Klemmensenmollerup1603
Each radiotherapy center should have a site-specific planning target volume (PTV) margins and image-guided (IG) radiotherapy (IGRT) correction protocols to compensate for the geometric errors that can occur during treatment. This study developed an automated algorithm for the calculation and evaluation of these parameters from cone beam computed tomography (CBCT)-based IG-intensity modulated radiotherapy (IG-IMRT) treatment.
A MATLAB algorithm was developed to extract the setup errors in three translational directions (x, y, and z) from the data logged by the CBCT system during treatment delivery. The algorithm also calculates the resulted population setup error and PTV margin based on the van Herk margin recipe and subsequently estimates their respective values for no action level (NAL) and extended no action level (eNAL) offline correction protocols. The algorithm was tested on 25 head and neck cancer (HNC) patients treated using IG-IMRT.
The algorithms calculated that the HNC patients require a PTV margin of 3.1, 2.7, and 3.2mm in the x-, y-, and z-direction, respectively, without IGRT. The margin can be reduced to 2.0, 2.2, and 3.0mm in the x-, y-, and z-direction, respectively, with NAL and 1.6, 1.7, and 2.2mm in the x-, y-, and z-direction, respectively, with eNAL protocol. The results obtained were verified to be the same with the margins calculated using an Excel spreadsheet. The algorithm calculates the weekly offline setup error correction values automatically and reduces the risk of input data error observed in the spreadsheet.
In conclusion, the algorithm provides an automated method for optimization and reduction of PTV margin using logged setup errors from CBCT-based IGRT.
In conclusion, the algorithm provides an automated method for optimization and reduction of PTV margin using logged setup errors from CBCT-based IGRT.
The somatic BRAF
mutation occurs in 38-64% of pediatric cases of Langerhans cell histiocytosis (LCH). Vorinostat Vemurafenib (VMF), a BRAF inhibitor, was approved for refractory BRAF
mutated LCH. In adults, VMF causes frequent cutaneous adverse events (CAE) including skin tumors (squamous cell carcinomas, melanomas), but little is known in children. The objective of this study was to evaluate the frequency, clinical spectrum, and severity of CAEs in children treated with VMF for LCH. In addition, a correlation between CAE occurrence and VMF dose, residual plasma levels (RPLs), and efficacy was searched for.
Multicentric retrospective observational study including patients <18years treated with VMF alone for refractory BRAF
mutated LCH in 13 countries between October 1, 2013 and December 31, 2018.
Fifty-seven patients 56% female, median age 2.1years (0.2-14.6), median treatment duration 4.1months (1.4-29.7). Forty-one patients (72%) had at least one CAE photosensitivity (40%), keratosis pilaris (32%), rash (26%), xerosis (21%), and neutrophilic panniculitis (16%). No skin tumor was observed. Five percent of CAEs were grade 3. None were grade 4 or led to permanent VMF discontinuation. Dose reduction was necessary for 12% of patients, temporary treatment discontinuation for 16%, none leading to loss of efficacy. VMF dose, median RPL, and efficacy were not correlated with CAE occurrence.
At doses used for pediatric LCH, CAEs are frequent but rarely severe and have little impact on the continuation of treatment when managed appropriately. Regular dermatological follow-up is essential to manage CAEs and screen for possible induced skin tumors.
At doses used for pediatric LCH, CAEs are frequent but rarely severe and have little impact on the continuation of treatment when managed appropriately. Regular dermatological follow-up is essential to manage CAEs and screen for possible induced skin tumors.This paper examines individual and societal duties to older adults in sub-Saharan Africa who reside in skipped generation households, which are households in which a young and old generation live together with the middle generation absent. As they age, older adults in skipped generation households may lack the prospect of social and economic support from offspring, making their situation precarious. If ill health results in an older adult's inability to work, who will support them? If they need assistance with basic activities of daily living, who will provide it? This paper addresses these questions through the lens of African ethics. Section I appeals to the African ethic of ubuntu ('humanness') to identify normative conceptions of persons and moral character relevant to skipped generation ethics. Section II elaborates this focus by means of the virtues of gratitude and reciprocity, discussing their conditions, requirements, and limits and comparing surrogate parent-child to parent-child cases. Section III explores the application of an ubuntu ethic to society as a whole and defines societal duties toward older adults by appealing to African conceptions of dignity and justice.According to the triangular love theory, this study investigated the roles of three components of love (i.e., passion, intimacy, commitment) and the moderating role of conflicts in predicting different forms of sexting (i.e., experimental, nonconsensual, under pressure) in teen dating relationships. Participants were 409 adolescents (Mage = 17.20, SDage = 1.61; 62.6% girls) who completed an online questionnaire. Three moderated regressions were performed. Conflicts positively predicted all forms of sexting. Passion positively predicted experimental sexting. Intimacy negatively predicted experimental and nonconsensual sexting, and positively predicted sexting under pressure. Three interaction effects emerged, pointing out the moderating role of conflicts. Passion positively predicted nonconsensual sexting in the presence of high conflicts, while this relationship became negative when conflicts were low. Commitment negatively predicted nonconsensual sexting and sexting under pressure in the presence of high conflicts, but these relationships were not significant when conflicts were low. Research and applicative implications are discussed.
