Feasibility Study of Robust Treatment Planning in VMAT for Head and Neck Cancer

PURPOSE/OBJECTIVE(S)

In general, patient positional uncertainty is considered by adding a geometrically expanded margin to clinical target volume (CTV) in photon radiation therapy. However, this method may not be suitable because image-guided radiotherapy is available. In intensity modulated proton beam therapy, robust treatment planning is currently common to take patient positional uncertainty into account in optimization rather than in margins. The purpose of this study is to assess the feasibility of clinical implementation of the method in volumetric modulated arc therapy (VMAT) for head and neck cancer. We quantitatively evaluated whether the plans with the robust optimization (Robust plans) can adequately cover CTV against patients' positional uncertainties and body shape change throughout a treatment course.

MATERIALS/METHODS

Ten head and neck cancer patients were chosen, who were treated with PTV-based VMAT plans in our hospital between 2021.5-2022.4. RayStation V10A (RaySearch Laboratories, Stockholm, Sweden) was used for the robust optimization, which was applied to the CTVs with patient positional uncertainty of 5 mm in the 6-axis direction. Dose prescribed to the high- and low-risk CTVs were to 70 and 56 Gy in 35 fractions, respectively. To create the patients' CT images with residual set-up errors and body shape change at the treatment, pseudo simulation-CT images were created by deformable image registration with CBCT and simulation-CT. Dose distribution at the treatment was re-calculated by applying the plan to the pseudo simulation-CT images. The variation of D98 for the high-risk CTV from the time of treatment planning was evaluated on a weekly basis. For comparison, planning target volume (PTV) -based plans (5 mm margin circumference) were created and a similar evaluation was performed.

RESULTS

D98 for the high-risk CTV varied between -3∼2% in the robust plan and between -5∼1% in the PTV-based plan during the treatment course. There was no significant difference in the amount of D98 variation between the two plans by t-test, except for one case with hypopharyngeal cancer. In this case, D98 for the high-risk CTV varied within ±1% with the PTV-based plan, whereas the value decreased up to 3% with the robust plan (p < 0.05). This case often had a residual setup error of approximately 5 mm at the sites related to the pitch rotation of head, suggesting that the dose distribution for the robust plan was affected by non-rigid positional errors. Patient weight loss during the treatment period was -3.5±2.4 kg, showing a weak correlation (r = -0.33) with the variation in D98 for the high-risk CTV.

CONCLUSION

The robust treatment planning exhibits comparable CTV coverage to the conventional PTV-based planning against positional uncertainty and body shape change throughout a treatment period. In order to overcome set-up baseline shift by the non-rigid positional errors, re-planning should be recommended. Further planning studies will be conducted to promote clinical implementation of the method.

Evaluation of Shear Horizontal Surface Acoustic Wave Biosensors Using "Layer Parameter" Obtained from Sensor Responses during Immunoreaction

Shear horizontal surface acoustic wave (SH-SAW) biosensors measure the reaction of capture antibodies immobilized on the sensing surface to capture test molecules (antigens) by using the change in SH-SAW propagation characteristics. SH-SAW displacement exists not only on the SH-SAW propagating surface, but also partially penetrates the specimen liquid to a certain depth, which is determined by the liquid properties of the specimen and the operating frequency of the SH-SAW. This phenomenon is called viscosity penetration. In previous studies, the effect of viscosity penetration was not considered in the measurement of SH-SAW biosensors, and the mass or viscosity change caused by the specific binding of capture antibodies to the target antigen was mainly used for the measurement. However, by considering the effect of viscosity penetration, it was found that the antigen-antibody reaction could be measured and the detection characteristics of the biosensor could be improved. Therefore, this study aims to evaluate the detection properties of SH-SAW biosensors in the surface height direction by investigating the relationship between molecular dimensions and SH-SAW propagation characteristics, which are pseudo-changed by varying the diameter of gold nanoparticles. For the evaluation, we introduced a layer parameter defined by the ratio of the SH-SAW amplitude change to the SH-SAW velocity change caused by the antigen-antibody reaction. We found a correlation between the layer parameter and pseudo-varied molecular dimensions. The results suggest that SH-SAW does not only measure the mass and viscosity but can also measure the size of the molecule to be detected. This shows that SH-SAW biosensors can be used for advanced functionality.

Synthetic heme protein models that function in aqueous solution

Supramolecular porphyrin–cyclodextrin complexes act as biomimetic heme protein models in aqueous solution.

Effects of preemptive analgesia with intravenous acetaminophen on postoperative pain relief in patients undergoing third molar surgery: a prospective, single-blind, randomized controlled trial

BACKGROUND

The efficacy of preemptive analgesia in managing postoperative pain remains controversial. The aim of this study was to compare the efficacy of intravenous (IV) acetaminophen administered before or immediately after the surgical extraction of an impacted mandibular third molar.

MATERIAL AND METHODS

This prospective randomized clinical trial included 120 patients. The patients were assigned to one of three groups: the preoperative-treatment group (pre-group), which received 1000 mg of IV acetaminophen 20 min before surgery; the postoperative-treatment group (post-group), which received 1000 mg of IV acetaminophen after surgery; the no-treatment group (control-group), which did not receive any analgesic. Rescue analgesic (60 mg loxoprofen) was issued to each patient, with instructions on self-administration if needed. For the rescue medication usage, the time of first loxoprofen usage and the total amount of loxoprofen consumption were obtained for a 17-hour period after surgery. We measured pain using the visual analogue scale at 1 hour and at 2, 3, 4, 5, and 15 hours after surgery.

RESULTS

There was no significant difference in pain level among the three groups at any time interval. However, the pre-group demonstrated significantly lower rescue analgesic consumption and longer time until initial administration.

CONCLUSIONS

Administration of IV acetaminophen before third molar surgery provides more effective pain control than postoperative administration and no treatment.

Sarcopenia-derived exosomal micro-RNA 16-5p exerts the cardio-repair disturbance via pro-apoptotic mechanism in myocardial infarction of mice

Background

Sarcopenia is a pathophysiological malfunction induced by skeletal muscle atrophy, and several studies reported an association between sarcopenia-induced cardiac cachexia and poor prognosis in heart disease. Since only a few established animal models are recently available, the underlying mechanism of disturbed cardiac repair accompanied with sarcopenia remains poorly understood.

Purpose

We hypothesized that specific microRNAs in sarcopenia-derived exosomes play crucial roles in disturbed cardiac repair with sarcopenia, and these microRNAs directly exacerbate cardiomyocyte injury following cardiac ischemia and reperfusion.

Methods

We developed a novel sarcopenia-induced cardiac repair disturbance mouse model that is induced by tail suspension (TS) 7 days after a 45-min coronary occlusion of cardiac ischemia and reperfusion (I/R). The reduction of the left ventricular ejection fraction (LVEF) after I/R was compared in mice with TS [I/R-TS(+), n=14] and without [I/R-TS(−), n=12] by echocardiography. To investigate the exosomal mechanism of cardiac repair disturbance, a comprehensive analysis of extracted exosomal microRNAs from mice serum was performed in the 2 groups at day 8. Then, we investigated the impact of the identified candidate microRNA in neonatal rat cardiomyocytes (NRVMs). After 4 days in primary culture, candidate microRNA was transfected into NRVMs under hypoxic culture conditions. TUNEL analysis and quantitative PCR analysis of apoptosis-related genes were performed on the NRVMs.

Results

At day 8 after I/R, the LVEF of I/R-TS(+) was not significantly ameliorated compared to that of I/R-TS(−) (ΔLVEF; 1.59±6.92 vs. 8.04±7.71% p=0.034). Four candidate microRNAs obtained from I/R mice serum were identified in the microRNA array analysis. The re-analysis of these candidate micro-RNAs using all I/R mice demonstrated that the level of mir-16-5p in I/R-TS(+) was raised by approximately nine-fold than that in I/R-TS(−) (9.67±13.35 vs. 0.99±1.41, p&lt;0.05). Next, an in vitro experimental model using a microRNA mimic revealed that apoptosis in NRVMs was greatly enhanced by the transfection of a mir-16-5p mimic in hypoxic culture conditions (mir-16-5p vs. control = 5.77±2.84 vs. 1.72±0.55%, p&lt;0.01). Furthermore, by qRT-PCR analysis, the expression of CASP3 and TRP53 were upregulated in NRVMs treated with a mir-16-5p mimic than in control NRVMs.

Conclusion

Myocardial I/R injury in sarcopenia ended in cardiac repair disturbance accompanying with the enhanced expression of exosomal-mir-16-5p. A pro-apoptotic effect of mir-16-5p may exacerbate myocardial I/R injury and thus can be a novel therapeutic target for cardiac repair disturbance in sarcopenia.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science

Modelling haemoproteins: porphyrins and cyclodextrins as sources of inspiration

The association of hydrophobic cavities with porphyrin derivatives has been used to mimic haemoprotein structures. The most employed cavity in this field is β-cyclodextrin (β-CD), and scaffolds combining β-CDs and porphyrins are expected to inspire the combination of porphyrins and cucurbiturils in the near future. Aside from providing water solubility to various porphyrinic structures, the β-CD framework can also modulate and control the reactivity of the metal core of the porphyrin. After a general introduction of the challenges faced in the field of haemoprotein models and the binding behavior of β-CDs, this article will discuss covalent and non-covalent association of porphyrins with β-CDs. In each approach, the role of the CD differs according to the relative position of the concave CD host, either directly controlling the binding and transformation of a substrate on the metalloporphyrin or playing a dual role of controlling the water solubility and selecting the axial ligand of the metal core. The discussion will be of interest to the cucurbituril community as well as to the cavitand community, as the information provided should be useful for the design of haemoprotein mimics using cucurbiturils.

P4144Pericyte-specific deletion of ninjurin1 induces abnormal vasa vasorum formation and persistent inflammation and enhances intimal hyperplasia of injured vasculature

Introduction

Atherosclerosis is fundamental pathological condition inducing severe ischemic diseases such as ischemic heart disease and stroke. New concept has been proposed that adventitial abnormalities including enhanced malformation of adventitial microvessel, vasa vasorum are associated with development and vulnerability of atherosclerotic plaque. However, the role of vasa vasorum malformation in vascular remodelling has not been fully clarified. We recently reported that Ninjurin1 (Ninj1) is critical adhesion molecule to associate pericytes (PCs) with endothelial (EC) tubes to form stabilized mature neovessels. The purpose of this study is to examine if formation of adventitial microvessels affects the vascular remodelling of injured vessels using PCs-specific Ninj1 deletion mouse model.

Methods and results

Deletion of Ninj1 gene in NG2-positive PCs was induced by tamoxifen (Tam)-treated NG2-CreER/Ninj1loxp mice (Ninj1KO, n=9). Tam-treated-NG2-CreER (n=4) or Tam-nontreated NG2-CreER/Ninj1loxp (n=5) mice were used as Control (Ct1 and Ct2 respectively). Femoral arteries were injured by insertion of coiled wire. After 4 weeks of surgery, blood vessels were stained by venous injection of FITC-lectin. Isolated femoral arteries were fixed with paraformaldehyde and decolorized with CUBIC reagent. Wire-mediated vessel injury induced intimal hyperplasia, as assessed by intima/media (I/M) ratio and accordingly grew microvessels in adventitia. Intimal hyperplasia in Ninj1KO were significantly enhanced compared to Controls. Although there was no significant difference in total length of adventitial microvessels among three groups, extravasation of FITC-lectin from adventitial microvessels were significantly enhanced in Ninj1KO. The number of infiltrated macrophages in adventitia were increased in Ninj1KO.

Conclusion

Deletion of Ninj1 in PCs contributes to formation of immature microvessels in adventitia of injured vasculature and to adventitial microbleeding, and subsequently enhances intimal hyperplasia. Ninj1 is an attractive target to normalize microvessels for anti-atherosclerotic therapy.

A water-soluble supramolecular complex that mimics the heme/copper hetero-binuclear site of cytochrome c oxidase

The O₂ adduct of an aqueous synthetic heme/copper model system built on a porphyrin/cyclodextrin supramolecular complex has been characterized.

In mitochondria, cytochrome c oxidase (CcO) catalyses the reduction of oxygen (O₂) to water by using a heme/copper hetero-binuclear active site. Here we report a highly efficient supramolecular approach for the construction of a water-soluble biomimetic model for the active site of CcO. A tridentate copper(ii) complex was fixed onto 5,10,15,20-tetrakis(4-sulfonatophenyl)porphinatoiron(iii) (Fe^IIITPPS) through supramolecular complexation between Fe^IIITPPS and a per-O-methylated β-cyclodextrin dimer linked by a (2,2′:6′,2′′-terpyridyl)copper(ii) complex (Cu^IITerpyCD₂). The reduced Fe^IITPPS/Cu^ITerpyCD₂ complex reacted with O₂ in an aqueous solution at pH 7 and 25 °C to form a superoxo-type Fe^III–O₂^–/Cu^I complex in a manner similar to CcO. The pH-dependent autoxidation of the O₂ complex suggests that water molecules gathered at the distal Cu site are possibly involved in the Fe^III–O₂^–/Cu^I superoxo complex in an aqueous solution. Electrochemical analysis using a rotating disk electrode demonstrated the role of the FeTPPS/CuTerpyCD₂ hetero-binuclear structure in the catalytic O₂ reduction reaction.

Detection and Removal of Endogenous Carbon Monoxide by Selective and Cell-Permeable Hemoprotein Model Complexes

Carbon monoxide (CO) is produced in mammalian cells during heme metabolism and serves as an important signaling messenger. Here we report the bioactive properties of selective CO scavengers, hemoCD1 and its derivative R8-hemoCD1, which have the ability to detect and remove endogenous CO in cells. HemoCD1 is a supramolecular hemoprotein-model complex composed of 5,10,15,20-tetrakis(4-sulfonatophenyl)porphinatoiron(II) and a per-O-methylated β-cyclodextrin dimer having an pyridine linker. We demonstrate that hemoCD1 can be used effectively to quantify endogenous CO in cell lysates by a simple spectrophotometric method. The hemoCD1 assay detected ca. 260 pmol of CO in 10⁶ hepatocytes, which was well-correlated with the amount of intracellular bilirubin, the final breakdown product of heme metabolism. We then covalently attached an octaarginine peptide to a maleimide-appended hemoCD1 to synthesize R8-hemoCD1, a cell-permeable CO scavenger. Indeed, R8-hemoCD1 was taken up by intact cells and captured intracellular CO with high efficiency. Moreover, we revealed that removal of endogenous CO by R8-hemoCD1 in cultured macrophages led to a significant increase (ca. 2.5-fold) in reactive oxygen species production and exacerbation of inflammation after challenge with lipopolysaccharide. Thus, R8-hemoCD1 represents a powerful expedient for exploring specific and still unidentified biological functions of CO in cells.

Proposal of a new mechanism for the directional propagation of the action potential using a mimicking system

A nerve conduction model is constructed by using some liquid-membrane cells that mimic the function of the K⁺ and Na⁺ channels. By imitating two types of Na⁺ channels (ligand-gated Na⁺ channels and voltage-gated Na⁺ channels), a new mechanism for the directional propagation of the action potential along the axon toward the axon terminal is proposed. When the nerve cell is excited by an external (outer) stimulus, it can be presumed that the ligand-gated channels work as power sources at the synapse to propagate the change in the membrane potential, and then the voltage-gated channels locally assist the propagation at each site of the axon (nodes of Ranvier).