Myelosuppressive chemotherapy is effective for breast cancer but carries a potential risk of febrile neutropenia (FN). Clinical practice guidelines have recommended prophylaxis with granulocyte ...colony-stimulating factor (G-CSF) to reduce the incidence of FN in patients receiving chemotherapy. We aimed to examine the use of G-CSFs for primary prophylaxis for FN and to see whether it follows the guidelines. In addition, we examined the changes in the use of long-acting and short-acting G-CSFs in patients with breast cancer over the past ten years.
This was a retrospective observational real-world study. The data were obtained from the clinical research database of three hospitals affiliated with Taipei Medical University. Patients with breast cancer who initiated their first chemotherapy regimen between January 1, 2011, and December 31, 2020, were identified by the ICD codes and their use of filgrastim or pegfilgrastim was identified by the Anatomical Therapeutic Chemical codes. Whether and how G-CSF was prescribed during the study patients' first chemotherapy regimen was examined, and the annual change in the total number of short- and long-acting G-CSFs prescribed to the study patients from 2011 to 2020 was analyzed.
Among the 2,444 patients who were prescribed at least one of the examined 15 breast cancer chemotherapy drugs, 1,414 did not use any G-CSFs during their first chemotherapy regimen while 145 used G-CSFs for primary prophylaxis and 185 for treatment. Among the patients receiving high FN risk regimens, only 8.6% used G-CSF for primary prophylaxis. The average (± SD) number of days for short-acting G-CSF use was 2.3 (± 1.5) days with a median of 2 days. In addition, it was found that there was a significant reduction in long-acting G-CSF use (p = 0.03) whereas the changes in short-acting G-CSF use over time were not significant (p = 0.50).
Our study results show that G-CSFs are used for primary prophylaxis in a small percentage of patients with breast cancer and the duration of short-acting G-CSF use is relatively short. Considering the significant clinical and economic impact of FN, it is hoped that the prescription patterns of G-CSFs observed can provide an important reference for future clinical practice and reimbursement policy.
Purpose To measure foveal avascular zone (FAZ) dimensions in healthy eyes using optical coherence tomography angiography (OCTA) and calculate interobserver variability. Design Reliability analysis. ...Methods Thirty-four eyes of 17 healthy subjects underwent OCTA at the Retina Service of Wills Eye Hospital. Two masked graders performed measurements of FAZ dimensions including area, perimeter, and maximum horizontal and vertical diameters using ImageJ. Intraclass correlation coefficient (ICC) between graders was calculated. Results Mean area (mm2 ), perimeter (mm), and maximum horizontal and vertical diameters (mm) were 0.27 ± 0.101, 2.21 ± 0.451, 0.59 ± 0.126, and 0.56 ± 0.118, respectively, at the superficial and 0.34 ± 0.116, 2.50 ± 0.462, 0.69 ± 0.123, and 0.63 ± 0.110 at the deep network. Interobserver agreement was high for all superficial FAZ measurements (ICC ≥0.90) but did not meet the lowest acceptable grader agreement for the deep vascular network (ICC <0.85). Fellow eyes had statistically similar values ( P > .05). Conclusion Manual measurement of FAZ dimensions using OCTA is a noninvasive and reliable method for quantifying FAZ at the superficial vascular network. Assessing FAZ alterations in the deep vascular network may be subject to greater interobserver variability.
Since 2012, several immune checkpoint inhibitors have been approved by the Taiwan FDA for various types of cancer treatment. However, none of them are covered by Taiwan National Health Insurance due ...to the fact that they are expensive, and there is a lack of clinical evidence as to their effectiveness.
This study was aimed toward an exploration of clinical experiences with use of immune checkpoint inhibitors, including indications, prescription types, drug effectiveness, adverse drug event types, and incidence, all of which shall serve as references for future clinical drug use.
This is a retrospective study focusing on three immune checkpoint inhibitors (ipilimumab, nivolumab, and pembrolizumab), which are available for cancer treatment in Taiwan. We collected data from medical records for the period from January 1st, 2015 to January 12th, 2017 at National Cheng Kung University Hospital (NCKUH), a medical center in southern Taiwan, and recorded these cases until May 31st, 2017. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, and adverse drug reaction odds ratios were analyzed using a chi-square analysis.
The 50 patients under consideration in this study had used any one of the immune checkpoint inhibitors in NCKUH. Non-small cell lung cancer (n = 24, 48%) accounted for the highest percentage, followed by hepatocellular carcinoma (n = 4, 8%). The median OS was not reached, and the PFS for all immunotherapies was 4.9 months. The median OS period and PFS for non-small cell lung cancer (NSCLC) patients were 13 and 4.9 months, respectively, which were similar to those in many clinical trials. For NSCLC patients, the OS and PFS were only 0.63 and 1.37 months for squamous cell type NSCLC, and for patients who were PD-L1 negative, the OS and PFS were only 11.53 and 2.6 months, respectively. The most common adverse events in this study included fatigue (42%), rashes (22%), nausea (20%), and fever (20%), while one patient developed severe deep venous thrombosis and tissue inflammation, which was not confirmed in previous clinical trials.
The histological subtype, the intensity of the PD-L1 expression, and the timing of treatment affected the NSCLC therapeutic results. It is recommended that clinical tests be conducted in order to enhance therapeutic effectiveness. It is expected that more testing, observation-based studies, and research results will validate their efficacy and the tolerance levels of patients.
Most of the literature on shoulder arthroplasty failure comes from high-volume centers. These reports tend to exclude the experience of community orthopedic surgeons, who perform most of the shoulder ...joint replacements.
We analyzed the failure reports mandated by the US Food and Drug Administration for all hospitals. Each reported event from 2012 to 2016 was characterized by implant, failure mode, and year of surgery.
For the 1673 anatomic arthroplasties, the most common failure modes were glenoid component failure (20.4%), rotator cuff/subscapularis tear (15.4%), pain/stiffness (12.9%), dislocation/instability (11.8%), infection (9%), and humeral component loosening (5.1%). For the 2390 reverse arthroplasties, the most common failure modes were dislocation/instability (32%), infection (13.8%), glenosphere-baseplate dissociation (12.2%), failed/loosened baseplate (10.4%), humeral component dissociation/tray fracture (5.5%), difficulty inserting the baseplate (4.8%), and difficulty inserting the glenosphere (4.2%). Although the percentage distribution among the different failure modes was relatively consistent over the years of this study, the percentage distribution of these failure modes differed substantially among different implant manufacturers.
The Food and Drug Administration database reveals modes of shoulder arthroplasty failure that are not emphasized in the published literature, such as rotator cuff tear, infection, and postoperative pain/stiffness for anatomic total shoulder arthroplasty and implant dissociation and baseplate failure for reverse shoulder arthroplasty. Knowledge of these failure modes may help inform surgical technique and implant design in ways that will lower the risk of implant failure in the future.
This study is aimed toward establishing a decision-making model with multiple criteria for appraisal and reimbursement to compare the attitudes of different stakeholders toward various dimensions and ...criteria and to evaluate the five targeted therapies (bevacizumab, cetuximab, panitumumab, aflibercept, and regorafenib) for metastatic colorectal cancer.
This study is a multi-criteria decision analysis (MCDA) using a model that includes three dimensions and nine criteria. Both the overall and individual scores of the respective targeted therapies in different dimensions and criteria were calculated. A sensitivity analysis was carried out in order to evaluate the robustness of the research results. An interview-based questionnaire survey was applied to obtain the performance information for the targeted therapies and the weights of the dimensions and criteria.
Overall, the clinical dimension had the highest weight, followed by the economic dimension, and finally, the social dimension. In the clinical dimension, the "comparative efficacy" criterion had the highest weight; in the economic dimension, the "cost-effectiveness" criterion" was given the greatest importance; in the social dimension, the "social concern and patient needs" criterion was given more emphasis. The overall values ranked from high to low as follows: cetuximab (overall score 3.3666), bevacizumab (3.3043), panitumumab (3.2030), aflibercept (2.8923) and regorafenib (2.8366).
A comprehensive value assessment system combining "multi-dimensional criteria," "multi-perspectives," and an "integrative assessment" is necessary to evaluate the value of medicines. The results showed not only the order of weights of different dimensions or criteria, but also the rankings of the value of the targeted therapies.
is the most common bacterium associated with periprosthetic shoulder infections. Sequencing of
has been proposed as a potential rapid diagnostic tool and a method of determining subtypes associated ...with pathogenicity and antibiotic resistance patterns. When multiple deep samples from the same surgery are culture positive for the same species and the isolates show the same culture phenotype, it is typically assumed that these isolates are clonal. However, it is well-known that
is not clonal on the skin of most individuals. We hypothesized that the
bacteria recovered at the time of revision shoulder arthroplasty would often represent more than one subtype, and we tested this hypothesis in this work. For patients undergoing revision shoulder arthroplasty, multiple samples from the surgical field were taken. For those patients with multiple samples that were culture positive for
, isolates from each sample were subjected to full genome sequencing. Of 11 patients, 5 (45%) had different subtypes of
within the deep tissues even though the colony morphology was similar. One patient had four subtypes in the deep tissues, while four patients had two different subtypes. Up to four different subtypes of
were observed in the deep tissues of a single patient. Clonality of
isolates from deep specimens from a potential periprosthetic shoulder infection cannot be assumed. Sequence-based characterization of virulence and antibiotic resistance may require testing of multiple deep specimens.
Abstract Purpose To quantify density of macular vascular networks over regions of interest in healthy subjects using optical coherence tomography angiography (OCTA). Design Prospective ...cross-sectional study. Methods Settings: Retina and Oncology Services of Wills Eye Hospital. Subjects with no known systemic disease and without retinal pathology were included. OCTA was performed on a 3×3-mm region centered on the macula (RTVue-XR Avanti, Optovue) and en face angiograms of the superficial and deep vascular networks were acquired. Vascular density was calculated using an automated image thresholding method (ImageJ, National Institutes of Health) over regions of interest. Foveal and parafoveal vascular density were calculated. The differences between vascular networks, genders, fellow eyes and correlation between vascular density, signal strength, and age as well as reproducibility of measurements were evaluated. Results A total of 198 healthy eyes were imaged from which 163 eyes of 122 subjects were included based on image quality criteria. In the parafoveal region, deep vascular density was significantly higher than the superficial (52±2.4% vs. 46±2.2%; P< 0.001) whereas the opposite was found in the foveal region (27±5.2% vs. 32±3.2%; P< 0.001). All vascular density measurements were statistically similar in fellow eyes and there was no gender difference ( P >0.05). There was a negative correlation between vascular density and age that persisted upon adjusting for signal strength. Vascular density measurements were highly correlated between separate imaging sessions with intraclass correlation coefficients of over 0.85 for all assessments. Conclusions Calculation of vascular density using OCTA is a reproducible and non-invasive method to quantitate individual networks within the macula. Understanding normal values and their correlations could affect clinical evaluation of the macula in healthy patients and disease states.
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