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Scientific African Mar 2022The Coronavirus pandemic outbreak has induced many urgent adaptation measures in Morocco including medical education that had to abruptly adopt an exclusive distant...
The Coronavirus pandemic outbreak has induced many urgent adaptation measures in Morocco including medical education that had to abruptly adopt an exclusive distant education approach, without former sufficient preparation. The present study aimed to assess medical students' engagement in their acutely implemented distant learning and to identify factors that could be associated to the students' studying engagement levels. Medical students from 1st to 5th years of medical studies, enrolled in all Moroccan public medical faculties were invited to fill-in an anonymous online questionnaire. 3174 medical students took part in the study, with a mean age of 20.4 +/- 1.8 years old, and 65.4% of them were women. 90% of the participants reported moderate to drastic change of their sleeping habits and 65% suffered depression symptoms. 20.7% of students didn't engage at all in their learning, 26% studied for less than one hour daily, and only 53.3% studied for one hour or more daily. Only 46.4% of the participants had access to multimedia studying resources and only 20.9% were offered online interactive sessions with their teachers. 41.8% of the participants were unsatisfied from their distant learning experience. Lower studying engagement rates were significantly associated with older age, male gender, change of sleeping patterns, depression symptoms, and also with lack of access to multimedia studying resources and poor general satisfaction from the distant learning experience. Distant Education needs to include more interactive activities and more multimedia studying resources to engage students more efficiently in their self-regulated learning.
PubMed: 34977441
DOI: 10.1016/j.sciaf.2021.e01087 -
The Journal of Laryngology and Otology Dec 2009We report an extremely rare case of distant metastasis to the rectus femoris muscle from a laryngeal squamous cell carcinoma. (Review)
Review
OBJECTIVE
We report an extremely rare case of distant metastasis to the rectus femoris muscle from a laryngeal squamous cell carcinoma.
METHOD
We present a case report and a review of the world literature concerning distant skeletal muscle metastasis from head and neck squamous cell carcinoma.
RESULTS
The patient showed no evidence of distant muscular recurrence at follow up after 21 months; however, two years later he died from brain and suprarenal metastases.
CONCLUSION
This report describes the first case of haematogenous distant metastasis to the left rectus femoris muscle from a laryngeal squamous cell carcinoma, without evidence of cervical lymph node metastases. To the best of our knowledge, this is the second reported case of muscular distant metastasis without cervical lymph node involvement. Although the prognosis associated with skeletal muscle metastasis is considered to be poor, surgical excision may be indicated for an isolated muscular metastasis.
Topics: Aged; Carcinoma, Squamous Cell; Fatal Outcome; Humans; Laryngeal Neoplasms; Male; Muscle Neoplasms; Quadriceps Muscle
PubMed: 19470188
DOI: 10.1017/S0022215109005544 -
Gland Surgery Oct 2020Distant metastases from well-differentiated thyroid carcinoma (WDTC) occasionally occur over a wide range of time intervals after primary thyroid surgery. The prognostic...
BACKGROUND
Distant metastases from well-differentiated thyroid carcinoma (WDTC) occasionally occur over a wide range of time intervals after primary thyroid surgery. The prognostic impact of the timing of distant metastasis onset remains unclear.
METHODS
We retrospectively reviewed the clinicopathologic features and clinical outcomes of 57 patients with WDTC and distant metastases, and evaluated the mutational profiles of , , and promoter genes. All patients underwent thyroidectomy and radioactive iodine (RAI) ablation using the same treatment protocol. Synchronous distant metastases were defined as those detected within 12 months of the primary WDTC diagnosis. Metachronous metastases were considered early- and late-onset diseases if detected 1-5 and ≥5 years after the primary diagnosis, respectively.
RESULTS
In all patients, the 5- and 10-year cancer-specific survival (CSS) rates after the diagnosis of distant metastasis were 86% and 57%, respectively. Late-onset (≥5 years) metachronous distant metastasis was associated with age of ≥55 years (P=0.043) and patients refractory to RAI therapy (P=0.026). promoter mutations were associated with RAI refractivity (P=0.026). V600E and mutations had no prognostic significance. Bone metastasis (P=0.002) and the onset time of distant metastasis (P=0.004) were associated with poor CSS. There was no significant difference in CSS between patients with synchronous distant metastases and those with early-onset (1-5 years) metachronous distant metastases. In the multivariate analysis, bone metastasis [hazard ratio (HR) =10.24; 95% confidence interval (CI): 1.25-83.74; P=0.030] and late-onset (≥5 years) metachronous distant metastasis (HR =5.20; 95% CI: 1.01-26.63; P=0.048) were independent predictors for worse CSS.
CONCLUSIONS
The prognosis of patients with WDTC was poorer for late metachronously detected metastases than for synchronous or early metachronous metastases. Patients with distant metastasis occurring 5 years later after primary thyroid diagnosis should, therefore, be more carefully treated.
PubMed: 33224861
DOI: 10.21037/gs-20-416 -
Journal of the College of Physicians... Dec 2021To investigate whether age or other factors are determinants of distant metastasis in patients with lung cancer. (Observational Study)
Observational Study
OBJECTIVE
To investigate whether age or other factors are determinants of distant metastasis in patients with lung cancer.
STUDY DESIGN
Observational study.
PLACE AND DURATION OF STUDY
Department of Nuclear Medicine, Recep Tayyip Erdogan University, Rize, Turkey between December, 2018 and February, 2019.
METHODOLOGY
A total of 152 patients with lung cancer, who underwent positron emission tomography/computed tomography (PET/CT) for staging, were included in this study. Patients were grouped according to age (>65 and <65 years) and distant metastasis status. Metastasis localisation of patients was evaluated by PET/CT. Univariate/multivariate regression analyses were performed to determine risk factors for distant metastasis.
RESULTS
No significant difference was found when the relation of distant metastasis with stage distribution was examined in both age groups. Distant metastasis rates were significantly higher in female patients than in male patients (p = 0.019) and in patients with small-cell lung carcinoma (SCLC)-adenocarcinoma than in those with other histopathological subtypes (p <0.001). Most of the patients in both groups had a stage 4 disease, and bone distant metastasis was the most common in both age groups. Univariate/multivariate analyses identified that female gender (p = 0.017/p = 0.003), SCLC subtype (p = 0.013/p = 0.008), T3/T4 tumour (p <0.001/p <0.001), and smoking history of >66 pack-years (p = 0.047/p = 0.047) were independent factors for the presence of distant metastasis.
CONCLUSION
Although age is not a risk factor for distant metastasis in lung cancer, female gender, T3/4 tumour, SCLC subtype, and smoking history of >66 pack-years are high-risk factors. PET/CT is recommended as the first-choice imaging technique in patients with lung cancer indicated for distant metastasis scanning. Key Word: Lung cancer, PET/CT, Metastases, Histological subtype, T-stage.
Topics: Aged; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Neoplasm Metastasis; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Retrospective Studies; Small Cell Lung Carcinoma
PubMed: 34794284
DOI: 10.29271/jcpsp.2021.12.1438 -
Clinical Nuclear Medicine Jun 2022Patients with esophageal cancer can develop distant metastases between the start of neoadjuvant chemoradiotherapy (nCRT) and planned surgery (ie, interval distant...
PURPOSE
Patients with esophageal cancer can develop distant metastases between the start of neoadjuvant chemoradiotherapy (nCRT) and planned surgery (ie, interval distant metastases). 18F-FDG PET/CT restaging after nCRT detects interval distant metastases in ~8% of patients. This study aimed to identify patients for whom 18F-FDG PET/CT restaging after nCRT could be omitted using an existing prediction model predicting for interval distant metastases or by using clinical stage groups.
PATIENTS AND METHODS
Patients with locally advanced esophageal cancer who underwent baseline and restaging 18F-FDG PET/CT, nCRT, and were planned for esophagectomy between 2017 and 2021 were eligible for inclusion in this retrospective study. The primary outcome was the existing model's external performance (ie, discrimination and calibration) for predicting interval distant metastases. The existing model predictors included tumor length, cN status, squamous cell carcinoma histology, and baseline SUVmax. The secondary outcome determined the clinical stage groups (AJCC/UICC eighth edition) for adenocarcinoma and squamous cell carcinoma for which the incidence of interval distant metastases was <10%.
RESULTS
In total, 127 patients were included, of whom 17 patients developed interval distant metastases (13%; 95% confidence interval [CI], 8%-21%) and 9 patients were deemed to have false-positive lesions on 18F-FDG PET/CT (7%; 95% CI, 2%-11%). Applying the existing model to this cohort yielded a discriminatory c-statistic of 0.56 (95% CI, 0.40-0.72). The calibration of the existing model was poor (ie, mostly underestimating the actual risk). The incidence of true-positive versus false-positive interval distant metastases for patients with clinical stage II disease was 5% versus 0%; clinical stage III, 14% versus 8%; and clinical stage IVa, 22% versus 9%.
CONCLUSIONS
The existing prediction model cannot reliably identify patients at risk for developing interval distant metastases after nCRT for esophageal cancer. Omission of 18F-FDG PET/CT restaging after nCRT could be considered in patients with clinical stage II esophageal cancer.
Topics: Carcinoma, Squamous Cell; Chemoradiotherapy; Esophageal Neoplasms; Fluorodeoxyglucose F18; Humans; Neoadjuvant Therapy; Neoplasm Staging; Neoplasms, Second Primary; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Retrospective Studies
PubMed: 35384907
DOI: 10.1097/RLU.0000000000004191 -
Journal of Gastrointestinal Oncology Jun 2019High neutrophil-lymphocyte ratio (NLR) is associated with poor overall survival (OS) in gastric cancer. This study evaluates whether NLR, in addition to other parameters...
BACKGROUND
High neutrophil-lymphocyte ratio (NLR) is associated with poor overall survival (OS) in gastric cancer. This study evaluates whether NLR, in addition to other parameters including absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute eosinophil count (AEC), absolute monocyte count (AMC), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) are associated with distant metastases, a common and poor prognostic feature of gastric cancer.
METHODS
Clinical data from 502 gastric cancer patients treated at King Hussein Cancer Center (Amman, Jordan) have been retrospectively reviewed. We examined the association between ANC, ALC, AEC, AMC, NLR, MLR and PLR with the baseline distant metastases and OS. Receiver operating characteristic (ROC) curve analysis was utilized to determine the optimal NLR cutoff value for association with distant metastases.
RESULTS
Univariate and multivariate analyses showed that patients with high baseline NLR (≥3.9) had more distant metastases on presentation than patients with low NLR (<3.9), (P value: 0.0001 and 0.0005, respectively). Furthermore, patients with high baseline ANC (≥6,015/µL), AEC (≥215/µL), PLR (≥0.15) had more distant metastases in comparison to patients with low baseline ANC (<6,015/µL), AEC (<215/µL), PLR (<0.15) (P value: 0.024, 0.001, and 0.001, respectively). High ANC, NLR, MLR and PLR are associated with poor OS (P value: 0.046, 0.0003, 0.027, and <0.0001, respectively).
CONCLUSIONS
High ANC, AEC, NLR, and PLR are associated with distant metastases on presentation in gastric cancer. In the era of cancer immunotherapy, whether these immune phenomena predict the response of gastric cancer to immunotherapy is unknown.
PubMed: 31183204
DOI: 10.21037/jgo.2019.01.12 -
Frontiers in Psychology 2022Relational integration is essential for learning, working, and living, as we must encode enormous volumes of information and extract their relations to construct...
Relational integration is essential for learning, working, and living, as we must encode enormous volumes of information and extract their relations to construct knowledge about the environment. Recent research hints that generating distant analogies can temporarily facilitate learners' state-based relational integration. This study aimed to investigate the internal mechanism underlying the facilitation effect and preliminarily confirm its application in education. First, we adopted the classical n-term premise integration task (Experiment 1a) and the Latin Square Task (Experiment 1b) to explore the robustness of the facilitation effect. Then we employed an emerging multidimensional relational reasoning task to further explore the internal mechanism underlying this facilitation effect (Experiment 2). Finally, we verified the practical role of the facilitation effect in learning the interaction concept in statistics (Experiment 3). The results showed that generating distant analogies did facilitate students' relational integration performance, both in classical cognitive tasks and in a practical learning task, and a relational mindset and cognitive load play an intermediary role in the facilitation, supporting the cognitive load theory. The results suggest that generating distant analogies can be a useful warm-up activity to assist educators in promoting students' relational integration.
PubMed: 36176804
DOI: 10.3389/fpsyg.2022.1012081 -
Acta Radiologica (Stockholm, Sweden :... Sep 2023Sarcopenia is associated with a poor prognosis in patients with breast cancer (BC). Currently, there are few quantitative assessments carried out between muscle...
BACKGROUND
Sarcopenia is associated with a poor prognosis in patients with breast cancer (BC). Currently, there are few quantitative assessments carried out between muscle biomarkers and distant metastasis using existing methods.
PURPOSE
To assess the predictive value of the pectoralis muscle for BC distant metastasis, we developed a deep learning radiomics nomogram model (DLR-N) in this study.
MATERIAL AND METHODS
A total of 493 patients with pathologically confirmed BC were registered. Image features were extracted from computed tomography (CT) images for each patient. Univariate and multivariate Cox regression analyses were performed to determine the independent prognostic factors for distant metastasis. The DLR-N was built based on independent prognostic factors and CT images to predict distant metastases. The model was assessed in terms of overall performance, discrimination, calibration, and clinical value. Finally, the predictive performance of the model was validated using the testing cohort.
RESULTS
The developed DLR-N combined multiple radiomic features and clinicopathological factors and demonstrated excellent predictive performance. The C-index of the training cohort was 0.983 (95% confidence interval [CI] = 0.969-0.998) and the C-index of the testing cohort was 0.948 (95% CI = 0.917-0.979). Decision curve analysis (DCA) showed that patients could benefit more from incorporating multimodal radiomic features into clinicopathological models.
CONCLUSIONS
DLR-N verified that there were biomarkers at the level of the fourth thoracic vertebra (T4) that affected distant metastasis. Multimodal prediction models based on deep learning could be a potential method to aid in the prediction of distant metastases in patients with BC.
Topics: Humans; Female; Breast Neoplasms; Pectoralis Muscles; Deep Learning; Retrospective Studies; Biomarkers
PubMed: 37439012
DOI: 10.1177/02841851231187373 -
Frontiers in Endocrinology 2021Children with papillary thyroid cancer (PTC) have a higher invasive rate and distant metastasis rate, but the mortality rate is lower with unknown reasons. The majority...
OBJECTIVE
Children with papillary thyroid cancer (PTC) have a higher invasive rate and distant metastasis rate, but the mortality rate is lower with unknown reasons. The majority of PTC cases comprise classical papillary thyroid carcinoma (CPTC) and follicular variant papillary thyroid carcinoma (FVPTC). This study aimed to determine the relationship between histopathological subtype and rate of distant metastasis and investigate factors influencing distant metastasis in pediatric PTC.
METHODS
A total of 102,981 PTC patients were recruited from SEER registry, 2004-2015. Proportion of distant metastasis between children (≤18 years) and adults with different histopathological subtypes was compared by propensity score matching. The cut-off age for distant metastasis in children was calculated by receiver operating characteristic (ROC) curve, and the risk factors for distant metastasis in pediatric patients were analyzed by logistic regression models.
RESULTS
Among the 1,484 children and 101,497 adults included in the study, the incidence of CPTC patients with distant metastasis in children was higher than that in adults (<0.001). The ROC curve was calculated, which yielded a cut-off age for distant metastasis in CPTC children as 16 years old. In CPTC, the proportion of young children (2-16 years) with distant metastasis was higher than that of adolescents (17-18 years) and adults (>18 years) (both <0.001). While there was no such trend in FVPTC. In young children (2-16 years), the incidence of CPTC with distant metastasis was higher than FVPTC (=0.006). There was no difference between the proportion of CPTC and FVPTC with distant metastasis in adolescents (17-18 years) and adults. Logistic regression models revealed that extrathyroidal extension, lymph node metastasis and CPTC histopathological subtype were risk factors for distant metastasis in young children aged 2 -16 years.
CONCLUSIONS
In CPTC, the incidence of distant metastasis in young children (2-16 years) was significantly higher than that in adolescents (17-18 years) and adults (>18 years). In patients with distant metastasis aged 2-16 years, the proportion of CPTC was higer than that of FVPTC. Extrathyroidal extension, lymph node metastasis, and CPTC histopathological subtype were risk factors for distant metastasis in young children aged 2-16 years.
Topics: Adolescent; Adult; Carcinoma, Papillary; Carcinoma, Papillary, Follicular; Child; Female; Humans; Incidence; Logistic Models; Lymphatic Metastasis; Male; Retrospective Studies; Risk Factors; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroidectomy
PubMed: 34858334
DOI: 10.3389/fendo.2021.760901 -
Cancer Medicine Jul 2023Small intestine cancer (SIC) is difficult to diagnose early and presents a poor prognosis due to distant metastasis. This study aimed to develop nomograms for diagnosing...
BACKGROUND
Small intestine cancer (SIC) is difficult to diagnose early and presents a poor prognosis due to distant metastasis. This study aimed to develop nomograms for diagnosing and assessing the prognosis of SIC with distant metastasis.
METHODS
Patients diagnosed with SIC between 2010 and 2015 were included from the Surveillance, Epidemiology and End Results database. Univariate and multifactor analysis determined independent risk factors for distant metastasis and prognostic factors for overall and cancer-specific survival. We then constructed the corresponding three nomograms and assessed the diagnostic accuracy of the nomograms by net reclassification improvement, receiver operating characteristic curves and calibration curves, assessed the clinical utility by decision curve analysis.
RESULTS
The cohort consisted of 6697 patients, of whom 1299 had distant metastasis at diagnosis. Tstage, Nstage, age, tumor size, grade, and histological type were independent risk factors for distant metastasis. Age, histological type, T stage, N stage, grade, tumor size, whether receiving surgery, number of lymph nodes removed, and the presence of bone or lung metastases were predictors of both overall survival and cancer-specific survival. The nomograms showed excellent accuracy in predicting distant metastasis and prognosis.
CONCLUSION
Nomograms were developed and validated for SIC patients with distant metastasis, aiding physicians in making rational and personalized clinical decisions.
Topics: Humans; Duodenal Neoplasms; Research; Nomograms; Calibration; Intestine, Small; Prognosis; SEER Program
PubMed: 37255376
DOI: 10.1002/cam4.6166