An Unparalleled Sexual Dimorphism of Sperm Whale Encephalization

The sperm whale Physeter macrocephalus (Linnaeus, 1758) is the largest toothed whales and possesses the highest absolute values for brain weight on the planet (together with the killer whale Orcinus orca). Former calculations of the encephalization quotient (EQ), which is used to compare brain size of different mammalian species, showed that the sperm whale brain is smaller than expected for its body mass. However, the data reported in the literature and formerly used to calculate the sperm whale EQ suffered from a potential bias due to the tendency to measure mostly larger males of this extreme sexually dimorphic species. Accordingly, we found that the brains of female sperm whales are close to the absolute weight range of the males, but, given the much lower body mass of females, their EQ results more than double of what reported before for the whole species, and is thus nearly into the primate range (female EQ = 1.28, male EQ = 0.56). This sexual dimorphism is unique among mammals. Female sperm whales live in large families in which social interactions and inter-individual communication are essential, while adult males live solitarily. Thus the particular sex-specific behavior of SWs may have led to a maternally-driven social evolution, and eventually contributed to achieve female EQ values (but not male EQs) among the highest ever calculated for mammals with respect to their large body mass

Post-COVID syndrome: Turning convalescence into illness?

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Fire in the Operating Room During Hypospadias Repair

Fire in the operating room (OR) is a very distressful and shocking occurrence with potential dramatic consequences. Despite safety rules and rigorous recommendations, such unintentional events do occur every so often. Notably, the vast majority of cases have been reported in the adult population, with very few pediatric cases described to date. Herein, we report on a 16-month-old boy undergoing reconstructive surgery for penoscrotal hypospadias, who experienced an OR fire most likely related to the use of alcohol-based solution ignited by monopolar electrocautery

Case Report: Simil-Appendicitis Presentation May Precede Cardiac Involvement in MIS-C Patient

Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a new clinical entity characterized by a systemic hyperinflammation triggered by SARS-CoV-2 infection in children and adolescents. This condition could potentially involve all organs with main complications concerning cardiovascular system. Despite up to 90% of patients complain gastrointestinal symptoms (nausea, vomit, and diarrhea), a presentation mimicking acute appendicitis has rarely been reported, and can be the presenting feature of the disease, potentially leading to misdiagnosis and delayed treatment. Case Description: A 15-year-old boy presented to the Emergency Department for a 2-day history of fever, vomiting, and mild abdominal pain. One month before, the patient complained ageusia and anosmia while his mother tested positive for Sars-CoV2 nasopharyngeal swab. At admission, laboratory tests showed leukocytosis with lymphopenia and elevation of inflammatory markers, while cardiac enzymes, electrocardiogram and echocardiography were unremarkable. An abdominal ultrasound displayed a thickening of terminal ileus and cecum with ascites. Because of the worsening abdominal pain and a physical examination suggestive of acute appendicitis, a laparoscopy was performed but no surgical condition was found. After surgery, fever and generalized malaise persisted, so a cardiac evaluation was repeated, showing a relevant increase in inflammatory markers and cardiac enzymes. Electrocardiogram demonstrated a QTc prolongation with mild decrease in left ventricular ejection fraction at echocardiogram. A MIS-C was diagnosed and intravenous immunoglobulin along with a steroid treatment started. After 36 h, the patient presented a complete clinical recovery with fever cessation. Cardiac anomalies normalized in 3 weeks. Conclusion: MIS-C has been defined as a systemic inflammation, involving at least two organs, after a previous SARS-CoV2 infection in children and adolescents. Physicians should be aware that while gastrointestinal manifestations are common, a pseudo appendicitis presentation may also occur, leading to misdiagnosis and delayed treatment. This report suggests that in patients with symptoms suggestive of an acute appendicitis, the presence of lymphopenia, hypoalbuminemia and ultrasound images of terminal ileus inflammation, should raise the suspect for MIS-C even without initial overt signs of cardiac involvement

Simultaneous integrated boost radiotherapy for bilateral breast: a treatment planning and dosimetric comparison for volumetric modulated arc and fixed field intensity modulated therapy

<p>Abstract</p> <p>Purpose</p> <p>A study was performed comparing dosimetric characteristics of volumetric modulated arcs (RapidArc, RA) and fixed field intensity modulated therapy (IMRT) on patients with bilateral breast carcinoma.</p> <p>Materials and methods</p> <p>Plans for IMRT and RA, were optimised for 10 patients prescribing 50 Gy to the breast (PTVII, 2.0 Gy/fraction) and 60 Gy to the tumour bed (PTVI, 2.4 Gy/fraction). Objectives were: for PTVs V_90%>95%, D_max<107%; Mean lung dose MLD<15 Gy, V_{20 Gy}<22%; heart involvement was to be minimised. The MU and delivery time measured treatment efficiency. Pre-treatment dosimetry was performed using EPID and a 2D-array based methods.</p> <p>Results</p> <p>For PTVII minus PTVI, V_90%was 97.8 ± 3.4% for RA and 94.0 ± 3.5% for IMRT (findings are reported as mean ± 1 standard deviation); D_5%-D_95%(homogeneity) was 7.3 ± 1.4 Gy (RA) and 11.0 ± 1.1 Gy (IMRT). Conformity index (V_95%/V_PTVII) was 1.10 ± 0.06 (RA) and 1.14 ± 0.09 (IMRT). MLD was <9.5 Gy for all cases on each lung, V_{20 Gy}was 9.7 ± 1.3% (RA) and 12.8 ± 2.5% (IMRT) on left lung, similar for right lung. Mean dose to heart was 6.0 ± 2.7 Gy (RA) and 7.4 ± 2.5 Gy (IMRT). MU resulted in 796 ± 121 (RA) and 1398 ± 301 (IMRT); the average measured treatment time was 3.0 ± 0.1 minutes (RA) and 11.5 ± 2.0 (IMRT). From pre-treatment dosimetry, % of field area with γ <1 resulted 98.8 ± 1.3% and 99.1 ± 1.5% for RA and IMRT respectively with EPID and 99.1 ± 1.8% and 99.5 ± 1.3% with 2D-array (ΔD = 3% and DTA = 3 mm).</p> <p>Conclusion</p> <p>RapidArc showed dosimetric improvements with respect to IMRT, delivery parameters confirmed its logistical advantages, pre-treatment dosimetry proved its reliability.</p

On the dosimetric impact of inhomogeneity management in the Acuros XB algorithm for breast treatment

BACKGROUND: A new algorithm for photon dose calculation, Acuros XB, has been recently introduced in the Eclipse, Varian treatment planning system, allowing, similarly to the classic Monte Carlo methods, for accurate modelling of dose deposition in media. Aim of the present study was the assessment of its behaviour in clinical cases. METHODS: Datasets from ten breast patients scanned under different breathing conditions (free breathing and deep inspiration) were used to calculate dose plans using the simple two tangential field setting, with Acuros XB (in its versions 10 and 11) and the Anisotropic Analytical Algorithm (AAA) for a 6MV beam. Acuros XB calculations were performed as dose-to-medium distributions. This feature was investigated to appraise the capability of the algorithm to distinguish between different elemental compositions in the human body: lobular vs. adipose tissue in the breast, lower (deep inspiration condition) vs. higher (free breathing condition) densities in the lung. RESULTS: The analysis of the two breast structures presenting densities compatible with muscle and with adipose tissue showed an average difference in dose calculation between Acuros XB and AAA of 1.6%, with AAA predicting higher dose than Acuros XB, for the muscle tissue (the lobular breast); while the difference for adipose tissue was negligible. From histograms of the dose difference plans between AAA and Acuros XB (version 10), the dose of the lung portion inside the tangential fields presented an average difference of 0.5% in the free breathing conditions, increasing to 1.5% for the deep inspiration cases, with AAA predicting higher doses than Acuros XB. In lung tissue significant differences are found also between Acuros XB version 10 and 11 for lower density lung. CONCLUSIONS: Acuros XB, differently from AAA, is capable to distinguish between the different elemental compositions of the body, and suggests the possibility to further improve the accuracy of the dose plans computed for actual treatment of patients