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Abstract Background To investigate the impact of using contrast-enhanced computed tomography (CHCT) in the dosimetry of stereotactic body radiation therapy (SBRT) for liver metastases treated with MR-Linac. Methods A retrospective study was conducted on 21 liver cancer patients treated with SBRT (50 Gy in 5 fractions) using a 1.5 Tesla Unity MR-Linac. The clinical treatment plans optimised on plain computed tomography (pCT) were used as reference. The electronic density (ED) of regions of interest (ROIs) including the liver, duodenum, esophagus, spinal cord, heart, ribs, and lungs, from pCT and CHCT, was analysed. The average ED of each ROI from CHCT was used to generate synthetic CT (sCT) images by assigning the average ED value from the CHCT to the pCT. Clinical plans were recalculated on sCT images. Dosimetric comparisons between the original treatment plan (TPpCT) and the sCT plan (TPsCT) were performed using dose-volume histogram (DVH) parameters, and gamma analysis. Results Significant ED differences (p

Abstract Purpose Lympho-vascular invasion (LVI) and perineural invasion (PNI) have been established as prognostic factors in various types of cancers. The preoperative prediction of LVI and PNI has the potential to guide personalized medicine strategies for patients with esophageal squamous cell cancer (ESCC). This study investigates whether radiomics features derived from preoperative contrast-enhanced CT could predict LVI and PNI in ESCC patients. Methods and materials A retrospective cohort of 544 ESCC patients who underwent esophagectomy were included in this study. Preoperative contrast-enhanced CT images, pathological results of PNI and LVI, and clinical characteristics were collected. For each patient, the gross tumor volume (GTV-T) and lymph nodes volume (GTV-N) were delineated and four categories of radiomics features (first-order, shape, textural and wavelet) were extracted from GTV-T and GTV-N. The Mann–Whitney U test was used to select significant features associated with LVI and PNI in turn. Subsequently, radiomics signatures for LVI and PNI were constructed using LASSO regression with ten-fold cross-validation. Significant clinical characteristics were combined with radiomics signature to develop two nomogram models for predicting LVI and PNI, respectively. The area under the curve (AUC) and calibration curve were used to evaluate the predictive performance of the models. Results The radiomics signature for LVI prediction consisted of 28 features, while the PNI radiomics signature comprised 14 features. The AUCs of the LVI radiomics signature were 0.77 and 0.74 in the training and validation groups, respectively, while the AUCs of the PNI radiomics signature were 0.69 and 0.68 in the training and validation groups. The nomograms incorporating radiomics signatures and significant clinical characteristics such as age, gender, thrombin time and D-Dimer showed improved predictive performance for both LVI (AUC: 0.82 and 0.80 in the training and validation group) and PNI (AUC: 0.75 and 0.72 in the training and validation groups) compared to the radiomics signature alone. Conclusion The radiomics features extracted from preoperative contrast-enhanced CT of gross tumor and lymph nodes have demonstrated their potential in predicting LVI and PNI in ESCC patients. Furthermore, the incorporation of clinical characteristics has shown additional value, resulting in improved predictive performance.

Abstract Background Magnetic resonance-guided adaptive radiotherapy (MRgART) at MR-Linac allows for plan optimisation on the MR-based synthetic CT (sCT) images, adjusting the target and organs at risk according to the patient’s daily anatomy. Conversely, conventional linac image-guided radiotherapy (IGRT) involves rigid realignment of regions of interest to the daily anatomy, followed by the delivery of the reference computed tomography (CT) plan. This study aims to evaluate the effectiveness of MRgART versus IGRT for rectal cancer patients undergoing short-course radiotherapy, while also assessing the dose accumulation process to support the findings and determine its usefulness in enhancing treatment accuracy. Methods Nineteen rectal cancer patients treated with a 1.5 Tesla MR-Linac with a prescription dose of 25 Gy (5 Gy x 5) and undergoing daily adapted radiotherapy by plan optimization based on online MR-based sCT images, were included in this retrospective study. For each adapted plan ( $$\:{\text{T}\text{P}}_{\text{a}\text{d}\text{a}\text{p}}$$ ), a second plan ( $$\:{\text{T}\text{P}}_{\text{I}\text{G}\text{R}\text{T}}$$ ) was generated by recalculating the reference CT plan on the daily MR-based sCT images after rigid registration with the reference CT images to simulate the IGRT workflow. Dosimetry of $$\:{\text{T}\text{P}}_{\text{a}\text{d}\text{a}\text{p}}$$ and $$\:\:{\text{T}\text{P}}_{\text{I}\text{G}\text{R}\text{T}}$$ was compared for each fraction. Cumulative doses on the first and last fractions were evaluated for both workflows. The dosimetry per single fraction and the cumulative doses were compared using dose-volume histogram parameters. Results Ninety-five fractions delivered with MRgART were compared to corresponding simulated IGRT fractions. All MRgART fractions fulfilled the target clinical requirements. IGRT treatments did not meet the expected target coverage for 63 out of 94 fractions (67.0%), with 13 fractions showing a V95 median point percentage decrease of 2.78% (range, 1.65-4.16%), and 55 fractions exceeding the V107% threshold with a median value of 15.4 cc (range, 6.0-43.8 cc). For the bladder, the median $$\:{\text{D}}_{15\text{c}\text{c}}$$ values were 18.18 Gy for the adaptive fractions and 19.60 Gy for the IGRT fractions. Similarly the median $$\:{\text{D}}_{5\text{c}\text{c}}$$ values for the small bowel were 23.40 Gy and 25.69 Gy, respectively. No statistically significant differences were observed in the doses accumulated on the first or last fraction for the adaptive workflow, with results consistent with the single adaptive fractions. In contrast, accumulated doses in the IGRT workflow showed significant variations mitigating the high dose constraint, nevertheless, more than half of the patients still did not meet clinical requirements. Conclusions MRgART for short-course rectal cancer treatments ensures that the dose delivered matches each fraction of the planned dose and the results are confirmed by the dose accumulation process, which therefore seems redundant. In contrast, IGRT may lead to target dose discrepancies and non-compliance with organs at risk constraints and dose accumulation can still highlight notable dosimetric differences.

Access to solid organ transplantation in patients with intellectual disability is associated with health inequities due to concerns about treatment adherence, survival rates, and post-transplant quality of life. This systematic literature review aims to compare outcomes after organ transplantation in patients with intellectual disability compared to patients without intellectual disability. Embase, Medline Ovid, PsycINFO, Web of Science, Cochrane Central Register of Trials, and Google Scholar databases were systematically searched for studies concerning pediatric or adult solid organ transplantation in recipients with a diagnosis of intellectual disability prior to transplantation. Primary outcomes were patient and graft survival rates. Secondary outcomes were acute rejection rate, adherence rates, and quality of life. Nine studies were included, describing kidney (n = 6), heart (n = 4) and liver (n = 1) transplantation. Reported graft survival rates were non-inferior or better compared to patients without intellectual disability, while patient survival was reportedly slightly lower in two studies reporting on kidney transplantation. Although current evidence has a potential selection bias based on including patients with a sufficient support network, intellectual disability alone should not be regarded a relative or absolute contra-indication for solid organ transplantation.

Sericulture is the cultivation of silkworms to produce silk using white mulberry leaves (Morus alba L.); thus, the sector's quality production of mulberry seedlings on a large scale is economically important. The production of seedlings through cuttings is the most effective and fastest reproduction method. Still, it can also be enhanced using synthetic rooting agents, increasing the productive potential of white mulberry crops. The current work aims to evaluate the response of cuttings taken from different parts of the branch of M. alba var. Miura (Apical 1, Apical 2, Medial, Basal 1, and Basal 2) and treated with indolebutyric acid (IBA; 500, 1,000, and 1,500 mg L-1) and commercial rooting agent Forth® (10 % v/v), in addition to a control treatment. After treating the branches, they were placed in polyethylene containers filled with substrate and kept in a greenhouse for 70 days. The application of hormones on cuttings of M. alba favored several morpho-agronomic parameters evaluated for the propagules obtained from different positions on the branch. In conclusion, applying 500 or 1,000 mg L-1 of IBA is recommended for the various positions, with Basal 1 and Basal 2 showing higher values ​​in the evaluated parameters than the other positions. The results can help silk breeders optimize white mulberry crop production.

Abstract Objective Neoadjuvant chemotherapy (NACT) has become the standard of care for patients with triple-negative breast cancer (TNBC) with tumors > 1 cm or positive axillary nodes. Pathologic complete response (pCR) has been used as an endpoint to select patients for treatment scaling. This study aimed to examine the benefit of adding adjuvant capecitabine for TNBC patients who did not achieve pCR after standard NACT in a real-world scenario. Methods This retrospective cohort study included all patients with TNBC who underwent NACT between 2010 and 2020. Clinicopathological data were obtained from the patient records. Univariate and multivariate analyses were conducted at the 5 years follow-up period. Results We included 153 patients, more than half of whom had stage III (58.2%) and high-grade tumors (60.8%). The overall pCR rate was 34.6%, and 41% of the patients with residual disease received adjuvant capecitabine. Disease-specific survival (DSS) among the patients who achieved pCR was significantly higher (p

Este artigo busca compreender o legado autoritário brasileiro e sua relação com os recentes episódios de censura às artes. Para tal, o estudo realiza um levantamento das produções culturais censuradas e/ou alvo de ataques de grupos conservadores no período entre junho de 2017 e março de 2020. Foram consideradas as produções que se enquadraram em três critérios: foram alvo de ação conservadora de julgamento ou criminalização da arte; tiveram repercussão nacional na mídia mainstream; envolveram reação e/ou mobilização em defesa das manifestações artísticas. Argumentamos que o atual cenário de ruptura democrática aflorou o passado autoritário do país, o que contribuiu por desencadear diversos episódios de censura. Partimos dos conceitos de autoritarismo, censura e liberdade de expressão aliados à análise de conteúdo para empreender tal reflexão.

Advancements in radiotherapy auto-segmentation necessitate reliable and efficient workflows. Therefore, a standardized fully automatic workflow was developed for three commercially available deep learning-based auto-segmentation applications and compared to a manual workflow for safety and efficiency. The workflow underwent safety evaluation with failure mode and effects analysis. Notably, eight failure modes were reduced, including seven with severity factors ≥7, indicating the effect on patients, and two with Risk Priority Number value >125, which assesses relative risk level. Efficiency, measured by mouse clicks, showed zero clicks with the automatic workflow. This automation illustrated improvement in both safety and efficiency of workflow.

In radiotherapy treatment planning, optimization is essential for achieving the most favorable plan by adjusting optimization criteria. This study introduced an innovative approach to automatically fine-tune optimization parameters for volumetric modulated arc therapy prostate planning, ensuring all constraints were met. A knowledge-based planning model was invoked, and the fine-tuning process was applied through an in-house developed script. Among 25 prostate plans, this fine-tuning increased the number of plans meeting all constraints from 10/25 to 22/25, with a reduction in mean monitor units per gray without increasing plan’s complexity. This automation improved efficiency by saving time and resources in treatment planning.

In recent years, several strategies have been developed for the treatment of transthyretin-related amyloidosis, whose complex clinical manifestations involve cardiomyopathy and polyneuropathy. In view of this, transthyretin stabilizers represent a major cornerstone in treatment thanks to the introduction of tafamidis into therapy and the entry of acoramidis into clinical trials. However, the clinical treatment of transthyretin-related amyloidosis still presents several challenges, urging the development of new and improved therapeutics. Bearing this in mind, in this paper, the most promising among the recently published transthyretin stabilizers were reviewed. Their activity was described to provide some insights into their clinical potential, and crystallographic data were provided to explain their modes of action. Finally, structure–activity relationship studies were performed to give some guidance to future researchers aiming to synthesize new transthyretin stabilizers. Interestingly, some new details emerged with respect to the previously known general rules that guided the design of new compounds.

Abstract In order to examine the progressive chemical evolution of halogens (F, Cl, Br, I) in altered ocean crust (AOC) during prograde subduction, this study compares bulk and in situ halogen concentrations in mafic samples from three petrogenetically related exhumed terrains in the Western Alps (the Chenaillet ophiolite, the Queyras ophiolites of the Schistes Lustrés, and the Monviso ophiolite). Samples from the Chenaillet ophiolite represent oceanic crust unaffected by metamorphic halogen loss and define a protolith halogen content (122 μg/g F, 29 μg/g Cl, 82 ng/g Br, and 98 ng/g I). Samples from the Queyras ophiolites experienced blueschist facies conditions, undergoing recrystallization and halogen loss (74 μg/g F, 19 μg/g Cl, 70 ng/g Br, and 63 ng/g I). Eclogite facies samples from the Monviso meta‐ophiolite exhibit markedly reduced Cl (8 μg/g Cl) and Br (42 ng/g Br) contents relative to samples from Chenaillet and Queyras. Using electron probe microanalysis (EPMA), F and Cl host minerals (e.g., amphibole, chlorite, epidote) are identified and characterized in selected samples, showing a broad distribution of F and Cl, lending support to the view that halogen devolatilization in the subducting slab occurs continuously and is not dependent on the breakdown of a particular phase. In situ Cl concentrations decrease significantly between sub‐greenschist and blueschist assemblages. Fluorine is retained within subducting AOC and is decoupled from the heavy halogens (Cl, Br, I), which undergo continuous devolatilization during prograde metamorphism.

IntroductionRecent studies have identified inflammatory mediators as potential biomarkers for monitoring or diagnosing periodontitis. However, the brief half-life of these mediators, coupled with their variability among different individuals and across different stages of periodontal disease, may limit their reliability as biomarkers.MethodsIn this study, we assessed the concentration profile of salivary biomarkers (IL-6, IL-8, and total protein) through repeated measurements within the same day and across different days in 79 patients exhibiting various states of periodontal health: intact periodontium, stable periodontitis, and active periodontitis. Additionally, we explored how daily variations, such as the interval between toothbrushing and eating, impact the levels of these salivary biomarkers and their diagnostic efficacy for periodontitis activity.ResultsOur results showed high salivary levels of IL-6 and total proteins in periodontitis patients (p

This study investigates the influence of Olsen phosphorus (Ps) within-field variability on common wheat production in Ps-deficient soil. It covers a comprehensive investigation conducted over two growing seasons in Tuscany, Italy, aiming to evaluate the impact of within-field Ps variation on common wheat production and crop responses to different agronomic treatments. Field experiments were undertaken, employing 24 treatments, including 4 wheat varieties, 2 seeding densities, and 3 nitrogen fertilization levels. Soil samples were collected to determine within field variability of main soil properties. At harvesting, aboveground biomass was collected to determine grain yield, straw, and total protein content. Firstly, an ANOVA was performed to account for the effect of the agronomical treatments on crop parameters, namely the Agronomical Input Model (AIM). Then, soil total nitrogen (Ns) and Ps, were added as covariates in a new model, namely the Agronomical and Soil Input Model (ASIM). Results showed a significant spatial variability of Ps within the fields, ranging between 13.7 and 17.4 mg kg-1. Despite this minimal variation in Ps, we observed a linear increase in GY of about 1430 kg ha-1 for each increase of 1 mg kg-1 in Ps. Further studies should be conducted to account for non-linear responses at both lower and higher Ps levels. The ASIM model outperformed AIM, indicating a notable increase in predictive accuracy for both grain yield and protein concentration due to its incorporation of soil parameters. The variance explained by ASIM in predicting the grain yield and protein concentration in grain increased by about 11.0 % and 17.3 %, respectively, with respect to AIM. The study emphasizes the necessity of managing within-field Ps variability through targeted fertilization strategies to enhance wheat production in Ps-deficient soils. By addressing soil nutrient variability, this research aims to contribute to more precise and efficient common wheat production systems.

Turfgrass systems hold significant climate change mitigation value, but their management often negates the beneficial effects due to the intense adoption of external inputs. The research objective in this paper was to assess the nitrogen fertilization rate able to maintain the ideal esthetic characteristics of Zoysia turfgrass, reducing the environmental impacts associated with greenhouse gas (GHG) emissions. A two-year open field experiment was conducted. Nitrogen was added to the soil at six rates (0, 50, 100, 150, 200, and 250 kg ha−1). The GHG emissions were monitored using a portable gas analyzer and the static chamber methodology. Cumulative environmental impacts were calculated from the inclusion of CO2, CH4, and, N2O using the Global Warming Potential (GWP). The quality assessment of the turf was assessed through a visual and instrumental approach. Higher CO2 and N2O fluxes were linked to high nitrogen rates, ranging from 83.55 to 87.50 and from 0.046 to 0.047 g N-N2O ha−1 day−1 for 200 and 250 kg N ha−1, respectively. CH4 emissions were not correlated to nitrogen rates. Higher GWP impacts were linked to high N rate treatments. A rate of 100 kg N ha−1 is recommended as the best strategy to reduce GHG emissions while maintaining high turf quality.