Quality assurance of 3D-CRT: indications and difficulties in their applications

Although more advanced techniques such as intensity-modulated radiotherapy are rapidly spreading, 3D conformal radiotherapy (3D-CRT) remains the standard of treatment for many diseases. The authors outline essential indications to guarantee the quality of 3D-CRT treatments. Criteria for clinical indications and potential clinical advantages and disadvantages of 3D-CRT technology are presented. After briefly listing human and technological resources requirements, procedures for 3D-CRT and physical aspects peculiar to 3D-CRT are described. Medical physics support activities are also considered, including suggestions concerning quality control protocols. Difficulties in the application of correct quality procedures, particularly related to human and technological resources, procedures for patient positioning, imaging, contouring, treatment planning, in vivo dosimetry, set-up verification, follow-up, dose delivery are then discussed.     

Data Mining Technologies for Blood Glucose and Diabetes Management

Data mining is the process of selecting, exploring, and modeling large amounts of data to discover unknown patterns or relationships useful to the data analyst. This article describes applications of data mining for the analysis of blood glucose and diabetes mellitus data. The diabetes management context is particularly well suited to a data mining approach. The availability of electronic health records and monitoring facilities, including telemedicine programs, is leading to accumulating huge data sets that are accessible to physicians, practitioners, and health care decision makers. Moreover, because diabetes is a lifelong disease, even data available for an individual patient may be massive and difficult to interpret. Finally, the capability of interpreting blood glucose readings is important not only in diabetes monitoring but also when monitoring patients in intensive care units. This article describes and illustrates work that has been carried out in our institutions in two areas in which data mining has a significant potential utility to researchers and clinical practitioners: analysis of (i) blood glucose home monitoring data of diabetes mellitus patients and (ii) blood glucose monitoring data from hospitalized intensive care unit patients.     

Exocrine pancreatic function during the early recovery phase of acute pancreatitis

BACKGROUND:Exocrine pancreatic dysfunction has been reported in humans in the convalescent period after acute pancreatitis,but the data are scarce and conflicting.This study aimed to prospectively assess the exocrine pancreatic function in patients with acute pancreatitis at the time of their refeeding. METHODS:Fecal elastase-1 was determined on the day of refeeding in all consecutive acute pancreatitis patients with their first episode of the disease.They were 75 patients including 60(80.0%)patients with m...     

Thalidomide-dexamethasone versus Interferon-alpha-dexamethasone as maintenance treatment after ThaDD induction for multiple myeloma: a prospective, multicentre, randomised study

Maintenance therapy was explored in multiple myeloma (MM) patients after conventional thalidomide, dexamethasone and pegylated liposomal doxorubicin (ThaDD). Patients with newly or relapsed MM obtaining at least minor response after 6 ThaDD courses, were randomised to receive α-interferon (IFN) 3 MU 3 times a week or thalidomide 100 mg daily until relapse. Both groups also received pulsed dexamethasone 20 mg 4 d a month. Fifty-one patients were randomized in the IFN-dexamethasone (ID) arm and 52 in the thalidomide-dexamethasone (TD) arm. The characteristics of two groups were similar. A significantly better 2-years progression-free survival (PFS; 63% vs. 32%; P  = 0·024) and overall survival (84% vs. 68%; P  = 0·030) was observed in the thalidomide arm. In high-risk patients and in those achieving less than very good partial response after induction, TD fared better in term of PFS. Main side effects were peripheral neuropathy and constipation in TD group, fatigue, anorexia and haematological toxicity in ID arm. There was a 21% probability of discontinuation at 3 years in the thalidomide arm and 44% in the IFN arm ( P  = 0·014). Low-dose thalidomide plus pulsed low-dose dexamethasone after conventional thalidomide combination-based therapy was also feasible in the long term, enabling significantly better residual disease control if compared with a standard maintenance therapy.     

Molecular Epidemiology of Multidrug-Resistant Acinetobacter baumannii in a Tertiary Care Hospital in Naples,Italy, Shows the Emergence of a Novel Epidemic Clone

The molecular epidemiology of multidrug-resistant Acinetobacter baumannii was investigated in two intensive care units of the V. Monaldi university hospital in Naples, Italy, from May 2006 to December 2007. Genotype analysis by pulsed-field gel electrophoresis (PFGE), trilocus sequence-based typing (3LST), and multilocus sequence typing (MLST) of A. baumannii isolates from 71 patients identified two distinct genotypes, one assigned to PFGE group A, 3LST group 1, and ST2 in 14 patients and the other to PFGE group B, 3LST group 6, and ST78 in 71 patients, that we named ST2/A and ST78/B, respectively. Of these, ST2/A corresponded to European clone II identified in the same hospital during 2003 and 2004; ST78/B was a novel genotype that was isolated for the first time in May 2006 but became prevalent during 2007. The ST78/B profile was also identified in five patients from two additional hospitals in Naples during 2007. The ST2/A and ST78/B isolates were resistant to all antimicrobials tested, including carbapenems, but were susceptible to colistin. Both ST2/A and ST78/B isolates possessed a plasmid-borne carbapenem-hydrolyzing oxacillinase gene, bla_OXA-58, flanked by ISAba2 and ISAba3 elements at the 5′ and 3′ ends, respectively. The selection of the novel ST78/B A. baumannii clone might have been favored by the acquisition of the bla_OXA-58 gene.Acinetobacter baumannii is an emerging opportunistic nosocomial pathogen, with increasing prevalence worldwide, responsible for a variety of nosocomial infections, especially in intensive care unit (ICU) patients (10, 15). Several hospital outbreaks caused by the selection of multiresistant A. baumannii clones have been described in Europe and worldwide (1, 10, 15, 27). Genotypic characterization of epidemic A. baumannii isolates through amplified fragment length polymorphism analysis has identified clusters of highly similar strains, which were assumed to represent distinct clonal lineages and were defined as European clones I, II, and III (9, 24). Similarly, three distinct groups were recently identified among A. baumannii isolates from five different countries by sequence-based typing (ST): group 1, corresponding to European clone II; group 2, corresponding to European clone I; and group 3, corresponding to European clone III (22). Moreover, epidemics caused by A. baumannii genotypes assigned to novel ST groups 4 and 5 have been recently described in different Greek and Turkish cities (11). The majority of the outbreaks occurring in Europe were caused by carbapenem-resistant strains that carried the bla_OXA-58 gene or a distinct carbapenem-hydrolyzing oxacillinase (CHDL) gene (4, 8, 11-13, 16, 20, 27, 28).We have previously reported the occurrence of two sequential outbreaks from August 1999 to February 2001 and from January 2002 to December 2002 along with the emergence of carbapenem-resistant A. baumannii in the ICU of the Federico II university hospitals in Naples, Italy, during 2002 (26). More recently, we have shown that the same epidemic A. baumannii clone isolated during 2002 was responsible for a large and sustained outbreak in the V. Monaldi tertiary care teaching hospital of Naples between June 2003 and June 2004 (25). An increase in the number of cases of A. baumannii infection was observed after 2 years in the V. Monaldi hospital. The objectives of the present study were (i) to investigate the molecular epidemiology of A. baumannii in the V. Monaldi hospital, (ii) to study the genetic characteristics of A. baumannii isolates responsible for the epidemic, and (iii) to analyze the antimicrobial susceptibilities of the A. baumannii isolates and their mechanisms of resistance.     

Is math lateralised on the same side as language? Right hemisphere aphasia and mathematical abilities

The main purpose of the present study was to learn how mathematical abilities are located and develop in the brain with respect to language. Mathematical abilities were assessed in six right-handed patients affected by aphasia following a lesion to their non-dominant hemisphere (crossed aphasia) and in two left-handed aphasics with a right-sided lesion. Acalculia, although in different degrees, was found in all cases. The type of acalculia depended on the type of aphasia, following patterns that have been previously observed in the most common aphasias resulting from left hemisphere lesions. No sign of right hemisphere or spatial acalculia (acalculia in left lateralised right-handed subjects) was detected. These results suggest that, as a rule, language and calculation share the same hemisphere. A primitive computational mechanism capable of recursion may be the precursor of both functions.     

Preparation and Characterization of Hybrid Nanocomposites Coated on LDPE

Summary: Hybrid organic‐inorganic nanocomposites containing hyperbranched structures were prepared through a dual‐curing process, which involves photopolymerization and condensation alkoxysilane groups. In particular, an oligomer containing PEO units and α,ω‐methacrylate groups was used together with a HBP bearing acrylic groups as the organic phase precursors. MEMO, as the organic‐inorganic linker, and TEOS, as inorganic phase precursor, were also employed. The kinetics of both photopolymerization and condensation reactions were investigated by double bond conversion analysis (via FT‐IR) and weight loss determination, respectively. The mobility of the organic phase was studied by means of DSC and DMTA and correlated with hybrid composition. TEM analyses performed on microtomed film slices indicated the formation of nanoscale silica domains. Hybrids were coated onto an LDPE film previously subjected to a plasma treatment, and substrate‐coating interfacial adhesion was investigated through stress‐strain and DMTA experiments.

Reaction scheme showing the insertion of furanic units in copolyester chains by ester interchange reaction.