Mayovalencia8307

To compare the dosimetric performances of small-spot three-dimensional (3D) and four-dimensional (4D) robustly optimized intensity-modulated proton (IMPT) plans in the presence of uncertainties and interplay effect simultaneously for distal esophageal carcinoma.

Thirteen (13) patients were selected and re-planned with small-spot (





σ



~2-6mm) 3D and 4D robust optimization in IMPT, respectively. The internal clinical target volumes (CTV

, CTV

) were used in 3D robust optimization. Different CTVs (CTV

, CTV

) were generated by subtracting an inner margin of the motion amplitudes in three cardinal directions from the internal CTVs and used in 4D robust optimization. All patients were prescribed the same dose to CTVs (50Gy[RBE] for CTV

/CTV

and 45Gy[RBE] for CTV

/CTV

). Dose-volume histogram (DVH) indices were calculated to assess plan quality. Comprehensive plan robustness evaluations that consisted of 300 perturbed scenarios (10 different motion patterns to consider irregular motal esophageal carcinoma with small spots in IMPT.

Even with small spots in IMPT, 4D robust optimization outperformed 3D robust optimization in terms of normal tissue protection and robustness to uncertainties and interplay effect simultaneously. Our findings support the use of 4D robust optimization to treat distal esophageal carcinoma with small spots in IMPT.Mature neotropical lowland forests have relatively lower symbiotic nitrogen fixation (SNF) rates compared with secondary forests. Canopy gap formation may create transient SNF hotspots in mature forests that increase overall SNF rates in these ecosystems, as canopy gaps are pervasive across the landscape and increasing in frequency. However, what environmental conditions are driving SNF upregulation in canopy gaps is unknown. In a field experiment to test these potential environmental controls on SNF, we grew 540 neotropical nitrogen-fixing legume seedlings (Pentaclethra macroloba, Zygia longifolia, and Stryphnodendron microstachyum) under manipulated light and soil nitrogen availability in canopy gaps and intact forests at La Selva Biological Station, Costa Rica. Seedling biomass, nodule biomass, and SNF (g N seedling-1  h-1 ) were 4-, 17- and 42-fold higher, respectively, in canopy gaps than in the intact forest. Nitrogen additions decreased SNF, but light had a stronger positive effect. Upregulation of SNF in canopy gaps was driven by increased plant growth and not a disproportionate increased SNF allocation. These data provide evidence that canopy gap SNF hotspots are driven, in part, by light availability, demonstrating a potential driver of SNF spatial heterogeneity. This further suggests that canopy gap dynamics are important for understanding the biogeochemistry of neotropical forests.

The controversy on the best surgical approach for vesicovaginal fistula (VVF) repair remains due to the scarcity of high-level evidences. We aim to analyze the efficacy and safety of the laparoscopic transvesical (LT) and laparoscopic extravesical (LE) approaches to posthysterectomy VVF (PH-VVF).

Data of 64 patients with PH-VVFs who were laparoscopicly treated in the First Affiliated Hospital of Nanchang University and the Hangzhou Third Hospital from January 2011 to November 2019 were retrospectively collected. The operative time (OT), estimated bleeding volume (EBV), postoperative bladder function and complications, hospital stay length (HSL), surgery success rate, and recurrence were compared between the two groups.

In all, there were no significant differences in baseline characteristics between those two arms. Both approaches were successfully performed without open conversion in either group. The LT group was significantly corrected with a shorter mean OT than the LE group (p < 0.001), regardless of the fistula's position. No significant differences existed in the mean EBV and HSL between the two interventions (p = 0.136 and p = 0.210, respectively). The tendency of postoperative complications and success rates of surgery were also comparable in both groups. The patients in the LT group had similar bladder functions to those in LE group. The recurrence occurred in one patient in each arm during the follow-up periods of 12-36 months.

The LT approach is significantly related to a shorter OT than the LE approach without compromising the safety and success rates in repairing PH-VVF.

The LT approach is significantly related to a shorter OT than the LE approach without compromising the safety and success rates in repairing PH-VVF.

Plasma is frequently administered to patients with prolonged INR prior to invasive procedures. However, there is limited evidence evaluating efficacy and safety.

We performed a pilot trial in hospitalized patients with INR between 1.5 and 2.5 undergoing procedures conducted outside the operating room. We excluded patients undergoing procedures proximal to the central nervous system, platelet counts <40,000/μl, or congenital or acquired coagulation disorders unresponsive to plasma. We randomly allocated patients stratified by hospital and history of cirrhosis to receive plasma transfusion (10-15 cc/kg) or no transfusion. The primary outcome was change in hemoglobin concentration within 2 days of procedure.

We enrolled 57 patients, mean age 56.0, 34 (59.6%) with cirrhosis, and mean INR 1.92 (SD=0.27). In the intention to treat analysis, there were 10 of 27 (38.5%) participants in the plasma arm with a post procedure INR <1.5 and one of 30 (3.6%) in the no treatment arm (p < .01). The mean INR after receiving plasma transfusion was -0.24 (SD 0.26) lower than baseline. The change from pre-procedure hemoglobin level to lowest level within 2 days was -0.6 (SD=1.0) in the plasma transfusion arm and -0.4 (SD=0.6) in the no transfusion arm (p=.29). selleck kinase inhibitor Adverse outcomes were uncommon.

We found no differences in change in hemoglobin concentration in those treated with plasma compared to no treatment. The change in INR was small and corrected to less than 1.5 in minority of patients. Large trials are required to establish if plasma is safe and efficacious.

We found no differences in change in hemoglobin concentration in those treated with plasma compared to no treatment. The change in INR was small and corrected to less than 1.5 in minority of patients. Large trials are required to establish if plasma is safe and efficacious.