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Objective In this study, the authors aimed to compare the nasal physiology and nasal cavity volume with three-dimensional computed tomography (3D-CT) 1 year after the operation with the values before the operation to investigate the possible narrowing and loss of function in the nasal cavity after septorhinoplasty (SRP) operation. Methods Of 415 patients who had a primary SRP operation, 28 patients who met the criteria were included in the study. Nasal cavity volumes of patients with postoperative CTs were measured three-dimensionally after a mean 13 months, and objective rhinologic measurements (rhinomanometry, acoustic rhinometry, and peak nasal inspiratory flow [PNIF]) and subjective assessment methods (Visual Analog Scale [VAS], Nasal Obstruction Symptom Evaluation [NOSE]) were performed. Results The mean postoperative VAS and PNIF values of the patients were significantly higher than the mean preoperative values. The mean postoperative NOSE value of the patients was significantly lower than the mean preoperative values. Although the mean MCA-1 and MCA-2 levels of the patients increased postoperatively, the increase was not significant. Although the postoperative mean values of VOL-1 and VOL-2 increased compared with the preoperative values, the increase was not significant. In the CT measurements of the patients, the nasal cavity volumes were significantly higher than the preoperative values. Conclusion Nasal cavity volumes in patients undergoing SRP were compared with 3D-CT for the first time in the literature, and a significant increase in nasal volume was observed in the postoperative first year. This finding suggests that the correction of intranasal problems leads to an increase in the nasal volume in SRP operations, although nasal osteotomy is performed.

Objective: We aim to quantify the magnitude of setup errors in intensity-modulated radiotherapy (IMRT) treated Head and Neck cancer patients and recommend appropriate PTV margin. Methods: 60 patients with head and neck cancer required bilateral neck irradiation were planned and treated by simultaneous integrated boost IMRT technique either treated radically or postoperative. Patients undergoing image-guided radiotherapy (IGRT) each with once weekly scheduled cone beam computed tomography (CBCT). The 3D displacements, systematic and random errors were calculated. The appropriate PTV expansion was determined using Van Herk’s formula. Results: Mean 3D displacement was 0.16 cm in the vertical direction, 0.14 cm in the horizontal direction and 0.16 cm in the longitudinal direction. Conclusion: Use of weekly CBCT allows the planning target volume (PTV) expansion to be reduced according to our setup. The appropriate clinical target volume (CTV)-PTV margin for our institute is 0.30 cm, 0.38 cm, and 0.33 cm in the horizontal, vertical, and longitudinal directions, respectively.

Aim: To keep the cervical canal dilated after the fi rst high dose rate (HDR) brachytherapy fraction to avoid general anesthesia during subsequent applications.

Aim This study evaluated the survival outcome, pattern of failure and prognostic factors in cervix uteri cancer patients. Methods We reviewed the data of 60 patients with stages IB-IVA cancer who were treated between January 2004 and December 2010. Results Most patients (n = 50; 83%) had squamous cell carcinoma. Stage IIB was the most common presentation (n = 41; 68%). Forty-seven patients (78%) received Cisplatin concurrent with radiotherapy (CRT). The 2- and 4-year overall survival (OS) was 82% and 79%, respectively. Prolongation of the overall treatment time (OAT) for greater than 56 days, advanced stage and pretreatment hemoglobin (Hb) levels (

Objectives: The aim of this study was to assess the effectiveness of bilateral submandibular duct relocation and bilateral sublingual gland excision in combination with botulinum toxin A injection into the parotid glands in children with sialorrhea. Previously in the literature, either surgery or botulinum toxin injection but not their combination has been reported. Methods: Preoperative and at least 6-month postoperative assessments using the Drooling Severity Scale and Drooling Frequency Scale (Thomas-Stonell and Greenberg classification) and the Teacher Drooling Scale and by interviewing parents and caregivers face to face or via telephone were performed. Also, decreases in the daily number of bib changes and hourly frequency of saliva wiping were recorded as success. Complications were recorded. Results: The Drooling Frequency and Severity Scale, the Teacher Drooling Scale, daily number of bib changes, and hourly frequency of saliva wiping decreased significantly in 21 patients (95.5%) and remained unchanged in 1 patient (4.5%). Postoperative bleeding was observed in 1 patient (4.5%). Conclusions: Drooling is a complex problem that benefits from a multidisciplinary approach. Many treatment methods exist, each with advantages and disadvantages. In this study botulinum toxin A injection was applied in conjunction with bilateral submandibular duct relocation and bilateral sublingual gland excision surgery, achieving a success rate of 95.5%. Moreover, minimal complications and no recurrence after at least 6-month follow-up were observed. The authors therefore recommend further use of this combination treatment. Larger and longer term studies may also help clarify its effectiveness.

Purpose: To retrospectively compare the potential dosimetric advantages of a multichannel vaginal applicator vs. a single channel one in intracavitary vaginal high-dose-rate (HDR) brachytherapy after hysterectomy, and evaluate the dosimetric advantage of fractional re-planning. Material and methods: We randomly selected 12 patients with endometrial carcinoma, who received adjuvant vaginal cuff HDR brachytherapy using a multichannel applicator. For each brachytherapy fraction, two inverse treatment plans (for central channel and multichannel loadings) were performed and compared. The advantage of fractional re-planning was also investigated. Results: Dose-volume-histogram (DVH) analysis showed limited, but statistically significant difference (p = 0.007) regarding clinical-target-volume dose coverage between single and multichannel approaches. For the organs-at-risk rectum and bladder, the use of multichannel applicator demonstrated a noticeable dose reduction, when compared to single channel, but statistically significant for rectum only (p = 0.0001). For D 2cc of rectum, an average fractional dose of 6.1 ± 0.7 Gy resulted for single channel vs. 5.1 ± 0.6 Gy for multichannel. For D 2cc of bladder, an average fractional dose of 5 ± 0.9 Gy occurred for single channel vs. 4.9 ± 0.8 Gy for multichannel. The dosimetric benefit of fractional re-planning was demonstrated: DVH analysis showed large, but not statistically significant differences between first fraction plan and fractional re-planning, due to large inter-fraction variations for rectum and bladder positioning and filling. Conclusions: Vaginal HDR brachytherapy using a multichannel vaginal applicator and inverse planning provides dosimetric advantages over single channel cylinder, by reducing the dose to organs at risk without compromising the target volume coverage, but at the expense of an increased vaginal mucosa dose. Due to large inter-fraction dose variations, we recommend individual fraction treatment plan optimization. J Contemp Brachytherapy 2014; 6, 4: 362–370 DOI: 10.5114/jcb.2014.47816

Purpose: To retrospectively assess the incidence and magnitude of air pockets around vaginal cylinders and its impact on dose distribution in vaginal cuff image-guided high-dose-rate (HDR) brachytherapy. Material and methods: Fifty endometrial carcinoma patients treated by postoperative HDR vaginal cuff brachytherapy were included in the study. The average age of patients was 58.3 ± 11.8 years (range: 31-87 years). Brachytherapy was performed using cylindrical applicators, and the dose prescribed to 0.5 cm from the applicator’s surface, over a length of 5 cm from the applicator’s tip. Computed tomography (CT) simulation was used for each brachytherapy fraction. The incidence, vaginal mucosa displacement, volume, and dosimetric effect of air pockets around the vaginal cylinder were evaluated. Results: A total of 78 air pockets were found in 29/50 patients (58%) and 45/135 (33%) brachytherapy plans. They were located at the apex: 16/78 (20%) and lateral to the applicator: 62/78 (80%). The volume of air pockets ranged between 0.01 and 2.1 cm 3 (mean: 0.15 cm 3 ± 0.36 cm 3 ), and the maximum displacement of vaginal mucosa from cylinder surface was between 0.1 and 1.09 cm (mean: 0.34 cm ± 0.2 cm). The dose reduction to the vaginal mucosa generated by the air pockets ranged from 0.5 to 66% (mean: 26.4% ± 13.9%). Conclusions: The presence of air pockets around vaginal cylinder applicators is frequently noticed in post-operative vaginal cuff brachytherapy. The dose to the vaginal mucosa is reduced, as a result of displacement generated by air pockets. The effect on the clinical outcome of this dose reduction is yet to be determined. J Contemp Brachytherapy 2014; 6, 3: 271–275 DOI: 10.5114/jcb.2014.45436

This paper present 32 Element microstrip rectangular patch array antenna for KU-Band. The aim of the design is to achieve low cost, low weight and high gain antenna for the transmissions frequency range of KU – Band satellite system. The paper also present 5 designs for array antenna 2, 4,8,16 and 32 elements and the results comparison between them. The substrate material is FR-4 with 1.58 mm thickens. The simulation made by CST Microwave studio 2017. The size of final design is 85×98.81 mm and the bandwidth is 1.489 GHz. The frequency range of design starting from 13.318 GHz to 14.842 GHz with maximum Gain 13.7 dB. The final design of 32 elements array antenna has been fabricated and compared with the simulation results, a good agreements were obtained and the difference between fabrication and measurements results was due to fabrication and measurements tools tolerance. The fabricated design has been measured using Vector network analyzer ROHDE & SCHWARZ ZVB20.

Almost all the certificateless two-party authenticated key agreement (CTAKA) protocols found in the literature, suffer either serious security problems or inefficient performance that involves high computational costs. In this paper, we design a secure and efficient CTAKA protocol. Within the proposed CTAKA protocol, the KGC publishes the public keys of the users in a public directory (LDAP server) that has a certificate to prove its identity to the users. The LDAP certificate is the only existing certificate within the scheme. Both the two communicating parties are able to compute a common secret per session key using a secure generated random number. The protocol is fully secure against type 1 attack and fully secure against type 2 attacks under the assumptions that the KGC is an honest party and each party within the network has the full capability to keep its secret values safe. Moreover, the setup of the protocol does not include pairings and the whole key agreement process requires only four point scalar multiplications, two point additions, one hash function evaluation and one message exchange.

Synovial sarcoma accounts for 5 to 10% of soft tissue sarcoma. It occurs mainly in young adults, where 90% of cases occur before 50 years.

Purpose To investigate the correlation between the dose predicted by the treatment planning system using digitally reconstructed radiographs or three-dimensional (3D)–reconstructed CT images and the dose measured by semiconductor detectors, under clinical conditions of high-dose-rate brachytherapy of the cervix uteri. Patients and methods Thirty-two intracavitary brachytherapy applications were performed for 12 patients with cancer of the cervix uteri. The prescribed dose to Point A was 7 Gy. Dose was calculated for both International Commissioning on Radiation Units and Measurements (ICRU) bladder and rectal points based on digitally reconstructed radiographs and for 3D CT images–based volumetric calculation of the bladder and rectum. In vivo diode dosimetry was performed for the bladder and rectum. Results The ICRU reference point and the volumes of 1, 2, and 5 cm3 received 3.6 ± 0.9, 5.6 ± 2.0, 5.1 ± 1.7, 4.3 ± 1.4 and 5.0 ± 1.2, 5.3 ± 1.3, 4.9 ± 1.1, and 4.2 ± 0.9 Gy for the bladder and rectum, respectively. The ratio of the 1 cm3 and the ICRU reference point dose to the diode dose was 1.8 ± 0.7 and 1.2 ± 0.5 for the bladder and 1.9 ± 0.6 and 1.7 ± 0.5 for the rectum, respectively. Conclusions 3D image–based dose calculation is the most accurate and reliable method to evaluate the dose given to critical organs. In vivo diode dosimetry is an important method of quality assurance, but clinical decisions should be made based on 3D-reconstructed CT image calculations.

AIM: Women in Saudi Arabia develop breast cancer at a young age with high prevalence of poor prognostic features. Because of such features, it is necessary to examine prognostic factors in this population. One such factor is the prognostic role of lymph node ratio (LNR). METHODS: We performed retrospective analyses of patients with invasive non-metastatic breast cancer who underwent axillary lymph node dissection and had one or more positive axillary lymph nodes. RESULTS: Two hundred and seventeen patients were considered eligible for the analysis. The median age was 46 years. At a median follow-up of 39.8 months, the median disease-free survival (DFS) was 67.3 months (95% CI, 50.4 to 84.3 months). Neither the classification of patients based on positive lymph node (pN) staging system, nor the absolute number of pN prognosticated DFS. Conversely, age 0.20 to 0.65) LNR categories were the only variables that were independently associated with adverse DFS. Using these variables in a prognostic model allowed the classification of patients into three distinctive risk strata. The overall survival (OS) in this series was 92.5 months (95% CI, 92.1-92.6). Only ER negative tumor adversely influenced OS. CONCLUSION: Analysis of survival outcome of mostly young patients with early breast cancer identified adverse prognostic variables affecting DFS. If the utility of the derived model including LNR is proven in a larger patient population, it may replace the use of absolute number of positive axillary lymph nodes

The objective of this study was to determine the association between circulating (Progesterone, oestradiol-17β and P4/E2 ratio) concentrations and embryonic loss in Friesian cows under Egyptian condition. On day 25 by both progesterone (P4) level and sonography, 65.71% (69/105) cows were continued their gestation normal and 17.14% (18/105) cows not conceived. While, 17.14% (18/105) of inseminated cows showed high P4 level firstly and decline before day 25 suspecting early pregnancy loss, EPL. Also, 5 cows (7.25%) of the pregnant cows lost their feti from day 25 to day 45 (late pregnancy loss, LPL) were detected. Progesterone concentrations was noticed that increased P4 level starting from day 4 to day 7after AI in cows diagnosed pregnant (P

Myxofibrosarcoma is a common sarcoma in the extremities, but is rare in the head and neck region. Here, we report a case of 76 year old female patient in whom myxofibrosarcoma generated from the thyroid. The tumor was characterized by spindle cell proliferation with low to moderate cellular density in myxoid stroma. Immunohistochemically, the tumor cells showed positive reactivity for vimentin and actin, but negative staining for S-100, CK and desmin. Tumor cells showed low proliferative activity as demonstrates by low Ki-67 labelling index (5%). The tumor was diagnosed as a low-grade myxofibrosarcoma. Despite the suboptimal general conditions of the patient, yet, surgery was the sole treatment of her and was successfully done. Adjuvant radiotherapy was indicated due to close circumferential margin. Myxofibrosarcoma is a very rare tumor in the head and neck region, and morphology beside immunohistochemistry is powerful tools to establish the diagnosis. Surgery is the main line of treatment followed by adjuvant radiotherapy to improve patient's survival.

sion, by quantitative reverse-transcription polymerase chain reaction (RT-PCR). Findings: The overall rate of MAGE-A3 expression was 41% (37% in Taiwan and 48% in Thailand, from 132 valid samples). MAGEA3 expression was lower in patients with HBV infection (33.3%) than in HCV-infected patients (63.0%). No difference in MAGEA3 expression was noted for the following factors: age, gender, liver cirrhosis, Child-Pugh class, chronic alcohol abuse, number and size of (largest) tumours. No clinical effects on survival were associated with MAGE-A3 expression in this HCC Asian population. The hazard ratio (HR) for the disease-free interval for MAGE-A3-positive versus MAGE-A3-negative patients was 1.06 (p = 0.82; HR adjusted for T stage, tumour number and size, cirrhosis, Child-Pugh score, and ECOG performance status was 1.40 [p = 0.29]). HRs for disease-free and overall survival were 1.03 (p = 0.91) and 0.97 (p = 0.94), respectively; adjusted HRs were 1.32 (p = 0.37) and 1.33 (p = 0.63). However, because of the small number of patients, no subset analysis by stage or other variables that affect disease-free and overall survival could be done. Interpretation: MAGE-A3 can be assessed by RT-PCR on surgically resected HCC. The overall expression rate is sufficient to consider MAGE-A3 a target for active immunotherapy. The relatively higher expression in HCV-infected patients has no explanation, so far. Clinical evaluation of MAGE-A3 antigen-specific cancer immunotherapeutics in early HCC after resection is being discussed. Funding: GlaxoSmithKline Biologicals. D.D., J.L., A.M., and P.T. are employed by GlaxoSmithKline.

The metabolic syndrome is a clustering of cardiovascular risk factors, specifically, hypertension, diabetes, dyslipidemia and obesity is increasingly being recognized as an important factor in the pathophysiology of atherosclerosis and as a target of therapy. Objective: The aim of this work was to screen the prevalence of metabolic syndrome in Suez Canal area among adults. Subjects and methods: This study was conducted as a cross-sectional study. 145 subjects Inhabitants of Suez Canal area were included into this study. Detailed medical history with complete clinical examination and laboratory analysis were performed to screen the metabolic syndrome (MS). Results: 42.1% of the studied population had metabolic syndrome. 35.2% of the studied subjects were hypertensive and 33.8% of them were diabetic. 64.1% of the studied subjects had a family history of diabetes and 61.4% of them had a family history of obesity. There were significantly higher mean of age, weight, BMI, waist circumference, SBP, DBP, triglycerides and FBS among subjects with MS than subjects without MS (p

The mechanical auxiliary ventricle (MAV) is an avalvular prosthesis that is permanently implanted in the descending thoracic aorta. It is counterpulsated like the intraaortic balloon pump (IABP); however, the MAV, with its larger pumping chamber, can provide greater hemodynamic effects than the IABP. The IABP is an accepted therapy for alleviating acute pharmacologically refractory congestive heart failure (CHF). The beneficial actions of the MAV in advanced CHF have been documented, using an earlier version of the system [Kantrowitz A, Krakauer JS, Zorzi G, Rubenfire M, Freed PS, Phillips S, Lipsius M, Titone C, Cascade P, Jaron D (1971) Current status of the intraaortic balloon pump and initial clinical experience with an aortic patch mechanical auxiliary ventricle. Transplant Proc 3:1459] These studies also confirmed that the MAV, because of the small surface area of artificial material in contact with the blood, is minimally thrombogenic, allowing the system to be turned off at will and permitting the patient to be untethered when physiologically appropriate. However, these studies also demonstrated that the MAV’s percutaneous access device had led to infection. The MAV system was therefore redesigned, necessitating in vitro and in vivo studies to determine the reliability of the reconfigured prosthesis. In this report, the results of in vivo tests of biochemical and hematological studies of four calves with long-term, intermittently activated, MAVs are presented. Four animals were pumped intermittently for 2-h sessions, 5 days a week, for 22, 26, 60, and 112 weeks, respectively. In the aggregate, the four animals were pumped for 3790 h. During this time, the blood pumps were activated for more than 20 million cycles and were restarted after inactivation of hours or days more than 1700 times. No aberrations of clinical significance were discovered. The results of other tests, including an exhaustive search for thromboemboli and other pathological responses to the MAV, also proved negative. These results provide evidence that turning the MAV ‘Off’ and ‘On’ does not activate the host’s hemostatic mechanism. In clinical application, with the MAV ‘Off,’ the patient can be free of any external connection, or have the option of a standby wearable drive unit weighing

bile tumor) and another one cholangitis complicated by sepsis (one Klatskin III tumor), so only 20 patients underwent HDR-192Ir-ILBT. One biliary brachytherapy catheter was used in 14 patients, two catheters in 6 patients. The dose delivered was 15 Gy in 3 patients, 20 Gy in 9 patients and 25 Gy in 8 patients with daily 500 cGy per fraction. During the brachytherapy procedure, cholangitis occurred in two patients. The median followup was 42 months (range 6e76 months). Two patients developed late toxicity (1 hemobilia, 1 hepatic abscess). Subsequent bouts of cholangitis occurred in 16 patients (72,7%, median 7 months) while stent occlusion (due to biliary sludge, tumor ingrown and overgrown) was observed in 12 patients (54,5%, median 13 months). Six-month and oneyear overall survival was 77% and 59%, with a median of 13 months; sixmonth and one-year local progression (tumor ingrown and overgrown) was 82% and 72% (median not reached).

A familial decrease in activity in plasma protease inhibitor, Antithrombin III (AT III «as observed in three generations. This autosomal trait is not associated with thrombsis. It is a benign abnormality despite AT III functional values of 23% of normal in heparin co-factor assay. The low activity AT III was purified from fresh plasma on a heparm affinity column. Its functional, biochemical and immunochemical properties were studied. In the progressive AT III assay, both proteins behaved similarly. Binding of low activity I125 AT III to α1, thrombin or heparin column was identical Purified and plasma AT III from normal and propositus had the same electrophoretic mobilit on Polyacrylamide gel and by Immunoelectrophoresis (IEP) in 1.5K agar gelsHowever plasma and purified low activity AT III when analyzed by two dimensional (IEP) with heparin placed in the first gel showed one major immunoprecipltate and a much smaller more electronegative one against AT III antiserum. Under identical conditions, purifi normal AT III showed a reversed pattern. On electrofocusing and by immunodiffusion against antiserum to thrombin, the major immunoprecipltate was identified as an AT III thrombin comply. A variant of the propositus’ AT III favors rapid binding of thrombi without need of heparin.

Immunologic techniques have proven to be useful tools in characterizing the action of pituitary protein hormones on the target organs. Specifically, an antibody to luteinizing hormone can prevent ovulation, delay implantation, or cause fetal resorption depending on the time of administration of the antiserum to female rats. The immunologic interference with ovarian function appears to be associated with the steroidogenesis process during early pregnancy, and with fetal placental function during mid pregnancy in the rat. Progesterone synthesis is diminished, probably by the prevention of luteinizing hormone from stimulating the Δ5Β hydroxysteroid dehadrogenase within the interstitial tissue of the ovary. In later pregnancy, the antibody combines with specific cells within the placenta, thereby eliminating any placental influence on the ovarian steroidogenic process.