Local Control and Toxicity of Multilevel Spine Stereotactic Body Radiotherapy

Neurosurgery ◽  
2019 ◽  
Author(s):  
Whitney H Beeler ◽  
Kelly A Speth ◽  
Michael T Broderick ◽  
Neil K Jairath ◽  
Dena Ballouz ◽  
...  
Keyword(s):  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Time To Event ◽  
Mixed Effect ◽  
Cox Models ◽  
Single Level ◽  
Mixed Effect Models ◽  
Random Intercept ◽  
Significant Difference ◽  
One Year

Abstract BACKGROUND Spine stereotactic body radiotherapy (sSBRT) is commonly limited to 1 or 2 vertebral levels given a paucity of efficacy and toxicity data when more than 2 levels are treated. OBJECTIVE To prove our hypothesis that multilevel sSBRT could provide similar rates of local control (LC) (primary endpoint) and toxicity as single-level treatment using the same clinical target, planning target, and planning organ-at-risk volumes. METHODS We analyzed consecutive cases of sSBRT treated from 2013 to 2017. Time-to-event outcomes for single-level and multilevel cases were compared using mixed effect Cox models and differences in toxicity rates were evaluated using linear mixed effect models. All models incorporate a patient-level random intercept to account for any within-patient correlation across cases. RESULTS There were 101 single-level and 84 multilevel sSBRT cases (2-7 continuous vertebral levels). One-year LC was 95% vs 85%, respectively. After adjusting for baseline covariates, dose delivered, and accounting for within-patient correlation, there was no significant difference in time to local failure (hazard ratio, HR 1.79 [0.59-5.4]; P = .30). Pain improved in 83.5% of the 139 initially symptomatic tumors. There were no significant differences in grade 2+ acute or late toxicities between single-level and multilevel sSBRT. CONCLUSION With rigorous patient immobilization, quality assurance, and image guidance, multilevel sSBRT provides high rates of LC, similar to single-level treatment, without need for larger planning volume margins. Efforts to improve prognostication and case selection for multilevel sSBRT are warranted to ensure that the benefits of improved LC over palliative radiation are justified.

scholarly journals Selenium level is associated withapoE ε4in rural elderly Chinese

2009 ◽  
Vol 12 (12) ◽  
pp. 2371-2376 ◽  
Author(s):  
Sujuan Gao ◽  
Yinlong Jin ◽  
Kathleen S Hall ◽  
Chaoke Liang ◽  
Frederick W Unverzagt ◽  
...  
Keyword(s):  
Random Effect ◽  
Rural Elderly ◽  
Mixed Effect ◽  
Apoe Ε4 ◽  
Mixed Effect Models ◽  
Significant Difference ◽  
Elderly Chinese ◽  
Chinese Cohort ◽  
And Gender

AbstractObjectiveSe is an essential trace element in human nutrition associated with antioxidant activity. Previous studies on predictors of toenail Se or serum Se have mostly concentrated on demographic factors such as age and gender. The present paper examines the association betweenapoEgenotype and Se levels in nail samples in a rural elderly Chinese cohort.DesignTwo thousand Chinese aged 65 years and over from four counties in China were enrolled in a cohort to study the association of Se with cognitive decline. Nail samples were collected from each participant and analysed for Se levels. Dietary Se intake was estimated from an FFQ using Se contents measured in food items collected from each village. Blood samples on filter cards were collected and analysed forapoEgenotype. Mixed-effect models were constructed with nail Se level as the dependent variable and each village as the random effect, which controlled for the potential confounding effect from correlation in Se measures obtained from participants residing in the same village.ResultsIn this elderly Chinese cohort, carriers of theapoE ε4allele had significantly lower Se levels measured in nail samples than non-carriers after adjusting for other significant covariates and controlling for estimated dietary Se intake. There was no significant difference between the two genotypes on estimated Se dietary intake (P= 0·6451).ConclusionsFuture studies are needed to examine the mechanism underlying the association between theapoE ε4allele and Se levels, including the role of oxidative stress and that of reduced lipid metabolism in theapoE ε4carriers.

Refractive change in children with accommodative esotropia

2019 ◽  
pp. bjophthalmol-2019-314891
Author(s):  
Lucas Bonafede ◽  
Lloyd Bender ◽  
James Shaffer ◽  
Gui-shuang Ying ◽  
Gil Binenbaum
Keyword(s):  
Refractive Error ◽  
Retrospective Cohort ◽  
Annual Change ◽  
Mixed Effect ◽  
Mixed Effect Models ◽  
Significant Difference ◽  
Refractive Change ◽  
Accommodative Esotropia ◽  
Measurable Change ◽  
Linear Mixed Effect Models

ObjectiveTo determine whether there is a measurable change in hyperopia in children with accommodative esotropia over time.Methods and analysisA retrospective cohort of children with fully or partially accommodative esotropia diagnosed by age 7 years, followed to age 10 or older, and with at least two cycloplegic refractions, one before age 7 years and one after age 10 years. The annual change was calculated from linear mixed-effect models, overall and during two age periods with subgroup analysis by baseline refractive error (<4D, ≥4D) and type (partial, full) of accommodative esotropia.Results405 subjects were studied. Mean age at first and last visit was 3.2 and 12.1 years, respectively, with mean 7.6 cycloplegic refractions. The annual change (95% CI) in refractive error was −0.071 (−0.087 to –0.055) D/yr. Between ages 3 and 7, hyperopia among children with baseline hyperopia <4D increased by 0.12 (0.08 to 0.16) D/yr, while hyperopia among those with baseline 4D or greater was stable (0.0D/yr, −0.03 to 0.04) (p<0.001). Hyperopia decreased from age 7 to 15 years in both subgroups: <4D subgroup −0.17 (−0.20 to –0.14) D/yr, ≥4D subgroup −0.18 (−0.21 to –0.15) D/yr (p=0.58). There was no significant difference in refractive change between fully (n=274) and partially (n=131) accommodative esotropia (p≥0.10).ConclusionHyperopia in children with accommodative esotropia is stable or increases up to age 7 years, depending on baseline hyperopia, but decreases gradually between ages 7 and 15 years regardless of baseline refractive error.

Comparison of stereotactic body radiotherapy and conventional external beam radiotherapy in renal cell carcinoma.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 434-434 ◽  
Author(s):  
Christopher L. Tinkle ◽  
Stephen Lawrence Shiao ◽  
Vivian K. Weinberg ◽  
Amy M. Lin ◽  
Alexander R. Gottschalk
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Renal Cell ◽  
External Beam Radiotherapy ◽  
Local Treatment ◽  
Multivariable Analysis ◽  
External Beam ◽  
Significant Difference

434 Background: Renal cell carcinoma (RCC) is considered a radiation-resistant histology, often with poor response to conventionally fractionated external beam radiotherapy (EBRT). We compared outcomes for patients treated with EBRT versus stereotactic body radiotherapy (SBRT) for RCC. Methods: From 2004 and 2012, a total of 89 patients were treated with either EBRT or SBRT and retrospectively reviewed. Patients with locally recurrent RCC, bone or soft tissue RCC metastases, or primary RCC in a solitary kidney were included. 51 patients received EBRT, while 38 patients received SBRT. The median biologically effective dose (BED), assuming an α/β ratio of 10, was 32.6 Gy10 for the EBRT group and 48.0 Gy10 for the SBRT group. Local failure (LC) was defined pathologically or by imaging according to RECIST 1.1 and toxicity reported according to CTCAE v4.0 guidelines. Univariable and multivariable analyses using Cox’s regression model was performed to determine predictors of local control. Results: Median follow up from RT was 9.8 mo (range: <1-73 mo) with EBRT and 19.7 mo (range: <1-61 mo) with SBRT (p=0.26). EBRT patients were younger (p=0.02) and more were M1 (p=0.04), yet other baseline features did not differ significantly. Total RT dose, dose/fraction, and BED10 were significantly higher in the SBRT group (p≤0.002 for each), while number of fractions was significantly fewer (p<0.001). The 1-year LC estimate was 88% (95% CI, 72-96%) with SBRT and 50% (95% CI, 32-65%) with EBRT (p=0.001), with no significant difference in rate of distant recurrences (p=0.37). The 1-year progression free survival (PFS) and overall survival (OS) between the EBRT and SBRT groups were 17% (95% CI, 8-29%) vs. 39% (95% CI, 24-54%) (p=0.06) and 39% (95% CI, 25-52%) vs. 82% (95% CI, 65-91%) (p=0.002), respectively. The use of SBRT was the most important independent factor significantly predictive of local control on multivariable analysis (p=0.001, LLR test; HR=0.29, 95% CI, 0.13-0.61), while neither age nor metastasis at diagnosis was predictive. No drade 3-4 toxicity was observed in either RT group. Conclusions: The data support that SBRT improves local control over standard fractionation schemes. Higher dose per fraction, with a BED in the range of 48 Gy10, is a safe and effective local treatment modality for RCC.

scholarly journals Switching to Integrase Inhibitors Unlinked to Weight Increase in Perinatally HIV-Infected Young Adults and Adolescents: A 10-Year Observational Study

2020 ◽  
Vol 8 (6) ◽  
pp. 864
Author(s):  
Lucia Taramasso ◽  
Antonio Di Biagio ◽  
Francesca Bovis ◽  
Federica Forlanini ◽  
Elena Albani ◽  
...  
Keyword(s):  
Weight Gain ◽  
Strand Transfer ◽  
Outpatient Services ◽  
Weight Changes ◽  
Mixed Effect ◽  
Mixed Effect Models ◽  
Significant Difference ◽  
Integrase Strand Transfer Inhibitors ◽  
Control Study

An unexpected increase in weight gain has recently been reported in the course of integrase strand transfer inhibitors (INSTI) treatment. The possibility of this effect in people who are perinatally infected with HIV (PHIV) and thus exposed to lifelong therapy needs to be explored. This is a retrospective multicenter case-control study. Adults with PHIV followed between 2010 and 2019 in two outpatient services in Northern Italy were included if they had at least two weight measures in two successive years of observation. Patients were considered as cases if they were switched to INSTI (INSTI group), or controls if they were never exposed to INSTI (non-INSTI group). The date of the switch in cases was considered to be the baseline (T0), while it was randomly selected in controls. Mixed effect models were used to assess the weight changes in INSTI and non-INSTI groups. A total of 66 participants, 50.0% women, 92.4% Caucasian, were included. Median follow-up was 9 years (range 2–10): 4 years (range 1–8) before and 3 (range 1–9) after-T0. Mean age at the last study visit was 27.3 (±4.8) years, and mean CD4+ T-cells were 820.8 (±323.6) cells/mm3. Forty-five patients were switched to INSTI during the study, while 21 remained in the non-INSTI group. The INSTI group experienced a mean increase (pre-post T0) in bodyweight of 0.28 kg/year (95% CI − 0.29; 0.85, p = 0.338), while in the non-INSTI group, the mean increase was 0.36 kg/year (95% CI − 0.47; 1.20, p = 0.391), without a significant difference between groups (p for interaction between time and treatment regimen = 0.868). Among patients on INSTI, the weight gain after T0 was higher than pre-T0, amounting to +0.28 kg/year (95% CI − 0.29; 0.85), although this difference did not reach significance (p = 0.337). PHIV switched to an INSTI-based regimen did not experience an excessive weight gain compared to those who were treated with a non-INSTI based regimen in our cohort.

Abstract 18435: ETCO2 Alone is Inadequate to Verify CPR Quality

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chengcheng Hu ◽  
Dan Spaite ◽  
Tyler Vadeboncoeur ◽  
Cameron Hypes ◽  
Ryan A Murphy ◽  
...  
Keyword(s):  
Secondary Analysis ◽  
Covariance Structure ◽  
Ventilation Rate ◽  
Quality Monitoring ◽  
Mixed Effect ◽  
Mixed Effect Models ◽  
Random Intercept ◽  
Wide Range ◽  
Cpr Quality ◽  
End Tidal

Background: Previous studies have described modest correlation between end-tidal CO 2 (ETCO 2 ) and CPR quality during resuscitation of cardiac arrest patients, but it is unclear whether ETCO 2 alone can indicate CPR quality. The present study investigated whether ETCO 2 adequately identifies the quality of CPR provided during out-of-hospital cardiac resuscitation. Methods: ETCO 2 was monitored with side-stream CO 2 (Philips/Respironics) and CPR quality measured with an accelerometer-based system (E Series, ZOLL Medical) during the treatment of consecutive adult OHCA patients with presumed cardiac etiology by 2 EMS agencies in the Arizona SHARE QI Program between 10/08-06/13. Minute-by-minute ETCO 2 and CPR quality were extracted. ETCO 2 values were log transformation to achieve approximate normality. Linear mixed effect models were fitted to use (transformed) ETCO 2 level to predict four CPR variables: chest compression (CC) depth, CC rate, CC release velocity (CCRV), and ventilation rate (VR). A random intercept for each case was included and a spatial power covariance structure assumed for measurements over time. Results: 230 subjects (median age 69 yrs, 69% male) with 1581 minutes of data were studied. Transformed ETCO 2 was significant for CC depth (p< 0.0001), CCRV (p=0.003) and VR (p<0.0001), but only explained 3.7%, 2.7%, and 10.0% of the total variance for these variables, respectively. Transformed ETCO 2 was not a significant predictor for CC rate (p=0.89). The Figure illustrates the overlap in CC depth over quartiles of ETCO 2 , demonstrating that any specific ETCO 2 level could be found over a wide range of CC depths. Conclusion: In this secondary analysis, ETCO 2 was not an independent indicator of CC rate but was a weak predictor for CC depth, CCRV and VR. These findings suggest that ETCO 2 may be not be an adequate substitute for CPR quality monitoring. Future studies should investigate how ETCO 2 and CPR quality monitoring can be used in conjunction to optimize CPR.

Comparing Three Different Contrast Sensitivity Tests in Adults and in Children with and without Amblyopia

2019 ◽  
Vol 236 (04) ◽  
pp. 434-437 ◽  
Author(s):  
Kerstin Ulrich ◽  
Anja Palmowski-Wolfe
Keyword(s):  
Contrast Sensitivity ◽  
Healthy Subjects ◽  
Floor Effect ◽  
Mixed Effect ◽  
Additional Information ◽  
Mixed Effect Models ◽  
Spatial Frequencies ◽  
Sensitivity Tests ◽  
Significant Difference ◽  
Linear Mixed Effect Models

Abstract Background Tests of contrast sensitivity (CS) are not routinely performed in the clinic, although CS is reduced in many conditions, such as amblyopia or glaucoma. This may be due to perceived time constraints or unaffordability of equipment. Patients and Methods Monocular CS functions obtained with the FACT, CSV 1000E, and Lea Symbols were compared in 19 healthy subjects aged 24 – 78 years and 24 subjects aged 5 – 16 years, 9 of whom had amblyopia. Results CS functions could be obtained with all three tests. The tests were equally comfortable for young and adult patients, and took less than 5 minutes to perform (one eye). All measured CSs at 3, 6, 12, and 18 cycles per degree (cpd), but the FACT included 1.5 cpd. Linear mixed effect models were performed. While there was no significant difference at low spatial frequencies, the Lea CS test showed a ceiling effect in that range, while the FACT showed a floor effect at high spatial frequencies. CS in amblyopic children did not differ between the contralateral and the amblyopic eye. Overall, amblyopic eyes had lower CS values than the control eyes and CS did not correlate significantly to visual acuity at distance. Conclusion All three CS tests could be usefully applied in the clinic in adults as well as children over the age of 4 years. Only the CSV 1000E exhibited neither a ceiling nor a floor effect. This was also the fastest test. In children with amblyopia, CS testing offers additional information on visual function. In contrast to previous reports, we did not find that the CSV and FACT are interchangeable.

scholarly journals Stereotactic body radiotherapy vs radiofrequency ablation in the treatment of hepatocellular carcinoma: a meta-analysis

2019 ◽  
Author(s):  
Yang-Xun Pan ◽  
Qian Long ◽  
Dan-Dan Hu ◽  
Yi-Zhen Fu ◽  
Jun-Cheng Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Meta Analysis ◽  
Tumor Burden ◽  
Eligibility Criteria ◽  
Post Transplant ◽  
Online Databases ◽  
Significant Difference

Abstract Background Both stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) are effective local treatments for hepatocellular carcinoma (HCC), but whether RFA is superior to SBRT is still controversial. Therefore, we performed a meta-analysis to compare the treatment outcomes of SBRT with RFA as curable or bridge intention.Methods We searched online databases for studies that compared treatment outcome for SBRT and RFA. Eligibility criteria included evaluation of local control, overall survival (OS), transplant rate, and post-transplant pathological necrosis.Results 10 retrospective studies with a total of 2732 patients were included. 2 studies were in favor of SBRT in local control, 2 studies preferred RFA in OS and others reported comparable outcomes for both. SBRT demonstrated significantly higher 1- and 3-year local control than RFA (OR 0.42, 95% CI 0.24 to 0.74, P =0.003; OR 0.54, 95% CI 0.37 to 0.80, P =0.002, respectively). However, SBRT reported significantly shorter 1- and 2-year OS (OR 1.52, 95% CI 1.21 to 1.90, P =0.0003; OR 1.66, 95% CI 1.38 to 2.01, P <0.00001, respectively). As bridge treatment, no significant difference was shown in transplant rate and post-transplant pathological necrosis rate (OR 0.57, 95% CI 0.32 to 1.03, P =0.060; OR 0.49, 95% CI 0.13 to 1.82, P =0.290, respectively).Conclusions This study demonstrates SBRT is able to complete a better local control for HCC than RFA, though the OS is inferior to RFA because of tumor burden or liver profiles of the enrolled studies. Well-designed, randomized, multicenter trials will be required to further investigate the conclusion.

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 484-489 ◽  
Author(s):  
Tom Barker ◽  
Felicity Evison ◽  
Ruth Benson ◽  
Alok Tiwari
Keyword(s):  
Venous Thromboembolism ◽  
Varicose Vein ◽  
Lower Incidence ◽  
Varicose Veins ◽  
Secondary Data ◽  
Foam Sclerotherapy ◽  
Increased Risk ◽  
Significant Difference ◽  
Chi Squared ◽  
One Year

Abstract. Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson’s Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15–0.35 % at 30 days, 0.26–0.50 % at 90 days, and 0.46–0.58 % at one year. At 30 days there was a significantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other significant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments.

Levels of Prothrombin Fragment F1+2 in Patients with Hyperhomocysteinemia and a History of Venous Thromboembolism

1997 ◽  
Vol 78 (05) ◽  
pp. 1327-1331 ◽  
Author(s):  
Paul A Kyrle ◽  
Andreas Stümpflen ◽  
Mirko Hirschl ◽  
Christine Bialonczyk ◽  
Kurt Herkner ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Thrombin Generation ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Control Group ◽  
Prothrombin Fragment ◽  
Hemostatic System ◽  
Significant Difference ◽  
System Activation ◽  
One Year

SummaryIncreased thrombin generation occurs in many individuals with inherited defects in the antithrombin or protein C anticoagulant pathways and is also seen in patients with thrombosis without a defined clotting abnormality. Hyperhomocysteinemia (H-HC) is an important risk factor of venous thromboembolism (VTE). We prospectively followed 48 patients with H-HC (median age 62 years, range 26-83; 18 males) and 183 patients (median age 50 years, range 18-85; 83 males) without H-HC for a period of up to one year. Prothrombin fragment Fl+2 (Fl+2) was determined in the patient’s plasma as a measure of thrombin generation during and at several time points after discontinuation of secondary thromboprophylaxis with oral anticoagulants. While on anticoagulants, patients with H-HC had significantly higher Fl+2 levels than patients without H-HC (mean 0.52 ± 0.49 nmol/1, median 0.4, range 0.2-2.8, versus 0.36 ± 0.2 nmol/1, median 0.3, range 0.1-2.1; p = 0.02). Three weeks and 3,6,9 and 12 months after discontinuation of oral anticoagulants, up to 20% of the patients with H-HC and 5 to 6% without H-HC had higher Fl+2 levels than a corresponding age- and sex-matched control group. 16% of the patients with H-HC and 4% of the patients without H-HC had either Fl+2 levels above the upper limit of normal controls at least at 2 occasions or (an) elevated Fl+2 level(s) followed by recurrent VTE. No statistical significant difference in the Fl+2 levels was seen between patients with and without H-HC. We conclude that a permanent hemostatic system activation is detectable in a proportion of patients with H-HC after discontinuation of oral anticoagulant therapy following VTE. Furthermore, secondary thromboprophylaxis with conventional doses of oral anticoagulants may not be sufficient to suppress hemostatic system activation in patients with H-HC.

Comparative Study between Endoscopic Aided Septoplasty with Two Handed Technique using Endoholder and Conventional Septoplasty

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Apar Pokharel ◽  
Naganawalachullu Jaya Prakash Mayya ◽  
Nabin Gautam
Keyword(s):  
Comparative Study ◽  
Nasal Septum ◽  
Deviated Nasal Septum ◽  
Endoscopic Septoplasty ◽  
Septal Surgery ◽  
Significant Difference ◽  
Common Causes ◽  
Prospective Comparative Study ◽  
Evolutionary Step ◽  
One Year

Introduction: Deviated nasal septum is one of the most common causes for the nasal obstruction. The objective of this study is to compare the surgical outcomes in patients undergoing conventional septoplasty and endoscopic septoplasty in the management of deviated nasal septum. Methods:  Prospective comparative study was conducted on 60 patients who presented to the Department of ENT, College of Medical sciences, during a period of one year. The severity of the symptoms was subjectively assessed using NOSE score and objectively assessed using modified Gertner plate. Results: There was significant improvement in functional outcome like NOSE Score and area over the Gertner plate among patients who underwent endoscopic septoplasty. Significant difference in incidence of post-operative nasal synechae and haemorrhage was seen in conventional group compared to endoscopic group. Conclusions: Endoscopic surgery is an evolutionary step towards solving the problems related to deviated nasal septum. It is safe, effective and conservative, alternative to conventional septal surgery.

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