Converting Treatment Plans From Helical Tomotherapy to L-Shape Linac: Clinical Workflow and Dosimetric Evaluation.

This work evaluated a commercial fallback planning workflow designed to provide cross-platform treatment planning and delivery. A total of 27 helical tomotherapy intensity-modulated radiotherapy plans covering 4 anatomical sites were selected, including 7 brain, 5 unilateral head and neck, 5 bilateral head and neck, 5 pelvis, and 5 prostate cases. All helical tomotherapy plans were converted to 7-field/9-field intensity-modulated radiotherapy and volumetric-modulated radiotherapy plans through fallback dose-mimicking algorithm using a 6-MV beam model. The planning target volume (PTV) coverage ( D1, D99, and homogeneity index) and organs at risk dose constraints were evaluated and compared. Overall, all 3 techniques resulted in relatively inferior target dose coverage compared to helical tomotherapy plans, with higher homogeneity index and maximum dose. The organs at risk dose ratio of fallback to helical tomotherapy plans covered a wide spectrum, from 0.87 to 1.11 on average for all sites, with fallback plans being superior for brain, pelvis, and prostate sites. The quality of fallback plans depends on the delivery technique, field numbers, and angles, as well as user selection of structures for organs at risk. In actual clinical scenario, fallback plans would typically be needed for 1 to 5 fractions of a treatment course in the event of machine breakdown. Our results suggested that <1% dose variance can be introduced in target coverage and/or organs at risk from fallback plans. The presented clinical workflow showed that the fallback plan generation typically takes 10 to 20 minutes per case. Fallback planning provides an expeditious and effective strategy for transferring patients cross platforms, and minimizing the untold risk of a patient missing treatment(s)

Hematoproteinuria in a Lupic Patient with Diabetes: Which One is the Winner?

We report the case of a 46-year-old woman referred to nephrology consult for non-nephrotic proteinuria and hematuria.info:eu-repo/semantics/publishedVersio

Phytoplankton community succession and dynamics using optical approaches

The phytoplankton in coastal regions are responding to constant environmental changes, thus the use of proxies derived from in situ frequent time-series observations and validated from traditional microscopic or pigment methods can be a solution for detecting rapid responses of community dynamics and succession. In this study, we combined in situ high-frequency (every 30 min from May to September 2017) optical and hydrographic data from a moored buoy and weekly discrete samplings to track phytoplankton community dynamics and succession in Mausund Bank, a highly productive region of the coast of Norway. Three hydrographic regimes were observed: mixing period (MP) in spring, onset of stratification (transient period, TP) in summer and a stratified period (SP) in fall, with occasional strong winds that disrupted the surface stratification in the beginning of September. A bloom dominated by the diatom Skeletonema costatum was observed in the MP due to intense mixing and nutrient availability, while flagellates prevailed in nutrient-poor waters during the TP, followed by a bloom dominated by rhizosolenid diatoms (Proboscia alata and Guinardia delicatula), when stratification peaked. A mixed assemblage of diatoms (e.g. Pseudo-nitzschia), coccolithophores and dinoflagellates occurred during the SP, as strong winds reintroduced nutrients to surface waters. Through pigment (chemotaxonomy) and microscopic observations, we tested, for the first time in a coastal region, whether an ‘optical community index’ derived from in situ measurements of chlorophyll a fluorescence (Fchla) and optical particulate backscattering (bbp) is suitable to differentiate between diatom versus flagellate dominance. We found a negative relationship between Fchla:bbp and diatom:flagellate, contrary to previous observations, possibly because of the influence of non-algal contribution (e.g. zooplankton, fecal pellets and detritus) to the bbp pool in highly productive systems. This finding suggests that such relationship is not universal and that other parameters are needed to refine the optical community index in coastal regions

Forestry restoration in abandoned pastures of Urochloa by different sizes of brushwood.

A galharia é um método de complexação ambiental, que consiste no aproveitamento de resíduos vegetais. Esse método, quando bem estabelecido tecnicamente, pode exercer influência sobre a qualidade da cama de sementes, favorecendo o estabelecimento de plantas nativas e a restauração do ecossistema. Dessa forma, objetivou-se avaliar a eficiência de galharia para a indução da regeneração natural de espécies nativas em área coberta por gramíneas exóticas inibidoras do gênero Urochloa, bem como verificar o tamanho mínimo necessário para conter a reinvasão das forrageiras. Como hipótese, adotou-se a largura mínima de 4 m como suficiente para o estabelecimento da regeneração natural, antes da reocupação das forrageiras. O experimento foi conduzido entre maio 2014 e maio 2016 em Morretes-PR, na Floresta Ombrófila Densa de Terras Baixas. Foram implantados sete tamanhos de galharia: 6 x 1, 6 x 2, 6 x 3, 6 x 4, 6 x 5, 6 x 6 m e testemunha. As espécies lenhosas foram identificadas e contadas e a porcentagem de cobertura herbácea estimada após 4, 8, 12, 18 e 24 meses. Não se verificou retomada da sucessão natural por espécies nativas. Independentemente do tamanho, a galharia foi ineficiente para conter a reinvasão pelas gramíneas a partir das bordas das parcelas e, como pilha de resíduos, dificultou o estabelecimento de espécies lenhosas. Para a criação de safe sites e consequente restauração via regeneração natural, faz-se necessária a eliminação local das forrageiras Urochloa, sem a qual espécies nativas terão pouca probabilidade de sobreviver

Chronic obstructive pulmonary disease in older persons: A comparison of two spirometric definitions

SummaryBackgroundAmong older persons, we previously endorsed a two-step spirometric definition of chronic obstructive pulmonary disease (COPD) that requires a ratio of forced expiratory volume in 1sec to forced vital capacity (FEV1/FVC) below .70, and an FEV1 below the 5th or 10th standardized residual percentile (“SR-tile strategy”).ObjectiveTo evaluate the clinical validity of an SR-tile strategy, compared to a current definition of COPD, as published by the Global Initiative for Obstructive Lung Disease (GOLD-COPD), in older persons.MethodsWe assessed national data from 2480 persons aged 65–80 years. In separate analyses, we evaluated the association of an SR-tile strategy with mortality and respiratory symptoms, relative to GOLD-COPD. As per convention, GOLD-COPD was defined solely by an FEV1/FVC<.70, with severity staged according to FEV1 cut-points at 80 and 50 percent predicted (%Pred).ResultsAmong 831 participants with GOLD-COPD, the risk of death was elevated only in 179 (21.5%) of those who also had an FEV1<5th SR-tile; and the odds of having respiratory symptoms were elevated only in 310 (37.4%) of those who also had an FEV1<10th SR-tile. In contrast, GOLD-COPD staged at an FEV1 50–79%Pred led to misclassification (overestimation) in terms of 209 (66.4%) and 77 (24.6%) participants, respectively, not having an increased risk of death or likelihood of respiratory symptoms.ConclusionRelative to an SR-tile strategy, the majority of older persons with GOLD-COPD had neither an increased risk of death nor an increased likelihood of respiratory symptoms. These results raise concerns about the clinical validity of GOLD guidelines in older persons

Massive sacrococcygeal teratoma in a preterm infant

In extreme preterm infants, massive congenital sacrococcygeal teratomas with great hemodynamic commitment may be a situation for limitation of care

Economic results of the integrated crop-livestock systems implementation in degraded pastures in Pium, TO, Brazil.

In Pium, Tocantins state, Brazil, in 2012 Embrapa developed a technology transference project in partnership with the state?s rural extension service for the consolidation of low carbon emissions agriculture. The goal was to recover the degraded grasslands of the Trigueira farm (49°1'37.44"W and 10°24'58.84"S) with low cost using a crop-livestock system