Cytokine Signaling in Pediatric Kidney Tumor Cell Lines WT-CLS1, WT-3ab and G-401.

Renal tumors comprise ~7% of all malignant pediatric tumors. Approximately 90% of pediatric kidney tumors comprise Wilms tumors, and the remaining 10% include clear cell sarcoma of the kidney, malignant rhabdoid tumor of the kidney, renal cell carcinoma and other rare renal tumors. Over the last 30 years, the role of cytokines and their receptors has been considerably investigated in both cancer progression and anti-cancer therapy.

A patent review of MAPK inhibitors (2018 - present).

Introduction: The mitogen-activated protein kinase (MAPK) family consist of p38 MAP kinases, c-Jun N-terminal kinases (JNKs) and extracellular signal-regulated kinases (ERKs). They are involved in a multitude of diseases, including inflammatory, autoimmune, neurodegenerative, and metabolic diseases as well as cancer. In recent years, further developments in the field of MAPK-inhibitors have been reported, including an isoform or downstream target selective inhibition of MAPKs as well as target protein degradation approaches.

The Contribution of Neighborhood Context to the Association of Race with Severe Maternal Morbidity.

Objective: Severe maternal morbidity (SMM) has disproportionate frequencies among racial minorities and those of socioeconomic disadvantage, with people of Black race consistently having the highest proportion. Neighborhood level deprivation has been associated with maternal morbidity and mortality, including adverse pregnancy outcomes. We sought to explore the relationship between neighborhood socioeconomic disadvantage and SMM and describe how neighborhood context impacts the relationship between race and SMM.

The Alexis Laparoscopic System as Minimally Invasive Surgical Technique in Operative Management of Huge Cystic Ovarian Tumors in Children and Young Adolescents: A Case Report.

Background: The use of the Alexis wound protector-retractor (AWPR) could further improve the laparoscopic techniques for safely removing huge ovarian tumors in children.

Case: A 15-year-old patient presented to our emergency department with a history of weeks of persistent abdominal pain. Clinical examination and magnetic resonance imaging demonstrated a 25 × 21 × 21 cm cystic mass arising from the left ovary.

Geometrical frustration of phase-separated domains in diatom frustules.

Diatoms are single-celled organisms with a cell wall made of silica, called the frustule. Even though their elaborate patterns have fascinated scientists for years, little is known about the biological and physical mechanisms underlying their organization. In this work, we take a top-down approach and examine the micrometer-scale organization of diatoms from the Coscinodiscus family.

Less Time Is Less Motion: Analysis of Practical Efficiencies Gained With a Modified Workflow Integrating Planar kV Midimaging With CBCT for Spine Stereotactic Body Radiation Therapy.

Purpose: Our purpose was to optimize an image guided radiation therapy (IGRT) workflow to achieve practical setup accuracy in spine stereotactic body radiation therapy (SBRT). We assessed the time-saving efficiencies gained from incorporating planar kV midimaging as a surrogate for cone beam computed tomography (CBCT) for intrafraction motion monitoring.

Methods And Materials: We selected 5 thoracic spine SBRT patients treated in 5 fractions and analyzed patient shifts captured by a modified IGRT workflow using planar kV midimaging integrated with CBCT to maintain a tolerance of 1 mm and 1°.

Robotically Assisted Surgery in Children-A Perspective.

The introduction of robotically assisted surgery was a milestone for minimally invasive surgery in the 21st century. Currently, there are two CE-approved robotically assisted surgery systems for use and development in pediatrics. Specifically, tremor filtration and optimal visualization are approaches which can have enormous benefits for procedures in small bodies.

Implementation of a universal postpartum blood pressure monitoring program: feasibility and outcomes.

Background: New-onset postpartum preeclampsia has a higher risk of maternal morbidity and mortality than preeclampsia with antepartum onset, underscoring the need for earlier identification of elevated blood pressure among patients with this condition. Given the decrease in healthcare engagement, which is typical of the postpartum period, new-onset postpartum hypertension often goes unrecognized. Currently, there are no recommendations for universal postpartum blood pressure surveillance in women without hypertensive disorders of pregnancy.

Comparative Analysis of Obstetric Hemorrhage Risk Prediction Tools.

Objective: Hemorrhage risk prediction tools were developed in response to rising rates of obstetric hemorrhage (OBH). The California Maternal Quality Care Collaborative (CMQCC) risk prediction tool classifies patients as low, medium, and high risk for OBH based on individual risk factors. At our institution, Magee-Womens Hospital (MWH), a unique OBH risk prediction tool was derived from the CMQCC tool that differs through its use of weighted risk factors and distinctive laboratory value cutoffs.

Correlation between hemorrhage risk prediction score and severe maternal morbidity.

Background: Obstetrical hemorrhage is a leading cause of severe maternal morbidity, a key indicator of a nation's healthcare delivery system and often associated with a high rate of preventability. Limited data suggest that a patient's hemorrhage risk score may be associated with risk for maternal morbidity such as severe hemorrhage, intensive care unit admission, or transfusion. Little is known regarding the relationship between hemorrhage risk score and nontransfusion-related morbidity.

Robotic surfaces with reversible, spatiotemporal control for shape morphing and object manipulation.

Continuous and controlled shape morphing is essential for soft machines to conform, grasp, and move while interacting safely with their surroundings. Shape morphing can be achieved with two-dimensional (2D) sheets that reconfigure into target 3D geometries, for example, using stimuli-responsive materials. However, most existing solutions lack the ability to reprogram their shape, face limitations on attainable geometries, or have insufficient mechanical stiffness to manipulate objects.

Development and Implementation of an Online Adaptive Stereotactic Body Radiation Therapy Workflow for Treatment of Intracardiac Metastasis.

Cardiac metastases pose clinical challenges for radiation oncologists given the need to balance the benefit of local therapy against the risks of cardiac toxicity in the setting of cardiac motion, respiratory motion, and nearby organs at risk. Stereotactic magnetic resonance-guided adaptive radiation therapy has recently become more commonly used, conferring benefits in tumor visualization for setup, real-time motion management monitoring, and enabling plan adaptation for daily changes in tumor and/or normal tissues. Given these benefits, we developed and implemented a workflow for local treatment of metastatic disease within the heart using stereotactic magnetic resonance-guided adaptive radiation therapy.

Use of a healthy volunteer imaging program to optimize clinical implementation of stereotactic MR-guided adaptive radiotherapy.

Purpose: MR-linacs (MRLs) have enabled the use of stereotactic magnetic resonance (MR) guided online adaptive radiotherapy (SMART) across many cancers. As data emerges to support SMART, uncertainty remains regarding optimal technical parameters, such as optimal patient positioning, immobilization, image quality, and contouring protocols. Prior to clinical implementation of SMART, we conducted a prospective study in healthy volunteers (HVs) to determine optimal technical parameters and to develop and practice a multidisciplinary SMART workflow.

Lessons Learned From a Gap Analysis of Obstetric Hemorrhage Protocols across a Health System.

Introduction: The United States has experienced a rising incidence of maternal deaths, including those attributable to obstetric hemorrhage (OBH). In response, the National Partnership for Maternal Safety developed a standardized OBH Consensus Bundle with the goal of universal adoption. In 2016 a large western Pennsylvania health system adopted the OBH Consensus Bundle across its 8 obstetrical units, with the goal to improve maternal outcomes.

Feasibility of hippocampal avoidance whole brain radiation in patients with hippocampal involvement: Data from a prospective study.

Purpose: Among patients with brain metastases, hippocampal avoidance whole brain radiation (HA-WBRT) preserves neurocognitive function relative to conventional WBRT but the feasibility of hippocampal sparing in patients with metastases in/near the hippocampus is unknown. We identified the incidence of hippocampal/perihippocampal metastases and evaluated the feasibility of HA-WBRT in such patients.

Materials/methods: Dosimetric data from 34 patients randomized to HA-WBRT (30 Gy/10 fractions) in a phase III trial (NCT03075072) comparing HA-WBRT to stereotactic radiation in patients with 5 to 20 brain metastases were analyzed.

Isolated echogenic intracardiac foci and the role of cell-free fetal DNA: A cost-effectiveness analysis.

Objectives: Cell-free fetal DNA (cfDNA) has been increasingly incorporated into prenatal aneuploidy screening paradigms given its relatively high sensitivity for Down syndrome (DS). This is often the case when fetal ultrasonographic soft markers are present, such as the relatively common echogenic intracardiac focus (EIF). We sought to evaluate the cost-effectiveness of a screening strategy that included cfDNA screening when an isolated EIF is identified in a low-risk population with prior aneuploidy screening.

Optimization of MLC parameters for TPS calculation and dosimetric verification: application to single isocenter radiosurgery of multiple brain lesions using VMAT.

Linac and MLC-based stereotactic radiosurgery (SRS) using single-isocenter-multiple-target (SIMT) VMAT has become increasingly popular in the management of multi-focal cranial metastases. However, significant geometrical and dosimetric challenges exist due to the typically small target volumes and in most cases, non-isocentric locations. To the best of our knowledge, there hasn't been a study in the optimization of MLC parameters, in the context of SIMT SRS, to ensure TPS calculation accuracy.

Ventricular Tachycardia: A Treatment Comparison Study of the CyberKnife with Conventional Linear Accelerators.

The work described here compared the available technical solutions for the treatment of ventricular tachycardia with stereotactic body radiation therapy. Due to the complexity of target motion during cardiac and pulmonary motion as well as the several proximate radio-sensitive structures of the tracheobronchial tree and esophagogastrointestinal tract, four potential candidates for this treatment were identified: Accuray CyberKnife (Accuray Incorporated, Sunnyvale, California, United States), Varian TrueBeam (Varian Medical Systems, Palo Alto, California, USA), Elekta Infinity (Elekta, Stockholm, Sweden), and Varian Edge (Varian Medical Systems, Palo Alto, California, USA). All four treatment modalities were evaluated for their ability to deliver a conformal, homogeneous dose to most of the target volume, to spare nearby and distant critical and sensitive anatomical structures as well as for treatment efficiency.

Nonsurgical Treatment of Chest Wall Deformities: Contradiction or Complement?

For decades, open surgical repair was the only available method to treat congenital and acquired chest wall deformities (CWDs). In 1998, D. Nuss described a minimally invasive procedure for surgical repair of pectus excavatum (PE), and a few years later H.

Two-argument total scatter factor for small fields simultaneously collimated by MLC and jaws: application to stereotactic radiosurgery and radiotherapy.

Direct use of the total scatter factor (S ) for independent monitor unit (MU) calculations can be a good alternative approach to the traditional separate treatment of head/collimator scatter (S ) and phantom scatter (S ), especially for stereotactic small fields under the simultaneous collimation of secondary jaws and tertiary multileaf collimators (MLC). We have carried out the measurement of S in water for field sizes down to 0.5  ×  0.

Clinical Outcomes After Lung Stereotactic Body Radiation Therapy in Patients With or Without a Prior Lung Resection.

Objectives: Tumor control (TC), toxicity and survival, following stereotactic body radiation therapy (SBRT) were compared between patients with and without a prior lung resection (PLR).

Materials And Methods: The study is comprised of 130 patients with 141 peripheral tumors treated with SBRT at our institution from 2009 to 2013. Primary TC and lobar control (LC) were defined per RTOG 0236.

Inter-scan and inter-observer tumour volume delineation variability on cone beam computed tomography in patients treated with stereotactic body radiation therapy for early-stage non-small cell lung cancer.

Introduction: Quantification of volume changes on cone beam computed tomography (CBCT) during lung stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC) may provide a useful radiological marker for radiation response and for adaptive treatment planning. This study quantifies inter-scan and inter-observer variability in tumour volume delineation on CBCT.

Methods: Three clinicians independently contoured the primary gross tumour volume (GTV) manually on CBCTs taken immediately before SBRT treatment (pre) and after the same SBRT treatment (post) for 19 NSCLC patients.

Dynamic Compression System: An Effective Nonoperative Treatment for Pectus Carinatum: A Single Center Experience in Basel, Switzerland.

 Several nonoperative treatments are currently available for the correction of pectus carinatum (PC).  The objective of this study is to report our single center experience with the dynamic compression system (DCS).  The DCS is a rigid aluminum brace.

Laparoscopy-Assisted Single-Port Appendectomy in Children: Safe Alternative also for Perforated Appendicitis?

Because of its low complication rate, favorable safety, cost-effectiveness, and technical ease, mono-instrumental, laparoscopy-assisted single-port appendectomy (SPA) has been the standard therapy for appendicitis in our department since its introduction 10 years ago. We report our experience with this technique and compare its outcome to open appendectomy (OA). The records of all children who underwent appendectomy at our institution over a period of 8 years were analyzed retrospectively.