Adjuvant chemotherapy in stage 1 colon cancer: Patient characteristics and survival analysis from the national cancer database

BACKGROUND

A subset of patients in ACS-NCDB with stage-1 colon cancer received adjuvant chemotherapy (AC), in contrast to national guidelines. This study aimed to define this population and evaluate associations between AC and survival.

METHODS

Patients with T1-2N0 colon cancer from 2004 to 2016 were separated into AC and non-AC groups. Adverse pathological features (APF) included T2, poor differentiation, lymphovascular invasion, positive margin, and inadequate lymph nodes (<12). Cox proportional hazard models were used to estimate prognostic factors for overall survival (OS).

RESULTS

A total of 1745 of 139,857 patients (1.2 %) received AC. Receiving AC was associated with male sex (p = 0.02), uninsured (p < 0.01), low income (p = 0.02), or having ≥2 APFs (p < 0.001). In the total cohort, AC was associated with increased mortality (HR 1.14 [1.04-1.24] P < 0.01). On subset analysis, AC was associated with improved OS for patients with ≥2 APFs (log-rank P=<0.001), and decreased mortality when adjusted for covariates (HR 0.81 [0.69-0.95] P=<0.01). The most significant predictor of mortality was old age (HR 3.78 [3.67, 3.89] p ≤ 0.01), followed by higher Charlson Comorbidity Index (HR 1.73 [1.69, 1.76] (p ≤ 0.01), and higher APF score (HR 1.46 [1.42, 15.2] p ≤ 0.01).

CONCLUSION

AC was associated with decreased survival in the total cohort of stage 1 colon cancer patients, but was associated with improved survival for patients with multiple APFs.

Correlation of palatal anatomic characteristics with dermatoglyphic heterogeneity in different growth patterns

AIM AND OBJECTIVE

The study aimed to explore the correlation between dermatoglyphic patterns and quantitative palatal anatomic variables in individuals with different growth patterns.

MATERIALS AND METHOD

A cross-sectional study was conducted involving 126 healthy patients aged 17-25 years. Participants were divided into three groups based on growth patterns: average, vertical, and horizontal. Dermatoglyphic patterns were recorded using an optical fingerprint sensor, and palatal characteristics were measured using digital software. Palatal characteristics, including intercanine width, intermolar width, and palatal depth, were measured using digital software. The results were statistically analyzed.

RESULTS

Significant differences were observed in ridge counts among the three growth patterns. The average growth pattern showed lower ridge counts compared to the vertical and horizontal growth patterns. Dermatoglyphic patterns, such as double loops and tented arches, were significantly higher in the horizontal growth pattern. Weak correlations were found between certain dermatoglyphic patterns and palatal characteristics, with simple arch patterns showing a negative correlation with inter-canine width and symmetrical whorl patterns showing a positive correlation with palatal depth. Loop patterns, spiral patterns, double loop patterns, symmetrical whorl, and simple arch patterns were significant predictors of growth patterns.

CONCLUSION

This study revealed distinct dermatoglyphic patterns and ridge counts among individuals with different growth patterns. Weak correlations were observed between dermatoglyphic patterns and palatal characteristics. However, the predictive value of dermatoglyphics for skeletal malocclusion requires further investigation. Understanding the relationships between dermatoglyphic patterns and craniofacial growth can provide valuable insights into genetic and developmental factors affecting dental and orthodontic conditions.

Transvenous biopsy of inferior vena cava leiomyosarcoma: two case reports

Leiomyosarcomas of the inferior vena cava (IVC) are uncommon malignancies. There is limited research detailing optimal diagnostic and clinical management. Here, we present 2 unique cases of IVC leiomyosarcoma including one in which the mass was partially ruptured through the vessel at initial presentation. We detail radiologic findings, 2 different transvenous approaches for biopsy of these masses, and subsequent oncological management.

The association between telemedicine, advance care planning, and unplanned hospitalizations among high-risk patients with cancer

BACKGROUND

Despite the widespread implementation of telemedicine, there are limited data regarding its impact on key components of care for patients with incurable or high-risk cancer. For these patients, high-quality care requires detailed conversations regarding treatment priorities (advance care planning) and clinical care to minimize unnecessary acute care (unplanned hospitalizations). Whether telemedicine affects these outcomes relative to in-person clinic visits was examined among patients with cancer at high risk for 6-month mortality.

METHODS

This retrospective cohort study included adult patients with cancer with any tumor type treated at the University of Pennsylvania who were newly identified between April 1 and December 31, 2020, to be at high risk for 6-month mortality via a validated machine learning algorithm. Separate modified Poisson regressions were used to assess the occurrence of advance care planning and unplanned hospitalizations for telemedicine as compared to in-person visits. Additional analyses were done comparing telemedicine type (video or phone) as compared to in-person clinic visits.

RESULTS

The occurrence of advance care planning was similar between telemedicine and in-person visits (6.8% vs. 6.0%; adjusted risk ratio [aRR], 1.25; 95% CI, 0.92-1.69). In regard to telemedicine subtype, patients exposed to video encounters were modestly more likely to have documented advance care planning in comparison to those seen in person (7.5% vs. 6.0%; aRR, 1.48; 95% CI, 1.03-2.11). The 3-month risk for unplanned hospitalization was comparable for telemedicine compared to in-person clinic encounters (21% vs. 18%; aRR, 1.06; 95% CI, 0.81-1.38).

CONCLUSIONS

In this study, care delivered by telemedicine, compared to in-person clinic visits, produced comparable rates of advance care planning conversations without increasing hospitalizations, which suggests that vulnerable patients can be managed safely by telemedicine.

Survival impact of post-operative immunotherapy in resected stage III cutaneous melanomas in the checkpoint era

BACKGROUND

Checkpoint inhibitors have shown improvement in recurrence-free survival in the post-operative setting for node-positive melanoma and were first approved in late 2015. However, single-agent checkpoint therapies have yet to show benefit to overall survival (OS) for lower-risk stage III cancers. We evaluated the OS benefit of post-operative immunotherapy in the National Cancer Database (NCDB).

PATIENTS AND METHODS

Patient cases were selected from the NCDB 2020 Participant Use File. Patients diagnosed with stage III cutaneous melanoma between 2016 and 2019 who underwent definitive resection for their melanoma were included. OS between those who received post-operative immunotherapy within 84 days of surgery and those who did not was analyzed by the Kaplan-Meier method. Demographic and clinical characteristics between the two groups were compared via Cox proportional hazard models.

RESULTS

14 978 patients with stage III melanoma were included. Of those, 34.9% (n = 5234) received post-operative immunotherapy and 65.1% (n = 9744) did not. Using the American Joint Committee on Cancer version 8 (AJCCv8) staging, 36-month survival was significantly higher in patients who received post-operative immunotherapy compared to no post-operative systemic therapy in those diagnosed with stage IIIB (88.0% versus 84.7%, P = 0.011), IIIC (75.6% versus 68.1%, P < 0.001), or IIID (59.2% versus 48.4%, P = 0.002). No significant improvement in 36-month survival was seen in patients who received post-operative immunotherapy in patients with stage IIIA disease (93.0% versus 92.2%, P = 0.218).

CONCLUSIONS

Post-operative immunotherapy had an OS benefit in patients with AJCCv8 stage IIIB, IIIC, and IIID disease, but had no significant survival benefit for patients with stage IIIA melanomas.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Significant enhancement in the cold emission characteristics of chemically synthesized super-hydrophobic zinc oxide rods by nickel doping

The current article presents a huge enhancement in the field emission characteristics of zinc oxide (ZnO) micro/nanorods by nickel doping. The synthesis of pure and nickel-doped zinc oxide (ZnO) micro/nanorods was done by a simple low-temperature chemical method. Both the as-prepared pure and doped samples were analyzed by X-ray diffraction and electron microscopy to confirm the proper phase formation and the developed microstructure. UV-vis transmittance spectra helped in determining the band gap of the samples. Fourier-Transform Infrared Spectroscopy (FTIR) spectra showed the different bonds present in the sample, whereas X-ray Photoelectron Spectroscopy (XPS) confirmed the presence of nickel in the doped sample. Photoluminescence (PL) spectra showed that after doping, the band-to-band transition was affected, whereas defect-induced transition had increased significantly. After the nickel doping, contact angle measurement revealed a significant decrease in the sample's surface energy, leading to a remarkably high water contact angle (within the superhydrophobic region). Simulation through ANSYS suggested that the doped sample has the potential to function as an efficient cold emitter, which was also verified experimentally. The cold emission characteristics of the doped sample showed a significant improvement, with the turn-on field (corresponding to J = 1 μA cm-2) reduced from 5.34 to 2.84 V μm-1. The enhancement factor for the doped sample reached 3426, approximately 1.5 times higher compared to pure ZnO. Efforts have been made to explain the results, given the favorable band bending as well as the increased number of effective emission sites.

Excited state spectroscopy and spin splitting in single layer MoS2 quantum dots

Semiconducting transition metal dichalcogenides (TMDCs) are very promising materials for quantum dots and spin-qubit implementation. Reliable operation of spin qubits requires the knowledge of the Landé g-factor, which can be measured by exploiting the discrete energy spectrum on a quantum dot. However, the quantum dots realized in TMDCs are yet to reach the required control and quality for reliable measurement of excited state spectroscopy and the g-factor, particularly in atomically thin layers. Quantum dot sizes reported in TMDCs so far are not small enough to observe discrete energy levels on them. Here, we report on electron transport through discrete energy levels of quantum dots in a single layer MoS2 isolated from its environment using a dual gate geometry. The quantum dot energy levels are separated by a few (5-6) meV such that the ground state and the first excited state transitions are clearly visible, thanks to the low contact resistance of ∼700 Ω and relatively low gate voltages. This well-resolved energy separation allowed us to accurately measure the ground state g-factor of ∼5 in MoS2 quantum dots. We observed a spin-filling sequence in our quantum dots under a perpendicular magnetic field. Such a system offers an excellent testbed to measure the key parameters for evaluation and implementation of spin-valley qubits in TMDCs, thus accelerating the development of quantum systems in two-dimensional semiconducting TMDCs.

Association between oxidative stress, antioxidant enzymes, and homocysteine in patients with polycystic ovary syndrome

OBJECTIVE

Polycystic ovary syndrome (PCOS) is a prevalent health condition that commonly affects adolescent girls and young women. The purpose of this study was to evaluate the correlation between levels of total glutathione (TG), reduced glutathione (GSH), superoxide dismutase (SOD), lipid peroxidation, and homocysteine with PCOS.

PATIENTS AND METHODS

This study employed a cross-sectional case-control design, involving a target population of 305 Sudanese females. Among them, 205 individuals were categorized as cases, and 100 served as controls. The TG, GSH, SOD, lipid peroxidation, and homocysteine levels were measured in the serum of study participants through enzyme-linked immunosorbent essay.

RESULTS

Total glutathione (1,174.5 ± 271.4 vs. 986.1 ± 191.5, p = 0.01), GSH (801.3 ± 132.2 vs. 748.6 ± 103.1, p = 0.007), SOD (225.2 ± 57.8 vs. 195.5 ± 49.6, p = 0.009), lipid peroxidation (3.4 ± 1.1 vs. 2.4 ± 0.7, p = 0.03), and homocysteine (14.9 ± 2.1 vs. 13.5 ± 1.6, p = 0.04), showed significant differences between the two groups (cases vs. controls). A moderate positive correlation between TG, GSH, SOD, lipid peroxidation, homocysteine, BMI, age, and duration of PCOS was observed. Furthermore, a strong positive correlation between BMI, age, and duration of PCOS was noted within the patient group.

CONCLUSIONS

In conclusion, this study demonstrates that patients with PCOS have elevated levels of TG, GSH, SOD, lipid peroxidation, and homocysteine compared to the control group. These findings suggest a potential association between PCOS and oxidative stress, lipid metabolism, and homocysteine pathways. Moreover, the observed positive correlation with BMI, age, and duration of PCOS indicates the importance of these factors in disease progression.

Self-assembling peptides for managing white spot lesions: a systematic review and meta-analysis

PURPOSE

The primary objective of the review was to assess the effectiveness of self-assembling P11-4 peptide (SAP) with or without any fluoride agents (FA) in remineralization of the White spot lesions (WSLs)/incipient carious lesions (ICLs) compared to other enamel remineralizing agents/non-intervention/placebo.

METHODS

Human RCTs published during the period from 1st January 2000-30th June 2021 were searched in the electronic bibliographic databases and scanning reference lists of articles from PubMed, Google Scholar, and The Cochrane Central Register of Controlled Trials. The Risk-of-Bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) tool for all included studies. The statistical heterogeneity between studies was assessed by the Cochrane Q test and I2 test. A random-effects model was used considering the variations in true effects size between the included studies. The quality of the evidence for remineralizing effectiveness of SAP/SAP + FA was done using the GRADEpro GDT software which employs GRADE.

RESULTS

Four out of eight included trials were assessed to have "high risk" of bias. Mean difference for Laser fluorescence outcome assessment method (SAP v/s FA) was - 4.89 (95% CI: - 17.35 to 7.57; p = 0. 44; I2 = 89%). The combined risk ratio observed through Nyvad criteria (SAP v/s FA) was 0.12 (95% CI: 0.01-1.59; p = 0.11; I2 = 71%). Mean difference for Laser fluorescence outcome assessment method (SAP + FA v/s FA) was - 11.52 (95% CI: - 14.43 to - 8.61; p =  < 0.001;I2 = 0%). The combined risk ratio for ICDAS outcome assessment method (SAP + FA v/s FA) was 0.27 (95% CI: 0.03-2.84; p = 0.15; I2 = 53%).

CONCLUSION

Considering the results observed from the included trials we are uncertain whether SAP/SAP + FA increases/decreases the remineralizing/regeneration of WSLs/ICLs.

MGMT Promoter Methylation Predicts Survival in 1p19q-Codeleted Gliomas after Chemotherapy

PURPOSE/OBJECTIVE(S)

MGMT promoter methylation (mMGMT) is predictive of response to alkylating chemotherapy in glioblastomas and used to guide treatment decisions. However, the role of MGMT promoter status in low-grade and anaplastic gliomas remains unclear due to molecular heterogeneity and the lack of sufficiently large datasets. We recently found that MGMT promoter methylation predicts progression-free survival in 1p19q-codeleted gliomas after alkylating chemotherapy in a meta-analysis of three prospective cohorts. There were not enough deaths to determine the effect on overall survival. Here, we query a large national database to determine the association between MGMT promoter methylation and overall survival in patients with 1p19q-codeleted gliomas.

MATERIALS/METHODS

We identified all patients with newly diagnosed gliomas in the National Cancer Database (NCDB) from 2010-2016 with 1p19q-codeletion and information on MGMT promoter methylation status. The cohort was stratified based on receipt of chemotherapy. Multivariable Cox proportional hazards regression modeling was used to assess the effect of MGMT promoter methylation status on overall survival after adjusting for age, sex, race, co-morbidity, grade, extent of resection, chemotherapy, and radiotherapy.

RESULTS

We identified 530 eligible patients, 373 (70.4%) of whom received chemotherapy in their initial course of treatment. The MGMT promoter was methylated in 400 (75.5%) patients. For all patients, unmethylated MGMT (uMGMT) was associated with poorer survival compared to mMGMT (75% survival time [75%ST] 45 months vs. not reached, P = .003, adjusted hazard ratio [aHR] 2.36 [95% confidence interval (95% CI) 1.53-3.62]). uMGMT was associated with poorer survival in patients who received chemotherapy (75%ST 22 vs. 66 months, P<.001, aHR 2.55 [95% CI 1.60-4.06]) but not in patients who did not receive chemotherapy (75%ST 110 months vs. not reached, P = 0.7, HR 1.24 [95% CI 0.40-3.81]).

CONCLUSION

To our knowledge, this is the first study to demonstrate an association between overall survival and MGMT promoter status in 1p19q-codeleted gliomas. MGMT promoter status should be used as a stratification factor in future clinical trials of 1p19q-codeleted gliomas that use overall survival as an endpoint.

Feasibility and outcomes of Desarda vs Lichtenstein hernioplasty by local anesthesia for inguinal hernia: a noninferiority randomized clinical trial

INTRODUCTION

The Desarda autologous tissue repair is comparable to the Lichtenstein hernioplasty for inguinal hernia regarding recurrence, chronic groin pain, and return to work activities. This study was designed to establish the outcomes of Desarda's repair versus Lichtenstein's hernioplasty concerning post-operative recovery to normal gait and its feasibility under local anesthesia (LA).

MATERIALS AND METHODS

This study was a single-center, prospective, double-blinded, non-inferiority, randomized trial. Patients undergoing open hernia repair for primary inguinal hernia were included. Patients were randomly assigned and followed up for 2 years. The primary endpoint was the time to return to normal gait post-surgery with comfort (non-inferiority margin fixed as 0.5 days). The secondary outcomes studied were post-operative pain score, the time required to return to work (all previously performed activities), and surgical-site occurrences (SSO).

RESULTS

One hundred ten eligible patients were randomly assigned [56 patients (50.9%) in the Desarda group and 54 patients (49.1%) in the Lichtenstein group]. All the procedures were safely performed under LA. The median (interquartile range) time for resuming gait post-surgery with comfort was 5 days in the Desarda vs 4 days in Lichtenstein's arm (P = 0.16), thereby failing to demonstrate non-inferiority of Desarda against Lichtenstein hernioplasty. However, there were no significant differences in days to return to work, SSO, chronic groin pain, and recurrence within two years of surgery.

CONCLUSIONS AND RELEVANCE

This study could not demonstrate the non-inferiority of the Desarda repair versus Lichtenstein hernioplasty regarding the time taken to return to normal gait. Comparing the days to return to work, pain score, SSO, and chronic groin pain, including recurrence rate, Desarda repair faired equally with Lichtenstein hernioplasty, thereby highlighting its feasibility and efficacy under LA.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03512366.

Optically Active Spin Defects in Few-Layer Thick Hexagonal Boron Nitride

Optically active spin defects in hexagonal boron nitride (hBN) are promising quantum systems for the design of two-dimensional quantum sensing units offering optimal proximity to the sample being probed. In this Letter, we first demonstrate that the electron spin resonance frequencies of boron vacancy centers (V_{B}^{-}) can be detected optically in the limit of few-atomic-layer thick hBN flakes despite the nanoscale proximity of the crystal surface that often leads to a degradation of the stability of solid-state spin defects. We then analyze the variations of the electronic spin properties of V_{B}^{-} centers with the hBN thickness with a focus on (i) the zero-field splitting parameters, (ii) the optically induced spin polarization rate and (iii) the longitudinal spin relaxation time. This Letter provides important insights into the properties of V_{B}^{-} centers embedded in ultrathin hBN flakes, which are valuable for future developments of foil-based quantum sensing technologies.

UNVEILING THE COMPLEX ROLE OF NF-ΚB IN ALZHEIMER'S DISEASE: INSIGHTS INTO BRAIN INFLAMMATION AND POTENTIAL THERAPEUTIC TARGETS

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and dementia. One of the major pathologies underlying AD is chronic neuroinflammation mediated by microglia and astrocytes in the brain. The nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signalling pathway is a key regulator of inflammation and has been implicated in the neuroinflammatory processes associated with AD. This review comprehensively summarizes current findings on the complex role of NF-κB signalling in AD pathogenesis. The canonical and non-canonical NF-κB activation pathways are described, along with evidence from human studies and animal models demonstrating increased NF-κB activity in AD brains. The deleterious effects of NF-κB-mediated neuroinflammation are discussed, including the upregulation of inflammatory cytokines, chemokines, and enzymes that exacerbate neuronal damage over time. Targeting the NF-κB pathway is proposed as a promising therapeutic approach to dampen neuroinflammation in AD. Preclinical studies utilizing genetic or pharmacological inhibition of NF-κB are reviewed, and key challenges in translating these findings to clinical applications are analyzed. Overall, this review unveils the multifaceted contributions of NF-κB signalling to AD neuropathology and highlights anti-neuroinflammatory NF-κB modulation as a potential avenue for future AD treatments. Further research is warranted to fully elucidate the complex interactions between NF-κB and AD pathogenesis.

Withdrawal Notice: Analysing the Quality of Food using Convolution Neural Network and Fuzzy Classifier in Hyperspectral Imagery

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Spina bifida occulta with the persistent spinous process in living: A three-dimensionally reconstructed sacrum from computed tomographic imaging

Background

Here we aim to report the persistent spinous process in the 'pan sacral type' of spina bifida occulta in an asymptomatic male and discuss its clinical significance. The presence of this type of dorsal wall defect with a bony spur attached to it has never been described in the literature to the best of our knowledge after extensive literature search. Our work presents the first anatomic description where the spinous and paraspinous cleft are seen in a sacrum of a live subject.

Case Report

During a morphometric study of the sacra, normal subject computed tomography imaging (CT) was procured from the Department of Radio-diagnosis. A three-dimensional (3D) image of the sacrum was created using Dicom to Print and Geomagic freeform plus software. A complete dorsal wall defect was observed in a 3D reconstructed sacrum of an adult male. The sacral canal was converted into a groove with a bony spur hanging in the centre. The longitudinal bony spur attached to the lamina was the persistent spinous process.

Conclusion

Such congenital defects are clinically significant for the anaesthetist during caudal epidural block and for orthopaedic surgeons before any surgical procedure. It may be misdiagnosed as an abnormal bony injury on CT. Thus, it is essential to ensure that patients with congenital anomalies are not treated unnecessarily for spinal fractures.

Older patients with primary central nervous system lymphoma: Survival and prognostication across 20 U.S. cancer centers

There is a paucity of large-scale data delineating outcomes and prognostication of older patients with primary central nervous system lymphoma (PCNSL). We retrospectively analyzed 539 newly-diagnosed PCNSL patients ages ≥60 years across 20 U.S. academic centers. The median age was 70 years (range 60-88); at least one geriatric syndrome was present in 46%; the median Cumulative Index Ratings Scale-Geriatrics (CIRS-G) score was 6 (range, 0-27); and 36% had impairment in activities of daily living (ADL). The most common induction regimens were high-dose methotrexate (HD-MTX) ± rituximab; methotrexate, temozolomide, rituximab (MTR); and rituximab, methotrexate, procarbazine, vincristine (R-MPV). Overall, 70% of patients achieved remission, with 14% undergoing consolidative autologous stem cell transplant (ASCT) and 24% receiving maintenance. With 58-month median follow-up, median progression-free survival (PFS) and overall survival (OS) were 17 months (95% CI 13-22 months) and 43 months (95% CI 31-56 months), respectively. Three-year PFS and OS were highest with MTR (55% and 74%, respectively). With single-agent methotrexate ± rituximab, 3-year PFS and OS were 30% (p = .0002) and 47% (p = .0072). On multivariate analysis, increasing age at diagnosis and Cooperative Oncology Group (ECOG) performance status (PS) was associated with inferior PFS; age, hypoalbuminemia, higher CIRS-G score, and ECOG PS adversely affected OS. Among patients receiving maintenance, 3-year PFS was 65% versus 45% without maintenance (p = 0.02), with 3-year OS of 84% versus 61%, respectively (p = .0003). Altogether, outcomes in older PCNSL patients appeared optimized with HD-MTX combination induction regimens and maintenance therapy. Furthermore, several prognostic factors, including geriatric measures, were associated with inferior outcomes.

Dynamics of reactive oxygen species and lignin biosynthesis during leaf spot disease of Withania somnifera (L.) Dunal

Withania somnifera is an important medicinal plant, however, its cultivation and quality are compromised due to infestation by leaf spot disease caused by the fungus Alternaria alternata. To decipher suitable strategies against the disease, studies on post-infectional changes are important. Reactive oxygen species (ROS) are critical as they cross-talk with other defense signaling pathways. Our study involved the analysis of ROS-generating and scavenging systems in the healthy and diseased leaf samples of W. somnifera and ROS-driven downstream defence pathways. DAB and NBT assays for ROS detection, spectrophotometric and in gel assays for ROS scavenging enzymes, thioglycolic acid (TGA) based assay and histochemical staining for lignin content and qRT-PCR for transcript-level expression studies were performed. Leaf spot infection in W. somnifera led to increased NADPH oxidase activity and ROS accumulation in the infected leaves which were supported by the enhanced antioxidant enzyme activities. Leaf spot infected leaves exhibited increased lignin content with higher expression of lignin biosynthesis genes. In addition, the transcript levels of defense-related genes, NPR1 and PR genes were also upregulated. The present work provides insights into the response of leaf spot disease in invoking the defense-related signaling in W. somnifera. It demonstrates the cross-talk between ROS and lignin biosynthesis. This work identifies potential targets for developing future strategies to confer disease resistance against leaf spot pathogen in W. somnifera.

Crowd cluster data in the USA for analysis of human response to COVID-19 events and policies

We provide data on daily social contact intensity of clusters of people at different types of Points of Interest (POI) by zip code in Florida and California. This data is obtained by aggregating fine-scaled details of interactions of people at the spatial resolution of 10 m, which is then normalized as a social contact index. We also provide the distribution of cluster sizes and average time spent in a cluster by POI type. This data will help researchers perform fine-scaled, privacy-preserving analysis of human interaction patterns to understand the drivers of the COVID-19 epidemic spread and mitigation. Current mobility datasets either provide coarse-level metrics of social distancing, such as radius of gyration at the county or province level, or traffic at a finer scale, neither of which is a direct measure of contacts between people. We use anonymized, de-identified, and privacy-enhanced location-based services (LBS) data from opted-in cell phone apps, suitably reweighted to correct for geographic heterogeneities, and identify clusters of people at non-sensitive public areas to estimate fine-scaled contacts.

Hybrid descriptors-conjoint indices: a case study on imidazole-thiourea containing glutaminyl cyclase inhibitors for design of novel anti-Alzheimer's candidates

Clinical studies show that the pyroglutamate alteration of amyloid-β (Aβ) catalysed by metalloenzyme glutaminyl cyclase results in the formation of the more neurotoxic pGlu-Aβ, and inhibition of glutaminyl cyclase can bring down the load of pGlu-Aβ in the brain and reduces Alzheimer's disease pathology with improvement in cognition. The present study involves the identification of activity-modulating structural features of 188 inhibitors of glutaminyl cyclase under the influence of index of ideality of correlation (IIC) and correlation intensity index (CII) as prediction parameters. The QSAR models developed employing IIC and CII were found to be statistically better and had better predictability than the models developed without them. The best model (split 4) showed r² values of 0.8155 and 0.8218 for calibration and validation sets, respectively. The structural features classified from QSAR models were used to design some new glutaminyl cyclase inhibitors. Among the designed ligands, ligand 5 possesses the highest pIC₅₀ value (6.30) as well as binding affinity (-6.2 kcal/mol) and creates hydrogen bonds with TRP 329, π-alkyl interactions with ILE 303 and TYR 299, π-π stacking interaction with PHE 325 and interactions with ZN 391. All novel designed ligands have better pIC₅₀ values and binding affinities.

NCCN Guidelines® Insights: Distress Management, Version 2.2023

These NCCN Guidelines for Distress Management discuss the identification and treatment of psychosocial problems in patients with cancer. All patients experience some level of distress associated with a cancer diagnosis and the effects of the disease and its treatment regardless of the stage of disease. Clinically significant levels of distress occur in a subset of patients, and identification and treatment of distress are of utmost importance. The NCCN Distress Management Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights describe updates to the NCCN Distress Thermometer (DT) and Problem List, and to the treatment algorithms for patients with trauma- and stressor-related disorders.

EBV-positive PCNSL in older patients: incidence, characteristics, tumor pathology, and outcomes across a large multicenter cohort

The objective of this multicenter retrospective study was to examine the incidence, patient characteristics, pathology, and outcomes associated with Epstein-Barr virus (EBV)-related CNS lymphoma (CNSL) in older patients. Among 309 CNSL patients aged ≥60, 11.7% had EBV + tumors of which 72.2% were solid organ transplant (SOT)-related post-transplant lymphoproliferative disorders (PTLD). Younger age, SOT or autoimmune disease, and immunosuppressive treatment correlated highly with EBV-positivity. EBV + tumors were associated with absent C-MYC and BCL6 expression. EBV + PTLD was more likely to be associated with the absence of CD5 expression. EBV + non-PTLD had better median OS (not reached) compared to EBV + PTLD (10.8 months) and EBV-negative patients (43 months). Multivariable Cox regression analysis showed that age, performance status, and PTLD were negative predictors of OS. EBV status and immunosuppressive treatment were not correlated with OS. Our findings merit further investigation of EBV + PCNSL tumors and EBV-directed therapies.

Behavioural economic interventions to embed palliative care in community oncology (BE-EPIC): study protocol for the BE-EPIC randomised controlled trial

INTRODUCTION

Palliative care (PC) is a medical specialty focusing on providing relief from the symptoms and stress of serious illnesses such as cancer. Early outpatient specialty PC concurrent with cancer-directed treatment improves quality of life and symptom burden, decreases aggressive end-of-life care and is an evidence-based practice endorsed by national guidelines. However, nearly half of patients with advanced cancer do not receive specialty PC prior to dying. The objective of this study is to test the impact of an oncologist-directed default PC referral orders on rates of PC utilisation and patient quality of life.

METHODS AND ANALYSIS

This single-centre two-arm pragmatic randomised trial randomises four clinician-led pods, caring for approximately 250 patients who meet guideline-based criteria for PC referral, in a 1:1 fashion into a control or intervention arm. Intervention oncologists receive a nudge consisting of an electronic health record message indicating a patient has a default pended order for PC. Intervention oncologists are given an opportunity to opt out of referral to PC. Oncologists in pods randomised to the control arm will receive no intervention beyond usual practice. The primary outcome is completed PC visits within 12 weeks. Secondary outcomes are change in quality of life and absolute quality of life scores between the two arms.

ETHICS AND DISSEMINATION

This study has been approved by the Institutional Review Board at the University of Pennsylvania. Study results will be disseminated in peer-reviewed journals and scientific conferences using methods that describe the results in ways that key stakeholders can best understand and implement.

TRIAL REGISTRATION NUMBER

NCT05365997.

Unmasking of systemic lupus erythematosus in a patient with hemophagocytic lymphohistiocytosis- macrophage activation syndrome (HLA-MAS) and diffuse alveolar hemorrhage

Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome caused by macrophages and cytotoxic T cells with aberrant activation. The primary (genetic) form, which is caused by mutations that affect lymphocyte cytotoxicity and immune regulation, is most prevalent in children, whereas the secondary (acquired) form is prevalent in adults. Secondary HLH is commonly caused by infections or cancers, but it can also be caused by autoimmune disorders, in which case it is known as macrophage activation syndrome (MAS; or MAS-HLH). A 25-year-old female presented with a high-grade fever that lasted for two weeks. His laboratory results revealed pancytopenia, neutropenia, hypertriglyceridemia, hypofibrinogenemia, and hyperferritinemia. Based on the clinical presentation and laboratory findings, a provisional diagnosis of HLH has been made. A HLH protocol was utilized to treat the patient. During the course of hospitalization, systemic lupus erythematosus (SLE) was identified as the underlying cause. She improved dramatically after receiving an immunosuppressive regimen of etoposide, cyclosporine, and dexamethasone according to HLH protocol-2004 with individualized modifications. The clinician should be aware that HLH may be the initial manifestation of underlying SLE. Early diagnosis and aggressive, individualized treatment are the key to improving outcomes.

Design of 2-amino-6-methyl-pyrimidine benzoic acids as ATP competitive casein kinase-2 (CK2) inhibitors using structure- and fragment-based design, docking and molecular dynamic simulation studies

Overexpression of casein kinase-2 (CK2) has been implicated in several carcinomas, mainly lung, prostate and acute myeloid leukaemia. The smaller nucleotide pocket compared to related kinases provides a great opportunity to discover newer ATP-competitive CK2 inhibitors. In this study, we have employed an integrated structure- and fragment-based design strategy to design 2-amino-6-methyl-pyrimidine benzoic acids as ATP-competitive CK2 inhibitors. A statistically significant four features-based E-pharmacophore (ARRR) model was used to screen 780,092 molecules. Further, the retrieved hits were considered for molecular docking study to identify essential binding interactions. At the same time, fragment-based virtual screening was performed using a dataset of 1,542,397 fragments. The identified hits and fragments were used as structure templates to rationalize the design of 2-amino-6-methyl-pyrimidine benzoic acids as newer CK2 inhibitors. Finally, the binding interactions of the designed hits were identified using an induced fit docking (IFD) study, and their stability was estimated by a molecular dynamics (MD) simulation study of 100 ns.

Long-term Effect of Machine Learning-Triggered Behavioral Nudges on Serious Illness Conversations and End-of-Life Outcomes Among Patients With Cancer: A Randomized Clinical Trial

Importance

Serious illness conversations (SICs) between oncology clinicians and patients are associated with improved quality of life and may reduce aggressive end-of-life care. However, most patients with cancer die without a documented SIC.

Objective

To test the impact of behavioral nudges to clinicians to prompt SICs on the SIC rate and end-of-life outcomes among patients at high risk of death within 180 days (high-risk patients) as identified by a machine learning algorithm.

Design, Setting, and Participants

This prespecified 40-week analysis of a stepped-wedge randomized clinical trial conducted between June 17, 2019, and April 20, 2020 (including 16 weeks of intervention rollout and 24 weeks of follow-up), included 20 506 patients with cancer representing 41 021 encounters at 9 tertiary or community-based medical oncology clinics in a large academic health system. The current analyses were conducted from June 1, 2021, to May 31, 2022.

Intervention

High-risk patients were identified using a validated electronic health record machine learning algorithm to predict 6-month mortality. The intervention consisted of (1) weekly emails to clinicians comparing their SIC rates for all patients against peers' rates, (2) weekly lists of high-risk patients, and (3) opt-out text messages to prompt SICs before encounters with high-risk patients.

Main Outcomes and Measures

The primary outcome was SIC rates for all and high-risk patient encounters; secondary end-of-life outcomes among decedents included inpatient death, hospice enrollment and length of stay, and intensive care unit admission and systemic therapy close to death. Intention-to-treat analyses were adjusted for clinic and wedge fixed effects and clustered at the oncologist level.

Results

The study included 20 506 patients (mean [SD] age, 60.0 [14.0] years) and 41 021 patient encounters: 22 259 (54%) encounters with female patients, 28 907 (70.5%) with non-Hispanic White patients, and 5520 (13.5%) with high-risk patients; 1417 patients (6.9%) died by the end of follow-up. There were no meaningful differences in demographic characteristics in the control and intervention periods. Among high-risk patient encounters, the unadjusted SIC rates were 3.4% (59 of 1754 encounters) in the control period and 13.5% (510 of 3765 encounters) in the intervention period. In adjusted analyses, the intervention was associated with increased SICs for all patients (adjusted odds ratio, 2.09 [95% CI, 1.53-2.87]; P < .001) and decreased end-of-life systemic therapy (7.5% [72 of 957 patients] vs 10.4% [24 of 231 patients]; adjusted odds ratio, 0.25 [95% CI, 0.11-0.57]; P = .001) relative to controls, but there was no effect on hospice enrollment or length of stay, inpatient death, or end-of-life ICU use.

Conclusions and Relevance

In this randomized clinical trial, a machine learning-based behavioral intervention and behavioral nudges to clinicans led to an increase in SICs and reduction in end-of-life systemic therapy but no changes in other end-of-life outcomes among outpatients with cancer. These results suggest that machine learning and behavioral nudges can lead to long-lasting improvements in cancer care delivery.

Trial Registration

ClinicalTrials.gov Identifier: NCT03984773.

Sociodemographic and Clinical Characteristics of Child Sexual Abuse Reported to an Urban Public Hospital in Southern India, 2019-22

OBJECTIVES

To describe the profile of child sexual abuse (CSA) reported to a tertiary care hospital.

METHODS

A retrospective analysis of CSA reported in children aged below 18 years from January, 2019 to June, 2022.

RESULTS

Out of the 231 cases of sexual abuse reported, 115 (49.8%) were children below 18 years. Most of the victims were children from 10 to 15 years (37.4%), and there were only two male victims. In 89.6%, the perpetrator was known to the victim. Revictimization was seen in 31%. The reported perpetrators were friends (27%), neighbors (34.8%), strangers (10.4%), or fathers (7.8%). Penetrative abuse was seen in 58.3% of reports. External injuries were seen in 6.96%. Eight victims were pregnant and HIV screening was positive in one victim.

CONCLUSION

Early identification of CSA is important to prevent revictimization. Children from all age groups can be victims of CSA. Perpetrators can hail from all walks of life of the children.

QSAR study of tetrahydropteridin derivatives as polo-like kinase 1(PLK1) Inhibitors with molecular docking and dynamics study

PLK1 is the key target for dealing with different cancer because it plays an important role in cell proliferation. According to the regulation of OECD, a QSAR model was developed from a dataset of 68 tetrahydropteridin derivatives. Three descriptors (maxHaaCH, ATSC7i, AATS7m) were considered for the development of the QSAR model. The reliability and predictability of the developed QSAR model were evaluated by various statistical parameters (r² = 0.8213, r²_ext = 0.8771 and CCC_ext = 0.9364). The maxHaaCH descriptor is positively correlated to pIC₅₀ whereas, the ATSC7i and AATS7m are negatively correlated with pIC₅₀. The QSAR model explains all the structural features and shows a good correlation with the activity. Based on molecular modelling techniques, five compounds (D1-D5) were designed. Molecular docking and dynamics studies of the most active compound were performed with PDB ID: 2RKU. The results of the present investigation may be employed to identify and develop effective inhibitors for the treatment of PLK1-related pathophysiological disorders.

Effect of virtual reality training on standing balance in individuals with incomplete spinal cord injury

Recovery of balance ability during standing is one of the primary and essential aims of rehabilitative programs in individuals with incomplete spinal cord injury (iSCI). A sample of ten participants (mean age: 35.7 years, range: 25-63 years) with traumatic or non-traumatic iSCI (AIS grade C or D) and were able to stand with or without the support of an assistive device for a minimum of 2 min were recruited from the rehabilitation department of the Indian Spinal Injuries Centre, New Delhi, India. The participants received Virtual Reality (VR) based balance training for one hour, three times a week for four weeks on the Nintendo Wii gaming console. Participants were assessed three times: pre-intervention, post-intervention and follow-up assessment for the total ellipse area (TEA), total sway perimeter (TSP), sway range (anterior-posterior/medio-lateral (AP/ML)) and limits of stability (LOS). At post-intervention assessment, significant increases in comparison with pre-intervention scores was found in LOS (P=0.00), TEA with eyes open (EO) (P=0.00) and eyes closed (EC) (P=0.00), TSP with EO (P=0.00) and EC (P=0.00), sway range in AP direction (SD-AP) with EO (P=0.01) and EC (P=0.02) and sway range in ML direction (SD-ML) with EO (P=0.02) and EC (P=0.01). At follow-up assessment, a significant improvement in comparison to post intervention scores was found in TEA measured both in EO (P=0.01) and EC conditions (P=0.02), TSP measured with EO (P=0.01) and SD-ML both with EO (P=0.04) and EC (P=0.01). No significant changes were found in LOS (P=0.89), TSP measured with EC (P=0.38) and SD-AP both with EO (P=0.50) and EC (P=1). However, significant improvement was seen on comparing follow-up assessment scores with pre-intervention scores for all variables, such as LOS (P=0.00), TEA in EO (P=0.00) and EC (P=0.00), TSP with EO (P=0.00) and EC (P=0.00), SD-AP with EO (P=0.01) and EC (P=0.02) and SD-ML with EO (P=0.01) and EC (P=0.00). VR-based balance training intervention was able to elicit improvements in balance ability and maintain it during follow-up despite a small training dosage suggesting that it is a promising intervention for standing balance rehabilitation among individuals with iSCI. The VR-based balance training challenges elements of balance, which physical therapists may want to consider when designing a comprehensive rehabilitation program.

Clinical Trials Registry-India: CTRI/2018/12/016814.

P-079 INCIDENCE AND RISK FACTORS OF ABDOMINAL FASCIAL DEHISCENCE AFTER EXPLORATORY LAPAROTOMY- AN AUDIT OF 282 CASES

Background

An audit was performed to identify the incidence and risk factors of post-operative abdominal fascial dehiscence after Exploratory laparotomy.

Methods

The prospectively maintained database of a single unit was reviewed.The demographic parameters, comorbidities, degree of contamination, type of procedures, and the types of suture & needles were reviewed.We analyzed the relation of the type of sutures, type of surgery and degree of contamination on the development abdominal fascial dehiscence within 30 days of surgery .Difference between the groups were analyzed by t tests for continuous variables and Chi squared tests for categorical variables.

Results

50 (17.7%) patients developed fascial dehiscence.Mean Albumin was 2.45 +/- 0.69 g/dl in the dehiscence group, compared to 2.97 +/- 0.86 g/dl in those without dehiscence (p= 0.00).The prevalence of diabetics, smokers and incidence of postoperative surgical site infection were significantly more in the patients with dehiscence (p value - 0.045, 0.043 and 0.00 respectively).Prevalence of class 4 wounds was higher in the group with dehiscence (70% vs 44%, p value 0.001).Type of suture used (Loop PDS No. 1 vs PDS 2–0) did not significantly influence development of facial dehiscence within 1 month.

Conclusion

Results of our study are consistent with existing literature. Important preoperative/intraoperative parameters such as smokingr, diabetics, preoperative hypovolemic shock, albumin are significant predictors of fascial dehiscence in the post operative period. This will enable surgeons to take corrective measures before the surgery

Assessing Bladder Radiotherapy Response With Quantitative Diffusion-Weighted Magnetic Resonance Imaging Analysis

AIMS

Radiotherapy with radiosensitisation offers opportunity for cure with organ preservation in muscle-invasive bladder cancer (MIBC). Treatment response assessment and follow-up are reliant on regular endoscopic evaluation of the retained bladder. In this study we aim to determine the role of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) analysis to assess bladder radiotherapy response.

MATERIALS AND METHODS

Patients with T2-T4aN0-3M0 MIBC suitable for radical radiotherapy were recruited prospectively to an ethics approved protocol. Following transurethral resection of the bladder tumour and prior to any treatment, magnetic resonance imaging including DWI was performed on a 1.5T system using b values of 0, 100, 150, 250, 500, 750 s/mm2. DWI was repeated 3 months after completing radiotherapy. Cystoscopy and tumour site biopsy were undertaken following this. The response was dichotomised into response (

RESULTS

Thirty-four patients were evaluated. Response was associated with a significant increase in ΔADC mean compared with poor response at ΔADCall (0.57 × 10-3 mm2/s versus -0.01 × 10-3 mm2/s; P < 0.0001) and ΔADCb100 (0.58 × 10-3 mm2/s versus -0.10 x 10-3 mm2/s; P = 0.007). A 48.50% increase in %ΔADCall mean was seen in response compared with a 1.37% decrease in poor response (P < 0.0001). This corresponded to a %ΔADCb100 mean increase of 50.34% in response versus a 7.36% decrease for poor response (P < 0.0001). Significant area under the curve (AUC) values predictive of radiotherapy response were identified at ΔADC and %ΔADC for ADCall and ADCb100 mean, 10th, 25th, 50th, 75th and 90th percentiles (AUC >0.9, P < 0.01). ΔADCall mean of 0.16 × 10-3 mm2/s and ΔADCb100 mean 0.12 × 10-3 mm2/s predicted radiotherapy response with sensitivity/specificity/positive predictive value/negative predictive value of 92.9%/100.0%/100.0%/75.0% and 89.3%/100.0%/100.0%/66.7%, respectively.

CONCLUSIONS

Quantitative DWI analysis can successfully provide non-invasive assessment of bladder radiotherapy response. Multicentre validation is required before prospective testing to inform MIBC radiotherapy follow-up schedules and decision making.

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Key Words

• Bladder cancer
• Diffusion-weighted MRI
• MRI
• Radiotherapy

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MESH Headings

• Diffusion Magnetic Resonance Imaging/methods
• Humans
• Magnetic Resonance Imaging
• Prospective Studies
• ROC Curve
• Urinary Bladder/diagnostic imaging
• Urinary Bladder Neoplasms/diagnostic imaging
• Urinary Bladder Neoplasms/pathology
• Urinary Bladder Neoplasms/radiotherapy

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Grants

• 28724 Cancer Research UK
• C33589/A19727 Cancer Research UK
• Department of Health
• C33589/A28284 Cancer Research UK

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Affiliation(s)

S Hafeez The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
M Koh The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
K Jones The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
A El Ghzal The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
J D'Arcy The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
P Kumar The Royal Marsden NHS Foundation Trust, London, UK
V Khoo The Royal Marsden NHS Foundation Trust, London, UK
S Lalondrelle The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
F McDonald The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
A Thompson The Royal Marsden NHS Foundation Trust, London, UK
E Scurr The Royal Marsden NHS Foundation Trust, London, UK
A Sohaib The Royal Marsden NHS Foundation Trust, London, UK
R Huddart The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK

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