This Special Report presents a description of Geant4‐DNA user applications dedicated to the simulation of track structures (TS) in liquid water and associated physical quantities (e.g., range, ...stopping power, mean free path…). These example applications are included in the Geant4 Monte Carlo toolkit and are available in open access. Each application is described and comparisons to recent international recommendations are shown (e.g., ICRU, MIRD), when available. The influence of physics models available in Geant4‐DNA for the simulation of electron interactions in liquid water is discussed. Thanks to these applications, the authors show that the most recent sets of physics models available in Geant4‐DNA (the so‐called “option4” and “option 6” sets) enable more accurate simulation of stopping powers, dose point kernels, and W‐values in liquid water, than the default set of models (“option 2”) initially provided in Geant4‐DNA. They also serve as reference applications for Geant4‐DNA users interested in TS simulations.
To explore the efficacy of human papillomavirus (HPV) vaccination on the risk of HPV infection and recurrent diseases related to HPV infection in individuals undergoing local surgical treatment.
...Systematic review and meta-analysis DATA SOURCES: PubMed (Medline), Scopus, Cochrane, Web of Science, and ClinicalTrials.gov were screened from inception to 31 March 2021.
Studies reporting on the risk of HPV infection and recurrence of disease related to HPV infection after local surgical treatment of preinvasive genital disease in individuals who were vaccinated were included. The primary outcome measure was risk of recurrence of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) after local surgical treatment, with follow-up as reported by individual studies. Secondary outcome measures were risk of HPV infection or other lesions related to HPV infection. Independent and in duplicate data extraction and quality assessment were performed with ROBINS-I and RoB-2 tools for observational studies and randomised controlled trials, respectively. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was implemented for the primary outcome. Observational studies and randomised controlled trials were analysed separately from post hoc analyses of randomised controlled trials. Pooled risk ratios and 95% confidence intervals were calculated with a random effects meta-analysis model. The restricted maximum likelihood was used as an estimator for heterogeneity, and the Hartung-Knapp-Sidik-Jonkman method was used to derive confidence intervals.
22 articles met the inclusion criteria of the review; 18 of these studies also reported data from a non-vaccinated group and were included in the meta-analyses (12 observational studies, two randomised controlled trials, and four post hoc analyses of randomised controlled trials). The risk of recurrence of CIN2+ was reduced in individuals who were vaccinated compared with those who were not vaccinated (11 studies, 19 909 participants; risk ratio 0.43, 95% confidence interval 0.30 to 0.60; I
=58%, τ
=0.14, median follow-up 36 months, interquartile range 24-43.5). The effect estimate was even stronger when the risk of recurrence of CIN2+ was assessed for disease related to HPV subtypes HPV16 or HPV18 (six studies, 1879 participants; risk ratio 0.26, 95% confidence interval 0.16 to 0.43; I
=0%, τ
=0). Confidence in the meta-analysis for CIN2+ overall and CIN2+ related to HPV16 or HPV18, assessed by GRADE, ranged from very low to moderate, probably because of publication bias and inconsistency in the studies included in the meta-analysis. The risk of recurrence of CIN3 was also reduced in patients who were vaccinated but uncertainty was large (three studies, 17 757 participants; 0.28, 0.01 to 6.37; I
=71%, τ
=1.23). Evidence of benefit was lacking for recurrence of vulvar, vaginal, and anal intraepithelial neoplasia, genital warts, and persistent and incident HPV infections, although the number of studies and participants in each outcome was low.
HPV vaccination might reduce the risk of recurrence of CIN, in particular when related to HPV16 or HPV18, in women treated with local excision. GRADE assessment for the quality of evidence indicated that the data were inconclusive. Large scale, high quality randomised controlled trials are required to establish the level of effectiveness and cost of HPV vaccination in women undergoing treatment for diseases related to HPV infection.
PROSPERO CRD42021237350.
Although local treatments for cervical intraepithelial neoplasia (CIN) are highly effective, it has been reported that treated women remain at increased risk of cervical and other cancers. Our aim is ...to explore the risk of developing or dying from cervical cancer and other human papillomavirus (HPV)- and non-HPV-related malignancies after CIN treatment and infer its magnitude compared with the general population.
Design: Systematic review and meta-analysis. Eligibility criteria: Studies with registry-based follow-up reporting cancer incidence or mortality after CIN treatment. Data synthesis: Summary effects were estimated using random-effects models.
Incidence rate of cervical cancer among women treated for CIN (per 100 000 woman-years). Relative risk (RR) of cervical cancer, other HPV-related anogenital tract cancer (vagina, vulva, anus), any cancer, and mortality, for women treated for CIN versus the general population.
Twenty-seven studies were eligible. The incidence rate for cervical cancer after CIN treatment was 39 per 100 000 woman-years (95% confidence interval 22–69). The RR of cervical cancer was elevated compared with the general population (3.30, 2.57–4.24; P < 0.001). The RR was higher for women more than 50 years old and remained elevated for at least 20 years after treatment. The RR of vaginal (10.84, 5.58–21.10; P < 0.001), vulvar (3.34, 2.39–4.67; P < 0.001), and anal cancer (5.11, 2.73–9.55; P < 0.001) was also higher. Mortality from cervical/vaginal cancer was elevated, but our estimate was more uncertain (RR 5.04, 0.69–36.94; P = 0.073).
Women treated for CIN have a considerably higher risk to be later diagnosed with cervical and other HPV-related cancers compared with the general population. The higher risk of cervical cancer lasts for at least 20 years after treatment and is higher for women more than 50 years of age. Prolonged follow-up beyond the last screening round may be warranted for previously treated women.
•Women previously treated for CIN are at elevated risk of cervical and other HPV-related neoplasms.•Risk of cervical cancer remains elevated for at least 20 years after treatment.•Prolonged cervical screening beyond current last screening round at 60 or 65 should be considered.•Increased awareness for prevention or early cancer detection of other HPV-related malignancies is needed.
Age-specific type-distribution of high-risk human papillomavirus (hrHPV) in cervical precancerous lesions is subject to change in the HPV vaccination era. Knowing the pre-vaccination ...type-distribution helps to anticipate changes induced by mass vaccination and optimize screening.
We recruited 1279 women referred to colposcopy for abnormal cytology into a population-based study on HPV type distribution in diagnostic cervical samples (ISRCTN10933736). The HPV genotyping findings were grouped as: HPV16/18+, other hrHPV+ (HPV31/33/35/39/45/51/52/56/58/59/66/68), non-vaccine targeted hrHPV+ (HPV35/39/51/56/59/66/68), low-risk HPV, and HPV negative. We estimated the HPV group-specific prevalence rates according to diagnostic histopathological findings in the age groups of <30 (n = 339), 30–44.9 (n = 614), and ≥45 (n = 326).
Altogether 503 cases with high grade squamous intraepithelial lesion or worse (HSIL+) were diagnosed. More than half, 285 (56.7%) of HSIL+ cases were associated with HPV16/18: 64.3% (101/157) in women <30 years (reference group), 58.4% (157/269) in women 30–44.9 years (risk ratio (RR) 0.91, 95% confidence interval (95% CI) 0.78–1.06), and 35.1% (27/77) in women ≥45 years of age (RR 0.55, 95% CI 0.39–0.75). Conversely, other hrHPV's were associated with 191 (38.0%) of HSIL+: 31.9% (50/157) in women <30, 36.8% (99/269) in women 30–44.9 years, 54.6% (42/77) and in women ≥45 (RR 1.71, 95% CI 1.26–2.33). The proportion of non-vaccine targeted hrHPV and HPV negative HSIL+ increased with advancing age.
Pre-vaccination HPV type distribution in HSIL+ was distinctly polarised by age with HPV16/18 attributed disease being markedly more prevalent in women aged <30. In the older women the other hrHPV types, however, dominated suggesting a need for more age-dependent screening strategies.
•HPV distribution was markedly polarised by age in women referred to colposcopy.•HPV16/18 was twice as common in women <30 years than in women ≥45 with HSIL lesions.•In women ≥45 years other high-risk HPVs were more common in HSIL lesions.•In women ≥45 years approximately 10% of HSIL lesions were negative for high-risk HPV.
Background
One of the core skills of competent dentist is the ability to search and analyse high‐quality evidence. Problems in understanding the basic aspects of knowledge‐based information may ...impede its implementation into clinical practice. We examined how Finnish dental students acquire scientific information and how familiar they are with methods for evaluating scientific evidence related to clinical questions.
Methods
All fifth‐year dental students (n = 120) at the three universities in Finland received a self‐administered questionnaire.
Results
The three most commonly used sources of information were colleagues, the commercial Health Gate Portal for dental practitioners and personal lecture notes. Although students rarely read scientific journals, they did find that they possess at least passable or even good skills in literature retrieval. Three questions related to the appraisal of evidence in dentistry revealed that students' knowledge of evidence‐based dentistry was inadequate to critically evaluate clinical research findings.
Conclusion
Most students seem to lack knowledge of key methodological evidence‐based terms. The present curricula in dental schools fail to encourage the students to search and acquire knowledge wider than their patients themselves do. Universities have the responsibility to teach dentists various methods of critical appraisal to cope with scientific information.
Objective
To carry out a double‐blind randomized controlled trial (RCT) to compare the effectiveness of topical tacrolimus (TAC), triamcinolone acetonide (TRI), and placebo (PLA) in symptomatic oral ...lichen planus (OLP).
Subjects and Methods
A clinical score (CS, range 0–130) was developed to measure the clinical signs and symptoms of OLP. Twenty‐seven OLP patients with a CS of ≥20 were randomly allocated to receive 0.1% TAC ointment (n = 11), 0.1% TRI paste (n = 7), or Orabase® paste as PLA (n = 9) for 3 weeks. If the CS dropped ≥20% (interpreted as response), the patients continued the same medication for another 3 weeks. If the CS dropped <20% or increased (non‐response), the patients were switched to TAC for 6 weeks. A 6‐month follow‐up period ensued. The primary outcome variable was the change in CS from baseline to week 3. In primary outcome analysis, CS values between the treatment arms were compared.
Results
Tacrolimus and TRI were more effective (P = 0.012 and 0.031, respectively) than PLA in reducing the CS at week 3. No difference in the efficacy was noted between TAC and TRI (P = 0.997).
Conclusions
This pilot RCT provides evidence for the effectiveness of TAC and TRI over PLA in the management of OLP.
Geant4 developments and applications Allison, J.; Amako, K.; Apostolakis, J. ...
IEEE transactions on nuclear science,
02/2006, Letnik:
53, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Geant4 is a software toolkit for the simulation of the passage of particles through matter. It is used by a large number of experiments and projects in a variety of application domains, including ...high energy physics, astrophysics and space science, medical physics and radiation protection. Its functionality and modeling capabilities continue to be extended, while its performance is enhanced. An overview of recent developments in diverse areas of the toolkit is presented. These include performance optimization for complex setups; improvements for the propagation in fields; new options for event biasing; and additions and improvements in geometry, physics processes and interactive capabilities
Mercury is a toxic metal that can be disseminated into the environment from both natural and anthropogenic sources. Human exposure to the metal stems mainly from food, and more particularly from the ...consumption of fish and other seafoods. Examining dietary exposure and measuring mercury levels in body tissues are two ways of estimating exposure to mercury. In this study, we utilized a modelling system consisting of three linear toxicokinetic models for describing the fate of methyl mercury, inorganic mercury, and metallic mercury in the body, in order to estimate daily intake of mercury as measured through total mercury concentrations in the blood. We then compared the results stemming from our modelling system to those of the detailed semi-quantitative food frequency questionnaire (FFQ) of the Norwegian Fish and Game (NFG) Study, a project that focused on dietary mercury exposure.
The results indicate that toxicokinetic modelling based on blood levels gave higher daily intake values of mercury compared to those of the FFQ. Furthermore, the former had a wider range of estimates than the latter. The properties of the toxicokinetic model or limitations in the dietary exposure assessment could be posited as reasons for the differences between the respective methods. Moreover, the results may have been influenced by sources of mercury exposure that cannot be described as dietary, such as amalgam fillings.
•Total mercury in blood was employed to estimate daily intake of mercury.•A modelling system based upon three linear toxicokinetic models was utilized.•Toxicokinetic modelling suggested a higher daily intake than the FFQ.
Abstract This systematic review focuses on definitions of social competence and assessment methods and provides an overview of the main findings in childhood epilepsy. A total of 45 studies drawn ...from MEDLINE and PsycINFO (1998–2010) and their reference lists met the selection criteria. Social competence was not defined in the studies reviewed. The study samples varied and consisted mostly of school-aged children. The majority of the studies focused on social adjustment and addressed problems in this area. Little is known about other aspects of social competence, namely social skills or social performance. A broader perspective on and definition of the assessment of social competence in children with epilepsy are proposed. More studies of the abilities underlying social competence, such as social and socio-cognitive skills, are needed in order to gain insight into the developmental pathways of social competence and protective factors for later development.
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