London Health Sciences Centre is a hospital network in London, Ontario and is collectively one of Canada's largest acute-care teaching hospitals. It was formed in 1995 as a result of the merger of University Hospital and Victoria Hospital. In affiliation with the Schulich School of Medicine & Dentistry at the University of Western Ontario, it trains more than 1,800 medical and care professionals annually. It operates two hospital facilities, University Hospital and Victoria Hospital which includes the Children's Hospital at London Health Sciences Centre..
Bariatric surgery is effective for severe obesity, but recovery is often complicated by pain, nausea, and high opioid use. This systematic review and meta-analysis (SRMA) evaluates the role of erector spinae plane block (ESPB) in reducing pain, opioid consumption, and postoperative nausea and vomiting (PONV) after bariatric surgery. Electronic databases were systematically searched from their inception to March 2025 for randomized controlled trials (RCTs) assessing bilateral ESPB in adults undergoing bariatric surgery. This review included studies which compared ESPB to a control group and reported at least one postoperative outcome. The primary outcome was resting pain at 6 h and 24 h. The mean difference (MD) and 95
The optimal adjuvant alkylating chemotherapy regimen for high-risk WHO grade 2 glioma in the molecular era remains uncertain. We evaluated real-world treatment patterns, toxicity, and outcomes following radiotherapy with adjuvant temozolomide (TMZ) or procarbazine, lomustine, and vincristine (PCV) in a multicentre Canadian cohort. PROTECT is a retrospective multicentre cohort study including adults with clinically defined high-risk WHO grade 2 diffuse glioma treated with radiotherapy and adjuvant alkylating chemotherapy. Clinical, molecular, treatment delivery, toxicity, surveillance, and survival data were collected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared using the log-rank test and Cox regression. A total of 116 patients were included, with a median follow-up of 71 months. Isocitrate dehydrogenase (IDH) mutation was present in 84.6
ZNF711 is one of eleven zinc-finger genes on the X chromosome that have been associated with X-linked intellectual disability. This association is confirmed by the clinical findings in 20 new cases in addition to 11 cases previously reported. No consistent growth aberrations, craniofacial dysmorphology, malformations or neurologic findings are associated with alterations in ZNF711. The intellectual disability is typically mild and coexisting autism occurs in half of the cases. Carrier females show no manifestations. A ZNF711-specific methylation signature has been identified which can assist in identifying new cases and in confirming the pathogenicity of variants in the gene.
PURPOSE:To provide evidence-based recommendations for patients with stage IV non-small cell lung cancer with driver alterations. METHODS:This ASCO living guideline offers continually updated recommendations based on an ongoing systematic review of randomized controlled trials (RCTs), with the latest time frame spanning March-October 2025. An Expert Panel of medical oncology, pulmonary, community oncology, research methodology, and advocacy experts was convened. The literature search included systematic reviews, meta-analyses, and RCTs. Outcomes of interest include efficacy and safety. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS:This guideline consolidates all previous updates and reflects the body of evidence informing this guideline topic. Thirteen studies were identified in the latest search of literature to date. RECOMMENDATIONS:Evidence-based recommendations were updated to address first, second, and subsequent treatment options for patients with driver alterations.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
BACKGROUND AND OBJECTIVE:The role of ultrahypofractionated (UH) whole-pelvis radiotherapy (WPRT) as an alternative to conventionally fractionated (CF) WPRT is not well defined. METHODS:HOPE is a phase 2, multi-institutional, unblinded, randomized clinical trial designed to compare toxicity and patient-reported outcomes between UH-WPRT and CF-WPRT using the Expanded Prostate Cancer Index Composite (EPIC-50) questionnaire at 1 yr after treatment. Eighty patients with unfavorable intermediate-risk, high-risk, or very high-risk disease for whom high-dose-rate prostate brachytherapy was planned were randomly assigned 1:1 to either CF-WPRT or UH-WPRT. KEY FINDINGS AND LIMITATIONS:Baseline clinical characteristics were similar for the CF-WPRT (39 patients) and UH-WPRT (41 patients) arms. All patients received treatment according to their randomization allocation. Median follow-up was 3.34 yr. At 1 yr after radiotherapy, the mean (± standard deviation) EPIC bowel function score was noninferior between the CF-WPRT and UH-WPRT arms (88.4 ± 12.1 vs 90.6 ± 11.1; p = 0.0016 for noninferiority). Similarly, the mean EPIC bowel total score (86.7 ± 14.2 vs 89.0 ± 12.3; p = 0.24) and bother score (85.0 ± 18.0 vs 87.4 ± 16.3; p = 0.28) did not significantly differ between the arms. No significant differences in EPIC urinary subdomains at 1 yr were observed between the arms. No late (>6 wk) grade 3-5 genitourinary or gastrointestinal toxicities were reported in the CF-WPRT arm, while one patient in the UH-WPRT arm experienced grade 3 genitourinary toxicity. The data are not yet mature enough for evaluation of oncological endpoints. CONCLUSIONS AND CLINICAL IMPLICATIONS:Results from the HOPE trial demonstrate that UH-WPRT is as well tolerated as CF-WPRT when combined with a high-dose-rate brachytherapy boost to the prostate.
