Clinical-Pathological Correlation of Breast Non-mass Enhancing Lesions

Introduction/Objective

MRI imaging of breast is mainly reserved for screening high-risk individuals with occasional application in women bearing moderate or average risk. Areas showing enhancement in MRI without space-occupying mass are defined as non-mass enhancement (NME). As biopsy of NME lesion is rare encounter in clinical practice, thorough clinical-pathological investigation is warranted.

Methods/Case Report

289 patients who underwent core biopsy for NME lesion(s) in our institution between 2011 to 2021 were included in this retrospective study. Pathological diagnoses were lumped into 3 categories, namely benign, precursor lesions (atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ), and malignant lesions (ductal carcinoma in situ, pleomorphic lobular carcinoma in situ, and invasive carcinoma). The age distribution, MRI indications, and pathological diagnoses stratified by indications were studied. MRI patterns of NME lesions were compared between malignant versus benign lesions.

Results (if a Case Study enter NA)

Patient’s age ranges 25-79 yo (mean age 51.9 yo, median age 50 yo). Indications of MRI include high-risk screening (162 cases, 162/289, 56%), pre-operative staging (116 cases, 116/289, 40%), and problem-solving (11 cases, 11/289, 4%). There are 220 benign cases (220/289, 76%), 50 malignant cases (50/289, 17%), and 19 precursor lesions (19/289, 7%) in this study. There were 16 malignant cases identified in the high-risk group (16/162, 10%), 24 in the pre-operative staging group (24/116, 20.7%), and 2 in problem-solving group (2/11, 18.2%). Focal distribution is significantly associated with malignant lesions as compared to other patterns (linear, segmental, and regional) (Chi-square test, p<0.001).

Conclusion

High-risk screening is the major indication for biopsy NME lesions, followed by pre-operative staging, and problem-solving. Benign lesions are the predominant pathological findings of NME lesions, followed by malignant and then precursor lesions. Malignant lesions were mostly identified in high-risk group, followed by pre-operative staging and problem-solving group. Malignant lesions tend to assume the “focal distribution” than other MRI patterns.

Impact of limbs pneumatic compression during cardiopulmonary resuscitation (CPR) on cardiac arrest patients: a randomized controlled trial

Background

Limbs pneumatic compression during cardiopulmonary resuscitation (CPR) for cardiac arrest patient were rarely reported.

Purpose

To evaluate the effect of this therapy on the patients of cardiac arrest.

Methods

A randomized, controlled and trial, a total of 62 elderly (75.8±8.3 yrs) cardiac arrest patients were included and randomized to “CPR group” (n=31) and “CPR + Pneumatic Compression group” (n=31). Each individual in CPR group received standard CPR. In addition to the standard CPR, all patients in “Pneumatic Compression group” accepted intermittent pneumatic compression (IPC) by Air Compression Therapy System, which digital six-tiered rippling full-body pressure (0.45–0.6 kg/cm2) and 1 minute interval every 5 minutes.

Results

Compared with standard CPR group, significant improvements of cardiac output (CO) and survival of patient were found in Pneumatic Compression group (Figure 1). Patients with pneumatic compression had lower incidence (19.4% vs. 45.2%, p=0.03) of acute kidney injury (AKI) than that in standard CPR group. Besides, the lower occurrence of hypoxic ischemic encephalopathy (HIE) was observed in Pneumatic Compression group (Figure 2). There was no ischemic myonecrosis of limbs caused by compression.

Conclusions

Intermittent limbs pneumatic compression during cardiopulmonary resuscitation (CPR) maybe could improve the blood flow of the crucial organs (e.g. brain) and increase survival of cardiac arrest patients, which is superior to the strategy for CPR alone.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): SHOU FA2020-4-1045 Fundation

Effect of TGF-β2 on the Mechanical Properties of Posterior Scleral Fibroblasts in Experimental Myopia

Objective

The effects of TGF-β2 on mechanical properties of sclerotic desmocytes isolated from healthy and myopic guinea pigs were investigated in order to further understand the pathogenesis of myopia. To study the effect of TGF-β2 on the mechanical properties of posterior scleral fibroblasts in experimental myopia.

Methods

A lens-induced myopia (LIM) animal model was developed in 12 guinea pigs, with the opposite eye serving as a self-control (SC). Five untreated guinea pigs served as normal controls. Lenses were removed 30 days after model onset. Primary scleral fibroblasts were isolated and passaged twice and then treated with vehicle control or 1, 10, or 100 ng/mL TGF-β2. After 24 h, micropipette aspiration was used to investigate the viscoelastic properties of the cells.

Results

Scleral fibroblasts from LIM exhibited significantly higher equilibrium moduli and apparent viscosities relative to SC without TGF-β2 treatment. Treatment of LIM or SC scleral fibroblasts with 1 or 10 ng/mL TGF-β2 led to significantly different (p < 0.05) equilibrium moduli and apparent viscosities compared with vehicle control, whereas no significant differences were observed upon treatment with 100 ng/mL TGF-β2. LIM cells treated with 1 and 10 ng/mL TGF-β2 exhibited lower equilibrium moduli and apparent viscosities compared with similarly treated SC cells, but LIM cells and SC cells treated with 100 ng/mL TGF-β2 had similar mechanical properties.

Conclusions

The addition of 1 and 10 ng/mL TGF-β2 can lower the equilibrium modulus and apparent viscosity of scleral fibroblasts in the normal eye.

Randomized control trial evaluating the use of a shared decision-making aid for older ventral hernia patients in the Geriatric Assessment and Medical Preoperative Screening (GrAMPS) Program

PURPOSE

Shared decision making (SDM) is ideally suited to abdominal wall surgery in older adults given the breadth of decision making required by the hernia surgeon and the impact on quality of life (QOL) by various treatment options. Given the paucity of literature surrounding SDM in hernia patients, the feasibility of a novel, formalized SDM aid/tool was evaluated in a pilot randomized trial.

METHODS

Patients 60 years or older with a diagnosed ventral hernia were prospectively randomized at an academic hernia center. In the experimental arm, a novel SDM tool, based on the SHARE Approach, guided the consultation. Previously validated SDM assessments and patient's hernia knowledge retention was measured.

RESULTS

Eighteen (18) patients were randomized (9 control and 9 experimental). Cohorts were well matched in age (p = 0.51), comorbidities (Charlson Comorbidity Score: p = 0.43) and frailty (mFI-11: p = 0.19; Risk Analysis Index: p = 0.33). Consultation time was 11 min longer in the experimental cohort (p < 0.01). There was a trend towards better Decisional Conflict Scores in the experimental group (p = 0.25) and the experimental cohort had improved post-visit retained hernia knowledge (p < 0.01). All patients in the experimental arm (100%) enjoyed working through the SDM aid/tool and felt it was a worthwhile exercise.

CONCLUSION

Incorporating a formalized SDM tool into a busy hernia surgical practice is feasible and well received by patients. In addition, early results suggest it improves retention of basic hernia knowledge and may reduce patient's decisional conflict. Next steps include condensing the SDM tool to enhance efficiency within the clinic and beginning a large, randomized control trial.

Safety, pharmacokinetics, and efficacy of BPI-15086 in patients with EGFR T790M-mutated advanced non-small-cell lung cancer: results from a phase I, single-arm, multicenter study

Background

Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) resistance frequently occurs in patients with non-small-cell lung cancer (NSCLC). EGFR Thr790Met mutation (T790M+) is seen in ∼50% of patients. We assessed the safety, tolerability, and pharmacokinetics (PK) of BPI-15086, a novel, ATP-competitive, irreversible, third-generation, mutation-selective EGFR-TKI in patients with EGFR T790M-mutated NSCLC.

Patients and methods

This two-center, phase I, dose-escalation study included patients who were 18-65 years old, with an Eastern Cooperative Oncology Group performance status of 0-2, with histologically or cytologically confirmed locally advanced or metastatic T790M+ NSCLC who were not surgical or radiotherapy candidates, and had imaging-identified disease progression after prior EGFR-TKIs. This dose-escalation study enrolled patients using a 3 + 3 study design. Patients received 25, 50, 100, 200, and 300 mg/day orally in 21-day cycles. The primary endpoints were safety, tolerability, and PK. Secondary endpoints were objective response rate (ORR) and disease control rate (DCR). The dose-expansion study was not conducted.

Results

We enrolled 17 patients from 29 December 2016 to 16 May 2018, in the safety and full analysis sets. All patients completed a single dosing trial, and no adverse events (AEs) causing drug discontinuation were seen. Grade 1-2 nausea, hypoalbuminemia, and decreased appetite were the most common treatment-related AEs. Grade 3 hyperglycemia was seen in one patient dosed at 300 mg/day. The ORR and DCR were 17.7% [95% confidence interval (CI) 3.8% to 43.4%] and 47.1% (95% CI 23.0% to 72.2%), respectively.

Conclusion

BPI-15086 is a safe and tolerable third-generation EGFR-TKI with a rationale for further clinical studies.

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BPI-15086 is safe and has partial effectiveness in patients with advanced T790M+ NSCLC after previous EGFR-TKI therapy.

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A different safety profile for BPI-15086 compared with other third-generation EGFR-TKIs.

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The modest efficacy in this study is still deemed important and should be added to the literature of third-generation TKIs.

A retrospective study of factors contributing to anchorage loss in upper premolar extraction cases

Background

Anchorage control is one of the components in the treatment of extraction cases. However, what determines more or less anchorage loss is still an unanswered question. Aim: The purpose of this study was to investigate the most important factors contributing to the anchorage loss of maxillary first molars in premolar extraction cases.

Materials and Methods

The study included 726 upper premolar extraction cases, including 214 male patients and 512 female patients, and the mean age was 14.4 ± 4.5 years old (range: 9-45). Factors including physiological characteristics, treatment mechanics, and cephalometric variables were collected and their influences on the angulation changes of maxillary first molars were analyzed.

Results

The mean angulation change of maxillary first molar after treatment was 2.81°(mesial tipping). The change of UM/PP showed a statistically significant difference in different sex (male 3.84° ± 5.26° vs female 2.38° ± 5.10°), age (adult -0.05° ± 4.73° vs teenager 3.46° ± 5.07°), and molar relationship (Class II 3.28° ± 5.15° vs Class I 2.36° ± 5.19°). There are six variables accounted in the regression analysis (R = 0.608, R² = 37.0%). Among them, the pre-treatment molar tipping (Standardized Coefficients: -0.65) and the pre-treatment incisor/molar height ratio (Standardized Coefficients: -0.27) were the most important factors influencing anchorage loss during treatment.

Conclusion

Compared with treatment-related factors, the patient's physiological characteristics play a more important role in anchorage loss. The pre-treatment angulation of the maxillary first molar is the most influential factor in changes to maxillary molar angulation, which are often predisposing anchorage loss.

[Effects of primary preventive treatment under endoscope for esophageal and gastric varices on bleeding rate and its relevant factors]

Objective: To investigate the effects of primary preventive treatment under endoscope for esophageal and gastric varices on bleeding rate and its relevant factors. Methods: 127 cases with liver cirrhosis accompanied with esophageal and gastric varices without bleeding history were included in the endoscopic and non-endoscopic treatment group, respectively. Informed consent was obtained from both groups. Gastric varices (Lgf) and esophageal varices (Leg) were diagnosed according to LDRf classification criteria, and the corresponding treatment scheme was selected according to the recommended principle of this method.The incidence rate of bleeding from ruptured esophageal varices were observed at 3, 6 months, and 1, and 2 years in the treated and the untreated group, and the patients with different Child-Pugh scores were followed-up for 2 years. Gender, age, etiology, varicose degree, Child-Pugh grade, platelet count, prothrombin activity, portal vein thrombosis, collateral circulation, portal vein width and other factors affecting the bleeding rate were assessed. Measurement data were described as mean ± standard deviation (x¯±s), and qualitative data of categorical variables were expressed as percentage (%), and χ² test was used. Results: 127 cases were followed up for 2 years. There were 55 cases in the endoscopic treatment group (18 cases underwent band ligation, 2 cases underwent band ligation combined with tissue adhesive embolization, 28 cases underwent sclerotherapy, and 7 cases underwent sclerotherapy combined with tissue adhesive embolization). Recurrent bleeding and hemorrhage was occurred in 5 (9.1%) and 28 cases (38.9%), respectively (P<0.05). In addition, there were 72 cases in the untreated group (P<0.05). Severe varicose veins proportions in treated and untreated group were 91.1% and 85.1%, respectively (P>0.05). There was no statistically significant difference in liver cirrhosis-related medication and β-blocker therapy between the treated and untreated group (P>0.05). There was no statistically significant difference in the bleeding rate between the different treated groups (P>0.05). The bleeding rates at 3, 6 months, 1, and 2 years in endoscopic treated and untreated group were 2.00% vs. 2.59% (P>0.05), 2.30% vs. 5.88% (P>0.05), 3.10% vs. 7.55% (P>0.05) and 4.00% vs. 21.62% (P<0.05), respectively. All patients with Child-Pugh grade A, B and C in the treated and the untreated group were followed-up for 2 years, and the bleeding rates were 1.8% vs. 8.1% (P<0.05), 1.1% vs. 9.4% (P<0.05) and 9.1% vs. 10.1% (P>0.05), respectively. There were statistically significant differences in the rupture and bleeding of esophageal and gastric varices, varices degree, Child-Pugh grade and presence or absence of thrombosis formation in portal vein (P<0.05); however, no statistically significant differences in gender, age, etiology, platelet count, prothrombin activity, collateral circulation and portal vein width (P>0.05). There was no intraoperative bleeding and postoperative related serious complications in the treated group. Conclusion: The risk of initial episodes of bleeding from esophageal and gastric varices is significantly correlated with the varices degree, Child-Pugh grade, and portal vein thrombosis. Primary preventive treatment under endoscope is safe and effective for reducing the long-term variceal bleeding risk from esophageal and gastric varices.

Safety and efficacy of dendritic cell-based immunotherapy (DCVAC/LuCa) combined with carboplatin/pemetrexed for patients with advanced non-squamous non-small-cell lung cancer without oncogenic drivers

Background

Our prospective, open-label, single-arm phase II study investigated the safety and efficacy of DCVAC/LuCa (dendritic cell vaccines for lung cancer) combined with standard carboplatin/pemetrexed in advanced non-squamous (nsq) non-small-cell lung cancer (NSCLC).

Patients and methods

Eligible patients had stage IV nsq NSCLC without oncogenic drivers and had not received prior systemic cancer therapy. Treatment consisted of carboplatin/pemetrexed for up to 6 cycles followed by 21 cycles of pemetrexed maintenance or until progression or intolerance. Non-progression patients after two cycles of chemotherapy started to receive DCVAC/LuCa subcutaneously (s.c.) on day 15 of cycle 3, and thereafter q3w (day 15 of chemotherapy cycles) for up to 15 doses. Dosing of DCVAC/LuCa s.c. varied among patients depending on the baseline number of leucocytes but remained constant for each single patient. Safety was assessed by adverse events (AEs), treatment-related adverse events (TRAEs), serious adverse events (SAEs), and adverse events of special interest (AESIs). Efficacy was measured by overall survival (OS), progression-free survival (PFS), time to progression (TTP), and objective response rate (ORR).

Results

Sixty-one patients were enrolled. In the safety population (n = 60), eight patients (13.33%) had grade 3 or greater TRAEs, and six patients (10.0%) showed SAEs which were not related to leukapheresis or DC vaccination. Six grade 1 AEs were considered to be related to leukapheresis. No AESIs or DCVAC/LuCa-induced AEs were observed. The 2-year survival rate in the modified intention-to-treat population (n = 44) was 52.57%. Median OS was not reached. Median PFS was 8.0 months, median TTP was 10.2 months, and the ORR was 31.82%.

Conclusion

In treatment-naïve stage IV nsq NSCLC patients without oncogenic drivers, the combination of carboplatin/pemetrexed and DCVAC/LuCa was well tolerated and showed promising efficacy. Therefore, a study to prove our immunotherapeutic concept in a randomized phase III trial is planned.

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We investigated the safety and efficacy of DCVAC/LuCa combined with standard carboplatin/pemetrexed in nsq NSCLC.

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The combination therapy showed a favorable tolerability profile in a selected Chinese population.

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The 2-year survival rate in the modified intention-to-treat population (n = 44) was 52.57%.

[Clinical application of sacral alar screw fixation in surgical treatment of lumbosacral degenerative disease]

Objective: To verify the safety and feasibility of sacral alar screw fixation and fusion surgery in lumbosacral area. Methods: The clinical and radiological data of patients receiving L₅/S₁ single-level cortical bone trajectory screw combined with sacral alar screw decompression fixation and fusion in Beijing Chaoyang Hospital due to lumbar spinal stenosis from January 2019 to January 2020 were retrospectively analyzed. The clinical data included operation duration, intraoperative blood loss, postoperative drainage, pain and function scores during follow-up. The radiological data included preoperative and postoperative follow-up X-rays and three-dimensional reconstruction of lumbar spine CT. The fusion status and complication of internal fixation, such as screw loosening and fixation failure were evaluated by the radiological examination. Results: According to the inclusion and exclusion criteria, a total of 16 patients (7 males and 9 females) were included, with an average age of (69.6±5.2) years. The patients were followed-up for (16.2±1.7) months. The average operation duration was (144±21) min, the intraoperative blood loss was (103±20) ml, and the postoperative drainage was (80±34) ml. The patient's low back pain visual analogue scale (VAS) score was 6.8±1.0 before surgery, and it was improved to 0.9±0.7 at the last follow-up; leg pain VAS score was 6.1±0.9 before the operation and it improved to 0.9±0.7 at the last follow-up; Oswestry disability index (ODI) function score was 66.2%±8.0% before the surgery and it decreased to 26.6%±7.2% at the last follow-up. No neurological complications, surgical site infection, screw loosening, internal fixation failure or cage displacement were observed during the follow-up. The fusion rate was 68.8% (11/16) at 6 months post operation. Conclusion: It is safe, feasible and effective to apply cortical screws combined with sacral alar screws in short-segment decompression, fixation and fusion surgery on the lumbosacral region to treat lumbosacral spinal stenosis.