Focused Versus Conventional Radiotherapy in Spinal Oncology: Is There any Difference in Fusion Rates and Pseudoarthrosis?

Abstract IntroductionRadiotherapy is considered standard of care for adjuvant peri-operative treatment of many spinal tumors, including those with instrumented fusion. Unfortunately, radiation treatment has been linked to increased risk of pseudoarthrosis. Newerfocused radiotherapy strategies with enhanced conformalitycould offer improved fusion rates for these patients, but this has not been confirmed.MethodsWe performed a retrospective analysis of patients at three tertiary care academic institutions withprimary and secondary spinal malignancies that underwent resection, instrumented fusion, and peri-operative radiotherapy. Two board certified neuro-radiologists used theLenke fusion score to grade fusion status at6 and 12-months after surgery. Secondary outcomes includedclinical pseudoarthrosis, wound complications, and the effect of radiation timing, radiobiological dose delivered, the use of photons versus protons, tumor type, tumor location,and use of autograft on fusion outcomes.ResultsAfter reviewof 1252 spinal tumor patients, there were 60 patients with at least 6 months follow-up that were included in our analyses. Twenty-five of these patients received focused radiotherapy,20 patients received conventional radiotherapy, and 15 patients were treated with protons. There was no significant difference between the groups for covariates such assmoking status,obesity, diabetes, intraoperative use of autograft, and use of peri-operative chemotherapy. There was a significantly higher rate of fusion for patients treated with focused radiotherapy compared to those treated with conventional radiotherapy at 6-months (64.0% versus 30.0%, Odds ratio: 4.15, p=0.036) and 12-months (80.0% versus 42.1%, OR: 5.50, p=0.022). There was a significantly higher rate of clinical pseudoarthrosis in the conventional radiotherapy cohortcompared to patients in the focused radiotherapy cohort (19.1% versus 0%,p=0.037). There was no difference in fusion outcomes for any of the secondary outcomes except for use of autograft. The use ofintra-operative autograft was associated with an improved fusion at 12-months (66.7% versus 37.5%, OR: 3.33, p=0.043). ConclusionFocused radiotherapy may be associated withan improved rate of fusion and clinical pseudoarthrosis when compared to conventional radiation delivery strategiesin patients with spinal tumors.Use of autograft at the time of surgery may be associated with improved 12-month fusion rates.Further large-scale prospective and randomized controlled studies are needed to better stratify the effects of radiation delivery modality in these patients.

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Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

10.2196/preprints.23937 ◽

2020 ◽

Author(s):

Dr. Animesh Ray ◽

Dr. Komal Singh ◽

Souvick Chattopadhyay ◽

Farha Mehdi ◽

Dr. Gaurav Batra ◽

...

Keyword(s):

Tertiary Care ◽

Age Groups ◽

Hospitalized Patients ◽

North India ◽

P Value ◽

Care Hospital ◽

Igg Antibodies ◽

Igg Antibody ◽

Increased Risk ◽

Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

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Risk of bevacizumab-associated gastrointestinal perforation in patients with colorectal cancer and noncolorectal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9622 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9622-9622

Author(s):

D. T. Chu ◽

S. Hapani ◽

S. Wu

Keyword(s):

Colorectal Cancer ◽

Relative Risk ◽

Solid Tumors ◽

Random Effect ◽

Angiogenesis Inhibitor ◽

Phase Iii ◽

Tumor Type ◽

Increased Risk ◽

Significant Difference ◽

American Society

9622 Background: Bevacizumab is a recombinant humanized monoclonal antibody that inhibits vascular endothelial growth factor. It is a widely used angiogenesis inhibitor in the treatment of colorectal cancer (CRC) and other solid tumors. Gastrointestinal (GI) perforation is a potentially fatal adverse event associated with bevacizumab, but the risk unclear. This study was conducted to determine the risk of developing GI perforation among CRC and non-CRC patients receiving bevacizumab. Methods: Databases from PUBMED and the Web Science from January 1966 until July 2008 and abstracts presented at the American Society of Clinical Oncology conferences from January 2000 to through July 2008 were searched to identify relevant studies. Eligible studies included prospective phase III clinical trials in which standard anti-neoplastic therapy was administered with and without the use of bevacizumab with available data for GI perforation. Summary incidence rate, relative risk (RR), and 95% confidence interval (CI) were calculated using fixed or random effect models based upon the heterogeneity of the included studies. Results: A total of 12084 patients with various solid tumors from 14 phase III trials were included for analysis. Among patients receiving bevacizumab, the incidence of GI perforation was 0.8% (95% CI: 0.6–1.1%), and RR was 2.0 (95% CI: 1.1–3.8, p = 0.028) in compared with controls. The risk of GI perforation was significantly increased in patients receiving bevacizumab at 5 mg/kg/week (RR 2.6, 95% CI: 1.0–6.6, p=0.04), but not at 2.5 mg/kg/week (RR=1.5, 95%CI: 0.7–3.3, p=0.3). Among 2151 patients with CRC, the incidence of GI perforation was 0.8% (95% CI: 0.5–1.6%); while for 2.999 patients with non-CRC malignancies, the incidence of GI perforation was 0.7% (95% CI: 0.5–1.1%); The relative risk of GI perforation varied with tumor type, with significantly increased risk observed in patients with CRC (RR = 3.1, 95% CI: 1.2–8.2, p<0.023), but not non-CRC (RR=1.5, 95% CI: 0.67–3.4, p=0.3). Conclusions: There is a significant difference in the risk of developing GI perforation in CRC and non-CRC patients receiving bevacizumab with a higher relative risk in patients with CRC. Further investigation into the etiology of this difference is recommended. No significant financial relationships to disclose.

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High-grade proteinuria associated with bevacizumab in patients with renal cell cancer and non-renal cell cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16089 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16089-e16089

Author(s):

C. Y. Kim ◽

D. Chu ◽

L. Baer ◽

S. Wu

Keyword(s):

Renal Cell Cancer ◽

Renal Cell ◽

Cell Cancer ◽

Significant Risk ◽

Close Monitoring ◽

Tumor Type ◽

High Grade ◽

Randomized Controlled ◽

Increased Risk ◽

Significant Difference

e16089 Background: Bevacizumab is a humanized monoclonal antibody that inhibits vascular endothelial growth factor. It is a widely used angiogenesis inhibitor in the treatment of renal cell cancer (RCC) and other solid tumors. Proteinuria is associated with significant morbidity and treatment interruptions. The overall risk for proteinuria is unclear. This study was conducted to determine the risk of developing proteinuria among RCC and non-RCC patients receiving bevacizumab. Methods: Databases from PUBMED and Web Science from January 1966 until July 2008 and abstracts presented at ASCO from January 2000 to July 2008 were searched to identify relevant studies. Studies included randomized controlled clinical trials in which standard anti-neoplastic therapy was administered with and without bevacizumab with available data for proteinuria. Summary incidence rate, relative risk (RR), and 95% confidence interval (CI) were calculated employing fixed or random effect models based upon the heterogeneity of included studies. Results: A total of 6,702 patients from 14 randomized controlled studies were included for analysis. The incidence of all-grade proteinuria in patients receiving bevacizumab was 19.3% (95% CI: 11.9–29.6%) with 2.3% (95% CI: 1.2–4.1%) being high-grade (grade 3 or 4). Patients treated with bevacizumab had an increased risk of developing high-grade proteinuria with RR of 6.3 (95% CI: 4.0–9.9) compared with controls. Risk may vary with dose of bevacizumab; significant difference may exist in patients receiving bevacizumab at 5 mg/kg/week (RR 9.1, 95% CI: 4.3–19.6, p < 0.001) and 2.5 mg/kg/week (RR = 5.1, 95%CI: 3.0–8.8, p < 0.001). The risk of high-grade proteinuria may also depend on tumor type; the incidence of high-grade proteinuria was 10.0% (95% CI: 4.3–22.4%) with a RR 48.7 (95% CI: 9.7–244.3) among 703 RCC patients compared with an incidence of 1.7% (95% CI: 0.09–3.2%) and RR of 5.2 (95% CI: 3.3–8.4) among 5,999 non-RCC patients. Conclusions: There is a significant risk for high-grade proteinuria in patients receiving bevacizumab. The risk may vary with bevacizumab dose and tumor type. RCC patients may have higher risk than non-RCC patients. Close monitoring and management are recommended for patients at high risk. No significant financial relationships to disclose.

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Facial Nerve Outcomes in Middle Cranial Fossa vs Translabyrinthine Approaches

Otolaryngology ◽

10.1016/j.otohns.2005.08.021 ◽

2005 ◽

Vol 133 (6) ◽

pp. 906-910 ◽

Cited By ~ 29

Author(s):

Brandon Isaacson ◽

Steven A. Telian ◽

Hussam K. El-Kashlan

Keyword(s):

Facial Nerve ◽

Tertiary Care ◽

Middle Cranial Fossa ◽

Vestibular Schwannomas ◽

Care Hospital ◽

Case Review ◽

Retrospective Case ◽

Increased Risk ◽

Significant Difference ◽

Cranial Fossa

OBJECTIVE: To compare the final facial nerve outcomes between middle cranial fossa (MCF) vs translabyrinthine (TL) resection of size-matched vestibular schwannomas. STUDY DESIGN AND SETTING: Retrospective case review at a tertiary care hospital. All patients who underwent resection utilizing either MCF or TL approaches with tumors 18 mm or smaller and complete data were included in the analysis. One hundred twenty-four patients were identified meeting the above criteria, with sixty-three in the translabyrinthine group and sixty-one in the middle fossa group. One-week-postoperative and final facial nerve examinations were compared in the two surgical groups. Patients were separately analyzed in subgroups: tumors smaller than 10 mm and those that were between 10 and 18 mm. RESULTS: The tumor size range for the MCF group was 3-18 mm while it was 4-18 mm for the TL group. No statistically significant difference was found in facial nerve outcomes between the two surgical groups, at the first postoperative visit week and at last follow-up. CONCLUSION: Facial nerve outcomes are similar using TL and MCF approaches for resection of vestibular schwannomas up to 18 mm in size. SIGNIFICANCE: Patients undergoing the MCF approach for hearing preservation can be counseled that there is no increased risk of permanent facial nerve weakness, compared to the TL approach. EBM RATING: B-3

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Short-term outcome in preterm infants depending on whether they were born from singleton, twin or triplet pregnancy: Data from a tertiary care hospital in Serbia

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh181228061v ◽

2020 ◽

Vol 148 (1-2) ◽

pp. 58-63

Author(s):

Gordana Velisavljev-Filipovic ◽

Aleksandra Matic ◽

Marina Dragicevic ◽

Divna Damjanovski

Keyword(s):

Preterm Infants ◽

Tertiary Care ◽

Mode Of Delivery ◽

Fertility Treatment ◽

Care Hospital ◽

Multiple Pregnancies ◽

Short Term ◽

Gestation Age ◽

Increased Risk ◽

Significant Difference

Introduction/Objective. After the introduction of the national program of fertility treatment, increased frequency of multiple pregnancies was noted. The literature has shown controversies regarding the higher risk of morbidity and mortality of the preterm newborns from multiple pregnancies. Methods. Preterm singletons, twins and triplets born within a two-year study period were included in the analysis. Data about preterm twins were extracted first. For each pair of twins, two singletons of the same gestation age were chosen. The set of the examinees was completed by including the triplets born during the same period. The short-term outcomes were compared between these three groups. Results. A total of 210 preterm infants were included in the study, out of which 84 singletons, 84 twins and 42 triplets. Statistical analysis showed significant difference between the three groups regarding type of conception (p < 0.0001), mode of delivery (p < 0.001) and birth weight (p = 0.005). Short-term mortality and morbidity (neonatal death, the need for intubation at birth, respiratory support, surfactant therapy, and intracranial hemorrhage) were significantly increased in triplets comparing to singletons and twins. Conclusion. Preterm triplets have an increased risk for adverse short-term outcomes comparing to singletons and twins of the similar gestation age in our study sample.

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Functional outcome of instrumented and non-instrumented fusion in lumbar canal stenosis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203518 ◽

2020 ◽

Vol 6 (5) ◽

pp. 981

Author(s):

Ansari Muqtadeer Abdul Aziz ◽

Nair Pradeepkumar Sasidharan ◽

Ansari Ishtyaque Abdul Aziz ◽

Venktesh Dattatray Sonkawade

Keyword(s):

Functional Outcome ◽

Indian Population ◽

Graduate Training ◽

Tertiary Care ◽

Instrumented Fusion ◽

Lumbar Canal Stenosis ◽

Medical College ◽

Canal Stenosis ◽

Significant Difference ◽

Post Graduate Training

Background: Lumbar canal stenosis (LSS) is a source of significant morbidity and economic burden in the Indian population. Spinal canal compression is the sine qua non of lumbar canal stenosis but whether instrumentation should be done or not is the major dilemma. In this study, we aim to compare the functional outcome of instrumented versus non-instrumented fusions for the treatment of lumbar stenosis along with the post-operative complications and cost-effectiveness of both procedures.Methods: This study was conducted at a tertiary-care medical college and hospital, Aurangabad specializing in post-graduate training, where all patients who underwent surgical treatment between May 2016 and May 2018 were included. Patients were assessed using the modified Oswestry disability index (MODI) and visual analogue scale (VAS). These evaluations were done at 3, 6, 12 and 24 months.Results: We found similar pain relief and stabilization in both the groups in the initial post-operative period, but after 2 years, there was a significant difference (p=0.0001) between the two groups in terms of VAS (back) and MODI score. Complication rate was higher in instrumented patients. Conclusions: Patient selection is the most important thing in the management of lumbar canal stenosis. We believe that, with the flowchart on the management of lumbar canal stenosis, it would help choosing patients better as to who would require instrumented fusion. Non-instrumented fusions might cost less and have fewer complications, but the overall outcome of the patient in the future should be kept in mind.

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Does Early Artificial Rupture of Membranes Speed Labor in Preterm Inductions?

American Journal of Perinatology ◽

10.1055/s-0037-1612631 ◽

2017 ◽

Vol 35 (08) ◽

pp. 716-720 ◽

Cited By ~ 1

Author(s):

Spencer Kuper ◽

Victoria Jauk ◽

Sima Baalbaki ◽

Alan Tita ◽

Lorie Harper ◽

...

Keyword(s):

Controlled Trial ◽

Care Center ◽

Tertiary Care ◽

Adverse Outcomes ◽

Optimal Timing ◽

Randomized Controlled ◽

Increased Risk ◽

Observational Cohort ◽

Secondary Outcomes ◽

The Impact

Objective In full-term patients, early artificial rupture of membranes (AROMs) decreases time in labor. We assessed the impact of early AROM in preterm patients undergoing indicated induction of labor. Study Design We conducted a retrospective cohort study of all patients undergoing indicated preterm induction (23–34 weeks) at a single tertiary care center from 2011 to 2014. Early AROM was defined as <4 cm and late AROM was defined as ≥4 cm. The primary outcomes evaluated were cesarean delivery and time in labor. Secondary outcomes were chorioamnionitis and a composite of maternal and neonatal adverse outcomes. Results Of the 149 women included, 65 (43.6%) had early AROM. Early AROM was associated with an increased time from the start of induction to delivery (25.7 ± 13.0 vs. 19.0 ± 10.3 hours, p < 0.01) and with an increase in the risk of cesarean (53.4 vs. 22.6%, adjusted odds ratio: 3.5, 95% confidence interval: 1.60–7.74). Early AROM was not associated with an increased risk of chorioamnionitis or adverse maternal or fetal outcomes. Conclusion In this observational cohort, early AROM was associated with an increased risk of cesarean. A randomized controlled trial is necessary to determine the optimal timing of AROM in preterm patients requiring delivery.

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Comparison of open reduction and internal fixation versus closed reduction and percutaneous fixation for medial malleolus fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000286 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Andrew Matson ◽

Stephen Barchick ◽

Samuel Adams

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Wound Complications ◽

Complication Rates ◽

Percutaneous Fixation ◽

Open Injury ◽

Increased Risk ◽

Significant Difference

Category: Ankle, Trauma Introduction/Purpose: Open approaches are often used for the operative treatment of medial malleolar (MM) fractures. Compared to percutaneous approaches, open approaches may entail an increased risk of operative morbidity, postoperative pain, wound complications, and reoperation for hardware removal. However, inherent to minimally invasive or percutaneous techniques is incomplete fracture visualizationwhich may hinder acceptable reduction. In this study, we aimed to compare patients treated with closed reduction and percutaneous fixation (CRPF) to those patients treated with traditional open reduction and internal fixation (ORIF). We hypothesized that the two groups would be similar with regard to patient factors, injury variables, and outcomes. Methods: The study group consisted of 184 consecutive patients who met inclusion criteria and were treated with operative fixation of a MM fracture from 2011-2015 at a single institution. Forty underwent CRPF and 144 underwent ORIF. Patient demographics, injury characteristics, treatment methods, and outcome variables were recorded through review of patient charts, radiographs, and operative reports. Results: Patient variables were similar between groups except for years of age, which was greater on average in the CRPF group (55 vs. 48, p = 0.03). The CRPF treatment group had a higher rate of initial open injury (22% vs. 7%, p<0.01), a lower rate of MM fracture comminution (12% vs. 29%, p = 0.03), and a higher rate of provisional external fixation (35% vs. 14%, p<0.01). There was no statistically significant difference observed between the CRPF and ORIF groups with regard to outcomes including: nonunion (2% vs. 3%), malunion (10% vs. 5%), time to union (10 weeks, each), removal of hardware (8% vs. 14%), or wound complications (0% vs. 4%). Conclusion: Both CRPF and ORIF resulted in acceptable radiographic outcomes and low complication rates for the treatment of MM fractures. Compared to the ORIF group, patients in the CRPF group on average were older and more often had comminution, open fractures, and provisional external fixation.

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Effect of aspirin on cancer incidence and mortality in older adults

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa114 ◽

2020 ◽

Cited By ~ 3

Author(s):

John J McNeil ◽

Peter Gibbs ◽

Suzanne G Orchard ◽

Jessica E Lockery ◽

Wendy B Bernstein ◽

...

Keyword(s):

Older Adults ◽

Cancer Incidence ◽

Controlled Trial ◽

Community Dwelling ◽

Tumor Type ◽

Risk Of Death ◽

Increased Risk ◽

Incidence And Mortality ◽

Significant Difference ◽

Clinical Records

Abstract Background ASPirin in Reducing Events in the Elderly (ASPREE), a randomized double-blind placebo-controlled trial (RCT) of daily low-dose aspirin (100 mg) in older adults, showed an increase in all-cause mortality, primarily due to cancer. In contrast prior RCTs, mainly involving younger individuals, demonstrated a delayed cancer benefit with aspirin. We now report a detailed analysis of cancer incidence and mortality. Methods 19,114 Australian and U.S. community-dwelling participants aged 70+ years (U.S. minorities 65+ years) without cardiovascular disease, dementia or physical disability were randomized and followed for a median of 4.7 years. Fatal and non-fatal cancer events, a prespecified secondary endpoint, were adjudicated based on clinical records. Results 981 cancer events occurred in the aspirin and 952 in the placebo groups. There was no statistically significant difference between groups for all incident cancers (HR = 1.04, 95% CI = 0.95 to 1.14), hematological cancer (HR = 0.98, 95% CI = 0.73 to 1.30), or all solid cancers (HR = 1.05, 95% CI = 0.95 to 1.15), including by specific tumor type. However, aspirin was associated with an increased risk of incident cancer that had metastasized (HR = 1.19, 95% CI = 1.00 to 1.43) or was stage 4 at diagnosis (HR = 1.22, 95% CI = 1.02 to 1.45), and with higher risk of death for cancers that presented at stages 3 (HR = 2.11, 95% CI = 1.03 to 4.33) or 4 (HR = 1.31, 95% CI = 1.04 to 1.64). Conclusions In older adults, aspirin treatment had an adverse effect on later stages of cancer evolution. These findings suggest that in older persons, aspirin may accelerate the progression of cancer and thus, suggest caution with its use in this age group.

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A comparative study of two layer versus three-layer repair of mediolateral episiotomy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203333 ◽

2020 ◽

Vol 9 (8) ◽

pp. 3412

Author(s):

Manasi V. Gaikwad ◽

M. Vijaya Sree ◽

Swapnil V. Bobde

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Tertiary Care ◽

Obstetric Care ◽

Wound Complications ◽

Layer Versus ◽

Care Hospital ◽

Suture Materials ◽

Mediolateral Episiotomy ◽

Significant Difference

Background: Since majority of the women attending study hospital are belonging to lower socioeconomic strata and active involvement of paramedical staff in providing obstetric care, this study was undertaken to find the utility of a two-layer repair of mediolateral episiotomy and compare it with the standard method of closure in relation to its simplicity, cost-effectiveness and superiority if any, over the traditional three-layered repair of episiotomy.Methods: This was a prospective interventional study comparing 100 women who underwent two-layer closure with 100 women who underwent three-layer closure of episiotomy in a tertiary care hospital in Pune, India over a period of 2 years from October 2012 to October 2014. The parameters assessed were operative time, number of suture materials required, immediate post procedure pain and complications at follow-up. Qualitative and quantitative data was analysed using unpaired t-test, chi square test and Fisher exact test.Results: Both the groups were comparable in terms of hospital stay and wound complications such as oedema, dehiscence, hematoma, requirement of resuturing, cosmesis and long-term complications such as dyspareunia. However, two-layer repair required less operative time, lesser number of suture materials and decreased pain during hospital stay as there was statistically significant difference observed between the two groups.Conclusions: In this study experience, it can be concluded that two-layer repair of episiotomy is faster, with less post-operative pain and more cost effective. Hence it provides mother with better services.

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