The effect of glycemic control on salivary antimicrobial peptide levels in patients with periodontitis and type 2 diabetes mellitus

Amaç: İnsan beta-defensinler (hBD) ve kathelisin (LL-37) homeostazın sağlanmasında önemli ve çoklu görevler alırlar. Oral ve periodontal doku ve sıvılarda, Tip 2 Diabetes Mellitus (T2DM) ile bu peptidler arasındaki ilişki net değildir. Çalışmamızın amacı, T2DM’li bireylerde glisemik kontrol seviyesinin, salya hBD ve LL-37 konsantrasyonu üzerine olan etkisinin incelenmesidir. Gereç ve Yöntem: Çalışmaya 178 birey dahil edilmiştir. Demografik veriler, dental ve medikal geçmişler sözlü olarak elde edilmiştir. Glisemik kontrol seviyeleri için açlık kan şekeri ve glikolize hemoglobin (HbA1c) değerleri ölçülmüştür. Tüm ağız periodontal indeks değerleri ölçülerek panaromik filmler yardımıyla periodontal teşhisler yapılmıştır. Bireylerden stimüle olmayan yöntemle salya örnekleri toplanmış ve ELISA tekniği ile salya hBD -1, -2, -3, LL-37 ve ileri glikolizasyon son ürünü (AGE) değerleri ölçülmüştür. Bulgular: Dişeti sağlıklı bireylerden oluşan gruplar arasında ve kontrollü T2DM bireylerin salya hBD seviyelerinin diğer gruplara oranla anlamlı derecede yüksek olduğu tespit edilmiştir. (p<0.001) Periodontitisli ve kontrollü T2DM’li bireylerin salya hBD seviyelerinin ise; diğer periodontitisli gruplara göre anlamlı derecede düşük olduğu tespit edilmiştir. (p<0.001). Salya LL-37 değerleri incelendiğinde ise; hem dişeti sağlıklı hem de periodontitisli bireylerden oluşan gruplarda, kontrolsüz T2DM’li bireylerden oluşan gruplarda en yüksek olduğu tespit edilmiştir. (p<0.001, p<0.001, sırasıyla) Korelasyon analizlerine göre, periodontitisli ve kontrollü T2DM’li bireylerin salya hBD-1, -2, -3 değerleri salya AGE miktarı ile negatif korelasyon gösterirken (r=-0.411 p=0.020, r=-0.389 p=0.028, r=-0.344 p=0.044, sırasıyla) LL-37 miktarı pozitif korelasyon göstermektedir (r=0.601 p=<0.001). Sonuç: Glisemik kontrol salya hBD ve LL-37 konsantrasyonu üzerinde bağımsız bir belirteçtir.Aim: The purpose of this study was to evaluate the dentists’ knowledge, attitude and behaviour regarding dental trauma in Rize Province. Materials and Methods: Total of 121 dentists, 73 females and 48 males, were included in this study. A questionnaire consisted of 34 questions and three sections was applied face to face. Personal and professional knowledge and attitudes about dental trauma were evaluated. The association between the dentists at different education level and trauma intervention were analyzed with chi-square test. Results: Most of general dentists (48.1%), postgraduate students (69.6%) and specialists (53.3%) preferred composite, fiber and ligature wire as splint materials, respectively (p<0.001). There was statistically significant association between dental education level with permanent extrusion (p = 0.004) and avulsion cases with closed apex in dry environ ment less than 1 hour (p = 0.004) and more than 1 hour (p<0.001) outside the mouth, enamel fracture of permanent tooth (p = 0.027) and alveolar fracture (p = 0.013), primary tooth extrusion (p = 0.013), and avulsion injuries (p = 0.017). Also, statistically significant relationship was found between dental education level and management of enamel fracture (p<0.001), uncomplicated crown fracture (p<0.001), intrusion (p = 0.018) along with alveolar fracture (p = 0.002) injuries. Conclusion: Dentists had sufficient knowledge about dental trauma but avoided intervention in various types of traumatic dental injuries. With in the limits of this study, additional theoretical and practical training on the emergency treatment of cases.may be recommended

The effect of prosthesis implant materials on doses in external beam treatment comparison with different dose calculation algorithms and dosimetry in phantom model

Amaç: Bu çalışmada amaç, yüksek atom numarasına sahip protez malzemelerinin radyoterapide kullanılan 6 MV X ışını tedavi dozlarına etkisini ölçmek ve tedavi planlama sistemlerinde kullanılan iki farklı doz hesaplama algoritması ile dozları hesaplayıp sonuçları karşılaştırmaktır. Gereç ve Yöntem: Üzerinde doz hesaplarının ve ölçümlerinin yapıldığı fantomlar parafin malzeme ve PMMA plakalar kullanılarak oluşturulmuştur. Protez malzemesi örnekleri Ti6Al4V ve CoCrMo'dur. Bu örnekler ayrı ayrı parafin malzemelerin içine yerleştirilmiştir. Oluşturulan fantom uzaylarının Nucletron Oncentra MasterPlan tedavi planlama sisteminde (TPS) ve GAMOS kodunda benzeşimi gerçekleştirilmiştir. TPS'de Collapsed Cone (CC ) algoritması, GAMOS kodunda Monte Carlo (MC) algoritması ile doz hesapları yapılmıştır. Doz hesapları sonuçları, fantom içinde ışın merkez ekseni boyunca yüzde derin doz olarak ve fantomun 2.9 cm, 10 cm derinliklerinde doz profilleri olarak okunmuştur. Daha sonra iyon odası ve EDR 2 film ile radyasyon dozları deneysel olarak ölçülmüştür. Yüzde derin dozlar iyon odası ile, doz profilleri EDR 2 film ile elde edilmiştir. Bulgular: Hesap ve ölçüm sonuçlarında, doz profillerinde EDR 2 film ölçümlerinin ve MC hesaplarının uyumlu olduğu, ancak CC algoritması hesaplarında protez malzemesinin bulunduğu bölgede sonuçların farklı olduğu görülmüştür. EDR 2 film sonuçlarına göre rölatif hatalar hesaplandığında, MC algoritması hesaplarında hatalar minimum %0.11, maksimum %1.15 olmuştur. CC algoritması hesaplarında ise rölatif hataları sırasıyla %7.87 ile %21.6 olarak hesaplanmıştır. İyon odası ölçümlerinde ise ölçümler protez malzemesinin altından itibaren etkin şekilde alınabilmiştir. Protez malzemesi üstünde, iyon odası adaptörü yeterli hassasiyette ölçüm alınmasını engellemiştir. Protez malzemesinin 3.5 cm altında iyon odası ölçümleri referans alınarak yapılan rölatif hatalarda sonuçlar MC hesapları için minimum %0.24, maksimum %0.86'dır. CC hesaplarında ise rölatif hatalar sırasıyla %10.4 ve %16.2'dir. Sonuç: Protez malzemelerinin dozlarda önemli değişimlere yol açtığı görülmüştür. Protez malzemesi önünde yaklaşık %10 doz artışı, protez malzemesi arkasında %45'lere varan doz düşüşleri meydana gelmiştir. Monte Carlo hesapları, deney sonuçları ile %2'nin içinde uyumluluk gösterirken, Collapsed Cone hesaplarında, deney sonuçlarına göre bu uyumluluk sağlanmamıştır. Purpose: This comparative study was to investigate the effect of high-Z pelvic prostheses on 6 MV-X external beam radiotherapy doses. Study was based on comparison of measurements of the radiation doses and calculation of these doses in two different dose calculation algorithms. Material and Methods: Paraffin materials and PMMA slabs have been used to form phantoms where we have implemented dose calculations and measurements. Prosthesis sample materials are Ti6Al4V and CoCrMo. These samples have been fixed in paraffin materials separately. In Nucletron Oncentra MasterPlan treatment planning system (TPS) and GAMOS code, phantom simulations have been carried out. Collapsed Cone (CC) algorithm have been used in TPS and Monte Carlo (MC) algorithm have been used in GAMOS code. Dose calculation results have been achieved in phantom as percentage depth doses along the beam central axis and dose profiles at 2.9 and 10 cm depths of the phantom. Afterwards doses have been measured with ion chamber and EDR 2 film. For percentage depth doses, ion chamber and for dose profiles EDR 2 film have been used. Results: Measurements and calculations of dose profiles shows that, EDR 2 film and Monte Carlo results are well matched. In comparison with EDR 2 films, Monte Carlo results have relative difference of minimum 0.11% and maximum 1.15%. However, Collapsed Cone results have deviations in the prostheses sample zone from EDR 2 and Monte Carlo results. Relative differences of Collapsed Cone results are minimum 7.87% and maximum 21.6%. Ion chamber measurements showed consistance only with Monte Carlo results below placement of prostheses sample. Above prostheses, ion chamber adaptor caused difficulty in fine measurements. Below 3.5 cm of prostheses sample, relative differences of Monte Carlo in comparison with ion chamber by minimum and maximum, are 0.24% and 0.86% respectively. In Collapsed Cone calculations, relative differences are minimum 10.4% and maximum 16.2%. Conclusion: Pelvic prostheses caused significant effects on the radiation doses. Above the prostheses samples, doses have been increased by aprroximately 10% and below the prostheses samples, decreasement of doses approaching to 45% have been observed. Our results show an agreement within 2% between Monte Carlo calculations and experiments, yet Collapsed Cone calculations didn't achieve the acceptable consistency

A heart atlas for breast radiation therapy and the influence of delination education on both intra and interobserver variability

PurposeWe developed a heart atlas for breast radiation therapy and evaluated the influence of education on intra and inter-observer similarity, and cardiac dose reporting.Materials and methodsThe data of 16 left breast cancer patients were analyzed. Eight observers delineated heart and cardiac subunits [left (LCA) and right (RCA) coronary arteries, left anterior descending artery (LAD), bilateral atrium and ventricles] before the education. A radiologist and radiation oncologist developed the atlas and delineated the gold standard (GS) volumes. Observers repeated the delineation after education. RT plans were made for pre/post-atlas contours. The similarity was assessed by Dice (DSC) and Jaccard (JSC) similarity coefficient indices. The absolute difference rate was calculated for the dose analysis.ResultsThe inter-observer similarity increased in heart and all subunits. The intra-observer similarity showed a heterogeneous distribution. The absolute difference rate in dose reporting was statistically significant for the bilateral atrium, right ventricle, LAD, LCA+LAD, RCA's maximum doses (p<0.05). The maximum dosereporting differences from the GS decreased from 16.9 to 8.9% for LAD (p=0.011); from 14.8 to 9.3% for LCA+LAD (p=0.010).ConclusionThe cardiac atlas reduces the intra-interobserver differences and improves dosereporting consistency. The first intra-observer similarity analysis was made in our study and revealed the need for repeated education to increase the consistency

The importance of mesorectum motion in determining PTV margins in rectal cancer patients treated with neoadjuvant radiotherapy

New precision radiotherapy (RT) techniques reduce the uncertainties in localizing soft and moving tumors. However, there are still many uncontrollable internal organ movements. In our study, patients who underwent neoadjuvant chemoradiotherapy (NA-CRT) for rectal cancer were evaluated to determine inter-fraction mesorectum motion and dosimetric changes. Fourteen patients treated with NA-CRT for rectal cancer between 2014 and 2016 were included in the analysis. The mesorectum and clinical target volume (CTV) were delineated on planning computed tomography (CT) and cone-beam CT (CB-CT) scans. After planning with a volumetric modulated arc therapy (VMAT) plan, re-planning was performed on all CB-CTs. Finally, the volumetric and dosimetric changes of PTV and mesorectum were evaluated in all CB-CTs compared with the initial CT and VMAT plans. The geometrical center of mesorectum volume in CB-CTs had moved 1 (0.2-6.6), 1.6 (0.2-3.8) and 1.6 (0-4.9) mm in the x, y and z-axis respectively compared with the initial CT. The dosimetric parameters of PTV including D2, D95 and D98 on CB-CT showed a median 47.19 (46.70-47.80), 45.05 (44.18-45.68) and 44.69 (43.83-45.48) Gy and median 1% (1-2), 0% (0-2) and 1% (0-2) dosimetric change compared with the initial VMAT plan. In our study, we have shown that the mesorectum has moved up to 20 mm in the lateral and anterior-posterior direction and almost 10 mm in the superior/inferior direction during RT, causing a median of similar to 2% change in dosimetric parameters. Therefore, these movements must be considered in determining PTV margins to avoid dosimetric changes

Comparison of Hybrid Techniques with 3D-Conformal Radiotherapy in Patients with Lung Cancer

Purpose: It’s postulated that hybrid techniques (HT) with lower weighting of IMRT/VMAT component would improve lung dose-volume parameters despite some disadvantage in PTV homogeneity index (HI) and target coverage (TC). &#x0D;Material and Methods: Conformal plans were prepared using 6-10-15 MV-X photon energies while IMRT/VMAT plans of HTs were prepared using 6MV-X. Four HTs were developed having two different ratios (10% and 50%) of IMRT/VMAT component (h-IMRT1, h-IMRT2 and h-VMAT1, h-VMAT2, respectively). HTs were compared with 3D-CRT in terms of HI and TC for PTV, and total lung (TL) and contralateral lung (CL) V5Gy, V10Gy, V20Gy and mean lung dose (MLD). &#x0D;Results: All HTs were advantageous for HI and TC, while disadvantageous for TL and CL-V5Gy. H-IMRT2 provided better TC than h-IMRT1, and so did h-VMAT2 compared to h-VMAT1. Lower weighting of IMRT/VMAT decreased TL and CL-V5Gy in HTs. In addition, h-IMRT1 decreased TL and CL-MLD and CL-V20Gy compared to h-IMRT2, while h-VMAT2 decreased TL-V20Gy and CL-MLD compared to h-VMAT2. &#x0D;Conclusion: In the RT of lung tumors close to vertebra, it may be appropriate to suggest a ratio of IMRT/VMAT component about 10% in order to decrease the low and intermediate dose-wash lung volume, if HI and TC values are acceptable.</jats:p

Which One is The Better Radiotherapy Technique for Patients with Thoracic Esophageal Tumors, IMRT or VMAT?

Comparison of IMRT and VMAT techniques in thoracic esophageal tumors. IMRT and VMAT plans were created for a total of 10 thorax-located esophagus patients. All plans were compared in terms of HI and CI for PTV; V-5, V-10, V-20 and mean lung dose parameters for total lung; V-30, V-40 and mean heart dose for the heart; and the Dmax for the medulla spinalis. IMRT and VMAT techniques yielded similar results with respect to HI and CI values (p> 0.05). Median mean lung dose was found to be lower in VMAT (11.77 Gy) technique compared to IMRT (12.05 Gy). While the lowest lung median V-5 (67.17%) and V-10 (41.95%) values belonged to IMRT, the V-20 value was achieved with VMAT (17.85%) planning. Median mean heart dose was found the lowest in VMAT (28.81 Gy) and the highest IMRT (29.31 Gy) planning. The lowest heart median V30 value was obtained with IMRT (43.00%) and median V-40 value was obtained with VMAT (18.95%) planning. The median mean medulla spinalis maximum dose was found to be lower with VMAT (41.54 Gy), with no statistically significant difference between them (p= 0.074). VMAT technique was better for reducing cardiovascular and medulla spinalis doses with reduced duration of treatment time and dosimetric uncertainties, while YART technique provides higher PTV control with less low-dose lung volume. Both threatment options have advantages and disadvantages over normal tissue and tumor volume compared to each other, and should be evaluated according to the other clinical conditions of the patient