Efficacy and safety of combined immunotherapy and stereotactic radiosurgery in NSCLCBM patients and a novel prognostic nomogram: A real-world study

ObjectiveTo explore the effectiveness of combined immunotherapy (IT) and stereotactic radiosurgery (SRS) and address the gap between evidence-based clinical practice and academic knowledge of optimal timing of IT relative to SRS. In addition, to meet the unmet need for an up-to-date prognostic assessment model in the era of IT.MethodsThe data of 86 non-small cell lung cancer brain metastasis (NSCLCBM) patients treated with SRS to 268 brain metastases (BMs) were retrospectively extracted from our hospital database. The Kaplan–Meier analysis was employed for overall survival (OS) and a log-rank test for comparison between groups. Cox proportional hazards regression models were used to identify the significant prognostic factors. The prognostic nomogram was established utilizing the rms package of R software.ResultsIT was found to be associated with improved OS (from BM diagnosis: HR 0.363, 95% CI 0.199 - 0.661, P < 0.001; from SRS: HR 0.472, 95% CI 0.260 - 0.857, P = 0.014). Individuals who received IT in combination with SRS had better OS than those who didn’t (from the day of BM diagnosis: 16.8 vs. 8.4 months, P = 0.006; from the day of SRS: 12 vs. 7 months, P = 0.037). Peri-SRS timing of IT administration was a significant prognostic factor for OS (from BM diagnosis: HR 0.132, 95% CI 0.034 - 0.517, P = 0.004; from SRS: HR 0.14, 95% CI 0.044 - 0.450, P = 0.001). Initiating IT after SRS led to superior OS than concurrent or before (from BM diagnosis: 26.5 vs. 14.1 vs. 7.1 months; from SRS: 21.4 vs. 9.9 vs. 4.1 months, respectively). Additionally, we build a nomogram incorporating IT, cumulative intracranial tumor volume (CITV), and recursive partitioning analysis (RPA), demonstrating a remarkable prognosis prediction performance for SRS-treated NSCLCBM patients.ConclusionPeri-SRS IT is a promising approach in treating NSCLCBM, as improved OS was observed without significantly increasing adverse events. Receipt of IT post-SRS was associated with superior OS than those who received IT concurrently or before. Incorporating IT and CITV into the RPA index could augment its prognosis assessment value for SRS-treated NSCLCBM patients, predominantly in the wild-type

Policy Versus Place Luck: Achieving Local Economic Prosperity

This research focuses on the relative impact of place luck and economic development policy in contributing to long-term economic growth. Using a unique national data set composed of surveys of public officials, three decades of census data, and a variety of other data covering climate, health, amenities, and so on, the following research questions are addressed: (a) Is economic prosperity better explained by local development policy or simple place luck? (b) Are particular economic development policies more strongly related to prosperity than others? (c) Are there other attributes of cities such as school quality, service quality, and safety, for example, that appear to enhance economic health?state and local economic development policy, quality of life, government policy (parks, schools)

The landscape of gentrification: exploring the diversity of “upgrading” processes in Hong Kong, 1986–2006

<div><p>In the late twentieth century, Hong Kong experienced a transformation from an industrial to a specialized services and high-tech economy. Accompanying this shift, extensive local redevelopment has fundamentally altered the physical and social characteristics of the city. This analysis explores the physical and social transformation of Hong Kong from 1986 to 2006, examining the diversity of gentrification processes. The specific questions focus on: (1) How extensive are gentrification processes operating within Hong Kong? and (2) What is the role of new-builds in facilitating displacement? Principal component analysis and K-means clustering are used to identify areas within Hong Kong that are experiencing physical and social upgrading. From the quantitative analysis, three neighborhoods—Kennedy Town, Tiu Keng Leng, and Yuen Long—are selected for a qualitative study into the complexity and the diversity of capital reinvestment, social conflict, and displacement.</p></div