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The objective of this study has been to identify monitor unit (MU) and treatment time variations, volume coverage dissimilarity among 3D conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) treatment plans for head and neck cancer (HNC) based on literature review.
A number of HNC cases were studied with the investigation of conformity and homogeneity index.
When high-dose modulation was required around small organs at risk (OARs), a clinically acceptable IMRT plan was achieved as VMAT usually required longer dose optimisation time. The greatest benefit of VMAT has been rapid treatment delivery allowing improved patient comfort, reduced intra-fraction motion and increased patient throughput. In some papers, 3D-CRT was shown not to meet well the requirements on parotid glands. One paper showed that cerebellum dose was lower for 3D-CRT than IMRT. However, it was found in other papers that OAR sparing with 3D-CRT was reasonable but in complex cases not enough.
IMRT usually consists of several treatment fields with different directions, hundreds of beam lets with modulated intensity, an advantage over 3D-CRT, whereas VMAT has advantage over IMRT due to rotating beam utilisation. VMAT has lower total MU and treatment times than IMRT and 3D-CRT, while maintaining similar dosimetric endpoints.
Cold dissection is the most commonly used tonsillectomy technique, with low post-operative haemorrhage rates. Coblation is an alternative technique that may cause less pain, but could have higher post-operative haemorrhage rates.
This study evaluated the peri-operative outcomes in paediatric tonsillectomy patients by comparing coblation and cold dissection techniques.
A systematic review was conducted of all comparative studies of paediatric coblation and cold dissection tonsillectomy, up to December 2018. Any studies with adults were excluded. Outcomes such as pain, operative time, and intra-operative, primary and secondary haemorrhages were recorded.
Seven studies contributed to the summative outcome. Coblation tonsillectomy appeared to result in less pain, less intra-operative blood loss (p < 0.01) and a shorter operative time (p < 0.01). There was no significant difference between the two groups for post-operative haemorrhage (p > 0.05).
The coblation tonsillectomy technique may offer better peri-operative outcomes when compared to cold dissection, and should therefore be offered in paediatric cases, before cold dissection tonsillectomy.
Thermoelectric (TE) materials, or materials that can generate an electrical energy from temperature gradient, are promising for renewable energy technology. One fundamental aspect in the TE research is the demand to maximize the TE power-factor, PF = S2 σ, by having as large Seebeck coefficient (S) and electrical conductivity (σ) as possible. In the early 90s, Hicks and Dresselhaus proposed the PF enhancement by using low-dimensional materials, in which electrons are confined in certain directions and they move freely in the other directions. This quantum effect is known as the confinement length (L) effect, in which L is the thickness or diameter of the two-dimensional (2D) or one-dimensional materials, respectively. However, a key challenge is to understand the critical value of L, at which the PF can be significantly enhanced. Recently, we reevaluated the confinement theory of the low-dimensional materials to solve this issue. We showed that electrons are fully confined only when L is smaller than an intrinsic length Λ, the so-called thermal de Broglie wavelength, which depends on the materials and can be experimentally measured. Monolayer 2D materials naturally satisfy the condition of L < Λ since their confinement length is ∼ 1 nm, while their thermal de Broglie wavelength is ∼ 5-10 nm. Therefore, they could be a good candidate for TE materials. In this review article, we first review the TE materials with low dimensions. Then, we show the basic concept of the confinement effect and the consequence of such an effect. Finally, based on this effect, we turn our attention to the progress achieved recently in the TE properties of the 2D materials such as monolayer InSe, GaN electron gas, and SrTiO3 superlattices.
Accurate localisation of target position is crucial when using techniques with sharp dose fall off such as volumetric modulated arc therapy (VMAT). Gold seed fiducial markers have been used for target localisation in image-guided radiation therapy for various tumors including intact prostate cancers. However, their role for target localisation in post-prostatectomy radiotherapy is unclear. This study was undertaken to determine the feasibility and effectiveness of gold seed fiducial markers in patients undergoing prostate bed VMAT.
Materials and methods:
The institutional radiation oncology database was used to analyse the treatment data of 18 post-prostatectomy patients with implanted gold seed fiducial markers. The shifts of the fiducial markers were reviewed, tabulated and statistically analysed.
Three hundred and eighty-six orthogonal pair images for 18 patients were reviewed. Specifically, the average gold seed fiducial shifts were 0·34 cm in the superior–inferior (S/I) axis (0·31 SD), 0·31 cm (0·29 SD) in the anterior–posterior (A/P) axis and 0·28 cm (0·25 SD) in the lateral axis (R/L). As a result, the 95% probability of fiducial marker displacement was 0·96 cm in the S/I, 0·89 cm in the A/P and 0·78 cm in the R/L axes. The most frequent shifts occurred in the inferior, left and posterior directions. The percentage of shifts more than 0·5 cm were 19·74, 21·56 and 12·47% for the S/I, A/P and R/L axes, respectively.
In the absence of fiducial markers, non-uniform planning target volume (PTV) margins of 1 cm for S/I, 9 mm for A/P and 8 mm for the lateral direction are necessary for target localisation in post-prostatectomy radiotherapy. By improving prostate bed localisation, gold seed fiducial markers can decrease PTV margins, reduce normal tissue radiation exposure and allow for dose-escalated and/or hypofractionated radiotherapy to be considered in appropriate clinical scenarios.
A core question in the debate about how to organise mental healthcare is whether in- and out-patient treatment should be provided by the same (personal continuity) or different psychiatrists (specialisation). The controversial debate drives costly organisational changes in several European countries, which have gone in opposing directions. The existing evidence is based on small and low-quality studies which tend to favour whatever the new experimental organisation is.
We compared 1-year clinical outcomes of personal continuity and specialisation in routine care in a large scale study across five European countries.
This is a 1-year prospective natural experiment conducted in Belgium, England, Germany, Italy and Poland. In all these countries, both personal continuity and specialisation exist in routine care. Eligible patients were admitted for psychiatric in-patient treatment (18 years of age), and clinically diagnosed with a psychotic, mood or anxiety/somatisation disorder.
Outcomes were assessed 1 year after the index admission. The primary outcome was re-hospitalisation and analysed for the full sample and subgroups defined by country, and different socio-demographic and clinical criteria. Secondary outcomes were total number of inpatient days, involuntary re-admissions, adverse events and patients’ social situation. Outcomes were compared through mixed regression models in intention-to-treat analyses. The study is registered (ISRCTN40256812).
We consecutively recruited 7302 patients; 6369 (87.2%) were followed-up. No statistically significant differences were found in re-hospitalisation, neither overall (adjusted percentages: 38.9% in personal continuity, 37.1% in specialisation; odds ratio = 1.08; confidence interval 0.94–1.25; p = 0.28) nor for any of the considered subgroups. There were no significant differences in any of the secondary outcomes.
Whether the same or different psychiatrists provide in- and out-patient treatment appears to have no substantial impact on patient outcomes over a 1-year period. Initiatives to improve long-term outcomes of psychiatric patients may focus on aspects other than the organisation of personal continuity v. specialisation.
Rabies is one of the major public health problems in China, and the mortality rate of rabies remains the highest among all notifiable infectious diseases. A meta-analysis was conducted to investigate the post-exposure prophylaxis (PEP) vaccination rate and risk factors for human rabies in mainland China. The PubMed, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical and Wanfang databases were searched for articles on rabies vaccination status (published between 2007 and 2017). In total, 10 174 human rabies cases from 136 studies were included in this meta-analysis. Approximately 97.2% (95% confidence interval (CI) 95.1–98.7%) of rabies cases occurred in rural areas and 72.6% (95% CI 70.0–75.1%) occurred in farmers. Overall, the vaccination rate in the reported human rabies cases was 15.4% (95% CI 13.7–17.4%). However, among vaccinated individuals, 85.5% (95% CI 79.8%–83.4%) did not complete the vaccination regimen. In a subgroup analysis, the PEP vaccination rate in the eastern region (18.8%, 95% CI 15.9–22.1%) was higher than that in the western region (13.3%, 95% CI 11.1–15.8%) and this rate decreased after 2007. Approximately 68.9% (95% CI 63.6–73.8%) of rabies cases experienced category-III exposures, but their PEP vaccination rate was 27.0% (95% CI 14.4–44.9%) and only 6.1% (95% CI 4.4–8.4%) received rabies immunoglobulin. Together, these results suggested that the PEP vaccination rate among human rabies cases was low in mainland China. Therefore, standardised treatment and vaccination programs of dog bites need to be further strengthened, particularly in rural areas.
The present analysis has been developed to investigate the heat transfer phenomenon in peristaltic flow of Carreau fluid in a curved channel with rhythmic contraction and expansion of waves along the walls (similar to blood flow in tubes). Magnetic field is imposed in radial direction. The heat transfer aspect is further studied with viscous dissipation effect. The curved channel walls are influenced by flow and thermal partial slip. In addition the flow stream comprised porous medium. The system of relevant non-linear PDEs have been reduced to ODEs by utilizing the long wavelength approximation. The striking features of flow and temperature characteristics under the involved parameters are examined by plotting graphs. The generation of fluid temperature and velocity due to viscous dissipation and gravitational efforts are recorded respectively. Moreover indicated results signify activation of velocity, temperature and heat transfer rate with Darcy number.
Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88) presented a critique of our recently published paper in Cell Reports entitled ‘Large-Scale Cognitive GWAS Meta-Analysis Reveals Tissue-Specific Neural Expression and Potential Nootropic Drug Targets’ (Lam et al., Cell Reports, Vol. 21, 2017, 2597–2613). Specifically, Hill offered several interrelated comments suggesting potential problems with our use of a new analytic method called Multi-Trait Analysis of GWAS (MTAG) (Turley et al., Nature Genetics, Vol. 50, 2018, 229–237). In this brief article, we respond to each of these concerns. Using empirical data, we conclude that our MTAG results do not suffer from ‘inflation in the FDR [false discovery rate]’, as suggested by Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88), and are not ‘more relevant to the genetic contributions to education than they are to the genetic contributions to intelligence’.
The Khyber Pakhtunkhwa province of North-West Pakistan has endured increased levels of violence in recent years. The psychological sequelae of such trauma including the presence of dissociative symptoms has been minimally investigated to date. The study examines psychopathology experienced including the presence of dissociative symptoms, and ascertain what factors are potentially predictive of these symptoms.
Third-level students (n=303) completed psychometric instruments relating to their experience of traumatic events and assessed depression, anxiety and dissociative symptoms.
Symptoms suggestive of post-traumatic stress disorder were evident in 28% of individuals. Symptoms relating to intrusive experiences and alterations in reactivity predicted dissociative, depressive and anxiety symptoms (p<0.01).
Trauma related to violence in this study was associated with significant pathology including dissociative symptoms. Identification and subsequent treatment of dissociative symptoms in individuals who have experienced trauma, may have a significant ameliorating effect on levels of functioning and thus should be included in clinical assessment.
The nuculanid bivalve Costinuculana magharensis new genus new species is described from the middle to upper Bathonian Kehailia Formation of Gebel Maghara, North Sinai, Egypt. Costinuculana differs from other genera of the family Nuculanidae by the presence of opisthocline ribs along the rostrum. These ribs are variable in shape and size, straight to folded posteriorly, bifurcate ventrally and occasionally postero-dorsally, and cover an area ~45% of the total valve length from the posterior end. The life position of C. magharensis n. gen. n. sp. is reconstructed on the basis of a functional interpretation of its morphology and by comparison with closely related Recent forms. The asymmetrical commarginal ribs facilitated the burrowing process. The posterior oblique ribs are asymmetrical in cross-section with a steeply concave side in the burrowing direction and slightly convex side in the opposite direction. They probably kept the bivalve in a stable position once the desired depth had been reached. The thick oblique ribs probably also increased the strength of the rostrum and offered resistance against durophagous predators, being presumably partly exposed above the sediment-water interface. Based on the associated fauna, Costinuculana n. gen. lived in a low-energy environment characterized by a fine-grained, soft substrate.
A paraxial ray formalism is developed to study the evolution of an on axis intensity spike on a Gaussian laser beam in a plasma dominated by relativistic and ponderomotive non-linearities. Ion motion is taken to be frozen. A single beam width parameter characterizes the evolution of the spike. The spike introduces two competing influences: diffraction divergence and self-convergence. The former grows with the reduction in spot size of the spike, while the latter depends on the gradient in non-linear permittivity. Parameter δ = (ωpr00/c) a00/(3.5 r00/r01) characterizes the relative importance of the two, where r01 and r00 are the spike and main beam radii, ωp is the plasma frequency, and a00 is the normalized laser amplitude. For δ > 1, the intensity ripple causes faster self-focusing of the beam; higher the ripple amplitude stronger the focusing. In the opposite limit, diffraction divergence increases more rapidly, slowing down the self-focusing of the beam. As the beam intensity rises due to self-focusing, it causes stronger generation of the third harmonic.
Avian pathogenic Escherichia coli (APEC) is one of the most
economically damaging diseases affecting the poultry industry. This group of
extra-intestinal E. coli causes a variety of clinical
conditions including air-sacculitis and cellulitis. The economic impact of APEC
is mainly due to mortality, slower growth rates and carcass downgrading. In
commercial broiler operations, APEC infections are controlled indirectly by
vaccination against other respiratory diseases and minimising stress conditions,
and directly by administration of antimicrobial agents to suppress symptoms in
infected flocks. Several studies have demonstrated that the most common
virulence factors studied in APEC are rarely present in the same isolate,
showing that APEC strains constitute a heterogeneous group. Different isolates
may harbour different associations of virulence factors, each able to induce
colibacillosis. Despite its economical relevance, the pathogenesis of
colibacillosis is poorly understood. The O antigen, a component of the surface
lipopolysaccharide, has been identified as a promising vaccine target. With the
availability of a novel bioconjugation technology it is expected that
multivalent O antigen conjugate vaccines can be produced on an industrial scale.
Despite the potential for developing an efficacious vaccine to combat this
economically important poultry disease, several obstacles hinder such efforts.
These include cost, vaccine delivery method and timing of vaccination. The
present discusses current knowledge on APEC virulence, host response to
infection and various attempts to develop an effective vaccine
We examined functional outcomes and quality of life of whole brain radiotherapy (WBRT) with integrated fractionated stereotactic radiotherapy boost (FSRT) for brain metastases treatment. Methods Eighty seven people with 1-3 brain metastases were enrolled on this Phase II trial of WBRT (30Gy/10)+simultaneous FSRT, (60Gy/10). Results Mean (Min-Max) baseline KPS, Mini Mental Status Exam (MMSE) and FACT-BR quality of life were 83 (70-100), 28 (21-30) and 143 (98-153). Lower baseline MMSE (but not KPS or FACT-Br) was associated with worse survival after adjusting for age, number of metastases, primary and extra-cranial disease status. Crude rates of deterioration (>10 points decrease from baseline for KPS and FACT-Br, MMSE fall to<27) ranged from 26-38% for KPS, 32-59% for FACT-Br and 0-16%for MMSE depending on the time-point assessed with higher rates generally noted at earlier time points (<6months post-treatment). Using a linear mixed models analysis, significant declines from baseline were noted for KPS and FACT-Br (largest effects at 6 weeks to 3 months) with no significant change in MMSE. Conclusions The effects on function and quality of life of this integrated treatment of WBRT+simultaneous FSRT were similar to other published series combining WBRT+SRS.
Avian influenza viruses have become endemic in land-based domestic poultry and have crossed species barriers. Turkeys are an important host in influenza virus ecology because they are susceptible to infection with these viruses and are often involved in inter species transmission. Several previous studies reveal that waterfowl-origin influenza viruses can be more easily transmitted to domestic turkeys than to chickens. Studies indicate turkeys to be better hosts for low pathogenic avian influenza viruses isolated from commercial poultry operations and live bird markets in comparison to chickens. Moreover, turkeys require low, 50% infectious-dose titres from wild bird as well as poultry adapted viruses, suggesting their high susceptibility for infection following a low dose exposure. Additionally, interspecies transmission of swine influenza viruses to turkeys occurs frequently, thus turkeys may be considered as a bridge species between poultry and wildlife. These findings suggest that turkeys can be easily infected with influenza viruses of different origins and highlight the potential role of turkeys in the transmission and maintenance of influenza viruses between premises.
Background: Infection to the facet joints has been reported sporadically but the significance of this type of infection has not been clarified. In our study on spine infection, we identified the cases of spinal epidural abscess with septic joints and was able to compare to cases of epidural abscess with discitis and osteomyelitis. Methods: Between 2007 and 2014, we experienced 176 cases of spine infection including discitis, osteomyelitis and epidural abscess. Retrospective review of the clinical data and radiological findings was performed. Among 176 cases, 80 patients had epidural abscess. They were divided to two groups, one with septic joint and the other with discitis and osteomyelitis. Results: 23 patients were found to have septic joints with epidural abscess based on the MRI findings. Mean age was 45.5. 15 of 23 patients (65%) required surgery and all treated with laminectomy. 78% had a good neurological outcome.
57 patients had epidural abscess with discitis and osteomyelitis. Mean age was 54. 51% required surgery. Only 62 % was treated with laminectomy alone. Good neurological outcome was seen in 67% of the patients. Conclusions: Infected facet joints are not as rare as generally believed. The patients with septic joints are younger. Surgery was done more often and laminectomy provided better neurological outcome
Cardiopulmonary bypass is associated with systemic inflammatory response. Steroids suppress this response, although the therapeutic evidence remains controversial. We hypothesised that intravenous steroids in children undergoing open-heart surgery would decrease inflammation leading to better early post-operative outcomes. We conducted a randomised controlled trial to evaluate the trends in the levels of immunomodulators and their effects on clinical parameters.
To assess the effects of intravenous steroids on early post-operative inflammatory markers and clinical parameters in children undergoing open-heart surgery.
Materials and methods
A randomised controlled trial involving 152 patients, from one month up to 18 years of age, who underwent open-heart surgery for congenital heart disease from April 2010–2012 was carried out. Patients were randomised and administered either three scheduled intravenous pulse doses of dexamethasone (1 mg/kg) or placebo. Blood samples were drawn at four time intervals and serum levels of inflammatory cytokines – Interleukin-6, 8, 10, 18, and tumour necrosis factor-alpha – were measured. Clinical parameters were also assessed.
Blood cytokine levels were compared between the dexamethasone (n=65) and placebo (n=64) groups. Interleukin-6 levels were lower at 6 and 24 hours post-operatively (p<0.001), and Interleukin-10 levels were higher 6 hours post-operatively (p<0.001) in the steroid group. Interleukin-8, 18, and tumour necrosis factor-alpha levels did not differ between the groups at any time intervals. The clinical parameters were similar in both the groups.
Dexamethasone caused quantitative suppression of Interleukin-6 and increased Interleukin-10 activation, contributing to reduced immunopathology, but it did not translate into clinical benefit in the short term.
The mechanisms involved in the formation of titanium (Ti) nanoclusters produced by sputtering and inert gas condensation were investigated experimentally and numerically. Ti nanoclusters were generated inside an ultrahigh vacuum compatible system under different source parameters, i.e., inert gas flow rate (fAr), length of the aggregation region (L), and sputtering discharge power (P). Nanocluster size and yield were measured using a quadrupole mass filter (QMF). The variation of the above source parameters enabled fine-tuning of the nanocluster size and yield. Herein, Ti nanoclusters were produced within the size range 3.0–10.0 nm. The combination between the nanocluster size and yield as a function of source parameters enabled understanding Ti nanocluster formation mechanisms, i.e., three-body and two-body collisions. The results show that two-body collisions dominate nanocluster production at low fAr while the three-body collisions dominate at high fAr. In addition, nanocluster size increases as L increases due to the increase in nanocluster nucleation and growth times. The maximum nanocluster yield was obtained at fAr that maximize the probability of three-body and two-body collisions. Nanoclusters could be produced within an optimum range of the sputtering discharge power wherein the nanocluster size and yield increase with increasing the discharge power as a result of increasing the amount of sputtered material. The experimental results were compared with a theoretical model of nanocluster formation via three-body collision. Detailed understanding of the evolution of size and yield of Ti (and Ti-oxide) nanoclusters is essential for producing nanoclusters that can be utilized for environmental applications such as conversion of carbon dioxide and water vapor into hydrocarbons.