Purpose: We report our single-institution experience using hypofractionated radiotherapy in a patient population 75 years and older diagnosed with stage IA or IB (T1/T2 N0) Non-Small Cell Lung Carcinoma. Materials and...Purpose: We report our single-institution experience using hypofractionated radiotherapy in a patient population 75 years and older diagnosed with stage IA or IB (T1/T2 N0) Non-Small Cell Lung Carcinoma. Materials and methods: This is a single-institution, retrospective analysis examining disease free and overall survival and toxicity after hypofractionated radiation therapy in a patient population 75 years and older diagnosed with stage IA or IB (T1/T2 N0) NSCLC. Between 1991 and 2005, a total of 33 such patients were identified with a median age of 79 years. Patients were treated with a median total dose of 7000 cGy using median daily dose fractions of 250 cGy. Analysis of competing risks (local failure, distal failure or death as the first event) was performed and cumulative incidence functions (CIF) were estimated. Results: The median length of follow-up was 19.8 months (range: 4.3 - 103.8 months). Of the 33 patients treated, 21 (63.6% of total) had no evidence of disease recurrence on follow-up imaging over the course of the study. Of the 12 patients with disease recurrence, 6 (18.2% of total) had local failure as the first event and 6 (18.2% of total) had distant metastasis as the first event. Analysis of competing risks showed that at 5 years, the probability of local failure as the first detected event was 19.5% (95%CI: 7.6%, 35.6%);the probability of distal failure as the first detected event was 21.5% (95%CI: 7.9%,39.4%);and the probability of death without recording a failure was 44.1% (95%CI: 26.1%, 60.7%). There were no treatment related deaths reported. Conclusions: Elderly patients diagnosed with stage I non-small cell lung cancer may safely be offered hypofractionated radiotherapy as an effective option with curative intent.展开更多
Background Emergence of periodic leg movements(PLM)on adaptive servo-ventilation(ASV)is well known in patients with chronic heart failure and reduced ejection fraction(HFrEF),but its clinical significance remains uncl...Background Emergence of periodic leg movements(PLM)on adaptive servo-ventilation(ASV)is well known in patients with chronic heart failure and reduced ejection fraction(HFrEF),but its clinical significance remains unclear.We investigated the effect of ASV on the emergence of PLM with arousal(PLMA)in HFrEF patients with obstructive or central sleep apnea(OSA or CSA)and determined whether emergent PLMA modifies the effect of ASV on fatigue and sleepiness.Methods Sixty stable HFrEF patients(ASV n=29,control n=31)with moderate to severe OSA or CSA were included.Polysomnography(PSG)was obtained at baseline and after 12 weeks.Results In HFrEF patients with OSA and CSA,ASV significantly increased PLMA-Index compared to control.ASV was associated with a significant reduction in Epworth sleepiness scale(ESS)and fatigue severity scale(FSS)in patients without emergent PLMA(52%)compared to those with emergent PLMA(48%;delta ESS:−3(−3;0)vs.2(−2;4)p=0.027;delta FSS:−1.3(−2.1;0.1)vs.−0.3(−1.1;1.7)p=0.031)and compared to controls(0(−1;1)p=0.039);(0.1(−0.9;0.4)p=0.034).Conclusion ASV treatment increases PLMA in some HFrEF patients with OSA or CSA.On ASV treatment,patients reported only improved sleepiness and fatigue if no PLMA emerged.展开更多
This study looks into the current,and potential uses of Blockchain technology in business,specifically in Accounting and in cybersecurity.We relate Blockchain uses to current concerns within cybersecurity and accounti...This study looks into the current,and potential uses of Blockchain technology in business,specifically in Accounting and in cybersecurity.We relate Blockchain uses to current concerns within cybersecurity and accounting.We review the literature that includes topics such as Big Data in Accounting,blockchain’s use in financial security and cybersecurity,and its use in financial accounting though the use of ledger technology and also as a system of tracking financial misconduct.We also review the Department of Homeland Security plan for cybersecurity over the next few years to understand what the US Government plans because of the importance of cybersecurity development.We show that Blockchain impacts auditing in different ways that will change the profession drastically.We also find that blockchain should be effectively implemented into different aspects of cybersecurity,and accounting,such as Auditing and general accounting procedures.展开更多
文摘Purpose: We report our single-institution experience using hypofractionated radiotherapy in a patient population 75 years and older diagnosed with stage IA or IB (T1/T2 N0) Non-Small Cell Lung Carcinoma. Materials and methods: This is a single-institution, retrospective analysis examining disease free and overall survival and toxicity after hypofractionated radiation therapy in a patient population 75 years and older diagnosed with stage IA or IB (T1/T2 N0) NSCLC. Between 1991 and 2005, a total of 33 such patients were identified with a median age of 79 years. Patients were treated with a median total dose of 7000 cGy using median daily dose fractions of 250 cGy. Analysis of competing risks (local failure, distal failure or death as the first event) was performed and cumulative incidence functions (CIF) were estimated. Results: The median length of follow-up was 19.8 months (range: 4.3 - 103.8 months). Of the 33 patients treated, 21 (63.6% of total) had no evidence of disease recurrence on follow-up imaging over the course of the study. Of the 12 patients with disease recurrence, 6 (18.2% of total) had local failure as the first event and 6 (18.2% of total) had distant metastasis as the first event. Analysis of competing risks showed that at 5 years, the probability of local failure as the first detected event was 19.5% (95%CI: 7.6%, 35.6%);the probability of distal failure as the first detected event was 21.5% (95%CI: 7.9%,39.4%);and the probability of death without recording a failure was 44.1% (95%CI: 26.1%, 60.7%). There were no treatment related deaths reported. Conclusions: Elderly patients diagnosed with stage I non-small cell lung cancer may safely be offered hypofractionated radiotherapy as an effective option with curative intent.
基金support from Philips Respironics,the ResMed Foundation,and the Else-Kroener Fresenius Foundation(project number:2018_A159)by the German Federal Ministry of Education and Research(Bundesministerium für Bil-dung ud Forschung,BMBF,project number:01ZZ2324C).
文摘Background Emergence of periodic leg movements(PLM)on adaptive servo-ventilation(ASV)is well known in patients with chronic heart failure and reduced ejection fraction(HFrEF),but its clinical significance remains unclear.We investigated the effect of ASV on the emergence of PLM with arousal(PLMA)in HFrEF patients with obstructive or central sleep apnea(OSA or CSA)and determined whether emergent PLMA modifies the effect of ASV on fatigue and sleepiness.Methods Sixty stable HFrEF patients(ASV n=29,control n=31)with moderate to severe OSA or CSA were included.Polysomnography(PSG)was obtained at baseline and after 12 weeks.Results In HFrEF patients with OSA and CSA,ASV significantly increased PLMA-Index compared to control.ASV was associated with a significant reduction in Epworth sleepiness scale(ESS)and fatigue severity scale(FSS)in patients without emergent PLMA(52%)compared to those with emergent PLMA(48%;delta ESS:−3(−3;0)vs.2(−2;4)p=0.027;delta FSS:−1.3(−2.1;0.1)vs.−0.3(−1.1;1.7)p=0.031)and compared to controls(0(−1;1)p=0.039);(0.1(−0.9;0.4)p=0.034).Conclusion ASV treatment increases PLMA in some HFrEF patients with OSA or CSA.On ASV treatment,patients reported only improved sleepiness and fatigue if no PLMA emerged.
文摘This study looks into the current,and potential uses of Blockchain technology in business,specifically in Accounting and in cybersecurity.We relate Blockchain uses to current concerns within cybersecurity and accounting.We review the literature that includes topics such as Big Data in Accounting,blockchain’s use in financial security and cybersecurity,and its use in financial accounting though the use of ledger technology and also as a system of tracking financial misconduct.We also review the Department of Homeland Security plan for cybersecurity over the next few years to understand what the US Government plans because of the importance of cybersecurity development.We show that Blockchain impacts auditing in different ways that will change the profession drastically.We also find that blockchain should be effectively implemented into different aspects of cybersecurity,and accounting,such as Auditing and general accounting procedures.
