Optimal partial-arcs in VMAT treatment planning

Purpose: To improve the delivery efficiency of VMAT by extending the recently published VMAT treatment planning algorithm vmerge to automatically generate optimal partial-arc plans. Methods and materials: A high-quality initial plan is created by solving a convex multicriteria optimization problem using 180 equi-spaced beams. This initial plan is used to form a set of dose constraints, and a set of partial-arc plans is created by searching the space of all possible partial-arc plans that satisfy these constraints. For each partial-arc, an iterative fluence map merging and sequencing algorithm (vmerge) is used to improve the delivery efficiency. Merging continues as long as the dose quality is maintained above a user-defined threshold. The final plan is selected as the partial arc with the lowest treatment time. The complete algorithm is called pmerge. Results: Partial-arc plans are created using pmerge for a lung, liver and prostate case, with final treatment times of 127, 245 and 147 seconds. Treatment times using full arcs with vmerge are 211, 357 and 178 seconds. Dose quality is maintained across the initial, vmerge, and pmerge plans to within 5% of the mean doses to the critical organs-at-risk and with target coverage above 98%. Additionally, we find that the angular distribution of fluence in the initial plans is predictive of the start and end angles of the optimal partial-arc. Conclusions: The pmerge algorithm is an extension to vmerge that automatically finds the partial-arc plan that minimizes the treatment time. VMAT delivery efficiency can be improved by employing partial-arcs without compromising dose quality. Partial arcs are most applicable to cases with non-centralized targets, where the time savings is greatest

Bambara groundnut, Vigna subterranea (L.) Verdc.

Bambara groundnut (Vigna subterranea) is an indigenous African crop that has been cultivated for centuries from Senegal to Kenya, and from the Sahara to South Africa and Madagascar. Despite its drought tolerant properties, bambara groundnut has largely been ignored by the scientific community being regarded as a poor man's crop. This workshop represents an effort to coordinate efforts across Africa aimed at the conservation of genetic resources of V. subterranea and its development as a crop. Following a brief introduction and a bibliographical review, country reports are presented from 11 African countries detailing production, genetic resources and potential for breeding. These are followed by 6 papers each in two sections on agronomy and genetic resources, the recommendations of working groups and a report on the establishment of the International Bambara Groundnut Network. Four appendices include the workshop programme, a list of participants, addresses of bambara groundnut researchers, and institutions maintaining collections. (Abstract © CAB ABSTRACTS, CAB International

Radiotherapy treatment planning of prostate cancer using magnetic resonance imaging

Purpose.-Magnetic resonance imaging (MRI) plays an increasing role in radiotherapy dose planning. Indeed, MRI offers superior soft tissue contrast compared to computerized tomography (CT) and therefore could provide a better delineation of target volumes and organs at risk than CT for radiotherapy. Furthermore, an MRI-only radiotherapy workflow would suppress registration errors inherent to the registration of MRI with CT. However, the estimation of the electronic density of tissues using MRI images is still a challenging issue. The purpose of this work was to design and evaluate a pseudo-CT generation method for prostate cancer treatments. Materials and methods.-A pseudo-CT was generated for ten prostate cancer patients using an elastic deformation based method. For each patient, dose delivered to the patient was calculated using both the planning CT and the pseudo-CT. Dose differences between CT and pseudo-CT were investigated. Results.-Mean dose relative difference in the planning target volume is 0.9% on average and ranges from 0.1% to 1.7%. In organs at risks, this value is 1.8%, 0.8%, 0.8% and 1% on average in the rectum, the right and left femoral heads, and the bladder respectively. Conclusio.-The dose calculated using the pseudo-CT is very close to the dose calculated using the CT for both organs at risk and PTV. These results confirm that pseudo-CT images generated using the proposed method could be used to calculate radiotherapy treatment doses on MRI images. (C) 2019 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.Peer reviewe

Considerable Variability Among Transplant Nephrologists in Judging Deceased Donor Kidney Offers

Introduction: Transplant clinicians may disagree on whether or not to accept a deceased donor kidney offer. We investigated the interobserver variability between transplant nephrologists regarding organ acceptance and whether the use of a prediction model impacted their decisions.Methods: We developed an observational online survey with 6 real-life cases of deceased donor kidneys offered to a waitlisted recipient. Per case, nephrologists were asked to estimate the risk of adverse outcome and whether they would accept the offer for this patient, or for a patient of their own choice, and how certain they felt. These questions were repeated after revealing the risk of adverse outcome, calculated by a validated prediction model. Results: Sixty Dutch nephrologists completed the survey. The intraclass correlation coefficient of their estimated risk of adverse outcome was poor (0.20, 95% confidence interval [CI] 0.08–0.62). Interobserver agreement of the decision on whether or not to accept the kidney offer was also poor (Fleiss kappa 0.13, 95% CI 0.129–0.130). The acceptance rate before and after providing the outcome of the prediction model was significantly influenced in 2 of 6 cases. Acceptance rates varied considerably among transplant centers. Conclusion: In this study, the estimated risk of adverse outcome and subsequent decision to accept a suboptimal donor kidney varied greatly among transplant nephrologists. The use of a prediction model could influence this decision and may enhance nephrologists’ certainty about their decision.</p

Are mesenchymal stromal cells immune cells?

Mesenchymal stromal cells (MSCs) are considered to be promising agents for the treatment of immunological disease. Although originally identified as precursor cells for mesenchymal lineages, in vitro studies have demonstrated that MSCs possess diverse immune regulatory capacities. Pre-clinical models have shown beneficial effects of MSCs in multiple immunological diseases and a number of phase 1/2 clinical trials carried out so far have reported signs of immune modulation after MSC infusion. These data indicate that MSCs play a central role in the immune response. This raises the academic question whether MSCs are immune cells or whether they are tissue precursor cells with immunoregulatory capacity. Correct understanding of the immunological properties and origin of MSCs will aid in the appropriate and safe use of the cells for clinical therapy. In this review the whole spectrum of immunological properties of MSCs is discussed with the aim of determining the position of MSCs in the immune system

Seasonal variability in the abundance and stable carbon-isotopic composition of lipid biomarkers in suspended particulate matter from a stratified equatorial lake (Lake Chala, Kenya/Tanzania): Implications for the sedimentary record

We studied the distribution and stable carbon-isotopic (δ13C) composition of various lipid biomarkers in suspended particulate matter (SPM) from the water column of Lake Chala, a permanently stratified crater lake in equatorial East Africa, to evaluate their capacity to reflect seasonality in water-column processes and associated changes in the lake's phytoplankton community. This lake has large seasonal variation in water-column dynamics (stratified during wet seasons and mixing during dry seasons) with associated phytoplankton succession. We analyzed lipid biomarkers in SPM collected monthly at 5 depths (0–80 m) from September 2013 to January 2015. Seasonal variation in total phytoplankton biovolume is strongly reflected in the concentration of phytadienes, a derivative of the general photosynthetic pigment chlorophyll. The wax and wane of several specific biomarker lipids between June and December 2014 reflect pronounced phytoplankton succession after deep mixing, starting with a long and sustained chlorophyte bloom (reflected by C23:1, C25:1 and Cn-alkenes, and C21 and C23n-alkanes), followed by a peak in diatoms between July and October (loliolide and isololiolide), and then eustigmatophytes (C30 and C32 1,15 diols) once stratification resumes in October. Peak abundance of the C19:1n-alkene during shallow mixing of the water column in January–February 2014 can be tentatively linked to the seasonal distribution of cyanobacteria. The concentration, seasonal variability, and low δ13C values of the C28 fatty acid in the SPM suggest that this biomarker is produced in the water column of Lake Chala instead of having the typically assumed vascular plant origin. The δ13C signature of particulate carbon and all aquatic biomarkers become increasingly more negative (by up to 16‰) during mixing-induced episodes of high productivity, whereas enrichment would be expected during such blooms. This reversed fractionation may be attributed to chemically enhanced diffusion, which generates depleted HCO3− under high pH (>9) conditions, as occur in the epilimnion of Lake Chala during periods of high productivity. The influence of this process can potentially explain previously observed 13C-depleted carbon signatures in the paleorecord of Lake Chala, and should be considered prior to paleorecord interpretation of organic-matter δ13C values derived (partially) from aquatic organisms in high-pH, i.e. alkaline, lake

Evaluation of Convalescent Plasma for Ebola Virus Disease in Guinea

: In the wake of the recent outbreak of Ebola virus disease (EVD) in several African countries, the World Health Organization prioritized the evaluation of treatment with convalescent plasma derived from patients who have recovered from the disease. We evaluated the safety and efficacy of convalescent plasma for the treatment of EVD in Guinea. : In this nonrandomized, comparative study, 99 patients of various ages (including pregnant women) with confirmed EVD received two consecutive transfusions of 200 to 250 ml of ABO-compatible convalescent plasma, with each unit of plasma obtained from a separate convalescent donor. The transfusions were initiated on the day of diagnosis or up to 2 days later. The level of neutralizing antibodies against Ebola virus in the plasma was unknown at the time of administration. The control group was 418 patients who had been treated at the same center during the previous 5 months. The primary outcome was the risk of death during the period from 3 to 16 days after diagnosis with adjustments for age and the baseline cycle-threshold value on polymerase-chain-reaction assay; patients who had died before day 3 were excluded. The clinically important difference was defined as an absolute reduction in mortality of 20 percentage points in the convalescent-plasma group as compared with the control group. : A total of 84 patients who were treated with plasma were included in the primary analysis. At baseline, the convalescent-plasma group had slightly higher cycle-threshold values and a shorter duration of symptoms than did the control group, along with a higher frequency of eye redness and difficulty in swallowing. From day 3 to day 16 after diagnosis, the risk of death was 31% in the convalescent-plasma group and 38% in the control group (risk difference, -7 percentage points; 95% confidence interval [CI], -18 to 4). The difference was reduced after adjustment for age and cycle-threshold value (adjusted risk difference, -3 percentage points; 95% CI, -13 to 8). No serious adverse reactions associated with the use of convalescent plasma were observed. : The transfusion of up to 500 ml of convalescent plasma with unknown levels of neutralizing antibodies in 84 patients with confirmed EVD was not associated with a significant improvement in survival. (Funded by the European Union's Horizon 2020 Research and Innovation Program and others; ClinicalTrials.gov number, NCT02342171.).<br/