Our understanding of the impact of solar eclipse events on animal behaviors is mostly based on anecdotal reports, and rigorous scientific studies are scarce. On April 8, 2024, a significant portion of North America witnessed a rare total solar eclipse. This was a unique chance to study how animals in zoological institutions react to unpredictable and sudden environmental changes. Although based on a short-duration event (approximately 3 h in total and 1-4 min of total eclipse), such an event is an opportunity to carry out comparative studies on animal behavior and cognition. We compared the behavior and space use of animals during the eclipse to the same time period on days before and after the eclipse (baseline). While most species showed little response, Japanese macaques showed a significant and noticeable response by reducing their activity level and moving up higher on branches in their habitat. They returned to their normal behavior when the light intensity came back to normal. Zebras reacted with increased activity level and some signs of stress that lasted beyond totality. Incidentally, we found that the observers' subjective appraisal of behavioral responses does not fully match the data collected, emphasizing the importance of standardized protocols and training in animal behavior studies. As the zoo was closed to visitors during the observations, our study allows for a better understanding of animal behavioral reactions to total eclipse events, without the confusing effect of surrounding humans' reactions.
In organic molecules that exhibit conformational isomers-namely, a staggered and an eclipsed arrangement, as observed in compounds such as ethane or propane-the staggered conformation generally represents the equilibrium structure. This preference is commonly attributed to steric hindrance, Pauli repulsion or hyperconjugation. Surprisingly, in 2-butyne or dimethylacetylene the eclipsed form is lower in energy, but only by 0.017 kcal mol-1 or 5.98 cm-1. The present study shows that in this case neither 'Pauli repulsion' nor 'hyperconjugation' plays the decisive role, but the kinetic energy of the electrons. A rigid rotation around the linear C-CC-C axis from the eclipsed equilibrium structure to the staggered one increases the electronic kinetic energy by as much as 0.126 kcal mol-1, while the increase of the total energy is rather small. The rotationally symmetric ring of the π-orbitals around the acetylenic CC bond is modulated at three angles in the eclipsed conformer, but at six angles in the staggered one, and this causes the larger electronic kinetic energy. Of course, an increase of both the total energy and the electronic kinetic energy violates the virial theorem. This is then restored by a small increase of only 0.0008 Å in the C-C bond distances, which leads to an elongation and smoothing of the σ-orbitals at the C-CC-C axis and to a reduction of their kinetic energy. In addition to the explanation, why the energy of the eclipsed form of 2-butyne is lower than that of the staggered form, our calculations confirm the experimental observation that the rotation barrier in 2-butyne is very small, only about 6 cm-1.
We develop a deterministic mathematical model to quantify the distinct in vitro infection dynamics of Bunyamwera virus (BUNV) and Batai virus (BATV) in A549 cells, incorporating cell division and natural death, continued entry of virions into already-infected cells, and shortening of the eclipse phase driven by re-infection. The model parameters were estimated making use of viral decay data, growth curves at two different inoculum concentrations, and extra-cellular genome copy measurements (for BUNV) via Markov chain Monte Carlo. Genome copy measurements were essential for constraining estimates of the number of cells that can become infected per unit of infectious virus for BUNV. We found that BUNV exhibited substantially longer eclipse and infectious periods than BATV, while BATV showed a higher per-cell virus production rate. Re-infection was predicted to shorten the eclipse phase for both viruses, but the effect was markedly stronger for BUNV. Together, these results provide a quantitative comparison of the in vitro viral kinetics of BUNV and BATV and reveal substantial differences in their replication dynamics.
Preeclampsia (PE) is a leading cause of maternal and perinatal morbimortality, particularly in low- and middle-income countries. Despite advances in clinical management, its etiology and pathogenesis remain unclear, and effective predictive biomarkers are lacking. The Brazilian Longitudinal Study for the Investigation of Preeclampsia (ECLIPSE-BRAZIL) is a prospective cohort designed to investigate genetic, immunological, hemostatic, biochemical, and angiogenic profiles in pregnant women at risk for PE, aiming to identify biomarkers that effectively and affordably predict PE risk early in pregnancy. ECLIPSE-BRAZIL follows 500 to 1,000 pregnant women receiving care at the High-Risk Prenatal Care clinics in Belo Horizonte and Divinópolis, Minas Gerais, Brazil. Clinical and laboratory assessments are conducted at four gestational stages and postpartum for PE cases. Clinical data, including sociodemographic, clinical and behavioral factors, and blood and urine samples are systematically collected. Plasma and urine levels of inflammatory markers, angiogenic factors, oxidative stress parameters, extracellular vesicles, microRNAs, endothelial and platelet markers will be analyzed. Participants are stratified by PE development and gestational age at diagnosis. Standardized criteria and data protocols ensure rigor, while quality check and audits enhance data reliability. To minimize follow-up loss, participants are contacted frequently, with flexible sampling and the use of hospital records. ECLIPSE-BRAZIL will provide novel insights into PE pathophysiology, improving disease prediction and management. By studying a diverse population, we will identify biological signatures to inform health innovations: development of cost-effective diagnostic tools, point-of-care tests and simple clinical algorithms to identify women at risk before symptoms become severe. Finally, we will provide a deeper understanding of biological mechanisms driving PE and its subtypes, including endothelial function and immune response, which may lead to the discovery of new therapeutic targets. ECLIPSE-BRAZIL represents a major advancement in PE research, integrating a comprehensive evaluation of clinical, biochemical, and molecular markers throughout pregnancy. Its findings may inform public health policies and improve clinical practices worldwide. Not applicable. This is an observational cohort study approved by the Research Ethics Committees, as documented under the following CAAE numbers: 12471918.0.0000.5149, 12471918.0.3002.5119, 12471918.0.3003.5130, 12471918.0.3006.5545.
To provide a detailed and reproducible description of the development and clinical implementation of a RapidPlan knowledge‑based planning (KBP) model for lung stereotactic body radiotherapy (SBRT) in Eclipse v15.6, including training dataset composition, model analytics, objective template design, and prospective validation. A RapidPlan model was constructed using 161 coplanar VMAT SBRT plans calculated with Acuros XB (2.0 mm grid) and 6 MV FFF beams. Structure matching, outlier identification, and DVH prediction behavior were assessed using Varian Model Analytics report. A unified optimization template was assembled with explicit target priorities, a PTV gEUD objective, and gradient‑focused constraints addressing near‑target fall‑off and chest‑wall interfaces. The model was prospectively validated on 21 patients by comparing KBP plans with previously approved clinical plans. Model Analytics indicated stable DVH prediction bands after refinement; 4 plans were removed for atypical geometric or dosimetric behavior. The finalized template produced clinically acceptable plans for both peripheral and central tumors across the prescription range represented in the training set. In validation, most plans met target and OAR criteria on first optimization; where needed, minor adjustments (typically <10 minutes) resolved remaining issues. This technical note provides a complete, practical workflow for constructing a lung SBRT RapidPlan model in Eclipse v15.6. The reported training selection, analytics‑based refinement, and optimization template parameters enable other centers to reproduce or adapt the model for standardized SBRT planning without outcome comparisons.
Increasing commercial shipping in Eclipse Sound, Nunavut, has reshaped low-frequency ocean soundscapes, necessitating tools that quantify vessel noise contributions and mitigation potential. Here, we combine passive acoustic measurements from Eclipse Sound in 2023 with propagation modeling to derive monopole source levels (MSLs) from 289 unique transits, validate spatiotemporal noise model predictions, and map noise exposure across vessel transit case studies. Cargo vessels dominated encounters (n = 251; 63-Hz mean MSL = 157.8 dB re 1 μPa·m), while tankers had the highest MSLs (170.1 dB re 1 μPa·m at 63 Hz) despite a low sample size. Spatiotemporal underwater noise models (error < ±3 dB) were generated and validated for six transit scenarios: conventional and Det Norske Veritas (DNV) SILENT-E two-vessel convoys, conventional and SILENT-E single-vessel transits, and loaded and unloaded transits of the same vessel. Case studies contrasted conventional vs. DNV SILENT-E single transits and loaded vs. unloaded passages, revealing frequency-dependent noise impacts (10-20 dB excess at 63 Hz vs. 2-10 dB at 1,000 Hz). This enabled comparisons of quiet-design, loading optimization, and convoy routing scenarios relevant to Arctic underwater noise management amid rising shipping activity.
Eclipsed mitral regurgitation (MR) is a rare, paroxysmal entity with preserved left ventricular ejection fraction, marked by abrupt, severe, but reversible MR that is demonstrable only during episodes. We report the case of an 82-year-old woman with systemic sclerosis and persistent atrial fibrillation who had four admissions for acute heart failure within six months. Transthoracic echocardiography captured massive MR with leaflet malcoaptation, severe pulmonary hypertension, a dagger-shaped MR jet, and a blood pressure drop; between episodes, MR was mild and leaflet coaptation was normal, and provocation testing was negative. Recurrent events during hospitalization prompted urgent surgery. Mitral valve replacement with concomitant tricuspid annuloplasty prevented recurrence, and the postoperative course was uneventful until death from tuberculosis-related sepsis. Operative inspection showed minimal structural change of the mitral valve, and histopathology demonstrated preserved leaflet architecture with mild fibrosis and myxomatous change, indicating no significant intrinsic valvular damage. These findings indicate that eclipsed MR is a unique pathophysiological entity.
Prostate-specific membrane antigen radioligand therapy (PSMA-RLT) is approved for the treatment of metastatic castration-resistant prostate cancer (mCRPC). Following the phase 3 VISION clinical trial showing prolonged overall and progression-free survival after PSMA-RLT, 177Lu-PSMA-617 was initially introduced as a standard of care for patients with mCRPC with prior exposure to an androgen receptor pathway inhibitor (ARPI) and taxane chemotherapy. In recent years, three phase 3 clinical trials with published, presented, or announced results (PSMAfore, SPLASH, and ECLIPSE, respectively) have shown that PSMA-RLT delays progression-free survival when compared with a change in ARPI in patients with post-ARPI, chemotherapy-naive mCRPC. This mini-review summarizes the available results from these phase 3 trials and select randomized phase 2 trials and discusses their impact on mCRPC management and optimal sequencing of PSMA-RLT. PATIENT SUMMARY: PSMA-RLT is a targeted radioactive drug that prolongs the lives of patients living with advanced prostate cancer when given after chemotherapy. PSMA-RLT has also been shown to delay cancer progression in patients who have not received any chemotherapy, making it an emerging option for those who are not eligible for chemotherapy.
Intravascular large B-cell lymphoma (IVLBCL) is a rare extranodal neoplasm in which malignant B cells proliferate predominantly within small blood vessels. Because lymphadenopathy, mass lesions, circulating malignant cells, and specific radiological findings may be absent, IVLBCL can closely mimic other medical conditions, resulting in delayed diagnosis. This case is notable for a prolonged culture-negative sepsis-like presentation with persistent unexplained hypoxemia due to predominant pulmonary microvascular involvement, further obscured by lupus-like autoimmune features and subsequent COVID-19 infection. An older woman in her early 70s presented with fever, lethargy, weight loss, back pain, hypotension, raised inflammatory markers, cytopenia, markedly elevated lactate dehydrogenase (LDH), and progressive hypoxemia. She was initially treated for presumed sepsis, but repeated microbiological investigations and serial imaging did not identify an infectious source, and clinical improvement was not sustained. A transient malar rash and a positive antinuclear antibody raised concern for a lupus-like autoimmune disease; however, testing for anti-double-stranded DNA and extractable nuclear antigen was negative, and the broader autoimmune workup did not support systemic lupus erythematosus as the unifying diagnosis. Subsequent severe acute respiratory syndrome coronavirus 2 infection further complicated the interpretation of hypoxemia and deterioration. Despite antimicrobial therapy, corticosteroids, antiviral treatment, and supportive care, she developed progressive multiorgan failure and died approximately six weeks after admission. Postmortem examination revealed widespread multiorgan IVLBCL involving the lungs, heart, kidneys, liver, spleen, and multiple additional extranodal sites. Pulmonary capillary involvement provided a clinicopathological explanation for persistent unexplained hypoxemia. This case demonstrates how IVLBCL may remain concealed when several plausible diagnoses coexist. Persistent culture-negative fever, constitutional decline, cytopenia, high LDH, nondiagnostic imaging, treatment nonresponse, and unexplained hypoxemia should prompt consideration of IVLBCL and early tissue-based investigation.
Isolated renal tuberculosis (RTB) is a rare extrapulmonary manifestation of tuberculosis that often mimics common urinary tract infections, resulting in delayed diagnosis and complications. We report an exceptionally rare case of isolated RTB presenting with a spectrum of destructive sequelae-including a perinephric abscess with a nephrocutaneous fistula, renal replacement lipomatosis (RRL), and synchronous clear cell renal cell carcinoma (RCC) within a single kidney. We report the case of a 77-year-old diabetic man who presented with left loin pain and chronic lumbar sinus discharge. Multiphase computed tomography (CT) revealed an enlarged, distorted kidney with extensive sinus and perinephric fat proliferation consistent with RRL; a hyperenhancing superior-pole mass suggestive of RCC; calyceal distortion and infundibular stenosis suspicious for RTB; and a perinephric abscess with a cutaneous fistula. Radical nephrectomy was performed, and histopathological examination confirmed renal tuberculosis and its associated complications. Subsequent antitubercular therapy (ATT) resulted in stable clinical and functional outcomes. To the best of our knowledge, this is the first reported case demonstrating this constellation of infectious-inflammatory-neoplastic pathologies within a single kidney. This case highlights the indolent yet destructive nature of isolated RTB and emphasizes the role of early imaging and histopathology for timely diagnosis, prevention of serious complications, and an improved prognosis.
Airway-occluding mucus plugs (MPs)-as identified on CT scans-are frequent in patients with chronic obstructive pulmonary disease (COPD). Prior studies have shown that body mass index (BMI) tends to be lower among individuals with MPs. To further investigate this relationship, we assessed whether BMI is associated with MPs in two large, multicentre cohorts of tobacco-exposed participants with and without COPD. In multivariable models, lower BMI was associated with an increased prevalence of MPs in COPD and non-COPD groups. Future studies are warranted to elucidate the mechanisms underlying this association.
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The historical submersion of the State Career Plan agenda within the Brazilian Unified Health System (SUS) is directly linked to the diffusion of managerial principles structured by New Public Management. This article aims to document the theoretical reasons and practical effects of the weakening of labour rights in the construction of SUS. Drawing on data related to the process of precarious labour relations and outsourcing, as well as the increasing municipalization of health management, we identify three key areas where labour management is central to the historical challenges faced by SUS: the pressure of personnel expenses on municipal budgets; the expansion of the public-private hybrid model in public administration; and the limitations in implementing a Regionalized Health Care Network. In conclusion, we argue that the ideology and practices of 'management culture' undermine the central role of labour management in the realization of SUS. Strengthening the State Career Program for workers hinges on this critique of managerialism, from which it will be possible to restore the dignity of labour in public health. A submersão histórica da agenda da Carreira de Estado no Sistema Único de Saúde (SUS) está diretamente relacionada com a difusão dos princípios teóricos gerencialistas estruturados pela Nova Gestão Pública. A partir dessa problematização, o presente artigo procura fundamentar as razões teóricas e os efeitos práticos da fragilização dos direitos do trabalho na construção do SUS. Considerando dados que documentam o processo de precarização e terceirização dos vínculos de trabalho e a crescente municipalização da gestão na saúde, apontamos em três dimensões a centralidade da gestão do trabalho para impasses históricos do SUS: a pressão das despesas com pessoal sobre o orçamento municipal; a expansão do hibridismo público-privado na administração pública; a limitação da implementação de uma Rede Regionalizada de Atenção à Saúde. A título de conclusão, apontamos que o ideário e a prática da “cultura management” rebaixam a centralidade da gestão do trabalho na realização do SUS. O fortalecimento do Programa da Carreira de Estado para as trabalhadoras e trabalhadores depende dessa crítica ao gerencialismo, do qual se tornará possível recuperar a dignidade do trabalho na saúde pública. La sumersión histórica de la agenda de la Carrera de Estado en el Sistema Único de Salud (SUS) está directamente relacionada con la difusión de los principios teóricos gerencialistas estructurados por la Nueva Gestión Pública. A partir de esta problematización, el presente artículo busca fundamentar las razones teóricas y los efectos prácticos del debilitamiento de los derechos laborales en la construcción del SUS. Considerando datos que documentan el proceso de precarización y tercerización de los vínculos laborales, así como la creciente municipalización de la gestión en salud, señalamos, en tres dimensiones, la centralidad de la gestión del trabajo para los impases históricos del SUS: la presión del gasto en personal sobre el presupuesto municipal; la expansión del hibridismo público-privado en la administración pública; y la limitación de la implementación de una Red Regionalizada de Atención a la Salud. A modo de conclusión, sostenemos que el ideario y la práctica de la “cultura management” reducen la centralidad de la gestión del trabajo en la materialización del SUS. El fortalecimiento del Programa de la Carrera de Estado para las trabajadoras y los trabajadores depende de esta crítica al gerencialismo, a partir de la cual será posible recuperar la dignidad del trabajo en la salud pública.
To determine if version upgrades to treatment planning system software have an impact on the clinical application of a knowledge-based planning model built in a previous version. Twenty patients' data sets treated for prostate cancer were retrospectively selected for planning on three different versions of Eclipse (Varian Medical Systems) treatment planning system, (Vn13.6, Vn15.6, Vn16.1) using a multi-centre RapidPlan model that was built in Vn13.6. Each plan was created using identical beam arrangement, and optimisation objectives and calculation settings. The RapidPlan model was also re-trained in Vn15.6 and Vn16.1 and the datasets were replanned using these models with the same method. Seven plan comparisons were performed, evaluating four target metrics and eight organ at risk (OAR) metrics. Statistically significant differences to median values for target dose metrics  were observed in 10 out of 28 plan comparisons and for OARs in 23 out of 56 plan comparisons. Re‑extracted and re‑trained models in Vn15.6 and Vn16.1 improved target coverage and several OAR dose metrics. Small increases were observed in some OAR metrics for a subset of plans using the Vn15.6 model; however, the largest variations were minor (≤1.4%), including Bladder_65Gy (<1.3%), Bladder_70Gy (<0.7%), Rectum_65Gy (<0.9%), and Rectum_70Gy (<1.4%). Eclipse version upgrades will have varying effects on the resultant plans optimised using a RapidPlan models developed and trained in earlier versions. This study confirms the recommendation from the vendor that it is important to re-extract and re-train RapidPlan models when an Eclipse version upgrade is undertaken to ensure optimal dosimetry is achieved.
Spatially fractionated radiation therapy (SFRT) planning requires three coordinated tasks: generation of high-dose sphere structures, position-aware optimization, and peak-valley dose ratio evaluation. In practice, clinicians and researchers address these tasks with a combination of closed-source scripts, research codes, and manual calculation. The absence of a unified, commercially deployable toolkit remains a barrier to multi-institutional SFRT trials. We present MAAS-SFRThelper, a shared-source plugin that integrates structure generation, geometric-aware optimization, and peak-valley dose ratio evaluation for SFRT into a single workflow inside Varian's Eclipse treatment planning system. MAAS-SFRThelper is a Windows Presentation Foundation (WPF) application built on the Model-View-ViewModel (MVVM) pattern, implemented in C# against ESAPI for Eclipse 15.6 and later. The plugin currently contains five task-oriented tabs that share common services for sphere extraction and objective creation. The SphereLattice tab generates sphere lattices using five placement patterns: hexagonal close-packed, simple cubic, alternating cubic, centroidal Voronoi tessellation, and a constraint-based Monte Carlo method. The SCART tab creates contracted spindle-like boost volumes for stereotactic central ablative radiation therapy. The Optimization tab auto-populates structure list, searches over candidate lattice positions using a four-metric geometric surrogate score, and triggers Eclipse VMAT optimization along with dose calculation on the best candidate. The Evaluation tab implements four analysis modes including 1D, 2D, and 3D PVDR analysis. We validated all functionality on digital phantoms against analytic ground truth. In phantom testing, the optimized lattice achieved 22.5% higher PVDR. The plugin is distributed as source code that compiles to a single dynamic-link library (DLL); all third-party dependencies are bundled at build time. At first launch, users review the Varian Limited Use Software License Agreement (LUSLA) and enter an access code that is emailed upon request. The plugin accepts the patient structure set and, where applicable, a plan with calculated dose; outputs include new structures written directly to the structure set through ESAPI and summary statistics exported as comma-separated value (CSV) files. Source code and documentation are publicly available on GitHub under the LUSLA. MAAS-SFRThelper supports clinical lattice SFRT planning with consistent workflows across institutions and standardized peak-valley dose ratio reporting for multi-institutional trials. The shared-services architecture enables community contributions of new placement patterns, evaluation metrics, and validation datasets. These features represent a practical step toward the dosimetric consistency called for in the 2024 NRG Oncology/AAPM consensus on SFRT. The plugin also serves as a platform for research extensions to GRID therapy, minibeam radiation therapy, and other heterogeneous dose-delivery modalities.
Chronic obstructive pulmonary disease (COPD) is a major public health problem. Research over the past few years has shown that COPD is the result of dynamic and cumulative gene-environment interactions starting early in life. This opens new opportunities for the Prediction, Prevention, Personalized and Precise management (P4) of COPD in young adults. The P4COPD study sought to: (1) investigate the genomic and environmental/lifestyle determinants of COPD in young adults (18-50 years); (2) contrast them with those determined in children, adolescent and older individuals; and (3) explore the feasibility and cost of implementing a P4 strategy for COPD in young adults in clinical practice. The P4COPD study leverages from already existing cohorts (EarlyCOPD, INMA, LEVANTE, Aduheart) of young subjects (18-50 years) and de novo recruitment from primary care centers, in whom we: (1) analyzed demographic, epidemiological, clinical and physiologic information; (2) measured genetic, epigenetic and proteomic markers; (3) used analytical methods to identify endotypes, biomarkers and potential therapeutic targets associated with the presence of COPD, pre-COPD and/or low peak lung function. Results in young individuals: (4) were contrasted with healthy controls from the general population (IMPACT cohort) and COPD cohorts in older patients (BIOMEPOC, CHAIN and ECLIPSE). Besides, we (5) explored how to implement results in clinical practice; and (6) estimated its potential health cost implications. First results are expected in the third and fourth quarters of 2026. Identifying young individuals at risk of COPD, in whom to establish a P4 strategy is highly relevant to promote healthy aging. La enfermedad pulmonar obstructiva crónica (EPOC) es un problema mayor de salud pública. La investigación de los últimos años ha demostrado que la EPOC es el resultado de interacciones dinámicas y acumulativas entre los genes y el medio ambiente que comienzan en la vida temprana. Esto abre nuevas oportunidades para la predicción, prevención y el manejo personalizado y preciso (P4) de la EPOC en adultos jóvenes. El estudio P4COPD tuvo como objetivos: (1) investigar los determinantes genómicos y ambientales/de estilo de vida de la EPOC en adultos jóvenes (20–50 años); (2) compararlos con los determinados en niños, adolescentes y personas de mayor edad; y (3) explorar la viabilidad y el coste de implementar una estrategia P4 para la EPOC en adultos jóvenes en la práctica clínica. El estudio P4COPD aprovecha cohortes ya existentes (EarlyCOPD, INMA, LEVANTE, Aduheart) de sujetos jóvenes (18–50 años), así como un reclutamiento de novo desde centros de atención primaria, en los que: (1) analizaremos información demográfica, epidemiológica, clínica y fisiológica; (2) mediremos marcadores genéticos, epigenéticos y proteómicos; (3) utilizaremos métodos analíticos para identificar endotipos, biomarcadores y posibles dianas terapéuticas asociadas con la presencia de EPOC, pre-EPOC y/o bajo pico de función pulmonar. Los resultados en individuos jóvenes (4) se contrastarán con controles sanos de la población general (cohorte IMPACT) y con cohortes de EPOC en pacientes de mayor edad (BIOMEPOC, CHAIN y ECLIPSE). Además, (5) exploraremos cómo implementar los resultados en la práctica clínica; y (6) estimaremos sus posibles implicaciones en costes sanitarios. Se espera que los primeros resultados estén disponibles en el tercer y cuarto trimestre de 2026. Identificar a individuos jóvenes en riesgo de EPOC, en quienes establecer una estrategia P4, es altamente relevante para promover un envejecimiento saludable.
The primary aim was to evaluate the accuracy of the generated Mid-Ventilation (MidV) Gross Tumour Volume (GTV) and Planning Target Volume (PTV) using three Deformable Image Registration (DIR) algorithms (Eclipse DIR, MIM DIR, Velocity DIR) and two starting phases for contour propagation (0% vs. 20%), compared with inter-observer variation (IOV). 27 stereotactic ablative radiotherapy (SABR) lung datasets were analysed. For each patient, three contours and a consensus reference contour was created. This reference contour was used to generate six DIR-based 4D contours (three algorithms with two starting phases). Performance was assessed using contour agreement metrics (mean distance to agreement [MDA)], Dice similarity coefficient [DSC], Hausdorff distance [HD], and volume ratio). Non-inferiority tests (one-sided, Dunnett-adjusted) evaluated DIR performance relative to IOV. DIR with a 20% starting phase outperformed 0% predominantly. Eclipse and Velocity DIR-20% met all published tolerances (MDA within 2 mm, DSC more than 0.8, and volume ratio within 10%) and were non-inferior to IOV. Secondary analyses showed improved consistency in MidV phase determination, MidV to Mid-position (MidP) centroid deviation (within 1 mm), 4D motion estimation (<1 mm), and PTV margin calculation (<1 mm difference). DIR algorithms using a 20% starting phase demonstrated superior performance compared with a 0% starting phase. Commercial DIR algorithms can support MidV contouring for lung SABR when initiated from the 20% starting phase. DIR-20% produced contour accuracy comparable to IOV with robust performance across MidV subprocesses.
Artificial intelligence (AI) is reshaping every stage of leukemia diagnostics, from digital morphology and multiparameter flow cytometry to next-generation sequencing, multi-omics analysis, and emerging computational frontiers such as quantum-inspired feature selection. This review outlines how contemporary AI tools can automate labor-intensive quantitation, flag diagnostically salient patterns, and standardize interpretation, while the pathologist or hematologist retains authority over validation, context-specific integration, and clinical decision-making. We present an illustrative "human-in-the-loop" workflow that embeds AI modules within current laboratory information systems, emphasizing points where expert oversight mitigates algorithmic bias and resolves discordant findings. We further map the validator-integrator role across morphology, flow cytometry, and genomic/multi-omic interpretation and provide practical training competencies and use cases for AI-assisted hematopathology. Beyond technical deployment, the article addresses the educational transformation required for sustainable adoption. Drawing on international competency frameworks, including the Digital Health Competencies in Medical Education Framework and recently proposed AI-specific Entrustable Professional Activities, we map core skills that future hematopathologists must master: data-science literacy, critical appraisal of AI outputs, and ethical governance. We highlight evaluated training models such as the Pathology Informatics Essentials for Residents curriculum, Stanford Artificial Intelligence in Machine and Imaging workshops, and College of American Pathologists bootcamps and propose integration strategies adaptable across resource settings. By pairing rigorous validation with targeted education, AI can elevate rather than eclipse the diagnostic role of the leukemia specialist, enabling more timely, reproducible, and personalized patient care.
Clinical implementation of lattice radiotherapy (LRT) remains constrained by the absence of standardized, automated tools for comprehensive post-plan dosimetric analysis within commercial treatment planning systems (TPS). Herein, an automated script-based tool was developed using the Eclipse Scripting API (ESAPI) to enable rapid, standardized calculation of key LRT-specific metrics, including peak-to-valley dose ratio (PVDR), equivalent uniform dose (EUD), and ablative dose ratio (ADR). A modular computational architecture comprising four functional layers was implemented: (1) user interface for protocol configuration, (2) computation layer integrating multiple PVDR algorithms, (3) data service layer providing direct read-only access to three-dimensional dose and anatomical data via ESAPI, and (4) reporting module. To accommodate ESAPI security restrictions, a dual-script architecture incorporating a preprocessing sphere segmentation module was established. Validation was performed using a retrospective cohort of 12 lung cancer LRT patients, with accuracy assessed against manual TPS measurements and established reference values. Concordance between automated and manual TPS measurements was high. Standard dose-volume parameter extraction exhibited perfect agreement. For spatially explicit PVDR analysis, mean absolute error relative to manual profile assessment was 0.034 (absolute VPDR units). EUD calculations deviated less than 3% from published reference data. Evaluation time per plan was reduced from 15.41 ± 3.20 min (manual) to 1.97 ± 0.34 min (automated), representing a 7.8-fold efficiency gain with elimination of inter-operator variability. This ESAPI-based tool automates and standardizes dosimetric evaluation of LRT, addressing a practical workflow bottleneck. Integration of multiple calculation methods within a deterministic framework establishes a shareable benchmark for consistent multi-institutional analysis, providing a foundation for future investigations correlating detailed dosimetric parameters with clinical outcomes in spatially fractionated radiotherapy.