Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy by Video-Assisted Surgery for Pleural Malignancies: Technical Aspects and Safety Profile

Background: Pleural malignancies are challenging conditions in terms of possibility of cure. Recent growing interest towards Hyperthermic Intrathoracic Chemotherapy (HITHOC) after Cytoreductive Surgery (CRS) has been referred. Minimally invasive approach (VATS) may be suggest in this context but evidence is still lacking. Methods: A preliminary experience in seven patients submitted to cytoreductive surgery and HITHOC is described, with a focus on technical aspects related to VATS approach, operating median time and postoperative complication. Results: A triportal VATS approach has been employed in all cases. Median time of surgery including pleural perfusion was 200 min (range 165 to 370). Mean blood loss was 217 cc (range 100 and 600). Thirty days mortality was nothing. Conclusion: VATS cytoreductive surgery and HITHOC is a safe procedure and could be proposed in the setting of a multimodality strategy employing adjuvant radio-chemotherapy in referral centers

Colorectal Cancer with Peritoneal Metastases: The Impact of the Results of PROPHYLOCHIP, COLOPEC, and PRODIGE 7 Trials on Peritoneal Disease Management

HIPEC is a potentially useful locoregional treatment combined with cytoreduction in patients with peritoneal colorectal metastases. Despite being widely used in several cancer centers around the world, its role had never been investigated before the results of three important RCTs appeared on this topic. The PRODIGE 7 trial clarified the role of oxaliplatin-based HIPEC in patients treated with radical surgery. Conversely, the PROPHYLOCHIP and the COLOPEC were designed to chair the role of HIPEC in patients at high risk of developing peritoneal metastases. Although all three trials demonstrated the relative ineffectiveness of HIPEC for treating or preventing peritoneal metastases, these results are not sufficient to abandon this technique. In addition to some criticisms relating to the design of the trials and their statistical value, the oxaliplatin-based HIPEC was found to be ineffective in preventing or treating peritoneal colorectal metastases, especially in patients already treated with systemic platinum-based chemotherapy. Several studies are ongoing investigating further HIPEC drugs and regimens. The review deeply discussed all the aspects and relapses of this new evidence

Association of ionizing radiation dose from common medical diagnostic procedures and lymphoma risk in the Epilymph case-control study

Medical diagnostic X-rays are an important source of ionizing radiation (IR) exposure in the general population; however, it is unclear if the resulting low patient doses increase lymphoma risk. We examined the association between lifetime medical diagnostic X-ray dose and lymphoma risk, taking into account potential confounding factors, including medical history. The international Epilymph study (conducted in the Czech-Republic, France, Germany, Ireland, Italy, and Spain) collected self-reported information on common diagnostic X-ray procedures from 2,362 lymphoma cases and 2,465 frequency-matched (age, sex, country) controls. Individual lifetime cumulative bone marrow (BM) dose was estimated using time period-based dose estimates for different procedures and body parts. The association between categories of BM dose and lymphoma risk was examined using unconditional logistic regression models adjusting for matching factors, socioeconomic variables, and the presence of underlying medical conditions (atopic, autoimmune, infectious diseases, osteoarthritis, having had a sick childhood, and family history of lymphoma) as potential confounders of the association. Cumulative BM dose was low (median 2.25 mGy) and was not positively associated with lymphoma risk. Odds ratios (ORs) were consistently less than 1.0 in all dose categories compared to the reference category (less than 1 mGy). Results were similar after adjustment for potential confounding factors, when using different exposure scenarios, and in analyses by lymphoma subtype and by type of control (hospital-, population-based). Overall no increased risk of lymphoma was observed. The reduced ORs may be related to unmeasured confounding or other sources of systematic bias.We found little evidence that chronic medical conditions confound lymphoma risk and medical radiation associations

A web-based educational therapy intervention associated with physical exercise to promote health in fibromyalgia in Brazil: the Amigos De Fibro (Fibro Friends) study protocol.

Health education is one of the main items to enable health promotion to patients with fibromyalgia. The objective of the study "Amigos de Fibro (Fibro Friends)" is to evaluate the impact of an educational intervention associated with physical exercise based on the web in promoting health and quality of life of patients with fibromyalgia in Brazil. A study with a randomized controlled trial approach will be carried out. The sample will consist of 24 participants, divided into two groups, with 12 individuals each. The experimental group will participate in meetings with lectures, debates, conversation rounds and exercises by a multidisciplinary team. Physical exercises will also be performed in an online environment. On the other hand, the control group will receive an e-book of education and self-care. Primary outcomes will be quality of life. The secondary outcomes will be sociodemographic and health profile, pain intensity, sleep quality, self-care agency, usage and costs of health and social care services, viability of the program and program participation. In addition, a qualitative evaluation process will be carried out with the participants. After the intervention, the data of both groups will be collected again, as well as after 3, 6, and 12 months to verify the effect and the maintenance of the intervention. The results will provide data for studies to consider the use of this tool in the future by professionals working in the field of rheumatology. The protocol was registered in the Brazilian Registry of Clinical Trials RBR-3rh759 ( https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-3rh759 ). Date of registration: 07/02/2020]

Immune responses and clinical outcomes after COVID-19 vaccination in patients with liver disease and liver transplant recipients

Background &amp; Aims: Comparative assessments of immunogenicity following different COVID-19 vaccines in patients with distinct liver diseases are lacking. SARS-CoV-2-specific T-cell and antibody responses were evaluated longitudinally after one to three vaccine doses, with long-term follow-up for COVID-19-related clinical outcomes. Methods: A total of 849 participants (355 with cirrhosis, 74 with autoimmune hepatitis [AIH], 36 with vascular liver disease [VLD], 257 liver transplant recipients [LTRs] and 127 healthy controls [HCs]) were recruited from four countries. Standardised immune assays were performed pre and post three vaccine doses (V1-3). Results: In the total cohort, there were incremental increases in antibody titres after each vaccine dose (p &lt;0.0001). Factors associated with reduced antibody responses were age and LT, whereas heterologous vaccination, prior COVID-19 and mRNA platforms were associated with greater responses. Although antibody titres decreased between post-V2 and pre-V3 (p = 0.012), patients with AIH, VLD, and cirrhosis had equivalent antibody responses to HCs post-V3. LTRs had lower and more heterogenous antibody titres than other groups, including post-V3 where 9% had no detectable antibodies; this was heavily influenced by intensity of immunosuppression. Vaccination increased T-cell IFNγ responses in all groups except LTRs. Patients with liver disease had lower functional antibody responses against nine Omicron subvariants and reduced T-cell responses to Omicron BA.1-specific peptides compared to wild-type. 122 cases of breakthrough COVID-19 were reported of which 5/122 (4%) were severe. Of the severe cases, 4/5 (80%) occurred in LTRs and 2/5 (40%) had no serological response post-V2. Conclusion: After three COVID-19 vaccines, patients with liver disease generally develop robust antibody and T-cell responses to vaccination and have mild COVID-19. However, LTRs have sustained no/low antibody titres and appear most vulnerable to severe disease. Impact and implications: Standardised assessments of the immune response to different COVID-19 vaccines in patients with liver disease are lacking. We performed antibody and T-cell assays at multiple timepoints following up to three vaccine doses in a large cohort of patients with a range of liver conditions. Overall, the three most widely available vaccine platforms were immunogenic and appeared to protect against severe breakthrough COVID-19. This will provide reassurance to patients with chronic liver disease who were deemed at high risk of severe COVID-19 during the pre-vaccination era, however, liver transplant recipients had the lowest antibody titres and remained vulnerable to severe breakthrough infection. We also characterise the immune response to multiple SARS-CoV-2 variants and describe the interaction between disease type, severity, and vaccine platform. These insights may prove useful in the event of future viral infections which also require rapid vaccine development and delivery to patients with liver disease.</p

Immune responses and clinical outcomes after COVID-19 vaccination in patients with liver disease and liver transplant recipients

Background &amp; Aims: Comparative assessments of immunogenicity following different COVID-19 vaccines in patients with distinct liver diseases are lacking. SARS-CoV-2-specific T-cell and antibody responses were evaluated longitudinally after one to three vaccine doses, with long-term follow-up for COVID-19-related clinical outcomes. Methods: A total of 849 participants (355 with cirrhosis, 74 with autoimmune hepatitis [AIH], 36 with vascular liver disease [VLD], 257 liver transplant recipients [LTRs] and 127 healthy controls [HCs]) were recruited from four countries. Standardised immune assays were performed pre and post three vaccine doses (V1-3). Results: In the total cohort, there were incremental increases in antibody titres after each vaccine dose (p &lt;0.0001). Factors associated with reduced antibody responses were age and LT, whereas heterologous vaccination, prior COVID-19 and mRNA platforms were associated with greater responses. Although antibody titres decreased between post-V2 and pre-V3 (p = 0.012), patients with AIH, VLD, and cirrhosis had equivalent antibody responses to HCs post-V3. LTRs had lower and more heterogenous antibody titres than other groups, including post-V3 where 9% had no detectable antibodies; this was heavily influenced by intensity of immunosuppression. Vaccination increased T-cell IFNγ responses in all groups except LTRs. Patients with liver disease had lower functional antibody responses against nine Omicron subvariants and reduced T-cell responses to Omicron BA.1-specific peptides compared to wild-type. 122 cases of breakthrough COVID-19 were reported of which 5/122 (4%) were severe. Of the severe cases, 4/5 (80%) occurred in LTRs and 2/5 (40%) had no serological response post-V2. Conclusion: After three COVID-19 vaccines, patients with liver disease generally develop robust antibody and T-cell responses to vaccination and have mild COVID-19. However, LTRs have sustained no/low antibody titres and appear most vulnerable to severe disease

Understanding the health effects of low doses of ionizing radiation from medical procedures : Challenges for epidemiology

La aplicación de la radiación ionizante (RI) en ámbito médico ha llegado, sin duda, para salvar vidas. Sin embargo, hay una preocupación entre los expertos de salud pública y protección radiológica con relación al incremento de la exposición medica a RI, sobretodo en pacientes pediátricos. Esta tesis tiene como objetivo contribuir a una mejor caracterización del riesgo de radiación en pacientes oncológicos. Con ese fin, se creó un estudio de cohorte de supervivientes de cáncer infantil, como base para el análisis futuro y, anidado a esta cohorte, se implementó un estudio transversal sobre el efecto del neurodesarrollo después de haber recibido radioterapia no-craneal. Aquí se presenta un análisis descriptivo del estado de salud mental de la cohorte en forma de articulo científico. También se ha estimado la asociación entre la dosis acumulada de RI de los procedimientos de diagnóstico médico, como la exposición al radio-diagnostico y el cáncer (linfoma en adultos y tumores cerebrales en niños-adolescentes), en dos grandes estudios internacionales caso-control y dicho trabajo se unió a una estimación de dosimetría que puede ser aprovechada aún más para estudios similares. Este trabajo se presenta en forma de tres articulo científicos. En el marco de esta tesis, también, se sintetizó la evidencia actual de un efecto en el neurodesarrollo de la exposición a RI de dosis baja a moderada, en una revisión sistemática (en forma de artículo científico), concluyendo que la evidencia de este efecto es limitada e inadecuada. La estimación de los efectos de radiación médica requiere grandes esfuerzos y la colaboración entre epidemiólogos y clínicos es un aspecto clave en este tema.The application of ionising radiation (IR) in the medical sector is undoubtedly lifesaving. There are, however, risks associated with IR and there is growing concern among public health and radiation protection experts, in particular for the increasing medical radiological exposure in children. The aim of this dissertation is to contribute to a better characterisation of the IR risk in patients. A hospital-based cohort study of childhood cancer survivors was developed as a basis for future analysis and, nested within the cohort, a cross-sectional study on neurodevelopmental effect after non-cranial radiotherapy was implemented. A descriptive analysis of the mental health status of the cohort is presented here in the form of a Manuscript. The association between cumulative IR from medical diagnostic procedures and cancer (adult lymphoma and childhood/adolescent brain cancer), in two large international case-control studies, were estimated and a dosimetry estimation was developed. This work has lead to three manuscripts, included in the thesis. Evidence of a neurodevelopmental effect at low-to moderate IR dose was synthesized in a systematic review (presented here in a form of a Manuscript) and was found to be limited to inadequate. The estimated effect at this low dose range requires greater effort from epidemiologists to design more informative studies, and collaboration with clinicians is key for future research in radiation epidemiology

Understanding the health effects of low doses of ionizing radiation from medical procedures : Challenges for epidemiology

La aplicación de la radiación ionizante (RI) en ámbito médico ha llegado, sin duda, para salvar vidas. Sin embargo, hay una preocupación entre los expertos de salud pública y protección radiológica con relación al incremento de la exposición medica a RI, sobretodo en pacientes pediátricos. Esta tesis tiene como objetivo contribuir a una mejor caracterización del riesgo de radiación en pacientes oncológicos. Con ese fin, se creó un estudio de cohorte de supervivientes de cáncer infantil, como base para el análisis futuro y, anidado a esta cohorte, se implementó un estudio transversal sobre el efecto del neurodesarrollo después de haber recibido radioterapia no-craneal. Aquí se presenta un análisis descriptivo del estado de salud mental de la cohorte en forma de articulo científico. También se ha estimado la asociación entre la dosis acumulada de RI de los procedimientos de diagnóstico médico, como la exposición al radio-diagnostico y el cáncer (linfoma en adultos y tumores cerebrales en niños-adolescentes), en dos grandes estudios internacionales caso-control y dicho trabajo se unió a una estimación de dosimetría que puede ser aprovechada aún más para estudios similares. Este trabajo se presenta en forma de tres articulo científicos. En el marco de esta tesis, también, se sintetizó la evidencia actual de un efecto en el neurodesarrollo de la exposición a RI de dosis baja a moderada, en una revisión sistemática (en forma de artículo científico), concluyendo que la evidencia de este efecto es limitada e inadecuada. La estimación de los efectos de radiación médica requiere grandes esfuerzos y la colaboración entre epidemiólogos y clínicos es un aspecto clave en este tema.The application of ionising radiation (IR) in the medical sector is undoubtedly lifesaving. There are, however, risks associated with IR and there is growing concern among public health and radiation protection experts, in particular for the increasing medical radiological exposure in children. The aim of this dissertation is to contribute to a better characterisation of the IR risk in patients. A hospital-based cohort study of childhood cancer survivors was developed as a basis for future analysis and, nested within the cohort, a cross-sectional study on neurodevelopmental effect after non-cranial radiotherapy was implemented. A descriptive analysis of the mental health status of the cohort is presented here in the form of a Manuscript. The association between cumulative IR from medical diagnostic procedures and cancer (adult lymphoma and childhood/adolescent brain cancer), in two large international case-control studies, were estimated and a dosimetry estimation was developed. This work has lead to three manuscripts, included in the thesis. Evidence of a neurodevelopmental effect at low-to moderate IR dose was synthesized in a systematic review (presented here in a form of a Manuscript) and was found to be limited to inadequate. The estimated effect at this low dose range requires greater effort from epidemiologists to design more informative studies, and collaboration with clinicians is key for future research in radiation epidemiology