND), and frequent stage II/III lymphedema at Tlymh_Dx than those who did not receive PMRT (p Conclusion PMRT, especially RNI, was associated with a consistent increase in PEV in patients with arm lymphedema. Therefore, timely physical therapy is necessary for this patient population.

Objective This study aimed to assess the clinical and radiographic outcomes of juvenile patients who suffered from stage II or III osteochondritis dissecans (OCD) of the knee and underwent arthroscopic retrograde drilling and internal fixation with bioabsorbable pins. Design Medical and radiological records from patients aged 11 to 16 years, who underwent arthroscopic treatment for OCD lesions of the knee in 2 tertiary hospitals, were retrospectively reviewed. The procedure was indicated by persistent pain and by magnetic resonance imaging (MRI). All patients underwent retrograde drilling and arthroscopic fixation of the lesion with bioabsorbable pins. MRI was conducted at least 1 year postoperative in all patients to evaluate healing. Functional outcomes were evaluated through the Visual Analogue Scale (VAS) for pain, Lysholm, and IKDC (International Knee Documentation Committee) scores. Results A total of 40 patients, with an average age of 13.1 years (range = 11-16 years) and an average follow-up of 6.6 years (range = 3-13 years) were reviewed. MRI findings confirmed the healing of the lesion in 36 out of the 40 (90%) patients. In particular, the healing rate was 95% (20/21) and 84% (16/19) for stage II and stage III, respectively. Lysholm, IKDC, and VAS scores revealed a statistically significant improvement ( P < 0.05) at final follow-up in comparison to preoperative status. No infection, knee stiffness, or other complication was recorded. Conclusions Retrograde drilling combined with internal fixation with bioabsorbable pins, of stages II and III OCD lesions of the knee provides good to excellent outcomes to juvenile patients, with a high healing rate.

Most malware employs packing technology to escape detection; thus, packer identification has become increasingly important in malware detection. To improve the accuracy of packer identification, this article analyses the differences in the function call graph (FCG) and file attributes between the non-packed executable files and the executable files packed by different packers, and further proposes a 2-stage packer i dentification method based on FCG and file attributes (2-SPIFF). In 2-SPIFF, the detection model of stage I distinguishes non-packed executable files from packed executable files based on the graph features extracted from the FCG, while the identification model of stage II identifies the packer used for packing the original executable file by using the concatenated features extracted from the FCG and file attributes. The experimental results show that 2-SPIFF can achieve an accuracy of 99.80% for packer detection and an accuracy of 98.49% for packer identification.

Background This study examined the financial toxicity faced by breast cancer (BC) patients in Vietnam and the factors associated with the risk and degree of that toxicity. Methods A total of 309 BC patients/survivors completed an online survey (n=209) or a face-to-face interview (n=100) at two tertiary hospitals. Descriptive statistics and χ2 tests were used to identify and analyse the forms and degree of financial toxicity faced by BC patients/survivors. A Cragg hurdle model assessed variation in risk and the degree of financial toxicity due to treatment. Results 41% of respondents faced financial toxicity due to BC treatment costs. The mean amount of money that exceeded BC patients/survivors’ ability to pay was 153 million Vietnamese Dong (VND) ($6602) and ranged from 2.42 million VND to 1358 million VND ($104–58,413). A diagnosis at stage II or III of BC was associated with 16.0 and 18.0 million VND (~$690–777) more in the degree of financial toxicity compared with patients who were diagnosed at stage 0/I, respectively. Being retired or married or having full (100%) health insurance was associated with a decrease in the degree of financial toxicity. Conclusions A significant proportion of Vietnamese BC patients/survivors face serious financial toxicity due to BC treatment costs. There is a need to consider the introduction of measures that would attenuate this hardship and promote uptake of screening for the reduction in financial toxicity as well as the health gains it may achieve through earlier detection of cancer.

Aim: The aim of this in vitro study is to compare the efficacy of three diagnostic methods, Direct visual method, Magnifying loupes and Dental operating microscope in recognising all the canals of the root canal system in maxillary first molars using CBCT and reference standard method. Materials and Methods: A total of 65 maxillary first molars were selected for this study. Teeth selected were evaluated by Periapical radiographs and CBCT. Access cavities of selected extracted human maxillary first molars were prepared, and the floor of the pulp chamber was then explored to locate the MB2 canal in five stages: Stage I (Direct Visual Method), Stage II (under ×3.5 Magnifying Loupes with light-emitting diode [LED] light), Stage III (Under Dental Operating Microscope), and Stage IV (Cross-sectioning was done below CEJ and the sections were evaluated using stereomicroscope at 10x magnification). Statistical Analysis: The descriptive statistics were tabulated using Chi square test to compare the efficacy between the diagnostic methods. Senstivity, specificity, Positive /Negative predictive values were calculated for each method. Results: The results obtained in this study showed that CBCT was most accurate with the dimensional accuracy of 96% followed by Dental operating microscope which performed better (with the diagnostic accuracy of 76%) than the magnifying loupes (with the diagnostic accuracy of 64%) direct visual method (with the diagnostic accuracy 60%). Conclusion: The dental operating microscope was most effective in the detection of MB2 canals followed by magnifying loupes and direct visual method. Additionally, CBCT could be used as a supplementary diagnostic tool in cases in which canals are not found using the methods available in the dental office. Keywords: Diagnostic methods, Direct visual method, Magnifying loupes, Dental operating microscope, CBCT, Cross-sectioning, Diagnostic accuracy.