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1), respectively. For cT1b cancers, there was no statistically significant difference in overall survival between the treatment groups (HR 0.87, 95% CI 0.66-1.14, P = 0.3). The corresponding 5-year survival for ER and esophagectomy were 53% versus 61% (P = 0.3), respectively. Conclusions This study demonstrates ER has comparable long-term outcomes for clinical T1aN0 and T1bN0 esophageal adenocarcinoma. However, 15% of patients with cT1b esophageal cancer were found to have positive nodal disease. Future research should seek to identify the subset of T1b cancers at high risk of nodal metastasis and thus would benefit from esophagectomy with lymphadenectomy.Objective To investigate the clinical significance of IL-10 tumor-associated macrophages (TAMs) in gastric cancer. Background Due to the plasticity and diversity of TAMs, it is necessary to phenotypically and functionally classify subsets of TAMs to better understand the critical role of TAMs in cancer progression. TAMs expressing interleukin-10 (IL-10) have been found to facilitate immune evasion in many malignancies, but the role of IL-10 TAMs in gastric cancer remains obscure. Methods Four hundred and sixty-eight tumor tissue microarray specimens, 52 fresh tumor tissue samples of gastric cancer patients from Zhongshan Hospital, and data of 298 gastric cancer patients from the Cancer Genome Atlas (TCGA) were analyzed. IL-10 TAM level and immune contexture were examined by CIBERSORT, immunohistochemistry, and flow cytometry. Clinical outcomes were analyzed by Kaplan-Meier curves and Cox model. Results Gastric cancer patients with high IL-10 TAM infiltration exhibited poor prognosis and inferior therapeutic responsiveness to fluorouracil-based adjuvant chemotherapy. IL-10 TAM infiltration yielded an immunoevasive tumor microenvironment featured by regulatory T cell infiltration and CD8 T cell dysfunction. The combinational analysis of IL-10 TAM and CD8 T cell infiltration stratified patients into distinct risk groups with different clinical outcomes. Moreover, IL-10 TAM infiltration was correlated with tumor-intrinsic characteristics including EBV status, PD-L1 expression, and genome stability in gastric cancer. https://www.selleckchem.com/products/Staurosporine.html Conclusions This study revealed that IL-10 TAMs might drive an immunoevasive microenvironment and determine poor prognosis and inferior therapeutic responsiveness to fluorouracil-based adjuvant chemotherapy, indicating IL-10 TAMs could be applied as a potential target for immunotherapeutic approach in gastric cancer.Objective The aim of this single-center cohort study was to compare direct oral feeding (DOF) to standard of care after a minimally invasive esophagectomy (MIE) performed in a center with a stable and acceptable postoperative complication rate. Background A recent multicenter, international randomized controlled trial showed that DOF following a MIE is comparable to standard of care (nil-by-mouth). However, the effect of DOF was potentially influenced by postoperative complications. Methods Patients in this single-center prospective cohort study received either DOF (intervention) or nil-by-mouth for 5 days postoperative and tube feeding (standard of care, control group) following a MIE with intrathoracic anastomosis. Primary outcome was time to functional recovery and length of hospital stay. Secondary outcomes included anastomotic leakage, pneumonia, and other surgical complications. Results Baseline characteristics were similar in the intervention (n = 85) and control (n = 111) group. Median time to functional recovery was 7 and 9 days in the intervention and control group (P less then 0.001), respectively. Length of hospital stay was 8 versus 10 days (P less then 0.001), respectively. Thirty-day postoperative complication rate was significantly reduced in the intervention group (57.6% vs 73.0%, P = 0.024). Chyle leakage only occurred in the control group (18.9%, P less then 0.001). Anastomotic leakage, pneumonia, and other postoperative complications did not differ between groups. Conclusion Direct oral feeding following a MIE results in a faster time to functional recovery and lower 30-day postoperative complication rate compared to patients that were orally fasted.Objective To determine the outcomes of patients undergoing tracheostomy for COVID-19 and of healthcare workers performing these procedures. Background Tracheostomy is often performed for prolonged endotracheal intubation in critically ill patients. However, in the context of COVID-19, tracheostomy placement pathways have been altered due to the poor prognosis of intubated patients as well as the risk of transmission to providers through this highly aerosolizing procedure. Methods A prospective single-system multi-center observational cohort study was performed on patients who underwent tracheostomy following acute respiratory failure secondary to COVID-19. Results Of the 53 patients who underwent tracheostomy, the average time from endotracheal intubation to tracheostomy was 19.7 days ± 6.9 days. The most common indication for tracheostomy was ARDS, followed by failure to wean ventilation and post-ECMO decannulation. 30 patients (56.6%) were liberated from the ventilator, 16 (30.2%) have been discharged alive, 7 (13.2%) have been decannulated, and 6 (11.3%) died. The average time from tracheostomy to ventilator liberation was 11.8 days ± 6.9 days (range 2 - 32 days). Both open surgical and percutaneous dilational tracheostomy techniques were performed utilizing methods to mitigate aerosols. No healthcare worker transmissions resulted from performing the procedure. Conclusions Alterations to tracheostomy practices and processes were successfully instituted. Following these steps, tracheostomy in COVID-19 intubated patients appears safe for both patients and healthcare workers performing the procedure.Background Emergent cardiac catheterization laboratory activation (CCLA) for patients with suspected ST-elevation myocardial infarction (STEMI) is employed to expedite acute revascularization (AR). The incidence of false-positive CCLA, in which AR is not performed, remains high. The combination of chest pain (CP) and electrocardiographic ST elevation (STE) are the hallmarks of STEMI. However, CCLA is sometimes initiated for patients lacking this combination. The study objective was to quantify the difference in likelihood of AR and mortality in patients with vs. without both CP and STE. Methods Retrospective analysis of 1621 consecutive patients for whom CCLA was initiated in a six-hospital network. We assessed the likelihood of acute myocardial infarction (AMI), presence of a culprit lesion (CL), performance of AR, and hospital mortality among patients with both CP and STE (+CP/+STE) compared with patients lacking one or both [non(CP/STE)]. Results 87.0% of patients presented with CP, 82.4% with STE, and 73.7% with both. Among +CP/+STE patients, AMI was confirmed in 90.4%, a CL in 88.9%, and AR performed in 83.1%. The corresponding values among non(CP/STE) patients were 35.8, 31.9, and 28.1%, respectively (P less then 0.0001 for each). Nevertheless, mortality among non(CP/STE) patients was three-fold higher than in +CP/+STE patients (13.3% vs. 4.5%; P less then 0.0001), with non-coronary deaths 24-fold more likely. Conclusion Patients lacking the combination of CP and STE have a markedly lower likelihood of AMI and AR than +CP/+STE patients, but significantly higher mortality. Protocols aimed at rapid, focused evaluation of non(CP/STE) patients prior to CCLA are needed.Objectives Evaluate the effect of the COVID-19 pandemic and the "shelter-in-place" order on orthopaedic trauma presenting to a community level II trauma center. It is hypothesized the overall number of orthopaedic trauma encounters (OTE), the number of OTEs related to both high and low severity injuries, as well as the proportion of OTEs related to high severity versus low severity injuries decreased compared to previous years. Methods A retrospective analysis was conducted of OTEs between 2016-2020. High and low severity OTEs were classified according to an algorithm created by the researchers. Data were statistically analyzed and compared to external data for traffic counts, motor vehicle accidents, and TSA checkpoints. Results A 45.1% decrease (p=.0005) was seen in OTEs from March and April 2016-2019 compared to 2020. The decrease began approximately 12 days prior to the shelter-in-place order. There was a 58.8% decrease in high severity injuries with a fracture (p=.013) and a 42.9% decrease in low severities injuries (p=.0003). Proportion of high to low severity OTEs was unchanged. Conclusions The quantity of OTEs was significantly affected by the COVID-19 pandemic and Michigan shelter-in-place order. A decrease in both high and low severity OTEs was found, however there was no statistically significant change in the ratio of high to low severity OTEs compared to previous years. While it is difficult to determine what portion of the decrease in OTE is attributable to the shelter-in-place order verses the COVID-19 pandemic in general, data suggest both play a role. Level of evidence Level III. See Instructions for Authors for a complete description of Levels of Evidence.Background Patients with lung cancer suffer from significant psychological distress. The underlying theoretical model that may explain what predicts or mediates the degree of psychological distress has not been elucidated. Objectives To describe the incidence of psychological distress in patients with lung cancer and to test a predictive theoretical model of psychological distress based on symptom burden, type D personality, social support, and intrusive thoughts. Methods Three hundred eighty-nine patients with stages I to IV lung cancer were recruited. Participants completed a battery of scales, including measures of psychological distress, symptom burden, type D personality, perceived social support, intrusive thoughts, and demographic and clinical characteristics. The predictive theoretical model was tested using structural equation modeling. Results Experiencing clinically significant psychological distress was reported by 63.75% of participants. Consistent with the social cognitive processing model, symptom burden, type D personality, social support, and intrusive thoughts all significantly and directly predicted the level of psychological distress in patients with lung cancer. Moreover, intrusive thoughts mediated the effects of type D personality and symptom burden on psychological distress; social support and symptom burden mediated the effects of type D personality on psychological distress. Conclusions The majority of the participants experienced psychological distress at a clinically significant level. Intrusive thoughts and social support mediated the effects of type D personality and symptom burden on psychological distress. Implications for practice Patients with type D personality and symptom burden should be identified. Interventions for targeting social support and intrusive thoughts might ultimately reduce their psychological distress.Background Healthcare professionals have driven decision-making in the past. However, shared decision-making has the potential to increase quality of care. Objective To determine to what degree patients undergoing routine pelvic radiotherapy care perceive decision-making as being shared between patient and healthcare professionals. Methods This exploratory longitudinal study covered 193 patients undergoing pelvic radiotherapy, mostly women (n = 161 [84%]) treated for a gynecological (n = 132 [68%]) or colorectal (n = 54 [28%]) cancer. We collected data regarding self-perceived level of shared decision-making at the start of radiotherapy and quality of life (QoL) (91%-95% response rate per week) during the radiotherapy period. Results The patients reported that they shared the decision-making with the healthcare professionals much (n = 137 [71%]), moderately (n = 33 [17%]), a little (n = 12 [6%]), or not at all (n = 11 [6%]). Male patients (P = .048), patients who did not live with their partner (P = .034), patients with higher education (P = .
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