Recurrent scoliosis one year after surgical correction

A year after anterolateral spondylodesis for progressive scoliosis, the patient showed a flexion gait pattern with recurrent deformity, due to late infection. Surgical debridement resolved all symptoms. Whereas most postoperative infections occur after posterior spondylodesis and present with back pain and mild increase of infection parameters, late infection after anterolateral approach is rare. In this case the patient did not present with the classic symptoms

The impact of cessation or continuation of family violence on children

Children exposed to family violence are at risk for developing long-lasting problems. Family violence is a pervasive problem, however, studies comparing continuation with cessation of family violence are limited. Understanding the cessation or continuation of family violence on child development is a prerequisite to prevent enduring problems and develop interventions. This study compares posttraumatic stress and delinquent behavior of children aged between eight and eighteen years for whom severe violence continues to children for whom violence diminishes or ceases. Children (N = 162, 43% boys, mean age 12 years) and their parents reported to child protection services (CPS) with severe violence were included. Levels of family violence, posttraumatic stress and delinquent behavior were re-assessed after 18 months. Most families (74%) still experienced severe family violence at the second assessment despite involvement of CPS. Structural equation modelling was applied. In the group where violence diminished or stopped, delinquent behavior decreased. A decrease of posttraumatic stress only occurred when violence diminished but surprisingly no decrease was observed when violence stopped completely. The findings demonstrate that overall family violence is persistent. Differing paths can be discerned for delinquent behavior and posttraumatic stress, indicating different developmental and recovery pathways after cessation of family violence. Nonetheless, it is fair to state that specialized and long-term care is crucial

Effective Prolonged Therapy with Voriconazole in a Lung Transplant Recipient with Spondylodiscitis Induced by Scedosporium apiospermum

Scedosporium/Pseudallescheria species are frequently seen in cystic fibrosis patients. However, disseminated forms after lung transplantation in these patients are rarely seen, but often with poor outcome. In this case report we describe a lung transplant recipient with cystic fibrosis who developed a spondylodiscitis that was caused by Scedosporium apiospermum. The patient was treated with anti-fungal treatment by voriconazole for over three years with a clinical good response and without the need for surgical intervention. To our opinion this is the first anti-fungal treated case of invasive disease caused by Scedosporium/Pseudallescheria in a cystic fibrosis (CF) patient who underwent lung transplantation that survived

Establishment of the New Particle Therapy Research Center (PARTREC) at UMCG Groningen

After 25 years of successful research in the nuclear and radiation physics domain, the KVI-CART research center in Groningen is upgraded and re-established as the PARticle Therapy REsearch Center (PARTREC). Using the superconducting cyclotron AGOR and being embedded within the University Medical Center Groningen, it operates in close collaboration with the Groningen Proton Therapy Center. PARTREC uniquely combines radiation physics, medical physics, biology and radiotherapy research with an R&D program to improve hadron therapy technology and advanced radiation therapy for cancer. A number of further upgrades, scheduled for completion in 2023, will establish a wide range of irradiation modalities, such as pencil beam scanning, shoot-through with high energy protons and SOBP for protons, helium and carbon ions. Delivery of spatial fractionation (GRID) and dose rates over 300 Gy/s (FLASH) are envisioned. In addition, PARTREC delivers a variety of ion beams and infrastructure for radiation hardness experiments conducted by scientific and commercial communities, and nuclear science research in collaboration with the Faculty of Science and Engineering of the University of Groningen

Radiation-Induced Myocardial Fibrosis in Long-Term Esophageal Cancer Survivors

Purpose: Radiation-induced cardiac toxicity is a potential lethal complication. The aim of this study was to assess whether there is a dose-dependent relationship between radiation dose and myocardial fibrosis in patients who received neoadjuvant chemoradiation (nCRT) for esophageal cancer (EC). Methods and Materials: Forty patients with EC treated with a transthoracic esophagectomy with (n = 20) or without (n = 20) nCRT (CROSS study regimen) were included. Cardiovascular magnetic resonance imaging (1.5 Tesla) for left ventricular (LV) function, late gadolinium enhancement, and T1 mapping were performed. Extracellular volume (ECV), as a surrogate for collagen burden, was measured for all LV segments separately. The dose-response relationship between ECV and mean radiation dose per LV myocardial segment was evaluated using a mixed-model analysis. Results: Seventeen nCRT and 16 control patients were suitable for analysis. The mean time after treatment was 67.6 +/- 8.1 (nCRT) and 122 +/- 35 (controls) months (P = .02). In nCRT patients, we found a significantly higher mean global ECV of 28.2% compared with 24.0% in the controls (P < .001). After nCRT, LV myocardial segments with elevated ECV had received significantly higher radiation doses. In addition, a linear dose-effect relation was found with a 0.136% point increase of ECV for each Gy (P < .001). There were no differences in LV function measures and late gadolinium enhancement between both groups. Conclusions: Myocardial ECV was significantly higher in long-term EC survivors after nCRT compared with surgery only. Moreover, this ECV increase was linear with the radiation dose per LV segment, indicating radiation-induced myocardial fibrosis. (C) 2021 The Author(s). Published by Elsevier Inc

The role of supportive parenting and stress reactivity in the development of self-regulation in early childhood

Maternal sensitivity and supportive discipline are important determinants of child self-regulation. Some evidence suggests that specific genetic or temperamental markers determine children’s susceptibility to the impact of maternal parenting on child self-regulation. Cortisol reactivity as a susceptibility marker moderating the relation between maternal parenting and child self-regulation has not yet been studied. In this longitudinal population-based study (N = 258), the moderating role of infant cortisol stress response to the Strange Situation Procedure at age 1 was examined in the association between parenting (sensitivity and supportive discipline) at age 3 and child self-regulation at age 3 and 4. Maternal sensitivity and supportive discipline were related to child immediate and prolonged delay of gratification at age 3, and maternal sensitivity was related to working memory skills at age 4. No evidence of differential susceptibility to maternal parenting was found, based on differences in infant cortisol stress response

Parotid Gland Stem Cell Sparing Radiation Therapy for Patients With Head and Neck Cancer:A Double-Blind Randomized Controlled Trial

BACKGROUND: Radiotherapy for head and neck cancer (HNC) frequently leads to salivary gland damage and subsequent xerostomia. The radiation response of parotid glands of rats, mice, and patients critically depends on dose to its stem cells, mainly located in the gland's main ducts (stem cell rich (SCR) region). Therefore, this double-blind randomized controlled trial aimed to test the hypothesis that parotid gland stem cell sparing radiotherapy preserves parotid gland function better than currently-used whole parotid gland sparing radiotherapy. METHODS: HNC patients (n=102) treated with definitive radiotherapy were randomized between standard parotid sparing and stem cell sparing (SCS) techniques. The primary endpoint was >75% reduction in parotid gland saliva production compared to pretreatment production (FLOW12M). Secondary endpoints were several aspects of xerostomia 12 months after treatment. RESULTS: Fifty-four patients were assigned to the standard arm and 48 to the SCS arm. Only dose to the SCR regions (contralateral 16 and 11 Gy (p=0.004) and ipsilateral 26 and 16 Gy (p=0.001), standard and SCS arm respectively) and pretreatment patient-rated daytime xerostomia (35% and 13% (p=0.01), standard and SCS arm respectively) differed significantly between the arms. In the SCS arm, 1 patient (2.8%) experienced FLOW12M compared to 2 (4.9%) in the standard arm (p=1.00). However, a trend towards better relative parotid gland salivary function in favor of SCS radiotherapy was shown. Moreover, multivariable analysis showed that mean contralateral SCR region dose was the strongest dosimetric predictor for moderate-to-severe patient-rated daytime xerostomia and grade ≥2 physician-rated xerostomia, the latter including complaints of alteration in diet. CONCLUSIONS: No significant better parotid function was observed in SCS radiotherapy. However, additional multivariable analysis showed that dose to the SCR region was more predictive for development of parotid gland function related xerostomia endpoints, than dose to the entire parotid gland

Late cardiac toxicity of neo-adjuvant chemoradiation in esophageal cancer survivors:A prospective cross-sectional pilot study

Purpose: Although cure rates in esophageal cancer (EC) have improved since the introduction of neoadjuvant chemoradiation (nCRT), evidence for treatment-related cardiac toxicity is growing, of which the exact mechanisms remain unknown. The primary objective of this study was to identify (subclinical) cardiac dysfunction in EC patients after nCRT followed by surgical resection as compared to surgery alone. Materials and Methods: EC survivors followed for 5-15 years after curative resection with (n = 20) or without (n = 20) nCRT were enrolled in this prospective cross-sectional pilot study. All patients underwent several clinical and diagnostic tests in order to objectify (sub)clinical cardiac toxicity including cardiac CT and MRI, echocardiography, ECG, 6-minutes walking test, physical examination and EORTC questionnaires. Results: We found an increased rate of myocardial fibrosis (Linear late gadolinium enhancement (LGE) 4 vs. 1; p = 0.13; mean extracellular volume (ECV) 28.4 vs. 24.0; p < 0.01), atrial fibrillation (AF) (6 vs. 2; p = 0.07) and conduction changes in ECG among patients treated with nCRT as compared to those treated with surgery alone. The results suggested an impact on quality of life in terms of worse role functioning for this patient group (95.0 vs. 88.8; p = 0.03). Conclusion: Based on our analyses we hypothesize that in EC patients, radiation-induced myocardial fibrosis plays a central role in cardiac toxicity leading to AF, conduction changes and ultimately to decreased role functioning. The results emphasize the need to verify these findings in larger cohorts of patients. (C) 2021 The Author(s). Published by Elsevier B.V