1,720,959 research outputs found
Preoperative endoscopy and pathology report of the specimen to be recommended in sleeve gastrectomy?
Full text linkObjective: Preoperative upper gastrointestinal endoscopy (UGIE) and postoperative histopathological examination (HPE) of resected specimens are still controversial issues in bariatric surgery. Methods: A retrospective review of prospectively collected laparoscopic sleeve gastrectomies (SG) performed at our institution for morbid obesity was carried out. All patients underwent pre-operative UGIE with biopsy, post-operative HPE and conventional post-operative follow-up. Results: From January 2019 through January 2021 we performed a total of 501 laparoscopic SG. A total of 12 (2.4%) neoplasms were found, 2 evident at preoperative UGIE, 4 detected during operation, and 6 at HPE. Eight of these 12 cases had some malignant potential and 5 would not have been detected without HPE of the specimen. The most significant unexpected case was a fundic gland type adenocarcinoma in a 64-year-old female with severe obesity. Conclusion: On the basis of our clinical experience, we recommend both preoperative endoscopic assessment and postoperative HPE of the specimen to provide the best available treatment to these patients
Hepatic artery infusional chemotherapy in patients with unresectable liver-confined intrahepatic cholangiocarcinoma
No full textreservedBACKGROUND: Le opzioni di trattamento per il colangiocarcinoma intraepatico (ICC) non resecabile sono limitate. La chemioterapia sistemica standard offre benefici modesti, con i trial ABC che mostrano una sopravvivenza globale (OS) a 3 anni del solo 2,8% per i pazienti con ICC avanzato
confinato al fegato. L'aggiunta di immunoterapia prolunga la sopravvivenza mediana solo di pochi mesi. Il controllo della malattia nel fegato è associato a una migliore sopravvivenza e la chemioterapia tramite pompa di infusione intra-arteriosa epatica (HAIP) è emersa come un potenziale trattamento per il ICC non resecabile confinato al fegato, con o senza coinvolgimento linfonodale regionale, con l'obiettivo di migliorare il controllo locoregionale e la sopravvivenza attraverso la somministrazione di alte dosi di chemioterapici direttamente nel fegato tramite l'arteria epatica. L'HAIP combinata con la terapia sistemica può migliorare significativamente la sopravvivenza, ma il suo utilizzo rimane limitato.
METHODS: Proponiamo un'analisi aggregata dei dati individuali di pazienti arruolati in quattro trial clinici di fase II che hanno valutato la chemioterapia HAIP in pazienti con ICC non resecabile, confinato al fegato, con o senza malattia linfonodale regionale resecabile. L'endpoint primario era la OS. Gli endpoint secondari includevano la sopravvivenza libera da progressione epatica (PFS), i tassi di risposta e i tassi di resezione. La OS è stata stimata con il metodo di Kaplan-Meier e confrontata tramite test log-rank. Modelli di regressione univariata e multivariata di Cox hanno esaminato le associazioni tra covariate pre-selezionate e OS aggregata, con la progressione epatica analizzata come covariata dipendente dal tempo.
RISULTATI: Da Agosto 2003 a Settembre 2022, 142 pazienti sono stati inclusi in 2 studi monocentrici presso il Memorial Sloan Kettering Cancer Center (MSKCC), uno studio bi-istituzionale tra MSKCC e la Washington University di St. Louis, e un trial multicentrico nei Paesi Bassi. Le caratteristiche
demografiche e tumorali erano coerenti tra gli studi. La dimensione mediana dei tumori era di 9 cm (intervallo interquartile [IQR]: 6,9-11,3). Il coinvolgimento bilobare era presente in 96 pazienti (69%) e 92 pazienti (65%) presentavano malattia multifocale. Tutti i pazienti erano stati giudicati non resecabili all'esplorazione chirurgica, con malattia nodale osservata in 38 pazienti (27%). Il trattamento consisteva in HAIP con Floxuridina (FUDR) da sola (37, 26%) o con terapia sistemica (104, 73%); 1 paziente non ha ricevuto alcun trattamento. Una risposta parziale (RECIST) è stata
raggiunta in 78 pazienti (56%) e un controllo della malattia in 134 pazienti (96%). 13 pazienti (9,2%) sono stati sottoposti a resezione chirurgica con intento curativo dopo la chemioterapia HAIP, con 4 pazienti che hanno ottenuto una risposta patologica completa. La OS mediana aggregata era di 2,1
anni (95% CI: 1,8-2,5) senza differenze significative tra gli studi. I tassi di OS a 3 e 5 anni sono stati rispettivamente del 29% (95% CI: 22%, 38%) e del 15% (95% CI: 9,4%, 23%). Dopo aggiustamenti per covariate, la progressione epatica è risultata significativamente associata a una peggiore OS (HR:
4,21, 95% CI: 2,53-7,02; p< 0,001).
CONCLUSIONE: In questa analisi aggregata di pazienti con ICC non resecabile confinato al fegato, la OS a 3 e 5 anni ha superato di gran lunga quelle riportate in studi recenti che utilizzano solo la chemioterapia sistemica. La progressione epatica è il più forte predittore di mortalità in questa
coorte, evidenziando l'importanza di ritardare la progressione per migliorare i risultati di sopravvivenza.BACKGROUND: Treatment options for unresectable intrahepatic cholangiocarcinoma (ICC) are limited. Standard systemic chemotherapy provides modest benefits, with the ABC-trials demonstrating a dismal 3-year overall survival (OS) of only 2.8% for patients with advanced ICC confined to the liver. Addiction of immunotherapy extends median survival by only a few months. Control of disease in the liver is associated with improved survival and hepatic arterial infusion pump (HAIP) chemotherapy has emerged as a potential treatment for unresectable liver-confined ICC, with or without regional nodal involvement, aiming to improve locoregional control and survival by delivering high doses of chemotherapy directly to liver tumors via the hepatic artery. HAIP combined with systemic therapy can significantly enhance survival, but its use remains limited.
METHODS: We propose an individual patient data pooled analysis of four phase II trials that evaluated HAIP chemotherapy in patients with unresectable, liver-confined ICC, with or without resectable regional lymph node disease. The primary endpoint was OS. Secondary endpoints included hepatic progression-free survival (PFS), response rates, and resection rates. Kaplan-Meier methods estimated OS, compared by the log-rank test. Univariate and multivariable Cox proportional hazards regression models examined associations between pre-selected covariates and pooled OS, with
hepatic progression analyzed as a time-dependent covariate.
RESULTS: From August 2003 to September 2022, a total of 142 patients were included in 2 single center studies at Memorial Sloan Kettering Cancer Center (MSKCC), a bi-institutional study with MSKCC and Washington University in St. Louis, and a multicenter trial in the Netherlands. Patient
demographics and tumor characteristics were consistent across trials. The median tumor size was 9 cm (intraquartile range [IQR]: 6.9, 11.3). Bilobar involvement was present in 96 patients (69%), and 92 patients (65%) had multifocal disease. All patients were deemed unresectable upon surgical
exploration, with nodal disease observed in 38 patients (27%). Protocol treatment consisted of HAIP with Floxuridine (FUDR) alone (37, 26%) or with systemic therapy (104, 73%); 1 patient received no treatment. A partial response on imaging (RECIST) was achieved in 78 patients (56%) and a disease control in 134 patients (96%). 13 patients (9.2%) underwent surgical resection with curative intent following HAIP chemotherapy, with 4 patients achieving complete pathological response. Pooled median OS was 2.1 years (95% CI: 1.8, 2.5) with no significant difference across trials. The 3- and 5-year OS rates were 29% (95% CI: 22%, 38%) and 15% (95% CI: 9.4%, 23%), respectively. After adjusting for covariates, hepatic disease progression was significantly associated with worse OS (HR: 4.21, 95% CI: 2.53, 7.02; p< 0.001).
CONCLUSION: In this pooled analysis of patients with unresectable ICC confined to the liver, 3-year and 5-year OS far exceeded those reported in recent studies using systemic chemotherapy alone. Hepatic progression is the strongest predictor of mortality in this cohort, highlighting the importance
of delaying progression to improve survival outcomes
Textbook outcome and nomogram-guided approaches for enhancing surgical success in elderly HCC patients: Deciphering the influence of sarcopenia
Full text linkSarcopenia, serving as a surrogate for frailty, is clinically significant in liver resection (LR) for elderly hepatocellular carcinoma (HCC) patients. Our study aims to assess sarcopenia’s impact, measured by Psoas Muscle Index (PMI), on postoperative outcomes. We retrospectively studied patients aged ≥ 60 years who underwent LR for HCC between 2014 and 2018. PMI, derived from preoperative CT scans, and Textbook Outcome (TO) for LR were assessed. A nomogram predicting overall survival (OS) was developed via multivariable analysis. Of the 149 eligible HCC patients, the median PMI was 7.225 cm2/m2 in males and 4.882 cm2/m2 in females, with 37 (24.8%) patients identified as sarcopenic. Mortality was significantly associated with sarcopenia (HR 2.15; p = 0.032), MELD ≥ 10 (HR 3.13; p = 0.001), > 3 HCC nodules (HR 4.97; p = 0.001), and Clavien–Dindo ≥ 3 complications (HR 3.38; p < 0.001). Sarcopenic patients had a 5-year OS of 38.8% compared to 61% for non-sarcopenic individuals (p = 0.085). Achieving TO correlated with higher OS (p = 0.01). In sarcopenic cases, the absence of postoperative complications emerged as a limiting factor. Sarcopenic patients failing to achieve TO had worse OS compared to non-sarcopenic and TO-achieving counterparts (5-year OS 18.5%; p = 0.00039). Sarcopenia emerges as a prognostic factor for LR outcomes in elderly HCC patients. Postoperative complications in sarcopenic patients may compromise oncological outcomes
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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