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Cuomo A, Aguglia A, De Berardis D, Ventriglio A, Gesi C, Fagiolini A. Individualized strategies for depression: narrative review of clinical profiles responsive to vortioxetine. Ann Gen Psychiatry 2024; 23:20. [PMID: 38755657 PMCID: PMC11097484 DOI: 10.1186/s12991-024-00505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Depression is a highly heterogeneous disorder, often resulting in suboptimal response and remission rates. This underscores the need for more nuanced clinical characterization of patients to tailor individualized treatment plans. Emerging evidence highlights the critical role of cognitive and emotional dysfunction in major depression, prompting the exploration of novel therapeutic interventions that target these specific symptom domains. MAIN TEXT Vortioxetine, a multimodal antidepressant, enhances serotonergic activity while also modulating several other neurotransmitter systems involved in depressive symptoms such as emotional blunting, anhedonia, and cognitive dysfunction. Numerous randomized, placebo-controlled trials have demonstrated vortioxetine's efficacy and safety in treating depression, particularly in specific subgroups of depressed patients, including those with cognitive deficits and comorbid anxiety symptoms or disorders. Although not randomized or placebo-controlled, studies have also shown vortioxetine's efficacy in depressed patients with emotional blunting or anhedonia. Vortioxetine's ability to effectively treat a range of depressive symptoms, including anhedonia, emotional blunting, anxiety, and cognitive dysfunction, provides an individualized treatment solution for depressed individuals suffering from these symptoms. The purpose of this paper is to identify clinical profiles of patients who may benefit from vortioxetine, with the goal of optimizing therapeutic outcomes. CONCLUSION Vortioxetine has been shown to be effective for patients with depression and symptoms such as anhedonia, emotional blunting, anxiety, and cognitive dysfunction. Tailoring treatment plans to individual needs and personalizing treatment choices based on the specific symptoms presented by depressed patients improve treatment outcomes.
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Affiliation(s)
- Alessandro Cuomo
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine, Siena, Italy.
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Camilla Gesi
- Department of Mental Health and Addiction, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine, Siena, Italy
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Pflieger T, Venkatesh R, Dachtler M, Cooke K, Laufer S, Lunter D. Influence of design parameters on sustained drug release properties of 3D-printed theophylline tablets. Int J Pharm 2024; 658:124207. [PMID: 38718971 DOI: 10.1016/j.ijpharm.2024.124207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/14/2024]
Abstract
The application of three-dimensional printing (3DP) in the pharmaceutical industry brings a broad spectrum of benefits to patients by addressing individual needs and improve treatment success. This study investigates the sustained release properties of 3DP tablets containing Theophylline (TPH), which is commonly used to treat respiratory diseases and recently having a comeback due to its potential in the treatment of conditions like Covid-19. Since TPH is a narrow therapeutic window (NTW) drug with serious side effects in the event of overdose, the release properties must be observed particularly closely. We employed a state-of-the-art single screw extrusion 3D printer, which is fed with granules containing the drug. By employing a Taguchi orthogonal array design of experiments (DOE), tablet design parameters and factor related process stability were sought to be evaluated fundamentally. Following this, examinations regarding tailored TPH dosages were undertaken and a relationship between the real printed dose of selected tablet designs and their sustained drug release was established. The release profiles were analyzed using different mathematical model fits and compared in terms of mean dissolution times (MDT). Finally, in-vivo/in-vitro correlation (IVIVC) and physiologically based pharmacokinetic (PBPK) modeling showed that a paradigm patient group could be covered with the dosage forms produced.
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Affiliation(s)
- Thomas Pflieger
- DiHeSys Digital Health Systems GmbH, Marie-Curie-Strasse 19, 73529 Schwaebisch Gmuend, Germany; Chair of Pharmaceutical Technology, Eberhard Karls University, Auf der Morgenstelle 8, 72074 Tuebingen, Germany
| | - Rakesh Venkatesh
- DiHeSys Digital Health Systems GmbH, Marie-Curie-Strasse 19, 73529 Schwaebisch Gmuend, Germany
| | - Markus Dachtler
- DiHeSys Digital Health Systems GmbH, Marie-Curie-Strasse 19, 73529 Schwaebisch Gmuend, Germany
| | - Karin Cooke
- Gen-Plus GmbH & Co. KG, Staffelseestrasse 6, 81477 Munich, Germany
| | - Stefan Laufer
- Chair of Pharmaceutical Chemistry, Eberhard Karls University, Auf der Morgenstelle 8, 72074 Tuebingen, Germany
| | - Dominique Lunter
- Chair of Pharmaceutical Technology, Eberhard Karls University, Auf der Morgenstelle 8, 72074 Tuebingen, Germany.
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Duffy A, Grof P. Longitudinal studies of bipolar patients and their families: translating findings to advance individualized risk prediction, treatment and research. Int J Bipolar Disord 2024; 12:12. [PMID: 38609722 PMCID: PMC11014837 DOI: 10.1186/s40345-024-00333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Bipolar disorder is a broad diagnostic construct associated with significant phenotypic and genetic heterogeneity challenging progress in clinical practice and discovery research. Prospective studies of well-characterized patients and their family members have identified lithium responsive (LiR) and lithium non-responsive (LiNR) subtypes that hold promise for advancement. METHOD In this narrative review, relevant observations from published longitudinal studies of well-characterized bipolar patients and their families spanning six decades are highlighted. DSM diagnoses based on SADS-L interviews were decided in blind consensus reviews by expert clinicians. Genetic, neurobiological, and psychosocial factors were investigated in subsets of well-characterized probands and adult relatives. Systematic maintenance trials of lithium, antipsychotics, and lamotrigine were carried out. Clinical profiles that included detailed histories of the clinical course, symptom sets and disorders segregating in families were documented. Offspring of LiR and LiNR families were repeatedly assessed up to 20 years using KSADS-PL format interviews and DSM diagnoses and sub-threshold symptoms were decided by expert clinicians in blind consensus reviews using all available clinical and research data. RESULTS A characteristic clinical profile differentiated bipolar patients who responded to lithium stabilization from those who did not. The LiR subtype was characterized by a recurrent fully remitting course predominated by depressive episodes and a positive family history of episodic remitting mood disorders, and not schizophrenia. Response to lithium clustered in families and the characteristic clinical profile predicted lithium response, with the episodic remitting course being a strong correlate. There is accumulating evidence that genetic and neurobiological markers differ between LiR and LiNR subtypes. Further, offspring of bipolar parents subdivided by lithium response differed in developmental history, clinical antecedents and early course of mood disorders. Moreover, the nature of the emergent course bred true from parent to offspring, independent of the nature of emergent psychopathology. CONCLUSIONS Bipolar disorders are heterogeneous and response to long-term lithium is associated with a familial subtype with characteristic course, treatment response, family history and likely pathogenesis. Incorporating distinctive clinical profiles that index valid bipolar subtypes into routine practice and research will improve patient outcomes and advance the development and translation of novel treatment targets to improve prevention and early intervention.
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Affiliation(s)
- Anne Duffy
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Paul Grof
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Yonghao O, Yongyang W, Siqing Y, Chengchao F, Lihua C, xin L, Shuju T. Establishment of Prognosis Nomogram for Primary Splenic Diffuse Large B Cell Lymphoma: A Study Based on SEER Database. Indian J Hematol Blood Transfus 2024; 40:220-230. [PMID: 38708154 PMCID: PMC11065835 DOI: 10.1007/s12288-023-01706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 10/04/2023] [Indexed: 05/07/2024] Open
Abstract
Despite being the most common primary tumor of the spleen, in the past, few studies have predicted the prognosis of primary spleen diffuse large B cell lymphoma. This study aimed to establish a nomogram prediction model of overall survival in primary DLBCL of the spleen. We screened out 347 patients with primary splenic DLBCL from surveillance, epidemiology, and end results database. According to the Cox regression results (age, Ann Arbor Stage, splenectomy and chemotherapy was the independent risk factor for primary splenic DLBCL), the nomogram was constructed. We evaluated the predictive ability of nomogram with C-Index (training cohort: 0.719 [0.669-0.769]; validation cohort: 0.711 [0.641-0.781]) and 3-year/5-year receiver operating characteristic area under curve (3-year/5-year ROCAUC, training cohort: 0.731/0.742; validation cohort: 0.721/0.742). Calibratioin plot shows that our predicted values fluctuate around the actual value, indicating good agreement with nomogram. The decision curve analysis (DCA) results showed that our nomogram could benefit more than Ann Arbor Stage for predicts the prognosis of the primary splenic DLBCL. The Kaplan-Meier and landmark analysis showed that a great discrimination between high-risk group and low-risk group (P < 0.05) and indicating that our nomogram has the good ability to identify high-risk patients. In this study, a nomogram prediction model for primary spleen DLBCL was established, which has good ability of prediction and generalization. It can help clinicians carry out individualized treatment measures.
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Affiliation(s)
- Ouyang Yonghao
- Nanchang University, 461 Bayi Avenue, Nanchang, 330006 Jiangxi China
| | - Wei Yongyang
- Nanchang University, 461 Bayi Avenue, Nanchang, 330006 Jiangxi China
| | - Yi Siqing
- Nanchang University, 461 Bayi Avenue, Nanchang, 330006 Jiangxi China
| | - Fu Chengchao
- Nanchang University, 461 Bayi Avenue, Nanchang, 330006 Jiangxi China
| | - Chu Lihua
- Jinggangshan University, Ji’an, 3343000 China
| | - Liu xin
- Gannan Medical University, Ganzhou, 341000 China
| | - Tu Shuju
- Nanchang University, 461 Bayi Avenue, Nanchang, 330006 Jiangxi China
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Eidmann A, Lüdemann M, Raab P, Rudert M. [Individualized surgical treatment of sarcomas of the extremities]. Chirurgie (Heidelb) 2024; 95:288-293. [PMID: 38360873 DOI: 10.1007/s00104-024-02049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
Sarcomas of the extremities are rare entities, the treatment of which requires special expertise. Even if the treatment of patients is always interdisciplinary, the surgical R0 resection is the key point of each curatively intended treatment. In addition to resection in sano, the aim is to preserve the extremities and function, so that defect reconstruction after resection plays a decisive role. Due to the heterogeneity of tumors as well as their localization and extent, reconstruction is always an individually adapted treatment. Modular tumor endoprostheses are often used in this context, which can be constructed according to the size of the defect. The transplantation of autologous or allogeneic bone is also frequently used alone or as an additive procedure. Patient-specific (mega)prostheses are used particularly for pelvic tumors. Defect reconstruction using scaffold-based procedures from the field of tissue engineering is being tested as a promising procedure for the future. This article provides an overview of the treatment principles for sarcomas of the extremities and their individual reconstruction options.
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Affiliation(s)
- Annette Eidmann
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland.
| | - Martin Lüdemann
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland
| | - Peter Raab
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland
| | - Maximilian Rudert
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland
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6
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Li H, Liang J, Han M, Gao Z. Polyphenols synergistic drugs to ameliorate non-alcoholic fatty liver disease via signal pathway and gut microbiota: A review. J Adv Res 2024:S2090-1232(24)00091-2. [PMID: 38471648 DOI: 10.1016/j.jare.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease with an increasing incidence worldwide. Single drug therapy may have toxic side effects and disrupt gut microbiota balance. Polyphenols are widely used in disease intervention due to their distinctive nutritional properties and medicinal value, which a potential gut microbiota modulator. However, there is a lack of comprehensive review to explore the efficacy and mechanism of combined therapy with drugs and polyphenols for NAFLD. AIM OF REVIEW Based on this, this review firstly discusses the link between NAFLD and gut microbiota, and outlines the effects of polyphenols and drugs on gut microbiota. Secondly, it examined recent advances in the treatment and intervention of NAFLD with drugs and polyphenols and the therapeutic effect of the combination of the two. Finally, we highlight the underlying mechanisms of polyphenol combined drug therapy in NAFLD. This is mainly in terms of signaling pathways (NF-κB, AMPK, Nrf2, JAK/STAT, PPAR, SREBP-1c, PI3K/Akt and TLR) and gut microbiota. Furthermore, some emerging mechanisms such as microRNA potential biomarker therapies may provide therapeutic avenues for NAFLD. KEY SCIENTIFIC CONCEPTS OF REVIEW Drawing inspiration from combination drug strategies, the use of active substances in combination with drugs for NAFLD intervention holds transformative and prospective potential, both improve NAFLD and restore gut microbiota balance while reducing the required drug dosage. This review systematically discusses the bidirectional interactions between gut microbiota and NAFLD, and summarizes the potential mechanisms of polyphenol synergistic drugs in the treatment of NAFLD by modulating signaling pathways and gut microbiota. Future researches should develop multi-omics technology to identify patients who benefit from polyphenols combination drugs and devising individualized treatment plans to enhance its therapeutic effect.
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Affiliation(s)
- Hongcai Li
- College of Food Science and Engineering, Northwest A&F University, 712100 Yangling, Shaanxi, People's Republic of China
| | - Jingjing Liang
- College of Food Science and Engineering, Northwest A&F University, 712100 Yangling, Shaanxi, People's Republic of China
| | - Mengzhen Han
- College of Food Science and Engineering, Northwest A&F University, 712100 Yangling, Shaanxi, People's Republic of China
| | - Zhenpeng Gao
- College of Food Science and Engineering, Northwest A&F University, 712100 Yangling, Shaanxi, People's Republic of China.
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Huang X, Chen Y, Zeng D, Liang R, Liao Z, Wei G, Hao W, Lu W, Chen Y. Complete resorption of the humerus in metastatic thyroid carcinoma: a case report. BMC Musculoskelet Disord 2024; 25:177. [PMID: 38413955 PMCID: PMC10897982 DOI: 10.1186/s12891-024-07250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Thyroid carcinoma is the most common endocrinological malignancy, but its spread to bone is rare. Particularly, bone metastases leading to complete resorption of the humerus are extremely uncommon. We aimed to explore factors affecting treatment decision in humeral metastasis by presenting a case and analyze the possible treatments via conducting a literature review. CASE PRESENTATION We described a case of a 68-year-old woman experiencing chronic pain in her right upper arm for six years. Clinical, radiological, and pathological evaluations confirmed humeral metastasis from thyroid carcinoma. Surgical treatments like tumor removal or limb amputation were suggested for prolonging life and pain relief, but the patient refused them and pursued conservative managements such as herbal medicine, radioactive iodine (131I) therapy, and Levothyroxine Sodium(L-T4). The humeral destruction aggravated gradually, ultimately leading to complete resorption of her right humerus. The patient could not move her right shoulder, but her forearm motion was almost normal; thus, she could complete most of her daily living activities independently. Surgical treatments such as limb amputation were advised but she still refused them for preservation of the residual limb function and preferred conservative managements. CONCLUSION A personalized multidisciplinary approach is important for patients with bone metastasis. The balance between limb amputation for life-prolonging and pain relief and limb salvage for preservation of residual function and social and psychological well-being should be considered. Our literature review revealed that some novel surgical treatments and techniques are available for bone metastases. This case adds to our current understanding of bone metastases and will contribute to future research and treatments.
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Grants
- 82060406 National Natural Science Foundation of China
- 82060406 National Natural Science Foundation of China
- 82060406 National Natural Science Foundation of China
- 82060406 National Natural Science Foundation of China
- 82060406 National Natural Science Foundation of China
- 82060406 National Natural Science Foundation of China
- 82060406 National Natural Science Foundation of China
- 82060406 National Natural Science Foundation of China
- 82060406 National Natural Science Foundation of China
- 2022JJA141126 Natural Science Foundation of Guangxi
- 2022JJA141126 Natural Science Foundation of Guangxi
- 2022JJA141126 Natural Science Foundation of Guangxi
- 2022JJA141126 Natural Science Foundation of Guangxi
- 2022JJA141126 Natural Science Foundation of Guangxi
- 2022JJA141126 Natural Science Foundation of Guangxi
- 2022JJA141126 Natural Science Foundation of Guangxi
- 2022JJA141126 Natural Science Foundation of Guangxi
- 2022JJA141126 Natural Science Foundation of Guangxi
- 2019M650235 Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University, China Postdoctoral Science Foundation
- 2019M650235 Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University, China Postdoctoral Science Foundation
- 2019M650235 Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University, China Postdoctoral Science Foundation
- 2019M650235 Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University, China Postdoctoral Science Foundation
- 2019M650235 Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University, China Postdoctoral Science Foundation
- 2019M650235 Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University, China Postdoctoral Science Foundation
- 2019M650235 Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University, China Postdoctoral Science Foundation
- 2019M650235 Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University, China Postdoctoral Science Foundation
- 2019M650235 Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University, China Postdoctoral Science Foundation
- 2021003 Key R&D Project of Qingxiu District, Nanning, Guangxi
- 2021003 Key R&D Project of Qingxiu District, Nanning, Guangxi
- 2021003 Key R&D Project of Qingxiu District, Nanning, Guangxi
- 2021003 Key R&D Project of Qingxiu District, Nanning, Guangxi
- 2021003 Key R&D Project of Qingxiu District, Nanning, Guangxi
- 2021003 Key R&D Project of Qingxiu District, Nanning, Guangxi
- 2021003 Key R&D Project of Qingxiu District, Nanning, Guangxi
- 2021003 Key R&D Project of Qingxiu District, Nanning, Guangxi
- 2021003 Key R&D Project of Qingxiu District, Nanning, Guangxi
- Key R&D Project of Qingxiu District, Nanning, Guangxi
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Affiliation(s)
- Xiajie Huang
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yeping Chen
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Daofu Zeng
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rongyuan Liang
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhidong Liao
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guizheng Wei
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wenjun Hao
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - William Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Yan Chen
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
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Zhu HB, Zhao B, Li XT, Zhang XY, Yao Q, Sun YS. Value of multiple models of diffusion-weighted imaging to predict hepatic lymph node metastases in colorectal liver metastases patients. World J Gastroenterol 2024; 30:308-317. [PMID: 38313236 PMCID: PMC10835543 DOI: 10.3748/wjg.v30.i4.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND About 10%-31% of colorectal liver metastases (CRLM) patients would concomitantly show hepatic lymph node metastases (LNM), which was considered as sign of poor biological behavior and a relative contraindication for liver resection. Up to now, there's still lack of reliable preoperative methods to assess the status of hepatic lymph nodes in patients with CRLM, except for pathology examination of lymph node after resection. AIM To compare the ability of mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted imaging (DWI) models in distinguishing between benign and malignant hepatic lymph nodes in patients with CRLM who received neoadjuvant chemotherapy prior to surgery. METHODS In this retrospective study, 97 CRLM patients with pathologically confirmed hepatic lymph node status underwent magnetic resonance imaging, including DWI with ten b values before and after chemotherapy. Various parameters, such as the apparent diffusion coefficient from the mono-exponential model, and the true diffusion coefficient, the pseudo-diffusion coefficient, and the perfusion fraction derived from the intravoxel incoherent motion model, along with distributed diffusion coefficient (DDC) and α from the stretched-exponential model (SEM), were measured. The parameters before and after chemotherapy were compared between positive and negative hepatic lymph node groups. A nomogram was constructed to predict the hepatic lymph node status. The reliability and agreement of the measurements were assessed using the coefficient of variation and intraclass correlation coefficient. RESULTS Multivariate analysis revealed that the pre-treatment DDC value and the short diameter of the largest lymph node after treatment were independent predictors of metastatic hepatic lymph nodes. A nomogram combining these two factors demonstrated excellent performance in distinguishing between benign and malignant lymph nodes in CRLM patients, with an area under the curve of 0.873. Furthermore, parameters from SEM showed substantial repeatability. CONCLUSION The developed nomogram, incorporating the pre-treatment DDC and the short axis of the largest lymph node, can be used to predict the presence of hepatic LNM in CRLM patients undergoing chemotherapy before surgery. This nomogram was proven to be more valuable, exhibiting superior diagnostic performance compared to quantitative parameters derived from multiple b values of DWI. The nomogram can serve as a preoperative assessment tool for determining the status of hepatic lymph nodes and aiding in the decision-making process for surgical treatment in CRLM patients.
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Affiliation(s)
- Hai-Bin Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Bo Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Qian Yao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
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Böttinger BW, Aggensteiner PM, Hohmann S, Heintz S, Ruf M, Glennon J, Holz NE, Banaschewski T, Brandeis D, Baumeister S. Exploring real-time functional magnetic resonance imaging neurofeedback in adolescents with disruptive behavior disorder and callous unemotional traits. J Affect Disord 2024; 345:32-42. [PMID: 37852585 DOI: 10.1016/j.jad.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Adolescents with increased callous unemotional traits (CU traits) in the context of disruptive behavior disorder (DBD) show a persistent pattern of antisocial behavior with shallow affect and a lack of empathy or remorse. The amygdala and insula as regions commonly associated with emotion processing, empathy and arousal are implicated in DBD with high CU traits. While behavioral therapies for DBD provide significant but small effects, individualized treatments targeting the implicated brain regions are missing. METHODS In this explorative randomized controlled trial we randomly assigned twenty-seven adolescents with DBD to individualized real-time functional magnetic resonance neurofeedback (rtfMRI-NF) or behavioral treatment as usual (TAU). Visual feedback of either amygdala or insula activity was provided during rtfMRI-NF by gauges and included a simple and concurrent video run plus a transfer run. A linear mixed model (LMM) was applied to determine improvement of self-regulation. Specificity was assessed by correlating individual self-regulation improvement with clinical outcomes. RESULTS The rtfMRI-NF (n = 11) and TAU (n = 10) completers showed comparable and significant clinical improvement indicating neither superiority nor inferiority of rtfMRI-NF. The exploratory LMM revealed successful learning of self-regulation along the course of training for participants who received feedback from the amygdala. A significant exploratory correlation between individual target region activity in the simple run and clinical improvement was found for one dimension of DBD. CONCLUSIONS This exploratory study demonstrated feasibility and suggests clinical efficacy of individualized rtfMRI-NF comparable to active TAU for adolescents with DBD and increased CU traits. Further studies are needed to confirm efficacy, specificity and to clarify underlying learning mechanisms.
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Affiliation(s)
- Boris W Böttinger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Pascal-M Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Heintz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Matthias Ruf
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jeffrey Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands; Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
| | - Nathalie E Holz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, the Netherlands; Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands; Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH, Zurich, Zurich, Switzerland
| | - Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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Zhang L, Zeng J, Yao Z. Surgical management of tuberous sclerosis complex with big fat-poor bilateral renal angiomyolipomas: A case report. Int J Surg Case Rep 2023; 113:109060. [PMID: 37979555 PMCID: PMC10685003 DOI: 10.1016/j.ijscr.2023.109060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 11/20/2023] Open
Abstract
INTRODUCTION Tuberous sclerosis complex (TSC) is an autosomal dominant disease that affects multiple organs. Medical therapy with the mTOR inhibitor everolimus has become the first option in patients with angiomyolipomas. But mTOR inhibitor treatment shows no effect in some patients, in the case, surgery is a suitable method for treatment. PRESENTATION OF CASE A 30-year-old Chinese male patient received an ultrasound examination of the kidney, which showed bilateral hyperechogenic structures without stones or ureterohydronephrosis. A computed tomography (CT) scan of the kidneys showed multiple slightly high-density masses (largest size: left 6.5 cm, right 5.2 cm), and the masses lacking of lipids were obviously enhanced in the arterial phase. To clarify the components of the tumors, we performed retroperitoneal laparoscopic tumor enucleation to remove all visible masses in left kidney. The pathological results and genetic tests confirmed the diagnosis of TSC. For reducing the further spontaneously bleeding risk and the cost burden, the right renal tumors were also enucleated. Twelve months after the second operation, renal function remained normal, and no tumors were detected by CT. DISCUSSION Large angiomyolipomas (>4 cm in diameter) may develop life-threatening hemorrhage or compress normal kidney tissue. Fat-poor renal angiomyolipomas are difficult for making a differential diagnosis from renal cancer or renal sarcomatoid carcinoma. When medication treatment does not work, surgery is a good option to diagnose and treat big bilateral renal angiomyolipomas. CONCLUSION After 12 months of follow-up, retroperitoneal laparoscopic tumor enucleation may be a safe and effective method for treating big fat-poor renal angiomyolipomas in patients with TSC.
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Affiliation(s)
- Long Zhang
- Department of Urology, the People's Hospital of Jiulongpo District, 400050 Chongqing, China.
| | - Jiayuan Zeng
- Department of Urology, the People's Hospital of Jiulongpo District, 400050 Chongqing, China
| | - Zhilin Yao
- Department of Urology, the People's Hospital of Jiulongpo District, 400050 Chongqing, China
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11
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Liu W, Xia K, Zheng D, Huang X, Wei Z, Wei Z, Guo W. Construction of a prognostic risk score model based on the ARHGAP family to predict the survival of osteosarcoma. BMC Cancer 2023; 23:1179. [PMID: 38041020 PMCID: PMC10693137 DOI: 10.1186/s12885-023-11673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Osteosarcoma (OS) is the most common primary malignancy of bone tumors. More and more ARHGAP family genes have been confirmed are to the occurrence, development, and invasion of tumors. However, its significance in osteosarcoma remains unclear. In this study, we aimed to identify the relationship between ARHGAP family genes and prognosis in patients with OS. METHODS OS samples were retrieved from the TCGA and GEO databases. We then performed LASSO regression analysis and multivariate COX regression analysis to select ARHGAP family genes to construct a risk prognosis model. We then validated this prognostic model. We utilized ESTIMATE and CIBERSORT algorithms to calculate the stroma and immune scores of samples, as well as the proportions of tumor infiltrating immune cells (TICs). Finally, we conducted in vivo and in vitro experiments to investigate the effect of ARHGAP28 on osteosarcoma. RESULTS We selected five genes to construct a risk prognosis model. Patients were divided into high- and low-risk groups and the survival time of the high-risk group was lower than that of the low-risk group. The high-risk group in the prognosis model constructed had relatively poor immune function. GSEA and ssGSEA showed that the low-risk group had abundant immune pathway infiltration. The overexpression of ARHGAP28 can inhibit the proliferation, migration, and invasion of osteosarcoma cells and tumor growth in mice, and IHC showed that overexpression of ARHGAP28 could inhibit the proliferation of tumor cells. CONCLUSION We constructed a risk prognostic model based on five ARHGAP family genes, which can predict the overall survival of patients with osteosarcoma, to better assist us in clinical decision-making and individualized treatment.
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Affiliation(s)
- Wenda Liu
- Department of Orthopaedics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China, Hubei Province
| | - Kezhou Xia
- Department of Orthopaedics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China, Hubei Province
| | - Di Zheng
- Department of Orthopaedics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China, Hubei Province
| | - Xinghan Huang
- Department of Orthopaedics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China, Hubei Province
| | - Zhun Wei
- Department of Orthopaedics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China, Hubei Province
| | - Zicheng Wei
- Department of Orthopaedics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China, Hubei Province
| | - Weichun Guo
- Department of Orthopaedics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China, Hubei Province.
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12
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Wang H, Yan L, Liu L, Lu X, Chen Y, Zhang Q, Chen M, Cai L, Dai Z. A pyroptosis gene-based prognostic model for predicting survival in low-grade glioma. PeerJ 2023; 11:e16412. [PMID: 38025749 PMCID: PMC10652862 DOI: 10.7717/peerj.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Background Pyroptosis, a lytic form of programmed cell death initiated by inflammasomes, has been reported to be closely associated with tumor proliferation, invasion and metastasis. However, the roles of pyroptosis genes (PGs) in low-grade glioma (LGG) remain unclear. Methods We obtained information for 1,681 samples, including the mRNA expression profiles of LGGs and normal brain tissues and the relevant corresponding clinical information from two public datasets, TCGA and GTEx, and identified 45 differentially expressed pyroptosis genes (DEPGs). Among these DEPGs, nine hub pyroptosis genes (HPGs) were identified and used to construct a genetic risk scoring model. A total of 476 patients, selected as the training group, were divided into low-risk and high-risk groups according to the risk score. The area under the curve (AUC) values of the receiver operating characteristic (ROC) curves verified the accuracy of the model, and a nomogram combining the risk score and clinicopathological characteristics was used to predict the overall survival (OS) of LGG patients. In addition, a cohort from the Gene Expression Omnibus (GEO) database was selected as a validation group to verify the stability of the model. qRT-PCR was used to analyze the gene expression levels of nine HPGs in paracancerous and tumor tissues from 10 LGG patients. Results Survival analysis showed that, compared with patients in the low-risk group, patients in the high-risk group had a poorer prognosis. A risk score model combining PG expression levels with clinical features was considered an independent risk factor. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses indicated that immune-related genes were enriched among the DEPGs and that immune activity was increased in the high-risk group. Conclusion In summary, we successfully constructed a model to predict the prognosis of LGG patients, which will help to promote individualized treatment and provide potential new targets for immunotherapy.
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Affiliation(s)
- Hua Wang
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lin Yan
- Department of Breast Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lixiao Liu
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Xianghe Lu
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yingyu Chen
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qian Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mengyu Chen
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lin Cai
- Department of Neurosurgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhang’an Dai
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Matsushita K, Ito J, Isaka A, Higuchi S, Minamishima T, Sakata K, Satoh T, Soejima K. Predicting readmission for heart failure patients by echocardiographic assessment of elevated left atrial pressure. Am J Med Sci 2023; 366:360-366. [PMID: 37562544 DOI: 10.1016/j.amjms.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 04/10/2023] [Accepted: 08/05/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Pathophysiologically, an elevated left ventricular (LV) filling pressure is the major reason for heart failure (HF) readmission. The 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines provide a simplified algorithm for the echocardiographic assessment of LV filling pressure; however, this algorithm is yet to be sufficiently validated. MATERIALS AND METHODS We retrospectively studied 139 consecutive patients with acute decompensated HF. High estimated left atrial pressure (eLAP) was defined according to the 2016 ASE/EACVI guidelines. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for HF readmission within one year of discharge. RESULTS Across the study cohort, 68 patients (49%) did not have a high eLAP, 32 (23%) had an indeterminate eLAP, and 39 (28%) had a high eLAP. The number of HF readmission events within one year in the without high eLAP, indeterminate, and high eLAP groups were 4 (7.5%), 5 (18.5%), and 10 (33.3%), respectively. The HF readmission rate was significantly higher in patients with high eLAP than in those without high eLAP. Multivariate analysis revealed high eLAP (odds ratio, 5.924; 95% confidence interval, 1.664-21.087; P = 0.006) as a significant risk factor for HF readmission within one year. Furthermore, the exploratory analysis of the two-year outcomes revealed a similar finding: patients with high eLAP had a significantly higher rate of readmission for HF. CONCLUSIONS The present study demonstrated that echocardiographic assessment of elevated LAP based on the 2016 ASE/EACVI guidelines is clinically valid for predicting readmission in patients with HF.
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Affiliation(s)
- Kenichi Matsushita
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan; Division of Advanced Cardiovascular Therapeutics, Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto 860-8556, Japan; Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; The Maruki Memorial Medical and Social Welfare Center, Saitama 350-0495, Japan; National Research Institute for Child Health and Development, Tokyo 157-8535, Japan.
| | - Junnosuke Ito
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Aoi Isaka
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Satoshi Higuchi
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Toshinori Minamishima
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Konomi Sakata
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Toru Satoh
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
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Ji P, Lu Q, Chen X, Chen Y, Peng X, Chen Z, Lin C, Lin S, Zong J. Individualized Concurrent Chemotherapy for Patients with Stage III-IVa Nasopharyngeal Carcinoma Receiving Neoadjuvant Chemotherapy Combined with Definitive Intensity-Modulated Radiotherapy. Cancer Res Treat 2023; 55:1113-1122. [PMID: 37170497 PMCID: PMC10582526 DOI: 10.4143/crt.2022.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/10/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE This retrospective study aimed to re-evaluate the effect of concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS A total of 498 patients who received neoadjuvant chemotherapy (NCT) combined with concurrent chemoradiotherapy (CCRT) or IMRT were retrospectively reviewed. The distribution of baseline characteristics was balanced using propensity score matching. Additionally, the results of NCT+IMRT and NCT+CCRT were compared using Kaplan-Meier survival analysis, and differences in survival rates were analyzed using the log rank test. RESULTS There were no significant differences in overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and local progression-free survival (LRFS) between the two groups. Patients were further categorized into risk subgroups based on pretreatment Epstein-Barr virus (EBV) DNA cutoff values using receiver operating characteristic curve analysis. There were no statistically significant differences in OS, PFS, DMFS, and LRFS between patients who received NCT+CCRT and NCT+IMRT in the high-risk group. In the low-risk group, although there were no differences between NCT+CCRT and NCT+IMRT in OS, PFS, and LRFS, patients who received NCT+CCRT had better DMFS than those who received NCT+IMRT. CONCLUSION Pretreatment EBV DNA level can be used to individualize concurrent chemotherapy for patients with locally advanced NPC. Patients with low pretreatment EBV DNA levels may benefit from concurrent chemotherapy, whereas those with high levels may not. Other treatment modalities need to be explored for high-risk patients to improve their prognosis.
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Affiliation(s)
- Pengjie Ji
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian,
China
| | - Qiongjiao Lu
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian,
China
| | - Xiaoqiang Chen
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fujian,
China
| | - Yuebing Chen
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian,
China
| | - Xiane Peng
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fujian,
China
| | - Zhiwei Chen
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fujian,
China
- Fuzhou Center for Disease Control and Prevention, Fuzhou, Fujian,
China
| | - Cheng Lin
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian,
China
| | - Shaojun Lin
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian,
China
- Fujian Key Laboratory of Translational Cancer Medicine, Fujian,
China
| | - Jingfeng Zong
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian,
China
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Hao Y, Zhong L. Feasibility study on individualized management of postoperative patients with differentiated thyroid cancer based on internet and programming technology. J Cancer Res Clin Oncol 2023; 149:12405-12412. [PMID: 37438541 DOI: 10.1007/s00432-023-05078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE To explore the feasibility of individualized management of postoperative patients with differentiated thyroid cancer by a mode based on internet and programming technology. METHODS The enrolled patients were randomly divided into the study group and the control group. The study group used a mobile application to collect patient information, evaluate the risk of thyroid cancer recurrence and levothyroxine medication risk, develop individual thyrotropin control targets, and push levothyroxine adjustment recommendations to patients. In the control group, the traditional outpatient follow-up mode was used. RESULTS Two hundred patients were randomly divided into the study group and the control group at a 1:1 ratio. There was no significant difference in the physical and chemical indices between the two groups at baseline. During the 1-year follow-up, there was no significant difference in the thyrotropin attainment rate, heart rate or bone mineral density between the study group and the control group. During the 2-year follow-up, the thyrotropin attainment rate of the study group was better than that of the control group. The total score of Symptom Checklist 90 of the study group was lower than the control group, and satisfaction with the treatment was significantly higher than that of the control group. CONCLUSION The management based on the internet and programming technology is not inferior to the traditional outpatient follow-up mode, and is beneficial to improve patients' quality of life, promote the implementation of the national graded diagnosis and treatment system and the grassroots management of chronic diseases.
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Affiliation(s)
- Yabin Hao
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, No. 119 Nansihuan West Road, Fengtai District, Beijing, 100070, China
- Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - LiYong Zhong
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, No. 119 Nansihuan West Road, Fengtai District, Beijing, 100070, China.
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Wang L, Zhu L, Yan J, Qin W, Wang C, Xi W, Xu Z, Chen Y, Jiang J, Huang S, Yan C, Zhang H, Pan Z, Zhang J. CT-Based Radiomic Score: A Risk Stratifier in Far-Advanced Gastric Cancer Patients. Acad Radiol 2023; 30 Suppl 1:S220-S229. [PMID: 36610930 DOI: 10.1016/j.acra.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/12/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To prolong the survival, the value of a computed tomography-based radiomic score (RS) in stratifying survival and guiding personalized chemotherapy strategies in far-advanced gastric cancer (FGC) was investigated. MATERIALS AND METHODS This retrospective multicenter study enrolled 283 FGC patients (cT4a/bNxM0-1) from three centers. Patients from one center were randomly divided into the training (n = 166) and internal validation (n = 83) cohorts, whereas the external validation cohort (n = 34) consisted of patients from the two other centers. The RS was calculated for each patient to predict progression-free survival (PFS). Features from the primary tumor and main metastasis (peritoneum, liver, and lymph node) were integrated in the training cohort and then validated for its ability to stratify PFS and overall survival (OS) in the validation cohort. The association between the RS and efficacy of neoadjuvant intraperitoneal and systemic (NIPS) therapy was also explored. RESULTS The RS demonstrated a favorable prognostic ability to predict PFS in all cohorts (training: C-index 0.83, 95% confidence interval [CI]: 0.788-0.872; internal validation: C-index 0.75, 95% CI: 0.682-0.818; external validation: C-index 0.76, 95% CI: 0.669-0.851; all p < 0.05), as well as an excellent ability to stratify the PFS and OS in both the whole population and metastatic subgroups (p < 0.05). Patients with a low score were more likely to undergo surgery after perioperative chemotherapy (p < 0.05). Furthermore, only high-scoring patients with peritoneal metastasis benefited from NIPS. CONCLUSION The RS may be an effective risk stratifier for the outcomes of FGC patients and may be used to select patients who can benefit from NIPS therapy.
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Affiliation(s)
- Lan Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Yan
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Wenxing Qin
- Department of Oncology, Changzheng Hospital, Shanghai, China
| | - Chun Wang
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Wenqi Xi
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, China
| | - Zhihan Xu
- Department of DI CT Collaboration, Siemens Healthineers Ltd, Shanghai, China
| | - Yong Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Jiang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shixing Huang
- Department of Cardiovascular surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Yan
- Department of General Surgery, Gastrointestinal Surgery Unit, Ruijin Hospital, Shanghai, China
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zilai Pan
- Department of Radiology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, China.
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Zhang M, Zhang X, Ma T, Wang C, Zhao J, Gu Y, Zhang Y. Precise subtyping reveals immune heterogeneity for hormone receptor-positive breast cancer. Comput Biol Med 2023; 163:107222. [PMID: 37413851 DOI: 10.1016/j.compbiomed.2023.107222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/18/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
A significant proportion of breast cancer cases are characterized by hormone receptor positivity (HR+). Clinically, the heterogeneity of HR+ breast cancer leads to different therapeutic effects on endocrine. Therefore, definition of subgroups in HR+ breast cancer is important for effective treatment. Here, we have developed a CMBR method utilizing computational functional networks based on DNA methylation to identify conserved subgroups in HR+ breast cancer. Calculated by CMBR, HR+ breast cancer was divided into five subgroups, of which HR+/negative epidermal growth factor receptor-2 (Her2-) was divided into two subgroups, and HR+/positive epidermal growth factor receptor-2 (Her2+) was divided into three subgroups. These subgroups had heterogeneity in the immune microenvironment, tumor infiltrating lymphocyte patterns, somatic mutation patterns and drug sensitivity. Specifically, CMBR identified two subgroups with the "Hot" tumor phenotype. In addition, these conserved subgroups were broadly validated on external validation datasets. CMBR identified the molecular signature of HR+ breast cancer subgroups, providing valuable insights into personalized treatment strategies and management options.
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Affiliation(s)
- Mengyan Zhang
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150001, China
| | - Xingda Zhang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150081, China
| | - Te Ma
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150001, China
| | - Cong Wang
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150001, China
| | - Jiyun Zhao
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150001, China
| | - Yue Gu
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150001, China
| | - Yan Zhang
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150001, China; College of Pathology, Qiqihar Medical University, Qiqihar, 161042, China.
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Xiang M, Gao Y, Zhou Y, Wang M, Yao X. A novel nomogram based on cell cycle-related genes for predicting overall survival in early-onset colorectal cancer. BMC Cancer 2023; 23:595. [PMID: 37370046 DOI: 10.1186/s12885-023-11075-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Although the incidence of late-onset colorectal cancer (LOCRC) has decreased, the incidence of early-onset colorectal cancer (EOCRC) is still rising dramatically. Heterogeneity in the genomic, biological, and clinicopathological characteristics between EOCRC and LOCRC has been revealed. Therefore, the previous prognostic models based on the total CRC patient population might not be suitable for EOCRC patients. Here, we constructed a prognostic classifier to enhance the precision of individualized treatment and management of EOCRC patients. METHODS EOCRC expression data were downloaded from the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) databases. The regulatory pathways were explored by gene set enrichment analysis (GSEA). The prognostic model was developed by univariate Cox-LASSO-multivariate Cox regression analyses of GEO samples. TCGA samples were used to verify the model. The expression and mutation profiles and immune landscape of the high-risk and low-risk cohorts were analyzed and compared. Finally, the expression and prognostic value of the model genes were verified by immunohistochemistry and qRT‒PCR analysis. RESULTS The cell cycle was identified as the most significantly enriched oncological signature of EOCRC. Then, a 4-gene prognostic signature comprising MCM2, INHBA, CGREF1, and KLF9 was constructed. The risk score was an independent predictor of overall survival. The area under the curve values of the classifier for 1-, 3-, and 5-year survival were 0.856, 0.893, and 0.826, respectively, in the training set and 0.749, 0.858, and 0.865, respectively, in the validation set. Impaired DNA damage repair capability (p < 0.05) and frequent PIK3CA mutations (p < 0.05) were found in the high-risk cohort. CD8 T cells (p < 0.05), activated memory CD4 T cells (p < 0.01), and activated dendritic cells (p < 0.05) were clustered in the low-risk group. Finally, we verified the expression of MCM2, INHBA, CGREF1, and KLF9. Their prognostic value was closely related to age. CONCLUSION In this study, a robust prognostic classifier for EOCRC was established and validated. The findings may provide a reference for individualized treatment and medical decision-making for patients with EOCRC.
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Affiliation(s)
- Meijuan Xiang
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
- Department of General Surgery, Guangdong Provincial People's Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, 341000, China
- Department of General Surgery, Foresea Life Insurance Shaoguan Hospital, Shaoguan, 512000, China
| | - Yuan Gao
- Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
- Department of General Surgery, Guangdong Provincial People's Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, 341000, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Yue Zhou
- Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
- Department of General Surgery, Guangdong Provincial People's Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, 341000, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Muqing Wang
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Xueqing Yao
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.
- Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
- Department of General Surgery, Guangdong Provincial People's Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, 341000, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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Mansani FP, Freitas-Junior R. Validation of the 70-gene signature test (MammaPrint) to identify patients with breast cancer aged ≥70 years with ultralow risk of distant recurrence: A population-based cohort study. J Geriatr Oncol 2023:101526. [PMID: 37225532 DOI: 10.1016/j.jgo.2023.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
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王 汐, 程 超, 刘 大, 陈 燕, 官 鑫. [Preliminary analysis of the effect of individualized voice therapy on pediatric voice disorders]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:350-353. [PMID: 37138396 PMCID: PMC10495782 DOI: 10.13201/j.issn.2096-7993.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 05/05/2023]
Abstract
Objective:To determine the effectiveness of individualized voice therapy in persistent pediatric voice disorders. Methods:Thirty-eight children who were admitted to the Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University due to persistent voice disorder from November 2021 to October 2022 were included. All children were evaluated by dynamic laryngoscopy before voice therapy. Two voice doctors performed GRBAS score and acoustic analysis on the children's voice samples to obtain the relevant parameters including F0, Jitter, Shimmer, and MPT; All children were given personalized voice therapy for 8 weeks. Results:Among 38 children with voice disorders, 75.8%(29 cases) were diagnosed with vocal nodules, 20.6%(8 cases) were vocal polyps, and 3.4%(1 case) were vocal cysts. And in all children. And 51.7%(20 cases) had the sign of supraglottic extrusion under dynamic laryngoscopy. GRBAS scores decreased from 1.93 ± 0.62, 1.82 ± 0.55, 0.98 ± 0.54, 0.65 ± 0.48, 1.05 ± 0.52 to 0.62 ± 0.60, 0.58 ± 0.53, 0.32 ± 0.40, 0.22 ± 0.36, 0.37 ± 0.36. F0, Jitter, Shimmer decreased from(243.11±39.73) Hz, (0.85±0.99)%, (9.96±3.78)% to(225.43±43.20) Hz, (0.33±0.57)%, (7.72±4.32)%, respectively MPT was prolonged from(5.82±2.30) s to(7.87±3.21) s after treatment. All parameters changes had statistical significance. Conclusion:Voice therapy can solve children's voice problems, improve their voice quality and effectively treat children's voice disorders.
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Affiliation(s)
- 汐 王
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University, Shenzhen, 518000, China
| | - 超 程
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University, Shenzhen, 518000, China
| | - 大波 刘
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University, Shenzhen, 518000, China
| | - 燕红 陈
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University, Shenzhen, 518000, China
| | - 鑫 官
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University, Shenzhen, 518000, China
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21
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Nunn K, Vallila-Rohter S. Theory-driven treatment modifications: A discussion on meeting the linguistic, cognitive, and psychosocial needs of individual clients with aphasia. J Commun Disord 2023; 103:106327. [PMID: 37060857 PMCID: PMC10247540 DOI: 10.1016/j.jcomdis.2023.106327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/17/2023] [Accepted: 04/07/2023] [Indexed: 06/03/2023]
Abstract
There is a growing body of literature demonstrating that language rehabilitation can improve naming impairments for individuals with aphasia. However, there are challenges applying evidence-based research to clinical practice. Well-controlled clinical studies often consist of homogenous samples and exclude individuals who may confound group-level results. Consequently, the findings may not generalize to the diverse clients serviced by speech-language therapists. Within evidence-based guidelines, clinicians can leverage their experiences and theoretical rationale to adapt interventions to meet the needs of individual clients. However, modifications to evidence-based interventions should not alter aspects of treatment that are necessary to produce change within the treatment target. The current discussion paper uses errorless learning, errorful learning, and retrieval practice for naming in aphasia to model how treatment theories can guide clinicians in making theory-informed modifications to interventions. First, we briefly describe the learning mechanisms hypothesized to underlie errorless learning, errorful learning, and retrieval practice. Next, we identify ways clinicians can provide targeted supports to optimize learning for individual clients. The paper ends with a reflection on how well-defined treatment theories can facilitate the generation of practice-based evidence and clinically relevant decision making.
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Affiliation(s)
- Kristen Nunn
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA.
| | - Sofia Vallila-Rohter
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
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22
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Hansen MS, Bencke J, Kristensen MT, Kallemose T, Hölmich P, Barfod KW. Achilles tendon gait dynamics after rupture: A three-armed randomized controlled trial comparing an individualized treatment algorithm vs. operative or non-operative treatment. Foot Ankle Surg 2023; 29:143-150. [PMID: 36528540 DOI: 10.1016/j.fas.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Individual treatment selection has been proposed as the key to optimized treatment. The purpose was to investigate if treatment selection using the individualized treatment algorithm Copenhagen Achilles Rupture Treatment Algorithm (CARTA) differs between patients treated as usual regarding gait dynamics and tendon elongation. METHODS The patients were randomized to one of three parallel groups: 1) intervention group: participants treated according to CARTA, 2) control group: participants treated non-operatively, 3) control group: participants treated operatively. The primary outcome was ankle peak power during push off during walking at 12 months. RESULTS 156 patients were assessed for eligibility. 21 were allocated to the intervention group, and 20 and 19 to the control groups. The results indicated no statistically significant differences between the intervention group and the control groups. CONCLUSIONS Individualized treatment selection based on CARTA did not demonstrate less affected gait dynamics or less tendon elongation than patients treated as usual.
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Affiliation(s)
- Maria Swennergren Hansen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Denmark; Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital Amager-Hvidovre, Denmark.
| | - Jesper Bencke
- Human Movement Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Denmark.
| | - Morten Tange Kristensen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Denmark.
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Denmark.
| | - Kristoffer Weisskirchner Barfod
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Denmark.
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23
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Wu Y, Du B, Lv C, Ji X, Lai J. LAPS score for individualized treatment of advanced EGFR-mutated non-small cell lung cancer receiving EGFR-TKIs with or without bevacizumab. Ann Med 2023; 55:2257227. [PMID: 37713583 PMCID: PMC10506427 DOI: 10.1080/07853890.2023.2257227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND To establish a risk stratification score to facilitate individualized treatment for patients with advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC). METHODS We enrolled 160 advanced EGFR-mutated NSCLC who received first-generation EGFR-tyrosine kinase inhibitor (EGFR-TKI) with or without bevacizumab. Kaplan-Meier curves were used for survival analysis. Univariate and multivariate analyses were used to identify independent prognostic factors associated with progression-free survival (PFS) and overall survival (OS). RESULTS There were 107 patients in EGFR-TKI monotherapy (T group) and 53 patients in EGFR-TKI with bevacizumab (A + T group). The median PFS in the A + T group was significantly longer than that in the T group (p = 0.002). No difference in the median OS between the A + T and T groups (p = 0.721). The multivariate analyses showed that Eastern Cooperative Oncology Group performance status (ECOG PS) and the pre-treatment lactate dehydrogenase-albumin ratio (LAR) were independent prognostic factors for PFS and OS. The LAR-ECOG PS (LAPS) score was constructed by combining the pre-treatment LAR and ECOG PS. We defined ECOG PS 2 and high pre-treatment LAR as a score of 1. Then, patients with a total LAPS score of 0 were categorized as low-risk and those with 1-2 scores were classified as high-risk. For patients in low-risk group, there was no significant difference in PFS, OS, objective response rate (ORR), and disease control rate (DCR) among those who received EGFR-TKI with or without bevacizumab. However, patients in high-risk group had a significant benefit in PFS and DCR when treated with EGFR-TKI plus bevacizumab compared to those who received EGFR-TKI alone. CONCLUSIONS Novel LAPS score may help to facilitate individualized treatment of advanced EGFR-mutated NSCLC receiving EGFR-TKI with or without bevacizumab.
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Affiliation(s)
- Yahua Wu
- Department of Medical Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Bin Du
- Department of Medical Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Chengliu Lv
- Department of Medical Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Xiaohui Ji
- Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, P.R. China
| | - Jinhuo Lai
- Department of Medical Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
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24
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Kouijzer IJE, Fowler VG, Ten Oever J. Redefining Staphylococcus aureus bacteremia: A structured approach guiding diagnostic and therapeutic management. J Infect 2023; 86:9-13. [PMID: 36370898 PMCID: PMC11105116 DOI: 10.1016/j.jinf.2022.10.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/20/2022] [Accepted: 10/23/2022] [Indexed: 11/11/2022]
Abstract
The current duration of therapy in patients with Staphylococcus aureus bacteremia (SAB) is based on differentiating complicated from uncomplicated disease. While this approach allows clinicians and investigators to group SAB patients into broadly similar clinical categories, it fails to account for the intrinsic heterogeneity of SAB. This is due in part to the fact that risk factors for metastatic infection and confirmed metastatic infection are considered as equivalent in most scoring systems. In this viewpoint, we propose a two-step system of categorizing patients with SAB. Initially, patients with SAB would be categorized as 'high risk' or 'low risk' for metastatic infection based upon an initial set of diagnostic procedures. In the second step, patients identified as 'high-risk' would undergo additional diagnostic evaluation. The results of this stepwise diagnostic evaluation would define a 'final clinical diagnosis' to inform an individualized final treatment plan.
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Affiliation(s)
- Ilse J E Kouijzer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - Vance G Fowler
- Department of Medicine, Duke University, Durham North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jaap Ten Oever
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands.
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Sun X, Liu X, Zhao Y, Tian G, Wang W. Detection of Circulating Tumor DNA in Plasma Using Targeted Sequencing. Methods Mol Biol 2023; 2695:27-46. [PMID: 37450110 DOI: 10.1007/978-1-0716-3346-5_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Cell-free DNA (cfDNA) is the degradation product of extracellular DNA. Circulating tumor DNA (ctDNA), as a fraction of cfDNA, comes from tumor cells and contains variations, including mutation, deletion, insertion, rearrangement, copy number variation, and methylation. Therefore, biomarkers identified in ctDNA show promising clinical applications in early diagnosis, recurrence monitoring, and conducting individualized treatment. In this chapter, we introduce experimental workflow and bioinformatic pipeline of targeted sequencing of cfDNA.
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Debus ES, von Kodolitsch Y, Behrendt CA, Kölbel T, Sachweh A, Preuß M. [Vascular surgery in old people]. Chirurgie (Heidelb) 2023; 94:10-16. [PMID: 36459217 DOI: 10.1007/s00104-022-01770-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 12/05/2022]
Abstract
The age pyramid in Germany is upside down. According to the Federal Statistical Office this development will continue in the coming years, which presents a challenge for surgeons to surgically treat increasingly more and increasingly older people. Particularly in vascular surgery, which is a surgery of old people, this fact represents a special challenge. The frailty of old people is, among other things, due to a series of comorbidities, which must be taken into consideration within the framework of surgical treatment. They can have an important influence on the perioperative planning, the operation, the postoperative treatment and the outcome of the patient. This treatment planning becomes more and more challenging, because due to the progress in endovascular surgery there will soon be no limits to what is feasible; however, the question arises whether the feasible is also reasonable? Within the scope of this article the authors try to give answers to the treatment of old patients in vascular surgery and to find strategies for planning and to establish an individualized optimal treatment.
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Affiliation(s)
- E S Debus
- Klinik und Poliklinik für Gefäßmedizin (Gefäßchirurgie - Angiologie - Endovaskuläre Therapie), Universitären Herzzentrum Hamburg-Eppendorf, Deutsches Aortenzentrum des Universitären Herzzentrums Hamburg, Gebäude O70, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Y von Kodolitsch
- Klinik und Poliklinik für Gefäßmedizin (Gefäßchirurgie - Angiologie - Endovaskuläre Therapie), Universitären Herzzentrum Hamburg-Eppendorf, Deutsches Aortenzentrum des Universitären Herzzentrums Hamburg, Gebäude O70, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Ch-A Behrendt
- Klinik und Poliklinik für Gefäßmedizin (Gefäßchirurgie - Angiologie - Endovaskuläre Therapie), Universitären Herzzentrum Hamburg-Eppendorf, Deutsches Aortenzentrum des Universitären Herzzentrums Hamburg, Gebäude O70, Martinistraße 52, 20246, Hamburg, Deutschland
| | - T Kölbel
- Klinik und Poliklinik für Gefäßmedizin (Gefäßchirurgie - Angiologie - Endovaskuläre Therapie), Universitären Herzzentrum Hamburg-Eppendorf, Deutsches Aortenzentrum des Universitären Herzzentrums Hamburg, Gebäude O70, Martinistraße 52, 20246, Hamburg, Deutschland
| | - A Sachweh
- Universitäres Herz- und Gefäßzentrum, UKE Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Preuß
- Klinik und Poliklinik für Gefäßmedizin (Gefäßchirurgie - Angiologie - Endovaskuläre Therapie), Universitären Herzzentrum Hamburg-Eppendorf, Deutsches Aortenzentrum des Universitären Herzzentrums Hamburg, Gebäude O70, Martinistraße 52, 20246, Hamburg, Deutschland
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27
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Noordhoek I, Bastiaannet E, de Glas NA, Scheepens J, Esserman LJ, Wesseling J, Scholten AN, Schröder CP, Elias SG, Kroep JR, Portielje JEA, Kleijn M, Liefers GJ. Validation of the 70-gene signature test (MammaPrint) to identify patients with breast cancer aged ≥ 70 years with ultralow risk of distant recurrence: A population-based cohort study. J Geriatr Oncol 2022; 13:1172-1177. [PMID: 35871138 DOI: 10.1016/j.jgo.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/22/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION When risk estimation in older patients with hormone receptor positive breast cancer (HR + BC) is based on the same factors as in younger patients, age-related factors regarding recurrence risk and other-cause mortality are not considered. Genomic risk assessment could help identify patients with ultralow risk BC who can forgo adjuvant treatment. However, assessment tools should be validated specifically for older patients. This study aims to determine whether the 70-gene signature test (MammaPrint) can identify patients with HR + BC aged ≥70 years with ultralow risk for distant recurrence. MATERIALS AND METHODS Inclusion criteria: ≥70 years; invasive HR + BC; T1-2N0-3M0. EXCLUSION CRITERIA HER2 + BC; neoadjuvant therapy. MammaPrint assays were performed following standardized protocols. Clinical risk was determined with St. Gallen risk classification. Primary endpoint was 10-year cumulative incidence rate of distant recurrence in relation to genomic risk. Subdistribution hazard ratios (sHR) were estimated from Fine and Gray analyses. Multivariate analyses were adjusted for adjuvant endocrine therapy and clinical risk. RESULTS This study included 418 patients, median age 78 years (interquartile range [IQR] 73-83). Sixty percent of patients were treated with endocrine therapy. MammaPrint classified 50 patients as MammaPrint-ultralow, 224 patients as MammaPrint-low, and 144 patients as MammaPrint-high risk. Regarding clinical risk, 50 patients were classified low, 237 intermediate, and 131 high. Discordance was observed between clinical and genomic risk in 14 MammaPrint-ultralow risk patients who were high clinical risk, and 84 patients who were MammaPrint-high risk, but low or intermediate clinical risk. Median follow-up was 9.2 years (IQR 7.9-10.5). The 10-year distant recurrence rate was 17% (95% confidence interval [CI] 11-23) in MammaPrint-high risk patients, 8% (4-12) in MammaPrint-low (HR 0.46; 95%CI 0.25-0.84), and 2% (0-6) in MammaPrint-ultralow risk patients (HR 0.11; 95%CI 0.02-0.81). After adjustment for clinical risk and endocrine therapy, MammaPrint-high risk patients still had significantly higher 10-year distant recurrence rate than MammaPrint-low (sHR 0.49; 95%CI 0.26-0.90) and MammaPrint-ultralow patients (sHR 0.12; 95%CI 0.02-0.85). Of the 14 MammaPrint-ultralow, high clinical risk patients none developed a distant recurrence. DISCUSSION These data add to the evidence validating MammaPrint's ultralow risk threshold. Even in high clinical risk patients, MammaPrint-ultralow risk patients remained recurrence-free ten years after diagnosis. These findings justify future studies into using MammaPrint to individualize adjuvant treatment in older patients.
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Affiliation(s)
- I Noordhoek
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - E Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - N A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Scheepens
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - L J Esserman
- Department of Surgical Oncology, University of California San Francisco, United States of America
| | - J Wesseling
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands; Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A N Scholten
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C P Schröder
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - S G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - M Kleijn
- Department of Medical Affairs, Agendia N.V., Amsterdam, the Netherlands
| | - G J Liefers
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
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Bredemeier K, Larsen S, Shivakumar G, Grubbs K, McLean C, Tress C, Rosenfield D, DeRubeis R, Xu C, Foa E, Morland L, Pai A, Tsao C, Crawford J, Weitz E, Mayinja L, Feler B, Wachsman T, Lupo M, Hooper V, Cook R, Thase M. A comparison of prolonged exposure therapy, pharmacotherapy, and their combination for PTSD: What works best and for whom; study protocol for a randomized trial. Contemp Clin Trials 2022; 119:106850. [PMID: 35842108 DOI: 10.1016/j.cct.2022.106850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/22/2022] [Accepted: 07/10/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several efficacious psychological and pharmacological treatments for posttraumatic stress disorder (PTSD) are available; however, the comparative effectiveness of these treatments represents a major gap in the literature. The proposed study will compare the effectiveness of two leading PTSD treatments - Prolonged Exposure (PE) therapy and pharmacotherapy with paroxetine or venlafaxine extended release - as well as the combination of PE and medication. METHODS In a randomized clinical trial, veterans with PTSD (N = 450) recruited across six Veterans Affairs Medical Centers will complete assessments at baseline, mid-treatment (Week 7), post-treatment (Week 14), and follow-up (Weeks 27 and 40). The primary outcome will be change in (both clinician-rated and self-reported) PTSD severity. Depression symptoms, quality of life, and functioning will also be measured and examined as secondary outcomes. Baseline demographic and clinical data will be used to develop "personalized advantage indices" (PAIs), with the goal of identifying who is most likely to benefit from which treatment. CONCLUSIONS This planned trial will yield findings to directly inform clinical practice guidelines for PTSD, by providing comparative effectiveness data to support recommendations about what can be considered the "first-line" treatment option(s) for PTSD. Further, findings from this trial have the potential to guide treatment planning for individual patients, through implementation of PAIs developed from study data, in service of "personalized medicine." TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04961190.
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Affiliation(s)
- Keith Bredemeier
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Sadie Larsen
- Milwaukee VA Medical Center, 5000 West National Avenue, Milwaukee, WI 53295-1000, USA; Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Geetha Shivakumar
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA; University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Kathleen Grubbs
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA; University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Carmen McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA; Stanford University, 450 Serra Mall, Stanford, CA 94305, USA.
| | - Carmella Tress
- Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - David Rosenfield
- Southern Methodist University, 6425 Boaz Lane, Dallas, TX 75205, USA.
| | - Rob DeRubeis
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Colin Xu
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Edna Foa
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Leslie Morland
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA; University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Anushka Pai
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA; University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Carol Tsao
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Jaclyn Crawford
- Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - Erica Weitz
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Lindiwe Mayinja
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA; Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - Bridget Feler
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Tamara Wachsman
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA.
| | - Margaret Lupo
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA.
| | - Vaughan Hooper
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
| | - Riley Cook
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA.
| | - Michael Thase
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA.
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Yu Y, Wu H, Qiu J, Ke D, Wu Y, Lin M, Zheng Q, Zheng H, Wang Z, Li H, Liu L, Li J, Yao Q. The novel pretreatment immune prognostic index discriminates survival outcomes in locally advanced non-operative esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy: a 6-year retrospective study. Transl Oncol 2022; 21:101430. [PMID: 35452997 PMCID: PMC9046998 DOI: 10.1016/j.tranon.2022.101430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022] Open
Abstract
dNLR and LDH were correlated with OS and PFS in locally advanced ESCC patients received dCRT. The EIPI, a novel inflammatory-based and immune-related prognostic score, was an independent prognostic indicator in locally advanced ESCC. The risk stratification of EIPI can help set individualized treatment strategies and intensities for different subgroups of ESCC patients.
Objective We aimed to construct risk stratification to help set individualized treatment strategies and intensities for different subgroups of patients. Methods The Esophagus Immune Prognostic Index (EIPI) scores were constructed according to the levels of derived neutrophil-to-lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH) before treatment, and the patients were divided into low-, medium-, and high-risk groups. Finally, restricted cubic splines (RCS) were used to explore the relationship between dNLR, LDH, and survival outcomes. Results The median follow-up period of overall survival (OS) and progression-free survival (PFS) were 25.2 and 17.6 months, respectively. Multivariate Cox regression analysis showed dNLR were the independent prognostic factors that were associated with OS and PFS. The 3-year OS and PFS rates in the low-, medium-, and high-risk groups were 44.4% and 38.2%, 26.1% and 23.6%, and 10.5% and 5.3%, respectively. Patients who received chemotherapy had better OS and PFS than those who did not receive chemotherapy in low-risk and medium/high-risk groups (all p < 0.05). Besides, the results also revealed significant differences for patients with clinical T, N, and TNM stage groups of the OS and PFS in different risk groups. Finally, RCS analysis indicated a nonlinear relationship between the dNLR, LDH, and survival for esophageal squamous cell carcinoma (ESCC) patients. The death hazard ratios of dNLR and LDH sharply increased at 1.97 and 191, respectively. Conclusions In summary, the EIPI, a novel inflammatory-based and immune-related prognostic score, is an independent prognostic indicator in locally advanced ESCC patients undergoing definitive chemoradiotherapy (dCRT).
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Affiliation(s)
- Yilin Yu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Haishan Wu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Jianjian Qiu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Dongmei Ke
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Yahua Wu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Mingqiang Lin
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Qunhao Zheng
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Hongying Zheng
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Zhiping Wang
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Hui Li
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Lingyun Liu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Jiancheng Li
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China.
| | - Qiwei Yao
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China.
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HUO J, DUAN J, LIU L, ZHANG F, ZHU K, SUI J, JIAN W. Evaluation of individualized treatment of nonproliferative diabetic retinopathy: a multicenter, randomized, parallel-controlled study. J TRADIT CHIN MED 2022; 42:90-95. [PMID: 35322637 PMCID: PMC10164625 DOI: 10.19852/j.cnki.jtcm.20210425.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/03/2021] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To evaluate the differences in the efficacy of stationary treatment and individualized treatment for patients with nonproliferative diabetic retinopathy (NPDR). METHODS This study was a randomized, controlled, multicenter clinical trial. Participants with NPDR were randomized into the stationary treatment group or the individualized treatment group. The stationary treatment group was given the basic treatment and Qiming granules, and the individualized treatment group was given the basic treatment, Qiming granules, and individualized Chinese herbal medicines over a 12-week period. The individualized therapeutic formula was also changed over time to adjust to the changes in the clinical presentation of the patient. We conducted observations of fundus retinal exudation and hemorrhage, visual acuity, Traditional Chinese Medicine symptom scores and other indicators. RESULTS A total of 140 participants with NPDR were randomized into the stationary treatment group or the individualized treatment group, and 132 participants completed this study. Following the 12-week treatment, significant improvements in both primary and secondary outcomes were observed in the stationary and individualized treatment groups. No remarkable difference in the primary outcomes between the two groups was observed. However, there was a significant difference in the Traditional Chinese Medicine symptom scores (18 ± 7 vs 15 ± 6; P < 0.05). There were no severe adverse effects. CONCLUSION Compared with stationary treatment, individualized treatment is more effective at relieving the Traditional Chinese Medicine symptoms and improving vision and fundus lesions at 12 weeks post treatment.
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Affiliation(s)
- Jian HUO
- 1 Department of Ophthalmology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Junguo DUAN
- 2 College of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Lisha LIU
- 2 College of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Fuwen ZHANG
- 2 College of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Keyu ZHU
- 2 College of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Jiaqing SUI
- 2 College of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Wenyuan JIAN
- 2 College of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
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Ding H, Huang Y, Shi J, Wang L, Liu S, Zhao B, Liu Y, Yang J, Chen Z. Attenuated expression of SNF5 facilitates progression of bladder cancer via STAT3 activation. Cancer Cell Int 2021; 21:655. [PMID: 34876150 PMCID: PMC8650342 DOI: 10.1186/s12935-021-02363-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND SWI/SNF, a well-known ATP-dependent chromatin-remodeling complex, plays an essential role in several biological processes. SNF5, the core subunit of the SWI/SNF remodeling complex, inactivated in 95% of malignant rhabdoid tumors (MRT), highlighting its significance in tumorigenesis. However, the role of SNF5 in bladder cancer (BC) remains unknown. In this study, we aimed to investigate the function and potential clinical applicability of SNF5 in BC. METHODS Data from The Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO) and Cancer Cell Line Encyclopedia (CCLE) databases were used to evaluate the clinical significance of SNF5 in BC. We performed Gene Set Enrichment Analysis (GSEA) and functional assays to investigate the role of SNF5 in BC. Genomics of Drug Sensitivity in Cancer (GDSC) and drug-susceptibility tests were performed to identify the potential value of SNF5 in the treatment of BC. RESULTS Low SNF5 expression conferred a poor prognosis and was significantly associated with the N-stage in BC. ROC curves indicated that SNF5 could distinguish BC from the normal tissues. In vitro and in vivo functional assays demonstrated that attenuated SNF5 expression could promote cell proliferation and enhance migration by STAT3 activation. We imputed that low SNF5 expression could confer greater resistance against conventional first-line drugs, including cisplatin and gemcitabine in BC. GDSC and drug-resistance assays suggested that low SNF5 expression renders T24 and 5637 cells high sensitivity to EGFR inhibitor gefitinib, and combination of EZH2 inhibitor GSK126 and cisplatin. CONCLUSIONS To the best of our knowledge, the present study, for the first time, showed that low SNF5 expression could promote cell proliferation and migration by activating STAT3 and confer poor prognosis in BC. Importantly, SNF5 expression may be a promising candidate for identifying BC patients who could benefit from EGFR-targeted chemotherapy or cisplatin in combination with EZH2 inhibitor treatment regimens.
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Affiliation(s)
- Hua Ding
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yaqin Huang
- Department of Cell Biology, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Jiazhong Shi
- Department of Cell Biology, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Liwei Wang
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.,Unit 32357 of People's Liberation Army, Pujiang, 611630, China
| | - Sha Liu
- Department of Cell Biology, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Baixiong Zhao
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yuting Liu
- Department of Cell Biology, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Jin Yang
- Department of Cell Biology, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Zhiwen Chen
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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Pfob A, Mehrara BJ, Nelson JA, Wilkins EG, Pusic AL, Sidey-Gibbons C. Machine learning to predict individual patient-reported outcomes at 2-year follow-up for women undergoing cancer-related mastectomy and breast reconstruction (INSPiRED-001). Breast 2021; 60:111-122. [PMID: 34619573 PMCID: PMC8551470 DOI: 10.1016/j.breast.2021.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Women undergoing cancer-related mastectomy and reconstruction are facing multiple treatment choices where post-surgical satisfaction with breasts is a key outcome. We developed and validated machine learning algorithms to predict patient-reported satisfaction with breasts at 2-year follow-up to better inform the decision-making process for women with breast cancer. METHODS We trained, tested, and validated three machine learning algorithms (logistic regression (LR) with elastic net penalty, Extreme Gradient Boosting (XGBoost) tree, and neural network) to predict clinically important differences in satisfaction with breasts at 2-year follow-up using the validated BREAST-Q. We used data from 1553 women undergoing cancer-related mastectomy and reconstruction who were followed-up for two years at eleven study sites in North America from 2011 to 2016. 10-fold cross-validation was used to train and test the algorithms on data from 10 of the 11 sites which were further validated using the additional site's data. Area-under-the-receiver-operating-characteristics-curve (AUC) was the primary outcome measure. RESULTS Of 1553 women, 702 (45.2%) experienced an improved satisfaction with breasts and 422 (27.2%) a decreased satisfaction. In the validation set (n = 221), the algorithms showed equally high performance to predict improved or decreased satisfaction with breasts (all P > 0.05): For improved satisfaction AUCs were 0.86-0.87 and for decreased satisfaction AUCs were 0.84-0.85. CONCLUSION Long-term, individual patient-reported outcomes for women undergoing mastectomy and breast reconstruction can be accurately predicted using machine learning algorithms. Our algorithms may be used to better inform clinical treatment decisions for these patients by providing accurate estimates of expected quality of life.
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Affiliation(s)
- André Pfob
- University Breast Unit, Department of Obstetrics & Gynecology, Heidelberg University Hospital, Heidelberg, Germany; MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Babak J Mehrara
- Department of Plastic & Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Department of Plastic & Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edwin G Wilkins
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrea L Pusic
- Patient-Reported Outcome Value & Experience (PROVE) Center, Department of Surgery, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA
| | - Chris Sidey-Gibbons
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Sarmiento Doncel S, Diaz Mosquera GA, Cortes JM, Ramirez Plazas N, Meza FJ, Agudelo Rico C. Impact of pharmacokinetics to reduce bleeding in a cohort of patients with severe hemophilia A in a personalized comprehensive management program. Hematol Rep 2021; 13:8904. [PMID: 35003570 PMCID: PMC8672215 DOI: 10.4081/hr.2021.8904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/17/2021] [Indexed: 11/25/2022] Open
Abstract
In recent decades, hemophilia A treatment has been focused on body weight, without taking pharmacokinetic parameters into account. Previous research has shown that the individual pharmacokinetic response is more effective in predicting the required dose of clotting factor. We want to evaluate the impact on reducing the frequency of bleeding in patients treated with recombinant factor VIII, based on a personalized comprehensive management program. Our aim was to compare the results of a standard comprehensive treatment program (stage I) vs. a personalized pharmacokinetic - based treatment program (stage II) in a cohort of 60 patients with severe hemophilia without inhibitors. The median age was 15.5 years (3-68). The annual bleeding rate (ABR) was 1.03 (62 episodes) in the first stage and 0.58 (35 episodes) in the second one, (p=0.004). By type of bleeding, the impact of the intervention differs significantly in spontaneous bleeding (p=0.007) and a 73% reduction in the first stage. There were no significant differences in traumatic bleeding. The use of pharmacokinetics (PK) for personalized dosing of patients with severe hemophilia A, significantly reduces ABR and spontaneous bleeding, improving the patient’s quality of life and costs for the health system.
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Gan H, Tang H, Huang Y, Wang D, Pu P, Zuo Z. The 'diamond' approach to personalized drug treatment of heart failure with reduced ejection fraction. Rev Cardiovasc Med 2021; 22:573-584. [PMID: 34565061 DOI: 10.31083/j.rcm2203069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 11/06/2022] Open
Abstract
Heart failure (HF) is a complex clinical syndrome with symptoms and signs due to cardiac dysfunction, leading to high hospitalization and morbidity. HF treatment has rapidly developed in recent decades, and breakthroughs have been made. Although conventional neurohormonal blockade therapies, including β-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs), significantly improve the prognosis of patients with heart failure with reduced ejection fraction (HFrEF), mortality and rehospitalization remain high. Therefore, new therapies are needed. Previous studies demonstrated that ivabradine, angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 (SGLT2) inhibitor, vericiguat, and omecamtiv mecarbil (OM) are beneficial for HFrEF. However, there is a lack of systematic review of the most optimal manner to use under various clinical conditions. This review summarizes the current knowledge regarding these therapies to give suggestions regarding clinical use timing, application scope, and optimal therapies under various conditions. Most importantly, we propose the HF diamond approach to express the necessity of conjunction of therapies. Different from the current guidelines, we suggest to use the diamond approach in an early and comprehensive manner at the beginning of ventricular remodeling in HFrEF to prevent further deterioration of HF and maximize the prognosis of patients.
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Affiliation(s)
- Hongbo Gan
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
| | - Heng Tang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
| | - Yujie Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, 400060 Chongqing, China
| | - Dan Wang
- Department of Cardiology, Chongqing Red Cross Hospital, 400020 Chongqing, China
| | - Peng Pu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
| | - Zhong Zuo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
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Zhang X, Pang X, Zhang Z, Liu Q, Zhang H, Xiang Q, Cui Y. Co-expression and prognosis analyses of GLUT1-4 and RB1 in breast cancer. BMC Cancer 2021; 21:1026. [PMID: 34525987 PMCID: PMC8442321 DOI: 10.1186/s12885-021-08763-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Current treatment methods for patients with triple-negative breast cancer (TNBC) are very limited, and the prognosis of TNBC is relatively poor. It has been reported that glucose transporter 1 (GLUT1) is overexpressed in breast cancer cells; however, its association with the prognosis is mostly unclear. Moreover, retinoblastoma gene 1 (RB1) might be used as a biomarker for the sensitivity of breast cancer cells to GLUT1 inhibitors, which brought us to the hypothesis that there might be a close correlation between the expression of GLUT1-4 and the expression of RB1. METHODS In this study, we systematically analyzed the co-expression of GLUT1-4 and the influence of GLUT1-4 gene expression on the prognosis of breast cancer using data mining methods. We also explored possible relationships between GLUT1-4 and RB1 expression in breast cancer tissues. We used public databases such as ONCOMINE, GEPIA, LinkedOmics, and COEXPEDIA. RESULTS According to the results, the mRNA expression of SLC2A1 was significantly higher in breast cancer, while the expression levels of SLC2A2-4 were downregulated. The results also indicate that GLUT1 expression does not have significant influence on the overall survival of patients with breast cancer. The mRNA expression of SLC2A1 and RB1 is significantly correlated, which means that tissues with high RB1 mRNA expression might have relatively higher mRNA expression of SLC2A1; however, further study analyzing their roles in the expression regulation pathways with human samples is needed to verify the hypothesis. CONCLUSIONS The mRNA expression of SLC2A1 was significantly higher in breast cancer. The overall survival of breast cancer patients wasn't significantly correlated with GLUT1-4 expression. The mRNA expression of SLC2A1 and RB1 is significantly correlated according to the analysis conducted in LinkedOmics. It provides reference for future possible individualized treatment of TNBC using GLUT1 inhibitors, especially in patients with higher mRNA expression of RB1. Further study analyzing the roles of these two genes in the regulation pathways is needed.
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Affiliation(s)
- Xiaodan Zhang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, No. 8, Xishku Street, Beijing, 100034, P. R. China
| | - Xiaocong Pang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, No. 8, Xishku Street, Beijing, 100034, P. R. China
| | - Zhuo Zhang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, No. 8, Xishku Street, Beijing, 100034, P. R. China
| | - Qianxin Liu
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, No. 8, Xishku Street, Beijing, 100034, P. R. China
| | - Hanxu Zhang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, No. 8, Xishku Street, Beijing, 100034, P. R. China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, 100191, P. R. China
| | - Qian Xiang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, No. 8, Xishku Street, Beijing, 100034, P. R. China.
| | - Yimin Cui
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, No. 8, Xishku Street, Beijing, 100034, P. R. China.
- Institute of Clinical Pharmacology, Peking University, No.38, Xue Yuan Street, Haidian District, Beijing, 100191, China.
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O'Connor PJ, Reuber M. 'It's both challenging and probably the most rewarding work' - A qualitative study of psychological therapy provider's experiences of working with people with dissociative seizures. Epilepsy Behav 2021; 122:108156. [PMID: 34175664 DOI: 10.1016/j.yebeh.2021.108156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Limited research exists exploring the experiences of psychological therapy providers (PTPs) working with people with dissociative seizures (DS). PTPs play a key role in the treatment of DS, yet sit at the end of a long, often ineffective process of diagnosis and waiting before treatment can commence. This qualitative study was undertaken involving 12 PTPs from specialist DS services throughout England and Scotland. Semi-structured interviews were carried out, using thematic analysis to evaluate the data. Four key themes were identified, "neurological to psychological", "putting the person with DS at the center", "treatment process", and "issues and impact of therapy with patients with DS". The findings showed that an unclear and uncomprehended diagnosis, together with waiting times had a detrimental impact on patients at the starting point of therapy. People with DS were perceived as a heterogeneous group whose treatment needed to be individualized, using the PTPs' full 'toolkit' of modalities and techniques, with a focus on improving quality of life, rather than reducing seizures. The study highlighted the complexity for PTPs of working with major but also accumulated minor traumas, compounded by the impact of DS on both PTPs and treatment. The desire of PTPs to be totally patient-focused meant that individualized treatment was considered essential and meant that participants were doubtful about the possibility of compiling an effective manual for the psychological treatment for DS.
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Affiliation(s)
- Peri Jane O'Connor
- School of Health and Community Studies, Leeds Beckett University, City Campus, Leeds LS1 3HE, United Kingdom.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.
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Vousoura E, Gergov V, Tulbure BT, Camilleri N, Saliba A, Garcia-Lopez L, Podina IR, Prevendar T, Löffler-Stastka H, Chiarenza GA, Debbané M, Markovska-Simoska S, Milic B, Torres S, Ulberg R, Poulsen S. Predictors and moderators of outcome of psychotherapeutic interventions for mental disorders in adolescents and young adults: protocol for systematic reviews. Syst Rev 2021; 10:239. [PMID: 34462006 PMCID: PMC8404358 DOI: 10.1186/s13643-021-01788-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adolescence and young adulthood is a risk period for the emergence of mental disorders. There is strong evidence that psychotherapeutic interventions are effective for most mental disorders. However, very little is known about which of the different psychotherapeutic treatment modalities are effective for whom. This large systematic review aims to address this critical gap within the literature on non-specific predictors and moderators of the outcomes of psychotherapeutic interventions among adolescents and young adults with mental disorders. METHODS The protocol is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) Statement. PubMed and PsycINFO databases will be searched for randomized controlled and quasi-experimental/naturalistic clinical trials. Risk of bias of all included studies will be assessed by the Mixed Methods Appraisal Tool. The quality of predictor and moderator variables will be also assessed. A narrative synthesis will be conducted for all included studies. DISCUSSION This systematic review will strengthen the evidence base on effective mental health interventions for young people, being the first to explore predictors and moderators of outcome of psychotherapeutic interventions for a wide range of mental disorders in young people. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020166756 .
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Affiliation(s)
- Eleni Vousoura
- Department of Psychology, American College of Greece - Deree, 6 Gravias Street GR-153 42 Aghia Paraskevi, Athens, Greece.
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 74 Vas. Sofias Ave, 11528, Athens, Greece.
| | - Vera Gergov
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Nigel Camilleri
- Mental Health Services, Attard, Malta
- University of Malta, Msida, Malta
| | - Andrea Saliba
- Mental Health Services, Attard, Malta
- University of Malta, Msida, Malta
| | | | - Ioana R Podina
- Laboratory of Cognitive Clinical Sciences, Department of Psychology, University of Bucharest, Bucharest, Romania
| | | | | | | | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | | | - Sandra Torres
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Randi Ulberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Almangush A, Alabi RO, Mäkitie AA, Leivo I. Machine learning in head and neck cancer: Importance of a web-based prognostic tool for improved decision making. Oral Oncol 2021; 124:105452. [PMID: 34266743 DOI: 10.1016/j.oraloncology.2021.105452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Alhadi Almangush
- Department of Pathology, University of Helsinki, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Institute of Biomedicine, Pathology, University of Turku, Turku, Finland; Faculty of Dentistry, Misurata University, Misurata, Libya.
| | - Rasheed Omobolaji Alabi
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland; Department of Pathology, Turku University Hospital, Turku, Finland
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Buttgereit T, Vera C, Weller K, Gutsche A, Grekowitz EM, Aykanat S, Wahn V, Krüger R, Maurer M, Magerl M. Lanadelumab Efficacy, Safety, and Injection Interval Extension in HAE: A Real-Life Study. J Allergy Clin Immunol Pract 2021; 9:3744-3751. [PMID: 34023564 DOI: 10.1016/j.jaip.2021.04.072] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Lanadelumab has been available in Germany for the prophylactic treatment of hereditary angioedema since February 2019. OBJECTIVE To investigate real-life treatment outcome of lanadelumab and gain practical experience in adapting the therapy to individual patients. METHODS The study included 34 patients. In 24 patients with hereditary angioedema and 4 patients with angioedema due to acquired C1-inhibitor deficiency, the previous treatment was switched to lanadelumab. In 6 patients with hereditary angioedema, lanadelumab from the open-label Hereditary Angioedema Long-term Prophylaxis study was continued in regular care. During the transition, patients were monitored using the angioedema control test and the angioedema quality of life questionnaire. At the time at which patients became symptom-free, the dosage interval was increased gradually (+3 days). RESULTS On average, the angioedema control test values improved from 7.5 (poorly controlled disease) to 14.9 (well-controlled disease), and all patients showed adequate disease control. All treated patients, except 1 outlier, scored angioedema quality of life questionnaire values representing only a slight reduction in quality of life (mean, 14 points). At the time point of data collection, 9 patients used an average fixed injection interval of 30 days. Twenty-two patients were symptom-free from the beginning of the treatment phase and intended to extend their injection interval from 30 to 32.5 days (median). We recommended reducing the initial dosing interval from 24 to 21 days (median) to 3 patients because of intermediately occurring symptoms. CONCLUSIONS Gradual extension of injection intervals of lanadelumab presented in this study can minimize the burden of therapy without losing efficacy.
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Affiliation(s)
- Thomas Buttgereit
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carolina Vera
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karsten Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Annika Gutsche
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva Maria Grekowitz
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Seda Aykanat
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Volker Wahn
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Renate Krüger
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Markus Magerl
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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Kuo JR, Zeifman RJ, Morrison AS, Heimberg RG, Goldin PR, Gross JJ. The moderating effects of anger suppression and anger expression on cognitive behavioral group therapy and mindfulness-based stress reduction among individuals with social anxiety disorder. J Affect Disord 2021; 285:127-135. [PMID: 33647580 DOI: 10.1016/j.jad.2021.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/17/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND . Cognitive-behavioral therapy and mindfulness-based stress reduction (MBSR) are two prominent evidence-based treatments for social anxiety disorder (SAD). It is not clear, however, whether outcomes of these two treatments are moderated by similar factors. For example, whereas anger suppression and anger expression each predict outcomes in cognitive- behavioral group therapy (CBGT), it is unknown whether they differentially influence outcomes in CBGT versus MBSR. METHODS . One hundred eight participants with SAD were randomized to CBGT, MBSR or Waitlist (WL). WL participants were later randomized to CBGT or MBSR, and their data were combined with data from those originally randomized to CBGT or MBSR. Anger suppression and anger expression were assessed at pre-treatment, and social anxiety was assessed at pre-treatment, post-treatment, and every 3 months throughout a 12-month follow-up period. RESULTS . From pre- to post-treatment, higher anger suppression was associated with significantly greater reduction in social anxiety in CBGT compared with MBSR. From post-treatment through follow-up, higher anger expression was associated lesser reduction in social anxiety in MBSR but not in CBGT. LIMITATIONS . Data are limited by sole reliance on self-report and it is unclear whether these findings generalize beyond group-based interventions. CONCLUSIONS . Individuals with SAD who are higher in anger suppression and/or expression might be better suited to CBGT than MBSR.
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Affiliation(s)
- Janice R Kuo
- Department of Psychology, Palo Alto University, 1791 Arastradero Rd., Palo Alto, CA 94304, United States.
| | - Richard J Zeifman
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| | - Amanda S Morrison
- Department of Psychology, California State University, East Bay, 25800 Carlos Bee Boulevard, Hayward, CA 94542, United States
| | - Richard G Heimberg
- Department of Psychology, Temple University, Weiss Hall 1701 N. 13t St., Philadelphia, PA 19122, United States
| | - Philippe R Goldin
- Betty Irene Moore School of Nursing, UC Davis Health System, Sacramento, CA 98517, United States
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA 94305, United States
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Schmidt L, Jensen BO, Walker A, Keitel-Anselmino V, di Cristanziano V, Böhm M, Knops E, Heger E, Kaiser R, de Luca A, Oette M, Häussinger D, Timm J, Fuchs A, Lübke N. Torque Teno Virus plasma level as novel biomarker of retained immunocompetence in HIV-infected patients. Infection 2021; 49:501-9. [PMID: 33537915 DOI: 10.1007/s15010-020-01573-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To predict the course of immune recovery (IR) in HIV-1-infected patients after initiation of combined antiretroviral therapy (cART) by determination of the plasma concentration of Torque Teno Virus (TTV). TTV has been identified as marker for risk assessment in immunosuppressed patients after transplantation procedures. Here, TTV was analyzed in HIV-1-infected therapy-naïve patients to evaluate its use as predictor of the course of IR for guidance of individualized treatment. METHODS TTV DNA was quantified in plasma samples of 301 therapy-naïve HIV-1-infected patients and correlated to CD4+ cell count, HIV viral load, presence of the herpes viruses CMV, EBV and HHV-8, age and sex. Patients were classified according to their initial CD4+ cell count and to the extent of CD4+ T-cell increase within the first year of cART. RESULTS TTV DNA was detectable in 96% of the patients' plasma samples with a median TTV plasma concentration of 5.37 log10 cop/ml. The baseline CD4+ cell count was negatively correlated with TTV plasma concentration (p = 0.003). In patients with a CD4+ cell recovery < 50 cells/µl, the median TTV plasma concentration was significantly higher compared to patients with a CD4+ cell recovery of > 200 CD4+ cells/µl (5.68 log10 cop/ml versus 4.99 log10 cop/ml; p = 0.011). TTV plasma concentration in combination with baseline CD4+ cell count were significantly correlated to CD4+ cell recovery (p = 0.004). For all other parameters considered, no significant correlation for CD4+ cell recovery was found. CONCLUSION Within the cohort, the significantly elevated TTV plasma concentration in patients with diminished CD4+ cell recovery indicates a more profound immune defect. Baseline TTV plasma concentrations and CD4+ cell count are predictive for the course of immune recovery in HIV-1-infected patients with severe immunodeficiency.
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Abstract
Pancreatic cancer is a tumor with a high degree of malignancy, morbidity, and mortality. Immunotherapy is another important treatment for pancreatic cancer in addition to surgery and chemotherapy, but its application in pancreatic cancer is very limited, which is related to the unique biological behavior of pancreatic cancer and the tumor microenvironment. The immunosuppressive microenvironment of pancreatic cancer is highly heterogeneous and presents challenges for immunotherapy. The transformation of tumor immunosuppressive microenvironment contributes to the response to tumor immunotherapy, such that the tumor undergoes functional reprogramming to change from immunologically "cold" to immunologically "hot." In this review, we summarized the research and progress in immunotherapy for pancreatic cancer, including immune checkpoint inhibitors, vaccines, adoptive T cell therapy, oncolytic viruses, and immunomodulators, and suggest that individualized, combination, and precise therapy should be the main direction of future immunotherapy in pancreatic cancer.
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Affiliation(s)
- Jia Wu
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang Province, China
| | - Jianting Cai
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang Province, China.
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Pfob A, Sidey-Gibbons C, Lee HB, Tasoulis MK, Koelbel V, Golatta M, Rauch GM, Smith BD, Valero V, Han W, MacNeill F, Weber WP, Rauch G, Kuerer HM, Heil J. Identification of breast cancer patients with pathologic complete response in the breast after neoadjuvant systemic treatment by an intelligent vacuum-assisted biopsy. Eur J Cancer 2020; 143:134-146. [PMID: 33307491 DOI: 10.1016/j.ejca.2020.11.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neoadjuvant systemic treatment elicits a pathologic complete response (pCR) in about 35% of women with breast cancer. In such cases, breast surgery may be considered overtreatment. We evaluated multivariate algorithms using patient, tumor, and vacuum-assisted biopsy (VAB) variables to identify patients with breast pCR. METHODS We developed and tested four multivariate algorithms: a logistic regression with elastic net penalty, an Extreme Gradient Boosting (XGBoost) tree, Support Vector Machines (SVM), and neural network. We used data from 457 women, randomly partitioned into training and test set (2:1), enrolled in three trials with stage 1-3 breast cancer, undergoing VAB before surgery. False-negative rate (FNR) and specificity were the main outcome measures. The best performing algorithm was validated in an independent fourth trial. RESULTS In the test set (n = 152), the logistic regression with elastic net penalty, XGboost tree, SVM, and neural network revealed an FNR of 1.2% (1 of 85 patients with missed residual cancer). Specificity of the logistic regression with elastic net penalty was 52.2% (35 of 67 women with surgically confirmed breast pCR identified), of the XGBoost tree 55.2% (37 of 67), of SVM 62.7% (42 of 67), and of the neural network 67.2% (45 of 67). External validation (n = 50) of the neural network showed an FNR of 0% (0 of 27) and a specificity of 65.2% (15 of 23). Area under the ROC curve for the neural network was 0.97 (95% CI, 0.94-1.00). CONCLUSION A multivariate algorithm can accurately select breast cancer patients without residual cancer after neoadjuvant treatment.
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Affiliation(s)
- André Pfob
- Department of Gynecology, Heidelberg University, Heidelberg, Germany
| | - Chris Sidey-Gibbons
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Cancer Research Institute, Seoul National University, Seoul, South Korea
| | | | - Vivian Koelbel
- Department of Gynecology, Heidelberg University, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology, Heidelberg University, Heidelberg, Germany
| | - Gaiane M Rauch
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Fiona MacNeill
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Walter Paul Weber
- Department of Breast Surgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, And Berlin Institute of Health, Berlin, Germany
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Joerg Heil
- Department of Gynecology, Heidelberg University, Heidelberg, Germany.
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Abstract
Advanced and metastatic stages of bladder cancer are associated with a poor prognosis. Therapy options are currently limited to systemic therapy with chemo- and immunotherapeutics. In order to improve individual therapy and especially to achieve a more favorable prognosis for these patients, intrinsic molecular subtypes have recently been identified in urothelial carcinoma of the bladder. This review article presents the latest developments, background, and clinical relevance of molecular subtypes in urothelial carcinoma of the bladder. The existing literature and current study data were analyzed to present and evaluate the different molecular classification systems. A focus was placed on the possible therapeutic implications of these molecular subtypes. Although promising progress has been made in the molecular subtyping of urothelial carcinoma, this classification has not yet found its way into clinical application. Multicenter prospective studies with standardized study protocols are still lacking. Previous studies differ in molecular markers, sample collection and preparation procedures, and analytical protocols. Standardization is urgently needed before guidelines can be established and targeted treatment regimens implemented. In principle, the aim should be to develop a stable and as simple as possible methodology, enabling personalized treatment based on molecular subtypes to be broadly applied, and not just in specialized expert centers.
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Affiliation(s)
- Philipp Erben
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.,Fachgruppe Molekulare Urologie der Arbeitsgruppe urologische Forschung (AuF) der Deutschen Gesellschaft für Urologie, Berlin, Deutschland
| | - Christoph Becker
- Fachgruppe Molekulare Urologie der Arbeitsgruppe urologische Forschung (AuF) der Deutschen Gesellschaft für Urologie, Berlin, Deutschland. .,Forschungskoordination, Deutsche Gesellschaft für Urologie (DGU) e. V., Uerdinger Straße 64, 40474, Düsseldorf, Deutschland.
| | - Igor Tsaur
- Fachgruppe Molekulare Urologie der Arbeitsgruppe urologische Forschung (AuF) der Deutschen Gesellschaft für Urologie, Berlin, Deutschland.,Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Matthias B Stope
- Fachgruppe Molekulare Urologie der Arbeitsgruppe urologische Forschung (AuF) der Deutschen Gesellschaft für Urologie, Berlin, Deutschland.,Klinik für Gynäkologie und Gynäkologische Onkologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Tilman Todenhöfer
- Fachgruppe Molekulare Urologie der Arbeitsgruppe urologische Forschung (AuF) der Deutschen Gesellschaft für Urologie, Berlin, Deutschland.,Studienpraxis Urologie, Nürtingen, Deutschland
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Chen SY, Huang XQ. [Exploring scientific research with the participation of multidisciplinary team in the clinical management of portal hypertension]. Zhonghua Gan Zang Bing Za Zhi 2020; 28:724-7. [PMID: 33053969 DOI: 10.3760/cma.j.cn501113-20200616-00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The etiological factors of portal hypertension are different. Therefore, there are many types of esophagogastric varices and the combined diseases are serious. However, with the continuous development of treatment technology, the importance of multidisciplinary team in the management of portal hypertension has gradually become well-known. Importantly, finding problems from the case discussion, summarizing the characteristics, conducting further clinical studies to evaluate the effect of endoscopic treatment on varicose veins, improving the safety of tissue adhesives therapy through the technological innovation, summarizing the treatment experience from treatment failure, and paying attention to the pathological examination of unexplained portal hypertension, and the comprehensive diagnosis and treatment under special circumstances through multidisciplinary team has provided us high-quality clinical research evidence for different phases and different treatment plan, and recognized the risk assessment and personalized precise diagnosis and treatment in patients with portal hypertension.
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46
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Zhao Z, Bai H, Duan JC, Wang J. [ Individualized treatment recommendations for lung cancer patients at different stages of treatment during the outbreak of 2019 novel coronavirus disease]. Zhonghua Zhong Liu Za Zhi 2020; 42:301-304. [PMID: 32375446 DOI: 10.3760/cma.j.cn112152-20200228-00146] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In order to achieve the overall victory over 2019 novel coronavirus disease epidemic, especially to prevent the disease recurrence from rebounding during the resumption of labor, the government has not loosened any control of personnel mobility, which has obviously affected the normal examination and treatment of lung cancer patients under the influence of this epidemic. During the epidemic period, cancer patients with low immunity levels face the double ordeals of disease and epidemic situation. Compared with the general population, they are more likely to be infected with the new coronavirus. Among the infected cancer patients, lung cancer is the most common type. It is necessary to provide more appropriate individualized treatment recommendations for patients with lung cancer based on the epidemic situation of the patient's location and in combination with the patient's own condition. Through active prevention of infection, timely conversion of treatment strategies, online and offline joint control, and positive psychological counseling, we do our best to help patients with lung cancer to survive this difficult period.
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Affiliation(s)
- Z Zhao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - H Bai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - J C Duan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - J Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Tseng Y, Ma L, Lv M, Luo T, Liu C, Wei Y, Liu C, Zhou J, Yan Z, Xu P, Hu G, Ding H, Ji Y, Chen S, Wang J. The role of a multidisciplinary team in the management of portal hypertension. BMC Gastroenterol 2020; 20:83. [PMID: 32245413 PMCID: PMC7119157 DOI: 10.1186/s12876-020-01203-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/21/2020] [Indexed: 12/14/2022] Open
Abstract
Background Gastroesophageal variceal hemorrhage is the most severe complication of portal hypertension, with a high mortality rate. The current recommendations for gastroesophageal varices include pharmacological treatment, endoscopic treatment, transjugular intrahepatic portosystemic shunt (TIPS) placement, and splenectomy with devascularization surgery. Multidisciplinary team (MDT) comprises of a group of medical experts and specialists across a range of disciplines, providing personalized and targeted patient care tailored to each individual’s condition, circumstances, and expectations. Methods Patients referred to the MDT clinic since its establishment in September 2014 were prospectively enrolled and followed-up for at least 12 months. Patient baseline characteristics, treatment methods, outcome and survival were compared to non-MDT patients retrieved from a prospectively maintained database with propensity score matching. Results Propensity-score matching (PSM) was carried out to balance available covariates, resulting in 58 MDT patients vs. 111 non-MDT patients. Overall survival and variceal rebleed was compared between the two groups. The rate of variceal rebleed was significantly higher in the non-MDT group, while no difference in overall survival was observed. Conclusions This study is the first to investigate the role of a multidisciplinary team in the management of gastroesophageal varices secondary to portal hypertension. Patients treated based on MDT clinic recommendations had a significantly lower risk for variceal rebleed.
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Affiliation(s)
- Yujen Tseng
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China.,Department of Digestive Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Lili Ma
- Department of Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-based Medical Center, Fudan University, Shanghai, China
| | - Tiancheng Luo
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China
| | - Chengfeng Liu
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China
| | - Yichao Wei
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chu Liu
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China
| | - Ji Zhou
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pengju Xu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guohua Hu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Ding
- Department of Diagnostic Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shiyao Chen
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China.,Department of Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-based Medical Center, Fudan University, Shanghai, China
| | - Jian Wang
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China.
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48
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Tseng Y, Ma L, Lv M, Luo T, Liu C, Wei Y, Liu C, Zhou J, Yan Z, Xu P, Hu G, Ding H, Ji Y, Chen S, Wang J. The role of a multidisciplinary team in the management of portal hypertension. BMC Gastroenterol 2020. [PMID: 32245413 DOI: 10.1186/s12876-020-01203-4.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastroesophageal variceal hemorrhage is the most severe complication of portal hypertension, with a high mortality rate. The current recommendations for gastroesophageal varices include pharmacological treatment, endoscopic treatment, transjugular intrahepatic portosystemic shunt (TIPS) placement, and splenectomy with devascularization surgery. Multidisciplinary team (MDT) comprises of a group of medical experts and specialists across a range of disciplines, providing personalized and targeted patient care tailored to each individual's condition, circumstances, and expectations. METHODS Patients referred to the MDT clinic since its establishment in September 2014 were prospectively enrolled and followed-up for at least 12 months. Patient baseline characteristics, treatment methods, outcome and survival were compared to non-MDT patients retrieved from a prospectively maintained database with propensity score matching. RESULTS Propensity-score matching (PSM) was carried out to balance available covariates, resulting in 58 MDT patients vs. 111 non-MDT patients. Overall survival and variceal rebleed was compared between the two groups. The rate of variceal rebleed was significantly higher in the non-MDT group, while no difference in overall survival was observed. CONCLUSIONS This study is the first to investigate the role of a multidisciplinary team in the management of gastroesophageal varices secondary to portal hypertension. Patients treated based on MDT clinic recommendations had a significantly lower risk for variceal rebleed.
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Affiliation(s)
- Yujen Tseng
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China.,Department of Digestive Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Lili Ma
- Department of Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-based Medical Center, Fudan University, Shanghai, China
| | - Tiancheng Luo
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China
| | - Chengfeng Liu
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China
| | - Yichao Wei
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chu Liu
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China
| | - Ji Zhou
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pengju Xu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guohua Hu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Ding
- Department of Diagnostic Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shiyao Chen
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China.,Department of Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-based Medical Center, Fudan University, Shanghai, China
| | - Jian Wang
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 0086200032, China.
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Heil J, Pfob A, Kuerer HM. De-escalation towards omission is the tipping point of individualizing breast cancer surgery. Eur J Surg Oncol 2020; 46:1543-1545. [PMID: 32241595 DOI: 10.1016/j.ejso.2020.03.208] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 02/08/2023] Open
Abstract
Tailoring of breast cancer treatment to the individual has especially occurred in breast cancer surgery: paradigms have changed from Halsted's radical mastectomy in 1882, to simple mastectomy, to lumpectomy. Within the next decade, we might face another paradigm change of omitting breast cancer surgery at all in case of a complete response after neoadjuvant systemic treatment. In this article, we provide an overview of the reasoning for this new paradigm change, the criticism it has evoked, and under which conditions it might be incorporated into clinical practice. We also take a look at previous paradigm changes in breast cancer surgery and the insights they provide us in the current situation on a statistical but also on a psychological level.
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Affiliation(s)
- Joerg Heil
- Department of Gynecology/ Breast Unit, Heidelberg University, Heidelberg, Germany.
| | - André Pfob
- Department of Gynecology/ Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Henry Mark Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
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50
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Yang LY. [The advances in surgery for cirrhotic portal hypertension in China]. Zhonghua Wai Ke Za Zhi 2020; 58:183-8. [PMID: 32187922 DOI: 10.3760/cma.j.issn.0529-5815.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The cirrhotic portal hypertension is very common worldwide and poses a serious threat to the health of patients.Over past three decades, the surgical treatment for cirrhotic portal hypertension was strongly challenged by the drugs, endoscopy, interventional therapy and liver transplantation.However, under the multidisciplinary team(MDT) cooperative diagnosis and treatment mode, the surgical treatment still plays a unique and irreplaceable role.Laparoscopic pericardial vascular devascularization is characterized by less injury and bleeding, rapid postoperative recovery, which will coexist with open surgery for portal hypertension. It is important to focus on the development and application of new methods, new technologies and new concepts under the MDT cooperative diagnosis and treatment mode, giving full play to the advantages of each discipline and advocate standardized, individualized and precise treatment should be emphasized to maximize patient clinical benefits.
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