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Li Q.,Shanghai University | Yu H.,Shanghai University | Zhang L.,Lin Yi Peoples Hospital | Fan L.,Shanghai University | Liu S.-Y.,Shanghai University
Clinical Radiology | Year: 2013

Aim: To evaluate the image quality of contrast-enhanced chest computed tomography (CT) with low tube voltage settings using an iterative reconstruction algorithm (iDose4) and standard dose filtered back projection (FBP) CT in patients with normal body mass index (BMI). Materials and methods: Eighty patients with normal BMI were referred for a contrast-enhanced chest CT. Patients were randomly assigned into two groups: 120 kVp and 80 kVp. Standard convolution FBP was used to reconstruct the 120 kVp group (A) and 80 kVp group (C) image sets and iterative reconstruction (iDose4) was used to reconstruct the 80 kVp group (B) image sets. The mean image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and effective dose (ED) were calculated for each protocol. Image quality was graded (scale: 1-3) and compared among the three groups. Results: The radiation dose was 71.35% less for the low-voltage protocol. Noise was significantly lower in the low-voltage images reconstructed with iDose4 (group B) compared with images reconstructed with FBP (group C). Group B had the highest SNR and CNR. There was no difference in subjective image quality scores between groups B and A (p > 0.05). Conclusions: Compared with standard FBP reconstruction, the iDose4 iterative reconstruction yields higher SNR, CNR, and better image quality in contrast-enhanced chest CT with low tube voltage settings. © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Sheng Z.,Shandong University | Ma H.,Weifang Peoples Hospital | Pang W.,Sun Yat Sen University | Niu S.,Lin Yi Peoples Hospital | Xu J.,Sun Yat Sen University
Acta Haematologica | Year: 2013

To assess the effect of prophylactic treatment with antithymocyte globulin (ATG) on graft-versus-host disease (GvHD) in myeloablative transplant patients, we performed a meta-Analysis of randomized and cohort studies. Medline, Embase, the Cochrane Controlled Trial Register and the Science Citation Index were searched for studies on ATG treatment in patients with hematologic disorders undergoing myeloablative transplantation. Four randomized controlled trials, six retrospective and one prospective cohort study were included, covering 1,549 patients. The summary hazard ratios (HRs) for overall survival were 0.84.

Sheng Z.,Weifang Peoples Hospital | Liu G.,Lin Yi Peoples Hospital
Hematological Oncology | Year: 2016

The use of pomalidomide after lenalidomide and (or) bortezomib failure in patients with multiple myeloma is not clearly clarified in clinical practice. We sought to compile the available clinical reports to better understand the effectiveness of pomalidomide after failure of lenalidomide and (or) bortezomib. We searched published reports including pomalidomide, lenalidomide and (or) bortezomib. Seven reports were identified. Pomalidomide-based regimen was pomalidomide plus low-dose dexamethasone (POM + LoDEX). Six randomized controlled trials enrolling a total of 641 patients that evaluated the treatment effects of pomalidomide after lenalidomide and (or) bortezomib failure in patients with multiple myeloma were included. Pooled results showed that the overall response rate (ORR) was 31% in the POM + LoDEX group. Analysis of heterogeneity showed very little (p = 0.997, I2 = 0%), suggesting that response rates of POM + LoDEX therapy were consistent across those included trials. Stable disease was achieved in 40% of 603 patients (heterogeneity: p = 0.980, I2 = 0%). In those >65 years, overall response was achieved in 32% of 71 patients (heterogeneity: p = 0.77, I2 = 0%). POM + LoDEX showed promising activity in the 95 patients with high-risk cytogenetic abnormalities: ORR was 27% (heterogeneity: p = 0.97, I2 = 0%). In the pooled analysis, toxicity consisted primarily of myelosuppression: Grade 3 or 4 neutropenia was seen in 53% (heterogeneity: p = 0.857, I2 = 0%). Pomalidomide may produce clinical benefits in patients who had shown refractory on prior lenalidomide and (or) bortezomib therapy. Moreover, elder patients and high-risk cytogenetic abnormalities were not negative predictors for pomalidomide response after lenalidomide and (or) bortezomib failure. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Zou Y.,Internal Medicine | Lin M.,Weifang Peoples Hospital | Sheng Z.,Weifang Peoples Hospital | Niu S.,Lin Yi Peoples Hospital
Leukemia and Lymphoma | Year: 2014

The objective of the study was to investigate the effects and safety of novel agents such as bortezomib and lenalidomide in the treatment of newly diagnosed patients with multiple myeloma. We performed a comprehensive meta-analysis of randomized controlled trials (RCTs). An initial search yielded 627 citations, of which 10 RCTs enrolling 4534 patients met the inclusion criteria. The addition of bortezomib to first-line therapy significantly prolonged overall survival (OS) (hazard ratio [HR], 0.75 [0.65, 0.87], p < 0.001). On the other hand, the addition of lenalidomide had no impact on survival (HR, 0.88 [0.65, 1.20], p = 0.42). Both lenalidomide and bortezomib consistently improved progression-free survival (PFS) compared with conventional therapy alone. The corresponding HRs were 0.65, 95% confidence interval (CI) [0.55, 0.77] (p < 0.001) for bortezomib and 0.48, 95% CI [0.42, 0.55]; (p < 0.001) for lenalidomide, respectively. Some of the increased adverse events reported were herpes zoster (relative risk [RR], 3.64 [2.23, 5.94], p < 0.001), peripheral neuropathy (RR, 3.59 [1.89, 6.83], p < 0.001) and gastrointestinal effects (RR, 2.19 [1.37, 3.50], p = 0.001) among patients receiving bortezomib, and gastrointestinal effects (RR, 2.36 [1.33, 4.17], p = 0.003) and thromboembolic events (RR, 2.55 [1.48, 4.38], p < 0.001) among patients receiving lenalidomide. Interestingly, treatment with bortezomib seemed to be associated with a lower rate of treatment related mortality (RR, 0.39 [0.18, 0.85], p = 0.02). An increased incidence of second primary cancers was observed in the lenalidomide group (RR 2.61 [1.60, 4.27], p < 0.001). In summary, bortezomib improved OS, and both lenalidomide and bortezomib consistently improved PFS of patients with newly diagnosed myeloma when it was added to standard therapy. © 2014 Informa UK, Ltd.

EGFR-TKIs added to chemotherapy and EGFR-TKIs single agent have been used as first-line treatment for advanced non-small cell lung cancer patients with and without EGFR mutations. However, direct head-to-head comparison between them is still lacking. We performed indirect comparisons to assess the treatment effects of EGFR-TKIs added to chemotherapy versus EGFR-TKIs alone via common comparator of standard chemotherapy in both subgroups. A comprehensive literature search was undertaken. Finally, 12 randomized controlled trials enrolling more than 2,160 patients with EGFR mutation analysis met the inclusion criteria. We found that EGFR-TKIs combined with chemotherapy did confer an additive PFS advantage over standard chemotherapy both for patients with mutant EGFR tumors (HR 0.54, 95 % CI [0.30, 0.95], P = 0.03) and for patients with wild-type EGFR tumors (HR 0.82, [0.68, 0.98], P = 0.03), but no survival difference between the treatments in both subgroups. When using standard chemotherapy as common comparator, indirect comparison indicated that addition of chemotherapy to EGFR-TKIs did confer an additive PFS benefit (HR 0.38, [0.32, 0.46], P < 0.001) and survival benefit (HR 0.75, [0.66, 0.85], P < 0.001) over EGFR-TKIs alone in patients with wild-type EGFR, but showed a PFS disadvantage (HR 1.35, [1.03, 1.77], P = 0.03) and a marginal trend toward survival disadvantage (HR 1.16, [0.99, 1.35], P = 0.06) compared with EGFR-TKIs alone in patients with mutant EGFR tumors. In summary, addition of chemotherapy to EGFR-TKIs as first-line treatment did confer an additive benefit over EGFR-TKIs alone in patients with wild-type EGFR tumors, but was inferior to EGFR-TKIs alone in patients with mutant EGFR tumors. © 2014, Springer Science+Business Media New York.

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