5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial.

BACKGROUND In a phase 3, randomised, non-inferiority trial, accelerated partial breast irradiation (APBI) for patients with stage 0, I, and IIA breast cancer who underwent breast-conserving treatment was compared with whole-breast irradiation. Here, we present 5-year follow-up results. METHODS We did a phase 3, randomised, non-inferiority trial at 16 hospitals and medical centres in seven European countries. 1184 patients with low-risk invasive and ductal carcinoma in situ treated with breast-conserving surgery were centrally randomised to either whole-breast irradiation or APBI using multicatheter brachytherapy. The primary endpoint was local recurrence. Analysis was done according to treatment received. This trial is registered with ClinicalTrials.gov, number NCT00402519. FINDINGS Between April 20, 2004, and July 30, 2009, 551 patients had whole-breast irradiation with tumour-bed boost and 633 patients received APBI using interstitial multicatheter brachytherapy. At 5-year follow-up, nine patients treated with APBI and five patients receiving whole-breast irradiation had a local recurrence; the cumulative incidence of local recurrence was 1·44% (95% CI 0·51-2·38) with APBI and 0·92% (0·12-1·73) with whole-breast irradiation (difference 0·52%, 95% CI -0·72 to 1·75; p=0·42). No grade 4 late side-effects were reported. The 5-year risk of grade 2-3 late side-effects to the skin was 3·2% with APBI versus 5·7% with whole-breast irradiation (p=0·08), and 5-year risk of grade 2-3 subcutaneous tissue late side-effects was 7·6% versus 6·3% (p=0·53). The risk of severe (grade 3) fibrosis at 5 years was 0·2% with whole-breast irradiation and 0% with APBI (p=0·46). INTERPRETATION The difference between treatments was below the relevance margin of 3 percentage points. Therefore, adjuvant APBI using multicatheter brachytherapy after breast-conserving surgery in patients with early breast cancer is not inferior to adjuvant whole-breast irradiation with respect to 5-year local control, disease-free survival, and overall survival. FUNDING German Cancer Aid.

Lung Pattern Classification for Interstitial Lung Diseases Using a Deep Convolutional Neural Network

Automated tissue characterization is one of the most crucial components of a computer aided diagnosis (CAD) system for interstitial lung diseases (ILDs). Although much research has been conducted in this field, the problem remains challenging. Deep learning techniques have recently achieved impressive results in a variety of computer vision problems, raising expectations that they might be applied in other domains, such as medical image analysis. In this paper, we propose and evaluate a convolutional neural network (CNN), designed for the classification of ILD patterns. The proposed network consists of 5 convolutional layers with 2×2 kernels and LeakyReLU activations, followed by average pooling with size equal to the size of the final feature maps and three dense layers. The last dense layer has 7 outputs, equivalent to the classes considered: healthy, ground glass opacity (GGO), micronodules, consolidation, reticulation, honeycombing and a combination of GGO/reticulation. To train and evaluate the CNN, we used a dataset of 14696 image patches, derived by 120 CT scans from different scanners and hospitals. To the best of our knowledge, this is the first deep CNN designed for the specific problem. A comparative analysis proved the effectiveness of the proposed CNN against previous methods in a challenging dataset. The classification performance (~85.5%) demonstrated the potential of CNNs in analyzing lung patterns. Future work includes, extending the CNN to three-dimensional data provided by CT volume scans and integrating the proposed method into a CAD system that aims to provide differential diagnosis for ILDs as a supportive tool for radiologists.

The multiple location time weighted index: Using patient activity spaces to calculate primary care service areas

Geographic health planning analyses, such as service area calculations, are hampered by a lack of patient-specific geographic data. Using the limited patient address information in patient management systems, planners analyze patient origin based on home address. But activity space research done sparingly in public health and extensively in non-health related arenas uses multiple addresses per person when analyzing accessibility. Also, health care access research has shown that there are many non-geographic factors that influence choice of provider. Most planning methods, however, overlook non-geographic factors influencing choice of provider, and the limited data mean the analyses can only be related to home address. This research attempted to determine to what extent geography plays a part in patient choice of provider and to determine if activity space data can be used to calculate service areas for primary care providers. ^ During Spring 2008, a convenience sample of 384 patients of a locally-funded Community Health Center in Houston, Texas, completed a survey that asked about what factors are important when he or she selects a health care provider. A subset of this group (336) also completed an activity space log that captured location and time data on the places where the patient regularly goes. ^ Survey results indicate that for this patient population, geography plays a role in their choice of health care provider, but it is not the most important reason for choosing a provider. Other factors for choosing a health care provider such as the provider offering "free or low cost visits", meeting "all of the patient's health care needs", and seeing "the patient quickly" were all ranked higher than geographic reasons. ^ Analysis of the patient activity locations shows that activity spaces can be used to create service areas for a single primary care provider. Weighted activity-space-based service areas have the potential to include more patients in the service area since more than one location per patient is used. Further analysis of the logs shows that a reduced set of locations by time and type could be used for this methodology, facilitating ongoing data collection for activity-space-based planning efforts. ^

(Table 3) Concentration of Au, Pd, and Pt in the interstitial waters of ODP Leg 125 samples

Palladium, platinum, and gold were analyzed for 20 interstitial water samples from Leg 125. No Pd or Pt was detected in fluids from serpentinite muds from Conical Seamount in the Mariana forearc, indicating that low-temperature seawater-peridotite interaction does not mobilize these elements into the serpentinizing fluids to levels above 0.10 parts per billion (ppb) in solution. However, Au may be mobilized in high pH solutions. In contrast, fluids from vitric-rich clays on the flanks of the Torishima Seamount in the Izu-Bonin forearc have Pd values of between 4.0 and 11.8 nmol/L, Pt values between 2.3 and 5.0 nmol/L and Au values between 126.9 and 1116.9 pmol/L. The precious metals are mobilized, and possibly adsorbed onto clay mineral surfaces, during diagenesis and burial of the volcanic-rich clays. Desorption during squeezing of the sediments may produce the enhanced precious metal concentrations in the analyzed fluids. The metals are mobilized in the fluids probably as neutral hydroxide, bisulfide, and ammonia complexes. Pt/Pd ratios are between 0.42 and 2.33, which is much lower than many of the potential sources for Pt and Pd but is consistent with the greater solubility of Pd compared with Pt in most natural low-temperature fluids.

(Table 1) Interstitial-water chemistry at DSP Leg 58 Holes

Interstitial waters from several sites drilled during Leg 58 have been analyzed for major constituents. Data for Sites 442, 443, and 444 in Shikoku Basin indicate that only small changes occur in the chemical composition. We did not note any influence on the interstitial water chemistry resulting from reactions taking place in the underlying basalts. Site 445 data indicate that reactions must occur in the sediment column, leading to decreases in dissolved magnesium and increases in dissolved calcium. In addition, a source of dissolved calcium appears in the underlying basalts. At Site 446, changes appear in dissolved-calcium and -magnesium concentrations, resulting mainly from alteration reactions in the basalts. Dissolved potassium has its main sink in deeper-lying sediments or basalts. Changes in dissolved strontium at Sites 445 and 446 can be explained in terms of carbonate recrystallization. At all sites, changes in dissolved manganese and lithium appear to be related to the presence of biogenic silica in the sediments.

Interstitial water chemistry at DSDP Leg 57 Holes

Analyses of water samples taken by means of an in-hole sampler generally show good agreement with analyses of samples collected by routine shipboard squeezing techniques. At Sites 438 and 439, a decrease in salinity with depth is related to former freshwater flow from an aquifer that crops out at an anticline on a deep sea terrace between Japan and the top of the trench slope of the Japan Trench. This former subaerial recharge suggests significant late Cenozoic subsidence of the terrace, because it now lies at a water depth of 1500 meters. Samples from the trench slope at Site 440 have extremely high values of alkalinity and ammonia, presumably because of a favorable combination of high sedimentation rate and organic carbon content. Diagenetic conditions on the trench slope favor formation of the Fe-Mg carbonate mineral, ankerite; at Site 440 it first occurs at a depth below the sea floor of only 29 meters in late Pleistocene strata. Undissolved diatoms persist to relatively great depth at the sites of Leg 57 because of a low geothermal gradient caused by subduction. Secondary silica lepispheres first appear at 851 meters at the most landward and warmest site, Site 438, in strata 16 million years old with an ambient temperature of 31 °C.