The October 2016 NEJM publication of the PESIT trial by Prandoni et al set the world of social media ablaze (1). There were the standard fear mongering headlines noting that 1 in 6 patients admitted to the hospital following syncope had a pulmonary embolism. This was followed by a reactionary flurry of commentary by the […]
EMCrit by Rory Spiegel.
A cybersecurity expert offers a soup-to-nuts IoT security guide for every organization, individual and device with confidential data to protect
http://ift.tt/2qUs1hV
The purpose of this study is to investigate the dosimetric advantages of volumetric modulated arc therapy (VMAT) in the treatment of intraocular cancer by comparing it directly with three-dimensional conformal radiotherapy (CRT) and intensity-modulated radiotherapy (IMRT).
CRT plan, 7f-IMRT plan, and one-arc VMAT plan were generated for 14 intraocular cancer patients. Dosimetric and biological quality indices for target volume and organs at risks (OARs) were evaluated and compared.
The target coverage presented by V95 for CRT, IMRT and VMAT were 95.02% ± 0.67%, 95.51% ± 2.25%, and 95.92% ± 3.05%, respectively. The homogeneity index (HI) for CRT, IMRT and VMAT were 0.15 ± 0.05, 0.23 ± 0.05, and 0.23 ± 0.06, respectively. IMRT and VMAT greatly decreased the dose to ipsilateral lens compared with CRT with a D1 of 2972.66 ± 1407.12 cGy, 3317.82 ± 915.28 cGy and 4809.54 ± 524.60 cGy for IMRT, VMAT and CRT, respectively. Similar results were observed for ipsilateral eyeballs. IMRT and VMAT also spared better on brainstem, optical nerves and optical chiasm compared CRT. However, CRT achieved lower dose to the eyeballs compared with IMRT and VMAT. VMAT and IMRT showed mixed results on target coverage and OAR sparing. The average MUs and delivery time of IMRT and VMAT were 531.25 ± 81.21 vs. 400.99 ± 61.49 and 5.05 ± 0.53 vs.1.71 ± 0.69 min, respectively.
Although no clear distinction on PTV coverage among CRT, IMRT and VMAT plans was observed in the treatment of intraocular cancer, VMAT and IMRT achieved better homogeneity and conformity for target volume, and delivered fewer doses to ipsilateral lens and eyeballs compared with CRT. However, VMAT and IMRT increased the low dose volume to the contralateral OARs. Although VMAT and IMRT showed mixed results on target coverage and OAR sparing, VMAT decreased MU and delivery time significantly compared with IMRT. VMAT is a promising and feasible external beam radiotherapy technique in the treatment of intraocular cancer patients.
This review aims to provide a comprehensive overview of the literature and elucidate open questions for future clinical trials concerning diagnostics and treatment modalities for cervical cancer of unknown primary (CUP).
A literature search for head and neck CUP was performed with focus on diagnostics and therapies as well as molecular markers.
High level evidence on CUP is limited. However, it seems that a consensus exists regarding the optimal diagnostic procedures. The correct implementation of biomarkers for patient stratification and treatment remains unclear. An even greater dispute dominates about the ideal treatment with publications ranging from sole surgery to surgery with postoperative bilateral radiotherapy with inclusion of the mucosa and concomitant chemotherapy.
Cervical CUP represents a very heterogeneous malignant disease. On this account many aspects concerning treatment optimization remain unclear, despite a considerable number of publications in the past. Future research in form of prospective randomized trials is needed in order to better define patient stratification criteria and enable tailored treatment.
Hematological and serum biochemical reference intervals are essential laboratory variables for optimal diagnostic purposes. The present study was delineated to provide an insight into the hemato-biochemical alterations as well as the measurement of selected acute phase proteins in buffaloes showing some digestive disorders. The present study included 40 native breed water buffalo showing various symptoms of digestive troubles. Based on competent case history, clinical and laboratory findings, the diseased buffaloes were allocated into four equal sized groups, namely stomatitis, acute traumatic reticuloperitonitis (TRP), acute rumen impaction, and enteritis. Ten apparently healthy buffaloes were randomly selected from the same animal population and considered as control group. Blood samples were drawn from all investigated animals for hematologic examination and measurements of a panel of serum biochemical variables. All diseased buffaloes showed statistically significant high values of total leucocytes (P ≤ 0.05) with significantly low values of total erythrocytes and hemoglobin concentration compared with controls (P ≤ 0.05). Serum magnesium, sodium, and iron showed a statistically (P ≤ 0.05) lower values in all studied buffaloes than those of controls; while serum calcium levels were significantly decreased (P ≤ 0.05) in buffaloes showing stomatitis and those with TRP compared with controls. Serum hepatic enzyme activities beside serum haptoglobin and C-reactive protein were significantly (P ≤ 0.05) higher in all diseased buffaloes than those of controls. The results herein concluded that diseased buffalo were associated with marked hematological and elemental alterations besides a distinct inflammatory reaction. Further studies are needed to explore the potential ameliorative value of using supplementary agents to help mitigate the associated biochemical and inflammatory reactions in buffaloes exhibiting digestive disorders.
