Predictors of aneurysm occlusion following treatment with the WEB device: systematic review and case series

The Woven EndoBridge (WEB) device is becoming increasingly popular for treatment of wide-neck aneurysms. As experience with this device grows, it is important to identify factors associated with occlusion following WEB treatment to guide decision making and screen patients at high risk for recurrence. The aim of this study was to identify factors associated with adequate aneurysm occlusion following WEB device treatment in the neurosurgical literature and in our case series. A systematic review of the present literature was conducted to identify studies related to the prediction of WEB device occlusion. In addition, a retrospective review of our institutional data for patients treated with the WEB device was performed. Demographics, aneurysm characteristics, procedural variables, and 6-month follow-up angiographic outcomes were recorded. Seven articles totaling 450 patients with 456 aneurysms fit our criteria. Factors in the literature associated with inadequate occlusion included larger size, increased neck width, partial intrasaccular thrombosis, irregular shape, and tobacco use. Our retrospective review identified 43 patients with 45 aneurysms. A total of 91.1% of our patients achieved adequate occlusion at a mean follow-up time of 7.32 months. Increasing degree of contrast stasis after WEB placement on the post-deployment angiogram was significantly associated with adequate occlusion on follow-up angiogram (p?=?0.005) and with Raymond-Roy classification (p?=?0.048), but not with retreatment (p?=?0.617). In our systematic review and case series totaling 450 patients with 456 aneurysms, contrast stasis on post-deployment angiogram was identified as a predictor of adequate aneurysm occlusion, while morphological characteristics such as larger size and wide neck negatively impact occlusion.

     

Gallbladder Polyps: What are the factors affecting the possibility of malignancy? A Single Center Experience

Hellenic Journal of Surgery - With the increasing use of imaging methods, there has been an increase in the number of patients diagnosed with gallbladder polyp. In patients undergoing...     

Prevalence of Smoke-Free Zone Compliance among Schools in Indonesia: A Nationwide Representative Survey

Background: With the increasing prevalence of teenage or school-age smokers, schools have become the main focus of the Indonesian government in tobacco control, including through the smoke-free zone (SFZ) policy. This study aims to obtain information related to the implementation of SFZ policies in schools. Methods: A nationally representative survey was employed in 900 elementary, junior high, and senior high schools that were located in 60 regions or 24 provinces of Indonesia. Each school’s compliance with SFZ parameters was measured using a closed-ended questionnaire. The dataset was analyzed using frequency distribution, while the chi-square was performed to analyze the measurement effect of each parameter for SFZ compliance. Results: Java Island is the region with the largest proportion of school units (10%) studied in this study, and the largest group of the schools are high schools (36.1%). In terms of SFZ compliance, 413 (45.9%) of schools had perfect compliance scores of 8, followed by 183 schools (20.3%) with a score of 7 and 107 (11.9%) with a score of 6. It was found that parameter 5, namely cigarette butts found in the school environment, had the largest proportion when a school did not apply SFZ. Cigarette butts were found in 261 (29.0%) schools. Cigarette butts found in schools contributed 7.8 times to not applying SFZ compared to schools where no cigarette cutters were found. Conclusion: Although the SFZ compliance rate in Indonesian schools is 66.2% at least on 7 of 8 existed parameters, this means most of schools still aren’t fully complying with the regulations for SFZs. This recent evidence will help decisionmakers to enforce tobacco control, particularly among youth, which form the pillar of national development.     

Does the efficacy of regorafenib differ in chemotherapy refractory metastatic colorectal cancer patients who had mucinous pathology compared to those who had non-mucinous pathology?

Purpose: To investigate the importance of mucinous histopathology on the assessment of tumor response in patients with metastatic colorectal cancer (mCRC) receiving regorafenib. Materials and method: All patients diagnosed with histologically confirmed mCRC in 2 oncology centers between 2013 and 2018 were retrospectively analyzed. Among 678 patients diagnosed with mCRC, 103 patients were treated with regorafenib. Ninety-four of these patients who had used at least 2 cycles of regorafenib and evaluable for treatment response were included in the analysis. Histopathologically, 18 patients with mucinous adenocarcinoma and 76 patients with nonmucinous adenocarcinoma were compared in terms of response rate and survival durations. Results: Median follow-up duration of 6 months, median age of the patients was 61 (34-77) years. While 19.1% of the patients had mucinous histology, 80.9% had nonmucinous histology. The overall response rate was significantly lower in the mucinous subgroup than the nonmucinous subgroup (5.6% vs 43.4%, respectively, P = 0.003). Similarly, both progression-free survival (3.0 vs 4.0 months, respectively, P = 0.011) and overall survival duration were shorter in the mucinous subgroup (3.0 vs 7.0 months, P = 0.016, respectively) compared with the nonmucinous subgroup. Conclusion: The histological subgroup may predict tumor response in mCRC patients receiving regorafenib. Its efficacy on nonmucinous histology had significantly more favorable than mucinous subtype.     

Real-world analysis of clinical and economic impact of 21-gene recurrence score (RS) testing in early-stage breast cancer (ESBC) in Ireland

Purpose

Results from TAILOR-X suggest that up to 70% of hormone receptor-positive (HR+) node-negative (N0) ESBC patients (pts) may avoid chemotherapy (CT) with RS?≤?25. We assess clinical and economic impacts of RS testing on treatment using real-world data.

Methods

From October 2011 to February 2019, a retrospective, cross-sectional observational study was conducted of HR+ N0 ESBC pts who had RS testing in Ireland. Pts were classified low risk (RS?≤?25) and high risk (RS?>?25). Clinical risk was calculated. Data were collected via electronic patient records. Cost data were supplied by the National Healthcare Pricing Regulatory Authority.

Results

963 pts. Mean age is 56 years. Mean tumour size is 1.7 cm. 114 (11.8%), 635 (66%), 211 (22%), 3 (0.2%) pts had G1, G2, G3 and unknown G, respectively. 796 pts (82.8%) low RS, 159 (16.5%) high RS and 8 pts (0.7%) unknown RS. 263 pts (26%) were aged?≤?50 at diagnosis; 117 (45%) had RS 0–15, 63 (24.5%) 16–20, 39 (15.3%) 21–25 and 40 (15.2%) RS 26–100. 4 pts (1.5%) had unknown RS. Post-RS testing, 602 pts (62.5%) had a change in CT decision; 593 changed to hormone therapy (HT) alone. In total, 262 pts received CT. Of pts receiving CT; 138 (53%) had RS?>?25, 124 (47%) had RS?≤?25. Of pts aged?≤?50, 153 (58%) had high clinical risk, of whom 28 had RS 16–20. Assay use achieved a 62.5% change in treatment with 73% of pts avoiding CT. This resulted in savings of €4 million in treatment costs. Deducting assay costs, savings of €1.9 million were achieved.

Conclusion

Over the 8 years of the study, a 62.5% reduction in CT use was achieved with savings of over €1,900,000.

     

Some serum acute phase proteins and immunoglobulins concentrations in calves with rotavirus,coronavirus, E. coli F5 and Eimeria species

The purpose of this study was to evaluate the changes in the serum concentrations of haptoglobin (Hp), serum amyloid A (SAA) and IgG, IgA in calves with diarrhea caused by rotavirus, coronavirus, Escherichia coli F5 and Eimeria species. The experiment was carried out on 40 diarrhoeic and 10 non-diarrhoeic calves (group C). A total of 13 calves were infected with rotavirus or coronavirus (group V), 12 calves with E. coli F5 (group B) and 15 calves with Eimeria species (group P). SAA and Hp levels of calves in groups V, B and P were statistically higher than group C (P<0.05). SAA and Hp levels of the group B and group P were significantly higher than the group V (P<0.05). SAA and Hp levels in group B were not significantly higher than the group P. The levels of IgG and IgA were found to be lower in groups B and V compared to other groups. There was a negative correlation between immunoglobulins and the levels of serum Hp and SAA in groups B and V (r=-0.315 and r=-0.369, respectively, P<0.05). Serum SAA, Hp, IgA and IgG levels could be useful for the diagnosis and differential diagnosis of diarrhea caused by rotavirus, coronavirus, E. coli F5 and Eimeria species.Key Words: Diarrhea, Serum amyloid A, Haptoglobin, IgA, Calves