Background
Peritoneal sarcomatosis (PS) is a rare tumor with limited therapeutic options. Bidirectional intraoperative chemotherapy (BDIC) using intravenous ifosfamide and doxorubicin-based ...hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) is an emerging treatment for peritoneal malignancies.
Patients and Methods
Patients with PS who underwent CRS/BDIC using intravenous ifosfamide and HIPEC from January 2017 to July 2021 were retrospectively analyzed. The last follow-up date was May 2022.
Results
A total of 29 patients were included. Overall survival (OS) rates at 6, 12, 24, and 48 months after CRS/BDIC were 93.1%, 89.2%, 81.4%, and 73.3%, respectively. As of May 2022, 6 patients (20.6%) had died, including four (13.8%) with a proven recurrent tumor and two with incomplete tumor resection completeness of cytoreduction (CC)-2 or CC-3. Of the 20 patients (68.9%) with CC-0 or CC-1, 7 had locoregional tumor recurrence without distant metastasis, whereas the other 13 were alive with no evidence of recurrent tumor in May 2022. Disease recurrence rates were 15% at 6 months and 35% at 12, 24, and 48 months after CRS/BDIC. Clavien–Dindo class ≥ IIIa complications developed in 9 patients (31.0%) with no deaths. Leukopenia occurred in 5 patients (17.2%) and thrombocytopenia in 12 patients (41.3%); these hematologic abnormalities resolved. A total of 9 (31.0%) patients developed nephrotoxicity; all recovered except one, who progressed to chronic kidney disease.
Conclusions
CRS/BDIC using intravenous ifosfamide and doxorubicin-based HIPEC is a potentially effective treatment for PS and has an acceptable rate of complications.
Ancient schwannomas are a rare variation of schwannomas, with the distinction being based on histopathological examination of the excised specimen. On histopathological examination, ancient ...schwannomas exhibit degenerative changes such as calcification, hyalinization, and cystic necrosis, along with S100 positivity. Complete surgical excision is the mainstay treatment for ancient schwannomas and carries a favorable prognosis. Recurrence is the most common complication, often arising from incomplete surgical excision. Herein, we present a case of a 41-year-old male who presented to our center as a case of a retroperitoneal mass for further investigations and diagnostic workup. Imaging showed a retroperitoneal mass in the right iliac fossa. We proceeded with ultrasound guided needle biopsy, and examination of the specimen confirmed the diagnosis of ancient schwannoma. Subsequently, the patient underwent surgery, and complete surgical excision was achieved. On follow-up 3-months later, the patient is doing well, and no signs of recurrence were found.
BACKGROUND Malignant peritoneal mesothelioma (MPM) is an aggressive neoplasm with a poor prognosis. Bidirectional intraoperative chemotherapy (BDIC) using concurrent intraperitoneal and intravenous ...chemotherapy in combination with cytoreductive surgery (CRS) is an emerging treatment option for selected cases of MPM. It is a locoregional treatment that involves intraoperative chemoperfusion of heated chemotherapy. The administration of systemic along with intraperitoneal chemotherapy allows for a bidirectional chemotherapy gradient in peritoneal tumor cells. The aim of this treatment is eradication of microscopic residual cancer cells after major removal of macroscopic tumor nodules. To date, there is no consensus on the chemotherapeutic regimen that can be used in BDIC to manage MPM in patients with severe renal impairment. Administering intravenous ifosfamide with hyperthermic intraperitoneal cisplatin and doxorubicin is a promising regimen in treating peritoneal mesothelioma. Nephrotoxicity is a dose-limiting adverse effect of cisplatin and ifosfamide. Therefore, dose adjustment is required in patients with renal impairment. CASE REPORT In this report, we describe a 46-year-old female patient with recurrent MPM and severe renal impairment. Her treatment was managed with hyperthermic intraperitoneal cisplatin and doxorubicin along with intravenous ifosfamide following CRS. The cisplatin dose was reduced to 50% and the ifosfamide dose was reduced by 25%. The patient tolerated the procedure well, without deterioration in her renal function. At her 9-month follow-up, she did not report experiencing chemotherapy-related adverse effects, and her kidney function remained stable. CONCLUSIONS Severe renal impairment might not be a contraindication to using potentially nephrotoxic chemotherapeutic agents in CRS-BDIC.
Gallbladder cancer (GBC) is a rare and highly aggressive malignancy, often characterized by nonspecific clinical presentations and late diagnosis, which contribute to its poor prognosis. It is ...commonly detected at advanced stages, leading to low survival rates. Surgical resection is the primary treatment, with the extent of surgery depending on the T stage of the cancer. In advanced cases, surgery is only considered if it can potentially be curative. Despite various treatment approaches for advanced GBC, survival outcomes remain poor. In our case series, we introduce a novel treatment approach combining cytoreductive surgery, intraoperative radiation therapy, and hyperthermic intraperitoneal chemotherapy. Remarkably, we observed a 100% one-year survival rate, with one patient achieving eight years of disease-free survival without recurrence or metastasis. This aggressive treatment strategy did not lead to increased morbidity or mortality, suggesting its safety and feasibility. However, larger-scale studies are required to draw definitive conclusions.
The COVID-19 pandemic has become a significant public health threat. Therefore, the purpose of this survey was to assess knowledge, attitudes, and precautionary measures related to COVID-19 among ...college students.
A convenient sample of 3263 volunteers responded to a self-administered electronic questionnaire during the period from October to December 2020. The knowledge, attitude, and practice (KAP) score level was calculated with a range of 0–34 points.
The mean age of the participants was 21 (+/−1.2) years, 69% were female, and 60.3% were urban. The majority of respondents received information about COVID-19 symptoms (93.9%), how to protect yourself (92.5%), and how it is transmitted (86.8%). The most cited sources of information were social media (75.7%), and the most credible were government websites and international organizations. More than half (65%) expressed concern regarding contracting COVID-19, and 89.2% believed that COVID-19 is a dangerous infection due to the rapid spread of the virus. The mean total KAP score was 26.1 (+/−4.2), which differed significantly between gender groups and residential areas. Logistic regression analysis showed that volunteers with good knowledge were 1.3 and 1.0 times more willing to volunteer and maintain a physical distance than those with less knowledge. Female students were 40% less likely to volunteer than males, yet they were 1.8 times more cautious about practicing protective measures such as washing their hands with soap and water than male students. Classifying the COVID-19 pandemic as a serious infection, urban communities have twice been careful to wear masks outdoors and maintain a social distance of at least 2 m from one another compared to rural inhabitants.
The current survey revealed that medical students have good knowledge regarding COVID-19, a positive attitude towards the use of protective measures, which were necessary to limit the spread of the disease. However, improvement is still required, and community education should occur as usual with a commitment to utilizing all the strategies that can support knowledge to improve and change attitudes as well as practices of the population.
Pheochromocytomas are rare catecholamine-secreting tumors with a high potential for recurrence post-surgery, necessitating prolonged follow-up. This case highlights the diagnostic and therapeutic ...challenges in managing recurrent pheochromocytoma.
A 25-year-old female, with a history of left pheochromocytoma treated with adrenalectomy a decade earlier, presented with a right adrenal mass. Despite controlled hypertension, elevated urine metanephrines suggested recurrence. Imaging showed a right adrenal mass and suspicious left paraaortic lymph nodes, confirming the diagnosis of recurrent malignant pheochromocytoma in the left adrenal bed and right adrenal gland, with metastasis to the paraaortic lymph nodes. The patient underwent right adrenalectomy coupled with cytoreductive surgery (CRS) in the form of excision of left-sided adrenal bed recurrence and left paraaortic lymph node dissection, intraoperative radiation therapy (IORT), and hyperthermic intraperitoneal chemotherapy (HIPEC). On follow-up six years later, the patient remains free from recurrence.
This case illustrates the importance of continued surveillance in pheochromocytoma patients, even those with a low-risk profile. The recurrence in this case, despite a smaller initial tumor size and no genetic predispositions, underscores the unpredictable nature of pheochromocytomas. The successful management with CRS, IORT, and HIPEC emphasizes the need for a personalized and multifaceted treatment approach.
Pheochromocytoma patients, including those initially considered low risk, require long-term monitoring due to the risk of recurrence. The utilization of CRS, IORT, and HIPEC in this case was pivotal in managing the recurrent and metastatic malignant disease effectively, demonstrating the significance of a comprehensive, multidisciplinary treatment strategy in such complex cases.
•Low risk pheochromocytoma patients require at least a 10-year follow-up.•Malignant pheochromocytoma is defined by the presence of extra-adrenal metastasis.•Recurrence of pheochromocytoma can be masked by controlled hypertension.•CRS, HIPEC, and IORT, a novel approach, was successful in treating pheochromocytoma.•HIPEC and IORT help achieve better local control and limit peritoneal spread.
Gastrointestinal stromal tumors (GISTs) can occur synchronously with other neoplasms, including the genitourinary (GU) system. Machine learning (ML) may be a valuable tool in predicting synchronous ...GU tumors in GIST patients, and thus improving prognosis. This study aims to evaluate the use of ML algorithms to predict synchronous GU tumors among GIST patients in a specialist research center in Saudi Arabia.
We analyzed data from all patients with histopathologically confirmed GIST at our facility from 2003 to 2020. Patient files were reviewed for the presence of renal cell carcinoma, adrenal tumors, or other GU cancers. Three supervised ML algorithms were used: logistic regression, XGBoost Regressor, and random forests (RFs). A set of variables, including independent attributes, was entered into the models.
A total of 170 patients were included in the study, with 58.8% (
= 100) being male. The median age was 57 (range: 9-91) years. The majority of GISTs were gastric (60%,
= 102) with a spindle cell histology. The most common stage at diagnosis was T2 (27.6%,
= 47) and N0 (20%,
= 34). Six patients (3.5%) had synchronous GU tumors. The RF model achieved the highest accuracy with 97.1%.
Our study suggests that the RF model is an effective tool for predicting synchronous GU tumors in GIST patients. Larger multicenter studies, utilizing more powerful algorithms such as deep learning and other artificial intelligence subsets, are necessary to further refine and improve these predictions.
An innovative, simple and cost effective Tb
3+
-atorvastatin photo probe was designed and used as a core for a spectrofluorometric approach to sensitively determine two vital biological compounds in ...serum samples. Tb
3+
-atorvastatin complex displays a characteristic electrical band with
λ
em
at 545 nm with significant luminescence intensity, which is quenched in the presence of progesterone and testosterone at two variant sets of pH; 6.2 and 7.5, respectively. The conditions were optimized and the best solvent for operation was found to be acetonitrile with
λ
ex
at 320 nm. Progesterone and testosterone were assessed in serum samples using the same optimal conditions within concentration ranges of 2 × 10
−9
to 2.9 × 10
−6
and 3.1 × 10
−9
to 4.8 × 10
−6
mol L
−1
, respectively. The proposed luminescence method was validated in accordance to ICH guidelines and found to be accurate, precise and specific and free from any interference. The cost effectiveness and applicability of the method make it a good choice for routine analysis of the two compounds and early diagnosis of chronic diseases associated with abnormalities in their physiological levels.
The absorption spectrum of (1) atorvastatin, (2) Tb
3+
-atorvastatin complex (Tb
3+
-Ator), (3) Tb
3+
-atorvastatin complex (Tb
3+
-Ator)-progesterone (P), and (4) Tb
3+
-atorvastatin complex (Tb
3+
-Ator)-testosterone (T).
An innovative, simple and cost effective Tb
-atorvastatin photo probe was designed and used as a core for a spectrofluorometric approach to sensitively determine two vital biological compounds in ...serum samples. Tb
-atorvastatin complex displays a characteristic electrical band with
at 545 nm with significant luminescence intensity, which is quenched in the presence of progesterone and testosterone at two variant sets of pH; 6.2 and 7.5, respectively. The conditions were optimized and the best solvent for operation was found to be acetonitrile with
at 320 nm. Progesterone and testosterone were assessed in serum samples using the same optimal conditions within concentration ranges of 2 × 10
to 2.9 × 10
and 3.1 × 10
to 4.8 × 10
mol L
, respectively. The proposed luminescence method was validated in accordance to ICH guidelines and found to be accurate, precise and specific and free from any interference. The cost effectiveness and applicability of the method make it a good choice for routine analysis of the two compounds and early diagnosis of chronic diseases associated with abnormalities in their physiological levels.
Abstract
Structures made of reinforced concrete are susceptible to developing cracks when they are in the path of earthquakes, strong winds, or increased structural loading. It is therefore possible ...that it will be necessary to manage structural cracking in the Service Limit State to maximise the lifetime and strength of the structural components under any stress. Helical containment is superior to rectangular containment in terms of its ability to strengthen and ductile the Reinforced Concrete (RC) structural member. In the current work, six distinct beams were each subjected to a series of tests to see how they behaved in terms of cracking when subjected to bending loads. Each of these tests used a unique helical pitch space distance. The beams all measured 150 mm by 150 mm and 750 mm in length. They were designed in accordance with the criteria of Euro code 2, with the identical dimensions. Both 50 and 100 mm were used to take the measurement for the helical pitch. The findings indicate that the utilisation of helical elements does influence the cracking behaviour of the beams. The most important finding was that the measurement of the crack’s thickness was slightly reduced when the beams were restricted to a helical zone with a closer spacing between them. The fact that the theoretical crack is longer than the actual crack that was measured experimentally demonstrates that the Euro code 2 standard provides a more accurate forecast as well as a higher factor of safety. This is demonstrated by the fact that the theoretical crack is larger than the actual crack that was measured.
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