Staging Protocol Research Articles

Use of 'omics for endometrial timing: the cycle moves on.

ABSTRACTFor some years, the prospect of precise and personalized timing of the endometrial cycle for optimal embryo replacement has been held out as a potential solution to low implantation rates. It is envisaged that a receptive state can be defined and reached at a predictable time, and embryo replacement performed in synchrony. In the last century, morphological changes characteristic of the mid secretory phase were defined in precisely timed cycles in women of proven fertility, but when deviations from this standardized schedule occur, their significance for implantation has remained uncertain. ‘Omics technologies have been widely advocated for staging the endometrial cycle and defining a set of biochemical requirements for implantation, but after two decades of research, improvements to pregnancy rates have not followed, and there is a striking lack of agreement regarding the molecular characterization of the receptive state. Some of the rationale underlying these problems is now emerging with the application of higher-level computational and biological methodology. Here, we consider the challenges of defining an endometrial phenotype that can support implantation and continuing pregnancy. Receptivity may be an emergent trait depending on contributions from multiple proteins that have low pathway connectivity. We recommend that authors choose language which rigorously avoids the implication that protocols for molecular staging of the mid secretory phase inherently identify a state of receptivity to the implanting blastocyst.

Multi-Institutional Validation of Two-Streamed Deep Learning Method for Automated Delineation of Esophageal Gross Tumor Volume Using Planning CT and FDG-PET/CT.

BackgroundThe current clinical workflow for esophageal gross tumor volume (GTV) contouring relies on manual delineation with high labor costs and inter-user variability.PurposeTo validate the clinical applicability of a deep learning multimodality esophageal GTV contouring model, developed at one institution whereas tested at multiple institutions.Materials and MethodsWe collected 606 patients with esophageal cancer retrospectively from four institutions. Among them, 252 patients from institution 1 contained both a treatment planning CT (pCT) and a pair of diagnostic FDG-PET/CT; 354 patients from three other institutions had only pCT scans under different staging protocols or lacking PET scanners. A two-streamed deep learning model for GTV segmentation was developed using pCT and PET/CT scans of a subset (148 patients) from institution 1. This built model had the flexibility of segmenting GTVs via only pCT or pCT+PET/CT combined when available. For independent evaluation, the remaining 104 patients from institution 1 behaved as an unseen internal testing, and 354 patients from the other three institutions were used for external testing. Degrees of manual revision were further evaluated by human experts to assess the contour-editing effort. Furthermore, the deep model’s performance was compared against four radiation oncologists in a multi-user study using 20 randomly chosen external patients. Contouring accuracy and time were recorded for the pre- and post-deep learning-assisted delineation process.

Intramedullary application of local antibiotic bullets for the treatment of long bone fracture related infection.

The optimal means of local antibiotic delivery for fracture related infection is unknown. Until now, intramedullary application of calcium sulphate based local antibiotics has been challenging. We report on the use of a newly available mode of preparation and delivery: the Stimulan Bullet Mat and Introducer (Biocomposites Ltd, Staffordshire, England). A retrospective analysis of prospectively collected data for infection cases at two separate tertiary referral institutions was performed. We included cases of long bone FRI with a retained intramedullary nail, treated with a single stage protocol of metalwork removal, debridement, local antibiotic application using the novel mould and applicator, with additional bony stabilisation and soft tissue reconstruction where required. All 13 patients achieved infection remission rate with an average follow-up of 19.7months (range 12-28). All 6 patients with infection around an unhealed fracture achieved union at an average 8months (range 4-12) from debridement. No patients developed aseptic wound leak. Antibiotic impregnated calcium sulphate can be used safely as part of a single stage treatment protocol for the treatment of long bone fracture related infection following intramedullary nailing. We have demonstrated high rates of infection remission and union, using a newly available intramedullary applicator.

Concepts of Pathological Staging and Prognosis in Papillary Thyroid Carcinoma.

American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (AJCC/UICC) staging and American Thyroid Association (ATA) risk predication system are the best predicators of mortality and cancer recurrence, respectively, in patients with differentiated thyroid carcinoma, including papillary thyroid carcinoma. In ATA risk stratification of differentiated thyroid carcinomas, clinical features, nodal features, and pathological features are assessed. Many of the features are also assessed in pathological staging. The prognostic stage grouping of papillary thyroid carcinoma in AJCC/UICC depends on the age of the patients as well as the standard parameters-extent of tumor (T), lymph node status (N), and presence of distant metastasis (M). Major changes noted in the current pathological staging protocol include the cut-off age from 45-year to 55-year in grouping of patients, use of gross invasion of strap muscles instead of minimal microscopic extrathyroidal extensions as T3b and downstage of many prognostic groups such as those with lymph node metastases (without distant metastases) from Stage III to Stage II. The staging protocol have moved many patients with papillary thyroid carcinoma into good prognostic groups for better predication of patients' survival rates and to avoid unnecessary treatment. This new approach has been verified by different groups globally, although modifications could be expected in the future for better prognostic assessment in patients with papillary thyroid carcinoma.

Compilation of Developmental and Neoplastic Entities in Kidney with Histomorphology and Immunohistochemistry as an Eye Opener in Troubleshooting the Diagnostic Errors

Introduction: Renal cell tumours are common neoplasms with varying incidence and mortality rates across the globe. There are many histological types forming not merely the basis of classification but being associated with unique immunological and molecular profiles governing the biological behaviour. Apart from these, there are separate spectrum of neoplasms restricted particularly to paediatric age group. The overall prognosis is conferred by an array of factors including the histological grade, stage, necrosis and lympho-vascular invasion. Case Reports: This discussion aims to outline the renal mass encountered in our setting with special reference to age group and the light microscopic picture. However, we encountered diagnostic dilemmas while dealing with the cases and these were further resolved employing relevant immunohistochemical markers. A particular mention of protocols for staging, grading and relevance of special stains has also been outlined. Conclusion: To conclude, 1 case each of chromophobic renal cell carcinoma and infiltrating urothelial carcinoma of pelvis in middle aged adults have been discussed. 2 cases in paediatric age group have been highlighted namely triphasic nephroblastoma and multicystic dysplastic kidney (MCDK).

Utilizing Telemedicine and Modified Fibrosis Staging Protocols to Maintain Treatment Initiation and Adherence Among Hepatitis C Patients During the COVID-19 Pandemic.

The COVID-19 pandemic exacerbated the decline in Hepatitis C Virus (HCV) screening and treatment globally in part due to lockdowns and restrictions at healthcare centers. The goal of this retrospective cohort study was to assess the effectiveness of an updated workflow implemented at Boston Medical Center (BMC) HCV clinics. Revised workflow incorporated appointments via telemedicine, transitioning to blood test-based fibrosis scoring, and delivering medication by mail to mitigate the lack of in-person services. We compared 2 cohorts of patients who attended at least the initial intake appointment at BMCHCV clinics: 170 before the pandemic and 133 after the pandemic. Outcome variables included treatment starts, fibrosis lab tests completed, appointment attendance, and SVR achievement. Proportions for outcome variables were compared between groups by use of χ2 and 2-sample t-tests where appropriate. Our results showed a 14.43% decrease in completing fibrosis scoring tests (P-value: <.001) and a 15.21% decrease in medication initiation (P-value: <.001) among the patients who initiated care during the pandemic (modified workflow group). Furthermore, we found a 18.56% decrease in sustained virologic response (SVR) among the modified workflow group when compared to the controls. Overall, these results align with current trends of patients’ decreasing engagement in HCV care but show higher retention than other published data. Furthermore, these figures support how appointments via telemedicine, transitioning to blood test-based fibrosis scoring, and medication delivery by mail can serve as tools to increase access to HCV care and successful HCV treatment completion even after COVID restrictions are lifted.

Evaluation of the Effectiveness of Titanium-prepared Platelet rich Fibrin (T-PRF) and Demineralized Freeze-dried Bone Allograft (DFDBA) in Socket Preservation Followed by Implant Placement Using Two Stage Approach

Background: The focus of the implant therapy is now shifting to a stable restoration rather than mere osseointegration. Placement of dental implants has become an indispensable part of mainstream dentistry, offering an improved quality of life to patients. One of the physiological changes that occurs after tooth extraction is alveolar ridge resorption. A variety of bone graft materials and platelet concentrates which are abundant in growth factors have been incorporated that provides the added effect of combination for early and better healing.&#x0D; Objectives: Evaluation of effectiveness of Titanium Prepared Platelet Rich Fibrin (T-PRF) and Demineralized Freeze-Dried Bone Graft (DFDBA) in socket preservation and simultaneous evaluation of implant stability three months after implant placement using two stage protocol.&#x0D; Methodology: Present study will be performed over one year period. Twelve patients, each having one tooth indicated for extraction in either of the arches will be selected. Atraumatic extraction will be done followed by socket preservation using combination of T-PRF and DFDBA to promote early healing followed by placement of implant.&#x0D; Expected Results: We expect early and better results of bone formation in healing sockets after preservation using T-PRF and DFDBA, which will be advantageous for implant placement. Better results in terms of bone volume, bone height, bone density and histomorphometry are expected.&#x0D; Conclusion: Combined effect of DFDBA and T-PRF is expected to improve the periodontal parameters including both soft tissue and hard tissue outcomes.

Patients presenting with stage IV uveal melanoma: Lessons learned.

Challenges persist in identifying patients with stage IV uveal melanoma. While clinical, histopathologic, and genetic features of the primary tumor have been shown to provide prognostic value for assessing metastatic risk, biopsy-related genetic analyses are expensive and not universally available. Therefore, this review will focus on clinical characteristics. Initial staging and follow-up screening protocols have evolved for patients with uveal melanoma. The Collaborative Ocular Melanoma Study (COMS) required a physical examination, chest X-ray, and hematologic survey (primarily liver function tests). Though these studies were found to have a high specificity, COMS investigators typically found late-stage metastases. More recently, protocols have concentrated on liver imaging (abdominal ultrasound, computed tomography, and magnetic resonance imaging). Though hepatic radiographic imaging has been found more likely to reveal earlier metastatic uveal melanoma, by definition it cannot detect most extrahepatic and multiorgan metastases. An international multicenter registry study recently focused on patients who were diagnosed with stage IV uveal melanoma simultaneously with their primary intraocular melanoma. Therein, utilizing center-specific diagnostic methods, stage IV was found to occur in about 2% of patients. However, subgroup analysis found that a disproportionate number of multi-organ metastases were discovered when whole-body positron emission tomography/computed tomography was used for staging. Herein, we review the literature on patients who present with stage IV uveal melanoma, how they were detected, and their outcomes.

Analyzing the Usage of Pencil-Beam Proton Radiotherapy for Patients With Atypical Teratoid Rhabdoid Tumor of Central Nervous System

Atypical teratoid rhabdoid tumor of the central nervous system is a rare tumor affecting very young children. Treatment of ATRT includes different regimens of radiotherapy depending on age, stage and treatment protocols. Proton therapy allows to reduce acute and late toxicity. This reduction (among other benefits) helps to finish irradiation without interruptions. It matters for kids receiving craniospinal irradiation as well as for kids receiving radiotherapy after high dose chemotherapy.We reviewed data of 30 patients with ATRT treated with pencil-beam proton therapy from 06.2018 to 12.2020. We analyzed treatment characteristics, outcomes and other factors that could be prognostic for progression free survival.Median age at the start of radiotherapy was 28 months. Patients received local radiotherapy (18 patients) and craniospinal irradiation (12 patients). Total dose in case of local radiotherapy was 54 Gy. A median craniospinal dose was 29.8 Gy (24-36 Gy). Four patients got re-irradiation course because of local or leptomeningeal progression. One of them received craniospinal re-irradiation. All the patients who were 5 years old and younger received daily general anesthesia (sedation) during radiotherapy course. Two of the patients did not finish course of radiotherapy because of distant progression. Median follow-up was 10 months. No interruptions were needed for any of the patients. Inability to achieve gross tumor resection (P = 0.01) and M3-stage (P = 0.03) were the most unfavorable prognostic factors for progression-free survival.This is one of the largest reports of using pencil-beam proton therapy for children with ATRT of CNS treated in one facility. Proton therapy was well tolerated even by patients receiving re-irradiation course. Further research should be conducted in order to get information about late toxicity and survival outcomes.

How to identify patients who require aortic vascular control in placenta accreta spectrum disorders?

The placenta accreta spectrum disorder may lead to severe complications. Helpful interventions to prevent placenta accreta spectrum bleeding include vascular control procedures in the aorta or pelvic vessels. Although these procedures are related to lower intraoperative bleeding, they are associated with complications, so the possibility of selecting patients at highest risk of bleeding while avoiding vascular procedures for all cases is attractive. We describe an intraoperative staging protocol whose objective is to identify the need to use vascular control procedures in patients with placenta accreta spectrum. We also describe the results of its application in a placenta accreta spectrum referral hospital. This descriptive, retrospective study included patients with suspected prenatal placenta accreta spectrum treated at a referral center for placenta accreta spectrum between April 2016 and June 2020. The use of the resuscitative endovascular balloon occlusion of the aorta allowed the prevention and treatment of excessive bleeding; its application was performed according to 3 approaches: (1) presurgical use in all placenta accreta spectrum patients (Group 1), (2) according to the prenatal placenta accreta spectrum topography (Group 2), and (3) according to the "intraoperative staging" (Group 3). In addition, the frequency of use of resuscitative endovascular balloon occlusion of the aorta and the clinical results in the management of placenta accreta spectrum were described in the 3 groups. Seventy patients underwent surgery for a prenatal suspicion of placenta accreta spectrum. Of these, 16 underwent intraoperative staging (Group 3); in 20 cases, resuscitative endovascular balloon occlusion of the aorta was used based on the prenatal imaging topographic classification (Group 2), and in the remaining 34 patients (Group 1), it was always used before the laparotomy. The frequency of use of resuscitative endovascular balloon occlusion of the aorta was progressively lower in Groups 1 (32 patients, 94.1% of cases), 2 (11 patients, 75% of cases), and 3 (4 patients, 25% of cases). Similarly, resuscitative endovascular balloon occlusion of the aorta went from being applied predominantly before the laparotomy (all cases in Group 1) to being applied after intraoperative staging (all cases in Group 3). The percentage of endovascular devices applied but not used, decreased from 23.5% in Group 1 to 0% in Group 3. Complications related to the resuscitative endovascular balloon occlusion of the aorta were seen in 4 patients (2 women in Group 1, and 1 woman each in Groups 2 and 3). The "intraoperative staging" of placenta accreta spectrum allows the optimization of the use of resuscitative endovascular balloon occlusion of the aorta, which decreases the frequency of its use without increasing the volume of blood loss.

A MACHINE LEARNING ALGORITHM WITH SELF-UPDATE PARAMETER CALIBRATION TO IMPROVE INTRUSION DETECTION OF DDOS IN COMMUNICATION NETWORKS

Currently DDoS attack has become one of the most common network attacks worldwide. This is largely due to the fact that we live in the age of the Internet of Things, with the rapid development of computer and communication technology evolving into big, complex and distributed systems that are exposed to several kinds of attacks in addition to new threats. In order to detect intruders in an efficient and timely manner, a real time detection mechanism, proficient in dealing with a variety of forms of attacks is highly important. However, due to the uniformity and evolution of DDoS attack modes and the variable size of attack traffic, there has not yet been a detection method with satisfactory detection accuracy at present and considerable effort made by both the scientific research and industry for several years to mitigate DDoS detection potential DDoS target indicate that DDoS attacks have not been fully addressed. This study therefore aimed at developing a machine learning a Machine learning algorithm with self-update parameter calibration to improve intrusion detection of DDoS in communication networks, in two steps: Feature extraction and model detection that is, we extract DDoS attack traffic characteristics with large proportion and compare the data packages according to the protocol in the Feature extraction stage whereas in the model detection stage, the features that were extracted are used as the input features in machine learning after which the Random Forest algorithm used to train the developed detection model. Finally, the model was validated by three metrics (accuracy, false negative rate and false positive rate). The results show that the DDoS attack detection method based on machine learning proposed in this study has a good detection rate and accuracy compared to the current popular DDoS attack detection methods. The developed model achieved accuracy of 96% over a real-time dataset.

400 OUTCOME OF PATIENTS THAT DO NOT UNDERGO RESECTION AFTER NEOADJUVANT TREATMENT FOR CANCER OF THE ESOPHAGUS.

Abstract Patients with locally advanced esophageal cancer usually receive neoadjuvant treatment prior to surgery. A proportion of patients will not receive their surgery due to disease progression. Little is known about what happens to these patients and their prognosis. The aim of this study was to evaluate outcomes in patients that have received neoadjuvant treatment but not undergone esophagectomy. Methods A review of a contemporaneously maintained database of all patients that underwent neoadjuvant treatment for esophageal adenocarcinoma, or squamous cell carcinoma (SCC) but did not have a subsequent esophagectomy was carried out. Patients that were diagnosed with cancer between January 2009 and December 2018 were included. All patients underwent a standardised staging protocol, and were restaged on completion of their neoadjuvant treatment. Overall survival from the date of their initial staging CT and any subsequent treatments were recorded. Results Over the time period 927 patients received neoadjuvant treatment, and 107 did not progress to surgery. Of the 107, 106 received neoadjuvant chemotherapy and one chemoradiotherapy. 83 of the 107 were adenocarcinoma and 24 SCC. The median age of patients who had surgery was 66 compared to 67 for those that did not. Overall median survival for patients not having surgery was 328.5 days. 40 patients had subsequent oncological treatments. Median survival for patients who received no further treatment was 264 days, palliative chemotherapy 412 days palliative radiotherapy 418.5 days and any combination of the two was 390.5 days. Conclusion These results show median survival after disease progression during neoadjuvant treatment was over 10 months and this was extended with further oncological treatment with radiotherapy prolonging survival times the most to over 13 months. This information can help when counselling patients to potential treatment options.

Retrospective analysis of adjuvant therapy using dabrafenib plus trametinib in Japanese patients with advanced melanoma: analysis of 36 cases.

Patients with resected stage IIIB, IIIC and IIID melanomas have a high risk of recurrence. Therefore, an appropriate protocol for stage III melanoma is needed. Since adjuvant dabrafenib plus trametinib (D+T) combined therapy and anti-PD1 antibody (Ab) therapy reduce the risk of recurrence in patients with resected stage III BRAF-mutated melanoma, selecting the adjuvant therapy for BRAF-mutated melanoma is controversial. The efficacy and safety profiles of D+T combined therapy in the adjuvant setting were retrospectively analyzed in 36 Japanese. BRAF-mutated advanced melanoma patients. The relapse-free rate (RFR) at 12 months was 82.1% (95% confidential interval (CI), 63.9-92.6%). In the 21 patients who completed the protocol, the RFR at 12 months was 85.7% (95% CI, 64.5-95.9%). In the seven patients whose protocol was interrupted by adverse events, the RFR was 71.4% (95% CI, 35.2-92.4%). The incidence rate of any AEs for all patients was 69.7% (95% CI, 52.5-82.8%), including 13 cases of pyrexia, five cases of skin rash and four cases of liver dysfunction. The present study suggested that D+T therapy in the adjuvant setting is a useful and very tolerable protocol for BRAF-mutated melanoma in the Japanese population.

The Role of Ultra-Widefield Fundus Imaging and Fluorescein Angiography in Diagnosis and Treatment of Diabetic Retinopathy.

Early detection and treatment are important for preventing vision loss from diabetic retinopathy. Historically, the gold standard for grading diabetic retinopathy has been based on 7-field 30-degree color fundus photographs that capture roughly the central third of the retina. Our aim was to review recent literature on the role of ultra-widefield (allowing capture of up to 82% of the retina in one frame) fundus imaging in screening, prognostication, and treatment of diabetic retinopathy. Ultra-widefield fundus imaging can capture peripheral retinal lesions outside the traditional 7-field photographs that may correlate with increased risk of diabetic retinopathy progression. The speed and ability to image through undilated pupils make ultra-widefield imaging attractive for tele-ophthalmology screening. Ultra-widefield fluorescein angiography may help guide targeted laser treatment in eyes with proliferative diabetic retinopathy. Ultra-widefield imaging has potential to help shape new diabetic retinopathy screening, staging, and treatment protocols.

Right Care, First Time: Developing a Theory-Based Automated Protocol to Help Clinically Stage Young People Based on Severity and Persistence of Mental Illness.

Most mental disorders emerge before the age of 25 years and, if left untreated, have the potential to lead to considerable lifetime burden of disease. Many services struggle to manage high demand and have difficulty matching individuals to timely interventions due to the heterogeneity of disorders. The technological implementation of clinical staging for youth mental health may assist the early detection and treatment of mental disorders. We describe the development of a theory-based automated protocol to facilitate the initial clinical staging process, its intended use, and strategies for protocol validation and refinement. The automated clinical staging protocol leverages the clinical validation and evidence base of the staging model to improve its standardization, scalability, and utility by deploying it using Health Information Technologies (HIT). Its use has the potential to enhance clinical decision-making and transform existing care pathways, but further validation and evaluation of the tool in real-world settings is needed.

Comparison Of Adult Omni Rate Of Perceived Exertion With Heart Rate During Aerobic Field Test

INTRODUCTION: Adult OMNI Rate of Perceived Exertion (OMNI RPE) has been widely validated in laboratory settings with physiological variables across gender, race, adults, children and health status. However, comparative studies on adults with physiological variables in field settings are limited. PURPOSE: To compare OMNI RPE with heart rate (HR) in Progressive Aerobic Cardiovascular Endurance Run (PACER) test for adults. METHODS: Fifteen healthy male participants ((age: 23.47 ± 1.56 yrs, height: 1.73 ± 0.03 m, weight: 67.91 ± 5.8 kg, body fat percent (%BF): 13.6 ± 4.51%)) were recruited. It consisted of two sessions conducted at least 24 hours apart between each session. The first session involved an OMNI RPE familiarization session with standardized instructions and a discontinuous running submaximal graded exercise treadmill test (GXT). The GXT was conducted at a 4-minute per stage (run/rest) protocol and terminated with HR at 70% maximum HR (HRmax) (HRmax = 220 - age). It started at 6 km/h and increased 0.5 km/h per stage. HR and OMNI RPE values were recorded at the last minute per stage. The second session was a 20 m PACER test which terminated when participants failed to keep up with the pace twice or till volitional exhaustion. HR and OMNI RPE values were recorded at alternate stages. HR was measured with a HR transmitter in GXT and PACER test. Participants gestured their OMNI RPE score when asked “on a scale of 0 to 10, can you tell me how tired are you feeling overall” in GXT and PACER test. RESULTS: A significant positive correlation was observed between average HR and OMNI RPE in the PACER test (HR: 173.29 ± 17.13beats•min-1, OMNI RPE: 5.34 ± 3.24, r = 0.90, p = 0.00) and GXT (HR: 134.67 ± 23.10beats•min-1, OMNI RPE: 3.92 ± 2.20, r = 0.81, p = 0.00). A significant linear regression analysis indicated that OMNI RPE responses distributed a positive linear function to HR in PACER test (R2 = 0.51, r = 0.71, p = 0.001, SEE: 16.36) and GXT (R2 = 0.65, r = 0.81, p = 0.000, SEE: 13.67). CONCLUSIONS: Regression analysis indicated a positive linear relationship between OMNI RPE and HR during PACER test and GXT. OMNI RPE and HR results from GXT and PACER test were similar and increased progressively as exercise intensity increased. Thus, OMNI RPE can be used instead of using HR monitors to monitor HR in field exercises for self-regulation of exercise intensity.

Thymoma Staging: An Analysis of the Different Schemas.

Over the last years, a number of changes has taken place in the evaluation of thymomas. More recently, the introduction of a TNM staging system in the assessment of thymic epithelial tumors, in general, has been put forward. Important to highlight is that this TNM system is not based on tumor size, and because of that shortcoming, it was in need to borrow most if not all of the information from the experience derived from other schemas that over the years have been tested with larger series of cases. Also important to recognize is that this TNM system is nothing new as previous authors in the past had already attempted to provide a TNM system for thymomas without much success. Therefore, it becomes important that those involved with the staging of thymomas become familiar with previous schemas as the TNM system provides a slight different spin in the T component, while the M component truly represents advance stages of previous schemas. More importantly is to also highlight that despite the specific anatomic structures addressed in the T or M assessment, there is little information in the most important aspect of any staging system-clear definitions of invasion and metastasis and the gross assessment of these tumors to provide an accurate staging. Capsular integrity still remains paramount in such assessment. A critical assessment of TNM system compared with previously proposed staging systems and whether there is a real advancement in applying it is discussed as well as the gross assessment of these tumors to highlight the importance of the staging protocol.

P-7 Surgical versus Organ preservation protocol for stage T3/T4 laryngeal and hypopharyngeal cancer

P-7 Surgical versus Organ preservation protocol for stage T3/T4 laryngeal and hypopharyngeal cancer

Significance of Brain Imaging for Staging in Patients With Clinical Stage T1-2 N0 Non–Small-Cell Lung Cancer on Positron Emission Tomography/Computed Tomography

BackgroundRoutine positron emission tomography/computed tomography (PET/CT) has been recommended even for clinical stage I non–small-cell lung cancer (NSCLC). In spite of the progress in the screening procedure, and revisions to TNM classification, there is no evidence to support brain imaging screening of patients assessed with the current staging protocol including PET/CT. Materials and MethodsWe retrospectively investigated the frequency of extrathoracic metastasis in 466 consecutive patients with clinical stage T1-2 N0 NSCLC with the complete staging assessment comprised of thin-section CT, PET/CT, and brain contrast-enhanced magnetic resonance imaging between 2008 and 2016. All patients were reclassified according to the eighth edition of the tumor, node, and metastasis (TNM) classification. ResultsAmong all patients, 70% of the tumors were pure solid and 30% had part-solid ground-glass opacity on thin-section CT, and 388 (83%) and 78 (17%) were classified into clinical stages T1 and T2, respectively. Eight patients (1.7%) had extrathoracic metastasis, including 3 (0.6%) with brain metastasis, and all showed pure-solid tumors. The frequency of extrathoracic and brain metastasis was 1.0% and 0.5% in 388 T1 patients, and 5.0% and 3.0% in 78 T2 patients. Although brain metastases were detected in 2 of 7 patients (29%) with PET/CT detectable extrathoracic metastases and 1 of 459 patients (0.2%) without PET/CT detectable extrathoracic metastasis, there were no neurologically asymptomatic brain metastases in patients with early-stage NSCLC confirmed by PET/CT. ConclusionRoutine screening of brain imaging is unnecessary in patients with early-stage NSCLC, assessed with the current staging protocol including PET/CT.

Outcome of Universal Neonatal Hearing Screening Programme at a Tertiary Care Centre: A Prospective Study.

Hearing is an important sense organ for human beings essential for speech, language and overall development. Universal neonatal hearing screening programmes are mandatory in many developed countries. In India out of 1000 neonates approximately 5-6 infants are diagnosed with hearing impairment but still universal neonatal hearing screening programme is in its infancy. To screen all neonates delivered at our centre in three years, with secondary objective of determining the significance of risk factors with neonatal hearing loss and to provide appropriate intervention following the detection of a permanent hearing impairment. It is a non-randomised prospective cohort study conducted at a tertiary care centre to screen all neonates born between Jan 2017 and Dec 2019 with 2 stage protocol using distortion product otoacoustic emission and auditory brainstem response. The study population was also divided into two groups, ''at risk'' and ''no risk'' groups to determine the significance of risk factors on neonatal hearing loss. Total 2676 neonates were screened, OAE referral rate was 1.53%. There was a 94.12% follow up. The incidence of hearing impairment was found to be 7 per 1000(In the "no risk" group, 2.9 per 1000 and in the "at risk" group, 41.38 per 1000). Statistically, a significant difference was found in the incidence of hearing impairment between the two groups (p < 0.05, chi-square Test). Hospital based universal hearing screening of new born before discharge is feasible at a tertiary care centre. A high incidence of 0.7% congenital hearing impairment warrants universal newborn hearing screening programme. Considering the limitations and infrastructure in India, we should at least employ screening for all high risk neonates.