Cardiovasc Diabetol

Lower-extremity arterial disease (LEAD) is a major endemic disease with an alarming increased prevalence worldwide. It is a common and severe condition with excess risk of major cardiovascular events and death. It also leads to a high rate of lower-limb adverse events and non-traumatic amputation. The American Diabetes Association recommends a widespread medical history and clinical examination to screen for LEAD. The ankle brachial index (ABI) is the first non-invasive tool recommended to diagnose LEAD although its variable performance in patients with diabetes. The performance of ABI is particularly affected by the presence of peripheral neuropathy, medial arterial calcification, and incompressible arteries. There is no strong evidence today to support an alternative test for LEAD diagnosis in these conditions. The management of LEAD requires a strict control of cardiovascular risk factors including diabetes, hypertension, and dyslipidaemia. The benefit of intensive versus standard glucose control on the risk of LEAD has not been clearly established. Antihypertensive, lipid-lowering, and antiplatelet agents are obviously worthfull to reduce major cardiovascular adverse events, but few randomised controlled trials (RCTs) have evaluated the benefits of these treatments in terms of LEAD and its related adverse events. Smoking cessation, physical activity, supervised walking rehabilitation and healthy diet are also crucial in LEAD management. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in LEAD management. The revascularization strategy should take into account several factors including anatomical localizations of lesions, medical history of each patients and operator experience. Further studies, especially RCTs, are needed to evaluate the interest of different therapeutic strategies on the occurrence and progression of LEAD and its related adverse events in patients with diabetes

Locally Recurrent Prostate Cancer after External Beam Radiation Therapy: Diagnostic Performance of 1.5-T Endorectal MR Imaging and MR Spectroscopic Imaging for Detection1

Results of the current and prior studies suggest that use of an approach in which all MR techniques (T2-weighted MR, MR spectroscopic, dynamic contrast material–enhanced MR, and diffusion-weighted MR imaging) are incorporated, commonly known as multiparametric MR imaging, has the potential to improve the detection of recurrent cancer to clinically relevant levels

The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma

BACKGROUND: This study evaluates the influence of facility case-volume on nasopharyngeal carcinoma (NPC) treatments and overall survival (OS). METHODS: The 2004-2015 National Cancer Database was queried for NPC patients receiving definitive treatment. RESULTS: A total of 8,260 patients (5-year OS: 63.4%) were included. The 1,114 unique facilities were categorized into 854 low-volume (treating 1-8 patients), 200 intermediate-volume (treating 9-23 patients), and 60 high-volume (treating 24-187 patients) facilities. Kaplan-Meier log-rank analysis demonstrated significantly improved OS with high-volume facilities (p<0.001). On cox proportional-hazard multivariate regression after adjusting for age, gender, income, insurance, comorbidity index, histology, AJCC clinical stage, and treatment type, high-volume facilities were associated with lower mortality risk than low-volume (HR=0.865, p=0.019) and intermediate-volume facilities (HR=0.916, p=0.004). Propensity score matching analysis confirmed this association (p<0.001). CONCLUSION: Higher facility volume was an independent predictor of improved OS in NPC, suggesting a possible survival benefit of referrals to high-volume medical centers