Treatment selection for esophageal cancer: evaluation from a nationwide database

Abstract

Background

Most elderly patients poorly tolerate the standard treatment for esophageal cancer; however, little information is available regarding the appropriateness of non-standard esophageal cancer treatments for those patients. This study aims to analyze the treatment costs and completion rates of patients undergoing a real-world treatment for esophageal cancer to elucidate the treatment selection and its quality.

Materials and methods

We analyzed treatment costs and completion rates for patients with esophageal cancer and analyzed these data relative to patient age and center volumes. Patients with esophageal cancer [UICC, TMN, Clinical stage II/III (excluding T4)] who were diagnosed in 2013 were analyzed. Patients were classified into five groups defined as follows: surgical therapy, chemotherapy, concurrent chemoradiotherapy (CCRT), modified concurrent chemoradiotherapy (mCRT), and radiotherapy (RT).

Results

Mean and median age of patients who received surgery and CCRT were comparable; however, patients who underwent mCRT and RT tended to be older. Medical costs associated with surgery were higher than costs associated with other non-surgical treatments. Cost and completion rate of chemoradiotherapy did not differ between CCRT and mCRT; however, both had higher completion rates compared to that of RT. Surgical expenses tended to be the highest in low-volume centers and the lowest in high-volume centers.

Conclusion

Treatment of esophageal cancer at high-volume centers seems well balanced compared with medium- to low-volume centers. mCRT was widely performed and comparable in medical cost to CCRT, although additional clinical impacts were unclear.

Conflicting intentions: rectifying the consistency requirements

Abstract

Many philosophers are convinced that rationality dictates that one's overall set of intentions be consistent. The starting point and inspiration for our study is Bratman's planning theory of intentions. According to this theory, one needs to appeal to the fulfilment of characteristic planning roles to justify norms that apply to our intentions. Our main objective is to demonstrate that one can be rational despite having mutually inconsistent intentions. Conversely, it is also shown that one can be irrational despite having a consistent overall set of intentions. To overcome this paradox, we argue that it is essential for a successful planning system that one's intentions are practically consistent rather than being consistent or applying an aggregation procedure. Our arguments suggest that a new type of norm is needed: whereas the consistency requirement focuses on rendering the contents of one's intentions consistent, our new practical consistency requirement demands that one's intentions be able to simultaneously and unconditionally guide one's action. We observe that for intentions that conform to the 'own-action condition', the practical consistency requirement is equivalent to the traditional consistency requirement. This implies that the consistency requirement only needs to be amended in scenarios of choice under uncertainty.

Responsibility for forgetting

Abstract

In this paper, we focus on whether and to what extent we judge that people are responsible for the consequences of their forgetfulness. We ran a series of behavioral studies to measure judgments of responsibility for the consequences of forgetfulness. Our results show that we are disposed to hold others responsible for some of their forgetfulness. The level of stress that the forgetful agent is under modulates judgments of responsibility, though the level of care that the agent exhibits toward performing the forgotten action does not. We argue that this result has important implications for a long-running debate about the nature of responsible agency.

Bier spots treated with intense pulsed light

Adsorptive removal of organics from aqueous phase by acid-activated coal fly ash: preparation, adsorption, and Fenton regenerative valorization of “spent” adsorbent

Abstract

Raw coal fly ash was activated to an adsorbent by sulfuric acid impregnation. The activation condition, the adsorption capacity, and the regenerative valorization of the adsorbent were studied. The results show that the optimal preparation conditions of the adsorbent are [H₂SO₄] = 1 mol L⁻¹, activation time = 30 min, the ratio of coal fly ash to acid = 1:20 (g:mL), calcination temperature = 100 °C. The adsorption of p-nitrophenol on the adsorbent accords with the pseudo-second-order kinetic equation and the adsorption rate constant is 0.089 g mg⁻¹ min⁻¹. The adsorption on this adsorbent can be considered enough after 35 min, when the corresponding adsorption capacity is 1.07 mg g⁻¹ (85.6% of p-nitrophenol removal). Compared with raw coal fly ash, the adsorbent has a stable adsorption performance at low pH range (pH = 1–6) and the adsorption of p-nitrophenol is an exothermic process. Ninety minutes is required for the regenerative valorization of saturated adsorbent by Fenton process. The regenerative valorization for this saturated adsorbent can reach 89% under the optimal proposed conditions (30 °C, pH = 3, [H₂O₂] = 5.0 mmol L⁻¹, [Fe²⁺] = 5.5 mmol L⁻¹). Within 15 experimental runs, the adsorbent has a better and better stability with the increase of experimental runs. Finally, the mechanism of activating coal fly ash is proposed, being verified by the results of the SEM and BET test.

The environmental Kuznets curve in the presence of corruption in developing countries

Abstract

Environmental degradation is at an alarming level in developing economies. The present paper examines the direct and indirect impacts of corruption on environmental deterioration using the panel data of 64 developing countries. Adopting the generalized method of moments (GMM) technique, the paper finds evidence that corruption exhibits a positive impact on pollution. Subsequently, there is also evidence indicating that the level of pollution tends to be higher in countries with a higher level of corruption, eliminating the effectiveness of income effect on environmental preservation. These results also suggest that environmental degradation is monotonically increasing with higher corruption and invalidate the presence of the EKC. Hence, a policy focuses that an anti-corruption particularly in the environmental and natural resources sector needs to be emphasized and enforced in order to reduce or possibly to totally eliminate the rent for corruption.

Toxicological study of the degradation products of antineoplastic agent etoposide in commercial formulation treated by heterogeneous photocatalysis using SrSnO 3

Abstract

Etoposide is an antineoplastic agent used for treating lung cancer, testicular cancer, breast cancer, pediatric cancers, and lymphomas. It is a pollutant due to its mutagenic and carcinogenic potential. Disposal of waste from this drug is still insufficiently safe, and there is no appropriate waste treatment. Therefore, it is important to use advanced oxidative processes (AOPs) for the treatment and disposal of medicines like this. The use of strontium stannate (SrSnO₃) as a catalyst in heterogeneous photocatalysis reactions has emerged as an alternative for the removal of organic pollutants. In our study, SrSnO₃ was synthesized by the combustion method and characterized by X-ray diffraction (XRD), Raman, UV-Vis, and scanning electron microscopy (SEM) techniques, obtaining a surface area of 3.28 m² g⁻¹ with cubic and well-organized crystallinity and a band gap of 4.06 eV. The experimental conditions optimized for degradation of an etoposide solution (0.4 mg L⁻¹) were pH 5 and catalyst concentration of 1 g L⁻¹. The results showed that the degradation processes using SrSnO₃ combined with H₂O₂ (0.338 mol L⁻¹) obtained total organic carbon removal from the etoposide solution, 97.98% (± 4.03 × 10⁻³), compared with TiO₂, which obtained a mineralization rate of 72.41% (± 6.95 × 10–3). After photodegradation, the degraded solution showed no toxicity to zebrafish embryos through embryotoxicity test (OECD, 236), and no genotoxicity using comet assay and micronucleus test.

Study of the efficacy of carboxytherapy in alopecia

Summary

Background

Management of alopecia areata (AA) and androgenetic alopecia (AGA) is often challenging. The use of carboxytherapy may be a novel therapeutic option for such cases.

Objective

To evaluate the clinical efficacy and safety of carboxytherapy in alopecia areata and androgenetic alopecia.

Patients and methods

This study was conducted on 80 patients with alopecia divided into two groups; Group I included 40 AA patients (Group IA received carboxytherapy and Group IB control received placebo), and Group II included 40 AGA patients (Group IIA received carboxytherapy and Group IIB control received placebo), and followed up monthly for 3 months. They were evaluated clinically (by assessment of Severity of Alopecia Tool (SALT) score in group I, and Sinclair scale and Norwood-Hamilton scale in group II), by dermoscopy and digital dermoscopy at each visit.

Results

Group IA patients showed significant clinical improvement in SALT score and dermoscopic improvement after carboxytherapy and at the end of follow-up period with significant reduction in dystrophic hair, black dots, yellow dots, and tapered hair coinciding with significant emergence of regrowing hair. Group IIA patients showed significant clinical and dermoscopic improvement after carboxytherapy with significant increase in hair density measured by digital dermoscopy. However, regression of these results was observed during the follow-up period but was still significantly better than before treatment. There were statistically significant improvements in clinical score, global assessments, dermoscopic, and digital dermoscopic findings in both group IA and group IIA received carboxytherapy in comparison with group IB and group IIB received placebo injections, respectively.

Conclusion

Carboxytherapy seems to be a promising therapeutic option for patchy AA and could be helpful as an adjuvant therapy of AGA but more than 6 sessions are required and adjuvants are recommended for maintenance of the results.

Safety assessment, biological effects, and mechanisms of Myrica rubra fruit extract for anti-melanogenesis, anti-oxidation, and free radical scavenging abilities on melanoma cells

Summary

Objective

Currently, the cosmetic and medical industries are paying considerable attention to solve or prevent skin damage or diseases, such as hyperpigmentation and oxidation and free radical damage. In this study, the effective compounds in Myrica rubra fruit were extracted and studied the biological effects of these M. rubra fruit extracts.

Methods

In this study, we extracted M. rubra fruit using solutions with various ratios of water to ethanol (100:0, 50:50, 5:95) and studied the anti-melanogenesis, anti-oxidation and radical scavenging effects of these M. rubra fruit extracts on two melanoma cell lines: mouse melanoma (B16-F0) and human melanoma (A2058). The cytotoxicity, melanin synthesis, mushroom and cellular tyrosinase activities, enzyme kinetics, melanogenesis-related gene expression, melanogenesis-related protein secretion, radical DPPH scavenging activity and ROS inhibition after treatment with M. rubra fruit extracts were determined.

Results

The results showed that the water extract of M. rubra fruit was less cytotoxic to the melanoma cell lines, effectively inhibited melanin synthesis and tyrosinase activity and down-regulated the gene expression and protein secretion of MITF and TRP-1. In addition, the M. rubra fruit extracts also showed the abilities to scavenge DPPH free radicals and suppress ROS production. Finally, the effective compounds in the water extract were Myricetin-O-deoxyhexoside, Quercetin-O-deoxyhexoside, and Kaempferol-O-hexoside determined by LC/MS/MS assay.

Conclusion

Overall, the water extract of M. rubra fruit is a safe and effective melanin inhibitor and anti-oxidant and can be applied widely in the fields of cosmetics and medicine.

Vitamin D levels in acne vulgaris patients treated with oral isotretinoin

Summary

Background/Objectives

Acne vulgaris is a common inflammatory skin disease. Vitamin D deficiency plays a role in many inflammatory skin diseases. It may play a role in pathogenesis of acne vulgaris. This study aimed to assess serum levels of 25 hydroxy vitamin D in patients with acne vulgaris before and after treatment with isotretinoin and its relation with acne vulgaris severity.

Methods

Ninety patients with acne vulgaris and 60 age-sex matched healthy subject as controls have been recruited in this study. Patients were treated with 0.75 mg/kg/d isotretinoin for 3 months. Serum level of 25 hydroxy vitamin D has been measured at baseline and after treatment.

Results

Serum levels of 25 hydroxy vitamin D were significantly higher in patients with acne vulgaris than healthy controls (P = .001). There was a significant inverse relation between level of 25 hydroxy vitamin D and severity of acne vulgaris before treatment (P = .001). Serum levels of 25 hydroxy vitamin D were significantly increased after isotretinoin treatment in patients with acne vulgaris (P = .001).

Conclusion

This study concluded that vitamin D may play a potential role in pathogenesis of acne vulgaris or acne vulgaris may have a negative effect on vitamin D synthesis. Further studies are needed to confirm these potential relations.

Comparative virulence of Candida auris with Candida haemulonii, Candida glabrata and Candida albicans in a murine model

Summary

The incidence of invasive fungal infections (IFIs) caused by uncommon Candida species with diverse virulence and susceptibility profiles has increased in recent years. Due to scarce clinical and experimental data on the pathogenicity of Candida auris, the aim of this study was to evaluate and compare the virulence of two rare clinically relevant species, C. auris and Candida haemulonii with Candida glabrata and Candida albicans in an immunocompetent murine model of disseminated infection. Immunocompetent ICR female mice were infected with three inoculum sizes (1×10⁵, 1×10⁶ and 1×10⁷ CFU/mouse) of two C. auris strains and one isolate of C. haemulonii, C. glabrata and C. albicans. Tissue burden on days 5 and 10 post challenge and mortality rate were used as virulence markers. A high virulence was found for C. albicans, followed by C. auris, C. glabrata and C. haemulonii, respectively. C. albicans showed high virulence with a medium survival time of 9.5 days for mice infected with 1×10⁷ CFU/mouse. For inocula at 1×10⁶ and 1×10⁷ CFU/mouse, there were significant differences in fungal burden at day 10 between C. albicans, C. auris and C. glabrata isolates compared with C. haemulonii (P <0.0001). Overall, no significant differences between C. albicans with C. auris and C. glabrata were observed in mice infected with three different inocula (P >0.05). In general, the highest fungal load of all isolates was detected in kidney followed by spleen, liver and lung tested with three different inocula on the two different experimental days. Histopathological examination revealed the abundant presence of yeast cells with pseudohyphae for C. albicans and only yeast cells for C. auris, C. glabrata and C. haemulonii, in all the kidney tissue samples. In conclusion, C. albicans is a highly virulent opportunistic fungus, as the clinical and experimental data demonstrate, and also our results demonstrate a low virulence of C. haemulonii in immunocompetent animals. Altogether, this study highlights the pathogenic potential of C. auris.

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Table of Contents

Dermoscopy of eccrine angiomatous hamartoma: The popcorn pattern

A 21-year-old woman presented with a congenital red-yellow, velvety plaque on the right side of the neck (Fig 1). She complained of mild pruritus and excessive sweating on that area.

Lichen planopilaris associated with pembrolizumab in a patient with metastatic melanoma

Pembrolizumab, a programmed cell death receptor 1 (PD-1) inhibitor, has been used effectively for treatment of metastatic melanoma.1 Reported cutaneous adverse events ascribed to PD-1 inhibitors include lichenoid reactions such as lichen planus of the skin and oral mucosa, lichen planus pemphigoides, and lichenoid drug eruptions, as well as alopecia areata and vitiligo.2-5 We present a patient with metastatic melanoma who had lichen planopilaris (LPP) after receiving pembrolizumab. We find no previous report in the literature of LPP in association with PD-1 inhibitors.

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Dermoscopy of pediculosis pubis

A 62-year-old man presented to our department because of pubic pruritus for 1 week, claiming it started after wearing a new pair of briefs. Cutaneous examination found small, yellowish-brown moving flecks attached to the hair in the pubic region (Fig 1).

Successful treatment of juvenile pityriasis rubra pilaris with ustekinumab in a 7-year-old girl

Pityriasis rubra pilaris (PRP) is an uncommon inflammatory dermatosis characterized by erythematous salmon-colored plaques with islands of sparing and palmoplantar hyperkeratosis. The etiology of PRP is not well understood.1 Histopathologic features of PRP are variable but presents with some similarities to psoriasis.1,2 PRP is classified into 5 subgroups, with groups III (classical juvenile), IV (circumscribed juvenile), and V (atypical juvenile) affecting the pediatric population. These subtypes occur in approximately 10%, 25%, and 5% of PRP patients, respectively.

Ulcerative livedoid vasculopathy responding to clopidogrel

Livedoid vasculopathy (LV) is a thrombotic, noninflammatory disorder that typically affects the lower extremities. Treatments for LV are widely varied and can be difficult to obtain because of high cost or lack of availability. We present a case of LV with ulcers in an adult woman successfully treated with clopidogrel, a widely available antiplatelet agent. Our case suggests that clopidogrel can be an effective and accessible treatment option for ulcerative LV.

Digital metastasis of tongue squamous cell carcinoma

Nail disorders are common complications in oncologic patients who have received chemotherapy.1-4 The all-grade incidence of nail changes with paclitaxel treatment has been reported to be 43.7%.3 Nail characteristics can be divided into anatomic sites—nail matrix (Beau's line, onychomadesis), nail bed (onycholysis, pigmentation changes), and nail fold (paronychia, pyogenic granuloma). This study reports a patient with advanced squamous cell carcinoma of the tongue who had nail changes on the left index finger after treatment with taxane chemotherapy and an epidermal growth factor receptor inhibitor.