A CT-based radiomics nomogram for distinguishing between malignant and benign Bosniak IIF masses: a two-centre study

AIM

To establish and assess a computed tomography (CT)-based radiomics nomogram for identifying malignant and benign Bosniak IIF masses.

MATERIALS AND METHODS

In total, 150 patients with Bosniak IIF masses were separated into a training set (n=106) and a test set (n=44) in a ratio of 7:3. A radiomics signature was calculated based on extracted features from the three phases of CT images. A clinical model was constructed based on clinical characteristics and CT features, and a nomogram incorporating the radiomics signature and independent clinical variables was established. The calibration ability, discrimination accuracy, and clinical value of the nomogram model were assessed.

RESULTS

Twelve features derived from CT images were applied to establish the radiomics signature. The performance levels of three machine-learning models were improved by adding the synthetic minority oversampling technique algorithm. The optimised machine learning model was a combination of the minimum redundancy maximum relevance-least absolute shrinkage and selection operator feature screening method + logistic regression classifier + synthetic minority oversampling technique algorithm, which demonstrated excellent identification ability on the test set (area under the curve [AUC], 0.970; 95% confidence interval [CI], 0.940-1.000). The nomogram model displayed outstanding discrimination ability on the test set (AUC, 0.972; 95% CI, 0.942-1.000).

CONCLUSIONS

The CT-based radiomics nomogram was useful for discriminating between malignant and benign Bosniak IIF masses, which improved the precision of preoperative diagnosis.

Preoperative contrast-enhanced CT-based radiomics signature for predicting hypoxia-inducible factor 1α expression in retroperitoneal sarcoma

AIM

To develop and test a contrast-enhanced computed tomography (CECT)-based radiomics signature (RS) to preoperatively predict hypoxia-inducible factor 1α (HIF-1α) expression in retroperitoneal sarcoma (RPS).

MATERIALS AND METHODS

This study included 129 patients with RPS retrospectively who underwent CECT, including 64 male and 65 female patients (55 [2-84] years). Participants were divided into a training set comprising 85 patients and a test set comprising 44 patients. Clinical data and CECT findings of all patients were collected. RS construction was performed by the minimum redundancy maximum relevance method and least absolute shrinkage and selection operator algorithm. The clinical information was analysed by univariate and multivariate logistic regression analysis. The RS and risk factors were included to build a radiomics nomogram. The predictive efficacy of different models was evaluated by accuracy, area under the receiver operating characteristic curve (AUC), and decision curve analysis.

RESULTS

The RS combined signature was constructed on the basis of multi-phase CECT and had an accuracy of 0.795 and an AUC of 0.719 (95% confidence interval [CI], 0.552-0.886) in the test set, which were higher than that of the radiomics nomogram (accuracy: 0.636; AUC: 0.702 [95% CI, 0.547-0.857]) and the clinical model (accuracy: 0.682; AUC: 0.486 [95% CI, 0.324-0.647]). The decision curve analysis showed that the RS combined signature provided better clinical application than the clinical model and radiomics nomogram.

CONCLUSIONS

The multi-phase CECT-based RS constructed can be used as a powerful tool for predicting HIF-1α expression in patients with RPS.

Long-term safety and efficacy of anacetrapib in patients with atherosclerotic vascular disease

AIMS

REVEAL was the first randomized controlled trial to demonstrate that adding cholesteryl ester transfer protein inhibitor therapy to intensive statin therapy reduced the risk of major coronary events. We now report results from extended follow-up beyond the scheduled study treatment period.

METHODS AND RESULTS

A total of 30 449 adults with prior atherosclerotic vascular disease were randomly allocated to anacetrapib 100 mg daily or matching placebo, in addition to open-label atorvastatin therapy. After stopping the randomly allocated treatment, 26 129 survivors entered a post-trial follow-up period, blind to their original treatment allocation. The primary outcome was first post-randomization major coronary event (i.e. coronary death, myocardial infarction, or coronary revascularization) during the in-trial and post-trial treatment periods, with analysis by intention-to-treat. Allocation to anacetrapib conferred a 9% [95% confidence interval (CI) 3-15%; P = 0.004] proportional reduction in the incidence of major coronary events during the study treatment period (median 4.1 years). During extended follow-up (median 2.2 years), there was a further 20% (95% CI 10-29%; P < 0.001) reduction. Overall, there was a 12% (95% CI 7-17%, P < 0.001) proportional reduction in major coronary events during the overall follow-up period (median 6.3 years), corresponding to a 1.8% (95% CI 1.0-2.6%) absolute reduction. There were no significant effects on non-vascular mortality, site-specific cancer, or other serious adverse events. Morbidity follow-up was obtained for 25 784 (99%) participants.

CONCLUSION

The beneficial effects of anacetrapib on major coronary events increased with longer follow-up, and no adverse effects emerged on non-vascular mortality or morbidity. These findings illustrate the importance of sufficiently long treatment and follow-up duration in randomized trials of lipid-modifying agents to assess their full benefits and potential harms.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN) 48678192; ClinicalTrials.gov No. NCT01252953; EudraCT No. 2010-023467-18.

Technique to manage intraoperative cuff leak from damaged endotracheal tube pilot balloon

We report a technique that was utilized to manage an intraoperative airway complication occurring during orthognathic surgery wherein the endotracheal tube pilot balloon was inadvertently damaged during the procedure. Readily available operating room materials were used to safely and rapidly repair the damaged endotracheal tube pilot balloon. This allowed the perioperative team to avoid emergent endotracheal tube exchange and potential airway complications.

Repair of facial scars using free and pedicle-expanded deltopectoral flaps

This study aimed to evaluate the effectiveness and long-term outcomes of free and pedicled, expanded deltopectoral flaps with perforation of the internal thoracic artery to repair facial scars. This retrospective review was of 37 patients who presented between June 2013 and June 2019 with various types of facial scar. Ten patients received a free expanded deltopectoral flap and 27 a pedicled, expanded deltopectoral flap. During the stage-one operation, the expander was implanted into the deltopectoral area and fully expanded by normal saline injection. In stage two, the facial lesions were incised, and the free or pedicled flap transferred to reconstruct the defect. Flap necrosis did not occur in the 10 patients treated with free flaps. Two patients need to have the pedicle trimmed three months after surgery because it had become bloated. Distal necrosis occurred in five of 27 patients who received a pedicled, expanded deltopectoral flap. Healing by conservative treatment was noted in two cases and healing after skin grafting was documented in the other three. All 37 patients achieved satisfactory results. A pedicled, expanded deltopectoral flap appears to be a reliable and safe option for the treatment of facial scars.

Radiomics-based machine-learning method for prediction of distant metastasis from soft-tissue sarcomas

AIM

To construct and validate a radiomics-based machine-learning method for preoperative prediction of distant metastasis (DM) from soft-tissue sarcoma.

MATERIALS AND METHODS

Seventy-seven soft-tissue sarcomas were divided into a training set (n=54) and a validation set (n=23). The performance of three feature selection methods (ReliefF, least absolute shrinkage and selection operator [LASSO], and regularised discriminative feature selection for unsupervised learning [UDFS]) and four classifiers, random forest (RF), logistic regression (LOG), K nearest neighbour (KNN), and support vector machines (SVMs), were compared for predicting the likelihood of DM. To counter the imbalance in the frequencies of DM, each machine-learning method was trained first without subsampling, then with the synthetic minority oversampling technique (SMOTE). The performance of the radiomics model was assessed using area under the receiver-operating characteristic curve (AUC) and accuracy (ACC) values.

RESULTS

The performance of the LASSO and SVM algorithm combination used with SMOTE was superior to that of the algorithm combination alone. The combination of SMOTE with feature screening by LASSO and SVM classifiers had an AUC of 0.9020 and ACC of 91.30% in the validation dataset.

CONCLUSION

A machine-learning model based on radiomics was favourable for predicting the likelihood of DM from soft-tissue sarcoma. This will help decide treatment strategies.

[Acetaminophen induced delayed-type urticaria and angioedema in a child]

A 4-month-old child with skin rash for 2 days and fever for 1 day was hospitalized in the Department of Pediatrics of Erdos Central Hospital in November 2019. According to the clinical symptoms, medical history and medication history at the time of admission, it was diagnosed as urticaria with angioneuroedema. In this case, the urticaria occurred 3 days after acetaminophen administration, which is a delayed reaction.

Impact of COVID-19 on Canadian medical oncologists and cancer care: Canadian Association of Medical Oncologists survey report

Background

The covid-19 pandemic has presented unprecedented professional and personal challenges for the oncology community. Under the auspices of the Canadian Association of Medical Oncologists, we conducted an online national survey to better understand the impact of the pandemic on the medical oncology community in Canada.

Methods

An English-language multiple-choice survey, including questions about demographics, covid-19 risk, use of personal protective equipment (ppe), personal challenges, and chemotherapy management was distributed to Canadian medical oncologists. The survey was open from 30 March to 4 April 2020, and attracted 159 responses.

Results

More than 70% of medical oncologists expressed moderate-to-extreme concern about personally contracting covid-19 and about family members or patients (or both) contracting covid-19 from them. Despite that high level of concern, considerable variability in the use of ppe in direct cancer care was reported at the time of this survey, with 33% of respondents indicating no routine ppe use at their institutions and 69% indicating uncertainty about access to adequate ppe. Of the respondents, 54% were experiencing feelings of nervousness or anxiety on most days, and 52% were having feelings of depression or hopelessness on at least some days. Concern about aging parents or family and individual wellness represented the top personal challenges identified. The management of cancer patients has been affected, with adoption of telemedicine reported by 82% of respondents, and cessation of clinical trial accrual reported by 54%. The 3 factors deemed most important for treatment decision-making were■ cancer prognosis and anticipated benefit from treatment,■ risk of treatment toxicity during scarce health care access, and■ patient risk of contracting covid-19.

Conclusions

This report describes the results of the first national survey assessing the impact of the covid-19 on Canadian medical oncologists and how they deliver systemic anticancer therapies. We hope that these data will provide a framework to address the challenges identified.

A Canadian cancer trials group phase IB study of durvalumab (anti-PD-L1) plus tremelimumab (anti-CTLA-4) given concurrently or sequentially in patients with advanced, incurable solid malignancies

Background The IND.226 study was a phase Ib study to determine the recommended phase II dose of durvalumab + tremelimumab in combination with standard platinum-doublet chemotherapy. Sequential administration of multiple agents increases total chair time adding costs overall and inconvenience for patients. This cohort of the IND.226 study evaluated the safety and tolerability of durvalumab + tremelimumab given either sequentially (SEQ) or concurrently (CON). Methods Patients with advanced solid tumours were enrolled and randomised to either SEQ tremelimumab 75 mg IV over 1 h followed by durvalumab 1500 mg IV over 1 h q4wks on the same day, or CON administration over 1 h. The serum pharmacokinetic profile of SEQ versus CON of durvalumab and tremelimumab administration was also evaluated. Results 14 patients either received SEQ (n = 7pts) or CON (n = 7 pts). There were no infusion related reactions. Drug related adverse events (AEs) were mainly low grade and manageable, and comparable in frequency between SEQ/CON- fatigue (43%/57%), rash (43%/43%), pruritus (43%/29%) and nausea (14%/29%). One patient in each cohort discontinued treatment due to toxicity. The PK profiles of durvalumab and tremelimumab were similar between CON and SEQ, and to historical reference data. Conclusions Concurrent administration of durvalumab and tremelimumab over 1 h is safe with a comparable PK profile to sequential administration.

Expression and correlation of MMP-9, VEGF, and p16 in infantile hemangioma

OBJECTIVE

The incidence and progression of infantile hemangioma depend on several factors. The objective of the present study was to analyze the expression of MMP-9, VEGF, and p16 in hemangioma, and evaluate the clinical significance of the correlation between the gene and protein expression of MMP-9 and VEGF.

PATIENTS AND METHODS

60 pathological tissue samples from patients with hemangioma (30 cases of proliferative hemangioma and 30 cases of degenerative hemangioma) and 30 normal epidermal tissue samples were collected. Tissues were examined by immunohistochemistry. Additionally, MMP-9 and VEGF gene expression were evaluated by qRT-PCR to determine the correlation between gene and protein level.

RESULTS

Immunohistochemistry showed that the expression of MMP-9 and VEGF was higher in proliferative hemangioma, while the expression of p16 was lower, and the differences were statistically significant (p<0.05). According to qRT-PCR, MMP-9 and VEGF gene expression were positively correlated with their protein expression (p<0.05).

CONCLUSIONS

The tumor suppressor gene p16 is negatively correlated with the occurrence and degradation of hemangioma. Furthermore, the gene and protein expression of MMP-9 and VEGF in infantile hemangioma are positively correlated. The levels of MMP-9 and VEGF are higher in the proliferative stage of hemangioma than other stages. Both MMP-9 and VEGF facilitate angiogenesis and tumorigenesis, and are likely to serve as markers for the development of hemangioma in the future.

Feasibility of three-dimensional constructive interference in steady state sequences for evaluating the anterolateral ligament

AIM

The purpose of the study was to determine the feasibility of three-dimensional (3D) constructive interference in steady state (CISS) sequences for evaluating the anterolateral ligament (ALL).

MATERIALS AND METHODS

Magnetic resonance imaging (MRI) of the right knee joint in 30 healthy volunteers was performed using a 3 T MRI machine. Axial T2-weighted imaging with fat saturation (T2WI-FS), coronal proton-density-weighted imaging with fat saturation (PDWI-FS), and 3D-CISS were included in the protocol. Multiplanar reconstruction (MPR) and rotating stretched curved planar reconstructions (CPRs) of the ALL at 30°, 60°, 90°, 120°, and 150° were generated from the 3D-CISS images. The visibility of the femoral part, meniscal part, tibial part, meniscal insertion, femoral footprint, and tibial footprint of the ALL on the imaging of all sequences was recorded.

RESULTS

Based on the CPR of 3D-CISS MRI, the presence of tibial and femoral footprints of the ALL was rated superior to MPR and PDWI-FS (96.67% and 96.67%, respectively; p<0.017). Rotating CPR of 3D-CISS MRI imaging was rated superior to PDWI-FS with respect to the tibial part, meniscal part, and meniscal insertion of the ALL (96.67%, 83.33%, and 83.33%, respectively; p<0.05). Rotating CPR of 3D-CISS MRI was rated superior to PDWI-FS with respect to the femoral part of the ALL, but the difference was not statistically significant (p=0.095). The angle between the ALL and lateral collateral ligament (LCL) on the oblique sagittal image was 18.34±1.88°.

CONCLUSIONS

The MRI 3D-CISS sequences significantly enhanced the ability to identify the ALL compared to the 2D MRI sequences.

Canadian consensus: oligoprogressive, pseudoprogressive, and oligometastatic non-small-cell lung cancer

Background

Little evidence has been generated for how best to manage patients with non-small-cell lung cancer (nsclc) presenting with rarer clinical scenarios, including oligometastases, oligoprogression, and pseudoprogression. In each of those scenarios, oncologists have to consider how best to balance efficacy with quality of life, while maximizing the duration of each line of therapy and ensuring that patients are still eligible for later options, including clinical trial enrolment.

Methods

An expert panel was convened to define the clinical questions. Using case-based presentations, consensus practice recommendations for each clinical scenario were generated through focused, evidence-based discussions.

Results

Treatment strategies and best-practice or consensus recommendations are presented, with areas of consensus and areas of uncertainty identified.

Conclusions

In each situation, treatment has to be tailored to suit the individual patient, but with the intent of extending and maximizing the use of each line of treatment, while keeping treatment options in reserve for later lines of therapy. Patient participation in clinical trials examining these issues should be encouraged.

[Application of plasma sprayed zirconia coating in dental implant: study in implant]

Objective: To investigate the osseointegration of a novel coating-plasma-sprayed zirconia in dental implant. Methods: Zirconia coating on non-thread titanium implant was prepared using plasma spraying, the implant surface morphology, surface roughness and wettability were measured. In vivo, zirconia coated implants were inserted in rabbit tibia and animals were respectively sacrificed at 2, 4, 8 and 12 weeks after implantation. The bond strength between implant and bone was measured by push-out test. The osseointegration was observed by scanning electron microscopy (SEM), micro CT and histological analyses. Quantified parameters including removal torque, and bone-implant contact (BIC) percentage were calculated. Results: The surface roughness (1.6 µm) and wettability (54.6°) of zirconia coated implant was more suitable than those of titanium implant (0.6 µm and 74.4°) for osseointegration. At 12 weeks, the push-out value of zirconia coated implant and titanium implant were (64.9±3.0) and (50.4±2.9) N, and BIC value of these two groups were (54.7±3.6)% and (41.5±3.6)%. All these differences had statistical significance. Conclusions: The surface characters of zirconia coated implant were more suitable for osseointegration and present better osseointegration than smooth titanium implant in vivo, especially at early stage.

Alberta CancerBridges development of a care plan evaluation measure

Background

No standardized measures specifically assess cancer survivors' and healthcare providers' experience of Survivor Care Plans (scps). We sought to develop two care plan evaluation (cpe) measures, one for survivors (cpe-s) and one for healthcare providers (cpe-p), examine initial psychometric qualities in Alberta, and assess generalizability in Manitoba, Canada.

Methods

We developed the initial measures using convenience samples of breast (n = 35) and head and neck (n = 18) survivors who received scps at the end of active cancer-centre treatment. After assessing Alberta's scp concordance with Institute of Medicine (iom) recommendations using a published coding scheme, we examined psychometric qualities for the cpe-s and cpe-p. We examined generalizability in Manitoba, Canada, with colorectal survivors discharged to primary care providers for follow-up (n = 75).

Results

We demonstrated acceptable internal consistency for the cpe-s and cpe-p subscales and total score after eliminating one item per subscale for cpe-s, two for cpe-p, resulting in revised scales with four 7-item and 6-item subscales, respectively. Subscale scores correlated highly indicating that for each measure the total score may be the most reliable and valid. We provide initial cpe-s discriminant, convergent, and predictive validity using the total score. Using the Manitoba sample, initial psychometrics similarly indicated good generalizability across differences in tumour groups, scp, and location.

Conclusions

We recommend the revised cpe-s and cpe-p for further use and development. Studies documenting the creation and standardization of scp evaluations are few, and we recommend further development of patient experience measures to improve both clinical practice and the specificity of research questions.

Neoadjuvant versus adjuvant chemoradiation for stage II-III esophageal squamous cell carcinoma: a single institution experience

Esophageal cancer is the eighth most common cancer worldwide. It is the fourth most common cause of cancer death in China and esophageal squamous cell carcinoma (ESCC) is the most prevalent histologic type. Many clinical trials have explored the value of neoadjuvant or adjuvant chemoradiation therapy in potentially resectable ESCC; however, these studies have produced conflicting results. This retrospective study was performed to investigate whether patients with resectable stage II/III ESCC should receive neoadjuvant or adjuvant therapy in addition to surgery. A review of stage II/III thoracic ESCC patients who underwent esophagectomy and either neoadjuvant or adjuvant chemoradiation was performed. Chemotherapy regimen consisted of cisplatin 75 mg/m2 divided into 3 days and fluorouracil 500 mg/m2 on days 1 to 5. The patients who underwent neoadjuvant therapy were treated with one cycle of chemotherapy concurrently with radiotherapy (40 Gy in 20 fractions, 5 days/week), and those receiving adjuvant therapy were treated with two cycles of chemotherapy concurrently with radiotherapy (46-50 Gy in 23-25 fractions, 5 days/week). A total of 122 patients met inclusion criteria, of which 49 underwent neoadjuvant chemoradiation and 73 underwent adjuvant chemoradiation. Median follow up was 36.5 months. The median survival times and 3, 5-year overall survival (OS) rates for the neoadjuvant and adjuvant groups were 39.3 versus 31.5 months, and 53.0%, 45.7% versus 42.9%, 29.7%, respectively (P = 0.091). For the patients with stage III ESCC, the median survival times and 5-year OS rates for the neoadjuvant and adjuvant groups were 39.3 versus 21.3 months, and 43.4% versus 21.0%, respectively (P = 0.021). Among lymph node-positive patients, the median survival times and 5-year OS rates for the neoadjuvant and adjuvant groups were 55.6 versus 23.7 months, and 43.0% versus 25.7%, respectively (P = 0.085). The incidence of perioperative and postoperative complications was comparable between the two groups (P > 0.05). For patients with resectable stage II/III ESCC, neoadjuvant chemoradiation does not increase postoperative complications and is associated with a trend toward better OS when compared to adjuvant chemoradiation.

Treatment with hydrogen sulfide attenuates sublesional skeletal deterioration following motor complete spinal cord injury in rats

Treatment with hydrogen sulfide mitigates spinal cord injury-induced sublesional bone loss, possibly through abating oxidative stress, suppressing MMP activity, and activating Wnt/β-catenin signaling.

INTRODUCTION

Spinal cord injury (SCI)-induced sublesional bone loss represents the most severe osteoporosis and is resistant to available treatments to data. The present study was undertaken to explore the therapeutic potential of hydrogen sulfide (H₂S) against osteoporosis in a rodent model of motor complete SCI.

METHODS

SCI was generated by surgical transaction of the cord at the T3-T4 levels in rats. Treatment with NaHS was initiated through intraperitoneal injection of 0.1 ml/kg/day of 0.28 mol/l NaHS from 12 h following the surgery and over 14 subsequent days.

RESULTS

H₂S levels in plasma of SCI rats were lower, which was restored by treatment with exogenous H₂S. Treatment of SCI rats with exogenous H₂S had no significant effect on body mass but increased bone mineral density in femurs and tibiae, increased BV/TV, Tb.Th, and Tb.N and reduced Tb.Sp in proximal tibiae, and increased mineral apposition rate (MAR), bone formation rate (BFR), and osteoblast surface and reduced eroded surface and osteoclast surface in proximal tibiae. More importantly, H₂S treatment led to a significant enhancement in ultimate load, stiffness, and energy to max force of femoral diaphysis. Treatment of SCI rats with exogenous H₂S reduced malondialdehyde (MDA) levels in serum and femurs, decreased hydroxyproline levels, suppressed activities of matrix metallopeptidase 9 (MMP9), and upregulated Wnt3a, Wnt6, Wnt10, and ctnnb1 expression in femurs.

CONCLUSION

Treatment with H₂S mitigates SCI-induced sublesional bone loss, possibly through abating oxidative stress, suppressing MMP activity, and activating Wnt/β-catenin signaling.