Response evaluation of chemotherapy in metastatic colorectal cancer by contrast enhanced ultrasound

AIM： To evaluate whether contrast enhanced ultra- sound （CEUS） might also be used for response predic- tion and early response evaluation in patients receiving bevacizumab based chemotherapy for metastasized colorectal cancer.METHODS： Thirty consecutive patients with non prima- ry resectable liver metastases from colorectal cancer underwent CEUS before treatment （CEUS date 1） and before the second （CEUS date 2） and fourth （CEU5 date 3） cycle of bevacizumab based chemotherapy. Three parameters [PEAK, Time to peak （l-I-P） and RISE RATE]were correlated with radiological response.RESULTS： For neoadjuvant purpose a reduction of tu- mour mass was required to assume clinical response. Based on these response criteria there was a significant （P 〈 0.001） correlation in TTP between metastases of responders （9.08 s） and non-responders （14.76 s） ar- chived on CEUS date 1. By calculating a standardized quotient （metastases divided by normal liver tissue） we were able to define a cut off, predicting response with a sensitivity of 92.3 % and a specificity of 100 %. To reflect a palliative intention only those patients with progressive disease were classified as non-responders. In this stetting -FI-P was also significantly （P 〈 0.01） dif- ferent between responders and non-responders. In con- trast, Peak and Rise rate did not show any significant difference between responder and non-responder. CONCLUSION： CEUS might serve as a surrogate mark- er to predict treatment response in patients with me- tastasized colorectal cancer who receive antiangiogenic therapy.

Enhanced diagnostic workup increases pathological findings in patients with acute ischaemic stroke:results of the prospective HEBRAS study

Background Stroke aetiology remains cryptogenic in a relevant proportion of patients with acute ischaemic stroke(AIS).We assessed whether enhanced diagnostic workup after AIS yields a higher rate of prespecified pathological findings compared with routine diagnostic care in-hospital.Methods Hospitalised patients with AIS were prospectively enrolled in the investigator-initiated observational HEart and BRain Interfaces in Acute Ischaemic Stroke(HEBRAS)study at the Charité,Berlin,Germany.Patients with AIS without known atrial fibrillation(AF)underwent cardiovascular MR imaging(CMR),MR-angiography of the aortic arch and prolonged Holter-ECG monitoring on top of routine diagnostic care.Results Among 356 patients with AIS(mean age 66 years,37.6%female),enhanced workup yielded a higher rate of prespecified pathological findings compared with routine care(17.7%vs 5.3%;p<0.001).Consequently,fewer patients were classified as cryptogenic after enhanced diagnostic workup(38.5%vs 45.5%,p<0.001).Routine care included echocardiography in 228(64.0%)patients.CMR was successfully performed in 292(82.0%)patients and revealed more often a prespecified pathological finding compared with routine echocardiography(16.1%vs 5.3%).Furthermore,study-related ECG monitoring(median duration 162 hours(IQR 98–210))detected AF in 16(4.5%)patients,while routine monitoring(median duration 51 hours(IQR 34–74))detected AF in seven(2.0%)patients.Conclusions Enhanced diagnostic workup revealed a higher rate of prespecified pathological findings in patients with AIS compared with routine diagnostic care and significantly reduced the proportion of patients with cryptogenic stroke.Trial registration number NCT02142413.

高血压急症的治疗——钙离子拮抗剂尼群地平的一种新剂型与心痛定胶囊的比较

现已开发迅速发挥作用的尼群地平新型口服制剂,其包装为塑料小瓶,内含1ml乙醇溶液和5mg尼群地平。 本研究的目的在于观察尼群地平新剂型在高血压急症中的降压作用。用心痛定(10mg的胶囊)作对照,其对高血压急症的降压作用和剂量业已得到充分肯定。 由德国23个研究中心进行随机、双盲、平行分组比较。

Low SARS-CoV-2 seroprevalence but high perception of risk among healthcare workers at children’s hospital before second pandemic wave in Germany

Background Healthcare workers are considered a particularly high-risk group during the coronavirus disease 2019(COVID-19)pandemic.Healthcare workers in paediatries are a unique subgroup:they come into frequent contact with children,who often experience few or no symptoms when infected with severe acute respiratory syndrome coronavirus 2(SARS CoV-2)and,therefore,may transmit the disease to unprotected staff.In Germany,no studies exist evaluating the risk of COVID-19 to healthcare workers in paediatric institutions.Methods We tested the staff at a large children's hospital in Germany for immunoglobulin(Ig)G antibodies against the nucle-ocapsid protein of SARS CoV-2 in a period between the first and second epidemic wave in Germany.We used a questionnaire to assess each individual's exposure risk and his/her own perception of having already been infected with SARS-CoV-2.Results We recruited 619 participants from all sectors,clinical and non-clinical,constituting 70%of the entire staff.The seroprevalence of SARS CoV-2 antibodies was 0.325%(95%confidence interval 0.039-I.168).Self-perceived risk of a previ-ous SARS-CoV-2 infection decreased with age(odds ratio,0.81;95%confidence interval,0.70-0.93).Having experienced symptoms more than doubled the odds of a high self-perceived risk(odds ratio,2.18;95%confidence interval,1.59--3.00).There was no significant difference in self perceived risk between men and women.Conclusions Seroprevalence was low among healtheare workers at a large children's hospital in Germany before the second epidemic wave,and it was far from a level that confers herd immunity.Self-perceived risk of infection is often overestimated.