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Background/aim Adaptive radiation therapy (ART) is a technique capable of reducing radiation dose to normal tissue without compromising local control. For potentially resectable thymoma, induction therapy is standard of care. Because large disease volume is common in this context, ART has been suggested to reduce toxicity from induction chemoradiation. This has not been previously illustrated in the literature. Case report A 38-year-old man with initially unresectable thymoma was treated with induction chemoradiation including cisplatin and etoposide. He received 45 Gy in 25 fractions and ART was utilized to shrink the radiotherapy field for the final 10 fractions. Results Thymectomy showed Masaoka stage III disease with negative margins. He experienced no treatment-related toxicity and has no evidence of disease 8 years after diagnosis. Conclusion Induction chemoradiotherapy with ART appears to be feasible, safe, and efficacious for locally advanced intact thymoma.

Background and Aims Acute graft pyelonephritis(AGPN) is thought to affect graft and patient survival among renal transplant recipients. Our objective was to compare these outcomes in those having early AGPN(6months from transplant) Method This retrospective study analyzed 150 patients who had AGPN over a period of 8 years from 2005 to 2013. They were divided into early AGPN group and late AGPN group. Their baseline characteristics were compared. Predictors of graft loss and mortality were compared using logistic regression analysis. Graft survival and patient survival were analyzed using Kaplan-Meyer survival plots Results A total of 150 patients with AGPN were analyzed. Of these 55.3% (n=83) had early AGPN and 44.7% (n=67) had late AGPN. These two groups were comparable regarding baseline characteristics and immunosuppression. In early AGPN group, 13.3% (n=11) patients had CMV disease during follow up compared to 3% (n=2) in late AGPN group(p5days) following transplant surgery compared to 7.5% (n=5) in late AGPN group (p2weeks) following transplant surgery compared to 19.4% (n=13) in the late AGPN group (p Conclusion Occurrence of early AGPN had a significant impact on long term graft survival in renal transplant recipients with no significant effect on patient survival. This study underlines the paramount importance of the prevention of UTIs in renal transplant recipients.

The purpose of this study is to determine whether the use of helical tomotherapy can reduce dose to the heart, breast tissue, and thyroid gland in children receiving whole lung irradiation (WLI). Computed tomography simulation scans from nine pediatric patients previously treated with WLI were used for this dosimetry study. Each scan was alternatively planned using helical tomotherapy to minimize dose to surrounding critical structures. The clinical target volume (CTV) included both lungs. The ribs and spine in proximity to the lungs were included in the CTV to minimize bone asymmetry resulting from partial irradiation. The planning target volume (PTV) included the CTV with a 0.8-cm margin. The following structures were contoured: right atrium, left atrium, right ventricle, left ventricle, right and left breast, thyroid gland, and the humeral heads. Median dose (D med), minimum dose (D min), and maximum dose (D max) for the PTV, CTV, heart chambers, thyroid gland, right and left breast as well as right and left humeral heads were also obtained. The median PTV receiving the prescription dose was 97 %, with PTVs ranging from 95 to 99 %. The average D med for each of the four chambers of the heart ranged from 37 to 55 % of the prescription dose. The average D med for the breasts ranged from 88 to 95 % while for the thyroid gland was 10 % of the prescription dose. Helical tomotherapy can minimize the radiation dose delivered to nontarget organs such as the heart, breasts, and thyroid gland.

Stereotactic body radiation therapy (SBRT) is a promising treatment option for prostate cancer. Hypofractionation regimens, such as SBRT, may be more advantageous compared with conventional regimens because low α:β ratio of prostate cancer has high sensitivity to dose per fraction. In addition, a smaller and tighter margin with SBRT is expected to provide a low toxicity rate without reducing tumor control. The purpose of this article is to examine radiobiological, technical and clinical aspects of SBRT for prostate cancer.

Chronic myelogenous leukemia (CML) is genetically characterized by the reciprocal translocation of chromosome 9 and 22. Around 5-8% of CML develop complex variant Ph translocations involving one or more chromosomal regions besides 9 and 22. Chromosome 3 is not frequently involved in complex translocations in CML. We report in this study a case of CML displaying a t(3;9;22) 3-way translocation. A review of the literature appears to indicate that CML patients with this translocation tend to have an aggressive course and poor outcome. Additional 3-way chromosome translocations associated with CML are also reviewed.

Following the global financial crisis, global trade contracted sharply and, after an initial recovery, grew at an unusually slow pace relative to global GDP. This article reviews cyclical and structural explanations for this phenomenon, and finds econometric evidence that cyclical factors – namely shifts in the composition of aggregate demand toward less import-intensive components and heightened economic uncertainty – can explain most of the slowdown in trade in a panel of advanced economies. Although the slowdown in aggregate global trade is well explained by the model used, the results vary by country. For Australia, the model performed well until 2012, after which it over-predicted import growth, most likely because it did not adequately capture the import intensity of mining investment and resource exports.

A patient of ALS-like disorder in an HIV-1 clade-C-infected heterosexual male is being reported. A 37-year-old gentleman presented with subacute, progressive asymmetrical onset of weakness and wasting of upper limbs associated with brisk muscle stretch reflexes and without any sensory or sphincter involvement. While nerve conduction tests were normal, the EMG of proximal and distal limb muscles on both sides revealed evidence of denervation and reinnervation. Routine blood and urine tests and investigations for underlying causes of motor neuron disease were noncontributory. He was HIV-1, subtype clade C seropositive. A diagnosis of HIV-related anterior horn cell disease was considered and zidovudine, lamivudine and nevirapine were started. After 1 month, there was a subjective improvement of 10% and objective improvement in strength of muscles of proximal upper limb on both sides by one grade power on MRC scale. Reports of amyotrophic lateral sclerosis (ALS)-like illness in HIV are sparse. The reversibility of “ALS”-like features in this subgroup of patients might offer an insight into the pathogenesis of amyotrophic lateral sclerosis. This is a first report of ALS-like illness caused by subtype C of HIV-1 strain.

Fortuitously, within a 1-month period, we were referred two individuals for routine cytogenetic amniocenteses involving one chromosome 21 from each patient, which had apparently lost the entire short arm and a major portion of the centromeric alphoid sequences in their amniocytes. Breakage may have occurred within alphoid sequences resulting in extreme variants. Variations of a similar nature were originally referred to as Christchurch (Ch 1 ) chromosomes and have been wrongly determined to be abnormal. The 21p- chromosome variants were similar in both cases, though they are from unrelated individuals. These rare variants, whose origins were both maternal and have no clinical consequences, were characterized by the FISH-technique to provide a greater degree of certainty.

Stereotactic body radiation therapy (SBRT) is a novel treatment modality in radiation oncology that delivers a very high dose of radiation to the tumor target with high precision using single or a small number of fractions. SBRT is the result of technological advances in patient/tumor immobilization, image guidance, and treatment planning and delivery. This modality is safe and effective in both early stage primary cancer and oligometastases. Compared to the use of stereotactic radiosurgery for other tumor sites, SBRT is slow to be adopted in the management of genitourinary malignancies. There are now emerging data that show the safety and efficacy of this treatment modality in genitourinary (GU) malignancies especially in prostate cancer and renal cell carcinoma. Preclinical data, clinical experience, and challenges are reviewed and discussed.

Pericentric inversion of the secondary constriction region (qh) of human chromosome 9 is a frequent occurrence. This structural alteration is regarded as a normal familial variant, termed heteromorphism, and is inherited in a Mendelian fashion without any apparent phenotypic consequences. We characterized the qh region of chromosome 9 from five individuals using a series of molecular cytogenetic techniques. Four out of the five individuals have an additional area composed of alphoid DNA sequences on the inverted chromosome 9 while one case was found to have an apparently intact alphoid DNA sequence. Although the direct function(s) of alphoid DNA sequences remain unclear, the centromeric breakage involving these sequences in inverted chromosome 9 raises a series of questions pertaining to the monocentric, dicentric and pseudodicentric nature of pericentric inversions. Nevertheless, these findings have prompted us to suggest that the structural organization of alphoid DNA sequences of the centromeric region of chromosome 9 are apparently “breakage prone” and may be associated with a higher incidence of pericentric inversions. Furthermore, the hierarchical organization of various satellite DNA families (alpha-satellite, beta-satellite and satellite III) within the primary and secondary constriction regions of chromosomes 9 are elucidated here.

Ovarian hyperstimulation syndrome (OHSS) is a rare but potentially fatal complication of IVF treatment. The risk of OHSS increases with increasing numbers of follicles aspirated and oocytes retrieved, but there is little evidence to support whether threshold values of either can be used to correctly predict OHSS. Since the most severe forms of OHSS are usually associated with pregnancy, cryopreservation of all embryos may prevent this. The authors attempted to find thresholds of follicle and oocyte numbers that would optimally predict OHSS, through a retrospective analysis of 2253 consecutive cycles of IVF/intracytoplasmic sperm injection treatment reaching oocyte retrieval, between 1 January 2003 and 31 March 2006. Receiver operator characteristic (ROC) curves were calculated for both parameters, to determine threshold values that might predict OHSS in women with ≥20 oocytes. For the prediction of early onset OHSS, ROC curves showed that an optimal balance between sensitivity and specificity was achieved using thresholds of 24 oocytes (79%, 60%) and 29 follicles (82%, 65%) respectively. Using these thresholds, cryopreservation of all embryos may be offered as an alternative to cancellation of a treatment cycle due to excessive ovarian response, thus minimizing the number of unnecessary interventions while still correctly predicting most cases of early onset OHSS.

Sweet's syndrome (acute febrile neutrophilic dermatosis) is characterized by an acute onset of erythematous plaques, fever, and leukocytosis. This syndrome has been reported to be associated with leukemia including chronic myelogenous leukemia (CML). Sweet's syndrome seen in patients with leukemia is usually associated with active and/or refractory disease. Imatinib Mesylate (STI-571, Gleevec) is widely used for therapy of CML. In this case report, CML cell infiltration of the skin was documented by fluorescence in situ hybridization (FISH) analysis in a patient with chronic-phase CML on Imatinib Mesylate (STI-571, Gleevec), who was at the time in molecular remission.

At present it is common to perform a risk assessment for contaminated sites by just comparing the actual site contamination with non-site-specific maximum list values. Site specific exposure pathways are not taken into consideration. This means that the risk is evaluated only by comparing the contaminant concentrations in the different media on the site with maximum list values without considering the source of exposure/point of release and the path of the contaminants. It is recomended that this method should no longer be applied especially for the development of remediation goals (RSU 1995). Instead exposure models should be used to account for the site-specific situation (Mathews & Bracke 1995). The remediation goals shall be derived based on the principle of prevention in order to protect the inhabitants or users of a site as well as the environment according to § 1 Sec. 5 of the Baugesetztbuch. The remediation goal is understood as a contaminant concentration in the soil or groundwater with a tolerable risk for the human health and the environment (groundwater protection) under a given site use (e.g. drin-kingwater, general groundwater protection of non-used groundwater).

We report a successful twin pregnancy in a woman with secondary amenorrhea who is genotypically 47, XXX. Cytogenetic markers suggested that they are apparently monozygotic twins.

One thousand children ranging from newborns to 13 years of age with a variety of clinical disorders were referred to us to investigate the possible presence of chromosomal abnormalities. Various types of chromosomal anomalies were found in 166 children (16.6%), which is significantly (p0.01) higher than in an unselected (control) population (0.48-0.55%). The male:female ratio was 3:2 for the total population. Furthermore, in our survey population, the sex ratio of Down's syndrome cases of males to females was 3:2.

We report the smallest secondary constriction region (h) in human chromosome 16. The cytochemical, cytogenetic, and molecular techniques revealed the complex heterogeneity of heterochromatin observed in this region. The heteromorphisms can be found due to the variation in centromeric (c) region alone or in combination with the h region. Routine selective staining techniques fail to differentiate the C region from the h region. However, the fluorescence in situ hybridization technique clearly demonstrated that the centromere of chromosome 16, which is composed of 340-base-pair dimers arranged in a tandem array of 1.7-kb higher-order repeat units, is not heteromorphic in the present case, but other molecular cytogenetic techniques demonstrated the presence of a very small h region. The evolution of heterochromatin of this region is discussed.

An unusual large heterochromatic segment around the pericentromeric region of the X-chromosome is reported. In normal circumstances, the pericentromeric region of the X-chromosome is negative by the restriction endonuclease AluI/Giemsa technique. However, this unusual X-chromosome was found to have AluI resistant (positive) chromatin. The evolution of extra heterochromatin is a postzygotic event as substantiated by the presence of a normal cell line.

The last two decades have witnessed a logarithmic growth in demand for prenatal diagnosis of human disease through amniocentesis. Consequently, culture turn-around-time has become the major concern of all those who are primary care providers for patients seeking help. We report a rapid method for obtaining cytogenetic results from amniocytes as early as 5 days. Early tapping and reducing the turn-around-time during cytogenetic analysis may provide an alternative to chorionic villi sampling.