Predictors of Quality of Life Decline in Patients with Oligometastases treated with Stereotactic Ablative Radiotherapy: Analysis of the Population-Based SABR-5 Phase II Trial.

AIMS: Most patients experience stable quality of life (QoL) after stereotactic ablative radiotherapy (SABR) treatment for oligometastases. However, a subset of patients experience clinically relevant declines in QoL on post-treatment follow-up. This study aimed to identify risk factors for QoL decline. MATERIALS AND METHODS: The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases. Prospective QoL was measured using treatment site-specific tools at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. The time to persistent QoL decline was calculated as the time from SABR to the first decline in QoL score meeting minimum clinically important difference with no improvement to baseline score on subsequent assessments. Univariable and multivariable logistic regression analyses were carried out to determine factors associated with QoL decline. RESULTS: One hundred and thirty-three patients were included with a median follow-up of 32 months (interquartile range 25-43). Thirty-five patients (26%) experienced a persistent decline in QoL. The median time until persistent QoL decline was not reached. The cumulative incidence of QoL decline at 2 and 3 years were 22% (95% confidence interval 14.0-29.6) and 40% (95% confidence interval 28.0-51.2), respectively. In multivariable analysis, disease progression (odds ratio 5.23, 95% confidence interval 1.59-17.47, P = 0.007) and adrenal metastases (odds ratio 9.70, 95% confidence interval 1.41-66.93, P = 0.021) were associated with a higher risk of QoL decline. Grade 3 or higher (odds ratio 3.88, 95% confidence interval 0.92-16.31, P = 0.064) and grade 2 or higher SABR-associated toxicity (odds ratio 2.24, 95% confidence interval 0.85-5.91, P = 0.10) were associated with an increased risk of QoL decline but did not reach statistical significance. CONCLUSIONS: Disease progression and adrenal lesion site were associated with persistent QoL decline following SABR. The development of grade 3 or higher toxicities was also associated with an increased risk, albeit not statistically significant. Further studies are needed, focusing on the QoL impact of metastasis-directed therapies.

Prospective Longitudinal Assessment of Quality of Life After Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-based SABR-5 Phase II Trial.

AIMS: To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. MATERIALS AND METHODS: The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases, conducted in six regional cancer centres in British Columbia, Canada from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and at 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and the baseline score of individual patients. The mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with 'stable', 'improved' or 'worsened' QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI functional interference score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). RESULTS: All enrolled patients with baseline QoL assessment and at least one follow-up assessment were analysed (n = 133). On equivalence testing, the patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% confidence interval 1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% confidence interval 1.15 to 2.21; FACIT-AD TOI mean difference: -8.76, 90% confidence interval -11.29 to -6.24; POSI mean difference: -4.61, 90% confidence interval -6.09 to -3.14). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). Most patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. CONCLUSIONS: Transient decreases in QoL that met MCID were seen between patients' worst QoL scores and baseline scores. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterise patients at greatest risk for decreased QoL.

Kayser-Fleischer-like rings in patients with hepatic disease.

Purpose: The aim of this work was to study Kayser-Fleischer [KF]-like rings in patients with hepatic or cholestatic liver disease and to find out the relation between serum bilirubin level and the presence of KF like ring in these patients. Methods: In this study, we evaluated patients with hepatic and cholestatic liver diseases with total Serum bilirubin levels >10 mg/dl. These patients were evaluated for the presence or absence of KF like ring. Results: A total of 67 patients with total bilirubin >10 mg/dl were included in the study. Patients were divided into 3 groups based on total S. bilirubin level: Group 1 with S. bilirubin >30 mg/dl, Group 2 with S. bilirubin >20 - <30 mg/dl and Group 3 with S. bilirubin >10 - <20 mg/dl at baseline evaluation. On follow-up they were divided into 3 groups based on the serum bilirubin level. Group 1- >20 mg/dl, Group 2- >10 - <20 mg/dl, Group 3- <10 mg/dl. KF like ring was seen in 98.5% of patients with high total S. bilirubin level. KF like ring disappeared in 87.5% of patients with reduction in the total S. bilirubin level to less than 10 mg/dl. Conclusion: KF like ring was seen in 98.5% of patients with high total S. bilirubin, disappeared in 87.5% of patients with reduction in the total S. bilirubin level to less than 10 mg/dl. There was no significant difference between the Total S. bilirubin levels, age, gender and KF Like Ring.

First Observation of Multiple Transverse Wobbling Bands of Different Kinds in

We report the first observation of two wobbling bands in ^{183}Au, both of which were interpreted as the transverse wobbling (TW) band but with different behavior of their wobbling energies as a function of spin. It increases (decreases) with spin for the positive (negative) parity configuration. The crucial evidence for the wobbling nature of the bands, dominance of the E2 component in the ΔI=1 transitions between the partner bands, is provided by the simultaneous measurements of directional correlation from the oriented states ratio and the linear polarization of the γ rays. Particle rotor model calculations with triaxial deformation reproduce the experimental data well. A value of spin, I_{m}, has been determined for the observed TW bands below which the wobbling energy increases and above which it decreases with spin. The nucleus ^{183}Au is, so far, the only nucleus in which both the increasing and the decreasing parts are observed and thus gives the experimental evidence of the complete transverse wobbling phenomenon.

Investigation of Morphological Variations of Photoplethysmography Signal in Human Epilepsy.

The purpose of this study is to analyse the ictal variations in peripheral blood flow using photoplethysmogram (PPG) and single lead Electrocardiogram (ECG) signals. 11 subjects with 56 partial seizures were recorded with the PPG sensor worn on their left ankles. 6 different features from PPG pulse morphology related to hemodynamics were derived. The seizures were divided into two groups based on the side of the seizure activity. The investigation of ictal variations in features did not show any significant difference between the seizures' lateralizations. The analysis of latencies of ictal changes in the PPG features revealed the PPG pulse amplitude precede the variations in other PPG features including ictal heart rate variability. In addition, analysis of the effect of seizure lengths on ictal variations showed the seizures' lengths have no significant effect on the feature variation rates.Clinical relevance- Analysis of the extracted PPG features and their timing suggest an increase in vascular resistance due to increase in sympathetic tone which occurs prior to the ictal tachycardia. These variations is independent of the seizures' lengths and lateralizations.

Agreement and repeatability of Icare ic100 tonometer.

PURPOSE: To find the agreement and repeatability of Icare ic100 tonometer. METHODS: We included 150 subjects above the age of 18 years for this cross-sectional, multicenter study with intraocular pressure (IOP) ≥7 mmHg. After the initial ophthalmic examination, two masked examiners took five IOP measurements using three different instruments; Icare ic100, Icare TA01i, and Goldmann applanation tonometer (GAT) in only one eye of the participants. Comparison of agreement of IOP using different instruments was quantified with intraclass correlation coefficient (ICC) using the two-way random effects models of absolute agreement and Cronbach's alpha. The test-retest variability of the instruments was assessed by deriving repeatability coefficient (RC) and coefficient of variation (CV). RESULTS: Agreement between the tonometers across the different IOP groups had no statistically significant difference in their mean IOP. Icare ic100 was found to have good reliability across all IOP groups (ICC value >0.78) when compared with Icare TA01i. In comparison with GAT, Icare ic100 showed good reliability across all IOP groups (ICC >0.87) except >16 to <23 mmHg group where it showed moderate reliability (ICC = 0.52). Icare ic100 showed good repeatability with RC and CV of 2.67 and 4.89, respectively. CONCLUSION: Icare ic100 rebound tonometer can measure IOP with relatively small measurement error and can provide a reliable and repeatable reading in comparison with GAT across a wide pressure range without hampering corneal health.

Perineurioma -a rare cause of proptosis.

Perineurioma is a rare benign soft tissue tumor arising from the peripheral nerve sheath. To date only two cases of orbital perineurioma have been reported in literature. A 45-year-old, with no comorbidities, presented with protrusion of the right eye since one-year. Examination revealed 8mm proptosis of the right eye. Dilated fundoscopy of the right eye showed a pale optic disc with choroidal folds temporal to it. Computerised Tomogram (CT) of the orbit showed a well-defined intraconal mass in the inferotemporal part of the orbit. A trans conjunctival orbitotomy with lateral canthotomy was performed and the tumor was removed en bloc. On immunohistochemistry, the tumour was negative for S-100 and showed patchy weak Epithelial Membrane Antigen positivity which was suggestive of a soft tissue perineurioma.

A comparison of posterior capsular opacification after implantation of three different hydrophobic square edge intraocular lenses.

Purpose: To compare the posterior capsular opacification (PCO) after implantation of three types of hydrophobic square edge intraocular lenses (IOLs). Methods: A single-center, hospital-based, cross-sectional, observational study was conducted wherein patients with senile cataract who had undergone phacoemulsification by a single surgeon, with the implantation of three different types of square edge, hydrophobic IOLs [Group 1: enVista, Bausch and Lomb; Group 2: Tecnis 1 ZCBOO, AMO and Group 3: Acrysof IQ SN60WF, Alcon], and followed up for 12 months were included. The PCO was graded clinically and scored using the EPCO 2000 software. Results: 90 eyes of 90 patients were included. There was no significant difference in the PCO with respect to age, gender, or associated presence of systemic disease. The median PCO score was 0.035, 0.045 and 0.085 in groups 1, 2 and 3, respectively. The PCO grade and score differences between the groups were statistically significant with P < 0.001. Conclusion: The hydrophobic nature and posterior square edge design in the IOLs probably contributed to the minimal visually-significant PCO in all the groups, in our study. However, PCO scores were lesser in the square edge IOLs having a continuous 360 degrees posterior enhanced barrier, than those without this feature.

Reducing the Computational Complexity of EEG Source Localization With Cortical Patch Decomposition and Optimal Electrode Selection.

OBJECTIVE: Real-time implementation of EEG source localization can be employed in a broad area of applications such as clinical diagnosis of neurologic diseases and brain-computer interface. However, a power-efficient, low-complexity, and real-time implementation of EEG source localization is still challenging due to extensive iterations in the solutions. In this study, two techniques are introduced to reduce the computational burden of the subspace-based MUltiple SIgnal Classification (MUSIC) algorithm. METHODS: To shrink the exhaustive search inherent in MUSIC, the cortex is parsed into cortical regions. A novel nomination procedure involving a dictionary learning step will pick a number of regions to be searched for the active sources. In addition, a new electrode selection algorithm based on the Cramer-Rao bound of the errors is introduced to pick the best set of an arbitrary number of electrodes out of the total. RESULTS: The performance of the proposed techniques were evaluated using simulated EEG signal under variation of different parameters such as the number of nominated regions, the signal to noise ratio, and the number of electrodes. The proposed techniques can reduce the computational complexity by up to $90\%$. Furthermore, the proposed techniques were tested on EEG data from an auditory oddball experiment. CONCLUSION: A good concordance was observed in the comparison of the topographies and the localization errors derived from the proposed technique and regular MUSIC. SIGNIFICANCE: Such reduction can be exploited in the real-time, long-run, and mobile monitoring of cortical activity for clinical diagnosis and research purposes.

Serum Bile Acids in Patients With Primary Open-angle Glaucoma.

PURPOSE: To measure the serum bile acids (SBA) in patients with primary open-angle glaucoma (POAG) and to compare with nonglaucomatous controls. PATIENTS AND METHODS: A hospital-based case control study of 90 patients above the age of 40 years was conducted. Patients with POAG formed the study group and individuals without glaucoma in the same age group formed the control group. SBA estimation was done using ELISA kit enzymatic assay technique and the median value was compared between the 2 groups. RESULTS: The median of SBA level was found to be more in POAG patients when compared with the control group. The difference was statistically significant (P<0.001). Median SBA level was not affected by the age or sex of the participants in the study. CONCLUSIONS: "Bile acids" may have a role in the oxidative stress and apoptosis involved in the pathophysiology of POAG.

Isolated neurofibroma of the eyelid mimicking recurrent chalazion.

Neurofibroma is a peripheral nerve sheath tumor which is seen in neurofibromatosis type 1 and is characterized by various ophthalmic manifestations. Solitary neurofibroma of the eyelid is rare. We report a case of a 53-year-old female patient who presented with a painless swelling in the left upper lid of 4 years' duration. She had undergone surgery for the same lesion twice. The lesion was excised and histopathological examination revealed a solitary neurofibroma. She did not have any other features of generalized neurofibromatosis.

Primary squamous cell carcinoma arising from palpebral conjunctiva: A rare presentation.

Squamous cell carcinoma (SCC) of the conjunctiva usually arises from the limbal conjunctiva. Rarely, it can arise from the palpebral conjunctiva. We report a case of primary conjunctival SCC of the palpebral conjunctiva which was treated successfully.

Application of infrared scanning of the neck muscles to control a cursor in Human-Computer Interface.

The feasibility of using infrared (IR) spectroscopy of the neck muscles in controlling a cursor in a 2-dimensional screen was assessed. The proposed technique utilizes two IR photoplethysmography sensors (λ = 940nm) to monitor the morphological changes of the Scalene and Sternocleidomastoid muscles. Since the reflection of the light has valuable information about the type of contraction, the direction of the movement (right/left, up/down) can be simply derived using two sensors. A MATLAB platform was developed in which a cursor moves using the recorded signal. Three scenarios of high/low sensitivity and joystick mode were tested. The results from 4 different healthy subjects shows the feasibility of control in terms of throughput, overshoot, and path efficiency.

Corneal ulcer due to a rare pleosporalean member of the genus Bipolaris following cow tail injury to the eye: A case report and review of literature.

Aspergillus and Fusarium are the most common fungi causing mycotic keratitis. Injury to the eye with vegetable matter, cow tail injury, long-term use of topical steroids are some of the risk factors for mycotic keratitis. There are few case reports of keratitis caused by Bipolaris. The human pathogenic species in the genus are Bipolaris spicifera, Bipolaris hawaiiensis, Bipolaris papendorfii, and Bipolaris australiensis. Most commonly reported keratitis is caused by B. hawaiiensis, followed by B. spicifera. Literature review showed only one case report of keratitis due to B. australiensis reported from Australia. We present a first case report of keratitis due to B. australiensis (currently Curvularia australienis) from India.

Role of the Δ Resonance in the Population of a Four-Nucleon State in the

The ^{54}Fe nucleus was populated from a ^{56}Fe beam impinging on a Be target with an energy of E/A=500 MeV. The internal decay via γ-ray emission of the 10^{+} metastable state was observed. As the structure of this isomeric state has to involve at least four unpaired nucleons, it cannot be populated in a simple two-neutron removal reaction from the ^{56}Fe ground state. The isomeric state was produced in the low-momentum (-energy) tail of the parallel momentum (energy) distribution of ^{54}Fe, suggesting that it was populated via the decay of the Δ^{0} resonance into a proton. This process allows the population of four-nucleon states, such as the observed isomer. Therefore, it is concluded that the observation of this 10^{+} metastable state in ^{54}Fe is a consequence of the quark structure of the nucleons.

Rare Case of Polymicrobial Keratitis With Balantidium coli.

PURPOSE: To report a rare case of polymicrobial keratitis due to Balantidium coli and gram-negative bacteria, Pseudomonas aeruginosa and Klebsiella pneumoniae, in a soft contact lens (CL) wearer. METHODS: We report a case of CL-related keratitis due to B. coli, P. aeruginosa, and K. pneumoniae. RESULTS: The culture of the corneal scrapings, the CL cleaning solution, and the CL revealed the growth of a rare ciliated parasite, B. coli, along with gram-negative bacteria, namely, P. aeruginosa and K. pneumoniae. The patient was successfully treated with topical broad-spectrum antibiotics and intravenous metronidazole. CONCLUSIONS: Polymicrobial keratitis has seldom been reported with B. coli as the causative agent. CL wear can be a risk factor for this infection. Treatment with topical antibiotics may not suffice, and the intravenous route of antiprotozoal drugs may be a useful adjunct. Increasing awareness, early diagnosis, and treatment may improve the final visual outcome.