Evaluation of surface dose outside the treatment area for five breast cancer irradiation modalities using thermo-luminescent dosimeters

Purpose: To measure and compare the surface dose outside the treatment area at six different points of interest (POIs) for five different breast cancer radiation treatment modalities by using thermo-luminescent dosimeters (TLDs). This experiment will evaluate the magnitude of the dose due to scatter and leakage radiation at different areas outside the target on a patient that could potentially lead, in the long term, to radiation induced secondary malignancies.Methods: TLD-100 were calibrated according to the University of Wisconsin Radiation Calibration Laboratory protocol and then used for dose measurements at selected POIs namely sternum, lower abdomen, contralateral breast, thyroid, shoulder, and eye. Twenty five breast cancer patients and the following modalities were included in this study: Strut-adjusted volume implant (SAVI), mammosite multi-lumen (ML), Accuboost, electron boost and photon boost. The surface doses in all patients were measured in a single fraction. The delivered target doses were normalized to 200 cGy. Finally, breast quadrant analysis was performed.Results: The maximum average dose for each POI was as follows: Sternum 6.51 cGy (SD 2.93), lower abdomen 4.50 cGy (SD 2.63), contralateral breast 8.52 cGy (SD 3.86), thyroid 5.50 cGy (SD 2.75), shoulder 5.58 cGy (SD 2.77), and eye 2.65 cGy (SD 0.68). The highest POI dose of 15.84 cGy was found in contralateral breast.Conclusion: The measured surface dose at each POI varies with the modality of treatment. The surface doses show a strong correlation to the tumor bed location in the breast quadrant. The SAVI, electron boost, and photon boost modalities had delivered smaller surface dose at POIs than the Accuboost and Mammosite ML modalities. While the measured doses fall within the low range, its significance in producing second malignancies would require a large cohort of patients and a longer follow up

RESPONSE OF AZOTOBACTER IN CAULIFLOWER (BRASSICA OLERACEA L. VAR. BOTRYTIS) PRODUCTION AT LAMJUNG, NEPAL

A field experiment was carried out at research field of Lamjung Campus, Nepal during September 2015 to February 2016 to assess the response of cauliflower (Brassica oleracea L. var. botrytis) to different combination of nitrogenous fertilizer with Azotobacter. 6 treatment with 4 replications were laid out in Randomized Complete Block Design. Phosphorous and potassium was applied full does in all the treatments with chemical fertilizer. It was recorded that the application of recommended doses of nitrogen along with the bio-fertilizer significantly increased morphological characters and yield as compared to other treatments. Besides, the stem diameter was non-significant to the different treatments. It was followed by the full dose of NPK without azotobacter and then 50% nitrogen with azotobacter, which was statistically at par with 25% nitrogen with azotobacter, followed by FYM + Azotobacter. Curd yield along with all the morphological characters were seen lowest in control. Cauliflower curd yield at recommended dose of nitrogen did not significantly differ with the curd yield recorded at half of recommended dose of nitrogen with azotobacter. The finding demonstrated a saving of 50% of nitrogen where it can be substituted with the application of bio-fertilizer to increase the yield and morphological character

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Evaluation of surface dose outside the treatment area for five breast cancer irradiation modalities using thermo-luminescent dosimeters

Purpose: To measure and compare the surface dose outside the treatment area at six different points of interest (POIs) for five different breast cancer radiation treatment modalities by using thermo-luminescent dosimeters (TLDs). This experiment will evaluate the magnitude of the dose due to scatter and leakage radiation at different areas outside the target on a patient that could potentially lead, in the long term, to radiation induced secondary malignancies.Methods: TLD-100 were calibrated according to the University of Wisconsin Radiation Calibration Laboratory protocol and then used for dose measurements at selected POIs namely sternum, lower abdomen, contralateral breast, thyroid, shoulder, and eye. Twenty five breast cancer patients and the following modalities were included in this study: Strut-adjusted volume implant (SAVI), mammosite multi-lumen (ML), Accuboost, electron boost and photon boost. The surface doses in all patients were measured in a single fraction. The delivered target doses were normalized to 200 cGy. Finally, breast quadrant analysis was performed.Results: The maximum average dose for each POI was as follows: Sternum 6.51 cGy (SD 2.93), lower abdomen 4.50 cGy (SD 2.63), contralateral breast 8.52 cGy (SD 3.86), thyroid 5.50 cGy (SD 2.75), shoulder 5.58 cGy (SD 2.77), and eye 2.65 cGy (SD 0.68). The highest POI dose of 15.84 cGy was found in contralateral breast.Conclusion: The measured surface dose at each POI varies with the modality of treatment. The surface doses show a strong correlation to the tumor bed location in the breast quadrant. The SAVI, electron boost, and photon boost modalities had delivered smaller surface dose at POIs than the Accuboost and Mammosite ML modalities. While the measured doses fall within the low range, its significance in producing second malignancies would require a large cohort of patients and a longer follow up.</p

Seasonal variation in giant cell arteritis and polymyalgia rheumatica hospitalizations: Data from Nationwide Inpatient Sample

Most studies looking at seasonal variations in giant cell arteritis (GCA) note a seasonal trend, but show disparity on timing. Concurrent peaks of GCA and polymyalgia rheumatica (PMR) have been described by some studies questioning a common precipitating agent. We aimed to analyze the seasonal variation of GCA and PMR in the US using a large inpatient database