Category: Nevin Manimala

Acad Radiol. 2023 Apr 14:S1076-6332(23)00129-0. doi: 10.1016/j.acra.2023.03.018. Online ahead of print.

ABSTRACT

OBJECTIVES: The objective of this prospective study was to evaluate the virtual monoenergetic images (VMI) and virtual noncontrast (VNC) phase in the detection of endoleaks after endovascular abdominal aortic repair (EVAR). The potential dose reduction of abbreviated examination protocols was calculated.

MATERIALS AND METHODS: Ninety-seven patients after the EVAR procedure were enrolled in this study. An initial single-source noncontrast acquisition was followed by two dual-energy acquisitions (arterial and 60 s delayed). Fast-kVp switching scanner was used. VNC images were reconstructed from the delayed phase. First examination session (reference) included a full triphasic study protocol consisting of true noncontrast (TNC) images and two postcontrast phases, the latter ones presented as classical polyenergetic reconstructions. Reading sessions II and III were performed by two independent and blinded readers evaluating VMIs in abbreviated protocols-biphasic (VNC + arterial, delayed phase), monophasic (VNC + delayed phase). The diagnostic accuracy of sessions II and III was calculated.

RESULTS: The calculated sensitivity of the biphasic protocol with the use of VMIs in endoleak detection was 100%, with a statistically significant increase in the number of endoleaks detected in comparison with the reference study. The monophasic protocol showed 83.33% sensitivity. The use of abbreviated examination protocols led to a decrease in the mean effective dose (ED) of 23.28% (biphasic protocol) and 61.37% (monophasic protocol).

CONCLUSION: The use of VMIs increases the number of endoleaks diagnosed with a possible radiation reduction by up to ¼ (biphasic protocol). Further reduction to a monophasic protocol leads to over 60% dose reduction but with a decrease in diagnostic accuracy.

PMID:37062628 | DOI:10.1016/j.acra.2023.03.018

Eur J Cancer. 2023 Mar 17:S0959-8049(23)00144-2. doi: 10.1016/j.ejca.2023.03.010. Online ahead of print.

ABSTRACT

BACKGROUND: An increasing number of clinical trials are being conducted exploring the efficacy of neoadjuvant immune checkpoint inhibitors. Surrogate end-points for overall survival (OS) are urgently needed.

METHODS: Phase II or III trials of neoadjuvant immunotherapy that reported data on OS and surrogate end-points were identified from January 1, 2000, to November 25, 2022. Individual patient data, and trial-level data were requested from corresponding authors or extracted from eligible trials. At the individual level, correlations between radiological and pathological response and OS were measured by the Cox model and quantified by hazard ratio (HR). C-statistic was used to quantify the predictive performance of radiological and pathological response for OS. The coefficient of determination (R²) between RFS and OS was evaluated by a bivariate survival model.

RESULTS: A total of 29 trials reporting 2901 patients were included. ORR correlated with improved OS (3-year OS: 87.0% versus 70.4% for ORR versus non-ORR, respectively; HR, 0.34, 95% confidence interval [CI], 0.17-0.68). The HRs for OS in patients achieving MPR and pCR were 0.24 (95% CI, 0.12-0.46) and 0.13 (95% CI, 0.05-0.36). The survival benefit maintained after adjusting tumour type. C-statistics of ORR, MPR and pCR were 0.63, 0.63 and 0.65, respectively. The strength of association between RFS and OS was strong (R² = 0.88, 95% CI, 0.79-0.94).

CONCLUSIONS: These findings suggest that ORR, MPR, pCR and RFS are valid predictors for OS when using neoadjuvant immune checkpoint inhibitors. Moreover, MPR, pCR and RFS may be the most optimal surrogates for OS.

PMID:37062625 | DOI:10.1016/j.ejca.2023.03.010

Phys Med. 2023 Apr 14;109:102586. doi: 10.1016/j.ejmp.2023.102586. Online ahead of print.

ABSTRACT

PURPOSE: To develop an automated planning approach in Raystation and evaluate its feasibility in multiple clinical application scenarios.

METHODS: An automated planning approach (Ruiplan) was developed by using the scripting platform of Raystation. Radiotherapy plans were re-generated both automatically by using Ruiplan and manually. 60 patients, including 20 patients with nasopharyngeal carcinoma (NPC), 20 patients with esophageal carcinoma (ESCA), and 20 patients with rectal cancer (RECA) were retrospectively enrolled in this study. Dosimetric and planning efficiency parameters of the automated plans (APs) and manual plans (MPs) were statistically compared.

RESULTS: For target coverage, APs yielded superior dose homogeneity in NPC and RECA, while maintaining similar dose conformity for all studied anatomical sites. For OARs sparing, APs led to significant improvement in most OARs sparing. The average planning time required for APs was reduced by more than 43% compared with MPs. Despite the increased monitor units (MUs) for NPC and RECA in APs, the beam-on time of APs and MPs had no statistical difference. Both the MUs and beam-on time of APs were significantly lower than that of MPs in ESCA.

CONCLUSIONS: This study developed a new automated planning approach, Ruiplan, it is feasible for multi-treatment techniques and multi-anatomical sites cancer treatment planning. The dose distributions of targets and OARs in the APs were similar or better than those in the MPs, and the planning time of APs showed a sharp reduction compared with the MPs. Thus, Ruiplan provides a promising approach for realizing automated treatment planning in the future.

PMID:37062102 | DOI:10.1016/j.ejmp.2023.102586

J Mech Behav Biomed Mater. 2023 Apr 5;142:105804. doi: 10.1016/j.jmbbm.2023.105804. Online ahead of print.

ABSTRACT

PURPOSE: This in vitro study aims to evaluate the bonding strengths of Polyether ether ketone (PEEK), Polyether ketone (PEKK), Fiber, and Zirconia (ZrO₂) post-core restorations with posts in different diameter and length following chewing simulator.

MATERIALS AND METHODS: Endodontic treatment was performed on 256 intact maxillary central teeth. The test specimens were prepared in four groups according to the types of materials: Glass fiber post-composite core (FB-n:64), Zirconia post-core (Zr-n:64), PEEK post-core (PE-n:64), and PEKK post-core (PK-n:64). The groups were divided into four subgroups according to diameter and length (n:16): Group 1: 10 mm length 1.75 mm diameter, Group 2: 10 mm length 1.5 mm diameter, Group 3: 7 mm length 1.75 mm diameter, Group 4: 7 mm length 1.5 mm diameter. Custom PEKK, PEEK, Zirconia post-cores, and Zirconia crowns were milled on the CAD/CAM. The post-cores and crowns were cemented to the teeth with dual-cure resin cement. After that, all subgroups were divided into control and cyclic loading groups. During the cycling, the control test group was kept in distilled water at 37±1^oC before the push-out test. Half of the specimens were loaded with 250,000 cycles and 50 N with a chewing simulator. All test specimens had 1.5 mm sections taken from their roots. Then, the push-out test was applied to these sections for bond strength. Data were analyzed by Mann-Whitney U test, Shapiro-Wilk, Kruskal-Wallis’s test, and Chi-Square. The statistical significance level was determined as 0.05.

RESULTS: The bond strength of all test groups decreased after the cycling loading. The bond strength values of zirconia posts showed a statistically significant difference (p < 0.05). The 10 mm length 1.75 mm diameter posts made of Zirconium had the highest bond strength observed in all control and cyclic loading groups of test specimens (9.74 MPa-6.25 MPa). The PEEK test specimens with a 7 mm length and 1.75 mm diameter showed the weakest bond strength in all control and cyclic loading groups (5.44 MPa-3.37 MPa). The average of the cervical region’s bond strength values was statistically significantly higher than the apical region (p < 0.05).

CONCLUSION: Within the limitations of this study, one-piece custom-milled Zirconia post-cores appear promising, as they perform well under functional forces, especially in the anterior region. In addition, custom-milled PEKK post-cores might be considered a suitable alternative to prefabricated fiber-reinforced posts.

PMID:37062099 | DOI:10.1016/j.jmbbm.2023.105804

J Mech Behav Biomed Mater. 2023 Apr 5;142:105819. doi: 10.1016/j.jmbbm.2023.105819. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the influence of intaglio ceramic surface treatments, resin cement viscosities, and storage regimens on the microshear bond strength of lithium disilicate ceramic. In addition, to investigate the dynamic viscosity of the resin-based luting agents.

MATERIALS AND METHODS: Ceramic slices were randomly allocated into eight groups (n = 19) considering three factors: ceramic surface treatment (hydrofluoric acid followed by silane, HF; or self-etching ceramic primer, E&P), resin cement viscosity (high, HIGH; or low, LOW) and storage regimen (baseline or aging). Surface treatments were performed, resin cement cylinders were built and microshear bond strength tests (μSBS, wire-loop method, speed: 1.0 mm/min) were run according to the storage factor. Failure mode, topographic and dynamic viscosity (37 °C; shear rate of 1.0-100 s^-1) of resin cement components (base, high and low catalyst) were also performed.

RESULTS: Resin cement viscosity and the association among ceramic surface treatment, resin cement viscosity, and storage regimen were statistically significant factors (p < 0.05). Worse behavior was identified for the E&P_HIGH group compared to the E&P_LOW and HF_LOW in the baseline condition. After aging, the HF_HIGH group (16.78 MPa) presented the worst result among the aged groups (21.44-25.25 MPa). Most of the failures were adhesive. Surface micrographs revealed a distinct pattern after etching, more aggressive by HF and milder by E&P. High viscosity catalyst is 5.3 and 8.5-fold more viscous than the base and low viscosity catalyst, respectively (high > base > low).

CONCLUSION: Differences in filler content can impact the resin viscosity of the material (more fillers increase the viscosity), which in turn can influence the bond strength of a lithium disilicate ceramic, depending on the surface treatment and storage regimen.

PMID:37062098 | DOI:10.1016/j.jmbbm.2023.105819

Cancer Med. 2023 Apr 16. doi: 10.1002/cam4.5918. Online ahead of print.

ABSTRACT

BACKGROUND: An ever-increasing number of efforts are focused on identifying effective biomarkers for immune checkpoint inhibitors (ICIs). Cytokines and chemokines are critical to tumor growth, metastasis, tumor angiogenesis, and the immune response against tumor cells. In the study here, we determined the correlation between circulating cytokines/chemokines and the clinical benefit of ICIs for non-small cell lung cancer (NSCLC) patients.

METHODS: Peripheral blood samples were collected before and during treatment (at 12th week). Plasma levels of cytokines/chemokines and specific stress response markers were measured using the Bio-Plex Pro Human Cytokines Grp I Panel (27-plex), an APEX1 detection kit, and a human LAP(TGF-β1) immunoassay kit. A Mann-Whitney U-test or Wilcoxon signed-rank test and a Cox proportional hazards model were employed for statistical analysis.

RESULTS: In the ICI monotherapy cohort, a high level of IL-6 at pretreatment or an elevation of IL-6, IL-8, FGF2, CXCL10, CCR1, PDFGB, TNF, and APEX1 posttreatment was associated with poor progress-free survival (PFS). A posttreatment elevation (defined herein as change rate) of CXCL10 was also associated with poor overall survival (OS). In the combinational therapy group, a high level of IL-12, IL-17A, FGF2, VEGF, and APEX1 at pretreatment and an elevation of CCL2 posttreatment were associated with poor PFS. A high level of IL-9, FGF2, PDFGB, CCL4, TFGB, and APEX1 at pretreatment and an elevation of IL-13, CSF2, and CCL2 at posttreatment were associated with poor OS of patients receiving combination therapy.

CONCLUSIONS: The study here suggests that circulating cytokines/chemokines are feasible, noninvasive biomarkers for predicting clinical benefit of ICI treatment for NSCLC. Distinct circulating factor profiles were observed in individuals receiving ICI monotherapy or combination therapy.

PMID:37062076 | DOI:10.1002/cam4.5918

Cancer Med. 2023 Apr 16. doi: 10.1002/cam4.5895. Online ahead of print.

ABSTRACT

PURPOSE: To clarify the necessity and effect of a single intraoperative instillation of chemotherapy during radical cystectomy.

METHODS: Patients who underwent radical cystectomy for bladder cancer between January 2013 and April 2019 were retrospectively evaluated and divided into a non-instillation group and an instillation group according to the intraoperative instillation of chemotherapy. Univariate and multivariate Cox regression was used to determine the clinical predictors of overall survival and disease-free survival. Kaplan-Meier analysis and log-rank tests were performed to analyze overall survival and disease-free survival.

RESULTS: Of the 320 patients who were enrolled in the study, 113 underwent radical cystectomy with intraoperative instillation of chemotherapy. Univariate Cox analysis showed that intraoperative instillation was not a risk factor for overall survival or disease-free survival (HR: 1.04, 95% CI: 0.66-1.63, p = 0.864; HR: 1.11, 95% CI: 0.76-1.62, p = 0.602, respectively). As shown in the Kaplan-Meier analysis, no significant differences were noted in overall survival (p = 0.857) and disease-free survival (p = 0.600) between the two groups. A subgroup analysis demonstrated that intraoperative instillation was not associated with a statistically better overall survival and disease-free survival in the nonmuscle invasive (p = 0.852 and 0.836) and muscle-invasive (p = 0.929 and 0.805) patients.

CONCLUSION: A single intraoperative instillation of chemotherapy during radical cystectomy was not related to better disease-free survival or overall survival. It is unnecessary to consider single instillation of chemotherapy as a regular procedure during radical cystectomy.

PMID:37062074 | DOI:10.1002/cam4.5895

Cancer Med. 2023 Apr 16. doi: 10.1002/cam4.5917. Online ahead of print.

ABSTRACT

BACKGROUND: Few studies have investigated the efficacy of comprehensive therapies, including immunotherapy, for gastric cancer with synchronous liver metastases (GCLM). We retrospectively compared the effect of immunochemotherapy and chemotherapy alone as conversion therapies on the oncological outcomes of patients with GCLM.

METHODS: The clinicopathological data of 100 patients with GCLM from February 2017 to October 2021 at our institution were retrospectively analyzed. Patients were divided into immunochemotherapy (n = 33) and chemotherapy-alone (n = 67) groups.

RESULTS: Baseline clinicopathological data did not differ significantly between the two groups. The immunochemotherapy group had a higher overall response rate (59.4% vs. 44.0%, p = 0.029) and disease control rate (71.9% vs. 49.2%, p = 0.036) than the chemotherapy group. The immunochemotherapy group showed better tumor regression in the gastric mass, metastatic lymph nodes, and liver lesions than the chemotherapy group. Ten (30.3%) patients in the immunochemotherapy group and 13 (19.4%) patients in the chemotherapy group underwent surgery after conversion therapy. However, the difference was not statistically significant. The overall survival (OS) and progression-free survival (PFS) rates were better in the immunochemotherapy group than in the chemotherapy group. Treatment-related adverse events occurred in 24 (72.7%) and 47 (70.1%) patients in the immunochemotherapy and chemotherapy groups, respectively.

CONCLUSIONS: As a conversion therapy for GCLM, immunotherapy yielded better primary and metastatic tumor regression and survival benefits, with no increase in adverse events compared to chemotherapy.

PMID:37062073 | DOI:10.1002/cam4.5917

Clin Transplant. 2023 Apr 16:e14994. doi: 10.1111/ctr.14994. Online ahead of print.

ABSTRACT

BACKGROUND: Recent evidence has demonstrated that transplantation of hearts with blood culture positive donors (BCPDs) to pediatric recipients is safe and effective. Few studies have analyzed the effect of BCPD on adult heart transplant recipients.

METHODS: The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from September, 1987 to March, 2021. Exclusion criteria included pediatric donors/recipients, donor ejection fraction <10% or >85%, inactive listed recipients, donors missing blood cultures, and recipients missing follow-up time. Outcomes were compared with fully adjusted logistic models. To account for discrepancies in BCPD and non-BCPD covariates, an inverse proportionally weighted model with regression adjustment (IPWRA) was used.

RESULTS: A total of 60 592 donors were non-BCPD, while 4009 were BCPD. 7% of hearts not transplanted were BCPD, while 6% of hearts transplanted were BCPD (p = .001). These rates have been nearly constant since 2005. There were no differences in short term survival between the two groups in the adjusted or IPWRA models (p = .103 and .277, respectively). Additionally, the BCPD group had longer ischemic time (3.24 vs. 3.06 h, p < .001), older donor age (32.73 vs. 31.65 years, p < .001), and older recipient age (52.76 vs. 52.09 years, p = .001). The IPWRA revealed an average additional 3.4 years of overall survival and 2.25 years of graft function for BCPD versus non-BCPD recipients, although these results failed to reach statistical significance (p = .387 and .527, respectively).

CONCLUSIONS: Given the need for more donor hearts, donors with positive blood cultures should be considered. Great care in evaluating such patients is advised to eliminate donors with untreated infections, while carefully selected donors can be considered and used.

PMID:37062052 | DOI:10.1111/ctr.14994

J Cancer Res Clin Oncol. 2023 Apr 16. doi: 10.1007/s00432-023-04741-y. Online ahead of print.

ABSTRACT

PURPOSE: For patients with cancer of unknown primary (CUP), treatment options are limited. Precision oncology, the interplay of comprehensive genomic profiling (CGP) and targeted therapies, aims to offer additional treatment options to patients with advanced and hard-to-treat cancers. We aimed to highlight the use of a molecular tumor board (MTB) in the therapeutic management of CUP patients.

METHODS: In this single-center observational study, CUP patients, presented to the MTB of the Comprehensive Cancer Center Munich LMU, a tertiary care center, were analyzed retrospectively. Descriptive statistics were applied to describe relevant findings.

RESULTS: Between June 2016 and February 2022, 61 patients with unfavorable CUP were presented to the MTB, detected clinically relevant variants in 74% (45/61) of patients, of which 64% (29/45) led to therapeutic recommendation. In four out of 29 patients (14%), the treatment recommendations were implemented, unfortunately without resulting in clinical benefit. Reasons for not following the therapeutic recommendation were mainly caused by the physicians’ choice of another therapy (9/25, 36%), especially in the context of worsening of general condition, lost to follow-up (7/25, 28%) and death (6/25, 24%).

CONCLUSION: CGP and subsequent presentation to a molecular tumor board led to a high rate of therapeutic recommendations in patients with CUP. Recommendations were only implemented at a low rate; however, late GCP diagnostic and, respectively, MTB referral were found more frequent for the patients with implemented treatment. This contrast underscores the need for early implementation of CGP into the management of CUP patients.

PMID:37062035 | DOI:10.1007/s00432-023-04741-y