Search

Purpose: To use preoperative MRI data to construct a nomogram to predict survival in patients who have undergone R0 resection for gallbladder cancer. Methods: The present retrospective study included 143 patients (M:F, 76:67; 67.15 years) with gallbladder cancer who underwent preoperative MRI and subsequent R0 resection between 2013 and 2021 at two tertiary institutions. Clinical and radiological features were analyzed using univariate and multivariate Cox regression analysis to identify independent prognostic factors. Based on the multivariate analysis, we developed an MRI-based nomogram for determining prognoses after curative resections of gallbladder cancer. We also obtained calibration curves for 1-,3-, and 5-year survival probabilities. Results: The multivariate model consisted of the following independent predictors of poor overall survival (OS), which were used for constructing the nomogram: age (years; hazard ratio [HR] = 1.04; 95% confidence interval [CI], 1.04–1.07; p = 0.033); tumor size (cm; HR = 1.40; 95% CI, 1.09–1.79; p = 0.008); bile duct invasion (HR = 3.54; 95% CI, 1.66–7.58; p = 0.001); regional lymph node metastasis (HR = 2.47; 95% CI, 1.10–5.57; p = 0.029); and hepatic artery invasion (HR = 2.66; 95% CI, 1.04–6.83; p = 0.042). The nomogram showed good probabilities of survival on the calibration curves, and the concordance index of the model for predicting overall survival (OS) was 0.779. Conclusion: Preoperative MRI findings could be used to determine the prognosis of gallbladder cancer, and the MRI-based nomogram accurately predicted OS in patients with gallbladder cancer who underwent curative resection. [ABSTRACT FROM AUTHOR]

Purpose: Robotic surgery has been incorporated in the treatment of endometrial cancer, with evidence suggesting that minimal access surgery offers advantages over laparotomy including less blood loss, lower rate of perioperative complications, and accelerated postoperative recovery. The laparoscopic approach to cervical cancer (LACC) study has recently demonstrated inferior survival outcomes in cervical cancer patients treated with minimal access surgery including robotic surgery. It is, therefore, imperative that further evaluation of the latter in endometrial cancer is performed. Methods: A retrospective analysis of clinical data was performed. We compared two different types of surgery performed for the treatment of FIGO stage 1 to 3 endometrial cancer; open surgery performed in the years 2013–2015 vs robotic surgery performed in 2017–2019, after the implementation of the robotic program in our institution. Main outcome measures were recurrence-free survival and overall survival, with secondary outcomes including surgical morbidity and postoperative recovery. Results: We compared 123 patients who had open surgery with 104 patients who underwent robotic surgery. One case from the second group was converted to open surgery due to the inability to complete it robotically. After a median follow-up of 68 months, there was no difference in recurrence-free survival or overall survival between the two groups. Length of stay after an operation was significantly different with mean hospital stay of 1.6 days after robotic surgery and 5 days after open surgery (p = 0.001). No significant difference was identified in the rate of complications (p = 0.304). Conclusion: Our analysis has demonstrated that robotic surgery offers better perioperative outcomes without compromising the oncological safety. [ABSTRACT FROM AUTHOR]

The essential oil of Cananga odorata was prepared as an emulsifiable concentrate formulation and examined for its insecticidal activity against Spodoptera littoralis larvae. The effectiveness of C. odorata oil in both pure and EC formulations was investigated in terms of enzymatic activity and survival. In addition, their persistence effect was studied in semi-field conditions. Benzyl benzoate (18.86%), benzyl acetate (9.18%), β-Maaliene (15.53%), alloaromadendrene (6.41%), cis-Thujopsene (6.16%), cedrene (5.35%), and benzyl alcohol (5.98%) were the most abundant compounds found in C. odorata oil by gas chromatography-mass spectrometry analysis. The EC formulation exhibited the highest toxicity and produced LC values of 0.47, 1.02, and 3.78% for LC40, LC50, and LC90, respectively, compared to 1.05, 1.70, and 4.96%, respectively, resulted from pure oil after 72 h of exposure. Following EC application, the mean survival time was only 3.60 ± 0.57 days, compared to pure oil treatment (7.70 ± 1.11 days) and control (14.0 ± 0.0 days). The LC40 of EC formulation induced a more potent inhibitory effect for the detoxification enzyme carboxylesterases (CarE; α- and β-esterase) and the oxidative stress enzyme superoxide dismutase (SOD). Under semi-field conditions, the cumulative mortality of S. littoralis larvae increased by increasing the exposure time to LC90 of both formulations. The EC formulation had the highest mortality rates for the total exposure period (7 days). According to these results, C. odorata EC formulation demonstrated enhanced toxicity and persistence effects, and it can be utilized as a green bio-insecticide for the management of S. littoralis larvae. [ABSTRACT FROM AUTHOR]

Pink pine nut, a dried fruit, is produced by a Mexican pine species. However, unlike other nuts, the lack of management practices and the absence of grafting techniques hinder its production. This work evaluated the behavior and growth of Pinus cembroides (PC) and P. orizabensis (PO) grafted onto four rootstocks. Two trials were conducted in April and June 2020 with PC and PO scions. The rootstocks used were PC, P. patula (PP), P. teocote (PT), and P. greggii var. australis (PG). The variables evaluated were engraftment (%), height increase (HI), scion diameter (SD), rootstock diameter (RD), scion-rootstock ratio (SRR), survival (%), and number of shoots (NS). No statistical analyses were performed for engraftment, survival, and SRR; for HI, SD, and RD, a mean comparison was performed (Tukey ≤ 0.05), and NB was analyzed by Poisson regression. In the first trial, successful engraftment varied from 45.5 to 100%; in the second trial, the range was from 73.3 to 100%. In terms of height, the PO/PC combination reached 21.14 cm, and the PC/PC combination measured 17.69 cm for April and June. The average survival was 60.42% for the first experiment; for the second experiment, only two combinations (PC/PG and PC/PC) survived with an average of 75.85%. Thus, it is possible to implement the grafting technique in pine nut species. This is the first work reporting successful grafting for this species, focusing on seed production. [ABSTRACT FROM AUTHOR]

The inoculation of forest species with plant growth-promoting bacteria has grown and is increasingly sought to reduce the use of synthetic products. Thus, the objective was to evaluate the effect of the interaction between endophytic bacteria and synthetic indole butyric acid (IBA) on the initial development of Corymbia citriodora x Corymbia torelliana (CcCt) plants. The treatments were established by factorial (6 × 2) + 1, in which the mini-cuttings were inoculated with Pantoea vagans strains 7URP1-6 (B07) and 45URP4-1 (B45), Priestia megaterium (B11), Exiguobacterium sibiricum (B19), Bacillus sp. (B58) and a control treatment with the inoculation vehicle only, followed by immersion in 0 or 1,000 mg kg− 1 of synthetic IBA, plus an additional control not inoculated and treated with 2,000 mg kg− 1 of IBA. In relation to the cuttings treated only with 2,000 mg kg− 1 of IBA, cuttings inoculated with bacteria B07, B11, B19, and B58 had a similar survival rate, an increase of 29–36% in the percentage of rooting and of 27–34% in plant height, produced rooted cuttings with larger collar diameters and greater dry mass of roots and shoots, and a greater number of colony forming units of bacteria in the rhizosphere and in root and shoot tissues. The inoculation of mini-cuttings of CcCt with B07, B11, B19 and B58, followed by immersion in 1,000 mg kg− 1 of IBA improved the development of rooted cuttings relative to inoculated cuttings without IBA treatment, although it is not known if the effect is directly attributable to these bacterial strains. [ABSTRACT FROM AUTHOR]

Background: There have been concerns about the use of tumor necrosis factor inhibitors (TNFi) for autoimmune disease in patients with recently diagnosed cancer. We assessed the survival of patients with rheumatoid arthritis (RA) and newly diagnosed early breast cancer (BC) treated with TNFi in the first two years after BC diagnosis. Methods: We identified patients in two datasets: (1) Optum's de-identified Clinformatics® Data Mart Database (CDM), (2) Surveillance, Epidemiology, and End Results program (SEER) and Texas Cancer Registry (TCR) Medicare-linked cohort. We grouped patients according to whether they received TNFi, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) only, or no DMARDs within 2 years after BC. Outcomes were overall survival (OS) and BC-specific survival (BCSS). We conducted landmark analyses at years 1 and 2, with multivariable Cox regressions using propensity scores for adjustment. Results: In the first year after BC, 165/970 (17.0%) and 201/1246 (16.1%) patients received TNFi in CDM and SEER/TCR-Medicare respectively. In the 1 year landmark, no significant differences in OS were observed between patients treated with TNFi and patients treated with csDMARDs only in CDM (hazard ratio [HR] = 0.77, 95% confidence interval [CI] 0.42–1.40) or SEER/TCR-Medicare (HR = 0.84, 95% CI 0.54–1.31). BCSS (SEER/TCR-Medicare) was better in patients receiving TNFi than in those receiving csDMARDs only (HR = 0.28, 95% CI 0.08–0.98). In CDM, glucocorticoid therapy had worse OS than those without glucocorticoids (HR = 2.18, 95% CI 1.13–4.18). This was also observed in SEER/TCR-Medicare (not statistically significant). Similar results were observed for the 2 year landmark. Conclusions: TNFi treatment during the first two years after early BC was not associated with worse survival. [ABSTRACT FROM AUTHOR]

Introduction: Historically, patients recently (≤ 6 months) diagnosed with pulmonary arterial hypertension (PAH; incident) have had poorer survival than those with a longer (> 6 months) time from PAH diagnosis (prevalent). Despite guideline recommendations for initial combination therapy for most patients with PAH, many are initiated and maintained on monotherapy. Real-world evidence to evaluate the benefit of early combination treatment in newly-diagnosed patients is lacking. Methods: Patients with PAH initiating combination therapy with the endothelin receptor antagonist macitentan and the phosphodiesterase-5 inhibitor tadalafil (M+T) were identified from the combined dataset of the US, multicenter OPUS (prospective, observational drug registry; NCT02126943) and OrPHeUS (retrospective, medical chart review; NCT03197688) studies (2013–2020). Descriptive analyses were performed for the incident and prevalent cohorts, as well as the subcohort of incident patients who received M+T as first-line combination therapy (incident initial combination). Results: In OPUS/OrPHeUS, 1336 patients with PAH received M+T during the observation period. For the incident [n = 453 (33.9%)], incident initial combination [n = 272 (20.4%)], and prevalent [n = 837 (62.6%)] cohorts: median (Q1, Q3) M+T exposure was 14.2 (4.2, 27.5), 12.2 (3.2, 25.5), and 14.7 (4.5, 28.0) months. 12-month Kaplan–Meier estimates (95% confidence limits) for survival were 91.2% (87.7, 93.7), 88.5% (83.2, 92.2), and 92.9% (90.6, 94.6), for patients free from hospitalization were 59.4% (54.1, 64.4), 56.3% (49.1, 62.9), and 62.3% (58.5, 65.9), and for patients persisting on combination therapy were 68.6% (63.9, 72.8), 65.0% (58.8, 70.6) and 66.9% (63.5, 70.0). Adverse events (OPUS only) were reported in 77.8%, 80.2%, and 80.3% of patients, respectively, with no unexpected adverse events observed. Conclusions: Despite a historically worse prognosis, incident patients receiving M+T, including as initial combination therapy, had similar survival and hospitalization as prevalent patients. Safety profiles were similar across cohorts. Together, these data support the use of early combination therapy with macitentan and tadalafil. Plain Language Summary: In earlier studies, patients diagnosed with pulmonary arterial hypertension (PAH) within the past 6 months (newly-diagnosed PAH, called 'incident patients' in this article) had worse health than patients diagnosed with PAH more than 6 months before (long-standing PAH, called 'prevalent patients' in this article). This is because some newly-diagnosed patients have very advanced disease and do poorly within the first 6 months. The OPUS (NCT02126943) and OrPHeUS (NCT03197688) studies collected information on patients with PAH treated in US clinics between 2013 and 2020. We identified patients that were treated with a combination of two PAH medications, macitentan and tadalafil. We then grouped them as newly-diagnosed (453 patients) or long-standing (837 patients). We also looked at the subgroup of newly-diagnosed patients who received the combination as their first treatment (272 patients, called 'incident initial combination patients' in this article). We then looked at how these patients did over time. Patients were treated with macitentan and tadalafil for an average of 12–14 months. We found that after 1 year of combination treatment, results were similar between the groups: patient survival was 91%, 89%, and 93% for those with newly-diagnosed, newly-diagnosed and previously untreated, and long-standing PAH; the proportion remaining hospitalization-free was 59%, 56%, and 62%; and the proportion remaining on combination treatment was 69%, 65%, and 67%, respectively. Side effects were in line with the known safety profiles of the medications. Despite historically having worse health outcomes, newly-diagnosed patients receiving the macitentan and tadalafil combination had similar survival and hospitalization as patients with long-standing PAH. These data suggest that there is a benefit to starting this combination of medicines early in the treatment of PAH. [ABSTRACT FROM AUTHOR]

Background: Assessment of individual tumor biology and response to systemic therapy in pancreatic ductal adenocarcinoma (PDAC) remains a clinical challenge. The significance of anthropometric (body composition) changes during chemotherapy as a surrogate for tumor biology in the setting of localized PDAC is unknown. Methods: A retrospective, single-institution analysis of patients with PDAC who received neoadjuvant therapy (NAT) and pancreatectomy from 2017 to 2021 was performed. Radiologic anthropometric analysis used artificial intelligence-driven software to segment and compute total and sub-compartment muscle area, adipose tissue area, and attenuation values at the level of the L3 vertebra. Kaplan–Meier survival estimates, log-rank tests, and multivariable Cox regression models were used in survival analyses. Results: The inclusion criteria were met by 138 patients. Although decreases in muscle and adipose tissue areas during NAT were predominant, a subset of patients experienced an increase in these compartments. Increases in muscle greater than 5% (hazard ratio [HR], 0.352; 95% confidence interval [CI] 0.135–0.918; p = 0.033) and increases in adipose tissue greater than 15% (HR, 0.375; 95% CI 0.144–0.978; p = 0.045), were significantly associated with improved survival, whereas loss of visceral fat greater than 15% was detrimental (HR 1.853; CI 1.099–3.124; p = 0.021). No significant associations with single time-point anthropometrics were observed. Gains in total muscle and adipose mass were associated with improved pathologic response to systemic therapy and less advanced pathologic tumor stage. Conclusions: Dynamic anthropometric analysis during NAT for PDAC is a stronger prognostic indicator than measurements taken at a single point in time. Repeated anthropometric analysis during preoperative chemotherapy may serve as a biomarker for individual tumor biology and response to therapy. [ABSTRACT FROM AUTHOR]

Background: Margin accentuation using irreversible electroporation (MA-IRE) improves recurrence and overall survival (OS) in pancreatic cancer patients; however, there have been limited outcome comparisons to similarly risked patients who did not receive MA-IRE. Methods: Patients with borderline resectable or locally advanced pancreatic adenocarcinoma who underwent a pancreaticoduodenectomy (PD) between 2017 and 2022 were included. Those who did not receive neoadjuvant chemotherapy for major vessel involvement were excluded. One-to-one propensity score matching (PSM) was used to match the MA-IRE group with the corresponding non-MA-IRE control group with similar risk factors. Results: A total of 36 patients were included in this study. Seventeen (47.2%) patients who underwent MA-IRE matched with 19 control patients (52.8%) with similar risk factors who did not have MA-IRE. Before matching, OS and disease-free survival (DFS) were comparable between the MA-IRE and non-MA-IRE groups. After matching, the MA-IRE group showed improved OS (746 vs. 509 days, hazard ratio 0.313; p = 0.034) compared with the non-MA-IRE group. DFS (p = 0.768), negative margin status (p = 0.317), and 30-day complication rates (p = 1.000) remained statistically different between the groups. Conclusions: MA-IRE in PD results in longer OS but does not impact margin status, DFS, or postoperative complication rates in our cohort. These findings suggest that MA-IRE is safe and potentially promotes immune cell activation rather than upfront margin mitigation. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis (HD) is the modality of renal replacement therapy (RRT) with the highest mortality rate. The identification of prognostic factors will help achieve better outcomes among HD patients. In this study, we sought to conduct a survival analysis and determine the predictors of mortality among adult Indonesian HD patients using data obtained from Indonesian Renal Registry (IRR). Methods: This is a retrospective cohort study which reviewed all adult hemodialysis patients in Indonesia based on the records of IRR during 2007–2022. Variables analyzed in this study include age, sex, etiology of CKD, cause of death, HD frequency, and initial vascular access. A 5-year follow-up was performed until the outcome of death or drop out was found. Results: Among 99,552 eligible patients, the mean survival length was 1536.21 ± 2.50 days. The 5-year survival rate was 77%. Cox proportional hazard regression model revealed demographic and clinical characteristics that are significantly associated with mortality: male sex (HR: 1.038, 95% CI 1.002–1.075), age of 60 years or older (HR: 1.329, 95% CI 1.281–1.379), diabetic nephropathy (HR: 1.347, 95% CI 1.249–1.452), twice-weekly hemodialysis frequency (HR: 1.080, 95% CI 1.011–1.155), initial vascular accesses with femoral vein puncture (HR: 2.710, 95% CI 2.568–2.860), and CVC (HR: 2.992, 95% CI 2.848–3.144). Conclusions: The 5-year survival rate of Indonesian HD patients is 77. Male sex, age of HD onset at 60 years or older, diabetic nephropathy, twice-weekly HD frequency, and the initial vascular accesses with femoral vein puncture and CVC are associated with increased risk of mortality. [ABSTRACT FROM AUTHOR]

Purpose: Histological grading of tumours is a well-established biomarker used to guide treatment in female breast cancer. However, its significance in male breast cancer remains unclear. This systematic review investigates the prognostic significance of tumour grade in relation to breast cancer-specific survival (BCSS) in male breast cancer patients undergoing surgery. Methods: MEDLINE, PUBMED Central and EMBASE databases were searched to identify randomised trials and observational studies related to male breast neoplasms, tumour grading, recurrence, and survival. Results: A total of fifteen observational type studies were included in the review. A significant association between tumour grade and BCSS was reported in a majority of studies. This association was most evident with regard to high-grade (grade III) compared to low grade (grade I) tumours, with a significant relationship in 4 out of 4 studies. For intermediate-grade II tumours an association was demonstrated in a minority of studies. Conclusions: This study confirms an association between high-grade male breast cancers and poorer disease-specific survival, however, the significance of intermediate-grade tumours remains unclear. Further research is required to investigate the biology of male breast cancer in relation to histological grade and optimally define intermediate-grade disease. [ABSTRACT FROM AUTHOR]

Background: Second and third surgeries were demonstrated as safe and efficient in recurrent diffuse low-grade glioma (LGG). Here, the feasibility of more than 3 resections is investigated. Methods: Patients who underwent 4 or 5 operations for recurrent initially WHO grade 2 IDH-mutated gliomas were consecutively selected. Results: Twenty-three operations were performed in five patients (all males, mean age 27.2 ± 4 years). Three patients underwent 5 surgeries and two patients underwent 4 surgeries. Twelve procedures (52%) were achieved with awake mapping, including all 4th and 5th operations but one. Repeat electrical mapping detected changes of the cortical maps between at least two awake surgeries in 4 patients. No patients experienced permanent neurological impairment (KPS score ≥ 80 in all cases). The patients returned to work after 22 surgeries among 23 (95.6%). There were 3 oligodendrogliomas and 2 astrocytomas (4 gliomas became malignant at fourth or fifth operation). Although the preoperative tumor volume significantly increased before the fourth (p = 0.026) and fifth operation (p = 0.003) compared with the first operation, there was no significant difference between the residual tumor volume after the fourth or fifth resection versus the first one. The mean delay was 10.6 ± 3.9 years before chemotherapy and 15.4 ± 3.4 years before radiotherapy (one patient never received adjuvant treatment after 21.5 years). The mean follow-up duration was 18.3 ± 3.1 years since the first surgery (2.3 ± 1.8 years since the last surgery). Three patients were still alive at last follow-up. Conclusions: This is the first series showing that to reoperate beyond three times is feasible with a low functional risk and a long survival in multiple LGG recurrences, with the use of awake mapping in 87.5% of 4th and 5th surgeries. [ABSTRACT FROM AUTHOR]

Purpose: The C-reactive protein-albumin-lymphocyte (CALLY) index, which simultaneously evaluates the nutritional, immunological, and inflammatory statuses, is a new prognostic biomarker in patients with various cancers; however, no study has reported the clinical significance of the CALLY index in patients with pancreatic cancer. This study aimed to investigate whether the preoperative CALLY index is a prognostic biomarker in patients undergoing surgical resection of pancreatic cancer. Methods: We retrospectively enrolled 461 patients with pancreatic cancer who underwent surgical resection between January 2013 and December 2022. The overall survival (OS) and relapse-free survival (RFS) rates were calculated using the Kaplan–Meier method. Univariate and multivariate analyses were performed using Cox proportional hazards regression models. Results: The optimal cut-off value for the preoperative CALLY index was 1.9. In the low CALLY group, patients were older (p = 0.012), more patients underwent pancreaticoduodenectomy (p = 0.002), the median tumor size was larger (p < 0.001), more patients had pathologically confirmed metastatic lymph nodes (p = 0.015) and worse pathological stage (p = 0.015), and fewer patients received adjuvant chemotherapy (p = 0.003). A low CALLY index was associated with decreased OS (22.1 vs. 37.9 months) and RFS (12.4 vs. 16.4 months). Univariate and multivariate analyses showed that the preoperative CALLY index was an independent prognostic factor for OS (p < 0.001) and RFS (p = 0.045). Conclusion: The preoperative CALLY index is a prognostic biomarker for both OS and RFS in patients undergoing surgery for pancreatic cancer. [ABSTRACT FROM AUTHOR]

Background: Video-assisted thoracic surgery decortication for phase 3 thoracic empyema is widely accepted, but its optimal timing has not been established. We aim to investigate and assess this timing, in terms of overall survival, for chronic empyema. Methods: Two hundred four patients with pneumonia-caused phase 3 empyema were treated with video-assisted thoracic surgery decortication over 10-years at Changhua Christian Hospital. The 90-day post-operative survival status was analyzed, and we compared the survivor group versus the non-survivor group. A receiver operating characteristic curve was used to identify the optimal decortication timing. Results: A comparison between survivors and non-survivors showed statistical differences among age (p=0.004), presence of cardiovascular disease (p=0.018), presence of end-stage renal disease (p=0.002), duration to surgery (p=0.013), length of intensive care unit stay (p=0.010), and overall length of hospital stay (p=0.015). ROC curve analysis determined the cut-off for video-assisted thoracic surgery decortication, based on optimal 90-day post-operative survival, to be 7.5 days after hospitalization; mortality increases threefold thereafter (14.2% vs 44.6%, p<0.001). Multivariate analysis revealed that age, end-stage renal disease, pleural effusion pH≦7.2 and duration to surgery >7.5 days negatively impacted 90-day post-operative survival. Conclusions: Patients receiving decortication surgery within 7.5 days of hospital admission had better overall survival. [ABSTRACT FROM AUTHOR]

In recent years, CD9 has been extensively studied as a potential biomarker for cancer. However, the biological role of CD9 in gliomas remains unclear. This study investigates the function of CD9 in gliomas and its molecular mechanisms. Utilizing pan-cancer analysis with TCGA, CGGA, and GEO databases, differential expression of CD9 was observed in 11 tumor types within the TCGA cohort, and it was associated with patient survival rates. Analysis of the CGGA glioma database revealed that patients with high CD9 expression had lower survival rates. The area under the ROC curve (AUC) for GSE16011 was greater than 0.7, indicating a high discriminative ability. Through gene set enrichment analysis (GSEA), immune-related analysis, and CD9 mutation detection, CD9 was found to have the strongest correlation with neutrophil involvement (cor = 0.30, P < 0.05), and the high CD9 expression group exhibited higher rejection responses and TIDE scores, suggesting a lower likelihood of successful immunotherapy. The high CD9 expression group was more sensitive to 81 drugs, indicating potential therapeutic effects for gliomas. Furthermore, overexpression of CD9 in gliomas may be associated with gene mutations. Down-regulation or up-regulation of CD9 expression in the glioblastoma cell line LN229 showed that CD9 could positively regulate the migratory ability of LN229 cells. Further, several marker genes, such as VEGFR-2, TGF-β1, CASP1 and PI3K, were down regulated in CD9 knockdown cell lines and up regulated in CD9 overexpression cell lines, compared with control cell line. This study preliminarily explores the role of CD9 in gliomas and its prognostic value, providing new insights for personalized treatment strategies in glioma therapy. [ABSTRACT FROM AUTHOR]

Purpose: Pancreatic ductal adenocarcinoma (PDAC) can be classified into distinct histological subtypes based on the WHO nomenclature. The aim of this study was to compare the prognosis of conventional PDAC (cPDAC) against the other histological variants at the population level. Methods: The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients with microscopically confirmed PDAC. These patients were divided into 9 histological subgroups. Overall survival was assessed using the Kaplan-Meier method and Cox regression models stratified by tumor histology. Results: A total of 159,548 patients with PDAC were identified, of whom 95.9% had cPDAC, followed by colloid carcinoma (CC) (2.6%), adenosquamous carcinoma (ASqC) (0.8%), signet ring cell carcinoma (SRCC) (0.5%), undifferentiated carcinoma (UC) (0.1%), undifferentiated carcinoma with osteoclast-like giant cells (UCOGC) (0.1%), hepatoid carcinoma (HC) (0.01%), medullary carcinoma of the pancreas (MCP) (0.006%) and pancreatic undifferentiated carcinoma with rhabdoid phenotype (PUCR) (0.003%). Kaplan-Meier curves showed that PUCR had the worst prognosis (median survival: 2 months; 5-year survival: 0%), while MCP had the best prognosis (median survival: 41 months; 5-year survival: 33.3%). In a multivariable Cox model, several histological subtypes (i.e. CC, ASqC, SRCC, UCOGC) were identified as independent predictors of overall survival when compared to cPDAC. Conclusion: PDAC is a heterogenous disease and accurate identification of variant histology is important for risk stratification, as these variants may have different biological behavior. [ABSTRACT FROM AUTHOR]

The increasing abundance of animal species thriving in urban environments is a source of conflicts with managers and users of public spaces. Although opportunistic urban species often use resources originating from human food leftovers, the potential impact of a reduction in these resources on their demography is hard to quantify. The COVID-19 epidemic, which led many countries to set up lockdowns, gave us the opportunity to estimate the impact of a drastic reduction in such food resources and human activities on the demography of an urban bird population. Based on 7 years (2015–2021) of capture-mark-recapture of carrion crows (Corvus corone) in the city of Paris, France, we used multi-state models to examine the intra-annual (3-month time steps) apparent survival and movement patterns of crows during and outside COVID-19 lockdowns. We showed that the apparent survival of juvenile carrion crows decreased down during lockdown, while adult movements increased during this period, with more adult crows moving out of the urban district. Lockdown modified the demography of this urban crow population, suggesting that the reduction in food resources was sufficient to affect fitness and reduce carrying capacity. [ABSTRACT FROM AUTHOR]

Purpose: To assess the impact of neoadjuvant and adjuvant chemotherapy on survival outcomes, within a large multicenter cohort of Upper tract urothelial carcinoma patients treated with Nephroureterectomy. Methods: A multicenter retrospective analysis utilizing the Robotic surgery for Upper Tract Urothelial Cancer Study registry was performed. Baseline, preoperative, perioperative, and pathologic variables of three groups of patients receiving surgery only, neoadjuvant or adjuvant chemotherapy were compared. Categorical and continuous variables among the three subgroups were compared with Chi square and ANOVA tests. The impact of perioperative chemotherapy on survival outcomes was assessed with the Kaplan Meier method. Univariable and multivariable Cox regression analyses were performed to identify predictors of survival. Results: Overall, 1,994 patients were included. Overall and Clavien grade ≥3 complications rates were comparable among the three subgroups (p = 0.65 and p = 0.92). At Kaplan Meier analysis, neoadjuvant chemotherapy significantly improved cancer-specific survival (p = 0.03) and overall survival (p = 0.03) probabilities of patients with cT ≥ 3 tumors and of those with positive cN (p = 0.03 and p = 0.02). On multivariable analysis, neoadjuvant chemotherapy was independently associated with an improvement of cancer-specific survival in cT ≥ 3 patients (HR 0.44; p = 0.04), and of both cancer-specific survival (HR 0.50; p = 0.03) and overall survival (HR 0.53; p = 0.02) probabilities in positive cN patients. Conclusions: This large multicenter retrospective analysis suggests significant survival benefit in Upper tract urothelial carcinoma patients with either locally advanced or clinically positive nodes disease receiving neoadjuvant chemotherapy. These findings can be regarded as "hypothesis generating", stimulating future trials focusing on such advanced stages. [ABSTRACT FROM AUTHOR]

Background: The utility of sentinel lymph node biopsy (SLNB) in older patients remains controversial. Advancements in human epidermal growth factor receptor 2 (HER2)-directed therapy have revolutionized disease response rates and prognosis, supporting efforts to re-evaluate the utility of SLNB. We aimed to assess the differences in treatment and overall survival (OS) in older patients with HER2-positive breast cancer based on SLNB. Methods: Using the National Cancer Database (2010–2020), patients ≥ 70 years of age diagnosed with cT1-2/cN0/M0, HER2-positive breast cancer were identified. Logistic regression assessed associations with SLNB, systemic therapy, and radiation. Cox proportional hazard models were used to identify factors associated with OS. Analyses were stratified by treatment sequence, i.e. upfront surgery or neoadjuvant therapy (NAT) followed by surgery. Results: Of the 17,609 patients included, 94% underwent upfront surgery (n = 16,492) and the remaining underwent NAT (n = 1117). Those who underwent SLNB were more likely to receive adjuvant therapy, irrespective of nodal status {upfront surgery/systemic therapy (odds ratio [OR] 2.82, 95% confidence interval [CI] 2.17–3.67); upfront surgery/radiation (OR 3.97, 95% CI 3.03–5.21); NAT/radiation (OR 5.69, 95% CI 1.83–17.69)}. The breast pathologic complete response (pCR) rate was highest among the hormone receptor (HR)-negative/HER2-positive subtype (50.0%), of which none were found to be ypN+. Comorbidity burden was associated with significantly lower rates of adjuvant systemic therapy and worse OS. Conclusions: Patients who underwent SLNB, regardless of pN status, were more likely to receive adjuvant therapy. Nodal positivity is exceedingly rare for patients with a breast pCR following NAT, especially among the HR-negative/HER2-positive subtype. It is reasonable to consider omission of SLNB in select subgroups of older patients with HER2-positive breast cancer. [ABSTRACT FROM AUTHOR]

Purpose: Altered lipid metabolism frequently occurs in patients with solid cancers and dyslipidemia has been associated with poorer outcomes in patients with colorectal cancer. This study sought to investigate whether cholesterol levels are associated with clinical outcomes and can serve as survival predictors. Methods: We conducted a retrospective cohort study with Danish patients diagnosed with colorectal cancer who had surgery with curative intent for UICC stages I to III between 2015 and 2020. Using propensity score adjustment, we matched patients in a 1:1 ratio to examine the impact of total cholesterol (TC) > 4 mmol/L vs. ≤ 4 mmol/L within 365 days prior to surgery on overall survival (OS) and disease-free survival (DFS). Results: A total of 3443 patients were included in the study. Median follow-up time was 3.8 years. Following propensity score matching, 1572 patients were included in the main analysis. There was no statistically significant difference in OS or DFS between patients with TC > 4 mmol/L compared with TC ≤ 4 mmol/L (HR: 0.82, 95% CI, 0.65–1.03, HR: 0.87, 95% CI, 0.68–1.12, respectively.). A subgroup analysis investigating TC > 4 mmol/L as well as low-density lipoprotein (LDL) > 3 mmol/L found a significant correlation with OS (HR: 0.74, 95% CI, 0.54–0.99). Conclusion: TC levels alone were not associated with OS or DFS in patients with colorectal cancer. Interestingly, higher TC and LDL levels were linked to better overall survival, suggesting the need for further exploration of cholesterol's role in colorectal cancer. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Dementia is a common comorbidity in older patients with traumatic brain injury (TBI), potentially affecting their care processes and outcomes. However, the impact of pre-existing dementia on TBI remains unclear as research on TBI often excludes older adults with comorbidities. This study aimed to investigate the association between pre-existing dementia and outcomes in older patients admitted to hospitals after TBI. Methods: This observational study included patients aged ≥ 65 years with TBI who were identified from the Japan Trauma Data Bank between January 1, 2019, and December 31, 2021. Associations between pre-existing dementia and outcomes were assessed using multivariable logistic regression analysis. The primary outcome was survival at discharge. Secondary outcomes were neurosurgical interventions and discharge to home. Results: In total, 16,270 patients from 175 hospitals were analyzed. Of these, 1,750 (10.8%) had pre-existing dementia, and 13,520 (83.1%) survived to discharge. No significant association was observed between pre-existing dementia and neurosurgical interventions and survival at discharge. In contrast, pre-existing dementia was associated with a significantly lower likelihood of being discharged to home. Subgroup analysis revealed interactions between pre-existing dementia and the subgroups, showing adverse impact in relatively younger patients and those without severe head injury. Conclusions: Patients with pre-existing dementia had similar chances for neurosurgical intervention and survival at discharge than their counterparts without dementia. However, pre-existing dementia was associated with a significantly lower likelihood of being discharged to home, especially in relatively younger patients and those without severe head injury. Therefore, recognizing the risks within this population and taking measures to facilitate social reintegration is necessary. [ABSTRACT FROM AUTHOR]

Background: Differences in 30-day survival between males and females following out-of-hospital cardiac arrest (OHCA) are well documented. Biological sex does not appear to be responsible for this survival gap independently of potential mediating factors. We investigated the role of potential mediating factors in the association between sex and 30-day survival after OHCA in Scotland. Methods: A retrospective cohort study of adult non-emergency medical services (EMS)-witnessed OHCA cases was conducted. We included incidents from the whole of Scotland where resuscitation was attempted by the Scottish Ambulance Service (SAS) between April 1, 2011 and March 1, 2020. Logistic regression was used to assess the contribution of age, socioeconomic status, urban–rural location of the incident, initial cardiac rhythm, bystander cardiopulmonary resuscitation (CPR) and location of the arrest (home or away from home). Results: The cohort consisted of 20,585 OHCA cases (13,130 males and 7,455 females). Median (IQR) age was 69 years (22) for males versus 72 years (23) for females. A higher proportion of males presented with initial shockable rhythm (29.4% versus 12.4%) and received bystander CPR (56.7% versus 53.2%) compared with females. A higher proportion of females experienced OHCA at home (78.8% versus 66.8%). Thirty-day survival after OHCA was higher for males compared with females (8.2% versus 6.2%). Males had higher age-adjusted odds for 30-day survival after OHCA than females (OR, 1.26; (95% CI), 1.12–1.41). Mediation analyses suggested a role for initial cardiac rhythm and location of the arrest (home or away from home). Conclusion: Males had higher age-adjusted 30-day survival after OHCA than females. However, after adjusting for confounding/mediating variables, sex was not associated with 30-day survival after OHCA. Our findings suggest that initial cardiac rhythm and location of the arrest are potential mediators of higher 30-day OHCA survival in males than females. Improving proportions of females who present with initial shockable rhythm may reduce sex differences in survival after OHCA. [ABSTRACT FROM AUTHOR]

Introduction: The methylation of the O6-Methylguanine-DNA Methyltransferase (MGMT) promoter is a valid biomarker for predicting response to therapy with alkylating agents and, independently, prognosis in IDH-wildtype(IDH-w) glioblastoma. We aim to study the impact of its methylation in overall survival of the unresectable IDH-w glioblastoma undergoing biopsy and systemic treatment. Methods: We collected six-year retrospective (2017–2023) data at a quaternary neurosurgery center for patients undergoing biopsy as the only surgical procedure for an unresectable IDH wildtype glioblastoma. Data was collected from patient records including neuro-oncology multidisciplinary team meeting (MDT) documentation. Patients were grouped into categories according to different types of treatment received after biopsy (no treatment, chemotherapy (CT), radiotherapy (RT), chemoradiotherapy (CRT), chemoradiotherapy with adjuvant temozolomide (CRT with adjuvant TMZ), EORTC-NCIC protocol followed by second line treatment) and according to methylation status (unmethylated (< 5%), borderline methylated (5–15%) and strongly methylated (> 15%)). Survival analysis was performed. Results: 166 glioblastoma IDH wildtype patients were included in the study with mean age of 62.5 years (M: F = 1.5: 1). 70 (49.3%) patients had unmethylated MGMT status (< 5%), 29 (20.4%) patients had borderline methylated MGMT status (5–15%) and 43 (30.2%) patients had methylated MGMT status (> 15%). 36 (25.3%) patients did not receive any treatment post biopsy, 13 (9.1%) received CT only, 27 (19%) RT only, 12 (8.4%) CRT, 33 (23.2%) CRT with adjuvant TMZ, whereas 21 (14.7%) received EORTC-NCIC protocol along with second line treatment. In biopsy only group, there was no notable difference in survival outcomes among the different methylation statuses. For biopsy and any-other-form-of-treatment methylated groups showed a distinct trend of better survival compared to the borderline or unmethylated groups. Overall, methylated patients had better survival as compared to unmethylated or borderline groups. Conclusion: Methylated MGMT status are predictors for better overall survival in unresectable IDH wildtype glioblastoma patients undergoing biopsy and treatment regardless of the treatment modality. [ABSTRACT FROM AUTHOR]

Bronchus-associated lymphoid tissue (BALT) is a rare cause of extranodal marginal zone lymphoma (MZL). Although most patients with BALT lymphoma (BALToma) show an indolent clinical course and are monitored without treatment, there are limited real-world data on the long-term outcome of "watch-and-wait' strategy in comparison with other treatments. The survival outcomes of patients newly diagnosed with BALToma at three tertiary hospitals in Korea undergoing two treatment strategies were analyzed: group A, patients who were monitored without any treatment or received only radiotherapy after diagnosis; and group B, patients receiving any kind of systemic chemotherapy after diagnosis, regardless of their history of any local treatment such as surgery or radiotherapy. Of the 67 patients included in our analysis, the 10-year progression-free survival (PFS) and 10-year overall survival (OS) rates were 65.3% and 83.2%, respectively. The 10-year PFS rates for observation or localized treatment and systemic chemotherapy were 78.7% and 56.9%, respectively (p = 0.044). Ten-year OS rates for observation or localized treatment and systemic chemotherapy were 100% and 71.7%, respectively (p = 0.016). Multivariate analysis showed that bilateral lung (HR 2.462, p = 0.047) and extrapulmonary organ (HR 4.485, p = 0.004) involvement were the only significant factors associated with poor PFS. Prognostic factor analysis for OS did not yield significant results. Patients with BALToma show a favorable prognosis, suggesting that observation or localized therapy alone may be effective for patient management. However, patients with bilateral lung or extrapulmonary involvement may require careful monitoring for disease progression and more aggressive treatment approaches. [ABSTRACT FROM AUTHOR]

Background: Early risk stratification is necessary to prevent chronic kidney disease progression and complications. This systematic review aims to evaluate the association of soluble suppression of tumorigenicity 2 (sST2), a member of the interleukin-1 receptor family, with all-cause mortality, cardiovascular disease and renal function deterioration among chronic kidney disease patients. Methods: PubMed, Scopus, Web of Science, CENTRAL and Google Scholar were systematically searched from inception to December 20, 2023. Cohort studies examining the prognostic role of sST2 levels in pre-dialysis and dialysis patients were included. In case of 3 or more studies per outcome, conventional and dose–response meta-analyses were conducted. Results: Overall, 21 studies were included comprising 15,100 patients. In pre-dialysis patients, the qualitative synthesis of studies suggested that high sST2 is associated with significantly increased all-cause mortality, while evidence regarding cardiovascular events or kidney disease progression was conflicting. In the dialysis population, high sST2 was linked to an elevated risk of all-cause (Hazard ratio-HR: 3.00, 95% confidence intervals-CI: 1.95–4.61) and cardiovascular (HR: 2.38, 95% CI: 1.69–3.34) mortality. Dose–response meta-analysis suggested a log-linear association of sST2 with both all-cause (χ2: 34.65, p value < 0.001) and cardiovascular (χ2: 29.14, p value < 0.001) mortality, whereas findings regarding cardiovascular events were limited with mixed results. Conclusions: High sST2 values are associated with an increased risk of all-cause mortality in pre-dialysis and dialysis patients, as well as with an elevated risk of cardiovascular mortality in the dialysis population. Further studies are needed to elucidate its potential association with cardiovascular events and kidney disease progression. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this prospective randomized controlled trial was to compare the clinical outcome and the survival rate of total knee arthroplasty between CT- and MRI-based patient-specific instrumentation 5 years after initial surgery. Methods: At a mean follow-up of 5.8 years (SD 0.3), 98 patients (64% women, loss to follow-up 28%) were included in this analysis. To assess the differences in clinical outcome, patients fulfilled PROMs preoperatively and at each follow-up moment. At final follow-up, the Forgotten Joint Score was adjusted. Results: At final follow-up, no new patients underwent revision surgery in both groups. Regarding the clinical outcome, no statistically significant difference between the groups was found. The Forgotten Joint Score was only performed at final follow-up and showed no significant difference between both groups. Conclusion: At mid-term follow-up, survival rates between CT- and MRI-based patient-specific instrumentation did not show a significant difference. Regarding clinical outcome, only the EQ-5D-VAS (p < 0.040) showed a statistically significant difference over time, in favor of the MRI-group. Level of evidence: Level I. [ABSTRACT FROM AUTHOR]

Springtails are a very common, widely spread component of soil fauna that play a significant role in numerous physical, chemical, and biological processes in the soil. Therefore, it is important to understand how their evolution and demographic parameters have changed throughout time. Since salinity is a relevant condition in the soils around the World and particularly in Mexico, the major goal of the current research is to understand the life cycle strategies of two springtail species from saline soils in Mexico. The studied species are Clavisotoma filifera and Brachystomella gabrielae, both widely distributed in Mexico, but their development or life history strategies are unknown. We found from laboratory cultures that C. filifera had a shorter life cycle and a faster reproduction rate than B. gabrielae. Nevertheless, both species show the same number of developmental stages, but there are interspecific differences in their duration. Although both species continuously reproduce throughout the year, the reproductive rate is lower in the months that are associated with the dry season at the source site. Additionally, we discovered variations in both the size and number of eggs in each species. It was found that the species under study had various life strategies for growth in the same environment. Clavisotoma filifera shows a more r-focused strategy (high fecundity, numerous offspring, shorter gestation and faster maturity), B. gabrielae shows an opposite strategy, closer to q strategy, with a lower fecundity, larger eggs, fewer reproductive events and slower maturity. [ABSTRACT FROM AUTHOR]

Previous research has reported high occult nodal metastases rates for T3/T4 mucoepidermoid carcinoma (MEC) of the oropharynx (OP) and oral cavity (OC). Our study evaluates if there is a benefit of neck dissection (ND) in these patients. The 2004–2016 National Cancer Database was queried for cases of adult MEC of the OC and OP. Patients with clinical T3/T4 disease were included while those with metastatic disease were excluded. Patients were divided into two cohorts: those treated with and without ND. Univariate chi-square, Kaplan-Meier, and multivariable Cox regression analyses were implemented. A total of 243 patients met inclusion criteria, of which 79 (32.5%) underwent ND. The majority of patients were less than 60 years old (60.1%), White (76.2%), and male (53.5%). 92 (37.9%) patients had clinically node-positive (cN+) disease. ND patients had higher rates of cN + disease (53.2% vs. 30.5%, p = 0.002). Of patients undergoing ND, 35 (44.3%) had cN0 disease while 42 (53.2%) had cN + disease. ND patients more commonly had grade III/IV tumors (45.1% vs. 23.4%, p = 0.002). Upon examination of dissected nodes, 20.3% of cN0 patients undergoing ND were found to have occult nodal metastases. There was no significant difference in 5-year overall survival between patients with and without ND (61.8% vs. 53.6%, p = 0.610), even on multivariable Cox analysis (hazard ratio: 1.52, 95% confidence interval: 0.73–3.18, p = 0.269). Our study found patients with cN0 MEC of the OC and OP have a high rate (20.3%) of occult nodal metastasis. In this cohort, patients with ND were not found to have improved survival, possibly due to statistical underpowering. Further research is needed to evaluate the indications and benefit of ND for this rare tumor presentation. Keypoints: Previous research has reported high occult nodal metastases rates for T3/T4 mucoepidermoid carcinoma (MEC) of the oropharynx (OP) and oral cavity (OC). Neck dissection patients had higher rates of cN + disease and more commonly had grade III/IV tumors. Patients with MEC of the OP and OC have a high rate of occult nodal metastasis, suggesting neck dissection should be given strong consideration for these patients. There was no significant difference in 5-year overall survival between patients treated with and without neck dissection. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies on multisystem atrophy (MSA) are scarce. Our aim has been to analyse 10-year incidence, point prevalence, survival, and the time to diagnosis of MSA in Navarre, a northern Spanish region. Methods: This is a population-based observational retrospective study, from 2012 to 2021, which covered the population of Navarre (followed until 31 December 2021). Data from various sources of health information were reviewed in order to identify all potential diagnoses of MSA, that were validated from medical records. Patients were included if they fulfilled the new Movement Disorder Society criteria. Results: We observed a crude average annual incidence rate (IR) of 0.49/100,000 person-years, with the highest occurring in the age group of 60–69 years. No significant IR differences by sex or subtype were observed. Point prevalence in December 2021 was 2.43/100,000 inhabitants. Joinpoint analysis for global incidence and prevalence experienced stable annual rates during the whole period, showing an upward trend for prevalence without a statistically significant slop. The median age at symptom onset was 65 years (range 47–76). The median time to diagnosis was 36 months, without statistically significant differences between sex, age at diagnosis or subtypes. Median time of survival from clinical onset was 7 years. Age of onset above 70 years and autonomic onset were associated with reduced survival. Conclusions: This is the first population-based epidemiological study on MSA in Spain. It provides detailed incidence and prevalence data for MSA that may be useful for appropriate management of health resources. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to determine the nutritional status and its prognostic effect on the survival of patients with advanced gastrointestinal cancer. Methods: A prospective cohort study design was conducted in a tertiary hospital in Shanghai, China. The study consisted of 202 advanced gastrointestinal (GI) cancer patients from a palliative care unit. The following data were collected from the patients: biochemical indicators, i.e., anemia (hemoglobin levels), albumin, pre-albumin, C-reactive protein (CRP), and anthropometric parameters, i.e., body mass index (BMI), nutritional status by Patient-Generated Subjective Global Assessment (PG-SGA), and performance status by Karnofsky Performance Status (KPS). Severe malnutrition was confirmed with the PG-SGA score of ≥ 9. Kaplan–Meier survival analysis and the log-rank test were used to calculate overall survival (OS). The effect of nutritional status on survival was performed by Cox regression analysis. Results: Severe malnutrition was found in 71.3% of patients according to the cutoff of the PG-SGA. PG-SGA score ≥ 9, albumin level < 35 g/L, and CRP level ≥ 10 mg/L predicted shortened life expectancy. Multivariate Cox regression analysis results showed that the PG-SGA score ≥ 9 and the albumin level < 35 g/L were predictive of OS. Conclusion: Our data support that severe malnutrition is a predictor for OS in patients with advanced GI cancer. Information on nutritional status should be considered to individualize palliative care plan for these patients, and hence improve their quality of life. [ABSTRACT FROM AUTHOR]

To assess whether there were statistically significant differences in terms of overall survival (OS) and progression-free survival (PFS) between pelvic lymphadenectomy (PL) and sentinel lymph node biopsy (SLNB) alone as a nodal assessment method in patients with early-stage cervical cancer (IA1 with ILV to IB2 or IIA1 of the FIGO 2018 classification). A retrospective study was conducted among patients with early-stage cervical cancer who underwent radical surgery with pelvic lymph node assessment at La Paz University Hospital between 2005 and 2022. For nodal staging, either PL, SLNB + PL, or exclusive SLNB were performed, depending on the time period. Kaplan–Meier survival curves were compared between the PL and SLNB groups. Predictors of bilateral sentinel lymph node (SLN) detection were identified with Cox proportional hazard models. Among the 128 patients included, PL ± SLNB was performed in 79 (61.7%) patients and exclusive SLNB in 49 (38.3%) patients. There was no difference between PL and SLNB in OS (log-rank 0.0730) or PFS (log-rank 0.0189). Lower limb lymphedema (LLL) was significantly lower in the SLNB group (p = 0.001). Pelvic nodal assessment with SLNB alone did not worsen survival rates compared with the standard PL in patients with early-stage cervical cancer, and it is associated with a lower rate of LLL. [ABSTRACT FROM AUTHOR]

Background: Critically ill patients with chronic obstructive pulmonary disease (COPD) face significant mortality after hospital discharge. Delirium is common in patients with COPD, but its impact on long-term mortality in critically ill COPD patients who survive to discharge remains uncertain. Methods: Critically ill patients with COPD who survived to discharge were selected from the Medical Information Mart for Intensive Care IV database. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. The primary outcome was 365- and 180-day mortality after discharge. The secondary outcomes included 90- and 30-day mortality following discharge, length of intensive care unit (ICU) and hospital stays, and nursing care needs after hospital discharge. Results: Of the 2621 survivors of critically ill COPD patients, 982 had suffered delirium during their ICU stay and 709 died within 365 days after hospital discharge. Delirium was significantly associated with 365-day mortality after hospital discharge (adjusted hazard ratio [HR] 1.22; 95% confidence interval [CI] 1.02–1.47). The results were consistent for 180-, 90-, and 30-day post-discharge mortality (adjusted HR [95% CI]: 1.35 [1.09–1.66], 1.48 [1.16–1.89], and 1.68 [1.21–2.32], respectively). Additionally, patients with delirium had longer ICU and hospital stay (adjusted β 2.75; 95% CI 2.35–3.16 and 4.25; 95% CI 3.51–4.98, respectively) and increased nursing care needs after hospital discharge (adjusted odds ratio, 1.56; 95% CI 1.13–2.14). Conclusion: ICU delirium was an independent risk factor for both long-term and short-term mortality in critically ill patients with COPD who survived to discharge. [ABSTRACT FROM AUTHOR]

The study was designed to assess the association of ACE I/D polymorphism with the severity and prognosis of COVID-19 in the Iranian population. Hence, 186 adult patients were categorized into three clinical groups based on the severity of COVID-19: 1) Outpatients or mildly symptomatic patients as control (n = 71); 2) Hospitalized patients or severe symptomatic cases (n = 53); 3) Inpatients led to ICU/death or critically ill patients needed mechanical ventilation (n = 62). The possible association of ACE I/D polymorphism with the risk of comorbidities and serum level of C-reactive protein was evaluated in two severe cases. The results showed that the frequency of D and I alleles are 69.35% and 30.65%, respectively, in the total population. The analysis of allelic frequencies via Fisher's exact test confirmed significantly higher frequency of D allele in both severe groups than that in the mild one, 78.31% in Hospitalized patients (OR = 2.56; 95% CI 1.46 to 4.46; p-value = 0.0011) and 74.19% in Inpatients led to ICU/death (OR = 2.04; 95% CI = 1.22 to 3.43; p-value = 0.0094) compared to 58.45% in Outpatients. The results of genotype proportions displayed an association between COVID-19 severity and DD genotype. Overall, our findings in Iranian patients supported the undeniable role of the DD genotype in the intensity of the disease, comparable to other populations. Furthermore, there is no definite evidence regarding the protective effect of the I allele in our inquiry. [ABSTRACT FROM AUTHOR]

Objective: One of the possible risks of sinonasal malignancy is its possible spread in the orbit. However, there is no clear consensus among the different departments as to whether it is necessary to exenterate the orbit in limited tumorous infiltration of periorbital fat. The purpose of the study was to demonstrate that periorbital infiltration and periorbital fat invasion without involvement of deeper orbital tissues are not the indication of orbital exenteration. Materials and methods: Retrospective analysis was performed over a 17-year period of patients undergoing surgical treatment for sinonasal malignancy with histologically verified periorbital infiltration or deeper invasion into the orbit. A total of 32 patients were included in the study. For each group, the following data were analysed: sex, age, preoperative imaging studies, histological findings, site of origin, stage, surgical reconstruction, oncological treatment, survival, cause of death, number of recurrences in the orbit and functional status of preserved eyes. Results: Based on our criteria for orbital exenteration, orbital preservation was feasible in 18 patients. Orbital exenteration was performed in 14 patients with deeper tumor infiltration. There was a statistically insignificant difference in survival between the two groups. The 5-year overall survival (OS) was 44% for the orbital preservation group (only 2 patients died from local tumor recurrence) and 34% for the orbital exenteration group. The groups did not differ in other observed factors other than the extent of orbital infiltration. In 11 (61.1%) patients, vision was without significant change after radiation therapy. In 2 (11.1%) patients, visual function was impaired due to diplopia. 5 (27.8%) patients had severely impaired vision due to optic nerve atrophy after radiation therapy. Conclusions: Our results show a relatively high survival rate in the group of patients with orbital preservation with a high chance of vision preservation, which justifies our approach to orbital preservation even in some tumors with periorbital infiltration. [ABSTRACT FROM AUTHOR]

Purpose: Patients with p16 positive tonsillar cancer (p16 + TC) have an excellent prognosis and long-life expectancy. Deintensification of therapy is a prevalent topic of discussion. Proton radiotherapy is one way to reduce radiation exposure and thus reduce acute and late toxicity. The aim is to evaluate treatment outcomes and toxicity of postoperative treatment with intensity-modulated proton therapy (IMPT). Methods: Between September 2013 and November 2021, 47 patients with p16 + TC were treated postoperatively with IMPT. Median age was 54.9 (38.2–74.9) years, 31 were males and 16 were females. All patients had squamous cell carcinoma and underwent surgery as a primary treatment. Median dose of radiotherapy was 66 GyE in 33 fractions. Bilateral neck irradiation was used in 39 patients and unilateral in 8. Concomitant chemotherapy was applied in 24 patients. Results: Median follow-up time was 4.2 (0.15–9.64) years. Five-year overall survival, relapse free survival and local control were 95.7%, 97.8% and 100%. The most common acute toxicities were dermatitis and mucositis, with grade 2 + in 61.7% and 70.2% of patients. No acute percutaneous gastrostomy insertion was necessary and intravenous rehydration was used in 12.8% of patients. The most common late toxicity was grade 1 xerostomia in 70.2% of patients and grade 2 in 10.6% of patients. Subcutaneous fibrosis of grades 2 and 3 occurred in 17.0% and 2.1% of patients, respectively. One patient developed late severe dysphagia and became PEG-dependent. Conclusion: IMPT for the postoperative treatment of p16 + TC is feasible with excellent efficiency and acceptable acute and late toxicity. [ABSTRACT FROM AUTHOR]

Purposes: Delayed chest closure (DCC) is a widely accepted procedure in the context of lung transplantation (LTx); yet there are few reports detailing its long-term survival and clinical outcomes. Methods: We reviewed the medical records of recipients who underwent deceased-donor lung transplantation (LTx) at Tohoku University Hospital. Long-term survival, including overall survival, freedom from chronic lung allograft dysfunction (CLAD), and CLAD-free survival and the clinical outcomes of graft function and physical performance and constitution were reviewed in recipients with DCC. Results: Between 2009 and 2022, 116 patients underwent LTx, 33 of whom (28.4%) required DCC. The intra—and post-operative courses of the recipients who required DCC were more complicated than those of the recipients who underwent primary chest closure (PCC), with frequent volume reduction surgery and longer periods of invasive mechanical ventilation. Pulmonary vascular disease was considered a risk factor for these complications and DCC. Nonetheless, long-term survival and graft functions were comparable between the DCC and PCC groups. The physical performance and constitution of recipients who required DCC continued to improve, and by 2 years after transplantation, exhibited almost no difference from those who underwent PCC. Conclusions: In view of the profoundly complicated intra- and post-operative courses, DCC should be performed cautiously and only when clinically indicated, despite which it can result in equivalent long-term survival and acceptable outcomes to PCC. [ABSTRACT FROM AUTHOR]

Women with a personal history of breast cancer (PHBC) are at an increased risk of either a local recurrence or a new primary breast cancer. Thus, surveillance is essential for the detection of recurrent disease at the earliest possible stage, allowing for prompt treatment, and potentially improving overall survival. Nowadays, mammography follow-up is the only surveillance imaging technique recommended by international guidelines. Nevertheless, sensitivity of mammography is lower after breast cancer treatment, particularly during the first 5 years, due to increased density or post-treatment changes. Contrast-enhanced breast imaging techniques, such as MRI or contrast-enhanced mammography (CEM), are very sensitive to detect malignant enhancement, especially in dense breasts. This Special Report will provide arguments in favor of and against breast cancer follow-up with MRI or CEM, in a debate style between experts in Breast Imaging. Finally, the scientific points of pros and cons arguments will be summarized to help objectively decide the best follow-up strategy for women with a personal history of breast cancer. Clinical relevance statement: A personalized approach to follow-up imaging after conservative breast cancer treatment could optimize patient outcomes, using mammography as a baseline for most patients, and MRI or CEM selectively in patients with higher risks for a recurrence. Key Points: • Women with a personal history of breast cancer are at an increased risk of either a local recurrence or a new primary breast cancer. • Breast cancer survivors may benefit from additional imaging with MRI/CEM, in case of increased risk of a second breast cancer, with dense breasts or a cancer diagnosis before age 50 years. • As survival after local recurrence seems to depend on the initial stage at diagnosis, imaging should be more focused on detecting tumors in the earliest stages. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the IRECAP study was to evaluate the rate of locally advanced pancreas cancer patients (LAPC) who could undergo R0 or R1 surgery after irreversible electroporation (IRE). Materials and methods: IRECAP study is a phase II, single-center, open-label, prospective, non-randomized trial registered at clinicaltrials.gov (NCT03105921). Patients with LAPC were first treated by 3-month neo-adjuvant chemotherapy in order to avoid inclusion of either patients with LAPC having become resectable after chemotherapy or patients with rapid disease progression. In cases of stable disease, IRE was performed percutaneously under CT guidance. Surgery was planned between 28 and 90 days after IRE. Tumor specimens were studied to evaluate the resection margins (R0/R1/R2). Results: Six men and 11 women were included (median age 61 years, range 37–77 years). No IRE-related death was observed. Ten patients (58%, 10/17) experienced 25 serious adverse events related to IRE. Four patients progressed between IRE and surgery and were excluded from surgery. Thirteen patients were finally operated, six withheld for pancreas resection, three for diffuse peritoneal carcinosis, two for massive vascular entrapment, and one for hepato-cellular carcinoma not diagnosed before surgery. Rate of R1-R0 was 35% (n = 6/17). Median overall survival was 31 months (95% CI; 4–undefined) for the six patients with R0/R1 resection and 21 months (95% CI; 4–25) for the 11 patients without resection or R2 resection (logrank p = 0.044). Conclusion: After neoadjuvant chemotherapy, IRE could provide R0 or R1 resection in 35% of LAPC, which seems to be associated with higher OS. Clinical relevance statement: After induction chemotherapy, stable locally advanced pancreatic cancers can be treated by irreversible electroporation, which could lead to a secondary 35% rate of R0 or R1 surgical resection which may be associated with a significantly higher overall survival. Key Points: • In cases of unresectable LAPC (locally advanced pancreatic cancer), percutaneous irreversible electroporation (pIRE) is feasible (100% success rate of the procedure), but is associated with a 58% rate of grade 3–4 adverse events. • In patients with unresectable LAPC, pIRE could lead 35% of patients to R0-R1 surgical resection. • From IRE, median overall survival was 31 months (95% CI; 4–undefined) for the patients with R0/R1 resection and 21 months (95% CI; 4–25) for the patients without resection or R2 resection (logrank p = 0.044). [ABSTRACT FROM AUTHOR]

The pine processionary moth Thaumetopoea wilkinsoni (Tams, 1926) (Lepidoptera: Notodontidae) is one of the most harmful species that causes destruction in pine ecosystems and also causes critical skin reactions in humans and animals due to its urticating hairs. This study aimed to evaluate the efficacy of different strains [Bti ATCC 35646 (wild-type strain), Bti pHT315, and Bti pHTppk (mutant strain)] of Diptera-targeted Bacillus thuringiensis subsp. israelensis (Bti) and toxins (spore/crystal mixtures) obtained from these strains against the 4th larval stage of T. wilkinsoni under laboratory conditions. T. wilkinsoni eggs were collected from pine trees at Ondokuz Mayıs University in Samsun, Turkey, in 2022. Pine needles were contaminated with bacterial strains of different concentrations (1 × 107, 1 × 108, 1 × 109 cfu/mL) in 5 mL and toxins in different concentrations (0.15, 0.3, 0.6, 1.25, 2.5, 5 mg/mL) in 2 mL. Larvae were placed in containers with 30 larvae in each group and were observed for 25 days. As a result of the study, Bti ATCC 35646 with 63.4% mortality and the lowest LC50 value of 1.2 × 109 cfu/mL among the three strains of Bti and Bti pHTppk with 76.7% mortality and the lowest LC50 value of 1.2 mL among the toxins from the Bti strains had found to be virulent for T. wilkinsoni. The results obtained from our study suggest that Diptera-targeted Bti is virulent to T. wilkinsoni and that this strain and spore/crystal mixture can be used in the biological control of this species. [ABSTRACT FROM AUTHOR]

This study aims to analyze survival rates in milkfish modular cultivation systems and their correlation with fluctuations in temperature and salt content. The modular system method was used, with three plots: plot A as the nursery plot, plot B as the first rearing plot, and plot C as the enlargement plot 2. The research was conducted over 1 year with three maintenance cycles, each cycle lasting 4 months. The organisms were placed in plot A for a period of 1–8 months. Thus, in 1 year, plot A gets the opportunity to rest for 4 months while preparing, then in grow-out plot 1 and grow-out plot 2 for 2 months each, so that each grow-out plot gets the opportunity to rest while preparing for the next maintenance cycle. Results revealed that the temperature, salt content, pH, and dissolved oxygen were within the optimal range, with an average value of 29.4 °C, pH of 6.9, and dissolved oxygen of 31 ppm. However, the salt content fluctuated a lot, with values ranging between 5 and 45 ppt with an average value of 26.9 ppm. The average survival rate was 91% with a correlation of R2 = 0.906 (cycle 1), 95% with a correlation of R2 = 0.890 (cycle 2), and 97% with a correlation of R2 = 0.997 (cycle 3). To conclude, the modular cultivation system, apart from increasing survival rates, can also improve the pond soil environment. This system is highly suitable as a promising approach for sustainable fisheries development in the region. [ABSTRACT FROM AUTHOR]

Salinity and temperature significantly affect the growth and production of giant freshwater prawn Macrobrachium rosenbergii. This research investigated the effect of these two vital parameters on behaviour, survival, haemocyte-based cellular immunity, and proximate composition of M. rosenbergii. Adolescent prawns were exposed at five different salinities (0, 5, 10, 15, 20 ppt) and temperatures (22, 26, 30, 34, 38 °C) at a stocking of 6-ind/25-L glass tank with three replication and nursed up to 168 h. Prawn showed normal behaviour and movement up to salinity of 10 ppt, while rising salinity to 20 ppt associated with abnormal behaviour caused 50% mortality within 72 h and showed complete mortality after 96 h. Prawns exposed at 22–30 °C exhibited normal behaviours, while uplifting temperature to 34 °C showed unusual behaviour and mortality. Further increase of temperature to 38 °C, survival rapidly decreased to 33.33% after 24 h, and complete mortality happened within 72 h. Total haemocyte count and differential haemocyte count did not exhibit significant variation at salinity ≤ 10 ppt and temperature ≤ 30 °C, while there was a significant declination at higher salinities (≥ 15 ppt) and temperatures (≥ 34 °C). Interestingly, after a significant fall in protein content at 30 °C, it started to increase at higher temperatures. Meanwhile, a significant decrease in lipid content was recorded at salinity ≥ 15 ppt. Water quality measurements were within acceptable norms for prawn aquaculture throughout the experiment. According to this study, prawns' growth, behaviour, and immune system were mostly unaffected by saline levels up to 10 ppt and temperatures below 30 °C; thus, ranges could be adopted for climatically altered coastal environments. [ABSTRACT FROM AUTHOR]

Upper tract urothelial carcinoma (UTUC) accounts for the 5–10% of all urothelial carcinomas (UCs). In this analysis, we reported the real-world data from the ARON-2 study (NCT05290038) on the efficacy of pembrolizumab in patients with UTUC who recurred or progressed after platinum-based chemotherapy. Medical records of patients with metastatic UTUC treated with pembrolizumab as second-line therapy were reviewed from 34 institutions in 14 countries. Patients were assessed for overall survival (OS), progression-free survival (PFS), and overall response rate (ORR). Univariate and multivariate analyses were used to explore the association of variables of interest with OS and PFS. 235 patients were included in our analysis. Median OS was 8.6 months (95% CI 6.6–12.1), the 1 year OS rate was 43% while the 2 years OS rate 29%. The median PFS was 5.1 months (95% CI 3.9–6.9); 46% of patients were alive at 6 months, 34% at 12 months and 25% at 24 months. According to RECIST 1.1, 18 patients (8%) experienced complete response (CR), 57 (24%) partial response (PR), 44 (19%) stable disease (SD), and 116 (49%) progressive disease (PD), with an ORR of 32%. Our study confirms the effectiveness of pembrolizumab in patients pretreated with a platinum-based combination, irrespective of their sensitivity to the first-line treatment and of their histology. In addition, we emphasized the limited benefit of the treatment with pembrolizumab in patients with hepatic metastases and poor ECOG performance status. [ABSTRACT FROM AUTHOR]

Purpose: The current paper is devoted to the analysis of the mediation of non-heteronormative masculinities within discourses on intimate partner violence (IPV) and domestic violence and abuse (DVA) in contemporary Russian media. Methods: The article presents a discourse analysis of five samples of media texts devoted to IPV and/or DVA among LGBTQ people. The media texts were sampled through a keyword search completed on the websites of two openly pro-LGBTQ media outlets (news and entertainment portals Meduza and Takie Dela) and two media outlets catered for predominantly LGBTQ audiences (the news and entertainment portal Parni PLUS and the website of the NGO SPID-Tsentr). Results: The interpretative qualitative analysis of the sampled texts demonstrated that the IPV/DVA survivors' confessional narratives are framed within wider discourses on non-heteronormative masculinities, which are represented both as transgressing concepts of hegemonic masculinity and as challenging stereotypes about non-heteronormative masculinities. Conclusions: The outcome of the analysis presented in the paper is that there is evidence of the emergence of new media discourses on IPV and DVA among LGBTQ communities. Drawing on feminist discourses on IPV and DVA in heterosexual relationships and using media strategies of LGBTQ coming-out confessional narratives, the sampled media data reveals an ongoing search for a new language of discussing the relatively new societal problem. Further research into mediation of non-heteronormative male survivors of IPV and DVA promises insightful findings concerning the evolution of discourses on non-heteronormative masculinities in contemporary Russian media. [ABSTRACT FROM AUTHOR]

Context: Landscape composition and configuration are essential factors for species distribution and persistence. Disturbance changes landscapes and can impact individuals' movement and space use based on mobility with tradeoffs between resource acquisition and survival. Objectives: We evaluated how spring space use and survival of female sage-grouse varied depending on the composition and configuration of disturbances within sagebrush and non-sagebrush dominated habitats, and whether the size of spring neighborhoods affected survival. Methods: We created annual spring neighborhoods for individual female sage-grouse using location data from GPS-marked birds. We calculated the proportion, clumpiness, and interspersion and juxtaposition index (IJI) for each cover class within each neighborhood. We used linear mixed and Cox proportional hazards models to examine the interactive effects of composition and configuration on the area of space use and cumulative survival. Results: Spring neighborhood size decreased when the proportion and interspersion of non-sagebrush and sagebrush cover was high but increased when interspersion was low. Neighborhood size decreased when interspersion and proportion of anthropogenic footprint was high but increased when proportion was low. Sage-grouse survival decreased as the proportion of anthropogenic footprint increased, regardless of configuration. Survival decreased when the proportion of juniper cover was high, and interspersion was moderate. Females that spent more time on nest had smaller neighborhood sizes and were more likely to survive during the spring season. However, there was no effect of neighborhood size on survival. Conclusions: Our results indicate that heterogeneity of habitat and disturbance reduces spring neighborhood size and decreases spring survival of female sage-grouse. These results suggest that management actions should focus on reducing pinyon-juniper where interspersion is high and reducing or removing anthropogenic disturbance near sage-grouse breeding areas. [ABSTRACT FROM AUTHOR]

Background: Textbook outcome (TO) is a composite measure used in surgery to evaluate post operative outcomes. No review has synthesised the evidence in relation to TO regarding the elements surgeons are utilising to inform their TO composite measure and the rates of TO achieved. Methods: Our systematic review and meta analysis was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. PubMed, EMBASE, and Cochrane central registry of controlled trials were searched up to 8th November 2023. Pooled proportions of TO, clinical factors considered and risk factors in relation to TO are reported. Results: Fifteen studies with 301,502 patients were included in our systematic review while fourteen studies comprising of 247,843 patients were included in our meta-analysis. Pooled rates of TO achieved were 55% with a 95% confidence interval (95% CI) of 54–55%. When stratified by elective versus mixed case load, rates were 56% (95% CI 49–62) and 54% (95% CI 50–58), respectively. Studies reported differing definitions of TO. Reported predictors of achieving TO include age, left sided surgery and elective nature. Conclusions: TO is achieved, on average in 55% of reported cases and it may predict short and long term post operative patient outcomes. This study did not detect a difference in rates between elective versus mixed case load TO proportions. There is no standardised definition in use of TO. Standardisation of the composite is likely required to enable meaning comparison using TO in the future and a Delphi consensus is warranted. [ABSTRACT FROM AUTHOR]

Background and objective: Hypernatremia is a possible side effect of intravenous fosfomycin. The aim of this study was to investigate the effects of changes in sodium (Na) levels on hospital stay and survival in patients hospitalized in the intensive care unit receiving fosfomycin. Subjects and methods: This study was conducted retrospectively on the files of patients over the age of 60, who were admitted to the Internal Medicine Intensive Care Unit. Plasma sodium levels were observed and documented over a period of 14 days. The patients were divided into two groups (Hypernatremia group Na > 145 mEq/L vs normonatremia group 135–145 mEq/L). In addition, daily sodium changes were noted for 14 days in patients. Results: The mean age of the patients was 75 years. Hospitalization days were longer for hypernatremia patients (31.5 days vs 41 days, p = 0.003). Patients with hypernatremia had an extended duration of stay in the intensive care unit. (21 days vs 31 days p = 0.002). The 1-month survival rate was 61.4% in patients with hypernatremia and 24.9% in patients without hypernatremia (p = 0.004). The absence of hypernatremia increases mortality by 2.09 times (95% CI 1.35–3.23). When discharge and mortality rates were analyzed according to sodium fluctuation, discharged patients exhibited a lower sodium fluctuation (4 min/max (−10/19) vs 6 min/max (−16/32) p < 0.001). Conclusion: In conclusion, the strength of our study is that it specifically focuses on the consequences of the sodium fluctuation on patient management and provides results. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of early and continuous postoperative inpatient rehabilitation during chemoradiotherapy on functional outcomes and overall survival (OS) in patients with glioblastoma (GBM), particularly in different age groups. Methods: This retrospective cohort study at a university hospital (2011–2016) included 75 of 119 consecutive patients newly diagnosed with GBM who underwent standardized treatment and postoperative rehabilitation. Patients were divided into older (≥ 65 years, n = 45) and younger (< 65 years, n = 30) groups, engaging in a 50-day rehabilitation program. We assessed rehabilitation progress, Barthel Index (BI), Brunnstrom Recovery Stage (BRS), adverse events, and OS. BI at discharge and survival were analyzed using multivariate and Cox regression models, respectively. Results: The mean age was 72.5 ± 6.3 and 52.4 ± 7.8 years in the older and younger groups, respectively. Both groups demonstrated significant improvements in BI and BRS. Despite more adverse events in the older group, no significant difference existed in median OS (older group: 18.7 months vs. younger group: 18.3 months, p = 0.87). Early walking training, reduced fatigue during chemoradiotherapy, and high Karnofsky Performance Status at admission significantly impacted the BI at discharge. Cox regression analysis identified the BI at discharge as a significant predictor of survival (hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.97–0.99, p = 0.008). Conclusion: Integrated rehabilitation improves functional outcomes, and enhanced ADL at discharge is associated with improved survival outcomes in patients with GBM, regardless of age. This highlights the need for personalized rehabilitation in treatment protocols. Further prospective studies are warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives: Standard of care treatment for glioblastoma (GBM) involves surgical resection followed by chemoradiotherapy. However, variations in treatment decisions and outcomes exist across hospitals and physicians. In Belgium, where oncological care is dispersed, the impact of hospital volume on GBM outcomes remains unexplored. This nationwide study aims to analyse interhospital variability in 30-day postoperative mortality and 1-/2-year survival for GBM patients. Methods: Data collected from the Belgian Cancer Registry, identified GBM patients diagnosed between 2016 and 2019. Surgical resection and biopsy cases were identified, and hospital case load was determined. Associations between hospital volume and mortality and survival probabilities were analysed, considering patient characteristics. Statistical analysis included logistic regression for mortality and Cox proportional hazard models for survival. Results: A total of 2269 GBM patients were identified (1665 underwent resection, 662 underwent only biopsy). Thirty-day mortality rates post-resection/post-biopsy were 5.1%/11.9% (target < 3%/<5%). Rates were higher in elderly patients and those with worse WHO-performance scores. No significant difference was found based on hospital case load. Survival probabilities at 1/2 years were 48.6% and 21.3% post-resection; 22.4% and 8.3% post-biopsy. Hazard ratio for all-cause death for low vs. high volume centres was 1.618 in first 0.7 year post-resection (p < 0.0001) and 1.411 in first 0.8 year post-biopsy (p = 0.0046). Conclusion: While 30-day postoperative mortality rates were above predefined targets, no association between hospital volume and mortality was found. However, survival probabilities demonstrated benefits from treatment in higher volume centres, particularly in the initial months post-surgery. These variations highlight the need for continuous improvement in neuro-oncological practice and should stimulate reflection on the neuro-oncological care organisation in Belgium. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of recurrence of OKC varied from 2.5 to 62%. Studies have linked recurrence to treatment methods and also clinical and pathological features. The aim of this study was to evaluate the 5-year recurrence and the factors associated with recurrence in odontogenic keratocysts of the jaws. Methods: A retrospective review of records was done from the Institute's Medical Records Directory from 2010 to 2021. The following data were obtained of the lesion; age at presentation, gender, site, subsite, radiographic presentation (locularity), radiographic borders, presence or absence of satellite cysts, inflammatory infiltrate, and treatment rendered presence or absence of cortical perforation and soft-tissue extension and presence or absence of recurrence. Kaplan Meir estimator was used to evaluate recurrence rate and log rank test was used to compare the survival amongst groups. Cox regression analysis was used to evaluate the odds ratio to find out the possible factors influencing risk of recurrence. A p value of < 0.05 was considered statistically significant at 95% confidence interval. Results: In our study cohort, 27.2% of patients had recurrence. Posterior maxillary lesions, multilocular lesions, lesions with scalloped borders, presence of soft-tissue extension and cortical perforation, presence of satellite cysts and inflammatory infiltrate and enucleation with peripheral ostectomy were significantly associated with recurrence. However, soft-tissue extension, cortical perforation, multilocular lesions and presence of satellite cysts were independent risk factors. Conclusion: There is still debate on the best treatment modality for the management of OKCs. More studies are required to quantify the results. [ABSTRACT FROM AUTHOR]

Background: Surgical excision of the tumor remains the primary choice for the treatment of head and neck cancer patients, but it often leads to facial disfigurement, which further causes mutilation in the patients. Mutilation causes shame and stigma, which imparts significant psychological strain on patients, and tends to impair their quality of life. Objective: The present study aimed to assess the shame and stigma over long-term postoperative survival duration in head and neck cancer patients. Methodology: Total 100 postoperative patients of head and neck cancer were recruited from the outpatient department of the host institute, and shame and stigma was assessed using the Hindi version of the shame and stigma scale. Results: The global shame and stigma score was 22.67 ± 16.22, with the highest perceived stigma due to changes in appearance (11.94 ± 8.805), followed by impaired speech (4.490 ± 3.243), feeling of regret (3.950 ± 3.313), and feeling of stigma (4.490 ± 3.243). The shame and stigma was found to be significantly higher in maxillary cancer patients (33.22 ± 16.60), followed by larynx cancer patients (22.06 ± 13.41) and oral cancer patients (21.53 ± 16.49). Patients with stage III and stage IV of cancer were found to perceive higher shame and stigma (35.91 ± 22.23 and 27.36 ± 14.71, respectively) compared to the patients having stage I and stage II cancer (9.583 ± 9.709 and 16.44 ± 11.82, respectively). A significantly declining linear trend was found between shame and stigma and postoperative survival duration. Conclusion: We concluded that shame and stigma act as important determinants of quality of life over long-term survival in head and neck cancer patients, and should be considered while designing psychological interventions and surgical reconstruction protocols. The present study will help clinicians to assess the mutilation among head and neck cancer patients in a better way and will help in devising new psychological strategies to manage psychological aspects associated with mutilation, which will ultimately enhance the quality of life of patients. [ABSTRACT FROM AUTHOR]