Kaplan–Meier survival analysis showed a better survival probability for trabeculectomy than for canaloplasty (p < 0.001) and Cox regression analysis revealed an HR of 6.03  after canaloplasty. Trabeculectomy showed superiority in terms of IOP decrease , use of AGM , and the number of revision surgeries . Occurrence of complications was similar in both groups . Conclusions: Trabeculectomy showed superiority in efficacy and equality in safety compared to modified canaloplasty.Background: To evaluate the long-term efficacy and safety of modified canaloplasty versus trabeculectomy in open-angle glaucoma. Methods: In total, 210 subjects with open-angle glaucoma were included. 70 were treated with Mitomycin C-augmented modified canaloplasty with enhanced subconjunctival filtration and 140 with Mitomycin C-augmented trabeculectomy. Cases were matched 1:2 by sex and age. Results: In canaloplasty and trabeculectomy groups, 61.4% and 57.9% of participants were female. Mean age was 60.0 ± 13.9 and 63.0 ± 12.2 years, median follow-up time was 4.6  years and 5.8 . Strict success was achieved in 20.0% and 56.4%, complete success in 24.3% and 66.4%, and qualified success in 34.3% and 73.6% (each  Glaucoma affects 3.54% of people aged 40 to 80 years worldwide  and is tToday, trabeculectomy is the standard procedure when it comes to glaucoma surgery . OutcomeMost studies concerning this issue only offer a limited follow-up time span . The aimThis retrospective cohort study was conducted at the Department of Ophthalmology of the University Medical Center Mainz, Germany. Patients with open-angle glaucoma, who had undergone a modified canaloplasty between February 2016 and January 2018 were enrolled in this study. An electronic surgical case register was searched, and the subjects were manually reviewed for eligibility. Inclusion criteria were age 18 years or older and a diagnosis of open-angle glaucoma without prior filtering surgery. We identified 133 eligible patients with a minimum follow-up of three years after surgery. In total, 23 patients were excluded because the surgery did not comply with the standard surgery procedure protocol. Thirty patients were lost to follow-up  and thus excluded. Of 10 patients, both eyes were treated with modified canaloplasty and were eligible for inclusion; however, only the right eyes were included to facilitate the data evaluation. The remaining 70 cases were matched by sex and age with two trabeculectomy cases each (n = 140). Trabeculectomy cases were treated between January 2013 and February 2017 at the same center. The requirement for informed consent was waived by the ethics committee of the medical board of Rhineland-Palatinate according to regional laws. The study adhered to the tenets of the Declaration of Helsinki.Collected data were fully pseudonymized and comprised demographics, glaucoma diagnosis, maximum preoperative IOP and pre- and postoperative IOP, and number of AGM and revision surgeries. The diagnosis was graded into three groups: primary open-angle glaucoma , secondary open-angle glaucoma  and normal-tension glaucoma. If the necessary data were not available in the medical records, information was obtained from either patients or treating ophthalmologists.Surgeries were conducted either in topical, retrobulbar, or general anesthesia. Indications for surgery were uncontrolled IOP exceeding the individual target pressure which was between 10 and 18 mmHg and lower in the case of a more severe glaucomatous optic disc damage, faster rate of progression, lower untreated maximum IOP, longer life expectance, thinner central corneal thickness, positive family history of glaucoma, the status of the fellow eye and in light of patients’ preferences . SurgeryFor modified canaloplasty, a fornix-based conjunctival flap was dissected. As shown in a previous meta-analysis, IOP decrease can be enhanced by the application of antifibrotic substances. Thus, a sponge soaked with MMC (0.2 mg/mL) was placed below the conjunctiva for 3 min, followed by rinsing with 30 mL saline solution. A superficial 4 × 4 mm scleral flap was prepared followed by dissection of a second deep scleral flap of size 1.5 × 3 mm leaving only a thin scleral layer over the choroid to allow some filtration into the suprachoroidal space, reaching into the clear cornea. The roof of SC was carefully detached, and the inner scleral flap was removed. Then, the iTrack microcatheter was inserted over 360 degrees guided by illumination and injecting viscoelastic every 2 clock hours into SC. A 10–0 Polypropylene suture was tied to the distal tip of the catheter after reemerging from the opposite opening of SC. Then the microcatheter was withdrawn from the canal and the suture was threaded through the canal. To dilatate SC, the Polypropylene suture was tautened to give a moderate pressure to its inner wall. The scleral flap then was closed loosely with 2 to 4 sutures (at the discretion of the surgeon) to allow gentle filtration and the conjunctiva was sutured in a meander-like fashion.Using this modified method of canaloplasty a three-way outflow is targeted: First, by dilatation and spanning of SC; second, by augmentation of suprachoroidal outflow by dissecting a deep scleral flap; and third, by gentle filtering function promoted by the use of MMC and loose scleral flap reattachment. Thereby, MMC is used to prevent both the subconjunctival space and the scleral flap from scarring with the aim of maintaining gentle filtration without targeting a bleb, which usually only forms with steady filtration.A fornix-based flap was dissected followed by mobilization of Tenon’s capsule. A sponge soaked with MMC (0.2 mg/mL) was inserted under the conjunctiva for 3 min, followed by intensive rinsing with 30 mL saline solution. A 4 × 4 mm scleral flap of one-third scleral thickness was created, and a temporal paracentesis was made. An anteriorly placed trabeculectomy was conducted and a peripheral iridectomy was created. The scleral flap was closed with four 10–0 nylon sutures, two at the edges and two at the sides. The conjunctiva was closed with meander-shaped sutures described by Pfeiffer and Grehn . To re-cFollowing both procedures, 4 mg dexamethasone was injected under the conjunctiva of the inferior fornix.Perioperative management was similar for both surgical procedures.Antiglaucomatous medication (AGM) was stopped 2 to 4 weeks prior to the surgery and topical dexamethasone 4 times daily was prescribed for 5 days prior to surgery to reduce conjunctival injections to prevent scarring. IOP spikes were treated with oral acetazolamide. After surgery, antibiotic prophylaxis with ofloxacin was applied for 7 days and topical dexamethasone was prescribed 6 times daily tapering off over 6 weeks. During the in-patient stay, subconjunctival injections of 5 fluorouracil, suture lysis, and bleb massage were performed at the discretion of the surgeon.Outcome variables followed the Guidelines on Design and Reporting of Glaucoma Surgical Trials . The priStrict success was defined as IOP reduction of at least 20% compared to preoperative IOP, IOP at follow-up between 5 and 18 mmHg, no use of AGM, and no revision surgery (target IOP according to the European Glaucoma Society Terminology and Guidelines for Glaucoma ).Complete success was defined as IOP at follow-up between 5 and 18 mmHg, no use of AGM, and no revision surgery.Qualified success was defined as IOP at follow-up between 5 and 18 mmHg under the use of AGM and no revision surgery.To ensure comparability with previous studies ,16,17,18Failure was further considered if IOP was <5 (with signs of hypotony maculopathy) or >18 mmHg, or if revision surgery was necessary.Revision surgery was considered necessary when the IOP was above the individual target IOP and if topical therapy was not desired or tolerated by the patient or if topical therapy was not sufficient. Laser suture lysis or goniopuncture were not regarded as revision surgery.Descriptive statistics such as demographic and ocular characteristics were calculated as mean ± standard deviation for normally distributed continuous variables and median and interquartile range for nonnormally distributed variables. Categorial variables were described in absolute and relative frequencies.t-test or a paired t-test for within-group comparisons, and with χ2 test for categorial variables. Survival analysis of complete surgical success was performed using Kaplan–Meier curves and Cox regression analysis. Tests for proportional hazard assumptions were conducted and Schoenfeld residues were calculated.Comparison of continuous variables was conducted with a Student’s Statistical analysis was conducted with R (v4.1.3).p = 0.07): for example, 31.4% of the canaloplasty group consisted of secondary glaucoma whereas the proportion in the TE group was lower (18.0%). Reported maximum IOP was higher in the modified canaloplasty group (35.3 ± 11.5 mmHg) than in the trabeculectomy group ; however, measured preoperative IOP did not significantly differ between the two groups . The duration of glaucoma at the time of surgery was similar in both groups  and the mean defect of visual field examinations did not differ significantly . Baseline characteristics are shown in Seventy eyes of 70 patients treated with modified canaloplasty , and 140 eyes of 140 patients treated with trabeculectomy  were included. The mean age was 60.0 ± 13.9 and 63.0 ± 12.2 years. The distribution of diagnosis differed slightly between the groups (p < 0.001). Complete success was attained in 17/70 (24.3%) cases versus 93/140 (66.4%) cases (p < 0.001) and qualified success was seen in 24/70 (34.3%) cases versus 103/140 (73.6%) cases (p < 0.001).Strict surgical success was achieved in 14/70 subjects (20.0%) for modified canaloplasty and in 79/140 (56.4%) subjects for trabeculectomy after a median follow-up time of 4.6  years for modified canaloplasty and 5.8  for trabeculectomy (p < 0.001). Survival probability was independent of sex, age, and diagnosis (p < 0.001) for modified canaloplasty, whereas the Cox regression of years 1 to 5 showed an HR of 2.48 . However, the test for proportional hazard assumption was statistically significant  and thus not fulfilled.Cox regression analysis of qualified success showed a hazard ratio (HR) of 6.03 for modified canaloplasty . IOP at follow-up amounted to 14.5 ± 5.2 mmHg and 11.6 ± 4.1 mmHg (p < 0.001), respectively. The mean percentage IOP decrease at the last follow-up examination after 4.6 and 5.8 years was 36.0 ± 28.0% and 48.3 ± 25.9% (p = 0.002), and absolute IOP decrease was 9.2 ± 7.9 mmHg versus 13.7 ± 10.4 mmHg (p = 0.002). Preoperative IOP was 24.0 ± 6.9 mmHg for modified canaloplasty cases and 25.3 ± 9.9 mmHg for trabeculectomy cases (p = 0.03) with significant difference of absolute and relative IOP decrease . When cases without AGM and revision surgery were included to rule out any influence of postoperative procedures, i.e., all failures by AGM or revision surgery were excluded, the mean IOP at the last follow-up was 13.1 ± 3.3 mmHg after modified canaloplasty compared to 11.3 ± 3.6 mmHg after trabeculectomy (p < 0.001). If—in case a revision surgery was conducted—IOP prior to the first revision surgery instead of IOP at last follow-up was taken into account , the mean IOP was 19.9 ± 9.4 mmHg after modified canaloplasty versus 13.3 ± 6.3 mmHg after trabeculectomy (p < 0.001). After modified canaloplasty, the number of AGM was reduced from 2.8 ± 1.1 to 0.8 ± 1.0, whereas the number of AGM in the trabeculectomy group was 3.2 ± 1.0 preoperatively and 0.1 ± 0.3 postoperatively.During the follow-up time, 35/70 (50.0%) of modified canaloplasty subjects needed AGM compared to 15/140 (10.7%) in the trabeculectomy group (p = 0.004). The median time to first revision surgery was 0.58  years for canaloplasty cases and 2.03  years for trabeculectomy cases. Revision surgery was necessary in 29/70 (41.4%) of modified canaloplasty cases and in 30/140 (21.4%) of trabeculectomy cases . The most common complication after modified canaloplasty was hyphema  followed by hypotony , choroidal effusion , IOP decompensation , iris incarceration , and synechiae . After trabeculectomy, the most common complication was controlled hypotony , followed by IOP decompensation , scleral thinning , choroidal effusion , and malignant glaucoma .Surgical complications occurred in 10/70 (14.5%) of eyes after modified canaloplasty and in 10/134 (7.5%) after trabeculectomy (p = 0.003). At the last visit, the VA amounted to 0.40 ± 0.6 LogMAR versus 0.39 ± 0.32 LogMAR (p = 0.77). The mean difference between preoperative VA and postoperative IOP was −0.17 LogMAR (p = 0.01) in the modified canaloplasty group and 0.03 (p = 0.26) in the trabeculectomy group (paired t-test).Preoperative visual acuity (VA) was 0.24 ± 0.4 LogMAR in the modified canaloplasty group and 0.41 ± 0.4 LogMAR in the trabeculectomy group (p < 0.001) for cases after modified canaloplasty, independent of age and sex. The median survival probability was 0.77 . Details on success, IOP, AGM, revision surgeries, complications, and visual acuity are presented in The aim of this study was to evaluate the long-term success, efficacy, and safety of modified canaloplasty versus trabeculectomy with a minimum follow-up time of 3 years. Although the trabeculectomy group had a longer mean follow-up time, it showed a better survival probability, lower IOP at follow-up, and less need for AGM or revision surgeries, whereas the occurrence of surgical complications was not statistically significantly higher after trabeculectomy.Survival analysis demonstrated the inferiority of modified canaloplasty compared to trabeculectomy: 50% of canaloplasty cases had failed after 12 months when applying qualified success criteria . The risk of failure was more than four times higher during the first year after surgery than afterward. Surgical success after the follow-up period was more than twice as high after trabeculectomy than after modified canaloplasty, independently from how success was defined. Previous studies showed inconsistent findings regarding surgical success: Some studies found similar results to this study with a higher complete success after trabeculectomy ,17,18,19Trabeculectomy was more efficient in terms of IOP control with a lower IOP at follow-up than after modified Canaloplasty and a significantly better absolute and percentage IOP decrease which was similarly described in previous studies and meta-analyses ,23,24,25p = 0.11) [Throughout the follow-up period, every second modified canaloplasty case needed supplemental AGM, whereas 89.3% of trabeculectomy cases did not, and the number of medications was significantly lower after trabeculectomy than after modified canaloplasty. The same trend (either significant or not) was visible in all previous comparative studies ,24,25,26 = 0.11) ; the two = 0.11) ,19.p < 0.001) in the canaloplasty groups, whereas the odds were a third (p = 0.01) for hypotony and a quarter (p = 0.03) for choroidal effusion/detachment in the canaloplasty groups compared to trabeculectomy groups. Although canaloplasty is not a penetrating procedure, hyphema is likely to occur because of blood reflux from the collector channels, indicating a functioning outflow pathway and the correct position of the suture [p = 0.01), while it was stable after trabeculectomy . A possible explanation might be the almost two times higher revision rate after canaloplasty compared to trabeculectomy.Non-penetrating procedures have been developed to avoid surgical complications which are feared to occur in high proportions after trabeculectomy. The decision for trabeculectomy or non-penetrating surgery mainly depends on the individual risk for adverse events, e.g., high myopia or non-compliance with the postoperative therapy regimen. Adverse events range from transient hypotony over permanent hypotony with choroidal detachment and/or hemorrhage to bleb leak, blebitis, and vision-threatening endophthalmitis. The prospective Collaborative Bleb-related Infection Incidence and Treatment Study (CBIITS) found a 5-year cumulative incidence of bleb-related endophthalmitis of 2.2 ± 0.5% after MMC-augmented trabeculectomy . Contrare suture . The resTrabeculectomy showed superior long-term results than canaloplasty in this study, yet there still might be reasonable indications for canaloplasty in the clinical setting. In highly myopic eyes, postsurgical complications, in particular hypotony with subsequent choroidal detachment or hemorrhage, are considered to occur more frequently due to the thin sclera with low rigidity being more likely to collapse . AlthougFurthermore, trabeculectomy needs more intensive postsurgical care related to the risk of bleb scarring . FrequenLastly, canaloplasty in combination with antiglaucomatous medication can achieve a satisfying IOP stabilization and therefore might be an adequate therapy. Surgeons should inform their patients about the expected IOP decreasing effect and rates for postoperative AGM and revision surgeries and make an individual, shared decision.Several limitations must be mentioned: First, the distribution of diagnosis differed between the groups with a higher proportion of secondary glaucoma in the modified canaloplasty group. As IOP sometimes is more difficult to control in secondary glaucoma, the success of modified canaloplasty might be falsely low. Second, 30 patients of the canaloplasty group were lost to follow-up and excluded prior to the study . Due to the multilevel healthcare system in Germany, follow-up examinations are usually performed by the general ophthalmologist. Patients are only referred to the clinic in case of difficulties such as a re-increase of IOP. Thus, a high proportion of the lost patients might have had a successful surgery, which did not require further referrals, leading to falsely high failure rates. Failure in canaloplasty often directly led to revision surgery while there are also less invasive revision procedures, such es YAG-goniopuncture, that may be rather comparable to suture lysis in case of trabeculectomy. Third, the proportional hazard assumption was not met for the Cox regression analysis, which might be caused by the high number of events during the first year. Although the graphical presentation of Schoenfeld residuals did not indicate non-proportional hazards, the hazard ratio thus should be carefully interpreted.This retrospective analysis showed the superiority of trabeculectomy in terms of survival probability, IOP decrease, and the necessity for anti-glaucomatous medication and revision surgery compared to modified canaloplasty after a median follow-up period of 4.6 and 5.8 years in open-angle glaucoma patients, whereas the occurrence of complications was similar in both groups.


The functional properties (water absorption capacity and water solubility index) of the flours were determined. Sensory evaluation of biscuits was determined. The proximate and mineral contents of the most preferred biscuits were determined. Results showed that the substitution significantly increases the functional properties of the flours (P < 0.05). Sample 75% (T3) is the most preferred biscuit. The incorporation of sweet potato and soy flour in the formulation significantly increases the moisture, fat, protein, fiber, copper, manganese, calcium, magnesium, and potassium contents of the biscuits (P < 0.05). Biscuit 75% (T3) records the highest levels in protein and fiber while sample T0 (control) records the highest levels of iron, zinc, and sodium. In terms of overall acceptability and nutrient contents, sample 75% (T3) is the best biscuits.The aim of this study was to evaluate the nutritional composition of biscuits from wheat-sweet potato-soybean composite flours. Substitutions of wheat flour with sweet potato and soybean flours at the rate of 25%  (T1), 50%  (T2), 75%  (T3), and 100%  (T4) were made to obtain the wheat-sweet potato-soybean composite flours. Wheat flour without sweet potato and soybean flour was used as control (T The consumption of wheat products especially bread and biscuits occupies a prominent place in the diet of populations, even in non-wheat-producing countries. The latter are becoming more and more dependent on nations of wheat producers, particularly during economic crises where wheat is very expensive to import. This cereal is imported while our local products remain unexploited and are decaying .World wheat production is around 580 million tons per year, of which 350 million tons are processed into flour and meal. In Cameroon, since the year 2000, the quantities of wheat imported have increased sharply. Until 2007, they were around 280,000 tons. From 2008, there was a significant increase in these quantities of which 681,778 tons were imported in 2017 at a cost of around 103.7 billion francs CFA with an average price of around US $300 per ton. The unit import price increased to 3.3%.In Cameroon, the attempt to introduce wheat cultivation has not produced the expected results. However, to reduce the use of imports of wheat flour and to improve the value of local products, the solution is to integrate the tubers (sweet potatoes and cassava) in manufacturing of bread wheat flour when producing biscuit. The tubers have not yet undergone a significant modern transformation, due to their low value. To remedy this situation, technologies are increasingly being developed to replace wheat flour with flour obtained from local food resources . Sweet pAlso, sweet potato is an important source of carbohydrates 96%), in the form of simple carbohydrates and dietary fibers, which plays an important role in energy deficiencies . Apart f%, in theIn Cameroon, the annual production of sweet potato is 288,970 tons and that of soya is 12,544 tons [Ipomoea batatas), soybean (Glycine max), and other ingredients were collected from the local market, Maroua, a town in the Far North region of Cameroon.Sweet potato , and dried in an oven at 105°C for 24 h. The dried pellet weight (M2) was determined. The water absorption capacity (WAC) was calculated as follows: WAC = (M1 − M2) × 100/M2. All samples were analyzed in triplicate.The water absorption capacity of the studied flours was determined according to the method of Beuchat . A samplM0 − M1)/M0 × 100, where M0 is the mass of sample and M1 is the final mass after dissolution in water. All samples were analyzed in triplicate.The water solubility index (WSI) was determined according to Anderson et al. . WSI refThe quantities of each ingredient used in the preparation are presented in After weighing the ingredients, the margarine and sugar were mixed using a manual thresher to give a cream. The beaten egg was incorporated into the cream, and then, the mixing continues until a snow-white paste was obtained.The ingredients and raw materials in powder form previously prepared  were added to the cream and the whole were manually mixed. Water was added until the dough was smooth. After kneading, the dough was spread on the pastry board using the rolling pin. The display thickness was fixed at 4 mm for better cooking. This thickness was measured using a fabricated frame.The oven was preheated to 180°C. The biscuit dough pieces were placed on the baking trays and placed in the oven at a temperature between 140 and 150°C. The temperature was set manually. This operation allowed us to obtain good quality biscuits by adjusting the baking temperature. When the biscuits are golden brown after 20 min, the trays are removed from the oven and cooled. After cooling, the biscuits were packaged in sachets and then closed with a heat sealer.The sensory evaluation was carried out in the University of Maroua. Thirty panelists aged between 18 and 35 years, all of them students of the University of Maroua, participated. They were informed about the objectives and asked not to eat 2 h before. The samples were compared on the basis of the following organoleptic characteristics: taste, color, texture, flavor, and overall acceptability. About 3 g to 5 g of each sample was served to each of the panelists under a white light in a random order. An information sheet was given to them. Between each tasting, they had to rinse their mouths with mineral water and pause for about 2 min in order to avoid appreciation errors. Each attribute was scored based on its intensity scaled on a 9-point hedonic scale .The proximate composition of the flours and biscuits was determined according the standard analytical methods (AOAC) . All samThe method described by AOAC  was usedP < 0.05 using Duncan multiple range test.Data were presented as means ± standard deviation (SD). Values were statistically analyzed by one-way analysis of variance (ANOVA test) using IBM SPSS Statistics version 20.0.1 software package, Armonk, New York, USA. Differences were considered significant at P < 0.05). The moisture content is a crucial parameter in the storage of flour. Indeed, a moisture content of flour greater than 12% promotes the development of microorganisms. The lower the moisture content of the flour, the more it is possible to hydrate it during kneading to reach an optimal consistency of the dough [The moisture content in the flours ranged from 7.49 (soy bean flour) to 10.58 g/100 g (wheat flour) and was significantly different (he dough .P < 0.05). The ash content is an indicator of the purity of the flour. It is related to its extraction rate and the mineralization of the grains milled. It also defines the commercial types of flour, particularly with regard to wheat flour [The ash content in the flours was in the range of 0.99 (wheat flour) to 2.01/100 g (soy bean flour) and was significantly different (at flour .P < 0.05). The fat content obtained for sweet potato flour is lower than (1.54%) obtained by Siédogo [The fat content in the biscuits ranged from 0.55 for sweet potato flour to 27.3/100 g for soy bean flour and was significantly different ( Siédogo . This di Siédogo .P < 0.05). The protein content of wheat flour (13.48%) is greater than 7%, corresponding to the minimum set by the Codex Alimentarius [Protein content in the biscuits varied from 2.57 for sweet potato flour to 36.44 g/100 g for soy bean flour and was significantly different (entarius . The proP < 0.05). The high fiber content in sweet potato and soy flour may increase the water absorption capacity of the flour.The fiber content in the biscuits was in the range of 0.56 to 5.01 g/100 g. The lowest fiber content was obtained from wheat flour while the highest was obtained from soy bean flour. The values of fiber content were significantly different (P < 0.05). Energy content in the biscuits varied from 348.31 for sweet potato to 478.43/100 g for soy bean flour and was significantly different (P < 0.05).Carbohydrate content in the biscuits varied from 21.74 for soy bean flour to 83.27 g/100 g for sweet potato flour and was significantly different (0) to a high value 84.33% in T4 (100%). Substitution significantly increases the water absorption capacity of the flours (P < 0.05). The increase in water absorption capacity would therefore be due to the availability of hydrophilic carbohydrates and functional groups of proteins in flour which are capable of forming hydrogen bonds with water. Indeed, the water absorption capacity depends on the affinity of flour with water. The higher the affinity, the higher the water absorption capacity.The water absorption capacity of the flours ranged from a low value 73% in control (T0) and 42.76% of T4 (100%). Substitution also significantly increases the water solubility index of the flours (P < 0.05). These results are in agreement with those of Legesse and Admassu [The water solubility index of the flours varied between 17.31 of control  were found to be the best and biscuit T2 (50%) was closer to biscuit T3 (75%). The taste is the primary factor which determines the acceptability of any product, which has the highest impact as far as market success of product is concerned. Biscuit containing 100% soy and sweet potato flours (T4) was rated the poorest in taste (6.26). Biscuit containing 75% soy and sweet potato flours (T3) has the highest mean score (7.61). The mean scores for color of the biscuits changed from 5.4 to 7.19. The highest score (7.19) was also obtained in biscuit T3 (75%). As increase in soy flour, mean score for color was also increasing. This is in contradiction with the result of Banureka and Mahendran .The texture of the crust was related to the external appearance of the biscuit top which implies smoothness or roughness of the crust. The highest score (7.41) was also obtained in biscuit T3 (75%). Except in biscuit T1 (25%) and biscuit T4 (100%), substitution increases the texture of biscuits. In the case of flavor of the biscuits, it was decreased with an increase in the substitution except in biscuit T2 (50%) and T3 (75%). Overall acceptability includes many implications, which is an important parameter in organoleptic estimation. Biscuit T3 (75%) had the highest mean value (7.61), and T1 (25%) had the least mean value (6.23) for the overall acceptability.P < 0.05) and varied from 8.62 for T0 (control) to 9.59/100 g for T3 (75%). We then note that the incorporation of sweet potato and soy flour in the formulation significantly increases the moisture content. This increase would be the direct consequence of the water absorption capacity of the flours which we have used. Indeed, the functional properties of the compound flours presented above in the characterization of the flours show that the flours composed of wheat-sweet potato-soybeans have a high capacity for absorbing water compared to control and this capacity increases with the substitution.The moisture content in the biscuits significantly increased with substitution (P < 0.05) and varied from 1.36 of biscuit T2 (50%) to 2.02 g/100 g of biscuit T3 (75%). The values obtained are lower compared to the value reported by Eyenga et al. [P < 0.05) and varied from 2.02 for biscuit T0 (control) to 2.55 g/100 g for biscuit T3 (75%). The values obtained were compared to those found by Siedogo [The ash content in the biscuits also significantly increased with substitution  and varied from 11.41 for biscuit T0 (control) to 13.08 g/100 g for biscuit T3 (75%). This increase could be due to the increase in the proportion of soy flour. The values obtained are higher compared to the value reported by Eyenga et al. [P < 0.05) and varied significantly from 1.4 to 4.2 g/100 g. The lowest fiber content was obtained from biscuit T0 (control) while the highest was obtained from biscuit T3 (75%). Similar trends in fiber increase in fiber content were also reported by Ayo et al. [Protein content in the biscuits significantly increased with substitution . The highest carbohydrate content was observed in biscuit T0 (control) (75.02 g/100 g), and the lowest was reported in biscuit T3 (75%) (68.90 g/100 g). A similar trend in decrease in carbohydrate content was also reported by Ayo et al. [P < 0.05) and varied from 349.4 for biscuit T3 (75%) to 363.9 kcal/100 g for biscuit T0 (control). Those values are lower compared to 506 kcal/100 g found by Eyenga et al. [Carbohydrate content in biscuit significantly decreased with substitution  and ranged from 0.302 for biscuit T0 (control) to 0.374 mg/100 g for biscuit T3 (75%). The copper content increases with substitution. Copper participates in the activity of many enzymes and chemical reactions. It is involved in the oxidation of glucose and is essential for the proper functioning of the myocardium (muscle of the heart). Copper controls bone mineralization and the quality of cartilage and plays a role in the regulation of neurotransmitters, by regulating mood, sleep, memory, and attention. Copper is also involved in the immune process and iron metabolism [The copper content in the biscuits significantly increased with substitution (tabolism . The conP < 0.05) and ranged from 0.908 for biscuit T0 (control) to 0.9824 mg/100 g for biscuit T3 (75%). The results obtained are higher compared to those reported by Bello et al. [The manganese content in the biscuits also significantly increased with substitution . Biscuit T0 (control) records the highest content (5.89 mg/100 g), and biscuit T3 (75%) records the lowest score (3.456 mg/100 g). The results of this study are comparable to those found by Maria et al. [The iron content in biscuits significantly decreases with substitution . Biscuit T0 (control) records the highest content (2.127 mg/100 g), and biscuit T3 (75%) records the lowest score (1.509 mg/100 g). The zinc contents are close to those found by Campos-vega [0 (control) is the best source of zinc.The zinc content also decreases significantly with substitution (pos-vega  (1.4-1.9pos-vega . Among tP < 0.05) and varied from 30 for biscuit T0 (control) from 77 mg/100 g for biscuit T3 (75%). The increase in calcium content with substitution can be explained by the presence of soybeans which 277 mg calcium/100 g [The calcium content in the biscuits also significantly increased with substitution  and ranged from 32 for biscuit T0 (control) to 49 mg/100 g for biscuit T3 (75%). The results obtained are low compared to 62 mg/100 g obtained by Maria et al. [The magnesium content in the biscuits also significantly increased with substitution  and ranged from 184 for biscuit T0 (control) to 541 mg/100 g for biscuit T3 (75%). The magnesium content also increases with substitution. The presence of soy and sweet potato in the formulation is responsible for this increase in fact; Badila et al. [The potassium content in the biscuits also significantly increased with substitution  and ranged from 94 mg for biscuit T3 (75%) to 254 mg/100 g for biscuit T0 (control). A low intake of sodium and sufficient potassium constitutes the dietary challenge that humans have to face daily. High consumption of dietary sodium plays an important role in raising blood pressure [The sodium content in the biscuits significantly decreased with substitution (pressure . The respressure . Therefo0 (control) would meet 88.83%, 75.67%, 84.15%, 70.9%, 6%, 40%, 6.13%, and 25.4% of the dietary reference intakes, respectively, for copper, manganese, iron, zinc, calcium, magnesium, potassium, and sodium. Consumption of 100 g of biscuit T2 (50%) would meet 96.17%, 79.58%, 51.4%, 56.83%, 7.4%, 50%, 14.46%, and 24.1% of the dietary reference intakes, respectively, for copper, manganese, iron, zinc, calcium, magnesium, potassium, and sodium. Consumption of 100 g of biscuit T3 (75%) would meet 110%, 81.83%, 49.37%, 50.3%, 15.4%, 61.25%, 18.03%, and 9.4% of the dietary reference intakes, respectively, for copper, manganese, iron, zinc, calcium, magnesium, potassium, and sodium. The consumption these biscuits will significantly contribute for improving the RDI of the children.The required daily intake (RDI) values for minerals in foods intended to human consumption were established by the United States Department of Agriculture . The RDI0 (control) records the highest levels of iron, zinc, and sodium. In terms of overall acceptability and nutrient content, biscuit T3 (75%) is the best biscuit. The biscuits produced from the mixture wheat flour-sweet potato-soy would be beneficial for reducing protein and mineral deficiencies.Substitution significantly increases the water absorption capacity and the water solubility index of the flours. Biscuit T3 (75%) is the most preferred biscuits. The incorporation of sweet potato and soy flour in the formulation significantly increases the moisture, fat, protein, fiber, copper, manganese, calcium, magnesium, and potassium content in the biscuits. Biscuit T3% (75%) records the highest levels in protein and fiber while biscuit T


Mismanagement in foliar fertilizer application at different crop stages decreases the productivity of the crop. Likewise, higher application of phosphorus (P) beyond recommended application rates not only decrease zinc (Zn) uptake in rice but also increase fertilizer use cost. Inoculation of arbuscular mycorrhizae (AMF) may optimize the uptake of P and improve crops production via organic secretions. That’s why the current study was conducted to examine the individual and coordinated effects of 0.5% Zn (0.5Zn) foliar spray (tillering (T) and/or panicle (P) initiation stage) and AMF application. Application of foliar 0.5Zn at tillering+panicle stage remained significantly better for significant enhancement in plant height, spike length, gas exchange attributes and total chlorophyll contents than control. A significant decrease in electrolyte leakage Also validated the effectiveness of treatment 0.5ZnT+P compared to control. Compared to control, the maximum increase in N (14.5 and 25.7%), P (42.1 and 33.3%), K (22.2 and 30.0%) and Zn (19.3 and 27.8%) accumulation was also found in 0.5ZnT+P, with and without AMF, respectively. In conclusion, 0.5ZnT+P with AMF is a better approach than sole application of Zn at tillering or panicle initiation stages. Nevertheless, more investigations are suggested at field level under variable climatic zones to confirm the effectiveness of 0.5ZnT+P with AMF for improvement in rice growth and production. Poor availability of micronutrients is one of the major hurdles to the achievement of optimum crop productivity –4, becauTo overcome this issue, scientists suggest the application of Zn as fertilizer –16, 19. The poor management of phosphate fertilizers in soils also decreases Zn availability to the plants. When phosphate fertilizers are applied in large amounts, they make complexes with Zn and decreases their uptake in the plants . InoculaRice is considered an important food in human’s diet, as more than 50 million people consume it for their daily intake . It has o E, 30.2o N and 122 meters above sea level), Bahauddin Zakariya University Multan.A pot study was conducted in the research area of the Department of Soil Science ), 0.5% Zn foliar spray at tillering stage (0.5ZnT), 0.5% Zn foliar spray at panicle stage (0.5ZnP) and 0.5% Zn foliar spray at panicle and tillering stages (0.5ZnP+T). While two levels of AMF were used in the study including No AMF (no AMF inoculated) and AMF. The treatment plan includes TW+AMF, 0.5ZnT+AMF, 0.5ZnP+AMF, 0.5ZnP+T+AMF, TW, 0.5ZnT, 0.5ZnP and 0.5ZnP+T. The experimental treatments were laid out in a completely randomized design (CRD) under the factorial arrangement, and each treatment was replicated three times.Clay pots were utilized for the experiment having 60 cm depth and 45 cm diameter. The soil was sampled from the experimental area. After sieving from a 2mm sieve, 8 kg soil was filled in each pot. A composite sample was also taken for the characterization of soil attributes. The texture was analyzed through the determination of sand, silt and clay; the textural triangle of USDA was utilized for computation of soil texture . For anaSeed of SUPER BASMATI rice variety was purchased from the certified seed dealer for the plantation of rice nursery. After 25 days of germination, seedlings were transplanted in the pots.-1 with Glomus species, as a major ingredient of the product. At the time of transplantation, AMF inoculation was again applied to the seedling in treatment with AMF application for maximum colonization  as described by Danish and Zafar-ul-Hye  at 45 daFor chlorophyll contents assessment, Arnon  method wPlants were harvested at the time of maturity. Morphological attributes i.e., number of spikes, plant height, 1000 grains weight and spike length were recorded soon after harvesting of the crop. Grains and straw yield were noted via manual separation of grains and straw. After that top weight balance was use for the assessment of grains and straw yield.2SO4. After digestion distillation was done on Kjeldhal’s distillation apparatus [3:HClO4 = 2:1) [Nitrogen in grains was computed by digestion of sample at 400°C with Hpparatus . For pho4 = 2:1) . Yellow 4 = 2:1)  while a 4 = 2:1) , 36.The standard statistical procedure was followed for statistical analysis of data . Data coEffects of treatments were significant on AMF colonization with roots, plant height, spike length and number of spikes. Results showed that 0.5ZnT+P with AMF remained significantly better compared to all other treatments for the improvement in AMF root colonization. Treatment 0.5ZnT and 0.5ZnP also differed significantly over control (TW+AMF) for AMF colonization with roots. No significant change in AMF colonization with roots was observed where TW and 0.5ZnT were apploed as treatments. However, 0.5 ZnP and 0.5 ZnT+P performed significantly better than the control (TW) for enhancement in AMF colonization with roots compared to TW . For enhThe influences of treatments were significant on 1000 grains weight, total chlorophyll and electrolyte leakage. Application of 0.5ZnT+P and 0.5ZnP with and without AMF was significantly different than TW for the enhancement in 1000 grains weight. No significant change was noted in 0.5ZnT with and without AMF for 1000 grains weight than TW . TreatmeThe addition of treatments caused a significant change in gas exchange attributes i.e., photosynthetic rate, transpiration rate and stomatal conductance. Application of 0.5ZnT+P and 0.5ZnP with and without AMF remained significantly different than TW for the photosynthetic rate. Treatment 0.5ZnT did not differ significantly for photosynthetic rate compared to TW. Results also showed that 0.5ZnT+P, 0.5ZnP and 0.5ZnT without AMF were significantly better over TW for photosynthetic rate . A signiIt was noted that grains and straw yields were also significantly changed by the addition of treatments. A significant improvement in grains  and straApplication of treatments also caused a significant change in grains N, P, K and Zn accumulation. The addition of 0.5ZnT+P and 0.5ZnP with and without AMF performed significantly better than TW for enhancement in grains N. Treatment 0.5ZnT with and without did not cause any significant change in grains N over TW. For grains P, 0.5ZnT+P cause a significant increase compared to TW . TreatmePearson correlation showed that AMF root colonization was significantly and positively correlated with plant height, spike length, number of spikes, 1000 grains weight, total chlorophyll, photosynthetic rate, transpiration rate, stomatal conductance, straw yield, grains N, P and Zn concentration. It was also noted that only electrolyte leakage was significant negatively correlated with AMF root colonization and grains Zn concentration. Grains yield was significantly positive in correlation with photosynthetic rate, spikes length, N, P, K concentration in grains and stomatal conductance .2 assimilation rate through optimization of stomatal conductance in the plants [Results of the current study confirmed that application of 0.5% foliar Zn at tillering+panicle stages with AMF significantly enhanced plant height, spike length, number of spikes and 1000 grains weight. The development of symbiosis between plants roots and fungal hyphae significantly enhanced the expansion of roots. Better elongation in roots resulted in optimum uptake of water and nutrients which ultimately improved plant growth , 40. Bete plants , 44. Appe plants . Howevere plants . It has e plants , 47. In e plants , chlorope plants . This miFoliar application of Zn at tillering and panicle initiation stages improved the growth and yield of rice than control. However, such effects were provoked with AMF inoculation. Sole application of Zn at panicle initiation stage was more effective than its application at tillering for improvement in 1000 grains weight, and grains nutrient accumulation. In crux, foliar Zn application at tillering+panicle stages with AMF inoculation is better to approach compared to sole application for significant improvement in rice growth and yield. It is suggested to grower to inoculate AMF and apply 0.5%Zn foliar at tillering+panicle stages for better rice crop growth. However, more investigations are suggested on different cereal crops under the agroclimatic zone to declare foliar 0.5%Zn at tillering+panicle as the best treatment.


Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies affecting patients' life. Performing endoscopic carpal tunnel release is now a new technique that is being gradually applied in Vietnam. This paper seeks to investigate the effectiveness of Chow’s method for CTS treatment.This is a prospective cohort study involving seventy-seven patients with CTS who underwent Chow’s endoscopic method at our hospital from March 2019 to January 2020. The Boston Carpal Tunnel Questionnaire and electromyography (EMG) were used primarily to evaluate surgical decompression pre-operatively, one week, three weeks, three months, and six months after surgery. We also recorded incision length, pain at the scar, the improvement of symptoms and thenar atrophy and return-to-work time after surgery.A total of 85.7% of the patients were women. A moderate severity of EMG was seen in 64.9% of cases. Six-month post-operative functional status scale (FSS) (1.05±0.1) and symptom severity scale (SSS) (1.05±0.1) showed significant improvement when compared with preoperative FSS (2.8±0.5) and SSS (3.2±0.5). Post-operative EMG showed the distal sensory latency (DSL) and distal motor latency (DML) had returned to the norm in 88% and 89.3%, respectively. The average incision length was 12.1±1.2mm. Six months after surgery, numbness and hand pain had resolved in 97.4%, a painless scar was seen in 94.7%, but full recovery of thenar atrophy was only seen in 9.1%. Patients could get back to work after 10.2±2.4 days.Chow’s endoscopic carpal tunnel release is a safe and effective procedure for patients suffering from carpal tunnel syndrome that showed promising outcomes on clinical symptoms and functions on EMG with minimal pain and scarring, and early return to work. It is often caused by incorrect wrist posture when working continuously in a fixed or flexed position for a long time3. CTS's most frequent symptoms include numbness and paraesthesia in the part of the hand distributed by the median nerve5. Conservative treatment is often indicated for patients who suffer mild symptoms or brief duration of illness. However, applying conservative treatment for a long time or having many severe symptoms can increase median nerve damage, leading to impairment and disability. Therefore, surgery should be considered timely for appropriate patients7.Carpal tunnel syndrome (CTS) is caused by compression of the median nerve in the carpal tunnel. It is one of the most common peripheral neuropathy seen in about 1% - 10% of the population8. Endoscopic carpal tunnel release had many advantages over open surgery, such as a small scar, high aesthetics, less pain after surgery, and helping patients return to work earlier6.The transverse carpal ligament release was described to treat post-traumatic median nerve compression in 1933 by Learmonth and treat non-traumatic median nerve compression in 1946 by Cannon and Love. Open carpal tunnel release has been the surgical standard in treating carpal tunnel syndrome. The endoscopic method was first introduced in 1987 by a Japanese orthopaedic surgeon. In 1989, Chow reported using two incisions to transect the transverse carpal ligament using an endoscopeThere are many reports of carpal tunnel syndrome and its treatment results with transverse ligamentectomy worldwide. However, there are very few reports about endoscopic surgery in Vietnam. We conducted this study to investigate the clinical characteristics and EMG of CTS patients and evaluate the results of endoscopic carpal tunnel release (ECTR) at Can Tho Central General Hospital.et al studied endoscopic carpal tunnel release in a Chinese population to assess its outcome9. They found that 68% of the patient’s hands had improved symptoms after surgery. Using the formula for estimating a proportion, we calculated the sample size of 70 was needed for our study. Seventy-seven patients were recruited in our study. After clinical examination, an EMG was done and the severity of CTS was classified according to Padua (1997)10. Patients with moderate or severe CTS, moderate CTS with failure of non-operative treatment or CTS with thenar atrophy were included for surgery. They underwent endoscopic carpal tunnel release at Can Tho Central General Hospital from March 2019 to January 2020.We performed a prospective cohort study. For seven years from 2001 to 2007, Lam CH We excluded patients with a history of other compression neuropathies, wrist injuries, or surgeries. We also excluded pregnant patients, patients with recurrent CTS, and patients who did not attend follow-up examination, could not be contacted or did not agree to join the study.General characteristics including age, gender, occupation, CTS hand, illness duration, risk factors and associated conditions and previous conservative treatments were documented. Hand pain and numbness were the most common reasons patients came to us. Before surgery, all patients’ clinical characteristics were checked. We studied hand pain and numbness severity and looked for thenar muscle wasting. We also assessed the ability of thumb opposition, handgrip, Phalen’s manoeuvre, and Tinel’s sign. Electromyographic was indicated not only for detecting CTS but also for observing the response after surgery.st, bracelet line, between the palmaris longus tendon and the flexor carpi ulnaris tendon. We were also cautious not to cut the palmar cutaneous branch. The endoscope and a light cord under the carpal transverse ligament were inserted to make a tunnel. Using the light to determine the second incision 3-4cm distally  version 22.0  for Windows. The χPre-operative characteristics were described in The Boston Questionnaire reported FSS and SSS were improved significantly after surgery. It is shown in The electromyographic results , which sAt 6-months post-surgery, numbness and hand pain resolved in 97.4%. However, only 7 (9.1%) patients from 19 (24.7%) with thenar atrophy fully recovered. We found that the average length of the incision was 12.1±1.2mm. The shortest was 10mm, and the longest was 16mm. A total of 59.7% of patients had an incision length of 12 to 14mm. At 3-month post-operatively, 22.7% of the patients still had minimal pain at the surgical scar, which decreased to 5.3% after 6-months. This change was statistically significant at p<0.001. There was a positive correlation between incision length and return-to-work time. This correlation was statistically significant (p<0.001) .Two cases did not shown any improvement in their symptoms; CTS recurred in patients with prolonged wrist immobility and not enough physical therapy. There was no median nerve or tendon injury during the operation.This study involved 77 patients, 85.7% of whom were women. The 40-60-year-olds was most affected, accounting for 62.3%. The moderate and severe CTS on EMG was seen in 64.9% and 10.4%, respectively. Boston Carpal Tunnel Questionnaire and post-operative electromyographic were primarily used to assess surgical decompression. Six months after post-operative FSS (1.05±0.1) and SSS (1.05±0.1) showed a significant improvement in comparison with preoperative FSS (2.8±0.5) and SSS (3.2±0.5). Post-operative EMG showed the DSL and DML returned to the norm in 88% and 89.3%, respectively. The average incision length was 12.1±1.2mm. At 6-months after surgery, numbness and hand pain had resolved in 97.4% while 94.7% had pain-free scars. However, full recovery of thenar atrophy was only seen in 9.1%. Patients could get back to work after 10.2±2.4 days.3. Another causative factor is that the carpal tunnel area in women is smaller than in men as women's hands are smaller than men's3. The mean age of the patients was 50.6±12.4; this was consistent with studies of many other authors12. In general, the common age for carpal tunnel syndrome was from 40 to 60 years old and related to the decrease of elasticity of the carpal transverse ligament. The most common risk factor was repetitive wrist movement 6-8 hours/day (90.9%), more common in patients doing housework (29.9%) or farmers (29.9%).In this study, 85.7% of patients were women in 77 patients. This has also been reported in many other studies, although with different rates. CTS is common in middle-aged women, mostly due to changes in the hormone, oestrogen15. Most of the patients in our study had symptoms for three months or more. A total of 57.1% of the patients had symptoms for 1 to 3 years, while 33.8% had symptoms between 6-month-to-1-year. The above results were also relatively consistent with the results of some other studies. Patients often noted the silent progression of the disease, with slow onset and patient tolerance. A total of 74% of the patients had previously received anti-inflammatory and analgesic therapy at the time of registration. Surgical intervention should be indicated for patients who fail with conservative treatment.Repetitive wrist movements and wrist vibration increases pressure on components in the carpal tunnel and causes this syndrome, respectively, comparable with previous estimates16. CTS signs included weakness of thumb opposition (35.1%), loss of grip strength (31.2%), loss of manual dexterity (24.7%), wrist vibration (13%), and thenar atrophy (24.7%). The differences in many studies could be explained by different sampling criteria and different sample sizes17. Positive Phalen’s manoeuvre was seen in 81.8% and Tinel’s sign in 71.4%, respectively, consistent with the research results of many other authors. Although the rates vary, the authors believed this was one of the most valuable clinical signs in diagnosing carpal tunnel syndrome21. However, the diagnosis of these signs depended a lot on the surgeon’s skills. According to some literature, the more severe the disease and later the stage, the lower the positive rate of these signs23.The most common symptom was hand numbness at night (87%) or when driving or working 94.8%. Numbness in the median nerve distribution was seen in 67.5% of patients, while hand pain was 22.1%. Other studies have also noted that the most common symptom is numbness in the median nerve distribution. However, our study results differed from other studies in the degree of the diseaseet al also recorded a marked change in average Boston FSS and SSS before and after surgery17. The symptom recovery was faster and could be seen after one to four weeks, while the functional recovery was more gradual, lasting from three to six months. Other studies also showed a positive correlation between the average Boston FSS and SSS and the electromechanical resolution of the median nerve25.The Boston Questionnaire was a reliable tool for evaluating the results of carpal tunnel decompression. The average preoperative Symptom Severity Score was 3.2±0.5, higher than the Functional Status Score of 2.8±0.5 (p<0.001). Our patients had an average of 64.9% of the neurological damage on EMG when there was only sensory conduction damage to the median nerve and no motor conduction damage. In contrast, at the level of moderate and severe EMG , the effect on motor conduction causes hand dysfunction. With the results, the mean preoperative FSS correlated positively with the Padua evaluation on electromyography. The more severe the disease, the higher the mean pre-operative FSS score (p<0.001). With FSS and SSS, at the time of 6 months post-op, the score had improved to 1.05±0.1 and 1.05±0.1, respectively, which was statistically significant with p<0.05. Other studies by Gurpinar or Gumustas 26.There was a statistically significant improvement of EMG after surgery (p<0.001). The distal motor latency the distal sensory latency, and their differences returned to the norm after 6-months of surgery in over 80% of patients. These results were consistent with the research results of other authors5. In 24.7% of patients with thenar atrophy before surgery, there was no change at 4 weeks after surgery. However, at 3 months and 6 months after surgery, 6.5% and 9.1% of patients fully recovered from thenar atrophy, respectively, while partial recovery rate was 10.4%, and no change was seen in 5.2%. Our results were similar to other studies. Thenar atrophy was considered a complication of CTS due to long-term compression of the median nerve. The longer the compression time on the median nerve, the more degenerative the axon and the greater the degree of muscle atrophy seen. After surgery, the recovery of thenar atrophy could be very slow, and in some cases, it may not be reversed24.One week after surgery, all patients expressed improvement in symptoms. At 4-weeks post-operatively, 83.3% of patients had full resolution. There were 2 cases (2.6%) in which there were no improvements of the symptoms; CTS recurred in patients with wrist immobility and poor physical therapy after 1 week of operation. At 6 months post-surgery, the rate of patients whose symptoms had fully recovered increased to 97.4%. Our results were somewhat similar to other studieset al also noted that the endoscopic incision is always smaller than the conventional surgery27. A total of 22.7% of patients presented with pain at the surgical scar at 3 months post-op, and just 5.3% of them still had pain at the scar at 6 months post-op. Gurpinar found that at the time of 3-month post-op, pain at the scar between the endoscopic release group and open release group was seen in 7.4% and 16%, respectively, and pain-free in the endoscopic release group at 1-year post-op12. The average back-to-work time was 10.2±2.4 days. We observed a positive correlation between back-to-work time and incision length  and similarities with other studies30. Endoscopic surgery helped limit wrist soft tissue damage, short skin incisions, smaller surgical scar with minimal pain, and early return to work or daily activities compared to conventional surgery.With Chow’s method, we were also interested in the length of the incision, recording an average of 12.1±1.2mm, of which the shortest was 10mm, and the longest was 16mm. The authors Gurpinar or Heidarian 31. Nerve or tendon injuries could affect the primary outcome and were seen as a procedure failure. In our study, we did not record those injuries. We carefully performed this method with every hand we operated on, from approaching the tunnel to cutting the transverse carpal ligament under good visualisation.Complications from endoscopic carpal tunnel release are injury to nerves or tendonsIt is plausible that several limitations might have influenced the results. The number of patients was just 77 patients, showing limited power. We did not completely assess the severity of the signs, which were needed to use specific tools that would help predict and objectively evaluate the treatment results. On a few occasions, we met some difficulties in manipulating instruments that unintentionally made the incisions larger and affected the result of incision length.32. In Vietnam, endoscopic carpal tunnel release is still new among orthopaedic surgeons so far, and less work has been done to evaluate its outcomes. This study demonstrated the endoscopic method's effectiveness and encouraged practitioners to apply it in treating CTS.Endoscopic carpal tunnel release has become a more common procedure for treating carpal tunnel syndrome worldwide. Previous studies have demonstrated that ECTR helps patients reduce pain and return to work earlier. Besides, ECTR was adduced to be more effective in restoring hand strength and fewer complications than open release surgeryChow’s endoscopic carpal tunnel release is a safe and effective procedure for patients suffering from carpal tunnel syndrome that showed promising outcomes on clinical symptoms and functions, on EMG with minimal pain and scarring, and earlier return to work.


Conversely, the specificity of qSOFA ≥ 2 for sepsis detection was higher than that of NEWS ≥ 5 (90% versus 55%). The negative predictive value of NEWS > 5 was higher than that of qSOFA ≥ 2 (77% versus 54%), while the positive predictive value of qSOFA ≥ 2 was higher than that of NEWS ≥ 5 (80% versus 69%). Finally, the accuracy of NEWS ≥ 5 was higher than that of qSOFA ≥ 2 (72% versus 60%). Conclusions: The sensitivity of NEWS ≥ 5 was superior to that of qSOFA ≥ 2 to identify patients with sepsis in the ED and predict ICU admission and 28-day mortality. In contrast, qSOFA ≥ 2 had higher specificity and positive predictive values than NEWS ≥ 5 for these three endpoints.Background: Prompt recognition of sepsis is critical to improving patients’ outcomes. We compared the performance of NEWS and qSOFA scores as sepsis detection tools in patients admitted to the emergency department (ED) with suspicion of sepsis. Methodology: A single-center 12-month retrospective study comparing NEWS using the recommended cut-off of ≥5 and qSOFA as sepsis screening tools in a cohort of patients transported by emergency medical services (EMS) to the Lausanne University Hospital (LUH). We used the Sepsis-3 consensus definition. The primary study endpoint was the detection of sepsis. Secondary endpoints were ICU admission and 28-day all-cause mortality. Results: Among 886 patients admitted to ED by EMS for suspected infection, 556 (63%) had a complete set of vital parameters panel enabling the calculation of NEWS and qSOFA scores, of whom 300 (54%) had sepsis. For the detection of sepsis, the sensitivity of NEWS > 5 was 86% and that of qSOFA ≥ 2 was 34%. Likewise, the sensitivities of NEWS ≥ 5 for predicting ICU admission and 28-day mortality were higher than those of qSOFA ≥ 2 (82%  It is one of the most commonly used early warning scores (EWS) worldwide. Some studies suggested that the use of an EWS might be a superior screening tool for sepsis . We > 5 was 86% (95% CI 82–90%) and that of qSOFA ≥ 2 was 34% (95% CI 29–40%). These numbers were similar if using sepsis-2 definitions, limited to severe sepsis and septic shock (see versus 55% (95% CI 49–62%)]. The negative predictive value of NEWS ≥ 5 was higher than that of qSOFA ≥ 2 [77% (95% CI 70–83%) versus 54% (95% CI 49–59%)], while the positive predictive values of qSOFA ≥ 2 were higher than that of NEWS ≥ 5 [80% (95% CI 72–87%) versus 69% (95% CI 64–74%)] for sepsis detection, though these remained similar for ICU [13% (95% CI 9–16%) versus 15% (95% CI 9–22%)] and 28-day mortality [31% (95% CI 27–36%) versus 39% (95% CI 30–48%)]. Finally, the accuracy of NEWS ≥ 5 was higher than that of qSOFA ≥ 2 [72% (95% CI 68–76%) versus 60% (95% CI 56–64%)]. ROC curve analyses confirmed the superior performance of NEWS over qSOFA for sepsis detection [0.79 (95% CI 0.74–0.82) versus 0.65 (95% CI 0.61–0.69)], ICU admission [0.67 (95% CI 0.59–0.74) versus 0.58 (95% CI 0.51–0.65)], and mortality [0.70 (95% CI 0.65–0.75) versus 0.62 (95% CI 0.57–0.67)] ] .2 and SpO2 had the most impact (0.11 and 0.10 relative contributions) on the NEWS performance for the detection of sepsis  curve analyses. For the entire patient cohort, FiOf sepsis . Given tf sepsis . We found that a NEWS score equal to or greater than 5 had higher sensitivity than a qSOFA score equal to or greater than 2 to identify patients with sepsis admitted to the emergency department of a large university medical center in the Western part of Switzerland. NEWS was also found to be superior to qSOFA for the prediction of ICU admission and 28-day mortality. On the contrary, qSOFA was more specific than NEWS and it exhibited a higher positive predictive value than NEWS. The latter showed a higher negative predictive value. Taken altogether, the present findings suggest that NEWS would be the favored score for the detection of sepsis in the emergency department, while qSOFA would be a more specific sepsis detection tool with the capacity to reduce the rate of false positives.To the best of our knowledge, this is the first study comparing NEWS and qSOFA using the latest international consensus definitions for sepsis and septic shock (Sepsis-3)  PreviousIn the present study, we used a NEWS cut-off value of 5 or higher, as is applied in England for the early detection of sepsis in the emergency department (ED)  Mathematversus 3 h, respectively) [In contrast to NEWS, a score designed to identify patient deterioration irrespective of its etiology, qSOFA, was specifically designed to identify infected patients at increased risk of mortality  Consistectively) . In viewOur work has several limitations. First, 38% of cases were excluded due to missing parameters for the calculation of NEWS or qSOFA. Second, missing bilirubin values (91% of cases) were deemed normal, which may result in an underestimation of the number of sepsis cases. The third limitation is that NEWS is a score of patient deterioration; here, we compare sensitivity amongst a cohort of infected patients. However, this may not capture the performance of NEWS in an emergency department with non-infected patients in addition to infected patients.We used a previously described cohort of patients brought by EMS to the LUH emergency department . Among 1We computed SOFA scores as described previously with the following assumptions or corrections ,13 Firsthttps://CRAN.R-project.org/package=epiR, accessed on 29 September 2022). We used conditional permutation importance [The statistical analyses were performed using a random Forest/Z-value method. Statistical metrics and their 95% confidence intervals were computed using the exact method of the epi.tests function in R’s epiR package  and the rapid assessment of the severity of sepsis at the bedside (qSOFA) may best serve the evaluation and management of patients with sepsis at the time of admission in the emergency department.


A total of 96.8% of patients were treated with ABVD.:84.3% achieved complete remission (CR) and 6.02% partial remission (PR), being the CR rate higher in private hospitals. End-of-treatment metabolic CR was achieved in 85.4% (n = 373). The interim PET scan was widely used in our cohort , but in only 23.3% (n = 116) was the treatment strategy response-adapted. The 5-year progression-free survival (PFS) was 76% (CI 95% 70–81). The 2 and 5-years-OS rates were 91% (CI 95% 88–94%) and 85% (CI 95% 80–89%), respectively. No differences in OS were found between public and private institutions (p = 0.27). This is one of the largest retrospective cHL cohorts reported. In Argentina ABVD is the chemotherapy regimen of choice and, although it is well tolerated, it is not exempt from toxicity. We showed that early initiation of treatment impacts the induction results. Although the use of PET scan is widespread, only a minority of patients was treated with respons- adapted strategies. The use of PET-guided treatment is strongly encouraged.There are no data in Argentina on the response rates to first-line treatment of classical Hodgkin Lymphoma (cHL) outside clinical trials. A total of 498 patients from 7 public and private hospitals in Argentina were retrospectively examined. The median follow-up was 37.4 months (CI 95% 17.7–63.5). The median time from diagnosis to treatment was 22 days (IQR 14–42), which was significantly longer in public hospitals (49.3 (IC 95% 38.5–60.2) versus 32.5 (IC 95% 27–38);  Hodgkin lymphoma is an aggressive hematological malignancy with high cure rates . It is mFurthermore, given that cHL patients have a long-life expectancy following first-line treatment, the risk of acute and, specially, long-term treatment-related toxicity is an aspect of particular concern  that hasAlthough cHL has a high cure rate, 10% of the patients are primary refractory. Around 30% of them relapse after achieving complete remission (CR), resulting in an estimated 5-year OS around 90% in stage I–IIa and 60% in stage IV .The primary objectives of this study were to assess the real-world RR, PFS and OS, after first-line treatment of cHL in public and private hospitals in Argentina. Secondly, we sought to identify epidemiological characteristics of the patients of the participating hospitals that could determine discrepancies in the response to first-line treatment.Data from all consecutive newly diagnosed cHL patients aged 18 and above who were diagnosed and treated in eight public and private participating medical centers of Argentina  between 1/1/2008 and 2/1/2019 were retrospectively reviewed. The study was approved by the local Institutional Committees. The inclusion criteria for this study were: age 18 or above at diagnosis, histologically confirmed cHL, treatment with chemotherapy and available follow up data. Baseline characteristics, treatment protocol, adverse events during and after treatment and outcome measures were recorded. PET-CT results at diagnosis, interim analysis (iPET-CT), and end-of-treatment (EOT-PET-CT) were recorded and analyzed. Following local treatment protocols in the participating sites, iPET-CT was scheduled for after 2 cycles of chemotherapy, 12–14 days after the last chemotherapy administration. The 5-point scale Deauville score (DS) of the level of residual FDG uptake at compromised sites was used to evaluate response to treatment on iPET and EOT-PET-CT scans , 7. DS ot tests were used to compare means of normally distributed variables between two groups. Proportions across categories were compared using chi-squared tests. PFS was defined as the time from diagnosis of cHL to death or disease relapse/progression, including less than complete remission (CR) at the end of the treatment protocol. OS was defined as the time from diagnosis of cHL to death or last follow-up visit. Qualitative variables were expressed as total number and percentage (%) and quantitative variables as median and interquartile range (IQR). Survival rates were estimated by the Kaplan–Meier method and compared by the log-rank test. Variables with p value < 0.05 in univariate analysis were entered into the multivariable Cox proportional hazards model in a stepwise fashion. A p < 0.05 was established as limit of significance for all analyses.Statistical analysis was carried out with Stata 16.1 (StataCorp LLC). Descriptive statistics was used to analyze histopathological findings and clinical variables. Five hundred and twenty patients from seven public and private hospitals in Buenos Aires and Rosario were examined. Twenty-two patients (22/520) had nodular lymphocyte predominant Hodgkin Lymphoma and were excluded form this analysis; only data on the 498 patients with cHL are included in this study.n = 281, 54%). Most patients had nodular sclerosing subtype  and B symptoms .The baseline characteristics of patients are presented in Table n = 164, 31.5%), defined as a tumor mass of > 7 cm and, extranodal involvement . A low proportion of patients were stage I at diagnosis (4.8%), while almost half of the cohort were at stage II (47.3%). Forty eight percent of our patients presented with advanced disease . Regarding risk stratification, early and advanced favorable groups represented around 15% of the patients each, while around 30% were classified as early unfavorable or advanced unfavorable . The therapeutic strategies and outcome in the full cohort and according to risk group is shown in Table p = 0.0001). Additionally, an estimated 9.64% of the full cohort of patients had progressive disease (PD) at the end-of first-line treatment (Table n = 373) had negative (DS1-3) EOT-PET-CT results. IPET-CT was performed in 70.5% of our cohort (n = 351), with 83.8% achieving metabolic CR. However, only 23.3% (n = 116) were treated with response-adapted strategies . Regarding hematologic toxicity, anemia was present in 28.2%, neutropenia in 56.4% and thrombocytopenia in 7% of patients (Table p < 0.0001). The mean Charlson’s comorbidity index was 3.9 (IC 95% 3.1–4.8) for deceased patients versus 1.8 (IC 95% 1.6–2.02); p < 0.0001 for the alive patients. The 5-year PFS was 76% (CI 95% 70–81). The 2 and 5-year OS rates were 91% (CI 95% 88–94%) and 85% (CI 95% 80–89%), respectively .The median follow-up time was 37.4 months CI 95% 17.7–63.5). The median time from diagnosis to treatment was 22 days (IQR 14–42), and was significantly longer in public hospitals (49.3 (IC 95% 38.5–60.2) versus 32.5 (IC 95% 27–38); 7.7–63.5.p < 0.0001) and for those who achieved a negative EOT-PET CT. Variables that remained independent predictors of OS on multivariate analysis were the Charlson score < 3  and the EOT-PET-CT .Variables associated with significantly better outcomes were Table : age youSince a real-world analysis was lacking, we retrospectively assessed a large Argentinian cohort of cHL patients who underwent first-line treatment outside of clinical trials. Ours is one of the largest retrospective cohorts reported in cHL and, importantly, reflects a real-life experience outside a clinical trial setting. Previous studies have shown discrepancies in outcome of cHL patients treated in a clinical trial , or in aAs to the differences we found between public and private hospitals, it must be highlighted that, in Argentina, access to diagnostic and therapeutic tools tends to be faster in private institutions. In our study, patients treated in the latter achieved CR in a higher proportion. It is noteworthy that achieving higher rates of CR, as it was found in private hospitals compared to public institutions, was not translated in an improvement of OS. This may be due to the low percentage of patients who progress, and also probably to the success of the available rescue strategies for patients who are in first relapse or who progress after first-line –26.p 0.0027), where the percentage of patients achieving CR after first-line treatment was significantly higher (86.6% versus 78.6% p = 0.0001).A finding in our cohort that has not been reported in other studies, which perhaps impacts the possibility of achieving CR, is the time between diagnosis and initiation of first-line treatment. This was significantly shorter in private institutions , the use of PET-guided treatment should be strongly encouraged.Within the main limitations of our study, we must mention its retrospective rather than prospective nature, and the lack of a central review of both the anatomopathological samples and PET images. Data collected through cancer registry analysis are dependent on accurate coding in the database. It is difficult to accurately track the number of chemotherapy cycles, PET scans, dosing, and duration of radiotherapy. The strengths of this analysis were the number of patients analyzed, the long follow-up and the uniform treatment in a multicenter setting, despite being outside a clinical trial.It is possible that in the near future, the treatment of HL will change, with a new generation of drugs able to modify or even replace the current standards. This will doubtless represent a new challenge in the clinical management of this disease. Further research is needed to see if these novel drugs could improve the quality of life for both HL patients undergoing treatment and for the growing cohort of HL survivors.


Intensive care is of great significance for very low birth weight infants (VLBWI). The Yangtze River Delta is the most ecomonically developed area in China. However, there are few data on the care practices and survival of VLBWI in this region.To investigate the prevalence, care practices and motality of VLBWI in Yangtze River Delta in China.A multi-center retrospective investigation study was conducted at five tertiary hospitals within the Yangtze River Delta in China from January to December 2017. Clinical data included the general characteristics of the infants and the mothers, clinical prognosis, care practices in NICUs was collected by trained research members.During the study period, 1059 VLBWIs were included. Infants with birth weight < 750 g, 750-1000 g, 1000-1250 g and 1250-1500 g accounted for 2.3, 14.9, 34.8 and 47.8%, respectively. Premature rupture of membranes (17.8%) was the main cause of premature delivery. The catheterization rates of umbilical vein catheterization (UVC) and peripherally inserted central catheter (PICC) were 25.0 and 64.4%, respectively. The duration of parenteral nutrition was 27.0 ± 19.5 d, the meantime of feeding tube indwelling was 36.2 ± 24.2 d. The corrected gestational age of the infants who reached full oral feeding was 35.8 ± 2.7 weeks. The breast feeding rate in the investigated infants was 61.9%. The mortality rate of preterm infants was 3.4%. The incidence of main complications BPD, PDA, ROP, NEC and sepsis were 24.9, 29.9, 21.7, 9.4 and 13.3% respectively.Maternal and infant care practices need to be improved in the very preterm births. This study provides a baseline for the improvement in the further study. Very low birth weight infants (VLBWI) are defined as neonates with birth weight of less than 1500 g. VLBWI accounted for 20% of total hospitalized infants in the neonatal intensive care units (NICU), while extremely low birth weight infants (ELBWI) with a birth weight of less than 1000 g accounted for 15.1%  with theWith the rapid development of perinatal medicine and neonatal intensive care in China, more VLBWI have been admitted and treated in Chinese NICUs. Several epidemiological studies have been conducted aiming to describe the prevalance and prognosis of VLBWI in NICU. These data were widely used to assist clinical decision-making, evaluate the quality of neonatal treatment, and carry out quality improvement of NICU , 3, 7. TA multi-center cohort observational study was conducted in NICUs at 5 tertiary hospitals within the Yangtze River Delta in China. The Yangtze River Delta region incorporate Shanghai District, Jiangsu Province and Zhejiang Province. It is one of the most densely populated regions on earth, with over 150 million registered residents living in more than twenty developed cities including Nanjing, Hangzhou, Suzhou, Ningbo, Wuxi, and Changzhou. All the participating hospitals were tertiary neonatal care centers. The data came from the care database of VLBWIs in the Yangtze River Delta. All preterm infants with a weight of less than 1500 g who were younger than seven days at admission were included and the data from admission to discharge or death were all in the database. The data of all stillbirths and infants who were not discharged or died in these hospitals were not in the database. The data of infants discharged from January 1, 2017, to December 31, 2017 were analyzed in this study. Infants’ guardian signed informed consent. The study was approved by Ethics committee of Children’s Hospital of Fudan University ([2018]-211).The collected data included the general characteristics of the infants and the mother, clinical prognosis, conditions of nursing related care in NICU. Each unit designated a special data collector  who was responsible for data collection. All data collectors were trained before the study. The data of each unit was uploaded to the special database established for the VLBWI project in the Yangtze River Delta. The research group located at Children’s Hospital of Fudan University (CHFU) was responsible for checking the integrity and quality of the data. In addition, members of different research centers traveled to other centers for data audit. All data for this study were collected from the electronic medical record system of each hospital.The important data involved in the study were defined as follows: (1) gestational age: defined as the gestational age evaluated by early pregnancy ultrasound, obstetric examination, and obstetric history. If the difference between obstetric gestational age and neonatal gestational age assessment in NICU was more than 2 weeks, the neonatal simple gestational age assessment form was used for the assessment. The New Ballard score was used to evaluate the gestational age of preterm infants less than 28 weeks . (4) Int2 tests and continuous data using analysis of variance (ANOVA). A p-value < 0.05 was considered to be statistically significant with two-tail test.SPSS Version 22.0 software was used for statistical analysis of all data. For the objective of this study, the status of care measures, mortality & morbidity of neonatal outcome were described and summarized among VLBWIs. Continuous variables with normal distribution were expressed as means ± Standard deviation while those with highly-skewed distribution were represented by the median (p25-p75). Categorical variables were expressed as number of case (percentage). The denominator for percentages was the total number of infants with no missing data for each variable analyzed. Missing data were not imputed. For formal statistical analyses, we examined categorical variables using χA total of 1059 VLBWIs with an average gestational age of 29.8 ± 2.3 weeks and an average birth weight of 1216.6 ± 198.0 g were included in the study. Infants with birth weight < 750 g, 750-1000 g, 1000-1250 g and 1250-1500 g accounted for 2.3% (25 infants), 14.9% (158 infants), 34.8% (369 infants) and 47.8% (507 infants), respectively. Among them, 183 infants (17.2%) were ELBW, while 126 infants (11.9%) were infants with multiple pregnancies. Of total mothers of 1059 infants, 86.0% (911 mothers) had a regular prenatal examination, 21.1% (223 mothers) received prenatal glucocorticoids. Among the causes of preterm delivery, preterm rupture of membranes, fetal distress, placental abruption, and placenta previa accounted for 17.9, 4.4, 3.1, and 14.5%, respectively. The proportion of Apgar score in 1 min less than 3 reduced as the increase of birth weight, see Tables Rate of pulmonary surfactant use increased with decreased birth weight, from 64% at < 1000 g to 43% at 1251-1500 g. The top three utilization of respiratory support modes were CPAP (59.8%), conventional mechanical ventilation , and nasal tube oxygen inhalation (39.7%). Of total VLBWI, 688 (65.0%) infants, 536 (50.6%) infants, 207 (19.6%) infants were treated with caffeine, PS and aerosol inhalation respectively, see Table Umbilical vein catheterization  and Peripheral central venous catheterization PICC, 64.4%) were the most commonly used for vascular accesses in VLBWI. Among VLBWIs undergoing UVC, the mean indwelling time was 6.7 ± 4.8 days. The mean catheterization time of VLBWIs with PICC was 23.7 ± 16.2 days. See Table .4% were The duration of parenteral nutrition was 27.0 ± 19.5 days and the average duration of feeding tube indwelling was 36. 2 ± 24.2 days. The corrected gestational age of the VLBWI who reached full oral feeding was 35.8 ± 2.7 weeks in this study. The exclusive breast feeding rate was 61.9% among VLBWI (Table Hypothermia occurred in 11.7% of study population during hospitalization. The incidence of Hypothermia decreased significantly with the increase of birth weight: 28% at infants < 750 g, 19% at 750-1000 g, 13.3% at 1250-1500 g and 7.5% at 1250-1500 g. The proportion of VLBWI undergoing EEG monitoring, continuous glucose monitoring and percutaneous partial pressure of oxygen monitoring was 16.8, 15.8 and 20.9% respectively (Table The smaller of the birth weight, there was a greater risk of mortality due to prematurity. The mortality rate of VLBWI was 32% at < 750 g, 6.3% at 750-1000 g, 3% at 1000-1250 g and 1.4% at 1250-1500 g. There was significantly reduction of incidence of Sepsis with the increase of birth weight: 28% at < 750 g, 19.6% at 750-1000 g, 15.2% at 1000-1250 g and 9.3% at 1250-1500 g. The incidences of BPD, PDA, ROP and NEC were 24.9, 29.9, 21.7 and 9.4%, respectively. There were significant differences in the incidence of BPD, ROP and NEC among different birth weight groups (Table There are many factors causing preterm delivery, , 16 suchPrevious studies have also suggested a protective effect of noninvasive ventilation in preterm infants. CPAP is recommended as the preferred noninvasive ventilation mode after birth . Early CIn addition to noninvasive ventilation, caffeine administration also played major roles on promotion of neonatal morbidity. Caffeine can help VLBWIs wean earlier, reduce the incidence of BPD, and improve the prognosis of neurodevelopment –27. In tAdequate nutrition supply is the key for the survival of preterm infants. Proper vascular access is the key to parenteral nutrition but limited studies focus on the vascular choices in the NICU. UVC and PICC are the most commonly used vascular accesses for VLBWIs. In this study, UVC and PICC were used in 25.0 and 64.4% infants, respectively. Meanwhile, smaller birth weight was associated with the longer indwelling time of UVC and PICC, which was consistent with previous study . In thisIn terms of enteral nutrition, breast milk is the first choice for VLBWIs, and it is related to the prognosis and survival rate , 31. AccThe management of body temperature is very important for preterm infants, in this study, hypothermia was observed in 19.3% of cases during hospitalization. We concluded that the smaller birth weight was associated with a higher incidence of hypothermia. Some researchers have suggested that bundles of golden hour temperature management including plastic bags usage, pre-warming the linens could significantly reduce the incidence of hypothermia in VLBWIs , 39. In EEG monitoring, brain or intestinal oxygen monitoring, and transcutaneous oxygen partial pressure monitoring are very important noninvasive monitoring methods in clinic. However, our results revealed that these monitoring methods were not frequently applied in VLBWIs, which also indicated that this kind of monitoring was not taken as routine monitoring in clinic. Infants with smaller birth weight and the more serious diseases were associated with the higher the proportion of such kind of monitoring.The mortality rate of VLBWIs included in this study was 2.4%. Lower birth weight was associated with a higher mortality rate. Compared with other domestic studies,  the mortThis study described the care practices of VLBWIs in the NICU of the Yangtze River Delta region, thus providing baseline data for the care of VLBWIs in the future. Our results also showed that the care strategies of VLBWIs in the Yangtze River Delta region needed to be improved.


The primary endpoint was a ≥50% reduction in PSA. Secondary endpoints were median time to PSA progression, duration of response and overall survival. Thirteen patients were initiated on protocol therapy. Median age was 77 (range 55–90). Twelve patients (92%) had bone metastases. Four patients (30%) had both bone and visceral metastases. PSA response was seen in 10 patients , 46.2–94.9%]). Two patients had stable disease (SD), yielding a disease control rate of 92%. Median time to PSA progression was 8 months . Median duration of response (DOR) was 7.3 months . Median overall survival at 5 years was 35.1 months [95% CI 25.7–57.7]. No new safety signals were noted. No patients experienced grade 3 or above anemia. One patient (7%) experienced febrile neutropenia. A PSA response rate of 76.9% and median survival of 35.1 months compares favorably to the 45% PSA response rate and 17.4 months median survival reported for the TAX 237 trialists. While our study was limited due to small sample size, our results suggest that the combination of docetaxel and lycopene merits further study.We carried out a phase II study to investigate the activity of docetaxel plus lycopene in advanced castrate resistant adenocarcinoma of the prostate. Patients were chemotherapy and biological therapy naive. Docetaxel 75 mg/m Among men in the U.S., the current estimated lifetime risk is about one in nine . AccordiMetastatic prostate cancer presents a therapeutic challenge and is currently incurable. Most advanced prostate cancers initially respond well to androgen deprivation therapy (ADT) with luteinizing hormone releasing hormone (LHRH) analogues, orchiectomy, and/or testosterone receptor antagonists. After a variable time, however, all patients progress to castration resistant prostate cancer (CRPC), which has a median overall survival of approximately 2–2.5 years . CRPC do2 every three weeks, docetaxel 30 mg/m2 weekly, or mitoxantrone 12 mg/m2 every three weeks , as assessed by the proportion of subjects who achieved ≥50% reduction in PSA after start of treatment, which consisted of ten of thirteen patients achieving PSA response . Two pat< 20 ng/ml baseline serum which had median DOR 14.7 months .The median duration of response was 7.3 months  . Sub-gro< 20, while the group of patients with elevated baseline serum PSA ≥ 20 ng/ml showed median time to progression of 7 months . On long term follow- up, median overall survival was 35.1 months [95% CI 25.7–57.7]. Kaplan-Meir survival curves for time to PSA progression and overall survival can be seen in Median time to PSA progression was 8 months 95% CI, 3.5–8.7]. Time to PSA progression was higher at 13.8 months [95% CI 7.5–21.7] in the sub group with baseline serum PSA .5–8.7. T3.3.Treatment with docetaxel plus lycopene was relatively well tolerated and no dose limiting toxicities were observed in the initial six patients enrolled in the study. Two patients (15%) required dose reduction and both were due to peripheral neuropathy. The most common adverse events  occurring in at least 15% of patients included diarrhea, nausea or vomiting or both, peripheral neuropathy, weight loss, appetite changes, fatigue, onycholysis and alopecia neutropenia, and anemia, as listed in 4.In this phase 2 study, docetaxel plus lycopene was administered to patients with metastatic castrate resistant prostate cancer. For men with advanced prostate cancer, ADT is usually the first choice of treatment and can provide disease control for a substantial amount of time. However, the vast majority eventually progress on ADT to castrate resistant disease and may benefit from chemotherapy. Lycopene, a carotenoid found in tomatoes, is a compound found to have anti-prostate cancer activity and has been shown both in vitro and in vivo to enhance the activity of docetaxel . The resThese results compare favorably to the landmark TAX 327 trial. The group given docetaxel every 3 weeks had a PSA response rate of 45%, and the group given docetaxel weekly had a PSA response rate of 48% [2, cabazitaxel 25 mg/m2 or docetaxel 75 mg/m2 yielded similar findings. The authors found PSA response rates to be 60.7%, 68.7%, and 68.4%, respectively [A phase 3 trial of 1168 patients with metastatic CRPC treated with cabazitaxel 20 mg/mectively . Median Multiple large phase 3 trials have studied docetaxel in combination with other agents. One trial that evaluated docetaxel plus bevacizumab versus docetaxel alone in men with metastatic CRPC found that patients on the docetaxel plus bevacizumab arm had a PSA response rate of 69.5% and median PFS of 9.9 months . HoweverIn conclusion, our findings suggest that docetaxel plus lycopene has favorable activity in patients with metastatic castrate resistant prostate cancer. Duration of response and time to PSA progression were comparable to previous trials. Treatment was relatively well tolerated, and adverse event rates were similar if not improved compared to previous trials. Lycopene alone has demonstrated single-agent activity towards prostate cancer and is very well tolerated with low risk of adverse events. In addition, lycopene may have synergistic activity with docetaxel through downregulation of IGF-I signaling inhibition and decreased survivin expression. Further study on docetaxel plus lycopene is warranted.