Improved results of induction chemoradiation before surgical intervention for selected patients with stage IIIA-N2 non–small cell lung cancer

ObjectiveOptimal management of stage IIIA-N2 non–small cell lung cancer remains controversial. The surgical arm of the North American Intergroup 0139 trial was adopted as the standard treatment for patients with resectable N2 disease at the University Health Network. Results after 7 years of experience are reported.MethodsThis is a retrospective study of consecutive patients with biopsy-proved T1-3 N2 M0 lung cancer who underwent induction chemoradiation before surgical intervention from January 1997 through August 2004. Induction chemotherapy consisted of cisplatin, 50 mg/m2, on days 1 and 8; etoposide, 50 mg/m2, on days 1 to 5, weeks 1 and 5; and concurrent daily external beam radiotherapy to 45 Gy. Lung resection was performed within 6 weeks of completion of chemoradiation, followed by 2 further cycles of consolidation chemotherapy.ResultsBetween January 1997 and August 2004, 40 patients were treated according to this protocol (25% T1, 62.5% T2, 7.5% T3, and 5% T4). Overall and disease-free median survivals were 40 and 37.1 months, respectively, whereas overall and disease-free 3-year survivals were 51.7% and 52.3%, respectively. R0 resection was achieved in 92.5%. The overall operative mortality rate was 7.5% (0% for lobectomy and 27% for pneumonectomy). Notably, all mortalities occurred within the first 2 years of our experience with this regimen.ConclusionChemoradiation before pulmonary resection in carefully selected patients with surgically resectable stage IIIA (N2) non–small cell lung cancer can lead to improved overall and disease-free survival

Improving stamina and mobility with preop walking in surgical patients with frailty traits -OASIS IV: randomized clinical trial study protocol

BACKGROUND: Frail older surgical patients face more than a two-fold increase in postoperative complications, including myocardial infarction, deep vein thrombosis, pulmonary embolism, pneumonia, ileus, and others. Many of these complications occur because of postoperative loss of stamina and poor mobility. Preoperative exercise may better prepare these vulnerable patients for surgery. We present the protocol for our ongoing randomized trial to assess the impact of a preoperative walking intervention with remote coaching and pedometer on outcomes of stamina (six-minute walk distance- 6MWD) and mobility (postoperative steps) in older adults with frailty traits. METHODS: We will be conducting a randomized clinical trial with a total of 120 patients permitting up to a 33% rate of attrition, to reach a final sample size of 80 (with 40 patients for each study arm). We will include patients who are age 60 or higher, score 4 or greater on the Edmonton Frailty Scale assessment, and will be undergoing a surgical operation that requires a 2 or more night hospital stay to be eligible for our trial. Using block randomization stratified on baseline 6MWD, we will assign patients to wear a pedometer. At the end of three baseline days, an athletic trainer (AT) will provide a daily step count goal reflecting a 10-20% increase from baseline. Subsequently, the AT will call weekly to further titrate the goal or calls more frequently if the patient is not meeting the prescribed goal. Controls will receive general walking advice. Our main outcome is change in 6MWD on postoperative day (POD) 2/3 vs. baseline. We will also collect 6MWD approximately 4 weeks after surgery and daily in-hospital steps. CONCLUSION: If changes in a 6MWD and step counts are significantly higher for the intervention group, we believe this will confirm our hypothesis that the intervention leads to decreased loss of stamina and mobility. Once confirmed, we anticipate expanding to multiple centers to assess the interventional impact on clinical endpoints. TRIAL REGISTRATION: The randomized clinical trial was registered on clinicaltrials.gov under the identifier NCT03892187 on March 27, 2019

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Philippines: Overlooked by Soft Power and Media Mix

Studies on the success of Japanese popular culture overseas, particularly anime and manga have often been linked to Japan\u27s soft power or more recently, with Japanese industries’ media mix in cultural studies. However, in both cases, the emphasis is on Japan\u27s active involvement in the promotion of popular culture abroad. Furthermore, the role of the consuming country is subsumed to be a mere recipient. This chapter presents an alternative perspective by highlighting how the consuming country, its industry and its consumers played active roles in the importation of Japanese popular culture content and merchandise through legal/illegal means. To highlight this phenomenon, the case study of the Philippines will be presented, beginning with the importation of Chōdenji Machine Voltes V or Voltes V in the 1970s by the television network GMA-7, in search for cheap content to fill its programming. Commercial venues which can distribute merchandise, such as Kinokuniya and Animate and anime conventions, did not exist in the country until the year 2000, despite their presence in other Southeast Asian countries such as Singapore, Malaysia, Thailand, and Indonesia. This proves that in the Philippines, a different pathway was followed throughout which anime became ubiquitous in the country

Extraction of phenolic compounds from defatted rice bran by two-step methanol-alkali process and subcritical water extraction

Rice bran is a good source of different antioxidants, namely, phenolic compounds which help fight diseases such as coronary heart diseases and cancer.Defatted rice bran (DRB) was extracted by a 2-step process, methanol extraction using 80% methanol solution followed by alkaline hydrolysis using 2M NaOH solution, and a subcritical water extraction (SWE) as control experiment. Altering of parameters such as the bran-to-solvent ratio, extraction time and temperature was done in the 2-step process (methanol extraction followed by alkaline hydrolysis) and was each analyzed for total phenolic content. In the methanol extraction part, the 10g:150ml 50 degree celcius 10hr sample (methanol extract) gave the highest amount of total phenolic content using the Folin-Ciocalteu analysis with gallic acid as standard with a value of 17.6 mg Gallic Acid Equivalent (GAE)/g Defatted Rice Bran (DRB). On the other hand, the 10g:150ml 50 degree celcius 4hr sample (alkaline extract) in the alkaline hydrolysis part gave the highest yield with a value of 14.1 mg Gallic Acid Equivalent (GAE)/g Defatted Rice Bran (DRB). The total phenolic content obtained from the 2-step process was of 31.7 mg GAE/g DRB.Comparing the two-step process and subcritical water extraction, the 2-step method gave a higher yield with a total phenolic content of 31.7 mg GAE/g compared to the yield obtained from the subcritical water extraction with only 6.91 mg GAE/g DRB. A higher yield for the subcritical water extract could have been obtained if a higher temperature was used but this study was only able to use 124 degree celcius for this was the maximum temperature available in the autoclave. HPLC analysis was used to quantify the amount of each phenolic acid: gallic acid, ferulic acid and p-coumaric acid from the extracts of the 2-step process and was found to be 6.94 mg GA+Ca+FA/g DRB and of the subcritical water extract which was 0.645 mg GA+CA+FA/g DRB. This study revealed that 2-step method (methanol extraction followed by alkaline hydrolysis) was more effective than the subcritical water extraction only at the conditions studied

Boy Meets World: The Worldview of Shōnen Kurabu in the 1930s

Shōnen kurabu (Boys\u27 Club) was a monthly magazine geared towards young Japanese boys, founded in 1914. Managed by the Dai Nihon Yūbenkai Kōdansha (present day Kōdansha), the magazine was transformed to become a popular read and Japan\u27s bestselling children\u27s magazine, educating and moulding young minds. Aside from stories and educational information, splashed across the magazine were several pages of manga, which not only entertained the young readers, but also functioned to provide them with a view of the contemporary world. This study will focus on how manga in the magazine represented the non-Japanese other of the South Seas (Nan\u27yō), China, and its inhabitants. These representations contrasted stereotypes of ‘savage’ black natives and cowardly inept Chinese with Japanese as members of ‘white’ civilization and natural leaders of Asia. The study argues that through the manga, the magazine was able to influence its readers, who would become future adults, and hence helped to shape the future of Japanese society