Botulinum Toxin Injection for Painful Adductor Pollicis Contracture after Thumb Carpometacarpal Resection Arthroplasty

Pollux adductus deformity is an accompanying symptom of thumb carpometacarpal osteoarthritis. We describe a case of a patient who presented with increased muscle tone of the adductor pollicis muscle and chronic pain in the thenar musculature, i.e., recurrence of an adduction deformity. The patient reported a symptom-free period of 5.5 years after having received resection-suspension-arthroplasty for stage IV thumb carpometacarpal osteoarthritis until spasmodic pain appeared. Due to the functional impairment of this condition, we administered therapy including 100 units of Botox® (onabotulinumtoxinA, Allergan, Dublin, Ireland) injected with a fanning technique into the adductor pollicis muscle. Thus, we observed a substantial improvement in the patient-reported outcome measures as well as pain levels compared with initial values. The current case shows the pivotal role of the adductor pollicis muscle when patients report pain at the base of the thumb, which can cause considerable impairments despite the complication-free surgical treatment of thumb CMC OA.

Distal Gastrectomy for Symptomatic Stage IV Gastric Cancer Contributes to Prognosis with Acceptable Safety Compared to Gastrojejunostomy

Background: The prognostic prolongation effect of reduction surgery for asymptomatic stage IV gastric cancer (GC) is unfavorable; however, its prognostic effect for symptomatic stage IV GC remains unclear. We aimed to compare the prognosis of gastrectomy and gastrojejunostomy for symptomatic stage IV GC. Methods: This multicenter retrospective study analyzed record-based data of patients undergoing palliative surgery for symptomatic stage IV GC in the middle or lower-third regions between January 2015 and December 2019. Patients were divided into distal gastrectomy and gastrojejunostomy groups. We compared clinicopathological features and outcomes after propensity score matching (PSM). Results: Among the 126 patients studied, 46 and 80 underwent distal gastrectomy and gastrojejunostomy, respectively. There was no difference in postoperative complications between the groups. Regarding prognostic factors, surgical procedures and postoperative chemotherapy were significantly different in multivariate analysis. Each group was further subdivided into groups with and without postoperative chemotherapy. After PSM, the data of 21 well-matched patients with postoperative chemotherapy and 8 without postoperative chemotherapy were evaluated. Overall survival was significantly longer in the distal gastrectomy group (p = 0.007 [group with postoperative chemotherapy], p = 0.02 [group without postoperative chemotherapy]). Conclusions: Distal gastrectomy for symptomatic stage IV GC contributes to prognosis with acceptable safety compared to gastrojejunostomy.

Plumage Response of Young Turkeys to Diets with Increased Methionine to Lysine Ratios at Three Dietary Arginine Levels

A 2 × 3 factorial experiment was conducted to evaluate the effects of two dietary methionine levels (Met; 30% and 45% of Lys content) and three arginine levels (Arg; 90%, 100%, and 110% of Lys content) on plumage development in 4- and 16-week-old female turkeys. One-day-old turkey poults were assigned to six groups (eight replicate pens per group and 18 birds per pen) and fed experimental diets containing 1.6%, 1.5%, 1.3%, and 1.0% of Lys in four successive four-week periods. After weeks 4 and 16 of feeding, eight turkeys per group were selected for plumage evaluation. Feathers were collected from the outer side of one thigh and from an area of 4 cm2 in the interscapular region. Plumage was evaluated based on an established pattern of five feather development stages in turkeys, from stage I (pinfeathers covered in sheaths) to stage V (mature feathers). An increase in the Met inclusion rate to 45% of Lys content had no significant effect on feather growth in 4-week-old turkeys, but it accelerated the development of feathers in 16-week-old birds. A lower percentage of stage II (p = 0.035), stage III (p = 0.019), and stage IV (p = 0.003) immature feathers, and a higher percentage of stage V (mature) feathers (p = 0.001) were observed. Methionine exerted a greater effect on the development of thigh feathers (p = 0.001) than interscapular feathers (p = 0.074). Unlike Met, different Arg concentrations had no influence on plumage development in turkeys. Overall, the present results indicate that supplemental Met has a potential for accelerating feather development in 16-week-old turkeys via an increased supply of total sulfur amino acids.

Prevalence, Risk Factors and Residential Variation among HIV/TB co-infected Mortality in Amhara Region, Fenote Selam Hospital: Application of Multilevel Logistic Regression

The purpose of this study was to identify the factors that affect the mortality among adult HIV/TB co-infected patients and to see the nutritional difference among mortality in residence level. Retrospective cohort studies of 417 patients which fulfill our criteria were included. Multilevel logistic regression models were used. MLwiN and SPSS software are used to estimate the parameter. The variance of the random factor in the empty model was significant which indicates that there were residential differences in TB-HIV co-infected mortality and it shows multilevel analysis was an appropriate approach for further analysis. The prevalence of HIV/TB co-infected patients' death was 12.9% in study time. Functional status, age of patients, WHO clinical stages, nutritional status, CD4 counts, regimen, and BMI were found to be significant determinants of HIV/TB co-infected mortality. In our study, patients with the bedridden category of functional status, the fourth stages of WHO clinical stages (stage IV), patients with higher age, patients whose treatments were second-line regimen and low CD4 cell counts were more at risk of death. The study also revealed that; poor nutritional status increased the risk of mortality among HIV/TB co-infected patients and it varies among the residence of the patients (rural area were more at risk).

FIVE YEARS SURVIVAL AND QUALITY OF LIFE AFTER RADICAL NEPHRECTOMY: A DESCRIPTIVE SINGLE CENTER STUDY

Objective: This study aims to evaluate five years of survival rate, and quality of life of the patient after radical nephrectomy in our center. Material & Methods: This descriptive longitudinal study included thirty patients who were diagnosed as having renal mass in the Urology division H. Adam Malik General Hospital between January 2014 and December 2015. All patients were completely followed-up for 5 years or the patient died during the observation. We used a translated and validated Indonesian written European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0 (EORTC QLQ-C30) questionnaire to assess the patient’s quality of life. Results: Overall 5-years survival of kidney tumor patients was 100%, 66.67%, 50%, 8.33%, respectively for stage 1 to 4. We found a sharp decrease in the cumulative survival rate of stage IV group in the first 24 months compared to the first 12 months, from 66.67% to 25%. This pattern of decrease was not found in the other group of stage. Overall, the quality of life of patients has increased in the first three years postoperatively and decreased in the two years afterward. These fluctuations consistently occur in all groups. All of the groups had reached the maximum quality of life at the third year postoperatively. Conclusion: Stage I renal cell carcinoma patient shown the best five-years survival rate and quality of life among others. The quality of life for all groups inclined for the first three years after surgery and decline consistently afterward. These findings are in accordance with many studies that have been published previously.

Validated method for automated glioma diagnosis from GFAP immunohistological images: a complete pipeline

Background and objective: Glial fibrillar acid protein is a common marker for brain tumor because of its particular rearrangement during tumor development. It is commonly used in manually histological glioma detection and grading. An automatic pipeline for tumor diagnosis based on GFAP is proposed in the present manuscript for detecting and grading canine brain glioma in stages III and IV. Methods: The study was performed on canine brain tumor stages III and IV as well as healthy tissue immunohistochemically stained for gliofibrillar astroglial protein. Four stereological indexes were developed using the area of the image as reference unit: density of glioma protein, density of neuropil, density of astrocytes and the glioma nuclei number density. Images of the slides were subset for image analysis (n=1415) and indexed. The stereological indexes of each subset constituted an array of data describing the tumor phase of the subset. A 5% of these arrays were used as training set for decision tree classification with PCA. The other arrays were further classified in a supervised approach. ANOVA and PCA analysis were applied to the indexes. Results: The final pipeline is able to detect brain tumor and to grade it automatically. Added to it, the role the neuropil during tumor development has been quantified for the first time. While astroglial cells tend to disappear, glioma cells invade all the tumor area almost to a saturation in stage III before reducing the density in stage IV. The density of the neuropil is reduced during the tumour growth. Conclusions: The method validated ere allows the automated diagnosis and grading of glioma in dogs. This method opens the research of the role of the neuropil in tumor development.

Costs of breast cancer treatment incurred by women in Vietnam

Background There is a paucity of research on the cost of breast cancer (BC) treatment from the patient’s perspective in Vietnam. Methods Individual-level data about out-of-pocket (OOP) expenditures on use of services were collected from women treated for BC (n = 202) using an online survey and a face-to-face interview at two tertiary hospitals in 2019. Total expenditures on diagnosis and initial BC treatment were presented in terms of the mean, standard deviation, and range for each type of service use. A generalised linear model (GLM) was used to assess the relationship between total cost and socio-demographic characteristics. Results 19.3% of respondents had stage 0/I BC, 68.8% had stage II, 9.4% had stage III, none had stage IV. The most expensive OOP elements were targeted therapy with mean cost equal to 649.5 million VND ($28,025) and chemotherapy at 36.5 million VND ($1575). Mean total OOP cost related to diagnosis and initial BC treatment (excluding targeted therapy cost) was 61.8 million VND ($2667). The mean OOP costs among patients with stage II and III BC were, respectively, 66 and 148% higher than stage 0/I. Conclusions BC patients in Vietnam incur significant OOP costs. The cost of BC treatment was driven by the use of therapies and presentation stage at diagnosis. It is likely that OOP costs of BC patients would be reduced by earlier detection through raised awareness and screening programmes and by providing a higher insurance reimbursement rate for targeted therapy.

Randomized Phase III Trial of Paclitaxel and Carboplatin Versus Paclitaxel and Ifosfamide in Patients With Carcinosarcoma of the Uterus or Ovary: An NRG Oncology Trial

PURPOSE This phase III randomized trial ( NCT00954174 ) tested the null hypothesis that paclitaxel and carboplatin (PC) is inferior to paclitaxel and ifosfamide (PI) for treating uterine carcinosarcoma (UCS). PATIENTS AND METHODS Adults with chemotherapy-naïve UCS or ovarian carcinosarcoma (OCS) were randomly assigned to PC or PI with 3-week cycles for 6-10 cycles. With 264 events in patients with UCS, the power for an overall survival (OS) hybrid noninferiority design was 80% for a null hazard ratio (HR) of 1.2 against a 13% greater death rate on PI with a type I error of 5% for a one-tailed test. RESULTS The study enrolled 536 patients with UCS and 101 patients with OCS, with 449 and 90 eligible, respectively. Primary analysis was on patients with UCS, distributed as follows: 40% stage I, 6% stage II, 31% stage III, 15% stage IV, and 8% recurrent. Among eligible patients with UCS, PC was assigned to 228 and PI to 221. PC was not inferior to PI. The median OS was 37 versus 29 months (HR = 0.87; 90% CI, 0.70 to 1.075; P < .01 for noninferiority, P > .1 for superiority). The median progression-free survival was 16 versus 12 months (HR = 0.73; P = < 0.01 for noninferiority, P < .01 for superiority). Toxicities were similar, except that more patients in the PC arm had hematologic toxicity and more patients in the PI arm had confusion and genitourinary hemorrhage. Among 90 eligible patients with OCS, those in the PC arm had longer OS (30 v 25 months) and progression-free survival (15 v 10 months) than those in the PI arm, but with limited precision, these differences were not statistically significant. CONCLUSION PC was not inferior to the active regimen PI and should be standard treatment for UCS.

CHANGE IN THE VITREUOSNESS GRAIN OF DURUM WHEAT IN THE BREEDING PROCESS IN THE MIDDLE VOLGA REGION

The vitreousness of grain is an important trait taken into account by the state standards of many countries when determining its quality class. When creating new cultivars, this trait is controlled at all stages of breeding. The article presents the results of studying the vitreousness of grain cultivars of Samara Research Institute of Agriculture, related to the 4 stages of breeding covering the periods - 1957-1990 (stage I), 2003-2004 (stage II), 2007-2008 (stage III), 2012-2018 (stage IV). The study was carried out on the experimental field of Samara Research Institute of Agriculture during 2012-2020. Experimental plots with an accounting area of 20.0 m2 were placed in randomized blocks. Vitreousness was determined by the percentage of vitreous grains on the endosperm section in refined grain samples taken in 3 field replicates. The evaluation of the data obtained was carried out on the basis of 2-factor, one-way dispersion and correlation analyzes, parameters of stability and responsiveness according to the methods of Kilchevsky, Khotyleva, Eberhart-Russell, Khangildin, Nettevich. The dispersion of grain vitreousness was determined by environmental conditions – 61.2%, genotype factors and genotype/environmental interactions – 9.3% and 19.0%, respectively. Progress in breeding relative to the first stage was observed at the 2nd and 4th stages and was absent at the 3rd stage. According to the absolute values of vitreousness (91.8-94.3%), 4 cultivars were distinguished - Bezenchukskaya zolotistaya, Bezenchukskaya krepost, Bezenchukskaya nivaand Bezenchukskaya 210, belonging to the 4th stage. Values close to these (89.2-89.6%) were noted in the varieties of the 2nd stage - Bezenchukskaya stepnaya and Pamyaty Chekhovicha. Successful breeding for the vitreousness of durum wheat grain is associated with an improvement in the parameters of the stability of the formation of a trait in a variety of environmental conditions. Reliable genotypic correlations of glassiness, grain yield and macaroni color show the effectiveness of simultaneous selection for these traits. The absence of significant correlations of grain vitreousness with vegetation parameters, and quality, suggests the possibility of obtaining the necessary recombinations in the selection process. Genotypic correlation coefficients show the possibility of breeding productive cultivars with a high vitreousness of grain and a varied combination of parameters of the growing season and grain quality. Cultivars of the 4th stage, Bezenchukskaya zolotistaya and Bezenchukskaya krepost, were proposed as a initial material in breeding for grain vitreousness