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Transcranial magnetic stimulation and measurement of the magnetic motor-evoked potentials (MMEPS) in the thoracic and pelvic limbs of four recumbent horses and one recumbent donkey were used to assess the integrity of the descending motor pathways, in order to confirm or exclude a descending motor tract lesion as the cause of the recumbency. In two of the animals abnormal MMEPS were recorded; in one of the horses a lesion along the cervical spinal cord due to a fracture of the fifth cervical vertebra was diagnosed and confirmed by radiography and postmortem examination; in another horse, damage to the peripheral nerves of the left forelimb was diagnosed and confirmed postmortem when a large abscess was found to have been compressing the peripheral nerves at the level of the last cervical vertebra. In the three other animals, normal MMEPS were recorded, and laminitis, rhabdomyolysis and physitis were diagnosed as the causes of the recumbency. [ABSTRACT FROM AUTHOR]

The tobacco alkaloid nicotine is known for its activation of neuronal nicotinic acetylcholine receptors. Nicotine is consumed in different ways such as through conventional smoking, e-cigarettes, snuff or nicotine pouches. The use of snuff has been associated with several adverse health effects, such as inflammatory reactions of the oral mucosa and oral cavity cancer. We performed a metabolomic analysis of nicotine-exposed THP-1 human monocytes. Cells were exposed to 5 mM of the alkaloid for up to 4 h, and cell extracts and medium subjected to untargeted liquid chromatography high-resolution mass spectrometry. Raw data processing revealed 17 nicotine biotransformation products. Among these, cotinine and nornicotine were identified as the two major cellular biotransformation products. The application of multi- and univariate statistical analyses resulted in the annotation, up to a certain level of identification, of 12 compounds in the cell extracts and 13 compounds in the medium that were altered by nicotine exposure. Of these, four were verified as methylthioadenosine, cytosine, uric acid, and L-glutamate. Methylthioadenosine levels were affected in both cells and the medium, while cytosine, uric acid, and L-glutamate levels were affected in the medium only. The effects of smoking on the pathways involving these metabolites have been previously demonstrated in humans. Most of the other discriminating compounds, which were merely tentatively or not fully identified, were amino acids or amino acid derivatives. In conclusion, our preliminary data suggest that some of the potentially adverse effects related to smoking may also be expected when nicotine is consumed via snuff or nicotine pouches., (© 2024. The Author(s).)

Currently dynamic conformal arcs (DCA) and volumetric modulated arc therapy (VMAT) are two popular planning techniques to treat lung stereotactic body radiation therapy (SBRT) patients. Of the two, DCA has advantages in terms of multi-leaf collimator (MLC) motion, positioning error, and delivery efficiency. However, VMAT is often the choice when critical organ sparing becomes important. We developed a hybrid strategy to incorporate DCA component into VMAT planning, results were compared with DCA and VMAT plans. Four planning techniques were retrospectively simulated for 10 lung SBRT patients: DCA, Hybrid-DCA (2/3 of the doses from DCA beams), Hybrid-VMAT (2/3 of the doses from VMAT beams) and VMAT. Plan complexity was accessed by modulation complexity score (MCS). Conformity index (CI) for the planning target volume (PTV), V 20 and V 5 for the lung, V 30 for the chestwall, and maximum dose to all other critical organs were calculated. Plans were compared with regard to these metrics and measured agreement between the planned and delivered doses. DCA technique did not result in acceptable plan quality due to target location for five patients. Hybrid-DCA produced one unacceptable plan, and Hybrid-VMAT and VMAT produced no unacceptable plans. The CI improved with increasing VMAT usage, as did the dose sparing to critical structures. Compared to the VMAT technique, a total MU reduction of 14%, 25% and 37% were found for Hybrid-VMAT, Hybrid-DCA and DCA techniques for 54 Gy patient group, and 9%, 23% and 34% for 50 Gy patient group, suggesting improvement in delivery efficiency with increasing DCA usage. No significant variations of plan complexity were observed between Hybrid-DCA and Hybrid-VMAT (P = 0.46 from Mann-Whitney U-test), but significant differences were found among DCA, Hybrid and VMAT (P < 0.05). Better agreements between the planned and delivered doses were found with more DCA contributions. By adding DCA components to VMAT planning, hybrid technique offers comparable dosimetry to full VMAT, while increasing delivery efficiency and minimizing MLC complexity., (© 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

Modern three-dimensional image-guided intracavitary high dose rate (HDR) brachytherapy is often used in combination with external beam radiotherapy (EBRT) to manage cervical cancer. Intrafraction motion of critical organs relative to the HDR applicator in the time between the planning CT and treatment delivery can cause marked deviations between the planned and delivered doses. This study examines offline adaptive planning techniques that may reduce intrafraction uncertainties by shortening the time between the planning CT and treatment delivery. Eight patients who received EBRT followed by HDR boosts were retrospectively reviewed. A CT scan was obtained for each insertion. Four strategies were simulated: (A) plans based on the current treatment day CT; (B) plans based on the first fraction CT; (C) plans based on the CT from the immediately preceding fraction; (D) plans based on the closest anatomically matched previous CT, using all prior plans as a library. Strategies B, C, and D allow plans to be created prior to the treatment day insertion, and then rapidly compared with the new CT. Equivalent doses in 2 Gy for combined EBRT and HDR were compared with online adaptive plans (strategy A) at D 90 and D 98 for the high-risk CTV (HR-CTV), and D 2 cc for the bladder, rectum, sigmoid, and bowel. Compared to strategy A, D 90 deviations for the HR-CTV were -0.5 ± 2.8 Gy, -0.9 ± 1.0 Gy, and -0.7 ± 1.0 Gy for Strategies B, C, and D, respectively. D 2 cc changes for rectum were 2.7 ± 5.6 Gy, 0.6 ± 1.7 Gy, and 1.1 ± 2.4 Gy for Strategies B, C, and D. With the exception of one patient using strategy B, no notable variations for bladder, sigmoid, and bowel were found. Offline adaptive planning techniques can shorten time between CT and treatment delivery from hours to minutes, with minimal loss of dosimetric accuracy, greatly reducing the chance of intrafraction motion., (© 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

Background: Although some studies have questioned whether cardiopulmonary resuscitation (CPR) in older people could be futile, age is not considered an essential out-of-hospital cardiac arrest (OHCA) prognostic factor. However, in the daily clinical practice of mobile medical teams (MMTs), age seems to be an important factor affecting OHCA care., Aims: The purpose of this study was to compare OHCA care and outcomes between young patients (<65 years old) and older patients., Methods: We performed a case-control study based on data extracted from the French National Cardiac Arrest (CA) registry. All adult patients with CA recorded between July 2011 and May 2014 were included. Each older patient was matched on three criteria: sex, initial cardiac rhythm and no-flow duration., Results: We studied 4347 pairs. We found significantly less basic life support initiation, shorter advanced cardiac life support duration, less MMT automated chest compression, less MMT ventilation and less MMT epinephrine injection in the older patients. Significant differences were also observed for return of spontaneous circulation (odds ratio (OR)=0.84, 95% confidence interval (CI) 0.77-0.92, p<0.001), transport to hospital (OR=0.58, 95% CI 0.51-0.61, p<0.001), vital status at hospital admission (OR=0.55, 95% CI 0.50-0.60, p<0.001) and vital status 30 days after CA (OR=0.42, 95% CI 0.35-0.50, p<0.001)., Conclusion: All OHCA guidelines, ethical statements and clinical procedures do not propose age as a discrimination criterion in OHCA care. However, in our case-control study, we notice a shorter duration and less intensive care among older patients. This finding may partly explain the lower survival rate compared with younger people.

The photon optimization (PO) algorithm was recently released by Varian Medical Systems to improve volumetric modulated arc therapy (VMAT) optimization within Eclipse (Version 13.5). The purpose of this study is to compare the PO algorithm with its predecessor, progressive resolution optimizer (PRO) for lung SBRT and brain SRS treatments. A total of 30 patients were selected retrospectively. Previously, all the plans were generated with the PRO algorithm within Eclipse Version 13.6. In the new version of PO algorithm (Version 15), dynamic conformal arcs (DCA) were first conformed to the target, then VMAT inverse planning was performed to achieve the desired dose distributions. PTV coverages were forced to be identical for the same patient for a fair comparison. SBRT plan quality was assessed based on selected dose-volume parameters, including the conformity index, V 20 for lung, V 30 Gy for chest wall, and D 0.035 cc for other critical organs. SRS plan quality was evaluated based on the conformity index and normal tissue volumes encompassed by the 12 and 6 Gy isodose lines (V 12 and V 6 ). The modulation complexity score (MCS) was used to compare plan complexity of two algorithms. No statistically significant differences between the PRO and PO algorithms were found for any of the dosimetric parameters studied, which indicates both algorithms produce comparable plan quality. Significant improvements in the gamma passing rate (increased from 97.0% to 99.2% for SBRT and 96.1% to 98.4% for SRS), MCS (average increase of 0.15 for SBRT and 0.10 for SRS), and delivery efficiency (MU reduction of 29.8% for SBRT and 28.3% for SRS) were found for the PO algorithm. MCS showed a strong correlation with the gamma passing rate, and an inverse correlation with total MUs used. The PO algorithm offers comparable plan quality to the PRO, while minimizing MLC complexity, thereby improving the delivery efficiency and accuracy., (© 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

Purpose: Modeling dose to a moving target in lung is a very difficult task. Current approaches to planning lung stereotactic body radiotherapy (SBRT) generally calculate dose on either free breathing or average computed tomography (CT) scans, which do not always accurately predict dose to parts of the target volume not occupied by tumor on the planning scan. In this work, the authors look at using density overrides of the target volumes to more accurately predict dose for lung SBRT using the analytic anisotropic algorithm (AAA)., Methods: Volumetric modulated arc therapy plans were created on free breathing scans (FBP), time average scans (AVGP), free breathing scans with the internal target volume overridden to tumor density (ITVP), free breathing scans with the planning target volume overridden to tumor density (PTVP), and free breathing scan using a hybrid scheme with the internal target volume set to tumor density and the planning target volume minus the internal target volume set to a density intermediate between lung and tumor (HP) for the case of a 4D motion phantom and five patient cases. Radiochromic film measurements were made for the phantom plans, with gamma analysis used to compare the planned to delivered dose. The patient plans were recalculated on each of the phases of a 4DCT to evaluate tumor coverage and conformity index (CI). A modified modulation complexity score (MCSv) and average open area per control point (AA) metrics were used to evaluate multileaf collimator (MLC) modulation for each of the plans., Results: The HP plans showed significantly higher gamma passing rates (p < 0.05) than the FBP, AVGP, and ITVP for criteria of 2 mm/2% and 1 mm/1%. No significant correlation was observed between gamma values and AA or MCSv. The tumor volume was covered by the prescription dose on all phases of the 4DCT for all patient plans. The PTVP and HP yielded lower mean CI than the other plans for all five patients, with three of the cases showing statistically significant differences (p < 0.05). No meaningful correlation was observed between the mean CI and AA or MCSv., Conclusions: These measurements suggest that the HP planning method may provide more accurate dose modeling and decreased normal lung irradiation for lung SBRT compared to the commonly used FBP and AVG planning methods when used with the AAA. The HP method does not appear to have a strong relationship with MLC modulation.

Recent developments of tools for targeted genome modification have led to new concepts in how multiple traits can be combined. Targeted genome modification is based on the use of nucleases with tailor-made specificities to introduce a DNA double-strand break (DSB) at specific target loci. A re-engineered meganuclease was designed for specific cleavage of an endogenous target sequence adjacent to a transgenic insect control locus in cotton. The combination of targeted DNA cleavage and homologous recombination-mediated repair made precise targeted insertion of additional trait genes (hppd, epsps) feasible in cotton. Targeted insertion events were recovered at a frequency of about 2% of the independently transformed embryogenic callus lines. We further demonstrated that all trait genes were inherited as a single genetic unit, which will simplify future multiple-trait introgression., (© 2013 Bayer CropScience N.V. Plant Biotechnology Journal published by Society for Experimental Biology, Association of Applied Biologists and John Wiley & Sons Ltd.)

In an attempt to understand the feasibility of future targeted genome optimization in agronomic crops, we tested the efficiency of homologous recombination-mediated sequence insertion upon induction of a targeted DNA double-strand break at the desired integration site in maize. By the development of an efficient tissue culture protocol, and with the use of an I-SceI gene optimized for expression in maize, large numbers of precisely engineered maize events were produced in which DNA integration occurred very accurately. In a subset of events examined in detail, no additional deletions and/or insertions of short filler DNA at the integration site were observed. In 30%-40% of the recovered events, no traces of random insertions were observed. This was true for DNA delivery by both Agrobacterium and particle bombardment. These data suggest that targeted double-strand break-induced homologous recombination is a superior method to generate specific desired changes in the maize genome, and suggest targeted genome optimization of agronomic crops to be feasible.

Background: Compared with in-center hemodialysis, self-care dialysis (including home and self-care hemodialysis and peritoneal dialysis) is less resource intensive and associated with similar clinical outcomes. However, utilization of self-care dialysis has been very low. We performed a randomized controlled trial in predialysis patients with chronic kidney disease (CKD) (GFR <30 mL/min) to determine the impact of a patient-centered educational intervention on patients' intention to initiate dialysis with self-care dialysis., Methods: Seventy patients with CKD who were receiving care in a multidisciplinary predialysis clinic were randomized to receive either (1) a two-phase patient-centered educational intervention (phase 1 included educational booklets and a 15-minute video on self-care dialysis; phase 2 included a 90-minute small group interactive educational session on self-care dialysis) in addition to their regular multidisciplinary care, or (2) ongoing standard care and education in the multidisciplinary predialysis clinic. The primary outcome was patients' intention to initiate dialysis with self-care dialysis, assessed by questionnaire., Results: Thirty-five patients were randomized to standard care; 34 completed the study. Thirty-five patients were randomized to the educational intervention; 30 completed phase 1 and 28 completed phase 2. By study end, significantly more patients in the intervention group (82.1%) intended to start dialysis with self-care dialysis compared with the standard care group (50%, P= 0.015). This difference persisted after controlling for the small baseline differences among patients in the two study groups (P= 0.004)., Conclusion: A two-phase educational intervention can increase the proportion of patients who intend to initiate dialysis with self-care dialysis.

Periradicular surgery combined with final laser sterilisation was performed on 62 teeth of 50 patients by 3 trained oral surgeons, according to a well defined treatment protocol. It concerned a 5 Watt continuous wave CO2-laser. After a follow-up period ranging from 6 to 17 months all patients were recalled. 28 patients (56%) or 33 teeth (53%) could be evaluated. The success rate was determined by a questionnaire, a standard clinical examination and an X-ray evaluation. Complete surgical healing was found in 59% of the teeth and incomplete healing in 23%. Uncertain healing and unsatisfactory healing were observed in respectively 11% and 7% of the teeth. Better healing results were found in elements with one endodontic canal (67% complete healing) and when endodontic treatment was combined with the intervention (71% complete healing). Comparison of the results of the present study with comparable studies without laser sterilisation, showed however no statistical significant improvement.

Sternocostoclavicular hyperostosis (SCCH) or intersternocostoclavicular ossification is a recently recognized disorder of unknown origin. SCCH is characterized by painful, condensing hypertrophy of the sternum, both clavicles, and the upper ribs. Since its original description by Sonozaki in 1974, approximately 40 cases have been reported, mainly in the Japanese literature. This peculiar hyperostotic syndrome is often misdiagnosed. The differentiation from osteitis deformans can be difficult. Clinically, the disease produces a swelling in the upper chest area with persistent, pulling pain exacerbated by cold and dampness. The condition is a nonspecific inflammatory syndrome. Radiographs usually show symmetric hyperostosis of the sternal portions of the clavicles, synostosis of the sternoclavicular joints, a thickened sternum, and varying degrees of involvement of the upper ribs and intercostoclavicular space. Biopsy specimens reveal hyperostotic sclerosis of the cancellous bone. Although the cause of the syndrome is unknown, clinical, radiologic, and histologic findings indicate that it represents a distinct entity. The treatment of SCCH remains symptomatic.