Adjuvant chemotherapy for isolated resectable colorectal lung metastasis: A retrospective study using inverse probability treatment weighting propensity analysis

BACKGROUND The benefit of adjuvant chemotherapy(ACT)for patients with no evidence of disease after pulmonary metastasis resection(PM)from colorectal cancer(CRC)remains controversial.AIM To assess the efficacy of ACT in patients after PM resection for CRC.METHODS This study included 96 patients who underwent pulmonary metastasectomy for CRC at a single institution between April 2008 and July 2023.The primary end-point was overall survival(OS);secondary endpoints included cancer-specific survival(CSS)and disease-free survival(DFS).An inverse probability of treat-ment-weighting(IPTW)analysis was conducted to address indication bias.Sur-vival outcomes compared using Kaplan-Meier curves,log-rank test,Cox regre-ssion and confirmed by propensity score-matching(PSM).RESULTS With a median follow-up of 27.5 months(range,18.3-50.4 months),the 5-year OS,CSS and DFS were 72.0%,74.4%and 51.3%,respectively.ACT had no significant effect on OS after PM resection from CRC[original cohort:P=0.08;IPTW:P=0.15].No differences were observed for CSS(P=0.12)and DFS(P=0.68)between the ACT and non-ACT groups.Multivariate analysis showed no association of ACT with better survival,while sublobar resection(HR=0.45;95%CI:0.20-1.00,P=0.049)and longer disease-free interval(HR=0.45;95%CI:0.20-0.98,P=0.044)were associated with improved survival.CONCLUSION ACT does not improve survival after PM resection for CRC.Further well-designed randomized controlled trials are needed to determine the optimal ACT regimen and duration.

Effectiveness of antibiotic prophylaxis for acute esophageal variceal bleeding in patients with band ligation: A large observational study

BACKGROUND Esophageal variceal bleeding is a severe complication associated with liver cirrhosis and typically necessitates endoscopic hemostasis.The current standard treatment is endoscopic variceal ligation(EVL),and Western guidelines recom-mend antibiotic prophylaxis following hemostasis.However,given the impro-vements in prognosis for variceal bleeding due to advancements in the management of bleeding and treatments of liver cirrhosis and the global concerns regarding the emergence of multidrug-resistant bacteria,there is a need to reassess the use of routine antibiotic prophylaxis after hemostasis.AIM To evaluate the effectiveness of antibiotic prophylaxis in patients treated for EVL.METHODS We conducted a 13-year observational study using the Tokushukai medical database across 46 hospitals.Patients were divided into the prophylaxis group(received antibiotics on admission or the next day)and the non-prophylaxis group(did not receive antibiotics within one day of admission).The primary outcome was composed of 6-wk mortality,4-wk rebleeding,and 4-wk spontaneous bacterial peritonitis(SBP).The secondary outcomes were each individual result and in-hospital mortality.A logistic regression with inverse probability of treatment weighting was used.A subgroup analysis was conducted based on the Child-Pugh classification to determine its influence on the primary outcome measures,while sensitivity analyses for antibiotic type and duration were also performed.RESULTS Among 980 patients,790 were included(prophylaxis:232,non-prophylaxis:558).Most patients were males under the age of 65 years with a median Child-Pugh score of 8.The composite primary outcomes occurred in 11.2%of patients in the prophylaxis group and 9.5%in the non-prophylaxis group.No significant differences in outcomes were observed between the groups(adjusted odds ratio,1.11;95%confidence interval,0.61-1.99;P=0.74).Individual outcomes such as 6-wk mortality,4-wk rebleeding,4-wk onset of SBP,and in-hospital mortality were not significantly different between the groups.The primary outcome did not differ between the Child-Pugh subgroups.Similar results were observed in the sensitivity analyses.CONCLUSION No significant benefit to antibiotic prophylaxis for esophageal variceal bleeding treated with EVL was detected in this study.Global reassessment of routine antibiotic prophylaxis is imperative.

Non-Relativistic Treatment of a Generalized Inverse Quadratic Yukawa Potential

A bound state solution is a quantum state solution of a particle subjected to a potential such that the particle＇s energy is less than the potential at both negative and positive infinity. The particle＇s energy may also be negative as the potential approaches zero at infinity. It is characterized by the discretized eigenvalues and eigenfunctions, which contain all the necessary information regarding the quantum systems under consideration. The bound state problems need to be extended using a more precise method and approximation scheme. This study focuses on the non-relativistic bound state solutions to the generalized inverse quadratic Yukawa potential. The expression for the non-relativistic energy eigenvalues and radial eigenfunctions are derived using proper quantization rule and formula method, respectively. The results reveal that both the ground and first excited energy eigenvalues depend largely on the angular momentum numbers, screening parameters, reduced mass, and the potential depth. The energy eigenvalues, angular momentum numbers, screening parameters, reduced mass, and the potential depth or potential coupling strength determine the nature of bound state of quantum particles. The explored model is also suitable for explaining both the bound and continuum states of quantum systems.

Predicting portal venous anomalies by left-sided gallbladder or rightsided ligamentum teres hepatis: A large scale, propensity scorematched study

BACKGROUND Right-sided ligamentum teres(RSLT)is often associated with portal venous anomalies(PVA)and is regarded as a concerning feature for hepatobiliary intervention.Most studies consider RSLT to be one of the causes of left-sided gallbladder(LGB),leading to the hypothesis that LGB must always be present with RSLT.However,some cases have shown that right-sided gallbladder(RGB)can also be present in livers with RSLT.AIM To highlight the rare variation that RSLT may not come with LGB and to determine whether ligamentum teres(LT)or gallbladder location is reliable to predict PVA.METHODS This study retrospectively assessed 8552 contrast-enhanced abdominal computed tomography examinations from 2018 to 2021[4483 men,4069 women;mean age,59.5±16.2(SD)years].We defined the surrogate outcome as major PVAs.The cases were divided into 4 subgroups according to gallbladder and LT locations.On one hand,we analyzed PVA prevalence by LT locations using gallbladder location as a controlled variable(n=36).On the other hand,we controlled LT location and computed PVA prevalence by gallbladder locations(n=34).Finally,we investigated LT location as an independent factor of PVA by using propensity score matching(PSM)and inverse probability of treatment weighting(IPTW).RESULTS We found 9 cases of RSLT present with RGB.Among the LGB cases,RSLT is associated with significantly higher PVA prevalence than typical LT[80.0%vs 18.2%,P=0.001;OR=18,95%confidence interval(CI):2.92-110.96].When RSLT is present,we found no statistically significant difference in PVA prevalence for RGB and LGB cases(88.9%vs 80.0%,P>0.99).Both PSM and IPTW yielded balanced cohorts in demographics and gallbladder locations.The RSLT group had a significantly higher PVA prevalence after adjusted by PSM(77.3%vs 4.5%,P<0.001;OR=16.27,95%CI:2.25-117.53)and IPTW(82.5%vs 4.7%,P<0.001).CONCLUSION RSLT doesn't consistently coexist with LGB.RSLT can predict PVA independently while the gallbladder location does not serve as a sufficient predictor.

Is ypTNM staging a comparable predictor as pTNM staging for survival in non-metastatic rectal cancer after preoperative chemoradiation therapy?

Abstract:Background:The pTNM staging system is widely recognized as the most effective prognostic indicator for cancer.The latest update of this staging system introduced a new pathological staging system(ypTNM)for patients receiving neoadjuvant chemoradiotherapy(NACRT).However,whether the prognostic value of the ypTNM staging system for rectal cancer is similar to that of the pTNM staging system remains unclear.This study was conducted to compare the ypTNM and pTNM staging systems in terms of their prognostic value for patients with nonmetastatic rectal cancer undergoing proctectomy.Material and Methods:This study was conducted at a large teaching hospital.Between January 2014 and December 2022,542 patients with rectal cancer were analyzed(median follow-up period,60 months;range,6–105 months).Of them,258 and 284 were included in the pTNM and ypTNM groups,respectively.Inverse probability of treatment weighting(IPTW)was performed to account for the effects of confounders.Cox proportional-hazards regression was performed for the between-group comparison of overall survival(OS).Results:The crude model revealed that OS was similar between the two groups(p=0.607).After performing IPTW,we found that patients with the same ypTNM-and pTNM-classified stages had similar overall survival(hazard ratio=1.15;95%CI=0.76–1.73;p=0.5074).Conclusions:For patients with rectal cancer who have received preoperative NACRT,the prognostic value of ypTNM staging appears to be similar to that of pTNM staging,mostly because of the downstaging effect of neoadjuvant chemoradiotherapy。

An evaluation of treatments and survival rates for pancreatic adenocarcinoma through survival analysis with inverse probability of treatment weighting:a population-based study

Objective:This study conducted inverse probability of treatment weighting(IPTW)survival analysis to examine survival in pancreatic adenocarcinoma patients.Methods:In this population-based study,data from the Surveillance,Epidemiology,and End Results program of the United States were analyzed to identify patients diagnosed with adenocarcinoma of the pancreas 2004 to 2014.Differences in survival rates were examined among patients who underwent pancreatectomy alone,radiotherapy alone,and those who had pancreatectomy plus adjuvant radiotherapy.Kaplan-Meier estimates and Cox proportional hazards models with the IPTW were performed to determine the effect of different treatments on overall and cancer-specific survival.This study was approved by the Ethics Review Board of Weifang Medical University.Results:A total of 8191 patients were included,with 3409 taking pancreatectomy only,2865 taking radiotherapy only,and 1917 taking pancreatectomy plus adjuvant radiotherapy.Patients who received surgery plus adjuvant radiotherapy had statistically a higher survival rate than those who received the other 2 treatments.Survival analysis with the IPTW for the 3 different groups showed that the difference in median overall survival time among these patient groups was significant.Conclusion:Using IPTW survival analysis,the present study shows that surgery with adjuvant radiotherapy is significantly associated with improved overall and cancer-specific survival among patients with pancreatic adenocarcinoma.

Association of food intake with a risk of metabolic dysfunction-associated fatty liver disease:a cross-sectional study

Background:Metabolic dysfunction-associated fatty liver disease(MAFLD)is a common liver disease,the risk of which can be increased by poor diet.The objective of this study was to evaluate the associations between food items and MAFLD,and to propose reasonable dietary recommendations for the prevention of MAFLD.Methods:Physical examination data were collected from April 2015 through August 2017 at Nanping First Hospital(n=3,563).Dietary intakes were assessed using a semi-quantitative food frequency questionnaire.The association between food intake and the risk of MAFLD was assessed by using the inverse probability weighted propensity score.Results:Beverages(soft drinks and sugar-sweetened beverages)and instant noodles were positively associated with MAFLD risk,adjusting for smoking,drinking,tea intake,and weekly hours of physical activity[adjusted odds ratio(ORadjusted):1.568;P=0.044;ORadjusted:4.363;P=0.001].Milk,tubers,and vegetables were negatively associated with MAFLD risk(ORadjusted:0.912;P=0.002;ORadjusted:0.633;P=0.007;ORadjusted:0.962;P=0.028).In subgroup analysis,the results showed that women[odds ratio(OR):0.341,95%confidence interval(CI):0.172–0.676]had a significantly lower risk of MAFLD through consuming more tubers than men(OR:0.732,95%CI:0.564–0.951).Conclusions:These findings suggest that reducing consumption of beverages(soft drinks and sugar-sweetened beverages)and instant noodles,and consuming more milk,vegetables,and tubers may reduce the risk of MAFLD.