Deformable MRI fusion for intracranial SRS: Can we trust?

Purpose/Objective: The aim of this study is to evaluate the reliability of MRI fusion for the determination of target volume when performing CT based intracranial stereotactic radiosurgery. Materials and Methods: Patients treated with CT based intracranial stereotactic radiosurgery with various diagnoses are included in the study. All patients were immobilized using stereotactic thermoplastic masks prior to simulation. The planning CT was obtained both with and without iv contrast with 1mm slice thickness

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Ternary FeCrNi martensitic thin films sputtered on a flexible substrate from a single AISI 304 austenitic stainless steel source: Effect of deposition rate on structural and magnetic properties

WOS:000456696000090The effect of deposition rates on the structural and magnetic properties of the ternary FeCrNi martensitic thin films produced via a source material made of the commercial AISI 304 austenitic stainless steel was investigated. The films with 50 nm thickness were deposited on a flexible amorphous polymer substrate by using dc magnetron sputtering. As increasing deposition rate, the Fe and Ni contents of the films increased while the Cr component decreased confirming the same materials in the source. And, all films examined by X-ray diffraction have a body centred tetragonal structure confirming the martensitic state, and the peak intensities changed depending on the film content which was varied by deposition rate. Also, the morphological analysis of the surfaces performed by a scanning electron microscope (SEM) displayed that the smoothest surface were obtained at high deposition rates. Further measurements by an atomic force microscopy disclosed an increase in the film surface smoothness and a decrease in the values of roughness parameters confirming the SEM images. As to magnetic analysis, the increase of total of Fe and Ni contents resulted in an increase in saturation magnetization, MS. The MS values of films, were detected to increase from 991.0 to 1283.1 emu/cm(3) with decreasing coercivity from 131 to 74 Oe as the deposition rate increased from 0.04 to 0.12 nm/s. In this study, the increase of the Fe and Ni components and smoothness in surfaces may give rise to the ternary FeCrNi martensitic thin films gain the softer magnetic properties with increasing deposition rate. A probable explanation to this results may come from the hysteresis loops; the change in the deposition rate produces an increase in the M-S and remanent magnetization, M-r, and decrease in the coercivities which led to almost unchanged shape of the loops since the M-r/M-S ratio is between 6.3 and 6.8. The ternary FeCrNi thin films produced by a magnetron sputtering technique have a martensitic phase, which indicates the soft ferromagnetic state without any further treatment. To our knowledge, this has not been expressed in previous relevant studies. It is seen that the magnetic properties of the ternary FeCrNi martensitic thin films can be easily controlled by changing production parameters for potential electric and electronic devices on flexible substrates.Balikesir University BAPBalikesir University [2016/132]; State Planning Organization/TurkeyTurkiye Cumhuriyeti Kalkinma Bakanligi [2005K120170]This study was financially supported by the Balikesir University BAP under grant no 2016/132, also by the State Planning Organization/Turkey under grant no 2005K120170 for Sputtering and VSM systems. We are very grateful to the Selcuk University/Advanced Technology Research & Application Center for SEM and EDX analysis, the Karamanoglu Mehmetbey University/Scientific and Technological Researches Application and Research Center for XRD measurements and AFM imaging

A Case of Ectrodactyly, Ectodermal Dysplasia, Cleft Lip and Palate Syndrome Associated with Hydrocephaly

Ectrodactyly, ectodermal dysplasia, cleft lip, and palate syndrome (EEC) is a genetic developmental disorder characterized by ectrodactyly, ectodermal dysplasia and orofacial clefts (cleft lip/ palate). A few cases have been reported in literature. The cardinal components of the syndrome are ectrodactyly and syndactyly of the hands and feet, cleft lip with or without cleft palate, and abnormalities ectodermal structures including skin (i.e. hypopigmented and dry skin, hyperkeratosis, skin atrophy), hair (sparse hair and eye brows), teeth (small, absent or dysplastic teeth), nails (nail dystrophy) and exocrine glands (reduction/ absence of sweat, sebaceous and salivary glands). A multidisciplinary approach for treatment is needed which is co-ordinated by orthopedic, plastic, dental surgeons, ophthalmologist, dermatologists and speech therapists, psychologists. We presented EEC syndrome case with hydrocephaly by the literature. [Cukurova Med J 2013; 38(3.000): 531-535

Characterizations of binary fecr (AISI 430) thin films deposited from a single magnetron sputtering under easy controllable deposition parameters

WOS:000477028600020A series of 50-nm binary FeCr martensitic thin films were sputtered from a single source made of commercial AISI 430 ferritic stainless steel under the deposition rates gradually increased from 0.03 to 0.11nm/s with 0.02nm/s steps at stationary condition. And, under 0.09nm/s deposition rate, a second series of the films were also deposited under the rotation speed of their substrates which was chosen at 0, 25, and 45rpm. As far as we are concerned, this study is the first investigation of properties of the thin films produced from AISI 430. The atomic Fe content in the films increased from 79.3 to 98.6% while atomic Cr content decreased from 20.5 to 1.2% with the increase of deposition rate from 0.03 to 0.11nm/s. According to compositional analysis, the Fe content increased while Cr content decreased with increasing deposition rate. The reason for this may be attributed to the relatively different bond energy/melting point of metals which have different contents sputtered from source material since this physical parameter is very significant for the sputtering process. And, the Fe content in the films decreased from 84.9 to 79.2at. % while the Cr content increased from 14.9 to 20.6at. % when the increase of rotation speed of substrate. The crystal structure of all films was observed to have a body-centered tetragonal phase and the intensity of (110) peak varied with the atomic Fe content. The surface observations of films performed by a scanning electron microscope exposed that the number of surface grains increased with the increase of deposition rate and decreased with the increase of rotation speed. According to surface roughness analysis done by an atomic force microscope, the roughness of the film surfaces increased as the deposition rate increased. And, the roughness of the film surfaces decreased as the rotation speed increased. This has been consistent with the grain size and roughness parameters. Thus, increasing deposition rate and decreasing rotation speed of the substrate caused an increase in grain size and roughness parameters. The magnetic measurements of the films achieved, by a vibrating sample magnetometer at room temperature, displayed that the saturation magnetization, M-s, values increased from 820.1 to 1700.4emu/cm(3), the remanence magnetization, M-r, values increased from 293 to 817emu/cm(3), and the coercivity, H-c, value also increased from 38 to 107Oe with the increasing of deposition rate. It is also seen that the magnetic easy axis are in the film plane due to the shape anisotropy. With the increase rotation speed, the values of M-s and M-r increased and the H-c decreased. It was seen that variation of Fe content in the films influences the M-s values and the H-c values are consistent with the surface properties. It was concluded that the deposition rate and the rotation speed of the substrate play a considerable role on the structural and related magnetic properties of the sputtered FeCr thin films, and the properties of the films can be easily controlled by changing production parameters.Balikesir University, BAPBalikesir University [2016/149]; State Planning Organization/TurkeyTurkiye Cumhuriyeti Kalkinma Bakanligi [2005K120170]This study was financially supported by the Balikesir University, BAP under grant no 2016/149 and also by the State Planning Organization/Turkey under grant no 2005K120170 for Sputtering and VSM system

Boost volume assessment in breast cancer: Preop tumor volume vs clips used in oncoplastic surgery

WOS: 000463117902107The aim of this study was to compare the volumes obtained with surgical clips during breast conserving surgery of breast cancer patients with volume determined using FDG positive tumor volumes outlined in pre -operative PET-CT imaging and find out the deviations that arise

Does preoperative positron emission tomography help delineate the boost volume after oncoplastic surgery for breast cancer?

WOS: 000424788200005OBJECTIVE The tumor bed within the breast shifts during oncoplastic surgery (OPS) for breast cancer (BC). Preoperative imagery is used to determine the boost volume (BV) for patients not implanted with surgical clips. This prospective study was conducted to geometrically compare BVs determined using preoperative imagery and BVs determined utilizing surgical clips. METHODS Patients diagnosed with BC were scanned using PET-CT during 2013-2015. Twenty patients who had undergone OPS but who did not have metastasis underwent CT prior to radiotherapy. Their preoperative images were fused with planning CT images. The tumor volume (CTVboost-pet), as determined from the preoperative PET-CT images, was contoured. Next, CTVboost-clips was determined using surgical clips. Geometric relationships between these two volumes were statistically compared. RESULTS Planar projections of CTVboost-pet and CTVboost-clips were evaluated. Displacements between CTVboost-pet and CTVboost-clips in the axial (XZ) and coronal (XY) planes were 1.17 cm (min-max: 0.03-3.64 cm) and 1.67 cm (min-max: 0.38-4.14 cm), respectively, and were statistically significant (p0.7). CONCLUSION Preoperative imaging alone was not reliable when determining the BV in patients who had undergone OPS and had no clips. Large PTV margins can be an option to overcome this issue. Surgical clips need to be inserted during OPS

Easy controlled properties of quaternary fenicrcd thin films deposited from a single dc magnetron sputtering under the influence of deposition rate

WOS:000497271900021The quaternary FeNiCrCd thin films were produced from a single FeNiCrCr source on a commercial flexible polymer substrate using one dc magnetron sputtering technique. For that, a series of the films with a thickness of 50 nm were produced at different deposition rates of 0.02, 0.04, 0.06, and 0.08 nm/s, separately. In this study, as far as concerned, this was the first time that structural and magnetic properties of FeNiCrCd thin films were investigated. According to compositional analysis, the Fe and Cr contents slightly decreased with increasing deposition rate while Ni was almost constant, whereas those of the amount of Cd atoms increased. However, the atomic amounts of Fe and Cd in the films are quite different from those of the source material. The change of the atomic contents in the films from the source may be attributed to the relatively different bond energy/melting point of metals which have different contents sputtered from source material since this physical parameter is very significant for the sputtering process. For crystal structural analysis, a combination of hexagonal close-packed (hcp) and body-centered cubic (bcc) were observed. The peak intensity of the bcc-dominated planes decreased while the hcp-dominant plane increased since the change in peak intensities is compatible with the compositional analysis with increasing deposition rate. And, the grain sizes decreased gradually from 40.1 to 23.4 nm, with increasing deposition rate from 0.02, to 0.08 nm/s. Also, the film surfaces transformed from a rough to smooth surfaces with decreasing grain sizes as deposition rate increased. For magnetic analysis, the saturation magnetization M-s values decreased as 1030, 773, 730, and 217 emu/cm(3) with increasing deposition rate as 0.02, 0.04, 0.06, and 0.08 nm/s, respectively. In the same manner, the coercivity H-c values were found as 11, 7, 6, and 2 Oe with the deposition rate of 0.02, 0.04, 0.06, and 0.08 nm/s, respectively. The decrease of the H-c may have primarily come from the transformation of rough to smooth surface of the films. It may also be said that the films showed soft magnetic properties due to their low H-c values with increasing deposition rate. Thus, the magnetic properties of the quaternary FeNiCrCd alloy films were seen to be easily improved with the deposition rate parameter for potential use in different industrial applications.Balikesir UniversityBalikesir University [BAP 2018/107]; State Planning Organization/TurkeyTurkiye Cumhuriyeti Kalkinma Bakanligi [2005K120170]This work was financially supported by Balikesir University Research Grant No. BAP 2018/107. Also, it was financially supported by the State Planning Organization/Turkey under grant no. 2005K120170 for Sputtering and VSM systems

The effect of adaptive planning on target and critical structures during radiation treatment for locally advanced lung cancer

WOS: 000370365102148

The effect of depth and control point number for MLC transmission and dosimetric leaf gap

Purpose/Objective: MLC transmision (MLCT) and dosimetric leaf gap (DLG) in Treatment Planning System (TPS) are important parameters for dose calculation and they provide accuracy of delivering IMRT plans. MLCT and DLG account the leakage of MLC and the effect of rounded leaf ends, respectively. The aim of this study is to examine control point (CP) and depth dependance for MLCT and DLG. Materials and Methods: MLCT and DLG parameters were measured with PTW 0.125 cc semi-flex ionization chember in a solid water phantom for Varian Trilogy machine with Millenium MLC. MLCT measurements were obtained 15x15cm2 field size at different depths (Dmax,5,10 and 15cm) for 6 MV photon beam. To derive the DLG measurement , a series of Sliding Window (SW) fields of 2,4,7,10,15 and 20 mm gap widths were used. These SW fields were prepared with different number of CP (2,3,5,7,9,11,13,16 and 21) and DLG measuremets were performed at same depths and field size. DLG values were calculated for each depth using MLCT parameters which were measured at same depth