Application of Continuous Positive Airway Pressure for Thoracic Respiratory Motion Management: An Assessment in a Magnetic Resonance Imaging-Guided Radiation Therapy Environment

PURPOSE: Patient tolerability of magnetic resonance (MR)-guided radiation treatment delivery is limited by the need for repeated deep inspiratory breath holds (DIBHs). This volunteer study assessed the feasibility of continuous positive airway pressure (CPAP) with and without DIBH for respiratory motion management during radiation treatment with an MR-linear accelerator (MR-linac). METHODS AND MATERIALS: MR imaging safety was first addressed by placing the CPAP device in an MR-safe closet and configuring a tube circuit via waveguide to the magnet bore. Reproducibility and linearity of the final configuration were assessed. Six healthy volunteers underwent thoracic imaging in a 0.35T MR-linac, with one free breathing (FB) and 2 DIBH acquisitions being obtained at 5 pressures from 0 to 15 cm-H(2)O. Lung and heart volumes and positions were recorded; repeatability was assessed by comparing 2 consecutive DIBH scans. Blinded reviewers graded images for motion artifact using a 3-point grading scale. Participants completed comfort and perception surveys before and after imaging sessions. RESULTS: Compared with FB alone, FB-10, FB-12, and FB-15 cm H(2)O significantly increased lung volumes (+23%, +34%, +44%; all P \u3c.05) and inferiorly displaced the heart (0.86 cm, 0.96 cm, 1.18 cm; all P \u3c . 05). Lung volumes were significantly greater with DIBH-0 cm H(2)O compared with FB-15 cm H(2)O (+105% vs +44%, P = .01), and DIBH-15 cm H(2)O yielded additional volume increase (+131% vs +105%, P = .01). Adding CPAP to DIBH decreased lung volume differences between consecutive breath holds (correlation coefficient 0.97 at 15 cm H(2)O vs 0.00 at 0 cm H(2)O). The addition of 15 cm H(2)O CPAP reduced artifact scores (P = .03) compared with FB; all DIBH images (0-15 cm H(2)O) had less artifact (P \u3c .01). CONCLUSIONS: This work demonstrates the feasibility of integrating CPAP in an MR-linac environment in healthy volunteers. Extending this work to a larger patient cohort is warranted to further establish the role of CPAP as an alternative and concurrent approach to DIBH in MR-guided radiation therapy

Latin Americans and Caribbeans in Europe. A cross-country analysis

With the beginning of the 21st century, there has been an acceleration of migratory flows from Latin America and the Caribbean (LAC) to Europe. As a result, and despite the negative impact of the economic crisis, 4.6 million Latin American and Caribbean immigrants reside in Europe, half of them in Spain. This article analyses the recent evolution of these migratory flows, their territorial distribution, and their demographic profiles according to the 2011 European census data disseminated by a new tool -the Census Hub- implemented by the European Statistical System. The analysis shows the existence of a high LAC immigrant concentration in Spain and in certain European cities, a marked young and feminized demographic profile, a great variety of educational levels and a different insertion in each European labour market, although many LAC immigrants work in low-skill occupations, being overqualified and underemployed in most of the countries

Uncovering the multifaceted roles played by neutrophils in allogeneic hematopoietic stem cell transplantation

Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a life-saving procedure used for the treatment of selected hematological malignancies, inborn errors of metabolism, and bone marrow failures. The role of neutrophils in alloHSCT has been traditionally evaluated only in the context of their ability to act as a first line of defense against infection. However, recent evidence has highlighted neutrophils as key effectors of innate and adaptive immune responses through a wide array of newly discovered functions. Accordingly, neutrophils are emerging as highly versatile cells that are able to acquire different, often opposite, functional capacities depending on the microenvironment and their differentiation status. Herein, we review the current knowledge on the multiple functions that neutrophils exhibit through the different stages of alloHSCT, from the hematopoietic stem cell (HSC) mobilization in the donor to the immunological reconstitution that occurs in the recipient following HSC infusion. We also discuss the influence exerted on neutrophils by the immunosuppressive drugs delivered in the course of alloHSCT as part of graft-versus-host disease (GVHD) prophylaxis. Finally, the potential involvement of neutrophils in alloHSCT-related complications, such as transplant-associated thrombotic microangiopathy (TA-TMA), acute and chronic GVHD, and cytomegalovirus (CMV) reactivation, is also discussed. Based on the data reviewed herein, the role played by neutrophils in alloHSCT is far greater than a simple antimicrobial role. However, much remains to be investigated in terms of the potential functions that neutrophils might exert during a highly complex procedure such as alloHSCT