Visual rehabilitation with mini scleral contact lenses in scarred corneas.

PURPOSE: To present a case series of patients with corneal scars who were successfully fitted with mini scleral contact lenses (mSCL). METHODS: Case series study. RESULTS: Six eyes of six patients with corneal scars were fitted with mSCLs. All scars were situated in the visual axis within the scotopic pupillary zone. The sizes of the scars varied, with the smallest being confined to a central corneal area (case 5) and the largest covering the entire visual axis (case 2). In addition to compromising corneal transparency, these scars also induced significant corneal irregularities, especially in cases 1, 3, and 4. The average corrected distance visual acuity (CDVA) with spectacles was 20/80, with a range of 20/200 to 20/40. With the use of mSCLs, CDVA improved to an average of 20/25, ranging from 20/40 to 20/16. The mean visual acuity improvement observed was five optotype lines, with a range of 3 to 7 lines. CONCLUSION: Corneas with scars often exhibit increased higher-order aberrations (HOA), and affected patients not only experience reduced vision but also suffer from seriously reduced optical quality and optical phenomena such as photophobia. Utilizing mSCLs in such individuals can significantly enhance visual acuity and improve optical side effects resulting from corneal opacity and irregularity.

[Role of neoadjuvant rectal score in prognosis and adjuvant chemotherapy decision-making in locally advanced rectal cancer following neoadjuvant short-course radiotherapy and consolidation chemotherapy].

Objectives: To assess the prognostic impact of the neoadjuvant rectal (NAR) score following neoadjuvant short-course radiotherapy and consolidation chemotherapy in locally advanced rectal cancer (LARC), as well as its value in guiding decisions for adjuvant chemotherapy. Methods: Between August 2015 and August 2018, patients were eligible from the STELLAR phase III trial (NCT02533271) who received short-course radiotherapy plus consolidation chemotherapy and for whom the NAR score could be calculated. Based on the NAR score, patients were categorized into low (＜8), intermediate (8-16), and high (＞16) groups. The Kaplan-Meier method, log rank tests, and multivariate Cox proportional hazard regression models were used to evaluate the impact of the NAR score on disease-free survival (DFS). Results: Out of the 232 patients, 24.1%, 48.7%, and 27.2% had low (56 cases), intermediate (113 cases), and high NAR scores (63 cases), respectively. The median follow-up period was 37 months, with 3-year DFS rates of 87.3%, 68.3%, and 53.4% (P＜0.001) for the low, intermediate, and high NAR score groups. Multivariate analysis demonstrated that the NAR score (intermediate NAR score: HR, 3.10, 95% CI, 1.30-7.37, P=0.011; high NAR scores: HR=5.44, 95% CI, 2.26-13.09, P＜0.001), resection status (HR, 3.00, 95% CI, 1.64-5.52, P＜0.001), and adjuvant chemotherapy (HR, 3.25, 95% CI, 2.01-5.27, P＜0.001) were independent prognostic factors for DFS. In patients with R0 resection, the 3-year DFS rates were 97.8% and 78.0% for those with low and intermediate NAR scores who received adjuvant chemotherapy, significantly higher than the 43.2% and 50.6% for those who did not (P＜0.001, P=0.002). There was no significant difference in the 3-year DFS rate (54.2% vs 53.3%, P=0.214) among high NAR score patients, regardless of adjuvant chemotherapy. Conclusions: The NAR score is a robust prognostic indicator in LARC following neoadjuvant short-course radiotherapy and consolidation chemotherapy, with potential implications for subsequent decisions regarding adjuvant chemotherapy. These findings warrant further validation in studies with larger sample sizes.

Evaluación de la supervivencia de los pacientes con cáncer de recto metastásico mediante parámetros radiómicos y volumétricos de la PET/TC con [18F]FDG de estadificación / Evaluation of the survival of patients with metastatic rectal cancer by staging [18F]FDG PET/CT radiomic and volumetric parameters

Objetivo El objetivo de este estudio es predecir el pronóstico de pacientes con cáncer de recto metastásico (CRM) mediante la obtención de un modelo con algoritmos de aprendizaje automático (AA) a través de datos volumétricos y radiómicos obtenidos de la PET/TC basal. Métodos Pacientes con CRM que se sometieron a imágenes PET/TC con [18F]FDG para estadificación en nuestro hospital entre enero 2015 y enero de 2021 se evaluaron mediante el software LIFEx. El volumen de interés (VOI) del tumor primario fue generado. Además, se evaluaron los valores del volumen metabólico tumoral total (tMTV) y la glucólisis de lesión total (TLG) de los focos tumorales en todo el cuerpo. Se evaluaron los datos clínicos y radiómicos con algoritmos de AA para crear un modelo que predijera la supervivencia. Se investigaron asociaciones significativas entre estas características y la supervivencia a 1 y 2 años. Resultados El algoritmo de bosque aleatorizado fue el algoritmo más exitoso para predecir la supervivencia a 2 años (AUC: 0,843; PRC: 0,822 y CCM: 0,583). Los valores de tMTV y tTLG tuvieron éxito en la predicción de la supervivencia a un año (p 0,002 y 0,007, respectivamente). Conclusiones Además del importante papel de la PET/TC con [18F]FDG en la estadificación de pacientes con CRM, este estudio muestra que es posible predecir la supervivencia con métodos de AA, con parámetros obtenidos mediante el análisis de textura a partir del tumor primario y parámetros volumétricos de todo el cuerpo (AU)

Objective The aim of this study was to predict the prognosis in patients with metastatic rectal cancer (mRC) by obtaining a model with machine learning (ML) algorithms through volumetric and radiomic data obtained from baseline 18-Fluorine Fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) images. Methods Sixty-two patients with mRC who underwent [18F]FDG PET/CT imaging for staging between January 2015 and January 2021 were evaluated using LIFEx software. The volume of interest (VOI) of the primary tumor was generated and volumetric and textural features were obtained from this VOI. In addition, the total metabolic tumor volume (tMTV) and total lesion glycolysis (TLG) values of tumor foci in the whole body were evaluated. Clinical and radiomic data were evaluated with ML algorithms to create a model that predicts survival. Significant associations between these features and 1- and 2-year survival were investigated. Results The random forest algorithm was the most successful in predicting 2-year survival (AUC: 0.843, precision-recall curve: 0.822 and Matthew's correlation coefficient: 0.583). The model obtained with this algorithm was able to predict 49 patients with 79.03% accuracy. While tMTV and TLG values were successful in predicting 1-year survival (p: 0.002 and 0.007, respectively), texture characteristics of the primary tumor did not show a significant relationship with 1-year survival. Conclusions In addition to the important role of [18F]FDG PET/CT in staging patients with mRC, this study shows that it is possible to predict survival with ML methods, with parameters obtained using texture analysis of the primary tumor and whole body volumetric parameters (AU)

¿Existe asociación del tiempo entre el urocultivo y la cirugía intrarrenal retrógrada y la tasa de síndrome de respuesta inflamatoria sistémica? / Does time elapsed between urine culture and retrograde intrarenal surgery affect the rate of systemic inflammatory response syndrome?

Objetivo: Identificar los factores preoperatorios e intraoperatorios que podrían causar el síndrome de respuesta inflamatoria sistémica (SRIS) tras la cirugía intrarrenal retrógrada (CRIR) y estudiar el efecto del tiempo de espera entre la fecha del urocultivo vesical preoperatorio (UCVP) y la fecha de la cirugía en el SRIS postoperatorio.Materiales y métodos: La población objetivo la constituyeron 467 pacientes intervenidos mediante CRIR entre enero de 2013 y junio de 2020. Se obtuvieron UCVP de todos los pacientes antes de la cirugía. En el postoperatorio, los pacientes recibieron seguimiento estrecho en busca de fiebre y otros signos de SRIS. Se realizaron análisis de regresión logística univariante y multivariante para revelar los factores predictivos de SRIS después de CRIR.Resultados: La cohorte completa del estudio estaba formada por 467 pacientes. La tasa de SRIS fue del 5,6%. En el análisis univariante, la tasa de diabetes mellitus, los antecedentes de infección urinaria recurrente, el tiempo quirúrgico y la carga litiásica fueron factores predictivos significativos de SRIS. Según el análisis multivariante, la tasa de antecedentes de infección urinaria recurrente, el tiempo quirúrgico y la carga litiásica eran factores predictivos estadísticamente significativos. El tiempo transcurrido entre la fecha de realización del UCVP y la fecha de la cirugía fue el mismo en el grupo con SRIS y en el grupo normal.Conclusión: El intervalo de tiempo entre la fecha de realización del UCVP y la fecha de la cirugía no es un factor influyente para el SRIS. Aclarar esta cuestión mediante estudios prospectivos puede ayudar a resolver este problema con el que los endourólogos se enfrentan con frecuencia en la práctica diaria. (AU)

Objective: To identify the preoperative and intraoperative factors that might cause systemic inflammatory response syndrome (SIRS) after retrograde intrarenal surgery (RIRS), and to investigate the effect of time elapsed between the date of performing preoperative bladder urine culture (PBUC) and surgery date on postoperative SIRS.Materials and methods: Four hundred sixty-seven patients who had RIRS between January 2013 and June 2020 constituted the target population of this study. PBUC were obtained from all patients before undergoing surgery. Postoperatively, patients were closely monitored for fever and other signs of SIRS. Univariate and multivariate logistic regression analysis were performed to reveal the predictive factors for SIRS after RIRS.Results: The entire study cohort consisted of 467 patients. The rate of SIRS was 5.6%. In univariate analysis, the rate of diabetes mellitus, recurrent urinary tract infection history, surgical time, and stone burden were significant predictive factors for SIRS. In multivariate analysis, the rate of recurrent urinary tract infection history, surgical time and stone burden were observed to be statistically significant predictive factors. Time elapsed between the date of performing PBUC and surgery date was not different between the SIRS group and the normal group.Conclusion: We conclude that the time between the date of performing PBUC and surgery date is not an influential factor for SIRS. Clarifying this issue with prospective studies may be useful, as endourologists frequently encounter this situation in daily practice. (AU)