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Abdul Halim A, Abreu P, Aglietta M, Allekotte I, Cheminant KA, Almela A, Aloisio R, Alvarez-Muñiz J, Yebra JA, Anastasi GA, Anchordoqui L, Andrada B, Andringa S, Anukriti, Apollonio L, Aramo C, Ferreira PRA, Arnone E, Velázquez JCA, Assis P, Avila G, Avocone E, Bakalova A, Barbato F, Mocellin AB, Bellido JA, Berat C, Bertaina ME, Bhatta G, Bianciotto M, Biermann PL, Binet V, Bismark K, Bister T, Biteau J, Blazek J, Bleve C, Blümer J, Boháčová M, Boncioli D, Bonifazi C, Arbeletche LB, Borodai N, Brack J, Orchera PGB, Briechle FL, Bueno A, Buitink S, Buscemi M, Büsken M, Bwembya A, Caballero-Mora KS, Cabana-Freire S, Caccianiga L, Caruso R, Castellina A, Catalani F, Cataldi G, Cazon L, Cerda M, Cermenati A, Chinellato JA, Chudoba J, Chytka L, Clay RW, Cerutti ACC, Colalillo R, Coleman A, Coluccia MR, Conceição R, Condorelli A, Consolati G, Conte M, Convenga F, Dos Santos DC, Costa PJ, Covault CE, Cristinziani M, Sanchez CSC, Dasso S, Daumiller K, Dawson BR, de Almeida RM, de Jesús J, de Jong SJ, Neto JRTDM, De Mitri I, de Oliveira J, Franco DDO, de Palma F, de Souza V, de Errico BPDS, De Vito E, Del Popolo A, Deligny O, Denner N, Deval L, di Matteo A, Dobre M, Dobrigkeit C, D'Olivo JC, Mendes LMD, Dorosti Q, Dos Anjos JC, Dos Anjos RC, Ebr J, Ellwanger F, Emam M, Engel R, Epicoco I, Erdmann M, Etchegoyen A, Evoli C, Falcke H, Farmer J, Farrar G, Fauth AC, Fazzini N, Feldbusch F, Fenu F, Fernandes A, Fick B, Figueira JM, Filipčič A, Fitoussi T, Flaggs B, Fodran T, Fujii T, Fuster A, Galea C, Galelli C, García B, Gaudu C, Gemmeke H, Gesualdi F, Gherghel-Lascu A, Ghia PL, Giaccari U, Glombitza J, Gobbi F, Gollan F, Golup G, Berisso MG, Vitale PFG, Gongora JP, González JM, González N, Goos I, Góra D, Gorgi A, Gottowik M, Grubb TD, Guarino F, Guedes GP, Guido E, Gülzow L, Hahn S, Hamal P, Hampel MR, Hansen P, Harari D, Harvey VM, Haungs A, Hebbeker T, Hojvat C, Hörandel JR, Horvath P, Hrabovský M, Huege T, Insolia A, Isar PG, Janecek P, Jilek V, Johnsen JA, Jurysek J, Kampert KH, Keilhauer B, Khakurdikar A, Covilakam VVK, Klages HO, Kleifges M, Knapp F, Köhler J, Kunka N, Lago BL, Langner N, de Oliveira MAL, Lema-Capeans Y, Letessier-Selvon A, Lhenry-Yvon I, Lopes L, Lu L, Luce Q, Lundquist JP, Payeras AM, Majercakova M, Mandat D, Manning BC, Mantsch P, Marafico S, Mariani FM, Mariazzi AG, Mariş IC, Marsella G, Martello D, Martinelli S, Bravo OM, Martins MA, Mathes HJ, Matthews J, Matthiae G, Mayotte E, Mayotte S, Mazur PO, Medina-Tanco G, Meinert J, Melo D, Menshikov A, Merx C, Michal S, Micheletti MI, Miramonti L, Mollerach S, Montanet F, Morejon L, Morello C, Mulrey K, Mussa R, Namasaka WM, Negi S, Nellen L, Nguyen K, Nicora G, Niechciol M, Nitz D, Nosek D, Novotny V, Nožka L, Nucita A, Núñez LA, Oliveira C, Palatka M, Pallotta J, Panja S, Parente G, Paulsen T, Pawlowsky J, Pech M, Pękala J, Pelayo R, Pereira LAS, Martins EEP, Armand JP, Bertolli CP, Perrone L, Petrera S, Petrucci C, Pierog T, Pimenta M, Platino M, Pont B, Pothast M, Shahvar MP, Privitera P, Prouza M, Puyleart A, Querchfeld S, Rautenberg J, Ravignani D, Akim JVR, Reininghaus M, Ridky J, Riehn F, Risse M, Rizi V, de Carvalho WR, Rodriguez E, Rojo JR, Roncoroni MJ, Rossoni S, Roth M, Roulet E, Rovero AC, Ruehl P, Saftoiu A, Saharan M, Salamida F, Salazar H, Salina G, Gomez JDS, Sánchez F, Santos EM, Santos E, Sarazin F, Sarmento R, Sato R, Savina P, Schäfer CM, Scherini V, Schieler H, Schimassek M, Schimp M, Schmidt D, Scholten O, Schoorlemmer H, Schovánek P, Schröder FG, Schulte J, Schulz T, Sciutto SJ, Scornavacche M, Segreto A, Sehgal S, Shivashankara SU, Sigl G, Silli G, Sima O, Simkova K, Simon F, Smau R, Šmída R, Sommers P, Soriano JF, Squartini R, Stadelmaier M, Stanič S, Stasielak J, Stassi P, Strähnz S, Straub M, Suomijärvi T, Supanitsky AD, Svozilikova Z, Szadkowski Z, Tairli F, Tapia A, Taricco C, Timmermans C, Tkachenko O, Tobiska P, Peixoto CJT, Tomé B, Torrès Z, Travaini A, Travnicek P, Trimarelli C, Tueros M, Unger M, Vaclavek L, Vacula M, Galicia JFV, Valore L, Varela E, Vásquez-Ramírez A, Veberič D, Ventura C, Quispe IDV, Verzi V, Vicha J, Vink J, Vorobiov S, Watanabe C, Watson AA, Weindl A, Wiencke L, Wilczyński H, Wittkowski D, Wundheiler B, Yue B, Yushkov A, Zapparrata O, Zas E, Zavrtanik D, Zavrtanik M. Demonstrating Agreement between Radio and Fluorescence Measurements of the Depth of Maximum of Extensive Air Showers at the Pierre Auger Observatory. PHYSICAL REVIEW LETTERS 2024; 132:021001. [PMID: 38277596 DOI: 10.1103/physrevlett.132.021001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 01/28/2024]
Abstract
We show, for the first time, radio measurements of the depth of shower maximum (X_{max}) of air showers induced by cosmic rays that are compared to measurements of the established fluorescence method at the same location. Using measurements at the Pierre Auger Observatory we show full compatibility between our radio and the previously published fluorescence dataset, and between a subset of air showers observed simultaneously with both radio and fluorescence techniques, a measurement setup unique to the Pierre Auger Observatory. Furthermore, we show radio X_{max} resolution as a function of energy and demonstrate the ability to make competitive high-resolution X_{max} measurements with even a sparse radio array. With this, we show that the radio technique is capable of cosmic-ray mass composition studies, both at Auger and at other experiments.
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Wang J, Lin T, Reddy AV, Hill C, Sehgal S, McPhaul T, Herman JM, He J, Zheng L, Meyer JJ, Narang A. Pathway Mutations are Associated with Clinical Outcomes in Localized Pancreatic Cancer Treated with Neoadjuvant Chemoradiation Followed by Surgery. Int J Radiat Oncol Biol Phys 2023; 117:e348-e349. [PMID: 37785208 DOI: 10.1016/j.ijrobp.2023.06.2419] [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 purpose of this study was to determine if mutations in biological pathways are associated with clinical outcomes in patients with localized pancreatic cancer who undergo neoadjuvant chemoradiation followed by surgical resection. MATERIALS/METHODS Patients treated with neoadjuvant chemoradiation followed by oncologic resection from 2015-2019 who also underwent next generation sequencing (NGS) of the primary tumor were included in this retrospective analysis. NGS was done using either Foundation One (n = 20), in-house Solid Tumor Panel (n = 121), or Tempus XT (n = 1). Genes were included in pathway analysis if at least one patient harbored a mutation in the gene. Pathways were defined from the Molecular Signatures Database Hallmark, KEGG, and Reactome gene sets. A pathway was deemed mutated if at least one gene within the pathway was mutated. Univariable Cox regression was performed to determine the association between pathway mutation status and overall survival (OS) as well as progression-free survival (PFS). RESULTS In total, 142 patients met criteria for study inclusion. For pathway analysis, 329 genes met inclusion criteria. Patients were typically treated with neoadjuvant chemotherapy (either 5-fluorouracil-based or gemcitabine-based) followed by radiation. Patients received SBRT (n = 104, most commonly 33 Gy in 5 fractions) or conventionally fractionated radiation (n = 38, most commonly 50.4 Gy in 28 fractions). For clinical variables, worse OS was significantly associated with T stage (p = 0.036), N stage (p = 0.044), and lymphovascular invasion (LVI, p = 0.011); worse PFS was significantly associated with T stage (p = 0.0008), N stage (p = 0.022), LVI (p = 0.026), and conventional RT (p = 0.007). Mutations in major pathways were associated with worse OS, notably hedgehog signaling (p = 0.001), chromatin modifying enzymes (p = 0.002), WNT/beta-catenin signaling (p = 0.005), mismatch repair (0.006), E2F targets (p = 0.008), FLT signaling (p = 0.012), VEGF signaling (0.025), innate immune system (p = 0.026), and NOTCH signaling (p = 0.029). Pathway mutations associated with worse PFS included mismatch repair (p = 0.007) and hedgehog signaling (p = 0.013). CONCLUSION For pancreatic cancer patients that undergo neoadjuvant chemoradiation followed by oncologic resection of the primary tumor, mutations in key biological pathways are associated with OS and PFS. Characterizing the importance of common pathway mutations may become increasingly valuable to help categorize less commonly mutated genes assayed by NGS.
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Madan V, Lin TA, Reddy AV, Hill C, Sehgal S, Hacker-Prietz A, McPhaul T, He J, Zheng L, Ngwa W, Herman JM, Meyer JJ, Narang A. Characterization of DNA Damage Response-Associated Somatic Mutations in Borderline Resectable and Locally Advanced Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e321. [PMID: 37785147 DOI: 10.1016/j.ijrobp.2023.06.2361] [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 role of radiation for pancreatic cancer remains controversial, with recent studies showing conflicting results, highlighting the need to develop biomarkers of radiation response. Despite its potential utility in predicting radiosensitivity, the landscape of somatic mutations in borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC), as related to DNA damage response (DDR), has not been well characterized. This study aimed to characterize the frequency of such mutations in a cohort of patients with BRPC/LAPC treated with neoadjuvant chemotherapy and stereotactic body radiotherapy (SBRT). MATERIALS/METHODS Mutational data was collected from patients with BRPC/LAPC treated at a single institution with neoadjuvant chemotherapy and SBRT, followed by surgical resection from 2016-2021. Chemotherapy consisted of modified FOLFIRINOX or gemcitabine/nab-paclitaxel, and patients were treated with SBRT in 33 Gy in 5 fractions. Genomic data was obtained from either endoscopic biopsy or surgical specimens, and next-generation sequencing was performed either in-house with a Solid Tumor Panel or with FoundationOne CDx. Specific emphasis was placed on the characterization of double-strand DNA break (DSB) repair genes, as this is the type of tumor cell damage traditionally induced by radiation therapy. Genes associated with the two main pathways of DSB repair, non-homologous end joining (NHEJ) and homologous repair (HR), were analyzed. Specific HR pathway mutations assessed were BLM, BRCA1/2, MRE11, NBN, PALB2, RAD50, RAD51B-D, and RAD54L, while PRKDC mutations were assessed for the NHEJ pathway. Mutations in ATM, an important initiator of DDR pathways, were also analyzed. Additionally, the frequency of mutations in TP53, CDKN2A and SMAD4 in patients with concomitant KRAS mutations was assessed. RESULTS Eighty-five patients were included in the study. Five (5.9%) patients had mutations in the NHEJ pathway of the PRKDC gene. Twenty (23.5%) patients had mutations in the HR pathway, including BRCA2 (10/85; 11.8%), PALB2 (5/85; 5.9%), BRCA1 (3/85; 3.5%), and RAD50 (1/85; 1.2%). Six (7.1%) patients had mutations in ATM. No patients were found to have mutations in BLM, RAD51B-D, RAD54L, or NBN. Amongst patients with KRAS mutations (72/85), concomitant mutations were observed in TP53 (47/85; 55.3%), CDKN2A (16/85; 18.8%), and SMAD4 (9/85; 10.6%). CONCLUSION Herein, we characterized the frequency of somatic mutations associated with DSB repair genes in patients with BRPC/LAPC. Data analysis on outcomes related to radiation response in patients with mutations in DDR pathways is ongoing, but will likely also benefit from multi-institutional efforts to increase the power to answer this question.
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Mao S, Lin TA, Sehgal S, Reddy AV, Hill C, Herman JM, Meyer JJ, Narang A. Utilization of the Triangle Volume in Patients with Localized PDAC Undergoing Pre-Operative SBRT: Report of Early Outcomes. Int J Radiat Oncol Biol Phys 2023; 117:S14. [PMID: 37784357 DOI: 10.1016/j.ijrobp.2023.06.230] [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) In patients with borderline resectable or locally advanced pancreatic adenocarcinoma (BRPC/LAPC), advances in neoadjuvant therapy have led to an increased proportion of patients undergoing margin negative resection. Nevertheless, locoregional recurrence rates remain high. We have previously reported that the location of locoregional recurrences in this setting map to the "Triangle Volume (TV)," the anatomical space between the celiac artery, superior mesenteric artery, common hepatic artery, and portal vein, which is enriched in extrapancreatic perineural tracts at risk for microscopic residual disease after resection. At the beginning of 2021, we systematically changed our target volume to include the TV, in addition to gross disease and involved vasculature. Herein, we report early locoregional failure outcomes after resection in the setting of BRPC or LAPC treated with pre-operative stereotactic body radiation therapy (SBRT) to the TV, as compared to historical rates. MATERIALS/METHODS Patients who received a diagnosis of BRPC or LAPC and who were treated at our institution with neoadjuvant chemotherapy (CTX) and SBRT between 2016 and 2022 were retrospectively reviewed. Between 2016 and 2020, the SBRT clinical tumor volume (CTV) included gross disease and full circumference of involved vasculature at the level of involvement. From 2021 onward, the CTV also included the TV. Survival was estimated using the Kaplan-Meier method. Statistical analyses were performed using scientific 2-D graphing and statistics software. RESULTS From January 2016 to December 2022, 204 patients with localized PDAC underwent neoadjuvant CTX followed by SBRT. After completion of SBRT, all patients proceeded with surgical exploration. Of these patients, 111 (54%) had LAPC and 92 (45%) had BRPC disease. All patients were treated with induction CTX, mostly commonly with FOLFIRINOX (N = 166, 81%). Following CTX, the most frequently used SBRT regimen was 33 Gy in 5 fractions (N = 191, 94%). 155 (67%) patients were treated between 2016 and 2020 to the traditional CTV, while 49 (24%) patients were treated after 2020 to a CTV that included the TV. The 2-year local progression free survival rate of patients treated with SBRT using the TV was 77.6% as compared to 47.5% in patients treated with the traditional CTV. Over a median follow up of 15.7 months (range: 1 to 78.2 months), 47% (N = 73 out of 155) of patients who underwent SBRT with the traditional CTV developed locoregional recurrence, but only 12% (N = 6 out of 49) treated with SBRT to the TV have thus far developed locoregional recurrence (p<0.0001). CONCLUSION In patients with localized PDAC who undergo pre-operative SBRT for BRPC/LAPC, targeting the TV may help reduce locoregional recurrence. More data and longer follow-up are needed to verify these findings and inform whether the TV may serve as a new standard for target volume delineation in this setting.
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Liu IC, Lin TA, Sehgal S, Reddy AV, Hill C, Herman JM, Meyer JJ, Narang A. Visceral Artery Pseudoaneurysm Rates after Pancreatoduodenectomy in Patients Who Received Pre-Operative Radiation for Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e317. [PMID: 37785138 DOI: 10.1016/j.ijrobp.2023.06.2352] [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 role of pre-operative radiation therapy (RT) for localized pancreatic ductal adenocarcinoma (PDAC) with peri-pancreatic vascular involvement remains controversial, with two recent randomized controlled trials, namely PREOPANC-1 and Alliance A021501, showing conflicting results. Opponents of pre-operative radiation point towards the unclear oncologic benefit and potential added toxicity. While hemorrhage from a pseudoaneurysm (PsA) rupture is a known rare but potentially fatal complication after pancreaticoduodenectomy (PD), with published incidence rates of around 2 to 5%, it has been increasingly common in the pancreatic cancer surgical community for pre-operative RT to be cited as a risk factor for PsA development, despite the absence of data supporting this notion. Certainly, accurate characterization of relevant RT-related toxicities is critical to prevent inaccurate decision-making regarding foregoing its use. As such, we aim to report on the incidence of PsA in a cohort of patients with PDAC who underwent pre-operative RT prior to PD at a high-volume center. MATERIALS/METHODS Consecutive patients treated with pre-operative RT via stereotactic body radiation therapy (SBRT) or intensity modulated radiation therapy (IMRT) prior to PD for borderline resectable or locally advanced PDAC were retrospectively reviewed. Incidence of radiographic or clinically apparent PsA was reported. We also characterized the timing of PsA identification in relation to surgery and RT, the artery in which the PsA developed, and the clinical outcomes of patients after PsA identification. RESULTS One hundred seventy-five patients met eligibility criteria for our analysis. Most of our cohort (163 patients, 93%) received SBRT to a median dose of 6.6 Gy x 5 (median BED10 54.78 Gy, range: 48 Gy - 61.92 Gy), and only 12 patients (7%) received IMRT in various fractionation and dose patterns (median BED10 62.94 Gy, range 59.47 Gy - 97.5 Gy). The median time between surgery and last contrast-enhanced abdominal imaging was 17 months (range: 0.23 - 68 months). There were fourteen visceral arteries among thirteen patients (7%) that were found to have a PsA on routine follow-up imaging or after a post-PD hemorrhage. The median time between completion of radiation and surgery to PsA were 19.5 weeks (range: 8.6 to 98.1 weeks) and 13 weeks (range: 1.6 to 87.9 weeks), respectively. The two most commonly involved arteries were the gastroduodenal and superior mesenteric arteries. Rate of PsA development was similar among patients treated with SBRT (7%) and IMRT (8%). In terms of Clavien-Dindo classification of complications, there were six patients with grade 3a complications, five patients with grade 4b complications, and two patients with grade 5 complications. CONCLUSION Compared to historical data, pre-operative RT does not appear to significantly increase the risk of PsA development after PD. More data on the impact of pre-operative radiation dose-fraction regimen and longer follow-up are needed.
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Abreu P, Aglietta M, Albury JM, Allekotte I, Almeida Cheminant K, Almela A, Aloisio R, Alvarez-Muñiz J, Alves Batista R, Ammerman Yebra J, Anastasi GA, Anchordoqui L, Andrada B, Andringa S, Aramo C, Araújo Ferreira PR, Arnone E, Arteaga Velázquez JC, Asorey H, Assis P, Avila G, Avocone E, Badescu AM, Bakalova A, Balaceanu A, Barbato F, Bellido JA, Berat C, Bertaina ME, Bhatta G, Biermann PL, Binet V, Bismark K, Bister T, Biteau J, Blazek J, Bleve C, Blümer J, Boháčová M, Boncioli D, Bonifazi C, Bonneau Arbeletche L, Borodai N, Botti AM, Brack J, Bretz T, Brichetto Orchera PG, Briechle FL, Buchholz P, Bueno A, Buitink S, Buscemi M, Büsken M, Caballero-Mora KS, Caccianiga L, Canfora F, Caracas I, Caruso R, Castellina A, Catalani F, Cataldi G, Cazon L, Cerda M, Chinellato JA, Chudoba J, Chytka L, Clay RW, Cobos Cerutti AC, Colalillo R, Coleman A, Coluccia MR, Conceição R, Condorelli A, Consolati G, Contreras F, Convenga F, Correia Dos Santos D, Covault CE, Dasso S, Daumiller K, Dawson BR, Day JA, de Almeida RM, de Jesús J, de Jong SJ, de Mello Neto JRT, De Mitri I, de Oliveira J, de Oliveira Franco D, de Palma F, de Souza V, De Vito E, Del Popolo A, Del Río M, Deligny O, Deval L, di Matteo A, Dobre M, Dobrigkeit C, D'Olivo JC, Domingues Mendes LM, Dos Anjos RC, Dova MT, Ebr J, Engel R, Epicoco I, Erdmann M, Escobar CO, Etchegoyen A, Falcke H, Farmer J, Farrar G, Fauth AC, Fazzini N, Feldbusch F, Fenu F, Fick B, Figueira JM, Filipčič A, Fitoussi T, Fodran T, Fujii T, Fuster A, Galea C, Galelli C, García B, Garcia Vegas AL, Gemmeke H, Gesualdi F, Gherghel-Lascu A, Ghia PL, Giaccari U, Giammarchi M, Glombitza J, Gobbi F, Gollan F, Golup G, Gómez Berisso M, Gómez Vitale PF, Gongora JP, González JM, González N, Goos I, Góra D, Gorgi A, Gottowik M, Grubb TD, Guarino F, Guedes GP, Guido E, Hahn S, Hamal P, Hampel MR, Hansen P, Harari D, Harvey VM, Haungs A, Hebbeker T, Heck D, Hill GC, Hojvat C, Hörandel JR, Horvath P, Hrabovský M, Huege T, Insolia A, Isar PG, Janecek P, Johnsen JA, Jurysek J, Kääpä A, Kampert KH, Keilhauer B, Khakurdikar A, Kizakke Covilakam VV, Klages HO, Kleifges M, Kleinfeller J, Knapp F, Kunka N, Lago BL, Langner N, Leigui de Oliveira MA, Lenok V, Letessier-Selvon A, Lhenry-Yvon I, Lo Presti D, Lopes L, López R, Lu L, Luce Q, Lundquist JP, Machado Payeras A, Mancarella G, Mandat D, Manning BC, Manshanden J, Mantsch P, Marafico S, Mariani FM, Mariazzi AG, Mariş IC, Marsella G, Martello D, Martinelli S, Martínez Bravo O, Mastrodicasa M, Mathes HJ, Matthews J, Matthiae G, Mayotte E, Mayotte S, Mazur PO, Medina-Tanco G, Melo D, Menshikov A, Michal S, Micheletti MI, Miramonti L, Mollerach S, Montanet F, Morejon L, Morello C, Mostafá M, Müller AL, Muller MA, Mulrey K, Mussa R, Muzio M, Namasaka WM, Nasr-Esfahani A, Nellen L, Nicora G, Niculescu-Oglinzanu M, Niechciol M, Nitz D, Norwood I, Nosek D, Novotny V, Nožka L, Nucita A, Núñez LA, Oliveira C, Palatka M, Pallotta J, Papenbreer P, Parente G, Parra A, Pawlowsky J, Pech M, Pękala J, Pelayo R, Peña-Rodriguez J, Pereira Martins EE, Perez Armand J, Pérez Bertolli C, Perrone L, Petrera S, Petrucci C, Pierog T, Pimenta M, Pirronello V, Platino M, Pont B, Pothast M, Privitera P, Prouza M, Puyleart A, Querchfeld S, Rautenberg J, Ravignani D, Reininghaus M, Ridky J, Riehn F, Risse M, Rizi V, Rodrigues de Carvalho W, Rodriguez Rojo J, Roncoroni MJ, Rossoni S, Roth M, Roulet E, Rovero AC, Ruehl P, Saftoiu A, Saharan M, Salamida F, Salazar H, Salina G, Sanabria Gomez JD, Sánchez F, Santos EM, Santos E, Sarazin F, Sarmento R, Sarmiento-Cano C, Sato R, Savina P, Schäfer CM, Scherini V, Schieler H, Schimassek M, Schimp M, Schlüter F, Schmidt D, Scholten O, Schoorlemmer H, Schovánek P, Schröder FG, Schulte J, Schulz T, Sciutto SJ, Scornavacche M, Segreto A, Sehgal S, Shellard RC, Sigl G, Silli G, Sima O, Smau R, Šmída R, Sommers P, Soriano JF, Squartini R, Stadelmaier M, Stanca D, Stanič S, Stasielak J, Stassi P, Streich A, Suárez-Durán M, Sudholz T, Suomijärvi T, Supanitsky AD, Szadkowski Z, Tapia A, Taricco C, Timmermans C, Tkachenko O, Tobiska P, Todero Peixoto CJ, Tomé B, Torrès Z, Travaini A, Travnicek P, Trimarelli C, Tueros M, Ulrich R, Unger M, Vaclavek L, Vacula M, Valdés Galicia JF, Valore L, Varela E, Vásquez-Ramírez A, Veberič D, Ventura C, Vergara Quispe ID, Verzi V, Vicha J, Vink J, Vorobiov S, Wahlberg H, Watanabe C, Watson AA, Weindl A, Wiencke L, Wilczyński H, Wittkowski D, Wundheiler B, Yushkov A, Zapparrata O, Zas E, Zavrtanik D, Zavrtanik M, Zehrer L. Limits to Gauge Coupling in the Dark Sector Set by the Nonobservation of Instanton-Induced Decay of Super-Heavy Dark Matter in the Pierre Auger Observatory Data. PHYSICAL REVIEW LETTERS 2023; 130:061001. [PMID: 36827568 DOI: 10.1103/physrevlett.130.061001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/30/2022] [Accepted: 12/14/2022] [Indexed: 06/18/2023]
Abstract
Instantons, which are nonperturbative solutions to Yang-Mills equations, provide a signal for the occurrence of quantum tunneling between distinct classes of vacua. They can give rise to decays of particles otherwise forbidden. Using data collected at the Pierre Auger Observatory, we search for signatures of such instanton-induced processes that would be suggestive of super-heavy particles decaying in the Galactic halo. These particles could have been produced during the post-inflationary epoch and match the relic abundance of dark matter inferred today. The nonobservation of the signatures searched for allows us to derive a bound on the reduced coupling constant of gauge interactions in the dark sector: α_{X}≲0.09, for 10^{9}≲M_{X}/GeV<10^{19}. Conversely, we obtain that, for instance, a reduced coupling constant α_{X}=0.09 excludes masses M_{X}≳3×10^{13} GeV. In the context of dark matter production from gravitational interactions alone, we illustrate how these bounds are complementary to those obtained on the Hubble rate at the end of inflation from the nonobservation of tensor modes in the cosmological microwave background.
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Sehgal S, Reddy A, Hill C, Lin T, Zheng L, He J, Herman J, Meyer J, Narang A. Neoadjuvant Chemotherapy and Stereotactic Body Radiation Therapy in Patients with Early Onset Pancreatic Cancer: Clinical Outcomes and Toxicity. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Reddy A, Hill C, Sehgal S, He J, Zheng L, Herman J, Meyer J, Narang A. Stereotactic Body Radiation Therapy is Safe and Feasible for the Treatment of Locally Recurrent Pancreatic Adenocarcinoma after Curative Resection. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1116] [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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Lin T, Reddy A, Hill C, Sehgal S, He J, Zheng L, Herman J, Meyer J, Narang A. The Optimal Timing of Surgery Following Stereotactic Body Radiation Therapy for Borderline Resectable or Locally Advanced Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reddy AV, Hill CS, Sehgal S, He J, Zheng L, Herman JM, Meyer J, Narang AK. Efficacy and Safety of Reirradiation with Stereotactic Body Radiation Therapy for Locally Recurrent Pancreatic Adenocarcinoma. Clin Oncol (R Coll Radiol) 2022; 34:386-394. [PMID: 34974972 DOI: 10.1016/j.clon.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/07/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022]
Abstract
AIMS The purpose of this study was to report on outcomes of a cohort of patients who were treated with reirradiation with stereotactic body radiation therapy (SBRT) for locally recurrent pancreatic adenocarcinoma. MATERIALS AND METHODS Patients treated with SBRT reirradiation for locally recurrent pancreatic adenocarcinoma from December 2009 to April 2020 were included in the study. Descriptive statistics were used to record patient demographics, tumour and treatment characteristics. Kaplan-Meier analysis was used to evaluate overall survival, local progression-free survival (LPFS), distant metastasis-free survival and progression-free survival (PFS). RESULTS In total, 27 patients were included in the study. The median follow-up time from local recurrence was 19.7 months (range 4.2-43.1 months). Most patients received five-fraction SBRT (26/27, 96%). The median overall survival after local recurrence treatment was 18.3 months (range 3.0-42.6 months), with 6-month, 1-year and 2-year overall survival rates of 88.5%, 73.1% and 33.6%. The median LPFS after local recurrence treatment was 16.2 months (range 2.3-33.6 months), with 6-month, 1-year and 2-year LPFS rates of 95.8%, 62.9% and 27.2%. Peri-SBRT chemotherapy improved LPFS (median 17.5 versus 8.5 months; P = 0.010) and overall survival (median 19.3 versus 5.5 months; P = 0.049). Tumours ≤ 3 cm in the greatest dimension showed better local control (median LPFS 19.2 versus 10.2 months; P = 0.130). There was one case (4%) of acute grade 3 pain and one case (4%) of late grade 3 gastrointestinal toxicity. CONCLUSIONS Reirradiation with five-fraction SBRT is safe, but local control remains suboptimal. Patients with smaller tumours experienced improved outcomes, as did patients whose treatment plan included the administration of peri-SBRT chemotherapy.
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Lashari B, Mangukia C, Ramakrishnan K, Kumaran M, Toyoda Y, Shigemura N, Sehgal S. Conservative Management of Right Middle Lobe Torsion Post Lung Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bilaver L, Wang H, Naidech A, Luo Y, Das R, Sehgal S, Gupta R. P107 FOOD ALLERGY AND INFORMATICS: USING NATURAL LANGUAGE PROCESSING TO IDENTIFY CLINICAL PREDICTORS IN PROGRESS NOTES. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.125] [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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13
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Reddy A, Hill C, Sehgal S, Ding D, Zheng L, He J, Herman J, Meyer J, Narang A. KRAS and NOTCH1/2 Mutations are Associated With Pathologic and Clinical Outcomes in Localized Pancreatic Cancer Treated With Neoadjuvant Chemotherapy and Stereotactic Body Radiotherapy Followed by Surgical Exploration. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hill C, Sehgal S, Reddy A, Herman J, Meyer J, Narang A. What Should We Cover Beyond Gross Disease With Radiation Therapy for Localized Pancreatic Ductal Adenocarcinoma (PDAC): Proposal of an Innovative and Standardized Clinical Tumor Volume (CTV) for PDAC of the Head – The Triangle. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Heena N, Zia NU, Sehgal S, Anwer S, Alghadir A, Li H. Effects of task complexity or rate of motor imagery on motor learning in healthy young adults. Brain Behav 2021; 11:e02122. [PMID: 34612612 PMCID: PMC8613406 DOI: 10.1002/brb3.2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/26/2021] [Accepted: 03/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A growing body of evidence suggests the benefit of motor imagery in motor learning. While some studies tried to look at the effect of isolated mental practice, others evaluated the combined effect of motor imagery and physical practice in clinical rehabilitation. This study aimed to investigate the effects of task complexity or rates of motor imagery on motor learning in health young adults. METHODS Eighty-eight healthy individuals participated in this study. Participants were randomly allocated to either Group A (50% complex, N = 22), Group B (75% complex, N = 22), Group C (50% simple, N = 22), or Group D (75% simple, N = 22). Participants in the complex groups performed their task with nondominant hand and those in simple groups with a dominant hand. All participants performed a task that involved reach, grasp, and release tasks. The performance of the four groups was examined in the acquisition and retention phase. The main outcome measure was the movement time. RESULTS There were significant differences between immediate (i.e., acquisition) and late (i.e., retention) movement times at all three stages of task (i.e., MT1 [reaching time], MT2 [target transport time], and TMT [reaching time plus object transport time]) when individuals performed complex task with 75% imagery rate (p < .05). Similarly, there were significant differences between immediate and late movement times at all stages of task except the MT2 when individuals performed simple task with 75% imagery rate (p < .05). There were significant effects of task complexity (simple vs. complex tasks) on immediate movement time at the first stage of task (i.e., MT1 ) and late movement times of all three stages of task (p < .05). There were significant effects of the rate of imagery (50% vs. 75%) on late movement times at all three stages of tasks (p > .05). Additionally, there were no interaction effects of either task complexity or rate of imagery on both immediate and late movement times at all three stages of tasks (p > .05). CONCLUSION This study supports the use of higher rates (75%) of motor imagery to improve motor learning. Additionally, the practice of a complex task demonstrated better motor learning in healthy young adults. Future longitudinal studies should validate these results in different patient's population such as stroke, spinal cord injury, and Parkinson's disease.
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Horlick S, Sehgal S, Al-Dulaimy B, Anmolsingh R, Goswamy J. 302 Migratory Foreign Body in The Neck- How A Fishbone Morphed into A Piece of Glass In 18 Months. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Foreign body (FB) ingestion is a common presentation to ear, nose, and throat (ENT) surgeons. Usual culprits include fish or chicken bones, steak, or non-organic items. FBs can be categorised into batteries, hard objects, and soft boluses. Hard objects that have not passed beyond the post-cricoid region require removal to minimise perforation risk. In rare cases FBs are reported to migrate extra-luminally into surrounding tissues of the neck necessitating cross-sectional imaging ahead of neck exploration.
Case Report
A 70-year-old lady presented to A&E with a sensation of FBs in her throat. She was aphagic without dyspnoea. Home-cooked fish ingestion was the precursor. Panendoscopy was clear. The patient was discharged once tolerating fluids and soft diet. She presented 14 months later to the ENT clinic with a persistent FB sensation in her throat. A computed-tomography scan of neck showed a right sided, radio-opaque, 3 cm foreign body sitting just anterior to the carotid sheath, behind the right superior thyroid lobe. An elective external neck exploration revealed a 3 cm shard of glass which was successfully removed without complications.
Conclusions
Extra-luminal migration of FBs is extremely rare. They may present with life-threatening suppurative or vascular complications. A literature review revealed that migratory FBs tend to be sharp and long such as needles, wires, or fishbones. To allow prompt diagnosis and management, we propose a low threshold for CT imaging in instances with a clear history and persistent symptoms even when panendoscopy is negative.
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Javaid A, Sehgal S, Khetarpal BK, Singh A, Diep J, Ahsan C, Malhotra S. Clinical course and surgical outcomes in middle-age adults with anomalous aortic origin of a coronary artery. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.006] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Patients with anomalous aortic origin of a coronary artery (AAOCA) present with a wide range of clinical manifestations, including ischemic symptoms (chest pain or dyspnea) and sudden cardiac death (SCD). Studies have identified coronary anatomic characteristics associated with a higher risk of SCD. However, most of the published literature consists of studies in adolescents and young adults. There is a paucity of data regarding outcomes in middle-aged patients. Current guidelines reveal gaps in evidence for identification of adults are at risk for SCD, and for whom surgery is beneficial.
Purpose
To study the clinical course and rate of major adverse cardiac events (MACE) in middle-aged adults with AAOCA based on presenting symptoms, coronary anatomy on coronary computed tomography angiography (CCTA), stress test results, and surgical management.
Methods
We included all patients from January 2013 to December 2019 age > 18 at our institution who were found to have AAOCA. Patients with the following were excluded to minimize confounding factors which could cause MACE: coronary artery disease (CAD) with >50% stenosis in any coronary vessel, CAD requiring revascularization, heart failure with ejection fraction <40%, history of heart transplant, and non-AAOCA congenital heart disease. All patient charts were reviewed for demographics, coronary anatomy on CCTA, presenting symptoms, rationale for pursuing stress testing and CCTA, nature of surgical interventions, post-surgical course, and MACE (cardiovascular death, myocardial infarction, and need for coronary revascularization). All patients underwent PET as well as treadmill stress testing.
Results
Of 19,367 patients who underwent CCTA, 47 met inclusion criteria, with median age at diagnosis of 54 and median follow-up of 48 months. No patients suffered MACE. Twenty-five patients had AAORCA and 22 had AAOLCA (Table 1). Ten patients with AAORCA and 8 patients with AAOLCA presented with ischemic symptoms and had coronary anatomy characteristics associated with higher risk of SCD, as well as ischemia corresponding to the anomalous artery on stress testing and did not undergo surgery due to personal preference. Five symptomatic patients with stress-induced ischemia corresponding to the anomalous artery underwent surgery and all achieved symptom relief over a median follow up of 5 years.
Conclusion
As AAOCA is a significant cause of SCD in young adults, it is compelling to observe this adult cohort in which no patients experienced MACE, including 18 symptomatic patients with high-risk anatomy and stress-induced ischemia, as well as a Class I recommendations for surgery. The results suggest that although surgery may be beneficial for symptom relief, it does not necessarily improve mortality over an intermediate follow-up period. Future studies should examine surgical outcomes in middle-aged cohorts with larger sample sizes.
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Heldman M, Kates O, Multani A, Steinbrink J, Lewis A, Alexander B, Beaird O, Sehgal S, Mishkin A, La Hoz R, Blumberg E, Nelson J, Safa K, Kotton C, Hemmersbach-Miller M, Chaudhry Z, Saharia K, Morillas J, Rakita R, Sait A, Meloni F, Wilkens H, Camargo P, Tanna S, Tomic R, Ison M, Lease E, Fisher C, Limaye A. A Multicenter Prospective Registry Study of Lung Transplant Recipients Hospitalized with COVID-19. J Heart Lung Transplant 2021. [PMCID: PMC7979361 DOI: 10.1016/j.healun.2021.01.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Outcomes of lung transplant recipients (LTR) hospitalized for COVID-19 and comparisons to non-lung solid organ transplant recipients (SOTR) are incompletely described. Methods Using a multicenter prospective registry of SOTR, we examined 28-day outcomes (mortality [primary outcome], intensive care unit (ICU) admission, mechanical ventilation, and bacterial pneumonia) among both LTR and non-lung SOTR hospitalized with laboratory-confirmed COVID-19 diagnosed between March 1, 2020 and September 21, 2020. Data were analyzed using Stata (StataCorp, College Station, TX); chi-square tests were used to compare categorical variables and multivariable logistic regression was used to assess risk factors for mortality. Results The cohort included 72 LTR and 392 non-lung SOTR (Table 1). Overall, 28-day mortality trended higher in LTR vs. non-lung SOTR (27.8% vs. 19.9%, P=0.136). Other 28-day outcomes were similar between LTR and non-lung SOTR: ICU admission (45.8% vs. 39.1%, P=0.28), mechanical ventilation (32.9% vs. 31.1%, P=0.78), and bacterial pneumonia (15.3% vs. 8.2%, P=0.063). Congestive heart failure, diabetes, age >65 years, and obesity (BMI >= 30) were independently associated with mortality in non-lung SOTR, but not in LTR (Table 2). Conclusion In this large prospective cohort comparing lung and non-lung SOTR hospitalized for COVID-19, there were high but not significantly different rates of short-term morbidity and mortality. Baseline comorbidities appeared to drive mortality in non-lung SOTR but not LTR. Further studies are needed to identify risk factors for mortality among LTR.
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Chanda A, Chauhan A, Kaur P, Soni A, Sehgal S, Khurana A, Parkash O, Verma Y. P37.11 Assessment of Plasma D-Dimer as a Predictive Biomarker for Treatment Response in Lung Cancer Treated with Radiation Therapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chauhan A, Chanda A, Kaur P, Soni A, Sehgal S, Khurana A, Verma Y, Parkash O. P30.06 Outcome Differences Amongst Histopathological Variants of Non Small Cell Lung Cancer Treated With Palliative Radiotherapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Small JE, Macey MB, Wakhloo AK, Sehgal S. CTA Evaluation of Basilar Septations: An Entity Better Characterized as Aberrant Basilar Fenestrations. AJNR Am J Neuroradiol 2021; 42:701-707. [PMID: 33602748 DOI: 10.3174/ajnr.a7008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A basilar artery intraluminal septation is an exceedingly rarely reported, presumed congenital abnormality. In our clinical practice, we have occasionally noticed an intraluminal band within the inferior aspect of the basilar artery on CTA. Furthermore, we have noticed, at times, the presence of a punctate calcification associated with this finding. We hypothesized that what previous studies have called "basilar septations" in fact represent miniature and thus aberrant basilar fenestrations. MATERIALS AND METHODS We retrospectively reviewed CTA studies obtained between January 1, 2017, and August 31, 2019. Identified intraluminal basilar abnormalities were classified as either basilar septations or basilar fenestrations. Association with other posterior circulation abnormalities was documented. RESULTS A total of 3509 studies were examined. A basilar intraluminal abnormality was evident in 80 patients (2.3%). Of these 80 patients, 59 were classified as having a basilar fenestration (1.7%) and 21 were classified as having basilar septations (0.6%). Associated calcification was evident in 3 of the basilar fenestration cases and 13 of the basilar septation cases. CONCLUSIONS Basilar septations most likely represent and should be referred to as aberrant basilar fenestrations. They should be interpreted as benign congenital incidental findings and should not be misinterpreted as focal dissections or arterial webs. Important variations in the morphology of aberrant basilar fenestrations exist, including areas of thinning, varying thickness, and nodularity. Therefore, when associated with calcification or nodularity, aberrant basilar fenestrations should not be confused with focal intraluminal thrombi or calcified or noncalcified emboli.
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Brar R, Bharti J, Nigam J, Sehgal S. ADENOID CYSTIC CARCINOMA MISINTERPRETED AS ANTROCHOANAL POLYP: A RARE PRESENTATION. Ann Ib Postgrad Med 2020; 18:160-162. [PMID: 34421458 PMCID: PMC8369394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Adenoid cystic Carcnoma (ACC) is an uncommon malignant tumour accounting for <1% of all oral and maxillofacial tumors. However, in the sinonasal tract, ACC is the most common salivary gland tumor. The sinonasal ACC is asymptomatic initially or causes non-specific symptoms that are similar to those caused by inflammatory sinus disease and local neurological symptoms such as trigeminal neuralgia in advance stage due to perineural invasion by the tumour.We present a case of 35-year-old female who presented with complaints of nasal obstruction and headache. CT scans revealed an antrochoanal polyp without any bony involvement. The histopathological examination revealed unremarkable respiratory epithelium with underlying sheets and acini of small hyperchromatic cells with hyaline-like material in the lumina, confirming adenoid cystic carcinoma. The highlight of this case is that sinonasal polyps are not always inflammatory in origin, these can be neoplastic also.
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Saxena A, Sehgal S, Jangra MK. Effectiveness of Neurodynamic Mobilization versus Conventional Therapy on Spasticity Reduction and Upper Limb Function in Tetraplegic Patients. Asian Spine J 2020; 15:498-503. [PMID: 33059433 PMCID: PMC8377221 DOI: 10.31616/asj.2020.0146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN The study employed a pre- and post-test experimental design. PURPOSE This study was designed to assess the effect of neurodynamic mobilization of the median nerve on upper limb spasticity in tetraplegic patients. OVERVIEW OF LITERATURE Spasticity is a common and potentially disabling and bothersome complication in patients with spinal cord lesion; this disorder can negatively influence the quality of life by restricting the patient's ability to perform activities of daily living. Neural mobilization is currently used for reducing the spasticity in individuals with neurological disorders. METHODS Twenty subjects with traumatic spinal cord injury (level C5-C8) and upper limb spasticity in the finger and wrist flexors were enrolled. They were randomly allocated to two different groups using a computer-generated randomization schedule: group I comprised the neurodynamic mobilization group (n=11) and group II was the conventional therapy group (n=9); the subjects were administered therapy for 5 days every week for a period of 4 weeks. Upper limb spasticity was assessed using the Modified Ashworth Scale for wrist and finger flexors; F-wave amplitude, latency, and F-wave/M-wave amplitude ratio (F/M ratio) were examined using the F-wave scores of the median nerve; and upper limb function was determined using the Capabilities of Upper Extremity (CUE) Questionnaire. RESULTS After 4 weeks of intervention, between-group comparisons showed a significant difference in the pre-intervention and postintervention scores on the Modified Ashworth Scale score for wrist flexors (-1.64±0.67), Modified Ashworth Scale score for finger flexors (-1.00±0.63), F-wave amplitude (-154.09±220.86), F/M ratio (-0.18±0.24), and CUE scores (17.82±13.49). CONCLUSIONS These results suggest that neurodynamic mobilization of the median nerve may be effective for upper limb spasticity control and upper limb functional improvement in tetraplegic patients.
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Sehgal S, Foulkes AJ. Numerical analysis of subcritical Hopf bifurcations in the two-dimensional FitzHugh-Nagumo model. Phys Rev E 2020; 102:012212. [PMID: 32795073 DOI: 10.1103/physreve.102.012212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/24/2020] [Indexed: 11/07/2022]
Abstract
It had been shown that the transition from a rigidly rotating spiral wave to a meandering spiral wave is via a Hopf bifurcation. Many studies have shown that these bifurcations are supercritical, but, by using simulations in a comoving frame of reference, we present numerical results which show that subcritical bifurcations are also present within FitzHugh-Nagumo. We show that a hysteresis region is present at the boundary of the rigidly rotating spiral waves and the meandering spiral waves for a particular set of parameters, a feature of FitzHugh-Nagumo that has previously not been reported. Furthermore, we present a evidence that this bifurcation is highly sensitive to initial conditions, and it is possible to convert one solution in the hysteresis loop to the other.
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Kennedy C, Budev M, Wille K, Lease E, Chandrashekaran S, Levine D, Nunley D, Chan K, Wilson M, Hayanga J, Shigemura N, Kumar A, Girgis R, Sharma N, Lyu D, Sehgal S, Mattar A, Loor G, A. On Behalf of the Donor Quality Working Group. Multi-Center Validation of a Consensus-Based Scoring Guide for Evaluating Donor Lung Offers. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.844] [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] Open
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