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BJS Open Jul 2022Older patients are at high risk of experiencing delayed functional recovery after surgical treatment. This study aimed to identify factors that predict changes in the... (Observational Study)
Observational Study
BACKGROUND
Older patients are at high risk of experiencing delayed functional recovery after surgical treatment. This study aimed to identify factors that predict changes in the level of support for activities of daily living and mobility 1 year after colonic cancer surgery.
METHODS
This was a multicentre, observational study conforming to STROBE guidelines. The prospective data included pre-and postoperative mobility and need for support in daily activities, co-morbidities, onco-geriatric screening tool (G8), clinical frailty scale (CFS), operative data, and postoperative surgical outcomes.
RESULTS
A total of 167 patients aged 80 years or more with colonic cancer were recruited. After surgery, 30 per cent and 22 per cent of all patients had increased need for support and decreased motility. Multivariableanalysis with all patients demonstrated that preoperative support in daily activities outside the home (OR 3.23, 95 per cent c.i. 1.06 to 9.80, P = 0.039) was associated with an increased support at follow-up. A history of cognitive impairment (3.15, 1.06 to 9.34, P = 0.038) haemoglobin less than 120 g/l (7.48, 1.97 to 28.4, P = 0.003) and discharge to other medical facilities (4.72, 1.39 to 16.0, P = 0.013) were independently associated with declined mobility. With functionally independent patients, haemoglobin less than 120 g/l (8.31, 1.76 to 39.2, P = 0.008) and discharge to other medical facilities (4.38, 1.20 to 16.0, P = 0.026) were associated with declined mobility.
CONCLUSION
Increased need for support before surgery, cognitive impairment, preoperative anaemia, and discharge to other medical facilities predicts an increased need for support or declined mobility 1 year after colonic cancer surgery. Preoperative assessment and optimization should focus on anaemia correction, nutritional status, and mobility with detailed rehabilitation plan.
Topics: Activities of Daily Living; Aged, 80 and over; Anemia; Colonic Neoplasms; Geriatric Assessment; Hemoglobins; Humans; Physical Functional Performance; Prospective Studies
PubMed: 35973109
DOI: 10.1093/bjsopen/zrac094 -
Toxicology and Applied Pharmacology Sep 2022Resistance to antitumor treatments is one of the most important problems faced by clinicians in the management of colorectal cancer (CRC) patients. Cancer-Associated...
Resistance to antitumor treatments is one of the most important problems faced by clinicians in the management of colorectal cancer (CRC) patients. Cancer-Associated Fibroblasts (CAFs) are the main producers and remodelers of the extracellular matrix (ECM), which is directly involved in drug resistance mechanisms. Primary Normal Fibroblasts (NFs) and CAFs and cell lines (fibroblasts and tumor cells), were used to generate ECM and to identify its role in the oxaliplatin and cetuximab chemoresistance processes of CRC cells mediated by SNAI1-expressing fibroblasts. Matrices generated by Snai1 KO MEFs (Knockout Mouse Embryonic Fibroblasts) confer less resistance on oxaliplatin and cetuximab than wild-type MEF-derived matrices. Similarly, matrices derived from CAFs cause greater survival of colorectal cancer cells than NF-derived matrices, in a similar way to Snai1 expression levels. In addition, Snail1 expression in fibroblasts regulates drug resistance and metabolism gene expression in tumor cells mediated by ECM. Finally, a series of 531 patients (TCGA) with CRC was used to assess the role of SNAI1 expression in patients' prognosis indicating an association between tumor SNAI1 expression and overall survival in colon cancer patients but not in rectal cancer patients. SNAI1 expression in CRC cancer patients, together with in vitro experimentation, suggests the possible use of SNAI1 expression in tumor-associated fibroblasts as a predictive biomarker of response to oxaliplatin and cetuximab treatments in patients with CRC.
Topics: Animals; Cell Line, Tumor; Cetuximab; Colorectal Neoplasms; Drug Resistance; Extracellular Matrix; Fibroblasts; Mice; Mice, Knockout; Oxaliplatin
PubMed: 35878797
DOI: 10.1016/j.taap.2022.116171 -
Acta Radiologica (Stockholm, Sweden :... Mar 2023Three-dimensional endoanal ultrasound (3D EAUS) has been the gold standard for detecting anal sphincter lesions in patients with a history of obstetric anal sphincter...
BACKGROUND
Three-dimensional endoanal ultrasound (3D EAUS) has been the gold standard for detecting anal sphincter lesions in patients with a history of obstetric anal sphincter injury (OASI). Advances in imaging technologies have facilitated the detection of these lesions with external phased-array magnetic resonance imaging (MRI), which could offer an alternative imaging modality for the diagnosis of residual OASI (ROASI) in centers where 3D EAUS imaging is not available.
PURPOSE
To compare two diagnostic modalities: the 3D EAUS and 3T external phased-array MRI in the detection of residual anal sphincter lesions.
MATERIAL AND METHODS
A total of 24 women with a history of OASI were imaged with both 3D EAUS and 3T external phased-array MRI after primary repair of the injury. Intraclass correlation (ICC) and interrater reliability (IRR) values were calculated for the grade and circumference of the sphincter lesion. Sphincter lesions were graded according to the Sultan classification.
RESULTS
There was an almost perfect agreement between 3D EAUS and 3T external phased-array MRI in determining the extent of the sphincter lesions according to the Sultan classification (κ = 0.881; < 0.001) and the circumference of the external anal sphincter defects, measured in degrees (κ = 0.896; < 0.001).
CONCLUSION
The results of this study indicate that 3T external phased-array MRI and 3D EAUS yield comparable results in the diagnosis of ROASI. These findings suggest that 3T external phased-array MRI could serve as an alternative diagnostic modality to 3D EAUS in the diagnosis of ROASI.
Topics: Pregnancy; Humans; Female; Anal Canal; Pilot Projects; Fecal Incontinence; Reproducibility of Results; Magnetic Resonance Imaging; Endosonography
PubMed: 35787708
DOI: 10.1177/02841851221109139 -
Frontiers in Genetics 2022Pinnipeds found across islands provide an ideal opportunity to examine the evolutionary process of population subdivision affected by several mechanisms. Here, we report...
Pinnipeds found across islands provide an ideal opportunity to examine the evolutionary process of population subdivision affected by several mechanisms. Here, we report the genetic consequences of the geographic distribution of rookeries in Galapagos fur seals (GFS: ) in creating population structure. We show that rookeries across four islands (nine rookeries) are genetically structured into the following major groups: 1) a western cluster of individuals from Fernandina; 2) a central group from north and east Isabela, Santiago, and Pinta; and possibly, 3) a third cluster in the northeast from Pinta. Furthermore, asymmetric levels of gene flow obtained from eight microsatellites found migration from west Isabela to Fernandina islands (number of migrants = 1), with imperceptible in any other direction. Our findings suggest that the marked structuring of populations recovered in GFS is likely related to an interplay between long-term site fidelity and long-distance migration in both male and female individuals, probably influenced by varying degrees of marine productivity.
PubMed: 35664327
DOI: 10.3389/fgene.2022.725772 -
Heredity Apr 2022The Galapagos Archipelago is recognized as a natural laboratory for studying evolutionary processes. San Cristóbal was one of the first islands colonized by tortoises,...
The Galapagos Archipelago is recognized as a natural laboratory for studying evolutionary processes. San Cristóbal was one of the first islands colonized by tortoises, which radiated from there across the archipelago to inhabit 10 islands. Here, we sequenced the mitochondrial control region from six historical giant tortoises from San Cristóbal (five long deceased individuals found in a cave and one found alive during an expedition in 1906) and discovered that the five from the cave are from a clade that is distinct among known Galapagos giant tortoises but closely related to the species from Española and Pinta Islands. The haplotype of the individual collected alive in 1906 is in the same clade as the haplotype in the contemporary population. To search for traces of a second lineage in the contemporary population on San Cristóbal, we closely examined the population by sequencing the mitochondrial control region for 129 individuals and genotyping 70 of these for both 21 microsatellite loci and >12,000 genome-wide single nucleotide polymorphisms [SNPs]. Only a single mitochondrial haplotype was found, with no evidence to suggest substructure based on the nuclear markers. Given the geographic and temporal proximity of the two deeply divergent mitochondrial lineages in the historical samples, they were likely sympatric, raising the possibility that the lineages coexisted. Without the museum samples, this important discovery of an additional lineage of Galapagos giant tortoise would not have been possible, underscoring the value of such collections and providing insights into the early evolution of this iconic radiation.
Topics: Animals; DNA, Mitochondrial; Ecuador; Genome; Haplotypes; Humans; Microsatellite Repeats; Museums; Phylogeny; Turtles
PubMed: 35217806
DOI: 10.1038/s41437-022-00510-8 -
Anticancer Research Feb 2022Stereotactic body radiotherapy (SBRT) allows high doses of radiation to be administered in a limited number of fractions. The high doses per session might allow the... (Review)
Review
Stereotactic body radiotherapy (SBRT) allows high doses of radiation to be administered in a limited number of fractions. The high doses per session might allow the theoretical radioresistance of renal carcinoma to be overcome. SBRT may be a therapeutic alternative in inoperable patients with localized renal carcinoma. This review studied the available literature on the use of SBRT in inoperable localized renal carcinoma. The review including data from English-language studies was conducted in PubMed and MEDLINE between January 2010 and December 2020. Articles were included with data from patients with renal carcinoma treated with SBRT, their indications, simulation, dose and fractionation, local control, survival and side effects, comparison with other treatments, response assessment and radioimmunotherapy. The articles included were evaluated for content and validation. The immobilization systems were variable between studies. Doses and fractions were variable from 25-26 Gy in single fractions to 21-48 Gy in 3-5 fractions, with local control being around 90% with a low rate of side-effects. We review the state of the art in SBRT for renal cell carcinoma. More research is needed to determine optimal doses and fractionation, and to develop a reliable response assessment tool. The role of radioimmunotherapy in renal carcinoma is being studied.
Topics: Carcinoma, Renal Cell; Dose Fractionation, Radiation; Humans; Kidney Neoplasms; Radiation Injuries; Radioimmunotherapy; Radiosurgery; Radiotherapy Planning, Computer-Assisted; Survival Analysis; Treatment Outcome
PubMed: 35093865
DOI: 10.21873/anticanres.15525 -
World Journal of Clinical Oncology Dec 2021Complete resection continues to be the gold standard for the treatment of early-stage lung cancer. The landmark Lung Cancer Study Group trial in 1995 established... (Review)
Review
Complete resection continues to be the gold standard for the treatment of early-stage lung cancer. The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the management of early-stage non-small cell lung cancer, as it was associated with lower recurrence and metastasis rates than sublobar resection and lower postoperative morbidity and mortality than pneumonectomy. There is a growing tendency to perform sublobar resection in selected cases, as, depending on factors such as tumor size, histologic subtype, lymph node involvement, and resection margins, it can produce similar oncological results to lobectomy. Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery.
PubMed: 35070733
DOI: 10.5306/wjco.v12.i12.1089 -
Hepatobiliary & Pancreatic Diseases... Aug 2022Radiomics is changing the world of medicine and more specifically the world of oncology. Early diagnosis and treatment improve the prognosis of patients with cancer.... (Review)
Review
Radiomics is changing the world of medicine and more specifically the world of oncology. Early diagnosis and treatment improve the prognosis of patients with cancer. After treatment, the evaluation of the response will determine future treatments. In oncology, every change in treatment means a loss of therapeutic options and this is key in pancreatic cancer. Radiomics has been developed in oncology in the early diagnosis and differential diagnosis of benign and malignant lesions, in the evaluation of response, in the prediction of possible side effects, marking the risk of recurrence, survival and prognosis of the disease. Some studies have validated its use to differentiate normal tissues from tumor tissues with high sensitivity and specificity, and to differentiate cystic lesions and pancreatic neuroendocrine tumor grades with texture parameters. In addition, these parameters have been related to survival in patients with pancreatic cancer and to response to radiotherapy and chemotherapy. This review aimed to establish the current status of the use of radiomics in pancreatic cancer and future perspectives.
Topics: Forecasting; Humans; Oncologists; Pancreatic Neoplasms; Prognosis
PubMed: 34961674
DOI: 10.1016/j.hbpd.2021.12.006 -
Anatolian Journal of Cardiology Dec 2021Stereotactic ablative body radiotherapy (SABR) allows the administration of ablative doses of radiation in a focused form with a low probability of side effects and is... (Review)
Review
Stereotactic ablative body radiotherapy (SABR) allows the administration of ablative doses of radiation in a focused form with a low probability of side effects and is widely used for cancer treatment. However, in the recent years its usefulness in benign cardiac pathology is being studied. In this study, we aimed to guide the cardiologist in SABR and its applications in treatment of refractory ventricular tachycardia. In this review, we analyzed published literature on PubMed and MEDLINE with papers published in the past 5 years. We included papers in the English language with information about indications, radiotherapy plan, doses and fractionations, and outcomes. All citations were evaluated for relevant content and validation.
Topics: Arrhythmias, Cardiac; Humans; Radiosurgery; Tachycardia, Ventricular
PubMed: 34866579
DOI: 10.5152/AnatolJCardiol.2021.187 -
Journal of Cancer Education : the... Feb 2022In 2018, my wife, Susan, died from an aggressive form of neuroendocrine cancer nine months after receiving her diagnosis. In this article, I share some of what I learned...
In 2018, my wife, Susan, died from an aggressive form of neuroendocrine cancer nine months after receiving her diagnosis. In this article, I share some of what I learned about living and dying from Susan with the hope that other caregivers and medical professionals providing end-of-life support might benefit from my experience. This included viewing dying in ways that I had not expected; grieving the many "small deaths" during her illness that helped prepare for the final loss; learning the important values in life; needing to find meaning and purpose in life after caregiving; experiencing guilt on different levels; and deciding on readiness to move forward with my life.
Topics: Caregivers; Female; Grief; Humans; Learning; Neoplasms; Spouses
PubMed: 34792793
DOI: 10.1007/s13187-021-02117-9