-
BMC Nephrology Jun 2024There is still a very high morbidity and mortality rate for patients undergoing peritoneal dialysis (PD). The advanced lung cancer inflammation index (ALI) has been...
BACKGROUND
There is still a very high morbidity and mortality rate for patients undergoing peritoneal dialysis (PD). The advanced lung cancer inflammation index (ALI) has been demonstrated to be associated with the prognosis in multiple types of cancers. Like in cancer, systemic chronic low-grade inflammation is one of the distinguishing features of PD patients. Therefore, we aimed to investigate the relationships between the ALI and all-cause and cardiovascular disease (CVD) mortality in PD patients.
METHODS
Patients who started PD at Shaoxing People's Hospital between 1 January 2013 and 31 December 2020 (n = 277) were recruited and followed up until 1 July 2023. They were divided into high-ALI group and low-ALI group according to the median of ALI. Kaplan-Meier curves and multivariate Cox regression analyses were used to assess the associations between the ALI and all-cause and CVD mortality. Receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUC) was calculated to determine the predictive power of the ALI for all- cause and CVD mortality.
RESULTS
During the median follow-up of 40.50 months (interquartile range, 26.42-59.77 months), a total of 55 patients died, 31 of whom died due to CVD. Kaplan-Meier curves revealed that patients in the low-ALI group had significantly lower cumulative and cardiovascular cumulative survival rates than did those in the high-ALI group (all P < 0.001). After we corrected for confounders, the risk of all-cause and CVD mortality was significantly greater in the low-ALI group than in the high-ALI group [hazard ratio (HR) 1.944, 95% confidence interval (CI) 1.068-3.540, P = 0.030, and HR 2.672, 95% CI 1.188-6.009, P = 0.017, respectively]. The predictive value of ALI (AUC = 0.708, 95% CI 0.630-0.786, P < 0.001) for all-cause mortality was superior to albumin (AUC = 0.644, 95% CI 0.556-0.726, P < 0.001), body mass index (AUC = 0.581, 95% CI 0.496-0.659, P = 0.069) and neutrophil-to-lymphocyte ratio (AUC = 0.675, 95% CI 0.596-0.754, P < 0.001).
CONCLUSION
A lower ALI is an independent risk factor for all-cause and cardiovascular mortality in PD patients. The ALI may be an effective indicator for predicting outcomes in PD patients.
Topics: Humans; Male; Female; Middle Aged; Peritoneal Dialysis; Inflammation; Lung Neoplasms; Cardiovascular Diseases; Aged; Cause of Death; Adult; Kaplan-Meier Estimate; Kidney Failure, Chronic; ROC Curve; Prognosis
PubMed: 38918730
DOI: 10.1186/s12882-024-03645-4 -
Asian Pacific Journal of Cancer... Jun 2024The goal of this study is to determine the accuracy of the PTW Beamscan program in determining the inflection point from Flattening Filter Free Beam Profile utilizing...
OBJECTIVE
The goal of this study is to determine the accuracy of the PTW Beamscan program in determining the inflection point from Flattening Filter Free Beam Profile utilizing Multiple Detectors.
METHODS
True Beam Linear Accelerator with 6FFF and 10FFF Photon Energies and 10 cm, 15 cm and 20 cm Field Sizes were used for this study. Profile measurements were taken with PTW's 729, 1,500, and 1,600 and the Starcheck system, the Pinpoint 3D with Beamscan system, and Linac's EPID. The first-order derivative was utilized in both the Excel spreadsheet and Beamscan software to analyse raw measured data to locate inflection point and the FWHM was calculated. The accuracy of inflection points and FWHM between the Excel sheet calculation and the software program were investigated.
RESULTS
For 10X10 cm2 in the 729 Array, the greatest differences in FWHM were 5.16 mm and 5.04 mm for the X6 FFF and X10 FFF Energies, respectively. The largest difference was 2.26 mm for 1,600 SRS arrays with a 15×15 cm2 field size. The difference in FWHM between Manual and software analysis for 10X10 cm2 and 20X20 cm2 Field Sizes is in decreasing order for detectors from 729, 1,500, 1,600 SRS, Starcheck, Pinpoint 3D, and EPID. In contrast, there is no climbing or declining pattern detected in the difference in Field Width for the 15×15 cm2 Field Size. Similarly, for all detectors except the 1,600 SRS array, the peak of the first-order derivative occurs at the chamber position for a 15X15 cm2 field size.
CONCLUSION
The higher resolution of measurement yields more accuracy in inflection point and the FWHM. Irrespective of measurement resolution, the Beamscan software provided the FWHM closer to the respective nominal Field Size. Out of all detectors, results obtained with Excel Starcheck and EPID are good in agreement with values obtained by the software analysis. Thus, it is shown that Beamscan software is so accurate in determining inflection point of a FFF beam profile and used for routine profile analysis.
Topics: Software; Particle Accelerators; Humans; Radiotherapy Planning, Computer-Assisted; Photons; Radiotherapy Dosage; Radiometry; Algorithms
PubMed: 38918681
DOI: 10.31557/APJCP.2024.25.6.2177 -
Asian Pacific Journal of Cancer... Jun 2024The study aimed to validate a method for minimizing phase errors by combining full-length lung 4DCT (f4DCT) scans with shorter tumor-restricted 4DCT (s4DCT) scans. It...
PURPOSE
The study aimed to validate a method for minimizing phase errors by combining full-length lung 4DCT (f4DCT) scans with shorter tumor-restricted 4DCT (s4DCT) scans. It assessed the feasibility of integrating two scans one covering the entire phantom length and the other focused on the tumor area. The study also evaluated the impact of Maximum Intensity Projection (MIP) volume and imaging dose for different slice thicknesses (2.5mm and 1.25mm) in both full-length and short target-restricted 4DCT scans.
METHODS
The study utilized the Quasar Programmable Respiratory Motion Phantom, simulating tumor motion with a variable lung insert. The setup included a tumor replica and a six-dot IR reflector marker on the breathing platform. The objective was to analyze volume differences in fMIP_2.5mm compared to sMIP_1.25mm within their respective 4D_MIP CT series. This involved varying breathing periods (2.5s, 3.0s, 4.0s, and 5.0s) and longitudinal tumor sizes (6mm, 8mm, and 10mm). The study also assessed exposure time and expected CTDIvol of s4D_2.5mm and s4D_1.25mm for different breathing periods (5.0s to 2.0s) in the sinusoidal wave motion of the six-dot marker on the breathing platform.
RESULTS
Conducting two consecutive 4DCT scans is viable for patients with challenging breathing patterns or when the initial lung tumor scan is in close proximity to the tumor location, eliminating the need for an additional full-length 4DCT. The analysis involves assessing MIP volume, imaging dose (CTDIvol), and exposure time. Longitudinal tumor shifts for 6mm are [16.6-17.2] in fMIP_2.5mm and [16.8-17.5] in sMIP_1.25mm, for 8mm [17.2-18.3] in fMIP_2.5mm and [17.8-18.4] in sMIP_1.25mm, and for 10mm [19-19.9] in fMIP_2.5mm and [19.4-20] in sMIP_1.25mm (p≥ 0.005), respectively.
CONCLUSION
The Quasar Programmable Respiratory Motion Phantom accurately replicated varied breathing patterns and tumor motions. Comprehensive analysis was facilitated through detailed manual segmentation of Internal Target Volumes and Internal Gross Target Volumes.
Topics: Humans; Four-Dimensional Computed Tomography; Phantoms, Imaging; Respiration; Feasibility Studies; Lung Neoplasms; Radiotherapy Planning, Computer-Assisted
PubMed: 38918671
DOI: 10.31557/APJCP.2024.25.6.2089 -
JCO Clinical Cancer Informatics Jun 2024The estimation of prognosis and life expectancy is critical in the care of patients with advanced cancer. To aid clinical decision making, we build a prognostic strategy...
PURPOSE
The estimation of prognosis and life expectancy is critical in the care of patients with advanced cancer. To aid clinical decision making, we build a prognostic strategy combining a machine learning (ML) model with explainable artificial intelligence to predict 1-year survival after palliative radiotherapy (RT) for bone metastasis.
MATERIALS AND METHODS
Data collected in the multicentric PRAIS trial were extracted for 574 eligible adults diagnosed with metastatic cancer. The primary end point was the overall survival (OS) at 1 year (1-year OS) after the start of RT. Candidate covariate predictors consisted of 13 clinical and tumor-related pre-RT patient characteristics, seven dosimetric and treatment-related variables, and 45 pre-RT laboratory variables. ML models were developed and internally validated using the Python package. The effectiveness of each model was evaluated in terms of discrimination. A Shapley Additive Explanations (SHAP) explainability analysis to infer the global and local feature importance and to understand the reasons for correct and misclassified predictions was performed.
RESULTS
The best-performing model for the classification of 1-year OS was the extreme gradient boosting algorithm, with AUC and F1-score values equal to 0.805 and 0.802, respectively. The SHAP technique revealed that higher chance of 1-year survival is associated with low values of interleukin-8, higher values of hemoglobin and lymphocyte count, and the nonuse of steroids.
CONCLUSION
An explainable ML approach can provide a reliable prediction of 1-year survival after RT in patients with advanced cancer. The implementation of SHAP analysis provides an intelligible explanation of individualized risk prediction, enabling oncologists to identify the best strategy for patient stratification and treatment selection.
Topics: Humans; Machine Learning; Bone Neoplasms; Palliative Care; Male; Female; Prognosis; Aged; Middle Aged; Algorithms
PubMed: 38917384
DOI: 10.1200/CCI.24.00027 -
PloS One 2024The implementation of AI assisted cancer detection systems in clinical environments has faced numerous hurdles, mainly because of the restricted explainability of their...
The implementation of AI assisted cancer detection systems in clinical environments has faced numerous hurdles, mainly because of the restricted explainability of their elemental mechanisms, even though such detection systems have proven to be highly effective. Medical practitioners are skeptical about adopting AI assisted diagnoses as due to the latter's inability to be transparent about decision making processes. In this respect, explainable artificial intelligence (XAI) has emerged to provide explanations for model predictions, thereby overcoming the computational black box problem associated with AI systems. In this particular research, the focal point has been the exploration of the Shapley additive explanations (SHAP) and local interpretable model-agnostic explanations (LIME) approaches which enable model prediction explanations. This study used an ensemble model consisting of three convolutional neural networks(CNN): InceptionV3, InceptionResNetV2 and VGG16, which was based on averaging techniques and by combining their respective predictions. These models were trained on the Kvasir dataset, which consists of pathological findings related to gastrointestinal cancer. An accuracy of 96.89% and F1-scores of 96.877% were attained by our ensemble model. Following the training of the ensemble model, we employed SHAP and LIME to analyze images from the three classes, aiming to provide explanations regarding the deterministic features influencing the model's predictions. The results obtained from this analysis demonstrated a positive and encouraging advancement in the exploration of XAI approaches, specifically in the context of gastrointestinal cancer detection within the healthcare domain.
Topics: Humans; Gastrointestinal Neoplasms; Neural Networks, Computer; Artificial Intelligence; Diagnosis, Computer-Assisted
PubMed: 38917159
DOI: 10.1371/journal.pone.0305628 -
JAMA Network Open Jun 2024Although most women with BRCA-associated breast cancer choose bilateral mastectomy, current guidelines support breast-conserving therapy as an option. As the indications...
IMPORTANCE
Although most women with BRCA-associated breast cancer choose bilateral mastectomy, current guidelines support breast-conserving therapy as an option. As the indications for genetic testing expand and targeted therapies emerge, understanding the outcomes of breast-conserving therapy in the population of patients choosing breast conservation is important.
OBJECTIVE
To describe the clinical outcomes of women with BRCA-associated breast cancer who were treated with breast-conserving therapy, including the risks of ipsilateral and contralateral cancer events and bilateral mastectomy-free survival.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study conducted at a single-institution academic national comprehensive cancer center included 172 women identified from a prospectively maintained database who had pathogenic BRCA1/2 variants and were treated with breast-conserving therapy from January 1, 1977, to December 31, 2021.
MAIN OUTCOMES AND MEASURES
Clinical and pathologic characteristics for patients with BRCA1 and BRCA2 were compared, and estimates of overall survival, bilateral mastectomy-free survival, distant disease-free survival, risk of ipsilateral breast cancer, and risk of contralateral cancer were computed.
RESULTS
The cohort included 172 women (mean [SD] age, 47.1 [11.7] years), with 42 (24.4%) receiving a diagnosis of breast cancer prior to 40 years of age. Compared with BRCA2 variant carriers (80 [46.5%]), women with BRCA1 variants (92 [53.5%]) were younger at breast cancer diagnosis and tended to have more advanced tumors, which were more likely to be hormone receptor negative and higher grade. At a median follow-up of 11.8 years (IQR, 5.7-18.2 years), estimates of 10-year survival and risk were: overall survival, 88.5% (95% CI, 83.1%-94.2%); bilateral mastectomy-free survival, 70.7% (95% CI, 63.3%-78.9%); risk of an ipsilateral breast cancer event, 12.2% (95% CI, 5.8%-18.2%); and risk of contralateral cancer, 21.3% (95% CI, 13.3%-28.6%). Risks continued to increase after 10 years of follow-up.
CONCLUSIONS AND RELEVANCE
In this cohort study, although women with breast cancer and pathogenic BRCA1/2 variants treated with breast-conserving therapy had above-average risks of ipsilateral and contralateral breast cancer events, most did not have another cancer event and remained bilateral mastectomy free. These findings may be useful for informing patients with BRCA variants choosing breast conservation.
Topics: Humans; Female; Middle Aged; Breast Neoplasms; Mastectomy, Segmental; Adult; BRCA2 Protein; BRCA1 Protein; Cohort Studies; Treatment Outcome; Disease-Free Survival
PubMed: 38916888
DOI: 10.1001/jamanetworkopen.2024.18486 -
Microbiology Spectrum Jun 2024The incidence of heterogeneous vancomycin-intermediate (hVISA) infection is increasing and is associated with vancomycin treatment failures. However, studies...
The incidence of heterogeneous vancomycin-intermediate (hVISA) infection is increasing and is associated with vancomycin treatment failures. However, studies investigating the risk factors for treatment failure in hVISA infection are limited. Patients with hVISA bacteremia treated with vancomycin over 7 days between August 2008 and June 2020 were enrolled in this study. Clinical and microbiological characteristics were compared between vancomycin treatment failure and success groups to identify the risk factors for vancomycin treatment failure. Among the 180 patients with hVISA bacteremia, 102 patients treated with vancomycin over 7 days were included. Vancomycin treatment failed in 80 (78%) patients. Patients in the vancomycin treatment failure group were older ( < 0.001) and more frequently had solid cancer ( = 0.04) than those in the vancomycin treatment success group. Solid organ transplantation (SOT) was more frequent ( < 0.001) in the vancomycin treatment success group. The Charlson comorbidity index ( = 0.01) and Acute Physiology and Chronic Health Evaluation II scores ( < 0.001) were higher in the vancomycin treatment failure group. In multivariate analysis, independent risk factors for vancomycin treatment failure were old age and severity of bacteremia. SOT and vancomycin minimal inhibitory concentration (MIC) ≤ 1.0 mg/L using the broth microdilution (BMD) method were associated with successful vancomycin treatment. Old age and infection severity were independent risk factors for vancomycin treatment failure. Vancomycin MIC using the BMD method is an important risk factor for vancomycin treatment failure, and its use should be considered in hVISA bacteremia.IMPORTANCEIn this study, we assessed the clinical and microbiological characteristics of heterogeneous vancomycin-intermediated (hVISA) bacteremia and identified risk factors for vancomycin treatment failure. We found that advanced age and severity of infection were independent risk factors for vancomycin treatment failure. On the other hand, solid organ transplantation and a low vancomycin minimal inhibitory concentration were associated with successful vancomycin treatment. This study highlights the importance of vancomycin minimal inhibitory concentration in hVISA bacteremia.
PubMed: 38916352
DOI: 10.1128/spectrum.00333-24 -
International Journal of Nanomedicine 2024Extracellular vesicles (EVs) are microparticles released from cells in both physiological and pathological conditions and could be used to monitor the progression of... (Review)
Review
Extracellular vesicles (EVs) are microparticles released from cells in both physiological and pathological conditions and could be used to monitor the progression of various pathological states, including neoplastic diseases. In various EVs, tumor-derived extracellular vesicles (TEVs) are secreted by different tumor cells and are abundant in many molecular components, such as proteins, nucleic acids, lipids, and carbohydrates. TEVs play a crucial role in forming and advancing various cancer processes. Therefore, TEVs are regarded as promising biomarkers for the early detection of cancer in liquid biopsy. However, the currently developed TEV detection methods still face several key scientific problems that need to be solved, such as low sensitivity, poor specificity, and poor accuracy. To overcome these limitations, DNA walkers have emerged as one of the most popular nanodevices that exhibit better signal amplification capability and enable highly sensitive and specific detection of the analytes. Due to their unique properties of high directionality, flexibility, and efficiency, DNA walkers hold great potential for detecting TEVs. This paper provides an introduction to EVs and DNA walker, additionally, it summarizes recent advances in DNA walker-based detection of TEVs (2018-2024). The review highlights the close relationship between TEVs and DNA walkers, aims to offer valuable insights into TEV detection and to inspire the development of reliable, efficient, simple, and innovative methods for detecting TEVs based on DNA walker in the future.
Topics: Humans; Extracellular Vesicles; Neoplasms; DNA; Biomarkers, Tumor; Liquid Biopsy; Early Detection of Cancer
PubMed: 38915916
DOI: 10.2147/IJN.S464895 -
Bioinformatics Advances 2024Genomics-based diagnostic methods that are quick, precise, and economical are essential for the advancement of precision medicine, with applications spanning the...
MOTIVATION
Genomics-based diagnostic methods that are quick, precise, and economical are essential for the advancement of precision medicine, with applications spanning the diagnosis of infectious diseases, cancer, and rare diseases. One technology that holds potential in this field is optical genome mapping (OGM), which is capable of detecting structural variations, epigenomic profiling, and microbial species identification. It is based on imaging of linearized DNA molecules that are stained with fluorescent labels, that are then aligned to a reference genome. However, the computational methods currently available for OGM fall short in terms of accuracy and computational speed.
RESULTS
This work introduces OM2Seq, a new approach for the rapid and accurate mapping of DNA fragment images to a reference genome. Based on a Transformer-encoder architecture, OM2Seq is trained on acquired OGM data to efficiently encode DNA fragment images and reference genome segments to a common embedding space, which can be indexed and efficiently queried using a vector database. We show that OM2Seq significantly outperforms the baseline methods in both computational speed (by 2 orders of magnitude) and accuracy.
AVAILABILITY AND IMPLEMENTATION
https://github.com/yevgenin/om2seq.
PubMed: 38915884
DOI: 10.1093/bioadv/vbae079 -
Frontiers in Genetics 2024Investigating therapeutic miRNAs is a rewarding endeavour for pharmaceutical companies. Since its discovery in 1993, our understanding of miRNA biology has advanced... (Review)
Review
Genetic Alchemy unveiled: MicroRNA-mediated gene therapy as the Artisan craft in the battlefront against hepatocellular carcinoma-a comprehensive chronicle of strategies and innovations.
Investigating therapeutic miRNAs is a rewarding endeavour for pharmaceutical companies. Since its discovery in 1993, our understanding of miRNA biology has advanced significantly. Numerous studies have emphasised the disruption of miRNA expression in various diseases, making them appealing candidates for innovative therapeutic approaches. Hepatocellular carcinoma (HCC) is a significant malignancy that poses a severe threat to human health, accounting for approximately 70%-85% of all malignant tumours. Currently, the efficacy of several HCC therapies is limited. Alterations in various biomacromolecules during HCC progression and their underlying mechanisms provide a basis for the investigation of novel and effective therapeutic approaches. MicroRNAs, also known as miRNAs, have been identified in the last 20 years and significantly impact gene expression and protein translation. This atypical expression pattern is strongly associated with the onset and progression of various malignancies. Gene therapy, a novel form of biological therapy, is a prominent research area. Therefore, miRNAs have been used in the investigation of tumour gene therapy. This review examines the mechanisms of action of miRNAs, explores the correlation between miRNAs and HCC, and investigates the use of miRNAs in HCC gene therapy.
PubMed: 38915826
DOI: 10.3389/fgene.2024.1356972