In situ evidence of the magnetospheric cusp of Jupiter from Juno spacecraft measurements

The magnetospheric cusp connects the planetary magnetic field to interplanetary space, offering opportunities for charged particles to precipitate to or escape from the planet. Terrestrial cusps are typically found near noon local time, but the characteristics of the Jovian cusp are unknown. Here we show direct evidence of Jovian cusps using datasets from multiple instruments onboard Juno spacecraft. We find that the cusps of Jupiter are in the dusk sector, which is contradicting Earth-based predictions of a near-noon location. Nevertheless, the characteristics of charged particles in the Jovian cusps resemble terrestrial and Saturnian cusps, implying similar cusp microphysics exist across different planets. These results demonstrate that while the basic physical processes may operate similarly to those at Earth, Jupiter's rapid rotation and its location in the heliosphere can dramatically change the configuration of the cusp. This work provides useful insights into the fundamental consequences of star-planet interactions, highlighting how planetary environments and rotational dynamics influence magnetospheric structures.

[Educational attainment increases the risk of developing allergic rhinitis and (or) eczema: a Mendelian randomization study based on genome-wide association studies in European patients]

Objective: To determine the causal relationship between educational attainment and the risk of allergic rhinitis and (or) eczema using Mendelian randomization (MR) analyses. Methods: This study was a secondary data analysis based on the summary data of genome-wide association studies (GWAS), which involved 293 723 participants (educational attainment) from the Social Science Genetics Association Consortium and 462 013 participants [allergic rhinitis and (or) eczema] from the UK Biobank. Genetic variants that were closely related to educational attainment were identified as instrumental variables. Two-sample MR analyses, including inverse-variance weighted (IVW), MR-Egger regression, weighted median method and weighted model-based estimation, were performed to investigate the causal relationship between educational attainment and the risk of allergic rhinitis and (or) eczema, in which the odds ratio (OR) values were used as indicators. Results: A total of 70 single-nucleotide polymorphisms (SNPs) were chosen as instrumental variables. The MR-Egger regression results suggested that the genetic pleiotropy was unlikely to bias our results (P=0.107). In the univariable MR analyses, IVW regression showed that the risk of allergic rhinitis and (or) eczema was OR=1.044 (95%CI: 1.020-1.069, P<0.001) and OR=1.170 (95%CI: 1.074-1.256, P<0.001), respectively, for the increase in the duration of education by one year or one standard deviation (SD) (3.71 years). In the reverse MR analysis, IVW regression showed little evidence that allergic rhinitis and (or) eczema affected educational attainment (OR=1.020, 95%CI: 0.927-1.023, P=0.683). The results of the weighted median method and weighted mode-based estimation were consistent with the results of IVW. Conclusion: This study suggests that there is a positive causal relationship between educational attainment and the risk of allergic rhinitis and (or) eczema, which means that educational attainment can increase the occurrence of allergic rhinitis and (or) eczema.

Immune checkpoint inhibitors and anti-vascular endothelial growth factor antibody/tyrosine kinase inhibitors with or without transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma (CHANCE2201): a target trial emulation study

Background

The role of transarterial chemoembolization (TACE) in the treatment of advanced hepatocellular carcinoma (HCC) is unconfirmed. This study aimed to assess the efficacy and safety of immune checkpoint inhibitors (ICIs) plus anti-vascular endothelial growth factor (anti-VEGF) antibody/tyrosine kinase inhibitors (TKIs) with or without TACE as first-line treatment for advanced HCC.

Methods

This nationwide, multicenter, retrospective cohort study included advanced HCC patients receiving either TACE with ICIs plus anti-VEGF antibody/TKIs (TACE-ICI-VEGF) or only ICIs plus anti-VEGF antibody/TKIs (ICI-VEGF) from January 2018 to December 2022. The study design followed the target trial emulation framework with stabilized inverse probability of treatment weighting (sIPTW) to minimize biases. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), objective response rate (ORR), and safety. The study is registered with ClinicalTrials.gov, NCT05332821.

Findings

Among 1244 patients included in the analysis, 802 (64.5%) patients received TACE-ICI-VEGF treatment, and 442 (35.5%) patients received ICI-VEGF treatment. The median follow-up time was 21.1 months and 20.6 months, respectively. Post-application of sIPTW, baseline characteristics were well-balanced between the two groups. TACE-ICI-VEGF group exhibited a significantly improved median OS (22.6 months [95% CI: 21.2-23.9] vs 15.9 months [14.9-17.8]; P < 0.0001; adjusted hazard ratio [aHR] 0.63 [95% CI: 0.53-0.75]). Median PFS was also longer in TACE-ICI-VEGF group (9.9 months [9.1-10.6] vs 7.4 months [6.7-8.5]; P < 0.0001; aHR 0.74 [0.65-0.85]) per Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. A higher ORR was observed in TACE-ICI-VEGF group, by either RECIST v1.1 or modified RECIST (41.2% vs 22.9%, P < 0.0001; 47.3% vs 29.7%, P < 0.0001). Grade ≥3 adverse events occurred in 178 patients (22.2%) in TACE-ICI-VEGF group and 80 patients (18.1%) in ICI-VEGF group.

Interpretation

This multicenter study supports the use of TACE combined with ICIs and anti-VEGF antibody/TKIs as first-line treatment for advanced HCC, demonstrating an acceptable safety profile.

Funding

National Natural Science Foundation of China, National Key Research and Development Program of China, Jiangsu Provincial Medical Innovation Center, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, and Nanjing Life Health Science and Technology Project.

[Clinical diagnostic practices for Chinese developmental dyslexia]

Objective: To explore the optimization of the standardized assessment tool for clinical diagnosis of Chinese developmental dyslexia (DD). Methods: A cross-sectional study was conducted from May to December 2023, in which 130 primary school children in grades 1 to 3 with clinical signs of literacy lag and positive screening results on the screening scales were recruited from the outpatient clinic of Child Health Care Medical Division, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine. Chinese dyslexia screening behavior checklist for primary students (CDSBC) was used as the screening scales, and supplemented by dyslexia checklist for Chinese children. Referring to the standard procedure of the"expert advice on diagnosis and intervention of chinese developmental dyslexia", the developmental dyslexia scale for standard mandarin (DDSSM) was used to evaluate the children's literacy-related cognitive abilities and conduct the diagnostic assessment, and divided the children into learning backward group and the DD group. The t-test and χ2 test were used to compare the differences in the distribution of intelligence, literacy and attention deficit hyperactivity disorder between the two groups. Spearman's correlation was used to analyze the correlation between the scores for each cognitive ability in the DDSSM and the CDSBC. Results: Of the 130 children, 90 were male, aged (8.3±1.0) years; 40 were female, aged (8.1±0.9) years. A final diagnosis of DD was made in 59 cases, of which 41 were males. There was no statistically significant difference in operational intelligence quotient (101±15 vs.100±15, t=0.53, P>0.05) and statistically significant difference in literacy of DDSSM (32±5 vs.21±4, t=11.56, P<0.001) between the learning backward group and the DD group. Eighteen cases (25.4%) of the learning backward group were children with attention deficit subtype attention deficit hyperactivity disorder (ADHD-I), and 16 cases (27.1%) in DD group, the difference in incidence between the two groups was not statistically significant (χ2=0.05, P>0.05). There were correlations between the DDSSM (for oral vocabulary, morphological awareness and orthographic awareness) and the CDSBC total score (r=-0.42, -0.32, -0.35, all P<0.01), but the correlations for visuospatial perception and rapid automatized naming with CDSBC total score were not statistically significant (r=-0.09 and -0.20,both P>0.05). Conclusions: For literacy-related cognitive abilities, screening scales CDSBC are not sufficiently useful for assessment, so the introduction of standardized assessment tools DDSSM is an optimization of the clinical diagnosis of Chinese DD, which is crucial for achieving accurate diagnosis and intervention.

[The value of minimal residual disease and IKZF1 deletion for predicting prognosis in adult patients with B-cell acute lymphoblastic leukemia]

Objective: To reassess the prognostic value of minimal residual disease (MRD) and IKZF1 gene deletions in adults with B-cell acute lymphoblastic leukemia (B-ALL) who received pediatric-specific chemotherapy regimens during the Nanfang Hospital PDT-ALL-2016 trial. Methods: We retrospectively analyzed the prognosis of 149 adult patients with B-ALL who were admitted to Nanfang Hospital from January 2016 to September 2020. Prognostic factors were identified using Cox regression models. Results: The complete remission rate was 93.2% in 149 patients, with a 5-year overall survival (OS) rate of (54.3±5.0) % and a cumulative incidence of relapse (CIR) of (47.5±5.2) %. The Cox regression analysis revealed that MRD positivity at day 45 (MRD(3)) after induction therapy was independently associated with relapse risk (HR=2.535, 95%CI 1.122-5.728, P=0.025). Deletion of IKZF1 gene was independently associated with mortality risk (HR=1.869, 95%CI 1.034-3.379, P=0.039). Based on MRD(3) and IKZF1 gene status, we categorized adult patients with B-ALL into the low-risk (MRD(3)-negative and IKZF1 gene deletion-negative) and high-risk (MRD(3)-positive and/or IKZF1 gene wild type) groups. The 5-year OS and CIR rates were (45.5±6.0) % vs (69.4±8.6) % (P<0.001) and (61.6±8.3) % vs (25.5±6.5) % (P<0.001), respectively, in the high-risk and low-risk groups, respectively. The multivariate analysis showed that the high-risk group was an independent risk factor for OS (HR=3.937, 95%CI 1.975-7.850, P<0.001) and CIR (HR=4.037, 95%CI 2.095-7.778, P<0.001) . Conclusion: The combined use of MRD and IKZF1 gene in prognostic stratification can improve clinical outcome prediction in adult patients with B-ALL, helping to guide their treatment.

[A survey on the current situation of serum vitamin A and vitamin D levels among children aged 2-<7 years of 20 cities in China]

Objective: To investigate serum vitamin A and vitamin D status in children aged 2-<7 years in 20 cities in China. Methods: A cross-sectional study was conducted. A total of 2 924 healthy children aged 2-<7 years were recruited from September 2018 to September 2019 from 20 cities in China, categorized by age groups of 2-<3 years, 3-<5 years, and 5-<7 years. The demographic and economic characteristics and health-related information of the enrolled children were investigated. Body weight and height were measured by professional staff members. The serum vitamin A and vitamin D levels were detected by high-performance liquid chromatography-tandem mass spectrometry. Chi-square test and Logistic regression were applied to analyze the association between vitamin A and vitamin D deficiency and insufficiency as well as their underlying impact factors. Results: The age of the 2 924 enrolled children was 4.33 (3.42, 5.17) years. There were 1 726 males (59.03%) and 1 198 females (40.97%). The prevalences of vitamin A and vitamin D deficiency in enrolled children were 2.19% (64/2 924) and 3.52% (103/2 924), respectively, and the insufficiency rates were 29.27% (856/2 924) and 22.20% (649/2 924), respectively. Children with both vitamin A and vitamin D deficiencies or insufficiencies were found in 10.50% (307/2 924) of cases. Both vitamin A (χ2=7.91 and 8.06, both P=0.005) and vitamin D (χ2=71.35 and 115.10, both P<0.001) insufficiency rates were higher in children aged 3-<5 and 5-<7 years than those in children aged 2-<3 years. Vitamin A and vitamin D supplementation in the last 3 months was a protective factor for vitamin A and D deficiency and insufficiency, respectively (OR=0.68 and 0.22, 95%CI 0.49-0.95 and 0.13-0.40, both P<0.05). The rates of vitamin A and D insufficiency was higher in children with annual household incomes <60 000 RMB than in those with annual household incomes ≥60 000 RMB (χ2=34.11 and 10.43, both P<0.01). Northwest and Southwest had the highest rates of vitamin A and vitamin D insufficiency in children aged 2-<7 yeas, respectively (χ2=93.22 and 202.54, both P<0.001). Conclusions: Among 20 cities in China, children aged 2-<7 years experience high rates of vitamin A and vitamin D insufficiency, which are affected by age, family economic level, vitamin A and vitamin D supplementation, and regional economic level. The current results suggest that high level of attention should be paid to vitamin A and vitamin D nutritional status of preschool children.

Locoregional therapies for hepatocellular carcinoma: The current status and future perspectives

Hepatocellular carcinoma (HCC) is one of the most common cancers and a leading cause of cancer-related mortality. Locoregional therapies (LRTs) play a crucial role in HCC management and are selectively adopted in real-world practice across various stages. Choosing the best form of LRTs depends on technical aspects, patient clinical status and tumour characteristics. Previous studies have consistently highlighted the efficacy of combining LRTs with molecular targeted agents in HCC treatment. Recent studies propose that integrating LRTs with immune checkpoint inhibitors and molecular targeted agents could provide substantial therapeutic benefits, a notion underpinned by both basic and clinical evidence. This review summarised the current landscape of LRTs in HCC and discussed the anticipated outcomes of combinations with immunotherapy regimens.

New First-line Immunotherapy-based Therapies for Unresectable Hepatocellular Carcinoma: A Living Network Meta-analysis

Background and Aims

Several first-line immune checkpoint inhibitor (ICI)-based combination therapies have been identified for unresectable hepatocellular carcinoma (uHCC). This network meta-analysis (NMA) aimed to provide the most updated evidence about the preferred first-line ICI-based regimens for uHCC.

Methods

A comprehensive literature search was performed in various databases from database inception to May 2022. The phase 3 trials evaluating first-line single-agent ICIs, molecular-target agents (MTAs), or their combinations in uHCC were included. The main endpoints were overall survival (OS) and progression-free survival (PFS). Pooled effect estimates were calculated using a random effects model within the frequentist framework. Subgroup analyses based on etiology were also conducted.

Results

Twelve trials at low risk of bias with 8,275 patients comparing 13 treatments were included. OS with atezolizumab plus bevacizumab was comparable to sintilimab plus IBI305 [hazard ratio (HR): 1.16; 95% confidence interval (CI): 0.80-1.68] and camrelizumab plus apatinib (HR: 1.06; 95% CI: 0.75-1.51). The combination therapies, apart from atezolizumab plus cabozantinib in OS and durvalumab plus tremelimumab in PFS, had higher P-score than single-agent MTAs or ICIs. The survival benefits were associated with a high risk of adverse events leading to treatment discontinuation. The proportion of patients with hepatitis B virus-related HCC receiving ICIs combinations might positively correlate with survival advantages (R2=0.8039, p=0.0155).

Conclusion

This NMA demonstrated that atezolizumab plus bevacizumab remains the stand of care and confers comparable survival benefits to sintilimab plus IBI305 and camrelizumab plus apatinib in first-line therapy for uHCC. The optimal treatment algorithms should consider efficacy, safety, and etiology.

[Investigation and analysis on the detection of IgG antibodies against the rubella virus among rural childbearing-age women in preconception period in Yunnan Province from 2013 to 2019]

A study was conducted on rural women of childbearing age aged 20-49 who underwent the National Free Preconception Health Examination Project (NFPHEP)in Yunnan Province from 2013 to 2019. Descriptive analysis was conducted to determine the negative rate of IgG antibodies against the rubella virus and its differences among various socio-demographic characteristics. Among the 1 511 203 study subjects, the negative rate of IgG antibodies against the rubella virus was 24.36%. Only 2.64% of the population had received rubella virus vaccine. The negative rate of IgG antibodies among rural childbearing-age women in the preconception period in Yunnan Province decreased with age and educational level (Ptrend<0.001). The negative rate of IgG antibodies in ethnic minority women of childbearing age in the preconception period (25.19%) was higher than that of Han women (23.88%). Among the 22 ethnic groups with over 1 000 participants, the negative rates of IgG antibodies in women of childbearing age from the Blang (32.85%), Bouyei (31.03%), Zhuang (31.01%), and Miao (30.70%) ethnic groups were higher than those of women from other ethnic groups. Among the 16 states (cities) in Yunnan Province, the negative rate of IgG antibodies in pregnant women of childbearing age in Wenshan Zhuang and Miao Autonomous Prefecture (38.06%) and Lincang City (32.63%) was higher than that in other states (cities). The negative rate of serum IgG antibodies in women who reported having received rubella virus vaccine (18.60%) was lower than that in other non-vaccinated populations (24.52%). The proportion of rural women of childbearing age in Yunnan Province who were susceptible to the rubella virus before pregnancy was still high. It is necessary to promote rubella vaccination among people susceptible to rubella, especially pregnant women, to prevent rubella virus infection and reduce the incidence rate and disease burden of rubella people.

Real-world efficacy and safety of TACE plus camrelizumab and apatinib in patients with HCC (CHANCE2211): a propensity score matching study

OBJECTIVES

This study aimed to investigate the efficacy and safety of transarterial chemoembolization (TACE) plus camrelizumab, a monoclonal antibody targeting programmed death-1, and apatinib for patients with intermediate and advanced hepatocellular carcinoma (HCC) in a real-world setting.

METHODS

A total of 586 HCC patients treated with either TACE plus camrelizumab and apatinib (combination group, n = 107) or TACE monotherapy (monotherapy group, n = 479) were included retrospectively. Propensity score matching analysis was used to match patients. The overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and safety in the combination group were described in comparison to monotherapy.

RESULTS

After propensity score matching (1:2), 84 patients in the combination group were matched to 147 patients in the monotherapy group. The median age was 57 years and 71/84 (84.5%) patients were male in the combination group, while the median age was 57 years with 127/147 (86.4%) male in the monotherapy group. The median OS, PFS, and ORR in the combination group were significantly higher than those in the monotherapy group (median OS, 24.1 vs. 15.7 months, p = 0.008; median PFS, 13.5 vs. 7.7 months, p = 0.003; ORR, 59.5% [50/84] vs. 37.4% [55/147], p = 0.002). On multivariable Cox regression, combination therapy was associated with significantly better OS (adjusted hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.26-0.64; p < 0.001) and PFS (adjusted HR, 0.52; 95% CI, 0.37-0.74; p < 0.001). Grade 3 or 4 adverse events occurred in 14/84 (16.7%) and 12/147 (8.2%) in the combination and monotherapy groups, respectively.

CONCLUSIONS

TACE plus camrelizumab and apatinib showed significantly better OS, PFS, and ORR versus TACE monotherapy for predominantly advanced HCC.

CLINICAL RELEVANCE STATEMENT

Compared with TACE monotherapy, TACE plus immunotherapy and molecular targeted therapy showed better clinical efficacy for predominantly advanced HCC patients, with a higher incidence of adverse events.

KEY POINTS

• This propensity score-matched study demonstrates that TACE plus immunotherapy and molecular targeted therapy have a longer OS, PFS, and ORR compared with TACE monotherapy in HCC. • Grade 3 or 4 adverse events occurred in 14/84 (16.7%) patients treated with TACE plus immunotherapy and molecular targeted therapy compared with 12/147 (8.2%) patients in the monotherapy group, while no grade 5 adverse events were observed in all cohorts.

Ru-Based Organometallic Agents Bearing Phenyl Hydroxide: Synthesis and Antibacterial Mechanism Study against Staphylococcus aureus

The development of antimicrobial agents with novel model of actions is a promising strategy to combat multiple resistant bacteria. Here, three ruthenium-based complexes, which acted as potential antimicrobial agents, were synthesized and characterized. Importantly, three complexes all showed strong bactericidal potency against Staphylococcus aureus. In particular, the most active one has a MIC of 6.25 μg/mL. Mechanistic studies indicated that ruthenium complex killed S. aureus by releasing ROS and damaging the integrity of bacterial cell membrane. In addition, the most active complex not only could inhibit the biofilm formation and hemolytic toxin secretion of S. aureus, but also serve as a potential antimicrobial adjuvant as well, which showed synergistic effects with eight traditional antibiotics. Finally, both G. mellonella larva infection model and mouse skin infection model all demonstrated that ruthenium complex also showed significant efficacy against S. aureus in vivo. In summary, our study suggested that ruthenium-based complexes bearing a phenyl hydroxide are promising antimicrobial agents for combating S. aureus.

Teaching Trainees to be Effective Mentors: A Needs-Based Assessment in Radiation Oncology

PURPOSE/OBJECTIVE(S)

Mentorship plays a critical role in the training and career development of medical trainees. Teaching-the-teacher workshops for residents translate to higher long-term job satisfaction and improved patient communication skills. Further, near-peer mentorship has been associated with increased job satisfaction and patient care experience. Resident-as-mentors can add benefit to the mentorship networks of students, particularly in resource-limited environments, while benefiting residents' own mentorship relations and career satisfaction. We hypothesized that residents would desire to be a mentor, but would lack specific skills needed for effective mentoring of students in radiation oncology.

MATERIALS/METHODS

A multi-institution, cross-sectional study was conducted among residents in the Radiation Oncology Education Collaborative Study Group (ROECSG) Graduate Medical Education working group from 06/2022-10/2022. Participants completed the Mentorship Competency Assessment (MCA), a validated 26-item questionnaire, scored on a Likert scale from 0-7 (0: most unprepared with mentorship skill, 7: most prepared with mentorship skill). The primary endpoint was the average score in individual mentorship skills among participants. Kruskal-Wallis test assessed associations between total MCA score (range 0-182) and demographics.

RESULTS

A total of 36 of 39 participants (92% response rate) responded. A majority were male (58%), from a residency size >10 (75%), and P Gy-2/3 (52%). Most had no formal training in teaching (86%) or mentorship (89%). Many believed they would be a good mentor to students on a rotation (89%), but most felt they would benefit from a formal mentorship program (92%). From the MCA, the mentorship skills residents felt most unprepared for were: coordinating effectively with other mentors (3.4/7), helping mentees acquire resources (3.6/7), negotiating a path to professional independence with mentees (3.6/7), helping mentees network effectively (3.7/7), and working with mentees to set clear expectations of the mentoring relationship (3.9/7). The mentorship skills residents felt most prepared for were: acknowledging mentees' professional contributions (5.6/7), establishing a relationship based on trust (5.6/7), active listening (5.5/7), building mentees' confidence (4.9/7), and working effectively with mentees with personal backgrounds differing from one's own (4.8/7). Higher MCA scores were associated with former training in mentorship (p = 0.0143), and a trend for former training in teaching (p = 0.0525), but was not associated with sex (p = 0.5986), residency size (p = 0.1415), or P Gy-year (p = 0.9747).

CONCLUSION

Residents are interested in mentorship training and report unpreparedness in several important skills. Future work should focus on formal training and assessment of mentoring skills for residents.

Natural Language Processing Identification of Symptoms in Emergency Department Visits in Patients Receiving Radiation

PURPOSE/OBJECTIVE(S)

Patients undergoing radiotherapy (RT) for cancer often require emergency department (ED) attention with possible hospitalization. Designing strategies to mitigate hospital admissions requires understanding the causal symptoms to tailor interventional strategies. Natural language processing (NLP) has previously been shown to accurately identify documented symptoms and may help characterize factors contributing to admission. The objective of this study was to use NLP to identify documented symptoms during ED visits and their association with subsequent hospital admission of patients undergoing RT.

MATERIALS/METHODS

A de-identified, single tertiary-care institution cohort of patients who received radiation between 2013 and 2022 was identified from the electronic health record using International Classification of Disease (ICD) and Current Procedural Terminology (CPT) codes. We applied a previously validated clinical Text Analysis and Knowledge Extraction System (cTAKES)-based NLP pipeline to extract Common Terminology Criteria for Adverse Events (CTCAE) encoded symptoms from ED encounter clinical notes. Chi-squared testing was used to compare demographics, and logistic regression was used to identify symptoms associated with subsequent admission from ED visits.

RESULTS

We identified 14,007 patients who received radiation, of whom 270 (1.9%) experienced 302 ED visits during their radiation course. 141 (46.7%) of ED visits resulted in an admission. Among patients with an ED encounter, there were no differences in admission rates based on primary language (p = 0.771), sex (p = 0.824), marital status (p = 0.753), race (p = 0.222), or age (p = 0.123). In admitted patients, the top 5 symptoms were pain (94.3%), nausea (92.1%), vomiting (73.7%), constipation (70.9%), and weakness (63.8%). In patients who did not require admission, the most common symptoms were pain (84.5%), nausea (67.1%), vomiting (47.2%), headache (36.6%), and weakness (35.4%). The 10 symptoms most associated with admission from the ED based on logistic regression were malaise (OR 21.7, [95% CI 10.1 - 51.0]), lethargy (19.1, [8.5 - 51.3]), flushing (15.7, [8.6 - 30.4]), agitation (12.4, [3.5 - 78.7]), somnolence (10.3, [4.7 - 25.9]), fall (8.5, [3.7 - 23.2]), fatigue (7.8, [4.6 - 13.4]), constipation (6.9, [4.2 - 11.6]), nausea (5.8, [3.0 - 12.2]), and swelling (5.4, [3.3 - 9.1]).

CONCLUSION

Admitted and non-admitted ED patients with cancer seen in the ED during radiotherapy are documented to experience similar symptoms, but certain symptoms are associated with a higher risk of hospital admission. NLP may offer a mechanism for early, automated identification to facilitate supportive interventions for patients at high risk for admission during radiotherapy.

Attitudes and Barriers to Planned Family Building among Professionals and Trainees in Radiation Oncology

PURPOSE/OBJECTIVE(S)

The timing of residency training often coincides with peak biological fertility. However, family building is frequently deferred and may lead to unanticipated infertility. The attitudes and barriers to family planning are not well described among medical professionals and trainees in radiation oncology (RO).

MATERIALS/METHODS

The Society for Women in Radiation Oncology (SWRO) conducted an electronic survey among practicing physicians, physicists, and residents between January and February 2023, using email and social media as recruitment tools. The survey questions queried demographics, family planning, fertility. Frequencies of responses were summarized using descriptive statistics.

RESULTS

On interim analysis, 147 responses were collected; 123 (89.8%) were SWRO members. Gender identities reported were female (136, 93.2%), male (7, 4.8%), nonbinary or gender diverse (2, 1.4%), and transgender female (1, 0.7%). 95 (64.6%) respondents were age 35 or younger. The majority were practicing physicians (72, 49.0%) followed by RO residents (45, 30.6%), medical physicists (17, 11.6%), medical students, (5, 3.4%), and medical physics residents (4, 2.7%). Most respondents agreed that their reproductive timeline had been impacted by medical training (106, 76.3%). Of those who deferred parenthood due to training or career, 40 (36.7%) were dissatisfied with their choice and 33 (30.2%) were satisfied. 129 (92.8%) reported not receiving any information about fertility preservation during training. Only 65 (47.4%) felt they had a mentor with whom they could approach to discuss family planning. Overall, 84 (60.4%) expressed concern about their fertility and 34 (24.5%) had previously undergone fertility testing. 16 (11.5%) completed at least one cycle of elective fertility preservation and 12 (8.6%) were planning to do so. 39 (28.1%) had considered elective fertility preservation but not pursued it, while 65 (46.8%) had not considered it. Among those two groups, the common reported barriers to accessing fertility services were financial burden (n = 28, 28.6%), lack of awareness of available options (n = 12, 12.2%), difficulty accessing fertility services (n = 6, 6.1%), and difficulty finding time during training (n = 4, 4.1%). Insurance coverage for elective fertility preservation was fully or partially covered by insurance for 12 (8.8%), not covered for 53 (38.7%), and 72 (52.6%) were uncertain of their coverage.

CONCLUSION

The study highlights the impact of training on family building plans of medical professionals in RO. Despite high levels of concern about fertility, few respondents received education about fertility options in training and a limited number had access to mentors to discuss this issue. Significant barriers exist to accessing fertility services, including knowledge gaps about insurance coverage, highlighting a need for further exploration of these barriers and advocacy for improved family planning support for those in RO who desire it.

TEAMRO: TEAching Mentorship in Radiation Oncology, a Multicenter Prospective Phase 2 Intervention Study on Teaching Mentorship Skills to Residents Working with Medical Students

PURPOSE/OBJECTIVE(S)

While formal curriculum on resident teaching have been associated with improved career growth and sustained positive impact on patient care, mentorship skills are rarely taught in academic medicine. We hypothesized that a formalized resident mentorship curriculum coupled with a near-peer resident-medical student mentoring program would improve resident career growth.

MATERIALS/METHODS

A multi-institutional, prospective, phase 2 intervention study, approved by each participating center's institutional review board, was conducted from 4/2022-10/2022 among interested residents in the Radiation Oncology Education Collaborative Study Group Graduate Medical Education. Intervention included: 1) a 4-week mentorship curriculum (utilizing a Six Steps approach) composed of self-guided readings, didactic lecture, and 30-minute faculty check-in, and 2) a formalized 1:1 resident-medical student mentorship program during an existing radiation oncology sub-internship with weekly meetings. Resident participants completed the Mentorship Competency Assessment (MCA), a 26-item validated survey on mentorship skills in medicine scored from 0 (most unprepared) to 7 (most prepared) before and after the intervention. The primary endpoint was average change in MCA skill from pre- to post-intervention survey, with score ranges from -7 (a decrease in 7 points) to +7 (an increase of 7 points).

RESULTS

A total of 8 residents participated and all completed pre- and post-intervention surveys. Most residents were PGY-4/5 (75%), from programs with >10 residents (68%), and did not have prior training in teaching (88%) or mentorship (88%). Residents met students on average twice weekly (range 1-3) for an average of 2 hours a week (range 1-5). After the program, most residents felt confident in being a future mentor to students (100%), their overall well-being was positively impacted (63%), and their mentorship relationships were positively impacted (50%). All 26 mentorship skills increased on MCA after intervention (average +1.3/7 per skill). Skills that showed greatest improvement were helping mentees network effectively (+2.6/7), acquire resources (+2.1/7), negotiate a path to professional independence (+2.0/7), set career goals (+1.8/7), and balance work and personal life (+1.7/7). Skills that showed least improvement were establishing a relationship based on trust (+0.4/7), identifying and accommodating different communication styles (+0.6/7), providing constructive feedback (+0.7/7), and aligning mentor-mentee expectations (+0.8/7).

CONCLUSION

The formalized mentorship program improved mentorship skills among residents, translating to increased satisfaction in residents' own mentorship relations and overall well-being. Further studies are needed to assess the sustainability of these skills, as well as impact on career growth and satisfaction.

Patient Education Practices and Preferences of Interprofessional Radiation Oncology Providers

PURPOSE/OBJECTIVE(S)

Patient understanding of radiotherapy (RT) processes and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. Our objective was to evaluate PE practices and preferences of interprofessional RO providers to inform recommendations for delivering inclusive, accessible, and patient-centered education.

MATERIALS/METHODS

An anonymous 17-item online survey, approved by an ethics review board, was administered to all members of the Radiation Oncology Education Collaborative Study Group (ROECSG) between 10/5/22 to 11/23/22. Respondent demographics, provider practices/preferences, and institutional practices were collected. Qualitative items explored key strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. Fisher's exact test compared PE practices by provider role and PE timing. Thematic analysis was used for qualitative responses.

RESULTS

A total of 123 ROECSG members, including RO attendings (64%), RO trainees (21%), medical physicists (7%), physician assistants/nurses (2%), and radiation therapists (2%), completed the survey (31% response rate). Most practiced in an academic setting (86%) in North America (82%). The most common PE resources used were custom created institution-specific (61%) and electronic health system generated materials (38%). PE was delivered primarily by one-on-one teaching (72%), paper handouts (69%), and organizational websites (21%) (e.g., RTanswers.org). Almost half (41%) reported that PE practices differed based on type of clinical encounter, for example paper handouts for in-person visits and multimedia for virtual visits. The majority (86%) stated that their institution has disease site-specific PE materials, with nearly all having breast cancer materials (91%). Only 58% reported access to non-English PE materials. RO attendings/trainees were more likely than other team members to deliver PE at consultation (98% vs 71%, p = 0.03). PE practices amongst radiation oncologists differed according to the timing along the RT care path (consultation vs simulation vs first fraction, respectively): one-on-one teaching: 89% vs 49% vs 56%, p<0.01 and paper handouts: 69% vs 28% vs 16%, p<0.01. Key PE strategies included incorporating multimedia resources, personalizing delivery, and repetition at multiple timepoints by the interprofessional team. Limited time, inadequate administrative support, and lack of customized resources were identified as challenges in PE delivery.

CONCLUSION

Interprofessional RO providers engage in PE, with most utilizing institution-specific materials. PE practices differ according to the type of clinical encounter and timing in the RT care path. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources based on language, learning styles, and cultural preferences are needed to foster high-quality, patient-centered PE delivery.

The Society for Women in Radiation Oncology: Where are We Five Years Later?

PURPOSE/OBJECTIVE(S)

The Society for Women in Radiation Oncology (SWRO) was founded in 2017 with a mission to promote representation and gender equity in the field of radiation oncology (RO). SWRO members include faculty and trainee radiation oncologists and medical physicists. We aim to assess the current experiences of SWRO members using a comprehensive survey of gender-related workforce issues we developed. Data was used to establish a 5-year benchmark.

MATERIALS/METHODS

From January to February 2023, an anonymous survey was distributed to current SWRO members. Questions included demographics, family planning/fertility issues, perceptions of the field, and membership needs. Descriptive statistics were used to summarize frequencies of the multiple-choice items on the survey.

RESULTS

On interim analysis, 115 of 680 (17%) completed the survey from 11 countries, 81% of which reside in the US. 55% were faculty physicians, 26% resident physicians, 10% faculty physicists, and 3% physics residents. The majority were female (97%) and either married or in a domestic partnership (74%). 47% reported having at least one child, and 26% reported that they or their partner became pregnant during residency. Length of leave was impacted by residents' desire to complete residency training on schedule. 53% felt RO was perceived as family-friendly, but much fewer (17%) agreed that it is. After clinical responsibilities (70%), insufficient mentorship was cited as the second most common limitation to professional productivity (35%). 48% reported being somewhat or extremely satisfied with current mentorship availability at their institution, while 56% reported being similarly satisfied with the mentorship available within the field. 69% reported seeking or having sought female mentorship outside of their institution. Unwanted sexual comments, attention, or advances by superiors or colleagues was reported by 38% of respondents. Additionally, 72% either agreed or strongly agreed that SWRO membership and participation were a valuable use of their time, with the top three reasons for joining being networking opportunities, mentorship opportunities, and increasing the visibility of women and gender minorities in RO. Suggested improvements included increasing female physics representation and advocacy, and physics-related events, as well as providing opportunities for members to socialize and interact.

CONCLUSION

This study provides an update on the experiences of women and gender minorities in the field of RO since the creation of SWRO in 2017. The study highlights ongoing targets for improvement such as gender-based obstacles, opportunity for additional education and advocacy, support of family-friendly culture shifts, mentorship, and increased physics inclusion and advocacy. These findings support the need for organizations such as SWRO to continue to promote representation and gender equity in RO.

[Recognition of abnormal changes in echocardiographic videos by an artificial intelligence assisted diagnosis model based on 3D CNN]

Objective: To investigate the diagnostic efficiency and clinical application value of an artificial intelligence-assisted diagnosis model based on a three-dimensional convolutional neural network (3D CNN) on echocardiographic videos of patients with hypertensive heart disease, chronic renal failure (CRF) and hypothyroidism with cardiac involvement. Methods: This study is a retrospective study. The patients with hypertensive heart disease, CRF and hypothyroidism with cardiac involvement, who admitted in Henan Provincial People's Hospital from April 2019 to October 2021, were enrolled. Patients were divided into hypertension group, CRF group, and hypothyroidism group. Additionally, a simple random sampling method was used to select control healthy individuals, who underwent physical examination at the same period. The echocardiographic video data of enrolled participants were analyzed. The video data in each group was divided into a training set and an independent testing set in a ratio of 5 to 1. The temporal and spatial characteristics of videos were extracted using an inflated 3D convolutional network (I3D). The artificial intelligence assisted diagnosis model was trained and tested. There was no case overlapped between the training and validation sets. A model was established according to cases or videos based on video data from 3 different views (single apical four chamber (A4C) view, single parasternal left ventricular long-axis (PLAX) view and all views). The statistical analysis of diagnostic performance was completed to calculate sensitivity, specificity and area under the ROC curve (AUC). The time required for the artificial intelligence and ultrasound physicians to process cases was compared. Results: A total of 730 subjects aged (41.9±12.7) years were enrolled, including 362 males (49.6%), and 17 703 videos were collected. There were 212 cases in the hypertensive group, 210 cases in the CRF group, 105 cases in the hypothyroidism group, and 203 cases in the normal control group. The diagnostic performance of the model predicted by cases based on single PLAX view and all views data was excellent: (1) in the hypertensive group, the sensitivity, specificity and AUC of models based on all views data were 97%, 89% and 0.93, respectively, while those of models based on a single PLAX view were 94%, 95%, and 0.94, respectively; (2) in the CRF group, the sensitivity, specificity and AUC of models based on all views data were 97%, 95% and 0.96, respectively, while those of models based on a single PLAX view were 97%, 89%, and 0.93, respectively; (3) in the hypothyroidism group, the sensitivity, specificity and AUC of models based on all views data were 64%, 100% and 0.82, respectively, while those of models based on a single PLAX view were 82%, 89%, and 0.86, respectively. The time required for the 3D CNN model to measure and analyze the echocardiographic videos of each subject was significantly shorter than that for the ultrasound physicians ((23.96±6.65)s vs. (958.25±266.17)s, P<0.001). Conclusions: The artificial intelligence assisted diagnosis model based on 3D CNN can extract the dynamic temporal and spatial characteristics of echocardiographic videos jointly, and quickly and efficiently identify hypertensive heart disease and cardiac changes caused by CRF and hypothyroidism.

Role of Transarterial Chemoembolization in the Treatment of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, transarterial chemoembolization (TACE) is the first-line recommendation for intermediate-stage HCC. In real-world clinical practice, TACE also plays an important role in early- and advanced-stage HCC. This review article by the experts from Chinese Liver Cancer Clinical Study Alliance (CHANCE) summarizes the available clinical evidence pertaining to the current application of TACE in patients with early-, intermediate-, and advanced-stage HCC. In addition, combination of TACE with other treatment modalities, especially immunotherapy, is reviewed.

Nicosulfuron stress on the glyoxalase system and endogenous hormone content in sweet maize seedlings

To reduce the harmful effects of nicosulfuron on sweet corn, the physiological regulation mechanism of sweet corn detoxification was studied. This study analyzed the effects of nicosulfuron stress on the glyoxalase system, hormone content, and key gene expression of nicosulfuron-tolerant "HK301" and nicosulfuron-sensitive "HK320" sweet corn seedling sister lines. After spraying nicosulfuron, the methylglyoxal (MG) content in HK301 increased first and then decreased. Glyoxalase I (GlyI) and glyoxalase II (GlyII) activities, non-enzymatic glutathione (GSH), and the glutathione redox state glutathione/(glutathione + glutathione disulfide) (GSH/(GSH + GSSG)) showed a similar trend as the MG content. Abscisic acid (ABA), gibberellin (GA), and zeatin nucleoside (ZR) also increased first and then decreased, whereas the auxin (IAA) increased continuously. In HK301, all indices after spraying nicosulfuron were significantly greater than those of the control. In HK320, MG accumulation continued to increase after nicosulfuron spraying and GlyI and GlyII activities, and GSH first increased and then decreased after 1 day of stress. The indicators above were significantly greater than the control. The GSH/(GSH + GSSG) ratio showed a decreasing trend and was significantly smaller than the control. Furthermore, ABA and IAA continued to increase, and the GA and ZR first increased and then decreased. Compared with HK320, HK301 significantly upregulated the transcription levels of GlyI and GlyII genes in roots, stems, and leaves. Comprehensive analysis showed that sweet maize seedlings improved their herbicide resistance by changing the glyoxalase system and regulating endogenous hormones. The results provide a theoretical basis for further understanding the response mechanism of the glyoxalase system and the regulation characteristics of endogenous hormones in maize under nicosulfuron stress.

Transarterial chemoembolization with PD-(L)1 inhibitors plus molecular targeted therapies for hepatocellular carcinoma (CHANCE001)

There is considerable potential for integrating transarterial chemoembolization (TACE), programmed death-(ligand)1 (PD-[L]1) inhibitors, and molecular targeted treatments (MTT) in hepatocellular carcinoma (HCC). It is necessary to investigate the therapeutic efficacy and safety of TACE combined with PD-(L)1 inhibitors and MTT in real-world situations. In this nationwide, retrospective, cohort study, 826 HCC patients receiving either TACE plus PD-(L)1 blockades and MTT (combination group, n = 376) or TACE monotherapy (monotherapy group, n = 450) were included from January 2018 to May 2021. The primary endpoint was progression-free survival (PFS) according to modified RECIST. The secondary outcomes included overall survival (OS), objective response rate (ORR), and safety. We performed propensity score matching approaches to reduce bias between two groups. After matching, 228 pairs were included with a predominantly advanced disease population. Median PFS in combination group was 9.5 months (95% confidence interval [CI], 8.4-11.0) versus 8.0 months (95% CI, 6.6-9.5) (adjusted hazard ratio [HR], 0.70, P = 0.002). OS and ORR were also significantly higher in combination group (median OS, 19.2 [16.1-27.3] vs. 15.7 months [13.0-20.2]; adjusted HR, 0.63, P = 0.001; ORR, 60.1% vs. 32.0%; P < 0.001). Grade 3/4 adverse events were observed at a rate of 15.8% and 7.5% in combination and monotherapy groups, respectively. Our results suggest that TACE plus PD-(L)1 blockades and MTT could significantly improve PFS, OS, and ORR versus TACE monotherapy for Chinese patients with predominantly advanced HCC in real-world practice, with an acceptable safety profile.