QUEnch assiSTed (QUEST) MRI Used as a Novel Approach to Identify Reactive Oxygen Species as a Result of Experimental TBI

Introduction: Traumatic brain injury (TBI) generates reactive oxygen species (ROS), promoting inflammatory processes and impeding TBI recovery. Within the VA population, over 70% of military personnel that sustain a TBI receive opioid-based pain relief, however, opiates may actually exacerbate post-TBI complications through its documented recruitment of oxidative and inflammatory systems. Thus, we hypothesize that TBI and opioid treatment act synergistically to worsen post-TBI oxidative stress. Methods: Mice were exposed to either TBI or sham injury and administered morphine or saline in the acute post-injury period. Afterwards, neuroimaging was conducted using a novel technique, QUEnch assiSTed (QUEST) MRI, which compares standard MRI signals across mice that acutely receive an antioxidant “quench” therapy and those receiving saline as control. Therefore, differential MRI signals between these groups are an index of ROS generation. Changes in hippocampus and cortex signals were measured, as these structures are most commonly affected by TBI. Methylene blue and α-lipoic acid were used as antioxidants in the quenching step as they halt mitochondrial ROS production and scavenge excess ROS, respectively. Results: No significant changes in ROS levels were detected as a result of TBI, opioid exposure or their combination using QUEST MRI in either the cortex or hippocampus. Conclusions and Future Directions: While QUEST imaging did not yield significant changes between experimental groups, future work will include ex-vivo biochemical ROS analyses from harvested tissues, which will provide higher resolution quantification of oxidative processes than that of QUEST MRI

Ocular Complications of Facial Burns in the Pediatric Population

Introduction: Pediatric burns commonly involve the face and periocular areas, with a possibility of impairing vision. The aim of this study is to characterize ocular injuries in burn patients and identify the patients at most risk of ocular complications. Methods: This study is a retrospective review within a single academic, urban pediatric burn center. All burn patients under 18 years of age admitted from January 2010 to December 2020 with ocular involvement were included. Variables analyzed included patient demographics, burn characteristics, presence of ophthalmology consultation, ocular exam findings, follow up time period, and early and late ocular complications. Results: In the study period, 2,781 patients were admitted to our burn center, 300 of whom had facial burns involving the eyes and/or eyelids. Etiologies of burn injuries were as follows: 112 (37.5%) scald, 80 (26.8%) flame, 35 (11.7%) contact, 31 (10.4%) chemical, 28 (9.4%) grease, and 13 (4.3%) friction. Overall, 70.9% of patients with ocular burns received an ophthalmology consult. Of these patients, 61.5% had periorbital swelling and 39.8% had corneal injuries. Of the 207 patients who were seen by ophthalmology inpatient, only 61 (29.5%) had a follow-up visit as recommended. Among patients seen outpatient, 6 had serious ocular sequelae including ectropion, entropion, symblepharon, and corneal decompensation, 4 of whom had firework-related injury. Conclusion: Burns involving the ocular surface and eyelid margins are at particular risk for long-term damage. As ocular burns can cause immediate as well as delayed sequalae, ophthalmologic evaluation is important in acute and subacute periods after injury

Proton beam reirradiation for locally recurrent pancreatic adenocarcinoma

BackgroundLocal recurrence following definitive treatment for pancreatic adenocarcinoma is common and can be associated with significant morbidity and mortality. Retreatment options for these patients are limited. Proton beam reirradiation (PRT) may limit dose and toxicity to previously irradiated normal tissues in patients without evidence of metastatic disease.MethodsBetween 8/2010-2/2015, 15 patients with isolated, locally-recurrent pancreatic cancer were treated with PRT. Acute toxicity was graded using CTC v 4.0 and defined as occurring within 90 days. Kaplan-Meier survival analysis was performed from the start of PRT. A log-rank test was used to compare survival with or without concurrent chemotherapy.ResultsMedian follow-up was 15.7 months [2-48] from the start of PRT. The median clinical target volume (CTV) was 71 cc [15-200]. Ten (67%) patients received concurrent chemotherapy. Median PRT dose was 59.4 Gy (37.5-59.4 Gy). The median time interval from the prior treatment course was 26.7 months (7-461.3). There was a rate of 13% acute ≥ grade 3 toxicities attributed to PRT. The median overall survival (OS) was 16.7 months (95% CI, 4.7-36) and OS at 1 year was 67%. The "in-field" failure free survival at one year was 87%. The locoregional progression free survival (LPFS) and distant metastasis free survival (DMFS) at 1 year was 72% and 64% respectively. Concurrent chemotherapy was associated with a higher median survival.ConclusionsPRT was well tolerated, resulted in prolonged clinical outcomes compared to historical controls, and should be considered as a treatment option with concurrent chemotherapy in selected patients with locally-recurrent pancreatic cancer