Treatment planning comparison of volumetric modulated arc therapy employing a dual-layer stacked multi-leaf collimator and helical tomotherapy for cervix uteri

Purpose

To ascertain the dosimetric performance of a new delivery system (the Halcyon system, H) equipped with dual-layer stacked multi-leaf collimator (MLC) for risk-adapted targets in cervix uteri cancer patients compared to another ring-based system in clinical operation (Helical Tomotherapy, HT).

Methods

Twenty patients were retrospectively included in a treatment planning study (10 with positive lymph nodes and 10 without). The dose prescription (45Gy to the primary tumour volume and a simultaneously integrated boost up to 55Gy for the positive patients) and the clinical planning objectives were defined consistently as recommended by an ongoing multicentric clinical trial. Halcyon plans were optimised for the volumetric modulated arc therapy. The plan comparison was performed employing the quantitative analysis of the dose-volume histograms.

Results

The coverage of the primary and nodal target volumes was comparable for both techniques and both subsets of patients. The primary planning target volume (PTV) receiving at least 95% of the prescription isodose ranged from 97.2 ± 1.1% (node-negative) to 99.1 ± 1.2% (node-positive) for H and from 96.5 ± 1.9% (node-negative) to 98.3 ± 0.9% (node-positive) for HT. The uncertainty is expressed at one standard deviation from the cohort of patient per each group. For the nodal clinical target volumes, the dose received by 98% of the planning target volume ranged 55.5 ± 0.1 to 56.0 ± 0.8Gy for H and HT, respectively. The only significant and potentially relevant differences were observed for the bowels. In this case, V_40Gy resulted 226.3 ± 35.9 and 186.9 ± 115.9 cm³ for the node-positive and node-negative patients respectively for Halcyon. The corresponding findings for HT were: 258.9 ± 60.5 and 224.9 ± 102.2 cm³. On the contrary, V_15Gy resulted 1279.7 ± 296.5 and 1557.2 ± 359.9 cm³ for HT and H respectively for node-positive and 1010.8 ± 320.9 versus 1203.8 ± 332.8 cm³ for node-negative.

Conclusion

This retrospective treatment planning study, based on the dose constraints derived from the Embrace II study protocol, suggested the essential equivalence between Halcyon based and Helical Tomotherapy based plans for the intensity-modulated rotational treatment of cervix uteri cancer. Different levels of sparing were observed for the bowels with H better protecting in the high-dose region and HT in the mid-low dose regions. The clinical impact of these differences should be further addressed.

An Investigation on the Coinfection of Measles and HSV-1 in Hospitalized Acute Encephalitis Syndrome Patients in Eastern India

Acute encephalitis syndrome (AES) is a clinical condition that occurs due to infectious and noninfectious agents- however, viruses are considered to be the dominant pathogen. agents- however, viruses are considered to be the dominant pathogen. In this study, suspected AES cases were enrolled and tested for viral etiology through serology and polymerase chain reaction (PCR)/reverse transcriptase PCR from August 2012-July 2013. During this period, 820 cases were investigated and 96 cases were diagnosed to have a viral etiology whereas 20 patients had IgM antibodies for measles in serum and HSV-1 DNA in cerebrospinal fluid. All 20 of the patients were children below 14 years of age. The median hospital stay was 15 days (IQR: 14.2-17 days) and median GCS score was 7(IQR: 6-8) and were significantly different with patients with co-infections when comapred with patients having HSV-1 infection only. It may be suspected that the measles infection may have a role in the pathogenesis and thus an impact on the prognosis of the AES when present with HSV-1.

Epidemiological and clinical profile of Influenza A(H1N1) pdm09 in Odisha, eastern India

Epidemic of flu is highly contagious and it spreads through air. In 2009 H1N1 influenza virus emerged after reassortment of North American TRIG and Eurasia Avian like virus of swine and started epidemic in Mexico. The first cases were reported from Hyderabad city on 16th May 2009 in India that spread rapidly within a short span of time. During this period large population of Odisha situated at the eastern side of India was also affected and incidences of H1N1 cases were recorded through state Government surveillance system. In this study real time RT-PCR based diagnosis was conducted for the throat swabs collected from suspected H1N1 cases in Odisha during 2009–2017. A total of 2872 throat swabs were received from 23 different Government and private hospitals and 21.1% positivity was confirmed. The disease affected mostly 46–60 years age group, males (50.6%) being more affected. The clinical features had shown that fever with cough (89.6%) was the most common symptom followed by shortness of breath (72.7%). Post monsoon was the peak season in which most of the cases were reported. Neurological signs, pregnancy, diabetes and hypertension were found to be risk factors for H1N1. The case fatality rate (CFR) was 15%.

Short implants and platelet-rich fibrin for transcrestal sinus floor elevation: a prospective multicenter clinical study

INTRODUCTION

Inadequacy of residual bone height due to sinus pneumatization and alveolar bone remodeling could jeopardize the option for implant supported rehabilitation in posterior atrophied maxillae.

AIM

The aim of this prospective, multi-centric clinical study is to investigate and assess the survival rate of short implants in single posterior maxillae atrophied sites with adjacent natural teeth, when augmented with leukocyte and platelet-rich fibrin (L-PRF) alone using a minimally invasive trans-crestal approach.

MATERIALS AND METHODS

Seventy-four short implants were installed in 53 patients with residual bone height (RBH) <4mm using piezoelectric ultrasonic guided sinus elevation by transcrestal approach. Six perforations of the sinus membrane occurred (11.3% perforation rate), out of which five were managed by using just L-PRF as grafting material. Postoperatively, the implants were clinically evaluated for survival rate. The cumulative implant survival rate was 93.3% at the end of first year of follow-up. Considering 2 dropouts by the end of 2nd year follow-up, and no further implant loss, the cumulative survival rate remained 93.3% up to 5 years follow-up period.

DISCUSSION

The use of L-PRF plug as grafting and careful preparation of osteotomy site with piezoelectric ultrasonic device could allow for simultaneous crestal sinus floor elevation and short implant installation in posterior atrophied maxillae with RBH <4mm, extending the indications for implant rehabilitation.

Prospective association between late evening food consumption and risk of prediabetes and diabetes: the Whitehall II cohort study

AIMS

We examined whether late evening food consumption was prospectively associated with the risk of developing prediabetes or diabetes in a large observational study of individuals with normoglycaemia.

METHODS

Participants were 2642 men and women with normoglycaemia (HbA_1c < 39 mmol/mol; < 5.7%) from the Whitehall II study. Time of last eating episode (TLEE) before the examination day was assessed at baseline. We studied the associations of TLEE with 5-year changes in HbA_1c and risk of developing prediabetes or diabetes (HbA_1c ≥ 39 mmol/mol; ≥ 5.7%). Potential heterogeneity in the association between TLEE and prediabetes or diabetes was examined using recursive partitioning modelling for time-to-event outcomes.

RESULTS

There was a tendency of an overall association of TLEE with change in HbA_1c but with little effect size [β per 1-h increase in TLEE = 0.2 mmol/mol, 95% CI -0.0 to 0.3 (0.01%, -0.00 to 0.03); P = 0.055] and no association with the risk of developing prediabetes/diabetes (risk ratio per 1-h increase in TLEE = 1.03, 95% CI 0.94 to 1.13; P = 0.511). According to the recursive partitioning modelling, women with HbA_1c ≤ 36 mmol/mol and TLEE after 21:00 had a 1.51 times (95% CI 1.16 to 1.93) higher 5-year risk of developing prediabetes or diabetes than those having their TLEE between 16:00 and 21:00 (35.4% vs. 23.5%; P = 0.003).

CONCLUSIONS

There was no overall association of TLEE with the development of prediabetes or diabetes in the Whitehall II population. However, explorative analyses suggested that eating late in the evening was associated with increased risk of developing prediabetes/diabetes among women with good glycaemic control. Whether restricting late evening food consumption is effective and feasible for the prevention of Type 2 diabetes needs testing in randomized controlled trials.

Molecular and phylogenetic analysis of the dengue strains circulating in Odisha, India

Dengue has emerged as a major public health challenge in terms of both changing clinical pattern and epidemiological features. The state of Odisha reported first dengue epidemic in the year 2010 and this continued each year in epidemic form during post monsoon period gradually becoming an endemic phenomenon. Present study depicts the changing epidemiological and clinical pattern of dengue with reference to its serotypes and genotypes. The study included 5320 suspected dengue cases from different health facilities of the state during 2010-2017. Dengue NS1 antigen and IgM antibody was done through ELISA. Serotyping was done through RTPCR by amplifying a part of core-pre-membrane gene (CprM) followed by sequencing and phylogenetic analysis. Dengue IgM antibody in 17.7% cases and NS1 antigen in 53.20% cases was detected. Dengue serotype 2 (DEN-2) was the only serotype detected in 2010 and 2011 where as all four serotypes 1, 2, 3, 4 were detected in 2012-2017, DEN-2 being dominant but in 2017 DEN-3 was found to be dominant. Phylogenetic analysis revealed genotype IV of DEN-2 and genotype III of DEN-1 and DEN-3 circulating in this region. In 6 cases involvement of DEN-2 in clinically evident encephalitis cases is an important observation in this region and needs public health attention. High prevalence of dengue was observed without any previous reported outbreaks in the state with increased number of cases from 2010 to 2012 affecting both urban and rural areas. High incidence in 2012 was due to co-circulation of more than one serotype which continued in the following years. Severity in some cases was associated with mixed infection but in most cases it was mild indicating the endemic nature of the virus in most parts of Odisha.

Predictive accuracy of Demirjian's, Modified Demirjian's and India specific dental age estimation methods in Odisha (Eastern Indian) population

This study is aimed at finding the predictive accuracy of Demirjian's (D), modified Demirjian's (MD) and India specific age estimation methods (AA) Indian specific age estimation methods in 522 healthy children of Odisha population among 3-18 years. Correlations between chronological age (CA) and derived age (DA) by above mentioned methods were evaluated by Wilcoxon signed rank test and Pearson's correlation analysis. Analysis of mean absolute error concluded that D and MD predicted the CA with fair accuracy, whereas, AA had lower accuracy in Odisha children. Odisha specific polynomial regression formula, derived in this study is showing a strong correlation with CA (r=0.84). Comparison of mean absolute error of D, MD, AA and Odisha specific method indicated a better predictive accuracy of Odisha specific method.

Molecular-Level Insights into the Microstructure of a Hydrated and Nanoconfined Deep Eutectic Solvent

Despite the recent advancements in the field of deep eutectic solvents (DESs), their high viscosity often prevents practical applications. A versatile strategy to overcome this problem is either to add a co-solvent or to confine the DES inside a nanoscaled self-organized system. This work assesses the microstructures of a hydrated and nanoconfined DES comprising benzyltripropylammonium chloride [BTPA]Cl and ethylene glycol (EG). They act as a hydrogen-bond acceptor and a donor, respectively. The hydrogen bonding between [BTPA]Cl and EG in the DES (i.e., BTEG) and the molecular states of water in the hydrated BTEG were studied by Raman spectroscopy. The results show different hydrogen-bonding associations between water-water and water-BTEG or EG molecules. In addition, we investigated the confinement effects of BTEG in a Polysorbate 80 (Tween-80)/cyclohexane reverse micellar (RM) system. The results are compared with those of an ionic liquid-encapsulated RM system. The formation, bonding characteristics, and thermal stability of the RM droplets were studied by solubilization, dynamic light scattering, rheology, and Raman spectroscopy experiments. Furthermore, it is shown that hydrogen bonding between the DES and the surfactant leads to a stable RM system. Interestingly, the viscosity of the RM system is significantly lower than that of the neat DES suggesting that DESs have a much wider practical applicability in the form of RMs.

An Arcak-type state estimation design for time-delayed static neural networks with leakage term based on unified criteria

The issue of unified dissipativity-based Arcak-type state estimator design for delayed static neural networks (SNNs) with leakage term and noise distraction was considered here. An Arcak-type state observer, which is compact than the usually used Luenberger-type state estimator, is selected to implement the subject of a unified dissipativity performance of SNNs. This paper primarily concentrates on the issue of Arcak-type state estimator of delayed SNNs involving leakage delay. The first attempt is made to tackle the Arcak-type state estimator of SNNs with time delay in leakage term in this paper based on the unified criteria, by constructing a novel Lyapunov functional together with newly improved integral inequalities. As a result, a novel unified state estimation criterion is launched in the form of linear matrix inequalities (LMIs) and put forward to justify the dynamics of error system is extended dissipative with the influence of leakage term and estimator gain matrices K¯₁ and K¯₂. Finally, an interesting simulation study is ultimately explored to show the performance of the established unified dissipativity-based theoretical results, in which, comparison results are also made together with recent works as a special case.

Aggregation behaviour of biocompatible choline carboxylate ionic liquids and their interactions with biomolecules through experimental and theoretical investigations

The self-assembly of long-chain choline carboxylates accompanied by their interaction with BSA protein were investigated with focus on environmental sustainability.

Thermal conductivity, thermal diffusivity, and volumetric heat capacity of silicone elastomer nanocomposites

Silicone elastomer (SiR) nanocomposites were prepared using multiwalled carbon nanotubes (MWCNT) and nano-graphite (NG). The morphology of the SiR nanocomposites has been studied using scanning electron microscopy and high-resolution transmission electron microscopy techniques. Detailed analysis of the morphology reveals a uniform distribution of the MWCNT and NG filler particles in the silicone matrix. On increasing the filler loading, a continuous network structure is formed and aggregation takes place. The effect of the MWCNT and NG loadings on the thermal properties of the silicone elastomer has been investigated. The thermal properties of the SiR nanocomposites were measured by a thermal properties analyzer based on the transient hot-wire method. Studies also suggest that incorporation of nanoparticles improves the thermal conductivity of SiR nanocomposites. The thermal conductivity of SiR nanocomposites increased from 0.200 W/(m K) to 0.440 W/(m K) and to 0.310 W/(m K) for 6 wt% MWCNT and NG loadings, respectively. Because of the positive temperature coefficient and the conductive nature of the nanoparticles, the thermal conductivity of the material increased on increasing the temperature. The thermal diffusivity and the volumetric heat capacity of the SiR nanocomposites were measured. The thermal diffusivity of the SiR nanocomposites increased from 0.1194 mm2/s to 0.3209 mm2/s and to 0.2050 mm2/s for 6 wt% MWCNT and NG loadings, respectively. This indicates that the temperature response becomes faster with MWCNT and NG loadings. The volumetric heat capacity of the silicone elastomer nanocomposites decreased from 1.80 MJ/(m3K) to 1.34 MJ/(m3K) and to 1.40 MJ/(m3K) for 6 wt% MWCNT and NG loadings, respectively. Thus, MWCNT particles are more effective in increasing the thermal conductivity and diffusivity of the SiR nanocomposites, when compared to NG fillers at any loading.

Physicochemical and tribophysical properties of trioctylalkylammonium bis(salicylato)borate (N888n-BScB) ionic liquids: effect of alkyl chain length

The alkyl chain length in trioctylalkylammonium bis(salicylato)borate ionic liquids plays an important role in controlling the viscosity, friction and wear characteristics.