Diagnostic work-up and systemic treatment for advanced non-squamous non-small-cell lung cancer in four Southeast Asian countries.

BACKGROUND: Lung cancer is the second most common cancer and leading cause of cancer mortality worldwide. Recent advances in molecular testing and targeted therapy have improved survival among patients with metastatic non-small-cell lung cancer (NSCLC). We sought to quantify and describe molecular testing among metastatic non-squamous NSCLC cases in selected Southeast Asian countries and describe first-line therapy chosen. PATIENTS AND METHODS: A retrospective study was conducted based on incident lung cancer cases diagnosed between 2017 and 2019 in Lampang (Thailand), Penang (Malaysia), Singapore and Yogyakarta (Indonesia). Cases (n = 3413) were defined using the International Classification of Diseases for Oncology third edition. In Singapore, a clinical series obtained from the National Cancer Centre was used to identify patients, while corresponding population-based cancer registries were used elsewhere. Tumor and clinical information were abstracted by chart review according to a predefined study protocol. Molecular testing of epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) gene rearrangement, ROS1 gene rearrangement and BRAF V600 mutation was recorded. RESULTS: Among 2962 cases with a specified pathological diagnosis (86.8%), most patients had non-squamous NSCLC (75.8%). For cases with staging information (92.1%), the majority presented with metastatic disease (71.3%). Overall, molecular testing rates in the 1528 patients with stage IV non-squamous NSCLC were 67.0% for EGFR, 42.3% for ALK, 39.1% for ROS1, 7.8% for BRAF and 36.1% for PD-L1. Among these patients, first-line systemic treatment included chemotherapy (25.9%), targeted therapy (35.6%) and immunotherapy (5.9%), with 31% of patients having no record of antitumor treatment. Molecular testing and the proportion of patients receiving treatment were highly heterogenous between the regions. CONCLUSIONS: This first analysis of data from a clinically annotated registry for lung cancer from four settings in Southeast Asia has demonstrated the feasibility of integrating clinical data within population-based cancer registries. Our study results identify areas where further development could improve patient access to optimal treatment.

Behavioral outcomes following below-knee amputation in the coordination between balance and leg movement.

Lateral leg movement is accompanied by opposite movements of the supporting leg and trunk segments. This kinematic synergy shifts the center of mass (CM) towards the supporting foot and stabilizes its final position, while the leg movement is being performed. The aim of the present study was to provide insight in the behavioral substitution process responsible for the performance of this kinematic synergy. The kinematic synergy was assessed by the principal component analysis (PCA) applied to both hip joints and supporting ankle joint. Patients after unilateral below-knee amputation and control subjects were asked to perform a lateral leg raising. The first principal component (PC(1)) accounted for more than 99% of the total angular variance for all subjects (amputees and controls). PC(1) thus well represents the possibility to describe this complex multi-joint movement as a one degree of freedom movement with fixed ratios between joint angular time course. In control subjects, the time covariation between joints changes holds during all phases of the leg movement (postural phase, ascending and braking phases). In amputees, PC(1) score decreased during the ascending phase of the movement (i.e. when the body weight transfer is completed, while the movement is initiated). We conclude that a feedback mechanism is involved and discuss the hypothesis that this inter-joint coordination in amputees results from a failure in the pre-setting of the inter-joint coupling.

Reorganization of equilibrium and movement control strategies after total knee arthroplasty.

This work was aimed at identifying changes in posturomotor control strategies in patients with unilateral total knee arthroplasty. Using kinetic and kinematic data, a previous study had revealed that, during a side step, patients with unilateral knee arthritis showed a shortened monopodal phase and a lengthened postural phase when the affected leg was the supporting one. It was expected that these strategies would be modified after undergoing total knee arthroplasty. Postoperatively the durations of the monopodal phase and of the postural phase became similar when the operated limb was supporting and when the sound limb was supporting. Concerning the upper body movements, the same asymmetrical results as before surgery were observed. Hence, patients with total knee arthroplasty exhibit posturomotor strategies which, although they become close to normal, remain asymmetrical. The durations of the monopodal and of the postural phases could be considered to assess the results of total knee arthroplasty.

Equilibrium and movement control strategies in trans-tibial amputees.

This study was aimed at identifying changes in equilibrium and movement control strategies in trans-tibial amputees (TTA) related to both the biomechanical changes and the loss of afferent inflow. The coordinations between equilibrium and movement were studied in traumatical TTA and in controls during transition from bipedal to monopodal stance. TTA failed to perform the task in a high percentage of trials both when the sound and the prosthetic limb were supporting. Significant differences were also found between TTA and controls in the duration of the weight transfer phase, in the length of the initial centre of pressure (CP) displacement and in the electromyographic (EMG) patterns. Despite adaptive posturomotor control strategies, transition from bipedal to monopodal stance remains a difficult task to perform for TTA, both when the supporting limb is the affected one and when the sound one is. The results of this study are discussed with respect to the rehabilitation programme and the prosthesis design for transtibial amputees.

Multidimensional Scaling Methods for Many-Object Sets: A Review.

Given a set of dissimilarities data between n objects, multidimensional scaling is the problem of reconstructing a geometrical pattern of these objects, using n points, so that between-points distance corresponds to between-objects dissimilarity. Often, the collection of input data requires rating the dissimilarities between all n(n - 1)/2 possible pairs of stimuli. When the number of stimuli is large, say n $ 30, the number of pairs to be compared becomes very large and the similarity task inefficient. Hence a question of major importance is how to increase the efficiency of the similarity task while maintaining satisfactory scaling solutions. This article reviews the main similarity task methods suitable for a large objects set.

Reorganization of equilibrium and movement control strategies in patients with knee arthritis.

The purpose of this study was to identify changes in equilibrium and movement control strategies in patients with arthritis of the knee. These strategies were expected to be different from those of healthy subjects because of the impairments caused by knee arthritis. The different phases of a side step were studied in patients with severe knee arthritis using a movement analysis system and force-plates. The duration of the postural phase and the intensity of the horizontal ground reaction forces during the postural phase were increased when the pathological limb was the supporting one. The monopodal phase was shortened on the pathological leg. These results show that knee arthritis patients develop new posturomotor strategies mainly aimed at shortening the monopodal phase when the affected leg is the supporting one. This movement analysis method enables quantification of differences that cannot be observed on clinical examination between knee arthritis patients and control subjects, and provides additional information to the usual clinical evaluation scales.

Postural reorganization of weight-shifting in below-knee amputees during leg raising.

The position of the center of gravity (CG) is a reference value that is controlled by the nervous system during the performance of movements. In order to maintain equilibrium, leg movement is preceded by a shift of the CG towards the supporting side. This CG shift is initiated by an early displacement of the center of pressure (CP) towards the moving leg. This characteristic CP thrust partly results from the activity of a distal muscle in the leg to be moved: the gastrocnemius medialis (GM). The aim of this study was to determine how this weight-shifting is initiated when the distal muscles are missing, as in amputees, and to identify any change in the central command. Experiments were performed on ten subjects: five below-knee amputees with no pathology and five control subjects. While standing, the subjects were instructed to raise one leg laterally as fast as possible to an angle of 45 degrees and to maintain the final position. The same weight-shifting strategy was used by both groups, whereas local adaptations associated with the behavior occurred. When the GM is lacking, an early tensor-fasciae-latae (TFL) burst is observed just prior to and associated with the onset of the lateral CP change. This moving-leg abductor may be responsible for initiating the thrust at a proximal level when that leg is still on the ground. In addition, upon analyzing the lateral displacement of the CP, two modes of CP shift were detected. The first CP-shift mode has been previously described and the second mode (which we term here the pre-pushing mode) was used by both amputees and controls. The prepushing mode consisted of two thrusts: an early thrust onto the ground was exerted by the leg about to become the supporting leg followed by the previously described thrust exerted by the leg about to be raised. The early thrust, which could be exerted by either the sound or prosthetic leg, may have increased the efficiency of the second, classical thrust by initiating a swing.

[Treatment of congenital convex foot]. / A propos du traitement du pied convexe congénital.

In the surgical management of congenital pes valgus, vertical talus is the hardiest deformity to be reduced. By opening the lower tibio-fibular joint, associated with classic capsulotomies and tendons-lengthening, the authors have reduced vertical talus easily in three feet, for two children. One of them had a myopathy (central core disease), the other had a muscular hypotonia by cerebral palsy. Morphological results are good, but the function remains fair, due to the muscular weakness, that is usual in these lesions.