293 research outputs found
When Should Surgical Cytoreduction in Advanced Ovarian Cancer Take Place?
Initial surgical management is commonly accepted to date as paramount in the treatment of women presenting with epithelial ovarian cancer and permits the assessment of the disease (staging), the histological confirmation of disease type and grade, and the practice of maximal debulking preceding platinum-based chemotherapy. Many studies have shown that the volume of residual disease after initial surgical cytoreduction inversely correlates with survival. Thus, women with optimal debulking performed by a trained specialist have improved median survival. In this review, we will focus on the answers gleaned from clinical trials on primary and interval surgery, which prompts the question on the timing of surgery in respect to chemotherapy. Interval debulking surgery (IDS) is secondary cytoreduction following primary debulking and is carried out in between the courses of chemotherapy. The major clinical trials and the latest systematic reviews seem unable to give any definitive guidance or recommendation for clinical practice. The choice of aggressive primary cytoreduction or upfront chemotherapy followed by second line surgical cytoreduction seems among others to have to be individualized according to tumour load, prediction of its resectability, and response to chemotherapy. The role of tumour biology must also be kept in mind. Finally, concrete answers are awaited on the timing of surgery from the ongoing prospective randomized control trials (CHORUS and EORTC 55971) though preliminary data from the latter have already been presented at major meetings (IGCS 2008; SGO 2009) and ignited strong debate
Timing coincidence search for supernova neutrinos with optical transient surveys
Neutrinos allow the probing of stellar interiors during core collapse,
helping to understand the different stages and processes in the collapse. To
date, supernova neutrinos have only been detected from a single event, SN1987A.
Most studies from then on have focused on two distance extremes; Galactic/local
supernovae and all past cosmic supernovae forming the diffuse supernova
neutrino background. We focus on the intermediate distance regime as a target
for detecting core-collapse supernova neutrinos at next generation detectors
like Hyper-Kamiokande. To quantify the significance of neutrino detections, we
draw on expected discoveries by surveys of near galaxies as well as large
synoptic surveys to monitor for optical counterparts of core-collapse
supernovae. We find that detection prospects require approximately ten years of
operation. We discuss how the ability of electromagnetic surveys to pinpoint
the time of core collapse to within the timescale of hours is key for confident
neutrino detections. Transient surveys like DLT40 which frequently observe
nearby galaxies can help with such crucial information.Comment: 13 pages, 7 figures, 1 table; should match published versio
FIGO staging of endometrial cancer: 2023
INTRODUCTION: Many advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the publication of The Cancer Genome Atlas (TCGA) data and provide improved clarity on the diverse biological nature of this collection of endometrial cancers and their differing prognostic outcomes. The goals of the new staging system are to better define these prognostic groups and create substages that indicate more appropriate surgical, radiation, and systemic therapies.
METHODS: The FIGO Women\u27s Cancer Committee appointed a Subcommittee on Endometrial Cancer Staging in October 2021, represented by the authors. Since then, the committee members have met frequently and reviewed new and established evidence on the treatment, prognosis, and survival of endometrial cancer. Based on these data, opportunities for improvements in the categorization and stratification of these factors were identified in each of the four stages. Data and analyses from the molecular and histological classifications performed and published in the recently developed ESGO/ESTRO/ESP guidelines were used as a template for adding the new subclassifications to the proposed molecular and histological staging system.
RESULTS: Based on the existing evidence, the substages were defined as follows:
SUMMARY: The updated 2023 staging of endometrial cancer includes the various histological types, tumor patterns, and molecular classification to better reflect the improved understanding of the complex nature of the several types of endometrial carcinoma and their underlying biologic behavior. The changes incorporated in the 2023 staging system should provide a more evidence-based context for treatment recommendations and for the more refined future collection of outcome and survival data
Pulmonary hypertension and homebased (PHAHB) exercise intervention: protocol for a feasibility study
Introduction Novel therapies for pulmonary hypertension
(PH) have improved survival and slowed disease
progression. However, patients still present with symptoms
of exertional dyspnoea and fatigue, which impacts their
ability to perform activities of daily living, reduces exercise
tolerance and impairs their quality of life (QoL). Exercise
training has shown to be safe and effective at enhancing
QoL and physical function in PH patients, yet it remains
an underused adjunct therapy. Most exercise training
for PH patients has been offered through hospital-based
programmes. Home-based exercise programmes provide
an alternative model that has the potential to increase
the availability and accessibility of exercise training as
an adjunct therapy in PH. The purpose of this study is to
investigate the feasibility, acceptability, utility and safety
of a novel remotely supervised home-based PH exercise
programme.
Methods Single arm intervention with a pre/post
comparisons design and a follow-up maintenance phase
will be employed. Eligible participants (n=25) will be
recruited from the Mater Misericordiae University Hospital
PH Unit. Participants will undergo a 10-week home-based
exercise programme, with induction training, support
materials, telecommunication support and health coaching
sessions followed by a 10-week maintenance phase.
The primary outcomes are feasibility, acceptability, utility
and safety of the intervention. Secondary outcomes will
include the impact of the intervention on exercise capacity,
physical activity, strength, health-related QoL and exercise
self-efficacy.
Ethics and dissemination Ethics approval has been
obtained from the Mater Misericordiae Institutional Review
Board REF:1/378/2032 and Dublin City University Research
Ethics DCUREC/2018/246. A manuscript of the results will
be submitted to a peer-reviewed journal and results will
be presented at conferences, community and consumer
forums and hospital research conferences.
Trial registration number ISRCTN83783446; Pre-result
Exploration of physical activity knowledge, preferences and support needs among pulmonary hypertension patients
Objective: Physical activity (PA) is an established adjunct therapy for pulmonary hypertension (PH) patients to mitigate PH symptoms and improve quality of life. However, PA engagement within this population remains low. This study investigated PH patients’ knowledge of PA, recalled advice, exercise preferences and PA support needs. Methods: Semi-structured interviews were conducted with 19 adults (mean age 50 years; SD ±12 years) diagnosed with PH, living in Ireland. Interview scripts were digitally recorded and transcribed verbatim. Thematic analysis was used to analyse the data. Results: Four key themes were identified: Lack of PA knowledge; exercise setting preference; accountability and monitoring; and clinician delivered PA information and guidance. Conclusion: This study found that PH clinicians provide suboptimal PA advice, yet patients desired clinician-delivered PA guidance. Home-based exercise was preferred with monitoring and external accountability deemed as important to facilitate sustained engagement. Practice implications: PH clinicians are well positioned to play a critical role in assisting and empowering PH patients to engage in PA. Providing training and education to PH clinicians regarding exercise prescription may be beneficial. Further research is needed to evaluate the feasibility and efficacy of home-based exercise interventions to improve quality of life and physical activity in PH
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