scholarly journals 430 Evaluation of A Prioritisation Policy for HPB Resections in the COVID-19 Era

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O El-Koubani ◽  
C Schneider ◽  
P Srinivasan
Keyword(s):  
Statistical Analysis ◽  
Performance Status ◽  
Control Group ◽  
Rapid Progression ◽  
Long Term Outcomes ◽  
Borderline Resectable ◽  
Aggressive Disease ◽  
Cancer Complications ◽  
Delay In Treatment

Abstract Aim The COVID19 pandemic has caused oncological services worldwide to face unprecedented challenges resulting in treatment disruptions for cancer patients requiring surgery. Hepatopancreatico-biliary cancers are characterised by a low resectability rate and rapid progression. This study aims to assess the effectiveness of a prioritisation policy for this cohort of patients during the initial COVID19 outbreak. Method The prioritisation policy and triage system are described in detail. Patients undergoing surgery between April-July 2020 (COVID period) were compared to a control group from the preceding year. Statistical analysis was carried out to evaluate timeliness of treatment, peri-operative characteristics and short-outcomes. Results Patient selection was restructured to prioritise patients with performance status of < 2 with presence of cancer complications, borderline resectable- or biologically aggressive disease. Where feasible, neoadjuvant therapy was advocated. An elective safe corridor pathway was established to reduce the risk of COVID19 infection. During the COVID19 and pre-COVID19 period, 94 and 115 patients underwent surgery, respectively. No patients contracted COVID19 post-operatively. There were less patients with ASA≥3 during the COVID19 period vs. pre-COVID19 (12.8% vs. 34.2%; p < 0.001). Median time between referral and surgery was greater during the COVID19 compared to the pre-COVID19 period, at 64 days vs. 49 days, respectively (p = 0.023). Despite this difference no NHS waiting list breaches occurred. Incidence of postoperative complications were comparable between groups. Conclusions The outlined prioritisation policy for oncological hepatopancreatico-biliary resections was effective in providing safe surgery during the COVID-19 outbreak. Whether the observed delay in treatment will affect long-term outcomes remains to be seen

Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence

2020 ◽  
Vol 48 (4) ◽  
pp. 329-334
Author(s):  
Soo Jin Han ◽  
Seung Mi Lee ◽  
Sohee Oh ◽  
Subeen Hong ◽  
Jeong Won Oh ◽  
...  
Keyword(s):  
Cord Blood ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Control Group ◽  
Long Term Outcomes ◽  
Neurodevelopmental Outcomes ◽  
Monochorionic Twin ◽  
Increased Risk ◽  
Study Population

AbstractBackgroundIn monochorionic twin pregnancy, placental anastomosis and inter-twin blood transfusion can result in specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). It is well established that adverse outcomes are increased in TTTS, but reports on the neonatal and long-term outcomes of TAPS are lacking. The objective of this study was to evaluate the neonatal and neurodevelopmental outcomes in spontaneous TAPS.MethodsThe study population consisted of monochorionic twin pregnancies with preterm birth (24–37 weeks of gestation) between November 2003 and December 2016 and in which cord blood was taken at the time of delivery. According to the result of hemoglobin in cord blood, the study population was divided into two groups: a spontaneous TAPS group and a control group. Neonatal and neurodevelopmental outcomes were compared between the two groups.ResultsDuring the study period, 11 cases were diagnosed as spontaneous TAPS (6.4%). The TAPS group had lower gestational age at delivery and had a higher risk for cesarean delivery. However, neonates with TAPS were not at an increased risk for neonatal mortality and significant neonatal morbidity. In addition, the frequency of severe cerebral lesion during the neonatal period and the risk of cerebral palsy at 2 years of age were not different between the two groups.ConclusionThe spontaneous TAPS diagnosed by postnatal diagnostic criteria was not associated with the increased risk of adverse neonatal and neurodevelopmental outcomes. Further studies are needed to evaluate the morbidity of antenatally diagnosed TAPS.

scholarly journals Combined low-dose everolimus and low-dose tacrolimus after Alemtuzumab induction therapy: a randomized prospective trial in lung transplantation

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alberto Benazzo ◽  
Ara Cho ◽  
Anna Nechay ◽  
Stefan Schwarz ◽  
Florian Frommlet ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Lung Transplantation ◽  
Kidney Function ◽  
Induction Therapy ◽  
Low Dose ◽  
Prospective Trial ◽  
Control Group ◽  
Long Term Outcomes ◽  
Maintenance Immunosuppression

Abstract Background Long-term outcomes of lung transplantation are severely affected by comorbidities and development of chronic rejection. Among the comorbidities, kidney insufficiency is one of the most frequent and it is mainly caused by the cumulative effect of calcineurin inhibitors (CNIs). Currently, the most used immunosuppression protocols worldwide include induction therapy and a triple-drug maintenance immunosuppression, with one calcineurin inhibitor, one anti-proliferative drug, and steroids. Our center has pioneered the use of alemtuzumab as induction therapy, showing promising results in terms of short- and long-term outcomes. The use of alemtuzumab followed by a low-dose double drug maintenance immunosuppression, in fact, led to better kidney function along with excellent results in terms of acute rejection, chronic lung allograft dysfunction, and survival (Benazzo et al., PLoS One 14(1):e0210443, 2019). The hypothesis driving the proposed clinical trial is that de novo introduction of low-dose everolimus early after transplantation could further improve kidney function via a further reduction of tacrolimus. Based on evidences from kidney transplantation, moreover, alemtuzumab induction therapy followed by a low-dose everolimus and low-dose tacrolimus may have a permissive action on regulatory immune cells thus stimulating allograft acceptance. Methods A randomized prospective clinical trial has been set up to answer the research hypothesis. One hundred ten patients will be randomized in two groups. Treatment group will receive the new maintenance immunosuppression protocol based on low-dose tacrolimus and low-dose everolimus and the control group will receive our standard immunosuppression protocol. Both groups will receive alemtuzumab induction therapy. The primary endpoint of the study is to analyze the effect of the new low-dose immunosuppression protocol on kidney function in terms of eGFR change. The study will have a duration of 24 months from the time of randomization. Immunomodulatory status of the patients will be assessed with flow cytometry and gene expression analysis. Discussion For the first time in the field of lung transplantation, this trial proposes the combined use of significantly reduced tacrolimus and everolimus after alemtuzumab induction. The new protocol may have a twofold advantage: (1) further reduction of nephrotoxic tacrolimus and (2) permissive influence on regulatory cells development with further reduction of rejection episodes. Trial registration EUDRACT Nr 2018-001680-24. Registered on 15 May 2018

scholarly journals Head orthosis therapy in positional plagiocephaly: longitudinal 3D-investigation of long-term outcomes, compared with untreated infants and with a control group

2018 ◽  
Vol 41 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Felix Kunz ◽  
Tilmann Schweitzer ◽  
Stephan Große ◽  
Nina Waßmuth ◽  
Angelika Stellzig-Eisenhauer ◽  
...  
Keyword(s):  
Control Group ◽  
Long Term Outcomes ◽  
Positional Plagiocephaly

Long-term outcomes after adolescent in-patient treatment due to alcohol intoxication: A control group study

2016 ◽  
Vol 162 ◽  
pp. 116-123 ◽  
Author(s):  
Cornelius Groß ◽  
Olaf Reis ◽  
Ludwig Kraus ◽  
Daniela Piontek ◽  
Ulrich S. Zimmermann
Keyword(s):  
Alcohol Intoxication ◽  
Patient Treatment ◽  
Control Group ◽  
Long Term Outcomes

scholarly journals Comparison of Long-term outcomes between Lynch sydrome and sporadic colorectal cancer: a propensity score matching analysis

2020 ◽  
Author(s):  
Yun Xu ◽  
Cong Li ◽  
Charlie Zhi-Lin Zheng ◽  
Yu-Qin Zhang ◽  
Tian-An Guo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Control Group ◽  
Sporadic Colorectal Cancer ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Tumor Stages

Abstract Background Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Comparison of prognosis between LS and sporadic CRC (SCRC) were rare,with conflicting results. This study aimed to compare the long-term outcomes between patients with LS and SCRC. Methods Between June 2008 and September 2018, a total of 47 patients were diagnosed with LS by genetic testing at Fudan University Shanghai Cancer Center. A 1:2 propensity score matching was performed to obtain homogeneous cohorts from SCRC group. Thereafter, 94 SCRC patients were enrolled as control group. The long-term survival rates between the two groups were compared, and the prognostic factors were also analyzed. Results The 5-year OS rate of LS group was 97.6%, which was significantly higher than of 82.6% for SCRC group (p = 0.029). The 5-year PFS rate showed no significant differences between the two groups (78.0% for LS group vs. 70.6% for SCRC patients; p = 0.262). The 5-year TFS rates in LS group was 62.1% for LS patients, which were significantly lower than of 70.6% for SCRC group (p = 0.039). By multivariate analysis, we found that tumor progression of primary CRC and TNM staging were independent risk factors for OS. Conclusion LS patients have better long-term survival prognosis than SCRC patients. Strict regular follow-up monitoring, detection at earlier tumor stages, and effective treatment are key to ensuring better long-term prognosis.

scholarly journals Polyhedral Fenestration Technique Used for Combined Partial Hepatectomy and Cyst Fenestration for Polycystic Liver Disease: A Small Case Series

2020 ◽  
Vol 104 (3-4) ◽  
pp. 159-165
Author(s):  
Yoshiki Sato ◽  
Daisuke Morioka ◽  
Kazuya Yamaguchi ◽  
Nobutoshi Horii ◽  
Kentaro Miyake ◽  
...  
Keyword(s):  
Liver Disease ◽  
Case Series ◽  
Patient Characteristics ◽  
Control Group ◽  
Polycystic Liver Disease ◽  
Long Term Outcomes ◽  
Ct Volumetry ◽  
Polycystic Liver ◽  
Cyst Fenestration

Objective: To assess the safety and efficacy of “polyhedral fenestration technique” (PFT), which we newly developed, in combined hepatectomy and cyst fenestration (CHCF) for symptomatic polycystic liver disease (PLD). Summary of background data: CHCF for PLD has been reportedly less efficacious for its invasiveness because 50% to 70% patients suffered recurrent symptoms after CHCF. Methods: Patient characteristics, intra- and early postoperative variables were compared between 5 PLD patients undergoing CHCF performed with PFT (PLD group) and 95 patients with diseases other than PLD receiving hepatectomy without biliary reconstruction during the same period (Control group) to assess safety of PFT. Chronological changes in total liver volume (TLV) measured by computed tomography (CT) volumetry as well as recurrent symptoms after CHCF were investigated to assess long-term outcomes. Results: Although ≧ Clavien-Dindo grade 2 complications were more common in the PLD group than in the Control group (PLD vs Control, 5/5[100%] vs 27/95[28%], p=0.004), patient characteristics, intra-, and early postoperative variables, including ≧ Clavien-Dindo grade 3 complications, were comparable among the 2 groups. Postoperative observational period of the 5 PLD patients ranged 30 to 88 months with a median of 63. CT volumetry revealed that TLV continued to reduce up to 1 year after surgery and thereafter retained less than 0.5 times of preoperative TLV in all patients. Recurrent liver enlargement or recurrent symptoms were not observed in any of the 5 PLD patients. Conclusions: Although our case series was very small, newly-developed PFT in CHCF for PLD yielded acceptable safety and excellent long-term outcomes.

scholarly journals Long-Term Outcomes in Children with Acute Flaccid Myelitis

2021 ◽  
Author(s):  
Megan Henley ◽  
Lindie Hill ◽  
Sydney Inman ◽  
Molly King ◽  
Sam Lopez ◽  
...  
Keyword(s):  
Case Series ◽  
Rehabilitation Program ◽  
Fine Motor ◽  
Control Group ◽  
Long Term Outcomes ◽  
Functional Deficits ◽  
Acute Flaccid Myelitis ◽  
Group A ◽  
Study Designs

The purpose of our critically appraised topic is to combine the best evidence regarding the long-term outcomes in children with acute flaccid myelitis (AFM) regarding posture and movement, gross and fine motor control, and activities of daily living (ADL) performance. The final portfolio contains eight articles. The study designs of these articles include a retrospective cohort study, two retrospective non-randomized studies without a control group, a retrospective review, a nationwide follow-up questionnaire analysis study, a case report, a case series, and a multiple quantitative case study. All studies related directly to our evidence-based PICO question and were used to determine the best evidence of the long-term outcomes in children with AFM. Overall, our findings showed that functional improvements were seen in most i ndividuals, however, this varied from complete to incomplete recovery along with some persistent motor and functional deficits. Every case is different depending on when they were diagnosed, and how quickly they were able to implement a rehabilitation program into their everyday routine.

scholarly journals Outcomes of extensive surgeries in combination treatment of stage III–IV ovarian cancer

2020 ◽  
Vol 10 (1) ◽  
pp. 43-49
Author(s):  
Kh. I. Mamazhonov ◽  
S. O. Nikogosyan ◽  
A. S. Shevchuk ◽  
V. V. Kuznetsov
Keyword(s):  
Ovarian Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Intraoperative Complications ◽  
Stage Iii ◽  
Control Group ◽  
Node Dissection ◽  
Long Term Outcomes ◽  
Experimental Group

Objective: to evaluate short-term and long-term outcomes of lymph node dissection in patients with stage III–IV ovarian cancer.Materials and methods. This retrospective study included patients with stage III–IV ovarian cancer who have undergone either complete or optimal cytoreduction. Patients in the experimental group additionally had lymph node dissection, whereas patients in the control group had surgery without lymph node dissection. We evaluated 3‑year relapse-free survival (primary outcome measure), 3‑year overall survival, incidence of intraoperative and postoperative complications, and frequency of lymph node lesions.Results. The study included 272 patients: 43 women in the experimental group and 229 women in the control group. Intraoperative complications were significantly more common in patients who had lymph node dissection compared to those who had cytoreductive surgery alone (37.2 % vs 16.6 % respectively; р = 0.0001). The incidence of postoperative complications did not vary significantly between the groups (27.9 % in the experimental group vs 16.2 % in the control group; р = 0.128). Thirty-three patients (76.7 %) were found to have metastasis in the lymph nodes excised. The three-year overall survival rate was 82.6 % among patients who had lymph node dissection and 75.7 % among patients who had no lymph node dissection (р = 0.306). The three-year relapse-free survival rate was 26.2 % in the experimental group and 38.4 % in the control group (р = 0.858).Conclusions. Systemic lymph node dissection does not improve long-term outcomes and increases the incidence of intraoperative complications in patients with stage III–IV ovarian cancer undergoing complete or optimal cytoreduction.

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