Gastrointestinal (GI) cancers often require a multidisciplinary approach involving surgeons, endoscopists, oncologists, and interventional radiologists to diagnose and treat primitive cancers, ...metastases, and related complications. In this context, interventional radiology (IR) represents a useful minimally-invasive tool allowing to reach lesions that are not easily approachable with other techniques. In the last years, through the development of new devices, IR has become increasingly relevant in the context of a more comprehensive management of the oncologic patient. Arterial embolization, ablative techniques, and gene therapy represent useful and innovative IR tools in GI cancer treatment. Moreover, IR can be useful for the management of GI cancer-related complications, such as bleeding, abscesses, GI obstructions, and neurological pain. The aim of this study is to show the principal IR techniques for the diagnosis and treatment of GI cancers and related complications, as well as to describe the future perspectives of IR in this oncologic field.
Non-surgical treatment of hilar cholangiocarcinoma Inchingolo, Riccardo; Acquafredda, Fabrizio; Ferraro, Valentina ...
World journal of gastrointestinal oncology,
11/2021, Letnik:
13, Številka:
11
Journal Article
Odprti dostop
Cancer of the biliary confluence also known as hilar cholangiocarcinoma (HC) or Klatskin tumor, is a rare type of neoplastic disease constituting approximately 40%-60% of intrahepatic malignancies, ...and 2% of all cancers. The prognosis is extremely poor and the majority of Klatskin tumors are deemed unresectable upon diagnosis. Most patients with unresectable bile duct cancer die within the first year after diagnosis, due to hepatic failure, and/or infectious complications secondary to biliary obstruction. Curative treatments include surgical resection and liver transplantation in highly selected patients. Nevertheless, very few patients are eligible for surgery or transplant at the time of diagnosis. For patients with unresectable HC, radiotherapy, chemotherapy, photodynamic therapy, and liver-directed minimally invasive procedures such as percutaneous image-guided ablation and intra-arterial chemoembolization are recommended treatment options. This review focuses on currently available treatment options for unresectable HC and discusses future perspectives that could optimize outcomes.
Identifying the neurocognitive mechanisms that lead individuals remembering to execute an intention at the right moment (prospective memory, PM) and how such mechanisms are influenced by the features ...of that intention is a fundamental theoretical challenge. In particular, the functional contribution of subcortical regions to PM is still unknown. This study was aimed at investigating the role of the medial subdivision of the mediodorsal thalamic nucleus (mMDT) in PM, with particular focus on the processes that are mediated by the projections from/to this structure. We analysed the performance of a patient (OG) with a right‐sided lesion involving the mMDT in a series of PM tasks that varied for focality (i.e., overlapping of processes for the PM and ongoing tasks) and emotional valence of the stimuli, comparing the patient's performance with that of a control group. We found that the mMDT damage led to deficits in PM that were modulated by focality and emotional valence. OG indeed showed: a greater cost in the ongoing performance when a non‐focal PM task was added; a slowing down in retrieving the intentions, in particular when these were associated with focal PM cues; an abnormal performance in the task with positive PM cues. Our findings provide evidence of a contribution of mMDT to PM and suggest a modulation of prefrontal‐dependent strategic monitoring and a possible interaction with the limbic structures in the integration of emotion and PM processes. They also give support to the still controversial idea that connections with the perirhinal cortex mediate familiarity‐based recognition.
PURPOSENo standard treatment has yet been established for recurrent glioblastoma (GBM). In this context, the aim of the current study was to evaluate safety and efficacy of reirradiation (re-RT) by ...radiosurgery or fractionated stereotactic radiotherapy (SRS/FSRT) in association with regorafenib.METHODSPatients with a histological or radiological diagnosis of recurrent GBM who received re-RT by SRS/FSRT and regorafenib as second-line systemic therapy were included in the analysis.RESULTSFrom January 2020 to December 2022, 21 patients were evaluated. The median time between primary/adjuvant RT and disease recurrence was 8 months (range 5-20). Median re-RT dose was 24 Gy (range 18-36 Gy) for a median number of 5 fractions (range 1-6). Median regorafenib treatment duration was 12 weeks (range 3-26). Re-RT was administered before starting regorafenib or in the week off regorafenib during the course of chemotherapy. The median and the 6‑month overall survival (OS) from recurrence were 8.4 months (95% confidence interval CI 6.9-12.7 months) and 75% (95% CI 50.9-89.1%), respectively. The median progression-free survival (PFS) from recurrence was 6 months (95% CI 3.7-8.5 months). The most frequent side effects were asthenia that occurred in 10 patients (8 cases of grade 2 and 2 cases of grade 3), and hand-foot skin reaction (2 patients grade 3, 3 patients grade 2). Adverse events led to permanent regorafenib discontinuation in 2 cases, while in 5/21 cases (23.8%), a dose reduction was administered. One patient experienced dehiscence of the surgical wound after reintervention and during regorafenib treatment, while another patient reported intestinal perforation that required hospitalization.CONCLUSIONFor recurrent GBM, re-RT with SRT/FSRT plus regorafenib is a safe treatment. Prospective trials are necessary.
Pancreatic cancer is the 7
leading cause of death due to cancer in industrialized countries and the 11
most common cancer globally, with 458918 new cases (2.5% of all cancers) and 432242 deaths (4.5% ...of all cancer deaths) in 2018. Unfortunately, 80% to 90% of the patients present with unresectable disease, and the reported 5-year survival rate range between 10% and 25%, even after successful resection with tumor-free margins. Systemic chemotherapy, radiotherapy, and minimally invasive image-guided procedures that have emerged over the past years, are used for the management of non-operable PC. This review focuses on currently available non-surgical options of locally advanced pancreatic cancer.
Background:
Allergic diseases are a major public health burden worldwide. Evidence suggests that early nutrition might play a key role in the future development of allergies and the use of hydrolyzed ...protein formulas have been proposed to prevent allergic disease, mainly in term infants with risk factors.
Aim:
To evaluate the preventive effect of a hydrolyzed protein formula vs. an intact protein formula on allergy development in preterm infants with or without risk factors.
Methods:
We performed a 3-year follow-up study of a previous triple-blind, placebo-controlled randomized trial. Evidence of atopic dermatitis, asthma and IgE-mediated food allergies were evaluated according to a validated parental questionnaire (Comprehensive Early Childhood Allergy Questionnaire). Food sensitization was also investigated by skin prick test at 3 years of chronological age.
Results:
Of the 30 subjects in the intact protein formula group and 30 in the extensively hydrolyzed formula group, respectively 18 and 16 completed the 3-year follow-up and entered the final analysis. No group differences in the incidence of atopic dermatitis, asthma, IgE-mediated food allergies, and food sensitization were found.
Conclusion:
Despite the small number of cases, extensively hydrolyzed protein formula seems to be ineffective in allergic diseases prevention in preterm neonates. Further adequately powered, randomized controlled trials evaluating hydrolyzed protein formula administration to prevent allergic diseases in preterm neonates are needed.
We investigated the associations of prospective memory (PM) with memory, attentional control, and conscientiousness and whether they differed between young-old (YO) and old-old adults (OO).
We ...analyzed data from 562 older adults (mean = 80.04 years) who were tested on four PM tasks, memory (immediate and delayed cued recall), attentional control (letter and category fluency), and reported conscientiousness.
Latent variable analyses showed that in both YO and OO PM was associated with memory and attentional control (but not conscientiousness). Notably, testing for moderation effects revealed that the relation between PM and attentional control was significantly stronger in YO than in OO.
YO may be able to better (than OO) achieve a good PM performance with good attentional control.
This study compares hysteroscopic and histopathological results in postmenopausal women with abnormal uterine bleeding (AUB) and asymptomatic postmenopausal women with a thickened endometrium.
This ...is a retrospective study of 570 cases hysteroscopically examined between January 2008 and July 2012. The patients were followed up at the Istituto Tumori 'Giovanni Paolo II', Bari, Italy.
A total of 320 of the 570 cases were selected. The inclusion criteria were transvaginal ultrasound, hysteroscopy and endometrial biopsy. In the AUB group, if the hysteroscopy results were normal, a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100, 95, 71 and 100%, respectively, were achieved, while in the asymptomatic group these values were 100, 97, 90 and 100%, respectively. For both the group with polyps and that with myomas, the sensitivity, specificity, PPV and NPV were 100%. For endometrial hyperplasia, hysteroscopy showed a sensitivity, specificity, PPV and NPV of 81, 96, 87 and 93%, respectively, in the AUB group, while in the asymptomatic group, the sensitivity was 60%, the specificity and PPV were 100%, and the NPV was 98%. The sensitivity of hysteroscopy for endometrial cancer was 63%, the specificity 97%, the PPV 77%, and the NPV 95%.
In postmenopausal women with a thickened endometrium with or without AUB, hysteroscopy allows for an accurate diagnosis in benign endometrial pathology. Hysteroscopy also allows directed biopsies of suspicious lesions, which is useful in malignant endometrial pathology.
Die COVID-19-Pandemie stellt das deutsche Gesundheitssystem seit Anfang 2020 vor große Herausforderungen. Neben Einschränkungen der stationären Versorgung war auch die Aufrechterhaltung der ...ambulanten Patientenversorgung durch Heilmittelerbringer*innen von den pandemiebedingten Einschränkungen, beispielsweise durch Behandlungsrückgänge und vorübergehenden Praxisschließungen, betroffen. Ziel der Studie war daher die Erhebung der Arbeits- und Versorgungssituation in ambulanten Physiotherapiepraxen während der ersten Pandemiewelle.
Zwischen dem 01. Juni und dem 31. August 2020 wurde eine anonyme, schriftliche Online-Befragung mit quantitativen und qualitativen Fragen bei ambulant tätigen Physiotherapeut*innen durchgeführt. Die Erhebung ist Teil der Mixed-Methods Studie „ArTheCo“, die deutschlandweit unter ambulant tätigen Therapeut*innen und Patient*innen der Physiotherapie, Logopädie und Ergotherapie durchgeführt wurde.
An der Befragung nahmen deutschlandweit n=577 Physiotherapeut*innen teil. Bei 45% der Einrichtungen fiel die Auslastung während der ersten Pandemiewelle auf unter die Hälfte, 15% der Einrichtungen mussten vorübergehend schließen. Bei 58% der Befragten wurde Kurzarbeit angemeldet. Die Versorgung der Patient*innen wurde hierdurch und durch die Umsetzung der Hygienemaßnahmen stark eingeschränkt. Dies betraf vor allem Patient*innen mit einem erhöhten Risiko für einen schweren COVID-19 Krankheitsverlauf, wie zum Beispiel Patient*innen in Pflegeheimen. Durch die vielschichtigen Veränderungen in Praxisorganisation und Patientenversorgung fühlten sich viele der Befragten in ihrer Existenz bedroht und beschrieben zudem starke physische und psychische Belastungen. Bereits vor der Pandemie bestehende Unzufriedenheiten wurden durch die Pandemie scheinbar verschärft.
Durch Therapierückgänge und die Umsetzung der Hygienemaßnahmenwurde die ambulante Patientenversorgung in der Physiotherapie deutlich beeinflusst. Aufgrund der beobachteten Existenzbedrohungen durch die Pandemie in Kombination mit dem steigenden Fachkräftemangel zeigt sich die kontinuierliche Versorgung durch ambulante Physiotherapie auch über die Pandemie hinaus beeinträchtigt. Neben einer Umstrukturierung des Leistungsvergütungssystems stellen leicht zugängliche, einheitliche und auf Umsetzbarkeit geprüfte Handlungsempfehlungen für Praxen eine Unterstützungsmöglichkeit dar.
Die aktuelle Pandemie hat seit langem bestehende Herausforderungen und Unzufriedenheiten hervorgehoben, die den Beruf für einige der Befragten zunehmend unattraktiver werden lassen. Vor allem die Politik sollte die Unterstützungsbedarfe der Physiotherapeut*innen zur Gewährleistung der Patientenversorgung thematisieren und wertschätzende Lösungen erarbeiten. Diese Studie zeigt dafür mögliche Ansatzpunkte auf.
Due to the COVID-19 pandemic, the German health system has faced major challenges since spring 2020. In addition to restrictions in the inpatient health care sector, the maintenance of outpatient care by health care providers has also been affected by the pandemic-related restrictions. Both a decline in treatment frequencies and temporary practice closures have been observed. The aim of the study was to survey the work and care situation in outpatient physiotherapy practices during the first wave of the pandemic.
An anonymous online survey including quantitative and qualitative items was conducted among physiotherapists in the outpatient sector in Germany between June 1 and August 31, 2020. The survey is part of the mixed-methods study “ArTheCo”, which was conducted throughout Germany including outpatient therapists and patients in physiotherapy, speech therapy and occupational therapy.
In total, 577 physiotherapists from all over Germany took part in the survey. During the first wave of the pandemic, the occupancy rate fell below 50% at 45% of the facilities. 15% of the facilities had to close temporarily. Short-time work was announced at 58% of the respondents’ practices. This and the implementation of hygiene measures restricted the provision of physiotherapy. This mainly affected patients with a higher risk of a severe clinical course of disease, such as nursing home patients. Due to complex changes in practice organisation and patient care, many of the interviewees felt that their economic existence was threatened and also described a large physical and psychological burden. Existing dissatisfaction seemed to have increased by the pandemic.
To maintain continuous physical therapy, a reorganisation of the reimbursement system as well as easily accessible, consistent and feasible action plans for practices are needed. In combination with threats to existence due to the pandemic and increasing skill shortage, the outpatient physiotherapeutic care also appears to be threatened beyond the pandemic.
The current pandemic has highlighted long-standing challenges causing dissatisfaction and making the profession increasingly unattractive for some of the respondents. Political action to support physiotherapists needs to be initiated. This study indicates potential starting points.
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