Search

Median sternotomy and steel wires for sternal closure are the standard approach for cardiac surgery. An incomplete repair associated with chest wall motion, especially in the presence of predisposing factors, can lead to life-threatening deep sternal wound infection, also known as mediastinitis, in 2–5% of cases. Despite current antibiotic and surgical treatments, mediastinitis is associated with a 10–40% mortality rate and a significant increase in morbidity and hospital stay. High mortality and difficult treatment appear to be due to bacterial biofilm, a self-produced extracellular polymeric product that incorporates host tissue and is responsible for the failure of immune defenses and standard antimicrobial therapies. Nanostructures are an effective strategy to enhance the healing process, as they establish a favorable environment for the neosynthesis of the extracellular matrix, supporting tissue development. Synthetic polymers have been proven to exhibit suitable biodegradable and mechanical properties, and their biofunctionalization to enhance cell attachment and interaction with the extracellular matrix is being widely investigated. The use of antibiotic treatments suspended in poly-D,L-lactide and polyethylene oxide and electrospun into nanofibers, or in sponges, has been shown to inhibit bacterial biofilm production. Additionally, growth factors can be incorporated into 3D bioresorbable scaffolds with the aim of constituting a structural and biological framework to organize and expedite the healing process. Therefore, these combined approaches may change the treatment of mediastinitis in the near future.

Despite cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) being the current gold standard for non-invasive myocardial characterization and fibrosis quantification, its accessibility is limited, particularly in acute settings and in certain patient populations with contraindications to magnetic resonance imaging. Late iodine enhancement (LIE) in computed tomography (CT) imaging has emerged as a potential alternative, capitalizing on the similarities in the contrast kinetics between gadolinium and iodinated contrast agents. Studies have investigated LIE-CT’s effectiveness in myocardial infarction (MI) detection, revealing promising outcomes alongside some disparities compared to LGE-CMR. LIE-CT also proves beneficial in diagnosing non-ischemic heart diseases such as myocarditis, hypertrophic cardiomyopathy, and sarcoidosis. While LIE-CT demonstrates good accuracy in detecting certain myocardial pathologies, including acute MI and chronic fibrotic changes, it has limitations, such as the inability to detect diffuse myocardial enhancement. Nonetheless, thanks to the availability of optimized protocols with minimal radiation doses and contrast medium administration, integrating LIE-CT into cardiac CT protocols could enhance its clinical utility, particularly in acute settings, providing valuable prognostic and management insights across a spectrum of cardiac ischemic and non-ischemic conditions.

Recensione di Arnd Schneider, Expanded visions. A new anthropology of the moving image, London-New York, Routledge, 2021, pp. 212.

Background/Objectives: Multiple-drug-resistant (MDR) bacteria are pathogens resistant to three or more antibiotic classes, and infection with these bacteria is associated with increased mortality, morbidity, and hospital management costs. Given the rise in antibiotic resistance, selecting appropriate antimicrobial drugs and avoiding the unnecessary use of new antibiotics are crucial. Due to their nosocomial nature, monitoring and preventing MDR infections are essential. Methods: This study enrolled patients who underwent cardiac surgery from January 2020 to May 2022. The patients included were those 18 years or older who tested positive for MDR intestinal colonization before surgery. Excluded were patients who tested positive after surgery, or were younger than 18, pregnant, or lactating. For each positive patient, the National Surgical Quality Improvement Program (NSQIP) score was calculated. The data collected included age, gender, body mass index (BMI), the type of surgery, the intensive care unit (ICU) length of stay, ICU readmission, mortality, and other infections (pneumonia, bacteremia, or surgical site infection) to establish a control group and postoperative outcome measures. Results: No statistically significant differences were found between the groups regarding the ICU length of stay, new ICU admissions, or mortality. Additionally, there were no differences in the infection rates, such as bacteremia, wound infections, and pneumonia. Conclusions: Preoperative rectal colonization by MDR bacteria does not appear to worsen postoperative outcomes for cardiac surgery patients. These findings suggest that patients with a preoperative MDR-positive rectal sample might undergo cardiac surgery without significantly increased risk. Besides the limitations of this study, pre-surgical antibiotic prophylaxis may not need to be adjusted for patients with preoperative MDR positivity. [ABSTRACT FROM AUTHOR]

Epigenetic modifications play a fundamental role in the progression of coronary artery disease (CAD). This panoramic review aims to provide an overview of the current understanding of the epigenetic mechanisms involved in CAD pathogenesis and highlights the potential implications for personalized medicine approaches. Epigenetics is the study of heritable changes that do not influence alterations in the DNA sequence of the genome. It has been shown that epigenetic processes, including DNA/histone methylation, acetylation, and phosphorylation, play an important role. Additionally, miRNAs, lncRNAs, and circRNAs are also involved in epigenetics, regulating gene expression patterns in response to various environmental factors and lifestyle choices. In the context of CAD, epigenetic alterations contribute to the dysregulation of genes involved in inflammation, oxidative stress, lipid metabolism, and vascular function. These epigenetic changes can occur during early developmental stages and persist throughout life, predisposing individuals to an increased risk of CAD. Furthermore, in recent years, the concept of personalized medicine has gained significant attention. Personalized medicine aims to tailor medical interventions based on an individual’s unique genetic, epigenetic, environmental, and lifestyle factors. In the context of CAD, understanding the interplay between genetic variants and epigenetic modifications holds promise for the development of more precise diagnostic tools, risk stratification models, and targeted therapies. This review summarizes the current knowledge of epigenetic mechanisms in CAD and discusses the fundamental principles of personalized medicine.

Median sternotomy and steel wires for sternal closure are the standard approach for cardiac surgery. An incomplete repair associated with chest wall motion, especially in the presence of predisposing factors, can lead to life-threatening deep sternal wound infection, also known as mediastinitis, in 2–5% of cases. Despite current antibiotic and surgical treatments, mediastinitis is associated with a 10–40% mortality rate and a significant increase in morbidity and hospital stay. High mortality and difficult treatment appear to be due to bacterial biofilm, a self-produced extracellular polymeric product that incorporates host tissue and is responsible for the failure of immune defenses and standard antimicrobial therapies. Nanostructures are an effective strategy to enhance the healing process, as they establish a favorable environment for the neosynthesis of the extracellular matrix, supporting tissue development. Synthetic polymers have been proven to exhibit suitable biodegradable and mechanical properties, and their biofunctionalization to enhance cell attachment and interaction with the extracellular matrix is being widely investigated. The use of antibiotic treatments suspended in poly-D,L-lactide and polyethylene oxide and electrospun into nanofibers, or in sponges, has been shown to inhibit bacterial biofilm production. Additionally, growth factors can be incorporated into 3D bioresorbable scaffolds with the aim of constituting a structural and biological framework to organize and expedite the healing process. Therefore, these combined approaches may change the treatment of mediastinitis in the near future. [ABSTRACT FROM AUTHOR]

OBIETTIVI I Centri di Radioterapia UPMC San Pietro FBF di Roma (CC#1) e UPMC Villa Maria di Mirabella Eclano (CC#2) hanno condotto uno studio con l’obiettivo di analizzare le variazioni avvenute durante la pandemia sui workload e i workflow di reparto. È stato, inoltre, ricercato l’eventuale nesso tra queste e l’introduzione di nuove procedure per la prevenzione e il contenimento del contagio da Covid-19. MATERIALI E METODI I dati utilizzati sono stati ricavati da reports presenti nel sistema ARIA (V.15.1 Varian Medical System, CA, Palo Alto, USA). Per esaminare i workload è stato utilizzato il Downtime, un indicatore che quantifica direttamente l'inattività del reparto, ricavato dal rapporto tra il tempo di standby giornaliero dei LINAC (TrueBeam STx®, Varian Medical System, CA, Palo Alto, USA) e la media di trattamenti giornalieri effettuati. Per esaminare workflow ed eventuali ritardi tra le attività, sono stati valutati gli intervalli di tempo tra una terapia e la successiva (Intervalli di terapia). RISULTATI Il Downtime nel CC#1 ha subìto un leggero aumento del valore medio dal 3.1% del 2019 al 3.8% del 2020, tuttavia l’analisi mensile mostra consistenti picchi di riduzione (marzo-aprile-maggio) e di incremento (novembre-dicembre). Per il CC#2 il trend del Downtime nel 2020 è abbastanza regolare (valore medio del 3,3%), con un incremento durante la prima ondata della pandemia. Gli Intervalli di terapia di “5-10 min” nel CC#1, analizzati confrontando il trimestre marzo-aprile-maggio 2020 col 2019, risultano maggiori per i primi mesi e ridotti a maggio; quelli di “10-15” min risultano stabili; quelli “>20 min” sono leggermente aumentati a marzo 2020. Per il CC#2 il trend nel 2020 decresce nei mesi di maggiore emergenza sanitaria e incrementa nei mesi estivi. CONCLUSIONI Il fatto che i trend degli indicatori utilizzati abbiano dei picchi esclusivamente in corrispondenza dei periodi di maggiore emergenza sanitaria, è indice di un certo impatto – sia in termini di workload che di workflow – della pandemia, ma anche della capacità del personale di adattarsi in breve tempo alle nuove procedure da eseguire, senza inficiare sul rendimento generale dei Centri.

INTRODUZIONE I successi della moderna radioterapia sono spesso guidati da elevati standard di qualità. Questo studio punta a valutare percorsi di cura automatizzati e personalizzabili per definire nuovi indicatori di qualità quantitativi in radioterapia oncologica, al fine di ottimizzare l’efficienza e la sicurezza dei servizi erogati. MATERIALI E METODI Per questo studio, sono stati coinvolti due centri oncologici internazionali appartenenti allo stesso network (UPMC San Pietro di Roma (CC#1) ed UPMC Villa Maria di Mirabella Eclano (CC#2)), entrambi dotati di un acceleratore lineare ed uno scanner TC. L’analisi dei dati ha preso in considerazione il periodo compreso tra gennaio 2019 e dicembre 2019. Seguendo il workflow delle attività di entrambi i centri, nello sviluppo della cartella clinica elettronica, sono stati creati dei modelli automatizzati adattabili alle differenti tipologie di trattamento, e quindi personalizzabili per ciascun paziente: utilizzando il software ARIA v15 (Varian Medical System, CA, Palo Alto, USA), abbiamo convertito tutti gli step del percorso di cura del paziente in moduli che hanno la possibilità di essere collegati per andare a formare il processo di cura del paziente stesso. I “Carepaths” infatti, rappresentano dei moduli in un processo automatizzato all’interno dei quali sono presenti attività (“task”) e appuntamenti (“appointment”), aventi dei tempi di esecuzione ben definiti entro i quali devono essere completati elettronicamente. Per avere un riferimento in merito alle prestazioni in termini quantitativi riguardo i centri, abbiamo focalizzato l’attenzione su tre fattori: percentuale di attività completate in relazione al tempo di esecuzione, giorni trascorsi e compliance dello staff con l’utilizzo di questo sistema automatizzato. RISULTATI La misurazione delle attività completate consente di definire la conformità del processo automatizzato ai percorsi assistenziali, mentre le tempistiche del completamento delle attività consentono di determinare le aree di miglioramento. In questo studio, i "Timeout" vengono sempre eseguiti con puntualità, ma i risultati su "Peer Review" e "Treatment Approval" non sono soddisfacenti. Un tempo di ritardo definito ci consente di tenere traccia delle attività in modo preciso, e l’analisi di questi valori in entrambi i centri oncologici presi in analisi, ci consente di capire se il tempo di consegna per le attività è appropriato o se c'è un margine di miglioramento. Tutti i dati osservati mostrano che la percentuale di attività completate in entrambi i centri oncologici e i tempi trascorsi per il completamento delle stesse sono differenti. CONCLUSIONI I percorsi assistenziali automatizzati, con i relativi moduli, possono essere uno strumento valido ed efficiente per misurare le attività in un reparto di radioterapia oncologica, soprattutto se utilizzati come strumento di miglioramento continuo della qualità delle prestazioni.

GOALS The Advanced Radiotherapy Centers of UPMC San Pietro FBF of Rome (CC#1) and UPMC Villa Maria of Mirabella Eclano (CC#2) conducted a study to review variations in department workloads and workflows experienced during the pandemic. The potential relation between these variations and the new procedures introduced to prevent and contain the COVID-19 infection was also studied. MATERIALS AND METHODS The data used were obtained from reports present in the ARIA® system (v. 15.1 Varian Medical Systems, Palo Alto, CA, U.S.A.). To examine the workloads was used the Downtime, an indicator that directly quantifies the inactivity of the department, derived from the ratio between the daily stand-by time of the LINACs (TrueBeam STx®, Varian Medical Systems, Palo Alto, CA, U.S.A.) and the mean number of treatments performed every day. In order to examine the workflows and possible delays, we measured the time between the treatments ("Therapy intervals"). RESULTS The Downtime average at CC#1 slightly increased from 3.1% in 2019 to 3.8% in 2020. However, the monthly analysis shows significant reduction (March-April-May) and increase (November-December) peaks. At CC#2, the 2020 Downtime trend was fairly consistent (average value: 3.3%), with an increase during the first wave of the pandemic. The "5-10 min" Therapy intervals at CC#1, reviewed comparing the March-April-May 2020 quarter with 2019, were higher in the first months and lower in May; the "10-15 min" intervals were stable; the ">20 min" intervals slightly increased in March 2020. At CC#2, the trend in 2020 decreased during the months of higher health care emergency and increased during the summer months. CONCLUSIONS The fact that the trends of the indicators show peaks only during the periods of major health care emergency indicates an impact of the pandemic, both on the workload and on the workflow. However, they also highlight the staff's ability to rapidly adapt to the new procedures, without affecting the overall performance of the both centers.

INTRODUCTION High quality standards are often the key for success in modern radiotherapy. The goal of this study is to assess automated and targeted care paths to define new quantitative quality indicators in radiation oncology and optimize the efficiency and safety of the services provided. MATERIALS AND METHODS For this study, two international cancer centers part of the same network (UPMC San Pietro in Rome (CC#1) and UPMC Villa Maria in Mirabella Eclano (CC#2)) have been involved, both equipped with a linear accelerator and a CT scan. The data reviewed refers to a period between January 2019 and December 2019. Following the workflow of both centers during electronic medical record data input, we created automated models adaptable to the different types of treatment and customizable for each patient. Using the ARIA v15 (Varian Medical System, CA, Palo Alto, USA) software, we converted the various steps of the care path in modules that can be connected to create the patient's care process. Care paths are therefore modules of an automated process consisting of tasks and appointments, with well-defined execution times within which they must be completed electronically. To obtain quantitative information on both centers we focused on three factors: tasks completed in relation to their execution times, number of days, and staff compliance with the automated system. RESULTS Measuring the completed tasks allows to define the compliance of the automated process with the care paths, whereas the time required to complete the tasks helps identify areas for improvement. Within this study timeouts are always performed on time, but peer review and treatment approval outcomes are unsatisfactory. A defined delay time allows to keep track of tasks in a precise manner and reviewing these values in both centers helps us understand if the task delivery time is appropriate or if there is room for improvement. All analyzed data show that the percentage of tasks completed in both centers and the completion times are different. CONCLUSIONS Automated care paths and their modules can be an effective and efficient tool to measure the tasks performed by a radiation oncology unit, especially if they are used as a tool of continuous quality improvement.

Copyright of Tracce Urbane: Rivista Italiana Transdisciplinare di Studi Urbani is the property of Sapienza University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The high incidence of atrial fibrillation (AFib) following cardiac surgery (postoperative atrial fibrillation, POAF) relies on specific surgical features. However, in the setting of POAF, the role of the microbiome in the modulation of cardiac fibrosis is still not clear. This study aimed to analyze the effect of the microbiome and its main metabolic product (trimethylamine-N-oxide, TMAO) in the fibrosis of myocardial tissue, to investigate its role in POAF. Patients undergoing elective cardiac surgery with cardiopulmonary bypass, central atrio-caval cannulation and no history of AFib, were included. A fragment of the right atrium was analyzed for qualitative and mRNA-quantitative evaluation. A preoperative blood sample was analyzed with enzyme-linked immunosorbent assay (ELISA). A total of 100 patients have been included, with POAF occurring in 38%. Histologically, a higher degree of fibrosis, angiogenesis and inflammation has been observed in POAF. Quantitative evaluation showed increased mRNA expression of collagen-1, collagen-3, fibronectin, and transforming growth factor beta (TGFb) in the POAF group. ELISA analysis showed higher levels of TMAO, lipopolysaccharide and TGFb in POAF, with similar levels of sP-selectin and zonulin. TMAO ≥ 61.8 ng/mL (odds ratio, OR 2.88 [1.35–6.16], p = 0.006), preoperative hemoglobin < 13.1 g/dL (OR 2.37 [1.07–5.24], p = 0.033) and impaired right ventricular function (OR 2.38 [1.17–4.83], p = 0.017) were independent predictors of POAF. Also, TMAO was significantly associated with POAF by means of increased fibrosis. Gut microbiome product TMAO is crucial for myocardial fibrosis, which is a key factor for POAF. Patients in preoperative sinus rhythm who will develop POAF have increased genetic expression of pro-fibrotic genes and enhanced fibrosis in histological staining. Elevated TMAO level (≥61.8 ng/mL) is an independent risk factor for POAF. [ABSTRACT FROM AUTHOR]

Despite cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) being the current gold standard for non-invasive myocardial characterization and fibrosis quantification, its accessibility is limited, particularly in acute settings and in certain patient populations with contraindications to magnetic resonance imaging. Late iodine enhancement (LIE) in computed tomography (CT) imaging has emerged as a potential alternative, capitalizing on the similarities in the contrast kinetics between gadolinium and iodinated contrast agents. Studies have investigated LIE-CT's effectiveness in myocardial infarction (MI) detection, revealing promising outcomes alongside some disparities compared to LGE-CMR. LIE-CT also proves beneficial in diagnosing non-ischemic heart diseases such as myocarditis, hypertrophic cardiomyopathy, and sarcoidosis. While LIE-CT demonstrates good accuracy in detecting certain myocardial pathologies, including acute MI and chronic fibrotic changes, it has limitations, such as the inability to detect diffuse myocardial enhancement. Nonetheless, thanks to the availability of optimized protocols with minimal radiation doses and contrast medium administration, integrating LIE-CT into cardiac CT protocols could enhance its clinical utility, particularly in acute settings, providing valuable prognostic and management insights across a spectrum of cardiac ischemic and non-ischemic conditions. [ABSTRACT FROM AUTHOR]

Peripheral arterial disease (PAD) is an increasingly pathological condition that commonly affects the femoropopliteal arteries. The current fashionable treatment is percutaneous transluminal angioplasty (PTA), often with stenting. However, the in-stent restenosis (ISR) rate after the stenting of the femoropopliteal (FP) district remains high. Many techniques have been proposed for the treatment of femoropopliteal ISR, such as intravascular brachytherapy, laser atherectomy, second stenting and drug-coated balloons angioplasty (DCB). DCB showed a significantly lower rate of restenosis and target lesions revascularization (TLR) compared to conventional PTA. However, further studies and multi-center RCTs with dedicated long-term follow-up are needed to verify the true efficiency of this approach. Nowadays, the correlation between PAD and inflammation biomarkers is well known. Multiple studies have shown that proinflammatory markers (such as C-reactive proteins) and the high plasma levels of microRNA could predict the outcomes after stent placement. In particular, circulating microRNA-320a, microRNA-3937, microRNA-642a-3p and microRNA-572 appear to hold promise in diagnosing ISR in patients with PAD, but also as predictors of stent patency. This narrative review intends to summarize the current knowledge on the value of circulating biomarkers as predictors of ISR and to foster the scientific debate on the advantages of using DCB in the treatment of ISR in the FP district.

INTRODUZIONE La radioterapia adattiva è una pratica clinica consolidata, soprattutto in alcuni tipi di trattamenti soggetti a rapidi cambiamenti a causa della presenza di organi a rischio (OAR) che influenzano il movimento del target. Il processo di adattabilità del trattamento al singolo caso combina strumenti come l’acquisizione di immagini pretrattamento, la valutazione clinica del reale bisogno di adattamento, la pianificazione del nuovo trattamento e la garanzia della qualità finale di questo processo. Le moderne apparecchiature di radioterapia permettono di attuare diverse strategie in modalità online o offline. Lo scopo di questo lavoro è definire una procedura di ART offline capace di garantire un corretto replanning nei trattamenti prostatici secondo parametri di valutazione oggettivi. MATERIALI E METODI Il protocollo di simulazione e trattamento dei pazienti prostatici prevede lo svuotamento dell’ampolla rettale (quando ritenuto clinicamente necessario) e il riempimento della vescica previa assunzione di un predeterminato volume d’acqua da parte del paziente e un’attesa utile al defluire dell’urina nella stessa. Affinchè le condizioni della simulazione vengano rispettate anche durante il trattamento, si effettuano controlli giornalieri tramite immagini CBCT. Il protocollo IGRT prevede la fusione rigida delle immagini acquisite nel bunker con quelle derivate dalla TC di simulazione. Per lo studio sono stati selezionati 23 pazienti affetti da adenocarcinoma della prostata (medio e basso rischio) sottoposti a 40 frazioni con una dose giornaliera di 2Gy/die (80 Gy). I pazienti sono stati trattati in posizione supina, le braccia sopra il torace e le gambe su un sistema di immobilizzazione (Prostep Klarity). Il workflow ART offline ha richiesto l’uso delle verifiche pretrattamento, la registrazione con le immagini della simulazione e il calcolo delle variazioni di riempimento di retto e vescica. L’analisi è stata effettuata tramite software Velocity v4.0 (Varian Medical System). Alla fine del procedimento automatico generato dal software Velocity, si sono rese disponibili delle immagini adattate tra TC e CBCT chiamate aCT (adaptive CT). La contornazione degli organi di interesse sulle aCT è avvenuta in maniera automatica. Per permettere un confronto quantitativo efficace sono stati presi in considerazione il coefficiente di DICE e indici statistici di dispersione e distribuzione. RISULTATI La dispersione dei valori percentuali relativi al volume del retto risulta maggiore nei casi afferenti al gruppo A. La distribuzione delle percentuali di cambiamento del retto nel gruppo A ha avuto come valore IQR = 5,55% (Q1=-4,06%; Q2= -1,13%; Q3= 1,49%) mentre nel gruppo B IQR= 4,24% (Q1= -2,50%; Q2= 2,09%; Q3= 1,75%). La dispersione dei valori percentuali relativi al volume della vescica risulta maggiore nei casi afferenti al gruppo A. La distribuzione delle percentuali di cambiamento della vescica nel gruppo A ha avuto come valore IQR = 9,65% (Q1=-7,34%; Q2= -2,32%; Q3= 2,31%) mentre nel gruppo B IQR= 12,13% (Q1= -7,18%; Q2= -1,56%; Q3= 4,96%). Il coefficiente di DICE nel gruppo A ha evidenziato una sovrapponibilità giornaliera della vescica in media pari a 0,91 ± 0,07. Nel gruppo B, la stessa sovrapponibilità ha raggiunto il valore medio di 0,92 ± 0,06. Il volume del retto, nel gruppo A ha avuto coefficiente di Dice medio pari a 0,87 ± 0,10, mentre nel gruppo B la stessa sovrapponibilità ha raggiunto un valore medio di 0,89 ± 0,09. CONCLUSIONI Dai risultati ottenuti si evince che il valore del coefficiente DICE è un indice utile per stabilire se la localizzazione dei volumi è sovrapponibile a quella della TC di simulazione. Andrebbe perciò verificato, in fase di attuazione di un protocollo di ART Offline, per le prime cinque frazioni di terapia, ritenute nella nostra pratica clinica un tempo utile affinché si possa stimare velocemente l’effettiva necessità di ripianificazione. Poiché questo indice non prende in considerazione i volumi ma solo la loro sovrapponibilità geometrica, in caso di adozione di un workflow di radioterapia adattiva offline, si consiglia di effettuare anche un controllo delle medie dei volumi degli OAR, soprattutto per quel che concerne la vescica, più soggetta a cambiamenti di questo tipo che di variazioni della localizzazione spaziale.

INTRODUCTION Adaptive radiation therapy (ART) is an established clinical practice, especially for treatments requiring rapid changes due to organs-at-risk (OAR) that might influence the target position. Adapting the procedure to a case-to-case basis involves combining different tools, such as scanning pretreatment images, clinically assessing the need for adaptation, replanning a new treatment, and guaranteeing the final quality of the entire process. Modern radiation therapy equipment enables multiple optimization strategies, both online and offline. The primary aim of this study is to define an offline ART procedure to correct the replanning of prostate treatments according to objective evaluation criteria. MATERIALS AND METHOS The simulation and treatment protocols for prostate patients involve emptying the rectum when needed and ensuring that the bladder is filled with adequate urine volume. To comply with the simulation conditions during the treatment, daily cone-beam computed tomography (CBCT) images are acquired and controlled on a daily basis. The image-guided radiation therapy (IGRT) protocol provides a rigid fusion of the images acquired in the bunker with those collected from the simulation CT. For this study, we selected 23 patients with prostate adenocarcinoma (medium and low risk) treated with 40 fractions, with a daily dose of 2 Gy (80 Gy) at UPMC San Pietro FBF Advanced Radiotherapy Center in Rome, from October 2018 to May 2019. During the treatment, patients were placed in the supine position, with their arms on their chest and legs restrained by an immobilization device (ProSTEP™ Klarity). The offline ART workflow required pretreatment verifications, registration with the simulation images, and calculation of the rectum and bladder filling variations. The analysis was performed using the Velocity v4.0 software (Varian Medical System, Palo Alto CA). At the end of the Velocity-based software-automated process, the CT and CBCT images were used to generate an aCT (adaptive CT). Organs of interest were contoured on the aCT automatically. The Dice coefficient and the dispersion and distribution statistical indexes were taken into consideration to ensure accurate qualitative comparison. RESULTS Percentage dispersion of the rectum volume values was higher in Group A. Distribution of rectum volume variation percentage in Group A had an IQR = 5,55% (Q1=-4,06%; Q2= -1,13%; Q3= 1,49%), whereas Group B had an IQR= 4,24% (Q1= -2,50%; Q2= 2,09%; Q3= 1,75%). Percentage dispersion of the bladder volume values was higher in Group A. Distribution of bladder volume variation percentage in Group A had an IQR = 9,65% (Q1=-7,34%; Q2= -2,32%; Q3= 2,31%), whereas Group B had an IQR = 12,13% (Q1= -7,18%; Q2= -1,56%; Q3= 4,96%). The Dice coefficient in Group A showed an average daily superimposition of the bladder of 0,91 ± 0,07, whereas in Group B this was 0,87 ± 0,10. In both groups, the rectum volume had an average Dice coefficient of 0,89 ± 0,09. CONCLUSIONS The results show that the Dice coefficient can be useful to establish whether the volume localization can be superimposed to the simulation CT. Based on our practice, we suggest that the offline ART protocol should be verified over the first five therapy fractions, representing an adequate window to assess the need for replanning. Because this index does not consider the volumes but only the possibility of their geometric superimposition, we recommend checking the mean OAR volumes when using an offline ART workflow. This is particularly important for the bladder, which is more susceptible to this kind of change than variations in its localization.

L’articolo presenta l’opera dell’artista beninese Georges Adéagbo, conosciuto per la realizzazione di complessi assemblaggi di oggetti recuperati, testi, sculture, segni eterogenei di cultura colta e popolare, immagini del mondo dei mass-media, elementi della tradizione orale, cultuale e letteraria di tempi e luoghi diversi che esemplificano la relazione spesso controversa tra conservazione e memoria. L’inclinazione archivistica include il ricorso a fonti e frammenti etnografici, fornendo una prospettiva decentrata che, interrogando le narrative dominanti e di senso comune, conduce a una riflessione su temi politici globali. L’opera di Adéagbo si muove nell'area estesa nel contatto interculturale in cui arte e antropologia mantengono una relazione stretta e complessa. Prendendo in esame questa relazione l’articolo sottolinea il ruolo dell’artista, delle istituzioni museali, dei critici e dei curatori nella produzione del valore e nelle strategie di consumo della differenza in un contesto culturale globale.

Rubus spp. (wild raspberries) is one of genera belongs to Rosaceae, also distributed in the mountain forest of Indonesia. It has a high potency to be cultivated plant. Although, some of the potential of Rubus has already known, information of about fruit nutrients of species that distribute in the mountain forest of Indonesia are not known yet. This study was aimed to determine the fruit nutrients of five species of wild raspberries that was collected in Cibodas Botanical Garden. The results of our experiments demonstrate that the fruits nutrients contents varied among five species of wild raspberries from Indonesian mountain's forests. Rubus fraxinifolius has the highest content of sugar (5.05 g sugar per 100 g fruits) compared to Rubus rosifolius, Rubus chrysophyllus, Rubus lineatus and raspberry. During the ripening and ripe period, there were a different value of vitamin C and iron contents. The highest vitamin C of R. fraxinifolius (83.65 mg/100 gram) on the ripening fruit stage II. On the other hand, the highest vitamin C of R. rosifolius (54.30 mg/100 gram) found on the stage of ripe fruit.

Copyright of Journal of Syntax Literate is the property of Ridwan Institute and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)