Pre-Brachytherapy Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) Response as Predictor of Local Control in the Definitive Treatment of Cervical Cancer

PURPOSE/OBJECTIVE(S)

Chemoradiation consisting of external beam radiotherapy (EBRT) followed by brachytherapy (BT) is the standard of care for Stage IB2-IVA cervical cancer (CC). Multi-parametric MRI (mpMRI) is a valuable tool for initial staging, treatment planning and response assessment. In this study, we aim to explore the potential of mpMRI, in particular DW-MRI, to predict overall tumor control following chemoradiation in CC.

MATERIALS/METHODS

We identified 78 consecutive patients treated with chemoradiation for FIGO IB2-IVA CC between 2012-2020, who had an MRI at baseline (MRb) and post-EBRT prior to brachytherapy boost (MRpb) that included DW-MRI (b-value = 0 and 800 s/mm2). Median age was 53 years, most patients had squamous cell carcinoma (76.9%) and advanced-stage disease (56.4% stage IIIA-IVA). Median time from completion of EBRT to MRpb was 3 days. Regions of interest (ROI) in primary tumor were delineated on DW image (b = 0 s/mm2) using ITK-SNAP software. DW-MRI data were fitted to a monoexponential model to calculate apparent diffusion coefficient (ADC) values using in-house software platform (MRI-QAMPER). MRpb mean ADC values (n = 78) and relative changes (%) in mean ADC values between MRb and MRpb (n = 64) were correlated with outcomes, including local failure (LF), regional or distant failure (RDF), and failure at any site (FAS), with death without failure as a competing risk. Median follow-up time was 45 months (95% CI 38, 53).

RESULTS

At first post treatment assessment, 72 patients (92.3%) had a complete response (CR) in the cervix and 68 patients (87.2%) had CR in all disease sites. Of patients who had CR in the cervix (n = 72), only 1 patient had local recurrence. Of patients who had CR in all disease sites, 10 later recurred (1 LF only, 1 LF&RDF, 8 RDF only). Overall, 7 patients (9%) had LF, and 19 patients (24.4%) had FAS. A higher mean ADC value in MRpb was associated with LF (HR 4.3, 95% CI 1.32, 14.6; P = 0.016), but not with RDF (P = 0.4) or FAS (P = 0.5). A higher relative change in the mean ADC value between MRb and MRpb was associated with a lower risk of LF (HR 0.94, 95% CI 0.90, 0.98; P = 0.002), but not with RDF (P = 0.8) or FAS (P = 0.4).

CONCLUSION

Treatment response as measured on prebrachytherapy DW-MRI is a significant predictor of local control in patients undergoing chemoradiation for stage IB2-IVA CC. ADC values, a quantitative imaging biomarker on MRpb may be instrumental in dose intensification/de-escalation efforts in CC.

Favorable Toxicity and Local Control with Ultrahypofractionated Radiation Therapy (UH-RT) for Melanoma of the Lower Genital Tract (LGT)

PURPOSE/OBJECTIVE(S)

To report our experience using UH-RT +/- immunotherapy (IO) in women with melanoma of the LGT.

MATERIALS/METHODS

We retrospectively identified 23 patients who received UH-RT to primary tumor for vulvovaginal melanoma from 2012 to 2022. Median age was 69 years (IQR: 62-76). Stage included localized, node positive, or metastatic. 18 (78%) had tumors involving the vagina/cervix and 5 (22%) had vulvar tumors. 6 patients had c-KIT mutations; 13 patients were wild-type; 4 patients were unknown. 12 (52%) were treated at initial presentation (cohort A) and 11 (48%) at local progression/recurrence following prior therapy (cohort B). In cohort A, most (n = 11) received concurrent IO. In cohort B, 3 recurred after surgery alone, 4 after systemic therapy alone and 4 after surgery and systemic therapy. RT consisted of 6 Gy x 6 (n = 11), 6 Gy x 5 (n = 10) and 5 Gy x 5-6 (n = 2) delivered to the primary tumor + 0.5 cm margin. Patients initiated IO either ≥3 months preRT (n = 8), concurrent with RT (n = 12) or ≥3 months following RT (n = 2). 1 patient in cohort B did not receive IO. Toxicity was graded using CTCAE v 5. Overall survival (OS) was measured from end of RT. Cumulative incidence of local progression was measured from end of RT. Kaplan-Meier method and Cox regression were used for survival analyses. Landmark method was used for timing of IO. Median follow-up as determined by reverse Kaplan-Meier method was 60 months (95% CI: 37-N/A).

RESULTS

Overall incidence of acute/late grade 2+ toxicity for the entire cohort was 34%. Grade 2 acute toxicity included: dermatitis (n = 3), urinary (n = 2), vaginitis (n = 2) and diarrhea (n = 1). 3 patients experienced grade 3 acute dermatitis. 1 patient experienced late grade 2 vaginitis. No grade 3 or 4 toxicity was noted. No significant differences in toxicity were noted between RT regimens. Local disease control was achieved in 61% of patients. Local only, local and distant, and distant-only progression were seen in 17%, 22%, and 30% of patients respectively. 2-year cumulative incidence of local progression was 33% for the whole cohort, 28% for cohort A, and 36% for cohort B (p = 0.4). On UVA, factors associated with local progression were vulvar disease (p = 0.02) and c-KIT mutation (p = 0.011). No significant difference in local control was noted based on biologic effective dose (BED10 < = 48Gy vs >48Gy) (p = 0.06). Median OS for entire cohort, cohort A, and cohort B were 46, 72, and 30 months, respectively. 2-year survival (95% CI) was 67% (50%-91%), 73% (51%-100%), and 64% (41%-99%) respectively. On UVA, non-local disease at time of RT (p = 0.016) and receipt of IO ≥3 months prior to RT (p = 0.030) had worse OS.

CONCLUSION

UH-RT+/- IO for melanoma of the LGT is well-tolerated with local disease control achieved in 61% of patients. Vulvar primary and c-Kit mutations were associated with worse local control. Additional follow-up may be necessary to determine the value of dose escalation.

Air pollution and suicide in rural and urban America: Evidence from wildfire smoke

Air pollution poses well-established risks to physical health, but little is known about its effects on mental health. We study the relationship between wildfire smoke exposure and suicide risk in the United States in 2007 to 2019 using data on all deaths by suicide and satellite-based measures of wildfire smoke and ambient fine particulate matter (PM2.5) concentrations. We identify the causal effects of wildfire smoke pollution on suicide by relating year-over-year fluctuations in county-level monthly smoke exposure to fluctuations in suicide rates and compare the effects across local areas and demographic groups that differ considerably in their baseline suicide risk. In rural counties, an additional day of smoke increases monthly mean PM2.5 by 0.41 μg/m3 and suicide deaths by 0.11 per million residents, such that a 1-μg/m3 (13%) increase in monthly wildfire-derived fine particulate matter leads to 0.27 additional suicide deaths per million residents (a 2.0% increase). These effects are concentrated among demographic groups with both high baseline suicide risk and high exposure to outdoor air: men, working-age adults, non-Hispanic Whites, and adults with no college education. By contrast, we find no evidence that smoke pollution increases suicide risk among any urban demographic group. This study provides large-scale evidence that air pollution elevates the risk of suicide, disproportionately so among rural populations.

Whānau Māori and Pacific peoples' knowledge, perceptions, expectations and solutions regarding antibiotic treatment of upper respiratory tract infections: a qualitative study

INTRODUCTION

The rate of community antibiotic use is high in Aotearoa New Zealand (NZ) when compared to other nations, and in NZ, as in most other nations, antibiotics are very commonly prescribed for self-limiting upper respiratory tract infections (URTIs). Resources that build knowledge, perceptions and understanding can potentially reduce unnecessary antibiotic consumption.

METHODS

To inform the content of educational resources, we conducted an in-depth qualitative study with 47 participants via 6 focus groups of the knowledge, attitudes, and expectations of whānau Māori and Pacific peoples about antibiotics and URTIs.

RESULTS

Focus groups with 47 participants identified four themes: Knowledge that might influence expectations to receive antibiotics for URTIs; Perceptions - the factors that influence when and why to seek medical care for URTI; Expectations - the features of successful medical care for URTI; Solutions - how to build community knowledge about URTI and their treatment and prevention. Knowledge that might reduce expectations to receive antibiotics for URTI included confidence in the use of alternative remedies, knowledge that URTI are usually caused by viruses, and concerns about antibiotic adverse effects. Participants commonly reported that they would confidently accept their doctor's recommendation that an antibiotic was not necessary for an URTI, provided that a thorough assessment had been performed and that treatment decisions were clearly communicated.

CONCLUSION

These findings suggest that building patients' knowledge and skills about when antibiotics are necessary, and increasing doctors' confidence and willingness not to prescribe an antibiotic for patients with an URTI, could significantly reduce inappropriate antibiotic prescribing in NZ.

Increasing the use of perioperative risk scoring in emergency laparotomy: nationwide quality improvement programme

Background

Emergency laparotomy is associated with high morbidity and mortality. The early identification of high-risk patients allows for timely perioperative care and appropriate resource allocation. The aim of this study was to develop a nationwide surgical trainee-led quality improvement (QI) programme to increase the use of perioperative risk scoring in emergency laparotomy.

Methods

The programme was structured using the active implementation framework in 15 state-funded Irish hospitals to guide the staged implementation of perioperative risk scoring. The primary outcome was a recorded preoperative risk score for patients undergoing an emergency laparotomy at each site.

Results

The rate of patients undergoing emergency laparotomy receiving a perioperative risk score increased from 0–11 per cent during the exploratory phase to 35–100 per cent during the full implementation phase. Crucial factors for implementing changes included an experienced central team providing implementation support, collaborator engagement, and effective communication and social relationships.

Conclusions

A trainee-led QI programme increased the use of perioperative risk assessment in patients undergoing emergency laparotomy, with the potential to improve patient outcomes and care delivery.

Joint Determination of Reactor Antineutrino Spectra from ^{235}U and ^{239}Pu Fission by Daya Bay and PROSPECT

A joint determination of the reactor antineutrino spectra resulting from the fission of ^{235}U and ^{239}Pu has been carried out by the Daya Bay and PROSPECT Collaborations. This Letter reports the level of consistency of ^{235}U spectrum measurements from the two experiments and presents new results from a joint analysis of both data sets. The measurements are found to be consistent. The combined analysis reduces the degeneracy between the dominant ^{235}U and ^{239}Pu isotopes and improves the uncertainty of the ^{235}U spectral shape to about 3%. The ^{235}U and ^{239}Pu antineutrino energy spectra are unfolded from the jointly deconvolved reactor spectra using the Wiener-SVD unfolding method, providing a data-based reference for other reactor antineutrino experiments and other applications. This is the first measurement of the ^{235}U and ^{239}Pu spectra based on the combination of experiments at low- and highly enriched uranium reactors.

Joint Measurement of the ^{235}U Antineutrino Spectrum by PROSPECT and STEREO

The PROSPECT and STEREO collaborations present a combined measurement of the pure ^{235}U antineutrino spectrum, without site specific corrections or detector-dependent effects. The spectral measurements of the two highest precision experiments at research reactors are found to be compatible with χ^{2}/ndf=24.1/21, allowing a joint unfolding of the prompt energy measurements into antineutrino energy. This ν[over ¯]_{e} energy spectrum is provided to the community, and an excess of events relative to the Huber model is found in the 5-6 MeV region. When a Gaussian bump is fitted to the excess, the data-model χ^{2} value is improved, corresponding to a 2.4σ significance.

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log₁₀ increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

Electronic search programs are effective in identifying patients with minimal trauma fractures

We assessed two electronic search tools that screen medical records for documented fractures. Both programs reliably identified patients with any fracture but missed individuals with minimal trauma fracture to different degrees. A hybrid tool combining the methodology of both tools is likely to improve the identification of those with osteoporosis.

PURPOSE

Most patients who suffer a minimal trauma fracture remain undiagnosed, placing them at high risk of refracture. Case finding can be improved by electronic search tools that screen medical records for documented fractures. Here, we assessed the efficacy of two new programs, AES and XRAIT, in identifying patients with minimal trauma fracture.

METHODS

Each tool was applied to search the electronic medical record and/or radiology reports at two tertiary hospitals in Sydney, Australia, from 1 July to 31 December 2018. Samples of the extracted reports were then manually reviewed to determine the sensitivity of each program in detecting minimal trauma fractures.

RESULTS

At the two centers, AES detected 872 and 1364 cases, whereas XRAIT identified 1414 and 2180 patients with fractures, respectively. The true positive rate for "any fracture" was similar for both instruments (77-88%). However, the ability to detect "minimal trauma fractures" differed between programs and centers (53-75% accuracy), with each tool identifying separate subsets of patients. Concordance between both tools was less than half of the combined total number of minimal trauma fractures (43-45%). Considering the total number of minimal trauma fractures detected by both tools combined, AES correctly identified 52-55% of cases while XRAIT identified 88-93% of cases.

CONCLUSION

Both programs reliably identified patients with any fracture but missed individuals with minimal trauma fracture to different degrees. Hybrid tools combining the methodology of XRAIT and AES are likely to improve the identification of patients who require investigation and treatment for osteoporosis.

Decision-Making Processes Related to Perseveration Are Indirectly Associated With Weight Status in Children Through Laboratory-Assessed Energy Intake

Decision-making contributes to what and how much we consume, and deficits in decision-making have been associated with increased weight status in children. Nevertheless, the relationships between cognitive and affective processes underlying decision-making (i.e., decision-making processes) and laboratory food intake are unclear. We used data from a four-session, within-subjects laboratory study to investigate the relationships between decision-making processes, food intake, and weight status in 70 children 7-to-11-years-old. Decision-making was assessed with the Hungry Donkey Task (HDT), a child-friendly task where children make selections with unknown reward outcomes. Food intake was measured with three paradigms: (1) a standard ad libitum meal, (2) an eating in the absence of hunger (EAH) protocol, and (3) a palatable buffet meal. Individual differences related to decision-making processes during the HDT were quantified with a reinforcement learning model. Path analyses were used to test whether decision-making processes that contribute to children’s (a) expected value of a choice and (b) tendency to perseverate (i.e., repeatedly make the same choice) were indirectly associated with weight status through their effects on intake (kcal). Results revealed that increases in the tendency to perseverate after a gain outcome were positively associated with intake at all three paradigms and indirectly associated with higher weight status through intake at both the standard and buffet meals. Increases in the tendency to perseverate after a loss outcome were positively associated with EAH, but only in children whose tendency to perseverate persistedacross trials. Results suggest that decision-making processes that shape children’s tendencies to repeat a behavior (i.e., perseverate) are related to laboratory energy intake across multiple eating paradigms. Children who are more likely to repeat a choice after a positive outcome have a tendency to eat more at laboratory meals. If this generalizes to contexts outside the laboratory, these children may be susceptible to obesity. By using a reinforcement learning model not previously applied to the study of eating behaviors, this study elucidated potential determinants of excess energy intake in children, which may be useful for the development of childhood obesity interventions.

Health-related quality of life in women after colposcopy: results from a longitudinal patient survey

BACKGROUND

Information concerning the health-related quality-of-life (HRQoL) consequences of colposcopy is limited, particularly over time. In a longitudinal study, we investigated women's HRQoL at 4, 8 and 12 months post colposcopy and the factors associated with this.

METHODS

Women attending colposcopy at two large hospitals affiliated with the national screening programme in Ireland were invited to complete questionnaires at 4, 8 and 12 months post colposcopy. HRQoL was measured using the EQ-5D-3L and compared across a range of socio-demographic, clinical and attitudinal variables. A mixed-effects logistic multivariable model was employed to investigate associations between these variables and low HRQoL.

RESULTS

Of 584 women initially recruited, 429, 343 and 303 completed questionnaires at 4, 8 and 12 months, respectively. The mean overall HRQoL score for the sample across all time points was 0.90 (SD 0.16). Approximately 18% of women experienced low HRQoL at each of the three time points. In multivariable testing, over the entire 12-month follow-up period, non-Irish nationals (OR 8.99, 95% CI 2.35-34.43) and women with high-grade referral cytology (OR 2.78, 95% CI 1.08-7.13) were at higher odds of low HRQoL. Women who were past (OR 0.20, 95% CI 0.07-0.58) or never (OR 0.42, 95% CI 0.16-1.12) smokers were at lower odds of low HRQoL than current smokers. As women's satisfaction with their healthcare increased their odds of experiencing low HRQoL fell (OR per unit increase 0.51, 95% CI 0.34-0.75).

CONCLUSIONS

Women's HRQoL did not change over the 12 months post colposcopy, but some subgroups of women were at higher risk of experiencing low HRQoL. These subgroups may benefit from additional support.

Population Mortality and Laws Encouraging Influenza Vaccination for Hospital Workers

BACKGROUND

Since 1995, 14 states have passed laws encouraging or mandating influenza vaccination for hospital workers. Although the Centers for Disease Control and Prevention recommends vaccinating health care workers to reduce disease transmission and patient risk, the effect of these laws on pneumonia and influenza mortality is unknown.

OBJECTIVE

To measure the effect of state-level hospital worker influenza vaccination laws on pneumonia and influenza mortality.

DESIGN

Quasi-experimental observational study.

SETTING

United States.

PARTICIPANTS

Population of all states from 1995 to 2017.

INTERVENTION

State adoption of a law promoting influenza vaccination for hospital workers.

MEASUREMENTS

Pneumonia and influenza mortality per 100 000 persons by state and by month, both population-wide and separately by age group, obtained from restricted-access National Vital Statistics System files. Linear and log-linear models were used to compare changes in mortality rates for adopting versus nonadopting states.

RESULTS

Implementation of state laws requiring hospitals to offer influenza vaccination to their employees was associated with a 2.5% reduction in the monthly pneumonia and influenza mortality rate (-0.16 deaths per 100 000 persons [95% CI, -0.29 to -0.02]; P = 0.022) during the years when the vaccine was well matched to the circulating strains. The largest effects occurred among elderly persons and during peak influenza months.

LIMITATION

Utilization of large-scale national data precluded analysis of more specific outcomes, such as laboratory-confirmed or hospital-acquired influenza.

CONCLUSION

State laws promoting hospital worker vaccination against influenza may be effective in preventing pneumonia- and influenza-related deaths, particularly among elderly persons. Vaccinating hospital workers may substantially reduce the spread of influenza and protect the most vulnerable populations.

PRIMARY FUNDING SOURCE

None.

Nonfuel Antineutrino Contributions in the High Flux Isotope Reactor

Reactor neutrino experiments have seen major improvements in precision in recent years. With the experimental uncertainties becoming lower than those from theory, carefully considering all sources of ν ¯ e is important when making theoretical predictions. One source of ν ¯ e that is often neglected arises from the irradiation of the nonfuel materials in reactors. The ν ¯ e rates and energies from these sources vary widely based on the reactor type, configuration, and sampling stage during the reactor cycle and have to be carefully considered for each experiment independently. In this article, we present a formalism for selecting the possible ν ¯ e sources arising from the neutron captures on reactor and target materials. We apply this formalism to the High Flux Isotope Reactor (HFIR) at Oak Ridge National Laboratory, the ν ¯ e source for the the Precision Reactor Oscillation and Spectrum Measurement (PROSPECT) experiment. Overall, we observe that the nonfuel ν ¯ e contributions from HFIR to PROSPECT amount to 1% above the inverse beta decay threshold with a maximum contribution of 9% in the 1.8-2.0 MeV range. Nonfuel contributions can be particularly high for research reactors like HFIR because of the choice of structural and reflector material in addition to the intentional irradiation of target material for isotope production. We show that typical commercial pressurized water reactors fueled with low-enriched uranium will have significantly smaller nonfuel ν ¯ e contribution.

CT findings in dogs with gastric malposition: 6 cases (2016-2019)

OBJECTIVES

To describe the computed tomographic (CT) findings of gastric malposition in a group of dogs with suspected chronic gastric instability.

MATERIALS AND METHODS

A multicentre retrospective study of CT studies of dogs with abnormal gastric position in the absence of clinical signs referable to gastric dilatation and volvulus.

RESULTS

Gastric malposition was identified in six dogs as either an incidental finding or in dogs with histories of chronic and intermittent gastroenteropathy. Gastric malposition was similar in all six cases; the pyloric canal was positioned in the left cranial abdomen in close proximity to the cardia and the pyloric antrum was found either to the left or ventral to the fundus.

CLINICAL SIGNIFICANCE

Recognition of gastric malposition as an incidental or chronic finding may prevent unnecessary emergency intervention on patients presenting for unrelated conditions.

Individual differences in the influence of taste and health impact successful dietary self-control: A mouse tracking food choice study in children

In order to improve dietary quality among children, there is a need to understand how they make decisions about what foods to eat. This study used a mouse tracking food choice task to better understand how attributes such as health and taste contribute to food decisions among 70 children aged 7-to-11 years old. Children rated health, taste, and desire to eat for 76 common foods that varied in energy density and then used a computer mouse to select which of two presented foods they would like to eat. The presented food pairs were based on children's own ratings of taste and health so that some trials required self-control to choose the healthier option (i.e., healthy/not tasty paired with unhealthy/tasty). Children's body mass index (BMI) percentile was not associated with number of healthy choices. To examine mouse trajectories, we replicated previous analytic techniques and applied a novel technique, time-varying effects modeling (TVEM). Results showed that desire to eat impacted food decision-making sooner than taste and health during trials that required self-control, with TVEM showing that early discounting of desire to eat enabled healthier choices. However, these temporal dynamics varied by age, BMI percentile, and overall self-control performance in the task. When the less healthy food was chosen (i.e., self-control failure), older children and children with better overall self-control were more influenced by taste and desire to eat. However, children with higher BMI percentiles showed stronger discounting (i.e., negative influence) of taste when choosing the healthier food. Together this highlights how the influence of hedonic food attributes on food decision-making varies by individual child-level characteristics. Understanding individual differences in the cognitive processes that support healthy food choices in children may help identify targets for interventions aimed at improving child nutrition.

Association of glycaemic variables with trabecular bone score in post-menopausal women with type 2 diabetes mellitus

AIM

To determine the relationship between bone microarchitecture, as measured by trabecular bone score, and advanced glycation end-product accumulation, as assessed by skin autofluorescence.

METHODS

This was a cross-sectional study. Participants were 64 post-menopausal women with type 2 diabetes and 175 post-menopausal women without diabetes. Trabecular bone score and skin autofluorescence data were obtained at time of bone density measurement.

RESULTS

Trabecular bone score and skin autofluorescence were inversely correlated in women with type 2 diabetes (r = -0.34, P = 0.006); no correlation was seen in post-menopausal women without diabetes (r = -0.029, P = 0.707). After adjustment, neither skin autofluorescence nor a diagnosis of diabetes were associated with trabecular bone score, but HbA_1c and waist circumference were independently associated with trabecular bone score.

CONCLUSION

Skin autofluorescence did not predict trabecular bone score. In contrast, glycaemia, as reflected by HbA_1c , and visceral adiposity, as reflected by waist circumference, were independently associated with trabecular bone score.

Improved Constraints on Sterile Neutrino Mixing from Disappearance Searches in the MINOS, MINOS+, Daya Bay, and Bugey-3 Experiments

Searches for electron antineutrino, muon neutrino, and muon antineutrino disappearance driven by sterile neutrino mixing have been carried out by the Daya Bay and MINOS+ collaborations. This Letter presents the combined results of these searches, along with exclusion results from the Bugey-3 reactor experiment, framed in a minimally extended four-neutrino scenario. Significantly improved constraints on the θ_{μe} mixing angle are derived that constitute the most constraining limits to date over five orders of magnitude in the mass-squared splitting Δm_{41}^{2}, excluding the 90% C.L. sterile-neutrino parameter space allowed by the LSND and MiniBooNE observations at 90% CL_{s} for Δm_{41}^{2}<13  eV^{2}. Furthermore, the LSND and MiniBooNE 99% C.L. allowed regions are excluded at 99% CL_{s} for Δm_{41}^{2}<1.6 eV^{2}.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Temperature and mental health: Evidence from the spectrum of mental health outcomes

This paper characterizes the link between ambient temperatures and a broad set of mental health outcomes. We find that higher temperatures increase emergency department visits for mental illness, suicides, and self-reported days of poor mental health. Specifically, cold temperatures reduce negative mental health outcomes while hot temperatures increase them. Our estimates reveal no evidence of adaptation, instead the temperature relationship is stable across time, baseline climate, air conditioning penetration rates, accessibility of mental health services, and other factors. The character of the results suggests that temperature affects mental health very differently than physical health, and more similarly to other psychological and behavioral outcomes. We provide suggestive evidence for sleep disruption as an active mechanism behind our results and discuss the implications of our findings for the allocation of mental health services and in light of climate change.

Tuna robotics: A high-frequency experimental platform exploring the performance space of swimming fishes

Tuna and related scombrid fishes are high-performance swimmers that often operate at high frequencies, especially during behaviors such as escaping from predators or catching prey. This contrasts with most fish-like robotic systems that typically operate at low frequencies (< 2 hertz). To explore the high-frequency fish swimming performance space, we designed and tested a new platform based on yellowfin tuna (Thunnus albacares) and Atlantic mackerel (Scomber scombrus). Body kinematics, speed, and power were measured at increasing tail beat frequencies to quantify swimming performance and to study flow fields generated by the tail. Experimental analyses of freely swimming tuna and mackerel allow comparison with the tuna-like robotic system. The Tunabot (255 millimeters long) can achieve a maximum tail beat frequency of 15 hertz, which corresponds to a swimming speed of 4.0 body lengths per second. Comparison of midline kinematics between scombrid fish and the Tunabot shows good agreement over a wide range of frequencies, with the biggest discrepancy occurring at the caudal fin, primarily due to the rigid propulsor used in the robotic model. As frequency increases, cost of transport (COT) follows a fish-like U-shaped response with a minimum at ~1.6 body lengths per second. The Tunabot has a range of ~9.1 kilometers if it swims at 0.4 meter per second or ~4.2 kilometers at 1.0 meter per second, assuming a 10-watt-hour battery pack. These results highlight the capabilities of high-frequency biological swimming and lay the foundation to explore a fish-like performance space for bio-inspired underwater vehicles.

C-35 Clinical Diagnosis of Behavioral Variant Frontotemporal Dementia with Underlying Primary Age-Related Tauopathy

Objective

Primary age-related tauopathy (PART) is a neuropathologic entity characterized by neurofibrillary tangles in medial temporal regions comparable to Alzheimer’s disease (AD), but with few or no amyloid plaques. A definitive clinical phenotype for PART has not been determined. Some studies report milder deficits and a longer course compared with AD. In the National Alzheimer’s Coordinating Center database, the most common clinical diagnosis of PART cases classified as dementia is AD, though primary progressive aphasia/behavioral-variant frontotemporal dementia (bvFTD) is also common. We describe 3 patients diagnosed with bvFTD later found to have PART to further describe possible PART phenotypes.

Method

Charts of 3 autopsy-proven PART cases clinically diagnosed as bvFTD by consensus conference were reviewed. All patients (A, B, C) were male and presented with behavioral changes. Only B was APOE4+. Neuroimaging was mostly unremarkable (ventriculomegaly in patient C).

Results

All subjects presented with anosognosia, fatigue, and behavioral changes, 1 (A) with pronounced apathy and 2 (B, C) with disinhibition, impulsivity, and mood swings. Onset was early 70’s for A & C, and 50’s for B. Patients B & C had gradual onset/course (~20 years) with initial subtle executive (EF) dysfunction and intact memory. Patient A had a 6-year course and initial deficits in EF and memory.

Conclusion

This review underscores the varied presentation and clinical course of PART, including presence of early behavioral changes. Slower progression as previously reported was seen in 2 of 3 patients. Future research is warranted to better characterize the entire spectrum of clinical presentations in subjects with PART neuropathology.

Measurement of the Antineutrino Spectrum from ^{235}U Fission at HFIR with PROSPECT

This Letter reports the first measurement of the ^{235}U ν[over ¯]_{e} energy spectrum by PROSPECT, the Precision Reactor Oscillation and Spectrum experiment, operating 7.9 m from the 85  MW_{th} highly enriched uranium (HEU) High Flux Isotope Reactor. With a surface-based, segmented detector, PROSPECT has observed 31678±304(stat) ν[over ¯]_{e}-induced inverse beta decays, the largest sample from HEU fission to date, 99% of which are attributed to ^{235}U. Despite broad agreement, comparison of the Huber ^{235}U model to the measured spectrum produces a χ^{2}/ndf=51.4/31, driven primarily by deviations in two localized energy regions. The measured ^{235}U spectrum shape is consistent with a deviation relative to prediction equal in size to that observed at low-enriched uranium power reactors in the ν[over ¯]_{e} energy region of 5-7 MeV.

Search for Sterile Neutrinos in MINOS and MINOS+ Using a Two-Detector Fit

A search for mixing between active neutrinos and light sterile neutrinos has been performed by looking for muon neutrino disappearance in two detectors at baselines of 1.04 and 735 km, using a combined MINOS and MINOS+ exposure of 16.36×10^{20} protons on target. A simultaneous fit to the charged-current muon neutrino and neutral-current neutrino energy spectra in the two detectors yields no evidence for sterile neutrino mixing using a 3+1 model. The most stringent limit to date is set on the mixing parameter sin^{2}θ_{24} for most values of the sterile neutrino mass splitting Δm_{41}^{2}>10^{-4}  eV^{2}.

First Search for Short-Baseline Neutrino Oscillations at HFIR with PROSPECT

This Letter reports the first scientific results from the observation of antineutrinos emitted by fission products of ^{235}U at the High Flux Isotope Reactor. PROSPECT, the Precision Reactor Oscillation and Spectrum Experiment, consists of a segmented 4 ton ^{6}Li-doped liquid scintillator detector covering a baseline range of 7-9 m from the reactor and operating under less than 1 m water equivalent overburden. Data collected during 33 live days of reactor operation at a nominal power of 85 MW yield a detection of 25 461±283 (stat) inverse beta decays. Observation of reactor antineutrinos can be achieved in PROSPECT at 5σ statistical significance within 2 h of on-surface reactor-on data taking. A reactor model independent analysis of the inverse beta decay prompt energy spectrum as a function of baseline constrains significant portions of the previously allowed sterile neutrino oscillation parameter space at 95% confidence level and disfavors the best fit of the reactor antineutrino anomaly at 2.2σ confidence level.

Periostin overexpression in collecting ducts accelerates renal cyst growth and fibrosis in polycystic kidney disease

In polycystic kidney disease (PKD), persistent activation of cell proliferation and matrix production contributes to cyst growth and fibrosis, leading to progressive deterioration of renal function. Previously, we showed that periostin, a matricellular protein involved in tissue repair, is overexpressed by cystic epithelial cells of PKD kidneys. Periostin binds α_Vβ₃-integrins and activates integrin-linked kinase (ILK), leading to Akt/mammalian target of rapamycin (mTOR)-mediated proliferation of human PKD cells. By contrast, periostin does not stimulate the proliferation of normal human kidney cells. This difference in the response to periostin is due to elevated expression of α_Vβ₃-integrins by cystic cells. To determine whether periostin accelerates cyst growth and fibrosis, we generated mice with conditional overexpression of periostin in the collecting ducts (CDs). Ectopic CD expression of periostin was not sufficient to induce cyst formation or fibrosis in wild-type mice. However, periostin overexpression in pcy/pcy ( pcy) kidneys significantly increased mTOR activity, cell proliferation, cyst growth, and interstitial fibrosis; and accelerated the decline in renal function. Moreover, CD-specific overexpression of periostin caused a decrease in the survival of pcy mice. These pathological changes were accompanied by increased renal expression of vimentin, α-smooth muscle actin, and type I collagen. We also found that periostin increased gene expression of pathways involved in repair, including integrin and growth factor signaling and ECM production, and it stimulated focal adhesion kinase, Rho GTPase, cytoskeletal reorganization, and migration of PKD cells. These results suggest that periostin stimulates signaling pathways involved in an abnormal tissue repair process that contributes to cyst growth and fibrosis in PKD.

What Proportion of Cancers in the UK and Its Constituent Countries Could Be Prevented? An Updated Analysis

Background: Understanding population-level exposure to cancer risk factors is vital when devising risk-reduction policies. By reducing exposure to cancer risk factors, many cancers could be prevented. But what impact on cancer incidence do these risk factors have? And what proportion of cancers could be prevented if these risk factors are avoided? Aim: The aim of this analysis was to update the estimates of the number and proportion of theoretically preventable cancers in the UK to reflect the changing behavior as assessed in representative national surveys, and new epidemiologic evidence. Separate estimates were also calculated for England, Wales, Scotland, and Northern Ireland because prevalence of risk factor exposure varies between them. Methods: Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. Results: Around four in ten (38%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (39%) than UK females (37%). Comparing UK countries, the attributable proportion for persons was highest in Scotland (41%) and lowest in England (37%). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight and obesity, accounting for 15% and 6%, respectively, of all cases in the UK in 2015. Conclusion: Around four in ten (38%) cancer cases in the UK could be prevented. Tobacco and obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to reduce the level of harm associated with exposure or reduce exposure levels - both approaches may be effective in preventing cancer. The variation in PAFs between UK countries is affected by sociodemographic differences which drive differences in exposure to theoretically avoidable 'lifestyle' factors. PAFs at UK country level have not been available previously and they should be used by policymakers in the devolved nations to develop more targeted public health measures. This analysis demonstrates the importance of nationally representative exposure prevalence data and cancer registration in informing evidence-based public health policy.