Notes

Two-group time-to-event continuous reassessment approach making use of likelihood estimation.
INTRODUCTION Hip fracture is common among the elderly and is associated with increased morbidity and mortality, particularly when surgery is delayed. Direct oral anticoagulants (DOACs) use might increase bleeding and postpone hip repair surgery. We aimed to assess the association between preoperative DOACs use and adverse outcomes in elderly patients with hip fracture. MATERIALS AND METHODS This retrospective cohort study included all elderly patients (≥65 years), from the district of Haifa and Western Galilee, Israel, who underwent hip repair surgery for hip fracture between 2014 and 2018. Regression models with adjustment for propensity score were used to assess the association with all-cause mortality and other adverse outcomes. RESULTS A total of 3418 patients with hip fracture were included of whom 163 (4.8%) were vitamin K antagonists (VKAs) users and 247 (7.2%) were DOCAs users. Propensity score adjusted models revealed that, compared to no anticoagulants use, DOACs use were independently associated with decreased risk of 30-day and 90-day mortality; HR 0.38 (95% CI, 0.17-0.88) and 0.47 (0.27-0.82), respectively. No significant associations were detected between VKAs use and all-cause mortality, compared to no anticoagulants use. LY2874455 purchase DOACs and VKAs had significantly longer waiting time for hip repair surgery, and longer stay in hospital. DOACs and VKAs users had a non-significant higher estimated intraoperative bleeding. However, only VKAs users required a significantly higher number of blood transfusions. CONCLUSIONS Albeit being associated with longer waiting time for surgery and longer hospitalization, DOACs use appears to be associated with reduced risk of mortality among elderly patients with hip fracture. Sand column experiments were performed under saturated conditions to investigate impact of humic acid (HA) on attachment of nC60 nanoparticles (NPs) in NaCl and CaCl2 at ionic strengths (ISs) from 1 mM to 100 mM and subsequent detachment via reducing solution IS. The attachment increased with increasing IS due to reduced repulsive Derjaguin-Landau-Verwey-Overbeek (DLVO) interaction energy and accordingly increased retention in primary energy wells. More attachments occurred in CaCl2 compared to NaCl because Ca2+ exhibited greater charge screen ability and served as a bridging agent between the NPs and sand surfaces. The presence of HA significantly reduced nC60 NPs attachment on sand surfaces (especially on nanoscale physical heterogeneities) in 10 mM NaCl and 1 mM CaCl2 because of enhanced electrostatic and steric repulsions. Interestingly, although the HA did not cause reduction of attachment in 100 mM NaCl and 10 mM CaCl2 compared to the case in absence of HA, the HA caused weak attachment of nC60 on sand surfaces and then much more significant detachment by decreasing IS. The HA did not alter both attachment and detachment in 100 mM CaCl2, because the Ca2+ at the high concentration caused formation of very stable complex of HA and NPs, and strong interaction of the complex with the sand surfaces via cation bridge. Our study highlighted that the HA can not only enhance the transport of NPs by inhibiting attachment as revealed in the literature, but also by the continuous capture and release of the NPs from surfaces in subsurface environments. PURPOSE To evaluate the performance of machine-learning-based computed tomography (CT) radiomic analysis to differentiate high-risk thymic epithelial tumours (TETs) from low-risk TETs according to the WHO classification. METHOD This retrospective study included 155 patients with a histologic diagnosis of high-risk TET (n = 72) and low-risk TET (n = 83) who underwent unenhanced CT (UECT) and contrast-enhanced CT (CECT). The radiomic features were extracted from the UECT and CECT of each patient at the largest cross-section of the lesion. The classification performance was evaluated with a nested leave-one-out cross-validation approach combining the least absolute shrinkage and selection operator feature selection and four classifiers generalised linear model (GLM), k-nearest neighbor (KNN), support vector machine (SVM) and random forest (RF). The receiver-operating characteristic curve (ROC) and the area under the curve (AUC) were used to evaluate the performance of the classifiers. RESULTS The combination of UECT and CECT radiomic features demonstrated the best performance to differentiate high-risk TETs from low-risk TETs for all four classifiers. Among these classifiers, the RF had the highest AUC of 0.87, followed by GLM (AUC = 0.86), KNN (AUC = 0.86) and SVM (AUC = 0.84). CONCLUSIONS Machine learning-based CT radiomic analysis allows for the differentiation of high-risk TETs and low-risk TETs with excellent performance, representing a promising tool to assist clinical decision making in patients with TETs. Early oral cavity cancers comprise a favorable entity, amenable to clinical staging and single modality treatment. Surgery typically forms the mainstay of treatment and should ideally address both the primary and the neck in all cases. Careful attention must be paid to reconstruction and rehabilitation of such patients. Radical radiotherapy mainly in the form of brachytherapy can achieve excellent disease related and functional outcomes in a carefully chosen subset of patients. Increasingly, a subset of patients is being recognized, who harbor single or multiple adverse features on histopathology and may therefore benefit from escalation of adjuvant therapy. This review discusses the management of early oral cavity squamous carcinomas (Early OSCCs) in detail and highlights the dilemmas and controversies faced in the management of the same. OBJECTIVES The molecular landscape of head and neck squamous cell carcinoma (HNSCC) harbors potentially actionable genomic alterations. We aimed to study the utility of liquid biopsy to (i) characterize the mutational landscape of recurrent/metastatic HNSCC using a comprehensive gene panel and (ii) estimate the concordance between DNA mutations identified from circulating tumor DNA (ctDNA) and matched tumor tissues. MATERIALS AND METHODS Targeted next-generation sequencing (NGS) was performed on cell-free DNA (cfDNA) of 39 patients with locoregional recurrent (n = 19) and/or metastatic (n = 20) HNSCC. Tumor biopsy (n = 18) was sequenced using the same technique. RESULTS ctDNA was detected in 51% of patients (20/39) with a higher probability of detection in metastatic than locoregional recurrent disease (70% versus 30%, p = 0.025). 81% and 58% of the tissue tumor variants were not detected in plasma when considering all patients and only metastatic patients with detectable ctDNA, respectively. In a multivariate analysis, the likelihood of detecting the tissue tumor variant in plasma was related to metastatic status (p = 0.
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