Palliative treatment for incurable malignant colorectal obstructions: A meta-analysis

AIM:To perform a meta-analysis of palliative stent placement vs palliative surgical decompression for management of incurable malignant colorectal obstructions.METHODS:The databases of Medline,Web of Science,Embase,and the Cochrane Central Register of Controlled Trials were searched from their inception to July 2012 for studies(prospective,retrospective,randomized controlled trials,and case-control trials)designed as comparative analyses of patients with incurable malignant colorectal obstructions treated by selfexpanding metallic stents(SEMS)or palliative surgery.No language restrictions were imposed.The main outcome measures were hospital stay,intensive care unit admission,clinical success rate,30-d mortality,stoma formation,complications,and overall survival time.The data extraction was conducted by two investigators working independently and using a standardized form.The Mantel-Haenszel 2method was used to estimate the pooled risk ratios with 95%CI under a fixed-effects model;when statistical heterogeneity existed in the pooled data(as evaluated by Q test and I2statistics,where P<0.10 and I2<25%indicated heterogeneity),a random-effects model was used.RESULTS:Thirteen relevant articles,representing837 patients(SEMS group,n=404;surgery group,n=433),were selected for analysis.Compared to the surgery group,the SEMS group showed lower clinical success(99.8%vs 93.1%,P=0.0009)but shorter durations of hospital stay(18.84 d vs 9.55 d,P<0.00001)and time to initiation of chemotherapy(33.36 d vs15.53 d,P<0.00001),and lower rate of stoma formation(54.0%vs 12.7%,P<0.00001).Additionally,the SEMS group experienced a significantly lower rate of30-d mortality(4.2%vs 10.5%,P=0.01).Stent-related complications were not uncommon and included perforation(10.1%),migration(9.2%),and occlusion(18.3%).Surgery-related complications were slightly less common and included wound infection(5.0%)and anastomotic leak(4.7%).The rate of total complications was similar between these two groups(SEMS:34.0%vs surgery:38.1%,P=0.60),but the surgeryrelated complications occurred earlier than stent-related complications(rate of early complications:33.7%vs13.7%,P=0.03;rate of late complications:32.3%vs12.7%,P<0.0001).The overall survival time of SEMSand surgery-treated patients was not significantly different(7.64 mo vs 7.88 mo).CONCLUSION:SEMS is less effective than surgery for palliation of incurable malignant colorectal obstructions,but is associated with a shorter time to chemotherapy and lower 30-d mortality.

Female Genital Fistula Deemed Incurable in a National Obstetric Fistula Reference Center in Niger

Introduction Female genital fistula remains a global concern especially in incoming countries. The majority of cases resulted from obstructed delivery labor. The treatment is by surgery exceptional by probe for very small cases. But some ones remain incurable after several surgery theaters. The objective of this study is to establish the epidemiology anatomopathological types and prognosis of FGF considered being incurable in our center. Methods This is a retrospective and prospective descriptive study from January 2, 2017 to July 14, 2021 on incurable cases of female genital fistula recorded at the Centre National de Réparation de Fistule Obstétricale (CNRFO) of Niamey for complex cases of fgf. The epidemiology, the lesions of vagina, uretra, bladder, the treatment and prognosis have been studied. Results A total of 522 cases were operated within 5 cases given incurable (0.95%). The 5 cases were 37 - 49 years old, they had fistula at their first delivery, the mean age of the fistula was around 9 years. The anatomopathological founds were vaginal severe sclerosis, extensive supra-trigonal fistula, total ureteral destruction, and partial bladder destruction. All the 5 patients treated by surgery were declared incurable. Conclusion Female genital fistula is not life-threatening but a major definitive handicap for theses prim parous. The treatment fail is linked with local lesions, continuous urine and fecal incontinency, added by iterative surgery. They remain judged incurable whether a surgery was by skilled practitioner.

Strengthening life expectancy in incurable patients based on the philosophical foundations of Sheikh Shahab al-Din Suhrawardi

-Physical diseases,especially incurable diseases,are one of the most important problems of human beings in the world.Suffering from these types of diseases,in addition to t h e sick person,affects many people around them and their families.On the other hand,some sciences,such as philosophy,have dealt with various parts of human life.Some of the deep intellectual foundations in this science can help reduce the suffering caused by physical illnesses,especially those nearing the end of life.For this reason,it is important examine the intellectual foundations of some philosophical thinkers.The present study is a problem-oriented and descriptive-analytical method to reduce the suffering caused by physical diseases with the focus on the thoughts of Sheikh Shahabuddin Suhrawardi.The findings of this study indicate the existence of appropriate principles to reduce the suffering of physical illnesses,especially incurable diseases.

Rotationplasty type BIIIb as an effective alternative to limb salvage procedure in adults:Two case reports

BACKGROUND Rotationplasty is often performed for malignant tumors,but type BIIIb rotationplasty is rarely reported,and there needs to be more evidence of the procedure and treatment.The purpose of this case study was to report a new direction in the use of type BIIIb rotationplasty in treating patients with limb salvage and longterm non-healing infections.CASE SUMMARY Case 1:A 47-year-old man underwent radiotherapy for hemangioendothelioma in his left thigh,resulting in a femoral fracture.Despite the use of plates,intramedullary nailing,and external fixators,the femoral bone failed to unite due to infectious nonunion.Multiple operations were unable to control the infection,leaving the patient immobile.We performed a modified tibia-pelvic-constrained hip rotationplasty,utilizing a constrained prosthetic hip between the tibia and pelvis following a femur resection.Two years post-surgery,the patient was able to walk with the prosthetic device without any signs of recurring infection.The corresponding functional scores were 72 points for the Musculoskeletal Tumor Society(MSTS),53 for the Functional Mobility Assessment(FMA),93 for the Toronto Extremity Salvage Score(TESS),and 56 for the MOS 36-item short form health survey(SF-36).Case 2:A 59-year-old woman presented with liposarcoma in her left thigh.Magnetic resonance imaging revealed tumors in the medial,anterior,and posterior femur muscles,encircling the femoral vessels and nerves.Fortunately,there were no symptoms of sciatic dysfunction,and the tumor had not invaded the sciatic nucleus.After one year of follow-up,the patient expressed satisfaction with limb preservation post-type BIIIb rotationplasty.The corresponding functional scores were 63 points for the MSTS,47 for the FMA,88 for the TESS,and 52 for the SF-36.CONCLUSION Our study suggests that type BIIIb rotationplasty may be an alternative to amputation in patients with incurable infections.For malignant tumors of the lower extremities without invasion of the sciatic nerve,type BIIIb rotationplasty remains an excellent alternative to amputation.This surgical method may prevent amputation,improve functional outcomes,and facilitate biological reconstruction.

Evaluation of the etiologies and rehabilitation status of patients with blindness: A prospective observational study

Objective:Preventive measures and appropriate rehabilitation are important in reducing the social burden of blindness.This study was to evaluate the etiologies,proportions,and level of rehabilitation for patients with blindness.Materials and Methods:A prospective observational study with 1000 visually impaired patients was conducted.The data regarding age,gender,socioeconomic status(SES),etiologies,curable or incurable blindness(IB),treatments,awareness,and state of rehabilitation were collected and reviewed.Results:The ratio of curable to IB was 0.82:1.The proportion of blindness rises after 40,even while the proportion of curable blindness(CB)increases after 60.The male–female ratios were 1.25:1 and 1:1.66 in the cases of CB and IB,respectively.On the other hand,the male–female ratio for childhood blindness was 1.66:1.Cataracts(78.22%)were the most common cause of CB,whereas diabetic retinopathy(24%),corneal opacity(17.5%),and trauma(12.4%)were causes of IB.Patients with illiteracy,low SES,and female gender were more likely to develop IB.There were low enrollment rates at the blind school and poor rehabilitation,mainly because of a lack of knowledge.Conclusion:Diabetic retinopathy,corneal opacity,and trauma are the major causes of IB.IB and poor rehabilitation were more profound in women and were associated with illiteracy,low SES,and a lack of awareness.

Determination of mycophenolic acid in human plasma by ultra performance liquid chromatography tandem mass spectrometry

A simple, sensitive and high throughput ultra performance liquid chromatography tandem mass spectrometry method has been developed for the determination of mycophenolic acid in human plasma. The method involved simple protein precipitation of MPA along with its deuterated analog as an internal standard （IS） from 50 mL of human plasma. The chromatographic analysis was done on Acquity UPLC C18 （100mm×2.1mm,1.7μm） column under isocratic conditions using acetonitrile and 10 mM ammonium formate, pH 3.00 （75：25, v/v） as the mobile phase. A triple quadrupole mass spectrometer operating in the positive ionization mode was used for quantitation. In-source conversion of mycophenolic glucuronide metabolite to the parent drug was selectively controlled by suitable optimization of cone voltage, cone gas flow and desolvation temperature. The method was validated over a wide concentration range of 15-15000 ng/mL. The mean extraction recovery for the analyte and IS was 〉95%. Matrix effect expressed as matrix factors ranged from 0.97 to 1.02. The method was successfully applied to support a bioequivalence study of 500 mg mycophenolate mofetil tablet in 72 healthy subjects.

Claim reserving for insurance contracts in line with the International Financial Reporting Standards 17:a new paid‑incurred chain approach to risk adjustments

This study considers the risk management of insurance policies in line with the implementation of the new International Financial Reporting Standards 17.It applies the paid-incurred chain method to model the future unpaid losses by combining the information channels of both the incurred claims and paid losses.We propose the recovery of the empirical distribution of the outstanding claims liabilities associated with a group of contracts via moment-based density approximation.We determine the risk measures and adjustments that are compliant with the new standard using the Monte–Carlo simulation method and approximated distributions.The historical data on the aggregate Ontario automobile insurance claims over a 15-year period are analyzed to examine the appropriateness and accuracy of our approach.

Searching Clue of the Relationship between the Alteration of Bioactive Ingredients and the Herbal “Property” Transformation from Raw Rehmanniae Radix (<i>Sheng-Di-Huang</i>) to Steam-Heating-Processed Rehmanniae Radix (<i>Shu-Di-Huang</i>) by Chromatographic Fingerprint Analysis

“Di-Huang” (Rehmanniae Radix) is a peculiar Chinese herbal drug, the fresh root named “Xian-Di-Huang” (“Xian” means fresh;the commerce is now rarely available), mild-baking-dried raw roots “Sheng-Di-Huang” (“Sheng” means raw) and steam-processed “Shu-Di-Huang” (“Shu” implies steam-processed). The both kinds of herbal drug exert different efficiencies with different property according to the traditional clinical theory. It would be of interest that searching the clue of why the therapeutic functions of the same drug differ between the pre- and post-processing. To disclose the comprehensive alteration of the iridoids, saccharides and phenylethanoids occurred between the raw and steam-processed “Di-Huang”, the HPTLC and HPLC chromatographic fingerprint analysis has been carried out. The results showed that in the raw crude drug, the iridoids like catalpol is the major bioactive components, and the oligosaccharides composition kept rather consistent;however, in the steam-processed Di-Huang, iridoids was almost disappeared and the oligosaccharides were hydrolyzed gradually through the repeated steam-heating process. The worst case showed only fructose was detected with other minor residual components in the root tuber. It is due to presumably the uncontrollable steaming process in folk workshops. Defining reasonably the boundary between the “Sheng-Di-Huang” (mild-baking-dried Rehmanniae radix) and “Shu-Di-Huang” (steaming processed Rehmanniae radix) set up by chromatographic fingerprint pattern and standardizing the process would be necessary for assuring the consistent quality of the commercial herbal drugs.

Development and validation of an HPLC-UV method for routine trough plasma concentration monitoring of imatinib in Chinese patients with gastrointestinal stromal tumor

Imatinib is the first-line medication for the treatment of advanced gastrointestinal stromal tumor(GIST). Due to the large inter-individual variability, it is recommended to monitor the trough plasma concentration of imatinib to ensure the efficacy and safety of imatinib therapy. In the present study, an HPLC-UV method was developed and validated for quantitating imatinib in the plasma of Chinese GIST patients. The samples were processed by protein precipitation and then mixed with a neutralizing agent(1.4 gK2CO3 and 0.65g KCl dissolved in 5mL ultrapure water). The chromatographic separation was performed on an Inert Sustain C18 column(250 mm×4.6 mm, 5 μM) maintained at 40 ℃ utilizing the mobile phase consisted of 25 m MNH4H2PO4(pH 8.0)–acetonitrile(61:39, v/v) at a flow rate of 1 m L/min, with an ultraviolet detector set at 265 nm. The method was fully validated according to the published guidelines. The plotted calibration curves were all linear within the range of 50 to 10 000 ng/m L. The validation results of the intra-day and inter-day accuracies and precisions ranged from –5.81% to 6.33%. The extraction recoveries were within the range of 92.38% to 97.86%. All the results of stability studies were all consistent with the acceptance criteria of within ±15%. Finally, the method was successfully applied to trough plasma concentration monitoring of imatinib in 150 Chinese GIST patients orally administrated with imatinib. Incurred sample reanalysis was conducted, results of which were also in accordance with the acceptance criteria of within ±20%.

LC-MS/MS assay for olanzapine in human plasma and its application to a bioequivalence study

This paper describes a selective and sensitive assay for the determination of olanzapine(OLZ)in human plasma based on liquid chromatography-tandem mass spectrometry(LC-MS/MS).The analyte and quetiapine as internal standard(IS)were extracted from 200μL plasma via solid phase extraction on Waters Oasis HLB cartridges.Chromatographic separation was achieved on an ACE 5C18-300 column(100 mm × 4.6 mm,5μm)under isocratic conditions in a run time of 3.5 min.Mass spectrometric detection involved electrospray ionization in the positive ion mode followed by multiple reaction monitoring(MRM)of the transitions at m/z 313/256 for OLZ and m/z 384/253 for the IS.The assay was linear in the range 0.10-40.0 ng/mL with a lower limit of quantitation and limit of detection of 0.10 and 0.012 ng/mL,respectively.Intra-and inter-day precision(as coefficient of variation)and relative recovery were<5.0% and>90%,respectively.The method was succesfully applied to a bioequivalence study of 5 and 10 mg OLZ disintegrating tablets in 40 healthy Indian males with reproducibility by incurred sample reanalysis in the range-7.43 to 8.07%.