The COVID-19 disease causes pneumonia in many patients that in the most serious cases evolves into the Acute Distress Respiratory Syndrome (ARDS), requiring assisted ventilation and intensive care. ...In this context, identification of patients at high risk of developing ARDS is a key point for early clinical management, better clinical outcome and optimization in using the limited resources available in the intensive care units. We propose an AI-based prognostic system that makes predictions of oxygen exchange with arterial blood by using as input lung Computed Tomography (CT), the air flux in lungs obtained from biomechanical simulations and Arterial Blood Gas (ABG) analysis. We developed and investigated the feasibility of this system on a small clinical database of proven COVID-19 cases where the initial CT and various ABG reports were available for each patient. We studied the time evolution of the ABG parameters and found correlation with the morphological information extracted from CT scans and disease outcome. Promising results of a preliminary version of the prognostic algorithm are presented. The ability to predict the evolution of patients’ respiratory efficiency would be of crucial importance for disease management.
Partial breast irradiation for the treatment of early-stage breast cancer patients can be performed by means of Intra Operative electron Radiation Therapy (IOeRT). One of the main limitations of this ...technique is the absence of a treatment planning system (TPS) that could greatly help in ensuring a proper coverage of the target volume during irradiation. An IOeRT TPS has been developed using a fast Monte Carlo (MC) and an ultrasound imaging system to provide the best irradiation strategy (electron beam energy, applicator position and bevel angle) and to facilitate the optimisation of dose prescription and delivery to the target volume while maximising the organs at risk sparing. The study has been performed in silico, exploiting MC simulations of a breast cancer treatment. Ultrasound-based input has been used to compute the absorbed dose maps in different irradiation strategies and a quantitative comparison between the different options was carried out using Dose Volume Histograms.
The system was capable of exploring different beam energies and applicator positions in few minutes, identifying the best strategy with an overall computation time that was found to be completely compatible with clinical implementation. The systematic uncertainty related to tissue deformation during treatment delivery with respect to imaging acquisition was taken into account.
The potential and feasibility of a GPU based full MC TPS implementation of IOeRT breast cancer treatments has been demonstrated in-silico. This long awaited tool will greatly improve the treatment safety and efficacy, overcoming the limits identified within the clinical trials carried out so far.
•A fast GPU based MC has been developed for IOeRT breast treatment planning.•The input is an ultrasound image with defined PTV and OARs.•Different applicator positions, dimensions and angles and beam energies are tested.•Plan is optimised using absorbed dose maps and related DVHs.•Results in the context of conventional and FLASH irradiations are discussed.
The treatment of deep-seated tumours with electrons of very high energies (VHEE, 70–150 MeV) has already been explored in the past, suggesting that a dosimetric coverage comparable with ...state-of-the-art proton (PT) or photon radiotherapy (RT) could be achieved with a large (
>
10) number of fields and high electron energy. The technical and economical challenges posed by the deployment of such beams in treatment centres, together with the expected small therapeutic gain, prevented the development of such technique. This scenario could radically change in the light of recent developments that occurred in the compact, high-gradient, electron acceleration technology and, additionally, of the experimental evidence of the sparing of organs at risk achieved in ultra-high dose rate irradiation, also referred to as FLASH. Electrons with the energy required to treat intracranial lesions could be provided, at dose rates compatible with what is needed to trigger the FLASH effect, by accelerators that are a few metres long, and the organ sparing could be exploited to significantly simplify the irradiation geometry, decreasing the number of fields needed to treat a patient. In this paper, the case of two patients affected by a chordoma and a meningioma, respectively, treated with protons in Trento (IT) is presented. The proton plans have been compared with VHEE plans and X-ray intensity-modulated radiotherapy (IMRT) plans. The VHEE plans were first evaluated in terms of physical dose distribution and then assuming that the FLASH regimen can be achieved. VHEE beams demonstrated their potential in obtaining plans that have comparable tumour coverage and organs at risk sparing when benchmarked against current state-of-the-art IMRT and PT. These results were obtained with a number of explored fields that was in the range between 3 and 7, consistent with what is routinely performed in IMRT and PT conventional irradiations. The FLASH regimen, in all cases, showed its potential in reducing damage to the organs placed nearby the target volume, allowing, particularly in the chordoma case where the irradiation geometry is more challenging, a better tumour coverage with respect to the conventional treatments.
Eight dogs with cutaneous lesions, clinical signs and cytological findings compatible with bacterial overgrowth syndrome were compared with four healthy dogs. The affected dogs were treated for 28 ...days with 30 mg/kg/day cephalexin. The results showed that the syndrome was a superficial cutaneous disorder characterised by marked pruritus, greasy seborrhoea, offensive odour, erythema, lichenification, hyperpigmentation, excoriations and alopecia involving principally the ventral aspect of the body, but no papules, pustules, epidermal collarettes or crusts; it was caused by overgrowths of Staphylococcus intermedius all over the body surface. Histopathological findings included a superficial, perivascular, hyperplastic and spongiotic dermatitis with a mixed inflammatory infiltrate, but no lesions suggestive of a true pyoderma. In the affected dogs, anti-staphylococcal immunoglobulin G levels were high, but anti-staphylococcal immunoglobulin E levels were low, suggesting that staphylococcal hypersensitivity is not the underlying pathogenic process. The antibiotic treatment improved the condition of all the dogs, but five of the eight had an underlying allergic skin disease.
The authors report 10 cases of localised sarcoptic mange in dogs. In each case, lesions were localised to one precise area of the skin. Pruritus was present in nine cases and absent in one. Affected ...areas were the feet (one case), the face and/or the pinnae (six cases), the abdominal skin (one case), the flank (one case) and the lumbar area (one case). The types of lesions were erythema, papules, lichenification, scales, crusts and alopecia. Parasites were found in all cases except one, in which anti-immunoglobulin G Sarcoptes serology was positive. The acaricidal treatments given were lindane, ivermectin or selamectin and were all successful.
Objectives: The aim of this study was to assess the clinical and aetiological aspects of contact dermatitis of the scrotum in dogs. Methods: The medical records of 13 dogs with suspected scrotal ...contact dermatitis were retrospectively included in the study. For each case, historical findings, results of physical and dermatological examination and of avoidance tests as well as follow-up were included. Results of re-exposure tests and patch tests were also included when available. Results: Avoidance tests to various suspected substances such as floor detergents, bleach, cement, laundry detergent and plastic fabric were performed and led to clinical improvement in all patients. Provocative re-exposure was performed in six cases, with five positive responses. Patch tests were undertaken in three of the five re-exposed cases, with two responding positively. Clinical Significance: Scrotal skin is thin and with few hair follicles, and is therefore very susceptible to contact dermatitis. A range of substances can induce contact dermatitis. The diagnosis of contact dermatitis is made by results of avoidance and/or provocation tests and/or patch tests. Once an aetiological agent has been identified, treatment is straightforward consisting of avoidance of this agent.
A randomised, placebo-controlled, double blind study was conducted on 25 dogs that had atopic dermatitis, together with skin test reactivity and elevated serum IgE to
Dermatophagoides farinae (Df) ...and at least one additional allergen. Dogs were treated with either a Df-restricted immunotherapy solution (
n
=
14) or a placebo (
n
=
11) and evaluated 6 weeks and 3, 5, 7 and 9 months after the initiation of treatment using a clinical scoring system (SASSAD) and pruritus analogue scale scores. The Df-restricted solution and the placebo had an equal effect on both pruritus and the skin manifestations (
P
>
0.05). The results of this study indicate that in dogs with atopic dermatitis based on hypersensitivity to environmental allergens in addition to
D. farinae, Df-restricted immunotherapy is insufficient to control the disease. Consequently, a solution for allergen-specific immunotherapy should remain customised.
Pugs are predisposed to the development of deeply pigmented, slightly elevated hyperkeratotic noncancerous plaques. Polymerase chain reaction amplification of a papillomavirus (PV)‐like DNA fragment ...from such lesions suggested that PV may be responsible for them, although the predicted virus has not yet been identified. The goal of the present study was to make use of pigmented plaques from four pugs to identify and sequence the predicted virus. Taking advantage of the circular nature of PV DNA, the entire viral genome was amplified by rolling circle amplification and restriction enzyme analysis disclosed the same pattern in all four cases. Sequencing of one of the amplificates revealed a novel canine PV, termed CPV4, related to the recently described CPV3 but clearly distinct from canine oral PV and CPV2. Thus, a novel canine PV and a method for its future diagnosis are described.
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