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Kim HJ, Han B, Lee HI, Ju JW, Shin HI. Current Status of Trypanosoma grosi and Babesia microti in Small Mammals in the Republic of Korea. Animals (Basel) 2024; 14:989. [PMID: 38612228 PMCID: PMC11010837 DOI: 10.3390/ani14070989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Small mammals, such as rodents and shrews, are natural reservoir hosts of zoonotic diseases, including parasitic protozoa. To assess the risk of rodent-borne parasitic protozoa in the Republic of Korea (ROK), this study investigated the status of parasitic protozoa, namely Trypanosoma, Babesia, and Theileria, in small mammals. In total, 331 blood samples from small mammals were analyzed for parasites using PCR and sequenced. Samples were positive for Trypanosoma grosi (23.9%; n = 79) and Babesia microti (10%; n = 33) but not Theileria. Small mammals from Seogwipo-si showed the highest infection rate of T. grosi (48.4%), while the highest B. microti infection rate was observed in those from Gangneung-si (25.6%). Sequence data revealed T. grosi to be of the AKHA strain. Phylogenetic analysis of B. microti revealed the US and Kobe genotypes. B. microti US-type-infected small mammals were detected throughout the country, but the Kobe type was only detected in Seogwipo-si. To our knowledge, this is the first nationwide survey that confirmed T. grosi and B. microti infections at the species level in small mammals in the ROK and identified the Kobe type of B. microti. These results provide valuable information for further molecular epidemiological studies on these parasites.
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Affiliation(s)
| | | | | | | | - Hyun-Il Shin
- Division of Vectors and Parasitic Diseases, Korea Disease Control and Prevention Agency, 187 Osongsaenmyeong 2-ro, Osong-eup, Heungdeok-gu, Cheongju 28159, Republic of Korea; (H.J.K.); (B.H.); (H.-I.L.); (J.-W.J.)
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Wang LY, Hu QL, Chen M, Yang C, Han B. [Eculizumab in patients with paroxysmal nocturnal hemoglobinuria: a real-world study in China]. Zhonghua Xue Ye Xue Za Zhi 2024; 45:184-189. [PMID: 38604796 DOI: 10.3760/cma.j.cn121090-20231106-00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Objective: To evaluate the efficacy and safety of eculizumab in the treatment of paroxysmal nocturnal hemoglobinuria (PNH) in China. Methods: Data from PNH patients who received at least 3 months of full-dose eculizumab and were followed for at least 3 months between December 2022 and July 2023 were retrospectively collected. We evaluated changes in clinical and laboratory parameters after 1, 2, 3, and 6 months of eculizumab treatment. The rates of breakthrough hemolysis (BTH), extravascular hemolysis (EVH), and the occurrence of adverse reactions were also monitored. Results: The study included nine patients, six males and three females, with a median age of 54 (28-69) years. 5 of the patients had classic PNH, while 4 had PNH/AA. The number of episodes of hemoglobinuria was 5 (1-25) per month before eculizumab. 4 patients required blood transfusion, 5 had thrombosis and one had renal impairment before eculizumab. The median time to eculizumab was 6 (3-7) months and the followup period was 3 (3-6) months after treatment. The number of episodes of hemoglobinuria following eculizumab was 0 (0-1). During the followup period, no additional thrombotic events occurred. LDH at any time after eculizumab was lower than at baseline, and some patients' HGB increased. All transfused patients became transfusion-independent after receiving eculizumab. The FACIT-Fatigue score improved by an average of 17.3 points following treatment. 2 patients developed BTH and improved with symptomatic treatment. There were three adverse events that caused mild symptoms. There are no serious adverse events or deaths. Conclusion: Eculizumab can effectively control the hemolytic-related symptoms of PNH in China, reducing the need for blood transfusions to some extent, while also demonstrating a higher safety profile.
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Affiliation(s)
- L Y Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Q L Hu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - M Chen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - C Yang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - B Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Lin JX, Chen LL, Han B, Chen S, Li WR, Jin ZL, Fang B, Bai YX, Wang L, Wang J, He H, Liu YH, Hu M, Song JL, Cao Y, Sun YN, Liu XM, Zhang JN, Zhang YF. [Technical specification for orthodontic transmission straight wire technique]. Zhonghua Kou Qiang Yi Xue Za Zhi 2023; 58:1217-1226. [PMID: 38061863 DOI: 10.3760/cma.j.cn112144-20230811-00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Malocclusion is an oral disease with a high prevalence. The goal of orthodontic treatment is health, aesthetics, function and stability. The transmission straight wire appliance and technique is an innovative orthodontic system with independent intellectual property rights invented by Professor Jiuxiang Lin's team based on decades of clinical experience, which provides a new solution for the non-surgical correction of skeletal malocclusions, especially class Ⅲ malocclusion, and it is also a good carrier for the implementation of the concept of healthy orthodontics. Due to the lack of guidelines, how to implement standardized application of transmission straight wire technique remains a problem to be solved. This technical specification was formed by combining the guidance from Professor Jiuxiang Lin and joint revision by a number of authoritative experts from the Orthodontic Special Committee, Chinese Stomatological Association, with reference to relevant literatures, and combined with abundant clinical experience of many experts. This specification aims to provide reference to standardize the clinical application of transmission straight wire technique, so as to reduce the risk and complications, and finally to improve the clinical application level of this technique.
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Affiliation(s)
- J X Lin
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - L L Chen
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology & School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology & Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, China
| | - B Han
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - S Chen
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - W R Li
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Z L Jin
- Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Xi'an 710032, China
| | - B Fang
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Y X Bai
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - L Wang
- Department of Orthodontics, The Affiliated Stomatological Hospital of Nanjing Medical University & Jiangsu Province Key Laboratory of Oral Diseases & Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210029, China
| | - J Wang
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University & State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Chengdu 610041, China
| | - H He
- Department of Orthodontics Division 1, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Y H Liu
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University & Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai 200001, China
| | - M Hu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Jilin 130021, China
| | - J L Song
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University & Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences & Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - Y Cao
- Department of Orthodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
| | - Y N Sun
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - X M Liu
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - J N Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Y F Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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Chen M, Fan Q, Li H, Ma YP, Qin XQ, Suo XH, Yang C, Zhu TN, Duan MH, Han B, Wang SJ, Zhou DB, Zhuang JL. [Efficacy of different regimens and prognostic factors in patients with first relapsed multiple myeloma treated after front-line bortezomib, cyclophosphamide, and dexamethasone]. Zhonghua Nei Ke Za Zhi 2023; 62:1436-1443. [PMID: 38044070 DOI: 10.3760/cma.j.cn112138-20230619-00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Objective: To analyze the efficacy of second-line regimens and prognostic factors in patients with first-relapsed multiple myeloma (MM) treated with bortezomib, cyclophosphamide, and dexamethasone (BCD). Methods: A retrospective cohort study. Clinical data were collected in first-relapsed MM patients after BCD treatment from three tertiary hospitals in north China from July 2009 to October 2022. Patients were classified according to the second-line regimen into the immunotherapy group, single novel agent group [either proteasome inhibitor (PI) or immunomodulatory drug (IMiD)], combination treatment group (both PI+IMiD), and traditional treatment group. Responses to second-line regimens and survival data were analyzed. The Kaplan-Meier method was used for survival analysis and the Cox proportional risk model was used for univariate and multivariate analyses. Results: A total of 217 patients were enrolled including 8.8% (19/217) in the immunotherapy group, 48.4% (105/217) in the PI/IMiD group, 29.9% (65/217) in the PI+IMiD group, and 12.9% (28/217) in the traditional treatment group. The median age was 62 years (range 31-83 years) and 56.2% (122/217) were males. The overall response rates (ORRs) in the four groups were 94.7% (18/19) vs. 56.2% (59/105) vs. 73.8% (48/65) vs. 32.1% (9/28) (χ2=24.55; P<0.001), respectively. The progression-free survival (PFS) of the second-line regimens (2ndPFS) was 17.7 vs. 9.0 vs. 9.2 vs. 4.6 months (χ2=22.74; P<0.001), respectively, among which patients in the PI/IMiD and PI+IMiD groups had comparable 2ndPFS (χ2=1.76; P=0.923). Patients with high-risk cytogenetic abnormalities (HRCAs) achieved the longest 2ndPFS of 22.0 months in the immunotherapy group (χ2=15.03; P=0.002). Multivariate analysis suggested that immunotherapy (HR=0.11, 95%CI 0.05-0.27), achievement of efficacy of partial response or better (HR=0.47, 95%CI 0.34-0.66), and non-aggressive relapse (HR=0.25, 95%CI 0.17-0.37) were independent prognostic factors of 2ndPFS. Conclusion: In this real-world study, immunotherapy was associated with a more favorable efficacy and PFS for first-relapsed MM patients after BCD treatment, with similar outcomes in patients with HRCAs.
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Affiliation(s)
- M Chen
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Q Fan
- Department of Hematology, Beijing Shunyi Hospital, Beijing 101399, China
| | - H Li
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y P Ma
- Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - X Q Qin
- Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - X H Suo
- Department of Hematology, Handan Central Hospital, Handan 057150, China
| | - C Yang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - T N Zhu
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - M H Duan
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - B Han
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - S J Wang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - D B Zhou
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Zhu ZX, Wang Q, Zhuang JL, Han B, Chen M. [The 503rd case: monoclonal IgM immunoglobulinemia, severe anemia with recurrent fever]. Zhonghua Nei Ke Za Zhi 2023; 62:1369-1372. [PMID: 37935507 DOI: 10.3760/cma.j.cn112138-20230302-00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
A 42-year-old woman was diagnosed with Waldenström macroglobulinemia (WM) with fatigue, anemia, and monoclonal IgM immunoglobulinemia 6 years prior. She experienced persistent severe anemia with only transient remission after initial chemotherapy and after multiple chemotherapy regimens and immunosuppressive therapies, which were accompanied by recurrent high fever with severe complications including urinary infection, sepsis and shock, rectal perforation, and severe obstructive jaundice. The anemia was diagnosed as warm autoimmune hemolytic anemia and aplastic crisis with inflammation anemia. She received ibrutinib 140 mg once a day, and her hemoglobin levels returned to normal. WM remained stable in very good partial remission with no infection.
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Affiliation(s)
- Z X Zhu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Q Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - B Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - M Chen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Shi M, Simiele EA, Han B, Pham D, Palomares P, Aguirre M, Gensheimer MF, Vitzthum L, Surucu M, Kovalchuk N. First-Year Experience of IMRT/SBRT Treatments Using a Novel Biology-Guided Radiation Therapy System. Int J Radiat Oncol Biol Phys 2023; 117:e717. [PMID: 37786094 DOI: 10.1016/j.ijrobp.2023.06.2222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) This study presents the first-year experience of treating patients using intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) with the X1 system, the first biology-guided radiation therapy (BgRT) machine installed in a clinical setting. MATERIALS/METHODS A total of 78 patients underwent IMRT and SBRT treatments on the X1 system from May 2021 to May 2022. Clinical and technical data, such as treatment sites, number of pre-treatments kVCT scans, beam on time, patient setup time, imaging time per kVCT, and couch shifts after kVCT match, were collected and analyzed. Additionally, daily machine output stability, patient-specific quality assurance (QA) results, machine uptime, and user survey were also documented and reported. RESULTS The most commonly treated site was the head and neck (63%), followed by the pelvis (23%), thorax (6%), and abdomen (8%). All treatments, except for 5 pelvis patients (6%) who received SBRT treatments for bony metastases, were conventionally fractionated IMRT (CF IMRT). The average number of kVCT scans per fraction is 1.2 ± 0.5 for all treatments. The average beam on time in minutes was 9.2 ± 3.5 for all treatments, 8.4 ± 2.4 for head and neck, 6.7 ± 1.3 for thorax, 10.3 ± 1.6 for abdomen, 11.6 ± 5.1 for CF IMRT pelvis, and 10.8 ± 5.3 for SBRT pelvis. The average patient setup time and imaging time per kVCT was 4.8 ± 2.6 minutes and 4.6 ± 1.5 minutes, respectively. The average couch corrections based on kVCT images were 0.4 ± 4.4 mm, 1.0 ± 4.5 mm, and 1.3 ± 4.3 mm along the x, y, and z direction, respectively; the average couch rotation corrections were 0.1 ± 0.9° for pitch, 0.0 ± 0.9° for roll, and 0.2 ± 1.2° for yaw. The daily machine output was 0.4 ± 1.2% from the baseline. The patient QA had a gamma passing rate of 97.4 ± 2.8%. The machine uptime was 92% of the total treatment time. The kVCT image quality and daily QA process received the highest level of satisfaction, while the treatment workflow for therapists received the lowest level of satisfaction (table 1). CONCLUSION At one year after the installation of the X1 system, this study reports successful treatment of 78 patients using IMRT/ SBRT. With the recent FDA clearance of BgRT, our institution is preparing to treat patients using PET-guidance via a new product release, which should address deficiencies in the current IGRT workflow.
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Affiliation(s)
- M Shi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA; Department of Radiation Oncology, University of California Irvine School of Medicine, Orange, CA
| | - E A Simiele
- University of Alabama at Birmingham, Birmingham, AL
| | - B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D Pham
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - P Palomares
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M Aguirre
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Bal G, Xu S, Shi L, Voronenko Y, Narayanan M, Shao L, Kuduvalli G, Han B, Kovalchuk N, Surucu M. Evaluation of Treatment Interruptions and Recovery during Biology-Guided Radiotherapy Delivery. Int J Radiat Oncol Biol Phys 2023; 117:e722-e723. [PMID: 37786107 DOI: 10.1016/j.ijrobp.2023.06.2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A Biology-guided Radiotherapy (BgRT) based device is designed to use Positron Emission Tomography (PET) signals to achieve tracked dose delivery. The goal of this study is to investigate the dose delivery accuracy in case of interruption during BgRT treatment, and resumption in a separate treatment session for a multi-target delivery, as the PET activity continues to decay. MATERIALS/METHODS A custom-built large anthropomorphic phantom (LAP) including a 26 mm spherical target with 3D independent motion and two 22 mm spherical targets with 1D sinusoidal motion embedded in water was used. All three targets were filled with FGD in an 8:1 target to background uptake ratio (41.52 kBq/ml in target and 5.19 kBq/ml in background). During BgRT delivery, the treatment was intentionally paused during delivery to the second target and the current treatment session was ended to generate a partial fraction. Then the partial fraction was continued in a new session, where the CT scan localization and PET pre-scan were repeated using the existing PET activity present in the phantom. The newly acquired PET pre-scan, was then used to determine if sufficient PET counts were present to resume treatment delivery. The interruption and recovery algorithm is designed to calculate the fluence that needs to be delivered to the remaining targets as well as the residual fluence to be given to the targets that have already received partial dose prior to the interruption. Once the new fluence is recomputed, the treatment is resumed. The delivered doses were captured using radiochromic film (EBT-XD) inserted in the target as well as post-treatment dose calculations based on the delivered beamlet sequence to evaluate the results in terms of dosimetric coverage and margin loss. The margin loss is calculated as the maximum difference between the distance from the Clinical Target Volume (CTV) contour to the 97% isodose contour in the treatment plan and the on the film. The dosimetric coverage is defined as the percentage of voxels within the CTV that lies within 97% and 130% of the prescribed dose. RESULTS As shown in the table below, a margin loss of less than 3 mm for all targets and 100% CTV coverage was achieved. After treatment interruptions, the PET safety evaluation based on the PET pre-scan helped to determine whether the treatment could be continued on the same day using the same injected PET activity (an NTS value ≧ 2 and AC value ≧ 5 kBq/ml). CONCLUSION This study demonstrated that the BgRT system is able to deliver the prescribed dose to all targets with independent motion, even when an interruption and resumption occurs during treatment. In case such an interruption if the remaining PET activity satisfies the BgRT safety evaluation, the treatment can continue to deliver the remainder of the BgRT doses.
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Affiliation(s)
- G Bal
- RefleXion Medical, Inc., Hayward, CA
| | - S Xu
- RefleXion Medical, Inc., Hayward, CA
| | - L Shi
- RefleXion Medical, Inc., Hayward, CA
| | | | | | - L Shao
- RefleXion Medical, Inc., Hayward, CA
| | | | - B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Fan P, Lu YT, Han B, Zhou XL, Tian T. [Advances in Sengers syndrome]. Zhonghua Nei Ke Za Zhi 2023; 62:1245-1248. [PMID: 37766448 DOI: 10.3760/cma.j.cn112138-20221029-00801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- P Fan
- Department of Cardiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Y T Lu
- Department of Cardiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - B Han
- Department of Ophthalmology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - X L Zhou
- Department of Cardiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - T Tian
- Department of Cardiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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9
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Bal G, Kovalchuk N, Schmall J, Voronenko Y, Bailey T, Xu S, Shi L, Groll A, Sharma S, Ramos K, Shao L, Narayanan M, Kuduvalli G, Han B, Surucu M. Intrafraction Dosimetric Evaluation of Biology-Guided Radiotherapy to a Target Under Respiratory Motion. Int J Radiat Oncol Biol Phys 2023; 117:e680-e681. [PMID: 37786004 DOI: 10.1016/j.ijrobp.2023.06.2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To evaluate the reproducibility and variability of biology-guided radiotherapy (BgRT) treatments using a large anthropomorphic phantom modeling the motion amplitude of a lung tumor. MATERIALS/METHODS RefleXion X1 is equipped with two opposing 90 degrees PET detector arcs to capture the radionuclide emissions and direct the 6MV Linac to treat the lesions in real time. A custom-built phantom filled with a liquid [¹⁸F]Fluorodeoxyglucose (FDG) solution was used. Fillable target and OAR structures were 3D printed and attached to motion stages. The GTV = CTV was matched to the spherical 22 mm diameter target, and the PTV was a 5 mm expansion from the CTV volume. The Biology Tracking Zone (BTZ) was generated after adding 5 mm margin to the motion extent of the CTV. The OAR was a large C-shape annulus (emulating a heart) that was approximately 3 cm from the target. The 3D independent motion trajectory of the target was designed to mimic lung motion: range of +5.8 mm to -4.9 mm in LR, range of +14.4 mm to -11.3 mm in SI, and range of +5.2 mm to -5.1 mm in AP directions. The OAR motion waveform used a 1D sinusoidal pattern with a 5 mm amplitude in SI direction. The target and the OAR were filled with 40 kBq/mL while the background had 5 kBq/mL FDG. A BgRT Modeling (imaging-only) PET acquisition was performed using RefleXion X1 and used to generate a 4-fraction BgRT treatment plan prescribing 10 Gy/fraction to PTV. For each delivery, target, OAR and background were filled with the same FDG concentrations as in the BgRT Modeling PET planning scan. Dosimetry to the target and OAR were both measured using an ion-chamber (Exradin A14SL) and film in the coronal plane through the center of the GTV for all 4 fractions. RESULTS The mean activity concentration within the (BTZ) was 7.4 ± 0.8 kBq/mL. The calculated signal-to-noise ratio metric (Normalized Target Signal) within the BTZ was 4.0 ± 0.3. Total treatment times were all less than 35 minutes (34.3 ± 0.2). Prescription dose coverage to the CTV for all 4 fractions was 100%. Ion chamber measurements in the CTV were -1.6 ± 1.3% relative to the planned dose over the active area of the ion-chamber. Minimum and maximum doses to the CTV, measured on film, were -7.7 ± 2.2% and 1.3 ± 1.4%, calculated relative to the planned dose distribution, respectively. The OAR maximum point dose measured on film was -8.7 ± 2.9%, calculated relative to the maximum OAR dose predicted on the bounded dose-volume histogram. CONCLUSION Based on this initial study, accurate and reproducible dosimetry can be achieved for targets under respiratory motion using biology-guided radiotherapy over the course of a complete course of treatment. Further studies are needed to evaluate the intrafraction dosimetry of BgRT delivery under various motion models and tumor sizes.
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Affiliation(s)
- G Bal
- RefleXion Medical, Inc., Hayward, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - J Schmall
- RefleXion Medical, Inc., Hayward, CA
| | | | - T Bailey
- RefleXion Medical, Inc., Hayward, CA
| | - S Xu
- RefleXion Medical, Inc., Hayward, CA
| | - L Shi
- RefleXion Medical, Inc., Hayward, CA
| | - A Groll
- RefleXion Medical, Inc., Hayward, CA
| | - S Sharma
- RefleXion Medical, Inc., Hayward, CA
| | - K Ramos
- RefleXion Medical, Inc., Hayward, CA
| | - L Shao
- RefleXion Medical, Inc., Hayward, CA
| | | | | | - B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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10
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Schmall J, Bal G, Khan S, Xu S, Voronenko Y, Shi L, Mitra A, Groll A, Sharma S, Ramos K, Shao L, Narayanan M, Olcott P, Kuduvalli G, Han B, Kovalchuk N, Surucu M. Dosimetric Accuracy of Multi-Target Biology-Guided Radiotherapy Treatments in a Single Session. Int J Radiat Oncol Biol Phys 2023; 117:e722. [PMID: 37786108 DOI: 10.1016/j.ijrobp.2023.06.2232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We present the first dosimetric measurements of single session, multi-target BgRT deliveries using a clinically realistic motion phantom on a research-only version of the RefleXion X1 system. MATERIALS/METHODS A custom-made anthropomorphic phantom of a human torso with embedded fillable targets mimicking 18F-FDG-avid lesions was used. From the three embedded spherical targets, Target 1 was 26 mm in diameter coupled with a 3D independent respiratory motion with 22 mm range, whereas Target 2 and 3 were 22 mm in diameter and moved with a 1D 5 mm maximum sinusoidal motion. The 18F-FDG concentration in the background cavity of the phantom was 5 kBq/ml, and the targets were loaded with 10:1, 8:1 and 6:1 contrast relative to the background for Targets 1, 2, 3, respectively. Spherical structures were contoured as GTVs (CTV = GTV) and a 5 mm margin was added to create PTVs. Motion extent of the tumors were captured to create biological tracking zones for each target. Treatment plans were generated using a research version of the Reflexion treatment planning software to deliver 8 Gy/fx to the PTVs. The treatment delivery was repeated 2 times, and each time the phantom was refilled according to the plan. PET image evaluation metrics for each of the three targets were also recorded. Target dosimetry was measured using a combination of radiographic film and ion chamber. The maximum distance between the 97% prescription isodose line from the plan and the film measurements was used to characterize the dosimetric accuracy of the tracked deliveries. CTV and PTV min, max, and mean doses measured on film were also recorded for each target. RESULTS Treatment plans were successfully created with 100% prescription dose coverage to each target loaded with different FDG ratios. Total treatment times for the single-plan, three-target deliveries were less than 80 minutes. PET evaluation metrics at imaging-only and pre-scan, and planning and film dosimetry to the GTV and PTV for each of the three targets is shown in table below (mean ± standard deviation of both deliveries). The CTV dose coverage was maintained for all targets. The shrinkage distance of the 97% prescription dose isodose line on the film plane for all three targets was less than 3 mm for both tests, and ranged from -0.4 to -2.34 mm. CONCLUSION These results demonstrate that high tracking accuracy and dosimetric accuracy can be achieved in single session, multi-target deliveries over a range of target-to-background 18F-FDG concentrations and target motion patterns.
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Affiliation(s)
- J Schmall
- RefleXion Medical, Inc., Hayward, CA
| | - G Bal
- RefleXion Medical, Inc., Hayward, CA
| | - S Khan
- RefleXion Medical, Inc., Hayward, CA
| | - S Xu
- RefleXion Medical, Inc., Hayward, CA
| | | | - L Shi
- RefleXion Medical, Inc., Hayward, CA
| | - A Mitra
- RefleXion Medical, Inc., Hayward, CA
| | - A Groll
- RefleXion Medical, Inc., Hayward, CA
| | - S Sharma
- RefleXion Medical, Inc., Hayward, CA
| | - K Ramos
- RefleXion Medical, Inc., Hayward, CA
| | - L Shao
- RefleXion Medical, Inc., Hayward, CA
| | | | - P Olcott
- RefleXion Medical, Inc., Hayward, CA
| | | | - B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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11
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Han B, Bagshaw HP, Gensheimer MF, Xing L, Chen Y. Patient-Adaptive Automated Segmentation in Daily kVCT Images for Radiotherapy of Head and Neck and Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e668. [PMID: 37785974 DOI: 10.1016/j.ijrobp.2023.06.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The purpose of this study was to examine the use of transfer learning in deep learning-based auto-segmentation of daily kilovoltage computed tomography (kVCT) images for patient-specific adaptive radiotherapy. Using data from the first cohort of patients treated with the innovative BgRT system, the objective of this study was to evaluate the potential benefits of this approach in facilitating efficient and effective adaptive radiotherapy. MATERIALS/METHODS For the head and neck (HaN) site and pelvic site, we first trained a deep convolutional segmentation network using a population dataset, consisting of 67 and 56 patient cases, respectively. This population network was then fine-tuned for a specific patient using a transfer learning approach, adapting the network weights. The auto-segmentation network utilized in this study was a 23-layer U-Net with batch normalization, a dropout rate of 0.5, and four skip connections between the encoder and decoder at different levels. We used initial planning CT and 5-26 sets of daily kVCT scans with a total of 8,039 images for patient-specific learning in the 6 HaN cases and 4 pelvic cases, particularly analyzing the relationship between the number of sequential patient-specific training data and the performance of the auto-segmentation. We compared the performance of the patient-specific network with the population network and the clinical rigid registration method, using the Dice similarity coefficient (DSC) as the evaluation metric. Additionally, we investigated the corresponding dosimetric impacts of the different auto-segmentation and registration methods. RESULTS The patient-specific network showed improved mean DSC scores of 0.88 and 0.90 for three HaN organs at risk (OARs) and eight pelvic targets and OARs, respectively, compared to the population network (0.70 and 0.63) and the registration method (0.72 and 0.72). The DSC of the patient-specific network steadily improved as the number of longitudinal training cases increased, reaching near saturation after 6 training cases. The use of the patient-specific auto-segmentation resulted in a reduction of the mean discrepancy in target and OAR doses between delivery and planning from 5.5% with the clinical rigid registration to 1.1%. CONCLUSION The use of patient-specific transfer learning in auto-segmenting kVCT images showed higher accuracy compared to a conventional population network and clinical registration-based method. This approach holds promise for enhancing dose evaluation accuracy in adaptive radiotherapy.
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Affiliation(s)
- B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - H P Bagshaw
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Y Chen
- Department of Radiation Oncology, Stanford University, Stanford, CA
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12
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Surucu M, Vitzthum L, Chang DT, Gensheimer MF, Kovalchuk N, Han B, Iagaru AH, Da Silva A, Narayanan M, Aksoy D, Feghali K, Shirvani SM, Maniyedath A, Cai B, Pompos A, Dan T, Öz OK, Iyengar P, Timmerman RD, Garant A. Analysis of the Measured FDG Uptake from the First-in-Human Clinical Trial of Biology-Guided Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e61-e62. [PMID: 37785835 DOI: 10.1016/j.ijrobp.2023.06.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The RefleXion X1 system is a novel linear accelerator equipped with dual 90° PET arcs incorporated into its architecture to capture emissions from tumors and designed to respond by directing the radiation beam towards target. This study reports on the measured FDG uptake from the first in human multi-institutional clinical trial (BIOGUIDE-X) evaluating the performance and safety of the RefleXion X1 PET-LINAC. MATERIALS/METHODS A total of nine patients treated with stereotactic body radiotherapy (SBRT) for lung (5) and bone (4) tumors were enrolled in the Cohort II of this study after screening their pre-study diagnostic PET/CT, acquired up to 60 days prior to enrollment, to ensure their tumor size between 2 to 5 cm and SUVmax >6. After CT simulation, the tumor and OARs were delineated, and patients had a 4-pass Imaging-only (BgRT Modeling) PET/CT acquisition on the X1 system to generate biology-guided radiotherapy (BgRT) plans. Before the patients' first and last SBRT fractions, they were injected with FDG, and short PET pre-scan (1-pass) was performed on the X1 followed by a long-PET acquisition (4-pass) to emulate the expected BgRT dose distribution without firing beam. Patients were also imaged on a third-party diagnostic PET/CT scanner after the last-fraction X1 scan. This study compares the SUVmax from the screening PET/CT, X1 Imaging-only scan, X1 PET pre-scan and long scan before the first and last-fractions, and final diagnostic PET/CT. RESULTS The median time from injection to PET imaging was 84 ± 15.4 mins for X1 Imaging-only (used for generating BgRT plans), 77 ± 21.6 mins for X1 pre-scan (safety check before treatment start), 108+/- 22 mins for X1 long-PET (used to emulate treatment delivery), and 161 ± 23 mins for final diagnostic PET. For a nominal 10 mCi injection, the mean SUVmax for screening imaging performed on the diagnostic PET/CT was 10.8 ± 4.3. For a 15 mCi nominal injection, the mean SUVmax calculated on the X1 was 5.3 ± 2.6, 5.4 ± 2.0, 5.5 ± 2.6, 5.2 ± 1.8 and 5.4 ± 2.2 for the Imaging-only, first-fraction PET pre-scan, first-fraction long PET scan, last-fraction PET pre-scan, and last-fraction long PET scan, respectively. The overall median SUVmax for all patients across all timepoints and scans with X1 was calculated to be 4.8 with a range of 2.4 to 9.8. The median SUVmax for the diagnostic PET/CT scan after the last fraction X1 scan was 15.8 with a range of 8.5 to 27.7. CONCLUSION The dual PET arcs and limited axial extent of the X1 PET subsystem results in lower system sensitivity in comparison to diagnostic PET scanners equipped with full ring and larger axial extent, as expected. With the same FDG injection, the RefleXion X1 produced SUVmax values that were 30.4 % of the diagnostic PET/CT scanners' values. Nevertheless, the X1 collected sufficient emission data to enable successful completion of emulated BgRT deliveries that met dose accuracy criteria in a clinical setting.
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Affiliation(s)
- M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA; Department of Radiation Oncology, Michigan Medicine, Ann Arbor, MI
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - A H Iagaru
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA
| | | | | | - D Aksoy
- RefleXion Medical, Inc., Hayward, CA
| | - K Feghali
- RefleXion Medical, Inc., Hayward, CA
| | | | | | - B Cai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A Pompos
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - T Dan
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - O K Öz
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - P Iyengar
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - R D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A Garant
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
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13
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Garant T, Iyengar P, Dan T, Pompos A, Timmerman RD, Öz OK, Cai B, Shirvani SM, Aksoy D, Al Feghali KA, Maniyedath A, Narayanan M, Da Silva A, Surucu M, Gensheimer MF, Kovalchuk N, Han B, Pham D, Chang DT, Vitzthum L. Imaging Performance of the PET Scan on a Novel Ring Gantry-Based PET/CT Linear Accelerator System in the First-in-Human Study of Biology-Guided Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e665. [PMID: 37785968 DOI: 10.1016/j.ijrobp.2023.06.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Biology-guided radiotherapy (BgRT) is a novel tracked dose delivery modality using real-time positron emission tomography (PET) to guide radiotherapy beamlets. The present study was performed with sequential cohorts of participants to evaluate the performance and safety of BgRT. Primary endpoints were previously reported. We hereby report on one of the secondary endpoints assessing a novel treatment planning machine with integrated dual kVCT/PET imaging ("novel device") performance in comparison to a third-party diagnostic PET/CT scan. MATERIALS/METHODS This single-arm, open-label, prospective study included participants with at least 1 FDG-avid targetable primary or metastatic tumor (≥2cm and ≤5cm) in the lung or bone. PET imaging data were collected on the novel device and on a third-party diagnostic PET/CT performed in sequence once at the planning timepoint in Cohort I, and immediately before the last fraction among patients undergoing stereotactic radiotherapy in Cohort II. Three central read radiation oncologists (CRRO) provided an interpretation of the novel device PET scans which were compared to an agreement standard based on 3 central radiologists' review of the paired diagnostic PET/CT scan. Positive percent agreement for localization of the target tumor within the biology-tracking zone (BTZ) was the key metric because it reflects whether advancing patients to subsequent steps in the BgRT workflow based on the novel device's imaging was ultimately appropriate. RESULTS In Cohort 1, 6 image comparisons were performed. The positive (%) agreement for the aggregate radiation oncologist review was 100% (5/5), reflecting that in all 5 cases where the aggregate radiation oncologists deemed the tumor to fall within the BTZ based upon the novel device PET images, the central radiologists came to the same conclusion upon review of the paired diagnostic PET/CT images. The overall (%) agreement for the aggregate radiation oncologist review was 83.3% (5/6): localization was not established on the novel device in 1 case, even though it was established on the diagnostic PET/CT. This would not pose risk in real world practice as BgRT candidacy would be aborted for tumors not visible on the novel device. In Cohort II, among the 7 image comparisons, there was 100% positive percent agreement between the aggregate CRRO and the agreement standard as the localization criteria was met in both scans for all 7 patients. This was concordant with a 100% overall percent agreement. CONCLUSION This investigation demonstrated a 100% positive percent agreement between central review of this novel device images by radiation oncologists and central review of the accompanying third-party PET/CT images by radiologists. There were no cases where a positive localization by the aggregate CRRO was not confirmed by the third-party PET/CT standard, providing evidence against the likelihood of falsely positive localizations on the novel device that would inappropriately advance patients in the workflow.
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Affiliation(s)
- T Garant
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - P Iyengar
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - T Dan
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - A Pompos
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - R D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - O K Öz
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - B Cai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - D Aksoy
- RefleXion Medical, Inc., Hayward, CA
| | | | | | | | | | - M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D Pham
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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14
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Surucu M, Vitzthum L, Chang DT, Gensheimer MF, Kovalchuk N, Han B, Pham D, Da Silva A, Narayanan M, Aksoy D, Feghali K, Shirvani SM, Maniyedath A, Cai B, Pompos A, Dan T, Öz OK, Iyengar P, Timmerman RD, Garant A. Workflow Considerations for Biology-Guided Radiotherapy (BgRT) Implementation. Int J Radiat Oncol Biol Phys 2023; 117:e441. [PMID: 37785431 DOI: 10.1016/j.ijrobp.2023.06.1618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Biology-guided radiotherapy (BgRT) is a novel platform that combines real-time PET imaging with a 6MV Linac to target tumors. The performance and safety of BgRT was assessed in the BIOGUIDE-X clinical trial. This study aims to report on the BgRT workflow steps and assess the time required for each step of the BgRT process during this trial. MATERIALS/METHODS A total of nine patients were enrolled in the second Cohort of the BIOGUIDE-X study which included patients treated with stereotactic body radiotherapy (SBRT) for lung tumors (5) and bone tumors (4). The pre-treatment BgRT workflow includes CT simulation, contouring, imaging-only (BgRT Modeling) PET acquisition, BgRT planning, patient specific QA and plan approval. The imaging-only PET acquisition on the X1 collects a representative PET volumetric 3D image and is an input to develop the BgRT treatment plan. The steps during the BgRT delivery session are kVCT localization, PET pre-scan, PET evaluation and BgRT delivery. The PET PreScan is a 1-pass short-duration PET acquisition that is used to confirm that the PET biodistribution on the day of treatment is consistent with that of the imaging-only PET. During BIOGUIDE-X, the BgRT delivery step was replaced by a 4-pass long-PET acquisition that was used to emulate the expected BgRT dose distribution without turning the beam on. To assess BgRT workflow, times from 18F-FDG injection to image-only PET acquisition, 18F-FDG injection to PET pre-scan, Pre-scan to PET evaluation, and PET evaluation to BgRT delivery (long PET acquisition) were recorded. RESULTS Time between the 18F-FDG injection and the X1 imaging-only PET scan was 84 ± 19 minutes which includes time for 18F-FDG update. Average time to perform imaging-only PET scan was 26 ± 4 minutes. During the BgRT 'delivery' session, the mean time between the kVCT acquisition and PET pre-scan acquisition was 7 ± 3 minutes. The mean time to acquire a 1-pass PET pre-scan was 6 ± 1 then followed by 6 ± 1 minutes for the PET pre-scan dose calculation to estimate the BgRT doses that it would have delivered for this fraction. On average, the PET reconstruction, the PET signal localization verification and the evaluation of safety metrics took 11 ± 4 minutes. The mean time for BgRT 'delivery' was 27 ± 5 minutes based on the 4-pass long PET acquisition. Time from the start of the BgRT session to the end of the BgRT 'delivery' with this version of the investigative product release was 65 ± 9 minutes. CONCLUSION The new processes introduced by the BgRT technology were evaluated and found clinically feasible. Improvements are being undertaken to shorten the time required for each step and to increase patient comfort ahead of BgRT clinical implementation.
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Affiliation(s)
- M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA; Department of Radiation Oncology, Michigan Medicine, Ann Arbor, MI
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D Pham
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - D Aksoy
- RefleXion Medical, Inc., Hayward, CA
| | - K Feghali
- RefleXion Medical, Inc., Hayward, CA
| | | | | | - B Cai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A Pompos
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - T Dan
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - O K Öz
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - P Iyengar
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - R D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A Garant
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
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15
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Simiele EA, Han B, Skinner L, Pham D, Lewis J, Gensheimer MF, Vitzthum L, Chang DT, Surucu M, Kovalchuk N. Mitigation of IMRT/SBRT Treatment Planning Errors on the First Biology-Guided Radiotherapy System Using FMEA within Six Sigma Framework. Int J Radiat Oncol Biol Phys 2023; 117:S145. [PMID: 37784370 DOI: 10.1016/j.ijrobp.2023.06.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Utilize the Six Sigma methodology and Failure Mode and Effect Analysis (FMEA) to prevent and mitigate errors in IMRT/SBRT treatment planning with the first clinical installation of biology-guided radiotherapy (BgRT) system. MATERIALS/METHODS The Six Sigma approach consisted of five phases: Define-Measure-Analyze-Improve-Control. The Define-Measure-Analyze phases consisted of process mapping and an FMEA of the IMRT/SBRT treatment planning process on the BgRT system. The multidisciplinary team outlined the workflow process and identified the failure modes associated with the plan check items using AAPM TG-100 recommendations. Items with the highest average risk priority numbers (RPN) and Severity ≥7 were prioritized for automation using the treatment planning system scripting API (ESAPI). The Improve phase consisted of developing ESAPI scripts prior to the launch of the BgRT system to improve efficiency and safety. In the Control phase, the FMEA ranking was re-evaluated 1-year post-clinical launch. RESULTS Overall, 100 plan check items were identified where the RPN values ranged from 10.2 to 429.0. Fifty of these items (50%) were suitable for automation within ESAPI. Of the 10 highest-risk items (Table 1), 8 were suitable for automation. Based on the results of the FMEA, two scripts were developed: Planning Assistant used by the planner during preparation for planning and the Automated Plan Check used by the planner and the plan checker during plan preparation for treatment. At 1-year post-clinical launch, the scripts were used for 80 patients successfully treated in 1747 fractions. During this period only 3 errors were reported: omitted bolus during treatment, nomenclature error in the BgRT system plan prescription, and dose tracking plan not approved following physics plan check. The average RPN pre-scripts was 138.0 compared to the average post-scripts RPN of 47.8 (p < 0.05) signifying a safer process. CONCLUSION Implementing new technology into the clinic can be an error-prone process where the likelihood of errors increases with increasing pressure to implement the technology quickly. To limit errors in the clinical implementation of the first BgRT system, the Six Sigma methodology was utilized to identify failure modes, establish quality control checks, and re-evaluate these checks 1-year post-clinical launch.
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Affiliation(s)
- E A Simiele
- University of Alabama at Birmingham, Birmingham, AL
| | - B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D Pham
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - J Lewis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D T Chang
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, MI
| | - M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Han B, Schmall J, Bal G, Khan S, Voronenko Y, Xu S, Shi L, Mitra A, Groll A, Sharma S, Ramos K, Shao L, Narayanan M, Olcott P, Kuduvalli G, Kovalchuk N, Surucu M. Characterization of Biology-Guided Radiotherapy Accuracy as a Function of PET Tracer Uptake. Int J Radiat Oncol Biol Phys 2023; 117:e668-e669. [PMID: 37785972 DOI: 10.1016/j.ijrobp.2023.06.2113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To characterize the tracking capability and dosimetric accuracy of biology-guided radiotherapy (BgRT) under clinically relevant PET tracer uptake scenarios relative to the background. MATERIALS/METHODS A custom-made anthropomorphic phantom filled with a liquid 18F-FDG solution including two embedded fillable 22 mm diameter spherical structures mimicking GTV (= CTV) and OAR was coupled to motion stages to create an independent 3D respiratory motion with 22 mm maximum range for target and a 5 mm 1D sinusoidal motion in the OAR. The biology-tracking zone (BTZ) was generated by adding 5 mm margin to the motion extent. The three BgRT scenarios studied were representative of tumors with good (8:1), borderline (4:1) and undesired (2:1) PET biodistributions compared to background. The clinical safety limit of BgRT uses Activity Concentration within the BTZ (AC ≥ 5 kBq/ml) and Normalized Target Signal as a contrast metric (NTS ≧ 2.7 for planning and ≧ 2 for delivery). The BgRT deliveries were repeated 3 times with radiochromic film and integrated ion chamber capturing the target and OAR doses. Tracked dosimetry was assessed using a margin-loss calculation defined as the maximum linear difference in distance between the planned and delivered 97% prescription iso-dose lines. RESULTS The imaging-only PET images used to create BgRT plans had an AC of 7.0, 5.3, and 1.6 kBq/ml with an NTS of 6.8, 5.3, and 1.8 for 8:1, 4:1, and 2:1 concentrations, respectively. Qualitatively, the target was not visible on the planning PET images 2:1 loading scenario. At delivery, the mean pre-scan activity concentrations were 6.8, 4.7, and 3.7 kBq/ml with corresponding mean NTS of 3.7, 2.6, 1.5 for 8:1, 4:1 and 2:1 deliveries. The pre-scan values of AC or NTS did not satisfy the clinical system safety limits for 4:1 and 2:1 ratio experiments, but the engineering software allowed for the delivery to capture the resulting doses. The deliveries showed a prescription dose coverage to the CTV of 100% for the 8:1 and 4:1 cases, but 88% for the 2:1 case. When compared to the planned dose values, the delivered minimum doses were -7.6%, -8.6% and -10.9%, whereas the maximum dose differences in CTV were 1.2%, 0% and -4.8% of the planned dose distributions of the 8:1, 4:1 and 2:1 cases, respectively. Calculated margin losses were -2.3, -3.8, and -5.5 mm, for the 8:1, 4:1, and 2:1 cases, respectively. The maximum OAR doses were less than the maximum doses predicted on the bounded DVH curves for all scenarios. CONCLUSION With sufficient tracer uptake in the target, BgRT can deliver tracked dosimetry for targets with a large respiratory motion profile. Both the good BgRT candidate and borderline cases produced clinically acceptable delivered doses, even though the borderline case was flagged by the clinical system safety checks. As expected, the delivered BgRT dose distributions were suboptimal with reduced tumor over background PET contrast.
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Affiliation(s)
- B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - J Schmall
- RefleXion Medical, Inc., Hayward, CA
| | - G Bal
- RefleXion Medical, Inc., Hayward, CA
| | - S Khan
- RefleXion Medical, Inc., Hayward, CA
| | | | - S Xu
- RefleXion Medical, Inc., Hayward, CA
| | - L Shi
- RefleXion Medical, Inc., Hayward, CA
| | - A Mitra
- RefleXion Medical, Inc., Hayward, CA
| | - A Groll
- RefleXion Medical, Inc., Hayward, CA
| | - S Sharma
- RefleXion Medical, Inc., Hayward, CA
| | - K Ramos
- RefleXion Medical, Inc., Hayward, CA
| | - L Shao
- RefleXion Medical, Inc., Hayward, CA
| | | | - P Olcott
- RefleXion Medical, Inc., Hayward, CA
| | | | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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17
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Lv C, Wang R, Li S, Yan S, Wang Y, Chen J, Wang L, Liu Y, Guo Z, Wang J, Pei Y, Yu L, Wu N, Lu F, Gao F, Chen J, Liu Y, Wang X, Li S, Han B, Zhang L, Ma Y, Ding L, Wang Y, Yuan X, Yang Y. Randomized phase II adjuvant trial to compare two treatment durations of icotinib (2 years versus 1 year) for stage II-IIIA EGFR-positive lung adenocarcinoma patients (ICOMPARE study). ESMO Open 2023; 8:101565. [PMID: 37348348 PMCID: PMC10515286 DOI: 10.1016/j.esmoop.2023.101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/30/2023] [Accepted: 04/24/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Despite the prolonged median disease-free survival (DFS) by adjuvant targeted therapy in non-small-cell lung cancer patients with epidermal growth factor receptor (EGFR) mutations, the relationship between the treatment duration and the survival benefits in patients remains unknown. PATIENTS AND METHODS In this multicenter, randomized, open-label, phase II trial, eligible patients aged 18-75 years with EGFR-mutant, stage II-IIIA lung adenocarcinoma and who had not received adjuvant chemotherapy after complete tumor resection were enrolled from eight centers in China. Patients were randomly assigned (1 : 1) to receive either 1-year or 2-year icotinib (125 mg thrice daily). The primary endpoint was DFS assessed by investigator. The secondary endpoints were overall survival (OS) and safety. This study was registered at ClinicalTrials.gov (NCT01929200). RESULTS Between September 2013 and October 2018, 109 patients were enrolled (1-year group, n = 55; 2-year group, n = 54). Median DFS was 48.9 months [95% confidence interval (CI) 33.1-70.1 months] in the 2-year group and 32.9 months (95% CI 26.6-44.8 months) in the 1-year group [hazard ratio (HR) 0.51; 95% CI 0.28-0.94; P = 0.0290]. Median OS for patients was 75.8 months [95% CI 64.4 months-not evaluable (NE)] in the 2-year group and NE (95% CI 66.3 months-NE) in the 1-year group (HR 0.34; 95% CI 0.13-0.95; P = 0.0317). Treatment-related adverse events (TRAEs) were observed in 41 of 55 (75%) patients in the 1-year group and in 36 of 54 (67%) patients in the 2-year group. Grade 3-4 TRAEs occurred in 4 of 55 (7%) patients in the 1-year group and in 3 of 54 (6%) patients in the 2-year group. No treatment-related deaths or interstitial lung disease was reported. CONCLUSIONS Two-year adjuvant icotinib was shown to significantly improve DFS and provide an OS benefit in EGFR-mutant, stage II-IIIA lung adenocarcinoma patients compared with 1-year treatment in this exploratory phase II study.
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Affiliation(s)
- C Lv
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - R Wang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebi
| | - S Li
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - S Yan
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - Y Wang
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - J Chen
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - L Wang
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - Y Liu
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - Z Guo
- Department of Thoracic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia
| | - J Wang
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - Y Pei
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - L Yu
- Department of Thoracic Surgery, Beijing Tongren Hospital, CMU, Beijing
| | - N Wu
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - F Lu
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - F Gao
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebi
| | - J Chen
- Thoracic Neoplasms Surgical Department, Tianjing Medical University General Hospital, Tianjing
| | - Y Liu
- Thoracic Neoplasms Surgical Department, Inner Mongolia People's Hospital, Inner Mongolia
| | - X Wang
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - S Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing
| | - B Han
- Department of Thoracic Surgery, PLA Pocket Force Characteristic Medical Center, Beijing
| | - L Zhang
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - Y Ma
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing
| | - L Ding
- Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Y Wang
- Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - X Yuan
- Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Y Yang
- Department of Thoracic Surgery II, Beijing Cancer Hospital, Beijing.
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18
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DA R, Zhou Y, Cheng Y, Lv J, Han B. [UhpT E350Q mutation along with the presence of fosA6/5 genes in the genome probably contributes to inherent fosfomycin resistance of Klebsiella pneumoniae]. Nan Fang Yi Ke Da Xue Xue Bao 2023; 43:1110-1115. [PMID: 37488793 PMCID: PMC10366525 DOI: 10.12122/j.issn.1673-4254.2023.07.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
OBJECTIVE To investigate the molecular mechanism underlying inherent fosfomycin resistance of Klebsiella pneumoniae (K. pneumoniae). METHODS The draft genomic sequences of 14 clinical hypervirulent/hypermucoviscous K. pneumoniae (HvKP/ HmKP) isolates were obtained using the next-generation sequencing technology. The genomic sequences were analyzed using the Resistance Gene Identifier (RGI) software for predicting the resistome based on homology and SNP models in the Comprehensive Antibiotic Resistance Database (CARD) and for identification of the presence of phosphomycin resistancerelated genes uhpt and fosA and their mutations in the bacterial genomes. The results were verified by analyzing a total of 521 full-length genomic sequences of K. pneumonia strains obtained from GenBank. RESULTS All the 14 clinical isolates of HvKP/ HmKP carried hexose phosphate transporter (UhpT) gene mutation, in which the glutamic acid was mutated to glutamine at 350aa (UhpTE350Q mutation); the presence of fosA6 gene was detected in 12 (85.71%) of the isolates and fosA5 gene was detected in the other 2 (14.29%) isolates. Analysis of the genomic sequences of 521 K. pneumonia strains from GenBank showed that 508 (97.50%) strains carried UhpTE350Q mutation, 439 (84.26%) strains harbored fosA6, and 80 (15.36%) strains harbored fosA5; 507 (97.31%) strains were found to have both UhpTE350Q mutation and fosA6/5 genes in the genome. Only 12 (2.30%) strains carried fosA6/5 genes without UhpTE350Q mutation; 1 (0.19%) strain had only UhpTE350Q mutation without fosA6/5 genes, and another strain contained neither UhpTE350Q mutation nor fosA6/5 genes. CONCLUSION UhpTE350Q mutation with the presence of fosA6/5 genes are ubiquitous in K. pneumonia genomes, indicating a possible intrinsic mechanism of fosfomycin resistance in the bacterium to limit the use of fosfomycin against infections caused by K. pneumoniae, especially the multi-resistant HvKP/HmKP strains.
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Affiliation(s)
- R DA
- Department of Clinical Laboratory, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Y Zhou
- School of Public Health, Health Science Center of Xi'an Jiaotong University, Xi'an 710061, China
| | - Y Cheng
- School of Public Health, Health Science Center of Xi'an Jiaotong University, Xi'an 710061, China
| | - J Lv
- School of Public Health, Health Science Center of Xi'an Jiaotong University, Xi'an 710061, China
| | - B Han
- School of Public Health, Health Science Center of Xi'an Jiaotong University, Xi'an 710061, China
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Zhou F, Yang Y, Zhang L, Cheng Y, Han B, Lu Y, Wang C, Wang Z, Yang N, Fan Y, Wang L, Ma Z, Zhang L, Yao Y, Zhao J, Dong X, Zhu B, Zhou C. Expert consensus of management of adverse drug reactions with anaplastic lymphoma kinase tyrosine kinase inhibitors. ESMO Open 2023; 8:101560. [PMID: 37230029 DOI: 10.1016/j.esmoop.2023.101560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/26/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
Anaplastic lymphoma kinase (ALK) rearrangements occur in ∼3%-6% of patients with advanced non-small-cell lung cancer (NSCLC). Small molecular drugs that effectively inhibit ALK gene have revolutionized the therapeutic paradigm for patients with ALK rearrangements, resulting in significant improvements in objective response rate, progression-free survival, and overall survival compared with classical platinum-based chemotherapy. Several ALK tyrosine kinase inhibitors (ALK-TKIs), including crizotinib, alectinib, ceritinib, brigatinib, ensartinib, and lorlatinib, have been recommended as standard first-line treatment for advanced NSCLC patients with ALK rearrangements. Patients with ALK rearrangements typically exhibit long-term durable responses to ALK-TKIs; therefore, the management of adverse drug reactions (ADRs) with ALK-TKIs is crucial in clinical practice to maximize clinical benefits, prevent an adverse impact on quality of life, and improve patient compliance. In general, ALK-TKIs are well tolerated. There are, however, a number of serious toxicities that may necessitate dose modification or even discontinuation of treatment and the management of ADRs with ALK-TKIs has grown in importance. The therapeutic use of this class of medications still carries some risk because there are currently no pertinent guidelines or consensus recommendations for managing ADRs caused by ALK-TKIs in China. In order to improve the clinical management of ADRs with ALK-TKIs, the Chinese Society of Clinical Oncology (CSCO) Non-small Cell Lung Cancer Professional Committee led the discussion and summary of the incidence, diagnosis and grading standards, and prevention and treatment of ADRs caused by ALK-TKIs.
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Affiliation(s)
- F Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai
| | - Y Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - L Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - Y Cheng
- Department of Internal Medicine-Oncology, Jilin Cancer Hospital, Changchun
| | - B Han
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai
| | - Y Lu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu
| | - C Wang
- Department of Lung Cancer, Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin
| | - Z Wang
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Jinan
| | - N Yang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha
| | - Y Fan
- Department of Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou
| | - L Wang
- Department of Medical Oncology, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing
| | - Z Ma
- Department of Respiratory Medicine, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou
| | - L Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - Y Yao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - J Zhao
- Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing
| | - X Dong
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - B Zhu
- Department of Oncology, Xinqiao Hospital, The Army Medical University, Chongqing, China
| | - C Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai.
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Hu QL, Han B, He WH, Yang C, Chen M. [Allogeneic unrelated non HLA matched umbilical cord blood transfusion for refractory immune cytopenia: results of a phase I clinical trial]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:431-435. [PMID: 37550196 PMCID: PMC10440616 DOI: 10.3760/cma.j.issn.0253-2727.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Indexed: 08/09/2023]
Affiliation(s)
- Q L Hu
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - B Han
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - W H He
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - C Yang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - M Chen
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Ren S, Wang X, Han B, Pan Y, Zhao J, Cheng Y, Hu S, Liu T, Li Y, Cheng Y, Feng J, Yi S, Gu S, Gao S, Luo Y, Liu Y, Liu C, Duan H, Zhou C, Fan J. 43P Camrelizumab plus famitinib as first-line treatment in advanced NSCLC patients with PD-L1 TPS ≥1%: A report from a multicenter, open-label, phase II basket trial. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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22
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Ling X, Zhong R, Cao S, Zhang L, Xu J, Zhang B, Zhang X, Wang H, Han B, Zhong H. 45P DCVAC/LuCa with chemotherapy in patients with stage IV, non-squamous NSCLC without EGFR/ALK aberrations: Five-year survival update. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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23
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Ferrara R, Vansteenkiste J, Yang X, Grossi F, Melosky B, Ahn MJ, Calles A, Chan O, Han B, Bulusu V, Califano R, Nishino K, Ghori V, Ronga P, Berghoff K, Vlassak S, Le X. 33P Real-world experience of MET TKI-induced peripheral edema. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00287-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Zang Z, Qiao R, Zhu Q, Zhou X, Gu W, Han B, Yang R. [Peripheral blood KCNMA1 methylation level is associated with the occurrence and progression of lung cancer]. Nan Fang Yi Ke Da Xue Xue Bao 2023; 43:349-359. [PMID: 37087578 PMCID: PMC10122738 DOI: 10.12122/j.issn.1673-4254.2023.03.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
Abstract
OBJECTIVE To explore the association of KCNMA1 gene methylation levels in peripheral blood with lung cancer. METHODS The methylation levels of 4 CpG sites in KCNMA1 gene were quantitatively detected in 285 patients with lung cancer, 186 age- and sex-matched patients with benign pulmonary nodules and 278 matched healthy control subjects using mass spectrometry (MALDI-TOF-MS). The association of KCNMA1 methylation levels with lung cancer was analyzed using logistic regression models adjusted for covariates. The KCNMA1 methylation levels in different subgroups of lung cancer patients were compared using Mann-Whitney U test. RESULTS In subjects over 55 years and in female subjects, the highest quartile (Q4) vs the lowest quartile (Q1) of KCNMA1_CpG_5 methylation levels were significantly correlated with lung cancer (for subjects over 55 years: OR=2.60, 95% CI: 1.25-5.41, P=0.011; for female subjects: OR=2.09, 95% CI: 1.03?4.26, P=0.042). From Q2 to Q4 of KCNMA1_CpG_5 methylation levels, their correlation with lung cancer became gradually stronger (P=0.003 and 0.038, respectively). In male subjects, the OR of Q4 of KCNMA1_CpG_5 methylation levels was 0.35 in patients with lung cancer as compared with patients with benign nodules (95% CI: 0.16-0.79, P=0.012). KCNMA1_CpG_3 methylation level was significantly lower in invasive adenocarcinoma than in noninvasive adenocarcinoma (P=0.028), and that of KCNMA1_CpG_1 was significantly higher in patients with larger tumors (T2-4) than in those with smaller tumors (T1) (P=0.021). CONCLUSION The change of peripheral blood KCNMA1 methylation level is correlated with the occurrence and development of lung cancer.
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Affiliation(s)
- Z Zang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - R Qiao
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Q Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - X Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - W Gu
- Department of Clinical Laboratory, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, China
| | - B Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - R Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
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Han B, Jiao S, Chen J, Wang Z, Zhao Y, Zhang G, Chen G, Zhou M, Zhou J, Du Y, Wu L, Xu Z, Mei X, Zhang W, He J, Cui J, Zhang Z, Luo H, Liu W, Sun Y. 59MO Final analysis of AK105-302: A randomized, double-blind, placebo-controlled, phase III trial of penpulimab plus carboplatin and paclitaxel as first-line treatment for advanced squamous NSCLC. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Han B, Zhong H, Tian P, Zhao Y, Guo Q, Yu X, Yu Z, Zhang X, Li Y, Chen L, Zhang Y, Shi X, Wang J. 136P Tislelizumab (TIS) plus chemotherapy (chemo) for EGFR-mutated non-squamous non-small cell lung cancer (nsq-NSCLC) failed to EGFR tyrosine kinase inhibitors (TKIs) therapies: The primary analysis. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Li Y, Jiang H, Qian F, Cheng Y, Zhang Y, Lu J, Lou Y, Han B, Zhang W. 81P Is PD-1 inhibitor based treatment better than chemotherapy for metastatic NSCLC patients with PD-L1≥50% who develop EGFR-TKI resistance? A real-world investigation. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Huang W, Han B. Clinical-Pathological Correlation of Breast Non-mass Enhancing Lesions. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
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.
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Affiliation(s)
- W Huang
- Pathology, Milton S. Hershey Medical Center , Hershey, Pennsylvania , United States
| | - B Han
- Pathology, Milton S. Hershey Medical Center , Hershey, Pennsylvania , United States
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Zhang W, Yang H, Kong T, Han B. 355P Anlotinib plus standard chemotherapy as first-line treatment in extensive-stage small cell lung cancer patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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30
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Chen Y, Yu L, Zhou Y, Shen L, Kovalchuk N, Xing L, Han B, Gensheimer M. Systematic Study of Patient-Specific Organs at Risk Auto-Segmentation on Daily kVCT Images for Adaptive Head and Neck Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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31
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Chen Y, Butler S, Xing L, Han B, Bagshaw H. Patient-Specific Auto-Segmentation of Target and OARs via Deep Learning on Daily Fan-Beam CT for Adaptive Prostate Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Han B, Li B, Guifeng Z. Impact of limbs pneumatic compression during cardiopulmonary resuscitation (CPR) on cardiac arrest patients: a randomized controlled trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
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
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Affiliation(s)
- B Han
- PLA Rocket Force Characteristic Medical Center , Beijing , China
| | - B Li
- Aviation General Hosptial, CCU , Beijing , China
| | - Z Guifeng
- PLA Rocket Force Characteristic Medical Center , Beijing , China
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Lee S, Schulz C, Prabhash K, Han B, Szczesna A, Cortinovis D, Rittmeyer A, Baz DV, Califano R, Anh LT, Liu G, Cappuzzo F, Contreras JR, Reck M, Hu Y, Morris S, Hoeglander E, Connors M, Vollan H, Peters S. LBA11 IPSOS: Results from a phase III study of first-line (1L) atezolizumab (atezo) vs single-agent chemotherapy (chemo) in patients (pts) with NSCLC not eligible for a platinum-containing regimen. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Zhang W, Yang H, Kong T, Han B. EP14.01-025 Anlotinib Plus Standard Chemotherapy as First-line Treatment in Extensive-Stage Small Cell Lung Cancer Patients. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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35
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Lu J, Gu A, Zhong H, Han B. EP05.01-36 Role of Nanoparticle Polymeric Micellar Paclitaxel in Reducing Toxicity and Enhancing Efficacy in Non-small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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36
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Han B, Fang V, Yao F, Song P, Yue D, Qi Y, Zhang B, Zhang W, Zhang Y, Tan L. 948TiP Efficacy and safety of almonertinib in the adjuvant treatment of resectable stage I non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR)-sensitizing mutations in solid and/or micropapillary components. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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37
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Lu J, Wu J, Lou Y, Wang H, Zhong H, Chu T, Han B. EP16.01-032 Guiding Monotherapy with Docetaxel or Atezolizumab via the Tumour Mutation Index in Non-small Cell Lung Cancer Patients. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Zhou Y, Han B, Zhong H. EP16.02-028 Schwann Cell Exosomes Promote Lung Cancer Progression via miRNA-21-5P Cargo. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Han B, Chu T, Yu Z, Wang J, Zhao Y, Mu X, Yu X, Shi X, Shi Q, Guan M, Ding C, Geng N. LBA57 Sintilimab plus anlotinib versus platinum-based chemotherapy as first-line therapy in metastatic NSCLC (SUNRISE): An open label, multi-center, randomized, phase II study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kushner BS, Holden T, Han B, Sehnert M, Majumder A, Blatnik JA, Holden SE. 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. Hernia 2022; 26:901-909. [PMID: 34686942 DOI: 10.1007/s10029-021-02524-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/04/2021] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- B S Kushner
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.
| | - T Holden
- Department of Medicine, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - B Han
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - M Sehnert
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - A Majumder
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - J A Blatnik
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - S E Holden
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
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Xing P, Zheng X, Wang Y, Chu T, Wang S, Jiang J, Qian J, Han X, Ding L, Wang Y, Cui L, Li H, Li L, Chen X, Han B, Hu P, Shi Y. 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. ESMO Open 2022; 7:100473. [PMID: 35526510 PMCID: PMC9271465 DOI: 10.1016/j.esmoop.2022.100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
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. BPI-15086 is safe and has partial effectiveness in patients with advanced T790M+ NSCLC after previous EGFR-TKI therapy. A different safety profile for BPI-15086 compared with other third-generation EGFR-TKIs. The modest efficacy in this study is still deemed important and should be added to the literature of third-generation TKIs.
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Su H, Xu K, Han B, Chen G, Xu T. A retrospective study of factors contributing to anchorage loss in upper premolar extraction cases. Niger J Clin Pract 2022; 25:664-669. [PMID: 35593610 DOI: 10.4103/njcp.njcp_1791_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- H Su
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing 100034; National Center of Stomatology and National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing, China
| | - K Xu
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, USA
| | - B Han
- Department of Orthodontics, Peking University School and Hospital of Stomatology; National Center of Stomatology and National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing, China
| | - G Chen
- Department of Orthodontics, Peking University School and Hospital of Stomatology; National Center of Stomatology and National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing, China
| | - T Xu
- Department of Orthodontics, Peking University School and Hospital of Stomatology; National Center of Stomatology and National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing, China
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Wang YL, Han J, Ma XM, Liu TT, Qi XB, Han B, Zhang HJ, Zhang WH. [Effects of primary preventive treatment under endoscope for esophageal and gastric varices on bleeding rate and its relevant factors]. Zhonghua Gan Zang Bing Za Zhi 2022; 30:407-412. [PMID: 35545566 DOI: 10.3760/cma.j.cn501113-20200529-00284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Y L Wang
- Liver Cirrhosis Diagnosis and Treatment Center, Fifth Medical Center of Chinese PLA General Hospital of China, Beijing 100039, China
| | - J Han
- Liver Cirrhosis Diagnosis and Treatment Center, Fifth Medical Center of Chinese PLA General Hospital of China, Beijing 100039, China
| | - X M Ma
- Liver Cirrhosis Diagnosis and Treatment Center, Fifth Medical Center of Chinese PLA General Hospital of China, Beijing 100039, China
| | - T T Liu
- Liver Cirrhosis Diagnosis and Treatment Center, Fifth Medical Center of Chinese PLA General Hospital of China, Beijing 100039, China
| | - X B Qi
- Liver Cirrhosis Diagnosis and Treatment Center, Fifth Medical Center of Chinese PLA General Hospital of China, Beijing 100039, China
| | - B Han
- Liver Cirrhosis Diagnosis and Treatment Center, Fifth Medical Center of Chinese PLA General Hospital of China, Beijing 100039, China
| | - H J Zhang
- Liver Cirrhosis Diagnosis and Treatment Center, Fifth Medical Center of Chinese PLA General Hospital of China, Beijing 100039, China
| | - W H Zhang
- Liver Cirrhosis Diagnosis and Treatment Center, Fifth Medical Center of Chinese PLA General Hospital of China, Beijing 100039, China
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Ren S, Wang J, Ying J, Mitsudomi T, Lee DH, Wang Z, Chu Q, Mack PC, Cheng Y, Duan J, Fan Y, Han B, Hui Z, Liu A, Liu J, Lu Y, Ma Z, Shi M, Shu Y, Song Q, Song X, Song Y, Wang C, Wang X, Wang Z, Xu Y, Yao Y, Zhang L, Zhao M, Zhu B, Zhang J, Zhou C, Hirsch FR. Corrigendum to 'Consensus for HER2 Alterations Testing in Non-small Cell Lung Cancer': [ESMO Open Volume 7 Issue 1 (2022) 100395]. ESMO Open 2022; 7:100482. [PMID: 35461023 DOI: 10.1016/j.esmoop.2022.100482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- S Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - J Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - J Ying
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - T Mitsudomi
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - D H Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Z Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Q Chu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - P C Mack
- Center of Thoracic Oncology/Tisch Cancer Institute and Icahn School of Medicine, Mount Sinai, New York, USA
| | - Y Cheng
- Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - J Duan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Y Fan
- Department of Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou
| | - B Han
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai
| | - Z Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - A Liu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang
| | - J Liu
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian
| | - Y Lu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu; Huaxi Student Society of Oncology Research, West China School of Medicine, Sichuan University, Chengdu
| | - Z Ma
- Department of Respiratory Medicine, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou
| | - M Shi
- Department of Medical Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing
| | - Y Shu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Provincial People's Hospital, Nanjing
| | - Q Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan
| | - X Song
- Department of Respiration Medicine, Shanxi Provincial Cancer Hospital, Taiyuan
| | - Y Song
- Department of Respiratory Medicine, General Hospital of Eastern Theater Command, Nanjing
| | - C Wang
- Department of Lung Cancer, Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin
| | - X Wang
- Department of Oncology, Qilu Hospital of Shandong University, Jinan
| | - Z Wang
- Department of Oncology, Shandong Cancer Hospital and Institute, Jinan
| | - Y Xu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Y Yao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - L Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - M Zhao
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang
| | - B Zhu
- Department of Oncology, Xinqiao Hospital, The Army Medical University, Chongqing, China
| | - J Zhang
- Division of Medical Oncology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City; Department of Cancer Biology, University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, USA
| | - C Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai.
| | - F R Hirsch
- Center of Thoracic Oncology/Tisch Cancer Institute and Icahn School of Medicine, Mount Sinai, New York, USA
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Yang Y, Wang Z, Fang J, Yu Q, Han B, Cang S, Chen G, Mei X, Yang Z, Stefaniak V, Lin Y, Wang S, Zhang W, Sun L, Zhang Y. 4MO Final overall survival (OS) data of sintilimab plus pemetrexed (SPP) and platinum as first-line (1L) treatment for locally advanced or metastatic nonsquamous NSCLC (AMnsqNSCLC) in the phase III ORIENT-11 study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yu L, Xu J, Qiao R, Han B, Zhong H, Zhong R. 148P Pathological stage N1 limited-stage small-cell lung cancer patients can benefit from surgical resection. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Qing Z, Gabrail N, Uprety D, Rotow J, Han B, Jänne P, Nagasaka M, Zheng M, Zhang Y, Yang G, Sun Y, Peng B, Wu YL. 22P EMB-01: An EGFR-cMET bispecific antibody, in advanced/metastatic solid tumors phase I results. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Zhong R, Ling X, Cao S, Xu J, Zhang B, Zhang X, Wang H, Han B, Zhong H. 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. ESMO Open 2021; 7:100334. [PMID: 34959168 PMCID: PMC8718955 DOI: 10.1016/j.esmoop.2021.100334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/28/2021] [Accepted: 11/15/2021] [Indexed: 12/25/2022] Open
Abstract
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. We investigated the safety and efficacy of DCVAC/LuCa combined with standard carboplatin/pemetrexed in nsq NSCLC. The combination therapy showed a favorable tolerability profile in a selected Chinese population. The 2-year survival rate in the modified intention-to-treat population (n = 44) was 52.57%.
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Affiliation(s)
- R Zhong
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - X Ling
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - S Cao
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - J Xu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - B Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - X Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - H Wang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - B Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
| | - H Zhong
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
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Ding HT, Liu YZ, Hai Y, Guan L, Pan AX, Zhang XN, Han B, Li Y. [Clinical application of sacral alar screw fixation in surgical treatment of lumbosacral degenerative disease]. Zhonghua Yi Xue Za Zhi 2021; 101:3718-3723. [PMID: 34856699 DOI: 10.3760/cma.j.cn112137-20210422-00966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- H T Ding
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Y Z Liu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Y Hai
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - L Guan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - A X Pan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - X N Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - B Han
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Y Li
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Zhao XS, Han B, Zhao JX, Tao N, Dong CY. MiR-155-5p affects Wilms' tumor cell proliferation and apoptosis via targeting CREB1. Eur Rev Med Pharmacol Sci 2021; 25:6826. [PMID: 34859841 DOI: 10.26355/eurrev_202111_27223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The article "MiR-155-5p affects Wilms' tumor cell proliferation and apoptosis via targeting CREB1", by X.-S. Zhao, B. Han, J.-X. Zhao, N. Tao, C.-Y. Dong, published in Eur Rev Med Pharmacol Sci 2019; 23 (3): 1030-1037-DOI: 10.26355/eurrev_201902_16990-PMID: 30779069, has been retracted by the authors due to a slight deviation in the data. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/16990.
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Affiliation(s)
- X-S Zhao
- Department of Pediatric Surgery, the First Hospital of Jilin University, Changchun, China
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