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Background Depth-of-anesthesia monitoring is often utilized for patients receiving xenon anesthesia. Processed electroencephalogram (EEG) depth-of-anesthesia monitoring relies to a significant extent on frequency domain analysis of the frontal EEG, and there is evidence that the spectral features observed under anesthesia vary significantly between anesthetic agents. The spectral features of the EEG during xenon anesthesia for a surgical procedure have not previously been described. Methods Twenty-four participants scheduled for general anesthesia for lithotripsy were randomized to receive either xenon anesthesia or sevoflurane anesthesia. Frontal EEG recordings were obtained from each participant via the Brain Anesthesia Response Monitor (BARM). Twenty-two EEG recordings were suitable for analysis: 11 in participants who received sevoflurane and 11 in participants who received xenon. Spectrograms for the duration of the anesthetic episode were produced for each participant. Group-level spectral analysis was calculated for two 30-second EEG epochs: one recorded at awake baseline and the other during maintenance anesthesia. A linear mixed-effects model was utilized to compare the changes in 5 frequency bands from baseline to maintenance between the 2 groups. Results The spectrograms of sevoflurane participants illustrate an increase in frontal delta (0.5-4 Hz), theta (4-8 Hz), and alpha (8-13 Hz) band power during maintenance anesthesia. In contrast, spectrograms of the xenon participants did not illustrate an increase in alpha power. The results of the linear mixed-effects model indicate that both agents were associated with a significant increase in delta power from baseline to maintenance. There was no significant difference in the magnitude of this increase observed between the agents. In contrast, sevoflurane anesthesia was associated with significantly greater absolute power in the theta, alpha, and beta (13-30 Hz) bands when compared to xenon. In terms of relative power, xenon was associated with a significant increase in delta power compared to sevoflurane, while sevoflurane was associated with greater increases in relative theta, alpha, and beta power. Conclusions Both xenon anesthesia and sevoflurane anesthesia were associated with significant increases in delta power. Sevoflurane anesthesia was also associated with increases in theta, alpha, and beta power, while xenon anesthesia was associated with greater consolidation of power in the delta band. Xenon anesthesia and sevoflurane anesthesia are associated with distinct spectral features. These findings suggest that appropriate depth-of-anesthesia monitoring may require the development of agent-specific spectral measures of unconsciousness.

BackgroundThis unblinded randomised crossover study compares two endotracheal tube introducers (ETIs): the FROVA and the “Flexible Tip Bougie” (FTB), in an airway manikin mimicking difficult intubation with a percentage of glottic opening view of 30%. Participants were Emergency Medicine and Anaesthesia trainees with recent experience of less than twenty patient intubations. The primary outcome was time to intubation, further divided into time taken to pass the ETI and time to railroad the endotracheal tube (ETT) over the ETI. The secondary outcome was the difficulty of intubation.ResultsThe median total time to ETT placement was significantly shorter with the FTB (37.5 s) compared with the FROVA ETI (63.0 s),P= 0.0006. The median difficulty reported (scores 0–10 with 0 being no difficulty) with the FTB was 2 compared with 5 for the FROVA,P< 0.0001.ConclusionsThe FTB enabled significantly faster and easier placement of the endotracheal tube compared with the FROVA in inexperienced hands intubating a difficult intubation manikin.

Background Investigations of the electrophysiology of gaseous anesthetics xenon and nitrous oxide are limited revealing inconsistent frequency-dependent alterations in spectral power and functional connectivity. Here, the authors describe the effects of sedative, equivalent, stepwise levels of xenon and nitrous oxide administration on oscillatory source power using a crossover design to investigate shared and disparate mechanisms of gaseous xenon and nitrous oxide anesthesia. Methods Twenty-one healthy males underwent simultaneous magnetoencephalography and electroencephalography recordings. In separate sessions, sedative, equivalent subanesthetic doses of gaseous anesthetic agents nitrous oxide and xenon (0.25, 0.50, and 0.75 equivalent minimum alveolar concentration–awake [MACawake]) and 1.30 MACawake xenon (for loss of responsiveness) were administered. Source power in various frequency bands were computed and statistically assessed relative to a conscious/pre-gas baseline. Results Observed changes in spectral-band power (P < 0.005) were found to depend not only on the gas delivered, but also on the recording modality. While xenon was found to increase low-frequency band power only at loss of responsiveness in both source-reconstructed magnetoencephalographic (delta, 208.3%, 95% CI [135.7, 281.0%]; theta, 107.4%, 95% CI [63.5, 151.4%]) and electroencephalographic recordings (delta, 260.3%, 95% CI [225.7, 294.9%]; theta, 116.3%, 95% CI [72.6, 160.0%]), nitrous oxide only produced significant magnetoencephalographic high-frequency band increases (low gamma, 46.3%, 95% CI [34.6, 57.9%]; high gamma, 45.7%, 95% CI [34.5, 56.8%]). Nitrous oxide—not xenon—produced consistent topologic (frontal) magnetoencephalographic reductions in alpha power at 0.75 MACawake doses (44.4%; 95% CI [−50.1, −38.6%]), whereas electroencephalographically nitrous oxide produced maximal reductions in alpha power at submaximal levels (0.50 MACawake, −44.0%; 95% CI [−48.1,−40.0%]). Conclusions Electromagnetic source-level imaging revealed widespread power changes in xenon and nitrous oxide anesthesia, but failed to reveal clear universal features of action for these two gaseous anesthetics. Magnetoencephalographic and electroencephalographic power changes showed notable differences which will need to be taken into account to ensure the accurate monitoring of brain state during anaesthesia. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

We present a case where awake videolaryngoscopy (VL) was used, along with a flexible-tipped bougie to allow endotracheal intubation in a challenging airway. The patient presented for resection of a large left-sided parapharyngeal mass. Examination and imaging led to concerns about a potentially difficult airway. Awake VL was used to assess the grade of intubation before induction of anesthesia. Once the patient was anesthetized, a flexible-tipped bougie was used to navigate past the mass, allowing successful intubation. This case report demonstrates the combination of these two technologies to provide effective airway management in the potentially difficult airway.

A patient with a base of tongue tumor was judged to be safe to intubate under general anesthesia, with a new flexible tip "bougie." This enabled rapid and easy navigation around the distorted anatomy caused by the tumor. The bougie's tip can be flexed or extended by activating a slide on the shaft and was intended for use with the hyperangulated blade of a videolaryngoscope.

B. AbstractBackground.Despite their intriguing nature, investigations of the neurophysiology of N-methyl-D-aspartate (NMDA)-antagonists Xenon (Xe) and nitrous oxide (N2O) are limited and have revealed inconsistent frequency-dependent alterations, in spectral power and functional connectivity. Discrepancies are likely due to using low resolution electroencephalography restricted to sensor level changes, concomitant anesthetic agent administration and dosage. Our intention was to describe the effects of equivalent stepwise levels of Xe and N2O administration on oscillatory source power using a crossover design, to explore universal mechanisms of NMDA-based anesthesia.Methods.22 healthy males participated in a study of simultaneous magnetoencephalography and electroencephalography recordings. In separate sessions, equivalent subanesthetic doses of gaseous anesthetic agents N2O and Xe (0.25, 0.50, 0.75 equi MAC-awake) and 1.30 MAC-awake Xe (for Loss of Responsiveness) were administered. Source power in various frequency bands was computed and statistically assessed relative to a conscious baseline.Results.Delta (l-4Hz) and theta (4-8Hz) band power was significantly increased at the highest Xe concentration (42%, 1.30 MAC-awake) relative to baseline for both magnetoencephalography and electroencephalography source power (p2O administration, and shown to be stronger than equivalent Xe dosage reductions (p=0.005). Higher frequency activity increases were observed in magnetoencephalographic but not encephalographic signals for N2O alone with occipital low gamma (30-49Hz) and widespread high gamma (51-99Hz) rise in source power.Conclusions.Magnetoencephalography source imaging revealed unequivocal and widespread power changes in dissociative anesthesia, which were divergent to source electroencephalography. Loss of Responsiveness anesthesia at 42% Xe (1.30 MAC-awake) demonstrated, similar to inductive agents, low frequency power increases in frontal delta and global theta. N2O sedation yielded a rise in high frequency power in the gamma range which was primarily occipital for lower gamma bandwidth (3049 Hz) and substantially decreased alpha power, particularly in frontal regions.Clinical trial number and Registry URLNot applicable.Prior PresentationsPelentritou Andria, Kuhlmann Levin; Lee Heonsoo; Cormack John; Mcguigan Steven; Woods Will; Sleigh Jamie; Lee UnCheol; Muthukumaraswamy Suresh; Liley David. Searching For Universal Cortical Power Changes Linked To Anesthetic Induced Reductions In Consciousness. The Science of Consciousness April 4th2018. Tucson, Arizona, USA.Summary StatementNot applicable.

Anesthesia arguably provides one of the only systematic ways to study the neural correlates of global consciousness/unconsciousness. However to date most neuroimaging or neurophysiological investigations in humans have been confined to the study of γ-Amino-Butyric-Acid-(GABA)-receptor-agonist-based anesthetics, while the effects of dissociative N-Methyl-D-Aspartate-(NMDA)-receptor-antagonist-based anesthetics ketamine, nitrous oxide (N(2)O) and xenon (Xe) are largely unknown. This paper describes the methods underlying the simultaneous recording of magnetoencephalography (MEG) and electroencephalography (EEG) from healthy males during inhalation of the gaseous anesthetic agents N(2)O and Xe. Combining MEG and EEG data enables the assessment of electromagnetic brain activity during anesthesia at high temporal, and moderate spatial, resolution. Here we describe a detailed protocol, refined over multiple recording sessions, that includes subject recruitment, anesthesia equipment setup in the MEG scanner room, data collection and basic data analysis. In this protocol each participant is exposed to varying levels of Xe and N(2)O in a repeated measures cross-over design. Following relevant baseline recordings participants are exposed to step-wise increasing inspired concentrations of Xe and N(2)O of 8, 16, 24 and 42%, and 16, 32 and 47% respectively, during which their level of responsiveness is tracked with an auditory continuous performance task (aCPT). Results are presented for a number of recordings to highlight the sensor-level properties of the raw data, the spectral topography, the minimization of head movements, and the unequivocal level dependent effects on the auditory evoked responses. This paradigm describes a general approach to the recording of electromagnetic signals associated with the action of different kinds of gaseous anesthetics, which can be readily adapted to be used with volatile and intravenous anesthetic agents. It is expected that the method outlined can contribute to the understanding of the macro-scale mechanisms of anesthesia by enabling methodological extensions involving source space imaging and functional network analysis.

Elastomeric infusion pumps are used to deliver local anesthetic after surgery.[1][1],[2][2] Simplicity and portability are advantages over electronic pumps.[3][3] Such infusions can be continued at home, but unlike electronic pumps, the precise flow rates may be difficult to monitor.[4][4]

• Provides a 3D map to check the pathway of the access needle and its planned trajectory.

UNLABELLED The aim of this study was to compare hemodynamic responses to intubation and pin head-holder application in two groups of neurosurgical patients given oral clonidine (3 microg/kg) or oral temazepam (10-20 mg) 90 min before the induction of anesthesia. Fifty patients undergoing elective craniotomy were randomized to either group. Anesthesia was induced with i.v. propofol 1500 mg/h, fentanyl 4 microg/kg, vecuronium 0.15 mg/kg, and lidocaine 1.5 mg/kg and was maintained with propofol 6 mg x kg(-1) x h(-1). Mean arterial blood pressure (MAP) and heart rate were recorded before the induction of anesthesia and before and after intubation and application of the pin head holder. Interventions required to maintain hemodynamic stability were compared between groups. Preinduction sedation scores and MAP values were similar between groups. MAP was significantly lower (P = 0.031) in the clonidine group after pin head-holder application. Interventions to stabilize MAP were not significantly different between groups (P = 0.11). We conclude that clonidine is effective in reducing the MAP increase with pin head-holder application in patients undergoing craniotomy. IMPLICATIONS In this study, we investigated an approach to the prevention of increased blood pressure often seen during the early part of anesthesia for brain surgery. Oral clonidine was effective in reducing the mean arterial blood pressure increase resulting from pin head-holder application. Clonidine, a blood pressure-reducing drug, was given to 25 patients before anesthesia. Their blood pressure measurements were then compared with those of 25 patients not given clonidine.

SummarySamples of fruit from machine harvested red raspberry were examined for insect contaminants. Earwigs (Dermaptera: Forficulidae), aphids (Homoptera: Aphidae), and spiders (Arachnida: Araneae) were the most common contaminants. Earwigs were approximately twice as numerous in a single nocturnal sample than in equivalent daytime samples. Application of the short harvest interval synthetic pyrethroid insecticide, deltamethrin, close to harvest decreased the overall number of arthropod contaminants, but did not significantly decrease the numbers of earwigs or spiders. The role of earwigs, spiders and other arthropod fruit contaminants in the red raspberry crop, and engineering improvements to raspberry harvesters to reduce the level of contamination are discussed.

Background Pain after craniotomy is often under-treated. Opiates carry distinct disadvantages. Non-steroidal anti-inflammatory drugs have an anti-platelet action and carry a bleeding risk. Cyclo-oxygenase 2 inhibitors such as parecoxib are not associated with a bleeding risk and would be welcome analgesics if shown to be effective. Methods In a prospective double-blind, randomized, placebo-controlled study, we investigated the analgesic effect of a single dose of parecoxib 40 mg given at dural closure in 82 patients undergoing elective craniotomies. Remifentanil was used intraoperatively, and i.v. morphine was titrated to the requirement in the post-anaesthetic unit. On the ward, i.m. morphine 5 mg as required and regular acetaminophen was prescribed. Morphine use and visual analogue pain scores were recorded at 1, 6, 12, and 24 h after surgery. Results Parecoxib reduced pain scores at 6 h and morphine use at 6 and 12 h after operation. However, overall, it had only minimal impact on postoperative analgesia. We found a wide variability in analgesic requirements where 11% of patients required no opioids and 16% required more than 15 mg i.v. morphine 1 h after the surgery. Conclusions We found only limited evidence to support parecoxib as an analgesic after craniotomy.

Purpose: To calculate the effect of lack of backscatter from air and attenuation of bone on dose distributions in brachytherapy surface treatment of head. Existing treatment planning systems based on TG43 do not account for heterogeneities, and thus may overestimate the dose to the brain. While brachytherapy generally has rapid dose falloff, the dose to the deeper tissues (in this case, the brain) can become significant when treating large curved surfaces. Methods: Applicator geometries representing a range of clinical cases were simulated in MCNP5. An Ir-192 source was modeled using the energy spectrum presented by TG-43. The head phantom was modeled as a 7.5-cm radius water sphere, with a 7 -mm thick skull embedded 5-mm beneath the surface. Dose values were calculated at 20 points inside the head, in which 10 of them were on the central axis and the other 10 on the axis connecting the central of the phantom with the second to last source from the applicator edge. Results: Central and peripheral dose distributions for a range of applicator and head sizes are presented. The distance along the central axis at which the dose falls to 80% of the prescribed dose (D80) was 7 mm for a representative small applicator and 9 mm for a large applicator. Corresponding D50 and D30 for the same small applicator were 17 mm and 32 mm respectively. D50 and D30 for the larger applicator were 32 mm and 60 mm respectively. These results reflect the slower falloff expected for larger applicators on a curved surface. Conclusion: Our results can provide guidance for clinicians to calculate the dose reduction effect due to bone attenuation and the lack of backscatter from air to estimate the brain dose for the HDR treatments of surface lesions.

Purpose: It has been proposed that routinely used inert radiotherapy (RT) biomaterials (e.g. fiducials, spacers) can be upgraded to smarter ones by coating/loading them with radiosensitizing gold nanoparticles (GNPs), for sustained in-situ release after implantation to enhance RT. In this work, we developed prototypes of such RT biomaterials and investigated the sustained release of GNPs from the biomaterials as a function of design parameters. Methods: Prototype smart biomaterials were produced by incorporating the GNPs in poly(D,L-lactide-co-glycolide) (PLGA) polymer millirods during the gel phase of production. For comparison, commercially available spacers were also coated with a polymer film loaded with fluorescent GNP. Optical/spectroscopy methods were used to monitor in vitro release of GNPs over time as a function of different design parameters: polymer weighting, type, and initial (loading) GNP concentrations. Inductively coupled plasma mass spectrometry was employed to verify GNP release. Results: Results showed that gold nanoparticles could be successfully loaded in the new RT biomaterial prototypes. Burst release of GNPs could be achieved within 1 to 25 days depending on the preparation approach. Burst release was followed by sustained release profile over time. The amount of released GNP increased with increasing loading concentration as expected. The release profiles could also be customized as a function of polymer weighting, or preparation approaches. Conclusion: Considered together, our results highlight potential for the development of next generation RT biomaterials loaded with GNPs customizable to different RT schedules. Such biomaterials could be employed as needed instead of currently used inert spacers/fiducials at no additional inconvenience to patients, to enhance RT.

Purpose: To investigate the hazards in cervical-cancer HDR brachytherapy using a novel hazard-analysis technique, System Theoretic Process Analysis (STPA). The applicability and benefit of STPA to the field of radiation oncology is demonstrated. Methods: We analyzed the tandem and ring HDR procedure through observations, discussions with physicists and physicians, and the use of a previously developed process map. Controllers and their respective control actions were identified and arranged into a hierarchical control model of the system, modeling the workflow from applicator insertion through initiating treatment delivery. We then used the STPA process to identify potentially unsafe control actions. Scenarios were then generated from the identified unsafe control actions and used to develop recommendations for system safety constraints. Results: 10 controllers were identified and included in the final model. From these controllers 32 potentially unsafe control actions were identified, leading to more than 120 potential accident scenarios, including both clinical errors (e.g., using outdated imaging studies for planning), and managerial-based incidents (e.g., unsafe equipment, budget, or staffing decisions). Constraints identified from those scenarios include common themes, such as the need for appropriate feedback to give the controllers an adequate mental model to maintain safe boundaries of operations. As an example, one finding was that the likelihood of the potential accident scenario of the applicator breaking during insertion might be reduced by establishing a feedback loop of equipment-usage metrics and equipment-failure reports to the management controller. Conclusion: The utility of STPA in analyzing system hazards in a clinical brachytherapy system was demonstrated. This technique, rooted in system theory, identified scenarios both technical/clinical and managerial in nature. These results suggest that STPA can be successfully used to analyze safety in brachytherapy and may prove to be an alternative to other hazard analysis techniques.

OBJECTIVES To compare high-frequency jet ventilation (HFJV) with spontaneous ventilation (SV) in general anesthesia for extracorporeal shock wave lithotripsy (ESWL). METHODS We conducted a retrospective review of 91 consecutive patients undergoing either HFJV with a Ben Jet airway or SV with a laryngeal mask airway, comparing the total number of shocks for stone ablation and the time in the post-anesthetic care unit between groups. Stone ablation rates on postoperative x-rays were compared. RESULTS The HFJV group needed significantly fewer shocks for stone ablation (median, 2000 versus 3000, P = 0.0001), and there was no difference in post-anesthetic care unit time. No patient in either group had significant clinical signs of ESWL-related tissue trauma. There was no difference in stone ablation rates on follow-up x-ray (HFJV 77% versus SV 74%). CONCLUSIONS This study supports the use of HFJV as a ventilation mode for ESWL when general anesthesia is chosen. Similar stone fragmentation rates can be achieved with fewer shocks, which may have beneficial effects, such as less pain and nausea, requiring further study.

Background Levobupivacaine is an effective local anaesthetic agent for nerve blockade with less systemic toxicity than racemic bupivacaine. The safety and efficacy of levobupivacaine for scalp blockade during awake craniotomy have not been addressed previously. Methods Serial arterial plasma levobupivacaine concentrations following scalp blockade were measured to 2 h in 10 patients booked for awake craniotomy for epilepsy or tumour surgery. Bilateral scalp blockade providing surgical anaesthesia was achieved with a mean dose of 177 mg (2.5 mg kg−1, range 1.6–3.2 mg kg−1) of levobupivacaine (0.5%, 5 mg ml−1) with epinephrine (5 μg ml−1) added immediately before the block insertion. Results The maximum measured plasma levobupivacaine concentration was 1.58 (0.44) μg ml−1 [mean ( sd )] with a mean time to peak plasma concentration of 12 (4) min. There were no episodes in any of the 10 patients of symptoms or signs suggestive of either CNS or CVS toxicity. Conclusions This study demonstrated a relatively rapid rise of plasma levobupivacaine concentration without evidence of cardiovascular or central nervous system sequelae in a sample population of patients who may be particularly prone to perioperative seizures.

The plasma levels of ropivacaine HCl with 5 mcg/mL epinephrine were measured in 10 patients following scalp blockade for awake craniotomy. A mean dose of 260 mg (3.6 mg/kg) resulted in peak plasma concentrations of 1.5 +/- 0.6 mcg/mL, with a median time to peak plasma concentration of 15 minutes. The pattern of rise of plasma level was similar in all patients and rapid compared with other regional blocks (epidural, intercostal, and axillary brachial plexus block). Despite this rapid rise of plasma level, no signs of cardiovascular or central nervous system toxicity were observed. In this group of patients undergoing awake craniotomy for excision of lesions in the eloquent areas of the cerebral cortex, ropivacaine HCl with epinephrine appeared to be a safe and effective local anesthetic agent in the dosages used.

Poor oral feeding abilities in high-risk infants and children require interdisciplinary assessment and treatment in relation to nutrition, growth, oral feeding skills, behavioural interactions, and family coping. This paper describes the Perinatal Feeding Team's experiences, the format of our assessments, and the frequency of interventions recommended for 33 patients referred over 18 months. The most frequent reasons for assessment were suspected oral sensorimotor dysfunction/disorganization, decreased growth velocity, and feeding skills delay (each 18.3%); aversive reactions to feeding (14%) and significant parental stress around feedings (13.3%). Preassessment tools facilitated identification of relevant feeding problems. The dietitian, occupational therapist, psychologist, and parents played specific roles in providing a comprehensive feeding assessment. Interventions most frequently recommended were nutrition counselling (97%), food texture and feeding skill progression (90.9%), and normalizing sensorimotor function (84.8%). These findings led to the development of the Oral Eating Readiness Assessment List (ORAL(c)). Coordinated care plans are individualized and prioritized with parents. Our collaborative approach to multifaceted feeding difficulties in a follow-up clinic for preterm, high-risk children continues to evolve as we learn more about the needs of these children and their families.

Capture–recapture, also known as dual- or multiple-system estimation (DSE or MSE), is an indirect way of estimating the unknown size N of a population from two (DSE) or more (MSE) incomplete lists of identifiable individuals from the population. With two lists the observed proportion of the individuals in list A who also occur in list B [nAB/nA] is equated to the unknown proportion [nB/N] of the population who occur in list B. It is used in demography (especially the census), ecology, epidemiology, social care, industry, language. The problem is closely related to the classical species problem (how many types?). DSE requires probability sampling, or at least independence and homogeneity. MSE allows dependence between lists or heterogeneity between individuals to be modeled, as can birth, death, and migration. The data can be viewed as a contingency table, giving log linear models and Rasch models if covariates are known. Inference involves model selection or model averaging, while statistical theory is never straightforward because of the nature of the parameter of interest. Asymptotics are often questionable because of small numbers of overlaps between lists. The truth of model assumptions is crucial: their implausibility has led to many unjustified estimates.

We report the findings of a transperineal magnetic resonance image (MRI) guided biopsy of the prostate in a man with increasing prostate specific antigen who was not a candidate for a transrectal ultrasound guided biopsy.Using an open configuration 0.5 Tesla MRI scanner and pelvic coil, a random sextant sample was obtained under real time MRI guidance from the peripheral zone of the prostate gland as well as a single core from each MRI defined lesion. The patient had previously undergone proctocolectomy for ulcerative colitis and, therefore, was not a candidate for transrectal ultrasound guided biopsy. Prior attempts to make the diagnosis of prostate cancer using a transurethral approach were unsuccessful.The random sextant samples contained benign prostatic hyperplasia, whereas Gleason grade 3 + 3 = 6 adenocarcinoma was confirmed in 15% and 25% of the 2 cores obtained from the MRI targeted specimens of 2 defined lesions. The procedure was well tolerated by the patient.Transperineal MRI guided biopsy is a new technique that may be useful in detecting prostate cancer in men with increasing prostate specific antigen who are not candidates for transrectal ultrasound guided biopsy.

A large number of men are diagnosed with early-stage prostate cancer as a result of prostate-specific antigen (PSA) screening. For many of these men, prostatectomy results in long-term freedom from biochemical and clinical failure. Despite limited follow-up data, ultrasound-guided prostate brachytherapy has gained acceptance as a treatment for early-stage prostate cancer, in part due to its favorable side effect profile and brief recovery period. We report on the use of three-dimensional real-time magnetic resonance (MR) guidance, which has several advantages compared with biplanar ultrasound guidance for prostate brachytherapy, including enhanced geometric and dosimetric feedback during the procedure.Median clinical target volume coverage of 96% was achieved using MR guidance. The ability to define more precisely the clinical target volume with MR and the use of real-time assessment of dose distribution resulted in an excellent acute side effect profile. Only 19% of patients required oral alpha1 blockers for postimplant urethritis and 9% required temporary reinsertion of the Foley catheter due to acute urinary obstruction.These results compare favorably to those of ultrasound-guided brachytherapy. Further follow-up is needed to ascertain the impact this technique will have on cancer control and long-term quality of life.

Forty-two patients undergoing inhalation induction with isoflurane in nitrous oxide and oxygen, were allocated randomly to receive either humidified or non-humidified gas. Humidification resulted in a significantly lower incidence of problems during induction (P less than 0.05).

A holographic sundial, to our knowledge the first sundial that does not use a gnomen or shadow-casting device, is designed and demonstrated. The accuracy of the device is measured and analyzed.

SummaryThe interaction between vegetative canes and fruiting canes of red raspberry was examined at sites in Scotland and N. America, using a range of cultivars. In the absence of vegetative canes, yields from fruiting canes were increased; and in the absence of fruiting canes, greater numbers of vegetative canes were produced. Separating the two phases in this way produced a biennial cropping system, in which the yield in the cropping year was considerably higher than in the conventional annual system. Cultivars varied both in the magnitude of their responses and in the nature of the changes in yield components influencing productivity. Among the cultivars tested the greatest response was obtained from Norfolk Giant, where cane numbers and yield per cane both contributed significantly to enhanced yield. The implications of these results for cultural methods and cultivar testing are discussed.

I. Beroea, in the church of ἡ Μακρὴ Kυριώτισσα, a marble plaque acting as a window sill within the ἱερόν. The plaque has been built into the structure of the church in such a way that the lower half of the inscription is now beyond recovery, while the upper half which projects has in its present position to be read upside down. To this fortunate accident of choice on the part of the builder we owe the preservation of the upper and, no doubt more important part of one of the most interesting inscriptions relating to the Macedonian Koinon yet reported. The inscribed surface is surrounded by a well-cut moulding varying in width from 0·085 to 0·10 m.

1. Beroea. In the Old Metropolis, headquarters of the local Boy Scouts, in a collection of miscellaneous marbles, a Hellenistic marble stele, broken at the bottom, damaged along the lower two-thirds of the left edge. H. 0·475 m.; w. (between preserved sides) 0·392 m.; th. ca. 0·10 m. Letters, ll. 1–2, 0·02 m. (0, 0·015 m.), l. 3, 0·015 m.; interspace, ll. 1–2, 0–005 m., ll. 2–3, 0.001 m.Relief: r., tree along trunk and branch of which a serpent coils. In front of tree at foot, small boy with arms folded, head facing his r. Second from r., man clad in cloak, turned to his r. and shaking hands with similarly clad man in l. of relief area. Between the two men, another small boy facing his r. (Pl. 30, no. 1).

1. Edessa. This inscription is still where Leake first reported it, in the courtyard of the Metropolitan Church, the Dormition of the Virgin, built into the south end of the west wall of the Γραφεῖον of the Δεσπότης. Although it has been published half a dozen times, the text has never been read correctly in its entirety, largely because its height from the ground makes the taking of a photograph or the making of a squeeze, let alone a study of the letters, very difficult. I was fortunate to be able to examine it in situ, and the accompanying photograph of a squeeze will facilitate the establishment of the text (Plate 5).It is a rough block, c. 0·46 m. in height and 0·50 m. in width, with a moulding all round, the first line being engraved on the upper moulding. The letters are irregular, measuring on an average 0·025 m. in ll. 1–6 and 0·01 m. in ll. 7–18. The letter-forms, especially important in a dated inscription, are noteworthy. Alpha, delta, and lambda have short tails on the apex; in ll. 1–6 epsilon is square, in ll. 7–18 lunar; similarly in ll. 1–6 sigma is square, in ll. 7–18 lunar. The forms of mu and omega are to be noted; see the accompanying photograph. There are no ligatures.

Of the considerable epigraphic harvest gathered by W. Kubitschek and W. Reichel in Geyre (Aphrodisias) in 1893, during their stay of sixteen days, only a few inscriptions were published in the Anzeiger der kaiserl. Akademie der Wissensch. zu Wien 1893, 100–3. Some of the inscriptions recorded in Kubitschek and Reichel's notebooks were published independently by Th. Reinach from Gaudin's squeezes, in REG xix (1906), 79–150, 205–98. Reinach's nos. 13, 17, 127, 7, 70, 77, 50, 146 bis, 32, and 62 (all published as new) are respectively nos. 1, 3, 4, 7, 8, 9, 10, 11, 12, and 14 of Kubitschek and Reichel's article cited above.

Although Plassart, when publishing for the first time the inscription referred to as Text A in this article, mentioned that he had seen it ‘assez rapidement’ and that it ‘mériterait révision’, Crönert did not realise in SEG ii, 398, that he was restoring a text which had not been published in its entirety. I was able, during a visit to Beroea in the autumn of 1936 in the company of Mr. C. F. Edson of Harvard University, to examine the inscription carefully and, in addition to correcting some inaccuracies in Plassart's copy, removed, with the permission of the Δεσπότης of Beroea, a wooden bench which covered a portion of the inscription, and thus was able to read all the extant text. The accompanying photograph (fig. 5) shows clearly the part of the text hitherto unread.