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The aim of this study was to investigate the extent to which lung stereotactic body radiotherapy (SBRT) treatment plans can be improved by replacing conventional flattening filter (FF) beams with flattening filter-free (FFF) beams.
Materials and methods:
We selected 15 patients who had received SBRT with conventional 6-MV photon beams for early-stage lung cancer. We imported the patients’ treatment plans into the Eclipse 13·6 treatment planning system, in which we configured the AAA dose calculation model using representative beam data for a TrueBeam accelerator operated in 6-MV FFF mode. We then created new treatment plans by replacing the conventional FF beams in the original plans with FFF beams.
The FFF plans had better target coverage than the original FF plans did. For the planning target volume, FFF plans significantly improved the D98, D95, D90, homogeneity index and uncomplicated tumour control probability. In most cases, the doses to organs at risk were lower in FFF plans. FFF plans significantly reduced the mean lung dose, V10, V20, V30, and normal tissue complication probability for the total lung and improved the dosimetric indices for the ipsilateral lung. For most patients, FFF beams achieved lower maximum doses to the oesophagus, heart and the spinal cord, and a lower chest wall V30.
Compared with FF beams, FFF beams achieved lower doses to organs at risk, especially the lung, without compromising tumour coverage; in fact, FFF beams improved coverage in most cases. Thus, replacing FF beams with FFF beams can achieve a better therapeutic ratio.
Purported superior outcomes for treatment of psychosis in low- and middle-income (LMICs) compared with high-income (HICs) countries have not been examined in the context of early intervention services (EIS).
To compare 2-year clinical outcomes in first-episode psychosis (FEP) treated in EIS in Chennai (LMIC) and Montreal (HIC) using a similar EIS treatment protocol and to identify factors associated with any outcome differences.
Patients with FEP treated in EIS in Chennai (n = 168) and Montreal (n = 165) were compared on change in level of symptoms and rate and duration of positive and negative symptom remission over a 2-year period. Repeated-measures analysis of variance, and logistic and linear regression analyses were conducted.
Four patients died in Chennai compared with none in Montreal. Family support was higher for Chennai patients (F = 14.05, d.f. = 1, P < 0.001, ƞp2 = 0.061) and increased over time at both sites (F = 7.0, d.f. = 1.915, P < 0.001, ƞp2 = 0.03). Negative symptom outcomes were significantly better in Chennai for level of symptoms (time × site interaction F = 7.36, d.f. = 1.49, P = 0.002, ƞp2 = 0.03), duration of remission (mean 16.1 v. 9.78 months, t = −7.35, d.f. = 331, P < 0.001, Cohen's d = 0.80) and the proportion of patients in remission (81.5% v. 60.3%, χ2 = 16.12, d.f. = 1, P < 0.001). The site differences in outcome remained robust after adjusting for inter-site differences in other characteristics. Early remission and family support facilitated better outcome on negative symptoms. No significant differences were observed in positive symptom outcomes.
Patients with FEP treated in EIS in LMIC contexts are likely to show better outcome on negative symptoms compared with those in HIC contexts. Early remission and family support may benefit patients across both contexts.
Herein, we report a synthetic route capable of producing superparamagnetic, stable and biocompatible glucosamine (GLU) nanocarriers, composed by colloidal iron oxide nanoparticles (ION, ~6 nm) surface-functionalized with GLU dispersed in physiological media (pH 7.2). The route consists first of the preparation of ION by aqueous alkaline co-precipitation of 1:2 Fe(II)/Fe(III) followed by surface treatment with citric acid, activation of acidic groups via carbodiimide intermediary and further amidation using GLU as the amine reactant. Results from cell viability tests performed with human dental pulp tissue cells suggest that ION–GLU nanocolloids are biocompatible and non-toxic for two different concentrations and several hours of incubation. Moreover, optical microscopy shows that ION–GLU adsorbs at the cells walls and also transposes them, reaching cytoplasm and nucleus as well. All findings point out the promising use of ION–GLU as biocompatible nanocarriers for GLU delivery such as in articulation diseases.
Studies on relationships between music, visual imagery or therapeutic techniques, like mindfulness and emotions have been undertaken with varying success in predominantly adult populations. Their role in the child and adolescent population remains unclear.
Aims and objectives
We undertook a systematic literature review to assess current evidence in the use of music, guided imagery with/without therapeutic techniques for emotional processing in adults, children and adolescents.
We identified 87 relevant papers (JSTOR, OVID Medline, Cochrane, PubMed, Science Direct, Taylor & Francis and Wiley). We excluded non-English papers and qualitative analyses. Nine studies used quantitative techniques (Neuroimaging) for assessing emotional change using musical and non-musical stimuli (n = 77). Of these, four studies used fMRI and two used PET scans.
fMRI demonstrates a significant relation between amygdalar activation and emotional response to visual imagery (P < 0.05, n = 45). Early information using PET scanning shows a significant association between activation of different parts of brain with varied visual imagery (one study, n = 5) and varied music (one study, n = 10). There is similarity in the activation of specific cortical areas using musical and non-musical stimuli. Two separate studies of patients with damaged amygdala due to disease (n = 6) showed significant impairment of emotional processing and response.
There is early encouraging data providing evidence of possible relationships between music and visual imagery in emotional processing. Further studies are needed to examine these in detail, especially in children/adolescents. Music with visual imagery may be a useful adjunct in the self-guided processing of milder emotional disorders with components of anxiety, depression, adjustment and emotional dysregulation.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
To investigate the impact of intra-fractional motion on dose distribution in patients treated with intensity-modulated radiotherapy (IMRT) for lung cancer.
Materials and methods:
Twenty patients who had undergone IMRT for non-small cell lung cancer were selected for this retrospective study. For each patient, a four-dimensional computed tomography (CT) image set was acquired and clinical treatment plans were developed using the average CT. Dose distributions were then recalculated for each of the 10 phases of respiratory cycle and combined using deformable image registration to produce cumulative dose distributions that were compared with the clinical treatment plans.
Intra-fractional motion reduced planning target volume (PTV) coverage in all patients. The median reduction of PTV covered by the prescription isodose was 3·4%; D98 was reduced by 3·1 Gy. Changes in the mean lung dose were within ±0·7 Gy. V20 for the lung increased in most patients; the median increase was 1·6%. The dose to the spinal cord was unaffected by intra-fractional motion. The dose to the heart was slightly reduced in most patients. The median reduction in the mean heart dose was 0·22 Gy, and V30 was reduced by 2·5%. The maximum dose to the oesophagus was also reduced in most patients, by 0·74 Gy, whereas V50 did not change significantly. The median number of points in which dose differences exceeded 3%/3 mm was 6·2%.
Intra-fractional anatomical changes reduce PTV coverage compared to the coverage predicted by clinical treatment planning systems that use the average CT for dose calculation. Doses to organs at risk were mostly over-predicted.
India has the second largest number of people with type 2 diabetes (T2D) globally. Epidemiological evidence indicates that consumption of white rice is positively associated with T2D risk, while intake of brown rice is inversely associated. Thus, we explored the effect of substituting brown rice for white rice on T2D risk factors among adults in urban South India. A total of 166 overweight (BMI ≥ 23 kg/m2) adults aged 25–65 years were enrolled in a randomised cross-over trial in Chennai, India. Interventions were a parboiled brown rice or white rice regimen providing two ad libitum meals/d, 6 d/week for 3 months with a 2-week washout period. Primary outcomes were blood glucose, insulin, glycosylated Hb (HbA1c), insulin resistance (homeostasis model assessment of insulin resistance) and lipids. High-sensitivity C-reactive protein (hs-CRP) was a secondary outcome. We did not observe significant between-group differences for primary outcomes among all participants. However, a significant reduction in HbA1c was observed in the brown rice group among participants with the metabolic syndrome (−0·18 (se 0·08) %) relative to those without the metabolic syndrome (0·05 (se 0·05) %) (P-for-heterogeneity = 0·02). Improvements in HbA1c, total and LDL-cholesterol were observed in the brown rice group among participants with a BMI ≥ 25 kg/m2 compared with those with a BMI < 25 kg/m2 (P-for-heterogeneity < 0·05). We observed a smaller increase in hs-CRP in the brown (0·03 (sd 2·12) mg/l) compared with white rice group (0·63 (sd 2·35) mg/l) (P = 0·04). In conclusion, substituting brown rice for white rice showed a potential benefit on HbA1c among participants with the metabolic syndrome and an elevated BMI. A small benefit on inflammation was also observed.
Nature’s optical nanomaterials are poised to form the platform for future optical devices with unprecedented functionality. The brilliant colors of many animals arise from the physical interaction of light with nanostructured, multifunctional materials. While their length scale is typically in the 100-nm range, the morphology of these structures can vary strongly. These biological nanostructures are obtained in a controlled manner, using biomaterials under ambient conditions. The formation processes nature employs use elements of both equilibrium self-assembly and far-from-equilibrium and growth processes. This renders not only the colors themselves, but also the formation processes technologically and ecologically highly relevant. Yet, for many biological nanostructured materials, little is known about the formation mechanisms—partially due to a lack of in vivo imaging methods. Here, we present the toolbox of natural multifunctional nanostructures and the current knowledge about the understanding of their far-from-equilibrium assembly processes.
Far-from-equilibrium systems are ubiquitous in nature. They are also rich in terms of diversity and complexity. Therefore, it is an intellectual challenge to be able to understand the physics of far-from-equilibrium phenomena. In this article, we revisit a standard tabletop experiment, the Rayleigh–Bénard convection, to explore some fundamental questions and present a new perspective from a first-principles point of view. We address how nonequilibrium fluctuations differ from equilibrium fluctuations, how emergence of order out of equilibrium breaks symmetries in the system, and how free energy of a system gets locally bifurcated to operate a Carnot-like engine to maintain order. The exploration and investigation of these nontrivial questions are the focus of this article.
Materials can be endowed with unique properties by the integration of molecular motors. Molecular motors can have a biological origin or can be chemically synthesized and produce work from chemical energy or light. Their ability to access large internal or external reservoirs of energy enables a wide range of nonequilibrium behaviors, including the production of force, changes in shape, internal reorganization, and dynamic changes in mechanical properties—muscle tissue is one illustration of the possibilities. Current research efforts advance our experimental capabilities to create such “active matter” by using either biomolecular or synthetic motors, and also advance our theoretical understanding of these materials systems. Here, we introduce this exciting research field and highlight a few of the recent advances as well as open questions.
This article addresses why biomaterials are a growing part of materials science. We consider two areas at two different scales. At the nanometer scale, enzymes are heterogeneous nanoparticles of extraordinary deformability; this property allows us to view biomolecules informed by concepts of materials science and nonlinear physics. A degree of universality in the mechanical behavior of the molecules appears in the ubiquitous softening transitions; some results obtained dynamically by nanorheology, and others obtained in equilibrium experiments through the method of the DNA springs are summarized. These soft molecules represent an opportunity for studies of dissipation at the atomic scale. At the mesoscopic scale, composite functional materials with biological components hold promise for applications such as low power, chemically driven, biodegradable devices. A concrete example, and a program for the future, is the artificial axon. It is a synthetic structure that supports action potentials based on the same physical mechanism as the voltage spikes in nerve cells. A network of such axons, which is yet to come, would constitute an artificial brain. Beyond device applications, the focus here is on the basic science, namely, a constructivist approach to cybernetics, algorithmic mathematics, and the brain.