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Background Quebec is one of the Canadian provinces with the highest rates of cancer incidence and prevalence. A study by the Rossy Cancer Network (RCN) of McGill university assessed six aspects of the patient experience among cancer patients and found that emotional support is the aspect most lacking. To improve this support, trained patient advisors (PAs) can be included as full-fledged members of the healthcare team, given that PA can rely on their knowledge with experiencing the disease and from using health and social care services to accompany cancer patients, they could help to round out the health and social care services offer in oncology. However, the feasibility of integrating PAs in clinical oncology teams has not been studied. In this multisite study, we will explore how to integrate PAs in clinical oncology teams and, under what conditions this can be successfully done. We aim to better understand effects of this PA intervention on patients, on the PAs themselves, the health and social care team, the administrators, and on the organization of services and to identify associated ethical and legal issues. Methods/design We will conduct six mixed methods longitudinal case studies. Qualitative data will be used to study the integration of the PAs into clinical oncology teams and to identify the factors that are facilitators and inhibitors of the process, the associated ethical and legal issues, and the challenges that the PAs experience. Quantitative data will be used to assess effects on patients, PAs and team members, if any, of the PA intervention. The results will be used to support oncology programs in the integration of PAs into their healthcare teams and to design a future randomized pragmatic trial to evaluate the impact of PAs as full-fledged members of clinical oncology teams on cancer patients’ experience of emotional support throughout their care trajectory. Discussion This study will be the first to integrate PAs as full-fledged members of the clinical oncology team and to assess possible clinical and organizational level effects. Given the unique role of PAs, this study will complement the body of research on peer support and patient navigation. An additional innovative aspect of this study will be consideration of the ethical and legal issues at stake and how to address them in the health care organizations.

ObjectivesTo compare the magnetic resonance imaging (MRI) and Doppler ultrasound (DUS) findings with the pathological findings of soft tissue vascular tumors (STVTs) according to the 2018 ISSVA (International Society for the Study of Vascular Anomalies) classification to differentiate vascular tumors from vascular malformations.MethodsThis retrospective study included patients with STVTs who underwent contrast-enhanced MRI and pathological analysis at our hospital between 2010 and 2020. The presumptive diagnosis based on the on-site imaging and histological analysis was compared with imaging and histological analysis conducted off-site utilizing the ISSVA criteria.ResultsThis study included 31 patients with 31 vascular tumors located in the head and neck (n = 3), trunk (n = 2), and extremities (n = 26). The off-site pathological analysis confirmed benign vascular tumors in 54.8% of cases (non-involuting congenital hemangioma: 35.5%; epithelioid hemangioma: 13%; pyogenic granuloma: 3%; and spindle cell hemangioma: 3%). Based on the off-site histological analysis, 25.8% were reclassified as having a vascular malformation whereas three had other benign lesions. Only phleboliths were associated with a vascular malformation (p = 0.03). The concordance between off-site MRI and pathological findings was fair (k = 0.3902 (0.0531–0.7274)), whereas that between on-site and off-site pathological analyses was poor (k = −0.0949 (−0.4661 to 0.2763)).ConclusionBenign vascular tumors have non-specific imaging features on imaging with some overlap with atypical vascular malformations. Therefore, histological analysis is recommended. Imaging and pathological analyses should be performed in accordance with the ISSVA classification to minimize inter-observer discrepancies.Critical relevance statementImaging features of benign vascular tumors on MRI are non-specific, leading to discrepancies with pathological findings and potential overlap with atypical vascular malformations. Imaging and histological analyses should be performed in accordance with ISSVA guidelines to improve patient management.Key PointsThe imaging features of benign vascular tumors are non-specific.Histological analysis is recommended for soft tissue vascular tumors in adults.Analyses of soft tissue vascular tumors should be performed in accordance with ISSVA guidelines.

An amendment to this paper has been published and can be accessed via the original article.

To determine whether the fibula free flap is the most frequently used osteocutaneous flap for mandible reconstruction, and whether it provides quality of life, depression and anxiety advantages. A systematic review of the public Medline database was conducted. Thirteen patients who underwent mandibular reconstruction at our hospital centre completed questionnaires to evaluate quality of life, depression and anxiety outcomes. The most frequently used free flaps are those of the fibula (n = 982), radial forearm (n = 201), iliac crest (n = 113), subscapular system (n = 50) and rib-serratus (n = 7). In our patient population, there was a trend towards a better quality of life in those with a fibula free flap. However, patients in this group were significantly younger than patients with other flap types (p = 0.025). Patients with a subscapular system free flap were more depressed (p = 0.031); however, they had large through-and-through defects. The flap used most frequently in the literature is the fibula free flap. Comparative quality of life data are lacking, and homogeneous populations should be used to reach significant conclusions.

Pilot randomized controlled trial with parallel groups. Engaging individuals with carpal tunnel syndrome (CTS) awaiting carpal tunnel decompression surgery in a preoperative rehabilitation program may mitigate pain and sensorimotor impairments, enhance functional abilities before surgery, and improve postoperative outcomes. To assess the feasibility and the efficacy of a novel preoperative neuromobilization exercise program (NEP). Thirty individuals with CTS were randomly allocated into a four-week home-based neuromobilization exercise group or a standard care group while awaiting surgery. Outcome measures included feasibility (ie, recruitment, attrition, adherence, satisfaction, and safety) and efficacy metrics (ie, median nerve integrity and neurodynamics, tip pinch grip, pain, and upper limb functional abilities) collected before (ie, at the baseline and about four weeks later) and four weeks after surgery. Thirty individuals with CTS were recruited (recruitment rate = 11.8%) and 25 completed the study (attrition rate = 16.7%). Adherence (94%) and satisfaction with the program (eg, enjoy the exercises and likeliness to repeat the NEP (≥4.2/5) were high and no serious adverse event was reported. NEP-related immediate pre- and post-surgery beneficial effects on pain interference were documented (P = .05, η2 = .10), whereas an overall increased neurodynamics (P = .04, η2 = .11) and decreased pain severity (P = .01, η2 = .21) were observed. Engaging in the proposed NEP has limited beneficial effect as a stand-alone intervention on pre- and post-surgery outcomes for individuals with CTS. Expanding the program’s content and attribute by adding other components including desensitization maneuvers and novel therapies promoting corticospinal plasticity is recommended. A preoperative NEP completed by individuals with CTS awaiting surgery is feasible, acceptable, and safe. However, given the limited beneficial effectsof the program, revision of its content and attributes is recommended before proceeding to large-scale trials. •The preoperative neuromobilization exercise program is feasible, acceptable, and safe.•Neuromobilization exercises have beneficial, although limited, effects on median nerve integrity.•Neuromobilization exercises have beneficial, although limited, effects on pain and functional abilities.

Since 1992, sentinel lymph node (SLN) biopsy was generally applied to melanoma for tumor staging. As the literature points out, an increasing number of nodes are being removed for each procedure, driving up the cost for this procedure and wandering away from the defining concept of sentinel lymph node. The objective of the current study was to show that the number of sentinel lymph node s removed can be minimized without influencing the reliability of tumor staging. We conducted a single-arm prospective study in patients with stage I melanoma. For each patient, the sentinel lymph node was identified using the hand-held gamma probe technique. We removed only the hottest nodes as well as the nodes with radioactivity greater than 70% compared to the hottest. We analyzed the characteristics of each melanoma, the success rate of this procedure, how many nodes were removed and how many had micro metastases. The results were compared to those of the literature, previously published Porter study using the chi-square test. We included 90 patients. The success rate of this technique was 100%. We dissected 1.3 sentinel lymph nodes for each patient, with 22% positive SLN. Statistical analyses point out a better selectivity of our study for a similar rate of pathological positivity and recurrence compared to the literature. Our technique for decreasing the number of sentinel lymph nodes removed is reliable. The removal of minimal number of nodes doesn't compromise the sensitivity of tumor staging, while it does reduce the cost of the procedure.

The multidisciplinary team in our hand center, located in a university hospital in Montreal, has developed an expertise in treating all types of hand and wrist conditions, making it the most important French-speaking hand center in North America. Methods Translation of the questionnaires was carried according to published guidelines, in 6 steps: (1) forward translation from English to Canadian French by two independent translators; (2) production of consensus versions through an expert committee; (3) backward translation of the consensus versions by two new translators; (4) discrepancies resolution and production of pre-final versions; (5) field-testing of the pre-final versions on patients from the target population; (6) production of the final versions (MHQ-CF and bMHQ-CF) based on qualitative feedback from participants. Test-retest reliability will thus be assessed by comparing both MHQ-CF and bMHQ-CF from T1 and T2, via an intraclass correlation coefficient for total scores, as well as Cohen’s kappa coefficient for individual items.

Purpose: With lymphedema, secondary to oncologic breast surgery, the increase in volume and the propensity for recurrent infections can substantially disable afflicted patients. Despite the high prevalence, there are no studies demonstrating superiority of one treatment over another. Thus, we sought to perform a systematic review and meta-analysis of the literature to determine and compare the long-term effects of different surgical treatments. Method: A literature review of all published data on surgical management of upper extremity lymphedema after breast cancer from 1965 to 2016 was performed with PubMed/Medline, Cochrane Review, National Library of Medicine, and Google Scholar. Only case controls, prospective cohorts and randomized controlled trials with control groups were included. Comparison between groups of treatment was performed using contingency tables and chi-square tests, followed by a meta-analysis based on treatment modality. Results: Two hundred ninety-seven patients with upper extremity lymphedema after breast cancer removal were included with a mean follow-up of 3 years. Patients were equally distributed between intervention and control groups (147 vs 150 respectively). Treatment with lymphaticovenular anastomosis demonstrated the largest reduction of circumference at 53.9%, which was statistically significant when compared with conservative measures (P < .0001). Liposuction, lymph node transfers, lasers and transplantations resulted in reduction of circumference of 33%, 13%, 31% and 27% respectively. Conclusions: Surgical management of lymphedema in the upper extremity after breast cancer surgery demonstrates promising long-term results in reduction of circumference of the affected arm. Lymphaticovenular bypass seems to generate the most significant reduction, while other surgical modalities produce positive outcomes at a lower rate. Learning Objectives: Participants will be able to compare surgical treatments offered for upper extremity lymphedema secondary to oncologic breast surgery.

Clinically relevant bacteria have been engineered to lyse synchronously at a threshold population density and release genetically encoded therapeutics; treatment of mice with these bacteria slowed the growth of tumours. Engineering self-control into anti-tumour bacteria There is growing interest in using bacteria as living therapeutics, although the complications due to host responses and long-term effectiveness remain to be established. Omar Din et al . have now engineered a quorum-sensing clock into a strain of Salmonella known to target solid tumours by releasing a tumour-targeting toxin. The clock drives periodic lyses of the bacterial colony, thereby controlling the bacterial population and ensuring sustained anti-tumour toxin delivery in a mouse cancer model. Although the system as it stands does not represent an effective cure, this work indicates that synthetic biology can be harnessed to achieve dynamic and sustained delivery of therapeutics in vivo . The widespread view of bacteria as strictly pathogenic has given way to an appreciation of the prevalence of some beneficial microbes within the human body 1 , 2 , 3 . It is perhaps inevitable that some bacteria would evolve to preferentially grow in environments that harbour disease and thus provide a natural platform for the development of engineered therapies 4 , 5 , 6 . Such therapies could benefit from bacteria that are programmed to limit bacterial growth while continually producing and releasing cytotoxic agents in situ 7 , 8 , 9 , 10 . Here we engineer a clinically relevant bacterium to lyse synchronously at a threshold population density and to release genetically encoded cargo. Following quorum lysis, a small number of surviving bacteria reseed the growing population, thus leading to pulsatile delivery cycles. We used microfluidic devices to characterize the engineered lysis strain and we demonstrate its potential as a drug delivery platform via co-culture with human cancer cells in vitro . As a proof of principle, we tracked the bacterial population dynamics in ectopic syngeneic colorectal tumours in mice via a luminescent reporter. The lysis strain exhibits pulsatile population dynamics in vivo , with mean bacterial luminescence that remained two orders of magnitude lower than an unmodified strain. Finally, guided by previous findings that certain bacteria can enhance the efficacy of standard therapies 11 , we orally administered the lysis strain alone or in combination with a clinical chemotherapeutic to a syngeneic mouse transplantation model of hepatic colorectal metastases. We found that the combination of both circuit-engineered bacteria and chemotherapy leads to a notable reduction of tumour activity along with a marked survival benefit over either therapy alone. Our approach establishes a methodology for leveraging the tools of synthetic biology to exploit the natural propensity for certain bacteria to colonize disease sites.