An assessment of the use of patient reported outcome measurements (PROMs) in cancers of the pelvic abdominal cavity: identifying oncologic benefit and an evidence-practice gap in routine clinical practice.

BACKGROUND: Patient reported outcome measurements (PROMs) are emerging as an important component of patient management in the cancer setting, providing broad perspectives on patients' quality of life and experience. The use of PROMs is, however, generally limited to the context of randomised control trials, as healthcare services are challenged to sustain high quality of care whilst facing increasing demand and financial shortfalls. We performed a systematic review of the literature to identify any oncological benefit of using PROMs and investigate the wider impact on patient experience, in cancers of the pelvic abdominal cavity specifically. METHODS: A systematic review of the literature was conducted using MEDLINE (Pubmed) and Ovid Gateway (Embase and Ovid) until April 2020. Studies investigating the oncological outcomes of PROMs were deemed suitable for inclusion. RESULTS: A total of 21 studies were included from 2167 screened articles. Various domains of quality of life (QoL) were identified as potential prognosticators for oncologic outcomes in cancers of the pelvic abdominal cavity, independent of other clinicopathological features of disease: 3 studies identified global QoL as a prognostic factor, 6 studies identified physical and role functioning, and 2 studies highlighted fatigue. In addition to improved outcomes, a number of included studies also reported that the use of PROMs enhanced both patient-clinician communication and patient satisfaction with care in the clinical setting. CONCLUSIONS: This review highlights the necessity of routine collection of PROMs within the pelvic abdominal cancer setting to improve patient quality of life and outcomes.

Phytoremediation of Potentially Toxic Elements from Contaminated Saline Soils Using Salvadora persica L.: Seasonal Evaluation.

Plants in coastal ecosystems are primarily known as natural sinks of trace metals and their importance for phytoremediation is well established. Salvadora persica L., a medicinally important woody crop of marginal coasts, was evaluated for the accumulation of metal pollutants (viz. Fe, Mn, Cu, Pb, Zn, and Cr) from three coastal areas of Karachi on a seasonal basis. Korangi creek, being the most polluted site, had higher heavy metals (HM's) in soil (Fe up to 17,389, Mn: 268, Zn: 105, Cu: 23, Pb: 64.7 and Cr up to 35.9 mg kg-1) and S. persica accumulated most of the metals with >1 TF (translocation factor), yet none of them exceeded standard permissible ranges except for Pb (up to 3.1 in roots and 3.37 mg kg-1 in leaves with TF = 11.7). Seasonal data suggested that higher salinity in Clifton and Korangi creeks during pre- and post-monsoon summers resulted in lower leaf water (ΨWo) and osmotic potential at full turgor (ΨSo) and bulk elasticity (ε), higher leaf Na+ and Pb but lower extractable concentrations of other toxic metals (Cr, Cu, and Zn) in S. persica. Variation in metal accumulation may be linked to metal speciation via specific transporters and leaf water relation dynamics. Our results suggested that S. persica could be grown on Zn, Cr and Cu polluted soils but not on Pb affected soils as its leaves accumulated higher concentrations than the proposed limits.

Multi-organ segmentation of abdominal structures from non-contrast and contrast enhanced CT images.

Manually delineating upper abdominal organs at risk (OARs) is a time-consuming task. To develop a deep-learning-based tool for accurate and robust auto-segmentation of these OARs, forty pancreatic cancer patients with contrast-enhanced breath-hold computed tomographic (CT) images were selected. We trained a three-dimensional (3D) U-Net ensemble that automatically segments all organ contours concurrently with the self-configuring nnU-Net framework. Our tool's performance was assessed on a held-out test set of 30 patients quantitatively. Five radiation oncologists from three different institutions assessed the performance of the tool using a 5-point Likert scale on an additional 75 randomly selected test patients. The mean (± std. dev.) Dice similarity coefficient values between the automatic segmentation and the ground truth on contrast-enhanced CT images were 0.80 ± 0.08, 0.89 ± 0.05, 0.90 ± 0.06, 0.92 ± 0.03, 0.96 ± 0.01, 0.97 ± 0.01, 0.96 ± 0.01, and 0.96 ± 0.01 for the duodenum, small bowel, large bowel, stomach, liver, spleen, right kidney, and left kidney, respectively. 89.3% (contrast-enhanced) and 85.3% (non-contrast-enhanced) of duodenum contours were scored as a 3 or above, which required only minor edits. More than 90% of the other organs' contours were scored as a 3 or above. Our tool achieved a high level of clinical acceptability with a small training dataset and provides accurate contours for treatment planning.

Incidence and relevance of clinically indeterminate nonregional lymph nodes in the treatment of oesophageal cancer.

OBJECTIVES: Metastatic involvement of nonregional supraclavicular or superior mediastinal lymph nodes in distal oesophageal cancer is rare but has important implications for prognosis and management. The management of nonregional lymph nodes which appear indeterminate on CT and FDG PET-CT (subcentimeter nodes or those with preserved normal morphology, but increased FDG avidity) can present a diagnostic dilemma. This study investigates the incidence, work-up and clinical significance of nonregional clinically indeterminate FDG avid lymph nodes. METHODS: A single-centre retrospective review of all FDG PET-CT scans conducted over 5 years was conducted. Patients with mid- or distal oesophageal cancer with nonregional FDG avid nodes were identified. Subsequent work-up, management and outcomes were retrieved from electronic health records. RESULTS: Reports for 1189 PET-CT scans were reviewed. A total of 79 patients met the inclusion criteria. Of these, 18 (23%) were deemed to have disease and performance status potentially amenable to radical surgery and underwent further assessment. The indeterminate lymph nodes were successfully sampled via endobronchial ultrasound (EBUS) or ultrasound-guided fine-needle aspiration (US-FNA) in 100% of cases. 15/18 (83.3%) of samples were benign and proceeded to surgery. Outcomes for patients who proceeded to surgery were similar to other cohorts. None had pathology suggesting false-negative lymph node sampling. CONCLUSIONS: EBUS and US-FNA are effective means of sampling clinically indeterminate nonregional lymph nodes, and can significantly impact prognosis, and management. Further investigations in this context are of value in this cohort and should be pursued. Nonregional clinically indeterminate lymph nodes represent a diagnostic dilemma in oesophageal cancer staging. Additional investigations in the form of endobronchial ultrasound are effective at providing additional staging information, and can substantially influence patient care.

Health risks of heavy metal exposure and microbial contamination through consumption of vegetables irrigated with treated wastewater at Dubai, UAE.

The shortage of fresh water is a major problem throughout the world, but the situation is worst in the arid and semiarid regions. Therefore, reuse of nonconventional water resources such as treated wastewater (TWW) is a common practice to irrigate field crops, vegetables, and forestry sectors. The present study was conducted to evaluate the significant impact of different heavy metals such as copper (Cu), iron (Fe), chromium (Cr), and zinc (Zn) on the soil and leafy, root, and fruit vegetables following irrigation with TWW through subsurface drip irrigation. Our results indicate that iron (Fe) was highest in lettuce followed by spinach, and Zn and Cr were second and third most abundant element in the different vegetables. Eggplant and radish showed the lowest concentrations of various heavy metals. A significant difference was observed in transfer factor (TF) among vegetables, and highest TFsoil-veg was observed for Fe in lettuce and the lowest for Cr in eggplant. Estimated daily intake (EDI) was the lowest in adults and highest in children. Target hazard quotient (THQ) of Cu, Zn, and Fe being < 1.0 appears relatively safe in all the tested vegetables. Risk index (RI) values showed that heavy metals were lower than 1.0 and hence lower risk for human. The combined HI values for Cu, Zn, Cd, Cr, and Pb were substaintionaly higher 12.8 and 9.21 after consumption of lettuce and carrot. So, consumption of these vegetables should be avoided after irrigation with TWW. Spinach exhibited maximum total coliform loading, while ecological risk was negligible due to sandy nature of soil type. Health risks to human could be reduced through proper selection of suitable vegetables, time of maturity, and consumed organs (leaf, fruit, or root part). Appropriate should be followed to decontaminate the microbial load in order to avoid any risks to human health (both adults and children).

Dedifferentiated chordoma with a sarcomatous component: an overlooked diagnosis.

A 60 year old male presented with unremitting complaints of acute urinary retention and constipation. Computerized Tomography of the abdomen and pelvis confirmed a sacral mass. The biopsy diagnosed dedifferentiated sacral chordoma; an extremely rare entity, seldom reported and frequently misdiagnosed. We present a unique case report after an extensive review of retrospective literature on dedifferentiated chordomas.

Evaluating heavy metal accumulation and potential health risks in vegetables irrigated with treated wastewater.

Effect of irrigation with treated municipal wastewater on the accumulation of heavy metals in soils and food crops and potential health risks to human via consumption of these food crops are evaluated. The higher concentrations of iron (Fe), copper (Cu), chromium (Cr) and zinc (Zn) were found in lettuce, radish and carrots, respectively. However, trace metal levels in all vegetables were far lower than the food safety criteria of World Health Organization and European Union. Bioaccumulation factors (BAF) for heavy metals in different vegetables showed a trend in the order: Fe > Zn > Cu > Cr. The trends of estimated dietary intake (EDIs) for adults were in the order of Fe > Zn > Cr > Cu. The highest level of total coliform was recorded in spinach, followed by radish, egg plant, tomatoes and lettuce. The low uptake of heavy metals by vegetables shows that the health risks for human are insignificant. As the variations in transfer factor of metals is related to absorption capability of vegetables, soil properties and nutrient management, the risk of human exposure to metal contamination can be significantly reduced by selecting appropriate crops.

Colorectal cancer treatment.

INTRODUCTION: Colorectal cancer is the third most common malignancy in the developed countries, and about a quarter of people present with intestinal obstruction or perforation. Risk factors for colorectal cancer are mainly dietary and genetic. Overall 5-year survival is about 50%, with half of people having surgery experiencing recurrence of the disease. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for colorectal cancer? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 57 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: adjuvant systemic chemotherapy, preoperative radiotherapy, and routine intensive follow-up.