Concord Repatriation General Hospital (abbreviated CRGH), commonly referred to as Concord Hospital, is a major hospital in Sydney, Australia, on Hospital Road in Concord. It is a teaching hospital of Sydney Medical School at the University of Sydney, where it is referred to as Concord Clinical School, and a major facility in the Sydney Local Health District and the former Sydney South West Area Health Service. The NSW Statewide Severe Burn Injury Service and the Bernie Banton Centre, an asbestos diseases research institute, are located there.Parts of the television series All Saints were filmed at CRGH.
The prognosis of non-curative endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (UD-EGC) remains unclear. This study aimed to identify risk factors for residual tumor, lymph node metastasis (LNM), and recurrence after non-curative ESD, and to define a potential low-risk subgroup suitable for active surveillance rather than additional surgery. This retrospective multicenter study included patients with non-curative ESD for UD-EGC from five institutions between 2017 and 2021. Patients were categorized into an additional surgery group or an observation group according to subsequent management. Clinicopathologic characteristics and survival outcomes were compared. Ninety-nine patients were analyzed, including 44 in the observation group and 55 in the additional surgery group. The median follow-up duration was 64 months. Six patients undergoing surveillance experienced recurrence within 12.0 to 37.3 months after ESD. Fourteen patients in the additional surgery group showed residual tumor or LNM. Vertical margin involvement independently predicted recurrence in the observation group, while ulceration and vertical margin involvement were independent predictors of residual tumor or LNM in surgical specimens or recurrence. Overall and disease-free survival were worse in the observation group. Disease-free survival in the observation group was associated with depth of invasion, lymphatic invasion, venous invasion, and resection margin status. Lesions with negative resection margins and no lymphovascular invasion meeting either (1) pT1a, UL0, > 2 cm, or (2) pT1a, UL1, ≤ 3 cm demonstrated excellent long-term outcomes without recurrence. Additional surgery remains standard after non-curative ESD for UD-EGC. However, a carefully selected low-risk subgroup may be appropriate candidates for close surveillance instead of further surgical intervention.
BACKGROUND AND HYPOTHESIS:Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are anti-hyperglycaemic agents, with cardioprotective effects, however their renal protective effects remain unclear. We aimed to assess the effects of GLP1-RAs on renal outcomes in patients with or without diabetes. METHODS:We performed a systematic review and meta-analysis with Medline, EMBASE and the Cochrane Register searched to December 2024. The primary outcome was the composite of kidney failure (defined as estimated glomerular filtration rate <15 mL/min/1.73 m2) or dialysis requirement, worsening of renal function and changes in proteinuria. Subgroup analysis was performed based on diabetic status, a (CKD) and individual GLP1-RA drugs. Relative risks (RR) with 95% confidence intervals (CI) for individual trials were pooled using random effects models. RESULTS:We identified 19 trials including 90 882 patients. Mean age was 60.8 years and mean follow-up was 25.9 months. GLP1-RAs were associated with a 19% reduction in the risk of primary renal outcome (RR 0.81, 95% CI 0.73-0.89), a 12% reduction in renal functional decline (RR 0.88, 95% CI 0.81-0.95) and a 0.45 mL/min/1.73 m2 reduction in yearly loss [16 trials, mean difference (MD) 0.45, 95% CI 0.10-0.81]. GLP1-RAs also reduced microalbuminuria by 24% (RR 0.76, 95% CI 0.71-0.82), HbA1c (units: %) by 0.61 (MD -0.61, 95% CI -0.76 to -0.49) and body weight by 5 kg (MD -5.24, 95% CI -7.46 to -3.02). Although there were no significant differences in progression to kidney failure (RR 0.86, 95% CI 0.71-1.05), GLP1-RAs reduced the incidence of major adverse cardiovascular events by 15% (RR 0.85, 95% CI 0.81-0.90) and all-cause mortality by 14% (RR 0.86, 95% CI 0.82-0.91). No significant differences were seen in severe adverse events (RR 0.96, 95% CI 0.90-1.01). However, there were more gastroenterological side effects. CONCLUSIONS:GLP1-RAs demonstrated cardiovascular and renal benefits. Further high-quality randomized trials assessing their effects in patients without diabetes, with or without proteinuria and/or CKD are needed.
OBJECTIVE:Cancer-related cognitive impairment (CRCI) is a frequent side effect of cancer and its treatment that can persist well after treatment completion, with major impacts on quality of life, daily living activities, and return to work. This randomised pilot study assesses the feasibility and acceptability of methods and procedures intended for use in a definitive trial of a web-based cognitive rehabilitation program-'Responding to Cognitive Concerns" (eReCog)-in people with low perceived cognitive function after chemotherapy for aggressive lymphoma within the past 5 years and were in remission. Potential efficacy was also explored. METHODS:Participants were randomised one-to-one to receive usual care or eReCog plus usual care. The 4-week eReCog program consists of four online modules based on the principles of cognitive behavioral therapy. Operational, neuropsychological test and patient-reported outcome measures (PROMs) data were collected before randomisation and approximately 8 weeks later to assess trial outcomes. Primary feasibility outcomes included recruitment and retention rates (a priori progression criteria: ≥ 3 patients/month and ≥ 80% of participants complete the trial, respectively). Feasibility data were summarised using a rate or proportion, as appropriate, with 95% confidence intervals. Neuropsychological test and PROMs data were analyzed using analysis of covariance. RESULTS:38 of 53 eligible participants consented to participate over 10 months (3.8 patients/month, 95% CI [2.7, 5.2]), 19 were randomised to each arm, and 36 of 38 (95%, 95% CI [83, 99]) completed the trial, indicating acceptable feasibility. Acceptable feasibility was also found for all four secondary outcomes: adherence to, usability of, and intrinsic motivation to engage with eReCog; and compliance with assessments. A large-sized difference favoring the intervention arm was observed on the SCWT Word score measuring processing speed. Medium-sized differences were observed on other neuropsychological test and PROM scales, but confidence intervals were wide and included zero. CONCLUSIONS:Recruitment and retention rates, compliance with assessments and favorable changes on potential outcome measures suggest a large-scale, appropriately powered trial is warranted, as do findings that eReCog is acceptable to the study population. TRIAL REGISTRATION NUMBER:Australian New Zealand Clinical Trials Registry ACTRN 12623000705684.
BACKGROUND:Dysphagia is commonly associated with intensive care unit-acquired weakness (ICUAW), with oropharyngeal muscular weakness considered a major precipitating factor. Unfortunately, evidence for effective rehabilitation of dysphagia associated with ICUAW is lacking. AIM:The aim of this study was to examine the feasibility, safety, and effectiveness of a strength-based dysphagia treatment protocol for patients with dysphagia associated with ICUAW. METHODS:A prospective pilot cohort study was conducted on all critically ill patients admitted to an Australian tertiary referral intensive care unit (ICU) over a 3-year period, diagnosed with dysphagia and ICUAW. A strength-based dysphagia treatment protocol was implemented incorporating expiratory muscle strength training and swallowing exercises to target the tongue base, pharyngeal, suprahyoid, and respiratory muscles. A regime of five sets of five repetitions, conducted 5 days per week, was employed. Treatment commenced in the ICU, continuing until swallowing recovery or swallowing function plateaued. Key swallowing and respiratory outcomes were collected weekly: clinical swallow examination (Functional Oral Intake Scale [FOIS]: 1-7), flexible endoscopic evaluation of swallowing (New Zealand Secretion Scale: 0-7, Penetration-Aspiration Scale: 1-8] Yale Pharyngeal Residue Scale [Yale]: 1-5), peak expiratory flow (PEF), and maximum expiratory pressure (MEP). RESULTS:Thirteen participants (11 male, median age = 52 years) were recruited. Medical diagnoses included severe burn injury, influenza-A, necrotising pancreatitis, sepsis, and COVID-19 infection. Median mechanical ventilation was of 19 days (interquartile range [IQR] = 16-36 days), ICU length of stay was of 34 days (IQR = 21-43 days), and hospital length of stay was of 71 days (IQR = 43-86 days). Four required tracheostomy (median: 18 days, IQR = 13-24 days). All participants exhibited profound dysphagia (FOIS = 1-3, New Zealand Secretion Scale = 3-7, Penetration-Aspiration Scale = 3-8, Yale Pharyngeal Residue Scale = 2-5) and respiratory impairment at baseline (MEP = 21-114 cmH2O, PEF = 80-310 L/min). All completed the treatment protocol and achieved premorbid diet and fluids (FOIS = 7) and functional respiratory status (MEP = 62-178 cmH2O, PEF = 260-520 L/min) by hospital discharge. No adverse events were recorded. CONCLUSIONS:Pilot study findings suggest that a strength-based dysphagia treatment protocol for patients with ICUAW and dysphagia is safe and feasible with promising outcomes indicating that it may support dysphagia recovery in this challenging population.
This is the second of two articles presenting the European Crohn's and Colitis Organisation [ECCO] evidence‑based consensus guidelines on the management of adult patients with ulcerative colitis [UC]. The first article covers the medical management of UC, including acute severe colitis. The present article addresses the surgical management of medically refractory UC, including the general surgical approach and perioperative optimisation, surgical strategies and techniques, and recommended levels of centre expertise and surgical specialisation. Together, these two articles aim to inform shared decision‑making and to guide clinicians and healthcare professionals involved in the care of patients with UC, drawing on the best available evidence.
