Intensive Radiation Research Articles

Cascaded nanocavity-shaped metasurfaces for realizing an intensive radiation absorption in the mid-to-long infrared region based on electromagnetic wavefield resonance response and accumulation

A type of cascaded metal-insulator-metal nanocavity-shaped (CMNM) metasurface has been developed for realizing an intensive radiation absorption in the mid-to-long infrared (IR) region. The radiation absorption characteristics are analyzed according to the impedance matching mechanism. By evaluating the electromagnetic wavefield properties at several wavelength points selected, the spatial resonance morphology of the electric field and magnetic field components excited mainly by the resonance of the free electrons over the surfaces of the metasurface are simulated effectively. The stimulating and redistributing behaviors of the conductive electric-currents, including the surface equivalent eddy-currents surrounding a couple of dielectric films configurated in the cascaded nanocavities, and the net charges distributed over three Ti films, which will induce a resonant accumulation enhancement of the wavefields in the metasurfaces corresponding to the incident IR radiation, are exhibited. An average absorption level of more than 85% in the 3–14µm wavelength region is already achieved. Due to the IR responding and manipulating approaches proposed by us, the CMNM samples also exhibit an insensitivity of the beam incident angle for some typical applications in uncooled infrared imaging and thermal radiation detection.

Characteristics of water dissolved organic matter in Zoige alpine wetlands, China

BackgroundDissolved organic matter (DOM) plays a significant role in the biogeochemical cycle of crucial elements in aquatic ecosystem. However, it is still not clear on the spectral characteristics of water DOM in different types of alpine wetlands, which have less anthropogenic influences and intensive ultraviolet radiation. Here, we collected 107 water samples from marsh, lake, and river wetlands in the Zoige plateau, China, and analyzed the chemical characteristics, compositions, and potential sources of chromophoric DOM by combining UV–vis spectroscopy and excitation–emission matrix fluorescence spectroscopy coupled with parallel factor analysis (EEMs-PARAFAC).ResultsUVC and UVA fulvic-like substances were the prevailing fluorescence components in water DOM, which accounted for 23.74–71.59% and 16.76–30.01% of the total fluorescence intensity, respectively. Compared with the lake and river wetlands, fluoresce intensities of UVC and UVA fulvic-like substances in DOM were higher in marsh wetland. Marsh wetlands possessed the highest SUVA254, E2/E3, E2/E4, and E4/E6 of DOM, suggesting higher humification degree, higher relative molecular nominal size, and higher aromaticity. And the E2/E4 ratios in most water samples were higher than 12, indicating water DOM was mainly derived from autochthonous sources in alpine wetlands.ConclusionsWetland types strongly affected the spectral characteristics of water DOM in Zoige plateau. These findings may be beneficial for sustainable management of alpine wetlands.Graphical

De Novo Genome Assembly of Toniniopsis dissimilis (Ramalinaceae, Lecanoromycetes) from Long Reads Shows a Comparatively High Composition of Biosynthetic Genes Putatively Involved in Melanin Synthesis.

Lichens have developed numerous adaptations to optimize their survival in various environmental conditions, largely by producing secondary compounds by the fungal partner. They often have antibiotic properties and are involved in protection against intensive UV radiation, pathogens, and herbivores. To contribute to the knowledge of the arsenal of secondary compounds in a crustose lichen species, we sequenced and assembled the genome of Toniniopsis dissimilis, an indicator of old-growth forests, using Oxford Nanopore Technologies (ONT, Oxford, UK) long reads. Our analyses focused on biosynthetic gene clusters (BGCs) and specifically on Type I Polyketide (T1PKS) genes involved in the biosynthesis of polyketides. We used the comparative genomic approach to compare the genome of T. dissimilis with six other members of the family Ramalinaceae and twenty additional lichen genomes from the database. With only six T1PKS genes, a comparatively low number of biosynthetic genes are present in the T. dissimilis genome; from those, two-thirds are putatively involved in melanin biosynthesis. The comparative analyses showed at least three potential pathways of melanin biosynthesis in T. dissimilis, namely via the formation of 1,3,6,8-tetrahydroxynaphthalene, naphthopyrone, or YWA1 putative precursors, which highlights its importance in T. dissimilis. In addition, we report the occurrence of genes encoding ribosomally synthesized and posttranslationally modified peptides (RiPPs) in lichens, with their highest number in T. dissimilis compared to other Ramalinaceae genomes. So far, no function has been assigned to RiPP-like proteins in lichens, which leaves potential for future research on this topic.

Dosimetric Study and Robustness Analysis of Base Note Intensive Locked Field Radiotherapy for Left Breast Cancer.

The locked vision plan can make the left breast cancer heart and lung organs dose. The aim of the present study was to compare the dosimetric differences between field-locked and field-split plans in intensity-modulated radiotherapy for left-sided breast cancer, to explore the effect of field-locking on the low-dose region, and to evaluate its robustness to the radiotherapy target, in order to provide a reference for the selection of clinical radiotherapy protocols. A total of 30 patients were selected after radical left breast cancer surgery, and 7-field locked-field and split-field plans were developed to compare the dose difference (∆D) between the target area and each organ at risk, and to introduce offsets of 3, 5 and 7 mm in six directions and recalculate the perturbed dose distributions, and to compare the ∆D between the original and the perturbed plans according to the robustness of the plans. The results revealed that the D98%, D95% and Dmean values of the planning target volume (PTV) of the two plans differed little and were not statistically different. The locked field plan provided better protection for the left lung, right lung, heart, right breast and left anterior descending coronary artery. For PTV∆D98%, PTV∆D95%, PTV∆Dmean, the ∆D was higher for the Locked Fields plan, and for LungL∆5, LungL∆20 and Heart∆mean, the ∆D was higher for the original plan. It was concluded that the field-locking plan could reduce the low-dose area of the affected lung and provide improved protection to the remaining critical organs, and the field-locking plan was more robust in protecting critical organs. Meanwhile, the field-locking plan showed higher sensitivity to positional deviation for target PTV.

Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support.

Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support.

Measurement Guidance in Diffusion Models: Insight from Medical Image Synthesis.

In the field of healthcare, the acquisition of sample is usually restricted by multiple considerations, including cost, labor- intensive annotation, privacy concerns, and radiation hazards, therefore, synthesizing images-of-interest is an important tool to data augmentation. Diffusion models have recently attained state-of-the-art results in various synthesis tasks, and embedding energy functions has been proved that can effectively guide the pre-trained model to synthesize target samples. However, we notice that current method development and validation are still limited to improving indicators, such as Fréchet Inception Distance score (FID) and Inception Score (IS), and have not provided deeper investigations on downstream tasks, like disease grading and diagnosis. Moreover, existing classifier guidance which can be regarded as a special case of energy function can only has a singular effect on altering the distribution of the synthetic dataset. This may contribute to in-distribution synthetic sample that has limited help to downstream model optimization. All these limitations remind that we still have a long way to go to achieve controllable generation. In this work, we first conducted an analysis on previous guidance as well as its contributions on further applications from the perspective of data distribution. To synthesize samples which can help downstream applications, we then introduce uncertainty guidance in each sampling step and design an uncertainty-guided diffusion models. Extensive experiments on four medical datasets, with ten classic networks trained on the augmented sample sets provided a comprehensive evaluation on the practical contributions of our methodology. Furthermore, we provide a theoretical guarantee for general gradient guidance in diffusion models, which would benefit future research on investigating other forms of measurement guidance for specific generative tasks. Codes and models are available at: https://github.com/yangqy1110/MGDM.

Oncology and Palliative Care Integration Model: A Cost Analysis Study in a Brazilian Hospital Setting.

Background: In 2019, the São Paulo State Cancer Institute (ICESP) implemented a novel model integrating Oncology with Palliative Care specialists. We evaluated the impact of this model on healthcare resource utilization and costs. Methods: We analyzed data from all patients who passed away in February (1month prior to implementation) and November (8months after model implementation group) at ICESP, Brazil. Healthcare utilization data, including emergency department visits, hospital and intensive care unit admissions, chemotherapy, and radiotherapy use, were retrieved from Electronic Medical Records. Unit cost values were obtained from the administrative database. Results: A total of 198 patients who died in February and 196 in November were included in the analysis. Groups exhibited similarities in sex, age, ECOG, cancer type, previous outpatient palliative care consultations, and place of death (ward: 56.6% pre-intervention, 50% post-intervention). The mean cost per patient was US$13,226.29 pre-intervention and US$11,445.82 post-intervention (P = .007). Statistically significant differences were noted in days hospitalized in the surgical ward (227 vs 115), emergency department visits (233 vs 45), chemotherapy sessions (140 vs 26), and radiotherapy sessions (146 vs 10). Excluding outpatient treatments, the total costs for chemotherapy and radiotherapy in the last 30days of life were US$16,924.45 pre-intervention and US$7851.65 post-intervention. Reductions were more pronounced in patients with ECOG 3-4 (P = .039). Conclusion: Our data suggests that the integration model was associated with a reduction in potentially inappropriate treatments during the last month of life, leading to decreased healthcare utilization and costs.

Abstract B004: Molecular crosstalk between NF-κB and NRF2 signaling affects prognosis in HPV-associated head and neck cancer

Abstract The incidence of head and neck squamous cell carcinoma (HNSCC) is on the rise and is expected to increase by 50% by 2030. Around half of the patient population affected are diagnosed when the tumor is at a locally advanced stage. These patients are usually treated with intense radiotherapy, leading to severe side-effects. Precision medicine would revolutionize the treatment of head and neck cancer by accurately identifying patients that are at low risk of recurrence, reduce treatment related side-effects and aid in overall improvement in quality of life of patients after treatment. This generates the need to develop biomarkers to identify patients with less aggressive tumors as candidates for treatment de-escalation. We applied an unbiased approach (weighted gene correlation network analysis (WGCNA)) that allows detection of autocorrelated gene sets on 3 independent cohorts of HPV+ HNSCC and created 22 consensus transcriptional modules by selecting genes that grouped together in WGCNA analyses from all 3 cohorts. Interestingly, only 1 module intrinsically divided HPV+ HNSCC into 2 subtypes, displaying different mutational profiles, mutational signatures, HPV gene expression patterns, HPV integration status, and patient survival. Gene set enrichment analysis revealed that this module was enriched in NF-kB genes and strongly associated with NF-κB signaling, confirming our prior findings that defined HPV+ HNSCC subtypes by presence or absence of NF-kB regulators, TRAF3 or CYLD defects and by the NF-κB activity classifier. We hypothesized that NF-kB-driven intrinsic tumor characteristics contribute to increased sensitivity of NF-kB active HPV+ head and neck tumors to radiation, providing patients survival benefits. Indeed, TRAF3 or CYLD deletion dramatically increased radiation sensitivity of HPV+ head and neck cancer cells. As we began to investigate mechanisms of radiation sensitization associated with TRAF3 and CYLD deletion, we found that activation of NF-κB significantly correlated with marked downregulation of nuclear factor erythroid 2-related factor 2 (NRF2) activity in tumors from 3 independent cohorts, as well as in HPV+ HNSCC cells that harbor constitutively active NF-kB due to deletion of TRAF3 or CYLD. Interestingly, TRAF3 CRISPR KO cells had lower NRF2 protein levels that were restored by MG132 treatment, indicating an involvement of KEAP1/CUL3 mediated proteasomal degradation of NRF2. In summary, our data showcases an inverse correlation between NF-kB and NRF2 pathways in HPV+ HNSCC. Currently, there are no prognostic biomarkers to distinguish patients who require aggressive therapy versus those that are appropriate for reduced intensity treatment. Identification of markers distinguishing the 2 subtypes of HPV+ HNSCC (high NF-kB and low NRF2 activity) may serve as prognostic biomarkers to help clinicians with therapeutic decisions. Citation Format: Aditi Kothari, Travis Schrank, Wendell Yarbrough, Natalia Isaeva. Molecular crosstalk between NF-κB and NRF2 signaling affects prognosis in HPV-associated head and neck cancer [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2023 Oct 11-15; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2023;22(12 Suppl):Abstract nr B004.

Study of The Effect of Using Modulated Intensity Radiotherapy Compared to Three Dimension Conformal Radiotherapy on Urinary Bladder Tumors

Study of The Effect of Using Modulated Intensity Radiotherapy Compared to Three Dimension Conformal Radiotherapy on Urinary Bladder Tumors

Economic evaluation of a non-medical financial assistance program on missed treatment appointments among adults with cancer.

282 Background: Addressing patients’ cancer-related financial needs is critical to ensuring equitable cancer care delivery. Although many cancer centers report having financial support programs available to meet patients' medical and non-medical financial needs, formal evaluation of these programs has been limited. We retrospectively evaluated the impact of a program providing non-medical financial assistance on missed treatment appointments among patients receiving cancer treatment at a large, Southeastern public hospital system. Methods: We used patient electronic health records, program records, and cancer registry data to examine the impact of the program on rates of missed (or “no-show”) radiation therapy and infusion chemotherapy/immunotherapy appointments in the six months following treatment initiation. We employed propensity weighting to estimate the average treatment effect on those exposed to the program, stratified by treatment appointment type (radiation therapy, infusion chemotherapy/immunotherapy). We developed a decision tree-based economic model to assess the program’s cost-effectiveness from the health system perspective in a hypothetical cohort over a six-month time horizon. Results: Of 1,347 patients receiving radiation therapy between 2015 and 2019, 53% (N=715) had ≥1 no-shows, and 28% (N=378) received program assistance. Receipt of any assistance was associated with a 2.1 percentage point (95% CI: 0.6 – 3.5) decrease in the proportion of no-shows, corresponding to a 51% decrease in the overall mean no-show proportion. Under the current funding model, the program is estimated to save the health system $153 per missed appointment averted, relative to not providing non-medical financial assistance. Of the 1,641 patients receiving infusion chemotherapy/immunotherapy, 33% (N=541) received program assistance, and only 14% (N=223) had ≥1 no-shows. The financial assistance program did not have a significant effect on no-show proportions among infusion visits. Conclusions: This study employed a novel approach to retrospectively evaluate a non-medical financial assistance program for patients undergoing active cancer treatment. Findings support investment in programs that address patients’ non-medical financial needs, particularly for those undergoing intensive radiation therapy.

Economic Evaluation of a Nonmedical Financial Assistance Program on Missed Treatment Appointments Among Adults With Cancer.

We retrospectively evaluated the clinical and economic impact of a program providing nonmedical financial assistance on missed treatment appointments among patients receiving cancer treatment at a large, Southeastern public hospital system. We used patient electronic health records, program records, and cancer registry data to examine the impact of the program on rates of missed (or no-show) radiation therapy and infusion chemotherapy/immunotherapy appointments in the 180 days after treatment initiation. We used propensity weighting to estimate the effect of the program, stratified by treatment appointment type (radiation therapy, infusion chemotherapy/immunotherapy). We developed a decision tree-based economic model to conduct a cost-consequence analysis from the health system perspective in a hypothetical cohort over a 6-month time horizon. Of 1,347 patients receiving radiation therapy between 2015 and 2019, 53% (n = 715) had ≥1 no-shows and 28% (n = 378) received program assistance. Receipt of any assistance was associated with a 2.1 percentage point (95% CI, 0.6 to 3.5) decrease in the proportion of no-shows, corresponding to a 51% decrease in the overall mean no-show proportion. Under the current funding model, the program is estimated to save the health system $153 in US dollars per missed appointment averted, relative to not providing nonmedical financial assistance. Of the 1,641 patients receiving infusion chemotherapy/immunotherapy, 33% (n = 541) received program assistance, and only 14% (n = 223) had ≥1 no-shows. The financial assistance program did not have a significant effect on no-show proportions among infusion visits. This study used a novel approach to retrospectively evaluate a nonmedical financial assistance program for patients undergoing active cancer treatment. Findings support investment in programs that address patients' nonmedical financial needs, particularly for those undergoing intensive radiation therapy.

Immunoregulatory liposomes hitchhiking on neutrophils for enhanced carbon ion radiotherapy-assisted immunotherapy of glioblastoma

Glioblastoma with low cure and high recurrence is a serious threat to human health. Multifaceted synergy of intensive radiotherapy (RT) and systemic chemo-immunotherapy can develop a safe and effective treatment for glioblastoma. Herein, we dope bacterial membrane (BM) into the phospholipid layer of liposome to obtain BM-doping liposome (B-Lipo), which could be further loaded with 1-methyl-D-tryptophan (1-MT) and curcumin (Cur). Utilizing the BM doping, B-Lipo/1-MT&Cur could be effectively taken up by neutrophils, and cross the blood-brain barrier to brain tumor under the stimulation of up-regulated chemokines after RT. In the RT-treated glioblastoma, BM and the loaded drugs in B-Lipo/1-MT&Cur could reinforce RT-induced positive anti-tumor immune stimulation effect, such as immunogenic cell death and T cells infiltration, and reverse RT-caused negative immune stimulation effect including the polarization of macrophages and the expression of IDO, together realizing a potent systemic innate and adaptive anti-tumor immunity. More importantly, the combination of carbon ion RT and B-Lipo/1-MT&Cur could cure most of orthotopic glioblastoma-bearing mice and prevent its recurrence without causing any physiological and neuropsychiatric damage. Therefore, glioblastoma would be completely removed by intensive RT and the ingenious combination of local and systemic therapies, promoting the development of carbon ion RT and its combination therapy.

Experimental, analytical, and simulation studies of modified concrete mix for radiation shielding in a mixed radiation field

The current study assessed two concrete mixes prepared using dolomite and barite/limonite aggregates to shield against both energetic photons and neutrons. After that, a designed mix which comprised barite/goethite aggregates plus fine-powdered boron carbide additive, was proposed to improve the overall radiation shielding properties and in the same time, doesn’t compromise or even improve the physic-mechanical properties of the mature concrete. The assessment started first with intensive experimental investigations to investigate the prepared mixes’ shielding capabilities against both γ-rays and fast neutrons. Then, analytical computations were performed via number of reliable software programs such as; Phy-X, NXCom, MRCsC, JANIS-4, and MCNP5, in order to confirm the experimental results and to validate the created Monte-Carlo models. Finally, an intensive radiation shielding assessment for all concrete mixes understudy using, mainly, the validated MCNP models, was performed. The obtained results have revealed the superiority of barite mixes over the dolomite mix concerning attenuating photons moreover, the proposed designed mix has shown superiority over the other two prepared mixes considering shielding against; energetic photons, fast/thermal neutrons, and secondary emitted γ-rays, which nominates this mix to be a suitable universal shield that can be used even in mixed radiation fields.

High-Energy Composite Fuels with Improved Combustion Efficiency by Using AlH3 Embedded with Al Particles.

Aluminum hydride (AlH3) has attracted much attention due to its potential to replace aluminum (Al) as a novel energetic material in solid propellants. In this research, ammonium perchlorate (AP) and perfluoropolyether (PFPE) as functionalized coatings and a combination of acoustic resonance and spray drying technology have been employed to prepare AlH3@Al@AP (AHAPs) and AlH3@Al@AP@PFPE (AHAPs-F) energetic composite particles. The formulations of composite propellants and modified AlH3 particles were designed and fabricated. Their thermal reactivity, reaction heat, density, vacuum stability, combustion performance, and condensed combustion products (CCPs) have been systematically investigated. The results show that the solid propellants containing AHAPs (SP13) and AHAPs-F (SP14) composites can significantly enhance the reactivity and energy output compared to conventional solid propellants with the mechanical mixture Al/AlH3 (SP12). In particular, the total heat releases of SP13 and SP14 are almost 1.2 and 1.7 times higher than those of conventional ones (SP12, 1442 J g-1), respectively. Among the AlH3-based propellants, SP14 propellants exhibit the highest reaction heat of 5887 J g-1, the most intensive flame radiation of 31.4 × 103, and the highest combustion wave temperature of 2495 °C. Moreover, the particle size distribution of CCPs from SP14 propellants is much narrower and smaller than that of SP12, resulting in higher combustion efficiency.

Optical characterizations of lightly doped (PbS)1−x Znx thin films influenced by film thickness and annealing temperature for applications in highly intensive radiation systems

The lightly Zn-doped (PbS)1−x (Zn)x thin films were synthesized by the thermal deposition technique. The structure, morphology, and elemental analyses were carried out by XRD, SEM, and EDS, respectively, and characterised by UV–VIS–NIR spectroscopy. The optical absorption, transmission, and reflection have been studied and analysed. The linear and non-linear parameters have been determined, explained, and compared with the reported results. The effects of Zn-doping, film thickness, and annealing temperature on NLO-parameters have been considered. The better 2.78 × 10–10 and 2.93 × 10–10 esu values of the non-linear refractive index n2 and 3rd-order optical polarizability χ(3), respectively, were attained by (PbS)0.97 (Zn)0.03 film of 150 nm thick annealed at 200 °C.

Electron contamination suppression in transmission detectors for radiotherapy.

Higher energy and intensity radiotherapy beams are being used, in part, due to the increased spatial accuracy of treatments. However, higher intensity beams can result in a larger total dose error, motivating the increasing need for real-time dose monitoring. We are developing a thin, real-time upstream Monolithic Active Pixel Sensor based system for beam monitoring with excellent precision on measuring the beam shape. Here we present a method to additionally provide dosimetry by adding thin conversion material in strips to the surface of the detector, a grating structure. 
Approach: By modulating the thickness of the conversion material to minimally disturb the contamination electron signal while enhancing the photon signal, the difference in these signals can be used to extract a photon-only signal, and hence dose. The simulation software Gate, based on Geant4, is utilised to study whether well functioning gratings can be better made from aluminium or copper and to optimise the thickness of a copper grating. 
Main results: It is possible to enhance the photon signal by a factor 6.7 (7.7) compared to the bare sensor for a 5.8 (6.7) MV beam, without modulation of the signal due to beam electrons. 
Significance: The grating can be used to perform dosimetry in real-time using a thin upstream detector.

​Occult extracranial malignancy after complete remission of pineal mixed germ cell tumors: a rare case report and literature review

Background​Extracranial metastasis can occur in intracranial germ cell tumors (GCTs), but it is very rare. Recurrence or metastasis of non-germinomatous germ cell tumors (NGGCTs) is often accompanied by elevated tumor markers. ​Occult extracranial metastases or recurrences with negative markers are often difficult to detect in time, resulting in a very poor prognosis.Case presentationA 12-year-old boy was admitted to our institution with dizziness, headache, vomiting, and sleepiness. Magnetic resonance imaging (MRI) showed a pineal mass, accompanied by a significant increase in serum alpha-fetoprotein (AFP). The patient subsequently underwent total removal of the tumor. Pathology revealed that the tumor was a mixed GCT, consisting of mature teratoma, germinoma, and yolk sac tumor. Intracranial GCT achieved complete remission after intensive adjuvant chemotherapy and radiotherapy. Regular follow-up MRI revealed no recurrence of the intracranial tumor and continued monitoring of tumor markers revealed no abnormalities. ​Eight months later, the patient was readmitted due to progressive abdominal pain. Imaging and physical examination revealed abdominal occupation and lymphatic mass in the neck. He received salvage chemotherapy, anti-PD-1 immunotherapy, and palliative chemotherapy, but still developed multiple organ dysfunction syndromes (MODS) due to tumor progression and eventually died after one month.Conclusions​This profound case suggests that intracranial NGGCTs may develop occult extracranial malignancy, which can be very severe at the time of clinical symptoms and has an extremely poor prognosis. Therefore, in addition to tumor marker monitoring, regular follow-up with extracranial imaging may be warranted to detect extracranial tumors as early as possible, although perhaps not as frequently as with neuroimaging.

Observation of impurity accumulation and its compatibility with high plasma performance in W7-X

At the W7-X stellarator, the bolometer system has measured an intensive radiation zone in the inner plasma region (at a normalized radius ρ ∼ 0.3–0.4) in the hydrogen plasma generated by electron cyclotron resonance heating; it differs from the normal plasma radiation distribution with an edge-localized emission zone. Spectroscopic diagnostics have recorded high-Z elements such as iron. This phenomenon happens in the plasma phases after gas supply turn-off, which results in all impurity relevant diagnostic signals increasing for several seconds. Despite the enhancement of the core radiation, the plasma energy confinement is improved. A transport analysis shows that this impurity radiation behavior is associated with a low diffusion coefficient (D∼ 0.02 m2 s−1) and a reversal of the convection around the radial position of the emission peak, which, under normal conditions, separates the zones of outward convection in the central (|V| ∼ 0.1 m s−1) and inward convection in the outer region (|V| ∼ 0.3 m s−1). An impurity accumulation around this radial position has been identified. The transport coefficients obtained are comparable with the theoretical predictions of collisional impurity transport. In the plasma phases studied, both impurity and energy confinement are enhanced. The mechanism responsible for the improvement is believed to be a reduction of micro-instabilities associated with the observed steepening of the density profile, initiated by a low edge plasma density (<1.0 × 1019 m−3) after switching off the gas fueling. The normalized temperature and density gradients fulfil the condition for the suppression of ITG turbulence.

Immunotherapy with PD-1 Inhibitor Nivolumab in Recurrent/Metastatic Platinum Refractory Head and Neck Cancers-Early Experiences from Romania and Literature Review.

Prognosis in recurrent/metastatic head and neck squamous-cell carcinoma (HNSCC) refractory to platinum-based chemotherapy is poor, making therapy optimization a priority. Anti-programmed cell death protein 1 (anti-PD-1) monoclonal antibody Nivolumab was approved in such cases. We present the early experience with Nivolumab immunotherapy at three cancer clinics from south and northeast Romania, aiming to describe the main characteristics and outcomes relative to literature reports, and to suggest patient selection criteria. Diagnostic, clinical, biological, therapeutic, and outcomes-related data from January 2020 until March 2023 were analyzed retrospectively. Eighteen patients with platinum refractory HNSCC (85.7% men, median age 58.9) were administered Nivolumab for 1-14 months (median 5.6 months) in addition to other treatments (surgery, radiotherapy, chemotherapy), and monitored for up to 25 months. Median neutrophil-to-lymphocyte ratio (NLR) ranged from 2.72 initially to 6.01 during treatment. Overall survival (OS) was 16 months, and patients who died early had the sharpest NLR increases (13.07/month). There were no severe immune-related adverse events. Lower NLR values and combined intensive chemotherapy, radiotherapy, and immunotherapy were related to better outcomes. To our knowledge, we also report the first two cases of second primary malignancy (SPM) in the head and neck region treated with Nivolumab in Romania (for which the sequential administration of radiotherapy and immunotherapy seems better). The work of other Romanian authors on the role of HPV status in HNC is also discussed. Multi-center trials are needed in order to investigate and confirm these observations.

Economical Evaluation of Cancer Types Using Intensity-Modulated Radiation Therapy Compared to 3D Conformal Radiation Therapy: A Systematic Review.

Cancer is the second most common cause of death worldwide. Economic evaluation of cancer treatment to reduce costs can save the health care system millions of dollars while optimizing care. Therefore, this systematic review aimed to study the economic evaluation of cancer treatment using intermediate intensity radiation therapy (IMRT) compared to conventional 3D conformal radiation therapy (3D-CRT). Literatures from PubMed, Embase, Cochran Library, Google scholar, Scopus and Iranian databases were retrieved since Jan 2000 to Apr 2020 for eligible English studies. The quality of the studies was evaluated using Cheers' checklist and then the textual data were analyzed manually by content analysis method. Overall, 1790 articles were retrieved, of which 12 studies were reviewed. The article quality score ranged from 14.5 to 23 out of a maximum of 24 points. Eleven studies referred to cost-effectiveness analysis and one study referred to cost-utility analysis. Studies have been conducted in the United States, Canada, Australia, Brazil, the Netherlands, the United Kingdom, and Hungary. IMRT appears to be a cost-effective treatment strategy for rectal cancer, soft tissue sarcoma, and localized carcinoma of the pharynx, and for prostate cancer in terms of prolonging survival, but it is a cost-effective treatment strategy for head cancer. In addition, the neck was not in India's cancer control program. The results can help to decide whether to use radiation therapy and radiotherapy in the standard treatment path. Furthermore, they underline that IMRT treatment technique was cost effective for a long-time care service.