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Radiation-induced lung injury is a consequence of therapeutic irradiation (TR) for thoracic cancers. Studies report that up to 80% of patients who undergo TR will have CT-detectable interstitial lung abnormalities, and strategies to limit the risk of RILI may make radiotherapy less effective at treating cancer. Our lab and others have reported that lung tissue from patients with idiopathic pulmonary fibrosis exhibit metabolic defects including increased glycolysis and lactate production. Here, we hypothesized that patients with radiation-induced lung damage will exhibit distinct changes in lung metabolism that may be associated with incidence of fibrosis. Using liquid chromatography/tandem mass spectrometry to identify metabolic compounds, we analyzed exhaled breath condensate (EBC) in subjects with CT-confirmed lung lesions after TR for lung cancer, compared to healthy subjects, smokers, and cancer patients who had not yet received TR. The lung metabolomic profile of the fibrosis case group was significantly different from the 3 control groups. Along with increased levels of lactate, pathway enrichment analysis revealed that EBC from the case patients exhibited upregulations of the fatty acid oxidation and glutamate pathways. As radiation induces aerobic glycolysis and production of lactate which drives myofibroblast differentiation, our results support the hypothesis that preferential conversion of pyruvate to lactate deprives the tricarboxylic acid cycle of a key input, requiring compensatory upregulation of alternative energy inputs to meet the metabolic demands of chronic wound repair. Utilizing an 'omics' approach to probe lung disease in a non-invasive manner could inform future mechanistic investigations and development of novel therapeutic targets.

This study aimed to understand baseline knowledge of basic principles of radiation therapy for lung cancer among medical oncology, thoracic surgery, and pulmonology trainees and practicing physicians and also assess whether a didactic lecture will improve objective knowledge and perceived comfort level in making appropriate referrals to radiation oncology (RO). Radiation oncologists at 8 academic institutions offered a presentation covering indications, logistics, efficacy, and toxicity of thoracic radiation. Participants completed a survey to assess their prior exposures to RO and perceived value of the lecture, and objective knowledge gained based on pre/post-lecture questions. Among 121 attendees, 76 completed the pre-test, and 25 the post-test (response rates 62.8% and 20.7%, respectively). Fifty-seven (75.0%) had never previously experienced a RO didactic about lung cancer, 62 (81.6%) had never seen a linear accelerator, and 65 (85.5%) had never rotated in a RO department. The mean pre-test score was 53.5% (SD 17.6%), with a trend (p = 0.066) towards thoracic surgeons (61.5%) performing better than medical oncologists (55.5%) or pulmonologists (48.3%). Level of training (p = 0.130), and prior RO exposures (p = 0.240), did not significantly impact pre-test scores. The mean post-test score of 75.1% (SD 3.6%) was significantly higher than mean pre-test score (p 0.001). After the lecture, 25 participants (100%) felt more knowledgeable about RO, and 24 (96%) felt more comfortable making appropriate referrals to RO. A didactic lecture about RO for trainees and physicians who treat lung cancer at 8 academic institutions was feasible, filled a gap in exposure, and improved knowledge.

Contains fulltext : 290818.pdf (Publisher’s version ) (Open Access) BACKGROUND: Flow cytometry (FCM) aids the diagnosis and prognostic stratification of patients with suspected or confirmed myelodysplastic syndrome (MDS). Over the past few years, significant progress has been made in the FCM field concerning technical issues (including software and hardware) and pre-analytical procedures. METHODS: Recommendations are made based on the data and expert discussions generated from 13 yearly meetings of the European LeukemiaNet international MDS Flow working group. RESULTS: We report here on the experiences and recommendations concerning (1) the optimal methods of sample processing and handling, (2) antibody panels and fluorochromes, and (3) current hardware technologies. CONCLUSIONS: These recommendations will support and facilitate the appropriate application of FCM assays in the diagnostic workup of MDS patients. Further standardization and harmonization will be required to integrate FCM in MDS diagnostic evaluations in daily practice. 01 januari 2023

Hölderlin’s reflections on form can be grasped with the concept of the ›principle of form‹, which transforms a fragment into a productive concept with reference to the ›logic of being produced‹ (Adorno). The tragic fragment, as a principle of form, divides tragedy and the tragic. In order to trace this moment of fragmentation in terms of its historical efficacy, this study examines the Empedocles project and presents two vignettes of impact: 1. Nietzsche’s fragment collection on Empedocles, which also indicates a moment of fragmentation and can be read as a precursor of Zarathustra; and 2. Szondi’s work on Hölderlin as a firm reevaluation of Hölderlin’s work as a philosophy of the tragic.

Purpose: In this study, the relation between radiation pneumonitis (RP) and a wide spectrum of clinical, radiographic and treatment-related factors was investigated. As scoring of low-grade RP can be subjective, RP grade ≥3 (RP ≥ G3) was chosen as a more objective and clinically significant endpoint for this study. Methods and Materials: 105 consecutive patients with locally advanced non-small cell lung cancer underwent conventionally fractionated radio-(chemo-)therapy to a median dose of 64 Gy. A retrospective analysis of 25 clinical (gender, race, pulmonary function, diabetes, statin use, smoking history), radiographic (emphysema, interstitial lung disease) and radiotherapy dose- and technique-related factors was performed to identify predictors of RP ≥ G3. Following testing of all variables for statistical association with RP using univariate analysis (UVA), a forward selection algorithm was implemented for building a multivariate predictive model (MVA) with limited sample size. Results: Median follow-up of surviving patients was 33 months (9–132 months). RP ≥ G3 was diagnosed in 10/105 (9·5%) patients. Median survival was 28·5 months. On UVA, predictors for RP ≥ G3 were diabetes, lower lobe location, planning target volume, volumetric modulated arc therapy (VMAT), lung V5 Gy (%), lung Vspared5 Gy (mL), lung V20 Gy (%) and heart V5 Gy (% and mL). On MVA, VMAT was the only significant predictor for RP ≥ G3 (p = 0·042). Lung V5 Gy and lung V20 Gy were borderline significant for RP ≥ G3. Patients with RP ≥ 3 had a median survival of 10 months compared to 29·5 months with RP < G3 (p = 0·02). Conclusions: In this study, VMAT was the only factor that was significantly correlated with RP ≥ G3. Avoiding RP ≥ G3 is important as a toxicity per se and as a risk factor for poor survival. To reduce RP, caution needs to be taken to reduce low-dose lung volumes in addition to other well-established dose constraints.

Establish a workflow to evaluate radiotherapy (RT) dose variation induced by respiratory and cardiac motion on the left ventricle (LV) and left ventricular myocardium (LVM).Eight lung cancer patients underwent 4D-CT, expiratory T1-volumetric-interpolated-breath-hold-examination (VIBE), and cine MRI scans in expiration. Treatment plans were designed on the average intensity projection (AIP) datasets from 4D-CTs. RT dose from AIP was transferred onto 4D-CT respiratory phases. About 50% 4D-CT dose was mapped onto T1-VIBE (following registration) and from there onto average cine MRI datasets. Dose from average cine MRI was transferred onto all cardiac phases. Cumulative cardiac dose was estimated by transferring dose from each cardiac phase onto a reference cine phase following deformable image registration. The LV was contoured on each 4D-CT breathing phase and was called clinical LV (cLV); this structure is blurred by cardiac motion. Additionally, LV, LVM, and an American Heart Association (AHA) model were contoured on all cardiac phases. Relative maximum/mean doses for contoured regions were calculated with respect to each patient's maximum/mean AIP dose.During respiration, relative maximum and mean doses on the cLV ranged from -4.5% to 5.6% and -14.2% to 16.5%, respectively, with significant differences in relative mean doses between inspiration and expiration (P 0.0145). During cardiac motion at expiration, relative maximum and mean doses on the LV ranged from 1.6% to 59.3%, 0.5% to 27.4%, respectively. Relative mean doses were significantly different between diastole and systole (P = 0.0157). No significant differences were noted between systolic, diastolic, or cumulative cardiac doses compared to the expiratory 4D-CT (P 0.14). Significant differences were observed in AHA segmental doses depending on tumour proximity compared to global LV doses on expiratory 4D-CT (P 0.0117).In this study, the LV dose was highest during expiration and diastole. Segmental evaluation suggested that future cardiotoxicity evaluations may benefit from regional assessments of dose that account for cardiopulmonary motion.

In this study, we investigated 3D convolutional neural networks (CNNs) with input from radiographic and dosimetric datasets of primary lung tumors and surrounding lung volumes to predict the likelihood of radiation pneumonitis (RP). Pre-treatment, 3- and 6-month follow-up computed tomography (CT) and 3D dose datasets from one hundred and ninety-three NSCLC patients treated with stereotactic body radiotherapy (SBRT) were retrospectively collected and analyzed for this study. DenseNet-121 and ResNet-50 models were selected for this study as they are deep neural networks and have been proven to have high accuracy for complex image classification tasks. Both were modified with 3D convolution and max pooling layers to accept 3D datasets. We used a minority class oversampling approach and data augmentation to address the challenges of data imbalance and data scarcity. We built two sets of models for classification of three (No RP, Grade 1 RP, Grade 2 RP) and two (No RP, Yes RP) classes as outputs. The 3D DenseNet-121 models performed better (F1 score [0.81], AUC [0.91] [three class]; F1 score [0.77], AUC [0.84] [two class]) than the 3D ResNet-50 models (F1 score [0.54], AUC [0.72] [three-class]; F1 score [0.68], AUC [0.71] [two-class]) (p = 0.017 for three class predictions). We also attempted to identify salient regions within the input 3D image dataset via integrated gradient (IG) techniques to assess the relevance of the tumor surrounding volume for RP stratification. These techniques appeared to indicate the significance of the tumor and surrounding regions in the prediction of RP. Overall, 3D CNNs performed well to predict clinical RP in our cohort based on the provided image sets and radiotherapy dose information.

This study investigates plan quality generated by an MR-Linac (MRL) treatment planning system (TPS) for 5-fraction stereotactic body radiation therapy (SBRT) of primary pancreatic cancer (PCa). In addition, an isotoxic dose escalation was investigated with the MRL TPS based on stereotactic MR-guided adaptive radiation therapy (SMART) trial constraints. A clinical workflow was developed for adaptive and non-adaptive treatments with the MRL, on which a time-driven activity-based costing (TDABC) analysis was performed to quantify clinical efficacy. Fifteen PCa patients previously treated with a conventional Linac were retrospectively re-planned for this study. Three plans were generated for each patient using the original prescription dose (PD) and organ at risk (OAR) constraints (Plan 1), following SMART trial’s OAR constraints but with the original PD (Plan 2), starting with Plan 2, following an isotoxic dose escalation strategy where the dose was escalated until any one of the SMART trial’s OAR constraints reached its limit (Plan 3). Conformity index (CI) and the ratio of the 50% isodose volume to PTV (R50%) conformity metrics were calculated for all 45 MRL plans, in addition to standard dose-volume indices. Forty-five MRL plans were created which met their respective dosimetric criteria described above. For Plan 1, the MRL TPS successfully achieved equivalent or lower OAR doses while maintaining the prescribed PTV coverage for the 15 plans. A maximum dose to the small bowel was reduced on average by 4.97 Gy (range: 1.11–10.58 Gy). For Plan 2, the MRL TPS successfully met all SMART trial OAR constraints while maintaining equivalent PTV coverage. For Plan 3, the MRL TPS was able to escalate the prescription dose from the original 25–33 Gy by, on average, 36 Gy (range: 15–70 Gy), and dose to the PTV was successfully escalated to at least 50 Gy for all 15 plans. These achievements were made possible, in part, due to the omission of the ITV afforded by the MRL’s real-time target tracking technology and sharper dose penumbra due to its unique dual-focus MLC design. The 0.35T MRL TPS can generate plans that are equivalent to conventional Linac-based plans for SBRT of PCa. Through analyzing Plan 2 and 3 strategies, and due to the real-time target localization capabilities of the MRL system, increased OAR sparing and/or target dose escalation are possible.

Plant physiologists have used microscopy to study how leaf anatomy is related to photosynthetic performance and how this relation is affected by environmental conditions. However, leaf anatomy is not invariant over time: small pores on the leaf surface (stomata) open and close within minutes in response to the availability of water, CO2 and light. Within tens of minutes following a water deficit, cells in many leaves also shrink significantly in volume and the leaf undergoes structural changes as a result of wilting. Gas-exchange setups can monitor changes in photosynthesis and transpiration under such conditions, but classical microscopy techniques are not well-suited to capture the concomitant changes in leaf anatomy for two main reasons. First, available non-destructive microscopy techniques are limited in resolution and imaging depth, making it difficult to analyze changes in anatomy to the required detail. Second, using sectioned fixated samples is known to be associated with tissue shrinkage, swelling or deformation, making estimates of cellular volumes and surfaces prone to artifacts. Moreover, the destructive nature of these techniques makes it impossible to monitor changes in leaf anatomy during ongoing gas-exchange measurements. These limitations hinder advancing our understanding of the relation between leaf anatomy and photosynthesis or transpiration.Here, we present a novel gas-exchange setup that combines synchrotron-based high-resolution computed tomography (microCT) with concurrent measurements of gas-exchange using an commercially available infra-red gas analyzer. We designed and constructed a novel gas-exchange cuvette with CO2 and H2O control that allows for non-invasive monitoring of leaf anatomy in a microCT setup. Custom-built sensors were used to measure light intensity and leaf temperature. At given time points during gas-exchange measurements, 300-500 X-ray projections (100 ms) were taken while the chamber rotated 180°. From this data, a leaf volume corresponding to 0.5 mm2 leaf surface was reconstructed at high resolution (0.325 µm per voxel edge). The setup provides 3D images that can be used to measure the aperture of multiple stomata and the volumes, shapes and surface areas of cells and airspaces within the leaf. We found that the same leaf section can be scanned several times without measurable radiation damage, allowing for the combination of three spatial dimensions with time to create a 4D analysis of the leaf structure. Using poplar, willow and Arabidopsis leaves we studied how leaf anatomy rapidly adjusts after limiting water availability and show that such effects are not limited to the stomatal pore alone. We discuss the issues and pitfalls with the methodology and suggest avenues for future improvement.

Purpose Fatal radiation pneumonitis is a rare event. In recent years, higher incidences of grade 5 pneumonitis have been reported. Based on 3 cases in our clinic, a literature review was performed to assess specific clinical features and risk factors for fatal pneumonitis. Methods and Materials Three patients with nonsmall cell lung cancer were treated with conventionally fractionated radiation therapy, 2 with volumetric modulated arc therapy and one with intensity modulated radiation therapy. All 3 patients had high volumes of 5 Gy in the total lung and contralateral lungs. Patients died of pneumonitis between 2 and 5 months after the end of radiation therapy. A literature review focused on grade 5 pneumonitis was performed for conventionally fractioned and stereotactic radiation therapy for lung cancer. Results Patients with grade 5 pneumonitis develop symptoms sooner than lower grade pneumonitis. Symptoms often do not respond to steroid treatment or return after steroid taper. Imaging features extend beyond the high dose area and involve the contralateral lung. Dosimetric risk factors include both low dose and high dose lung volumes. For patients undergoing stereotactic radiation therapy interstitial lung disease has been described as a risk factor. Conclusions Despite decades of investigating radiation pneumonitis, the question of the optimum dose distribution in the lung, a large dose to a small volume versus a small dose to a large volume, is still unresolved. When both low and high dose lung volume constraints are followed, the risk for grade 5 pneumonitis has been shown to be low even with intensity modulated radiation therapy and concurrent chemotherapy. In addition to dose factors, underlying clinical and radiographic parameters play an important role for the development of grade 5 pneumonitis.

Myelodysplastic syndromes (MDS) comprise a heterogeneous group of diseases classified by comprehensive diagnostics. Identification of homogeneous subgroups is desirable to understand differences in clinical course and to develop targeted treatment approaches. We identified a specific CD11b/CD16 expression pattern in granulocytes associated with reduced CD45 expression in myeloid progenitor cells (MPC) in MDS cases and assessed its genetic background by whole genome (WGS) and whole transcriptome sequencing (WTS).The cohort consisted of 32 MDS cases with the specific aberrant immunophenotype. Since all these 32 cases were found to be SRSF2 mutated additional 51 SRSF2 mutated MDS cases without this specific immunophenotype were selected as controls. For all cases WGS and WTS were performed.The immunophenotype newly identified in SRSF2 mutated MDS patients is characterized (1) by a specific maturation pattern, i.e. an increase of CD11b expression without CD16 expression followed by an increase in CD16 expression without further CD11b expression and (2) by only dim CD45 expression of MPC. STAG2 mutations were exclusively found in MDS cases with the specific immunophenotype (17/32, 53% vs. 0%, p 0.001). Hence,50% of cases with the specific immunophenotype were characterized by co-mutations in SRSF2 and STAG2. In addition, cluster analysis revealed a specific gene expression profile of such cases.We here for the first time describe a specific immunophenotype which defines MDS cases with SRSF2 mutations and a consistent and specific mutational and gene expression profile. This comprehensive data warrants analysis of further such cases to assess the feasibility of defining a new sub-entity of MDS.

Magnetic resonance imaging (MRI)-based investigations into radiotherapy (RT)-induced cardiotoxicity require reliable registrations of magnetic resonance (MR) imaging to planning computed tomography (CT) for correlation to regional dose. In this study, the accuracy of intra- and inter-modality deformable image registration (DIR) of longitudinal four-dimensional CT (4D-CT) and MR images were evaluated for heart, left ventricle (LV), and thoracic aorta (TA).Non-cardiac-gated 4D-CT and T1 volumetric interpolated breath-hold examination (T1-VIBE) MRI datasets from five lung cancer patients were obtained at two breathing phases (inspiration/expiration) and two time points (before treatment and 5 weeks after initiating RT). Heart, LV, and TA were manually contoured. Each organ underwent three intramodal DIRs ((A) CT modality over time, (B) MR modality over time, and (C) MR contrast effect at the same time) and two intermodal DIRs ((D) CT/MR multimodality at same time and (E) CT/MR multimodality over time). Hausdorff distance (HD), mean distance to agreement (MDA), and Dice were evaluated and assessed for compliance with American Association of Physicists in Medicine (AAPM) Task Group (TG)-132 recommendations.Mean values of HD, MDA, and Dice under all registration scenarios for each region of interest ranged between 8.7 and 16.8 mm, 1.0 and 2.6 mm, and 0.85 and 0.95, respectively, and were within the TG-132 recommended range (MDA 3 mm, Dice 0.8). Intramodal DIR showed slightly better results compared to intermodal DIR. Heart and TA demonstrated higher registration accuracy compared to LV for all scenarios except for HD and Dice values in Group A. Significant differences for each metric and tissue of interest were noted between Groups B and D and between Groups B and E. MDA and Dice significantly differed between LV and heart in all registrations except for MDA in Group E.DIR of the heart, LV, and TA between non-cardiac-gated longitudinal 4D-CT and MRI across two modalities, breathing phases, and pre/post-contrast is acceptably accurate per AAPM TG-132 guidelines. This study paves the way for future evaluation of RT-induced cardiotoxicity and its related factors using multimodality DIR.

To develop an automated lung tumor segmentation method for radiation therapy planning based on deep learning and dual-modality positron emission tomography (PET) and computed tomography (CT) images.A 3-dimensional (3D) convolutional neural network using inputs from diagnostic PETs and simulation CTs was constructed with 2 parallel convolution paths for independent feature extraction at multiple resolution levels and a single deconvolution path. At each resolution level, the extracted features from the convolution arms were concatenated and fed through the skip connections into the deconvolution path that produced the tumor segmentation. Our network was trained/validated/tested by a 3:1:1 split on 290 pairs of PET and CT images from patients with lung cancer treated at our clinic, with manual physician contours as the ground truth. A stratified training strategy based on the magnitude of the gross tumor volume (GTV) was investigated to improve performance, especially for small tumors. Multiple radiation oncologists assessed the clinical acceptability of the network-produced segmentations.The mean Dice similarity coefficient, Hausdorff distance, and bidirectional local distance comparing manual versus automated contours were 0.79 ± 0.10, 5.8 ± 3.2 mm, and 2.8 ± 1.5 mm for the unstratified 3D dual-modality model. Stratification delivered the best results when the model for the large GTVs (25 mL) was trained with all-size GTVs and the model for the small GTVs (25 mL) was trained with small GTVs only. The best combined Dice similarity coefficient, Hausdorff distance, and bidirectional local distance from the 2 stratified models on their corresponding test data sets were 0.83 ± 0.07, 5.9 ± 2.5 mm, and 2.8 ± 1.4 mm, respectively. In the multiobserver review, 91.25% manual versus 88.75% automatic contours were accepted or accepted with modifications.By using an expansive clinical PET and CT image database and a dual-modality architecture, the proposed 3D network with a novel GTVbased stratification strategy generated clinically useful lung cancer contours that were highly acceptable on physician review.

Cardiorespiratory fitness (CRF) is a robust and independent predictor of cardiovascular health and overall mortality. Patients with lung cancer often have chronic lung disease, contributing to impaired CRF. Radiation to the heart during lung cancer treatment may further reduce CRF. The determinants of CRF in this population are not well understood. We prospectively evaluated 12 patients with lung cancer without known cardiovascular disease with reduced lung function receiving curative intent thoracic radiotherapy to determine whether cardiac diastolic function, as assessed by Doppler echocardiography and N-terminal pro-brain natriuretic peptide (NTproBNP) levels, correlate with CRF measured by peak oxygen consumption (VO(2)). Doppler-derived measures of diastolic function and serum NTproBNP levels inversely correlated with peak VO(2.) In a multivariate regression model, NTproBNP was the strongest independent variable associated with peak VO(2). These results suggest that diastolic dysfunction further contributes to reduced CRF in patients with lung cancer who have received radiotherapy.

Antimetabolites are small molecules that inhibit enzymes by mimicking physiological substrates. We report the discovery and structural elucidation of the antimetabolite 7-deoxy-sedoheptulose (7dSh). This unusual sugar inhibits the growth of various prototrophic organisms, including species of cyanobacteria, Saccharomyces, and Arabidopsis. We isolate bioactive 7dSh from culture supernatants of the cyanobacterium Synechococcus elongatus. A chemoenzymatic synthesis of 7dSh using S. elongatus transketolase as catalyst and 5-deoxy-d-ribose as substrate allows antimicrobial and herbicidal bioprofiling. Organisms treated with 7dSh accumulate 3-deoxy-d-arabino-heptulosonate 7-phosphate, which indicates that the molecular target is 3-dehydroquinate synthase, a key enzyme of the shikimate pathway, which is absent in humans and animals. The herbicidal activity of 7dSh is in the low micromolar range. No cytotoxic effects on mammalian cells have been observed. We propose that the in vivo inhibition of the shikimate pathway makes 7dSh a natural antimicrobial and herbicidal agent., Mother Nature is a valuable resource for the discovery of drug and agricultural chemicals. Here, the authors show that 7-deoxy-sedoheptulose produced by a cyanobacterium is an antimicrobial and herbicidal compound that acts through inhibition of 3-dehydroquniate synthase in the shikimate pathway.

Cardiorespiratory fitness (CRF) is a robust and independent predictor of cardiovascular health and overall mortality. Patients with lung cancer often have chronic lung disease, contributing to impaired CRF. Radiation to the heart during treatment of lung cancer may further reduce CRF. The determinants of reduced CRF in this population are not well understood. In this study, we sought to determine whether cardiac diastolic function, as assessed by Doppler echocardiography and N-terminal pro-brain natriuretic peptide (NTproBNP) levels, correlate with CRF as measured by peak oxygen consumption (VO 2 ), in patients with reduced lung function who received chest irradiation for lung cancer. We found that Doppler-derived measures of diastolic function and serum levels of NTproBNP inversely correlate with peak VO 2. In a multivariate regression model, NTproBNP was the strongest independent variable associated with peak VO 2 . These results suggest that diastolic dysfunction may further contribute to reduced CRF in patients with lung cancer who have received radiotherapy and have reduced lung function.

Background: Staple line (SL) recurrences of non-small cell lung cancer (NSCLC) are commonly treated with radiotherapy (RT), but the target volume definition — whole SL versus focused on recurrence — is unclear. The aim of the study was to determine the appropriate target volume for RT of SL recurrences. Materials and methods: Twenty-two consecutive patients (20 stage I, 2 stage II) treated with salvage RT for SL recurrences were retrospectively analyzed. Imaging features at the time of SL recurrence were evaluated to guide target volume definition. Results: Surgery : All patients had complete tumor resection (wedge resection in 10 (45%) and lobectomy in 12 (55%) patients). 14 (64%) patients had risk factors for recurrence, including surgical margins ≤ 2 cm, angiolymphatic and visceral pleural invasion. Salvage RT : After a median 26 months (9–67), all 22 patients developed SL recurrence which was metabolically active on PET in all and biopsy-confirmed in 18/22 (82%) patients. All patients underwent RT targeting the location of the SL recurrence only. 13/22 (59%) patients had additional PET-negative nodular or linear SL changes that were not included in the irradiated volume. Recurrence after RT : After a median 17 months (9–34) 10/22 (45%) patients recurred either regionally 6/10 (60%), in the lungs 4/10 (40%) or distally 3/10 (30%). No patient recurred at the SL. Two-year overall and disease-free survival rates after RT were 71% and 65%, respectively. Conclusion: RT to SL recurrences alone results in excellent local control. Additional treatment to reduce regional and distant recurrences should be considered.

The handling of left ventricular assist devices (LVADs) can be challenging for patients and requires appropriate training. The devices’ usability impacts patients’ safety and quality of life. In this study, an eye tracking supported human factors testing was performed to reveal problems during use and test the trainings’ effectiveness. In total 32 HeartWare HVAD patients (including 6 pre-VAD patients) and 3 technical experts as control group performed a battery change (BC) and a controller change (CC) as an everyday and emergency scenario on a training device. By tracking the patients’ gaze point, task duration and pump-off time were evaluated. Patients with LVAD support ≥1 year showed significantly shorter BC task duration than patients with LVAD support., Journal of Medical Systems, 45, ISSN:0148-5598, ISSN:1573-689X

Magnonics attracts increasing attention in the view of novel low-energy computation technologies based on spin waves. Recently, spin-wave propagation in longitudinally magnetized nano-scaled spin-wave conduits was demonstrated, proving the fundamental feasibility of magnonics at the sub-100 nm scale. Transversely magnetized nano-conduits, which are of great interest in this regard as they offer a large group velocity and a potentially chirality-based protected transport of energy, have not yet been investigated due to their complex internal magnetic field distribution. Here, we present a study of propagating spin waves in a transversely magnetized nanoscopic yttrium iron garnet conduit of 50 nm width. Space and time-resolved micro-focused Brillouin-light-scattering spectroscopy is employed to measure the spin-wave group velocity and decay length. A long-range spin-wave propagation is observed with a decay length of up to (8.0+-1.5) {\mu}m and a large spin-wave lifetime of up to (44.7+-9.1) ns. The results are supported with micromagnetic simulations, revealing a single-mode dispersion relation in contrast to the common formation of localized edge modes for microscopic systems. Furthermore, a frequency non-reciprocity for counter-propagating spin waves is observed in the simulations and the experiment, caused by the trapezoidal cross-section of the structure. The revealed long-distance spin-wave propagation on the nanoscale is particularly interesting for an application in spin-wave devices, allowing for long-distance transport of information in magnonic circuits, as well as novel low-energy device architectures.