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2022 ◽  
Vol 11 ◽  
Author(s):  
Sebastian Regnery ◽  
Carolin Buchele ◽  
Fabian Weykamp ◽  
Moritz Pohl ◽  
Philipp Hoegen ◽  
...  

PurposeTo explore the benefit of adaptive magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) for treatment of lung tumors in different locations with a focus on ultracentral lung tumors (ULT).Patients & MethodsA prospective cohort of 21 patients with 23 primary and secondary lung tumors was analyzed. Tumors were located peripherally (N = 10), centrally (N = 2) and ultracentrally (N = 11, planning target volume (PTV) overlap with proximal bronchi, esophagus and/or pulmonary artery). All patients received MRgSBRT with gated dose delivery and risk-adapted fractionation. Before each fraction, the baseline plan was recalculated on the anatomy of the day (predicted plan). Plan adaptation was performed in 154/165 fractions (93.3%). Comparison of dose characteristics between predicted and adapted plans employed descriptive statistics and Bayesian linear multilevel models. The posterior distributions resulting from the Bayesian models are presented by the mean together with the corresponding 95% compatibility interval (CI).ResultsPlan adaptation decreased the proportion of fractions with violated planning objectives from 94% (predicted plans) to 17% (adapted plans). In most cases, inadequate PTV coverage was remedied (predicted: 86%, adapted: 13%), corresponding to a moderate increase of PTV coverage (mean +6.3%, 95% CI: [5.3–7.4%]) and biologically effective PTV doses (BED10) (BEDmin: +9.0 Gy [6.7–11.3 Gy], BEDmean: +1.4 Gy [0.8–2.1 Gy]). This benefit was smaller in larger tumors (−0.1%/10 cm³ PTV [−0.2 to −0.02%/10 cm³ PTV]) and ULT (−2.0% [−3.1 to −0.9%]). Occurrence of exceeded maximum doses inside the PTV (predicted: 21%, adapted: 4%) and violations of OAR constraints (predicted: 12%, adapted: 1%, OR: 0.14 [0.04–0.44]) was effectively reduced. OAR constraint violations almost exclusively occurred if the PTV had touched the corresponding OAR in the baseline plan (18/19, 95%).ConclusionAdaptive MRgSBRT is highly recommendable for ablative treatment of lung tumors whose PTV initially contacts a sensitive OAR, such as ULT. Here, plan adaptation protects the OAR while maintaining best-possible PTV coverage.


2022 ◽  
Vol 12 ◽  
Author(s):  
Katarzyna Grebosz-Haring ◽  
Anna K. Schuchter-Wiegand ◽  
Anja C. Feneberg ◽  
Nadine Skoluda ◽  
Urs M. Nater ◽  
...  

Psychobiological responses to music have been examined previously in various naturalistic settings in adults. Choir singing seems to be associated with positive psychobiological outcomes in adults. However, evidence on the effectiveness of singing in children and adolescents is sparse. The COVID-19 outbreak is significantly affecting society now and in the future, including how individuals engage with music. The COVID-19 pandemic is occurring at a time when virtual participation in musical experiences such as singing in a virtual choir has become more prevalent. However, it remains unclear whether virtual singing leads to different responses in comparison with in-person singing. We evaluated the psychobiological effects of in-person choral singing (7 weeks, from January to March 2020, before the COVID-19 outbreak) in comparison with the effects of virtual choral singing (7 weeks, from May to July 2020, after schools partly re-opened in Austria) in a naturalistic pilot within-subject study. A group of children and young adolescents (N = 5, age range 10–13, female = 2) from a school in Salzburg, Austria were recruited to take part in the study. Subjective measures (momentary mood, stress) were taken pre- and post-singing sessions once a week. Additionally, salivary biomarkers (cortisol and alpha-amylase) and quantity of social contacts were assessed pre- and post-singing sessions every second week. Psychological stability, self-esteem, emotional competences, and chronic stress levels were measured at the beginning of in-person singing as well as at the beginning and the end of the virtual singing. We observed a positive impact on mood after both in-person and virtual singing. Over time, in-person singing showed a pre-post decrease in salivary cortisol, while virtual singing showed a moderate increase. Moreover, a greater reduction in stress, positive change in calmness, and higher values of social contacts could be observed for the in-person setting compared to the virtual one. In addition, we observed positive changes in psychological stability, maladaptive emotional competences, chronic stress levels, hair cortisol, self-contingency and quality of life. Our preliminary findings suggest that group singing may provide benefits for children and adolescents. In-person singing in particular seems to have a stronger psychobiological effect.


2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Laure Felix ◽  
Peggy Jacon ◽  
Maxime Lugosi ◽  
Justine Cristante ◽  
Julie Roux ◽  
...  

Background and Objective It has been reported recently in a cross sectional study that patients with amiodarone induced thyrotoxicosis (AIT) showed a ‘white’ thyroid on unenhanced computed tomography, due to intrathyroid iodine accumulation. However, the link between increase in thyroid radiologic density and amiodarone induced thyrotoxicosis remains unknown. We sought to analyze this link. Methods We present the case of a 34-year-old patient with severe sarcoidosis-related hypertrophic cardiomyopathy who was followed with successive unenhanced CT scans integrated with FDG PET scans. After the first CT scans the patient, who initially had a normal thyroid function, was exposed to amiodarone during 23 months and developed AIT, very likely by thyroiditis (AIT type 2). There were no thyroid antibodies, no evidence of thyroid sarcoidosis on FDG PET scan, while thyroid sonogram showed a homogenous 22 ml moderate goiter with normal echogenicity and no nodules. Results Analysis of the successive enhanced CT scans revealed that after initiation of amiodarone treatment, thyroid radiologic density steadily increased before detection of AIT, peaked after cessation of amiodarone and initiation of thyrotoxicosis treatment, before returning to normal as thyrotoxicosis receded. Thyroid volume also showed a moderate increase, peaking at the detection of thyrotoxicosis, before returning to normal. Conclusion This case suggests that AIT is preceded by a very high intrathyroid iodine accumulation before the ‘burst’ of thyroiditis occurs and that measurements of thyroid gland radiological density might predict the development and remission of AIT.


2021 ◽  
Vol 8 (4) ◽  
pp. 435-443
Author(s):  
Marcela Lascsáková

The focus of this paper aims at comparison of two prognostic numerical models with different strategies for accuracy improvement. To verify prediction performance of proposed models, the forecasts of aluminium stock exchanges on the London Metal Exchange were carried out as numerical solution of the Cauchy initial problem for the first-order ordinary differential equation. Two techniques for accuracy improvement were utilized, replacing the initial condition value by the nearest known stock exchange and a modification of the differential equation in solved Cauchy initial problem by means of two known initial values. We dealt with an idea of how different price development affected the accuracy of proposed strategies. With regard to obtained results, it was found that the prognoses obtained by using two known initial values were more increasing or decreasing than prognoses calculated by utilizing the initial condition drift. The strategy of a changing form of the differential equation in the Cauchy initial problem can be considered slightly more accurate. Faster increased prognoses were more advantageous especially at a steep price increase and within a price increase following the price decline. A moderate increase of the prognoses determined by the initial condition drift fit reasonably well a price fluctuation and a price decline following the price increase.


Author(s):  
Ye. DEMCHENKO

Purpose. In modern conditions, Ukraine, having an extensive railway network and a developed infrastructure of seaports located on its Black Sea coast, is becoming a link in new goods delivery routes in the direction of the EU-China. Transportation of large consignments of goods in the direction is usually carried out in containers by sea transport. At the same time, such transportation is characterized, on the one hand, by a relatively low cost, and on the other hand, by rather long delivery times. An alternative case is transportation by mixed rail-water communication, which allows, with a moderate increase in cost, to achieve a significant reduction in the delivery time of goods. The economic attractiveness of such a transportation scheme depends significantly on the performance of ferry crossings in the Caspian and Black Seas. In this regard, the purpose of this work is to increase the efficiency of international ferry services by improving its logistics support on coastal ferry complexes. Methodology. To achieve the work purpose, methods of statistical analysis were used to determine the volume and structure of ferry traffic; simulation methods to determine effective options for loading ferries; theory of shunting work to optimize the car classification according to the cargo plan. Results. There were analyzed the requirements for ferry loading and developed a computer model that allows to create acceptable plans for the cars location on ferry decks (cargo plan). On the basis of the obtained variants of the cargo plan, the modeling of the multi-group trains forming by combinatorial and distribution methods has been carried out. Based on the simulation results, recommendations of choosing the effective method for train forming and the required number of cargo plan variants were given. Scientific novelty. The author has improved the method for determining the effective cargo plan of the ferry loading, which takes into account the process of forming the trains of cars to be supplied to the ferry. Practical significance. The obtained results can be used to improve the efficiency of international freight transportation management in mixed rail-water traffic.


2021 ◽  
Vol 8 ◽  
Author(s):  
Zi-xuan Yang ◽  
Xuan Chen ◽  
Si-qi Tang ◽  
Qing Zhang

Although immune checkpoint inhibitor (ICI)-related myocarditis has been widely discussed, a lot of gaps and challenges in its clinical course and rational intervention remain elusive. We present the case of a 33-year-old man with a history of metastatic thymoma who developed dyspnea and muscle weakness 1 month after the first dose of sintilimab. He was asymptomatic but found to have a mild elevation of troponin-T and a moderate increase of creatine kinase 20 days after the infusion. Although the scheduled second dose was deferred, he developed dyspnea, left bundle branch block, and left ventricular enlargement that is suggestive of Grade 3 ICI-related myocarditis, complicated with myositis/myasthenia gravis 10 days later. Fortunately, his response to intensive immunosuppressive therapy was good.


Land ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 12
Author(s):  
Leonardo Bianchini ◽  
Rosanna Salvia ◽  
Giovanni Quaranta ◽  
Gianluca Egidi ◽  
Luca Salvati ◽  
...  

Metropolitan fringes in Southern Europe preserve, under different territorial contexts, natural habitats, relict woodlands, and mixed agro-forest systems acting as a sink of biodiversity and ecosystem services in ecologically vulnerable landscapes. Clarifying territorial and socioeconomic processes that underlie land-use change in metropolitan regions is relevant for forest conservation policies. At the same time, long-term dynamics of fringe forests in the northern Mediterranean basin have been demonstrated to be rather mixed, with deforestation up to the 1950s and a subsequent recovery more evident in recent decades. The present study makes use of Forest Transition Theory (FTT) to examine spatial processes of forest loss and expansion in metropolitan Rome, Central Italy, through local regressions elaborating two diachronic land-use maps that span more than 80 years (1936–2018) representative of different socioeconomic and ecological conditions. Our study evaluates the turnaround from net forest area loss to net forest area gain, considering together the predictions of the FTT and those of the City Life Cycle (CLC) theory that provides a classical description of the functioning of metropolitan cycles. The empirical findings of our study document a moderate increase in forest cover depending on the forestation of previously abandoned cropland as a consequence of tighter levels of land protection. Natural and human-driven expansion of small and isolated forest nuclei along fringe land was demonstrated to fuel a polycentric expansion of woodlands. The results of a Geographically Weighted Regression (GWR) reveal the importance of metropolitan growth in long-term forest expansion. Forest–urban dynamics reflect together settlement sprawl and increased forest disturbance. The contemporary expansion of fringe residential settlements and peri-urban forests into relict agricultural landscapes claims for a renewed land management that may reconnect town planning, reducing the intrinsic risks associated with fringe woodlands (e.g., wildfires) with environmental policies preserving the ecological functionality of diversified agro-forest systems.


Author(s):  
Ghada Hussein Naguib ◽  
Abou Bakr Hashem ◽  
Zuhair Natto ◽  
Ahmed Abougazia ◽  
Hisham Mously ◽  
...  

The aim of this study is to evaluate the effectiveness of the implant diameter and length on force dissemination of tooth-implant and implant retained fixed restorations. A finite analysis model was used via a 3D simulation of a unilateral mandibular Kennedy Class I arch. Through thresholding the resultant assembly, a region of interest was selected from the CT scan. Details of the diameter (D) and length (L) of implant were introduced. Ds used were 3.7, 4.7, and 5.7, while Ls used were 10, 11.5, and 13. The constant was the use of rigid connectors in both designs (implant–implant and implant–tooth fixed partial dentures) and the mesial implant (D 3.7 and L 11.5).  Stress in cancellous bone around mesial abutment, which is the second premolar in tooth-implant FPD and mesial implant in the implant-implant fixed partial denture (FPD), revealed that the stress was significantly lower in tooth-implant FPD when compared to implant-implant FPD (21.1±0.00 versus 46.1±0.00, p <0.001). Stress distribution in the bone around any implant depends on several factors such as diameter, length, and tooth-implant vs. implant-implant support. The implant diameter was more significant for improved stress distribution than implant length. A moderate increase in the length of the implant consequently reduced stress.


Author(s):  
Laura M. Raffield ◽  
Annie Green Howard ◽  
Misa Graff ◽  
Dan‐Yu Lin ◽  
Susan Cheng ◽  
...  

Background Research examining the role of obesity in cardiovascular disease (CVD) often fails to adequately consider heterogeneity in obesity severity, distribution, and duration. Methods and Results We here use multivariate latent class mixed models in the biracial Atherosclerosis Risk in Communities study (N=14 514; mean age=54 years; 55% female) to associate obesity subclasses (derived from body mass index, waist circumference, self‐reported weight at age 25, tricep skinfold, and calf circumference across up to four triennial visits) with total mortality, incident CVD, and CVD risk factors. We identified four obesity subclasses, summarized by their body mass index and waist circumference slope as decline (4.1%), stable/slow decline (67.8%), moderate increase (24.6%), and rapid increase (3.6%) subclasses. Compared with participants in the stable/slow decline subclass, the decline subclass was associated with elevated mortality (hazard ratio [HR] 1.45, 95% CI 1.31, 1.60, P <0.0001) and with heart failure (HR 1.41, 95% CI 1.22, 1.63, P <0.0001), stroke (HR 1.53, 95% CI 1.22, 1.92, P =0.0002), and coronary heart disease (HR 1.36, 95% CI 1.14, 1.63, P =0.0008), adjusting for baseline body mass index and CVD risk factor profile. The moderate increase latent class was not associated with any significant differences in CVD risk as compared to the stable/slow decline latent class and was associated with a lower overall risk of mortality (HR 0.85, 95% CI 0.80, 0.90, P <0.0001), despite higher body mass index at baseline. The rapid increase latent class was associated with a higher risk of heart failure versus the stable/slow decline latent class (HR 1.34, 95% CI 1.10, 1.62, P =0.004). Conclusions Consideration of heterogeneity and longitudinal changes in obesity measures is needed in clinical care for a more precision‐oriented view of CVD risk.


Author(s):  
S. Klyueva ◽  
S. Bugorkova ◽  
T. Kashtanova

In conditions when the assessment of changes in the incidence rate cannot be used as an indicator of the effectiveness of a live plague vaccine, there is a real need to search for other, in particular, immunological correlates of the vaccine's protection. Modern concepts of the patho- and immunogenesis of plague make it possible to narrow the search for possible correlates of protection, focusing on the assessment of cellular factors of the immune response. The aim of this work is to identify the immunological correlates of protection against plague in mice immunized with Yersinia pestis EV NIIEG, and to assess the dynamics of selected markers of immunological effectiveness of vaccination in people vaccinated against plague. Experimental model - BALB / c mice, 40 individuals in each group were immunized with Y. pestis EV at doses of 2 × 102, 1 × 103, 5 × 103, 2.5 × 104 CFU, and on the 21st day they were infected with Y. pestis 231 at a dose of 400 LD50. Control group - intact animals. Immunogenicity was determined by ImD50 and calculated by the Kerber method. Volunteers - 20 people who were first vaccinated with the live plague vaccine and 20 people who were not vaccinated against the plague (comparison group). The production of cytokines in the blood was determined on an enzyme-linked immunosorbent analyzer "LAZURIT" (Dynex Technologies, USA): in mice before infection with Y. pestis 231 on the 14th and 21st days after vaccination; in humans - before vaccination, 1, 6 and 12 months after vaccination. We used commercial kits in accordance with the instructions for their use. The immunized mice showed a significant increase (2.2 times) in the induced IFN-γ production and a moderate increase in the concentration of TNF-α, IL-10 and IL-17A on the 14th day of immunogenesis. A high correlation was found between the survival rate of animals and the level of antigen- / mitogen-induced production of IFN-γ (r = 0.94, p = 0.039), both on the 14th and 21st days, as well as a noticeable relationship with the level of production of IL-10 and IL-17A on the 14th day of immunogenesis. In volunteers one month after inoculation, an increase in the indicators of mitogen-induced production of all detectable cytokines was noted, but the levels of IFN-γ, TNF-α, IL-10, IL-17A significantly increased by the 6th month of observation (p <0.05), although only for IFN-γ and IL-17A, the induced production of these cytokines remained at a sufficiently high level up to a year after inoculation. Thus, IFN-γ and IL-17A can be considered as possible informative correlates of protection of mice from Y. pestis on days 14 and 21, considering the increase in the induced production of these cytokines as adequate markers of the protective efficacy of immunization, and the assessment of the dynamics of these parameters in volunteers vaccinated with the plague live vaccine, an increase in the levels of IFN-γ and IL-17A can be considered a favorable prognostic marker of the immunological efficacy of the vaccine in the period from the 6th to the 12th month of observation.


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