While the noninvasive breast brachytherapy (NIBB) treatment procedure, known as AccuBoost, for breast cancer patients is well established, the treatment quality can be improved by the efficiency of ...the workflow delivery. A formalized approach evaluated the current workflow through failure modes and effects analysis and generated insight for developing new procedural workflow techniques to improve the clinical treatment process.
AccuBoost treatments were observed for several months while gathering details on the multidisciplinary workflow. A list of possible failure modes for each procedure step was generated and organized by timing within the treatment process. A team of medical professionals highlighted procedural steps that unnecessarily increased treatment time, as well as introduced quality deficiencies involving applicator setup, treatment planning, and quality control checks preceding brachytherapy delivery. Procedural improvements and their impact on the clinical workflow are discussed.
The revised clinical workflow included the following key procedural enhancements. Prepatient arrival: Improvement of prearrival preparation requires advance completion of dose calculation documentation with patient-specific setup data. Patient arrival pretreatment: Physicists carry out dwell time calculations and check the plan, while the therapist concurrently performs several checks of the ensuing hardware configuration.
An electronic method to export the associated HDR brachytherapy paperwork to the electronic medical record system with electronic signatures and captured approvals was generated. Posttreatment: The therapist confirms the applicators were appropriately positioned, and treatment was delivered as expected.
The procedural improvements reduced the overall treatment time, improved consistency across users, and eased performance of this special procedure for all participants.
The purpose of this article is to report the clinical experience and technical feasibility of percutaneous radiofrequency ablation in conjunction with brachytherapy, a novel approach in the treatment ...of lung neoplasms. Data from three patients with lung malignancies illustrate the expanding therapeutic indications of this minimally invasive intervention.
Percutaneous radiofrequency ablation in conjunction with brachytherapy is a promising minimally invasive combination modality. It may be a treatment option for patients with primary, recurrent, or metastatic malignancies of the lung that are not amenable to surgery or further external beam radiation therapy.
El objetivo de este trabajo es demostrar la utilidad de las técnicas de tensor de difusión de alta densidad (DTI 32 direcciones) para visualizar el trayecto de los pares craneales antes de la cirugía ...en pacientes con patología tumoral de la base del cráneo.
Se estudiaron 26 pacientes con patología tumoral de la base del cráneo con secuencias de tensor de difusión de alta densidad. Los resultados imagenológicos fueron correlacionados con los hallazgos intraoperatorios.
En todos los pacientes estudiados fue posible la identificación prequirúrgica del recorrido de los nervios involucrados por las lesiones de la base del cráneo y también hubo una correlación entre los datos obtenidos mediante las imágenes y los hallazgos intraoperatorios.
La visualización del recorrido de los nervios craneales mediante la difusión de alta densidad demostró ser segura y reproducible para identificar los pares y su recorrido.
The objective of this work is to demonstrate the usefulness of high density diffusion tensor imaging techniques (HD-DTI 32 directions), to visualize the course of the cranial nerves prior to surgery in patients with skull base tumor disease.
Twenty-six patients with skull base tumor disease were studied with sequences of high density diffusion tensor imaging. The imaging results were correlated with the intra-operative findings.
Pre-surgical identification of the course of the nerves affected by the injuries of the skull base was possible in all the studied patients, with the imaging results correlating with the intraoperative findings.
The visualization of the course of the cranial nerves with high density diffusion tensor imaging was shown to be safe and reproducible for the identification of cranial nerves and their course.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Dog bites are a frequent injury, but the incidence and type of lesions vary across countries. Although only few patients develop complications, the treatment of advanced injuries has a considerable ...medical, social and economic impact. A frequently isolated pathogen in dog bite wounds is Capnocytophaga canimorsus, a bacterium that can cause sepsis or meningitis. Hyperbaric oxygen (HBO₂) therapy has been shown to be useful in treating anaerobic infections, most likely because it creates an inhospitable environment for the bacterium and enhances the patient's immune response.
We present a case series of C. canimorsus infections treated with HBO₂ in adjunction to antibiotic therapy. Furthermore, we tested the in vitro activity of ceftaroline against C. canimorsus, alone and in association with hyperbaric oxygen therapy.
We included nine (9) patients admitted to the surgery department of "A. Cardarelli" Hospital (Naples) after dog bite, from 2010 to 2016. All were initially treated with antibiotics and required transfer to the intensive care unit due to worsening conditions. C. canimorsus was isolated from wounds, and HBO₂ therapy was administered in adjunction to antibiotics, until clinical improvement and microbiological test negativity. We tested the activity of hyperbaric oxygen therapy in adjunction to ceftaroline on cultured plates with C. canimorsus versus ceftaroline alone. Minimal inhibitory concentration was evaluated.
Our findings confirm the utility of HBO₂ therapy after biting injuries. Indeed, increased oxygen supply to the wound (as well as in vitro) may be toxic for bacteria, can improve healing and may improve the effectiveness of antibiotics.
In free-radical polymerization, a monomer-initiator mixture is converted into a polymer. Depending on initial and boundary conditions, free-radical polymerization can occur either in a bulk mode (BP) ...or in a frontal mode (FP) via a propagating self-sustaining reaction front. The main goal of this paper is to study the role that bulk polymerization plays in frontal polymerization processes for various one-step kinetics models.
We use numerical simulations to study the influence of reaction kinetics on one-dimensional frontal polymerization. We show that the long-time behavior of systems modeled with discontinuous distributed kinetics (e.g. step-function kinetics) significantly departs from the long-time behavior of systems modeled with Arrhenius kinetics. The difference is due to slow BP in the initial mixture of reagents, which influences both the speed and the long-time stability of the reaction front.
Further, we show that for distributed kinetics a “true” FP is only possible for a steadily propagating, traveling-wave reaction front. When a front propagates in a pulsating mode, we demonstrate the existence of pockets of unreacted monomer behind the front. These pockets evolve via a bulk polymerization mechanism.
A mathematical model of one-step free-radical frontal polymerization is identical to the model of gasless combustion, so bulk reactions play a role in the latter context, as well. However, fronts propagate much faster in combustion than in polymerization, and slow bulk reactions in regions ahead of the burning front can generally be neglected.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Monitoring of chemical and physical groundwater parameters has been carried out worldwide in seismogenic areas with the aim to test possible correlations between their spatial and temporal variations ...and strain processes. It is shown in this paper that uranium groundwater anomalies, which were observed in cataclastic rocks crossing the underground Gran Sasso National Laboratory (LNGS), can be used as a possible strain meter in domains where continental lithosphère is subducted. Moreover, whereas at the Gran Sasso National Laboratory only the natural radioactivity in the rock, the concrete, as well as the induced part coming from interaction of cosmic ray muons with the rock or the detector materials itself were considered as possible sources for the neutron flux background, the water-rock interaction and its spatial-temporal variation induced by the hydrological pattern of the Gran Sasso aquifer must be taken into account. Water must be considered not only as moderator in concrete, but also as additional source for neutron flux modulation due to its variable concentration and its radioactivity.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
•Sr isotope analyses of sheep/goat tooth enamel inform about past herding strategies.•Sr isotope analyses of livestock tooth enamel offer insights on trade and exchange.•Multi-proxy environmental ...baseline are fundamental to test mobility patterns.•To Bronze Age wool economies sheep were costly, possibly allowed a limited mobility.
In recent years, extensive archaeological studies have provided us with new knowledge on wool and woollen textile production at the Terramare site of Montale, in the Po plain, northern Italy. The large number of textile tools, and of zooarchaeological evidence suggesting intense sheepherding, hints at Montale being a specialized centre of wool production during the local Middle and Recent Bronze Age. The aim of our study has been to investigate, by means of strontium isotope analyses, whether engagement in this economic activity was facilitated by mobile herding practices or by regional/interregional exchange/trade of animals. To this aim, we conducted 75 strontium isotope analyses of tooth enamel from 36 zoo-archaeological remains of as many sheep/goat individuals from all the 11 archaeological phases identified at Montale and of four from the neighbouring early Middle Bronze Age site of Baggiovara. We also created a multi-proxy baseline from environmental samples of the region around Montale to interpret the results of the analyses from the sheep/goat teeth. Strontium isotope analyses have proven to be a powerful tool for the investigation of mobility when relevant and well-established baselines are available; our results hint at sheep herded to a consistent extent in the territory surrounding the respective sites. The data obtained in this study support earlier works suggesting that the territory around Montale had a significant pastoral vocation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The aim of this study was to select patients with heart anatomy that is specifically unfavorable for tangential irradiation in whole-breast radiotherapy (WBRT), to be used as an experimental cohort ...to compare cardiac dosimetric and radiobiological parameters of three-dimensional conformal external beam accelerated partial breast irradiation (3D-CRT APBI) to WBRT with techniques as defined by the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/Radiation Therapy Oncology Group (RTOG) 0413 clinical trial.
A dosimetric modeling study that compared WBRT and 3D-CRT APBI was performed on CT planning data from 8 patients with left-sided breast cancer. Highly unfavorable cardiac anatomy was defined by the measured contact of the myocardium with the anterior chest wall in the axial and para-sagittal planes. Treatment plans of WBRT and 3D-CRT APBI were generated for each patient in accordance with NSABP B-39/RTOG 0413 protocol. Dose-volume relationships of the heart, including the V5min (minimum dose delivered to 5% of the cardiac volume), biological effective dose (BED) of the V5min, and normal tissue complication probability (NTCP) were analyzed and compared.
Despite expected anatomic variation, significantly large differences were found favoring 3D-CRT APBI in cumulative dose-volume histograms (p < 0.01), dose to the entire heart (mean difference 3.85 Gy, p < 0.01), NTCP (median difference, 1.00 Gy; p < 0.01), V5min (mean difference, 24.53 Gy; p < 0.01), and proportional reduction in radiobiological effect on the V5min (85%, p < 0.01).
Use of 3D-CRT APBI can demonstrate improved sparing of the heart in select patients with highly unfavorable cardiac anatomy for WBRT, and may result in reduced risk of cardiac morbidity and mortality.
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GEOZS, IJS, NUK, OILJ, UL, UM, UPUK
General anesthetics and contrast media can cause anaphylactic as well as anaphylactoid reactions. These events are of great concern to radiologists and anesthesiologists because of their relatively ...high prevalence, possible threat to life, and medical-legal consequences. Points discussed in this review are the critical evaluation of risk factors affecting prevention strategies, the need to be aware of pathogenic mechanisms relevant to prevention strategies, the use of alternative products if a culprit agent is known, the recognition of early signs of a reaction, the need to keep records of reactions on a patient's medical chart, the planning of prophylactic therapy, recommended actions after a reaction to an anesthetic or contrast medium, and the suggested establishment of allergy-anesthesiology centers to improve cooperation, and medical-legal issues. As any drug or contrast medium administered during general anesthesia or a diagnostic procedure can induce a potentially life-threatening or fatal event even in the absence of any evident risk factor in the patient's medical history or clinical status, we usually premedicate susceptible individuals at least to attenuate the severity of an unpredictable reaction, although we cannot rely on the efficacy of premedication to completely prevent a severe event. These recommendations, which are based on the literature and on the experience of our working group, aim to provide useful information for physicians and other specialists who operate in the absence of an allergy consultant.
Treatment of relapsed Wilms' tumor remains a challenge. We describe a case of an 11-year-old girl with multiply relapsed Wilms' tumor in whom combined percutaneous computed tomography (CT)-guided ...radiofrequency ablation and brachytherapy directed at a retroperitoneal tumor mass resulted in pain palliation and local tumor control.
Over the course of few weeks, her requirement for narcotic pain medications dramatically decreased. A contrast-enhanced CT scan obtained at 8 months after the procedure showed no evidence for local tumor recurrence. However, she subsequently developed myelodysplasia with evolution into leukemia, presumably secondary to chemotherapy, and died 9.5 months after the procedure.
Combined CT-guided radiofrequency ablation and brachytherapy is a promising new minimally invasive palliative treatment of recurrent Wilms' tumor.
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