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2021 ◽  
Vol 14 (3) ◽  
pp. 54-64
Author(s):  
A. Zh. Fursova ◽  
Ju. A. Gamza ◽  
O. G. Gusarevich ◽  
A. S. Derbeneva ◽  
M. A. Vasil’eva

Purpose: to study the long-term changes of functional, structural, and hemodynamic parameters of the optic nerve in primary open-angle glaucoma (POAG) accompanied by diabetes mellitus (DM).Material and methods. The study involved 258 patients (258 eyes), which were divided into five groups: 1st group — 58 patients with stage I POAG and DM; 2nd group — 50 patients (50 eyes) with stage I POAG; 3rd — 50 patients with stage III POAG and DM; 4th — 50 patients with stage III POAG; 5th — 50 patients with DM. In addition to a complete ophthalmological examination, the patients underwent spectral optical coherence tomography (OCT), OCT angiography of the optic nerve head and macula. The observation period was 24 months.Results. The worst decrease in maximally corrected visual acuity was noted in patients with DM + POAG (groups 1 and 3): in 1 year of observation — stage I — 10.29%, stage III — 7.32 %, in control groups with isolated POAG stages I and III, 1.15 and 2.04%, respectively, in patients with DM, 1.39%; in 2nd year — 14.71 and 14.63% with a comorbid course of the disease and 1.15 and 4.08% in the absence of DM, respectively. The MD index in the group DM + POAG stage I after 12 months was significantly lower compared to patients with stage I POAG (by 5.05%), after 24 months by 12.12, 0.34 and 1.69%, respectively (p £ 0.05). The groups of comorbid patients showed lower average thickness levels of the retinal nerve fibers layer than in the control groups: 78.81 ± 11.39 μm at stage I and 63.08 ± 10.32 μm at stage III. A similar pattern was noted for the thickness of the neuroretinal rim and its areas as well indicators of the optic disc excavation (volume and c/d ratio).No significant difference was noted in the density of the optic nerve disc perfusion in stages I and III POAG with DM against the respective control groups during the first visit, but we noted a significantly lower vascular density in patients with the initial stage of POAG and DM (0.39 ± 0.04 / mm) than in patients with isolated glaucoma (0.42 ± 0.03 / mm). As the disease progressed, there was a further significant decrease in the average indicators of optic nerve disc perfusion and vascular density (group 3: 39.17 ± 3.43% and 0.33 ± 0.03 / mm).Conclusion. The study of the changes of visual, functional, structural and hemodynamic parameters of the optic nerve showed a faster rate of progression of glaucomatous optic neuropathy if accompanied with DM.


Dermatology ◽  
2021 ◽  
pp. 1-11
Author(s):  
Michael Schultheis ◽  
Petra Staubach ◽  
Georgios Nikolakis ◽  
Stephan Grabbe ◽  
Christian Ruckes ◽  
...  

<b><i>Background:</i></b> Hidradenitis suppurativa (HS) is a chronic, inflammatory, burdensome skin disease where medical first-line treatment is still limited to long-term, topical and/or systemic antibiotics. The RELIEVE study aimed at evaluating the efficacy of LAight® therapy – a combination of intense pulsed light and radiofrequency – as an adjunct treatment to first-line therapies in Hurley stage I and II HS. <b><i>Methods:</i></b> The RELIEVE study was performed as a two-period multicenter randomized controlled trial with blinded assessment. For period A from week 0 to week 16, the 88 participating subjects were randomized into either an intervention group (IG) or a control group (CG). The IG received topical clindamycin 1% solution combined with 8 additional bi-weekly treatments with LAight® therapy. The CG was treated with topical clindamycin 1% solution only. After 16 weeks, patients entered open-label period B and both groups were treated exclusively with LAight® therapy for an additional 16 weeks (8 sessions). The primary efficacy endpoint was the change in International Hidradenitis Suppurativa Score System (∆IHS4) at week 16 to baseline. Secondary endpoints were DLQI, HiSCR, Pain-NRS, and HADS. <b><i>Results:</i></b> In total, from the 88 patients enrolled in RELIEVE, 81 patients were included in the endpoint analysis after period A. After 16 weeks of treatment, the ∆IHS4 of the group treated with the combination of LAight® therapy and topical clindamycin 1% solution was −7.2 ± 6.7 (−60.0%), which was significantly higher in magnitude than the ∆IHS4 in the group treated with clindamycin 1% solution alone (−1.8 ± 5.6, −17.8%, <i>p</i> &#x3c; 0.001). Secondary endpoints, including other clinical scores as well as patient-reported outcomes, confirmed that the efficacy of the combined treatment was superior to monotherapy. <b><i>Conclusion:</i></b> The results of the primary endpoint analysis of period A of the RELIEVE study show that the combined therapy with LAight® and topical clindamycin 1% solution, resulted in a significantly higher decrease in disease severity and an improvement of quality of life in comparison to topical clindamycin 1% solution monotherapy. Treatment was well tolerated, and side effects were all mild and transitory. These data speak for the implementation of the combined treatment as a first-line therapy in Hurley stage I and II HS. LAight® therapy as long-term monotherapy (results from period B), will be analyzed in a consecutive paper.


2021 ◽  
Author(s):  
Menghan Zhu ◽  
Nan Jia ◽  
Wei Jiang

Abstract AimTo analyze and compare the demographics, treatment, and survival rates in patients with ovarian clear cell carcinoma (OCCC).MethodsWe conducted a population-based retrospective study examining the Surveillance, Epidemiology, and End Results Program from 1998 to 2016. Data of 4344 women with OCCC were compared, and survival was analyzed using the Kaplan–Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model.ResultsThere was no significant difference in cause specific survival (CSS) regardless of chemotherapy in stage I and stage II OCCC. In women with stage III/IV OCCC, there was an increased mortality in women without chemotherapy (5-year CSS 29.80% vs. 24.90%, p<0.001). Among stage I women younger than 60 years old, the 5-year CSS of those underwent chemotherapy was worse than that of non-chemotherapy (86.4% vs. 97.50%, p=0.002). Among these patients, omitting chemotherapy had improved CSS (HR 0.539; 95% CI 0.386-0.753), and omitting lymph nodes examination had decreased CSS (HR 1.666; 95% CI 1.230-2.256). In stage III/IV women who were 60 years or older, the 5-year CSS of those underwent chemotherapy was better than that of non-chemotherapy (32.60% vs. 24.30%, p<0.001). Among these patients, omitting chemotherapy (HR 1.769; 95% CI 1.385-2.258) and omitting lymph nodes examination (HR 1.709; 95% CI 1.371-2.130) had lower CSS.ConclusionChemotherapy has different effects in patients with OCCC at different stages and ages. Age and lymph nodes examination may be factors that affect the outcome of patients with OCCC.


BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shin-Hoo Park ◽  
Yun-Suhk Suh ◽  
Tae-Han Kim ◽  
Yoon-Hee Choi ◽  
Jong-Ho Choi ◽  
...  

Abstract Background This study aimed to evaluate the surgical outcome and quality of life (QoL) of totally laparoscopic total gastrectomy (TLTG) compared with laparoscopy-assisted total gastrectomy (LATG) in patients with clinical stage I gastric cancer. Methods From 2012 to 2018, EGC patients who underwent TLTG (n = 223), including the first case with intracorporeal hemi-double stapling, were matched to those who underwent LATG (n = 114) with extracorporeal circular stapling, using 2:1 propensity score matching (PSM). Prospectively collected morbidity was compared between the TLTG and LATG groups in conjunction with the learning curve. The European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires QLQ-C30, STO22, and OG25 were prospectively surveyed during postoperative 1 year for patient subgroups. Results After PSM, grade I pulmonary complication rate was lower in the TLTG group (n = 213) than in the LATG group (n = 111) (0.5% vs. 5.4%, P = 0.007). Other complications were not different between the groups. The learning curve of TLTG was overcome at the 26th case in terms of the comprehensive complication index. The TLTG group after learning curve showed lower grade I pulmonary complication rate than the matched LATG group (0.5% vs. 4.7%, P = 0.024). Regarding postoperative QoL, the TLTG group (n = 63) revealed less dysphagia (P = 0.028), pain (P = 0.028), eating restriction (P = 0.006), eating (P = 0.004), odynophagia (P = 0.023) than the LATG group (n = 21). Multivariate analyses for each QoL item demonstrated that TLTG was the only common independent factor for better QoL. Conclusions TLTG reduced grade I pulmonary complications and provided better QoL in dysphagia, pain, eating, odynophagia than LATG for patients with clinical stage I gastric cancer.


Cancers ◽  
2021 ◽  
Vol 13 (18) ◽  
pp. 4547
Author(s):  
Jun Gong ◽  
Andrew Hendifar ◽  
Alexandra Gangi ◽  
Karen Zaghiyan ◽  
Katelyn Atkins ◽  
...  

Emerging data suggest that circulating tumor DNA (ctDNA) can detect colorectal cancer (CRC)-specific signals across both non-metastatic and metastatic settings. With the development of multiple platforms, including tumor-informed and tumor-agnostic ctDNA assays and demonstration of their provocative analytic performance to detect minimal residual disease, there are now ongoing, phase III randomized clinical trials to evaluate their role in the management paradigm of CRC. In this review, we highlight landmark studies that have formed the basis for ongoing studies on the clinically applicability of plasma ctDNA assays in resected, stage I–III CRC and metastatic CRC. We discuss clinical settings by which ctDNA may have the most immediate impact in routine clinical practice. These include the potential for ctDNA to (1) guide surveillance and intensification or de-intensification strategies of adjuvant therapy in resected, stage I–III CRC, (2) predict treatment response to neoadjuvant therapy in locally advanced rectal cancer inclusive of total neoadjuvant therapy (TNT), and (3) predict response to systemic and surgical therapies in metastatic disease. We end by considering clinical variables that can influence our ability to reliably interpret ctDNA dynamics in the clinic.


2021 ◽  
Vol 11 ◽  
Author(s):  
Dakui Luo ◽  
Yufei Yang ◽  
Zezhi Shan ◽  
Qi Liu ◽  
Sanjun Cai ◽  
...  

The aim of this study was to explore the prognostic factors in stage I-III colorectal cancer (CRC) patients who had survived for over five years. A total of 9754 stage I-III CRC patients who received curative surgery in the Department of Colorectal Surgery, Fudan University Shanghai Cancer Center were enrolled in this study. Of them, 3640 patients had survived for over five years after surgery. Univariate and multivariate Cox regression analyses were performed in the entire cohort and those who had survived for over five years. Compared with patients in the entire cohort, patients who had survived for over five years were more likely to be younger, have less disease of signet ring cell histology, perineural invasion and vascular invasion, more well differentiated tumors and stage I disease. In the entire cohort, increased age, signet ring cell, poor differentiation, more advanced pathological stage, perineural invasion and vascular invasion were inversely associated with disease-free survival (DFS) and overall survival (OS) using multivariable Cox regression analyses. Only age, pathological stage and perineural invasion remained significant in patients who had survived for over five years. Moreover, tumor location was an independent factor for OS in this subgroup. Predictors for prognosis of CRC change over time. Age, pathological stage and perineural invasion deserve more attention among patients who have survived for over five years.


2021 ◽  
Author(s):  
Roberto Palencia ◽  
Amrita Sandhu ◽  
Sarah Webb ◽  
Tom Blaikie ◽  
Murtuza Bharmal

Aim: There is a need to evaluate current treatments for stages I–III of Merkel cell carcinoma (MCC). Materials & methods: A systematic literature review was conducted to understand how patients with stage I–III MCC are treated and assess efficacy, safety, health-related quality of life and economic impact of current therapies. Embase was searched using the following inclusion criteria: publications from 2014 to 2019, in English, with adult patients (≥18 years) with early-stage MCC (i.e., stages I–III) and any interventions/comparators. Publications were excluded if they included only patients with stage IV MCC, had no distinction between early and advanced or metastatic MCC or had no extractable data. Results: A total of 18 retrospective studies were included. Few studies had evidence that surgery plus adjuvant radiotherapy significantly increased survival versus surgery alone in early MCC. Limited safety data were reported in three studies. None of the studies reported data on health-related quality of life or economic impact of treatment in patients with early-stage MCC. Conclusion: Although surgery plus adjuvant radiotherapy was a common treatment, no clear standard of care exists for stages I–III MCC and treatment outcomes need to be improved. All studies were retrospective with a high variability in sample sizes; hence, findings should be interpreted with caution.


2021 ◽  
Author(s):  
Osamu Noritake ◽  
Keiju Aokage ◽  
Ayako Suzuki ◽  
Kenta Tane ◽  
Tomohiro Miyoshi ◽  
...  

Abstract Purpose:Intratumoral macrophages are reportedly involved in tumor progression in non-small cell lung cancer; however, little is known about the prognostic impact and function of alveolar macrophages (AMs). This study aims to investigate the prognostic impact of the number of peritumoral AMs in patients with stage I lung adenocarcinoma.Methods:We investigated 514 patients with pathological stage I lung adenocarcinoma who underwent complete resection with lobectomy or pneumonectomy. The number of peritumoral AMs were counted, and patients were classified into two groups based on the number of peritumoral AMs. Using the Cancer Genome Atlas (TCGA) database of stage I lung adenocarcinoma, we compared gene expression profiles of high and low peritumoral AM contents.Results:The median number of peritumoral AMs per alveolar space was 15.5. Patients with a high peritumoral AM content had significantly shorter disease-free survival and overall survival than patients with a low peritumoral AM content (both p < 0.01). In the multivariate analyses, a higher number of peritumoral AMs was an independent prognostic factor (p = 0.02). The analysis of TCGA database revealed that patients with a high peritumoral AM content had shorter disease-free survival than those with a low peritumoral AM content (p = 0.04). Gene expression analysis of TCGA stage I lung adenocarcinoma revealed enrichment of biological processes, such as chemotaxis and epithelial proliferation, in patients with a high peritumoral AM content.Conclusion:The number of peritumoral AMs had a strong impact on disease-free survival in patients with stage I lung adenocarcinoma.


2021 ◽  
pp. ijgc-2021-002728
Author(s):  
Emily MacDuffie ◽  
Sruthi Sakamuri ◽  
Rebecca Luckett ◽  
Qiao Wang ◽  
Memory Bvochara-Nsingo ◽  
...  

ObjectivesVulvar cancer is a rare gynecological malignancy. However, the incidence of human papillomavirus (HPV)-associated vulvar disease is increasing, particularly in low- and middle-income countries. HIV infection is associated with an increased risk of HPV-associated vulvar cancer. We evaluated treatment patterns and survival outcomes in a cohort of vulvar cancer patients in Botswana. The primary objective of this study was to determine overall survival and the impact of treatment modality, stage, and HIV status on overall survival.MethodsWomen with vulvar cancer who presented to oncology care in Botswana from January 2015 through August 2019 were prospectively enrolled in this observational cohort study. Demographics, clinical characteristics, treatment, and survival data were collected. Factors associated with survival including age, HIV status, stage, and treatment were evaluated.ResultsOur cohort included 120 women with vulvar cancer. Median age was 42 (IQR 38–47) years. The majority of patients were living with HIV (89%, n=107) that was well-controlled on antiretroviral treatment. Among women with HIV, 54.2% (n=58) were early stage (FIGO stage I/II). In those without HIV, 46.2% (n=6) were early stage (stage I/II). Of the 95 (79%) patients who received treatment, 20.8% (n=25) received surgery, 67.5% (n=81) received radiation therapy, and 24.2% (n=29) received chemotherapy, either alone or in combination. Median follow-up time of all patients was 24.7 (IQR 14.2–39.1) months and 2- year overall survival for all patients was 74%. Multivariate analysis demonstrated improved survival for those who received surgery (HR 0.26; 95% CI 0.08 to 0.86) and poor survival was associated with advanced stage (HR 2.56; 95% CI 1.30 to 5.02). Survival was not associated with HIV status.ConclusionsThe majority of women with vulvar cancer in Botswana are young and living with HIV infection. Just under half of patients present with advanced stage, which was associated with worse survival. Improved survival was seen for those who received surgery.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Neelima Vidula ◽  
Sally Greenberg ◽  
Laura Petrillo ◽  
Jimmy Hwang ◽  
Michelle Melisko ◽  
...  

AbstractWe evaluated disseminated tumor cells (DTCs) and circulating tumor cells (CTCs) in patients with stage I-III breast cancer with >4 MM/mL DTC at baseline who received adjuvant zoledronic acid (ZOL). ZOL was administered every 4 weeks for 24 months, and patients underwent bone marrow aspiration at baseline, and 12 and 24 months of ZOL. Complete DTC response (<4 DTC/mL), serial CTCs, survival, recurrence, and toxicity were determined. Forty-five patients received ZOL. Median baseline DTC was 13.3/mL. Significant reduction in median DTC occurred from baseline to 12 months, and 24 months. Complete DTC response was seen in 32% at 12 months, and 26% at 24 months. Nine patients developed recurrence. Baseline DTC > 30/mL and CTC > 0.8/mL were significantly associated with recurrence and death. Serial reduction in DTCs occurred. Higher baseline DTC > 30/mL and CTC > 0.8/mL correlated with recurrence and death.


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