圣拉斐尔医院

Gastric bleeding is a major symptom of locally advanced gastric cancer and a significant cause of mortality. Management options include surgery, endoscopic interventions, embolization and radiotherapy (RT). Although palliative RT appears effective for hemorrhage control, evidences are limited to underpowered retrospective studies from Asia, with issues of patient heterogeneity and response evaluation criteria. This study is a multicenter retrospective analysis carried out across Italian radiation oncology centers to evaluate real-world outcomes of hemostatic RT in patients with bleeding gastric cancer. Clinical and dosimetric data were retrospectively collected for patients with active bleeding gastric cancer treated across twelve Italian radiation oncology centers. The primary endpoint was to evaluate hemoglobin stabilization or improvement at four weeks post-treatment. Secondary outcomes included treatment parameters, acute toxicity profile and time to rebleeding. Between January 2018 and October 2024, 100 patients receiving hemostatic RT were collected for the analysis. The median age was 77 years, 68

BACKGROUND:Cataract is the leading cause of blindness worldwide despite treatment being very cost-effective. To stimulate efforts to address the large unmet need for affordable, good-quality cataract services, member states at the 74th World Health Assembly endorsed a global target of a 30 percentage-point increase in effective cataract surgical coverage (eCSC) by 2030. In this Article, we report on progress towards that target. METHODS:We did a secondary analysis of 233 participant-level population-based survey datasets (Rapid Assessment of Avoidable Blindness [RAAB] surveys and other population-based cross-sectional surveys) from 68 countries (2003-24) to estimate eCSC with a cataract surgical threshold of worse than 6/18 pinhole visual acuity and a threshold of 6/18 or better for postoperative presenting visual acuity (eCSC6/18) for each country. Eligible studies included people aged 50 years and older, without any further age restrictions. eCSC was calculated as the number of people who had received surgery and had a good visual outcome as a proportion of all people who had received or were still to receive surgery. For countries with only one survey estimate available, we reported the survey as the country estimate; for each country with two or more surveys, we used more recent and nationally representative survey to generate estimates. We included 228 of 233 datasets (excluding five datasets from the European region) in a mixed-effects logistic regression to estimate global and WHO regional temporal trends in eCSC6/18 from 2000 to 2030. For global estimates, we used eCSC in the Americas region as a proxy for the European region. We used 120 RAAB surveys that measured visual acuity at the 6/12 threshold to analyse causes of non-good outcomes (postoperative presenting visual acuity worse than 6/12) and estimated potential gains in eCSC (with a cataract surgical threshold of worse than 6/12 pinhole visual acuity and a 6/12 or better threshold for postoperative presenting visual acuity [eCSC6/12]) from correcting residual postoperative refractive errors. Potential gains were estimated by comparing eCSC6/12 calculated using postoperative presenting visual acuity with eCSC6/12 calculated using pinhole visual acuity (a proxy for visual acuity with optical correction of refractive error). FINDINGS:We used 130 studies to report 68 country estimates of eCSC6/18. Country estimates for eCSC6/18 from surveys ranged from 2·1% (95% CI 0·9-3·4) in Burundi (2024) to 77·7% (72·9-82·5) in Qatar (2023). Globally, we predicted eCSC6/18 of 48·2% (39·7-57·2) in 2025, increasing by 8·4 percentage points (8·1-8·6) between 2020 and 2030 (from 43·9% [36·6-51·2] to 52·3% [41·4-62·7]). Uncorrected refractive error accounted for a median 26·4% of non-good outcomes per survey; we estimated that treating this condition could yield a median 3·7 percentage-point gain in eCSC6/12 globally. INTERPRETATION:Global efforts are not on track to meet the target of a 30 percentage-point increase in eCSC between 2020 and 2030-immediate and substantial investment in cataract services is, therefore, required. Survey data indicated which elements of the cataract care pathway could be targeted for quality-improvement initiatives. A suite of cataract surgery quality indicators should be collected to better inform service providers. FUNDING:Indigo Trust, The Fred Hollows Foundation, and Wellcome Trust.

Oncologic imaging plays a critical role in the diagnosis, staging, treatment planning, and follow-up of cancer patients. Recent advancements in computed tomography, particularly the development of photon-counting detector CT (PCCT), have introduced new opportunities for improving diagnostic accuracy and tissue characterization, while reducing contrast agent usage and radiation exposure. By offering ultra-high spatial resolution, enhanced contrast-to-noise ratio, and intrinsic spectral capabilities, PCCT addresses many limitations of conventional energy-integrating detector CT (EID-CT) and unlocks new possibilities for quantitative imaging. This review explores the emerging applications of PCCT across various tumor types—including thoracic, abdominal, and musculoskeletal malignancies—highlighting its potential to improve cancer imaging and patient care. Photon-counting detector CT (PCCT) offers several advantages in oncologic imaging, providing superior spatial resolution, spectral imaging capabilities, and reduced radiation dose, enhancing lesion characterization and precise treatment planning, making PCCT a valuable tool for personalized cancer care.

BACKGROUND:There is a paucity of data informing on the current use, adverse events, outcomes, and prognostic drivers for patients receiving venopulmonary extracorporeal life support (VP ECLS). We aimed to provide a contemporary, large sample size study to describe the real-world outcomes of adults supported with VP ECLS across different clinical conditions. METHODS:We queried the Extracorporeal Life Support Organization Registry to retrieve all adult patients who received VP ECLS as the first support modality from July 2020 to July 2024. Study population was grouped according to hospital death outcome and to the diagnosis leading to VP ECLS use. Adverse outcomes are reported according to the diagnosis leading to VP ECLS use. A time-to-event Cox regression model was applied to identify predictors of death. RESULTS:A total of 838 patients [32.3% females; age 8 (46, 67) years] were included. Patients were treated for heart failure/cardiogenic shock (HF/CS) in 54.4%, for acute respiratory failure/acute respiratory distress syndrome (ARF/ARDS) in 26.6%, for post-cardiotomy shock in 6.7%, for acute coronary syndrome/ischemic heart disease in 5.3%, for valvular heart disease/complications of intracardiac devices in 4.2%, and for pulmonary embolism in 2.9%. Most common adverse events included continuous renal replacement therapy (CRRT) use or acute kidney injury (37.4%), infections (35.4%), cardiac arrhythmias (13.5%), surgical site bleeding (12.1%), gastrointestinal (GI) bleeding (6.1%). Complications were more common in non-survivors and patterns of complications differed among diagnosis groups. The Kaplan-Meier estimated 60-day survival was 49.3 (45.3, 53.1)%. Age (HRadj 1.15 for 5 years increase; 95%CI 1.11, 1.20; p < 0.001), female sex (HRadj 1.40; 95%CI 1.12, 1.76; p = 0.003), body mass index (HRadj 1.02 for 3 kg/m2 increase; 95%CI 1.01, 1.04; p < 0.018), CRRT use prior VP ECLS cannulation (HRadj 1.44; 95%CI 1.11, 1.86; p < 0.006) were independent predictors of death. CONCLUSIONS:In this large Extracorporeal Life Support Organization registry analysis, VP ECLS was chiefly used for HF/CS and ARF/ARDS. Hospital outcomes, complications, and survival differed according to the diagnosis leading to VP ECLS use. Younger age, male sex, lower BMI, and no CRRT use prior to VP ECLS cannulation confer a lower risk of death and provide targets for future research and potential domains for clinical improvement.

To evaluate novel intravesical and systemic combination therapies for improving outcomes in BCG-naïve patients with non-muscle invasive bladder cancer (NMIBC), this systematic review and meta-analysis assessed first-line treatment strategies, including combinations with systemic immune-checkpoint inhibitors (ICIs). In this prospectively registered review (CRD420251163026), MEDLINE, Embase, Web of Science, and the ESMO 2025 abstract book were searched for randomized controlled trials (RCTs) evaluating first-line therapies in BCG-naïve NMIBC. Meta-analyses estimated HRs for recurrence-related time-to-event outcomes (disease-free and event-free survival). Grade ≥ 3 treatment-related adverse events were pooled as relative risks (RRs). Risk of bias was assessed using the Cochrane RoB 2 tool. Out of 5202 records screened, six RCTs including 3485 patients were eligible. Modifications to intravesical BCG alone (three trials, n = 895) did not significantly improve recurrence-related outcomes. Systemic ICIs given additional to intravesical BCG significantly reduced recurrence-related events compared to BCG alone (HR 0.77, 95