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1.
Materials (Basel) ; 17(10)2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38793241

RESUMO

While binder jetting (BJ) additive manufacturing (AM) holds considerable promise for industrial applications, defects often compromise part quality. This study addresses these challenges by investigating binding mechanisms and analyzing common defects, proposing tailored solutions to mitigate them. Emphasizing defect identification for effective quality control in BJ-AM, this research offers strategies for in-process rectification and post-process evaluation to elevate part quality. It shows how to successfully process metallic parts with complex geometries while maintaining consistent material properties. Furthermore, the paper explores the microstructure of AISI M2 tool steel, utilizing advanced image processing techniques like digital image analysis and SEM images to evaluate carbide distribution. The results show that M2 tool steel has a high proportion of M6C carbides, with furnace-cooled samples ranging from ~2.4% to 7.1% and MC carbides from ~0.4% to 9.4%. M6C carbides ranged from ~2.6% to 3.8% in air-cooled samples, while water-cooled samples peaked at ~8.52%. Sintering conditions also affected shrinkage, with furnace-cooled samples showing the lowest rates (1.7 ± 0.4% to 5 ± 0.4%) and water-cooled samples showing the highest (2 ± 0.4% to 14.1 ± 0.4%). The study recommends real-time defect detection systems with autonomous corrective capabilities to improve the quality and performance of BJ-AM components.

2.
Adv Radiat Oncol ; 9(7): 101509, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38799108

RESUMO

Background: Current standard of care treatment for patients with ≥15 brain metastases (BM) is whole brain radiation therapy (WBRT), despite poor neurocognitive outcomes. We analyzed our institutional experience of treating these patients with stereotactic radiosurgery (SRS), with the aim of evaluating safety, cognitive outcomes, and survival metrics. Methods: Patients who received SRS for ≥15 BMs in 1 to 5 fractions from 2014 to 2022 were included. Cognitive outcomes were objectively evaluated using serial Patient-Reported Outcome Measurement Information System (PROMIS) scores. The Kaplan-Meier method was used for survival analysis and log-rank test for intergroup comparisons. Results: Overall, 118 patients underwent 124 courses of LINAC-based SRS. The median number of lesions treated per course was 20 (range, 15-94). Most patients received fractionated SRS to a dose of 24 Gy in 3 fractions (81.5%). At the time of SRS, 19.4% patients had received prior WBRT, and 24.2% had received prior SRS. The rate of any grade radiation necrosis (RN) and grade ≥3 RN were 15.3% and 3.2%, respectively. When evaluating longitudinal PROMIS score trends, 25 of 31 patients had a stable/improved PROMIS score. Patients who did not receive prior brain RT had a longer median survival (7.4 months vs 4.6 months, P = .034). The 12m local control was 97.6%, and the cumulative incidence of distant intracranial failure, with death as a competing event, was 46% (95% CI, 36%, 55%). One year freedom from neurologic death, leptomeningeal disease, and salvage WBRT were 89%, 94.6%, and 84%, respectively. Conclusion: We present here one of the largest studies evaluating SRS for patients with ≥15 BMs. SRS was safe, had favorable cognitive outcomes, and had comparable survival outcomes to contemporary studies evaluating WBRT in this population. Treatment-naïve patients had a median survival of >6 months, long enough to benefit from cognitive sparing with SRS. Our study supports randomized studies comparing SRS and hippocampal avoidance WBRT approaches for these patients.

3.
JCI Insight ; 8(24)2023 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-38131377

RESUMO

Long noncoding RNAs (lncRNAs) regulate the expression of protein-coding genes and have been shown to play important roles in inflammatory skin diseases. However, we still have limited understanding of the functional impact of lncRNAs in skin, partly due to their tissue specificity and lower expression levels compared with protein-coding genes. We compiled a comprehensive list of 18,517 lncRNAs from different sources and studied their expression profiles in 834 RNA-Seq samples from multiple inflammatory skin conditions and cytokine-stimulated keratinocytes. Applying a balanced random forest to predict involvement in biological functions, we achieved a median AUROC of 0.79 in 10-fold cross-validation, identifying significant DNA binding domains (DBDs) for 39 lncRNAs. G18244, a skin-expressing lncRNA predicted for IL-4/IL-13 signaling in keratinocytes, was highly correlated in expression with F13A1, a protein-coding gene involved in macrophage regulation, and we further identified a significant DBD in F13A1 for G18244. Reflecting clinical implications, AC090198.1 (predicted for IL-17 pathway) and AC005332.6 (predicted for IFN-γ pathway) had significant negative correlation with the SCORAD metric for atopic dermatitis. We also utilized single-cell RNA and spatial sequencing data to validate cell type specificity. Our research demonstrates lncRNAs have important immunological roles and can help prioritize their impact on inflammatory skin diseases.


Assuntos
RNA Longo não Codificante , Dermatopatias , Humanos , RNA Longo não Codificante/genética , RNA Longo não Codificante/metabolismo , Pele/metabolismo , Dermatopatias/genética
4.
Br J Dermatol ; 190(1): 70-79, 2023 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-37672660

RESUMO

BACKGROUND: Multiple treatment options are available for the management of psoriasis, but clinical response varies among individual patients and no biomarkers are available to facilitate treatment selection for improved patient outcomes. OBJECTIVES: To utilize retrospective data to conduct a pharmacogenetic study to explore the potential genetic pathways associated with drug response in the treatment of psoriasis. METHODS: We conducted a retrospective pharmacogenetic study using self-evaluated treatment response from 1942 genotyped patients with psoriasis. We examined 6 502 658 genetic markers to model their associations with response to six treatment options using linear regression, adjusting for cohort variables and demographic features. We further utilized an integrative approach incorporating epigenomics, transcriptomics and a longitudinal clinical cohort to provide biological implications for the topmost signals associated with drug response. RESULTS: Two novel markers were revealed to be associated with treatment response: rs1991820 (P = 1.30 × 10-6) for anti-tumour necrosis factor (TNF) biologics; and rs62264137 (P = 2.94 × 10-6) for methotrexate, which was also associated with cutaneous mRNA expression levels of two known psoriasis-related genes KLK7 (P = 1.0 × 10-12) and CD200 (P = 5.4 × 10-6). We demonstrated that KLK7 expression was increased in the psoriatic epidermis, as shown by immunohistochemistry, as well as single-cell RNA sequencing, and its responsiveness to anti-TNF treatment was highlighted. By inhibiting the expression of KLK7, we further illustrated that keratinocytes have decreased proinflammatory responses to TNF. CONCLUSIONS: Our study implicates the genetic regulation of cytokine responses in predicting clinical drug response and supports the association between pharmacogenetic loci and anti-TNF response, as shown here for KLK7.


Assuntos
Psoríase , Humanos , Calicreínas/genética , Calicreínas/uso terapêutico , Farmacogenética , Testes Farmacogenômicos , Psoríase/tratamento farmacológico , Psoríase/genética , Psoríase/patologia , Estudos Retrospectivos , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Fator de Necrose Tumoral alfa/genética
5.
Br J Ophthalmol ; 2023 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-37704267

RESUMO

BACKGROUND/AIMS: The incidence of retinopathy of prematurity (ROP) is increasing and treatment options are expanding, often without accompanying safety data. We aimed to define a minimal, patient-centred data set that is feasible to collect in clinical practice and can be used collaboratively to track and compare outcomes of ROP treatment with a view to improving patient outcomes. METHODS: A multinational group of clinicians and a patient representative with expertise in ROP and registry development collaborated to develop a data set that focused on real-world parameters and outcomes that were patient centred, minimal and feasible to collect in routine clinical practice. RESULTS: For babies receiving ROP treatment, we recommend patient demographics, systemic comorbidities, ROP status, treatment details, ophthalmic and systemic complications of treatment, ophthalmic and neurodevelopmental outcomes at initial treatment, any episodes of retreatment and follow-up examinations in the short and long-term to be collected for use in ROP studies, registries and routine clinical practice. CONCLUSIONS: We recommend these parameters to be used in registries and future studies of ROP treatment, to reduce the variation seen in previous reports and allow meaningful assessments and comparisons. They form the basis of the EU-ROP and the Fight Childhood Blindness! ROP Registries.

6.
Transl Vis Sci Technol ; 12(8): 13, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37578427

RESUMO

Purpose: Retinopathy of prematurity (ROP) is a sight-threatening vasoproliferative retinal disease affecting premature infants. The detection of plus disease, a severe form of ROP requiring treatment, remains challenging owing to subjectivity, frequency, and time intensity of retinal examinations. Recent artificial intelligence (AI) algorithms developed to detect plus disease aims to alleviate these challenges; however, they have not been tested against a diverse neonatal population. Our study aims to validate ROP.AI, an AI algorithm developed from a single cohort, against a multicenter Australian cohort to determine its performance in detecting plus disease. Methods: Retinal images captured during routine ROP screening from May 2021 to February 2022 across five major tertiary centers throughout Australia were collected and uploaded to ROP.AI. AI diagnostic output was compared with one of five ROP experts. Sensitivity, specificity, negative predictive value, and area under the receiver operator curve were determined. Results: We collected 8052 images. The area under the receiver operator curve for the diagnosis of plus disease was 0.75. ROP.AI achieved 84% sensitivity, 43% specificity, and 96% negative predictive value for the detection of plus disease after operating point optimization. Conclusions: ROP.AI was able to detect plus disease in an external, multicenter cohort despite being trained from a single center. Algorithm performance was demonstrated without preprocessing or augmentation, simulating real-world clinical applicability. Further training may improve generalizability for clinical implementation. Translational Relevance: These results demonstrate ROP.AI's potential as a screening tool for the detection of plus disease in future clinical practice and provides a solution to overcome current diagnostic challenges.


Assuntos
Aprendizado Profundo , Retinopatia da Prematuridade , Recém-Nascido , Lactente , Humanos , Inteligência Artificial , Retinopatia da Prematuridade/diagnóstico , Idade Gestacional , Austrália/epidemiologia , Algoritmos
7.
Pract Radiat Oncol ; 13(6): 510-516, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37516957

RESUMO

Carbon-fiber reinforced (CFR) polyetheretherketone hardware is an alternative to traditional metal hardware used for spinal fixation surgeries before postoperative radiation therapy for patients with spinal metastases. CFR hardware's radiolucency decreases metal artifact, improving visualization and accuracy of treatment planning. We present the first clinical use and proof of principle of CFR spinal hardware with tantalum markers used for successful tracking of intrafraction motion (IM) using Varian TrueBeam IMR (Intrafraction Motion Review) software module during postoperative spine stereotactic radiation. A 63-year-old woman with history of endometrial cancer presented with acute back pain. Imaging demonstrated pathologic T12 vertebral fracture with cord compression. She underwent T12 vertebrectomy with circumferential decompression and posterior instrumented T10-L2 fusion at our facility using CFR-polyetheretherketone hardware with tantalum screw markers followed by postoperative stereotactic body radiation therapy to 3000 cGy in 5 fractions delivered to T11-T12. Tantalum screw markers were used for IMR tracking. During irradiation, 260 kV images were acquired, and IMR software was able to identify and track markers. During the entire treatment, the IM motions were less than 3 mm. This is the first presented case of CFR spinal hardware with tantalum markers used for successful IMR tracking of IM during daily spine stereotactic treatment. Future work will be needed to improve workflow and create a spine-specific IMR protocol.


Assuntos
Radiocirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Fibra de Carbono , Tantálio/uso terapêutico , Polímeros , Polietilenoglicóis , Cetonas
8.
Nat Genet ; 55(7): 1149-1163, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37386251

RESUMO

Hereditary congenital facial paresis type 1 (HCFP1) is an autosomal dominant disorder of absent or limited facial movement that maps to chromosome 3q21-q22 and is hypothesized to result from facial branchial motor neuron (FBMN) maldevelopment. In the present study, we report that HCFP1 results from heterozygous duplications within a neuron-specific GATA2 regulatory region that includes two enhancers and one silencer, and from noncoding single-nucleotide variants (SNVs) within the silencer. Some SNVs impair binding of NR2F1 to the silencer in vitro and in vivo and attenuate in vivo enhancer reporter expression in FBMNs. Gata2 and its effector Gata3 are essential for inner-ear efferent neuron (IEE) but not FBMN development. A humanized HCFP1 mouse model extends Gata2 expression, favors the formation of IEEs over FBMNs and is rescued by conditional loss of Gata3. These findings highlight the importance of temporal gene regulation in development and of noncoding variation in rare mendelian disease.


Assuntos
Paralisia Facial , Animais , Camundongos , Paralisia Facial/genética , Paralisia Facial/congênito , Paralisia Facial/metabolismo , Fator de Transcrição GATA2/genética , Fator de Transcrição GATA2/metabolismo , Neurônios Motores/metabolismo , Neurogênese , Neurônios Eferentes
9.
Nat Commun ; 14(1): 3455, 2023 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-37308489

RESUMO

The immunopathogenesis of psoriasis, a common chronic inflammatory disease of the skin, is incompletely understood. Here we demonstrate, using a combination of single cell and spatial RNA sequencing, IL-36 dependent amplification of IL-17A and TNF inflammatory responses in the absence of neutrophil proteases, which primarily occur within the supraspinous layer of the psoriatic epidermis. We further show that a subset of SFRP2+ fibroblasts in psoriasis contribute to amplification of the immune network through transition to a pro-inflammatory state. The SFRP2+ fibroblast communication network involves production of CCL13, CCL19 and CXCL12, connected by ligand-receptor interactions to other spatially proximate cell types: CCR2+ myeloid cells, CCR7+ LAMP3+ dendritic cells, and CXCR4 expressed on both CD8+ Tc17 cells and keratinocytes, respectively. The SFRP2+ fibroblasts also express cathepsin S, further amplifying inflammatory responses by activating IL-36G in keratinocytes. These data provide an in-depth view of psoriasis pathogenesis, which expands our understanding of the critical cellular participants to include inflammatory fibroblasts and their cellular interactions.


Assuntos
Queratinócitos , Psoríase , Humanos , Pele , Fibroblastos , Células Epidérmicas
10.
Ann Neurol ; 94(2): 384-397, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37127916

RESUMO

OBJECTIVE: Psoriasis and multiple sclerosis (MS) are complex immune diseases that are mediated by T cells and share multiple comorbidities. Previous studies have suggested psoriatic patients are at higher risk of MS; however, causal relationships between the two conditions remain unclear. Through epidemiology and genetics, we provide a comprehensive understanding of the relationship, and share molecular factors between psoriasis and MS. METHODS: We used logistic regression, trans-disease meta-analysis and Mendelian randomization. Medical claims data were included from 30 million patients, including 141,544 with MS and 742,919 with psoriasis. We used genome-wide association study summary statistics from 11,024 psoriatic, 14,802 MS cases, and 43,039 controls for trans-disease meta-analysis, with additional summary statistics from 5 million individuals for Mendelian randomization. RESULTS: Psoriatic patients have a significantly higher risk of MS (4,637 patients with both diseases; odds ratio [OR] 1.07, p = 1.2 × 10-5 ) after controlling for potential confounders. Using inverse variance and equally weighted trans-disease meta-analysis, we revealed >20 shared and opposing (direction of effect) genetic loci outside the major histocompatibility complex that showed significant genetic colocalization (in COLOC and COLOC-SuSiE v5.1.0). Co-expression analysis of genes from these loci further identified distinct clusters that were enriched among pathways for interleukin-17/tumor necrosis factor-α (OR >39, p < 1.6 × 10-3 ) and Janus kinase-signal transducers and activators of transcription (OR 35, p = 1.1 × 10-5 ), including genes, such as TNFAIP3, TYK2, and TNFRSF1A. Mendelian randomization found psoriasis as an exposure has a significant causal effect on MS (OR 1.04, p = 5.8 × 10-3 ), independent of type 1 diabetes (OR 1.05, p = 4.3 × 10-7 ), type 2 diabetes (OR 1.08, p = 2.3 × 10-3 ), inflammatory bowel disease (OR 1.11, p = 1.6 × 10-11 ), and vitamin D level (OR 0.75, p = 9.4 × 10-3 ). INTERPRETATION: By investigating the shared genetics of psoriasis and MS, along with their modifiable risk factors, our findings will advance innovations in treatment for patients suffering from comorbidities. ANN NEUROL 2023;94:384-397.


Assuntos
Esclerose Múltipla , Psoríase , Humanos , Diabetes Mellitus Tipo 2/complicações , Estudo de Associação Genômica Ampla , Interleucina-17/genética , Análise da Randomização Mendeliana , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/genética , Esclerose Múltipla/complicações , Polimorfismo de Nucleotídeo Único/genética , Psoríase/epidemiologia , Psoríase/genética , Fatores de Risco , Janus Quinases/metabolismo , Fatores de Transcrição STAT/metabolismo
11.
Cancers (Basel) ; 15(9)2023 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-37173957

RESUMO

Low-grade gliomas (LGGs) are optimally treated with up-front maximal safe surgical resection, typically defined as maximizing the extent of tumor resection while minimizing neurologic risks of surgery. Supratotal resection of LGG may improve outcomes beyond gross total resection by removing tumor cells invading beyond the tumor border as defined on MRI. However, the evidence regarding supratotal resection of LGG, in terms of impact on clinical outcomes, such as overall survival and neurologic morbidities, remains unclear. Authors independently searched the PubMed, Medline, Ovid, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases for studies evaluating overall survival, time to progression, seizure outcomes, and postoperative neurologic and medical complications of supratotal resection/FLAIRectomy of WHO-defined LGGs. Papers in languages other than English, lacking full-text availability, evaluating supratotal resection of WHO-defined high-grade gliomas only, and nonhuman studies were excluded. After literature search, reference screening, and initial exclusions, 65 studies were screened for relevancy, of which 23 were evaluated via full-text review, and 10 were ultimately included in the final evidence review. Studies were evaluated for quality using the MINORS criteria. After data extraction, a total of 1301 LGG patients were included in the analysis, with 377 (29.0%) undergoing supratotal resection. The main measured outcomes were extent of resection, pre- and postoperative neurological deficits, seizure control, adjuvant treatment, neuropsychological outcomes, ability to return to work, progression-free survival, and overall survival. Overall, low- to moderate-quality evidence was supportive of aggressive, functional boundary-based resection of LGGs due to improvements in progression-free survival and seizure control. The published literature provides a moderate amount of low-quality evidence supporting supratotal surgical resection along functional boundaries for low-grade glioma. Among patients included in this analysis, the occurrence of postoperative neurological deficits was low, and nearly all patients recovered within 3 to 6 months after surgery. Notably, the surgical centers represented in this analysis have significant experience in glioma surgery in general, and supratotal resection specifically. In this setting, supratotal surgical resection along functional boundaries appears to be appropriate for both symptomatic and asymptomatic low-grade glioma patients. Larger clinical studies are needed to better define the role of supratotal resection in LGG.

13.
Clin Exp Dermatol ; 48(6): 642-647, 2023 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-36899474

RESUMO

BACKGROUND: Observational research suggests that vitamin D levels affect psoriasis. However, observational studies are prone to potential confounding or reverse causation, which complicates interpreting the data and drawing causal conclusions. AIM: To apply Mendelian randomization (MR) methods to comprehensively assess a potential association between vitamin D and psoriasis. METHODS: Genetic variants strongly associated with 25-hydroxyvitamin D (25OHD) in genome-wide association study (GWAS) data from 417 580 and 79 366 individuals from two independent studies served as instrumental variables (used as the discovery and replication datasets, respectively). As the outcome variable, we used GWAS data of psoriasis (13 229 people in the case group, 21 543 in the control group). We used (i) biologically validated genetic instruments, and (ii) polygenic genetic instruments to assess the relationship between genetically proxied vitamin D and psoriasis. We carried out inverse-variance weighted (IVW) MR analyses for the primary analysis. In sensitivity analyses, we used robust MR approaches. RESULTS: MR analyses of both the discovery and replication datasets did not show an effect of 25OHD on psoriasis. Neither the IVW MR analysis of the biologically validated instruments [discovery dataset: odds ratio (OR) 0.99; 95% confidence interval (CI) 0.88-1.12, P = 0.873; replication dataset: OR 0.98, 95% CI 0.66-1.46, P = 0.930] nor that of the polygenic genetic instruments (discovery dataset: OR 1.00, 95% CI 0.81-1.22, P = 0.973; replication dataset: OR 0.94, 95% CI 0.64-1.38, P = 0.737) revealed an impact of 25OHD on psoriasis. CONCLUSION: The present MR study did not support the hypothesis that vitamin D levels, measured by 25OHD, affect psoriasis. This study was conducted on Europeans, so the conclusions may not be applicable to all ethnicities.


Assuntos
Análise da Randomização Mendeliana , Psoríase , Humanos , Fatores de Risco , Análise da Randomização Mendeliana/métodos , Estudo de Associação Genômica Ampla , Vitamina D , Vitaminas , Psoríase/genética , Polimorfismo de Nucleotídeo Único
15.
Neurol Sci ; 44(7): 2501-2507, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36808311

RESUMO

INTRODUCTION: We sought to determine the influence of primary tumor histology and metastatic tumor location on the frequency of seizures among patients with brain metastases. A secondary aim was to determine if surgery reduced the occurrence and frequency of seizures. METHODS: We retrospectively reviewed patients with cerebral metastasis at a single institution from 2006 to 2016. RESULTS: Among 1949 patients identified as having had cerebral metastasis, 168 (8.6%) had documentation of one or more seizures. The incidence of seizures was highest among patients with metastases from melanoma (19.8%), followed by those with colon cancer (9.7%), renal cell carcinoma (RCC; 8.3%), and lung cancer (7.0%). Among 1581 patients with melanoma, colon cancer, RCC, non-small cell lung cancer, or breast cancer, having metastases in the frontal lobe seemed to confer the greatest risk of seizures (n = 100), followed by foci in the temporal lobe (n = 20) and elsewhere (n = 16). CONCLUSION: Patients with cerebral metastasis are at increased risk for seizures. Seizure rates seem to be higher for certain primary tumors, such as melanoma, colon cancer, and RCC, and for lesions located in the frontal lobe.


Assuntos
Neoplasias Encefálicas , Carcinoma Pulmonar de Células não Pequenas , Carcinoma de Células Renais , Neoplasias do Colo , Neoplasias Renais , Neoplasias Pulmonares , Melanoma , Humanos , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Estudos Retrospectivos , Neoplasias Encefálicas/epidemiologia , Convulsões/epidemiologia , Convulsões/etiologia , Melanoma/patologia , Neoplasias Renais/patologia , Neoplasias do Colo/complicações
16.
Clin Transl Radiat Oncol ; 38: 117-122, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36420099

RESUMO

Background: The standard treatment for patients with large brain metastases and limited intracranial disease is surgical resection and post-operative stereotactic radiosurgery (SRS). However, post-operative SRS still has elevated rates of local failure (LF) and is complicated by radiation necrosis (RN), and meningeal disease (MD). Pre-operative SRS may reduce the risk of RN and MD, while fractionated therapy may improve local control through delivering a higher biological effective dose. We hypothesize that pre-operative fractionated stereotactic radiation therapy (FSRT) will have less toxicity compared to patients who receive post-operative SRS or FSRT. Methods: A multi-institutional analysis was conducted and included patients who had surgical resection and stereotactic radiation therapy to treat at least one brain metastasis. Pertinent demographic, clinical, radiation, surgical, and follow up data were collected for each patient. The primary outcome was a composite endpoint defined as patients with one of the following adverse events: 1) LF, 2) MD, and/or 3) Grade 2 or higher (symptomatic) RN. Results: 279 patients were eligible for analysis. The median follow-up time was 9 months. 87 % of patients received fractionated treatment. 29 % of patients received pre-operative treatment. The composite endpoint incidences for post-operative SRS (n = 10), post-operative FSRT (n = 189), pre-operative SRS (n = 27), and pre-operative FSRT (n = 53) were 0 %, 17 %, 15 %, and 7.5 %, respectively. Conclusions: In our study, the composite endpoint of 7.5% for pre-operative FSRT compares favorably to our post-operative FSRT rate of 17%. Pre-operative FSRT was observed to have low rates of LF, MD, and RN. Prospective validation is needed.

17.
Front Oncol ; 12: 912799, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36505845

RESUMO

Background: With advances in systemic therapy translating to improved survival in metastatic malignancies, spine metastases have become an increasingly common source of morbidity. Achieving durable local control (LC) for patients with circumferential epidural disease can be particularly challenging. Circumferential stereotactic body radiotherapy (SBRT) may offer improved LC for circumferential vertebral and/or epidural metastatic spinal disease, but prospective (and retrospective) data are extremely limited. We sought to evaluate the feasibility, toxicity, and cancer control outcomes with this novel approach to circumferential spinal disease. Methods: We retrospectively identified all circumferential SBRT courses delivered between 2013 and 2019 at a tertiary care institution for post-operative or intact spine metastases. Radiotherapy was delivered to 14-27.5 Gy in one to five fractions. Feasibility was assessed by determining the proportion of plans for which ≥95% planning target volume (PTV) was coverable by ≥95% prescription dose. The primary endpoint was 1-year LC. Factors associated with increased likelihood of local failure (LF) were explored. Acute and chronic toxicity were assessed. Detailed dosimetric data were collected. Results: Fifty-eight patients receiving 64 circumferential SBRT courses were identified (median age 61, KPS ≥70, 57% men). With a median follow-up of 15 months, the 12-month local control was 85% (eight events). Five and three recurrences were in the epidural space and bone, respectively. On multivariate analysis, increased PTV and uncontrolled systemic disease were significantly associated with an increased likelihood of LF; ≥95% PTV was covered by ≥95% prescription dose in 94% of the cases. The rate of new or progressive vertebral compression fracture was 8%. There were no myelitis events or any grade 3+ acute or late toxicities. Conclusions: For patients with circumferential disease, circumferential spine SBRT is feasible and may offer excellent LC without significant toxicity. A prospective evaluation of this approach is warranted.

18.
iScience ; 25(12): 105633, 2022 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-36505927

RESUMO

Real-world scene perception unfolds remarkably quickly, yet the underlying visual processes are poorly understood. Space-centered theory maintains that a scene's spatial structure (e.g., openness, mean depth) can be rapidly recovered from low-level image statistics. In turn, the statistical relationship between a scene's spatial properties and semantic content allows for semantic identity to be inferred from its layout. We tested this theory by investigating (1) the temporal dynamics of spatial and semantic perception in real-world scenes, and (2) dependencies between spatial and semantic judgments. Participants viewed backward-masked images for 13.3 to 106.7 ms, and identified the semantic (e.g., beach, road) or spatial structure (e.g., open, closed-off) category. We found no temporal precedence of spatial discrimination relative to semantic discrimination. Computational analyses further suggest that, instead of using spatial layout to infer semantic categories, humans exploit semantic information to discriminate spatial structure categories. These findings challenge traditional 'bottom-up' views of scene perception.

19.
Nat Commun ; 13(1): 6565, 2022 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-36323703

RESUMO

Psoriasis and coronary artery disease (CAD) are related comorbidities that are well established, but whether a genetic basis underlies this is not well studied. We apply trans-disease meta-analysis to 11,024 psoriasis and 60,801 CAD cases, along with their associated controls, identifying one opposing and three shared genetic loci, which are confirmed through colocalization analysis. Combining results from Bayesian credible interval analysis with independent information from genomic, epigenomic, and spatial chromatin organization, we prioritize genes (including IFIH1 and IL23A) that have implications for common molecular mechanisms involved in psoriasis and CAD inflammatory signaling. Chronic systemic inflammation has been associated with CAD and myocardial infarction, and Mendelian randomization analysis finds that CAD as an exposure can have a significant causal effect on psoriasis (OR = 1.11; p = 3×10-6) following adjustment for BMI and waist-hip ratio. Together, these findings suggest that systemic inflammation which causes CAD can increase the risk of psoriasis.


Assuntos
Doença da Artéria Coronariana , Psoríase , Humanos , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/genética , Estudo de Associação Genômica Ampla , Polimorfismo de Nucleotídeo Único , Teorema de Bayes , Fatores de Risco , Análise da Randomização Mendeliana , Psoríase/complicações , Psoríase/epidemiologia , Psoríase/genética , Inflamação/complicações , Inflamação/genética , Predisposição Genética para Doença
20.
BMJ Open Ophthalmol ; 7(1)2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-36161833

RESUMO

OBJECTIVE: Paediatric (childhood or congenital) cataract is an opacification of the normally clear lens of the eye and has a genetic basis in at least 18% of cases in Australia. This study aimed to replicate clinical gene screening to identify variants likely to be causative of disease in an Australian patient cohort. METHODS AND ANALYSIS: Sixty-three reported isolated cataract genes were screened for rare coding variants in 37 Australian families using genome sequencing. RESULTS: Disease-causing variants were confirmed in eight families with variant classification as 'likely pathogenic'. This included novel variants PITX3 p.(Ter303LeuextTer100), BFSP1 p.(Glu375GlyfsTer2), and GJA8 p.(Pro189Ser), as well as, previously described variants identified in genes GJA3, GJA8, CRYAA, BFSP1, PITX3, COL4A1 and HSF4. Additionally, eight variants of uncertain significance with evidence towards pathogenicity were identified in genes: GJA3, GJA8, LEMD2, PRX, CRYBB1, BFSP2, and MIP. CONCLUSION: These findings expand the genotype-phenotype correlations of both pathogenic and benign variation in cataract-associated genes. They further emphasise the need to develop additional evidence such as functional assays and variant classification criteria specific to paediatric cataract genes to improve interpretation of variants and molecular diagnosis in patients.


Assuntos
Catarata , Cristalino , Austrália , Catarata/diagnóstico , Humanos , Cristalino/patologia , Proteínas de Membrana/genética , Mutação , Proteínas Nucleares/genética , Linhagem
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