Association Between Results of a Gene Expression Signature Assay and Recurrence-Free Interval in Patients With Stage II Colon Cancer in Cancer and Leukemia Group B 9581 (Alliance)

PURPOSE: Conventional staging methods are inadequate to identify patients with stage II colon cancer (CC) who are at high risk of recurrence after surgery with curative intent. ColDx is a gene expression, microarray-based assay shown to be independently prognostic for recurrence-free interval (RFI) and overall survival in CC. The objective of this study was to further validate ColDx using formalin-fixed, paraffin-embedded specimens collected as part of the Alliance phase III trial, C9581. PATIENTS AND METHODS: C9581 evaluated edrecolomab versus observation in patients with stage II CC and reported no survival benefit. Under an initial case-cohort sampling design, a randomly selected subcohort (RS) comprised 514 patients from 901 eligible patients with available tissue. Forty-nine additional patients with recurrence events were included in the analysis. Final analysis comprised 393 patients: 360 RS (58 events) and 33 non-RS events. Risk status was determined for each patient by ColDx. The Self-Prentice method was used to test the association between the resulting ColDx risk score and RFI adjusting for standard prognostic variables. RESULTS: Fifty-five percent of patients (216 of 393) were classified as high risk. After adjustment for prognostic variables that included mismatch repair (MMR) deficiency, ColDx high-risk patients exhibited significantly worse RFI (multivariable hazard ratio, 2.13; 95% CI, 1.3 to 3.5; P < .01). Age and MMR status were marginally significant. RFI at 5 years for patients classified as high risk was 82% (95% CI, 79% to 85%), compared with 91% (95% CI, 89% to 93%) for patients classified as low risk. CONCLUSION: ColDx is associated with RFI in the C9581 subsample in the presence of other prognostic factors, including MMR deficiency. ColDx could be incorporated with the traditional clinical markers of risk to refine patient prognosis

Guidelines on prevention, diagnosis and treatment of thoracic and thoracoabdominal aortic pathology: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE)

The aim of these Guidelines was to refresh and enhance the earlier 2015 Italian Guidelines regarding Thoracic and Thoracic - Abdominal Aortic Disease, aligning them with the National Guidelines System (SNLG) to assist all healthcare professionals in adopting the most appropriate treatment approach for this condition. The update utilized the GRADE-SIGN version methodology, adhering to the AGREE checklist for quality reporting. The initial step involved crafting clinical questions in the PICO (Population, Intervention, Comparison, Outcome) format to base the Recommendations on. Following this, systematic literature reviews were conducted for each PICO question or for related clusters of questions, leading to article selection and evaluation of their methodological quality via qualitative checklists. Subsequently, a Considered Judgment form was completed for each clinical question, assessing the overall evidence to facilitate the conversion from evidence level to recommendation strength and direction. These guidelines outline the best practices for managing thoracic-abdominal aortic disease, with a focus on screening and monitoring. They explore medical treatments and criteria for surgical intervention, including a thorough preoperative analysis of the patient's history and an assessment of surgical risks. Following the determination of surgical necessity, the guidelines compare traditional open surgery with endovascular procedures, paying particular attention to define new recommendations where there were not. Systematic literature reviews were executed for each PICO question. Considered judgments were made through evaluating the evidence level, and the recommendations, direction and strength. The document concludes by outlining protocols for both immediate and prolonged postoperative care. Recent literature has not only validated and refined previous recommendations but also introduced new ones on emerging topics

The sac evolution imaging follow-up after endovascular aortic repair: An international expert opinion-based Delphi consensus study

Objective: Management of follow-up protocols after endovascular aortic repair (EVAR) varies significantly between centers and is not standardized according to sac regression. By designing an international expert-based Delphi consensus, the study aimed to create recommendations on follow-up after EVAR according to sac evolution. Methods: Eight facilitators created appropriate statements regarding the study topic that were voted, using a 4-point Likert scale, by a selected panel of international experts using a three-round modified Delphi consensus process. Based on the experts’ responses, only those statements reaching a grade A (full agreement $75$80% and full disagreement &lt;5%) were included in the final document. Results: One-hundred and seventy-four participants were included in the final analysis, and each voted the initial 29 statements related to the definition of sac regression (Q1-Q9), EVAR follow-up (Q10-Q14), and the assessment and role of sac regression during follow-up (Q15-Q29). At the end of the process, 2 statements (6.9%) were rejected, 9 statements (31%) received a grade B consensus strength, and 18 (62.1%) reached a grade A consensus strength. Of 27 final statements, 15 (55.6%) were classified as grade I, whereas 12 (44.4%) were classified as grade II. Experts agreed that sac regression should be considered an important indicator of EVAR success and always be assessed during follow-up after EVAR. Conclusions: Based on the elevated strength and high consistency of this international expert-based Delphi consensus, most of the statements might guide the current clinical management of follow-up after EVAR according to the sac regression. Future studies are needed to clarify debated issues. (J Vasc Surg 2024;80:937-45.

Great saphenous vein versus expanded polytetrafluoroethylene graft in patients undergoing elective treatment of popliteal artery aneurysm with posterior approach

Background: Aim of this study is to compare 30-day and 5-year outcomes of great saphenous vein (GSV) vs. expanded polytetrafluoroethylene (ePTFE) graft in patients undergoing elective treatment of popliteal artery aneurysm (PAA) using a posterior approach. Methods: Between January 2010 and December 2023, a retrospectively maintained dataset of all consecutive asymptomatic PAAs who underwent open repair with posterior approach or endovascular repair in 40 centers was investigated. Out of of 971 cases, 525 patients were included in the present analysis. These were further divided into: posterior approach with GSV graft (252, GSV Group), and posterior approach with ePTFE graft (273, ePTFE Group). Thirty-day outcomes were assessed and compared. During follow-up, survival, primary patency, secondary patency, freedom from reintervention(s), and amputation-free survival were compared between the two groups using log-rank tests. Uni- and multivariate Cox regression analyses were performed in ePTFE Group to find predictive factors of poor outcomes. Results: Two groups were homogeneous in terms of preoperative risk factors and morphological data. Median follow-up duration was similar [24 months (IQR 10 - 36) GSV Group vs. 21 months (IQR 7-47) ePTFE Group; p = .123]. At 5 years, there were no differences between the two groups in terms of survival (84.7% GSV Group vs. 86.1% ePTFE Group; p = .097, log-rank = 2.756), secondary patency (94.9% GSV Group vs. 89.4% ePTFE Group; p = .068, log-rank = 3.336), and amputation-free survival (99.1% GSV Group vs. 99.6% ePTFE Group; p = .567, log-rank = .328). Five-year primary patency (89.5% GSV Group vs. 76.2% ePTFE Group; p = .007, log-rank = 7.239), and freedom from reintervention(s) (92.8% GSV Group vs. 80.6% ePTFE Group; p = .011, log-rank = 6.449) were significantly higher in GSV Group. Using multivariate analysis in ePTFE Group, factors compromising primary patency were patients on dialysis (p = .054, OR = 3.641), and patients that were not on any preoperative antiplatelet therapy or anticoagulation (p = .019, OR = 5.532), whilst none of the perioperative factors affected freedom from reintervention(s). Conclusion: GSV as graft guaranteed better primary patency with less reinterventions rates at mid-term follow-up after treatment of PAAs via a posterior approach. Patients on dialysis and who were not on any preoperative antiplatelet therapy or anticoagulation had lower patency rates

Reconstructing Allyn A. Young’s Theory of Increasing Returns

This paper deals with Young’s theory of increasing returns taking into account not only his 1928 article, but also various indications to be found in other works. I maintain that the logic of Young’s analysis is based on a multisectoral model subject to quantitative-qualitative transformations. Such a view enables us to understand the author’s emphasis on intersectoral proportionality and his attempt to explain the economic dynamics in the presence of different intersectoral growth rates. In the conclusions the value of Young’s analysis is particularly stressed, in that it represents an interesting request for a paradigmatic shift in the analysis of capitalist economies

Il contributo di Allyn A. Young all’Encyclopaedia Britannica

The article deals with A.A. Young’s contribution to the Encyclopaedia Britannica (14th ed., 1929). We argue that the 11 entries that Young wrote represent a sort of summary of the author’s economic thought, particularly in reference to his “increasing returns theory”, to his concept of equilibrium (in economics) and, more in general, to his view about the nature and the significance of economic theory. The main conclusion is that these entries, as a whole, may help us to reconstruct Young’s intellectual personality and theoretical approach, an approach that identifying economics as a “communal or political science” appears quite inconsistent with the neoclassical paradigm

On The Origins of Non-Proportional Economic Dy-namics: A Note on Tugan-Baranowsky’s Traverse Analysis

The article deals with some aspects of Tugan-Baranowsky’s contribution. Section 1 presents a brief explanation of Tugan’s disproportionality crisis theory. Section 2 gives a brief account of Tugan’s business cycle theory, since, as the author maintained, the latter would be organically connected with his disproportionality theory. Section 3 is devoted to Tugan’s analysis of an economic system in the presence of different intersectoral growth rates: unbalanced growth is assured by a traverse along which surplus value migrates to the sector which grows faster. In the concluding section, we maintain that Tugan-Baranowsky comes out as a pioneer in the field of non-proportional economic dynamics

Auguste Ott on commercial crises and distributive justice: An early reproduction scheme

In 1851 the French Social economist Auguste Ott discussed the problem of gluts and commercial crises, together with the issue of distributive justice between workers in co-operative societies. He did so by means of a ‘simple reproduction scheme’ sharing some features with modern intersectoral transactions tables, in particular in terms of their graphical representation. The paper presents Ott’s theory of crises (which was based on the disappointment of expectations) and the context of his model, and discusses its peculiarities, supplying a new piece for the reconstruction of the prehistory of input-output analysis