The aim of this mini-review is to compare and contrast the pros and cons of short-course and long-course neoadjuvant chemoradiation therapy regimens for stageⅡ&Ⅲrectal adenocarcinoma.Multiple trials have demonst...The aim of this mini-review is to compare and contrast the pros and cons of short-course and long-course neoadjuvant chemoradiation therapy regimens for stageⅡ&Ⅲrectal adenocarcinoma.Multiple trials have demonstrated the equal efficacy and safety of short-course and long-course radiation therapy as a part of neoadjuvant regimens.Published data also shows that total neoadjuvant therapy could be more successful than neoadjuvant chemoradiation followed by adjuvant chemotherapy.This review points out future research directions for patients with locally advanced rectal adenocarcinoma such as comparing total neoadjuvant therapy that contains a short-course of radiation therapy to the standard of care,and evaluating how the sequence of short-course radiation therapy and chemotherapy in the total neoadjuvant therapy impacts the pathological complete response(pCR)rate,local control,and survival outcomes.展开更多
BACKGROUND Acute cholangitis(AC)constitutes an infection with increased mortality rates in the past.Due to new diagnostic tools and therapeutic methods,the mortality of AC has been significantly reduced nowadays.The i...BACKGROUND Acute cholangitis(AC)constitutes an infection with increased mortality rates in the past.Due to new diagnostic tools and therapeutic methods,the mortality of AC has been significantly reduced nowadays.The initial antibiotic treatment of AC has been oriented to the most common pathogens connected to this infection.However,the optimal duration of the antibiotic treatment of AC is still debatable.AIM To investigate if shorter-course antibiotic treatments could be similarly effective to long-course treatments in adults with AC.METHODS This study constitutes a systematic review and meta-analysis of the existing literature concerning the duration of antibiotic therapy of AC and an assessment of the quality of the evidence.The study was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analyses.Fifteen studies were included in the systematic review,and eight were eligible for meta-analysis.Due to heterogeneous duration cutoffs,three study-analysis groups were formed,with a cutoff of 2-3,6-7,and 14 d.RESULTS A total of 2763 patients were included in the systematic review,and 1313 were accounted for the meta-analysis.The mean age was 73.66±14.67 years,and the male and female ratio was 1:08.No significant differences were observed in the mortality rates of antibiotic treatment of 2-3 d,compared to longer treatments(odds ratio=0.78,95% confidence interval:0.23-2.67,I2=9%)and the recurrence rates and hospitalization length were also not different in all study groups.CONCLUSION Short-and long-course antibiotic treatments may be similarly effective concerning the mortality and recurrence rates of AC.Safe conclusions cannot be extracted concerning the hospitalization duration.展开更多
In the following review we intend to ascertain the optimal neoadjuvant therapy inpatients with locally advanced rectal cancer. In 2004, a study revealed thatchemoradiotherapy (CRT) resulted in better local control whe...In the following review we intend to ascertain the optimal neoadjuvant therapy inpatients with locally advanced rectal cancer. In 2004, a study revealed thatchemoradiotherapy (CRT) resulted in better local control when performedpreoperatively rather than postoperatively, thus neoadjuvant treatment wasestablished as a standard treatment. Subsequently, the Polish study and the Trans-Tasman Radiation Oncology Group showed no statistically significant differencebetween concomitant CRT over 5 wk vs short-course radiotherapy (RT).Therefore, both were established as standard neoadjuvant treatments. Later, theStockholm III study demonstrated that short-course RT had a higher completepathological response than long-course RT. It also showed that a delay betweenRT and surgery presented fewer complications. This opened a window of time toprovide an early and effective systemic treatment to prevent distant metastases.Studies show that short-course RT plus oxaliplatin-based chemotherapy couldachieve this. When comparing this total neoadjuvant treatment (TNT) vsconcomitant CRT, the former showed greater complete pathological response andlower acute toxicity. Studies presented during 2020 have also shown the benefitsof TNT in terms of complete pathological response, as well as disease andmetastasis-free survival. Our review suggests that probably TNT should be thenew standard treatment for these patients. However, we will have to wait for thefull text publications of these studies to confirm this statement.展开更多
AIM To investigate second primary malignancy(SPM) risk after radiotherapy in rectal cancer survivors METHODS We used Taiwan's National Health Insurance Research Database to identify rectal cancer patients between ...AIM To investigate second primary malignancy(SPM) risk after radiotherapy in rectal cancer survivors METHODS We used Taiwan's National Health Insurance Research Database to identify rectal cancer patients between 1996 and 2011. Surgery-alone, preoperative short course, preoperative long course, and post-operative radiotherapy groups were defined. The overall and sitespecific SPM incidence rates were compared among the radiotherapy groups by multivariate Cox regression, taking chemotherapy and comorbidities into account. Sensitivity tests were performed for attained-year adjustment and long-term survivors analysis. RESULTS A total of 28220 patients were analyzed. The 10-year cumulative SPM incidence was 7.8% [95% confidence interval(CI): 7.2%-8.2%] using a competing risk model. The most common sites of SPM were the lung, liver, and prostate. Radiotherapy was not associated with increased SPM risk in multi-variate Cox model(hazard ratio = 1.05, 95%CI: 0.91-1.21, P = 0.494). The SPM hazard remained unchanged in 10-yearsurvivors. In addition, no SPM risk difference was found between the preoperative radiotherapy and postoperative radiotherapy groups.CONCLUSION In this large population-based cohort study, we demonstrated that radiotherapy had no increase in SPM.展开更多
Purpose: To study the factors influencing sputum smear conversion including Serum C-Reactive Protein (CRP) and its correlation with disease severity in tuberculosis patients. Method: Levels of Serum-CRP concentrations...Purpose: To study the factors influencing sputum smear conversion including Serum C-Reactive Protein (CRP) and its correlation with disease severity in tuberculosis patients. Method: Levels of Serum-CRP concentrations were deter-mined in 60 patients with pulmonary tuberculosis, 30 healthy volunteers and patients in follow-up after completion of antitubercular treatment (DOTS therapy). Results: Serum-CRP levels were found to be significantly higher in smear-positive group as compared with the follow-up patients and smear-negative control group. The values were 43.65 ± 23.68, 9.88 ± 5.23 and 4.04 ± 3.85 mg/L respectively (P Conclusion: Serum-CRP levels are significantly correlated with disease severity in patients with active pulmonary tuberculosis. Thus these findings from the present study would certainly add new criteria for early diagnosis of TB, which may lead to development of new strategies to treat TB.展开更多
Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopi...Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopia,there is a national TB control programme with the goal to eliminate TB,but uneven distribution across lifestyle gradients remains a challenge.Notably,the mobile pastoralist communities in the country are disproportionately left uncovered.The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia.Main text:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines and systematically reviewed articles in seven electronic databases:Excerptra Medical Database,African Journal Online,PubMed,Google Scholar,Centre for Agriculture and Bioscience International Direct,Cochrane Library and Web of Science.The databases were searched from inception to December 31,2018,with no language restriction.We screened 692 items of which 19 met our inclusion criteria.Using a meta-ethnographic method,we identified six themes:(i)pastoralism in Ethiopia;(ii)pastoralists’livelihood profile;(iii)pastoralists’service utilisation;(iv)pastoralists’knowledge and awareness on TB control services;(v)challenges of TB control in pastoral settings;and(vi)equity disparities affecting pastoralists.Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country.Conclusions:This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle.Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision.Targeting these two parameters holds promise to enhance effectiveness of an intervention.展开更多
文摘The aim of this mini-review is to compare and contrast the pros and cons of short-course and long-course neoadjuvant chemoradiation therapy regimens for stageⅡ&Ⅲrectal adenocarcinoma.Multiple trials have demonstrated the equal efficacy and safety of short-course and long-course radiation therapy as a part of neoadjuvant regimens.Published data also shows that total neoadjuvant therapy could be more successful than neoadjuvant chemoradiation followed by adjuvant chemotherapy.This review points out future research directions for patients with locally advanced rectal adenocarcinoma such as comparing total neoadjuvant therapy that contains a short-course of radiation therapy to the standard of care,and evaluating how the sequence of short-course radiation therapy and chemotherapy in the total neoadjuvant therapy impacts the pathological complete response(pCR)rate,local control,and survival outcomes.
文摘BACKGROUND Acute cholangitis(AC)constitutes an infection with increased mortality rates in the past.Due to new diagnostic tools and therapeutic methods,the mortality of AC has been significantly reduced nowadays.The initial antibiotic treatment of AC has been oriented to the most common pathogens connected to this infection.However,the optimal duration of the antibiotic treatment of AC is still debatable.AIM To investigate if shorter-course antibiotic treatments could be similarly effective to long-course treatments in adults with AC.METHODS This study constitutes a systematic review and meta-analysis of the existing literature concerning the duration of antibiotic therapy of AC and an assessment of the quality of the evidence.The study was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analyses.Fifteen studies were included in the systematic review,and eight were eligible for meta-analysis.Due to heterogeneous duration cutoffs,three study-analysis groups were formed,with a cutoff of 2-3,6-7,and 14 d.RESULTS A total of 2763 patients were included in the systematic review,and 1313 were accounted for the meta-analysis.The mean age was 73.66±14.67 years,and the male and female ratio was 1:08.No significant differences were observed in the mortality rates of antibiotic treatment of 2-3 d,compared to longer treatments(odds ratio=0.78,95% confidence interval:0.23-2.67,I2=9%)and the recurrence rates and hospitalization length were also not different in all study groups.CONCLUSION Short-and long-course antibiotic treatments may be similarly effective concerning the mortality and recurrence rates of AC.Safe conclusions cannot be extracted concerning the hospitalization duration.
文摘In the following review we intend to ascertain the optimal neoadjuvant therapy inpatients with locally advanced rectal cancer. In 2004, a study revealed thatchemoradiotherapy (CRT) resulted in better local control when performedpreoperatively rather than postoperatively, thus neoadjuvant treatment wasestablished as a standard treatment. Subsequently, the Polish study and the Trans-Tasman Radiation Oncology Group showed no statistically significant differencebetween concomitant CRT over 5 wk vs short-course radiotherapy (RT).Therefore, both were established as standard neoadjuvant treatments. Later, theStockholm III study demonstrated that short-course RT had a higher completepathological response than long-course RT. It also showed that a delay betweenRT and surgery presented fewer complications. This opened a window of time toprovide an early and effective systemic treatment to prevent distant metastases.Studies show that short-course RT plus oxaliplatin-based chemotherapy couldachieve this. When comparing this total neoadjuvant treatment (TNT) vsconcomitant CRT, the former showed greater complete pathological response andlower acute toxicity. Studies presented during 2020 have also shown the benefitsof TNT in terms of complete pathological response, as well as disease andmetastasis-free survival. Our review suggests that probably TNT should be thenew standard treatment for these patients. However, we will have to wait for thefull text publications of these studies to confirm this statement.
文摘AIM To investigate second primary malignancy(SPM) risk after radiotherapy in rectal cancer survivors METHODS We used Taiwan's National Health Insurance Research Database to identify rectal cancer patients between 1996 and 2011. Surgery-alone, preoperative short course, preoperative long course, and post-operative radiotherapy groups were defined. The overall and sitespecific SPM incidence rates were compared among the radiotherapy groups by multivariate Cox regression, taking chemotherapy and comorbidities into account. Sensitivity tests were performed for attained-year adjustment and long-term survivors analysis. RESULTS A total of 28220 patients were analyzed. The 10-year cumulative SPM incidence was 7.8% [95% confidence interval(CI): 7.2%-8.2%] using a competing risk model. The most common sites of SPM were the lung, liver, and prostate. Radiotherapy was not associated with increased SPM risk in multi-variate Cox model(hazard ratio = 1.05, 95%CI: 0.91-1.21, P = 0.494). The SPM hazard remained unchanged in 10-yearsurvivors. In addition, no SPM risk difference was found between the preoperative radiotherapy and postoperative radiotherapy groups.CONCLUSION In this large population-based cohort study, we demonstrated that radiotherapy had no increase in SPM.
文摘Purpose: To study the factors influencing sputum smear conversion including Serum C-Reactive Protein (CRP) and its correlation with disease severity in tuberculosis patients. Method: Levels of Serum-CRP concentrations were deter-mined in 60 patients with pulmonary tuberculosis, 30 healthy volunteers and patients in follow-up after completion of antitubercular treatment (DOTS therapy). Results: Serum-CRP levels were found to be significantly higher in smear-positive group as compared with the follow-up patients and smear-negative control group. The values were 43.65 ± 23.68, 9.88 ± 5.23 and 4.04 ± 3.85 mg/L respectively (P Conclusion: Serum-CRP levels are significantly correlated with disease severity in patients with active pulmonary tuberculosis. Thus these findings from the present study would certainly add new criteria for early diagnosis of TB, which may lead to development of new strategies to treat TB.
文摘Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopia,there is a national TB control programme with the goal to eliminate TB,but uneven distribution across lifestyle gradients remains a challenge.Notably,the mobile pastoralist communities in the country are disproportionately left uncovered.The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia.Main text:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines and systematically reviewed articles in seven electronic databases:Excerptra Medical Database,African Journal Online,PubMed,Google Scholar,Centre for Agriculture and Bioscience International Direct,Cochrane Library and Web of Science.The databases were searched from inception to December 31,2018,with no language restriction.We screened 692 items of which 19 met our inclusion criteria.Using a meta-ethnographic method,we identified six themes:(i)pastoralism in Ethiopia;(ii)pastoralists’livelihood profile;(iii)pastoralists’service utilisation;(iv)pastoralists’knowledge and awareness on TB control services;(v)challenges of TB control in pastoral settings;and(vi)equity disparities affecting pastoralists.Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country.Conclusions:This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle.Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision.Targeting these two parameters holds promise to enhance effectiveness of an intervention.
