Preoperative S-1 Therapy for Squamous Cell Carcinoma of The Head and Neck During the Waiting Period Before Surgery

Background: In patients with squamous cell carcinoma of head and neck (SCCHN), delayed surgery can result in poorer postoperative function and prognosis due to the growth of the tumor and the extended surgery. Further, delay may even make the tumor unresectable. To prevent tumor growth during the waiting period before surgery, S-1 has been administrated preoperatively at several facilities in Japan. To date, however, the safety and efficacy of preoperative S-1 remains unclear.Methods: We conducted a retrospective cohort study of 118 patients with SCCHN treated with S-1 before radical surgery at 2 institutions in Japan. We evaluated the safety of S-1 therapy, which was evaluated by the incidence of grade 3 or greater adverse events (AEs). The rate of achievement of the non-growth of tumors was also calculated.Results: Regarding safety, 125 AEs of all grades were recorded in 71 patients (60%). Of these, grade 3 AEs were detected in 3 patients (3%), and no grade 4 or 5 AEs occurred. The non-growth rate of primary lesions and lymph node metastases was 89% and 85%, respectively. Conclusion: Our data showed that preoperative S-1 therapy might be useful with acceptable toxicity on an outpatient basis in patients with SCCHN.

BATAS MARITIM INDONESIA DAN PALAU DI ZONA EKONOMI EKSKLUSIF

Indonesia is bordered by 10 countries, one of which is Palau. Indonesia has the right to the living natural resources in EEZ. As for the width of the EEZ a country can claim up to 200 miles. If the EEZ overlaps with other countries, one of which is Indonesia and Palau, namely using the principle of justice and followed up by making an agreement on the boundaries jurisdiction area. The goal is to have arrangements in use that are believed to be able to maintain the sustainability of living resources based on an agreement. The results show that the clarity of Indonesia's maritime boundaries has an impact on the use of its natural resources. The clarity of maritime boundaries provides the welfare of the Indonesian people, so it can be concluded that the determination of maritime boundaries between Indonesia and Palau will be sought immediately by referring to regulations and success in practices that have been carried out by Indonesia. While the determination of territorial boundaries has not reached an agreement or agreement that is final in nature, both Indonesia and Palau are obliged to follow dispute resolution procedures, according to Chapter XV UNCLOS 1982. UNCLOS 1982 also provides favorable arrangements for the parties concerned, namely during the waiting period / effort. in reaching the final arrangement, especially the regulation of biological resources in the border area, the biological resources can be utilized by implementing temporary arrangements. The research method used is the normative method by examining the related rules. Negara Indonesia berbatasan dengan 10 negara, salah satunya dengan Palau. Perbatasan maritim di ZEE Indonesia, Indonesia mempunyai hak atas sumber daya alam hayati yang terdapat di dalamnya. Adapun lebar ZEE suatu negara dapat mengklaim sampai 200 mil. Namun apabila wilayah yurisdiksi dalam hal ini ZEE tumpang tindih dengan negara lain, salah satunya Indonesia dengan Palau, maka harus dibagi sesuai ketentuan yang diatur dalam UNCLOS 1982, yaitu menggunakan prinsip keadilan dan ditindaklanjuti dengan membuat perjanjian tentang batas wilayah yurisdiksi. Tujuannya adalah adanya pengaturan dalam pemanfaatan yang diyakini dapat menjaga keberlanjutan sumber daya hayati yang didasarkan pada perjanjian. Hasil penelitian menunjukkan kejelasan batas wilayah maritim Indonesia berimbas pada pemanfaatan sumber daya alamnya. Kejelasan batas maritim memberikan kesejahteraan rakyat Indonesia, maka dapat disimpulkan penetapan batas maritim antara Indonesia dengan Palau segera diupayakan dengan mengacu pada peraturan dan keberhasilan dalam praktik-praktik yang telah dilakukan oleh Indonesia. Sementara penentuan batas wilayah belum tercapai kata sepakat atau perjanjian yang sifatnya final, baik Indonesia maupun Palau, wajib mengikuti prosedur penyelesaian sengketa, sesuai Bab XV UNCLOS 1982. UNCLOS 1982 juga memberikan pengaturan yang menguntungkan bagi pihak-pihak terkait, yaitu dalam masa tunggu/upaya dalam mencapai pengaturan final, terutama pengaturan sumber daya hayati di wilayah perbatasan tersebut, maka sumber daya hayati dapat dimanfaatkan dengan dilakukan pengaturan sementara. Metode penelitian yang digunakan adalah metode normatif dengan mengkaji aturan-aturan yang terkait.

A multicentered evaluation of the waiting period after PVI guided by the Ablation Index

Background Since the widespread availability of contact-force sensing catheters the need of a waiting period has not been reassessed in paroxysmal atrial fibrillation (AF) ablation. Objective The purpose of this study was to evaluate if pulmonary vein isolation (PVI) guided by the Ablation Index (AI) could spare the need for a waiting phase. Methods This multicentre, prospective, randomized study consecutively recruited patients referred for first-time catheter ablation of symptomatic drug-refractory paroxysmal AF from May 2019 to February 2020. Patients performed PVI tailored to different AI values according to the different left atrium walls (550 for anterior, 500 for roof, 450 for inferior and 400 for posterior). Patients were enrolled in 1:1 ratio to PVI and 20 min of waiting time versus PVI without a waiting period. Acute reconnection (either spontaneous or after adenosine) and 1-year arrhythmia freedom were analyzed. Results The study included 124 patients (61 in the waiting period group and 63 in the group without the waiting period). There was no significant differences between groups regarding baseline characteristics, echocardiographic and procedure data. There were no significant differences between both groups regarding the first-pass PV isolation (P=0.49) and the presence of low voltage areas (P=0.71). Median PVI time (P=0.40), median fluoroscopy time (P=0.35) and median overall procedure time (P=0.70) were also similar between groups. The acute PVR rate was similar between both groups (8.2% for the waiting period group vs 11.1% in the group without a waiting phase, P=0.40). After a median follow-up of 14 (IQR 12–18) months, there was no significant difference on the arrhythmia recurrence between groups (4.9% for the waiting group vs 12.7% for the group without a waiting phase, P=0.13). Both groups presented a similar arrhythmia freedom over time (log rank P of 0.109). The waiting period time was not a predictor of recurrence during follow-up (p=0.13). Conclusion PVI guided by Ablation Index preclude the need of a waiting phase. Adding a 20-minute waiting period did not significantly increase the acute PV reconnection, neither improve the 1-year arrhythmia freedom. FUNDunding Acknowledgement Type of funding sources: None.

Screening in rheumatology: the impact on the everyday experience of patients in the Brazilian public health system

Background In recent years, due to the increased incidence of rheumatologic diseases, the demand for consultations in rheumatology has risen. In the Brazilian public health system, patients with rheumatologic complaints are referred from primary care to specialized consultation, and must wait in a waiting list for the specialized care. In 2015, the waiting time for the first consultation in rheumatology, in Curitiba- Brazil, was 600 days. In attempt to reduce this time, in-person and remote screening was implemented that same year in a healthcare service in Curitiba. From 2015 to 2019 the variation in the number of patients in waiting lists for their first rheumatology consultation and the length of the waiting period for their first referral was evaluated. Methods Observational study in a time series. The patients in the study were referred to a primary healthcare center for an assessment of rheumatology in Curitiba, Brazil. The data was analyzed based on the first consultation with the rheumatologist. The variables were the number of patients in the waiting list and the waiting period for the appointment with the doctor. The research was carried out through a computerized system called “e-saude”[electronic health] runed by the Health Secretary of the Municipality of Curitiba. A comparison was made between the period of 2013–2015, in a model for treatment without screening, and 2015–2019, when the in-person and remote screening first began. Results Between 2015 and 2019 there was a reduction in the waiting list of 6,429 patients to 25 patients, while there was an average of 56.5 patients in the last two years;. With regard to the waiting period for the first appointment with the rheumatologist in 2019, there was a reduction of 600 days to a minimum of 4 days and a maximum of 52 days. Conclusion Both in-person and remote screening for asynchronous electronic consultations for rheumatologist in Curitiba led to a reduction in the waiting time and number of patients for the first appointment with the rheumatologist, proving to be a useful method for reducing the time and number of patients in the waiting list for a specialized consultation.

Predictive factors of spontaneously regressed uterine endometrial polyps during the waiting period before hysteroscopic polypectomy

Background The presence of uterine endometrial polyps is associated with not only abnormal uterine bleeding but also infertility, so the use of hysteroscopic polypectomy has been increasing. This operation is considered to increase cost-effectiveness when performed prior to infertility treatments. However, there are typical problems to consider, including the possibility of spontaneous regression of the polyp and the duration of complete endometrial wound healing after surgery. Meaningless interventions must be avoided, when possible. Therefore, data acquisition and analysis of various findings obtained from surgery have become important for improving treatment procedures and patient selection. To estimate the spontaneous regression rates and contributions of multiple factors to uterine endometrial polyps during the waiting period (approximately 2–3 months) before hysteroscopic polypectomy, we performed a multivariate analysis of data from the records in our hospital. Methods The medical records of 450 cases from September 2014 to April 2021 in our hospital were retrospectively reviewed under the approval of our Institutional Review Board. We included all cases of hysteroscopic polypectomy with postoperative pathological diagnosis. We defined cases as having a “spontaneously regressed polyp” when the target polyp was not detected by postoperative pathological examination. We extracted data on the following ten factors: “Advanced age” (≥ 42 years), “Small polyp” (< 10 mm), “High body mass index” (≥ 25 kg/m2), “Nulliparity,” “Single polyp,” “Infertility,” “Hypermenorrhea,” “Abnormal bleeding,” “No symptom,” and “Hormonal drug use.” We also classified cases into five groups according to the size of the polyp (≤ 4.9 mm, 5.0–9.9 mm, 10.0–14.9 mm, 15.0–19.9 mm, and ≥ 20.0 mm) and determined the frequency of spontaneously regressed polyp in each group. Results After exclusion of cases with insufficient data or other diseases, such as submucosal leiomyoma, 424 cases were analyzed. Among them, 28 spontaneously regressed polyps were identified, and the highest frequency of spontaneously regressed polyp was detected among the cases with polyps measuring 5.0–9.9 mm (16.4%). On multivariate analysis of the ten factors, “Small polyp” and “Hormonal drug use” were found to significantly impact the frequency of spontaneously regressed polyp. Conclusions On the basis of the factors identified in this analysis, the indications for observation or medical therapy adapted to small polyps might be expanded.

Tracer Study: Studi Rekam Jejak dan Tingkat Kepuasan Pengguna Terhadap Lulusan Program Studi Pendidikan Guru Madrasah Ibtidaiyah Institut Agama Islam Negeri Curup

The aims of this study are to determine: 1) the acceptance numbers of graduates for job opportunities, 2) the waiting period for graduates to get a job, 3) the relevance of the graduates’ qualification to the field of work, and 4) the level of stakeholders’ satisfaction with graduates of the PGMI (Education of Basic School Teachers) study program of IAIN (The Institute for Islamic Studies) Curup. This research method was survey research with quantitative descriptive data analysis. The data collection was carried out using questionnaires sent directly via email, social media, face to face and by telephone. The research results showed that: 1) the graduates of PGMI Study Program of IAIN Curup were well accepted in job opportunities, 2) the waiting period for graduates to get a job was in the range of 0 - 3 months after graduation, 3) there was relevance of graduates’ work field to their qualification, 4) the level of stakeholders’ satisfaction with graduates of the PGMI Study Program of IAIN Curup was in very good criteria. Based on the results of the study, it was suggested that institutions need to carry out tracer study activities in a sustainable manner so that they can find out the condition of graduates after completing their education in the institutions. Then, feedback was expected from alumni and stakeholders to get a higher response rate. In addition, the results of this study can be a consideration for stakeholders at universities to develop curriculum so that they can improve the competence of graduates in accordance with the demands of the work field.