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Kevin Kyung Ho Choi Santosh Sanagapalli 《World journal of gastrointestinal oncology》2022,14(3):568-586
Barrett's esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC). Progression to cancer typically occurs in a stepwise fashion through worsening dysplasia and ultimately, invasive neoplasia. Established EAC with deep involvement of the esophageal wall and/or metastatic disease is invariably associated with poor long-term survival rates. This guides the rationale of surveillance of Barrett’s in an attempt to treat lesions at an earlier, and potentially curative stage. The last two decades have seen a paradigm shift in management of Barrett’s with rapid expansion in the role of endoscopic eradication therapy (EET) for management of dysplastic and early neoplastic BE, and there have been substantial changes to international consensus guidelines for management of early BE based on evolving evidence. This review aims to assist the physician in the therapeutic decision-making process with patients by comprehensive review and summary of literature surrounding natural history of Barrett’s by histological stage, and the effectiveness of interventions in attenuating the risk posed by its natural history. Key findings were as follows. Non-dysplastic Barrett’s is associated with extremely low risk of progression, and interventions cannot be justified. The annual risk of cancer progression in low grade dysplasia is between 1%-3%; EET can be offered though evidence for its benefit remains confined to highly select settings. High-grade dysplasia progresses to cancer in 5%-10% per year; EET is similarly effective to and less morbid than surgery and should be routinely performed for this indication. Risk of nodal metastases in intramucosal cancer is 2%-4%, which is comparable to operative mortality rate, so EET is usually preferred. Submucosal cancer is associated with nodal metastases in 14%-41% hence surgery remains standard of care, except for select situations. 相似文献
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Dong Kyu Kim Joon Ho Kwon Heung Kyu Ko Junhyung Lee Kichang Han Gyoung Min Kim Man-Deuk Kim Jong Yun Won Hyun-Chel Joo Young-Guk Ko Do Yun Lee 《Journal of vascular and interventional radiology : JVIR》2021,32(1):39-48
PurposeTo evaluate the feasibility, safety, and effectiveness of N-butyl cyanoacrylate (NBCA) embolization for the treatment of aortic dissection.Materials and MethodsIn this single-center retrospective study conducted from February 2003 to June 2019, NBCA embolization of an aortic false lumen was attempted in 12 patients (median age, 59 y; range, 41–68 y) and thoracic endovascular aortic repair (TEVAR) was performed in 53 patients (median age, 59 y; range, 37–70 y) for aortic dissection with one or more indications of persisting pain, malperfusion, rupture or impending rupture, maximal aortic diameter ≥ 55 mm, and/or rapid aortic enlargement. The main exclusion criterion for embolization was the presence of fast blood flow in the aortic false lumen on aortography. The efficacy of NBCA embolization and TEVAR was compared by evaluating technical and clinical outcomes, repeat intervention–free survival (RFS), and overall survival (OS).ResultsTechnical success was achieved in 11 of the 12 patients treated with NBCA embolization (91.7%), and clinical success was achieved in 9 of these 11 (81.8%). No significant difference was found between embolization and TEVAR in clinical success rates (embolization, 81.8%; TEVAR, 84.9%; P = .409) or procedure-related complications (embolization, 1 patient [8.3%]; TEVAR, 4 patients [7.5%]; P = .701). In addition, embolization showed comparable 5-y RFS (embolization, 82.5% ± 9.3; TEVAR, 85.5% ± 4.8; P = .641) and 5-y OS (embolization, 100%; TEVAR, 95.4% ± 3.2; P = .744) rates to TEVAR.ConclusionsNBCA embolization of the false lumen in aortic dissection seems to be a safe and effective treatment modality for the closure of false lumen in selected patients. 相似文献
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Richard Huynh Deborah Du Jun Ho Im Jessica Zachar Sobia Zafar 《International dental journal》2022,72(3):308-314
ObjectivesThe aim of this study was to retrospectively examine trends in percutaneous exposure incidences (PEIs) at the School of Dentistry (SoD) from 2009 to 2019 and to report on the underreporting rate of PEIs, current attitudes, and awareness of PEI safety protocols from clinical staff and students at the SoD in 2019.MethodsRetrospective data were collected from deidentified archival incident reports from 2009 to 2019 from the SoD's incident reporting system (UQSafe and Legacy Database). Additionally, cross-sectional data were collected via the validated Percutaneous Exposure Incident Questionnaires (PEIQ) completed by clinical staff and students of the SoD in 2019.ResultsFrom the archival data, the majority (79.9%) of the 618 reported PEIs involved students. Local anaesthetic-related procedures were the most common cause in the archival (31.5%) and survey data (23.7%), whereas the needle-prick was the most common causative instrument in both data sets. Additionally, the finger was the most common site of injury found in the archival (53.0%) and survey data (52.8%). From 345 responses to the survey, 42.1% of PEIs sustained were not reported.ConclusionsStudents were at a higher risk of sustaining a PEI than staff members between 2009 and 2019. The reported knowledge on PEI classification and preventative measures is inadequate, suggesting that further PEI education is necessary. The study provides evidence of the trends in PEIs as well as data on the attitudes and awareness of student and staff at a dental teaching faculty to support the development of PEI safety management protocols. 相似文献
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Caryn Wujanto Jeremy Tey David Chia Francis Ho Kiat Huat Ooi Alvin S. Wong Yu Yang Soon Keith Lim 《Journal of Geriatric Oncology》2019,10(2):292-297
Background
Muscle invasive bladder cancer (MIBC) is prevalent in the older patients, who are a vulnerable population with multiple co-morbidities and at increased risk of complications. Radical cystectomy is often not suitable, hence radical radiotherapy (RT) is an alternative option. We reviewed the outcomes of older patients treated with RT with or without concurrent chemotherapy (CRT) at our institution.Methods
We retrospectively reviewed patients aged 65?years and above treated with radical RT for MIBC at our institution between March 2002 to January 2017. Data was collected from institutional medical records and RT databases. The primary outcome was 2- and 5-year overall survival (OS), recurrence free survival (RFS), and toxicities. Univariate cox proportional hazard regression models were performed to identify independent factors with significant impact on survival.Results
We identified 45 patients (34 males, 11 females) with a median age of 77?years (range 65–95). All patients received maximal transurethral resection of the bladder tumour prior to RT. Median dose of total RT was 64?Gy (range 50–69.8?Gy). Twenty one patients (47%) received CRT. Planned treatment was completed in 42 (93.3%) patients. Median follow-up was 31?months (range 1–147?months). The 2- and 5-year OS was 64% and 44%, respectively. The 2- and 5-year RFS was 68% and 49%, respectively. Median RFS was 34?months (range 8–121?months). Median OS was 56?months (range 18–100?months). Univariate analysis showed that performance status (0–1 vs. 2–3; HR 2.7, 95% CI 1.07–6.8, p?=?0.035) and International Society of Geriatric Oncology (SIOG) group (≤2 vs. >2; HR 3.23, 95% CI 1.12–8.64, p?=?0.019) were significantly associated with increased hazard for death. One patient (2%) had grade 3 cystitis.Conclusion
Radical RT is well tolerated in older patients with MIBC. We report outcomes similar to published data. Older patients should be considered for curative treatment despite their age. However, careful selection is warranted as frail patients (PS ≥2; SIOG >2) may benefit less. 相似文献8.
Anita Ho 《The Hastings Center report》2019,49(1):36-39
From predicting medical conditions to administering health behavior interventions, artificial intelligence technologies are being developed to enhance patient care and outcomes. However, as Mélanie Terrasse and coauthors caution in an article in this issue of the Hastings Center Report, an overreliance on virtual technologies may depersonalize medical interactions and erode therapeutic relationships. The increasing expectation that patients will be actively engaged in their own care, regardless of the patients’ desire, technological literacy, and economic means, may also violate patients’ autonomy and exacerbate access. Moreover, since AI design is both a technical and social process, algorithms may mirror human biases, calling into question the vision of AI technologies surpassing human judgment and avoiding prejudices in decision‐making. The best answer to these problems is to develop AI health technologies as part of a culture of health care quality improvement, responding to existing needs while being proactive about potential technical and ethical problems that can arise from the technologies’ design and implementation. 相似文献
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Won Kyung Cho Won Park Doo Ho Choi Yong Bae Kim Jin Ho Kim Su Ssan Kim Kyubo Kim Jin Hee Kim Sung Ja Ahn Sun Young Lee Jeongshim Lee Sang-Won Kim Jeanny Kwon Ki Jung Ahn 《Clinical breast cancer》2019,19(1):78-86