Cardiac Function Modifies the Impact of Heart Base Dose on Survival: A Voxel-Wise Analysis of Patients With Lung Cancer From the PET-Plan Trial.

INTRODUCTION: Heart dose has emerged as an independent predictor of overall survival in patients with NSCLC treated with radiotherapy. Several studies have identified the base of the heart as a region of enhanced dose sensitivity and a potential target for cardiac sparing. We present a dosimetric analysis of overall survival in the multicenter, randomized PET-Plan trial (NCT00697333) and for the first time include left ventricular ejection fraction (EF) at baseline as a metric of cardiac function. METHODS: A total of 205 patients with inoperable stage II or III NSCLC treated with 60 to 72 Gy in 2 Gy fractions were included in this study. A voxel-wise image-based data mining methodology was used to identify anatomical regions where higher dose was significantly associated with worse overall survival. Univariable and multivariable Cox proportional hazards models tested the association of survival with dose to the identified region, established prognostic factors, and baseline cardiac function. RESULTS: A total of 172 patients remained after processing and censoring for follow-up. At 2-years posttreatment, a highly significant region was identified within the base of the heart (p < 0.005), centered on the origin of the left coronary artery and the region of the atrioventricular node. In multivariable analysis, the number of positron emission tomography-positive nodes (p = 0.02, hazard ratio = 1.13, 95% confidence interval: 1.02-1.25) and mean dose to the cardiac subregion (p = 0.02, hazard ratio = 1.11 Gy-1, 95% confidence interval: 1.02-1.21) were significantly associated with overall survival. There was a significant interaction between EF and region dose (p = 0.04) for survival, with contrast plots revealing a larger effect of region dose on survival in patients with lower EF values. CONCLUSIONS: This work validates previous image-based data mining studies by revealing a strong association between dose to the base of the heart and overall survival. For the first time, an interaction between baseline cardiac health and heart base dose was identified, potentially suggesting preexisting cardiac dysfunction exacerbates the impact of heart dose on survival.

Role of Real-World Data in Assessing Cardiac Toxicity After Lung Cancer Radiotherapy.

Radiation-induced heart disease (RIHD) is a recent concern in patients with lung cancer after being treated with radiotherapy. Most of information we have in the field of cardiac toxicity comes from studies utilizing real-world data (RWD) as randomized controlled trials (RCTs) are generally not practical in this field. This article is a narrative review of the literature using RWD to study RIHD in patients with lung cancer following radiotherapy, summarizing heart dosimetric factors associated with outcome, strength, and limitations of the RWD studies, and how RWD can be used to assess a change to cardiac dose constraints.

Gaze patterns in viewing static and dynamic body expressions.

Evidence for the importance of bodily cues for emotion recognition has grown over the last two decades. Despite this growing literature, it is underspecified how observers view whole bodies for body expression recognition. Here we investigate to which extent body-viewing is face- and context-specific when participants are categorizing whole body expressions in static (Experiment 1) and dynamic displays (Experiment 2). Eye-movement recordings showed that observers viewed the face exclusively when visible in dynamic displays, whereas viewing was distributed over head, torso and arms in static displays and in dynamic displays with faces not visible. The strong face bias in dynamic face-visible expressions suggests that viewing of the body responds flexibly to the informativeness of facial cues for emotion categorisation. However, when facial expressions are static or not visible, observers adopt a viewing strategy that includes all upper body regions. This viewing strategy is further influenced by subtle viewing biases directed towards emotion-specific body postures and movements to optimise recruitment of diagnostic information for emotion categorisation.

Microwave spectrum, structure, and internal dynamics of the nitric acid dihydrate complex.

A-type rotational spectra of the complex HNO3-(H2O)2 have been observed by rotational spectroscopy in a supersonic jet. Extensive isotopic substitution and analysis of the resulting moments of inertia reveals that the complex adopts a cyclic geometry in which a second water inserts into the weak secondary hydrogen bond of the (also cyclic) HNO3-H2O dimer. The complex is planar, except for one free proton from each water unit that lies above or below the plane. The primary hydrogen bond, formed between the HNO3 proton and the first water molecule in the trimer, is 1.643(76) A in length. All intermolecular distances are smaller than those of the constituent dimers. Internal motion, inferred from spectral doubling and studied by isotopic substitution experiments, likely corresponds to proton interchange involving the second water unit, but no such motion is revealed by the a-type spectrum for the first water unit. The degree of proton transfer across the hydrogen bond is discussed in terms of the proton-transfer parameter, rhoPT, which assesses the degree of ionization on the basis of interatomic distances. Measured in this way, the complex is best described as hydrogen bonded, in accord with numerous theoretical predictions. However, an increase in the degree of ionization relative to that in HNO3-H2O is discernible. Using rhoPT as a metric, two water molecules do less to ionize nitric acid than one water does to ionize sulfuric acid.

Amine-hydrogen halide complexes: experimental electric dipole moments and a theoretical decomposition of dipole moments and binding energies.

The Stark effect has been observed in the rotational spectra of several gas-phase amine-hydrogen halide complexes and the following electric dipole moments have been determined: H(3)(15)N-H(35)Cl (4.05865 +/- 0.00095 D), (CH(3))(3)(15)N-H(35)Cl (7.128 +/- 0.012 D), H(3)(15)N-H(79)Br (4.2577 +/- 0.0022 D), and (CH(3))(3)(15)N-H(79)Br (8.397 +/- 0.014 D). Calculations of the binding energies and electric dipole moments for the full set of complexes R(n)()(CH(3))(3)(-)(n)()N-HX (n = 0-3; X = F, Cl, Br) at the MP2/aug-cc-pVDZ level are also reported. The block localized wave function (BLW) energy decomposition method has been used to partition the binding energies into contributions from electrostatic, exchange, distortion, polarization, and charge-transfer terms. Similarly, the calculated dipole moments have been decomposed into distortion, polarization, and charge-transfer components. The complexes studied range from hydrogen-bonded systems to proton-transferred ion pairs, and the total interaction energies vary from 7 to 17 kcal/mol across the series. The individual energy components show a much wider variation than this, but cancellation of terms accounts for the relatively narrow range of net binding energies. For both the hydrogen-bonded complexes and the proton-transferred ion pairs, the electrostatic and exchange terms have magnitudes that increase with the degree of proton transfer but are of opposite sign, leaving most of the net stabilization to arise from polarization and charge transfer. In all of the systems studied, the polarization terms contribute the most to the induced dipole moment, followed by smaller but still significant contributions from charge transfer. A significant contribution to the induced moment of the ion pairs also arises from distortion of the HX monomer.

Influence of a polar near-neighbor on incipient proton transfer in a strongly hydrogen bonded complex.

Rotational spectroscopy and ab initio calculations have been used to characterize the complexes H(3)N-HF and H(3)N-HF-HF in the gas phase. H(3)N-HF is a C(3v) symmetric, hydrogen bonded system with an NF distance of 2.640(21) A and an N...H hydrogen bond length of 1.693(42) A. The H(3)N-HF-HF complex, on the other hand, forms a six-membered HN-HF-HF ring, in which both the linear hydrogen bond in the H(3)N-HF moiety and the F-H-F angle of (HF)(2) are perturbed relative to those in the corresponding dimers. The N...F and F...F distances in the trimer are 2.4509(74) A and 2.651(11) A, respectively. The N...H hydrogen bond length in H(3)N-HF-HF is 1.488(12) A, a value which is 0.205(54) A shorter than that in H(3)N-HF. Similarly, the F...F distance, 2.651(11) A, is 0.13(2) A shorter than that in (HF)(2). Counterpoise-corrected geometry optimizations are presented, which are in good agreement with the experimental structures for both the dimer and trimer, and further characterize small, but significant, changes in the NH(3) and HF subunits upon complexation. Analysis of internal rotation in the spectrum of H(3)N-HF-HF gives the potential barrier for internal rotation of the NH(3) unit, V(3), to be 118(2) cm(-1). Ab initio calculations reproduce this number to within 10% if the monomer units and the molecular frame are allowed to fully relax as the internal rotation takes place. The binding energies of H(3)N-HF and H(3)N-HF-HF, calculated at the MP2/aug-cc-pVTZ level and corrected for basis set superposition error are 12.3 and 22.0 kcal/mol, respectively. Additional energy calculations have been performed to explore the lowest frequency vibration of H(3)N-HF-HF, a ring-opening motion that increases the NFF angle. The addition of one HF molecule to H(3)N-HF represents the first step of microsolvation of a hydrogen bonded complex and the results of this study demonstrate that a single, polar near-neighbor has a significant influence on the extent of proton transfer across the hydrogen bond. As measured using the proton-transfer parameter rho(PT), previously defined by Kurnig and Scheiner [Int. J. Quantum Chem., Quantum Biol. Symp. 1987, 14, 47], the degree of proton transfer in H(3)N-HF-HF is greater than that in either (CH(3))(3)N-HF or H(3)N-HCl but less than that in (CH(3))(3)N-HCl.