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1.
Br J Dermatol ; 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34741300

RESUMO

BACKGROUND: Tinea capitis is still common in developing countries, such as China. Its pathogen spectrum varies across regions and changes over time. OBJECTIVES: This study aimed to clarify the current epidemiological characteristics and pathogen spectrum of tinea capitis in China. METHODS: A multicentre, prospective descriptive study involving 29 tertiary hospitals in China was conducted. From August 2019 to July 2020, 611 patients with tinea capitis were enrolled. Data concerning demography, risk factors and fungal tests were collected. The pathogens were further identified by morphology or molecular sequencing when necessary in the central laboratory. RESULTS: Among all enrolled patients, 74.1% of the cases were 2- to 8-year-olds. The children with tinea capitis were mainly boys (56.2%) and more likely to have an animal contact history (57.4% vs. 35.3%, P = 0.012) and zoophilic dermatophyte infection (73.5%). The adults were mainly females (83.3%) and more likely to have anthropophilic agent infection (53.5%). The most common pathogen was zoophilic Microsporum canis (354, 65.2%), followed by anthropophilic Trichophyton violaceum (74, 13.6%). In contrast to the eastern, western and northeastern regions where zoophilic M. canis predominated, anthropophilic T. violaceum predominated in central China (69.2%, P < 0.0001), where the patients had the most tinea at other sites (20.3%) and dermatophytosis contact (25.9%) with the least animal contact (38.8%). Microsporum ferrugineum was the most common anthropophilic agent in the western area, especially in Xinjiang Province. CONCLUSIONS: Boys aged approximately 5 years were mainly affected. Dermatologists are advised to pay more attention to the different transmission routes and pathogen spectra in different age groups from different regions.

2.
Tech Coloproctol ; 2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34796435

RESUMO

BACKGROUND: Functional defecatory disorders (FDDs) are highly prevalent around the world. Biofeedback is an effective treatment for FDDs. Traditionally, this treatment is performed by clinicians in a limited number of hospitals because of procedure-related expenses and a need for a dedicated procedure room. To make the biofeedback therapy more widely available, we have designed a novel wireless, smartphone-based biofeedback device, with the ultimate goal of performing the therapy at home. The aim of this pilot study was to investigate whether the developed device can be employed to treat patients with FDDs in a clinical setting, prior to employing it in a home setting. METHODS: From March 2018 to July 2018, we performed the biofeedback therapy using the newly developed wireless, smartphone-based device in patients with FDDs 30 min daily during weekdays for 2 weeks. A Visual Analogue Scale (VAS) for bowel satisfaction, Patient Assessment of Constipation-Symptoms (PAC-SYM), Patient Assessment of Constipation Quality of Life (PAC-QOL), and a balloon expulsion test were assessed at baseline and after the therapy. RESULTS: Thirteen patients were recruited and ten of them (mean age 70.3 ± 8.9 years, female:male ratio: 3:7) completed the study. Spontaneous bowel movements, complete spontaneous bowel movements, and VAS were all significantly increased after the therapy compared with baseline, respectively (6.5 ± 4.3 vs. 1.5 ± 2.2, p = 0.006; 3.1 ± 2.2 vs. 0.2 ± 0.6, p = 0.002; 49.5 ± 31.0 vs. 12.0 ± 9.2, p = 0.003). There was a significant decrease in the PAC-SYM and PAC-QoL after the biofeedback therapy (0.7 ± 0.6 vs. 1.4 ± 0.3, p = 0.001; 0.7 ± 0. 6 vs. 1.5 ± 0.4, p = 0.001). The therapy reduced the balloon expulsion time significantly (83.9 ± 68.8 s vs. 160.0 ± 36.7 s, p = 0.002). No obvious adverse events related to the procedure itself occurred. CONCLUSIONS: Biofeedback training using the newly developed wireless, smartphone-based device is feasible in the clinic setting, and it seems to be a promising method for improving constipation and related symptoms in patients with FDDs. These findings could be used to develop a much-needed, home-based, suitably powered, randomized, controlled clinical trial.

3.
Zhonghua Fu Chan Ke Za Zhi ; 56(10): 677-683, 2021 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-34823316

RESUMO

Objective: To speculate the effect of birth spacing on the pelvic floor type Ⅰ and Ⅱ fiber muscle strength of postpartum women with parities of two in different delivery modes. Methods: Totally 2 361 parturients who were investigated in Xuzhou Central Hospital from June 2016 to December 2020 were included in the questionnaire, clinical examination and pelvic floor surface electromyography assessment. According to the interval years between two parities and the pelvic floor typeⅠ and Ⅱ fiber muscle strength under different modes of delivery, curve fitting function equation was performed using curve regression method. The accuracy of the equation was verified by the receiver operating characteristic curve and the maximum area under the curve, and calculating the relative error rate. Results: A total of 2 357 parturients were included in the study and were divided into 4 groups based on delivery modes, women with both normal vaginal delivery were assigned to group A (589 cases); women with a first vaginal delivery and a second cesarean section were assigned to group B (480 cases); women with both cesarean deliveries were assigned to group C (1 273 cases); women with a first cesarean section and a second vaginal delivery were assigned to group D (15 cases). All of the curve fitting results were quadratic curves, and the appropriate interval years were selected when the muscle strength of type Ⅰ muscle fibers was>35 µV and that of type Ⅱ muscle fibers was>40 µV: 6-8 years in the group A, 5-10 years in the group B, and 1-11 years in the group C. The peak values of the quadratic curve were as follows: 7-8 years in the group A, 7-8 years in the group B, and 6 years in the group C. The maximum area under the curve of the function equations were all>0.6 (all P<0.05), the average relative error rate was 4.909%. Conclusions: The pelvic floor function of postpartum women with parities of two increases firstly and then decreases over time, showing a quadratic curve shape. In order to protect the pelvic floor function, the appropriate interval of birth spacing is 6-8 years.


Assuntos
Cesárea , Diafragma da Pelve , Intervalo entre Nascimentos , Parto Obstétrico , Feminino , Humanos , Fibras Musculares Esqueléticas , Força Muscular , Período Pós-Parto , Gravidez
4.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(4): 672-676, 2021 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814449

RESUMO

Objective: To evaluate the prediction power of HIV infection risk assessment tool and the applicability in MSM in Guizhou province. Methods: MSM were recruited through snowball sampling method. Questionnaire surveys were conducted among the MSM using HIV infection risk assessment tool, and combined with HIV serologic test results, the risk prediction power of HIV infection risk assessment tool was evaluated. Results: A total of 3 379 MSM were recruited from January 2018 to December 2019 in Guizhou. The HIV infection rate was 3.3%(111/3 379). The mean risk scores of HIV positive and HIV negative MSM were (12.15±3.08) and (12.07±3.07), respectively. The difference in risk score was significant between MSM with different HIV status (t=8.69, P<0.001). According to the principle of decision tree, individual risk scores were divided into following three categories: ≤11.96, 11.97-14.80 and >14.80, the HIV infection rate was 0.8%, 4.3% and 8.6% respectively, suggesting that the higher the individual risk score was, the higher the HIV infection rate was (trend χ2=88.18, P<0.001). Multivariate logistic regression analysis showed that the higher the individual risk score was, the higher the risk of HIV infection was. Compared to the total score ≤11.96, the aOR values at total scores of 11.97-14.80 and >14.80 were 6.34 (95%CI: 3.38-11.88) and 14.07(95%CI: 7.44-26.61), respectively. The risk of HIV infection in Miao ethnic group was higher than that in Han ethnic group (aOR=1.83, 95%CI:1.04-3.21), and the risk of HIV infection in those with education level of primary school and below was higher than that in undergraduates or those with education level of junior college and above (aOR=2.50, 95%CI:1.06-5.88), and the risk of HIV infection was higher in those who had bisexual behaviors than in those who had homosexual behaviors (aOR=1.95, 95%CI:1.19-3.19). The risk of HIV infection was higher in those who had never received HIV testing (aOR=1.53, 95%CI:1.01-2.33). The area under the receiver operating characteristic (ROC) curve and area under ROC (AUC) for HIV infection prediction was 0.751 (95%CI:0.710-0.792, P<0.001). The maximum Youden's index was individual risk score of 12.56, and the sensitivity of the risk assessment tool was 0.838, and its specificity was 0.412. Conclusions: The results of HIV infection risk assessment tool in Guizhou indicated that in MSM the higher the individual risk score, the higher the risk of HIV infection is. The tool can be used to evaluate the risk of HIV infection in MSM, but the specificity should be improved.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Bissexualidade , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Medição de Risco
5.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(6): 983-991, 2021 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814496

RESUMO

Objective: To rapidly evaluate the level of healthcare resource demand for laboratory testing and prevention and control of corona virus disease 2019 (COVID-19) in different epidemic situation, and prepare for the capacity planning, stockpile distribution, and funding raising for infectious disease epidemic response. Methods: An susceptible, exposed, infectious, removed infectious disease dynamics model with confirmed asymptomatic infection cases and symptomatic hospitalized patients was introduced to simulate different COVID-19 epidemic situation and predict the numbers of hospitalized or isolated patients, and based on the current COVID-19 prevention and control measures in China, the demands of resources for laboratory testing and prevention and control of COVID-19 were evaluated. Results: When community or local transmission or outbreaks occur and total population nucleic acid testing is implemented, the need for human resources is 3.3-89.1 times higher than the reserved, and the current resources of medical personal protective equipment and instruments can meet the need. The surge in asymptomatic infections can also increase the human resource demand for laboratory testing and pose challenge to the prevention and control of the disease. When vaccine protection coverage reach ≥50%, appropriate adjustment of the prevention and control measures can reduce the need for laboratory and human resources. Conclusions: There is a great need in our country to reserve the human resources for laboratory testing and disease prevention and control for the response of the possible epidemic of COVID-19. Challenges to human resources resulted from total population nucleic acid testing and its necessity need to be considered. Conducting non-pharmaceutical interventions and encouraging more people to be vaccinated can mitigate the shock on healthcare resource demand in COVID-19 prevention and control.


Assuntos
COVID-19 , Pandemias , Humanos , Laboratórios , Pandemias/prevenção & controle , Equipamento de Proteção Individual , SARS-CoV-2
6.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(6): 1139-1142, 2021 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814522

RESUMO

COVID-19 spreads with strong infectivity and triggered a public health crisis, home and abroad. SARS-CoV-2 has high pathogenic homology with SARS-CoV and MERS-CoV, and the three coronaviruses all belong to the Betacoronavirus family. Due to pregnant women's physical and psychological vulnerability, they are the susceptible and high-risk groups during the epidemic. This article will review the reports on adverse effects of maternal and fetal health during the SARS and MERS and COVID-19 epidemics to provide evidence for the clinical management and prevention and control of pregnant cases in SARS-CoV-2 infection.


Assuntos
COVID-19 , Coronavírus da Síndrome Respiratória do Oriente Médio , Complicações Infecciosas na Gravidez , Feminino , Humanos , Saúde do Lactente , Transmissão Vertical de Doenças Infecciosas , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , SARS-CoV-2
7.
Artigo em Inglês | MEDLINE | ID: mdl-34620585

RESUMO

BACKGROUND AND PURPOSE: Arterial sclerosis resulting from hypertension slows CSF transportation in the perivascular spaces, showing the intrinsic relationship between the CSF and the blood vasculature. However, the exact effect of hypertension on human CSF flow dynamics remains unclear. The present study aimed to evaluate CSF flow dynamics in treatment-naive patients with essential hypertension using phase-contrast cine MR imaging. MATERIALS AND METHODS: The study included 60 never-treated patients with essential hypertension and 60 subjects without symptomatic atherosclerosis. CSF flow parameters, such as forward flow volume, forward peak velocity, reverse flow volume, reverse peak velocity, average flow, and net flow volume, were measured with phase-contrast cine MR imaging. Differences between the 2 groups were assessed to determine the independent determinants of these CSF flow parameters. RESULTS: Forward flow volume, forward peak velocity, reverse flow volume, reverse peak velocity, and average flow in the patients with hypertension significantly decreased (all, P < .05). Increasing systolic blood pressure was significantly associated with lower forward flow volume (ß = -0.44 mL/mL/mm Hg; 95% CI, -0.83 to -0.06 mL/mL/mm Hg), forward peak velocity (ß = -0.50 cm/s/mm Hg; 95% CI, -0.88 to -0.12 cm/s/mm Hg), reverse flow volume (ß = -0.61 mL/mL/mm Hg; 95% CI, -0.97 to -0.26 mL/mL/mm Hg), reverse peak velocity (ß = -0.55 cm/s/mm Hg; 95% CI, -0.91-0.18 cm/s/mm Hg), and average flow (ß = -0.50 mL/min/mm Hg; 95% CI, -0.93 to -0.08 mL/min/mm Hg). CONCLUSIONS: The CSF flow dynamics in patients with hypertension are decreased, and increasing systolic blood pressure is strongly associated with lower CSF flow dynamics.

8.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(9): 1129-1132, 2021 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-34619932

RESUMO

In 2019, the rate of primary tooth caries rate among 1 598 preschool children in Shinan District and Shibei District of Qingdao was 59.4%. The multivariate logistic regression model showed that compared with children ≤ 2 years old with history of iron deficiency anemia (IDA), suffering IDA, breastfeeding to 2 years old and no tooth melanin, children ≤ 2 years old without history of IDA, not suffering IDA, breastfeeding to less than 2 years old and heavy tooth melanin had a lower risk of primary tooth caries, with OR (95%CI) values about 0.328 (0.197-0.549), 0.354 (0.208-0.603), 0.636 (0.437-0.926) and 0.301 (0.143-0.635), respectively.


Assuntos
Cárie Dentária , Pré-Escolar , Cárie Dentária/epidemiologia , Humanos , Modelos Logísticos , Prevalência , Dente Decíduo
10.
Br J Surg ; 2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34643677

RESUMO

BACKGROUND: The therapeutic value of repeat hepatic resection (rHR) or radiofrequency ablation (RFA) for recurrent hepatocellular carcinoma (HCC) is unknown. This study aimed to investigate the safety and efficacy of rHR or RFA. METHODS: This was a retrospective multicentre study of patients with recurrent HCC within the Milan criteria who underwent rHR or RFA at nine university hospitals in China and Italy between January 2003 and January 2018. Survival after rHR or RFA was examined in unadjusted analyses and after propensity score matching (1 : 1). RESULTS: Of 847 patients included, 307 and 540 underwent rHR and RFA respectively. Median overall survival was 73.5 and 67.0 months after rHR and RFA respectively (hazard ratio 1.01 (95 per cent c.i. 0.81 to 1.26)). Median recurrence-free survival was longer after rHR versus RFA (23.6 versus 15.2 months; hazard ratio 0.76 (95 per cent c.i. 0.65 to 0.89)). These results were confirmed after propensity score matching. RFA was associated with lower morbidity of grade 3 and above (0.6 versus 6.2 per cent; P < 0.001) and shorter hospital stay (8.0 versus 3.0 days, P < 0.001) than rHR. CONCLUSION: rHR was associated with longer recurrence-free survival but not overall survival compared with RFA.

11.
Int J Radiat Oncol Biol Phys ; 111(3S): e232, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34700973

RESUMO

PURPOSE/OBJECTIVE(S): Host immunity has a significant impact on radiotherapy (RT) outcomes in cancer. We have previously demonstrated that Indoleamine 2, 3-dioxygenase (IDO), a known immunoinhibitory kinase, predicts the survival of patients with stage I/II after RT alone and stage III non-small cell lung cancer (NSCLC) after chemoradiation. We hypothesize that the IDO activity levels in the blood also change in patients with stage IV NSCLC following radiotherapy. MATERIALS/METHODS: This was part of a prospective study of circulating immune biomarkers for prognosis and prediction. Newly diagnosed or recurrent stage IV NSCLC patients were eligible. Blood samples were obtained before and after RT start and platelet-poor plasma samples were used for the kynurenine (Kyn) and tryptophan (Trp) measurement by high-performance liquid chromatography. Kyn and Trp was detected on a UV/vis channel at 360 nm and 285 nm, respectively, with more than 95% re-productivity. IDO activity was defined as the ratio between Kyn and Trp in synchronization. Student T-test was applied for group comparison. Data are presented as mean and 95% confidence interval (CI). P value < 0.05 was considered as statistical significance. RESULTS: Between July 2019 and Dec 2020, a total of 54 patients with stage IV NSCLC treated with radiotherapy was recruited. RT dose ranged from 20-60 Gray in 5-30 fractions, covering thoracic, spines or brain. Higher concentration of Kyn (mean = 1.88, CI = 1.48-2.27 mM) was detected before RT, compared with the Kyn concentration (mean = 1.20, CI = 0.70-1.70 mM) after RT (P = 0.052). The mean concentration of Trp was 20.81 (CI = 17.01-24.62) mM before RT, compared with 19.01 (CI = 17.03-21.00) mM after RT with no significant change (P = 0.982). In addition, the IDO activity (mean = 0.11, CI = 0.08-0.14) before RT was higher than the IDO activity after RT (mean = 0.08, CI = 0.05-0.10) with P = 0.130. Furthermore, a subgroup analysis of the IDO activity in patients with distant metastasis (n = 31) was conducted. The mean concentration of Kyn was significantly decreased from 1.78 (CI = 1.67-2.67) mM before RT to 0.68 (CI = 0.28-2.09) mM after RT (P = 0.028). The mean concentration of Trp was 18.12 (CI = 15.39-20.84) mM before RT versus 18.64 (CI = 14.41-22.86) mM after RT (P = 0.847). Besides, the IDO activity was also reduced from 0.15 (CI = 0.09-0.20) before RT to 0.07 (CI = 0.01-0.13) after RT (P = 0.051). CONCLUSION: This study reveals that the plasma kynurenine and IDO activity is reduced after RT, suggesting that potential roles of RT in releasing immune suppression status of the host that can be simply tested by IDO activity in patients with stage IV NSCLC.

12.
Int J Radiat Oncol Biol Phys ; 111(3S): e258, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34701031

RESUMO

PURPOSE/OBJECTIVE(S): Radiotherapy (RT) as a traditional treatment for Breast cancer (BC) not only could induce local tumor cell death but also modify the tumor microenvironment to engage antitumor immune response. High level of tumor infiltrating lymphocytes, especially CD8, T helper cells and dendritic cells, have great correlation with pathological complete response in BC patients. However, there is no systematic report on the dynamic changes of circulating immune cells in BC treated with RT. We detected the systemic lymphocyte subsets in the peripheral blood before, during, and after RT of BC patients to evaluate the effects of RT on different lymphocyte subtypes. MATERIALS/METHODS: BC patients treated with RT were recruited to a prospective study. Blood samples were obtained EDTA coated tubes and then centrifuged for white blood cell. The antibodies including CD11b, CD45, CD19, CD3, CD56, CD4, CD8a, CD133, HLA-DR, and FOXP3 were used to identify corresponding cell subtypes. Finally, the percentage of Lymphocytes, MDSC, DC, B cells, T cells, Treg, CD8+ T cells, CD4+ T cells, NK cells, and NKT were analyzed using flow cytometry software. The paired T-test was used to compare and analyze each cell subpopulation from Pre, Dur and End of RT. P < 0.05 was considered to be significant. RESULTS: Between July 2019 and January 2020, a total of 50 BC patients treated with RT that signed consent forms and sampled at three time points (Pre, Dur, End of RT) were enrolled in this study. After RT, the ratio of CD8/CD4 (Pre vs. End mean:0.73 vs. 0.60, P = 0.04) were significantly decreased while Tregs (Pre vs. End mean:2.03 vs. 2.68, P = 0.04) were increased. Analyzing the changes of myeloid Cells, DC were shown a significant gradual increase trend (Pre vs. End mean:0.23 vs. 0.37, P < 0.0001) from baseline (mean:0.23) to during (mean: 0.33) and end (0.37) of RT. Further explore the dynamic changes of lymphocytes subtypes before and after RT under each clinical stage. In stage III patients, CD4 cells (Pre vs. Dur mean:47.62 vs. 55.64, P = 0.03) and Tregs (Pre vs. Dur mean:1.83 vs. 3.37, P = 0.01) were significantly increased during RT treatment. Whereas there were drastically reduced in CD8 cells during (Pre vs. Dur mean:36.21 vs. 30.84, P = 0.003) and after (Pre vs. End mean:36.21 vs. 29.23, P = 0.03) RT treatment. After RT treatment for stage III patients, DC were shown a significant increase trend (Pre vs. Dur mean:0.25 vs. 0.37, P = 0.02; Pre vs. End mean: 0.24 vs. 0.48, P = 0.008). For other stages, there is no significant change in immune cell subsets before and after RT. CONCLUSION: Different immune cell subtypes have different sensitivity to radiotherapy. Overall, RT could induce CD8/CD4 ratio decrease, Treg and DC increase. Interestingly, Stage III Breast cancer patients are more sensitive to RT, and their immune status changes significantly during RT treatment. Although these findings need to be verified for a larger sample size, the preliminary results provide instructions for subsequent personalized and precise treatment for different individuals.

13.
Int J Radiat Oncol Biol Phys ; 111(3S): e544-e545, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34701712

RESUMO

PURPOSE/OBJECTIVE(S): To report our initial clinical implementation of a hypofractionated brain radiosurgery (hSRS) approach via packing hundreds of isocenters for treatment of a large target with a substantial GTV expansion in order to reduce dose hot spots in eloquent brain. MATERIALS/METHODS: A high-density isocenter packing (HDIP) technique similar to "onion peeling" was developed for hSRS, where a large target volume of 14.1 cc was sequentially shrunk or "peeled" by a margin of 2 to 4-mm depending on its size. The isocenters were densely packed inside each layer or each "peel" of the target, especially within the GTV-to-PTV margin. Once packed, the isocenter location, shapes and weights of the beams were inversely optimized and manually adjusted to achieve an optimal dose distribution. This technique was clinically implemented on a frameless SRS unit for the purpose of expediting the workflow in treating brain lesions with GTV-to-PTV expansion of at least 5 mm. RESULTS: HDIP enabled the target dose to be prescribed to the 80-90% isodose line (normalized to the dose maximum), thus reducing dose hot spots greater than 120% of prescription dose inside the GTV expansion volume comprised mostly of normal brain tissue. Compared to the conventional approach of using only 1/3 to 1/4 as many isocenters, HDIP achieved identical dose coverage (> 98%), dose conformality (< = 2.8) and Paddick gradient indices (< = 3.5) for the PTV. An important caveat in implementing HDIP was that when globally increasing the total number of isocenters, the dose contributions from some isocenters decreased rapidly, rendering their beam-on time to fall below the machine limit of 0.01 min. To overcome such a problem, manual blocking of beamlets associated with the affected isocenters was implemented to effectively lower the dose rate, propelling the treatment time at these isocenters > 0.01 min to enable clinical implementation. This strategy negligibly impacted the total treatment time of 20-30 min of a typical HDIP treatment with a dose rate of 2.0 Gy/min of our LGKI unit. CONCLUSION: HDIP is technically feasible and successfully implemented for the first time at our institution, enabling us to expedite the hSRS workflow to care for patients with targets in eloquent brain requiring substantial GTV-to-CTV/PTV margin expansion. AUTHOR DISCLOSURE: N. Cho: Employee; Thermo Fisher Scientific. D. Raleigh: None. B.P. Ziemer: None. T. Nano: None. P.V. Theodosopoulos: None. P.K. Sneed: None. L. Boreta: None. S.E. Braunstein: Advisory Board; Radiation Oncology Questions, LLC.L. Ma: Patent/License Fees/Copyright; University of California Regents.

14.
Int J Radiat Oncol Biol Phys ; 111(3S): e555-e556, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34701739

RESUMO

PURPOSE/OBJECTIVE(S): Previous studies have characterized dose gradient patterns for various hypo-fractionated brain radiosurgery (hSRS) treatment platforms. The Gamma Knife Icon (GKI) has consistently exhibited either superior or non-inferior peripheral dose fall-off and normal brain sparing characteristics when compared to other Linac-based hSRS treatment platforms. Given the prevalence of Linac-based treatments, identifying planning techniques to optimize treatment parameters is desirable. In this study, we investigated a novel Linac-based treatment approach that aimed to create the sharpest dose fall-off for hSRS of large brain lesions. MATERIALS/METHODS: A cohort of patient cases (n = 10) with single brain lesions (volume 27.6+/-8.1 mL, range 20.-42.1 mL) treated with GKI at our institution were selected as sample test cases for our study. A non-coplanar unconstrained VMAT (NCU-VMAT) treatment planning approach was developed, and its script was implemented on a commercial treatment planning system for clinical Linac treatment equipped with the latest high-definition multi-leaf collimators (MLCs). Treatment plans produced via the NCU-VMAT approach were then compared against further optimized treatment plans from GKI, as well as conventional coplanar and non-coplanar VMAT treatment planning approaches. The comparison was carried out using DVH-derived parameters including target volume coverage, target dose conformity, modified dose fall-off index defined as the volume of 50% prescribed target dose divided by the target volume (PIV50). RESULTS: For each case studied, NCU-VMAT achieved practically identical target coverage (0.98 ± 0.01) and Paddick dose conformity index (0.87 ± 0.02) compared to optimized GKI treatments. The mean PIV50 values were 2.99 ± 0.14, 3.77 ± 0.22, and 3.36 ± 0.19 for optimized GKI, conventional coplanar, and non-coplanar VMAT treatment plans, respectively. These results were in excellent agreement with previously published studies. However, the NCU-VMAT technique yielded a mean PIV50 of 2.41 ± 0.07. This represents an improvement of approximately 40% (P < 0.001, paired two-tailed Student t-test) over all existing approaches including GKI. Further analyses revealed that PIV50 of NCU-VMAT approached the theoretical minimum for all the studied cases. CONCLUSION: Our results demonstrate that in treatment of large brain tumors, a treatment planning approach using Bremsstrahlung x-ray based Linacs can achieve superior dose fall-off for intracranial hSRS compared to GKI. We dispel the myth that physical characteristics of Cobalt γ-rays are needed to create the sharpest dose fall-off. Given the prevalence of Linac-based treatments compared to GKI, we present a novel optimized planning technique that achieves a new benchmark of sharpest dose fall-off. AUTHOR DISCLOSURE: T. Nano: None. O. Morin: None. B.P. Ziemer: None. D. Raleigh: None. L. Boreta: None. J.L. Nakamura: None. S.E. Fogh: Independent Contractor; Accuray. P.K. Sneed: None. S. Hervey-Jumper: None. P.V. Theodosopoulos: None. S.E. Braunstein: Advisory Board; Radiation Oncology Questions, LLC.L. Ma: Patent/License Fees/Copyright; University of California Regents.

15.
Int J Radiat Oncol Biol Phys ; 111(3S): e565, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34701762

RESUMO

PURPOSE/OBJECTIVE(S): Patients with large brain metastases may receive fractionated stereotactic radiosurgery (FSRS) if they are not surgical candidates yet still pursuing cancer-directed therapy. FSRS with limited margins can allow for optimal sparing of uninvolved regional brain tissue. However, due to required treatment planning process, there is often elapsed time between MRI brain and treatment start which may contribute to marginal misses. Growth rates of large brain metastases and implications for optimal margin to account for growth rate and time interval between planning MRI and FSRS are incompletely characterized. MATERIALS/METHODS: Patients treated at a single institution from 2018-2020 who received frameless FSRS on a Cobalt-60 treatment unit for large (> 2cm diameter) brain metastases were identified. Patients with a prior diagnostic brain MRI scan with technically similar parameters to a second MRI obtained for treatment planning were included. Resection cavities and lesions undergoing re-treatment after prior SRS were excluded. Brain metastasis volumes were obtained by contouring on both diagnostic and planning MRIs. Patient characteristics and treatment details were also collected. Analysis was conducted using paired Student's t test and Pearson's R and growth rate was determined using a linear model. RESULTS: Thirty-six patients with 54 brain metastases met inclusion criteria. The most common primary cancer sites were lung (36%), colorectal (14%), and skin (14%), and most common histologies were adenocarcinoma (53%) and melanoma (17%). Nearly half (47%) of patients were on systemic therapy at the time of FSRS and the majority (85%) received steroids prior to starting FSRS. Treatment dose ranged from 24-32.5 Gy in 3-5 fractions, with median of 30 Gy in 5 fractions with zero margin. Median time from diagnostic to planning MRI was 15 days (IQR: 11-21) and planning MRI to FSRS was 1 day (IQR 1-3). The median size of included brain metastases on planning MRI was 7.38cc (IQR: 5.09-11.55) compared to 6.03cc (IQR: 3.87-8.95) on prior diagnostic MRI (P < 0.001). Eight metastases (15%) decreased in size in the context of concurrent central nervous system-penetrant systemic therapy or steroids. Median calculated daily growth was 0.10cc (2.37%) per day (IQR: 0.02-0.21cc, 0.41-3.78%). There was no significant association between lesion growth rate and histology, intracranial location, steroid use, and baseline tumor size. A 1.0 mm, 1.5 mm, 2.0 mm, and 2.5 mm margin would have covered anticipated growth in > 90% of lesions over 3, 7, 10, and 14 days between planning and treatment, respectively. CONCLUSION: In the absence of expedited planning, FSRT for intact large brain metastases with limited margins may result in geometric under treatment. An adaptive margin strategy based upon initial tumor size, and time between planning imaging and treatment delivery may be afforded to maintain ideal conformity, properly targeting a growing target lesion while maximally sparing uninvolved regional brain. AUTHOR DISCLOSURE: J. Chew: None. S. Sinha: None. S.J. Liu: None. S.E. Fogh: Independent Contractor; Accuray. L. Boreta: None. D. Raleigh: None. L. Ma: Patent/License Fees/Copyright; University of California Regents. S.E. Braunstein: Advisory Board; Radiation Oncology Questions, LLC.

16.
Int J Radiat Oncol Biol Phys ; 111(3S): e617, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34701889

RESUMO

PURPOSE/OBJECTIVE(S): Treatment of metastatic para-aortic lymph nodes (PAN) is critical for locally advanced cervical cancer (LACC) control. However, the clinical target volume (CTV) delineation for the para-aortic region is tedious and time-consuming even for a well-trained radiation oncologist. In this study, we trained a deep learning (DL) segmentation network that led to automatic and accurate PAN-CTV delineation. MATERIALS/METHODS: We retrospectively collected 47 radiotherapy planning CTs of LACC patients. For each planning CT, the Aorta, Inferior Vena Cava (IVC) and PAN-CTV were manually delineated for radiotherapy treatment planning for the elective para-aortic region from the left renal vein to the aortic bifurcation. The PAN-CTV was prophylactically contoured (ignoring gross para-aortic nodes) according to the recent Small et al. (2020) consensus guidelines. For each CT set, the spine structures were automatically delineated using threshold- and morphology-based segmentation. Then, all CTs were registered to a common reference frame based on the delineated spine structures and cropped to dimensions of 15 cm x 15 cm x 20 cm centered along the spine. A U-Net-based DL segmentation network was developed and trained to automatically segment Spine, Aorta, IVC, and PAN-CTV in the registered and cropped region. The segmented structures were converted into DICOM RTStruct with the original CT association. RESULTS: We used 32 CTs for training, 8 for validation, and 7 for testing. The Dice coefficient (DC) and Hausdorff distance (HD95) were used as the evaluation metrics. The mean (std) DC of PAN-CTV for training, validation and test sets were 0.911 (0.027), 0.757 (0.046) and 0.755 (0.073), respectively. The mean (std) HD95 of PAN-CTV for training, validation and test sets were 2.39 (2.77) mm, 10.12 (6.83) mm and 8.42 (4.52) mm, respectively. All testing PAN-CTVs were visually checked by an attending radiation oncologist specializing in gynecologic malignancies and deemed clinically acceptable. CONCLUSION: An Artificial Intelligence approach comprised of registration and DL network was developed and validated for automatic segmentation of Spine, Aorta, IVC, and PAN-CTV in LACC. Registration was used to improve the boundary definition of the virtual structure, PAN-CTV, for DL segmentation without human intervention. This approach could facilitate efficient workflow and allow for optimal dose delivery to the involved nodal basins in LACC. AUTHOR DISCLOSURE: W. Chi: None. P. D'Cunha: None. M. Chen: None. L. Ma: None. M. Kazemimoghadam: None. Z. Yang: None. X. Gu: None. K.V. Albuquerque: Research Grant; Astra Zeneca. Honoraria; ACR, ARRT. Travel Expenses; ACR, ARRT, ASCO.W. Lu: None.

17.
Int J Radiat Oncol Biol Phys ; 111(3S): e86-e87, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34701986

RESUMO

PURPOSE/OBJECTIVE(S): Host immune status plays an important role in treatment outcome prediction and prognosis in patients with various cancers. However, the relationship between circulating immune cell and tumor control has not been well studied in hepatocellular carcinoma (HCC) after stereotactic body radiation therapy (SBRT). MATERIALS/METHODS: Patients with recurrent HCC received liver SBRT were eligible. Patients must be deemed surgically unresectable, and had Trans Arterial Chemotherapy Embolization (TACE). The local tumor control was defined as no disease progression by treatment response assessment CT or MRI around 3 months, largely according to mRECIST. Complete metabolic responses were defined either with no enhancement on MRI or no FDG activity. The risk factors of our interest included demographics factors, liver disease history, Child Pugh score, pathology stage, and prior treatments. The counts of whole leukocytes, lymphocyte and neutrophil pre- and post-SBRT were recorded from clinical laboratory. Leukopenia was graded according to CTCAE v 5.0. The associations of variables with in-field treatment response were analyzed using Chi-square test and one-way ANOVA. RESULTS: A total of 22 patients enrolled between August 2015 and September 2020. All patients had disease progression after TACE treatment and received 5 fractions of SBRT. Twenty patients received a definitive dose of 40-50 Gy. The local tumor was controlled in 86.4% (19/22), and increased to 90% (18/20) after excluding 2 patients receiving lower doses of palliative SBRT. There were 2 (10%), 5 (25%) and 13 (65%) defined as progressive disease, stable disease, partial response, and complete metabolic response, respectively. Large tumor/multiple tumor (P = 0.003), vascular invasion (P = 0.042), surgery history (P = 0.023), and BCLC stage (P = 0.040) were significantly associated with the tumor control, while age, gender, family history, heavy drinking, smoking history, BMI, ECOG, hepatitis, cirrhosis, Child Pugh score, portal vein tumor emboli, TNM, tumor size, and radiation dose were not. In 20 patients with complete blood testing peri-SBRT and uninterrupted radiation treatment, 17 (85%), 18 (90%), 13 (65%) and 9 (45%) patients had reduction in leukocyte, lymphocyte, neutrophil and monocyte after SBRT, respectively. Post-SBRT leukocyte counts (P = 0.036), pre-monocyte (P = 0.029), pre-lymphocyte (P = 0.073) and post- lymphocyte (P = 0.092) were associated with tumor control. The pre-RT leukocyte, neutrophil, post-RT neutrophil and monocyte were not. CONCLUSION: This limited study suggests that SBRT may provide excellent local tumor control for patients with recurrent HCC after surgical resection and TACE with no local treatment options. The significance in post-SBRT circulating immune cell suggest a role of immune function on radiation tumor control and a potential value of improving SBRT technique to decrease damage of immune cells. Further validation study with large sample size and longer follow-up is needed.

18.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(5): 928-932, 2021 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-34650296

RESUMO

OBJECTIVE: To investigate the clinical characteristics, diagnosis and treatment of renal cell carcinoma with urinary tract tumor thrombus. METHODS: From January 1, 2015 to December 31, 2019, patients with renal cell carcinoma complicated with urinary tract tumor thrombus who were hospitalized in the Peking University Third Hospital and Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. Meanwhile, we reviewed the literature, and the reported patients of renal cell carcinoma with urinary tract tumor thrombus were also included in our study. The basic information, clinical manifestations, treatment, pathological characteristics and follow-ups of all the patients were analyzed. RESULTS: In our study, 6 patients from the two hospitals and 16 patients from previous literature reports were included. There were 13 males and 9 females with an average age of 54.7 years (22-79 years). Fifteen patients had renal cell carcinoma on the left side, 6 on the right side, and 1 on the unknown side. Gross hematuria was the most common chief complaint, including 18 patients. One patient complained of weight loss, 1 patient complained of microscopic hematuria, and 1 patient was found by ultrasound examination. Tumor thrombus was classified as grade Ⅰ in 9 cases (the tumor embolus protruded into the renal pelvis, but did not reach the ureteropelvic junction), grade Ⅱ in 10 cases (the tumor embolus protruded into the ureter, but not into the bladder), and grade Ⅲ in 3 cases (the tumor embolus passed through the ureter and protruded into the bladder). Only 11 patients were diagnosed with renal cell carcinoma before operation. Radical nephrectomy was performed in 9 cases and nephroureterectomy in 12 cases. In pathological diagnosis, there were 15 cases of clear cell renal cell carcinoma, 1 case of papillary renal cell carcinoma, 1 case of chromophobe cell carcinoma, 1 case of mixed cell renal cell carcinoma, 4 cases of renal cell carcinoma with undetermined classification. Eleven patients were followed up for 3-31 months, and 3 patients had lung metastasis within 6 months. CONCLUSION: Renal cell carcinoma with urinary tract tumor thrombus is rare in clinic. It needs to be differentiated from renal pelvis carcinoma in diagnosis. The treatment principle can refer to general renal carcinoma. For locally advanced cases, complete resection is the best treatment, and its oncological prognosis needs more long-term and large-scale follow-up observation.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Trombose , Neoplasias Urológicas , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Estudos Retrospectivos , Trombose/cirurgia
19.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(2): 219-225, 2021 Feb 06.
Artigo em Chinês | MEDLINE | ID: mdl-34645183

RESUMO

Objective: To evaluate the performance and application of a fast nucleic acid detection system for testing severe acute respiratory syndrome virus 2 (SARS-COV-2). Methods: Clinical samples were collected from February to July 2020 from Beijing Center for Diseases Prevention and Control and the Laboratory Department of China-Japan Friendship Hospital, to evaluate the sensitivity, specificity, anti-interference ability, precision and clinical sample coincidence rate of fast nucleic acid detection system for SARS-CoV-2. The analytical sensitivity was determined by a dilution series of 20 replications for each concentration. Analytical specificity study was performed by testing organisms whose infection produces symptoms similar to those observed at the onset of corona virus disease 2019 (COVID-19), and of the normal or pathogenic microflora that may be present in specimens collected. Potential interference substances were evaluated with different concentration in the interference study. Precision study was conducted by estimating intra-and inter-batch variability. Clinical evaluation was performed by testing 230 oropharyngeal swab specimens and 95 sputum specimens in fast nucleic acid detection system, comparing with conventional real-time fluorescent quantitative PCR (RT-qPCR) and clinical diagnostic results. Results: The analytical sensitivity of SARS-CoV-2 using fast nucleic acid detection system was 400 copies/ml. The result is negative for testing with the organisms that may likely in the circulating area or causing similar symptoms with SARS-CoV-2 and human nucleic acid, indicating that no cross reactivity with organisms. The results of precision test showed that the Coefficient of variation of Ct value of high, medium and low concentration samples was 1.90%-3.92%, and all of them were less than 5% in intra-and inter-batch testing. The results of the samples were still positive after adding the potential interfering substances, indicating that the possible interfering substances in the samples had no effect on the results. 98.46% and 97.85% diagnosis results of fast nucleic acid detection system were consistent with RT-qPCR and clinical diagnostic results, respectively. Conclusion: The fast nucleic acid detection system based on molecular parallel reaction can be used as a selection method for SARS-CoV-2 testing.


Assuntos
COVID-19 , Ácidos Nucleicos , Teste para COVID-19 , Humanos , RNA Viral , Reação em Cadeia da Polimerase em Tempo Real , SARS-CoV-2 , Sensibilidade e Especificidade
20.
Artigo em Inglês | MEDLINE | ID: mdl-34479791

RESUMO

The aim of this study was to evaluate the rare postoperative supraclavicular metastasis originating from oral squamous cell carcinoma (OSCC) and to discuss epidermal growth factor receptor (EGFR) as a potential predictive marker. Tumour specimens of OSCC patients divided into three groups were included: supraclavicular metastasis (n = 8), conventional cervical metastasis (n = 28), no metastasis (n = 48). Basic information and EGFR expression were compared among these groups and the data were analysed to identify potentially related risk factors for supraclavicular metastasis. In the supraclavicular metastasis group (n = 8), all primary tumours were T1-T2 and located in the tongue and buccal region; five of eight cases were pathologically N0. The median interval from the primary tumour resection to the development of supraclavicular metastases was 21.5 months. All related deaths (5/8) occurred within 2 years. In the supraclavicular metastasis group, EGFR expression was highest in the supraclavicular metastases, followed by cervical lymph nodes, and was lowest in the primary tumours (P = 0.39). In contrast, in the conventional metastasis group and the N0 group, EGFR expression was higher in the primary tumours than in the lymph nodes (P < 0.01). Supraclavicular metastasis of OSCC is infrequent and associated with a poor prognosis. EGFR might predict the occurrence of supraclavicular metastasis.

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