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Radiation therapy remains an important palliative tool for patients with bone metastases. The guidelines from the American Society for Therapeutic Radiation Oncology recommend the use of fewer fractions based on randomized data. We used the National Cancer Database to examine trends in radiation fractionation for patients with bone metastases. We queried breast, prostate, and non-small cell lung cancer in the National Cancer Database from 2010 to 2015 for patients with bone metastases at the time of diagnosis who received bone-directed radiation therapy of 8 Gy in 1 fraction, 20 Gy to 24 Gy in 5 to 6 fractions, 30 Gy in 10 fractions, or >30 Gy in 10 fractions. We tabulated the baseline characteristics, and a multivariable logistic regression analysis was used to identify predictors of single-fraction treatment. We identified 17,859 patients who met the study criteria. The median patient age was 67 years, and the majority of patients (67%) had primary prostate cancer. Most patients (62%) received spine treatment. Single-fraction treatment increased over time from 3% in 2010 to 7% by 2015. Use of more protracted courses (>30 Gy in 10 fractions) decreased from 34% to 15% over the same interval. The most commonly used regimen (50%-60% of cases) remained 30 Gy in 10 fractions. Predictors of single-fraction treatment included increased age, no systemic therapy, increasing distance from facility, treatment at an academic center, nonspine/nonskull metastasis, and more recent treatment year. Use of single-fraction radiation for bone metastases has increased steadily but still accounts for <10% of palliative courses. The use of more protracted regimens has decreased significantly, although 30 Gy in 10 fractions remains the most widely used regiment. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the gastrointestinal toxicity profile of a combined modality treatment for prostate cancer, consisting of external beam radiation (EBRT) and brachytherapy with rectal spacer hydrogel. The study aimed to assess the quality of prostate brachytherapy implants with spacer hydrogel in place and assess gastrointestinal complications in a real-world dataset. This study was a retrospective analysis of patients diagnosed with localized prostate cancer treated with combination EBRT and permanent prostate seed brachytherapy implant (PSI) after rectal hydrogel spacer placement from 2020 to 2022. Toxicity was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, and the incidence of rectal toxicity was recorded. The study also evaluated rectal wall infiltration (RWI) using a scoring method (0-3) based on CT scans after hydrogel placement, where 0 indicates no RWI, 1 represents minimal RWI, 2 represents moderate RWI, and 3 represents significant RWI. Dosimetric impact of hydrogel on the prostate and surrounding organs was assessed through ultrasound during the intra-operative seed implant procedure and post-operative CT scan by measuring Rectum D1cc, Rectum D2cc, Rectum D30%, PTV V100%, PTV D98% and PTV D90% as percentages of the prescription dose as both I-125 and Pd-103 are used in our institution. We identified 128 men who had hydrogel spacer placed followed by EBRT and PSI. The average age was 70.28yr (53-86yr), with most being white (87.5%) and having an average PSA level of 10.7 (1.4-65.7). The vast majority of patients (91%) had unfavorable intermediate and higher stage prostate cancer. 8.06% of patients had Grade 1 or 2 rectal toxicity, with 91.94% having no bowel symptoms. There was no correlation between the incidence of Grade 1 or higher rectal toxicity and RWI by hydrogel. Dosimetric variables showed significant differences when comparing ultrasound during the intra-operative seed implant procedure with post-operative CT scans. The results of paired t-tests indicated significant differences between all paired dosimetry variables (p<.0001 for Rectum D1cc, D2cc, D30%, PTV D98%, and p=0.0006 for PTV D90%, p=0.0002 for PTV V100%). The mean, median, and IQR values for dosimetric constraints are reported in table 1. The results of this study indicate that the majority of patients had no bowel symptoms and a low incidence of rectal toxicity when EBRT and PSI is delivered after rectal hydrogel spacer placement. Dosimetric analysis revealed significant differences between ultrasound during the intra-operative seed implant procedure and post-operative CT scans, suggesting the potential impact of hydrogel on intraoperative seed placement. [ABSTRACT FROM AUTHOR]

Abstract Fabricating a ceramic restoration for a discolored anterior tooth presents a clinical challenge. The dental technician is often hampered by being unaware of the shade of the discolored tooth preparation, which influences the color of the overlying ceramic restoration. A definitive cast that replicates the shade of the prepared tooth helps the ceramist to fabricate a restoration that masks the discoloration appropriately and still achieves the desired optical properties. This report demonstrates the use of a technique of recording and communicating the shade of a prepared tooth to the dental laboratory technician. [ABSTRACT FROM AUTHOR]

The Venezia gynecological applicator (Elekta) is a hybrid interstitial/intracavitary brachytherapy applicator used to treat cervical cancers. Previous data supporting the use of hybrid brachytherapy comes mainly from the EMBRACE cohort showing increased coverage of the high-risk CTV (HR-CTV) with decreased toxicity. Single-institution data, further supports this technique. We undertook this study to report our initial experience with the Venezia applicator for treatment of locally advanced cervical and endometrial cancers. We retrospectively reviewed 21 patients who received brachytherapy using the Venezia applicator for definitive treatment of cervical or endometrial cancer, treated from June, 2021 to March, 2022. All patients completed chemoradiotherapy followed by brachytherapy boost. For each brachytherapy fraction, patients received sedation and the Venezia applicator was placed. Radiation treatment planning was performed on CT imaging fused to daily MRI, using the Oncentra® treatment planning system. If needles were required for hybrid interstitial brachytherapy, the plan was optimized first without utilizing the needles, to meet constraint to organs at risk (OARs). Subsequently, planning was performed considering the interstitial needles with a focus on optimizing the balance of target coverage and dose to organs at risk. Radiation dose to target volumes and organs at risk were recorded as equivalent dose in 2Gy fractions (EQD2). Median age was 54 years. Ninety percent of patients were treated for a primary cervical cancer and 10% for primary endometrial cancer. Twenty-nine percent of patients had T1 primary tumor, 48% had a primary T2 tumor and 24% had a primary T3 tumor. The most common histology was squamous cell carcinoma (SCC) in 76% of patients, with adenocarcinoma in 10% and the remaining being undifferentiated or endometrioid. Median follow up was 4.3 months. Thirty-three percent of patients experienced acute toxicity with brachytherapy, all of which were grade 1-2. Twenty-nine percent experienced acute GI toxicity, 10% experienced acute GU toxicity and 10% experienced bleeding. Median brachytherapy dose and fractionation was 28Gy delivered over 4 fractions. Sixty-two percent of patients required hybrid interstitial brachytherapy and the median number of interstitial needles placed was 4. Median volume of the Gross Tumor Volume (GTV) and HR-CTV at first fraction were respectively 5.22cm3(IQR 4.26cm3-10.28cm3) and 27.84cm3(IQR 24.71cm3-40.36cm3). Median HR-CTV D90 and D98 were respectively 85.3Gy(IQR 83.1Gy-88.8Gy) and 76.8Gy (IQR 74.2Gy-79.6Gy). Median GTV D98 was 98.4Gy (IQR 94.3Gy-116.3Gy). Regarding OARs, median D2cc dose to the rectum, sigmoid and bladder were respectively 56.9Gy (IQR 53.7Gy-59.1Gy), 60Gy (IQR 55.9Gy-63.7Gy) and 75.3Gy (IQR 72.3Gy-77.6Gy). Median D1cc dose to the bowel was 50Gy (IQR 46.6Gy-56.8Gy). Median D0.1cc dose to the left and right ureter were respectively 71.8Gy (IQR 62.6Gy-85Gy) and 67.5Gy (IQR 61.6Gy-89.1Gy). Brachytherapy using the Venezia hybrid applicator was implemented with good dosimetry and sparing of organs at risk. Procedure related complications were mild. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) is the leading cause of death for both men and women in the United States. Percutaneous coronary intervention (PCI) with drug eluting stents (DES) has been a major advance in treatment with over 600,000 stents deployed annually. In-stent restenosis occurs in up to 10% of patients and is often managed with repeat DES placement. However, when stent-in-stent restenosis (SISR) occurs, options remain limited, and one technique includes angioplasty followed by intravascular brachytherapy (IVBT). We undertook this study to review efficacy and safety of PCI followed by IVBT for patients experiencing SISR. We retrospectively reviewed 78 patients from 2016-2021 with SISR involving 91 vessels who received PCI with balloon angioplasty followed by IVBT. IVBT with a strontium-90 source was delivered via The Beta Cath® system (Novoste; Bes Vascular, Norcross, Ga, USA). The radiation dose delivered was 23Gy to vessels of ≥ 3.5mm in diameter, while 18.4 Gy was delivered to vessels of < 3.5 mm diameter. Radiation was prescribed to an area encompassing the angioplasty injury length with a 10mm longitudinal margin on each side. Major adverse cardiac events (MACE) include myocardial infarction (MI), stroke and all-cause death. Target vessel revascularization (TVR) was defined as percutaneous or surgical revascularization of the previously treated vessel. Median age was 67 years. All patients had at least 2 drug-eluting stents previously placed in the affected vessel. Sixty-one treatments were delivered to the left anterior descending artery or the right coronary artery with the remaining 30 delivered to either to a circumflex vessel or marginal artery. Sixty-three percent received 23Gy while 37% received 18.4Gy. One patient experienced cardiac arrest while receiving intervention, but no other procedure-related toxicities were reported. Median follow up was 22.8 months (range 0.9-60.6). All patients were symptomatic prior to IVBT and 44% experienced symptomatic reduction after treatment. The most common persistent symptom was angina in 71% of those patients. MACE after IVBT include MI in 18%, stroke in 5% and all-cause death occurring in 16% at a median time of 9.3 months after treatment (range 0.9-29.6). Seventy-seven percent had patency of the irradiated lesion, while 23% percent experienced restenosis requiring TVR. PCI followed by IVBT is a safe and effective paradigm for patients with high-risk coronary artery disease experiencing SISR, who have few other treatment options. [ABSTRACT FROM AUTHOR]

This article explores the current status of MRI utilisation trends in King Fahd Hospital of the University (KFHU), as one of the major government hospitals of the Eastern Province in Saudi Arabia. The study covers a period of five years (2007-2011). The factors and indications of utilisation levels were identified, grouped and categorised according to their nature and according to their impact on MRI utilisation. Among other results it was revealed that the portion of “Non-Eligible” patients underwent MRI scan is not negligible (≈9%). The results showed serious obstacles in data collection so not all factors were found and incorporated in the analysis. Other utilisation factors of diagnostic imaging procedures- need to be considered carefully in respect to the appropriateness and effectiveness of policies and planning procedures. The outcome of this study is a start and can be benchmarked to other similar research studies in the field covering other hospitals and medical establishments in the region. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is a widespread chronic reproductive disorder that is associated with metabolic disturbances. Traditionally, the marjoram plant is well-known to restore hormonal balance and regulate the menstrual cycle. We aimed to investigate the ameliorative effects of marjoram extract on hormonal profiles, body and ovaries weight, insulin sensitivity, inflammation, and oxidative stress in a rat model of PCOS. A 75 postpubertal (42 days old) female Wistar rats were randomly assigned into five groups (control, dehydroepiandrosterone (DHEA) induced-PCOS model, marjoram-treated PCOS rats, metformin-treated PCOS rats and the combination of marjoram+metfomin treated PCOS model). PCOS induction was performed by subcutaneous injection of DHEA 60 mg/kg daily for 24 days. Ovaries weight, adiponectin, hormonal levels, inflammatory, and oxidative stress biomarker levels were measured at the end of the treatment period using ELISA assay. The current study showed that marjoram significantly decreased ovaries' weight and the estradiol levels (P -value<0.05) compared to the DHEA group. Interestingly, marjoram improved insulin sensitivity as manifested by a significant increase in the adiponectin serum levels (P -value<0.05). Marjoram alone or in combination with metformin prominently decreased the IL-6 level and improved the levels of ovarian SOD and GPx enzymes (P -value<0.05). Additionally, the group treated with the combination of marjoram and metformin remarkably decreased the level of TBARS (P -value<0.05). The present study established the beneficial effects of marjoram administration on DHEA-induced PCOS in female Wistar rats. The mechanistic effect includes improvement in the hormonal levels, ovaries weight, insulin sensitivity, antioxidants, and anti-inflammatory parameters. [ABSTRACT FROM AUTHOR]

More than 20 years ago prophylactic intravascular brachytherapy burst into the radiation oncology lexicon, only to be replaced within a few years by the introduction of drug eluting stents. However, restenosis still occurs in 5- 15% of high risk patients with two or more layers of drug eluting stents. We examined our experience in patients with in stent in stent restenosis who have no options for durable revascularization and therefore are forced to lead a shortened and sedentary life, comparing this to our historic control group. A retrospective cohort of 134 patients treated with angioplasty followed by intracoronary brachytherapy was compared to a current high risk group of 122 patients with in stent in stent restenosis. All patients had a minimum 6 month follow up post brachytherapy. None of the original cohort had stenting performed at the time of brachytherapy, while all patients in the restenosis cohort had placement of at least 2 layers of intracoronary stents prior to repeat angioplasty and IVBT. In the original cohort, there were no intraprocedural deaths, while the high risk cohort had a single intraprocedural death due to intracoronary thrombosis. No high risk patient developed any significant cardiovascular event otherwise at 6 months post-procedure. Intravascular brachytherapy for in stent in stent restenosis is equally safe compared to the historic post angioplasty IBVT safety profile, despite the fragile nature and relatively high risk disease status of these patients with limited options. [ABSTRACT FROM AUTHOR]

Abstract: In communication, language can be interpreted differently depending upon the emotional context. To clarify the effect of emotional context on language processing, we performed experiments using a cross-modal priming paradigm with an auditorily presented prime and a visually presented target. The primes were the names of people that were spoken with a happy, sad, or neutral intonation; the targets were interrogative one-word sentences with emotionally neutral content. Using magnetoencephalography, we measured neural activities during silent reading of the targets presented in a happy, sad, or neutral context. We identified two conditional differences: the happy and sad conditions produced less activity than the neutral condition in the right posterior inferior and middle frontal cortices in the latency window from 300 to 400ms; the happy and neutral conditions produced greater activity than the sad condition in the left posterior inferior frontal cortex in the latency window from 400 to 500ms. These results suggest that the use of emotional context stored in the right frontal cortex starts at ∼300ms, that integration of linguistic information with emotional context starts at ∼400ms in the left frontal cortex, and that language comprehension dependent on emotional context is achieved by ∼500ms. [Copyright &y& Elsevier]

Abstract: Electroencephalograms (EEGs) were recorded from eight Japanese speakers while they listened to Japanese and Spanish sentences (approximately 51s each). The sentences were modulated in amplitude by a binary m-sequence and played forward or backward. A circular cross-correlation function was computed between the EEG signals and the m-sequence and averaged across subjects. Independent component analysis of the averaged function revealed a component source response which was obtained only for the comprehensible Japanese and not for the incomprehensible sentences. The present study has thus shown that a 1-min long EEG signal is sufficient for the assessment of speech comprehension. [Copyright &y& Elsevier]

Abstract: A masked priming paradigm has been used to measure unconscious and automatic context effects on the processing of words. However, its spatiotemporal neural basis has not yet been clarified. To test the hypothesis that masked repetition priming causes enhancement of neural activation, we conducted a magnetoencephalography experiment in which a prime was visually presented for a short duration (50ms), preceded by a mask pattern, and followed by a target word that was represented by a Japanese katakana syllabogram. The prime, which was identical to the target, was represented by another hiragana syllabogram in the “Repeated” condition, whereas it was a string of unreadable pseudocharacters in the “Unrepeated” condition. Subjects executed a categorical decision task on the target. Activation was significantly larger for the Repeated condition than for the Unrepeated condition at a time window of 150–250ms in the right occipital area, 200–250ms in the bilateral ventral occipitotemporal areas, and 200–250ms and 200–300ms in the left and right anterior temporal areas, respectively. These areas have been reported to be related to processing of visual-form/orthography and lexico-semantics, and the enhanced activation supports the hypothesis. However, the absence of the priming effect in the areas related to phonological processing implies that automatic phonological priming effect depends on task requirements. [ABSTRACT FROM AUTHOR]

Tonsillectomy is a painful operation and some studies have suggested that preoperative non-pharmacologic preparations may decrease postoperative pain. In this randomized clinical trial study, we decided to determine which is more effective in the post-tonsillectomy pain; an informative booklet or a costly, time consuming, sophisticated, and multi-component preparation program. Patients were randomly assigned into two groups. In the booklet group, children and their parents only received an informative booklet as routine information preparation. On the other hand, in the multi-component group; in addition to receiving the same booklet, children and their parents received our multi-component pre-operative preparation program. The following items were included in the package: preoperative tour in the ward, an educational DVD, and therapeutic play intervention. All patients were observed at least for 8 h as a day case or ambulatory tonsillectomy. The pain score was recorded according to the visual analog scale for seven days. Finally, the post-tonsillectomy pain scores were compared in the two groups. The multi-component group included 121 children and booklet group 120. Minimum and maximum age was 9 and 12 years. Regarding post-tonsillectomy pain, we found no significant difference between the multi-component group and the booklet group. Our data revealed that a new concept which is more cost-effective and concise booklet is as effective as costly and sophisticated methods in post-tonsillectomy pain among 9–12 years old children. [ABSTRACT FROM AUTHOR]