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The treatment of acute lymphoblastic leukemia (ALL) in adolescent and young adult (AYA) patients has markedly improved with the adoption of pediatric-inspired protocols. However, there remain several subtypes of ALL that represent significant therapeutic challenges. Here, we review the current evidence guiding treatment of Philadelphia chromosome-positive (Ph+), Philadelphia chromosome-like (Ph-L), and early T-precursor (ETP) ALL in the AYA population.
Clinical trials in Ph + ALL have demonstrated the superior efficacy of second- and third-generation tyrosine kinase inhibitors (TKIs) to induce and maintain remission. Current efforts now focus on determining the durability of these remissions and which patients will benefit from transplant. For Ph-like and ETP ALL, recent studies are investigating the addition of novel agents to standard treatment. The treatment of Ph + ALL has significantly improved with the addition of potent TKIs. However, the treatment of Ph-like and ETP ALL remains a challenge. At this time, the judicious use of allogenic transplant is the only current approach to modify this increased risk.
Clinical trials in Ph + ALL have demonstrated the superior efficacy of second- and third-generation tyrosine kinase inhibitors (TKIs) to induce and maintain remission. Current efforts now focus on determining the durability of these remissions and which patients will benefit from transplant. For Ph-like and ETP ALL, recent studies are investigating the addition of novel agents to standard treatment. The treatment of Ph + ALL has significantly improved with the addition of potent TKIs. However, the treatment of Ph-like and ETP ALL remains a challenge. At this time, the judicious use of allogenic transplant is the only current approach to modify this increased risk.This study investigated cross-sectional morphological differences in the diaphysis of the third metacarpal bone (MC3) between prehistoric Jomon hunter-gatherers and modern Japanese people. Overall, 179 skeletal remains of 119 individuals (73 men and 46 women) from the Middle-to-Final Jomon period (3500 BC-500 BC) and 60 modern Japanese people (35 men and 25 women) were included in the analysis. Analyses were performed at the mid-shaft of the MC3 using linear measurement, elliptic Fourier analysis, and cross-sectional geometric properties. The standardized polar section modulus (ZpSTD) indicated sexual differences in both populations. The right MC3 was generally stronger than the left side. There was no populational difference in the ZpSTD in both sexes. In both men and women, the cross-sectional shape of the MC3 was relatively larger in the dorso-palmar direction than in the radioulnar direction in the Jomon population compared to the modern Japanese population. Sexual differences in cross-sectional shape were recognized only in the Jomon population, with the dorso-palmar elongation being greater in Jomon men than in women (particularly when comparing the left MC3). There was a significant side difference in the diaphyseal shape among Jomon women, with the right MC3 being relatively larger in the dorso-palmar direction. These findings were consistent, although skeletal remains of the Jomon population were excavated from different regions. Differences in the diaphyseal cross-sectional shape between populations suggest differences in habitual loading on MC3 associated with differences in subsistence behavior. Furthermore, differences in diaphyseal shape and strength between Jomon men and women suggest sexual division of labor, with men performing bimanual tasks and women performing unimanual tasks.
In this study, a three-step novel surgical technique was developed for incisional hernia, in which a laparoscopic procedure with a mini-laparotomy is combined so-called 'three-step incisional hybrid repair'. selleckchem The aim of this study was to reduce the risk of intestinal lacerations during adhesiolysis and recurrence rate by better symmetrical overlap placement of the mesh.
To evaluate first perioperative outcomes with this technique.
From 2016 to 2020, 70 patients (65.7% females) with an incisional hernia of > 2 and ≤ 10cm underwent a elective three-step incisional hybrid repair in two non-academic hospitals performed by two surgeons specialised in abdominal wall surgery. Intra- and postoperative complications, operation time, hospitalisation time and hernia recurrence were assessed.
Mean operation time was 100min. Mean hernia size was 4.8cm; 45 patients (64.3%) had a hernia of 1-5cm, 25 patients (35.7%) of 6-10cm. Eight patients had a grade 1 complication (11.4%), five patients a grade 2 (7.1%), two patients (2.8%) a grade 4 complication and one patient (1.4%) a grade 5 complication. Five patients had an intraoperative complication (7.0%), two enterotomies, one serosa injury, one omentum bleeding and one laceration of an epigastric vessel. Mean length of stay was 3.3days. Four patients (5.6%) developed a hernia recurrence during a mean follow-up of 19.5weeks.
A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low.
A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low.
To determine if tumor necrosis by pretreatment breast MRI and its quantitative imaging characteristics are associated with response to NAST in TNBC.
This retrospective study included 85 TNBC patients (mean age 51.8 ± 13years) with MRI before NAST and definitive surgery during 2010-2018. Each MRI included T2-weighted, diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging. For each index carcinoma, total tumor volume including necrosis (TTV), excluding necrosis (TV), and the necrosis-only volume (NV) were segmented on early-phase DCE subtractions and DWI images. NV and %NV were calculated. Percent enhancement on early and late phases of DCE and apparent diffusion coefficient were extracted from TTV, TV, and NV. Association between necrosis with pathological complete response (pCR) was assessed using odds ratio (OR). Multivariable analysis was used to evaluate the prognostic value of necrosis with T stage and nodal status at staging. Mann-Whitney U tests and area under the curve (AUC) were used to assess performance of imaging metrics for discriminating pCR vs non-pCR.
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