Improving Radiotherapy Targeting for Cancer Treatment Through Space and Time

Radiotherapy is a common medical treatment in which lethal doses of ionizing radiation are preferentially delivered to cancerous tumors. In external beam radiotherapy, radiation is delivered by a remote source which sits several feet from the patient\u27s surface. Although great effort is taken in properly aligning the target to the path of the radiation beam, positional uncertainties and other errors can compromise targeting accuracy. Such errors can lead to a failure in treating the target, and inflict significant toxicity to healthy tissues which are inadvertently exposed high radiation doses. Tracking the movement of targeted anatomy between and during treatment fractions provides valuable localization information that allows for the reduction of these positional uncertainties. Inter- and intra-fraction anatomical localization data not only allows for more accurate treatment setup, but also potentially allows for 1) retrospective treatment evaluation, 2) margin reduction and modification of the dose distribution to accommodate daily anatomical changes (called `adaptive radiotherapy\u27), and 3) targeting interventions during treatment (for example, suspending radiation delivery while the target it outside the path of the beam). The research presented here investigates the use of inter- and intra-fraction localization technologies to improve radiotherapy to targets through enhanced spatial and temporal accuracy. These technologies provide significant advancements in cancer treatment compared to standard clinical technologies. Furthermore, work is presented for the use of localization data acquired from these technologies in adaptive treatment planning, an investigational technique in which the distribution of planned dose is modified during the course of treatment based on biological and/or geometrical changes of the patient\u27s anatomy. The focus of this research is directed at abdominal sites, which has historically been central to the problem of motion management in radiation therapy

Performance of video processing at the edge for crowd-monitoring applications

Video analytics has a key role to play in smart cities and connected community applications such as crowd counting, activity detection, event classification, traffic counting etc. Using a cloud-centric approach where data is funneled to a central processor presents a number of key problems such as available bandwidth, real-time responsiveness and personal data privacy issues. With the development of edge computing, a new paradigm for smart data management is emerging. Raw video feeds can be pre-processed at the point of capture while integration and deeper analytics is performed in the cloud. In this paper we explore the capacity of video processing at the edge and shown that basic image processing can be achieved in near real-time on low-powered gateway devices. We have also investigated deep learning model capabilities for crowd counting in this context showing that its performance is highly dependent on the input size and re-scaling video frames can optimise processing and performance. Increased edge processing resolves a number of issues in video analytics for crowd monitoring applications

Nerve Transfers to Recover External Rotation of the Shoulder after Brachial Plexus Injuries in Adults

Restoration of external rotation of the shoulder in adults with partial brachial plexus palsies is challenging. While nerve grafts are possible, nerve transfers are currently the most use method for satisfactory restoration of function. Numerous nerve transfers have been described, although the transfer of the spinal accessory nerve to the suprascapular nerve remains the gold standard. The suprascapular nerve and the nerve to the teres minor muscle are the two preferred targets to restore external rotation of the shoulder. There are numerous nerve donors, but their use obviously depends on the initial injury. The most common donors are the spinal accessory nerve, the rhomboid nerve, branches of the radial nerve, the C7 root fascicle or the ulnar nerve. The choice for the transfer depends on the available nerves and first of all on chosen approach, whether it be cervical or scapular. It also depends on the other associated reconstruction procedures, grafts, or nerve transfers for the recovery of other functions, specifically, elevation of the shoulder and flexion of the elbow. The objective of this chapter is to present the main nerve transfers and to propose a therapeutic strategy

Importance of late fall ENSO teleconnection in the Euro-Atlantic sector

Recent studies have indicated the importance of fall climate forcings and teleconnections in influencing the climate of the northern mid-to-high latitudes. Here, we present some exploratory analyses using observational data and seasonal hindcasts, with the aim of highlighting the potential of the El Niño-Southern Oscillation (ENSO) as a driver of climate variability during boreal late fall/early winter (November/December) in the North Atlantic-European sector and motivating further research on this relatively unexplored topic. The atmospheric ENSO teleconnection in November/December is reminiscent of the East Atlantic pattern and distinct from the well-known arching extratropical Rossby wavetrain found from January to March. Temperature and precipitation over Europe in November are positively correlated with the Niño3.4 index, which suggests a potentially important ENSO climate impact during late fall. In particular, the ENSO-related temperature anomaly extends over a much larger area than during the subsequent winter mont

Understanding packet loss for sound monitoring in a smart stadium IoT testbed

The Smart Stadium for Smarter Living project provides an end-to-end testbed for IoT innovation through a collaboration between Croke Park Stadium in Dublin, Ireland and Dublin City University, Intel and Microsoft. This enables practical evaluations of IoT solutions in a controlled environment that is small enough to conduct trials but large enough to prove and challenge the technologies. An evaluation of sound monitoring capabilities during the 2016 sporting finals was used to test the capture, transfer, storage and analysis of decibel level sound monitoring. The purpose of the evaluation was to use existing sound level microphones to measure crowd response to pre-determined events for display on big screens at half-time and to test the end-to-end performance of the testbed. While this is not the specific original purpose of the sound level microphones, it provided a useful test case and produced engaging content for the project. Analysis of the data streams showed significant packet loss during the events and further investigations were conducted to understand where and how this loss occurred. This paper describes the smart stadium testbed configuration using Intel gateways linking with the Azure cloud platform and analyses the performance of the system during the sound monitoring evaluation

Inhibiting the inflammasome with MCC950 counteracts muscle pyroptosis and improves Duchenne muscular dystrophy

Background: Duchenne muscular dystrophy (DMD) is the most common inherited human myopathy. Typically, the secondary process involving severe inflammation and necrosis exacerbate disease progression. Previously, we reported that the NLRP3 inflammasome complex plays a crucial role in this disorder. Moreover, pyroptosis, a form of programmed necrotic cell death, is triggered by NLRP3 via gasdermin D (GSDMD). So far, pyroptosis has never been described either in healthy muscle or in dystrophic muscle. The aim of this study was to unravel the role of NLRP3 inflammasome in DMD and explore a potentially promising treatment with MCC950 that selectively inhibits NLRP3. Methods: Four‐week‐old mdx mice (n=6 per group) were orally treated for 2 months with MCC950 (mdx‐T), a highly potent, specific, small-molecule inhibitor of NLRP3, and compared with untreated (mdx) and wild-type (WT) mice. In vivo functional tests were carried out to measure the global force and endurance of mice. Ex vivo biochemical and molecular analyses were performed to evaluate the pathophysiology of the skeletal muscle. Finally, in vitro tests were conducted on primary cultures of DMD human myotubes. Results: After MCC950 treatment, mdx mice exhibited a significant reduction of inflammation, macrophage infiltration and oxidative stress (-20 to -65%, P<0.05 vs untreated mdx). Mdx‐T mice displayed considerably less myonecrosis (-54%, P<0.05 vs mdx) and fibrosis (-75%, P<0.01 vs mdx). Moreover, a more mature myofibre phenotype, characterized by larger-sized fibres and higher expression of mature myosin heavy chains 1 and 7 was observed. Mdx-T also exhibited enhanced force and resistance to fatigue (+20 to 60%, P<0.05 or less). These beneficial effects resulted from MCC950 inhibition of both active caspase-1 (-46%, P=0.075) and cleaved gasdermin D (N-GSDMD) (-42% in medium-sized-fibres, P<0.001). Finally, the anti-inflammatory action and the anti-pyroptotic effect of MCC950 were also recapitulated in DMD human myotubes. Conclusion: Specific inhibition of the NLRP3 inflammasome can significantly attenuate the dystrophic phenotype. A novel finding of this study is the overactivation of GSDMD, which is hampered by MCC950. This ultimately leads to less inflammation and pyroptosis and to a better muscle maturation and function. Targeting NLRP3 might lead to an effective therapeutic approach for a better management of DMD.Fund for Scientific Research de Bélgica (FNRS)-PDR/T.0026.2

Symptomatic postoperative compressive pneumocephalus after cholecystectomy

A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental status. There was placement of a ventriculoperitoneal shunt in 1970 complicated by meningitis, leading to removal of the material and ventriculociternostomy as definitive treatment in 2004. About one month previously, she had undergone a laparoscopic cholecystectomy complicated by an intra-abdominal collection. Clinical examination at the emergency department revealed a Glasgow score of 8 (E3 V1 M4). In the emergency department the patient presented a tonic-clonic seizure before a cerebral CT scan was performed showing a massive compressive pneumocephalus, then a second seizure. The patient was finally admitted to the neurosurgery department and underwent surgery

EEG paradigms as a supplemental tool to behavioral assessments of DOC

Introduction Diagnosis and prediction of recovery in the acute phase of disorders of consciousness (DOC) are critical for subsequent medical decisions. However, reliable assessment remains elusive due to the inability of current validated clinical scales to take into account motor and drive deficits. Recently, the Motor Behaviour Tool (MBT), a novel clinical scale, has been developed to address this caveat (1). In this context, neuroimaging and brain-computer interface (BCI) have also been proposed to improve the diagnosis and prognosis of these patients.(2). Objectives This pilot study aims to investigate the diagnostic and prognostic value of two electroencephalography (EEG)-based paradigms in patients with DOC, i.e., coma, Unresponsive Awareness Syndrome (UWS) or Minimally Conscious State (MCS). As a second step, we will employ them as evidence to further establish the added value of the MBT (i.e., assessment of minimal responses suggesting remaining conscious processing) combined with the Coma Recovery Scale-Revised (CRS-R), a standardized validated scale commonly used to assess consciousness in this population (3). Patients & Methods Acute DOC patients undergo CRS-R and MBT assessment prior to two EEG paradigms. Firstly, a motor attempt EEG-BCI coupled with Functional Electrical Stimulation (FES) is used (4). We hypothesize that replacing the need for overt movements with motor attempt can alleviate the tendency of CRS-R to underestimate the level of awareness in case of cognitive-motor dissociation (CMD) (5). In addition, a second EEG protocol presents patients with FES-tactile (T), auditory (A), and audio-tactile (AT) stimuli both in actionable and non-actionable space. EEG evoked potentials observed in the actionable space are expected to show a non-linear addition of sensory stimuli (i.e., A+T ≠ AT) indicating multisensory integration and the capacity of conscious processing (6). Results Pending elaborate analysis, preliminary findings show (Fig. 1) that BCI accuracy is significantly above chance only for a patient who was diagnosed as UWS by the CRS-R evaluation, but exhibited a motor behavior classified as CMD confirmed by the MBT tool, and not for one in real UWS (same diagnosis based on CRS-R and MBT), implying the presence of the hypothesized relation between motor EEG correlates and awareness (7). Average EEG evoked potentials of 8 patients during the second EEG paradigm highlight a difference between within (solid line) vs. outside (dashed line) the actionable space (Fig. 2), suggesting awareness-dependent modulation. Future analyses will explore correlations of such EEG descriptors with the clinical outcomes. Conclusion EEG correlates extracted from these EEG paradigms are promising tools for diagnosis of DOC and may supplement current clinical scales to help the validation of new tools like the MBT. References J. M. Pignat, E. Mauron, J. Jöhr, C. Gilart De Keranflec'h, D. Van De Ville, M. G. Preti, D. E. Meskaldji, V. Hörnberg, S. Laureys, B. Draganski, R. Frackowiak, K. Diserens, Outcome prediction of consciousness disorders in the acute stage based on a complementary motor behavioural tool, PLOS ONE 11(6), e0156882 (2016). A. M. Owen, M. R. Coleman, M. Boly, M. H. Davis, S. Laureys, J. D. Pickard, Detecting awareness in the vegetative state, Science, 313, 1402 (2006). J. T. Giacino, K. Kalmar, J. Whyte, The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility, Arch. Phys. Med. Rehabil. 85(12), 2020-9 (2004). T. Corbet, R. Leeb, A. Biasiucci, S. Perdikis, J. del R. Millán et al. BCI-NMES therapy enhances effective connectivity in the damaged hemisphere in stroke patients. 6th International Brain-Computer Interface Meeting, Asilomar, California, USA (2016). N. D. Schiff, Cognitive motor dissociation following severe brain injuries, JAMA Neurol. 72(12), 1413–1415 (2015). J. P. Noel, C. Pfeiffer, O. Blanke, A. Serino, Full body peripersonal space as the space of the bodily self, Cognition 144, 49-57 (2015). A. M . Goldfine, J. D. Victor, M. M. Conte, J. C. Bardin, N. D. Schiff, Determination of awareness in patients with severe brain injury using EEG power spectral analysis, Clin. Neurophysiol. 122(11), 2157-68 (2011)