Intraabdominal and retroperitoneal soft-tissue sarcomas – Surgical treatment and outcomes

BackgroundIntraabdominal and retroperitoneal sarcomas (IaRS) are malignant connective tissue tumors. Surgical resection is often the only curative treatment. The primary objective was to report the mid-term outcomes following contemporary treatment protocols and identify prognostic factors.MethodsA retrospective review of consecutive patients (n = 107) with IaRS treated at single center from 2013 until 2018 was conducted. Histological diagnosis, tumor grade, perioperative complications, mortality, and long-time survival were registered and retrieved from patient records. Primary and recurrent tumors were analyzed separately.ResultsA total of 107 patients were identified. Median follow-up time was 3.5 years. Thirty-day mortality was 3.4% and 90-day mortality was 5.6% for all tumors. The major complication rate was 18%. The 5-year estimated survival for primary and recurrent tumors was 55.4% and 48.4%, respectively. Multifocal disease was evident in 32% of the patient cohort, and 58% of patients in the recurrent group. Multivariate analysis for survival revealed a hazard ratio (HR) of 3.1 (95% CI 1.68–8.41) for multifocality, HR 2.9 (95% CI 1.28–6.98) for Clavien-Dindo grade, HR 2.3 (95% CI 1.21–4.31) for tumor grades 2 or 3, and HR 1.002 (95% CI 1.001–1.004) for surgical margins.ConclusionsOur study found overall acceptable morbidity and mortality, and identified prognostic markers for overall survival. Recurrent tumors were not associated with worse survival. Multifocality is associated with a worse overall survival. The prognostic factors identified were; tumor grade, multifocality, intralesional margins and postoperative complications.     

Sinonasal tract pathology: an updated review of select entities

The sinonasal tract is host to numerous benign and malignant entities that can pose diagnostic challenges to pathologists as a result of limited exposure in daily practice. This review concentrates on certain key characteristics of select entities with focus on differential diagnosis, novel subtypes and/or molecular distinction. The aim of this review is to summarize current knowledge and shed light on diagnostically challenging and emerging entities in sinonasal tract pathology.     

Proteases and their inhibitors as prognostic factors for high-grade serous ovarian cancer

Ovarian carcinoma is one of the most lethal malignancies, but only very few prognostic biomarkers are known. The degradome, comprising proteases, protease non-proteolytic homologues and inhibitors, have been involved in the prognosis of many cancer types, including ovarian carcinoma. The prognostic significance of the whole degradome family has not been specifically studied in high-grade serous ovarian cancer. A targeted DNA microarray known as the CLIP-CHIP microarray was used to identify potential prognostic factors in ten high-grade serous ovarian cancer women who had early recurrence (<1.6 years) or late/no recurrence after first line surgery and chemotherapy. In women with early recurrence, we identified seven upregulated genes (TMPRSS4, MASP1/3, SPC18, PSMB1, IGFBP2, CFI – encoding Complement Factor I – and MMP9) and one down-regulated gene (ADAM-10). Using immunohistochemistry, we evaluated the prognostic effect of these 8 candidate genes in an independent cohort of 112 high-grade serous ovarian cancer women. Outcomes were progression, defined according to CA-125 criteria, and death. Multivariate Cox proportional hazard regression models were done to estimate the associations between each protein and each outcome. High ADAM-10 expression (intensity of 2–3) was associated with a lower risk of progression (adjusted hazard ratio (HR): 0.51; 95% confidence interval (CI): 0.29-0.87). High complement factor I expression (intensity 2–3) was associated with a higher risk of progression (adjusted HR: 2.30, 95% CI: 1.17–4.53) and death (adjusted HR: 3.42; 95% CI: 1.72–6.79). Overall, we identified the prognostic value of two proteases, ADAM-10 and complement factor I, for high-grade serous ovarian cancer which could have clinical significance.     

Perioperative Bevacizumab-based Triplet Chemotherapy in Patients With Potentially Resectable Colorectal Cancer Liver Metastases

Background

In colorectal cancer liver metastases (CRCLM), bevacizumab-based neoadjuvant strategies provide increased pathologic response. We aimed at assessing the activity of perioperative capecitabine, oxaliplatin, irinotecan, and bevacizumab (COI-B regimen) in patients with potentially resectable CRCLM, and investigating biomarkers for early prediction of pathologic response.

黄芪药材性状和化学特征与绝对生长年限的相关性分析研究

目的通过分析黄芪AstragaliRadix药材的性状以及黄酮类化学成分与绝对生长年限的相关性,明确黄芪根的生长年限是引起黄芪药材性状和化学差异性的主要因素。方法收集不同产地、不同等级的黄芪药材,对其外观形态定性描述,长度、直径定量测定,并采用徒手切片法观察不同等级仿野生芪的生长年限分布,观察其分布规律。采用UPLC-UV法,色谱柱为Ultimate C18(250 mm×4.6 mm,5μm),柱温30℃,体积流量为1 mL/min,检测波长230 nm,进样量20μL,乙腈-水梯度洗脱,建立了24批不同产地黄芪药材黄酮类成分HPLC-UV指纹图谱,并对不同等级仿野生芪和栽培芪5种黄酮类成分进行含量测定。结果将不同生长方式的黄芪药材划分为仿野生芪和栽培芪2个规格。特等黄芪主要是5年以上生长年限的根段,一等主要是4～5年生的根段,二等主要是3～4年生的根段,三等主要是2～3年生的根段,四等主要是1～2年生的根段。不同产地、不同等级黄芪指纹图谱中指认出5个共有峰,采用相似度评价软件分析,以仿野生芪图谱为参照,仿野生芪样品相似度为0.892～0.994,栽培芪样品相似度为0.274～0.531,主成分分析和聚类分析均显示仿野生芪和栽培芪可以明显分成2类。仿野生芪5种黄酮类成分含量明显高于栽培芪,仿野生芪(除特等外)总黄酮含量与等级(或直径、年限)呈正相关,栽培芪与等级不相关。结论本研究为黄芪药材商品规格等级标准的制定提供科学依据,为进一步构建黄芪药材质量等级标准奠定基础。     

住院医师规范化培训制度对临床医学生就业的影响

目的通过对2019年2月-2019年6月在西安交通大学第二附属医院实习的大学四年级及大学五年级的临床医学专业的医学生就业意向及就业情况的分析,研究住院医师规范化培训制度对医学生就业的影响。方法运用自制的问卷进行匿名填写的方式对大学四年级、大学五年级的临床医学本科生及5+3模式的规范化培训医学生进行调查。结果大部分医学生选择继续升学,选择就业的学生多愿意留在大城市就业,选择住院医师规范化培训的学生只占极少数。结论做好住院医师规范化培训政策的宣传,落实各项优惠政策,鼓励学生进行住院医师规范化培训及到基层工作,引导学生理性考研,是目前社会及医学院校就业指导中的重要内容。     

Correlation of Molecular Markers in High Grade Gliomas with Response to Chemo-Radiation

Background: The standard of care in high grade glioma (HGG) is maximal safe surgical resection followed by adjuvant radiotherapy (RT) with/without chemotherapy. For anaplastic gliomas, studies have shown use of procarbazine, lomustine, vincristine (PCV) improves overall survival (OS) and progression free survival (PFS). Currently, there is substantial evidence that molecular markers strongly predict prognosis and response to treatment. Methods: Between January 2016 to January 2018, 42 patients were accrued and followed up till April 2019. The primary end points were to correlate molecular markers with response to therapy in terms of OS and PFS in HGG. The secondary end point was to evaluate frequency of 1p/19q codeletion, IDH 1 mutation, ATRX deletion and p53 in HGG patients. Results: The median age was 46 years (range 18-67) with M:F ratio 30:12. The frequency of IDH1 mutation,1p/19q codeletion, p53 mutation and ATRX mutation were 42.8%, 16.6%, 42.8% and 14.2% respectively. All the seven patients with 1p/19q codeletion had IDH1 mutation. Median follow up was 22 months. The 20-months PFS for different mutations were as follows; IDH1-mutated vs wild type: 53.6% vs 29.8%; p-0.035, 1p/19q codeleted vs non-codeleted: 85.7% vs 62.3%; p-0.011, p53 wild type vs mutated 32.1% vs 35.6%; p-0.035 and ATRX lost vs retained: 55.6% vs 53.3%; p- 0.369. The 20-months OS for IDH1 mutated vs wild type: 82.4% vs 30.6%; p-0.014, 1p/19q codeleted vs non-codeleted: 85.7% vs 65.8%; p-0.104, p53 wild-type vs mutated 45.5% vs 73.9%; p-0.036 and ATRX lost vs retained: 100% vs 60.3%; p-0.087. Conclusion: Codeletion of 1p/19q with IDH1 mutation in HGG is associated with a significantly favourable PFS. However, larger studies with longer follow up are required to evaluate OS and PFS in all the molecular subgroups.     

Readability of Patient Educational Materials in Hip and Knee Arthroplasty: Has a Decade Made a Difference?

BackgroundThe Internet has become an increasingly popular resource among orthopedic patients for health education. Numerous organisations recommend that patient educational materials (PEMs) should not exceed the 6^th grade reading level. Despite this, studies have repeatedly shown the reading grade level (RGL) of PEMs to be too advanced across a range of surgical specialties. We aimed to determine the readability of online hip and knee arthroplasty PEMs.MethodsThe readability of 134 articles pertaining to hip and knee arthroplasty from 5leading worldwide healthcare websites were assessed, using 8 readability formulae; the Flesch-Kincaid Reading Grade Level, the Flesch Reading Ease Score, Raygor Estimate, SMOG, Coleman-Liau, Fry, FORCAST and Gunning Fog. The mean RGL was compared to the 6^th and 8^thgrade reading level. The mean RGL of each website was also compared.ResultsThe mean cumulative RGL was 12 (range = 7-16.1). No articles (0%) were written at a 6^th grade reading level and only 4 articles (3%) were written at or below the 8^th grade reading level. The mean RGL was significantly higher than the 6^th (95% CI, 5.62-6.30; P < .0001) and 8^th grade reading level (95% CI, 3.63-4.30; P < .0001). There was a significant difference between the RGLs of the 5websites (P = .001).ConclusionArthroplasty PEMs produced by leading worldwide healthcare organisations have readability scores that are above the recommended levels. Given the imperative role of health literacy in patient outcomes and satisfaction, and the increasing prevalence of Internet use among orthopedic patients, a substantial amount of work needs to be done to improve the readability of these materials.