Treatment patterns and clinical outcomes in 157 patients with extensive-stage small cell lung cancer: real-world evidence from a single-center retrospective study

BackgroundImmune checkpoint inhibitors (ICIs) have changed the therapeutic options for extensive-stage small-cell lung cancer (ES-SCLC). In this real-world study, we analyzed the treatment patterns in patients with ES-SCLC and evaluated the efficacy of chemotherapy combined with immunotherapy as first-line therapy.MethodsA retrospective analysis was performed on patients with ES-SCLC who received treatment at China-Japan Friendship Hospital (Beijing, China) between August 1, 2020, and April 30, 2023. The treatment patterns appeared in the form of Sunburst Chart and Sankey diagram. The survival analyses were conducted by Kaplan-Meier curves.ResultsA total of 157 patients with ES-SCLC were retrospectively included. According to first-line therapy, patients were divided into the chemotherapy (CT) group (n=82) and chemo-immunotherapy (CIT) group (n=75). The median treatment lines were 2[1, 2] and cycles were 8[5, 12], respectively. 82 patients received the second line of therapy, followed by 37 for the third, 15 for the fourth, 11 for the fifth, and 5 for the sixth. Overall, the treatment patterns involved 11 options including 12 chemotherapy regimens, 11 ICIs, and 4 targeted agents. The second-line treatment pattern had the most options (9) and regimens (43). In the first 3 lines, chemotherapy was the largest proportion of treatment options. The addition of ICIs prolonged progression-free survival from 6.77 (95% confidence interval [CI], 6.00-7.87) to 7.33 (95% CI, 6.03-9.80) months (hazard ratio [HR]=0.67, 95% CI, 0.47-0.95; P=0.025), overall survival from 12.97 (10.90-23.3) to 14.33 (12.67-NA) months without statistically significant difference (HR=0.86, 95% CI, 0.55-1.34; P=0.505).ConclusionThe treatment options of patients with ES-SCLC are more diversified. Combination therapy is the current trend, where chemotherapy is the cornerstone. Meanwhile, ICIs participate in almost all lines of treatment. However, the clinical efficacy remains barely satisfactory. We are urgently expecting more breakthrough therapies except immunology will be applied in the clinic

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Polylactic Acid Improves the Rheological Properties, and Promotes the Degradation of Sodium Carboxymethyl Cellulose-Modified Alkali-Activated Cement

In consideration of the insolubility in water, sensitivity to heat and wide application in the oil and gas industry as a degradable additive, this paper introduces polylactic acid (PLA) to a self-degradable temporary sealing material (SDTSM) to investigate its effect on the SDTSM performance and evaluate its potential to improve the rheological properties and further promote the self-degradation of the material. The thermal degradation of PLA, the rheological properties, compressive strength, hydrated products and water absorption of SDTSMs with different PLA dosages were tested. The analysis showed that the addition of 2% PLA increased the fluidity by 13.18% and reduced the plastic viscosity by 38.04%, when compared to those of the SDTSM without PLA. PLA increased the water absorption of 200 °C-heated SDTSM and had small effect on the types but decreased the hydrate products of 85 °C-cured SDTSM, and created plenty of pores in 200 °C-heated SDTSM. PLA enhanced the self-degradation level of SDTSM by generating a large amount of pores in cement. These pores worked in two ways: one was such a large amount of pores led to a looser microstructure; the other was these pores made the water impregnate the cement more easily, and then made the dissolution of substances in the 200 °C-heated SDTSM progress faster to generate heat and to destruct the microstructure

Sustainability of local budget airlines.

This research is aimed to examine the sustainability of local budget airlines through two aspects, namely from the operational and consumer aspect. In addition, we will be giving recommendations to local budget airlines based on our findings

Using Fumed Silica to Develop Thermal Insulation Cement for Medium–Low Temperature Geothermal Wells

During geothermal energy development, the bottom high-temperature fluid continuously exchanges heat with the upper low-temperature wellbore and the stratum during its rising process. Thermal insulation cement (TIC) can increase the outlet temperature, thus effectively reducing the heat loss of the geothermal fluid and improving energy efficiency. In this study, vitrified microbubbles (VMB) were screened out by conducting an orthogonal test of compressive strength (CS) and thermal conductivity (TC) on three inorganic thermal insulation materials (VMB, expanded perlite (EP), and fly-ash cenosphere (FAC)). Fumed silica (FS) was introduced into the cement with VMBs, as its significant decreasing effect on the TC. Moreover, a cement reinforcing agent (RA) and calcium hydroxide [CH] were added to further improve the CS of TIC at 90 °C. The fresh properties, CS, TC, hydration products, pore-size distribution, and the microstructure of the cement were investigated. As a result, a TIC with a TC of 0.1905 W/(m·K) and CS of 5.85 MPa was developed. The main conclusions are as follows: (1) Increasing the mass fraction of the thermal insulation material (TIM) is an effective method to reduce TC. (2) The CH content was reduced, but the C–S–H gel increased as FS content increased due to the pozzolanic reaction of the FS. (3) As the C–S–H gel is the main product of both the hydration and pozzolanic reactions, the matrix of the cement containing 60% FS and VMBs was mainly composed of gel. (4) The 10% RA improved the cement fluidity and increased the CS of TIC from 3.5 MPa to 5.85 MPa by promoting hydration

Polylactic Acid Improves the Rheological Properties, and Promotes the Degradation of Sodium Carboxymethyl Cellulose-Modified Alkali-Activated Cement

In consideration of the insolubility in water, sensitivity to heat and wide application in the oil and gas industry as a degradable additive, this paper introduces polylactic acid (PLA) to a self-degradable temporary sealing material (SDTSM) to investigate its effect on the SDTSM performance and evaluate its potential to improve the rheological properties and further promote the self-degradation of the material. The thermal degradation of PLA, the rheological properties, compressive strength, hydrated products and water absorption of SDTSMs with different PLA dosages were tested. The analysis showed that the addition of 2% PLA increased the fluidity by 13.18% and reduced the plastic viscosity by 38.04%, when compared to those of the SDTSM without PLA. PLA increased the water absorption of 200 °C-heated SDTSM and had small effect on the types but decreased the hydrate products of 85 °C-cured SDTSM, and created plenty of pores in 200 °C-heated SDTSM. PLA enhanced the self-degradation level of SDTSM by generating a large amount of pores in cement. These pores worked in two ways: one was such a large amount of pores led to a looser microstructure; the other was these pores made the water impregnate the cement more easily, and then made the dissolution of substances in the 200 °C-heated SDTSM progress faster to generate heat and to destruct the microstructure

Market research : CanDia5

To undertake the role of market research consultants for Rockeby biomed Ltd to test the market feasibility of Candia5 in the local market, and investigate possible problems of introducing Candia5