Reasonable Treatment Strategy Research Articles

An International Radiosurgery Research Foundation Multicenter Retrospective Study of Gamma Ventral Capsulotomy for Obsessive Compulsive Disorder.

Obsessive compulsive disorder (OCD) across its full spectrum of severity is a psychiatric illness affecting ∼2% to 3% of the general population and results in significant functional impairment. There are few large patient series regarding Gamma ventral capsulotomy (GVC). To evaluate clinical outcomes of severe medically refractory OCD treated with GVC. This is an international, multicenter, retrospective cohort study. Forty patients with pre-GVC Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores≥24 (indicating severe OCD) were included. GVC was performed with 1 or 2 isocenters with a median maximum dose of 135 Gy (range, 120-180 Gy). Patients were deemed "responders" to GVC if there was≥35% reduction of follow-up Y-BOCS scores, and considered in remission if their Y-BOCS scores were≤16. The median follow-up was 36 mo (range, 6-96 mo). The median pre-SRS Y-BOCS score was 35 (range, 24-40). Eighteen patients (45%) were considered "responders," and 16 (40%) of them were in remission at their last follow-up. Nineteen patients (47.5%) remained stable with Y-BOCS of 33 (range, 26-36) following GVC, whereas 3 patients (7.5%) experienced worsening in Y-BOCS scores. Patients treated with 2 isocenters were more likely to have improvement in Y-BOCS score at 3 and 5 yr (P<.0005). Ten patients (25%) experienced post-GVC mood disturbance and neurological complications in 3 patients (7.5%). One patient developed radiation necrosis with edema that improved with steroids. GVC serves as a reasonable treatment strategy for severe medical refractory OCD. Patients treated with 2 isocenters were more likely to have substantial improvement in OCD.

The potential mechanism of postoperative cognitive dysfunction in older people.

Postoperative cognitive dysfunction (POCD) is a common disorder following surgery, which seriously threatens the quality of patients' life, especially the older people. Accumulating attention has been paid to POCD worldwide in pace with the popularization of anesthesia/surgery. The development of medical humanities and rehabilitation medicine sets higher demands on accurate diagnosis and safe treatment system of POCD. Although the research on POCD is in full swing, underlying pathogenesis is still inconclusive due to these conflicting results and controversial evidence. Generally, POCD is closely related to neuropsychiatric diseases such as dementia, depression and Alzheimer's disease in molecular pathways. Researchers have come up with various hypotheses to reveal the mechanisms of POCD, including neuroinflammation, oxidative stress, autophagy disorder, impaired synaptic function, lacking neurotrophic support, etc. Recent work focused on molecular mechanism of POCD in older people has been thoroughly reviewed and summed up here, concerning the changes of peripheral circulation, pathological pathways of central nervous system (CNS), the microbiota-gut-brain axis and the related brain regions. Accordingly, this article provides a better perspective to understand the development situation of POCD in older people, which is conductive to uncover the pathological mechanism and exploit reasonable treatment strategy of POCD.

Mechanisms of Relapse After CD19 CAR T-Cell Therapy for Acute Lymphoblastic Leukemia and Its Prevention and Treatment Strategies.

Chimeric antigen receptor (CAR) T-cell therapy is highly effective in the treatment of B-cell acute lymphoblastic leukemia (ALL) or B-cell lymphoma, providing alternative therapeutic options for patients who failed to respond to conventional treatment or relapse. Moreover, it can bridge other therapeutic strategies and greatly improve patient prognosis, with broad applicable prospects. Even so, 30–60% patients relapse after treatment, probably due to persistence of CAR T-cells and escape or downregulation of CD19 antigen, which is a great challenge for disease control. Therefore, understanding the mechanisms that underlie post-CAR relapse and establishing corresponding prevention and treatment strategies is important. Herein, we discuss post-CAR relapse from the aspects of CD19-positive and CD19-negative and provide some reasonable prevention and treatment strategies.

MNGI-06. EFFICACY OF 177LU-DOTATATE THERAPY IN RECURRENT ANAPLASTIC MENINGIOMA

Abstract BACKGROUND 177Lu-Dotatate (177Lu-DOTA0-Tyr3-Octreotate) is a beta-particle emitting somatostatin analog recently FDA approved for the treatment of somastatin receptor-positive gastroenteropancreatic neuroendocrine tumors. Somatostatin receptors are highly expressed in almost all meningiomas, therefore 177Lu-Dotatate may be a reasonable treatment strategy for this disease. Furthermore, the short path length of the beta particle should allow for treatment of previously radiated patients with low risk of cerebral radiation necrosis. CASE STUDY: A 61 year-old male presented with a history of atypical meningioma (WHO grade II), recurrent as anaplastic meningioma (WHO grade III). His previous treatments included multiple surgical resections, fractionated radiation therapy, stereotactic radiosurgery, everolimus/octreotide LAR, bevacizumab and hydroxyurea. MRI imaging revealed rapid volumetric progression over the prior nine months with a near tripling in size from 29.9 cm3 to 80.4 cm3. In-111 octreotide confirmed the presence of somatostatin receptors within the tumor. 177Lu-Dotatate was administered intravenously at a dose of 200 millicuries per dose, every eight weeks for four cycles. Treatment was tolerated very well, with no significant adverse events. Tumor volume initially increased to 98.3 cm3 after cycle 1 of treatment, and subsequently decreased to 91.2 cm3 after cycle 2. Eight months after treatment onset, the tumor volume remained stable (93.4 cm3). CONCLUSION 177Lu-Dotatate may be a safe and effective strategy for the treatment of somastatin receptor-positive meningioma. The transient increase in tumor volume after the first dose in this case may have represented delayed treatment effect or pseudoprogression. A phase II clinical trial is currently being activated to determine the progression-free survival associated with 177Lu-Dotatate in patients with recurrent meningioma.

Treatment of Asymptomatic Meningioma With Gamma Knife Radiosurgery: Long-Term Follow-up With Volumetric Assessment and Clinical Outcome.

Some patients are diagnosed with asymptomatic meningioma(s) after undergoing a screening CT and MRI for minor ailments or postresection. To help clinicians in decision making for treatment of asymptomatic meningiomas. A single center retrospective cohort study of 117 patients with 122 tumors treated with Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden). Patients were followed with longitudinal imaging and clinical evaluations. Tumor volumetry and developments of new signs or symptoms after GKRS were the end points in the study. Median patient age at GKRS was 60 yr (range 21-86 yr) with a median clinical follow-up of 53 mo (range 20-252 mo). The median pre-GKRS tumor volume was 3.6±3.8 cc (±standard deviation). Tumors were treated with a median margin dose of 14±2 Gy. At last follow-up, median tumor volume was 2.5±3.6 cc. Radiological progression-free survival (PFS) rates were 97% and 94.4% at 5 yr and 10 yr, respectively. Clinical PFS rates were 86% and 70% at 5 yr and 10 yr, respectively. Development of neurological complications was seen in 21 (18%) patients, and 11 (52%) of them had undergone surgical resection prior to GKRS. GKRS is a reasonable treatment strategy for asymptomatic meningiomas and compares favorably to natural history studies in terms of tumor control and neurological preservation. It results in relatively low morbidity in previously untreated meningiomas and serves as an appealing alternative treatment modality for recurrent meningiomas in asymptomatic patients.

T53

The simultaneous occurrence of acute ST-segment elevation myocardial infarction and acute ischemic stroke is an uncommon and complex clinical presentation. Although the medical treatment of both diseases is similar, data regarding optimal reperfusion therapy are limited. Nevertheless, use of tissue plasminogen activator may be a reasonable strategy for treatment of both diseases. We present a rare case of coexisting thrombosis of the coronary artery and mid cerebral artery that was managed successfully with tissue plasminogen activator thrombolytic therapy.

Effectiveness and safety of the tri-iodothyronine analogue Triac in children and adults with MCT8 deficiency: an international, single-arm, open-label, phase 2 trial

Deficiency of the thyroid hormone transporter monocarboxylate transporter 8 (MCT8) causes severe intellectual and motor disability and high serum tri-iodothyronine (T3) concentrations (Allan-Herndon-Dudley syndrome). This chronic thyrotoxicosis leads to progressive deterioration in bodyweight, tachycardia, and muscle wasting, predisposing affected individuals to substantial morbidity and mortality. Treatment that safely alleviates peripheral thyrotoxicosis and reverses cerebral hypothyroidism is not yet available. We aimed to investigate the effects of treatment with the T3 analogue Triac (3,3',5-tri-iodothyroacetic acid, or tiratricol), in patients with MCT8 deficiency. In this investigator-initiated, multicentre, open-label, single-arm, phase 2, pragmatic trial, we investigated the effectiveness and safety of oral Triac in male paediatric and adult patients with MCT8 deficiency in eight countries in Europe and one site in South Africa. Triac was administered in a predefined escalating dose schedule-after the initial dose of once-daily 350 μg Triac, the daily dose was increased progressively in 350 μg increments, with the goal of attaining serum total T3 concentrations within the target range of 1·4-2·5 nmol/L. We assessed changes in several clinical and biochemical signs of hyperthyroidism between baseline and 12 months of treatment. The prespecified primary endpoint was the change in serum T3 concentrations from baseline to month 12. The co-primary endpoints were changes in concentrations of serum thyroid-stimulating hormone (TSH), free and total thyroxine (T4), and total reverse T3 from baseline to month 12. These analyses were done in patients who received at least one dose of Triac and had at least one post-baseline evaluation of serum throid function. This trial is registered with ClinicalTrials.gov, number NCT02060474. Between Oct 15, 2014, and June 1, 2017, we screened 50 patients, all of whom were eligible. Of these patients, four (8%) patients decided not to participate because of travel commitments. 46 (92%) patients were therefore enrolled in the trial to receive Triac (median age 7·1 years [range 0·8-66·8]). 45 (98%) participants received Triac and had at least one follow-up measurement of thyroid function and thus were included in the analyses of the primary endpoints. Of these 45 patients, five did not complete the trial (two patients withdrew [travel burden, severe pre-existing comorbidity], one was lost to follow-up, one developed of Graves disease, and one died of sepsis). Patients required a mean dose of 38.3 μg/kg of bodyweight (range 6·4-84·3) to attain T3 concentrations within the target range. Serum T3 concentration decreased from 4·97 nmol/L (SD 1·55) at baseline to 1·82 nmol/L (0·69) at month 12 (mean decrease 3·15 nmol/L, 95% CI 2·68-3·62; p<0·0001), while serum TSH concentrations decreased from 2·91 mU/L (SD 1·68) to 1·02 mU/L (1·14; mean decrease 1·89 mU/L, 1·39-2·39; p<0·0001) and serum free T4 concentrations decreased from 9·5 pmol/L (SD 2·5) to 3·4 (1·6; mean decrease 6·1 pmol/L (5·4-6·8; p<0·0001). Additionally, serum total T4 concentrations decreased by 31·6 nmol/L (28·0-35·2; p<0·0001) and reverse T3 by 0·08 nmol/L (0·05-0·10; p<0·0001). Seven treatment-related adverse events (transiently increased perspiration or irritability) occurred in six (13%) patients. 26 serious adverse events that were considered unrelated to treatment occurred in 18 (39%) patients (mostly hospital admissions because of infections). One patient died from pulmonary sepsis leading to multi-organ failure, which was unrelated to Triac treatment. Key features of peripheral thyrotoxicosis were alleviated in paediatric and adult patients with MCT8 deficiency who were treated with Triac. Triac seems a reasonable treatment strategy to ameliorate the consequences of untreated peripheral thyrotoxicosis in patients with MCT8 deficiency. Dutch Scientific Organization, Sherman Foundation, NeMO Foundation, Wellcome Trust, UK National Institute for Health Research Cambridge Biomedical Centre, Toulouse University Hospital, and Una Vita Rara ONLUS.

A Mathematical Model on the Immune System Role in Achieving Better Outcomes of Cancer Chemotherapy

The incidence of neoplastic diseases shows that the search for more effective cancer treatments is still necessary. In addition to standard treatments such as chemo- and radiotherapy, new treatment modalities have been focused in recent advances in immunology. Since little has been discussed about the biological implications of chemotherapy with respect to its impact on the immune system and on the other normal, ``healthy'' cells, we devote the present mathematical modeling work to do so. First, we prove the invariance of the region where all state variables remain positive (i.e., the number of cancer cells, normal cells and immune cells, and the amount of chemotherapy); afterwards, we analyze the model in terms of the linear stability of the system, and we establish a necessary and sufficient condition for the local stability of the {\it{cure}} equilibrium point. Moreover, we simulate some scenarios involving both the immune system and chemotherapy, showing that a reasonable treatment strategy occurs when these are combined suitably.

Clinical Features of Chronic Graft-Versus-Host Disease Following Haploidentical Transplantation Combined with Infusion of a Cord Blood.

Our previous studies demonstrated promising outcomes after haploidentical donor transplant combined with unrelated umbilical cord blood (haplo-cord- hematopoietic stem cell transplantation [HSCT]) for hematological disorders. However, clinical profiling regarding chronic graft-versus-host disease (cGVHD) has not yet been fully described under this protocol. This study analyzed the clinical characteristics of cGVHD among 300 patients with hematological malignancies who received haplo-cord-HSCT between January 2012 and July 2016 at our center. During the follow-up, the 5-year cumulative incidence of cGVHD based on the National Institutes of Health (NIH) consensus criteria was 32.2% (95% confidence interval [CI], 28.7-35.7); the 5-year cumulative incidence of moderate to severe cGVHD was 11.4% (95% CI, 9.4-13.4). After the multivariate analysis, the GVHD overall survival (GOS) was associated with relapse, thrombocytopenia, bronchiolitis obliterans syndrome, and steroid-refractory cGVHD. The infused CD34+ cells (≥3.46 × 106/kg) from haploidentical grafts were a protective factor affecting GOS. This study proposed a nomogram for predicting GOS using the aforementioned five variables. The concordance index was 0.877 (95% CI, 0.859-0.895) for the accuracy evaluation of the nomogram. Our results suggested that the 5-year cumulative incidence of NIH-defined cGVHD after haplo-cord-HSCT was 32.2%, and this nomogram may help clinicians select reasonable treatment strategies.

Resistance to epidermal growth factor receptor tyrosine kinase inhibitors in mutated non-small cell lung cancer: new avenues and strategies to overcome resistance

The most common driver mutation in non-small cell lung cancer (NSCLC) is found within the tyrosine kinase domain of the epidermal growth factor receptor (EGFR). It commonly affects younger, female, and non-smoking patients. To date, there are five approved tyrosine kinase inhibitors (TKIs) for the treatment of EGFR-mutated NSCLC: erlotinib, gefitinib, the second-generation TKI afatinib and dacomitinib, and the third-generation TKI osimertinib. Sequencing TKI treatment or starting with osimertinib first are reasonable treatment strategies. Nevertheless, patients develop resistance to these TKIs, which can be primary or acquired. Primary resistance includes resistance mutations such as EGFR insertion 20, acquired resistance comprises the development of resistance mutations, activation of bypass signaling, or histological transformation into small cell lung cancer. This article summarizes the current landscape of treatment in EGFR-mutated lung cancer and discusses the different resistance mechanisms. It gives a perspective on novel EGFR TKIs and potential combination strategies to overcome resistance.

Bone flare after initiation of new endocrine therapy in patients with metastatic castration-resistant prostate cancer: two cases reports and literatures review

Objective To summarize the characteristics of clinical manifestation of after the treatment with new endocrine therapy in patients with metastatic castration-resistant prostate cancer(mCRPC) in order to evaluate the curative effect of patients properly and determine the reasonable treatment strategy. Methods We retrospectively analyzed the clinical data of two patients with mCRPC performed bone flare defined as PSA decline and metastases progression in the initial treatment with new endocrine therapy in Urology Department of Peking University First Hospital, and analyzed the clinical characteristics and treatment methods with the relative literature. Case 1, a 79-year-old man, presented with frequent urination and prostate-specific antigen (PSA) was 115.900 ng/ml, was diagnosed as prostate cancer(cT3N0M1)with metastasis .After androgen deprivation therapy of 24 months, PSA elevated and multiple metastases progressed. The patient was diagnosed with mCRPC and then began the treatment of enzalutamide. Case 2, a 62-year-old man, complained about emaciation and frequent urination, was diagnosed with prostate cancer(cT4N1M1)with and lymph metastases. After androgen deprivation therapy of 22 months, PSA elevated and multiple metastases progressed. The patient was diagnosed with mCRPC and then began the treatment of abiraterone. Results Case 1 was treated with enzalutamide and 2 months later PSA decreased from 133.400 ng/ml to 5.530 ng/ml, while scan showed multiple metastases, part of which was newly metastatic lesions. 6 months later, the number of metastatic lesions kept stable, and part of lesions presented metabolism decrease.8 months later, the number of metastatic lesions began to decrease. 1 year later, the patient started to receive chemical therapy because of the progression of the disease. After 5 cycles of chemotherapy, PSA progression occurred and chemotherapy was stopped. Liver failure and disseminated intravascular coagulation caused death in June 2016. Case 2 was treated with abiraterone and 2 months later PSA decreased from 54.820 ng/ml to 3.580 ng/ml, while scan showed multiple metastases, part of which was newly metastatic lesions. 6 months later, the number of metastatic lesions began to decline. 10 months later, the number of metastatic lesions kept stable.The treatment of abiraterone was continued so far and the patient was in a stable condition. Conclusions Enzalutamide and abiraterone, two new endocrine therapy, are determined as preferred methods for the treatment of mCRPC. The scanning is required to evaluate the possibility of bone flare which is defined as PSA decline and metastases progression in the initial treatment. These patients should be evaluated to make appropriate clinical decision. Key words: Castration-resistant prostate cancer; Abiraterone; Enzalutamide; Bone metastases; Bone scan

Heat treatment design of precursor solutions with different fluorine contents for YBa2Cu3O7−x films through the sol-gel approach

The extraordinary high Jc value up to 5.2 MA/cm2 was obtained in the pure YBCO film by optimizing the heat treatment process for the specific precursor solution. The orientation, surface morphology, texture, and performance of YBCO films fabricated by the different low-fluorine precursor solutions and heating rates are systematically investigated for the first time. A reasonable heat treatment strategy is proposed for obtaining satisfactory YBCO films considering the synergistic effect of the heating rate and fluorine content.

Cost-effectiveness and Budgetary Consequence Analysis of Durvalumab Consolidation Therapy vs No Consolidation Therapy After Chemoradiotherapy in Stage III Non–Small Cell Lung Cancer in the Context of the US Health Care System

In early 2018, durvalumab became the first immunotherapy to be approved for adjuvant treatment of patients with unresectable stage III non-small cell lung cancer (NSCLC) whose cancer has not progressed after definitive chemoradiotherapy. However, the cost-effectiveness and potential economic implications of using this high-priced therapy in this indication are unknown to date. To explore the cost-effectiveness and potential budgetary consequences of durvalumab consolidation therapy vs no consolidation therapy after chemoradiotherapy in stage III NSCLC in the context of the US health care system. A decision analytic microsimulation model was developed in an academic medical setting to compare the following 2 postchemoradiotherapy strategies: all patients receive no consolidation therapy until progression vs all patients receive durvalumab consolidation therapy until progression or for a maximum of 1 year. The potential budgetary consequence was calculated by applying the proportion of patients with NSCLC who were diagnosed in stage III and received chemoradiotherapy to the projected number of annual new cases for 2018 to 2022 to find total eligible patients and then multiplied by the mean difference in annual cost between the strategies over this 5-year period. Simulated conditions were matched to those of the PACIFIC phase 3 randomized clinical trial and reasonable treatment strategies for metastatic NSCLC. All simulated patients begin disease free after having received radical treatment with chemoradiotherapy and are followed up as they progress to metastatic disease first-line treatment, metastatic disease second-line treatment, end-stage progressive disease, and death. The main outcome of this study was the incremental cost-effectiveness ratio of durvalumab consolidation therapy vs no consolidation therapy, given as aggregate cost of treatment per quality-adjusted life-year gained. Among 2 million simulated patients, durvalumab consolidation therapy was cost-effective compared with no consolidation therapy at a $100 000 per quality-adjusted life-year willingness-to-pay threshold, with an estimated incremental cost-effectiveness ratio of $67 421 per quality-adjusted life-year, and would contribute an additional $768 million to national cancer spending in year 1. The annual budgetary consequence would then decrease to $241 million in year 5. Durvalumab consolidation therapy represents an indication where expensive immunotherapies can be cost-effective. Treating with immunotherapy earlier in the course of cancer progression can provide significant value, despite having a substantial budgetary consequence.

Therapy to Obese Type 2 Diabetes Mellitus: How Far Will We Go Down the Wrong Road?

Traditional glucose-lowering chemical agents, including various types of insulin and insulin secretagogues, insulin sensitizers, gliptins, etc., are based on diabetic pathogenesis of insulin resistance (IR) and islet insufficiency. Numerous evidence-based medical studies have shown that these traditional hypoglycemic chemical agents do not provide cardiovascular benefit to patients with type 2 diabetes mellitus (T2DM) and may even increase the risk of all-cause mortality. Based on research evidence published to date, these studies show that overload of energy could increase the incidence and prevalence of T2DM, and reduction in the heat load can significantly reduce the incidence of T2DM. Therefore, the essence of T2DM is heat overload, meaning heat overload is the etiology of obese T2DM. At the same time, results of numerous studies show that heat overloading is the cause of IR. IR and islet dysfunction are protective factors in intervening with heat overload. These drugs, which are based on the mechanisms of IR and islet insufficiency, increase caloric reserve and cause or worsen obesity, which is equivalent to exacerbating the basic etiology and the cardiovascular risk factor of T2DM. Thus, a reasonable strategy for prevention and treatment of obese T2DM appears to promote the negative balance of calories and the elimination of caloric reserves. Chinese herbal medicines can promote negative balance of heat in many aspects, which can bring new hope for prevention and treatment of T2DM.

Catheter Ablation of Ventricular Tachycardia in Patients With a Ventricular Assist Device: ASystematic Review of Procedural Characteristics andOutcomes.

This is a systematic review summarizing the procedural characteristics and outcomes of ventricular assist device (VAD)-related ventricular tachycardia (VT) ablation. Drug-refractory VT refractory commonly develops post-VAD implantation. Procedural and outcome data come from small series or case reports. An electronic search was performed using major databases. Primary outcomes were VT recurrence, mortality, and cardiac transplantation. Secondary endpoints were acute procedural success and procedural complications. Eighteen studies were included, with a total of 110 patients (mean age 59.6 ± 11 years, 89% men; VT storm 34%). Scar-related re-entry was the predominant mechanism of VT (90.3%) and cannula-related VT in 19.3% cases. Electroanatomical mapping interference occurred in 1.8% of cases; there were no reports of catheter entrapment. Noninducibility of clinical VT was achieved in 77.9%; procedural complications occurred in 9.4%. At a mean follow-up of 263.5 ± 267.0 days, VT recurred in 43.6%, 23.4% underwent cardiac transplant, and 48.1% died. There were no procedural-related deaths and no death was directly related to ventricular arrhythmia. In follow-up, there was a significant reduction in implantable cardioverter-defibrillator therapies or shocks (57.1% vs. 23.8%). Ablation allowed VT storm termination in 90% of patients. VAD-related VT is predominantly related to pre-existing intrinsic myocardial scar rather than inflow cannula site insertion. Catheter ablation is a reasonable treatment strategy, albeit with expectedly high rate of recurrence, transplantation, and mortality related to severe underlying disease.

The main points in the treatment for retinoblastoma

Thanks to the treatment of retinoblastoma (RB) having improved significantly in recent years, there is an increasing trend to use conservative treatment modalities that aim to preserve the globe as well as vision with minimum mortality. RB therapy is a long-term systemic treatment in clinical practice. Although there are many treatment options for RB therapy, such as cryotherapy, photocoagulation, systemic chemotherapy, enucleation and ophthalmic chemotherapy, it is recommended to consider in accordance with the following key points in gaining a reasonable treatment strategies: to make sure that RB is an intraocular period; to determine whether the intraocular RB to be treated with eye preservation or enucleation; what is the case of eye preservation therapy combined with chemotherapy and how to arrange the follow-up of RB patients. It's more complicated to choice the therapeutic measures for RB in clinical practice. So, the patient's condition, economic capability and medical condition should be evaluated comprehensively. The principle of RB treatment should be followed, which is protecting eyeball and visual function without life damage. Key words: Retinoblastoma/surgery; Retinoblastoma/drug therapy; Chemotherapy, cancer, regional perfusion; Cryotherapy; Laser coagulation; Editorial

Advances in mechanism and treatment strategy of cancer

Cancer is one of the most serious diseases with high incidence and high mortality rate threaten human health and quality of life. The researches on mechanisms of cancer development and metastasis, and effective and reasonable treatment strategies are of great significance. The traditional treatments for tumors such as surgery, radiotherapy, and chemotherapy have some benefits, but many drawbacks such as drug-resistance and side-effects. With the emergence of new therapeutic methods such as tumor-targeted drugs and immune drugs, the survival of cancer patients is improved, but reports on cardiac damage caused by therapeutic drugs are increasing.

Multicenter Clinicopathological Study of High-Grade Serous Carcinoma Presenting as Primary Peritoneal Carcinoma.

We conducted a multicenter clinicopathological study to characterize patients with high-grade serous carcinoma presenting as primary peritoneal carcinoma (clinical PPC). At 9 sites in Japan, patients with clinical PPC diagnosed according to Gynecologic Oncology Group criteria were enrolled retrospectively. The Gynecologic Oncology Group criteria allow for minor ovarian involvement by high-grade serous carcinoma. There was no systematic detailed histopathological review of the fallopian tubes to determine whether they were involved by serous carcinoma. There were 139 patients and 64% were aged 60 years or older. Median pretreatment serum CA-125 was 1653.5 IU/mL. Pretreatment performance status was poor in more than 50%, endometrial cytology was positive in 40.3%, and the preoperative clinical diagnosis was correct in 72.7%. Primary debulking surgery was performed in 36% of patients, whereas 64% underwent neoadjuvant chemotherapy (NAC) with interval debulking surgery (IDS). The main tumor sites were the upper abdomen (greater omentum), extrapelvic peritoneum, mesentery, and diaphragm. Lymph node metastasis was found in 46.8% of patients undergoing systematic retroperitoneal node dissection. The optimal surgery rate was 32.0% with primary debulking surgery versus 53.9% with NAC and IDS (P = 0.0139). The response rate was 82.0% with NAC and 80.6% with postoperative chemotherapy. Median progression-free survival was 19.0 months and median overall survival was 41.0 months. Multivariate analysis showed that prognostic factors for progression-free survival were NAC and residual tumor diameter after debulking surgery, whereas the only prognostic factor for overall survival was the residual tumor diameter. This study identified various characteristics of clinical PPC. Neoadjuvant chemotherapy with IDS is a reasonable treatment strategy, and complete debulking surgery is optimum.

A simple patient-tailored aortic arch tangential angle measuring method to achieve better clinical results for thoracic endovascular repair of type B aortic dissection.

To report a simple individual tailored aortic arch tangential angle (θ-AATA) measuring method and its clinical application efficacy in the endovascular treatment of type B aortic dissection (AD). From January 2013 to December 2014, acute type B AD patients were prospectively enrolled and treated with endovascular therapy in our center. Among these patients, a specific method was applied to measure θ-AATA based on the axial images of the CT scan. The length of proximal landing zone (PLZ) of each patient was measured at the routinely applied left-anterior oblique (LAO) 45-degree and θ-AATA. Respective treatment strategies based on the length of the PLZ were planned accordingly, and the stent-graft was deployed under the fluoroscopy at θ-AATA. The occurrence of immediate type I endoleak was recorded during the completion angiogram, while the alignment of the proximal marks was determined under fluoroscopy at θ-AATA and at LAO-45-degree as well. Totally 76 patients with type B AD were prospectively enrolled. The average value of θ-AATA was 58.3±5.2 degrees, which was significantly larger than the routine 45 degrees (P<0.01). The mean landing zone length measured under θ-AATA (18.4±3.9 mm) was longer than that (15.9±3.1 mm) obtained at the routine LAO-45 degrees (P<0.05). Stent-grafts' deployment strategies were substantially changed accordingly. Alignment of the proximal marks was achieved in 72 patients (93.4%) under θ-AATA and only in two patients (2.7%) at LAO-45 degrees (P<0.01). All stent-grafts' implantation was successfully completed. No major type I endoleak was found in the immediate post-deployment angiography. It is easy to apply this patient-tailored θ-AATA measuring method in clinical practice. This more precise measurement is benefit for more reasonable treatment strategy planning, more precise deployment, and therefore a better outcome.

Acute dislocation of the patella: should these patients be operated on more often?

Primary patellar dislocations should be operated on more often after the first dislocation. The role of surgery for first-time traumatic patellar dislocations is emerging as a reasonable treatment strategy. In highly active patients under 25 years of age with a pathoanatomy predisposing to recurrent dislocation (trochlear dysplasia associated or not with patella alta) surgical treatment could be considered as a first line of treatment in the first-time patellar dislocation because the recurrence risk is unacceptably high. This recommendation is based on recurrence predictive models after a first-time patella dislocation and in cost effectiveness economic models. Moreover, we must incorporate individual circumstances and preferences (patient’s goals such as sports) into the decision protocols. Obviously we need high quality clinical trials describing anatomical abnormalities and medial patellofemoral ligament (MPFL) tear site, ideally multicentric ones, which compare surgical and conservative treatments after a first-time lateral patellar dislocation to definitely answer the question we ask ourselves in this paper.