Dosimetric Advantages of VMAT TBI Plans: A Direct Comparison to Conventional TBI Plans

PURPOSE/OBJECTIVE(S)

Total body irradiation (TBI) continues to play an integral role in the conditioning of patients undergoing bone marrow transplantation. Historically, conventional TBI (C-TBI) has been delivered based on a clinical plan without CT simulation. However, volumetric modulated arc therapy TBI (V-TBI) is emerging as an alternative method to deliver TBI in a contemporary fashion. We aimed to compare these two methods of TBI delivery.

MATERIALS/METHODS

Patients undergoing treatment with V-TBI were identified. C-TBI plans were created using their existing simulation CT images. Patient thickness was measured on the scan and compensators such as lead sheets to attenuate dose in areas with less separation and lung blocks drawn on digitally reconstructed radiographs (DRR) were added when necessary. A 3D dose distribution was then calculated allowing for the direct comparison between C-TBI and V-TBI on the same patient using the same CT image set. Dosimetric data from each plan including target volume coverage, dose homogeneity, absolute max dose, and dose to lungs were recorded.

RESULTS

V-TBI and C-TBI plans for a total of four patients were preliminarily analyzed. Two patients were prescribed 200 cGy in a single fraction, while the other two were prescribed 1200 cGy in eight fractions. V-TBI resulted in a more favorable dosimetry for all four patients in most evaluated metrics including dose coverage, dose homogeneity, and lung dose (Table 1). V-TBI did result in an increased absolute maximum dose to all four patients compared to c-TBI, but still met the desired constraint of D0.03cc<125%.

CONCLUSION

V-TBI resulted in more favorable dosimetry for all four patients compared to C-TBI. To our knowledge, this is the first direct dosimetric comparison between the two methods. Analysis of 8 more V-TBI cases is currently underway. In the future, we plan to design a prospective study to evaluate the clinical outcomes of patients undergoing V-TBI vs C-TBI.

Biochemical studies on protein, phenolic contents and antioxidant activities of Sida cordifolia extracts

The study aimed to characterize the antioxidant properties regarding the Sida cordifolia with special reference to its detailed biochemical analysis. The study revealed that chlorophyll A (0.9 ± 0.3 mg/g), total chlorophyll content (3.0 ± 0.7 mg/g), total carotenoid content (0.3 ± 0.1 mg/g), total soluble proteins (7.5 ± 0.1 mg/g), and total phenolic contents (5.6 ± 1.3 mg/g) were found highest in flower tissue of S. cordifolia. However, peroxidase (POD) contents (118 ± 31 units/g), superoxide dismutase (SOD)  activity (64 ± 1.5 units/g) were maximum in the leaf tissues, while catalase (CAT)  contents (133 ± 25 units/g), ascorbate peroxidase (APX)  contents (145 ± 44 units/g) were also found more in the flowers of S. cordifolia rather than other parts. Our results conclude that leaves, stem, flower of S. cordifolia could be exploited in pharmacology due to presence of different antioxidants reflected in flower and leaf extract make them potent and profound therapeutic agents.                     KEY WORDS: Alkaloids, Flavonoids, Phenolics, Antioxidant, Sida cordifolia   Bull. Chem. Soc. Ethiop. 2020, 34(2), 427-434 DOI: https://dx.doi.org/10.4314/bcse.v34i2.18

Fidaxomicin versus oral vancomycin for severe Clostridium difficile infection: a retrospective cohort study

OBJECTIVES

This study was conducted to compare clinical outcomes of fidaxomicin versus oral vancomycin in the management of severe Clostridium difficile infection (CDI).

METHODS

The investigation was a retrospective, multicentre, propensity score-matched analysis using a national clinical administrative database. Veterans treated for severe CDI from any Veterans Affairs Medical Center between 1 June 2011 and 30 June 2017 were included if they received fidaxomicin or an oral vancomycin regimen for treatment. The two groups were matched by the nearest-neighbour method from a propensity score derived from independent variables associated with the selection of a fidaxomicin course.

RESULTS

Propensity score matching resulted in two well-matched cohorts consisting of 213 fidaxomicin and 639 oral vancomycin courses. No statistically-significant difference was found for the primary outcome of combined clinical failure or recurrence (68/213 (31.9%) versus 163/639 (25.5%), respectively, p 0.071). Additionally, no statistically significant differences were found for the secondary outcomes of 30-day (23/213 (10.8%) versus 75/639 (11.7%), respectively, p 0.71), 90-day (48/213 (22.5%) versus 140/639 (21.9%), respectively, p 0.85), and 180-day mortality (62/213 (29.1%) versus 186/639 (29.1%), respectively, p 1.0) between the two treatment groups.

CONCLUSIONS

Courses of fidaxomicin or oral vancomycin for severe CDI resulted in similar treatment outcomes. Study findings are consistent with current treatment guideline recommendations for the use of either agent in the management of severe CDI.

Superior mesenteric artery syndrome: an uncommon cause of abdominal pain mimicking gastric outlet obstruction

Upper gastrointestinal symptoms like vomiting, abdominal pain, abdominal distention may be caused by many conditions like complicated peptic/duodenal ulcer, gastritis or hiatal hernia. However, these symptoms are uncommonly produced by superior mesenteric artery (SMA) syndrome. SMA syndrome is triggered when there is narrowing of the mesenteric angle and shortening of the aortomesenteric distance. We report a case of 42-year-old female who presented with features of gastric outlet obstruction which on further investigation was revealed as SMA syndrome. The aetiology, presentation, diagnosis and management of this unusual condition are discussed.

Differential induction of pyruvate decarboxylase subunits and transcripts in anoxic rice seedlings

In 2-d-old rice (Oryza sativa L.) seedlings subjected to anoxic stress, pyruvate decarboxylase (PDC) activity increased 9-fold during a 168-h period. A polyclonal PDC antiserum that recognized alpha- and beta-subunits was used to quantify PDC protein by an enzyme-linked immunosorbant assay and showed a 5.6-fold increase, suggesting that the anoxically induced enzyme has a higher specific activity than the PDC isoform present under normoxia. Immunoblot analysis showed that levels of both PDC subunits were induced by anoxia. Immunoprecipitation of proteins labeled in vivo during anoxic treatment demonstrated that the alpha-subunit was preferentially synthesized at the onset of anoxia. Two partial cDNAs, including a novel sequence, were cloned from a cDNA library made from seedlings subjected to anoxia for 6 h. Gene-specific probes used to quantify northern blots showed that two or three PDC mRNAs are differentially induced by anoxia in rice seedlings. Immunoprecipitation of in vitro translation products of mRNAs isolated a different times of anoxic treatment confirmed this findings Our results suggest that anoxic induction of rice PDC involves transcriptional and posttranscriptional regulation of gene expression as well as differences in enzyme characteristics.