Comparison of conventional and CT-based planning for intracavitary brachytherapy for cervical cancer: target volume coverage and organs at risk doses

<p>Abstract</p> <p>Background</p> <p>To compare intracavitary brachytherapy (ICBT) planning methods for cervical cancer, based on either orthogonal radiographs (conventional plan) or CT sections (CT plan); the comparison focused on target volume coverage and dose volume analysis of organs at risk (OARs), by representing point doses defined by the International Commission on Radiation Units and Measurement (ICRU) and dose volume histograms (DVHs) from 3D planning.</p> <p>Methods</p> <p>We analyzed the dosimetric data for 62 conventional and CT-based ICBT plans. The gross tumor volume (GTV), clinical target volume (CTV) and organs at risk (OAR)s were contoured on the CT-plan. Point A and ICRU 38 rectal and bladder points were defined on reconstructed CT images.</p> <p>Results</p> <p>Patients were categorized on the basis of whether the >95% isodose line of the point-A prescription dose encompassed the CTV (group 1, n = 24) or not (group 2, n = 38). The mean GTV and CTV (8.1 cc and 20.6 cc) were smaller in group 1 than in group 2 (24.7 cc and 48.4 cc) (<it>P <</it>0.001). The mean percentage of GTV and CTV coverage with the 7 Gy isodose was 93.1% and 88.2% for all patients, and decreased with increasing tumor size and stage. The mean D2 and D5 rectum doses were 1.66 and 1.42 times higher than the corresponding ICRU point doses and the mean D2 and D5 bladder doses were 1.51 and 1.28 times higher. The differences between the ICRU dose and the D2 and D5 doses were significantly higher in group 2 than in group 1 for the bladder, but not for the rectum.</p> <p>Conclusion</p> <p>The CT-plan is superior to the conventional plan in target volume coverage and appropriate evaluation of OARs, as the conventional plan overestimates tumor doses and underestimates OAR doses.</p

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

ASSESSMENT OF WATER QUALITY IN DRAINAGE CANALS OF CARSAMBA PLAIN, TURKEY, THROUGH WATER QUALITY INDEXES AND GRAPHICAL METHODS

WOS: 000373927200007In this study, the seasonal variation on drainage water quality of Carsamba Plain, Turkey has been evaluated from July 2012 to January 2013 and determined the suitability of water for irrigation purpose. Water samples collected from 21 drainage canals during July and January were analysed for 12 water quality parameters including physico-chemical analyses. Piper diagram and United States Salinity Laboratory (USSL) diagram were prepared to investigate water quality. Sodium Adsorption Ratio (SAR), Percent Sodium (Na%), Residual Sodium Carbonate (RSC), Kelly Index (KI), Magnesium Ratio (MR), Langelier Saturation Index (LSI), Permeability Index (PI) and Potential Salinity (PS) were also used to assess suitability of waters for irrigation. In July 2012, EC values varied between 0.45-4.23 dS m(-1). Waters of 7 drainage canals were found to be unsuitable for irrigation with regard to KI, 3 canals with regard to RSC and 13 canals with regard to MR. According to USSL diagram, 24% of drainage waters were classified in C2S1, 62% in C3S1, 4% in C4S2 and 10% in C4S4 class. In January 2013, EC values varied between 0.16-1.44 dS m(-1). Waters of one canal was found to be unsuitable for irrigation with regard to KI and 8 canals with regard to MR values. The result obtained from paired sample t-test revealed that the drainage canal water quality varies significantly between July 2012 and January 2013 except for Ca, Mg and SO4. According to analysed parameters, some of the drainage canals were considered unsuitable for irrigation in July 2012. The water properties of all canals were observed as unsuitable to be used for drip irrigation in accordance to the LSI index. Classification of drainage water by USSL diagrams indicates a low sodium and high salinity hazard.Ondokuz Mayis UniversityOndokuz Mayis University [PYO.ZRT.1904.12.020]This study was supported by Ondokuz Mayis University, Scientific Research Programs under the project no. PYO.ZRT.1904.12.020

Effect of different framework materials of resin-bonded bridges on load to fracture values and stress distribution

WOS: 000454199000006PubMed: 30560821Purpose: The aim of this study was to compare in vitro fracture strengths (FSs) of metal- and fiber-reinforced frameworks of resin-bonded bridges and to evaluate stress distribution with finite element analysis (FEA). Materials and Methods: Totally 80 extracted maxillary central and maxillary canine teeth were used for in vitro part of this study as two groups; metal-reinforced framework (n = 20) [(metal-supported resin-bonded bridge (MR-RB)] and fiber-reinforced frameworks (n = 20) [fiber-reinforced resin-bonded bridge (FR-RB) were prepared for three unit resin-bonded bridges. All bridges were loaded from lateral pontic at 1 mm/min crosshead speed and fracture values were recorded. MannuWhitney U-test was used for statistical analysis, and fracture patterns were evaluated visually. FEA was carried out in the second part of the study, and stress distribution of MR-RB and FR-RB structures was analyzed using one of the models from in vitro specimens as main model. Results: The mean FSs of MR-RB and FR-RB were 637.47 151.91 N and 224.86 80.97 N, respectively. Fiber-reinforced specimens were found to distribute stress more homogeneous and connectors in each framework were the regions where stress concentrated mostly. Conclusion: In vitro FSs of MR-RB and the stress concentration of the point that the forces were applied were higher as compared to other parts of the restoration. Furthermore, in contrast to FR-RB specimens, retainer tooth fractures were observed in MR-RB specimens.Kirikkale University Scientific Research Projects Coordination UnitKirikkale University [2014/009]This study was carried out by the support of Kirikkale University Scientific Research Projects Coordination Unit with project no. 2014/009

The delicate balance between bleeding and thrombosis in cardiac patients undergoing thoracic surgery

Management of perioperative anti-coagulation is a general clinical dilemma, and generally accompanied by the signifi cant adverse effects. A personalized approach is necessary to minimize the risks of anesthesia and surgery in patients with comorbidities. Patients with coronary artery disease may not tolerate decreased oxygen delivery and increased oxygen demand in myocardium due to bleeding.On the other side there is an increased use of new anticoagulants in thoracic surgery. The essentials of perioperative management should be determined by creating a balance between the use of oral anticoagulants in low bleeding risk, and bridging treatment for patients having high thromboembolic risk. In this opinion article, we aimed to review the factors affecting bleeding and thrombosis during thoracic surgery. Classifi cation of bleeding and thrombosis risk in cardiac patients was reviewed with the recommendations for preventing the thrombotic complications.</p

Evaluation of renal tubular function in epileptic children treated with levetiracetam

Our study aim was to measure the urinary N-acetyl-&#946;-D-glucosaminidase/creatinine (NAG/UCr) index in epileptic children who received levetiracetam (LEV) treatment at least for 6 months, and compare it to healthy children. Thirty five children with epilepsy were enrolled in this prospective study. NAG was studied using the calorimetric method and NAG levels were expressed in units per liter (U/L) and NAG/UCre levels were determined in U/mmol creatinine. There were no statistically significant differences for the urine NAG and NAG/UCr index before and after LEV treatment in the epileptic group (p&gt;0.05, for each). There were no significant correlations between the serum concentration of LEV and urinary NAG levels (r=0.258, p=0.135) and NAG/UCr levels (r=0.164, p=0.346) before treatment. Our study demonstrated that LEV treatment was safe and did not interfere in renal tubular function in epileptic children. [Med-Science 2016; 5(3.000): 771-5