Medicine
-
EUS-guided fine needle aspiration cytology (FNA) is the gold standard of evaluation of solid pancreatic lesions. However, accuracy is generally low. The aim of this study was to compare the diagnostic yield of conventional cytology (CC) with liquid-based cytological analysis using an ethanol based fixative system (LBC) without onsite cytopathological assessment. ⋯ Liquid-based cytology performed significantly better than conventional cytology in terms of sensitivity (87.8% vs 67.2% (P = .021)), specificity (100% vs 87.1% (P = .047)) negative predictive value (NPV) (85% vs 58.7% (P = .009)) and accuracy (92.8% vs 74.2% (P = .001)). We observed no learning curve after implementation of LBC Liquid based cytology is a simple and inexpensive technique that helps improving sensitivity, specificity, NPV and accuracy over conventional cytology in fine needle aspirates from patients with pancreatic lesions. Therefore, this real-world evidence shows, that EUS-FNA specimen processing should be performed using LBC to achieve best possible results.
-
Due to extensive tumor spread, systemic chemotherapy is the main treatment for distant metastatic small-cell lung cancer (DM-SCLC). It is still unclear whether adding local radiotherapy (RT) on the basis of chemotherapy can improve the long-term survival of patients with DM-SCLC. This study aims to explore the population with DM-SCLC who can benefit from RT. ⋯ The median survival time of the RT group was 9 months, and that of the non-RT group was 7 months, and the difference was statistically significant (P < .001). RT improved survival in all sex subgroups, any N stage subgroup, any tumor size subgroup, no brain metastases subgroup, no liver metastases subgroup, any age subgroup, and 1-2 organ metastases subgroup. RT improves 1- and 2-year survival in DM-SCLC.
-
Observational Study
The impact of the pandemic on functional outcomes for joint replacement patients: An observational study.
Elective surgeries, as joint replacement, were resumed after the first COVID-19 pandemic wave in 2020 and a phase of coexistence with the virus began. Surgery was organized in a new way that incorporated procedures aimed at reducing the risk of spreading the virus. The aim of this study is to describe the early functional results for patients undergoing hip and knee replacements at the time healthcare services were being reopened and to compare them with the same outcomes recorded in the prepandemic period. ⋯ Multivariate analysis confirmed that the incidence of stair climbing was not associated with the prepandemic or pandemic inclusion. During the reopening of orthopedic surgery activity, the reorganization and treatment pathway did not affect the functional outcome achieved by patients underwent joint replacement. Constant monitoring of the functional outcomes will be required so as to further increase the number of joint replacement surgeries.
-
The use of immunosuppressive therapy for immunoglobulin A nephropathy (IgAN) patients with stage 3 or 4 chronic kidney disease (CKD) is controversial. We performed a monocentric retrospective study on 83 consecutive IgAN patients with stage 3 or 4 CKD and proteinuria ≥0.75 g/d (age 41 [33-56] years, 72% male, estimated glomerular filtration rate 36.1 [25.4-47.5] mL/min/1.73 m2) who received uncontrolled supportive care (Supp) (n = 36), corticosteroids/corticotherapy (CS) (n = 14), or CS combined with monthly pulses of cyclophosphamide (CS + CFM) (n = 33) between 2010 and 2017. Patients were followed until composite endpoint (doubling of serum creatinine, end-stage kidney disease (dialysis or kidney transplant) or death, whichever came first) or end of study (January 2020). ⋯ There were no differences between the 3 studied groups regarding age, estimated glomerular filtration rate, proteinuria, Oxford classification score, arterial hypertension, and therapy with renin-angiotensin system inhibitors. Mean kidney survival time for the entire cohort was 81.0 (95% confidence interval = 73.1-89.0) months, without significant differences between the 3 groups. In univariate and multivariate Cox regression analysis adjusted for IgAN progression factors, immunosuppressive therapy was not associated with better kidney survival when compared with supportive therapy.
-
Ligamentum flavum hypertrophy (LFH) is a known contributor to lumbar spinal canal stenosis (LSCS). However, the clinical significance and quantitative role of LFH compared to other components, such as disc bulging and facet hypertrophy, have not yet been examined. We investigated the correlation between the quantitative radiological factors, clinical symptoms, and outcomes in patients with LSCS. ⋯ Among various radiologic factors, the baseline LF thickness (odds ratio [OR] 1.73; 95% confidence interval [CI] 1.25-2.41) was the only major contributing factor to the severity of claudication in the multivariate logistic regression analysis. The types of surgery (decompression alone vs fusion) did not significantly differ in terms of their clinical outcomes, including back and leg VAS, ODI, SF-36 PCS, and satisfaction with the MacNab classification. LF thickness is a major factor contributing to claudication severity.