Aversion to a High Salt Taste is Disturbed in Patients With CKD.

Introduction: A reduced salt intake is a vital lifestyle modification in the management of hypertension. Initiatives aimed at decreasing the intake of salt are based on the preference by humans for a salt taste. Salt intake behavior appears to be affected by the balance between attraction to a low salt taste and aversion to a high salt taste. However, aversion to a high salt taste has not yet been quantitively investigated in both healthy individuals and patients with chronic kidney disease (CKD). Methods: Assessments of gustatory and aversion thresholds for salt, bitter, sour, and sweet tastes were performed using a stimulant-impregnated test strip in healthy subjects and patients with CKD. Results: In a pilot taste test of 125 healthy subjects, the number of participants with an aversive reaction increased at higher salt concentrations. The threshold for normal taste perception was arbitrarily defined as 10% NaCl, with 47.2% of healthy subjects displaying an aversive reaction. In taste tests performed by 70 patients with CKD, 10% were unable to recognize a salt taste, even at the highest concentration (20% NaCl), suggesting a significant impairment in taste perception in patients with CKD. Only 15.7% of patients with CKD exhibited a normal aversion to NaCl, whereas 78.6% showed the complete loss of aversion to salt. Conclusion: The present results confirmed the anticipated aversive response to a high salt taste in humans and demonstrated its impairment in patients with CKD, implying that patients with CKD have reduced resistance to a high salt intake.

The importance of proinflammatory failed-repair tubular epithelia as a predictor of diabetic kidney disease progression.

The immense public health burden of diabetic kidney disease (DKD) has led to an increase in research on the pathophysiology of advanced DKD. The present study focused on the significance of proinflammatory vascular cell adhesion molecule 1 (VCAM1)+ tubules in DKD progression. A retrospective cohort study of DKD patients showed that the percentage of VCAM1+ tubules in kidney samples was correlated with poor renal outcomes. We established an advanced DKD model by partial resection of the kidneys of db/db mice and demonstrated that it closely resembled the human advanced DKD phenotype, with tissue hypoxia, tubular DNA damage, tissue inflammation, and high tubular VCAM1 expression. Luseogliflozin ameliorated tissue hypoxia and proinflammatory responses, including VCAM1+ expression, in tubules. These findings suggest the potential of tubular VCAM1 as a histological marker for poor DKD outcomes. SGLT2 inhibitors may attenuate tissue hypoxia and subsequent tissue inflammation in advanced DKD, thereby ameliorating tubular injury.

Graph Comparison of Molecular Crystals in Band Gap Prediction Using Neural Networks.

In material informatics, the representation of the material structure is fundamentally essential to obtaining better prediction results, and graph representation has attracted much attention in recent years. Molecular crystals can be graphically represented in molecular and crystal representations, but a comparison of which representation is more effective has not been examined. In this study, we compared the prediction accuracy between molecular and crystal graphs for band gap prediction. The results showed that the prediction accuracies using crystal graphs were better than those obtained using molecular graphs. While this result is not surprising, error analysis quantitatively evaluated that the error of the crystal graph was 0.4 times that of the molecular graph with moderate correlation. The novelty of this study lies in the comparison of molecular crystal representations and in the quantitative evaluation of the contribution of crystal structures to the band gap.

Stereotactic body radiation therapy to the spine: contouring the cauda equina instead of the spinal cord is more practical as the organ at risk.

Background: Stereotactic body radiotherapy (SBRT) is recognized as a curative treatment for oligometastasis. The spinal cord becomes the cauda equina at the lumbar level, and the nerves are located dorsally. Recently, a consensus has been reached that the cauda equina should be contoured as an organ at risk (OAR). Here, we examined the separate contouring benefits for the spinal canal versus the cauda equina only as the OAR. Materials and methods: A medical physicist designed a simulation plan for 10 patients with isolated lumbar metastasis. The OAR was set with three contours: the whole spinal canal, cauda equina only, and cauda equina with bilateral nerve roots. The prescribed dose for the planning target volume (PTV) was 30 Gy/3 fx. Results: For the constrained QAR doses, D90 and D95 were statistically significant due to the different OAR contouring. The maximum dose (Dmax) was increased to the spinal canal when the cauda equina max was set to ≤ 20 Gy, but dose hotspots were observed in most cases in the medullary area. The Dmax and PTV coverage were negatively correlated for the cauda equina and the spinal canal if Dmax was set to ≤ 20 Gy for both. Conclusions: A portion of the spinal fluid is also included when the spinal canal is set as the OAR. Thus, the PTV coverage rate will be poor if the tumor is in contact with the spinal canal. However, the PTV coverage rate increases if only the cauda equina is set as the OAR.

Hemostatic Radiotherapy for Gastric Cancer: MRI as an Alternative to Endoscopy for Post-Treatment Evaluation.

INTRODUCTION: Pretreatment diagnosis by diffusion-weighted magnetic resonance imaging (DW-MRI) is useful to determine the effect of chemotherapy for gastric cancer. Here, we investigated the relationship among DW-MRI, endoscopy, and tumor markers. PATIENTS: Eight patients underwent hemostatic radiotherapy (RT) for gastric cancer in this prospective study from 2019 to 2021. The patients completed MRI, endoscopy, and blood tests before RT; MRI, endoscopy, and blood tests 1 month after RT; and MRI and blood tests 3 months after RT. Correlations between changes in apparent diffusion coefficient (ADC) derived from DW-MRI and the tumor marker carcinoembryonic antigen (CEA) were investigated. RESULTS: Univariate analysis of overall survival showed that sex and chemotherapy treatment were statistically significant factors. The CEA values before and 1 month after RT decreased significantly. There was no statistical difference between the CEA value 1 and 3 months after RT. The ADC value before and 1 month after RT increased significantly but not between 1 and 3 months after RT. Comparing the ratio of ADC before RT to 1 (or 3) month(s) after RT with that of CEA before RT to 1 (or 3) month(s) after RT, we found an inverse relationship between the two ratios. CONCLUSIONS: Therefore, changes in ADC and CEA are correlated. Additionally, 3 months after RT, the decrease in ADC appeared earlier than the decrease in CEA. ADC may indicate a biological change earlier than CEA, and the ratios of ADC and CEA may be important factors. These aspects warrant further confirmation in a larger sample population.

Carnitine supplements for people with chronic kidney disease requiring dialysis.

BACKGROUND: Carnitine deficiency is common in patients with chronic kidney disease (CKD) who require dialysis. Several clinical studies have suggested that carnitine supplementation is beneficial for dialysis-related symptoms. However, the clinical effectiveness and potential adverse effects of carnitine supplementation in dialysis patients have not been determined. OBJECTIVES: This review aimed to evaluate the effectiveness and safety of carnitine supplementation for the treatment of dialysis-related complications in CKD patients requiring dialysis. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 16 August 2022 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) and quasi-RCTs (RCTs in which allocation to treatment was obtained by alternation, use of alternate medical records, date of birth, or other predictable methods) that compared carnitine supplements with placebo or standard care in people with CKD requiring dialysis. DATA COLLECTION AND ANALYSIS: Two authors independently extracted study data and assessed study quality. We used a random-effects model to perform a quantitative synthesis of the data.  We used the I² statistic to measure heterogeneity amongst the studies in each analysis. We indicated summary estimates as a risk ratio (RR) for dichotomous outcomes, mean difference (MD) for continuous outcomes, or standardised mean differences (SMD) if different scales were used, with 95% confidence intervals (CI). We assessed the certainty of the evidence for each of the main outcomes using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. MAIN RESULTS: We included 52 studies (47 parallel RCTs and five cross-over RCTs) (3398 randomised participants). All studies compared L-carnitine with a placebo, other treatment, or no treatment. Standard care was continued as co-interventions in each group. Most studies were judged to have an unclear or high risk of bias. L-carnitine may have little or no effect on the quality of life (QoL) SF-36 physical component score (PCS) (4 studies, 134 participants: SMD 0.57, 95% CI -0.15 to 1.28; I² = 73%; low certainty of evidence), and the total QoL score (Kidney Disease Quality of Life (KDQOL), VAS (general well-being), or PedsQL) (3 studies, 230 participants: SMD -0.02, 95% CI -0.29 to 0.25; I² = 0%; low certainty of evidence). L-carnitine may improve SF-36 mental component score (MCS) (4 studies, 134 participants: SMD 0.70, 95% CI 0.22 to 1.18; I² = 42%; low certainty of evidence). L-carnitine may have little or no effect on fatigue score (2 studies, 353 participants: SMD 0.01, 95% CI -0.20 to 0.23; I² = 0%; low certainty of evidence), adverse events (12 studies, 1041 participants: RR, 1.14, 95% CI 0.86 to 1.51; I² = 0%; low certainty of evidence), muscle cramps (2 studies, 102 participants: RR, 0.44, 95% CI 0.18 to 1.09; I² = 23%; low certainty of evidence), and intradialytic hypotension (3 studies, 128 participants: RR, 0.76, 95% CI 0.34 to 1.69; I² = 0%; low certainty of evidence). L-carnitine may improve haemoglobin levels (26 studies, 1795 participants: MD 0.46 g/dL, 95% CI 0.18 to 0.74; I² = 86%; low certainty of evidence) and haematocrit values (14 studies, 950 participants: MD 1.78%, 95% CI 0.38 to 3.18; I² = 84%; low certainty of evidence). AUTHORS' CONCLUSIONS: The available evidence does not currently support the use of carnitine supplementation in the treatment of dialysis-related carnitine deficiency. Although carnitine supplementation may slightly improve anaemia-related markers, carnitine supplementation makes little or no difference to adverse events. However, these conclusions are based on limited data and, therefore, should be interpreted with caution.

Characteristics, Antithrombotic Patterns, and Prognostic Outcomes in Claudication and Critical Limb-Threatening Ischemia Undergoing Endovascular Therapy.

PURPOSE: The underlying difference between intermittent claudication (IC) and critical limb-threatening ischemia (CLTI) still remains unclear. This prospective multicenter observational study aimed to clarify differences in clinical features and prognostic outcomes between IC and CLTI, and prognostic factors in patients undergoing endovascular therapy (EVT). MATERIALS AND METHODS: A total of 692 patients with 808 limbs were enrolled from 20 institutions in Japan. The primary measurements were the 3-year rates of major adverse cardiovascular event (MACE) and reintervention. RESULTS: Among patients, 79.0% had IC and 21.0% had CLTI. Patients with CLTI were more frequently women and more likely to have impaired functional status, undernutrition, comorbidities, hypercoagulation, hyperinflammation, distal artery disease, short single antiplatelet and long anticoagulation therapies, and late cilostazol than patients with IC. Aortoiliac and femoropopliteal diseases were dominant in patients with IC and infrapopliteal disease was dominant in patients with CLTI. Patients with CLTI underwent less frequently aortoiliac intervention and more frequently infrapopliteal intervention than patients with IC. Longitudinal change of ankle-brachial index (ABI) exhibited different patterns between IC and CLTI (pinteraction=0.002), but ABI improved after EVT both in IC and in CLTI (p<0.001), which was sustained over time. Dorsal and plantar skin perfusion pressure in CLTI showed a similar improvement pattern (pinteraction=0.181). Distribution of Rutherford category improved both in IC and in CLTI (each p<0.001). Three-year MACE rates were 20.4% and 42.3% and 3-year reintervention rates were 22.1% and 46.8% for patients with IC and CLTI, respectively (log-rank p<0.001). Elevated D-dimer (p=0.001), age (p=0.043), impaired functional status (p=0.018), and end-stage renal disease (p=0.019) were independently associated with MACE. After considering competing risks of death and major amputation for reintervention, elevated erythrocyte sedimentation rate (p=0.003) and infrainguinal intervention (p=0.002) were independently associated with reintervention. Patients with CLTI merely showed borderline significance for MACE (adjusted hazard ratio 1.700, 95% confidence interval 0.950-3.042, p=0.074) and reintervention (adjusted hazard ratio 1.976, 95% confidence interval 0.999-3.909, p=0.05). CONCLUSIONS: The CLTI is characterized not only by more systemic comorbidities and distal disease but also by more inflammatory coagulation disorder compared with IC. Also, CLTI has approximately twice MACE and reintervention rates than IC, and the underlying inflammatory coagulation disorder per se is associated with these outcomes. CLINICAL IMPACT: The underlying difference between intermittent claudication (IC) and critical limb-threatening ischemia (CLTI) still remains unclear. This prospective multicenter observational study, JPASSION study found that CLTI was characterized not only by more systemic comorbidities and distal disease but also by more inflammatory coagulation disorder compared to IC. Also, CLTI had approximately twice major adverse cardiovascular event (MACE) and reintervention rates than IC. Intriguingly, the underlying inflammatory coagulation disorder per se was independently associated with MACE and reintervention. Further studies to clarify the role of anticoagulation and anti-inflammatory therapies will contribute to the development of post-interventional therapeutics in the context of peripheral artery disease.

Effect of stomach size on organs at risk in pancreatic stereotactic body radiotherapy.

BACKGROUND: In clinical practice, the organs at risk (OARs) should be carefully determined when performing pancreatic stereotactic body radiotherapy (SBRT). We conducted a simulation study to examine the effect of the stomach size on the radiation dose to the OARs when performing pancreatic SBRT. METHODS: Twenty-five cases were included in this study. Pancreatic head and body tumors were 2-cm-sized pseudotumors, which were included as gross target volume (GTV) contours. The stomach, pancreas, small intestine, liver, kidneys, and spinal cord were considered as the OARs. The prescription dose for planning target volume (PTV) was 40 Gy/5fx, and the dose limit for the OARs was determined. The dose to X% of the OAR volume at X values of 0.1, 5.0, and 10.0 cc (DX) and the percentage of the OAR volume that received more than X Gy were recorded. RESULTS: In terms of the radiation dose to the pancreatic body tumors, the stomach size was positively correlated with a dose of D10cc [correlation coefficient (r) = 0.5516) to the stomach. The r value between the radiation dose to the pancreatic head tumor and the stomach size was 0.3499. The stomach size and radiation dose to the head and body of the pancreas were positively correlated (pancreatic head D10cc: r = 0.3979, pancreatic body D10cc: r = 0.3209). The larger the stomach, the larger the radiation dose to the healthy portion of the pancreas outside the PTV. CONCLUSIONS: When performing pancreatic SBRT, the dose to the OARs depends on the stomach size. Reducing the dose to the stomach and pancreas can be achieved by shrinking the stomach.

Hemostasis radiotherapy for gastric cancer: Usefulness of the gastric cancer to spleen apparent diffusion coefficient ratio.

The hemostatic effect of radiation therapy on gastric cancer with bleeding is known. However, blood tests and endoscopes are mainly used to determine the therapeutic effect. Additionally, magnetic resonance imaging has been reported to be useful when needed because endoscopes are invasive. In this study, magnetic resonance diffusion-weighted imaging was used to evaluate the hemostatic effect of gastric cancer. The hemostatic effect and apparent diffusion coefficient value were correlated. The apparent diffusion coefficient value was also effective in salvage irradiation during rebleeding. Although the apparent diffusion coefficient value of gastric cancer did not change during rescue irradiation, the degree of hemostatic effect could be evaluated in more detail by using the ratio of the apparent diffusion coefficient values of diffusion-weighted imaging of gastric cancer and the spleen. In the future, it would be desirable to use diffusion-weighted imaging instead of endoscopy to evaluate the gastric cancer to spleen apparent diffusion coefficient ratio in a large number of cases.

Superelasticity of a photo-actuating chiral salicylideneamine crystal.

Superelasticity is a type of elastic response to an applied external force, caused by a phase transformation. Actuation of materials is also an elastic response to external stimuli such as light and heat. Although both superelasticity and actuation are deformations resulting from stimulus-induced stress, there is a phenomenological difference between the two with respect to whether force is an input or an output. Here, we report that a molecular crystal manifests superelasticity during photo-actuation under light irradiation. The crystal exhibits stepwise twisted actuation due to two effects, photoisomerization and photo-triggered phase transition, and the actuation behavior is simulated based on a dynamic multi-layer model. The simulation, in turn, reveals how the photoisomerization and phase transition progress in the crystal, indicating superelasticity induced by modest stress due to the formation of photoproducts. This work provides not only a successful simulation of stepwise twisted actuation, but also to the best of our knowledge the first indication of superelasticity induced by light.

Protocol for a systematic review and meta-analysis of studies on the use of brain natriuretic peptide and N-terminal brain natriuretic peptide levels in the diagnosis of cardiopulmonary edema in acute respiratory failure.

BACKGROUND: Dyspnea with bilateral pulmonary edema is common among patients in emergency departments (EDs) or intensive care units (ICUs). For the initial management of patients with this condition, cardiopulmonary edema (CPE) must be differentiated from acute respiratory distress syndrome (ARDS) in clinical settings. Brain natriuretic peptide (BNP) and N-terminal brain natriuretic peptide (NT-proBNP) are useful in distinguishing these conditions. However, current data about the use of these indexes are limited. Hence, we planned to perform a systematic review and meta-analysis to determine the accuracy of the two indexes for the diagnosis of CPE. METHODS: We designed and registered a study protocol for a systematic review and meta-analysis. This study aims to determine the diagnostic accuracy of BNP and NT-proBNP based on the standards of the methodology of the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies in reporting the findings of this review. We will search PubMed (MEDLINE), Cochrane Library, Embase, www.ClinicalTrials.gov , International Clinical Trials Registry Platform, and Google Scholar. Randomized controlled trials, cross-sectional studies, and observational cohort studies reporting the accuracy in diagnosing CPE among adult patients with dyspnea and bilateral pulmonary edema will be included in the analysis. There will be no limits regarding language and publication date for this review. Two reviewers will independently screen articles, extract data, evaluate for quality and bias using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2), and use Grading of Recommendations Assessment, Development and Evaluation to summarize the strength of body of evidence. Then, a meta-analysis will be performed, and different statistical methods will be used to investigate heterogeneity among studies. A subgroup analysis of elderly patients with left ventricular dysfunction or chronic renal dysfunction will be performed. In the meta-analysis, a hierarchical summary receiver operating characteristic model or a bivariate model will be used in each index test, as appropriate. DISCUSSION: A systematic review and meta-analysis of the accuracy of BNP and NT-proBNP for the diagnosis of CPE will be conducted. The result of this study can help clinicians to identify an appropriate initial treatment for patients with acute respiratory failure, including those with ARDS and CPE. To the best of our knowledge, this will be the first comprehensive systematic review focusing on ARDS management in a specific population. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID CRD42020201576.

Effect of computed tomography value error on dose calculation in adaptive radiotherapy with Elekta X-ray volume imaging cone beam computed tomography.

PURPOSE: We evaluated the effect of changing the scan mode of the Elekta X-ray volume imaging cone beam computed tomography (CBCT) on the accuracy of dose calculation, which may be affected by computed tomography (CT) value errors in three dimensions. METHODS: We used the electron density phantom and measured the CT values in three dimensions. CT values were compared with planning computed tomography (pCT) values for various materials. The evaluated scan modes were for head and neck (S-scan), chest (M-scan), and pelvis (L-scan) with various collimators and filter systems. To evaluate the effects of the CT value error of the CBCT on dose error, Monte Carlo calculations of dosimetry were performed using pCT and CBCT images. RESULTS: The L-scan had a CT value error of approximately 800 HU at the isocenter compared with the pCT. Furthermore, inhomogeneity in the longitudinal CT value profile was observed in the bone material. The dose error for ±100 HU difference in CT values for the S-scan and M-scan was within ±2%. The center of the L-scan had a CT error of approximately 800 HU and a dose error of approximately 6%. The dose error of the L-scan occurred in the beam path in the case of both single field and two parallel opposed fields, and the maximum error occurred at the center of the phantom in the case of both the 4-field box and single-arc techniques. CONCLUSIONS: We demonstrated the three-dimensional CT value characteristics of the CBCT by evaluating the CT value error obtained under various imaging conditions. It was found that the L-scan is considerably affected by not having a unique bowtie filter, and the S-scan without the bowtie filter causes CT value errors in the longitudinal direction. Moreover, the CBCT dose errors for the 4-field box and single-arc irradiation techniques converge to the isocenter.

The Value of Interleukin-6 among Several Inflammatory Markers as a Predictor of Respiratory Failure in COVID-19 Patients.

Patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure within a short period during the clinical course. It is essential to predict respiratory deterioration in the short term. We investigated the use of inflammatory markers to predict respiratory distress within three days from their analysis in COVID-19 patients. This retrospective observational study included 81 patients admitted with COVID-19. Patients were divided into two groups according to whether the maximum fraction of inspired oxygen (FiO2) for three days from the blood marker measurements was ≥0.4 (high FiO2 group; HFG) or <0.4 (low FiO2 group; LFG). Interleukin-6 (IL-6), C-reactive protein (CRP), lactate dehydrogenase (LDH), white blood cell, D-dimer, and creatinine levels were compared between the two groups. The levels of all markers were significantly higher in HFG patients. Areas under the receiver operating characteristic curve of IL-6, CRP, and LDH had high values of 0.85, 0.82, and 0.81, respectively. The odds ratio of IL-6 which was crude and adjusted for dexamethasone administration initiated before laboratory measurement, showed the high value of 29.1 (5.6-295.6) and 53.9 (4.5-3242.8), respectively. IL-6 can be used as a reliable marker for predicting respiratory illness within three days after assessment.

New Strategy to Prevent Acute Myocardial Infarction by Public Education　- A Position Statement of the Committee on Public Education About Emergency Medical Care of the Japanese Circulation Society.

Although many efforts have been made to prevent death from acute myocardial infarction (MI) by quick revascularization therapy and use of mechanical circulation support devices, and to prevent the occurrence of acute MI by optimal medical therapy, acute MI is still a leading cause of death worldwide. Because the majority of fatal MI cases occur outside hospital and death occurs so rapidly after MI onset, it is difficult to effectively prevent deaths from acute MI by improving the in-hospital treatment strategy of acute MI or by reducing the prehospital delay in the treatment. Therefore, we need a new strategy to prevent death from acute MI, mainly by preventing the occurrence of acute MI itself. In this review, we summarize the present status and propose a new strategy, the "STOP MI Campaign", to prevent acute MI by public education.

Usefulness of dual-energy computed tomography for oral cancer image.

OBJECTIVES: We aimed to compare dual-energy computed tomography (DECT) virtual monochromatic imaging (VMI) and iodine density imaging (IDI) of oral cancers in terms of visual scoring and tumour volume estimation. MATERIALS AND METHODS: Nine patients diagnosed with oral cancer who underwent DECT VMI and IDI were enrolled. One radiation oncologist, one head and neck surgeon and nine oral surgeons evaluated image clarity and quality in each patient in terms of metal artefacts due to dental prosthesis, internal tumour structure, tumour-organ boundary and total quality of images for diagnosis. Tumour volume was estimated using VMI, IDI and magnetic resonance imaging (MRI). RESULTS: The mean score for image artefact was significantly higher for IDI than for VMI in three observers, the mean score for internal structure was significantly higher for IDI than for VMI in five, the mean score for tumour-organ boundary was significantly higher for IDI than for VMI in two and the mean score for total quality of images for diagnosis was significantly higher for IDI than for VMI in five. Standard deviation of estimated tumour volume was not significantly different between VMI and IDI, but that of MRI was significantly lowest in three images. CONCLUSIONS: In DECT for oral cancer, IDI has a visual image superior to VMI; thus, we recommend the use of IDI. TRIAL REGISTRATION: Clinical trial number: UMIN000038994.

Microwave Spectroscopy of the Low-Temperature Skyrmion State in Cu_{2}OSeO_{3}.

In the cubic chiral magnet Cu_{2}OSeO_{3} a low-temperature skyrmion state (LTS) and a concomitant tilted conical state are observed for magnetic fields parallel to ⟨100⟩. Here, we report on the dynamic resonances of these novel magnetic states. After promoting the nucleation of the LTS by means of field cycling, we apply broadband microwave spectroscopy in two experimental geometries that provide either predominantly in-plane or out-of-plane excitation. By comparing the results to linear spin-wave theory, we clearly identify resonant modes associated with the tilted conical state, the gyrational and breathing modes associated with the LTS, as well as the hybridization of the breathing mode with a dark octupole gyration mode mediated by the magnetocrystalline anisotropies. Most intriguingly, our findings suggest that under decreasing fields the hexagonal skyrmion lattice becomes unstable with respect to an oblique deformation, reflected in the formation of elongated skyrmions.

Radiotherapy for prostate cancer: Effect of gold fiducial markers on diffusion-weighted magnetic resonance imaging.

PURPOSE: There has been an increase in the use of gold fiducial markers to ensure precise radiotherapy delivery in prostate cancer patients. However, metal artifacts may affect the quality of subsequent imaging used to assess disease status following treatment. In this study, we evaluated the effect of gold fiducial markers on magnetic resonance imaging (MRI), particularly on diffusion-weighted imaging (DWI). MATERIAL AND METHODS: Among 57 patients with prostate cancer, 21 patients in whom two gold markers were placed in the prostate tumor with abnormal signal intensity on DWI were evaluated. The effect of the markers on DWI was evaluated on a scale of 1-5, with a high score indicating clinical usefulness. Change inapparent diffusion coefficient (ADC; 10-3 mm2 /s) from before to after marker placement was also evaluated. RESULTS: The mean effect of the markers on DWI was 4.3 (standard deviation [SD] 1.3, range 2-5) points. The mean change in ADC was 0.045 (SD 0.041, range 0.025-0.089) × 10-3 mm2 /s. CONCLUSIONS: The gold fiducial markers demonstrated negligible effect on DWI quality. Therefore, gold markers do not affect MRI quality, particularly DWI, and may be used during follow-up in prostate cancer patients.

Scores of Child-Pugh Classification Impact Overall Survival After Stereotactic Body Radiation Therapy for Primary and Metastatic Liver Tumors.

BACKGROUND: Stereotactic body radiotherapy (SBRT) delivers high-dose radiation to tumor tissues in few fractions, thereby reducing radiation damage to at-risk organs. There are more potential effects of SBRT owing to the higher biological equivalent dose delivered. Herein, we retrospectively analyzed its effectiveness and toxicity at our institution. METHODS: Data from patients with hepatocellular carcinoma (HCC; n = 10) and liver metastases (n = 10) who underwent SBRT (total dose of 30-50 Gy in 5-10 fractions) between 2013 and 2016 were analyzed. Adverse events were recorded at the end of RT, 6 months after treatment, or upon death. Overall survival (OS) was calculated according to the biological effective dose (BED α/ß = 10) and liver function (Child-Pugh [CP] classification 5 or 6 vs. 7 or 8) after SBRT, using Kaplan-Meier analyses. RESULTS: Of the 20 patients, 6 declined the CP classification score after SBRT; grade 3 adverse events were not seen in any patient. A higher OS rate was seen in patients receiving a higher BED and in those with better CP classification after SBRT. Kaplan-Meier survival analysis yielded a median OS of 401 days and 1- and 2-year OS of 45% and 15%, respectively. CONCLUSION: The higher BED was significantly associated with tumor control, and there were no differences in the tumor control rate between HCC and metastatic tumors. Changes in CP scores after SBRT also affected the survival rate. Good liver function may permit multiple rounds of SBRT.