Early Volume Research Articles

Target Volume Dynamics During Radiation Therapy in Lung Cancer - Identifying the Window of Opportunity

To assess the dynamic changes in the target volume (TV) during the course of radical radiotherapy in Lung Cancer. We studied 83 consecutive patients with lung cancer treated with radical intent from January 2012 till December 2017.These patients received concurrent CTRT or Neoadjuvant Chemotherapy followed by Radiotherapy (RT) or RT alone. Radiotherapy was delivered to a total dose of 60-66Gy either with conventional fractionation or hypofractionation, using 3DCRT or IMRT technique. The gross tumor volume was contoured on the CBCTs and volume changes were computed from baseline planning scan for assessing the impact of treatment. Seventy-eight patients were found to be eligible for volume analysis (NSCLC = 69, SCLC = 9, CTRT = 38, NACT = 9, no chemotherapy = 31, conventional fractionation = 51, hypo fractionated RT = 27, 3DCRT = 38, IMRT = 40). The mean tumor volume at the beginning of radiotherapy was 105.62cc (range 4-689cc). The weekly mean percentage change in the volume of primary disease from pre-RT volume were 5.4% after week 1, 13.5% after week 2, 18.8% after week 3, 26.2% after week 4, 25.4% after week 5 and 31.5 % after week 6 (Pearson correlation coefficient - 0.607-1; moderate to strong relationship). Mean change in volume from week 1 to week 2 was 7.3%, week 2 to week 3 was 7.9%, week 3 to week 4 was 7.8%, week 4 to week 5 was 1% and week 5 to week 6 was 6.4 %. The weekly changes in volume with conventional fraction were 2.1%, 11%,17.2%,26.2%,25.3% and 31.5%, from week 1 till week 6; and with hypofractionation were 11.73%,17.63% and 23.87% from baseline till week 1, week 2 and after week 3 respectively. Weekly percentage changes seen with conventional fractionation were as follows: 8.4% for week 1-2; 7.2% for week 2-3; 7.8% for week 3-4; 1% for week 4-5 and 6.4% for week 5-6. For the entire cohort, at a median follow up of 36 months, 2-year overall survival (OS) rate was 65% and at 3-years was 56%. The 2-year PFS was 42% and 3 year was 30% with median PFS of 16 months. In patients with stable target volume, median PFS was 22 months compared to 14 months in patients with early volume reduction; early target increase and late decrease showed a similar PFS of 12 months (p value = 0.913, using log rank test). Also, patients with volume change at week 3 had statistically significant longer PFS compared to rest. Patients with a 20% volume change at week 4 had statistically significant longer OS. Patients with more than 10% and 30% volume change at week 4 had a trend towards better LRC (0.08) and OS (0.09) respectively. We observed that the maximum change in volume during treatment was seen at 3rd-4th week. This has implications, particularly for adaptive re-planning which may be done at mid treatment to reduce the doses delivered to normal tissue without compromising on the dose received by the target volume. We also observed significant correlation between various outcome parameters and volume changes during radiation for lung cancer.

Associations between early life stress and anterior pituitary gland volume development – A novel index of long‐term hypothalamic‐pituitary‐adrenal axis functioning

Previous research has established associations between early life stress (ELS) and altered pituitary gland volume (PGV) growth during adolescence. The pituitary gland, however, is composed of an anterior and a posterior lobe with distinct histological and neuroendocrinological properties. While the anterior (but not posterior) pituitary gland is directly involved in the hypothalamic-pituitary-adrenal axis (HPAA) stress response, no studies have examined the effects of ELS on anterior PGV (aPGV). The present study investigated whether previously reported associations between ELS and PGV development during adolescence were driven by aPGV versus posterior PGV (pPGV). Ninety-one adolescents (49 males) were included from a longitudinal, community-based adolescent development study investigating risk for psychopathology. ELS (maternal affective behavior, childhood maltreatment, stressful life events) was assessed during early adolescence. Participants underwent two waves of structural magnetic resonance imaging during mid- and late-adolescence, and aPGV and pPGV were manually traced. Regression analyses showed that childhood maltreatment predicted greater aPGV growth in females. This finding was stronger than that previously reported for PGV. No associations were found between ELS and pPGV development. Neither aPGV nor pPGV changes mediated associations between ELS and psychopathology. Results suggest that ELS may accelerate aPGV (but not pPGV) growth throughout adolescence. Investigating the development of aPGV, rather than PGV, represents a novel approach to studying the effects of stress on HPAA functioning.

Oncology News / Literature Review / July-December 2019

1. Overall survival (OS) results of a phase III randomized trial of standard-of-care therapy with or without enzalutamide for metastatic hormone-sensitive prostate cancer (mHSPC): ENZAMET (ANZUP 1304), an ANZUP-led international cooperative group trial. Testosterone suppression (TS) is the backbone of treatment for metastatic hormone-sensitive prostate cancer (mHSPC). Overall survival is improved by the addition of early docetaxel (DOC) or abiraterone to TS. The randomised phase 3 ENZAMET trial assessed the effects of enzalutamide (ENZA), a potent androgen receptor (AR) inhibitor, versus a nonsteroidal anti-androgen (NSAA: bicalutamide, nilutamide, or flutamide) in addition to SOC in mHSPC. Men (1125) with mHSPC were randomly assigned 1:1 to receive TS plus either ENZA (160 mg daily, by mouth, until clinical disease progression or prohibitive toxicity) or NSAA (conventional NSAA, by mouth until clinical disease progression or prohibitive toxicity). All participants were to receive standard background therapy with a LHRHA or surgical castration, as per standard of care. The choice of the LHRHA or surgical castration was at the discretion of the treating clinician. Randomization was stratified by: volume of disease (high vs low, according to CHAARTED); planned early DOC; planned anti-resorptive therapy, comorbidity score (ACE-27), and study site. The primary endpoint was overall survival. Subgroup analyses to assess possible modulation of the treatment effect were specified a priori and included planned early docetaxel (yes vs no) and volume of disease (high vs low). After a median follow-up of 33 months. Overall survival was prolonged by ENZA. At 3 years, 36% NSAA vs 64% ENZA were still on their assigned study treatment. Serious adverse events (regardless of attribution) within 30 days of study treatment occurred in 42% ENZA vs 34% NSAA, commensurate with the different durations of study treatment. ENZA significantly improved OS when added to SOC in mHSPC while the benefits appeared lower in those planned to receive early DOC.

Aneurysm Volumes After Endovascular Repair of Ruptured vs Intact Aortic Aneurysms: A Retrospective Observational Study

Purpose To compare changes in abdominal aortic aneurysm (AAA) sac volume between endovascular aneurysm repairs (EVAR) performed for ruptured (rEVAR) vs intact (iEVAR) AAAs and to determine the impact of early volume shrinkage on future complications. Materials and Methods A retrospective analysis was performed of all patients undergoing standard infrarenal EVAR from 2002 to 2016 at a tertiary referral institution. Only patients with degenerative AAAs and with 30-day and 1-year computed tomography angiography (CTA) imaging were included. Early sac shrinkage was defined as a volume sac reduction >10% between the first (<30-day) and the 1-year CTA. The primary endpoint was to compare AAA sac volume changes between patients undergoing rEVAR (n=51; mean age 71.0±8.5 years; 46 men) vs iEVAR (n=393; mean age 72.3±7.5 years; 350 men). Results are reported as the mean difference with the interquartile range (IQR Q1, Q3). The secondary endpoint was freedom from aneurysm-related complications after 1 year as determined by regression analysis; the results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results At baseline, the rEVAR group had larger aneurysms (p<0.001) and shorter (p<0.001) and more angulated (p=0.028) necks. Aneurysm sac volume decreased more in the rEVAR group during the first year [−26.3% (IQR −38.8%, −12.5%)] vs the iEVAR group [−11.9% (IQR −27.5%, 0); p<0.001]. However, after the first year, the change in sac volume was similar between the groups [−3.8% (IQR −32.9%, 31.9%) for rEVAR and −1.5% (IQR −20.9%, 13.6%) for iEVAR, p=0.74]. Endoleak occurrence during follow-up was similar between the groups. In the overall population, patients with early sac shrinkage had a lower incidence of complications after the 1-year examination (adjusted HR 0.59, 95% CI 0.39 to 0.89, p=0.01). Conclusion EVAR patients treated for rupture have more pronounced aneurysm sac shrinkage compared with iEVAR patients during the first year after EVAR. Patients presenting with early shrinkage are less likely to encounter late complications. These parameters may be considered when tailoring surveillance protocols.

Early prediction of final infarct volume with material decomposition images of dual-energy CT after mechanical thrombectomy.

Evaluation of water material density images (wMDIm) of dual-energy CT (DECT) for earlier prediction of final infarct volume (fiV) in follow-up single-energy CT (SECT) and correlation with clinical outcome. Fifty patients (69 years, ± 12.1, 40-90, 50% female) with middle cerebral artery (MCA) occlusions were included. Early infarct volumes were analyzed in monoenergetic images (MonoIm) and wMDIm at 60 keV and compared with the fiV in SECT 4.9 days (± 4) after thrombectomy. Association between infarct volume and functional outcome was tested by linear regression analysis. wMDIm shows a prior visible infarct demarcation (60.7 ml, ± 74.9 ml) compared with the MonoIm (37.57 ml, ± 76.7 ml). Linear regression analysis, Bland-Altman plots and Pearson correlation coefficients show a close correlation of infarct volume in wMDIm to the fiV in SECT (r = 0.86; 95% CI 0.76-0.92), compared with MonoIm and SECT (r = 0.81; 95% CI 0.69-0.89). The agreement with SECT is substantially higher in patients with infarct volumes < 70 ml (n = 33; 66%). Coefficients were smaller with r = 0.59 (95% CI 0.31; 0.78) for MonoIm and SECT compared with r = 0.77 (95% CI 0.57; 0.88) for wMDIm and SECT. At admission, the mean NIHSS score and mRS were 17.02 (± 4.7) and 4.9 (± 0.2). mRS ≤ 2 was achieved in 56% at 90 days with a mean mRS of 2.5 (± 0.8) at discharge. Material decomposition allows earlier visibility of the final infarct volume. This promises an earlier evaluation of the dimension and severity of infarction and may lead to faster initiation of secondary stroke prophylaxis.

Associations between early life stress and anterior pituitary gland volume development during late childhood

Early Life Stress (ELS) is thought to influence Hypothalamic-Pituitary-Adrenal-Axis (HPAA) functioning, contributing to an increased risk for psychopathology through dysregulation of biological stress responses. Research exploring relationships between ELS and HPAA functioning has largely focused on its key hormonal output, cortisol. However, findings have been inconsistent, potentially due to cortisol’s distinctive diurnal patterns and dynamic nature complicating its accurate measurement. Thus, this study explored the link between ELS and a more stable, structural component of the HPAA, specifically, anterior pituitary gland volume (PGV) in a community sample of children (N = 129, 68 female). PGV was traced from Magnetic Resonance Imaging brain scans across two time-points at ages 8 (baseline) and 10 years (follow-up). ELS exposure was assessed at baseline through parent-report questionnaires and maternal affective behavior observed in mother-child interaction tasks. ELS variables were reduced to a 5-factor structure using exploratory factor analysis – Uninvolved Parenting, Negative Affective Parenting, Neglect, Trauma, and Dysfunctional Discipline. Direct and sex-moderated associations between ELS and PGV were explored using regression and linear mixed models analyses. PGV-mediated associations between ELS and internalizing symptoms were also investigated. Childhood Neglect was significantly associated with greater baseline anterior PGV, that was stable over the follow-up period. This effect was found in the whole sample, and in males, specifically. No mediation effects were found. Results suggest that neglect may play a unique role in HPAA neurodevelopment; however, it is important that future research extends into adolescence to more clearly characterize these neurodevelopmental associations and any subsequent psychopathological outcomes.

Cost-effectiveness Analysis of Early Blood Volume-Guided Management In Hospitalized Heart Failure Patients

Background In a recent retrospective study, the use of early blood volume analysis (BVA) to guide treatment in Hospitalized Heart Failure (HHF) patients was associated with significantly lower readmission rates and mortality. A cost-effectiveness analysis was undertaken to quantify this benefit economically, based on the results of the study. Methods Costs for HHF with and without BVA were estimated from published data. Effectiveness was derived by modeling survival using outcomes from the retrospective study. A 3-state Markov simulation was performed, with all patients initially in state “In Hospital with Heart Failure”, with additional states “Not in Hospital with Heart Failure” and “Dead”. Transition probabilities and uncertainties for in-hospital mortality and readmission were determined by the observed outcomes of the retrospective study. Other parameters for the analysis (transitions, quality adjustments, etc.) were derived from published sources of large population studies. Probabilistic and deterministic sensitivity analysis was performed. Results The incremental cost-effectiveness ratio (ICER) for a 30-year simulation was $10,700. This was derived from an average life-extension of 2.32 quality-adjusted life years (QALYs) per patient, at an incremental cost of $24,800 per patient. Sensitivity analysis showed that the most critical parameters of the simulation were the long-term hospitalization rate for chronic heart failure, the age of the patients, the assumed cost of a single hospitalization, and the marginal cost assumed to be associated with longer Length of Stay (LOS) for subjects. Uncertainty analysis returned an estimate of ICER = $14,200±$5,620, based on incremental QALY = 2.69±1.76 and incremental cost=$35,400±$22,500. A goal-seeking analysis showed that an ICER of $50,000 would be achieved if the reduction in mortality and readmission was as little as 12%. Conclusion Use of BVA to guide treatment was demonstrated to be extremely cost-effective, as ICER values for all scenarios considered were far below the threshold of $50,000 which is generally taken to represent good value for health care.

The effect of shrinkage reducing admixtures on drying shrinkage, autogenous deformation, and early age stress development of concrete

AbstractThe current study investigates the effect of shrinkage reducing admixtures (SRA) on volume changes that may lead to shrinkage cracking and early age cracking. Drying shrinkage (DS) and autogenous deformation (AD), the impetus for shrinkage cracking, were measured over 2.5 years for three concretes with and without 1% SRA addition: an ordinary Portland concrete, a fly ash concrete and a slag concrete. The latter two concretes were also tested in the Temperature‐stress testing machine (TSTM), which measures AD, thermal dilation (TD) and restrained stress development for a concrete subjected to realistic temperature curing conditions. SRA was found to have a substantial and permanent impact on DS and AD for all three concretes (up to 32% reduction of the total deformation after 2.5 years). The higher the shrinkage, the higher the effect of SRA. For the slag concrete, where AD was found to be the main impetus of early age volume changes, SRA had a clear beneficial effect on the cracking tendency. For the fly ash concrete, where TD provided the main contribution to the volume changes, SRA had a less pronounced effect. The test results were also compared with AD and DS modeled by Model Code 2010.

Time-dependent variations in urine volume and serum creatinine levels during post-operative hospital stay period after renal transplantation: experience in a tertiary care hospital of Bangladesh

Background: Kidney transplantation is the preferred treatment for end stage kidney disease (ESKD). Early post kidney transplant urine volume may correlate with favorable allograft survival. The aim of the present study was to examine the potential changes in urine volume with serum creatinine during post-operative hospital stay period after renal transplantation.&#x0D; Methods: We retrospectively reviewed the medical records of patients who had undergone kidney transplantation at Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh between November 2004 and February 2019. Total patients were 133. Twenty four hour urine volume and serum creatinine levels were measured on day 1, day 5 and day 10 after operation. Correlation was performed by using Pearson correlation test.&#x0D; Results: The mean age of the renal allograft recipients was 36.7±10.3 years with male to female ratio of 2.7:1. The mean 24 hours urine volume on Day 1, Day 5 and Day 10 were 8990±5377 ml, 4860±2074 ml and 4485±1722 ml respectively and serum creatinine levels were 3.5±1.5 mg/dl, 1.6±1.2 mg/dl and 1.5±1.3 mg/dl respectively. Negative correlation were found between the Day 1, Day 5 and Day 10 serum creatinine and the urine volume (r=0.366, 0.507, 0.365 respectively) with significant p values (&lt;0.01) in each group.&#x0D; Conclusion: Although urine volume showed considerable variation in early post renal transplantation, it stabilized by the course of time, which was also negatively correlated with the serum creatinine levels.&#x0D; Birdem Med J 2020; 10(3): 149-151

Strategy for Prevention of Bronchopulmonary Dysplasia in Newborns

Bronchopulmonary dysplasia (BPD) is a chronic lung disease most commonly seen in premature infants who required mechanical ventilation and oxygen therapy for acute respiratory distress. While advances in neonatal care have resulted in improved survival rates of premature infants, limited progress has been made in reducing rates of BPD. Lack of progress may in part be attributed to the limited therapeutic options available for prevention and treatment of BPD. Several lung-protective strategies have been shown to reduce risks, including use of non-invasive support, as well as early extubation and volume ventilation when intubation is required. These approaches, along with optimal nutrition and medical therapy, decrease risk of BPD; however, impacts on long-term outcomes are poorly defined. Abnormal ventilatory responses and pulmonary hypertension can further complicate disease. These pulmonary morbidities, combined with environmental and infectious exposures, may result in significant long-term pulmonary sequalae and represent a growing burden on health systems.

Perfusion indices can predict early volume depletion in a blood donor model.

Blood donation from healthy donors is used experimental model that surrogates for class 1 hemorrhage in humans. We examined changes in the perfusion index (PI) and plethysmographic variability index (PVI) in healthy blood donors after donating a unit of blood, and we evaluated the usability of these indices in detecting blood loss volumes of less than 750mL (class 1 hemorrhagic shock trauma patients). This study is a prospective, cross-sectional study. 180 healthy volunteers aged 18 and over, who donated blood at the local blood bank, were included in the study consecutively. The age, gender, and body mass index of the volunteers were recorded and, before and after the blood donation, the vital signs and perfusion indices were measured. Of the donors, 61.7% were men (n = 111), and the median age of all donors was 32 (IQR: 21-39). A statistically significant difference was found between the hemodynamic parameters and PIs before and after the blood donation (p < 0.01 for all parameters; median difference of PI [-1.45, 95% CI: (-0.9)-( -2)], median difference of PVI [6, 95% CI: 7.77-4.23]. We evaluated the perfusion indices in the early diagnosis of blood volume loss in patients admitted to the emergency department due to trauma. After the participants donated one unit of blood, we found that their PI decreased and PVI increased compared to the measurements before the blood donation. Considering that major bleeding starts in the very early stage as minor bleeding, it is essential for emergency physicians to recognize class 1 hemorrhagic shock patients. Further, non-invasive and straightforward procedures, such as measuring PI and PVI, can be particularly useful in identifying blood loss volumes of less than 750mL.

Role of Bicarbonates and Mannitol in Rhabdomyolysis: A Comprehensive Review.

Rhabdomyolysis is characterized by rapid muscle breakdown and release of intracellular muscle components into the circulation. Acute renal injury is the most common and fatal complication of rhabdomyolysis. The current literature emphasizes the importance of preventing rhabdomyolysis and finding the benefits of sodium bicarbonates and mannitol in its prevention. A PubMed database search for the keywords "Rhabdomyolysis," "Sodium bicarbonate use in rhabdomyolysis," "Mannitol use in rhabdomyolysis," and a Medical Subject Headings (MeSH) search using the keyword "Rhabdomyolysis; Acute Kidney Injury (Subheading-Prevention and control)" generated 10,005 articles overall. After a thorough application of inclusion/exclusion criteria, 37 relevant studies were selected for this literature study. This analysis demonstrates that aggressive early volume resuscitation with normal saline should continue being the principal focus of therapy, and the use of sodium bicarbonate and mannitol in practical situations is not entirely justified. This article also emphasizes the need for future research on this topic and provides recommendations for future research.

Clinical efficacy of biomarkers for evaluation of volume status in dialysis patients.

Volume status is a key parameter for cardiovascular-related mortality in dialysis patients. Although N-terminal pro-B-type natriuretic peptide (NT-proBNP), myeloperoxidase, copeptin, and pro-adrenomedullin have been reported as volume markers, the relationship between body fluid status and volume markers in dialysis patients is uncertain. Therefore, we investigated the utility of volume status biomarkers based on body composition monitor (BCM) analyses.We enrolled pre-dialysis, hemodialysis (HD), and peritoneal dialysis (PD) patients and age- and gender-matched healthy Korean individuals (N = 80). BCM and transthoracic echocardiography were performed and NT-proBNP, myeloperoxidase, copeptin, and pro-adrenomedullin concentrations were measured. Relative hydration status (ΔHS, %) was defined in terms of the hydration status-to-extracellular water ratio with a cutoff of 15%, and hyperhydrated status was defined as ΔHS > 15%.Although there were no significant differences in total body water, extracellular water, or intracellular water among groups, mean amount of volume overload and hyperhydrated status were significantly higher in HD and PD patients compared with control and pre-dialysis patients. Mean amount of volume overload and hyperhydrated status were also significantly associated with higher NT-proBNP and pro-adrenomedullin levels in HD and PD patients, although not with myeloperoxidase or copeptin levels. Furthermore, they were significantly associated with cardiac markers (left ventricular mass index, ejection fraction, and left atrial diameter) in HD and PD patients compared with those in the control and pre-dialysis groups.On the basis of increased plasma NT-proBNP and pro-adrenomedullin concentrations, we might be able to make predictions regarding the volume overload status of dialysis patients, and thereby reduce cardiovascular-related mortality through appropriate early volume control.

Jean Mairet, Théâtre complet, iv: Le Roland furieux, L’Athénaïs, La Sidonie. Textes établis et commentés par Anne Surgers, Marianne Béthery et Hélène Baby

This is the fourth and final volume of the complete theatre of Jean Mairet, containing his last three plays, all tragicomedies, each (as in earlier volumes) with a different editor (all editors have worked under the general direction of Georges Forestier). Le Roland furieux, probably first performed at the Hôtel de Bourgogne in 1638, was published in 1640. Much of Anne Surgers’s Introduction is devoted to the way Mairet reduced Ariosto’s vast epic poem into a five-act play. This analysis is accompanied by a magisterial demonstration of the play’s use of multiple decor. Le Roland furieux seems to fly in the face of Mairet’s earlier commitment to the new illusionism of regular theatre, but Surgers encourages us to resist facile compartmentalization to rejoice in a ‘pièce un peu folle qui renvoie tout le monde dos à dos’ (p. 112). L’Athénaïs, probably first performed at the Hôtel de Bourgogne in 1638–39, was published in 1642. Mariane Béthery’s Introduction makes clear that it is a very different kind of tragicomedy from Le Roland furieux. Its key source is Nicolas Caussin’s La Cour sainte (1623) and it is set in the Eastern Roman Empire of Theodosius II, ending with the marriage of the Christian emperor to the pagan poet and philosopher Athénaïs. It observes the unity of place, but not the unity of time, and is exceptional in being a tragicomedy with a devotional theme, though Béthery finds ambiguities: it is a ‘tragi-comédie amoureuse, sans amour vraiment partagé’, a ‘tragi-comédie chrétienne sans élan religieux’ (p. 338). Mairet’s last play, La Sidonie, published in 1643, may have been performed at the Hôtel de Bourgogne in 1642, but there is no clear evidence to this effect. It is different from both its immediate predecessors, telling a story purely of Mairet’s imagination and set in Armenia with characters whose names sound Greek. Despite some ambiguity about the decor, Hélène Baby argues convincingly that the play is perfectly regular. She makes an interesting argument aiming to justify Mairet’s unique generic designation of the play as a ‘tragi-comédie héroïque’, claiming that the characters’ heroism lies in their unusual degree of moral perfection and their avoidance of confrontation (there is a high number of liaisons de fuite). In this respect, the play foreshadows Corneille’s Don Sanche d’Aragon and Nicomède. Baby’s key claim, however, is that La Sidonie’s lasting mark is on Racine’s Andromaque, since they both depict a female protagonist planning a heroic suicide immediately after marriage: ‘il est temps de rendre hommage à Mairet pour son invention’ (p. 490). All three editors address the negative assessments or downright neglect that have been the fate of these plays. Le Roland furieux ‘mérite d’être redécouvert et rejoué’ (p. 12). L’Athénaïs ‘mérite qu’on s’y intéresse’ (p. 339). As to La Sidonie, ‘à défaut d’infléchir le jugement du lecteur sur la médiocre qualité de cette pièce’, its editor wants to help us to ‘mieux en comprendre les enjeux’ (p. 456). The plays could not have found more sympathetic, eloquent, or erudite editors.

Early volume formulas, taper, implicit volume ratio, and auxiliary information: A new system of volume equations invariant to silvicultural practices, site, and genetic pedigree

This article returns to the Hossfeldt and Pressler volume formulas that were developed in the 19th century and uses them as predictor variables for total volume equations of species in North and South America. Both the Hossfeldt and Pressler formulas require an upper-stem measurement and are exact equations for the geometric shapes of a cone or paraboloid. Rarely is a direct measurement of the Hossfeldt diameter or Pressler height made on a stem, and a taper function is employed to indirectly obtain these values. A Kozak-type taper function is expanded to include routine auxiliary information of an inventory, such as age, dominant height, relative spacing, and a ranking variable that indicates position of the subject tree to a tree of average size. Using the Hossfeldt diameter and Pressler height, it is demonstrated how a merchantable volume ratio equation is indirectly derived. With the aid of one lower-stem measurement of diameter and height, such as the height at 5 m, vastly enhanced estimates of total stem volume are possible. These new volume equations imply that form factor is dependent upon the ratio of Pressler height to total tree height, and Hossfeldt diameter to diameter breast height (dbh). Therefore, the costly method of destructive tree sampling for making new volume equations can be obviated, since changes in form can be detected easily and less expensively by monitoring changes to the ratios of Pressler height to total tree height, and Hossfeldt diameter to dbh.

Normal reference values of left atrial volumes and volume-based functional properties using three-dimensional speckle-tracking echocardiography in healthy adults (Insights from the MAGYAR-Healthy Study).

The present study was designed to define normal reference values of three-dimensional speckle-tracking echocardiography (3DSTE)-derived left atrial (LA) volumes, stroke volumes (SVs), and emptying fractions (EFs) with regard to the cardiac cycle. The present study involved 256 healthy adult subjects in sinus rhythm who underwent complete two-dimensional Doppler echocardiography and 3DSTE at the same time. However, due to inferior image quality, 87 subjects have been excluded. The remaining population sample comprised of 169 patients who gave informed consent to participate in the study. While systolic maximum LA volume and early diastolic preatrial contraction LA volume did not change over age decades, late-diastolic minimum LA volume decreased and was lowest in subjects aged 40 to 49 years then increased after 50 years. Total atrial EF increased over age decades with a reduction after 50 years. Passive atrial EF showed a significant continuous increase over age decades. Active atrial EF did not change in younger ages and was the highest between ages 40 and 49 years with a significant impairment after 50 years. This study shows the age- and gender-dependency of normal values of 3DSTE-derived LA volumes, stroke volumes, and emptying fractions with regard to the cardiac cycle in healthy adult subjects.

Tumor Volume Dynamics as an Early Biomarker for Patient-Specific Evolution of Resistance and Progression in Recurrent High-Grade Glioma.

Recurrent high-grade glioma (HGG) remains incurable with inevitable evolution of resistance and high inter-patient heterogeneity in time to progression (TTP). Here, we evaluate if early tumor volume response dynamics can calibrate a mathematical model to predict patient-specific resistance to develop opportunities for treatment adaptation for patients with a high risk of progression. A total of 95 T1-weighted contrast-enhanced (T1post) MRIs from 14 patients treated in a phase I clinical trial with hypo-fractionated stereotactic radiation (HFSRT; 6 Gy × 5) plus pembrolizumab (100 or 200 mg, every 3 weeks) and bevacizumab (10 mg/kg, every 2 weeks; NCT02313272) were delineated to derive longitudinal tumor volumes. We developed, calibrated, and validated a mathematical model that simulates and forecasts tumor volume dynamics with rate of resistance evolution as the single patient-specific parameter. Model prediction performance is evaluated based on how early progression is predicted and the number of false-negative predictions. The model with one patient-specific parameter describing the rate of evolution of resistance to therapy fits untrained data (). In a leave-one-out study, for the nine patients that had T1post tumor volumes ≥1 cm3, the model was able to predict progression on average two imaging cycles early, with a median of 9.3 (range: 3–39.3) weeks early (median progression-free survival was 27.4 weeks). Our results demonstrate that early tumor volume dynamics measured on T1post MRI has the potential to predict progression following the protocol therapy in select patients with recurrent HGG. Future work will include testing on an independent patient dataset and evaluation of the developed framework on T2/FLAIR-derived data.

The left splenorenal venous shunt decreases clinical signs of sinistral portal hypertension associated with splenic vein ligation during pancreaticoduodenectomy with venous resection

BackgroundThe ligation of the splenic vein during pancreaticoduodenectomy with synchronous resection of the spleno-mesenteric-portal venous confluence has been associated with the development of left portal hypertension despite preservation of the natural confluence with the inferior mesenteric vein. This study aimed to assess whether a left splenorenal venous shunt might mitigate clinical signs of left portal hypertension associated with splenic vein ligation. MethodsWe retrospectively evaluated the presence of left portal hypertension based on biologic and radiologic parameters in patients undergoing pancreaticoduodenectomy with synchronous resection of the spleno-mesentericoportal confluence between January 1, 2012, and December 31, 2018. We compared several parameters between patients undergoing splenic vein ligation with preservation of the inferior mesenteric vein confluence and a splenorenal venous shunt: the early and late spleen volumes and spleen volume ratios, an early and late platelet count, the presence of thrombocytopenia, the presence of varices, and digestive bleeding in the long-term. ResultsThere were 114 consecutive patients: 36 with splenic vein ligation and 78 with splenorenal venous shunt. All had a pancreaticogastrostomy. Patients with splenic vein ligation had a comparable baseline and early and late platelet counts. Although baseline splenic volumes were comparable between the 2 groups (242 ± 115 mL vs 261 ± 138 mL; P = .51), patients with splenic vein ligation showed a statistically significant greater splenic volume beyond the 6th postoperative months (334 ± 160 mL vs 241 ± 111 mL; P = .004), higher early and late spleen volume ratios (1.42 ± 0.67 vs 1.10 ± 0.3; P = .001 and 1.38 ± 0.38 vs 0.97 ± 0.4; P = .0001) than patients with splenorenal venous shunt. Splenic vein ligation was also associated with a higher rate of varices (81% vs 50%; P = .002) and more frequent varices with a caliber greater than 1 cm (57% vs 36%; P = .05) and more colonic varices (33% vs 12%; P = .01). Only 1 patient had long-term digestive bleeding (splenic vein ligation). ConclusionThe left splenorenal shunt decreases clinical signs of left portal hypertension associated with splenic vein ligation and inferior mesenteric vein confluence preservation.

Increase in Brain Volumes after Implementation of a Nutrition Regimen in Infants Born Extremely Preterm

To assess the effect of early life nutrition on structural brain development in 2 cohorts of extremely preterm infants, before and after the implementation of a nutrition regimen containing more protein and lipid. We included 178 infants retrospectively (median gestational age, 26.6weeks; IQR, 25.9-27.3), of whom 99 received the old nutrition regimen (cohort A, 2011-2013) and 79 the new nutrition regimen (cohort B, 2013-2015). Intake of protein, lipids, and calories was calculated for the first 28 postnatal days. Brain magnetic resonance imaging (MRI) was performed at 30weeks postmenstrual age (IQR, 30.3-31.4) and term-equivalent age (IQR, 40.9-41.4). Volumes of 42 (left+right) brain structures were calculated. Mean protein and caloric intake in cohort B (3.4g/kg per day [P<.001] and 109kcal/kg per day [P=.038]) was higher than in cohort A (2.7g/kg per day; 104kcal/kg per day). At 30weeks, 22 regions were significantly larger in cohort B compared with cohort A, whereas at term-equivalent age, only the caudate nucleus was significantly larger in cohort B compared with cohort A. An optimized nutrition protocol in the first 28days of life is associated with temporarily improved early life brain volumes.

Modelling of the tensile behavior of SH-UHPFRC at low and high stress levels, under very low loading rates

The tensile behavior under low loading rates governs to a large extend the mechanical response of Strain Hardening Ultra High Performance Fiber Reinforced Concretes (SH-UHPFRC) at early age and long term, in applications of rehabilitation. A viscoelastic-viscohardening model was developed and applied to predict the tensile response of two types of SH-UHPFRC; Mix I with pure type I cement, silica fume and steel fibers and Mix II with 50% replacement of cement with limestone filler and a similar fibrous mix, and compare their time dependent performance. Different tensile loading conditions were investigated, including the behavior under restrained shrinkage deformations, the effect of very low monotonic strain rates, and linear and non-linear relaxation and creep tests. The predictions of the model were also compared with experimental results from literature. The interaction of ageing, hydration, early age volume changes, viscoelastic phenomena and damage and their influence on the overall tensile behavior of UHPFRC was discussed.