Patient Treatment Time Research Articles

A New Approach for Effective Reliability Management of Biomedical Equipment

Within the modern hospitals, an increasingly common problem is the efficient management of the maintenance of biomedical equipment. If effective management of medical equipment maintenance is applied, quality health services could be provided by reducing the downtime of medical equipment as well as by decreasing the recovery time for treatment of patients. Risk based maintenance strategy helps in designing an alternative methodology to minimize the risk by identifying the breakdown pattern and then increasing the reliability. The probability of failures that obstruct the reliability can be influenced by some technical, administrative or management actions. The proposed study is based on the analysis of reliability and availability for maintenance planning on the basis of risk index and fault tree analysis. Maintenance of equipment is prioritized based on the risk which helps in reducing the overall risk of the hospital. Fault tree diagram is also developed to understand the actual scenario where highest priority or risk events are sequentially arranged. Failure probability for different biomedical equipment has been established by applying statistical method. It has been observed that Magnetic Resonance Imaging has the lowest risk index while X-Ray has the highest risk index. Also, maintenance planning has been suggested based on the reduction of risk factor to meet the acceptable criteria and reduce the probability of failure. This approach depicts that reliability of equipment is increased after implementation of maintenance planning proposed which contributes to the availability of the equipment as well as its safe operation.

Early low blood MALT1 expression levels forecast better efficacy of PD‑1 inhibitor‑based treatment in patients with metastatic colorectal cancer.

Mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1) modulates colorectal cancer (CRC) malignant behaviors and tumor immune escape. The present study aimed to explore the association of MALT1 with treatment response and survival time among patients with metastatic CRC (mCRC) after programmed cell death protein-1 (PD-1) inhibitor-based treatment. MALT1 from the blood samples of 75 patients with unresectable mCRC receiving PD-1 inhibitor-based treatment at baseline and after 2-cycle treatment, as well as 20 healthy controls (HCs), was detected by reverse transcription-quantitative PCR. In the patients with mCRC, the objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were calculated. MALT1 expression was elevated in patients with mCRC compared with that in HCs (P<0.001). In patients with mCRC, MALT1 expression was positively correlated with multiple (vs. single) metastasis (P=0.032) and peritoneum metastasis (P=0.029). MALT1 levels before treatment were decreased in ORR patients vs. non-ORR patients (P=0.043) and in DCR patients vs. non-DCR patients (P=0.007). Additionally, MALT1 expression was reduced after treatment compared with that before treatment (P<0.001). Meanwhile, MALT1 expression after treatment was notably decreased in ORR patients vs. non-ORR patients (P<0.001) and in DCR patients vs. non-DCR patients (P<0.001). Furthermore, a low MALT1 level before treatment was associated with longer PFS (P=0.030) and OS (P=0.025) times. Decreased MALT1 expression after treatment and a decline in MALT1 expression of >30% after treatment (ratio to MALT1 before treatment) (both P≤0.001) presented more significant associations with prolonged PFS and OS times. In conclusion, early low levels of blood MALT1 during therapy may predict an improved response to PD-1 inhibitor-based treatment and survival time in patients with mCRC.

When to treat: A multicenter retrospective study of timing of radiation therapy in 1p19q co-deleted, IDH mutated oligodendrogliomas.

e14036 Background: Oligodendrogliomas, molecularly defined by IDH mutation and 1p19q codeletion, have a protracted natural history and are more chemoresponsive compared to astrocytomas. While the addition of chemotherapy to radiation improves survival, if chemoradiation should be initiated following diagnosis or at progression remains unknown. Given the potential for early and late radiation-related toxicity, a careful evaluation of timing of treatment is critical to optimize treatment guidelines for oligodendroglioma. We aimed to evaluate the benefit of initial adjuvant radiation therapy (RT) on survival in patients with oligodendrogliomas. Methods: We conducted a multicenter retrospective study of patients treated at the University of Washington and Stanford Medical Center with oligodendrogliomas using both 1p19q codeletion and IDH mutation to define the diagnosis, reflecting the World Health Organization 2021 diagnostic criteria. Survival probability, overall survival (OS) and time to first progression (PFS), were calculated using Kaplan-Meier method with distributions compared using log-rank test in GraphPad Prism. Propensity Score Matching was completed using XLSTAT. Results: 243 patients were identified as oligodendroglioma and 229 had treatment and survival data available with a median follow up of 5.8 years(y). Median OS was 22.5y and median PFS was 5.35y. 110 patients were treated with adjuvant radiation (aRT) within 1y of diagnosis and 119 underwent observation or chemotherapy alone (delayed RT, or dRT). PFS was comparable between aRT (7.7y) and dRT (4.6y) but OS was longer in dRT (27.8y) than aRT (13.7y) (p &lt; 0.001). Given imbalance in baseline characteristics, propensity score matching was used to adjust for high risk factors of age, grade and presence of residual disease resulting in 63 pairs. In this matched cohort, aRT prolonged PFS (aRT = 7.75y v. dRT = 4.33y, p = 0.006) however dRT still demonstrated a survival benefit (p = 0.017). 59 dRT patients were treated with RT at progression and also had longer medan OS of 22.6y compared to 13.7y in the aRT (p = &lt; 0.0001). The time to RT for this cohort ranged be 1.1-19y. Conclusions: To our knowledge this is the largest retrospective study of molecularly defined oligodendrogliomas that includes treatment information. This study confirms the protracted natural history of this disease. In our multi-institution cohort, early adjuvant radiation therapy may increase PFS but was not found to prolong OS. Prospective studies evaluating the timing of treatment in patients with oligodendroglioma are needed. [Table: see text]

Comparison of high-intensity focused ultrasound for the treatment of internal and external adenomyosis based on magnetic resonance imaging classification

Objective To compare the safety and efficacy of high-intensity focused ultrasound (HIFU) treatment for patients with internal or external adenomyosis based on magnetic resonance imaging (MRI) classification. Materials and methods A total of 238 patients with internal adenomyosis and 167 patients with external adenomyosis who received HIFU treatment were enrolled. HIFU treatment results and adverse effects between patients with internal and external adenomyosis were compared. Results The treatment time and sonication time for patients with external adenomyosis were significantly longer than that for patients with internal adenomyosis. The total energy used and EEF for patients with external adenomyosis were higher than that for patients with internal adenomyosis (p < 0.05). The pre-HIFU median dysmenorrhea score in patients with internal or external adenomyosis was 5 or 8 points, the median score decreased to 1 or 3 points in these two groups at 18-month post-HIFU (p < 0.05). The relief rate of dysmenorrhea was 79.5% in patients with internal adenomyosis, and it was 80.8% in patients with external adenomyosis. The pre-HIFU median menorrhagia score in patients with internal or external adenomyosis was 4 or 3 points, the median score decreased to 1 point in both groups at 18-month post-HIFU with a relief rate of 86.2% and 77.1%, respectively (p = 0.030). No serious complication occurred in any of these patients. Conclusions HIFU is a safe and effective treatment either for patients with internal adenomyosis or external adenomyosis. It seemed that internal adenomyosis is easier to be treated with HIFU and with a higher relief rate of menorrhagia than external adenomyosis.

Insight into immune checkpoint inhibitor therapy for colorectal cancer from the perspective of circadian clocks.

Colorectal cancer (CRC) is one of the most common malignant tumours and the third most common cause of cancer deaths worldwide, with high morbidity and mortality. Circadian clocks are widespread in humans and temporally regulate physiologic functions to maintain homeostasis. Recent studies showed that circadian components were strong regulators of the tumour immune microenvironment (TIME) and the immunogenicity of CRC cells. Therefore, insight into immunotherapy from the perspective of circadian clocks can be promising. Although immunotherapy, especially immune checkpoint inhibitor (ICI) treatment, has been a milestone in cancer treatment, greater accuracy is still needed for selecting patients who will respond positively to immunotherapy with minimal side effects. In addition, there were few reviews focusing on the role of the circadian components in the TIME and the immunogenicity of CRC cells. Therefore, this review highlights the crosstalk between the TIME in CRC and the immunogenicity of CRC cells based on the circadian clocks. With the goal to achieve the possibility that patients with CRC can benefit most from the ICI treatment, we provide potential evidence and a novel idea for building a predictive framework combined with circadian factors, searching for enhancers of ICIs targeting circadian components and clinically implementing the timing of ICI treatment for patients with CRC.

Development of a Novel Method for the Clinical Visualization and Rapid Identification of Multidrug-Resistant Candida auris.

Outbreaks of multidrug-resistant Candida auris infections, associated with a mortality rate of 30% to 60%, are of serious global concern. Candida auris demonstrates high transmission rates in hospital settings; however, its rapid and accurate identification using currently available clinical identification techniques is challenging. In this study, we developed a rapid and effective method for detecting C. auris based on recombinase-aided amplification combined with lateral flow strips (RAA-LFS). We also screened the appropriate reaction conditions. Furthermore, we investigated the specificity and sensitivity of the detection system and its ability to distinguish other fungal strains. Candida auris was accurately identified and differentiated from related species at 37°C within 15 min. The minimum detection limit was 1 CFU (or 10 fg/reaction) and was not affected by high concentrations of related species or host DNA. The simple and cost-efficient detection method established in this study exhibited high specificity and sensitivity and successfully detected C. auris in simulated clinical samples. Compared with other traditional detection methods, this method greatly reduces the time and cost of testing and is thus suitable for hospitals or clinics in remote underfunded areas for screening C. auris infection and colonization. IMPORTANCE Candida auris is a highly lethal, multidrug-resistant, invasive fungus. However, conventional methods of C. auris identification are time-consuming and laborious and have low sensitivity and high error rates. In this study, a new molecular diagnostic method based on recombinase-aided amplification combined with lateral flow strips (RAA-LFS) was developed, and accurate results could be obtained by catalyzing the reaction at body temperature for 15 min. This method can be used for rapid clinical detection of C. auris, consequently saving valuable treatment time for patients.

Use of Tenecteplase in Acute Ischemic Stroke in the Time of SARS-CoV-2.

Tenecteplase (TNK) is a fibrinolytic drug that is administrated in a single bolus, recommended in eligible patients with acute ischemic stroke prior to mechanical thrombectomy. This study explores its usefulness in adverse situations, such as the SARS-CoV-2 pandemic. We conducted a retrospective study involving consecutive patients with suspected acute ischemic stroke treated either with intravenous fibrinolysis with alteplase during 2019 or with TNK (.25 mg/kg) between March 2020 and February 2021. A comparative analysis was made to compare patient treatment times and prognosis. A total of 117 patients treated with alteplase and 92 with TNK were included. No significant differences were observed in age, main vascular risk factors or previous treatments. The median National Institutes of Health Stroke Scale was 8 in the alteplase group and 10 in those treated with TNK (P = .13). Combined treatment with mechanical thrombectomy was performed in 47% in the alteplase group and 46.7% in the TNK group; Thrombolysis In Cerebral Infarction scale 2b-3 recanalization was achieved in 83% and 90.7%, respectively (P = .30). There was a decrease in onset-to-needle median time (165min vs 140min, P < .01) and no significant variations in door-needle median time. There was no significant difference in the incidence of symptomatic hemorrhagic transformation in mortality or functional independence at 3months. The easier administration of TNK has improved the accessibility of fibrinolytic therapy, even in adverse circumstances, such as the COVID-19 pandemic. Its use appears to be safe and effective, even in patients who are not candidates for mechanical thrombectomy.

Near-infrared phototheranostics of tumors with protoporphyrin IX and chlorin e6 photosensitizers

BackgroundThe study aims to develop a method for phototheranostics of tumors in the near-infrared (NIR) range using protoporphyrin IX (PpIX) and chlorin e6 (Ce6) photosensitizers (PSs) Materials and MethodsPhototheranostics includes spectral fluorescence diagnostics of PS distribution and photodynamic therapy (PDT) using a single laser in the red spectral range. PpIX and Ce6 fluorescence were registered in the NIR range. PpIX and Ce6 photobleaching was determined during PDT by the change in PS fluorescence. NIR phototheranostics with PpIX and Ce6 were performed on optical phantoms and tumors of patients with oral leukoplakia and basal cell carcinoma. ResultsNIR spectral fluorescence diagnostics of optical phantoms with PpIX or Ce6 is possible when fluorescence is excited by 635 or 660 nm lasers. Fluorescence intensity of PpIX and Ce6 was measured in the range of 725–780 nm. The highest values of signal-to-noise in the case of phantoms with PpIX were observed at λexc=635 nm, and for phantoms with Ce6 at λexc=660 nm. NIR phototheranostics provides the detection of tumor tissues with PpIX or Ce6 accumulation. The PSs photobleaching in the tumor during PDT occurs according to a bi-exponential law. ConclusionPhototheranostics of tumors containing PpIX or Ce6 allows fluorescent monitoring of PS distribution in the NIR range and measuring PSs photobleaching during light exposure that provides personalization of the photodynamic exposure duration to deeper tumors. Using a single laser for fluorescence diagnostics and PDT reduces patient treatment time.

An appropriate and cost-effective hospital recommender system for a patient of rural area using deep reinforcement learning

Insufficient doctors and nurses enable a weak healthcare system in developing and undeveloped countries. This study aims to mitigate the demand-supply gap of doctor patients of an undeveloped or developing county. We observe people in a rural area, unaware of an appropriate hospital and doctors for their disease, and randomly go to the nearest hospital to check-up their health. However, each doctor has expertise in a specific disease, and hospitals' treatment performance varies. As a result, the patient engages multiple doctors and hospitals to cure their disease. This study develops as an appropriate and cost-effective hospital recommender system for a specific disease to provide the best hospital to a patient using deep reinforcement learning. Hence, the patient's treatment time, insignificant medicine consumption, the side effect of using inappropriate medicine, and a doctor's load can be minimized using the developed hospital recommender system.

Serial viral load analysis by DDPCR to evaluate FNC efficacy and safety in the treatment of mild cases of COVID-19.

The SARS-CoV-2 outbreak has threatened the human population globally as the numbers of reinfection cases even after large-scale vaccination. Trials have been carried out to find drugs effective in fighting the disease, as COVID-19 is being considered a treatable disease only after we have antivirals. A clinical candidate originally developed for HIV treatment, AZVUDINE (FNC), is a promising drug in the treatment of COVID-19. To predict the clinical outcome of COVID-19, we examined the course of viral load, every 48 h, by RT-PCR, and disease severity using an antiviral drug, FNC, with 281 participants. A randomized clinical trial was performed to evaluate the efficacy of FNC added to standard treatment, compared with placebo group added to standard treatment, for patients with mild COVID-19. RT-qPCR and ddPCR were applied to estimate the viral load in samples from patients. Also, the clinical improvement was evaluated as well as the liver and kidney function. Notably, the FNC treatment in the mild COVID-19 patients may shorten the time of the nucleic acid negative conversion (NANC) versus placebo group. In addition, the FNC was effective in reducing the viral load of these participants. The present clinical trial results showed that the FNC accelerate the elimination of the virus in and could reduce treatment time of mild patients and save a lot of medical resources, making it a strong candidate for the outpatient and home treatment of COVID-19. https://clinicaltrials.gov/ct2/show/NCT05033145, identifier NCT05033145.

Mechanical thrombectomy for in-hospital stroke: data from the Italian Registry of Endovascular Treatment in Acute Stroke

BackgroundThe benefit, safety, and time intervals of mechanical thrombectomy (MT) in patients with in-hospital stroke (IHS) are unclear. We sought to evaluate the outcomes and treatment times for IHS patients...

Early Thrombomodulin Improved Disseminated Intravascular Coagulation After Cardiac Surgery

BackgroundDisseminated intravascular coagulation (DIC) is a fatal complication in postoperative patients. Recombinant human thrombomodulin (rhTM) has been used to treat DIC in some settings; however, the use of rhTM as a therapy for DIC has not been established in the field of cardiovascular surgery. This study aimed to investigate the efficacy and optimal timing of rhTM treatment in patients with DIC after cardiovascular operation. MethodsData were retrospectively collected from patients in whom DIC developed after open cardiac operation and who were treated with rhTM. DIC scores, laboratory data, and major complications were assessed. The end point was the 30-day all-cause mortality. Risk factors influencing mortality were extracted for the survival and nonsurvival groups. ResultsA total of 27 patients with postoperative DIC were treated with rhTM. The 30-day mortality rate was 51.9%. Multivariate analysis revealed that rhTM administration ≥5 days after DIC diagnosis was associated with increased mortality. The early administration group (≤4 days after DIC diagnosis) showed significantly improved DIC scores, reduced C-reactive protein levels, and increased number of platelets after rhTM treatment compared with before treatment. ConclusionsEarly administration of rhTM after DIC diagnosis was associated with a decreased 30-day mortality rate in patients after cardiovascular operation.

One-stage revision reconstruction of the anterior cruciate ligament using autograft: retrospective cohort study

BACKGROUND: Revision reconstruction of the anterior cruciate ligament (ACL) is a technically more complex procedure than primary reconstruction. Recurrence of anterior instability is most often associated with a technical error during the primary operation. The primary task of revision reconstruction is to identify the cause of recurrence of anterior instability and careful preoperative planning. Thus, the principles of ACL anatomical location to be essential restore stability. This paper discusses options for revision anatomical reconstruction of the ACL, including surgical technique, preoperative preparation, and choice of autograft material.&#x0D; AIM: This study aimed to evaluate the results of a one-stage revision reconstruction of the ACL and show that this method can be performed in one stage, rather than in two stages, which will lead to a reduction in the patients recovery time and return to usual physical activity.&#x0D; MATERIALS AND METHODS: To monitor the long-term treatment results, 50 of 92 patients with revision through one-stage ACL reconstruction, who were examined 9, and 12 months after surgery, were enrolled. All patients were young, who were working from age 18 to 42 years. The mean age was 29 years. This group included only male patients. As a graft material, all patients underwent sampling of the tendons of the fine and semitendinous muscles from the diseased or the contralateral limb. To assess the treatment results, the IKDC scale, Lysholm scale, arthrometric testing on KT-1000, and functional tests were conducted.&#x0D; RESULTS: The use of developed surgical approaches made it possible to obtain good treatment results in patients with recurrences of anterior instability according to the Lysholm score of 82 points. Grade II residual lateral instability was observed in two (4%) patients in the observed group and in seven (14%) patients in the control group. According to the subjective assessment of treatment outcomes, 19 patients (38%) remained satisfied with them.&#x0D; CONCLUSION: The practical application of the proposed options for the location of the channels and methods for fixing the autograft in the intraosseous channels make it possible to perform revision arthroscopic reconstruction of the ACL in one stage, without additional bone grafting of the channels, which in turn reduces the treatment and recovery time of patients, as evidenced by the results.

Abstract TMP41: Machine Learning-Enabled Automated Large Vessel Occlusion Detection Improves Treatment Times: A Multi-Center Cluster Randomized Clinical Trial

Introduction: Automated LVO detection from CT angiography may improve treatment times in LVO acute ischemic stroke (AIS), as suggested by prior single center non-randomized studies. Here, we perform a cluster randomized trial to evaluate this question with improved rigor. Methods: We performed a cluster randomized stepped wedge clinical trial across four comprehensive stroke centers January 2021 to February 2022. An automated LVO detection software (Viz.AI) was implemented at the 4 hospitals in a stepped fashion, with a randomly determined order (Figure 1). We included patients who underwent EVT. Patients presenting within the 2-week software transition period were excluded. The primary outcome was door-to-groin puncture time (DTG) adjusted for age, sex and NIHSS and was determined using a mixed-effect linear regression, with a random effect for cluster (hospital site) and fixed effect for exposure status. Results: Among 249 patients that met inclusion criteria, median age was 67 [IQR 57-79], NIHSS 17 [IQR 11-22] and 50.6% were female. Median time from last known well to arrival was 222 minutes and 90% had ASPECTS ≥ 8. A total of 199 patients were treated in the unexposed period and 50 in the exposed. In univariable analysis, median DTG improved in the unexposed vs. exposed periods (91 min [IQR 63 - 108 min] vs. 73 [IQR 32-102 min], p&lt;0.05). In multivariable adjusted mixed-effects model, DTG improved by approximately 15 minutes [4 - 26 min, 95% CI, p&lt;0.01]. Discussion: In a multi-center cluster randomized trial, implementation of an automated LVO detection algorithm improved treatment times in patients with LVO AIS.

Lithium affects the circadian clock in the choroid plexus – A new role for an old mechanism

Lithium is an effective mood stabilizer, but the mechanism of its therapeutic action is not well understood. We investigated the effect of lithium on the circadian clock located in the ventricle barrier complex containing the choroid plexus (CP), a part of the glymphatic system that influences gross brain function via the production of cerebrospinal fluid. The mPer2Luc mice were injected with lithium chloride (LiCl) or vehicle, and their effects on the clock gene Nr1d1 in CP were detected by RT qPCR. CP organotypic explants were prepared to monitor bioluminescence rhythms in real time and examine the responses of the CP clock to LiCl and inhibitors of glycogen synthase kinase-3 (CHIR-99021) and protein kinase C (chelerythrine). LiCl affected Nr1d1 expression levels in CP in vivo and dose-dependently delayed the phase and prolonged the period of the CP clock in vitro. LiCl and CHIR-99021 had different effects on 1] CP clock parameters (amplitude, period, phase), 2] dexamethasone-induced phase shifts of the CP clock, and 3] dynamics of PER2 degradation and de novo accumulation. LiCl-induced phase delays were significantly reduced by chelerythrine, suggesting the involvement of PKC activity. The effects on the CP clock may be involved in the therapeutic effects of lithium and hypothetically improve brain function in psychiatric patients by aligning the function of the CP clock-related glymphatic system with the sleep-wake cycle. Importantly, our data argue for personalized timing of lithium treatment in BD patients.

Automated Pneumonia Based Lung Diseases Classification with Robust Technique Based on a Customized Deep Learning Approach.

Many people have been affected by infectious lung diseases (ILD). With the outbreak of the COVID-19 disease in the last few years, many people have waited for weeks to recover in the intensive care wards of hospitals. Therefore, early diagnosis of ILD is of great importance to reduce the occupancy rates of health institutions and the treatment time of patients. Many artificial intelligence-based studies have been carried out in detecting and classifying diseases from medical images using imaging applications. The most important goal of these studies was to increase classification performance and model reliability. In this approach, a powerful algorithm based on a new customized deep learning model (ACL model), which trained synchronously with the attention and LSTM model with CNN models, was proposed to classify healthy, COVID-19 and Pneumonia. The important stains and traces in the chest X-ray (CX-R) image were emphasized with the marker-controlled watershed (MCW) segmentation algorithm. The ACL model was trained for different training-test ratios (90-10%, 80-20%, and 70-30%). For 90-10%, 80-20%, and 70-30% training-test ratios, accuracy scores were 100%, 96%, and 96%, respectively. The best performance results were obtained compared to the existing methods. In addition, the contribution of the strategies utilized in the proposed model to classification performance was analyzed in detail. Deep learning-based applications can be used as a useful decision support tool for physicians in the early diagnosis of ILD diseases. However, for the reliability of these applications, it is necessary to undertake verification with many datasets.

Reperfusion measurements, treatment time, and outcomes in patients receiving endovascular treatment within 24 hours of last known well.

The aim of this study was to explore the interaction between reperfusion and treatment time on the outcomes of patients undergoing endovascular treatment presenting within 24 h of last known well, and to compare the predictive ability of different reperfusion measurements on outcomes. Eligible patients from a single-center cohort were enrolled in this study. Reperfusion was assessed using reperfusion index (decreased volume of hypoperfusion lesion compared with baseline) measured by repeated perfusion imaging, and modified treatment in cerebral ischemia score measured by digital subtraction angiography, respectively. The interactions between reperfusion measurements and treatment time on outcomes were explored using multivariate-adjusted logistic and linear regression models. The predictive abilities of reperfusion measurements on outcomes were compared using area under the receiver operating characteristic curve (ROC-AUC) and values of R-square. Reperfusion index and treatment time had significant interactions on 3-month modified Rankin Scale (mRS) 0-2 and infarct growth (p for interaction <0.05). Although the AUCs were statistically similar (AUCs of mRS 0-2 prediction, mTICI≥2b:0.63, mTICI≥2c:0.59, reperfusion index≥0.5:0.66, reperfusion index ≥0.9:0.73, P value of any of the two AUCs >0.05), reperfusion index≥0.9 showed the highest R-square values in outcome prediction (R-square values of 3-month mRS 0-2 and infarct growth=0.21) among all the reperfusion measurements. Treatment time mitigated the effect of reperfusion on outcomes of patients receiving endovascular treatment within 24 h of last known well. Reperfusion index≥0.9 might serve as a better proxy of good outcomes compared with other reperfusion measurements.

Changes in the urine proteome in patients with advanced lung cancer after different drug treatments

Lung cancer is one of the most threatening diseases to human life and health because of its mortality. How to choose more efficient drugs and the appropriate timing of treatment for patients with advanced lung cancer is still a problem. As the urine proteome can sensitively reflect the pathological or physiological changes of the body, it has the potential to reflect the dynamic changes of the body after drug treatment. To investigate the changes in the urine proteome of patients with advanced lung cancer after different drug treatments, urine samples were collected and analyzed at different time points. The changes in the urine proteome from the pretreatment state were different in each patient and the changes in the biological processes were consistent with the changes in the clinical manifestations of the patients. This study demonstrates that the pathophysiological changes of patients with advanced lung cancer can be reflected by changes in urinary protein after different drug treatments. In addition, the changes in urinary proteins can reflect the different biological processes in patients after the same drug treatment, and the patients’ clinical condition assessment results are consistent with these changes. These findings may provide additional information for clinical treatment.

Timing and duration of bevacizumab treatment and survival in patients with recurrent ovarian, fallopian tube, and peritoneal cancer: a multi-institution study.

Bevacizumab has demonstrated significant benefit in recurrent ovarian, fallopian tube and peritoneal cancer (OC), but its optimal position within the sequence of systemic therapies remains controversial. Since rebound progression after bevacizumab has been observed in other cancers, and because bevacizumab is incorporated in several regimens used in the recurrent setting, the duration of treatment may impact survival. We sought to identify whether earlier bevacizumab exposure is associated with prolonged bevacizumab therapy and survival by conducting a multi-institution retrospective study of recurrent OC patients treated with bevacizumab from 2004-2014. Multivariate logistic regression identified factors associated with receiving more than six bevacizumab cycles. Overall survival by duration and ordinal sequence of bevacizumab therapy were evaluated using logrank testing and Cox regression. In total, 318 patients were identified. 89.1% had stage III or IV disease; 36% had primary platinum resistance; 40.5% received two or fewer prior chemotherapy regimens. Multivariate logistic regression demonstrated that primary platinum sensitivity (Odds Ratio (OR) 2.34, p = 0.001) or initiating bevacizumab at the first or second recurrence (OR 2.73, p < 0.001) were independently associated with receiving more than six cycles of bevacizumab. Receiving more cycles of bevacizumab was associated with improved overall survival whether measured from time of diagnosis (logrank p < 0.001), bevacizumab initiation (logrank p < 0.001), or bevacizumab discontinuation (logrank p = 0.017). Waiting one additional recurrence to initiate bevacizumab resulted in a 27% increased hazard of death (Hazard Ratio (HR) 1.27, p < 0.001) by multivariate analysis. In conclusion, patients with primary platinum sensitive disease who received fewer prior lines of chemotherapy were able to receive more cycles of bevacizumab, which was associated with improved overall survival. Survival worsened when bevacizumab was initiated later in the ordinal sequence of therapies.

A controllable thoracolumbar external fixation brace

Based on the theoretical basis of "dynamic and static combination" in traditional Chinese medicine, a controllable thoracolumbar external fixation brace was developed. Using new photosensitive resin materials, combined with three-dimensional modeling technology and 3D printing technology, a controllable thoracolumbar external fixation brace was designed and developed. In this study, the new adjustable thoracolumbar spine brace can fix and support the body to assist in restoring the biomechanical stability of the spine, and has a better therapeutic effect on shortening the bed treatment time of patients with thoracic and lumbar compression fractures.