Cortical inhibition assessed using paired-pulse TMS-EEG is increased in older adults

Publication date: Available online 30 December 2017
Source:Brain Stimulation
Author(s): George M. Opie, Simranjit K. Sidhu, Nigel C. Rogasch, Michael C. Ridding, John G. Semmler
BackgroundAlterations in inhibitory processes mediated by gamma-aminobutyric acid type B (GABAB) receptors may contribute to age-related functional impairments. However, investigation of these circuits using conventional paired-pulse transcranial magnetic stimulation (TMS) at long interstimulus intervals (∼100-200ms) have produced conflicting results in older adults, possibly due to the indirect nature of the TMS motor evoked potential (MEP).ObjectiveTo utilise electroencephalography and TMS coregistration (TMS-EEG) to more directly assess age-related changes in GABAB-mediated long-interval intracortical inhibition (LICI).MethodsIn 17 young (24.2 ± 1.1 years) and 17 older (71.4 ± 1.4 years) subjects, the TMS-evoked potential (TEP) was used to assess the global scalp response to single-pulse TMS and LICI applied at two interstimulus intervals of 100 ms (LICI100) and 150 ms (LICI150).ResultsFor single-pulse stimulation, P30 amplitude was unaffected by age. Despite this, N45 amplitude was increased in older adults and both N100 and P180 showed altered spatial distributions. Furthermore, the latency of P30 was shorter, while the latency of P180 was longer, in the elderly. In addition, inhibition of the N100 and P180 was increased in older adults following both LICI100 and LICI150.ConclusionsThese findings with TMS-EEG suggest that the ageing process is associated with a potentiation of GABAergic inhibition, particularly for the GABAB-receptor subtype.



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Short Versions of Two Specific Phobia Measures: The Snake and the Spider Questionnaires

Publication date: Available online 30 December 2017
Source:Journal of Anxiety Disorders
Author(s): Andras N. Zsido, Nikolett Arato, Orsolya Inhof, Jozsef Janszky, Gergely Darnai
Zoophobias are the most prevalent form of specific phobia worldwide. Two of the most widely used measures, the Snake Questionnaire (SNAQ) and Spider Questionnaire (SPQ) are good indicators of specific fears, but researchers have recognised that shorter, yet nevertheless reliable measures are needed. Hence the aims of this research were to develop short forms of the SNAQ and SPQ using item response theory and to use receiver operating characteristic (ROC) curve analyses to determine cut-offs for use in future research. Twelve-item versions of both scales (SNAQ-12 and SPQ-12) demonstrated excellent discrimination along the latent continuum in a sample of 1354 people. The SNAQ-12 and SPQ-12 showed excellent reliability and were highly correlated with the corresponding full-length scale. The scales discriminated between participants who reported snake (3.25%) or spider (8.05%) phobia and those who did not. Further analyses revealed that non-phobic women report higher fear of both snakes and spiders than do men, but this difference was not present in phobics. These findings suggest that the SNAQ-12 and SPQ-12 have considerable strengths, including shorter assessment and scoring times, whilst retaining high reliability and potential utility as a clinical screening tool.



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Construct validation of the hybrid model of posttraumatic stress disorder: Distinctiveness of the new symptom clusters

Publication date: Available online 30 December 2017
Source:Journal of Anxiety Disorders
Author(s): Madison W. Silverstein, Nathalie Dieujuste, Lindsay B. Kramer, Daniel J. Lee, Frank W. Weathers
Despite the factor analytic support for the seven-factor hybrid model (Armour et al., 2015) of posttraumatic stress disorder (PTSD), little research has examined the degree to which newly established symptom clusters (i.e., negative affect, anhedonia, dysphoric arousal, anxious arousal, externalizing behavior) functionally and meaningfully differ in their associations with other clinical phenomena. The aim of the current study was to examine the degree to which newly established PTSD symptom clusters differentially relate to co-occurring psychopathology and related clinical phenomena through Wald testing using latent variable modeling. Participants were 535 trauma-exposed undergraduates who completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5; Weathers et al., 2013) and Personality Assessment Inventory (PAI; Morey, 1991). As expected and in line with results from previous studies, significant heterogeneity emerged for dysphoric arousal, anxious arousal, and externalizing behavior. However, there was less evidence for the distinctiveness of negative affect and anhedonia. Results indicate that only some of the newly established symptom clusters significantly differ in their associations with related clinical phenomena and that the hybrid model might not provide a meaningful framework for understanding which PTSD symptoms relate to associated features. Limitations include a non-clinical sample and reliance on retrospective self-report assessment measures.



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Plumbagin suppresses the human large cell lung cancer cell lines by inhibiting IL-6/STAT3 signaling in vitro

Publication date: February 2018
Source:International Immunopharmacology, Volume 55
Author(s): Tao Yu, Yan-Yan Xu, Ying-Ying Zhang, Kai-Yu Li, Yi Shao, Gang Liu
BackgroundLarge cell lung cancer (LCLC) patients have a poor prognosis because their tumors are highly malignant and show resistance to chemotherapy and radiotherapy. Plumbagin has anticancer activity toward several tumor types, but its effects on LCLC are unknown. This study investigated the effects of plumbagin on human L9981 and NL9980 large cell lung cancer cells and the mechanisms underlying its action.MethodsThe effects of plumbagin on L9981 and NL9980 cells proliferative activity and invasion were analyzed using MTT and Boyden chamber assays, respectively. Exogenous IL-6 was used to detect the presence of the IL-6/STAT3 signaling pathway in LCLC cell lines. L9981 cells were harvested after plumbagin treatment at 9.0μmol/L (IC50), while NL9980 were harvested after treatment at 7.5μmol/L for 6, 24, and 48h, and the expression of IL-6, IL-6R, gp130, and STAT3 and the downstream genes Bcl-2, VEGF, and CycD1 was assessed by RT-PCR. ELISA was performed to determine secreted IL-6 levels, and intracellular phospho-STAT3 levels were measured by western blotting.ResultsAfter the introduction of exogenous IL-6, the mRNA expression of signaling genes and downstream genes was significantly increased in a concentration-dependent manner. Furthermore, plumbagin significantly inhibited the expression of the above mentioned genes in a dose-dependent and time-dependent manner. The mRNA expression levels of downstream genes were correlated with those of signaling genes.ConclusionPlumbagin was found to significantly inhibit the proliferation and invasion of L9981 and NL9980 cells, and may be an effective therapy for LCLC through targeting the IL-6/STAT3 signaling pathway.



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Platelet-rich plasma inhibits Wnt/β-catenin signaling in rabbit cartilage cells activated by IL-1β

Publication date: February 2018
Source:International Immunopharmacology, Volume 55
Author(s): Jian Wu, Ji-Feng Huang, Xing-Xing Qin, Feng Hu, Zhao-Fei Chen, Yong Zheng, Yan-Xi Liu, Xian-Hua Cai
ObjectivePlatelet-rich plasma (PRP) has been reported to alleviate degenerative pathological damage to joint cartilage. This study aimed to investigate the effect of PRP on Wnt/β-catenin signaling in rabbit chondrocytes.MethodsUsing 3-month-old New Zealand white rabbits, PRP was prepared from venous blood, and chondrocytes were cultured from knee joint cartilage and identified by staining for type II collagen and proteoglycan. The effects of PRP on chondrocyte viability were measured. The chondrocytes were divided into 5 groups: control, IL-1β, PRP (100-fold dilution), Dkk-1 (100ng/mL) and Dkk-1+PRP. The IL-1β, PRP, Dkk-1 and Dkk-1+PRP groups were treated with interleukin (IL)-1β (50μL, 10μg/mL) for24h. Chondrocyte morphology was observed by electron microscopy. Levels of carboxy terminal peptide (CTX-II) and cartilage oligomeric matrix protein (COMP) in culture media were measured by ELISA. Wnt-1, β-catenin and GSK-3β mRNA and protein expression were determined by RT-PCR and western blot respectively.ResultsPRP enhanced chondrocyte proliferation. Chondrocytes in the IL-1β group showed ultrastructural abnormalities that were less pronounced in the PRP, Dkk-1 and Dkk-1+PRP groups. CTX-II and COMP concentrations were higher in the IL-1β group than in the control, PRP, Dkk-1 and Dkk-1+PRP groups (P<0.05). The IL-1β group had higher mRNA and protein Wnt1 and β-catenin levels and lower GSK-3β levels than the control, PRP, Dkk-1 and Dkk-1+PRP groups (P<0.05).ConclusionPRP may protect chondrocytes activated by IL-1β via inhibiting Wnt/β-catenin signaling.



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Outcomes of Endovascular Aneurysm Repair using the Ovation Stent Graft System in Adverse Anatomy

Publication date: Available online 29 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Nicholas S. Greaves, Aiden Moore, Dare Seriki, Jonathan Ghosh
ObjectiveThe aim was the evaluation of mid-term efficacy and safety outcome measures for the Ovation (Endologix, Santa Rosa, CA, USA) stent graft system in the management of infrarenal abdominal aortic aneurysms (iAAA) with adverse anatomy.MethodsA retrospective observational study of all patients undergoing elective iAAA repair was carried out from 2012 to 2017 using Ovation Prime or iX stent grafts with a minimum of 3 months follow-up at a single UK vascular centre. Post-operative surveillance involved computed tomography scans at 3 months and 1 year, with duplex ultrasound yearly thereafter. Outcome measures were established with retrospective analysis of pre- and post-operative imaging, and included peri-operative mortality, major adverse events, limb complications, aneurysm diameter change, and endoleak rates. All patients were within Ovation instructions for use (IFU), and assessment was made to determine whether aneurysms had anatomical features considered adverse for other commonly used stent graft platforms.ResultsOvation stent grafts were implanted in 52 patients (79% male, mean age 75.7 years) with a mean aneurysm diameter of 62.5 mm (range 55–107 mm). There was 100% technical deployment success. The 30 day mortality was 0% and there was no aneurysm related mortality during follow-up (median 24 months, range 3–48 months). There were no type I or III endoleaks, but 19% developed type II endoleaks with one patient requiring re-intervention. No iliac limb occlusions were identified but one case required relining for limb kinking. All 52 cases were within the IFU for Ovation but only 12% met the IFU criteria for the Cook and Medtronic devices.ConclusionsThe mid-term experience with Ovation demonstrates safe, durable treatment of iAAAs, including those with unfavourable anatomy, frequently off IFU for other commonly used devices.



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Reconsidering the Rupture Risk Potential of Abdominal Aortic Aneurysms in High Risk Patients

Publication date: Available online 29 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Kosmas I. Paraskevas




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Treatment of Femoral Vein Obstruction Concomitant with Iliofemoral Stenting in Patients with Severe Post-thrombotic Syndrome

Publication date: Available online 30 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Kaichuang Ye, Huihua Shi, Minyi Yin, Jinbao Qin, Xinrui Yang, Xiaobing Liu, Mier Jiang, Xinwu Lu
BackgroundThe aim was to assess the clinical and anatomical outcomes of iliofemoral stenting, with concomitant femoral stenting or balloon angioplasty alone, in patients with severe post-thrombotic syndrome (PTS) and compromised inflow.MethodsA database of patients with severe PTS who successfully underwent endovascular iliofemoral stenting was reviewed retrospectively. Patients with impaired inflow with chronic post-thrombotic obstructive lesions in the femoral vein (FV), but patent profunda vein, were selected and divided into two groups: the FV stenting (FV-S) group and the FV angioplasty (FV-A) group. Patients in the FV-S group were treated with concomitant iliofemoral and FV stenting, and patients in the FV-A group were treated with iliofemoral stenting and balloon angioplasty alone of the obstructed femoral vein. The clinical and stent outcomes were recorded and compared in the two groups.ResultsThere were 45 patients in the FV-S group and 69 patients in the FV-A group. The groups were well matched for age, gender, and diseased limbs. The pre-procedural symptoms, CEAP classifications, VCSS scores, Villalta scores, and prevalence of active ulcers were also similar between the two groups. Immediate failure (<30 days post-procedure) in the femoral segment occurred more frequently in the FV-A group (70% in FV-A group vs. 24% in FV-S group, p < .001); however, all treated femoral vein segments had occluded at 12 months. There was no significant difference between the FV-S and FV-A groups in cumulative primary and secondary patency rates of the iliofemoral stent at 3 years (55% vs. 52%, p = .71, and 77% vs. 85%, p = .32, respectively). Complete pain relief, swelling relief, VCSS score, Villalta score, and freedom from ulcers at a median of 22 months (1–48 months) following the procedure were similar in the two groups.ConclusionsStent placement to treat post-thrombotic iliofemoral obstruction with concomitant obstructed femoral vein but patent profunda vein shows cumulative patency rates and clinical outcomes similar to previous reports. Adjunctive femoral stenting or angioplasty of the obstructed femoral vein does not appear to improve clinical or stent outcomes in patients with severe PTS.



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Ethological approach to social isolation effects in behavioral studies of laboratory rodents

Publication date: 2 April 2018
Source:Behavioural Brain Research, Volume 341
Author(s): Hiroyuki Arakawa
The aim of the present review is to discuss how housing conditions affect behavioral performance in laboratory rodents from an ethological view. Commonly used laboratory rodents such as rats and mice, are originally captured animals that largely retain species-typical natural behaviors, while have fully adapted to a laboratory setting after long-term domestication. Laboratory settings including caging and artificial group housing are a considerable ethological factor influencing rodents' behaviors in commonly employed behavioral test paradigms, including emotional and defensive behaviors, learning and memory, and attention-related behaviors. Particularly, isolation rearing, single-housed in a cage, is referred to a deprivation of social relationships with cagemates, has a substantial impact on behavioral performance in laboratory rodents. In this review, we will fully examine the importance of caging related ethological factors, e.g., social relationships and its deprivation, which are essential for unraveling the nature of housing effect in laboratory rodents. These discussions regarding the housing conditions will provide valuable information for appropriately conducting behavioral studies and interpreting data of rodents' behaviors in neuroscience.



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A translational approach to the genetics of anxiety disorders

Publication date: 2 April 2018
Source:Behavioural Brain Research, Volume 341
Author(s): N.W. McGregor, J.J. Dimatelis, P.J. Van Zyl, S.M.J. Hemmings, C. Kinnear, V.A. Russell, D.J. Stein, C. Lochner
There have been important advances in our understanding of the genetic architecture of anxiety disorders. At the same time, relatively few genes have reached genome wide significance in anxiety disorders, and there is relatively little work on how exposure to an adverse environment impacts on gene expression in either animal models or human clinical populations. Here we assessed differential expression of genes of the dorsal striatum involved in synaptic transmission in an animal models of early adversity (maternal separation followed by restraint stress), and investigated whether variants in these genes were associated with risk for anxiety disorders, particularly in the presence of environmental stressors. Fifty-two male Sprague Dawley rats underwent maternal separation, and gene expression was studied using array technology. The human homologues of the differentially expressed genes were screened and analysed in a DSM-IV anxiety disorders cohort, and healthy controls (patients, n = 92; controls, n = 194), using blood. Two candidate genes (Mmp9 and Bdnf) were aberrantly expressed in the experimental rodent group relative to controls. Four single nucleotide polymorphisms (SNPs) in the human homologues of these genes were significantly associated with susceptibility for anxiety disorders (MMP9: rs3918242 and BDNF: rs6265, rs10835210 and rs11030107). Three of these (BDNF: rs6265, rs10835210, rs11030107) were found to interact significantly with childhood trauma severity resulting in increased likelihood of an anxiety disorder diagnosis. This study provides insights into the utility of rat models for identifying molecular candidates for anxiety disorders in humans.



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A hypothetical pathogenesis model for androgenic alopecia: clarifying the dihydrotestosterone paradox and rate-limiting recovery factors

Publication date: Available online 30 December 2017
Source:Medical Hypotheses
Author(s): Robert S. English
Androgenic alopecia, also known as pattern hair loss, is a chronic progressive condition that affects 80% of men and 50% of women throughout a lifetime. But despite its prevalence and extensive study, a coherent pathology model describing androgenic alopecia's precursors, biological step-processes, and physiological responses does not yet exist. While consensus isthat androgenic alopecia is genetic and androgen-mediated by dihydrotestosterone, questions remain regarding dihydrotestosterone's exact role in androgenic alopecia onset. What causes dihydrotestosterone to increase in androgenic alopecia-prone tissues? By which mechanisms does dihydrotestosterone miniaturize androgenic alopecia-prone hair follicles? Why is dihydrotestosterone also associated with hair growth in secondary body and facial hair? Why does castration (which decreases androgen production by 95%) stop pattern hair loss, but not fully reverse it? Is there a relationship between dihydrotestosterone and tissue remodeling observed alongside androgenic alopecia onset?We review evidence supporting and challenging dihydrotestosterone's causal relationship with androgenic alopecia, then propose an evidence-based pathogenesis model that attempts to answer the above questions, account for additionally-suspected androgenic alopecia mediators, identify rate-limiting recovery factors, and elucidate better treatment targets. The hypothesis argues that: [1] chronic scalp tension transmitted from the galea aponeurotica induces an inflammatory response in androgenic alopecia-prone tissues; [2] dihydrotestosterone increases in androgenic alopecia-prone tissues as part of this inflammatory response; and [3] dihydrotestosterone does not directly miniaturize hair follicles. Rather, dihydrotestosterone is a co-mediator of tissue dermal sheath thickening, perifollicular fibrosis, and calcification – three chronic, progressive conditions concomitant with androgenic alopecia progression. These conditions remodel androgenic alopecia-prone tissues – restricting follicle growth space, oxygen, and nutrient supply – leading to the slow, persistent hair follicle miniaturization characterized in androgenic alopecia.If true, this hypothetical model explains the mechanisms by which dihydrotestosterone miniaturizes androgenic alopecia-prone hair follicles, describes a rationale for androgenic alopecia progression and patterning, makes sense of dihydrotestosterone's paradoxical role in hair loss and hair growth, and identifies targets to further improve androgenic alopecia recovery rates: fibrosis, calcification, and chronic scalp tension.



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Pneumocephalus after Epidural Injection

Publication date: Available online 30 December 2017
Source:The Journal of Emergency Medicine
Author(s): Jerel Chacko, Kelly Levis, Barry Hahn
BackgroundPneumocephalus, or air in the intracranial space, is most commonly encountered after trauma or surgery. Epidural injections are commonly performed in obstetrics and pain management. Complications are uncommon and include hemorrhage, cerebrospinal fluid leak, and infection. A rare complication is pneumocephalus, described in only a few case reports of epidural anesthesia.Case ReportWe describe a 34-year-old woman complaining of a generalized headache 6 days after an unremarkable vaginal delivery that was assisted by an epidural injection. A noncontrast computed tomography scan of the head revealed pneumocephalus secondary to epidural injection.Why Should an Emergency Physician Be Aware of This?Pneumocephalus is an uncommon but serious complication of an epidural procedure. Emergency physicians must be aware of this complication entity and maintain this entity in their differential diagnosis given the potential for significant morbidity.



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Profound Prolonged Bradycardia and Hypotension after Interscalene Brachial Plexus Block with Bupivacaine

Publication date: Available online 30 December 2017
Source:The Journal of Emergency Medicine
Author(s): Mathew Nelson, Alexandra Reens, Lara Reda, David Lee
BackgroundInterscalene brachial plexus blocks have been a routinely performed method of anesthesia for shoulder surgery that decreases the need for general anesthesia, length of stay, and recovery time. We describe a case of bupivacaine toxicity after an interscalene block.Case ReportThe patient was a 66-year-old man who presented to our Emergency Department by emergency medical services from an ambulatory surgery center where he had undergone rotator cuff surgery, with bradycardia and hypotension. His symptoms began upon completion of the surgery in which he received interscalene nerve block with bupivacaine and lidocaine. He was given three doses of 0.5 mg atropine and one dose of 1 mg epinephrine for a heart rate of 40 beats/min without any improvement prior to arrival. His bradycardia was refractory to atropine. He was started on a dopamine drip and transferred to the coronary care unit. The timing of his symptoms, minutes after his regional nerve block, and his complete recovery with only supportive care, make the diagnosis of bupivacaine toxicity likely.Why Should an Emergency Physician Be Aware of This?Despite the safety profile of local anesthetics, we must be aware of their potential side affects. Whereas most adverse reactions are secondary to misdirection of anesthetic or accidental vascular puncture, local anesthetic systemic toxicity (LAST) is the major cause of significant adverse events with regional anesthesia. As regional anesthesia becomes more common, emergency physicians must be more aware of the potential complications and be able to both diagnose and treat.



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Point-of-Care Ultrasound–Guided Percutaneous Cannulation of Extracorporeal Membrane Oxygenation: Make it Simple

Publication date: Available online 30 December 2017
Source:The Journal of Emergency Medicine
Author(s): Hong Joon Ahn, Jun Wan Lee, Ki Hyuk Joo, Yeon Ho You, Seung Ryu, Jin Woong Lee, Seung Whan Kim
BackgroundCannulation of the great vessels is required for extracorporeal membrane oxygenation (ECMO). Currently, there is no guideline for optimal imaging modalities during percutaneous cannulation of ECMO.ObjectiveThe purpose of this study was to describe percutaneous cannulation guided by point-of-care ultrasound (POCUS) for ECMO and compare it with fluoroscopy and landmark guidance.MethodsThree groups (POCUS-, fluoroscopy-, and landmark-guided) of percutaneous cannulation for ECMO were analyzed retrospectively in a tertiary academic hospital. In the POCUS-guided group, visual confirmation of guidewire and cannula by ultrasound in both the access and return cannula were essential for successful cannulation. Fluoroscopy- and landmark-guided groups were cannulated with the conventional technique.ResultsA total of 128 patients were treated by ECMO during the study period, of which 94 (73.4%) cases were venoarterial ECMO. This included 56 cases of extracorporeal cardiopulmonary resuscitation. Also, there were 30 (23.4%) cases of venovenous ECMO and 4 (3.1%) cases of venoarteriovenous ECMO. A total of 71 (55.5%) patients were cannulated under POCUS guidance, and 43 (33.6%) patients were cannulated under fluoroscopy guidance and 14 (10.9%) patients were cannulated by landmark guidance. No surgical cut downs were required. Misplacement of cannula occurred in 3 (2.3%) cases. All three occurred in the landmark-guided group.ConclusionsPOCUS-guided cannulation is comparable to fluoroscopy-guided cannulation in terms of avoiding cannula misplacement. In our experience, POCUS-guided cannulation is a useful strategy over fluoroscopy- and landmark-guided cannulation during peripheral ECMO.



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Targeting the Warburg effect for Cancer Treatment: Ketogenic Diets for Management of Glioma

Publication date: Available online 30 December 2017
Source:Seminars in Cancer Biology
Author(s): Angela Poff, Andrew Kourtnik, Kathleen M. Egan, Solmaz Sahebjum, Dominic D'Agostino, Nagi B. Kumar




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In reply to recent letter to editor regarding: Towards consensus reporting of radiation induced liver toxicity in the treatment of primary liver malignancies: defining clinically relevant endpoints

Publication date: Available online 30 December 2017
Source:Practical Radiation Oncology
Author(s): Tobias R. Chapman, Stephen R. Bowen, Smith Apisarnthanarax




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Stereotactic radiosurgery for multiple brain metastases: Results of multi-centre benchmark planning studies

Publication date: Available online 30 December 2017
Source:Practical Radiation Oncology
Author(s): David J. Eaton, Jonathan Lee, Ian Paddick
PurposeStereotactic radiosurgery is indicated for treatment of multiple brain metastases. Various treatment platforms are available, but most comparisons are limited to single centre studies. As part of a national commissioning programme, benchmark planning cases were completed by 21 clinical centres, providing a unique dataset of current practice across a large number of providers and equipment platforms.Methods and MaterialsTwo brain metastases cases were provided, with images and structures pre-drawn, involving three and seven lesions. Centres produced plans according to their local practice, which were reviewed centrally using metrics for target coverage, selectivity, gradient fall-off and normal tissue sparing.Results50 plans were submitted, using 24 treatment platforms. 11 plans were revised following feedback, including two centres who acquired a new platform; and one other centre accepted a restriction of service. All centres prioritised coverage, with the prescription isodose covering ≥95% of 233/235 target volumes. Selectivity was much more variable, especially for smaller lesions, and when combined with poor gradient indices resulted in large volumes of normal tissue being irradiated. Tomotherapy submissions were outliers for either selectivity or gradient index, but other platforms could produce plans with relatively low gradient indices for larger lesion volumes. There was more variation among Varian and Elekta linac plans than for Gamma Knife and Cyberknife, and larger differences for smaller targets, both inter- and intra-treatment-platform. Doses to normal brain and brainstem were highest when margins were applied, but improvements were possible by re-planning alone.ConclusionsMulti-centre benchmarking exercises have highlighted some variation in clinical practice and priorities, with a few outliers. Most platforms are able to achieve comparable plans, except for the smallest volumes and when larger planning margins are used. The data will be used to progress standardisation and quality improvement of national services, and can provide useful guidance for centres worldwide.



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Regarding: “Towards consensus reporting of radiation-induced liver toxicity in the treatment of primary liver malignancies: defining clinically relevant endpoints”

Publication date: Available online 29 December 2017
Source:Practical Radiation Oncology
Author(s): Naoko Sanuki




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Optimal imaging surveillance after stereotactic ablative radiation therapy for early-stage non-small cell lung cancer: Findings of an International Delphi Consensus Study

Publication date: Available online 30 December 2017
Source:Practical Radiation Oncology
Author(s): Timothy K. Nguyen, Suresh Senan, Jeffery D. Bradley, Kevin Franks, Meredith Giuliani, Matthias Guckenberger, Mark Landis, Billy W. Loo, Alexander V. Louie, Hiroshi Onishi, Heidi Schmidt, Robert Timmerman, Gregory M.M. Videtic, David A. Palma
PurposeImaging after stereotactic ablative radiation therapy (SABR) for early-stage non-small cell lung cancer can detect recurrences and second primary lung cancers; however, the optimal follow-up practice of these patients remains unclear. We sought to establish consensus recommendations for surveillance after SABR.Methods and materialsInternational opinion leaders in thoracic radiation oncology and radiology were invited to participate (n = 31), with 11 accepting (9 radiation oncologists, 2 radiologists). Consensus-building was achieved using a 3-round Delphi process. Participants rated their agreement/disagreement with statements using a 5-point Likert scale. An a priori threshold of ≥75% agreement/disagreement was required for consensus.ResultsA 100% response rate was achieved and final consensus statements were approved by all participants. The consensus statements were: (1.1) thoracic computed tomography (CT) scans should be ordered routinely in follow-up; (1.2) if there is a suspicion for local recurrence (LR), fludeoxyglucose positron emission tomography/CT scans are strongly recommended. Otherwise, there is limited evidence to guide routine use of fludeoxyglucose positron emission tomography /CT; (1.3) CT imaging is not recommended at 6 weeks, but is recommended at months 3, 6, and 12 in year 1 and then every 6 months in year 2 and annually in years 3 through 5; (1.4) after 5 years, CT imaging should continue, although no consensus was reached regarding the frequency. (2.1) Response Evaluation Criteria in Solid Tumors 1.1 criteria are not sufficient for detecting LR; (2.2) a formal scoring system, informed by validated data, should be used to classify high-risk imaging features predictive of LR; (2.3) CT findings suspicious for LR include: infiltration into adjacent structures, bulging margins, sustained growth, mass-like growth, spherical growth, craniocaudal growth, and loss of air bronchograms. (3) Salvage therapy without pathologic confirmation of recurrence is acceptable if imaging findings are highly suspicious and a biopsy is not safe/feasible or if an attempted biopsy was nondiagnostic.ConclusionsThese guidelines provide international expert consensus on areas of uncertainty in the management of early-stage non-small cell lung cancer patients after SABR.



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Reviewer Acknowledgement

Publication date: January 2018
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms, Volume 1861, Issue 1





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