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Berkow D, Dunne M, Logan NS, Anderson SJ. Exemplifying practice-based research: the influence of age on myopia progression. Clin Exp Optom 2024:1-5. [PMID: 38373889 DOI: 10.1080/08164622.2024.2309219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
CLINICAL RELEVANCE The electronic storage of patient records and modern-day search engines present private practitioners with a unique opportunity to extract valuable data for investigative research purposes. However, practitioners seldom harness this resource and consequently a vast repository of clinical data remains largely unexplored. BACKGROUND This study, based on real-world data from an optometric practice, stands as an example of how clinicians can actively contribute to research. In doing so it underscores the role played by age in determining the rate of natural myopia progression. METHODS A retrospective data analysis of the refractive status, age and optical correction type of participants, was conducted over six years. Forty-four participants were recruited (25 contact lens and 19 spectacle wearers), with a presenting age varying from 5 to 20 years (median, 11 years). Non-cycloplegic, monocular foveal refractions were completed using a ShinNippon open-field autorefractor, corroborated with subjective refraction. The mean spherical equivalent refractive error was calculated for the participants' initial visit (baseline measure) and for a six-year follow-up visit (progression measure), with myopia progression defined as the difference between these measures. Statistical analyses were computed using Decision Tree Analysis, with a significance level set at 95%. RESULTS The participant age at first visit exerted a significant influence on natural myopia progression over the assessment period (F 1,42 = 17.11, p < 0.001). Individuals aged ≤ 10 years had approximately twice the myopic progression (mean, -2.27 D) of those aged > 10 years (mean, -1.13 D). Neither degree of myopia at the initial visit nor optical correction type had a significant effect on progression (p > 0.05). CONCLUSIONS Utilizing the advantage of small real-world data samples, the benefit of research by private practitioners was demonstrated, providing evidence that the age at which a child first presents for an eye examination is highly influential in determining their rate of myopia progression.
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Affiliation(s)
- David Berkow
- Rambam Health Care Campus Hospital, Department of Ophthalmology, Haifa, Israel
| | - Mark Dunne
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Nicola S Logan
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Stephen J Anderson
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
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Nicholson J, O'Neill BD, Thirion P, Cunningham M, McVey G, Coffey J, Mihai AM, Kelly PJ, Elbeltagi N, Dunne M, Noone E, Parker I, Shannon AM, McCague M, Alvarez-Iglesias A, Kelly H, O'Donovan R, Hajdaraj D, Lawler G, Armstrong JG. A Prospective Phase II Dose Escalation Study Using IMRT for High Risk N0M0 Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e422. [PMID: 37785387 DOI: 10.1016/j.ijrobp.2023.06.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Published data supports the use of very high dose intensity modulated radiotherapy (IMRT) in achieving high efficacy and low toxicity for high-risk prostate cancer (HRPCa). This phase II multi-institutional non-randomized prospective dose escalation study using intensity modulated radiotherapy (IMRT) for high risk N0M0 prostate cancer was designed to investigate dose escalation using 1.8 Gy increments from baseline 75.6 Gy up to maximum 81 Gy, once dose volume constraints were adhered to. MATERIALS/METHODS Inclusion criteria were patients undergoing a radical course of RT for high and very high-risk disease, defined as one or more of the criteria ≥ T3*, ≥ Gleason 8, Prostate specific antigen (PSA) > 20ng/ml. All patients received Androgen Deprivation Therapy (ADT) and none had radiological evidence of distant metastatic disease. The primary objective was to determine if dose escalated IMRT for high risk localized prostate cancer could provide freedom from biochemical relapse (BR; PSA rising > nadir +2ng/mL or initiation of salvage hormone therapy) similar to that reported in the literature. The Kaplan-Meier method was used to estimate survival times. Secondary objectives included OS, Disease Free Survival (DFS), and the incidence and severity of Genito-urinary (GU), Gastro-intestinal (GI) and erectile dysfunction (ED) toxicities (CTCAE v.3). Toxicities and performance status were collected and graded weekly during RT, 2 months after completing RT, 8 months' post RT, and 6 monthly thereafter to year five and annually thereafter to year nine. RESULTS A total of 230 evaluable patients were enrolled between April 2009 and June 2016. The median follow-up was 7.3 years. The cumulative proportion of patients surviving without BR at 5 years was 91% (95% Confidence Interval (CI): 86% to 94%). Overall survival at 5 and 7 years was 92% (88% to 95%) and 89% (83% to 92%) respectively, while the cumulative proportion of patients free from disease was 89% (84% to 93%) at 5 years and 81% (75% to 86%) at 7 years. The incidence of acute G2 and G3 toxicities were; GU; 57.8% G2, 12.6% G3, GI; 15.2% G2, 0.4% G3, ED; 30.0% G2 and 61.7% G3. The incidence of late G2, G3 and G4 toxicities were; GU; 40.9% G2, 8.7% G3, GI; 36.5% G2, 2.2% G3, 0.4% G4, ED; 11.7% G2 and 86.1% G3. The percentage of patients receiving each dose level was; 3.5% received 75.6Gy in 42 fractions, 2.2% received 77.4Gy in 43 fractions, 93% received 81Gy in 45 fractions. CONCLUSION The findings indicate that high-dose IMRT is well tolerated and is associated with excellent long-term tumor-control outcomes in patients with localized high and very high-risk prostate cancer, with 91% of patients surviving at 5 years without biochemical relapse. The rates of long term G3 GU and GI toxicity were low at 8.7% and 0.4% respectively.
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Affiliation(s)
- J Nicholson
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - B D O'Neill
- St.Luke's Radiation Oncology Network, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland
| | - P Thirion
- Beacon Hospital, Dublin, Ireland; St Luke's Radiation Oncology Network, Dublin, Ireland
| | - M Cunningham
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - G McVey
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - J Coffey
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - P J Kelly
- Cork University Hospital, Cork, Ireland
| | - N Elbeltagi
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - M Dunne
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - E Noone
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - I Parker
- Cancer Trials Ireland, Dublin, Ireland
| | | | - M McCague
- HRB Clinical Research Facility, NUI Galway, Galway, Ireland
| | | | - H Kelly
- HRB Clinical Research Facility, NUI Galway, Galway, Ireland
| | - R O'Donovan
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - D Hajdaraj
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - G Lawler
- Beacon Hospital, Dublin, Ireland
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Nugent K, Browne D, Dunne M, Osullivan L, Shannon AM, Sharma D, Bradshaw S, McArdle O, Salib O, Lavan N, Gillham C. Acute Gastrointestinal and Genitourinary Toxicity Results from a Prospective Randomized Phase II Trial Evaluating Adjuvant Pelvic Radiotherapy Using Either IMRT or 3-Dimensional Planning for Endometrial Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e702. [PMID: 37786059 DOI: 10.1016/j.ijrobp.2023.06.2189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To compare the incidence of grade ≥2 gastrointestinal (GI) or genitourinary (GU) toxicity for patients undergoing 3DRT versus IMRT in the post-operative setting for endometrial cancer. MATERIALS/METHODS Patients were post-operatively enrolled in a prospective randomized phase II trial from 2010 to 2020. Those eligible were adults aged ≥18 scheduled to receive adjuvant pelvic radiotherapy (RT) for histologically confirmed endometrial carcinoma with the following AJCC 2009 grade/stage: Grade 2: stage IB (LVSI +/or >60 yrs); Grade 3: stage IA and IB; or Grade 1-3: Stage II and IIIA, IIIB and IIIC1; who had an ECOG-PS 0-2, and who had surgery consisting of total hysterectomy, +/- bilateral salpingo-oophorectomy, +/- lymph node sampling. Exclusion criteria included previous irradiation to the pelvic region, patients in whom concurrent chemotherapy was planned, a history of inflammatory bowel disease, and previous bowel surgery. Patients were randomly assigned to one of two parallel groups in 1:1 ratio, to have their RT delivered using either a 3DRT technique or using IMRT. Prescription dose was 45 Gy in 25 fractions over 5 weeks followed by 11 Gy in 2 fractions vaginal vault brachytherapy. Toxicity was graded according to CTCAE ver. 3.0. Acute toxicity was assessed weekly during RT. Fisher's exact tests were used to test for associations between toxicity and arm. Differences in dosimetric parameters for patients with or without toxicity were tested using Mann-Whitney U-tests. RESULTS Ninety-two patients with a median age of 63 were enrolled, with 8 patients not evaluable for primary outcome. The median follow-up was 52 months. 14 (35%) participants from the 3DRT arm and 15 (34%) from the IMRT arm experienced acute grade ≥2 GI toxicity. 20 (50%) participants from the 3DRT arm and 25 (57%) from the IMRT arm experienced acute grade ≥2 GI or GU toxicity (p = .662). Grade 3 GI toxicity was 5 (12%) and 4 (9%) for 3DRT and IMRT, respectively. 12 (30%) patients from the 3DRT arm and 17 (39%) from the IMRT arm experienced acute grade ≥2 GU toxicity (p = .493). Rates for grade 3 GU toxicity were 4 (10%) and 4 (9%) for 3DRT and IMRT, respectively. Those with acute grade ≥2 GU toxicity had a median PTV D99% of 43.2 Gy (35.5-44.6) compared with a median of 43.4 Gy (41.5-44.6; p = 0.042) for those who did not have a grade ≥2 GU toxicity. CONCLUSION No statistically significant differences in the incidence of acute GI or GU toxicity were found between patients treated with adjuvant IMRT versus 3DRT radiotherapy for endometrial cancer. Although IMRT can reduce dose to normal tissue, in this study no benefit in acute toxicity outcome was seen.
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Affiliation(s)
- K Nugent
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - D Browne
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - M Dunne
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | | | | | - D Sharma
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - S Bradshaw
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - O McArdle
- St.Luke's Radiation Oncology Network, Dublin, Ireland; Faculty of Radiologists and Radiation Oncologists, RCSI, Dublin, Ireland
| | - O Salib
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | - N Lavan
- St. Luke's Hospital, Dublin 6, Ireland
| | - C Gillham
- St Luke's Radiation Oncology Network, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland
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Leitner L, Du J, Meile S, Baggenstos J, Jäggi T, Piffaretti P, Hunold L, Matter C, Kessler T, Loesser M, Kilcher S, Dunne M. Enhancing bacteriophage therapeutics through in situ production and release of heterologous antimicrobial effectors. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00778-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Gonzalez-Martin J, Garcia-Munoz M, Galdon-Quiroga J, Todo Y, Dominguez-Palacios J, Dunne M, van Vuuren AJ, Liu YQ, Sanchis L, Spong D, Suttrop W, Wang X, Willensdorfer M. Active Control of Alfvén Eigenmodes by Externally Applied 3D Magnetic Perturbations. Phys Rev Lett 2023; 130:035101. [PMID: 36763388 DOI: 10.1103/physrevlett.130.035101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 09/27/2022] [Accepted: 12/19/2022] [Indexed: 06/18/2023]
Abstract
The suppression and excitation of Alfvén eigenmodes have been experimentally obtained, for the first time, by means of externally applied 3D perturbative fields with different spatial spectra in a tokamak plasma. The applied perturbation causes an internal fast-ion redistribution that modifies the phase-space gradients responsible for driving the modes, determining, ultimately their existence. Hybrid kinetic-magnetohydrodynamic simulations reveal an edge resonant transport layer activated by the 3D perturbative field as the responsible mechanism for the fast-ion redistribution. The results presented here may help to control fast-ion driven Alfvénic instabilities in future burning plasmas with a significant fusion born alpha particle population.
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Affiliation(s)
- J Gonzalez-Martin
- Department of Mechanical Engineering and Manufacturing, University of Seville, Camino de los Descubrimientos s/n, 41092 Seville, Spain
- Department of Physics and Astronomy, University of California, Irvine, California 92697, USA
| | - M Garcia-Munoz
- Department of Atomic, Molecular and Nuclear Physics, University of Seville, 41012 Seville, Spain
| | - J Galdon-Quiroga
- Department of Atomic, Molecular and Nuclear Physics, University of Seville, 41012 Seville, Spain
| | - Y Todo
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - J Dominguez-Palacios
- Department of Atomic, Molecular and Nuclear Physics, University of Seville, 41012 Seville, Spain
| | - M Dunne
- Max Planck Institute for Plasma Physics, Boltzmannstrasse, 2 85748 Garching bei Munchen, Germany
| | - A Jansen van Vuuren
- Department of Atomic, Molecular and Nuclear Physics, University of Seville, 41012 Seville, Spain
| | - Y Q Liu
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608, USA
| | - L Sanchis
- Department of Applied Physics, Aalto University, FI-00076, Aalto, Finland
| | - D Spong
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - W Suttrop
- Max Planck Institute for Plasma Physics, Boltzmannstrasse, 2 85748 Garching bei Munchen, Germany
| | - X Wang
- Max Planck Institute for Plasma Physics, Boltzmannstrasse, 2 85748 Garching bei Munchen, Germany
| | - M Willensdorfer
- Max Planck Institute for Plasma Physics, Boltzmannstrasse, 2 85748 Garching bei Munchen, Germany
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Nugent K, Quinlan E, Cleary S, O'Driscoll H, Rohan C, Trousdell J, Williams J, Dunne M, McArdle O, Duane F. Implementation of 26 Gy in five fractions over 1 week adjuvant radiotherapy for breast cancer: Prospective report of acute skin toxicity and consideration of resource implications. Breast 2022; 67:55-61. [PMID: 36603414 PMCID: PMC9756602 DOI: 10.1016/j.breast.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE In March 2020, a 1-week adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions, was adopted to reduce the risk of COVID19 for staff and patients. This study quantifies acute toxicity rates and the effect on linac capacity. MATERIALS AND METHODS This is a report of consecutive patients receiving ultrafractionated breast radiotherapy ( ± sequential boost) Mar-Aug 2020. Virtual consultations assessed acute skin toxicity during treatment and weeks 1, 2, 3 and 4 post treatment using CTCAE V5 scoring criteria. The number of linac minutes saved was estimated accounting for boost and DIBH use. RESULTS In total, 128/135 (95%) patients, including 31/33 boost patients, completed at least 3/5 assessments. 0/128 (0%) reported moist desquamation not confined to skin folds or minor bleeding (Grade 3), 41/128 (32%) reported brisk erythema, moist desquamation confined to skin folds or breast swelling (Grade 2), 62/128 (48%) reported faint erythema or dry desquamation (Grade 1) as their worst skin toxicity, with the remaining 20% reporting no skin toxicity. The highest prevalence of grade 2 toxicity occurred week 1 following treatment (20%), reducing to 3% by week 4. There was no difference in toxicity between those who received a boost versus not (p = 1.00). Delivering this schedule to 135 patients over six months saved 21,300 linac minutes and 1485 hospital visits compared to a 3-week schedule. CONCLUSION Rapidly implementing ultrahypofractionated breast radiotherapy is feasible and acute toxicity rates are acceptable even when followed by boost.
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Affiliation(s)
- K. Nugent
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland
| | - E. Quinlan
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland
| | - S. Cleary
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland
| | - H. O'Driscoll
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland
| | - C. Rohan
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland
| | - J. Trousdell
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland
| | - J. Williams
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland
| | - M. Dunne
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland
| | - O McArdle
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland
| | - F.K. Duane
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland,Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland,School of Medicine, Trinity College Dublin, Ireland,Corresponding author. St Luke's Radiation Oncology Network and Trinity St. James's Cancer Institute, St James's Hospital, Dublin 8, Ireland.
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Glynn A, Harwood R, Garrett B, Harper D, Dunne M, Brennan S. Changing the Face of Head and Neck Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wallace N, Skourou C, Dunne M, Gillham C, McVey G, Armstrong J, Cunningham M, Rangaswamy G, Mahon M, Bradshaw S, Sharma D, Hennessy B, Mcdermott R, Shannon A, Osullivan L, Parker I, Toomey S, Marron J, O'Neill B. Acute Gastrointestinal Toxicity Results from a Multi-Institution, Phase 2, Randomized Controlled Trial Comparing 3D-Conformal Radiotherapy (3DCRT) Versus Intensity Modulated Radiotherapy (IMRT) for Locally-Advanced Rectal Cancer (TRI-LARC). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Geary R, Gillham C, McVey G, Armstrong J, Cunningham M, Rangaswamy G, Sharma D, Wallace N, Skourou C, Dunne M, Mahon M, Bradshaw S, Osullivan L, Marron J, Parker I, Shannon A, Mcdermott R, Toomey S, Hennessy B, O'Neill B. Quality of Life Analysis of a Phase II Randomized Controlled Trial Comparing 3D-Conformal Radiotherapy (3D-CRT) and Intensity Modulated Radiotherapy (IMRT) in Locally Advanced Rectal Cancer (TRI-LARC). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Geary R, O'Sullivan S, McDermott S, Dunne M, Keenan L, Sharma P, Thirion P. Evaluation of Radical Thoracic Re-Irradiation: A Single Institution Retrospective Study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Harrer GF, Faitsch M, Radovanovic L, Wolfrum E, Albert C, Cathey A, Cavedon M, Dunne M, Eich T, Fischer R, Griener M, Hoelzl M, Labit B, Meyer H, Aumayr F. Quasicontinuous Exhaust Scenario for a Fusion Reactor: The Renaissance of Small Edge Localized Modes. Phys Rev Lett 2022; 129:165001. [PMID: 36306746 DOI: 10.1103/physrevlett.129.165001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 06/16/2023]
Abstract
Tokamak operational regimes with small edge localized modes (ELMs) could be a solution to the problem of large transient heat loads in fusion reactors. A ballooning mode near the last closed flux surface governed by the pressure gradient and the magnetic shear there has been proposed for small ELMs. In this Letter, we experimentally investigate several stabilizing effects near the last closed flux surface and present linear ideal simulations that indeed develop ballooninglike fluctuations there and connect them with nonlinear resistive simulations. The dimensionless parameters of the small ELM regime in the region of interest are very similar to those in a reactor, making this regime the ideal exhaust scenario for a future device.
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Affiliation(s)
- G F Harrer
- Institute of Applied Physics, TU Wien, Fusion@ÖAW, Vienna, Austria
- Max Planck Institute for Plasma Physics, Garching, Germany
| | - M Faitsch
- Max Planck Institute for Plasma Physics, Garching, Germany
| | - L Radovanovic
- Institute of Applied Physics, TU Wien, Fusion@ÖAW, Vienna, Austria
- Max Planck Institute for Plasma Physics, Garching, Germany
| | - E Wolfrum
- Max Planck Institute for Plasma Physics, Garching, Germany
| | - C Albert
- Institute of Theoretical and Computational Physics, TU Graz, Graz, Austria
| | - A Cathey
- Max Planck Institute for Plasma Physics, Garching, Germany
| | - M Cavedon
- Dipartimento di Fisica "G. Occhialini," Università di Milano-Bicocca, Milano, Italy
| | - M Dunne
- Max Planck Institute for Plasma Physics, Garching, Germany
| | - T Eich
- Max Planck Institute for Plasma Physics, Garching, Germany
| | - R Fischer
- Max Planck Institute for Plasma Physics, Garching, Germany
| | - M Griener
- Max Planck Institute for Plasma Physics, Garching, Germany
| | - M Hoelzl
- Max Planck Institute for Plasma Physics, Garching, Germany
| | - B Labit
- École Polytechnique Fédérale de Lausanne (EPFL), Swiss Plasma Center (SPC), CH-1015 Lausanne, Switzerland
| | - H Meyer
- CCFE, Culham Science Centre, Abingdon, Oxon, United Kingdom
| | - F Aumayr
- Institute of Applied Physics, TU Wien, Fusion@ÖAW, Vienna, Austria
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Nugent K, O'Neill B, Brennan V, Lynch J, Higgins M, Dunne M, Skourou C. Quantification of organ motion in male and female patients undergoing long course radiotherapy for rectal cancer in the supine position. Adv Radiat Oncol 2022; 8:101109. [DOI: 10.1016/j.adro.2022.101109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
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Rangaswamy G, McNulty M, Browne D, Sharma P, Walkins F, Burke M, Houlihan O, Skourou C, Dunne M, Fitzpatrick D, El Beltagi N, Faul C. PO-1142 Clinical outcomes following Stereotactic Radiosurgery for Brain Metastases from Ovarian Carcinoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03106-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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McNulty M, Waldron O, Ather M, Rangaswamy G, Houlihan O, Dunne M, Curran B, Ryan S, Skourou C, El Beltagi N, Fitzpatrick D, O'Sullivan S, Faul C. PO-1141 Stereotactic ablative body radiation therapy for spinal metastases; A single institution study. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Burke M, Rangaswamy G, Dunne M, Armstrong J, Faul C, Fitzpatrick D. PO-1430 A Retrospective study of outcomes with stereotactic radiosurgery for melanoma brain metastasis. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kishan A, Sun Y, Pisansky T, Bolla M, Steigler A, Denham J, Shipley W, Sandler H, Feng F, Joseph D, Armstrong J, Dunne M, Zapatero A, Ma T, Romero T, Wang X, Steinberg M, Jackson W, Dess R, Spratt D. Individual Patient Data Meta-Analysis of Randomized Trials in Cancer of the Prostate (MARCAP) Consortium: Impact of Androgen Deprivation Therapy Use and Duration With Definitive Radiotherapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kishan A, Romero T, Wang X, Pisansky T, Roach M, Bolla M, Steigler A, Denham J, Shipley W, Sandler H, Feng F, Joseph D, Armstrong J, Dunne M, Malone S, Roy S, Zapatero A, Sun Y, Michalski J, Spratt D. Impact of High DosE rAdioTherapy (HEAT) in Localized Prostate Cancer: An Individual Patient Data (IPD) Meta-Analysis of 15 Randomized Trials. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Monaghan O, O’Dwyer N, Dunne M, Nugent J, Coughlan N, Nolan A, Gilbert F, Glynn A, Duane F, Parkes C, Brennan S. PO-0967 Factors associated with feeding tube requirement in Oropharyngeal Cancer treated with IMRT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Rangaswamy G, Houlihan O, Nicholson J, O’Driscoll H, Dunne M, Skourou C, Faul C, Fitzpatrick D. PO-1062 Stereotactic Radiosurgery for Brain Metastases from Renal Cell Carcinoma: A retrospective study. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Houlihan O, Rangaswamy G, Dunne M, Fennell L, Skourou C, Faul C, Fitzpatrick D. PO-1044 Stereotactic radiosurgery for meningioma: a single institution retrospective analysis. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Mihai AM, Armstrong PJ, Hickey D, Milano MT, Dunne M, Healy K, Thirion P, Heron DE, ElBeltagi N, Armstrong JG. Late Toxicity and Long-Term Local Control in Patients With Ultra-Central Lung Tumours Treated by Intensity-Modulated Radiotherapy-Based Stereotactic Ablative Body Radiotherapy With Homogenous Dose Prescription. Clin Oncol (R Coll Radiol) 2021; 33:627-637. [PMID: 34092462 DOI: 10.1016/j.clon.2021.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/21/2021] [Accepted: 05/13/2021] [Indexed: 12/14/2022]
Abstract
AIMS To report late toxicity and long-term outcomes of intensity-modulated radiotherapy (IMRT)-based stereotactic ablative body radiotherapy (SABR) in patients with ultra-central lung tumours. MATERIALS AND METHODS This is a single-institution retrospective analysis of patients treated with SABR for ultra-central tumours between May 2008 and April 2016. Ultra-central location was defined as tumour (GTV) abutting or involving trachea, main or lobar bronchi. Respiratory motion management and static-field dynamic-IMRT were used, with dose prescribed homogeneously (maximum <120%). Descriptive analysis, Kaplan-Meier method, log-rank test and Cox regression were used to assess outcomes. RESULTS Sixty-five per cent of patients had inoperable primary non-small cell lung cancer and 35% had lung oligometastases. The median age was 72 (range 34-85) years. The median gross tumour volume and planning target volume (PTV) were 19.6 (range 1.7-203.3) cm3 and 57.4 (range 7.7-426.6) cm3, respectively. The most commonly used dose fractionation was 60 Gy in eight fractions (n = 51, 87.8%). Median BED10 for D98%PTV and D2%PTV were 102.6 Gy and 115.06 Gy, respectively. With a median follow-up of 26.5 (range 3.2-100.5) months, fatal haemoptysis occurred in five patients (8.7%), of which two were directly attributable to SABR. A statistically significant difference was identified between median BED3 for 4 cm3 of airway, for patients who developed haemoptysis versus those who did not (147.4 versus 47.2 Gy, P = 0.005). At the last known follow-up, 50 patients (87.7%) were without local recurrence. Freedom from local progression at 2 and 4 years was 92 and 79.8%, respectively. The median overall survival was 34.3 (95% confidence interval 6.1-61.6) months. Overall survival at 2 and 4 years was 55.1 and 41.2%, respectively. CONCLUSION In patients with high-risk ultra-central lung tumours, IMRT-based SABR with homogenous dose prescription achieves high local control, similar to that reported for peripheral tumours. Although fatal haemoptysis occurred in 8.7% of patients, a direct causality with SABR was evident in only 3%. Larger studies are warranted to ascertain factors associated with outcomes, especially toxicity, and identify patients who would probably benefit from this treatment.
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Affiliation(s)
- A M Mihai
- Department of Radiotherapy, Beacon Hospital, Dublin, Ireland.
| | - P J Armstrong
- University College Dublin School of Medicine, Dublin, Ireland
| | - D Hickey
- Department of Radiotherapy, Beacon Hospital, Dublin, Ireland
| | - M T Milano
- University of Rochester, Rochester, NY, USA
| | - M Dunne
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - K Healy
- University College Dublin School of Medicine, Dublin, Ireland
| | - P Thirion
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - D E Heron
- Bon Secours Mercy Health, Cincinnati, OH, USA
| | - N ElBeltagi
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - J G Armstrong
- Department of Radiotherapy, Beacon Hospital, Dublin, Ireland
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Sheikh U, Dunne M, Frassinetti L, Labit B, Blanchard P, Duval B, Février O, Galassi D, Merle A, Reimerdes H, Theiler C. Impact of the new TCV baffled divertor upgrade on pedestal structure and performance. Nuclear Materials and Energy 2021. [DOI: 10.1016/j.nme.2021.100933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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McDermott RL, Mihai A, Dunne M, Keys M, O'Sullivan S, Thirion P, ElBeltagi N, Armstrong JG. Stereotactic Ablative Radiation Therapy for Large (≥5 cm) Non-small Cell Lung Carcinoma. Clin Oncol (R Coll Radiol) 2020; 33:292-299. [PMID: 33309479 DOI: 10.1016/j.clon.2020.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/28/2020] [Accepted: 11/25/2020] [Indexed: 12/25/2022]
Abstract
AIMS Stereotactic ablative radiation therapy (SABR) is a standard of care for medically inoperable early stage non-small cell lung carcinoma. Tumours greater than 5 cm have been excluded from randomised trials using SABR and, hence, it is not used as a standard for larger lung tumours. However, improvements in radiation therapy techniques and the success of SABR in treatment of early stage disease may allow safe delivery of ablative doses to larger tumours. We analysed our experience with tumours ≥5 cm to determine the efficacy and toxicity profile of SABR in this setting. MATERIALS AND METHODS We evaluated survival, control rates, patterns of failure and toxicity in patients with a tumour diameter larger than 5 cm that had no nodal or distant metastases treated with SABR technology. Patients had been treated in two centres since 2009 and were retrospectively analysed. All patients had positron emission tomography staging, were discussed at a tumour board and were documented to have no nodal or distant metastatic disease. Treatment outcomes were analysed using Kaplan-Meier estimates and compared using the Log-rank test. Cox regression was used to investigate the association between the survival outcomes and predictor variables. RESULTS In total, 86 patients were identified. Six patients had no follow-up imaging. Therefore, 80 patients were available for analysis. All patients were reclassified according to the updated AJCC eighth edition. The median follow-up was 19.6 months. No patients received neoadjuvant or concurrent systemic therapy. One patient received adjuvant systemic therapy. The median age at treatment was 77 years (range 58-91). Eighty-four per cent were stage T3N0M0 and 16% were staged T4N0M0. The median tumour diameter was 5.8 cm (range 5.0-9.3 cm). The median gross tumour volume, measured on a single phase of the respiratory cycle, was 45.7 cm3 (range 12.1-203.3 cm3). The median overall survival was 20.9 months (95% confidence interval 12.6-29.1 months). One-, 2- and 3-year overall survival was 71%, 48% and 32%, respectively. The median local failure-free survival was 19.5 months (95% confidence interval 14.4-24.6). The median disease-free survival was 15.1 months (95% confidence interval 9.9-20.4 months). Local control at 1, 2 and 3 years was 85% (95% confidence interval 76-94%), 71% (95% confidence interval 58-84%) and 57% (95% confidence interval 40-74%), respectively. Forty-four patients (55%) had any treatment failure (local, mediastinal, intrapulmonary or distant metastases). Out-of-field intrapulmonary disease progression was the most common mode of failure, occurring in 21 patients (26%). Local failure occurred in 19 patients (24%) - alone or in combination with other progression. Distant metastases occurred in 20 patients (25%). Neither histological subtype, tumour size nor gross tumour volume had a statistically significant effect on local failure-free survival. Two patients experienced grade 3 late dyspnoea. There were no other reported grade 3 or higher acute or late toxicities. CONCLUSION SABR for larger lung tumours ≥5 cm results in high local control and acceptable survival in patients with medically inoperable large non-small cell lung carcinoma treated with radiation alone. Such patients should be considered for SABR owing to fewer treatment fractions and acceptable toxicity. Local control analysis reveals a sustained pattern of local failure emphasising the need for long-term follow-up. Improvements in technical strategies are required to further improve local control.
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Affiliation(s)
- R L McDermott
- St Luke's Institute of Cancer Research, Rathgar, Dublin, Ireland; St Luke's Radiation Oncology Network, St Luke's Hospital, Rathgar, Dublin, Ireland.
| | - A Mihai
- Beacon Hospital, Sandyford, Dublin, Ireland
| | - M Dunne
- St Luke's Radiation Oncology Network, St Luke's Hospital, Rathgar, Dublin, Ireland
| | - M Keys
- St Luke's Radiation Oncology Network, St Luke's Hospital, Rathgar, Dublin, Ireland; St Luke's Radiation Oncology Network, St James' Hospital, Dublin, Ireland
| | - S O'Sullivan
- St Luke's Institute of Cancer Research, Rathgar, Dublin, Ireland; St Luke's Radiation Oncology Network, St Luke's Hospital, Rathgar, Dublin, Ireland
| | - P Thirion
- Beacon Hospital, Sandyford, Dublin, Ireland; St Luke's Radiation Oncology Network, St James' Hospital, Dublin, Ireland
| | - N ElBeltagi
- St Luke's Radiation Oncology Network, St Luke's Hospital, Rathgar, Dublin, Ireland
| | - J G Armstrong
- St Luke's Institute of Cancer Research, Rathgar, Dublin, Ireland; St Luke's Radiation Oncology Network, St Luke's Hospital, Rathgar, Dublin, Ireland; St Luke's Radiation Oncology Network, St James' Hospital, Dublin, Ireland
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Thirion P, Dunne M, Parker I, Small C, Shannon A, Clayton-Lea A, Parker M, Collins C, Coffey J, Elbeltagi N, Fitzpatrick D, McArdle O, Stevenson M, Alvarez-Iglesias A, Moriarty M, Salib O, Gillham C, Armstrong J. CTRIAL-IE (ICORG) 07-11: Phase II Trial Evaluating Radiobiological Based Reirradiation Strategy for Patients with Malignant Spinal Cord Compression. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Glynn A, Rangaswamy G, O'Shea J, Dunne M, Faul C, Fitzpatrick D. PO-0871: Outcomes in Pineal Parenchymal tumours of intermediate differentiation: A single institution study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nugent K, O'Neill B, Brennan V, Lynch J, Dunne M, Skourou C. Quantification of Rectal Motion in Male and Female Patients Undergoing Long Course Radiotherapy for Rectal Cancer in the Supine Position. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nugent K, Trousdell J, Driscoll H, Cleary S, Quinlan E, Williams J, Dunne M, McArdle O, Duane F. Effects of adjuvant breast radiotherapy delivered over one week (+/− sequential hypofractionated tumour bed boost): Prospective observational study confirming acceptable acute skin toxicity. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Worth C, Dunne M, Ghosh A, Harper S, Banerjee I. Continuous glucose monitoring for hypoglycaemia in children: Perspectives in 2020. Pediatr Diabetes 2020; 21:697-706. [PMID: 32315515 DOI: 10.1111/pedi.13029] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 12/20/2022] Open
Abstract
Hypoglycaemia in children is a major risk factor for adverse neurodevelopment with rates as high as 50% in hyperinsulinaemic hypoglycaemia (HH). A key part of management relies upon timely identification and treatment of hypoglycaemia. The current standard of care for glucose monitoring is by infrequent fingerprick plasma glucose testing but this carries a high risk of missed hypoglycaemia identification. High-frequency Continuous Glucose Monitoring (CGM) offers an attractive alternative for glucose trend monitoring and glycaemic phenotyping but its utility remains largely unestablished in disorders of hypoglycaemia. Attempts to determine accuracy through correlation with plasma glucose measurements using conventional methods such as Mean Absolute Relative Difference (MARD) overestimate accuracy at hypoglycaemia. The inaccuracy of CGM in true hypoglycaemia is amplified by calibration algorithms that prioritize hyperglycaemia over hypoglycaemia with minimal objective evidence of efficacy in HH. Conversely, alternative algorithm design has significant potential for predicting hypoglycaemia to prevent neuroglycopaenia and consequent brain dysfunction in childhood disorders. Delays in the detection of hypoglycaemia, alarm fatigue, device calibration and current high cost are all barriers to the wider adoption of CGM in disorders of hypoglycaemia. However, machine learning, artificial intelligence and other computer-generated algorithms now offer significant potential for further improvement in CGM device technology and widespread application in childhood hypoglycaemia.
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Affiliation(s)
- Chris Worth
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Mark Dunne
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Arunabha Ghosh
- Department of Inherited Metabolic Disease, St Mary's Hospital, Manchester, UK
| | - Simon Harper
- Faculty of Computer Engineering, University of Manchester, Manchester, UK
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
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Worth C, Yau D, Salomon Estebanez M, O'Shea E, Cosgrove K, Dunne M, Banerjee I. Complexities in the medical management of hypoglycaemia due to congenital hyperinsulinism. Clin Endocrinol (Oxf) 2020; 92:387-395. [PMID: 31917867 DOI: 10.1111/cen.14152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 12/12/2022]
Abstract
Congenital Hyperinsulinism (CHI) is a rare disease of hypoglycaemia but is the most common form of recurrent and severe hypoglycaemia causing brain injury and neurodisability in children. The management of CHI is complex due to the limited choice of medications, all with a limited therapeutic window, often lacking efficacy and associated with serious side effects. The therapeutic strategy in CHI is to recognize and treat hypoglycaemia promptly, thereby optimizing long-term neurological outcomes; this should be achieved through individualized treatment plans that deliver glycaemic stability while minimizing side effects. Further, such a strategy should consider the likelihood of reduction in disease severity over time, with dose adjustments and medication withdrawal as indicated to optimize both safety and tolerability. The option for pancreatic surgery should also be considered in specific circumstances as appropriate for the patient's best long-term interests.
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Affiliation(s)
- Christopher Worth
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Daphne Yau
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
- Department of Pediatrics, Division of Endocrinology, Jim Pattison Children's Hospital, Saskatoon, SK, Canada
| | - Maria Salomon Estebanez
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Elaine O'Shea
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Karen Cosgrove
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mark Dunne
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Dorji N, Dunne M, Deb S. Adverse childhood experiences: association with physical and mental health conditions among older adults in Bhutan. Public Health 2020; 182:173-178. [PMID: 32334184 DOI: 10.1016/j.puhe.2020.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) are events stressful, traumatic, and related to the development of a wide range of health conditions throughout the person's lifespan. This study explored the relationship between ACEs and health conditions among older adults in Bhutan. STUDY DESIGN Cross-sectional survey. METHODS Older adults aged 60-101 years (n = 337) completed a face-to-face interview in a convenient community setting in the four major towns of Bhutan. Measurements included the modified World Health Organization Adverse Childhood Experiences International Questionnaire and the checklist of chronic health conditions. RESULTS Commonest ACEs reported by the sample were related to the contribution of physical labour in childhood (n = 284 [84.3%]) and witnessing of community violence (n = 185 [54.9%]). Assuming an adult role while still a child highly co-occur with other forms of ACEs. Compared to 0-2 ACEs, participants with ≥7 ACEs had the higher odds of reporting lung disease (odds ratio [OR] = 2.15, 95% confidence interval [CI]: 1.03-4.49), visual impairment (OR = 2.38, 95%CI: 1.16-4.85), insomnia (OR = 2.35, 95%CI: 1.11-4.98), and memory decline (OR = 2.30, 95%CI: 1.10-4.78) by twofold and high blood pressure by threefold (OR = 3.21, 95%CI: 1.39-7.38). Overall, the odds of self-rated poor health conditions among those ≥7 ACEs compared to 0-2 ACEs was high by almost twofold (OR = 1.97; 95%CI: 1.04-3.73). CONCLUSIONS The influence of ACEs on health conditions persisted into late adulthood, and older people in Bhutan have had a complex variety of chronic health conditions implicating greater demand on the free healthcare system in Bhutan. ACEs prevention is critical to promote better health for a country like Bhutan, where the healthcare services are provided free of cost to its citizens.
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Affiliation(s)
- N Dorji
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Bhutan.
| | - M Dunne
- School of Public Health and Social Work, Queensland University of Technology, Australia
| | - S Deb
- Department of Applied Psychology, Pondicherry University, India
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Worth C, Hall C, Wilson S, Gilligan N, O'Shea E, Salomon-Estebanez M, Dunne M, Banerjee I. Delayed Resolution of Feeding Problems in Patients With Congenital Hyperinsulinism. Front Endocrinol (Lausanne) 2020; 11:143. [PMID: 32256453 PMCID: PMC7093368 DOI: 10.3389/fendo.2020.00143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Congenital Hyperinsulinism (CHI) is the most common cause of recurrent and severe hypoglycaemia in childhood. Feeding problems occur frequently in severe CHI but long-term persistence and rates of resolution have not been described. Methods: All patients with CHI admitted to a specialist center during 2015-2016 were assessed for feeding problems at hospital admission and for three years following discharge, through a combination of specialist speech and language therapy review and parent-report at clinical contact. Results: Twenty-five patients (18% of all patients admitted) with CHI were prospectively identified to have feeding problems related to sucking (n = 6), swallowing (n = 2), vomiting (n = 20), and feed aversion (n = 17) at the time of diagnosis. Sixteen (64%) patients required feeding support by nasogastric/gastrostomy tubes at diagnosis; tube feeding reduced to 4 (16%) patients by one year and 3 (12%) patients by three years. Feed aversion resolved slowly with mean time to resolution of 240 days after discharge; in 15 patients followed up for three years, 6 (24%) continued to report aversion. The mean time (days) to resolution of feeding problems was lower in those who underwent lesionectomy (n = 4) than in those who did not (30 vs. 590, p = 0.009) and significance persisted after adjustment for associated factors (p = 0.015). Conclusion: Feeding problems, particularly feed aversion, are frequent in patients with CHI and require support over several years. By contrast, feeding problems resolve rapidly in patients with focal CHI undergoing curative lesionectomy, suggesting the association of feeding problems with hyperinsulinism.
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Affiliation(s)
- Chris Worth
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Caroline Hall
- Therapy and Dietetic Department, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Sarah Wilson
- Therapy and Dietetic Department, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Niamh Gilligan
- Therapy and Dietetic Department, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Elaine O'Shea
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Maria Salomon-Estebanez
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Mark Dunne
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Tomkins M, Okon M, Dunne M, Bourke W. Impact of a medical admissions proforma on the quality of medical admission documentation in a general acute hospital in Ireland. Ir J Med Sci 2020; 189:71-73. [DOI: 10.1007/s11845-019-02069-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
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McDermott R, Mihai A, Thirion P, Keys M, O'Sullivan S, Dunne M, Elbeltagi N, Armstrong J. Clinical Outcomes of Stereotactic Ablative Radiation Therapy for large (>5cm) lung cancers. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yau D, Salomon-Estebanez M, Chinoy A, Grainger J, Craigie R, Padidela R, Skae M, Dunne M, Murray P, Banerjee I. Central venous catheter-associated thrombosis in children with congenital hyperinsulinism. Endocrinol Diabetes Metab Case Rep 2019; 2019. [PMID: 31373474 PMCID: PMC8115433 DOI: 10.1530/edm-19-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Congenital hyperinsulinism (CHI) is an important cause of severe hypoglycaemia in infancy. To correct hypoglycaemia, high concentrations of dextrose are often required through a central venous catheter (CVC) with consequent risk of thrombosis. We describe a series of six cases of CHI due to varying aetiologies from our centre requiring CVC for the management of hypoglycaemia, who developed thrombosis in association with CVC. We subsequently analysed the incidence and risk factors for CVC-associated thrombosis, as well as the outcomes of enoxaparin prophylaxis. The six cases occurred over a 3-year period; we identified an additional 27 patients with CHI who required CVC insertion during this period (n = 33 total), and a separate cohort of patients with CHI and CVC who received enoxaparin prophylaxis (n = 7). The incidence of CVC-associated thrombosis was 18% (6/33) over the 3 years, a rate of 4.2 thromboses/1000 CVC days. There was no difference in the frequency of genetic mutations or focal CHI in those that developed thromboses. However, compound heterozygous/homozygous potassium ATP channel mutations correlated with thrombosis (R2 = 0.40, P = 0.001). No difference was observed in CVC duration, high concentration dextrose or glucagon infused through the CVC. In patients receiving enoxaparin prophylaxis, none developed thrombosis or bleeding complications. The characteristics of these patients did not differ significantly from those with thrombosis not on prophylaxis. We therefore conclude that CVC-associated thrombosis can occur in a significant proportion (18%) of patients with CHI, particularly in severe CHI, for which anticoagulant prophylaxis may be indicated.
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Affiliation(s)
- Daphne Yau
- Departments of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Maria Salomon-Estebanez
- Departments of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Amish Chinoy
- Departments of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK
| | - John Grainger
- Departments of Paediatric Haematology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Ross Craigie
- Departments of Paediatric Surgery, Royal Manchester Children’s Hospital, Manchester, UK
| | - Raja Padidela
- Departments of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Mars Skae
- Departments of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Mark Dunne
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Philip Murray
- Departments of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Indraneel Banerjee
- Departments of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK
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Lunt T, Pan O, Herrmann A, Teschke M, Dunne M, Feng Y, Wischmeier M. 2D and 3D studies of the X-divertor configuration in the future upper divertor of ASDEX upgrade. Nuclear Materials and Energy 2019. [DOI: 10.1016/j.nme.2019.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kramer A, Dunne M, Choate K. 179 A Strategy Guide for a Successful Urology Match: Perspective from a Resident and Program Director. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Keys M, O'Sullivan S, Dermott RM, Wallace N, Dunne M, Armstrong J, Thirion P. EP-1354 Impact of Pulmonary SABR on Pulmonary Function Tests: Report of a single institution experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Cummins D, Skourou C, O'Sullivan S, Davenport P, Fitzpatrick D, Faul C, Javadpour M, Dunne M. EP-1908 A Guide For Predicting Normal Tissue Dose in Stereotactic Radiosurgery. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32328-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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39
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Cavedon M, Dux R, Pütterich T, Viezzer E, Wolfrum E, Dunne M, Fable E, Fischer R, Harrer G, Laggner F, Mink A, Plank U, Stroth U, Willensdorfer M, Upgrade Team ASDEX. On the ion and electron temperature recovery after the ELM-crash at ASDEX upgrade. Nuclear Materials and Energy 2019. [DOI: 10.1016/j.nme.2018.12.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ochoukov R, Bobkov V, Chapman B, Dendy R, Dunne M, Faugel H, García-Muñoz M, Geiger B, Hennequin P, McClements KG, Moseev D, Nielsen S, Rasmussen J, Schneider P, Weiland M, Noterdaeme JM. Observations of core ion cyclotron emission on ASDEX Upgrade tokamak. Rev Sci Instrum 2018; 89:10J101. [PMID: 30399687 DOI: 10.1063/1.5035180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The B-dot probe diagnostic suite on the ASDEX Upgrade tokamak has recently been upgraded with a new 125 MHz, 14 bit resolution digitizer to study ion cyclotron emission (ICE). While classic edge emission from the low field side plasma is often observed, we also measure waves originating from the core with fast fusion protons or beam injected deuterons being a possible emission driver. Comparing the measured frequency values with ion cyclotron harmonics present in the plasma places the origin of this emission on the magnetic axis, with the fundamental hydrogen/second deuterium cyclotron harmonic matching the observed values. The actual values range from ∼27 MHz at the on-axis toroidal field BT = -1.79 T to ∼40 MHz at BT = -2.62 T. When the magnetic axis position evolves during this emission, the measured frequency values track the changes in the estimated on-axis cyclotron frequency values. Core ICE is usually a transient event lasting ∼100 ms during the neutral beam startup phase. However, in some cases, core emission occurs in steady-state plasmas and lasts for longer than 1 s. These observations suggest an attractive possibility of using a non-perturbing ICE-based diagnostic to passively monitor fusion alpha particles at the location of their birth in the plasma core, in deuterium-tritium burning devices such as ITER and DEMO.
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Affiliation(s)
- R Ochoukov
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - V Bobkov
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - B Chapman
- Centre for Fusion, Space and Astrophysics, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - R Dendy
- Centre for Fusion, Space and Astrophysics, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - M Dunne
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - H Faugel
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - M García-Muñoz
- FAMN Department, Faculty of Physics, University of Seville, 41012 Seville, Spain
| | - B Geiger
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - P Hennequin
- Laboratoire de Physique des Plasmas, Ecole Polytechnique, 91128 Palaiseau, France
| | - K G McClements
- CCFE, Culham Science Center, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - D Moseev
- Max Planck Institute for Plasma Physics, Wendelsteinstr. 1, 17491 Greifswald, Germany
| | - S Nielsen
- Department of Physics, Technical University of Denmark, Fysikvej, b. 309, DK-2800 Kongens Lyngby, Denmark
| | - J Rasmussen
- Department of Physics, Technical University of Denmark, Fysikvej, b. 309, DK-2800 Kongens Lyngby, Denmark
| | - P Schneider
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - M Weiland
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - J-M Noterdaeme
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
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Higgins MJ, Burke O, Nugent K, Skourou C, Dunne M, Javadpour M, Fitzpatrick D, Faul C. P05.03 Stereotactic Radiosurgery to Surgical Cavity Post Resection of Brain Metastases: Local Recurrence and Overall Survival Rates. A Single Centre Experience. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M J Higgins
- St Lukes Radiation Oncology Network, Dublin, Irel
| | - O Burke
- St Lukes Radiation Oncology Network, Dublin, Irel
| | - K Nugent
- St Lukes Radiation Oncology Network, Dublin, Irel
| | - C Skourou
- St Lukes Radiation Oncology Network, Dublin, Irel
| | - M Dunne
- St Lukes Radiation Oncology Network, Dublin, Irel
| | | | | | - C Faul
- St Lukes Radiation Oncology Network, Dublin, Irel
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Lee KA, Dunne M, Small C, Kelly PJ, McArdle O, O’Sullivan J, Hacking D, Pomeroy M, Armstrong J, Moriarty M, Clayton-Lea A, Parker I, Collins CD, Thirion P. (ICORG 05-03): prospective randomized non-inferiority phase III trial comparing two radiation schedules in malignant spinal cord compression (not proceeding with surgical decompression); the quality of life analysis. Acta Oncol 2018; 57:965-972. [PMID: 29419331 DOI: 10.1080/0284186x.2018.1433320] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The optimal primary external beam radiation therapy (EBRT) radiation schedule for malignant epidural spinal cord compression (MSCC) remains to be determined. The ICORG 05-03 trial assessed if a 10 Gy single fraction radiation schedule was not inferior to one with 20 Gray (Gy) in five daily fractions, in terms of functional motor outcome, for the treatment of MSCC in patients not proceeding with surgical decompression. This article reports on two of the secondary endpoints, Quality of life (QoL), assessed according to the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) version 3.0 (EORTC Data Center, Brussels, Belgium) and pain control assessed using a visual analog scale. METHODS A randomized, parallel group, multicenter phase III trial was conducted by Cancer Trials Ireland (formerly All-Ireland Cooperative Oncology Research Group, ICORG), across five hospital sites in Ireland and Northern Ireland. Patients were randomized to 10 Gy single fraction of EBRT or 20 Gy in five fractions in a 1:1 ratio. Patients with baseline and 5-week follow up QoL data are included in this analysis. FINDINGS From 2006 to 2014, 112 eligible patients were enrolled for whom 57 were evaluated for this secondary analysis. After adjusting for pre-intervention scores, there was no statistically significant difference in post-treatment Summary scores (excl. FI and QL), or pain scores between the two RT schedules at 5 weeks and 3 months following EBRT. There was a statistically significant relationship between the pretreatment and post-treatment Summary scores (p = .002) but not between the pre-treatment and post-treatment pain scores. INTERPRETATION Primary radiotherapy for the treatment of MSCC significantly improves QoL in patients not proceeding with surgical decompression. After adjusting for pre-intervention scores, there was no statistically significant difference between a 10 Gy single fraction radiation schedule and one with 20 Gy in five daily fractions on post-treatment QoL Summary scores. For most patients, an effective treatment with low burden would be desirable. A single fraction schedule should be considered for this group of patients.
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Affiliation(s)
- K. A. Lee
- Radiation Oncology Department, St Luke’s Radiation Oncology Network, Dublin, Ireland
| | - M. Dunne
- Clinical Trials Unit, St Luke’s Radiation Oncology Network, Dublin, Ireland
| | - C. Small
- Radiation Oncology Department, Galway University Hospital, Galway, Ireland
| | - P. J. Kelly
- Radiation Oncology Department, Cork University Hospital, Cork, Ireland
| | - O. McArdle
- Radiation Oncology Department, St Luke’s Radiation Oncology Network, Dublin, Ireland
| | - J. O’Sullivan
- Radiation Oncology Department, Belfast City Hospital, Belfast, UK
| | - D. Hacking
- Radiation Oncology Department, Whitfield Clinic, Waterford, Ireland
| | - M. Pomeroy
- Radiation Oncology Department, Galway University Hospital, Galway, Ireland
| | - J. Armstrong
- Radiation Oncology Department, St Luke’s Radiation Oncology Network, Dublin, Ireland
| | - M. Moriarty
- Radiation Oncology Department, St Luke’s Radiation Oncology Network, Dublin, Ireland
| | - A. Clayton-Lea
- Operational Services, St Luke’s Radiation Oncology Network, Dublin, Ireland
| | - I. Parker
- Radiation Oncology Department, All Ireland Cooperative Oncology Research Group, Dublin, Ireland
| | - C. D. Collins
- Radiology Department, St Luke’s Radiation Oncology Network, Dublin, Ireland
| | - P. Thirion
- Radiation Oncology Department, St Luke’s Radiation Oncology Network, Dublin, Ireland
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Morrissey M, Byrne R, Lynam-Lennon N, Butler C, Nulty C, Kennedy S, Dunne M, McCabe N, Reynolds J, O’Sullivan J. PO-388 The gastrointestinal tract tumour microenvironment differentially influences maturation of and cytokine secretion from dendritic cells. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Nugent K, O'Neill B, Lynch J, Higgins M, Brennan V, Dunne M, Skourou C. EP-1503: Rectal motion in patients receiving neoadjuvant radiotherapy for rectal cancer in supine position. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Glynn A, Rangaswamy G, O’Shea J, Dunne M, Grogan R, McNally S, Fitzpatrick D, Faul C. EP-1184: Elderly patients with Glioblastoma Multiforme treated with radiotherapy: a single institution study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31494-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Higgins M, Burke O, Nugent K, Dunne M, Skourou C, Fitzpatrick D, Faul C. EP-1193: SRS to cavity post resection of intracranial metastases. A single centre experience 2013-2016. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Willensdorfer M, Cote TB, Hegna CC, Suttrop W, Zohm H, Dunne M, Strumberger E, Birkenmeier G, Denk SS, Mink F, Vanovac B, Luhmann LC. Field-Line Localized Destabilization of Ballooning Modes in Three-Dimensional Tokamaks. Phys Rev Lett 2017; 119:085002. [PMID: 28952752 DOI: 10.1103/physrevlett.119.085002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Indexed: 06/07/2023]
Abstract
Field-line localized ballooning modes have been observed at the edge of high confinement mode plasmas in ASDEX Upgrade with rotating 3D perturbations induced by an externally applied n=2 error field and during a moderate level of edge localized mode mitigation. The observed ballooning modes are localized to the field lines which experience one of the two zero crossings of the radial flux surface displacement during one rotation period. The localization of the ballooning modes agrees very well with the localization of the largest growth rates from infinite-n ideal ballooning stability calculations using a realistic 3D ideal magnetohydrodynamic equilibrium. This analysis predicts a lower stability with respect to the axisymmetric case. The primary mechanism for the local lower stability is the 3D distortion of the local magnetic shear.
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Affiliation(s)
- M Willensdorfer
- Max Planck Institute for Plasma Physics, 85748 Garching, Germany
| | - T B Cote
- University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - C C Hegna
- University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - W Suttrop
- Max Planck Institute for Plasma Physics, 85748 Garching, Germany
| | - H Zohm
- Max Planck Institute for Plasma Physics, 85748 Garching, Germany
| | - M Dunne
- Max Planck Institute for Plasma Physics, 85748 Garching, Germany
| | - E Strumberger
- Max Planck Institute for Plasma Physics, 85748 Garching, Germany
| | - G Birkenmeier
- Max Planck Institute for Plasma Physics, 85748 Garching, Germany
- Physik-Department E28, Technische Universität München, 85748 Garching, Germany
| | - S S Denk
- Max Planck Institute for Plasma Physics, 85748 Garching, Germany
- Physik-Department E28, Technische Universität München, 85748 Garching, Germany
| | - F Mink
- Max Planck Institute for Plasma Physics, 85748 Garching, Germany
| | - B Vanovac
- FOM-Institute DIFFER, Dutch Institute for Fundamental Energy Research, 5612 AJ Eindhoven, Netherlands
| | - L C Luhmann
- University of California at Davis, Davis, California 95616, USA
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Reimer R, Marchuk O, Geiger B, Mc Carthy PJ, Dunne M, Hobirk J, Wolf R. Influence of non-local thermodynamic equilibrium and Zeeman effects on magnetic equilibrium reconstruction using spectral motional Stark effect diagnostic. Rev Sci Instrum 2017; 88:083509. [PMID: 28863658 DOI: 10.1063/1.4994889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Motional Stark Effect (MSE) diagnostic is a well established technique to infer the local internal magnetic field in fusion plasmas. In this paper, the existing forward model which describes the MSE data is extended by the Zeeman effect, fine-structure, and relativistic corrections in the interpretation of the MSE spectra for different experimental conditions at the tokamak ASDEX Upgrade. The contribution of the non-Local Thermodynamic Equilibrium (non-LTE) populations among the magnetic sub-levels and the Zeeman effect on the derived plasma parameters is different. The obtained pitch angle is changed by 3°…4° and by 0.5°…1° including the non-LTE and the Zeeman effects into the standard statistical MSE model. The total correction is about 4°. Moreover, the variation of the magnetic field strength is significantly changed by 2.2% due to the Zeeman effect only. While the data on the derived pitch angle still could not be tested against the other diagnostics, the results from an equilibrium reconstruction solver confirm the obtained values for magnetic field strength.
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Affiliation(s)
- R Reimer
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, Teilinstitut Greifswald, Wendelsteinstraße 1, 17491 Greifswald, Germany
| | - O Marchuk
- Institut für Energie und Klimaforschung-Plasmaphysik, Forschungszentrum Juelich GmbH, 52425 Jülich, Germany
| | - B Geiger
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, Boltzmannstraße 2, 85748 Garching, Germany
| | - P J Mc Carthy
- Department of Physics, University College Cork, Association EURATOM-DCU, Cork, Ireland
| | - M Dunne
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, Boltzmannstraße 2, 85748 Garching, Germany
| | - J Hobirk
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, Boltzmannstraße 2, 85748 Garching, Germany
| | - R Wolf
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, Teilinstitut Greifswald, Wendelsteinstraße 1, 17491 Greifswald, Germany
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Lunt T, Zohm H, Herrmann A, Kallenbach A, Dunne M, Feng Y, Neu R, Wischmeier M. Proposal of an alternative upper divertor in ASDEX Upgrade supported by EMC3-EIRENE simulations. Nuclear Materials and Energy 2017. [DOI: 10.1016/j.nme.2016.12.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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McDermott RM, Lebschy A, Geiger B, Bruhn C, Cavedon M, Dunne M, Dux R, Fischer R, Kappatou A, Pütterich T, Viezzer E. Extensions to the charge exchange recombination spectroscopy diagnostic suite at ASDEX Upgrade. Rev Sci Instrum 2017; 88:073508. [PMID: 28764552 DOI: 10.1063/1.4993131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A new core charge exchange recombination spectroscopy diagnostic has been installed in the ASDEX Upgrade tokamak that is capable of measuring the impurity ion temperature, toroidal rotation, and density on both the low field side (LFS) and high field side (HFS) of the plasma. The new system features 48 lines-of-sight (LOS) with a radial resolution that varies from ±2 cm on the LFS down to ±0.75 cm on the HFS and has sufficient signal to run routinely at 10 ms and for special circumstances down to 2.5 ms integration time. The LFS-HFS ion temperature profiles provide an additional constraint on the magnetic equilibrium reconstruction, and the toroidal rotation frequency profiles are of sufficiently high quality that information on the poloidal velocity can be extracted from the LFS-HFS asymmetry. The diagnostic LOS are coupled to two flexible-wavelength spectrometers such that complete LFS-HFS profiles from two separate impurities can be imaged simultaneously, albeit with reduced radial coverage. More frequently, the systems measure the same impurity providing very detailed information on the chosen species. Care has been taken to calibrate the systems as accurately as possible and to include in the data analysis any effects that could lead to spurious temperatures or rotations.
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Affiliation(s)
- R M McDermott
- Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching, Germany
| | - A Lebschy
- Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching, Germany
| | - B Geiger
- Max-Planck-Institut für Plasmaphysik, Wendelsteinstr. 1, 17491 Greifswald, Germany
| | - C Bruhn
- Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching, Germany
| | - M Cavedon
- Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching, Germany
| | - M Dunne
- Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching, Germany
| | - R Dux
- Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching, Germany
| | - R Fischer
- Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching, Germany
| | - A Kappatou
- Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching, Germany
| | - T Pütterich
- Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching, Germany
| | - E Viezzer
- Department of Atomic, Molecular and Nuclear Physics, University of Seville, Avenida Reina Mercedes, 41012 Seville, Spain
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