rss_2.0Medicine FeedSciendo RSS Feed for Medicine Feed of 8 days of water-only fasting and vigorous exercise on anthropometric parameters, lipid profile and HOMA-IR in middle-aged men<abstract> <title style='display:none'>Abstract</title> <p><italic>Study aim</italic>: The aim of the present study was to determine the effect of 8 days of water-only fasting and physical exercise on somatic variables, lipid profile, insulin resistance and cardiovascular function in middle-aged men.</p> <p><italic>Material and methods</italic>: Body weight, body composition, lipid profile, serum concentrations of insulin, glucose, β-hydroxybutyrate (β-HB), heart rate (HR), blood pressure and the homeostasis model assessment of insulin resistance (HOMA-IR) were determined in 16 apparently healthy men at rest and after aerobic exercise. This test procedure was also repeated after 8 days of water-only fasting.</p> <p><italic>Results</italic>: Fasting intervention resulted in a reduction in body weight and fat mass (p &lt; 0.001). The simultaneous effect of fasting and exercise resulted in significant changes in lipid profile, carbohydrate metabolism and cardiovascular function. Post hoc analyses showed that the reductions in insulin and glucose concentrations as well as the HOMA-IR index were caused by the fasting, and changes in the lipid profile and cardiovascular function were caused by the exercise test.</p> <p><italic>Conclusion</italic>: The combined use of fasting and physical effort resulted in an optimal effect on health indicators of the surveyed men.</p> </abstract>ARTICLEtrue Inflamed Non-Calcified Coronary Plaques Sealed with Stents in Patients with Zero Calcium Score – a Case Series and Review of the Literature<abstract> <title style='display:none'>Abstract</title> <p>The modern management of coronary artery disease (CAD) uses coronary computed tomography angiography (CCTA) to enhance plaque evaluation and cardiovascular risk assessment. CCTA identifies high-risk plaques, and the latest CT technologies based on calculation of fat attenuation index (FAI) allow assessment of inflammation at the level of the target coronary artery. We present a series of case studies with chest pain and positive CCTA, in whom a significant stenosis was detected in the left anterior descendent coronary artery, and the existence of high-risk, inflamed plaques was documented even in the context of a zero calcium score. A severe narrowing of the left anterior descending artery, exhibiting the pattern of high-risk anatomy, was associated with a very high inflammation depicted by FAI analysis in all three cases, an association that may be extremely dangerous. In this case series, CCTA examination led to immediate stenting of the obstructive stenosis, sealing the dangerous plaque.</p> </abstract>ARTICLEtrue Inflammation and Coronary Calcification in an Acute Coronary Syndrome Successfully Treated with Cutting Balloon<abstract> <title style='display:none'>Abstract</title> <p>Complex coronary atherosclerosis may exhibit different phenotypes of coronary plaques, from non-calcified highly vulnerable atheroma to heavily calcified ones. Computed coronary tomography angiography (CCTA) may identify these different phenotypes and the recently introduced CCTA-based techniques for mapping coronary inflammation along the coronary arteries may provide useful additional information on cardiovascular risk. Here we present the case of a 68-year-old male patient with acute coronary syndrome in whom invasive coronary angiography and CCTA revealed a severe three-vessel disease with a heavily calcified lesion. Mapping of the CT fat attenuation index along the coronary arteries identified a high level of coronary inflammation, especially associated with the non-calcified lesions. All lesions were successfully revascularized by implantation of drug-eluting stents. A cutting balloon was used for the lesion identified by CCTA as heavily calcified, followed by stent implantation, with good results. In conclusion, CCTA, in association with novel techniques for mapping coronary inflammation, may represent an extremely useful tool for preparing complex interventions in multivessel diseases, helping preprocedural planning in high-risk patients.</p> </abstract>ARTICLEtrue Race Against Time: Coronary Computed Tomography Angiography Discovers a Highly Inflamed Plaque in 49-Year-Old Right Before STEMI<abstract> <title style='display:none'>Abstract</title> <p>In the modern management of coronary artery disease (CAD), cardiac computed tomography angiography (CCTA) has emerged as a pivotal diagnostic tool, offering detailed visualization of coronary artery lumens and atherosclerotic plaques. We present the case of a 49-year-old woman, with no prior cardiovascular history but with several risk factors, in whom CCTA identified a highly inflamed atherosclerotic plaque, which led immediately to an acute myocardial infarction. Significantly, this case spotlights the vital role of perivascular inflammation mapping in CCTA, crucial for identifying high-risk plaques. The case emphasizes the necessity for a comprehensive, multifaceted diagnostic approach in the evaluation and management of CAD, incorporating advanced techniques like perivascular inflammation mapping for a more accurate and predictive assessment.</p> </abstract>ARTICLEtrue Case for Utilizing Ultrasound Contrast Agents During Echocardiography East European Journal of Cardiology<P><STRONG>The South East European Journal of Cardiology</STRONG> (SEEJCA) is an open-access, peer-reviewed journal, founded in 2015 and is restarting its’ publication process this year. SEEJCA is indexed in scientific databases (OpenAIRE, BASE, SciLit, Dimensions) and cooperates with several institutions (Crossref, Sherpa Romeo, Publons). Our mission is to build an internationally recognized journal, for researchers and scientists alike, from different parts of the world and unite in our common goal, new practical research that will expand our knowledge and enrich the cardiology literature with new and break-through research and science.</P> <P>We are inviting you to publish your work in our journal and by that partner with an editorially independent journal, a distinguished world recognized editorial board and editor in chief, that are committed to maintaining the highest standards of medical science in the cardiology field. The peer-review process in our journal is in the safe hands of our distinguished editorial board of world recognized cardiologists. We will be dedicated to a thorough, but fast review process, so we can give our authors a fast delivery of their science to the world cardiology community and make it reproducible for future generations.</P> <P>The journal covers a broad scope of topics in cardiology mostly, but not limited to several areas: General Cardiology, Cardiovascular Imaging, Interventional Cardiology, Cardiac Electrophysiology, Cardiovascular Surgery, Molecular Cardiology, Case Reports in Cardiology, Reviews in Cardiology, Thematic Issues in Cardiology.</P> <P>Our journal team will take great care, so your work is highly visible to a worldwide network of researchers, clinicians, industry professionals, policy makers, media outlets, patients, and the wider public, and we will work with you and your affiliated institutions to expand the impact of your research on the world.</P> <P>Lastly, South East European Journal of Cardiology is an on-line only, Open Access journal, in which published papers are immediately made available free of charge to the scientific community.<BR></P> <P><STRONG>Archiving</STRONG></P> <P>Sciendo archives the contents of this journal in <A href="">Portico</A> - digital long-term preservation service of scholarly books, journals and collections.</P> <P><STRONG>Plagiarism Policy</STRONG></P> <P>The editorial board is participating in a growing community of <A href="">Similarity Check System</A>'s users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. </P> JOURNALtrue aligner therapy procedures and protocols of orthodontists in New Zealand<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Objective</title> <p>To survey clear aligner therapy (CAT) procedures and protocols of orthodontists in New Zealand.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>One hundred and ten full members of the New Zealand Association of Orthodontists were invited to complete an e-survey. The questions related to respondent demographics, aligner choice and use, CAT planning and treatment protocols, case selection, patient-reported CAT problems and relevant respondent opinions. The reasons for respondents not providing CAT were also surveyed.</p> </sec> <sec> <title style='display:none'>Results</title> <p>The response rate was 70%. Most respondents (88.3%; <italic>N</italic> = 68) reported that they used CAT as a treatment modality with 43.15% (<italic>N</italic> = 29) treating between 1 and 20 patients per year. The predominant CAT system was the Invisalign appliance (70.3%; <italic>N</italic> = 45) with 49.2% (<italic>N</italic> = 32) stating that they used more than one CAT system. The respondents reported the areas which were always or mostly in need of amendment prior to acceptance of the CAT treatment plan were attachments (75.6%; <italic>N</italic> = 50) and final tooth positions (62.1%; <italic>N</italic> = 41). A median of 0% (IQR: 0, 1) of initial digital treatment plans were approved without changes according to the respondents with a median of 90% (IQR: 80, 99) of CAT patients requiring an additional aligner phase. Almost 80% (78.1%; <italic>N</italic> = 50) indicated that they were not comfortable in treating cases with increased overbite and 66.7% (<italic>N</italic> = 44) rarely or never carried out premolar extractions when using CAT. A remote monitoring system was mostly or always used by 32.4% (<italic>N</italic> = 21) of respondents in conjunction with CAT. Concern regarding patient compliance with CAT protocols was expressed by 43.5% (<italic>N</italic> = 22). That fixed appliances provided better treatment outcomes was a moderate or major influence on the decision of all respondents (<italic>N</italic> = 8) who did not provide CAT.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>Although CAT provision by orthodontists is commonplace among orthodontists in New Zealand, there is wide variation in its usage and procedures.</p> </sec> </abstract>ARTICLEtrue in three perspectives: Associations with depression and suicidal ideation in a clinical adolescent sample<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Background</title> <p>Adolescence is a critical period for mental development where the consequences of psychopathologies can be exceedingly harmful, and compassion has been identified as a protective factor for adolescents’ mental well-being.</p> </sec> <sec> <title style='display:none'>Aim</title> <p>The aim of this study was to explore three perspectives of compassion – Self-compassion, Compassion for others, and Compassion from others – and their relationship with depression and suicidal ideation in adolescents.</p> </sec> <sec> <title style='display:none'>Method</title> <p>This Swedish cross-sectional study included 259 psychiatric patients (ages 16–22). Participants completed a survey including the self-assessment scales “Reynolds Adolescent Depression Scale – Second Edition” (RADS-2), “Suicidal Ideation Questionnaire – Junior Version” (SIQ-JR), and “Compassion Engagement and Action Scale – Youth” (CEAS-Y). Linear regression analyses were used to determine whether participants’ levels of compassion predicted depression and suicidal ideation.</p> </sec> <sec> <title style='display:none'>Results</title> <p>Self-compassion and Compassion from others significantly predicted both depression and suicidal ideation. Girls, on average, reported higher levels of depressive symptoms and suicidal ideation and lower levels of self-compassion compared to boys. The correlation between compassion and depressive symptoms, however, appeared to be stronger in boys. There was also a positive correlation between Compassion for others and suicidal ideation.</p> </sec> <sec> <title style='display:none'>Conclusions</title> <p>The results suggest that Self-compassion and Compassion from others may have a significant protective effect against depression and suicidal ideation, especially in boys. However, due to the relatively small sample of boys (n = 40), further research is needed before any solid conclusion can be drawn regarding possible gender differences. Additionally, the combination of low Self-compassion and higher levels of Compassion for others may be associated with suicidal ideation.</p> </sec> </abstract>ARTICLEtrue of hematological and blood biochemical indices in cultured Nile tilapia ) as affected by using phage therapy against<abstract> <title style='display:none'>Abstract</title> <p><italic>Pseudomonas</italic> spp. causes significant losses in aquaculture, consecutive use of antibiotics, and reveals bacterial resistance; therefore, therapeutic bacteriophages, commonly called phages, are a promising potential alternative to antibiotics in the management of bacterial infections of a wide range of organisms, including cultured fish. The novelty of current work represented in examining the lytic activity of four phages and their combination compared to the antibiotic streptomycin on <italic>Pseudomonas aeruginosa-</italic>infected Nile tilapia (<italic>Oreochromis niloticus</italic>) while measuring the hematological and blood biochemical parameters as a response for phage therapy. This study evaluated the <italic>in vitro</italic> killing curve for each phage using a growth curve that measured the OD600 after a single phage suspension was combined with the host <italic>P. aeruginosa,</italic> considered the best multiplicity of infection (MOI) for each phage. A144 healthy fish were acclimatized in the laboratory and divided into six groups: control, <italic>P. aeruginosa</italic>-infected fish<italic>,</italic> streptomycin, phage Ps1, Ps2, both (Ps1 and Ps2), were added to the T3, T4, T5, and T6 groups, respectively. Our findings demonstrated that <italic>P. aeruginosa</italic> infection caused surface body hemorrhages, tail and fin rot, irritated skin, superficial ulcers, and 100% mortality through 14 days. <italic>P. aeruginosa</italic> caused a reduction in hemoglobin (Hb), red blood cells (RBCs), platelet number (PLt), and platelet crit (PCT) count protein, albumin, and A/G ratio; however, an increase in hematocrit (Hct); Red cell distribution width (RDW), PDW, MPV compared to other groups after three days of infection and the effects increased after 12 days post-infection. The fish vaccinated with P1 (T4) and P1+P2 (T6) showed enhanced levels of Hb, RBCs, PLt, PCt, protein, albumin and decreased levels of RDW, PDW, MPV, and liver and kidney enzymes with enhanced contents more than streptomycin and closer to the control group. The biochemical markers recorded significant changes indicating liver and kidney impairments due to the infection with <italic>P. aeruginosa</italic>. It can concluded that P1 and P1+P2 combinations could use as therapy in <italic>Pseudomonas</italic>-infectd fish to enhance their blood parameters and performance.</p> </abstract>ARTICLEtrue Primary Pulmonary Artery Rhabomyosarcoma: A Case Report<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p> Pulmonary artery sarcomas (PAS) are rare tumours causing an insidiously progressive obstruction of the pulmonary circulation. The clinical presentation is often indistinguishable from chronic thromboembolic pulmonary hypertension (CTEPH). However, the atypical appearance of a heterogeneous filling defect in CT pulmonary angiography (CTPA) should prompt further investigation.</p> </sec> <sec><title style='display:none'>Case Presentation</title> <p> A previously healthy young man presented with massive haemoptysis, acute respiratory distress, and progressive exertional dyspnea since the year before. Echocardiography demonstrated severe right ventricular dysfunction and highly probable pulmonary hypertension. CTPA revealed an extensive filling defect with an appearance concerning PAS. Due to syncopal episodes at rest, the patient underwent urgent pulmonary artery endarterectomy (PEA). A massive tree-like tumour was excised as a result. Post-operatively, reperfusion injury and refractory pulmonary oedema mandated extracorporeal membrane oxygenation (ECMO). Unfortunately, ECMO was complicated with massive haemolysis and acute kidney injury. The patient succumbed to multi-organ failure. Through tissue analysis established a diagnosis of embryonal rhabdomyosarcoma.</p> </sec> <sec><title style='display:none'>Discussion</title> <p> Unfortunately, the patient had not reached out for his worsening dyspnea. PASs should not be mistaken for a thrombus and anticoagulation should be avoided. The urgent condition precluded biopsy and tissue diagnosis. Similarly, neoadjuvant chemotherapy was not feasible. Post-operatively, reperfusion injury and pulmonary oedema ensued, which mandated ECMO. This complication should be anticipated preoperatively. There is a need for more data on PASs to establish a consensus for management.</p> </sec> </abstract>ARTICLEtrue does survive in food and food-production environments?<abstract> <title style='display:none'>Abstract</title> <p><italic>Listeria monocytogenes</italic> is one of the most dangerous food-borne pathogens and is responsible for human listeriosis, a severe disease with a high mortality rate, especially among the elderly, pregnant women and newborns. Therefore, this bacterium has an important impact on food safety and public health. It is able to survive and even grow in a temperature range from -0.4°C to 45°C, a broad pH range from 4.6 to 9.5 and at a relatively low water activity (a<sub>W</sub> &lt; 0.90), and tolerates salt content up to 20%. It is also resistant to ultraviolet light, biocides and heavy metals and forms biofilm structures on a variety of surfaces in food-production environments. These features make it difficult to remove and allow it to persist for a long time, increasing the risk of contamination of food-production facilities and ultimately of food. In the present review, the key mechanisms of the pathogen’s survival and stress adaptation have been presented. This information may grant better understanding of bacterial adaptation to food environmental conditions.</p> </abstract>ARTICLEtrue insight on chlamydiae<abstract> <title style='display:none'>Abstract</title> <p>This article provides an overview of the current knowledge on chlamydiae, which are intracellular bacteria belonging to the <italic>Chlamydiaceae</italic> family. Whole-genome sequencing leads to great increases in the available data about <italic>Chlamydia</italic> spp. Recently, novel chlamydial taxons in various hosts living in different environments have been recognised. New species and taxons with <italic>Candidatus</italic> status have been recorded mainly in birds and reptiles. <italic>Chlamydia gallinacea</italic> is an emerging infectious agent in poultry with indirectly confirmed zoonotic potential. Recently, a new group of avian <italic>C. abortus</italic> strains with worldwide distribution in various wild bird families has been described. The definition of <italic>C. abortus</italic> species became outdated with the discovery of these strains and has been amended. It now includes two subgroups, mammalian and avian, the latter including all isolates hitherto referred to as atypical <italic>C. psittaci</italic> or <italic>C. psittaci</italic>/<italic>C. abortus</italic> intermediates.</p> </abstract>ARTICLEtrue diffusion coefficient measurements of bone marrow infiltration patterns in multiple myeloma for the assessment of tumor burden – a feasibility study<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>The purpose of our study was to explore and compare the tumor burden of different bone marrow infiltration patterns and evaluate the feasibility of apparent diffusion coefficient (ADC) value to identify patterns in multiple myeloma (MM).</p> </sec> <sec><title style='display:none'>Patients and methods</title> <p>Ninety-three patients with newly diagnosed multiple myeloma and 23 controls had undergone routine magnetic resonance imaging (MRI) and diffusion-weighted MRI (DWI) from January 2019 to November 2020. Five bone marrow (BM) infiltration patterns were allocated according to routine MRI. The laboratory data and ADC values of patterns were analyzed and compared. ROC analysis was used to establish the best diagnostic ADC threshold value for identifying these patterns and distinguishing normal pattern from controls. Besides, the correlation between the ADC values of diffuse pattern and the plasma cells ratio was assessed.</p> </sec> <sec><title style='display:none'>Results</title> <p>The values of hemoglobin, beta-2 microglobulin (β2-MG), plasma cell, M protein, the percentages of stage, high-risk fluorescence in situ hybridization, and ADC values showed significant difference among patterns. ADC<sub>mean</sub> at a specific value (368.5×10<sup>−6</sup> mm<sup>2</sup>/s) yielded a maximum specificity (95.5%) and sensitivity (92.0%) in diagnosing MM. A specific value (335.5×10<sup>−6</sup>mm<sup>2</sup>/s) yielded a maximum specificity (84.7%) and sensitivity (88.0%) in discriminating visually normal pattern in MM from controls. There was a moderate positive correlation between the plasma cells ratio and ADCs of diffuse infiltration patterns (r = 0.648, P &lt; 0.001).</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>The bone marrow infiltration patterns in MM patients can indicate the tumor burden and ADC value has the ability to discriminate these patterns objectively.</p> </sec> </abstract>ARTICLEtrue of short-term effect of platelet-rich plasma treatment of tendinosis using texture analysis of ultrasound images<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Computer-aided diagnosis (<italic>i.e.</italic>, texture analyses) tools are becoming increasingly beneficial methods to monitor subtle tissue changes. The aim of this pilot study was to investigate short-term effect of platelet rich plasma (PRP) treatment in supraspinatus and common extensor of the forearm tendinosis by using texture analysis of ultrasound (US) images as well as by clinical questionnaires.</p> </sec> <sec><title style='display:none'>Patients and methods</title> <p>Thirteen patients (7 male and 6 female, age 36–60 years, mean age 51.2 ± 5.2) were followed after US guided PRP treatment for tendinosis of two tendons (9 patients with lateral epicondylitis and 4 with supraspinatus tendinosis). Clinical and US assessment was performed prior to as well as 3 months after PRP treatment with validated clinical questionnaires. Tissue response in tendons was assessed by using gray level run length matrix method (GLRLM) of US images.</p> </sec> <sec><title style='display:none'>Results</title> <p>All patients improved of tendinosis symptoms after PRP treatment according to clinical questionnaires. Almost all GLRLM features were statistically improved 3 months after PRP treatment. GLRLM-long run high gray level emphasis (LRLGLE) revealed the best moderate positive and statistically significant correlation after PRP (<italic>r</italic> = 0.4373, <italic>p</italic> = 0.0255), followed by GLRLM-low gray level run emphasis (LGLRE) (<italic>r</italic> = 0.3877, <italic>p</italic> = 0.05).</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Texture analysis of tendinosis US images was a useful quantitative method for the assessment of tendon remodeling after minimally invasive PRP treatment. GLRLM features have the potential to become useful imaging biomarkers to monitor spatial and time limited tissue response after PRP, however larger studies with similar protocols are needed.</p> </sec> </abstract>ARTICLEtrue SSTR-PET/CT for predicting response and survival outcomes in patients with pancreatic neuroendocrine tumors receiving CAPTEM<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>This study aimed to evaluate the predictive and monitoring role of somatostatin receptor (SSTR) positron emission tomography-computed tomography (PET/CT) and clinical parameters in patients with neuroendocrine liver metastases (NELM) from pancreatic neuroendocrine tumors (pNET) receiving capecitabine and temozolomide (CAPTEM).</p> </sec> <sec><title style='display:none'>Patients and methods</title> <p>This retrospective study included twenty-two patients with pNET and NELM receiving CAPTEM who underwent pre- and post-therapeutic <sup>68</sup>Ga-DOTATATE/-TOC PET/CT. Imaging (including standardized uptake value [SUV] of target lesions [NELM and pNET], normal spleen and liver) and clinical (Chromogranin A [CgA], Ki-67) parameters were assessed. Treatment outcome was evaluated as response according to RECIST 1.1, progression free survival (PFS) and overall survival (OS).</p> </sec> <sec><title style='display:none'>Results</title> <p>The median PFS (mPFS) was 7 months. Responders had a significantly longer mPFS compared to non-responders (10 <italic>vs</italic>. 4 months p = 0.022). Median OS (mOS) was 33 months (mOS: responders = 80 months, non-responders = 24 months p = 0.182). Baseline imaging showed higher SUV in responders, including absolute SUV, tumor-to-spleen (T/S), and tumor-to-liver (T/L) ratios (p &lt; 0.02). All SUV parameters changed only in the responders during follow-up. Univariable Cox regression analysis identified baseline Tmax/Smean ratio and percentage change in size of pNETs as significant factors associated with PFS. A baseline Tmax/Smean ratio &lt; 1.5 was associated with a shorter mPFS (10 <italic>vs</italic>. 4 months, (p &lt; 0.05)). Prognostic factors for OS included age, percentage change in CgA and in T/S ratios in univariable Cox regression.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>SSTR-PET/CT can be useful for predicting response and survival outcomes in pNET patients receiving CAPTEM: Higher baseline SUV values, particularly Tmax/Smean ratios of liver metastases were associated with better response and prolonged PFS.</p> </sec> </abstract>ARTICLEtrue of tumor volume changes during preoperative radiotherapy for extremity soft tissue sarcoma: a new strategy of adaptive radiotherapy<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Using adaptive radiotherapy (ART), to determine objective clinical criteria that identify extremity soft tissue sarcoma (ESTS) patients requiring adaptation of their preoperative radiotherapy (RT) plan.</p> </sec> <sec><title style='display:none'>Patients and methods</title> <p>We included 17 patients with a lower extremity ESTS treated between 2019 and 2021 with preoperative RT, using helicoidal intensity-modulated RT (IMRT) tomotherapy, before surgical resection. We collected clinical, tumor parameters and treatment data. Repositioning was ascertained by daily Megavoltage computed tomography (MVCT) imaging. Using the PreciseART technology we retrospectively manually delineated at least one MVCT for each patient per week and recorded volume and dosimetric parameters. A greater than 5% change between target volume and planned target volume (PTV) dosimetric coverage from the initial planning CT scan to at least one MVCT was defined as clinically significant.</p> </sec> <sec><title style='display:none'>Results</title> <p>All 17 patients experienced significant tumor volume changes during treatment; 7 tumors grew (41%) and 10 shrank (59%). Three patients (18%), all undifferentiated pleomorphic sarcomas (UPS) with increased volume changes, experienced significant reductions in tumor dose coverage. Seven patients required a plan adaptation, as determined by practical criteria applied in our departmental practice. Among these patients, only one ultimately experienced a significant change in PTV coverage. Three patients had a PTV decrease of coverage. Among them, 2 did not receive plan adaptation according our criteria. None of the patients with decreased tumor volumes had reduced target volume coverage. Monitoring volume variations by estimating gross tumor volume (GTV) on MVCT, in addition to axial and sagittal linear tumor dimensions, appeared to be most effective for detecting reductions in PTV coverage throughout treatment.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Variations in ESTS volume are evident during preoperative RT, but significant dosimetric variations are rare. Specific attention should be paid to grade 2–3 UPSs during the first 2 weeks of treatment. In the absence of dedicated software in routine clinical practice, monitoring of tumor volume changes by estimating GTV may represent a useful strategy for identifying patients whose treatment needs to be replanned.</p> </sec> </abstract>ARTICLEtrue prognostic significance of tumor-immune microenvironment in ascites of patients with high-grade serous carcinoma<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>High-grade serous carcinoma (HGSC) is often associated with ascites at presentation. Our objective was to quantify immune cells (ICs) in ascites prior to any treatment was given and evaluate their impact on progression-free survival (PFS) and overall survival (OS).</p> </sec> <sec><title style='display:none'>Patients and methods</title> <p>Forty-seven patients with primary HGSC and ascites were included. Flow-cytometric analysis was performed to detect percentages of CD3<sup>+</sup> T cells (CD4<sup>+</sup>, CD8<sup>+</sup>, Tregs, and NKT cells), B cells, NK cells (CD56<sup>bright</sup>CD16<sup>−</sup> and CD56<sup>dim</sup>CD16<sup>+</sup> subsets), macrophages and dendritic cells (DCs). Furthermore, CD103 expression was analyzed on T cells and their subsets, while PD-1 and PD-L1 expression on all ICs. Cut-off of low and high percentages of ICs was determined by the median of variables, and correlation with PFS and OS was calculated.</p> </sec> <sec><title style='display:none'>Results</title> <p>CD3<sup>+</sup> cells were the predominant ICs (median 51%), while the presence of other ICs was much lower (median ≤10%). CD103<sup>+</sup> expression was mostly present on CD8<sup>+</sup>, and not CD4<sup>+</sup> cells. PD-1 was mainly expressed on CD3<sup>+</sup> T cells (median 20%), lower expression was observed on other ICs (median ≤10%). PD-L1 expression was not detected. High percentages of CD103<sup>+</sup>CD3<sup>+</sup> T cells, PD-1<sup>+</sup> Tregs, CD56<sup>bright</sup>CD16<sup>−</sup> NK cells, and DCs correlated with prolonged PFS and OS, while high percentages of CD8<sup>+</sup> cells, macrophages, and PD-1<sup>+</sup>CD56<sup>bright</sup>CD16<sup>−</sup> NK cells, along with low percentages of CD4<sup>+</sup> cells, correlated with better OS only. DCs were the only independent prognostic marker among all ICs.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Our results highlight the potential of ascites tumor-immune microenvironment to provide additional prognostic information for HGSC patients. However, a larger patient cohort and longer follow-up are needed to confirm our findings.</p> </sec> </abstract>ARTICLEtrue between maximum heart distance and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during deep inspiration breath-hold (DIBH)<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Cardioprotection is valued in radiotherapy for patients with left-sided breast cancer. Deep inspiration breath-hold (DIBH) technique can achieve cardioprotection well. However, during DIBH, the extent to which the heart enters the radiation field is affected by the movement of the thorax and diaphragm. The aim of this study was to analyze the correlation between the maximum distance of the heart entering the field (maximum heart distance, MHD) and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during DIBH.</p> </sec> <sec><title style='display:none'>Patients and methods</title> <p>Ninety-eight patients with left-sided breast cancer were included in this retrospective study. They performed simulation in Sentinel-guided DIBH, and two sets of CT images were collected under both free breathing (FB) and DIBH, and diaphragm positions, anteroposterior thoracic diameter (ATD), transverse thoracic diameter (TTD), gating window level (GWL), and MHD were measured, and the change (Δ) of each parameter in DIBH relative to that in FB were calculated. Pearson or Spearman test were used to analyze the correlation between ΔMHD and the changes in other parameters.</p> </sec> <sec><title style='display:none'>Results</title> <p>For all patients with DIBH, the average of ΔMHD was −8.3 mm, and the average of ΔATD and ΔTTD were 11.0 and 8.6 mm, and the median of both left diaphragmatic descent (LDD) and right diaphragmatic descent (RDD) were 35.0 mm, and the median of GWL was 11.1 mm. The correlation coefficients between MHD decrease (ΔMHD) and LDD, RDD, and ΔTTD were −0.430 (p = 0.000), −0.592 (p = 0.000) and 0.208 (p = 0.040), respectively, but not significantly correlated with ΔATD or GWL.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>The MHD decrease showed a moderate correlation with diaphragmatic descent In Sentinel-guided DIBH for patients with left-sided breast cancer, while there was a weak or no correlation with thoracic diameter changes or GWL. Abdominal breathing can lower diaphragm more and may be more beneficial to the heart stay away from tangential field.</p> </sec> </abstract>ARTICLEtrue xerostomia therapy with allogeneic mesenchymal stromal stem cells in patients with head and neck cancer: study protocol for phase I clinical trial<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Xerostomia is a common side effect of radiotherapy in patients with head and neck tumors that negatively affects quality of life. There is no known effective standard treatment for xerostomia. Here, we present the study protocol used to evaluate the safety and preliminary efficacy of allogeneic mesenchymal stromal stem cells (MSCs) derived from umbilical cord tissue.</p> </sec> <sec><title style='display:none'>Patients and methods</title> <p>Ten oropharyngeal cancer patients with post-radiation xerostomia and no evidence of disease recurrence 2 or more years after (chemo)irradiation (intervention group) and 10 healthy volunteers (control group) will be enrolled in this nonrandomized, open-label, phase I exploratory study. MSCs from umbilical cord tissue will be inserted under ultrasound guidance into both parotid glands and both submandibular glands of the patients. Toxicity of the procedure will be assessed according to CTCAE v5.0 criteria at days 0, 1, 5, 28, and 120. Efficacy will be assessed by measuring salivary flow and analyzing its composition, scintigraphic evaluation of MSC grafting, retention, and migration, and questionnaires measuring subjective xerostomia and quality of life. In addition, the radiological, functional, and morphological characteristics of the salivary tissue will be assessed before, at 4 weeks, and at 4 months after the procedure. In the control group subjects, only salivary flow rate and salivary composition will be determined.</p> </sec> <sec><title style='display:none'>Discussion</title> <p>The use of allogeneic MSCs from umbilical cord tissue represents an innovative approach for the treatment of xerostomia after radiation. Due to the noninvasive collection procedure, flexibility of cryobanking, and biological advantages, xerostomia therapy using allogeneic MSCs from umbilical cord tissue may have an advantage over other similar therapies.</p> </sec> </abstract>ARTICLEtrue therapy combined with systemic therapy (LRT + ST) for unresectable and metastatic intrahepatic cholangiocarcinoma: a systematic review and meta-analysis<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>The outcome of systemic therapy (ST) for unresectable and metastatic intrahepatic cholangiocarcinoma (iCCA) is poor. This study aims to further evaluate the efficacy and safety of locoregional therapy combined with systemic therapy (LRT + ST) compared with only ST in unresectable and metastatic iCCA by performing a systematic literature review and meta-analysis.</p> </sec> <sec><title style='display:none'>Methods</title> <p>A comprehensive search was performed in PubMed, Web of Science, EMBASE, and the Cochrane Library up to November 3, 2022. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs).</p> </sec> <sec><title style='display:none'>Results</title> <p>Ten retrospective cohort studies with 3,791 unresectable or metastatic iCCA patients were enrolled in this study, including 1,120 who received ablation, arterially directed therapy (ADT), or external beam radiation therapy (EBRT) combined with ST. The meta-analysis showed that the LRT + ST group had a better OS (<italic>HR</italic> = 0.51; <italic>95% CI</italic> =0.41–0.64; <italic>p value</italic> &lt; 0.001), PFS (<italic>HR</italic> = 0.40, <italic>95% CI</italic> = 0.22–0.71, <italic>p value</italic> = 0.002) and ORR (<italic>RR</italic> = 1.68; <italic>95% CI</italic> = 1.17–2.42; <italic>p value</italic> = 0.005). Subgroup analysis showed that both ST combined with ADT (<italic>HR</italic> = 0.42, <italic>95% CI</italic> = 0.31–0.56, <italic>p value</italic> &lt; 0.001) and EBRT (<italic>HR</italic> = 0.67, <italic>95% CI</italic> = 0.63–0.72, <italic>p value</italic> &lt; 0.001) could improve OS. Neutropenia, thrombocytopenia, anemia, anorexia, and vomiting did not show significant differences between the groups (p value &gt; 0.05).</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Compared with only ST, LRT + ST improved survival outcomes for unresectable and metastatic iCCA patients without increasing severe AEs, which can further provide a basis for guidelines.</p> </sec> </abstract>ARTICLEtrue