Encoding colors and tones into working memory concurrently: A developmental investigation.

Working memory serves as a means to accumulate information and reorganize it. Researchers have long assumed that the natural organization of information is one stream at a time. This logic leads to the expectation that, when two different series of stimuli are to be remembered, performance should be superior if the series are presented one before the other in succession, rather than concurrently. Moreover, different accounts of attentional limits lead to different expectations for the change in the ability to encode two sets across age groups in childhood. Testing children from first grade (6-7 years) to adulthood, we presented sequences of colored objects and tones in succession or concurrently (with one color accompanying an unrelated tone) and found that performance was equally good no matter which presentation method was used. The results for both presentation methods closely matched the intricate pattern of development observed by Cowan et al. (2018), who used successive presentation only. We found marked developmental improvement in the ability to retain materials in each modality without an increasing cost of attention-sharing between modalities. Humans at least from the elementary school years through young adulthood thus display an ability to accommodate and organize two concurrent streams of information. RESEARCH HIGHLIGHTS: Memory for stimuli from multiple modalities is relevant to school performance and learning; here we investigate how attention is shared between remembering colors and tones. Participants received four colors and/or four tones for subsequent recognition on a trial, with dual modalities presented successively (0.5 s per stimulus) or concurrently (0.5 s per pair). Successive versus concurrent presentation had little effect on recognition, and the marked increase in memory performance with age did not come from dividing attention during encoding or maintenance. Children as young as first grade thus can encode and organize for later recognition colors and concurrently-presented, but unrelated, tones.

Altered correlation of concurrently recorded EEG-fMRI connectomes in temporal lobe epilepsy.

Whole-brain functional connectivity networks (connectomes) have been characterized at different scales in humans using EEG and fMRI. Multimodal epileptic networks have also been investigated, but the relationship between EEG and fMRI defined networks on a whole-brain scale is unclear. A unified multimodal connectome description, mapping healthy and pathological networks would close this knowledge gap. Here, we characterize the spatial correlation between the EEG and fMRI connectomes in right and left temporal lobe epilepsy (rTLE/lTLE). From two centers, we acquired resting-state concurrent EEG-fMRI of 35 healthy controls and 34 TLE patients. EEG-fMRI data was projected into the Desikan brain atlas, and functional connectomes from both modalities were correlated. EEG and fMRI connectomes were moderately correlated. This correlation was increased in rTLE when compared to controls for EEG-delta/theta/alpha/beta. Conversely, multimodal correlation in lTLE was decreased in respect to controls for EEG-beta. While the alteration was global in rTLE, in lTLE it was locally linked to the default mode network. The increased multimodal correlation in rTLE and decreased correlation in lTLE suggests a modality-specific lateralized differential reorganization in TLE, which needs to be considered when comparing results from different modalities. Each modality provides distinct information, highlighting the benefit of multimodal assessment in epilepsy.

The relationship between resting-state hemodynamic (fMRI) and electrophysiological (EEG) connectivity has been investigated in healthy subjects, but this relationship is unknown in patients with left and right temporal lobe epilepsies (l/rTLE). Does the magnitude of the relationship differ between healthy subjects and patients? What role does the laterality of the epileptic focus play? What are the spatial contributions to this relationship? Here we use concurrent EEG-fMRI recordings of 65 subjects from two centers (35 controls, 34 TLE patients), to assess the correlation between EEG and fMRI connectivity. For all datasets, frequency-specific changes in cross-modal correlation were seen in lTLE and rTLE. EEG and fMRI connectivities do not measure perfectly overlapping brain networks and provide distinct information on brain networks altered in TLE, highlighting the benefit of multimodal assessment to inform about normal and pathological brain function.

Results of the study of factors predicting the risk of the development of grade III radiation-induced mucositis during radiation or chemoradiation therapy in patients with oral cavity and oropharynx cancer.

BACKGROUND: Today, a number of methods and ways of prevention and treatment of radiation- -induced mucositis of the oral cavity and oropharynx have been developed, but the represented approaches are still not effective enough. Therefore, to increase the effectiveness of the prevention and treatment of radiation-induced mucositis, it is necessary to approach this problem comprehensively and individually, and to evaluate the factors affecting the development of mucositis. MATERIALS AND METHODS: In this single-center prospective controlled non-randomized clinical trial, the results of clinical observation of the development of complications of radiation and chemoradiation therapy in 105 patients with a newly diagnosed squamous cell cancer of the oral cavity and oropharynx were analyzed. Factors affecting the risk of the development of grade III radiation-induced mucositis including the age, gender of the patients, their general condition before the treatment according to World Health Organisation scales, type of the treatment and its doses, additional use of immunotherapy with alpha/beta defensins, characteristic signs of the tumor process and all indices of the immune status of the patients before the treatment have been analyzed. RESULTS: The method of construction and analysis of one-factor logistic regression models, where 24 indices were analyzed as factorial features, showed that the reduction of the risk of the development of grade III radiation-induced mucositis is predicted by several factors: immunotherapy, gender, serum concentrations of IgG and IgA. A decrease (P < 0.001) in the risk of the development of grade III radiation-induced mucositis was revealed if immunotherapy with alpha/beta defensins (with a total dose of 40 mg) was included into the treatment scheme (relative odds (RO) 0.05; 95% reference interval (RI) 0.02-0.18), in comparison with patients of the groups where it was not present or this immune agent was used in a total dose of 60 mg (P = 0.001, RO 0.06; 95% RI 0.01-0.30). The next factorial sign was gender, namely the risk of the development of grade III radiation-induced mucositis was lower for men (P = 0.003; RO 0.15; 95% RI 0.04-0.53) compared to women. An increase (P = 0.024) in the risk of the development of grade III radiation-induced mucositis with an increase in the initial level of IgG serum concentration was revealed, (RO 1.08; 95% RI 1.01-1.16) for each 1 mg/mL, as well as an increase (P = 0.044) in the possibility of the appearance of grade III radiation-induced mucositis with an increase in the serum concentration of IgA (RO 1.23; 95% RI 1.01-1.50) for every 1 mg/mL also before the beginning of the treatment. Multifactorial analysis has also confirmed that the risk of the development of grade III radiation-induced mucositis increases (P = 0.008) with a high serum IgG concentration before the treatment or with an increase in this index during therapy (RO 1.13; 95% RI 1.03-1.09) for every 1 mg/mL (when standardized by other risk factors). It was determined that when standardizing according to other factors (gender, IgG level), the risk of the development of grade III radiation-induced mucositis in the use of the immune agent alpha/beta defensins in a total dose of 40 mg per course decreases (P < 0.001; RO 0.08; 95% RI 0.02-0.27) compared to patients with oral cavity and oropharynx cancer who were not treated with immunotherapy. The risk of the development of grade III radiation-induced mucositis also decreases (P = 0.001) in the use of immunotherapy in a higher dose, i.e. 60 mg per course (RO 0.03; 95% RI 0.004-0.24 compared to patients whose treatment did not include immunotherapy (when standardized by other factors). CONCLUSION: As a result of this controlled clinical study, some factors were determined in addition to the radiation as those affecting the risk of the development of grade III radiation-induced mucositis in patients with oral cavity and oropharynx cancer during special treatment. These factors comprise the inclusion of immunotherapy with alpha/beta defensins into the specific treatment; gender, and baseline levels of serum IgG and IgA concentrations suggest a pattern in which the higher the serum IgG and IgA concentrations are before the start of the treatment, the greater is the likelihood of severe radiation-induced mucositis degree during special therapy. The results of the study of humoral state of the immune system in patients with oral cavity and oropharynx cancer before the beginning of chemoradiation therapy can be used as prognostic risk factors for the development of severe gamma-irradiation-induced mucositis of the oropharyngeal area, as well as an indication for the use of immunotherapeutic agents (in particular, alpha/beta defensins) that are able to polarize the immune response towards type 1 T-helpers through their immunomodulatory action.

Evaluating the impact of a combined aerobic and strength training intervention on the physical performance of male Chinese People's Liberation Army air force pilots.

This study aimed to assess the impact of a 16-week combined training program on the physical performance of 20 male Air Force pilots, with an average age of 31.87 ± 2.75 years, body mass of 76.33 ± 0.79 kg, and height of 175.55 ± 3.65 cm. This intervention encompassed both aerobic and strength training, involving six weekly training sessions. The participants were categorized into two groups based on their initial physical performance levels to explore potential baseline influences on post-intervention adaptations. The study measured changes in estimated maximal oxygen uptake (VO2 max), maximal strength, muscular endurance, and long jump performance before and after the training program. Repeated measures ANOVA revealed significant differences over time in the V ˙ O2 max (F = 86.898; p < 0.001; η p 2  = 0.821), handgrip strength right hand (F = 160.480; p < 0.001; η p 2  = 0.894), handgrip strength left hand (F = 102.196; p < 0.001; η p 2  = 0.843), squat maximal strength (F = 525.725; p < 0.001; η p 2  = 0.965), push-ups (F = 337.197; p < 0.001; η p 2  = 0.974), sit up (F = 252.500; p < 0.001; η p 2  = 0.930) and standing long jump (F = 521.714; p < 0.001; η p 2  = 0.965). In conclusion, the 16-week combined training regimen significantly enhanced the physical performance of Air Force pilots, regardless of their initial performance levels.

Integrative effects of resistance training and endurance training on mitochondrial remodeling in skeletal muscle.

Resistance training activates mammalian target of rapamycin (mTOR) pathway of hypertrophy for strength gain, while endurance training increases peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α) pathway of mitochondrial biogenesis benefiting oxidative phosphorylation. The conventional view suggests that resistance training-induced hypertrophy signaling interferes with endurance training-induced mitochondrial remodeling. However, this idea has been challenged because acute leg press and knee extension in humans enhance both muscle hypertrophy and mitochondrial remodeling signals. Thus, we first examined the muscle mitochondrial remodeling and hypertrophy signals with endurance training and resistance training, respectively. In addition, we discussed the influence of resistance training on muscle mitochondria, demonstrating that the PGC-1α-mediated muscle mitochondrial adaptation and hypertrophy occur simultaneously. The second aim was to discuss the integrative effects of concurrent training, which consists of endurance and resistance training sessions on mitochondrial remodeling. The study found that the resistance training component does not reduce muscle mitochondrial remodeling signals in concurrent training. On the contrary, concurrent training has the potential to amplify skeletal muscle mitochondrial biogenesis compared to a single exercise model. Concurrent training involving differential sequences of resistance and endurance training may result in varied mitochondrial biogenesis signals, which should be linked to the pre-activation of mTOR or PGC-1α signaling. Our review proposed a mechanism for mTOR signaling that promotes PGC-1α signaling through unidentified pathways. This mechanism may be account for the superior muscle mitochondrial remodeling change following the concurrent training. Our review suggested an interaction between resistance training and endurance training in skeletal muscle mitochondrial adaptation.

Whole exome sequencing reveals diverse genomic relatedness between paired concurrent endometrial and ovarian carcinomas.

INTRODUCTION: Concurrent non-serous endometrial and ovarian tumours are often managed clinically as two separate primary tumours, but almost all exhibit evidence of a genomic relationship. METHODOLOGY: This study investigates the extent of relatedness using whole exome sequencing, which was performed on paired non-serous endometrial and ovarian carcinomas from 27 patients with concurrent tumours in a cohort with detailed clinicopathological annotation. Four whole exome sequencing-derived parameters (mutation, mutational burden, mutational signatures and mutant allele tumour heterogeneity scores) were used to develop a novel unsupervised model for the assessment of genomic similarity to infer genomic relatedness of paired tumours. RESULTS: This novel model demonstrated genomic relatedness across all four parameters in all tumour pairs. Mutations in PTEN, ARID1A, CTNNB1, KMT2D and PIK3CA occurred most frequently and 24 of 27 (89 %) tumour pairs shared identical mutations in at least one of these genes, with all pairs sharing mutations in a number of other genes. Ovarian endometriosis, CTNNB1 exon 3 mutation, and progression and death from disease were present across the similarity ranking. Mismatch repair deficiency was associated with less genomically similar pairs. DISCUSSION: Although there was diversity across the cohort, the presence of genomic similarity in all paired tumours supports the hypothesis that concurrent non-serous endometrial and ovarian carcinomas are genomically related and may have arisen from a common origin.

The positive reinforcing effects of cocaine and opposite-sex social contact: roles of biological sex and estrus.

RATIONALE: Preclinical studies report that drug use and social contact mutually influence the reinforcing effects of one another. Most of these studies have used same-sex dyads exclusively, and the role of factors related to biological sex and hormonal fluctuations are not well understood. OBJECTIVES: The purpose of this study was to examine the reinforcing effects of cocaine and social contact with an opposite-sex partner in male and female rats, and how these effects are modulated by ovarian hormones. METHODS: Male and female rats were trained in a nonexclusive choice procedure in which cocaine and social contact with an opposite-sex partner were simultaneously available on concurrent progressive ratio schedules of reinforcement. To examine the effects of ovarian hormones related to estrous cycling, Experiment 1 used naturally cycling, gonadally intact females, whereas Experiment 2 used ovariectomized females, and estrus was artificially induced with exogenous hormones. RESULTS: In both experiments, cocaine and social contact functioned as robust reinforcers, and there were no significant effects of biological sex or estrus status of the females. The positive reinforcing effects of both cocaine and social contact increased as a function of cocaine dose, indicating that contingent cocaine administration increases the reinforcing effects of social contact. CONCLUSIONS: These data suggest that cocaine use among opposite-sex partners may enhance factors that contribute to social bonding.

Lumbar and Cervical Concurrent Muscle Activity Analysis During Hamstring Length Testing to Design a Customized Treatment Plan: An Observational Cross-Sectional Study.

BACKGROUND:  Hamstring length plays a significant role in a spectrum of clinical entities, from injury prevention and gait dysfunction to posture correction. Evidence suggests that the prevalence of hamstring tightness (HT)/reduced length is increasing. Despite the number of available tests and treatment protocols, HT is still a functional diagnosis. This study's primary goal is to evaluate concurrent muscle (CM) usage during these testing procedures to design a unique, customized treatment protocol. METHODS: The study was conducted in two stages. In phase 1, Active Straight Leg Raise (ASLR), Active Total Knee Extension (ATKE), and Active Seated Total Knee Extension (ASTKE) were carried out. Next, two pressure gauges (PGs) were placed to align with the natural lumbar and cervical curvatures while testing ASLR and ATKE. After analyzing the results for pressure gauge placement, phase 2 data were collected for tests ASLR and ATKE with PG. RESULTS: The results of ASLR and ATKE, both with and without PG, indicate a high prevalence rate, whereas the results of ASTKE show no prevalence. Changes in the PG values indicate CM usage. Dichotomization revealed that participants with normal test scores (non-HT group) had increased usage of CM work. Positive and negative changes in PG indicate the involved CM group. CONCLUSION(S): In regular practice, most healthcare professionals and fitness trainers prefer ASTKE due to the ease of the testing procedure. Directing co-professionals on their choice of tests is challenging, whereas providing knowledge about CM use paves the way for creating customized treatment plans.

Intrathecal topotecan with systemic checkpoint inhibitor therapy for gastroesophageal cancer with leptomeningeal involvement: two case reports and review of the literature.

Background: Leptomeningeal metastases (LM) in gastroesophageal (GE) malignancies are exceedingly rare. Historically, treatment for LM has included steroids, radiation, chemotherapy, and intrathecal (IT) chemotherapy. However, the outcomes in GE malignancies with LM remain poor. Unfortunately, clinical trials in GE malignancies have traditionally excluded those with LM, limiting advances in therapeutic strategies. Given that LM poses potentially devastating neurologic and psychologic sequelae, there is an urgent need for more effective treatments. Case Description: Patient 1 is a 44-year-old woman with localized esophageal adenocarcinoma who undergoes neoadjuvant chemoradiation followed by esophagectomy. Seven months following surgery, she develops ataxia, weakness, and nausea/vomiting. Magnetic resonance imaging (MRI) reveals intracranial disease that is subsequently successfully resected and then treated with gamma knife (GK) radiation. Pathology confirms metastases. Three months later she is found to have LM. She receives palliative whole brain radiation therapy as well as focal radiation to the spine. Following this she transitioned to concurrent IT topotecan plus intravenous (IV) ipilumumab/nivolumab with durable response beyond 14 months. Patient 2 is a 71-year-old man with de novo metastatic esophageal adenocarcinoma with durable response to 5-fluorouracil plus irinotecan. Asymptomatic intracranial metastases are detected on surveillance scans 2 years after initial diagnosis for which he receives GK. Follow up MRI identifies new LM. As such, to treat the LM, he was transitioned to IT topotecan and IV pembrolizumab with good response for 6 months until death from a gastrointestinal bleed. Conclusions: We present two cases of LM in patients with GE adenocarcinoma who had longer survival than what has been reported. They were treated with combination IT topotecan and IV checkpoint inhibition. Further studies evaluating the central nervous system tumor immune-microenvironment can help expand our understanding of how this combination has worked well in our patients and how to care for others with similar scenarios.

Association of low adherence to weekly cisplatin with outcomes in patients with head and neck squamous cell carcinoma: a retrospective cohort study.

BACKGROUND: The National Comprehensive Cancer Network (NCCN) guideline recommends consideration of weekly cisplatin as an alternative option for patients with head and neck cancer undergoing definitive chemoradiation. However, in a recent phase III trial (ConCERT), 20% of patients treated with weekly cisplatin could not receive a total of 200 mg/m2, and the association of low adherence to weekly cisplatin and cancer control outcomes remains unclear. To fill this knowledge gap, we performed an observational cohort study of patients with head and neck cancer undergoing definitive chemoradiation with weekly cisplatin. METHODS: Our institutional database was queried for patients with non-metastatic head and neck cancer who underwent definitive chemoradiation with weekly cisplatin (40 mg/m2) between November 2007 and April 2023. Adherence to weekly cisplatin was defined as receiving at least 5 cycles with a total cumulative dose of 200 mg/m2. Survival outcomes were evaluated using Kaplan-Meier method, log-rank tests, Cox proportional hazard multivariable (MVA) analyses. Logistic MVA was performed to identify variables associated with low adherence to weekly cisplatin. Fine-Gray MVA was performed to analyze failure outcomes with death as a competing event. RESULTS: Among 119 patients who met our criteria, 51 patients (42.9%) had low adherence to weekly cisplatin. Median follow up was 19.8 months (interquartile range 8.8-65.6). Low adherence to weekly cisplatin was associated with worse overall survival (adjusted hazards ratio [aHR] 2.94, 95% confidence interval [CI] 1.58-5.47, p < 0.001) and progression-free survival (aHR 2.32, 95% CI 1.29-4.17, p = 0.005). It was also associated with worse distant failure (aHR 4.55, 95% CI 1.19-17.3, p = 0.03), but not locoregional failure (aHR 1.61, 95% CI 0.46-5.58, p = 0.46). KPS < 90 was the only variable associated with low adherence to weekly cisplatin (adjusted odds ratio [aOR] 2.67, 95% CI 1.10-6.65, p = 0.03). CONCLUSION: Our study suggested that over 40% of patients underwent fewer than 5 weekly cisplatin cycles and that low adherence to weekly cisplatin was an independent, adverse prognostic factor for worse survival and distant failure outcomes. Those with reduced adherence to weekly cisplatin were more likely to have poor performance status. Further studies are warranted to improve the adherence to chemotherapy and outcomes.

Statin therapy enhances survival in unresectable stage III lung squamous cell carcinoma with concurrent chemoradiotherapy.

To evaluate the impact of statin use on overall survival and lung cancer-specific survival in patients with unresectable stage III lung squamous cell carcinoma (LSCC) undergoing standard concurrent chemoradiotherapy (CCRT). Using data from the Taiwan Cancer Registry Database and National Health Insurance Research Database, this propensity score matching cohort study analyzed the influence of statin use during CCRT on overall survival and lung cancer-specific survival. Statin use during CCRT was independently associated with significant improvements in overall survival and lung cancer-specific survival. The adjusted hazard ratio (95% CI) for all-cause mortality in the statin group versus the non-statin group was 0.60 (0.53-0.68, P < 0.0001). Similarly, the adjusted hazard ratio for lung cancer-specific mortality in the statin group versus the non-statin group was 0.61 (95% CI, 0.54-0.70, P < 0.0001). Pravastatin and fluvastatin exhibited the greatest potential in reducing lung cancer-specific mortality among statins, with rosuvastatin following closely behind. Atorvastatin demonstrated comparable effectiveness, while simvastatin and lovastatin displayed lower efficacy in this regard. Furthermore, a dose-response relationship was observed, with higher cumulative defined daily doses and greater daily intensity of statin use associated with reduced mortality. Our study provides evidence that statin use during CCRT for unresectable stage III LSCC is associated with significant improvements in overall survival and lung cancer-specific survival. Pravastatin showed the highest potential for reducing lung cancer-specific mortality among statins, followed by rosuvastatin. Atorvastatin and fluvastatin exhibited similar effectiveness, while simvastatin and lovastatin demonstrated lower efficacy. The dose-response relationship showed higher statin utilization in reducing lung cancer-specific mortality.

Innovative approaches for vaccine trials as a key component of pandemic preparedness - a white paper.

BACKGROUND: WHO postulates the application of adaptive design features in the global clinical trial ecosystem. However, the adaptive platform trial (APT) methodology has not been widely adopted in clinical research on vaccines. METHODS: The VACCELERATE Consortium organized a two-day workshop to discuss the applicability of APT methodology in vaccine trials under non-pandemic as well as pandemic conditions. Core aspects of the discussions are summarized in this article. RESULTS: An "ever-warm" APT appears ideally suited to improve efficiency and speed of vaccine research. Continuous learning based on accumulating APT trial data allows for pre-planned adaptations during its course. Given the relative design complexity, alignment of all stakeholders at all stages of an APT is central. Vaccine trial modelling is crucial, both before and in a pandemic emergency. Various inferential paradigms are possible (frequentist, likelihood, or Bayesian). The focus in the interpandemic interval may be on research gaps left by industry trials. For activation in emergency, template Disease X protocols of syndromal design for pathogens yet unknown need to be stockpiled and updated regularly. Governance of a vaccine APT should be fully integrated into supranational pandemic response mechanisms. DISCUSSION: A broad range of adaptive features can be applied in platform trials on vaccines. Faster knowledge generation comes with increased complexity of trial design. Design complexity should not preclude simple execution at trial sites. Continuously generated evidence represents a return on investment that will garner societal support for sustainable funding. Adaptive design features will naturally find their way into platform trials on vaccines.

Effects of concurrent aerobic and strength training in women diagnosed with non-metastatic breast cancer: a systematic review and meta-analysis.

PURPOSE: To investigate the potential impact of concurrent aerobic and strength training (CT) on women diagnosed with breast cancer. METHODS: Articles published in English and indexed in the PubMed, Web of Science, SPORTDiscus, The Cochrane Library, PsycINFO, EMBASE, and CINAHL Plus databases from their inception to 12 December 2023 were searched. Eligible studies were randomized controlled trials that involved CT and assessed cardiorespiratory fitness, cancer-related fatigue, and quality of life (QoL) using specialized tools. Subgroup analyses were conducted as per treatment status and characteristics. Risk of bias was evaluated with the Cochrane risk-of-bias tool (RoB 2.0). RESULTS: This study included 29 studies involving 2071 participants. CT was found to significantly improve patients' cardiorespiratory fitness (weighted mean difference = 4.24 mL/kg/min, 95% confidence interval (CI) = 1.93-6.55, P < 0.001), cancer-related fatigue (standardized mean difference (SMD) = - 0.74, 95% CI = - 1.05 to - 0.44, P < 0.001), and QoL (SMD = 0.76, 95% CI = 0.50-1.01, P < 0.001). The analysis of secondary outcomes found that CT could significantly improve patients' body composition, anxiety, pain, sleep disorders, and anorexia and enhance upper and lower limb muscle strength, but was ineffective on depression. CONCLUSION: For women with breast cancer, CT significantly enhances cardiorespiratory fitness, alleviates cancer-related fatigue, and improves QoL. The health benefits of CT are inferior in the postmenopausal cohort compared to the overall study population. IMPLICATIONS FOR CANCER SURVIVORS: CT is advisable for female breast cancer survivors due to its significant effectiveness in mitigating cancer-related fatigue, enhancing cardiorespiratory fitness, and improving the QoL.

Teacher-assigned grades and external exams: sources of discrepancy.

Modest correlations between teacher-assigned grades and external assessments of academic achievement (r = .40-.60) have led many educational stakeholders to deem grades subjective and unreliable. However, theoretical and methodological challenges, such as construct misalignment, data unavailability and sample unrepresentativeness, limit the generalisability of previous findings. We overcome these challenges by exploiting rich, population-wide data from the National Registries in Norway (n = 511,858), where state regulations require close construct alignment between grades and external exams. Correlations between lower-secondary education final grades and external exam results (r = .64-.86) suggest that grades are better measures of academic achievement than previously acknowledged. Dominance analyses and multivariate regression analyses indicate that external exam results are the best predictor of grades in the same subject. However, our results also indicate that state regulations and quality assurance systems cannot completely eradicate potential sources of discrepancy.

Effects of Chemotherapy and Radiation Therapy on Early Laryngeal Cancers.

Background/Aim: Treatments for early laryngeal squamous cell carcinoma (SCC) include radiotherapy (RT), chemoradiotherapy (CRT), and larynx-preserving surgery. In this study, early laryngeal SCC was treated with RT in patients with stage I (T1N0) tumors and with CRT and docetaxel (DOC) in patients with stage II (T2N0) tumors and the treatment results and effectiveness of the chemotherapy were compared. Patients and Methods: A total of 78 patients with early-stage laryngeal SCC were enrolled in this study. The T1N0 patients received radiation for the primary lesions as outpatients at a total dose of 63-70 Gy. By contrast, the T2N0 patients were hospitalized and treated with CRT, receiving a total radiation dose of 66-70 Gy. Docetaxel (DOC, 10 mg/m2) was administered intravenously once a week for 6-8 consecutive weeks concurrently with radiotherapy. The adverse events and survival rates with local control rates were examined. Results: The number of non-glottic T2N0 patients was significantly higher than that of T1N0 patients. Although all patients completed their treatment schedule, significantly more grade 3 adverse events were observed in the T2N0 patients, in particular mucositis and dermatitis, than in T1N0 patients. The 5-year overall survival rate, disease specific survival rate, local control rate, and laryngeal preserve rate of the T1N0 and T2N0 patients were 86.1, 93.3, 88.6, and 94.3% and 85.9, 88.0, 93.1, and 93.1%, respectively. Conclusion: CRT with docetaxel showed the best therapeutic outcomes for the treatment of laryngeal SCC in patients with T2N0 tumours, with a higher local control rate, effective laryngeal preservation, and relatively few adverse events.

Dramatic Radiographic Response of Pelvis-Filling Locally Advanced Cervical Cancer Treated With Radiation and Chemotherapy.

Locally advanced cervical cancers are often treated with palliative intent due to concerns that the tumor is too far advanced or too large to be treated curatively. Also, patients greater than 65 years of age with cervical cancer are sometimes regarded as being too old or too frail to be cured with combined radiation and chemotherapy. These patients are often treated with radiation alone or with palliative therapy. Understanding the treatment modalities for cervical cancer is essential, as they can be complex and unique to each patient's specific diagnosis. This case report aims to describe the dramatic response to treatment with combined radiation and chemotherapy for a patient greater than 65 years of age with pelvis-filling cervical cancer with right-sided hydronephrosis. After a five-week course of concurrent chemoradiation, the cervical mass radiographically completely disappeared, with no evidence of disease noted on pelvic MRI.

Comprehensive Classification of the Capitellar Injury Concurrent with Radial Head Fracture.

BACKGROUND: Capitellar injury (CI) includes capitellar cartilage injury (CCI) and capitellar fracture (CF). A comprehensive classification of CI concurrent with radial head fracture (RHF) that can guide surgical strategy is lacking in the literature. Therefore, this study aimed to introduce a comprehensive classification of CI concurrent with RHF and investigate its value. METHODS: A total of 35 patients with CI concurrent with RHF confirmed by surgical exploration were retrospectively analyzed, includingmales in 19 cases and females in 16 cases. RHF was classified according to the Mason classification, and CI was classified into six types, including 3 types of CCI and CF, each based on the site and degrees of injuries (comprehensive classification method proposed in this study). The classification results were analyzed. Two radiologists were selected to independently classify the CI, and the inter- and intra-observer agreements were analyzed with kappa statistics. RESULTS: Mason Type I, II, III, and IV RHF accounted for 14.3%, 48.6%, 37.1%, and 0% of cases, respectively. Type I, II, III, IV, V, and VI CIs accounted for 22.9%, 34.3%, 25.7%, 11.4%, 2.9%, and 2.9% of cases, respectively. Therewas no obvious relationship between the CI and RHF types (p > 0.05). All Type I CIs underwent removal, 9 Type II CIs underwent microfracture repair, and 3 Type II CIs underwent removal. All Type III CIs underwent fixation, one Type IV CI underwent removal, and 3 Type IV CIs underwent fixation, one Type V CI underwent fixation, and one Type VI CI underwent arthroplasty. The inter- and intra-observer kappa coefficients were 0.830 ~ 0.905 and 0.805 ~ 0.892, respectively. At 12 months postoperatively, the elbow function evaluated by MEPS was 91, with an excellent and good rate of 97%. CONCLUSION: Different types of CI differ not only in pathology but also in treatment methods. The CI comprehensive classification put forth in this paper for the first time reflects different types of pathology well, with high consistency and repeatability, and can guide the selection of surgical methods, leading to satisfactory postoperative results.

Reliability, concurrent validity, and clinical feasibility of measurement methods determining volume in patients with lower limb lymphedema and healthy controls.

PURPOSE: To investigate reliability, concurrent validity, and clinical feasibility of measurements assessing volume in patients with lower limb lymphedema (LLL) and healthy controls. MATERIALS AND METHODS: To investigate intra- and interrater reliability, 47 patients with LLL and 30 healthy controls were assessed three times by two assessors. To investigate between session reliability, 50 participants were reassessed two weeks later. Each assessment included measurements of the midline region (hip circumference; suprapubic volume), leg volume (perimeter every 4 cm; Perometer®), and foot volume (water displacement; figure-of-eight method). Concurrent validity was assessed with correlation coefficients. Measurements were timed and practical limitations were reviewed. Clinical trial registration number: NCT: 05269264. RESULTS: Measurements of the total volume of different regions showed weak to very high intraclass correlation coefficients (ICCs) (0.131-998). Absolute and relative volume differences had lower ICC values (0.360-0.976). A strong correlation was found between the total volumes of the same region. The Perometer® and figure-of-eight method were the fastest method for leg and foot volume, respectively. CONCLUSIONS: The assessed total volumes might be more valuable in assessing the evolution of volume in bilateral LLL than the calculated absolute and relative differences between both limbs. The Perometer® and figure-of-eight method were the most time efficient for leg and foot volume, respectively.Implications for rehabilitationLymphedema is a chronic condition for which a reliable and clinically feasible assessment of volume is essential for the diagnosis, treatment decisions, and the evaluation of the treatment.This study shows that the total leg/foot volumes were more reliable than the calculated absolute and relative differences between both limbs and could therefore more valuable to evaluate bilateral lower limb lymphedema.For the assessment of leg volume, the Perometer® was the most reliable and fastest method.For the evaluation of the foot volume, the figure-of-eight method was overall the best method.

Mortality and Morbidity After Open Surgical Lower Extremity Revascularization in Patients With Peripheral Artery Disease and Concurrent Abdominal Stoma.

OBJECTIVES: Patients with peripheral artery disease (PAD) often require treatment with open lower extremity revascularization (LER). Patients with PAD often have other comorbidities and associated conditions that affect procedural outcomes, including abdominal stomas. The aim of this work is to investigate the impact that stomas may have on postoperative outcomes and complications. METHODS: We performed a 5-year (2016-2020) analysis of the Nationwide Readmission Database. We identified all adult patients undergoing open LER. These patients were categorized into 2 groups: stoma and no-stoma. Propensity score matching (1:1) was used to control for demographics and comorbidities. Index admission outcomes and readmission rate were examined. RESULTS: 212,275 open LER patients were identified. A matched cohort of 3088 patients (1:1 stoma vs no-stoma) was obtained. Patients with stomas had higher rates of several postoperative complications: acute posthemorrhagic anemia (29.1%, P < 0.01), acute kidney injury (21.4%, P < 0.001), index sepsis (10.3%, P < 0.001), and index SSI (2.8%, P < 0.001). There were no significant statistical differences between the 2 groups for acute myocardial infarction. Those with stomas had worse outcomes: greater in-hospital mortality (4.7%, P < 0.05), length of stays (median 7 days, P < 0.001), total charges (median 108,037 dollars, P < 0.001), discharges to long-term care facilities (30.8%, P < 0.001), discharges to their own homes needing home health care (30.1%, P < 0.001), 30-day readmission rates (23.2%, P < 0.01), and 30-day readmission mortality (6.1%, P < 0.01). CONCLUSIONS: Concurrent abdominal stoma is associated with increased postoperative morbidity and mortality after open LER. Further prospective studies are needed to validate these results.

PD-1 inhibitor plus concurrent chemoradiotherapy for high-risk locally advanced cervical cancer.

Aim: The prognosis of high-risk, locally advanced cervical cancer (LACC) remains poor following concurrent chemoradiotherapy (CCRT). We investigated whether the effect of CCRT can be enhanced by programmed cell death protein 1 (PD-1) inhibitor. Methods: A retrospective cohort study was conducted to compare the efficacy and safety of CCRT group (n = 82) and PD-1 inhibitor plus CCRT group (n = 70). Results: Compared with the CCRT group, the PD-1 inhibitor plus CCRT group had significantly higher objective response rate, median progression-free survival, leukopenia and fatigue. The addition of PD-1 inhibitor to CCRT showed a favorable trend in overall survival without statistical significance. Conclusion: PD-1 inhibitor plus CCRT presented a significant survival benefit and a manageable safety profile in high-risk LACC.

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