Long-Term Follow-Up of Patients with Conjunctival Lymphoma after Individualized Lens-Sparing Electron Radiotherapy: Results from a Longitudinal Study.

Irradiation with electrons is the primary treatment regime for localized conjunctival low-grade lymphomas. However, radiation-induced cataracts are a major cause of treatment-related morbidity. This study investigates whether lens-sparing electron irradiation produces sufficient disease control rates while preventing cataract formation. All consecutive patients with strictly conjunctival, low-grade Ann Arbor stage IE lymphoma treated with superficial electron irradiation between 1999 and 2021 at our department were reviewed. A total of 56 patients with 65 treated eyes were enrolled with a median follow-up of 65 months. The median dose was 30.96 Gy. A lens-spearing technique featuring a hanging rod blocking the central beam axis was used in 89.2% of all cases. Cumulative incidences of 5- and 10-year infield recurrences were 4.3% and 14.6%, incidences of 5- and 10-year outfield progression were 10.4% and 13.4%. We used patients with involvement of retroorbital structures treated with whole-orbit photon irradiation without lens protection-of which we reported in a previous study-as a control group. The cumulative cataract incidence for patients treated with electrons and lens protection was significantly lower (p = 0.005) when compared to patients irradiated without lens protection. Thus, electrons are an effective treatment option for conjunctival low-grade lymphomas. The presented lens-sparing technique effectively prevents cataract formation.

Household Debt, Maternal Well-Being, and Child Adjustment in Germany: Examining the Family Stress Model by Family Structure.

The amount of household debt tripled globally over the last decades and a sizable share of individuals and families are overindebted due to mortgages, credit cards, or consumer debt. Yet research on the distribution of debt across families, and potential ripple effects of the psychological burden related to debt on well-being and family relations, remains sparse. Our study aims to fill these gaps by examining the socio-demographic profiles of families that have accumulated household debt and the unique role that the psychological burden related to debt plays on associations between mothers' well-being, parental dynamics, and child adjustment based on the Family Stress Model (FSM). We used representative survey data collected in 2019 from Germany (N = 3271), which is one of the richest economies worldwide, yet about 10% of adults reported to be overindebted. Logistic regression results showed that single mothers were less likely to have debt compared to mothers in two-parent families. However, both single mothers and mothers in stepfamilies with high levels of perceived economic strain were particularly likely to report having debt. Structural equation modeling yielded that the links between the psychological burden of debt, maternal well-being, parental dynamics, and child adjustment were largely in line with the FSM, except for single mothers. We conclude that persisting financial disparities by family structure may be partially fostered by unique characteristics of the German welfare state, such as promoting more a traditional two-parent norm, and discuss our findings in light of practical implications.

Virtual 3D IVUS vessel model for intravascular brachytherapy planning. I. 3D segmentation, reconstruction, and visualization of coronary artery architecture and orientation.

Intravascular brachytherapy (IVB) can significantly reduce the risk of restenosis after interventional treatment of stenotic arteries, if planned and applied correctly. To facilitate computer-based IVB planning, a three-dimensional vessel model has been derived from information on coronary artery segments acquired by intravascular ultrasound (IVUS) and biplane angiography. Part I describes the approach of model construction and presents possibilities of visualization. The vessel model is represented by a voxel volume. Polygonal information about the vessel wall structure is derived by segmentation from a sequence of IVUS images automatically acquired ECG gated during pull back of the IVUS transducer. To detect horizontal, vertical, and radial contours, modified Canny-Edge and Shen-Castan filters are applied on Cartesian and polar coordinate representations of the IVUS tomograms as edge detectors. The spatial course of the vessel wall layers is traced in reconstructed longitudinal IVUS scans. By resampling the sequence of IVUS frames the voxel volume is obtained. For this purpose the frames are properly located in space and augmented with additional intermediate frames generated by interpolation. Their spatial location and orientation is derived from biplane X-ray angiography which is performed simultaneously. For resampling, two approaches are proposed: insertion of the vertices of the rectangular goal grid into the cells of a deformed hexahedral mesh derived from the IVUS sequence, and insertion of the vertices of the hexahedral mesh into the cells of the rectangular grid. Finally, the vessel model is visualized by methods of combined volume and polygon rendering. The segmentation process is verified as being in good agreement with results obtained by manual contour tracing with a commercial system. Our approach of construction of the vessel model has been implemented into an interactive software system, 3D IVUS-View, serving as the basis of a future system for intracoronary brachytherapy treatment planning being currently under development (Part II).