Tag: pubmed

Med Phys. 2024 Dec 23. doi: 10.1002/mp.17590. Online ahead of print.

ABSTRACT

BACKGROUND: Carbon-ion radiotherapy provides steep dose gradients that allow the simultaneous application of high tumor doses as well as the sparing of healthy tissue and radio-sensitive organs. However, even small anatomical changes may have a severe impact on the dose distribution because of the finite range of ion beams.

PURPOSE: An in-vivo monitoring method based on secondary-ion emission could potentially provide feedback about the patient anatomy and thus the treatment quality. This work aims to prove that a clinically relevant anatomical change in an anthropomorphic head phantom may be detected via charged-fragment tracking during a treatment fraction.

METHODS: A clinically representative carbon-ion treatment plan was created for a skull-base tumor in an anthropomorphic head phantom. In order to imitate an inter-fractional anatomical change – for example, through tissue swelling or mucous accumulation – a piece of silicone was inserted into the nasopharynx. Fragment distributions with and without the silicone insert were subsequently acquired with a mini-tracker made of four hybrid silicon pixel detectors. Experimental irradiations were carried out at the Heidelberg Ion Beam Therapy Centre (HIT, Germany). FLUKA Monte Carlo simulations were performed to support the interpretation of the experimental results.

RESULTS: It was found that the silicone causes a significant change in the fragment emission that was clearly distinguishable from statistical fluctuations and setup uncertainties. Two regions of fragment loss were observed upstream and downstream of the silicone with similar amplitude in both the measurement and the simulation. Monte Carlo simulations showed that the observed signature is a consequence of a complex interplay of fragment production, scattering, and absorption.

CONCLUSIONS: Carbon-ion therapy monitoring with charged nuclear fragments was shown to be capable of detecting clinically relevant density changes in an anthropomorphic head phantom under realistic clinic-like conditions. The complexity of the observed signal requires the development of advanced analysis techniques and underscores the importance of Monte Carlo simulations. The findings have strong implications for the ongoing InViMo clinical trial at HIT, which investigates the feasibility of secondary-ion monitoring for skull-base cancer patients.

PMID:39714780 | DOI:10.1002/mp.17590

Cell Oncol (Dordr). 2024 Dec 23. doi: 10.1007/s13402-024-01030-9. Online ahead of print.

ABSTRACT

PURPOSE: Renal cell carcinoma (RCC), exhibiting remarkable heterogeneity, can be highly infiltrated by regulatory T cells (Tregs). However, the relationship between Treg and the heterogeneity of RCC remains to be explored.

METHODS: We acquired single-cell RNA-seq profiles and 537 bulk RNA-seq profiles of TCGA-KIRC cohort. Through clustering, monocle2 pseudotime and prognostic analyses, we identified Treg states-related prognostic genes (TSRPGs), then constructing the RCC Treg states-related prognostic classification (RCC-TSC). We also explored its prognostic significance and multi-omics landmarks. Additionally, we utilized correlation analysis to establish regulatory networks, and predicted candidate inhibitors. More importantly, in Xinhua cohort of 370 patients with kidney neoplasm, we used immunohistochemical (IHC) staining for classification, then employing statistical analyses including Chi-square tests and multivariate Cox proportional hazards regression analysis to explore its clinical relevance.

RESULTS: We defined 44 TSRPGs in four different monocle states, and identified high immune infiltration RCC (HIRC, LAG3+, Mki67+) as the highly exhausted subtype with the worst prognosis in RCC-TSC (p < 0.001). BATF-LAG3-immune cells axis might be its underlying metastasis-related mechanism. Immunotherapy and inhibitors including sunitinib potentially conferred best therapeutic effects for HIRC. Furthermore, we successfully validated HIRC subtype as an independent prognostic factor within the Xinhua cohort (OS, HR = 16.68, 95% CI = 1.88-148.1, p = 0.011; PFS, HR = 4.43, 95% CI = 1.55-12.6, p = 0.005).

CONCLUSION: Through integrated bioinformatics analysis and a large-sample retrospective clinical study, we successfully established RCC-TSC and a diagnostic kit, which could stratify RCC patients with different prognosis and to guide personalized treatment.

PMID:39714755 | DOI:10.1007/s13402-024-01030-9

Tech Coloproctol. 2024 Dec 23;29(1):34. doi: 10.1007/s10151-024-03055-6.

ABSTRACT

BACKGROUND: Reduced-port laparoscopic surgery (RPLS) uses the minimum possible number of ports or small-sized ports in laparoscopic surgery. The combination of RPLS and natural orifice specimen extraction (NOSE) minimizes the procedural damage.

METHODS: A total of 17 patients diagnosed with right colon cancer were included: 5 patients in the RPLS + NOSE group and 12 patients in the conventional laparoscopic surgery (CL) + mini-laparotomy (ML) group. We highlight the key steps of the RPLS + NOSE procedure and compare the clinicopathological characteristics and short-term postoperative outcomes of the two groups.

RESULTS: Compared to CL + ML, RPLS + NOSE was associated with short hospitalization (8.80 ± 1.30 vs 13.75 ± 2.63, p = 0.001), faster first flatus (1.80 ± 0.45 vs 3.4 ± 0.90, p = 0.020) and less postoperative pain on the first day (2.40 ± 0.55 vs 4.25 ± 1.60, p = 0.025). Regarding operation time, intraoperative bleeding, tumor size, proximal and distal margin, number of lymph nodes harvested, number of positive lymph nodes, R0 resection, bowel movements, postoperative complications, Clavien-Dindo classification, Benz’s classification and postoperative pain on day 1, day 3 and day 5, no significant difference was observed.

CONCLUSION: In selected patients, RPLS with D3 lymph node dissection and transvaginal specimen extraction results in fast recovery and is indicated for colon cancer patients.

PMID:39714748 | DOI:10.1007/s10151-024-03055-6

Ophthalmologie. 2024 Dec 23. doi: 10.1007/s00347-024-02154-x. Online ahead of print.

ABSTRACT

BACKGROUND: The proportion of female ophthalmologists in Germany has risen to approximately 50% in recent years, and approximately 66% of medical students are women. This represents a reversal of the past situation with a male predominance. Despite this change, many international studies show that women are still underrepresented at scientific conferences, particularly among invited speakers, chairpersons, and program committees. This study aims to investigate whether these differences in gender representation are also reflected at German ophthalmological congresses and whether the situation has changed in recent years.

METHODS: Data collection covered the years 2013, 2022, and 2023 and included the congresses of the five large German ophthalmological associations: the German Ophthalmological Society (DOG), German Ophthalmic Surgical Society (DOC), German Ophthalmological Academy (AAD), German Society of Cataract and Refractive Surgery (DGII) and the German Retinological Society (RG). Data were collected based on online programs and information provided by the offices and the managing committees. The numbers of female and male speakers and chairpersons were identified, as were the gender distributions of the specific program committees.

RESULTS: Overall, the percentage of female speakers across all years and conferences surveyed averaged 25%, while female chairs averaged 17%. The percentage of females in the program committees ranged from 0% to 17%. There was an increase in the percentage of female speakers over 10 years (2013-2023). For the DOG (p_trend < 0.01) and the DOC (p_trend = 0.01) there was a significant rise, while it was highest at the DOG (37%) and lowest at the DGII (11%). The percentage of female chairs was in general lower than the percentage of female speakers for all conferences (between 11% and 26% in 2023). Only for the DOG was there a statistically significant increase over the 10 years (p_trend < 0.01).

CONCLUSION: The representation of women as speakers and chairpersons at German ophthalmology conferences is low; these continue to be predominantly male dominated. Although there has been an increase in female representation over time, it remains lower than the overall proportion of women in the profession in 2023. Significant differences are observed between the various ophthalmological conferences. Further investigation into the underrepresentation of women at these conferences is necessary, and measures to encourage greater female participation at congresses should be implemented.

PMID:39714740 | DOI:10.1007/s00347-024-02154-x

Arch Orthop Trauma Surg. 2024 Dec 23;145(1):89. doi: 10.1007/s00402-024-05723-6.

ABSTRACT

OBJECTIVES: Distal femur fractures (DFF) are frequently treated surgically with single traditional constructs (STC), such as with a lateral plate or intramedullary nail, although nail-plate combination constructs (NPCC) are gaining attention. The purpose of this study is to compare outcomes between NPCC and STC for surgical fixation of DFF to guide surgeon decision-making.

METHODS: Data Sources: This study is a systematic review and meta-analysis using PubMed, CINAHL, MEDLINE, Web of Science, Science Direct, and SPORTDiscus from database inception until January 10th, 2024.

STUDY SELECTION: Inclusion criteria were comparative studies that examined clinical outcomes and complications for NPCC versus STC for DFF in adult patients.

DATA EXTRACTION: Data included operative time, estimated blood loss (EBL), length of stay (LOS), as well as likelihood of total complications, total unplanned reoperations, and malunion.

DATA SYNTHESIS: Statistical analysis included a random-effects model using unstandardized mean difference or odds ratio (OR).

RESULTS: Five retrospective comparative studies (n = 1,368 patients; mean age: 52.3 ± 8.1 years; 134 patients in the NPCC group) were included. There was no statistically significant difference in operative time (p = 0.696), EBL (p = 0.408), or LOS (p = 0.963) between patients in the NPCC group as compared to patients in the STC group after DFF. Patients in the NPCC group had a statistically significant lower number of total complications (p = 0.009; OR: 0.31; 10.6% versus 16.0%) and total unplanned reoperations (p = 0.027; OR: 0.42; 8.2% versus 14.8%) as compared to patients in the STC group after DFF. However, there was no statistically significant difference in the number of malunion cases between groups (p = 0.130), although the NPCC group had far fewer cases than the STC group (2.9% versus 10.5%).

CONCLUSION: Patients treated with NPCC had significantly fewer cases of total complications and total unplanned reoperations without significant differences in operative time, EBL, or LOS as compared to patients treated with STC for DFF, although these associations are limited by sample size.

LEVEL OF EVIDENCE: Level IV.

PMID:39714731 | DOI:10.1007/s00402-024-05723-6

Pulm Ther. 2024 Dec 23. doi: 10.1007/s41030-024-00281-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Asthma is a complex condition characterized by airway inflammation. Interleukin-6 (IL-6) plays a significant role in asthma pathogenesis through its effects on T cells and its association with pro-inflammatory responses. Both lung and circulating IL-6 levels are elevated in asthma. IL-6 is positively associated with disease severity, frequent exacerbations, and impaired lung function, all of which can be observed clinically. We developed an IL-6 cut-off model to examine the association between high IL-6, race, high body mass index (BMI), metabolic disease, and asthma severity as assessed by reduced lung function.

METHODS: This study utilized the Coronary Artery Risk Development in Young Adults (CARDIA) database, comprised of 5115 adults, to investigate the relationship between IL-6 levels, asthma, race, and metabolic dysfunction. A “healthy” subset of 427 patients was used to compute the IL-6 cut-off. IL-6 levels within detection limits (0.15-12 pg/mL) were analyzed. The IL-6 cut-off was determined using the 95th percentile of log-transformed IL-6 values for lean (BMI < 25) and healthy individuals. Specific cut-offs were established for racial groups. Statistical analyses involved comparing patient characteristics between high and low IL-6 groups, regression analyses, and assessment of factors influencing lung function changes.

RESULTS: Using an IL-6 cut-off of 4.979 pg/mL, the cohort was divided into high and low IL-6 groups. High IL-6 correlated with Black race, higher BMI, hypertension, and markers of metabolic dysfunction, e.g., elevated HbA1c, C-reactive protein (CRP), and reduced lung function. Multivariable analysis linked high IL-6 with male gender, high BMI, Black race, HbA1c, CRP, and inversely with lung function and total cholesterol. Obesity showed a consistent positive association with elevated IL-6, regardless of the presence or absence of asthma. Patients with asthma and high IL-6 were more likely to be Black and showed increased CRP. Lung function was lowest in non-lean, high IL-6 patients with asthma, with similar trends in non-lean (BMI ≥ 25) patients without asthma.

CONCLUSION: This study underscores the significant association between IL-6, asthma, obesity, and metabolic dysfunction. Elevated IL-6 correlates with asthma severity, particularly in individuals with obesity. Future research should explore anti-IL-6 therapies for specific phenotypes, such as obesity-related asthma. These findings advance our understanding of asthma and the role of IL-6 in its pathogenesis.

PMID:39714726 | DOI:10.1007/s41030-024-00281-z

Phys Rev Lett. 2024 Dec 6;133(23):237101. doi: 10.1103/PhysRevLett.133.237101.

ABSTRACT

Optical simulators for the Ising model have demonstrated great promise for solving challenging problems in physics and beyond. Here, we develop a spatial optical simulator for a variety of classical statistical systems, including the clock, XY, Potts, and Heisenberg models, utilizing a digital micromirror device composed of a large number of tiny mirrors. Spins, with desired amplitudes or phases of the statistical models, are precisely encoded by a patch of mirrors with a superpixel approach. Then, by modulating the light field in a sequence of designed patterns, the spin-spin interaction is realized in such a way that the Hamiltonian symmetries are preserved. We successfully simulate statistical systems on a fully connected network, with ferromagnetic or Mattis-type random interactions, and observe the corresponding phase transitions between the paramagnetic and the ferromagnetic or spin-glass phases. Our results largely extend the research scope of spatial optical simulators and their versatile applications.

PMID:39714667 | DOI:10.1103/PhysRevLett.133.237101

Support Care Cancer. 2024 Dec 21;33(1):49. doi: 10.1007/s00520-024-09100-2.

ABSTRACT

PURPOSE: Compare the effects of low-intensity and moderate-intensity exercise on physical functioning in breast cancer survivors.

METHODS: Women aged 50 + years and post-primary treatment for stage 0 to III breast cancer were randomly assigned to a 6-month low-intensity (LIG) or moderate-intensity (MIG) exercise group. Participants were instructed to walk (low- or moderate-intensity) for 30 min five days a week, followed by flexibility exercises, and do strengthening and balance exercises twice weekly. Exercise adherence was facilitated with seven individual counseling sessions tapered over six months and a Theory of Planned Behavior-based booklet. Assessments occurred at baseline, 6 months (post-intervention), and 12 months. Primary measures were PROMIS Physical Functioning, PROMIS Global Health, and six-minute walk test (6MWT).

RESULTS: Of 101 women randomized, 65 (64.4%) completed the study. No statistically significant between-group differences occurred at post-intervention or 12 months. Compared to baseline, within-group improvements in PROMIS physical functioning occurred (LIG increased from 45.87 ± 7.58 to 48.37 ± 7.13 post-intervention (p = 0.01); MIG increased from 45.26 ± 7.27 to 49.53 ± 8.80 post-intervention (p = 0.002) and 48.91 ± 9.29 at 12 months (p = 0.02)). Similarly, Global Health physical health improved (LIG increased from 46.04 ± 5.00 to 49.19 ± 5.76 post-intervention (p = 0.001); MIG increased from 45.06 ± 6.59 to 48.20 ± 7.33 post-intervention (p = 0.005) and 48.49 ± 7.89 at 12 months (p = 0.007)). 6MWT improved between post-intervention and 12 months for the LIG (469.99 ± 64.69 m to 492.19 ± 68.64 m, p = 0.008) and between baseline and post-intervention for the MIG (471.01 ± 62.69 m to 495.88 ± 66.64 m, p = 0.006).

CONCLUSION: Both low and moderate-intensity exercise led to significant improvement in physical functioning. When feasible and acceptable, prescribing low-intensity exercise can yield important benefits.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02982564.

PMID:39714637 | DOI:10.1007/s00520-024-09100-2

Environ Monit Assess. 2024 Dec 23;197(1):94. doi: 10.1007/s10661-024-13562-6.

ABSTRACT

PM_2.5 pollution is a major global concern, especially in Vietnam, due to its harmful effects on health and the environment. Monitoring local PM_2.5 levels is crucial for assessing air quality. However, Vietnam’s state-of-the-art (SOTA) dataset with a 3 km resolution needs to be revised to depict spatial variation in smaller regions accurately. In this research, we investigated machine learning-based downscaling methods to improve the spatial resolution and quality of Vietnam’s existing 3 km PM_2.5 products using different approaches: traditional machine learning models (random forest, XGBoost, Catboost, support vector regression (SVR), mixed effect model (MEM)) and deep learning models (long short-term memory (LSTM), convolutional neural network (CNN), convolutional LSTM (ConvLSTM)). Overall, the CatBoost 2-day lag model exhibited superior performance. In terms of modeling, integrating temporal factors into tree-based models can enhance predictive accuracy. Furthermore, when faced with small datasets, traditional machine learning models demonstrate superior performance over complex deep learning approaches. The validation of machine and deep learning models based on their PM_2.5 generated maps is requested because these models can obtain very high results for model evaluation but are unrealistic for application. In this study, compared to the state-of-the-art (SOTA) PM_2.5 maps in Vietnam and the SOTA global maps, the proposed CatBoost 2-day lag model’s maps showed a 57% increase in the correlation coefficient (Pearson R), as well as 42-73%, 28-75%, and 39-75% reductions in root mean squared error (RMSE), mean relative error (MRE), and mean absolute error (MAE), respectively. Additionally, the daily, monthly, and year-average maps generated by the Catboost 2-day lag model effectively capture the spatial distribution and seasonal variations of PM_2.5 in Ho Chi Minh City. These findings indicate a substantial enhancement in the accuracy and reliability of downscaled PM_2.5 maps.

PMID:39714636 | DOI:10.1007/s10661-024-13562-6

Eur Radiol. 2024 Dec 23. doi: 10.1007/s00330-024-11315-0. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the associations between gadolinium-based contrast agent (GBCA) administration and the occurrence of acute kidney injury (AKI) in pediatric patients, and to determine the risks associated with AKI.

MATERIALS AND METHODS: This retrospective study was conducted on pediatric patients who underwent contrast-enhanced or unenhanced MRI between January 1st, 2015, and June 30th, 2021. Examinations were included if they had data on height and serum creatinine levels within 3 months before and 2 days after the examinations. AKI was defined according to the AKI Network criteria. Multivariable generalized estimating equations, propensity score analyses, and inverse probability of treatment weighting analysis were used to evaluate associations between GBCA and AKI. Subgroup analyses were conducted to evaluate the interaction effects of GBCA and each subgroup variable (age, sex, examination type, admission type, chronic kidney disease stage, diabetes mellitus, cardiovascular disease, or surgery or contrast-enhanced CT performed 7 days before and 2 days after MRI).

RESULTS: A total of 2508 examinations were included (1996 with contrast-enhanced, 512 with unenhanced MRI). AKI occurred in 1.5% of the contrast group and 1.2% of the noncontrast group. Multivariable analysis showed no significant difference in AKI incidence between the groups (adjusted OR, 1.29 [95% CI: 0.53, 3.11]; p = 0.58). Propensity score matching and inverse probability of treatment weighting analysis also showed no significant association (p = 0.22 and p = 0.21, respectively). Subgroup analysis showed no significant interaction between GBCA and any of the subgroup variables.

CONCLUSION: The study found no significant association between gadolinium-based contrast agent administration and the occurrence of acute kidney injury in pediatric patients.

KEY POINTS: Question There is limited data on the development of acute kidney injury following exposure to gadolinium-based contrast agent in pediatric patients. Findings There was no significant association between the administration of gadolinium-based contrast agent and occurrence of acute kidney injury in pediatric patients. Clinical relevance The administration of gadolinium-based contrast agents does not increase the risk of acute kidney injury in pediatric patients following MRI.

PMID:39714605 | DOI:10.1007/s00330-024-11315-0