Feasibility of assessment of skeletal muscle mass on a single cross-sectional image at the level of the fourth thoracic vertebra

Background Skeletal muscle mass (SMM) determined on computed tomography (CT) is emerging as a novel imaging biomarker. Cross-sectional area (CSA) of SMM at the level of the third lumbar vertebra (L3) on abdominal imaging is considered the clinical reference standard for measuring SMM. In certain patient groups, such as those with oncological or non-oncological lung disease like COVID-19, a chest CT may be available while an abdominal CT is not. The purpose of this study was to investigate whether determining SMM on a chest CT is a feasible alternative to abdominal CT.  Research question What is the correlation between SMM measurements at the level of L3 and the level of the fourth thoracic vertebra (Th4)?  Study design and methods  In this study we retrospectively analyzed abdominal and thoracic series of whole-body CT-scans of trauma patients (N = 47) and head and neck cancer patients (N = 194). All abdominal muscles were delineated on a single axial slice at the level of L3. The erector spinae, levator scapulae, rhomboideus minor and major and pectoralis minor and major muscles were delineated on a single axial slice at the level of Th4. CSA of the muscles at Th4 and the L3 level were compared using linear regression, and a multivariate linear regression model was established.  Results Muscle CSA at level Th4 strongly correlates with L3 muscle CSA (r = 0.791, p < 0.05). A multivariate model incorporating the patient characteristics arm positioning, age, sex, and weight achieved a stronger correlation (r = 0.856, p < 0.05). Interpretation: Skeletal muscle CSA measured at the level of Th4 is a feasible alternative to measurements at L3. This allows diagnosing low SMM using clinically available thoracic CT-scans. SMM measurements at the level of Th4 may become a prognostic or triage tool when faced with mechanical ventilator shortage

Role of eHealth application Oncokompas in supporting self-management of symptoms and health-related quality of life in cancer survivors:a randomised, controlled trial

Background Knowledge about the efficacy of behavioural intervention technologies that can be used by cancer survivors independently from a health-care provider is scarce. We aimed to assess the efficacy, reach, and usage of Oncokompas, a web-based eHealth application that supports survivors in self-management by monitoring health-related quality of life (HRQOL) and cancer-generic and tumour-specific symptoms and obtaining tailored feedback with a personalised overview of supportive care options. Methods In this non-blinded, randomised, controlled trial, we recruited patients treated at 14 hospitals in the Netherlands for head and neck cancer, colorectal cancer, breast cancer, Hodgkin lymphoma, or non-Hodgkin lymphoma. Adult survivors (aged ≥18 years) were recruited through the Netherlands Cancer Registry (NCR) and invited by their treating physician through the Patient Reported Outcomes Following Initial Treatment and Long term Evaluation of Survivorship (PROFILES) registry. Participants were randomly assigned (1:1) by an independent researcher to the intervention group (access to Oncokompas) or control group (access to Oncokompas after 6 months), by use of block randomisation (block length of 68), stratified by tumour type. The primary outcome was patient activation (knowledge, skills, and confidence for self-management), assessed at baseline, post-intervention, and 3-month and 6-month follow-up. Linear mixed models (intention-to-treat) were used to assess group differences over time from baseline to 6-month follow-up. The trial is registered in the Netherlands Trial Register, NTR5774 and is completed. Findings Between Oct 12, 2016, and May 24, 2018, 625 (21%) of 2953 survivors assessed for eligibility were recruited and randomly assigned to the intervention (320) or control group (305). Median follow-up was 6 months (IQR 6−6). Patient activation was not significantly different between intervention and control group over time (difference at 6-month follow-up 1·7 [95% CI −0·8–4·1], p=0·41). Interpretation Oncokompas did not improve the amount of knowledge, skills, and confidence for self-management in cancer survivors. This study contributes to the evidence for the development of tailored strategies for development and implementation of behavioural intervention technologies among cancer survivors

Outcome prediction of head and neck squamous cell carcinoma by MRI radiomic signatures.

OBJECTIVES: Head and neck squamous cell carcinoma (HNSCC) shows a remarkable heterogeneity between tumors, which may be captured by a variety of quantitative features extracted from diagnostic images, termed radiomics. The aim of this study was to develop and validate MRI-based radiomic prognostic models in oral and oropharyngeal cancer. MATERIALS AND METHODS: Native T1-weighted images of four independent, retrospective (2005-2013), patient cohorts (n = 102, n = 76, n = 89, and n = 56) were used to delineate primary tumors, and to extract 545 quantitative features from. Subsequently, redundancy filtering and factor analysis were performed to handle collinearity in the data. Next, radiomic prognostic models were trained and validated to predict overall survival (OS) and relapse-free survival (RFS). Radiomic features were compared to and combined with prognostic models based on standard clinical parameters. Performance was assessed by integrated area under the curve (iAUC). RESULTS: In oral cancer, the radiomic model showed an iAUC of 0.69 (OS) and 0.70 (RFS) in the validation cohort, whereas the iAUC in the oropharyngeal cancer validation cohort was 0.71 (OS) and 0.74 (RFS). By integration of radiomic and clinical variables, the most accurate models were defined (iAUC oral cavity, 0.72 (OS) and 0.74 (RFS); iAUC oropharynx, 0.81 (OS) and 0.78 (RFS)), and these combined models outperformed prognostic models based on standard clinical variables only (p < 0.001). CONCLUSIONS: MRI radiomics is feasible in HNSCC despite the known variability in MRI vendors and acquisition protocols, and radiomic features added information to prognostic models based on clinical parameters. KEY POINTS: • MRI radiomics can predict overall survival and relapse-free survival in oral and HPV-negative oropharyngeal cancer. • MRI radiomics provides additional prognostic information to known clinical variables, with the best performance of the combined models. • Variation in MRI vendors and acquisition protocols did not influence performance of radiomic prognostic models

Stepped care targeting psychological distress in head and neck and lung cancer patients: a randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Psychological distress is common in cancer survivors. Although there is some evidence on effectiveness of psychosocial care in distressed cancer patients, referral rate is low. Lack of adequate screening instruments in oncology settings and insufficient availability of traditional models of psychosocial care are the main barriers. A stepped care approach has the potential to improve the efficiency of psychosocial care. The aim of the study described herein is to evaluate efficacy of a stepped care strategy targeting psychological distress in cancer survivors.</p> <p>Methods/design</p> <p>The study is designed as a randomized clinical trial with 2 treatment arms: a stepped care intervention programme versus care as usual. Patients treated for head and neck cancer (HNC) or lung cancer (LC) are screened for distress using OncoQuest, a computerized touchscreen system. After stratification for tumour (HNC vs. LC) and stage (stage I/II vs. III/IV), 176 distressed patients are randomly assigned to the intervention or control group. Patients in the intervention group will follow a stepped care model with 4 evidence based steps: 1. Watchful waiting, 2. Guided self-help via Internet or a booklet, 3. Problem Solving Treatment administered by a specialized nurse, and 4. Specialized psychological intervention or antidepressant medication. In the control group, patients receive care as usual which most often is a single interview or referral to specialized intervention. Primary outcome is the Hospital Anxiety and Depression Scale (HADS). Secondary outcome measures are a clinical level of depression or anxiety (CIDI), quality of life (EQ-5D, EORTC QLQ-C30, QLQ-HN35, QLQ-LC13), patient satisfaction with care (EORTC QLQ-PATSAT), and costs (health care utilization and work loss (TIC-P and PRODISQ modules)). Outcomes are evaluated before and after intervention and at 3, 6, 9 and 12 months after intervention.</p> <p>Discussion</p> <p>Stepped care is a system of delivering and monitoring treatments, such that effective, yet least resource-intensive, treatment is delivered to patients first. The main aim of a stepped care approach is to simplify the patient pathway, provide access to more patients and to improve patient well-being and cost reduction by directing, where appropriate, patients to low cost (self-)management before high cost specialist services.</p> <p>Trial registration</p> <p>NTR1868</p

The association between skeletal muscle measures and chemotherapy-induced toxicity in non-small cell lung cancer patients

BACKGROUND: Chemotherapy-induced toxicities frequently occur in non-small cell lung cancer (NSCLC) patients treated with platinum-based chemotherapy. Low skeletal muscle mass (SMM) has been associated with a higher incidence of toxicities for several types of cancers and cytostatics. The aim of this study was to evaluate the association between skeletal muscle measures and chemotherapy-induced toxicity in a large cohort of NSCLC patients. METHODS: A multicentre prospective follow-up study (PGxLUNG, NTR number NL5373610015) in NSCLC patients was conducted. Included were patients diagnosed with NSCLC (stage II-IV) treated with first-line platinum-based (cisplatin or carboplatin) chemotherapy of whom pretreatment imaging was available. Skeletal muscle area (SMA) segmentation was performed on abdominal imaging at the level of the third lumbar vertebra (L3). SMA at the level of L3 was corrected for squared height (m2 ) to yield the lumbar skeletal muscle mass index (LSMI). Skeletal muscle density (SMD) was calculated as the mean Hounsfield Unit (HU) of the segmented SMA. SMM and SMD were categorized as low, intermediate, and high, based on LSMI and mean HU tertiles, respectively. Chemotherapy-induced toxicity was scored using CTCAE v4.03 and categorized into haematological (anaemia, leukocytopenia, neutropenia, and thrombocytopenia), non-haematological (nephrotoxicity, neurotoxicity, and esophagitis), and dose-limiting toxicity (DLT) (treatment switch, delay, de-escalation, discontinuation, or hospitalization). The relationship between SMM, SMD, and toxicities was assessed with logistic regression modelling taking into account potential confounders like gender and body mass index (BMI). RESULTS: In total, 297 patients (male n = 167, median age 64 years) were included. Haematological toxicity grade 3/4 was experienced in 36.6% (n = 108) of the patients, 24.6% (n = 73) experienced any non-haematological toxicity grade ≥2, and 55.6% (n = 165) any DLT. Multivariate logistic regression analysis showed that low SMM (ORadj 2.41, 95% CI 1.31-4.45, P = 0.005) and age at diagnosis >65 years (ORadj 1.76, 95% CI 1.07-2.90, P = 0.025) were statistically significantly associated with overall haematological toxicity grade 3/4. No statistically significant associations were found between low SMM or low SMD and non-haematological toxicities. Low SMM (ORadj 2.23, 95% CI 1.23-4.04, P = 0.008) and high SMD (ORadj 0.41, 95% CI 0.23-0.74, P = 0.003) were statistically significantly associated with a higher respectively lower risk of DLT. CONCLUSIONS: Non-small cell lung cancer patients with pretreatment low SMM are at significant higher risk for haematological toxicities grade 3/4 and DLT. NSCLC patients with high SMD are at significant lower risk for DLT. Further studies should be aimed to investigate whether platinum dosing based on skeletal muscle measurements and/or improvement of pretreatment SMM/SMD could reduce the risk of toxicity without compromising efficacy

Traiblazing, Object-Oriented Navigation in nodegoat

<p><strong>INTRODUCTION</strong></p> <p>In the discussion on the exploration of digital cultural collections we want to introduce a methodological substantiation on user experience strategies. This method transforms users into active agents where users engage with the collection dynamically by constantly negotiating and renegotiating their selections and selection parameters. We relate this approach to the work of Vannevar Bush and his concept of trailblazing and are able to implement this in various scenarios by means of the online research environment nodegoat (http://nodegoat.net). We will first introduce nodegoat and secondly set out how we foresee the implementation of explorative user experience strategies based on the concept of trailblazing.</p> <p><strong>NODEGOAT</strong></p> <p>nodegoat is a web-based data management, analysis and visualisation environment. Using nodegoat, users define, create, update, query, and manage any number of data sets by use of a graphic user interface. A custom data model autoconfigures the backbone of notegoat's core functionalities. Within nodegoat users are able to instantly analyse and visualise datasets. nodegoat allows users to enrich data with relational, geographical and temporal attributes. Therefore, the modes of analysis are inherently diachronic and ready-to-use for interactive maps and extensive trailblazing.</p> <p>nodegoat follows an object-oriented approach throughout its core functionalities. Borrowing from actor-network theory this means that people, events, artefacts, and sources are treated as equal: objects, and hierarchy depends solely on the composition of the network: relations. This object-oriented approach advocates the self-identification of individual objects and maps the correlation of objects within the collective.</p> <p>The conceptualisation and realisation of nodegoat was fueled by the goal to give scholars a tool that would allow them to transfer their skills in tackling complex research questions to a digital environment. Instead of focusing on a number of algorithms that would help scholars to crunch large sets of data, nodegoat sets out to give them the opportunity to formulate new research questions, to design their own data model, populate their research environment, perform analyses and visualise the results.</p> <p>This approach has had a number of implications for the development of nodegoat as a research environment. First of all, we did not focus on one research topic or field of research, but aimed to develop a generic tool that would be useful for a broad range of scholars with varying needs and diverse research questions. This generic approach makes nodegoat different from tools like the SNAC project (Social Networks and Archival Context)1, RoSE (Research Oriented Social Environment)2, SEASR (Software Environment for the Advancement of Scholarly Research)3, or Prosop4. nodegoat can not only be employed to navigate (aggregations of) collections and analyse social networks or prosopographical spheres, but can also analyse correlations between literary themes in classical texts or co-occurrences of allegorical iconography in early modern paintings. The methodological basis of nodegoat does not limit itself to one field only, but gives scholars of varying backgrounds new means — or more precise its object-oriented approach — to work with their data.</p> <p>Secondly, we decided to equip nodegoat with data management capabilities, modes of analysis and visualisation functionalities. nodegoat dynamically combines functionalities of a database management system (e.g. Access/FileMaker) with visualisation possibilities (i.e. Gephi or Pajek) and extends these functionalities (e.g. with in-text referencing) in one GUI. As this is all run in a web-based environment, nodegoat can be used in a collaborative manner with multiple scholars working together on one dataset.</p> <p>Since 2012, nodegoat has been used by the University of Amsterdam to produce diachronic mappings of correspondence networks of nineteenth century intellectuals. The goal of the project is to ‘map the dissemination of cultural nationalism across Europe by charting cultural patterns and networks as they evolve over time’ (http://spinnet.eu/spintimemappings/). The final products show how networks of the intellectuals, all trying to establish clearly defined national communities, transcended existing or newly created national/cultural boundaries.</p> <p>Together with Dutch research institute Huygens ING, we use nodegoat to map artist networks in 17th century Rome based on existing datasets of ECARTICO (UvA, http://www.vondel.humanities.uva.nl/ecartico/) and HADRIANVS (KNIR, http://hadrianus.it/). nodegoat will be used to connect these databases and to analyse and visualise co-occurances of objects in time and space (http://cdh.uva.nl/projects-2013-2014/knaw---mapping-notes-and-nodes-in-networks.html).</p> <p><strong>OBJECT-ORIENTED</strong></p> <p>nodegoat is able to achieve all this as it is built to be an object-oriented research platform, equipped to deal with diachronic, spatial and relational attributions. Moreover, users can specify numerous (conflicting) sources for each piece of evidence that is entered into nodegoat. Our object-oriented approach challenges users to take a rhizomatic perspective to their material as any object can be connected to any other object. This means that existing typologies have a secondary function as new groups or classifications may arise based on relational structures and/or temporal and geographic nearness. Due to the object-oriented nature of nodegoat, the networks that can be produced are inherently ‘hybrid’ and ‘multi-modal’. The visualisations of nodegoat are dynamically connected to the underlying data, which makes the distinction between analysis and visualisation mostly artificial.</p> <p><strong>TRAILBLAZE</strong></p> <p>As a research environment, nodegoat has shifted the focus from an predominating algorithmic approach towards an approach in which the user occupies the pivotal position. This shift is also reflected in the user interfaces that are developed using nodegoat. In these interfaces, users act like trailblazers within bodies of associative data in which the new paths they create function as the starting point of new explorations. This approach can be connected to the primordial concept of trailblazing, as envisioned by Vannagar Bush in 1945. A user trailblazers by creating trails in a maze of intrinsically associative objects. The trails allow one to interact, annotate and collaborate on any type of data, making it a practice of active transclusion; a continuous distribution of authority between the author and the maze.By means of this process we can positively state that search is over. We are finally able to leave this one dimensional approach behind as we do not need to limit ourselves to the dogma of 'keyword' -> 'query' -> 'result'. Instead we can offer users an experience in which they start from their field of interest or a specific question. They continue to browse by means of dynamic filtering that is continuously updated based on the users' behaviour. This process produces a path, or trail, which is a tangible product of the users' behaviour, making the process of exploration also a process of creation.</p> <p>As the object-oriented ground infrastructure is set up by means of a multitude of multi-modal relations, the ways in which new objects can be discovered are limitless. This allows for the exploration of direct and indirect (spanning numerous levels) relations like the co-authorship of pamphlets, master-pupil relationships, patronages, geographical nearness of birth locations or places of residence, and co-occurrences of iconographic classifications. Should a user be interested in, for example, artefacts created during a specific period in time, a filter will produce all objects and relations associated with this period, giving the user new opportunities to expand or limit the selection. From there on, the exploration continues by iconographic classifications or personal relationships. Moreover, geographical patterns can be discerned and analysed — or even mapped — in this selection as well. These geographical patterns can also be applied to study the geographical range of artefacts within one collection, or analyse how one geographical area is represented in a collection. When dealing with paintings, filtering on the provenance of one or more paintings will provide users with an overview, over distance, of how one collection relates to other collections or institutes.</p> <p>These tasks are obviously difficult or even impossible to perform by means of a search interface. Using our object-oriented approach, we want users to be able to navigate collections and artefacts with a high level of agency. This process makes the distinction between the level of the artefact and the level of the collection irrelevant as the user is engaged in a continuous navigation and exploration process between the two.</p> <p>1 http://socialarchive.iath.virginia.edu/home_prototype.html</p> <p>2 http://liu.english.ucsb.edu/rose-research-oriented-social-environment/</p> <p>3 http://www.seasr.org/</p> <p>4 http://www.prosop.org/</p

Glucocorticoid treatment in patients with complex regional pain syndrome: A systematic review

Background and objective The pathophysiology of complex regional pain syndrome (CRPS) is multifactorial, with an exaggerated inflammatory response being the most prominent. Treatment for CRPS is carried out according to the presenting pathophysiological mechanism. Anti-inflammatory treatment with glucocorticoids is therefore an option. The aim of this study was to systematically review the efficacy of glucocorticoids in CRPS. Databases and data treatment Embase, Medline, Web of Science and Google Scholar were systematically searched for articles focusing on glucocorticoid treatment and CRPS. Screening based on title and abstract was followed by full-text reading (including reference lists) to determine the final set of relevant articles. Bias was assessed using the revised Cochrane risk-of-bias-tool for randomized trials (Rob2). Results Forty-one studies were included, which reported on 1208 CRPS patients. A wide variety of glucocorticoid administration strategies were applied, with oral being the most frequently chosen. Additionally, researchers found great heterogeneity in outcome parameters, including clinical symptoms, pain relief and range of motion. The use of glucocorticoids caused an improvement of parameters in all but two studies. In particular, improvement in pain relief and range of motion were reported. Using glucocorticoids in CRPS of longer duration (i.e. more than 3 months) appears to be less effective. Conclusion Based on the present review, there is evidence to support glucocorticoid treatment in CRPS. However, the ideal administration route and dose remain unclear. We therefore recommend future research via an intervention study, as well as studies on the aetiological mechanisms and corresponding optimal treatment because CRPS pathogenesis is only partially understood. Significance Several studies point towards CRPS being an inflammatory response after tissue or nerve damage, with higher levels of pro-inflammatory cytokines in serum, plasma, cerebrospinal fluid and artificial skin blisters. Inflammation provides a possible role for glucocorticoids in treating CRPS. This systematic review provides a structured overview of glucocorticoid treatment in patients with CRPS. Improvement in pain and range of motion is shown. Systematic review registration number: PROSPERO-CRD42020144671

Mediating Research Through Technology @ NEP4DISSENT

Abstract and poster of paper 0217 presented at the Digital Humanities Conference 2019 (DH2019), Utrecht , the Netherlands 9-12 July, 2019