A randomized, double-blind, placebo-controlled phase II study to evaluate the efficacy and safety of ivarmacitinib (SHR0302) in adult patients with moderate-to-severe alopecia areata

BACKGROUND

Alopecia areata (AA) is a CD8+ T cell-mediated autoimmune disease characterized by nonscarring hair loss. Ivarmacitinib, which is a selective oral Janus kinase 1 inhibitor, may interrupt certain cytokine signaling implicated in the pathogenesis of AA.

OBJECTIVE

To evaluate the efficacy and safety of ivarmacitinib in adult patients with AA who have ≥25% scalp hair loss.

METHODS

Eligible patients were randomized 1:1:1:1 to receive ivarmacitinib 2, 4, or 8 mg once daily or placebo for 24 weeks. The primary end point was the percentage change from baseline in the Severity of Alopecia Tool score at week 24.

RESULTS

A total of 94 patients were randomized. At week 24, the least squares mean difference in the percentage change from baseline in the Severity of Alopecia Tool score for ivarmacitinib 2, 4, and 8 mg and placebo groups were -30.51% (90% CI, -45.25, -15.76), -56.11% (90% CI, -70.28, -41.95), -51.01% (90% CI, -65.20, -36.82), and -19.87% (90% CI, -33.99, -5.75), respectively. Two serious adverse events-follicular lymphoma and COVID-19 pneumonia-were reported.

LIMITATIONS

A small sample size limits the generalizability of the results.

CONCLUSION

Treatment with ivarmacitinib 4 and 8 mg doses in patients with moderate and severe AA for 24 weeks was efficacious and generally tolerated.

BMP9 functions as a negative regulator in the myogenic differentiation of primary mouse myoblasts

BMP9, a member of the TGF-β superfamily, reveals the great translational promise for it has been shown to have the strong effect of osteogenic activity in vitro and in vivo. However, the implantation of certain BMPs (bone morphogenetic proteins) into muscular tissues induces ectopic bone formation. BMPs induce osteoblastic differentiation in skeletal muscle, suggesting that myogenic stem cells, such as myoblasts, are the potential progenitors of osteoblasts during heterotopic bone differentiation. Here, we investigate the role of BMP9 during primary mouse myoblasts differentiation. We found BMP9 enhanced cell proliferation and reduced myogenic differentiation of primary mouse myoblasts. In addition, adenovirus-mediated overexpression of BMP9 delayed muscle regeneration after BaCl2-induced injury. ALK1 knockdown reversed the inhibition of myoblast differentiation induced by BMP9. Our data indicate that BMP9 inhibits myogenic differentiation in primary mouse myoblasts and delays skeletal muscle regeneration after injury.

Reconstitution of a minimal ESX-5 type VII secretion system suggests a role for PPE proteins in the outer membrane transport of proteins

Mycobacteria utilize type VII secretion systems (T7SSs) to secrete proteins across their highly hydrophobic and diderm cell envelope. Pathogenic mycobacteria have up to five different T7SSs, called ESX-1 to ESX-5, which are crucial for growth and virulence. Here, we use a functionally reconstituted ESX-5 system in the avirulent species Mycobacterium smegmatis that lacks ESX-5, to define the role of each esx-5 gene in system functionality. By creating an array of gene deletions and assessing protein levels of components and membrane complex assembly, we observed that only the five components of the inner membrane complex are required for its assembly. However, in addition to these five core components, active secretion also depends on both the Esx and PE/PPE substrates. Tagging the PPE substrates followed by subcellular fractionation, surface labeling and membrane extraction showed that these proteins localize to the mycobacterial outer membrane. This indicates that they could play a role in secretion across this enigmatic outer barrier. These results provide the first full overview of the role of each esx-5 gene in T7SS functionality. IMPORTANCE Pathogenic mycobacteria, such as the notorious Mycobacterium tuberculosis, are highly successful as pathogens, in part due to their specific and diderm cell envelope, with a mycolic acid-containing outer membrane. The architecture of this highly impermeable membrane is little understood and the proteins that populate it even less so. To transport proteins across their cell envelope, mycobacteria employ a specialized transport pathway called type VII secretion. While recent studies have elucidated the type VII secretion membrane channel that mediates transport across the inner membrane, the identity of the outer membrane channel remains a black box. Here, we show evidence that specific substrates of the type VII pathway could form these channels. Elucidating the pathway and mechanism of protein secretion through the mycobacterial outer membrane will allow its exploitation for the development of novel mycobacterial therapeutics.

[Chinese expert guidance on overall application of lenvatinib in hepatocellular carcinoma]

Lenvatinib mesylate is an oral receptor tyrosine kinase inhibitor against targets of vascular endothelial growth factor receptors 1-3, fibroblast growth factor receptors 1-4, platelet-derived growth factor receptor α, stem cell growth factor receptor, and rearranged during transfection, et al. Lenvatinib has been approved by the National Medical Products Administration of China on September 4, 2018, for the first-line treatment of patients with unresectable hepatocellular carcinoma who have not received systematic treatment before. Up to February 2023, Lenvatinib has been listed in China for more than 4 years, accumulating a series of post-marketing clinical research evidences. Based on the clinical practice before and after the launch of lenvatinib and referring to the clinical experience of other anti-angiogenesis inhibitors, domestic multidisciplinary experts and scholars adopt the Delphi method to formulate the Chinese Expert Guidance on Overall Application of Lenvatinib in Hepatocellular Carcinoma after repeated discussions and revisions, in order to provide reference for reasonable and effective clinical application of lenvatinib for clinicians.

Determination of Spin-Parity Quantum Numbers for the Narrow Structure near the pΛ[over ¯] Threshold in e^{+}e^{-}→pK^{-}Λ[over ¯]+c.c

A narrow structure in the pΛ[over ¯] system near the mass threshold, named as X(2085), is observed in the process e^{+}e^{-}→pK^{-}Λ[over ¯] with a statistical significance greater than 20σ. Its spin and parity are determined for the first time to be J^{P}=1^{+} in an amplitude analysis, with a statistical significance greater than 5σ over other quantum numbers (0^{-},1^{-} and 2^{+}). The pole positions of X(2085) are measured to be M_{pole}=(2084_{-2}^{+4}±9)  MeV and Γ_{pole}=(58_{-3}^{+4}±25)  MeV, where the first uncertainties are statistical and the second ones are systematic. The analysis is based on the study of the process e^{+}e^{-}→pK^{-}Λ[over ¯] and uses the data samples collected with the BESIII detector at the center-of-mass energies sqrt[s]=4.008, 4.178, 4.226, 4.258, 4.416, and 4.682 GeV with a total integrated luminosity of 8.35  fb^{-1}.

Precise Measurement of the e^{+}e^{-}→D_{s}^{*+}D_{s}^{*-} Cross Sections at Center-of-Mass Energies from Threshold to 4.95 GeV

The process e^{+}e^{-}→D_{s}^{*+}D_{s}^{*-} is studied with a semi-inclusive method using data samples at center-of-mass energies from threshold to 4.95 GeV collected with the BESIII detector operating at the Beijing Electron Positron Collider. The Born cross sections of the process are measured for the first time with high precision in this energy region. Two resonance structures are observed in the energy-dependent cross sections around 4.2 and 4.4 GeV. By fitting the cross sections with a coherent sum of three Breit-Wigner amplitudes and one phase-space amplitude, the two significant structures are assigned masses of (4186.8±8.7±30) and (4414.6±3.4±6.1)  MeV/c^{2}, widths of (55±15±53) and (122.5±7.5±8.1)  MeV, where the first errors are statistical and the second ones are systematic. The inclusion of a third Breit-Wigner amplitude is necessary to describe a structure around 4.79 GeV.

[Radiation-associated sarcomas of bone and soft tissue: a clinicopathological analysis of 46 cases]

Objective: To investigate the clinical, imaging, histological, and molecular features and the differential diagnosis of radiation-associated sarcomas of bone and soft tissue. Methods: Forty-six cases of radiation-associated sarcomas of the bone and soft tissue in Beijing Jishuitan Hospital from January 2010 to January 2022 were retrospectively analyzed; and the imaging, histological features and immunophenotype were examined. Results: There were 33 females and 13 males, aged from 18 to 74 years, with a mean of 52 years. The most common site of radiation-associated sarcomas were the limbs and spine (15 cases), followed by the chest (9 cases). The primary diseases included epithelial tumors (15 breast cancer, 6 cervical cancer, and 5 bowel cancer), hematolymphoid tumors, bone and soft tissue tumors and infectious lesions. The latent period of radiation-associated sarcomas ranged from 2-22 years, with an average of 11.6 years. Histopathologically, the morphology was divergent from the primary tumor. The most common malignant tumor type was undifferentiated sarcoma (22 cases), followed by osteosarcoma (16 cases). The immunophenotype of radiation-related sarcoma was almost the same as the corresponding soft tissue sarcoma. Conclusions: Radiation-induced sarcoma has a wide range of primary tumor types and its imaging, morphology and immunohistochemical features are similar to those of the primary sarcoma of bone and soft tissue. Clinical correlation is often recommended for the differential diagnosis.

First Experimental Study of the Purely Leptonic Decay D_{s}^{*+}→e^{+}ν_{e}

Using 7.33  fb^{-1} of e^{+}e^{-} collision data taken with the BESIII detector at the BEPCII collider, we report the first experimental study of the purely leptonic decay D_{s}^{*+}→e^{+}ν_{e}. Our data contain a signal of this decay with a statistical significance of 2.9σ. The branching fraction of D_{s}^{*+}→e^{+}ν_{e} is measured to be (2.1_{-0.9_{stat}}^{+1.2}±0.2_{syst})×10^{-5}, corresponding to an upper limit of 4.0×10^{-5} at the 90% confidence level. Taking the total width of the D_{s}^{*+} [(0.070±0.028)  keV] predicted with the radiative D_{s}^{*+} decay from the lattice QCD calculation as input, the decay constant of the D_{s}^{*+} is determined to be f_{D_{s}^{*+}}=(214_{-46_{stat}}^{+61}±44_{syst})  MeV, corresponding to an upper limit of 354 MeV at the 90% confidence level.

Dynamic Contrast Enhanced MRI as a Biomarker of Tumor Response and Oncologic Outcomes in Head and Neck Cancer: Results of a Single Institution Prospective Imaging Study

PURPOSE/OBJECTIVE(S)

We aim to determine the correlation between vascular parameters of Dynamic contrast enhanced (DCE) MRIs and tumor response and outcomes in head and neck (HNC) patients treated with definitive radiation therapy (RT).

MATERIALS/METHODS

Eighty-two HNC patients are included in this prospective study in one institute. All patients had malignant head and neck neoplasm indicative of curative- intent treatment. Patients were imaged using MRIs pre-, mid-, and post-RT completion at 8-12 weeks. T2-weighted sequences were used for tumor contouring then it was co-registered to respective DCE images. The response to treatment was checked at mid-radiotherapy (mid-RT) and at the end of RT. Mid-RT MRI was co-registered to baseline images and the manually segmented baseline primary tumor regions of interest were propagated to mid-RT images. Quantitative maps (Ktrans, Kep, Ve and Vp) were generated with the extended Tofts pharmacokinetic models and were used for analysis. These vascular parameters were presented as a mean value and percentile using histogram analysis and the following parameters were extracted using an in-house programming environment script: mean, 5th, 10th, 20th, 30th, 40th, 50th (i.e., median), 60th, 70th, 80th, 90th, 95th percentile. The non-parametric Wilcoxon signed-rank test was used to assess the changes of mid-RT DCE parameters compared to baseline. Recursive partitioning analysis (RPA) was used to identify the delta DCE threshold associated with relapse. We assessed the identified thresholds' correlation with oncological and survival endpoints using Cox regression with and without standard clinical variables.

RESULTS

The median age for patients is 61 years old (33-78 range). Never smokers are 39 (47%), 35 (43%) are former smoker and 8 (10%) are current smoker with a mean value of 14 pack per year and 26 standard deviations. Using AJCC 8th edition, 39 (47%) are stage I and 19 (23%) are stage II and stage III and IV are 15 (18%) and 9 (10%) respectively. HPV positive are 72 (88%). For patients with GTV-P at baseline (n = 60), 11 (18%) had mid-RT CR at the primary site which increased to 50 (83%) post-RT. The LC and RFS for the entire cohort were 91.4%, and 79.2% respectively. In GTV-P, none of the pre-radiotherapy DCE parameters were correlated with LC or RFS. Wilcoxon signed rank test was statistically significant in 80, 90 and 95 percentiles with (p<0.05). RPA analysis identified different thresholds for each DCE parameter, and its inclusions to the multivariate model improved its performance. In GTV-P, RPA analysis identified ΔKtrans 40 percentiles >15.6% at mid-RT as the most significant point. When this value of ΔKtrans added to the multivariate analysis it was associated with a significantly better model performance in RFS (p = 0.00001).

CONCLUSION

DCE parameters are a very promising tool to correlate with response and outcomes in H&N cancer patients. Future work is warranted for external validation of our findings.

Patient-Specific 3D CT Images Reconstruction from 2D KV Images Via Vision Transformer-Based Deep-Learning

PURPOSE/OBJECTIVE(S)

In some proton therapy facilities, patient alignment relies on two 2D orthogonal kV images, taken at fixed, oblique angles, as no 3D on-the-bed-imaging is available. The visibility of the tumor in kV images is limited since the patient's 3D anatomy is projected onto a 2D plane, especially when the tumor is behind a high-density structure such as bone. This can lead to a large patient setup error. A solution to this problem is to reconstruct the 3D CT image from the kV images obtained in the treatment position.

MATERIALS/METHODS

An asymmetric autoencoder-like network built with vision-transformer blocks was developed. The data was collected from a head and neck patient: 2 orthogonal kV images (1024X1024 voxels), 1 3D CT with padding (512X512X512) acquired from the in-room CT-on-rails before kVs were taken and 2 digitally-reconstructed-radiograph (DRR) images (512X512) based on the CT. We resampled kV images every 8 voxels and DRR and CT every 4 voxels, thus formed a dataset consisting of 262,144 samples, in which the images had a dimension of 128 for each direction. The value of each voxel in CT was normalized to range 0-1 with a uniform shift of 1000 and a denominator of 4000. For kV and DRR, we ranked all voxels value in an ascending order and normalized the values of the first 80% voxels to range 0-0.8 and the rest to range 0.8-1, thus yielding a quasi-Gaussian distribution, which was favorable by the deep neural networks. We further cropped kV and DRR images with a self-supervised bitmap based on the voxels' gradients. In training, both kV and DRR were utilized, and the encoder was encouraged to learn the same feature maps for kV images and its corresponding DRR images with mean-absolute-error (MAE) as the similarity loss. Then the decoder would reconstruct the 3D CT image from the feature maps of the kV images with the CT-on-rails as ground-truth (gCT) and MAE as the reconstruction loss. In testing, only independent kV images were used. The full-size synthetic CT (sCT) was achieved by concatenating the sCTs generated by the model according to their spatial information. The image quality of the sCT was evaluated using MAE and per-voxel-absolute-CT-number-difference volume histogram (CDVH). The proposed network was implemented with PyTorch deep learning library and both distributed data parallel (DDP) and automatic mixed precision (AMP) were applied to saving memory and accelerating the training speed. We used the AdamW optimizer with β1 = 0.9 and β2 = 0.999 and a cosine annealing learning rate scheduler with an initial learning of 1e-7 and 20 warm-up epochs.

RESULTS

The model achieved a MAE of <40HU and the CDVH showed that <5% of the voxels had a per-voxel-absolute-CT-number-difference larger than 185HU. The profile of a typical gCT slice and its corresponding sCT slice exhibited a high agreement, indicating the high similarity between the gCT and sCT.

CONCLUSION

A patient-specific vision-transformer-based network was developed and shown to be accurate and efficient to reconstruct 3D CT images from kV images.

Treatment outcomes of secukinumab in adult patients with moderate-to-severe plaque psoriasis in China: A real-world multicenter retrospective study

Secukinumab is effective in treating patients with moderate-to-severe plaque psoriasis. However, most studies assessing its effectiveness in routine clinical settings in China are mostly single-center studies with a limited sample size. The objective of this study was to assess secukinumab's efficacy, treatment patterns, and characteristics in patients with moderate-to-severe plaque psoriasis. This 24-week, multicenter (n = 5) retrospective study analyzed the data of Chinese adult patients with moderate-to-severe plaque psoriasis who initiated secukinumab treatment between May 2019 and March 2020. The Psoriasis Area and Severity Index (PASI), body surface area (BSA), Investigator's Global Assessment Modified 2011 (IGA mod 2011), and Dermatology Life Quality Index (DLQI) were assessed. Dermatologists documented the treatment dosage and modification reasons. Of the 244 secukinumab-naïve patients, most were men (73.4%, 179/244) and weighed 60-90 kg (72.8%, 177/243). The mean (SD) age at secukinumab initiation was 38.1 (11.6) years, and the disease duration was 13.5 (7.9) years. Most patients (97.1%, 237/244) received secukinumab 300 mg. At weeks 4, 12, 16, and 24, the proportion of patients achieving PASI 75 (≥75% reduction from baseline) was 40.0%, 92.1%, 88.4%, and 88.9%, respectively; PASI 90 was 15.0%, 73.7%, 81.4%, and 68.3%, respectively; and PASI 100 was 8.7%, 40.8%, 58.1%, and 41.3%, respectively. During the same periods, BSA and IGA mod 2011 showed similar improvement trends. An increasing proportion of patients achieved DLQI of 0-1 (21.6%, 65.7%, 75.0%, and 80.3%, respectively). Treatment modification was highest at week 12. The average interval between two administrations after week 4 was 62.95 days. Secukinumab was highly effective in improving the PASI, IGA, BSA, and DLQI in Chinese patients with moderate-to-severe plaque psoriasis throughout the first 24 weeks. The treatment pattern for Chinese patients differs from that in the clinical guidelines.

Longitudinal Monitoring of Quantitative Imaging Kinetics of Primary Tumor and Nodal Volumes Using the MR-Linac Device in Head and Neck Cancer Patients

PURPOSE/OBJECTIVE(S)

We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients.

MATERIALS/METHODS

Thirty patients with pathologically confirmed HNSCC and received curative-intent RT at the University of Texas MD Anderson Cancer Center, were included in this prospective study. Baseline and weekly MRIs (weeks 1-6) were obtained, and various ADC parameters (mean, 5th, 10th, 20th, 30th, 40th, 50th, 60th, 70th, 80th, 90th and 95th percentile) were extracted from the target regions of interest (ROIs). Pre-RT and weekly ADC parameters were correlated with response during RT, loco-regional control, and the development of relapse using the Mann-Whitney U test. The Wilcoxon signed-rank test was used to compare the weekly ADC versus baseline values. Weekly volumetric changes (Δvolume) for each ROI were correlated with ΔADC using Spearman's Rho test. Recursive partitioning analysis (RPA) was performed to identify the optimal ΔADC threshold associated with different oncologic outcomes.

RESULTS

There was an overall significant rise in all ADC parameters during different time points of RT compared to baseline values for both GTV-P & GTV-N. The increased ADC values for GTV-P were statistically significant only for primary tumors achieving CR during RT. RPA identified GTV-P ΔADC 5th percentile >13% at the 3rd week of RT as the most significant parameter associated with CR for GTV-P during RT (p <0.001). Baseline ADC parameters didn't significantly correlate with response to RT or other oncologic outcomes. There was a significant decrease in residual volume of both GTV-P & GTV-N throughout the course of RT. Additionally, a significant negative correlation between mean ΔADC and Δvolume for GTV-P at the 3rd and 4th week of RT was detected (r = -0.39, p = 0.044 & r = -0.45, p = 0.019, respectively).

CONCLUSION

Assessment of ADC kinetics at regular intervals throughout RT is potentially able to predict the response to RT and oncologic outcome. Further studies with larger cohorts and multi-institutional data are needed for validation of our results.

Real-Time Spinal Cord Motion Tracking for MR-guided Spine SBRT (A Pilot Study)

PURPOSE/OBJECTIVE(S)

The aim of this study was to assess the feasibility of real-time motion tracking of the spinal cord using 2D-cine MRI on the MR-Linac system. Spinal SBRT delivers high-precision doses to targets near the spinal cord but with the dosimetric cord tolerance sometimes defined using a spinal cord PRV and the treatment alignment visualizing a surrogate measure (spinal canal) with cone beam CT guidance. MR-guided spine SBRT enables clear visualization of the true spinal cord and real-time monitoring of the cord during treatment, which may allow for increased cord dose constraints and offer new treatment options for patients with epidural disease.

MATERIALS/METHODS

A Motion Monitoring Research Package (MMRP) that has the similar tracking functionality as the future motion management system for a 1.5 T MR-Linac system was used to track real-time target motion on 2D orthogonal T2-weighted bFFE cine MRI using a reference 3D T2 MRI scan to locate tracking object initially. The spinal cord was contoured from the T2 MRI scan as the tracking object, and the cine images were obtained in sagittal and coronal planes at the center of the contoured spinal cord with a temporal resolution of 1.2 seconds. The motion tracking data was collected for 20 min and retrospectively analyzed using standard deviation of motion was collected from two volunteers immobilized with the Klarity SBRT system on the MR-Linac couch during MRI scans of their cervical, thoracic, and lumbar spines.

RESULTS

In the thoracic spinal cord, the was 0.07mm (left-right excursion range: ±0.15mm), 0.15mm (anterior-posterior: ±0.26mm), and 0.27mm (superior-inferior: ±0.53mm). In the lumbar spinal cord, the standard deviation was 0.06mm (±0.12mm), 0.1mm (±0.14mm), and 0.1mm (±0.27mm). In the cervical spine, since the tracking accuracy in Sup/Inf direction was compromised by tilted spine orientation in the orthogonal 2D image, a single entire vertebra including the spinal cord was tracked with a standard deviation of 0.19mm (±0.31mm), 0.27mm (±0.62mm), and 0.25mm (±0.4mm).

CONCLUSION

This study demonstrated the possibility of real-time tracking of the spinal cord using 2D-cine MRI on an MR-Linac system. Future work will aim to increase sample size and evaluate the reproducibility of the tracking results over time. The excursion of the thoracic/lumbar spinal cord was found to be less than 0.5mm, while the anterior/posterior or superior-inferior excursion of the cervical spine was greater than 1.0mm during the 20-minute scan.

Assessment of Dynamic Contrast Enhanced (DCE) MRI for Detection of Radiotherapy Induced Alteration in Mandibular Vasculature

PURPOSE/OBJECTIVE(S)

We aim to determine the kinetics of DCE-MRI changes in various mandibular risk volumes based on radiation (RT) dose received.

MATERIALS/METHODS

Eighty-eight head and neck cancer (HNC) patients (Pts) who underwent definitive RT were enrolled in this prospective study after IRB approval and informed consent. Images were acquired at pre-RT (Baseline), 3 weeks after RT start date (Mid-RT), 3 mos post-RT (PostRT1), and 6 mos post-RT (PostRT2). Manually segmented mandibular volumes on T2-weighted images were propagated to co-registered DCE-MRIs. Planning CTs and dose grids were also co-registered to corresponding baseline T2 images to create 3-D dose subvolumes. These were used to create 3 risk subvolumes; <30 Gy, 30-50 Gy, and >50 Gy ROIs. DCE images of different timepoints (TPs) were deformably co-registered and the dose subvolumes were propagated to each TP. We used the extended-Tofts model to generate the vascular quantitative maps (Ktrans and Ve). Each subvolume histogram parameters were extracted at each TP. Wilcoxon Signed Rank test was used to compare the changes at different TPs compared to baseline. We classified Pts' delta parameters at different TPs -based on our prior extensive QA assessment- into Pts with stable vascular profile (±25% change), Pts with significant increase (>25% change) and Pts with significant decrease (<-25%). Chi-square test was used to assess the change at different TPs.

RESULTS

For <30 Gy subvolumes, there were no significant changes (p > 0.05) in the studied DCE parameters at all TPs except a significant decrease (p < 0.001) in median Ktrans at PostRT2. For 30-50 Gy subvolumes, there was a significant increase in median Ktrans that started at MidRT (p = 0.006) and continued at PostRT1 (p = 0.04) but recovered to baseline values at PostRT2. Median Ve on the other hand only showed significant increase at PostRT1 (p = 0.001), but other TPs were not significantly different compared to baseline. Similarly, subvolumes >50 Gy showed same kinetics as in 30-50 Gy with significant increase of Ktrans at MidRT and PostRT1 and significant increase in Ve in only PostRT1 (P <0.05). For <30 Gy, there was significant increase in the number of Pts with stable or decrease in Ktrans at PostRT2 compared to earlier TPs (70% vs. 60% at PostRT1 and 54% at MidRT p = 0.003). 30-50 Gy subvolumes showed similar profile like <30 Gy with significant increase in the percentage of Pts with recovery at PostRT2. However, for >50 Gy, there was no significant increase in the number of Pts who recovered at PostRT2 (p = 0.3). Ve showed no significant increase in the percentage of Pts with recovery at different TPs (p > 0.05).

CONCLUSION

Results showed that for all dose mandibular subvolumes, there is an acute vascular insult that tends to recover at +6 months post-RT except for a selective group of patients who continue to have persistence of the vascular insult at high dose subvolumes. These findings are of importance for future selection of high risk population for prophylactic intervention against osteoradionecrosis.

Search for Λ[over ¯]-Λ Baryon-Number-Violating Oscillations in the Decay J/ψ→pK^{-}Λ[over ¯]+c.c

We report on the first search for Λ[over ¯]-Λ oscillations in the decay J/ψ→pK^{-}Λ[over ¯]+c.c. by analyzing 1.31×10^{9}  J/ψ events accumulated with the BESIII detector at the BEPCII collider. The J/ψ events are produced using e^{+}e^{-} collisions at a center of mass energy sqrt[s]=3.097  GeV. No evidence for hyperon oscillations is observed. The upper limit for the oscillation rate of Λ[over ¯] to Λ hyperons is determined to be P(Λ)=[B(J/ψ→pK^{-}Λ+c.c.)/B(J/ψ→pK^{-}Λ[over ¯]+c.c.)]<4.4×10^{-6} corresponding to an oscillation parameter δm_{ΛΛ[over ¯]} of less than 3.8×10^{-18}  GeV at the 90% confidence level.

Measurement properties of the patient global assessment numerical rating scale in moderate-to-severe psoriasis

BACKGROUND

Patient global assessment (PtGA) has been recommended as one of the core domains in psoriasis clinical trials. Among multiple versions of PtGA, the single-question, 11-point PtGA numeric rating scale (NRS) remains to be validated in patients with plaque psoriasis.

OBJECTIVES

To evaluate the psychometric characteristics of an 11-point PtGA NRS for disease severity in patients with moderate-to-severe plaque psoriasis.

METHODS

Data were analysed from 759 patients with moderate-to-severe psoriasis in the Shanghai Psoriasis Effectiveness Evaluation CoHort (SPEECH), a prospective, multicentre and observational registry assessing the comparative effectiveness and safety of biologics (adalimumab, ustekinumab, secukinumab or ixekizumab), conventional systemic therapies (acitretin or methotrexate) and phototherapy.

RESULTS

The test-retest reliability of the PtGA NRS showed good agreement (intraclass correlation coefficient range 0.79-0.83). No floor or ceiling effects of PtGA NRS were observed. The PtGA NRS was significantly correlated with the Psoriasis Area and Severity Index (PASI), static Physician Global Assessment (sPGA), body surface area, Dermatology Quality of Life Index (DLQI) and Hospital Anxiety and Depression Scale. Relatively large correlations of PtGA NRS with PASI and the DLQI 'symptoms and feelings' domain (all correlations ≥ 0.4 except at baseline) supported convergent validity. The presence of psoriatic arthritis or joint symptoms had no significant association with the PtGA NRS. In multivariate regression analyses, the PtGA NRS at baseline was predicted by age, lesion extent, lesion intensity, patients' symptoms and feelings, and impact on work or school. The PtGA NRS displayed known-groups validity with the PASI, sPGA and DLQI score bands. The PtGA NRS was responsive to change in PASI and DLQI after treatment. Anchor- and distribution-based approaches supported -3 as the minimal important difference for PtGA NRS. An absolute PtGA NRS ≤ 2 during follow-up was concordant with the state of minimal disease activity based on a 90% reduction in PASI (PASI 90) or PASI 90 plus a DLQI of 0/1. Sensitivity analysis using subgroup comparison and multiple imputation model yielded consistent conclusions.

CONCLUSIONS

The PtGA NRS showed good reliability, validity and responsiveness in patients with psoriasis, and was feasible in clinical trials and daily practice.

Measurement of the Lifetime and Λ Separation Energy of _{Λ}^{3}H

The most precise measurements to date of the _{Λ}^{3}H lifetime τ and Λ separation energy B_{Λ} are obtained using the data sample of Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV collected by ALICE at the LHC. The _{Λ}^{3}H is reconstructed via its charged two-body mesonic decay channel (_{Λ}^{3}H→^{3}He+π^{-} and the charge-conjugate process). The measured values τ=[253±11(stat)±6(syst)]  ps and B_{Λ}=[102±63(stat)±67(syst)]  keV are compatible with predictions from effective field theories and confirm that the _{Λ}^{3}H structure is consistent with a weakly bound system.

A bibliometric analysis of Barrett's esophagus

OBJECTIVE

Esophageal adenocarcinoma is known to have a high incidence and poor prognosis in the population and is a serious threat to public health. As a precancerous lesion of esophageal adenocarcinoma, early intervention of Barrett's esophagus is key to the prevention and treatment of esophageal adenocarcinoma.

MATERIALS AND METHODS

Research publications on Barrett's esophagus (BE) were searched in the Web of Science Core Collection, and the extracted publications were screened to obtain relevant data. The included articles were analyzed bibliometrically using Microsoft Excel 2019, Citespace V, and VOSviewer 1.6.18. The keywords used for the search can be categorized into 4 clusters: endoscopic therapy, clinical screening, risk factors, and drug therapy.

RESULTS

A total of 3,497 publications from 83 countries and 3,319 research institutions were retrieved. Since 1983, there has been a rapid increase in publications in this field. The United States (n = 1,941) and Mayo Clinic (n = 218) were the most productive countries and institutions, respectively, and the most prominent author was Kenneth K. Wang, who published 89 papers.

CONCLUSIONS

In this study, we were able to perform a comprehensive and systematic analysis of literature related to BE. Endoscopic resection and radiofrequency ablation may emerge as research hotspots for BE in the future. Our findings provide insight into the current trends in the management of BE and facilitate the choice of appropriate measures to improve the prognosis of patients.

Measurement of the J/ψ Polarization with Respect to the Event Plane in Pb-Pb Collisions at the LHC

We study the polarization of inclusive J/ψ produced in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV at the LHC in the dimuon channel, via the measurement of the angular distribution of its decay products. We perform the study in the rapidity region 2.5 Collapse

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Grants Collapse

First Measurement of Antideuteron Number Fluctuations at Energies Available at the Large Hadron Collider

The first measurement of event-by-event antideuteron number fluctuations in high energy heavy-ion collisions is presented. The measurements are carried out at midrapidity (|η|<0.8) as a function of collision centrality in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV using the ALICE detector. A significant negative correlation between the produced antiprotons and antideuterons is observed in all collision centralities. The results are compared with a state-of-the-art coalescence calculation. While it describes the ratio of higher order cumulants of the antideuteron multiplicity distribution, it fails to describe quantitatively the magnitude of the correlation between antiproton and antideuteron production. On the other hand, thermal-statistical model calculations describe all the measured observables within uncertainties only for correlation volumes that are different with respect to those describing proton yields and a similar measurement of net-proton number fluctuations.