Objective The aim of this study was to evaluate the role of multicriteria optimization (MCO) in planning of intensity-modulated radiotherapy (IMRT).Methods Twenty IMRT patients (ten with prostate and ten with lung cancers) were randomly selected.For these patients,the treatment plans were designed with direct machine parameter optimization (DMPO).Based on these plans,new plans were designed with MCO,while keeping the setting conditions unchanged.Comparison was made between the two plans including the dose distribution,the dose volume histogram,the time of optimization and number of monitor unit (MU),but were play by pairing-t test.Results The plan designed in both optimizations satisfied all clinical requirements.For the same or better target coverage,rectum,bladder and small bowel were better with MCO compared with DMPO,MCO reduced 58％ of the time for optimization by average while MU increased 32％ by average for prostate cancer.For lung cancer,the whole lung,heart and spinal cord were better with MCO compared with DMPO,MCO reduced 59％ of the time for optimization by average while MU increased 11％ by average.Conclusions In comparison with DMPO,MCO reduces the dose of organs at risk,shorten the time of optimization.

Objective: To evaluate the cost-effectiveness of olaparib as a maintenance treatment versus routine surveillance (RS) in patients with BRCA mutated (BRCAm) advanced ovarian cancer (OC) following response to first-line platinum-based chemotherapy in Singapore. Methods: A 4-health state partitioned survival model was developed to simulate the lifetime (50 years) incremental cost-effectiveness ratio (ICER) of olaparib versus RS from a healthcare payer perspective. Progression-free survival, time to second disease progression, and overall survival were estimated using SOLO-1 data and extrapolated beyond the trial period using parametric survival models. Any patient who remained progression-free at year 7 was assumed to be no longer at risk of progression. Mortality rates were based on all-cause mortality, adjusted based on BRCA1/2 mutation. Health state utilities and adverse event frequencies were from SOLO-1. Drug costs were from local public healthcare institutions. Healthcare resource usage and costs were from local clinician input and publications. A 3% discount rate was applied to costs and outcomes. Deterministic and probabilistic sensitivity analyses (PSA) were performed to assess the robustness of results. Results: The base-case analysis of olaparib maintenance therapy versus RS resulted in an ICER of Singapore dollar (SGD) 19,822 per quality-adjusted life-year (QALY) gained. The ICER was most sensitive to variations in the discount rate. PSA demonstrated that olaparib had an 87% probability of being cost-effective versus RS at a willingness-to-pay of SGD 60,000 per QALY gained. Conclusion Olaparib has a high potential of being a cost-effective maintenance treatment versus RS for patients with BRCA1/2m advanced OC after response to first-line chemotherapy in Singapore.

BACKGROUNDThe mechanisms responsible for the occurrence of a kissing unsatisfied (KUS) result after classical crush stenting remain unclear. The present study aimed at analyzing the mechanisms and clinical significance of KUS.

METHODSTwo hundred and thirteen patients with true bifurcation lesions treated with classical crush stenting and final kissing balloon inflation (FKBI) were assigned to upper, middle, and lower groups according to the position of the side branch re-wiring assessed by visual estimation, quantitative coronary analysis (QCA) and intravascular ultrasound (IVUS). Angiographic follow-up was indexed at 12 months.

RESULTSThe upper group was characterized by a larger bifurcation angle of 55.53 degrees +/- 25.25 degrees (P = 0.030) and a longer procedural time (42.43 +/- 23.92) minutes (P = 0.015). The overall rate of KUS by visual estimation was 10.48%, with 5.4% in the upper group, 3.9% in middle group, and 36.1% in lower group (P < 0.001). For the diagnosis of KUS, visual inspection demonstrated a good correlation with both QCA and IVUS. Smaller stent diameter was the main reason for KUS in the upper group, while extra-stent side wire location, or re-wire in a low position was the main mechanism attributed to KUS in the lower group. The Lower group had more restenosis, with most restenotic lesions at a lower position of the side branch ostium. KUS (HR 1.652, 95% CI 1.332 - 2.088, P < 0.001) and re-wiring position (HR 2.341, 95% CI 1.780 - 4.329, P < 0.001) were two independent predictors of side branch restenosis. Re-wiring position (OR 0.458, 95%CI 0.336 - 0.874, P = 0.001) and side stent expansion (OR 3.122, 95%CI 2.883 - 5.061, P = 0.014) were factors predicting the findings of KUS.

CONCLUSIONSSide wire outside side stents resulted in more KUS and restenosis. Different restenotic lesion types reflected individual mechanisms contributing to the development of plaque proliferation.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Disease ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome

Objective To investigate the expression of Aspartate Beta-Hydroxylase (ASPH) in retroperitoneal liposarcoma (RL)and evaluate its clinical significances.Methods Relevant clinical data of 69 RL cases after surgical resection were collected.The expression of ASPH in tumor tissues was detected by immunohistochemistry.The CTL epitopes of ASPH protein HLA-A2 were predicted by SYFPEITHI and NetMHCpan software.Results The overall positive rate of ASPH expression for the whole group was 81％,that for well-differentiated liposarcoma was 73％,dedifferentiated liposarcoma was 87％ (P ＜ 0.05).ASPH expression was positively correlated with the postoperative recurrence free survival rate (P ＜ 0.05).Five HLA-A2 restricted CTL epitopes (9 peptides) were screened with the method of motif prediction.Conclusions ASPH expression is positively correlated with the degree of malignancy of RL,and the ASPH expression is an independent risk factor for postoperative recurrence free survival rate of RL.Moreover,ASPH was found to have 5 HLA-A2 restricted CTL epitopes,which are expected to be used for the immunotherapy of RL.

BACKGROUNDThe correlation between angiographic or intravascular ultrasound (IVUS) variables and fractional flow reserve (FFR) in patients with single left anterior descending artery (LAD) lesion has not been studied. The current study aimed at determining the best cutoff value of angiographic and IVUS parameters for defining FFR < 0.80 in patients with LAD lesion.

METHODSQuantitative coronary analysis, IVUS and FFR measurements were undergone in 169 patients with single LAD lesion. The best angiographic and IVUS cutoff value and their predictive value for FFR < 0.80 were compared using area under the receiver-operator characteristic curve (AUC) in overall patients or in subgroups stratified by lesion sites.

RESULTSFFR < 0.80 was found in 99 lesions (58.6%). Minimal lumen area (MLA), and plaque burden (PB) were two predictors of FFR < 0.80. Lesion length had less value in predicting FFR < 0.80. The cutoff value of PB and MLA for FFR < 0.80 was 75.4% and 3.03 mm(2). MLA and PB had similar high diagnostic value for proximal (cutoff value 3.04 mm(2) and 76.5%) and distal LAD lesion (2.82 mm(2) and 80.6%). Combination of MLA (2.82 mm(2)) and PB (80.6%) had increased diagnostic value for distal LAD lesion.

CONCLUSIONSMLA and plaque burden had equivalent diagnostic value for FFR < 0.80 when lesion localized in LAD. The predictive value of combination of MLA and plaque burden for distal LAD lesion was strengthened.

Coronary Angiography ; methods ; Coronary Artery Disease ; diagnostic imaging ; Coronary Vessels ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Plaque, Atherosclerotic ; diagnostic imaging ; Ultrasonography, Interventional ; methods

INTRODUCTIONThe aim of this study was to determine if racial differences exist in the rate of posterior capsule rupture (PCR) during cataract surgery in Singapore.

MATERIALS AND METHODSAll intraoperative complications during cataract surgery were prospectively reported as part of a clinical audit programme. A retrospective review of all patients who sustained a PCR during cataract surgery between July 1995 and December 1998 was performed.

RESULTSOf 8230 consecutive eyes which underwent cataract surgery, 6951 (84.5%) were Chinese, 597 (7.3%) were Malay, 524 (6.4%) were Indian, and 158 (1.9%) were of other races. The overall incidence of PCR was 1.9%. The PCR rates were 1.8% [125 of 6951; 95% confidence interval (CI), 1.49 to 2.11] in Chinese, 2.0% (12 of 597; 95% CI, 1.01 to 3.57) in Malay, 2.7% (14 of 524; 95% CI, 1.13 to 3.56) in Indian, and 2.5% (4 of 158; 95% CI, 0.00 to 4.98) in other races. There was no statistical difference between the PCR rates (P = 0.62, chi-square test).

CONCLUSIONRacial differences in Singapore do not have an effect on the rates of PCR during cataract surgery.

Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; genetics ; Capsulorhexis ; adverse effects ; Cataract Extraction ; adverse effects ; Eye Injuries ; ethnology ; etiology ; Female ; Humans ; Incidence ; Intraoperative Complications ; epidemiology ; Lens Capsule, Crystalline ; Lens Implantation, Intraocular ; adverse effects ; Logistic Models ; Male ; Medical Audit ; Middle Aged ; Phacoemulsification ; adverse effects ; Prospective Studies ; Retrospective Studies ; Rupture ; ethnology ; etiology ; Singapore ; epidemiology

BACKGROUNDThe safety of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year outcomes after CTO for PCI in ten centers around China where no on-site coronary artery bypass grafting (CABG) support was available.

METHODSA total of 152 patients from 10 Chinese hospitals without on-site surgical facilities were prospectively studied. Intra-procedural and in-hospital events were assessed. Angiographic follow-up was indexed eight months after the initial procedure. Clinical follow-up was extended to three years. The primary outcome was the rate of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction and target-vessel revascularization (TVR).

RESULTSThe incidence of CTO was 7.9% in patients who underwent PCI. Successful recanalization was achieved in 132 patients (86.8%). Compared with patients in the PCI success group, patients with PCI procedural failure had longer lesion lengths ((42.32 +/- 22.08) mm vs (27.61 +/- 22.85) mm, P = 0.023), a higher rate of perforation (25.0% vs 0, P = 0.014), and a greater need for pericardial puncture. There were significant differences in MACE in-hospital and at one year and three years between the failure (10.0%, 30.0% and 35.0%) and the success (3.0%, 12.1% and 14.4%) groups (P = 0.037, 0.034 and 0.040, respectively). These led to a significant decrease in the MACE-free survival rate at one and three years in the failure group, compared with the success group (P = 0.031 and 0.023, respectively). Stump was the only predictor of recanalization success (HR 0.158, 95% CI 0.041-0.612, P = 0.008), whereas procedural failure (OR 13.023, 95% CI 6.67-13.69, P = 0.002), incomplete revascularization (OR 9.71, 95% CI 2.93-5.59, P = 0.005), and total stent length (OR 6.02, 95% CI 1.55-11.93, P = 0.027) were three independent predictors of MACE.

CONCLUSIONSPCI for CTO was unsafe in remote hospitals without CABG facilities. Paying attention to coronary perforation is important for successful procedures.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; Chronic Disease ; Coronary Artery Bypass ; Coronary Stenosis ; epidemiology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Survival Rate ; Treatment Outcome

Cardiac Catheterization ; standards ; Humans ; Myocardial Revascularization ; standards ; Risk Factors

BACKGROUNDOff-label application of drug-eluting stents (DES) during percutaneous coronary intervention (PCI) was not uncommon in daily practice, however DES in treating Chinese patients with complex lesion subset was under-investigated. The primary objective of the FIREMAN registry was to evaluate the long term efficacy and safety of the Firebird sirolimus-eluting stent (SES) in treating patients with complex coronary lesions. Here we report the mid-term of one-year clinical outcomes and eight-month angiographic follow-up results of FIREMAN registry.

METHODSThe FIREMAN registry was a prospective multi-center registry, which included 1029 consecutive patients undergoing PCI with Firebird SES implantation between September 2006 and July 2007 in 45 centers in China. The clinical follow-up was designed to be performed at 1, 6, 12, 18, 24, 30 and 36 months post index procedure, and non-mandatory angiographic follow-up at 8 months was planned. One hundred percent site monitoring was conducted.

RESULTSLong lesions (59.2%), multi-vessel disease (50.4%), and small vessel disease (31.6%) were mostly found in angiography. Major adverse cardiac events (MACE) occurred in 51 (5.1%) patients at 1 year clinical follow-up, including cardiac mortality in 6 (0.6%), non-fatal myocardial infarction in 11 (1.1%), and target lesion revascularization in 36 (3.5%) of the patients. Definite and probable stent thrombosis (ST) by Academic Research Consortium (ARC) definition occurred in 12 (1.36%) patients at one-year clinical follow-up. The 8-month binary restenosis rate was 5.7% in-segment and 4.3% in-stent, respectively. Late lumen loss was (0.21 ± 0.40) mm in-segment and (0.23 ± 0.36) mm in-stent, respectively. Furthermore, Cox regression analysis revealed that diabetes, small vessel diameter, and chronic total occlusion were independent predictors of ST.

CONCLUSIONSThe results showed that the Firebird SES was effective and safe in treating Chinese patients with complex coronary lesions and occurrence of ST rate at one-year clinical follow-up was acceptable, however further long-term follow-up was still necessary. (NCT00552656)

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Asian Continental Ancestry Group ; Coronary Angiography ; Coronary Disease ; diagnostic imaging ; therapy ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Sirolimus ; therapeutic use ; Treatment Outcome

Autonomic Nervous System ; physiopathology ; Blood Pressure ; physiology ; Cardiovascular Diseases ; therapy ; Cardiovascular System ; physiopathology ; Diabetic Neuropathies ; therapy ; Humans