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Han D, Pan S. Skin wheal facilitates ultrasound-guided out-of-plane radial artery cannulation in children. Minerva Anestesiol 2024; 90:347-348. [PMID: 37997305 DOI: 10.23736/s0375-9393.23.17842-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Affiliation(s)
- Ding Han
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, China -
| | - Shoudong Pan
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, China
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Han D, Du X, Li Y, Wang Y, Wei L, Zhang L, Li F, Pan S. Supplemental low-dose esketamine to propofol versus propofol alone on perioperative characteristics in children undergoing surgery: a prospective randomized controlled trial. Minerva Anestesiol 2024; 90:162-171. [PMID: 37987990 DOI: 10.23736/s0375-9393.23.17550-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Limited data exist regarding the use of the esketamine-propofol combination (esketofol) in pediatric surgery. This study aimed to investigate the effect of esketofol versus propofol alone on the perioperative characteristics of children undergoing minor surgery. METHODS Eighty-four children aged two to six years were randomly assigned to either the propofol group or the esketofol group. Intraoperative outcomes included bispectral index, dosage of anesthetics, and extubation time. Postoperative outcomes comprised oropharyngeal airway usage, time to orientation, time to eye-opening, length of stay in the post-anesthesia care unit, the need for rescue opioids, pain rating using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale, Pediatric Anesthesia Emergence Delirium Score, nausea and vomiting, and psychotomimetic symptoms. The FLACC pain score was the primary outcome, and the remaining parameters were considered secondary outcomes. RESULTS The FLACC Score (2 [1, 3.3] vs. 4 [3, 5.3], P<0.001) and frequency of rescue opioids (14.3% vs. 33.3%, P=0.040) were significantly lower, while Bispectral Index (BIS) was higher (P<0.001) in the esketofol group compared with the propofol group. Moreover, the time to orientation and length of stay in the post-anesthesia care unit (PACU) were significantly longer in the esketofol group compared with the propofol group (P=0.029 and P=0.025, respectively). The other outcomes were similar between the two groups. CONCLUSIONS Esketofol reduces postoperative pain and the need for rescue opioids, but it extends recovery time in the PACU and increases BIS without affecting other outcomes.
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Affiliation(s)
- Ding Han
- Department of Anesthesia, Capital Institute of Pediatrics, Beijing, China
| | - Xuefang Du
- Department of Anesthesia, Hebei Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei, China
| | - Yongxin Li
- Department of Anesthesia, Capital Institute of Pediatrics, Beijing, China
| | - Yanxin Wang
- Department of Anesthesia, Hebei Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei, China
| | - Lina Wei
- Department of Anesthesia, Hebei Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei, China
| | - Limei Zhang
- Department of Anesthesia, Hebei Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei, China
| | - Fang Li
- Department of Anesthesia, Hebei Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei, China
| | - Shoudong Pan
- Department of Anesthesia, Capital Institute of Pediatrics, Beijing, China -
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Pan S, Wang J, Liu G, Zhang J, Song Y, Kong W, Zhou Y, Wu G. Factors influencing the detection rate of fumarate peak in 1H MR spectroscopy of fumarate hydratase-deficient renal cell carcinoma at 3 T MRI. Clin Radiol 2024; 79:e80-e88. [PMID: 37923625 DOI: 10.1016/j.crad.2023.09.026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/06/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
AIM To identify factors that may be associated with fumarate detection rate in 1H-magnetic resonance spectroscopy (MRS) in fumarate hydratase-deficient renal cell carcinoma (FH-RCC). MATERIALS AND MEHODS Between February 2018 and March 2022, 16 FH-RCC patients with 30 lesions underwent 1H-MRS. Detection results were classified as having a detected fumarate peak (n=12), undetected peak (n=10), or technical failure (n=8). Factors including tumour size, tumour location, treatment history, and metastasis status were collected and analysed. A Bayesian logistic regression model was applied to evaluate the association between these factors and the detection result. RESULTS Bayesian analysis demonstrated significant associations between fumarate detection results and the following factors: long-axis diameter (odds ratio [OR] of 1.64; 95% confidence interval [CI] of 1.07-2.53), short-axis diameter (OR of 1.90; 95% CI of 1.19-3.06), voxel size (OR of 2.85; 95% CI of 1.70-4.75), treatment history (OR of 0.35; 95% CI of 0.21-0.58), non-metastatic state (OR of 2.45; 95% CI of 1.48-4.06), and lymph node metastasis (OR of 0.35; 95% CI of 0.21-0.58). Technical failure results were associated with factors such as treatment history (OR of 2.59; 95% CI of 1.37-4.66), non-metastatic state (OR of 0.36; 95% CI of 0.19-0.66), and lymph node metastasis (OR of 2.61; 95% CI of 1.39-4.74). CONCLUSION Tumour size, treatment history, and metastasis character were associated with the detection of abnormal fumarate accumulation. This finding will serve as a reference for interpreting 1H-MRS results and for selecting suitable scenarios to evaluate FH-RCC.
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Affiliation(s)
- S Pan
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - J Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - G Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - J Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Y Song
- MR Scientific Marketing, Siemens Healthineers Ltd, Shanghai, 201318, China
| | - W Kong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Y Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - G Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
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Zou S, Guo L, Xu C, Liu T, Li L, Pan S, Qi D. Effect of chewing gum of different weights before surgery on sore throat after total thyroidectomy: A randomized controlled trial. World J Surg 2024; 48:130-137. [PMID: 38284756 DOI: 10.1002/wjs.12025] [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: 10/12/2023] [Revised: 10/21/2023] [Accepted: 10/31/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Postoperative sore throat (POST) is a common postoperative complication. COMPLICATION Chewing gum can inhibit the growth of oral bacteria, cleanse, and lubricate the oral cavity, which can help reduce postoperative sore throat. We hypothesize that chewing gum before surgery could relieve POST. METHODS Patients planned to undergo total thyroidectomy under general anesthesia with tracheal intubation were randomized to swallow saliva twice or chew 1.4 g/2.8 g of gum for 2 minutes before surgery. A standard anesthesia protocol was performed. The numerical rating scale scores of POST at 1, 24, and 48 h after surgery were collected. The primary outcome was the incidence of moderate/severe POST (numerical rating scale score >3) within 48 h. RESULTS Data from 148 patients (control group, n = 50; 1.4 g group, n = 48; and 2.8 g group, n = 50) were included in the analysis. Within 48 h, there was a significant difference among the three groups in the incidence of moderate/severe POST (control group: 74% vs. 1.4 g group: 65% vs. 2.8 g group: 50%. P = 0.04). The 2.8 g group had less incidence of moderate/severe POST than the control group (Odds Ratio = 0.351 95% Confidence Interval: (0.152 and 0.814) P = 0.02). CONCLUSION Chewing 2.8 g gum before total thyroidectomy can reduce the incidence of moderate/severe POST within 48 h after surgery.
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Affiliation(s)
- Shiya Zou
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, China
| | - Lulu Guo
- Department of Intensive Care Unit, Xuzhou Center Hospital, Xuzhou, China
| | - Chao Xu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianyu Liu
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Lei Li
- Suzhou Wujiang District Center for Disease Control and Prevention, Suzhou, China
| | - Shoudong Pan
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, China
| | - Dunyi Qi
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Peking, China
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Gaffney J, Rieu R, France AK, Glynn AM, Brown K, Rooney C, Swan A, Kapacee Z, Brennan B, Dyker K, Noble D, Dixon L, Houghton F, Mandeville HC, Brennan SM, Gains J, Lim P, Thomson DD, McPartlin A, Pan S. Evaluation of Radiotherapy Dose and Survival Outcomes for Teenagers, and Young Adults with Nasopharyngeal Carcinoma in UK and Ireland. Int J Radiat Oncol Biol Phys 2023; 117:e582. [PMID: 37785767 DOI: 10.1016/j.ijrobp.2023.06.1924] [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) Nasopharyngeal carcinoma (NPC) follows a bimodal distribution with a smaller incidence peak in teenagers and young adults (TYAs). In TYAs, an over-whelming proportion are associated with Epstein-Barr virus (EBV). We have evaluated the variation in TYA NPC practice patterns across the UK and Ireland, along with survival outcomes. MATERIALS/METHODS We performed a multicenter, observational cohort study, of patients aged 13-25 years, with histologically confirmed NPC, treated between the years 2002-2022. An initial expression of interest was sent to selected centers treating H&N patients in the UK and Ireland. For analysis, patients were assessed based on total prescribed dose, with a cut off for low dose (LD) (≤61.2Gy) versus a high dose (HD)(>61.2Gy). RESULTS Ninety-five patients, from 9 centers, were eligible for inclusion. Patient demographics are shown in table1. At a median follow up of 45 months (IQR 23-111), 3-year overall survival (OS) was 98% (95% CI 93%-100%) with LD versus 91% (95% CI 83%-99%) with HD (Hazard ratio (HR) = 3.0; 95% CI 0.3-27, p = 0.3). 3-year progression free survival (PFS) was 84% (95% CI 71%-97%) with LD versus 83% (95% CI 72%-94%) with HD (HR 1.3; 95% CI 0.4-4.0, p = 0.6), and 5-year PFS was 84% (95% CI 71%-97%) with LD versus 83% (95% CI 72%-94%) with HD (HR 1.3; 95% CI 0.4-4.0, p = 0.6). Incidence of distant metastasis (DM) was 9.9%. 2 patients (6%) with T3-T4 tumors, treated with LD, had locoregional failure (LRF) compared to 1 patient (3%) treated with HD. CONCLUSION We have demonstrated excellent survival outcomes for the UK & Ireland TYA NPC patients. As the majority of cases in this age group have EBV+ NPC, with survival similar between LD and HD protocols, we propose that pediatric protocols, with lower radiotherapy doses should be considered for all TYA NPC, with the aim of reducing late effects. Additional analysis to better understand the impact of heterogeneity between both groups, including choice of protocol, induction and adjuvant treatment will follow this study. Prospective evaluation, as part of an international collaboration, is required to optimize the management strategy for this rare cohort of patients.
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Affiliation(s)
- J Gaffney
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R Rieu
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A K France
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, United Kingdom
| | - A M Glynn
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - K Brown
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - C Rooney
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - Z Kapacee
- Leeds Teaching Hospital NHS Trust, Leeds, UK, Leeds, United Kingdom
| | - B Brennan
- Royal Manchester Children's Hospital, Manchester, UK, Manchester, United Kingdom
| | - K Dyker
- Leeds Teaching Hospital NHS Trust, Leeds, UK, Leeds, United Kingdom
| | - D Noble
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - L Dixon
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, Sheffield, United Kingdom
| | - F Houghton
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - H C Mandeville
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - S M Brennan
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - J Gains
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Lim
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - D D Thomson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A McPartlin
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - S Pan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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Wynne JF, Lei Y, Pan S, Wang T, Roper JR, Patel PR, Patel SA, Godette KD, Jani A, Yang X. Rapid Unpaired CBCT-Based Synthetic CT for CBCT-Guided Adaptive Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:S179. [PMID: 37784444 DOI: 10.1016/j.ijrobp.2023.06.2524] [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) Quantitative cone beam CT (CBCT) is the foundation for image-guided radiation therapy, improving treatment setup, tumor delineation and dose calculation. However, CBCT images suffer from severe artifacts, limiting clinical utility. Deep learning can overcome these limitations, boosting radiographic and dosimetric quality critical for online adaptive radiotherapy (ART). We hypothesize adapted contrastive unpaired translation (CUT), a recent method for image-to-image translation of photographic images, can improve CBCT quality while reducing compute time, demonstrating utility for ART. MATERIALS/METHODS Same-day CBCT and quality assurance CT (QACT) images acquired from 79 patients receiving proton therapy for prostate cancer between 2019 and 2020 at a single institution were retrospectively collected. QACT images were acquired for quality assurance in accordance with institutional policy. Seventy-nine patients yielded 102 non-contrast CBCT-QACT image sets. Each QACT image was rigidly registered to the corresponding CBCT and resampled to 1 × 1 × 2 mm to establish uniform voxel size and spacing. CBCT images were randomly shuffled prior to input to the CUT model for unsupervised training and QACT-quality synthetic CT images were generated as outputs. We compared mean absolute error (MAE), structural similarity index measure (SSIM), and Fréchet inception distance (FID) against same-day QACT. RESULTS MAE, SSIM, and FID were compared for the CycleGAN and CUT data relative to input QACT and are reported as the mean across five-fold cross-validation ± standard error. CUT achieved superior performance in MAE (19.5 ± 3.9 HU vs. cycleGAN 47.1 ± 25.4) and FID (31.5 ± 6.6 vs cycleGAN 75.9 ± 41.3). MAE indicates pixel-level correspondence to QACT HU intensity values, making the synthetic outputs of CUT useful for dose calculations during ART. FID further demonstrates perceptual visual similarity. SSIM for CycleGAN (0.7 ± 0.2) and CUT (0.8 ± 0.0) were similar, indicating acceptable reproducibility of global structure. CUT was faster and lighter than CycleGAN. CycleGAN contained a total of 28,286,000 parameters; CUT contained 14,703,000, approximately half that of CycleGAN. As a result, CycleGAN computes on a single CT image slice over 0.33s while CUT requires just 0.18s. CONCLUSION The contrastive method investigated here was demonstrated to be faster and more accurate than CycleGAN, requiring fewer networks and parameters to achieve superior performance. We demonstrated anatomic boundary preservation and HU fidelity superior to cycleGAN while significantly reducing compute time. We plan to investigate the use of these synthetic CT images in automated segmentation prior to exploration of CUT in a prospective setting.
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Affiliation(s)
- J F Wynne
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Y Lei
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - S Pan
- Emory University School of Medicine Department of Radiation Oncology, Atlanta, GA
| | - T Wang
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - J R Roper
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - P R Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - S A Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - K D Godette
- Winship Cancer Institute, Department of Radiation Oncology, Emory University, Atlanta, GA
| | - A Jani
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - X Yang
- Department of Radiation Oncology, Emory University, Atlanta, GA
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Gaito S, France AK, Aznar M, Crellin A, Indelicato DJ, Kirkby K, Pan S, Whitfield G, Price G, Sitch P, Smith E. Equity of Access to Proton Beam Therapy in England: A National NHS analysis. Int J Radiat Oncol Biol Phys 2023; 117:e19. [PMID: 37784822 DOI: 10.1016/j.ijrobp.2023.06.688] [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) Policies to improve population health have often focused on equitable access to health services. While new technologies have an enormous potential in improving health outcomes, they may not always be equally accessible across diverse geographical areas and socio-economic backgrounds. Between 2008 and 2018, 1352 patients with eligible indications for Proton Beam Therapy (PBT) were treated overseas within the NHS Proton Overseas Programme (POP) and 947 patients have been treated at the Christie since the National NHS PBT service started in December 2018. The 8 most common PBT cancer indications cover more than 80% of the referrals and referral rates depend on several factors. Aim of this study is to evaluate equity of access to PBT throughout the country and how this has changed since the national PBT service inception. MATERIALS/METHODS Incidence data were available for 7/8 of the most common PBT cancer indications. These data were provided by the National Disease Registration Service (NDRS) by diagnosis, age group and by the 7 NHS regions in England. The incidence data referred to the time period 2013-2019. The first national NHS PBT center started accepting referrals in October 2018, therefore this time period was split in pre-NHS PBT (1/1/13-30/9/18) and post-NHS PBT (1/10/18-31/12/19). Demographics and clinical characteristics of patients referred for PBT were extracted from the national NHS PBT registry for matching clinical diagnoses and time period. The ratio between the referred (observed) and newly diagnosed (expected) patients is the Proton Utilization Proportion (PUP), which tracks the proportion of eligible patients using the technology. RESULTS For the 7 common PBT indications examined, the total number of newly diagnosed patients was 2134 in the pre-NHS PBT period and 461 in the post-NHS PBT period. The (accepted) referrals were 587 and 300 in the pre-and post-NHS PBT period, respectively. An increase in the PUP between the pre-NHS PBT and the post-NHS PBT is noted for any diagnostic category, age group and NHS region. The most noticeable increase is noticed for Medulloblastoma, which became a commissioned indication for PBT only in 2016.The PUP in England increased post-NHS PBT by 137% overall. Of note, post-NHS PBT, 99% of the patients aged 0-15 with these 7 common indications for PBT were referred and treated with PBT. CONCLUSION Promoting equality of access to cutting-edge radiotherapy technologies is at the heart of NHS England's values. Throughout the development of the policies and processes related to PBT access in the UK, the NHS has given regard to the need to reduce geographical variation which may contribute to health inequalities. The PUP has increased since the opening of a National PBT service in England, which uses a central web-based Proton Referral Pathway managed by a National Proton Office. Further analysis will follow to examine whether socio-economic or geographical barriers exist within each region.
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Affiliation(s)
- S Gaito
- The Christie NHS Foundation Trust, Manchester, United Kingdom; The University of Manchester, Manchester, United Kingdom
| | - A K France
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, United Kingdom
| | - M Aznar
- The University of Manchester, Manchester, United Kingdom
| | - A Crellin
- The University of Manchester, Manchester, United Kingdom; NHS England, London, United Kingdom
| | - D J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - K Kirkby
- The Christie NHS Foundation Trust, Manchester, United Kingdom; The University of Manchester, Manchester, United Kingdom
| | - S Pan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - G Whitfield
- The Christie NHS Foundation Trust, Manchester, United Kingdom; The University of Manchester, Manchester, United Kingdom
| | - G Price
- The University of Manchester, Manchester, United Kingdom
| | - P Sitch
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - E Smith
- The Christie NHS Foundation Trust, Manchester, United Kingdom; The University of Manchester, Manchester, United Kingdom
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Gaito S, Burnet NG, Aznar MC, Marvaso G, Jereczek-Fossa BA, Crellin A, Indelicato D, Pan S, Colaco R, Rieu R, Smith E, Whitfield G. Proton Beam Therapy in the Reirradiation Setting of Brain and Base of Skull Tumour Recurrences. Clin Oncol (R Coll Radiol) 2023; 35:673-681. [PMID: 37574418 DOI: 10.1016/j.clon.2023.07.010] [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: 06/14/2023] [Revised: 07/04/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Abstract
The therapeutic management of local tumour recurrence after a first course of radical radiotherapy is always complex. Surgery and reirradiation carry increased morbidity due to radiation-induced tissue changes. Proton beam therapy (PBT) might be advantageous in the reirradiation setting, thanks to its distinct physical characteristics. Here we systematically reviewed the use of PBT in the management of recurrent central nervous system (CNS) and base of skull (BoS) tumours, as published in the literature. The research question was framed following the Population, Intervention, Comparison and Outcomes (PICO) criteria: the population of the study was cancer patients with local disease recurrence in the CNS or BoS; the intervention was radiation treatment with PBT; the outcomes of the study focused on the clinical outcomes of PBT in the reirradiation setting of local tumour recurrences of the CNS or BoS. The identification stage resulted in 222 records in Embase and 79 in Medline as of March 2023. Sixty-eight duplicates were excluded at this stage and 56 were excluded after screening as not relevant, not in English or not full-text articles. Twelve full-text articles were included in the review and are presented according to the site of disease, namely BoS, brain or both brain and BoS. This review showed that reirradiation of brain/BoS tumour recurrences with PBT can provide good local control with acceptable toxicity rates. However, reirradiation of tumour recurrences in the CNS or BoS setting needs to consider several factors that can increase the risk of toxicities. Therefore, patient selection is crucial. Randomised evidence is needed to select the best radiation modality in this group of patients.
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Affiliation(s)
- S Gaito
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK.
| | - N G Burnet
- Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - M C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - G Marvaso
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20126 Milan, Italy
| | - B A Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20126 Milan, Italy
| | - A Crellin
- National Lead Proton Beam Therapy NHSe, UK
| | - D Indelicato
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida, USA
| | - S Pan
- Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - R Colaco
- Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - R Rieu
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, London, UK
| | - E Smith
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - G Whitfield
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
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9
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Oguejiofor K, Gaito S, France AK, Aznar M, Merchant M, Richardson J, Pan S, Smith E. Dose Volume Thresholds Associated with Acute Skin Toxicities in Proton Beam Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e254. [PMID: 37784982 DOI: 10.1016/j.ijrobp.2023.06.1199] [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 depth-dose characteristics of proton beam therapy (PBT) mean that the skin-sparing effect is reduced with PBT, potentially leading to an increased incidence and severity of acute radiotherapy induced skin toxicities (RIST). Predictive factors of acute RIST in patients treated with PBT remain largely undefined. In this study, we retrospectively reviewed the acute RIST of patients treated with pencil beam scanning (PBS) PBT to identify dose-volume thresholds which are predictive of acute RIST. MATERIALS/METHODS All patients treated with PBS-PBT at a single institution between December 2018-October 2022 were included in this study. Acute RIST were recorded as per RTOG grading scale and dichotomized to Grade (G) <2 vs ≥2. Anonymized demographics, clinical and dosimetric data were extracted from electronic patient records and a treatment planning system. Skin structure is defined as 5mm rind grown as an inner margin from the patient contour. The following skin dose-volume statistics were collected: Dmax (maximum dose to any pixel inside the skin contour) and dose to skin volumes in 5Gy increments (V5Gy, V10Gy etc.). Preliminary analyses of dosimetric data of patients with G0, G1 vs ≥G2 acute RIST are presented, with significance assessed at the 5% level using t-tests and univariate logistic regression models, and risk thresholds determined using receiver operating characteristic (ROC) curves. RESULTS We report the data for 582 patients with extracted dosimetric data. The pediatric, teenage and young adult (TYA) and adult populations were 38%, 19% and 43% respectively. The three most common indications for PBT were head and neck cancers (HNC) (23%), sarcoma (21%), and chordoma (15%). Increasing age, HNC and sarcoma were associated with an increased risk of grade 2+ acute RIST. For patients who developed acute RIST of G2+, the median volume receiving 10Gy, 20Gy, 30Gy, 40Gy and 50Gy were significantly higher (P<0.0001) than patients with G0 and G1. The dose volume effect of acute RIST is greater at 30Gy and above. Similarly, median Dmax was significantly higher in the G2+ acute RIST group compared to G0 and G1 (P<0.0001) for all age groups. Using the ROC curve, we observed threshold volumes (in cm3) for V10Gy, V20Gy, V30Gy, V40Gy and V50Gy (Table 1). CONCLUSION The volume of irradiated skin and Dmax are associated with the risk of developing acute RIST in patients treated with PBS PBT. Further work is being done to develop a model predictive of acute RIST in clinical setting.
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Affiliation(s)
- K Oguejiofor
- University Hospital Southampton, Southampton, United Kingdom
| | - S Gaito
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, United Kingdom
| | - A K France
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, United Kingdom
| | - M Aznar
- The University of Manchester, Manchester, United Kingdom
| | - M Merchant
- University of Manchester, Manchester, United Kingdom
| | - J Richardson
- The Christie Hospital Manchester, Manchester, United Kingdom
| | - S Pan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - E Smith
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, United Kingdom
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10
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Gaito S, Aznar MC, Burnet NG, Crellin A, France A, Indelicato D, Kirkby KJ, Pan S, Whitfield G, Smith E. Assessing Equity of Access to Proton Beam Therapy: A Literature Review. Clin Oncol (R Coll Radiol) 2023; 35:e528-e536. [PMID: 37296036 DOI: 10.1016/j.clon.2023.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 04/28/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
Proton beam therapy (PBT) is one of the most advanced radiotherapy technologies, with growing evidence to support its use in specific clinical scenarios and exponential growth of demand and capacity worldwide over the past few decades. However, geographical inequalities persist in the distribution of PBT centres, which translate into variations in access and use of this technology. The aim of this work was to look at the factors that contribute to these inequalities, to help raise awareness among stakeholders, governments and policy makers. A literature search was conducted using the Population, Intervention, Comparison, Outcomes (PICO) criteria. The same search strategy was run in Embase and Medline and identified 242 records, which were screened for manual review. Of these, 24 were deemed relevant and were included in this analysis. Most of the 24 publications included in this review originated from the USA (22/24) and involved paediatric patients, teenagers and young adults (61% for children and/or teenagers and young adults versus 39% for adults). The most reported indicator of disparity was socioeconomic status (16/24), followed by geographical location (13/24). All the studies evaluated in this review showed disparities in the access to PBT. As paediatric patients make up a significant proportion of the PBT-eligible patients, equity of access to PBT also raises ethical considerations. Therefore, further research is needed into the equity of access to PBT to reduce the care gap.
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Affiliation(s)
- S Gaito
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK.
| | - M C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - N G Burnet
- Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - A Crellin
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; National Lead Proton Beam Therapy NHS England, UK
| | - A France
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK
| | - D Indelicato
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida, USA
| | - K J Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - S Pan
- Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - G Whitfield
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - E Smith
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
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11
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Chang L, Chong WT, Yau YH, Cui T, Wang XR, Pei F, Liu YQ, Pan S. An investigation of the PM 2.5 concentrations and cumulative inhaled dose during subway commutes in Changchun, China. Int J Environ Sci Technol (Tehran) 2023:1-14. [PMID: 37360559 PMCID: PMC10208554 DOI: 10.1007/s13762-023-04994-7] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/13/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023]
Abstract
Air quality in subway systems is crucial as it affects the health of passengers and staff. Although most tests of PM2.5 concentrations in subway stations have taken place in public areas, PM2.5 is less understood in workplaces. Few studies have estimated the cumulative inhaled dose of passengers based on real-time changes in PM2.5 concentrations as they commute. To clarify the above issues, this study first measured PM2.5 concentrations in four subway stations in Changchun, China, where measuring points included five workrooms. Then, passengers' exposure to PM2.5 during the whole subway commute (20-30 min) was measured and segmented inhalation was calculated. The results showed that PM2.5 concentration in public places ranged from 50 to 180 μg/m3, and was strongly correlated with outdoors. While the PM2.5 average concentration in workplaces was 60 µg/m3, and it was less affected by outdoor PM2.5 concentration. Passenger's cumulative inhalations in single commuting were about 42 μg and 100 μg when the outdoor PM2.5 concentrations were 20-30 μg/m3 and 120-180 μg/m3, respectively. The PM2.5 inhalation in carriages accounted for the largest proportion of the entire commuting, about 25-40%, because of the longer exposure time and higher PM2.5 concentrations. It is recommended to improve the tightness of the carriage and filter the fresh air to improve the air quality inside. The average daily PM2.5 inhaled by staff was 513.53 μg, which was 5-12 times higher than that of passengers. Installing air purification devices in workplaces and reminding staff to take personal protection can positively protect their health.
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Affiliation(s)
- L. Chang
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - W. T. Chong
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
- Centre for Energy Sciences, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Y. H. Yau
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
- UM-JAF Laboratory, Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - T. Cui
- Department of Building Environment and Energy Engineering, School of Civil Engineering, Chang’an University, Xi’an, 710061 China
| | - X. R. Wang
- Mechanical Engineering College, Tianjin University of Commerce, Tianjin, 300134 China
| | - F. Pei
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Y. Q. Liu
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - S. Pan
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, 100124 China
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12
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Zhao Q, Pan S, Zhang L, Zhang Y, Shahsavari A, Lotey P, Baetge C, Deveau M, Gregory C, Kapler G, Liu F. A Salivary Gland Resident Macrophage Subset Regulating Radiation Responses. J Dent Res 2023; 102:536-545. [PMID: 36883649 PMCID: PMC10150438 DOI: 10.1177/00220345221150005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Radiotherapy of head and neck cancers frequently leads to irreversible hypofunction of salivary glands, which severely compromises the quality of life and is extremely difficult to treat. We found recently that salivary gland resident macrophages are sensitive to radiation and interact with epithelial progenitors and endothelial cells through homeostatic paracrine factors. Heterogeneous subpopulations of resident macrophages are present in other organs with distinct functions, whereas subpopulations of salivary gland resident macrophages with distinct functions or transcriptional profiles have not been reported yet. Using single-cell RNA sequencing, we found that mouse submandibular glands (SMGs) contain 2 distinct self-renewing resident macrophage subsets, an MHC-IIhi subset present in many other organs and an uncommon Csf2r+ subset. The main source of Csf2 in SMGs are innate lymphoid cells (ILCs) that rely on IL15 for maintenance, while the main source of IL15 protein is Csf2r+ resident macrophages, indicating a homeostatic paracrine interaction between these cells. Csf2r+ resident macrophages are the major source of hepatocyte growth factor (Hgf) that regulates homeostasis of SMG epithelial progenitors. Meanwhile, Csf2r+ resident macrophages are responsive to Hedgehog signaling that can rescue salivary function impaired by radiation. Consistently, irradiation persistently decreased numbers of ILCs and levels of IL15 and Csf2 in SMGs, which were all recovered by transient activation of Hedgehog signaling after radiation. Csf2r+ resident macrophages and MHC-IIhi resident macrophages share transcriptome profiles of perivascular macrophages and macrophages associated with nerves and/or epithelial cells in other organs, respectively, and such niche preferences were supported by lineage tracing and immunofluorescent staining. These findings reveal an uncommon resident macrophage subset that regulates the homeostasis of the salivary gland and is promising as the target to restore salivary gland function impaired by radiation.
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Affiliation(s)
- Q. Zhao
- Cell Biology and Genetics Department, College
of Medicine, Texas A&M University Health Science Center, College Station, TX, USA
| | - S. Pan
- Cell Biology and Genetics Department, College
of Medicine, Texas A&M University Health Science Center, College Station, TX, USA
| | - L. Zhang
- Cell Biology and Genetics Department, College
of Medicine, Texas A&M University Health Science Center, College Station, TX, USA
| | - Y. Zhang
- Cell Biology and Genetics Department, College
of Medicine, Texas A&M University Health Science Center, College Station, TX, USA
| | - A. Shahsavari
- Cell Biology and Genetics Department, College
of Medicine, Texas A&M University Health Science Center, College Station, TX, USA
| | - P. Lotey
- Cell Biology and Genetics Department, College
of Medicine, Texas A&M University Health Science Center, College Station, TX, USA
| | - C.L. Baetge
- Department of Small Animal Clinical Sciences,
College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College
Station, TX, USA
| | - M.A. Deveau
- Department of Small Animal Clinical Sciences,
College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College
Station, TX, USA
| | - C.A. Gregory
- Cell Biology and Genetics Department, College
of Medicine, Texas A&M University Health Science Center, College Station, TX, USA
| | - G.M. Kapler
- Cell Biology and Genetics Department, College
of Medicine, Texas A&M University Health Science Center, College Station, TX, USA
| | - F. Liu
- Cell Biology and Genetics Department, College
of Medicine, Texas A&M University Health Science Center, College Station, TX, USA
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13
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Rzechorzek W, Malik A, Bandyopadhyay D, Goel A, Levine E, Gupta CA, Lanier G, Gass A, Pan S. Outcomes of Heart Transplant Recipients That Had a Percutaneous Coronary Intervention. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.460] [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: 04/05/2023] Open
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14
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Gregory V, Grunfeld M, Kanwal A, Bali A, Isath A, Pan S, Spielvogel D, Kai M, Ohira S. Escalation from Impella 5.5 to Ecpella Support as a Bridge to Mitral Valve Surgery in a Patient with Non-Ischemic Cardiomyopathy with Degenerative Mitral Regurgitation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1065] [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: 04/05/2023] Open
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15
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Isath A, Gass A, Pan S, Levine E, Gupta C, Lanier G, Spielvogel D, Kai M, Ohira S. Impella 5.5 with Veno-Arterial Extracorporeal Membrane Oxygenation Support as Ecpella 5.5. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1531] [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: 04/05/2023] Open
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16
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Hofmeyer M, Haas G, Kransdorf E, Ewald G, Morris A, Owens A, Lowes B, Stoller D, Tang W, Garg S, Trachtenberg B, Shah P, Pamboukian S, Sweitzer N, Wheeler M, Wilcox J, Katz S, Pan S, Jimenez J, Smart F, Wang J, Gottlieb S, Judge D, Moore C, Huggins G, Jordan E, Kinnamon D, Ni H, Hershberger R. Genetic Signature of Dilated Cardiomyopathy Severity: The DCM Precision Medicine Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1674] [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: 04/05/2023] Open
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17
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Ohira S, Okumura K, Isath A, Abhay D, Lanier G, Levine E, Pan S, Aggarwal Gupta C, Gass A, Spielvogel D, Kai M. Utilization of Hepatitis C Virus Infected Donor in Heart Transplant Recipients with Elevated Meld-Xi Score. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.661] [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: 04/05/2023] Open
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18
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Khan S, Seplowe M, Vemulakonda L, Shakil F, Aggarwal-Gupta C, Lanier G, Levine E, Ohira S, Spielvogel D, Gass A, Kai M, Pan S. Early Recurrence of Cardiac Sarcoidosis after Orthotopic Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.471] [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: 04/05/2023] Open
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19
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Isath A, Ohira S, Levine E, Pan S, Lanier G, Gupta C, Wolfe K, Spielvogel D, Gass A, Kai M. Ex-Vivo Heart Perfusion for Cardiac Transplantation: An Initial Experience in the United States. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.516] [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: 04/05/2023] Open
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20
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Pan S, Wang F, Jiang J, Lin Z, Chen Z, Cao T, Yang L. Chimeric Antigen Receptor-Natural Killer Cells: A New Breakthrough in the Treatment of Solid Tumours. Clin Oncol (R Coll Radiol) 2023; 35:153-162. [PMID: 36437159 DOI: 10.1016/j.clon.2022.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/20/2022] [Revised: 09/30/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022]
Abstract
Natural killer (NK) cells can quickly and directly eradicate tumour cells without recognising tumour-specific antigens. NK cells also participate in immune surveillance, which arouses great interest in the development of novel cancer therapies. The chimeric antigen receptor (CAR) family is composed of receptor proteins that give immune cells extra capabilities to target specific antigen proteins or enhance their killing effects. CAR-T cell therapy has achieved initial success in haematological tumours, but is prone to adverse reactions, especially with cytokine release syndrome in clinical applications. Currently, CAR-NK cell therapy has been shown to successfully kill haematological tumour cells with allogeneic NK cells in clinical trials without adverse reactions, proving its potential to become an off-the-shelf product with broad clinical application prospects. Meanwhile, clinical trials of CAR-NK cells for solid tumours are currently underway. Here we will focus on the latest advances in CAR-NK cells, including preclinical and clinical trials in solid tumours, the advantages and challenges of CAR-NK cell therapy and new strategies to improve the safety and efficacy of CAR-NK cell therapy.
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Affiliation(s)
- S Pan
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China; The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - F Wang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine
| | - J Jiang
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Z Lin
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Z Chen
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
| | - T Cao
- Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - L Yang
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China; The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
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21
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Zhang L, Cervantes MD, Pan S, Lindsley J, Dabney A, Kapler GM. Transcriptome analysis of the binucleate ciliate Tetrahymena thermophila with asynchronous nuclear cell cycles. Mol Biol Cell 2023; 34:rs1. [PMID: 36475712 PMCID: PMC9930529 DOI: 10.1091/mbc.e22-08-0326] [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: 12/12/2022] Open
Abstract
Tetrahymena thermophila harbors two functionally and physically distinct nuclei within a shared cytoplasm. During vegetative growth, the "cell cycles" of the diploid micronucleus and polyploid macronucleus are offset. Micronuclear S phase initiates just before cytokinesis and is completed in daughter cells before onset of macronuclear DNA replication. Mitotic micronuclear division occurs mid-cell cycle, while macronuclear amitosis is coupled to cell division. Here we report the first RNA-seq cell cycle analysis of a binucleated ciliated protozoan. RNA was isolated across 1.5 vegetative cell cycles, starting with a macronuclear G1 population synchronized by centrifugal elutriation. Using MetaCycle, 3244 of the 26,000+ predicted genes were shown to be cell cycle regulated. Proteins present in both nuclei exhibit a single mRNA peak that always precedes their macronuclear function. Nucleus-limited genes, including nucleoporins and importins, are expressed before their respective nucleus-specific role. Cyclin D and A/B gene family members exhibit different expression patterns that suggest nucleus-restricted roles. Periodically expressed genes cluster into seven cyclic patterns. Four clusters have known PANTHER gene ontology terms associated with G1/S and G2/M phase. We propose that these clusters encode known and novel factors that coordinate micro- and macronuclear-specific events such as mitosis, amitosis, DNA replication, and cell division.
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Affiliation(s)
- L. Zhang
- Department of Cell Biology and Genetics, Texas A&M University Health Science Center, College Station, TX 77840,Department of Statistics, Texas A&M University, College Station, TX 77843
| | - M. D. Cervantes
- Department of Cell Biology and Genetics, Texas A&M University Health Science Center, College Station, TX 77840
| | - S. Pan
- Department of Cell Biology and Genetics, Texas A&M University Health Science Center, College Station, TX 77840,Department of Statistics, Texas A&M University, College Station, TX 77843
| | - J. Lindsley
- Department of Cell Biology and Genetics, Texas A&M University Health Science Center, College Station, TX 77840
| | - A. Dabney
- Department of Statistics, Texas A&M University, College Station, TX 77843,*Address correspondence to: Geoffrey Kapler (); A. Dabney ()
| | - G. M. Kapler
- Department of Cell Biology and Genetics, Texas A&M University Health Science Center, College Station, TX 77840,*Address correspondence to: Geoffrey Kapler (); A. Dabney ()
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22
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Xie S, Han D, Chen G, Pan S. Prediction of fluid responsiveness by dynamic preload parameters in children undergoing thoracoscopic surgery with one-lung ventilation - A prospective observational study. Medicine (Baltimore) 2022; 101:e31795. [PMID: 36626414 PMCID: PMC9750656 DOI: 10.1097/md.0000000000031795] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Optimal perioperative fluid management is essential for reducing complications in children undergoing thoracoscopic surgery. The study aimed to assess the performance of 2 dynamic preload parameters - pulse pressure variation (PPV) and stroke volume variation (SVV)- either used alone or combined into a multivariable regression model for predicting fluid responsiveness in children undergoing video-assisted thoracoscopic surgery with one-lung ventilation. Children aged 1 to 6 years old undergoing video-assisted pulmonary segmentectomy or lobectomy were enrolled. Volume loading with 5 mL/kg of hydroxyethyl starch was administered over 15 minutes after establishment of artificial pneumothorax. PPV, SVV, cardiac index, cardiac cycle efficiency, and the difference between systolic blood pressure and dicrotic pressure were recorded using the pressure recording analytical method before and after volume loading. Patients with an elevation in cardiac index greater than 10% were defined as responders, and the remaining patients were nonresponders. Of 40 children, 36 were included in the final analysis, containing 13 responders and 23 nonresponders. SVV had an accuracy of 74% (95% confidence interval, 55-93%) for predicting fluid responsiveness, and a best cutoff of 22% showed a sensitivity of 62% and a specificity of 96%. PPV was incapable of discriminating responders from nonresponders. The multivariate regression model did not perform better than SVV alone. We found PPV failed to predict fluid responsiveness, while SVV predicted fluid responsiveness reasonably in the present context. There was no enhancement in predictivity accuracy with multivariable regression models. The accuracy of these approaches was limited, and more discriminative methods need to be found.
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Affiliation(s)
- Siyuan Xie
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, China
| | - Ding Han
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, China
| | - Gang Chen
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, China
| | - Shoudong Pan
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, China
- *Correspondence: Shoudong Pan, Department of Anesthesia, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China (e-mail: )
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Carstens D, Smith J, Chung Y, Pan S, Barlows T, Nepal B, Barron J. REDUCTIONS IN EXACERBATIONS OF SEVERE ASTHMA PATIENTS TREATED WITH BENRALIZUMAB – ZEPHYR 3. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.615] [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: 11/11/2022]
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24
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Lv J, Xiao L, Liu Y, Wang Y, Zhang R, Chen T, Zhang H, Tang C, Pan S, Nie X, Zhang M, Li T. Caloric Restriction Ketogenic Diets (KR) Enhance Radiotherapy Responses in Lung Cancer Xenografts. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2105] [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]
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Kanwal A, Ohira S, Levine A, Isath A, Pan S, Dhand A, Aggarwal-Gupta C, Lanier GM, Gass A, Spielvogel D, Kai M. Survival and renal outcomes of direct heart transplant from veno-arterial extracorporeal membrane oxygenation support. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2156] [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: 11/15/2022] Open
Abstract
Abstract
Backgrounds
Patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support are given the highest priority for cardiac transplantation (OHT) in the new UNOS heart allocation policy adopted in October 2018. Although patients may receive an organ quicker there may not be enough time to recover end-organ function. To date, little is known about survival and renal outcomes of direct OHT in patients that have been supported with VA-ECMO as a bridge to transplant due to limited experience in most transplant centers.
Purpose
The aim of this study was to investigate survival and renal outcomes of direct OHT in patients supported with VA-ECMO prior to transplant.
Methods
From January 2010 to February 2022, 23 patients who received single organ OHT alone directly from VA-ECMO support were retrospectively analyzed (16 patients after the new allocation policy). Kaplan-Meier analysis was used to estimate event-free survival.
Results
The median age of recipients was 48 years. The median length of pre-transplant VA-ECMO support was 5 days. Additional pre-transplant support with intra-aortic balloon pump or Impella was utilized in 15 patients (65.2%) and 2 patients (9%) respectively. There was a trend toward improvement of serum creatinine after initiation of VA-ECMO support (Pre-ECMO: 1.66±1.22 mg/dl vs. Pre-OHT: 1.20±0.74 mg/dl, P=0.084). Four patients required preoperative renal replacement therapy (RRT); three were on RRT at the time of OHT. The median ischemic time of donor hearts was 168 minutes. VA-ECMO support was continued in 10 patients (43.5%) after OHT.
Hospital mortality was 8.7% (2 patients). Post-transplant RRT was required in 9 patients (39.1%), and, of these, 5 patients were transitioned to permanent dialysis. Among the 14 patients who did not require post-transplant RRT, none required RRT during the follow-up period (median, 21.5 months). Kaplan-Meier survival analysis showed that estimated survival at 1 year and 3 years were 86.1%, and 77.5%, respectively (Figure 1A). The freedom from dialysis rate was 82.4% at 1 year, and 74.9% at 3 years (Figure 2A). Both survival (100% vs. 66.7%, P=0.008, Fig.1B) and dialysis free rate (100% vs. 55.6%, P=0.002, Figure 2B) at one-year were significantly worse in patients who required postoperative RRT.
Conclusions
To our knowledge this is the largest single center study of OHT in patients that were supported with VA-ECMO. VA-ECMO as a bridge to end-organ recovery and OHT resulted in excellent outcomes. Patients who required post-transplant RRT more likely to require long-term dialysis, while those that did not receive RRT showed favorable outcomes. Overall survival in this patient population is comparable to patients that were not on VA-ECMO prior to transplant.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kanwal
- Westchester Medical Center , New York , United States of America
| | - S Ohira
- Westchester Medical Center , New York , United States of America
| | - A Levine
- Westchester Medical Center , New York , United States of America
| | - A Isath
- Westchester Medical Center , New York , United States of America
| | - S Pan
- Westchester Medical Center , New York , United States of America
| | - A Dhand
- Westchester Medical Center , New York , United States of America
| | - C Aggarwal-Gupta
- Westchester Medical Center , New York , United States of America
| | - G M Lanier
- Westchester Medical Center , New York , United States of America
| | - A Gass
- Westchester Medical Center , New York , United States of America
| | - D Spielvogel
- Westchester Medical Center , New York , United States of America
| | - M Kai
- Westchester Medical Center , New York , United States of America
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Gaito S, Hwang E, Aznar M, France A, Sitch P, Crellin A, Holtsman AL, Pan S, Whitfield G, Smith E. P01.07.A Neurocognitive outcomes after proton beam therapy for skull base tumours. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.079] [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: 11/14/2022] Open
Abstract
Abstract
Background
Evidence suggests that Proton Beam Therapy (PBT) may lessen the risk of neurocognitive decline (NCD) by reducing the dose to the normal brain as compared to conventional photon radiotherapy (XRT). We report the incidence of moderate-severe (Grade ≥3) NCD in adults treated for skull base chordomas and chondrosarcomas within the United Kingdom’s Proton Overseas Programme (POP).
Material and Methods
Baseline (pre-PBT) and follow-up clinical outcomes data were prospectively collected as part of a national PBT-outcomes registry, which started in 2008 . This registry is curated by a dedicated Proton Clinical Outcomes Unit. Specifically, late toxicities ≥G3 as per CTCAE (Common Terminology Criteria for Adverse Events) v4.0 definition, occurring later than 90 days after treatment completion, were recorded. This study focuses on the incidence of memory impairment (MI) in the adult (≥25 y) cohort.
Results
Between 2008-2018, 141 adult patients were treated for skull base chordomas (77 patients, 54.6%) and chondrosarcomas (64 patients, 45.4%) via the POP (the majority -62.8%- treated at the University of Florida PBT Institute). Median age at treatment was 51 years (range 26-77). Median prescription dose was 73.8 GyRBE (70-75.6), with a median dose per fraction of 1.8 Gy (1.2-2.1). Of note, the median dose for chondrosarcomas was 70.2 GyRBE (70-75.6), whereas the median dose for chordomas was 73.8 GyRBE (72-75.6). Median follow up was 39 months (0-138). On clinical assessment, 4 patients (2 chordomas, 2 chondrosarcomas) were reported with G3 MI after a median time of 43 months (27-49). None of them had impaired memory at baseline, nor relevant neurological comorbidities. Median age of those who developed G3 MI was 63 y (39-70). Median prescription dose was 72.9 GyRBE (70-73.8). Plans were available for 3 of these 4 patients. Relevant dose statistics to hippocampi and temporal lobes were extracted. Dmean to the omo- and contralateral hippocampi in these 3 patient plans were: patient 1) 33.7 and 11.6 GyRBE; patient 2) 28.1 and 24.4 Gy; patient 3) 8.7 and 8.2 GyRBE, respectively. V20 to the omo- and contralateral temporal lobes in the same patients were: patient 1) 47% and 10%; patient 2) 29% and 28.7%; patient 3) 30% and 28%, respectively. Suggested constraints for these structures are: Dmean < 20 Gy to the hippocampi and V20Gy <10% to the temporal lobes.
Conclusion
Our results indicate that adult patients undergoing high dose radiation for radioresistant tumours may experience detrimental effects on memory. Neurocognitive baseline and follow-up assessment is not routinely performed in this age group but might be appropriate to explore which domains of cognitive function are mainly affected. Larger cohorts are warranted to establish predictive factors and better understand dose volume effect of brain structures and neurocognitive sequelae.
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Affiliation(s)
- S Gaito
- The Christie NHS FT , Manchester , United Kingdom
| | - E Hwang
- The Christie NHS FT , Manchester , United Kingdom
| | - M Aznar
- The University of Manchester , Manchester , United Kingdom
| | - A France
- The Christie NHS FT , Manchester , United Kingdom
| | - P Sitch
- The Christie NHS FT , Manchester , United Kingdom
| | - A Crellin
- The Christie NHS FT , Manchester , United Kingdom
| | - A L Holtsman
- University of Florida Proton therapy Institute , Jacksonville, FL , United States
| | - S Pan
- The Christie NHS FT , Manchester , United Kingdom
| | - G Whitfield
- The Christie NHS FT , Manchester , United Kingdom
| | - E Smith
- The Christie NHS FT , Manchester , United Kingdom
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Liu T, Cheng Z, Zou S, Xu C, Pan S, Zeng H, Shan Y, Feng Y, Zhang H. Effect of Weight-Adjusted Phenylephrine, Norepinephrine, and Metaraminol for Elective Cesarean Delivery on Neonatal Acid–Base Status: A Randomized Controlled Trial. Drug Des Devel Ther 2022; 16:3215-3223. [PMID: 36172051 PMCID: PMC9511707 DOI: 10.2147/dddt.s381048] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Many previous trials have compared the effects of different vasoactive drugs on cesarean section patients, but their infusion rate is based on experience rather than high-quality evidence. It is difficult to judge whether the effect of vasoactive drug comes from the better choice or a more appropriate at rates of vasoactive drugs. The effect of vasoactive drugs at the rates of the 90% effective dose needs to be verified and compared. Patients and Methods Women undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomized to receive phenylephrine or norepinephrine or metaraminol infusion at the rate that was assumed to be the 90% effective dose. Anesthetic management was standardized and included fluid loading with 10 mL/kg of Ringer. The primary outcome was the umbilical artery pH. Results 78 patients were included. The umbilical artery pH was not significantly different among the three groups (phenylephrine group: 7.33 ± 0.03 vs norepinephrine group: 7.33 ± 0.04 vs metaraminol group: 7.33 ± 0.04, P = 0.99). There were no significant differences in the incidence of hypotension, hypertension, bradycardia, and nausea and vomiting among the three groups. The SBP of the phenylephrine group was significantly higher than that of the metaraminol group (adjustive P value = 0.005). Conclusion Phenylephrine (0.54 μg/kg/min) or metaraminol (2 μg/kg/min) or norepinephrine (0.08 μg/kg/min) administered to healthy patients with elective cesarean section after spinal anesthesia has no significant effect on the acid-base balance of the fetus.
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Affiliation(s)
- Tianyu Liu
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Zhiyong Cheng
- Department of Anesthesiology, Suqian Maternity Hospital, Suqian, Jangsu, People’s Republic of China
| | - Shiya Zou
- Department of Anesthesiology, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, People’s Republic of China
| | - Chao Xu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Shoudong Pan
- Department of Anesthesiology, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, People’s Republic of China
| | - Huabei Zeng
- Department of Anesthesiology, Suqian Maternity Hospital, Suqian, Jangsu, People’s Republic of China
| | - Yidong Shan
- Department of Anesthesiology, Suqian Maternity Hospital, Suqian, Jangsu, People’s Republic of China
| | - Yi Feng
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Correspondence: Yi Feng; Hong Zhang, Department of Anesthesiology, Peking University People’s Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, People’s Republic of China, Tel +86-13601083503; +86-13311281808, Email ;
| | - Hong Zhang
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, People’s Republic of China
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Han D, Pan S. Comparison of Analgesic Efficacy of Local Anesthetic Infiltration and Ultrasound-guided Abdominal Wall Nerve Block in Children Undergoing Ambulatory Inguinal Hernia Repair. J Perianesth Nurs 2022; 37:699-705. [PMID: 35752525 DOI: 10.1016/j.jopan.2021.12.006] [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] [Received: 08/16/2021] [Revised: 12/01/2021] [Accepted: 12/26/2021] [Indexed: 10/17/2022]
Abstract
PURPOSE Placement of local anesthetics either as infiltration (LAI) or as abdominal wall nerve block (AWNB) has been shown to reduce postoperative pain following laparoscopic surgery. We aimed to compare intraoperative remifentanil consumption and postoperative pain of AWNB and LAI in children undergoing ambulatory two-port laparoscopic inguinal hernia surgery with propofol-remifentanil based general anesthesia. DESIGN Randomized controlled trial. METHODS Children aged between 1 and 6 years undergoing two-port laparoscopic inguinal hernia repair were enrolled for analysis. These children received one of the three anesthesia regimens (1) standard general anesthesia (SGA); (2) SGA with preemptive LAI; (3) SGA with preemptive AWNB; and were categorized accordingly. Primary outcome variable were intraoperative average infusion rate of remifentanil and postoperative FLACC (Face, Legs, Activity, Cry, and Consolability) pain score. Secondary outcome data included demographics, intraoperative variables (hemodynamics and bispectral index score recorded at three different time points), and duration of surgery. FINDINGS A total of 90 children (30 in each group) were included in the analysis. General information, intraoperative hemodynamic variables, bispectral index score, and duration of surgery were not significantly different among groups. The intragroup variation of hemodynamic variables were less stable in the SGA group compared with the other two groups, while BIS score was similar among groups. The intraoperative infusion rate of remifentanil was significantly lower in the AWNB group than in the SGA or the LAI group (median [25th to 75th centiles]: 0.11[0.11 to 0.11] µg/kg/min, 0.33[0.33 to 0.33] µg/kg/min; 0.17[0.17 to 0.20] µg/kg/min, respectively, P < .001 for both), and lower in the LAI group than in the SGA group (P < .001). The postoperative FLACC pain score was significantly lower in the AWNB group than in the SGA or the LAI group (P < .001 for both). CONCLUSIONS AWNB is associated with a lower intraoperative remifentanil requirement and a lower postoperative FLACC pain score compared with LAI in children undergoing laparoscopic inguinal hernia repair with propofol-remifentanil based general anesthesia.
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Affiliation(s)
- Ding Han
- Anesthesia Department, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Shoudong Pan
- Anesthesia Department, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China.
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Pilar A, Saunders D, Pan S, Gaito S, Charlwood F, Lowe M, Smith E, Mcpartlin A, Thorp N. PD-0167 Acute, late toxicities & early outcomes in children after proton therapy for head & neck malignancy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02772-4] [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: 10/18/2022]
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Gaito S, Hwang E, France A, Whitfield G, Pan S, Price G, Aznar M, Crellin A, Indelicato D, Smith E. MO-0883 Proton Beam Therapy for Central Nervous System tumours: outcomes from the Proton Overseas Programme. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02449-5] [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: 10/18/2022]
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31
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Kannikanti D, Charlwood F, Clarke M, Colaco R, Pan S, Saunders D, Sitch P, Thorp N, Whitfield G, Rasool M. PO-1161 Protons in posterior fossa ependymoma- a dosimetric comparison with photons. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03125-5] [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: 10/18/2022]
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32
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Pan S, Sitch P, Gaito S, McPartlin A, Sashidaran S, Smith E, Whitfield G, Abravan A. PD-0076 Predictive factors of severe radiation-induced lymphopenia in proton-treated patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02746-3] [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: 11/29/2022]
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Abravan A, Sitch P, van Herk M, Gaito S, McPartlin A, Sashidaran S, Smith E, Whitfield G, Pan S. PD-0164 Proton therapy reduces the incidence of severe lymphopenia compared with photon. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02769-4] [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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Zheng W, Guo J, Lu X, Liu D, Pan S, Liu Z. POS-357 CAMP-RESPONSE ELEMENT BINDING PROTEIN MEDIATES PODOCYTE INJURY IN DIABETIC NEPHROPATHY BY TARGETING LNCRNA DLX6-AS1. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.378] [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: 10/19/2022] Open
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Wu Y, Chen M, Huang M, Liao G, Tang S, Zheng H, Li Y, Peng B, Zheng X, Pan S, Hou J, Chen B. [Value of purple sign for predicting rebleeding events in cirrhotic patients following endoscopic selective varices devascularization]. Nan Fang Yi Ke Da Xue Xue Bao 2021; 41:1822-1827. [PMID: 35012914 PMCID: PMC8752418 DOI: 10.12122/j.issn.1673-4254.2021.12.10] [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] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the value of the purple sign for predicting long-term rebleeding events in cirrhotic patients following endoscopic selective varices devascularization. METHODS We retrospectively analyzed the clinical data of 97 patients with liver cirrhosis, who had a history of gastroesophageal variceal bleeding and underwent endoscopic selective varices devascularization. Thirty-two of the patients showed purple sign after endoscopic treatment. We used propensity score matching (PSM) to minimize the selection bias of the patients (purple sign vs no purple sign) and reduce the intergroup differences of clinical characteristics. The primary outcome measure of this study was cumulative rebleeding events after endoscopic selective varices devascularization. RESULTS The 1-year rebleeding rate (27.0% vs 36.7%) or 6-month rebleeding rate (10.9% vs 26.9%) following endoscopic treatment was not significantly different between the purple sign group and no purple sign group before PSM (P=0.2385). But after PSM, the 1-year rebleeding rate (28.2% vs 56.4%) and 6-month rebleeding rate (5.0% vs 37.0%) were significantly lower in the purple sign group than in the no purple sign group (P=0.0304). CONCLUSIONS The presence of purple sign indicates a lower risk of rebleeding after endoscopic treatment of cirrhotic gastroesophageal varices and a potentially favorable treatment response after endoscopic therapy, thus providing a clinical indicator for stratification of the patients for sequential endoscopic sessions.
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Affiliation(s)
- Y Wu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - M Chen
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - M Huang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - G Liao
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - S Tang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - H Zheng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - Y Li
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - B Peng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - X Zheng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - S Pan
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - J Hou
- Department of Gastroenterology and Hepatology of First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - B Chen
- Department of Gastroenterology and Hepatology of First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
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36
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Ji Y, Han D, Han L, Xie S, Pan S. The Accuracy of a Wireless Axillary Thermometer for Core Temperature Monitoring in Pediatric Patients Having Noncardiac Surgery: An Observational Study. J Perianesth Nurs 2021; 36:685-689. [PMID: 34384688 DOI: 10.1016/j.jopan.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/25/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE A wireless and wearable axillary thermometer (iThermonitor) has been validated for perioperative core temperature monitoring in adults. The purpose of this study was to evaluate its accuracy in pediatrics having non-cardiac surgery. DESIGN Prospective observational study. METHODS From January 2019 to December 2019, 70 children aged younger than 14 years undergoing surgery in a tertiary hospital were selected. Pairs of esophageal temperatures (TEso), rectal temperatures (TRec), and axillary temperatures monitored by the iThermonitor (TiTh) were collected every 5 min during surgery. Taking TEso as reference, the bias between TEso and TiTh and the proportion of bias within ±0.5°C were calculated. Bland-Altman method was used to analyze the 95% of limits of agreement (LOA) between TiTh and TEso. The same analyses were done for TRec. FINDINGS: A total of 2232 pairs of temperatures were collected. The bias (mean ± SD) between TiTh and TEso was -0.07 °C ± 0.25°C, and 95% LOA was -0.07°C ± 0.50°C. The proportion of bias within ±0.5°C accounted for 96% (95% Confidence Interval [CI], 92-98%). Higher bias and 95% LOA, and lower proportion of bias within ± 0.5°C were found between TRec and TEso than those between TiTh and TEso. CONCLUSION During pediatric non-cardiac surgery, axillary temperature derived from iThermonitor is in good agreement with esophageal temperature and can be used as an alternative to core temperature.
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Affiliation(s)
- Yingtong Ji
- Department of Anesthesiology, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Ding Han
- Department of Anesthesiology, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Lu Han
- Department of Anesthesiology, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Siyuan Xie
- Department of Anesthesiology, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Shoudong Pan
- Department of Anesthesiology, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China.
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Wang W, Guo S, Gao Y, Liang X, Liu L, Pan S. Comparative immunogenicity of outer membrane protein K and whole-cell antigens of Vibrio parahaemolyticus for diagnosis. Lett Appl Microbiol 2021; 73:460-470. [PMID: 34231245 DOI: 10.1111/lam.13536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/28/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022]
Abstract
The immunogenicity of soluble outer membrane protein K (OmpK)- small ubiquitin-like modifier, OmpK inclusion bodies, formalin, and heat-killed Vibrio parahaemolyticus cells were prepared and studied in a mouse model. The results of whole-cell ELISA and Western blot (WB) revealed that the serum against soluble OmpK and OmpK inclusion bodies reacted only with homologous V. parahaemolyticus. Furthermore, recombinant OmpK proteins were not recognized by the serum against whole-cell V. parahaemolyticus antigens. Unexpectedly, the serum against formalin and heat-killed V. parahaemolyticus reacted broadly with homologous (an immunization strain) and heterologous (non-immunization strains) V. parahaemolyticus and Vibrio species. The WB results revealed that the serum against the two V. parahaemolyticus whole-cell antigens primarily reacted with proteins that were approximately 100, 70, 36, 28, and 22 kDa in the cell lysates from different Vibrio strains, rather than the recombinant OmpK. The 70 and 28 kDa proteins exhibited specificity to Vibrio species, while the 22 kDa protein was more specific to V. parahaemolyticus. This study showed the limitation of recombinant OmpK to prepare diagnostic antibodies and revealed several specific Omps of Vibrio sp. and V. parahaemolyticus that were promising in diagnosis and vaccine development.
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Affiliation(s)
- W Wang
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, China.,Jiangsu Key Laboratory of Marine Biotechnology, Jiangsu Ocean University, Lianyungang, Jiangsu, China
| | - S Guo
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, China
| | - Y Gao
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, China
| | - X Liang
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, China
| | - L Liu
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, China
| | - S Pan
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, China.,Jiangsu Key Laboratory of Marine Biotechnology, Jiangsu Ocean University, Lianyungang, Jiangsu, China
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Liu T, Wang Y, Yin X, Liang X, Chen Y, Pan S, Chen Z, Geng X. Three-dimensional vectorcardiographic characteristics of breast cancer patients treated with chemotherapy. Europace 2021. [DOI: 10.1093/europace/euab116.020] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Patients receiving chemotherapy for breast cancer (BC) may develop cardiac electrophysiological abnormalities. The aim of this study is to examined possible alterations in cardiac electrophysiological parameters detected by three-dimensional vectorcardiograms (3D-VCGs) in BC patients who received chemotherapy.
Methods
This was a prospective single-center cohort study conducted. Patients with BC referred for chemotherapy from May 1, 2019, to October 1, 2019 were invited to participate in the study. 3D-VCG and echocardiography were recorded at rest four times (baseline, after the first cycle, after third cycles and at the end of the regimen, respectively).
Results
A total of 63 patients were included. Compared with baseline, decreases in 3-dimensional maximum T vector magnitude (TVM) (0.29 ± 0.10 vs. 0.25 ± 0.10mV; p < 0.05) and 3-dimensional T/QRS ratio (0.26 ± 0.11 vs. 0.21 ± 0.11; p < 0.05) were observed by the end of chemotherapy regimen, while echocardiographic parameters showed no significant variation before and after chemotherapy (all P > 0.05). Maximum TVM showed a significant positive correlation with left ventricular ejection fraction (LVEF) (all p < 0.05). Furthermore, the cut-off value with 0.23 of 3-dimensional T/QRS ratio (the area under the curve [AUC] 0.725) for differentiating LVEF reduction ≥10% following initiation of chemotherapy. The AUC of the front plane T/QRS ratio and horizontal plane T/QRS ratio for the detection of an LVEF reduction ≥10% was 0.725 and 0.763, respectively.
Conclusions
3D-VCGs can be used to detect electrophysiological abnormalities in BC patients receiving chemotherapy. Subclinical cardiac dysfunction can be revealed by 3D-VCGs before alterations in traditional echocardiographic parameters.
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Affiliation(s)
- T Liu
- 2nd Hospital of Tianjin Medical University, Tianjin, China
| | - Y Wang
- 2nd Hospital of Tianjin Medical University, Tianjin, China
| | - X Yin
- Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - X Liang
- Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Y Chen
- Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - S Pan
- Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Z Chen
- 2nd Hospital of Tianjin Medical University, Tianjin, China
| | - X Geng
- Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Ohira S, Spielvogel D, Gass A, Lanier G, Aggarwal-Gupta C, Levine A, Pan S, Abraham B, Austin-Matison C, McCrink K, Jenning E, Spencer P, Kai M. Early Outcomes of Direct Heart Transplant Off Veno-Arterial Extracorporeal Membrane Oxygenation Support after New Heart Allocation Policy: Analysis Based on Etiology of Cardiomyopathy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.562] [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: 10/21/2022] Open
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Ohira S, Spielvogel D, Gass A, Levine A, Aggarwal-Gupta C, Pan S, Lanier G, Abraham B, Austin-Mattison C, Jenning E, McCrink K, Spencer P, Kai M. Direct Advanced Therapy Off Veno-Arterial Extracorporeal Membrane Oxygenation Support: Impact of New Heart Allocation Policy on Early Outcomes. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.411] [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: 10/21/2022] Open
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Huang K, Pan S. Incidence and outcome of refeeding syndrome in neurocritically ill patients. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.303] [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: 10/23/2022]
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Zhang H, Cao X, Wang D, Xin H, Liu Z, Yan J, Feng B, Quan Z, Du Y, Liu J, Guan L, Shen F, Guan X, Jin Q, Pan S, Gao L. The acquisition of Mycobacterium tuberculosis infection in village doctors in China: a prospective study. Int J Tuberc Lung Dis 2020; 24:1241-1246. [PMID: 33317666 DOI: 10.5588/ijtld.20.0153] [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
BACKGROUND: Occupational exposure-related risk of Mycobacterium tuberculosis infection has been reported for village doctors in China. This prospective study aims to estimate the infection acquisition in this key population.METHODS: At baseline, all village doctors registered in Zhongmu County were tested by QuantiFERON®-TB Gold In-Tube (QFT) and QuantiFERON®-TB Gold Plus (QFT-Plus) in parallel. Those negatives for either of the tests were retested to identify conversions at the 2-year follow-up investigation.RESULTS: A total of 367 eligible participants completed the 2-year follow-up survey with frequency of conversion of 5.0% (18/361) for QFT and 6.1% (21/343) for QFT-Plus. The agreement of follow-up results between the tests was 93.2% with a κ coefficient of 0.43 (95%CI 0.20-0.65). Among QFT-Plus convertors, the difference between TB1 and TB2 tubes (TB2-TB1) was significantly increased as compared with baseline results (P = 0.039). Participants from the villages with occurrence of microbiologically confirmed pulmonary TB showed higher frequency of QFT conversions (11.0% vs. 3.2%, P = 0.011) and QFT-Plus conversions (12.3% vs. 4.4%, P = 0.027) than those from the villages without occurrence.CONCLUSION: Our results consistently suggest that capability on occupational protection and M. tuberculosis infection control should be improved in village doctors in China.
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Affiliation(s)
- H Zhang
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - X Cao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - D Wang
- Center for Disease Prevention and Control of Zhongmu County, Zhengzhou
| | - H Xin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Z Liu
- Center for Disease Prevention and Control of Zhongmu County, Zhengzhou
| | - J Yan
- Center for Disease Prevention and Control of Zhongmu County, Zhengzhou
| | - B Feng
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Z Quan
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Y Du
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - J Liu
- The Sixth People´s Hospital of Zhengzhou, Zhengzhou, China
| | - L Guan
- The Sixth People´s Hospital of Zhengzhou, Zhengzhou, China
| | - F Shen
- The Sixth People´s Hospital of Zhengzhou, Zhengzhou, China
| | - X Guan
- The Sixth People´s Hospital of Zhengzhou, Zhengzhou, China
| | - Q Jin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - S Pan
- Center for Disease Prevention and Control of Zhongmu County, Zhengzhou
| | - L Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
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Rekawek P, Liu L, Getrajdman C, Brooks C, Pan S, Overbey J, Wagner B. Large-for-gestational age diagnosed during second-trimester anatomy ultrasound and association with gestational diabetes and large-for-gestational age at birth. Ultrasound Obstet Gynecol 2020; 56:901-905. [PMID: 31763722 DOI: 10.1002/uog.21930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/31/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To determine if large-for-gestational age (LGA) diagnosed during second-trimester ultrasound examination is associated with the development of gestational diabetes mellitus (GDM) and LGA at birth. METHODS This was a retrospective cohort study of all pregnant women who underwent a second-trimester anatomy ultrasound examination between 18 and 22 weeks at our institution from 2012 to 2017. Patients were included in the LGA group if estimated fetal weight and/or fetal abdominal circumference was ≥ 90th percentile for gestational age. Patients with a history of pre-GDM, multiple gestation, preterm delivery, use of betamethasone or fetal anomaly were excluded. The control group consisted of appropriate-for-gestational-age (AGA) pregnancies that were scanned at 18-22 weeks during the study period. AGA was defined as EFW > 10th percentile and ≤ 89th percentile. Prenatal and delivery records were reviewed and demographic and outcome variables were collected. Multivariable logistic regression models were applied to assess the impact of LGA diagnosed in the second trimester on the development of GDM and LGA at birth (birth weight ≥ 90th percentile). RESULTS The study population included 756 patients with a LGA fetus and 756 with an AGA fetus on second-trimester ultrasound examination. In patients with a LGA fetus diagnosed during the second-trimester ultrasound examination, the incidence of GDM was 6.0% and the incidence of LGA at birth was 14.9%. Among patients with a LGA fetus in the second trimester, those who developed GDM or LGA at birth were significantly older and were more likely to be obese. Moreover, parity was associated with neonatal LGA (P = 0.0003) but not with GDM (P = 0.82). On multivariable logistic regression analysis with adjustment for age, parity, change in gestational body mass index, obesity, ethnicity and neonatal sex, LGA diagnosed during the second trimester was associated significantly with GDM (adjusted odds ratio (aOR), 2.54; 95% CI, 1.29-5.03; P = 0.007) and LGA at birth (aOR, 6.85; 95% CI, 3.60-13.05; P < 0.0001). CONCLUSIONS LGA diagnosed during second-trimester ultrasound examination is associated with the development of GDM and LGA at birth, independent of known risk factors, and could be used to identify these women earlier for intervention. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Rekawek
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L Liu
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Getrajdman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Brooks
- Washington University, Saint Louis, MO, USA
| | - S Pan
- Department of Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Overbey
- Department of Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - B Wagner
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Gaito S, Hwang E, Burnet N, Foden P, Howells C, Pan S, Whitfield G, Crellin A, Smith E. US-UK collaboration in Proton therapy: The Proton Overseas Program. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2456] [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]
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Chen M, Guo J, Wang Y, Wu X, Pan S, Han D. Effects of Local Warming on the Peripheral Vein Cross-Sectional Area in Children Under Sedation. J Perianesth Nurs 2020; 36:65-68. [PMID: 33268222 DOI: 10.1016/j.jopan.2020.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/18/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Peripheral venous catheterization is challenging in small children. The local warming technique has been used to increase the peripheral vein cross-sectional area (CSA) and improve the success rate. However, there is limited evidence on the effect of local warming on venous CSA in children under sedation. DESIGN A pilot randomized controlled trial. METHODS Eligible children aged 1 to 4 years undergoing ambulatory surgery were enrolled. At the bedside in the ambulatory surgery center, they were routinely sedated with 1 mcg/kg of intranasal dexmedetomidine. Through a computer allocation program, children were randomized into either a control group or a local warming group. Cephalic vein and basilic vein at 1 cm proximal to cubital fossa were scanned with ultrasound to measure venous CSA. Children in the control group received no intervention; those in the local warming group had a prepared hot pack of ~40°C applied to the target area on the arm for 5 minutes. A second ultrasound measurement was undertaken in both groups. FINDINGS A total of 35 from 40 children were analyzed. Cephalic vein CSA and basilic vein CSA increased significantly vs the first measurement within the local warming group (P < .05 for both) but not in the control group (P > .05 for both). Cephalic vein CSA was significantly different between groups at the second measurement (P < .05) but not at the first measurement (P > .05). Basilic vein CSA was significantly different between groups neither at the first measurement nor at the second measurement (P > .05 for both). The application of local warming resulted in an average of 34% increase (from 4.1 to 5.5 mm2) in cephalic vein CSA and an average of 21% increase (from 4.8 to 5.8 mm2) in basilic vein CSA. CONCLUSIONS The application of local warming induced mild venodilation in cephalic vein with an increase in CSA by 34% and had little venodilation effect on the basilic vein with an increase in CSA by only 21%.
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Affiliation(s)
- Meili Chen
- Nursing Department, Capital Institute of Pediatrics, Beijing, China
| | - Jia Guo
- Anesthesia Department, Capital Institute of Pediatrics, Beijing, China
| | - Yu Wang
- Anesthesia Department, Capital Institute of Pediatrics, Beijing, China
| | - Xinyan Wu
- Anesthesia Department, Capital Institute of Pediatrics, Beijing, China
| | - Shoudong Pan
- Anesthesia Department, Capital Institute of Pediatrics, Beijing, China
| | - Ding Han
- Anesthesia Department, Capital Institute of Pediatrics, Beijing, China.
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46
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Wang W, Sang Y, Liu J, Liang X, Guo S, Liu L, Yuan Q, Xing C, Pan S, Wang L. Identification of novel monoclonal antibodies targeting the outer membrane protein C and lipopolysaccharides for Escherichia coli O157:H7 detection. J Appl Microbiol 2020; 130:1245-1258. [PMID: 32910517 DOI: 10.1111/jam.14849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/03/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022]
Abstract
AIMS To identify and evaluate the application of two novel monoclonal antibody (mAb) 2G12 against outer membrane protein (Omp) C and mAb 12B1 targeting the O chain of the lipopolysaccharides (LPS) of Escherichia coli O157:H7 (ECO157). METHODS AND RESULTS The sensitivity and specificity of these two antibodies were evaluated with eight ECO157 strains and 68 untargeted strains. mAb 2G12 and 12B1 had no detectable binding with any of the non-O157 strains at 6·0 log10 CFU per ml, while its high specificity and affinity remained with all ECO157 strains. When a higher level (8·0 log10 CFU per ml) was tested, 2G12 and 12B1 did not react with 82·35 and 97·06% of the non-O157 strains respectively. Based on the pair of two antibodies, the sandwich enzyme-linked immunosorbent assay detected 100% (8/8) of ECO157 strains and none of the non-ECO157 strains. The detection limit of ECO157 strains in pure culture were 4·2 ± 0·2 log10 CFU per ml. When the developed test was applied to artificially inoculated beef samples, the detection limit was 6·0 log10 CFU per gram without enrichment and 1·0 log10 CFU per gram after 12 h of enrichment. CONCLUSIONS The two novel antibodies identified in this study served as great candidates for the recovery, and detection of ECO157 from different environmental and food samples. SIGNIFICANCE AND IMPACT OF THE STUDY ECO157-specific detection was improved by a combination of the novel OmpC mAb and LPS mAb with defined target antigen and good specificity.
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Affiliation(s)
- W Wang
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Jiangsu Key Laboratory of Marine Biotechnology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China
| | - Y Sang
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Jiangsu Key Laboratory of Marine Biotechnology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China
| | - J Liu
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Jiangsu Key Laboratory of Marine Biotechnology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China
| | - X Liang
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Jiangsu Key Laboratory of Marine Biotechnology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China
| | - S Guo
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Jiangsu Key Laboratory of Marine Biotechnology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China
| | - L Liu
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Jiangsu Key Laboratory of Marine Biotechnology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China
| | - Q Yuan
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Jiangsu Key Laboratory of Marine Biotechnology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China
| | - C Xing
- School of Food Science and Engineering, Nanjing University of Finance & Economics, Nanjing, Jiangsu, P.R. China
| | - S Pan
- Jiangsu Key Laboratory of Marine Bioresources and Environment, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Jiangsu Key Laboratory of Marine Biotechnology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China.,Co-Innovation Center of Jiangsu Marine Bio-industry Technology, Jiangsu Ocean University, Lianyungang, Jiangsu, P.R. China
| | - L Wang
- Department of Food Science and Technology, University of California Davis, Davis, CA, USA
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Han D, Pan S, Li H, Meng L, Luo Y, Ou-Yang C. Prognostic value of cardiac cycle efficiency in children undergoing cardiac surgery: a prospective observational study. Br J Anaesth 2020; 125:321-329. [PMID: 32636084 DOI: 10.1016/j.bja.2020.05.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/18/2019] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiac cycle efficiency (CCE) derived from a pressure-recording analytical method is a unique parameter to assess haemodynamic performance from an energetic view. This study investigated changes of CCE according to an anatomical diagnosis group, and its association with early postoperative outcomes in children undergoing cardiac surgery. METHODS Ninety children were included with a ventricular septal defect (VSD; n=30), tetralogy of Fallot (TOF; n=40), or total anomalous pulmonary venous connection (TAPVC; n=20). CCE along with other haemodynamic parameters, was recorded from anaesthesia induction until 48 h post-surgery. Predictive CCE (CCEp) was defined as the average of CCE at post-modified ultrafiltration and CCE at the end of surgery. The relationship between CCE and early outcomes was assessed by the comparison between the high-CCEp group (CCEp ≥75th centile) and the low-CCEp group (CCEp ≤25th centile). RESULTS There was a significant time × diagnostic group interaction effect in the trend of CCE. Compared with the high-CCEp group (n=23), the low-CCEp group (n=22) required more inotropics post-surgery, had higher lactate concentrations at 8 and 24 h post-surgery, a longer intubation time and longer ICU stay, and higher frequency of peritoneal fluid. CONCLUSIONS Perioperative changes of CCE vary according to anatomical diagnosis in children undergoing cardiac surgery. Children with TOF have an unfavourable trend of CCE compared with children with VSD or TAPVC. A decline in CCE is associated with adverse early postoperative outcomes. CLINICAL TRIAL REGISTRATION ChiCTR1800014996.
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Affiliation(s)
- Ding Han
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China
| | - Shoudong Pan
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China
| | - Hang Li
- Clinical Medicine, North China University of Science and Technology, Hebei, China
| | - Linghui Meng
- Department of Evidence based Medicine, Capital Institute of Paediatrics, Beijing, China
| | - Yi Luo
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China
| | - Chuan Ou-Yang
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China; Anaesthesia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Han D, Pan S, Ouyang C. Dynamic preload variables to predict fluid responsiveness in children with hyperdynamic circulation. Paediatr Anaesth 2020; 30:845. [PMID: 32856772 DOI: 10.1111/pan.13873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/09/2020] [Accepted: 03/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ding Han
- Anesthesia Department, Capital Institute of Pediatrics, Beijing, China
| | - Shoudong Pan
- Anesthesia Department, Capital Institute of Pediatrics, Beijing, China
| | - Chuan Ouyang
- Anesthesia Department, Capital Institute of Pediatrics, Beijing, China.,Anesthesia Department, Beijing Anzhen Hospital, Beijing, China
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Mercieca S, Pan S, Belderbos J, Salem A, Tenant S, Aznar MC, Woolf D, Radhakrishna G, van Herk M. Impact of Peer Review in Reducing Uncertainty in the Definition of the Lung Target Volume Among Trainee Oncologists. Clin Oncol (R Coll Radiol) 2020; 32:363-372. [PMID: 32033892 DOI: 10.1016/j.clon.2020.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/06/2019] [Accepted: 12/04/2019] [Indexed: 12/25/2022]
Abstract
AIMS To evaluate the impact of peer review and contouring workshops on reducing uncertainty in target volume delineation for lung cancer radiotherapy. MATERIALS AND METHODS Data from two lung cancer target volume delineation courses were analysed. In total, 22 trainees in clinical oncology working across different UK centres attended these courses with priori experience in lung cancer radiotherapy. The courses were made up of short presentations and contouring practice sessions. The participants were divided into two groups and asked to first individually delineate (IND) and then individually peer review (IPR) the contours of another participant. The contours were discussed with an expert panel consisting of two consultant clinical oncologists and a consultant radiologist. Contours were analysed quantitatively by measuring the volume and local distance standard deviation (localSD) from the reference expert consensus contour and qualitatively through visual analysis. Feedback from the participants was obtained using a questionnaire. RESULTS All participants applied minor editing to the contours during IPR, leading to a non-statistically significant reduction in the mean delineated volume (IND = 140.92 cm3, IPR = 125.26 cm3, P = 0.211). The overall interobserver variation was similar, with a localSD of 0.33 cm and 0.38 cm for the IND and IPR, respectively (P = 0.848). Six participants (29%) carried out correct major changes by either including tumour or excluding healthy tissue. One participant (5%) carried out an incorrect edit by excluding parts of the tumour, while another observer failed to identify a major contour error. The participants' level of confidence in target volume delineation increased following the course and identified the discussions with the radiologist and colleagues as the most important highlights of the course. CONCLUSION IPR could improve target volume delineation quality among trainee oncologists by identifying most major contour errors. However, errors were also introduced after IPR, suggesting the need to further discuss major changes with a multidisciplinary team.
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Affiliation(s)
- S Mercieca
- Faculty of Health Science, University of Malta, Msida, Malta; Faculty of Medicine (AMC), University of Amsterdam, Amsterdam, The Netherlands.
| | - S Pan
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - J Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Salem
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester Academic Health Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - S Tenant
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - M C Aznar
- University of Manchester, Manchester Academic Health Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - D Woolf
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G Radhakrishna
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - M van Herk
- University of Manchester, Manchester Academic Health Centre, The Christie NHS Foundation Trust, Manchester, UK
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Xin H, Cao X, Zhang H, Liu J, Pan S, Li X, Guan L, Shen F, Liu Z, Wang D, Guan X, Yan J, Li H, Feng B, Zhang M, Yang Q, Jin Q, Gao L. Dynamic changes of interferon gamma release assay results with latent tuberculosis infection treatment. Clin Microbiol Infect 2020; 26:1555.e1-1555.e7. [PMID: 32062048 DOI: 10.1016/j.cmi.2020.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/05/2019] [Revised: 02/02/2020] [Accepted: 02/08/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Using QuantiFERON-TB Gold In-Tube (QFT-GIT) for monitoring tuberculosis (TB) and latent TB infection treatment effect is controversial. The present study aimed to evaluate the dynamic changes of interferon gamma (IFN-γ) levels along with latent TB infection treatment via a randomized controlled study. METHODS A total of 910 participants treated with 8 weeks of once-weekly rifapentine plus isoniazid (group A), 890 treated with 6 weeks of twice-weekly rifapentine plus isoniazid (group B) and 818 untreated controls (group C) were followed for 2 years to track active TB development. QFT-GIT tests were repeated three times for all groups: before treatment (T0), at completion of treatment (T1) and 3 months after completion of treatment (T2). RESULTS Similar rates of persistent QFT-GIT reversion were observed in groups A (19.0%, 173/910), B (18.5%, 165/890) and C (20.7%, 169/818) (p 0.512). The dynamic changes of IFN-γ levels were not statistically significant among the three groups. In treated participants, individuals with higher baseline IFN-γ levels showed increased TB occurrence (1.0%, 9/896) compared to those with lower baseline levels (0.2%, 2/904) (p 0.037). A similar but statistically insignificant trend was also observed in untreated controls (1.8% (7/400) vs. 0.5% (2/418), p 0.100). When TB cases were matched with non-TB cases on baseline IFN-γ levels, no significant differences were found with respect to the dynamic changes in IFN-γ levels with time, regardless of whether they received treatment. CONCLUSIONS QFT-GIT reversion or decreased IFN-γ levels should not be used for monitoring host response to latent TB infection treatment.
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Affiliation(s)
- H Xin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - X Cao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - H Zhang
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - J Liu
- The Sixth People's Hospital of Zhengzhou, PR China
| | - S Pan
- The Centers for Disease Prevention and Control of Zhongmu County, Zhengzhou, PR China
| | - X Li
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - L Guan
- The Sixth People's Hospital of Zhengzhou, PR China
| | - F Shen
- The Sixth People's Hospital of Zhengzhou, PR China
| | - Z Liu
- The Centers for Disease Prevention and Control of Zhongmu County, Zhengzhou, PR China
| | - D Wang
- The Centers for Disease Prevention and Control of Zhongmu County, Zhengzhou, PR China
| | - X Guan
- The Sixth People's Hospital of Zhengzhou, PR China
| | - J Yan
- The Centers for Disease Prevention and Control of Zhongmu County, Zhengzhou, PR China
| | - H Li
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - B Feng
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - M Zhang
- Guangdong Key Laboratory for Diagnosis &Treatment of Emerging Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, PR China
| | - Q Yang
- Guangdong Key Laboratory for Diagnosis &Treatment of Emerging Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, PR China
| | - Q Jin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - L Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
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