Selection Of Treatment Modalities Research Articles

Comparative effects of direct plasma treatment and plasma-activated media on B16F10 cancer cells using a multipoint surface dielectric barrier discharge system

Abstract Cancer remains a leading cause of mortality worldwide, necessitating novel, effective, and selective therapies. Cold Atmospheric Plasma (CAP) generates reactive species that can selectively kill tumor cells while sparing healthy tissue. We developed a multipoint Surface Dielectric Barrier Discharge (SDBD) plasma system capable of simultaneously treating all wells in a 24-well plate, enhancing experimental throughput and consistency. We investigated both direct plasma treatment and indirect effects via plasma-activated media (PAM) on the viability of B16F10 melanoma cells and L929 fibroblasts. Characterizations confirmed uniform plasma generation and safe operating temperatures suitable for cell applications. Physicochemical analyses of PAMs showed time-dependent changes in pH, oxidation-reduction potential, and conductivity, indicating the generation of reactive species like nitrite, nitrate, and hydrogen peroxide. Cytotoxicity assays demonstrated that both direct plasma treatment and PAM significantly reduced melanoma cell viability, with direct treatment causing a more pronounced effect. After 3 minutes of direct exposure, melanoma cell viability decreased to approximately 30% after 24 hours and further to 13% after 48 hours. In contrast, healthy L929 fibroblasts remained largely unaffected under both treatment conditions. These results suggest that both short-lived and long-lived reactive species contribute to the selective cytotoxic effects observed in cancer cells. The multipoint SDBD plasma system shows potential as a selective anticancer treatment modality, effective through both direct plasma exposure and the application of PAM, offering a promising avenue for future cancer therapies.

Analysis of treatment methods and relapse factors of postoperative anastomotic stenosis in colorectal cancer.

Anastomotic stenosis following surgical intervention for colorectal cancer is a frequently encountered complication. Nevertheless, the optimal approach to effectively manage anastomotic stenosis at varying distances from the anal margin remains uncertain. The primary objective of this research endeavor was to explore the risk factors associated with recurrent anastomotic stenosis subsequent to colorectal cancer surgery, as well as to evaluate potential strategies for its management. The present study retrospectively analyzed the clinical data and treatment outcomes of 244 patients who underwent colorectal surgery and were subsequently diagnosed with anastomotic stenosis. The patients were categorized into two groups based on the location of anastomotic stenosis relative to the anal verge: the low anastomotic stenosis group (n = 107) and the high anastomotic stenosis group (n = 137). The severity of anastomotic stenosis was found to be significantly higher in the low anastomotic stenosis group compared to the high anastomotic stenosis group (71.0% vs 57.7%, P = 0.031). Furthermore, the high anastomotic stenosis group exhibited a greater inclination toward opting for endoscopic treatment when it came to the choice of treatment for anastomotic stenosis (62.8% vs 27.1%, P < 0.001). In addition, logistic regression analysis showed that stenosis length ≥ 0.8cm (odds ratio = 0.481; 95% CI = 0.248-0.936; P = 0.031) and lymph node metastasis (OR = 0.559, 95%CI = 0.313-0.998, P = 0.049) were independent risk factor for recurrence of anastomotic stenosis. Finally further build colorectal surgery of tumor recurrent anastomotic stenosis nomogram prediction model, using the internal validation and calculation model of the receiver-operating characteristic curve (ROC) area under curve (AUC) to evaluate the reliability and accuracy of the model. There exist variations in the severity of anastomotic stenosis, the extent of stenosis, and the selection of treatment modalities across different anatomic locations. Regarding the choice of anastomotic treatment, patients with elevated anastomotic stenosis exhibited a preference for endoscopic intervention. Furthermore, a multivariate analysis showed that stenosis length equal to or greater than 0.8cm and lymph node metastasis were autonomous risk factors for recurrence of benign stenosis after colorectal cancer surgery.

Comparative effectiveness of kilo- and megavoltage energies in low-dose radiotherapy for painful degenerative musculoskeletal diseases: asystematic review and meta-analysis.

This study aimed to assess the impact of different energy levels on the effectiveness of low-dose radiotherapy (LDRT) for treating painful degenerative musculoskeletal diseases, as comparative efficacy data are currently lacking. Asystematic review was conducted in PubMed, Embase, and the Cochrane Library databases to identify studies with response information on the energy used (kilovoltage [kV] vs. megavoltage [MV]). The primary endpoint was the overall response rate (ORR), and the secondary endpoint was the complete response rate (CRR). Exploratory subgroup analyses included treatment site, study period, study design, country, and dose per fraction. Atotal of 33studies involving 12,143patients were analyzed. Short-term follow-up (up to 6months) showed apooled ORR of 64% (95% CI 46-78%) for kV and of 62% (95% CI 54-70%) for MV. Long-term follow-up (at least 12months) revealed apooled ORR of 85% (95% CI 65-95%) for kV and of 69% (95% CI 62-75%) for MV. Subgroup analysis indicated no significant differences in ORR for energy level stratified by treatment site and other factors. Regarding dose per fraction (0.5 Gy vs.1.0 Gy), comparable ORRs were demonstrated between the two energies. No clinical side effects were noted. This meta-analysis suggests that the known effectiveness of LDRT in painful degenerative musculoskeletal disease may not depend on the energy used. Additional studies using standardized evaluation methods are warranted to establish consistency and enhance the comprehensiveness of research. Further research is also needed to explore treatment modality selection considering disease-specific biology.

Congenitally Missing Lateral Incisors: Prioritizing Space Closure Whenever Feasible.

Congenital missing teeth are among the most prevalent dental malformations. Maxillary lateral incisors are particularly prone to agenesis, often missing bilaterally. This condition presented complex challenges for both patients and clinicians. The etiology of maxillary lateral incisor agenesis is multifactorial, involving genetic and environmental factors. The management is also inherently complex, necessitating an interdisciplinary approach. Treatment options include orthodontic space closure, resin-bonded bridges, implants, removable partial dentures, and autotransplantation. Among these, implant placement and orthodontic space closure are most commonly preferred by clinicians. The selection of an appropriate treatment modality depends on multiple factors, such as patient growth, available space, condition of adjacent teeth, and initial malocclusion. This review aimed to evaluate and compare various treatment options for maxillary lateral incisor agenesis, providing a comprehensive analysis of the latest evidence and highlighting the benefits and limitations of each approach to inform clinical decision-making.

QLTI-13. A REVIEW OF THE BEST TREATMENT STRATEGY FOR NEUROFIBROMATOSIS TYPE 2 PATIENTS THROUGH A SINGLE-CENTER RETROSPECTIVE STUDY: HOW TO ORCHESTRATE MULTIMODAL TREATMENT OPTIONS

Abstract PURPOSE Neurofibromatosis type 2(NF2) is an autosomal-dominant tumor predisposition syndrome that affects the whole neuro-axis and causes various neurological symptoms decreasing the quality of life throughout the patient’s lifespan. However, due to the diversity of related diseases and the complexity of treatment, there are many cases in which only partial treatments are performed, the timing of the treatment is missed, and inappropriate treatment modality selection is made despite the intervention of many clinicians. Therefore, to increase the overall understanding of the disease, the single-institution experience was analyzed. MATERIALS AND METHODS Between 1998 and 2022, a total of 80 patients who clinically suspected NF2 visited our Brain Tumor Center. After excluding the patients with follow-up loss, the remaining 48 patients were finally analyzed. The patient’s symptoms, diagnosis process, treatment process, and outcomes were analyzed. RESULTS The average age at the time of symptom onset was 31.0(2-63) year-old. Hearing impairment was the major primary symptom(46.8%) among the patients. Five patients(10.9%) had family history of NF2. Thirty-five patients(76.1%) was clinically diagnosed as a NF2 for the bilateral vestibular schwannomas, and 34 patients(73.9%) had intracranial meningiomas, and 37 patients(80.4%) had spinal lesions at the time of diagnosis. Eleven patients were genetically confirmed as NF2. For vestibular schwannomas, 16 patients had surgical resection and 20 patients took gamma-knife surgery as a primary or secondary treatment. For intracranial meningiomas, 16 patients had surgical resection, 13 patients took gamma-knife surgery, and 15 patients took conventional radiation therapy as a primary or secondary treatment. Ventriculo-peritoneal shunt due to increased intracranial pressure was performed in 4 patients(8.7%). For spinal lesions, 16 patients had surgical resection. CONCLUSION NF2 is a disease group requiring a multidisciplinary team approach. The key to treatment is to set and implement a treatment sequence and method tailored to each patient. For this, an overall understanding of the disease and the treatment options is essential.

Stratified Care in Cognitive Behavioural Therapy: A Comparative Evaluation of Predictive Modelling Approaches for Individualized Treatment: La stratification des soins pour l'orientation vers une thérapie cognitivo-comportementale: une évaluation comparative des approches de modélisation prédictive pour un traitement individualisé.

In response to high demand and prolonged wait times for cognitive behavioural therapy (CBT) in Ontario, Canada, we developed predictive models to stratify patients into high- or low-intensity treatment, aiming to optimize limited healthcare resources. Using client records (n = 953) from Ontario Shores Centre for Mental Health Sciences (January 2017-2021), we estimated four binary outcome models to assign patients into complex and standard cases based on the probability of reliable improvement in Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. We evaluated two choices of cut-offs for patient complexity assignment: models at an ROC (receiver operating characteristic)-derived cut-off and a 0.5 probability cut-off. Final model effectiveness was assessed by assigning treatment intensity (high-intensity or low-intensity CBT) based on the combined performance of both GAD-7 and PHQ-9 models. We compared the treatment assignment recommendations provided by the models to those assigned by clinical assessors. The predictive models demonstrated higher accuracy in selecting treatment modality compared to provider-assigned treatment selection. The ROC cut-off achieved the highest prediction accuracy of case complexity (0.749). The predictive models exhibited large sensitivity and specificity trade-offs (which influence the rates of patient assignment to high-intensity CBT) despite having similar accuracy statistics (ROC cut-off = 0.749, 0.5 cut-off = 0.690), emphasizing the impact of cut-off choices when implementing predictive models. Overall, our findings suggest that the predictive model has the potential to improve the allocation of CBT services by shifting incoming clients with milder symptoms of depression to low-intensity CBT, with those at highest risk of not improving beginning in high-intensity CBT. We have demonstrated that models can have significant sensitivity and specificity trade-offs depending on the chosen acceptable threshold for the model to make positive predictions of case complexity. Further research could assess the use of the predictive model in real-world clinical settings. Stratified Care in Cognitive Behavioural Therapy: A Comparative Evaluation of Predictive Modeling Approaches for Individualized Treatment.

Abstract 041: Comparative Analysis of Radiographic Vasospasm, Clinical Vasospasm, and Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: Clipping, Sole Coiling, and Stenting/Stent‐Assisted Coiling

Introduction Aneurysmal subarachnoid hemorrhage (SAH) is a critical condition with a high risk of complications, including radiographic vasospasm, clinical vasospasm, and delayed cerebral ischemia (DCI), which significantly affect patient outcomes. To manage these risks, various aneurysm treatments—clipping, sole coiling, and stenting/stent‐assisted coiling—are employed. Stenting, which often involves antiplatelet therapy, might reduce the risk of DCI. This study aims to compare the risks of radiographic vasospasm, clinical vasospasm, and DCI among these treatment modalities to provide insight into their relative effectiveness. Methods A systematic search across four electronic databases, with no language restrictions, was conducted to identify studies comparing clipping, sole coiling, and stenting/stent‐assisted coiling for aneurysmal SAH. Radiographic vasospasm is defined as arterial narrowing on imaging, clinical vasospasm as neurological deficits due to cerebral ischemia, and DCI as new, sustained neurological deficits not attributed to other causes. A subgroup meta‐analysis was performed, and risk ratios (RR) were calculated to compare these treatment modalities. Results Of the 966 studies screened, 394 underwent full‐text review, and 91 were included, comprising 15,174 patients: 7,454 in the clipping group, 10,105 in the coiling group, and 513 in the stenting group. The overall incidence of clinical vasospasm was 35% [95% CI: 29‐41%], with 36% [95% CI: 26‐46%] in clipping, 35% [95% CI: 27‐42%] in coiling, and 34% [95% CI: 3‐64%] in stenting (p = 0.96). Radiographic vasospasm occurred in 42% [95% CI: 30‐54%] overall, with 51% [95% CI: 32‐71%] in clipping, 37% [95% CI: 13‐60%] in coiling, and 34% [95% CI: 3‐64%] in stenting (p = 0.96). The incidence of DCI was 23% [95% CI: 17‐28%] overall, with 27% [95% CI: 19‐36%] in clipping, 17% [95% CI: 11‐24%] in coiling, and 23% [95% CI: 5‐42%] in stenting (p = 0.13). Comparative analyses revealed that the risk of radiographic vasospasm was significantly higher in the clipping group compared to the coiling group (RR: 1.13 [95% CI: 0.89‐1.44], p = 0.04). Similarly, the risk of DCI was also significantly higher in the clipping group than in the coiling group (RR: 1.30 [95% CI: 0.83‐2.05], p &lt; 0.01). In contrast, the risk of clinical vasospasm was significantly lower in the stenting group compared to the coiling group (RR: 1.67 [95% CI: 0.45‐6.14], p = 0.01). Conclusion This analysis found that clipping is associated with a higher risk of radiographic vasospasm and DCI compared to coiling. In contrast, stenting demonstrated a lower risk of clinical vasospasm compared to coiling, likely due to the benefits of antiplatelet therapy. These findings underscore the need to consider specific complication risks when selecting treatment modalities for aneurysmal SAH. Further research is warranted to optimize treatment strategies.

Surgical Resection Followed by Stereotactic Radiosurgery (S+SRS) Versus SRS Alone for Large Posterior Fossa Brain Metastases: A Comparative Analysis of Outcomes and Factors Guiding Treatment Modality Selection.

Around 20% of cancer patients will develop brain metastases (BrMs), with 15-25% occurring in the posterior fossa (PF). Although the effectiveness of systemic therapies is increasing, surgery followed by stereotactic radiosurgery (S+SRS) versus definitive SRS remains the mainstay of treatment. Given the space restrictions within the PF, patients with BrMs in this location are at higher risk of brainstem compression, hydrocephalus, herniation, coma, and death. However, the criteria for treating large PF BrMs with S+SRS versus definitive SRS remains unclear. We reviewed a prospective registry database (2009 to 2020) and identified 64 patients with large PF BrMs (≥4 cc) treated with SRS or S+SRS. Clinical and radiological parameters were analyzed. The two endpoints were overall survival (OS) and local failure (LF). Patients in the S+SRS group were more highly symptomatic than patients in the SRS group. Gait imbalance and intracranial pressure symptoms were 97% and 80%, and 47% and 35% for S+SRS and SRS, respectively. Radiologically, there were significant differences in the mean volume of the lesions [6.7 cm3 in SRS vs. 29.8 cm3 in the S+SRS cohort, (p < 0.001)]; compression of the fourth ventricle [47% in SRS vs. 96% in S+SRS cohort, (p < 0.001)]; and hydrocephalus [0% in SRS vs. 29% in S+SRS cohort, (p < 0.001)]. Patients treated with S+SRS had a higher Graded Prognostic Assessment (GPA). LF was 12 and 17 months for SRS and S+SRS, respectively. Moreover, the S+SRS group had improved OS (12 vs. 26 months, p = 0.001). A higher proportion of patients treated with S+SRS presented with hydrocephalus, fourth-ventricle compression, and larger lesion volumes. SRS-alone patients had a lower KPS, a lower GPA, and more brain metastases. S+SRS correlated with improved OS, suggesting that it should be seriously considered for patients with large PF-BrM.

Real-world Decision-making Process for Stereotactic Body Radiotherapy Versus Minimally Invasive Surgery in Early-stage Lung Cancer Patients.

To generate a prediction model for selection of treatment modality for early-stage non-small cell lung cancer (NSCLC). Stereotactic body radiotherapy (SBRT) and minimally invasive surgery (MIS) are used in the local treatment of early-stage NSCLC. However, selection of patients for either SBRT or MIS remains challenging, due to the multitude of factors influencing the decision-making process. We analyzed 1291 patients with clinical stage I NSCLC treated with intended MIS or SBRT from January 2020 to July 2023. A prediction model for selection for SBRT was created based on multivariable logistic regression analysis. The receiver operating characteristic curve analysis stratified the cohort into 3 treatment-related risk categories. Post-procedural outcomes, recurrence and overall survival (OS) were investigated to assess the performance of the model. In total, 1116 patients underwent MIS and 175 SBRT. The prediction model included age, performance status, previous pulmonary resection, MSK-Frailty score, FEV1 and DLCO, and demonstrated an area-under-the-curve of 0.908 (95%CI, 0.876-0.938). Based on the probability scores (n=1197), patients were stratified into a low-risk (MIS, n=970 and SBRT, n=28), intermediate-risk (MIS, n=96 and SBRT, n=53) and high-risk category (MIS, n=10 and SBRT, n=40). Treatment modality was not associated with OS (HR of SBRT, 1.67 [95%CI: 0.80-3.48]; P=0.20). Clinical expertise can be translated into a robust predictive model, guiding the selection of stage I NSCLC patients for MIS versus SBRT and effectively categorizing them into three distinct risk groups. Patients in the intermediate category could benefit most from multidisciplinary evaluation.

Machine learning based androgen receptor regulatory gene-related random forest survival model for precise treatment decision in prostate cancer

BackgroundIt has been demonstrated that aberrant androgen receptor (AR) signaling contributes to the pathogenesis of prostate cancer (PCa). To date, the most efficacious strategy for the treatment of PCa remains to target the AR signaling axis. However, numerous PCa patients still face the issue of overtreatment or undertreatment. The establishment of a precise risk prediction model is urgently needed to distinguish patients with high-risk and select appropriate treatment modalities. MethodsIn this study, a consensus AR regulatory gene-related signature (ARS) was developed by integrating a total of 101 algorithm combinations of 10 machine learning algorithms. We evaluated the value of ARS in predicting patient prognosis and the therapeutic effects of the various treatments. Additionally, we conducted a screening of therapeutic targets and agents for high-risk patients, followed by the verification in vitro and in vivo. ResultsARS was an independent risk factor for biochemical recurrence and distant metastasis in PCa patients. The enhanced and consistent prognostic predictive capability of ARS across various platforms was confirmed when compared with 44 previously published signatures. More importantly, PCa patients in the ARShigh group benefit more from PARP inhibitors and immunotherapy, while chemotherapy, radiotherapy, and AR-targeted therapy are more effective for ARSlow patients. The results of in silico screening suggest that AURKB could potentially serve as a promising therapeutic target for ARShigh patients. ConclusionsCollectively, this prediction model based on AR regulatory genes holds great clinical translational potential to solve the dilemma of treatment choice and identify potential novel therapeutic targets in PCa.

Efficacy and Clinical Outcome of Single and Combined Therapies for Refractory Meibomian Gland Dysfunction: Probing, Intense Pulsed Light, and Thermal Pulsation Treatments

Background: Refractory meibomian gland dysfunction (MGD) is a prevalent condition characterized by chronic functional abnormalities of the meibomian glands, leading to altered tear film and ocular discomfort despite medical treatments. Traditional management strategies include various single-modality treatments, although there is growing interest in the efficacy of combined therapies. Aim: The aim of this study was to evaluate the efficacy of regimens used individually and in combination for the treatment of refractory MGD. Methods: This retrospective study involved pre- and posttreatment evaluations of the ocular surface and symptoms in patients with refractory MGD. Treatments included meibomian gland probing (MGP), intense pulsed light (IPL) therapy, thermal pulsation (LipiFlow), IPL + MGP, and MGP + LipiFlow. Results: In total, 325 eyes of 241 patients with refractory MGD were assessed. The MGP group showed significant improvements in the ocular surface disease index (OSDI), tear meniscus height (TMH), corneal and conjunctival staining, lid wiper epitheliopathy (LWE), and meibomian gland expression (MGX) score. The IPL group showed significant improvements in OSDI, TMH, redness, conjunctival staining, and MGX score. IPL + MGP resulted in significant improvements in corneal and conjunctival staining, LWE, and MGX score, while LipiFlow significantly improved conjunctival staining, LWE, and MGX score. No significant improvements were observed in the MGP + LipiFlow group. Conclusion: IPL or MGP alone could alleviate the signs and symptoms of refractory MGD, while LipiFlow and IPL + MGP could improve the ocular surface parameters. However, no significant improvements were observed with MGP + LipiFlow. These findings provide a valuable guide for ophthalmologists for the selection of effective treatment modalities for refractory MGD, suggesting a potential advantage of combined IPL + MGP to maximize therapeutic benefits.

Cutaneous Squamous Cell Carcinoma of the Head and Neck: Pathological Features and What They Mean for Prognosis and Treatment.

Cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers worldwide, with an incidence that has increased over the past 30 years. Although usually curable with excision, cSCC can become widely metastatic and aggressive with poor outcomes. Whereas the clinical and radiographic extent of any cancer will always guide selection of treatment modality, pathological features of cSCC also play an important role in determining prognosis and, subsequently, the need for further therapy. Therefore, reviewing and summarizing the current literature regarding pathological prognostic indicators of cSCC is essential to improving clinical outcomes. The present literature review yielded depth of invasion, surgical margins, perineural invasion, extranodal extension, lymphovascular invasion, tumor grade, tumor subtype, premalignant lesions, and molecular markers as key prognostic indicators, all with varying recommendations for adjuvant therapy. Notably, some of these factors have not been incorporated into either the American Joint Committee on Cancer staging system (8th edition) or National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for cSCC. This review highlights a need for further research into these prognostic indicators and their role in determining the need for adjuvant treatment in head and neck cSCC.

Optimization of treatment strategies for elderly patients with advanced non-small cell lung cancer.

Lung cancer stands as a malignant neoplasm bearing the highest burden of morbidity and mortality within the elderly population on a global scale. Among the lung cancer subtypes, non-small cell lung cancer (NSCLC) prevails as the most prevalent. As age advances, elderly patients often present with an increased prevalence of comorbidities, diminished organ reserve function, and alterations in drug pharmacokinetics, including absorption, distribution, metabolism, and clearance. These factors collectively contribute to a reduction in their capacity to tolerate therapeutic interventions. Regrettably, there exists a paucity of research data and evidence regarding the management of elderly patients afflicted by advanced lung cancer. This article endeavors to compile and elucidate strategies for the enhancement of treatment approaches, with the aim of aiding clinical decision-making. Prior to the selection of clinical treatment modalities for elderly patients with advanced NSCLC, a comprehensive assessment should be conducted, taking into account various facets, including tumor characteristics, patient age, physiological status, and the presence of comorbidities. The treatment strategy should be implemented in a tiered fashion, thereby affording the opportunity for the tailoring of individualized therapeutic approaches for elderly patients afflicted by advanced NSCLC. The demographic of elderly patients confronting advanced NSCLC presents a complex landscape marked by intricate underlying conditions, necessitating the imperative optimization of treatment strategies.

Demographic profile of thyroid malignancies in a tertiary care centre in South India

: Thyroid carcinomas were significantly on the rise all over the world, with 5.86 lakh new cases and 43,664 deaths reported in 2020. In this study, we focused on a detailed analysis pertaining to the incidence and demographic profile of all histological types of thyroid malignancies. : All cases of thyroid carcinomas reported in the department of Pathology at a tertiary care center in South India from January 2016-December 2020 were included in this study. The demographic profile and patient details were obtained from the medical records section. Pathology reports of the included cases were retrieved, and associated factors were analysed. : Out of the 98 cases included in the study, 16 cases (16.3%) were below 30 years of age, 44 cases (44.9%) were 30-50 years of age and 38 cases (38.8%) were above 50 years of age. The mean age was 45.78. Female preponderance was noted, with 66 cases (67.3%) being females and 32 cases (32.65%) were males. The histopathology results revealed 90 cases (91.8%) to be papillary carcinoma, 1 case (1.02%) of medullary carcinoma, 1 case (1.02%) of Insular carcinoma, 5 cases (5.102%) of follicular carcinoma and 1 case (1.02%) of anaplastic carcinoma. Most of the cases were classified as T1 tumours (45.91%) under the TNM classification. 24 cases (24.49%) were graded as N1 (Metastasis to regional nodes). 3 cases (3.06%) exhibited distant metastasis. Majority of the cases (71.42%) were samples from a total thyroidectomy procedure. : In our demographic study, we have noted that thyroid carcinomas have a peak incidence in the fourth decade of life with a female preponderance. Majority of the cases were noted to be papillary carcinomas in histological type. Understanding the histopathology and TNM staging of thyroid carcinomas is crucial for the selection of appropriate treatment modalities, predicting patient prognosis and clinical outcomes.

Decreased Strength, Complication Rate and Higher Satisfaction in Conservative Treatment of Partial Distal Biceps Tendon Rupture Compared to Surgical Treatment: A Systematic Review.

Treatment modalities for partial distal biceps tendon (DBT) ruptures include conservative management (immobilization, medication, and physical therapy) or surgery. Selecting treatment modality can present a challenge to both patient and provider. It was hypothesized that patients undergoing surgical treatment for partial DBT rupture would have higher complications but better overall strength, range of motion (ROM), and patient satisfaction. Systematic Review. A systematic review was performed in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cochrane, Embase, and Medline databases were searched for studies published through May 2023. Studies were included if they examined patients with a partial DBT rupture who underwent treatment. Exclusion criteria were non-human studies, studies not in English, reviews, technical notes, letters to the editor, surgical technique papers, and studies reported in a prior review. 13 studies consisting of 290 patients with a partial DBT tear were included in this review. 75% of the patients were male and the ages ranged from 23 - 75 years. The follow up for the patients ranged from 1 - 94 months. 55 patients underwent conservative treatment versus 256 patients underwent surgical treatment. Outcomes examined by the studies included pain, strength, range of motion (ROM), complications, patient reported outcomes (PROs), return to activity, and patient satisfaction. Treatment for partial DBT tear via surgery or conservative treatment both produce good clinical outcomes. There are similar outcomes between treatment options for pain and ROM. Conservative treatment had some poorer outcomes in terms of strength after treatment. Surgical treatment had more complications and a few patients with decreased satisfaction. Overall, both are viable treatment options, requiring a physician and patient discussion regarding the pros and cons of both options as a part of a shared decision-making process that incorporates patient priorities.

Artificial intelligence for the colorectal surgeon in 2024 – A narrative review of Prevalence, Policies, and (needed) Protections

Artificial Intelligence (AI) touches innumerable aspects of our lives today. It plays our music, turns on our lights, answers our weather questions, and even helps navigate our cars safely down the road - to name but a few capabilities. Review of the literature shows that AI applications are rapidly infiltrating most aspects of healthcare. For the microcosm of colorectal surgery, AI can assist in specimen acquisition, pathologic and radiologic diagnosis, selection of treatment modality, pre/postoperative risk stratification, and more globally in surgeon education, grantsmanship, and claims assessment. However, with such power comes the risk of its abuse, and subsequent harm to patients (and providers). Understanding a brief history of AI and the hierarchy of the predominant forms with which we interact, allow us to better understand the nature of these risks and how we can apply ethical frameworks to better understand and mitigate/prevent them. Finally, considering President Biden's October 2023 executive order, we can evaluate how US policy addresses these concerns.

A Simple Approach for the Diagnosis of Oral Ulcers: A Novel Algorithm

Ulcers are one of the most common lesions in the oral cavity and are caused by injuries to the oral mucosa for different reasons. These ulcers are clinically characterized by the loss of the whole thickness of the epithelium and the denuding of the underlying lamina propria in the presence of a white/yellow layer called the fibrinoleukocytic layer and are usually accompanied by pain. Due to the wide array of etiologic agents for oral ulcers, pinpointing the etiologic agent can be highly challenging, and the availability of a good diagnostic guide assists in the diagnosis and selection of proper treatment modalities because a fast and accurate diagnosis of some ulcers (e.g., the early stages of squamous cell carcinoma) is crucial for the early initiation of treatment. The present study attempts to present a proper and comprehensive diagnostic guide to facilitate the classification and diagnosis of different oral ulcers.

Research Progress on Predictive Biomarkers of Immunotherapy Efficacy in Non-small Cell Lung Cancer

Lung cancer is one of the most common malignant tumors in the world, of which non-small cell lung cancer (NSCLC) is the majority. The emergence of immune checkpoint inhibitors (ICIs) has greatly changed the treatment strategy of NSCLC and improved the prognosis of patients. However, in reality, only a small number of patients can achieve long-term benefit. Therefore, the identification of reliable predictive biomarkers is essential for the selection of treatment modalities. With the development of molecular biology and genome sequencing technology in recent years, as well as the in-depth understanding of tumor and its host immune microenvironment, research on biomarkers has emerged in an endless stream. This review focuses on the predictive biomarkers of immunotherapy efficacy in NSCLC, in order to provide some guidance for precision immunotherapy. .

Preoperative prediction of lymphovascular invasion and T-staging of rectal cancer via a dual-energy computed tomography iodine map: a feasibility study.

To investigate the value of dual-energy computed tomography (DECT) in predicting lymphovascular invasion (LVI) and the accuracy of preoperative T-staging of rectal cancer (RC). Forty-nine patients with RC who had not received radiotherapy were enrolled to undergo a DECT scan. All patients underwent surgical tumor resection within 3-5 days after the DECT scan. Preoperative T-staging of RC based on images was performed by experienced radiologists. The normalized iodine concentrations (NIC) of the tumor and the perirectal adipose tissue (PAT) from the arterial phase (AP) and venous phase (VP) were measured using DECT. The tumor LVI and T-staging confirmed by pathology were used as the gold standard for grouping (group A, LVI-; group B, LVI+; group C, T1-2; and group D, T3-4a). The NIC values between two groups were compared using the Mann-Whitney U test, with P < 0.05 indicating a statistically significant difference. The accuracy of NIC in predicting LVI and distinguishing T1-2 RC from T3-4a RC were determined via receiver operating characteristic curve analysis, and the optimal cut-off of NIC was determined using the area under the curve. The tumor NIC values were significantly higher in the LV+ group than in the LVI- group in the VP (0.728 ± 0.031 vs. 0.669 ± 0.034, P < 0.001). The NIC values of PAT were significantly higher in the T3-4a group than in the T1-2 group in both the AP (4.034 ± 0.991 vs. 3.115 ± 0.581, P < 0.05) and the VP (5.481 ± 1.054 vs. 3.450 ± 0.980, P < 0.001). The accuracy of using NIC values to distinguish between the LVI+ group and the LVI- group and to diagnose the T3-4a group were 85.7% and 89.8%, respectively. However, there was no statistically significant difference between the NIC value in the LVI+ group and in the LVI- group in the AP. There was also no statistical difference in the tumor NIC value between the T1-2 group and the T3-4a group. The tumor and PAT NIC are valuable indicators in RC that can preoperatively predict LVI and improve the accuracy of preoperative RC T-staging. The use of DECT improves the T-staging and LVI prediction of RC, which is helpful in guiding the clinical selection of appropriate treatment modalities and improving prognostic outcomes.

Trends in Early-Stage Cervical Cancer Management in the US: A National Cancer Database Analysis.

The Laparoscopic Approach to Cervical Cancer (LACC) trial was published in 2018 and demonstrated that minimally invasive surgery (MIS) yields inferior survival outcomes in early-stage cervical cancer compared to open surgery. This study investigates how the results of the LACC trial have impacted the selection of the primary treatment modality and adjuvant radiation utilization in early-stage cervical cancer. Using the National Cancer Database (NCDB), we compared patients with stage IA2-IB1 cervical cancer before (1/2016-12/2017) and after (1/2019-12/2020) the LACC trial. A total of 7930 patients were included: 4609 before and 3321 after the LACC trial. There was a decline in MIS usage from 67% pre-LACC to 35% thereafter (p < 0.001). In both the pre- and post-LACC periods, patients undergoing radical MIS more frequently had small volume disease (pre-LACC tumors ≤ 2 cm, 48% MIS vs. 41% open, p = 0.023; post-LACC stage IA2, 22% vs. 15%, p = 0.002). Pre-LACC, MIS radical hysterectomy was associated with White race (82% vs. 77%, p = 0.001) and private insurance (63% vs. 54%, p = 0.004), while there was no difference in socioeconomic factors in the post-LACC period. Although the proportion of patients treated with primary chemoradiation remained stable, the post-LACC cohort had a younger median age (52.47 vs. 56.37, p = 0.005) and more microscopic disease cases (13% vs. 5.4%, p = 0.002). There was no difference in the rate of radiation after radical hysterectomy before and after the trial (26% vs. 24%, p = 0.3). Conclusions: Post-LACC, patients were less likely to undergo MIS but received adjuvant radiation at similar rates, and primary chemoradiation patients were younger and more likely to have microscopic disease.