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Purpose: To assess retinopathy of prematurity (ROP) practice patterns during the coronavirus (COVID-19) pandemic. Methods: A survey on ROP practice patterns during the COVID-19 pandemic was sent to the American Academy of Ophthalmic Executives, the International Pediatric Ophthalmology and Strabismus Council members, and to various national societies on May 19, 2020. The survey closed on the 31st of June 2020. Results: Two hundred ninety-two ophthalmologists from 41 countries responded to the survey. Most replies originated in Asia (48%) and North America (38%). During the COVID-19 pandemic compared to the pre-COVID-19 period, respondents reported a reduction of 15% in the number of NICU inpatients and 19.8% of the ROP outpatients' follow-up visits. The number of ROP outpatients' follow-up visits and inpatients' exams was significantly greater in North America than in Asia (72.0% versus 37.2% and 87.8% versus 49.6%, respectively, P < 0.001). Only 14% of the ophthalmologists adopted new screening guidelines, and 7.2% reported changing their preferred treatment. In 50% of responders, laser photocoagulation was the preferred treatment. A significantly higher percentage of ophthalmologists reported using telemedicine during the pandemic, 29.8% (n = 85/285), and 15.6% (44/282) prior to the pandemic (χ2 = 15.51, p < 0.001). Conclusions: During the COVID-19 pandemic, fewer ROP screening and follow-up visits were conducted on premature infants; these findings were especially prominent among physicians in Asia. Telemedicine usage increased during the pandemic. This study highlights the need to maintain screening protocols for ROP during pandemics. The utility of technological measures could enable this, along with adequate prevention of physical contact. [ABSTRACT FROM AUTHOR]

Purpose: There are insufficient data about the optimal treatment for older patients with recurring medium or large hepatocellular carcinoma (HCC). The study intended to assess the effect of transcatheter arterial chemoembolization combined with microwave ablation (TACE-MWA) in an elderly cohort through a retrospective analysis. Methods: From 2011 to 2018, a cohort of individuals (age ≥ 70 years) with recurrent HCC tumors ranging from 3.1 cm to 7 cm underwent either a combination treatment of TACE and MWA (n = 43) or surgical intervention (n = 33). Using the Inverse Probability of Treatment Weighting (IPTW) technique, factors of disease-free survival (DFS), overall survival (OS), and rates of major adverse events were analyzed, retrospectively. Results: The group that underwent surgery had a greater history of alcohol use before treatment (P= 0.001), as well as a higher Barcelona Clinic Liver Cancer (BCLC) stage for the primary tumor before treatment (P= 0.014) and a higher primary tumor location before treatment (P= 0.045). The TACE-MWA group had DFS rates of 86.2%, 68.8%, and 60.4% at 1, 3, and 5 years, while the surgery group had rates of 53.0%, 42.2%, and 25.8% at the same time points. In the TACE-MWA treatment group, survival rates at 1 year, 3 years, and 5 years post-treatment were recorded as 93.0%, 80.8%, and 65.7%, respectively, while in the surgery group, they were 62.7%, 46.9%, and 42.6%. In the univariate analysis using IPTW, the type of treatment was found to have a significant correlation with disease progression (hazard ratio [HR] 0.41, 95% CI 0.20– 0.86, P=0.017). IPTW multivariate analysis showed that treatment modality (HR, 0.35; 95% CI, 0.17 to 0.79; P= 0.011) was the only significant prognostic factor for OS. Conclusion: In elderly patients with recurrent 3.1 cm≤ HCC ≤ 7 cm, TACE-WMA was superior to surgery in the respects of DFS and OS. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia, a condition marked by progressive muscle mass and function decline, presents significant challenges in aging populations and those with chronic illnesses. Current standard treatments such as dietary interventions and exercise programs are often unsustainable. There is increasing interest in pharmacological interventions like bimagrumab, a monoclonal antibody that promotes muscle hypertrophy by inhibiting muscle atrophy ligands. Bimagrumab has shown effectiveness in various conditions, including sarcopenia. Aim: The primary objective of this meta-analysis is to evaluate the impact of bimagrumab treatment on both physical performance and body composition among patients diagnosed with sarcopenia. Materials and methods: This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched PubMed, Ovid/Medline, Web of Science, and the Cochrane Library databases up to June 2024 using appropriate Medical Subject Headings (MeSH) terms and keywords related to bimagrumab and sarcopenia. Eligible studies were randomized controlled trials (RCTs) that assessed the effects of bimagrumab on physical performance (e.g., muscle strength, gait speed, six-minute walk distance) and body composition (e.g., muscle volume, fat-free body mass, fat body mass) in patients with sarcopenia. Data extraction was independently performed by two reviewers using a standardized form, with discrepancies resolved through discussion or consultation with a third reviewer. Results: From an initial search yielding 46 records, we screened titles, abstracts, and full texts to include seven RCTs in our meta-analysis. Bimagrumab treatment significantly increased thigh muscle volume (mean difference [MD] 5.29%, 95% confidence interval [CI] 4.08% to 6.50%, P < 0.001; moderate heterogeneity χ2 = 6.41, I2 = 38%, P = 0.17) and fat-free body mass (MD 1.90 kg, 95% CI 1.57 kg to 2.23 kg, P < 0.001; moderate heterogeneity χ2 = 8.60, I2 = 30%, P = 0.20), while decreasing fat body mass compared to placebo (MD − 4.55 kg, 95% CI − 5.08 kg to − 4.01 kg, P < 0.001; substantial heterogeneity χ2 = 27.44, I2 = 89%, P < 0.001). However, no significant improvement was observed in muscle strength or physical performance measures such as gait speed and six-minute walk distance with bimagrumab treatment, except among participants with slower baseline walking speeds or distances. Discussion and conclusion: This meta-analysis provides valuable insights into the effects of bimagrumab on sarcopenic patients, highlighting its significant improvements in body composition parameters but limited impact on functional outcomes. The observed heterogeneity in outcomes across studies underscores the need for cautious interpretation, considering variations in study populations, treatment durations, and outcome assessments. While bimagrumab shows promise as a safe pharmacological intervention for enhancing muscle mass and reducing fat mass in sarcopenia, its minimal effects on muscle strength and broader physical performance suggest potential limitations in translating body composition improvements into functional gains. Further research is needed to clarify its long-term efficacy, optimal dosing regimens, and potential benefits for specific subgroups of sarcopenic patients. [ABSTRACT FROM AUTHOR]

Epidemiological evidence on myoepithelial carcinoma is rare. This study aimed to investigate the effect of tumor primary site and treatment modality on survival in patients with head and neck myoepithelial carcinoma. Data on adult patients diagnosed with head and neck myoepithelial carcinoma between 2000 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Uni- and multivariable Cox proportional hazard models were utilized to evaluate the effects of different tumor primary sites and treatment modalities on overall survival (OS) and cancer-specific survival (CSS), and expressed as hazard ratio (HR) and 95% confidence interval (CI). A total of 415 patients were enrolled. No significant differences in OS and CSS were found between different tumor primary sites (P > 0.05). Compared with partial excision, patients with total excision (HR = 1.65, 95%CI: 1.12–2.42) (partial or total removal of the organ in which the tumor is located and complete removal of the tumor) or no surgery (HR = 3.52, 95%CI: 2.05–6.03) had worse OS. Compared with surgery only, patients with radiotherapy only had poorer OS (HR = 4.69, 95%CI: 2.32–9.46) and CSS (HR = 6.72, 95%CI: 2.59–17.46), while no significant differences in OS (P = 0.120) and CSS (P = 0.847) were found among patients who received surgery combined with radiotherapy. In patients with AJCC III/IV, patients with radiotherapy only (HR = 4.51, 95%CI: 1.61–12.62) had poorer OS compared to those with surgery only, whereas patients who received surgery combined with radiotherapy had better OS (HR = 0.50, 95%CI: 0.29–0.89). The tumor primary site may not affect the prognosis of patients with myoepithelial carcinoma, while the effect of treatment modality on prognosis is related to the primary site and stage of the tumor. • Primary site may not affect the survival of patients with myoepithelial carcinoma. • Total organ excision may be related to worse OS/CSS compared to partial excision. • Surgery plus radiotherapy did not show better survival compared to surgery alone. [ABSTRACT FROM AUTHOR]

This study investigated changes in treatment modalities and outcomes of chronic myeloid leukemia in the chronic phase (CP-CML) after the approval of second-generation tyrosine kinase inhibitors (2G-TKIs) for first-line therapy. Patients were grouped into those who underwent TKI therapy up to December 2010 (imatinib era group, n = 185) and after January 2011 (2G-TKI era group, n = 425). All patients in the imatinib era group were initially treated with imatinib, whereas patients in the 2G-TKI era group were mostly treated with dasatinib (55%) or nilotinib (36%). However, outcomes including progression-free survival, overall survival, and CML-related death (CRD) did not differ significantly between groups. When stratified by risk scores, the prognostic performance of the ELTS score was superior to that of the Sokal score. Even though both scoring systems predicted CRD in the imatinib era, only the ELTS score predicted CRD in the 2G-TKI era. Notably, the outcome of patients classified as high-risk by ELTS score was more favorable in the 2G-TKI era group than in the imatinib era group. Thus, expanding treatment options may have improved patient outcomes in CP-CML, particularly in patients classified as high-risk by ELTS score. [ABSTRACT FROM AUTHOR]

Objectives: To investigate prognostic factors in patients with head and neck Mucoepidermoid Carcinoma (MEC), especially the impact of treatment modalities on survival. Methods: Patients with primary head and neck MEC between 2000 and 2015 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic factors related to Overall Survival (OS) and Cancer-Specific Survival (CSS), as well as the impact of treatments, were evaluated by multivariable Cox regression analysis. Results: We identified 2692 patients diagnosed with head and neck MEC, of whom 1397 (51.89%) had a parotid gland primary, 569 (22.14%) died, and 341 (12.67%) died of MEC. Older age (≥53 years), males, unmarried, lower income, tumor site in other head and neck areas, higher tumor grade, larger tumor size, and higher stage were related to poorer OS and CSS. Patients who did not undergo surgery (HR = 3.20, 95% CI 2.45‒4.18) had worse OS, while no significant difference was detected between partial and total organ excision on patients’ OS (p = 0.729). For combination therapy, patients who received radiotherapy only (HR = 3.21, 95% CI 2.27–4.53) or no surgery and no radiotherapy (HR = 2.59, 95% CI 1.83–3.67) were correlated with worse OS (vs. surgery only), but no significant difference was detected between surgery only and surgery combined with radiotherapy on patients’ OS (p = 0.218). For CSS, the corresponding results were consistent with OS. Conclusion: Surgical resection only may be a better survival option for head and neck MEC.

Abstract Objective Nasopharyngeal adenoid cystic carcinoma (NACC) is a rare malignancy with special biological features. Controversies exist regarding the treatment approach and prognostic factors in the IMRT era. This study aimed to evaluate the long-term outcomes and management approaches in NACC. Methods Fifty patients with NACC at our institution between 2010 and 2020 were reviewed. Sixteen patients received primary radiotherapy (RT), and 34 patients underwent primary surgery. Results Between January 2010 and October 2020, a total of 50 patients with pathologically proven NACC were included in our analysis. The median follow-up time was 58.5 months (range: 6.0–151.0 months). The 5-year overall survival rate (OS) and progression-free survival rate (PFS) were 83.9% and 67.5%, respectively. The 5-year OS rates of patients whose primary treatment was surgery and RT were 90.0% and 67.3%, respectively (log-rank P = 0.028). The 5-year PFS rates of patients whose primary treatment was surgery or RT were 80.8% and 40.7%, respectively (log-rank P = 0.024). Multivariate analyses showed that nerve invasion and the pattern of primary treatment were independent factors associated with PFS. Conclusions Due to the relative insensitivity to radiation, primary surgery seemed to provide a better chance of disease control and improved survival in NACC. Meanwhile, postoperative radiotherapy should be performed for advanced stage or residual tumours. Cranial nerve invasion and treatment pattern might be important factors affecting the prognosis of patients with NACC.

Objective: Nasopharyngeal adenoid cystic carcinoma (NACC) is a rare malignancy with special biological features. Controversies exist regarding the treatment approach and prognostic factors in the IMRT era. This study aimed to evaluate the long-term outcomes and management approaches in NACC. Methods: Fifty patients with NACC at our institution between 2010 and 2020 were reviewed. Sixteen patients received primary radiotherapy (RT), and 34 patients underwent primary surgery. Results: Between January 2010 and October 2020, a total of 50 patients with pathologically proven NACC were included in our analysis. The median follow-up time was 58.5 months (range: 6.0–151.0 months). The 5-year overall survival rate (OS) and progression-free survival rate (PFS) were 83.9% and 67.5%, respectively. The 5-year OS rates of patients whose primary treatment was surgery and RT were 90.0% and 67.3%, respectively (log-rank P = 0.028). The 5-year PFS rates of patients whose primary treatment was surgery or RT were 80.8% and 40.7%, respectively (log-rank P = 0.024). Multivariate analyses showed that nerve invasion and the pattern of primary treatment were independent factors associated with PFS. Conclusions: Due to the relative insensitivity to radiation, primary surgery seemed to provide a better chance of disease control and improved survival in NACC. Meanwhile, postoperative radiotherapy should be performed for advanced stage or residual tumours. Cranial nerve invasion and treatment pattern might be important factors affecting the prognosis of patients with NACC. [ABSTRACT FROM AUTHOR]

Objective: This study endeavored to explore the optimal treatment strategy and conduct a prognostic analysis for patients diagnosed with pT4M0 (pathologic stage T4) colon adenocarcinoma (COAD). Methods and materials: A total of 8,843 patients diagnosed with pT4M0 COAD between January 2010 and December 2015 were included in this study from the Surveillance, Epidemiology, and End Results (SEER) database. These patients were randomly divided into a training set and an internal validation set using a 7:3 ratio. Variables that demonstrated statistical significance (P<0.05) in univariate COX regression analysis or held clinical significance were incorporated into the multivariate COX regression model. Subsequently, this model was utilized to formulate a nomogram. The predictive accuracy and discriminability of the nomogram were assessed using the C-index, area under the curve (AUC), and calibration curves. Decision curve analysis (DCA) was conducted to confirm the clinical validity of the model. Results: In the entire SEER cohort, the 3-year overall survival (OS) rate (74.22% vs. 63.20%, P<0.001) and the 3-year cancer-specific survival (CSS) rate (76.25% vs. 66.98%, P<0.001) in the surgery combined with postoperative adjuvant therapy (S+ADT) group surpassed those in the surgery (S) group. Multivariate COX regression analysis of the training set unveiled correlations between age, race, N stage, serum CEA (carcinoembryonic antigen), differentiation, number of resected lymph nodes, and treatment modalities with OS and CSS. Nomograms for OS and CSS were meticulously crafted based on these variables, achieving C-indexes of 0.692 and 0.690 in the training set, respectively. The robust predictive ability of the nomogram was further affirmed through receiver operating characteristic (ROC) and calibration curves in both the training and validation sets. Conclusion: In individuals diagnosed with pT4M0 COAD, the integration of surgery with adjuvant chemoradiotherapy demonstrated a substantial extension of long-term survival. The nomogram, which incorporated key factors such as age, race, differentiation, N stage, serum CEA level, tumor size, and the number of resected lymph nodes, stood as a dependable tool for predicting OS and CSS rates. This predictive model held promise in aiding clinicians by identifying high-risk patients and facilitating the development of personalized treatment plans. [ABSTRACT FROM AUTHOR]

Objective: To explore the appropriate treatment strategies, clinical outcomes, and prognostic factors of patients with pulmonary‐limited metastases derived from colorectal cancer (CRC), usually manifested as a less aggressive course. Methods: A retrospective review was conducted in 331 CRC patients diagnosed with pulmonary‐limited metastases at a single institution between January 2011 and November 2017. The Kaplan–Meier method was used to calculate the overall survival (OS). Further analysis was conducted according to treatment modalities. Univariate and multivariate analyses were used to determine potential prognostic factors influencing OS. Results: With a median follow‐up time of 38.6 months, the median OS in all patients was 45.2 months. A total of 163 patients received intensive local treatment with a median OS of 76.4 months, whereas 168 patients received palliative systemic treatment with a median OS of 29.7 months. The median OS was 68.9 months for patients treated with radiotherapy/radiofrequency ablation, with similar efficacy compared to surgery group, whose OS had not reached yet. No survival benefits were observed from the additional targeted therapy in systemic treatment group. The prognostic analysis demonstrated unilateral/bilateral lesions, synchronous/metachronous metastases, intensive local treatment, and resection of primary lesion that were significantly associated with survival of patients. Conclusions: Intensive local treatment alone for pulmonary lesions was associated with excellent survival in certain patients with CRC presented with metastases confined to lungs. Doublet systemic chemotherapy as the first‐line treatment also revealed satisfied efficacy and safety. [ABSTRACT FROM AUTHOR]

Abstract Background To determine the efficacy of adjuvant radiotherapy for stage II–III biliary tract carcinoma. Methods We retrospectively analyzed the data of 37 patients who underwent radical resection of biliary tract carcinomas at the Affiliated Hospital of Inner Mongolia Medical University between 2016 and 2020. We analyzed survival differences between patients who did (n = 17) and did not (n = 20) receive postoperative adjuvant radiotherapy by using Kaplan–Meier analysis. The log-rank test and Cox univariate analysis were used. The Cox proportional risk regression model was used for the multifactorial analysis of factors influencing prognosis. Results The median survival time (28.9 vs. 14.5 months) and the 1-year (82.40% vs. 55.0%) and 2-year survival rates (58.8% vs. 25.0%) were significantly higher among patients who received adjuvant radiotherapy than among those who did not (χ 2 = 6.381, p = 0.012). Multifactorial analysis showed that pathological tumor type (p = 0.004), disease stage (p = 0.021), and adjuvant radiotherapy (p = 0.001) were independent prognostic factors in biliary tract carcinoma. Subgroup analyses showed that compared to no radiotherapy, adjuvant radiotherapy significantly improved median survival time in patients with stage III disease (21.6 vs. 12.7 months; p = 0.017), positive margins (28.9 vs. 10.5 months; p = 0.012), and T3 or T4 tumors (26.8 vs. 16.8 months; p = 0.037). Conclusion Adjuvant radiotherapy significantly improved the survival of patients with biliary tract carcinoma, and is recommended especially for patients with stage III disease, positive surgical margins, or ≥ T3.

BackgroundGestational diabetes (GDM) is prevalent and benefits from timely and effective treatment, given the short window to impact glycemic control. Clinicians face major barriers to choosing effectively among treatment modalities [medical nutrition therapy (MNT) with or without pharmacologic treatment (antidiabetic oral agents and/or insulin)]. We investigated whether clinical data at varied stages of pregnancy can predict GDM treatment modality.MethodsAmong a population-based cohort of 30,474 pregnancies with GDM delivered at Kaiser Permanente Northern California in 2007-2017, we selected those in 2007-2016 as the discovery set and 2017 as the temporal/future validation set. Potential predictors were extracted from electronic health records at different timepoints (levels 1-4): (1) 1-year preconception to the last menstrual period, (2) the last menstrual period to GDM diagnosis, (3) at GDM diagnosis, and (4) 1 week after GDM diagnosis. We compared transparent and ensemble machine learning prediction methods, including least absolute shrinkage and selection operator (LASSO) regression and super learner, containing classification and regression tree, LASSO regression, random forest, and extreme gradient boosting algorithms, to predict risks for pharmacologic treatment beyond MNT.ResultsThe super learner using levels 1-4 predictors had higher predictability [tenfold cross-validated C-statistic in discovery/validation set: 0.934 (95% CI: 0.931-0.936)/0.815 (0.800-0.829)], compared to levels 1, 1-2, and 1-3 (discovery/validation set C-statistic: 0.683-0.869/0.634-0.754). A simpler, more interpretable model, including timing of GDM diagnosis, diagnostic fasting glucose value, and the status and frequency of glycemic control at fasting during one-week post diagnosis, was developed using tenfold cross-validated logistic regression based on super learner-selected predictors. This model compared to the super learner had only a modest reduction in predictability [discovery/validation set C-statistic: 0.825 (0.820-0.830)/0.798 (95% CI: 0.783-0.813)].ConclusionsClinical data demonstrated reasonably high predictability for GDM treatment modality at the time of GDM diagnosis and high predictability at 1-week post GDM diagnosis. These population-based, clinically oriented models may support algorithm-based risk-stratification for treatment modality, inform timely treatment, and catalyze more effective management of GDM.

Prevalence of type 2 diabetes increased from 2.5% of the US population in 1990 to 10.5% in 2018. This creates a major public health problem, due to increases in long-term complications of diabetes, including neuropathy, retinopathy, nephropathy, skin ulcers, amputations, and atherosclerotic cardiovascular disease. In this review, we evaluated the scientific basis that supports the use of physiologic insulin resensitization. Insulin resistance is the primary cause of type 2 diabetes. Insulin resistance leads to increasing insulin secretion, leading to beta-cell exhaustion or burnout. This triggers a cascade leading to islet cell destruction and the long-term complications of type 2 diabetes. Concurrent with insulin resistance, the regular bursts of insulin from the pancreas become irregular. This has been treated by the precise administration of insulin more physiologically. There is consistent evidence that this treatment modality can reverse the diabetes-associated complications of neuropathy, diabetic ulcers, nephropathy, and retinopathy, and that it lowers HbA1c. In conclusion, physiologic insulin resensitization has a persuasive scientific basis, significant treatment potential, and likely cost benefits.

Abstract Approximately 340,000 people in Japan are on chronic dialysis, and this number continues to increase. Even today, hemodialysis is the most frequently selected modality for renal replacement therapy in Japan, accounting for approximately 97% of chronic dialysis patients. This is because the facilities and insurance for hemodialysis were developed early in Japan, and the results of treatment were very good. Most cases of kidney disease are associated with diabetes or hypertension, and the average age of patients on dialysis is increasing, which means that many dialysis patients experience reduced activities of daily living (ADL) and quality of life (QOL). To address those issues, shared decision-making and advance care planning are now widely used in the process of selecting RRT. Because of the work required, including multiple processes and information sharing, medical professionals must practice team medicine in order to improve ADL and QOL for dialysis patients and renal transplant recipients as well as promote appropriate selection of RRT. Accordingly, the “Renal Replacement Therapy Professional Instructor” certification system was established to meet this need. In addition, due to the aging of dialysis patients, there are more situations where it is necessary to consider forgoing dialysis in terms of general condition and QOL. In such cases, conservative kidney management must be offered, and the “Renal Replacement Therapy Professional Instructor” is also required to participate in them. It is hoped that a comprehensive medical system centered around Renal Replacement Therapy Professional Instructors will be created to meet the increasingly diverse needs of patients with end-stage kidney disease and their families, with the aim of providing support that will enable them to lead richer lives.

Abstract Objectives This study is to investigate the referral pattern and treatment modality of dentists in the management of peri-implant diseases between periodontists and non-periodontist dentists (NPDs). Materials and methods A total of 167 validated questionnaires were obtained from periodontists and NPDs, who had experience of placing implants for at least one year. Question I to IV asked how the dentist would respond if a patient came for treatment of their peri-implant diseases with four different scenarios according to resource of patient and disease severity. For each Scenario, dentists also replied which treatment procedures they would use if they decide to treat the patient. Results Periodontal training, resource of patient, and disease severity were shown to significantly influence the referral pattern and treatment modality in the management of peri-implant disease (p

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the treatment of cancer patients, particularly in terms of treatment choices. This study aimed to assess the effects of the COVID-19 pandemic on the management of surgically treated laryngeal squamous cell carcinoma (LSCC) patients, focusing specifically on changes in treatment modalities. We retrospectively analyzed the data from 102 patients who underwent surgical treatment for LSCC between January 1, 2019, and December 31, 2021, at our tertiary medical center. Patient demographics, histological characteristics, and treatment modalities were extracted from electronic medical records and compared between two time periods: pre-COVID-19 and during COVID-19, marked by the introduction of the hospital entry triage. Of the total patients, 53 (52%) were in the pre-COVID-19 group, and 49 (48%) were in the COVID-19 group. No significant differences in patient characteristics at the initial work-up were observed between the two groups. However, a significant shift in treatment modalities was noted. Fewer patients received postoperative adjuvant therapy in the COVID-19 group (70.5%) compared to the pre-COVID-19 group (95.5%). Importantly, this change did not significantly impact the one-year overall survival (OS) rates. The reduction in the use of postoperative adjuvant therapy during the COVID-19 pandemic may be attributed to efforts to minimize hospital visits due to the risk of COVID-19 infection. Further research is warranted to validate these findings and to investigate the potential effects of such changes in treatment modalities on the long-term survival.

AbstractObjective To use logistic regression to analyze the attributes underlying patients’ treatment options for low-grade squamous intraepithelial lesion (LSIL) complicated with high-risk human papillomavirus (HR-HPV) infection, and identify the best benefit group of different treatment options.Methods Clinical data of 197 LSIL patients with HR-HPV infection between June 2009 and February 2022 were collected. According to the treatment options chosen by the patients, they were divided into the interferon, photodynamic therapy, follow-up observation, and focused ultrasound (FUS) treatment groups. One-way analysis of variance (ANOVA) and multivariate logistic regression analysis were used to analyze the influencing factors, including age, occupation, education level, maternity history, reason for encounter, route of consultation, annual personal and household income, screening for related risk factors, and identifying the best benefit group of different treatment options.Results One-way ANOVA revealed a statistically significant difference in age, education level, maternity history, reason for encounter, and annual household income (p

Background: To determine the efficacy of adjuvant radiotherapy for stage II–III biliary tract carcinoma. Methods: We retrospectively analyzed the data of 37 patients who underwent radical resection of biliary tract carcinomas at the Affiliated Hospital of Inner Mongolia Medical University between 2016 and 2020. We analyzed survival differences between patients who did (n = 17) and did not (n = 20) receive postoperative adjuvant radiotherapy by using Kaplan–Meier analysis. The log-rank test and Cox univariate analysis were used. The Cox proportional risk regression model was used for the multifactorial analysis of factors influencing prognosis. Results: The median survival time (28.9 vs. 14.5 months) and the 1-year (82.40% vs. 55.0%) and 2-year survival rates (58.8% vs. 25.0%) were significantly higher among patients who received adjuvant radiotherapy than among those who did not (χ2 = 6.381, p = 0.012). Multifactorial analysis showed that pathological tumor type (p = 0.004), disease stage (p = 0.021), and adjuvant radiotherapy (p = 0.001) were independent prognostic factors in biliary tract carcinoma. Subgroup analyses showed that compared to no radiotherapy, adjuvant radiotherapy significantly improved median survival time in patients with stage III disease (21.6 vs. 12.7 months; p = 0.017), positive margins (28.9 vs. 10.5 months; p = 0.012), and T3 or T4 tumors (26.8 vs. 16.8 months; p = 0.037). Conclusion: Adjuvant radiotherapy significantly improved the survival of patients with biliary tract carcinoma, and is recommended especially for patients with stage III disease, positive surgical margins, or ≥ T3. Highlights: 1. Adjuvant radiotherapy was an independent prognostic factor for stage II–III BTC. 2. Adjuvant radiotherapy improved the survival of patients with stage III BTC. [ABSTRACT FROM AUTHOR]

Intensive outpatient (IOP) psychiatric treatment is increasingly deployed to meet the needs of psychiatrically high-risk youth; however, documentation of treatment disposition for in-person and/or telehealth modalities following treatment referral is largely unknown. The current study examined psychiatrically high-risk youth baseline treatment disposition patterns and explored variations according to treatment modality (telehealth vs. in-person). Using archival records of 744 adolescents (M age = 14.91, SD = 1.60) admitted to a psychiatric IOP, multinomial logistic regressions revealed that commercially insured youth fared better than non-commercially insured youth with respect to treatment completion. When treatment modality was accounted for, youth treated on telehealth were no more likely to be psychiatrically hospitalized compared to youth treated with in-person services. However, youth treated on telehealth dropped out due to excessive absences or withdrawal/refusal to a greater extent than those treated in person. Future studies should examine clinical outcomes in addition to treatment disposition patterns to further understand youth's course of treatment at intermediate level of care settings (e.g., IOP). [ABSTRACT FROM AUTHOR]

The literature regarding Arteriovenous malformation of the external ear is sparse. A case of a patient clinically diagnosed with an arteriovenous malformation of the external ear that was managed empirically with embolization followed by surgical excision and reconstruction is presented. The pathogenesis, clinical presentation, radiological work up and management options regarding arteriovenous malformations are reviewed. [ABSTRACT FROM AUTHOR]

Endometriosis-associated pain can be managed by either surgery or hormonal therapy. The final decision as to which treatment modality to take is based on efficacy and possible complications of different treatment modalities, risk of recurrence, and the patient's wishes and preferences. But in the thicket of fears, doubts, and murky facts, the choice may ultimately be the trade-off between irrational fears and ignorance versus scientific evidence. We elaborate some pros and cons of the two treatment modalities and highlight some notable downsides of hormonal therapy, in particular the possible yet unquantified risk of long-term hormonal therapy for malignant transformation, perhaps with the only exception of combined oral contraceptives. Thus, when discussing with patients, we advocate the approach of discussing the advantages and disadvantages of all treatment options in detail, accounting for the known pros and cons with a full understanding of the predictive irrationality of human beings. For endometriosis-associated pain, surgery is definitely not a failure of medicine but, rather, a viable option, especially given the recently surfaced undercurrent of wariness and dissatisfaction with the current hormonal drugs among patients with endometriosis. Above all, there is a pressing need to fill the knowledge gap of perioperative interventions intended to reduce the risk of recurrence and to fulfill the demand for the development of safe and efficacious non-hormonal therapeutics. [ABSTRACT FROM AUTHOR]

Objectives: This study is to investigate the referral pattern and treatment modality of dentists in the management of peri-implant diseases between periodontists and non-periodontist dentists (NPDs). Materials and methods: A total of 167 validated questionnaires were obtained from periodontists and NPDs, who had experience of placing implants for at least one year. Question I to IV asked how the dentist would respond if a patient came for treatment of their peri-implant diseases with four different scenarios according to resource of patient and disease severity. For each Scenario, dentists also replied which treatment procedures they would use if they decide to treat the patient. Results: Periodontal training, resource of patient, and disease severity were shown to significantly influence the referral pattern and treatment modality in the management of peri-implant disease (p < 0.05). Periodontists were more likely to use variable treatment procedures, including occlusal adjustment (OR = 2.283, p < 0.01), oral hygiene instruction (OR = 3.751, p < 0.001), topical antiseptic agent (OR = 2.491, p < 0.005), non-surgical mechanical therapy (OR = 2.689, p < 0.001), surgical therapy (OR = 2.009, p < 0.01), and remove implant (OR = 3.486, p < 0.001) to treat peri-implant diseases, compared to NPDs. Conclusion: The periodontal specialty training, resource of patient, and disease severity significantly influenced the referral pattern and treatment modality of dentist treating an implant diagnosed with peri-implant disease. This study also highlighted the importance of educating basic periodontal and peri-implant disease-related knowledge to all dentists regularly performing dental implant treatments. Clinical relevance: Peri-implant diseases are highly prevalent among patients with dental implants. Periodontal specialty training could enhance using variable treatment procedures to treat peri-implant diseases for dentists. [ABSTRACT FROM AUTHOR]

Background: Locally advanced oesophageal cancer can be treated with definitive chemoradiation (dCRT) or with neoadjuvant chemoradiation followed by surgery (nCRT + S), but treatment modality choice is not always clear. The aim of this study was to investigate the factors associated with the choice of treatment modality in locally advanced oesophageal cancer. Methods: This was a retrospective cohort study of 149 patients treated with dCRT(n = 85) or nCRT + S (n = 64) for oesophageal cancer in Helsinki University Hospital in 2008–2018. Logistic regression was used to analyse factors associated with choice of treatment modality and to compare dosimetric factors with postoperative complications. Multivariate analyses identified factors associated with survival. Results: Surgery was performed after chemoradiation as planned on 64/91 patients (70%). 28/64 had pathological complete response (44%). Probability of nCRT + S was higher in stages I-III versus IV (OR 3.62, 95% CI 1.53–8.53; P =.003), ECOG 0–1 versus 2 (OR 6.99, 95% CI 1.81–26.96; P =.005) or in the middle/lower vs upper oesophageal tumours (OR 5.61, 95% CI 1.83–17.16, P =.003). Probability for surgery was lower, if patient had lost > 10% of body weight (OR 0.46, 95% CI 0.21–0.98, P = 0.043). Patients in the nCRT + S group had significantly better median overall survival (mOS) and local control than the dCRT group (60 vs. 10 months, P <.001 and 53 vs. 6 months, P < 0.0001, respectively). 10/85 (12%) patients died within three months after dCRT. In multivariate analysis, nCRT + S was associated with improved mOS (HR 0.28, 95% CI 0.17–0.44, P <.001). Current smokers had worse mOS (HR 2.02, 95% CI 1.04–3.92, P =.037) compared to never-smokers. No significant dosimetric factor associated with postoperative complications was found. Conclusion: The overall clinical status of the patients and the stage of the cancer guide the choice of treatment modalities, leading to overtreatment. Patients with better prognoses were more likely operated after chemoradiation, although there is no evidence of OS benefit in previous randomized trials. On the other hand, the prognosis was poor for patients with poor general health and advanced cancers, despite the chemoradiation. Thus, there are signs of overtreatment. MDT practice should be recommended to optimise the choice of treatment modalities. Smoking status is an independent factor associated with survival. [ABSTRACT FROM AUTHOR]

Simple Summary: Studies on the effects of high-density lipoprotein cholesterol (HDL-C) on gastric cancer mortality are few, and the results are inconsistent. In this study, we investigated the effects of HDL-C on gastric cancer mortality and conducted sub-group analysis by sex and treatment modality. In this cohort study including patients with gastric cancer (n = 22,468), HDL-C was inversely related with mortality with a dose-dependent manner. In validation cohort (n = 3379), HDL-C was also inversely associated with mortality with a dose-dependent manner. The two cohorts demonstrated consistent favorable effects of higher HDL-C on mortality in both sexes. In validation cohort, the beneficial effect of HDL-C was observed in both gastrectomy and endoscopic resection (p for trend < 0.001) as more remarkable in endoscopic resection group. In this study, we explored that an increased HDL-C reduced mortality in both sexes and curative resection group. Studies on the effects of high-density lipoprotein cholesterol (HDL-C) on gastric cancer mortality are few, and the results are inconsistent. In this study, we investigated the effects of HDL-C on gastric cancer mortality and conducted sub-group analysis by sex and treatment modality. Newly diagnosed patients with gastric cancer (n = 22,468) who underwent gastric cancer screening between January 2011 and December 2013 were included and followed up until 2018. A validation cohort (n = 3379) that had newly diagnosed gastric cancer from 2005 to 2013 at a university hospital, was followed up until 2017. HDL-C was inversely related with mortality; adjusted hazard ratio (aHR) 0.90 (95% confidence interval [CI], 0.83–0.98) for HDL-C of 40–49 mg/dL, 0.86 (0.79–0.93) for HDL-C of 50–59 mg/dL, 0.82 (0.74–0.90) for HDL-C of 60–69 mg/dL, and 0.78 (0.69–0.87) for HDL-C ≥ 70 mg/dL compared to HDL-C < 40 mg/dL. In the validation cohort, HDL-C was also inversely associated with mortality; aHR 0.81 (0.65–0.99) for HDL-C of 40–49 mg/dL, 0.64 (0.50–0.82) for HDL-C of 50–59 mg/dL, and 0.46 (0.34–0.62) for HDL-C ≥ 60 mg/dL compared to HDL-C < 40 mg/dL. The two cohorts demonstrated that higher HDL-C was associated with a low risk of mortality in both sexes. In validation cohort, this association was observed in both gastrectomy and endoscopic resection (p for trend < 0.001) as more remarkable in endoscopic resection group. In this study, we explored that an increased HDL-C reduced mortality in both sexes and curative resection group. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess the risk recall of complications among patients who underwent different vestibular schwannoma (VS) treatments.Study designPatients with VS completed a voluntary and anonymous survey.SettingSurvey links were distributed via the Acoustic Neuroma Association (ANA) website, Facebook, and email list.Subjects and methodsSurveys were distributed to ANA members from January to March 2017. Of the 3200 ANA members with a VS diagnosis at the time of survey distribution, 789 (25%) completed the survey.ResultsSubjects reported the following incidence of posttreatment complications: imbalance (60%), hearing issues (51%), dry eyes (30%), headache (29%), and facial weakness (27%). Overall, 188 (25%) recalled remembering all the risks associated with their treatment. Among those in the surgical cohort (52%) who experienced balance issues, facial weakness, cerebrospinal fluid leak, meningitis, and stroke, 73%, 91%, 77%, 67%, and 33% claimed recall of these associated risks. Among those in the radiosurgery cohort (28%) who experienced balance issues, facial weakness, and hydrocephalus, 56%, 52%, and 60% recalled discussions of those risks. Patients with higher-level education (P = .026) and those who underwent surgery (P = .001) had a significantly higher risk recall ratio, while sex, age, and tumor size were not significant contributing factors.ConclusionNot all patients with VS who experienced treatment complications recalled remembering those risks being discussed with them. Patients with higher education and those who underwent surgery had a better recall of risks associated with different treatment modalities. The risk recall ratio of patients experiencing complications ranged 33% to 91%, suggesting an opportunity for decision-making and discussion improvement.

Background: The expenses that the patient or the family pays directly to the health care provider, without a third-party (insurer or State) is known as 'Out of Pocket Expenditure' (OOPE). These expenses could be medical and non-medical. About 150 million people face financial catastrophe every year due to health care payments and cancer is one of the leading causes of high OOPE. Objectives: This study was conducted to estimate the OOPE among cancer patients and to determine the OOPE in relation to type of cancer and treatment modality. Methodology: A cross sectional study was conducted at a tertiary care centre in Hyderabad during August and September,2022 with a total study population of 400 cancer patients. After consenting the participants, data was collected via face-to-face interview using a semi structured questionnaire. Results: The mean OOPE per patient was found to be $1032.65 (₹84,643.20). This includes the medical and non-medical costs. Leukaemia was found to have the highest OOPE amongst all cancers followed by colon cancer. Similarly, radiotherapy + surgery was found to have the highest OOPE followed by chemotherapy + radiotherapy + surgery. Conclusion And Interpretation- This study is unique in its way that no other study has considered OOPE for different cancers in single research. We would like to highlight the quantification of OOPE among various types of cancers and its variation based on treatment modality used. It is necessary that future government initiatives consider the importance of mitigating the OOPE along with provision of cancer care.

Objective: The comparison of endovenous laser ablation (EVLA) with sclerotherapy for the treatment of varicose veins in the lower limbs will focus on their efficacy, safety, patient-reported results, and cost-effectiveness. Methods: 190 suitable patients with symptomatic lower limb varicose veins were divided into the EVLA and sclerotherapy groups at random. Age, gender, and patterns of venous insufficiency were noted as baseline parameters. Reduced severity of varicose veins (CEAP classification), patient-reported improvement (VCSS and AVVQ scores), and adverse events were the primary end measures. Costeffectiveness analysis and quality of life (EQ-5D scores) were secondary goals. Results: Sclerotherapy and EVLA both reduced the severity of varicose veins and enhanced patient-reported results. The majority of adverse events were minor and comparable between groups. Both groups had a marked improvement in quality of life. According to a cost-effectiveness analysis, EVLA might have a marginally better long-term value than sclerotherapy. Conclusion: For lower limb varicose veins, EVLA and sclerotherapy are both safe and effective treatment options, with comparable results in terms of symptom reduction and quality of life enhancement. Individual patient features, preferences, and the availability of healthcare resources should all be taken into account when deciding between these treatment modalities, with cost-effectiveness somewhat favouring EVLA. To determine the therapy outcomes' long-term viability, more investigation is required. [ABSTRACT FROM AUTHOR]

To use logistic regression to analyze the attributes underlying patients' treatment options for low-grade squamous intraepithelial lesion (LSIL) complicated with high-risk human papillomavirus (HR-HPV) infection, and identify the best benefit group of different treatment options. Clinical data of 197 LSIL patients with HR-HPV infection between June 2009 and February 2022 were collected. According to the treatment options chosen by the patients, they were divided into the interferon, photodynamic therapy, follow-up observation, and focused ultrasound (FUS) treatment groups. One-way analysis of variance (ANOVA) and multivariate logistic regression analysis were used to analyze the influencing factors, including age, occupation, education level, maternity history, reason for encounter, route of consultation, annual personal and household income, screening for related risk factors, and identifying the best benefit group of different treatment options. One-way ANOVA revealed a statistically significant difference in age, education level, maternity history, reason for encounter, and annual household income (p < 0.05). Multivariate logistic regression analysis was performed on these five factors, indicating that age ≤35 years, high school educational level or higher, and no childbirth history were independent risk factors influencing patients' choices of FUS treatment. The receiver operating characteristic curve was used to determine the age threshold of 31 years. Age, educational level, and maternity history were independent risk factors influencing patients' choice of treatment modality for LSIL complicated with HR-HPV infection. Age ≤31 years, high school, equivalent, or higher educational level, and no childbirth yielded a higher rate of choosing FUS treatment for LSIL patients with HR-HPV infection. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to provide a structured protocol for the treatment of verrucous carcinoma (VC) based on size, bone invasion, recurrence and whether neck dissection is necessary or not. In addition, the study evaluates the probability of a wrong histopathological diagnosis. Data Sources: A search was conducted in the Cochrane Library, PubMed and Google from January 1962 to October 2022 by using MeSH terms and keywords. Studies reporting treatment modalities for VC and different histopathological diagnoses after excision of the lesion were selected except case reports and review articles. Study Eligibility Criteria: Thirteen articles were selected. Six hundred and thirty cases of VC were treated by surgery, surgery + neck dissection, radiotherapy, chemotherapy and combination therapy. Statistical analysis revealed surgical treatment as a preferred option. Despite being enlarged, the lymph node was negative for metastasis. So, in OVC cases neck dissection adds only unnecessary morbidity to patients. Participants and Interventions: Radiotherapy or chemotherapy can be used to downstage the disease. 23.3% of cases reported wrong histopathology diagnosis. Study Appraisal and Synthesis Methods: Patients treated for squamous cell carcinoma (SCC) will only experience unnecessary morbidity unless the correct diagnosis is made between VC and hybrid VC. Irrespective of size VC does not metastasise until there are no foci of SCC. Conclusions: Surgical excision of T1- and T2-sized lesions can be performed under local anaesthetic as a biopsy procedure. T3 or T4 lesion can be resected with a safe margin. If it comes as hybrid VC or VC with close margin (0.5 cm, <0.5 cm), neck dissection and further margin should be excised as a second procedure respectively. [ABSTRACT FROM AUTHOR]

Objective: To determine the outcomes in children with MIS-C receiving different immunomodulatory treatment. Methods: In this multicentric, retrospective cohort study, data regarding treatment and outcomes of children meeting the WHO case definition for MIS-C, were collected. The primary composite outcome was the requirement of vasoactive/inotropic support on day 2 or beyond or need of mechanical ventilation on day 2 or beyond after initiation of immunomodulatory treatment or death during hospitalization in the treatment groups. Logistic regression and propensity score matching analyses were used to compare the outcomes in different treatment arms based on the initial immunomodulation, i.e., IVIG alone, IVIG plus steroids, and steroids alone. Results: The data of 368 children (diagnosed between April 2020 and June 2021) meeting the WHO case definition for MIS-C, were analyzed. Of the 368 subjects, 28 received IVIG alone, 82 received steroids alone, 237 received IVIG and steroids, and 21 did not receive any immunomodulation. One hundred fifty-six (42.39%) children had the primary outcome. On logistic regression analysis, the treatment group was not associated with the primary outcome; only the children with shock at diagnosis had higher odds for the occurrence of the outcome [OR (95% CI): 11.4 (5.19–25.0), p < 0.001]. On propensity score matching analysis, the primary outcome was comparable in steroid (n = 45), and IVIG plus steroid (n = 84) groups (p = 0.515). Conclusion: While no significant difference was observed in the frequency of occurrence of the primary outcome in different treatment groups, data from adequately powered RCTs are required for definitive recommendations. [ABSTRACT FROM AUTHOR]

Background/purpose: The unpredictable condition of cracked teeth warrants further investigation and clinical experiences. The purpose of this study was to collect and record data on demographics, clinical characteristics, different treatment modalities and survival of cracked teeth at 6-month, 1-year and 2-year recalls. Methods: 77 cracked teeth from 65 patients were included. Data on demographics, clinical parameters, treatment modalities and recall were collected. Binomial, multinomial and chi square tests were used for statistical analysis. Results: Most cracked teeth occurred in patients greater than 40 years old (p

Simple Summary: Recurrent nasopharyngeal carcinoma is one of the major causes of death among NPC patients. However, there are no international guidelines for the treatment of patients with recurrent NPC now. In this article, we summarize past publications on clinical research and mechanistic studies related to recurrent NPC, combined with the experience and lessons learned by our institutional multidisciplinary team in the treatment of recurrent NPC. We propose an objective protocol for the treatment of recurrent NPC. Recurrent nasopharyngeal carcinoma (NPC), which occurs in 10–20% of patients with primary NPC after the initial treatment modality of intensity-modulated radiation therapy (IMRT), is one of the major causes of death among NPC patients. Patients with recurrent disease without distant metastases still have a chance to be saved, but re-treatment often carries more serious toxicities or higher risks. For this group of patients, both otolaryngologists and oncologists are committed to developing more appropriate treatment regimens that can prolong patient survival and improve survival therapy. Currently, there are no international guidelines for the treatment of patients with recurrent NPC. In this article, we summarize past publications on clinical research and mechanistic studies related to recurrent NPC, combined with the experience and lessons learned by our institutional multidisciplinary team in the treatment of recurrent NPC. We propose an objective protocol for the treatment of recurrent NPC. [ABSTRACT FROM AUTHOR]

Objectives: To investigate prognostic factors in patients with head and neck Mucoepidermoid Carcinoma (MEC), especially the impact of treatment modalities on survival., Methods: Patients with primary head and neck MEC between 2000 and 2015 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic factors related to Overall Survival (OS) and Cancer-Specific Survival (CSS), as well as the impact of treatments, were evaluated by multivariable Cox regression analysis., Results: We identified 2692 patients diagnosed with head and neck MEC, of whom 1397 (51.89%) had a parotid gland primary, 569 (22.14%) died, and 341 (12.67%) died of MEC. Older age (≥53 years), males, unmarried, lower income, tumor site in other head and neck areas, higher tumor grade, larger tumor size, and higher stage were related to poorer OS and CSS. Patients who did not undergo surgery (HR=3.20, 95% CI 2.45‒4.18) had worse OS, while no significant difference was detected between partial and total organ excision on patients' OS (p=0.729). For combination therapy, patients who received radiotherapy only (HR=3.21, 95% CI 2.27-4.53) or no surgery and no radiotherapy (HR=2.59, 95% CI 1.83-3.67) were correlated with worse OS (vs. surgery only), but no significant difference was detected between surgery only and surgery combined with radiotherapy on patients' OS (p=0.218). For CSS, the corresponding results were consistent with OS., Conclusion: Surgical resection only may be a better survival option for head and neck MEC., (Copyright © 2024 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier España S.L.U. All rights reserved.)

Abstract Background The aim of this study was to comprehensively evaluate the risk factors of periprocedural ischemic stroke associated with endovascular treatment of intracranial aneurysms using a real-world database. Methods From August 2016 to March 2017, 167 patients were enrolled. Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors for periprocedural ischemic stroke. Results Among the 167 cases, periprocedural ischemic stroke occurred in 20 cases (11.98%). After univariate analysis, the ischemic group had a higher proportion of large (≥ 10 mm) aneurysms than the control group (45.0% vs. 23.1%, p = 0.036). The incidence of periprocedural ischemic stroke was higher in cases treated by flow diverter (21.6%) or stent-assisted coiling (11.8%) than in cases treated by coiling only (2.7%), and the differences were statistically significant (p = 0.043). After multivariate logistic regression analysis, treatment modality was the independent risk factor for periprocedural ischemic stroke. Compared with the coiling-only procedure, flow diverter therapy was associated with a significantly higher rate of periprocedural ischemic stroke (OR 9.931; 95% CI 1.174–84.038; p = 0.035). Conclusions Aneurysm size and treatment modality were associated with periprocedural ischemic stroke. Larger aneurysms were associated with increased risk of periprocedural ischemic stroke. Flow diverter therapy was associated with significantly more periprocedural ischemic stroke than the coiling procedure alone.

We aimed to evaluate the relationship between temporal muscle thickness and GH/IGF-1 elevation and the effect of acromegaly treatment on temporal muscle thickness. Patients with acromegaly and healthy controls were included in the study. While laboratory parameters, clinical findings and temporal muscle thickness of acromegaly patients at the time of diagnosis and one year after treatment were evaluated, laboratory parameters and temporal muscle thickness of healthy controls were evaluated only during the period when they were included in the study. Temporal muscle thickness was measured using pituitary MRI. Temporal muscle thickness of patients with acromegaly was compared with healthy controls. We also evaluated how temporal muscle thickness changes with treatment in patients with acromegaly and the association between laboratory parameters and temporal muscle thickness. In patients with acromegaly, measurements of left, right, and mean temporal muscle thickness at the time of diagnosis were found to be significantly higher than those of healthy controls' measurements at the time of their inclusion in the study (p = 0.007, p = 0.014 and p = 0.018, respectively). However, no significant difference was found when comparing the temporal muscle thickness of the 1st year of acromegaly treatment with the temporal muscle thickness of healthy controls at the time of their inclusion in the study (p = 0.155, p = 0.189, p = 0.198, respectively). In addition, a significant decrease was detected in the left, right and mean temporal muscle thicknesses of patients with acromegaly before and after treatment. While the temporal muscle thickness at the time of diagnosis was thicker in patients with acromegaly receiving surgical + medical treatment than in patients receiving exclusively surgical treatment, statistical significance was only found in the left temporal muscle thickness (p = 0.042). Temporal muscle thickness was found to be associated with treatment modalities in patients with acromegaly. • Patients with acromegaly exhibit greater temporal muscle thickness compared to healthy controls. • In the course of acromegaly treatment, TMT diminishes in correlation with reductions in GH and IGF-1 levels. • Patients with acromegaly who require medical treatment post-surgery have greater TMT compared to those who do not. [ABSTRACT FROM AUTHOR]

The therapeutic modalities of early-stage and advanced extranodal natural killer/T-cell lymphoma (NKTCL) patients are completely different. The former is mainly radiotherapy with or without chemotherapy, while the latter relies on chemotherapy-based systemic treatment. According to Ann Arbor staging system, approximately 70% of the NKTCL patients are classified as early-stage cases who are promising to be cured.Considering NKTCL is sensitive to radiation but may be resistant to chemotherapy, the radiotherapy is considered to be the most important treatment for some early-stage patients with a satisfactory local control rate and could be used alone. However, systemic recurrence after radiotherapy in a portion of NKTCL patients seriously affects their long-term survival, and the first-line treatment combined with radiotherapy and chemotherapy is considered necessary. Therefore, the use of radiotherapy alone in early-stage NKTCL is still a controversial issue. Read more in PDF.

Objective: This study aims to assess the outcomes of adjuvant interstitial brachytherapy (BT) to the tumor bed for oral cavity squamous cell carcinoma (SCC), and to compare the oncological outcomes and toxicity profile of low-dose-rate (LDR) and pulsed-dose-rate (PDR) BT. Design: This retrospective single-center study included all patients who underwent postoperative LDR- or PDR-BT to the tumor bed as the sole adjuvant treatment for an oral tongue or floor of the mouth SCC between January 2000 and December 2020. Results: A total of 79 patients were eligible for this study. The cohort was divided into an LDR group (n = 38) and a PDR group (n = 41). The median time interval between surgery and brachytherapy was 55 days. Median delivered total dose was 55 Gy and median hospital stay was 5 days. Five patients (8.3%) experienced grade 3–4 early toxicity, 2 in the LDR group and 3 in the PDR group. Late toxicities were present in 28 patients (44.4%) and were dominated by grade 1–2 residual pain and dysesthesia, without a statistical difference between the groups. After a median follow-up of 65.1 months, 5‑year local control (LC), disease-free survival (DFS), and overall survival (OS) for the whole cohort were 76.3% (95% CI = 63.4–85.1), 61.6% (95% CI = 49.0–72.0), and 71.4% (95% CI = 58.6–80.8), respectively. Conclusion: Adjuvant BT after excision of oral cavity SCC provides satisfactory oncological outcomes along with good tolerance. In our study, PDR-BT showed similar oncological and functional results to LDR-BT in this indication. [ABSTRACT FROM AUTHOR]

Background: This study compares select social determinants of health (SDOH) with treatment modality selection and treatment completion in head and neck cancer (HNC) patients, to better understand disparities in health outcomes. Methods: A retrospective cohort study of HNC (n = 1428) patients was conducted. Demographic and disease‐specific variables were recorded, including treatment modality selection and completion. Data were analyzed using two‐sample t tests, chi‐square, and Fisher's exact tests. Results: Primary language was significantly associated with treatment choice, where non‐English speakers were less likely to choose treatment as recommended by the Tumor Board. Lower mean distance from the hospital (37.38 [48.31] vs. 16.92 [19.10], p < 0.0001) and a county‐based higher mean percentage of bachelor degree or higher education (42.16 [8.82] vs. 44.95 [6.19], p < 0.0003) were associated with treatment selection. Conclusion: Language, distance from the hospital, and education affected treatment selection in this study and may be useful in understanding how to counsel patients on treatment selection for HNC. [ABSTRACT FROM AUTHOR]

Background/purpose: The unpredictable condition of cracked teeth warrants further investigation and clinical experiences. The purpose of this study was to collect and record data on demographics, clinical characteristics, different treatment modalities and survival of cracked teeth at 6-month, 1-year and 2-year recalls.Methods: 77 cracked teeth from 65 patients were included. Data on demographics, clinical parameters, treatment modalities and recall were collected. Binomial, multinomial and chi square tests were used for statistical analysis.Results: Most cracked teeth occurred in patients greater than 40 years old (p < 0.01). Cracked teeth themselves were most often molars (79.22%; p < 0.01), a non-terminal tooth in the arch (62.34%; p < 0.05) and nonendodontically-treated teeth (94.81%; p < 0.01). Cracked teeth exhibited pain to percussion (63.64%, p < 0.05) or biting (74.03%; p < 0.01), and no or only positive mobility (76.62%; p < 0.01). Cracks were most often oriented in the mesiodistal direction (68.83%; p < 0.01). Higher survival rates were noted in cracked teeth lacking pre-operative pain to palpation or spontaneous pain, and with no or only positive mobility at 6-month and 1-year recalls. In vital cracked teeth, higher survival rates were noted in teeth lacking pre-operative pain to palpation and with no or only positive mobility at 2-year recalls.Conclusion: The absence of pre-operative palpation discomfort, spontaneous pain and minimal mobility, as well as the presence of pulp vitality were associated with higher survival rates of cracked teeth at all recall times. Results are useful for diagnosis and outcomes-based treatment planning of cracked teeth. [ABSTRACT FROM AUTHOR]

Following the spread of novel coronavirus (COVID-19) pandemic, surgical associations have issued their different recommendations for managing the acute cholecystitis (AC) clinic during the pandemic. We aimed to examine the effects of the COVID-19 pandemic period on our clinical approach in patients who presented to the emergency department with abdominal pain and were diagnosed with AC. Medical records of patients diagnosed with AC in the emergency room between 11 March 2020 and 10 March 2021 and in the same period of one year before the pandemic were retrospectively reviewed. Patients were divided into 2 groups as COVID-19 period (Group 1) and non-COVID period (Group 2). Demographics and clinical characteristics, treatment modalities, and outcomes of these two groups were compared. The number of patients diagnosed with AC in the emergency department decreased during the ongoing COVID-19 pandemic. When the time between the onset of the complaints and the admission to the emergency service was evaluated, no statistically significant difference was found between the groups (p>0.05). The distribution of cholecystitis type and TG18 severity grading for AC were similar in both groups (p>0.05). While percutaneous cholecystostomy (PC) is more preferred in the treatment of AC during the pandemic period and the number of delayed interval laparoscopic cholecystectomy decreased, AC management was similar in both periods with no significant statistical difference (P>0.05). In conclusion, our clinical approach and management in the treatment of AC did not differ when compared to the pre-pandemic period. [ABSTRACT FROM AUTHOR]

Abstract Background Population-based analysis for the liver metastases of small bowel cancer is currently lacking. This study aimed to analyze the frequency, prognosis and treatment modalities for newly diagnosed small bowel cancer patients with liver metastases. Methods Patients with small bowel cancer diagnosed from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Binary logistic regression analysis was performed to determine predictors for the presence of liver metastases at diagnosis. Kaplan–Meier method and Cox regression analyses were performed for survival analyses. Results A total of 1461 small bowel cancer patients with liver metastases at initial diagnosis were identified, representing 16.5% of the entire set and 63.9% of the subset with metastatic disease to any distant site. Primary tumor with poorer histological type, larger tumor size, later N staging, more extrahepatic metastatic sites, and tumor on lower part of small intestine had increased propensity of developing liver metastases. The combined diagnostic model exhibited acceptable diagnostic efficiency with AUC value equal to 0.749. Patients with liver metastases had significant poorer survival (P

Objective To investigate the clinicopathological features and survival rate of oral squamous cell carcinoma patients in China. Methods The clinicopathological characteristics, stage, treatment modality, and 5-year disease-specific survival (DSS) rate of 1 915 OCSCC patients who received initial treatment at the Sun Yat-sen University Cancer Center from 1990 to 2013 were collected and analyzed. The clinicopathological characteristics, stage, treatment modality, and 5-year disease-specific survival (DSS) rate of OCSCC patients treated during the successive decades of 1990-1999, 2000-2009, and 2010-2013 were analyzed retrospectively to show the trends over time. Results The average age of all OCSCC patients who received initial treatment at this cancer center from 1990 to 2013 was 54.8 years (SD, 12.6 years). The sex ratio was approximately 2:1. The oral tongue was the site most prone for OCSCC, accounting for 63.6% of all cases. The proportions of early-stage (Ⅰ-Ⅱ) and advanced-stage (Ⅲ-Ⅳ) cases were approximate. Regarding the treatment modality, surgery-based treatment accounted for 80.4%. Survival analysis showed that the 5-year DSS rate of all cases was 57%. Survival decreased with age. The survival of females, nonsmokers, and nondrinkers was higher than that of males, smokers, and drinkers. The 5-year DSS rates of patients with squamous cell carcinoma of the lips, oral tongue, and other sites of the oral cavity were 81%, 63%, and 42%, respectively. The 5-year DSS rates of patients who received surgery-based treatment and nonsurgical treatment were 66% and 19%, respectively. The analysis of trends over time showed that in the period of 1990-1999 and 2010-2013, the age and sex ratio were relatively stable. The proportion of patients with squamous cell carcinoma of the lips and oral tongue gradually decreased, while the proportion of those with squamous cell carcinoma of the other sites of the oral cavity gradually increased. The proportion of surgery-based treatment increased from 77.7% to 91.3%. The 5-year DSS rate gradually increased from 53% in 1990-1999 to 64% in 2010-2013. The 5-year DSS rate of female patients increased significantly from 55% to 78%. However, the 5-year DSS rate of male patients was relatively stable. The 5-year DSS rate of patients who received surgery-based treatment gradually increased from 62% to 69%. Conclusion The 5-year DSS rate has steadily improved for OCSCC patients at this cancer center from 1990-2013, especially in female patients. The 5-year DSS rate of patients with squamous cell carcinoma of the oral tongue has reached the rate in developed countries worldwide. The proportion and survival rate of patients who received surgery-based treatment gradually increased. The survival rate of patients with squamous cell carcinoma of the other sites of the oral cavity was significantly lower than that of patients with squamous cell carcinoma of the lips and oral tongue, suggesting that more effort should be put into the treatment of patients with squamous cell carcinoma of the other sites of the oral cavity to improve the survival rate in the future.

The highly contagious new coronavirus virus, SARS-CoV-2, was first appeared in Wuhan, China in late 2019. The virus has spread to 216 countries, including Iran, until 7 September 2020. So far, the number of people infected by the new corona virus and died from the disease is 27032617 and 881464 worldwide, respectively. Therefore, it is necessary to introduce the available treatments for this virus, as a global dilemma. Articles for this review study were selected from Embase, Medline and Google Scholar. Published full articles in English, English full articles published from 1st December 2019 to 23rd July 2020, were included. The search terms included combinations of COVID-19, SARS-COV-2, chloroquine, convalescent plasma, antiviral, antibacterial, Remidesivir, hydroxychloroquine, chloroquine phosphate, vaccines and monoclonal antibodies. There were no restrictions on the types of study eligible for inclusion. Different available therapies generally can be divided into small molecules and biological products. Among the small molecule drugs used for COVID-19 patients Remdesivir, Favilavir, and hydroxychloroquine have been associated with considerable success in disease control. Separation and transfusion of plasma from blood of improved COVID-19 patients to new patients and the use of recombinant Angiotensin converting enzyme 2 (ACE2) have been two very successful biological therapies in the treatment of COVID-19 disease. However, many efforts are being made by researchers around the world to make other effective and promising biological products. The development of a safe and effective vaccine can lead to great success in eradicating the disease. Also, the production of anti-SARS-CoV-2 monoclonal antibodies and using of stem cell-based therapeutics can be a great success in treating the disease. In addition, according to the miRNA properties, many efforts have been made to inhibit the production of viral proteins using natural miRNAs or artificial siRNAs. It has been proposed that aptamers derived from SELEX can be used for the diagnosis and treatment of COVID-19. Subsequently, since the size of miRNAs is at the nanometer level, they can easily incorporate to the targeted exosomes and be delivered via circulation in human blood to the infected cells such as lung cells. Interestingly, miRNAs can be delivered into the lung by inhalation.

Purpose: This study aimed to determine the forms of ocular and adnexal injuries and to examine the treatment modalities applied after two major earthquakes in Turkey on February 6, 2023., Methods: Following the earthquakes, the medical records of 34 patients admitted with emergency ophthalmic complaints to Hatay Training and Research Field Hospital and Etlik City Hospital were retrospectively reviewed. Of these patients, 35 eyes of 34 individuals diagnosed with earthquake-related ocular and adnexal injuries were included in the study. Demographic characteristics were recorded, including ocular and adnexal findings, treatment modalities, and postoperative complications., Results: Of the patients, 16 (47.1%) were female, and 18 (52.9%) were male. The mean age was 37.38 ± 17.3 years. The mean time from the earthquake to the first admission to the hospital was 3.82 ± 1.78 days. Initial and final best-corrected visual acuities (BCVA) were 0.54 ± 0.66 logMAR and 0.22 ± 0.41 logMAR, respectively ( p  = 0.0003). The initial and final BCVA of 2 eyes was no light perception. The most common forms of ocular/periocular injury associated with earthquakes were eyelid laceration (n:25, 71.4%) and orbital fracture (n:17, 48.6%). The most common accompanied systemic trauma was extremity/rib fractures (38.2). The most frequently performed surgery was the primary repair of the eyelid/canalicular (n:17, 48.6%)., Conclusion: While earthquake-related ocular and adnexal traumas are relatively uncommon, understanding the specific injury types, promptly identifying cases requiring urgent intervention, and mastering effective treatment modalities are essential for minimizing the risk of severe permanent visual impairment in these patients., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.