Examination of formula for enhanced dynamic wedge factors in half fields

The method presented by Liu et al. in 1998 has generally been used in Japan to calculate the wedge factor of the enhanced dynamic wedge (EDW). When the points used to evaluate the dose exist outside the central beam axis in the half field (HF), however, a difference of about 3% can occur between the values calculated by this method and the measured values. In 2003, Liu et al. presented a new general formula for calculating MU using the EDW. We modified the formula for calculating the wedge factor by combining the conventional calculation formula and the formula of Liu et al., presented in 2003, and compared the calculated values of the wedge factor of the EDW in the HF with the measured values. Our formula employs a very simple method in which only the normalized golden segmented treatment table (NGSTT) on the center of the radiation field and the central beam axis are added to the existing formula. The values calculated by our formula and the measured values were consistent within 1% in most combinations of energy, wedge angle, and size of radiation field. When the EDW was used for irradiation to the tangent line of the HF breast, in particular, the values calculated by our formula and the measured values were consistent within 0.5%, and it was possible to calculate the wedge factor with a higher degree of accuracy than that calculated with the existing formula.     

Effect of resuscitative endovascular balloon occlusion of the aorta in hemodynamically unstable patients with multiple severe torso trauma: a retrospective study

Background

Although resuscitative endovascular balloon occlusion of the aorta (REBOA) may be effective in trauma management, its effect in patients with severe multiple torso trauma remains unclear.

Methods

We performed a retrospective study to evaluate trauma management with REBOA in hemodynamically unstable patients with severe multiple trauma. Of 5899 severe trauma patients admitted to our hospital between January 2011 and January 2018, we selected 107 patients with severe torso trauma (Injury Severity Score >?16) who displayed persistent hypotension [≥?2 systolic blood pressure (SBP) values ≤?90 mmHg] regardless of primary resuscitation. Patients were divided into two groups: trauma management with REBOA (n?=?15) and without REBOA (n?=?92). The primary endpoint was the effectiveness of trauma management with REBOA with respect to in-hospital mortality. Secondary endpoints included time from arrival to the start of hemostasis. Multivariable logistic regression analysis, adjusted for clinically important variables, was performed to evaluate clinical outcomes.

Results

Trauma management with REBOA was significantly associated with decreased mortality (adjusted odds ratio of survival, 7.430; 95% confidence interval, 1.081–51.062; p?=?0.041). The median time (interquartile range) from admission to initiation of hemostasis was not significantly different between the two groups [with REBOA 53.0 (40.0–80.3) min vs. without REBOA 57.0 (35.0–100.0) min ]. The time from arrival to the start of balloon occlusion was 55.7?±?34.2 min. SBP before insertion of REBOA was 48.2?±?10.5 mmHg. Total balloon occlusion time was 32.5?±?18.2 min.

Conclusions

The use of REBOA without a delay in initiating resuscitative hemostasis may improve the outcomes in patients with multiple severe torso trauma. However, optimal use may be essential for success.

     

Serum testosterone level as possible predictive marker in androgen receptor axis-targeting agents and taxane chemotherapies for castration-resistant prostate cancer

Purpose

Currently, several therapeutic options for castration-resistant prostate cancer (CRPC) are available, for which predictive biomarkers have not been established. Therefore, we aimed to reveal the association between pretreatment serum testosterone level and antitumor outcomes when treated with androgen receptor axis-targeting agents and taxane chemotherapies for CRPC.

Posterior shoulder dislocation associated with fracture of the humeral anatomic neck: treatment guidelines and long-term outcome

OBJECTIVE: We describe here 10 cases of posterior shoulder dislocation associated with fracture of the humeral anatomic neck. METHODS: Patients were treated according to our uniform treatment guidelines, in which only the dislocated humeral head (closed, if possible) was reduced, without any concomitant repositioning or internal fixation for fractures. RESULTS: Reduction resulted in an acceptable repositioning of the fractured fragments in all but one case. Anatomic neck fractures were impacted by applying longitudinal pressure for stabilization. Although early physiotherapy was initiated, redisplacement of the bone fragments did not occur. Of nine patients who were followed for more than 2 years, complete recovery of function was achieved in all but two patients. The completely detached humeral head became avascular necrotic accompanied by subchondral collapse in one case, and in the other case the displaced lesser tuberosity caused a decreased range of movement. CONCLUSION: We recommend initially treating such patients by either open or closed reduction of the dislocated humeral head and impaction of the fracture, with neither repositioning nor internal fixation of any of the fractured fragments. A completely detached humeral head or bone fragments displaced more than 10 mm after reduction of the dislocated humeral head contraindicate the use of this method.     

Age estimation by quantitative features of pubic symphysis using multidetector computed tomography

Macroscopic assessment of the pubic symphysis is commonly used for age estimation because its surface changes over time. However, postmortem computed tomography (PMCT), a method several forensic medical departments and institutes have begun to adopt, has the potential to simplify the information gathering process from the pelvic bone without requiring soft tissue removal. Some studies have previously evaluated the use of three-dimensional images of the pubic symphysis, but because of variance in the graphics processing among image analysis software packages, certain differences have been observed between these studies. Therefore, in this study, the PMCT findings of 199 subjects of known age and sex were retrospectively reviewed to examine the feasibility of age estimation using planar images of the pubic bones and soft tissue. The coronal and axial sectional images were observed at the center of the symphyseal surface, and the pubic bone length and thickness of the connective tissue of the pubic symphysis were measured at each slice. Our results revealed a significant positive correlation between the length of the pubic bone of the coronal section and age, suggesting that the use of a cutoff value for pubic bone length might be feasible for age estimations. In addition, the thickness of the connective tissue tended to narrow over time. Although the prediction interval range of planar images obtained by PMCT was major and is not usable in practice at this moment, it may still be a useful tool if used in conjunction with other findings obtained by PMCT.     

The Effect of Lateral Shift of Cricoid Cartilage on Pharyngeal Swallowing

Head rotation is widely used as one of the postural techniques for dysphagic patients. However, it cannot be used for patients with severe limitations to the range of motion of the neck. The purpose of this study was to determine the effect of applying pressure to the cricoid while swallowing and to explore the possibility of this maneuver as an alternative to head rotation. The swallowing function of 12 volunteers was examined with videofluorography under nine conditions: neutral, head rotated to the right, head rotated to the left, applying pressure to the cricoid on the right side at 5, 10, and 15 N, and applying pressure to the cricoid on the left side at 5, 10, and 15 N. To examine the effect of this maneuver on pharyngeal swallowing, the laterality of bolus flow was evaluated using 3 ml barium thin liquid from the posterior-anterior (P-A) view. The “pressing-cricoid” maneuver significantly altered the laterality of the bolus flow; the bolus flow was shifted to the side opposite to which the pressure was applied. The results of these changes were similar to those achieved with head rotation. These results demonstrated that the “pressing-cricoid” maneuver changes the bolus flow. This maneuver may have therapeutic value for the treatment of dysphagic patients as an alternative to head rotation.