SU-E-J-149: Is Rotational IMRT More Susceptible to Tumor Motion than Dynamic IMRT?

PURPOSE

To investigate whether rotational IMRT is more susceptible to organ motion than IMRT that uses fixed fields.

METHODS

RapidArc and sliding window IMRT treatment plans were each created for five lung and five pancreas cases. Dosimetric effects due to tumor motion were simulatedby incorporating sinusoidal couch motion into plans using in-house Monte Carlo dose verification software. Motion was emulated longitudinally (10 mm) for all cases with additional lateral and vertical motion (5 mm) for pancreatic tumors. Dose distributions of original and modified plans were compared using Gamma analysis and dose profiles.

RESULTS

Preliminary results show that for one lung case, a 95% Gamma pass rate can be achieved using 6%-6-mm criterion for RapidArc versus 8%-8-mm for sliding window. Findings are supported by expanding on a well-known model that demonstrates the effects of intra-fraction motion on the delivery of dynamic intensity modulation.

CONCLUSIONS

Rotational IMRT deliveries are believed to be no more susceptible to organ motion than sliding window IMRT, and results thus far support this conclusion.

WE-E-213AB-01: Medical Physics Challenges for Implementation of New Technologies in External Beam Radiotherapy

The AAPM has signed two formal Educational Exchange Agreements with the Spanish (SEFM) and the Russian (AMPR) medical physics societies. While the primary purpose of the Agreements is to provide educational opportunities for young medical physicists, the Agreements also contemplate holding joint sessions at scientific congresses. The purpose of this professional AAPM/SEFM/AMPR Joint Symposium is to explore the challenges that medical physicists in the three countries face when new external beam radiotherapy technologies are introduced in their facilities and to suggest potential solutions to limitations in testing equipment and lack of familiarity with protocols. Speakers from the three societies will present reviews of the technical aspects of IMRT, Arc EVIRT (IMAT/VMAT/Rapid Arc), SRS/SRBT, and IGRT/Adaptive radiotherapy, and will describe the status of these technologies in their countries, including the challenges found in tasks such as developing anatomical and biological dose optimization techniques and implementing QA management, risk assessment and patient safety programs. The SEFM will offer AAPM and AMPR members the possibility to participate in collaborative proposals for future research bids in UE and USA based on an ongoing Spanish project for adaptive radiotherapy using functional imaging. A targeted discussion will debate three propositions: the cost/benefit ratio of IGRT, whether IMRT requires IGRT, and the use of non-ionizing radiation technologies for realtime monitoring of prostate IGRT. For these debates, each society has designated one speaker to present and defend either "For" or "Against" the proposition, followed by discussion by all participants. The Symposium presentations and the country-tailored recommendations drawn will be made available to each society for inclusion in their websites. The WGNIMP, the AAPM Work Group charged with executing the AAPM/SEFM and AAPM/AMPR Agreements, will follow up on the commitments made by the AAPM.Di Yan's research on adaptive radiotherapy has been financially supported by: 1) NIH Research Grants, 2) Elekta Research Grants 3) Philips Research GrantConflicts of interest for Cedric X Yu: 1) Board Member of Prowess, Inc., 2) Shareholder of Xcision Medical Systems, LLC, 3) Inventor on patents licensed by Varian Medical Systems, Inc.

LEARNING OBJECTIVES

1. Describe fundamental aspects for four advanced radiotherapy techniques: IMRT, IGRT, SBRT, and adaptive radiotherapy. 2. Review technical and professional challenges for implementation of advanced techniques as a function of resources and capabilities available within each scientific society: AAPM, SEFM, and AMPR. 3. Discuss and plan a proposal for an international trial on IMRT/IGRT based on functional imaging. 4. Debate important implementation aspects of IMRT and IGRT according to country-specific resources.

Chronic sympathetic attenuation and energy metabolism in autonomic failure

The sympathetic nervous system regulates thermogenesis and energy homeostasis in humans. When activated it increases energy expenditure, particularly resting energy expenditure. Most human studies used acute infusion of β-blockers as a model to eliminate sympathetic stimulation and to examine the contribution of the sympathetic nervous system to energy metabolism and balance. Clinically, however, it is also important to assess the effect of chronic sympathetic attenuation on energy metabolism. In this context, we hypothesized that resting energy expenditure is decreased in patients with autonomic failure who, by definition, have low sympathetic tone. We measured 24-hour energy expenditure using whole-room indirect calorimeter in 10 adults with chronic autonomic failure (6 women; age, 64.9±9.1 years; body mass index, 25.2±4.4 kg/m(2)) and 15 sedentary healthy controls of similar age and body composition (8 women; age, 63.1±4.0 years; body mass index, 24.4±3.9 kg/m(2)). In 4 patients, we eliminated residual sympathetic activity with the ganglionic blocker trimethaphan. We found that, after adjusting for body composition, resting energy expenditure did not differ between patients with autonomic failure and healthy controls. However, resting energy expenditure significantly decreased when residual sympathetic activity was eliminated. Our findings suggest that sympathetic tonic support of resting energy expenditure is preserved, at least in part, in pathophysiological models of chronic sympathetic attenuation.

Characterization of a Tembusu virus isolated from naturally infected house sparrows (Passer domesticus) in Northern China

The house sparrow (Passer domesticus) is one of the most widely distributed wild birds in China. Tembusu virus (TMUV) strain, TMUV-SDHS, was isolated from house sparrows living around the poultry farms in Shandong Province, Northern China. Genetic analysis of E and NS5 genes showed that it had a close relationship with that of the YY5 strain, which can cause severe egg drop in ducks. Pathogenicity studies showed that the virus is highly virulent when experimentally inoculated into the ducks. These findings show that house sparrows carrying the Tembusu virus may play an important role in transmitting the virus among other species.

Copy number changes on the X chromosome in women with and without highly skewed X-chromosome inactivation

AIM

To test the hypothesis that microdeletions or microduplications below the resolution of a standard karyotype may be a significant cause of highly skewed X-inactivation (HSXI) in women without a cytogenetically detected X-chromosome anomaly.

METHODS

Cases were women with HSXI, defined as ≥85% of cells in a blood sample with the same active allele at the HUMARA locus. The skewing in controls ranged from 50 to <75%. We performed an SNP microarray analysis using the Affymetrix 6.0 platform for 45 cases and 45 controls.

RESULTS

Cases and controls did not differ in the frequency of X-chromosome copy number changes ≥100 kb or in the frequency of copy number changes that contained genes. However, one woman with HSXI >90% in blood and left and right buccal smears had a 5.5-Mb deletion in Xp22.2p22.1. This deletion could affect the viability of male conceptions and may have led to the dysmorphology found in female carriers.

CONCLUSION

HSXI in a blood sample is rarely due to X-chromosome copy number changes detectable by microarray.

Single-cell exome sequencing and monoclonal evolution of a JAK2-negative myeloproliferative neoplasm

Tumor heterogeneity presents a challenge for inferring clonal evolution and driver gene identification. Here, we describe a method for analyzing the cancer genome at a single-cell nucleotide level. To perform our analyses, we first devised and validated a high-throughput whole-genome single-cell sequencing method using two lymphoblastoid cell line single cells. We then carried out whole-exome single-cell sequencing of 90 cells from a JAK2-negative myeloproliferative neoplasm patient. The sequencing data from 58 cells passed our quality control criteria, and these data indicated that this neoplasm represented a monoclonal evolution. We further identified essential thrombocythemia (ET)-related candidate mutations such as SESN2 and NTRK1, which may be involved in neoplasm progression. This pilot study allowed the initial characterization of the disease-related genetic architecture at the single-cell nucleotide level. Further, we established a single-cell sequencing method that opens the way for detailed analyses of a variety of tumor types, including those with high genetic complex between patients.

Population-based surveillance of extensively drug-resistant tuberculosis in Shandong Province, China

To investigate the prevalence of extensively drug-resistant tuberculosis (XDR-TB) in Chinese populations, we analyzed the drug resistance profiles of 1787 Mycobacterium tuberculosis isolates through a population-based surveillance project in Shandong Province, China. We found 330 (18.5%; 95%CI 16.1-20.3) isolates resistant to ≥1 first-line drug and 65 (3.6%; 95%CI 2.9-4.6) multidrug-resistant (MDR) isolates, of which 13 (20.0%; 95%CI 11.9-31.4) were XDR; 47/65 MDR-TB isolates (70.8%; 95%CI 58.2-81.4) were resistant to fluoroquinolones. Our results indicate that inadequate application of second-line anti-tuberculosis drugs has caused increased prevalence of XDR-TB in certain Chinese populations.

Procoagulant activity of erythrocytes and platelets through phosphatidylserine exposure and microparticles release in patients with nephrotic syndrome

Recent studies showed that an imbalance of prothrombotic and antithrombotic factors and impaired thrombolytic activity contribute to the thrombophilia of the nephrotic syndrome (NS). However, it is not clear whether blood cell injury and/or activation is involved in hypercoagulability in NS patients. Our objectives were to study the increase in microparticle (MP) release and phosphatidylserine (PS) exposure on the outer membrane of MP-origin cells in NS patients, and to evaluate their procoagulant activity (PCA). The subjects were patients with membranous nephropathy (MN), minimal change nephrotic syndrome (MCNS) and healthy controls. Analyses of MPs and PS exposure were performed using a flow cytometer. PCA was determined by clotting time and purified coagulation complex assays. We found that lactadherin+ MPs, which derived from red blood cells (RBC), platelet and endothelial cell, increased in NS patients. Moreover, PS exposure on RBCs and platelets in each NS group, especially in MN, are higher than that in controls. MP shedding and PS exposure of RBCs/platelets were highly procoagulant in NS patients. However, blockade of PS with lactadherin inhibited over 90% of PCA while an anti-tissue factor antibody had no significant inhibition effect. Our results demonstrate that the thrombophilic susceptibility of NS may be partly ascribed to MP release and PS exposure of RBCs, platelets and endothelial cells. Lactadherin is a sensitive probe for PS that has high anticoagulant activity.

SOAP3: ultra-fast GPU-based parallel alignment tool for short reads

SOAP3 is the first short read alignment tool that leverages the multi-processors in a graphic processing unit (GPU) to achieve a drastic improvement in speed. We adapted the compressed full-text index (BWT) used by SOAP2 in view of the advantages and disadvantages of GPU. When tested with millions of Illumina Hiseq 2000 length-100 bp reads, SOAP3 takes < 30 s to align a million read pairs onto the human reference genome and is at least 7.5 and 20 times faster than BWA and Bowtie, respectively. For aligning reads with up to four mismatches, SOAP3 aligns slightly more reads than BWA and Bowtie; this is because SOAP3, unlike BWA and Bowtie, is not heuristic-based and always reports all answers.

Prospective study of the incidence and predictors of thrombus in children undergoing palliative surgery for single ventricle physiology

PURPOSE

To determine the incidence and clinical and biomarker predictors of perioperative thrombosis in children with single ventricle physiology undergoing staged palliation.

METHODS

Nineteen patients were enrolled and 16 completed the study. Serial ultrasounds of the central venous system were performed to evaluate for thrombus. Plasma antithrombin III, thrombin-antithrombin complex, protein C, protein S, tissue factor pathway inhibitor, plasminogen activator inhibitor-1, tissue plasminogen activator antigen, D-dimer, soluble CD40 ligand, and urinary thromboxane were measured serially before and after surgery. Cardiopulmonary bypass time, aortic cross clamp time, blood product administration, inotrope score, chest tube output, cardiac function by echocardiography, intensive care unit and hospital lengths of stay, and central venous catheter days were recorded.

RESULTS

The incidence of perioperative thrombus was 31%. Patients who developed a thrombus had poorer preoperative ventricular function (p = 0.03) and longer cardiopulmonary bypass times (p = 0.03) than those who did not develop a thrombus. Preoperative plasma antithrombin III was lower (p = 0.01) and tissue plasminogen activator antigen concentrations were higher (p = 0.02) in patients with a thrombus compared with patients without a thrombus. When measured over time, antithrombin III remained lower (p = 0.002) and tissue plasminogen activator antigen higher (p = 0.005) in those who developed a thrombus compared with those who did not. There were no other statistically significant differences in biomarkers of coagulation between patients with and without thrombosis.

CONCLUSION

One-third of patients undergoing palliative surgery for single ventricle physiology develop thrombosis. Decreased ventricular function, low antithrombin III, and increased tissue plasminogen activator may predict those most suitable for randomized clinical trials of anticoagulation.

Co-governing decentralised water systems: an analytical framework

Current discourses in urban water management emphasise a diversity of water sources and scales of infrastructure for resilience and adaptability. During the last 2 decades, in particular, various small-scale systems emerged and developed so that the debate has largely moved from centralised versus decentralised water systems toward governing integrated and networked systems of provision and consumption where small-scale technologies are embedded in large-scale centralised infrastructures. However, while centralised systems have established boundaries of ownership and management, decentralised water systems (such as stormwater harvesting technologies for the street, allotment/house scales) do not, therefore the viability for adoption and/or continued use of decentralised water systems is challenged. This paper brings together insights from the literature on public sector governance, co-production and social practices model to develop an analytical framework for co-governing such systems. The framework provides urban water practitioners with guidance when designing co-governance arrangements for decentralised water systems so that these systems continue to exist, and become widely adopted, within the established urban water regime.

CT and ultrasound features of basal cell adenoma of the parotid gland: a report of 22 cases with pathologic correlation

BACKGROUND AND PURPOSE

Parotid gland BCA is a rare benign tumor. Only a few studies describing the imaging features of BCA have been published. This study investigated CT and sonography characteristics of BCA of the parotid gland.

MATERIALS AND METHODS

Demographics of patients with BCA were evaluated, and lesion characteristics of CT (n = 22) and sonography (n = 20) were reviewed. These cases were grouped into 3 types: type 1 tumors, located at the superficial region of superficial lobe of the parotid gland; type 2 tumors, located at the deeper region of superficial lobe; and type 3 tumors, located in the deep lobe. Imaging findings were correlated with pathology.

RESULTS

Sixteen patients (73%) were female and 6 (27%) were male. The mean age was 51.5 years (SD 10.2; range 32-73). The size of the tumors was less than 30 mm. The sizes of type 1, type 2, and type 3 tumors were 11.4 ± 3.29 mm, 19.3 ± 5.44 mm, and 26 ± 3.6 mm, respectively. The CT attenuation increase was 64.5 ± 19 HU on contrast CT. The type 1 tumors were solid (11/11), showed homogeneous or slightly heterogeneous enhancement on CT, and were homogeneously or slightly heterogeneously hypoechoic on sonography. Cystic changes tended to occur in type 2 (7/8) or type 3 (2/3) tumors, which showed obvious heterogeneous attenuation on CT and anechoic on sonography.

CONCLUSIONS

The BCA tends to be small and shows early intense enhancement. The solid tumor is common in the superficial region of the parotid gland, and cystic lesions occur mostly in the deeper parts of the superficial lobe or in the deep lobe.

Resequencing 50 accessions of cultivated and wild rice yields markers for identifying agronomically important genes

Rice is a staple crop that has undergone substantial phenotypic and physiological changes during domestication. Here we resequenced the genomes of 40 cultivated accessions selected from the major groups of rice and 10 accessions of their wild progenitors (Oryza rufipogon and Oryza nivara) to >15 × raw data coverage. We investigated genome-wide variation patterns in rice and obtained 6.5 million high-quality single nucleotide polymorphisms (SNPs) after excluding sites with missing data in any accession. Using these population SNP data, we identified thousands of genes with significantly lower diversity in cultivated but not wild rice, which represent candidate regions selected during domestication. Some of these variants are associated with important biological features, whereas others have yet to be functionally characterized. The molecular markers we have identified should be valuable for breeding and for identifying agronomically important genes in rice.

Comparative effects of angiotensin-converting enzyme inhibition and angiotensin-receptor blockade on inflammation during hemodialysis

Biomarkers of oxidative stress and inflammation predict cardiovascular events in maintenance hemodialysis patients. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) reduce cardiovascular mortality in the general population, but their benefit in maintenance hemodialysis patients is not fully explored. To test whether ACE inhibitors and ARBs differentially affect markers of oxidative stress, inflammation, and fibrinolysis during hemodialysis, we conducted a randomized, double-blind, placebo-controlled 3×3 crossover study. We randomly assigned 15 participants undergoing hemodialysis to placebo, ramipril (5 mg/d), and valsartan (160 mg/d) for 7 days, with a washout period of 3 weeks in between the treatments. On the morning of the seventh day of drug treatment, participants underwent serial blood sampling during hemodialysis. Neither ramipril nor valsartan affected BP during hemodialysis. Ramipril increased IL-1β concentrations (P=0.02) and decreased IL-10 concentrations (P=0.04) compared with placebo. Valsartan and ramipril both lowered IL-6 levels during dialysis (P<0.01 for each compared with placebo). Valsartan increased F(2)-isoprostane levels, and ramipril suggested a similar trend (P=0.09). Valsartan and ramipril both lowered D-dimer levels (P<0.01 for both), whereas only ramipril seemed to prevent a rise in vWf levels (P=0.04). In summary, during hemodialysis, valsartan induces a greater anti-inflammatory effect compared with ramipril, although ramipril seems to prevent dialysis-induced endothelial dysfunction as measured by levels of vWf. A prospective clinical trial is necessary to determine whether ACE inhibitors and ARBs also differ with respect to their effects on cardiovascular mortality in this population.