A comparative study of rectal volume variation in patients with prostate cancer: A tertiary care center study

INTRODUCTION

Every day variations in rectal filling in prostate cancer radiotherapy can significantly alter the delivered dose distribution from what was intended. The goal of this study was to see if the time of treatment delivery affected the rectal filling.

METHODS

This is a retrospective study which included 50 patients with localized prostate cancer treated with volumetric modulated arc therapy (VMAT) to the primary and regional lymph nodes. Cone Beam Computed Tomography (CBCT) image-sets were done for all patient's daily setup verification. The radiation therapist contoured the rectum on all CBCT image sets. The rectal volumes delineated on CBCT and the planning CT image sets were compared. The change in rectal volumes between morning and afternoon treatments were calculated and compared.

RESULTS

A total of 1000 CBCT image sets were obtained on 50 patients in the morning and afternoon. The percentage variation of the CBCT rectal volumes over the planning CT scan was 16.57% in the AM group and 24.35% in the PM group.

CONCLUSION

The percentage change in rectal volume was significantly lesser in AM group compared to PM group and therefore morning treatments may result in dose distribution that is close to the intended dose distribution.

IMPLICATIONS FOR PRACTICE

In prostate cancer radiotherapy our study suggests that a simple technique of changing the time of treatment from afternoon to morning can help to reduce the rectal volume.

Multi-Institutional Clinical Outcomes of Biopsy Gleason Grade Group 5 Prostate Cancers Treated With Contemporary High-Dose Radiation and Long-Term Androgen Deprivation Therapy

AIMS

This multicentric retrospective study reports long-term clinical outcomes of non-metastatic grade group 5 prostate cancers treated with external beam radiotherapy (EBRT) alone with long-term androgen deprivation therapy (ADT).

MATERIALS AND METHODS

Patients treated across 19 institutions were studied. The key endpoints that were evaluated were 5-year biochemical recurrence-free survival (bRFS), metastases-free survival (MFS), overall survival, together with EBRT-related acute and late toxicities. The impact of various prognostic factors on the studied endpoints was analysed using univariate and multivariate analyses.

RESULTS

Among the 462 patients, 88% (405) had Gleason 9 disease and 31% (142) had primary Gleason pattern 5. A prostate-specific membrane antigen positron emission tomography-computed tomography scan was used for staging in 33% (153), 80% (371) were staged as T3/T4 and 30% (142) with pelvic nodal disease. The median ADT duration was 24 months; 66% received hypofractionated EBRT and 71.4% (330) received pelvic nodal irradiation. With a median follow-up of 56 months, the 5-year bRFS, MFS and overall survival were 73.1%, 77.4% and 90.5%, respectively. Primary Gleason pattern 5 was associated with worse bRFS, MFS and overall survival with hazard ratios of 0.51 (95% confidence interval 0.35 to 0.73, P < 0.001), 0.64 (95% confidence interval 0.43 to 0.96, P = 0.031) and 0.52 (95% confidence interval 0.28 to 0.97, P = 0.040), respectively, whereas pelvic nodal disease was associated with worse bRFS (hazard ratio 0.67, 95% confidence interval 0.46 to 0.98, P = 0.039) and MFS (hazard ratio 0.56, 95% confidence interval 0.37 to 0.85, P = 0.006). The acute and late radiation-related toxicities were low overall and pelvic nodal irradiation was associated with higher toxicities.

CONCLUSION

Contemporary EBRT and long-term ADT led to excellent 5-year clinical outcomes and low rates of toxicity in this cohort of non-metastatic grade group 5 prostate cancers. Primary Gleason pattern 5 and pelvic node disease portends inferior clinical outcomes.

Defect Engineering Boosted Ultrahigh Thermoelectric Power Conversion Efficiency in Polycrystalline SnSe

Two-dimensional (2D)-layered atomic arrangement with ultralow lattice thermal conductivity and ultrahigh figure of merit in single-crystalline SnSe drew significant attention among all thermoelectric materials. However, the processing of polycrystalline SnSe with equivalent thermoelectric performance as single-crystal SnSe will have great technological significance. Herein, we demonstrate a high zT of 2.4 at 800 K through the optimization of intrinsic defects in polycrystalline SnSe via controlled alpha irradiation. Through a detailed theoretical calculation of defect formation energies and lattice dynamic phonon dispersion studies, we demonstrate that the presence of intrinsically charged Sn vacancies can enhance the power factor and distort the lattice thermal conductivity by phonon-defect scattering. Supporting our theoretical calculations, the experimental enhancement in the electrical conductivity leads to a massive power factor of 0.9 mW/mK² and an ultralow lattice thermal conductivity of 0.22 W/mK through the vacancy-phonon scattering effect on polycrystalline SnSe. The strategy of intrinsic defect engineering of polycrystalline thermoelectric materials can increase the practical implementation of low-cost and high-performance thermoelectric generators.

Single-Step Direct Hydrothermal Growth of NiMoO₄ Nanostructured Thin Film on Stainless Steel for Supercapacitor Electrodes

We report a facile and direct growth of NiMoO₄ nanostructures on a nonreactive stainless steel substrate using a single-step hydrothermal method and investigated hydrothermal growth duration effects on morphology and electrochemical characteristics. The highest specific capacitances of 341, 619, and 281 F/g were observed for NiMoO₄ with 9, 18, and 27 h growth, respectively, at 1 A/g. Thus, grown samples preserved almost 59% of maximum specific capacitance at a high current density of 10 A/g. All samples exhibited a respectable cycling stability over 3000 charge-discharge operations. NiMoO₄ grown for 18 h exhibited 7200 W/kg peak power density at 14 Wh/kg energy density. Thus, the proposed single-step hydrothermal growth is a promising route to obtain NiMoO₄ nanostructures and other metal oxide electrodes for supercapacitor applications.

Negative Differential Resistance Device from Organic/Inorganic Hybrid Nanostructures

Negative differential resistance device (NDR) fabricated by spin coating of organic/inorganic hybrid nanostructures at room temperature, is reported in the present paper. The coated organic layer is MEH-PPV (poly-[2-methoxy-5-(2′-ethyl-hexyloxy)-1,4-phenylenevinylene] and inorganic layer is ZnO nanoparticles. The device shows negative differential resistance at low voltage and I–V characteristics of the device show multiple peaks at low voltage values. A value of 13 and 4 for the peak- to-valley ratio of current are reported in bi-layer and single layer structures respectively. Depending on the observed NDR signature, operating mechanisms are explored based on carrier (resonant) tunneling process and donor like trap mechanisms. This results show that the MEH-PPV/ZnO thin films gives good performance and is relevant for applications in optoelectronic devices such as a negative differential resistance.

Measurement of eye lens dose for Varian On-Board Imaging with different cone-beam computed tomography acquisition techniques

The objective of this work was to measure patient eye lens dose for different cone-beam computed tomography (CBCT) acquisition protocols of Varian's On-Board Imaging (OBI) system using optically stimulated luminescence dosimeter (OSLD) and to study the variation in eye lens dose with patient geometry and distance of isocenter to the eye lens. During the experimental measurements, OSLD was placed on the patient between the eyebrows of both eyes in line of nose during CBCT image acquisition to measure eye lens doses. The eye lens dose measurements were carried out for three different cone-beam acquisition protocols (standard dose head, low-dose head [LDH], and high-quality head [HQH]) of Varian OBI. Measured doses were correlated with patient geometry and distance between isocenter and eye lens. Measured eye lens doses for standard head and HQH protocols were in the range of 1.8-3.2 mGy and 4.5-9.9 mGy, respectively. However, the measured eye lens dose for the LDH protocol was in the range of 0.3-0.7 mGy. The measured data indicate that eye lens dose to patient depends on the selected imaging protocol. It was also observed that eye lens dose does not depend on patient geometry but strongly depends on distance between eye lens and treatment field isocenter. However, undoubted advantages of imaging system should not be counterbalanced by inappropriate selection of imaging protocol, especially for very intense imaging protocol.

Use of image guided radiation therapy techniques and imaging dose measurement at Indian hospitals: A survey

A national survey was conducted to obtain information about the use of image-guided radiotherapy (IGRT) techniques and IGRT dose measurement methods being followed at Indian radiotherapy centers. A questionnaire containing parameters relevant to use of IGRT was prepared to collect the information pertaining to (i) availability and type of IGRT delivery system, (ii) frequency of image acquisition protocol and utilization of these images for different purpose, and (iii) imaging dose measurement. The questionnaire was circulated to 75 hospitals in the country having IGRT facility, and responses of 51 centers were received. Survey results showed that among surveyed hospitals, 86% centers have IGRT facility, 78% centers have kilo voltage three-dimensional volumetric imaging. 75% of hospitals in our study do not perform computed tomography dose index measurements and 89% of centers do not perform patient dose measurements. Moreover, only 29% physicists believe IGRT dose is additional radiation burden to patient. This study has brought into focus the need to design a national protocol for IGRT dose measurement and development of indigenous tools to perform IGRT dose measurements.

Charge Carrier Transport Mechanism Based on Stable Low Voltage Organic Bistable Memory Device

A solution processed two terminal organic bistable memory device was fabricated utilizing films of polymethyl methacrylate PMMA/ZnO/PMMA on top of ITO coated glass. Electrical characterization of the device structure showed that the two terminal device exhibited favorable switching characteristics with an ON/OFF ratio greater than 1 x 10(4) when the voltage was swept between - 2 V and +3 V. The device maintained its state after removal of the bias voltage. The device did not show degradation after a 1-h retention test at 120 degrees C. The memory functionality was consistent even after fifty cycles of operation. The charge transport switching mechanism is discussed on the basis of carrier transport mechanism and our analysis of the data shows that the charge carrier trans- port mechanism of the device during the writing process can be explained by thermionic emission (TE) and space-charge-limited-current (SCLC) mechanism models while erasing process could be explained by the FN tunneling mechanism. This demonstration provides a class of memory devices with the potential for low-cost, low-power consumption applications, such as a digital memory cell.

Time-resolved x-ray diffraction techniques for bulk polycrystalline materials under dynamic loading

We have developed two techniques for time-resolved x-ray diffraction from bulk polycrystalline materials during dynamic loading. In the first technique, we synchronize a fast detector with loading of samples at strain rates of ~10(3)-10(4) s(-1) in a compression Kolsky bar (split Hopkinson pressure bar) apparatus to obtain in situ diffraction patterns with exposures as short as 70 ns. This approach employs moderate x-ray energies (10-20 keV) and is well suited to weakly absorbing materials such as magnesium alloys. The second technique is useful for more strongly absorbing materials, and uses high-energy x-rays (86 keV) and a fast shutter synchronized with the Kolsky bar to produce short (~40 μs) pulses timed with the arrival of the strain pulse at the specimen, recording the diffraction pattern on a large-format amorphous silicon detector. For both techniques we present sample data demonstrating the ability of these techniques to characterize elastic strains and polycrystalline texture as a function of time during high-rate deformation.

Inhibition of CXCR3-mediated chemotaxis by the human chemokine receptor-like protein CCX-CKR

BACKGROUND AND PURPOSE

Induction of cellular migration is the primary effect of chemokine receptor activation. However, several chemokine receptor-like proteins bind chemokines without subsequent induction of intracellular signalling and chemotaxis. It has been suggested that they act as chemokine scavengers, which may control local chemokine levels and contribute to the function of chemokines during inflammation. This has been verified for the chemokine-like receptor proteins D6 and DARC as well as CCX-CKR. Here, we provide evidence for an additional biological function of human (h)CCX-CKR.

EXPERIMENTAL APPROACH

We used transfection strategies in HEK293 and human T cells.

KEY RESULTS

Co-expression of hCCX-CKR completely inhibits hCXCR3-induced chemotaxis. We found that hCCX-CKR forms complexes with hCXCR3, suggesting a relationship between CCX-CKR heteromerization and inhibition of chemotaxis. Moreover, negative binding cooperativity induced by ligands both for hCXCR3 and hCCX-CKR was observed in cells expressing both receptors. This negative cooperativity may also explain the hCCX-CKR-induced inhibition of chemotaxis.

CONCLUSIONS AND IMPLICATIONS

These findings suggest that hCCX-CKR prevents hCXCR3-induced chemotaxis by heteromerization thus representing a novel mechanism of regulation of immune cell migration.

2-Amino-6-methylpyridinium 4-hydroxybenzoate

In the title mol­ecular salt, C₆H₉N₂⁺·C₇H₅O₃⁻, the dihedral angle between the benzene ring and the CO₂ group in the anion is 6.1 (2)°. In the crystal, the cation and anion are linked by N—H⋯O and C—H⋯O hydrogen bonds, and the anions are connected by O—H⋯O hydrogen bonds, forming a three-dimensional network.

Spectroscopic, quantum-chemical and X-ray diffraction studies of Piperidinium p-Hydroxybenzoate-combined experimental and theoretical studies on a novel NLO crystal

Large size and high quality single crystals of organic nonlinear optical material Piperidinium p-Hydroxybenzoate (PDPHB) have been grown by solution growth method. This crystal belongs to monoclinic system with a noncentrosymmetric space group of Cc. To confirm its structure and compositions this material was subjected to single and powder X-ray diffraction and microanalysis studies. Fourier transform infrared (FTIR), UV-VIS-NIR, photoluminescence and nuclear magnetic resonance spectra have been recorded and extensive spectroscopic investigations have been carried out. Frequency conversion property of the crystal was tested by using Kurtz and Perry powder technique and the relative conversion efficiency was about 19 times greater than that of KDP. Static and dynamic hyperpolarizability values were calculated to confirm the suitability of the crystal for nonlinear optical applications. In addition, frontier molecular orbital (FMO), Mulliken charge and molecular electrostatic potential (MEP) analyses were performed by density functional theory (DFT) at the B3LYP/6-31G (d) basis set.

Dosimetry investigation of MOSFET for clinical IMRT dose verification

In IMRT, patient-specific dose verification is followed regularly at each centre. Simple and efficient dosimetry techniques play a very important role in routine clinical dosimetry QA. The MOSFET dosimeter offers several advantages over the conventional dosimeters such as its small detector size, immediate readout, immediate reuse, multiple point dose measurements. To use the MOSFET as routine clinical dosimetry system for pre-treatment dose verification in IMRT, a comprehensive set of experiments has been conducted, to investigate its linearity, reproducibility, dose rate effect and angular dependence for 6 MV x-ray beam. The MOSFETs shows a linear response with linearity coefficient of 0.992 for a dose range of 35 cGy to 427 cGy. The reproducibility of the MOSFET was measured by irradiating the MOSFET for ten consecutive irradiations in the dose range of 35 cGy to 427 cGy. The measured reproducibility of MOSFET was found to be within 4% up to 70 cGy and within 1.4% above 70 cGy. The dose rate effect on the MOSFET was investigated in the dose rate range 100 MU/min to 600 MU/min. The response of the MOSFET varies from -1.7% to 2.1%. The angular responses of the MOSFETs were measured at 10 degrees intervals from 90 to 270 degrees in an anticlockwise direction and normalized at gantry angle zero and it was found to be in the range of 0.98 ± 0.014 to 1.01 ± 0.014. The MOSFETs were calibrated in a phantom which was later used for IMRT verification. The measured calibration coefficients were found to be 1 mV/cGy and 2.995 mV/cGy in standard and high sensitivity mode respectively. The MOSFETs were used for pre-treatment dose verification in IMRT. Nine dosimeters were used for each patient to measure the dose in different plane. The average variation between calculated and measured dose at any location was within 3%. Dose verification using MOSFET and IMRT phantom was found to quick and efficient and well suited for a busy radiotherapy department.

2-Amino-5-chloropyridinium 4-aminobenzoate

In the title molecular salt, C₅H₆ClN₂⁺·C₇H₆NO₂⁻, the cations and anions are connected by cation-to-anion and anion-to-anion N—H⋯O hydrogen bonds into a three-dimensional network. The dihedral angle between the ring and the CO₂ group in the anion is 7.14 (7)°.

Observation of room temperature negative differential resistance in multi-layer heterostructures of quantum dots and conducting polymers

Multi-layer heterostructure negative differential resistance devices based on poly-[2-methoxy-5-(2'-ethyl-hexyloxy)-1,4-phenylenevinylene] (MEH-PPV) conducting polymer and CdSe quantum dots is reported. The conducting polymer MEH-PPV acts as a barrier while CdSe quantum dots form the well layer. The devices exhibit negative differential resistance (NDR) at low voltages. For these devices, strong negative differential resistance is observed at room temperature. A maximum value of 51 for the peak-to-valley ratio of current is reported. Tunneling of electrons through the discrete quantum confined states in the CdSe quantum dots is believed to be responsible for the multiple peaks observed in the I-V measurement. Depending on the observed NDR signature, operating mechanisms are explored based on resonant tunneling and Coulomb blockade effects.

Evaluation of 25 y of environmental monitoring data around Madras Atomic Power Station (MAPS), Kalpakkam, India

The Environmental Survey Laboratory at Kalpakkam, India carries out elaborate monitoring programme involving atmospheric, terrestrial and aquatic samples for radioactivity to evaluate the impact of operating two pressurised heavy water reactors. This paper presents the evaluation of 25 y (1983-2008) data. Statistical analysis of the environmental data for different radionuclides showed that the data best fits log-normal distribution. The data analysed showed that fission products such as (137)Cs, (90)Sr and (131)I were due to global fallout only. A ratio of 0.2 was obtained for (90)Sr to (137)Cs in air filter samples, only during Chernobyl accident period. The transfer factor of (137)Cs and (90)Sr for rice was computed to be 0.23 and 0.03 and vegetables 0.25 and 0.10, respectively. Activation products (3)H and (41)Ar are the only radionuclides that are related to MAPS operation. A strong correlation (r = 0.9) was observed between (3)H activity in air and (3)H discharged to the atmosphere. A similar correlation (r = 0.8) was observed in (3)H concentration in seawater and (3)H discharged in the liquid waste. The annual internal dose due to (3)H and annual external dose due to (41)Ar evaluated in the last 25 y show that the members of the public received less than 2 % of the dose limit (1 mSv y(-1)) set by ICRP 72.

Unilateral neglect is more severe and common in older patients with right hemispheric stroke

INTRODUCTION

Unilateral neglect after acute right hemispheric stroke significantly impedes poststroke recovery. We studied patients with right hemispheric stroke to determine whether increasing age was associated with more frequent or more severe neglect.

METHODS

Eight neglect tests within 5 days of symptom onset (and within 24 hours of admission) were administered to 204 subjects with acute right hemispheric stroke. Size of infarct was measured, and neglect tests were scored as percent error. "Any neglect" was defined by an elevated neglect test score, standardized relative to a group of normal controls.

RESULTS

When tested for neglect soon after acute stroke admission, 69.6% of subjects older than 65 years had "any neglect" (defined by comparison to a group of normal controls), compared with 49.4% of subjects aged 65 years and younger (p = 0.008). For every additional 10 years of age, patients were 1.83 times as likely to have neglect, even after adjusting for diffusion-weighted imaging (DWI) infarct volume and NIH Stroke Scale (NIHSS) score (95% CI 1.38-2.43). In addition, DWI volume and NIHSS independently predicted neglect. Score on virtually all of the neglect tests worsened as an effect of age. Percentage error on a line cancellation task was 3.8% higher for every additional 10 years of age, after adjustment for DWI volume and NIHSS (p = 0.006). Similar results were found for other neglect tests.

CONCLUSIONS

Increasing age in patients with acute right hemispheric stroke significantly increases the odds of unilateral neglect as well as severity of neglect, independently of size of the stroke or NIH Stroke Scale score. The reason for this finding in older patients may be because they have more brain atrophy and may be less able to compensate for cerebral infarction, or because they tend to have more cardioembolic strokes, which may be more cortically based.

Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique

We present a new CT-based method which measures cover of the femoral head in both normal and dysplastic hips and allows assessment of acetabular inclination and anteversion. A clear topographical image of the head with its covered area is generated. We studied 36 normal and 39 dysplastic hips. In the normal hips the mean cover was 73% (66% to 81%), whereas in the dysplastic group it was 51% (38% to 64%). The significant advantage of this technique is that it allows the measurements to be standardised with reference to a specific anatomical plane. When this is applied to assessing cover in surgery for dysplasia of the hip it gives a clearer understanding of where the corrected hip stands in relation to normal and allows accurate assessment of inclination and anteversion.

Site of the ischemic penumbra as a predictor of potential for recovery of functions

BACKGROUND AND PURPOSE

Diffusion-perfusion mismatch has been used to estimate salvageable tissue and predict potential for recovery in acute stroke. Location of the salvageable tissue may be as important as volume or percentage in predicting potential for recovery of specific functions. Impaired naming, a common and disabling deficit after left hemisphere stroke, is often associated with tissue dysfunction of left Brodmann area (BA) 37, posterior inferior temporal cortex. We tested the hypothesis that the presence of diffusion-perfusion mismatch within left BA 37 predicts probability and extent of short-term improvement of naming.

METHODS

One hundred five patients with acute left hemisphere ischemic stroke had diffusion-weighted imaging, perfusion-weighted imaging, a test of picture naming, and other language tests at admission and 2 to 4 days later. Linear regression was used to determine whether diffusion-perfusion mismatch in any BA in language cortex, total volume of mismatch, or diffusion or perfusion abnormality predicted degree of improvement in naming by days 3 to 5.

RESULTS

The presence of >20% diffusion-perfusion mismatch in left BA 37 and total volumes of diffusion and perfusion abnormality at day 1 each independently predicted degree of improvement in naming. Mismatch in this area did not predict the degree of improvement in other language tests or the NIH Stroke Scale in this study.

CONCLUSIONS/RELEVANCE

Diffusion-perfusion mismatch in left Brodmann area 37 was strongly associated with acute improvement in naming, independently of volume or percentage of total mismatch or diffusion or perfusion abnormality. These data indicate that mismatch in a particular area is a marker of salvageable tissue and an important predictor of potential for recovery of functions that depend on that area. Location of mismatch before treatment may help to predict potential benefits of reperfusion.

Three dimensional conformal radiation therapy in prostate adenocarcinoma: survival and rectal toxicity

Technological advances in radiation beam planning and linear accelerator based radiation delivery have led to the development of three dimensional conformal radiation therapy (3D-CRT). The 3D-CRT clinical treatment in our hospital was started in September 1998 and till December 2002, 51 patients with M(0) stage prostate carcinoma were treated. Treatment method consisted of pelvis and leg immobilization, planning CT scan, marking of planning target volume and organs at risk and 3D beam plan using multileaf collimated beam shaping through beam's eye view display. Network controlled 3D conformal radiation therapy was delivered with portal image verification. The median 3D-CRT dose was 72 Gy. Of the 51 patients, 35 were followed-up till December 2002 (minimum follow-up 2 years) in whom 32 were disease free and 3 had progressive disease. Eleven patients died, 8 of progressive disease, one due to second malignancy and two of intercurrent illness. Five patients were lost for follow up during 0 - 29 months period, after 3D-CRT. The acute rectal reaction (RTOG criteria) in 51 patients was grade 0 in 4, grade I in 31 and grade II in 16. None had greater than grade II rectal toxicity. The late rectal toxicity in 49 patients who had a minimum 6 months follow-up was grade 0 in 41, grade I in 3 and grade II in 5. Our experience suggests that a dose of 72 Gy by 3D-CRT can be safely delivered to the prostate and gastrointestinal tolerance during treatment and follow-up period was excellent.