Healing Targeting of Notch Signaling Through Most cancers to inflammatory Disorders

PURPOSE/OBJECTIVES Medical students often complete clinical rotations at other institutions ("away rotations"). This study assesses the number of away rotations undertaken by radiation oncology residency applicants, and their value from the applicants' perspective. MATERIALS/METHODS A survey was sent to applicants to a single radiation oncology program from 2015-2017. Questions addressed away rotation frequency, funding, motivations, barriers, and match results. A Chi-square test was used to assess the correlation between number of away rotations and matching to an away program. Binary logistic regression was used to assess factors associated with undertaking >2 away rotations. RESULTS The response rate was 39% (n=194); 89% of respondents completed ≥1 away rotation (median 2, IQR 2-3), of which 39% (n=67) matched to an away program. The number of away rotations completed did not differ between those who did and did not match (p=0.29). Also, the number of away rotations did not correlate with matching at an away program (p=0.40). Factors associated with completing more away rotations included male gender and high loan burden (p less then 0.05). Away rotations were perceived as extremely important (71%), with interest in a specific program (44%) and obtaining letters of recommendation (31%) the most common reasons to pursue away rotations. Only 9% (n=15) of applicants did away rotations because they had no home program. Funding sources included personal savings (29%), family support (26%), and loans (22%). If costs were inconsequential, 67 applicants (35%) noted they would do more away rotations. CONCLUSIONS Away rotations are common and often result in students matching to an away program, though benefit to ≥2 away rotations appears limited and has associated costs. Limiting the number of away rotations in radiation oncology may decrease costs without sacrificing one's chances of matching. BACKGROUND Programmed death receptor ligand one (PD-L1) expression is known to predict response to PD-1/PD-L1 inhibitors in non-small cell lung cancer (NSCLC). However, the predictive role of this biomarker in brain metastases (BMs) is unknown. The aim of this study was to assess whether PD-L1 expression predicts survival in patients with NSCLC BMs treated with PD-1/PD-L1 inhibitors, after adjusting for established prognostic models. METHODS In this multi-institutional retrospective cohort study, we identified NSCLC-BM patients treated with PD-1/PD-L1 inhibitors after local BM treatment (radiotherapy or neurosurgery) but before intracranial progression. Cox proportional hazards models were used to assess predictive value PD-L1 expression for overall survival (OS) and intracranial progression free survival (IC-PFS). RESULTS Forty-eight BM patients with available PD-L1 expression were identified. PD-L1 expression was positive in 33 patients (69%). Median survival was 26 months. In univariable analysis, PD-L1 predicted favorable OS (HR = 0.44; 95% CI 0.19 - 1.02; p = 0.055). This effect persisted after correcting for lung-graded prognostic assessment (lung-GPA) and other identified potential confounders (HR = 0.24; 95% CI = 0.10 - 0.61; p = 0.002). Moreover, when modeled as a continuous variable, there appeared to be a proportional relationship between percentage of PD-L1 expression and survival (HR = 0.86 per 10% expression, 95% CI 0.77 - 0.98, p = 0.02). In contrast, PD-L1 expression did not predict IC-PFS in uni- or multivariable analysis (adjusted HR = 0.54, 95% CI 0.26 - 1.14, p = 0.11). CONCLUSIONS In patients with NSCLC-BMs treated with PD-1/PD-L1 checkpoint inhibitors and local treatment, PD-L1 expression may predict OS independent of lung-GPA. IC-PFS did not show association with PD-L1 expression, although the present analysis may lack power to assess this. Larger studies are required to validate these findings. OBJECTIVE Deep endometriosis infiltrating the rectum may be managed by full thickness disc excision, with the goal of preserving rectal function and avoiding low anterior rectal resection syndrome. Transanal staplers may be successfully used to remove rectal wall disc and concomitantly to perform rectal suture. The goal of the video article is to identify 10 steps which may render the procedure standardized and reproducible. Lysipressin research buy DESIGN Step-by-step video demonstration of the procedure. SETTING A French tertiary referral center. INTERVENTION The video presents disc excision of deep endometriosis infiltrating the rectum using transanal circular stapler, following 10 steps 1) Nodule dissection and rectum releasing; 2) Rectal shaving; 3) Removal of fat tissue on lateral rectal wall; 4) Placement of a suture on shaved area; 5) Introduction of the transanal circular stapler closed; 6) Stapler opening at nodule's level; 7) Knot performing; 8) Stapler closed and fired; 9) Stiches to reinforce the stapled line; 10) Bubbles' test. From 2009 to 2020, the author has performed this procedure in 205 patients; mean disc diameter was 40+/-8 mm, microscopic foci were found on disc edges in 25.7%, rectal recurrences rate was 1.5%, while leakage rate was 4.4%. The local institutional review board stated that approval was not required because the video describes a technique and does not report a clinical case. CONCLUSION Disc excision using transanal circular stapler following 10 steps is a standardized and reproducible procedure. The learning curve may be short, as colorectal surgeons routinely employ the stapler to perform laparoscopic colorectal anastomosis. Both ultraviolet radiation and visible light have biologic effects on the skin. Visible light can induce erythema in light skinned individuals and pigmentation in dark skinned individuals. Broad spectrum sunscreens protect against ultraviolet radiation and do not adequately protect against visible light. For a sunscreen to protect against visible light, it must be visible on the skin. Inorganic filters (also known as mineral filters), namely, zinc oxide and titanium dioxide, are used in the form of nanoparticles in sunscreens to minimize the chalky and white appearance on the skin; as such, they do not protect against visible light. Tinted sunscreens use different formulations and concentrations of iron oxides and pigmentary titanium dioxide to provide protection against visible light. Many shades of tinted sunscreens are available by combining different amounts of iron oxides and pigmentary titanium dioxide to cater to all skin phototypes. Therefore, tinted sunscreens are beneficial for patients with visible light-induced photodermatoses and those with hyperpigmentation disorders such as melasma and post-inflammatory hyperpigmentation.