scholarly journals What is the impact of a previously failed Robicsek repair in the subsequent treatment of sternal dehiscence with thermoreactive nitinol clips?

2021 ◽  
Author(s):  
Yunus Seyrek ◽  
Murat Akkuş
Keyword(s):  
Subsequent Treatment ◽  
Sternal Dehiscence ◽  
The Impact

Surgery for Lung Cancer and the Consequences for the Swallow

2016 ◽  
Vol 1 (13) ◽  
pp. 162-168
Author(s):  
Pippa Hales ◽  
Corinne Mossey-Gaston
Keyword(s):  
Lung Cancer ◽  
Treatment Options ◽  
Vocal Cord Palsy ◽  
Subsequent Treatment ◽  
Physiological Reserve ◽  
Palliative Phase ◽  
And Function ◽  
The Impact ◽  
Swallow Function

Lung cancer is one of the most commonly diagnosed cancers across Northern America and Europe. Treatment options offered are dependent on the type of cancer, the location of the tumor, the staging, and the overall health of the person. When surgery for lung cancer is offered, difficulty swallowing is a potential complication that can have several influencing factors. Surgical interaction with the recurrent laryngeal nerve (RLN) can lead to unilateral vocal cord palsy, altering swallow function and safety. Understanding whether the RLN has been preserved, damaged, or sacrificed is integral to understanding the effect on the swallow and the subsequent treatment options available. There is also the risk of post-surgical reduction of physiological reserve, which can reduce the strength and function of the swallow in addition to any surgery specific complications. As lung cancer has a limited prognosis, the clinician must also factor in the palliative phase, as this can further increase the burden of an already compromised swallow. By understanding the surgery and the implications this may have for the swallow, there is the potential to reduce the impact of post-surgical complications and so improve quality of life (QOL) for people with lung cancer.

Aspirin as adjuvant treatment for colorectal cancer: Rationale and progress of the Add-Aspirin trial.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. TPS3624-TPS3624
Author(s):  
Ruth E Langley ◽  
Richard H. Wilson ◽  
Fay Helen Cafferty ◽  
Nalinie Joharatnam ◽  
Janet Shirley Graham ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Treatment ◽  
Controlled Trial ◽  
Disease Free Survival ◽  
Mechanisms Of Action ◽  
Subsequent Treatment ◽  
Phase Iii ◽  
Double Blind ◽  
Pik3ca Mutations ◽  
The Impact

TPS3624 Background: There is now a body of evidence indicating a potential role for aspirin in colorectal cancer (CRC) prevention. In cardiovascular trials, effects on incidence of cancer metastases and short-term mortality suggest further possible roles in the treatment setting, supported by observational studies of aspirin use after cancer diagnosis. In the prevention setting, aspirin use has been limited by toxicity concerns, particularly of serious bleeding. In the adjuvant setting, benefits associated with reducing recurrence and subsequent treatment may outweigh these risks. The Add-Aspirin trial will investigate this, and will also consider possible mechanisms of action for aspirin effects, including the impact of PIK3CA mutations, where there are currently several theories and conflicting data. Methods: Add-Aspirin (ISRCTN74358648) is an international, phase III, double-blind, randomised, placebo-controlled trial recruiting patients who have undergone surgery and relevant adjuvant treatment for stage II or III CRC, as well as those with completely resected CRC liver metastases. Parallel randomised cohorts will address the question in breast, gastro-oesophageal and prostate cancer. Participants take aspirin 100mg daily for an 8-week run-in, to assess adherence and toxicity, and those suitable to proceed are randomised (1:1:1) to aspirin 100mg, aspirin 300mg or placebo daily for at least 5 years. A number of measures – including blood pressure control and PPI use where relevant - are in place to reduce bleeding risk. The primary outcome is disease-free survival (target hazard ratio = 0.8, n = 2600 in 5 years) with a long term analysis of survival planned across the tumour groups. Translational work includes a sub-study monitoring urinary thromboxane B2 as a marker of platelet activation in a subgroup (n = 500) to investigate mechanisms of action. Add-Aspirin opened in 2015 and recruited 1505 CRC patients during the first 3 years from 137 UK centres. 1282 (85%) proceeded to randomisation. A pre-planned feasibility analysis of run-in data (n = 2253 across all 4 tumour groups) provided reassuring data on safety, tolerability and adherence, and recruitment continues with centres in India and Republic of Ireland recently joining. Clinical trial information: 74358648.

Food price volatilities and civilian victimization in Africa

2017 ◽  
Vol 37 (2) ◽  
pp. 193-214
Author(s):  
Babak Rezaeedaryakenari ◽  
Steven T. Landis ◽  
Cameron G. Thies
Keyword(s):  
Food Insecurity ◽  
Agricultural Land ◽  
Subsequent Treatment ◽  
Food Price ◽  
Sub Saharan Africa ◽  
Rebel Groups ◽  
Human Rights Organizations ◽  
Violence Against Civilians ◽  
Sub Saharan ◽  
The Impact

This paper studies the impact of food insecurity on civilian–rebel interactions. We argue that food price volatilities affect the incentives of insurgent groups and their subsequent treatment of civilians. The hypotheses developed in this study are empirically evaluated across a battery of statistical models using monthly data from a sample of 112 first administrative districts in sub-Saharan Africa. The results show that increases in food insecurity substantially raise the likelihood of insurgent groups committing violence against civilians and that districts with a higher proportion of agricultural land are at greatest risk of civilian victimization by rebel groups during these episodes of food insecurity. The implications of this analysis suggest that the human impact of food insecurity does not simply relate to nutrition and questions of governance. Food price volatilities also incentivize the use of violence against civilians by non-state actors, which is a pertinent concern of human rights organizations and policymakers.

scholarly journals What is the impact of a previously failed Robicsek repair in the subsequent treatment of sternal dehiscence with thermoreactive nitinol clips?

2021 ◽  
Author(s):  
Yunus Seyrek ◽  
Murat Akkuş
Keyword(s):  
Treatment Group ◽  
High Risk ◽  
Complication Rate ◽  
Median Sternotomy ◽  
Sternal Dehiscence ◽  
High Risk Patients ◽  
Risk Patients ◽  
Group A ◽  
Group B ◽  
The Impact

Background: In this study, we conducted a retrospective review of patients at our institution with noninfectious sternal dehiscence (NISD) after median sternotomy who received thermoreactive nitinol clips (TRNC) treatment during a 10-year period. We compared TRNC patients with and without history of failed Robicsek repair. The purpose of the study was to analyze the impact of previous Robicsek repair on the treatment of sternal dehiscence with TRCN. Methods: Between December 2009 and January 2020, out of 283 patients with NISD who underwent refixation, we studied 34 cases who received TRNC treatment. We divided these 34 cases into two groups: patients who had a previously failed Robicsek procedure before TRNC treatment (group A, n=11) and patients who had been directly referred to TRCN treatment (group B, n= 23). Results: Postoperative complication rate was significantly higher in group A (p=0.026). Hospitalization duration was significantly longer in group A due to the higher complication rate (p=0.001). Operative time was significantly shorter and blood loss was significantly lower in group B (p=0.001). Conclusion: The Robicsek procedure is considered an effective method in the treatment of NISD but, in case of its failure, subsequent TRNC treatment might become cumbersome in high-risk patients. In our study, a previously failed Robicsek procedure caused significantly higher morbidity and additional operative risk in later TRNC treatment of high-risk cases. Ultimately, we speculate that a direct TRNC treatment for NISD is favorable in high-risk patients.

Impacts of toxicity on patient treatment choices for metastatic breast cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 18-18 ◽  
Author(s):  
Carol B. White ◽  
Mary Lou Smith ◽  
Oyewale O. Abidoye ◽  
Deepa Lalla
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Online Survey ◽  
Metastatic Breast ◽  
Treatment Decisions ◽  
Subsequent Treatment ◽  
Patient Treatment ◽  
Treatment Choices ◽  
Almost All ◽  
The Impact

18 Background: Most patients with metastatic breast cancer (MBC) are treated with chemotherapy and/or targeted therapy with varying toxicity profiles. Experience with adverse events (AE) may vary and factor into subsequent treatment decisions. As newer agents and combinations become available, it becomes increasingly important to understand which AEs impact treatment decisions. Methods: The objective was to assess patient experience with AEs and preferences for future treatments. Following focus groups and pretests, an online survey was released by breast cancer organizations to recruit patients with MBC. The survey assessed the impact of experiences on future treatment choices and measured preferences via conjoint analysis (CA). Results: A total of 551 respondents completed the online survey. Among the AEs studied to assess their impact on either treatment stops or breaks, neutropenia topped the list, particularly for a required break. Fatigue, hand and foot syndrome, diarrhea, joint pain and peripheral neuropathy (PN) were high for chosen stops. Five AEs (fatigue, alopecia, diarrhea, PN, neutropenia) were studied extensively. Almost all respondents report experiencing fatigue, ~80% experienced alopecia, and ~66% each of the other 3 AEs. For each AE, the majority of respondents reported their prior experience would not impact a future decision involving the same AE; about 1/3 report they’d be more likely to take a treatment with the same AE; 8% to 18% would be less likely to take a treatment with the same AE. CA was also used to assess influence of the 5 AEs on future decisions. Within the tested ranges of likelihood, severity and duration, alopecia had the highest impact; PN, diarrhea, and neutropenia were in the middle; and fatigue was lowest. Further analysis is ongoing and final results will include differences in patient subgroups. Conclusions: This information informs priorities for development of new therapies allowing additional attention on AEs that matter most to patients. In addition, these results may generate discussion and consideration of patient preferences in conversations about care and treatment selection.

Impact of Subsequent Therapies on Outcome of the FIRE-3/AIO KRK0306 Trial: First-Line Therapy With FOLFIRI Plus Cetuximab or Bevacizumab in Patients With KRAS Wild-Type Tumors in Metastatic Colorectal Cancer

2015 ◽  
Vol 33 (32) ◽  
pp. 3718-3726 ◽  
Author(s):  
Dominik P. Modest ◽  
Sebastian Stintzing ◽  
Ludwig Fischer von Weikersthal ◽  
Thomas Decker ◽  
Alexander Kiani ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Subsequent Treatment ◽  
Hazard Ratio ◽  
Second Line ◽  
Wild Type ◽  
First Line ◽  
Second Line Therapy ◽  
Line Therapy ◽  
The Impact

Purpose We investigated choice and efficacy of subsequent treatment, with special focus on second-line therapy, in the FIRE-3 trial (FOLFIRI plus cetuximab [arm A] or bevacizumab [arm B]) for patients with KRAS wild-type metastatic colorectal cancer. Patients and Methods Start of subsequent-line (second or third) therapy was defined as use of an antitumor drug that was not part of the previous regimen. We evaluated choice, duration, and efficacy of subsequent therapy and determined the impact of subsequent-line treatment on outcome of patients in FIRE-3. Results Of 592 patients in the intent-to-treat population, 414 (69.9%) received second-line and 256 (43.2%) received third-line therapy. In subsequent treatment lines, 47.1% of patients originally assigned to arm A received bevacizumab, and 52.2% originally assigned to arm B received either cetuximab or panitumumab. Oxaliplatin was subsequently used in 55.9% (arm A) and 53.2% (arm B) of patients. Second-line therapy was administered for a median duration of 5.0 versus 3.2 months (P < .001) in study arm A versus B. Progression-free (6.5 v 4.7 months; hazard ratio, 0.68; 95% CI, 0.54 to 0.85; P < .001) and overall survival (16.3 v 13.2 months; hazard ratio, 0.70; 95% CI, 0.55 to 0.88; P = .0021) from start of second-line therapy were longer in patients in arm A compared with arm B. Conclusion Our data suggest that the sequence of drug application might be more important than exposure to single agents. In patients with RAS wild-type tumors, first-line application of anti–epidermal growth factor receptor–directed therapy may represent a favorable condition for promoting effective subsequent therapy including antiangiogenic agents.

scholarly journals Lesion Development and Reperfusion Benefit in Relation to Vascular Occlusion Patterns after Embolic Stroke in Rats

2013 ◽  
Vol 34 (2) ◽  
pp. 332-338 ◽  
Author(s):  
Mark J R J Bouts ◽  
Ivo A C W Tiebosch ◽  
Annette van der Toorn ◽  
Jeroen Hendrikse ◽  
Rick M Dijkhuizen
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Blood Clot ◽  
Arterial Occlusion ◽  
Vascular Occlusion ◽  
Subsequent Treatment ◽  
Embolic Stroke ◽  
Spontaneously Hypertensive ◽  
The Impact

Vascular occlusion sites largely determine the pattern of cerebral tissue damage and likelihood of subsequent reperfusion after acute ischemic stroke. We aimed to elucidate relationships between flow obstruction in segments of the internal carotid artery (ICA) and middle cerebral artery (MCA), and (1) profiles of acute ischemic lesions and (2) probability of subsequent beneficial reperfusion. Embolic stroke was induced by unilateral intracarotid blood clot injection in normotensive ( n=53) or spontaneously hypertensive ( n=20) rats, followed within 2 hours by magnetic resonance (MR) angiography (MRA), diffusion- (DWI) and perfusion-weighted magnetic resonance imaging (MRI) (PWI). In a subset of animals ( n=9), MRI was repeated after 24 and 168 hours to determine the predictive value of the occlusion pattern on benefit of reperfusion. The extent of cerebral perfusion and diffusion abnormality was related to the pattern of flow obstruction in ICA and MCA segments. Hypertensive animals displayed significantly larger cortical perfusion lesions. Acute perfusion-diffusion lesion mismatches were detected in all animals that subsequently benefitted from reperfusion. Yet, the presence of an angiography-diffusion mismatch was more specific in predicting reperfusion benefit. Combination of DWI, PWI, and MRA exclusively informs on the impact of arterial occlusion profiles after acute ischemic stroke, which may improve prognostication and subsequent treatment decisions.

scholarly journals Time to get personal? The impact of researchers’ choices on the selection of treatment targets using the experience sampling methodology

2019 ◽  
Author(s):  
Jojanneke A. Bastiaansen ◽  
Yoram Kevin Kunkels ◽  
Frank Blaauw ◽  
Steven Marshall Boker ◽  
Eva Ceulemans ◽  
...  
Keyword(s):  
Experience Sampling ◽  
Primary Diagnosis ◽  
Subsequent Treatment ◽  
Clinical Implementation ◽  
Sampling Methodology ◽  
Vector Autoregressive ◽  
Experience Sampling Methodology ◽  
Treatment Targets ◽  
The Impact ◽  
Selection Of

One of the promises of the experience sampling methodology (ESM) is that it could be used to identify relevant targets for treatment, based on a statistical analysis of an individual’s emotions, cognitions and behaviors in everyday-life. A requisite for clinical implementation is that outcomes of person-centered analyses are not wholly contingent on the researcher performing them. To evaluate how much researchers vary in their analytical approach and to what degree outcomes vary based on analytical choices, we crowdsourced the analysis of one individual patient’s ESM data to 12 prominent research teams, asking them what symptom(s) they would advise the treating clinician to target in subsequent treatment. The dataset was from a 25-year-old male with a primary diagnosis of major depressive disorder and comorbid generalized anxiety disorder, who completed momentary assessments related to depression and anxiety psychopathology prior to psychotherapy. Variation was evident at different stages of the analysis, from preprocessing steps (e.g., variable selection, clustering, handling of missing data) to the type of statistics. Most teams did include a type of vector autoregressive model, which examines relations between variables (e.g., symptoms) over time. Although most teams were confident their selected targets would provide useful information to the clinician, not one advice was similar: both the number (0-16) and nature of selected targets varied widely. This study makes transparent that the selection of treatment targets based on personalized models using ESM data is currently highly conditional on subjective analytical choices and highlights key methodological issues that need to be addressed in moving toward clinical implementation. Research proposal, data and materials: osf.io/h3djy/

CLO19-033: Afatinib Followed by Osimertinib in EGFR Mutation-Positive (EGFRm+) Advanced NSCLC: Subgroup Analyses of the GioTag Study by ECOG PS, Age, and Ethnicity

2019 ◽  
Vol 17 (3.5) ◽  
pp. CLO19-033
Author(s):  
Balazs Halmos ◽  
Maximilian J. Hochmair ◽  
Alessandro Morabito ◽  
Desiree Hao ◽  
Cheng-Ta Yang ◽  
...  
Keyword(s):  
African American ◽  
Clinical Benefit ◽  
Poor Prognosis ◽  
Advanced Nsclc ◽  
Acquired Resistance ◽  
Subsequent Treatment ◽  
First Line ◽  
Subgroup Analyses ◽  
Ecog Ps ◽  
The Impact

Background: EGFR TKIs have shown first-line efficacy in EGFRm+ NSCLC but acquired resistance is inevitable; with afatinib, this is predominantly through the emergence of T790M. Therefore, a key consideration when assessing therapeutic choices is the availability of subsequent treatment options. The GioTag study (NCT03370770) is the first to assess outcomes of real-world patients (Pts) who received first-line afatinib followed by osimertinib; for pts with EGFRm+ NSCLC and acquired T790M this sequence resulted in a median time on treatment (ToT) of 27.6 months, which did not include chemotherapy. We present subgroup analyses of pts from the GioTag study who are under-represented in randomized controlled trials (RCTs) and assess the impact of afatinib treatment on ECOG PS. Methods: The GioTag study is an observational, multicenter study. Data were collected retrospectively (Dec 2017–May 2018). Pts had EGFRm+ (Del19/L858R) advanced NSCLC and acquired T790M after first-line afatinib. Pts completed afatinib and started osimertinib treatment ≥10 months before data entry to avoid early censoring and ensure mature data collection. Patient subgroups were defined based on baseline characteristics (eg, ECOG PS, age, ethnicity). The primary outcome was ToT from afatinib initiation to osimertinib discontinuation. Results: A total of 204 pts were included in the GioTag study: 15.2% had ECOG PS ≥2; 7.4% were aged ≥75 years; 8.8% were African-American. Pts generally considered to have a poor prognosis derived clinical benefit from the afatinib–osimertinib sequence: median ToT for pts with ECOG PS ≥2 (n=31) was 22.2 months (90%CI 16.0–27.0; vs pts with ECOG PS 0/1 [n=153; 31.3 months; 27.6–44.5] P<.001); and for pts aged ≥75 years (n=15), ToT was 19.9 months (9.7–not evaluable [NE]; vs pts aged <75 years [n=189; 28.1 months; 26.6–31.3] P=.382). In African-American pts, median ToT was 27.6 months (90%CI 24.7–NE). Of 180 pts with available data, 75.0% had no change or an improvement in ECOG PS from the start of afatinib to the start of osimertinib treatment; 24.4% of pts had a deterioration in ECOG PS by 1 step and 0.6% of pts had a deterioration by 2 steps. Conclusions: First-line afatinib followed by osimertinib is a feasible therapeutic strategy in pts with EGFRm+ NSCLC and acquired T790M, including those who are often under-represented in RCTs. Clinical benefit (measured by ToT) was seen among pts with poor prognosis (ECOG PS ≥2), pts aged ≥75 years, and African-American pts.

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