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Clinical nodal staging to assess the risk of local recurrence after rectal cancer resection:A nationwide cross-sectional study
No full textAim In rectal cancer, neo-adjuvant (chemo)radiotherapy (n(C)RT) should be used selectively, due to related toxicity. The decision to offer n(C)RT is mainly based on preoperative MRI staging. cN category has limited accuracy and its use when deciding on n(C)RT is controversial. This population-based study aimed to assess the association between cN category and local recurrence (LR) rate. Method Data from a national cross-sectional cohort of patients who underwent curative resection of primary rectal cancer in the Netherlands in 2016 were used. Patients were subdivided by neo-adjuvant treatment strategy: no n(C)RT, short-course RT with short interval to surgery (SCRT-SI) or downstaging therapy (SCRT with long interval to surgery, CRT, total neoadjuvant therapy or chemotherapy only). The 4-year LR rate was calculated per (y)cN category and corrected for known pre-operative confounders in Cox-regression analysis. Results Of 2148 included patients, 1000 received no n(C)RT, 449 SCRT-SI and 699 downstaging therapy. Median follow-up was 50 months (interquartile range [IQR] 38-55). The 4-year LR rates for cN0, cN1 and cN2 were 6.3%, 5.0% and 6.2% without n(C)RT, and 0%, 2.4% and 0% after SCRT-SI. In patients treated with downstaging therapy, not primary cN, but restaging ycN category was significantly associated with LR rate (9.1%, 17.4% and 18.5%; p = 0.006) in univariable analysis. In multivariable analysis, no association was observed between ycN and LR (p = 0.088). Conclusion Evaluation of nationwide clinical practice did not reveal significant associations between cN category and LR rate after rectal cancer resection within three neo-adjuvant treatment groups, which questions its validity for clinical decision-making
The trajectory of cancer-related fatigue throughout lung cancer treatment and its association with physical activity
No full textBackground: Cancer-related fatigue (CRF) is a debilitating symptom in patients with lung cancer and is often more severe than in other cancer populations. This study investigated the impact of different cancer treatments on CRF trajectories and the role of physical activity (PA) during treatment. Methods: Patients with non-small cell lung cancer (NSCLC) were included. CRF was assessed at diagnosis, during treatment, and 12 weeks after treatment initiation using the Multidimensional Fatigue Inventory (MFI-20). Delta MFI-20 (T-followup - T-diagnosis) was compared across treatments (surgery, surgery and (neo-)adjuvant treatment, and non-surgical treatment). PA was measured with an Actigraph GT3X (for 1 week during hospitalization after surgery and/or halfway through (neo-)adjuvant treatment), capturing daily step count and minutes of moderate to vigorous PA (MVPA). Delta MFI-20 between the three groups and the association with PA during treatment were examined using multivariable general linear models. Results: Sixty-two patients (66 +/- 8 years, 66% male) were included. CRF increased significantly more in patients receiving surgery and (neo-)adjuvant treatment (n = 12) compared to surgery alone (n = 29) (Delta MFI-20, 16 +/- 17 vs. 0.3 +/- 13; p < 0.05). The increase in CRF in non-surgically treated patients (n = 21) (Delta MFI-20, 6 +/- 19) was not statistically different (p = 0.41) from those receiving surgery. Patients performed 3695 +/- 2288 steps/day and 11 +/- 14 min of MVPA/day during treatment. Patients engaging in higher levels of PA during treatment (> 5000 steps/day or > 10 min of MVPA/day) tended to have lower CRF increases compared to most inactive patients (< 3000 steps/day) (Delta MFI-20, 6.4 +/- 4.9; p = 0.06). Conclusions: Patients with lung cancer experience significant increases in CRF throughout treatment, particularly those receiving (neo-)adjuvant treatment and surgery. PA levels during treatment were very low and tended to be related to lower fatigue increases. These findings highlight the importance of measuring CRF and the potential for exploring PA interventions to manage CRF
Evaluation of processing of canola protein isolate on postprandial plasma amino acid profiles in healthy, young females
No full textCanola protein is a rapeseed-derived protein that contains all essential amino acids in proportions that meet the WHO amino acid scoring requirements, making it an interesting protein for human food applications. It is currently unknown whether canola protein processing modulates postprandial plasma amino acid bioavailability in vivo in humans. This study compared postprandial plasma amino acid profiles following the ingestion of unprocessed (native) canola, processed canola, and whey protein isolate in healthy, young, females. In a randomized, clinical, cross-over design, 15 healthy young females (25 +/- 3 y) participated in four test days on which they consumed 20 g protein as either native canola, enzyme processed or heat processed canola protein, or 20 g whey protein. Blood samples were collected for 5 h following protein ingestion to assess plasma amino acid concentrations. Ingestion of native canola protein resulted in lower increases in plasma total amino acid (TAA) concentrations compared to whey protein (3191 +/- 794 vs. 4429 +/- 84 mu mol center dot L- 1, P < 0.001). Canola protein processing resulted in greater peak plasma total amino acids concentrations, reaching statistical significance for enzyme (3599 +/- 687 <mu>mol center dot L- 1, P = 0.045) but not heat (3565 +/- 722 mu mol center dot L- 1, P = 0.166) treated compared to native canola protein. Plasma total amino acid availability, expressed as incremental area under the curve over a 5 h postprandial period, did not differ between treatments and averaged 163 +/- 81, 171 +/- 76, 194 +/- 82, and 207 +/- 85 mmol center dot 300 min center dot L- 1 following ingestion of native, enzyme- and heat processed canola, and whey protein, respectively (P > 0.05). Ingestion of whey protein allows for a more rapid postprandial rise in circulating essential and non-essential amino acids and greater postprandial plasma total amino acid availability when compared to the ingestion of native canola protein. Ingestion of enzyme- or heat processed canola protein accelerates the postprandial rise in circulating amino acids but does not further augment overall plasma amino acid availability throughout a 5 h postprandial period when compared to the ingestion of native canola protein
Training teachers to teach learning:programme design and measurement insights using a multiple case study approach
No full textDespite teachers' impact on the instruction of effective learning strategies, they often lack the skills to teach them effectively. Therefore, an evidence-informed training programme was developed to enhance teachers' knowledge and beliefs in effective learning strategies, and the self-efficacy to teach them. Moreover, the authors investigated which measurement instruments are useful to assess participants' development. Therefore, a design-based approach was used. In two iterations both qualitative and quantitative data were collected to evaluate the programme and instruments. The authors concluded that the training programme can be suitable for fostering knowledge and beliefs in effective learning strategies and the self-efficacy to teach them. The collected data demonstrated the questionnaire's usefulness for measuring knowledge and self-efficacy. Nevertheless, for measuring beliefs, alternative instruments are needed, as evidenced by a noted misalignment between the results of the distinct instruments. Suggestions were offered for the further development of a programme for teaching effective learning strategies
Regional mortality disparities in Central and Eastern Europe 2000-22
No full textBackground European integration significantly influenced regional development in Central and Eastern Europe (CEE), yet evidence on regional mortality disparities is scarce. This study examines regional disparities in all-cause, cancer, cardiovascular, and external death rates in Czechia, Estonia, Lithuania, Poland, Romania, and Slovakia during 2000-22.Methods We collected official data on population and death counts by sex, age, cause, and region. A spline-based model was used to smooth the mortality surface and estimate stable age-standardized death rates (SDR). We calculated measures of absolute and relative disparities in regional SDR and examined their trends using segmented regression.Results In most CEE countries, absolute disparities in all-cause, cardiovascular, and external SDR have reduced over time, while relative disparities in cardiovascular SDR have increased. Trends in cancer SDR disparities varied between the countries. We detected increases in absolute, but not relative (except in Czechia), all-cause mortality disparities during the COVID-19 pandemic.Conclusion While reduced absolute mortality disparities represent a significant public health victory, increased relative disparities and overall disparities in some settings indicate the emergence of regions falling behind in mortality improvements. Our findings point to possible regional differences in health system capacities to address emerging or complex diseases by rapidly implementing health innovations
Power advantage and unit ambidexterity:A tripartite mediation framework
No full textWhile research on unit-level ambidexterity is burgeoning, the role of a unit's power advantage has been largely overlooked. Yet, organizational units are interdependent, and gaining an advantageous position across a network of multiple power relationships with other units enables them to create a context favorable to pursuing both exploration and exploitation. This study, therefore, examines how a unit's power advantage shapes its ability to achieve ambidexterity through a tripartite mediation of affective, behavioral, and cognitive contextual factors. Employing a multisource, time-separated sample of 146 marketing units engaging in 901 dyadic (power) relationships with other units, we find that power-advantaged units are more likely to attain ambidexterity directly or indirectly through fostering unit positive affect and cognitive diversity, but not through behavioral autonomy. We conclude by discussing the theoretical and practical implications of our findings
Bilateral vestibulopathy - insight in impact on quality of life and economic burden
No full textObjective: To investigate the impact of bilateral vestibulopathy (BV) on quality of life, capabilities and costs. Furthermore, to estimate the potential headroom of a vestibulocochlear implant treatment trajectory, and comparing it to the anticipated costs. Methods: Patients meeting the Bárány Society diagnostic criteria for BV were included. Data on quality of life (EQ-5D-5L) and capabilities (ICECAP-A) were obtained, along with BV related health care costs, and patient and family costs (last year and total disease duration) through a survey and interview. Productivity loss was measured using PRODISQ and Friction Cost Method. The one year and lifetime headroom were calculated. Experts were interviewed about anticipated health care consumption for a future treatment trajectory. Results: Fifty patients participated. The mean utility EQ-5D-5L score was 0.680, and the ICECAP-A score was 0.839. Mean total costs in the last year were €5,388 and €30,708 for the total disease duration. The one-year headroom was €12,261; and €306,489 for lifetime. The future treatment trajectory costs were €32,605 for the first year (excluding the implant and processor). Conclusion: BV patients have significantly lower health related quality of life compared to the general population. Combined with their health care consumption and other costs, this provides sufficient headroom for a potentially cost-effective vestibulocochlear implant treatment trajectory.</p
Book review: Christianity and the Chinese in Indonesia::Ethnicity, Education and Enterprise
No full textbook review: Christianity and the Chinese in Indonesia: Ethnicity, Education and Enterprise. By Chan-Yau Hoon. Liverpool University Press. 2023. xxvi+285 pp
Cardiac geometry alterations following bariatric surgery in severely obese adolescents:a one-year follow-up study of a randomised controlled trial
No full textBackground: Severe obesity in adolescents is a public health crisis of increasing concern. Cardiac maladaptation, such as left ventricular hypertrophy, increases the risk of future cardiovascular disease. This study aims to evaluate the impact of weight loss surgery on cardiac geometry in morbidly obese adolescents.Methods: A single-centre, randomised controlled trial titled comparing laparoscopic adjustable gastric banding with multidisciplinary lifestyle intervention against a control group with multidisciplinary lifestyle intervention alone. The trial included severely obese adolescents aged 14-16 who had not responded to a minimum of 12 months of multidisciplinary lifestyle intervention. The primary outcome measured was the percentage change in total body weight one year after surgery. Left ventricular geometry was evaluated ultrasonographically before and one year after bariatric surgery.Results: In the intervention and control group, a total of 10 and 8 patients received both the baseline and follow-up ultrasonographic examination. BMI significantly decreased in the intervention group compared to the control group (-6.75; 95% CI: -10.28 - -3.23). Moreover, left ventricular mass index (-8.21; 95% CI: -15.43 - -0.98) and relative left ventricular wall thickness (-0.04; 95% CI: -0.07 - 0.00) significantly decreased within the intervention group, reflecting amelioration of adverse remodelling, albeit without statistically significant intervention effect when compared to the control group.Conclusions: Significant weight loss through bariatric surgery may improve left ventricular geometry in severely obese adolescents. These findings support the potential of bariatric surgery not only for reducing weight loss but also for improving cardiac health
Outcome following open TAAA repair after TEVAR compared to conventional open type II TAAA repair
No full text: Background: Open thoracoabdominal aortic aneurysm (TAAA) repair for Crawford extent II aneurysms carries substantial risks. This study compares outcomes of open TAAA repair following prior thoracic endovascular aortic repair (TEVAR) with conventional open extent II repair. Patients and methods: A retrospective analysis of 91 patients (2006-2024) divided into prior TEVAR (n=29) and conventional repair Crawford extent II repair without previous TEVAR (n=62). Primary endpoints included mortality and complications; secondary endpoints assessed survival and reinterventions. This study was designed according to STROBE criteria. Results: The prior TEVAR group (n=29) had a mean age of 61.5 +/- 10.7 years and 72.4% were male, while the conventional extent II repair group (n=62) had a mean age of 63.2 +/- 9.8 years and 69.4% were male. Prior TEVAR patients underwent open repair for extent II (13.8%), III (58.6%), or IV (27.6%) aneurysms. In-hospital mortality was lower in the prior TEVAR group (6.9% vs. 25.8%, p =.07), as were rates of spinal cord ischemia (3.4% vs. 8.1%, p =.55), acute kidney injury (24.1% vs. 35.5%, p =.28), and massive transfusion (24.1% vs. 30.6%, p =.54). Pulmonary complications occurred less frequently after TEVAR (69.0% vs. 82.3%, p =.25). Kaplan-Meier analysis revealed no significant survival difference (log-rank p=.05), with 5-year survival rates of 94% (prior TEVAR) and 61% (conventional). Aortic reintervention rates were also similar (10.5% vs. 18.8%, p=.69). Conclusions: Open TAAA repair following prior TEVAR may offer clinically meaningful advantages over conventional open type II repair with acceptable survival rates; however, these findings should be interpreted cautiously given the study's retrospective design and small sample size. Staged hybrid approach could be a viable strategy for managing complex aortic pathologies