Stage Distribution Research Articles

Influence of stage and age on survival of patients with vulvar cancer in Germany: a retrospective study

ObjectivesTo evaluate the 5-year survival rate of patients with vulvar cancer, taking into account prognostic factors (International Federation of Gynecology and Obstetrics (FIGO) stage and age) and the influence of...

Spectrum of Surgico-Pathological Factors and Lymph Node Metastasis among Epithelial Ovarian Cancers: Experience of a Single Tertiary Care Institution from India

Introduction Epithelial ovarian cancer (EOC) is one of the leading causes of mortality among women worldwide. The present study aimed to estimate the frequency of various histopathological types, clinical and surgico-pathological factors, and spectrum of lymph node (LN) metastasis in early and advanced EOC. Material and Methods Women with EOCs who underwent cytoreductive surgery (CRS) between January 2019 and May 2022 were included. The distribution of Clinico-demographic parameters, histological type, stage, and LN metastasis were analyzed. Results A total of 101 women with EOCs underwent CRS, out of which 5 (4.95%) with coexistent endometrial cancer were excluded (N = 96). Fifty women (52%) underwent primary CRS and 46 (48%) women underwent interval CRS. The mean age of the women was 48.42 ± 11.6 years. Initial serum cancer antigen 125 (CA 125) level was elevated (>35 U/mL) in 88 (91.67%) women and normal in 8 (8.33%) women. Complete cytoreduction was achieved in 75 (78.12%) cases. High-grade serous carcinoma was the most common histology (66/96, 68.75%), followed by mucinous carcinoma (15/96, 15.63%), endometrioid carcinoma (6/96, 6.25%), low-grade serous carcinoma (4/96, 4.17%), and carcinosarcoma (2/96, 2.08%). The majority of women, 69 (71.88%), were in stages III and IV at presentation. Most serous carcinomas were diagnosed at stage III (71.22%) or IV (13.64%). In contrast, the majority of endometrioid, mucinous, and clear cell carcinomas were diagnosed at stages I and II. Seventy-five women (78.13%) with EOC underwent pelvic and/or para-aortic lymphadenectomy, out of which 23 (30.67%) were histologically positive. Three out of 23 patients (13%) with early-stage disease showed positive LNs. Conclusion Serous carcinoma ovary is the most common histological subtype, presenting mostly in the advanced stage. A significant number of affected women were younger at presentation and diagnosis was made a decade earlier than the western population. A systematic pelvic and para-aortic lymphadenectomy in apparently early-stage (pelvic confined) ovarian cancer could detect additional LNs in 13% of women, especially in high-grade tumors and serous histology, suggesting the role of systematic lymphadenectomy for accurate staging in apparently early-stage ovarian cancer.

Systematic Review of Technology-Based STEM Education Research in the United States

This study reviewed technology-based STEM education research papers published during 2015–2022. Data collection and analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Eighty-two papers were analyzed. The findings provide a summary of research trends over the past eight years. Technology education effects on STEM education participation are no longer emphasized when assessing knowledge and skills. Rich research contents, such as environment and experience-related research are emphasized. Furthermore, this study clarified the characteristics of technology education research distribution in various stages of general education and revealed some important research concerns.

A new era in surgical oncology: preliminary insights into the hinotori™ surgical robot system’s role in rectal surgery using the double bipolar method

BackgroundThe da Vinci™ Surgical System, recognized as the leading surgical robotic platform globally, now faces competition from a growing number of new robotic surgical systems. With the expiration of key patents, innovative entrants have emerged, each offering unique features to address limitations and challenges in minimally invasive surgery. The hinotori™ Surgical Robot System (hinotori), developed in Japan and approved for clinical use in November 2022, represents one such entrant. This study demonstrates initial insights into the application of the hinotori in robot-assisted surgeries for patients with rectal neoplasms.MethodsThe present study, conducted at a single institution, retrospectively reviewed 28 patients with rectal neoplasms treated with the hinotori from November 2022 to March 2024. The surgical technique involved placing five ports, including one for an assistant, and performing either total or tumor-specific mesorectal excision using the double bipolar method (DBM). The DBM uses two bipolar instruments depending on the situation, typically Maryland bipolar forceps on the right and Fenestrated bipolar forceps on the left, to allow precise dissection, hemostasis, and lymph node dissection.ResultsThe study group comprised 28 patients, half of whom were male. The median age was 62 years and the body mass index stood at 22.1 kg/m2. Distribution of clinical stages included eight at stage I, five at stage II, twelve at stage III, and three at stage IV. The majority, 26 patients (92.9%), underwent anterior resection using a double stapling technique. There were no intraoperative complications or conversions to other surgical approaches. The median operative time and cockpit time were 257 and 148 min, respectively. Blood loss was 15 mL. Postoperative complications were infrequent, with only one patient experiencing transient ileus. A median of 18 lymph nodes was retrieved, and no positive surgical margins were identified.ConclusionsThe introduction of the hinotori for rectal neoplasms appears to be safe and feasible, particularly when performed by experienced robotic surgeons. The double bipolar method enabled precise dissection and hemostasis, contributing to minimal blood loss and effective lymph node dissection.

Parasite transmission stage abundance varies in lakes over time and space

AbstractEnvironmentally transmitted parasites produce transmission stages that can remain viable and infective for extended periods of time in the environment where susceptible hosts may encounter them. Although many parasites have this mode of transmission, the abundance and distribution of environmental transmission stages have largely been overlooked, especially in aquatic habitats. Without empirical data to characterize spatial and temporal dynamics of parasite transmission stages in the environment, we might make incorrect assumptions about host–parasite contact rates. For aquatic environments, seasonal habitat structure driven by thermal stratification has been hypothesized to affect the patchiness of transmission stages within the water column, leading to uneven exposure risk to hosts. In this study, we quantified transmission stage concentrations of five common parasites of Daphnia spp. and Ceriodaphnia dubia at every meter of the water column at the deep basin of six lakes in southeastern Michigan every 2 weeks from June to November 2021. We found that transmission stage concentration varied by orders of magnitude over time and with depth. We investigated several possible drivers of these spatial and temporal patterns. For instance, our results suggest that greater mixing depth decreased transmission stage vertical patchiness within the water column of lakes with lower Fee's p values. However, horizontal spore patchiness across a lake was not correlated with the nearshore–offshore gradient of our study lakes. Overall, the results of our study show that parasite transmission stage concentrations have spatial and temporal dynamics that could affect disease dynamics within highly structured aquatic environments.

Spatio-temporal larval abundance dynamics of a depleted Baltic Sea herring ecotype

Abstract Fish stocks composed of several populations are considered to have more stable productivity than stocks containing only one or few populations. This stability is attributed to complementary or independent dynamics among the populations within the stock—the so-called portfolio effect. Declines of populations within stocks that have delayed recovery potentially increase risk to productivity and local extinctions. Portfolio effects may be relevant in the Baltic Sea, where autumn-spawning herring was the dominant herring ecotype until the early/mid-20th century. The current fishery assessment and management in the area assumes that the abundance of autumn spawning herring has been negligible since the 1970s; the share of spring spawning herring has become dominant and is considered to be the only ecotype. Data from a multi-annual ichthyoplankton survey in the southern Baltic Sea (Bornholm Basin) during autumn 2002–2019 show that abundance and spatial distribution of the smallest larval stages have increased significantly. This pattern could be due to an increase in autumn spawners in the area. Genetic studies confirm that these larval herring are offspring from true autumn spawners. Preserving intraspecific diversity is critical for a species’ future abilities to adapt to and survive in changing environmental conditions. Thus, our results not only provide new insights to the temporal dynamics of herring ecotypes and challenge the current understanding of central Baltic herring stock processes in general, but are also important in the context of monitoring, assessment, and spatial management of herring in the Baltic Sea.

Comparing SEER and NCDB: a case study using colorectal cancer.

Nationwide datasets are frequently used to examine cancer trends and outcomes in the U.S. Understanding the strengths and limitations of the commonly used Surveillance, Epidemiology, and End Results (SEER) Program and the National Cancer Database (NCDB) is important when designing studies and interpreting results. We used colorectal cancer (CRC) as a case study to compare information available. We identified 575,128 (SEER) and 1,578,046 (NCDB) adults diagnosed with CRC between 2004 and 2021. The distribution of age, tumor location, stage, and treatment did not meaningfully differ between SEER and NCDB. SEER represents racially and ethnically diverse populations, including a higher proportion of Hispanic (11.7% vs 5.8%) and Asian/Pacific Islander (8.6% vs 3.3%) persons. SEER includes more information on area-level characteristics, such as county-level measures of poverty, unemployment, and migration and census tract-level measures of socioeconomic status. Age-adjusted incidence, mortality rates, and cause-specific survival are only available in SEER, facilitating detailed analyses of racial, ethnic, and socioeconomic differences in cancer incidence and mortality. NCDB provides information on tumor characteristics and treatment not available in SEER, including microsatellite instability, KRAS mutation, palliative treatment, unplanned readmissions, and 30-day mortality after surgery, facilitating analyses of treatment effectiveness and outcomes. Five-year overall survival was similar in SEER (55.6%) vs NCDB (57.5%).

Time to Functional Loss as an Endpoint in Huntington's Disease Trials: Enrichment and Sample Size.

Clinical trial scenarios can be modeled using data from observational studies, providing critical information for design of real-world trials. The Huntington's Disease Integrated Staging System (HD-ISS) characterizes disease progression over an individual's lifespan and allows for flexibility in the design of trials with the goal of delaying progression. Enrichment methods can be applied to the HD-ISS to identify subgroups requiring smaller estimated sample sizes. Investigate time to the event of functional decline (HD-ISS Stage 3) as an endpoint for trials in HD and present sample size estimates after enrichment. We classified individuals from observational studies according to the HD-ISS. We assessed the ability of the prognostic index normed (PIN) and its components to predict time to HD-ISS Stage 3. For enrichment, we formed groups from deciles of the baseline PIN distribution for HD-ISS Stage 2 participants. We selected enrichment subgroups closer to Stage 3 transition and estimated sample sizes, using delay in the transition time as the effect size. In predicting time to HD-ISS Stage 3, PIN outperforms its components. Survival curves for each PIN decile show that groups with PIN from 1.48 to 2.74 have median time to Stage 3 of approximately 2 years and these are combined to create enrichment subgroups. Sample size estimates are presented by enrichment subgroup. PIN is predictive of functional decline. A delay of 9 months or more in the transition to Stage 3 for an enriched sample yields feasible sample size estimates, demonstrating that this approach can aid in planning future trials. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Dynamic response characteristics of backfill under blasting disturbance simulated through a three-dimensional model

During mining operations, the backfill body is subject to significant disturbance due to large-volume blasting, resulting in stress concentration and vibration response within the backfill. This alters energy distribution, leading to the continuous development, expansion, and accumulation of damage, potentially culminating in instability and collapse. Blasting disturbance in stopes is the main cause of filling instability and ore dilution. It is crucial to study the failure mechanism of filling bodies under blasting load to guide actual mine production. In this study, a custom mold was created to establish an innovative three-dimensional model of an ore-backfill system subject to explosion loading. Simultaneous detonation was selected as the control group and delayed detonation was selected as the experimental group. Monitoring and analysis methods, such as a high-speed camera system, MATLAB software, and vibration monitors, were utilized to investigate the impact of delay time on the dynamic response characteristics of the backfill. The results show that the dynamic fracture process of the backfill is mainly divided into four stages: initial crack initiation stage, crack development stage, crack expansion stage, and backfill collapse stage. The difference in delay time on the dynamic fracture process of the backfill is mainly reflected in two aspects: time effect and crack distribution. The surface flatness after delayed detonation is higher by 20.5 % as compared with that after simultaneous detonation. The average damping rate during delayed detonation decreases by 19.7 % as compared with that after simultaneous detonation, the frequency distribution of the single stage is more uniform, and the instantaneous peak energy during delayed detonation is 0.76 times that during simultaneous detonation. The maximum crushing size, average crushing size, and bulk crushing size after delayed detonation are reduced by 25 %, 15.26 %, and 9.23 %, respectively, compared with that after simultaneous blasting. Thus, delayed detonation effectively improves the crushing effect while reducing the degree of damage to the backfill.

Trends in cervical cancer: A decade‑long analysis of incidence, survival and demographic disparities in a Northern Italian province.

While cervical cancer is relatively uncommon in Western countries, it continues to pose significant concern due to its high mortality rates. Intraepithelial forms [cervical intraepithelial neoplasia (CIN) 2 and CIN 3] are more prevalent in regions with comprehensive screening coverage, particularly in areas that use the Papanicolaou test and HPV detection. The present study aims to characterize the trends of precancerous lesions and infiltrating tumors over a decade, assessing survival rates by age, stage and country of origin. A total of 1,752 CIN 2/3 lesions and 152 infiltrating cancers were recorded in the Reggio Emilia Cancer Registry between January 2008 and December 2018. A clear increase in CIN 2/3 lesions was observed over the years while infiltrating tumors remained rare and the numbers of cancer cases declined. The 5-year survival rate was found to be 67%, with survival closely correlated with stage (88, 82, 74 and 12% for stages I, II, III and IV, respectively) and age (84, 80 and 37% for ages <40, 40-65 and 65+, respectively). Multivariable analysis confirmed an excess risk for advanced stages III (HR 3.1; 95% CI, 1.3-7.3) and IV (HR 19.6; 95% CI, 8.2-46.7), as well as in women 65+ (HR 2.8; 95% CI, 1.0-8.1). Analysis of national origins revealed comparable stage distribution for Italians and non-Italians at stage I (41 vs. 47%), while a notable disparity emerged for stage IV (28 vs. 6%). This difference could be attributed to the average age of Italians compared to non-Italians (59 vs. 49 years). Overall, the present study underscored the importance of continued surveillance and intervention strategies targeting advanced-stage disease, particularly in older populations and among non-Italian patients. Efforts to enhance screening coverage and access to timely interventions remain critical in reducing the burden of cervical cancer and improving survival outcomes.

Size distribution and proportion of stages of Cyrtograpsus species in Playa Cangrejales, Argentina

AbstractCrabs are fundamental in coastal ecosystems due to their role in nutrient cycling, habitat structuring, population control and as indicators of environmental health. Investigating the size distribution and life stages of these species is crucial for understanding their ecology and designing effective conservation strategies. This study provides data on the distribution and stage ratios of two populations of local species of the genus Cyrtograpsus (Decapoda: Brachyura: Varunidae) in the Playa Cangrejales intertidal. These endemic species had not been previously described in the study area, highlighting the need for further research in the future. Three surveys were conducted from December 2019 to February 2020, following a transect perpendicular to the coast, obtaining two series of data (C‐I and C‐II). Specimens were identified, sexed and measured in situ for subsequent release. A total of 1099 individuals were counted, identifying Cyrtograpsus affinis (C‐I = 278; C‐II = 332) and Cyrtograpsus angulatus (C‐I = 215; C‐II = 277), with a higher proportion of C. affinis. The presence of these species at Playa Cangrejales coincides with the geographical distribution reported in the literature, although the proportions differ from those reported for other Argentinean beaches. The most frequent lengths were equal to or less than 10 mm cephalothorax length (±1 mm). The maximum lengths reported in the literature for each species were not recorded. For C. angulatus, juveniles always predominated over adults and recruits. C. affinis showed fluctuations between adult and juvenile proportions in the upper and middle zones, with adults predominating in the lower zone during December and February. Juveniles occupied all mesolittoral floors, whereas adults were more frequent in the middle and lower floors. This information is essential to develop management tools to protect these species and their environment. The division between stages was realized following criteria from the literature. Analyses and interpretations were made using data distribution and frequency graphs.

Early-Stage Lung Cancer in the Era of Lung Cancer Screening: Veterans Health Administration Outperforms Other Insurance Models

BackgroundLung cancer screening guidelines were introduced in the United States in 2013, with variable implementation. This study evaluated temporal diagnostic trends in non-small cell lung cancer (NSCLC) diagnosis since the introduction of these guidelines. MethodsThis retrospective cohort analysis used data from the Veterans Administration Corporate Data Warehouse and the National Cancer Database. We evaluated temporal trends in the distribution of NSCLC stage at the time of diagnosis along with differences based on insurance coverage type, including uninsured, privately insured, Medicare, Medicaid, and Veterans Affairs (VA) coverage, with adjustment for clinically relevant variables. ResultsAmong 1,450,965 patients diagnosed from 2006 to 2020, the proportion of NSCLC cases diagnosed at stage I increased in all insurance groups by 12.74%, 2%, 0.25%, and 2.57% for the VA, Medicare, private insurance, and Medicaid, respectively. If all insurance systems achieved the unadjusted stage distribution seen in the Veterans Health Administration, an additional 45,684 patients would be diagnosed with stage I NSCLC and 65,933 fewer patients would be diagnosed with stage IV disease. ConclusionsFor patients with any form of insurance, there has been an increase in the proportion of early-stage NSCLC (stage I and II) and a corresponding decrease in the proportion of stage III and IV since the introduction of national lung cancer screening guidelines. As the largest integrated single-payer health care system in the United States, the VA dramatically outperforms other insurance types, perhaps attributable to universal coverage and robust lung cancer screening programs.

Diffusion tensor MRI is sensitive to fibrotic injury in a mouse model of oxalate-induced chronic kidney disease.

Chronic kidney disease (CKD) is characterized by inflammation and fibrosis in the kidney. Renal biopsies and estimated glomerular filtration rate (eGFR) remain the standard of care, but these endpoints have limitations in detecting the stage, progression, and spatial distribution of fibrotic pathology in the kidney. MRI diffusion tensor imaging (DTI) has emerged as a promising noninvasive technology to evaluate renal fibrosis in vivo both in clinical and preclinical studies. However, these imaging studies have not systematically identified fibrosis particularly deeper in the kidney where biopsy sampling is limited, or completed an extensive analysis of whole organ histology, blood biomarkers, and gene expression to evaluate the relative strengths and weaknesses of MRI for evaluating renal fibrosis. In this study, we performed DTI in the sodium oxalate mouse model of CKD. The DTI parameters fractional anisotropy, apparent diffusion coefficient, and axial diffusivity were compared between the control and oxalate groups with region of interest (ROI) analysis to determine changes in the cortex and medulla. In addition, voxel-based analysis (VBA) was implemented to systematically identify local regions of injury over the whole kidney. DTI parameters were found to be significantly different in the medulla by both ROI analysis and VBA, which also spatially matched with collagen III immunohistochemistry (IHC). The DTI parameters in this medullary region exhibited moderate to strong correlations with histology, blood biomarkers, hydroxyproline, and gene expression. Our results thus highlight the sensitivity of DTI to the heterogeneity of renal fibrosis and importance of whole kidney noninvasive imaging.NEW & NOTEWORTHY Chronic kidney disease (CKD) can be characterized by inflammation and fibrosis of the kidney. Although standard of care methods have been limited in scope, safety, and spatial distribution, MRI diffusion tensor imaging (DTI) has emerged as a promising noninvasive technology to evaluate renal fibrosis in vivo. In this study, we performed DTI in an oxalate mouse model of CKD to systematically identify local kidney injury. DTI parameters strongly correlated with histology, blood biomarkers, hydroxyproline, and gene expression.

High Diagnostic Value of Transient Elastography for Advanced Fibrosis and Cirrhosis in Patients With Chronic Hepatitis Delta

Liver biopsy remains the gold standard for fibrosis staging in patients with chronic hepatitis delta (CHD). Here we comparatively evaluated the performance of transient elastography (TE) and biomarkers for the diagnosis of liver fibrosis in patients with CHD. 230 HDV-infected RNA-positive patients from various centers who underwent liver biopsy and liver stiffness measurements (LSM) using Fibroscan®, within a period of 6 months maximum, were investigated retrospectively. AUROC and Youden index were used to establish cut-off values of LSM. TE was compared with other noninvasive tests (NITs): APRI, Fibrosis-4 and Delta-4 fibrosis scores. Histologic fibrosis stage distribution was: 20.4% for F0-F1; 27.0% for F2; 18.7% for F3 and 33.9% for F4. TE demonstrated good diagnostic performance for detecting cirrhosis and advanced fibrosis with AUROC of 0.88 and 0.86, values, which were significantly higher than those obtained with the other NITs (P = .004 and P < .001). With a cutoff value >12 kPa for cirrhosis, sensitivity was 70.5%, specificity 86.2%, positive predictive value (PPV) 72.4% negative predictive value (NPV) 85.1% and accuracy 80.9%. Using 10.4 kPa as cut-off value for F3, sensitivity was 70.2%, specificity 83.5%, PPV 82.5%, NPV 71.7% and accuracy 76.5%. In 89% of patients with LSM ≤ 6.2 kPa, liver biopsy disclosed only absent or minimal fibrosis. TE demonstrated good diagnostic performance for advanced fibrosis and cirrhosis in CHD patients. Advanced fibrosis is highly probable for LSM values ≥10 kPa. LSM values < 6 kPa almost totally exclude significant fibrosis. Between 6 and 10 kPa, liver biopsy should be discussed.

Early life stages of the snapping shrimp Alpheus cf. packardii: morphological description of the first three zoeal stages

ABSTRACT The morphology of the zoeae I, II and III of Alpheus cf. packardii was described based on laboratory-hatched larvae. Parental female was captured at Ubatuba bay, north coast of São Paulo, Brazil. The morphological characteristics of the species were compared with descriptions of other Alpheus species with known first zoeal stages. The zoea I of A. cf. packardii differs from the other 27 species through: coxal endite of maxillule with 6 (4 simple, and 2 sparsely plumose) setae; basal endite with 2 stout spines, 1 small plumose setae and 1 small simple setae; coxal endite of maxilla not bilobed, with 2 long sparsely plumose setae; basal endite bilobed, proximal lobe 2 simple and 1 sparsely plumose setae, distal lobe with 2 simple setae and 1 sparsely plumose setae, both with one terminal protuberance; second maxilliped with endopod 4-segmented, 1 terminal simple, 0, 1 terminal serrate, 5 (1 proximal and 3 terminal simple, plus 1 terminal serrate) setae. Considering the importance of the identification of larval forms in the natural environment, our results can be used in a larval identification key and help to advance research on areas such as ecological distribution of early post-embryonic stages in the meroplankton community.

Tasa de filtración glomerular estimada para la pesquisa de enfermedad renal crónica desde la Atención Primaria de Salud.

Introduction: Primary health care (PHC) is fundamental in preventing and managing chronic kidney disease (CKD). By early detection of kidney disorders and providing comprehensive care to patients, PHC contributes to improving the quality of life of people with kidney disease and reducing the burden that this disease represents for health systems. This study aimed to determine the prevalence of chronic kidney disease in a primary care referral center in Holguín, Cuba. Methods: This analytical observational study was conducted at the “Máximo Gómez Báez” University Polyclinic, Cuba, from February to November 2021. Patients diagnosed with noncommunicable chronic disease without known CKD were included, subsequently Group 1 (G1): patients with CKD. Group 2 (G2): patients without CKD. The estimated glomerular filtration rate, comorbidities, nutritional status, and laboratory variables were recorded. Results: In Group 1 (CKD), 188 cases, and the control group, 348 cases. The prevalence of chronic kidney disease was 35% (95% CI 31-39%). The age in G1 was 61.6 ± 10.3 years in G2: 59.3 ± 11.6 (P =0.001). Women were the most affected by CKD (P =0.001). Of the total, 76% were hypertensive, with similar distributions between both groups (79% vs 74%). Type 2 diabetes was a risk factor for developing CKD (OR = 5.9; 95% CI: 3.9-8.9). 35%, 37% and 31% had an eGFR ≤ 60 mL/min/1.73 m2, by the CKD-EPI, MDRD-4 and Cockcroft-Gault formulas, respectively. The distributions of CKD stages were 76.1% for 3a, 16.5% for 3b, 6.9% for 4, and 0.5% for 5, by CKD-EPI. Conclusion: The eGFR by Cockcroft-Gault introduces erroneous results due to the patient's weight. CKD-EPI and MDRD-4 proved to be the most appropriate for diagnosing and staging CKD in the study population.

Changes in Time to Initial Physician Contact and Cancer Stage Distribution during the COVID-19 Pandemic in Patients with Head and Neck Squamous Cell Carcinoma at a Large Hungarian Cancer Center.

The aim of our study was to compare the characteristics and time to initial physician contact in patients with head and neck squamous cell carcinoma (HNSCC) before and during the COVID-19 pandemic at a large Hungarian cancer center. This was a retrospective study of patients 18 years or older presenting at the regional cancer center of Pécs Clinical Center with HNSCC between 1 January 2017, and 15 March 2020 (the pre-COVID-19 period) and between 16 March 2020, and 13 May 2021 (the COVID-19 period). Demographic and clinical data were collected, and the time between initial symptom onset and initial physician contact (TTP) was determined. Descriptive and exploratory statistical analyses were performed. On average, the number of patients diagnosed with HNSCC per month during the pandemic decreased by 12.4% compared with the pre-COVID-19 period. There was a significant increase in stage I and stage II cancers (from 15.9% to 20.3% and from 12.2% to 13.8%, respectively; p < 0.001); a decrease in stage III and IVa,c cancers; and a significant increase in stage IVb cancers (from 6% to 19.9%; p < 0.001) during the pandemic. The median TTP increased during the pandemic from 43 to 61 days (p = 0.032). To our knowledge, this is the first study investigating the effect of COVID-19 on patients with HNSCC in the Central-Eastern European region. We found a bidirectional shift in cancer stages and increased TTP during the pandemic. Our findings highlight the necessity for more nuanced analyses of the effects of COVID-19.

Gas Free Dissipation Characteristics Analysis and Safety Repair Time Determination of Buried Pipeline Leakage Based on CFD

Buried pipelines, as the most common method of natural gas transportation, are prone to pipeline leakage accidents and are difficult to detect due to their harsh and concealed environment. This paper focused on the problem regarding the free dissipation of residual gas in buried gas pipelines and soil after closing the gas supply end valve after a period of leakage by numerical simulation. A multiple non-linear regression model was established based on the least squares method and multiple regression theory, and MATLAB 2016b mathematical calculation software was used to solve the problem. The research results indicated that compared to the gas leakage diffusion stage, the pressure and velocity distribution during the free dissipation stage were significantly reduced. The increase in leakage time, pipeline pressure, leakage size, and pipeline burial depth led to a large accumulation of natural gas, which increased the concentration and distribution range of gas on the same free dissipation stage monitoring line. A prediction model for natural gas concentration in the free dissipation stage was established with an average error of 7.88%. A calculation model for the safety repair time of buried gas pipeline leakage accidents was further derived to determine the safety repair time of leakage accidents.

Disparities in the diagnosis and treatment of colorectal cancer among patients with disabilities.

Little is known about disparities in diagnosis and treatment among colorectal cancer (CRC) patients with and without disabilities. To investigate the patterns of diagnosis, treatment, and survival for people with and without disabilities who had CRC. We performed a retrospective analysis using the Korean National Health Insurance Service database, disability registration data, and Korean Central Cancer Registry data. The analysis included 21449 patients with disabilities who were diagnosed with CRC and 86492 control patients diagnosed with CRC. The overall distribution of CRC stage was not affected by disability status. Subjects with disabilities were less likely than those without disabilities to undergo surgery [adjusted odds ratio (aOR): 0.85; 95% confidence interval (95%CI): 0.82-0.88], chemotherapy (aOR: 0.84; 95%CI: 0.81-0.87), or radiotherapy (aOR: 0.90; 95%CI: 0.84-0.95). The rate of no treatment was higher in patients with disabilities than in those without disabilities (aOR: 1.48; 95%CI: 1.41-1.55). The overall mortality rate was higher in patients with disabilities [adjusted hazard ratio (aHR): 1.24; 95%CI: 1.22-1.28], particularly severe disabilities (aHR: 1.57; 95%CI: 1.51-1.63), than in those without disabilities. Patients with severe disabilities tended to have a late or unknown diagnosis. Patients with CRC and disabilities had lower rates of treatment with almost all modalities compared with those without disabilities. During the follow-up period, the mortality rate was higher in patients with disabilities than in those without disabilities. The diagnosis and treatment of CRC need improvement in patients with disabilities.

Outcomes of children with clear cell sarcoma of kidney following NWTS strategies in Shanghai China (2003-2021).

Although clear cell sarcoma of kidney (CCSK) is rare, it is the second most common renal tumor in children after Wilms' tumor. NWTS and SIOP are two major groups which had made tremendous efforts on renal tumors, but the strategies are different, for NWTS follows the upfront surgery principle providing definite pathology and the SIOP follows the upfront chemotherapy principle, each has its own advantages. Here we aimed to evaluate the outcomes of CCSK in China following NWTS strategies to analyze the prognostic factors. For this multicenter retrospective study, a total of 54 patients were enrolled from three children's hospitals, between April 2003 and December 2021. Treatment comprised upfront radical nephrectomy, followed by radiotherapy and intensive chemotherapy. Clinical records were regularly updated. Prognostic factors and survival rates were evaluated. The 54 enrolled patients had a median age of 37 months (range, 4 months to 11.4 years). The stage distribution was 16% stage I (n = 9), 30% stage II (n = 16), 39% stage III (n = 21), and 15% stage IV (n = 8). Among stage IV, metastasis sites included the lung (n = 6), bone (n = 1), and intra-orbital/cervical lymph node (n = 1). After a median follow-up of 5.6 years, the 5-year event-free survival (EFS) was 82.4±5.4%, and overall survival was 88.1±4.6%. The EFS was 100% for stage I, 93.8 ±6.1% for stage II, 71.1±10.0% for stage III, and 68.6±18.6% for stage IV. Univariate analysis revealed that staging (III/IV), tumor rupture, and inferior vena cava tumor thrombus were inferior prognostic factors. Multivariate analysis revealed that tumor rupture was independent poor prognostic factor (P = 0.01, HR 5.9). Among relapsed patients, relapse occurred a median of 11 months after diagnosis (range, 4-41 months), and 50% (4/8) achieved a second complete remission after multiple treatment. None of the six lung metastasis patients received lung RT, only one patient developed a relapse and was salvaged by RT after relapse. Tumor rupture was independent poor prognostic factor. Upfront surgery of NWTS strategies can make a definite pathology diagnosis, but how to reduce tumor rupture during surgery is important especially in developing countries. The outcomes of patients with stage I-III CCSK in China were comparable to findings in other developed countries. Better outcomes were achieved in stage IV CCSK by using an intensive chemotherapy regimen including carboplatin, which require further confirmation by AREN0321. Lung RT may be safely omitted in selected patients who achieve a compete radiographic response after 6 weeks of systemic treatment (including surgery). Treatment should be encouraged even in CCSK cases with metastasis and relapse.