Esophageal cancer in the elderly: an analysis of the factors associated with treatment decisions and outcomes

<p>Abstract</p> <p>Background</p> <p>Only limited data has been reported so far regarding oesophageal cancer (EC) in elderly patients. The aim of the study is to identify the baseline parameters that influenced therapeutic decision.</p> <p>Methods</p> <p>All consecutive patients 70 years or older being treated for EC were retrospectively analyzed. Patients without visceral metastasis were divided into two groups: treatment with curative intent (chemoradiotherapy, surgery, radiotherapy, mucosectomy or photodynamic therapy) or best supportive care (BSC). Patients with metastasis were divided into two groups: palliative treatment (chemotherapy, chemoradiotherapy or radiotherapy) or BSC.</p> <p>Results</p> <p>Two hundred and eighty-two patients were studied. Mean age was 76.5 ± 5.5 years and 22.4% of patients had visceral metastasis. In patients without visceral metastasis (n = 220) the majority had treatment with curative intent (n = 151) whereas in patients with metastasis (n = 62) the majority had BSC (n = 32). Severe adverse events (≥ grade 3) were observed in only 17% of the patients. Patients without specific carcinologic treatment were older, had more weight loss, worse WHO performance status and Charlson score in multivariate analysis.</p> <p>Discussion</p> <p>Our results suggest that elderly patients with an EC could benefit from cancer treatment without major toxicities. Weight loss, WHO performance status and the Charlson score could be used to select the appropriate treatment in an elderly patient.</p

The influence of hay steaming on clinical signs and airway immune response in severe asthmatic horses

ackground Avoidance of antigenic stimuli was found to significantly reverse airway obstruction of horses with severe equine asthma (sEA). To date, no published study investigated the influence of steaming hay on lower airway condition of sEA-affected horses. The objectives were to determine the clinical, cytological and cytokine respiratory responses of both sEA and control (CTL) horses experimentally exposed to steamed or dry hay. Results A cohort of 6 sEA horses and 6 CTL horses was involved in this field study. On day 0, both groups were fed with steamed hay for 5 consecutive days, followed by a wash-out period of 26 days prior to be fed with dry hay for 5 consecutive days. Investigations performed 2 days prior to and 5 days after each challenge included clinical score, tracheal mucus accumulation, and bronchoalveolar lavage fluid (BALF) cytology and cytokine mRNA expression. Feeding steamed hay significantly decreased its mould content (P < 0.001). Mucus score significantly increased when feeding dry hay (P = 0.01). No significant influence of challenge type was found on clinical score. Percentages of neutrophils (P < 0.001) as well as mRNA expression of IL-1β (P = 0.024), IL-6R (P = 0.021), IL-18 (P = 0.009) and IL-23 (P = 0.036) in BALF of sEA affected horses were significantly increased after both (steamed and dry hay) challenges. Relative mRNA expression of IL-1β, IL-6R and IL-23 in BALF were also significantly correlated to neutrophil percentages and both clinical and tracheal mucus score. Conclusions Steaming significantly decreased mould content but inconsistently influenced the respiratory response of sEA affected horses when fed hay. Based on BALF cytology and cytokine profiles, its relevance might be controversial as a non-medicinal therapy for sEA-affected horses

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Société d'Histoire du Droit des pays flamands, picards et wallons : compte rendu des journées tenues à Mons du 20 au 23 mai 1937

Paillot Pierre. Société d'Histoire du Droit des pays flamands, picards et wallons : compte rendu des journées tenues à Mons du 20 au 23 mai 1937. In: Revue du Nord, tome 23, n°91, août 1937. pp. 198-223

Meijers (E.-M.) et de Blécourt, professeurs à l'Université de Leyde — Le droit coutumier de Cambrai, 1932

Paillot Pierre. Meijers (E.-M.) et de Blécourt, professeurs à l'Université de Leyde — Le droit coutumier de Cambrai, 1932. In: Revue du Nord, tome 19, n°74, mai 1933. pp. 162-163

Coutumes de Lille et droit moderne

Paillot Pierre. Coutumes de Lille et droit moderne. In: Revue du Nord, tome 40, n°158, Avril-juin 1958. Numéro spécial dédié à la mémoire de Raymond Monier. pp. 349-351

Meijers (E.-M.) et de Blécourt, professeurs à l'Université de Leyde — Le droit coutumier de Cambrai, 1932

Paillot Pierre. Meijers (E.-M.) et de Blécourt, professeurs à l'Université de Leyde — Le droit coutumier de Cambrai, 1932. In: Revue du Nord, tome 19, n°74, mai 1933. pp. 162-163

La justice vicomtière dans la châtellenie de Lille et la châtellenie d'Orchies du XIVe siècle au XVIIIe siècle

Paillot Pierre. La justice vicomtière dans la châtellenie de Lille et la châtellenie d'Orchies du XIVe siècle au XVIIIe siècle. In: Revue du Nord, tome 25, n°99, Juillet-septembre 1939. pp. 161-205

Société d'Histoire du Droit des pays flamands, picards et wallons : compte rendu des journées tenues à Lille les 7, 8, 9 et 10 avril 1938

Paillot Pierre. Société d'Histoire du Droit des pays flamands, picards et wallons : compte rendu des journées tenues à Lille les 7, 8, 9 et 10 avril 1938. In: Revue du Nord, tome 24, n°95, août 1938. pp. 194-223

Société d'Histoire du Droit des pays flamands, picards et wallons : Compte rendu des journées tenues à Gand les 30, 31 mars, 1er et 2 avril 1939

Paillot Pierre. Société d'Histoire du Droit des pays flamands, picards et wallons : Compte rendu des journées tenues à Gand les 30, 31 mars, 1er et 2 avril 1939. In: Revue du Nord, tome 25, n°99, Juillet-septembre 1939. pp. 206-225