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Abstract Background Definitive local therapy with stereotactic ablative radiation therapy (SABR) for ultracentral lung lesions is associated with a high risk of toxicity, including treatment related death. Stereotactic MR-guided adaptive radiation therapy (SMART) can overcome many of the challenges associated with SABR treatment of ultracentral lesions. Methods We retrospectively identified 14 consecutive patients who received SMART to ultracentral lung lesions from 10/2019 to 01/2021. Patients had a median distance from the proximal bronchial tree (PBT) of 0.38 cm. Tumors were most often lung primary (64.3%) and HILUS group A (85.7%). A structure-specific rigid registration approach was used for cumulative dose analysis. Kaplan-Meier log-rank analysis was used for clinical outcome data and the Wilcoxon Signed Rank test was used for dosimetric data. Results Here we show that SMART dosimetric improvements in favor of delivered plans over predicted non-adapted plans for PBT, with improvements in proximal bronchial tree DMax of 5.7 Gy (p = 0.002) and gross tumor 100% prescription coverage of 7.3% (p = 0.002). The mean estimated follow-up is 17.2 months and 2-year local control and local failure free survival rates are 92.9% and 85.7%, respectively. There are no grade ≥ 3 toxicities. Conclusions SMART has dosimetric advantages and excellent clinical outcomes for ultracentral lung tumors. Daily plan adaptation reliably improves target coverage while simultaneously reducing doses to the proximal airways. These results further characterize the therapeutic window improvements for SMART. Structure-specific rigid dose accumulation dosimetric analysis provides insights that elucidate the dosimetric advantages of SMART more so than per fractional analysis alone.

Abstract Background Emphysematous pyelonephritis (EPN) with gas in the inferior vena cava (IVC) is a rare presentation and to our knowledge, this is the first case report in the urologic literature. Case presentation A 35-Year-old obese diabetic Hispanic female presented to the emergency room with a clinical picture of septic shock. Prompt computerized tomography scan revealed EPN with gas throughout the right renal parenchyma and extending to the right renal vein, IVC, and pulmonary artery. She died before surgical intervention Conclusion This case demonstrates that patients presenting with severe EPN have a high mortality risk and providers should acknowledge that septic shock, endogenous air emboli, or a combination of both could result in cardiovascular collapse and sudden death.

L´attitude thérapeutique à adopter sur la hanche radiologiquement «normale» d´un enfant présentant une épiphysiolyse fémorale supérieure sur la hanche controlatérale, reste controversée. Nous rapportons le cas d´un jeune adolescent de 12 ans qui a développé une ostéonécrose de la tête fémorale radiologiquement «normale» et asymptomatique, sur la hanche gauche qui a été fixée de façon prophylactique dans le cadre d´une épiphysiolyse fémorale aigue survenue sur la hanche controlatérale. Huit mois après la première chirurgie, le patient a développé des signes d´ostéonécrose avasculaire de la tête fémorale. Des critères spécifiques existent pour permettre de poser l´indication d´un vissage préventif ou d´une simple surveillance rapprochée. Malgré ces critères le risque de survenue d´ostéonécrose sur la hanche «saine», n´est pas nul.

The effects of cadmium and zinc on growth and mineral distribution in Populus tremula × P. alba genotype 717-1B4 were investigated. Exposure to 360 mg(Cd) kg-1(soil) resulted in accumulation of Cd in all organs and inhibition of primary and secondary growth as well as of the net photosynthetic rate. No growth inhibition occurred under zinc exposure. Cd was mainly stored in the woody parts of stem, whereas zinc was preferentially localized in the leaves. Cd treatment also altered distribution of Zn2+, Ca2+, Mg2+, K+, and Fe2+ in different organs.

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Dissolved fluxes of C which are an important component of the global C budget of peatlands may be affected by global change in different ways. The evolution of peatland vegetation is an issue caused by the indirect effect of global change that still needs to be addressed. The aim of this study was to study the temporal and spatial variations in the quantity and the characteristics of dissolved C within in a peatland stream continuum, the peatland being invaded by Molinia caerulea and Betula spp. The study highlighted the following key points: (i) Vegetation change tends to increase the DOC concentration of peat surface water. (ii) DOC exports were in the range of those found in the literature, and it was clearly established that peatland DOC can reach second order streams. (iii) Peat water was supersaturated in CO2 especially in summer during the peak of microbial activity. (iv) the CO2 critical layer at the surface of the soil may promote CO excess build-up in the peat water. This critical layer may promote CO2 export out of the peatland. The effect of vegetation change on the DOC content of peat water deserves further attention as it may have a deep impact on downstream river water quality. In particular, it is necessary to clarify whether the concentration of C dynamics is affected by the invading species. More attention should be paid to hydrological processes (e.g. pumping capacity of the different plants) and the microbial activity in the rhizosphere of the invading plants. Also, the relation between the CO2 critical zone at the surface of the soil and the CO2 concentration in water should be studied in detail. [ABSTRACT FROM AUTHOR]