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Zhao WL, Cai B, Shi CQ, Su ZZ, Feng WH. [Analysis of the effectiveness of cross-reactive carbohydrate antigen determinant antibody adsorbents in identifying allergen-specific IgE antibodies]. ZHONGHUA YU FANG YI XUE ZA ZHI [CHINESE JOURNAL OF PREVENTIVE MEDICINE] 2024; 58:1379-1383. [PMID: 39290020 DOI: 10.3760/cma.j.cn112150-20240615-00475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
This study aimed to investigate the influence of anti-cross-reactive carbohydrate determinant IgE antibodies (anti-CCD IgE) on the detection of allergen-specific IgE (sIgE) antibodies, as well as the application value of anti-CCD IgE adsorbents in detecting allergen sIgE. In this cross-sectional study, a total of 2 636 test samples from patients who received treatment in West China Hospital of Sichuan University and tested allergen sIgE using the western blot method from October 2020 to May 2021 were analyzed. In these samples, 709 samples tested postive of allergen sIgE. 46 stochastic venous serum samples that tested positive in both sIgE and anti-CCD IgE and 1 serum sample that tested positive in sIgE but negative in anti-CCD IgE were collected. These samples were processed by anti-CCD IgE adsorbents, followed by allergen sIgE detection. The difference between the two detection results before and after adsorption was analyzed. The allergen test results showed that the positive rate of anti-CCD IgE in samples was 2.6% (69/2 636) during the period of sample collection. After treatment with anti-CCD IgE adsorbents, the top three allergen-sIgE of the positive rate changed from tree combination 2 (willow/poplar/elm), common ragweed and peanut to dust mite combination, cockroach and crab. The positive anti-CCD IgE results of 46 samples all turned negative and the total positive sIgE antibody dropped by 62.8%; the positive rate of sIgE antibodies with the class result ≥2 significantly decreased after treatment with anti-CCD IgE adsorbents, especially the positive rate of common ragweed dropped by 96.2%. The results of positive samples showed that multiple sIgE antibodies declined by different ranges, involving up to 11 antibodies with a maximum decline of 4 classes. Strongly positive sIgE antibodies (the class result ≥4) also had a high conversion rate of negative (25.0%-100%). The positive sIgE antibodies in about 60% of the samples decreased by more than 2, and the sIgE antibodies in 17.4% of the samples turned completely negative. There was no change in the allergen sIgE detection results of the sample with negative anti-CCD IgE after treatment. In conclusion, sIgE antibodies including targeting common ragweed, humulus, tree combination 2 (willow/poplar/elm), etc. are susceptible to false positives caused by anti-CCD IgE. Treatment of samples with anti-CCD IgE adsorbents can significantly reduce the risk of false positives caused by anti-CCD IgE. It is necessary to pretreat samples that were anti-CCD IgE positive with anti-CCD IgE adsorbents, which can make laboratory results more accurate and provide a reference for diagnosis and prevention of allergic diseases.
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Luan L, Liu N, Zheng BF, Zhang ZY, Song YF, Li L, Gan M, Cao L, Huang ZY, Ye JK, Zhang ZN, Liu XX, Chen JL, Wang CS, Cai B, Yu WZ. [Thoughts and suggestions on digital services to enhance the level of vaccination management]. ZHONGHUA YU FANG YI XUE ZA ZHI [CHINESE JOURNAL OF PREVENTIVE MEDICINE] 2024; 58:159-165. [PMID: 38387944 DOI: 10.3760/cma.j.cn112150-20231012-00262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
With the development of information technology and the increasing demand for vaccination services among the people, it is a definite trend to enhance the quality of vaccination services through digitization. This article starts with a clear concept of digital services for vaccination, introduces the current development status in China and abroad, analyzes the advantages and disadvantages of existing models in leading regions, takes a glean from the summation, and proposes targeted solutions. This study suggests establishing a departmental coordination mechanism for data interconnection and sharing, formulating data standards and functional specifications, enhancing the functionalities of the immunization planning information system, strengthening data collection and analytical usage, and intensifying appointment management and science and health education to provide expert guidance for the construction of digital vaccination services across the country in the future.
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Ren JG, Cai B, Wang H, Wang XL, Cai DS. Effect of methoxymine on prevention and treatment of myocardial injury and cardiac function in elderly patients with hypotension during intraspinal anesthesia. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2023; 27:11755-11763. [PMID: 38164838 DOI: 10.26355/eurrev_202312_34773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE We aimed to investigate the effects of methoxamine to prevent hypotension in the elderly with intraspinal anesthesia (IA) on myocardial injury and cardiac function. PATIENTS AND METHODS A retrospective study was conducted by enrolling sixty elderly patients who underwent femoral head replacement (FHR) under IA in our hospital from August 2019 to August 2020. The patients were divided into two groups according to the random number table method. In the control group (CG) (30 patients), 5 mg of ephedrine was administered sedately when patients developed hypotension (20% below basal blood pressure). In the research group (RG) (30 cases), 2 μg/(kg·h) of methoxamine hydrochloride was given as a constant-rate pump before anesthesia, and 1 mg of methoxamine hydrochloride was administered intraoperatively if hypotension occurred. The hemodynamic [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR)], myocardial injury indexes [cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB), fatty acid binding protein (FABP), plasma amino-terminal brain natriuretic peptide precursor (NT-proBNP)], cardiac function indexes [systemic vascular resistance (SVR), stroke volume (SV), net percentage ejection time (ET)] were observed before anesthesia (T1), at the end of surgery (T2), and 6 h after surgery (T3) in both groups. The Bruggemann Comfort Score (BCS) and Visual Analog Scale (VAS) scores at T3, 12 h postoperatively (T4) and 24 h postoperatively (T5) in both groups were observed, and the incidence of adverse reactions to intralesional anesthesia in both groups was counted. RESULTS SBP, DBP and HR at T2 were lower than those at T1 in both groups, and SBP, DBP and HR at T3 were higher than those at T2, and SBP, DBP and HR at T2 and T3 in the RG were higher than those in the CG (p<0.05). In both groups, cTnⅠ, CK-MB and FABP were higher at T2 and T3 than at T1, higher at T3 than at T2, and NT-proBNP was higher at T2 than at T1 and T3, and lower in the RG than in the CG (p<0.05). In both groups, SVR and SV at time point T2 were lower than at time point T1 and ET was higher than at time point T1, SVR and SV at time point T3 were higher than at time point T2 and ET was lower than at time point T2, SVR and SV in the RG were higher than in the CG and ET was lower than in the CG (p<0.05). VAS scores were higher in both groups at T4 and T5 than at T3, and lower in the RG than in the CG (p<0.05). CONCLUSIONS Methoxamine can effectively reduce the risk of hypotension in geriatric endotracheal anesthesia, which can reduce myocardial injury and stabilize cardiac function in patients.
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Montalvo SK, Arbab M, Gonzalez Y, Lin MH, Parsons DDM, Zhuang T, Cai B, Pompos A, Hannan R, Westover KD, Zhang Y, Timmerman RD, Iyengar P. Predictive Factors for Response to Adaptive Therapy in Thoracic Stereotactic Ablative Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e43. [PMID: 37785405 DOI: 10.1016/j.ijrobp.2023.06.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Online adaptive radiotherapy (ART) has been increasingly adopted for clinical use. However, ART for thoracic malignancies has lagged beyond its implementation for other primary cancers. Efforts are needed to identify optimal patients for ART by finding trends for changes in tumor position, shape, or proximity to OARs are needed. We hypothesized tumor size, histology, pre-RT SUV value, and intrathoracic location could influence how tumors change during cone beam computed tomography (CBCT)-based ART Stereotactic Ablative Radiotherapy (SAbR) for thoracic disease. MATERIALS/METHODS Data was collected from a prospective registry of patients who received CBCT-ART and SAbR for primary and secondary lung tumors. Dosimetry data was obtained from the simulation planning and the daily adaptive workflow. Central lung tumors were defined as those located within 2 cm of the bronchial tree. Plans were either delivered as per simulation or through the online adaptive workflow delivery (AD). Change in planning tumor volumes (PTV) were calculated between initial and final fractions (ΔPTV). RESULTS A total of 42 patients with a median age of 67 (range 17-90) and median 8.3 months follow up, treated between June 2021 and December 2022 were included. Most patients had NSCLC or presumed NSCLC (73.85%, 31/42), and most lesions were peripheral (61.9%, 26/42) versus central (31%, 13/42) or apical (7.1%, 3/42). Mean dose and median fractions were 52.5 Gy (SD 8.07) and 5 (range 3-5) while median initial (i) PTV was 31.75 cm3 (IQR 42.3 cm3). On average, ΔPTV decreased by 4.9% (SD 21) and volume shrunk by 5 cm3 (SD 14.5). AD improved per fraction PTV coverage and conformality while esophageal, cardiac, and spinal cord dose were significantly decreased (all p < 0.05), and most fractions were delivered with AD (73.4%, 138/188). AD was aborted most often for small iPTVs. ΔPTV grew >10% for two lesions though their iPTV were < 10 cm3. 12/42 ΔPTV were >10% smaller by the end of RT and corresponded to larger iPTVs. Age, lung primary, metastatic disease, smoking status, and tumor location were not predictive for >10% decrease in ΔPTV. Among 24 biopsy-proven NSCLC ΔPTV was >10% smaller in 6/12 patients (50%) with adenocarcinoma and only in 2/12 (16.7%) with SCC, although this was not significant on χ2 testing (p = 0.08). There were no differences in local, regional, distant failure or death comparing those with a ΔPTV of >10% vs <10% (all p > 0.1). Comparing pre-treatment PET SUV and tumor response, lower SUVs appear to be associated with more PTV shrinkage, with no significant PTV change plateauing at SUV 20. However, this analysis was limited by the number of patients with high SUV values. CONCLUSION CBCT-ART SAbR is associated with improved PTV coverage, target conformality, and reduced OAR dose. Large iPTV and adenocarcinomas were more likely to decrease >10%. High metabolic activity appeared predictive for a lack of significant ΔPTV. Further clinical and radiographic features should be explored to predict response to ART.
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Gibbard G, Aguilera TA, Dan T, Zhuang T, Lin MH, Peng H, Jiang SB, Da Silva A, Kuduvalli G, Iyengar P, Sher DJ, Timmerman RD, Garant A, Cai B. Towards Biology-Guided Radiotherapy Planning and Delivery on a Novel O-Ring PET-Linac Platform: Extended Beyond Bone and Lung Lesions. Int J Radiat Oncol Biol Phys 2023; 117:e647. [PMID: 37785924 DOI: 10.1016/j.ijrobp.2023.06.2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Biology-guided radiotherapy (BgRT) with FDG signal collected via an on-board positron emission tomography (PET) system integrated in an O-ring gantry Linac was recently cleared by the FDA for lung and bone lesions. This study aims to determine if BgRT plans, guided via PET signal, are clinically acceptable for FDG-avid lesions in disease sites beyond bone and lung. MATERIALS/METHODS Ten patients previously treated for lesions in the liver, head and neck (HN), pancreas, renal and pelvic-abdominal lymph nodes were identified. Diagnostic PET/CT images of these treatment sites were first collected and processed/converted to mimic PET images that are acquired on PET-Linac and would be used to guide the delivery. For BgRT planning, the PTV was generated with 5 mm margin from GTV and a Biology Tracking Zone was generated including the anticipated full range of target motion. BgRT plans, guided by the emulated PET signal, were generated with 46Gy in 3 fractions for liver and 40Gy in 5 fractions for all other sites. BgRT plan deliverability was first assessed by evaluating the Activity Concentration (AC) and Normalized Target Signals (NTS) on converted PET images with the goal to meet NTS >2 (hard constraint) and AC >5kBq/ml (goal). BgRT plan quality was then evaluated with institutional guidelines on PTV coverage, OAR doses, conformity index (CI) and Heterogeneity index (HI). RESULTS BgRT plans were successfully generated for 11 target lesions among ten patients. The average diagnostic PET SUV, derived NTS and AC on converted PET images were 12.62, 9.33 and 12.10 kBq/ml, respectively. All images met the NTS constraints, and 8/11 plans met the AC goal for deliverability. All plans met the OAR hard constraints such as max dose on duodenum, small bowel, large bowel and spinal cord. Five of 11 plans had a limiting GI structure that resulted in an expected reduction in PTV coverage with an average PTV V100% = 77.9%, CI of 1.4, HI of 1.36 and max dose of 133.8%. The other 6 of 11 cases met the PTV V100% = 95%, had an average CI of 1.1, HI of 1.28 and Dmax of 127.67%. The estimated average time for BgRT delivery was 17 mins 25 secs. Although these plan parameters are deemed to be clinically acceptable, heterogeneity was detected inside the target region and suboptimal dose fall off was observed in some cases that may be caused by current implementation. CONCLUSION This preliminary study showed that BgRT plans were generated successfully with emulated PET images on 11 treatment sites covering HN, abdominal and pelvic regions. All plans met NTS constraints and 8 out of 11 met AC goals for deliverability. The plan quality of all BgRT plans were clinically acceptable based on institutional constraints. Further investigations are required to test more patients/sites for BgRT plan feasibility. Dosimetric benefit from margin reduction of BgRT target should also be investigated in future study.
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Li R, Montalvo SK, Zhuang T, Parsons DDM, Zhong X, Chen L, Iqbal Z, Kim H, Hrycushko BA, Westover KD, Zhang Y, Cai B, Lin MH, Iyengar P. Dosimetric Analysis of CBCT-Based Weekly Online Adaptive Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e36-e37. [PMID: 37785239 DOI: 10.1016/j.ijrobp.2023.06.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Anatomic and geometric changes are common during a radiotherapy course amongst patients receiving conventional fractionated radiotherapy for locally advanced non-small cell lung cancer (LA-NSCLC). These changes may cause significant deviation from initial reference plan resulting in over-treatment of normal tissue or under-coverage of the target. Cone-beam computed tomography (CBCT)-based online adaptive radiotherapy (ART) platforms allow for response to these changes and is being increasingly used in the clinic though less so for intrathoracic disease. We hypothesized weekly CBCT-ART would improve target coverage and decrease dose to organs at risk (OAR) in patients with LA-NSCLC. MATERIALS/METHODS Data was collected from a prospective registry of 23 LA-NSCLC patients treated to 60 Gy in 30 fractions with CBCT-ART between June 2021 and December 2022. For weekly ART (Wk-ART), online plan adaptation started on week two. The adapted plan was then used to treat patients with image guidance until the next ART. For comparison, doses were recalculated with the initial reference plan on the SCT with updated contours to derive non-adapted (non-ART) dosimetry for each week. The final dosimetric parameters were obtained by averaging weekly coverage (ITV, PTV) and critical OAR (Lung, esophagus, heart, spinal cord) doses for non-ART and weekly ART treatments respectively for each patient. Paired student t-test was performed to compare the dosimetric parameters between non-ART and Wk-ART. RESULTS We observed an average 29% ± 19% (median: 26%) reduction in ITV volume through the radiotherapy course, with 48% (11/23) of patients showing >30% reduction. Most significant volume reductions (16%) were observed between the third and fourth adaptation. Weekly ART showed significant (p<1×10-3) improvements in ITV and PTV coverage, and showed improved clinically relevant lung, esophageal, cardiac, and lung dosimetry (Table 1), especially in the later stages of treatment when the tumor showed significant shrinkage. The average time from contour review to quality assurance completed is 8.5±1.2 min. CONCLUSION CBCT-ART provides robust ART plan quality and efficient workflow. There are significant improvements in target coverage and OAR sparing in LA-NSCLC treated with weekly CBCT-ART and these are driven by the significant volume reduction of the ITV throughout treatment course.
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Keilty D, Visak J, Wang S, Chen L, Kim DN, Arbab M, Alluri PG, Zhong X, Iqbal Z, Zhuang T, Cai B, Kim H, Timmerman RD, Lin MH, Parsons DDM, Rahimi AS. Predicted Cardiac Toxicity in Daily Cone-Beam CT-Based Online Adaptive Stereotactic Partial Breast Irradiation with Decreased PTV Margins. Int J Radiat Oncol Biol Phys 2023; 117:e184-e185. [PMID: 37784811 DOI: 10.1016/j.ijrobp.2023.06.1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Partial breast irradiation (PBI) targets a smaller volume over less time compared to whole breast radiation, but the organ-at-risk (OAR) sparing allowed by its large (up to 1 cm) PTV can be improved. The heart is sensitive to low doses with conventional fractionation and NTCP models have been created for heart substructures. We hypothesized that daily online adaptive stereotactic PBI (A-SPBI) IMRT with 3-mm PTV improves dosimetry and predicted cardiac toxicity risk. MATERIALS/METHODS Patients treated with daily CBCT-based online A-SPBI IMRT were excluded if the minimum heart dose was <1 Gy. IMRT radiation plans with 3-mm PTV margins were recreated with 1-cm margins per the Florence APBI IMRT trial planning guideline. Dose statistics were converted to the equivalent doses in 2-Gy fractions (EQD2) using α/β = 3 for use in NTCP models and for comparison using paired t tests, with differences considered significant if p≤0.05. RESULTS The table details heart, left anterior descending artery (LAD), and left (LV) and right ventricle (RV) EQD2 statistics for 4 left-sided and 4 right-sided 3-mm PTV plans and their 1-cm PTV replans. For 2 patients with non-zero LV V5, 9-year excess cumulative risk of acute coronary event was <0.001% for both margin sizes. No plan reached thresholds for increased risk of non-cardiac death, major adverse cardiac event, or >10% decrease in LV ejection fraction. CONCLUSION Given the established relationship between low MHD and cardiac events, the significant decrease in MHD revealed in comparisons of 3-mm and 1-cm PTV A-SPBI plans of our first 8 patients is promising; we expect the forthcoming larger sample size to show significant differences in substructure doses. NTCP models created for non-IMRT breast plans and targets with higher heart exposure did not predict clinically-relevant differences in cardiac risk. NTCP model development for the low heart dose achieved with A-SPBI would define expected benefit in these patients; in their absence, daily adaptation should be considered in patients with unfavorable anatomy or cardiac risk factors.
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Keilty D, Visak J, Wang S, Chen L, Kim DN, Arbab M, Alluri PG, Zhong X, Iqbal Z, Zhuang T, Cai B, Kim H, Timmerman RD, Lin MH, Parsons DDM, Rahimi AS. Observed and Predicted Toxicity in Daily Cone-Beam CT-Based Online Adaptive Stereotactic Partial Breast Irradiation with Decreased PTV Margins. Int J Radiat Oncol Biol Phys 2023; 117:e184. [PMID: 37784810 DOI: 10.1016/j.ijrobp.2023.06.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Accelerated partial breast irradiation (APBI) delivers smaller radiation volumes over less time compared to whole breast irradiation (WBI), but the organ-at-risk (OAR) sparing allowed by its large (up to 1 cm) planning target volume (PTV) can be improved. PTV can be decreased with daily online adaptive planning, which we hypothesized yields low rates of adverse events observed and predicted by normal tissue complication probability (NTCP) models. MATERIALS/METHODS Intensity-modulated (IMRT) cone-beam CT (CBCT)-based daily online adaptive stereotactic PBI (A-SPBI) plans with 3-mm PTV from 8 patients were recreated with 1-cm PTV per the Florence APBI IMRT trial planning guideline. Dose statistics with evidence for association with toxicity were compared. Documented toxicities were collected for patients treated with A-SPBI with a minimum follow-up of 3.5 months and Common Terminology Criteria for Adverse Events (CTCAE) v.5.0 grade was assigned. Using α/β = 3 for breast and lung, dose statistics were converted to equivalent doses in 2-Gy fractions (EQD2) for use in NTCP models and for comparison using paired t tests, with differences considered significant if p≤0.05. RESULTS The table details EQD2 dose statistics for breast, lung, and cosmetic toxicity for A-SPBI plans with 3-mm PTV and their 1-cm PTV re-plans in 8 patients. PTV volume, mean lung dose (MLD), and lung V5, V20, and V30 were significantly lower in 1-cm plans. Acute, subacute (3-6 months), and late toxicities were collected for 30 patients followed for a median of 8 months (range 4-13 months). Radiation dermatitis was the most common acute toxicity (n = 16, 53%), followed by hyperpigmentation (n = 12, 40%), fibrosis (n = 9, 30%), and fatigue (n = 9, 30%). One grade 3 radiation dermatitis was the only grade ≥3 toxicity. Six patients (20%) acutely developed breast or axillary edema: 4 (13.3%) resolved, and 2 (6.7%) developed acutely and persist at last follow-up, >6 months after RT. No patient had a lung V20, V30, or MLD meeting thresholds for radiation-induced lung injury, radiation pneumonitis, or symptomatic or imaging-based pneumonitis models, respectively. The breast V55 model predicted a median risk of unfavorable cosmesis of 33% (range 26-44%) for A-SBPI plans and 35% (range 28-51) for 1-cm PTV plans (p = 0.28). CONCLUSION Observed acute toxicities are tolerable and rarely persist in patients treated with A-SPBI with 3-mm PTV margins with daily CBCT-based online adaptation. NTCP modeling predicts similar cosmetic outcome to 1-cm margins. The significant reduction in ipsilateral lung dose with a 3-mm PTV in our first 8 patients especially supports daily adaptation in low-risk breast cancer patients with smoking history and/or lung comorbidity.
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Surucu M, Vitzthum L, Chang DT, Gensheimer MF, Kovalchuk N, Han B, Iagaru AH, Da Silva A, Narayanan M, Aksoy D, Feghali K, Shirvani SM, Maniyedath A, Cai B, Pompos A, Dan T, Öz OK, Iyengar P, Timmerman RD, Garant A. Analysis of the Measured FDG Uptake from the First-in-Human Clinical Trial of Biology-Guided Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e61-e62. [PMID: 37785835 DOI: 10.1016/j.ijrobp.2023.06.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The RefleXion X1 system is a novel linear accelerator equipped with dual 90° PET arcs incorporated into its architecture to capture emissions from tumors and designed to respond by directing the radiation beam towards target. This study reports on the measured FDG uptake from the first in human multi-institutional clinical trial (BIOGUIDE-X) evaluating the performance and safety of the RefleXion X1 PET-LINAC. MATERIALS/METHODS A total of nine patients treated with stereotactic body radiotherapy (SBRT) for lung (5) and bone (4) tumors were enrolled in the Cohort II of this study after screening their pre-study diagnostic PET/CT, acquired up to 60 days prior to enrollment, to ensure their tumor size between 2 to 5 cm and SUVmax >6. After CT simulation, the tumor and OARs were delineated, and patients had a 4-pass Imaging-only (BgRT Modeling) PET/CT acquisition on the X1 system to generate biology-guided radiotherapy (BgRT) plans. Before the patients' first and last SBRT fractions, they were injected with FDG, and short PET pre-scan (1-pass) was performed on the X1 followed by a long-PET acquisition (4-pass) to emulate the expected BgRT dose distribution without firing beam. Patients were also imaged on a third-party diagnostic PET/CT scanner after the last-fraction X1 scan. This study compares the SUVmax from the screening PET/CT, X1 Imaging-only scan, X1 PET pre-scan and long scan before the first and last-fractions, and final diagnostic PET/CT. RESULTS The median time from injection to PET imaging was 84 ± 15.4 mins for X1 Imaging-only (used for generating BgRT plans), 77 ± 21.6 mins for X1 pre-scan (safety check before treatment start), 108+/- 22 mins for X1 long-PET (used to emulate treatment delivery), and 161 ± 23 mins for final diagnostic PET. For a nominal 10 mCi injection, the mean SUVmax for screening imaging performed on the diagnostic PET/CT was 10.8 ± 4.3. For a 15 mCi nominal injection, the mean SUVmax calculated on the X1 was 5.3 ± 2.6, 5.4 ± 2.0, 5.5 ± 2.6, 5.2 ± 1.8 and 5.4 ± 2.2 for the Imaging-only, first-fraction PET pre-scan, first-fraction long PET scan, last-fraction PET pre-scan, and last-fraction long PET scan, respectively. The overall median SUVmax for all patients across all timepoints and scans with X1 was calculated to be 4.8 with a range of 2.4 to 9.8. The median SUVmax for the diagnostic PET/CT scan after the last fraction X1 scan was 15.8 with a range of 8.5 to 27.7. CONCLUSION The dual PET arcs and limited axial extent of the X1 PET subsystem results in lower system sensitivity in comparison to diagnostic PET scanners equipped with full ring and larger axial extent, as expected. With the same FDG injection, the RefleXion X1 produced SUVmax values that were 30.4 % of the diagnostic PET/CT scanners' values. Nevertheless, the X1 collected sufficient emission data to enable successful completion of emulated BgRT deliveries that met dose accuracy criteria in a clinical setting.
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Garant T, Iyengar P, Dan T, Pompos A, Timmerman RD, Öz OK, Cai B, Shirvani SM, Aksoy D, Al Feghali KA, Maniyedath A, Narayanan M, Da Silva A, Surucu M, Gensheimer MF, Kovalchuk N, Han B, Pham D, Chang DT, Vitzthum L. Imaging Performance of the PET Scan on a Novel Ring Gantry-Based PET/CT Linear Accelerator System in the First-in-Human Study of Biology-Guided Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e665. [PMID: 37785968 DOI: 10.1016/j.ijrobp.2023.06.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Biology-guided radiotherapy (BgRT) is a novel tracked dose delivery modality using real-time positron emission tomography (PET) to guide radiotherapy beamlets. The present study was performed with sequential cohorts of participants to evaluate the performance and safety of BgRT. Primary endpoints were previously reported. We hereby report on one of the secondary endpoints assessing a novel treatment planning machine with integrated dual kVCT/PET imaging ("novel device") performance in comparison to a third-party diagnostic PET/CT scan. MATERIALS/METHODS This single-arm, open-label, prospective study included participants with at least 1 FDG-avid targetable primary or metastatic tumor (≥2cm and ≤5cm) in the lung or bone. PET imaging data were collected on the novel device and on a third-party diagnostic PET/CT performed in sequence once at the planning timepoint in Cohort I, and immediately before the last fraction among patients undergoing stereotactic radiotherapy in Cohort II. Three central read radiation oncologists (CRRO) provided an interpretation of the novel device PET scans which were compared to an agreement standard based on 3 central radiologists' review of the paired diagnostic PET/CT scan. Positive percent agreement for localization of the target tumor within the biology-tracking zone (BTZ) was the key metric because it reflects whether advancing patients to subsequent steps in the BgRT workflow based on the novel device's imaging was ultimately appropriate. RESULTS In Cohort 1, 6 image comparisons were performed. The positive (%) agreement for the aggregate radiation oncologist review was 100% (5/5), reflecting that in all 5 cases where the aggregate radiation oncologists deemed the tumor to fall within the BTZ based upon the novel device PET images, the central radiologists came to the same conclusion upon review of the paired diagnostic PET/CT images. The overall (%) agreement for the aggregate radiation oncologist review was 83.3% (5/6): localization was not established on the novel device in 1 case, even though it was established on the diagnostic PET/CT. This would not pose risk in real world practice as BgRT candidacy would be aborted for tumors not visible on the novel device. In Cohort II, among the 7 image comparisons, there was 100% positive percent agreement between the aggregate CRRO and the agreement standard as the localization criteria was met in both scans for all 7 patients. This was concordant with a 100% overall percent agreement. CONCLUSION This investigation demonstrated a 100% positive percent agreement between central review of this novel device images by radiation oncologists and central review of the accompanying third-party PET/CT images by radiologists. There were no cases where a positive localization by the aggregate CRRO was not confirmed by the third-party PET/CT standard, providing evidence against the likelihood of falsely positive localizations on the novel device that would inappropriately advance patients in the workflow.
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Gonzalez Y, Chen L, Lee H, Kim N, Arbab M, Alluri PG, Zhang Y, Chiu TD, Iqbal Z, Zhuang T, Cai B, Kim H, Pompos A, Jiang SB, Godley AR, Timmerman RD, Lin MH, Rahimi AS, Parsons DDM. Dosimetric Comparison of Adaptive Radiotherapy Modalities for Stereotactic Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2023; 117:S163-S164. [PMID: 37784408 DOI: 10.1016/j.ijrobp.2023.06.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) An increase in the availability of adaptive radiotherapy (ART) platforms have proven to be effective in the treatment of a variety of sites. In this study, we aim to evaluate the effectiveness of non-adaptive RT and 3 different ART platforms: (1) CBCT-based, (2) CT-based, and (3) MRI-based for stereotactic partial breast irradiation (SPBI). MATERIALS/METHODS Data were collected from 32 patients (16 left and 16 right breast) treated at a single institution. 16 patients (8 left and 8 right) treated using the non-ART platform were re-planned onto two different ART platforms, CBCT- and MRI-based. The remaining 16 patients treated using CT-based adaptive platform were not re-planned due to the prone patient treatment position (others systems supine). All cases were planned to 30 Gy in 5 fractions. Plan quality was evaluated based on pre-defined planning goals to the OARS: ipsilateral and contralateral lungs (Dmean, Dmax, V20 Gy, V9 Gy), ipsilateral (V15 Gy, V30 Gy) and contralateral breasts (Dmax), heart (Dmean, Dmax, V3 Gy, V1.5 Gy), skin (Dmax, V36.5 Gy), and rib (Dmax, V30 Gy). Target goals were defined by Dmax, Dmin, gradient index, and paddock conformality index. Re-planned cases were compared within the cohort using a paired t-test and a 2-sided t-test was used comparing to the CT-based platform. RESULTS Comparing the left and right breast cohort across all platforms, the CT-based ART system showed a signification dose reduction in Dmean (p<0.001 for all platforms), Dmax (p<0.001 for left breast, p<0.03 for right breast) and V9 Gy (p<0.004 for left breast, p<0.001 for right breast) to the ipsilateral lung, V15 Gy (p<0.004 for left breast cohort) to the ipsilateral breast, and Dmax to the contralateral breast (p<0.001) and ribs (p = 0.01, p<0.001, p = 0.01 for CBCT-ART, MRI-ART, and non-ART for left breast cohort only). On average, the MR-Linac platform showed the least degree of OAR sparing across nearly all dosimetric parameters evaluated when compared to all modalities, especially for contralateral lung Dmean and Dmax (p<0.05 for all dosimetric parameters for all platforms) and contralateral breast Dmax (p<0.003 for all platforms). The CBCT-based platform showed superior dose reduction in contralateral lung mean (p<0.03 for all platforms) and heart Dmean (p = 0.065, p<0.001, p = 0.045 for non-adaptive, MRI-ART, and CT-ART for left breast and p<0.008 for right breast). PTV coverage was comparable across all platforms, averaging at approximately 95%. The CT-based ART platform showed a significantly reduced gradient index relative to the CBCT- and MRI-based platforms (p<0.001). CONCLUSION For SPBI treatments, the CT-based ART platforms displayed a higher degree of OAR sparing for many of the dosimetric parameters recorded relative to the other ART and non-ART platforms presented. The MRI-based system typically showed less reduced OAR sparing; however, the advantage of the system is shown if soft tissue contrast is needed. PTV coverage remained comparable across all platforms.
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Surucu M, Vitzthum L, Chang DT, Gensheimer MF, Kovalchuk N, Han B, Pham D, Da Silva A, Narayanan M, Aksoy D, Feghali K, Shirvani SM, Maniyedath A, Cai B, Pompos A, Dan T, Öz OK, Iyengar P, Timmerman RD, Garant A. Workflow Considerations for Biology-Guided Radiotherapy (BgRT) Implementation. Int J Radiat Oncol Biol Phys 2023; 117:e441. [PMID: 37785431 DOI: 10.1016/j.ijrobp.2023.06.1618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Biology-guided radiotherapy (BgRT) is a novel platform that combines real-time PET imaging with a 6MV Linac to target tumors. The performance and safety of BgRT was assessed in the BIOGUIDE-X clinical trial. This study aims to report on the BgRT workflow steps and assess the time required for each step of the BgRT process during this trial. MATERIALS/METHODS A total of nine patients were enrolled in the second Cohort of the BIOGUIDE-X study which included patients treated with stereotactic body radiotherapy (SBRT) for lung tumors (5) and bone tumors (4). The pre-treatment BgRT workflow includes CT simulation, contouring, imaging-only (BgRT Modeling) PET acquisition, BgRT planning, patient specific QA and plan approval. The imaging-only PET acquisition on the X1 collects a representative PET volumetric 3D image and is an input to develop the BgRT treatment plan. The steps during the BgRT delivery session are kVCT localization, PET pre-scan, PET evaluation and BgRT delivery. The PET PreScan is a 1-pass short-duration PET acquisition that is used to confirm that the PET biodistribution on the day of treatment is consistent with that of the imaging-only PET. During BIOGUIDE-X, the BgRT delivery step was replaced by a 4-pass long-PET acquisition that was used to emulate the expected BgRT dose distribution without turning the beam on. To assess BgRT workflow, times from 18F-FDG injection to image-only PET acquisition, 18F-FDG injection to PET pre-scan, Pre-scan to PET evaluation, and PET evaluation to BgRT delivery (long PET acquisition) were recorded. RESULTS Time between the 18F-FDG injection and the X1 imaging-only PET scan was 84 ± 19 minutes which includes time for 18F-FDG update. Average time to perform imaging-only PET scan was 26 ± 4 minutes. During the BgRT 'delivery' session, the mean time between the kVCT acquisition and PET pre-scan acquisition was 7 ± 3 minutes. The mean time to acquire a 1-pass PET pre-scan was 6 ± 1 then followed by 6 ± 1 minutes for the PET pre-scan dose calculation to estimate the BgRT doses that it would have delivered for this fraction. On average, the PET reconstruction, the PET signal localization verification and the evaluation of safety metrics took 11 ± 4 minutes. The mean time for BgRT 'delivery' was 27 ± 5 minutes based on the 4-pass long PET acquisition. Time from the start of the BgRT session to the end of the BgRT 'delivery' with this version of the investigative product release was 65 ± 9 minutes. CONCLUSION The new processes introduced by the BgRT technology were evaluated and found clinically feasible. Improvements are being undertaken to shorten the time required for each step and to increase patient comfort ahead of BgRT clinical implementation.
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Cai B, Wilson A. A205 EVALUATING THE ASSOCIATION BETWEEN PERIPHERAL BLOOD EOSINOPHILS AND DRUG RESPONSE IN CROHN'S DISEASE: CONTINUING ANALYSIS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991192 DOI: 10.1093/jcag/gwac036.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Th2 cytokines, IL-5 and IL-13 enhance peripheral and mucosal eosinophil survival, recruitment and degranulation, facilitating inflammation in Crohn's Disease. In a preliminary analysis, peripheral eosinophilia (PBE) is seen to have an association with rates of steroid response and anti-TNF response in CD patients. Participants with high PBE (> 200 cells/μL) appear to be more steroid-responsive but less responsive to Th1-targeting anti-TNF therapies. We hypothesize the pattern of PBE at CD diagnosis can help identify distinct subsets within a larger CD population and correlate with response to treatments such as prednisone or anti-TNFs. Purpose We aim to evaluate the pattern of PBE of CD patients at time of diagnosis (prior to drug exposure) and with each subsequent treatment; and if baseline PBE or any changes seen with drug exposures are predictive of treatment response. Method A retrospective cohort study is ongoing with CD patients exposed to glucocorticoids and an anti-TNF seen at 3 hospitals affiliated with University of Western Ontario. Patients were identified using administrative databases and reviewed for biochemical data (complete blood count) and disease activity (Harvey Bradshaw Index) at baseline, before and after each drug exposure. Participants were classified as having high PBE (eosinophils>200 cells/μL) versus low PBE (eosinophils <200 cells/μL). To date, 350 patients have been screened. Subgroup analyses of PBE > 300 cells/μL, and differences between female and male patients will be carried out. Result(s) 46 of 200 CD patients are included in the continuing analysis with a mean age of 45 years. 26 had PBE >200 cells/μL at baseline and 20 did not. The median number therapies used was 4 (IQR=0.75). All received glucocorticoids followed by an anti-TNF. There was no difference in the occurrence of hospitalization or surgery between the two groups. Overall 50% participants with high PBE >200 and >300 cells/μL had clinical response to glucocorticoid exposure, seen as a 3-point decrease in HBI compared to 45%, 47% in the low PBE cohort (n=13/26 vs. n=9/20 p=0.77; n=6/12 vs. n=16/34 p=1.0 respectively). With subsequent anti-TNF exposure, PBE rebounded in 7 participants. 36% patients in the high PBE group required anti-TNF dose escalation versus 24% in the low PBE group (n=9/25 vs. n=5/21, p=0.52). The proportion of patients with anti-TNF discontinuation was similar in both groups (high PBE 19.2%, n=5/26 vs. low PBE 15%, n=3/20, p=1.0). Men had higher steroid response rates compared to women in both high and low PBE groups (n=6/8 vs. n=8/18 p=0.21; n=4/9 vs. 4/11 p=1.0 respectively). Conclusion(s) Peripheral eosinophilia is seen in varying degrees in CD patients. Participants with high PBE are more steroid-responsive. High PBE patients overall were less responsive to anti-TNF therapies, requiring more dose-escalation and discontinued anti-TNF treatment. Completion of this study will help clarify the association between PBE in CD and treatment response. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Cai B, Arnold Egloff S, Goyal R, Cai B, Caro N, Frost M, Mahmud S, Ansquer V, Davis K, Brisbin L, Lisi M, McKenzie A, Paulson S. PP01.63 Real-World Assessment of Clinical Outcomes Associated with Immunotherapy (IO) and chemotherapy in Non–Small Cell Lung Cancer (NSCLC) Patients with Brain Metastases and METexon14 Skipping Mutations Treated in US Community Centers. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Fan ZX, Wang CB, Fang LL, Cai B, Yuan P, Niu TT, Ma L, Yuan GB, Liu GZ. [Clinical features, risk factors and prognosis of idiopathic dilated cardiomyopathy complicated by ischemic stroke]. ZHONGHUA YI XUE ZA ZHI 2022; 102:3592-3597. [PMID: 36480862 DOI: 10.3760/cma.j.cn112137-20220427-00949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To analyze the clinical features, risk factors and prognosis of idiopathic dilated cardiomyopathy (DCM) complicated with ischemic stroke (IS) (DCM-IS). Methods: The clinical data of patients with idiopathic DCM (n=613) in Beijing Anzhen Hospital, Liangxiang Hospital and Fuxing Hospital from January 2016 to December 2020 were retrospectively collected, and among them, 123 cases were DCM-IS. Clinical features of patients with DCM-IS were summarized and multivariate logistic regression model was utilized to analyze the independent risk factors of DCM-IS. Furthermore, 1-year follow-up was conducted and Kaplan-Meier curve was adopted to analyze the prognosis of DCM, using all-cause death and heart transplantation as adverse outcomes. Results: Among the 70 patients with DCM-IS, 6 patients (8.6%, 6/70) were in accordance with the subtype of large artery atherosclerosis, and 47 patients (67.1%, 47/70) were in line with the subtype of cardiogenic embolism, and small artery occlusion subtype (ie, lacunar infarction) were detected in 17 cases (24.3%, 17/70). Hypertension [odds ratio (OR)=1.617, 95% confidence interval (CI): 1.049-2.491, P=0.029], hyperlipidemia (OR=1.918, 95%CI: 1.198-3.073, P=0.007), atrial fibrillation (AF) (OR=1.617, 95%CI: 1.016-2.572, P=0.043), lower estimated glomerular filtration rate (eGFR) (OR=0.986, 95%CI: 0.977-0.996, P=0.005) and a higher incidence of intracardiac thrombus (OR=6.127, 95%CI: 3.174-11.827, P<0.001) were risk factors for DCM-IS. The overall 1-year survival rate was lower in DCM-IS patients (70.7%) than DCM patients without stroke (83.6%, P=0.004), and the main causes of death included obstinate heart failure (3 cases of DCM-IS, and 5 cases of non-DCM-IS) and malignant arrhythmia (DCM-IS) (22 cases of DCM-IS, and 18 cases of non-DCM-IS). Conclusions: Among IS patients with idiopathic DCM, cardioembolism is the most common, followed by lacunar infarction, and the large-artery atherosclerotic subtype is the least common.Hypertension, hyperlipidemia, AF, lower eGFR value and higher incidence of intracardiac thrombus are risk factors for DCM-IS. DCM patients complicated with IS have poor short-term prognosis, and obstinate heart failure and malignant arrhythmia are their main causes of death.
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Meng B, Dohopolski M, Bai T, Jiang S, Cai B, Lin M. Quantifying AI Assisted Auto-Segmentations Performance for a Clinical Online Adaptive Radiotherapy System in Multiple Treatment Sites. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Montalvo S, Kim D, Nwachukwu C, Alluri P, Parsons D, Lin M, Cai B, Zhuang T, Hrycushko B, Chen L, Timmerman R, Rahimi A. Real-Time Online Adaptation for Accelerated Partial Breast Irradiation Significantly Improves Target Coverage without Compromising Organs at Risk. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Gonzalez Y, Meng B, Parsons D, Hrycushko B, Zhuang T, Cai B, Zhang Y, Westover K, Lin M, Iyengar P. Initial Clinical Experience of CBCT-Based Adaptive Online Radiotherapy for SAbR of Thoracic Malignancies. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Zhao H, Meng B, Dohopolski M, Choi B, Liang X, Bai T, Nguyen D, Cai B, Lin M, Jiang S. Segmentation of Targets and Organs at Risk for CBCT-Based Online Adaptive Radiotherapy Using Recurrent Neural Networks: A Clinical Evaluation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wang K, Morgan H, Yan Y, Desai N, Hannan R, Chambers E, Dohopolski M, Cai B, Lin M, Sher D, Wang J, Wang A, Jiang S, Timmerman R, Park J, Garant A. Time Dependence of Coverage of the Prostatic Fossa: Implications for Daily Adaptive Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Meng Y, Cai B, Lan Q, Niu F, Zhang X, Yang Y. Synthesis and Structural Characterization of a Di-nuclear Uranyl Complex with Quinoline-6-carboxylate. CRYSTALLOGR REP+ 2022. [DOI: 10.1134/s1063774522020092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cai B, Wilson A. A163 EVALUATING THE ASSOCIATION BETWEEN PERIPHERAL BLOOD EOSINOPHILS AND DRUG RESPONSE IN CROHN’S DISEASE: A PRELIMINARY REPORT. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859199 DOI: 10.1093/jcag/gwab049.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Th1, Th2, and Th17 immune pathways are variably activated in inflammatory bowel disease (IBD). The degree to which pathway having a more dominant role in propagating Crohn’s disease (CD) is not considered when selecting a treatment strategy. Th2 cytokines, IL-5 and IL-13 enhance eosinophil survival, recruitment and degranulation, facilitating inflammation. Mucosal eosinophilia has been documented in CD and its presence is a surrogate marker of Th2 pathway activation. Peripheral eosinophilia has an established role in asthma to help prognosticate treatment response to Th2-cytokine-specific therapies. We hypothesize the pattern of peripheral blood eosinophils (PBE) at CD diagnosis will identify distinct subsets within a larger CD population and correlate with response to treatments such as prednisone or anti-TNFs. Aims We aim to evaluate the pattern of PBE of CD patients at time of diagnosis (prior to drug exposure) and with each subsequent treatment; and if baseline PBE or any changes seen with drug exposures are predictive of treatment response. Methods A retrospective cohort study is ongoing with CD patients exposed to glucocorticoids and an anti-TNF seen at one of 3 hospitals affiliated with University of Western Ontario. Patients were identified using administrative databases and reviewed for biochemical data (complete blood count) and disease activity (Harvey Bradshaw Index) at baseline as well as before and after each drug exposure. Participants were classified as having high PBE (eosinophils >200 cells/μl) versus low PBE (eosinophils <200 cells/μl). Results To date,10 of 200 CD patients are included in the preliminary analyses with a mean age of 47. 8 had PBE >200 cells/μL at baseline, while 2 did not. The median number therapies used was 4 (IQR=0.75). All received glucocorticoids followed by an anti-TNF. There was no difference in the occurrence of hospitalization or surgery between the two cohorts. Overall 75% (n=6/8) participants with high PBE had clinical response to glucocorticoid exposure, seen as a 3-point decrease in HBI compared to 0% (n=0/2, p=0.5) in the low PBE cohort. With subsequent anti-TNF exposure, PBE rebounded in 6 participants. More patients in the high PBE group required anti-TNF dose escalation versus the low PBE group (63%, n=5/8 versus 50%, n=1/2, p=0.99). The proportion of patients with anti-TNF discontinuation was similar in both groups (high PBE, 50%, n=4/8 versus low PBE, 50%, n=1/2, p=1.00). Conclusions Peripheral eosinophilia is seen in varying degrees in CD patients. Participants with high PBE appear to be more steroid-responsive which is typical for Th2-mediated pathways. They were less responsive to Th1-targeting anti-TNF therapies, requiring more dose-escalation and discontinued anti-TNF treatment. Completion of this study will help clarify the association between PBE in CD and treatment response. Funding Agencies None
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Adhikari P, Ajaj R, Auty D, Bina C, Bonivento W, Boulay M, Cadeddu M, Cai B, Cárdenas-Montes M, Cavuoti S, Chen Y, Cleveland B, Corning J, Daugherty S, DelGobbo P, Di Stefano P, Doria L, Dunford M, Erlandson A, Farahani S, Fatemighomi N, Fiorillo G, Gallacher D, Garcés E, García Abia P, Garg S, Giampa P, Goeldi D, Gorel P, Graham K, Grobov A, Hallin A, Hamstra M, Hugues T, Ilyasov A, Joy A, Jigmeddorj B, Jillings C, Kamaev O, Kaur G, Kemp A, Kochanek I, Kuźniak M, Lai M, Langrock S, Lehnert B, Levashko N, Li X, Litvinov O, Lock J, Longo G, Machulin I, McDonald A, McElroy T, McLaughlin J, Mielnichuk C, Monroe J, Oliviéro G, Pal S, Peeters S, Pesudo V, Piro MC, Pollmann T, Rand E, Rethmeier C, Retière F, Rodríguez-García I, Roszkowski L, Sanchez García E, Sánchez-Pastor T, Santorelli R, Sinclair D, Skensved P, Smith B, Smith N, Sonley T, Stainforth R, Stringer M, Sur B, Vázquez-Jáuregui E, Viel S, Vincent A, Walding J, Waqar M, Ward M, Westerdale S, Willis J, Zuñiga-Reyes A. Erratum: Constraints on dark matter-nucleon effective couplings in the presence of kinematically distinct halo substructures using the DEAP-3600 detector [Phys. Rev. D
102
, 082001 (2020)]. Int J Clin Exp Med 2022. [DOI: 10.1103/physrevd.105.029901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Adhikari P, Ajaj R, Alpízar-Venegas M, Auty DJ, Benmansour H, Bina CE, Bonivento W, Boulay MG, Cadeddu M, Cai B, Cárdenas-Montes M, Cavuoti S, Chen Y, Cleveland BT, Corning JM, Daugherty S, DelGobbo P, Di Stefano P, Doria L, Dunford M, Ellingwood E, Erlandson A, Farahani SS, Fatemighomi N, Fiorillo G, Gallacher D, García Abia P, Garg S, Giampa P, Goeldi D, Gorel P, Graham K, Grobov A, Hallin AL, Hamstra M, Hugues T, Ilyasov A, Joy A, Jigmeddorj B, Jillings CJ, Kamaev O, Kaur G, Kemp A, Kochanek I, Kuźniak M, Lai M, Langrock S, Lehnert B, Leonhardt A, Levashko N, Li X, Lissia M, Litvinov O, Lock J, Longo G, Machulin I, McDonald AB, McElroy T, McLaughlin JB, Mielnichuk C, Mirasola L, Monroe J, Oliviéro G, Pal S, Peeters SJM, Perry M, Pesudo V, Picciau E, Piro MC, Pollmann TR, Raj N, Rand ET, Rethmeier C, Retière F, Rodríguez-García I, Roszkowski L, Ruhland JB, Sanchez García E, Sánchez-Pastor T, Santorelli R, Seth S, Sinclair D, Skensved P, Smith B, Smith NJT, Sonley T, Stainforth R, Stringer M, Sur B, Vázquez-Jáuregui E, Viel S, Walding J, Waqar M, Ward M, Westerdale S, Willis J, Zuñiga-Reyes A. First Direct Detection Constraints on Planck-Scale Mass Dark Matter with Multiple-Scatter Signatures Using the DEAP-3600 Detector. PHYSICAL REVIEW LETTERS 2022; 128:011801. [PMID: 35061499 DOI: 10.1103/physrevlett.128.011801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/15/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
Dark matter with Planck-scale mass (≃10^{19} GeV/c^{2}) arises in well-motivated theories and could be produced by several cosmological mechanisms. A search for multiscatter signals from supermassive dark matter was performed with a blind analysis of data collected over a 813 d live time with DEAP-3600, a 3.3 t single-phase liquid argon-based detector at SNOLAB. No candidate signals were observed, leading to the first direct detection constraints on Planck-scale mass dark matter. Leading limits constrain dark matter masses between 8.3×10^{6} and 1.2×10^{19} GeV/c^{2}, and ^{40}Ar-scattering cross sections between 1.0×10^{-23} and 2.4×10^{-18} cm^{2}. These results are interpreted as constraints on composite dark matter models with two different nucleon-to-nuclear cross section scalings.
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Adhikari P, Ajaj R, Alpízar-Venegas M, Amaudruz PA, Auty DJ, Batygov M, Beltran B, Benmansour H, Bina CE, Bonatt J, Bonivento W, Boulay MG, Broerman B, Bueno JF, Burghardt PM, Butcher A, Cadeddu M, Cai B, Cárdenas-Montes M, Cavuoti S, Chen M, Chen Y, Cleveland BT, Corning JM, Cranshaw D, Daugherty S, DelGobbo P, Dering K, DiGioseffo J, Di Stefano P, Doria L, Duncan FA, Dunford M, Ellingwood E, Erlandson A, Farahani SS, Fatemighomi N, Fiorillo G, Florian S, Flower T, Ford RJ, Gagnon R, Gallacher D, García Abia P, Garg S, Giampa P, Goeldi D, Golovko V, Gorel P, Graham K, Grant DR, Grobov A, Hallin AL, Hamstra M, Harvey PJ, Hearns C, Hugues T, Ilyasov A, Joy A, Jigmeddorj B, Jillings CJ, Kamaev O, Kaur G, Kemp A, Kochanek I, Kuźniak M, Lai M, Langrock S, Lehnert B, Leonhardt A, Levashko N, Li X, Lidgard J, Lindner T, Lissia M, Lock J, Longo G, Machulin I, McDonald AB, McElroy T, McGinn T, McLaughlin JB, Mehdiyev R, Mielnichuk C, Monroe J, Nadeau P, Nantais C, Ng C, Noble AJ, O’Dwyer E, Oliviéro G, Ouellet C, Pal S, Pasuthip P, Peeters SJM, Perry M, Pesudo V, Picciau E, Piro MC, Pollmann TR, Rand ET, Rethmeier C, Retière F, Rodríguez-García I, Roszkowski L, Ruhland JB, Sánchez-García E, Santorelli R, Sinclair D, Skensved P, Smith B, Smith NJT, Sonley T, Soukup J, Stainforth R, Stone C, Strickland V, Stringer M, Sur B, Tang J, Vázquez-Jáuregui E, Viel S, Walding J, Waqar M, Ward M, Westerdale S, Willis J, Zuñiga-Reyes A. Pulse-shape discrimination against low-energy Ar-39 beta decays in liquid argon with 4.5 tonne-years of DEAP-3600 data. THE EUROPEAN PHYSICAL JOURNAL. C, PARTICLES AND FIELDS 2021; 81:823. [PMID: 34720726 PMCID: PMC8550104 DOI: 10.1140/epjc/s10052-021-09514-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
The DEAP-3600 detector searches for the scintillation signal from dark matter particles scattering on a 3.3 tonne liquid argon target. The largest background comes from 39 Ar beta decays and is suppressed using pulse-shape discrimination (PSD). We use two types of PSD estimator: the prompt-fraction, which considers the fraction of the scintillation signal in a narrow and a wide time window around the event peak, and the log-likelihood-ratio, which compares the observed photon arrival times to a signal and a background model. We furthermore use two algorithms to determine the number of photons detected at a given time: (1) simply dividing the charge of each PMT pulse by the mean single-photoelectron charge, and (2) a likelihood analysis that considers the probability to detect a certain number of photons at a given time, based on a model for the scintillation pulse shape and for afterpulsing in the light detectors. The prompt-fraction performs approximately as well as the log-likelihood-ratio PSD algorithm if the photon detection times are not biased by detector effects. We explain this result using a model for the information carried by scintillation photons as a function of the time when they are detected.
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