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To evaluate the preventive effects of regional lymph node irradiation on lymph node recurrence in esophageal cancer (EC).
The study included 289 patients who received definitive radiotherapy for EC. The regional lymph node area of group 1 was determined as the area with the highest probability of lymph node metastasis and group 2 was determined as the area with the next highest probability of lymph node metastasis depending on the primary site of EC.
The patients in whom group 2 was completely included in the irradiated field had a significantly lower rate of recurrence of regional lymph node metastasis than those in whom group 2 was not or insufficiently included (p=0.0337). There was no significant difference in overall survival (p=0.4627) or disease-specific survival (p=0.6174) between the two groups.
Regional lymph node irradiation did not have survival-prolonging effects but significantly reduced regional lymph node recurrence.
Regional lymph node irradiation did not have survival-prolonging effects but significantly reduced regional lymph node recurrence.
Although computed tomography (CT) is the standard modality for diagnosing lymph node metastasis (LNM), transabdominal ultrasonography (US) can be useful due to its high spatial resolution and use of Doppler signals to precisely analyse lymph nodes. This study aimed to evaluate the accuracy of US for lymph node assessment, establish US-based diagnostic criteria for LNM, and compare the capability of US with that of CT for the diagnosis of LNM.
This retrospective, single-institution, cohort study included patients who underwent radical surgery for clinical stage 0-III colon cancer, between March 2012 and February 2019.
Overall, 34.9% (66/189) of patients had pathological LNM. The optimal US diagnostic criteria were 1) short axis ≥7 mm and short/long ratio ≥0.75 and 2) at least two of the following the absence of hilar echoes, expansive appearance, or peripheral/mixed vascularity by the colour Doppler and/or contrast-enhanced method. Compared to CT, US showed a higher diagnostic sensitivity (54.5% vs. 43.9%; p=0.296), higher concordance with the number of pathological LNM (correlation coefficient US, 0.42; CT, 0.27) and pathological N diagnosis (weighted ĸ US, 0.35; CT, 0.18), and higher sensitivity for advanced LNM, including multiple LNMs (47.4% vs. 18.4%; p=0.014) and N2 stage (27.8% vs. 5.6%; p=0.177).
US has higher sensitivity than CT for diagnosing LNM in colon cancer, along with a more accurate preoperative diagnosis of the N stage. Additionally, US may be more helpful than CT alone for preoperatively deciding the appropriateness of neoadjuvant treatment in colon cancer with advanced LNM.
US has higher sensitivity than CT for diagnosing LNM in colon cancer, along with a more accurate preoperative diagnosis of the N stage. Additionally, US may be more helpful than CT alone for preoperatively deciding the appropriateness of neoadjuvant treatment in colon cancer with advanced LNM.
The optimal indication of hepatectomy with adjuvant therapy for intrahepatic cholangiocarcinoma (ICC) has not been evaluated in detail.
We retrospectively studied 224 patients with ICC who underwent hepatectomy between 2000 and 2019. Prognostic factors for overall survival (OS) were evaluated by univariate and multivariate analysis. A total of 127 patients were treated with adjuvant therapy (62 patients with chemotherapy and 65 patients with immunotherapy) after hepatectomy, and 97 patients were treated with hepatectomy alone.
Intrahepatic metastasis (IM), lymph node metastasis (LNM) of ICC, adjuvant chemotherapy, and adjuvant immunotherapy were significant prognostic factors for OS on multivariate analysis. In 127 patients with neither IM nor LNM, the 5-year OS rate was significantly higher in 36 patients with adjuvant chemotherapy (81%) and in 34 patients with adjuvant immunotherapy (68%) than in 57 patients with hepatectomy alone (45%).
The absence of IM or LNM is the optimal indication for hepatectomy with adjuvant therapy in patients with ICC.
The absence of IM or LNM is the optimal indication for hepatectomy with adjuvant therapy in patients with ICC.We construct an Euler system associated to regular algebraic, essentially conjugate self-dual cuspidal automorphic representations of GL 3 over imaginary quadratic fields, using the cohomology of Shimura varieties for GU ( 2 , 1 ) .RationalCastleman disease is a rare lymphoproliferative disorder that can be subdivided into unicentric and multicentric forms, the latter of which causes a spectrum of serious medical conditions. Here, we present a case of idiopathic multicentric Castleman disease in the eighth decade of life. Patient Concerns. First hospitalized due to unexplained progressive anemia, the patient was readmitted to the hospital 18 months later with suspected lymphoma. Clinical examination revealed a progressive lymphadenopathy. Diagnoses. Histopathologic lymph node features, anemia, elevated CRP and IL6 levels, splenomegaly, and hypoalbuminemia indicated multicentric Castleman (MCD) disease. Interventions. The patient was treated intravenously with a dose of 11 mg/kg siltuximab every 3 weeks. Outcomes. Timely correct diagnosis through the stringent use of consensus diagnostic criteria and sufficient siltuximab therapy has considerably promoted favorable clinical outcomes in a patient suffering from MCD.To provide an online service learning opportunity for medical students during the COVID-19 pandemic, medical faculty and librarians developed and implemented a "Debunking Medical Myths" module in which students learned to search for emerging medical literature, evaluate evidence, and use that evidence to create an infographics debunking a COVID-19-related myth for a non-medical audience. The resultant infographics are visually appealing and designed to make complex health information easy to understand. selleck The module was well-received by students, who demonstrated a nuanced understanding of the use of infographics to convey health information, and students' work was evaluated highly by community members.
The online version contains supplementary material available at 10.1007/s40670-022-01541-w.
The online version contains supplementary material available at 10.1007/s40670-022-01541-w.
To evaluate the efficacy of the smartphone-based
-color test to detect color defects in patients with Age-related Macular Degeneration (AMD).
88 patients (
 = 135 eyes) with AMD and 28 controls (
 = 53 eyes) underwent color testing with the Hardy-Rand-Rittler (H-R-R), the
-color test, and the Ishihara test. The
-color test presents randomized colored shapes in decreasing steps of intensity, providing also a record system for result tele-transmission. Sensitivity, specificity, and reliability were examined to investigate the validity of the novel test. 26 participants with AMD also completed a questionnaire regarding the feasibility of the test.
Linear mixed-effects models indicated a significant difference (
< 0.001) between AMD and normal eyes. The areas under the curve (AUC) were estimated to be 0.897 [95% CI 0.841-0.952], 0.943 [95% CI 0.901-0.984], and 0.931 [95% CI 0.886-0.977] for the red, green, and blue color, respectively. Based on the H-R-R, the sensitivity of the test was 0.79, 0.90, and 0.95 for the red, green, and blue colors, respectively, and specificity was 0.88 for all colors. The new test recognized more abnormal cases than the Ishihara (sensitivity of 0.98 and 1.0 and specificity of 0.48 and 0.38 for red and green colors, respectively). Test-retest reliability was found to be high for the red [ICC = 0.996 (0.990-0.999)], green [ICC = 0.974 (0.929-0.990)], and blue [ICC = 0.992 (0.981-0.997)] colors. The majority of the asked participants stated that they could easily perform the test.
The
-color test was found to be sensitive and specific in detecting color defects in AMD patients. The
-color test may serve as a useful tool both for patients and their physicians.
The K-color test was found to be sensitive and specific in detecting color defects in AMD patients. The K-color test may serve as a useful tool both for patients and their physicians.
To investigate the efficacy and safety profile of retinal tacks (RTs) in cases of retinal detachment (RD) with advanced proliferative vitreoretinopathy (PVR).
In this single-center, retrospective study medical record, optical coherence tomography and ultra-widefield fundus images of patients with complex PVR-related and RT surgery were reviewed. All cases underwent 23G pars plana vitrectomy (PPV), RT implantation, retinectomy, circumferential intraoperative laser retinopexy, and silicone oil tamponade.
Fourteen eyes of 14 patients with complex rhegmatogenous RD with PVR were included 7 cases showed PVR grade C type P and 7 combined grades A and P. RTs were positioned at contracted, stiffened retinal areas to achieve attachment of retinectomy borders after extensive PVR peeling. Patients underwent on an average of 1.3 PPVs (range 0-3) prior RT surgery. An average of 2.5 RTs (range 1-4) were implanted. Only in a single eye, a recurrent RD occurred. In 10 eyes, the silicone oil tamponade was still in place at the last follow-up. In 5 eyes, the silicone oil could be removed without redetachment in all of these cases (average of 31.3 weeks, range 11.4-53). No RT-related intraoperative or postoperative complications like dislocation or bleedings were observed.
RTs have the potential to improve the treatment of complex PVR-associated RD. RT can be a useful surgical tool to reattach borders of retinectomies in advanced PVR. No RT-associated complication were observed in this study.
RTs have the potential to improve the treatment of complex PVR-associated RD. RT can be a useful surgical tool to reattach borders of retinectomies in advanced PVR. No RT-associated complication were observed in this study.Exomoons represent a crucial missing puzzle piece in our efforts to understand extrasolar planetary systems. To address this deficiency, we here describe an exomoon survey of 70 cool, giant transiting exoplanet candidates found by Kepler. We identify only one exhibiting a moon-like signal that passes a battery of vetting tests Kepler-1708 b. We show that Kepler-1708 b is a statistically validated Jupiter-sized planet orbiting a Sun-like quiescent star at 1.6 au. The signal of the exomoon candidate, Kepler-1708 b-i, is a 4.8σ effect and is persistent across different instrumental detrending methods, with a 1% false-positive probability via injection-recovery. Kepler-1708 b-i is ~2.6 Earth radii and is located in an approximately coplanar orbit at ~12 planetary radii from its ~1.6 au Jupiter-sized host. Future observations will be necessary to validate or reject the candidate.Roots secrete a vast array of low molecular weight compounds into the soil broadly referred to as root exudates. It is a key mechanism by which plants and soil microbes interact in the rhizosphere. The effect of drought stress on the exudation process and composition is rarely studied, especially in cereal crops. This study focuses on comparative metabolic profiling of the exudates from sensitive and tolerant genotypes of pearl millet after a period of drought stress. We employed a combined platform of gas and liquid chromatography coupled to mass spectrometry to cover both primary and secondary metabolites. The results obtained demonstrate that both genotype and drought stress have a significant impact on the concentration and composition of root exudates. The complexity and function of these differential root exudates are discussed. To reveal the potential effect of root exudates on the soil microbial community after a period of drought stress, we also tested for biological nitrification inhibition (BNI) activity.