Retrospective and molecular biologic data suggest that sunitinib may be effective in patients with non-clear cell renal cell carcinoma (nccRCC).
Eligibility criteria included advanced nccRCC except ...for collecting duct carcinoma and sarcomatoid carcinoma without identifiable renal cell carcinoma subtypes. Patients were treated with 50 mg/day oral sunitinib for 4 weeks, followed by 2 weeks of rest. The primary end point was overall response rate (RR).
Thirty-one eligible patients were enrolled. Twenty-four patients (77%) had prior nephrectomy. By Memorial Sloan-Kettering Cancer Center criteria, 8 patients (26%) had poor risk and 14 (45%) had intermediate risk. Twenty-two patients had papillary renal cell carcinoma (RCC), and three had chromophobe RCC. Eleven patients had partial response with a RR of 36% (95% confidence interval (CI) 19% to 52%) and an additional 17 patients (55%) had stable disease. Median duration of response was 12.7 months (95% CI 6.3–19.1 months), and median progression-free survival was 6.4 months (95% CI 4.2–8.6 months). At a median follow-up duration of 18.7 months (95% CI 13.7–23.7 months), 13 patients (42%) had died, resulting in an estimated median survival of 25.6 months (95% CI 8.4–42.9 months). Toxicity profiles were commensurate with prior reports.
Sunitinib has promising activity in patients with nccRCC (NCT01219751).
This study examined the prevalence of major depressive disorder (MDD), and the correlations and co-morbid conditions associated with MDD, in the adult Taiwanese population, which a previous estimate ...in the 1980s had found to be at the lower end of the spectrum worldwide. Possible explanations for the reported low prevalence of MDD were evaluated.
As part of a survey of common psychiatric disorders in a nationally representative sample of individuals aged ≥ 18 years who were non-institutionalized civilians in Taiwan, a face-to-face interview using the paper version of the World Mental Health Survey of the World Health Organization (WHO) Composite International Diagnostic Interview (WMH-CIDI) was conducted between 2003 and 2005. Functional impairment and help-seeking behaviors were compared between Taiwanese subjects with MDD and their counterparts in the USA.
Among the 10 135 respondents, the lifetime prevalence of MDD was 1.20% standard error (S.E.)=0.2%. Individuals who were divorced or widowed, aged ≤ 40 years, and female were at increased risk, whereas rural residents were at lower risk for MDD. The proportion of MDD cases co-morbid with other psychiatric disorders in this study was much lower than in the US study. Only one-third of Taiwanese individuals with MDD sought help despite having twice the number of lost workdays compared with the US sample.
Despite the low prevalence of MDD in Taiwanese adults, the pattern of low help-seeking behavior and profound functional impairment indicates much room for improvement in the early detection of and intervention in major depression in this population.
The epidemiology of mucormycosis in the era of modern diagnostics is relatively under-explored.
To examine the contemporary epidemiology, clinical manifestations, diagnosis and causative pathogens of ...mucormycosis.
Ovid MEDLINE and Ovid EMBASE from January 2000 to January 2017.
Published case reports/series of proven/probable mucormycosis.
Patients ≥18 years old.
Patient characteristics, disease manifestations and causative pathogens were summarized descriptively. Categorical variables were assessed by chi-square test or Fischer's exact test, and continuous variables by the Wilcoxon–Mann–Whitney or Kruskal–Wallis test. Risk factors for the different clinical manifestations of mucormycosis were identified using multivariate logistic regression.
Initial database searches identified 3619 articles of which 600 (851 individual patient cases) were included in the final analysis. Diabetes mellitus was the commonest underlying condition (340/851, 40%) and was an independent risk for rhino-orbital-cerebral mucormycosis (odds ratio (OR) 2.49; 95% CI 1.77–3.54; p < 0.001). Underlying haematological malignancy was associated with disseminated infection (OR 3.86; 95% CI 1.78–8.37; p 0.001), whereas previous solid organ transplantation was associated with pulmonary (OR 3.19; 95% CI 1.50–6.82; p 0.003), gastrointestinal (OR 4.47; 95% CI 1.69–11.80; p 0.003), or disseminated (OR 4.20; 95% CI 1.68–10.46; p 0.002) mucormycosis. Eight genera (24 species) of Mucorales organisms were identified in 447/851 (53%) cases, of which Rhizopus spp. (213/447, 48%) was the most common. Compared with other genera, Rhizopus spp. was predominantly observed in patients with rhino-orbital-cerebral mucormycosis (75/213, 35% versus 34/234, 15%; p < 0.001). Death was reported in 389/851 (46%) patients. Mortality associated with Cunninghamella infections was significantly higher than those caused by other Mucorales (23/30, 71% versus 185/417, 44%; p < 0.001). However, Cunninghamella spp. were isolated primarily in patients with pulmonary (17/30, 57%) or disseminated disease (10/30, 33%).
Findings from the current review have helped ascertain the association between various manifestations of mucormycosis, their respective predisposing factors and causative organisms.
Early detection of malignant thyroid nodules leading to patient-specific treatments can reduce morbidity and mortality rates. Currently, thyroid specialists use medical images to diagnose then follow ...the treatment protocols, which have limitations due to unreliable human false-positive diagnostic rates. With the emergence of deep learning, advances in computer-aided diagnosis techniques have yielded promising earlier detection and prediction accuracy; however, clinicians' adoption is far lacking. The present study adopts Xception neural network as the base structure and designs a practical framework, which comprises three adaptable multi-channel architectures that were positively evaluated using real-world data sets. The proposed architectures outperform existing statistical and machine learning techniques and reached a diagnostic accuracy rate of 0.989 with ultrasound images and 0.975 with computed tomography scans through the single input dual-channel architecture. Moreover, the patient-specific design was implemented for thyroid cancer detection and has obtained an accuracy of 0.95 for double inputs dual-channel architecture and 0.94 for four-channel architecture. Our evaluation suggests that ultrasound images and computed tomography (CT) scans yield comparable diagnostic results through computer-aided diagnosis applications. With ultrasound images obtained slightly higher results, CT, on the other hand, can achieve the patient-specific diagnostic design. Besides, with the proposed framework, clinicians can select the best fitting architecture when making decisions regarding a thyroid cancer diagnosis. The proposed framework also incorporates interpretable results as evidence, which potentially improves clinicians' trust and hence their adoption of the computer-aided diagnosis techniques proposed with increased efficiency and accuracy.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The purpose of this study was to evaluate the clinical usefulness of static and dynamic variables for the prediction of fluid responsiveness in children under general anaesthesia.
Thirty-three ...mechanically ventilated children received 10 ml kg−1 colloid for 10 min while stable during surgery. Arterial pressure, heart rate, central venous pressure (CVP), and pleth variability index (PVI), in addition to variation in systolic pressure, pulse pressure (including Δdown and Δup), respiratory aortic blood flow velocity (ΔVpeak), and inferior vena cava diameter were measured before and after volume expansion. Patients were classified as responders to fluid loading if their stroke volume index (SVI) increased by at least 10%.
There were 15 volume responders and 18 non-responders. Of the variables examined, ΔVpeak (r=0.516, P=0.004) and PVI (r=0.49, P=0.004) before volume expansion were significantly correlated with changes in SVI. The receiver-operating characteristic (ROC) curve analysis showed that PVI and ΔVpeak predicted fluid responsiveness. Areas under the ROC curves of PVI and ΔVpeak were statistically larger than that of CVP (P=0.006 and 0.014, respectively). However, those of other variables were similar to that of CVP.
ΔVpeak and PVI can be used to predict fluid responsiveness in mechanically ventilated children under general anaesthesia. The other static and dynamic variables assessed in this study were not found to predict fluid responsiveness significantly in children.
ClinicalTrials.gov, NCT01364103.
A new group of thin film metallic glasses (TFMGs) have been reported to exhibit properties different from conventional crystalline metal films, though their bulk forms are already well-known for high ...strength and toughness, large elastic limits, and excellent corrosion and wear resistance because of their amorphous structure. In recent decades, bulk metallic glasses have gained a great deal of interest due to substantial improvements in specimen sizes. In contrast, much less attention has been devoted to TFMGs, despite the fact that they have many properties and characteristics, which are not readily achievable with other types of metallic or oxide films. Nevertheless, TFMGs have been progressively used for engineering applications and, thus, deserve to be recognized in the field of thin film coatings. This article will thus discuss both properties and applications of TFMGs including a review of solid-state amorphization upon annealing, the glass-forming ability improvement due to thin film deposition, and mechanical properties, including residual stress, hardness and microcompression, adhesion, and wear resistance. Potential applications and simulations will also be discussed.
Although the clinical features of the Isocitrate dehydrogenase 2 (IDH2) mutation in acute myeloid leukemia (AML) have been characterized, its prognostic significance remains controversial and its ...stability has not been investigated. We analyzed 446 adults with primary non-M3 AML and found IDH2 R172, R140 and IDH1 R132 mutations occurred at a frequency of 2.9, 9.2 and 6.1%, respectively. Compared with wild-type IDH2, mutation of IDH2 was associated with higher platelet counts, intermediate-risk or normal karyotype and isolated +8, but was inversely correlated with expression of HLA-DR, CD34, CD15, CD7 and CD56, and was mutually exclusive with WT1 mutation and chromosomal translocations involving core-binding factors. All these correlations became stronger when IDH1 and IDH2 mutations were considered together. Multivariate analysis revealed IDH2 mutation as an independent favorable prognostic factor. IDH2(-)/FLT3-ITD(+) genotype conferred especially negative impact on survival. Compared with IDH2 R140 mutation, IDH2 R172 mutation was associated with younger age, lower white blood cell count and lactate dehydrogenase level, and was mutually exclusive with NPM1 mutation. Serial analyses of IDH2 mutations at both diagnosis and relapse in 121 patients confirmed high stability of IDH2 mutations. In conclusion, IDH2 mutation is a stable marker during disease evolution and confers favorable prognosis.
Development of efficient and durable oxygen evolution reaction (OER) catalysts has a direct impact on the water splitting efficiency and cost effectiveness. In this work, we report the successful ...synthesis of a new Ni(OH)
2
structure, strain-stabilized Ni(OH)
2
nanoribbons (NR-Ni(OH)
2
) two to three layers thick, with widths of 2-5 nm,
via
an electro-oxidation route. Conventional Ni(OH)
2
usually has negligible OER activity, while NR-Ni(OH)
2
shows high activity for the oxygen evolution reaction and an overpotential of 162 millivolts and furthermore exhibits long-term stability in alkaline electrolyte. The substantial reduction in the overpotential of NR-Ni(OH)
2
is due to its easier OOH* adsorption by the active four-coordinated Ni edge sites. The enhanced catalytic activity of NR-Ni(OH)
2
makes it an excellent candidate for industrial applications.
Development of efficient and durable oxygen evolution reaction (OER) catalysts has a direct impact on the water splitting efficiency and cost effectiveness.
The ring-opening process is the rate-determining step for photocatalytic decomposition of aromatic volatile organic compounds (VOCs). However, the ring-opening pathway has not been fully revealed, ...which enables efficient photocatalytic VOC degradation. Taking the photocatalytic toluene degradation as a typical case, the ring-opening pathway and regulation strategy were systematically investigated and proposed with an aim to regulate the rate-determining step and accelerate the reaction rates. Herein, BiOCl with tailored facets was designed as a model photocatalyst to clarify the mechanism of photocatalytic toluene degradation. Theoretical calculations and in situ DRIFTS technology were closely combined to dynamically predict and monitor the photocatalytic toluene degradation reactions. It is revealed that the lowest energy barrier was precisely located at the ring-opening of benzoic acid which was generated from toluene oxidation. This result implied that the benzyl must be fully oxidized to benzoic acid to elevate the ring-opening reaction rates. Moreover, the alternative charge arrangement on the {010} facet of BiOCl facilitated the benzyl oxidation and selectivity for benzoic acid ring-opening reactions, subsequently resulting in remarkably enhanced photocatalytic efficiency, exceeding that of the {001} facet by 100% towards toluene decomposition. This work demonstrates that probing and tailoring the ring-opening pathway are vital to increase the overall toluene decomposition efficiency and could provide new insights into the understanding of the photocatalytic reactions in VOC degradation.
ABSTRACT We conduct a multiwavelength continuum variability study of the Seyfert 1 galaxy NGC 5548 to investigate the temperature structure of its accretion disk. The 19 overlapping continuum light ...curves ( to ) combine simultaneous Hubble Space Telescope, Swift, and ground-based observations over a 180 day period from 2014 January to July. Light-curve variability is interpreted as the reverberation response of the accretion disk to irradiation by a central time-varying point source. Our model yields the disk inclination , temperature K at 1 light day from the black hole, and a temperature-radius slope ( ) of . We also infer the driving light curve and find that it correlates poorly with both the hard and soft X-ray light curves, suggesting that the X-rays alone may not drive the ultraviolet and optical variability over the observing period. We also decompose the light curves into bright, faint, and mean accretion-disk spectra. These spectra lie below that expected for a standard blackbody accretion disk accreting at .
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