Purpose: Although neoadjuvant chemotherapy (NAC) may benefit upper tract urothelial carcinoma (UTUC) treatment, most studies are retrospective and affected by selection bias, as healthier patients are more likely to receive NAC. We therefore aimed to investigate NAC’s impact on cancer specific mortality (CSM) in an other-cause mortality (OCM) matched cohort Methods: The Surveillance, Epidemiology, and End Results database was queried to identify patients with histological diagnosis of UTUC (pT1-4N0-3M0) at radical nephoureterectomy (RNU) between 2007–2021. Patients who underwent systemic therapy before RNU were classified as having received NAC. Cox regression was used to calculate the 5 year-OCM risk, which was used to construct a 1:3 propensity-score matched cohort. Then, in the matched cohort, we performed competing risk regression analysis to investigate the impact of NAC on CSM. Results: We included 4,936 patients, 388 (7.9%) of whom underwent NAC. Median (interquartile range) age at diagnosis was 72 (64–79) years. The 5-year OCM rate was 26.4% versus 37.1% (p=0.004) in patients who received NAC men versus in those who did not receive NAC, but that difference became not statistically significant after matching (p=0.9). The standardized mean difference was 0.0003 for OCM risk, indicating a good match. In the matched cohort, patients in the NAC-group were more likely to be younger (67 vs. 73, p<0.0001), to be diagnosed more recently (2018 vs. 2015, p<0.0001) and to have a pN+UTUC (28.8% vs. 12.3%, p<0.0001), compared to no-NAC group. At MVA analysis, patients who did not undergo NAC had a significantly higher CSM-risk (hazard ratio,1.78; 95% confidence interval, 1.27–2.51; p<0.01), than their counterpart who received NAC. Conclusion Compared to patients who did not receive NAC, those who received NAC seems to have a reduced CSM-risk for UTUC, when matched with their calculated OCM-risk. However, to establish it as the optimal treatment strategy for UTUC, additional prospective randomized studies are needed.

Background/Aims: Small intestinal bacterial overgrowth (SIBO) diagnosis is usually based on non-invasive breath tests (BTs), namely lactulose BT (LBT) and glucose BT (GBT). However, divergent opinions and problems of parameter standardization are still controversial aspects. We aim to perform a meta-analysis to analyze diagnostic performance of LBT/GBT for SIBO diagnosis. Methods: We searched in main literature databases articles in which SIBO diagnosis was achieved by LBT/GBT in comparison to jejunal aspirate culture (reference gold standard). We calculated pooled sensitivity, specificity, positive, and negative likelihood ratios and diagnostic odd ratios. Summary receiver operating characteristic curves were drawn and pooled areas under the curve were calculated. Results: We selected 14 studies. Pooled sensitivity of LBT and GBT was 42.0% and 54.5%, respectively. Pooled specificity of LBT and GBT was 70.6% and 83.2%, respectively. When delta over baseline cut-off > 20 H2 parts per million (ppm) was used, GBT sensitivity and specificity were 47.3% and 80.9%; when the cutoff was other than and lower than > 20 ppm, sensitivity and specificity were 61.7% and 86.0%. In patients with abdominal surgery history, pooled GBT sensitivity and specificity gave the impression of having a better performance (81.7% and 78.8%) compared to subjects without any SIBO predisposing condition (sensitivity = 40.6% and specificity = 84.0%). Conclusions GBT seems to work better than LBT. A cut-off of delta H2 expired other than and lower than > 20 ppm shows a slightly better result than > 20 ppm. BTs demonstrate the best effectiveness in patients with surgical reconstructions of gastrointestinal tract.

A 27-year-old man presented an anterior open bite relapse. He had low tongue posture positioned anteriorly at rest and during swallowing and reported chronic difficulty in nose breathing. Head cone-beam computed tomography revealed nasal septum deviation, right turbinate hypertrophy, and left maxillary sinus congestion, which were thought to contribute to the breathing problem, encourage the improper tongue posture, and thereby cause the relapse. Multidisciplinary treatment involving an otorhinolaryngologist, an orthodontist, and a periodontist resolved the upper airway obstruction and corrected the malocclusion. The follow-up examination after 3 years 5 months demonstrated stable results.
Adult ; Airway Obstruction* ; Cone-Beam Computed Tomography ; Deglutition ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Head ; Humans ; Hypertrophy ; Malocclusion ; Maxillary Sinus ; Nasal Septum ; Nose ; Open Bite* ; Posture ; Recurrence* ; Respiration ; Tongue ; Turbinates