Introducing magnetic resonance imaging into the lung cancer radiotherapy workflow - An assessment of patient experience

INTRODUCTION

Magnetic resonance imaging (MRI) offers superior soft tissue contrast to computed tomography (CT), the current standard imaging modality for planning radiotherapy treatment. Improved soft tissue contrast could reduce uncertainties in identifying tumour and surrounding healthy tissues, potentially leading to improved outcomes in patients with lung cancer. This study explored patient experience of MR treatment planning scans in addition to a CT scan.

METHODS

Participants were recruited to the 'Magnetic Resonance Imaging for the Delineation of Organs At Risk and Target Volumes in Lung Cancer Patients (MR-Lung)' study at a UK specialist cancer centre. Participants completed their standard of care radiotherapy planning CT scan and two additional MRI scans. Baseline and post-scan questionnaires were completed assessing anxiety and claustrophobia. Motion artefact during MRI was assessed by a modified visual grading analysis. Sixteen participants completed semi-structured interviews; transcripts were analysed thematically.

RESULTS

29 people (66% female; aged 54-89 years) participated. Nineteen participants completed all imaging and 10 participants withdrew before completion. There was minimal adverse impact on state and scan-specific anxiety levels from completing the MRI scans. Completers experienced significantly less scan-specific anxiety during MRI 1 compared to non-completers (U = 33, z = -1.98, p < 0.05). 78% of those who withdrew during or post MRI 1 were positioned 'arms up'. Motion artefact negatively impacted image quality in 34% of scans. Participants commonly reported concerns during MRI; noise, claustrophobia and pain in upper limbs.

CONCLUSION

Two thirds of participants tolerated two additional MR scans with minimal adverse impact on anxiety levels.

IMPLICATIONS FOR PRACTICE

Patient arm positioning and comfort ought to be considered when introducing MR-Linac systems. A screening tool to identify those at high risk of non-completion should be developed.

Precision measurement of the neutral pion lifetime

The explicit breaking of the axial symmetry by quantum fluctuations gives rise to the so-called axial anomaly. This phenomenon is solely responsible for the decay of the neutral pion π⁰ into two photons (γγ), leading to its unusually short lifetime. We precisely measured the decay width Γ of the [Formula: see text] process. The differential cross sections for π⁰ photoproduction at forward angles were measured on two targets, carbon-12 and silicon-28, yielding [Formula: see text], where stat. denotes the statistical uncertainty and syst. the systematic uncertainty. We combined the results of this and an earlier experiment to generate a weighted average of [Formula: see text] Our final result has a total uncertainty of 1.50% and confirms the prediction based on the chiral anomaly in quantum chromodynamics.

Deep androgen receptor suppression in prostate cancer exploits sexually dimorphic renal expression for systemic glucocorticoid exposure

BACKGROUND

Enzalutamide and apalutamide are potent next-generation androgen receptor (AR) antagonists used in metastatic and non-metastatic prostate cancer. Metabolic, hormonal and immunologic effects of deep AR suppression are unknown. We hypothesized that enzalutamide and apalutamide suppress 11β-hydroxysteroid dehydrogenase-2 (11β-HSD2), which normally converts cortisol to cortisone, leading to elevated cortisol concentrations, increased ratio of active to inactive glucocorticoids and possibly suboptimal response to immunotherapy. On-treatment glucocorticoid changes might serve as an indicator of active glucocorticoid exposure and resultant adverse consequences.

PATIENTS AND METHODS

Human kidney tissues were stained for AR and 11β-HSD2 expression. Patients in three trials [neoadjuvant apalutamide plus leuprolide, enzalutamide ± PROSTVAC (recombinant poxvirus prostate-specific antigen vaccine) for metastatic castration-resistant prostate cancer (CRPC) and enzalutamide ± PROSTVAC for non-metastatic castration-sensitive prostate cancer] were analyzed for cortisol and its metabolites using liquid chromatography-mass spectrometry (LC-MS/MS). Progression-free survival was determined in the metastatic CRPC study of enzalutamide ± PROSTVAC for those with glucocorticoid changes above and below the median.

RESULTS

Concurrent AR and 11β-HSD2 expression occurs only in the kidneys of men. A statistically significant rise in cortisol concentration, cortisol/cortisone ratio and tetrahydrocortisol/tetrahydrocortisone ratio with AR antagonist treatment occurred uniformly across all three trials. In the trial of enzalutamide ± PROSTVAC for metastatic CRPC, high cortisol/cortisone ratio in the enzalutamide arm was associated with significantly improved progression-free survival. However, in the enzalutamide + PROSTVAC arm, the opposite trend was observed.

CONCLUSION

Enzalutamide and apalutamide treatment toggles renal 11β-HSD2 and significantly increases indicators of and exposure to biologically active glucocorticoids, which is associated with clinical outcomes.

The Effects of Previous Error and Success in Alzheimer's Disease and Mild Cognitive Impairment

This work investigated in Alzheimer’s disease dementia (AD), whether the probability of making an error on a task (or a correct response) was influenced by the outcome of the previous trials. We used the antisaccade task (AST) as a model task given the emerging consensus that it provides a promising sensitive and early biological test of cognitive impairment in AD. It can be employed equally well in healthy young and old adults, and in clinical populations. This study examined eye-movements in a sample of 202 participants (42 with dementia due to AD; 65 with mild cognitive impairment (MCI); 95 control participants). The findings revealed an overall increase in the frequency of AST errors in AD and MCI compared to the control group, as predicted. The errors on the current trial increased in proportion to the number of consecutive errors on the previous trials. Interestingly, the probability of errors was reduced on the trials that followed a previously corrected error, compared to the trials where the error remained uncorrected, revealing a level of adaptive control in participants with MCI or AD dementia. There was an earlier peak in the AST distribution of the saccadic reaction times for the inhibitory errors in comparison to the correct saccades. These findings revealed that the inhibitory errors of the past have a negative effect on the future performance of healthy adults as well as people with a neurodegenerative cognitive impairment.

RNA silencing of South African cassava mosaic virus in transgenic cassava expressing AC1/AC4 hp- RNA induces tolerance

Cassava mosaic disease (CMD), caused by geminiviruses, is a major hurdle to cassava production. Due to the heterozygous nature of cassava, breeding for virus resistance is difficult, but cassava has been shown to be a good candidate for genetic engineering using RNA interference (RNAi). T This study reports on the ability of a transgene-derived RNA hairpin, homologous to an overlapping region of the SACMV replication associated protein and putative virus suppressor of silencing protein (AC1/AC4), to confer tolerance in the CMD-susceptible model cassava cultivar 60444. Three of the fourteen transgenic lines expressing SACMV AC1/AC4 hairpin-derived siRNAs showed decreased symptoms and viral loads compared to untransformed control plants. Expression of SACMV AC1/AC4 homologous siRNAs showed that this tolerance is most likely associated with post-transcriptional gene silencing of the virus. This is the first report of targeting the overlapping AC1 and AC4 genes of SACMV conferring CMD tolerance in cassava.

B-04 Combining tDCS and Cognitive Training for People with Severe Mental Illness: Preliminary Feasibility and Acceptability Findings

Objective

Technological advances in neuromodulation and cognitive remediation provide opportunities to develop novel interventions, though a critical first determination is whether such treatments are feasible and acceptable to participants. This study evaluated a combined transcranial direct current stimulation (tDCS) and computerized cognitive training intervention for individuals with severe mental illness; we examined participant recruitment, retention, and adherence to the interventions, along with qualitative feedback.

Method

Participants included adults with schizophrenia-spectrum or bipolar disorder and impaired working memory (performance ≤1 standard deviation below average of healthy individuals on a spatial span or letter-number span test). In this randomized crossover study, all participants received the combined intervention (ten tDCS sessions in the clinic concurrent with cognitive training), and ten hours of at-home training, and completed neuropsychological and clinical assessments at three time points.

Results

To date, thirteen participants provided informed consent. Seven participants were screened out; five exceeded the cognitive cutoff and one did not meet the diagnostic criterion. No remaining participants have withdrawn prior to study completion. Four participants completed all tDCS sessions, and one completed 80%. No tDCS session has been discontinued. At-home training has proven more challenging; only one participant completed all ten hours, and three did not complete any at all. Participant feedback has been positive; all expressed satisfaction with both treatments though some said symptoms or busy schedules interfered with at-home training.

Conclusions

Combining tDCS with computerized cognitive training appears feasible and acceptable. Strategic recruitment efforts to capture those with cognitive impairment appears necessary, as well as troubleshooting barriers to at-home training.

A-29 The Mediating Effects of Personality on Sleep Quality and Executive Dysfunction

Objective

This study examined the relationship between personality traits, sleep quality, and executive dysfunction.

Method

Participants were 195 college students (65.6% female; 53.8% Caucasian, 33.3% African American, 4.1% Asian,; age range 17 – 46 years, Mage = 19.58 years, SD = 3.41; 73.3% no psychological diagnosis) who completed the following attention tasks: 120-item IPIP Neo (NEO), the Pittsburgh Sleep Quality Index (PSQI), and the Barkley Deficits in Executive Functioning Rating Scale-IV (BDEFS-IV).

Results

Mediation analyses were tested using 5000 bootstrapping resamples with bias-corrected 95% confidence estimates to investigate if personality traits mediated the effect of sleep quality on executive dysfunction. The total effect between PSQI and BDEFS-IV was significant, F(1,193) = 15.80, p < .001, r2 = .08, 95% CI = 1.79, 5.31). The model was significant when examining the relationship between the independent variable, mediators, and dependent variable, F(6,188) = 29.31, p < .000, r2 = .48. Three of the five mediators demonstrated significant indirect effects: neuroticism, (B = 1.07, t (188) = 5.39, p = .000, 95% CI = .68, 1.46), extraversion (B = .63, t (188) = 3.46, p = .000, 95% CI = .27, .99), and conscientiousness (B = -1.91, t (188) = -7.46, p = .000, 95% CI = -2.42, -1.41). The direct effect of PSQI and BDEFS-IV was not significant (B = .731, t (188) = .99, p = .32, 95% CI = -.72, 2.18) when controlling for all five mediators, confirming a full mediation.

Conclusions

Neuroticism, Extraversion, and Conscientiousness significantly mediated the relationship between self-reported sleep quality and executive dysfunction.

A-64 The Relationship between Big-5 Personality Factors and Cognitive Health

Objective

The purpose of the current study was to examine the relationship between factors of personality and cognitive health.

Methods

Two hundred and two participants (M age = 19.51, SD = 3.33; M education = 12.40, SD = .75; 72.3% Female, 55.3% White, 36.0% African American, 4.6% Asian, 4.1% Other) completed the cognitive health questionnaire (CHQ) and a 120-item International Personality Item Pool Representation of the NEO-PI-R (IPIP-NEO) as a part of a larger battery in an institutional setting. A CHQ total score was calculated based on items of four positive factors of cognitive health including social/intellectual activities, nutrition, exercise, and eating habits.

Results

A multiple linear regression using backwards elimination was calculated to predict scores on the Cognitive Health Questionnaire utilizing the five personality factors of the IPIP-NEO. The overall five-factor regression model yielded a significant regression equation (F(5,196) = 7.76, p < .001), with an R2 of .165. The final three-factor regression model consisting of extraversion, openness, and consciousness yielded significant results (F(3,198) = 12.70, p < .001), with an R2 of .161.

Conclusions

This exploratory study investigated the relationship between factors of personality and cognitive health. Although a multiple regression model involving all five factors of personality were significantly predictive of cognitive health, the results of this study indicate that greater variance of cognitive health is predicted by extraversion, openness and conscientiousness than neuroticism and agreeableness. Further research should investigate each factor of cognitive health and how these components are predicted by features of personality.

First Measurement of Near-Threshold J/ψ Exclusive Photoproduction off the Proton

We report on the measurement of the γp→J/ψp cross section from E_{γ}=11.8  GeV down to the threshold at 8.2 GeV using a tagged photon beam with the GlueX experiment. We find that the total cross section falls toward the threshold less steeply than expected from two-gluon exchange models. The differential cross section dσ/dt has an exponential slope of 1.67±0.39  GeV^{-2} at 10.7 GeV average energy. The LHCb pentaquark candidates P_{c}^{+} can be produced in the s channel of this reaction. We see no evidence for them and set model-dependent upper limits on their branching fractions B(P_{c}^{+}→J/ψp) and cross sections σ(γp→P_{c}^{+})×B(P_{c}^{+}→J/ψp).

Acute abdominal pain due to internal herniation of the sigmoid colon, fallopian tube and left ovary, a rare presentation of Allen Masters syndrome

In 1955, Allen and Masters describe a painful syndrome which associates traumatic delivery to laceration found on the posterior leaf of the broad ligament. Herniation through this defect is a rare entity, accounted for about 4-7% of all internal hernias. Normally, it involves the small bowel. The authors present the case of a multiparous woman admitted at emergency for constipation and abdominal pain. The CT scan showed an extremely rare case of internal hernia of the sigmoid colon, fallopian tube and left ovary through a large defect of the broad ligament. The patient underwent a full laparoscopic surgery that allowed the reduction of the hernia and the suture of the defect with very good outcome.

Diagnostic pathways in Crohn's disease

The management of Crohn's disease (CD) is shifting from a stepwise, incremental approach based on symptom control to more aggressive early combined immunosuppression in an attempt to induce remission more rapidly and avoid long-term bowel damage. Accurately defining disease activity is a major challenge, as there is often a disconnect between symptomatology and underlying disease status. The role of imaging in CD has evolved such that it now plays a central role establishing the initial diagnosis, characterising disease phenotype, activity assessment, disease surveillance, and assessing response to therapy. Furthermore, the "treat-to-target" approach is being investigated in CD, with resolution of transmural inflammation on cross-sectional imaging being the treatment goal. In this review, we summarise the principal imaging techniques available to the radiologist, the key findings, and provide some guidance on the preferred imaging option in the diagnostic pathway. We consider the relative merits and drawbacks of each imaging technique before offering a brief discussion of some current developments and research avenues in CD imaging. We discuss how imaging may be useful in a "treat-to-target" approach. Finally, we highlight some practical considerations around service configuration and delivery to optimise imaging in CD in an accurate, cost-effective manner.

Ultrasound-enhanced hair dye application for natural dyeing formulations

Advances made in recent years have allowed the application of colorants obtained from natural sources into textile dyeing. The use of ultrasound in the dyeing method is reported to increase dye uptake and decrease dyeing times. The aim of this work is to further extend the knowledge of natural hair dyes considering the use of ultrasound in the dyeing method with commercially available herbal dyes and using goat hair as a model for human hair. Optimal ultrasonic parameters were selected by considering the effects of sonication times (5, 10 and 15 min), frequencies (44, 400 and 1000 kHz) and total dyeing times (30, 60 and 120 min) in the morphology of the dyed hair and the colour intensity. Damage to the hair surface was evaluated by scanning electron microscopy (SEM) images, differences in colour of the dyed hair was obtained by ImageJ analysis and quantification of dye uptake was determined by UV-visible spectroscopy. The evidence from this study suggests an increase in goat hair coloration with the use of ultrasonic energy. Optimal dyeing conditions in consideration of colouration efficacy without hair damage were identified as sonication at 400 kHz for 10 min with a total dyeing time of 60 min.

Volatolomics: A broad area of experimentation

Chemical analysis (detection and monitoring) of compounds associated with the metabolic activities of an organism is at the cutting edge of science. Volatile metabolomics (volatolomics) are applied in a broad range of applications including: biomedical research (e.g. disease diagnostic tools, personalized healthcare and nutrition, etc.), toxicological analysis (e.g. exposure tool to environmental pollutants, toxic and hazardous chemical environments, industrial accidents, etc.), molecular communications, forensics, safety and security (e.g. search and rescue operations). In the present review paper, an overview of recent advances and applications of volatolomics will be given. The main focus will be on volatile organic compounds (VOCs) originating from biological secretions of various organisms (e.g. microorganisms, insects, plants, humans) and resulting fusion of chemical information. Bench-top and portable or field-deployable technologies-systems will also be presented and discussed.

Data on items of AKUSSI in Alkaptonuria collected over three years from the United Kingdom National Alkaptonuria Centre and the impact of nitisinone

Alkaptonuria is a rare genetic disorder characterized by a high level of circulating (and urine) homogentisic acid (HGA), which contributes to ochronosis when it is deposited in connective tissue as a pigmented polymer. In an observational study carried out by National AKU Centre (NAC) in Liverpool, a total of thirty-nine AKU patients attended yearly visits in varying numbers. At each visit a mixture of clinical, joint and spinal assessments were carried out and the results calculated to yield an AKUSSI (Alkaptonuria Severity Score Index), see "Nitisinone arrests ochronosis and decreases rate of progression of Alkaptonuria: evaluation of the effect of nitisinone in the United Kingdom National Alkaptonuria Centre" (Ranganath at el., 2018). The aim of this data article is to produce visual representation of the change in the components of AKUSSI over 3 years, through radar charts. The metabolic effect of nitisinone is shown through box plots.