Oncologic benefit of adjuvant chemotherapy for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and curative surgery with selective lateral pelvic lymph node dissection: An international retrospective cohort study

IntroductionIntensive local treatment comprising total mesorectal excision (TME) with selective lateral pelvic lymph node dissection (LPND) after neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) has received attention among clinicians treating rectal cancer. It remains unclear whether adjuvant chemotherapy (ACT) after intensive local treatment is beneficial for these patients. We evaluated the oncologic benefit of ACT for patients with LARC who received intensive local treatment.Materials and methodsThis international multicentre retrospective cohort study included 737 patients treated in Japan and Korea between 2010 and 2017. The effectiveness of ACT on recurrence-free survival (RFS) was evaluated using univariable and multivariable Cox proportional hazards models, with subgroup analyses to identify subpopulations potentially benefiting from ACT.ResultsThe median follow-up was 49 months; the 5-year RFS and local recurrence rates for the entire cohort were 72.1% and 4.9%, respectively; 514 patients (69.7%) received adjuvant chemotherapy, without an oncologic benefit (hazard ratio, 1.14; 95% confidence interval [CI]: 0.79–1.68) demonstrated in the multivariable Cox regression analysis. In subgroup analyses, the distributions of the 95% CI in patients aged ≥70 years and those with ypStage 0 tended to place a disproportionate emphasis that favoured the non-ACT treatment strategy.ConclusionDespite achieving good local control with intensive local treatment strategy, the effectiveness of ACT for the LARC patients with CRT followed by TME with selective LPND was not proved. Elderly patients and those with ypStage0 may not receive benefit from ACT after CRT and TME ± LPND.     

The role of hip arthroplasty in management of the hip fracture patient

Hip fractures are becoming increasingly common in a growing elderly population, and are associated with significant morbidity and mortality. Displaced intracapsular femoral neck fractures are usually treated with either total hip arthroplasty (THA) or hemiarthroplasty, although the indication for each operation remains an area for debate. THA has been associated with longer operative time, increased risk of dislocation and a slight increase in general complications compared with hemiarthroplasty. However, it has also been associated with a modest improvement in functional outcomes and quality of life. Guidelines have been created within the UK to aid the decision-making process based upon current available literature. The principal focus of these has been to identify patients suitable for THA, and include patients who are cognitively intact, mobile outside their home with the use of no more than one stick, and who are medically fit enough for the procedure. However, implant selection must also be taken into consideration in order to achieve the best outcomes for patients. Options for implants include use of dual mobility cups and choice of femoral head size in THA, bipolar versus unipolar hemiarthroplasty, and cemented versus uncemented implants. Further research is required into this area to make additional recommendations.     

Learning curve analysis for lateral pelvic lymph node dissection in rectal cancers – Outcomes improve with experience

IntroductionLateral pelvic lymph node dissection (LPLND) is a technically challenging procedure and its learning curve has not been analysed against an oncologically relevant outcome. The purpose of the study was to determine the learning curve for LPLND in rectal cancers using nodal retrieval as performance measure.MethodsConsecutive LPLND for rectal adenocarcinomas from a single institution were retrospectively analysed. Cumulative sum (CUSUM) control charts were used to detect difference in performance with respect to lymph node yield. Negative binomial regression was used to determine factors influencing nodal harvest using Incidence Risk Ratios (IRR). Separate CUSUM curves were generated for open and minimally invasive surgeries (MIS).ResultsOne-hundred and twenty patients were included and all received preoperative radiation. MIS was used in 53.3%. Median lymph node yield was 6 with 20% nodal positivity. Increasing experience (IRR – 1.196) and MIS (IRR – 1.586) were the only factors that influenced nodal harvest. CUSUM charts revealed that learning curve was achieved after the 83rd case overall and after the 19 operations in MIS. There was a 20% increase in nodal yield after every 30 MIS LPLND performed.ConclusionsLearning curve for LPLND is relatively long and only increasing experience and minimally invasive operations increased nodal yield.     

Effect of peer support on adults with diabetes-related peripheral neuropathy

ObjectiveTo explore the effect of peer support on exercise self-efficacy, physical activity level, and neuropathic symptoms in patients with diabetes-related peripheral neuropathy (DPN).MethodsA total of 60 adults with DPN were assigned to groups. Patients in the control group received routine education (RE), while patients in the intervention group received peer support (PS) combined with routine diabetes education. Data were collected at baseline and after intervention (12 weeks).ResultsAt 12 weeks, better outcomes were found in the PS group compared to the RE group for the following aspects: exercise self-efficacy, steps, total physical activity, fasting blood glucose and 2-hour postprandial blood glucose. Decreases in scores on Toronto Clinical Scoring System occurred between baseline and post-intervention in both groups.ConclusionPeer support is an effective way to improve exercise self-efficacy, number of steps, and general physical activity and to reduce blood glucose for patients with DPN. But the effects of peer support on neuropathic symptoms is are obvious. Further research is needed.Practice implicationsAs a low-cost, effective education approach, peer support strategies should be integrated into our healthcare system to meet the minimum needs of patients with DPN.     

Exploring a 7-gene prognostic model based on ferroptosis for efficiently guiding immunotherapy in melanoma patients

PurposeAlthough skin cutaneous melanoma (SKCM) is a relatively immunotherapy-sensitive tumor type, there is still a certain fraction that benefits less from treatment. Ferroptosis has been demonstrated to modulate tumor progression in many cancer types. This study focused on ferroptosis-related genes to construct a prognostic model for SKCM patients.Materials and methodsGene expression profiles of SKCM samples were obtained from public databases. Unsupervised consensus clustering was used to determine molecular subtypes related to ferroptosis. Least absolute shrinkage and selection operator (LASSO) and stepwise Akaike information criterion (stepAIC) were applied to construct a prognostic model based on differentially expressed genes between two molecular subtypes.ResultsC1 and C2 subtypes were identified with differential prognosis and immune infiltration. A 7-gene prognostic model was constructed to classify samples into high-FPRS and low-FPRS groups. Low-FPRS group with favorable prognosis had higher immune infiltration and more enriched immune-related pathways than the high-FPRS group. The two groups showed distinct sensitivity to immunotherapy, with the low-FPRS group predicted to have more positive response to immunotherapy than the high-FPRS group. A nomogram based on the FPRS score and clinical features was built for more convenient use.ConclusionsThe critical role of ferroptosis involved in SKCM development was further validated in this study. The prognostic model was efficient and stable to be applied in clinical conditions to support clinicians in determining personalized therapy for SKCM patients especially those with metastasis.     

中西医联合治疗糖尿病周围神经病变效果观察

目的研究中西医联合治疗糖尿病周围神经病变患者的临床效果。方法按照随机数字表法将2017年7月-2018年6月期间本院收治的72例糖尿病周围神经病变患者分为两组,对照组36例采用常规西医治疗,观察组36例采用中西医联合治疗。将两组的神经传导速度、临床疗效、用药安全性进行比对。结果观察组糖尿病周围神经病变患者治疗后正中神经、尺神经的MNCV、SNCV均快于对照组,临床总有效率高于对照组,P<0.05;两组的不良反应发生率进行比较差异无统计学意义,P>0.05。结论中西医联合治疗糖尿病周围神经病变患者具有较高的有效性和安全性。