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1.
《Journal of vascular and interventional radiology : JVIR》2022,33(9):1034-1044.e29
PurposeTo assess the safety and tolerability of a vandetanib-eluting radiopaque embolic (BTG-002814) for transarterial chemoembolization (TACE) in patients with resectable liver malignancies.Materials and MethodsThe VEROnA clinical trial was a first-in-human, phase 0, single-arm, window-of-opportunity study. Eligible patients were aged ≥18 years and had resectable hepatocellular carcinoma (HCC) (Child-Pugh A) or metastatic colorectal cancer (mCRC). Patients received 1 mL of BTG-002814 transarterially (containing 100 mg of vandetanib) 7–21 days prior to surgery. The primary objectives were to establish the safety and tolerability of BTG-002814 and determine the concentrations of vandetanib and the N-desmethyl vandetanib metabolite in the plasma and resected liver after treatment. Biomarker studies included circulating proangiogenic factors, perfusion computed tomography, and dynamic contrast-enhanced magnetic resonance imaging.ResultsEight patients were enrolled: 2 with HCC and 6 with mCRC. There was 1 grade 3 adverse event (AE) before surgery and 18 after surgery; 6 AEs were deemed to be related to BTG-002814. Surgical resection was not delayed. Vandetanib was present in the plasma of all patients 12 days after treatment, with a mean maximum concentration of 24.3 ng/mL (standard deviation ± 13.94 ng/mL), and in resected liver tissue up to 32 days after treatment (441–404,000 ng/g). The median percentage of tumor necrosis was 92.5% (range, 5%–100%). There were no significant changes in perfusion imaging parameters after TACE.ConclusionsBTG-002814 has an acceptable safety profile in patients before surgery. The presence of vandetanib in the tumor specimens up to 32 days after treatment suggests sustained anticancer activity, while the low vandetanib levels in the plasma suggest minimal release into the systemic circulation. Further evaluation of this TACE combination is warranted in dose-finding and efficacy studies. 相似文献
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目的 调查北京市社区老年人潜在不适当用药(potentially inappropriate medication,PIM)现状.方法 采用自我报告方式,收集北京市社区215名老年人用药信息,根据2019版美国老年人PIM标准(Beers criteria for PIM use in older adults,Beers标准)和中国老年人潜在不适当用药判断标准(中国PIM标准)评价并做描述性分析.结果 根据2019版Beers标准发现66人(30.7%)存在84例次PIM,其中中枢神经系统药物(36例次)、血液系统药物(14例次)、内分泌系统药物(11例次)导致的PIM最多;采用中国PIM标准发现53人(24.7%)存在73例次PIM,前三位分别为:中枢神经系统药物(31例次),血液系统药物(17例次),解热、镇痛、抗炎与抗风湿药(17例次).结论 社区老年人PIM发生率较高,特别是中枢神经系统和血液系统用药需要引起关注.Beers标准和中国PIM标准可相互补充,且需不断更新完善. 相似文献
3.
Matthew D. Li Katrina F. Chu Allegra DePietro Vincent Wu Eric Wehrenberg-Klee Omar Zurkiya Raymond W. Liu Suvranu Ganguli 《Journal of vascular and interventional radiology : JVIR》2019,30(3):314-319
Purpose
To evaluate the feasibility of a same-day yttrium-90 (90Y) radioembolization protocol with resin microspheres (including pretreatment angiography, lung shunt fraction [LSF] determination, and radioembolization) for the treatment of hepatocellular carcinoma (HCC) and liver metastases.Materials and Methods
All same-day radioembolization procedures performed over 1 y (February 2017 to January 2018) were included in this single-institutional retrospective analysis, in which 34 procedures were performed in 26 patients (median age, 63 y; 13 women), 19 with liver metastases and 7 with HCC. Yttrium-90 treatment activities were calculated by body surface area method. Tumor imaging response was assessed by Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 for liver metastases and modified RECIST for HCC. Clinical side effects and adverse events were graded per Common Terminology Criteria for Adverse Events version 4.0.Results
All planned cases were technically successful, and no cases were canceled for elevated LSF or vascular anatomic reasons. Pretreatment angiography modified the planned 90Y treatment activity in 1 case in which vascular anatomy required a lobar-dose split into 2 for segmental infusions. In 18% of cases, patients were briefly admitted after the procedure for observation or symptom management. Imaging evaluation of initial efficacy at 1 month demonstrated partial response in 25% and stable disease in 67% of patients with liver metastases and partial/complete response in 43% and stable disease in 14% of patients with HCC. Grade ≥ 3 adverse events occurred in 6% of cases, with no systemic therapy–limiting toxicities. The mean total procedure time was 4.2 hours.Conclusions
A same-day 90Y radioembolization protocol with resin microspheres is feasible in select patients, which can expedite cancer therapy. 相似文献4.
Whitney S. Brandt Wanpu Yan Jian Zhou Kay See Tan Joseph Montecalvo Bernard J. Park Prasad S. Adusumilli James Huang Matthew J. Bott Valerie W. Rusch Daniela Molena William D. Travis Mark G. Kris Jamie E. Chaft David R. Jones 《The Journal of thoracic and cardiovascular surgery》2019,157(2):743-753.e3
Objective
Comparative survival between neoadjuvant chemotherapy and adjuvant chemotherapy for patients with cT2-4N0-1M0 non–small cell lung cancer has not been extensively studied.Methods
Patients with cT2-4N0-1M0 non–small cell lung cancer who received platinum-based chemotherapy were retrospectively identified. Exclusion criteria included stage IV disease, induction radiotherapy, and targeted therapy. The primary end point was disease-free survival. Secondary end points were overall survival, chemotherapy tolerance, and ability of Response Evaluation Criteria In Solid Tumors response to predict survival. Survival was estimated using the Kaplan–Meier method, compared using the log-rank test and Cox proportional hazards models, and stratified using matched pairs after propensity score matching.Results
In total, 330 patients met the inclusion criteria (n = 92/group after propensity-score matching; median follow-up, 42 months). Five-year disease-free survival was 49% (95% confidence interval, 39-61) for neoadjuvant chemotherapy versus 48% (95% confidence interval, 38-61) for adjuvant chemotherapy (P = .70). On multivariable analysis, disease-free survival was not associated with neoadjuvant chemotherapy or adjuvant chemotherapy (hazard ratio, 1.1; 95% confidence interval, 0.64-1.90; P = .737), nor was overall survival (hazard ratio, 1.21; 95% confidence interval, 0.63-2.30; P = .572). The neoadjuvant chemotherapy group was more likely to receive full doses and cycles of chemotherapy (P = .014/0.005) and had fewer grade 3 or greater toxicities (P = .001). Response Evaluation Criteria In Solid Tumors response to neoadjuvant chemotherapy was associated with disease-free survival (P = .035); 15% of patients receiving neoadjuvant chemotherapy (14/92) had a major pathologic response.Conclusions
Timing of chemotherapy, before or after surgery, is not associated with an improvement in overall or disease-free survival among patients with cT2-4N0-1M0 non–small cell lung cancer who undergo complete surgical resection. 相似文献5.
目的: 采用Beers标准(2015版)、《中国老年人潜在不适当用药判断标准》(简称"中国标准"2017版)分析我院心内科老年住院患者潜在不适当用药(Potential Inappropriate Medication,PIM)的发生情况。方法: 将我院心内科2018年1月至3月,年龄≥ 65岁的住院患者纳入本研究。收集患者年龄、性别、ADL评分、临床诊断、住院医嘱、住院天数、药品费用、总医疗费用等基本信息,分别采用上述两种标准审查老年住院患者的潜在不适当用药发生情况,并应用二元Logistic回归分析PIM发生的相关危险因素。结果: 共纳入患者661例,包括男性350例、女性311例,平均年龄73.86±6.55岁,平均用药种类10.17±4.01种,住院天数的区间为3~30天,临床诊断的区间为1~17种。依据Beers标准,387例(58.55%)患者至少发现1项PIM;依据中国标准,542例(82.00%)患者至少发现1项PIM,Logistic结果显示,用药种类是PIM发生的危险因素。结论: 联合使用Beers标准与中国标准可审查出更多老年患者应谨慎使用或避免使用的潜在不适当药物,在临床应用中,应结合两种标准给出的用药建议,通过减少或避免潜在不适当药物的应用来减少其可能引起的不良的临床结局。 相似文献
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《Journal of vascular and interventional radiology : JVIR》2020,31(6):925-933
PurposeTo determine predictors of survival after transarterial radioembolization of hepatic metastases from breast cancer.Materials and MethodsTwenty-four patients with chemotherapy-refractory hepatic metastases from breast cancer who underwent radioembolization from 2013 to 2018 were evaluated based on various demographic and clinical factors before and after treatment. Overall survival (OS) was estimated by Kaplan–Meier method. Log-rank analysis was performed to determine predictors of prolonged OS from the time of first radioembolization and first hepatic metastasis diagnosis.ResultsMedian OS times were 35.4 and 48.6 months from first radioembolization and time of hepatic metastasis diagnosis, respectively. Radioembolization within 6 months of hepatic metastasis diagnosis was a positive predictor of survival from first radioembolization, with median OS of 38.9 months vs 22.1 months for others (P = .033). Estrogen receptor (ER)–positive status predicted prolonged survival (38.6 months for ER+ vs 5.4 months for ER−; P = .005). The presence of abdominal pain predicted poor median OS: 12.8 months vs 38.6 months for others (P < .001). The presence of ascites was also a negative predictor of OS (1.7 months vs 35.4 months for others; P = .037), as was treatment-related grade ≥ 2 toxicity at 3 months (5.4 months vs 38.6 months for others; P = .017).ConclusionsIn patients with metastatic breast cancer, radioembolization within 6 months of hepatic metastasis diagnosis and ER+ status appear to be positive predictors of prolonged survival. Conversely, baseline abdominal pain, baseline ascites, and treatment-related grade ≥ 2 toxicity at 3 months after treatment appear to be negative predictors of OS. 相似文献
8.
Nursing schools strive to select a diverse student population who are likely to succeed by ensuring timely student progression through the program and effective use of educational sources. The purpose of this systematic literature review is to explore the preadmission variables and selection criteria that predict student success in 4-year baccalaureate nursing programs in the U.S. Sixteen articles met the eligibility criteria, and six measures were used to define student success: (a) early academic success, particularly during the first and second year; (b) attrition; (c) timely completion of the program; (d) graduation; (e) performance in nursing courses; and (f) academic performance in other science courses. Typically, the core set of cognitive predictors used in the admission process in nursing schools were pre-nursing GPA, pre-nursing collegiate science GPA, and scores on standardized aptitude exams. This review suggests that it is challenging to isolate one single variable as the best predictor of student success; however, using a combination of variables can offer a reliable prediction method. More researchers should consider using a theoretical basis to guide their inquiry on this topic. Additionally, researchers should examine admission variables that are most relevant across programs. 相似文献
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