Tumor-associated antigens (TAAs) have been tested in various clinical trials in cancer treatment but the patterns of specific T cell response to personalized TAA immunization remains to be fully ...understood. We report antigen-specific T cell responses in patients immunized with dendritic cell vaccines pulsed with personalized TAA panels. Tumor samples from patients were first analyzed to identify overexpressed TAAs. Autologous DCs were then transfected with pre-manufactured mRNAs encoding the full-length TAAs, overexpressed in the patients' tumors. Patients with glioblastoma multiforme (GBM) or advanced lung cancer received DC vaccines transfected with personalized TAA panels, in combination with low-dose cyclophosphamide, poly I:C, imiquimod and anti-PD-1 antibody. Antigen-specific T cell responses were measured. Safety and efficacy were evaluated. A total of ten patients were treated with DC vaccines transfected with personalized TAA panels containing 3–13 different TAAs. Among the seven patients tested for anti-TAA T cell responses, most of the TAAs induced antigen-specific CD4
+
and/or CD8
+
T cell responses, regardless of their expression levels in the tumor tissues. No Grade III/IV adverse events were observed among these patients. Furthermore, the treated patients were associated with favorable overall survival when compared to patients who received standard treatment in the same institution. Personalized TAA immunization-induced-specific CD4
+
and CD8
+
T cell responses without obvious autoimmune adverse events and was associated with favorable overall survival. These results support further studies on DC immunization with personalized TAA panels for combined immunotherapeutic regimens in solid tumor patients.
Trial registration
ClinicalTrials.gov, NCT02709616 (March, 2016), NCT02808364 (June 2016), NCT02808416 (June, 2016).
Objective
This study explores the level of stigma among Chinese nasopharyngeal carcinoma survivors, its influencing factors and relationship with self‐efficacy.
Methods
In total, 281 nasopharyngeal ...carcinoma survivors were recruited from China, who completed the demographic, disease‐related and late toxicities questionnaire, as well as the General Self‐Efficacy Scale and Social Impact Scale.
Results
The mean scores for stigma and self‐efficacy were 57.22 ± 9.58 and 28.06 ± 3.97, respectively, both showing a moderate level. The late toxicities with the highest incidence were xerostomia (91.8%), fatigue (78.3%) and hearing loss (63.0%). Stigma was significantly and negatively related to self‐efficacy (r = −0.295, P < 0.001). Multivariable linear regression showed that self‐efficacy, number of children, educational level, perceived support from spouse and other family members and some late toxicities (nasal obstruction and toothache) were influencing factors of stigma, accounting for 49.4% of the variance.
Conclusion
Medical staff should be more aware of stigma among Chinese nasopharyngeal carcinoma survivors, especially those with more children and weaker educational backgrounds who are at a higher risk of stigma. They should take effective measures to alleviate stigma by improving patients' self‐efficacy, relieving late toxicities and encouraging spouses and family members to provide more support for them.
Despite evidence suggesting the utility of Epstein‐Barr virus (EBV) markers to stratify individuals with respect to nasopharyngeal carcinoma (NPC) risk in NPC high‐risk regions, no validated NPC risk ...prediction model exists. We aimed to validate an EBV‐based NPC risk score in an endemic population undergoing screening for NPC. This prospective study was embedded within an ongoing NPC screening trial in southern China initiated in 2008, with 51 235 adult participants. We assessed the score's discriminatory ability (area under the receiver‐operator‐characteristics curve, AUC). A new model incorporating the EBV score, sex and family history was developed using logistic regression and internally validated using cross‐validation. AUCs were compared. We also calculated absolute NPC risk combining the risk score with population incidence and competing mortality data. A total of 151 NPC cases were detected in 2008 to 2016. The EBV‐based score was highly discriminating, with AUC = 0.95 (95% CI = 0.93‐0.97). For 90% specificity, the score had 87.4% sensitivity (95% CI = 81.0‐92.3%). As specificity increased from 90% to 99%, the positive predictive value increased from 2.4% (95% CI = 1.9‐3.0%) to 12.5% (9.9‐15.5%). Correspondingly, the number of positive tests per detected NPC case decreased from 272 (95% CI = 255‐290) to 50 (41‐59). Combining the score with other risk factors (sex, first‐degree family history of NPC) did not improve AUC. Men aged 55 to 59 years with the highest risk profile had the highest 5‐year absolute NPC risk of 6.5%. We externally validated the discriminatory accuracy of a previously developed EBV score in a high‐risk population. Adding nonviral risk factors did not improve NPC prediction.
What's new?
Evidence suggests that markers of Epstein‐Barr virus (EBV) infection are useful in screening for nasopharyngeal carcinoma (NPC). Few prospective studies, however, have validated the performance of EBV‐based risk scores for NPC. In this prospective validation study with data for more than 51 000 participants, EBV‐based risk score based on the combination of IgA antibodies against viral capsid antigen and EBV nuclear antigen 1 was found to be highly discriminating for NPC over follow‐up periods lasting five years. The findings indicate that EBV‐based scores could be valuable risk‐prediction tools for early NPC diagnosis, leading to improved clinical outcomes.
Aim
This study aimed to develop a patient classification system that stratifies patients admitted to the intensive care unit based on their disease severity and care needs.
Background
Classifying ...patients into homogenous groups based on clinical characteristics can optimize nursing care. However, an objective method for determining such groups remains unclear.
Methods
Predictors representing disease severity and nursing workload were considered. Patients were clustered into subgroups with different characteristics based on the results of a clustering algorithm. A patient classification system was developed using a partial least squares regression model.
Results
Data of 300 patients were analysed. Cluster analysis identified three subgroups of critically patients with different levels of clinical trajectories. Except for blood potassium levels (p = .29), the subgroups were significantly different according to disease severity and nursing workload. The predicted value ranges of the regression model for Classes A, B and C were <1.44, 1.44–2.03 and >2.03. The model was shown to have good fit and satisfactory prediction efficiency using 200 permutation tests.
Conclusions
Classifying patients based on disease severity and care needs enables the development of tailored nursing management for each subgroup.
Implications for Nursing Management
The patient classification system can help nurse managers identify homogeneous patient groups and further improve the management of critically ill patients.
Objective
To compare the value of the subcutaneous tunneling technique versus the normal technique in improving the outcomes of patients undergoing chemotherapy with peripherally inserted central ...catheters (PICCs).
Methods
One hundred thirty patients were randomly divided into an experimental group (subcutaneous tunneling technique) and control group (normal technique) according to the PICC placement technique, and clinical data were compared between the groups.
Results
In total, 129 PICCs were successfully inserted. Compared with the control group, the experimental group had a lower occurrence of complications after placement (especially catheter dislodgement: 3.1% vs. 15.4%, venous thrombosis: 3.1% vs. 15.4%, and wound oozing: 14.1% vs. 27.7%), lower occurrence of unscheduled PICC removal (3.1% vs. 13.8%), greater comfort during placement (14.16 ± 2.21 vs. 15.09 ± 2.49 on a scale ranging from 6 to 30 points, with higher scores indicating lower degrees of comfort), and lower costs of PICC maintenance (median (interquartile range) per-day maintenance cost: 13.90 (10.99–32.83) vs. 15.69 (10.51–57.46) Yuan). The occurrence of complications and amount of bleeding during placement were not significantly different between the two groups.
Conclusions
The subcutaneous tunneling technique can improve PICC placement by reducing complications and costs of maintenance with better patient comfort during placement.
Purpose
To explore the incidence, severity, and risk factors of multidimensional fatigue in patients with nasopharyngeal carcinoma (NPC) receiving concurrent chemoradiotherapy (CCRT).
Methods
This ...prospective study included 79 patients with NPC in Guangzhou (China) from June 2015 to July 2018. Data were collected before and after CCRT, including demographic and clinical characteristics, nutritional parameters, and fatigue scores, based on completion of the Multiple Dimensional Inventory-20 Questionnaire, with five subscales: General Fatigue, Mental Fatigue, Physical Fatigue, Reduced Activity, and Reduced Motivation.
Results
Increased general fatigue was found to be associated with lower lymphocyte count and body mass index <23 kg/m
2
. Increased physical fatigue was related to age > 42 years. Higher scores for reduced activity were associated with age > 42 years, female sex, and lower serum sodium. Increased mental fatigue was related with lower lymphocyte count and unemployment; and increased total fatigue was associated with lower lymphocyte count, age > 42 years, and 3–6 courses of treatment. Furthermore, 3–6 courses of treatment was an independent predictor of severe general fatigue, while age >42 years was an independent predictor of severe physical fatigue. Importantly, cancer stage IVB and 3–6 courses of treatment could predict severe total fatigue.
Conclusions
Our data demonstrate that fatigue is increased in all dimensions in NPC patients following CCRT, and that the predictors differ for each fatigue dimension. These results could guide the development of targeted interventions that may reduce the impact of cancer-related fatigue in patients with NPC.
Objective
To explore the effect of bone marrow mesenchymal stem cells (BM‐MSCs) transplantation on the changes of oligodendrocyte lineage in brain of experimental autoimmune encephalomyelitis (EAE) ...rats.
Methods
The animals were divided into normal control group, EAE model group (EAE group), cell culture medium injection treatment group (placebo treatment group), and MSCs treatment group (treatment group). The changes of A2B5‐, O4‐, and CNPase‐positive cells in oligodendrocyte lineage in rat brain were observed after 1, 3, 7, 14, 21, and 28 days.
Results
The number of A2B5‐positive cells in rat brain of the treatment group at each time point was significantly more than that of the EAE and placebo treatment groups, and most obvious at 14 days. The O4‐positive cells number at each time point in the treatment group was significantly increased compared with the EAE and placebo treatment groups, and most obvious at 14 days. The CNPase‐positive cells number at each time point in the treatment group was significantly increased compared with the EAE and placebo treatment groups, and most obvious at 14 days.
Conclusions
MSCs treatment can increase cells expression in oligodendrocyte lineage, which laying a solid foundation for myelin regeneration.
MSCs treatment can increase cells expression in oligodendrocyte lineage, which laying a solid foundation for myelin regeneration.
Objectives
To explore the relationship between the Comprehensive Nutritional Index (CNI) and survival in older patients with nasopharyngeal carcinoma (NPC) and to compare the prognostic performance ...of three nutritional indicators (CNI, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI)) for overall survival (OS).
Methods
This retrospective study involved 309 older NPC patients in Guangzhou (China) from November 2006 to November 2017. The CNI comprised five parameters: the body mass index (BMI), usual body weight percentage (UBW%), hemoglobin (Hb) level, albumin level, and total lymphocyte count (TLC). All single nutritional indicators were evaluated before and immediately after treatment. The principal component analysis (PCA) was used for calculation of the CNI by single nutritional indicators after treatment. The cutoff point for the CNI was evaluated and logistic regression used to explore the risk factors for the CNI. Univariable, multivariable Cox regression, and Kaplan–Meier methods were applied for OS and disease-free survival (DFS) analyses. Cox proportional hazards models were used to compare the prognostic value of the CNI, PNI, and NRI for OS.
Results
All single nutritional indicators decreased significantly after treatment (
P
< 0.05). The CNI cutoff point for mortality was 0.027, and the logistic regression indicated more complex treatments or higher cancer stage for NPC was associated with a low CNI (HR = 0.179; 95% CI: 0.037–0.856; 0.545, 0.367–0.811, respectively). In multivariable Cox regression, the CNI remained an independent prognostic factor of OS and DFS (HR = 0.468, 95% CI: 0.263–0.832; 0.527, 0.284–0.977, respectively). Kaplan–Meier curves showed that a low CNI was associated with worse OS and DFS (
P
= 0.001 and 0.013, respectively). The prognostic predictive performance of the CNI was superior to that of the PNI or NRI.
Conclusions
The CNI can be recommended as an appropriate indicator reflecting the integrated nutritional status of older NPC patients. A low CNI predicted a poor survival outcome and the prognostic performance of CNI was superior to PNI or NRI.
Despite increasing use, symptomatic venous thromboembolism (VTE) associated with peripherally inserted central catheter (PICC) is a common complication in nonmetastatic nasopharyngeal carcinoma (NPC) ...patients.
A total of 3012 nonmetastatic NPC patients were enrolled in this retrospective study, and we applied Cox regression and log-rank tests to assess the association between PICC-VTE and survival using the propensity score method (PSM) to adjust for gender, age, radiotherapy technique, tumor stage, node stage, UICC clinical stage and pre-treatment EBV DNA.
217 patients developed PICC-VTE, with an incidence of 7.20%. PSM identified 213 patients in the cohort with VTE and 852 in that without. Patients who developed PICC-VTE had a shorter 5-year PFS (77.5% vs 87.6%, p < 0.001), DMFS (85.0% vs 91.2%, p < 0.001), LRRFS (93.9% vs 97.7%, p < 0.001) and OS (85.4% vs 87.6%, p < 0.001). Subgroup analyses indicated that no significant survival difference was found between PICC-related superficial venous thrombosis and deep vein thrombosis, nor did different anticoagulant treatment methods.
PICC-VTE was associated with a worse survival outcome in nonmetastatic NPC patients. A prospective randomized clinical trial is required to verify the results.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
"Background and Objectives: The optimal energy intake for early nutrition therapy in critically ill patients is unknown, especially in Chinese patients with a lower BMI. This study investigated the ...relationship between energy intake and clinical outcomes in this patient population.
Methods and Study Design: A retrospective study was carried out at a tertiary hospital. Critically ill patients were recruited and divided into 3 tertiles according to the ratio of actual/target energy intake during the first week of hospitalization in the intensive care unit (ICU) (tertile I, <33.4%; tertile II, 33.4%-66.7%; and tertile III, >66.7%). 60-day mortality and other clinical outcomes were compared. To adjust for potentially confounding factors, multivariate and sensitivity analyses were performed exclusively in patients who stayed in the ICU for >/=7 days.
Results: A total of 325 patients with a mean BMI of 22.5+/-4.7 kg/m2 were recruited. 60-day mortality was similar between the 3 tertiles. In the unadjusted analysis, tertile III had a longer length of stay in the ICU and at the hospital, longer duration of mechanical ventilation, and higher rate of ICU-associated infections, but only the latter showed a significant difference between the 3 tertiles in the multivariate and sensitivity analyses. Logistic regression analysis showed that energy groups was an independent risk factor for ICU-associated infections.
Conclusions: Energy intake in early nutrition therapy influences risk of ICU-associated infections in Chinese critically ill patients with lower BMI. Furthermore, patients with near-target energy intake have more frequent ICU-associated infections."
PDF
