Forward versus inverse planning in oropharyngeal cancer: A comparative study using physical and biological indices

CONTEXT

Possible benefits of inverse planning.

AIMS

To analyze possible benefits of inverse planning intensity modulated radiation therapy (IMRT) over field-in-field 3D conformal radiation therapy (FIF-3DCRT) and to evaluate the differences if any, between low (6 Million Volts) and high energy (15 Million Volts) IMRT plans.

MATERIALS AND METHODS

Ten patients with squamous cell carcinoma of oropharynx, previously treated with 6 MV step and shoot IMRT were studied. V100, V33, V66 , mean dose and normal tissue complication probabilities (NTCP) were evaluated for parotid glands. Maximum dose and NTCP were the parameters for spinal cord.

STATISTICAL ANALYSIS USED

A two-tailed t-test was applied to analyze statistical significance between the different techniques.

RESULTS

For combined parotid gland, a reduction of 4.374 Gy, 9.343 Gy and 7.883 Gy were achieved for D100, D66 and D33, respectively in 6 MV-IMRT when compared with FIF-3DCRT. Spinal cord sparing was better in 6 MV-IMRT (40.963 ± 2.650), with an average reduction of maximum spinal cord dose by 7.355 Gy from that using the FIF-3DCRT technique. The uncomplicated tumor control probabilities values were higher in IMRT plans thus leading to a possibility of dose escalation.

CONCLUSIONS

Though low-energy IMRT is the preferred choice for treatment of oropharyngeal cancers, FIF-3DCRT must be given due consideration as a second choice for its well established advantages over traditional conventioan technique.

Increasing prevalence and incidence rates of multiple sclerosis in Kuwait

Background:

Kuwait was considered as low to intermediate risk area for MS.

Objectives:

To determine the prevalence and incidence rates of MS among Kuwaiti nationals based on 2011 population census.

Methods:

This cross-sectional study was conducted between October 2010 and April 2013 using the newly developed national MS registry in Kuwait. Patients with a diagnosis of MS according to 2010 revised McDonald criteria were identified. The crude, age- and sex-specific prevalence and incidence rates among Kuwaiti patients were calculated.

Results:

1176 MS patients were identified of which 927 (78.8%) were Kuwaitis and 249 (21.2%) were expatriates. Among Kuwaiti patients, female to male ratio was 1.8:1 with a mean age of 35.40 ± 10.99 years. The prevalence rate of MS was 85.05 per 100,000 persons (95% CI: 82.80 – 87.04). There was a peak in prevalence among patients aged 30–39 years. The incidence of MS was 6.88 per 100,000 persons (95% CI 5.52–8.55). Between 2003 and 2011, the incidence increased 3.22 and 2.54 times in women and men respectively.

Conclusion:

Kuwait is considered a high-risk area for MS. The significant increase in prevalence and incidence rates may represent a true increase despite the improvement in case ascertainment and case definition.

Self-similar nested flux closure structures in a tetragonal ferroelectric

In specific solid-state materials, under the right conditions, collections of magnetic dipoles are known to spontaneously form into a variety of rather complex geometrical patterns, exemplified by vortex and skyrmion structures. While theoretically, similar patterns should be expected to form from electrical dipoles, they have not been clearly observed to date: the need for continued experimental exploration is therefore clear. In this Letter we report the discovery of a rather complex domain arrangement that has spontaneously formed along the edges of a thin single crystal ferroelectric sheet, due to surface-related depolarizing fields. Polarization patterns are such that nanoscale "flux-closure" loops are nested within a larger mesoscale flux closure object. Despite the orders of magnitude differences in size, the geometric forms of the dual-scale flux closure entities are rather similar.

Cardiac function and lipid distribution in rats fed a high-fat diet: in vivo magnetic resonance imaging and spectroscopy

Obesity is a major risk factor in the development of cardiovascular disease, type 2 diabetes, and its pathophysiological precondition insulin resistance. Very little is known about the metabolic changes that occur in the myocardium and consequent changes in cardiac function that are associated with high-fat accumulation. Therefore, cardiac function and metabolism were evaluated in control rats and those fed a high-fat diet, using magnetic resonance imaging, magnetic resonance spectroscopy, mRNA analysis, histology, and plasma biochemistry. Analysis of blood plasma from rats fed the high-fat diet showed that they were insulin resistant (P < 0.001). Our high-fat diet model had higher heart weight (P = 0.005) and also increasing trend in septal wall thickness (P = 0.07) compared with control diet rats. Our results from biochemistry, magnetic resonance imaging, and mRNA analysis confirmed that rats on the high-fat diet had moderate diabetes along with mild cardiac hypertrophy. The magnetic resonance spectroscopy results showed the extramyocellular lipid signal only in the spectra from high-fat diet rats, which was absent in the control diet rats. The intramyocellular lipids in high-fat diet rats was higher (8.7%) compared with rats on the control diet (6.1%). This was confirmed by electron microscope and light microscopy studies. Our results indicate that lipid accumulation in the myocardium might be an early indication of the cardiovascular pathophysiology associated with type 2 diabetes.

Dosimetric comparison between bone marrow sparing intensity-modulated radiation therapy and conventional techniques in the treatment of cervical cancer: a retrospective study

PURPOSE

To investigate enlargement of prostate volume by edema during brachytherapy seed implantation and develop a nomogram model to calculate air-kerma strength (AKS) required for implantation of the enlarged transient prostatic volume.

MATERIALS AND METHODS

The prostate volume was measured prior and after seed implantation using trans-rectal ultrasound imaging in the operating room to obtain volume enlargement. A nomogram model was developed that calculates AKS required for implantation of the enlarged transient prostate volume with optimal dose coverage.

RESULTS

The measured prostate enlargement in this study was up to 60% of the initial volume. The effective prostatic volume enlargement was calculated for three isotopes: 125I, 103Pd and 131Cs. The effective volume enlargement for 125I implants was relatively small (< 10%) because of its long half-life. For 103Pd and 131Cs with short half-lives, additional AKS up to 20% and 30%, respectively, might be required to provide appropriate dose coverage of possible enlarged prostatic volumes.

CONCLUSIONS

Prostate volume enlargement should be considered to obtain optimal dose coverage particularly for short half-life isotopes such as 131Cs and 103Pd. The nomogram model developed in this work provides the AKS required for implants with a wide range of prostatic volume enlargements (5-100%) for three isotopes.

KEYWORDS

prostate brachytherapy, nomogram, airkerma strength, edema, volume enlargement.

Domain wall geometry controls conduction in ferroelectrics

A new paradigm of domain wall nanoelectronics has emerged recently, in which the domain wall in a ferroic is itself an active device element. The ability to spatially modulate the ferroic order parameter within a single domain wall allows the physical properties to be tailored at will and hence opens vastly unexplored device possibilities. Here, we demonstrate via ambient and ultrahigh-vacuum (UHV) scanning probe microscopy (SPM) measurements in bismuth ferrite that the conductivity of the domain walls can be modulated by up to 500% in the spatial dimension as a function of domain wall curvature. Landau-Ginzburg-Devonshire calculations reveal the conduction is a result of carriers or vacancies migrating to neutralize the charge at the formed interface. Phase-field modeling indicates that anisotropic potential distributions can occur even for initially uncharged walls, from polarization dynamics mediated by elastic effects. These results are the first proof of concept for modulation of charge as a function of domain wall geometry by a proximal probe, thereby expanding potential applications for oxide ferroics in future nanoscale electronics.

Controlling magnetoelectric coupling by nanoscale phase transformation in strain engineered bismuth ferrite

The magnetoelectric coupling in multiferroic materials is promising for a wide range of applications, yet manipulating magnetic ordering by electric field proves elusive to obtain and difficult to control. In this paper, we explore the prospect of controlling magnetic ordering in misfit strained bismuth ferrite (BiFeO(3), BFO) films, combining theoretical analysis, numerical simulations, and experimental characterizations. Electric field induced transformation from a tetragonal phase to a distorted rhombohedral one in strain engineered BFO films has been identified by thermodynamic analysis, and realized by scanning probe microscopy (SPM) experiment. By breaking the rotational symmetry of a tip-induced electric field as suggested by phase field simulation, the morphology of distorted rhombohedral variants has been delicately controlled and regulated. Such capabilities enable nanoscale control of magnetoelectric coupling in strain engineered BFO films that is difficult to achieve otherwise, as demonstrated by phase field simulations.

Electrical domain morphologies in compositionally graded ferroelectric films

We present a nonlinear thermodynamic formalism coupled with an electrostatic analysis of uniaxial n-layered compositionally graded heteroepitaxial ferroelectric films and extend this formalism to continuously graded ferroelectric films. We show that the domain morphology and its subsequent evolution in the presence of an electric field are determined by the spontaneous polarisation of the film induced through the compositional grading. The results for compositionally graded epitaxial (001) (Ba,Sr)TiO(3) and (001) Pb(Zr,Ti)O(3) films on (001)SrTiO(3) demonstrate that, while the domain morphologies in these two films are different in appearance, the dielectric displacement and the dielectric permittivity of such graded ferroelectric films exhibit a strong nonlinear behaviour which results in a high dielectric tunability. These findings indicate that it is possible to design specific domain structures that will yield desirable dielectric properties by controlling the strength of the compositional grading in the films.

From screen to structure with a harvestable microfluidic device

Advances in automation have facilitated the widespread adoption of high-throughput vapour-diffusion methods for initial crystallization screening. However, for many proteins, screening thousands of crystallization conditions fails to yield crystals of sufficient quality for structural characterization. Here, the rates of crystal identification for thaumatin, catalase and myoglobin using microfluidic Crystal Former devices and sitting-drop vapour-diffusion plates are compared. It is shown that the Crystal Former results in a greater number of identified initial crystallization conditions compared with vapour diffusion. Furthermore, crystals of thaumatin and lysozyme obtained in the Crystal Former were used directly for structure determination both in situ and upon harvesting and cryocooling. On the basis of these results, a crystallization strategy is proposed that uses multiple methods with distinct kinetic trajectories through the protein phase diagram to increase the output of crystallization pipelines.

Influence of photon energy on the quality of prostate intensity modulated radiation therapy plans based on analysis of physical indices

The goal of the present study was to study the effects of low- and high-energy intensity-modulated photon beams on the planning of target volume and the critical organs in cases of localized prostate tumors in a cohort of 8 patients. To ensure that the difference between the plans is due to energy alone, all other parameters were kept constant. A mean dose volume histogram (DVH) for each value of energy and for each contoured structure was created and was considered as completely representative for all patients. To facilitate comparison between 6-MV and 15-MV beams, the DVH-s were normalized. The different parameters that were compared for 6-MV and 15-MV beams included mean DVH, different homogeneity indices, conformity index, etc. Analysis of several indices depicts more homogeneous dose for 15-MV beam and more conformity for 6-MV beam. Comparison of all these parameters showed that there was little difference between the 6-MV and 15-MV beams. For rectum, 2 to 4 % more volume received high dose with the 6-MV beam in comparison with the 15-MV beam, which was not clinically significant, since in practice much tighter constraints are maintained, such that Normal Tissue Complication Probability (NTCP) is kept within 5 %. Such tighter constraints might increase the dose to other regions and other critical organs but are unlikely to increase their complication probabilities. Hence the slight advantages of 15-MV beam in providing benefits of better normal-tissue sparing and better coverage cannot be considered to outweigh its well-known risk of non-negligible neutron production.

Determination of the 14N quadrupole coupling constant of nitroxide spin probes by W-band ELDOR-detected NMR

Nitroxide spin probe electron paramagnetic resonance (EPR) has proven to be a very successful method to probe local polarity and solvent hydrogen bonding properties at the molecular level. The g(xx) and the (14)N hyperfine A(zz) principal values are the EPR parameters of the nitroxide spin probe that are sensitive to these properties and are therefore monitored experimentally. Recently, the (14)N quadrupole interaction of nitroxides has been shown to be also highly sensitive to polarity and H-bonding (A. Savitsky et al., J. Phys. Chem. B 112 (2008) 9079). High-field electron spin echo envelope modulation (ESEEM) was used successfully to determine the P(xx) and P(yy) principal components of the (14)N quadrupole tensor. The P(zz) value was calculated from the traceless character of the quadrupole tensor. We introduce here high-field (W-band, 95 GHz, 3.5 T) electron-electron double resonance (ELDOR)-detected NMR as a method to obtain the (14)N P(zz) value directly, together with A(zz). This is complemented by W-band hyperfine sublevel correlation (HYSCORE) measurements carried out along the g(xx) direction to determine the principal P(xx) and P(yy) components. Through measurements of TEMPOL dissolved in solvents of different polarities, we show that A(zz) increases, while |P(zz)| decreases with polarity, as predicted by Savitsky et al.

Nanoscale electromechanical phenomena in ferroelectric thin films

Focused ion beam milling was used to fabricate ferroelectric islands in Pb-Zr-Ti-O thin films. The islands ranged in size from 200μm×200μm to 0.3μm×0.3μm. The inverse piezoelectric effect was studied in these islands as a function of their size by tracking the surface displacement of the top electrode of the island (under an applied electric field) using an atomic force microscope (AFM). It was found that there was a substantial increase in the piezoresponse as the size of the island decreased below 100μm×100μm. This increase was attributed to the elastic deformation of the substrate.

Interaction networks of lithium and valproate molecular targets reveal a striking enrichment of apoptosis functional clusters and neurotrophin signaling

The overall neurobiological mechanisms by which lithium and valproate stabilize mood in bipolar disorder patients have yet to be fully defined. The therapeutic efficacy and dissimilar chemical structures of these medications suggest that they perturb both shared and disparate cellular processes. To investigate key pathways and functional clusters involved in the global action of lithium and valproate, we generated interaction networks formed by well-supported drug targets. Striking functional similarities emerged. Intersecting nodes in lithium and valproate networks highlighted a strong enrichment of apoptosis clusters and neurotrophin signaling. Other enriched pathways included MAPK, ErbB, insulin, VEGF, Wnt and long-term potentiation indicating a widespread effect of both drugs on diverse signaling systems. MAPK1/3 and AKT1/2 were the most preponderant nodes across pathways suggesting a central role in mediating pathway interactions. The convergence of biological responses unveils a functional signature for lithium and valproate that could be key modulators of their therapeutic efficacy.

Theory of giant electromechanical response from ferroelectric bilayers with polydomain structures due to interlayer and interdomain coupling

The effect of interdomain ferroelastic coupling in ferroic multilayers is investigated theoretically. Specifically, we use nonlinear thermodynamics to analyze a heteroepitaxial ferroelectric PbZrxTi1-xO3 (PZT) bilayer consisting of (001) tetragonal (T) PZT and (001) rhombohedral (R) PZT films. We predict for certain misfit strain regimes that interlayer and interdomain interactions lead to an adaptive domain structure in both the T and R layers and result in significant enhancements in the piezoelectricity compared to single-layer films. Our results demonstrate that electrostatic, magnetostatic, and elastic interactions in ferroic multilayers can be a generic route to generate ultrahigh susceptibilities.

EPR detected polarization transfer between Gd3+ and protons at low temperature and 3.3 T: the first step of dynamic nuclear polarization

Electron-electron double resonance pulsed electron paramagnetic resonance (EPR) at 95 GHz (3.3 T) is used to follow the dynamics of the electron spin polarization during the first stages of dynamic nuclear polarization in solids. The experiments were performed on a frozen solution of Gd(+3) (S=7/2) in water/glycerol. Focusing on the central vector -1/2 --> vector +1/2 transition we measured the polarization transfer from the Gd(3+) electron spin to the adjacent (1)H protons. The dependence of the echo detected EPR signal on the length of the microwave irradiation at the EPR "forbidden" transition corresponding to an electron and a proton spin flip is measured for different powers, showing dynamics on the microsecond to millisecond time scales. A theoretical model based on the spin density matrix formalism is suggested to account for this dynamics. The central transition of the Gd(3+) ion is considered as an effective S = 1/2 system and is coupled to (1)H (I = 1/2) nuclei. Simulations based on a single electron-single nucleus four level system are shown to deviate from the experimental results and an alternative approach taking into account the more realistic multinuclei picture is shown to agree qualitatively with the experiments.

Structure and bonding of [V(IV)O(acac)(2)] on the surface of AlF(3) as studied by pulsed electron nuclear double resonance and hyperfine sublevel correlation spectroscopy

Well defined isolated [V(IV)O(acac)(2)] surface complexes have been prepared on aluminium trifluoride, alpha-AlF(3), as solid support by equilibrium adsorption from liquid solution. The paramagnetic vanadium(iv) surface complexes were studied by pulsed electron spin resonance spectroscopy in combination with quantum chemical calculations using density functional theory. (19)F and (27)Al ligand hyperfine interactions with the nuclei of the AlF(3) support observed by pulsed electron nuclear double resonance and hyperfine sublevel correlation spectroscopy experiments verify the direct chemical bonding between the vanadium and a surface fluorine atom. Detailed analysis of the ligand hyperfine couplings supported by quantum chemical calculations indicates that the axial position of [V(IV)O(acac)(2)]trans to the oxo ligand is bound directly to a terminal fluorine atom of the support. Analysis of the (1)H ligand hyperfine interaction revealed that an acidic H(+) of the AlF(3) surface protonated a donor oxygen of the acetylacetone ligand in the surface complex.

Creation of damage-free ferroelectric nanostructures via focused ion beam milling

We present a novel method for creating damage-free ferroelectric nanostructures with a focused ion beam milling machine. Using a standard e-beam photoresist followed by a dilute acid wash, nanostructures ranging in size from 1 µm down to 250 nm were created in a 90 nm thick lead zirconate titanate (PZT) wafer. Transmission electron microscopy and piezoresponse force microscopy (PFM) confirmed that the surfaces of the nanostructures remained damage free during fabrication, and showed no gallium implantation, and that there was no degradation of ferroelectric properties. In fact DC strain loops, obtained using PFM, demonstrated that the nanostructures have a higher piezoresponse than unmilled films. As the samples did not have any top hard mask, the method presented is unique as it allows for imaging of the top surface to understand edge effects in well-defined nanostructures. In addition, as no post-mill annealing was necessary, it facilitates investigation of nanoscale domain mechanisms without process-induced artefacts.