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Stratification of outcomes for mucinous appendiceal adenocarcinoma with peritoneal metastasis by histological grade

World Journal of Gastrointestinal Oncology 2017年第9期9卷 354-362页

作者： travis edward grotz Richard E Royal Paul F Mansfield Michael James Overman Gary N Mann Kristen Ashlee Robinson Karen A Beaty Safiea Rafeeq Auerlio Matamoros Michelle W Taggart Keith Francis Fournier Department of Surgical Oncology at the University of Texas MD Anderson Cancer Center Department of Medical Oncology at the University of Texas MD Anderson Cancer Center Department of Radiology at the University of Texas MD Anderson Cancer Center Department of Pathology at the University of Texas MD Anderson Cancer Center Department of SurgicalOncology at the University of Texas MD Anderson Cancer Center

AIM To investigate the importance of a three-tiered histologic grade on outcomes for patients with mucinous appendiceal adenocarcinoma(MAA).METHODS Two hundred and sixty-five patients with MAA undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy were identified from a prospective database from 2004 through 2014. All pathology was reviewed by our gastrointestinal subspecialty pathologists and histological grade was classified as well-differentiated, moderately differentiated, and poorly differentiated. Survival analysis was performed using Cox proportional hazards *** There were 201(75.8%) well-, 45(16.9%) moderatelyand 19(7.2%) poorly-differentiated tumors. Histological grade significantly stratified the 5-year overall survival(OS), 94%, 71% and 30% respectively(P < 0.001) as well as the 5-year disease-free survival(DFS) 66%, 21% and 0%, respectively(P < 0.001). Independent predictors of DFS included tumor grade(HR = 1.78, 95%CI: 1.21-2.63, P = 0.008), lymph node involvement(HR = 0.33, 95%CI: 0.11-0.98, P < 0.02), previous surgical score(HR = 1.31, 95%CI: 1.1-1.65, P = 0.03) and peritoneal carcinomatosis index(PCI)(HR = 1.05, 95%CI: 1.02-1.08, P = 0.002). Independent predictors of OS include tumor grade(HR = 2.79, 95%CI: 1.26-6.21, P = 0.01), PCI(HR = 1.10, 95%CI: 1.03-1.16, P = 0.002), and complete cytoreduction(HR = 0.32, 95%CI: 0.11-0.92, P = 0.03). Tumor grade and PCI were the only independent predictors of both DFS and OS. Furthermore, histological grade and lymphovascular invasion stratified the risk of lymph node metastasis into a low(6%) and high(40%) risk groups. CONCLUSION Our data demonstrates that moderately differentiated MAA have a clinical behavior and outcome that is distinct from well-and poorly-differentiated MAA. The threetier grade classification provides improved prognostic stratification and should be incorporated into patient selection and treatment algorithms.

关键词： Hyperthermic intraperitoneal chemotherapy Pseudomyxoma peritonei Histology Grade Prognostic Outcomes

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Percutaneous transhepatic cholangioscopy and lithotripsy in treating difficult biliary ductal stones: Two case reports

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World Journal of Gastrointestinal Endoscopy 2019年第4期11卷 298-307页

作者： edward Alabraba Simon travis Ian Beckingham Department of Hepato-Pancreato-Biliary Surgery Queen's Medical Centre Department of Radiology Queen’s Medical Centre

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) is preferred for managing biliary obstruction in patients with bilio-enteric anastomotic strictures(BEAS) and calculi. In patients whose duodenal anatomy is altered following upper gastrointestinal(UGI) tract surgery, ERCP is technically challenging because the biliary tree becomes difficult to access by per-oral *** endoscopic therapies like balloon-enteroscopy or rendevous-ERCP may be considered but are not always feasible. Biliary sepsis and comorbidities may also make these patients poor candidates for surgical management of their biliary *** SUMMARY We present two 70-year-old caucasian patients admitted as emergencies with obstructive cholangitis. Both patients had BEAS associated with calculi that were predominantly extrahepatic in Patient 1 and intrahepatic in Patient 2. Both patients were unsuitable for conventional ERCP due to surgically-altered UGl anatomy. Emergency biliary drainage was by percutaneous transhepatic cholangiography(PTC) in both cases and after 6-weeks' maturation, PTC tracts were dilated to perform percutaneous transhepatic cholangioscopy and lithotripsy(PTCSL) for duct clearance. BEAS were firstly dilated fluoroscopically,and then biliary stones were flushed into the small bowel or basket-retrieved under visualization provided by the percutaneously-inserted video cholangioscope. Lithotripsy was used to fragment impacted calculi, also under visualization by video cholangioscopy. Satisfactory duct clearance was achieved in Patient 1 after one PTCSL procedure, but Patient 2 required a further procedure to clear persisting intrahepatic calculi. Ultimately both patients had successful stone clearance confirmed by check *** PTCSL offers a pragmatic, feasible and safe method for biliary tract clearance when neither ERCP nor surgical exploration is suitable.

关键词： Percutaneous transhepatic cholangiography Video cholangioscopy Lithotripsy Biliary calculi Endoscopic retrograde cholangiopancreatography Case report Bilio-enteric anastomotic strictures

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Sedentary Behavior Research Network members support new Canadian 24-Hour Movement Guideline recommendations

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Journal of Sport and Health Science 2020年第6期9卷 479-481页

作者： Mark S.Tremblay Scott Rollo travis J.Saunders Healthy Active Living and Obesity Research Group Children’s Hospital of Eastern Ontario Research InstituteOttawaONK1H 8L1Canada Department of Pediatrics Faculty of MedicineUniversity of OttawaOttawaONK1H 8M5Canada Department of Health Sciences Carleton UniversityOttawaONK1S 5B6Canada Department of Applied Human Sciences University of Prince Edward IslandCharlottetownPEIC1A 4P3Canada

A new paradigm employing 24-h movement guidelines that combines recommendations for movement behaviors across the whole day(physical activities of all intensities,sedentary behaviors,and sleep)is gaining momentum around the globe,and several jurisdictions are developing and releasing evidence-informed public health guidelines embracing this approach.1,2 The Sedentary Behavior Research Network(SBRN),the world’s largest network of researchers and health professionals focusing specifically on the health impact of sedentary behaviors,embraces this new paradigm and has worked to normalize the integration of sedentary behaviors into the movement-behavior paradigm.

关键词： movement den behavior

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Canadian Agility and Movement Skill Assessment(CAMSA):Validity, objectivity, and reliability evidence for children 8–12 years of age

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Journal of Sport and Health Science 2017年第2期6卷 231-240页

作者： Patricia E.Longmuir Charles Boyer Meghann Lloyd Michael M.Borghese Emily Knight travis J.Saunders Elena Boiarskaia Weimo Zhu Mark S.Tremblay Healthy Active Living and Obesity Research Group Children's Hospital of Eastern Ontario Research Institute Ottawa Ontario K1H 8L1 Canada Department of Pediatrics Faculty of Medicine and School of Human Kinetics University of Ottawa Ottawa K1H 8M5 Canada Faculty of Health Sciences University of Ontario Institute of Technology Oshawa L1H 7K4 Canada School of Kinesiology and Health Studies Queen 's University Kingston Ontario K7L 3N6 Canada Department of Applied Human Sciences University of Prince Edward Island Charlottetown Prince Edward Island C1A 4P3 Canada Department of Kinesiology and Community Health University of Illinois at Urbana-Champaign Urbana IL 61801 USA

Purpose: The primary aim of this study was to develop an assessment of the fundamental, combined, and complex movement skills required to support childhood physical literacy. The secondary aim was to establish the feasibility, objectivity, and reliability evidence for the ***: An expert advisory group recommended a course format for the assessment that would require children to complete a series of dynamic movement skills. Criterion-referenced skill performance and completion time were the recommended forms of evaluation. Children, 8–12 years of age, self-reported their age and gender and then completed the study assessments while attending local schools or day camps. Face validity was previously established through a Delphi expert(n = 19, 21% female) review process. Convergent validity was evaluated by age and gender associations with assessment performance. Inter-and intra-rater(n = 53, 34% female) objectivity and test–retest(n = 60, 47% female) reliability were assessed through repeated test ***: Median total score was 21 of 28 points(range 5–28). Median completion time was 17 s. Total scores were feasible for all 995 children who self-reported age and gender. Total score did not differ between inside and outside environments(95% confidence interval(CI) of difference:-0.7 to 0.6;p = 0.91) or with/without footwear(95%CI of difference:-2.5 to 1.9; p = 0.77). Older age(p < 0.001, η2= 0.15) and male gender(p < 0.001, η2= 0.02)were associated with a higher total score. Inter-rater objectivity evidence was excellent(intraclass correlation coefficient(ICC) = 0.99) for completion time and substantial for skill score(ICC = 0.69) for 104 attempts by 53 children(34% female). Intra-rater objectivity was moderate(ICC = 0.52) for skill score and excellent for completion time(ICC = 0.99). Reliability was excellent for completion time over a short(2–4 days; ICC = 0.84) or long(8–14days; ICC = 0.82) interval. Skill score reliability was moderate(

关键词： Agility course Children Dynamic motor skill Locomotor skill Object manipulation Population assessment

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