Technology integration for young children during COVID-19: Towards future online teaching.

To support young children's learning during the coronavirus 2019 (COVID-19) pandemic, preschool educators in Hong Kong were required to teach with digital technologies. In this study, 1035 educators from 169 preschools reported their views and practices in an online survey, which we examined via multilevel mixed-response analysis and thematic analysis. More than half of the respondents (53%) expected future online teaching to continue, and only 11% of educators believed that parents would reject this form of delivery. Administrators and teaching assistants were more likely than teachers to expect online preschool teaching to continue in the future. In addition, respondents with existing online platform experience, who taught the upper levels of preschool, or incorporated specific teaching practices (eg, after the online lesson, they assessed children and assigned homework tasks), were more likely than others to expect online teaching in the future. Many of these respondents also reported (a) difficulty with engaging their children when online and (b) inadequate support from parents for learning activities, which reduced the respondents' perceived likelihood of future online teaching. Administrators and teaching assistants were more likely than teachers to believe that parents would accept online teaching in the future. Respondents who felt they had inadequate training to teach online, children in families with inadequate technical skills and parents who believed that online lessons harmed children's well-being, were less likely than others to believe that parents would accept online teaching in the future. These educators believed that online learning communities could connect parents and schools and foster interaction that could help align with educator's support for children's learning needs.

Optimal Timing for Postsurgical Adjuvant Therapy in Patients with Gastric Cancer: A Propensity Score Matching Study.

Background: In clinical trials, adjuvant therapy (AT) has been shown to improve the prognosis in patients with gastric adenocarcinoma who undergo curative gastrectomy and adequate lymph node dissection. However, the optimal timing for initiating AT is still unclear. Method: We collected data from 538 patients with stage II-III gastric cancer who underwent curative gastrectomy and AT in two tertiary hospitals from 2006 to 2013. Patients were divided into the early group (≤8 weeks, n=393) and the late group (>8 weeks, n=145), based on the interval between gastrectomy and initiation of AT. Propensity score matching was applied according to baseline characteristics. Results: After 1:1 propensity score matching, an even distribution of characteristics in both groups (143:143) was achieved. The 5-year overall survival (OS) rates were 56.6% and 40.2% in the matched early and late groups, respectively (p=0.062), while the corresponding 5-year recurrence-free survival (RFS) rates were 57.6% and 46.4%, respectively (p=0.028). The time to AT initiation was correlated with RFS and had a positive association with OS. The 5-year distant metastasis-free survival was also significantly better (HR 0.682, 95% CI 0.472-0.985, p=0.040), suggesting an early AT results in a better outcome in patients. Conclusion: We observed that initiation of AT within 8 weeks of curative gastrectomy produces better disease control and may contribute to better overall survival.

Transmission of multidrug-resistant and extensively drug-resistant tuberculosis in a metropolitan city.

Multidrug-resistant (MDR)- tuberculosis (TB) and extensively drug resistant (XDR)-TB reportedly lead to increased household transmission. This is a retrospective cohort study of active TB occurring among household contacts exposed to MDR-TB. Of 704 contacts in 246 households, initial screening identified 12 (1.7%) TB cases (prevalent cases) and 17 (2.4%) contacts that subsequently developed active TB (secondary cases) after a median (range) duration of 17 (5-62.5) months. Eight prevalent cases and three secondary cases had MDR-TB. TB incidence rates per 100,000 person-years were 254.9 overall and 45.0 for MDR-TB. XDR-TB in the index MDR-TB patient significantly increased the odds of identifying a prevalent TB case to 4.8 (95% CI 1.02-22.5), and the hazard of finding a secondary TB case to 4.7 (95% CI 1.7-13.5). Molecular fingerprinting confirmed household transmission of MDR-TB. Of 20 retrievable isolates from 27 XDR-TB index cases, restriction fragment length polymorphism analysis showed clustering among 13 (65%), with 11 (55%) due to recent transmission by n-1 method and an identifiable household source in only three (27.2%) of the 11 cases. XDR-TB relative to MDR-TB significantly increases household transmission of TB, probably reflecting prolonged/higher infectivity, and indicating a need for prolonged household surveillance. XDR-TB may largely transmit outside of the household settings.

Pyrazinamide may improve fluoroquinolone-based treatment of multidrug-resistant tuberculosis.

The role of pyrazinamide in the current treatment of multidrug-resistant (MDR) tuberculosis (TB) is uncertain. From a territory-wide registry of MDR-TB cases diagnosed between 1995 and 2009, we assembled a cohort of 194 patients with MDR pulmonary TB given fluoroquinolone-containing regimens. Stratified by pyrazinamide use and susceptibility, there were 83 users with pyrazinamide-susceptible MDR-TB (subgroup A), 24 users with pyrazinamide-resistant MDR-TB (subgroup B), 40 nonusers with pyrazinamide-susceptible MDR-TB (subgroup C), and 47 nonusers with pyrazinamide-resistant MDR-TB (subgroup D). We estimated the adjusted risk ratio (ARR) of early sputum culture conversion (ARR-culture) that occurred within 90 days posttreatment and that of cure or treatment completion (ARR-success) that occurred by 2 years posttreatment due to pyrazinamide use with susceptibility. In comparison with subgroup B, ARR-culture and ARR-success were 1.38 (95% confidence interval [CI], 0.89 to 2.12) and 1.38 (95% confidence interval [CI], 0.88 to 2.17), respectively. Corresponding findings were 0.99 (95% CI, 0.81 to 1.22) and 0.99 (95% CI, 0.78 to 1.26) in comparison with subgroup C and 1.09 (95% CI, 0.84 to 1.42) and 0.94 (95% CI, 0.74 to 1.20) in comparison with subgroup D. Early culture conversion significantly increased the incidence proportion of cure or treatment completion by 71% (95% CI, 26% to 133%). Selection bias among pyrazinamide nonusers might have underestimated the role of pyrazinamide. Comparison of pyrazinamide users showed that pyrazinamide increased the incidence proportion of early culture conversion and that of cure or treatment completion by a best estimate of 38% for both. This magnitude of change exceeded the 15 to 20% increase in the 2-month culture conversion rate of drug-susceptible TB that results from adding pyrazinamide to isoniazid and rifampin. Pyrazinamide is likely important in fluoroquinolone-based treatment of MDR-TB.

High pathologic complete response in HER 2-positive locally advanced breast cancer after primary systemic chemotherapy with weekly docetaxel and epirubicin.

BACKGROUND: To evaluate pathological complete response rate and to identify the predictor of response after primary systemic chemotherapy (PST) with weekly docetaxel and epirubicin for locally advanced breast cancer. METHODS: Sixty-three patients with locally advanced breast cancer received three cycles PST on day 1 and 8 of each 3-week cycle with epirubicin and docetaxel (epirubicin 45 mg/m(2) intravenous bolus, docetaxel 35 mg/m(2) in 100 ml normal saline infused 1 h), followed by surgery and adjuvant chemotherapy with cyclophosphamide, epirubicin and 5-fluorouracil. The pathological complete response was defined as no invasive carcinoma in breast and axillary nodes after PST. RESULTS: The median tumor sizes (by ultrasound) before and after PST were 6.2 and 2.5 cm, respectively. The negative estrogen receptor (ER) by immunochemical stain was found in 33 (52.4%) patients and HER-2/neu-overexpression in 12 (19.0%) patients. Clinical overall response rate (ORR) was 89% (95% confidence intervals (95% CI: 81-97), including 38% complete response (95% CI: 26-50), sonographical ORR was 97% (95% CI: 93-100). The pathological complete response were found in 11 patients (18%, 95% CI: 9-27), and 15(24%, 95% CI: 13-35) patients achieved breast only pathological complete response. Nine (27.3%) of thirty-three ER (-) patients and 5 (41.7%) of 12 HER2-positive patients achieved pathological complete response. CONCLUSION: PST with weekly docetaxel and epirubicin were well-tolerated and very high pathological complete response rate was achieved in HER-2/neu-overexpression tumors.

Prognosis of breast cancer after supraclavicular lymph node metastasis: not a distant metastasis.

BACKGROUND: We performed this study to analyze the survival of breast cancer patients with isolated supraclavicular lymph node metastasis (SLNM) and assess whether SLNM is distant metastasis or not. METHODS: Sixty-three patients who developed an isolated SLNM among 3170 primary breast cancer patients between 1990 and 1999 were enrolled. The survival after SLNM was compared with that of 151 patients who developed local recurrences and 599 who had distant metastasis and was analyzed according to different levels and numbers of positive axillary nodes. RESULTS: Thirty-five of the 63 patients died during a median follow-up of 58.3 months. The 5-year overall survival (OS) rates after SLNM, local relapse, and distant metastasis were 33.6%, 34.9%, and 9.1%, respectively. The 5-year OS for patients with involved nodes confined to axillary level I was 74.4%, which was significantly better than that for involved nodes in level II or III or SLNM (49.2%, 52.8%, and 33.6%, respectively; P < .0001). For one to three positive axillary nodes, the 5-year OS was 83.2%, which was significantly better than that for four to nine positive nodes, more than nine positive nodes, and SLNM (62.6%, 42.3%, and 33.6%, respectively). There was no significant difference between SLNM and more than nine positive nodes. Surgical removal of the supraclavicular nodes was a significantly better prognostic factor for OS after SLNM (P = .0327). CONCLUSIONS: The 5-year OS after supraclavicular nodal metastosis, local relapse, and distant metastasis were 33.6%, 34.9%, and 9.1%, respectively. Good neck control either by surgery or chemotherapy achieved better survival.

Increased feasibility of weekly epirubicin and paclitaxel as neoadjuvant chemotherapy for locally advanced breast carcinoma.

BACKGROUND: Primary systemic therapy (PST) with a combination of epirubicin and paclitaxel achieves high response rates in locally advanced breast cancer (LABC), but considerable toxicity occurs and the patient's compliance is poor. In this open-label phase II trial toxicity of a weekly administration schedule was evaluated. PATIENTS AND METHODS: On days 1 and 8 of each 3-week cycle, 45 patients with non-inflammatory breast cancer received epirubicin (35 mg/m(2), intravenous bolus) followed by paclitaxel (80 mg/m(2) in 500 ml of normal saline infused over 3 h) for 3 cycles. Surgery was done 2 weeks after primary chemotherapy, followed by another 6 cycles of adjuvant CEF (cyclophosphamide 500 mg/m(2), epirubicin 70 mg/m(2), 5-fluorouracil 500 mg/m(2)) chemotherapy. RESULTS: The median tumor size before and after PST was 6.0 and 2.0 cm, respectively. The clinical response rate was 96%, including 24% complete remission; 5 patients (11%) achieved pathologically complete response (pCR) including 3 patients with carcinoma in situ. Only 5 (11%) patients underwent breast conserving surgery although there were 15 patients suitable. Axillary nodes were negative in 16 (36%) of the 45 patients. Febrile neutropenia was found in 1 patient. There was no severe cardiac toxicity or serious adverse events. CONCLUSIONS: PST with weekly epirubicin and paclitaxel was an effective and well-tolerated combination for LABC, although only few patients underwent breast conserving surgery.

Lhermitte's sign among nasopharyngeal cancer patients after radiotherapy.

BACKGROUND: Lhermitte's sign (LS) is a side effect of radiotherapy (RT) on the spinal cord and typically occurs shortly after the procedure has been conducted. When treating patients with cancer of the head and neck region with irradiation, it remains difficult to avoid exposing the cervical spinal cord to unintended radiation. In this study, we focused on nasopharyngeal cancer (NPC) alone and looked for various parameters that might influence the occurrence of LS associated with this disease after RT. METHODS: From 1979 through 1990, 1171 patients with NPC completed RT either with or without chemotherapy at the Lin-Kou Medical Center, Chang Gung Memorial Hospital (CGMH), Tao-Yuan, Taiwan; the RT regimens for these treated patients were very similar. The nasopharyngeal tumor was treated to 75 Gy by photon teletherapy and after-loading brachytherapy. The neck lymphatics were irradiated with photon irradiation to 46.8 Gy and then boosted with electron beams to 10 to 30 Gy, in accordance with the patient's nodal status, either unilaterally or bilaterally. Every patient was followed monthly for the first 3 months after therapy and subsequently every 2 to 3 months for the next 2 years and, finally, every 6 months thereafter. At follow-up, a neurologic checkup of each patient was performed to determine whether any injury to the spinal cord or brain stem had arisen. RESULTS: LS was observed for 121 patients (10.3%). The median development time for such signs was 3.0 months after the completion of RT (range, 0.2-72 months), and the appearance of such a sign lasted 1 to 82 weeks (median, 17 weeks). No statistically significant differences between the sexes were noted in the development of such a sign (p = .5263),or among various T classifications (p = .0757) and N classifications (p = .4412). The incidence of LS was significantly lower for those patients who had also received chemotherapy than it was for those who had not (p = .003), and it was also lower for patients older than 60 years than for those younger than 60 years (p = .0061). Of the subjects who did not undergo neck-lymphatic boosting or who had undergone only unilateral neck-lymphatic boosting, 7.2% had LS develop, whereas 11.5% of patients who had been boosted bilaterally had LS develop (p = .0285). CONCLUSIONS: The incidence of LS associated with NPC and after RT was higher in patients who underwent bilateral neck-lymphatic boosting by electron beams than for those who underwent unilateral boosting or who did not undergo boosting. A correlation between increased incidence of LS and RT dose on the cervical spinal cord was noted when the cord dose exceeded 48.9 Gy. Therefore, wherever possible, a CT simulator and a three-dimensional treatment-planning system should necessarily be used to verify the dose distribution of electron-beam RT to diminish the chance of radiation overdose on the cervical cord.

Preoperative magnetic resonance imaging evaluation for breast cancers after sonographically guided core-needle biopsy: a comparison study.

BACKGROUND: The aim of the study was to evaluate the efficacy of contrast-enhanced magnetic resonance imaging (MRI) for preoperative assessment of palpable breast cancer after sonographically guided percutaneous core-needle biopsy. METHODS: Thirty-six breast cancers in 35 women that had been diagnosed by sonographically guided core-needle biopsy prior to subsequent MRI were evaluated in this retrospective study. Radiological and pathological reports, multiplicity, retroareolar involvement, and the size of the breast cancers were reviewed. The cancer sizes, as derived from sonography and enhanced MRI, were correlated with histological size in greatest diameter by means of Pearson's correlation. The threshold value for significance was set at P <.05. RESULTS: Synchronous breast cancers were revealed in the index cases by means of enhanced MRI (10), sonography (8), and mammography (7). Two of the 36 index cancers (5.6%) benefited from MRI assessment. Retroareolar cancer extension was observed with enhanced MRI in five index cancers. Of these, one was also noted on both a sonogram and a mammogram. Four of the index cancers (11.1%) benefited from the enhanced MRI. Overall, five index cancers (13.9%) benefited from the enhanced MRI. With a gold standard of histology, the mean cancer sizes were underestimated by sonography and overestimated by enhanced MRI. In comparison with sonography, a stronger association was noted between MRI and histological measurements, with coefficients of 0.657 and 0.882, respectively (P <.001). CONCLUSIONS: In a clinical setting, MRI for preoperative assessment of breast cancers is warranted. Minimally invasive, percutaneous core-needle biopsy did not alter the clinical efficacy of the MRI evaluation.