Stereotactic Body Radiation Therapy (SBRT) for Liver Metastasis: Early Experience with the Cyberknife Robotic Radio-Surgery System

Background: The liver is a common site for malignant metastases. Surgical metastatic resection, ablative therapies, and external beam radiation therapy (EBRT) all have advantages and limitations. Preliminary reports reveal SBRT treats hepatic metastases with limited toxicities. We reviewed our institution’s SBRT experience for the treatment of liver metastases to assess toxicity and outcomes.Methods: Hepatic metastases treated with SBRT were retrospectively reviewed from 2008-2010. Computed tomography (CT) identified tumor volume prior to SBRT, local recurrence and out-of-field progression after SBRT. Study endpoints were local recurrence, toxicity, and overall survival.Results: Thirty-three patients had 37 liver metastases treated with a median SBRT dose of 30Gy. Median follow-up was 8.1 months. Five lesions (13.5%) locally recurred after a median of 10.6 months. Seventeen patients had out-of-field progression (15 liver, 6 systemic) after a median of 5.1 months. Overall 23.5-month survival was 45.5%. Five patients reported nausea and seven reported pain after SBRT. There were no grade 4-5 toxicities or cases of liver failure.Conclusion: SBRT is safe and well tolerated in patients with hepatic metastases. SBRT offers a local therapy with limited toxicities to patients with lesions not amenable to traditional ablative, surgical, or regional therapies

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Construction of master sintering curves to understand the effect of Na addition on ZnO-based varistors

This work describes the effect of a small sodium addition on the densification of Bi2O3-based ZnO varistors. The characterisation was performed using both the master sintering curve tool and the analyses of structural and microstructural characteristics of the materials. It was found that sodium-free varistor material exhibited very low activation energy for densification (149.2kJ/mol). This was explained by the liquid phase promoting diffusion through the enhanced reaction between ZnO and Bi2O3. For sodium-doped material, the calculated activation energy was much higher (292.5kJ/mol) and was very close to the one obtained for pure ZnO, which is often related to the grain boundary solid-state diffusion. It was shown that a small sodium addition prevented Bi2O3 from satisfactorily reacting with ZnO. Finally, a mechanism was proposed to explain how a slight sodium amount altered the reactivity between Bi2O3 and the ZnO matrix, resulting in some major changes in the final microstructures. © 2015 Elsevier Ltd