Integrating Frailty Assessment to Enhance Care in Cancer Patients with Borderline Eastern Cooperative Oncology Group Performance Status.

BACKGROUND: The (ECOG) performance status (PS) is commonly used to evaluate the functional ability of patients undergoing antitumor therapy. An ECOG PS of 2, indicating patients capable of self-care but restricted strenuous activity, can complicate treatment decisions owing to concerns regarding treatment-related toxicity. We investigated whether frailty assessment could help discriminate treatment tolerance and survival outcomes in patients with an ECOG PS of 2. METHODS: We prospectively included 45 consecutive patients, aged ≥65 years, with an ECOG PS of 2, and newly diagnosed solid cancer scheduled for chemotherapy. Frailty was assessed using an eight-indicator geriatric assessment. The primary outcome was overall survival (OS) based on frailty status; secondary outcomes included treatment tolerance and toxicity. RESULTS: The median patient age was 73 years (range 65-94), and 71% had stage IV disease. Predominant frailty-related deficits were functional decline (96%), malnutrition (78%), and polypharmacy (51%). The median OS was 12.6 months (95% confidence interval [CI]: 6.8-18.4). Patients with 4-6 deficits had significantly lower OS than those with 1-3 deficits (9.9 months vs. 20.0 months, adjusted hazard ratio 2.51, 95% CI: 1.16-5.44, P = .020). Frailty significantly correlated with reduced 12-week chemotherapy competence (52% vs. 85%, adjusted odds ratio [OR] .14, 95% CI: .03-.70, P = .016) and enhanced risk of unexpected hospitalization (60% vs. 20%, adjusted OR 6.80, 95% CI: 1.64-28.1, P = .008). CONCLUSION: Our findings highlight the multifaceted nature of patients with an ECOG PS of 2 and emphasize the importance of frailty assessment for treatment outcomes.

Frailty assessment by two screening instruments in non-elderly patients with head and neck cancer.

PURPOSE: Frailty assessment is often overlooked in non-elderly patients with cancer, possibly due to the lack of an effective frailty screening tool. This study aimed to evaluate the performance of two modern frailty screening tools, the Flemish version of the Triage Risk Screening Tool (fTRST) and the modified 5-Item Frailty Index (mFI-5), compared to the gold standard comprehensive geriatric assessment (GA) among non-elderly patients with head and neck cancer (HNC). METHODS: We prospectively included 354 consecutive patients aged < 65 years with newly diagnosed HNC scheduled for definitive concurrent chemoradiotherapy (CCRT) at three academic hospitals in Taiwan between January 2020 and December 2022. Frailty assessment using the GA, fTRST, and mFI-5 was performed in all patients to evaluate the relationship between frailty and treatment outcomes. RESULTS: The prevalence of frailty was 27.1%, 37.0%, and 42.4% based on GA, mFI-5, and fTRST, respectively. mFI-5 and fTRST demonstrated good predictive value in identifying frail patients compared to the GA. Patients with frailty, as defined by GA, mFI-5, and fTRST, exhibited higher risks of treatment-related complications, incomplete treatment, and poorer baseline quality of life (QoL). However, only GA showed significant prognostic value for overall survival. CONCLUSIONS: Frailty assessment using fTRST and mFI-5 is valuable for predicting treatment-related adverse events, treatment tolerance, and QoL in non-elderly patients with HNC. Incorporating frailty assessment into the management of non-elderly cancer patients can aid in the identification of high-risk individuals. However, the performance of these tools varies, highlighting the need for further validation and refinement.

Hydrogen-bond induced enhanced emission ratiometric fluorescent handy needle for visualization assay of amoxicillin by smartphone sensing platform.

Amoxicillin (AMO) is one of the most commonly used antibiotics, and its abuse in animal husbandry or clinical therapy can pose unpredictable hazards to humans. Therefore, it is crucial to develop a real-time and rapid method to accurately determine AMO content. Here, we designed a fluorescent nanoprobe for qualitative and quantitative AMO determination by using as-synthesized green safe materials of nontoxic red carbon dots (RCDs) and blue carbon dots (BCDs). In the presence of AMO, a reaction promoting hydrogen bonding occurred immediately, resulting in an instant increase in the intensity of the blue fluorescence of BCDs, accompanied by a marked color change from red to blue. For practical application, we designed a nontoxic sensing fluorescent handy needle to directly and quantitatively detect AMO in real samples. This portable and easy-to-use device was demonstrated on a smartphone platform based on 3D printing technology, which offers the advantages of simple production, excellent visualization, fast response, and instant quantitative detection. The device requires an extremely short detection time and has a sensitive detection limit of 2.39 nM. The method presented here enables real-time assessment for food safety, as well as on-site detection under field conditions to track various trace substances for timely health checks.

Long-term use and risk of major adverse cardiac events: Comparing enzalutamide and abiraterone in chemotherapy-naïve patients with metastatic castration-resistant prostate cancer.

This is a retrospective cohort study by analyzing a multi-institutional electronic medical records database in Taiwan to compare long-term effectiveness and risk of major adverse cardiac events (MACE) in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) patients treated with enzalutamide (ENZ) or abiraterone (AA). Patients aged 20 years and older and newly receiving androgen receptor targeted therapies ENZ or AA from September 2016 to December 2019 were included. We followed patients from initiation of therapies to the occurrence of outcomes (prostate-specific antigen (PSA) response rate, PSA progression free survival (PFS), overall survival (OS), and MACE), death, the last clinical visit, or December 31, 2020. We performed multivariable Cox proportional hazard models to compare ENZ and AA groups for the measured outcomes. A total of 363 patients treated with either ENZ (n = 157) or AA (n = 206) were identified. The analysis found a significantly higher proportion of patients with a PSA response rate higher than 50% among those receiving ENZ than among those receiving AA (ENZ vs AA: 75.80% vs 63.59%, P = .01). However, there was no significant difference in PSA PFS (adjusted hazard ratio: 0.86; 95% CI 0.63-1.17) and OS (0.68: 0.41-1.14) between the use of ENZ and AA in chemotherapy-naïve mCRPC patients. Regarding the cardiovascular (CV) safety outcome, there was a significantly lower risk of MACE in patients receiving ENZ, compared to patients receiving AA (0.20: 0.07-0.55). The findings suggest that enzalutamide may be more efficacious for PSA response and suitable for chemotherapy-naïve mCRPC patients with high CV risk profile.

Colorimetric fluorescent paper strip with smartphone platform for quantitative detection of cadmium ions in real samples.

Instrument-free, portable and direct read-out mini-devices have wider application prospects in various fields, especially for real-time/on-site detection in environmental science. Herein, a colorimetric fluorescent sensor for detecting cadmium ions (Cd2+) based on aggregation-induced emission (AIE) was established, fluorescent paper strips integrated with smartphone platform was further designed for the visualization, on-site and quantitative detection of Cd2+. The colorimetric fluorescent sensor was prepared by mixing orange emission glutathione-stabilized gold nanoclusters (AuNCs) with blue emission ethylenediamine functionalized graphene oxide (EDA-GO), and introducing copper ions (Cu2+) to quench the orange emission of AuNCs while the blue emission served as a background reference without color change. The Cd2+ can induce Cu2+-GSH-AuNCs to aggregation and emit orange fluorescence, causing the fluorescent color of the sensor changed from blue to red with the limit of detection (LOD) as low as 33.3 nM in solution. Moreover, fluorescent paper strips integrated with smartphone platform has a sensitive detection of Cd2+ with the LOD of 0.1 µM in rice samples. The method reported here might have great application prospects in real-time monitoring of foods safety and environmental protection.

A Portable Smartphone Platform Using a Ratiometric Fluorescent Paper Strip for Visual Quantitative Sensing.

Instrument-free, portable, and direct read-out mini-devices have wider application prospects in various fields, especially for real-time/on-site sensing. Herein, combined with a paper strip, a smartphone sensing platform integrated with a UV lamp and dark cavity by 3D-printing technology has been developed for the rapid, sensitive, instrument-free, and visual quantitative analysis in real-time/on-site conditions. The platform proved the feasibility for visual quantitative detection of pesticide via a fluorescence "on-off-on" response with a single dual-emissive ratiometric paper strip. Red-emitting CdTe quantum dots (rQDs) were embedded into the silica nanoparticles (SiO2 NPs) as an internal reference, while blue-emitting carbon dots (bCDs) as a signal report unit were covalently linked to the outer surface of SiO2 NPs. The blue fluorescence could be quenched by gold nanoparticles (Au NPs) and then recovered with pesticide. The red (R), green (G), and blue (B) channel values of the generated images were determined by a color recognizer application (APP) installed in the smartphone, and the R/B values could be used for pesticide quantification with a sensitive detection limit (LOD) of 59 nM. The smartphone sensing platform based on 3D printing might provide a general strategy for visual quantitative detection in a variety of fields including environments, diagnosis, and safety monitoring.

External validation of the Besançon nomogram in Asian patients with advanced pancreatic cancer receiving second-line chemotherapy: A multi-institute experience in Taiwan.

BACKGROUND: Determining survival outcome in advanced pancreatic ductal adenocarcinoma (aPDAC) patients receiving second-line (L2) chemotherapy is important for clinical decision-making. The Besançon group from France recently proposed a prognostic nomogram to predict overall survival (OS) for aPDAC patients receiving L2 chemotherapy. The present study aimed to externally validate the performance of the Besançon nomogram in predicting OS in an Asian cohort. METHODS: We retrospectively enrolled 349 patients who received L2 chemotherapy for aPDAC between 2010 and 2016 at four institutes in Taiwan. The performance of the Besançon model in this cohort was evaluated with C-index and calibration plots. RESULTS: The median OS time in our patient cohort was 4.5 months (95% confidence interval [CI], 3.0-5.0). Using the Besançon nomogram-predicted risk groups, the median OS times in the low, intermediate, and high-risk groups were 6.7 (95% CI, 5.3-8.2), 3.2 (95% CI, 2.4-3.9), and 1.7 months (95% CI, 0.6-2.7), respectively. The C-index of the predicted six- and 12-month survival probabilities for the Besançon nomogram were 0.766 (95% CI, 0.715-0.816) and 0.698 (95% CI, 0.641-0.754), respectively. The calibration plot showed that the observed six-month survival probability was close to the diagonal line, while that for 12-month survival deviated below the diagonal line compared to the survival probability predicted by the Besançon nomogram. CONCLUSIONS: Although the Besançon nomogram tended to over-estimate the 12-month survival probability, our study demonstrated that the nomogram is a reliable and readily applicable model to estimate survival outcomes of aPDAC patients receiving L2 chemotherapy.

Semiquantitative Visual Detection of Lead Ions with a Smartphone via a Colorimetric Paper-Based Analytical Device.

A simple, instrument-free, paper-based analytical device with dual-emission carbon dots (CDs) (blue CDs and red CDs) was developed for the semiquantitative, visual, and sensitive speciation analysis of lead ions in a real sample with a sensitive detection limit of 2.89 nM. When a paper strip was immersed into the sample solution, the blue fluorescence was quenched by Pb2+ in solution, while the red fluorescence served as a background reference without color change, and significant color evolutions from blue to red were observed under the ultraviolet lamp, resulting in a semiquantitative visual detection. Furthermore, a smartphone was used in the visual detection of lead ions by identifying the RGB value of the fluorescent probe solution and corresponding paper strip. The application of smartphones and fluorescent paper strips has greatly shortened the detection time and reduced the cost of detection, providing a new strategy for the on-site and semiquantitative detection of heavy-metal ions in water samples.

Semi-quantitative and visual assay of copper ions by fluorescent test paper constructed with dual-emission carbon dots.

A novel, simple and effective dual-emissive fluorescent probe for the sensitive and selective detection of Cu(ii) has been developed by mixing blue carbon dots and orange carbon dots, with a sensitive detection limit of 7.31 nM. The blue fluorescence can be selectively quenched by Cu(ii), while the orange fluorescence is a internal reference, resulting in a distinguishable fluorescence color change from blue to orange under a UV lamp. Meanwhile, its as-prepared text paper provides a convenient and simple approach for the visual detection of Cu(ii) and successfully applied in real water samples, with a dose-discerning ability as low as 50 nM. The methodology reported here opens a novel pathway toward the real applications of fluorescent test papers.

Fluorescence and visual detection of fluoride ions using a photoluminescent graphene oxide paper sensor.

The instant and on-site detection of trace aqueous fluoride ions is still a challenge for environmental monitoring and protection. This work demonstrates a new analytical method and its utility of a paper sensor for visual detection of F(-) on the basis of the fluorescence resonance energy transfer (FRET) between photoluminescent graphene oxide (GO) and silver nanoparticles (AgNPs) through the formation of cyclic esters between phenylborinic acid and diol. The fluorescence of GO was quenched by the AgNPs, and trace F(-) can recover the fluorescence of the quenched photoluminescent GO. The increase in fluorescence intensity is proportional to the concentration of F(-) in the range of 0.05-0.55 nM, along with a limit of detection (LOD) as low as 9.07 pM. Following the sensing mechanism, a paper-based sensor for the visual detection of aqueous F(-) has been successfully developed. The paper sensor showed high sensitivity for aqueous F(-), and the LOD could reach as low as 0.1 µM as observed by the naked eye. The very simple and effective strategy reported here could be extended to the visual detection of a wide range of analytes in the environment by the construction of highly efficient FRET nanoprobes.

Fabrication of Fe3O4/SiO2 core/shell nanoparticles attached to graphene oxide and its use as an adsorbent.

Amino-functionalized Fe(3)O(4)/SiO(2) core/shell nanoparticles were synthesized by reacting Fe(3)O(4) nanoparticles with tetraethyl orthosilicate and (3-aminopropyl) triethoxysilane to introduce amino groups on the surface. The amino groups on the Fe(3)O(4)/SiO(2) were reacted with the carboxylic groups of graphene oxide (GO) with the aid of 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide and N-hydroxysuccinnimide to form Fe(3)O(4)/SiO(2)GO nanoparticles. The structural, surface, and magnetic characteristics of the material were investigated by scanning and transmission electron microscopy, energy-dispersive X-ray spectrometry, powder X-ray diffraction, Fourier transform infrared spectroscopy, and thermogravimetric analysis. Adsorption equilibrium and kinetics of methylene blue on the Fe(3)O(4)/SiO(2)GO were studied in a batch system. The maximum adsorption capacities were found to be 97.0, 102.6, and 111.1 mg g(-1) at 25, 45, and 60°C, respectively. A second-order kinetic equation could best describe the sorption kinetics. Thermodynamic parameters indicated that the adsorption of methylene blue onto the material was thermodynamically feasible and could occur spontaneously.

Effect of pH and aging time on the kinetic dissociation of 243Am(III) from humic acid-coated gamma-Al2O3: a chelating resin exchange study.

The chelating resin was studied to assess its influence on metal availability and mobility in the environment. The association of organic-inorganic colloid-borne trace elements was investigated in this work. The radionuclide 243Am(III) was chosen as the representative and chemical homologue for trivalent lanthanide and actinide ions present in radioactive nuclear waste. The kinetic dissociation behavior of 243Am(III) from humic acid-coated gamma-Al2O3 was studied at pH values of 4.0 +/- 0.1, 5.0 +/- 0.2, and 6.0 +/- 0.2 with a contact time of 2 days after the addition of a chelating cation exchanger resin. The concentrations of the components were: 243Am(III) 3.0 x 10(-7) mol/L, gamma-Al2O3 0.5 g/L, HA 10 mg/L (pH 4.0 +/- 0.1, 5.0 +/- 0.2, and 6.0 +/- 0.2) and 50 mg/L (pH 6.0 +/- 0.2), respectively. The kinetics of dissociation of 243Am(III) after different equilibration time with humic acid-coated gamma-Al2O3 was also investigated at pH 5.0 +/- 0.2. The experiments were carried out in air and at ambient temperature. The results suggest that the fraction of irreversible bonding of radionuclides to HA-coated Al2O3 increases with increasing pH and is independent of aging time. The assumption of two different 243Am(III)-HA-Al2O3 species, with "fast" and "slow" dissociation kinetics, is required to explain the experimental results. 243Am(III) species present on HA-Al2O3 colloids moves from the "fast" to the "slow" dissociating sites with the increase of aging time.

Three-dimensional identification of the cystic infundibulum-cystic duct junction: a technique for identification of the cystic duct in laparoscopic cholecystectomy.

OBJECTIVE: The main cause of bile duct injury (BDI) at laparoscopic cholecystectomy is misidentification of the common bile duct as the cystic duct (CD). The aim of this article is to introduce a modified technique, i.e., three-dimensional identification of the cystic infundibulum (CI)-CD junction, to prevent misidentification-induced BDI during laparoscopic cholecystectomy. METHODS: The CI was extensively dissected to expose its anterior, interior-superior and inferior-dorsal aspects. With the CI nearly circularly dissected out, the CI and the appearance-indicated CI-CD junction might be three-dimensionally identified and the reality of the CI-CD junction as well as the reality of the CD could be precisely judged. RESULTS: Overall 10 BDIs were documented in this group. Since BDI occurred in 8 of 4382 patients receiving laparoscopic cholecystectomy, the technique for prevention of misidentification-induced BDI was established. Among the late batch of 7618 patients, only two BDIs were noted. CONCLUSIONS: Three-dimensional identification of the CI-CD junction is a reliable, feasible and relatively low experience-dependent technique to prevent most of misidentification-induced BDI.

Non-image diagnosis of bile duct injury during laparoscopic cholecystectomy.

OBJECTIVE: To evaluate the role of simple non-image technique in intraoperative diagnosis of bile duct injury (BDI). METHODS: BDI was highly suspected at the original laparoscopic cholecystectomy (LC) when the following 3 abnormal findings were noted: the "cystic duct" stump (the common bile duct stump actually) markedly retracted down to the duodenum; bile leakage from the porta hepatis; abnormal mucosal patch attached to the "cystic duct" stump of the removed gallbladder. All cases of suspected BDI were converted to have laparotomy. image techniques such as intraoperative cholangiography or ultrasonography were not utilized for recognition of BDI in all 9 patients. RESULTS: BDI in 4 of the 9 patients was suspected according to 1-3 abnormal intraoperative findings described above. The four patients were subjected immediately to converted laparotomy. Abnormal findings were not observed or misinterpreted in the other 5 misdiagnosed patients. CONCLUSIONS: Timely recognizing whether BDI occurs should be considered as a routine procedure of LC. Negligence of operators to the abnormalities of the original LC is the main cause of misdiagnosis for BDI. Simple non-Image approaches such as close observation of these abnormalities can make timely diagnosis for most BDIs during the original LC.