A margin-based analysis of the dosimetric impact of motion on step-and-shoot IMRT lung plans

PURPOSE: Intrafraction motion during step-and-shoot (SNS) IMRT is known to affect the target dosimetry by a combination of dose blurring and interplay effects. These effects are typically managed by adding a margin around the target. A quantitative analysis was performed, assessing the relationship between target motion, margin size, and target dosimetry with the goal of introducing new margin recipes. METHODS: A computational algorithm was used to calculate 1,174 motion-encoded dose distributions and DVHs within the patient’s CT dataset. Sinusoidal motion tracks were used simulating intrafraction motion for nine lung tumor patients, each with multiple margin sizes. RESULTS: D(95%) decreased by less than 3% when the maximum target displacement beyond the margin experienced motion less than 5 mm in the superior-inferior direction and 15 mm in the anterior-posterior direction. For target displacements greater than this, D(95%) decreased rapidly. CONCLUSIONS: Targets moving in excess of 5 mm outside the margin can cause significant changes to the target. D(95%) decreased by up to 20% with target motion 10 mm outside the margin, with underdosing primarily limited to the target periphery. Multi-fractionated treatments were found to exacerbate target under-coverage. Margins several millimeters smaller than the maximum target displacement provided acceptable motion protection, while also allowing for reduced normal tissue morbidity

Late Miocene to early Pliocene stratigraphic record in northern Taranaki Basin: Condensed sedimentation ahead of Northern Graben extension and progradation of the modern continental margin

The middle Pliocene-Pleistocene progradation of the Giant Foresets Formation in Taranaki Basin built up the modern continental margin offshore from western North Island. The late Miocene to early Pliocene interval preceding this progradation was characterised in northern Taranaki Basin by the accumulation of hemipelagic mudstone (Manganui Formation), volcaniclastic sediments (Mohakatino Formation), and marl (Ariki Formation), all at bathyal depths. The Manganui Formation has generally featureless wireline log signatures and moderate to low amplitude seismic reflection characteristics. Mohakatino Formation is characterised by a sharp decrease in the GR log value at its base, a blocky GR log motif reflecting sandstone packets, and erratic resistivity logs. Seismic profiles show bold laterally continuous reflectors. The Ariki Formation has a distinctive barrel-shaped to blocky GR log motif. This signature is mirrored by the SP log and often by an increase in resistivity values through this interval. The Ariki Formation comprises (calcareous) marl made up of abundant planktic foraminifera, is 109 m thick in Ariki-1, and accumulated over parts of the Western Stable Platform and beneath the fill of the Northern Graben. It indicates condensed sedimentation reflecting the distance of the northern region from the contemporary continental margin to the south

High Floral Tannin White Clover Reduces Rumen Ammonia Concentrations in Dairy Cows

White clover produces high quality forage for ruminant production, but it results in high rumen ammonia concentrations, indicating extensive protein degradation. The excess ammonia is absorbed through the rumen and excreted as urea in urine, at a cost to the animal and the environment. Condensed tannins (CT) contained in some forages reduce proteolysis in the rumen, which can lead to increased amino acid absorption and therefore improved animal performance. White clover produces CT in its flower heads, but concentrations are normally too low to benefit animals. This paper reports on comparisons of rumen ammonia concentrations in dairy cows grazing HT (high tannin) white clover (an experimental line of white clover with increased flowering) or Grasslands Huia white clover

Condensed Tannin Concentration and Herbage Accumulation of a White Clover Bred for Increased Floral Condensed Tannin

White clover is a high quality feed for ruminants, however, its high protein content results in excessive urea excretion in urine and can cause bloat, reducing its potential value for animal production. The condensed tannins (CT) in some forages can reduce these problems, but plants may have poor agronomic performance. White clover produces CT in its flower heads, but herbage CT concentrations are normally too low to benefit animals. This paper reports CT concentrations and herbage accumulation over 2 years of an experimental line of white clover (HT) selected for increased flowering and floral CT concentrations

Overwhelming postsplenectomy infection due to Mycoplasma pneumoniae in an asplenic cirrhotic patient: Case report

<p>Abstract</p> <p>Background</p> <p><it>Mycoplasma </it><it>pneumoniae </it>infection is usually self-limited, but some fulminant cases are fatal, even when occurring in previously healthy individuals. It can also be the cause of overwhelming postsplenectomy infection (OPSI).</p> <p>Case presentation</p> <p>We report a case of OPSI in a 41-year-old woman with hypersplenism associated with hepatitis B cirrhosis. We detected a significant <it>Mycoplasma pneumoniae </it>agglutination titer, but no evidence of infection with <it>Chlamydia pneumoniae, Legionnella spp</it>., or any other bacterial or fungal pathogens. She eventually died despite aggressive therapy.</p> <p>Conclusions</p> <p><it>M. pneumoniae </it>could be an underestimated cause of OPSI, and should be suspected in fulminant infectious cases in asplenic patients.</p

Dietary options to reduce the environmental impact of milk production

A range of options was explored to test the hypothesis that diets for dairy cows could be formulated to reduce the carbon footprint (CFP) of feed, increase efficiency of conversion of potentially human-edible feed into milk, increase nitrogen use efficiency (NUE) and reduce methane (CH4) emissions per kg milk. Diets based on grazed grass, grass silage, maize silage or straw, supplemented with raw material feeds, were formulated to meet requirements for metabolizable energy and metabolizable protein for a range of daily milk yields. At similar levels of milk yield, NUE, predicted CH4 emissions and diet CFP were generally higher for diets based on maize silage than for those based on grazed grass, grass silage or straw. Predicted CH4 emissions and human-edible proportion decreased, while NUE increased with the increasing level of milk yield. It is concluded that there is potential to reduce the environmental impact of milk production by altering diet formulation, but the extent to which this might occur is likely to depend on availability of raw material feeds with low CFPs

Genetic variation at MECOM, TERT, JAK2 and HBS1L-MYB predisposes to myeloproliferative neoplasms

Clonal proliferation in myeloproliferative neoplasms (MPN) is driven by somatic mutations in JAK2, CALR or MPL, but the contribution of inherited factors is poorly characterized. Using a three-stage genome-wide association study of 3,437 MPN cases and 10,083 controls, we identify two SNPs with genome-wide significance in JAK2V617F-negative MPN: rs12339666 (JAK2; meta-analysis P=1.27 × 10−10) and rs2201862 (MECOM; meta-analysis P=1.96 × 10−9). Two additional SNPs, rs2736100 (TERT) and rs9376092 (HBS1L/MYB), achieve genome-wide significance when including JAK2V617F-positive cases. rs9376092 has a stronger effect in JAK2V617F-negative cases with CALR and/or MPL mutations (Breslow–Day P=4.5 × 10−7), whereas in JAK2V617F-positive cases rs9376092 associates with essential thrombocythemia (ET) rather than polycythemia vera (allelic χ2 P=7.3 × 10−7). Reduced MYB expression, previously linked to development of an ET-like disease in model systems, associates with rs9376092 in normal myeloid cells. These findings demonstrate that multiple germline variants predispose to MPN and link constitutional differences in MYB expression to disease phenotype

Risk factors for postoperative complications after adrenalectomy for phaeochromocytoma: multicentre cohort study

Background: To determine the incidence and risk factors for postoperative complications and prolonged hospital stay after adrenalectomy for phaeochromocytoma. Methods: Demographics, perioperative outcomes and complications were evaluated for consecutive patients who underwent adrenalectomy for phaeochromocytoma from 2012 to 2020 in nine high-volume UK centres. Odds ratios were calculated using multivariable models. The primary outcome was postoperative complications according to the Clavien–­­Dindo classification and secondary outcome was duration of hospital stay. Results: Data were available for 406 patients (female n = 221, 54.4 per cent). Two patients (0.5 per cent) had perioperative death, whilst 148 complications were recorded in 109 (26.8 per cent) patients. On adjusted analysis, the age-adjusted Charlson Co-morbidity Index ≥3 (OR 8.09, 95 per cent c.i. 2.31 to 29.63, P = 0.001), laparoscopic converted to open (OR 10.34, 95 per cent c.i. 3.24 to 36.23,

Identification of the amino-acetonitrile derivative monepantel (AAD 1566) as a new anthelmintic drug development candidate

Anthelmintic resistance has become a global phenomenon in gastro-intestinal nematodes of farm animals, including multi-drug resistance against the three major classes of anthelmintics. There is an urgent need for an anthelmintic with a new mode of action. The recently discovered amino-acetonitrile derivatives (AADs) offer a new class of synthetic chemicals with anthelmintic activity. The evaluation of AADs was pursued applying in vitro assays and efficacy and tolerability studies in rodents, sheep, and cattle. Amongst various suitable compounds, AAD 1566 eliminated many tested pathogenic nematode species, both at larval and adult stages, at a dose of 2.5 mg/kg bodyweight in sheep and 5.0 mg/kg bodyweight in cattle. The same doses were sufficient to cure animals infected with resistant or multi-drug-resistant nematode isolates. These findings, complemented by the good tolerability and low toxicity to mammals, suggest that AAD 1566, monepantel, would be a suitable anthelmintic drug development candidate