(1) Background: The goal of the study was to evaluate psychological tolerance and health-related quality of life (QOL) in head and neck (HN) cancer patients treated with definitive accelerated radiotherapy (DART); (2) Methods: Seventy-six recurrence-free patients eligible for the study, who were treated with DART in the CAIR-2 phase III clinical study (median of follow-up=47 months), completed EORTC QLQ-C30 with H&N35 module, Hospital Anxiety and Depression Scale (HADS) and Visual–Analog Scales (VAS) of pain in HN and the neck / arm area.; (3) Results: The most dominating symptoms measured with QLQ-C30 were: fatigue (44/100), sleeplessness (39/100), financial problems (38/100) and pain (32/100). Within H&N35 the highest scores were reported on the subscales of sticky saliva (60/100), mouth dryness (65/100) and increased intake of painkillers (50/100). Pain (VAS) was reported by 87% (HN area) and 78% (shoulder) of the patients, with a mean score of 3/10. One-third reported depressive mood (HADS≥15 points) with an average score of 12.5/42 p. The depressed group, who smoked more as compared to non-depressed before DART (96% vs 78%) and required steroids treatment (85% vs 58%) during DART, also scored significantly worse on 23 of 35 subscales of QLQ-C30 and H&N35 and experienced more intense pain (VAS). Women, and less advanced patients scored better in several aspects of the quality of life; (4) Conclusions: Patients treated with DART struggle with low quality of life and persisting treatment-related symptoms including constant pain. HNC survivors, especially those, who are depressed, may require additional psychosocial, rehabilitation and medical intervention programs..

Postoperative RT is recommended after breast conserving surgery and mastectomy (with risk factors). Consideration of pros and cons including potential side effects demands for optimization of adjuvant RT and a risk-adapted approach. There is clear de-escalation in fractionation - hypofractionation should be considered standard. For selected low risk situations PBI only or even the omission of RT might be appropriate. In contrast, tendencies in escalating RT are obvious. Preoperative RT seems attractive for patients in whom breast reconstruction is planned or for defining the tumor location more precisely with the potential of giving ablative doses. Dose escalation by a (simultaneous integrated) boost or the combination with new compounds/systemic treatments may increase antitumor efficacy but also toxicity. Despite low evidence, RT for oligometastatic disease is becoming increasingly popular. The omission of axillary dissection in node-positive disease led to an escalation of regional RT. Studies are ongoing to test if any axillary treatment can be omitted and which oligometastatic patients do really benefit from RT. Besides technical improvements the incorporation of molecular risk profiles but also the response to neoadjuvant systemic therapy have the potential to optimize the decision-making if and how local and/or regional RT should be administered.

Artificial Intelligence (AI) and Machine Learning (ML) approaches that could learn from large data sources have been identified as useful tools to support clinicians in their decisional process; AI and ML implementations have had a rapid acceleration during the recent COVID-19 pandemic. However, many ML classifiers are “black box” to the final user, since their underlying reasoning process is often obscure. Additionally, the performance of such models suffer from poor generalization ability in presence of dataset shift. Here, we present a comparison between an explainable-by-design (“white box”) model (Bayesian Network (BN)) versus a black-box model (Random Forest), both studied with the aim to support clinicians of Policlinico San Matteo University Hospital in Pavia (Italy) during the triage of COVID-19 patients. Our aim is to evaluate whether the BN predictive performances are comparable with those of a widely used but less explainable ML model such as Random Forest and to test the generalization ability of the ML models across different waves of the pandemic.

Visualization of volumetric data holds great importance, particularly in medical and biomedical applications. Various imaging techniques, such as FMRI and 3D microscopy, are employed to generate volumetric data, used in medical practice, research, and teaching. Commonly utilized tools like 3D Slicer, Fiji, and MATLAB ® aid in rendering and analyzing 3D images. However, these tools may lack comprehensive rendering functionality and face challenges in handling computational demands as data sizes grow. To address these limitations, this work introduces a GPU-supported renderer with a MATLAB ® interface. This solution gives the user flexible control over rendering parameters and optimizes data transfer through a memory management system. By leveraging the computational power of NVIDIA GPUs, the renderer enables complex and high-quality renderings, enhancing speed and efficiency. It therefore facilitates the analysis and visualization of volumetric data within an integrated environment, namely MATLAB ®, streamlining their workflows. This advancement provides valuable opportunities for researchers and medical professionals to explore and comprehend volumetric data effectively.

The holographic principle states that the information about the volume of space is stored on its boundary. Assuming this holds, we can explain the aspects of gravity. The spacetime needs to be extended to 5D to explain gravity in this context. This naturally explains the four classical tests of gravity namely the gravitational redshift, the perihelion precession, the bending of light, and the gravitational time delay. We also show a novel way in which the universe expands in an accelerated manner at late times without the need for any form of dark energy.

This review explores the nuanced decision-making surrounding postoperative radiotherapy for diffuse low-grade glioma (DLGG) patients, emphasizing the need for personalized treatment to balance the benefits of tumor control with the risks of long-term side effects. Radiotherapy is a cornerstone of DLGG treatment, offering significant improvements in progression-free survival, but its potential for cognitive decline and vascular lesions necessitates careful consideration of individual patient factors. The review delves into the complexities of radiotherapy timing, revealing that while early radiotherapy enhances progression-free survival, it does not significantly impact overall survival and may lead to earlier onset of cognitive decline. Conversely, delayed radiotherapy may mitigate cognitive decline but may result in shorter progression-free survival and the onset of neurological symptoms. The review advocates for a patient-centered approach, emphasizing the importance of weighing individual risks and benefits, and highlights the potential of artificial intelligence in predicting cognitive decline and the need to revisit previous research findings in light of the 2021 WHO (World Health Organization) classification update, underscoring the evolving nature of DLGG treatment and the ongoing quest for optimal therapeutic strategies.

In this article the galactic rotation curve is analyzed as an effect of an accelerated reference frame. This phenomenon is the strongest evidence for the so called dark matter. We show that a non-inertial reference frame could explain the experimental data. We also show that general relativity is not enough to complete explain that which encouraged alternatives paths such as the MOND approach. Considering the effect of dark matter as a realization of accelerated reference frames is a simple but powerful hypothesis.

In this paper, we investigate a class of hierarchical variational inequalities (HVIPs, i.e., strongly monotone variational inequality problems defined on the solution set of multiple-set split common fixed point problems) with quasi-pseudocontractive mappings in real Hilbert spaces, which special cases can be found in many important engineering practical applications such as image recognizing, signal processing and machine learning. In order to solve HVIPs of potential application value, inspired by the primal-dual algorithm, we propose a novel accelerated cyclic iterative algorithm that combines the inertial method with a correction term and a self-adaptive step-size technique. Our approach eliminates the need for prior knowledge of the bounded linear operator norm. Under appropriate assumptions, we establish strong convergence of the algorithm. Finally, we apply our novel iterative approximation to solve multiple-set split feasibility problems and verify the effectiveness of the proposed iterative algorithm through numerical results.

Abstract Unlike accelerated motion or curvalinear motion,a nonlinear motion state(non-inertial system) can be described by differential equations or the other algebric equations in axiom 2, the accelerated motion in axiom 3 can be considered to be described by using the equation of the linear and curvilinear process of the continuum extending to infinitely distance.Further, this linear and curvilinear process of the continuum is a quantitative continuum in essence as a unity of infinitely quantities and infinitely dimensions at infinite distance (infinity) relative to all orientations in which we exist. These indicates that an accelerated motion accumulates continuously started from a finite quantities, leaping to transit from finite to infinite quantities by an infinitely great accelerating force.

Objective: To evaluate the effect of different surface treatment methods on the shear bond strength (SBS) of metal brackets bonded to two types of CAD/CAM composite restorations: milled and 3D-printed. Materials and Methods: A total of 160 flat-shaped specimens (10×10×2 mm³) were prepared from four different CAD-CAM composites; two milled (Lava Ultimate™ [LU], and Grandio™ [GR]) and two 3D-printed (Crowntec™ [CT] and C&B Permanent™ [CB]). These specimens underwent thermocycling (5000 cycles at 5-55 °C), then were categorized based on the surface treatment into four groups (n=10): Group C (control, no surface treatment), Group HF (treated with 9.6 % hydrofluoric acid), Group DB (mechanical roughening by a diamond bur), and Group SB (sandblasting using aluminum oxide). Metal brackets were bonded, stored in artificial saliva for 24 hours, then thermocycled again. Shear bond strength (SBS) was tested using a universal testing machine until bracket debonding occurred. The adhesive remnant index (ARI) was assessed using a stereomicroscope to quantify the residual adhesive following debonding. Result: Regarding material, GR and LU restorations had significantly higher SBS values compared to CT and CB, ranging from 13.90 MPa to 20.35 MPa. Regarding surface treatment, SB and HF groups showed significantly higher SBS values. The ARI scores showed different adhesive modes of failure, with higher instances of scores 0 and 1 which indicate no or minimal adhesive remaining. Conclusion: Both milled and 3D-printed materials had adequate SBS for clinical use, with milled materials showing superior results. Surface treatments like sandblasting and HF significantly improved bond strength, with adhesive failure being common.

Keywords: olfactory rehabilitation; chronic pain; fMRI;

Laser-plasma interactions of ultra-short laser pulses with solid targets can generate highly intense pulses of protons and ions with energies of several MeV. The spectra of these particles are spread over a wide range following a Maxwellian distribution. We report on the design and testing of a magnetic chicane for the selection of protons within a limited energy window. It consists in two successive, anti-parallel dipole fields generated by cost-effective, permanent C-magnets with customized configuration and longitudinal positions. The chicane has been implemented into the target vessel of a petawatt laser facility under constraints on the direction of the incoming laser beam and guidance of the outgoing particles through a vacuum port. The separation of protons and carbon ions within distinct energy intervals has been demonstrated and compared to a ray tracing code.

Conventional X-ray therapy (XRT) is commonly applied to suppress cancerous tumors, however it often inflicts collateral damage to nearby healthy tissue. In order to provide a better conformity of the dose distribution in the irradiated tumor, proton therapy (PT) is increasingly being used to treat solid tumors. Furthermore, radiosensitization with gold nanoparticles (GNPs) has been extensively studied to increase the therapeutic ratio. The mechanism of radiosensitization is assumed to be connected with an enhancement of the absorbed dose due to huge photoelectric cross-sections with gold. Nevertheless, numerous theoretical studies mostly based on Monte Carlo (MC) simulations did not provide consistent and thorough picture of dose enhancement and, therefore, radiosensitization effect. Radiosensitization by nanoparticles in PT is even less studied than in XRT. Therefore, we investigate physics picture of GNP-enhanced RT using MC simulation with Geant4 equipped with the most recent physics models, taking into account a wide range of physics processes relevant for realistic PT and XRT. Namely, we measured dose enhancement factors in the vicinity of GNP with diameters ranging from 10 nm to 80 nm. The dose enhancement in the vicinity of GNP reaches high values for XRT, while it is very modest for PT. The macroscopic dose enhancement factors for realistic therapeutic GNP concentrations are rather low for all RT scenarios, therefore other physicochemical and biological mechanisms should be additionally invoked for an explanation of the radiosensitization effect observed in many experiments.

BUB1 is overexpressed in most human solid cancers including breast cancer. Higher BUB1 levels are associated with poor prognosis especially in patients with triple-negative breast cancer (TNBC). Women with TNBC often develop resistance to chemotherapy and radiotherapy, which are still the mainstay of treatment for TNBC. Our previous studies demonstrated that BUB1 kinase inhibitor (BAY1816032) reduced tumor cell proliferation and significantly enhanced radiotherapy efficacy in TNBC. In this study, we evaluated the effectiveness of BAY1816032 with a PARP inhibitor (olaparib), platinum agent (cisplatin), and microtubule poison (paclitaxel) alone or in combination with radiotherapy using cytotoxicity and clonogenic survival assays. BUB1 inhibitor sensitized BRCA1/2 wild-type SUM159 and MDA-MB-231 cells to olaparib, cisplatin and paclitaxel synergistically (combination index; CI

Non-targeted effects (NTE) such as bystander effects or genomic instability have been known for many years but their significance for radiotherapy or medical diagnostic radiology are far from clear. Central to the issue are reported differences in response of normal and tumour tissues to signals from directly irradiated cells. This review will discuss possible mechanisms and implications of these different responses and will then discuss possible new therapeutic avenues suggested by the analysis. Finally, the importance of NTE for diagnostic radiology and nuclear medicine which stems from the dominance of NTE in the low dose region of the dose response curve will be presented. Areas such as second cancer induction and microenvironment plasticity will be discussed.

Patients with metastatic epidural spinal cord compression (MESCC) and favorable survival prognoses may benefit from radiation doses exceeding 10 x 3.0 Gy. In a multi-center phase 2 trial, patients receiving 15 x 2.633 Gy (41.6 Gy10) or 18 x 2.333 Gy (43.2 Gy10) were evaluated for local progression-free survival (LPFS), motor/sensory functions, ambulatory status, pain, distress, toxicity, and overall survival (OS). They were compared (propensity score adjusted Cox regression) to a historical control group (N=266) receiving 10 x 3.0 Gy (32.5 Gy10). In the phase 2-cohort, 50 (of 62 planned) patients were evaluable for LPFS. Twelve-month rates of LPFS and OS were 96.8% and 69.9%, respectively. Motor and sensory functions improved in 56% and 57.1% of patients, and 94.0% were ambulatory following radiotherapy. Pain and distress decreased in 84.4% and 78.0% of patients. Ten and two patients experienced grade 2 and 3 toxicities, respectively. Phase 2 patients showed significantly better LPFS than the control group (p = 0.039) and a trend for improved motor function (p = 0.057). Ambulatory and OS rates were not significantly different. Radiotherapy with 15 x 2.633 Gy or 18 x 2.333 Gy was well tolerated and appeared superior to 10 x 3.0 Gy.

Conventional MRI sequences are standard methods to monitor patients with brain tumors but have significant limitations especially after irradiation. Currently, the role of FET-PET in radiotherapy of glioblastoma is emerging, starting from target definition, response assessment and in distinguishing progression from post-irradiation changes. Recently a PET RANO criteria have been published providing optimal strategy for treatment evaluation with amino-acid PET. Earlier, a PET/RANO group reported contribution of PET imaging to radiotherapy planning and monitoring in glioma patients. Also, increasing evidence have showed advantages of amino-acid PET vs. RANO MRI for prediction of overall survival. In this narrative review we aimed to summarize published data on FET-PET based treatment response assessment to radiotherapy and focused on details in protocols.

This study investigates whether a chronotherapeutic treatment of hepatocellular carcinoma (HCC) may improve treatment efficacy and mitigate side effects on healthy liver (HL). HCC was induced in Per2::luc mice which were irradiated at four time points of the day. Proliferation and DNA-double strand breaks were investigated in irradiated and non-irradiated organotypic slice culture (OSC) and ex vivo samples by detection of Ki67 and γ-H2AX. OSC proved useful to determine dose-dependent effects on proliferation and DNA damage but appeared unsuited to test the chronotherapeutic approach. Irradiation of ex vivo samples was most effective at the proliferation peaks in HCC at ZT02 (early inactivity phase) and ZT20 (late activity phase). Irradiation effects on HL were minimal at ZT20. Ex vivo samples revealed disruption in daily variation and down-regulation of all investigated clock genes except Per1 in non-irradiated HCC as compared with HL. Irradiation affected rhythmic clock gene expression in HL and HCC at all ZTs except at ZT20. Irradiation at ZT20 had no effect on total leukocyte numbers. Our results indicate ZT20 as the optimal time point for irradiation of HCC in mice. Translational studies are now needed to evaluate whether the late activity phase is the optimal time point for irradiation of HCC in man.

After reviewing cancer theories, cancer treatment development histories, randomized clinical trial's performance, cancer treatment strategy, trial follow-up times, and conducting numerous simulations using existing data, the authors found: (1) medical treatments come with three to four lethal factors: treatment side-effects, emotional distress and chronic dress, lack of exercises or physical inactivity, and excessive nutrition in some cases; (2) clinical trial exaggerates the benefits of fast-acting treatments and underestimates the slow-delivering adverse side effects as a result of statistical averaging, interfering effects of personal lifestyle factors, and insufficient follow-up times; (3) the benefits of medical treatments are limited by chain comparison, where surgery sets up a negative standard relative to the best way for resolving cancer; (4) the strategy of destroying the tumor is unworkable; (5) medical treatments can turn natural cancer growth curve into approximately doubly exponential curve; (6) multiple factor non-medical measures are much more powerful than medical treatments in controlling cancer growth and metastasis rates; and (7) cancer early diagnosis and over treatments are bad strategies that have great adverse impacts on cancer patients. Based on huge increases in cancer growth rate constants, substantial of loss of organ functional capacity, and severe systemic aging-like cellular damages, the authors concluded that medical treatments promote cancer growth and metastasis rates and shorten patient lives in most cases, and the claimed benefits are caused by triple biases of clinical trials. The authors believe that the better strategy for ending the global cancer epidemic is abandoning clinical trails as the research model, changing caner treatment strategy from killing cancer cells to slowing down cancer growth rates by using multiple factors optimization approach in personalized medicine.

N6-methyladenosine (M6A) modification is the most abundant internal chemical modification on RNA molecules in eukaryotes and can affect mRNA metabolism and regulate RNA transcription, nuclear export, splicing, degradation, translation, ets, and has a significant impact on various aspects of physiology or pathobiology. Radiotherapy is the most common measure of tumor treatment, variety of cellular intrinsic mechanisms affect the responses of cells to ionizing radiation (IR) and effectiveness of cancer radiotherapy. In this review, we summarize and discuss the recent advances about the roles and mechanisms of RNA M6A methylation in cellular responses to radiation-induced DNA damage response, and outcomes of cancer radiotherapy. Insights into the RNA M6A methylation in radiation biology may facilitate the improvement of therapeutic strategies for cancer radiotherapy as well as radioprotection on normal tissues.

Background: Aging rate is affected by genetic changes, epigenetic modifications, oxidative stress, inflammation, lifestyle and environmental factors. In accelerated aging (AA), biological age exceeds the chronological one. Objective: To undertake a critical reappraisal of the AA concept and to reveal its weaknesses and limitations. Methods: We reviewed over 300 recent articles dealing with physiology of brain aging and pathophysiology of neurodegeneration. Results: (1) Organ systems age at different rates, which interferes with application of the AA concept to individual organs. (2) Aging rate can be decelerated due to individual structure–functional reserves built with cognitive, physical training or pharmacological interventions. (3) The AA concept lacks standardised terminology and methodology. (4) Specific molecular biomarkers (MBM) reflect aging. To consolidate the AA theory, researchers should validate numerous MBM candidates. (5) Aging factors, mechanisms and the exact nature of their biological outcomes are not well understood. Conclusion: Although considered as a perspective theory, the AA concept has serious limitations and it requires an update.

Artificial Intelligence is dominated by Artificial Neural Networks (ANNs). Currently, the Batch Gradient Descent (BGD) is the only solution to train ANN weights when dealing with large datasets. In this article, a modification to the BGD is proposed which significantly reduces the training time and improves the convergence. The modification, called Instance Eliminating Back Propagation (IEBP), eliminates correctly-predicted-instances from the Back Propagation. The speedup is due to the elimination of unnecessary matrix multiplication operations from the Back Propagation. The proposed modification does not add any training hyperparameter to the existing ones and reduces the memory consumption during the training.

A novel means of applying radiotherapy in cancer treatment is the application of the radiation dose at a very high intensity for a very short time, FLASH radiotherapy (FLASH-RT). This technique involves exposure of tumors to >40 Gy/s, usually for less than one second. Studies conducted in cell and preclinical models suggest that FLASH-RT seems less damaging to normal tissues from adverse effects, relative to the same overall dose of radiation administered in conventional therapy (CONV-RT) which involves administration of lower levels of radiation repeated intermittently over a protracted period. In contrast, the susceptibility of tumor tissues to FLASH-RT is not diminished relative to CONV-RT. Within solid tumors both modes of dispensation of radiation produce an equivalent degree of cell damage. This differential between normal and malignant material has been found in isolated tissues, animal studies, and more recently in clinical trials. However, the classical radiation concept is that high energy linear transfer radiation (LET) is more damaging than the equivalent total dose of low LET. Thus, the susceptibility of cells should be greater to short-term exposure to high LET. This article discusses the potential reasons that may account for this discrepancy. While the relative protection given to untransformed tissues by FLASH-RT relative to tumor tissue is a major step forward in radiation therapy of cancer, the processes that lie behind this phenomenon are incompletely understood and are considered here.

Purpose Radiotherapy is integral in the management of hematological malignancies (HM). Standard radiotherapy dose fractionation regimens range between 20-50 Gy in 10-25 fractions over 2-5 weeks. This study presents the outcomes of patients with HM treated with hypofractionation radiotherapy (HFRT) during the COVID-19 pandemic. Methods Patients (N=36) were treated with HFRT between January 2020 and September 2022. The outcomes measured were the overall response rate (ORR), freedom from local progression (FFLP), and overall survival (OS). Results Median follow-up was 13.2 months. Thirty-three patients (92%) had non-Hodgkin (NHL) or Hodgkin lymphoma (HL). Eighteen patients (50%) had aggressive and 9 (25%) had indolent NHL. Nineteen patients (53%) presented with stage I/II and 15(42%) with stage III/IV disease. Twenty-five (69.4%) and eleven (30%) received consolidative and definitive RT, respectively. Twenty patients (56%) received treatment to the neck and/or thorax, and 9 (25%) to the abdomen or pelvis. Total dose ranged from 18 to 42.5 Gy in 6-17 fractions/ 2.67-5 Gy per fraction. Median dose in 2 Gy fractions for an alpha/beta (α/β) ratio of 10 amounted to 39 Gy (SD ± 13.86), and 43.6 Gy (SD ± 12) for an α/β of 3. The most commonly used fractionation scheme was 39 Gy in 13 fractions. ORR was 94.4% for the entire cohort, and 100, 94.4, and 83.3% for indolent NHL, aggressive NHL, and HL patients. Two-year FFLP was 76% (95% CI: 34-93%) for the entire cohort, and 100, 87 (95%CI: 56.4-96.5%) and 42% (95% CI: 1.1-84.3%) for the indolent NHL, aggressive NHL, and HL patients. Two-year OS for the entire cohort was 80% (95% CI:59.9-90.5%), and 100, 66.1 (95% CI: 36.4-84.4%) and 100% for the indolent NHL, aggressive NHL, and HL patients. Only one patient presented with grade two pulmonary toxicity. Conclusion HFRT in HM provides excellent local control without any increase in toxicity.

Uveal melanoma represents the most prevalent form of primary malignant intraocular tumor in adults. Historically, enucleation was considered the gold-standard approach in the treatment of uveal melanoma. Nowadays, radiotherapy is the most commonly used therapy, aiming at a better quality of life. However, radiotherapy can result in several ocular complications, some of which may be vision-threatening. Radiation-induced dry eye, scleral necrosis, cataract, rubeosis iridis, neovascular glaucoma, radiation retinopathy and maculopathy and optic neuropathy are the most common. This article aims to summarize the current literature on the ocular complications after radiotherapy, their clinical features, risk factors and management strategies. A thorough understanding is crucial for ophthalmologists and oncologists to provide optimal patient care, improve visual outcomes, and minimize long-term complications.

Background: Although persistent systemic inflammation is considered to be predictive for future cardiovascular events, it remains unclear whether or not C-reactive protein (CrP) plays an active role in coronary-plaque instability. Here, we report a case of a patient with failed and super-infected renal allograft as a source for systemic inflammation presenting with repeat acute coronary syndromes. Case presentation: A 52-years-old male type-2 diabetic with a failed kidney transplant who was hospitalized for acute urinary-tract infection. In the presence of other, classic cardiovascular risk factors, peak values of CrP coincided with episodes of unstable angina treated by cardiologic interventions. Besides pyelonephritis, the histological examination of the kidney transplant revealed signs of chronic rejection and the presence of a renal cell carcinoma in situ. Once the renal allograft has been removed, systemic inflammation was attenuated, the patient was not rehospitalized for acute-coronary syndrome within the next 12 months. Conclusion: In this case, systemic inflammation was paralleled by instability of coronary plaques as documented by repeat coronary angiograms.

Background: This systematic review aims to investigate whether percutaneous transhepatic gallbladder drainage (PTGDB), as definitive treatment, is superior to emergency cholecystectomy (EC) in high-risk patients with acute cholecystitis (AC). Material and methods: A systematic literature search was performed until December 2022 using Scopus, Medline/PubMed and Web of Science databases in order to compare PTGDB as definitive treatment vs EC in AC. Results: Seventeen studies (1 Randomized Control Trials and 16 observational studies) have been included with a total of 783,672 patients (32,634 treated with PTGDB vs 4,663 who underwent laparoscopic cholecystectomy, 343 who underwent open cholecystectomy and 746,032 who underwent cholecystectomy, but without laparoscopic or open approach being specified). The quality assessment (ROBINS-I) of the not randomized studies showed a serious risk, differently the evaluation of the randomized study (RoB 2) showed a low risk of bias. Analysis of the results shows that PTGDB, despite being minimally invasive, do not have different incidence of complications than EC (RR 0.77 95% CI [0.44 to 1.34]; I2 = 99%; P=0.36). A lower postoperative mortality was reported in patients who underwent EC (2.37%) than in PTGDB group (13.78 %) (RR 4.21; 95% CI [2.69 to 6.58]; P < 0.00001), furthermore the risk of hospital readmission for biliary complications (RR 2.19 95% CI [1.72 to 2.79]; I2 = 48 %; P<0.00001) and hospital stay (MD 4.29 95% CI [2.40 to 6.19]; P<0.00001) were lower in EC group. Conclusions: No advantage in using PTGDB as a definitive treatment over EC in the management of critically ill patients with AC has been demonstrated; the results of our systematic review and meta-analysis suggest using EC as the treatment of first choice, even for very high-surgical-risk patient in which PTGDB should be reserved. The major limitation of this systematic review and meta-analysis is associated to a low quality of evidence for the serious bias in the not randomized studies. For this reason, new high powered and well-designed clinical trials are needed to recommend PTGDB as definitive treatment in patients unfit for surgery or those who refuse to undergo surgery.

Memory decline is considered a normal part of aging, while the relationship between melatonin deficiency and cognitive function is complex and not fully understood. The present study investigated the role of melatonin deficiency functioning as a hormone at different ages on working and short-term recognition and spatial memory in rats. An age-related decline in memory function was tested in the Y-maze, the object recognition test, and the radial arm maze. Aging was associated with reduced expression of brain-derived neurotrophic factor (BDNF) throughout the hippocampus, whereas pinealectomy exacerbated this process specifically in the CA3 region of 3- and 14-month-old rats. The region-specific reduced expression of the extracellular signal-regulated kinase (ERK)1/2 and pERK1/2 was observed in young adult rats with pinealectomy. However, in middle-aged rats, the expression of these signaling molecules was either downregulated or upregulated in different hippocampal regions. The reduced ratio of pCREB/CREB in the frontal cortex and hippocampus was associated with memory impairment in young adult and middle-aged melatonin-deficient rats, whereas old rats were unaffected. Our study provides insights into the molecular pathways involved in age-related memory changes associated with melatonin deficiency, highlighting the importance of the BDNF / ERK1/2 / CREB pathway in the hippocampus and suggesting a critical period for intervention.

Silver nanoparticles (AgNPs) have arisen as promising specialists in malignant growth treatment, especially in further developing radiotherapy results. In vitro examinations feature AgNPs' capacity to increment radiosensitivity in disease cell lines, prompting uplifted cell demise and decreased clonogenic endurance. Outstandingly, AgNPs display insignificant poisonousness to ordinary cells, recommending potential for specific focusing of disease cells during radiotherapy. The blend of AgNPs with cisplatin shows huge cytotoxicity and oxidative pressure, particularly in tumoral cells, underscoring the requirement for additional investigation of this therapeutic methodology. AgNPs likewise show guarantee in prompting oxidative pressure in pancreatic disease cells, recommending an expected application in pancreatic malignant growth treatment. In co-openness situations, AgNPs, when joined with cadmium, prompt metabolic variation, showing compromised cell safeguard systems. Moreover, AgNPs display potential in tweaking ABC carrier action, offering a procedure to defeat multidrug obstruction in disease cells. While featuring the significant capability of AgNPs in disease treatment, the rundown highlights the need for continuous exploration to clarify their components, well-being profiles, and clinical applications. Combining AgNPs with radiotherapy presents a promising road, tending to limits in ordinary disease therapies and underlining their multifunctionality in forming the eventual fate of malignant growth therapeutics.

The impact of sex in the development of long-term toxicities affecting the quality of life of cancer survivors has not been investigated experimentally. To address this issue, a series of neurologic and cardiologic endpoints were used to investigate sex-based differences triggered by paclitaxel treatment and radiotherapy exposure. Male and female WT mice were treated with Paclitaxel (150 and 300 mg/kg) administered weekly over 6 weeks or exposed to 19 Gy cardiac irradiation. Cohorts were analyzed for behavioral and neurobiologic endpoints to assess systemic toxicity of paclitaxel or cardiovascular endpoints to assess radiotherapy toxicity. Interestingly, female WT mice exhibited enhanced tolerance compared to male WT mice regardless of the treatment regimen. To provide insight into the possible sex-specific protective mechanisms, rhoB deficient animals and elderly mice (22 months) were used with a focus on the possible contribution of sex hormones including estrogen. RhoB deficiency and advanced age had no impact on neurocognitive impairment induced by Paclitaxel but reversed the cardioprotection was observed in females after radiotherapy. Conversely, rhoB deficiency protected males from radiation toxicity. In sum, rhoB was identified as a molecular determinant driving estrogen dependent cardioprotection in female mice, whereas neuroprotection was not sex-hormone dependent. To our knowledge, this study revealed for the first time sex- and organ-specific responses to paclitaxel and radiotherapy.

Oriented strand board (OSB) panels are widely marketed for several applications, from building to packaging. The manufacturing of poplar OSB started recently in Northern Italy representing a relevant innovation in the sector since this product is usually made of coniferous wood. The thermal treatment is widely used for reducing the hygroscopicity of wood-based products, nonetheless it influences the mechanical behavior and degrades the main components of wood, which can affect their finishing. Therefore, it is important to know the properties of the treated surfaces. To this purpose, in this study a lot of OSB panels, made of poplar wood, 15 mm thick and with a density of 590 kg/m³, were thermally treated under vacuum conditions at 190 °C for 2 h and then subjected to accelerated weathering. The changes in color and in wettability due to treatment and accelerated weathering were studied. The thermal treatment determined a significant darkening of the color; the accelerated weathering darkened the untreated surfaces and, on the opposite, lightened the thermo-treated surfaces. The wettability decreased after thermal treatment and increased after weathering, more evidently in treated panels. Overall, this study improves the knowledge about the behavior of the surface of thermo-treated poplar OSB, which is relevant for the industrial coating of this product.

This review focuses on Cu/TiO2 sequentially and Cu-TiO2 co-sputtered catalytic/photocatalytic surfaces leading to bacterial inactivation discussing their stability, synthesis, adhesion and antibacterial kinetics. The intervention of TiO2, Cu and the synergic effect of Cu and TiO2 on films prepared by a colloidal approach and other techniques is also reviewed leading to bacterial inactivation. Processes in aerobic media and anaerobic media leading to bacterial loss of viability on multidrug resistant (MDR) pathogens, Gram-negative (-) and Gram-positive(+) bacteria are described. Insight is provided for the interfacial charge transfer mechanism under solar irradiation occurring between TiO2 and Cu. surface properties of 2D TiO2/Cu and TiO2-Cu films are correlated with the bacterial inactivation kinetics observed in the dark and under light. The intervention of these antibacterial sputtered surfaces in health-care facilities leading to MRSA-isolates is described in the dark and under the actinic light. The synergic intervention of the Cu and TiO2 films leading to bacterial inactivation prepared by direct current magnetron sputtering (DCMS), pulsed direct current magnetron sputtering (DCMSP) and highly ionized pulse plasma magnetron sputtering (HIPIMS) is reported in a detailed way.

PARP inhibitors are used in tumor therapy exploiting their inhibitory role in DNA repair. Radiation therapy leads to DNA damage in the affected region comprising both tumor tissue and adjacent normal tissue. In addition, radiotherapy has long-standing effects on DNA integrity. The mechanisms for this are not well understood. We studied normal tissue damage of the lung after application of ionizing radiation (IR) in two well established rat models comprising both external (eIR) and internal (iIR) ionizing radiation. We found a nearly complete (~350-fold) loss of PARP-1 in the irradiated tissue in both models but no change in PARylated protein. This may be explained by the strong decrease in both ARH3 and PARG, both deparylating enzymes. We demonstrate, that of all these proteins are expressed in type II pneumocytes, but also in type I pneumocytes and the bronchiolar epithelium. The data suggest a severe disturbance of PARylation in these cells which may affect their major functions such as maintenance of the integrity of the alveolar wall. It is likely that the application of PARP inhibitors could have cumulative effects in radiation-damaged normal tissue.

In recent years, the field of radiotherapy has witnessed remarkable advancements with the integration of artificial intelligence (AI) technologies into clinical practice. Traditionally, radiotherapy treatment planning has been a labor-intensive process, requiring meticulous manual segmentation and optimization. With the advent of AI, particularly deep learning algorithms, the accuracy and efficiency of target delineation and organ-at-risk segmentation have significantly improved. AI-driven algorithms analyze voluminous medical imaging data, enabling rapid and precise contouring, thus expediting the planning phase and reducing inter-observer variability. Furthermore, AI's role extends to treatment plan optimization, where it intelligently explores vast parameter spaces to generate optimal plans tailored to individual patients. This not only saves dosimetrists' time but also enhances plan quality by accounting for complex anatomical variations and personalized clinical goals. In the realm of treatment delivery, AI-powered real-time image guidance enhances the accuracy of patient positioning, ensuring precise radiation targeting. Adaptive radiotherapy, enabled by AI, allows on-the-fly plan modifications in response to anatomical changes, significantly improving treatment accuracy in scenarios like tumor shrinkage or weight loss. Beyond planning and delivery, AI algorithms contribute to outcome prediction by analyzing historical patient data and treatment responses. This predictive capability aids clinicians in making informed decisions and refining treatment strategies for better prognoses. Despite the revolutionary potential, challenges remain in seamlessly integrating AI into clinical workflows. Ethical considerations, data privacy, and algorithm interpretability necessitate cautious implementation. Additionally, fostering interdisciplinary collaboration between AI experts and radiation oncologists is imperative to harness the technology's full potential. This paper explores the impact of AI in four key areas of radiotherapy: automated segmentation, dosimetric and machine quality assurance, adaptive radiation therapy, and clinical outcome prediction.

The most important prognostic factors in curatively treated prostate cancer at the initial diagnosis are T and N stage, histological subtype, Gleason score, initial PSA, PSA density and percentage of core biopsy positivity. Newer, but non-standard prognostic factors are urine PCA3 and genetic markers of prostate cancer. A simple, but seemingly underestimated standard test is serum Calcium (Ca) level, which has been shown by a previous study group to be a good predictor of lethal prostate cancer, but there is scarce evidence regarding the prognostic value of calcium levels at diagnosis. We aimed to determine whether a Ca level in the upper part of normal values has a prognostic value in curatively treated prostate cancer. We have retrospectively included 84 consecutive patients with prostate cancer, who underwent curative radiotherapy (primary or adjuvant; external beam RT with or without brachytherapy). We have performed statistical analysis of available prognostic factors. Ca level at diagnosis was found to be a statistically significant predictor of disease-free survival.

Cognitive Warfare (CogWar) is another form of warfare where the goal is to exploit cognition facets to disrupt, undermine, influence or modify human decisions. Famous examples include “Operation Gidlock” meddling with the US 2016 election, and CogWar campaigns assisting the annexation of Crimea. As Large Language Model(LLM)-based applications expand, reaching more users and their cognitive states, stealth Malicious Cognitive Behavioral Tactics (MCBT) can be embedded in trusted application sessions to systematically profile, then alter, each individual’s cognition over time. Successful MCBT can create more cases like Snowden, mass shootings, or January6. This short-form paper discusses a novel MCBT threat model, a novel kill chain, and an on-going prototype for demonstration.

We propose a toy model of a spherical universe made up of an exotic dark gas with temperature $T$ in thermal equilibrium with a black-body. Each particle of this exotic gas mimics a kind of particle of dark energy. So, each dark particle occupies a very small area of space so-called Planck area $L_p^{2}$, which represents the minimum area of the whole space-time given by the spherical surface with area $4\pi R_H^2$, where $R_H$ is the Hubble radius. We realize that such spherical surface is the surface of the black-body for representing the dark universe as if it were the surface of an expanding balloon. Thus, we are able to derive the law of universal gravitation, thus leading us to understand the cosmological anti-gravity. We estimate the tiny order of magnitude of the cosmological constant and the acceleration of expansion of the dark sphere. In this toy model, as the dark universe can be thought of as a large black body, when we obtain its power and frequency of emission of radiation, we find very low values. We conclude that such radiation and frequency of the black body made up of dark energy is a background gravitational wave with very low frequency in the order of $\sim 10^{-17}$Hz due to the slight stretching of the fabric of space-time.

Diabetes mellitus entails increased atherosclerotic burden and medial arterial calcification but the precise mechanisms are not fully elucidated. Our aim was to investigate the implication of CD36 in inflammation and calcification processes orchestrated by vascular smooth muscle cells (VSMCs) under hyperglycemic and atherogenic conditions. We examined the expression of CD36, pro-inflammatory cytokines, endoplasmic reticulum (ER) stress markers and mineralization-regulating enzymes by RT-PCR in human VSMCs, cultured in medium containing normal (5 mM) or high glucose (22 mM) for 72 h with or without oxLDL (24 h). The uptake of DiI-labelled oxLDL was quantified by flow citometry and fluorimetry and calcification assays were performed in VSMC cultured in osteogenic medium and stained by alizarin red. We observed an induction in the expression of CD36, cytokines, calcification markers and ER stress markers under high glucose that was exacerbated by oxLDL. These results were confirmed in carotid plaques from subjects with diabetes versus non-diabetic subjects. Accordingly, the uptake of DiI-labelled oxLDL was increased after exposure to high glucose. Silencing of CD36 abolished the induction of CD36 and reduced the expression of calcification enzymes and mineralization of VSMC. Our results indicate that CD36 signaling is involved in hyperglycemia and oxLDL-induced vascular calcification in diabetes.

The disease COVID-19 is highly infectious, and infectious in asymptomatic incubation period. The national epidemic development has been effectively controlled and continues improving, especially in areas outside Hubei province. Such periodical results were achieved by the joint efforts of the whole society, including not only the hard work and dedication of the front-line medical workers but also the active cooperation of the general public. The strict epidemic prevention and control measurements have brought remarkable control results. In the present study, the basic infection number of the coronavirus R0 (basic replication number of the infection) before and after prevention and control measurements was simulated to elaborate the measurements of the Chinese government on epidemic prevention and control, providing reference for the people around the world.

Smoothed particle hydrodynamics (SPH) is regarded as a pure Lagrangian approach, which can solve fluid dynamics problems without the creation of mesh. In this paper, a paralleled SPH solver is developed to solve particle-based computational acoustics (PCA). The aim of this paper is to study the feasibility of using SPH to solve acoustic problems and to improve the efficiency of solving processes by paralleling some procedures on GPU during calculating. A stand SPH code running serially in a CPU is proposed to solve wave equation. This is a wave propagating in a two-dimensional domain. After finishing the computation, the results are compared with the theoretical solutions and they agree well. So its feasibility is verified. There are two main methods for searching neighbor particles: all-pair search method and linked-list search method. Both methods are used in different codes to simulate an identical problem and their runtimes are compared to investigate their searching efficiencies. The runtime results show that linked-list search method has a higher efficiency, which can save a lot of searching time when simulating problems with huge amounts of particles. Furthermore, the percentages of different procedures’ runtimes in a simulation are also discussed to find the most consuming one. Then, some codes are modified to run in different GPUs and their runtimes are compared with those of serial ones on a CPU. Runtime results show that the paralleled algorithm can be more than 80 times faster than the serial one. The result shows that GPU paralleled SPH computing can achieve desirable accuracy and speed in solving acoustic problems.

The role of postmastectomy radiotherapy and regional nodal irradiation after radical mastectomy is defined in high-risk patients with locally advanced tumors, positive margins, and unfavorable biology. The benefit of postmastectomy radiotherapy in intermediate-risk patients (T3N0 tumors) remains a matter of controversy. It has been demonstrated that radiotherapy after breast-conserving surgery lowers the locoregional recurrence rate compared with surgery alone and improves the overall survival rate. In patients with 4 or more positive lymph nodes or extracapsular extension regional lymph node irradiation is indicated regardless of the surgery type (breast-conserving surgery or mastectomy). Despite the consensus that patients with more than 3 positive lymph nodes should be treated with radiotherapy, there is a controversy regarding the recommendations for patients with one to three involved lymph nodes. In patients with N0 disease with negative findings on axillary surgery, there is a trend to administer regional lymph node irradiation in patients with a high risk of recurrence. In patients treated with neoadjuvant systemic therapy and mastectomy, adjuvant radiotherapy should be administered in case of clinical stage III and/or ≥ypN1. In patients treated with neoadjuvant systemic therapy and breast-conserving surgery, postoperative radiotherapy is indicated irrespective of pathological response.

Background: Optimal hypofractionated schedule of post-prostatectomy radiotherapy remains to be established. We evaluated treatment outcomes and toxicity of the moderately hypofractionated post-prostatectomy radiotherapy in 16 daily fractions delivered with IMRT/VMAT. The treatment schedule selection was motivated by limited technology resources. Methods: One hundred consecutive M0 patients with post-prostatectomy radiotherapy were evaluated. Radiotherapy indication was adjuvant (ART) in 19%, early salvage (eSRT) in 46% and salvage (SRT) in 35%. The dose prescription for prostate bed PTV was 52.8 Gy in 16 fractions of 3.3 Gy. The Common Terminology Criteria v.4 for Adverse Events scale was used for toxicity grading. Results: The median follow-up was 61 months. Five-year biochemical recurrence-free survival (bRFS) was 78.6%, distant metastases-free survival was 95.7% and overall survival was 98.8%. Treatment indication was the only significant factor for 5-year bRFS in multivariate analysis which was 84.6% vs. 67.6% for ART or eSRT vs. SRT respectively (HR 0.15, 95% CI 0.05–0.47, p=0.001). Acute GI toxicity grade 2 was recorded in 24%, grade 3 in 2% and acute GU toxicity grade 2 in 10% and no grade 3. Cumulative rate of late GI toxicity grade ≥2 was observed in 9% and late GU toxicity grade ≥2 in 16%. Conclusion: Observed results confirmed efficacy and acceptable toxicity of post-prostatectomy hypofractionated radiotherapy in 16 daily fractions.

This review highlights normal and tumor tissue vasculature, immunological changes, and phenotypic alterations (VIP model) as fundamental in abscopal interaction. In the stereotactic body radiotherapy (SBRT) and immunotherapy era, we are moving toward “immunological radiation planning,” i.e., radiation scheduling with abscopal effect as a vital endpoint as well. Towards this end, this manuscript presents specific diagrammatic tumor models to optimize the outcome of abscopal response in SBRT, based on the principle of the four R’s - Repair, Redistribution, Repopulation, and Reoxygenation of radiotherapy. The article highlights the importance of restricting the dose of SBRT to < 10 Gy per fraction, appropriate use of dose painting, and concomitant/delayed SBRT boost potential. Current literature indicates that immunotherapy should not precede but follow SBRT within seven days. Included is the review of integrating “cyclical” antiangiogenics, immune adjuvants/immune-metabolites as abscopal effect enhancers with SBRT. The importance of proton, carbon-ion SBRT is dealt with briefly. Proposed six fundamental requirements for augmentation of the abscopal cascade are listed. The existing exploratory results need to develop a definitive strategy amidst complex interactions in SBRT, immunotherapy, immune-adjuvants, & abscopal effects. We now have enough literature evidence to convert “abscopal by chance” to “abscopal by design” by harmonized combinatorial approach.

The cycling of soil phosphorus (P) is inherently linked with soil organic carbon-iron (C-Fe) cycling, yet empirical integration of these processes within paddy soils remains scarce. In this study, we conducted a microcosm experiment using paddy soils subjected to six distinct fertilization regimes involving varying P inputs for five years. In addition to evaluating P activation under reflooding conditions, we assessed the Fe reduction process and characterized the properties of dissolved organic matter (DOM) at the molecular level using Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS), alongside profiling the composition of soil microbial communities with high-throughput sequencing. Our findings revealed that after 25 days of reflooding, soil Olsen-P content increased by an average of 73% compared to its initial state, showing a strong correlation with the Fe reduction process. Specifically, treatments involving pig manure application exhibited higher Fe reduction rates and enhanced P activation, highlighting the role of organic matter in facilitating Fe reduction. Investigations on the relative abundance of typical iron-reducing microbes further supported their importance in P activation, but the rate of iron reduction is limited by soil organic matter content. Delving deeper into DOM properties, soil DOM composition profiling and network analysis suggested that high-molecular-weight DOM, particularly lignins, served as the primary resources driving Fe reduction by iron-reducing microbes, consequently promoting Fe reduction and P release. Taken together, our study assembled the C-Fe-P cycling dynamics in paddy soils, emphasizing the pivotal role of microbial-driven Fe reduction facilitated by soil DOM in P availability and subsequently sustainable agricultural practices.

Prior research shows that individuals who have exhibited antisocial behavior are in poorer health than their same-aged peers. A major driver of poor health is aging itself, yet research has not investigated relationships between offending trajectories and biological aging. We tested the hypothesis that individuals following a life-course persistent (LCP) antisocial trajectory show accelerated aging in midlife. Trajectories of antisocial behavior from age 7 to 26 years were studied in the Dunedin Multidisciplinary Health and Development Study, a population-representative birth cohort (N=1037). Signs of aging were assessed at age 45 years using previously validated measures including biomarkers, clinical tests, and self-reports. First, we tested whether the association between antisocial behavior trajectories and midlife signs of faster aging represented a decline from initial childhood health. We then tested whether decline was attributable to tobacco smoking, antipsychotic medication use, debilitating illnesses in adulthood, adverse exposures in childhood (maltreatment, socioeconomic disadvantage) and adulthood (incarceration), and to childhood self-control difficulties. Study members with a history of antisocial behavior had a significantly faster pace of biological aging by midlife, and this was most evident among individuals following the LCP trajectory (β, .22, 95%CI, .14, .28, p.001). This amounted to 4.3 extra years of biological aging between ages 25-45 years for Study members following the LCP trajectory compared to low-antisocial trajectory individuals. LCP offenders also experienced more midlife difficulties with hearing (β, -.14, 95%CI, -.21, -.08, p.001), balance (β, -.13, 95%CI, -.18, -.06, p.001), gait speed (β, -.18, 95%CI, -.24, -.10, p.001), and cognitive functioning (β, -.25, 95%CI, -.31, -.18, p.001). Associations represented a decline from childhood health. Associations persisted after controlling individually for tobacco smoking, antipsychotic medication use, midlife illnesses, maltreatment, socioeconomic status, incarceration, and childhood self-control difficulties. However, the cumulative effect of these lifestyle characteristics together explained why LCP offenders have a faster Pace of Aging than their peers. While older adults typically age-out of crime, LCP offenders will likely age-into the healthcare system earlier than their chronologically same-aged peers. Preventing young people from offending is likely to have substantial benefits for health, and people engaging in a LCP trajectory of antisocial behaviors might be the most in need of health promotion programs. We offer prevention and intervention strategies to reduce the financial burden of offenders on health care systems and improve their wellbeing.

The standard care for metastatic breast cancer (MBC) is systemic therapies with imbrication of focal treatment for symptoms. Recently, thanks to implementation of radiological and metabolic exams and development of new target therapies, oligometastatic and oligoprogressive settings are even more common, paving the way to a paradigm change of focal treatments role. In fact, according to immunophenotype, radiotherapy can be considered with radical intent in these settings of patients. The aim of this literature review is to analyse available clinical data on prognosis of bone metastases from breast cancer and benefits of available treatments for developing a practical guide for clinicians.

Conceptual distance refers to the degree of proximity between two concepts within a conceptualization. It is closely linked with semantic similarity and relationship, but its computation relies entirely on the context of the given concepts. The DIS-C algorithm, which requires using search algorithms such as Breadth First Search, represents an advance in computing the semantic similarity/relation regardless of the type of knowledge structure and semantic relationships. The shortest path algorithm facilitates the determination of the semantic closeness between two indirectly connected concepts in an ontology by propagating local distances. This process is implemented for each concept pair to establish the most effective and efficient paths to connect these concepts. The algorithm identifies the shortest path between the concepts, allowing for the inference of the most relevant relationships between them. This approach contributes to developing a comprehensive understanding of the ontology and enhances the accuracy and precision of the semantic representation of the concepts. However, one of the critical issues is associated with the computational complexity due to the nature of the algorithm, which is errorn3. This paper studies alternatives to accelerate the DIS-C based on approximation and optimized algorithms, focusing on Dijkstra, pruned Dijkstra, and Sketched-based algorithms to compute conceptual distance. Based on the experiments, we discovered that the bottleneck can be avoided using the proposed 2-hop coverages, bringing DIS-C almost linearity.

With the wide application of flow sensor, their reliability under extreme conditions has been concerned in recent years. The reliability of a Micro Electro Mechanical Systems flow sensor under temperature (Ts) is researched in this paper. Firstly, the Step-stress accelerated degradation test is designed. Because this flow sensor consists flow sensor chip and signal processing system, the accelerated degradation testing is implemented, respectively. While the results show that the biggest drift is 3.15% for flow sensor chips with 150℃ conditions, and 32.91% for this flowmeter. By analysis, it could be found that the attenuation of the signal processing system is significant to the degeneration of this flowmeter. The minimum drift of the signal processing system accounts for 82.01% of this flowmeter. Secondly, using the Coffin-Manson model, the relationship between cycle-index and Ts is established. And the lifetime with different Ts is estimated by the Arrhenius model. In addition, the Weibull distribution is applied to evaluate the lifetime distribution. Finally, the reliability function of the Weibull distribution is demonstrated, and the survival rate within one year is 87.69% with 85℃ conditions. Thus, by the application of accelerated degradation testing, the acquired results are innovative and original. This research illustrates the reliability research, which provides a relational database for the application of this flow sensor.

Silicone RTV-based engineering rubber composite products have been widely used for several applications in various fields as a major component such as structure, automotive, and medical. In its application, the rubber composite product is placed in an open area that is directly exposed to sunlight and rain. It has a significant negative impact on changes in chemical and rheological properties, making the product life of rubber composite products shorter. Therefore, in this study, changes in the chemical and rheological properties of both isotropic and anisotropic magnetorheological elastomer (MRE) treated with accelerated weathering were studied compared to untreated specimens with specimens that had been treated. MRE specimens with 40% by weight CIP were prepared with no current excitation and another sample were made under 1.5 T of magnetic flux density. Each specimen was treated in an accelerated weathering machine Q-Sun Xe-1 Xenon Test Chamber with a UV light exposure cycle for 102 minutes and 18 minutes of UV light combined with water spray for 24 hours followed by a condensation cycle of 4 hours in a dark period. Material characterization was carried out using FTIR and Rheometer to determine the changes in chemical and rheological properties. The morphological analysis results showed that the surface was rough and more cavities occurred after being given weather treatment. Rheometer test results showed a decrease in storage modulus in each MRE specimen that had been treated compared to untreated MRE specimens. Meanwhile, FTIR testing showed a change in wave peak between untreated and treated MRE specimens.

The structural and strength analysis of the material used to construct such an important engine element as the turbine is of great significance, both at the design stage as well as during tests and expertises related to emergency situations. Bearing in mind the conditions above mentioned, the paper presents the results of research on the chemical composition, morphology and phased structure of the metallic construction material used to produce the blades of the high and low pressure turbine of the RD-33 jet engine, which is the propulsion unit of the MiG-29 aircraft. The data obtained as a result of the material tests of the blades allowed, on the basis of the analysis of chemical composition and phased structure, to determine the grade of the alloy used to construct the tested elements of the jet engine turbine. The structural stability of the material was found to be lower in comparison with engine operating conditions, which manifested itself as a clear decrease in the resistance properties of the blade material. The results obtained can be used as a basis for analyzing the life span of an object or a selection of material replacements, which enable to produce the analyzed engine element.

Background: Emerging data indicate that radiotherapy can modulate antitumour immune responses. Regulatory T cells (Tregs) are a key immunosuppressive subpopulation of interest. We aimed to evaluate the impact of conventional fractionated radiotherapy on circulating Treg levels in melanoma patients and to determine the correlation between these changes and survival. Understanding radiotherapy–immunity interactions may facilitate personalized combination therapies. Methods: Peripheral blood samples from 32 melanoma patients were analysed to quantify Tregs before and 1-3 months after regional lymph node radiotherapy using flow cytometry. Tregs were characterized as CD4+/CD25+/CD127-. Total CD4+ T cells were also evaluated. Changes were compared to those in a control group of 30 tumor-free patients. Overall survival was correlated with T-cell subset dynamics induced by radiotherapy. Results: At baseline, the median percentage of Tregs was not significantly lower in melanoma patients than in controls (7.4% vs 8.32%, p=0.17). Radiotherapy markedly increased the median Treg count to 10.01% (p=0.0008), with a concomitant increase in total CD4+ cells (to 11.71%, p=0.001), indicating systemic expansion. Patients exhibiting coordinated increases in Treg and CD4+ T cells after treatment had a significantly improved prognosis compared with nonresponders (median OS 27.8 vs 13.1 months, p=0.001). Conclusions: Our study demonstrated the significant effects of standard fractionated radiotherapy on systemic Treg levels in melanoma patients. Radiation-induced changes in T-cell subset proportions hold prognostic value. Monitoring of circulating lymphocyte subsets could facilitate personalized combination therapies.

The benefit of adjuvant radiotherapy (RT) after radical hysterectomy in patients with cervical cancer remains controversial. The aim of this study was to determine the impact on survival of adjuvant RT according to the Sedlis criteria. Patients with early-stage cervical cancer who underwent radical hysterectomy between 2005 and 2022 at a single tertiary institution were included. A multivariate analysis was performed to determinate if RT was an independent prognostic factor for recurrence or death. We also analyzed whether there was a statistically significant difference in overall survival (OS) between patients who met only one or two Sedlis criteria, depending on whether they received adjuvant RT or not. In this retrospective study 121 patients were included of whom 48(39.7%) received adjuvant RT due to the presence of unfavorable pathological findings. In multivariate analysis, RT was not found to be a statistically significant prognostic factor for OS (p=0.584) or disease-free survival (DFS) (p=0.559). When comparing patients who met one or two Sedlis criteria, there were no statistically significant differences in OS between RT and no adjuvant treatment in either group. Since the selection of patients with cervical cancer eligible for surgery is becoming more accurate, adjuvant RT might not be necessary for patients with intermediate-risk factors.

Introduction The outcome of radiotherapy (RT) for prostate cancer (PCA) depends on the delivered dose. While the evidence for dose-escalated RT up to 80 Gy is well established, there have been only few studies examining dose escalation above 80 Gy. We initiated the presented study to assess the safety of dose escalation up to 84 Gy. Patients and methods In our retrospective analysis, we included patients who received dose-escalated RT for PCA at our institution between 2016 and 2021. We evaluated acute genitourinary (GU) and gastrointestinal (GI) toxicity as well as late GU and GI toxicity. Results A total of 86 patients could be evaluated, of whom 24 patients had received 80 Gy and 62 patients had received 84 Gy (35 without pelvis- and 27 with pelvis-radiotherapy). Regarding acute toxicities, no adverse events > grade 2 occurred. 12.5% of patients treated with 80Gy, in 25.7% of patients treated with 84 Gy excluding pelvis, and in 51.9% of patients treated with 84Gy including pelvis suffered from Grade 2 GU acute toxicity (80 Gy versus 84 Gy: p=0.186; with pelvis versus without pelvis: p=0.032). Grade 2 GI toxicity occurred in 12.5% of patients irradiated with 80Gy, in 14.3% of patients treated with 84 Gy excluding pelvis, and in 12.9% of patients treated with 84Gy including pelvis (80 Gy versus 84 Gy: p=0.582; with pelvis versus without pelvis: p=0.510).GU late toxicity of grade ≥ 2 occurred in 4.2% of patients treated with 80 Gy, in 7.1% of patients treated with 84 Gy excluding pelvic RT, and in 18.2% of patients treated with 84 Gy including pelvic RT (logrank-test p=0.237). 8.3% of patients treated with 80 Gy, in 3.6% of patients treated with Gy excluding pelvic RT, and in 0% of patients treated with 84 Gy including pelvic RT suffered from GI late toxicity of grade ≥ 2(logrank-test p=0.358). Conclusion We were able to show that dose-escalated RT in PCA up to 84 Gy is feasible and safe without asubstantial increase in toxicity. Further follow up is needed to assess survival.

Glioblastoma (GBM), the most common and aggressive primary brain tumor in adults, remains one of the least treatable cancers. Current standard of care—combining surgical resection, radiation, and alkylating chemotherapy—results in a median survival of only 15 months. Despite decades of investment and research into the development of new therapies, most candidate anti-glioma compounds fail to translate into effective treatments in clinical trials. One key issue underlying this failure of therapies that work in pre-clinical models to generate meaningful improvement in human patients is the profound mismatch between drug discovery systems—cell cultures and mouse models—and the actual tumors they are supposed to imitate. Indeed, current strategies that evaluate the effects of novel treatments on GBM cells in vitro fail to account for a wide range of factors known to influence tumor growth. These include secreted factors, the brain’s unique extracellular matrix, circulatory structures, the presence of non-tumor brain cells, and nutrient sources available for tumor metabolism. While mouse models provide a more realistic testing ground for potential therapies, they still fail to account for the full complexity of tumor-microenvironment interactions, as well as the role of the immune system. Based on the limitations of current models, researchers have begun to develop and implement novel culture systems that better recapitulate the complex reality of brain tumors growing in situ. A rise in the use of patient derived cells, creative combinations of added growth factors and supplements, may provide a more effective proving ground for the development of novel therapies. This review will summarize and analyze these exciting developments in 3D culturing systems. Special attention will be paid to how they enhance the design and identification of compounds that increase the efficacy of radiotherapy, a bedrock of GBM treatment.

Tuberculosis (TB) caused by Mycobacterium tuberculosis remains a predominant cause of mortality, especially in low- and middle-income nations. Recently antimicrobial peptides were discovered that at low concentrations could stimulate the growth of M. tuberculosis (hormetic response). In this study, such a peptide was used to investigate the effects on the time to positivity (TTP). A systematic substitution analysis of peptide 14D was synthesized using Spot synthesis technology, resulting in 171 novel peptides. Our findings revealed a spectrum of interactions, with some peptides accelerating M. tuberculosis growth, potentially aiding in faster diagnostics, while others exhibited inhibitory effects. Notably, peptide NH2-wkivfiwrr-CONH2 significantly reduced the TTP by 25 hours compared to the wild-type peptide 14D, highlighting its potential in improving TB diagnostics by culture. Several peptides demonstrated potent antimycobacterial activity, with a minimum inhibitory concentration (MIC) of 20 µg/mL against H37Rv and a multidrug-resistant M. tuberculosis strain. Additionally, a reduction in the formation of cord-like structures was observed, which is indicative of reduced virulence and transmission potential. This study underscores the multifaceted roles of antimicrobial peptides in TB management, from enhancing diagnostic efficiency to offering therapeutic avenues against M. tuberculosis.

Radiotherapy is the primary treatment modality for non-metastatic nasopharyngeal carcinoma (NPC) across all TNM-stages. Locoregional control rates have been impressive even from the 2D-radiotherapy (RT) era, except when the ability to deliver optimal dose coverage to the tumor is compromised. However, short- and long-term complications following head and neck RT are potentially debilitating, and thus, there had been much research investigating technological advances in RT delivery over the past decades, with the primary goal of limiting normal tissue damage. On this note, with a plateau in gains of therapeutic ratio by modern RT techniques, future advances have to be focused on individualization of RT, both in terms of dose prescription and delineation of target volumes. In this review, we analyzed the guidelines and evidence related to contouring methods, and dose prescription for early and locoregionally-advanced (LA-) NPC. Next, with the preference for induction chemotherapy (IC) in patients with LA-NPC, we assessed the evidence concerning radiotherapy adaptations guided by IC response, as well as functional imaging and contour changes during treatment. Finally, we discussed on RT individualization that is guided by EBV DNA assessment, and its importance in the era of combinatorial immune checkpoint blockade therapy with RT.

Macrophages play a pivotal role in the process of healing burns. One of the major risks in the course of burns healing, in the absence of regenerating epidermis, is infections which greatly contribute to morbidity and mortality in such patients. Therefore, it is widely agreed that accelerating recruitment of macrophages into burns may contribute to faster regeneration of the epidermis and thus, decreasing the risk of infections. This review describes a unique method for rapid recruitment of macrophages into burns and activation of these macrophages to mediate accelerated regrowth of the epidermis and healing of burns. The method is based on application of bio-degradable “alpha-gal” nanoparticles to burns. These nanoparticles present multiple alpha-gal epitopes (Gal alpha1-3Gal beta1-4GlcNAc-R) which bind the abundant natural anti-Gal antibody that constitutes ~1% of immunoglobulins in humans. Anti-Gal/alpha-gal nanoparticles interaction activates the complement system, resulting in localized production of the complement cleavage-peptides C5a and C3a that are highly effective chemotactic factors for monocytes derived macrophages. The macrophages recruited into the alpha-gal nanoparticles treated burns are activated following interaction between the Fc portion of anti-Gal coating the nanoparticles and the multiple Fc receptors on macrophages cell membranes. The activated macrophages secrete a variety of cytokines/growth factors that accelerate the regrowth of the epidermis and regeneration of the injured skin, thereby cutting the healing time by half. Studies on healing of thermal injuries in the skin of anti-Gal producing mice, demonstrated a much faster recruitment of macrophages into burns treated with alpha-gal nanoparticles than in control burns treated with saline and healing of the burns within 6 days, whereas healing of control burns takes ~12 days. alpha-Gal nanoparticles are non-toxic, and do not cause chronic granulomas or keloids. These findings suggest that alpha-gal nanoparticles treatment may harness anti-Gal for inducing similar accelerated burn healing effects also in humans.

In light of the recent pandemic, several COVID-19 vaccines were developed, tested and approved in a very short time, a process that otherwise takes many years. Above all, these efforts have also unmistakably revealed the capacity limits and potential for improvement in vaccine production. This review aims to emphasize recent approaches for targeted rapid adaptation and production of vaccines from an interdisciplinary multifaceted perspective. Using literature research, stakeholder analysis and a value proposition canvas, we reviewed technological innovations on the pharmacological level, formulation, validation and resilient vaccine production to supply bottlenecks and logistic networks. We identified four main drivers to accelerate the vaccine product life cycle: computerized candidate screening, modular production, digitized quality management and a resilient business model with corresponding transparent supply chains. In summary, the results presented here can serve as a guide and implementation tool for flexible, scalable vaccine production to respond swiftly to pandemic situations in the future.

Evaluation of the effect of a high frequency acceleration device on clear aligner exchange intervals and treatment time required to achieve prescribed tooth movements. Sixteen subjects with similar Class I malocclusions, 5mm or less crowding, and treated with Invisalign were divided into two groups. Group 1 (experimental; N=8) underwent aligner treatment in conjunction with daily use of the high frequency acceleration device and exchanged aligners every 5 days. Group 2 (controls; N=8) underwent aligner treatment without use of the device and exchanged aligners every 14 days according to the manufacturer's recommended interval. All subjects were treated by one investigator, and results were evaluated by both; total number of aligners used, and number of refinements required, prior to final Vivera retention scan. A significant decrease in both treatment time, and number of aligners required to complete treatment was observed by experimental subjects as compared to controls. In addition, no refinements were required by experimental subjects, whereas 6 of 8 of the control subjects required 1 or more refinements. Use of the high frequency acceleration device in conjunction with Invisalign treatment resulted in more predictable tooth movement and a significant decrease in the length of treatment.

In this paper, a two-stage stochastic programming modelling is proposed to design a multi-period, multistage, and single-commodity integrated forward/reverse logistics network design problem under uncertainty. The problem involves both strategic and tactical decision levels. The first stage deals with strategic decisions, which are the number, capacity, and location of forward and reverse facilities. At the second stage tactical decisions such as base stock level as an inventory policy is determined. The generic introduced model consists of suppliers, manufactures, and distribution centers in forward logistic and collection centers, remanufactures, redistribution, and disposal centers in reverse logistic. The strength of proposed model is its applicability to various industries. The problem is formulated as a mixed-integer linear programming model and is solved by using Benders’ Decomposition (BD) approach. In order to accelerate the Benders’ decomposition, a number of valid inequalities are added to the master problem. The proposed accelerated BD is evaluated through small-, medium-, and large-sized test problems. Numerical results reveal that proposed solution algorithm increases convergence of lower bound and upper bound of BD and is able to reach an acceptable optimality gap in a convenient CPU time.

We hypothesise that anti-inflammatory macrolides can alleviate both the NLRP3 inflammasome activation and accelerated senescence in alveolar macrophages in COPD and/or response to cigarette smoke. Lung tissues from COPD patients and mice chronically exposed to cigarette smoke, cultures of human primary alveolar macrophages and macrophages derived from blood (MDM) or THP-1 monocytes were analysed for markers of macrophage NLRP3 inflammasome activation and accelerated senescence using multifluorescence quantitative confocal microscopy, Western blot, flow cytometry and histochemistry. Cultured macrophages were stimulated with 10% cigarette smoke extract (CSE), with or without presence of non-antibiotic macrolides 2'-desoxy-9-(S)-erythromycylamine and azithromycin-based 2'-desoxy molecule. Cigarette smoke and CSE induced in macrophages significant (p

Multifocal hepatic hemangiomas (MHHs) are the most common benign vascular tumours of the liver that are detected in children with concomitant multiple infantile hemangiomas. They still pose a diagnostic problem for GPs and are thus often detected far too late, due to their low prevalence rates. MHHs are usually undetectable at birth, usually detected within the first few weeks of life when the lesions proliferate. The heterogeneity of the lesions and the presence of comorbidities make often the management of infantile hepatic hemangiomas a true challenge, also for highly specialised medical professionals. Ultrasound (USG) should be the imaging examination performed in the first instance in search for vascular anomalies in children. In pharmacotherapy, the first choice treatment is propranolol and prednisone, administered orally. Invasive treatment is usually indicated in symptomatic or progressive multiple hepatic hemangiomas only. Recently published studies show a significant decrease in the incidence rate of the disease, which now ranges between 11% and 18% for treated and untreated hepatic hemangiomas, respectively.

In this work we introduce an end-to-end multi-modal neural network to segment the Gross Tumor Volume (GTV) from 3D-CBCT’s during radiotherapy. We improve the tumor segmentation by using a U-net which takes additional information such as the tumor mask generated at the planning phase along with the CBCT volume. The mask contains relevant information about the tumor’s location and can guide the model to use this knowledge appropriately to give a better prediction. This technique could become an alternative to produce segmentation masks of GTV in CBCT automatically during radiotherapy as in the traditional RT-pipeline, they are not segmented. We have evaluated our model on a dataset of 82 patients who have undergone radiotherapy. We compare the results of registered target volumes from planning CT as mask seed with 2 different types of multi-modal architectures. Our model shows a DSC of 0.706±0.002 with Late Fusion and 0.702±0.015 with Early Fusion using the GTV Mask. The performance of the two models on this mask is similar, so we perform further experiments with different types of masks which suggest that Late Fusion model produces a better segmentation of the tumor than the Early Fusion model. We also provide an ablation study consisting of a single modality U-net and a metric based on the Planning CT mask registration. It indicates a clear advantage of using our model to produce segmentation for this type of imaging.

Immunotherapy with stereotactic body radiotherapy (SBRT), low-dose antiangiogenics, immune adjuvants, nanomedicine, or other combinations will likely play a lead role in managing malignancies soon. Presently, its benefit extends to about 12% to 20% of patients, in the background of possible recurrence eventually and the toxicities, including in non-responders. Stereotactic body radiotherapy (SBRT) not only eliminates the indexed lesions, but recently, the evidence is accumulating about its systemic abscopal effects. It needs to be evolved to a dependable in situ therapeutic vaccine production and to activate short- and long-term memory immune lymphocytes. The in-situ immune cascade happens with the ability of SBRT to generate Tumor-specific neoantigens and neoepitopes, which enhance the activation of antigen-presenting cells, invoke and restore the competence of Tumor-infiltrating lymphocytes, resulting in cancer cell lysis. This cell lysis, in turn, can generate further neoantigens and epitopes, imparting a virtuous cycle that is the hallmark of effective vaccines. Additionally, SBRT can synergistically enhance the other in situ vaccination strategies, concurrent in vitro vaccines or nanomedicines, making it a primary tool for sensitizing even the “cold” tumors for immunotherapy. The present proposed hypotheses, primarily based on a preclinical literature review, focus on the critical aspects of the in-situ vaccination generation capability of SBRT when used in pulsed, cyclical, or intermittent endothelial-sparing single dose schedules along with immunotherapy and other supportive measures. This schedule is categorized as in situ vaccine dose (ISVD) radiotherapy (RT) (distinguishable from the standard therapeutic SBRT schedule) in metastatic cancer settings after standard /first-line therapies.

We examine here the discrepancy between the radiated power, calculated from the Poynting flux at infinity, and the power loss due to radiation reaction for an accelerated charge. It is emphasized that one needs to maintain a clear distinction between the electromagnetic power received by distant observers and the mechanical power loss undergone by the charge. In literature both quantities are treated as almost synonymous, the two in general could, however, be quite different. It is shown that in the case of a periodic motion, the two formulations do yield the power loss in a time averaged sense to be the same, even though, the instantaneous rates are quite different. It is demonstrated that the discordance between the two power formulas merely reflects the difference in the power going in self-fields of the charge between the retarded and present times. In particular, in the case of a uniformly accelerated charge, power going into the self-fields at the present time is equal to the power that was going into the self-fields at the retarded time plus the power going in acceleration fields, usually called radiation. From a comparison of the far fields with the instantaneous location of the uniformly accelerated charge, it is shown that all its fields, including the acceleration fields, remain around the charge and are not radiated away from it.

Background: CCL11 (eotaxin) is a chemokine with an important role in allergic conditions. Recent evidence indicates that CCL11 plays a role in brain disorders as well. Aims: This paper reviews the associations between CCL11 and aging, neurodegenerative, neuroinflammatory and neuropsychiatric disorders.Methods: Electronic databases were searched for original articles examining CCL11 in neuropsychiatric disorders.Results: CCL11 is rapidly transported from the blood to the brain through the brain-blood barrier. Age-related increases in CCL11 are associated with cognitive impairments in executive functions, episodic and semantic memory and, therefore, this chemokine was described as an “endogenous cognition deteriorating chemokine” (ECDC) or “accelerated brain-aging chemokine” (ABAC). In schizophrenia, increased CCL11 is not only associated with impairments in cognitive functions, but also with key symptoms including formal thought disorders. Some patients with mood disorders and premenstrual syndrome show increased plasma CCL11 levels. In diseases of old age, CCL11 is associated with lowered neurogenesis and neurodegenerative processes and, as a consequence, increased CCL11 increases risk towards Alzheimer's Disease. Polymorphisms in the CCL11 gene are associated with stroke. Increased CCL11 also plays a role in neuroinflammatory disease including multiple sclerosis. In animal models, neutralization of CCL11 may protect against nigrostriatal neurodegeneration. Increased production of CCL11 may be attenuated by glucocorticoids, minocycline, resveratrol and anti-CCL11 antibodies.Conclusion: Increased CCL11 production during inflammatory conditions may play a role in human disease including age-related cognitive decline, schizophrenia, mood disorders and neurodegenerative disorders. Increased CCL11 production is a new drug target in the treatment and prevention of those disorders.

Cognitive and behavioural disturbances are growing public healthcare issue for the modern society, as stressful lifestyle is becoming more and more common. Besides, several pieces of evidence state that environment is crucial in the development of several diseases as well as compromising healthy aging. Therefore, it is important to study the effects of stress on cognition and its relationship with aging. To address these queries, Chronic Mild Stress (CMS) paradigm was used in the senescence-accelerated mouse prone 8 (SAMP8) and resistant 1 (SAMR1). On one hand, we determined the changes produced in the three main epigenetic marks after 4 weeks of CMS treatment, such as a reduction in histone posttranslational modifications and DNA methylation, and up-regulation or down-regulation of several miRNA involved in different cellular processes in mice. In addition, CMS treatment induced reactive oxygen species (ROS) accumulation and loss of antioxidant defence mechanisms, as well as inflammatory signalling activation through NF-κB pathway and astrogliosis markers, like Gfap. Remarkably, CMS altered mTORC1 signalling in both strains, decreasing autophagy only in SAMR1 mice. We found a decrease in glycogen synthase kinase 3 β (GSK-3β) inactivation, hyperphosphorylation of Tau and an increase in sAPPβ protein levels in mice under CMS. Moreover, reduction in the non-amyloidogenic secretase ADAM10 protein levels was found in SAMR1 CMS group. Consequently, detrimental effects on behaviour and cognitive performance were detected in CMS treated mice, affecting mainly SAMR1 mice, promoting a turning to SAMP8 phenotype. In conclusion, CMS is a feasible intervention to understand the influence of stress on epigenetic mechanisms underlying cognition and accelerating senescence.

Physicians often label anatomical structure sets in Digital Imaging and Communications in Medicine (DICOM) images with nonstandard names. As these names vary widely, the standardization of the nonstandard names in the Organs at Risk (OARs), Planning Target Volumes (PTVs), and 'Other' organs inside the area of interest is a vital problem. Prior works considered traditional machine learning approaches on structure sets with moderate success. This paper presents integrated deep learning methods applied to structure sets by integrating the multimodal data compiled from the radiotherapy centers administered by the US Veterans Health Administration (VHA) and the Department of Radiation Oncology at Virginia Commonwealth University (VCU). The de-identified radiation oncology data collected from VHA and VCU radiotherapy centers have 16,290 prostate structures. Our method integrates the heterogeneous (textual and imaging) multimodal data with Convolutional Neural Network (CNN)-based deep learning approaches like CNN, Visual Geometry Group (VGG) network, and Residual Network (ResNet). Our model presents improved results in prostate (RT) structure name standardization. Evaluation of our methods with macro-averaged F1 Score shows that our deep learning model with single-modal textual data usually performs better than the previous studies. We also experimented with various combinations of multimodal data (masked images, masked dose) besides textual data. The models perform well on the textual data alone, while the addition of imaging data shows that deep neural networks can achieve improved performance using information present in the other modalities. Additionally, using masked images and masked doses along with text leads to an overall performance improvement with the various CNN-based architectures than using all the modalities together. Undersampling the majority class leads to further performance enhancement. The VGG network on the masked image-dose data combined with CNNs on the text data performs the best and establishes the state-of-the-art in this domain.

Background: We aimed to assess the risk of chemotherapy- and radiotherapy-related cognitive impairment in colorectal cancer patients. Methods: We randomly selected 40% of colorectal cancer patients from Korean National Health Insurance Database (NHID), 2004-2018 (N=148,848). Patients with one or more ICD-10 diagnostic codes for dementia or mild cognitive impairment was defined as cognitive impairment cases. Patients who were aged 18 or younger, diagnosed with cognitive impairment before colorectal cancer (N=8,225) and did not receive primary resection (N=45,320) were excluded. The effects of each chemotherapy agent on cognitive impairment were estimated. We additionally estimated the effect of radiotherapy in rectal cancer patients. Time-dependent competing risk Cox regression was conducted to estimate overall and age-specific hazard ratios (HR) separately for colon and rectal cancer. Results: In colon cancer, capecitabine and irinotecan was associated with higher cognitive im-pairment, while 5-fluorouracil was not. In rectal cancer, no chemotherapy agents increased the risk of cognitive impairment, nor did radiotherapy. Hazardous association of irinotecan was estimated larger in elderly patients compared with younger counterparts. Conclusion: Heterogeneous associations between various chemotherapy agents and cognitive impairment were observed. Elderly patients were more vulnerable to possible adverse cognitive effects. Radiotherapy did not increase the risk of cognitive impairment.

Background: Radiotherapy plays an important role in the management and survival of patients with breast cancer. The aim of this study was to examine the association between age, comorbidities and use of radiotherapy in this population. Methods: Patients diagnosed with breast cancer from 2004–2013 were identified from the American College of Surgeons National Cancer Database (NCDB). Follow-up time was measured from the date of diagnosis (baseline) to the date of death or censoring. Adjusted hazard ratios (aHR) and 95% confidence intervals (95%CI) were used as the measure of association. Results: Independently of comorbidities and other important outcome-related factors, patients >65 years of age who received radiotherapy survived significantly longer than those who did not receive radiotherapy (aHR = 0.53, 95%CI = 0.52–0.54). However, as women aged, those with comorbidities were less likely to receive RT (adjusted P-trend by age <0.0001). Conclusions: The development of decision-making tools to assist clinicians, and older women with breast cancer and comorbidities, are needed to facilitate personalized treatment plans regarding RT. This is particularly relevant as the population ages and the number of women with breast cancer is expected to increase in the near future.

Ship wave is of great interest for wave drag, coastal erosion and ship detection. In this paper, a highly-paralleled numerical scheme is proposed for simulating three-dimensional (3-D) nonlinear Kelvin ship waves effectively. First, a numerical model for nonlinear ship waves is established based on potential flow theory, boundary integral method and Jacobian-free Newton-Krylov (JFNK) method. In order to improve computational efficiency and reduce data storage of JFNK method, a banded preconditioner method is then developed by formulating the optimal bandwidth selection rule. After that, a Graphics Process Unit (GPU) based parallel computing framework is designed, and a GPU solver is developed by using Compute Unified Device Architecture (CUDA) language. Finally, numerical simulations of 3-D nonlinear ship waves under multiple scales are performed by using the GPU and CPU solvers. Simulation results show that the proposed GPU solver is more efficient than the CPU solver with the same accuracy. More than 66% GPU memory can be saved and the computational speed can be accelerated up to 20 times. Hence, the computation time for Kelvin ship waves simulation can be significantly reduced by applying the GPU parallel numerical scheme, which lays a solid foundation for practical ocean engineering.

Analysis of 1382 measures of battery State of Health (SoH) from 283 Nissan Leafs (“Leaf/s”), manufactured between 2011 and 2017, has detected a faster rate of decline in this measure of energy-holding capacity for 30 kWh variants. At two years of age, the mean rate of decline of SoH of 30 kWh Leafs was 9.9% per annum (95% uncertainty interval of 8.7% to 11.1%; n = 82). This was around three times the rate of decline of 24 kWh Leafs which at two years averaged 3.1% per annum (95% uncertainty interval of 2.9% to 3.3%; n = 201). For both variants there was evidence for an increasing rate of decline as they aged, although this was much more pronounced in the 30 kWh Leafs. Higher use of rapid DC charging was associated with a small decrease in SoH. Additionally, while 24 kWh cars with greater distances travelled showed a higher SoH, in 30 kWh cars there was a reduction in SoH observed in cars that had travelled further. The 30 kWh Leafs sourced from United Kingdom showed slower initial decline than those from Japan, but the rate of decline was similar at two years of age. Improvements in the battery health diagnostics, continuous monitoring of battery temperatures and state of charge, and verification of a fundamental model of battery health are needed before causes and remedies for the observed decline can be pinpointed. If the high rate of decline in battery capacity that we observed in the first 2.3 years of a 30 kWh Leaf’s lifetime were to continue, the financial and environmental benefits of this model may be significantly eroded. Despite 30 kWh Leafs accounting for only 14% of all light battery electric vehicles registered for use on New Zealand roads at the end of February 2018, there is also the potential for the relatively poor performance of this specific model to undermine electric vehicle uptake more generally unless remedies can be found.

Image-guided radiotherapy supported by surface guidance can help track lower lung lesion respiratory motion while reducing a patient’s exposure to ionizing radiation. However, it is not always clear how skin respiratory motion magnitudes and correlations with lung lesion respiratory motion vary between different skin regions of interest (ROI). Four-dimensional Computed Tomography (4DCT) images provide information on both skin and lung respiratory motion and are routinely acquired for the purpose of treatment planning in our institution. Analysis of 4DCT images for 57 patients treated in our institution has been conducted to provide information on respiratory motion magnitudes of nine skin ROIs of the torso, a tracking structure (TS) representing lower lung lobe lesion, as well as respiratory motion correlations between nine ROIs and TS. The effects of gender and adipose tissue volume and distribution on these correlations and magnitudes have been analyzed. Significant differences between ROIs in both respiratory motion magnitudes and correlations to TS have been detected. An overall negative correlation between ROI respiratory magnitudes and the adipose tissue has been detected for ROIs with rib cage support. A weak to moderate negative correlation between adipose tissue volume and ROI-to-TS respiratory correlations has been detected for upper thorax ROIs. Respiratory magnitudes in regions without rib support tended to be larger for men than for women, but no differences in ROI-to-TS correlation between sexes have been detected. Described findings should be considered when choosing skin surrogates for lower lung lesion motion management.

Backround: The purpose of this study was to evaluate the outcomes of different radiotherapy techniques used in routine clinical practice for the radical treatment of hypopharyngeal cancer and to assess improvements over the last few decades. Methods: We compared the outcomes of patients with hypopharyngeal squamous cell carcinoma treated with curative radiotherapy (RT) or chemoradiotherapy between January 1992 and December 2020, using 2D-RT, 3D-CRT/IMRT, and VMAT techniques. A retrospective analysis was conducted on eighty-one patients with hypopharyngeal cancer. Results: The median follow-up time was 26 months (range: 6-290). In multivariate analysis, radiotherapy technique, Karnofsky Performance Status (KPS), nodal stage, and clinical stage were identified as statistically significant factors affecting overall survival and local-regional relapse-free survival. Grade 2-4 early and late side effects were significantly more frequent in Group I patients (treated with 2D Conventional Radiotherapy) (20.3%) compared to Group II patients (treated with 3DCRT/IMRT and VMAT techniques) (3.1%) Conclusion: KPS, stage, and advanced RT techniques independently significantly affected outcomes. Moreover, advanced RT techniques were associated with a significant reduction in side effects.

Radiotherapy for cancer has been known to affect the responses of immune cells, especially those of CD8+ T cells that play a pivotal role in anti-tumor immunity. Clinical success of immune checkpoint inhibitors led to an increasing interest into the ability of radiation to modulate CD8+ T cell responses. Recent studies that carefully analyzed the CD8+ T cell responses following radiotherapy suggest the beneficial roles of radiotherapy on anti-tumor immunity. In addition, numerous clinical trials that evaluate the efficacy of combining radiotherapy with immune checkpoint inhibitors are undergoing. In this review, we summarize the current status of knowledge regarding the changes of CD8+ T cells following radiotherapy from various preclinical and clinical studies. Furthermore, key biologic mechanisms that underlie such modulation, including both direct and indirect effects, are described. Lastly, we discuss the current evidence and essential considerations for harnessing radiotherapy as a combination partner for immune checkpoint inhibitors.

As businesses increasingly adopt advanced technologies to enhance productivity and safety, the integration of human-robot collaboration (HRC) emerges as a transformative approach. This paper explores the role of GPU-accelerated computer vision and generative AI in optimizing HRC within business environments. By leveraging the computational power of GPUs, real-time data processing, and advanced machine learning algorithms, robots can better interpret complex visual cues and adapt to dynamic workspaces. Generative AI further enables the design of intelligent robotic systems capable of anticipating human actions, optimizing task allocation, and ensuring safety through predictive modeling. This research highlights the potential of these technologies to improve operational efficiency, reduce human error, and create safer, more adaptable workplaces. The implications of such advancements are discussed, providing insights into the future of HRC in various industries.

There is a need to find innovative learning methods that enable accelerated learning of ‎a foreign language. This study examined the effect of computer-assisted language ‎learning (CALL) in acquiring a foreign language, which combines cognitive and ‎emotional stimuli in the background. ‎ The study explored two factors related to the acquisition of a foreign language: the ‎duration and scope of the learning process and the depth of internalization of the newly ‎acquired language. Another objective was to assess the learning method in two ‎learning environments, a multimedia setting and a virtual reality headset (VRH), to ‎determine if the learning environment affects the learning results and leads to better ‎vocabulary retention. ‎ One hundred native French speakers, with an average age of 47.5, participated in the ‎study and had no prior knowledge of a new native language. We randomly divided the ‎participants into two groups (multimedia and VRH). They studied 550 words in a new ‎native language for five days: 30 minutes each evening and 15 minutes in the morning.‎ The post-learning test pointed out that both groups improved their vocabulary scores ‎significantly. Approximately one month after the learning experience, we administered ‎a knowledge retention test to 32 participants and found that the level of knowledge had ‎been retained. Finally, background variables (e.g., gender, age, previous knowledge of ‎the new native language) did not affect the learning results. ‎ The findings indicate that CALL, which integrates background cognitive and ‎emotional stimuli in both learning environments, significantly accelerates learning ‎pace, broadens the scope of newly acquired words, and ensures retention. The level of ‎improvement observed in our study is notably higher than reported in the literature ‎that had previously evaluated CALL and in-class language acquisition.

We performed electronic research for articles published in PubMed, MEDLINE, and ScienceDirect databases from January 2004 to January 2023. The systematic review of twenty (20) peer-reviewed articles about dosimetric parameters and eight (8) articles about clinical outcomes confirmed the dosimetric advantages of ART through better target coverage and Organs at Risk (OARs) sparing, with subsequent benefits on decreased toxicity and improved clinical outcome, specifically local control of the disease. ART replanning is a sustainable strategy for minimizing toxicity by improving normal tissue sparing. Furthermore, it enhances target volume coverage by correctly determining the specific amount of dose to be delivered to the tumor. In conclusion, this review confirms that ART benefits dosimetric, clinical/therapeutic, and toxicity outcomes.

A reliable and practical renal-lipid quantification and imaging method is needed. Here, the feasibility of an accelerated MRSI method to map renal fat fractions (FF) at 3T and its repeatability were investigated. A 2D density-weighted concentric-ring-trajectory MRSI was used to accelerate acquiring 48×48 voxels (each of 0.25 ml spatial-resolution) without respiratory navigation implementations. The data was collected over 512 complex-FID timepoints with a 1250 Hz spectral bandwidth. The MRSI sequence was designed with a metabolite-cycling technique for lipid-water separation. The in vivo repeatability performance of the sequence was assessed by conducting a test-reposition-retest study within healthy subjects. The coefficient of variation (CV) in the estimated FF from the test-retest measurements showed a high degree of repeatability of the MRSI-FF (CV= 4.3 ±2.5%). Additionally, the matching level of spectral signature within the same anatomical region was also investigated, and their intrasubject repeatability was also high, with a small standard deviation (8.1 ±6.4%). The MRSI acquisition duration was ~3 minutes only. The proposed MRSI technique can be a reliable technique to quantify and map renal metabolites within a clinically acceptable scan time at 3T that supports the future application of this technique for the non-invasive characterization of heterogeneous renal diseases and tumors.

Computational studies suggest that hesperidin, a flavonoid abundant in citrus peel, binding the three main cellular receptors of SARS-CoV-2 virus can act in the prophylaxis and treatment of COVID-19. Herein we urge the uptake of hydrodynamic cavitation industrial-scale reactors based on the low cost, reliable Venturi tube for the extraction of citrus pectin rich in hesperidin (and in other bioflavonoids including naringing) by very fast processing of waste orange peel or waste lemon peel in water only. A device able to process up to 500 kg of waste peels per session, similar to the one lately deployed in Italy for hydrodynamic cavitation-assisted brewing, is capable to provide 36,000 doses of 1000 mg hesperidin per day.

More than 50% of patients with non-small cell lung cancer (NSCLC) are treated with radiotherapy (RT) during different phases of treatment. However, radiation pneu-monitis (RP) and resistance often lead to RT failure in NSCLC patients. JWA, a tumor suppressor gene, is known to enhance DNA damage in gastric cancer cells while protect normal cells from DNA damage induced by cisplatin. Recently, we have re-ported that JWA agonist compound 4 (JAC4) effectively protects intestinal epithelium from RT triggered damage in mice. However, the potential synergistic and attenuated effects of JAC4 in chest RT of lung cancer are not been illuminated. The aim of this study was to investigate the effects of JAC4 on the radiotoxicities of both NSCLC and normal lung tissue. CCK-8 and colony formation assays showed that JAC4 played a bidirectional role in radiation-treated SPCA-1 and BEAS-2B cells. Western blotting and immunofluorescence assays showed that JAC4 in combination with RT increased DNA damage and apoptosis in SPCA-1 cells, while the opposite effect was observed in BEAS-2B cells. Mechanistically, JAC4 inhibited homologous recombination repair (HR) and non-homologous end joining (NHEJ) in SPCA-1 cells, but not in normal cells. JAC4 increased antioxidant capacity, and reduced oxidative stress and inhibited nu-clear factor Kappa-B (NF-κB, P65) translocation to the nucleus in BEAS-2B cells. Im-portantly, the bidirectional roles of JAC4 on RT were reversed by siJWA in both SPCA-1 and BEAS-2B cells. Finally, the bidirectional effects of JAC4 in combination with RT were further validated in NSCLC xenograft model mice. In conclusion, JAC4 enhanced effect of RT on tumor growth while alleviated RP and lung injury. Our re-sults may provide new strategy for optimizing RT regimen for NSCLC.

Background: Approximately 75% of all head and neck cancer patients are treated with radiotherapy (RT). RT to the oral cavity results in acute and late adverse events which can be severe and detrimental to a patient’s quality of life and function. The purpose of this study was to explore associations between RT dose to a defined oral cavity organ at risk (OAR) avoidance structure, provider and patient reported outcomes (PROs), opioid use, and hospitalization. Methods: This was a retrospective analysis of prospectively obtained outcomes using multivariable modeling. The study included 196 patients treated with RT involving the oral cavity for a head and neck tumor. A defined oral cavity OAR avoidance structure was used in all patients for RT treatment planning. Validated PROs were collected prospectively. Opioid use and hospitalization were abstracted electronically from medical records. Results: Multivariable modeling revealed the mean dose to the oral cavity OAR was significantly associated with opioid use (p=0.0082) and hospitalization (p=0.0356) during and within 30 days of completing RT. Conclusion: The findings of this study may be valuable in RT treatment planning for patients with tumors of the head and neck region to reduce the need for opioid use and hospitalization during treatment.

Failures in hydraulic systems in offshore wind turbines represent an enormous challenge for manufacturers and operators, as the pitch system statistically is one of the subsystems contributing the most to the downtime of the turbines, which is the case for both electrical and hydraulic pitch systems. However, the complex failure mechanisms of the various different hydraulic components mean that, typically, the critical components of hydraulic systems must be tested to better understand the failure mechanisms. Nonetheless, conventional testing procedures are lengthy and costly. Accelerated testing plays a critical role as it can mimic hydraulic system failure mechanisms in a shorter period. However, the lack of standardized test methods and detailed knowledge about the failure-accelerating effects complicates the process. Therefore, this paper offers a comprehensive examination of approaches applicable to conducting accelerated tests on hydraulic systems. It identifies and discusses five primary component types or sub-components related to the acceleration of testing in hydraulic systems being: pumps, cylinders, seals, valves, and hoses. Each section references studies that delve into accelerated testing methodologies for these individual components. Furthermore, within each component, a concise overview of the current techniques is provided, followed by a discussion and summary based on the state of the art.

Modern power system integrates more and more new energy and use a large number of power electronic equipment. This makes it face more challenges in online optimization and real-time control. Deep reinforcement learning(DRL) has the ability of processing big data and high-dimensional features, as well as the ability of independently learning and optimizing decision-making in complex environments. In this paper, we explore DRL based online combination optimization method of grid section for large complex power system. In our method, to improve the convergence speed of the model, we propose to discretize the output action of the unit and simplify the action space. We also design a reinforcement learning loss function with strong constraints to further improve the convergence speed of the model and facilitate the algorithm to obtain the stable solution. Moreover, to avoid the local optimal solution problem caused by the discretization of the output action, we propose to use the annealing optimization algorithm to make the granularity of the unit output finer. We verify our method on IEEE 118-bus system. The experimental results show that our model has fast convergence speed and better performance, and can obtain stable solutions.

Using a joint statistical analysis, we test a five-dimensional embedded model based on the Nash-Greene embedding theorem at late-time transition redshift. Performing a Markov Chain Monte Carlo (MCMC) modelling, we combine observational data sets as those of the recent Pantheon type Ia supernovae, Baryon Acoustic Oscillations (BAO) and the angular acoustic scale of the Cosmic Microwave Background (CMB) to impose restrictions on the model and correlating the model parameters to mimicking an equation of state. From statistical classifiers as the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC), we use the Jeffreys' scale and find a strong evidence favoring a statistically consistence a dynamical Dark energy (CPL parameterization) and a relative consistence with the $\Lambda$CDM model and $w$CDM model. Moreover, we find that the transition redshift used as a cosmic discriminator with the best fit $z_t=1.53\pm 0.17$ at 1-$\sigma$ C.L. with a range scenario for sharp late transitions.

In Chronic Myeloid Leukemia (CML) patients, CD34+/CD38-/CD26+ cell population represents a “CML specific” Leukemia Stem Cell (LSC) compartment. Indeed, preliminary studies showed that the expression of CD26 discriminates bone marrow CML Leukemic Stem Cells (LSCs) from nor-mal Hematopoietic Stem Cells (HSCs) or from LSCs of other myeloid neoplasms. We were first to demonstrate that at diagnosis CD34+/CD38-/CD26+ cells are easily measurable also in Peripheral Blood (PB) and that residual circulating CD26+LSCs persist, with a fluctuating trend, in most pa-tients in optimal response during treatment with Tyrosine Kinase Inhibitors (TKIs) and even after successful TKI discontinuation. These data corroborate and confirm the possibility of using flow-cytometry CD26+ evaluation as an important diagnostic tool that, combined with molecular biology and cytogenetic, could provide a rapid diagnosis of Chronic Phase (CP) CML starting from a simple PB sample. Yet, few data are available regarding the behavior of CD26+LSCs during Accelerated Phase (AP) or Blast Phase (BP) CML and the role, if any, this peculiar staminal cell compartment may play in disease progression. In the present study we compared the presence and phenotypic characteristics of circulating CD26+LSCs in CP CML patients at diagnosis, during AP and in cases of progression to lymphoid BP, inquiring a possible role of these cells during dis-ease evolution.

Accelerated degradation tests (ADT) are widely used in the manufacturing industry to obtain information on the reliability of components and materials, through degrading the lifespan of the product by applying an acceleration factor which causes damage to the material. The main objective is to obtain fast information which is modeled to estimate the characteristics of the material life under normal conditions of use and to save time and expenses. The purpose of this work is to estimate the lifespan distribution of gold nanoparticles stabilized with lipoic acid (GNPs@LA) through accelerated degradation tests applying sodium chloride (NaCl) as an acceleration factor. For this, the synthesis of GNPs@LA was carried out, a constant stress ADT (CSADT) was applied, and the non-linear Wiener process was proposed with random effects, error measures and different covariability for the adjustment of the degradation signals. The information obtained with the test and analysis allows us to obtain the life distribution in GNPs@LA, the results make possible to determine the guaranteed time for a possible commercialization and successful application based on the stability of the material. In addition, for the evaluation and selection of the model, the Akaike and Bootstraping criteria were used.

The incidence and mortality of cervical cancer are high in Romania compared to other European countries, particularly for locally advanced cervical cancer cases, which are predominant at the time of diagnosis. Widely accepted therapeutic guidelines indicate that the treatment for locally advanced cervical cancer consists of concurrent chemoradiotherapy (total dose 85-90Gy at point A), with surgery not being necessary as it does not lead to improved survival and results in significant additional morbidity. In Romania, the treatment for locally advanced cervical cancer differs, involving lower-dose chemotherapy (total dose 60-65Gy at point A), followed by surgery which, under these circumstances, ensures better local control. In this regard, we attempted to evaluate the role and necessity of surgery in Romania, considering that in our study, residual lesions were found in 55.84% of cases on resected specimens, especially in cases with unfavorable histology (adenocarcinoma and adenosquamous carcinoma). This type of surgery was associated with significant morbidity (28.22%) in our study. The recurrence rate was 24.21% for operated patients compared to 62% for non-operated patients receiving suboptimal concurrent chemotherapy alone. In conclusion, In Romania, surgery will continue to play a predominant role until radiotherapy achieves the desired effectiveness for local control.

Radiotherapy, also known as radiation therapy, is a treatment modality based on the use of high energy rays or radioactive substances, to damage tumoral cells and halt their growth and division. It is an effective tool for treating cancer of different kinds for more than 100 years with remarkable outcomes for cancer patients. This technique is characterised by notable technological innovations and methodologies, enhanced precision and effectiveness. Initially, precision and efficacy of radiotherapy are improved by technological advancements, such as the development of linear accelerators and brachytherapy. As a result, Radiotherapy has transformed the prognosis for cancer patients enhancing survival rates and improving quality of life. Also, it offers targeted and personalized treatment with advancements in imaging techniques such as Intensity-Modulated Radiation Therapy (IMRT) and Stereotactic Body Radiation Therapy (SBRT) and innovations like Image-Guided Radiation Therapy (IGRT), Adaptive Radiotherapy (ART) and Artificial Intelligence (AI). Additionally, techniques like proton therapy result in reduced side effects and collateral damage. Although, among the challenges and future perspectives we note the issue of affordability and accessibility. Ongoing research into immunotherapy and nanotechnology and their synergy with radiation therapy shows potential for further improving treatment outcomes. In conclusion, the evolution of radiotherapy has been a transformative journey, reshaping the prognosis and outcomes for cancer patients.

Aims. Bone metastases have an incidence of up to 75% in metastatic breast cancer, thanks to the evolution of imaging we can identify them in the oligometastatic phase. With the introduction of target therapies and increasingly effective conjugated antibodies, it is increasingly common to treat patients with radiotherapy although asymptomatic (if single or ≤5 bone lesions). Volumes and doses in this setting do not yet have a clear guidelines. In this study, the aim is to administer to the macroscopically evident disease an ablative dose that favors the local control of disease. Aim of this retrospective analysis is to evaluate the outcome of pts receiving SIB for treatment of bone metastases. Material and Methods. A retrospective analysis including mBC patients (pts) undergone RT on bone metastases was conducted for pts treated between January 2014 and January 2022. Primary endpoint was freedom from local progression (FFLP). Rate of disease progression after radiotherapy (DP-AR) and overall survival (OS) were secondary endpoints. Subgroup analysis (age, immunophenotype, line of therapy) were performed. Results. Among 954 mBC who underwent radiotherapy for metastases, 85 pts underwent SIB-IMRT with a boost on macroscopic lesion of 8-6 Gy in 5 fr. Mean follow up was 41 months (6-61.5 m). Nineteen pts had single bone metastase (22.4%), 20 pts were oligometastatic (23,5%), 46 pts were plurimetastatic (54,1%). FFLP was 17 months (95% CI 3.2-61.5 m). Only 6 pts (7%) had local relapse on SIB-IMRT site during follow up. DP-AR was 13,2 m (95% CI 3.1-56.9 m). OS was 82,7 m (95% CI 10.6-343 m). Local-relapse was not associated with age, immunophenotype or sistemic line ongoing. Among secondary outcomes, DP-AR resulted associated to immunophenotype (p 0.002). DP-AR and OS were not significantly associated with local relapse (respectively p 0.148 and p 0.4). Conclusions. Pts with breast tumor can be treated with SIB-IMRT on bone metastases with a 93% of local control at 17 months from radiotherapy. Further data are needed to individuate pts who can benefit of dose-escalation and also sinergic effect with systemic therapies to possibly increase DP-AR.

Up to now in breast cancer (BC) treatment, adjuvant chemotherapy (A-CT) precedes adjuvant radiotherapy (A-RT). It’s beyond question that A-RT improves local control while A-CT improves the Disease Free Survival (DFS) due to the reduction of metastatic distant recurrences. Taken togheter these two approaches impact favourably on the reduction of breast cancer mortality. In the last twenty years, the adjuvant treatment of BC has evolved quickly due to a better knowledge of its molecular biology , genetic prohile and its α/β ratio 3 / 4 Gy for the tumor and normal tissues radiosensitivity. Thus new schedules with hypofractionated radiotherapy have been tested and third generation of A-CT have been introduced leading to a better survival rate but a further delay in A-RT starting, raising the question to rethink the sequencing between these two approaches. However the sequencing timing between these two approaches still remains unchanged with A-CT before A-RT as the standard of care. Many attempts have been provided in order to optimize this sequencing. This comprehensive review is a journey among randomised, retrospective and prospective studies which highlights the past, the current and the novelties on timing sequencing proposals between these two modalities to assess the state of art. Sequential, concomitant and sandwitch modalities of chemotherapy with conventional or hypofractionated RT schedules from the most important studies will be analysed in this review.

Osteopontin (OPN)-CD44 signaling plays an important role in promoting tumor progression and metastasis. In cancer, OPN and CD44 overexpression is a marker of aggressive disease and poor prognosis, and correlates with therapy resistance. In this study, we aimed to evaluate the association of single nucleotide polymorphisms (SNPs) in the OPN and CD44 genes with clinical outcomes in 307 non-small cell lung cancer (NSCLC) patients treated with radiotherapy or chemoradiotherapy. The potential impact of the variants on plasma OPN levels was also inves-tigated. Multivariate analysis showed that OPN rs11730582 CC carriers had a significantly in-creased risk of death (p = 0.029), while the CD44 rs187116 A allele correlated with reduced risk of locoregional recurrence (p = 0.016) in the curative treatment subset. The rs11730582/rs187116 combination was associated with an elevated risk of metastasis in these patients (p = 0.016). Fur-thermore, the OPN rs1126772 G variant alone (p = 0.018) and in combination with rs11730582 CC (p = 7x10-5) was associated with poor OS in the squamous cell carcinoma subgroup. The rs11730582 CC, rs187116 GG and rs1126772 G, as well as their respective combinations, were in-dependent risk factors for unfavorable treatment outcomes. The impact of rs11730582-rs1126772 haplotypes on OS was also observed. These data suggest that OPN and CD44 germline variants may predict treatment effects in NSCLC.

Cytokines are mediators of inflammation that could lead to fibrosis. The aim was to monitor cytokine levels in saliva and serum after locally fractionated radiotherapy of the head and neck in mice and investigate associations with salivary gland fibrosis and hyposalivation. C57BL/6 mice were randomized to sham or X-ray irradiation of 66 Gy in 10 fractions over 5 days. Blood and saliva were collected on day -7, 5, 35, 80 and 105 with following cytokine analysis. The harvested submandibular salivary gland was assessed for presence of fibrosis. Decision tree regression analysis was used to investigate whether cytokine levels could predict late endpoints in terms of hyposalivation or fibrosis. Significant formation of fibrosis in gland tissue and reduced saliva production was found after irradiation. The pro-inflammatory cytokines IL-1α, TNF, TIMP1, G-CSF, KC and MIP-1α showed increased levels in saliva in irradiated mice and strong correlation with late endpoints. The decision tree analysis largely separated controls from irradiated animals with IL-1α being the strongest predictor. Pro-inflammatory cytokines in saliva, but not in serum, were associated with late endpoints. This indicates that cytokine expression in saliva is a good biomarker for local salivary gland damage with IL-1α as the strongest single predictor.

Berberis vulgaris L. (Berberidaceae) is a shrub that has been widely used in European folk medicine as an anti-inflammatory and antimicrobial agent. The purpose of our study was to elucidate the mechanisms of antiproliferative action of the plant’s methanolic root extract (BVR) against colon cancer cells. Cytotoxicity and pro-apoptotic activity were determined in human colon adenocarcinoma cell lines (LS180 and HT-29) and control colon epithelial CCD841 CoN cells. According to the MTT assay, after 48 h of cell exposure, the IC50 values were as follows: 4.3; 46.1 and 50.2 µg/mL for LS180, HT-29, and CCD841 CoN cells, respectively, showing the greater sensitivity of cancer cells to BVR. The Cell Death Detection ELISAPLUS kit demonstrated that BVR induced programmed cell death only against HT-29 cells. RT-qPCR with relative quantification method showed significant changes in the expression of genes related to apoptosis in both colon cancer cell lines. The genes BCL2L1 (126.84-366.66%), BCL2L2 (277.08-330.12%), CASP3 (180.36-261.36%) and CASP9 (158.08-213.46%) had significantly elevated expression, while BCL2 (23.08-52.06%) had reduced expression. Furthermore, in a panel of antioxidant tests, BVR showed positive effects (63.93±0.01, 122.92±0.01, and 220.29±0.02 mg Trolox equivalents (TE)/g in the DPPH•, ABTS•+ and ORAC assays, respectively). In the lipoxygenase (LOX) inhibition test, BVR revealed 62,60±0.87% of enzyme inhibition. The chemical composition of BVR was determined using UHPLC-UV-CAD-MS/MS analysis and confirmed the presence of several known alkaloids, including berberine, as well as other alkaloids and two derivatives of hydroxycinnamic acid (ferulic and sinapic acid hexosides). This is the first such extensive assessment of the biological activity of BVR. The results are very promising and encourage for the use of BVR as a comprehensive chemopreventive agent (anti-inflammatory, antioxidant, and pro-apoptotic) in colorectal cancer.

We study the resonant dipole-dipole interaction energy between two uniformly accelerated identical atoms, one excited and the other in the ground state, prepared in a correlated Bell-type state, and interacting with the scalar field or the electromagnetic field nearby a perfectly reflecting plate. We suppose the two atoms moving with the same uniform acceleration, parallel to the plane boundary, and that their separation is constant during the motion. We separate the contributions of vacuum fluctuations and radiation reaction field to the resonance energy shift of the two-atom system, and show that Unruh thermal fluctuations do not affect the resonance interaction, which is exclusively related to the radiation reaction field. However, nonthermal effects of acceleration in the radiation-reaction contribution, beyond the Unruh acceleration-temperature equivalence, affect the resonance interaction energy. By considering specific geometric configurations of the two-atom system relative to the plate, we show that the presence of the mirror significantly modifies the resonance interaction energy between the two accelerated atoms. In particular, we find that new and different features appear with respect to the case of atoms in the free space, related to the presence of the boundary and to the peculiar structure of the quantum electromagnetic field vacuum in the locally inertial frame. Our results suggest the possibility to exploit the resonance interaction between accelerated atoms, as a probe for detecting the elusive effects of atomic acceleration on radiative processes.

Wild strawberry (Fragaria vesca L.) leaves possess diverse antioxidant properties, mainly due to the different classes of phenolics. In this study, microwave-assisted extraction (MAE) and accelerated solvent extraction (ASE) of wild strawberry phenolics were carried out to understand the impact of extraction temperature, extraction time and solvent-to-sample ratio (SSR) on the quantitative and qualitative properties of the obtained extracts. The highest total phenolic content (8027 mg GA/100 g DW), as well the highest DPPH• antiradical activity (903 mol TE/g DW) was obtained with ASE at 150 °C, static time 5 min and SSR of 40:1; while the highest ABTS•+ antiradical activity (681 mol TE/g DW,) and FRAP (2389 mol TE/g DW) was obtained with MAE after 5 min at 80 °C and a SSR of 40:1. The correlation analysis showed that phenolics largely contributed to the antioxidant properties of the studied MAE extracts, while correlation was not found in ASE extracts. A total of 54 different phenolics were identified by UPLC/MS-MS in MAE and ASE extracts obtained at optimal extraction conditions. MAE extract was shown to have a higher content of phenolic acids (40%), but lower content of proanthocyanidins (88%), flavonols (29%), flavan-3-ols (50%) and flavones (39%) than ASE extract.

A mathematical model given by a two - dimensional differential system is introduced in order to understand the transition process from the normal hematopoiesis to the chronic and accelerated acute stages in chronic myeloid leukemia. A previous model of Dingli and Michor is refined by introducing a new parameter in order to differentiate the bone marrow microenvironment sensitivities of normal and mutant stem cells. In the light of the new parameter, the system now has three distinct equilibria corresponding to the normal hematopoietic state, to the chronic state, and to the accelerated acute phase of the disease. A characterization of the three hematopoietic states is obtained based on the stability analysis. Numerical simulations are included to illustrate the theoretical results.

Breast and prostate cancer lead incidence rankings in Chile, with obesity and overweight as important risk factors involved in prognosis. Nutritional interventions have shown to be beneficial therapies in patients with cancer, improving anthropometric and biochemical measurements. This study investigates the feasibility and effectiveness of Calorie Restriction and Time-Restricted Feeding in overweight or obese patients undergoing curative radiotherapy for breast and prostate cancer. The research was conducted as a prospective, interventional, non-randomized clinical trial, involving 27 participants, of whom 23 completed the study. Findings indicate that both interventions are feasible and effective. Notably, Time-Restricted Feeding demonstrated superior adherence and more significant improvements in weight loss and metabolic parameters. A mean weight reduction of 3.6 kg and waist circumference decrease of 4.9 cm was observed across participants. Serum levels of glucose, insulin, LDL, HDL and TG showed an average reduction, indicating positive metabolic changes. Results suggest that Time-Restricted Feeding could be a superior beneficial dietary intervention for cancer patients undergoing radiotherapy, due to its ease of adherence and positive impact on metabolic health. This research contributes to the growing evidence on the role of nutritional interventions in cancer treatment and underscores the need for more extensive studies to validate these findings.

(1) Background: Treatment of male stress incontinence in patients with prostate cancer treated with radical prostatectomy and adjuvant pelvic radiation is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is not well established, despite the general belief that outcomes are worse than in patients without radiation. (2) Methods: Retrospective multicenter study evaluating patients treated with silicone-covered scrotal port (SSP) ATOMS implant after radical prostatectomy and radiotherapy in nine different institutions between 2016 and 2022. The primary endpoint was dry patient rate, defined as pad-test ≤20 mL/day. The secondary endpoints were complication rate (defined using Clavien-Dindo classification), device removal and self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank sum test, Fisher’s exact test and logistic regression were performed using stepwise method with a 0.15 entry and 0.1 stay criteria. (3) Results: 223 patients fulfilled criteria for inclusion, 12 (5.4%) had received salvage prostatectomy after radiation and 27 (12.1%) previous devices for stress incontinence. After ATOMS adjustment, 95 patients (42.6%) were dry and 36 (16.1%) had complications of any grade (grade I, n=20; grade II, n=11; grade III, n=5) during the first 3 months postoperatively. At a mean 36 ± 21 months follow-up the device was explanted in 26 (11.7%) patients. Regarding self-perceived satisfaction with the implant, 105 of 125 patients (84%) considered themselves satisfied (PGI-I 1 to 3). In univariate analysis dryness was associated to younger age (p=.06), primary prostatectomy (p=.08), no previous incontinence surgery (p=.02), absence of overactive bladder symptoms (p=.04), absence of bladder neck stricture (p=.001), no need of surgical revision (p=.008) and lower baseline incontinence severity (p=.0003). Multivariate analysis identified absence of surgical revision (p=.018), absence of bladder neck stricture (p=.05), primary prostatectomy (p=.07) and baseline incontinence severity (p&lt;.0001) were independent predictors of dryness. A logistic regression model was proposed and internally validated. (4) Conclusions: ATOMS is an efficacious and safe alternative to treat male incontinence after radical prostatectomy and adjuvant radiotherapy. Factors predictive of dryness are identified in this complex scenario to allow better patient selection.

Currently, data regarding optimal treatment modality, response, and outcome specifically for N3 head and neck cancer are lacking. This study aimed to compare the treatment outcomes between definitive concurrent chemoradiotherapy (CCRT) to the neck and upfront neck dissection followed by adjuvant CCRT. 93 N3 squamous cell carcinoma head and neck cancer patients were included. Primary tumor treatment was divided to definitive CCRT (CCRT group) or curative surgery followed by adjuvant CCRT (surgery group). Neck treatment was also classified into two treatment modalities: definitive CCRT to the neck (CCRT group) or curative neck dissection followed by adjuvant CCRT (neck dissection group). Overall, the 2-year overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS) were 51.8%, 47.3%, 45.6%, and 43.6%, respectively. In both oropharyngeal cancer and nonoropharyngeal cancer patients, in terms of OS, LRFS, RRFS or DMFS no difference was noted regarding primary tumor treatment (CCRT vs. surgery) or neck treatment (CCRT vs. neck dissection). In summary, N3 neck patients treated with definitive CCRT can achieve similar outcomes to those treated with upfront neck dissection followed by adjuvant CCRT. Cautions should be made to avoid overtreatment for this group of patients.