Echocardiographic evaluation of left ventricular diastolic function in patients with diastolic heart failure and comparative study of real‐time cardiac catheterization / 中华超声影像学杂志

Objective To evaluate the left ventricular diastolic function of patients with normal left ventricular ejection fraction ( LVEF) by echocardiography and real‐time cardiac catheter measurement ,and improve the accuracy and reliability of echocardiographic diagnosis . Methods One hundred and twenty patients with know n or suspected coronary artery disease w ho underwent coronary angiography and left ventricular catheterization were prospectively selected from July 2017 to January 2018 in the Affiliated Hospital of Jiangsu University . According to the left ventricular end diastolic pressure ( LVEDP) real‐time measurement ,the patients were divided into groups of LVEDP ≤15 mm Hg ( 43 cases ) and LVEDP ＞ 15 mm Hg ( 77 cases) . General data were compared and the difference of echocardiographic parameters between the two groups were analyzed ,and the ROC curve of each echocardiographic parameter for diagnosing LVEDP was draw n . Results T he parameters including flow propagation velocity ( VP) ,the ratio of filling fraction of E and A ( E/A) ,early diastolic filling deceleration time ( DT ) ,the duration of mitral A ( A‐dur ,) mitral annulus velocity at the septal side ( e′sep) ,systolic pulmonary venous flow velocity ( PVs) ,diastolic pulmonary venous flow velocity ( PVd ) and PVs/PVd were used to the diagnosis of the increasing of LVEDP ,however their accuracies were low ( AUC between 0 .5～0 .7) . T he parameters including left atrial volume index ( LAVI ) , tricuspid regurgitation ( T Rmax ) ,mitral annulus velocity in lateral wall of left ventricle ( e′lat ) ,average e′,E/e′sep ,E/e′lat ,average E/e′,velocity of pulmonary vein atrial reversal ( PVa) ,pulmonary vein atrial reversal duration ( Pva‐dur) ,the difference between the duration of pulmonary venous A wave and mitral A wave( PvaD‐AD) were also used to the diagnosis of the increasing of LVEDP , but their accuracies were still poor ( AUC between 0 .7～0 .9 ) . According to the real‐time left ventricular pressure measurement and different parameters of echocardiography ,the multivariate regression equation :LVEDP＝ 0 .292 LAVI + 0 .35 PVa + 0 .04 T Rmax + 0 .075 ( PvaD‐AD ) －0 .109 PVs －6 .773 was put forward as a correction standard ,the accuracy of the diagnosis of LVEDP was significantly improved ( AUC ＝0 .922) . Conclusions T he assessment of left ventricular diastolic function needs to be performed comprehensively with multiple parameters . T he multiple regression equation can accurately evaluate left ventricular diastolic function in patients with normal LVEF .

Application of computer-assisted system in surgery for pediatric solid pseudopapillary tumor / 中华实用儿科临床杂志

Objective@#To explore the value of Hisense computer-assisted surgical systems (CAS) for precise surgery of pediatric solid pseudopapillary tumor.@*Methods@#A total of 5 cases with pancreatic solid pseudopapi-llary tumor who were admitted at the Affiliated Hospital of Qingdao University from June 2015 to September 2018 were adopting.Upper abdominal 64-slice dynamic enhanced computed tomography (CT) scan was performed.3D models were created by computer-assisted surgery systems.Based on 3D model, surgical planning, preoperative simulated tumor resection, intraoperative assisted guidance were performed.Operation time, intraoperative blood loss volume, blood transfusion rate were analyzed.@*Results@#Hisense CAS three-dimensional reconstruction could clearly show the adjacent relationship between pancreas, tumor and peripheral vascular organs.According to the preoperative virtual resection, pancreatic tumor resection was more accurate.Postoperative pathological results were solid pseudopapillary tumor of the pancreas.Among them, 2 tumors were located in the head of the pancreas, 1 case was located in the pancreatic neck, and 2 cases in the tail of the pancreas.The operation time was 150-360 min, with an average of 279 min.The average intraoperative blood loss was 40 mL, of which the minimum amount of bleeding was 5 mL, and the blood transfusion rate was 40%(2/5 cases). Surgical tumor removal was achieved successfully in 5 cases.All children were followed up for 6 months to 3 years, and no recurrence or metastasis was observed.@*Conclusions@#Three-dimensional reconstruction of computer-assisted surgery system can clearly show the adjacent relationship between tumor and surroun-ding vascular organs, and help to make the best surgical plan before surgery to improve the accuracy and safety of the operation.

PET and MRI-guided focused ultrasound surgery for hypoxic-tissue ablation combined with radiotherapy in solid tumors

The rationale was to develop an ablation approach to destroy regions of tumor resistant to radiation and thus reduce the time required for whole tumor ablation, while improving overall tumor control after radiotherapy. The system is composed of a micro positron emission tomography [mPET], 7T magnetic resonance imaging [MRI], and a customized MRI-compatible focused ultrasound applicator. 18F-fluoromisonidazole [18F-miso] radioactive tracer delineated hypoxic regions based on a threshold tumor/muscle activity ratio. 18F-miso PET/MRI fused images were used for targeting tumor hypoxic regions for focused ultrasound ablation. With MRI real-time temperature imaging guidance, PET-detected hypoxic regions of tumor could be selectively ablated to temperatures [T>55 [degree]C]. In vivo validation experiments were performed in SCK and 4T1 murine mammary carcinomas. In two tumor response assays, sequence dependence of combined radiotherapy and ablation was studied in the SCK tumor model. Tumor ablation was performed using a conductive probe or focused ultrasound and ionizing radiation administered in single doses of 15-20 Gy. Tumor growth was abolished when ablation was applied immediately AFTER radiation while interestingly; when ablation was administered immediately BEFORE radiation, there was no difference in observed growth delay compared to ablation or radiation alone. PET and MRI guided focused ultrasound surgery [MRgFUS] of tumor hypoxic regions is feasible and will be potentially useful for preclinical studies using ultrasound, radiation or chemotherapy. This study suggests that radiation precedes ablative therapy to avoid unwanted stress response or additional hypoxia induced by the ablation, potentially confounding the improved response potential for combined therapy

Immune checkpoint inhibitors in clinical trials / 癌症

Immunology-based therapy is rapidly developing into an effective treatment option for a surprising range of cancers. We have learned over the last decade that powerful immunologic effector cells may be blocked by inhibitory regulatory pathways controlled by specific molecules often called "immune checkpoints." These checkpoints serve to control or turn off the immune response when it is no longer needed to prevent tissue injury and autoimmunity. Cancer cells have learned or evolved to use these mechanisms to evade immune control and elimination. The development of a new therapeutic class of drugs that inhibit these inhibitory pathways has recently emerged as a potent strategy in oncology. Three sets of agents have emerged in clinical trials exploiting this strategy. These agents are antibody-based therapies targeting cytotoxic T-lymphocyte antigen 4 (CTLA4), programmed cell death 1 (PD-1), and programmed cell death ligand 1 (PD-L1). These inhibitors of immune inhibition have demonstrated extensive activity as single agents and in combinations. Clinical responses have been seen in melanoma, renal cell carcinoma, non-small cell lung cancer, and several other tumor types. Despite the autoimmune or inflammatory immune-mediated adverse effects which have been seen, the responses and overall survival benefits exhibited thus far warrant further clinical development.

Breakthrough cancer medicine and its impact on novel drug development in China: report of the US Chinese Anti-Cancer Association (USCACA) and Chinese Society of Clinical Oncology (CSCO) Joint Session at the 17th CSCO Annual Meeting / 癌症

The US Chinese Anti-Cancer Association (USCACA) teamed up with Chinese Society of Clinical Oncology (CSCO) to host a joint session at the17th CSCO Annual Meeting on September 20th, 2014 in Xiamen, China. With a focus on breakthrough cancer medicines, the session featured innovative approaches to evaluate breakthrough agents and established a platform to interactively share successful experiences from case studies of 6 novel agents from both the United States and China. The goal of the session is to inspire scientific and practical considerations for clinical trial design and strategy to expedite cancer drug development in China. A panel discussion further provided in-depth advice on advancing both early and full development of novel cancer medicines in China.

IGF-1R as an anti-cancer target--trials and tribulations / 癌症

Type I insulin-like growth factor receptor (IGF-1R) has long been recognized for its role in tumorigenesis and growth, but only recently have the tools for targeting the IGF pathway become available. More than 10 IGF/IGF-1R inhibitors have entered clinical trials, and these belong to three main classes: (1) monoclonal antibodies against IGF-1R, (2) monoclonal antibodies against IGF-1R ligands (IGF-1 and IGF-2), and (3) IGF-1R tyrosine kinase inhibitors. These IGF-1R-targeting agents share common effects on IGF-1R signaling but differ in mechanisms of action, spectrum of target inhibition, and pharmacological features. Clinical activity of IGF-1R inhibitors has been demonstrated with sustained responses in a small number of patients with select tumor types, such as Ewing sarcoma and thymoma. However, many large clinical trials involving patients with adult tumors, including non-small cell lung cancer, breast cancer, and pancreatic cancer, failed to show clinical benefit in the overall patient population. Possible reasons for failure include the complexity of the IGF-1R/insulin receptor system and parallel growth and survival pathways, as well as a lack of patient selection markers. While IGF-1R remains a valid target for selected tumor types, identification of predictive markers and rational combinations will be critical to success in future development.

Examining a hybrid plug-flow pilot reactor for anaerobic digestion of farm-based biodegradable solids

Plug-flow digesters with periodic loading mechanism are more enthusiastic than fully mechanized digestion plants for the majority of small or medium scale farms according to the costs and operational complexities. A dual-compartment plug-flow reactor equipped with a passive heating system was designed and experimentally operated by purpose of demonstrating a simple and low cost technology for handling the biodegradable agricultural wastes. The reactor was successfully started up with pig feces as feedstock under a quasi-continuous loading and semi-dry condition with an average total solids content of 12.8% inside the digester and an average organic loading rate of 2.06kg-VS/[m[3].d]. The start-up phase was followed by co-digestion of pig feces and pre-treated cotton stalk. Even though the digester actually worked at a temperature range 12 to 30% below the optimal mesophilic level, acceptable rates of methane generation and VS destruction were observed. The biogas and methane yield were measured for single digestion stage as 0.332 and 0.202 m[3] [kg-added VS] and for co-digestion stage as 0.482 and 0.325 m[3] [kg-added VS] respectively. The cumulative biogas production data demonstrated a reasonable correlation [R[2] over 0.99] with a simplified consecutive kinetic model