• Book : ()
• Pub. Date : 2025
• Page : pp.1-18
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AbstractThis review discusses the evolving role of radiotherapy (RT) in the surgical treatment of pancreatic ductal adenocarcinoma (PDAC). Despite advancements in multidisciplinary treatment, PDAC continues to present significant challenges in surgical treatment strategies. Neoadjuvant therapy, in combination with chemotherapy and RT, aims to improve patient outcomes by reducing tumor size, controlling local spread, and eradicating micrometastatic disease that cannot be detected at the time of diagnosis. Recent randomized trials have shown that both neoadjuvant chemoradiotherapy (NACRT) and neoadjuvant chemotherapy (NAC) improve surgical outcomes compared with upfront surgery. A network meta‐analysis integrating multiple trials demonstrated that NACRT significantly improves overall survival compared to NAC (HR: 0.79, 95% CI: 0.64–0.98). NACRT has also shown advantage in local tumor control. For locally advanced PDAC, the role of RT in conversion therapy is being actively investigated. The integration of RT in treatment regimens requires careful consideration of its therapeutic benefits against potential adverse effects. Although experimental studies suggest potential immunological benefits of RT, clinical validation remains incomplete. Recent advances in radiation delivery techniques have improved the therapeutic ratio, although further clinical validation is needed. The optimal sequence and combination of these treatment modalities with surgical strategies continue to be evaluated in ongoing clinical trials. This review synthesizes evidence from recent clinical trials and previous studies to evaluate the effectiveness, challenges, and potential of RT in PDAC treatment, aiming to inform both current clinical practice and future research directions.

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• Pub. Date : 2025
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• Book : ()
• Pub. Date : 2025
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The supermassive black hole Sgr A* at the center of our galaxy produces repeating near-infrared flares that are observed by ground- and space-based instruments. This activity has been simulated in the past with magnetically arrested disk models that include stable jet formations. We used a different approach, considering a standard and normal evolution (SANE) multi-loop model that lacks a stable jet structure. The main objective of this research is to identify regions that contain current sheets and high magnetic turbulence, and to subsequently generate a 2.2 μm light curve from nonthermal particles. These aims required the identification of areas that contain current sheets and high magnetic turbulence, and the averaging of the magnetization in the regions surrounding these areas. Subsequently, particle-in-cell fitting formulas were applied to determine the nonthermal particle distribution and to obtain the sought-after light curve. Additionally, we investigated the properties of the flares, in particular their evolution during flare events, and the similarity of flare characteristics between the generated and observed light curves. We employed 2D general relativistic magnetohydrodynamic simulation data from a SANE multi-loop model and introduced thermal radiation to generate a 230 GHz light curve. Physical variables were calibrated to align with the 230 GHz observations. We identified current sheets by analyzing toroidal currents, magnetization, plasma β, density, and dimensionless temperatures. We studied the evolution of current sheets during flare events and calculated higher-energy nonthermal light curves, focusing on the 2.2 μm near-infrared range. We obtain promising $2.2 μ$m light curves whose flare duration and spectral index behavior align well with observations. Our findings support the association of flares with particle acceleration and nonthermal emission in current sheet plasmoid chains and at the boundary of the disk inside the funnel above and below the central black hole.

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• Pub. Date : 2025
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• Book : ()
• Pub. Date : 2025
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• Book : ()
• Pub. Date : 2025
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Abstract Risk perceptions of energy systems, and their evolution under climate change and after accidents, affects public acceptance of generation technologies. Despite this, little is understood about how such factors impact public perception at different time scales and the drivers for perception. We use state-of-the-art natural language processing to measure temporal changes in sentiment toward energy technologies using the full twitter archive for 2009–2022. We find that perception of natural gas and wind has changed little as discussion of climate change on social media increased. However, climate-linked sentiment toward coal, solar, and hydropower has become more negative, while that for nuclear has improved. We also find that all generation technologies experience a drop in supportive discourse after definable accidents, but this typically rebounds with a half-life of less than 3 days. Yet, nuclear power is an exception in how it reacts to large scale events. After Fukushima, sentiment returned to its positive pre-accident levels with an 11.3-month relaxation half-life.

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• Pub. Date : 2025
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Abstract Objective To report our initial experience using a simple principle that helps mini-endoscopic relocation of the guidewire into renal pelvis, ureter or upper calyx to improve percutaneous nephrolithotomy (PNL) puncture efficacy and enable safe dilatation. Methods A hydrophilic guidewire (sensor) was introduced through the access needle to calyx with a casting stone. 8 F Alken guide rod was passed over the guidewire followed by serial dilatation until the 4th Alken dilator (18F). Mini-perc outer sheath (18 F) was passed over under fluoroscopic guidance. A 8/11 Fr semirigid ureteroscope was progressed through the mini-perc sheath. A second sensor guidewire was passed, negotiated at the side of the stone to run through the infundibulum and renal pelvis down to the ureter or up to upper calyx under direct ureteroscopic vision. Routine tract dilatation by sequential rigid Alken metal dilators was done to enlarge the tract to 30 Fr. Results Our technique was employed on 14 (23%) out of 61 cases of PNL. Mean patient age was 47.5 yrs. Average stone size was 4.3 cm. Mean mini-endoscopic time taken to relocate the guidewire into the ureter or upper calyx was 63 s. Mini-endoscopic fluoroscopy time from introduction of ureteroscope to passage of sensor guidewire into ureter or upper calyx was 7.7 s. No mini-endoscopic access complication reported. Conclusion The mini-endoscopic access directs and facilitates initial percutaneous access and dilatation safely with reducing radiation exposure. Technique novelty is due to being a simple, safe, effective, economic and benefit in simplifying the early learning curve of PNL.

• Book : 31(1)
• Pub. Date : 2025
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• Book : 20(1)
• Pub. Date : 2025
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Abstract Purpose The new high resolution positron emission tomography (PET) myocardial perfusion imaging tracer, 18F-flurpiridaz, is set to enter clinical use soon following its recent regulatory approval. We developed an approach for evaluating subendocardial analysis for stress total perfusion deficit (TPD) and ischemic TPD, assessed its performance for detection of coronary artery disease (CAD) and compared these measures to transmural analysis and expert physician assessments. Methods Myocardial perfusion image data from the 18F-flurpiridaz phase III clinical trial (NCT01347710) were used. The subendocardial layer was automatically defined on the left ventricular contours and used for the derivation of polar maps. Areas under the receiver operating characteristic curve (AUC) for quantitative and visual measures were evaluated for detecting CAD, defined as ≥ 50% stenosis by invasive coronary angiography. Results In total, 753 cases were analyzed, with a median age of 63 (interquartile range 56,69) and 69% male. AUC for detecting ≥ 50% stenosis was higher for subendocardial than transmural analysis for stress (0.795 vs. 0.762, respectively; p = 0.013) and ischemic (0.795 vs. 0.767, respectively; p = 0.049) TPD. Subendocardial and transmural TPD achieved diagnostic performance greater than or comparable to that of the readers’ assessments in the total population as well as across subgroups of interest. Conclusion Subendocardial analysis of ischemic perfusion improves the detection of CAD compared to transmural quantitative analysis or expert visual reading. These measures can be derived automatically with minimal user interaction. Integrating TPD quantitative measures could standardize the diagnostic approach for this novel tracer.

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• Pub. Date : 2025
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