Adjuvant therapy after resection of brain metastases. Frameless image-guided LINAC-based radiosurgery and stereotactic hypofractionated radiotherapy

BACKGROUND: Tumor bed stereotactic radiosurgery (SRS) after resection of brain metastases is a new strategy to delay or avoid whole-brain irradiation (WBRT) and its associated toxicities. This retrospective study analyzes results of frameless image-guided linear accelerator (LINAC)-based SRS and stereotactic hypofractionated radiotherapy (SHRT) as adjuvant treatment without WBRT. MATERIALS AND METHODS: Between March 2009 and February 2012, 44 resection cavities in 42 patients were treated with SRS (23 cavities) or SHRT (21 cavities). All treatments were delivered using a stereotactic LINAC. All cavities were expanded by ≥ 2 mm in all directions to create the clinical target volume (CTV). RESULTS: The median planning target volume (PTV) for SRS was 11.1 cm(3). The median dose prescribed to the PTV margin for SRS was 17 Gy. Median PTV for SHRT was 22.3 cm(3). The fractionation schemes applied were: 4 fractions of 6 Gy (5 patients), 6 fractions of 4 Gy (6 patients) and 10 fractions of 4 Gy (10 patients). Median follow-up was 9.6 months. Local control (LC) rates after 6 and 12 months were 91 and 77 %, respectively. No statistically significant differences in LC rates between SRS and SHRT treatments were observed. Distant brain control (DBC) rates at 6 and 12 months were 61 and 33 %, respectively. Overall survival (OS) at 6 and 12 months was 87 and 63.5 %, respectively, with a median OS of 15.9 months. One patient treated by SRS showed symptoms of radionecrosis, which was confirmed histologically. CONCLUSION: Frameless image-guided LINAC-based adjuvant SRS and SHRT are effective and well tolerated local treatment strategies after resection of brain metastases in patients with oligometastatic disease.

Sparse representation based action and gesture recognition

In this paper we present a solution to the problem of action and gesture recognition using sparse representations. The dictionary is modelled as a simple concatenation of features computed for each action or gesture class from the training data, and test data is classified by finding sparse representation of the test video features over this dictionary. Our method does not impose any explicit training procedure on the dictionary. We experiment our model with two kinds of features, by projecting (i) Gait Energy Images (GEIs) and (ii) Motion-descriptors, to a lower dimension using Random projection. Experiments have shown 100% recognition rate on standard datasets and are compared to the results obtained with widely used SVM classifier.

Identification and phenotypic characterization of a second collagen adhesin, Scm, and genome-based identification and analysis of 13 other predicted MSCRAMMs, including four distinct pilus loci, in Enterococcus faecium.

Attention has recently been drawn to Enterococcus faecium because of an increasing number of nosocomial infections caused by this species and its resistance to multiple antibacterial agents. However, relatively little is known about the pathogenic determinants of this organism. We have previously identified a cell-wall-anchored collagen adhesin, Acm, produced by some isolates of E. faecium, and a secreted antigen, SagA, exhibiting broad-spectrum binding to extracellular matrix proteins. Here, we analysed the draft genome of strain TX0016 for potential microbial surface components recognizing adhesive matrix molecules (MSCRAMMs). Genome-based bioinformatics identified 22 predicted cell-wall-anchored E. faecium surface proteins (Fms), of which 15 (including Acm) had characteristics typical of MSCRAMMs, including predicted folding into a modular architecture with multiple immunoglobulin-like domains. Functional characterization of one [Fms10; redesignated second collagen adhesin of E. faecium (Scm)] revealed that recombinant Scm(65) (A- and B-domains) and Scm(36) (A-domain) bound to collagen type V efficiently in a concentration-dependent manner, bound considerably less to collagen type I and fibrinogen, and differed from Acm in their binding specificities to collagen types IV and V. Results from far-UV circular dichroism measurements of recombinant Scm(36) and of Acm(37) indicated that these proteins were rich in beta-sheets, supporting our folding predictions. Whole-cell ELISA and FACS analyses unambiguously demonstrated surface expression of Scm in most E. faecium isolates. Strikingly, 11 of the 15 predicted MSCRAMMs clustered in four loci, each with a class C sortase gene; nine of these showed similarity to Enterococcus faecalis Ebp pilus subunits and also contained motifs essential for pilus assembly. Antibodies against one of the predicted major pilus proteins, Fms9 (redesignated EbpC(fm)), detected a 'ladder' pattern of high-molecular-mass protein bands in a Western blot analysis of cell surface extracts from E. faecium, suggesting that EbpC(fm) is polymerized into a pilus structure. Further analysis of the transcripts of the corresponding gene cluster indicated that fms1 (ebpA(fm)), fms5 (ebpB(fm)) and ebpC(fm) are co-transcribed, a result consistent with those for pilus-encoding gene clusters of other Gram-positive bacteria. All 15 genes occurred frequently in 30 clinically derived diverse E. faecium isolates tested. The common occurrence of MSCRAMM- and pilus-encoding genes and the presence of a second collagen-binding protein may have important implications for our understanding of this emerging pathogen.

Internet-based exercises and mini-exams for production and operations management

The purpose of the internet-based teachware mySCM is that students of economics, informatics and industrial engineering get familiar with quantitative methods for supply chain management. Input-output-relationships of various optimization methods can be detected by sampling input values, parameters, and alternative methods for the same problem. Students can gain extra benefits by passing so-called mini-exams that motivate active learning. mySCM can be used for free, round-the-clock, and any place where access to the Internet is available.

Influence of credibility, warnings, and source-monitoring questions on the misinformation effect.

Introduction. Erroneous answers in studies on the misinformation effect (ME) can be reduced in different ways. In some studies, ME was reduced by SM questions, warnings, or a low credibility of the source of post-event information (PEI). Results are inconsistent, however. Of course, a participant can deliberately decide to refrain from reporting a critical item only when the difference between the original event and the PEI is distinguishable in principle. We were interested in the question to what extent the influence of erroneous information on a central aspect of the original event can be reduced by different means applied singly or in combination. Method. With a 2 (credibility; high vs. low) x 2 (warning; present vs. absent) between subjects design and an additional control group that received neither misinformation nor a warning (N = 116), we examined the above-mentioned factors’ influence on the ME. Participants viewed a short video of a robbery. The critical item suggested in the PEI was that the victim was given a kick by the perpetrator (which he was actually not). The memory test consisted of a two-forced-choice recognition test followed by a SM test. Results. To our surprise, neither a main effect of erroneous PEI nor a main effect of credibility was found. The error rates for the critical item in the control group (50%) as well as in the high (65%) and low (52%) credibility condition without warning did not significantly differ. A warning about possible misleading information in the PEI significantly reduced the influence of misinformation in both credibility conditions by 32-37%. Using a SM question significantly reduced the error rate too, but only in the high credibility no warning condition. Conclusion and Future Research. Our results show that, contrary to a warning or the use of a SM question, low source credibility did not reduce the ME. The most striking finding was, however, the absence of a main effect of erroneous PEI. Due to the high error rate in the control group, we suspect that the wrong answers might have been caused either by the response format (recognition test) or by autosuggestion possibly promoted by the high schema-consistency of the critical item. First results of a post-study in which we used open-ended questions before the recognition test support the former assumption. Results of a replication of this study using open-ended questions prior to the recognition test will be available by June.

New anthropometry-based age- and sex-specific reference values for urinary 24-hour creatinine excretion based on the adult Swiss population.

BACKGROUND Urinary creatinine excretion is used as a marker of completeness of timed urine collections, which are a keystone of several metabolic evaluations in clinical investigations and epidemiological surveys. The current reference values for 24-hour urinary creatinine excretion rely on observations performed in the 1960s and 1970s in relatively small and mostly selected groups, and may thus poorly fit to the present-day general European population. The aim of this study was to establish and validate anthropometry-based age- and sex-specific reference values of the 24-hour urinary creatinine excretion on adult populations with preserved renal function. METHODS We used data from two independent Swiss cross-sectional population-based studies with standardised 24-hour urinary collection and measured anthropometric variables. Only data from adults of European descent, with estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m(2) and reported completeness of the urinary collection were retained. A linear regression model was developed to predict centiles of the 24-hour urinary creatinine excretion in 1,137 participants from the Swiss Survey on Salt and validated in 994 participants from the Swiss Kidney Project on Genes in Hypertension. RESULTS The mean urinary creatinine excretion was 193 ± 41 μmol/kg/24 hours in men and 151 ± 38 μmol/kg/24 hours in women in the Swiss Survey on Salt. The values were inversely correlated with age and body mass index (BMI). Based on current reference values (177 to 221 μmol/kg/24 hours in men and 133 to 177 μmol/kg/24 hours in women), 56% of the urinary collections in the whole population and 67% in people >60 years old would have been considered as inaccurate. A linear regression model with sex, BMI and age as predictor variables was found to provide the best prediction of the observed values and showed a good fit when applied to the validation population. CONCLUSIONS We propose a validated prediction equation for 24-hour urinary creatinine excretion in the general European population, based on readily available variables such as age, sex and BMI, and a few derived normograms to ease its clinical application. This should help healthcare providers to interpret the completeness of a 24-hour urine collection in daily clinical practice and in epidemiological population studies.

LC-MS/MS based assay and reference intervals in children and adolescents for oxysterols elevated in Niemann-Pick diseases

BACKGROUND Niemann-Pick type C (NP-C) is a rare progressive neurodegenerative lipid storage disorder with heterogeneous clinical presentation and challenging diagnostic procedures. Recently oxysterols have been reported to be specific biomarkers for NP-C but knowledge on the intra-individual variation and on reference intervals in children and adolescents are lacking. METHODS We established a LC-MS/MS assay to measure Cholestane-3β, 5α, 6β-triol (C-triol) and 7-Ketocholesterol (7-KC) following Steglich esterification. To assess reference intervals and intra-individual variation we determined oxysterols in 148 children and adolescents from 0 to 18 years and repeat measurements in 19 of them. RESULTS The reported method is linear (r>0.99), sensitive (detection limit of 0.03 ng/mL [0.07 nM] for C-triol, and 0.54 ng/mL [1.35 nM] for 7-KC) and precise, with an intra-day imprecision of 4.8% and 4.1%, and an inter-day imprecision of 7.0% and 11.0% for C-triol (28 ng/ml, 67 nM) and 7-KC (32 ng/ml, 80 nM), respectively. Recoveries for 7-KC and C-triol range between 93% and 107%. The upper reference limit obtained for C-triol is 40.4 ng/mL (95% CI: 26.4-61.7 ng/mL, 96.0 nM, 95% CI: 62.8-146.7 nM) and 75.0 ng/mL for 7-KC (95% CI: 55.5-102.5 ng/mL, 187.2 nM, 95% CI: 138.53-255.8 nM), with no age or gender dependency. Both oxysterols have a broad intra-individual variation of 46%±23% for C-triol and 52%±29% for 7-KC. Nevertheless, all Niemann-Pick patients showed increased C-triol levels including Niemann-Pick type A and B patients. CONCLUSIONS The LC-MS/MS assay is a robust assay to quantify C-triol and 7-KC in plasma with well documented reference intervals in children and adolescents to screen for NP-C in the pediatric population. In addition our results suggest that especially the C-triol is a biomarker for all three Niemann-Pick diseases.

Pressure, tilt, temperature and conductivity monitoring within the Immerged Santorini Caldera during Jul 2012 - Sep 2013

Bottom pressure, tilt and seawater physical-properties were monitored for a year using two instruments within the immerged Santorini caldera (Greece). Piggy-backed on the CALDERA2012 cruise, this geodetic experiment was designed to monitor evolution of the 2011-2012 Santorini unrest. Conducted during a quiescent period, it allowed us to study oceanographic and atmospheric signal in our data series. We observe periodic oceanographic signals associated with tides, and seiches that are likely linked to both the caldera and Cretan basin geometries. In winter, the caldera witnesses sudden cooling events that tilt an instrument towards the Southeast, indicating cold-water influx likely originating from the north-western passage between Thirasia and Oia. We do not obtain evidence of long-term vertical seafloor deformation from the pressure signal, although it may be masked by instrumental drift. However, tilt data suggests a local seafloor tilt event ~1 year after the end of the unrest period which could be consistent with inflation under or near Nea Kameni. Seafloor geodetic data recorded at the bottom of the Santorini caldera illustrates that the oceanographic signature is an important part of the signal, which needs to be considered for monitoring volcanic or geological seafloor deformation in shallow-water and/or nearshore areas.

(Table 3) Details of field-based ice and snow profile measurements from the SIMBA 2007 experiment

Although sea-ice extent in the Bellingshausen-Amundsen (BA) seas sector of the Antarctic has shown significant decline over several decades, there is not enough data to draw any conclusion on sea-ice thickness and its change for the BA sector, or for the entire Southern Ocean. This paper presents our results of snow and ice thickness distributions from the SIMBA 2007 experiment in the Bellingshausen Sea, using four different methods (ASPeCt ship observations, downward-looking camera imaging, ship-based electromagnetic induction (EM) sounding, and in situ measurements using ice drills). A snow freeboard and ice thickness model generated from in situ measurements was then applied to contemporaneous ICESat (satellite laser altimetry) measured freeboard to derive ice thickness at the ICESat footprint scale. Errors from in situ measurements and from ICESat freeboard estimations were incorporated into the model, so a thorough evaluation of the model and uncertainty of the ice thickness estimation from ICESat are possible. Our results indicate that ICESat derived snow freeboard and ice thickness distributions (asymmetrical unimodal tailing to right) for first-year ice (0.29 ± 0.14 m for mean snow freeboard and 1.06 ± 0.40 m for mean ice thickness), multi-year ice (0.48 ± 0.26 and 1.59 ± 0.75 m, respectively), and all ice together (0.42 ± 0.24 and 1.38 ± 0.70 m, respectively) for the study area seem reasonable compared with those values from the in situ measurements, ASPeCt observations, and EM measurements. The EM measurements can act as an appropriate supplement for ASPeCt observations taken hourly from the ship's bridge and provide reasonable ice and snow distributions under homogeneous ice conditions. Our proposed approaches: (1) of using empirical equations relating snow freeboard to ice thickness based on in situ measurements and (2) of using isostatic equations that replace snow depth with snow freeboard (or empirical equations that convert freeboard to snow depth), are efficient and important ways to derive ice thickness from ICESat altimetry at the footprint scale for Antarctic sea ice. Spatial and temporal snow and ice thickness from satellite altimetry for the BA sector and for the entire Southern Ocean is therefore possible.

Mid-Pleistocene (800-400 ka) records of benthic and planktic foraminfer d18O and d13C, planktic foraminifer based SST, and IRD of IODP Site 306-U1314

Stable carbon and oxygen isotopes from benthic and planktic foraminifers, planktic foraminifer assemblages and ice rafted debris from the North Atlantic Site U1314 (Integrated Ocean Drilling Program Expedition 306) were examined to investigate orbital and millennial-scale climate variability in the North Atlantic and its impact on global circulation focusing on the development of glacial periods during the mid-Pleistocene (ca 800-400 ka). Glacial initiations were characterized by a rapid cooling (6-10 °C in less than 7 kyr) in the mean annual sea surface temperature (SST), increasing benthic d18O values and high benthic d13C values. The continuous increase in benthic d18O suggests a continuous ice sheet growth whereas the positive benthic d13C values indicate that the flow of the Iceland Scotland Overflow water (ISOW) was vigorous. Strong deep water formation in the Norwegian Greenland Sea promoted a high transfer of freshwater from the ocean to the continents. However, low SSTs at Site U1314 suggest a subpolar gyre cooling and freshening that may have reduced deep water formation in the Labrador Sea during glacial initiations. Once the 3.5 per mil threshold in the benthic d18O record was exceeded, ice rafting started and ice sheet growth was punctuated by millennial-scale waning events which returned to the ocean part of the freshwater accumulated on the continents. Ice-rafting events were associated with a rapid reduction in the ISOW (benthic d13C values dropped 0.5-1 per mil) and followed by millennial-scale warmings. The first two millennial-scale warm intervals of each glacial period reached interglacial temperatures and were particularly abrupt (6-10 °C in ~3 kyr). Subsequent millennial-scale warm events were cooler probably because the AMOC was rather reduced as suggested by the low benthic d13C values. These two abrupt warming events that occurred at early glacial periods were also observed in the Antarctic temperature and CO2 records, suggesting a close correlation between both Hemispheres. The comparison of the sea surface proxies with the benthic d18O record (as the Southern sign) indicates the presence of a millennial-scale seesaw pattern similar to that seen during the Last Glacial period.

Planktonic foraminifera Mg/Ca-based temperatures and planktonic foraminiferal cenus counts of core GeoB10065-7 (Lombok Basin, Indonesia)

Modern variability in upwelling off southern Indonesia is strongly controlled by the Australian-Indonesian monsoon and the El Niño-Southern Oscillation, but multi-decadal to centennial-scale variations are less clear. We present high-resolution records of upper water column temperature, thermal gradient and relative abundances of mixed layer- and thermocline-dwelling planktonic foraminiferal species off southern Indonesia for the past two millennia that we use as proxies for upwelling variability. We find that upwelling was generally strong during the Little Ice Age (LIA) and weak during the Medieval Warm Period (MWP) and the Roman Warm Period (RWP). Upwelling is significantly anti-correlated to East Asian summer monsoonal rainfall and the zonal equatorial Pacific temperature gradient. We suggest that changes in the background state of the tropical Pacific may have substantially contributed to the centennial-scale upwelling trends observed in our records. Our results implicate the prevalence of an El Niño-like mean state during the LIA and a La Niña-like mean state during the MWP and the RWP.