AbstractBackgroundThe accuracy of the eighth AJCC ypTNM staging system on the prognosis of gastric cancer (GC) patients after neoadjuvant therapy (NAT) is controversial. This study aimed to develop and validate a novel staging system using the log odds of positive lymph nodes scheme (LODDS).MethodsA retrospective analysis of 606 GC patients who underwent radical gastrectomy after neoadjuvant therapy was conducted as the development cohort. (Fujian Medical University Affiliated Union Hospital (n = 183), Qinghai University Affiliated Hospital (n = 169), Mayo Clinic (n = 236), Lanzhou University First Hospital (n = 18)). The validation cohort came from the SEER database (n = 1701). A novel ypTLoddsS (ypTLM) staging system was established using the 3‐year overall survival. The predictive performance of two systems was compared. ResultsTwo‐step multivariate Cox regression analysis in both cohorts showed that ypTLM was an independent predictor of overall survival of GC patients after neoadjuvant therapy (HR: 1.57, 95% CI: 1.30–1.88, p < 0.001). In the development cohort, ypTLM had better discrimination ability than ypTNM (C‐index: 0.663 vs 0.633, p < 0.001), better prediction homogeneity (LR: 97.7 vs. 70.9), and better prediction accuracy (BIC: 3067.01 vs 3093.82; NRI: 0.36). In the validation cohort, ypTLM had a better prognostic predictive ability (C‐index: 0.614 vs 0.588, p < 0.001; LR: 11,909.05 vs. 11,975.75; BIC: 13,263.71 vs 13,328.24; NRI: 0.22). The time‐dependent ROC curve shows that the predictive performance of ypTLM is better than ypTNM, and the analysis of the decision curve shows that ypTLM achieved better net benefits. ConclusionA LODDS‐based ypTLM staging system based on multicenter data was established and validated. The predictive performance was superior to the eighth AJCC ypTNM staging system.
Pneumatosis Intestinalis Induced by Alpha-Glucosidase Inhibitors in Patients with Diabetes Mellitus
Alpha-glucosidase inhibitor (αGIs)-induced pneumatosis intestinalis (PI) has been narrated in case reports but never systematically investigated. This study aimed to investigate the concurrency of PI and αGIs. A literature search was performed in PubMed, Google Scholar, WorldCat, and the Directory of Open-Access Journals (DOAJ) by using the keywords “pneumatosis intestinalis”, “alpha-glucosidase inhibitors”, and “diabetes”. In total, 29 cases of αGIs-induced PI in 28 articles were included. There were 11 men, 17 women, and one undefined sex, with a median age of 67. The most used αGI was voglibose (44.8%), followed by acarbose (41.4%) and miglitol (6.8%). Nine (31%) patients reported concomitant use of prednisone/prednisolone with or without immunosuppressants. The main symptoms were abdominal pain (54.5%) and distention (50%). The ascending colon (55.2%) and the ileum (34.5%) were the most affected. Nineteen (65.5%) patients had comorbidities. Patients with comorbidities had higher rates of air in body cavities, the portal vein, extraintestinal tissues, and the wall of the small intestine. Only one patient was found to have non-occlusive mesenteric ischemia. Twenty-five patients were treated with conservative therapy alone, and two patients received surgical intervention. All patients recovered. In conclusion, comorbidities, glucocorticoids, and immunosuppressants aggravate αGIs-induced PI. Conservative therapy is recommended when treating αGIs-induced PI.
Evaluating the Effectiveness of Pretest and Posttest Model of Active Learning in a Medical School
Effective medical education is extremely challenging in these times of high competitiveness. With the evolving curriculum changes and shorter contact hours, it is becoming extremely difficult to perform TBL sessions and Flipped Classroom sessions of active learning. In order to strike a balance between short contact hours and effective learning, we tried adding a Pretest and a Posttest to the traditional didactic lecture session. This method works on the principle that by including a multiple‐choice questions based Pretest and Posttest session before and after the didactic lecture respectively, the educator can heighten the attentiveness of the students and make them actively seek information during the lecture session. In order to test this hypothesis, we divided the pharmacology class into two groups namely Group A and Group B and conducted a cross‐over study. On Day 1, Group A was given a Pretest and a Posttest while Group B was given only a Posttest. On Day 2, Group A was given only a Posttest while Group B was given a Pretest and a Posttest. The tests were scored, totalled and compared. Analysis of the results showed that the groups that took both a Pretest and a Posttest significantly scored higher percentages and passing grades compared to the groups that took only the Posttest, albeit not statistically significant. This study clearly demonstrates the advantage of sensitizing the student's minds with a Pretest before the lecture begins. Based on the results of this study, by including a Pretest and a Posttest session to the routine didactic lecture, we can help students not only gain considerably from the lectures but also measure the same.
Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)
1