Current Landscape of Sonodynamic Therapy for Treating Cancer.

Recent advancements have tangibly changed the cancer treatment landscape. However, curative therapy for this dreadful disease remains an unmet need. Sonodynamic therapy (SDT) is a minimally invasive anti-cancer therapy involving a chemical sonosensitizer and focused ultrasound. A high-intensity focused ultrasound (HIFU) beam is used to destroy or denature targeted cancer tissues. Some SDTs are based on unfocused ultrasound (US). In some SDTs, HIFU is combined with a drug, known as a chemical sonosensitizer, to amplify the drug's ability to damage cancer cells preferentially. The mechanism by which US interferes with cancer cell function is further amplified by applying acoustic sensitizers. Combining multiple chemical sonosensitizers with US creates a substantial synergistic effect that could effectively disrupt tumorigenic growth, induce cell death, and elicit an immune response. Therefore, the minimally invasive SDT treatment is currently attracting attention. It can be combined with targeted therapy (double-targeting cancer therapy) and immunotherapy in the future and is expected to be a boon for treating previously incurable cancers. In this paper, we will consider the current state of this therapy and discuss parts of our research.

Effectiveness of Pharmacist-Physician Collaborative Management for Patients With Idiopathic Pulmonary Fibrosis Receiving Pirfenidone.

Background: Pirfenidone is an anti-fibrotic agent used to treat patients with idiopathic pulmonary fibrosis (IPF). Managing adverse drug events and ensuring compliance with pirfenidone treatment for a prolonged period are important to reduce the rate of disease progression. To maximize the benefits of pirfenidone treatment, we established and evaluated an ambulatory care pharmacy practice, a model of pharmacist-physician collaborative management, for patients receiving pirfenidone. Methods: We conducted a retrospective chart review of 76 consecutive patients treated with pirfenidone in the Kobe City Medical Center General Hospital, Japan, between January 2012 and January 2019. The first group (61 patients) received pirfenidone treatment as conventional management, whereas the second group (15 patients) started pirfenidone based on collaborative pharmacist-physician management. The drug discontinuation rate and time to drug discontinuation were compared between the groups. To analyze factors associated with pirfenidone discontinuation, we used a multivariate Cox regression analysis to evaluate the baseline characteristics of patients, including those receiving the collaborative management. Clinical outcomes were compared using a propensity score matched analysis. Results: In the collaborative management group, pharmacists made 56 suggestions, including suggestions for supportive care (51 suggestions), to the physicians. Among these suggestions, 52 were accepted by the physicians. The discontinuation rates at 3 [6.7% (1/15) vs. 26.2% (16/61)] and 6 [9.1% (1/11) vs. 36.1% (22/61)] months were lower in the collaborative management group than in the conventional management group. Multivariate analysis revealed that collaborative management [hazard ratio (HR) 0.34, 95% CI 0.08-0.96, p = 0.041] and predicted baseline forced vital capacity <60% (HR 2.13, 95% CI 1.17-3.85, p = 0.015) were significantly associated with pirfenidone discontinuation. The time to drug discontinuation was also significantly longer in the collaborative management group than in the conventional management group (p = 0.034, log-rank test). Propensity score matched analysis confirmed a significant correlation between collaborative management and drug discontinuation time (HR 0.20, 95% CI 0.03-0.84, p = 0.027). Conclusions: We established an ambulatory care pharmacy practice for out-patients with IPF receiving pirfenidone. The results suggest that collaborative management may help prevent pirfenidone discontinuation compared with conventional management.

Development of a Surgical Sponge Counting System Using Radiographic Images.

Background. Retention of surgical sponges in patients is a relatively frequent medical malpractice. To prevent it, the surgical sites are scanned using X-ray. However, using radiography in the operation room induces X-ray exposure for both patients and staff. To prevent such issues, a novel sponge counting system was developed. Each surgical sponge used in common hospitals is composed of single radiopaque fibers. Methods. The proposed system scans surgical sponges to estimate their fiber length (EFL) and returns the number of it. In this study, an optimal image acquisition protocol was determined that allows an accurate count of sponges. X-ray doses and multi-angle image procedures were tested. Results. Measurement trials were performed and compared for both dry and blood-soaked sponges. As a result, the X-ray dose of 50 kV and 600 µA and the acquisition of 180 images per sample yielded an accurate EFL. The 180-image protocol achieved good performance in this study and allowed counting of one package of 10 sponges in 226 seconds. For these settings, a significant correlation was found between the actual number of sponges and the estimated fiber lengths. Additionally, the performance of the system was similar for either dry or blood-soaked items. Conclusion. The proposed system could accurately count surgical sponges and is a promising option in preventing the accidental retention of surgical sponges.

Evaluation of the usefulness of protocol-based pharmacist-facilitated laboratory monitoring to ensure the safety of immune checkpoint inhibitors in patients with lung cancer.

WHAT IS KNOWN AND OBJECTIVE: Immune checkpoint inhibitors can cause immune-related adverse events (irAEs). Improved monitoring systems for irAEs, which include laboratory tests by a qualified multidisciplinary team, might prevent patients from irAE-associated events. Kobe City Medical Center General Hospital developed protocol-based pharmacist-facilitated laboratory tests named protocol-based pharmacotherapy management (PBPM) to aid the administration of immunotherapy to patients with lung cancer. The protocol defines the laboratory test items and times at which they should be performed. It requires pharmacists to check laboratory orders initiated by physicians and enter additional test items if the orders are incomplete. We evaluated the efficacy of PBPM in irAE monitoring and compared it with those of conventional care systems. METHODS: From January 2016 to March 2018, 114 patients with lung cancer received immunotherapy, which was managed by conventional care (conventional group). From April to September 2018, 62 patients were managed by PBPM (PBPM group), among those 28 patients were transited from conventional group to PBPM group. Data on whether the laboratory tests were conducted or omitted were collected retrospectively for the conventional group and prospectively for the PBPM group. RESULTS: Within the conventional group, 4604 (87.6%) out of the 5253 laboratory test items were ordered by physicians. Of the remaining 649 test items, 224 (4.3%) items were added by physicians based on recommendations by pharmacists. However, of the 1581 (86.6%, from among 1826) test items that were previously ordered by physicians, only 231 (12.7%) test items were added by pharmacists. The execution rate was found to be significantly higher in the PBPM group (99.2% vs 91.9%, P < .001). WHAT IS NEW AND CONCLUSION: PBPM-based pharmacist-facilitated laboratory monitoring systems provided higher executing rate of laboratory order to monitor irAEs during immunotherapy.

Prediction of lower-grade glioma molecular subtypes using deep learning.

INTRODUCTION: It is useful to know the molecular subtype of lower-grade gliomas (LGG) when deciding on a treatment strategy. This study aims to diagnose this preoperatively. METHODS: A deep learning model was developed to predict the 3-group molecular subtype using multimodal data including magnetic resonance imaging (MRI), positron emission tomography (PET), and computed tomography (CT). The performance was evaluated using leave-one-out cross validation with a dataset containing information from 217 LGG patients. RESULTS: The model performed best when the dataset contained MRI, PET, and CT data. The model could predict the molecular subtype with an accuracy of 96.6% for the training dataset and 68.7% for the test dataset. The model achieved test accuracies of 58.5%, 60.4%, and 59.4% when the dataset contained only MRI, MRI and PET, and MRI and CT data, respectively. The conventional method used to predict mutations in the isocitrate dehydrogenase (IDH) gene and the codeletion of chromosome arms 1p and 19q (1p/19q) sequentially had an overall accuracy of 65.9%. This is 2.8 percent point lower than the proposed method, which predicts the 3-group molecular subtype directly. CONCLUSIONS: A deep learning model was developed to diagnose the molecular subtype preoperatively based on multi-modality data in order to predict the 3-group classification directly. Cross-validation showed that the proposed model had an overall accuracy of 68.7% for the test dataset. This is the first model to double the expected value for a 3-group classification problem, when predicting the LGG molecular subtype.

Corrosion Generation and Cleaning Effect on Surgical Instruments with Attached Radiofrequency Identification Tags in Long-Term Usage.

Background: Faulty cleaning of surgical instruments may lead to corrosion damage and a higher risk of surgical site infection. We have developed a method in which each instrument has an attached radiofrequency identification (RFID) tag for individual management. However, because of the structure of the instruments, a risk of corrosion from poor cleaning exists; therefore, observation during long-term usage is necessary. Methods: The cleaning effect at the jig of the RFID tag was verified by the amount of residual protein left by various cleaning methods. In our investigation of long-term usage, we examined 94 surgical instruments with RFID tags used in the operating room for 50 months employing a microscope to identify any corrosion at the jig. Results: The method using a washer disinfector (WD) was found to be highly effective. From observation after long-term usage, friction by the RFID tag occurred in about 70% of the jigs. However, no pitting or general corrosion was seen. Conclusions: When WD is used properly, there is only a minor risk of residual protein, and corrosion does not occur even with long-term use. By using surgical instruments with RFID tags, it is possible to determine the number of uses and the history at the individual level. This facilitates operation of safe surgical instruments by limiting the number of times a particular instrument is used.

Evaluation of Surgical Instruments With Radiofrequency Identification Tags in the Operating Room.

BACKGROUND: Surgical instrument retention and instrument breakage compromise surgery quality and lead to medical malpractice. We developed an instrument tracking system that could alert surgeons to instrument retention during surgery and monitor instrument use to reduce the risk of breakage. METHODS: This prospective, experimental clinical trial included 15 patients undergoing inguinal hernia surgery or lumpectomy under general anesthesia at Saiseikai Kurihashi Hospital. Radiofrequency identification (RFID)-tagged surgical instruments were used, and a detection antenna was placed on a mayo stand during the operation. We analyzed the 1-loop detection ratio (OLDR)-that is, the capability of the antenna to detect devices in a single reading-and the total detection rate (TDR)-that is, the data accumulated for the duration of the operation-of the RFID-tagged instruments. RESULTS: Data analysis revealed that the OLDR was 95% accurate, whereas the TDR was 100% accurate. The antenna could not detect the RFID tag when there was interference from electrocautery noise radiation, and 6% of instrument movement was undetected by the antenna; however, the TDR and instrument use were detected at all times. CONCLUSIONS: Surgical instruments can be tracked during surgery, and this tracking can clarify the usage rate of each instrument and serve as a backup method of instrument counting. However, this study was conducted on a small scale, and RFID tags cannot be attached to small surgical instruments used in complex operations such as neurosurgery. Further efforts to develop a tracking system for these instruments are warranted.

Management of surgical instruments with radio frequency identification tags.

PURPOSE: To prevent malpractices, medical staff has adopted inventory time-outs and/or checklists. Accurate inventory and maintenance of surgical instruments decreases the risk of operating room miscounting and malfunction. In our previous study, an individual management of surgical instruments was accomplished using Radio Frequency Identification (RFID) tags. The purpose of this paper is to evaluate a new management method of RFID-tagged instruments. DESIGN/METHODOLOGY/APPROACH: The management system of RFID-tagged surgical instruments was used for 27 months in clinical areas. In total, 13 study participants assembled surgical trays in the central sterile supply department. FINDINGS: While using the management system, trays were assembled 94 times. During this period, no assembly errors occurred. An instrument malfunction had occurred after the 19th, 56th, and 73 th uses, no malfunction caused by the RFID tags, and usage history had been recorded. Additionally, the time it took to assemble surgical trays was recorded, and the long-term usability of the management system was evaluated. ORIGINALITY/VALUE: The system could record the number of uses and the defective history of each surgical instrument. In addition, the history of the frequency of instruments being transferred from one tray to another was recorded. The results suggest that our system can be used to manage instruments safely. Additionally, the management system was acquired of the learning effect and the usability on daily maintenance. This finding suggests that the management system examined here ensures surgical instrument and tray assembly quality.

Validation of cleaning evaluation of surgical instruments with RFID tags attached based on cleaning appraisal judgment guidelines.

In medical institutions, the threat of infection is closely focused, in particular, inspections regarding surgical site infections (SSI) are carried out. In this study, development of the application of Radio frequency identification (RFID) tags for surgical instrument has been promoted. It enables traceability and individual management of surgical instruments. An experiment was carried out following the cleaning Appraisal guidelines, which contaminated surgical instruments, and using the washer-disinfector (WD) as the main cleaner for surgical instruments with developed RFID tags attached to them. As a result, all of the instruments with RFID tags, the amount of residual protein was less than the recommended acceptable level of 100µg. If WD is used correctly, a sufficient cleaning effect can be expected. From this result, it became evident that the secondary infection risk is low from surgical instrument with RFID tags attached.