Dosimetry characterization of 32^{32}P intravascular brachytherapy source wires using Monte Carlo codes PENELOPE and GEANT4

Monte Carlo calculations using the codes PENELOPE and GEANT4 have been performed to characterize the dosimetric parameters of the new 20 mm long catheter based $^{32}$P beta source manufactured by Guidant Corporation. The dose distribution along the transverse axis and the two dimensional dose rate table have been calculated. Also, the dose rate at the reference point, the radial dose function and the anisotropy function were evaluated according to the adapted TG-60 formalism for cylindrical sources. PENELOPE and GEANT4 codes were first verified against previous results corresponding to the old 27 mm Guidant $^{32}$P beta source. The dose rate at the reference point for the unsheathed 27 mm source in water was calculated to be $0.215 \pm 0.001$ cGy s$^{-1}$ mCi$^{-1}$, for PENELOPE, and $0.2312 \pm 0.0008$ cGy s$^{-1}$ mCi$^{-1}$, for GEANT4. For the unsheathed 20 mm source these values were $0.2908 \pm 0.0009$ cGy s$^{-1}$ mCi$^{-1}$ and $0.311 \pm 0.001$ cGy s$^{-1}$ mCi$^{-1}$, respectively. Also, a comparison with the limited data available on this new source is shown. We found non negligible differences between the results obtained with PENELOPE and GEANT4.Comment: 13 pages, 7 figures, 7 tables (accepted for publication in Medical Physics

Stent-Based Retrieval Techniques in Acute Ischemic Stroke Patients with and Without Susceptibility Vessel Sign.

BACKGROUND AND PURPOSE Randomized controlled trials have challenged the assumption that reperfusion success after mechanical thrombectomy varies depending on the retrieval techniques applied; however, recent analyses have suggested that acute ischemic stroke (AIS) patients showing susceptibility vessel sign (SVS) may respond differently. We aimed to compare different stent retriever (SR)-based thrombectomy techniques with respect to interventional outcome parameters depending on SVS status. METHODS We retrospectively reviewed 497 patients treated with SR-based thrombectomy for anterior circulation AIS. Imaging was conducted using a 1.5 T or 3 T magnetic resonance imaging (MRI) scanner. Logistic regression analyses were performed to test for the interaction of SVS status and first-line retrieval technique. Results are shown as percentages, total values or adjusted odds ratio (aOR) with 95% confidence intervals (CI). RESULTS An SVS was present in 87.9% (n = 437) of patients. First-line SR thrombectomy was used to treat 293 patients, whereas 204 patients were treated with a combined approach (COA) of SR and distal aspiration. An additional balloon-guide catheter (BGC) was used in 273 SR-treated (93.2%) and 89 COA-treated (43.6%) patients. On logistic regression analysis, the interaction variable of SVS status and first-line retrieval technique was not associated with first-pass reperfusion (aOR 1.736, 95% CI 0.491-6.136; p = 0.392), overall reperfusion (aOR 3.173, 95% CI 0.752-13.387; p = 0.116), periinterventional complications, embolization into new territories, or symptomatic intracerebral hemorrhage. The use of BGC did not affect the results. CONCLUSION While previous analyses indicated that first-line SR thrombectomy may promise higher rates of reperfusion than contact aspiration in AIS patients with SVS, our data show no superiority of any particular SR-based retrieval technique regardless of SVS status

Health Policy for Prostate Cancer Early Detection in the European Union and the Impact of Opportunistic Screening:PRAISE-U Consortium

With the new policy recommendation in 2022 to explore the possibilities of screening for prostate cancer by the European Commission, the landscape for prostate cancer early detection is evolving. In line with this recommendation, the PRAISE-U project aims to evaluate the early detection and diagnosis of prostate cancer through customised and risk-based screening programmes, with the goal to align protocols across European Union member states. This systematic review is part of the PRAISE-U project, with the goal to review the policy, medical guideline recommendations, and the current level of opportunistic screening presented in the scientific literature on prostate cancer early detection from 2016 to 2023 in European Union member states. An extensive literature search was performed on 1 June 2023 in a large number of databases, including Embase.com, Medline (Ovid), Web of Science Core Collection, Google Scholar, and Policy Commons. We identified 318 articles (qualitative, quantitative, and reviews), of which 41 were included in the full-text screening. Seventeen articles were ultimately identified as eligible for inclusion. The included articles revealed significant variations towards PSA-based early detection policies for prostate cancer in nine European countries. Despite official recommendations, opportunistic screening was prevalent across all nine countries regardless of recommendations for or against PSA-based early detection. This systematic review suggests that the current early detection policies are not fit for purpose. High levels of opportunistic screening and overdiagnosis persist, prompting policy recommendations for standardised guidelines, informed decision making, and increased awareness to improve efficiency and effectiveness in early detection.</p

Oestradiol-17β plasma concentrations after intramuscular injection of oestradiol benzoate or oestradiol cypionate in llamas (Lama glama)

<p>Abstract</p> <p>Background</p> <p>Llamas (<it>Lama glama</it>) are induced ovulators and the process of ovulation depends on dominant follicular size. In addition, a close relationship between behavioural estrus and ovulation is not registered in llamas. Therefore, the exogenous control of follicular development with hormones aims to predict the optimal time to mate. Oestradiol-17β (E₂) and its esters are currently used in domestic species, including camelids, in synchronization treatments. But, in llamas, there is no reports regarding the appropriate dosages to be used and most protocols have been designed by extrapolation from those recommended for other ruminants. The aim of the present study was to characterize plasma E₂concentrations in intact female llamas following a single intramuscular (i.m.) injection of two oestradiol esters: oestradiol benzoate (EB) and oestradiol cypionate (ECP).</p> <p>Methods</p> <p>Twelve non pregnant and non lactating sexually mature llamas were i.m. injected on day 0 with 2.5 mg of EB (EB group, n = 6) or ECP (ECP group, n = 6). Blood samples were collected immediately before injection, at 1, 6, 12, 24 h after treatment and then daily until day 14 post injection. Changes in hormone concentrations with time were analyzed in each group by analysis of variance (ANOVA) using a repeated measures (within-SS) design. Plasma E₂concentrations and area under the concentration-time curve (AUC) values were compared between groups by ANOVA. In all cases a Least-Significant Difference test (LSD) was used to determine differences between means. Hormonal and AUC data are expressed as mean ± S.E.M.</p> <p>Results</p> <p>Peak plasma E₂concentrations were achieved earlier and were higher in EB group than in ECP group. Thereafter, E₂returned to physiological concentrations earlier in EB group (day 5) than in ECP group (day 9). Although plasma E₂profiles differed over time among groups there were no differences between them on AUC values.</p> <p>Conclusions</p> <p>The i.m. injection of a single dose of both oestradiol esters resulted in plasma E₂concentrations exceeding physiological values for a variable period. Moreover, the plasma E₂profiles observed depended on the derivative of oestradiol administered. This basic information becomes relevant at defining treatment protocols including oestrogens in llamas.</p

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Sponsoringcontracten

With his work the author wants to investigate the legal problems concerning the closing, execution and termination of sponsorship agreements. The main objective of the research is to determine the existence of an (independent) cross-sector sponsorship concept and its (legal) consequences. Or, formulated differently, what legal framework is applicable to sponsorship as an independent legal concept? In turn, this research objective is divided into a number of sub-questions: 1) What is sponsorship and how is it aligned with other marketing instruments and fundraising techniques? 2) How to translate a sponsorship transaction into legal terms and what possible problems do parties encounter in this regard? 3) Is there - and if so: to what extent - a legal protection for the (potential) value created by the sponsorship transaction? Our research shows that sponsorship is a marketing technique, used by companies (or non-economic institutions) to generate a promotional association with a sponsored object. The sponsor provides money, goods or services to the sponsored party in exchange for one or more means to associate himself with the aforementioned object. On a legal level the sponsorship transaction is therefore constructed as a reciprocal agreement between the sponsor and the sponsored party. An important contractual obligation of the sponsored party is his obligation to facilitate the promotional association between the sponsor and the sponsored object. Several sponsorship bans and restrictions are also analyzed extensively in this regard. In addition to this obligation, the sponsored party is also usually bound by a non-association obligation. After all, the sponsor wants to be exclusive to a certain extent in order to distinguish himself (or: his products) from its competitors or to avoid promotional overexposure. Parties also value each other's good image. In the light of their promotional association a negative image on the part of one of them can influence the image of the other party (or: the sponsored object). That is why in principle each of the parties also has the obligation to withhold himself from blameworthy behavior that can bring the other party (or: the sponsored object) into disrepute. Specific obligations could also be found in naming-rights sponsorship and media sponsorship agreements, two particular types of sponsorship transactions. Because the closing of a sponsorship transaction only makes sense insofar as the (potential) value created by the promotional association is in some way protected, we also discuss the instrument of ambush marketing and the various ways to take action against it. As a sponsorship related figure, ambush marketing refers to those situations in which - intentionally or unintentionally - a promotional association is generated, without any permission hereto.status: publishe