Simultaneous integrated boost (SIB) radiation therapy of right sided breast cancer with and without flattening filter - A treatment planning study

Abstract

Background

The aim of the study was to compare the two irradiation modes with (FF) and without flattening filter (FFF) for three different treatment techniques for simultaneous integrated boost radiation therapy of patients with right sided breast cancer.

Methods

An Elekta Synergy linac with Agility collimating device is used to simulate the treatment of 10 patients. Six plans were generated in Monaco 5.0 for each patient treating the whole breast and a simultaneous integrated boost (SIB) volume: intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and a tangential arc VMAT (tVMAT), each with and without flattening filter. Plan quality was assessed considering target coverage, sparing of the contralateral breast, the lungs, the heart and the normal tissue. All plans were verified by a 2D-ionisation-chamber-array and delivery times were measured and compared. The Wilcoxon test was used for statistical analysis with a significance level of 0.05.

Results

Significantly best target coverage and homogeneity was achieved using VMAT FFF with V_95% = (98.7 ± 0.8) % and HI = (8.2 ± 0.9) % for the SIB and V_95% = (98.3 ± 0.7) % for the PTV, whereas tVMAT showed significantly lowest doses to the contralateral organs at risk with a D_mean of (0.7 ± 0.1) Gy for the contralateral lung, (1.0 ± 0.2) Gy for the contralateral breast and (1.4 ± 0.2) Gy for the heart. All plans passed the gamma evaluation with a mean passing rate of (99.2 ± 0.8) %. Delivery times were significantly reduced for VMAT and tVMAT but increased for IMRT, when FFF was used. Lowest delivery times were observed for tVMAT FFF with (1:20 ± 0:07) min.

Conclusion

Balancing target coverage, OAR sparing and delivery time, VMAT FFF and tVMAT FFF are considered the preferable of the investigated treatment options in simultaneous integrated boost irradiation of right sided breast cancer for the combination of an Elekta Synergy linac with Agility and the treatment planning system Monaco 5.0.

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Actualités en phytothérapie

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How receptive are patients with late stage cancer to rehabilitation services and what are the sources of their resistance?

Publication date: Available online 31 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Andrea L. Cheville, Lori Rhudy, Jeffrey R. Basford, Joan M. Griffin, Ann Marie Flores
ObjectiveTo describe the proportion and characteristics of patients with late stage cancer that are and are not receptive to receiving rehabilitation services, as well as the rationale for their level of interest.SettingA comprehensive cancer center in a Northcentral US quaternary medical centerDesignA prospective mixed methods studyParticipants311 adults with Stage IIIC or IV non-small cell or extensive stage small cell lung cancer.InterventionsNot applicableMain Outcome MeasuresTelephone acquired responses to the administration of: 1) the Activity Measure for Post Acute Care Computer Adaptive Test (AM-PAC-CAT); 2) Numerical rating scales for pain, dyspnea, fatigue, general emotional distress, and distress associated with functional limitations; 3) a query regarding receptivity to receipt of rehabilitation services, and 4) a query about rationale for non-receptivity.ResultsOverall 99 (31.8%) of the study's 311 participants expressed interest in receiving rehabilitation services; 38 at the time of enrollment and an additional 61 during at least one subsequent contact. Participants expressing interest were more likely to have a child as primary caregiver (18.18% vs. 9.91%, p = 0.04) and a musculoskeletal comorbidity (42.4% vs. 31.6%, p = 0.05). Function-related distress was highly associated with receptivity, as were lower AM-PAC-CAT scores. Reasons provided for lack of interest in receiving services included a perception of their limited benefit, being too busy, and prioritization below more pressing tasks/concerns.ConclusionsOne-third of patients with late stage lung cancer are likely to be interested in receiving rehabilitation services despite high levels of disability and related distress. These findings suggest that patient misperception of the role of rehabilitation services may be a barrier to improved function and quality of life. Efforts to educate patients on the benefits of rehabilitation and to more formally integrate rehabilitation as part of comprehensive care may curb these missed opportunities.



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Effet d’une association de Porphyra umbilicalis , de Polypodium leucotomos et de vitamines C et E sur la dose érythémateuse minimale chez des volontaires sains

Résumé

Les produits de protection solaire topiques protègent efficacement contre les ultraviolets mais présentent une efficacité de courte durée souvent limitée par une utilisation inadéquate. Des produits systémiques ont donc été développés en complément des méthodes de photoprotection externe. Nous avons évalué l'effet d'une association de Porphyra umbilicalis, de Polypodium leucotomos et de vitamines C et E sur la dose érythémateuse minimale (DEM). Cette étude en ouvert, avec comparaisons intra-individuelles, a été réalisée chez des volontaires sains de phototypes II et III ayant pris cette association pendant 14 jours. La DEM a été évaluée à j0, j3, j7 et j14. À j14, une augmentation statistiquement significative de la DEM de 19 % (p < 0,001) a été observée chez 82 % (18/22) des volontaires. Cette augmentation a été significative dès j7 (+10 % ; p = 0,002). L'analyse par phototype a montré que l'augmentation de la DEM était significative dès j3 chez les volontaires de phototype II (n = 13 ; +7 % ; p = 0,009), et à partir de j14 chez les volontaires de phototype III (n = 9 ; +17 % ; p = 0,011). Ces résultats suggèrent que l'association de Porphyra umbilicalis, de Polypodium leucotomos et de vitamines C et E pourrait renforcer les capacités de photoprotection chez un individu se protégeant déjà par voie externe.

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Safe landing strategies during a fall: Systemic review and meta-analysis

Publication date: Available online 31 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Yaejin Moon, Jacob J. Sosnoff
ObjectiveTo systematically synthesize information on safe landing strategies for a fall and quantitatively examine the effects of the strategies to reduce risk of injury from a fall.Data SourcesPubMed, Web of science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane LibraryStudy SelectionDatabases were searched using the combinations of keywords of "falls", "strategy", "impact" and "load". Randomized control trials, cohort studies, pre-post studies, or cross-sectional studies were included.Data ExtractionThe fall strategies were extracted and categorized by falling direction. Measurements of impact loads that reflect the risk of injuries were extracted (e.g. impact velocity, impact force, fall duration, and impact angle). Hedges g was used as effect size to quantify effect of a protective landing strategy to reduce the impact load.Data SynthesisA total of seven landing strategies (squatting, elbow flexion, forward rotation, martial arts rolling, martial arts slapping, relaxed muscle, and stepping) in 13 studies were examined. In general, all strategies, except for the martial arts slapping technique, significantly reduced impact load (g's=0.73 to 2.70). Squatting was an efficient strategy to reduce impact in backward falling (g=1.77) while elbow flexion with outstretched arms was effective in forward falling (g=0.82). Also, in sideways falling strategies, martial arts rolling (g=2.70) and forward rotation (g=0.82) were the most efficient strategies to reduce impact load.ConclusionsThe result showed that landing strategies have significant effect on reducing impact load during a fall and might be effective to reduce impact load of falling. The current study also highlighted limitations of the previous studies which focused on a young population and self-initiated falls. Further investigation with elderly individuals and unexpected falls is necessary to verify effectiveness and suitableness of the strategies to at-risk population in real-life falls.



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Affiliate faculty members honored

Dr. Bill McHugh and Dr. Franco Audia are the newest recipients of the Hungate Awards for Teaching Excellence, which recognize outstanding work by affiliate faculty.

The post Affiliate faculty members honored appeared first on UW School of Dentistry.

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Can fascia’s characteristics be influenced by manual therapy?

Publication date: Available online 31 August 2016
Source:Journal of Bodywork and Movement Therapies
Author(s): Serge Gracovetsky




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The carrying angle: racial differences and relevance to inter-epicondylar distance of the humerus

The human carrying angle (CA) is a measure of the lateral deflection of the forearm from the arm. The importance of this angle emerges from its functional and clinical relevance. Previous studies have correlated this angle with different parameters including age, gender, and handedness. However, no reports have focused on race-dependent variations in CA or its relation to various components of the elbow joint. This study aimed to investigate the variations in CA with respect to race and inter-epicondylar distance (IED) of the humerus. The study included 457 Jordanian and 345 Malaysian volunteers with an age range of 18–21 years. All participants were right-hand dominant with no previous medical history in their upper limbs. Both CA and IED were measured by well-trained medical practitioners according to a well-established protocol. Regardless of race, CA was greater on the dominant side and in females. Furthermore, CA was significantly greater in Malaysian males compared to Jordanian males, and significantly smaller in Malaysian females compared to their Jordanian counterparts. Finally, CA significantly decreased with increasing IED in both races. This study supports effects of gender and handedness on the CA independent of race. However, CA also varies with race, and this variation is independent of age, gender, and handedness. The evaluation also revealed an inverse relationship between CA and IED. These findings indicate that multiple factors including race and IED should be considered during the examination and management of elbow fractures and epicondylar diseases.

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Characteristics of Sertoli cells in the ectopic and scrotal testes of unilateral cryptorchid West African dwarf goats

Sertoli cell population and histology were studied in testes of unilateral cryptorchid goats. Histomorphological and electron microscopic techniques were employed. The results demonstrated that the number of Sertoli cell per testis was significantly (p < 0.05) higher in the descended scrotal testes of unilateral cryptorchid bucks compared with the right and left testes of the normal bucks, respectively. However there was no significant difference (p > 0.05) on comparing the number of Sertoli cells in the scrotal testes of the unilateral cryptorchid bucks with the paired testes of the normal bucks. Significant differences were not observed in the dimensions of the Sertoli cell nuclei in the retained, scrotal testes of the cryptorchids and the testes of the normal bucks. The Sertoli cells of the descended scrotal testes of the cryptorchid bucks and those of the normal bucks showed histological evidence of normal activity. Degeneration of Sertoli cells was observed in the retained testis of the cryptorchid bucks. The failure of one testis to descend most probably influenced compensatory hyperplasia of Sertoli cells and enhanced function of the cells in the descended testis of the unilateral cryptorchids.

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Interstitial cells of Cajal — systematic review

This paper reviews the distribution of interstitial cells of Cajal (ICC) in the human gastro­intestinal (GI) tract, based on ultrastructural and immunohistochemical evidence. The distribution and morphology of ICC at each level of the normal GI tracts is addressed from the perspective of their functional significance. Alterations of ICC reported in as well as in GI stromal tumours are reviewed, with emphasis on the place of ICC in the pathophysiology of disease.

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The impact of type 1 diabetes on the development of the craniofacial mineralised tissues (bones and teeth): literature review

 

Background: There are many reports on the impact of diabetes on periodontium as well as the state of organs in diabetics; however, there is little research on the impact of the disease on morphological and anatomical changes in the mineralised tissues like teeth and craniofacial bones. The aim of this study was to present a review of literature on morphological and anatomical changes of mineralised tissues in the course of type 1 diabetes.

Materials and methods: A review of PubMed database was made using the keywords: morphological changes, anatomical changes, enamel hypoplasia, type 1 diabetes, induced diabetes and the names of individual anatomical and morphological structures of the teeth.

Results: The analysis of experimental studies have shown that in induced type 1 diabetes in rats there is a substantial reduction in the thickness of the enamel and dentin, compared with the control group. The changes in the content of indivi­dual minerals in the tissues of the tooth have been shown — a decrease in the concentration of calcium and fluoride ions and an increase in the concentration of magnesium. In a study conducted on embryos of rats born of diabetic dams, defects were observed in enamel organ, which can cause delayed enamel hypo­plasia. Literature analysis revealed morphological disorders also in some clinical cases of patients with type 1 diabetes.

Conclusions: Type 1 diabetes mellitus as a metabolic disorder may affect changes in the structure of mineralised tissues, thereby increasing their susceptibility to caries development and orthognathic disorders.

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Vertebral level and measurements of conus medullaris and dural sac termination with special reference to the apex of the sacral hiatus: anatomical and magnetic resonance imaging radiologic study

Background: Anatomical orientation of the caudal space and termination level of conus medullaris (CMT) and dural sac (DST) has great significance for anaesthetists and neurosurgeons. This study aimed to explore the anatomical landmarks important to perform save spinal anaesthesia, lumber puncture and caudal analgesia through the correlation between the vertebral level of CMT, DST and sacral hiatus apex (SHA) in human cadavers and by using magnetic resonance imaging (MRI).

Materials and methods: Sixty adult cadavers (40 males, 20 females) and 200 (100 males, 100 females) MR lumbosacral images of 16–69-year-old persons were used in this study. Vertebral level of CMT, DST and SHA and their linear distances were determined in cadavers and MRI. Also, anteroposterior diameter at SHA, length and thickness of sacrococcygeal membrane were measured as well, and correlate these levels and their distances with age and sex.

Results: Mean and highest frequent number of MRI vertebral level of CMT was observed at lower third of L1 in men and L1-2 disc in women, that of DST at upper third of S2 in men and middle third of S2 in women, while SHA was seen at middle third of S4 in both men and women with no significant (p > 0.05) age or gender differences. In 5% of cases, CMT, DST and SHA were seen at vertebral level below L2, below S2-3 and above S3, respectively. However, mean vertebral level of CMT, DST, SHA was observed at L1L, S2M and S4U without sex differen­ce in cadaveric specimens, respectively. All linear distances of men MRI revealed significant difference (p < 0.05) compared with those of women except thickness of sacrococcygeal membrane and anterposterior diameter at SHA.

Conclusions: Accurate knowledge of vertebral level of CMT, DST and SHA and the distances in-between might decrease the iatrogenic injury of dural sac, spinal cord and cauda equina.

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Selected clinical challenges of a supraclavicular cephalic vein in cardiac implantable electronic device implantation

Background: Supraclavicular variations of the cephalic vein (CV) are detected sporadically. A somewhat more common finding is a CV variation with the typical course of the main vessel but with an additional supraclavicular branch, called the jugulocephalic vein (JCV). The aim of the study was to detect supraclavicular CVs or JCVs via intra-operative venography as well as assess their effects on primary and later revision cardiac implantable electronic device (CIED) procedures in our patients.

Materials and methods: We analysed venographic images obtained during CIED procedures at our centre between 2011 and 2015. Out of the 324 venographies conducted during first-time CIED implantation, we identified 14 showing either a supraclavicular course of the CV itself or a persistent JCV. Among revision procedure venographies, we identified 1 case of pertinent CV variations. These vessels had been morphometrically altered by previous medical interventions.

Results: Based on topography and morphometric parameters, we identified three anatomical variations of supraclavicular vessels: 2 cases of a supraclavicular CV and 12 cases of an infraclavicular CV accompanied by a persistent supraclavicular JCV (with the diameter larger than that of the main CV in 5 cases and smaller in 7 cases). In 2 cases the enlarged diameter of the JCV was probably due to increased collateral venous flow resulting from thrombotic lesions in the subclavian vein.

Conclusions: Supraclavicular CV variations are rare. Nonetheless, they may significantly affect both first-time and later revision CIED procedures. The presence of a supraclavicular vein is an indication for diagnostic venography in the area of the clavipectoral triangle before the CIED procedure.

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Lumbosacral plexus in Brazilian Common Opossum

The opossum has been suggested as an animal model for biomedical studies due to its adaptability to captivity and number of births per year. Despite many studies on morphology and experimental neurology using this opossum model, the literature does not offer details of the nerves of the lumbosacral plexus in this species. Ten lumbosacral plexus were dissected to describe the peripheral innervations of the Brazilian Common Opossum (Didelphis aurita) and compare the results with Eutheria clade species. The tensor fasciae latae muscle was absent and there was only one sartorius muscle for each limb. The distribution of the nerves were similar to other mammals, except for the caudal gluteal nerve, sartorius muscle innervations and the position of the pudendal nerve which arose from the major ischiatic foramen together with the ischiatic nerve, the cranial gluteal nerve and the caudal gluteal nerve. No anatomical variation was found. The special position of the pudendal nerve suggested that the Brazilian Common Opossum is a better model than rats or rabbits in surgical procedures with that specific nerve. In addition, the study revealed that the pelvic limb nerves are not an invariable structure of reference for muscle homology and homonym as reported previously. New investigation using other species of opossums are necessary to best comprehend the lumbosacral plexus distribution in the Methatheria clade and to confirm that other opossum species is eligible as a good model for pudendal nerve studies.

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Morphological study of the hoof in yak

The fore- and hindlimb of yak have been studied by the gross anatomical methods and standard histological techniques. The artery of ungula was also determined by X-ray and acrylonitrile-butadiene-styrene casting. Anatomical features of the forelimb of yak resemble those of hindlimb, including hoof periphery, hoof coronal, hoof wall, hoof sole, and hoof sphere. The forelimb and hindlimb are almost the same in histological structure. The epidermis comprised all 5 strata: stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum and stratum basale. The papillary layers and dermal lamellae contained a variable amount of capillary as well as collagen and elastic fibres. Many venules and arteriovenous anastomosis were distributed among the reticular layer. Subcutaneous tissue was composed of rich adipose and connective tissue in hoof periphery, hoof coronal, and, especially, hoof sphere. Major arteria in forelimb of yak include arteria digitalis palmaris communis III and arteriae digitales palmares propriae III and IV axialis. Those in hindlimb include arteria digitalis plantaris communis III and arteria digitalis plantaris propria III and IV axialis. Our findings highlight the main morphological features of yak and provide a morphological basis useful to researchers using yak hoof.

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The sciatic nerve in human cadavers — high division or low formation?

Variations of the sciatic nerve have been extensively studied in the past including its relationship with the piriformis muscle and associated clinical conditions like piriformis syndrome and sciatica. In the present study we noticed some interesting variations of the sciatic nerve, which were slightly different from the cases described earlier. In the previous studies most of the authors described the higher division of sciatic nerve and none of them discussed its formation. In this study we tried to look its formation from the sacral plexus and its divisions in the thigh.

We noticed that in one cadaver the two components of the sciatic nerve originated directly from the sacral plexus and coursed down without merging in the thigh. Should this be called a higher division or non formation of the sciatic nerve? On the other hand in two other cadavers, the two divisions after emerging separately from the sacral plexus, united in the gluteal region and in the thigh respectively. Should we call this as higher division or low formation of the sciatic nerve? In two other cadavers the sciatic nerve emerged from the greater sciatic foramen below the piriformis and divided in the gluteal region itself. Ideally this should be called as higher division of sciatic nerve.

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The beneficial roles of insulin and parathyroid hormones in the treatment of experimentally induced diabetic osteoporosis in female rats: bone mineral density, morphometric and histological studies

Background: Diabetes mellitus (DM) and osteoporosis are two frequent medical conditions with an increasing prevalence in elderly people and are responsible for large number of incurable fractures. This study is designed experimentally in female rats in order to determine whether combined treatment of insulin and parathyroid hormone (PTH) enhances the reversibility of the osteoporotic changes that occurred in streptozotocin (STZ)-induced DM.

Materials and methods: In this study, 30 adult female rats aged 3 months were used, they were randomly divided into: control group (6 rats) and diabetes group (24 rats), in which experimental DM was induced by i.p. injection of a single dose of STZ (60 mg/kg/body weight). Diabetic group was further divided into four subgroups (6 rats each): non-treated diabetic, insulin-treated (8–12 units s.c./day of Humalin U-40), PTH-treated (6.0 μg s.c./kg/day) and combined insulin and PTH-treated subgroups. All tested groups were assessed for body weight, food and water consumptions.

Results: At the end of the experimental period, the bone mineral density (BMD) was measured for all rats of different groups; then the rats were sacrificed and blood samples were collected for measuring glucose, alkaline phosphatase and osteocalcin levels. Right femora were dissected out and subjected to measurement of diameter of neck and shaft, length of shaft, and weight. Then the femora specimens were processed and stained with haematoxylin and eosin for histological study. The results showed that there was a statistically significant, decrease in BMD, increase in the level of alkaline phosphate, and decrease in the level of osteocalcin in rats in diabetic group compared with other groups; these parameters improved in other groups, especially in diabetes/insulin/PTH group. The rats in diabetic group showed statistically significant decrease in neck and shaft diameters and weight of femur bone compared with other groups, while rats in diabetes/insulin/PTH group showed a significant improvement of these parameters. In diabetic group, there were different histopathological changes in cortical bone and Haversian canals, which improved in other groups, especially in rats in diabetes/insulin/PTH group.

Conclusions: The untreated DM resulted in dramatic reduction in BMD and morphometric parameters. Treatment with insulin ameliorated these effects to some extent, while PTH co­-treatment had a more positive effect. The combination of PTH and insulin resulted in stronger improvement of all parameters to approximately like those of control rats.

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Zika Virus and the Guillain–Barré Syndrome — Case Series from Seven Countries

To the Editor: Zika virus (ZIKV) disease had been described as a mild, self-limiting illness associated with fever, rash, joint pain, and conjunctivitis. However, during the outbreak in French Polynesia, 42 patients with ZIKV disease were found to have the Guillain–Barré syndrome, which…

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In Vitro Analysis of the Co-Assembly of Type-I and Type-III Collagen

Abstract

An important step towards achieving functional diversity of biomimetic surfaces is to better understand the co-assembly of the extracellular matrix components. For this, we study type-I and type-III collagen, the two major collagen types in the extracellular matrix. By using atomic force microscopy, custom image analysis, and kinetic modeling, we study their homotypic and heterotypic assembly. We find that the growth rate and thickness of heterotypic fibrils decrease as the fraction of type-III collagen increases, but the fibril nucleation rate is maximal at an intermediate fraction of type-III. This is because the more hydrophobic type-I collagen nucleates fast and grows in both longitudinal and lateral directions, whereas more hydrophilic type-III limits lateral growth of fibrils, driving more monomers to nucleate additional fibrils. This demonstrates that subtle differences in physico-chemical properties of similar molecules can be used to fine-tune their assembly behavior.

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Welcome to the new associate Editor-in-Chief of memo

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A welcome statement from the associate Editor-in-Chief

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Osseointegration and implant stability of extraoral implants in Göttingen Minipigs after irradiation

The aim of this study was to compare the influence of implant surface treatment and irradiation dose on implant stability and osseointegration of 144 extraoral implants in irradiated frontal bone of minipigs.

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Zika Virus and the Guillain–Barré Syndrome — Case Series from Seven Countries

To the Editor: Zika virus (ZIKV) disease had been described as a mild, self-limiting illness associated with fever, rash, joint pain, and conjunctivitis. However, during the outbreak in French Polynesia, 42 patients with ZIKV disease were found to have the Guillain–Barré syndrome, which…

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Increased Bone Mineral Content During Rapid Weight Gain Therapy in Anorexia Nervosa

Horm Metab Res
DOI: 10.1055/s-0042-115304

Patients with anorexia nervosa (AN) are at high risk of reduced bone mass. Osteocalcin (OC), a bone formation marker, has been proposed to act as a link between bone and energy metabolism. We investigated how the 3 forms of OC respond during a 12-week intensive nutrition therapy in AN patients, in whom large changes in energy metabolism are expected.Twenty-two female AN patients, mean 20.9 years of age, with a starting mean body mass index (BMI) 15.5 kg/m2 (minimum-maximum) (13.4–17.3 kg/m2) completed the study. Biochemical markers, body composition, bone mass by DXA, and pQCT were assessed. Subjects gained in median 9.9 kg (5.5–17.0 kg), and BMI increased from median 15.4 kg/m2 (13.4–17.3 kg/m2) to 19.0 kg/m2 (16.2–20.6 kg/m2), p<0.0001. Fat mass increased from median 11.4% (4.4–24.8%) to 26.7% (16.9–39.8%). Total OC, carboxylated OC (cOC), undercarboxylated OC (ucOC), and bone-specific alkaline phosphatase (BALP) increased during the study period. No change was observed for the resorption marker carboxy-terminal cross-linking telopeptide of type I collagen (CTX). Total body bone mineral content (BMC) increased, but no changes were found for whole body or lumbar spine bone mineral density. Tibial trabecular density measured by pQCT decreased. Total OC, cOC, and ucOC were not associated with BMI, insulin or body composition parameters. This prospective study demonstrates that all 3 forms of OC (total OC, cOC, ucOC) increase during rapid weight gain. BALP increased while the resorption marker CTX was unchanged, which corroborate with the increased total body BMC.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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The journey of personalizing gastric cancer treatment

Gastric cancer ranks the fourth most prevalent malignancy yet it is the second leading cause of cancer-related death. Every year, gastric cancer adds nearly 1 million new cancer cases, and 723,000 or 10% of ca...

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Gastric cancer: current and evolving treatment landscape

Gastric (including gastroesophageal junction) cancer is the third leading cause of cancer-related death in the world. In China, an estimated 420,000 patients were diagnosed with gastric cancer in 2011, ranking...

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Aging increases the susceptibility of hepatic inflammation, liver fibrosis and aging in response to high-fat diet in mice

Abstract

We aimed to investigate whether aging increases the susceptibility of hepatic and renal inflammation or fibrosis in response to high-fat diet (HFD) and explore the underlying genetic alterations. Middle (10 months old) and old (20 months old) aged, male C57BL/6N mice were fed either a low-fat diet (4 % fat) or HFD (60 % fat) for 4 months. Young (3 months old) aged mice were included as control group. HFD-induced liver and kidney injuries were analyzed by serum and urine assay, histologic staining, immunohistochemistry, and reverse-transcription real-time quantitative polymerase chain reaction. Total RNA sequencing with next-generation technology was done with RNA extracted from liver tissues. With HFD feeding, aged was associated with higher serum alanine aminotransferase levels, marked infiltration of hepatic macrophages, and increased expression of inflammatory cytokines (MCP1, TNF-α, IL-1β, IL-6, IL-12, IL-17A). Importantly, aged mice showed more advanced hepatic fibrosis and increased expression of fibrogenic markers (Col-I-α1, αSMA, TGF-β1, TGF-β2, TGFβRII, PDGF, PDGFRβII, TIMP1) in response to HFD. Aged mice fed on HFD also showed increased oxidative stress and TLR4 expression. In the total RNA seq and gene ontology analysis of liver, old-aged HFD group showed significant up-regulation of genes linked to innate immune response, immune response, defense response, inflammatory response compared to middle-aged HFD group. Meanwhile, aging and HFD feeding showed significant increase in glomerular size and mesangial area, higher urine albumin/creatinine ratio, and advanced renal inflammation or fibrosis. However, the difference of HFD-induced renal injury between old-aged group and middle-aged group was not significant. The susceptibility of hepatic fibrosis as well as hepatic inflammation in response to HFD was significantly increased with aging. In addition, aging was associated with glomerular alterations and increased renal inflammation or fibrosis, while the differential effect of aging on HFD-induced renal injury was not remarkable as shown in the liver.

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Assessing the learning potential of an interactive digital game versus an interactive-style didactic lecture: the continued importance of didactic teaching in medical student education

Abstract

Background

Games with educational intent offer a possible advantage of being more interactive and increasing learner satisfaction.

Objective

We conducted a two-armed experiment to evaluate student satisfaction and content mastery for an introductory pediatric radiology topic, taught by either an interactive digital game or with a traditional didactic lecture.

Materials and methods

Medical students participating in a fourth-year radiology elective were invited to participate. Student cohorts were alternatively given a faculty-supervised 1h session playing a simple interactive digital Tic-tac-toe quiz module on pediatric gastrointestinal radiology or a 1h didactic introductory lecture on the same topic. Survey questions assessed the learners' perceived ability to recall the material as well as their satisfaction with the educational experience. Results of an end-of-rotation exam were reviewed to evaluate a quantitative measure of learning between groups. Survey responses were analyzed with a chi-squared test. Exam results for both groups were analyzed with a paired Student's t-test.

Results

Students in the lecture group had higher test scores compared to students in the game group (4.0/5 versus 3.6/5, P = 0.045). Students in the lecture group reported greater understanding and recall of the material than students in the game group (P < 0.001 and P = 0.004, respectively). Students in the lecture group perceived the lecture to be more enjoyable and a better use of their time compared to those in the game group (P = 0.04 and P < 0.001, respectively). There was no statistically significant difference between the lecture and game group in ability to maintain interest (P = 0.187). In comparison to pre-survey results, there was a statistically significant decrease in interest for further digital interactive materials reported by students in the game group (P = 0.146).

Conclusion

Our experience supported the use of a traditional lecture over a digital game module. While these results might be affected by the specific lecture and digital content in any given comparison, a digital module is not always the superior option.

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An Alternative Route for Entrapped Inferior Orbital Nerve in Orbital Floor Fracture

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0036-1592090

Orbital floor fractures pose a grave threat for injury to the infraorbital nerve, resulting in the patient suffering from a disturbing paraesthesia. It is challenging for the operating surgeon to release and secure the entrapped nerve with reconstruction of the orbital floor. We present an interesting case of orbital floor fracture with entrapped infraorbital nerve, wherein we have decompressed the nerve and provided it, a new course.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Diagnostic relevance of cell block procedure in secondary tumors of the pancreas

Antonio Ieni, Valeria Barresi, Giovanni Tuccari

CytoJournal 2016 13(1):19-19



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Fine-needle aspiration and core biopsy in the diagnosis of breast lesions: A comparison and review of the literature

Suvradeep Mitra, Pranab Dey

CytoJournal 2016 13(1):18-18

In recent times, the diagnosis of breast lesions has mostly become dependent on core needle biopsies (CNBs) with a gradual reduction in the rate of performing fine-needle aspiration cytology (FNAC). Both the procedures have their pros and cons and outsmart each other taking into account different parameters. Both the methods are found to be fraught with loopholes, taking into account different performance indices, diagnostic accuracy and concordance, patient benefit, and cost-effectiveness. Unlike the popular belief of an absolute superiority of CNB over FNAC, the literature review does not reveal a very distinct demarcation in many aspects. We recommend judicious use of these diagnostic modalities in resource-limited settings and screening programs taking into account parameters such as palpability and availability of an experienced cytopathologist.

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Stromal tissue as an adjunct tool in the diagnosis of follicular thyroid lesions by fine-needle aspiration biopsy

Kien T Mai, Kevin Hogan

CytoJournal 2016 13(1):20-20

Background: The stroma in fine-needle aspiration biopsy (FNAB) of thyroid lesions has not been well investigated. Design : We studied 256 consecutive cases of thyroid FNAB prepared with traditional smear technique. The stroma was categorized: Type 1a consisted of long (more than 3 mm), broad bands composed of mesh containing collagen fibrils thickened by entrapped blood components and follicular cells. Type 1b consisted of dense strands/bands. Type 2 was similar to Type 1a but with shorter (<2 mm) and looser stromal strands. Results : Types 1a and b showed straight/curved/circular branching patterns suggestive of incomplete frameworks of nodular/papillary architectures or fragments of capsule. Type 1b stroma likely represented thick/collagenized fibrous septae. Incomplete or complete rings of small encapsulated tumor were occasionally identified. These frameworks of stroma were frequently associated with multinodular goiters (MNGs) which are often hypocellular and follicular neoplasms/papillary thyroid carcinoma with increased cellularity. Type 2 was associated with microfollicles in encapsulated neoplasms or with macrofollicles in MNG. Follicular lesions of unknown significance (n = 41) either negative (n = 26) or positive (n = 15) for carcinoma in subsequent follow-up were frequently associated with stroma characteristic of MNG and carcinoma, respectively. Conclusion : The preservation of the in vivo architecture of Type 1 is likely due to its elasticity. Recognition of the stromal architecture will likely facilitate the diagnosis.

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Contrast-enhanced CT imaging in patients with chronic kidney disease

Abstract

Renal microvascular rarefaction characterizes chronic kidney disease (CKD). In murine models of CKD, micro-CT imaging reflected capillary rarefaction using quantification of renal relative blood volume (rBV). In addition, micro-CT imaging revealed morphological alterations of the intrarenal vasculature including reduced vascular branching and lumen diameter. Here, we retrospectively quantified rBV in contrast-enhanced CT angiography in patients and found that, compared to non-CKD patients, those with CKD and renal fibrosis had significantly reduced rBV in the renal cortex. rBV values closely mirrored capillary rarefaction in the corresponding nephrectomy specimens. In patients with follow-up CT angiography, reduction of renal function was paralleled by a decline in rBV. Using virtual autopsy, i.e., postmortem CT angiography, morphometry of intrarenal arteries in 3D-rendered CT images revealed significantly reduced arterial diameter and branching in CKD compared to non-CKD cases. In conclusion, in CKD patients, contrast-enhanced CT imaging with quantification of rBV correlates with functional renal vasculature, whereas virtual autopsy allows morphometric analyses of macrovascular changes. Importantly, the observed vascular alterations in CKD patients mirror those in animals with progressive CKD, suggesting a high relevance of animal models for studying vascular alterations in CKD and renal fibrosis.

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Repetitive Transcranial Magnetic Stimulation for Treatment Resistant Depression: Re-establishing connections

A significant number of individuals suffering from major depressive disorder (MDD) fail to achieve an adequate response to currently available treatments and are thus considered to be suffering from treatment resistant depression (TRD). A recent addition to the neurostimulation armamentarium for the treatment of individuals suffering from TRD is repetitive transcranial magnetic stimulation (rTMS). rTMS is a non-invasive technique for which accumulated evidence has demonstrated efficacy and safety for TRD (Perera et al.

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Preoperative Short Course Radiotherapy for Rectal Cancer Provides Excellent Disease Control and Toxicity: Results from a Single US Institution

Publication date: Available online 31 August 2016
Source:Practical Radiation Oncology
Author(s): Amit Roy, Pawinee Mahasittiwat, Ashley A. Weiner, Steven R. Hunt, Matthew G. Mutch, Elisa H. Birnbaum, Ira J. Kodner, Thomas E. Read, James W. Fleshman, Jeffrey R. Olsen, Robert J. Myerson, Parag J. Parikh
Purpose/ObjectivePreoperative short-course radiotherapy (SCRT) has rarely been utilized for rectal cancer in the United States (US), though two randomized phase III trials demonstrate equivalence to conventional chemoradiation (CRT)Bujko et al. (2006), Ngan S, Fisher R, Burmeister B, et al. Long-term Quality of Life in Patients Treated in TROG 01.04: A Randomized Trial Comparing Short Course and Long Course Preoperative Radiation Therapy for Rectal Cancer. Int. J. Radiat. Oncol (2012) and recent updates to national guidelines include this regimen as a treatment option. We sought to evaluate the efficacy and safety of preoperative SCRT followed by immediate surgery within one week to treat rectal cancer in the US setting.Methods and MaterialsAll patients treated with preoperative SCRT (4Gy x 5 fractions for total 20Gy) followed by planned surgery within one week at our institution were retrospectively evaluated. Censored cases with ≥2years of follow-up were included along with any disease failure or death. Patients with cM1 disease were excluded. Patients with yp stage II/III disease typically received adjuvant chemotherapy from the 1990s onwards. The primary outcomes were actuarial (Kaplan–Meier) five-year local control (LC), disease-free survival (DFS), and overall survival (OS) as well as late severe (≥ grade 3) toxicity.ResultsOur analysis included 202 consecutive patients with clinical stage I-III disease treated from 1977–2011. Median follow-up was 6.5years (range 2–29.2). Five-year disease outcomes were 95.9%±1.5% for LC, 76.4%±3.1% for DFS, and 84.6%±2.6% for OS. For patients with locally advanced rectal cancer (cT3–4 and/or cN+), five-year LC, DFS, and OS were 95.1%±2.1%, 73.3%±4.3%, and 80.6%±3.7%, respectively. The late severe toxicity rate was 11.4%.ConclusionsSCRT followed by immediate surgery is a safe and effective treatment for patients with rectal cancer in the US. Though SCRT has not been widely adopted, recent updates to the national guidelines for rectal cancer as well as financial pressures to reduce healthcare costs may lead to increased utilization of this treatment regimen in the future.



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Detailed Prospective Peer Review in a Community Radiation Oncology Clinic

Publication date: Available online 31 August 2016
Source:Practical Radiation Oncology
Author(s): James D. Mitchell, Thomas J. Chesnut, David V. Eastham, Carlo N. Demandante, David J. Hoopes
PurposeIn 2012, we instituted detailed prospective peer review of new cases. We present the outcomes of peer review on patient management, and time required for peer review.Methods and MaterialsPeer review rounds were held 3–4days weekly and required two physicians who reviewed pertinent information from the electronic medical record and treatment planning system. Eight aspects were reviewed for each case: 1. Workup and staging, 2. Treatment intent and prescription, 3. Position, immobilization, simulation, 4. Motion assessment and management, 5. Target contours, 6. Normal tissue contours, 7. Target dosimetry, and 8. Normal tissue dosimetry. Cases were marked as, "Meets standard of care," "Variation," or "Major deviation." Changes in treatment plan were noted. As our process evolved, we recorded the time spent reviewing each case.ResultsFrom 2012 to 2014, we collected peer review data on 442 of 465 (95%) radiotherapy patients treated in our hospital-based clinic. Overall, 91 (20.6%) of the cases were marked as having a variation, and 3 (0.7%) as major deviation. Forty-two (9.5%) of the cases were altered after peer review. An overall peer review score of "Variation" or "Major deviation" was highly associated with a change in treatment plan (p<0.01). Changes in target contours were recommended in 10% of cases. Gastrointestinal cases were significantly associated with a change in treatment plan after peer review. Indicators on position, immobilization, simulation, target contours, target dosimetry, motion management, normal tissue contours, and normal tissue dosimetry were significantly associated with a change in treatment plan. The mean time spent on each case was seven minutes.ConclusionsProspective peer review is feasible in a community radiation oncology practice. Our process led to changes in 9.5% of cases. Peer review should focus on technical factors like target contours and dosimetry. Peer review required seven minutes per case.



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8Gy Single-Fraction Radiation for Bone Metastases: Does the Data Support a One-Size-Fits-All Approach?

Publication date: Available online 31 August 2016
Source:Practical Radiation Oncology
Author(s): Victor J. Gonzalez, Krisha Howell




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Immunolocalization of pectic polysaccharides during abscission in pea seeds (Pisum sativum L.) and in abscission less def pea mutant seeds

In pea seeds (Pisum sativum L.), the presence of the Def locus determines abscission event between its funicle and the seed coat. Cell wall remodeling is a necessary condition for abscission of pea seed. The chan...

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Duodenal hemangiolymphangioma presenting as chronic anemia: a case report

Lymphangiomas are a heterogeneous group of congenital vascular malformations characterized by cystic dilation of lymphatic vessels. They can occur at any age, but they are more common during childhood and in c...

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Combining two open source tools for neural computation (BioPatRec and Netlab) improves movement classification for prosthetic control

Controlling a myoelectric prosthesis for upper limbs is increasingly challenging for the user as more electrodes and joints become available. Motion classification based on pattern recognition with a multi-ele...

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Pre-hospital portable monitoring of cerebral regional oxygen saturation (rSO2) in seven patients with out-of-hospital cardiac arrest

In recent years, measurement of cerebral regional oxygen saturation (rSO2) has attracted attention during resuscitation. However, serial changes of cerebral rSO2 in pre-hospital settings are unclear. The objectiv...

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Breathomics in asthma and COPD

Publication date: Available online 31 August 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Lieuwe D. Bos, Peter J. Sterk, Stephen J. Fowler
Exhaled breath contains thousands of volatile organic compounds (VOCs) that reflect the metabolic process occurring in the host both locally in the airways and systemically. They also arise from the environment and the airway microbiome. Comprehensive analysis of breath VOCs (breathomics) provides opportunities for non-invasive biomarker discovery and novel mechanistic insights. Applications in obstructive lung diseases, such as asthma and COPD, include not only diagnostics (especially in children and other challenging diagnostic areas) but also the identification of clinical treatable traits such as airway eosinophilia and risk of infection/exacerbation that are not specific to diagnostic labels. Whilst many aspects of breath sampling and analysis are challenging, proof of concept studies with mass-spectrometry and electronic noses technologies have provided independent studies with moderate to good diagnostic- and phenotypic accuracies. The present review evaluates the data obtained by breathomics in: a) predicting the inception of asthma or COPD, b) inflammatory phenotyping, c) predicting exacerbations and d) treatment stratification. The current findings merit the current efforts step of large multi-centre studies, using standardized sampling, shared anaytical methods and databases, including external validation cohorts. This will position this non-invasive technology in the clinical assessment and monitoring of chronic airways diseases.



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Barriers to follow-up care among survivors of adolescent and young adult cancer

Abstract

Purpose

Though the need for risk-based follow-up care for survivors of adolescent and young adult (AYA) cancer has been documented, survivors often report forgoing recommended care due to cost. We sought to understand whether additional barriers to follow-up care exist for AYA survivors.

Methods

We recruited survivors who were diagnosed with cancer between the ages of 15 and 39 using the Utah Cancer Registry (UCR). Overall, 28 survivors participated in 6 focus groups held between March and May 2015 in Salt Lake City and St. George, UT. Focus group discussions focused on the reasons survivors may or may not attend recommended medical visits after completing therapy.

Results

Survivors reported myriad barriers to follow-up medical visits, including lack of clear provider recommendation, fear of recurrent cancer diagnosis, wishing to move on with life, competing life responsibilities due to work and children, and not perceiving the need for a visit due to lack of symptoms.

Conclusions

Though cost likely plays a major part in follow-up care adherence for survivors of AYA cancer, in our focus groups, participants indicated there were many other psychosocial and logistic barriers to care. Such factors play an important role in the day-to-day lives of survivors and are critical in medical decision-making.

Implications for cancer survivors

Several factors impede follow-up care adherence for survivors of AYA cancer that are amenable to interventions, including clearer provider recommendations, flexible appointment times, and childcare availability in clinics.

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Unemployment risk 2 years and 4 years following gastric cancer diagnosis: a population-based study

Abstract

Purpose

The needs of gastric cancer survivors have received limited attention. Returning to work after gastric cancer has not yet been described in a population-based study. We aimed to examine the unemployment risk at 2 and 4 years after gastric cancer.

Methods

The present historical prospective cohort study included baseline measurements from the Israeli Central Bureau of Statistics 1995 National Census, with follow-up until 2011. A group with gastric cancer and an age-, sex-, and ethnicity-matched control group were sampled from the census population. Binary logistic regression analyses were used to assess odds ratios (ORs) for the study outcomes, controlling for socioeconomic factors, and employment status at 2 years before diagnosis.

Results

Data for 152 gastric cancer cases and 464 matched controls were analyzed. Those who died during the study period were excluded. Two years after diagnosis, 53.3 % of gastric cancer survivors and 43.8 % of controls were unemployed (p = 0.04); 4 years after diagnosis, 53.9 % of survivors, and 47.2 % of controls were unemployed (p = 0.15). In the adjusted models, gastric cancer was only associated with unemployment 2 years after diagnosis (OR = 1.47, 95 % confidence interval [CI] = 1.02–2.12). This association weakened and lost significance 4 years after diagnosis (OR = 1.42, 95 % CI = 0.89–2.28). Gastric cancer was not associated with decreased income at 2 (OR = 1.48, 95 % CI = 0.91–1.48) or 4 years (OR = 1.65, 95 % CI = 0.99–2.74) after diagnosis.

Conclusions

Gastric cancer survivorship was associated with unemployment 2 years after diagnosis. Longer-term survivors may have the prospect of returning to work.

Implications for cancer survivors

For patients with cancer, returning to work may be an indicator for returning to a normal lifestyle after serious illness. This study highlights the need for early social support in gastric cancer survivors to promote faster recovery.

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A local structured training program with live pigs allows performing ESD along the gastrointestinal tract with results close to those of Japanese experts

The high specific skill needed by ESD limit its widespread use in Europe and animal training is recommended in Europe to improve the results of ESD that are far from Japanese at present. We create a local training program using live pigs as models, along with our human cases, to provide continuous exposure to the technique.

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A simple scoring system to assess the need for an endoscopic intervention in suspected upper gastrointestinal bleeding: A prospective cohort study

Assessment of the emergent endoscopy for upper gastrointestinal bleeding (UGIB) patients has important clinical implications. There is no validated criterion to triage.

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A phase I study of recombinant (r) vaccinia-CEA(6D)-TRICOM and rFowlpox-CEA(6D)-TRICOM vaccines with GM-CSF and IFN-α-2b in patients with CEA-expressing carcinomas

Abstract

Prime-boost vaccination with recombinant (r) vaccinia(V)-CEA(6D)-TRICOM (triad of co-stimulatory molecules B7.1, ICAM-1 and LFA-3) and rFowlpox(F)-CEA(6D)-TRICOM infect antigen-presenting cells and direct expression of co-stimulatory molecules. We hypothesized that co-administration of vaccine with GM-CSF and interferon alpha (IFN-α) would have efficacy in CEA-expressing cancers. Patients with CEA-expressing cancers received the rV-CEA(6D)-TRICOM vaccine subcutaneously (s.c.) on day 1 followed by GM-CSF s.c. to the injection site on days 1–4. In Cycle 1, patients received thrice weekly s.c. injections of IFN-α-2b the week after rV-CEA(6D)-TRICOM. In Cycles 2–4, patients received thrice weekly s.c. injections of IFN-α-2b the same week that rF-CEA(6D)-TRICOM was given. The first cohort received no IFN followed by dose escalation of IFN-α in subsequent cohorts. Thirty-three patients were accrued (mean 59.8 years). Grade 3 toxicities included fatigue and hyperglycemia. Grade 4–5 adverse events (unrelated to treatment) were confusion (1), elevated aspartate transaminase (AST)/alanine transaminase (ALT) (1), and sudden death (1). No patients had a partial response, and eight patients exhibited stable disease of ≥3 months. Median progression-free survival and overall survival (OS) were 1.8 and 6.3 months, respectively. Significantly higher serum CD27 levels were observed after vaccine therapy (p = 0.006 post 1–2 cycles, p = 0.003 post 3 cycles, p = 0.03 post 4–7 cycles) and 42 % of patients assayed developed CEA-specific T cell responses. Pre-treatment levels of myeloid-derived suppressor cells correlated with overall survival (p = 0.04). Administration of IFN-α led to significantly increased OS (p = 0.02) compared to vaccine alone. While the vaccine regimen produced no clinical responses, IFN-α administration was associated with improved survival.

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Drug susceptibility patterns of the Mycobacterium tuberculosis isolated from previously treated and new cases of pulmonary tuberculosis at German-Nepal tuberculosis project laboratory, Kathmandu, Nepal

Multidrug resistant tuberculosis (MDR-TB) is a serious public health problem in Nepal. It is a major obstacle for the control of the tuberculosis. The main objectives of this study were to determine the preval...

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Re: Minimal invasive treatment using patient-specific template for pediatric mandibular fracture: “wing-splint” by CAD/CAM technology

Publication date: Available online 30 August 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.F. Hegab




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Preventing Long-Term Cardiac Damage in Pediatric Patients With Kawasaki Disease

Kawasaki disease is currently the leading cause of long-term cardiac damage in pediatric patients in the United States. Kawasaki disease is diagnosed based on symptomatology and by ruling out other etiology. There is a significant need for an improved, standardized treatment protocol for patients diagnosed with Kawasaki disease and a more rapid initiation of treatment for these patients. Decreasing the cardiac damage caused by Kawasaki disease with timely diagnosis and treatment needs be a principal goal.

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