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Primary target volume delineation for radiotherapy in nasopharyngeal carcinoma: CSTRO, CACA, CSCO, HNCIG, ESTRO, and ASTRO guidelines and contouring atlas
No full textThe Chinese Society for Therapeutic Radiology Oncology, the Chinese Anti-Cancer Association, the Chinese Society of Clinical Oncology, Head and Neck Cancer International Group, the European Society for Radiotherapy and Oncology, and the American Society for Radiation Oncology jointly developed evidence-based guidelines and a contouring atlas for primary target volume delineation for radiotherapy in nasopharyngeal carcinoma. The guidelines systematically address three crucial challenges: margin design of clinical target volumes; target volume delineation after induction chemotherapy; and low-risk clinical target volume delineation based on local stepwise extension patterns. Based on a comprehensive systematic review and critical appraisal by an international multidisciplinary panel of 50 nasopharyngeal carcinoma specialists from 17 countries and regions, these guidelines are in keeping with advances in nasopharyngeal carcinoma diagnosis and treatment, embodying contemporary treatment concepts, and elaborating on the differences in practice. These guidelines aim to support global clinical practice in radiotherapy target volume delineation, substantially enhancing homogeneity and reducing variability in nasopharyngeal carcinoma target delineation
Fish and CHIP: Concurrent Percutaneous Left-Ventricular Thrombus Retrieval and Complex Coronary Intervention With Hemodynamic Support
No full textA 77-year-old female with ACS, LM-triple vessel disease, LVEF 20% and a 1.8cm LVT(Figure 1), with prohibitive surgical risk and cardiac index of 1.5 L/min/m2 on inotropic support, was offered percutaneous coronary intervention (PCI) with concurrent thrombus aspiration with the AngioVAC system (AngioDynamic, USA) per heart team decision. Relevant Test Results Prior to Catheterization. ECG: TWI I, V5-V6, late precordial R transition. Echo: LVEF 20%. Apical aneurysm. 1.8 LV apical thrombus. Moderate mitral regurgitation. Relevant Catheterization Findings. Elevated filling pressures. RA 10mmHg PA 52/12 mmHg mean 32 mmHg, PCWP 28 mmHg Fick Cardiac output/index 2.6 / 1.5 Coronary arteriogram: LM bifurcation medina 1,1,1 disease mLAD subtotal occlusion pLCx 70-80% calcified lesion pRCA CTO, left-to-right collaterals. INTERVENTIONAL MANAGEMENT. Procedural Step. Right femoral vein access with a 26-French sheath with hemostatic valve (DrySeal, Gore Medical USA) preclosed with two proglides (Abbott Cardiovascular, USA) was obtained. Biradial accesses were used for cerebral embolic protection (figure 2, panel A). Transeptal puncture(B) and septostomy(C) followed by balloon-assisted tracking(D) brought a 22 French AngioVAC cannula into the left atrium (E), followed by mitral valve crossing to reach the LV apex via a Confida wire(G-I) (Medtronic, USA), followed by thrombectomy, all under transesophageal echocardiography (TEE) guidance (H-J). Blood was returned through an oxygenator into a 15 French cannula place in 16 French Dryseal sheath via right femoral artery access preclosed with proglides. After thrombectomy, the suction cannula was pulled back into the right atrium with the funnel retracted. At a flow rate of 3.5 liters-per-minute, it served as a venoarterial-extracorporeal membranous oxygenation (VA-ECMO) circuit (figure 3, panel A). Complex high-risk indicated PCI (CHIP) was performed via left femoral artery access to left anterior descending artery (LAD), left circumflex artery (LCx) and LM bifurcation (B-P) with good result on final angiogram (figure 4, panel A). Contrast echocardiography showed no further LV thrombus (B) and unchanged mitral regurgitation (C) after the thrombus was fished out (D). The patient recovered and was discharged. Conclusions. Acute coronary syndrome (ACS) with concurrent left main bifurcation disease, reduced left ventricular ejection fraction (LVEF) and left-ventricular thrombus (LVT) is a challenging situation where the micro axial flow pump for supporting coronary intervention is contraindicated owing to embolic risk. Off-label AngioVAC use for concurrent left-sided thrombectomy and hemodynamic support for CHIP is possible. Operator proficiency with large bore access and careful cannula positioning to avoid suctioning is required
Transcatheter Tricuspid Valve Replacement In Patients With Pacemakers: Can Cardiac Computed Tomography Analysis Predict Failure?
No full textIntroduction: Transcatheter tricuspid valve replacement (TTVR) with the Evoque valve (Edwards Lifesciences, USA) is a novel therapy in management of patients with severe tricuspid regurgitation (TR) at high risk for surgical intervention. The Evoque valve is stabilized by anchors as well as radial force from oversizing the to the tricuspid annular area. The potential impact of this radial force on permanent pacemaker (PPM) function in patients undergoing TTVR is inadequately understood. Methods: We retrospectively analyzed twenty patients who underwent commercial TTVR at a single center who had PPM prior to TTVR. Pre-procedural cardiac computed tomography (CCT) studies were analyzed to evaluate percent annular oversizing of the implanted valve. Measurements were performed using a variety of techniques including vendor supplied measurements, CCT multiplanar reconstruction measurements with no annular height offset (MPR), and CCT annular measurements using a minimum intensity projection (minIP). Lead slack was measured as a tortuosity index using curved reformatting of PPM lead length of the superior vena cava-atrial junction to lead insertion point divided by the straight-line distance. Post-procedurally, all patients had PPM interrogation to assess for signs of pacemaker dysfunction, defined as elevated lead thresholds as adjudicated by cardiac electrophysiology. Results: Two patients had signs of PPM dysfunction post-TTVR (11.1%). There was no difference between percent oversizing of the valve in patients who had PPM dysfunction post-procedurally utilizing vendor (18.0% vs 18.5%, p=0.90), MPR (12.4% vs 12.9%, p=0.80), and minIP measurements (18.4% vs 19.9%, p=0.61) techniques respectively. There was no difference amongst the degree of lead slack among patients with normal PPM function compared to PPM dysfunction (tortuosity index: 1.35 vs 1.30, p=0.70). Conclusions: CCT-derived tricuspid annular oversizing and PPM slack as defined as tortuosity index does not appear to predict post-procedural PPM dysfunction in our cohort of patients with severe TR and pre-existing PPM. However, this study has several limitations, namely this being a small retrospective sample size with a low event-rate. Further research is needed to identify patient specific CCT predictors of PPM lead dysfunction post TTVR
Does Exercise Intensity Differ Between Exercise Equipment In Cardiac Rehabilitation?: 1675...American College of Sports Medicine (ACSM) Annual Meeting, May 27-30, 2025, Atlanta, Georgia
No full textThe article focuses on the impact of exercise modality and prescription method on exercise intensity in cardiac rehabilitation (CR). A randomized trial assessed how different exercise modes (treadmill, upright bike, recumbent bike, and seated dual-action elliptical/stepper) and methods (ratings of perceived exertion (RPE) vs. target heart rate (THR)) influenced exercise heart rate (HR). Results indicated that patients using THR achieved higher exercise intensity across most modalities, while seated modalities, particularly the seated dual-action elliptical/stepper, resulted in the lowest intensity, especially in the RPE group. The findings emphasize the importance of using THR to guide exercise in CR for better fitness outcomes
Outage as Opportunity: Local Backups for Long-Term Access
No full textIn 2024, the Internet Archive (IA) experienced a DDoS attack and subsequent outage that disrupted access to its materials. The University of Maryland, Baltimore’s (UMB) Health Sciences and Human Services Library (HSHSL) was directly affected, as our institutional repository/digital collections platform, the UMB Digital Archive, relies on Internet Archive URLs for many of its digitized historical collections. Due to storage constraints, these collections were linked through IA URIs rather than hosted directly in the repository. Past digitization contracts with the Internet Archive provided only URIs to the scans, and HSHSL never received local copies, leaving us without any access to over 1800 digitized historical collections materials during this 2024 outage. Recognizing the risk of future outages, HSHSL launched a 2025 project to systematically download and preserve all prior contracted scanning done by the Internet Archive. These files are now being stored locally to ensure long-term stability and accessibility. This presentation will outline our workflow for identifying, retrieving, and organizing files, as well as the challenges we encountered and the solutions we developed. By sharing our experience, we aim to provide a practical example of how libraries can strengthen digital backups, reduce reliance on external platforms, and maintain access to their collections
The Case for Data Sharing: Generalist Repository Real-World User Stories
No full textThe NIH Data Management and Sharing (DMS) Policy presents a significant challenge for librarians tasked with guiding researchers through a complex data repository landscape. This session will provide attendees with both practical tools and illustrative examples to support open data sharing practices at their institutions. The first part of the session (5 minutes) will provide an overview of the Generalist Repository Ecosystem Initiative (GREI) toolkit. We will highlight key resources—such as the generalist repository comparison chart (https://doi.org/10.5281/zenodo.3946719) and a data submission checklist (https://doi.org/10.5281/zenodo.14278906)—which can be used to facilitate researcher consultations and clarify the process of complying with the NIH policy. The second portion of the session (15 minutes) will focus on the impact of data sharing, presenting real-world case studies that demonstrate the benefits of depositing data in generalist repositories. Through these examples, we will illustrate how researchers have: - Combined and reused data from separate clinical trials to create new disease models and directly inform national clinical practice guidelines. - Shared complex, multimodal datasets that have been reused by other labs, leading to new discoveries and collaborations. - Published analysis code, software, and workflows, improving reproducibility and accelerating research in computationally intensive fields like multi-omics and biomedical informatics. Attendees will leave the session with a clearer understanding of available tools and the demonstrated value of data sharing, enabling them to better support open science practices within their institutions
University of Alabama at Birmingham\u27s Research Data Catalog
No full textA dataset catalog can be a quickly implemented solution when hosting an institutional dataset repository simply isn’t possible. These resources can make institutional research data more locally discoverable, accessible, and reuseable. A dataset catalog (composed of metadata records) connects users with the institution’s research datasets and can be hosted on any repository platform. At the University of Alabama at Birmingham, our Research Data Catalog does not directly include or store datasets but is a functional directory that assists with discovery of datasets that researchers have deposited in external data repositories (such as Zenodo, Dryad, ICPSR, and Figshare), self-hosted, or a located elsewhere in the deep web. A data catalog is an accessible project that works within local constraints, relies on readily available API tools, and provides the opportunity to access and elevate the research of your institution in one place
Exploring Repository Platforms in Academic Health Sciences Libraries: Current Trends and Next Steps
No full textAs open access continues to expand in the health sciences, institutional repositories (IRs) play a critical role in preserving, disseminating, and enhancing the discoverability of scholarly and clinical outputs. Yet, the repository platforms and infrastructures adopted by medical and health-related institutions remain underexplored. This lightning talk presents findings from 171 U.S. universities and medical schools—members of the Association of Academic Health Sciences Libraries—focusing on the institutional repository platforms they employ (e.g., DSpace, Digital Commons, EPrints). The analysis highlights the distribution of IR platforms, institutional choices between open-source and hosted solutions, and the extent to which repositories support institution-wide versus health sciences–specific collections. By visualizing this landscape, the talk offers a snapshot of current practices while raising key questions about the suitability of existing platforms for managing diverse health resources. The presentation concludes with preliminary reflections and invites discussion on next research steps, including resource type and content analysis, interoperability, and support for open science
Serum levels of IL-31 and autotaxin are independently associated with pruritus severity in patients with primary sclerosing cholangitis
No full textBackground and aims: Primary Sclerosing Cholangitis (PSC) is a chronic cholestatic liver disease with no approved treatment and few effective off-label therapies to reduce the symptom burden. We previously reported that over 1 3 of patients with PSC experience moderate-to-severe pruritus. However, little is known about biomar_kers of pruritus in patients with PSC. The aim of this analysis was to prospectively identify biomarkers of pruritus in PSC. Method: Patients aged 18 and older, diagnosed with PSC and without a liver transplant were enrolled at 7 academic medical centers from July 2021 to March 2024. Itch numeric rating scale (NRS), 5-D Itch, PSC-PRO, and SF-36 were completed and serum collected at the time of enrollment. For the NRS, patients reported their average and worst itch (WI) in the past 24 hours, 7 days, and 6 months. Colitis activity was assessed in patients with inflammatory bowel disease (IBD) by the Simple Clinical Colitis Activity Index (P-SCCA). Total serum bile acids (TSBA), liver biochemistries, IL-31, and autotaxin were mea_sured. Spearman rank correlation, general linear models, and area under the receiver operator curve were used to examine the relationships between the WI in the past 7 days (WI-NRS) and serum biomarkers. Results: A total of 200 patients were enrolled (51% male; mean (SD) age of 44.6 (16.1) years; 71% White, 11% Black African American; 15% cirrhosis). Most patients (77%) had large duct PSC while 4% had small duct PSC and 2% had PSC-AIH. IBD was present in 70% (50% ulcerative colitis 17% Crohn’s disease 3% indeterminate). WI-NRS was reported as moderate or severe (WI-NRS 4–7 or 8–10, respectively) by 48 (24%). Alkaline phosphatase (ALP) (r = 0.26), GGT (r = 0.18), ALT (r = 0.15), AST (r = 0.20), total (r = 0.25) and direct bilirubin (r = 0.26), albumin (r = −0.18), total serum bile acids (r = 0.21), autotaxin (r = 0.28), and IL-31 (r = 0.40) all correlated with WI-NRS (all p-values \u3c0.05). Among patients with IBD, P-SCCA also correlated with WI_NRS (r = 0.41, p \u3c 0.0001). General linear modeling demonstrated that log AST (b = −3.2), log direct bilirubin (b = 1.4), log autotaxin (b = 1.9), and IL-31 (b = 0.6) independently associated with WI-NRS (all p_values \u3c0.05). Among patients with IBD, log autotaxin (b = 4.0, p = 0.0006) and P-SCCA (b = 1.5, P = 0.002), but not IL-31 (b = 0.5, p = 0.15) remained independently associated with WI-NRS. The area under the receiver-operator curve (AUROC) for WI-NRS \u3c4 vs ≥ 4 was 0.68 (0.57– 0.78) for autotaxin and 0.67 (0.56–0.79) for IL-31. Combining autotaxin and IL-31 did not improve the AUROC [0.70 (0.60–0.80)]. Conclusion: Both autotaxin and IL-31 independently associated with pruritus severity in patients with PSC. However, only autotaxin remained an independent predictor of pruritus severity after adjusting for colitis activity in patients with concomitant IBD. This study was supported by GSK (214524
IM-PROVE I: Rapid loss followed by transient increases in HBV RNA in chronic hepatitis B subjects during treatment with imdusiran and pegylated interferon alfa-2a is associated with HBsAg seroclearance
No full textBackground and aims: Functional cure (FC) of chronic hepatitis B (CHB) requires suppression of viral replication, reduction of HBV antigens and induction of anti-HBV immune responses. Imdusiran (IDR) is a N-Acetylgalactosamine–conjugated, pan-genotypic small interfering RNA therapeutic that blocks all HBV RNA transcripts, including HBV X protein, resulting in suppression of viral replication and all viral antigens. IM-PROVE I is an ongoing Phase 2a study assessing 24 weeks (W) of IDR lead-in followed by 12W or 24W of pegylated interferon alfa-2a (IFN) with or without additional IDR doses in 43 nucleos(t)ide analogue (NA) treated CHB subjects. Exploratory HBV biomarker profiles of subjects who achieved FC are compared to subjects who did not achieve FC but who had HBV DN