皇家维多利亚医院

To compare perioperative, oncological, and survival outcomes of total gastrectomy (TG) versus subtotal gastrectomy (SG) in patients with locally advanced distal diffuse gastric adenocarcinoma treated with perioperative 5-fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy. Diffuse distal gastric cancer is characterized by infiltrative growth patterns and early nodal metastasis. Whilst radical resection remains the cornerstone of curative treatment, the optimal extent of surgery with TG or SG, remains debated. This international multicenter cohort study analyzed data from patients with histologically confirmed diffuse gastric adenocarcinoma, located > 5 cm from the gastroesophageal junction. Endpoints included surgical margin status, nodal yield, perioperative morbidity, recurrence patterns, time-to-recurrence (TTR), and overall survival (OS). Outcomes were compared using multivariate analyses. In total, 188 (39.0

Importance:Understanding the reasons for variations in population-level survival differences in childhood cancer is important to guide improvement efforts. Collaboration between population-based cancer registries (CRs) to apply the international consensus Toronto guidelines to record tumor stage at diagnosis is a key first step. Objective:To test whether survival probabilities by tumor stage vary internationally, using 6 childhood solid tumors as exemplars. Design, Setting, and Participants:The International Benchmarking of Childhood Cancer Survival by Stage (BENCHISTA) population-based retrospective cohort study included all incident cases of neuroblastoma, Wilms tumor, medulloblastoma, osteosarcoma, Ewing sarcoma of bone, and rhabdomyosarcoma diagnosed between January 1, 2014, and December 31, 2017, with 3-year follow-up for survival. A total of 73 CRs from 27 countries (23 European as well as Australia, Brazil, Canada, and Japan) constituted the dataset. Analyses were conducted from June 2023 to December 2024. Main Outcomes and Measures:Three-year overall survival (OS) by stage for each tumor type, with comparisons between countries grouped into 5 predefined European areas. Multivariable Cox and logistic models estimated each area's hazard or odds ratio of death compared with Central Europe (Austria, Belgium, France, Germany, Switzerland, and the Netherlands), adjusted by age group and stage. Results:A total of 9883 cases were included; 4452 (45%) were girls and overall median (IQR) age was 54 (22-122) months; stage completeness was 93% (9199 of 9883). Three-year OS rates were as follows: Wilms tumor, 95% (95% CI, 94%-96%); neuroblastoma, 83% (95% CI, 81%-84%); medulloblastoma, 79% (95% CI, 77%-81%); Ewing sarcoma, 78% (95% CI, 75%-80%); rhabdomyosarcoma, 77% (95% CI, 74%-79%); and osteosarcoma, 75% (95% CI, 73%-77%). Geographical variations in age-adjusted OS were found for neuroblastoma, medulloblastoma, Ewing sarcoma, and rhabdomyosarcoma. Following additional adjustment for stage, differences were no longer significant for neuroblastoma (in the UK and Ireland) and rhabdomyosarcoma (in Eastern Europe) while becoming significant for neuroblastoma in Eastern Europe (hazard ratio, 1.36; 95% CI, 1.05-1.76) and medulloblastoma in Southern Europe (hazard ratio, 1.42; 95% CI, 1.03-1.94). However, no mitigation of survival variation was observed for Ewing sarcoma in the UK and Ireland (hazard ratio, 2.06; 95% CI, 1.39-3.04) and Eastern Europe (hazard ratio, 1.87; 95% CI, 1.22-2.86) as well as for medulloblastoma in Eastern Europe (hazard ratio, 1.68; 95% CI, 1.13-2.49). Conclusions and Relevance:In this BENCHISTA cohort study of 6 solid tumors, international variation in population-level OS was associated with differences in tumor stage distribution for some cancer types and regions. Additional factors are suggested for further investigation. The results have important implications for national health systems for monitoring early diagnosis efforts and supporting collaboration between CRs and clinicians to sustain standardized use of Toronto guidelines to improve understanding of survival variation in childhood cancer.

The use of multimodal artificial intelligence (AI) in plastic surgery is steadily increasing. Whether a general-purpose multimodal AI tool can, from photographs alone, assess facial aging and facelift candidacy at a level comparable to board-certified specialist plastic surgeons remains unknown. To determine if ChatGPT-5 (OpenAI, San Francisco, CA, USA) can identify facial aging features, stratify severity, and judge facelift candidacy from photographs alone, compared with board-certified plastic surgeons. Two-center observational pilot. Twenty-two volunteers (mean age 42.0 ± 16.8 years; median 34 years; range 24–80) provided standardized four-view facial composite photographs. Five board-certified plastic surgeons independently completed an eight-item questionnaire per case. ChatGPT-5 assessed the same images with identical wording. Assessments were image-only and blinded (no demographics/history). Surgeon consensus was defined by plurality. Primary outcomes were agreement and Cohen’s κ; for ordinal items, weighted κ, Spearman’s ρ, and mean absolute error (MAE) were reported. McNemar’s test assessed discordance for binary items. For facelift candidacy, agreement was 95.5 www.springer.com/00266 .

Acute Achilles tendon ruptures (AATRs), an extremely prevalent injury amongst adults who remain active, have been treated with surgical intervention for decades. This choice was made due to several decades-old studies demonstrating reduced re-rupture rates as opposed to nonsurgical interventions utilizing casts; however, numerous surgeons and researchers acknowledged potential complications such as wound problems and nerve damage. Functional braces and early weight-bearing now challenge this 'surgical by default' model. An evidence-based, focused review of randomized clinical trials, conventional and network meta-analysis, and large cohorts was conducted for the comparison of operative and nonoperative treatment for AATRs or the evaluation of various rehabilitation approaches. Operative management provides a lower rate of re-rupture in comparison to traditional cast-based nonoperative treatment; however, operative management also results in increased wound complications and sural nerve injuries. Nonoperative management employing functional bracing and early weight-bearing provides re-rupture rates approaching those of operative management, and the long-term functional outcome data are generally comparable. Differences in structural changes continue to exist between the two management groups, with longer tendon length and atrophy of the soleus muscle seen after conservative treatment, although for the majority of patients, the resultant strength and endurance deficits will be minimal. Both treatment options may provide optimal results if implemented through structured rehabilitation pathways. Treatment should be individualized based on the patient's specific factors, injury characteristics, and available resources. The use of current comparative effectiveness research to assist in making decisions regarding treatment with the patient is recommended.

Jejunostomy feeding tubes are commonly used during esophagectomy to provide postoperative nutritional support, but their impact on clinical outcomes remains uncertain. This retrospective study included 507 patients who underwent esophagectomy for esophageal cancer at the Northern Oesophagogastric Unit between 2012 and 2014 and 2016–2019. Routine postoperative jejunostomy feeding was introduced in 2015. Outcomes measured were percentage weight change at 2, 6, 12, and 24 weeks postoperatively, length of hospital stay, weight loss in patients with major complications (Clavien-Dindo > 3), and long-term survival. Of the 507 patients, 290 received routine jejunostomy feeding and 217 did not. Jejunostomy-fed patients experienced significantly less weight loss at all measured time points, with weight loss at 2 weeks of 3.22