Varian ethos online adaptive radiotherapy for prostate cancer: Early results of contouring accuracy, treatment plan quality, and treatment time.

The Varian Ethos system allows for online adaptive treatments through the utilization of artificial intelligence (AI) and deformable image registration which automates large parts of the anatomical contouring and plan optimization process. In this study, treatments of intact prostate and prostate bed, with and without nodes, were simulated for 182 online adaptive fractions, and then a further 184 clinical fractions were delivered on the Ethos system. Frequency and magnitude of contour edits were recorded, as well as a range of plan quality metrics. From the fractions analyzed, 11% of AI generated contours, known as influencer contours, required no change, and 81% required minor edits in any given fraction. The frequency of target and noninfluencer organs at risk (OAR) contour editing varied substantially between different targets and noninfluencer OARs, although across all targets 72% of cases required no edits. The adaptive plan was the preference in 95% of fractions. The adaptive plan met more goals than the scheduled plan in 78% of fractions, while in 15% of fractions the number of goals met was the same. The online adaptive recontouring and replanning process was carried out in 19 min on average. Significant improvements in dosimetry are possible with the Ethos online adaptive system in prostate radiotherapy.

Incidence of fever in labor and risk of neonatal sepsis.

BACKGROUND: The current recommendation regarding the management of a term newborn delivered of a mother with an intrapartum fever or a diagnosis of clinical chorioamnionitis is that the neonate should have baseline laboratory work drawn along with blood cultures and be universally treated with antibiotics until culture results return. These guidelines report that the rate of intrapartum fever is about 3%; however, a few large studies suggest that the rate is higher at about 7%. OBJECTIVE: We sought to prospectively evaluate the rate of fever during labor in a large number of deliveries and determine the rate of early-onset neonatal sepsis in newborns delivered from mothers with an intrapartum fever compared with newborns delivered from mothers without intrapartum fever. STUDY DESIGN: This was a prospective cohort study of all temperatures obtained in women in labor from Jan. 1, 2011, through June 30, 2014. Every patient with a fever of ≥38°C at ≥36 weeks' gestation was evaluated for gestational age, parity, spontaneous or induced labor, group B streptococcus status, regional anesthesia, mode of delivery, treatment with intrapartum antibiotics, and whether a clinical diagnosis of chorioamnionitis was made by the managing physician. Neonates were assessed for blood culture results, neonatal intensive care unit admission, length of stay, and any major newborn complications. Statistical analysis involved χ2, Fisher exact, and Student t test. RESULTS: A total of 412 patients (6.8%; 95% confidence interval, 6.2-7.5%) developed a fever in 6057 deliveries at ≥36 weeks' gestation. No cases of maternal sepsis occurred. Of the 417 newborns (5 sets of twins), only 1 (0.24%; 95% confidence interval, 0.01-1.3%) developed early-onset neonatal sepsis with a positive blood culture for Escherichia coli. There were 4 cases (0.07%; 95% confidence interval, 0.02-0.18%) of early-onset neonatal sepsis in the 5697 newborns (52 sets of twins) delivered from mothers who were not febrile and this difference was not significant (P = .3). The positive blood cultures in these 4 neonates were 3 group B streptococcus and 1 Enterococcus. The overall rate of early-onset neonatal sepsis in this population of newborns delivered at ≥36 weeks' gestation was 0.82/1000 deliveries. CONCLUSION: The incidence of an intrapartum fever of ≥38°C in pregnancies at ≥36 weeks' gestation is common at 6.8% and this is consistent with the findings of a few other large retrospective studies. The rate of an intrapartum fever occurs in approximately 1 in 15 women in labor. The risk of neonatal sepsis in newborns delivered of mothers with intrapartum fever or a diagnosis of clinical chorioamnionitis is low at 0.24%, a rate that is <1 in 400. The recommendation for universal laboratory work, cultures, and antibiotic treatment pending culture results for this newborn population needs further examination.

Comparison of Buffered, Acidified Plate Antigen to Standard Serologic Tests for the Detection of Serum Antibodies to Brucella abortus in Elk (Cervus canadensis).

Brucellosis (caused by the bacterium Brucella abortus) is a zoonotic disease endemic in wild elk (Cervus canadensis) of the Greater Yellowstone Ecosystem, US. Because livestock and humans working with elk or livestock are at risk, validated tests to detect the B. abortus antibody in elk are needed. Using the κ-statistic, we evaluated the buffered, acidified plate antigen (BAPA) assay for agreement with the results of the four serologic tests (card test [card], complement fixation test [CF], rivanol precipitation plate agglutination test [RIV], standard plate agglutination test [SPT]) that are approved by the US Department of Agriculture for the detection of the B. abortus antibody in elk. From 2006 to 2010, serum samples collected from elk within B. abortus-endemic areas (n = 604) and nonendemic areas (n = 707) and from elk culture-positive for B. abortus (n = 36) were split and blind tested by four elk serum diagnostic laboratories. κ-Values showed a high degree of agreement for the card (0.876), RIV (0.84), and CF (0.774) test pairings and moderate agreement for the SPT (0.578). Sensitivities for the BAPA, card, RIV, CF, and SPT were 0.859, 0.839, 0.899, 1.00, and 0.813, whereas specificities were 0.986, 0.993, 0.986, 0.98, and 0.968, respectively. The positive predictive values and the negative predictive values were calculated for 2.6%, 8.8%, and 16.2% prevalence levels. These findings suggest the BAPA test is a suitable screening test for the B. abortus antibodies in elk.

Responses of equine tendon- and bone marrow-derived cells to monolayer expansion with fibroblast growth factor-2 and sequential culture with pulverized tendon and insulin-like growth factor-I.

OBJECTIVE: To compare in vitro expansion of equine tendon- and bone marrow-derived cells with fibroblast growth factor-2 (FGF-2) supplementation and sequential matrix synthesis with pulverized tendon and insulin-like growth factor-I (IGF-I). SAMPLE: Cells from 6 young adult horses. PROCEDURES: Progenitor cells were expanded in monolayers with FGF-2, followed by culture with autogenous acellular pulverized tendon and IGF-I for 7 days. Initial cell isolation and subsequent monolayer proliferation were assessed. In pulverized tendon cultures, cell viability and expression of collagen types I and III and cartilage oligomeric matrix protein (COMP) mRNAs were assessed. Collagen and glycosaminoglycan syntheses were quantified over a 24-hour period. RESULTS: Monolayer expansion with FGF-2 significantly increased the mean ± SE number of tendon-derived cells (15.3 ± 2.6 × 10(6)), compared with bone marrow-derived cells (5.8 ± 1.8 × 10(6)). Overall, increases in collagen type III and COMP mRNAs were seen in tendon-derived cells, compared with results for bone marrow-derived cells. After IGF-I supplementation, increases in collagen type I and type III mRNA expression were seen in bone marrow-derived cells, compared with results for unsupplemented control cells. Insulin-like growth factor-I significantly increased collagen synthesis of bone marrow-derived cells. Monolayer expansion with FGF-2 followed by IGF-I supplementation significantly increased glycosaminoglycan synthesis in tendon-derived cells. CONCLUSIONS AND CLINICAL RELEVANCE: Tendon-derived cells had increased cell numbers and matrix synthesis after monolayer expansion with FGF-2, compared with results for bone marrow-derived cells. In vivo experiments with FGF-2-expanded tendon-derived cells are warranted to evaluate effects on tendon healing.

Comparison of equine tendon-, muscle-, and bone marrow-derived cells cultured on tendon matrix.

OBJECTIVE: To compare viability and biosynthetic capacities of cells isolated from equine tendon, muscle, and bone marrow grown on autogenous tendon matrix. SAMPLE POPULATION: Cells from 4 young adult horses. PROCEDURES: Cells were isolated, expanded, and cultured on autogenous cell-free tendon matrix for 7 days. Samples were analyzed for cell viability, proteoglycan synthesis, collagen synthesis, and mRNA expression of collagen type I, collagen type III, and cartilage oligomeric matrix protein (COMP). RESULTS: Tendon- and muscle-derived cells required less time to reach confluence (approx 2 weeks) than did bone marrow-derived cells (approx 3 to 4 weeks); there were fewer bone marrow-derived cells at confluence than the other 2 cell types. More tendon- and muscle-derived cells were attached to matrices after 7 days than were bone marrow-derived cells. Collagen and proteoglycan synthesis by tendon- and muscle-derived cells was significantly greater than synthesis by bone marrow-derived cells. On a per-cell basis, tendon-derived cells had more collagen synthesis, although this was not significant. Collagen type I mRNA expression was similar among groups. Tendon-derived cells expressed the highest amounts of collagen type III and COMP mRNAs, although the difference for COMP was not significant. CONCLUSIONS AND CLINICAL RELEVANCE: Tendon- and muscle-derived cells yielded greater cell culture numbers in shorter time and, on a per-cell basis, had comparable biosynthetic assays to bone marrow-derived cells. More in vitro experiments with higher numbers may determine whether tendon-derived cells are a useful resource for tendon healing.

Effects of sodium hyaluronate and methylprednisolone acetate on proteoglycan metabolism in equine articular chondrocytes treated with interleukin-1.

OBJECTIVE: To determine the effects of sodium hyaluronate (HA) in combination with methylprednisolone acetate (MPA) on interleukin-1 (IL-1)-induced inflammation in equine articular cartilage pellets. SAMPLE POPULATION: Chondrocytes collected from 7 horses euthanatized for problems unrelated to the musculoskeletal system. PROCEDURES: Chondrocyte pellets were treated with medium (negative control); medium containing IL-1 (positive control); or medium containing IL-1 with MPA only (0.05 or 0.5 mg/mL), HA only (0.2 or 2 mg/mL), or MPA (0.05 or 0.5 mg/mL) and HA (0.2 or 2 mg/mL) in combination. Proteoglycan (PG) synthesis was determined by incorporation of sulfur 35-labeled sodium sulfate into PGs. Glycosaminoglycan (GAG) content of the media and the pellets and total pellet DNA content were determined. RESULTS: Methylprednisolone acetate at 0.5 mg/mL caused an increase in PG synthesis, whereas HA had no effect alone. The combination of MPA, both 0.05 mg/mL and 0.5 mg/mL, with HA at 2 mg/mL increased PG synthesis, compared with IL-1-treated control. All treatment groups containing the high concentration of MPA (0.5 mg/mL) and the high concentration of HA (2.0 mg/mL) had pellets with increased GAG content. The addition of HA caused an increase in total GAG content in the media, regardless of MPA treatment. Cyclooxygenase-2 mRNA and aggrecan mRNA expression was significantly reduced with MPA treatment. Total pellet DNA content was unchanged by any treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Our results indicate that MPA in combination with HA has beneficial effects on PG metabolism of IL-1-treated equine chondrocytes.

Nonconscious idea generation.

The recognition of the correct solution to a problem after a period when one is not actively searching for an answer is well documented. However, previous research has focused on problems an individual has not yet resolved. We presented a scenario in which 125 participants believed that they had completed a task and so had no reason to seek further solutions. To their surprise, after a period of distraction, we resumed the testing session. This novel method was combined with accurate recording of both response content and timing. The results from the second session a remarkable similarity n initial burst to those from the first, including a ideas, allowing the inference that, even in the absence of a reason to seek solutions, a process of nonconscious idea generation might be operating.