Irwinbernard8253
The invivo dosimetric monitoring in HDR brachytherapy is important for improving patient safety. However, there are very limited options available for clinical application. In this study, we present a new invivo dose measurement system with a plastic scintillating detector (PSD) for GYN HDR brachytherapy.
An FDA approved PSD system, called OARtrac (AngioDynamics, Latham, NY), was used with various applicators for invivo dose measurements for GYN patients. An institutional workflow was established for the clinical implementation of the dosimetric system. Action levels were proposed based on the measurement and system uncertainty for measurement deviations. From October 2018 to September 2019, a total of 75 measurements (48 fractions) were acquired from 14 patients who underwent HDR brachytherapy using either a multichannel cylinder, Venezia applicator, or Syed-Neblett template. The PSDs were placed in predetermined catheters/channels. A planning CT was acquired for treatment planning in Oncentra (Elekta, Version-4.5.2) TPS. The PSDs were contoured on the CT images, and the PSD D
values were used as the expected doses for comparison with the measured doses.
The mean difference from patient measurements was -0.22%±5.98%, with 26% being the largest deviation from the expected value (Syed case). Large deviations were observed when detectors were placed in the area where dose rates were less than 1cGy/s.
The establishment of clinical workflow for the invivo dosimetry for both the intracavitary and interstitial GYN HDR brachytherapy will potentially improve the safety of the patient treatment.
The establishment of clinical workflow for the in vivo dosimetry for both the intracavitary and interstitial GYN HDR brachytherapy will potentially improve the safety of the patient treatment.
Radiation side effects and visual outcome for uveal melanoma patients managed with plaque radiotherapy are dependent on the radiation dose administered to the tumor and nearby healthy tissues. We have developed an open-source software tool, EyeDose, to simplify and standardize tumor and critical structure dose reporting for Collaborative Ocular Melanoma Study eye plaques.
EyeDose is a MATLAB-based program that calculates point dose and volume dose metrics for standard models of the tumor and critical ocular structures. It uses published three-dimensional dose distributions for eye plaques, calculated with Monte Carlo methods, which are oriented with respect to the eye using the tumor's position on a fundus diagram. A standard model for the ocular structures was created using published measurements and patient CT scans. EyeDose reports radiation statistics for the fovea, optic disc, lens, lacrimal gland, retina, and tumor. The dosimetric margin for implant placement uncertainty is also calculated.
EyeDoso assess plaque applicability.
The purpose of the study was to increase the proportion of youth living with HIV (YLWH) aged ≥11years who undergo developmentally appropriate disclosure about their HIV status.
A quality improvement project was initiated at an urban pediatric HIV clinic between July 2018 and March 2020. The primary outcome measure was the proportion of YLWH aged ≥11years who were disclosed to about their HIV status. The proportion of undisclosed YLWH who had documented nondisclosure status was also assessed as a process measure. Plan-Do-Study-Act (PDSA) cycles for change included monthly clinic staff check-ins to discuss new disclosures, quarterly team meetings to discuss strategies to improve disclosure, and modifying a clinic note template to prompt providers to document disclosure status. Annotated run charts were used to analyze the data.
Before the first PDSA cycle, 26/46 (57%) of the target population of YLWH aged ≥11years had their HIV status disclosed to them, and none of the undisclosed youth had disclosure status documented in their medical record. this website After 20 months and six PDSA cycles, the proportion of YLWH aged ≥11years disclosed to about their HIV status increased to 80% and the proportion of undisclosed YLWH with documentation of their disclosure status increased to 100%.
Several interventions integrated throughout the pediatric HIV care process were associated with an increase in the proportion of YLWH with developmentally appropriate HIV disclosure and documentation of disclosure status, an important psychosocial aspect of care in these individuals.
Several interventions integrated throughout the pediatric HIV care process were associated with an increase in the proportion of YLWH with developmentally appropriate HIV disclosure and documentation of disclosure status, an important psychosocial aspect of care in these individuals.Our previous study showed that dizocilpine (MK-801) induced schizophrenia-like behavior in rats, enhanced GFAP expression, and activated primary cultured hippocampal astrocytes. Astrocytes play an essential role in neuroinflammation and contribute to the crosstalk that generates chronic neuro-inflammation in neurological diseases. However, the effects of MK-801 treatment on astrocytic neuroinflammatory responses and its mechanism of action have not been studied in detail. To address this issue, IL1β, IL6, TNFα and IL10 expression and secretion levels were evaluated in hippocampal astrocytes in response to MK-801 for 24 h by ELISA and real-time PCR, with and without pretreatment of either the ERK1/2 inhibitor, PD98059 or the PI3K inhibitor, LY294002. Cell apoptosis, viability, and proliferation were also examined. MK-801 treatment did not induce hippocampal astrocytes apoptosis or proliferation, however, MK-801 enhanced astrocytes viability. Additionally, the expression and secretion levels of IL1β, IL6 and TNFα were elevated, but that of IL10 was decreased, in which ERK1/2 and PI3K signals were involved. These findings suggest that hippocampal astrocytes may regulate the expressions of inflammatory cytokines through ERK1/2 and PI3K signaling pathway to participate in the pathogenesis of schizophrenia.
Oxycodone is a synthetic opioid receptor agonist that exerts antinociceptive activity via κ-, μ- and δ-opioid receptors (KOR, MOR and DOR, respectively). Activation of MOR has been reported to provide protection against acute lung injury (ALI). We hypothesized that pretreatment with oxycodone would attenuate lung injury at the level of alveolar tight junctions (TJs) and aquaporins (AQPs) and investigated this possibility in a two-hit model of ALI induced by lipopolysaccharide (LPS) and mechanical ventilation (MV).
Male Sprague Dawley rats and A59 cells were divided into 6 groups the control group, ALI group, oxycodone-pretreated group, and oxycodone/κ-, μ-, or δ-opioid receptor antagonist-pretreated groups. The rats were pretreated with oxycodone 30min before intravenous injection of LPS and then allowed to recover for 24h prior to MV, establishing a two-hit model of ALI. The cells were similarly treated with oxycodone (with or without antagonists) 30min after exposure to lipopolysaccharide. The cells were cyclically stretched 24h later to mirror the in vivo MV protocol.
