Exploratory study of using Magnetic resonance Prognostic Imaging markers for Radiotherapy In Cervix cancer (EMPIRIC): a prospective cohort study protocol.

INTRODUCTION: Radical chemoradiotherapy represents the gold standard for locally advanced cervical cancer. However, despite significant progress in improving local tumour control, distant relapse continues to impact overall survival. The development of predictive and prognostic biomarkers is consequently important to risk-stratify patients and identify populations at higher risk of poorer treatment response and survival outcomes. Exploratory study of using Magnetic resonance Prognostic Imaging markers for Radiotherapy In Cervix cancer (EMPIRIC) is a prospective exploratory cohort study, which aims to investigate the role of multiparametric functional MRI (fMRI) using diffusion-weighed imaging (DWI), dynamic contrast-enhanced (DCE) and blood oxygen level-dependent imaging (BOLD) MRI to assess treatment response and predict outcomes in patients undergoing radical chemoradiotherapy for cervical cancer. METHODS AND ANALYSIS: The study aims to recruit 40 patients across a single-centre over 2 years. Patients undergo multiparametric fMRI (DWI, DCE and BOLD-MRI) at three time points: before, during and at the completion of external beam radiotherapy. Tissue and liquid biopsies are collected at diagnosis and post-treatment to identify potential biomarker correlates against fMRI. The primary outcome is to evaluate sensitivity and specificity of quantitative parameters derived from fMRI as predictors of progression-free survival at 2 years following radical chemoradiotherapy for cervical cancer. The secondary outcome is to investigate the roles of fMRI as predictors of overall survival at 2 years and tumour volume reduction across treatment. Statistical analyses using regression models and survival analyses are employed to evaluate the relationships between the derived parameters, treatment response and clinical outcomes. ETHICS AND DISSEMINATION: The EMPIRIC study received ethical approval from the NHS Health Research Authority (HRA) on 14 February 2022 (protocol number RD2021-29). Confidentiality and data protection measures are strictly adhered to throughout the study. The findings of this study will be disseminated through peer-reviewed publications and scientific conferences, aiming to contribute to the growing body of evidence on the use of multiparametric MRI in cervical cancer management. TRIAL REGISTRATION NUMBER: NCT05532930.

Salvage brachytherapy for second ipsilateral breast tumor event: Relating dosimetric analysis to late side effects.

PURPOSE: For second ipsilateral breast tumor event (2ndIBTE), conservative treatment (CT) involving wide local excision plus accelerated partial breast reirradiation (APBrI) is increasingly used as an alternative to mastectomy. This study investigates the impact of APBrI technique and multicatheter interstitial high dose-rate brachytherapy (MIB) dosimetry parameters on toxicity and survival in patients with 2ndIBTE. MATERIALS-METHODS: Data from patients with 2ndIBTE treated with CT, were analyzed. Inclusion criteria specified 2ndIBTE occurring at least one year after 1st CT for primary breast cancer. Treatment details and dosimetry parameters were recorded. Primary endpoint was late toxicity. Secondary endpoints were late toxicity prognostic factors analysis and oncological outcome. RESULTS: From 07/2005 and 07/2023, 201 patients (pts) received 2nd CT. With a median follow-up of 49.6 months (44.9-59.5), tumor size was less than 2 cm (88.1%), with estrogen receptor positive (92.7%). Patients were low (63.7%) or intermediate (29.8%) GEC-ESTRO APBI risk classification. Late toxicities were observed in 34.8% (G1 52.3%, G2 40.7%). Cutaneous fibrosis was the most common toxicity. Cosmetic outcomes were excellent in 64.1%. Dosimetry analysis revealed positive correlations between complications and absolute volumes of CTV, V100, V150, and V200. Volumes requiring higher needle number and lower DNR resulted in fewer complications. 5-year disease-free and overall survival were 88% and 95% respectively. CONCLUSION: Second CT for 2ndIBTE showed favorable oncological outcomes and survival rates. Complications were correlated with specific dosimetric parameters, emphasizing the importance of tailored treatment planning. This study provides valuable insights in risk stratification and MIB optimization for APBrI.

Nano-hydroxyapatite preparation for the remineralization of primary tooth enamel surface subjected to liquid medication: An observational study.

Background and Aims: Acid-induced demineralization may be caused by the consumption of liquid medications routinely administered to children. Therefore, different remineralizing agents, such as fluorides and nano-hydroxyapatite, have been added to oral care products to remineralize erosive lesions. This study was conducted to compare the effectiveness of 1% nano-hydroxyapatite suspension and 2% sodium fluoride solution on the surface texture of primary teeth enamel previously exposed to liquid drugs. Methods: Thirty posterior primary teeth were extracted and grouped depending on the remineralizing agent used: (A) nano-hydroxyapatite and (B) sodium fluoride. Groups A and B were subjected to liquid medication in two subgroups: cephalexin (cephalexin monohydrate) and ParAzar (acetaminophen), followed by remineralization with 1% nano-hydroxyapatite suspension and 2% sodium fluoride solution. An atomic force microscope was used to analyze the surface texture of the primary tooth enamel by measuring the roughness and waviness parameters of the tested surfaces. The examination was performed at baseline, 7 days after exposure to drugs, and after exposure to remineralizing agents. Results: A significant difference in enamel surface roughness between nano-hydroxyapatite-treated surfaces and sodium fluoride-treated surfaces was observed. A significant change was observed in the surface waviness of the primary enamel surface of sodium-fluoride-treated teeth that were subjected to cephalexin. Conclusion: Routine use of liquid medications could have a negative impact on primary enamel surface topography, because the primary tooth enamel is less mineralized than permanent tooth enamel. Our results show that compared with a 2% sodium fluoride solution, a 1% nano-hydroxyapatite suspension can be used for remineralizing and restoring defects of the enamel surface of primary teeth following exposure to liquid medication, thus reinforcing dental tissues with higher efficacy.

Immunotherapy in gastrointestinal cancer: The current scenario and future perspectives.

Gastrointestinal cancers include colorectal, gastric, oesophageal, pancreatic and liver cancers. They continue to be a significant cause of mortality and morbidity worldwide. Current treatment strategies include chemotherapy, surgery, radiotherapy and targeted therapies. Immunotherapy has recently been incorporated in treatment regimens for some gastrointestinal malignancies and research into different immune modifying treatments is being carried out in this context. Approaches to immune modulation such as vaccination, adoptive cell therapy and checkpoint inhibition have shown varying clinical benefit, with most of the benefit seen in checkpoint inhibition. This review summarises recent advances and future direction of immunotherapy in patients with gastrointestinal malignancies.

Characterization and determination of lignin in different types of Iraqi phoenix date palm pruning woods.

This study aimed to find analytical data base for Iraqi phoenix date palm pruning woods, which produced by pruning process at the season of date palm production. Lignin has been extracted and purified for five types of Iraqi date palm using Klason lignin method. The weight of the extracted lignin ranged from 0.410 g to 0.720 g, and the lignin % ranged from 17.6 to 36. The other ingredients (waxes, oils, resin, and proteins of wood gums) % ranged from 20 to 29.5. FT-IR characterization showed that the (-OH) phenolic group appear in Ashrasi lignin structure only and disappear in other lignin samples, and the (4-O-5 inter monomeric lignin linkage) showed strong to moderate intensity peaks for all studied samples except the Austa omran sample has a weak intensity peaks. Also (DODO inter monomeric lignin linkage) showed strong intensity peaks for all studied samples except the Barban sample showed moderate intensity peaks. UV-vis characterization showed that the lowest absorption maximum (266 nm) corresponds to Barban lignin sample, while the highest absorption maximum (271 nm) corresponds to Sultani lignin sample.

Fetal amelia: a case report.

Congenital limb defects are rare fetal anomalies with a birth prevalence of 0.55 per 1,000. Amelia is an extremely rare birth defect marked by the complete absence of one or more limbs. We report a case of fetal amelia, ultrasound findings, manifestations and the fetal outcome.