Late Events Research Articles

Incidence of alopecia in brain tumour patients treated with pencil scanning proton therapy and validation of existing NTCP models

Background and purposeRadiation-induced alopecia (RIA) is one of the most frequent and upsetting cosmetic side effects after radiotherapy (RT) for brain cancer. We report the incidence of RIA in a cohort of brain tumours patients treated with Proton Therapy (PT) and externally validate published NTCP models of grade 2 (G2) RIA for their implementation in clinical practice. MethodsData for patients treated for brain tumours with scanning beam PT between 2018 and 2022 were extracted. Acute, late and permanent RIA events were evaluated according to CTCAE 5.0. Lyman-Kutcher-Burman (LKB) and multivariable logistic regression (MLR) published models were computed from the relative dose-surface histogram of the scalp. External validity of models was assessed in terms of discrimination and calibration. ResultsIn the 264 patients analysed, rates of any grade acute (≤90 days after PT completion), late (>90 days) and permanent RIA (persisting for> 12 months) were 61.8 %, 24.7 % and 14.4 %, respectively. In our independent cohort, LKB- and MLR-NTCP showed a good discrimination for G2 RIA (0.71≤ROC-AUC≤0.83) while model calibration was unsatisfactory possibly due to a different outcome evaluation between training and validation cohorts, as well as differences in clinical and treatment related variables between the two groups. ConclusionsDespite the reasonable sensitivity and specificity of the NTCP models for RIA in the validation cohort, our study emphasizes the significance of differences between the cohorts utilized for model development and validation. Specifically, variations in the reporting of clinical outcomes inevitably jeopardize the validation of NTCP models. A standardize and objective RIA scoring system is essential.

Radiosensitization treatment using hydrogen peroxide for inoperable rectal cancer.

The treatment outcomes of patients with unresectable rectal cancer are complex, and concurrent chemoradiation therapy is the main treatment option. Radiosensitizers can enhance the effect of localized intratumoral hypoxia, contributing to local control and symptomatic relief. The present study evaluated the feasibility and safety of radiosensitization using hydrogen peroxide combined with radiation therapy (RT) in patients with unresectable rectal cancer. A total of 13 patients with rectal cancer were recruited in the present study. Radiosensitization was performed twice weekly in combination with RT. Gauze soaked in 3% hydrogen peroxide solution was inserted into the anus, ensuring firm contact with the lesion. In total, 45-65 Gy was delivered in 25-33 fractions to the whole pelvis from four directions using 10 MV X-rays 5 days per week. Acute and late adverse events were evaluated 1 and 6 months after the completion of RT. Treatment was well tolerated, with no acute grade 3 or worse events noted, and no patient developed rectal fistula, necrosis, obstruction, perforation, stenosis, ulcer or retroperitoneal hemorrhage. No notable late adverse events, beyond 6 months, were observed at the end of the analysis. All patients experienced pain relief, hemostatic effects and tumor shrinkage. Therefore, the use of a hydrogen peroxide solution-soaked gauze in the rectum may be a promising option for patients with inoperable rectal tumors. The limitations of the present study are that the patient population was small and the observation time was relatively short. This study was retrospectively registered with the University Hospital Medical Information Network Center (trial registration no. R000061902) on April 21, 2024.

Oceanic anoxic event 3 in Arctic Canada—Arc volcanism and ocean fertilization drove anoxia

The global extent of the Late Cretaceous oceanic anoxic event 3 (OAE 3) remains uncertain. It is not considered to have extended into the Boreal Realm. To test this, we examined Late Cretaceous organic- and metal-rich black mudstones of the Smoking Hills Formation in Arctic Canada. New high-precision U-Pb zircon ages indicate that deposition of the Smoking Hills Formation (88.535−78.230 Ma) was temporally coincident with OAE 3, indicating a much broader global expression of this event than previously thought. OAE 3 was likely manifest throughout the proto−Arctic Ocean (now Arctic Canada). Abundant bentonite layers and cryptotephra within the Smoking Hills Formation have rare earth element (REE) patterns that are consistent with ashfall derived from Cretaceous arc volcanism. Anomalously high organic matter content in the Smoking Hills Formation, as compared to underlying and overlying units, suggests that ocean fertilization led to enhanced productivity and metal drawdown. A peak in arc volcanism may have been a key driver of the OAE 3 event. We also explored the potential use of cadmium as a geochemical marker of volcanism and show that high volcanogenic metal loading could affect the use of Cd and other proxies for marine productivity (e.g., Zn, Cu).

Role of the Boreal Autumn Antarctic Oscillation in Controlling the Winter Frequency of Severe Pollution Events in the Beijing–Tianjin–Hebei Region, China

AbstractThe Antarctic Oscillation (AAO), which is the main mode of extratropical circulation in the Southern Hemisphere, also has a substantial effect on the Northern Hemisphere climate. We investigated the influence of the early AAO on the frequency of late severe pollution events (SPEF) in the Beijing–Tianjin–Hebei region (SPEFBTH) of China during winter. The results show that the winter (December–January–February) SPEFBTH is negatively correlated with the AAO from the previous autumn (August–September–October). The controlling mechanism can be briefly described as follows: the autumn AAO is positively correlated with the mid‐latitude sea surface temperature (SST) in the South Atlantic Ocean. The SST preserves the autumn anomaly signal into the following winter. This anomalous SST regulates changes in the tropical western Indian Ocean–Intertropical Convergence Zone (IN–ITCZ) via air–sea coupling. Subsequently, as a response to the IN–ITCZ anomalies, anomalous wave trains are excited in the upper troposphere from the tropical western Indian Ocean to East Asia. In addition, the local meridional circulation is modulated; therefore, the circulation field and other meteorological elements favorable for the SPEFBTH appear and exacerbate the SPEFBTH. This study describes a new physical mechanism for the pathway of the AAO influence on subsequent SPEFBTH and finds a predictable source in the Southern Hemisphere air–sea system.

Training and quality indicators in interventional endoscopic ultrasound.

Endoscopic ultrasound (EUS) has transformed the landscape of minimally invasive gastrointestinal procedures, necessitating specialized training for proficiency in interventional EUS (iEUS). This study evaluates the effectiveness of iEUS training, focusing on learning curves, success rates, and the associated risks in various procedures, aiming to recommend practices for standardizing training and ensuring competency. Key metrics such as procedure type, learning curve for proficiency, success rates, and risk of adverse events were analyzed to establish benchmarks for training programs. Proficiency in pancreatic fluid collection drainage was achieved after 20-30 procedures, with a 100% success rate and a complication rate ranging from 1.5 to 80%. Gallbladder drainage required 19 cases to reach an 86% success rate, with adverse events reported in 19% of cases. Choledocoduodenostomy mastery was observed after approximately 100 cases, with postintervention pancreatitis affecting 5.3-6.6% of all cases. Hepaticogastrostomy showed a 93% success rate after 33 cases, with a 24.8% adverse event rate. Hepaticoenterostomy reached 100% success beyond the 40th patient, with a 20% rate of postsurgical strictures. Pancreatic duct drainage achieved 89% technical and 87% clinical success after 27 cases, with 12-15% adverse events. Gastro-enteric anastomosis required 25 cases for proficiency and approximately 40 cases for mastery, with 5.5% immediate and 1% late adverse events. iEUS training outcomes vary significantly across different procedures, highlighting the importance of structured, procedure-specific training programs to achieve proficiency. These findings provide a foundation for developing universal competency benchmarks in iEUS, facilitating consistent and effective training worldwide.

Precambrian geological history of the Tarim Craton (NW China) involving the assembly and fragmentation of the Columbia and Rodinia supercontinents: review and synthesis

The Tarim Craton (NW China) is a significant archive of the tectonic events that occurred during the assembly and break-up of the Precambrian supercontinents Columbia and Rodinia. It provides a comprehensive record of crustal development during the Proterozoic. We review and synthesize the magmatic, metamorphic and stratigraphic records of the Precambrian Tarim Craton and delineate the geochronology of significant geological events that led to the formation of this major cratonic block. The extant geophysical and geological data show that the Tarim Craton consists mainly of the South and North Tarim blocks. The record of late Paleoproterozoic tectonothermal events is displayed well in and across the craton, involving the amalgamation of these two blocks to form its unified crystalline basement during the build-up of Columbia. However, the record of mid-Neoproterozoic events during the assembly of Rodinia is only exposed around its periphery. The Proterozoic record of the craton includes Mesoproterozoic–early Neoproterozoic low-grade metamorphic rock units and a late Neoproterozoic sedimentary cover. The early Mesoproterozoic stratigraphy in the SW, NE and SE of the Tarim Basin suggests a period of tectonic stability following the amalgamation of the North and South Tarim blocks in the late Paleoproterozoic, indicating the completion of its cratonic build-up.

Systematic Review and Meta-Analysis of Particle Beam Therapy versus Photon Radiotherapy for Skull Base Chordoma: TRP-Chordoma 2024.

[Objective] The aim of this study was to compare the efficacy of particle beam therapy (PT) with photon radiotherapy (RT) for treatment of skull base chordoma. [Methods] A systematic review was conducted for skull base chordoma treated with PT or photon RT reported from 1990 to 2022. Data were extracted for overall survival (OS) and progression-free survival (PFS), late adverse events, age, gender, gross total resection (GTR) rates, tumor volume, total irradiation dose, and treatment modality. Random-effects meta-regression analysis with the treatment modality as an explanatory variable was performed for each outcome to compare the modalities. [Results] A meta-analysis of 30 selected articles found 3- and 5-year OS rates for PT vs. photon RT or combined photon RT/proton beam therapy (PBT) of 90.8% (95% CI: 87.4-93.3%) vs. 89.5% (95% CI: 83.0-93.6%), p = 0.6543; 80.0% (95% CI: 75.7-83.6%) vs. 89.5% (95% CI: 83.0-93.6%), p = 0.6787. The 5-year PFS rates for PT vs. photon RT or photon RT/PBT were 67.8% (95% CI: 56.5-76.7%) vs. 40.2% (95% CI: 31.6-48.7%), p = 0.0004. A random-effects model revealed that the treatment modality (PT vs. photon RT or photon RT/PBT) was not a significant factor for 3-year OS (p = 0.42) and 5-year OS (p = 0.11), but was a significant factor for 5-year PFS (p < 0.0001). The rates of brain necrosis were 8-50% after PT and 0-4% after photon RT or photon RT/PBT. [Conclusion] This study shows that PT results in higher PFS compared to photon RT for skull base chordoma, but that there is a tendency for a higher incidence of brain necrosis with PT. Publication and analysis of further studies is needed to validate these findings.

Impact of dose distribution by a 3D planning system for brachytherapy with 198Au grains for head and neck cancer.

There has been no study in which the correlation between clinical results and dosimetry based on a 3D treatment planning system in patients with 198Au grains for head and neck cancer was evaluated. Thirty-two patients who were treated with 198Au grains for head and neck cancer were reviewed. Twenty-five patients were treated with brachytherapy alone and seven patients were treated with a combination of brachytherapy and neoadjuvant external beam radiation therapy. With a median observation period of 60 months, the 5-year local control rate was 82.9%. V85Gy of CTV in patients with local recurrence tended to be lower than that in patients without local recurrence (p = 0.07). The maximum dose of the keratinized gingiva in patients in whom bone exposure occurred was significantly higher than that in patients in whom bone exposure did not occur (p = 0.001). Dose distribution with 198Au grains can predict local control and late adverse events.

Role of mitochondrial reactive oxygen species in chemically-induced ferroptosis

Ferroptosis is a form of iron-dependent regulated cell death which is different from apoptosis. Chemically-induced ferroptosis is characterized by an accumulation of lipid reactive oxygen species (ROS) in the cells. A number of earlier studies have suggested the involvement of mitochondrial ROS in ferroptosis, and the present study seeks to further investigate the role of mitochondrial ROS in the induction of chemically-induced ferroptotic cell death. We find that during erastin-induced, glutathione depletion-associated ferroptosis, mitochondrial ROS accumulation is an important late event, which likely is involved in the final execution of ferroptotic cell death. The mitochondrion-originated ROS is found to accumulate in large quantities inside the nuclei during the late phases of erastin-induced ferroptosis. Completion of the late-phase accumulation of mitochondrion-produced ROS inside the nucleus of a cell likely marks an irreversible point in the cell death process. Similarly, accumulation of large amounts of mitochondrion-produced ROS inside the nucleus is also observed in the late phases of RSL3-induced ferroptosis. The results of this study indicate that the mitochondrial ROS play an important role in the final steps of both erastin- and RSL3-induced ferroptotic cell death.

Long-term outcomes and patterns of relapse in patients with bilateral Wilms tumor or bilaterally predisposed unilateral Wilms tumor, a report from the COG AREN0534 study.

The objective of this study is to report the long-term timing and patterns of relapse for children enrolled in Children's Oncology Group AREN0534, a multicenter phase III clinical trial conducted from 2009 to 2015. Participants included children with bilateral Wilms tumor (BWT) or unilateral WT with genetic predisposition to develop BWT followed for up to 10 years. Smoothed hazard (risk) functions for event-free survival (EFS) were plotted so that the timing of events could be visualized, both overall and within pre-specified groups. Two hundred and twenty-two children (190 BWT and 32 unilateral WT with BWT predisposition) were followed for a median of 8.6 years. Fifty events were reported, of which 48 were relapse/progression. The overall 8-year EFS was 75% (95% confidence interval: 69%-83%). The highest risk for an EFS event was immediately after diagnosis with a declining rate over 2 years. A second peak of events was observed around 4 years after diagnosis, and a small number of events were reported until the end of the follow-up period. In subset analyses, later increases in risk were more commonly observed in patients with female sex, anaplastic histology, negative lymph nodes or margins, and favorable histology Wilms tumor patients with post-chemotherapy intermediate risk. Among relapses that occurred after 2 years, most were to the kidney. These patterns suggest that late events may be second primary tumors occurring more commonly in females, although more investigation is required. Clinicians may consider observation of patients with BWT beyond 4 years from diagnosis.

Role of Dapagliflozin in Prevention of Contrast Induced Nephropathy in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract Background Contrast induced nephropathy (CIN), is a known complication of any coronary intervention regardless the amount of contrast. Studies have shown that patients who develop CIN have a greater risk for death or prolonged hospitalization, as well as for other adverse outcomes, including early or late cardiovascular events especially if after percutaneous coronary intervention (PCI). Research is continuous to find pharmacological interventions to prevent CIN. While many therapies in prevention of CIN have been studied, only good hydration has been proven to be of benefit. This Abstractattempt to provide the role of dapagliflozin in prevention of CIN. Aim and objectives The aim of the study was to study the efficacy of dapagliflozin administration as a preventive tool for Contrast induced nephropathy (CIN), in diabetic patients undergoing primary percutaneous coronary intervention (PCI). Patients and Methods This study included 250 diabetic patients presented to emergency departments of Ain shams university hospitals from July 2021 till June 2022 and diagnosed with STEMI as being defined as Patients with ST elevation myocardial infarction defined as having symptoms of ischemia and ST-segment elevation of at least two contiguous leads with ST-segment elevation ≥ 2.5 mm in men &amp;lt; 40 years, ≥2 mm in men ≥ 40 years, or ≥ 1.5 mm in women in leads V2 – V3 and/or ≥ 1 mm in the other leads 1, that had been revascularized by primary PCI as per the recommendations of The European society of cardiology guidelines for diagnosis and management of ST elevation myocardial infarction published in 2017. CIN was defined by renal function impairment after IV contrast as mirrored by an absolute increase by 0.5mg/dL (or greater) or relative increase by 25% (or greater) of baseline serum creatinine over 48 hours or, better, by a decrease by 25% in the estimated glomerular filtration rate (eGFR(. The patients were randomized using dedicated software programme into two groups. Study group including 125 patients was the dapagliflozin group. Control group including 125 patients was the standard control group. Results Our study had demonstrated that a higher proportion of patients developed CIN in the control group (21 (16.8%)) vs (13 (10.4%)) in the study group (dapagliflozin group) but it didn’t reach a statistically significant difference with P-value =0.139. Conclusion Dapagliflozin failed to prove any statistically significant prevention against CIN.

Late Miocene cooling and uplift recorded by bacterial H-GDGTs in the Xining Basin, northeastern Tibetan Plateau

The uplift history of the Tibetan Plateau (TP) remains uncertain despite many scientific studies. The development of a novel paleoaltimeter may provide a crucial tool for addressing this issue. H-shaped glycerol dialkyl glycerol tetraethers (H-GDGTs) are analogs of GDGTs and considered to have potential in paleotemperature reconstructions, becoming, in turn, a potential indicator of paleoaltitude. This study analyzed the H-GDGTs in Late Miocene sediments from the Mojiazhuang (MJZ) Section in the Xining Basin (XB) and evaluated the potential of these less-explored biomarkers in paleotemperature and paleoaltitude reconstructions. Only branched H-GDGTs (H-brGDGTs) were detected; their relative abundance in relation to brGDGTs (%H-brGDGTs) exhibited a strong correlation with proxy-based palaeotemperature. However, their exceptionally elevated values necessarily impose limitations on the feasibility of quantitatively reconstructing paleotemperatures based on %H-brGDGTs, rendering them suitable solely as a qualitative temperature indicator. The methylation index of H-brGDGTs (H-MBTacyclic) can be effectively used to quantitatively reconstruct paleotemperatures. The challenge H-MBTacyclic poses is its potentially limited use for lower temperatures, as it may exhibit incomplete detection of H-brGDGT components. These provisos being the case, both %H-brGDGTs and H-MBTacyclic were nonetheless effectively used to document the cooling and TP uplift event in the XB during the ∼10.5–8 Ma period, aligning with the reconstruction based on brGDGTs. The quantitative paleoaltitude reconstruction using H-MBTacyclic values indicated an uplift amplitude of ∼1 km. As an independent proxy of paleotemperature and paleoaltitude, H-brGDGTs once again would appear to underscore the presence and significance of this Late Miocene uplift event. Given the challenges encountered when using H-brGDGT-based proxies, further investigations into modern samples and evaluations of deep-time samples are imperative for any future application.

Long-Term Update of a Phase 3 Randomized Study Comparing Once-a-Week Versus Once-Every-3-Weeks Cisplatin Along With Radiation in Head and Neck Cancer

PurposeIn the weekly-3-weekly (W3W) study, cisplatin at 100 mg/m2 once-every-3-weeks led to superior locoregional control compared to cisplatin 30 mg/m2 once-a-week in combination with radical radiation for locally advanced head and neck squamous cell carcinoma (LAHNSCC). We report the updated analysis of the study. MethodsIn this phase III open label non-inferiority study conducted between 2013 and 2017, 300 patients with LAHNSCC were randomly assigned to receive cisplatin 100 mg/m2 once-in-3-weeks or cisplatin 30 mg/m2 once-a-week, concurrently with radiation. The primary endpoint was locoregional control (LRC). Secondary outcomes were overall survival (OS), progression free survival (PFS) and late adverse events. ResultsThe median follow-up was 6.91 years (95% CI, 6.12-7.36). The updated 2-year and 5-year LRC rates for the once-a-week cisplatin arm were 58.75% (95% CI, 51.08- 67.58) and 48.09% (95% CI, 40.26-57.43), while for the once-every-3-weeks cisplatin arm were 73.95% (95% CI, 66.93-81.70) and 56.76% (95% CI, 48.46-66.48), respectively; HR=1.44 (95% CI, 1.03-2.03), P=0.034. The 5-year OS was 43.60% (95% CI, 36.29-52.37) in the once-a-week cisplatin arm, and 50.55% (95% CI, 43.06-59.35) in the once-every-3-weeks cisplatin arm; P = 0.19. There was no difference in any grade or grade ≥ 3 late adverse events between the two arms, except for hearing dysfunction, which was significantly more common in patients who received high-dose cisplatin. ConclusionsLong term follow-up confirms that cisplatin at 100 mg/m2 administered once-every-3-weeks concurrently with radical radiation for LAHNSCC leads to superior locoregional control as compared to cisplatin 30 mg/m2 once-a-week and should remain one of the standard treatment options.

Constraints on the subduction and closure of the Hegenshan Ocean: Magmatic and sedimentary records from central Inner Mongolia, China

Petrological, geochronological, and geochemical data from the volcano-sedimentary sequences, granitoids, and ophiolite relics of central Inner Mongolia, China, were used to reconstruct the subduction and final closure of the Hegenshan Ocean. Geochronological dating and compilation reveal four phases (ca. 360−355 Ma, 348−320 Ma, 320−310 Ma, and 310−275 Ma) of magmatism in the Uliastai continental margin. The ca. 356 Ma I-type Halatumiao granodiorite and Amanwusu ophiolite relics are subduction-related, and the Halatumiao granodiorite provides solid evidence of the northward subduction of the Hegenshan Ocean beneath the Uliastai continental margin at ca. 360−355 Ma. The ca. 348−320 Ma and 320−310 Ma volcanic rocks and granitoids constitute two linear magmatic belts roughly parallel to the Erenhot-Hegenshan ophiolite belt, which record two phases of continental arc magmatism in the Uliastai continental margin. Overall, the ca. 360−310 Ma arc magmatism shows landward migration and then oceanward migration in the Uliastai continental margin, which indicates advancing subduction and subsequent slab steepening of the Hegenshan Ocean. By contrast, the ca. 310−275 Ma magmatic rocks are dominated by I- and A-type felsic volcanic rocks, granites, and dikes, which are post-accretionary, extension-related, and pervasive in the Uliastai continental margin and Erenhot-Hegenshan ophiolite belt. A provenance shift was identified between the Benbatu and Amushan formations of the Amanwusu area of the Erenhot-Hegenshan ophiolite belt. The early detritus was derived from the early Paleozoic rocks in the Sonid Zuoqi arc belt, whereas the late detritus originated from the Early Carboniferous ophiolite relics in the Erenhot-Hegenshan ophiolite belt. The provenance shift and emplacement of pervasive extension-related magmatic rocks imply a Late Carboniferous closure of the Hegenshan Ocean. The Late Carboniferous oceanic closure event in the north of the southeast Central Asian Orogenic Belt is also evidenced by the transition of Hf isotopic composition of zircons dated between ca. 360−310 Ma and 310−275 Ma.

The Early to Late Cretaceous (Albian–Cenomanian) transition in Putumayo, Colombia: a biostratigraphic and carbon isotope stratigraphic correlation for northwestern South America

Despite the rich geological and paleontological record of Colombia, the Putumayo region near Ecuador remains one of the least explored regions in the equatorial Neotropics, mainly due to its thick vegetation, deep rock weathering, soil formation, and ground cover, geographic remoteness, and inaccessibility of well-exposed outcrops. This has resulted in limited comparisons with neighboring basins and thus the generation of more comprehensive biostratigraphic correlations with western and northern South America, as well as other paleobiogeographic regions (e.g., Tethys, Western Interior Seaway). Here, we present 67 occurrences of uppermost Lower Cretaceous to lowermost Upper Cretaceous ammonoids and other macrofossils (e.g., bivalves, decapod crustaceans, osteichthyan fish remains, plant remains), as well as a δ13Corg chemostratigraphic curve derived from 105 samples from the middle Albian of the uppermost Caballos Formation and the upper Albian to lower Cenomanian lower Villeta Formation, collected in situ from a stratigraphic section exposed along the Mocoa–San Francisco Road, Putumayo, Colombia, here called the San Francisco section. The chemostratigraphic, carbon-isotope curve for the region shows a great similarity with the shape of the accepted curve for the late Albian Oceanic Anoxic Event 1d, which is characterized by a worldwide long positive δ13C excursion anomaly. The new biostratigraphic and isotopic data serve as a point of reference to compare the Putumayo Basin with neighboring basins (e.g., Marañon Basin in Perú, Oriente Basin in Ecuador, Upper Magdalena Valley Basin in Colombia), and thus the generation of more comprehensive upper Lower Cretaceous and lower Upper Cretaceous biostratigraphic and chemostratigraphic correlations for northwestern South America.

Carotid artery stenting with flow inversion cerebral protection and MicroNet-covered stent.

The study aims to evaluate the association of proximal flow-inversion cerebral protection and MicroNet-covered CGuard stents in reducing early and late embolic events in carotid artery stenting procedures. From 2018 to 2023, we performed 204 procedures in 180 patients with flow inversion cerebral protection and CGuard stents at the Vascular Surgery Unit of Sant'Eugenio Hospital in Rome. Cerebral protection was achieved with a Flow-Gate2 catheter connected to a peripheral vein. The tip balloon is inflated in the CCA to obtain an effective endoclamping, the pressure difference between the carotid bifurcation and the venous compartment ensures a constant back flow with wash-out in the venous compartment. Inclusion criteria were: life expectancy of >12 months, target lesions indicating treatment according to ESVS Guidelines, increased surgical risk due to comorbidities or anatomic issues. ECD follow-up was performed immediately postoperatively, at 30 days, 6 and 12 months, and subsequently annually. The treatment protocol was successfully implemented in 99% of cases. No major strokes occurred, while one minor stroke (0.5%) occurred within 8 hours of the procedure, regressing in the following months. One perioperative death (0.5%) due to cerebral hemorrhage occurred three hours after the procedure. All patients remained asymptomatic, with no short or medium-term neurological score deterioration. One hemodynamically significant restenosis (0.5%) was detected at the 6-month follow-up. All patients completed the 6 months follow-up, though 6 (3%) were lost at the 12-month appointment. Our prospective monocentric study has demonstrated the effectiveness and safety of the FlowGate2 flow inversion cerebral protection system in association with MicroNet covered CGuard stent.

Retrospective Analysis of the Clinical Usefulness of a Strut-Adjusted Volume Implant in a Single Center.

Reports demonstrating the effectiveness and safety of strut-adjusted volume implants (SAVI) in Japan are limited. Therefore, this study aimed to compare the treatment outcomes of SAVI and whole-breast irradiation (WBI) at a single facility. Data were retrospectively extracted from the medical records of patients treated with SAVI or WBI following partial mastectomy (Bp). Patients undergoing Bp, sentinel lymph node biopsy, and SAVI spacer insertion followed by brachytherapy with the SAVI device were compared to those followed with WBI. Local recurrence was assessed annually by physical examination, bilateral mammography, and breast ultrasonography. The SAVI and WBI groups comprised 53 and 113 patients, with a median age of 55 and 52 years, respectively; among them, 47 and 91 patients had a pathological tumor diameter ≤2 cm and six and 22 had a pathological tumor diameter >2 cm, respectively. Recurrence events, acute adverse events, and late adverse events were observed in the SAVI and WBI groups in 1 and 3 (p = 0.726), 24 and 79 (p = 0.01), and 24 and 18 patients (p = 0.00002), respectively, with median observation periods of 60.0 and 47.8 months, respectively. All adverse events were grades 1-2, with dermatitis being the most common in the acute phase. In the late phase, pigmentation was common in both groups. The local recurrence rate does not differ between SAVI and WBI within the relatively short-term follow-up period. Longer follow-up is required to confirm our results in the Japanese population.

Bevacizumab for Brain Radiation Necrosis in Patients With Nonsquamous Nonsmall Cell Lung Cancer

IntroductionRecent advances in therapies based on molecular targeted agents and immune checkpoint inhibitors have prolonged the survival of non–small cell lung cancer (NSCLC) patients and increased the number of such patients undergoing radiotherapy for brain metastases. Brain radiation necrosis, a late adverse event of radiotherapy, occurs in ∼10% of these latter individuals. Whereas bevacizumab has shown efficacy for brain radiation necrosis, optimal treatment strategies have remained elusive. We here assessed the efficacy of bevacizumab for brain radiation necrosis in NSCLC patients. Patients and MethodsIn this retrospective study, we evaluated NSCLC patients treated with bevacizumab for brain radiation necrosis diagnosed on the basis of MRI or [11C]methionine-PET. The volumes of radiation necrosis and peripheral edema were measured. ResultsFour NSCLC patients were treated with bevacizumab for brain radiation necrosis. All four patients manifested neurological symptoms with radiation necrosis accompanied by peripheral edema. Histological analysis showed adenocarcinoma in all patients, with two harboring EGFR mutations, one a HER2 mutation, and one a KRAS mutation. The median radiation dose was 24 Gy, median time from radiation to bevacizumab treatment was 27 months, and median time from the start of bevacizumab treatment to radiological improvement was 5 weeks. Neurological symptoms improved in two of the four patients, and the dose of dexamethasone was reduced in three patients. The volumes of necrosis and peripheral edema in each patient were noticeably reduced by bevacizumab treatment. ConclusionBevacizumab is an effective treatment for brain radiation necrosis in patients with nonsquamous NSCLC.

Hydrothermal enrichment of rare earth elements in the Lower Permian Lijiatian bauxite deposit, southern China

Bauxite deposits are an important source of Al and also host a variety of critical metals, including rare earth elements (REEs). However, the parent rocks of bauxite deposits generally have low REE contents, leading to uncertainty over the REE sources and enrichment mechanisms. In this study, we report high REE (2095 ppm; Ce = 1340 ppm) contents in the Lijiatian bauxite deposit in Luxi County, western Hunan Province, South China. The Lijiatian bauxite deposit is the largest deposit in Hunan Province, with a total Al resources exceeding 7 × 106 tons. The ore-bearing strata in the lower Permian Liangshan Formation (ca. 275 Ma) are comprised a 3–5-m-thick bauxite layer (bauxite ore/clay) and an underlying 4–8-m-thick Fe layer (Fe ore/Fe-rich clay). The high REE contents in the bauxites can be attributed to the widespread presence of bastnäsite. The bastnäsite commonly coexists with authigenic chlorite, which formed at temperatures of 221–285 °C, indicative of a hydrothermal origin. Uranium–Pb dating of the bastnäsite yielded an age of 141.4 ± 7.0 Ma, indicating a hydrothermal overprint occurred during the Early Cretaceous, which resulted in the enrichment of REEs in the bauxites. The high contents of REEs, Ba, and P in the Cambrian Niutitang Formation black shales indicate it was a potential source of these elements for bastnäsite and coexisting barite and apatite. The deep-seated hydrothermal fluids (enriched in HF, CO2, and H2S) associated with the late Yanshanian extensional tectonic event in South China (155–123 Ma) ascended along fractures. The ascending fluids interacted with the black shales, extracting REEs, Ba, and P. When the fluids reached a certain depth, they mixed with the infiltrating basinal waters to form a mineralising fluid. The fluid then migrated towards the bauxite layers, underwent cooling and depressurisation, and precipitated bastnäsite, barite, apatite, and chlorite. We propose that a hydrothermal event led to the enrichment of REEs in the bauxites in Hunan Province. Considering the scarcity of REEs in the parent rocks of bauxites worldwide, hydrothermal activity likely has a key role in REE enrichment in bauxites.

Studies on the 2.2 Ga monzogranite and its wall rocks in western part of North Qinling Orogen: Constraints on early Precambrian tectonic attributes and evolution of the southwestern margin of Ordos Block

Precambrian continent remnants in Phanerozoic orogenic belts contain vital information about not only the Precambrian evolution history of continent remnants but also the relationship between orogenic belts and adjacent blocks. This paper presents an integrated study of petrology, geochemistry and accessory mineral chronology on a monzogranite, its wall rocks biotite-quartz schist and an amphibolite interlayer in the schist in the Kuanping Group, from the western part of the North Qinling Orogen (NQO), adjacent to the southwestern margin of the Ordos Block (OB). The results reveal that the crystallization age of the monzogranite is 2200 ± 12 Ma and the protolith of the biotite-quartz schist deposited during 526–447 Ma, and they experienced similar multistage metamorphism during 450–400 Ma. The 2.2 Ga formation age of the monzogranite is significantly older than the protolith deposition age of the biotite-quartz schist, and there is almost no ca. 2.2 Ga detrital zircon age in the schist, indicating that the monzogranite is neither an intrusive body in the Kuanping Group, nor its provenance. Considering the ca. 2.2 Ga magmatism is widely distributed in North China Craton but never found in the NQO, and the monzogranite and host schist recorded similar metamorphic ages, we proposed that the monzogranite initially formed at the southwestern margin of the North China Craton and involved into the NQO during the closure of the Kuanping sedimentary basin at early Paleozoic. Combined with existing studies, three Paleoproterozoic magmatic events of ca. 2.5 Ga, 2.2–2.0 Ga and 1.8–1.75 Ga, and one ca. 1.9–1.85 Ga metamorphic event occurred at the southwestern margin of OB. These tectono-thermal events as well as their geological setting are very similar to the basement rocks of the central-southern part of the OB. Therefore, the early Precambrian rocks at the southwestern margin of the OB should belong to the basement of the central-southern part of OB, and the late tectonic events placed them at their present position.