Klitgaardbramsen6083

BACKGROUND Robotic nipple sparing mastectomy (R-NSM), which uses the da Vinci surgical platform, could perform NSM and immediate breast reconstruction through a small and inconspicuous extra-mammary axillary or lateral chest incision. R-NSM was reported with extremely low nipple areolar complex (NAC) necrosis rate, good cosmetic results, and high patient satisfaction. However, there was little evidence available comparing the effectiveness and safety of R-NSM and conventional NSM (C-NSM) in the management of breast cancer. METHODS A case control comparison study was conducted for patients with breast cancer who underwent R-NSM or C-NSM with immediate gel implant breast reconstruction (IGBR) from July 2011 to September 2019 at a single institution to compare the clinical outcomes, patient-reported esthetic results, and medical cost. RESULTS According to the study design, 54 procedures of R-NSM were compared with 62 procedures of C-NSM in the surgical management of breast cancer combined with IGBR. Compared with C-NSM, R-NSM was associated with higher overall satisfaction (92% excellent and 8% good versus 75.6% excellent and 24.4% good, P = 0.046), and wound/scar related outcome in patient-reported esthetic results. The NAC ischemia/necrosis risk, overall complication rate, and blood loss were not significantly different between R-NSM and C-NSM groups. However, longer operation time and higher overall medical cost (10,877 ± 796 versus 5,702 ± 661 US Dollars, P less then 0.01) was observed in R-NSM group. CONCLUSION Compared with C-NSM, R-NSM showed comparable clinical outcomes and favorable patients' satisfaction with the esthetic results, but at the price of longer operation time and higher cost. RATIONALE AND OBJECTIVES Noncontrast CT-based radiomics signature has shown ability for detecting hematoma expansion (HE) in spontaneous intracerebral hemorrhage (ICH). We sought to compare its predictive performance with clinical risk factors and develop a clinical-radiomics nomogram to assess the risk of early HE. MATERIALS AND METHODS In total, 1153 patients with ICH who underwent baseline cranial CT within 6 hours and follow-up scans within 72 hours of stroke onset were enrolled, of whom 864 (75%) were assigned to the derivation cohort and 289 (25%) to the validation cohort. Based on LASSO algorithm or stepwise logistic regression analysis, three models (clinical model, radiomics model, and hybrid model) were constructed to predict HE. The Akaike information criterion (AIC) and likelihood ratio test (LRT) were used for comparing the goodness of fit of the three models, and the AUC was used to evaluate their discrimination ability for HE. RESULTS The hybrid model (AIC = 681.426; χ2= 128.779) was the optimal model with the lowest AIC and highest chi-square values compared to the radiomics model (AIC = 767.979; χ2 = 110.234) or the clinical model (AIC = 753.757; χ2 = 56.448). The radiomics model was superior in the prediction of HE to the clinical model in both derivation (p = 0.009) and validation (p = 0.022) cohorts. In both datasets, the clinical-radiomics nomogram showed satisfactory discrimination and calibration for detecting HE (AUC = 0.771, Sensitivity = 87.0%; AUC = 0.820, Sensitivity = 88.1%; respectively). CONCLUSION Among patients with acute ICH, noncontrast CT-based radiomics model outperformed the clinical-only model in the prediction of HE, and the established clinical-radiomics nomogram with favorable performance can offer a noninvasive tool for the risk stratification of HE. BACKGROUND The present study aimed to assess the clinical features of patients who received lenvatinib treatment for unresectable hepatocellular carcinoma (HCC). METHODS The clinical characteristics, adverse events, and radiological responses were evaluated for 51 consecutive patients. RESULTS Of the study subjects, 37 patients had Child-Pugh class A (CPA) liver function, and 14 patients had Child-Pugh class B (CPB) liver function. The overall response rates in the CPA and CPB groups were 42.9% and 25.0%, respectively, and disease control rates were 82.9% and 83.3%, respectively, without significant difference (p = 0.2621 and 0.9697). There was no significant difference between CPA and CPB groups regarding the incidence of adverse events, except for hepatic coma. No significant difference was observed in the relative dose intensity between the CPA and CPB groups, for the first month, 1-2 months, or 2-3 months (p = 0.2368, 0.9368, and 0.9293). CONCLUSION The comparable outcomes between the CPA and CPB groups suggest the acceptability of lenvatinib treatment in patients with impaired liver function, at least in the acute phase. With careful follow-up, the dose can be relatively intensified, even in patients with impaired liver function and this may contribute to offering comparable treatment. PURPOSE While several advanced contact lens (CL) designs are commercially available for vision correction in keratoconus, their visual performance and optical quality, relative to each other and controls remains unclear. CBR-470-1 This prospective, crossover study tested the hypothesis that these CL designs would have a differential impact on visual performance and optical quality in subjects with advanced keratoconus, but not in early to moderate disease states. METHODS Spatial vision (logMAR acuity and contrast sensitivity), depth vision (stereoacuity) and optical quality (higher-order wavefront aberrations) were measured on 28 bilaterally mild to advanced keratoconics (age 20-28yrs; 15 males), novice to CL wear, and in 10 age-matched controls using well-established psychophysical and aberrometry techniques. All data were collected on keratoconic subjects with their spectacles and with conventional RGP, Kerasoft®, Rose K2® and Scleral RGP® CL's in randomized order, atleast a week apart from each other. RESULTS All outcome variables deteriorated with keratoconus severity and improved with CL wear, relative to spectacles (p  less then  0.05). This improvement was smaller for Kerasoft CL (p  less then  0.05) and higher but comparable for the other three CL designs (p = 0.3), across all disease severity. Visual functions and optical quality outcomes never reached control levels for any correction modality (p  less then  0.05). CONCLUSION Visual performance and optical quality in keratoconus does not appear to improve commensurately with the sophistication of CL design across disease severity. Non-visual factors like quality of CL fit, wearing comfort and cost may therefore drive the choice of CL dispensed in keratoconus more than the performance efficacy of these lenses.