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Phase 1 clinical trials have established low-dose, whole-lung radiation therapy (LD-RT) as safe for patients with coronavirus disease 2019 (COVID-19)-related pneumonia. By focally dampening cytokine hyperactivation, LD-RT may improve disease outcomes through immunomodulation.
Postoperative radiation therapy (RT) is a common therapy used for patients with prostate cancer. Although clinical trials have established the safety and efficacy of hypofractionation as a primary therapy, there are limited data in a postoperative setting. We conducted a prospective trial to evaluate the safety and feasibility of postoperative hypofractionated RT to the prostate bed.
Stereotactic body radiation therapy (SBRT) has demonstrated encouraging local tumor control rates in the treatment of pancreatic cancer, yet we lack prospective clinical trials evaluating dose-escalation strategies among patients treated with 5-fraction SBRT. This phase 1 dose-escalation trial was conducted to determine the maximum tolerated dose of SBRT in patients with pancreatic cancer.
Contouring inconsistencies are known but understudied in clinical radiation therapy trials. We applied auto-contouring to the Radiation Therapy Oncology Group (RTOG) 0617 dose escalation trial data. We hypothesized that the trial heart doses were higher than reported due to inconsistent and insufficient heart segmentation. We tested our hypothesis by comparing doses between deep-learning (DL) segmented hearts and trial hearts.
A poster entitled "Space Medicine - A New Role for Clinical Pharmacists" was presented in December 2001 highlighting an up-and-coming role for pharmacists at the Johnson Space Center (JSC) in Houston, Texas. Since that time, the operational need for the pharmacy profession has expanded with the administration s decision to open a pharmacy on site at JSC to complement the care provided by the Flight Medicine and Occupational Medicine Clinics. The JSC Pharmacy is a hybrid of traditional retail and hospital pharmacy and is compliant with the ambulatory care standards set forth by the Joint Commission. The primary charge for the pharmacy is to provide medication management for JSC. In addition to providing ambulatory care for both clinics, the pharmacists also practice space medicine. A pharmacist had been involved in the packing of both the Space Shuttle and International Space Station Medical Kits before the JSC Pharmacy was established; however, the role of the pharmacist in packing medical kits has grown. The pharmacists are now full members of the operations team providing consultation for new drug delivery systems, regulations, and patient safety issues. As the space crews become more international, so does the drug information provided by the pharmacists. This presentation will review the journey of the JSC Pharmacy as it celebrated its five year anniversary in April of 2008. The implementation of the pharmacy, challenges to the incorporation of the pharmacy into an existing health-care system, and the current responsibilities of a pharmacist at the Johnson Space Center will be discussed.
In the treatment of patients with metastatic cancer, the current paradigm states that metastasis-directed therapy does not prolong life. This paradigm forms the basis of clinical trial null hypotheses, where trials are built to test the null hypothesis that patients garner no overall survival benefit from targeting metastatic lesions. However, with advancing imaging technology and increasingly precise techniques for targeting lesions, a much larger proportion of metastatic disease can be treated. As a result, the life-extending benefit of targeting metastatic disease is becoming increasingly clear.
The Stereotactic Ablative Radiation therapy for Comprehensive Treatment of Oligometastatic Tumors phase 2 randomized clinical trial found that stereotactic ablative radiation therapy (SABR) improved outcomes among cancer patients with oligometastatic disease. Yet, the cost of SABR along with the large number of patients with oligometastatic disease raises the important question of value. This study sought to evaluate the cost-effectiveness of the addition of SABR compared with standard therapy alone among cancer patients with oligometastatic disease.
Randomized clinical trials have shown that regional nodal irradiation (RNI) in patients with unselected N1 breast cancer improves breast cancer-specific survival. However, the benefit of RNI in women with biologically low-risk N1 breast cancer is uncertain. We conducted a population-based study to determine whether RNI is associated with improved breast cancer recurrence-free interval (BCRFI) in this population.
Radiation pneumonitis remains a major limitation in the radiation therapy treatment of patients with lung cancer. Functional avoidance radiation therapy uses functional imaging to reduce pulmonary toxic effects by designing radiation therapy plans that reduce doses to functional regions of the lung. Lung functional imaging has been developed that uses 4-dimensional computed tomography (4DCT) imaging to calculate 4DCT-based lung ventilation (4DCT-ventilation). A phase 2 multicenter study was initiated to evaluate 4DCT-ventilation functional avoidance radiation therapy. The study hypothesis was that functional avoidance radiation therapy could reduce the rate of grade ≥2 radiation pneumonitis to 12% compared with a 25% historical rate, with the trial being positive if ≤16.4% of patients experienced grade ≥2 pneumonitis.
No abstract prepared.
Electric-field-assisted chemistry has attracted much attention in recent years, particularly in the context of oriented external electric fields for controlling molecular structure and reactivity. Such fields have been explored in a wide range of applications, including switching materials, nanoparticles, controllable catalysts, medicines, and clinical therapies. However, the determination of fixed fields in the laboratory frame becomes ineffective for flexible molecules, as conformational changes can significantly alter the relative orientation between the applied field and molecular structure. In this work, we propose two molecular reference frames─the principal axis frame and the local reference frame─to define oriented electric fields within the molecular framework. These coordinate systems powerfully eliminate ambiguities in the relative orientation between the applied field and the molecule. Analytic nuclear gradients in the presence of external electric fields are derived and implemented, with an initial application to field-dependent geometry optimizations of cis - and trans -formanilide. Analysis of the resulting field-induced equilibrium structures reveals distinct structural responses, validating the accuracy and robustness of the proposed formalism. The analytic gradient framework enables systematic investigations of molecular properties and reactivity under arbitrarily oriented electric fields, opening new opportunities for computational modeling and rational design in electric-field-controlled chemistry.
Mathematical models are a core component in the foundation of cancer theory and have been developed as clinical tools in precision medicine. Modeling studies for clinical applications often assume an individual’s characteristics can be represented as parameters in a model and are used to explain, predict, and optimize treatment outcomes. However, this approach relies on the identifiability of the underlying mathematical models. In this study, we build on the framework of an observing-system simulation experiment to study the identifiability of several models of cancer growth, focusing on the prognostic parameters of each model. Our results demonstrate that the frequency of data collection, the types of data, such as cancer proxy, and the accuracy of measurements all play crucial roles in determining the identifiability of the model. We also found that highly accurate data can allow for reasonably accurate estimates of some parameters, which may be the key to achieving model identifiability in practice. As more complex models required more data for identification, our results support the idea of using models with a clear mechanism that tracks disease progression in clinical settings. For such a model, the subset of model parameters associated with disease progression naturally minimizes the required data for model identifiability.
Physiology of intracranial blood circulation and clinical implications
Method of treatment of auricular fibrillation
The primary objective of this study is to determine which biomedical and human factors measurements must be made aboard a space station to assure adequate evaluation of the astronaut's health and performance during prolonged space flights. The study has employed, where possible, a medical and engineering systems analysis to define the pertinent life sciences and space station design parameters and their influence on a measurement program. The major areas requiring evaluation in meeting the study objectives include a definition of the space environment, man's response to the environment, selection of measurement and data management techniques, experimental program, space station design requirements, and a trade-off analysis with final recommendations. The space environment factors that are believed to have a significant effect on man were evaluated. This includes those factors characteristic of the space environment (e. g. weightlessness, radiation) as well as those created within the space station (e. g. toxic contaminants, capsule atmosphere). After establishing the general features of the environment, an appraisal was made of the anticipated response of the astronaut to each of these factors. For thoroughness, the major organ systems and functions of the body were delineated, and a determination was made of their anticipated response to each of the environmental categories. A judgment was then made on the medical significance or importance of each response, which enabled a determination of which physiological and psychological effects should be monitored. Concurrently, an extensive list of measurement techniques and methods of data management was evaluated for applicability to the space station program. The various space station configurations and design parameters were defined in terms of the biomedical and human factors requirements to provide the measurements program. Research design of experimental programs for various station configurations, mission durations, and crew sizes were prepared, and, finally, a trade-off analysis of the critical variables in the station planning was completed with recommendations to enhance the confidence in the measurement program.
Information processing technology for clinical investigations applied to effect of bed rest and exercise on cardiovascular responses
Use of telemetry in intensive-care wards
Diagnostic monitoring in office procedures - biotelemetry