patient outcome
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Author(s):  
Federica Penner ◽  
Pietro Zeppa ◽  
Fabio Cofano ◽  
Andrea Bianconi ◽  
Marco Ajello ◽  
...  

AbstractConfirmation bias is the tendency to seek information and evidence in order to confirm a preexisting hypothesis while giving less importance and overlook an alternative solution. This report describes the case of a 52-year-old man with a long history of neck pain and bilateral upper limbs paresthesias with a cervical intracanal inhomogeneously enhancing lesion. Despite all the preoperative radiological findings, a spinal meningioma an anterior approach was performed. The mass ended up being a large migrated hernia with the involvement of two levels. Before suggesting treatment, especially surgery, physicians and practitioners need to evaluate all of the possible alternatives in order to optimize patient outcome.


2021 ◽  
Vol 15 (3) ◽  
pp. 236-240
Author(s):  
Kefilwe Boineelo Benjamin ◽  
Nikiforos Saragas ◽  
Paulo Ferrão

Objective: We aimed to evaluate patient satisfaction after surgery for both single and two adjacent neuromas. Methods: We reviewed the data of patients treated operatively for interdigital neuromas between 2003 and 2016. We interviewed them and administered the Self-Reported Foot and Ankle Score questionnaire. Patient scores were then analyzed categorically, and variation between groups was assessed. Results: Sixty-two patients were available for review. Thirty-one patients had a single interdigital neuroma excised and 31 had two adjacente interdigital neuromas excised. Twenty-eight of the 31 (90%) patients with a single neuroma had good or excellent results while 23 (74.2%) of those with adjacent neuromas had similar outcomes. One patient with a single neuroma had a poor result while four patients with adjacent neuromas had poor results. The mean score was 41 (excellent) for patients with a single interdigital neuroma and 37 (good) for those with adjacent neuromas (p=0.473). The majority of patients in both groups would undergo surgery again. Conclusion: We found no statistically significant difference in outcomes of patients who undergo surgery for either single or two adjacent interdigital neuromas. General patient satisfaction is good and/or excellent post excision. Level of Evidence II; Prognostic Studies; Retrospective Study.


2021 ◽  
Vol 12 ◽  
Author(s):  
Ashlee Wheaton ◽  
Patrick T. Fok ◽  
Jessalyn K. Holodinsky ◽  
Peter Vanberkel ◽  
David Volders ◽  
...  

Background and Purpose: For an ischemic stroke patient whose onset occurs outside of the catchment area of a hospital that is capable of Endovascular Treatment (EVT) and whose stroke is suspected to be caused by a large vessel occlusion (LVO), a transportation dilemma exists. Bypassing the nearest stroke hospital will delay Alteplase but expedite EVT. Not bypassing allows for confirmation of an LVO diagnosis before transfer to an EVT-enabled facility, but ultimately delays EVT. Air transport can reduce a patient's overall time to treatment however, it is costly. We expanded on an existing model to predict where Drip-and-Ship vs. Mothership provides better outcomes by including rotary air transport, and we also included prediction of where either the transport method was most cost effective.Methods: An existing model predicts the outcome of patients who screen positive for an LVO in the field based on how they were transported, Drip-and-Ship (alteplase-only facility first, then EVT-enabled facility) or Mothership (direct to EVT-enabled facility). In our model, the addition of rotary wing transportation was conditionally applied to inter-facility transfer scenarios where it provided a time advantage. Both patient outcome and transport cost functions were developed for Mothership and Drip-and-Ship strategies including transfers via either ground or air depending on the conditional probabilities. Experiments to model real world scenarios are presented by varying the driving time between the alteplase-only and EVT-enabled facility, time to treatment efficiencies at the alteplase-only facility, and EVT eligibility for LVO patients. Patient outcome and transport costs were evaluated for Mothership and Drip-and-Ship strategies.Results: The results are presented in temporospatial diagrams that are color coded to indicate which strategy optimizes the objectives. In most regions, there was overall agreement between the optimal solution when considering patient outcomes or transport costs. Small regions exist where outcome and cost are divergent; however, the difference between the divergence in Mothership and Drip-and-Ship in these regions is marginal.Conclusions: The optimal transport method can be optimized for both patient outcomes and transport costs.


2021 ◽  
Vol 50 (1) ◽  
pp. 177-177
Author(s):  
Muhammad Javed ◽  
Douglas Hansell ◽  
Jennifer Sahatjian ◽  
Heath Latham

2021 ◽  
Author(s):  
Charlotte Degorre ◽  
Ophelie Renoult ◽  
Ann Christin Parplys ◽  
Hala Awada ◽  
Anne Clavreul ◽  
...  

Despite aggressive clinical protocol, all glioblastoma (GBM) recur at the initial site within the irradiated peritumoral microenvironment. Whereas irradiated microenvironment has been recently proposed to accelerate GBM relapse, molecular and cellular mechanisms remain unknown. Here, using relevant in vitro and in vivo models, we decipher how radiation-induced endothelial senescence drives the emergence of aggressive GBM cells. Secretome (SASP) of radiation-induced senescent (RIS) endothelium enhances genomic instability and intratumoral heterogeneity in irradiated GBM cells. In-depth molecular studies revealed that CXCL5 and CXCL8, from the SASP, activate CXCR2 receptor on tumor cells leading to increased DNA hyper-replication, micronuclei formation and aneuploidy. Importantly, through CXCL5/8-CXCR2 axis activation, this SASP increases GBM aggressiveness in vivo. Both chemokines were detected in relapsing, but not primary, GBM biopsies and positively correlated with worst patient outcome. In conclusion, we identify new molecular and preclinical insights of relapsing GBM aggressiveness where RIS vascular niches fuel aggressive tumor emergence.


2021 ◽  
Vol 12 ◽  
Author(s):  
Min Wu ◽  
Jie Liu ◽  
Shihao Wu ◽  
Jingru Liu ◽  
Hui Wu ◽  
...  

PurposeConsidering the limited data, we aimed to identify the greatest immune activation irradiated site of common metastases and response to immune checkpoint inhibitors simultaneously in non-small cell lung cancer (NSCLC).MethodsA total of 136 patients with advanced NSCLC who had received radiation to a primary or metastatic solid tumor were enrolled. We recorded blood cell counts in three time periods, before, during, and after radiotherapy (RT), and derived some blood index ratios including monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). The delta-IBs were calculated as medio-IBs ÷ pre-IBs − 1. We analyzed the changes before and during RT using Spearman rank correlation test, Kruskal–Wallis rank sum test, and logistic regression analyzing their correlation with efficacy.ResultsThe medians of delta-MLR and delta-PLR were both the lowest while the median of delta-L was the highest in brain. Therapeutic effect evaluation showed that the objective response rate (ORR) of 48.65% (18/37) in the brain irradiation group was the highest, compared with 17.07% (7/41) in bone and 41.94% (13/31) in lung.ConclusionsIn this study, results suggested that irradiation to brain has the best immune activation effect and patient outcome compared with other organs in NSCLC, and when the earlier-line ICIs were combined with RT, a better patient outcome was reached. Prospective studies are also necessary to provide more convincing evidence and standards for clinical irradiation metastases selection.


2021 ◽  
Vol 8 (4) ◽  
pp. 535-538
Author(s):  
Andrea Michelerio ◽  
Stefania Barruscotti ◽  
Nathalie Rizzo ◽  
Carlo Tomasini

We present the case of an 83-year-old woman who presented with an advanced cutaneous angiosarcoma of the head. The tumor had first appeared as a small ecchymosis on her forehead 3 months before admission. There was an extremely rapid and dramatic evolution, as evidenced by photographic documentation by her relatives. Unfortunately, the delay in access to the healthcare system due to the COVID-19 pandemic lockdown and the fulminant growth were the main determinants for our patient outcome.


Author(s):  
Andreas Enz ◽  
Silke Müller ◽  
Wolfram Mittelmeier ◽  
Annett Klinder

Abstract Background Periprosthetic fungal infections are considered rare and opportunistic infections. Treatment is difficult, and established standards do not yet exist. The choice of the appropriate antifungal drug might affect the patient outcome. Cases All the three cases presented showed polybacterial recurrent infection of the revision hip arthroplasty. All patients were of younger age, had multiple revisions of the endoprosthesis, each had a large partial femoral replacement greater than 40% of the femoral length, gentamycin-loaded cement, and a long anchoring distance of the used intramedullary stem. Due to the severe life-threatening infection with deep osteomyelitis, an amputation had to be performed. However, despite surgical intervention, the fungal dominated infection persisted. Finally, only the use of caspofungin allowed permanent infection control. Conclusion The polybacterial infection is driven by the symbiosis between fungi and bacteria. Therefore, eradication of the fungus is required to achieve elimination of the bacteria. Antimycotics of the echinocandin-class, such as caspofungin, may be considered as initial treatment.


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