Diagnostic and prognostic value of parameters of erector spinae in patients with uremic sarcopenia

AIM

This study aimed to investigate whether computed tomography (CT)-measured erector spinae parameters (ESPs) have diagnostic, severity assessment, and prognostic predictive value in uremic sarcopenia (US).

MATERIALS AND METHODS

A total of 202 uremic patients were enrolled and divided into two groups: a control group and a sarcopenia group. Sarcopenia was classified into two types: severe and nonsevere. The area, volume, and density of the erector spinae (ES) were measured using chest CT images, and the relevant ESP, including the erector spinae index (ESI), total erector spinae volume (TESV), erector spinae density (ESD), and erector spinae gauge (ESG) were calculated. The occurrence of adverse events was followed-up for 36 months. The diagnostic value and severity of US were determined using the receiver operating characteristic (ROC) curve. Survival curves diagnosed using CT were plotted and compared with the curve drawn using the gold standard. Cox regression analysis was used to identify independent risk factors associated with survival in US.

RESULTS

With an area under the curve (AUC) of 0.840 and 0.739, the combined ESP has diagnostic value and the ability to assess the severity of US. There was no significant difference in the survival curve between the combined ESP for the diagnosis of US and the gold standard (P > 0.05). ESI is a standalone predictor of survival in patients with US.

CONCLUSION

ESP measured by CT has diagnostic values for US and its severity, as well as being a predictive value for the prognosis of US.

Predicting Dental General Anesthesia Use among Children with Behavioral Health Conditions

OBJECTIVES

To evaluate how different data sources affect the performance of machine learning algorithms that predict dental general anesthesia use among children with behavioral health conditions.

STUDY DESIGN

Observational study using claims data.

METHODS

Using Medicaid claims from Partners For Kids (2013-2019), electronic medical record data, and the Ohio Child Opportunity Index, we conducted a retrospective cohort study of 12,410 children with behavioral health diagnoses. Four lasso-regularized logistic regression models were developed to predict dental general anesthesia use, each incorporating different data sources. Lift scores, or the ratio of positive predictive value to base case prevalence, were used to compare models, and a lift score of 2.5 was considered minimally acceptable for risk prediction.

RESULTS

Dental general anesthesia use ranged from 3.2% to 3.9% across models, which made it difficult for the machine learning models to achieve high positive predictive value. Model performance was best when either the electronic medical record (lift = 2.59) or Ohio Child Opportunity Index (lift = 2.56), but not both (lift = 2.34) or neither (lift = 1.87), was used.

CONCLUSIONS

Incorporating additional data sources improved machine learning model performance, and 2 models achieved satisfactory performance. The model using electronic medical record data could be applied in hospital-based settings, and the model using the Ohio Child Opportunity Index could be more valuable in community-based settings.

KNOWLEDGE TRANSFER STATEMENT

Machine learning was applied to satisfactorily predict which children with behavioral health diagnoses would require dental treatment under general anesthesia. Incorporating electronic medical record data or area-level social determinants of health data, but not both, improved the performance of the machine learning predictions. The 2 highest performing models could be applied by hospitals using medical record data or by organizations using area-level social determinants of health data to risk stratify the pediatric behavioral health population.

A phase I study of TAK-659 and paclitaxel in patients with taxane-refractory advanced solid tumors

BACKGROUND

Paclitaxel resistance limits durability of response in patients with initial clinical benefit. Overexpression of spleen tyrosine kinase (SYK) has been proposed as a possible resistance mechanism. This phase I trial evaluated the safety and preliminary activity of the SYK inhibitor TAK-659 combined with paclitaxel in patients with advanced taxane-refractory solid tumors.

PATIENTS AND METHODS

Patients with advanced solid tumors and prior progression on taxane-based therapy received intravenous infusion of paclitaxel on days 1, 8, and 15 plus oral TAK-659 daily in 28-day cycles. The dose-escalation phase included six cohorts treated at different dose levels; the dose-expansion phase included patients with ovarian cancer treated at the highest dose level. Toxicity was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Efficacy was evaluated using Response Evaluation Criteria in Solid Tumors version 1.1.

RESULTS

Our study included 49 patients. Maximum tolerated dose was not reached, but higher rates of adverse events were observed at higher dose levels. There were no treatment-related deaths. The most common treatment-related adverse events of any grade were increased aspartate aminotransferase (n = 31; 63%), increased alanine aminotransferase (n = 26; 53%), decreased neutrophil count (n = 26; 53%), and decreased white blood cell count (n = 26; 53%). Most adverse events were either grade 1 or 2. In the 44 patients with evaluable disease, 12 (27%) had stable disease as the best overall response, including three patients with prolonged stable disease, and 4 patients (9%) achieved a partial response.

CONCLUSIONS

The combination of paclitaxel and TAK-659 showed preliminary activity possibly overcoming resistance to taxane-based therapy as well as a tolerable safety profile in patients with advanced solid tumors.

[Clinical analysis of 9 children with refractory N-methyl-D-aspartate receptor antibody encephalitis children treated with tocilizumab]

Objective: To analyze the clinical features of children with refractory N-methyl-D-aspartate (NMDA) receptor antibody encephalitis treated with tocilizumab. Methods: Demographic and clinical manifeatations, immunotherapy and prognosis data of 9 children with refractory NMDA receptor antibody encephalitis who received tocilizumab in the Department of Pediatrics Neurology, XiangYa Hospital of Central South University from August 2021 to September 2023 were collected retrospectively. Prognosis was evaluated using the modified Rankin scale at initial diagnosis, at the initiation of tocilizumab treatment, and at the last follow-up. Treatment related complications, neuroimaging, and electroencephalography data were analyzed. Results: Among the 9 children, 6 were male and 3 were female, with an onset age of 4.2 (2.8, 8.7) years. At the onset of the disease, 9 children had a modified Rankin scale score of 5. When tocilizumab treatment was initiated, 7 children had a score of 5, and 2 children had a score of 4. The interval between the onset and initiation of tocilizumab treatment was 12 (5, 27) months, and the treatment frequency was 8 (5, 13) times. The follow-up time was 2.8 (1.5, 3.7) years. At the last follow-up, the symptoms of 9 children, including movement disorder, sleep disorder, consciousness disorder, silence and autonomic dysfunction, were improved to varying degrees, and none of them had seizures. At the last follow-up, 4 cases with a modified Rankin scale score of 0, 1 case with a score of 1, 2 cases with a score of 3, 1 case with a score of 4 and 1 case with a score of 5. The modified Rankin scale at the last follow-up was significantly different from that at the start of tocilizumab (Z=-2.56, P=0.014). All children had no serious adverse reactions during the treatment. Conclusions: After treatment with tocilizumab, the symptoms in patievts with refractory NMDA receptor antibody encephalitis, including movement disorder, sleep disorder, consciousness disorder, silence and autonomic dysfunction were improved, and none of them had seizures. The modified Rankin scale were improved, and the safety was good.

The COSPAR planetary protection policy for missions to Icy Worlds: A review of history, current scientific knowledge, and future directions

Recent discoveries related to the habitability and astrobiological relevance of the outer Solar System have expanded our understanding of where and how life may have originated. As a result, the Icy Worlds of the outer Solar System have become among the highest priority targets for future spacecraft missions dedicated to astrobiology-focused and/or direct life detection objectives. This, in turn, has led to a renewed interest in planetary protection concerns and policies for the exploration of these worlds and has been a topic of discussion within the COSPAR (Committee on Space Research) Panel on Planetary Protection. This paper summarizes the results of those discussions, reviewing the current knowledge and the history of planetary protection considerations for Icy Worlds as well as suggesting ways forward. Based on those discussions, we therefore suggest to (1) Establish a new definition for Icy Worlds for Planetary Protection that captures the outer Solar System moons and dwarf planets like Pluto, but excludes more primitive bodies such as comets, centaurs, and asteroids: Icy Worlds in our Solar System are defined as all bodies with an outermost layer that is believed to be greater than 50 % water ice by volume and have enough mass to assume a nearly round shape. (2) Establish indices for the lower limits of Earth life with regards to water activity (LLAw) and temperature (LLT) and apply them into all areas of the COSPAR Planetary Protection Policy. These values are currently set at 0.5 and -28 °C and were originally established for defining Mars Special Regions; (3) Establish LLT as a parameter to assign categorization for Icy Worlds missions. The suggested categorization will have a 1000-year period of biological exploration, to be applied to all Icy Worlds and not just Europa and Enceladus as is currently the case. (4) Have all missions consider the possibility of impact. Transient thermal anomalies caused by impact would be acceptable so long as there is less than 10-4 probability of a single microbe reaching deeper environments where temperature is >LLT in the period of biological exploration. (5) Restructure or remove Category II* from the policy as it becomes largely redundant with this new approach, (6) Establish that any sample return from an Icy World should be Category V restricted Earth return.

Atmospheric environment characteristic of severe dust storms and its impact on sulfate formation in downstream city

This study comprehensively investigated the impact of dust storms (DSs) on downstream cities, by selecting representative DS events. In this paper, we discussed the characteristics of meteorological conditions, air pollutants, PM2.5 components, and their influence on sulfate formation mechanisms. During DSs, strong winds, reaching speeds of up to 10 m/s, led to significant increases in PM10 and PM2.5, with maximum concentrations of 2684.5 and 429 μg/m3, respectively. Primary gaseous pollutants experienced substantial reductions, with decline rates of 48.1, 34.9, 36.8, and 9.0 % for SO2, NO2, NH3, and CO, respectively. Despite a notable increase in PM2.5 concentrations, only 7.6 % of the total mass of PM2.5 was attributed to ionic and carbonaceous components, a much lower value than observed before the DSs (77.3 %). Concentrations of Fe, Ti, and Mn exhibited increases by factors of 6.5-14.1, 10.4-17.0, and 1.6-4.7, respectively. In contrast to the significant decrease of >76.2 % in nitrogen oxidation ratio (NOR), sulfur oxidation ratio (SOR) remained at a relatively high level, displaying a strong positive correlation with high concentrations of Fe, Mn, and Ti. Quantitative analysis revealed an average increase of 0.187 and 0.045 μg/m3 in sulfate from natural sources and heterogeneous generation, respectively. The heterogeneous reaction on mineral dust was closely linked to atmospheric humidity, radiation intensity, the form of metal existence, and concentrations of it. High concentrations of titanium dioxide and iron‑manganese oxides in mineral dust promoted heterogeneous oxidation of SO2 through photocatalysis during the daytime and metal ion catalysis during the nighttime. This study establishes that the metal components in mineral dust promote heterogeneous sulfate formation, quantifies the yield of sulfate generated as a result, and provides possible mechanisms for heterogeneous sulfate formation.

Sudomotor dysfunction is associated with impaired left ventricular diastolic function in persons with type 2 diabetes: a cross-sectional study

BACKGROUND

The incidence of preserved ejection fraction heart failure has significantly increased in persons with type 2 diabetes mellitus (T2DM). Left ventricular (LV) diastolic dysfunction is an early and important manifestation of preserved ejection fraction heart failure. The onset of heart failure in persons with diabetes is associated with diabetic neuropathy. However, the relationship among sudomotor function, which is an early manifestation of small fiber neuropathy, and LV diastolic function remains unclear. This study aimed to explore the association between sudomotor function and LV diastolic function in persons with T2DM.

METHODS

In total, 699 persons with T2DM were enrolled and divided into three groups according to electrochemical skin conductance (ESC) assessed using the SUDOSCAN device: "no dysfunction" group (NSF), "moderate dysfunction" group (MDF), and "severe dysfunction" group (SDF). LV diastolic function was assessed using Doppler echocardiography. To evaluate the relationship between ESC and echocardiographic parameters, Pearson's correlation analysis was performed. Additionally, logistic regression analysis was used to determine the association between LV diastolic function and ESC. A receiver operating characteristic (ROC) curve was constructed to evaluate the performance of sudomotor function indicators in detecting impaired cardiac diastolic function.

RESULTS

There were 301 persons (43.06%) in the NSF group, 232 (33.19%) in the MDF group, and 166 (23.75%) in the SDF group. Compared to the NSF group, the MDF and SDF groups had higher A and E/e' and lower e' values (all p < 0.05). Pearson's correlation analysis showed that A and E/e' were negatively associated with foot ESC (FESC) and hand ESC (HESC), whereas e' was positively associated with FESC and HESC (all p < 0.05). After adjusting for confounding factors, binary logistic regression analysis showed that ESC was independently associated with impaired LV diastolic function (p = 0.003). The area under the ROC curve values for FESC and HESC were 0.621 and 0.635, respectively (both p < 0.05).

CONCLUSIONS

Deteriorating sudomotor function was associated with reduced diastolic function indicators. ESC can be used as a biomarker for detecting LV diastolic impairment.

Secondary Organic Aerosol Formation Potential from Vehicular Non-tailpipe Emissions under Real-World Driving Conditions

Traffic emissions are a dominant source of secondary organic aerosol (SOA) in urban environments. Though tailpipe exhaust has drawn extensive attention, the impact of non-tailpipe emissions on atmospheric SOA has not been well studied. Here, a closure study was performed combining urban tunnel experiments and dynamometer tests using an oxidation flow reactor in situ photo-oxidation. Results show a significant gap between field and laboratory research; the average SOA formation potential from real-world fleet is 639 ± 156 mg kg fuel-1, higher than the reconstructed result (188 mg kg fuel-1) based on dynamometer tests coupled with fleet composition inside the tunnel. Considering the minimal variation of SOA/CO in emission standards, we also reconstruct CO and find the critical role of high-emitting events in the real-world SOA burden. Different profiles of organic gases are detected inside the tunnel than tailpipe exhaust, such as more abundant C6-C9 aromatics, C11-C16 species, and benzothiazoles, denoting contributions from non-tailpipe emissions to SOA formation. Using these surrogate chemical compounds, we roughly estimate that high-emitting, evaporative emission, and asphalt-related and tire sublimation share 14, 20, and 10% of the SOA budget, respectively, partially explaining the gap between field and laboratory research. These experimental results highlight the importance of non-tailpipe emissions to atmospheric SOA.

Investigating the impact of high-altitude on vehicle carbon emissions: A comprehensive on-road driving study

This study addresses the literature gap concerning accurately identifying vehicle carbon emission characteristics in high-altitude areas. Utilizing a portable emission measurement system (PEMS) for real-world testing, we quantified the influence of altitude on carbon emissions from light-duty gasoline (LDGV) and diesel vehicles (LDDV). The Random Forest (RF) algorithm was employed to analyze the complex nonlinear relationships between altitude, meteorological conditions, driving patterns, and carbon dioxide (CO2) emissions, enabling predictions across different altitudes. The results showed that CO2 emissions progressively increase with elevation. Furthermore, as altitude increases, combustion efficiency declines, and the overall impact of driving conditions on emission rates diminishes. Altitude and meteorological factors significantly contributed to CO2 emissions, whereas driving conditions and road grades contributed less. Compared with the COPERT model, the RF model demonstrates strong accuracy in predicting carbon emissions at different altitudes. Specifically, the CO2 emission rate nearly triples as altitude increases from 2.0 km to 4.5 km. This research bridges a critical gap in the understanding carbon emissions from high-altitude vehicles, offering insights into policy development for emission reduction strategies in such regions. Future studies should integrate diverse testing methodologies and comprehensive surveys to validate and extend the findings.

Insights into PM2.5 pollution of four small and medium-sized cities in Chinese representative regions: Chemical compositions, sources and health risks

Fine particles (PM2.5) pollution is still a severe issue in some cities in China, where the chemical characteristics of PM2.5 remain unclear due to limited studies there. Herein, we focused on PM2.5 pollution in small and medium-sized cities in key urban agglomerations and conducted a comprehensive study on the PM2.5 chemical characteristics, sources, and health risks. In the autumn and winter of 2019-2020, PM2.5 samples were collected simultaneously in four small and medium-sized cities in four key regions: Dingzhou (Beijing-Tianjin-Hebei region), Weinan (Fenwei Plain region), Fukang (Northern Slope of the Tianshan Mountain region), and Bozhou (Yangtze River Delta region). The results showed that secondary inorganic ions (43.1 %-67.0 %) and organic matter (OM, 8.6 %-36.4 %) were the main components of PM2.5 in all the cities. Specifically, Fukang with the most severe PM2.5 pollution had the highest proportion of SO42- (31.2 %), while the dominant components in other cities were NO3- and OM. The Multilinear Engine 2 (ME2) analysis identified five sources of PM2.5 in these cities. Coal combustion contributed most to PM2.5 in Fukang, but secondary sources in other cities. Combined with chemical characteristics and ME2 analysis, it was preliminarily determined that the primary emission of coal combustion had an important contribution to high SO42- in Fukang. Potential source contribution function (PSCF) analysis results showed that regional transport played an important role in PM2.5 in Dingzhou, Weinan and Bozhou, while PM2.5 in Fukang was mainly affected by short-range transport from surrounding areas. Finally, the health risk assessment indicated Mn was the dominant contributor to the total non-carcinogenic risks and Cr had higher carcinogenic risks in all cities. The findings provide a scientific basis for formulating more effective abatement strategies for PM2.5 pollution.

Regenerative braking system effectively reduces the formation of brake wear particles

Brake wear particles (BWPs) are considered one of the most significant non-exhaust particle emission sources from motor vehicles. Previous studies have primarily focused on BWPs from conventional fuel vehicles (CFVs), with limited research available on BWPs from new energy vehicles (NEVs). We developed an independent BWP emission testing system applicable to NEVs and conducted BWP emission tests on representative NEVs and CFVs under various testing cycles via a chassis dynamometer. The BWP emission characteristics of the NEVs equipped with regenerative braking system significantly differed from those of gasoline vehicles. For transient emission characteristics, gasoline vehicles exhibited higher peak concentrations during brake events than brake drag events, while those with regenerative braking exhibited the opposite feature. Under continuous braking, the concentration of ultrafine particles emitted by NEVs was reduced by more than 3 orders of magnitude compared to gasoline vehicles. In terms of single-particle morphology, BWPs could be mainly divided into three categories: carbonaceous particles, iron-rich particles, and mixed metal particles. We obtained realistic emission characteristics of BWPs from NEVs, which could provide data support and a scientific basis for the formulation of relevant emission standards and control measures in the future.

Transforming waste brake pads from automobiles into Nano-Catalyst: Synergistic Fe-C-Cu triple sites for efficient fenton-like oxidation of organic pollutants

The arbitrary disposal of used brake pads from motor vehicles has resulted in severe heavy metal pollution and resource wastage, highlighting the urgent need to explore the significant untapped potential of these discarded materials. In this study, The in-situ growth of highly dispersed Fe2O3 nanocrystals was achieved by simple oxidation annealing of brake pad debris(BPD). Interestingly, Cu remained unoxidized and acted as a "valence state transformation bridge of Fe2O3" to construct the "triple Fe-C-Cu sites". The Fenton degradation experiment of pollutants was conducted under constant temperature conditions at 40 °C, a stirring rate of 1300 rpm, a pH value of 3, a catalyst dosage of 0.5 g/L, pollutant dosage ranging from 50 to 400 mg/L, and H2O2 dosage of 0.25 g/L. Experimental results showed that BPD treated at 300 °C for 2 h exhibited optimal Fenton-like oxidation activity, achieving rapid degradation of over 90 % of refractory antibiotics, such as tetracycline and ciprofloxacin, in organic wastewater within 10 min. This remarkable performance was mainly attributed to the synergistic effect of "Fe-C-Cu triple sites", where the electron-donating role of C in the Fe-C and Cu-C interfaces facilitated the conversion of the Fe(III) to Fe(II) and Cu(II) to Cu(I). In addition, the ability of Cu2+ to accept electrons at the Fe-Cu interface promoted the transition from Fe (II) to Fe (III). This "balance of electron gain and loss" accelerated the interfacial electron transfer and the recycle of dual Fenton sites, Fe(II)/Fe(III) and Cu(I)/Cu(II), to generate more ·OH from H2O2. Therefore, this strategy of functionalizing BPD as Fenton-like catalysts without the addition of external Fe provides intriguing prospects for understanding the construction of Fe-based Fenton catalysts and resource utilization of Fe-containing solid waste materials.

Direct measurement of brake and tire wear particles based on real-world driving conditions

With implementing vehicle emission control policies, tailpipe particulate emissions have been gradually controlled, and the relative contribution of non-tailpipe particulate emissions, such as brake and tire wear, has further increased. A unified and scientific method for sampling non-tailpipe particulate matter (PM) emissions is essential to improve the accuracy of the emission characteristics and factors. This study proposes a novel sampling method based on real-world driving conditions to obtain information on emissions and extract characteristic conditions for tire and brake pad wear. We extracted 200 representative braking segments for simulation experiments based on road type, initial and final velocities, temperature, and deceleration rate. Two standard test cycles to simulate the tire wear conditions of the front and rear wheels were constructed based on velocity, lateral, and vertical forces. Under the real-world driving condition test cycle, the emission factors of PM2.5 and PM10 for brake wear particles of passenger vehicles were 2.66 mg/km and 11.65 mg/km, respectively. In contrast, the emission factors of PM2.5 and PM10 for tire wear particles were 0.21 mg/km and 1.27 mg/km, respectively. Moreover, this study provides insights and basic data for localizing and improving the emission model, which can enhance its applicability and accuracy.

Chemical characteristics of fine tire wear particles generated on a tire simulator

Tire wear is one of the major sources of traffic-related particle emissions, however, laboratory data on the components of tire wear particles (TWPs) is scarce. In this study, ten brands of tires, including two types and four-speed grades, were chosen for wear tests using a tire simulator in a closed chamber. The chemical components of PM2.5 were characterized in detail, including inorganic elements, water-soluble ions (WSIs), organic carbon (OC), elemental carbon (EC), and polycyclic aromatic hydrocarbons (PAHs). Inorganic elements, WSIs, OC, and EC accounted for 8.7 ± 2.1%, 3.1 ± 0.7%, 44.0 ± 0.9%, and 9.6 ± 2.3% of the mass of PM2.5, respectively. The OC/EC ratio ranged from 2.8 to 7.6. The inorganic elements were dominated by Si and Zn. The primary ions were SO42- and NO3-, and TWPs were proven to be acidic by applying an ionic balance. The total PAHs content was 113 ± 45.0 μg g-1, with pyrene being dominant. In addition, the relationship between the chemical components and tire parameters was analyzed. Inorganic elements and WSIs in TWPs were more abundant in all-season tires than those in winter tires, whereas the content of PAHs was the opposite. The mass fractions of OC, Si, and Al in the TWPs all showed increasing trends with increasing tire speed grade, but the PAHs levels showed a decreasing trend. Ultimately, to provide more data for further research, a TWPs source profile was constructed considering the tire weighting factor.

Deep Learning and GAN-Synthesis for Auto-Segmentation of Pancreatic Cancer by Non-Enhanced CT for Adaptive Radiotherapy

PURPOSE/OBJECTIVE(S)

In conventional adaptive radiotherapy (ART) for pancreatic cancer, contrast-enhanced CT (CECT) helps to more precisely delineate primary gross tumor volume (GTV) than non-enhanced CT (NECT). However, frequent use of contrast medium can damage kidneys and prolong treatment time. Moreover, traditional manual delineation is labor-intensive and highly dependent on the experience of oncologists. Currently, automatic delineation based on deep learning with Generative Adversarial Networks (GAN)-based CT synthesis is one of the most feasible solutions to these problems.

MATERIALS/METHODS

A dataset of 35 pancreatic cancer patients was retrospectively collected from May 2021 to December 2022. All patients consist of a pair of NECT and CECT. We designed and developed an automatic delineation framework (Proposed) for GTV of pancreatic cancer based on Trans-cycleGAN and a modified 3D U-Net. TranscycleGAN can not only synthesize CECT from NECT, but can also augment the amount of CT images; then all real and synthesized CT images were used to train the modified 3D U-Net for automatic delineation of GTV; finally, our framework was able to automatically delineate GTV by NECT, but not only by CECT. Our framework was evaluated by dice similarity coefficient (DSC), 95% Harsdorff distance (95HD) and average surface distance (ASD) with oncologists' manual delineation ("gold standard").

RESULTS

The evaluation results were summarized in Table 1. The proposed framework achieved the best automatic delineation results by NECT, which was superior to that of CECT: 0.917 & 0.903 of DSC, 2.498mm & 3.029mm of HD95, 0.481mm & 0.534mm of ASD, p < 0.05 for DSC and HD95. Specifically, it is significantly superior to the automatic delineation results using U-Net by CECT 0.917 & 0.818 of DSC, 2.498mm & 13.228mm of HD95, 0.481mm & 3.633mm of ASD, p < 0.05 for DSC.

CONCLUSION

We proposed an automatic delineation framework for contouring GTV in ART of pancreatic cancer based on deep learning and Trans-cycleGAN network. This framework could automatically delineate GTV and achieve better performance with NECT compared to CECT. Our method could not only reduce the use of contrast medium, but also increase the precision and effectiveness of tumor delineation, which could have a positive impact on precision radiotherapy.

Efficacy and Safety of High-Dose Vitamin C Combined with Total Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer (HCCSC R02 Study)

PURPOSE/OBJECTIVE(S)

Forpatients with locally advanced rectal cancer (LARC), the standard treatment is fluoropyrimidine (FU) -based neoadjuvant chemoradiotherapy (NCRT) combined with curative surgery. The CAO/ARO/AIO-04 trial and FORWARC trial reported that the addition of oxaliplatin to FU -based NCRT contributed to improve pathologic complete response (pCR), nevertheless, increased the acute therapeutic toxicity. Some studies showed that vitamin C (VitC) had potential benefits on anti-tumor therapy and anti-inflammatory response. Therefore, we conducted this HCCSC R02 study to explore the efficacy and safety of adding a high-dose intravenous VitC to mFOLFOX6/XELOX -based NCRT in LARC.

MATERIALS/METHODS

HCCSCR02 study was designed as a prospective, single-center phase II trial, which including pts aged 18-75 years with stage II/III rectal adenocarcinoma, distance from anus ≤12cm. The enrollment criteria included: staged with MRI as cT3/cT4 or cN1/2, or mesorectal fascia involvement (MRF+), or difficult to preserve the anus. Patients with glucose-6-phosphate dehydrogenase enzyme(G6PD) deficiency were excluded. Pelvic intensity modulated radiation therapy (IMRT) was given in 45-50.4Gy/25-28 fractions. Concurrently, two cycles of chemotherapy (mFOLFOX6 or XELOX) were administered during IMRT, as well as intravenous VitC (24g) delivered daily after the end of each radiation therapy. Additional 2-3 cycles of mFOLFOX6 / XELOX were adopted between the completion of radiotherapy and surgery. The primary endpoint was pCR rate. The secondary endpoints included radiation-related toxicities, overall survival (OS) and disease-free survival (DFS). This study is still recruiting.

RESULTS

From May 15, 2021 to Feb 8, 2023, 19 pts were recruited and finished all the scheduled NCRT, of which the proportion of cT4, cT3, cN2, cN1 were 31.6%, 63.2%, 52.6%, 36.8%, respectively. In addition, 10 pts (52.6%) were diagnosed as MRF+ initially, and 8 pts (42.1%) had a lower primary tumor(≤5cm) who were considered difficult for anal preservation before NCRT. All subjects enrolled were confirmed to be proficient mismatch repair (pMMR). As a result, 18 pts underwent a total mesorectal excision (TME) all with R0-resection, and 8 pts were evaluated as pCR (44.4%, 8/18, confidence interval: 0.246-0.663), 11 as major pathological response rate (MPR) (61.6%, 11/18), respectively. The anus preservation rate in patients with lower diseases was 87.5% (7/8). One case accepted a watch-and-wait strategy because of clinical complete response (cCR). Overall, grade 3 toxicities were observed in 4 pts, including 3 leucopenia (15.8%, 3/19), 2 neutropenia (10.5%, 2/19) and 1 diarrhea (5.3%, 1/19). No grade 4 adverse event was observed.

CONCLUSION

The addition of high-dose VitC to the mFOLFOX6/XELOX-based NCRT in LARC showed a promising pCR, well tolerance, particularly low rate of diarrhea, thus warrants further investigation.

CLINICAL TRIAL INFORMATION

NCT04801511.

PD-L1 Inhibitors Combined with Thoracic Radiotherapy in First-Line Treatment of Extensive Stage Small Cell Lung Cancer: A Propensity Score-Matched, Real-World Study

PURPOSE/OBJECTIVE(S)

The CREST study showed that the addition of thoracic radiotherapy (TRT) could improve the survival of extensive stage small cell lung cancer (ES-SCLC), but whether TRT can bring survival benefit in the era of immunotherapy is controversial. This study aims to explore the efficacy and safety of adding TRT to the combination of PD-L1 inhibitors and chemotherapy.

MATERIALS/METHODS

Thepatients who received PD-L1 inhibitors combined with platinum-based chemotherapy as the first-line treatment of ES-SCLC from January 2019 to December 2021 were retrospectively collected. According to whether they received TRT, they were divided into two groups, and the follow-up analysis was performed. Propensity score matching (PSM) in with a 1:1 ratio was performed to balance the baseline characteristics of the two cohorts. The endpoints were progression-free survival (PFS) and OS.

RESULTS

A total of 211 patients with ES-SCLC were enrolled, of whom 70 (33.2%) patients received standard therapy plus TRT as first-line treatment, and 141 (66.8%) patients in the control group received PD-L1 inhibitors plus chemotherapy. After PSM, a total of 65 pairs of patients were enrolled in the analysis. There were no significant differences in baseline characteristics between the two groups of patients who received TRT and those who did not. In all patients, the median PFS (mPFS) in the TRT group and the non-TRT groupwere 9.5 months and 7.2 months, respectively, with HR = 0.60 (95% CI 0.41-0.87, p = 0.007). The median OS (mOS) in the TRT group was also significantly longer than that in the non-TRT group (24.1 months vs. 18.5 months, HR = 0.53, 95% CI 0.32-0.85, p = 0.009). Multivariable analysis showed that baseline liver metastasis and bone metastasis were independent prognostic factors for OS. In terms of safety, immunotherapy combined with thoracic radiotherapy increased the incidence of treatment-related pneumonia (p<0.001), most of which were grade 1-2.

CONCLUSION

This real-world study shows that adding TRT to durvalumab or atezolizumab plus chemotherapy significantly improves survival in ES-SCLC. It leads to more treatment-related pneumonia, but most of them can be relieved after symptomatic treatment. This treatment model deserves to be explored in prospective clinical trials.

Heavy vehicles' non-exhaust exhibits competitive contribution to PM2.5 compared with exhaust in port and nearby areas

Heavy port transportation networks are increasingly considered as significant contributors of PM2.5 pollution compared to vessels in recent decades. In addition, evidence points to the non-exhaust emission of port traffic as the real driver. This study linked PM2.5 concentrations to varied locations and traffic fleet characteristics in port area through filter sampling. The coupled emission ratio-positive matrix factorisation (ER-PMF) method resolves source factors by avoiding direct overlap from collinear sources. In the port central and entrance areas, freight delivery activity emissions including vehicle exhaust and non-exhaust particles, as well as induced road dust resuspension, accounted for nearly half of the total contribution (42.5%-49.9%). In particular, the contribution of non-exhaust from denser traffic with high proportion of trucks was competitive and equivalent to 52.3% of that from exhaust. Backward trajectory statistical models further interpreted the notably larger-scale coverage of non-exhaust emissions in the port's central area. The distribution of PM2.5 were interpolated within the scope of the port and nearby urban areas, displaying the potential contribution of non-exhaust within 1.15 μg/m3-4.68 μg/m3, slightly higher than the urban detections reported nearby. This study may provide useful insights into the increasing percentage of non-exhaust from trucks in ports and nearby urban areas and facilitate supplementary data collection on Euro-VII type-approval limit settings.

Evaluating vehicular exhaust and evaporative emissions via VOC measurement in an underground parking garage

Vehicular emissions, including both tailpipe exhaust and evaporative emissions, are major anthropogenic sources of volatile organic compounds (VOCs) in urban cities. Current knowledge on vehicle tailpipe and evaporative emissions was mainly obtained via laboratory tests on very few vehicles under experimental conditions. Information on fleet gasoline vehicles emission features under real-world conditions is lacking. Here, VOC measurement was conducted in a large residential underground parking garage in Tianjin, China, to reveal the feature of the exhaust and evaporative emissions from real-world gasoline vehicle fleets. The VOC concentration in the parking garage was on average 362.7 ± 87.7 μg m-3, significantly higher than that in the ambient atmosphere at the same period (63.2 μg m-3). Aromatics and alkanes were the mainly contributors on both weekdays and weekends. A positive correlation between VOCs and traffic flow was observed, especially in the daytime. Source apportionment through the positive matrix factorization model (PMF) revealed that the tailpipe and evaporative emissions accounted for 43.2% and 33.7% of VOCs, respectively. Evaporative emission contributed 69.3% to the VOCs at night due to diurnal breathing loss from numerous parked cars. In contrast, tailpipe emission was most remarkable during morning rush hours. Based on the PMF results, we reconstructed a vehicle-related VOCs profile representing the combination of the tailpipe exhaust and evaporative emission from fleet-average gasoline vehicles, which could benefit future source apportionment studies.

Brake wear-derived particles: Single-particle mass spectral signatures and real-world emissions

Brake wear is an important but unregulated vehicle-related source of atmospheric particulate matter (PM). The single-particle spectral fingerprints of brake wear particles (BWPs) provide essential information for understanding their formation mechanism and atmospheric contributions. Herein, we obtained the single-particle mass spectra of BWPs by combining a brake dynamometer with an online single particle aerosol mass spectrometer and quantified real-world BWP emissions through a tunnel observation in Tianjin, China. The pure BWPs mainly include three distinct types of particles, namely, Ba-containing particles, mineral particles, and carbon-containing particles, accounting for 44.2%, 43.4%, and 10.3% of the total BWP number concentration, respectively. The diversified mass spectra indicate complex BWP formation pathways, such as mechanical, phase transition, and chemical processes. Notably, the mass spectra of Ba-containing particles are unique, which allows them to serve as an excellent indicator for estimating ambient BWP concentrations. By evaluating this indicator, we find that approximately 4.0% of the PM in the tunnel could be attributable to brake wear; the real-world fleet-average emission factor of 0.28 mg km^-1 veh^-1 is consistent with the estimation obtained using the receptor model. The results presented herein can be used to inform assessments of the environmental and health impacts of BWPs to formulate effective emissions control policies.

Characteristics, sources, and health risks of inorganic elements in PM2.5 and PM10 at Tianjin Binhai international airport

To study air pollution from aircraft activity at airport and its risks to human health, we conducted an experiment near Tianjin Binhai International Airport from November 11 to November 24, 2017. The characteristics, source apportionment, and health risk of inorganic elements in particles were determined in the airport environment. The mean mass concentrations of inorganic elements in PM₁₀ and PM_2.5 were 17.1 and 5.0 μg/m³, accounting for 19.0% of PM₁₀ mass and 12.3% of PM_2.5 mass, respectively. Inorganic elements, including arsenic, chromium, lead, zinc, sulphur, cadmium, potassium, sodium, and cobalt, were mainly concentrated in fine particulate matter. The particle number concentration within the 60-170 nm particle size range was significantly higher under polluted than non-polluted conditions. A principal component analysis revealed important contributions of Cr, Fe, K, Mn, Na, Pb, S, and Zn originating from airport activities, including aircraft exhaust, braking, tire wear, ground service equipment, and airport vehicles. Based on analyses of the non-carcinogenic and carcinogenic risks of heavy metal elements in PM₁₀ and PM_2.5, there were notable human health impacts, emphasising the importance of relevant research.