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Safi SA, Alexander A, Neuhuber W, Haeberle L, Rehders A, Luedde T, Esposito I, Fluegen G, Knoefel WT. Defining distal splenopancreatectomy by the mesopancreas. Langenbecks Arch Surg 2024; 409:127. [PMID: 38625602 PMCID: PMC11021282 DOI: 10.1007/s00423-024-03320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The implementation of the pathologic CRM (circumferential resection margin) staging system for pancreatic head ductal adenocarcinomas (hPDAC) resulted in a dramatic increase of R1 resections at the dorsal resection margin, presumably because of the high rate of mesopancreatic fat (MP) infiltration. Therefore, mesopancreatic excision (MPE) during pancreatoduodenectomy has recently been promoted and has demonstrated better local disease control, fueling the discussion of neoadjuvant downsizing regimes in MP + patients. However, it is unknown to what extent the MP is infiltrated in patients with distal pancreatic (tail/body) carcinomas (dPDAC). It is also unknown if the MP infiltration status affects surgical margin control in distal pancreatectomy (DP). The aim of our study was to histopathologically analyze MP infiltration and elucidate the influence of resection margin clearance on recurrence and survival in patients with dPDAC. Furthermore, the results were compared to a collective receiving MPE for hPDAC. METHOD Clinicopathological and survival parameters of 295 consecutive patients who underwent surgery for PDAC (n = 63 dPDAC and n = 232 hPDAC) were evaluated. The CRM evaluation was performed in a standardized fashion and the specimens were examined according to the Leeds pathology protocol (LEEPP). The MP area was histopathologically evaluated for cancerous infiltration. RESULTS In 75.4% of dPDAC patients the MP fat was infiltrated by vital tumor cells. The rates of MP infiltration and R0CRM- resections were similar between dPDAC and hPDAC patients (p = 0.497 and 0.453 respectively). MP- infiltration status did not correlate with CRM implemented resection status in dPDAC patients (p = 0.348). In overall survival analysis, resection status and MP status remained prognostic factors for survival. In follow up analysis. surgical margin clearance in dPDAC patients was associated with a significant improvement in local recurrence rates (5.2% in R0CRM- resected vs. 33.3 in R1/R0CRM + resected, p = 0.002). CONCLUSION While resection margin status was not affected by the MP status in dPDAC patients, the high MP infiltration rate, as well as improved survival in MP- dPDAC patients after R0CRM- resection, justify mesopancreatic excision during splenopancreatectomy. Larger scale studies are urgently needed to validate our results and to study the effect on neoadjuvant treatment in dPDAC patients.
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Affiliation(s)
- S-A Safi
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - A Alexander
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - W Neuhuber
- Institute of Anatomy I, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstr. 1, Erlangen, Germany
| | - L Haeberle
- Institute of Pathology, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - A Rehders
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - T Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - I Esposito
- Institute of Pathology, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - G Fluegen
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - W T Knoefel
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
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Cruz-Lim EM, Mou B, Baker S, Arbour G, Stefanyk K, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R. Prospective Longitudinal Assessment of Quality of Life After Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:148-156. [PMID: 38087705 DOI: 10.1016/j.clon.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/11/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases, conducted in six regional cancer centres in British Columbia, Canada from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and at 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and the baseline score of individual patients. The mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with 'stable', 'improved' or 'worsened' QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI functional interference score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). RESULTS All enrolled patients with baseline QoL assessment and at least one follow-up assessment were analysed (n = 133). On equivalence testing, the patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% confidence interval 1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% confidence interval 1.15 to 2.21; FACIT-AD TOI mean difference: -8.76, 90% confidence interval -11.29 to -6.24; POSI mean difference: -4.61, 90% confidence interval -6.09 to -3.14). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). Most patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. CONCLUSIONS Transient decreases in QoL that met MCID were seen between patients' worst QoL scores and baseline scores. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterise patients at greatest risk for decreased QoL.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - S Baker
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - G Arbour
- University of British Columbia, British Columbia, Canada
| | - K Stefanyk
- University of British Columbia, British Columbia, Canada
| | - W Jiang
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, British Columbia, Canada; BC Cancer - Abbotsford, Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Ho
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada.
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Cruz-Lim EM, Mou B, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R, Baker S. Predictors of Quality of Life Decline in Patients with Oligometastases treated with Stereotactic Ablative Radiotherapy: Analysis of the Population-Based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:141-147. [PMID: 38296662 DOI: 10.1016/j.clon.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/15/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
AIMS Most patients experience stable quality of life (QoL) after stereotactic ablative radiotherapy (SABR) treatment for oligometastases. However, a subset of patients experience clinically relevant declines in QoL on post-treatment follow-up. This study aimed to identify risk factors for QoL decline. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases. Prospective QoL was measured using treatment site-specific tools at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. The time to persistent QoL decline was calculated as the time from SABR to the first decline in QoL score meeting minimum clinically important difference with no improvement to baseline score on subsequent assessments. Univariable and multivariable logistic regression analyses were carried out to determine factors associated with QoL decline. RESULTS One hundred and thirty-three patients were included with a median follow-up of 32 months (interquartile range 25-43). Thirty-five patients (26%) experienced a persistent decline in QoL. The median time until persistent QoL decline was not reached. The cumulative incidence of QoL decline at 2 and 3 years were 22% (95% confidence interval 14.0-29.6) and 40% (95% confidence interval 28.0-51.2), respectively. In multivariable analysis, disease progression (odds ratio 5.23, 95% confidence interval 1.59-17.47, P = 0.007) and adrenal metastases (odds ratio 9.70, 95% confidence interval 1.41-66.93, P = 0.021) were associated with a higher risk of QoL decline. Grade 3 or higher (odds ratio 3.88, 95% confidence interval 0.92-16.31, P = 0.064) and grade 2 or higher SABR-associated toxicity (odds ratio 2.24, 95% confidence interval 0.85-5.91, P = 0.10) were associated with an increased risk of QoL decline but did not reach statistical significance. CONCLUSIONS Disease progression and adrenal lesion site were associated with persistent QoL decline following SABR. The development of grade 3 or higher toxicities was also associated with an increased risk, albeit not statistically significant. Further studies are needed, focusing on the QoL impact of metastasis-directed therapies.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - W Jiang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - C Ho
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Baker
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada.
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Agostini M, Alexander A, Araujo GR, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brudanin V, Brugnera R, Caldwell A, Cattadori C, Chernogorov A, Comellato T, D’Andrea V, Demidova EV, Marco ND, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hakenmüller J, Hemmer S, Hofmann W, Huang J, Hult M, Inzhechik LV, Csáthy JJ, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Kneißl R, Knöpfle KT, Kochetov O, Kornoukhov VN, Korošec M, Krause P, Kuzminov VV, Laubenstein M, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Misiaszek M, Morella M, Müller Y, Nemchenok I, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Ransom C, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Vasenko AA, Veresnikova A, Vignoli C, Sturm KV, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. An improved limit on the neutrinoless double-electron capture of 36Ar with GERDA. Eur Phys J C Part Fields 2024; 84:34. [PMID: 38229675 PMCID: PMC10788323 DOI: 10.1140/epjc/s10052-023-12280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/21/2023] [Indexed: 01/18/2024]
Abstract
The GERmanium Detector Array (Gerda) experiment operated enriched high-purity germanium detectors in a liquid argon cryostat, which contains 0.33% of 36 Ar, a candidate isotope for the two-neutrino double-electron capture (2ν ECEC) and therefore for the neutrinoless double-electron capture (0ν ECEC). If detected, this process would give evidence of lepton number violation and the Majorana nature of neutrinos. In the radiative 0ν ECEC of 36 Ar, a monochromatic photon is emitted with an energy of 429.88 keV, which may be detected by the Gerda germanium detectors. We searched for the 36 Ar 0ν ECEC with Gerda data, with a total live time of 4.34 year (3.08 year accumulated during Gerda Phase II and 1.26 year during Gerda Phase I). No signal was found and a 90% CL lower limit on the half-life of this process was established T 1 / 2 > 1.5 · 10 22 year. Supplementary Information The online version contains supplementary material available at 10.1140/epjc/s10052-023-12280-6.
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5
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Agostini M, Alexander A, Araujo GR, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brugnera R, Caldwell A, Calgaro S, Cattadori C, Chernogorov A, Chiu PJ, Comellato T, D'Andrea V, Demidova EV, Di Giacinto A, Di Marco N, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hackenmüller S, Hemmer S, Hofmann W, Huang J, Hult M, Inzhechik LV, Janicskó Csáthy J, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Knöpfle KT, Kochetov O, Kornoukhov VN, Krause P, Kuzminov VV, Laubenstein M, Lehnert B, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Miloradovic M, Mingazheva R, Misiaszek M, Morella M, Müller Y, Nemchenok I, Neuberger M, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Ransom C, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Sailer S, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Sullivan S, Vasenko AA, Veresnikova A, Vignoli C, von Sturm K, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. Final Results of GERDA on the Two-Neutrino Double-β Decay Half-Life of ^{76}Ge. Phys Rev Lett 2023; 131:142501. [PMID: 37862664 DOI: 10.1103/physrevlett.131.142501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/15/2023] [Indexed: 10/22/2023]
Abstract
We present the measurement of the two-neutrino double-β decay rate of ^{76}Ge performed with the GERDA Phase II experiment. With a subset of the entire GERDA exposure, 11.8 kg yr, the half-life of the process has been determined: T_{1/2}^{2ν}=(2.022±0.018_{stat}±0.038_{syst})×10^{21} yr. This is the most precise determination of the ^{76}Ge two-neutrino double-β decay half-life and one of the most precise measurements of a double-β decay process. The relevant nuclear matrix element can be extracted: M_{eff}^{2ν}=(0.101±0.001).
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Affiliation(s)
- M Agostini
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - A Alexander
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - G R Araujo
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - A M Bakalyarov
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - M Balata
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - I Barabanov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - L Baudis
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - C Bauer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - S Belogurov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Bettini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - L Bezrukov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - V Biancacci
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - E Bossio
- Physik Department, Technische Universität München, Germany
| | - V Bothe
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - R Brugnera
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A Caldwell
- Max-Planck-Institut für Physik, Munich, Germany
| | - S Calgaro
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | | | - A Chernogorov
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - P-J Chiu
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - T Comellato
- Physik Department, Technische Universität München, Germany
| | - V D'Andrea
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell'Aquila, L'Aquila, Italy
| | - E V Demidova
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Di Giacinto
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - N Di Marco
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - E Doroshkevich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - F Fischer
- Max-Planck-Institut für Physik, Munich, Germany
| | - M Fomina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A Gangapshev
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - A Garfagnini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - C Gooch
- Max-Planck-Institut für Physik, Munich, Germany
| | - P Grabmayr
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - V Gurentsov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - K Gusev
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre "Kurchatov Institute," Moscow, Russia
- Physik Department, Technische Universität München, Germany
| | | | | | - W Hofmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - J Huang
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - M Hult
- European Commission, JRC-Geel, Geel, Belgium
| | - L V Inzhechik
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | | | - J Jochum
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - M Junker
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - V Kazalov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - Y Kermaïdic
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - H Khushbakht
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - T Kihm
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K Kilgus
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - I V Kirpichnikov
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Klimenko
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K T Knöpfle
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - O Kochetov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - V N Kornoukhov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - P Krause
- Physik Department, Technische Universität München, Germany
| | - V V Kuzminov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - M Laubenstein
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - B Lehnert
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - M Lindner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | | | - B Lubsandorzhiev
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - G Lutter
- European Commission, JRC-Geel, Geel, Belgium
| | - C Macolino
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell'Aquila, L'Aquila, Italy
| | | | - W Maneschg
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | - G Marshall
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - M Miloradovic
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - R Mingazheva
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - M Misiaszek
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - M Morella
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - Y Müller
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - I Nemchenok
- Joint Institute for Nuclear Research, Dubna, Russia
| | - M Neuberger
- Physik Department, Technische Universität München, Germany
| | - L Pandola
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - K Pelczar
- European Commission, JRC-Geel, Geel, Belgium
| | - L Pertoldi
- Physik Department, Technische Universität München, Germany
- INFN Padova, Padua, Italy
| | - P Piseri
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - A Pullia
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - C Ransom
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - L Rauscher
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - S Riboldi
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - N Rumyantseva
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - C Sada
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - S Sailer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - F Salamida
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell'Aquila, L'Aquila, Italy
| | - S Schönert
- Physik Department, Technische Universität München, Germany
| | - J Schreiner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M Schütt
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A-K Schütz
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - O Schulz
- Max-Planck-Institut für Physik, Munich, Germany
| | - M Schwarz
- Physik Department, Technische Universität München, Germany
| | | | - O Selivanenko
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - E Shevchik
- Joint Institute for Nuclear Research, Dubna, Russia
| | - M Shirchenko
- Joint Institute for Nuclear Research, Dubna, Russia
| | - L Shtembari
- Max-Planck-Institut für Physik, Munich, Germany
| | - H Simgen
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A Smolnikov
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - D Stukov
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - S Sullivan
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A A Vasenko
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Veresnikova
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - C Vignoli
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - K von Sturm
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - T Wester
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - C Wiesinger
- Physik Department, Technische Universität München, Germany
| | - M Wojcik
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - E Yanovich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - B Zatschler
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - I Zhitnikov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - S V Zhukov
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - D Zinatulina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A Zschocke
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - K Zuber
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - G Zuzel
- Institute of Physics, Jagiellonian University, Cracow, Poland
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6
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Hawkins TJ, Kopischke M, Duckney PJ, Rybak K, Mentlak DA, Kroon JTM, Bui MT, Richardson AC, Casey M, Alexander A, De Jaeger G, Kalde M, Moore I, Dagdas Y, Hussey PJ, Robatzek S. NET4 and RabG3 link actin to the tonoplast and facilitate cytoskeletal remodelling during stomatal immunity. Nat Commun 2023; 14:5848. [PMID: 37730720 PMCID: PMC10511709 DOI: 10.1038/s41467-023-41337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
Members of the NETWORKED (NET) family are involved in actin-membrane interactions. Here we show that two members of the NET family, NET4A and NET4B, are essential for normal guard cell actin reorganization, which is a process critical for stomatal closure in plant immunity. NET4 proteins interact with F-actin and with members of the Rab7 GTPase RABG3 family through two distinct domains, allowing for simultaneous localization to actin filaments and the tonoplast. NET4 proteins interact with GTP-bound, active RABG3 members, suggesting their function being downstream effectors. We also show that RABG3b is critical for stomatal closure induced by microbial patterns. Taken together, we conclude that the actin cytoskeletal remodelling during stomatal closure involves a molecular link between actin filaments and the tonoplast, which is mediated by the NET4-RABG3b interaction. We propose that stomatal closure to microbial patterns involves the coordinated action of immune-triggered osmotic changes and actin cytoskeletal remodelling likely driving compact vacuolar morphologies.
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Affiliation(s)
- Timothy J Hawkins
- Department of Biosciences, University of Durham, South Road, Durham, DH1 3LE, UK
| | - Michaela Kopischke
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
- LMU Munich Biocenter, Großhadener Strasse 4, 82152, Planegg, DE, Germany
| | - Patrick J Duckney
- Department of Biosciences, University of Durham, South Road, Durham, DH1 3LE, UK
| | - Katarzyna Rybak
- LMU Munich Biocenter, Großhadener Strasse 4, 82152, Planegg, DE, Germany
| | - David A Mentlak
- Department of Biosciences, University of Durham, South Road, Durham, DH1 3LE, UK
| | - Johan T M Kroon
- Department of Biosciences, University of Durham, South Road, Durham, DH1 3LE, UK
| | - Mai Thu Bui
- Gregor Mendel Institute (GMI), Austrian Academy of Sciences, Vienna BioCenter, Vienna, AUT, Austria
| | | | - Mary Casey
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK
| | | | - Geert De Jaeger
- VIB-University Ghent, Center for Plant System Biology, Technologiepark 927, 9052, Ghent, BE, Belgium
| | - Monika Kalde
- Department of Plant Sciences, University of Oxford, South Parks Rd., Oxford, OX1 3RB, UK
| | - Ian Moore
- Department of Plant Sciences, University of Oxford, South Parks Rd., Oxford, OX1 3RB, UK
| | - Yasin Dagdas
- Gregor Mendel Institute (GMI), Austrian Academy of Sciences, Vienna BioCenter, Vienna, AUT, Austria
| | - Patrick J Hussey
- Department of Biosciences, University of Durham, South Road, Durham, DH1 3LE, UK.
| | - Silke Robatzek
- The Sainsbury Laboratory, Norwich Research Park, Norwich, NR4 7UH, UK.
- LMU Munich Biocenter, Großhadener Strasse 4, 82152, Planegg, DE, Germany.
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7
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Agostini M, Alexander A, Araujo G, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brugnera R, Caldwell A, Calgaro S, Cattadori C, Chernogorov A, Chiu PJ, Comellato T, D’Andrea V, Demidova EV, Di Giacinto A, Di Marco N, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hakenmüller J, Hemmer S, Hofmann W, Hult M, Inzhechik LV, Janicskó Csáthy J, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Knöpfle KT, Kochetov O, Kornoukhov VN, Krause P, Kuzminov VV, Laubenstein M, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Misiaszek M, Morella M, Müller Y, Nemchenok I, Neuberger M, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Sailer S, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Sullivan S, Vasenko AA, Veresnikova A, Vignoli C, von Sturm K, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. Search for tri-nucleon decays of 76Ge in GERDA. Eur Phys J C Part Fields 2023; 83:778. [PMID: 37674593 PMCID: PMC10477131 DOI: 10.1140/epjc/s10052-023-11862-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/25/2023] [Indexed: 09/08/2023]
Abstract
We search for tri-nucleon decays of 76 Ge in the dataset from the GERmanium Detector Array (GERDA) experiment. Decays that populate excited levels of the daughter nucleus above the threshold for particle emission lead to disintegration and are not considered. The ppp-, ppn-, and pnn-decays lead to 73 Cu, 73 Zn, and 73 Ga nuclei, respectively. These nuclei are unstable and eventually proceed by the beta decay of 73 Ga to 73 Ge (stable). We search for the 73 Ga decay exploiting the fact that it dominantly populates the 66.7 keV 73 m Ga state with half-life of 0.5 s. The nnn-decays of 76 Ge that proceed via 73 m Ge are also included in our analysis. We find no signal candidate and place a limit on the sum of the decay widths of the inclusive tri-nucleon decays that corresponds to a lower lifetime limit of 1.2× 1026 yr (90% credible interval). This result improves previous limits for tri-nucleon decays by one to three orders of magnitude.
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Affiliation(s)
- M. Agostini
- Department of Physics and Astronomy, University College London, London, UK
| | - A. Alexander
- Department of Physics and Astronomy, University College London, London, UK
| | - G. Araujo
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | | | - M. Balata
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - I. Barabanov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - L. Baudis
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - C. Bauer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - S. Belogurov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- NRNU MEPhI, Moscow, Russia
| | - A. Bettini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - L. Bezrukov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - V. Biancacci
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - E. Bossio
- Physik Department, Technische Universität München, Munich, Germany
| | - V. Bothe
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - R. Brugnera
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A. Caldwell
- Max-Planck-Institut für Physik, Munich, Germany
| | - S. Calgaro
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | | | - A. Chernogorov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - P.-J. Chiu
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - T. Comellato
- Physik Department, Technische Universität München, Munich, Germany
| | - V. D’Andrea
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - E. V. Demidova
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Di Giacinto
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - N. Di Marco
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - E. Doroshkevich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - F. Fischer
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Fomina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A. Gangapshev
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - A. Garfagnini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - C. Gooch
- Max-Planck-Institut für Physik, Munich, Germany
| | - P. Grabmayr
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - V. Gurentsov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - K. Gusev
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Hakenmüller
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Present Address: Duke University, Durham, NC USA
| | | | - W. Hofmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Hult
- European Commission, JRC-Geel, Geel, Belgium
| | - L. V. Inzhechik
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Moscow Institute of Physics and Technology, Moscow, Russia
| | - J. Janicskó Csáthy
- Physik Department, Technische Universität München, Munich, Germany
- Present Address: Leibniz-Institut für Kristallzüchtung, Berlin, Germany
| | - J. Jochum
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - M. Junker
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - V. Kazalov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - Y. Kermaïdic
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - H. Khushbakht
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - T. Kihm
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K. Kilgus
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - I. V. Kirpichnikov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Klimenko
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Dubna State University, Dubna, Russia
| | - K. T. Knöpfle
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - O. Kochetov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - V. N. Kornoukhov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- NRNU MEPhI, Moscow, Russia
| | - P. Krause
- Physik Department, Technische Universität München, Munich, Germany
| | - V. V. Kuzminov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - M. Laubenstein
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - M. Lindner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | | | - B. Lubsandorzhiev
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - G. Lutter
- European Commission, JRC-Geel, Geel, Belgium
| | - C. Macolino
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | | | - W. Maneschg
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | - G. Marshall
- Department of Physics and Astronomy, University College London, London, UK
| | - M. Misiaszek
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - M. Morella
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - Y. Müller
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - I. Nemchenok
- Joint Institute for Nuclear Research, Dubna, Russia
- Dubna State University, Dubna, Russia
| | - M. Neuberger
- Physik Department, Technische Universität München, Munich, Germany
| | - L. Pandola
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - K. Pelczar
- European Commission, JRC-Geel, Geel, Belgium
| | - L. Pertoldi
- Physik Department, Technische Universität München, Munich, Germany
- INFN Padova, Padua, Italy
| | - P. Piseri
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - A. Pullia
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - L. Rauscher
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - S. Riboldi
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - N. Rumyantseva
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - C. Sada
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - S. Sailer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - F. Salamida
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - S. Schönert
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Schreiner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Schütt
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A.-K. Schütz
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - O. Schulz
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Schwarz
- Physik Department, Technische Universität München, Munich, Germany
| | | | - O. Selivanenko
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - E. Shevchik
- Joint Institute for Nuclear Research, Dubna, Russia
| | | | | | - H. Simgen
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. Smolnikov
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - D. Stukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - S. Sullivan
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. A. Vasenko
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Veresnikova
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - C. Vignoli
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - K. von Sturm
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - T. Wester
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | | | - M. Wojcik
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - E. Yanovich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - B. Zatschler
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - I. Zhitnikov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - S. V. Zhukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | | | - A. Zschocke
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - K. Zuber
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - G. Zuzel
- Institute of Physics, Jagiellonian University, Cracow, Poland
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8
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Jayasooriya S, Stolbrink M, Khoo EM, Sunte IT, Awuru JI, Cohen M, Lam DC, Spanevello A, Visca D, Centis R, Migliori GB, Ayuk AC, Buendia JA, Awokola BI, Del-Rio-Navarro BE, Muteti-Fana S, Lao-Araya M, Chiarella P, Badellino H, Somwe SW, Anand MP, Garcí-Corzo JR, Bekele A, Soto-Martinez ME, Ngahane BHM, Florin M, Voyi K, Tabbah K, Bakki B, Alexander A, Garba BL, Salvador EM, Fischer GB, Falade AG, ŽivkoviĆ Z, Romero-Tapia SJ, Erhabor GE, Zar H, Gemicioglu B, Brandão HV, Kurhasani X, El-Sharif N, Singh V, Ranasinghe JC, Kudagammana ST, Masjedi MR, Velásquez JN, Jain A, Cherrez-Ojeda I, Valdeavellano LFM, Gómez RM, Mesonjesi E, Morfin-Maciel BM, Ndikum AE, Mukiibi GB, Reddy BK, Yusuf O, Taright-Mahi S, Mérida-Palacio JV, Kabra SK, Nkhama E, Filho NR, Zhjegi VB, Mortimer K, Rylance S, Masekela RR. Clinical standards for the diagnosis and management of asthma in low- and middle-income countries. Int J Tuberc Lung Dis 2023; 27:658-667. [PMID: 37608484 PMCID: PMC10443788 DOI: 10.5588/ijtld.23.0203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs).METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards.RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94-98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3-5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0-3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6-11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12-18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS.The following standards (14-18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual's lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available.CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.
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Affiliation(s)
- S Jayasooriya
- Academic Unit of Primary Care, University of Sheffield, Sheffield
| | - M Stolbrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E M Khoo
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - I T Sunte
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - J I Awuru
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - M Cohen
- Hospital Centro Médico, Guatemala City, Guatemala, Mexico, Asociación Latinoamericana de Tórax, Montevideo, Uruguay
| | - D C Lam
- Department of Medicine, University of Hong Kong, Hong Kong, Asian Pacific Society of Respirology, Hong Kong, China
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como
| | - D Visca
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Department of Medicine, University of Hong Kong, Hong Kong
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - A C Ayuk
- College of Medicine, University of Nigeria, Enugu, Nigeria
| | - J A Buendia
- Affiliation Departamento de Farmacologia y Tóxicologia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - B I Awokola
- Medical Research Council, The Gambia at the London School of Tropical Medicine, The Gambia
| | | | - S Muteti-Fana
- Department of Primary Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - M Lao-Araya
- Division of Allergy and Clinical Immunology, Chian Mai University, Chiang Mai, Thailand
| | - P Chiarella
- Health Sciences School, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - H Badellino
- Head Pediatric Respiratory Medicine Department, Clinica Regional del Este, San Francisco, Argentina
| | - S W Somwe
- Paediatrics and Child Health, University of Lusaka, Lusaka, Zambia
| | - M P Anand
- Department of Respiratory Medicine, JSS Medical College, Mysore, India
| | - J R Garcí-Corzo
- Department of Pediatrics, Universidad Industrial de Santander, Santander, Colombia
| | - A Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - M E Soto-Martinez
- Department of Pediatrics, Universidad de Costa Rica, San Jose, Costa Rica
| | - B H M Ngahane
- Douala General Hospital, University of Douala, Douala, Cameroon
| | - M Florin
- Institute of Pneumology M. Nasta, Bucharest, Romania
| | - K Voyi
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - K Tabbah
- College of Medicine, Ajman University, Ajman, United Arab Emirates
| | - B Bakki
- University of Maiduguri Teaching Hospital, Maiduguri
| | - A Alexander
- Deparment of Medicine, University of Abuja, Abuja
| | - B L Garba
- Department of Paediatrics, Usmanu Danfodiyo, University Teaching Hospital, Sokoto, Nigeria
| | - E M Salvador
- Deparment of Biological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - G B Fischer
- University of Medical Sciences, Porto Alegre, RS, Brazil
| | - A G Falade
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Zorica ŽivkoviĆ
- Dragiša Mišovic, Childrens Hsopital for Lung Disease and TB, Belgrade, Serbia
| | - S J Romero-Tapia
- Health Sciences, Academic Division, Juarez Autononous, University of Tabasco, Villahermosa, Mexico
| | - G E Erhabor
- Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - H Zar
- Department of Paediatrics & Child Health & SA MRC Unit on Children & Adolescent Health, Red Cross Childrens Hospital, University of Cape Town, Cape Town, South Africa
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University, Cerrahpasa, Turkey
| | - H V Brandão
- State University of Feira de Santana, Feira de Santana, BA, Brazil
| | - X Kurhasani
- UBT Higher Education Institution, Prishtina, Kosovo
| | | | - V Singh
- MJ Rajasthan Hospital, Jaipur, India
| | | | - S T Kudagammana
- Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - M R Masjedi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J N Velásquez
- Medical School, Santander Industrial, Bucaramanga, Colombia
| | - A Jain
- Department of Community Medicine, Kasturba Medical College, Mangalore
| | | | - L F M Valdeavellano
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Francisco Morroguín University, Guatemala City, Guatemala
| | - R M Gómez
- Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina
| | - E Mesonjesi
- Department of Allergy and Clinical Immunology, University Hospital Centre "Mother Teresa", Tirana, Albania
| | | | - A E Ndikum
- The University of Yaounde 1, Yaounde, Cameroon
| | | | - B K Reddy
- Shishuka Children's Speciality Hospital, Bangalore, India
| | - O Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - S Taright-Mahi
- Medecin Faculty, Mustapha Universitary Hospital Algiers, Algeria
| | - J V Mérida-Palacio
- Centrode Investigación de Enfermedades Alérgicas y Respiratorias SC, Mexico DF, Mexico
| | - S K Kabra
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - E Nkhama
- Levy Mwanawasa Medical University, School of Public Health and Environmental Sciences, Lusaka, Zambia
| | - N R Filho
- Federal University of Parana, Curitiba, PA, Brazil
| | - V B Zhjegi
- Social Medicine, Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - K Mortimer
- University of Cambridge, Cambridge, Imperial College, London, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - S Rylance
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - R R Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
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9
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Agostini M, Alexander A, Araujo GR, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brugnera R, Caldwell A, Calgaro S, Cattadori C, Chernogorov A, Chiu PJ, Comellato T, D’Andrea V, Demidova EV, Di Giacinto A, Di Marco N, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hakenmüller J, Hemmer S, Hofmann W, Hult M, Inzhechik LV, Csáthy JJ, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Knöpfle KT, Kochetov O, Kornoukhov VN, Krause P, Kuzminov VV, Laubenstein M, Lehnert B, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Miloradovic M, Mingazheva R, Misiaszek M, Morella M, Müller Y, Nemchenok I, Neuberger M, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Sailer S, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Sullivan S, Vasenko AA, Veresnikova A, Vignoli C, von Sturm K, Wegmann A, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. Liquid argon light collection and veto modeling in GERDA Phase II. Eur Phys J C Part Fields 2023; 83:319. [PMID: 37122826 PMCID: PMC10126063 DOI: 10.1140/epjc/s10052-023-11354-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/24/2023] [Indexed: 05/03/2023]
Abstract
The ability to detect liquid argon scintillation light from within a densely packed high-purity germanium detector array allowed the Gerda experiment to reach an exceptionally low background rate in the search for neutrinoless double beta decay of76 Ge. Proper modeling of the light propagation throughout the experimental setup, from any origin in the liquid argon volume to its eventual detection by the novel light read-out system, provides insight into the rejection capability and is a necessary ingredient to obtain robust background predictions. In this paper, we present a model of the Gerda liquid argon veto, as obtained by Monte Carlo simulations and constrained by calibration data, and highlight its application for background decomposition.
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Affiliation(s)
- M. Agostini
- Department of Physics and Astronomy, University College London, London, UK
| | - A. Alexander
- Department of Physics and Astronomy, University College London, London, UK
| | - G. R. Araujo
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | | | - M. Balata
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - I. Barabanov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - L. Baudis
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - C. Bauer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - S. Belogurov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- Moscow Inst. of Physics and Technology, Dolgoprudny, Russia
| | - A. Bettini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - L. Bezrukov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - V. Biancacci
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - E. Bossio
- Physik Department, Technische Universität München, Munich, Germany
| | - V. Bothe
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - R. Brugnera
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A. Caldwell
- Max-Planck-Institut für Physik, Munich, Germany
| | - S. Calgaro
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | | | - A. Chernogorov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - P. -J. Chiu
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - T. Comellato
- Physik Department, Technische Universität München, Munich, Germany
| | - V. D’Andrea
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - E. V. Demidova
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Di Giacinto
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - N. Di Marco
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - E. Doroshkevich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - F. Fischer
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Fomina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A. Gangapshev
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - A. Garfagnini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - C. Gooch
- Max-Planck-Institut für Physik, Munich, Germany
| | - P. Grabmayr
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - V. Gurentsov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - K. Gusev
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Hakenmüller
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Present Address: Duke University, Durham, NC USA
| | | | - W. Hofmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Hult
- European Commission, JRC-Geel, Geel, Belgium
| | - L. V. Inzhechik
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Dubna State University, Dubna, Russia
| | - J. Janicskó Csáthy
- Physik Department, Technische Universität München, Munich, Germany
- Present Address: Leibniz-Institut für Kristallzüchtung, Berlin, Germany
| | - J. Jochum
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - M. Junker
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - V. Kazalov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - Y. Kermaïdic
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Present Address: Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France
| | - H. Khushbakht
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - T. Kihm
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K. Kilgus
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - I. V. Kirpichnikov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Klimenko
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Dubna State University, Dubna, Russia
| | - K. T. Knöpfle
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- NRNU MEPhI, Moscow, Russia
| | - O. Kochetov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - V. N. Kornoukhov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - P. Krause
- Physik Department, Technische Universität München, Munich, Germany
| | - V. V. Kuzminov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - M. Laubenstein
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - B. Lehnert
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
- Present Address: Nuclear Science Division, Berkeley, USA
| | - M. Lindner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | | | - B. Lubsandorzhiev
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - G. Lutter
- European Commission, JRC-Geel, Geel, Belgium
| | - C. Macolino
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | | | - W. Maneschg
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | - G. Marshall
- Department of Physics and Astronomy, University College London, London, UK
| | - M. Miloradovic
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - R. Mingazheva
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - M. Misiaszek
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - M. Morella
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - Y. Müller
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - I. Nemchenok
- Joint Institute for Nuclear Research, Dubna, Russia
- Present Address: Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France
| | - M. Neuberger
- Physik Department, Technische Universität München, Munich, Germany
| | - L. Pandola
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - K. Pelczar
- European Commission, JRC-Geel, Geel, Belgium
| | - L. Pertoldi
- Physik Department, Technische Universität München, Munich, Germany
- INFN Padova, Padua, Italy
| | - P. Piseri
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - A. Pullia
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - L. Rauscher
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - S. Riboldi
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - N. Rumyantseva
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - C. Sada
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - S. Sailer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - F. Salamida
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - S. Schönert
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Schreiner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Schütt
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. -K. Schütz
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - O. Schulz
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Schwarz
- Physik Department, Technische Universität München, Munich, Germany
| | | | - O. Selivanenko
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - E. Shevchik
- Joint Institute for Nuclear Research, Dubna, Russia
| | | | | | - H. Simgen
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. Smolnikov
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - D. Stukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - S. Sullivan
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. A. Vasenko
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Veresnikova
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - C. Vignoli
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - K. von Sturm
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A. Wegmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - T. Wester
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - C. Wiesinger
- Physik Department, Technische Universität München, Munich, Germany
| | - M. Wojcik
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - E. Yanovich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - B. Zatschler
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - I. Zhitnikov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - S. V. Zhukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | | | - A. Zschocke
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - K. Zuber
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - G. Zuzel
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - Gerda collaboration
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
- INFN Laboratori Nazionali del Sud, Catania, Italy
- Institute of Physics, Jagiellonian University, Cracow, Poland
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
- Joint Institute for Nuclear Research, Dubna, Russia
- European Commission, JRC-Geel, Geel, Belgium
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Department of Physics and Astronomy, University College London, London, UK
- INFN Milano Bicocca, Milan, Italy
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
- Max-Planck-Institut für Physik, Munich, Germany
- Physik Department, Technische Universität München, Munich, Germany
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
- Physik-Institut, Universität Zürich, Zurich, Switzerland
- Present Address: Duke University, Durham, NC USA
- Present Address: Leibniz-Institut für Kristallzüchtung, Berlin, Germany
- Present Address: Nuclear Science Division, Berkeley, USA
- Present Address: Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France
- NRNU MEPhI, Moscow, Russia
- Moscow Inst. of Physics and Technology, Dolgoprudny, Russia
- Dubna State University, Dubna, Russia
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Meshram S, Gupta S, Alexander A, Agrawal S, Lanjewar N, Meshram K, Patel A, More A, Yadav R, Muley S, Shamkuwar C, Singh A. Sleep quality in COVID-19 patients and its association with severity of COVID. Sleep Med 2022. [PMCID: PMC9300259 DOI: 10.1016/j.sleep.2022.05.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bondarenko AS, Aviles J, Alexander A, Korepanov A, Mendoza R. Tomographic and centroid reconstructions of plasma emission on C-2W via enhanced 300-channel bolometry system. Rev Sci Instrum 2022; 93:103517. [PMID: 36319330 DOI: 10.1063/5.0101656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
The C-2W experimental device at TAE Technologies utilizes neutral beam injection and edge biasing to sustain long-lived, stable field reversed configuration (FRC) plasma. An ongoing effort is under way to optimize the electrode biasing system, which provides boundary control to stabilize the FRC. To this end, tomography offers a powerful and non-invasive technique as tomographic reconstruction of the FRC emission profile provides an important assessment of global stability. Recently, a new signal acquisition system was implemented on a bolometer array dedicated to tomography on C-2W, significantly enhancing the signal-to-noise of the collected data. The array consists of 300 simultaneously digitized photodiode channels that respond to a broad range of wavelengths, from soft x-ray to near-infrared, as well as energetic particles, yielding 180 unique lines of sight that intersect a toroidal plane of the FRC near the mid-plane. Utilizing the collected photo-signals from a set of plasma discharges in which the electrode biasing was intentionally terminated mid-shot, time-resolved reconstruction of the plasma emissivity is achieved via pixel-based 1D and 2D tomographic algorithms, revealing sharply annular profiles with a clear magnetohydrodynamic (MHD) mode structure. In addition, reconstruction of the plasma center-of-emission trajectories via a centroid algorithm applied to the same set of discharges demonstrates a cyclical plasma wobble. Crucially, both the tomography reconstruction and centroid reconstruction indicate an n = 1 toroidal mode that reverses from the electron diamagnetic direction to the ion diamagnetic direction and grows in amplitude after bias termination, qualitatively consistent with the expected stabilizing effect of electrodes.
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Affiliation(s)
- A S Bondarenko
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - J Aviles
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - A Alexander
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - A Korepanov
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - R Mendoza
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
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Wahood W, Hallak H, Mushannen T, Alexander A, Brinjikji W. Abstract No. 565 Trends in utilization of endotracheal anesthesia for mechanical thrombectomy in acute ischemic stroke in the United States. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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13
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Kundapur V, Mayer M, Auer RN, Alexander A, Weibe S, Pushie MJ, Cranmer-Sargison G. Is Mini Beam Ready for Human Trials? Results of Randomized Study of Treating De-Novo Brain Tumors in Canines Using Linear Accelerator Generated Mini Beams. Radiat Res 2022; 198:162-171. [PMID: 35536992 DOI: 10.1667/rade-21-00093.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
The main challenge in treating malignant brain neoplasms lies in eradicating the tumor while minimizing treatment-related damage. Conventional radiation treatments are associated with considerable side effects. Synchrotron generated micro-beam radiation (SMBRT) has shown to preserve brain architecture while killing tumor cells, however physical characteristics and limited facility access restrict its use. We have created a new clinical device which produces mini beams on a linear accelerator, to provide a new type of treatment called mini-beam radiation therapy (MBRT). The objective of this study is to compare the treatment outcomes of linear accelerator based MBRT versus standard radiation treatment (SRT), to evaluate the tumor response and the treatment-related changes in the normal brain with respect to each treatment type. Pet dogs with de-novo brain tumors were accrued for treatment. Dogs were randomized between standard fractionated stereotactic (9 Gy in 3 fractions) radiation treatment vs. a single fraction of MBRT (26 Gy mean dose). Dogs were monitored after treatment for clinical assessment and imaging. When the dogs were euthanized, a veterinary pathologist assessed the radiation changes and tumor response. We accrued 16 dogs, 8 dogs in each treatment arm. In the MBRT arm, 71% dogs achieved complete pathological remission. The radiation-related changes were all confined to the target region. Structural damage was not observed in the beam path outside of the target region. In contrast, none of the dogs in control group achieved remission and the treatment related damage was more extensive. Therapeutic superiority was observed with MBRT, including both tumor control and the normal structural preservation. The MBRT findings are suggestive of an immune related mechanism which is absent in standard treatment. These findings together with the widespread availability of clinical linear accelerators make MBRT a promising research topic to explore further treatment and clinical trial opportunities.
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Affiliation(s)
- V Kundapur
- Radiation Oncology, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - M Mayer
- Veterinary Radiation Oncology, Department of Small Animal clinical Sciences, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - R N Auer
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - A Alexander
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - S Weibe
- Department of Clinical Imaging, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - M J Pushie
- Department of Surgery, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - G Cranmer-Sargison
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
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Sayed L, Valand P, Brewin M, Matthews A, Robson M, Nayaran N, Alexander A, Davies L, Scott E, Steele J, McMullen E. Determining the appropriate use of Technology Enabled Care Services (TECS) to manage upper limb trauma injuries during the COVID-19 pandemic: A multicentre retrospective observational study. J Plast Reconstr Aesthet Surg 2022; 75:2127-2134. [PMID: 35367161 PMCID: PMC8855640 DOI: 10.1016/j.bjps.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/14/2022] [Indexed: 10/25/2022]
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Verma VS, Badwaik HR, Vaishnav Y, Alexander A, A A. Synthesis, Characterization, Molecular Modelling and Biological Evaluation of Substituted Benzo (h) Chromene-3-Carboxylate Derivatives as a Potential Agent for the Treatment of Hyperlipidemia. Indian J Pharm Sci 2022. [DOI: 10.36468/pharmaceutical-sciences.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Prabhu JS, Patil S, Rajarajan S, Ce A, Nair M, Alexander A, Ramesh R, Bs S, Sridhar T. Triple-negative breast cancers with expression of glucocorticoid receptor in immune cells show better prognosis. Ann Oncol 2021; 32. [PMID: 34220400 DOI: 10.1016/j.annonc.2021.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Glucocorticoid receptor (GR) is shown to have variable frequency of expression in invasive tumors of the breast. Investigation of additional nuclear receptors like GR in receptor negative tumors like triple negative breast cancer (TNBC) may have prognostic and therapeutic significance. Methods Expression of GR was evaluated by immunohistochemistry in 175 tumors of invasive breast cancer with long term follow up. GR Expression was separately evaluated in invasive tumor cells, stromal cells and tumor infiltrating lymphocytes (TIL's). Staining pattern was categorised as positive when more than 1% of the cells stained in each subpopulation of cells. Disease free survival was analysed between GR positive and negative status by Kaplan Meier analysis. Results Of the 175 tumors, 121 (70%) were ER positive, 53 (30%) were ER negative and 29% (51) were triple negative. 74% (130/175) tumors showed expression of GR in invasive tumor cells while (84%) 147/175 had expression in TIL's. No significant difference in distribution of GR was noted between ER positive and ER negative tumors (78% vs 66%, p-0.1). Of the TNBC's 54% (28/51) and 70% (36/51) showed expression of GR in invasive tumor and TIL's respectively. Overall, GR positive tumors had significant better survival than GR negative tumors (mean survival time of 85 vs 59 months respectively, p-0.04) Contrary to the reports that GR expression in TIL's are associated with immunosuppressive activity in model systems, TNBC's with increased expression of GR in immune cells were associated with better survival (Mean survival time 74 vs 41 months, log rank test- p-0.03). TNBC tumors which were GR negative had higher lymph node metastases (p-0.04) and none of the other clinical features like age, menopausal state, tumor size and grade were different between GR positive and negative tumors within TNBC. Conclusions Glucocorticoids (GC) are often used to alleviate the adverse symptoms during chemotherapy. Determining the GR status is of importance due to the pro cell survival effect of the glucocorticoids mediated through GR during chemotherapy. Though GC mediated effects on chemotherapy are controversial, our results indicate favourable effects in TNBC.
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Affiliation(s)
- J S Prabhu
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - S Patil
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - S Rajarajan
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - A Ce
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - M Nair
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - A Alexander
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - R Ramesh
- Department of Surgical Oncology, St Johns Medical College Hospital, Bangalore, India
| | - S Bs
- Department of Surgical Oncology, Shankara Cancer Hospital & Research Centre, Bangalore, India
| | - T Sridhar
- Molecular Medicine, St Johns Research Institute, Bangalore, India
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Lokesh PK, Chowdhary S, Pol SA, Rajeswari M, Saxena SK, Alexander A. Quantification of biomaterial dispersion during otologic procedures and role of barrier drapes in Covid 2019 era - a laboratory model. J Laryngol Otol 2020; 134:1-6. [PMID: 33143756 PMCID: PMC7684199 DOI: 10.1017/s002221512000239x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Aerosol generation during temporal bone surgery caries the risk of viral transmission. Steps to mitigate this problem are of particular importance during the coronavirus disease 2019 pandemic. OBJECTIVE To quantify the effect of barrier draping on particulate material dispersion during temporal bone surgery. METHODS The study involved a cadaveric model in a simulated operating theatre environment. Particle density and particle count for particles sized 1-10 μ were measured in a simulated operating theatre environment while drilling on a cadaveric temporal bone. The effect of barrier draping to decrease dispersion was recorded and analysed. RESULTS Barrier draping decreased counts of particles smaller than 5 μ by a factor of 80 in the operating theatre environment. Both particle density and particle count showed a statistically significant reduction with barrier draping (p = 0.027). CONCLUSION Simple barrier drapes were effective in decreasing particle density and particle count in the operating theatre model and can prevent infection in operating theatre personnel.
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Affiliation(s)
- P K Lokesh
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S Chowdhary
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S A Pol
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - M Rajeswari
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S K Saxena
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - A Alexander
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
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Alexander A, Serena G, González J, DeFaria W, Ciancio G. Renal transplantation using vascular conduit reconstruction in deceased kidneys with multiple renal arteries and short renal veins. Actas Urol Esp 2020; 44:623-629. [PMID: 32534829 DOI: 10.1016/j.acuro.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transplantation of kidneys with vascular anatomical variants remains a challenge. Due to its varying success in regard to graft function after transplantation, these organs have been frequently discarded assuming in advance an unaffordable rate of vascular complications. PATIENTS AND METHODS We performed three kidney transplants using organs from deceased donors harboring vascular variants (multiple arteries and short veins), including an unsplittable horseshoe kidney. Different grafts harvested from the same donor aorta, common iliac artery, and inferior vena cava, were used to reconstruct the initial vascular configuration by creating single arterial and venous conduits aimed to simplify the vascular anastomoses in the recipient. RESULTS No post-operative complications were recorded. Warm ischemia times remained comparable to single artery renal allografts. No delayed graft function was noted in any case, and every patient regained normal renal function after transplantation. CONCLUSIONS Vascular reconstruction using arterial and venous grafts harvested from the same deceased donor may result a helpful tool to simplify vascular anastomoses during transplantation surgery, thus avoiding their discard in advance, minimizing perioperative complications, and enabling normal graft function rates in the long-term follow-up. The successful outcome obtained by using this approach would help to expand the donor criteria for the inclusion of organs containing vascular anatomical variants.
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Kundapur V, Mayer M, Auer R, Pushie J, Alexander A, Sheldon W. Is Microbeam Radiation Treatment Ready For Prime Time? Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Shippy S, Allgood H, Messenger K, Gatson B, Alexander A, Wellehan J, Johnson A. Pharmacodynamics and pharmacokinetics of intramuscular alfaxalone in central bearded dragons (Pogona vitticeps): effect of injection site. Vet Anaesth Analg 2020. [DOI: 10.1016/j.vaa.2020.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tan H, Hannon C, Gopalan A, Alexander A, Patel J, Bergeon D, Andreoli L, Jarski R, McKeown T, Gunaga S. 204 Screening for Balance and Vision Symptoms in Triage to Enhance Identification of Strokes in the Emergency Department. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Ge L, Alexander A, Rydelek S, Carrion R, Barrera E, Perito P, Hakky T. 029 Biomechanical Effects of Rear Tip Extenders on Inflatable Penile Implants: A Cadaveric Study. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Alexander A, Marx AN, Reddy SM, Reuben JM, Le-Petross HC, Lane D, Huang ML, Krishnamurthy S, Gong Y, Gombos DS, Patel N, Tung CI, Allen RC, Kandl TJ, Wu J, Liu S, Patel AB, Futreal A, Wistuba I, Layman RM, Valero V, Tripathy D, Ueno NT, Lim B. Abstract OT3-05-04: Phase II study of atezolizumab, cobimetinib, and eribulin in patients with recurrent or metastatic inflammatory breast cancer (IBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-05-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: IBCs that do not completely respond to chemotherapy often have dysregulated immune pathways, and novel therapies are needed to improve outcomes in recurrent/metastatic disease. One-third of IBCs express the atezolizumab target PD-L1, and cobimetinib increases PD-L1 expression; thus, we hypothesize that atezolizumab and cobimetinib may act synergistically in IBC. The FDA-approved agent eribulin is active in IBC and has anti-stem cell activity and can reverse the IBC phenotype of epithelial-to-mesenchymal transition. Hence the use of eribulin as a chemotherapy backbone in combination with other novel agents is well justified.
Trial Design: This single-arm, open-label trial is enrolling patients with recurrent IBC or de novo metastatic IBC that has progressed on at least 1 line of standard chemotherapy. During a 4-week pharmacodynamic window, patients have an upfront biopsy, receive atezolizumab and cobimetinib treatment for 4 weeks, and have a second biopsy. Triple-combination treatment then commences, with standard eribulin dosing. After 4 cycles of eribulin, patients receive maintenance targeted therapy until disease progression or intolerable toxicity.
Eligibility Criteria: Patients with metastatic IBC of any molecular subtype must have measurable disease (per RECIST 1.1) amenable to biopsy. Patients with HER2+ disease must have received both pertuzumab and T-DM1. Patients with treated stable brain metastases are allowed. Patients must have recovered from the acute effects of any prior therapies and have adequate hematologic, organ, and cardiac function. Patients with autoimmune diseases or a history of pneumonitis are ineligible.
Specific Aims: The primary objective is to determine the overall response rate (ORR) of the combination therapy. Secondary objectives include determining the safety and tolerability, clinical benefit rate, response duration, progression-free survival, 2-year overall survival rate and predictive biomarker analyses.
Statistical Methods: The trial will enroll up to 9 patients in its phase I/safety lead-in portion and up to 33 patients total. A Bayesian optimal interval design is used to efficiently determine the maximum tolerated cobimetinib dose in phase I. Patients start cobimetinib at the FDA-approved dose of 60 mg/day with a target toxicity rate is 0.3. Phase II will enroll 24 patients to determine the efficacy of the triple-combination therapy. The historical ORR in metastatic IBC is 10%; our sample size provides 80% power to detect an ORR improvement to 25%.
Accrual: The trial has enrolled 7 patients since its start in August 2017.
Citation Format: Alexander A, Marx AN, Reddy SM, Reuben JM, Le-Petross HC, Lane D, Huang ML, Krishnamurthy S, Gong Y, Gombos DS, Patel N, Tung CI, Allen RC, Kandl TJ, Wu J, Liu S, Patel AB, Futreal A, Wistuba I, Layman RM, Valero V, Tripathy D, Ueno NT, Lim B. Phase II study of atezolizumab, cobimetinib, and eribulin in patients with recurrent or metastatic inflammatory breast cancer (IBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-05-04.
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Affiliation(s)
- A Alexander
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AN Marx
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - SM Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - JM Reuben
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - HC Le-Petross
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Lane
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - ML Huang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Y Gong
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - DS Gombos
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - N Patel
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - CI Tung
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - RC Allen
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - TJ Kandl
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Wu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Liu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AB Patel
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - A Futreal
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - I Wistuba
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - RM Layman
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - V Valero
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Tripathy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - NT Ueno
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - B Lim
- University of Texas MD Anderson Cancer Center, Houston, TX
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Mahmood J, Alexander A, Samanta S, Soman S, Shukla H, Davila E, Carrier F, Jackson I, Vujaskovic Z. Radiation Therapy in Combination with Hyperthermia and Immunotherapy Inhibit Pancreatic Tumor Growth and Modulate Tumor Microenvironment in Mice. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rajarajan S, Prabhu J, Korlimarla A, Nair M, Alexander A, Kaluve R, Ps H, Raja U, Ramesh R, Patil S, Bs S, Ts S. MicroRNA based immune response signature identifies poor prognostic subgroup within ER negative breast cancers. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy428.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Alexander A, Willey J, Sun H, Parker CA, Marx AN, Wood AL, Reddy SM, Reuben JM, Bassett RL, Le-Petross HT, Krishnamurthy S, Gong Y, Woodward WA, Valero V, Ueno NT, Lim B. Abstract OT1-02-05: A single arm phase II study of adjuvant anti-PD1 (pembrolizumab) in combination with hormonal therapy in patients with hormone receptor (HR)-positive localized inflammatory breast cancer (IBC) who did not achieve a pathological complete response (pCR) to neoadjuvant chemotherapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-02-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The pCR rate to conventional chemotherapy in hormone receptor positive IBC has historically been low (7.4% for HR+ HER2-, and 30% for HR+ HER2+), and despite the use of adjuvant endocrine therapy, the recurrence rate is still as high as 40%. To date, no targeted agent is proven to improve the efficacy of adjuvant endocrine therapy within the IBC population to improve this poor disease free survival (DFS). One plausible reason for the poor efficacy of endocrine therapy is a suppressed immune system, which allows tumor cells to avoid detection despite expression of potential immunogenic surface antigens.
Trial Design: This is a single arm trial that will enroll stage III HR+ IBC patients who have completed neoadjuvant therapy but had residual disease at mastectomy. Enrollment should be before or within 2 months of beginning endocrine therapy. Monitoring of DFS will be done with radiological imaging every 3 cycles (starting at cycle 4) as clinically indicated, per standard of care. Pembrolizumab is given on day 1 of each 21 day cycle for up to 2 years if the disease is controlled, and hormonal therapy will be administered per standard of care.
Eligibility Criteria: Clinical stage 3 IBC ER+/PR+ and HER2 negative patients who completed neoadjuvant chemotherapy and surgery with evidence of residual cancer in the breast or lymph nodes, but be clinically disease-free with good performance status at the start of study. Patients also must have adequate hematologic and organ function, and have recovered from the acute effects from prior treatments.
Specific Aims: The primary objective is to determine the disease free survival (DFS) at 2 years of patients with adjuvant therapy using Pembrolizumab in combination with standard adjuvant hormonal therapy. The secondary objective is to determine the safety and toxicity profile of this combination.
Statistical Methods: With a sample size of 37 patients, assuming that 80% are alive (20% increase from historical data) and disease-free at 2 years, and all patients are followed for >2 years after enrollment with no dropout, a 95% confidence interval around the 2-year estimate of DFS will be generated. DFS will then be compared with the historical control rate of 60% by year 2 using a one-sided exponential MLE test.
Accrual: To date we have enrolled 3 patients since activation in January 2017, and the target enrollment is 37 patients.
Contact information: For more information or to refer a patient, please contact study coordinator, Angela Alexander - aalexand@mdanderson.org
Citation Format: Alexander A, Willey J, Sun H, Parker CA, Marx AN, Wood AL, Reddy SM, Reuben JM, Bassett RL, Le-Petross HT, Krishnamurthy S, Gong Y, Woodward WA, Valero V, Ueno NT, Lim B. A single arm phase II study of adjuvant anti-PD1 (pembrolizumab) in combination with hormonal therapy in patients with hormone receptor (HR)-positive localized inflammatory breast cancer (IBC) who did not achieve a pathological complete response (pCR) to neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-02-05.
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Affiliation(s)
- A Alexander
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Willey
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - H Sun
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - CA Parker
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AN Marx
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AL Wood
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - SM Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - JM Reuben
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - RL Bassett
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - HT Le-Petross
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Y Gong
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - WA Woodward
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - V Valero
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - NT Ueno
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - B Lim
- University of Texas MD Anderson Cancer Center, Houston, TX
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Alexander A, Kaluve R, Prabhu JS, Korlimarla A, BS S, Manjunath S, Patil S, KS G, Sridhar TS. Abstract P4-10-12: Treatment decision making, and strategies for coping with financial stress in Indian women diagnosed with breast cancer and their families. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-10-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: In spite of rapid urbanization and modernization the family remains central in the socio-cultural structure of India. The individuals are enmeshed into this unit and tend to be interlinked financially, emotionally and socially. The head of this family unit tends to be a male more often than not. As is well known, despite recent attempts by the governments at the state and centre at providing health coverage for cancer through regional cancer centres, a majority have to raise the money for cancer care by themselves. We have examined the role of the family in treatment decision making and in the strategies employed to raise the money and cope with the financial stress imposed by a diagnosis of breast cancer.
Method: 378 women with breast cancer were enrolled into a longitudinal study at first diagnosis between the years 2008-2012, at two tertiary care hospitals in Bangalore, India. The median follow up as of May 31st 2017 is 78 months with only 2% loss to follow-up over the past 8 years. Follow-up was maintained by frequent meetings between a counselling psychologist (AA) and the patient and/or a family member. The frequency of meetings was monthly during the initial treatment and then quarterly over the next 5 years. Information on demographics was collected during the treatment phase and information on the psychosocial aspects was collected in non-structured interactions subsequently. This information included details of support structure, decision making, and financial arrangements.
Results: This is a predominantly urban cohort with 80% being urban. The median age of patients at first diagnosis was 55 years. Almost all of our patients (99%) had the support of one or more family members. We analysed the pattern of decision making for treatment and in half of all cases either the husband or the son were the decision makers. In an additional 15% daughters and other relatives were the primary decision makers. Approximately a third of women made the decision concerning treatment themselves, and these women tended to be college educated (51% vs 16%) and employed (53% vs 12%).
30% of the patients met the costs incurred through medical insurance plans purchased by the family. Another quarter of patients were able to meet the costs from their savings. 45% had difficulty in finding the money for treatment and 15% took personal loans while 30% had to sell land/gold ornaments or take loans against assets of these sorts. Only (3%) discontinued the treatment due to financial difficulties. As in the case of decision making those who had the financial resources tended to be more educated (41% vs 11%), and were employed (31% vs 21%).
Conclusion: The data from a predominantly urban cohort of breast cancer enrolled between 2008-2012, supports the general belief that in India the family remains the fulcrum of an individual during crises, and not surprisingly education and employment lead to both psychological and economic emancipation of women.
Citation Format: Alexander A, Kaluve R, Prabhu JS, Korlimarla A, BS S, Manjunath S, Patil S, KS G, Sridhar TS. Treatment decision making, and strategies for coping with financial stress in Indian women diagnosed with breast cancer and their families [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-12.
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Affiliation(s)
- A Alexander
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - R Kaluve
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - JS Prabhu
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - A Korlimarla
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - S BS
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - S Manjunath
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - S Patil
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - G KS
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - TS Sridhar
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
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Thulborn KR, Atkinson IC, Alexander A, Singal M, Amin-Hanjani S, Du X, Alaraj A, Charbel FT. Comparison of Blood Oxygenation Level-Dependent fMRI and Provocative DSC Perfusion MR Imaging for Monitoring Cerebrovascular Reserve in Intracranial Chronic Cerebrovascular Disease. AJNR Am J Neuroradiol 2018; 39:448-453. [PMID: 29371256 DOI: 10.3174/ajnr.a5515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/07/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Loss of hemodynamic reserve in intracranial cerebrovascular disease reduces blood oxygenation level-dependent activation by fMRI and increases asymmetry in MTT measured by provocative DSC perfusion MR imaging before and after vasodilation with intravenous acetazolamide. The concordance for detecting hemodynamic reserve integrity has been compared. MATERIALS AND METHODS Patients (n = 40) with intracranial cerebrovascular disease and technically adequate DSA, fMRI and provocative DSC perfusion studies were retrospectively grouped into single vessels proximal to and distal from the circle of Willis, multiple vessels, and Moyamoya disease. The vascular territories were classified as having compromised hemodynamic reserve if the expected fMRI blood oxygenation level-dependent activation was absent or if MTT showed increased asymmetry following vasodilation. Concordance was examined in compromised and uncompromised vascular territories of each group with the Fischer exact test and proportions of agreement. RESULTS Extensive leptomeningeal collateral circulation was present in all cases. Decreased concordance between the methods was found in vascular territories with stenosis distal to but not proximal to the circle of Willis. Multivessel and Moyamoya diseases also showed low concordance. A model of multiple temporally displaced arterial inputs from leptomeningeal collateral flow demonstrated that the resultant lengthening MTT mimicked compromised hemodynamic reserve despite being sufficient to support blood oxygenation level-dependent contrast. CONCLUSIONS Decreased concordance between the 2 methods for assessment of hemodynamic reserve for vascular disease distal to the circle of Willis is posited to be due to well-developed leptomeningeal collateral circulation providing multiple temporally displaced arterial input functions that bias the perfusion analysis toward hemodynamic reserve compromise while blood oxygenation level-dependent activation remains detectable.
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Affiliation(s)
- K R Thulborn
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - I C Atkinson
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - A Alexander
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - M Singal
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - S Amin-Hanjani
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
| | - X Du
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
| | - A Alaraj
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
| | - F T Charbel
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
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Einstein N, Okubanjo O, Alexander A, Putman M, Watts H. 158 Caring for a Critically Ill Simulated Left Ventricular Assist Device Patient With or Without a Cognitive Aid Improves Physician Comfort. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mahmood J, Jackson I, Pavlovic R, Zhang A, Connors C, Alexander A, Kaytor M, Vujaskovic Z. Treatment With Nano-Genistein for the Prevention of Radiation-Induced Erectile Dysfunction. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nair M, Prabhu J, Remacle J, S H, Korlimarla A, Kaluve R, Alexander A, Patil S, S S, Srinivas S. Examination of the role of integrin β3 in chemoresistance by analysis of residual NACT tumor specimens and knock-in experiments. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx140.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tyldesley S, Parimi S, Tsang E, Bachand F, Aparicio M, Duncan G, Sunderland K, Olson R, Pai H, Alexander A, Lapointe V, Chi K. EP-1359: Pain response in a Population-based study of Radium-223 for Metastatic Prostate Cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gagne I, Zavgorodni S, Alexander A, Vallieres I. EP-1649: Comparison of two thermoplastic immobilization shells for frameless stereotactic radiotherapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jiang ZD, Ajami NJ, Petrosino JF, Jun G, Hanis CL, Shah M, Hochman L, Ankoma-Sey V, DuPont AW, Wong MC, Alexander A, Ke S, DuPont HL. Randomised clinical trial: faecal microbiota transplantation for recurrent Clostridum difficile infection - fresh, or frozen, or lyophilised microbiota from a small pool of healthy donors delivered by colonoscopy. Aliment Pharmacol Ther 2017; 45:899-908. [PMID: 28220514 DOI: 10.1111/apt.13969] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/29/2016] [Accepted: 01/14/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Faecal microbiota transplantation (FMT) has become routine in managing recurrent C. difficile infection (CDI) refractory to antibiotics. AIM To compare clinical response and improvements in colonic microbiota diversity in subjects with recurrent CDI using different donor product. METHODS Seventy-two subjects with ≥3 bouts of CDI were randomised in a double-blind study to receive fresh, frozen or lyophilised FMT product via colonoscopy from 50 g of stool per treatment from eight healthy donors. Recipients provided stools pre- and 7, 14 and 30 days post-FMT for C. difficile toxin and, in a subset, microbiome composition by 16S rRNA gene profiling. RESULTS Overall resolution of CDI was 87% during 2 months of follow-up after FMT. Stool samples before FMT had significantly decreased bacterial diversity with a high proportion of Proteobacteria compared to donors. Cure rates were highest for the group receiving fresh product seen in 25/25 (100%), lowest for the lyophilised product 16/23 (78%; P = 0.022 vs. fresh and 0.255 vs. frozen) and intermediate for frozen product 20/24 (P = 0.233 vs. fresh). Microbial diversity was reconstituted by day 7 in the subjects receiving fresh or frozen product. Improvement in diversity was seen by day 7 in those randomised to lyophilised material with reconstitution by 30 days. CONCLUSIONS Comparative efficacy in faecal microbiota transplantation was observed in subjects receiving fresh or frozen faecal product from the same donors. The lyophilised product had a slightly lowered efficacy compared with fresh product, but it resembled other treatments in microbial restoration 1 month after faecal microbiota transplantation.
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Affiliation(s)
- Z D Jiang
- University of Texas School of Public Health, Houston, TX, USA
| | - N J Ajami
- Baylor College of Medicine, Houston, TX, USA
| | | | - G Jun
- University of Texas School of Public Health, Houston, TX, USA
| | - C L Hanis
- University of Texas School of Public Health, Houston, TX, USA
| | - M Shah
- University of Texas School of Public Health, Houston, TX, USA
| | - L Hochman
- Baylor St Luke's Medical Center, Houston, TX, USA
| | - V Ankoma-Sey
- Baylor St Luke's Medical Center, Houston, TX, USA
| | - A W DuPont
- University of Texas Medical School, Houston, TX, USA
| | - M C Wong
- Baylor College of Medicine, Houston, TX, USA
| | - A Alexander
- Baylor St Luke's Medical Center, Houston, TX, USA
| | - S Ke
- University of Texas School of Public Health, Houston, TX, USA
| | - H L DuPont
- University of Texas School of Public Health, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,Baylor St Luke's Medical Center, Houston, TX, USA.,Kelsey Research Foundation, Houston, TX, USA
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Prabhu JS, Kaul R, Korlimarla A, Desai K, Gangadharan C, Rajarajan S, Nair MG, Alexander A, Kaluve R, Manjunath S, Correa M, Prasad MSN, Patil S, Srinath BS, Sridhar TS. Abstract P4-07-10: Epithelial mesenchymal transition associated with high miR-221 and integrin β6 leads to poor prognosis in hormone receptor positive HER2 negative breast cancers. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-07-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: MicroRNA mediated molecular alterations are involved in the initiation and progression of cancer. Altered expression of multiple microRNAs is associated with endocrine resistance in hormone receptor positive HER2 negative (HR+/HER2-ve) cancer. The role of miR-221 in inducing epithelial to mesenchymal transition (EMT) is well documented especially in cell line model systems. However, the detailed mechanism of specific microRNAs in intrinsic and acquired resistance to endocrine therapy needs to be worked out. In addition, more needs to be done in the documentation of these mechanisms in human breast cancer specimens with complete clinical documentation and long-term follow-up. In this study, we have evaluated the clinical significance of miR-221 and its mechanistic role in EMT using human specimens and cell line models.
Materials and Methods: Formalin fixed paraffin embedded tumor from 129 HR+/HER2-ve breast cancer patients with a median follow up of 63 months were used for estimation of miR-221 by quantitative real time PCR. Expression levels of genes which are direct targets of miR-221 and related genes in EMT were analysed from these tumors. Survival between miR-221 high and low groups was compared by Kaplan Meier survival curves and prognostic relevance was estimated by Cox proportional hazard model.
Cell line experiments to investigate the role of miR-221 in inducing EMT through integrin β6 are underway in both wild type and tamoxifen resistant MCF-7 cell lines (A gift from Prof Ben Ho Park, Johns Hopkins University School of Medicine).
Results: A significant elevated level of miR-221 was observed in small proportion (14%) of HR+/HER2-ve tumors. miR-221 expression had an inverse correlation with both ER protein and ESR1 mRNA levels within HR+/HER2-ve tumors. Tumors with high levels of miR-221 showed significantly higher expression of integrin β6 which is a robust marker of EMT. Patients with high expression of miR-221 had a poorer survival in Kaplan Meier analysis.
Results of interrogation of EMT mediated through integrin related pathways involving miR-221 in cell line models will be presented.
Discussion: The association between miR-221 and integrin β6 in HR+/HER2-ve breast cancer with endocrine resistance suggests a potential link between an epigenetic regulator and a mediator of tumor-stromal interaction. The other mediators involved in this pathway are being investigated. miR-221 could be potentially used as a marker for identification of a poor prognostic subtype within HR+/HER2-ve breast cancers.
Citation Format: Prabhu JS, Kaul R, Korlimarla A, Desai K, Gangadharan C, Rajarajan S, Nair MG, Alexander A, Kaluve R, Manjunath S, Correa M, Prasad MSN, Patil S, Srinath BS, Sridhar TS. Epithelial mesenchymal transition associated with high miR-221 and integrin β6 leads to poor prognosis in hormone receptor positive HER2 negative breast cancers [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-07-10.
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Affiliation(s)
- JS Prabhu
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - R Kaul
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - A Korlimarla
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - K Desai
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - C Gangadharan
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - S Rajarajan
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - MG Nair
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - A Alexander
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - R Kaluve
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - S Manjunath
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - M Correa
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - MSN Prasad
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - S Patil
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - BS Srinath
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
| | - TS Sridhar
- St Johns Research Institute, Bangalore, Karnataka, India; St Johns Medical College Hospital, Bangalore, Karnataka, India; St Johns Medical College, Bangalore, Karnataka, India; Shankara Cancer Hospital and Research Center, Bangalore, India
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Whiting M, Alexander A, Habiba M, Volk HA. Survey of veterinary clients' perceptions of informed consent at a referral hospital. Vet Rec 2016; 180:20. [PMID: 27738244 DOI: 10.1136/vr.104039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/03/2022]
Abstract
This retrospective questionnaire study evaluates the perceptions of veterinary clients of the informed consent process and the consent form in a veterinary referral hospital. Replicating a validated perception survey from human medicine, 470 clients at the Queen Mother Hospital for Animals were surveyed on their perceptions during the consenting process through postal survey examining their understanding, experience and recall of informed consent. Of the 165 responses (35 per cent response rate), the majority of clients recalled the process and signing the form; however, half of the clients did not feel in control (51 per cent) or reassured (53 per cent) by the process. There was limited understanding of the purpose of consent, with 45 per cent thinking it removed their right to compensation for negligence and 31 per cent thought the veterinarian could do something different from the agreed procedure. Sixty per cent of clients did not read the form, as they trusted their veterinarian, but 33 per cent of clients felt frightened by the process. This survey highlights the need to understand the process of consent from the client's perspective, and adapt the consenting process to incorporate this into professional communication to ensure that the professional and contractual objectives of consent are met fully.
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Affiliation(s)
- M Whiting
- Animal Welfare and Ethics, Department of Production and Population Health, Royal Veterinary College, Hawkshead Lane, North Mymms, Herts AL9 7TA, UK
| | - A Alexander
- Royal Veterinary College, Hawkshead Lane, North Mymms, Herts AL9 7TA, UK
| | - M Habiba
- Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester LE1 5WW, UK
| | - H A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Herts AL9 7TA, UK
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Gyamfi C, Ndambuki JM, Diabene PY, Kifanyi GE, Githuku CR, Alexander A. Using GIS for spatial exploratory analysis of borehole data: a firsthand approach towards groundwater development. ACTA ACUST UNITED AC 2016. [DOI: 10.4314/just.v36i1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
When studying the pathological mechanisms of epilepsy, there are a seemingly endless number of approaches from the ultrastructural level-receptor expression by EM-to the behavioral level-comorbid depression in behaving animals. Epilepsy is characterized as a disorder of recurrent seizures, which are defined as "a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain" (Fisher et al., 2005). Such abnormal activity typically does not occur in a single isolated neuron; rather, it results from pathological activity in large groups-or circuits-of neurons. Here we choose to focus on two aspects of aberrant circuits in temporal lobe epilepsy: their organization and potential mechanisms to control these pathological circuits. We also look at two scales: microcircuits, ie, the relationship between individual neurons or small groups of similar neurons, and macrocircuits, ie, the organization of large-scale brain regions. We begin by summarizing the large body of literature that describes the stereotypical anatomical changes in the temporal lobe-ie, the anatomical basis of alterations in microcircuitry. We then offer a brief introduction to graph theory and describe how this type of mathematical analysis, in combination with computational neuroscience techniques and using parameters obtained from experimental data, can be used to postulate how microcircuit alterations may lead to seizures. We then zoom out and look at the changes which are seen over large whole-brain networks in patients and animal models, and finally we look to the future.
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Affiliation(s)
- A Alexander
- Stanford University, Stanford, CA, United States
| | - M Maroso
- Stanford University, Stanford, CA, United States
| | - I Soltesz
- Stanford University, Stanford, CA, United States.
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Alexander A, Crewson C, Davis W, Mayer M, Cranmer-Sargison G, Kundapur V. PO-0867: Treatment planning study for spatially fractionated minibeam radiotherapy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32117-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Alexander A, Ahmed O, Patel M, Jilani D, Ginsburg M, Van Ha T. Effect of stent graft diameter in post-TIPS encephalopathy. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Arnold M, Itzikowitz R, Young B, Machoki SM, Hsiao NY, Pillay K, Alexander A. Surgical manifestations of gastrointestinal cytomegalovirus infection in children: Clinical audit and literature review. J Pediatr Surg 2015; 50:1874-9. [PMID: 26265193 DOI: 10.1016/j.jpedsurg.2015.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/17/2015] [Accepted: 06/22/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Gastrointestinal sequelae of cytomegalovirus are rare, usually associated with significant immune compromise, and carry a high morbidity and mortality. Gastrointestinal disease frequently requires surgical intervention for diagnosis and management. AIM The aim of the study is to evaluate the incidence, presentation and management of gastrointestinal cytomegalovirus disease in a pediatric population. METHOD Between January 2003 and June 2011, a retrospective folder review was conducted of all symptomatic children with proven CMV disease, presenting to the surgical service. Eligible patients were identified using the surgical, histopathology and serology databases. RESULTS Thirty-eight patients (1.8/1000 surgical admissions) were identified with a median presenting age of 5months (range 3days-12years). Esophagitis (n=18) and small bowel disease (n=16) predominated, but CMV was seen throughout the gastrointestinal tract. Risk factors included HIV infection (n=21, 55%) and recent gastrointestinal surgery or infection (n=10, 26%). Characteristic multiple jejunoileal perforations were seen in six patients. Compared to upper GIT disease, intestinal involvement was associated with younger age and doubled mortality. In HIV-infected children, median CD4 (%) was lower in intestinal compared to upper gastrointestinal disease. Morbidities included anastomotic breakdowns (5), anastomotic strictures (3), relook laparotomies (10), resistant esophageal strictures (5) and prolonged parenteral nutrition (5). Anti-CMV drugs were given in 63%. Overall mortality was 32% (12/38) and was associated with lower GIT disease. CONCLUSION Invasive CMV gastrointestinal disease in our children was predominantly HIV-associated, or followed a major lower gastrointestinal inflammatory insult in infants younger than 6months. Successful therapy requires a high index of suspicion of active CMV disease to allow early implementation of CMV viral load control and aggressive treatment of the underlying immune impairment. Multiple surgical interventions are often required for both tissue diagnosis and management of acute and chronic complications. CMV-viral-load-tailored anti-CMV therapy is supported by recent literature.
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Affiliation(s)
- M Arnold
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - R Itzikowitz
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - B Young
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - S M Machoki
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - N Y Hsiao
- Division of Medical Virology, National Health Laboratory Service/University of Cape Town, Cape Town, South Africa
| | - K Pillay
- Department of Histopathology, NHLS, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - A Alexander
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Serban M, Seuntjens J, Roussin E, Alexander A, Tremblay JR, Wierzbicki W. Patient-specific compensation for Co-60 TBI treatments based on Monte Carlo design: A feasibility study. Phys Med 2015; 32:67-75. [PMID: 26498377 DOI: 10.1016/j.ejmp.2015.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/19/2015] [Accepted: 09/25/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To develop an AP-PA treatment technique for the delivery of total body irradiation (TBI) at extended SSD using a modified Co-60 unit equipped with flattening filter and patient-specific compensators supported by Monte Carlo (MC) simulations and measurements. METHODS An existing Eldorado-78 Co-60 teletherapy unit was stripped of its original collimator and equipped with two beam-defining cerrobend blocks. An acrylic flattening filter was numerically designed based on detailed mapping of the dose distribution of the large open field at a 10 cm depth in water using a primary radiation attenuation calculation. An EGSnrc/BEAMnrc MC model of the resulting unit was developed and experimentally validated and was used to calculate MC dose distributions in whole-body supine and prone CT images of a patient. AP-PA patient-specific compensators were designed based on the supine and prone mid-plane dose distributions. RESULTS The designed flattening filter flattens the beam to within ±2% over a 200 cm × 70 cm area at 10 cm depth in water. Experimental validation of the calculated dose profiles in the open and flattened beams shows agreement of better than 2% and 1%, respectively. Patient MC dose calculations in the flattened, uncompensated beam showed dose deviations from prescription dose most notably in lung, neck and extremities ranging from -5% to +25%. The use of patient-specific compensators reduced inhomogeneities to within -5% to +10%. CONCLUSIONS This work demonstrates that a Co-60 TBI setup upgraded with patient-specific compensators, numerically designed using MC patient dose calculations, is feasible and considerably improves the dose homogeneity.
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Affiliation(s)
- M Serban
- Hopital Maisonneuve-Rosemont, Montreal, Canada; Department of Medical Physics, McGill University Health Centre, Montreal, Canada.
| | - J Seuntjens
- Department of Medical Physics, McGill University Health Centre, Montreal, Canada
| | - E Roussin
- Hopital Maisonneuve-Rosemont, Montreal, Canada
| | - A Alexander
- Department of Medical Physics, McGill University Health Centre, Montreal, Canada; Department of Medical Physics, Saskatchewan Cancer Agency, Saskatoon, Canada
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Serban M, Renaud M, Maglieri R, Alexander A, Freeman C. EP-1454: Eliminating dosimetric uncertainties in tomotherapy delivery in sarcoma patients using Monte Carlo techniques. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41446-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mestrovic A, Fortin D, Alexander A. Sci-Sat AM: Stereo - 08: Stereotactic Ablative Radiotherapy (SABR) for low, intermediate and high risk prostate cancer using Volumetric Modulated Arc Therapy (VMAT) with a 10x Flattening Filter Free (FFF) beam. Med Phys 2014. [DOI: 10.1118/1.4894969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Connell T, Alexander A, Papaconstadopoulos P, Serban M, Devic S, Seuntjens J. Sci-Thur PM: Planning & Delivery - 03: Automated delivery and quality assurance of a modulated electron radiation therapy plan. Med Phys 2014. [DOI: 10.1118/1.4894983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
BACKGROUND AND PURPOSE Reduced cerebral perfusion has been observed with elevated intracranial pressure. We hypothesized that arterial spin-labeled CBF can be used as a marker for symptomatic hydrocephalus. MATERIALS AND METHODS We compared baseline arterial spin-labeled CBF in 19 children (median age, 6.5 years; range, 1-17 years) with new posterior fossa brain tumors and clinical signs of intracranial hypertension with arterial spin-labeled CBF in 16 age-matched controls and 4 patients with posterior fossa tumors without ventriculomegaly or signs of intracranial hypertension. Measurements were recorded in the cerebrum at the vertex, deep gray nuclei, and periventricular white matter and were assessed for a relationship to ventricular size. In 16 symptomatic patients, we compared cerebral perfusion before and after alleviation of hydrocephalus. RESULTS Patients with uncompensated hydrocephalus had lower arterial spin-labeled CBF than healthy controls for all brain regions interrogated (P < .001). No perfusion difference was seen between asymptomatic patients with posterior fossa tumors and healthy controls (P = 1.000). The median arterial spin-labeled CBF increased after alleviation of obstructive hydrocephalus (P < .002). The distance between the frontal horns inversely correlated with arterial spin-labeled CBF of the cerebrum (P = .036) but not the putamen (P = .156), thalamus (P = .111), or periventricular white matter (P = .121). CONCLUSIONS Arterial spin-labeled-CBF was reduced in children with uncompensated hydrocephalus and restored after its alleviation. Arterial spin-labeled-CBF perfusion MR imaging may serve a future role in the neurosurgical evaluation of hydrocephalus, as a potential noninvasive method to follow changes of intracranial pressure with time.
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Affiliation(s)
- K W Yeom
- From the Departments of Radiology (K.W.Y.)
| | - R M Lober
- Neurosurgery (R.M.L., A.A., S.H.C., M.S.B.E.)
| | - A Alexander
- Neurosurgery (R.M.L., A.A., S.H.C., M.S.B.E.)
| | - S H Cheshier
- Neurosurgery (R.M.L., A.A., S.H.C., M.S.B.E.)Division of Pediatric Neurosurgery (S.H.C., M.S.B.E.), Lucile Packard Children's Hospital at Stanford University, Palo Alto, California
| | - M S B Edwards
- Neurosurgery (R.M.L., A.A., S.H.C., M.S.B.E.)Division of Pediatric Neurosurgery (S.H.C., M.S.B.E.), Lucile Packard Children's Hospital at Stanford University, Palo Alto, California
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Connell T, Alexander A, Papaconstadopoulos P, Serban M, Devic S, Seuntjens J. Delivery validation of an automated modulated electron radiotherapy plan. Med Phys 2014; 41:061715. [DOI: 10.1118/1.4876297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Cooks‐Fagbodun S, McHugh M, Graham M, Scott M, Sleets H, Quarcoo F, Witola W, Alexander A. Molecular identification of Trypanosoma cruzi in Anasa tristis (LB268). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.lb268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sheritta Cooks‐Fagbodun
- Department of Agriculture and Environmental Science Tuskegee UniversityTuskegeeALUnited States
| | - Mark McHugh
- Department of Agriculture and Environmental Science Tuskegee UniversityTuskegeeALUnited States
| | - Martha Graham
- Department of Pathobiology Tuskegee UniversityTuskegeeALUnited States
| | - Maya Scott
- Department of Agriculture and Environmental Science Tuskegee UniversityTuskegeeALUnited States
| | - Halston Sleets
- Department of Agriculture and Environmental Science Tuskegee UniversityTuskegeeALUnited States
| | - Franklin Quarcoo
- Department of Agriculture and Environmental Science Tuskegee UniversityTuskegeeALUnited States
| | - William Witola
- Department of Agriculture and Environmental Science Tuskegee UniversityTuskegeeALUnited States
| | - A. Alexander
- Department of Pathobiology Tuskegee UniversityTuskegeeALUnited States
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Hattingh M, Alexander A, Meijering I, van Reenen C, Dicks L. Malting of barley with combinations of Lactobacillus plantarum, Aspergillus niger, Trichoderma reesei, Rhizopus oligosporus and Geotrichum candidum to enhance malt quality. Int J Food Microbiol 2014; 173:36-40. [DOI: 10.1016/j.ijfoodmicro.2013.12.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/10/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022]
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