Sole conformal perioperative interstitial brachytherapy of early stage breast carcinoma using high-dose rate afterloading: longer-term results and toxicity

Aims and BackgroundThis study of high-dose-rate brachytherapy to the lumpectomy site as the sole radiation presents longer-term results and toxicity of accelerated partial-breast irradiation, using three-dimensional treatment planning.Materials and MethodsFrom March 2002 to July 2004, 25 patients were prospectively included in this study. Six patients were excluded because of definitive histology of lobular carcinoma or positive margin. The median age at the time of treatment was 63.2 years (range 44–77 years). Median follow-up of all patients was 44 months (range 30–53 months) with a minimum follow-up of 30 months. Radiation was delivered using the high-dose-rate remote afterloader VariSource with 192Ir source. The patients received radiation twice a day at least 6 hours apart for a total of 10 fractions over five days with a single dose of 3.4 Gy. The total dose was 34.0 Gy prescribed as a minimum peripheral dose to match or minimally exceed the volume defined by the surgical clips as seen on computed-tomography (CT) scans. Free-hand technique allows conformal placement of the catheters to the shape of the lumpectomy cavity. Side-effects and toxicity were scored using the EORTC/RTOG scale.ResultsAt a median follow-up of 44 months none of the women had developed in-field breast recurrences, one patient had out-of-field recurrences and one patient presented distant metastases. There were no regional nodal recurrences. In each woman, target volume size in cm3 (median 91.3 cm3), dose volume histogram (DVH), and dose homogeneity index (DHI) were calculated. Median DHI was 0.42. Median volume of breast tissue receiving 100% of the prescription dose, V100, was 87%; and V150 48.5%. We noticed two treatment complications: haematoma and abscess in the place of the tumour bed after extirpation. At last follow-up, all patients rated the overall cosmetic outcome as excellent or good.ConclusionsThis method is suitable only for patients with histologically confirmed small tumours

Automated video-based assessment of facial bradykinesia in de-novo Parkinson's disease.

Even though hypomimia is a hallmark of Parkinson's disease (PD), objective and easily interpretable tools to capture the disruption of spontaneous and deliberate facial movements are lacking. This study aimed to develop a fully automatic video-based hypomimia assessment tool and estimate the prevalence and characteristics of hypomimia in de-novo PD patients with relation to clinical and dopamine transporter imaging markers. For this cross-sectional study, video samples of spontaneous speech were collected from 91 de-novo, drug-naïve PD participants and 75 age and sex-matched healthy controls. Twelve facial markers covering areas of forehead, nose root, eyebrows, eyes, lateral canthal areas, cheeks, mouth, and jaw were used to quantitatively describe facial dynamics. All patients were evaluated using Movement Disorder Society-Unified PD Rating Scale and Dopamine Transporter Single-Photon Emission Computed Tomography. Newly developed automated facial analysis tool enabled high-accuracy discrimination between PD and controls with area under the curve of 0.87. The prevalence of hypomimia in de-novo PD cohort was 57%, mainly associated with dysfunction of mouth and jaw movements, and decreased variability in forehead and nose root wrinkles (p < 0.001). Strongest correlation was found between reduction of lower lip movements and nigro-putaminal dopaminergic loss (r = 0.32, p = 0.002) as well as limb bradykinesia/rigidity scores (r = -0.37 p < 0.001). Hypomimia represents a frequent, early marker of motor impairment in PD that can be robustly assessed via automatic video-based analysis. Our results support an association between striatal dopaminergic deficit and hypomimia in PD

Detection of persons with Parkinson's disease by acoustic, vocal, and prosodic analysis

Abstract—70 % to 90 % of patients with Parkinson’s disease (PD) show an affected voice. Various studies revealed, that voice and prosody is one of the earliest indicators of PD. The issue of this study is to automatically detect whether the speech/voice of a person is affected by PD. We employ acoustic features, prosodic features and features derived from a two-mass model of the vocal folds on different kinds of speech tests: sustained phonations, syllable repetitions, read texts and monologues. Classification is performed in either case by SVMs. A correlation-based feature selection was performed, in order to identify the most important features for each of these systems. We report recognition results of 91 % when trying to differentiate between normal speaking persons and speakers with PD in early stages with prosodic modeling. With acoustic modeling we achieved a recognition rate of 88 % and with vocal modeling we achieved 79%. After feature selection these results could greatly be improved. But we expect those results to be too optimistic. We show that read texts and monologues are the most meaningful texts when it comes to the automatic detection of PD based on articulation, voice, and prosodic evaluations. The most important prosodic features were based on energy, pauses and F0. The masses and the compliances of spring were found to be the most important parameters of the two-mass vocal fold model. I

Sole conformal perioperative interstitial brachytherapy of early stage breast carcinoma using high-dose rate afterloading: longer-term results and toxicity

SummaryAims and BackgroundThis study of high-dose-rate brachytherapy to the lumpectomy site as the sole radiation presents longer-term results and toxicity of accelerated partial-breast irradiation, using three-dimensional treatment planning.Materials and MethodsFrom March 2002 to July 2004, 25 patients were prospectively included in this study. Six patients were excluded because of definitive histology of lobular carcinoma or positive margin. The median age at the time of treatment was 63.2 years (range 44–77 years). Median follow-up of all patients was 44 months (range 30–53 months) with a minimum follow-up of 30 months. Radiation was delivered using the high-dose-rate remote afterloader VariSource with 192Ir source. The patients received radiation twice a day at least 6 hours apart for a total of 10 fractions over five days with a single dose of 3.4 Gy. The total dose was 34.0 Gy prescribed as a minimum peripheral dose to match or minimally exceed the volume defined by the surgical clips as seen on computed-tomography (CT) scans. Free-hand technique allows conformal placement of the catheters to the shape of the lumpectomy cavity. Side-effects and toxicity were scored using the EORTC/RTOG scale.ResultsAt a median follow-up of 44 months none of the women had developed in-field breast recurrences, one patient had out-of-field recurrences and one patient presented distant metastases. There were no regional nodal recurrences. In each woman, target volume size in cm3 (median 91.3 cm3), dose volume histogram (DVH), and dose homogeneity index (DHI) were calculated. Median DHI was 0.42. Median volume of breast tissue receiving 100% of the prescription dose, V100, was 87%; and V150 48.5%. We noticed two treatment complications: haematoma and abscess in the place of the tumour bed after extirpation. At last follow-up, all patients rated the overall cosmetic outcome as excellent or good.ConclusionsThis method is suitable only for patients with histologically confirmed small tumours (<3 cm in diameter) without negative prognostic factors for local recurrence. We observed low treatment-related morbidity and mild long-term toxicity with good treatment results

Relationship between serum calprotectin (S100A8/9) and clinical, laboratory and ultrasound parameters of disease activity in rheumatoid arthritis: A large cohort study

<div><p>Background</p><p>Calprotectin may be a sensitive biomarker of rheumatoid arthritis (RA) disease activity.</p><p>Objectives</p><p>In the current study, we investigated whether calprotectin is a better biomarker than CRP for predicting clinical activity and ultrasound parameters in patients with RA.</p><p>Methods</p><p>A total of 160 patients with RA underwent clinical (swollen joint count—SJC, tender joint count—TJC, Disease Activity Score—DAS28, Clinical Disease Activity Index—CDAI, and simplified Disease Activity Index—SDAI) and ultrasound (German US7) examination. Clinical and laboratory measures were correlated with ultrasound findings using Spearman´s correlation coefficient. Differences in serum calprotectin levels in patients with variable disease activity according to the DAS28-ESR and CDAI scores were assessed using ANOVA. Multivariate regression analysis was used to determine the predictive values of calprotectin, CRP and SJC for CDAI and PD US synovitis scores.</p><p>Results</p><p>Serum calprotectin was significantly associated with DAS28-ESR (r = 0.321, p<0.001), DAS28-CRP (r = 0.346, p<0.001), SDAI (r = 0.305, p<0.001), CDAI (r = 0.279, p<0.001) scores and CRP levels (r = 0.556, p<0.001). Moreover, calprotectin was significantly correlated with GS (r = 0.379, p<0.001) and PD synovitis scores (r = 0.419, p<0.001). The multivariate regression analysis showed that calprotectin is a better predictor of the CDAI score and PD US synovitis than CRP.</p><p>Conclusions</p><p>The results of this study support an additional role of calprotectin in assessing inflammatory activity in patients with RA.</p></div

Receiver-operator characteristic curves of serum calprotectin and CRP for distinguishing patients with ultrasound remission from those with subclinical ultrasound activity.

<p>All the patients achieved clinical remission according to a) DAS28-ESR, b) DAS28-CRP, c) SDAI and d) CDAI criteria.</p

Box plots showing the associations between Power Doppler synovitis score and disease activity according to A) DAS28-ESR, B) DAS28-CRP, C) SDAI, and D) CDAI.

<p>Box plots showing the associations between Power Doppler synovitis score and disease activity according to A) DAS28-ESR, B) DAS28-CRP, C) SDAI, and D) CDAI.</p

Multiple regression analyses predicting residual ultrasound activity in rheumatoid arthritis patients in clinical remission.

<p>Multiple regression analyses predicting residual ultrasound activity in rheumatoid arthritis patients in clinical remission.</p