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This study seeks to define long-term variation in body composition in patients undergoing esophagectomy for cancer and to associate those changes with survival. Assessment of skeletal muscle, visceral (VAT) and subcutaneous adipose tissue (SAT) was performed using computed tomography (CT) images routinely acquired at diagnosis; after neoadjuvant therapy, and; >6 months after esophagectomy. In cases where multiple CT scans were performed >6 months after surgery, all available images were assessed. https://www.selleckchem.com/products/Sunitinib-Malate-(Sutent).html Ninty-seven patients met inclusion criteria with a median of 2 (range 1-10) postoperative CT images acquired between 0.5 and 9.7 years after surgery. Following surgical treatment of esophageal cancer, patients lost on average 13.3% of their skeletal muscle, 64.5% of their VAT and 44.2% of their SAT. Sarcopenia at diagnosis was not associated with worse overall survival (66.3% vs. 68.5%; P = 0.331). Sarcopenia 1 year after esophagectomy was however associated with lower 5-year overall survival (53.8% vs. 87.5%; P = 0.019). Survival was lower in those patients who had >10% decrease in skeletal muscle index (SMI; 33.3% vs. 72.1%; P = 0.003) and >40% decrease in SAT 1 year after surgery (40.4% vs. 67.4%; P = 0.015). On multivariate analysis, a decline in SMI 1 year after surgery was predictive of worse survival (HR 0.38, 95%CI 0.20-0.73; P = 0.004). This study provides new insight relating to long-term variation in body composition in patients undergoing esophagectomy for cancer. Findings provide further evidence of the importance of body composition, in particular depletion of skeletal muscle, in predicting survival following esophagectomy. Histological healing might be the ultimate therapeutic goal in ulcerative colitis (UC). Our aim was to investigate the association between histological disease activity as measured by a validated index and long-term outcomes in patients with UC. An observational retrospective cohort study was conducted at the Nancy University Hospital between January 2014 and March 2020. All consecutive patients with confirmed UC undergoing colonoscopy with biopsies and available histological reports were eligible for inclusion. A total of 156 patients were included (53% female with a mean age of 41.3 ± 15.4 years). About a quarter of patients were in histological remission (Nancy index=0) at baseline (n=42, 26.9%). Median follow-up was 30.5 months (range 0-75). Sixteen patients with histological disease activity at baseline (Nancy index ≥ 1) underwent surgery during follow-up compared with no subject in the histological remission group (14.0% vs 0.0%, respectively, p=0.01). Similarly, a higher rate of hospitalization was found in patients with histological disease activity at baseline than in the histological remission group (36.0% vs 7.1%, respectively, p=0,001). The Kaplan Meier analysis showed that patients with histological disease activity at baseline had a 5-year surgery rate of 16.7% (logrank p=0.01) and a 5-year hospitalization rate of 19.7% (logrank p=0.0002). In the multivariate regression model, Nancy index > 0 was independently associated with the risk of hospitalization (hazard ratio 8.88, CI 95% 2.5-31.1, p=0.0007). UC patients with histological disease activity, as measured by the Nancy index, have a greater risk of surgery and hospitalization.UC patients with histological disease activity, as measured by the Nancy index, have a greater risk of surgery and hospitalization.The diverse cerebral consequences of preterm birth create significant challenges for understanding pathogenesis or predicting later outcome. Instead of focusing on describing effects common to the group, comparing individual infants against robust normative data offers a powerful alternative to study brain maturation. Here we used Gaussian process regression to create normative curves characterizing brain volumetric development in 274 term-born infants, modeling for age at scan and sex. We then compared 89 preterm infants scanned at term-equivalent age with these normative charts, relating individual deviations from typical volumetric development to perinatal risk factors and later neurocognitive scores. To test generalizability, we used a second independent dataset comprising of 253 preterm infants scanned using different acquisition parameters and scanner. We describe rapid, nonuniform brain growth during the neonatal period. In both preterm cohorts, cerebral atypicalities were widespread, often multiple, and varied highly between individuals. Deviations from normative development were associated with respiratory support, nutrition, birth weight, and later neurocognition, demonstrating their clinical relevance. Group-level understanding of the preterm brain disguises a large degree of individual differences. We provide a method and normative dataset that offer a more precise characterization of the cerebral consequences of preterm birth by profiling the individual neonatal brain.The right temporoparietal junction (rTPJ) and insula both play a key role for the processing of relevant stimuli. However, while both have been conceived as neural "switches" that detect salient events and redirect the focus of attention, it remains unclear how these brain regions interact to achieve this behavioral goal. Here, we tested human participants with focal left-hemispheric or right-hemispheric lesions in a spatial cuing task that requires participants to react to lateralized stimuli preceded by a distracter that shares or does not share a relevant feature with the target. Using machine learning to identify significant lesion-behavior relationships, we found that rTPJ damage produces distinctive, pathologically increased attentional capture, but only by relevant distracters. Functional connectivity analyses revealed that the degree of capture is positively associated with a functional connection between insula and rTPJ, together with functional isolation of the rTPJ from right dorsal prefrontal cortex (dPFC). These findings suggest a mechanistic model where the insula-rTPJ connection constitutes a crucial functional unit that breaks attentional focus upon detection of behaviorally relevant events, while the dPFC appears to attune this activity.
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This study seeks to define long-term variation in body composition in patients undergoing esophagectomy for cancer and to associate those changes with survival. Assessment of skeletal muscle, visceral (VAT) and subcutaneous adipose tissue (SAT) was performed using computed tomography (CT) images routinely acquired at diagnosis; after neoadjuvant therapy, and; >6 months after esophagectomy. In cases where multiple CT scans were performed >6 months after surgery, all available images were assessed. https://www.selleckchem.com/products/Sunitinib-Malate-(Sutent).html Ninty-seven patients met inclusion criteria with a median of 2 (range 1-10) postoperative CT images acquired between 0.5 and 9.7 years after surgery. Following surgical treatment of esophageal cancer, patients lost on average 13.3% of their skeletal muscle, 64.5% of their VAT and 44.2% of their SAT. Sarcopenia at diagnosis was not associated with worse overall survival (66.3% vs. 68.5%; P = 0.331). Sarcopenia 1 year after esophagectomy was however associated with lower 5-year overall survival (53.8% vs. 87.5%; P = 0.019). Survival was lower in those patients who had >10% decrease in skeletal muscle index (SMI; 33.3% vs. 72.1%; P = 0.003) and >40% decrease in SAT 1 year after surgery (40.4% vs. 67.4%; P = 0.015). On multivariate analysis, a decline in SMI 1 year after surgery was predictive of worse survival (HR 0.38, 95%CI 0.20-0.73; P = 0.004). This study provides new insight relating to long-term variation in body composition in patients undergoing esophagectomy for cancer. Findings provide further evidence of the importance of body composition, in particular depletion of skeletal muscle, in predicting survival following esophagectomy. Histological healing might be the ultimate therapeutic goal in ulcerative colitis (UC). Our aim was to investigate the association between histological disease activity as measured by a validated index and long-term outcomes in patients with UC. An observational retrospective cohort study was conducted at the Nancy University Hospital between January 2014 and March 2020. All consecutive patients with confirmed UC undergoing colonoscopy with biopsies and available histological reports were eligible for inclusion. A total of 156 patients were included (53% female with a mean age of 41.3 ± 15.4 years). About a quarter of patients were in histological remission (Nancy index=0) at baseline (n=42, 26.9%). Median follow-up was 30.5 months (range 0-75). Sixteen patients with histological disease activity at baseline (Nancy index ≥ 1) underwent surgery during follow-up compared with no subject in the histological remission group (14.0% vs 0.0%, respectively, p=0.01). Similarly, a higher rate of hospitalization was found in patients with histological disease activity at baseline than in the histological remission group (36.0% vs 7.1%, respectively, p=0,001). The Kaplan Meier analysis showed that patients with histological disease activity at baseline had a 5-year surgery rate of 16.7% (logrank p=0.01) and a 5-year hospitalization rate of 19.7% (logrank p=0.0002). In the multivariate regression model, Nancy index > 0 was independently associated with the risk of hospitalization (hazard ratio 8.88, CI 95% 2.5-31.1, p=0.0007). UC patients with histological disease activity, as measured by the Nancy index, have a greater risk of surgery and hospitalization.UC patients with histological disease activity, as measured by the Nancy index, have a greater risk of surgery and hospitalization.The diverse cerebral consequences of preterm birth create significant challenges for understanding pathogenesis or predicting later outcome. Instead of focusing on describing effects common to the group, comparing individual infants against robust normative data offers a powerful alternative to study brain maturation. Here we used Gaussian process regression to create normative curves characterizing brain volumetric development in 274 term-born infants, modeling for age at scan and sex. We then compared 89 preterm infants scanned at term-equivalent age with these normative charts, relating individual deviations from typical volumetric development to perinatal risk factors and later neurocognitive scores. To test generalizability, we used a second independent dataset comprising of 253 preterm infants scanned using different acquisition parameters and scanner. We describe rapid, nonuniform brain growth during the neonatal period. In both preterm cohorts, cerebral atypicalities were widespread, often multiple, and varied highly between individuals. Deviations from normative development were associated with respiratory support, nutrition, birth weight, and later neurocognition, demonstrating their clinical relevance. Group-level understanding of the preterm brain disguises a large degree of individual differences. We provide a method and normative dataset that offer a more precise characterization of the cerebral consequences of preterm birth by profiling the individual neonatal brain.The right temporoparietal junction (rTPJ) and insula both play a key role for the processing of relevant stimuli. However, while both have been conceived as neural "switches" that detect salient events and redirect the focus of attention, it remains unclear how these brain regions interact to achieve this behavioral goal. Here, we tested human participants with focal left-hemispheric or right-hemispheric lesions in a spatial cuing task that requires participants to react to lateralized stimuli preceded by a distracter that shares or does not share a relevant feature with the target. Using machine learning to identify significant lesion-behavior relationships, we found that rTPJ damage produces distinctive, pathologically increased attentional capture, but only by relevant distracters. Functional connectivity analyses revealed that the degree of capture is positively associated with a functional connection between insula and rTPJ, together with functional isolation of the rTPJ from right dorsal prefrontal cortex (dPFC). These findings suggest a mechanistic model where the insula-rTPJ connection constitutes a crucial functional unit that breaks attentional focus upon detection of behaviorally relevant events, while the dPFC appears to attune this activity.
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