10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
CONCLUSIONS: 10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
Conclusions: 10-Year survival of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Combined Esophagogastrectomies: Survival Outcomes in Patients with Local Adva...Oleg Kshivets
CONCLUSIONS: 5YS of local advanced ECP after combined radical procedures significantly depended on: tumor characteristics, blood cell circuit, cell ratio factors, biochemical factors, hemostasis system, anthropometric data and adjuvant treatment. Optimal strategies for local advanced ECP are: 1) availability of very experienced thoracoabdominal surgeons because of complexity radical procedures; 2) aggressive en block surgery and adequate lymph node dissection for completeness; 3) precise prediction; 4) AT for ECP with unfavorable prognos
Kshivets O. Esophageal and Cardioesophageal Cancer SurgeryOleg Kshivets
5-YEAR SURVIVAL OF ESOPHAGEAL AND CARDIOESOPHAGEAL CANCER PATIENTS AFTER RADICAL SURGERY SIGNIFICANTLY DEPENDED ON PHASE TRANSITION “EARLY-INVASIVE CANCER”, LYMPH NODE METASTASES AND CELL RATIO FACTORS
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
CONCLUSIONS: 10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
Conclusions: 10-Year survival of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Combined Esophagogastrectomies: Survival Outcomes in Patients with Local Adva...Oleg Kshivets
CONCLUSIONS: 5YS of local advanced ECP after combined radical procedures significantly depended on: tumor characteristics, blood cell circuit, cell ratio factors, biochemical factors, hemostasis system, anthropometric data and adjuvant treatment. Optimal strategies for local advanced ECP are: 1) availability of very experienced thoracoabdominal surgeons because of complexity radical procedures; 2) aggressive en block surgery and adequate lymph node dissection for completeness; 3) precise prediction; 4) AT for ECP with unfavorable prognos
Kshivets O. Esophageal and Cardioesophageal Cancer SurgeryOleg Kshivets
5-YEAR SURVIVAL OF ESOPHAGEAL AND CARDIOESOPHAGEAL CANCER PATIENTS AFTER RADICAL SURGERY SIGNIFICANTLY DEPENDED ON PHASE TRANSITION “EARLY-INVASIVE CANCER”, LYMPH NODE METASTASES AND CELL RATIO FACTORS
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Abstract—Colorectal cancer is leading cancer-related public health problem. This study was conducted to determine the effect of High-Dose-Rate intraluminal brachytherapy (HDR-BT) with or without interstitial brachytherapy during neoadjuvant chemoradiation for locally advanced rectal cancer. This randomized contrial was conducted on 28 patients attended with locally advanced rectal cancer (T3, T4 or N+) treated initially with concurrent capecitabine (800 mg/m2 twice daily for 5 days per week) and pelvic external beam radiation therapy (45Gy in 25 Fractions) after one week MRI for all patients; received intraluminal HDR-BT with 4Gy x 2 Fractions with one week interval for those had gross residual disease within 1cm of rectal wall and receiveed intraluminal and interstitial brachytherapy with 4Gy x 2 Fractions with one week interval for those had gross residual disease far from 1cm of rectal wall. All patients underwent surgery within 4-8 week after completion of neoadjuvant therapy. In the control group which were not randomized, twenty-eight patients underwent neoadjuvant chemoradiation (45Gy in 25 Fraction with concurrent capecitabine 800mg/m2 twice daily for 5 days per week) followed by surgery. It was found that in HDR-BT group pathologic complete response (pCR), pathologic partial response (pPR) and pathologic response rates (pCR+pPR) based on AJCC TNM staging for colorectal cancer were %35.7, %35.7, and %71.4 respectively. The pCR, pPR, and pRR were %25, %17, and %42 in the control group respectively. pCR, pPR, and pRR were improved with HDR-BT. However, only response rate improvement was statistically significant (p=0.031). There was no a statistically significant difference in the complications between the two groups (p > 0.05). So it can be concluded that HDR intraluminal with or without interstitial brachytherapy may be an effective method of dose escalation technique in neoadjuvant chemoradiation therapy of locally advanced rectal cancer with higher response rate and manageable side effects.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Gastric Cancer: Сlinical Implementation of Artificial Intelligence, Synergeti...Oleg Kshivets
5-year survival of GCP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC cell dynamics; 9) GC characteristics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of sufficient quantity of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
Local Advanced Esophageal Cancer (T3-4N0-2M0): Artificial Intelligence, Syner...Oleg Kshivets
5YS of local advanced ECP after combined radical procedures significantly depended on: tumor characteristics, blood cell circuit, cell ratio factors, biochemical factors, hemostasis system, anthropometric data and adjuvant treatment. Optimal strategies for local advanced ECP are: 1) availability of very experienced thoracoabdominal surgeons because of complexity radical procedures; 2) aggressive en block surgery and adequate lymph node dissection for completeness; 3) precise prediction; 4) AT for ECP with unfavorable prognosis.
Esophageal Cancer: Artificial Intelligence, Synergetics, Complex System Analy...Oleg Kshivets
5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC cell dynamics; 9) EC characteristics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
Kshivets Oleg Optimization of Management for Esophageal Cancer Patients (T1-...Oleg Kshivets
Optimization of Management for Esophageal Cancer Patients (T1-4N0-2M0).
Kshivets Oleg Surgery Department, Bagrationovsk Hospital, Bagrationovsk, Kaliningrad, Russia
ABSTRACT
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP)(T1-4N0-2M0) - alive supersysems was analyzed. The importance must be stressed of using complex system analysis, artificial intelligence (neural networks computing), simulation modeling and statistical methods in combination, because the different approaches yield complementary pieces of prognostic information.
METHODS: We analyzed data of 563 consecutive ECP (age=56.6±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2024 (m=419, f=144; esophagogastrectomies (EG) Garlock=289, EG Lewis=274, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=170; adenocarcinoma=323, squamous=230, mix=10; T1=131, T2=119, T3=185, T4=128; N0=285, N1=71, N2=207; G1=161, G2=143, G3=259; early EC=112, invasive=451; only surgery=428, adjuvant chemoimmunoradiotherapy-AT=135: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 1915.4±2284.8 days and cumulative 5-year survival (5YS) reached 52.6%, 10 years – 46.3%, 20 years – 33.3%, 30 years – 27.5%. 193 ECP lived more than 5 years (LS=4309.1±2507.4 days), 105 ECP – more than 10 years (LS=5860.8±2469.2 days). 228 ECP died because of EC (LS=629.8±324.1 days). AT significantly improved 5YS (69% vs. 49.1%) (P=0.0007 by log-rank test). 5YS of ECP of upper/3 was significantly better than others (65.3% vs.50.3%) (P=0.003). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.019). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and healthy cells/CC (rank=1), PT N0—N12 (2), PT early-invasive EC (3), erythrocytes/CC (4), thrombocytes/CC (5); segmented neutrophils/CC (6), stick neutrophils/CC (7), lymphocytes/CC (8), eosinophils/CC (9), monocytes/CC (10), leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC cell dynamics; 9) EC characteristics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and trea
5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) EC cell dynamics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP) (T1-4N0-2M0) was analyzed. The importance must be stressed of using complex system analysis, artificial intelligence (neural networks computing), simulation modeling and statistical methods in combination, because the different approaches yield complementary pieces of prognostic information.
METHODS: We analyzed data of 557 consecutive ECP (age=56.6±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2023 (m=415, f=142; esophagogastrectomies (EG) Garlock=288, EG Lewis=269, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=168; adenocarcinoma=319, squamous=228, mix=10; T1=130, T2=115, T3=184, T4=128; N0=282, N1=70, N2=205; G1=157, G2=142, G3=258; early EC=111, invasive=446; only surgery=425, adjuvant chemoimmunoradiotherapy-AT=132: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 1876.9±2219.8 days and cumulative 5-year survival (5YS) reached 52%, 10 years – 45.5%, 20 years – 33.4%, 30 years – 26.9%. 187 ECP lived more than 5 years (LS=4271±2411.9 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 228 ECP died because of EC (LS=629.8±324.1 days). AT significantly improved 5YS (67.8% vs. 48.7%) (P=0.00084 by log-rank test). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.019). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and
healthy cells/CC (rank=1), PT early-invasive EC (2); PT N0—N12 (3), erythrocytes/CC (4), thrombocytes/CC (5); stick neutrophils/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), eosinophils/CC (9), leucocytes/CC (10); monocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) EC cell dynamics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5)AT
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP) (T1-4N0-2M0) was analyzed. The importance must be stressed of using complex system analysis, artificial intelligence (neural networks computing), simulation modeling and statistical methods in combination, because the different approaches yield complementary pieces of prognostic information.
METHODS: We analyzed data of 557 consecutive ECP (age=56.6±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2023 (m=415, f=142; esophagogastrectomies (EG) Garlock=288, EG Lewis=269, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=168; adenocarcinoma=319, squamous=228, mix=10; T1=130, T2=115, T3=184, T4=128; N0=282, N1=70, N2=205; G1=157, G2=142, G3=258; early EC=111, invasive=446; only surgery=425, adjuvant chemoimmunoradiotherapy-AT=132: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 1876.9±2219.8 days and cumulative 5-year survival (5YS) reached 52%, 10 years – 45.5%, 20 years – 33.4%, 30 years – 26.9%. 187 ECP lived more than 5 years (LS=4271±2411.9 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 228 ECP died because of EC (LS=629.8±324.1 days). AT significantly improved 5YS (67.8% vs. 48.7%) (P=0.00084 by log-rank test). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.019). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and
healthy cells/CC (rank=1), PT early-invasive EC (2); PT N0—N12 (3), erythrocytes/CC (4), thrombocytes/CC (5); stick neutrophils/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), eosinophils/CC (9), leucocytes/CC (10); monocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) EC cell dynamics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant ch
5-year survival of GCP after radical procedures
significantly depended on: 1) PT “early-invasive
cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood
cell circuit; 5) biochemical factors; 6) hemostasis
system; 7) AT; 8) GC characteristics; 9) GC cell
dynamics; 10) tumor localization; 11) anthropometric
data; 12) surgery type. Best diagnosis and treatment
strategies for GC are: 1) screening and early detection
of GC; 2) availability of experienced abdominal
surgeons because of complexity of radical procedures;
3) aggressive en block surgery and adequate lymph
node dissection for completeness; 4) precise
prediction; 5) adjuvant chemoimmunotherapy for GCP
with unfavorable prognosis.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence.
RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: PT early-invasive cancer; PT N0--N12; cell ratio factors; blood cell circuit; biochemical factors; hemostasis system; AT; LC characteristics; surgery type; anthropometric data.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence.
RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence.
RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 556 consecutive ECP (age=56.5±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2022 (m=415, f=141; esophagogastrectomies (EG) Garlock=287, EG Lewis=269, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=167; adenocarcinoma=318, squamous=228, mix=10; T1=129, T2=115, T3=184, T4=128; N0=281, N1=70, N2=205; G1=157, G2=141, G3=258; early EC=110, invasive=446; only surgery=424, adjuvant chemoimmunoradiotherapy-AT=132: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 1877±2221.6 days and cumulative 5-year survival (5YS) reached 52%, 10 years – 45%, 20 years – 33.4%, 30 years – 27%. 186 ECP lived more than 5 years (LS=4283.3±2412.6 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 227 ECP died because of EC (LS=631.8±323.4 days). AT significantly improved 5YS (60.3% vs. 42%) (P=0.0029 by log-rank test). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.021). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and P PT early-invasive EC (rank=1); healthy cells/CC (2), erythrocytes/CC (3), PT N0—N12 (4) thrombocytes/CC (5); segmented neutrophils/CC (6), stick neutrophils/CC (7), lymphocytes/CC (8), monocytes/CC (9); leucocytes/CC (10); eosinophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
Survival of Lung Cancer Patients after Lobectomies was Significantly Superior...Oleg Kshivets
OBJECTIVE: This study aimed to determine surgery type influence for 5-year survival (5YS) of non-small cell lung cancer (LC) patients (LCP) after complete en block (R0) lobectomies and pneumonectomies.
METHODS: We analyzed data of 765 consecutive patients (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated (R0) and monitored in 1985-2022 (m=659, f=106; bi/lobectomies=512, pneumonectomies=253, mediastinal lymph node dissection=765; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=192; only surgery-S=616, adjuvant chemoimmunoradiotherapy-AT=149: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=318, T2=255, T3=133, T4=59; N0=514, N1=131, N2=120, M0=765; G1=194, G2=241, G3=330; squamous=417, adenocarcinoma=298, large cell=50; early LC=212, invasive LC=553. Multivariate Cox modeling, discriminant analysis, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 2240.1±1751.6 days and cumulative 5-year survival (5YS) reached 72.8%, 10 years – 64.2%, 20 years – 42.9%. 499 LCP lived more than 5 years (LS=3126.8±1540 days), 143 LCP – more than 10 years (LS=5083.3±1518.6 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.6% vs.63.1%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). 5YS of LCP after Lobectomies (77.6%) was significantly superior in comparison with LCP after pneumonectomies (63%) (P=0.00001 by log-rank test). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12(rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), monocytes/CC (9); stick neutrophils/CC (10), leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) surgery type: lobectomy/pneumonectomy; 10) anthropometric data.
• Gastric cancer prognosis and cell ratio factors Oleg Kshivets
OBJECTIVE: We examined cell ratio factors (CRF) significantly affecting gastric cancer (EC) patients GCP) survival. CRF - ratio between cancer cells (CC) and blood cells subpopulations.
METHODS: We analyzed data of 799 consecutive GCP (T1-4N0-2M0) (age=57.1±9.4 years; tumor size=5.4±3.1 cm) radically operated (R0) and monitored in 1975-2022 (m=558, f=241; total gastrectomies=173, distal gastrectomies=461; proximal gastrectomies=165; combined gastrectomies=247 with resection of esophagus, pancreas, liver, duodenum, diaphragm, colon transversum, splenectomy, etc; only surgery-S=624, adjuvant chemoimmunotherapy-AT=175 (5-FU + thymalin/taktivin); T1=238, T2=220, T3=184, T4=157; N0=437, N1=109, N2=253, M0=799; G1=222, G2=164, G3=413. Variables selected for prognosis study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of GCP were evaluated using a log-rank test. Multivariate Cox modeling, discriminant analysis, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 2128.9±2300.3 days and cumulative 5-year survival (5YS) reached 58.4%, 10 years – 51.9%, 20 years – 39%, 30 years – 27.2%. 318 GCP lived more than 5 years (LS=4304.5±2290.6 days), 169 GCP – more than 10 years (LS=5919.5±2020 days). 290 GCP died because of GC (LS=651±347.2 days). Cox modeling displayed that G CP survival significantly depended on CRF: healthy cells/CC, erythrocytes/CC, monocytes/CC, phase transition (PT) in terms of synergetics early—invasive cancer; PT N0--N12, age, G1-3, hemorrhage time, ESS, sex, AT, prothrombin index, residual nitrogen. Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early—invasive cancer (rank=1); PT N0--N12 (2); healthy cells/CC (3), erythrocytes/CC (4), thrombocytes/CC (5), monocytes/CC (6), segmented neutrophils/CC (7), leucocytes/CC (8), lymphocytes/CC (9), stick neutrophils/CC (10), eosinophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: GCP survival after radical procedures significantly depended on CRF.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Kshivets esophageal cancer_management
1. International Journal of Clinical Medicine Research
2017; 4(4): 30-37
http://www.aascit.org/journal/ijcmr
ISSN: 2375-3838
Keywords
Esophageal Cancer,
Management,
Optimization
Received: April 21, 2017
Accepted: May 16, 2017
Published: August 3, 2017
Optimization of Management for
Esophageal Cancer Patients with
Stage T1-4N0-2M0
Oleg Kshivets
Surgery Department, Roshal Hospital, Roshal, Moscow, Russia
Email address
kshivets003@yahoo.com
Citation
Oleg Kshivets. Optimization of Management for Esophageal Cancer Patients with Stage T1-4N0-
2M0. International Journal of Clinical Medicine Research. Vol. 4, No. 4, 2017, pp. 30-37.
Abstract
OBJECTIVE: Search of best management for esophageal cancer (EC) patients (ECP)
(T1-4N0-2M0) was realized. METHODS: We analyzed data of 499 consecutive ECP
(age=56.3±8.9 years; tumor size=6.3±3.4 cm) radically operated and monitored in 1975-
2017 (m=365, f=134; esophagogastrectomies (EG) Garlock=280, EG Lewis=219,
combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon
transversum, lung, trachea, pericardium, splenectomy=147; adenocarcinoma=284,
squamous=205, mix=10; T1=92, T2=113, T3=171, T4=123; N0=234, N1=69, N2=196;
G1=140, G2=123, G3=236; early EC=73, invasive=426; only surgery=382, adjuvant
chemoimmunoradiotherapy-AT=117: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy).
Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural
networks computing were used to determine any significant dependence. RESULTS:
Overall life span (LS) was 1763.2±2213.7 days and cumulative 5-year survival (5YS)
reached 47.3%, 10 years – 40.7%, 20 years – 29.8%. 148 ECP lived more than 5 years
(LS=4382.9±2551 days), 80 ECP – more than 10 years (LS=6027.2±2445.6 days). 223
ECP died because of EC (LS=630.2±320.5 days). AT significantly improved 5YS (67.7%
vs. 43.1%) (P=0.00002 by log-rank test). Cox modeling displayed (Chi2=283.82, df=18,
P=0.0000) that 5YS of ECP significantly depended on: phase transition (PT) N0—N12
in terms of synergetics, cell ratio factors (ratio between cancer cells and blood cells
subpopulations), G, age, AT, localization, blood cells, prothrombin index, coagulation
time, residual nitrogen (P=0.000-0.048). Neural networks, genetic algorithm selection
and bootstrap simulation revealed relationships between 5YS and PT N0--N12 (rank=1),
PT early-invasive EC (rank=2), T (3), AT (4), prothrombin index (5), glucose (6), healthy
cells/CC (7), thrombocytes/CC (8), erythrocytes/CC (9), segmented neutrophils/CC (10),
lymphocytes/CC (11), monocytes/CC (12). Correct prediction of 5YS was 100% by
neural networks computing. CONCLUSIONS: Optimal management for ECP are: 1)
screening and early detection of EC; 2) availability of experienced thoracoabdominal
surgeons because of complexity of radical procedures; 3) aggressive en block surgery
and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant
chemoimmunoradiotherapy for ECP with unfavorable prognosis.
1. Introduction
The high mortality rate associated with esophageal cancer (EC) is primarily due to the
high incidence of late stage and the lack of curative management for the majority of EC
patients (ECP). Up to 70-90% of ECP present with stage III-IV disease. The role of
adjuvant chemotherapy or chemoradiotherapy after complete esophagectomies in ECP
with stage II-III remains controversial [1]. Moreover, the optimal treatment plan in
2. 31 Oleg Kshivets: Optimization of Management for Esophageal Cancer Patients with Stage T1-4N0-2M0
general and optimal approach for adjuvant
chemoradiotherapy in particular has not been defined and
long-term prognosis of ECP especially with stage III-IVA
remains poor, because of local relapse and distant metastases,
with the real 5-year survival rate after radical procedures
only 20-35% [2]. One of the approaches developed
aggressive en-block surgery and extensive lymphadenectomy
for completeness. Another of the modern approaches
developed to enhance the efficacy of surgery is the
combination of chemotherapy, irradiation and
immunotherapy or gene therapy which offers the advantage
of exposing EC cell population for drugs and immune factors
thus obviating cancer cell-cycle cytotoxic and host-
immunoprotective effects [3]. Nevertheless, very few studies
have demonstrated convincing clinical results. We developed
optimal treatment strategies that incorporate bolus
chemotherapy, irradiation and immunotherapy after radical
aggressive en-block surgery.
2. Patients and Methods
We conducted this study from September 1975 to March
2017. 499 consecutive ECP (male – 365, female – 134;
age=56.3±8.9 years, tumor size=6.3±3.4 cm) (mean±standard
deviation) entered this trial. Patients were not considered
eligible if they had stage IV (nonregional lymph nodes
metastases and distant metastases), previous treatment with
chemotherapy, immunotherapy or radiotherapy or if there
were two primary tumors of the time of diagnosis. Patients
after non-radical procedures, postoperative died ECP were
excluded to provide a homogeneous patient group. The
preoperative staging protocol included clinical history,
physical examination, complete blood count with
differentials, biochemistry and electrolyte panel, chest X-
rays, roentgenoesophagogastroscopy, computed tomography
scan of thorax, abdominal ultrasound,
fibroesophagogastroscopy, electrocardiogram. Computed
tomography scan of abdomen, liver and bone radionuclide
scan were performed whenever needed. All ECP were
diagnosed with histologically confirmed EC. All had
measurable tumor and ECOG performance status 0 or 1.
Before any treatment each patient was carefully examined by
medical panel composed of surgeon, chemotherapeutist and
radiologist to confirm the stage of disease. All patients signed
a written informed consent form approved by the local
Institutional Review Board.
The initial treatment was started with radical procedures.
We performed two types procedures: 219 complete
esophagogastrectomies with lesser and partially major
omentum with preservation of right gastroepiploic vessels
and lymph node dissection through separate abdominal and
right thoracic incision (Ivor-Lewis) and 280 - through left
thoracoabdominal incision (Garlock). The present analysis
was restricted to ECP with complete resected tumors with
negative surgical resection margin and with N1 and celiac
lymph node metastases (N2). Surgical complete resection
consisted of esophagogastrectomy with one-sage
esophagogastroplasty with intrapleural anastomosis in 364,
and with anastomosis on the neck in 135. EC was localized in
lower third of esophagus in 317, middle third - in 56, upper
third – in 73, total – in 53. Among these, 147 ECP underwent
combined and extensive radical procedures with the resection
of diaphragm, pericardium, lung, liver left lobe, splenectomy,
pancreas, aorta, vena cava superior, colon transversum. 317
patients underwent lymph nodal D2-dissection (in terms of
gastric cancer surgery). Extensive lymph nodal D3-dissection
was performed in 182 ECP. Routine two-field
lymphadenectomy (in terms of EC surgery) was performed in
317, three-field – in 182. All ECP were postoperatively
staged according to the TNMG-classification. Histological
examination showed adenocarcinoma in 284, squamos cell
carcinoma - in 205 and mixed carcinoma - in 10 patients. The
pathological T stage was T1 in 92, T2 - in 113, T3 - in 171,
T4 - in 123 cases; the pathological N stage was N0 in 234,
N1 - in 69, N2 - in 196 patients. The tumor differentiation
was graded as G1 in 140, G2 - in 123, G3 - in 236 cases.
After surgery postoperative chemoimmunoradiotherapy were
accomplished ECP in ECOG performance status 0 or 1.
All patients (499 ECP) were divided between the two
protocol treatment: 1) surgery and adjuvant
chemoimmunoradiotherapy (117 ECP – group A)
(age=56.0±7.4 years; males - 81, females - 36; tumor
size=7.4±3.7 cm); 2) surgery alone without any adjuvant
treatment (382 ECP – group B) (age=56.4±9.4 years; males -
284, females - 98; tumor size=6.0±3.2 cm) – the control
group.
117 ECP were performed adjuvant
chemoimmunoradiotherapy consisted of
chemoimmunotherapy (5-6 cycles) and thoracic radiotherapy
(group A). 1 cycle of bolus chemotherapy was initiated 3-5
weeks after complete esophagectomies and consisted of
fluorouracil 500 mg/m2
intravenously for 5 days.
Immunotherapy consisted thymalin or taktivin 20 mg
intramuscularly on days 1, 2, 3, 4 and 5. These
immunomodulators produced by Pharmaceutics of Russian
Federation (Novosibirsk) and approved by Ministry of Health
of Russian Federation. Thymalin and taktivin are
preparations from calf thymus, which stimulate proliferation
of blood T-cell and B-cell subpopulations and their response
[4]. The importance must be stressed of using
immunotherapy in combination with chemotherapy and
radiotherapy, because immune dysfunctions of the cell-
mediated and humoral response were induced by tumor,
surgical trauma, chemotherapy and radiation [3]. Such
immune deficiency induced generalization of EC and
compromised the long-term therapeutic result. In this sense
immunotherapy shielded human organism from side and
adverse effects of basic treatment. Concurrent radiotherapy
(60
CO; ROKUS, Russia) with a total tumor dose 45-50 Gy
starting 5-7 weeks after surgery. Radiation consisted of single
daily fractions of 180-200 cGy 5 days weekly. The treatment
volume included the ipsilateral hilus, the supraclavicular
3. International Journal of Clinical Medicine Research 2017; 4(4): 30-37 32
fossa and the mediastinum from the incisura jugularis to 8 cm
below the carina. The lower mediastinum and upper abdomen
were included in cases of primary tumors in the lower third
of esophagus or N2. The resected tumor bed was included in
all patients. Parallel-opposed AP-PA fields were used. All
fields were checked using the treatment planning program
COSPO (St. Petersburg, Russia). Doses were specified at
middepth for parallel-opposed technique or at the intersection
of central axes for oblique technique. No prophylactic cranial
irradiation was used.
During chemoimmunoradiotherapy antiemetics were
administered. Gastrointestinal side effects, particularly nausea
and vomiting, were mild, and chemoimmunoradiotherapy was
generally well tolerated. Severe leukopenia, neutropenia,
anemia and trombocytopenia occurred infrequently. There
were no treatment-related deaths.
A follow-up examination was, generally, done every 3
month for the first 2 years, every 6 month after that and
yearly after 5 years, including a physical examination, a
complete blood count, blood chemistry, chest
roentgenography. Endoscopy and abdominal ultrasound were
done every 6-month for the first 3 years and yearly after that.
Zero time was the data of surgical procedures. No one was
lost during the follow-up period and we regarded the
outcome as death through personal knowledge, physician's
reports, autopsy or death certificates. Survival time (days)
was measured from the date of surgery until death or the
most-recent date of follow-up for surviving patients.
Variables selected for 5-year survival and life span study
were the input levels of 45 blood parameters sex, age,
TNMG, cell type, tumor size. Survival curves were estimated
by the Kaplan-Meier method. Differences in curves between
groups of ECP were evaluated using a log-rank test.
Multivariate proportional hazard Cox regression, structural
equation modeling (SEPATH), Monte Carlo, bootstrap
simulation and neural networks computing were used to
determine any significant dependence [3, 5, 6, 7, 8, 9, 10].
Neural networks computing, system, biometric and statistical
analyses were conducted using CLASS-MASTER program
(Stat Dialog, Inc., Moscow, Russia), SANI program (Stat
Dialog, Inc., Moscow, Russia), DEDUCTOR program
(BaseGroup Labs, Inc., Riazan, Russia), STATISTICA and
STATISTICA Neural Networks program (Stat Soft, Inc.,
Tulsa, OK, the USA), MATHCAD (MathSoft, Inc.,
Needham, MA, the USA), SIMSTAT (Provalis Research,
Inc., the USA). All tests were considered significant when the
resulting P value was less than 0.05.
3. Results
For the entire sample of 499 patients overall life span (LS)
was 1763.2±2213.7 days (95% CI, 1568.5-1958.0;
median=793). General cumulative 5 year survival was
47.3%, 10-year survival – 40.7%, 20-year survival – 29.8%.
245 ECP (49.1%) were alive, 148 ECP lived more than 5
years (LS=4382.9±2551 days) and 80 ECP – more than 10
years (LS=6027.2±2445.6 days) without any features of EC
progressing. 223 ECP died because of EC during the first 5
years after surgery (LS=630.2±320.5 days).
For the 117 ECP in adjuvant chemoimmunoradiotherapy
arm (group A), overall LS was 1859.3±2475.1 days (95% CI,
1406.1-2312.5; median=687). For the 382 ECP in the control
(group B), overall LS was 1733.8±2129.9 days (95% CI,
1519.6-1948.1; median=811). The overall cumulative 5-year
survival of ECP for group A was 67.7% and was significantly
superior compared to 43.1% for group B (P=0.00002 by log-
rank test) (Figure 1).
Figure 1. Survival of ECP after esophagogastrectomies in group A (adjuvant chemoimmunoradiotherapy) (n=117) and B (surgery alone) (n=382). Survival of
ECP in group A was significantly better compared with group B (P=0.023 by log-rank).
4. 33 Oleg Kshivets: Optimization of Management for Esophageal Cancer Patients with Stage T1-4N0-2M0
Accordingly, the overall 10-year survival for group A was 62.3% and was much better compared to 35.9% for group B.
It is necessary to pay attention on the two very important prognostic phenomenons. First, 100% 5-years survival for ECP
with the early cancer as against 38% for the others ECP after esophagogastrectomies (P=0.00000 by log-rank test) (Figure 2).
Figure 2. Survival of ECP with early cancer (n=73) was significantly better compared with invasive cancer (n=426) (P=0.00000 by log-rank).
We understand as the early cancer the tumor up to 2 cm in
diameter, witch invades submucosa without lymph node and
distant metastases [10]. Correspondingly, the overall 10-year
survival for ECP with the early cancer was 95.1% and was
significantly better compared to 308% for others ECP.
Second, good 5-year survival for ECP with N0 (68.4%) as
compared with ECP with N1-2 (5-year survival was 27.7%)
after radical procedures (P=0.00000 by log-rank test) (Figure 3).
Figure 3. Survival of ECP with N0 (n=234) was significantly better compared with N1-2 metastases (n=265) (P=0.00000 by log-rank).
5. International Journal of Clinical Medicine Research 2017; 4(4): 30-37 34
Table 1. Results of multivariate proportional hazard Cox regression modeling in prediction of ECP survival after esophagogastrectomies (Chi2=283.823;
df=18; P=0.0000; n=499).
Factors Standard - Error t-value p Risk ratio
Segmented Neutrophils (%) 0.019874 3.54882 0.000388 1.07308
Coagulation Time 0.000408 3.98026 0.000069 1.00163
Residual Nitrogen 0.012015 4.54340 0.000006 1.05611
Prothrombin Index 0.006795 3.38158 0.000722 1.02325
Segmented Neutrophils (abs) 0.108797 -2.80952 0.004965 0.73663
Lymphocytes (abs) 0.279282 3.13763 0.001705 2.40195
Phase Transition N0---N1-2 0.157731 3.83253 0.000127 1.83036
Age 0.007710 2.46343 0.013767 1.01917
G1-3 0.083201 2.97580 0.002924 1.28093
Adjuvant Chemoimmunoradiotherapy 0.207624 -4.94425 0.000001 0.35824
Phase Transition Early---Invasive Cancer 0.563160 0.66659 0.505038 1.45557
Eosinophils (tot) 0.149638 3.27512 0.001057 1.63245
Leucocytes/Cancer Cells 1.099462 -2.61308 0.008977 0.05653
Stick Neutrophils/Cancer Cells 1.135675 3.18936 0.001427 37.41531
Segmented Neutrophils/Cancer Cells 1.113770 2.42686 0.015235 14.92394
Lymphocytes/Cancer Cells 1.136820 2.20179 0.027687 12.21954
Monocytes/Cancer Cells 1.219576 3.63945 0.000274 84.65498
Localization: Upper/3 vs. Others/3 0.194984 -1.98089 0.047612 0.67961
Accordingly, the overall 10-year survival for ECP with N0
was 63% and was significantly superior compared to 20.3%
for ECP with lymph node metastases.
All parameters were analyzed in a Cox model. In
accordance with this Cox model (global χ2
=283.82; Df=18;
P=0.00000), the eighteen variables significantly explained 5-
year survival of ECP after complete esophagogastrectomies:
phase transition “early---invasive cancer”, phase transition
N0---N1-2, adjuvant chemoimmunoradiotherapy, age, G1-3,
cell ratio factors (ratio between cancer cells and blood cells
subpopulations), tumor localization (upper/3 vs. others/3),
blood cell circuit (segmented neutrophils, lymphocytes,
eosinophils), prothrombin index, coagulation time, residual
nitrogen (P=0.000-0.048) (Table 1).
Table 2. Results of neural networks computing in prediction of 5-year
survival of ECP after esophagogastrectomies (n=371: 5-year survivors=148
and losses=223) (Baseline Error=0.000; Area under ROC Curve=1.000;
Correct Classification Rate=100%).
Factors Rank Sensitivity
Phase Transition N0---N12 1 4301
Phase Transition Early---Invasive Cancer 2 3489
T1-4 3 3181
Adjuvant Chemoimmunoradiotherapy 4 2922
Prothrombin Index 5 2258
Glucose 6 1636
Healthy Cells/Cancer Cells 7 1530
Thrombocytes/Cancer Cells 8 1273
Erythrocytes/Cancer Cells 9 1008
Segmented Neutrophils/Cancer Cells
Lymphocytes/Cancer
10 442
Cells 11 427
Monocytes/Cancer Cells 12 351
Table 3. Results of bootstrap simulation in prediction of 5-year survival of
ECP after esophagogastrectomies (n=371: 5-year survivors=148 and
losses=223).
Significant Factors (Number of
Samples=3333)
Rank
Kendal
Tau-A
P
Tumor Size 1 -0.272 0.000
Healthy Cells/Cancer Cells 2 0.270 0.000
T1-4 3 -0.269 0.000
Erythrocytes/Cancer Cells 4 0.261 0.000
Leucocytes/Cancer Cells 5 0.248 0.000
Thrombocytes/Cancer Cells 6 0.247 0.000
Lymphocytes/Cancer Cells 7 0.241 0.000
Segmented Neutrophils/Cancer Cells 8 0.229 0.000
Residual Nitrogen 9 -0.222 0.000
Phase Transition N0---N12 10 -0.213 0.000
Monocytes/Cancer Cells 11 0.207 0.000
Coagulation Time 12 -0.201 0.000
Phase Transition Early---Invasive Cancer 13 -0.179 0.000
Stick Neutrophils/Cancer Cells 14 0.159 0.000
Chlorides 15 0.157 0.000
Eosinophils/Cancer Cells 16 0.144 0.000
Tumor Growth 17 -0.121 0.001
G1-3 18 -0.118 0.001
Erythrocytes 19 0.086 0.05
Glucose 20 0.085 0.05
Prothrombin Index 21 -0.081 0.05
Localization 22 0.079 0.05
Weight 23 0.076 0.05
For comparative purposes, clinicomorphological variables
of ECP (n=371: 148 5-year survivors and 223 losses) were
6. 35 Oleg Kshivets: Optimization of Management for Esophageal Cancer Patients with Stage T1-4N0-2M0
tested by neural networks computing. For more exact analysis
128 patients were excluded from the sample, which were alive
less than 5 years after complete esophagectomies without
relapse. Multilayer perceptron was trained by BFGS method.
Obviously, analyzed data provide significant information about
EC prediction. High accuracy of classification – 100% (5-year
survivors vs. losses) was achieved in analyzed sample
(baseline error=0.000, are under ROC curve=1.0). In other
words it remains formally possible that reviled twelve factors
might predate neoplastic generalization: N-status, T-status,
prothrombin index, blood glucose, adjuvant treatment and cell
ratio factors (Table 2). Bbootstrap simulation confirmed
significant dependence between 5-year survival of ECP after
radical procedures and all recognized variables (Tables 3).
Moreover, bootstrap simulation confirmed the paramount
value of cell ratio factors.
It is necessary to note very important law. Transition of the
early cancer into the invasive cancer as well as the cancer
with N0 into the cancer with N1-2 has the phase character.
These results testify by mathematical (Holling-Tenner) and
imitating modeling of system “EC—patient homeostasis” in
terms of synergetics (Figure 4).
This also proves the first results received earlier in the
works [3, 10]. Presence of two phase transitions is evidently
shown on Kohonen self-organizing neural networks maps
(Figure 5). Figure 4. Presence of the two phase transitions “early cancer—invasive
cancer” and “cancer with N0—N1-2” in terms of synergetics.
Figure 5. Results of Kohonen self-organizing neural networks computing in prediction of ECP Survival after Esophagectomies (n=371).
All of these differences and discrepancies were further
investigated by structural equation modeling (SEPATH) as
well as Monte Carlo simulation. From data, summarized in
Figure 6, it was revealed that the ten clusters significantly
predicted 5-year survival and life span of ECP after
esophagectomies: 1) phase transition “early EC—invasive
EC”; 2) phase transition N0---N1-2; 3) EC characteristics; 4)
cell ratio factors; 5) blood cell circuit; 6) biochemical
homeostasis; 7) hemostasis system; 8) adjuvant
chemoimmunoradiotherapy; 9) tumor localization in the
esophagus; 10) anthropometric data (Figure 6).
It is necessary to pay attention, that both phase transitions
strictly depend on blood cell circuit and cell ratio factors.
7. International Journal of Clinical Medicine Research 2017; 4(4): 30-37 36
Figure 6. Significant networks between ECP (n=371) survival, cancer characteristics, blood cell circuit, cell ratio factors, hemostasis system, biochemic and
anthropometric data, cancer localization, phase transition “early cancer—invasive cancer”, phase transition “cancer with N0—N1-2” and treatment
protocols (SEPATH network model).
4. Discussion
Treatment of ECP is extremely difficult problem. On the
one hand, the esophagus cancer surgery demands masterly
surgical technique and always will remain the privilege of
very experienced professionals [11]. Actually surgical
removal of tumor and its metastases remains basic
management of this very aggressive cancer giving the real
chance for recovery in spite of quite intensive researches
developed during the last 30 years in terms of chemotherapy,
radiotherapy, immunotherapy and gene therapy [1, 2, 12]. On
the other hand, the effectiveness of complete esophagectomy
already reached its limit and leaves much to be desired: the
average real 5-year survival rate of radically operated ECP
even after combined and extensive procedures is 30-40% and
practically is not improved during the past 30-40 years, as the
great majority of patients has already EC with advance stage
[3, 10, 13]. And finally, modern TNM-classification is based
only on cancer characteristics and does not take into account
at all the features of extremely complex alive supersystem –
the patient’s organism. Therefore the prediction of EC is
rather inexact and approximate with the big errors.
Central goal of the present research was to estimate the
efficiency of complete esophagectomies with
lymphadenectomies and adjuvant chemoimmunoradiotherapy
after radical surgery. The importance must be stressed of
using complex system analysis, artificial intelligence (neural
networks computing) and statistical methods in combination,
because the different approaches yield complementary pieces
of prognostic information. Not stopping in details on these
supermodern technologies because of the journal limit rules,
great advantage of the artificial intelligence methods is the
opportunity to find out hidden interrelations which cannot be
calculated by analytical and system methods. While huge
merit of simulation modeling is the identification of
dynamics of any supersystem on the hole in time [3, 10].
Although there is no consensus on adjuvant treatment after
radical procedures the two of the most commonly employed
strategies are surgery alone and adjuvant (neoadjuvant)
chemoradiotherapy with or without immunotherapy. In the
last 10-15 years a number of new drugs have been shown to
have good activity against EC, including mitomycin C,
cisplatin, doxetacel, etc. [14, 15, 16]. On the other hand new
immunomodulators, new adoptive immunotherapeutic
modalities with lymphokine-activated killer cells, tumor-
infiltrating lymphocytes and high-dose interleukins have
been developed and antitumor effect have been successfully
demonstrated in advanced malignancies [17, 18].
Theoretically chemoimmunotherapy is most effective
when used in patients with a relatively low residual
malignant cell population (approximately 1 billion cancer
cells per patient) in terms of hidden micrometastases [3, 10].
This is typical clinical situation for ECP with N1-2 after
complete esophagogastrectomies. Present research only
confirmed this axiom.
In summary, when adjuvant chemoimmunoradiotherapy is
applied to complete esophagogastrectomies for EC with N1-2,
the following benefits should be considered: 1) possibility of
total elimination of residual hidden micrometastases; 2) surgery
and chemoradiotherapy can result immunosuppressive state,
which can be improved by immunotherapy; 3) radical
operated ECP with advance stage are thought to be
potentially good candidates for adjuvant
chemoimmunoradiotherapy as the majority of these patients
would be expected to have EC progressing.
As regards the early EC that it is all quite clear. For these
patients only radical surgery is absolutely sufficient and
8. 37 Oleg Kshivets: Optimization of Management for Esophageal Cancer Patients with Stage T1-4N0-2M0
adjuvant treatment is no need. From this it follows the
paramount importance of screening and early detection of EC.
Concerning ECP with N0 further investigations will be
required to determine efficiency, compatibility and tolerance
of new drugs and immunomodulators after esophagectomies.
The results of the present research will offer guidance for the
design of future studies.
5. Conclusion
Optimal treatment strategies for ECP are: 1) screening and
early detection of EC; 2) availability of very experienced
surgeons because of complexity radical procedures; 3)
aggressive en block surgery and adequate lymph node
dissection for completeness; 4) precise prediction and 5)
adjuvant chemoimmunoradiotherapy for ECP with
unfavorable prognosis.
References
[1] Graham AJ, Shrive FM, Ghali WA, Manns BJ, Grondin SC,
Finley RJ, Clifton J. Defining the optimal treatment of locally
advanced esophageal cancer: a systematic review and decision
analysis. Ann Thorac Surg. 2007 Apr; 83 (4): 1257-64.
[2] Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J,
Simes J; Australasian Gastro-Intestinal Trials Group. Survival
benefits from neoadjuvant chemoradiotherapy or
chemotherapy in oesophageal carcinoma: a meta-analysis.
Lancet Oncol. 2007 Mar; 8 (3): 226-34.
[3] Kshivets O. Expert system in diagnosis and prognosis of
malignant neoplasms. Dissertation for Sc. D., Tomsk, 1995:
639pp.
[4] Morozow V. G., Chavinson V. C. Isolation, refinement and
identification of immunomodulated polypeptide from calf and
human thymus. Biochemistry, 1981; 9: 1652-59.
[5] Odom-Maryon T. Biostatistical methods in oncology. Cancer
management: A multidisciplinary approach. 1st ed.
Huntington, NY: PRP Inc., 1996: 788-802.
[6] Mirkin B. G. A sequential fitting procedure for linear data
analysis models. J Classification 1990; 7: 167-196.
[7] Joreskog K. G., Sorbom D. Recent development in structural
equation modeling. J Marketing Research 1982; 19: 404-416.
[8] Bostwick D. G., Burke H. B. Prediction of individual patient
outcome in cancer: comparison of artificial neural networks
and Kaplan-Meier methods. Cancer. 2001; 91 (8): 1643-1646.
[9] Husmeier D. The Bayesian evidence scheme for regularizing
probability-density estimating neural networks. Neural
Comput. 2000; 12 (11): 2685-2717.
[10] Kshivets O. Optimization of diagnosis process for patients
with malignant neoplasms. Dissertation for PhD. St.
Petersburg, 1992: 354 pp.
[11] Chernousov A. F., Bogopolsky P. M., Kurbanov F. S.
Esophageal surgery. M.: Moscow Publishers, 2000: 352 pp.
[12] D'Journo XB, Doddoli C, Michelet P, Loundou A, Trousse D,
Giudicelli R, Fuentes PA, Thomas PA. Transthoracic
esophagectomy for adenocarcinoma of the oesophagus:
standard versus extended two-field mediastinal
lymphadenectomy? Eur J Cardiothorac Surg. 2005 Apr; 27
(4): 697-704.
[13] Stilidi I, Davydov M, Bokhyan V, Suleymanov E. Subtotal
esophagectomy with extended 2-field lymph node dissection
for thoracic esophageal cancer. Eur J Cardiothorac Surg. 2003
Mar; 23 (3): 415-20.
[14] Lerut T, Coosemans W, Decker G, De Leyn P, Moons J,
Nafteux P, Van Raemdonck D. Diagnosis and therapy in
advanced cancer of the esophagus and the gastroesophageal
junction. Curr Opin Gastroenterol. 2006 Jul; 22 (4): 437-41.
[15] Refaely Y, Krasna MJ. Multimodality therapy for esophageal
cancer. Surg Clin North Am. 2002 Aug; 82 (4): 729-46.
[16] Luketich JD, Schauer P, Urso K, Kassis E, Ferson P, Keenan
R, Landreneau R. Future directions in esophageal cancer.
Chest. 1998 Jan; 113 (1 Suppl): 120S-122S.
[17] Yano T., Sugio K., Yamazaki K., et al. Postoperative adjuvant
adoptive immunotherapy with lymph node-LAK cells and IL-
2 for pathologic stage I non-small cell lung cancer. Lung
Cancer 1999; 26: 143-8.
[18] Kshivets O. Immune cell and humoral circuit in prediction of
non-small cell lung cancer patients survival after complete
resections. Journal of Tumor Marker Oncology 2001; 16 (2):
161-174.