Brachytherapy: An emblematic example of extreme hypofractionated regimen

In order to provide more convenient irradiation regimens for patient comfort, radiation facility organization and health expenses, new hypofractionated protocols have been evaluated. Moderately (dose/fraction: 2.3 to 3 Gy), then ultra (dose/fraction: 5.2 to 6.1 Gy) hypofractionated irradiations were first validated. The current question is: is it possible to go forward using extreme hypofractionated regimens (EHR) based on 1 to 3 fractions. Different irradiation techniques are under investigation. However, brachytherapy remains the smartest way to deliver a high dose in a small volume. We report prospective and retrospective study results which evaluated EHR for breast and prostate brachytherapy. While oncological outcome and toxicity profile appear extremely encouraging for low-risk breast cancer after a 1 to 4 fractions (6.25 to 20 Gy/fraction), the use of a single fraction of 19 to 23 Gy appears debatable for prostate cancer. Brachytherapy represents an emblematic example of EHR but longer follow-up and more mature results are awaited in order to specify the right indications and refine the EQD2 calculation method including new biological and technical factors.     

Inferior Vena Cava Filters: Aligning Practice With Evidence to Improve Patient Outcomes

BackgroundDespite indications for the removal of temporary inferior vena cava (IVC) filters, many filters are unintentionally left in place, predisposing patients to adverse outcomes.ObjectiveThis quality improvement study set out to determine the impact of an IVC filter retrieval protocol on filter retrieval rates and patients lost to follow-up for patients who had undergone placement of a temporary IVC filter.MethodsFollowing a quasi-experimental design, data of all consecutive patients who underwent insertion of a temporary IVC filter for a period of 24-month preprotocol and 12-month postprotocol were compared.ResultsFilter retrieval rates of eligible filters increased from 64.2% to 100%; patients lost to follow-up decreased from 35.9% to 0% (p < .01, both outcomes).ConclusionAdoption of a comprehensive IVC filter protocol by the service that implants these devices can improve filter retrieval rates and decrease patients being lost to follow-up.     

肝癌组织LncRNA TINCR表达水平对术后长期生存的影响

目的 探讨肝癌组织中LncRNA TINCR 表达水平对术后长期生存的影响。方法 回顾性分析2013 年4 月～2016 年2 月间在本院接受手术治疗的157 例肝细胞肝癌患者的临床资料。RT-PCR 法检测肝癌标本内LncRNA TINCR 表达水平，采用ROC 曲线和Kaplan-Meier 法分析LncRNA TINCR 表达水平对肝癌术后长期生存的影响。结果 肝癌组织LncRNA TINCR 表达水平对术后长期生存预测的曲线下面积（AUC）为0.812，特异度为73.77%，灵敏度为79.17%，最佳判读值为1.89（P＜0.0001）。根据ROC 曲线分析结果，将肝癌组织LncRNA TINCR 相对表达水平大于1.89 的93 例（59.24%）患者纳入高表达组，而肝癌组织LncRNA TINCR 相对表达水平小于或等于1.89的64 例（40.76%）患者纳入低表达组。Kaplan－Meier 法生存分析发现高表达组术后3 年内有76 例患者死亡，3 年总生存率为18.28%（17/93）；低表达组术后3 年内有20 例患者死亡，3 年总生存率为68.75%（44/64），低表达组3 年总生存率明显优于高表达组（P＜0.0001，两组间死亡风险比为3.7534，95%可信区间为2.5158～5.6000）。结论 肝癌组织LncRNA TINCR 表达水平与肝癌术后长期生存显著相关，LncRNA TINCR 表达水平升高则预示着预后不佳。     

Cementless Total Hip Arthroplasty for Adult Patients With Sequelae From Childhood Hip Infection: A Medium-Term Follow-Up Study

BackgroundThe aim of this study is to evaluate midterm clinical and radiographic results of total hip arthroplasties (THAs) with cementless implants for adult patients with sequelae from childhood hip infection.MethodsBetween 2002 and 2016, 165 patients (165 hips) who had a hip infection during childhood were treated with THAs with cementless implants. The average duration of follow-up was 93.5 months (range 26-206). Clinical results were evaluated via the Harris Hip Score and radiographic results were analyzed with postoperative serial X-rays.ResultsThe average Harris Hip Score increased from 27 (range 8-53) before surgery to 91 (range 45-100) at the latest follow-up examination (P < .001). At the latest follow-up evaluation, 9 cementless acetabular components demonstrated partial, nonprogressive radiolucencies. No subsidence of more than 2 mm or evidence of a radiolucent line was observed around the femoral components. Intraoperative periprosthetic fractures occurred in 11 hips, including 3 acetabular fractures, 2 fractures of greater trochanter, 1 femoral shaft fracture, and 5 fractures of femoral calcar. Postoperative complications included 3 cases of periprosthetic infection, 1 episode of dislocation, 1 case of a femoral periprosthetic fracture, 5 cases of sciatic nerve injury, 1 case of femoral nerve injury, and 1 case of squeaking from a ceramic bearing surface.ConclusionCementless THA for adult patients with sequelae from childhood hip infection presents significant technical challenges and a relatively high complication rate. With meticulous surgical planning and anticipation for the key technical challenges frequently encountered, the medium-term clinical and radiographic results of THA in this setting were good with high implant survivorship and patient satisfaction.     

Long-term skeletal stability in the treatment of mandibular prognathism with a physiological positioning strategy

Our aim was to evaluate the long-term skeletal stability of the mandible in 21 patients after orthognathic surgery with physiological positioning. The measurement points SNB, B point (X, Y), Pog (X, Y), and the angle of the ramus were measured on cephalometric photographs to assess skeletal stability preoperatively, immediately after operation, and one and two years postoperatively. In addition, we evaluated the clinical symptoms of disorders of the temporomandibular joint (TMJ). The analysis of the cephalometric photographs showed that SNB, B point X, and Pog X showed no significant differences among the postoperative time points. On the other hand, B point Y and Pog Y showed no significant differences throughout the study period. We compared the angle of the ramus before operation and two years postoperatively, and no significant difference was found. In addition, no cases showed any pathological symptoms of disorders of the TMJ two years postoperatively. The long-term stability after orthognathic surgery with physiological positioning was confirmed, and it seems to be a reliable orthognathic treatment in patients with mandibular prognathism.     

Manejo y seguimiento radiológico del paciente post-COVID-19

Most of the patients who overcome the SARS-CoV-2 infection do not present complications and do not require a specific follow-up, but a significant proportion (especially those with moderate / severe clinical forms of the disease) require clinicalradiological follow-up. Although there are hardly any references or clinical guidelines regarding the long-term follow-up of post-COVID-19 patients, radiological exams are being performed and monographic surveillance consultations are being set up in most of the hospitals to meet their needs. The purpose of this work is to share our experience in the management of the post-COVID-19 patient in two institutions thathave had a high incidence of COVID-19 and to propose general follow-uprecommendations from a clinical and radiological perspective.     

Clinical features of hepatocellular carcinoma that occur after sustained virological response to interferon for chronic hepatitis C

Background and Aim: This study investigated the clinical features of hepatocellular carcinoma in patients with sustained virological response to interferon for hepatitis C viral (HCV) infection. Methods: A total of 7715 patients with HCV infection were treated with interferon and followed up for more than 1 year after withdrawal of interferon in 64 Japanese hospitals and clinics between July 1988 and August 2001. Sustained virological response was obtained in 2515 (32.6%) patients. Of these 2515 patients, clinical data were collected for 38 patients in whom hepatocellular carcinoma developed. Sustained virological response was defined as HCV RNA negativity more than 6 months after the termination of interferon. Results: All patients were HCV RNA negative at the time of diagnosis of hepatocellular carcinoma. The median period until the detection of hepatocellular carcinoma was 4.7 years (range 1.4–9.0 years). There were significant improvements in hepatic function including serum albumin, aspartate aminotransferase, alanine aminotransferase, indocyanine green test, platelet count and histological activity grade in comparison with those before interferon therapy and at the onset of hepatocellular carcinoma. The maximum tumor size in patients without medical follow‐up for 1 year or more (median: 60 mm) was significantly larger than in patients who were periodically followed up for 6 months or less (median: 25 mm) (P = 0.002). Conclusions: The present findings emphasize the importance of regular medical follow up of patients with HCV infection, as even patients showing a sustained virological response to interferon and in whom hepatic function has improved have the potential to develop hepatocellular carcinoma.