Comparison of the Effect of Different Bonding Agents on the Microleakage of Two Hydrophilic Pit and Fissure Sealants: An Ex Vivo Study.

Aim: To compare the impact of fifth- and seventh-generation bonding agents on the microleakage between Embrace WetBond sealants and Ionoseal. Materials and methods: Forty extracted human premolar teeth were used for the study and grouped according to different sealants and bonding agents-group I: Embrace WetBond sealant with fifth-generation bonding agent; group II: Embrace WetBond sealant with seventh-generation bonding agent; group III: Ionoseal with fifth-generation bonding agent; group IV: Ionoseal with seventh-generation bonding agent. For microleakage evaluation, all the teeth were subjected to invasive sealant placement using the respective sealant materials in combination with bonding agents as specified. The treated teeth were stored at 37°C for 24 hours and then thermocycled for 100 cycles at temperatures of 5°C and 55°C with a dwell time of 30 seconds. In order to assess microleakage, the samples were immersed in 0.2% methylene blue dye for 24 hours, then sectioned in buccolingual direction, and evaluated under stereomicroscope. Results: The mean microleakage scores in group III were highest at 0.90 ± 0.57, while the least was in group IV at 0.30 ± 0.68, indicating that Ionoseal with seventh-generation bonding agent was the most effective. However, when the mean microleakage scores of the four groups were compared using Kruskal-Wallis test, it indicated that the differences were not statistically significant. How to cite this article: V R, P P, A A, et al. Comparison of the Effect of Different Bonding Agents on the Microleakage of Two Hydrophilic Pit and Fissure Sealants: An Ex Vivo Study. Int J Clin Pediatr Dent 2024;17(3):270-273.

In vitro analysis of material micro-leakage in pit and fissure sealants.

A preferable choice of material offers superior resistance against micro-leakage for clinical applications in preventing dental caries in pits and fissures is of interest. A total of 45 extracted human premolars were cleaned, stored in a saline solution, and randomly divided into three groups, each intended for treatment with one of the sealants: Fuzi VII, ClinPro, and Embrace Wetbond. The application of the sealants followed the manufacturers' instructions strictly. The teeth were subjected to thermal cycling to simulate oral conditions. Marginal micro-leakage was then assessed by dye penetration method using a 0.5% methylene blue dye. Teeth were sectioned, and dye penetration was measured under a stereomicroscope. The results showed that all the tested materials exhibited some degree of micro-leakage. Within the limitations of this In vitro study, it was concluded that Embrace Wetbond exhibited superior performance in terms of minimizing marginal micro-leakage among the tested pit and fissure sealants.

EMBRACE (Empowering Medical students' skills in BReaking bAd news with Compassion and Empathy) module improves the skills of undergraduate medical students in effectively breaking the bad news: a case-control study.

Effective communication skills are pivotal in health care, particularly when conveying distressing information to patients and their families. However, medical education still lacks the adoption of a universal model that can be incorporated into the curricula to train and assess students in effectively communicating with patients. This study aims to assess the impact of training undergraduate medical students to deliver bad news effectively using the Empowering Medical students' skills in BReaking bAd news with Compassion and Empathy (EMBRACE) module. This randomized case-control study involved medical students from the first, second, and third professional years (study group, n = 75; control group, n = 75). For the study group, the EMBRACE modules were distributed. Then, a 1-hour training session on effectively delivering bad news was followed by a multiple-choice question test and objective structured clinical examination with response, interpretation, and communication skills stations. Participants' feedback was obtained on a five-point Likert scale. There was a highly significant improvement in knowledge and skills among the study group compared to controls with a P value less than 0.0001. Of the participants, 98.76% perceived that the training equipped them with practical skills, and 98.77% felt that the facilitator had demonstrated the steps of delivering bad news clearly and effectively. Only 4.44% of participants were confident in effectively interacting with patients before the session, and an overwhelming 81.11% gained confidence in their communication skills after the training. With demonstrated significant improvement in knowledge and skills, this study supports the adoption of EMBRACE modules in undergraduate medical education, ultimately improving patient experiences, doctor-patient relationships, and health outcomes.NEW & NOTEWORTHY The Empowering Medical students' skills in BReaking bAd news with Compassion and Empathy (EMBRACE) module is noteworthy for its holistic approach to training medical students in the delicate art of delivering distressing news to patients. It not only incorporates the evidence-based setting, perception, invitation, knowledge, emotions, and strategy (SPIKES) method but also distinguishes itself by providing real-life conversation examples and self-assessment cases, which make the training highly relatable and practical for students to actively engage in their learning and personal development.

Comparative Evaluation of Sealing Ability of Moisture-tolerant Sealant and Glass Ionomer Sealant Using Stereomicroscope: An In Vitro Study.

Introduction/background: The preventive benefits of pit and fissure sealants rely on their retention and sealing ability. The drawback of the conventional pit and fissure sealant is its poor retention due to the presence of moisture. Among the numerous pit and fissure sealants available, newer hydrophilic sealants are ideal for children. This study evaluates and compares the sealing ability of hydrophilic sealant Embrace WetBond with conventionally used glass ionomer sealant under a stereomicroscope. Materials and methods: A total of 48 extracted human premolars were randomly divided into two groups (N = 24) and sealed with Embrace WetBond and GC Fuji VII as per manufacturers' instructions. Following thermocycling, the sectioned samples were evaluated for sealant penetration, unfilled space, and total length of fissure under a stereomicroscope at magnifications 2.5×, 4×, and 5×. The values were measured in microns and in various fissure types using the "ImageJ app" to measure the sealant penetrability and sealing ability. The data recorded were statistically evaluated. Results: The penetrability of moisture-tolerant sealant was better (87.8 ± 10.7) compared to that of glass ionomer sealant (73.8 ± 15.5) (p = 0.002). Among the samples, U-type fissure patterns displayed greater penetrability (94.2 ± 6.2), whereas IK-type fissures revealed the lowest degree of penetrability (67.5 ± 7.3). Conclusion: Embrace WetBond is better than glass ionomer sealant with respect to penetrability and sealing ability under stereomicroscope hence recommended as a better sealant for pediatric clinical practice. How to cite this article: Priscilla S, Shivashankarappa PG, Mohandoss S, et al. Comparative Evaluation of Sealing Ability of Moisture-tolerant Sealant and Glass Ionomer Sealant Using Stereomicroscope: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-1):S67-S71.

Assessment of Embrace-WetBond and Fissurit F Pit and Fissure Sealants' Marginal Sealing Abilities.

Objectives: The goal of the current research was to assess marginal sealing abilities of 2 commercial pit and fissure sealants. Materials and Methods: A total of 30 premolar teeth were equally classified into 2 groups: Group A-application of Embrace-WetBond sealant and Group B-application of Fissurit F, Voco sealant. After sealant placement, samples were preserved in artificial saliva for 48 hours prior to thermocycling. Later, samples were submerged for 24 hours in a 2% methylene blue solution. The amount of microleakage based on the quantity of dye penetration at interface between the tooth substance and sealant was compared under an optical stereomicroscope. The obtained data were statistically analysed for the dye penetration scores in both groups. Result: It was observed that 8 samples from Group A (53%) had no dye penetration (Grade 0), whereas 4 samples from Group B (26%) showed Grade 0 penetration. In 5 out of 15 samples (33%) from Group B, the dye penetration was the greatest (Grade 3; P = 0.012). Conclusion: It was concluded that Embrace-WetBond had lesser microleakage compared to group 2-Fissurit F, Voco sealant.

Clinical Evaluation of Retention of Hydrophilic and Hydrophobic Pit and Fissure Sealants in Permanent First Molars: An 18 Months Follow-up: Randomized Controlled Trial.

Introduction: Deep pits and fissures are more prone to caries development due to their complex morphological anatomy. Preventive measures, such as pit and fissure sealants, can help in the reduction of dental caries. Conventional sealants being hydrophobic in nature, require isolation. Sealants which are hydrophilic have been introduced as an alternative where isolation is difficult to achieve. Aim: To compare and evaluate the retention and marginal integrity of hydrophilic pit and fissure sealant (Embrace WetBond) with hydrophobic pit and fissure sealant (Clinpro) in permanent first molars. Materials and methods: Sealants were applied randomly using the split-mouth design technique on 80 permanent first molars in children aged between 6 and 9 years and evaluation was done at 3, 6, 9, and 18 months. Results: The difference in retention rates between the groups was not significant using the Chi-squared test, though the WetBond group exhibited better results with 40% complete retention at the end of 18 months while in the Clinpro group, it was 37.50%. The marginal integrity in both the sealant groups was also found to be statistically insignificant. Caries incidence was found to be slightly higher in the Clinpro group. Conclusion: The clinical performance of Embrace WetBond was better when compared to Clinpro because of its moisture-tolerance capacity. Embrace Wetbond pit and fissure sealant can be the choice of material in cases where moisture control is a challenging issue. How to cite this article: Gyati O, Jain M, Sogi S, et al. Clinical Evaluation of Retention of Hydrophilic and Hydrophobic Pit and Fissure Sealants in Permanent First Molars: An 18 Months follow-up: Randomized Controlled Trial. Int J Clin Pediatr Dent 2023;16(2):350-356.

A Novel Flexible Fixation Method for Syndesmotic Injury.

BACKGROUND: This study aims to evaluate the results and the safety of a novel fixation method we developed for syndesmosis injuries that we call the "embrace" technique. METHODS: Between March 2018 and October 2020, a total of 67 patients with ankle fractures and syndesmotic injuries underwent syndesmosis fixation with the embrace technique at our institute. Plain radiographs and computed tomographic (CT) scans were obtained preoperatively. Postoperative radiographic assessment included anteroposterior (AP) and lateral radiographs and CT scans of both ankles. Additionally, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, Olerud-Molander Ankle Score, and visual analog scale (VAS) score were used for postoperative assessment. RESULTS: The mean age was 27.6 ± 10.9 (range, 14-56) years. The mean follow-up time was 30.3 ± 6.2 (range, 24-48) months. There were no malreductions indicated by any CT parameter except fibular rotation in a postoperative comparison between 2 sides. We found significant preoperative-postoperative changes in anterior difference, posterior difference, and fibular rotation but no significant preoperative-postoperative difference in fibular translation. There was no significant postoperative difference between the affected-side and normal-side measurements of any parameter. Complications included delayed wound healing, lateral pain because of wire knot irritation (11.9%), and medial fiber wire irritation (7.5%). The mean AOFAS, Olerud-Molander, and VAS scores at the last follow-up were 94.4 ± 6.8 (range, 84-100), 95.4 ± 6.1 (range, 80-100), and 0.68 ± 1.0 (range, 0-3) points, respectively. CONCLUSION: In our cohort, this novel technique proved to be an effective method for syndesmosis fixation in patients with ankle fractures associated with very good radiologic and patient-reported outcomes. LEVEL OF EVIDENCE: Level IV, case series.

A Comparative Evaluation of Shear Bond Strength of Embrace WetbondTM Pit and Fissure Sealant with or without the Use of a Universal Dental Adhesive System [ScotchbondTM Universal Adhesive] Using Different Bonding Protocols: A Multiparametric In Vitro Study.

Aim: To evaluate and compare the shear bond strength (SBS) of Embrace WetBondTM (EWS) Pit and Fissure Sealant (PF sealants) with or without the use of a universal dental adhesive system ScotchbondTM Universal Adhesive (SBU) using different bonding and curing protocols and to assess and compare the mode of failure as determined by visualization of the fractured surfaces of the test specimens after shear testing under an optical microscope at a magnification of 20×. Materials and methods: A total of 85 samples were prepared for testing SBS on enamel on caries-free, extracted permanent human molars. The specimens were randomly divided into five groups based on different bonding and curing protocols. A knife-edge blade in a universal testing machine was used to perform the SBS test with a crosshead speed of 1 mm/minute. Then the mode of failure was assessed. Statistical analysis: Results were analyzed using a one-way analysis of variance with Tukey's post hoc test and Chi-squared test. A probability value 0.05 (p ≤ 0.01) was regarded as significant. Results: ScotchbondTM Universal Adhesive (SBU) in total-etch (TE) mode/etch-and-rinse (ER) mode with individual light curing of the sealant and adhesive showed the highest SBS to enamel (5.40 ± 2.51 MPa). A predominance of cohesive mode of failure was observed for all the test groups. Conclusion: Embrace WetBondTM (EWS) PF sealants with SBU in the ER mode of application, with either curing mode, can be used as an alternative to a conventional technique for sealant placement for improving interfacial bond strength to enhance sealant retention and efficacy. Clinical significance: Embrace WetBondTM (EWS) PF sealants with SBU in the ER mode of application can be used as an alternative to a conventional technique for sealant placement for improving interfacial bond strength. How to cite this article: Swathy SR, Naidu J. A Comparative Evaluation of Shear Bond Strength of Embrace WetbondTM Pit and Fissure Sealant with or without the Use of a Universal Dental Adhesive System [ScotchbondTM Universal Adhesive] Using Different Bonding Protocols: A Multiparametric In Vitro Study. Int J Clin Pediatr Dent 2023;16(1):48-53.

Safety and efficacy of single insertion accelerated MR-image guided brachytherapy following chemo-radiation in locally advanced cervix cancer: modifying our EMBRACE during the COVID pandemic.

BACKGROUND: Utero-vaginal brachytherapy (BT) is an irreplaceable care component for the curative treatment of locally advanced cervix cancer (LACC). Magnetic Resonance Imaging (MRI)-image guided adaptive BT (IGABT) using the GYN-GEC-ESTRO EMBRACE guidelines is the international care standard. Usually following chemo-radiation therapy (CRT), IGABT has high proven utility in LACC but requires significant health system resources. Timely access was disrupted by the COVID-19 pandemic which challenged us to re-design our established IGABT care pathway. METHODS: From April 2020 consecutive patients with LACC were enrolled after CRT in a single arm exploratory non-inferiority study of a modified IGABT (mIGABT) protocol. This delivered an iso-effective IGABT dose (39.3 Gy: EQD2: α/ß10Gy concept) over a 24-h period during a single overnight hospitalisation. RESULTS: Fourteen LACC patients received mIGABT from April 2020 to March 2022. Median age was 62.5 years (37-82 years). LACC histology was primary squamous (9/14) or adeno-carcinoma (5/14). International Federation of Gynaecology and Obstetrics (FIGO) 2018 stages ranged from IB1/2 (N = 3), IIA1/IIB (5), IIIB (2), IIIC1/2 (4) with mean ± standard deviation (SD) gross tumour volume-at-diagnosis (GTV_D) of 37.7 cc ± 71.6 cc. All patients achieved complete metabolic, clinical, and cytologic cancer response with CRT and IGABT. High-risk HPV was cleared by 6-months. Complete MRI-defined cancer response before mIGABT (GTV_Fx1) was seen in 77% of cases (10/13). Only two women developed metastatic disease and one died at 12-months; 13 patients were alive without cancer at mean 20.3 ± 7.2 months follow-up. Actuarial 2-year overall survival was 93%. Compared with our pre-COVID IGABT program, overall mIGABT cost-saving in this cohort was USD 22,866. Prescribed dose covered at least 90% (D90) of the entire cervix and any residual cancer at time of BT (HRCTV_D90: high-risk clinical target volume) with 3-fractions of 8.5 Gy delivered over 24-h (22.8 ± 1.7 h). Total treatment time including CRT was 38 days. The mIGABT schedule was well tolerated and the entire cohort met EMBRACE recommended (EQD2: α/ß10Gy) combined HRCTV_D90 coverage of 87.5 ± 3.7 Gy. Similarly, organ-at-risk (OAR) median: interquartile range D2cc constraints (EQD2: α/ß3Gy) were EMBRACE compliant: bladder (65.9 Gy: 58.4-72.5 Gy), rectum (59.1 Gy: 55.7-61.8 Gy), and sigmoid colon (54.6 Gy: 50.3-58.9 Gy). ICRU recto-vaginal point dose was significantly higher (75.7 Gy) in our only case of severe (G4) pelvic toxicity. CONCLUSIONS: This study demonstrated the utility of mIGABT and VMAT CRT in a small cohort with LACC. Loco-regional control was achieved in all cases with minimal emergent toxicity. Single insertion mIGABT was logistically efficient, cost-saving, and patient-centric during the COVID-19 pandemic.

A 1-Tesla MRI system for dedicated brain imaging in the neonatal intensive care unit.

Objective: To assess the feasibility of a point-of-care 1-Tesla MRI for identification of intracranial pathologies within neonatal intensive care units (NICUs). Methods: Clinical findings and point-of-care 1-Tesla MRI imaging findings of NICU patients (1/2021 to 6/2022) were evaluated and compared with other imaging modalities when available. Results: A total of 60 infants had point-of-care 1-Tesla MRI; one scan was incompletely terminated due to motion. The average gestational age at scan time was 38.5 ± 2.3 weeks. Transcranial ultrasound (n = 46), 3-Tesla MRI (n = 3), or both (n = 4) were available for comparison in 53 (88%) infants. The most common indications for point-of-care 1-Tesla MRI were term corrected age scan for extremely preterm neonates (born at greater than 28 weeks gestation age, 42%), intraventricular hemorrhage (IVH) follow-up (33%), and suspected hypoxic injury (18%). The point-of-care 1-Tesla scan could identify ischemic lesions in two infants with suspected hypoxic injury, confirmed by follow-up 3-Tesla MRI. Using 3-Tesla MRI, two lesions were identified that were not visualized on point-of-care 1-Tesla scan: (1) punctate parenchymal injury versus microhemorrhage; and (2) small layering IVH in an incomplete point-of-care 1-Tesla MRI with only DWI/ADC series, but detectable on the follow-up 3-Tesla ADC series. However, point-of-care 1-Tesla MRI could identify parenchymal microhemorrhages, which were not visualized on ultrasound. Conclusion: Although limited by field strength, pulse sequences, and patient weight (4.5 kg)/head circumference (38 cm) restrictions, the Embrace® point-of-care 1-Tesla MRI can identify clinically relevant intracranial pathologies in infants within a NICU setting.

Let the Farmers Embrace "Carbon Neutrality": Taking the Centralized Biogas as an Example.

The promotion of rural centrally produced biogas (CPB) is an effective carbon neutrality development solution in rural areas. How to better encourage farmers to adopt such products is an important part of the sustainable development of a project. For this reason, focus is needed on the "willingness to embrace (WTE)" and "Willingness to motivate (WTM)" of rural residents for CPB projects and their influencing factors. We chose to conduct questionnaire surveys in rural areas of the Hebei and Shandong provinces of China, using the contingent valuation method (CVM). The results show that 85% of the respondents support CPB. Compared with urban gas, the subsidy demand of rural residents for CPB is 56.78%. The influencing factors of the residents' WTE are affected by the number of children in the family, whether the village cadres are installed in the family, solar water heaters installed in the family, knowledge and attitudes towards environmental protection, and the embracing of daily energy habits. The influencing factors on the residents' WTM are age, education level, ownership of arable land, knowledge of environmental protection, etc. Therefore, we propose policy recommendations. First, we must fully understand the willingness and demands of farmers, adopt a reasonable compensation response mechanism, and scientifically calculate financial inputs. The second step is to guide farmers through multi-channel publicity. Third, we aim to improve project operation efficiency, reduce operating costs, and minimize the government's financial burden on the basis of ensuring that farmers' demands are considered in a coordinated manner.

Tension offloading improves cutaneous scar formation in Achilles tendon repair.

Hypertrophic scar formation and non-healing wounds following Achilles tendon repair arise from poor vascularity to the incisional site or from excess mechanical stress/strain to the incision during the healing process. The embrace® scar therapy dressing is a tension offloading device for incisional scars. This study explored the effects of tension offloading during Achilles scar formation. A healthy 30-year-old male without any medical co-morbidities developed an acute rupture of his left Achilles tendon. The patient underwent open repair 1 week after injury. At post-operative day (POD) 14, the patient started daily tension offloading treatment on the inferior portion of the incision through POD 120. By POD 120, the untreated portion of the Achilles incision appeared hypertrophic and hyperpigmented, while the treated portion of the scar appeared flat with minimal pigmentation changes. The 12-week treatment of tension offloading on an Achilles tendon repair incision significantly improved cosmesis compared to untreated incision.

Feasibility of electronic brachytherapy in cervix cancer-A dosimetric comparison of different brachytherapy techniques.

INTRODUCTION: This study analyzes cases in which electronic brachytherapy (eBT) led to acceptable treatment plans in cervical cancer. Findings were compared with dosimetry values obtained in 192Ir-based treatments according to the high-risk clinical target volume (HR-CTV) and the disease stage. MATERIAL AND METHODS: We retrospectively analyzed 48 patients with cervical cancer from two centers. The patients were treated with 192Ir based on MRI. It was possible to use interstitial needles via an Utrecht-type applicator. Dosimetry was simulated using eBT and the parameters D90 and D98 (HR-CTV) and D2cc, D1cc, and D0.1cc (bladder, rectum, and sigmoid colon) were evaluated. The Mann-Whitney U test was used for comparison. The overall cohort of patients was analyzed, as were the sub-cohorts based on stage (FIGO stages I+IIA, IIB and III-IV). Finally, the dosimetry of the eBT plans was evaluated, and the plans obtained were classified as "good", "acceptable", or "poor". RESULTS: Statistically significant differences were found between the eBT and 192Ir plans for D98 (HR-CTV), D1cc and D0.1cc (bladder), and D1cc and D0.1cc (sigmoid colon). A total of 31 cases (64.6%) were considered good, seven (14.6%) were considered acceptable, and 10 (20.8%) were considered poor. For volumes <30 cc, all the plans were good or acceptable; for volumes >30 cc, 54.3% were good, and 71.4% were good or acceptable. By stage, eBT plans for patients with stage IB-IIA disease were good in 100%, whereas those for patients with stage IIB were good in 70.6% and III-IV disease were good in 50%. CONCLUSIONS: eBT provides appropriate dosimetry for treatment of cervical cancer in selected cases.

Dose-effect relationship between vaginal dose points and vaginal stenosis in cervical cancer: An EMBRACE-I sub-study.

BACKGROUND AND PURPOSE: To evaluate dose-effect relationships between vaginal dose points and vaginal stenosis in patients treated for locally advanced cervical cancer with radio(chemo)therapy and image-guided adaptive brachytherapy. MATERIAL AND METHODS: Patients from six centres participating in the EMBRACE-I study were included. Information on doses to different vaginal dose points, including the Posterior-Inferior Border of Symphysis (PIBS) points and recto-vaginal reference (RV-RP) point, were retrieved from the treatment planning system. In addition, the vaginal reference length (VRL) was evaluated. Vaginal stenosis was prospectively assessed according to the CTCAEv3.0 system at baseline and follow-up. Primary endpoint was grade 2 or higher (G ≥ 2) vaginal stenosis. Impact of dose to the vaginal dose points, and impact of VRL, age, vaginal involvement and applicator on vaginal stenosis G ≥ 2 was evaluated with a Cox proportional-hazard regression model. RESULTS: 301 patients were included. Median follow-up was 49 months. During follow-up, the incidence of G0, G1, G2, and G3 vaginal stenosis was 25% (76), 52% (158), 20% (59) and 3% (8), respectively. Median total doses to PIBS+2 cm, PIBS, PIBS-2 cm and the RV-RP were 52.9 (IQR 49.3-64.7), 41.0 (IQR 15.4-49.0), 4.1 (IQR 2.9-7.0) and 64.6 (IQR 60.0-70.6) Gy EQD23, respectively. Higher doses to the PIBS, PIBS + 2 cm and RV-RP points were significantly associated with increased risk for vaginal stenosis G ≥ 2. Other risk factors for vaginal stenosis were: vaginal involvement at diagnosis, higher age, shorter VRL and use of a tandem-ovoid applicator. CONCLUSION: Higher doses to the PIBS+2 cm, PIBS and RV-RP dose points are associated with vaginal stenosis G ≥ 2.

The role of pre-treatment paraaortic surgical staging for cervical cancer in the EMBRACE criteria.

Background: The State-of-the-Art Treatment for Locally Advanced Cervical Cancer (LACC) is Definite Radio-Chemotherapy based on the Image-guided intensity modulated External beam radiochemotherapy and MRI-based adaptive BRAchytherapy (EMBRACE) trial, according to the FIGO staging. This staging is based on clinical examination and imaging studies; however, there are limitations of imaging techniques which may result in adverse events or death due to insufficient or overtreatment. The aim of the study was to evaluate the feasibility and outcomes of surgical staging in LACC prior to radiotherapy (RT) to personalise target volumes for radiotherapy. Methods: From 2008 to 2018, 138 patients with FIGO 2018 stages IB3-IIIC2 cervical cancer underwent a pretherapeutic laparoscopic staging procedure. The pathological diagnosis was compared with the results of preoperative CT scan. Patients were treated with chemoradiotherapy tailored according to the staging results. Results: The mean patient age was 43 years, the mean body mass index was 27 kg/m2; most lesions were squamous cervical cancer (92%). Staging CT scan had a 77% concordance with the histological findings. Sensitivity was 29%, specificity 85%, positive predictive value 21% and negative predictive value 89%. Surgical staging led to change of stage in 24% of cases. Para -aortic dissection led to change the initially planned radiotherapy fields in 47% of the cases. Major complications included involuntary section of the inferior mesenteric artery (IMA) without clinical repercussion, an infected retroperitoneal haematoma and a symptomatic lymphocele requiring laparoscopic drainage. Conclusion: Laparoscopic staging before primary chemoradiation in patients with LACC was feasible, safe and reproducible, allowing reduction of the radiotherapy treatment volumes of patients.

High-dose-rate brachytherapy boost for locally advanced cervical cancer: Oncological outcome and toxicity analysis of 4 fractionation schemes.

PURPOSE: Brachytherapy (BT) boost after radio-chemotherapy (RCT) is a standard of care in the management of locally advanced cervical cancer (LACC). As there is no consensus on high-dose-rate (HDR) BT fractionation schemes, our aim was to report the oncological outcome and toxicity profile of four different schemes using twice-a-day (BID) HDR-BT. PATIENTS AND METHODS: This was an observational, retrospective, single institution study for patients with LACC receiving a HDR-BT boost. The latter was performed with a single implant and single imaging done on day 1. The different fractionation schemes were: 7 Gy + 4x3.5 Gy (group 1); 7 Gy + 4x4.5 Gy (group 2); 3x7Gy (group 3) and 3x8Gy (group 4). Local (LFS), nodal (NFS) and metastatic (MFS) recurrence-free survival as well as progression-free survival (PFS) and overall survival (OS) were analyzed. Acute (≤6 months) and late toxicities (>6 months) were reported. RESULTS: From 2007 to 2018, 191 patients were included. Median follow-up was 57 months [45-132] and median EQD210D90CTVHR was 84, 82 and 90 Gy for groups 2, 3 and 4 respectively (dosimetric data missing for group 1). The 5-year LFS, NFS, MFS, PFS and OS were 85% [81-90], 83% [79-86], 70% [67-73], 61% [57-64] and 75% [69-78] respectively, with no significant difference between the groups. EQD210D90CTVHR < 85 Gy was a prognostic factor for local recurrence in univariate analysis (p = 0.045). The rates of acute/late grade ≥ 2 urinary, digestive and gynecological toxicities were 9%/15%, 3%/15% and 9%/25% respectively. CONCLUSION: Bi-fractionated HDR-BT boost seems feasible with good oncological outcome and slightly more toxicity after dose escalation.

The influence of duration, arm crossing style, gender, and emotional closeness on hugging behaviour.

Hugging is one of the most common types of affective touch encountered in everyday life. However, little is known about the factors that influence hugging evaluation and behaviour. Here, we aimed to assess how different hugs would be evaluated and whether they can affect mood. Furthermore, we aimed to investigate what kind of arm crossing is common in a naturalistic setting and whether arm crossing style could be predicted from gender, emotional closeness, and the height difference of huggers. We conducted two studies addressing these questions. In study 1, participants hugged a confederate for 1 second (s), 5 s or 10 s with two different arm crossing styles and reported how pleasant, arousing and under control the touch felt. Additionally, participants were asked about their mood ("self-ratings") immediately after, 3 minutes (min) after and 6 min after each hug. In study 2, participants were approached on campus and asked to share a hug, with arm crossing style being the dependent variable. The height difference, gender and self-rated emotional closeness to the hug partner were recorded as possible predictors for arm crossing style. Results from study 1 indicate that duration matters more than arm crossing style for hug pleasure, arousal, and control, with 1 s hugs being rated as least pleasant and under control than 5 s and 10 s hugs. Accordingly, 1 s hugs also resulted in lower pleasure self-ratings immediately post hug than 5 s and 10 s hugs. Arousal self-ratings were higher immediately post hug than several minutes after a hug. In study 2, gender was linked to arm crossing style, with male-male hug dyads exhibiting a different hugging style from female-female dyads. These findings are discussed in relation to previous hug research and gender differences in touch behaviour.

Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer: An EMBRACE analysis.

OBJECTIVE: To assess risk factors for nodal failure (NF) after definitive (chemo)radiotherapy and image-guided brachytherapy for locally advanced cervical cancer (LACC) for patients treated in the EMBRACE I study. MATERIALS AND METHODS: Data for pelvic NF and para-aortic (PAO) NF (NFPAO) were analysed. After multiple imputation, univariable and multivariable Cox-regression was performed for clinical and treatment-related variables. For patients with affected pelvic nodes but no PAO nodes at diagnosis, additional analyses were performed for two subgroups: 1. 'small pelvis' nodes in internal and external iliac, obturator, parametrial, presacral and/or common iliac (CI) region and 2. any CI nodes (subgroup of 1). RESULTS: 1338 patients with 152 NF and 104 NFPAO events were analysed with a median follow-up of 34.2 months (IQR 16.4-52.7). For the entire group, larger tumour width, nodal risk groups (in particular any CI nodes without PAO nodes), local failure, and lower Hb-nadir increased the risk of NF. Elective PAO-irradiation was independently associated with a decreased risk of NFPAO (HR 0.53, 95%-CI 0.28-1.00, p = 0.05). For subgroup 1, having 'any CI nodes without PAO nodes' and local failure significantly increased NF risk. Additionally, elective PAO-irradiation was associated with less risk of NFPAO (HR 0.38, 95%-CI 0.17-0.86, p = 0.02). For subgroup 2 only local failure was associated with higher risk of NF. CONCLUSION: In this patient cohort, nodal disease and tumour width at diagnosis, as well as local failure, are risk factors for NF after definitive treatment. Having either 'any PAO nodes' (with or without pelvic nodes) or 'any CI nodes' (without PAO nodes) are stronger risk factors than involvement of nodes in the small pelvis alone. Elective PAO-irradiation was associated with significantly less NFPAO, particularly in patients with nodal disease in the 'small pelvis' and/or CI region at time of diagnosis.

Evaluation of the impact of EMBRACE II protocol in Spanish centers, with a large cohort of patients using a ranking index.

PURPOSE: The aim of this paper was to assess development of high-dose-rate (HDR) cervix brachytherapy (BT) implants in three Spanish institutions before and after introduction of EMBRACE II protocol. MATERIAL AND METHODS: 392 patients from three different institutions, treated between 2009 and 2019 were analyzed. D90 of high-risk clinical target volume (HR-CTV) and D2cc of organs at risk (OARs) of all patients were collected. Statistical distribution was analyzed for two different periods of time: before and after EMBRACE II publication. Index I was applied based on collected dosimetric quantities (D90 and D2cc) to enhance equilibrium between HR-CTV coverage and doses to OARs. Variation in dosimetry and index depending on CTV and technique used (IC vs. IC/IT) were also evaluated. RESULTS: Adaptation of institutions to EMBRACE II protocol resulted in a statistically significant increase of D90 HR-CTV (Institution 1; p < 0.00001) or decrease of D2cc OARs (Institution 2; p < 0.04). Increase in the use of interstitial component showed higher coverage of HR-CTV for Institution 3 (p = 0.03), and lower doses to OARs for the same coverage of HR-CTV at Institution 2 (p-OARs < 0.03). Even though index I was only significantly different between periods for Institution 1 (p < 0.0000001), it was able to show a reduction of dose variability related to higher expertise and higher interstitial component. CONCLUSIONS: Depending on local protocol before EMBRACE II, the adaptation through increasing interstitial component and physician and physicist training, resulted in a significant increase of HR-CTV doses or reduction of OARs doses. Index I was able to describe an evolution of equilibrium between CTV coverage and OARs' sparing.