Follow-up of patients after stereotactic radiation for lung cancer: a primer for the nonradiation oncologist.

BACKGROUND: The use of stereotactic ablative radiotherapy (SABR) as primary treatment for early stage non-small-cell lung cancer, or for ablation of metastases, has increased rapidly in the past decade. With local recurrence rates reported at approximately 10%, and a patient population that is becoming increasingly fit and amenable to salvage treatment, appropriate multidisciplinary follow-up care is critical. Appropriate follow-up will allow for detection and management of radiation-related toxicity, early detection of recurrent disease and differentiation of recurrence from radiation-induced lung injury. METHODS: This narrative review summarizes issues surrounding follow-up of patients treated with SABR in the context of a multidisciplinary perspective. We summarize treatment-related toxicities including radiation pneumonitis, chest wall pain, rib fracture, and fatal toxicity, and highlight the challenges of early and accurate detection of local recurrence, while avoiding unnecessary biopsy or treatment of benign radiation-induced fibrotic lung damage. RESULTS: Follow-up recommendations based on the current evidence and available guidelines are summarized. Imaging follow-up recommendations include serial computed tomography (CT) imaging at 3-6 months posttreatment for the initial year, then every 6-12 months for an additional 3 years, and annually thereafter. With suspicion of progressive disease, recommendations include a multidisciplinary team discussion, the use of high-risk CT features for accurate detection of local recurrence, and positron emission tomography/CT SUV max cutoffs to prompt further investigation. Biopsy and/or surgical or nonsurgical salvage therapy can be considered if safe and when investigations are nonreassuring. CONCLUSIONS: The appropriate follow-up of patients after SABR requires collaborative input from nearly all members of the thoracic multidisciplinary team, and evidence is available to guide treatment decisions. Further research is required to develop better predictors of toxicity and recurrence

Potential Impacts of Food Borne Ill Incidence on Market Movements and Prices of Fresh Produce in the US

For many decades, fresh fruits and vegetables enjoyed a reputation as the healthiest products full of essential vitamins, minerals, and other beneficial substances for a balanced diet. However, numerous recent food outbreaks associated with fresh produce have raised concerns on the mind of the consumer. Following an outbreak, consumers reduce their immediate consumption of the affected products. Even tough fresh fruits and vegetables have unique characteristics and flavors, consumers tend to substitute affected outbreak products with other fruits and vegetables. The potential impact of food borne illness on consumption has also a longer term impact, reducing consumption of the products over a period of several months after the outbreak. This paper used historical decomposition analysis to study both, the contemporaneous and lagged effects of food borne illness in the fresh produce industry using three case studies, spinach, cantaloupes, and tomatoes.Food safety, fresh produce, historical decomposition, Food Consumption/Nutrition/Food Safety,

Systematic review of hepatitis C virus prevalence and incidence among HIV-positive men who have sex with men (MSM) in England

Background: Hepatitis C virus (HCV) infection is a leading cause of hepatitis C, liver cancer, and cirrhosis. It is treatable with directing acting antivrials (DAAs), yet still accounts for over 580,000 global deaths annually. Due to the nature of transmission and particular risk factors, men living with HIV who have sex with other men (HIV+ MSM) are disportionately burdened. Whilst HCV is a statutorily notifiable disaease in England and a virtually complete registry exists, data specific to MSM are not captured, leaving gaps in our knowledge of HCV trends among HIV+ MSM. Methods: This paper aims to investigate the HCV prevalence and incidence among HIV+ MSM in England through a systematic review of academic literature. Results: The systematic review resulted in six articles. Evidence suggests that incidence has generally risen between 2002-2015 and declined between 2015-2018, which may be attributed to the introduction of DAAs. The range of reported prevalences varied from 2.2%-9.9% , the most recent estimate being 4.24% in 2018. Conclusions: This review's deficiency is the non-existent record of behavioural risk factors across the studies. Most studies recruited HIV+ MSM from HIV clinics, an arguably robust sampling method considering that 90% of those living with HIV in England are engaged in care at an HIV clinic. The gaps in the academic literature and national surveillance for HCV among HIV+ MSM demonstrate this group to be disproportionately under-studied. National surveillance ought to record HCV cases and risk factors specific to HIV+ MSM to better inform interventions

Convergent evolution of SWS2 opsin facilitates adaptive radiation of threespine stickleback into different light environments

Repeated adaptation to a new environment often leads to convergent phenotypic changes whose underlying genetic mechanisms are rarely known. Here, we study adaptation of color vision in threespine stickleback during the repeated postglacial colonization of clearwater and blackwater lakes in the Haida Gwaii archipelago. We use whole genomes from 16 clearwater and 12 blackwater populations, and a selection experiment, in which stickleback were transplanted from a blackwater lake into an uninhabited clearwater pond and resampled after 19 y to test for selection on cone opsin genes. Patterns of haplotype homozygosity, genetic diversity, site frequency spectra, and allele-frequency change support a selective sweep centered on the adjacent blue- and red-light sensitive opsins SWS2 and LWS. The haplotype under selection carries seven amino acid changes in SWS2, including two changes known to cause a red-shift in light absorption, and is favored in blackwater lakes but disfavored in the clearwater habitat of the transplant population. Remarkably, the same red-shifting amino acid changes occurred after the duplication of SWS2 198 million years ago, in the ancestor of most spiny-rayed fish. Two distantly related fish species, bluefin killifish and black bream, express these old paralogs divergently in black- and clearwater habitats, while sticklebacks lost one paralog. Our study thus shows that convergent adaptation to the same environment can involve the same genetic changes on very different evolutionary time scales by reevolving lost mutations and reusing them repeatedly from standing genetic variation

Magnetic resonance imaging biomarkers of chronic obstructive pulmonary disease prior to radiation therapy for non-small cell lung cancer.

OBJECTIVE: In this prospectively planned interim-analysis, the prevalence of chronic obstructive lung disease (COPD) phenotypes was determined using magnetic resonance imaging (MRI) and X-ray computed tomography (CT) in non-small-cell-lung-cancer (NSCLC) patients. MATERIALS AND METHODS: Stage-III-NSCLC patients provided written informed consent for pulmonary function tests, imaging and the 6-min-walk-test. Ventilation defect percent (VDP) and CT lung density (relative-of-CT-density-histogram RESULTS: Seventeen stage-III NSCLC patients were evaluated (68 ± 7 years, 7 M/10 F, mean FEV1 = 77%pred) including seven current and 10 ex-smokers and eight patients with a prior lung disease diagnosis. There was a significant difference for smoking history (p = .02) and FEV1/FVC (p = .04) for subgroups classified using quantitative imaging. Patient subgroups classified using qualitative imaging findings were significantly different for emphysema (RA950, p \u3c .001). There were significant relationships for whole-lung VDP (p \u3c .05), but not RECIST or tumour-lobe VDP measurements with pulmonary function and exercise measurements. Preliminary analysis for non-tumour burden ventilation abnormalities using Reader-operator-characteristic (ROC) curves reflected a 94% classification rate for smoking pack-years, 93% for FEV1/FVC and 82% for RA950. ROC sensitivity/specificity/positive/negative likelihood ratios were also generated for pack-years, (0.92/0.80/4.6/0.3), FEV1/FVC (0.92/0.80/4.6/0.3), RA950 (0.92/0.80/4.6/0.3) and RECIST (0.58/0.80/2.9/1.1). CONCLUSIONS: In this prospectively planned interim-analysis of a larger clinical trial, NSCLC patients were classified based on COPD imaging phenotypes. A proof-of-concept evaluation showed that FEV1/FVC and smoking history identified NSCLC patients with ventilation abnormalities appropriate for functional lung avoidance radiotherapy

miR-10a is aberrantly overexpressed in Nucleophosmin1 mutated acute myeloid leukaemia and its suppression induces cell death

<p>Abstract</p> <p>Background</p> <p>Acute myeloid leukaemia (AML) with nucleophosmin-1 (<it>NPM1</it>) mutation is a major subtype of AML. The <it>NPM1 </it>mutation induces a myeloproliferative disorder, but evidence indicates that other insults are necessary for the development of AML. We utilised microRNA microarrays and functional assays to determine if microRNA dysregulation could be involved in the pathogenesis of in <it>NPM1 </it>mutated (<it>NPM1^mut</it>)-AML.</p> <p>Results</p> <p>We used a stringent locked nucleic acid (LNA) based microRNA microarray platform to profile bone marrow samples of patients with normal karyotype AML. A panel of five microRNAs dichotomised AML patients according to their <it>NPM1 </it>mutational status. miR-10a, let-7b and let-7c were significantly over-expressed, while miR-130a and miR-335 were under-expressed in <it>NPM1^mut</it>-AML when compared to <it>NPM1^wildtype</it>-AML. Of these, miR-10a is the most differentially expressed in <it>NPM1^mut</it>-AML versus <it>NPM1^wildtype</it>-AML (> 10 fold higher as confirmed by qRT-PCR). To investigate the functions of miR-10a, the OCI-AML3 cell line was utilised, which is the only commercially available cell line bearing <it>NPM1^mut</it>. OCI-AML3 cells were firstly demonstrated to have a similarly high miR-10a expression to primary <it>NPM1^mut</it>-AML patient samples. Inhibition of miR-10a expression by miRCURY LNA Inhibitors (Exiqon) in these cells resulted in increased cell death as assessed by MTS, cell cycle and Annexin-V assays and reduced clonogenic capacity, indicative of an involvement in leukaemic cell survival. <it>In silico </it>filtering of bioinformatically predicted targets of miR-10a identified a number of potential mRNA targets with annotated functions in haematopoiesis, cell growth and apoptosis. Lucferase reporter assays confirmed a number of these putative tumorogenic genes that are miR-10a suppressible including <it>KLF4 </it>and <it>RB1CC1</it>. This provides a potential mechanism for the pathogenic role of miR-10a in <it>NPM1^mut</it>-AML.</p> <p>Conclusions</p> <p>This study provides, for the first time, <it>in vitro </it>evidence of a pro-survival role of miR-10a in <it>NPM1^mut</it>-AML, that it may contribute to the pathogenesis of <it>NPM1^mut</it>-AML and identifies putative tumorogenic targets.</p

Inoculation with rumen fluid in early life as a strategy to optimize the weaning process in intensive dairy goat systems

Ruminants are born with an undeveloped physical, metabolic, and microbial rumen. Rumen development is limited under artificial rearing systems when newborn animals are separated from the dam, fed on milk replacer, and weaned at an early age. This study aims to evaluate the effects of early-life inoculation of young ruminants with rumen fluid from adult animals. Eighty newborn goat kids were randomly allocated to 1 of 4 experimental treatments and inoculated daily from d 1 to wk 11 with autoclaved rumen fluid (AUT), fresh rumen fluid obtained from adult goats fed either a forage diet (RFF) or concentrate-rich diet (RFC), or absence of inoculation (CTL). Goat kids were artificially reared with ad libitum access to milk replacer, starter concentrate, and forage hay. Blood was sampled weekly and rumen microbial fermentation was monitored at 5 (preweaning), 7 (weaning), and 9 wk of age (postweaning). Results indicated that inoculation with fresh rumen fluid accelerated the rumen microbial and fermentative development before weaning. As a result, RFC and RFF animals had higher solid feed intake (+73%), rumen concentrations of ammonia-N (+26%), total volatile fatty acids (+46%), butyrate (+50%), and plasma β-hydroxybutyrate (+48%), and lower milk intake (−6%) than CTL and AUT animals at wk 5. Inoculation with fresh inoculum also promoted early rumen colonization by a complex and abundant protozoal community, whereas CTL animals remained protozoa free. Although all kids experienced moderate growth retardation during 1 wk after weaning, inoculation with fresh rumen fluid favored the weaning process, leading to 2.2 times higher weight gain than CTL and AUT animals during wk 8. Some of these advantages were retained during the postweaning period and RFF and RFC animals showed higher forage intake (up to +44%) than CTL and AUT animals with no detrimental effects on feed digestibility or stress levels. The superior microbial load of RFC compared with RFF inoculum tended to provide further improvements in terms of forage intake, plasma β-hydroxybutyrate, and rumen protozoa, whereas AUT inoculation provided minor (if any) advantages with respect to CTL animals. Although no differences were noted on animal growth, this study suggests that early life inoculation of goat kids with rumen microbiota can represent an effective strategy to accelerate the rumen development, facilitating a smooth transition from milk to solid feed and to the potential implementation of early weaning strategies.This study was funded by the Spanish government through the project AGL2017-86938-R and the Training Program for Academics grant, Madrid, Spain (FPU16/01981)