Prediction of initial objective response to drug-eluting beads transcatheter arterial chemoembolization for hepatocellular carcinoma using CT radiomics-based machine learning model.

Objective: A prognostic model utilizing CT radiomics, radiological, and clinical features was developed and validated in this study to predict an objective response to initial transcatheter arterial chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma (HCC). Methods: Between January 2017 and December 2022, the baseline clinical characteristics and preoperative and postoperative follow-up imaging data of 108 HCC patients who underwent the first time treatment of DEB-TACE were analyzed retrospectively. The training group (n = 86) and the validation group (n = 22) were randomly assigned in an 8:2 ratio. By logistic regression in machine learning, radiomics, and clinical-radiological models were constructed separately. Finally, the integrated model construction involved the integration of both radiomics and clinical-radiological signatures. The study compared the integrated model with radiomics and clinical-radiological models using calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). Results: The objective response rate observed in a group of 108 HCC patients who received initial DEB-TACE treatment was found to be 51.9%. Among the three models, the integrated model exhibited superior predictive accuracy in both the training and validation groups. The training group resulted in an area under the curve (AUC) of 0.860, along with sensitivity and specificity values of 0.650 and 0.913, respectively. Based on the findings from the validation group, the AUC was estimated to be 0.927. Additionally, it was found that values of sensitivity and specificity were 0.875 and 0.833, respectively. In the validation group, the AUC of the integrated model showed a significant improvement when contrasted to the clinical-radiological model (p = 0.042). Nevertheless, no significant distinction was observed in the AUC when comparing the integrated model with the radiomics model (p = 0.734). The DCA suggested that the integrated model demonstrates advantageous clinical utility. Conclusion: The integrated model, which combines the CT radiomics signature and the clinical-radiological signature, exhibited higher predictive efficacy than either the radiomics or clinical-radiological models alone. This suggests that during the prediction of the objective responsiveness of HCC patients to the first DEB-TACE treatment, the integrated model yields superior outcomes.

Lessons learned from practices during the initial response to COVID-19 on the cruise ship Diamond Princess.

The battle against coronavirus disease 2019 (COVID-19) still continues three years after the onset of the pandemic, but there are concerns about the next emerging infectious disease. This study reports the practices during the initial response to COVID-19 on the cruise ship Diamond Princess and lessons learned from a nursing perspective. During these practices, one of the authors dealt with a sample collection team from the Self-Defense Forces and collaborated with the Disaster Medical Assistance Team (DMAT), Disaster Psychiatric Assistance Team (DPAT), and other teams. They mentioned the passengers' state and the distress and fatigue of the personnel assisting them. This revealed the specifics of emerging infectious diseases and their commonalities, regardless of the disaster. Results identified three crucial points: i) predicting the impact of lifestyle changes on health due to isolation and implementing preventive measures, ii) protecting individual human rights and dignity even in health emergencies, and iii) support for personnel providing assistance.

Comparison of Optimal Machine Learning Algorithms for Early Detection of Unknown Hazardous Chemicals in Rivers Using Sensor Monitoring Data.

Water environment pollution due to chemical spills occurs constantly worldwide. When a chemical accident occurs, a quick initial response is most important. In previous studies, samples collected from chemical accident sites were subjected to laboratory-based precise analysis or predictive research through modeling. These results can be used to formulate appropriate responses in the event of chemical accidents; however, there are limitations to this process. For the initial response, it is important to quickly acquire information on chemicals leaked from the site. In this study, pH and electrical conductivity (EC), which are easy to measure in the field, were applied. In addition, 13 chemical substances were selected, and pH and EC data for each were established according to concentration change. The obtained data were applied to machine learning algorithms, including decision trees, random forests, gradient boosting, and XGBoost (XGB), to determine the chemical substances present. Through performance evaluation, the boosting method was found to be sufficient, and XGB was the most suitable algorithm for chemical substance detection.

Comparison of skin decontamination strategies in the initial operational response following chemical exposures.

In mass casualty incidents including hazardous chemical skin exposure, decontamination is the primary intervention to avoid systemic uptake of the toxic compound. The protocol needs to be both simple and efficient to enable a rapid response and avoid delay of patient management. In the present study, decontamination strategies included in the initial operational response were evaluated following human skin exposure in vitro to four different contaminants. Results demonstrated that the efficacy of selected decontamination procedures was highly dependent on the chemical contaminant used. Dry removal of the sulfur mustard simulant methyl salicylate prior to wet decontamination was found beneficial compared to wet decontamination alone. Rapidly initiated wet decontamination was more efficient compared to dry and wet removal of the industrial chemical 2-butoxyethanol and the nerve agent tabun. Following VX-exposure, all wet decontamination procedures resulted in increased agent penetration compared to the control. In conclusion, challenges in establishing simple and efficient decontamination procedures for a broad-spectrum of chemicals have been demonstrated. The impact of including a dry removal step during decontamination was evidently agent specific. Despite the variation in efficacy, immediately initiated dry removal may facilitate patient management until wet decontamination resources are available and to reduce the risk of secondary contamination.

Univariate fast initial response statistical process control with taut strings.

We present a novel real-time univariate monitoring scheme for detecting a sustained departure of a process mean from some given standard assuming a constant variance. Our proposed stopping rule is based on the total variation of a nonparametric taut string estimator of the process mean and is designed to provide a desired average run length for an in-control situation. Compared to the more prominent CUSUM fast initial response (FIR) methodology and allowing for a restart following a false alarm, the proposed two-sided taut string (TS) scheme produces a significant reduction in average run length for a wide range of changes in the mean that occur at or immediately after process monitoring begins. A decision rule for when to choose our proposed TS chart compared to the CUSUM FIR chart that takes into account both false alarm rate and average run length to detect a shift in the mean is proposed and implemented. Supplementary materials are available online.

Comparison of initial tumor responses to transarterial bland embolization and drug-eluting beads-transarterial chemoembolization in the management of hepatocellular carcinoma: a propensity-score matching analysis.

BACKGROUND: Transarterial bland embolization (TABE) is widely used to treat the spontaneous rupture of hepatocellular carcinoma (HCC), and can lead to ischemic necrosis of the tumor. In this study, we used the propensity-score matching (PSM) method to compare the initial responses of treatment-naïve HCC patients to TABE and drug-eluting beads-transarterial chemoembolization (DEB-TACE), and the safety of these treatments. METHODS: Patients with treatment-naïve HCC, who had been admitted to 2 medical centers from January 2016 to December 2020, were enrolled as the research subjects. The data of 26 patients treated with TABE for ruptured HCC and 52 patients treated with DEB-TACE for primary HCC were collected according to our inclusion and exclusion criteria, and a PSM analysis was conducted to assess the safety and effectiveness of these two interventional techniques 1 month postoperatively. RESULTS: In relation to ruptured HCC, TABE had a hemostatic success rate of 97.0%. Before PSM, the TABE group had a larger maximum tumor diameter (P<0.05), a higher proportion of multiple tumors (P<0.05), a higher proportion of Child-Pugh class B (P<0.05), and a higher proportion of Barcelona Clinic Liver Cancer (BCLC) stage B (P<0.05) than the DEB-TACE group. After PSM, the baseline characteristics of these two groups were well balanced, and there was no significant difference in patients' initial therapeutic responses and tumor recurrence rates (both P>0.05). The multivariate regression analysis showed that tumor size was an independent predictor of the objective response rate (ORR) [odds ratio (OR): 3.312; 95% CI: 0.152-5.944; P<0.05]. Tumor number and BCLC stage also affected ORR; however, ORR was not significantly correlated with the interventional technique (TABE vs. DEB-TACE; P>0.05). The incidences of post-embolization syndrome (PES) and 48-h hepatotoxicity were significantly lower in the TABE group than the DEB-TACE group (both P<0.05), but there was no significant difference in hepatotoxicity after 1 month (P>0.05). CONCLUSIONS: TABE is highly effective at managing hemorrhage from ruptured HCC. The initial therapeutic response of HCC to TABE is similar to that to DEB-TACE; however, TABE is associated with lower hepatotoxicity and fewer adverse effects, which paves the way for subsequent treatments and systemic therapies.

Analysis of Initial Nonresponders to Galcanezumab in Patients With Episodic or Chronic Migraine: Results From the EVOLVE-1, EVOLVE-2, and REGAIN Randomized, Double-Blind, Placebo-Controlled Studies.

OBJECTIVE: To examine the likelihood of response with continued galcanezumab treatment in patients with episodic or chronic migraine without initial clinical improvement. BACKGROUND: A percentage of patients with migraine may require additional time on pharmacotherapy but discontinue treatment prematurely. Additionally, recognizing when continued treatment is unlikely to provide improvement limits unnecessary exposure. METHODS: Post hoc analysis of response after continued galcanezumab treatment was conducted in a subset of patients with episodic (N = 879) and chronic (N = 555) migraine who did not achieve "good" early improvement (episodic, ≥50% reduction in baseline migraine headache days [MHD] and chronic, ≥30% reduction) after 1 month of dosing (NR-1; episodic, n = 450 and chronic, n = 306). This subset was categorized by level of reduction in MHD during 1 month of treatment: "modest" (>30% to <50% fewer MHD for episodic and >10% to <30% fewer MHD for chronic), "limited" (episodic only; >10% to ≤30% fewer MHD), or "minimal/no" early improvement (≤10% fewer MHD to ≤10% more MHD), or "worsening" (>10% more MHD). The percentages of patients having "better" (≥75% fewer MHD for episodic and ≥50% for chronic), "good," or "little-to-no" (≤10% fewer MHD) response during the remaining treatment period were calculated for each category. Similarly, the subset of NR-1 patients who did not achieve "good" early improvement after 2 months of treatment (NR-2; episodic, n = 290 and chronic, n = 240) were categorized by level of their average monthly reduction across 1 and 2 months using similar categories. RESULTS: Of NR-1 patients with episodic migraine having "modest" early improvement, 62% (96/155) achieved "good" and 20% (31/155) achieved "better" responses with continued treatment. A percentage of patients with "limited" (43%; 46/108) or "minimal/no" (34%; 29/85) early improvement, or "worsening" (20%; 20/102) achieved a "good" response after continued treatment. A percentage of NR-1 patients with chronic migraine having "modest" early improvement achieved "good" (38%; 44/116) and "better" (13%; 15/116) responses with continued treatment. A "good" response was achieved for a percentage of patients with "minimal/no" early improvement (17%; 23/133). Similar patterns were observed for the NR-2 subset, though percentages were lower. CONCLUSIONS: Galcanezumab-treated patients with episodic or chronic migraine without response following 1 or 2 months of treatment appear to have a reasonable likelihood of continued improvement in months following initial treatment and this opportunity is more likely in patients showing greater early improvements. While a small percentage of patients with episodic or chronic migraine who experienced worsening in the number of MHD following initial treatment responded with continued treatment, most do not show substantial reduction in MHD. Overall benefit of therapy should be determined collaboratively between the patient and physician.

Comparación de la respuesta inicial luego de la ablación con 30 mCi de 131I versus no ablación en pacientes con cáncer diferenciado de tiroides de bajo riesgo de recurrencia. Estudio prospectivo multicéntrico / Comparison of initial response to treatment after remnant ablation (RA) with 30 mCi of 131 I versus no RA in patients with differentiated thyroid cancer with low risk of recurrence. Multicentric prospective study

RESUMEN Material y métodos Estudio prospectivo multicéntrico. Se incluyeron 174 pacientes con CDT tratados consecutivamente desde junio 2014 hasta mayo 2015. Se los dividió en 2 grupos (ablacionados y no ablacionados) con 87 pacientes incluidos en cada uno. La respuesta inicial al tratamiento se determinó con la medición de tiroglobulina, anticuerpos anti-tiroglobulina y ecografía de cuello. Resultados Se compararon las características basales de ambos grupos y no se evidenciaron diferencias estadísticamente significativas: sexo femenino 84% y 88% (p = 0,5); edad promedio de 46,8 y 47,5 años (p = 0,7); carcinoma papilar variedad clásico 68% y 75,9% (p = 0,15), respectivamente. El resto de las características basales como tamaño tumoral, bilateralidad, multifocalidad, tiroiditis de Hashimoto y estadio tumoral tampoco mostraron diferencias significativas. La evaluación de la respuesta inicial al tratamiento se realizó en 64 pacientes del grupo ablacionado y en 76 del grupo no ablacionado. Se observó una respuesta excelente en 81% de pacientes ablacionados vs. 87% del grupo no ablacionado, con una frecuencia de respuesta estructural incompleta de 1,6% y 1,4%, respectivamente, (p = 0,9). Un 17% de los ablacionados y 12% de los no ablacionados presentaron una respuesta indeterminada. Conclusión: Los pacientes de bajo riesgo, ablacionados o no, presentan similares frecuencias de respuesta inicial excelente y estructural incompleta. El seguimiento a largo plazo podrá definir si estas respuestas iniciales se mantienen en el tiempo, lo que permitirá reducir la indicación de ablación con radioyodo en este grupo de pacientes con CDT.

ABSTRACT Patients and methods We included 174 patients; 87 patients in each group (ablated and nonablated). Assessment of the initial response to treatment was performed by measurement of thyroglobulin and anti-thyroglobulin antibodies and by neck ultrasonography. Results Baseline characteristics of both groups were compared, and no statistically significant differences were found: female sex 84% and 88,5%, respectively, (p = 0.5); mean age of 46.8 and 47.5 years, respectively (p = 0.7); papillary carcinoma classic variant 68% and 75.9%, respectively (p = 0.15). The remaining of the baseline characteristics such as tumor size, presence of bilaterality, multifocality, Hashimoto's thyroiditis and tumor stage were not statistically significant, either. The evaluation of the response to treatment was finally performed in 64 patients from the ablated group and in 76 from the non-ablated group. An excellent response to treatment was observed in 81% of ablated patients vs. 87% of the non-ablated group, with a frequency of structural incomplete response of 1.6% and 1.4%, respectively (p = 0.9). On the other hand, 17% and 12% of patients in each group had an indeterminate response. Conclusion Low-risk ablated and non-ablated patients have a similar frequency of excellent initial and structural incomplete response to treatment. Long-term follow-up is needed to establish whether these initial responses are maintained over time, and thus further refine the indications of RA in this group of patients with DTC.

A low initial botulinum toxin A treatment response does not predict poor long-term outcomes in patients with axillary bromhidrosis.

PURPOSE: For patients with axillary bromhidrosis, it is not clear that whether a low response to initial botulinum toxin A (BTX-A) treatment is related to poor long-term outcomes. PATIENTS AND METHODS: From August 2011 to March 2016, 31 patients with primary axillary bromhidrosis were recruited. They had the duration of efficacy for less than 4 weeks (median, 3 weeks; range, 1-3 weeks) after the first BTX-A injection (50 U per underarm) and were considered to have a low response to BTX-A treatment. The second injection with the same dose was immediately administered once the symptoms recurred. Subsequent sessions were performed with a double dose. RESULTS: The duration of efficacy rose significantly to 10 weeks (range, 1-24 weeks) after the second injection (p < .01). Twenty-five patients received the third injection. The resultant duration further increased to 16 weeks (range, 12-26 weeks). No patients reported adverse effects during our follow-up period. CONCLUSIONS: For patients with primary axillary bromhidrosis, a low initial BTX-A treatment response does not predict poor long-term outcomes. Immediate reinjection with the same dose and subsequent sessions with a double dose is a safe strategy and can increase the duration of BTX-A therapy.

Resistance training status modifies inflammatory response to explosive and hypertrophic resistance exercise bouts.

The purpose of the present study was to examine the immediate and prolonged immune response in circulating cytokine and adipocytokine concentrations after two different resistance exercise bouts: hypertrophic (HYP1, 5 × 10, 80% of 1RM) and maximal explosive (POW1, 10 × 5, 60% of 1RM) resistance exercise bouts and how 12 weeks of resistance training (RT) modifies these responses (HYP2, POW2). Eight men completed the study. RE-induced interleukin-6 (IL-6), interleukin-1ß (IL-1ß), interleukin-1 receptor antagonist (IL-1ra), monocyte-chemoattractant protein-1 (MCP-1), leptin, resistin, and adiponectin were measured before (PRE) and immediately (POST0), 24 (POST24) and 48 (POST48) hours after RE bouts before and after RT. In the untrained state, IL-6 increased immediately after RE in HYP1 (p = 0.002) and in POW1 (p = 0.003) whereas no changes were observed after RT. Similar results were observed in IL-1ß, whereas conversely, IL-1ra increased only after RT in HYP2 and POW2 (p < 0.05). Resistin increased before RT in HYP1 and in POW1 (p = 0.011 and p = 0.003, respectively), but after RT, significant responses were not observed. Interestingly, in HYP2, MCP-1 increased significantly at POST24 (p = 0.009) and at POST48 (p = 0.032) only following RT. The present study shows that RT modifies RE-induced cytokine responses towards an anti-inflammatory direction.

Complete response at first chemoembolization is still the most robust predictor for favorable outcome in hepatocellular carcinoma.

BACKGROUNDS & AIMS: The aim of this study is to evaluate the prognostic significances of not only the initial and the best response during repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), but if eligible, also the time point of achieving treatment responses. METHODS: Three hundred and fourteen treatment-naïve patients with well-preserved liver function undergoing TACE were recruited. Treatment responses were assessed using modified Response Evaluation Criteria in Solid Tumors. Overall survival (OS) was analyzed using Kaplan-Meier methods, and Cox regression analysis was performed for multivariate analysis. RESULTS: After adjusting other variables, objective response (complete response [CR] and partial response [PR]) as the initial response (adjusted hazard ratio [HR] 0.410) and the best response (adjusted HR 0.335) had independent prognostic significances for OS, respectively (both p < 0.001). Objective responders as the initial response had the longest OS, followed by patients who subsequently achieved objective response after at least two sessions and those who did not achieve objective response during treatment course eventually (52.6, 27.0, and 10.8 months, respectively; log-rank test, p < 0.001). Likewise, patients with CR as the initial response had the longest OS, followed by those who subsequently achieved CR after at least two sessions and those who achieved PR as the best response (70.2, 40.6, and 23.0 months, respectively; log-rank test, p < 0.001). Large (>5 cm) and multiple (⩾ 4) tumors were independently associated with failure to achieve CR after the initial TACE (both p < 0.05). CONCLUSION: Both the initial and the best response predicts OS effectively. However, achievement of treatment response at an early time point is still the most robust predictor for favorable outcomes.

Clinical significance of the best response during repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma.

BACKGROUND & AIMS: We assessed the clinical implications of the best response compared with the initial response during repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). METHODS: We evaluated 332 patients with intermediate-stage HCC and preserved liver function initially treated with repeated TACE. All had ≥1 lesion measuring ≥1 cm, and the response measured after each session was based on EASL and mRECIST criteria. We performed survival analyses according to response kinetics, and identified clinical factors associated with the need for repeated TACE to achieve the best response. RESULTS: An objective response, either a complete response (CR) or a partial response (PR), after the first TACE was seen in about 50% of patients by both EASL and mRECIST. In terms of the best response during serial TACE, 250 patients (75.3%) by EASL and 278 (83.7%) by mRECIST were overall responders. The sizes of the largest and second largest tumors were the only parameters positively correlated with the number of TACE sessions required to achieve the best response (p<0.05). Multivariate Cox analysis showed that achieving a CR or PR as the best response was the best predictor of survival following TACE with a hazard ratio of 0.45 by EASL and 0.24 by mRECIST, and more than 0.69 and 0.71, respectively for initial responders (p<0.05). CONCLUSIONS: The best response observed during serial TACE, rather than the initial response, most strongly predicts the survival of patients with intermediate-stage HCC. The number of TACE sessions needed to achieve a best response is a function of tumor size.

Initial response to sorafenib by using enhancement criteria in patients with hepatocellular carcinoma.

PURPOSE: Sorafenib induces early vascularity reduction in patients with hepatocellular carcinoma (HCC). We sought to identify differences in radiological assessment approaches and to evaluate their usefulness for the prediction of the initial response to sorafenib. METHODS: Forty-eight patients with advanced HCC treated with sorafenib were evaluated by four-phase contrast-enhanced computed tomography. All target lesions were analyzed using the Response Evaluation Criteria in Solid Tumors (RECIST), the EASL criteria, and modified RECIST (mRECIST). RESULTS: At the initial evaluation at 4-6 weeks, rates of objective response (OR) (including both complete and partial responses), stable disease (SD), and progressive disease (PD) were 2, 71, and 27 %, respectively, according to RECIST; 15, 56, and 29 %, respectively, according to the EASL criteria; and 15, 58, and 27 %, respectively, according to mRECIST. Patients who achieved an OR according to the EASL criteria also achieved an OR according to mRECIST. Patients who achieved an OR according to the EASL criteria or mRECIST had better predicted overall survival (OS) than did patients who achieved SD (p = 0.033 and 0.028, respectively). Patients with SD according to RECIST had different outcomes depending on the response according to enhancement criteria. Patients classified as responders (complete and partial) had better predicted OS than those classified as non-responders (those classified as SD and PD) (p = 0.048). CONCLUSIONS: The enhancement criteria could be useful for prediction of the initial response to sorafenib in patients with HCC. Moreover, mRECIST appears to be simple and convenient.