Techniques for measuring weight bearing during standing and walking

OBJECTIVE: To classify and assess techniques for measuring the amount of weight bearing during standing and walking.BACKGROUND: A large variety of weight bearing measuring techniques exists. This review describes their advantages and limitations to assist clinicians and researchers in selecting a technique for their specific application in measuring weight bearing.METHODS: A literature search was performed in Pubmed-Medline, CINAHL, and EMBASE. Measurement techniques were classified in 'clinical examination', 'scales', 'biofeedback systems', 'ambulatory devices' and 'platforms', and assessed on aspects of methodological quality, application, and feasibility.RESULTS: A total of 68 related articles was evaluated. The clinical examination technique is a crude method to estimate the amount of weight bearing. Scales are useful for static measurements to evaluate symmetry in weight bearing. Biofeedback systems give more reliable, accurate and objective data on weight bearing compared to clinical examination and scales, but the high costs could limit their use in physical therapy departments. The ambulatory devices can measure weight bearing with good accuracy and reliability in the hospital and at home. Platforms have the best methodological quality, but are mostly restricted to a gait laboratory, need trained personnel, and are expensive.CONCLUSIONS: The choice of a technique largely depends upon the criteria discussed in this review; however the clinical utilisation, the research question posed, and the available budget also play a role. The new developments seen in the field of 'ambulatory devices' are aimed at extending measuring time, and improved practicality in data collection and data analysis. For these latter devices, however, mainly preliminary studies have been published about devices that are not (yet) commercially available.</p

Spatiotemporal Interpolation of Elevation Changes Derived from Satellite Altimetry for Jakobshavn Isbrae, Greenland

Estimation of ice sheet mass balance from satellite altimetry requires interpolation of point-scale elevation change (dHdt) data over the area of interest. The largest dHdt values occur over narrow, fast-flowing outlet glaciers, where data coverage of current satellite altimetry is poorest. In those areas, straightforward interpolation of data is unlikely to reflect the true patterns of dHdt. Here, four interpolation methods are compared and evaluated over Jakobshavn Isbr, an outlet glacier for which widespread airborne validation data are available from NASAs Airborne Topographic Mapper (ATM). The four methods are ordinary kriging (OK), kriging with external drift (KED), where the spatial pattern of surface velocity is used as a proxy for that of dHdt, and their spatiotemporal equivalents (ST-OK and ST-KED)

Characterisation and classification of oligometastatic disease : a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation

Oligometastatic disease has been proposed as an intermediate state between localised and systemically metastasised disease. In the absence of randomised phase 3 trials, early clinical studies show improved survival when radical local therapy is added to standard systemic therapy for oligometastatic disease. However, since no biomarker for the identification of patients with true oligometastatic disease is clinically available, the diagnosis of oligometastatic disease is based solely on imaging findings. A small number of metastases on imaging could represent different clinical scenarios, which are associated with different prognoses and might require different treatment strategies. 20 international experts including 19 members of the European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer OligoCare project developed a comprehensive system for characterisation and classification of oligometastatic disease. We first did a systematic review of the literature to identify inclusion and exclusion criteria of prospective interventional oligometastatic disease clinical trials. Next, we used a Delphi consensus process to select a total of 17 oligometastatic disease characterisation factors that should be assessed in all patients treated with radical local therapy for oligometastatic disease, both within and outside of clinical trials. Using a second round of the Delphi method, we established a decision tree for oligometastatic disease classification together with a nomenclature. We agreed oligometastatic disease as the overall umbrella term. A history of polymetastatic disease before diagnosis of oligometastatic disease was used as the criterion to differentiate between induced oligometastatic disease (previous history of polymetastatic disease) and genuine oligometastatic disease (no history of polymetastatic disease). We further subclassified genuine oligometastatic disease into repeat oligometastatic disease (previous history of oligometastatic disease) and de-novo oligometastatic disease (first time diagnosis of oligometastatic disease). In de-novo oligometastatic disease, we differentiated between synchronous and metachronous oligometastatic disease. We did a final subclassification into oligorecurrence, oligoprogression, and oligopersistence, considering whether oligometastatic disease is diagnosed during a treatment-free interval or during active systemic therapy and whether or not an oligometastatic lesion is progressing on current imaging. This oligometastatic disease classification and nomenclature needs to be prospectively evaluated by the OligoCare study

ESA's Ice Sheets CCI: validation and inter-comparison of surface elevation changes derived from laser and radar altimetry over Jakobshavn Isbræ, Greenland – Round Robin results

In order to increase the understanding of the changing climate, the European Space Agency has launched the Climate Change Initiative (ESA CCI), a program which joins scientists and space agencies into 13 projects either affecting or affected by the concurrent changes. This work is part of the Ice Sheets CCI and four parameters are to be determined for the Greenland Ice Sheet (GrIS), each resulting in a dataset made available to the public: Surface Elevation Changes (SEC), surface velocities, grounding line locations, and calving front locations. All CCI projects have completed a so-called Round Robin exercise in which the scientific community was asked to provide their best estimate of the sought parameters as well as a feedback sheet describing their work. By inter-comparing and validating the results, obtained from research institutions world-wide, it is possible to develop the most optimal method for determining each parameter. This work describes the SEC Round Robin and the subsequent conclusions leading to the creation of a method for determining GrIS SEC values. The participants used either Envisat radar or ICESat laser altimetry over Jakobshavn Isbræ drainage basin, and the submissions led to inter-comparisons of radar vs. altimetry as well as cross-over vs. repeat-track analyses. Due to the high accuracy of the former and the high spatial resolution of the latter, a method, which combines the two techniques will provide the most accurate SEC estimates. The data supporting the final GrIS analysis stem from the radar altimeters on-board Envisat, ERS-1 and ERS-2. The accuracy of laser data exceeds that of radar altimetry; the Round Robin analysis has, however, proven the latter equally capable of dealing with surface topography thereby making such data applicable in SEC analyses extending all the way from the interior ice sheet to margin regions. This shows good potential for a~future inclusion of ESA CryoSat-2 and Sentinel-3 radar data in the analysis, and thus for obtaining reliable SEC estimates throughout the entire GrIS

Spatiotemporal interpolation of elevation changes derived from satellite altimetry for Jakobshavn Isbræ, Greenland

Estimation of ice sheet mass balance from satellite altimetry requires interpolation of point-scale elevation change (dHdt) data over the area of interest. The largest dHdt values occur over narrow, fast-flowing outlet glaciers, where data coverage of current satellite altimetry is poorest. In those areas, straightforward interpolation of data is unlikely to reflect the true patterns of dHdt. Here, four interpolation methods are compared and evaluated over Jakobshavn Isbr, an outlet glacier for which widespread airborne validation data are available from NASAs Airborne Topographic Mapper (ATM). The four methods are ordinary kriging (OK), kriging with external drift (KED), where the spatial pattern of surface velocity is used as a proxy for that of dHdt, and their spatiotemporal equivalents (ST-OK and ST-KED)

Time-evolving mass loss of the Greenland Ice Sheet from satellite altimetry

Mass changes of the Greenland Ice Sheet may be estimated by the input–output method (IOM), satellite gravimetry, or via surface elevation change rates (dH/dt). Whereas the first two have been shown to agree well in reconstructing ice-sheet wide mass changes over the last decade, there are few decadal estimates from satellite altimetry and none that provide a time-evolving trend that can be readily compared with the other methods. Here, we interpolate radar and laser altimetry data between 1995 and 2009 in both space and time to reconstruct the evolving volume changes. A firn densification model forced by the output of a regional climate model is used to convert volume to mass. We consider and investigate the potential sources of error in our reconstruction of mass trends, including geophysical biases in the altimetry, and the resulting mass change rates are compared to other published estimates. We find that mass changes are dominated by surface mass balance (SMB) until about 2001, when mass loss rapidly accelerates. The onset of this acceleration is somewhat later, and less gradual, compared to the IOM. Our time-averaged mass changes agree well with recently published estimates based on gravimetry, IOM, laser altimetry, and with radar altimetry when merged with airborne data over outlet glaciers. We demonstrate that, with appropriate treatment, satellite radar altimetry can provide reliable estimates of mass trends for the Greenland Ice Sheet. With the inclusion of data from CryoSat-2, this provides the possibility of producing a continuous time series of regional mass trends from 1992 onward

Molecular data show conserved DNA locations distinguishing lung cancer subtypes and regulation of immune genes

Introduction: Non-small-cell lung cancer exhibits a range of transcriptional and epigenetic patterns that not only define distinct phenotypes, but may also govern immune related genes, which have a major impact on survival. Methods: We used open-source RNA expression and DNA methylation data of the Cancer Genome Atlas with matched non-cancerous tissue to evaluate whether these pretreatment molecular patterns also influenced genes related to the immune system and overall survival. Results: The distinction between lung adenocarcinoma and squamous c

Individualized early death and long-term survival prediction after stereotactic radiosurgery for brain metastases of non-small cell lung cancer:Two externally validated nomograms

Introduction Commonly used clinical models for survival prediction after stereotactic radiosurgery (SRS) for brain metastases (BMs) are limited by the lack of individual risk scores and disproportionate prognostic groups. In this study, two nomograms were developed to overcome these limitations. Methods 495 patients with BMs of NSCLC treated with SRS for a limited number of BMs in four Dutch radiation oncology centers were identified and divided in a training cohort (n = 214, patients treated in one hospital) and an external validation cohort n = 281, patients treated in three other hospitals). Using the training cohort, nomograms were developed for prediction of early death (<3 months) and long-term survival (>12 months) with prognostic factors for survival. Accuracy of prediction was defined as the area under the curve (AUC) by receiver operating characteristics analysis for prediction of early death and long term survival. The accuracy of the nomograms was also tested in the external validation cohort. Results Prognostic factors for survival were: WHO performance status, presence of extracranial metastases, age, GTV largest BM, and gender. Number of brain metastases and primary tumor control were not prognostic factors for survival. In the external validation cohort, the nomogram predicted early death statistically significantly better (p < 0.05) than the unfavorable groups of the RPA, DS-GPA, GGS, SIR, and Rades 2015 (AUC = 0.70 versus range AUCs = 0.51–0.60 respectively). With an AUC of 0.67, the other nomogram predicted 1 year survival statistically significantly better (p < 0.05) than the favorable groups of four models (range AUCs = 0.57–0.61), except for the SIR (AUC = 0.64, p = 0.34). The models are available on www.predictcancer.org. Conclusion The nomograms predicted early death and long-term survival more accurately than commonly used prognostic scores after SRS for a limited number of BMs of NSCLC. Moreover these nomograms enable individualized probability assessment and are easy into use in routine clinical practice

Clinical trials update of the European Organization for Research and Treatment of Cancer Breast Cancer Group

The present clinical trial update consists of a review of two of eight current studies (the 10981-22023 AMAROS trial and the 10994 p53 trial) of the European Organization for Research and Treatment of Cancer Breast Cancer Group, as well as a preview of the MIND-ACT trial. The AMAROS trial is designed to prove equivalent local/regional control for patients with proven axillary lymph node metastasis by sentinel node biopsy if treated with axillary radiotherapy instead of axillary lymph node dissection, with reduced morbidity. The p53 trial started to assess the potential predictive value of p53 using a functional assay in yeast in patients with locally advanced/inflammatory or large operable breast cancer prospectively randomised to a taxane regimen versus a nontaxane regimen

Dosimetric consequences of the shift towards computed tomography guided target definition and planning for breast conserving radiotherapy

Background: The shift from conventional two-dimensional (2D) to three-dimensional (3D)conformal target definition and dose-planning seems to have introduced volumetric as well as geometric changes. The purpose of this study was to compare coverage of computed tomography (CT)-based breast and boost planning target volumes (PTV), absolute volumes irradiated, and dose delivered to the organs at risk with conventional 2D and 3D-conformal breast conserving radiotherapy. Methods: Twenty-five patients with left-sided breast cancer were subject of CT-guided target definition and 3D-conformal dose-planning, and conventionally defined target volumes and treatment plans were reconstructed on the planning CT. Accumulated dose-distributions were calculated for the conventional and 3D-conformal dose-plans, taking into account a prescribed dose of 50 Gy for the breast plans and 16 Gy for the boost plans. Results: With conventional treatment plans, CT-based breast and boost PTVs received the intended dose in 78% and 32% of the patients, respectively, and smaller volumes received the prescribed breast and boost doses compared with 3D-conformal dose-planning. The mean lung dose, the volume of the lungs receiving > 20 Gy, the mean heart dose, and volume of the heart receiving > 30 Gy were significantly less with conventional treatment plans. Specific areas within the breast and boost PTVs systematically received a lower than intended dose with conventional treatment plans. Conclusion: The shift towards CT-guided target definition and planning as the golden standard for breast conserving radiotherapy has resulted in improved target coverage at the cost of larger irradiated volumes and an increased dose delivered to organs at risk. Tissue is now included into the breast and boost target volumes that was never explicitly defined or included with conventional treatment. Therefore, a coherent definition of the breast and boost target volumes is needed, based on clinical data confirming tumour control probability and normal tissue complication probability with the use of 3D-conformal radiotherapy