Early Group Research Articles

Clonal hematopoiesis–derived therapy-related myeloid neoplasms after autologous hematopoietic stem cell transplant for lymphoid and non-lymphoid disorders

Therapy-related myeloid neoplasms (tMN) are complications of cytotoxic therapies. Risk of tMN is high in recipients of autologous hematopoietic stem cell transplantation (aHSCT). Acquisition of genomic mutations represents a key pathogenic driver but the origins, timing and dynamics, particularly in the context of preexisting or emergent clonal hematopoiesis (CH), have not been sufficiently clarified. We studied a cohort of 1507 patients undergoing aHSCT and a cohort of 263 patients who developed tMN without aHSCT to determine clinico-molecular features unique to post-aHSCT tMN. We show that tMN occurs in up to 2.3% of patients at median of 2.6 years post-AHSCT. Age ≥ 60 years, male sex, radiotherapy, high treatment burden ( ≥ 3 lines of chemotherapy), and graft cellularity increased the risk of tMN. Time to evolution and overall survival were shorter in post-aHSCT tMN vs. other tMN, and the earlier group’s mutational pattern was enriched in PPM1D and TP53 lesions. Preexisting CH increased the risk of adverse outcomes including post-aHSCT tMN. Particularly, antecedent lesions affecting PPM1D and TP53 predicted tMN evolution post-transplant. Notably, CH-derived tMN had worse outcomes than non CH-derived tMN. As such, screening for CH before aHSCT may inform individual patients’ prognostic outcomes and influence their prospective treatment plans. Presented in part as an oral abstract at the 2022 American Society of Hematology Annual Meeting, New Orleans, LA, 2022.

Midterm Outcome of Early Pregnancy Versus Late Pregnancy After Laparoscopic Sleeve Gastrectomy.

Controversy regarding the timing of pregnancy and its implications is present in the literature. To evaluate the midterm outcome of weight loss in women who have undergone laparoscopic sleeve gastrectomy (LSG) followed by pregnancy at two different times. We retrospectively reviewed 53 women who matched the inclusion criteria and included them in the analysis. Demographics and anthropometric measurements were collected. Women who conceived within 12 months of LSG were labeled as early group (EG), and who conceived after 12 months were noted as late group (LG). There were no differences between the groups regarding obesity-associated disease and number of pregnancies before. EG had higher weight (P = 0.0001) and body mass index (BMI) (P = 0.002) at LSG. The mean interval time for EG was 6.7 ± 3.2 months, and LG was 20 ± 5.2 months. Gestational weight gain (GWG) was lower in the EG (P = 0.001). There were no differences in the number of small for gestational age (SGA) births or gestational weight. In the first 2 years after LSG, LG had a higher percentage of total weight loss (%TWL) and percentage of body mass index loss (%EBMIL) (P < 0.0001). After 5 years of follow-up, %TWL (P = 0.4) and %EBMIL (P = 0.1) were not statistically significant between both groups. Conception within 12 months from LSG might hinder the weight loss process in the short term but have no significant effect over 5 years of follow-up.

Impact of time-of-day on nivolumab monotherapy infusion in patients with metastatic gastric cancer.

268 Background: Nivolumab monotherapy, an immune checkpoint inhibitor, is a standard of care for patients with metastatic gastric cancer (mGC) as a later-line treatment. Several studies have suggested that the circadian rhythm is essential in immune system function, including anti-cancer immunity. This study evaluated whether the time-of-day patterns of nivolumab infusion alter the efficacy of mGC treatment. Methods: This study retrospectively analyzed 298 consecutive mGC patients who received nivolumab monotherapy at a single institution between December 2014 and December 2022. Patients were divided into early (EA)- and late (LA)-nivolumab infusion groups: EA group = ≥70% of their infusions before 14:00, and LA group = &lt;70% of their infusions before 14:00. Treatment efficacy (overall response rate [ORR], disease control rate [DCR], progression-free survival [PFS], and overall survival [OS]) was evaluated. Multivariate analyses included variables with P values &lt;0.1 in univariate analyses. Results: A total of 248 patients were eligible; 140 were classified as having EA, and 108 as having LA. Most baseline characteristics were similar between EA and LA. In contrast, the median infusion time was earlier in EA than in LA (11:50 vs. 14:22). The median follow-up time was 9.0 months (range, 1.2–64.7 months). ORR and DCR were significantly higher in the EA than in the LA among 149 patients with measurable lesions (ORR, 16.9% vs. 3.3%, P=0.01; DCR, 47.2% vs. 20.0%, P&lt;0.01). Patients with EA had significantly better prognoses than those with LA in terms of PFS (median PFS, 2.3 vs. 1.6 months.; hazard ratios [HR], 0.65; P&lt;0.01) and OS (median OS, 7.6 vs. 3.9 months.; HR, 0.64; P&lt;0.01). EA patients received the subsequent chemotherapy more frequently than those in LA (54% vs. 32%; P&lt;0.01). Multivariate analyses, including factors such as age, ECOG performance status, histological type, ascites, modified Glasgow Prognostic Score, and timing of nivolumab infusion, showed that EA was an independent prognostic factor for PFS (adjusted HR, 0.66; P&lt;0.01) and OS (adjusted HR, 0.62; P&lt;0.01). Conclusions: Our data suggest that efforts to schedule nivolumab infusions before mid-afternoon could be considered in daily practice.

Precise classification and regional delineation of maturity groups in soybean cultivars across China

The maturity group (MG) system is a widely recognized and effective approach for assessing the photothermal sensitivity of soybean cultivars and determining their optimal adaptation zones. In China, soybean have been cultivated extensively for thousands of years, evolving into various ecotypes through natural and artificial selection. In this study, the relative maturity groups (RMGs) of a total of 766 soybean cultivars collected from the Northeast Spring Planting Sub-region (NE), Huang-Huai-Hai Summer Planting Region (HH), Northwest Spring Planting Sub-region (NW,), and South Multiple Cropping Region (SC) of China were evaluated using linear regression models at 36 sites nationwide. The results show that the RMGs of Chinese soybean cultivars range from MG m1.6 to MG 9.5. Among all the identified soybean cultivars, MG III cultivars account for the largest proportion of 22.19 %, followed by MG II (21.67 %) and MG I (18.54 %). Conversely, MG IX has the fewest number of cultivars, representing only 0.26 % of all cultivars. The MG ranges for spring- and summer-sowing cultivars are MG 000-V and MG II-IX, respectively. The adaptive soybean MG zones across China were mapped using the method of Kriging interpolation based on the soybean RMGs data from 816 sites of 29 soybean-producing provinces. Cultivars of MG 0 and earlier groups are primarily distributed in the NE, and MG III and MG IV are the major MGs in HH and NW. The cultivars in MG V and later groups mainly distribute in SC. This study realizes the unification and normalization of the MG system between China and other major soybean- producing countries worldwide. Such unification and standardization will facilitate global germplasm exchanges and assist soybean producers in making more informed decisions when selecting cultivars.

Simultaneous hybrid off-pump coronary artery bypass grafting and transcatheter aortic valve implantation in elderly patients.

Optimal strategy for transcatheter aortic valve implantation (TAVI) in patients with coronary artery disease (CAD) is unresolved. We evaluated the surgical outcomes of hybrid coronary artery bypass grafting (CABG) and TAVI in elderly patients. We retrospectively evaluated patients who underwent simultaneous TAVI and CABG at Wakayama Medical University, Japan. All patients underwent off-pump CABG (OPCAB) including minimally invasive cardiac surgery (MICS-CABG). In an earlier period, OPCAB + transfemoral TAVI (TF-TAVI) was the only method used, while in a later period, we introduced MICS-CABG and alternative approaches for TAVI. Twenty-seven patients were enrolled, the average age was 83.6 ± 5.1years. In the MICS-CABG and TAVI group, average patient age was higher (87.0 ± 3.1years) than in the earlier group. Thirty-day and in-hospital mortalities were zero. Incomplete revascularization rate was 33.3% and one patient required percutaneous coronary intervention after the operation. Graft patency rate was 100%. In MICS-CABG group, the number of distal anastomoses was smaller (1.29, range 1-2), but the number of days required to re-starting walking and postoperative hospital stay were shorter, and the rate of discharge to home was higher (100%) than in the other groups. Although 33.3% of patients did not achieve complete revascularization, there was no 30-day or in-hospital mortality. TAVI and hybrid OPCAB, including MICS-CABG, were suggested to be feasible treatment in elderly patients.

Learning curve of lung dose optimization in intensity-modulated radiotherapy for locally advanced non-small cell lung cancer.

Intensity-modulated radiotherapy (IMRT) has been increasingly used for patients with locally advanced non-small cell lung cancer (LA-NSCLC). However, there are some barriers to implementing IMRT for LA-NSCLC, including the complexity of treatment plan optimization. This study aimed to evaluate the learning curve of lung dose optimization in IMRT for LA-NSCLC and identify the factors that affect the degree of achievement of lung dose optimization. We retrospectively evaluated 40 consecutive patients with LA-NSCLC who received concurrent chemoradiotherapy at our institution. These 40 patients were divided into two groups: 20 initially treated patients (earlier group) and 20 subsequently treated patients (later group). Patient and tumor characteristics were compared between the two groups. The dose-volume parameter ratio between the actually delivered IMRT plan and the simulated three-dimensional conformal radiotherapy plan was also compared between the two groups to determine the learning curve of lung dose optimization. The dose-volume parameter ratio for lung volume to receive more than 5 Gy (lung V5) and mean lung dose (MLD) significantly decreased in later groups. The spread of the beam path and insufficient optimization of dose coverage of planning target volume (PTV) might cause poor control of lung V5, MLD. A learning curve for lung dose optimization was observed with the accumulation of experience. Appropriate techniques, such as restricting the beam path and ensuring dose coverage of PTV during the optimization process, are essential to control lung dose in IMRT for LA-NSCLC.

Neurogranin and BACE1 as biomarkers for early detection of Alzheimer’s disease

AbstractBackgroundA major goal on Alzheimer’s disease (AD) is to identify the disease in its earliest stages to provide optimal care for patients as soon as possible. Currently, the initial clinical diagnosis of AD is substantiated by the quantitative analysis of amyloid β (Aβ) peptide and Tau protein (Tau) in the cerebrospinal fluid (CSF). However, when AD becomes manifest in mental disturbances, Aβ and Tau levels have already become static. Thus, the identification of biomarkers within the earliest stages of AD are of utmost interest.This study aimed to investigate the postsynaptic proteins neurogranin and beta‐secretase 1 (BACE1) for early discrimination in AD spectrum.MethodWe analyzed the data from DELCODE, a multicenter prospective cohort study. CSF levels of neurogranin and BACE1 were measured using ELISA and compared in participants with unimpaired cognition, subjective cognitive decline (SCD), mild cognitive impairment (MCI), mild AD dementia and first‐degree relatives of patients with AD dementia. To explore differences between earlier groups, we further divided SCD into two groups based on Aβ42/pTau181: Aβ42/pTau181‐SCD, Aβ42/pTau181+SCD. Differences between the groups were analyzed with non‐parametric tests. The significance values of group‐wise comparisons were adjusted by Bonferroni correction for multiple tests.ResultA total of 530 participants were finally enrolled, including 91 healthy controls, 212 SCD (155 Aβ42/pTau181‐SCD, 57 Aβ42/pTau181+SCD), 114 MCI, 67 AD dementia and 46 first‐degree relatives. The comparisons between different groups showed CSF levels of neurogranin and BACE1 were significantly higher in Aβ42/pTau181+SCD (503.08 ± 202.89 pg /ml and 2406.39 ± 613.89 pg /ml, respectively) than those in Aβ42/pTau181‐SCD (330.94 ± 134.02 pg /ml and 1972.19 ± 561.94 pg /ml, respectively, both P &lt; 0.0001). The AD group showed higher neurogranin levels than all other groups except Aβ42/pTau181+SCD (all P &lt; 0.05). Furthermore, the CSF levels of Neurogranin were correlated with baseline MMSE scores (spearman r = ‐ 0.16, P &lt; 0.001).ConclusionThis study reveals that neurogranin and BACE1 provide new perspectives for discriminating AD, which may open up possibilities of new therapeutic targets for AD.

Surgery with adjuvant chemotherapy versus chemoradiation for early-stage large cell neuroendocrine cancer (LCNEC) of the lung: A SEER plus based analysis.

e20616 Background: LCNEC of the lung is a rare and highly aggressive tumor with neuroendocrine differentiation. Given its rare occurrence and lack of data from large randomized trials, treatment recommendations are based on the extrapolation of data, primarily from small-cell lung cancer studies. We conducted this study to evaluate the survival difference among patients with LCNEC with an N1 disease between those who received surgery and adjuvant chemotherapy versus definitive chemotherapy and radiotherapy. Methods: We utilized Surveillance, Epidemiology, and End Results (SEER) plus 18 registries database to identify patients diagnosed with LCNEC with tumor stage of T1, T2, or T3 and nodal stage of N1. The study population included patients, 18 years and above, who underwent surgical resection followed by adjuvant chemotherapy and patients who received definitive chemo-radiotherapy for early stage LCNEC. Kaplan-Meier and log rank test were used to compare overall survival (OS) and Cancer specific survival (CSS). Multivariate survival analysis was done using the cox proportional hazards regression model. Results: A total of 178 patients were included, 57.3% (n = 102) were &lt; 65-year-old, 50.56% (n = 90) were male, mostly Caucasian 87.08% (n = 155) and identified as non-Hispanic 93.26% (n = 166). Out of them, 70.22% (n = 125) underwent surgery plus adjuvant chemotherapy and 29.78% (n = 53) underwent chemoradiation. Patients who underwent surgery with adjuvant chemotherapy had higher overall survival (OS) than chemoradiation (37 vs. 11 months respectively). 3-year (49.9% vs. 15.7%) and 5-year OS rates (36.7% vs. 10.4%) were also higher in the earlier group. On multivariate analysis after adjusting for age, gender, race and origin, patients who received chemoradiation had higher hazards as compared to those who received surgery and adjuvant chemotherapy (Hazard ratio: 2.91, 95% Confidence interval (CI):1.93,4.37, P value &lt; 0.001). When examining the cancer specific survival (CSS), similar results were observed with higher CSS in the surgery with adjuvant chemotherapy group (18 vs. 8 months) reaching a statistical significance of P &lt; 0.001 and higher hazards in chemoradiation group (Hazard ratio: 3.33, 95% Confidence interval (CI):2.09,5.28, P value &lt; 0.001). 3-year survival (26.47% vs. 2.7 %) and 5-year CSS rates (11.76% vs. not reached) were also pronounced in the patients treated with surgery with adjuvant chemotherapy. Conclusions: Our study demonstrates that patients with early stage LCNEC (T1-3 N1) disease treated with surgery and adjuvant chemotherapy had statistically significant overall and cancer specific survival rates compared to those treated with chemoradiation.

Retention in nursing education and scholarship programs: Survival analysis of the Veterans Health Administration National Nursing Education Initiative Data.

To investigate factors affecting non-completion by registered nurses (RNs) participating in degree programs supported by the scholarship program of the National Nursing Education Initiative of the United States Veterans Health Administration. Secondarily, to assess overall retention in the scholarship program over time. Retrospective longitudinal design using administrative data. Defining retention time as the time elapsed from enrollment date to non-completion, we performed survival (retention) analysis (i.e.,Kaplan-Meier survival functions, log-rank tests and Cox regressions) to retrospectively analyzea national sample of RNs (N =15,908) enrolled in the scholarship program between the United States federal fiscal years 2000 and 2020. Nurses' mean age was 44 years (range: 19-71), and 86% were females. Six- and 12-month cumulative educational program retention rates were 92% and 84% respectively. The newest group of enrollees (2016-2020), younger nurses (<50 years), and nurses in traditional degree programtype were more likely to complete their academic programs than the earlier groups, older nurses and nurses in non-traditional type, respectively. Male nurses who aspired to advanced occupational levels upon completion were more likely to complete their academic programs compared to those who expected no change from their current level of practice. Multiple factors affected non-completion of academic degree programs by RNs enrolled in the scholarship program. More work is needed to examine these plus additional plausible factors and their correlates extensively. Our findings highlighted areas for quality improvement in employee scholarship programs for RNs. The findings are expected to inform tailoring of proactive helpful intervention towards individual needs and prioritization of limited resources to maximize graduation rate from academic programs for scholarship recipients. The study will have impact on nursing workforce policy makers interested in implementing employee scholarship programs, and on their scholarship recipients.

Early vs. Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis – A Single Center Study

Introduction: Laparoscopic cholecystectomy is regarded as the gold standard for the treatment of acute cholecystitis; however the timing of the procedure is controversial. There exist studies that support both early and delayed laparoscopic cholecystectomy. Aim: The aim of the study is to determine which modality: early or delayed laparoscopic cholecystectomy is the preferred timing in the treatment of acute cholecystitis by examining: duration of hospitalization, conversion rate, duration of surgery and intraoperative, postoperative complications. Materials and Methods: This was a retrospective study of 300 patients. Laparoscopic cholecystectomy was performed within 72 hours of admission for patients in the Early LC Group. Patients in the Delayed LC group were treated conservatively and discharged They were readmitted 6-12 weeks later for elective laparoscopic. Results: The mean operating time was 83.55 mins vs. 60.72 mins in the delayed group, conversion rate in Early LC Group was 5.3% vs. 8.0 % in the delayed LC group. The mean postoperative hospital stay was 1.98 days in the earlier group and 3.35 days in the delayed group. Overall mortality was zero. Conclusion: Early laparoscopic cholecystectomy within 72 hours of symptom onset offers both medical and economic benefits and should be the preferred method for patients treated by surgeons with adequate laparoscopic cholecystectomy experience.

Understanding Osteoporosis and its Ayurvedic Management - A Review

Osteoporosis is a generalized skeletal disorder of low bone mass and deterioration in its architecture causing susceptibility to fracture. Multiple etiological factors like physical, hormonal, nutritional and life style contribute to the development of disease. It usually generates along with senile and postmenopausal changes in the body. Morbidity associated with Osteoporotic fracture is on the rise. Currently the disease is increasing in much earlier groups, owing to present lifestyle. So preventive strategies should be adopted much earlier as maintaining a healthy life style itself can protect against fractures in later life. As disease prevention and treatment have improved over last two decades, public awareness of Osteoporosis remains minimal particularly in rural areas. Conventional medications are often effective for symptomatic relief only. However this provides much scope to Ayurveda, which aims at treatment as well as disease prevention. It can be considered as a disease characterized by localization of vitiated Vata in Asthi Dhatu i.e.; ‘Asthigata Vata’ resulting in Asthi Kshaya. Vata Kopa and Asthikshaya can result in osteoporosis. Condition can be managed in Ayurveda adopting Asthigata Vata Chikitsa, Asthikshaya chikitsa, Bhagna chikitsa and usage of drugs with Brimhana, Rasayana and Vata Hara property.

Influence of nasal septum deviation on fluctuating asymmetries of the nasomaxillary complex: A cross‐sectional study

An important parameter in diagnostic analysis and treatment planning of different biological areas is facial symmetry, and several etiological factors have been attributed to skeletal facial asymmetry. Although causality cannot be determined, previous studies have reported a relationship between the anatomical deviation of the nasal septum and facial development. Diagnosis is critical for patients in growth stages due to the association between nasal septum deviation (NSD) and abnormal growth of the nasomaxillary complex. To understand this relationship, this study aimed to investigate the influence of nasal septum deviation on fluctuating asymmetries (FA) of the nasomaxillary complex at different stages of skeletal maturation. Another goal was to determine whether an association exists between the degrees of septal deviation severity and asymmetry of the nasomaxillary complex. This was a retrospective, cross-sectional observational study comprising 60 selected cone-beam computed tomography (CBCT) scans that were divided into four groups (n= 15) according to the degree of septal deviation and skeletal maturation: mild deviation (MD; <10°), moderate to severe deviation (MSD; ≥10°), early group (EG), and late group (LG). The angle and area of deviation were measured for the greatest NSD, and a geometric morphometric approach was used to evaluate the nasal septum (NS) shape. The morphology of the nasomaxillary complex and the presence of fluctuating asymmetries were evaluated using 23 two-dimensional landmarks on the nasomaxillary complex (nasal, lateral, and palatal regions) with Procrustes ANOVA and Mann-Whitney test. Additionally, Spearman's correlation and multivariate regression were used to correlate the NSD with asymmetries in these regions. No significant differences were observed in the Procrustes FA scores of the nasomaxillary complex between the MD-EG × MSD-EG and MD-LG × MSD-LG (p> 0.05). However, the results of the multivariate regression revealed more specific aspects of asymmetry (asymmetry component), there was a positive correlation between the NSD angle and the palatal regions (p= 0.035 and p= 0.047, middle and posterior, respectively), and the nasal septum shape and anterior palatal regions (p= 0.039). The nasal and lateral regions did not correlate with the NSD angle in the multivariate regression analysis (p> 0.05). The results of this study indicate that there were no significant differences in the fluctuating asymmetry of the nasomaxillary complex between the mild and moderate to severe nasal septum deviation groups, in both early and late skeletal maturation stages. However, a positive correlation was observed in the degree of nasal septum deviation angle and asymmetry components of the middle and posterior palatal regions, likewise between the nasal septum shape and asymmetry components of the anterior palatal region. The diagnosis of nasal septum deviation by both physicians and dentists is important, as a relationship was observed with fluctuating asymmetry component of the palatal region. This information can guide the decision of the treatment planning for these individuals, and should be considered, especially in cases of severe septum deviation, due to the great anatomical proximity of these structures.

Effect of low molecular weight heparin on bleeding after radical gastrectomy: A retrospective study from a high-volume center in China

BackgroundAlthough low molecular weight heparin (LMWH) is recommended to prevent venous thromboembolism (VTE) in patients with gastric cancer, it's difficult for surgeons to choose appropriate time to start anti-coagulation because of the risk of surgical field bleeding after radical gastrectomy. We compared the risk of VTE and bleeding between patients receiving LMWH within and beyond 48 ​h after surgery. MethodsThe medical records of consecutive cases receiving radical gastrectomy from November 1st, 2017 to October 31st, 2018 in Zhongshan Hospital Gastric Cancer Center were carefully reviewed. Patients receiving LMWH within and beyond 48 ​h after surgery were regarded as Early Group (EG) and Delayed Group (DG), respectively. Incidence of VTE and bleeding complications were compared and risk factors of bleeding were evaluated. ResultsSix hundred and sixty-five cases were enrolled, including 465 in EG and 200 in DG. No significant differences of clinicopathological or operative features were observed except for fewer combined resection (DG: 5.0%, EG: 1.9%, P ​= ​0.030) and shorter surgery duration (DG: 194min, EG: 168min, P ​< ​0.001). No patients suffered from deep venous thrombosis or pulmonary embolism in our study. However, postoperative bleeding rate was higher in EG (DG: 1.5%, EG: 7.5%, P ​= ​0.002). Multivariate analysis suggested that EG was the independent risk factor of bleeding (OR: 3.744, 1.13–12.36, P ​= ​0.030). ConclusionUse of LMWH 48 ​h after radical gastrectomy maybe a good choice for clinical surgeons to reduce postoperative bleeding rate without increasing VTE risk in gastric cancer patients.

Survival Outcome of BCLC Stage C Hepatocellular Carcinoma after Hepatectomy, before and after the Development of Tyrosine Kinase Inhibitor

Introduction: Systemic therapy for hepatocellular carcinoma (HCC) has progressed after the development of tyrosine kinase inhibitors (TKIs). The aim is to evaluate the outcome of hepatectomy for BCLC stage C (BCLC-C) HCC, after the development of TKI. Method: 68 curative hepatectomy had been performed for BCLC-C HCC during 2005-2017 (Table.1). Cases with hepatectomy before 2009, before TKI was administered in Japan for the treatment of HCC to be covered by national health insurance, was grouped as Earlier group (n=24), and cases with hepatectomy after 2010 (n=44) as Recent group. Results: 5 years DFS and OS was 11.8% and 35.6% for all cases. Sex, AFP, Differentiation, pVp, Timing of hepatectomy, before or after TKI approval, were detected as possible prognostic factors for OS by univariate analysis and Timing of hepatectomy was detected as the only independent prognostic factor for OS by multivariate analysis. 5 years OS and DFS for Earlier/Recent was 20.8%/43.9% (p=0.022) and 8.3/13.6% (p=0.479, Figure.1). No statistical differences were detected between clinicopathological result of Earlier/Recent group. For 57 cases with recurrent HCC, statistical difference between Earlier/Recent was detected in whether TKI was administrated after recurrence, 1 out of and 20 out of 36 (p<0.001), and 5 years OS after the recurrence 6.5%/35.0% (p=0.011). Conclusions: OS of BCLC-C HCC after hepatectomy has improved recently, as TKI administration became a treatment option for the recurrent lesions with improved OS after the recurrent. Hepatectomy for BCLC-C HCC may be accepted with TKI as a treatment option after the recurrence of HCC.Tabled 1EP01C-103SexM:F60:8AFP (ng/mL)110038±726624 (2.2-5986980)pVv1:040:28Age (yrs-old)62.3±9.8 (34-86)PIVKAII (mAU/ml)35129±132277 (14-928799)pN1:04:64ASA2:358:9Tumor size (cm)8.1±4.9 (1-20.6)pStage0:1:2:3:4a1:1:3:28:35HBVor/andHCV+:-56:9Tumor number1:2or3:>436:25:7Hr0:S:1:2:34:3:6:48:7Child-PughA:B64:4Differentiationwell:mod:por0:14:52OT (min)333±75 (194-576)ICG 15 min (%)15.6±9.1 (3-47.9)cVp1:050:18BL (mL)811±1173 (30-7620)Alb (g/dL)3.9±0.4 (2.6-4.7)cVv1:021:47C-D0:1:2:3a:3b:541:2:18:4:2:1PT (INR)88.1±12.4 (54.5-113.6)cN1:05:63Plt (104/μL)18.5±8.8 (5.9-54.1)pVp1:054:14 Open table in a new tab

Domestic Servants and Master–Servant Regulations in Colonial Calcutta, 1750s–1810s

Abstract In the Indian historiography of law and labour, master–servant regulations are an under-explored subject. Based on English precedents, these regulations acquired a specifically colonial nature when applied to control labour in the growing city of Calcutta. Questioning the assumed associations of domestic servants with privacy and informality, this article shows that in fact they were unambiguously one of the earliest groups to be regulated. It approaches the law from both ends, from its formal promulgation to its actual implementation. It analyses various regulations from 1759 to the 1810s that were passed to control employment relations between masters and servants, while for the first time analysing three different sets of court records to reconstruct the history of justice and the enforcement of law. It argues that domestic servants engaged with the law strategically: they made complaints of the non-payment of wages against their Indian masters but never brought such charges against their European masters. This absence is better understood if we unpack the hidden histories behind the juristic terms of these complaints, such as neglect of duty, running away (with or without advance payment of wages), demand for exorbitant wages, and theft, and see them as interlinked modes of control exercised under the master–servant regulations.

Comparison Between Early and Late Retensioning of an Adjustable-Loop Cortical Suspension Device During Hamstring ACL Reconstruction.

Background:Biomechanical studies have demonstrated significant loosening of the adjustable-loop device as compared with the fixed-loop device used in anterior cruciate ligament reconstruction. Retensioning of the adjustable loop has been recommended; however, the timing of the retensioning is unknown.Hypothesis:Early (ER) and late retensioning (LR) will show similar gapping between the femoral tunnel and graft on follow-up magnetic resonance imaging (MRI) and similar clinical outcomes.Study Design:Cohort study; Level of evidence, 3.Methods:This study included 101 patients who underwent hamstring anterior cruciate ligament reconstruction using the adjustable-loop device for femoral fixation between June 2016 and January 2018. All patients a had follow-up MRI on postoperative day 1. Patients with revision surgery and those with reinjury after reconstruction were excluded. In the ER group, retensioning and knot tying of the initially tightened adjustable loop were performed after the flip of the button and before the graft was fixed at the tibia. In the LR group, retensioning and knot tying were performed after initial tightening of the adjustable loop and graft fixation at the tibial side. The tunnel-graft gap measured on multiplanar reformatted images of MRI scans was compared between the groups, as were clinical outcomes.Results:The mean age of the patients at the time of surgery was 30.3 years (range, 14-61 years). ER and knot tying were performed in 56 patients and LR and knot tying in 45. Preoperative characteristics of the 2 groups showed no significant differences. The mean ± SD tunnel-graft gap was 1.5 ± 2.0 mm in the ER group and 5.4 ± 4.0 mm in the LR group (P < .001). There were no significant differences in clinical outcomes between the groups.Conclusion:ER and knot tying demonstrated less tunnel-graft gap than that of LR. However, there were no differences in clinical outcomes according to the timing of retensioning.

Totally Laparoscopic Pancreaticoduodenectomy: Comparison Between Early and Late Phase of an Initial Single-Center Learning Curve.

Despite recent advances in minimally invasive pancreatic surgery, laparoscopic pancreaticoduodenectomy (LPD) has not reach a wide diffusion, mainly due to its technical difficulty. Considering its potential benefits, efforts should be made to improve its adoption. Between January 2017 and March 2020, LPD was offered as the primary approach to all the patients with an indication to pancreaticoduodenectomy. The overall cohort was divided into two groups: the early group (EG), including the first 30 cases, and the late group (LG), with the remaining patients. Perioperative data were gathered from a prospectively collected database and retrospectively analyzed, comparing the short-term outcomes of the two groups. In the study period, 52 patients underwent LPD. Among these, 88.4% patients were preoperatively diagnosed with a malignant disease. No difference was found between EG and LG in terms of baseline characteristics, mean operative time, estimated blood loss, and conversion to laparotomy. The overall complication rate was 57.7%, with severe complications occurring in 14 patients (26.9%). Two patients (3.8%) deceased within 90days from the operation. No difference was found between EG and LG regarding postoperative outcomes. Among oncological patients, 86.7% received an R0 resection, and 13.3% had an R1 resection. The EG and LG did not differ in terms of oncological radicality and number of lymph nodes retrieved. LPD is a reproducible surgical technique that may provide acceptable results in both early and late phase of experience, when performed by surgical team with broad background in laparoscopic surgery.

The Vhambedzi origin and the expansion of Zimbabwe stone building tradition south of the Vhembe River

The Vhambedzi clan is one of the earlier Vhavenda sibs that settled south of the Limpopo (Vhembe) River before the arrival of the Masingo group that later conquered and subjugated them. The Masingo is the ruling elite of Venda. The Vhambedzi claim authorship and occupation of various Zimbabwe-type stone-walled sites (which the Masingo also occupied) in the eastern Soutpansberg area of South Africa. The Vhambedzi represents a segment of the earlier Vhavenda groups that predominantly settled south of the Vhembe River in an area known as Vhambedzi, extending to Tshituzi, Malungudzi (Marungudzi), and Hamatibi in southern Zimbabwe. The dominant legend states that Vhambedzi originated in Malungudzi. Conflicting justifications exist regarding this concern. Other counter-traditions associate them with other known earlier Vhavenda groups, the Vhangona. These earlier groups are autochthonous. The research for this article focused on unfamiliar Zimbabwe-type sites and oral legends clarifying the status of these sites concerning the known Vendaungubwe, Great Zimbabwe, Thulamela, Makahane, and Khami stone building traditions. The cultural continuity transcending the geographical divide, which the Vhambedzi represent, is of great significance.

Disability trajectories prior to death for ten leading causes of death among middle-aged and older adults in Taiwan

BackgroundProlonged life expectancy is associated with increased prevalence of chronic diseases. The aim of this study was to determine the different disability trajectories for the top ten leading causes of death in Taiwan .MethodsA total of 2,431 participants aged 50–96 in 1996 from the Taiwan longitudinal study on aging (TLSA) who died from 1996 to 2016 were analyzed. Integration of Cause of Death Data and TLSA helped sort out participants who had died from the ten leading causes of death. The level of physical disability was evaluated with the Activities of Daily Living Scale (ADLs), ranging from 0 to 6 points, in 1996, 1999, 2003, 2007, and 2011. A multilevel model was used to investigate the levels and rates of change in disability development before death.ResultsThe outcome of the research showed that the earliest group to experience physical limitation was individuals living with diabetes. The groups with the highest ADL scores were participants with diabetes, cerebrovascular disease, and hypertension-related diseases. Most groups reach ADL scores ≥ 1 (mild-level) during 4–6 years before death except chronic hepatitis and cirrhosis and injury.ConclusionsPeople who had died from the ten leading causes of death experienced different disability trajectories before death. The trajectory of the participants who had died from diabetes showed a unique pattern with the earliest occurrence and more severe deterioration in terms of development of disabilities. Disability trajectories provide a prediction of survival status for middle-aged and older adults associated with the ten leading causes of death.

The Enigma of the Hyksos, Volume 1: ASOR Conference Boston 2017—ICAANE Conference Munich 2018—Collected Papers

The Enigma of the Hyksos, Volume 1: ASOR Conference Boston 2017—ICAANE Conference Munich 2018—Collected Papers