An exploration of the relationship between wastewater viral signals and COVID-19 hospitalizations in Ottawa,Canada

Monitoring of viral signal in wastewater is considered a useful tool for monitoring the burden of COVID-19,especially during times of limited availability in testing.Studies have shown that COVID-19 hospitalizations are highly correlated with wastewater viral signals and the increases in wastewater viral signals can provide an early warning for increasing hospital admissions.The association is likely nonlinear and time-varying.This project employs a distributed lag nonlinear model(DLNM)(Gasparrini et al.,2010)to study the nonlinear exposure-response delayed association of the COVID-19 hospitalizations and SARS-CoV-2 wastewater viral signals using relevant data from Ottawa,Canada.We consider up to a 15-day time lag from the average of SARS-CoV N1 and N2 gene concen-trations to COVID-19 hospitalizations.The expected reduction in hospitalization is adjusted for vaccination efforts.A correlation analysis of the data verifies that COVID-19 hospital-izations are highly correlated with wastewater viral signals with a time-varying rela-tionship.Our DLNM based analysis yields a reasonable estimate of COVID-19 hospitalizations and enhances our understanding of the association of COVID-19 hospi-talizations with wastewater viral signals.

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

AIM: To assess if certain triaging rules could be established to optimize the yield of mesenteric angiography. METHODS: Medical records of 101 patients were retrospectively reviewed and parameters relating to age, gender, pulse rate, blood pressure, serum hemoglobin, intensive care unit(ICU) admission, and the number of packed red blood cells(PRBC) transfused in the 12 and 24 h prior to the angiography were tabulated in two groups with positive and negative angiography results. RESULTS: We found no correlation between gender, pulse rate, blood pressure or serum hemoglobin and positivity of the mesenteric angiogram. But patients with positive angiogram were found to be on average 7 years older(73.2 years vs 65.9 years old)(P = 0.02). Angiogram was positive in 39.3 %(11/28) of patientsadmitted in ICU vs 23.2%(17/73) who were admitted elsewhere in the hospital(P = 0.03). In the 12 and 24 h prior to angiography, patients with a positive angiogram received a mean of 2.7 ± 2.3 and 3.3 ± 2.6 units of PRBC s respectively, while patients with a negative angiogram had a mean of 1.6 ± 1.9(P = 0.02) and 2.1 ± 2.6 units(P = 0.04) received respectively in the same period. CONCLUSION: Older age, ICU admission, having received at least 4 units PRBC over 12 h or 5 units over 24 h prior to angiogram are leading indicators for a positive study.

Perceptions of the effectiveness of Advanced Practice Nurses on a neurosurgery unit in a Canadian Tertiary Care Centre:A pre-and-post implementation design

Objectives:A framework for the advanced practice nurse(APN)role was developed in our Canadian Tertiary Care Centre,delineating five domains of advanced nursing practice:clinical practice,consultation,research,education and leadership.The goal of this study was to evaluate perceptions of the effectiveness of the implementation of an innovative APN role on an in-patient Neurosurgery unit.Methods:A pre-and-post implementation design,incorporating both qualitative and quantitative data,was utilized.An innovative APN role was implemented within the Neurosurgery program focusing on the clinical domain and required the successful candidates to be NP prepared.This APN role was designed to improve patient flow,documentation,communication and patient and staff satisfaction.Three primary outcomes were measured:pre-implementation questionnaire(nurses),post-implementation questionnaire(nurses and residents)and number of pages to the on-call resident.Results:Survey scores by nurses and residents indicated improvement across all aspects studied.Average scores increased from 1.1 to 2.6,reflecting an overall statistically significant increase.The number of pages to the on-call resident also showed a decrease.Conclusion:Perceptions of patient care delivery and professional collaboration improved following implementation of the APN role.Responses indicated that APNs significantly impacted patient care and improved nurses and residents'job satisfaction.

Long term outcomes of cardiac transplant for immunoglobulin light chain amyloidosis:The Mayo Clinic experience

AIM: To determine the outcome of orthotopic heart transplantation(OHT) in immunoglobulin light chain(AL) amyloidosis.METHODS: The medical records of patients with AL who underwent orthotopic heart transplantation at the Mayo Clinic in Rochester Minnesota from 1992 to 2011 were reviewed. Patients met at least one of the following at: New York Heart Association class Ⅳ heart failure, ventricular thickness > 15 mm, ejection fraction < 40%. Selection guidelines for heart transplant included age < 60 years, absence of multiple myeloma and significant extra-cardiac organ involvement. Baseline characteristics including age, gender, organinvolvement, and New York Heart Association functional class were recorded. Laboratory data, waiting time until heart transplant, and type of treatment of the underlying plasma cell disorder were recorded. Survival from the time of OHT was calculated using KaplanMeier survival curves. Survival of patients undergoing OHT for AL was compared to that of non-amyloid patients undergoing OHT during the same time period.RESULTS: Twenty-three patients(median age 53 years) with AL received OHT. There were no deaths in the immediate perioperative period. Twenty patients have died post OHT. For the entire cohort, the median overall survival was 3.5 years(95%CI: 1.2, 8.2 years). The 1-year survival post OHT was 77%, the 2-year survival 65%, and the 5-year survival 43%. The 5-year survival for non-amyloid patients undergoing OHT during the same era was 85%. Progressive amyloidosis contributed to death in twelve patients. Of those without evidence of progressive amyloidosis, the cause of death included complications of autologous hematopoietic stem cell transplantation for 3 patients, post-transplant lymphoproliferative disorder for 2 patients; and for the remaining one death was related to each of the following causes: acute rejection; cardiac vasculopathy; metastatic melanoma; myelodysplastic syndrome; and unknown. Eight patients had rejection at a median of 1.8 mo post OHT(range 0.4 to 4.9 mo); only one patient died of rejection. Median survival of seven patients who achieved a complete hematologic response to either chemotherapy or autologous hematopoietic stem cell transplantation was 10.8 years. CONCLUSION: Our data demonstrate that long term survival after heart transplant is feasible in AL patients with limited extra-cardiac involvement who achieve complete hematologic response.

Predictors of Malignant Pathology and the Role of Trans-Thoracic Needle Biopsy in Management of Solitary Fibrous Tumors of the Pleura: A 30-Year Review of a Tertiary Care Center Patient Cohort

Background: Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms with unpredictable behavior. Lack of unifying criteria for benign or malignant SFTP has resulted in reports of SFTP exhibiting malignant behavior years after complete surgical resection (despite benign initial diagnosis). Additionally, the role of trans-thoracic needle biopsy in initial management of SFTP is unclear. Understanding predictors of malignancy identifies patients at unacceptably high risk for non-surgical primary therapy, and for recurrence despite complete surgical resection. Objectives: The primary objectives were to identify clinicopathological predictors of malignancy & recurrence in SFTP. The secondary aim was to determine the role of trans-thoracic needle biopsy in the management decision algorithm of SFTP. Methods: Retrospective chart review was conducted (Jan. 1983-Dec. 2013) at the Ottawa Hospital for pathologically confirmed SFTP. Data were collected on biopsy-related, clinical, histopathological & immunohistochemistry (IHC) variables. Appropriate tests of statistical inference were conducted for all variables. Results: Pathologically confirmed SFTP was identified in 26 cases. Transthoracic needle biopsy was conducted in 22 (84.6%);with 16 (72.7%) biopsies diagnostic of SFTP with IHC;3 (13.6%) being malignant. Primary management was surveillance in 3 and complete surgical resection in 23. Surgical pathology reported 15 (65.2%) benign and 8 (34.8%) malignant cases. Local recurrence occurred in 3 and distant recurrence in 1. Initial pathology was benign in 3 (75%) with recurrence. Clinicopathologic variables analyzed did not predict recurrent disease. IHC features did not differ between malignant & benign pathology significantly. Predictors of malignant pathology included: infiltrative cellular pattern (p = 0.042), nuclear crowding (p = 0.006), tumour necrosis (p 4 mitoses/ 10 high power field (p Conclusion: Because numerous variables analyzed did not predict recurrent disease, long-term follow-up is warranted regardless of benign or malignant initial histology. Histologic not IHC features predicted malignant pathology. Trans-thoracic needle biopsy did identify malignant SFTP;however its main use should be to differentiate SFTP from other pleural neoplasms using IHC.

Gender differences in the etiology of heart failure： A systematic review

背景心失败(HF ) 是为变老的人口的一个增加的问题，明确地在女人之中。HF 的病原学影响治疗的选择和结果。在不同研究在在病态和死亡的性之间有变化，可能思考的病原学。这研究的目的是在长期的心失败的病原学检验为性差别可得到的证据的力量。为在心失败的病原学的性差别的从 1980 ～ 2009 的方法帮助计算机的搜索被执行(Medline， EMBASE 和 PubMed ) 。从基于包括标准考察的 2347 篇摘要， 35 篇原来的文章为评论被选择。数据抽取基于观察研究(未来 / 回顾的队或十字部分) 与一个平均数列在后面在上面 3 个月。在数据抽取上的 2 个评论家之间没有 interrater 可变性。结果是更多与男性别联系了的室的收缩机能障碍，而是女性别是报导与保存左室的功能被联系的更多。Ischemic 病原学和联系的冠的心疾病强烈与男性别被相关。为 HF 的风险是戏剧性地，更多与收缩高血压为女人提高了，但是糖尿病 mellitus 的协会在男性和女性之间作为 HF 的病原学是有点相等的。在在心血管的疾病关于性差别得出结论的限制之一是许多主要临床的试用不包括性分析也不他们是动力的那么作为女人做的结论在大多数 HF 研究是未被充分代表的。需要基于性差别有或没有心失败和分析病原学和风险因素为男、女的病人的足够的数字的很好设计的未来的研究留下。

Diagnostic accuracy of thoracic imaging modalities for the detection of COVID-19

The ongoing coronavirus disease 2019(COVID-19)pandemic continues to present diagnostic challenges.The use of thoracic radiography has been studied as a method to improve the diagnostic accuracy of COVID-19.The‘Living’Cochrane Systematic Review on the diagnostic accuracy of imaging tests for COVID-19 is continuously updated as new information becomes available for study.In the most recent version,published in March 2021,a meta-analysis was done to determine the pooled sensitivity and specificity of chest X-ray(CXR)and lung ultrasound(LUS)for the diagnosis of COVID-19.CXR gave a sensitivity of 80.6%(95%CI:69.1-88.6)and a specificity of 71.5%(95%CI:59.8-80.8).LUS gave a sensitivity rate of 86.4%(95%CI:72.7-93.9)and specificity of 54.6%(95%CI:35.3-72.6).These results differed from the findings reported in the recent article in this journal where they cited the previous versions of the study in which a metaanalysis for CXR and LUS could not be performed.Additionally,the article states that COVID-19 could not be distinguished,using chest computed tomography(CT),from other respiratory diseases.However,the latest review version identifies chest CT as having a specificity of 80.0%(95%CI:74.9-84.3),which is much higher than the previous version which indicated a specificity of 61.1%(95%CI:42.3-77.1).Therefore,CXR,chest CT and LUS have the potential to be used in conjunction with other methods in the diagnosis of COVID-19.

Assessing Patient Outcomes after Palliative Radiotherapy Using IG-IMRT

Purpose: To assess clinical outcomes after using IG-IMRT for palliation among patients with advanced cancers. Methods: Patients with advanced and/or metastatic cancers were treated on our Tomo-PAL (Tomotherapy?-Planning and Administration Linked) protocol using helical TomoTherapy? and evaluated to assess clinical efficacy of treatment as well as to assess side effects. Results: A total of 40 patients were treated to 40 sites from Feb 2007 to May 2009. There were 25 men and 15 women with a median age of 70 years (range 16 - 94). Pain and bleeding were the most common symptoms being palliated (80% and 12.5% respectively). The dose prescribed ranged from 5 - 25 Gy in 1 - 5 fractions. A qualitative improvement in symptoms was documented in 82% of patients (75% partial relief and 7% complete relief) and major side effects were not encountered. Conclusions: IG-IMRT can be used for palliation and produces response rates that compare favourably with those reported in the published literature.

Role of Radiotherapy-Induced Malignancies in Patients with Both Breast and Lung Cancer Diagnoses

Background:Breast and lung cancer are two of the most commonly diagnosed cancers in North America. While patients are living longer with advances in treatment and supportive care, some patients are being diagnosed with a second malignancy. The primary objective in this study was to assess the correlation between the development of an ipsilateral lung cancer or breast cancer, and prior radiation therapy. In addition, we sought to report the survival outcomes of patients in these clinical scenarios. Methods: We conducted a single institution (the Ottawa Hospital Cancer Centre) retrospective review of patients with the diagnoses of both breast and lung cancer treated between 1995 and 2013. Patients were included if they received radiation for a breast primary, and subsequently developed an ipsilateral lung primary, or vice-versa. Data included patient demographics, lifestyle factors, tumor location and subtype, cancer stages, treatment modalities, and survival outcomes. Results: Of 252 patients included in the study, 217 patients developed a breast primary first, with 35 patients developing a lung primary first. Median disease-free survival from the second primary diagnosis was 36 months in breast primary first patients, and 59 months in the lung primary first cohort. There was no significant correlation between the laterality of radiation treatment and side of second primary based on Fisher’s exact test. Conclusions: Our data reveal no association between side of radiation treatment and subsequent cancer development. The benefits of radiotherapy outweigh the risk of radiation-induced primaries. Longer term studies with matched patient cohorts are required to further assess treatment and lifestyle factors that may contribute towards the development of second malignancies.

Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract

Congenital abnormalities of the kidney and urinary tract(CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis(bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number(agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography(US) is typically the first imaging performed as it is easily available, noninvasive and radiation free used both antenatally and postnatally. Computed tomography(CT) and magnetic resonance imaging(MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management.

Current management of cryptoglandular fistula-in-ano

Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of continence.Treatment options continue to evolve-as a result,it is important to review old and new options on a regular basis to ensure that our patients are provided with up to date information and options.This paper will briefly cover some of the traditional approaches that have been used as well as some newer promising procedures.

BRCA mutated pancreatic cancer:A change is coming

Pancreatic cancer remains a leading cause of cancer-related death with few available therapies for advanced disease.Recently,patients with germline BRCA mutations have received increased attention due to advances in the management of BRCA mutated ovarian and breast tumors.Germline BRCA mutations significantly increase risk of developing pancreatic cancer and can be found in up to 8%of patients with sporadic pancreatic cancer.In patients with germline BRCA mutations,platinum-based chemotherapies and poly(ADP-ribose)polymerase inhibitors are effective treatment options which may offer survival benefits.This review will focus on the molecular biology,epidemiology,and management of BRCA-mutated pancreatic cancer.Further-more,we will discuss future directions for this area of research and promising active areas of research.

Variability of Serum Concentration of Calcium, Phosphate and Parathyroid Hormone Depending on Time of Blood Draw for Patients on Nocturnal Home Hemodialysis

Background: Guidelines for patients treated with conventional hemodialysis patients have been written for target serum levels for calcium (Ca), phosphate (PO4) and intact parathyroid hormone (iPTH). No guidelines exist for nocturnal home hemodialysis (NHHD) patients for target values or timing of the blood sample draw. We undertook a prospective cohort study to examine the variability in pre, post and clinic (post-post) serum values for Ca, PO4, and iPTH in NHHD patients to determine if timing of blood draw could affect clinical decisions. Methods: Twenty prevalent NHHD patients collected blood pre and post their usual NHHD session with an additional blood sample drawn in clinic (post-post). Median and interquartile range of pre, post and clinic (post-post) values of iPTH, PO4 and Ca were calculated and compared with Freidman/Wilcoxon test. Serum concentrations were also categorized according to Canadian Society of Nephrology (CSN) guidelines target values for pre and clinic (post-post) samples. The proportion of patients that would be categorized differently by clinic (post-post) samples was determined. Results: There was a significant difference between pre-serum values compared to post and clinic (post-post) values. Overall, iPTH, PO4 and Ca values would be misclassified in 25%, 70% and 50% respectively if blood was drawn at the clinic visit (post-post) compared to pre-HD as per CSN guidelines. Conclusions: Although no specific guideline has been written for NHHD patients, to ensure consistency of management compared to in-centre HD patients, lab values should be drawn pre-HD until clinical evidence suggests that the recommendations should be different for NHHD.

Nationwide retrospective study of hepatitis B virological response and liver stiffness improvement in 465 patients on nucleos(t)ide analogue

BACKGROUND Hepatitis B virus(HBV)nucleos(t)ide analog(NA)therapy reduces liver disease but requires prolonged therapy to achieve hepatitis B surface antigen(HBsAg)loss.There is limited North American real-world data using non-invasive tools for fibrosis assessment and few have compared 1st generation NA or lamivudine(LAM)to tenofovir disoproxil fumarate(TDF).AIM To assess impact of NA on virological response and fibrosis regression using liver stiffness measurement(LSM)(i.e.,FibroScan®).METHODS Retrospective,observational cohort study from the Canadian HBV Network.Data collected included demographics,NA,HBV DNA,alanine aminotransferase(ALT),and LSM.Patients were HBV monoinfected patients,treatment naïve,and received 1 NA with minimum 1 year follow-up.RESULTS In 465(median 49 years,37%female,35%hepatitis B e antigen+at baseline,84%Asian,6%White,and 9%Black).Percentage of 64(n=299)received TDF and 166 were LAM-treated with similar median duration of 3.9 and 3.7 years,respectively.The mean baseline LSM was 11.2 kPa(TDF)vs 8.3 kPa(LAM)(P=0.003).At 5-year follow-up,the mean LSM was 7.0 kPa in TDF vs 6.7 kPa in LAM(P=0.83).There was a significant difference in fibrosis regression between groups(i.e.,mean-4.2 kPa change in TDF and-1.6 kPa in LAM,P<0.05).The last available data on treatment showed that all had normal ALT,but more TDF patients were virologically suppressed(<10 IU/mL)(n=170/190,89%)vs LAM-treated(n=35/58,60%)(P<0.05).None cleared HBsAg.CONCLUSION In this real-world North American study,approximately 5 years of NA achieves liver fibrosis regression rarely leads to HBsAg loss.

PCSK9 and triglyceride-rich lipoprotein metabolism

Pro-protein convertase subtilisin-kexin 9 （PCSK9） is known to affect low-density lipoprotein （LDL） metabolism, but there are indications from several lines of research that it may also influence the metabolism of other lipopro- teins, especially triglyceride-rich lipoproteins （TRL）. This review summarizes the current data on this possible role of PCSK9. A link between PCSK9 and TRL has been suggested through the demonstration of （1） a correlation between plasma PCSK9 and triglyceride （TG） levels in health and disease, （2） a correlation between plasma PCSK9 and markers of carbohydrate metabolism, which is closely related to TG metabolism, （3） an effect of TG-lowering fibrate therapy on plasma PCSK9 levels, （4） an effect of PCSK9 on postprandial lipemia, （5） an effect of PCSK9 on adipose tissue biology, （6） an effect of PCSK9 on apolipoprotein B production from the liver and intestines, （7） an effect of PCSK9 on receptors other than low density lipoprotein receptor （LDLR） that are involved in TRL metabolism, and （8） an effect of anti-PCSK9 therapy on serum TG levels. The underlying mechanisms are unclear but starting to emerge.

Unique Occurrence of a Subependymoma Presenting Bilaterally with Hemorrhage:A Case Report

Subependymomas are rare brain tumors derived from the ventricular system and are usually asymptomatic. The interest of this report is to demonstrate that subependymomas can very exceptionally present bilaterally and with hemorrhage. A 69-year-old woman presented with headache, ataxia, and focal neurologic deficits. Magnetic resonance imaging revealed a bilateral intra-axial lesion with unilateral hemorrhage. Patient underwent surgical resection of the tumor and the pathology was consistent with subependymoma. Postoperatively, patient recovered progressively with improvement of symptoms. This is the first case of a subependymoma that is both bilateral and hemorrhagic, two rare occurrences previously mutually exclusive in literature for this type of tumor. In the present case report we perform a review of the literature to analyze and compare retrospectively all other cases of hemorrhagic subependymomas.

Prognostic Significance of Standardized Uptake Value of PET Scan in Non-Small Cell Lung Cancer

Background: To determine if the maximum standardized uptake value (SUVmax) of the primary tumor as determined by preoperative (18)F-fluoro-2-deoxyglucose ((18)F-FDG) positron emission tomography (PET) is an independent predictor of overall survival, mediastinal lymph node metastasis, and stage in patients with non-small cell lung cancer (NSCLC). Methods: A retrospective review of 1033 patients with stage I-IV histologically proven NSCLC who had an (18)F-FDG PET done between 2005 and 2011 for staging before receiving therapy was performed. SUVmax of primary NSCLC was measured and correlated with tumor characteristics, lymph node involvement, cancer stage and overall survival. The patients were divided into three groups according to their SUVmax value: group I SUVmax < 5;group II SUVmax 5 - 10;and group III SUVmax > 10. The primary outcome was survival and recurrence rate, compared using Log Rank Test. Results: The median duration of follow up was 675 days (22.5 months). The overall survival at two years for group I was 88%, group II 60% and group III 53%, significantly different among the three groups (p-value < 0.0001). Earlier stage lung cancer was found in patients with lower SUVmax values: in group I, 73% of patients had stage I cancer and only 4% had stage IV. The rate of ipsilateral mediastinal lymph node involvement (N2) in group I was 12.9% compared to 44.4% in group III (p-value < 0.0001). The overall survival was significantly different between group I and group II (Hazard Ratio (HR) 3.6;95% C.I 2.2 - 5.7 and a p-value < 0.0001) and between group II and group III (HR 1, 4;1.1 - 1.8 and a p-value = 0.013). Conclusion: There was a statistically significant difference in the overall survival, mediastinal lymph node metastases, and higher cancer stage with greater values of SUVmax on PET scan in patients with NSCLC.

对症状复发或残留卵巢癌进行有效的姑息性放疗

Objective.:To evaluate the efficacy of radiotherapy (RT) for symptomatic recurrent or residual ovarian cancer. Methods.:A review was conducted on patients (pts) treated with palliative RT for symptomatic ovarian cancer at The Ottawa Hospital Regional Cancer Centre between 1990 and 2003. Patient demographics,tumor factors,treatment variables,and clinical outcome were entered into a database. Symptom response was defined as complete (CR),partial (PR),or none. Results.:62 courses of RT were delivered to 53 pts. The symptoms treated were:bleeding (40%),pain (37%),and ‘others’(23%). The most common dose fractionation scheme was 30 Gy in 10 fractions (f) (range:5 Gy/1 f to 52.5 Gy/20 f). The overall response rate was 100%,with 68%achieving a CR. The CR rates were 88,65,and 36%for the symp- toms of bleeding,pain,and ‘others’,respectively (P = 0.003). The median duration of response was 4.8 months (range:1-71 months). In multivariate analysis,the only factors that were found to be significant positive predictors of symptom control were:the symptom bleeding (P = 0.015) and stage III/IV disease at presentation (P = 0.01). The most commonly reported toxicities were grades 1 and 2 nausea/vomiting and diarrhea. There were no grade 3/4 toxicities reported. Conclusions.:Radiotherapy is highly effective in palliating symptomatic ovarian cancer. Excellent results are achieved for patients presenting with bleeding or pain. Symptomatic patients should be strongly considered for palliative radiotherapy. Higher doses of radiotherapy should be considered for those with symptoms other than bleeding or pain and those with longer life expectancies.

复发卵巢颗粒细胞瘤的姑息放疗:报道3例患者的放射学反应证据

Background:The role of radiotherapy for recurrent or residual granulosa cell tumor of the ovary (GCTO) is controversial. One reason for this controversy may be that most published studies on this topic have not utilized sectional imaging to assess response to radiotherapy. We report on three cases of recurrent or residual GCTO that were treated with radiotherapy for which pre-and post-treatment CT scans were available to assess response. Case reports:Case #1:A 77-year-old woman with a 7 ×10 cm pelvic mass post-surgery was treated with radiotherapy to a dose of 45 Gy in 25 fractions followed by a boost of 10 Gy in 5 fractions. Post-treatment scans revealed a decrease in tumor size to 4 ×2.5 cm. The reduction in tumor volume was 86%,and the duration of response was 13 months. Case #2:A 73-year-old woman with multiple abdominal recurrences was treated with radiotherapy to a dose of 30Gy in 20 fractions. The dominant mass shrank from 13 ×17 cm to 5.1 ×6.6 cm. The reduction in volume was 85%,and the duration of response has been 5 months. Her symptom of abdominal bloating and early satiety abated. Case #3:An 83-year-old woman with a 20 ×20 ×15-cm mass in the left abdomen was treated with radiotherapy to a dose of 45 Gy in 25 fractions. The mass decreased in size to 3.7 ×2.5 cm post-treatment. The duration of response has been 21 months. Her symptom of left leg swelling disappeared after therapy. Conclusion:Radiotherapy is highly effective in treating recurrent or residual GCTO. In these three cases,the tumor volume decreased by 85 to 90%,and the duration of response has,up to now,been 5 to 21 months.

The SUPER reporting guideline suggested for reporting of surgical technique

Background:Existing reporting guidelines pay insufficient attention to the detail and comprehensiveness reporting of surgical technique.The Surgical techniqUe rePorting chEcklist and standaRds(SUPER)aims to address this gap by defining reporting standards for surgical technique.The SUPER guideline intends to apply to articles that encompass surgical technique in any study design,surgical discipline,and stage of surgical innovation.Methods:Following the EQUATOR(Enhancing the QUAlity and Transparency Of health Research)Network approach,16 surgeons,journal editors,and methodologists reviewed existing reporting guidelines relating to surgical technique,reviewed papers from 15 top journals,and brainstormed to draft initial items for the SUPER.The initial items were revised through a three-round Delphi survey from 21 multidisciplinary Delphi panel experts from 13 countries and regions.The final SUPER items were formed after an online consensus meeting to resolve disagreements and a three-round wording refinement by all 16 SUPER working group members and five SUPER consultants.Results:The SUPER reporting guideline includes 22 items that are considered essential for good and informative surgical technique reporting.The items are divided into six sections:background,rationale,and objectives(items 1 to 5);preoperative preparations and requirements(items 6 to 9);surgical technique details(items 10 to 15);postoperative considerations and tasks(items 16 to 19);summary and prospect(items 20 and 21);and other information(item 22).Conclusions:The SUPER reporting guideline has the potential to guide detailed,comprehensive,and transparent surgical technique reporting for surgeons.It may also assist journal editors,peer reviewers,systematic reviewers,and guideline developers in the evaluation of surgical technique papers and help practitioners to better understand and reproduce surgical technique.