Local Treatment Effect Research Articles

An integrated approach to secondary prevention of cervical intraepithelial neoplasia

Secondary prevention of cervical precancer is aimed at preventing recurrence of cervical intraepithelial neoplasia (CIN) after excisional treatment. Recurrence of CIN after surgical treatment occurs in 8.1–14.4% of cases, which increases the risk of developing cervical cancer (CC). Despite the high effectiveness of local surgical treatment of patients with high-grade intraepithelial lesions (HSIL), an increased risk of late diagnosis of cervical cancer has been proven in comparison with the risk in the general population. The review article presents current data on factors that increase the potential risk of recurrence of precancer. Human papillomavirus (HPV) persistence is considered one of the leading predictors of relapse of CIN2+, regardless of the type of excision treatment. The combination of persistent high-risk (HR) HPV and a positive sectional margin significantly increases the risk of persistent/recurrent CIN2+. A negative co-test after conization during follow-up contributes to a favorable prognosis and the development of HSIL is observed less frequently than in the population. Only an integrated approach, including detection of cervical HPV HR infection after excisional treatment of CIN, assessment of the radicality of resection and timely measures to eliminate ineffective treatment, as well as subsequent active monitoring of patients, allows avoiding its recurrence and progression of cervical precancer

Dynamics of the effect of local treatment on the frequency of nuclei with perinuclear vacuole in the cytogram of buccal epithelium in patients with the erosive and ulcerative form of the lichen planus in the oral cavity mucosa lining

INTRODUCTION. The use of cytologic studies allows evaluating the dynamics of the local treatment conducted of the EUF (L43.82) LP OCML (Erosive and Ulcerative Form of the Lichen Planus in the Oral Cavity Mucosa Lining) in a comprehensive way.AIM. Evaluation of the effect of local the effect of local treatment on the frequency of nuclei with perinuclear vacuole in the cytogram of buccal epithelium of the reticular mesh surface, hyperemic zone and erosive and ulcerative elements in patients with the erosive and ulcerative form of the flat lichen of the oral mucosa (L43.82).MATERIAL AND METHODS. 86 patients with the EUF (L43.82) LP OCML participated in the study. The number of nuclei with perinuclear vacuole was assessed in cytologic preparations obtained from buccal epithelium, which was a reliable criterion to confirm the nature of chronic inflammation. The dynamics of cells with necrosis in the cytogram of buccal epithelium was evaluated using nonparametric criteria as follows: Mann-Whitney test (comparison between subgroups and with the experimental group), Wilcoxon test (to compare within subgroups before and after treatment). Significant differences did not exceed 0.05.RESULTS. In the course of the treatment conducted in the cytogram of buccal epithelium there was a decrease in the frequency of nuclei with perinuclear vacuole of the reticular mesh surface and erosive and ulcerative elements in patients of the main clinical groups 1 and 2(p< 0.001). When analyzing the frequency of nuclei with perinuclear vacuole in the cytogram of buccal epithelium taken from the surface of erosions and ulcers, there were significant differences before and after treatment according to the Wilcoxon test. In the clinical group using the treatment method according to federal guidelines, the frequency of nuclei with perinuclear vacuole was observed at a significance level of p< 0.05, and when using the local treatment complex proposed respectively at p< 0.001.CONCLUSION. Thus, in the cytogram of buccal epithelium according to the Wilcoxon test before and after the local treatment proposed, there was a more evident decrease in the number of nuclei with perinuclear vacuole than with the use of federal guidelines.

Local Antimicrobial Therapy with Combined Aminoglycoside and Vancomycin Compared to Aminoglycoside Monotherapy in the Surgical Management of Osteomyelitis and Fracture-Related Infection.

We investigated the effect of combination aminoglycoside and vancomycin local antibiotic treatment compared to aminoglycoside alone in the surgical management of bone infection. Data including patient demographics, type of surgery, microbiological characteristics, BACH score, duration of antibiotic treatment and clinical outcomes were collected. Failure of therapy was a composite of recurrence of infection, continued or new antimicrobial therapy, or reoperation with suspected or confirmed infection at one year after index surgery. A total of 266 patients met the inclusion criteria. 252 patients reached the final follow-up and were included in the final analysis. 113 patients had treatment with aminoglycoside alone and 139 patients had combination aminoglycoside and vancomycin. There was no difference in the failure rate between groups; 10/113 (8.8%) in the aminoglycoside alone and 12/139 (8.6%) in the combination group, p = 0.934. Multivariate analysis showed that there was no added benefit of combination therapy (OR 1.54: 95% CI 0.59-4.04, p = 0.38). BACH score and low BMI were associated with increased risk of failure (BACH OR 3.49: 95% CI 1.13-10.76, p = 0.03; Low BMI OR 0.91: 95% CI 0.84-0.99, p = 0.037). The form of the carrier material (pellets or injectable paste) had no effect on failure rate (p = 0.163). The presence of aminoglycoside resistance had no effect on failure rate (OR 0.39: 95% CI 0.05-3.01, p = 0.37). Clinical outcome was not improved by the addition of vancomycin to aminoglycoside alone as local therapy for the management of bone infection.

Efficacy of Topical Anticholinergic in Control of Symptoms in Patients with Vasomotor Rhinitis and non-Vasomotor Rhinitis Patients and Normal Individuals. A Controlled Comparative Study

Abstract Background The use of a topical anticholinergic medication, ipratropium bromide, and its ability to inhibit methacholine and rhinitis-induced hypersecretion is emphasized. Ipratropium bromide appears to be both safe and effective in reducing this troublesome symptom. This study is designed to show the therapeutic effect of anticholinergic local treatment on nasal mucosa in patients with vasomotor rhinitis. Objective To assess the therapeutic effect of local anticholinergic treatment on nasal mucosa in patients with vasomotor rhinitis compared to non-vasomotor (allergic) patients and normal individuals, and if there any down regulation of the muscarinic receptors or not. Patients and Methods This prospective interventional study was conducted in Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University. This study was conducted on 60 cases. All patients were divided into 3 groups: Study group (1): includes 20 patients diagnosed clinically non allergic rhinitis suggestive to be vasomotor rhinitis. Study group (2): includes 20 patients diagnosed as allergic rhinitis. Study group (3): includes 20 patients performing surgery for non-vasomotor rhinitis non allergic causes (as septoplasty or rhinoplasty). Results Comparison between the pre and post SNOT questionnaire of symptoms among vasomotor group showed that there was a significant difference between the pre and post treatment SNOT questionnaire symptoms; Nasal obstruction, runny nose, post nasal drip, thick nasal discharge and lack of good night sleep. Among allergic cases group, there was a significant difference between the pre and post treatment immunohistochemistry findings considering epithelium, glands, arteries and veins. 20% of cases had grade 3 epithelium before treatment while after treatment, this was dropped to 0%. Comparison between the pre and post SNOT questionnaire of symptoms among allergic group showed that there was a significant difference between the pre and post treatment SNOT questionnaire symptoms; runny nose, post nasal drip, and thick nasal discharge. Among non- vasomotor rhinitis non allergic causes (as septoplasty or rhinoplasty) group, there was a significant difference between the pre and post treatment IHC findings considering epithelium, glands, and arteries, however no significant difference between the pre and post IHC veins grade. Also, there was no significant difference between the pre and post treatment SNOT questionnaire symptoms. Conclusion Topical anticholinergic such as ipratropium bromide nasal spray are effective in treating rhinorrhea symptoms in allergic and non-allergic rhinitis. Further controlled studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.

EFFECTIVENESS OF AUTOLOGOUS PLATELET-RICH PLASMA FOR HEALING DIABETIC FOOT ULCERS

Autologous platelet-rich plasma (APRP) is widely used to accelerate the healing of chronic wounds. However, the advisability of its use in patients with diabetic foot ulcers (DFU), which develop in various forms of the disease and are associated with complex metabolic conditions, is still being discussed. This study consisted in a comparative analysis of the effectiveness of local use of autologous platelet-rich plasma in the treatment of DFU in patients with neuropathic and neuroischemic forms of the disease. A total of 106 patients with type 2 diabetes mellitus undergoing hospital treatment were divided into a study group (n=48) and a traditional wound therapy group (n=58), similar in ankle-brachial index values ​​and ulcer size. Systemic therapy in both groups of patients included measures to regulate metabolism and nutrition, and infection control. Treatment results were assessed by the area of foot wounds and duration of healing. The duration of therapy and the mean platelet concentration in autologous plasma did not differ between groups. The wound healing time in patients with the neuropathic form (60.4±23.77 days) and the neuroischemic form of the disease (64.8±29.6 days) during treatment with APRP was significantly shorter than in the subgroups of the comparison group with traditional treatment of DFU (85.11±40.7 and 90.40±47.12 days respectively) (p<0.01), but there was no significant difference between the subgroups receiving treatment with APRP. Although there was no significant difference in the average daily healing area among all subgroups (p>0.05), the rate of wound healing in the subgroups with APRP was higher (14.85±10.66 and 15.33±14.91 mm2/day, respectively) than in the subgroups of the comparison group (8.39±6.02 and 8.79±7.13 mm2/day, respectively), which confirms the effectiveness of local treatment with APRP in combination with traditional systemic therapy.

Favorable prostate-specific antigen levels correlate with a worse prognosis in high-grade prostate cancer: a population-based analysis.

To compare the association between prostate-specific antigen (PSA) levels and prostate cancer-specific mortality (PCSM), and the effectiveness of local treatment in patients with high-grade and low-grade prostate cancer (PCa). This retrospective cohort study enrolled patients diagnosed with clinically localized PCa (cT1-4N0M0) from January 2010 to December 2020 in the Surveillance, Epidemiology and End Results (SEER) database. Fine-Gray competing risk regression analysis was conducted to generate cumulative incidence plots and estimate the hazards ratio (HR) and 95% confidence interval (95% CI) of PCSM. Multivariable restricted cubic spline (RCS) analysis was used to examine the non-linear associations of continuous values of PSA levels with PCSM. Inverse probability of treatment weighting (IPTW) was employed to minimize imbalances in baseline characteristics between different local treatment cohorts. A total of 392083 eligible patients were included in the study, including 327659 low-grade (Gleason score [GS]≤7) PCa and 64424 high-grade (GS≥8) PCa. In multivariate Fine-Gray competing risk regression analysis, using PSA levels of 4.1-10.0ng/ml as the reference, the adjusted HR among high-grade patients with PSA levels ≤2.5ng/ml, 2.6-4.0ng/ml, 10.1-20.0ng/ml and >20.0ng/ml were 1.988 (95% CI=1.677-2.358), 1.411 (95% CI=1.194-1.668), 1.472 (95% CI=1.351-1.603) and 2.506 (95% CI=2.318-2.709), respectively. Among low-grade PCa, the adjusted HR were 0.985 (95% CI=0.800-1.213), 0.727 (95% CI=0.602-0.877), 1.844 (95% CI=1.679-2.026) and 3.574 (95% CI=3.220-3.966), respectively. Multivariable-adjusted RCS analysis showed a U/J-shaped distribution relationship between PSA levels and PCSM in high-grade PCa, while there was a positive association between PSA levels and PCSM in low-grade PCa. As for local treatment effectiveness, radiation therapy (RT) provided better control of PCSM compared to radical prostatectomy (RP) and RP+RT in high-grade PCa, while RP provided better control of PCSM compared to RT and RP+RT in low-grade PCa. Low PSA level (≤2.5ng/ml) is significantly associated with very high risk of PCSM in high-grade localized PCa but not in low-grade localized PCa. High-grade localized PCa patients benefit more from RT in terms of PCSM control, while low-grade localized PCa patients benefit more from RP. High-grade localized PCa with low PSA level may be a unique subgroup that could benefit from novel risk stratification strategies in PCa, which requires further studies to investigate the potential of developing novel therapeutic strategies, prognostic tools, and clinical management approaches.

Investigation of Two Laser Heat Treatment Strategies for Local Softening of a Sheet in Age-Hardening Aluminum Alloy by Means of Physical Simulation

AbstractCar manufacturers increasingly aid high-strength aluminum alloys for their advantageous weight-to-strength ratio, but their limited formability poses challenges in plastic deformation processes. Tailored heat-treated blanks (THTBs) are a propitious approach to improve formability. Surface laser treatment is the predominant technology for obtaining THTB. To design this process quickly and accurately, without material waste, the use of physical simulation is increasingly promising. It allows replicating the process on a lab-scale and studying posttreatment mechanical and metallurgical properties. By adopting Gleeble® physical simulator, this study investigates the softening effects of local surface laser heat treatment on a EN AW 6082 T6 aluminum alloy blank. Two laser movement strategies—single linear path and multiple rectangular paths—were investigated at two treatment speeds for each. A finite element (FE) model was developed for simulating the process under all explored conditions. FE-derived thermal cycles were reproduced by means of physical simulation. After physical tests, alloy mechanical properties were evaluated. Results show that these properties depend on both the peak temperature thermal cycle and the interaction time between the laser source and the material surface. The comparison between the two strategies revealed that the multiple rectangular paths strategy allows to achieve a wider softened area at comparable interaction times.

Residual stress relief strategy in thick steel weldments via local induction heat treatment: Simulation and neutron diffraction experiment

This study investigated the effect of local induction post-weld heat treatment (PWHT) on residual stress relief in thick submerged arc welded steel plates. A combination of numerical and neutron diffraction methods was used to examine the effect of various PWHT parameters, such as annealing temperature and holding time, on the relief of residual stress in welded plates with various thicknesses. A sequentially coupled thermal–mechanical finite element model was used to calculate the residual stress distribution in welded AH36 steel plates before and after PWHT. The model was validated by comparing its predictions with the experimental measurements, and the results showed good agreement. The residual stress of the thick welded plates was effectively reduced via PWHT with local induction. The primary mechanism for this stress release was identified as stress relaxation caused by creep strain. Furthermore, a process map was established considering the PWHT conditions and plate geometry. This map provides a means of determining the optimal PWHT conditions to achieve desired stress reduction levels.

Local Alpha1-Antitrypsin Accelerates the Healing of Tympanic Membrane Perforation in Mice.

Most tympanic membrane (TM) perforations heal spontaneously, but 10%-20% remain chronic and might lead to impaired hearing and recurrent middle ear infections. Alpha1-antitrypsin (AAT) is a circulating tissue-protective protein that is elevated under inflammatory conditions and is currently indicated for genetic AAT deficiency. Recently, AAT has been shown to promote tissue remodeling and inflammatory resolution. This study aimed to examine the effects of local clinical-grade AAT treatment on tissue repair in a mouse model of acute traumatic TM perforation. Wild-type mice underwent unilateral TM perforation and were either left untreated or treated locally with human AAT (9 × 10-3 mL at 20 mg/mL on days 0, 1, and 2; n = 15/group). The perforations were evaluated macroscopically on a serial basis. Mice were sacrificed on various days post-injury, and TMs were excised for gene analysis by RT-PCR. There were no adverse reactions in hAAT-treated ears throughout the study period. Compared with untreated animals, TM closure occurred earlier in the treated group (days until full closure, median: 4 and 9, respectively). According to gene expression analysis, VEGF, TGFβ, and collagen-5A1 were induced earlier in AAT-treated mice (day 4-5 compared with day 9). Additionally, IL-10 expression levels were higher and IL-6 levels were lower in treated versus untreated mice. A local tissue environment rich in AAT promotes early tissue repair in a perforated TM model both macroscopically and molecularly. Studies are underway to examine TM functionality and recombinant AAT formulations for micro-dosing in the format of a single local application. NA Laryngoscope, 134:3802-3806, 2024.

The Effects of Local Treatment of PTH(1-34) and Whitlockite and Hydroxyapatite Graft to the Calvarial Defect in a Rat Osteoporosis Model.

With the aging population, there is a rising incidence of senile diseases, notably osteoporosis, marked by fractures, prolonged recovery, and elevated mortality rates, underscoring the urgency for effective treatments. In this study, we applied the method of absorbing parathyroid hormone (PTH), a treatment for osteoporosis, into graft materials. Two types of graft materials with different properties, whitlockite (WH) and hydroxyapatite (HAP), were used. After forming calvarial defects in osteoporotic rats, WH and HAP grafts were implanted, with PTH applied directly to the graft sites. Micro-CT analysis was employed to assess bone regeneration, while tissue sections were stained to elucidate the regeneration process and bone cell dynamics. The results showed that bone regeneration was higher in the grafts that were actively degraded by osteoclasts in the early stage of regeneration. When PTH was applied, osteoclast activity increased, leading to enhanced bone regeneration. Furthermore, the activation of osteoclasts resulted in the penetration and formation of new bone within the degraded graft, which exhibited higher osseointegration. Therefore, for osteoporotic bone defects, bone grafts that can be easily degraded by osteoclasts are more suitable. Additionally, treatment with PTH can activate osteoclasts around the bone graft in the early stages of regeneration, inducing higher bone regeneration and improving osseointegration.

Effect of Local Rapid Cooling Heat Treatment on Residual Stress of Pressure Vessel Inner Wall Welding Layer

Effect of Local Rapid Cooling Heat Treatment on Residual Stress of Pressure Vessel Inner Wall Welding Layer

Initial evaluation of the application of autologous protein gel in the treatment of extensive skin loss wounds

Objective: Develop a process and evaluate the effects of local treatment with protein gel on the patient’s skin graft wound. Subjects and methods: The case series study reported the results of treating skin loss wounds with protein gel application on 5 patients at the Department of Orthopedics and Traumatology - 7A Military Hospital from August 2023 to November 2023. Results: At the time of removing the skin graft bandage (day 7), a very good adhesion rate of the skin graft to the graft base was recorded (from 92-97%). After 2 weeks of transplantation, the graft skin adhesion rate reached 97-100%. By 4 weeks after transplantation, the grafted skin adhered 100% to the graft base in all 5 patients and all patients reported good results after skin grafting. Conclusion: The use of protein gel in the skin grafting process increases the adhesion of the grafted skin, reduces pain, reduces exudate at the wound, and increases the survival rate of the grafted skin.

A computational approach to identification of treatment effects for policy evaluation

For counterfactual policy evaluation, it is important to ensure that treatment parameters are relevant to policies in question. This is especially challenging under unobserved heterogeneity, as is well featured in the definition of the local average treatment effect (LATE). Being intrinsically local, the LATE is known to lack external validity in counterfactual environments. This paper investigates the possibility of extrapolating local treatment effects to different counterfactual settings when instrumental variables can be only binary. We propose a novel framework to systematically calculate sharp nonparametric bounds on various policy-relevant treatment parameters that are defined as weighted averages of the marginal treatment effect (MTE). Our framework is flexible enough to fully incorporate statistical independence (rather than mean independence) of instruments and a large menu of identifying assumptions beyond the shape restrictions on the MTE that have been considered in prior studies. We apply our method to understand the effects of medical insurance policies on the use of medical services.

Effects of local and systemic treatment with human natural killer-1 mimetic peptide (HNK-1) after ventral root avulsion and reimplantation in mice.

Spinal ventral root injuries generate significant motoneuron degeneration, which hinders full functional recovery. The poor prognosis of functional recovery can be attributed to the use or combination of different therapeutic approaches. Several molecules have been screened as potential treatments in combination with surgical reimplantation of the avulsed roots, the gold standard approach for such injuries. Among the studied molecules, human natural killer-1 (HNK-1) stands out as it is related to the stimulation of motor axon outgrowth. Therefore, we aimed to comparatively investigate the effects of local administration of an HNK-1 mimetic peptide (mp-HNK-1) and systemic treatment with ursolic acid (UA), another HNK-1 mimetic, after ventral root avulsion and reimplantation with heterologous fibrin biopolymer (HFB). Female mice of the isogenic strain C57BL/6JUnib were divided into five experimental groups: Avulsion, Reimplantation, mp-HNK-1 (in situ), and UA (systemic treatment). Mice were evaluated 2 and 12 weeks after surgery. Functional assessment was performed every four days using the Catwalk platform. Neuronal survival was analyzed by cytochemistry, and glial reactions and synaptic coverage were evaluated by immunofluorescence. Treatment with UA elicited long-term neuroprotection, accompanied by a decrease in microglial reactions, and reactive astrogliosis. The neuroprotective effects of UA were preceded by increased glutamatergic and GABAergic inputs in the ventral spinal cord two weeks after injury. However, a single application of mp-HNK-1 had no significant effects. Functional analysis showed that UA treatment led to an improvement in motor and sensory recovery. Overall, the results indicate that UA is neuroprotective, acting on glial cells and synaptic maintenance, and the combination of these findings led to a better functional recovery.

Local Treatment and Treatment-Related Adverse Effects Among Patients With Advanced Prostate Cancer

Recent data suggest that local treatment with radical prostatectomy or radiation may improve survival outcomes in men with advanced prostate cancer. However, evidence is lacking on treatment-related adverse effects among men with advanced prostate cancer. To assess the association of local treatment on treatment-related adverse effects among men diagnosed with advanced prostate cancer. This cohort study assessed men diagnosed with advanced prostate cancer (defined as T4, N1, and/or M1 prostate cancer) between January 1, 1999, and December 31, 2013, with follow-up through December 31, 2021, who were treated at Veterans Health Administration medical centers. Local treatment with radical prostatectomy or radiation. Main outcomes were treatment-related adverse effects, including constitutional, gastrointestinal, pain, sexual function, and urinary function conditions, at 3 intervals after initial treatment (≤1 year, >1 to ≤2 years, and >2 to ≤5 years) after initial treatment. This cohort study consisted of 5502 men (mean [SD] age, 68.7 [10.3] years) diagnosed with advanced prostate cancer. Of the cohort, 1705 men (31.0%) received local treatment. There was a high prevalence of adverse conditions in men receiving both local and nonlocal treatment, and these adverse conditions persisted for more than 2 years to 5 years or less after initial treatment. A total of 916 men (75.2%) with initial local treatment and 897 men (67.1%) with initial nonlocal treatment reported the presence of at least 1 adverse condition for more than 2 years to 5 years or less after initial treatment. In the first year, local treatment (vs nonlocal) was associated with adverse gastrointestinal (multivariable-adjusted odds ratio [AOR], 4.08; 95% CI, 3.06-5.45), pain (AOR, 1.57; 95% CI, 1.35-1.83), sexual (AOR, 2.96; 95% CI, 2.42-3.62), and urinary (AOR, 2.25; 95% CI, 1.90-2.66) conditions. Local treatment (without secondary treatment) remained significantly associated with adverse gastrointestinal (AOR, 2.39; 95% CI, 1.52-3.77), sexual (AOR, 3.36; 95% CI, 2.56-4.41), and urinary (AOR, 1.39; 95% CI, 1.09-1.78) conditions at more than 2 years to 5 years or less after treatment. In this cohort study of men with advanced prostate cancer, local treatment was associated with persistent treatment-related adverse effects across multiple domains. These results suggest that patients and clinicians should consider the adverse effects of local treatment when making treatment decisions in the setting of advanced prostate cancer.

Design and Analysis of Clustered Regression Discontinuity Designs for Probing Mediation Effects

Prior research has suggested that clustered regression discontinuity designs are a formidable alternative to cluster randomized designs because they provide targeted treatment assignment while maintaining a high-quality basis for inferences on local treatment effects. However, methods for the design and analysis of clustered regression discontinuity designs have not been fully developed to address the array of core effects (e.g., main, moderation and mediation) typically examined in education studies. In this study, we complement prior design literature by developing principles of estimation, sampling variability, and closed-form expressions to predict the statistical power to detect mediation effects in clustered regression discontinuity designs. The results suggest that sample sizes typically seen in educational intervention studies (e.g., about 50 schools) can be sufficient to detect a mediation effect under some conditions when studies are carefully designed. We implement the results in software and a Shiny App (BLINDED FOR REVIEW).

Identification of multi-valued treatment effects with unobserved heterogeneity

In this paper, we establish sufficient conditions for identifying treatment effects on continuous outcomes in endogenous and multi-valued discrete treatment settings with unobserved heterogeneity. We employ the monotonicity assumption for multi-valued discrete treatments and instruments, and our identification condition has a clear economic interpretation. In addition, we identify the local treatment effects in multi-valued treatment settings and derive closed-form expressions of the identified treatment effects. We provide examples to illustrate the usefulness of our result.

Efficacy of local treatment for isolated liver metastasis after pancreatectomy in pancreatic ductal adenocarcinoma: A propensity score-matched analysis.

Although attempts of local treatment for isolated liver recurrence in patients with pancreatic ductal adenocarcinoma (PDAC) have increased, the efficacy remains unclear. Therefore, we aimed to evaluate the effect of local treatment for recurrent liver lesions after pancreatectomy on the survival of patients with PDAC. Patients who were diagnosed with isolated liver recurrence after pancreatectomy at a high-volume center were included. We classified these patients based on the treatment options after recurrence and performed propensity score matching to minimize confounding. Median with interquartile range survival after recurrence was significantly longer for patients who underwent local treatment for recurrent liver lesions plus chemotherapy (22.0 [17.0-29.0] months) than those treated with chemotherapy alone (13.0 [7.0-21.0] months, p = .027). In multivariate analysis, not only local treatment for recurrent liver lesions plus chemotherapy (hazard ratio [95% confidence interval], 0.55 [0.32-0.94]; p = .030) but also indicators for systemically controlled tumor such as late recurrence (0.57 [0.35-0.92]; p = .021), chemotherapy for ≥6 months (0.25 [0.15-0.42]; p < .001), and disease control by chemotherapy (0.36 [0.22-0.60]; p < .001) were identified as favorable prognostic factors. PDAC patients with stable recurrent liver lesions should be considered a candidate for local treatment.

Effect of Local Laser Treatment on the Strengthening of Thin-Walled Structures Fabricated from Non-Alloy Steel.

This paper describes the development of new metal-processing technologies that enable the control and improvement of the microstructure and properties of metals. This study investigates the impact of one such technology, laser treatment, on the surface of a thin sheet of non-alloy structural steel. This research aims to address a crucial challenge in expanding the industrial applications of thin-sheet steel products by developing a laser processing technology to create structural strengthening ribs, which can significantly influence the overall strength and stiffness of metal components.

The impact of COVID-19 on the interpretation of psycho-oncological support trial results: a quasi-experimental approach using the data from the new form of care “Integrated cross-sectoral psycho-oncology (nFC-isPO)”

ObjectiveIn addition to the common difficulties of ongoing trials, the COVID-19 pandemic posed several challenges to scientists worldwide and created an additional burden for vulnerable patient groups. In the nFC-isPO of individualised treatment for anxiety and depression in newly diagnosed patients with cancer caregivers (e.g. psycho-oncologists) reported elevated HADS scores in newly enrolled patients after the outbreak of the COVID-19 pandemic. Accordingly, the question arises whether the pandemic affected HADS scores. Therefore, stratified analyses by the time of enrolment (T1) were performed for patients with 12 months of care (T3).MethodsPatients with 12 months of care (N = 1,140) were analysed. A comparison within the regression discontinuity design according to the time points at which patients completed the baseline (T1) HADS questionnaire was conducted to examine differences between patients recruited before Q2/2020 (pre-pandemic) and after the coronavirus outbreak. Furthermore, mean HADS scores at T1 and T3 for all quarters during the study were compared.ResultsMean T1 and T3 HADS scores of patients with cancer during the pandemic are only slightly higher than those of the pre-pandemic group. No significant treatment effect was observed in either the pre-pandemic (p = 0.5495, Late = 1.7711) or the post-pandemic group (p = 0.9098, LATE=-0.2933). In contrast, the average local treatment effect in the post-pandemic group suggests a minimal decrease in HADS score in the predefined range and thus a positive treatment effect for isPO. Comparison of mean HADS scores at T1 and T3 did not show a large increase by pandemic-related timepoints, however, a decrease of approximately 2–3 points over each quarter at 12 months compared to baseline is observed.ConclusionThe existing nFC-isPO care is resilient to crisis and may counteract external influences such as the Corona pandemic. Accordingly, the pandemic had little influence on the fears of patients with cancer in the nFC-isPO. This emphasises that psycho-oncology is vital for the reduction of stress, anxiety and depression in patients with cancer.Trial RegistrationThe study was registered in the German Clinical Trials Registry on 30 October 2018 under the ID “DRKS00015326”.