| 1. |
- Sahin, O, et al.
(author)
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International Multi-Specialty Expert Physician Preoperative Identification of Extranodal Extension n Oropharyngeal Cancer Patients using Computed Tomography: Prospective Blinded Human Inter-Observer Performance Evaluation
- 2024
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In: medRxiv : the preprint server for health sciences. - : Cold Spring Harbor Laboratory.
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Journal article (peer-reviewed)abstract
- BackgroundExtranodal extension (ENE) is an important adverse prognostic factor in oropharyngeal cancer (OPC) and is often employed in therapeutic decision making. Clinician-based determination of ENE from radiological imaging is a difficult task with high inter-observer variability. However, the role of clinical specialty on the determination of ENE has been unexplored.MethodsPre-therapy computed tomography (CT) images for 24 human papillomavirus-positive (HPV+) OPC patients were selected for the analysis; 6 scans were randomly chosen to be duplicated, resulting in a total of 30 scans of which 21 had pathologically-confirmed ENE. 34 expert clinician annotators, comprised of 11 radiologists, 12 surgeons, and 11 radiation oncologists separately evaluated the 30 CT scans for ENE and noted the presence or absence of specific radiographic criteria and confidence in their prediction. Discriminative performance was measured using accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and Brier score for each physician. Statistical comparisons of discriminative performance were calculated using Mann Whitney U tests. Significant radiographic factors in correct discrimination of ENE status were determined through a logistic regression analysis. Interobserver agreement was measured using Fleiss’ kappa.ResultsThe median accuracy for ENE discrimination across all specialties was 0.57. There were significant differences between radiologists and surgeons for Brier score (0.33 vs. 0.26), radiation oncologists and surgeons for sensitivity (0.48 vs. 0.69), and radiation oncologists and radiologists/surgeons for specificity (0.89 vs. 0.56). There were no significant differences between specialties for accuracy or AUC. Indistinct capsular contour, nodal necrosis, and nodal matting were significant factors in regression analysis. Fleiss’ kappa was less than 0.6 for all the radiographic criteria, regardless of specialty.ConclusionsDetection of ENE in HPV+OPC patients on CT imaging remains a difficult task with high variability, regardless of clinician specialty. Although some differences do exist between the specialists, they are often minimal. Further research in automated analysis of ENE from radiographic images is likely needed.
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| 2. |
- Agudo, I., et al.
(author)
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Panning for gold, but finding helium: Discovery of the ultra-stripped supernova SN 2019wxt from gravitational-wave follow-up observations
- 2023
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In: Astronomy and Astrophysics. - 0004-6361 .- 1432-0746. ; 675
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Journal article (peer-reviewed)abstract
- We present the results from multi-wavelength observations of a transient discovered during an intensive follow-up campaign of S191213g, a gravitational wave (GW) event reported by the LIGO-Virgo Collaboration as a possible binary neutron star merger in a low latency search. This search yielded SN 2019wxt, a young transient in a galaxy whose sky position (in the 80% GW contour) and distance (∼150 Mpc) were plausibly compatible with the localisation uncertainty of the GW event. Initially, the transienta's tightly constrained age, its relatively faint peak magnitude (Mi ∼ -16.7 mag), and the r-band decline rate of ∼1 mag per 5 days appeared suggestive of a compact binary merger. However, SN 2019wxt spectroscopically resembled a type Ib supernova, and analysis of the optical-near-infrared evolution rapidly led to the conclusion that while it could not be associated with S191213g, it nevertheless represented an extreme outcome of stellar evolution. By modelling the light curve, we estimated an ejecta mass of only ∼0.1 M·, with 56Ni comprising ∼20% of this. We were broadly able to reproduce its spectral evolution with a composition dominated by helium and oxygen, with trace amounts of calcium. We considered various progenitor channels that could give rise to the observed properties of SN 2019wxt and concluded that an ultra-stripped origin in a binary system is the most likely explanation. Disentangling genuine electromagnetic counterparts to GW events from transients such as SN 2019wxt soon after discovery is challenging: in a bid to characterise this level of contamination, we estimated the rate of events with a volumetric rate density comparable to that of SN 2019wxt and found that around one such event per week can occur within the typical GW localisation area of O4 alerts out to a luminosity distance of 500 Mpc, beyond which it would become fainter than the typical depth of current electromagnetic follow-up campaigns.
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| 3. |
- Lundin, Samuel B, 1970, et al.
(author)
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A novel precision-serology assay for SARS-CoV-2 infection based on linear B-cell epitopes of Spike protein
- 2023
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In: Frontiers in Immunology. - 1664-3224. ; 14
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Journal article (peer-reviewed)abstract
- IntroductionThe COVID-19 pandemic illustrates the need for serology diagnostics with improved accuracy. While conventional serology based on recognition of entire proteins or subunits thereof has made significant contribution to the antibody assessment space, it often suffers from sub-optimal specificity. Epitope-based, high-precision, serology assays hold potential to capture the high specificity and diversity of the immune system, hence circumventing the cross-reactivity with closely related microbial antigens. MethodsWe herein report mapping of linear IgG and IgA antibody epitopes of the SARS-CoV-2 Spike (S) protein in samples from SARS-CoV-2 exposed individuals along with certified SARS-CoV-2 verification plasma samples using peptide arrays. ResultsWe identified 21 distinct linear epitopes. Importantly, we showed that pre-pandemic serum samples contain IgG antibodies reacting to the majority of protein S epitopes, most likely as a result of prior infection with seasonal coronaviruses. Only 4 of the identified SARS-CoV-2 protein S linear epitopes were specific for SARS-CoV-2 infection. These epitopes are located at positions 278-298 and 550-586, just proximal and distal to the RBD, as well as at position 1134-1156 in the HR2 subdomain and at 1248-1271 in the C-terminal subdomain of protein S. To substantiate the applicability of our findings, we tested three of the high-accuracy protein S epitopes in a Luminex assay, using a certified validation plasma sample set from SARS-CoV-2 infected individuals. The Luminex results were well aligned with the peptide array results, and correlated very well with in-house and commercial immune assays for RBD, S1 and S1/S2 domains of protein S. ConclusionWe present a comprehensive mapping of linear B-cell epitopes of SARS-CoV-2 protein S, that identifies peptides suitable for a precision serology assay devoid of cross-reactivity. These results have implications for development of highly specific serology test for exposure to SARS-CoV-2 and other members of the coronaviridae family, as well as for rapid development of serology tests for future emerging pandemic threats.
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| 4. |
- Ye, Z, et al.
(author)
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Fully-automated sarcopenia assessment in head and neck cancer: development and external validation of a deep learning pipeline
- 2023
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In: medRxiv : the preprint server for health sciences. - : Cold Spring Harbor Laboratory.
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Journal article (other academic/artistic)abstract
- PurposeSarcopenia is an established prognostic factor in patients diagnosed with head and neck squamous cell carcinoma (HNSCC). The quantification of sarcopenia assessed by imaging is typically achieved through the skeletal muscle index (SMI), which can be derived from cervical neck skeletal muscle (SM) segmentation and cross-sectional area. However, manual SM segmentation is labor-intensive, prone to inter-observer variability, and impractical for large-scale clinical use. To overcome this challenge, we have developed and externally validated a fully-automated image-based deep learning (DL) platform for cervical vertebral SM segmentation and SMI calculation, and evaluated the relevance of this with survival and toxicity outcomes.Materials and Methods899 patients diagnosed as having HNSCC with CT scans from multiple institutes were included, with 335 cases utilized for training, 96 for validation, 48 for internal testing and 393 for external testing. Ground truth single-slice segmentations of SM at the C3 vertebra level were manually generated by experienced radiation oncologists. To develop an efficient method of segmenting the SM, a multi-stage DL pipeline was implemented, consisting of a 2D convolutional neural network (CNN) to select the middle slice of C3 section and a 2D U-Net to segment SM areas. The model performance was evaluated using the Dice Similarity Coefficient (DSC) as the primary metric for the internal test set, and for the external test set the quality of automated segmentation was assessed manually by two experienced radiation oncologists. The L3 skeletal muscle area (SMA) and SMI were then calculated from the C3 cross sectional area (CSA) of the auto-segmented SM. Finally, established SMI cut-offs were used to perform further analyses to assess the correlation with survival and toxicity endpoints in the external institution with univariable and multivariable Cox regression.ResultsDSCs for validation set (n = 96) and internal test set (n = 48) were 0.90 (95% CI: 0.90 – 0.91) and 0.90 (95% CI: 0.89 - 0.91), respectively. The predicted CSA is highly correlated with the ground-truth CSA in both validation (r = 0.99,p< 0.0001) and test sets (r = 0.96,p< 0.0001). In the external test set (n = 377), 96.2% of the SM segmentations were deemed acceptable by consensus expert review. Predicted SMA and SMI values were highly correlated with the ground-truth values, with Pearson r β 0.99 (p < 0.0001) for both the female and male patients in all datasets. Sarcopenia was associated with worse OS (HR 2.05 [95% CI 1.04 - 4.04], p = 0.04) and longer PEG tube duration (median 162 days vs. 134 days, HR 1.51 [95% CI 1.12 - 2.08], p = 0.006 in multivariate analysis.ConclusionWe developed and externally validated a fully-automated platform that strongly correlates with imaging-assessed sarcopenia in patients with H&N cancer that correlates with survival and toxicity outcomes. This study constitutes a significant stride towards the integration of sarcopenia assessment into decision-making for individuals diagnosed with HNSCC.SUMMARY STATEMENTIn this study, we developed and externally validated a deep learning model to investigate the impact of sarcopenia, defined as the loss of skeletal muscle mass, on patients with head and neck squamous cell carcinoma (HNSCC) undergoing radiotherapy. We demonstrated an efficient, fullyautomated deep learning pipeline that can accurately segment C3 skeletal muscle area, calculate cross-sectional area, and derive a skeletal muscle index to diagnose sarcopenia from a standard of care CT scan. In multi-institutional data, we found that pre-treatment sarcopenia was associated with significantly reduced overall survival and an increased risk of adverse events. Given the increased vulnerability of patients with HNSCC, the assessment of sarcopenia prior to radiotherapy may aid in informed treatment decision-making and serve as a predictive marker for the necessity of early supportive measures.
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| 5. |
- Bustamante-Jaramillo, Luisa F., et al.
(author)
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Imaging of Hepatitis B Virus Nucleic Acids: Current Advances and Challenges
- 2022
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In: Viruses-Basel. - : MDPI AG. - 1999-4915. ; 14:3
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Journal article (peer-reviewed)abstract
- Hepatitis B virus infections are the main reason for hepatocellular carcinoma development. Current treatment reduces the viral load but rarely leads to virus elimination. Despite its medical importance, little is known about infection dynamics on the cellular level not at least due to technical obstacles. Regardless of infections leading to extreme viral loads, which may reach 10(10) virions per mL serum, hepatitis B viruses are of low abundance and productivity in individual cells. Imaging of the infections in cells is thus a particular challenge especially for cccDNA that exists only in a few copies. The review describes the significance of microscopical approaches on genome and transcript detection for understanding hepatitis B virus infections, implications for understanding treatment outcomes, and recent microscopical approaches, which have not been applied in HBV research.
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| 6. |
- Ho, Anna Y. Q., et al.
(author)
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Cosmological Fast Optical Transients with the Zwicky Transient Facility : A Search for Dirty Fireballs
- 2022
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In: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 938:1
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Journal article (peer-reviewed)abstract
- Dirty fireballs are a hypothesized class of relativistic massive-star explosions with an initial Lorentz factor Γinit below the Γinit ∼ 100 required to produce a long-duration gamma-ray burst (LGRB), but which could still produce optical emission resembling LGRB afterglows. Here we present the results of a search for on-axis optical afterglows using the Zwicky Transient Facility (ZTF). Our search yielded seven optical transients that resemble on-axis LGRB afterglows in terms of their red colors (g − r > 0 mag), faint host galaxies (r > 23 mag), rapid fading (dr/dt > 1 mag day−1), and in some cases X-ray and radio emission. Spectroscopy of the transient emission within a few days of discovery established cosmological distances (redshift z = 0.876 to 2.9) for six of the seven events, tripling the number of afterglows with redshift measurements discovered by optical surveys without a γ-ray trigger. A likely associated LGRB (GRB 200524A, GRB 210204A, GRB 210212B, and GRB 210610B) was identified for four events (ZTF 20abbiixp/AT 2020kym, ZTF 21aagwbjr/AT 2021buv, ZTF 21aakruew/AT 2021cwd, and ZTF 21abfmpwn/AT 2021qbd) post facto, while three (ZTF 20aajnksq/AT 2020blt, ZTF 21aaeyldq/AT 2021any, and ZTF 21aayokph/AT 2021lfa) had no detected LGRB counterpart. The simplest explanation for the three "orphan" events is that they were regular LGRBs missed by high-energy satellites owing to detector sensitivity and duty cycle, although it is possible that they were intrinsically subluminous in γ-rays or viewed slightly off-axis. We rule out a scenario in which dirty fireballs have a similar energy per solid angle to LGRBs and are an order of magnitude more common. In addition, we set the first direct constraint on the ratio of the opening angles of the material producing γ-rays and the material producing early optical afterglow emission, finding that they must be comparable.
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| 7. |
- Manry, Jérémy, et al.
(author)
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The risk of COVID-19 death is much greater and age dependent with type I IFN autoantibodies.
- 2022
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In: Proceedings of the National Academy of Sciences of the United States of America. - : Proceedings of the National Academy of Sciences. - 1091-6490. ; 119:21
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Journal article (peer-reviewed)abstract
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection fatality rate (IFR) doubles with every 5 y of age from childhood onward. Circulating autoantibodies neutralizing IFN-α, IFN-ω, and/or IFN-β are found in ∼20% of deceased patients across age groups, and in ∼1% of individuals aged <70 y and in >4% of those >70 y old in the general population. With a sample of 1,261 unvaccinated deceased patients and 34,159 individuals of the general population sampled before the pandemic, we estimated both IFR and relative risk of death (RRD) across age groups for individuals carrying autoantibodies neutralizing type I IFNs, relative to noncarriers. The RRD associated with any combination of autoantibodies was higher in subjects under 70 y old. For autoantibodies neutralizing IFN-α2 or IFN-ω, the RRDs were 17.0 (95% CI: 11.7 to 24.7) and 5.8 (4.5 to 7.4) for individuals <70 y and ≥70 y old, respectively, whereas, for autoantibodies neutralizing both molecules, the RRDs were 188.3 (44.8 to 774.4) and 7.2 (5.0 to 10.3), respectively. In contrast, IFRs increased with age, ranging from 0.17% (0.12 to 0.31) for individuals <40 y old to 26.7% (20.3 to 35.2) for those ≥80 y old for autoantibodies neutralizing IFN-α2 or IFN-ω, and from 0.84% (0.31 to 8.28) to 40.5% (27.82 to 61.20) for autoantibodies neutralizing both. Autoantibodies against type I IFNs increase IFRs, and are associated with high RRDs, especially when neutralizing both IFN-α2 and IFN-ω. Remarkably, IFRs increase with age, whereas RRDs decrease with age. Autoimmunity to type I IFNs is a strong and common predictor of COVID-19 death.
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| 8. |
- Mattola, S., et al.
(author)
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Nuclear entry and egress of parvoviruses
- 2022
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In: Molecular Microbiology. - : Wiley. - 0950-382X .- 1365-2958. ; 118:4, s. 295-308
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Research review (peer-reviewed)abstract
- Parvoviruses are small non-enveloped single-stranded DNA viruses, which depend on host cell nuclear transcriptional and replication machinery. After endosomal exposure of nuclear localization sequence and a phospholipase A(2) domain on the capsid surface, and escape into the cytosol, parvovirus capsids enter the nucleus. Due to the small capsid diameter of 18-26 nm, intact capsids can potentially pass into the nucleus through nuclear pore complexes (NPCs). This might be facilitated by active nuclear import, but capsids may also follow an alternative entry pathway that includes activation of mitotic factors and local transient disruption of the nuclear envelope. The nuclear entry is followed by currently undefined events of viral genome uncoating. After genome release, viral replication compartments are initiated and infection proceeds. Parvoviral genomes replicate during cellular S phase followed by nuclear capsid assembly during virus-induced S/G2 cell cycle arrest. Nuclear egress of capsids occurs upon nuclear envelope degradation during apoptosis and cell lysis. An alternative pathway for nuclear export has been described using active transport through the NPC mediated by the chromosome region maintenance 1 protein, CRM1, which is enhanced by phosphorylation of the N-terminal domain of VP2. However, other alternative but not yet uncharacterized nuclear export pathways cannot be excluded.
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| 9. |
- Rossi, A., et al.
(author)
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A blast from the infant Universe : The very high-z GRB210905A
- 2022
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In: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 665
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Journal article (peer-reviewed)abstract
- We present a detailed follow-up of the very energetic GRB 210905A at a high redshift of z = 6.312 and its luminous X-ray and optical afterglow. Following the detection by Swift and Konus-Wind, we obtained a photometric and spectroscopic follow-up in the optical and near-infrared (NIR), covering both the prompt and afterglow emission from a few minutes up to 20 Ms after burst. With an isotropic gamma-ray energy release of Eiso = 1.27−0.19+0.20 × 1054 erg, GRB 210905A lies in the top ∼7% of gamma-ray bursts (GRBs) in the Konus-Wind catalogue in terms of energy released. Its afterglow is among the most luminous ever observed, and, in particular, it is one of the most luminous in the optical at t ≳ 0.5 d in the rest frame. The afterglow starts with a shallow evolution that can be explained by energy injection, and it is followed by a steeper decay, while the spectral energy distribution is in agreement with slow cooling in a constant-density environment within the standard fireball theory. A jet break at ∼46.2 ± 16.3 d (6.3 ± 2.2 d rest-frame) has been observed in the X-ray light curve; however, it is hidden in the H band due to a constant contribution from the host galaxy and potentially from a foreground intervening galaxy. In particular, the host galaxy is only the fourth GRB host at z > 6 known to date. By assuming a number density n = 1 cm−3 and an efficiency η = 0.2, we derived a half-opening angle of 8.4 ° ±1.0°, which is the highest ever measured for a z ≳ 6 burst, but within the range covered by closer events. The resulting collimation-corrected gamma-ray energy release of ≃1 × 1052 erg is also among the highest ever measured. The moderately large half-opening angle argues against recent claims of an inverse dependence of the half-opening angle on the redshift. The total jet energy is likely too large to be sustained by a standard magnetar, and it suggests that the central engine of this burst was a newly formed black hole. Despite the outstanding energetics and luminosity of both GRB 210905A and its afterglow, we demonstrate that they are consistent within 2σ with those of less distant bursts, indicating that the powering mechanisms and progenitors do not evolve significantly with redshift.
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| 10. |
- Rossi, A., et al.
(author)
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The Peculiar Short-duration GRB 200826A and Its Supernova
- 2022
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In: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 932:1
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Journal article (peer-reviewed)abstract
- Gamma-ray bursts (GRBs) are classified into long and short events. Long GRBs (LGRBs) are associated with the end states of very massive stars, while short GRBs (SGRBs) are linked to the merger of compact objects. GRB 200826A was a peculiar event, because by definition it was an SGRB, with a rest-frame duration of similar to 0.5 s. However, this event was energetic and soft, which is consistent with LGRBs. The relatively low redshift (z = 0.7486) motivated a comprehensive, multiwavelength follow-up campaign to characterize its host, search for a possible associated supernova (SN), and thus understand the origin of this burst. To this aim we obtained a combination of deep near-infrared (NIR) and optical imaging together with spectroscopy. Our analysis reveals an optical and NIR bump in the light curve whose luminosity and evolution are in agreement with several SNe associated to LGRBs. Analysis of the prompt GRB shows that this event follows the E-p,E-i-E-iso relation found for LGRBs. The host galaxy is a low-mass star-forming galaxy, typical of LGRBs, but with one of the highest star formation rates, especially with respect to its mass (log M-*/M-circle dot = 8.6, SFR similar to 4.0 M-circle dot yr(-1)). We conclude that GRB 200826A is a typical collapsar event in the low tail of the duration distribution of LGRBs. These findings support theoretical predictions that events produced by collapsars can be as short as 0.5 s in the host frame and further confirm that duration alone is not an efficient discriminator for the progenitor class of a GRB.
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