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Pathology Oncology Research : POR 2024The treatment of early stage non-small cell lung cancer (NSCLC) has improved enormously in the last two decades. Although surgery is not the only choice, lobectomy is... (Review)
Review
The treatment of early stage non-small cell lung cancer (NSCLC) has improved enormously in the last two decades. Although surgery is not the only choice, lobectomy is still the gold standard treatment type for operable patients. For inoperable patients stereotactic body radiotherapy (SBRT) should be offered, reaching very high local control and overall survival rates. With SBRT we can precisely irradiate small, well-defined lesions with high doses. To select the appropriate fractionation schedule it is important to determine the size, localization and extent of the lung tumor. The introduction of novel and further developed planning (contouring guidelines, diagnostic image application, planning systems) and delivery techniques (motion management, image guided radiotherapy) led to lower rates of side effects and more conformal target volume coverage. The purpose of this study is to summarize the current developments, randomised studies, guidelines about lung SBRT, with emphasis on the possibility of increasing local control and overall rates in "fit," operable patients as well, so SBRT would be eligible in place of surgery.
Topics: Humans; Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Radiosurgery; Lung; Dose Fractionation, Radiation; Small Cell Lung Carcinoma; Neoplasm Staging
PubMed: 38476352
DOI: 10.3389/pore.2024.1611709 -
World Neurosurgery Oct 2023Stereotactic radiosurgery (SRS) is a well-established treatment for vestibular schwannomas (VS). Hearing loss remains a main morbidity of VS and its treatments,...
OBJECTIVE
Stereotactic radiosurgery (SRS) is a well-established treatment for vestibular schwannomas (VS). Hearing loss remains a main morbidity of VS and its treatments, including SRS. The effects of radiation parameters of SRS on hearing remain unknown. The goal of this study is to determine the effect of tumor volume, patient demographics, pretreatment hearing status, cochlear radiation dose, total tumor radiation dose, fractionation, and other radiotherapy parameters on hearing deterioration.
METHODS
Multicenter retrospective analysis of 611 patients who underwent SRS for VS from 1990-2020 and had pre- and post-treatment audiograms.
RESULTS
Pure tone averages (PTAs) increased and word recognition scores (WRSs) decreased in treated ears at 12-60 months while remaining stable in untreated ears. Higher baseline PTA, higher tumor radiation dose, higher maximum cochlear dose, and usage of single fraction resulted in higher post radiation PTA; WRS was only predicted by baseline WRS and age. Higher baseline PTA, single fraction treatment, higher tumor radiation dose, and higher maximum cochlear dose resulted in a faster deterioration in PTA. Below a maximum cochlear dose of 3 Gy, there were no statistically significant changes in PTA or WRS.
CONCLUSIONS
Decline of hearing at one year in VS patients after SRS is directly related to maximum cochlear dose, single versus 3-fraction treatment, total tumor radiation dose, and baseline hearing level. The maximum safe cochlear dose for hearingtbrowd preservation at one year is 3 Gy, and the use of 3 fractions instead of one fraction was better at preserving hearing.
Topics: Humans; Neuroma, Acoustic; Retrospective Studies; Radiosurgery; Follow-Up Studies; Hearing; Treatment Outcome
PubMed: 37268187
DOI: 10.1016/j.wneu.2023.05.098 -
Journal of Applied Physiology... Aug 2023The conditions of temperature, pressure, and saturation in which respiratory gas volumes are expressed [standard temperature and pressure, dry (STPD), ambient...
The conditions of temperature, pressure, and saturation in which respiratory gas volumes are expressed [standard temperature and pressure, dry (STPD), ambient temperature and pressure, saturated (ATPS), or body temperature and pressure, saturated (BTPS)] are physiologically relevant, but often ignored or unknown in clinical practice. In this study, we aimed to investigate whether and at which extent the gas volume corrections, either in natural or artificial lung, may alter key respiratory and metabolic variables and the possible clinical consequences. We primarily referred to the effects of gas volume corrections on three physiological variables: physiological dead space, venous admixture, and total CO production (V̇co) during extracorporeal support. We used three physiological models in which calculations of these variables have been performed with and without correction of gas volumes, both in a theoretical model and in 448 patients. The lack of gas volume correction leads to an error in the computation of physiological dead space fraction between 0.05 and 0.15, both in the theoretical model and in the patient population. The venous admixture was minimally affected by the absence of correction (0.01-0.04 error). During extracorporeal support, if the V̇co of natural and membrane lung is expressed in different conditions, potentially large errors (0%-18.4%) may occur in the computation of total V̇co (V̇co = V̇co + V̇co). This may lead to inappropriate settings of mechanical ventilation with higher plateau pressure. As the dead space and the CO sharing between natural and artificial lung are relevant both as prognostic index and as a guide for appropriate mechanical ventilation, their inappropriate computation may lead to erroneous categorization of the patients and inappropriate mechanical treatment. Gas volume conditions are often ignored or unknown in the clinical practice. However, they could have relevance for the calculation of some key variables in ICU setting. This study shows that gas volume corrections are mostly relevant when assessing CO clearance, both in mechanical ventilation and during extracorporeal support, whereas irrelevant for oxygenation assessment of patients. Knowing when the appropriate corrections are needed allows to better understand patients' clinical conditions and to tailor the treatment.
Topics: Humans; Carbon Dioxide; Respiration, Artificial; Lung; Ventilators, Mechanical; Intensive Care Units; Tidal Volume; Pulmonary Gas Exchange
PubMed: 37345856
DOI: 10.1152/japplphysiol.00225.2023 -
Physical Chemistry Chemical Physics :... Jul 2023In this study, polarization Raman spectra were collected for binary mixtures of formic acid/methanol and formic acid/acetonitrile with different volume fractions. The...
In this study, polarization Raman spectra were collected for binary mixtures of formic acid/methanol and formic acid/acetonitrile with different volume fractions. The broad band of formic acid in the CO vibration region was divided into four vibration peaks, corresponding to CO symmetric and anti-symmetric stretching vibration from cyclic dimer, CO stretching from open dimer, and CO stretching from the free monomer. The experiments showed that as the volume fraction of formic acid in the binary mixture decreased, the cyclic dimer gradually converted to the open dimer, and at a volume fraction of 0.1, fully depolymerized into monomer form (free monomer, solvated monomer, and hydrogen bonding monomer clusters with solvent). The contribution percentage of the total CO stretching intensity of each structure at different concentrations was quantitatively calculated using high resolution infrared spectroscopy, and the results were consistent with the conclusions predicted by polarization Raman spectroscopy. Concentration-triggered 2D-COS synchronous and asynchronous spectra also confirmed the kinetics of formic acid diluted in acetonitrile. This work provides a spectroscopic method for studying the structure of organic compounds in solution and concentration-triggering kinetics in mixtures.
PubMed: 37378660
DOI: 10.1039/d3cp01876h -
Medicina (Kaunas, Lithuania) Nov 2023: It would be important to know what happens to the volume and volume-based functional properties of one atrium if the size of the other atrium is larger or smaller than...
Similarities and Differences between Three-Dimensional Speckle-Tracking Echocardiography-Derived Left and Right Atrial Volumes and Volume-Based Functional Properties in the Same Healthy Adults-A Detailed Analysis from the MAGYAR-Healthy Study.
: It would be important to know what happens to the volume and volume-based functional properties of one atrium if the size of the other atrium is larger or smaller than the average. Therefore, the present study aimed to perform three-dimensional speckle-tracking echocardiography (3DSTE)-derived quantification of left atrial (LA) and right atrial (RA) volumes and volume-based functional properties to examine these associations in healthy adults with mean and lower or higher than mean atrial volumes. : The present study consisted of 179 healthy volunteers with a mean age of 32.3 ± 12.3 years (92 males). Three-dimensional speckle-tracking echocardiography-derived LA and RA volumes and volume-based functional properties were determined in all cases. : When different LA or RA volume groups were evaluated, both LA and RA showed the same pattern of volume changes in all phases of atrial function with higher LA or RA volumes. In case of low and mean LA volumes, RA volumes were higher compared to their LA counterpart. In case of mean and high RA volumes, RA volumes proved to be higher as well. In case of mean LA or RA volumes, differences between LA and RA stroke volumes (SVs) could not be detected, but all atrial emptying fractions (EFs) were lower for RA than for LA. Some differences were detected in counterpart LA/RA total, passive, and active atrial SVs and EFs values in the presence of lower/higher than mean LA/RA volume. : In case of mean LA or RA volumes, RA volumes are higher compared to their LA counterpart, LA-SVs and RA-SVs are similar, but atrial EFs are lower for RA than for LA. If lower/higher than mean LA or RA volumes are present, some differences in patterns of changes in counterpart atrial volumes-SVs and EFs-could be detected.
Topics: Adult; Male; Humans; Young Adult; Echocardiography, Three-Dimensional; Heart Atria; Echocardiography; Atrial Function; Atrial Appendage
PubMed: 38138154
DOI: 10.3390/medicina59122051 -
Clinical and Translational Radiation... Sep 2023Our institution was the first in the world to clinically implement MR-guided adaptive radiotherapy (MRgART) in 2014. In 2021, we installed a CT-guided adaptive...
INTRODUCTION
Our institution was the first in the world to clinically implement MR-guided adaptive radiotherapy (MRgART) in 2014. In 2021, we installed a CT-guided adaptive radiotherapy (CTgART) unit, becoming one of the first clinics in the world to build a dual-modality ART clinic. Herein we review factors that lead to the development of a high-volume dual-modality ART program and treatment census over an initial, one-year period.
MATERIALS AND METHODS
The clinical adaptive service at our institution is enabled with both MRgART (MRIdian, ViewRay, Inc, Mountain View, CA) and CTgART (ETHOS, Varian Medical Systems, Palo Alto, CA) platforms. We analyzed patient and treatment information including disease sites treated, radiation dose and fractionation, and treatment times for patients on these two platforms. Additionally, we reviewed our institutional workflow for creating, verifying, and implementing a new adaptive workflow on either platform.
RESULTS
From October 2021 to September 2022, 256 patients were treated with adaptive intent at our institution, 186 with MRgART and 70 with CTgART. The majority (106/186) of patients treated with MRgART had pancreatic cancer, and the most common sites treated with CTgART were pelvis (23/70) and abdomen (20/70). 93.0% of treatments on the MRgART platform were stereotactic body radiotherapy (SBRT), whereas only 72.9% of treatments on the CTgART platform were SBRT. Abdominal gated cases were allotted a longer time on the CTgART platform compared to the MRgART platform, whereas pelvic cases were allotted a shorter time on the CTgART platform when compared to the MRgART platform. Our adaptive implementation technique has led to six open clinical trials using MRgART and seven using CTgART.
CONCLUSIONS
We demonstrate the successful development of a dual platform ART program in our clinic. Ongoing efforts are needed to continue the development and integration of ART across platforms and disease sites to maximize access and evidence for this technique worldwide.
PubMed: 37529627
DOI: 10.1016/j.ctro.2023.100661 -
Journal of Pharmaceutical and... Oct 2023The release of metabolites from their bound to free forms is the main regulatory path in living species. Therefore, the ability to determine the free concentrations of... (Review)
Review
The release of metabolites from their bound to free forms is the main regulatory path in living species. Therefore, the ability to determine the free concentrations of small molecules is highly critical in many biological samples. The main challenges in achieving this task are the interferences inherent to complex matrices and the ability to distinguish between the free and total concentrations. This paper presents a non-invasive microextraction method that enables the determination of endocannabinoids in brain tissue. The proposed method is based on two key principles: the availability of the free concentration of endocannabinoids for partitioning to the solid-phase microextraction (SPME) fiber; and negligible depletion enabled by the small volume of extraction phase on the fiber. These features allow the presented SPME method to provide information about the free concentration of analytes without disturbing the binding equilibrium between the analytes and the matrix. The determination of spiked samples with known concentrations enables the percentage of analyte bound to the tissue to be calculated, which can then be applied to calculate the total concentration from the determined free concentration. This manuscript focuses on the determination of the free concentration and tissue binding percentages of endocannabinoids in brain tissue. Significantly, SPME's small size and potential for non-invasive sampling enable its application in live animal subjects with minimal tissue damage.
Topics: Animals; Endocannabinoids; Brain; Solid Phase Microextraction
PubMed: 37595355
DOI: 10.1016/j.jpba.2023.115624 -
European Radiology Jan 2024To assess the feasibility of spectral CT-derived extracellular volume (ECV) for differentiating aldosterone-producing nodules (APN) from nonfunctioning adrenal nodules...
OBJECTIVE
To assess the feasibility of spectral CT-derived extracellular volume (ECV) for differentiating aldosterone-producing nodules (APN) from nonfunctioning adrenal nodules (NFN).
METHODS
Sixty-nine patients with biochemically and histologically confirmed unilateral APN (34) and NFN (35) as well as 23 patients with bilateral APN (19) and NFN (27) confirmed biochemically and by adrenal vein sampling (AVS) were enrolled in this retrospective study from October 2020 to April 2022. All patients underwent contrast-enhanced spectral CT of the adrenal glands with a 10-min delayed phase. The haematocrit level was measured within 2 days of CT. An iodine density map was derived from the delayed CT. The ECV fractions of the APN and NFN were calculated and compared in the test cohort of 69 patients with unilateral adrenal nodules. The optimal cut-off value was determined to evaluate the diagnostic efficacy of the ECV fraction for differentiating APN from NFN in the validation cohort of 23 patients with bilateral adrenal nodules.
RESULTS
The ECV fractions of the APN (11.17 ± 4.57%) were significantly lower (p < 0.001) than that of the NFN (24.79 ± 6.01%) in the test cohort. At cut-off ECV value of 17.16%, the optimal area under the receiver operating characteristic curve was 0.974 (95% confidence interval: 0.942-1) with 91.4% sensitivity, 93.9% specificity, and 92.8% accuracy in the test cohort and 89.5% sensitivity, 96.3% specificity, and 93.5% accuracy in the validation cohort for differentiating APN from NFN.
CONCLUSION
The spectral CT-derived ECV fraction can differentiate APN from NFN with high diagnostic performance.
CLINICAL RELEVANCE STATEMENT
Spectral CT-derived extracellular volume fraction could accurately differentiate between adrenal aldosterone-producing nodules and nonfunctioning nodules. It might serve as a noninvasive alternative to adrenal vein sampling in primary aldosteronism patients with bilateral adrenal nodules.
KEY POINTS
• Conventional CT cannot differentiate aldosterone-producing adrenal nodules from nonfunctioning nodules. • Extracellular volume of adrenal aldosterone-producing nodules was significantly lower than that of nonfunctioning nodules and normal adrenal glands. It can accurately differentiate between aldosterone-producing and nonfunctioning adrenal nodules. • Extracellular volume may be a novel, noninvasive biomarker alternative to adrenal vein sampling for determining the functional status of bilateral adrenal nodules in patients with primary aldosteronism.
Topics: Humans; Aldosterone; Hyperaldosteronism; Retrospective Studies; Feasibility Studies; Tomography, X-Ray Computed; Adrenal Glands
PubMed: 37566275
DOI: 10.1007/s00330-023-10077-5 -
Materials (Basel, Switzerland) Jul 2023The magnetic properties of magnetic nanocomposites consisting of hard and soft magnetic phases are dependent not only on the intrinsic properties but also on the grain...
The magnetic properties of magnetic nanocomposites consisting of hard and soft magnetic phases are dependent not only on the intrinsic properties but also on the grain structure and volume ratio of the two phases. In this study, we performed a systematic micromagnetic simulation on the magnetic properties of CeFeB/α-Fe and NdFeB/α-Fe nanocomposites. The volume fractions of the hard magnetic NdFeB or CeFeB phase were varied from 80% to 40%, and the grain sizes of the hard magnetic phase and the soft magnetic α-Fe phase were changed independently from 10 nm to 40 nm. The results show that when the grain size of both hard and soft phases is 10 nm and the volume fraction of the hard phase is 70%, the highest maximum magnetic energy product can be obtained in both CeFeB/α-Fe and NdFeB/α-Fe nanocomposites. The hard magnetic properties of CeFeB/α-Fe nanocomposite decrease significantly when the volume fraction of the α-Fe phase exceeds 30%. However, for the NdFeB/α-Fe system, this situation only occurs when the α-Fe volume fraction exceeds 40%. The reason for this is not only because of the low anisotropic field and the smaller exchange coupling length between the soft and hard magnetic phases, but also because of the lower saturation magnetization of the hard phase. The grain size has greater effects on the magnetic properties compared to the volume fraction of the hard magnetic phase. The main reason is that as the grain size increases, the remanence of the nanocomposite decreases sharply, which also leads to a rapid decrease in the maximum magnetic energy product. The simulation results on the effects of phase ratio and grain size have been verified by experiments on melt-spun CeFeB/α-Fe alloys with various compositions prepared by melt-spinning followed by annealing for various lengths of time. Due to the influence of demagnetization energy, the hard magnetic phase with high saturation magnetization is preferred for the preparation of high-performance nanocomposite magnets.
PubMed: 37569964
DOI: 10.3390/ma16155260