An IAEA survey of radiotherapy practice including quality assurance extent and depth.

Background: The IAEA recommends a quality assurance program in radiotherapy to ensure safe and effective treatments. In this study, radiotherapy departments were surveyed on their current practice including the extent and depth of quality assurance activities.Methods: Radiotherapy departments were voluntarily surveyed in three stages, firstly, in basic facility information, secondly, in quality assurance activities and treatment techniques, and thirdly, in a snapshot of quality assurance, departmental and treatment activities.Results: The IAEA received completed surveys from 381 radiotherapy departments throughout the world with 100 radiotherapy departments completing all three surveys. Dominant patterns were found in linac-based radiotherapy with access to treatment planning systems for 3D-CRT and 3D imaging. Staffing levels for major staff groups were on average in the range recommended by the IAEA. The modal patient workload per EBRT unit was as expected in the range of 21-30 patients per day, however significant instances of high workload (more than 50 patients per day per treatment unit) were reported. Staffing levels were found to correlate with amount of treatment equipment and patient workload. In a self-assessment of quality assurance performance, most radiotherapy departments reported that they would perform at least 60% of the quality assurance activities itemized in the second survey, with particular strength in equipment quality control. In a snapshot survey of quality assurance performance, again equipment quality control practice was well developed, particularly for the treatment equipment.Conclusions: The IAEA surveys provide a snapshot of current radiotherapy practice including quality assurance activities.

The effect of subchronic supplementation with folic acid and l-arginine on homocysteine-induced seizures.

The aim of the present study was to examine the effect of subchronic co-administration of folic acid (F) and l-arginine (A) on behavioural and electroencephalographic (EEG) characteristics of dl homocysteine thiolactone (H) induced seizures in adult rats. The activity of membrane ATPases in different brain regions were also investigated. Rats were treated with F, A, or vehicle for 15 days (regimen: F 5 mg/kg + A 500 mg/kg (F5A500); F 10 mg/kg + A 300 mg/kg (F10A300)). Seizures were elicited by convulsive dose of H (H, F5A500H, F10A300H) Subchronic supplementation with F and A did not affect seizure incidence, number of seizure episodes, and severity in F5A500H and F10A300H groups vs. H group. However, a tendency to increase latency and decrease the number of seizure episodes was noticed in the F10A300H group. EEG mean spectral power densities during ictal periods were significantly lower in F10A300H vs. H group. The activity of Na+/K+-ATPase and Mg2+-ATPase was significantly increased in almost all examined structures in rats treated with F and A. We can conclude that subchronic supplementation with folic acid and l-arginine has an antiepileptic effect in dl homocysteine thiolactone induced epilepsy.

Substantial bone loss in the mandibular central incisors area as a complication of tongue piercing: a case report.

BACKGROUND: Along with the increasing popularity of oral piercings, the number of reported complications and side effects increases, too. CASE REPORT: The aim of this report is to present a case of substantial bone loss in the area of the mandibular central incisors caused by lingual piercing and persistent bad habits. Dentist should be aware of potential complications associated with oral piercings and warn patients about them.

EURADOS ISO/IEC 17025 guidance for IMS: suggestions on how to interpret and implement the requirements including examples from accredited laboratories.

Individual monitoring of external radiation is an activity usually regulated by national regulatory bodies in most countries. Regulations generally contain technical requirements to be met by the individual monitoring services (IMS), in order to ensure that the measurements are correct and therefore the dosimetry results are reliable. In some countries, the requirements include or even consist of the accreditation of the service according to the standard ISO/IEC 17025: 'General requirements for the competence of testing and calibration laboratories.' It is a fact that accreditation is a growing trend among European IMS as a way to guarantee confidence in their technical competence. The acceptance of the dosimetry results between countries and their indentation in the respective National Dose Registries is facilitated if laboratories conform to the ISO/IEC 17025 standard. In the framework of the activities of EURADOS (European Radiation Dosimetry Group) working group 2 'Harmonization of Individual Monitoring in Europe' and attending to the concern of many European IMS in the process of accreditation, a guide has been prepared. The purpose was to assist and encourage IMS to apply for accreditation and to share the authors' own experience with the process. The guide intends to be a practical reference for IMS on how to interpret and implement the ISO/IEC 17025 requirements to the specific activity of a personal dosimetry service for external radiation, emphasizing those aspects of special interest. It includes examples from dosimetry laboratories already accredited. The major novelties from a new edition of ISO/IEC 17025: 2017 are also identified in the guide. Finally, the guide aims to assist the auditing process, giving examples of auditor's questions and how to show evidence of compliance. The main findings are presented.

Case-control design as investigative approach to assessing cancer etiology: development and future perspectives.

The case-control method evolved out of analyses of series of cases. The analytic form of the case-control study can be found in the 19th century medical literature, but did not appear to be viewed as a special or distinct methodology. The first modern case-control study was the Janet Lane-Claypon's study of breast cancer in 1926, but the design was used only sporadically in medicine until 1950, when 4 published casecontrol studies linked smoking and lung cancer. These 1950s studies synthesized the essential elements of the case-control comparison, produced a conceptual shift within epidemiology, and laid the foundation for the rapid development of the case-control design in the subsequent half century. The powerful consistency of these case-control studies, and the replication of their findings in later prospective studies, promoted the general acceptance of the case-control study as a scientific tool in clinical research. Newer case-control studies have benefited from the advances in design, execution and analysis since 1950s. These advances include more rigorous selection and matching of case and control population, improved interviewing techniques, location of the design within a general framework of epidemiologic strategies for relating exposure to disease, understanding of the measures of effect, and application of increasingly sophisticated statistical procedures to findings. This review traces the development and future perspectives of the case-control design to assessing cancer etiology. With illustrations drawn primarily from the literature on its use and the value of its results to unravelling the etiology of malignant diseases, we tried to explore if the case-control approach firmly ensconced in epidemiology as investigational tool and rivals in importance the more straightforward cohort approach.

Effects of anthocyanins and anthocyanin-rich extracts on the risk for cancers of the gastrointestinal tract.

Anthocyanins are the largest group of water-soluble pigments in the plant kingdom. Anthocyanins are responsible for most of the red, blue, and purple colors of fruits, vegetables, flowers, and other plant tissues or products. In recent years, numerous studies have shown that anthocyanins display a wide range of biological activities. This review summarises recent literature evidence on the association of anthocyanins and anthocyanin-rich extracts consumption with the risk for gastrointestinal tract cancer, concentrating on the results from in vivo animal model tumor systems, as well as data from human epidemiological studies. Potential cancer chemopreventive activities of anthocyanins were revealed from in vitro studies. In vivo animal model tumor systems showed that dietary anthocyanins inhibit cancers of the gastrointestinal tract. Some epidemiological studies have revealed protective effects of anthocyanins consumption on gastrointestinal cancer risk in humans. Pharmacokinetic data indicate that absorption of anthocyanins into the bloodstream of rodents and humans is minimal, suggesting that they may have little efficacy in tissues other than the gastrointestinal tract and skin. Future studies should be undertaken to determine if the anticancer effects of anthocyanins are due to the parent compounds and/or to their metabolites.

Clinical and biological characteristics of breast cancer.

PURPOSE: in view of the crucial importance of early detection and diagnosis of breast cancer for subsequent treatment and prognosis, the aim of this study was to identify clinical and biological characteristics of breast cancer at the time of diagnosis. METHODS: the study enrolled 449 breast cancer patients in Clinical Centre Nis. Results were analyzed using Student's t-test for paired and unpaired samples, chi-square test, Mantel- Haenszel test and Fisher's test of exact probability. RESULTS: The average patient age was 56.2 ± 12 years (range 23-85). Seventyhorbar;three percent of the affected women were postmenopausal and 8.3% below 40 years of age. Operable disease was identified in 78% of the cases, and metastatic in 3.6%. TNM clinical stage IIA was identified in 27.6% of the patients, T2 in 49.2% and Tis in 0.9%. Almost 44% had negative axillary lymph nodes. Most common monolocalization of metastatic disease was the liver and the supraclavicular lymph nodes, and combined localization was the liver and bones. Histologic and nuclear grades 2 and ductal carcinoma were most common. Estrogen receptor positive (ER+) status was 3-fold higher than ER negative (ER-) status. Human epidermal growth factor receptor 2 (HER2) positive patients were most commonly ER-. The most common primary tumor site was the upper lateral quadrant. Left breast was more commonly involved. Radical surgery was the most common type of operation. CONCLUSION: in view of the unfavorable age of patients at the time of diagnosis and clinical and biological tumor characteristics, the results confirmed that it is of vital importance to provide breast cancer prevention, screening, and to organize breast cancer units according EUSOMA guidelines.

The cytotoxic effects of some selected gold(III) complexes on 4T1 cells and their role in the prevention of breast tumor growth in BALB/c mice.

PURPOSE: to investigate the cytotoxic activity of newly synthesized gold(III) complexes [AuCl(2)(en)](+), [AuCl(2) (SMC)](+), [AuCl(2)(DMSO)(2)(+) (en: ethylenediamine, SMC: S-methyl- L-cysteine and DMSO: for dimethylsulfoxide) in 4T1 mouse breast cancer cell line in vitro and in vivo and to compare their antitumor characteristics with cisplatin complex [PtCl(2)(NH(3))(2)]. METHODS: the in vitro, effects of the tested complexes on 4T1 cell viability were determined using MTT colorimetric technique. In vivo, progression of mouse breast tumor growth in BALB/c mice was measured by using external caliper. RESULTS: among the tested gold(III) complexes, [AuCl(2) (en)](+) showed best cytotoxic effects in vitro. The cytotoxic effects of [AuCl(2)(en)](+) and [PtCl(2)(NH(3))(2)] were similar at all concentrations. The data from the in vivo experiment showed that among the tested gold(III) complexes only [AuCl(2)(en)](+) can prevent the primary breast tumor growth. [AuCl(2)(en)](+) was tolerated well and much better than [AuCl(2)(DMSO)(2)(+), [AuCl(2)(SMC)](+) and [PtCl(2)(NH(3))(2)] complex which was confirmed by weight gain in mice that received [AuCl(2)(en)](+). In addition, mice that received [AuCl(2)(en)](+) showed better survival time in comparison with mice that received [PtCl(2) (NH(3))(2)] complex. CONCLUSION: [AuCl(2) (en)](+) complex seems to be good candidate for future pharmacological evaluation in breast cancer research.

Hormone sensitivity of primary breast carcinoma.

PURPOSE: This study was designed to evaluate hormonal sensitivity of primary breast cancer by way of determination of estrogen receptors (ER) and progesterone receptors (PR) status as an important prognostic and predictive parameter of breast cancer. METHODS: The study enrolled 449 breast cancer patients surgically treated at the Surgical Clinic Nis, in a period covering 3 years, who continued treatment at the Clinic of Oncology, Clinical Centre Nis. All of the patients were divided into 4 groups depending on the positive or negative status of ER and PR, and 2 subgroups, those with positive or negative HER2 status. Standard descriptive statistical parameters were calculated and several types of tests were applied: Student's t-test for paired and unpaired samples, chi-square test, Mantel- Haenszel test, Fisher's test of exact probability and binary logistic regression model. RESULTS: The level of ER and PR status positively correlated with patient age, postmenopausal status, lower clinical stage, lower histologic grade (HG) and nuclear grade (NG) and better prognosis. Amplification/overexpression of HER2 positively correlated with premenopausal status and ER negative breast cancer phenotype. According to the model of binary logistic regression, clinical stage and NG of the breast primary were significantly associated with hormonal sensitivity of the tumor. CONCLUSION: Measurements of receptor macromolecules in clinical oncology is very important, especially in breast cancer patients. ER and PR analysis is an integral part of breast cancer study since it can provide information essential for both treatment and prognosis.

Risk factors for breast cancer: a hospital-based case-control study.

PURPOSE: The factors responsible for the genesis of breast cancer remain unclear. A case-control study was undertaken to investigate the possibility of an association between hypothesized risk factors and the development of breast cancer in Serbia. PATIENTS AND METHODS: This hospital-based case-control study comprised 120 new breast cancer cases and 120 hospital controls matched with respect to age (+/- 2 years). This study used a targeted and detailed questionnaire to obtain information from respondents. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated from multivariate conditional logistic regression models. RESULTS: Five independent predictors of breast cancer were: delayed age at first birth (OR=6.1, 95% CI=4.2-12.4), alcohol consumption (OR=4.8, 95% CI=1.9-12.4), family history of breast cancer in 2nd degree relatives (OR=2.5, 95% CI=1.4-4.3), never having breastfed (OR=5.2, 95% CI=1.4-18.5) and maternal death in childhood (OR=3.3, 95% CI=1.2-8.6). CONCLUSION: The results of this study confirmed that the aetiology of breast cancer in Serbia, as elsewhere, is complex. More research is needed to understand the interactions between factors that could affect vulnerability to breast cancer.

The evaluation of the neutron dose equivalent in the two-bend maze.

The purpose of this study was to explore the effect of the second bend of the maze, on the neutron dose equivalent, in the 15MV linear accelerator vault, with two bend maze. These two bends of the maze were covered by 32 points where the neutron dose equivalent was measured. There is one available method for estimation of the neutron dose equivalent at the entrance door of the two bend maze which was tested using the results of the measurements. The results of this study show that the neutron equivalent dose at the door of the two bend maze was reduced almost three orders of magnitude. The measured TVD in the first bend (closer to the inner maze entrance) is about 5m. The measured TVD result is close to the TVD values usually used in the proposed models for estimation of neutron dose equivalent at the entrance door of the single bend maze. The results also determined that the TVD in the second bend (next to the maze entrance door) is significantly lower than the TVD values found in the first maze bend.

Catalytic properties of rabbit serum esterases hydrolyzing esterified monosaccharides.

Rabbit serum and one enzyme fraction isolated from rabbit serum by column chromatography (Fraction II) were used as catalysts in regioselective hydrolysis of radiolabelled pivaloylated monosaccharides (Piv = Me3CCO). The hydrolysis of 14C-labelled methyl 2-O-pivaloyl-(2-MP)-, 6-O-pivaloyl (6-MP)-, 2,6-di-O-pivaloyl-(2,6-DP) alpha-D- glucopyranosides and methyl 2-acetamido-2-deoxy-3,6- di-O-pivaloyl-(3,6-DPNAc) alpha-D-glucopyranosides, was studied, as well as that of the non-sugar substrates butyrylthiocholine, thiophenylbutyrate, phenylacetate and paraoxon. The specific activities of 2,6-DP, 3,6-DPNAc, butyrylthiocholine and thiophenylbutyrate were higher in Fraction II than in native sera, while those of phenylacetate and paraoxon were lower. Inhibition studies were done using the substrates mentioned and five different inhibitors, namely bis(p-nitrophenyl phosphate) (BNPP), eserine, paraoxon, HgCl2 and EDTA. The hydrolysis of 2,6-DP and 3,6-DPNAc was not inhibited by HgCl2 and only slightly by EDTA. Paraoxon, eserine and BNPP were progressive inhibitors of the hydrolysis of the two sugar substrates, and the pattern of inhibition resembled closely the inhibition of butyrylthiocholine and thiophenylbutyrate hydrolysis. This result applied to both, native serum and Fraction II. It was concluded that esterases in rabbit serum which hydrolyze pivaloylated sugar substrates belong to the category of serine esterases. Kinetic parameters (KM and Vmax), effects of temperature and pH on activity of esterases from Fraction II were also determined for the hydrolysis of sugar substrates.

The effect of subchronic supplementation with folic acid on homocysteine induced seizures.

Influence of folic acid on the CNS is still unclear. Folate has a neuroprotective effect, while on the other hand excess folate can exacerbate seizures in epileptics. The aim of the present study was to examine the effect of subchronic administration of folic acid on behavioural and electroencephalographic (EEG) characteristics of DL homocysteine thiolactone induced seizures in adult rats. The activity of Na⁺/K⁺-ATPase and Mg²âº-ATPase in different brain regions was investigated. Adult male Wistar rats were divided into groups: 1. Controls (C, 0.9% NaCl); 2. DL homocysteine-thiolactone 8.0 mmol/kg (H); 3. Subchronic supplementation with folic acid 5 mg/kg for 7 days (F) and 4. Subchronic supplementation with F + single dose of H (FH). Seizure behaviour was assessed by incidence, latency, number and intensity of seizure episodes. Seizure severity was described by a descriptive scale with grades 0-4. For EEG recordings, three gold-plated recording electrodes were implanted into the skull. Subchronic supplementation with folic acid did not affect seizure incidence, median number of seizure episodes and severity in FH, comparison with H (p > 0.05). The majority of seizure episodes in all groups were of grade 2. There were no significant differences in lethal outcomes at 24 h upon H injection in the FH vs. H group. The activity of Na⁺/K⁺-ATPase and Mg²âº-ATPase was significantly increased in almost all examined structures in the FH vs. H group. Subchronic folic acid administration did not exacerbate H induced seizures and completely recovered the activity of ATPases.

Suicide in the elderly 60 years of age and over in the south-east part of Serbia.

Some previous investigations indicated that economic crisis (inflation in Serbia 1993/94) have great influence on increasing suicide rates in Serbia. After that suicide decreased, despite the war and bombing in 1999, specially among the elderly people. A total of 453 suicides were registered on the territory of south-eastern Serbia during 1995-2001 years. Of them 295 (65.1%) were aged over 60 years. Generally linear trends of suicide among both genders from 1995 to 2001 decreased, but the slope of decreasing was grater among males than among females. The highest rates among the both genders were registered in the years with the maximum number of suicides, but the linear trends of rates have statistically important correlation with time (r>0.5). Average annual suicide rate among males was 42.5, and among women it was 18.7. The highest average annual suicide rate among men was observed in the age group 75 years and over (93.3), and the lowest in the age group 65-69 (20.6). Among males, in the all age group linear trends of suicide rates decreased, with the highest slope among 75 years and over and the lowest among 65-69 years. The highest suicide rate among females was registered in age group 75 years and over (25.6), the lowest in the age group 65-69 (13.5). The linear trends are similar as among males: downward trend was observed among all aged groups, with the highest slope among women 75 years and over. The most common way of suicide among men was hanging up (63%), poisoning and by firearms. There were no statistical differences between way of suicide and age groups. The most frequent way of suicide among females was hanging up (55%), poisoning (25%) and drowning (12%). There were statistically significant differences in drowning between age groups, 70-74 and 75 and over (p<0.05), and between poisoning and age groups 60-64 years and 75 years and over. Poisoning and drowning are statistically more frequent among women than among men.

Epidemiology of irritable bowel syndrome in Croatia.

This epidemiological study of irritable bowel syndrome (IBS) was the first one of the type in Croatia. The aim of the study was to determine prevalence and association between IBS and gender, age, education and urban/rural living. Study design included a questionnaire based on Rome criteria, which was send to 500 study subjects by post. Study population matched the adult population of Croatia according last census. Study result showed a high prevalence of IBS: i.e. 28% (10% of males and 18% of females). Age, education and urban/rural type of living were not related to the prevalence of IBS. Logistic regression gave gender-body mass index (BMI) model for IBS determination: the relative risk for getting IBS in females was by 165% higher than in males and BMI increase of 5 kg/m2 increased the risk of IBS by 36%. BMI was indicated as a possible new factor of IBS prevalence.

Efficiency of biofeedback therapy for chronic constipation in children.

Chronic constipation is a common disorder in childhood. The underlying mechanisms responsible for chronic constipation remain unknown. Conventional methods of treatment often fail to produce satisfactory results. Favorable effects of biofeedback treatment for constipation have been suggested, however, with variable results reported in the literature. The main aim of the study was to evaluate biofeedback versus conventional therapeutic protocol in the treatment of chronic constipation over a short period of time (3 months). Forty-nine children with chronic idiopathic constipation, 24 allocated to conventional and 25 to biofeedback therapy were included in the study. Thorough history data on bowel function and symptoms, anorectal status and manometric testing were collected before and after treatment. Follow up consisted of a structured interview. Mean age was 94 and 92 months in the children treated by the conventional and biofeedback method, respectively. The initial prevalence of abnormal defecation dynamics was 58% and 56% in the group children allocated to conventional and biofeedback therapy, respectively. The difference was not statistically significant. After the treatment, the values of rectal sensation threshold, critical volume, and recto-anal inhibitory reflex volume were significantly higher, and the prevalence of abnormal defecation dynamics was significantly lower in the group on biofeedback therapy. Biofeedback is an effective method of treatment for chronic constipation in children in short term. Therapeutic results are especially favorable in the recovery of abnormal anorectal dynamics and manometric parameters. There is no clear evidence for long-term benefits of biofeedback therapy.

Diet and breast cancer.

Nutritional factors have been prominent among the environmental determinants of breast cancer hypothesized to account for the large increases in rates among offspring of migrants from countries with low incidence to countries with high incidence. The dominant hypothesis has been that high fat intake increases risk, but in addition to this possibility, several alternative hypotheses have been suggested, too.

Epidemiology of breast cancer in the city of Nis, Serbia.

PURPOSE: Over the past 10 years, Serbia has been affected by a heavy economic and political crisis that in 1999 even led to war and bombardment. Numerous facts indicate that the crisis has resulted in low-level health protection, increasing mortality, as well as other deteriorating effects over the general health of the population. The aim of the study was to assess mortality trends in female breast cancer in the city of Nis prior to (1986-1993) and following (1995- 1999) the socio-economic crisis peak. MATERIALS AND METHODS: Population and hospital cancer registry data for the 1986-1999 period were used for analysis, as well as death certificate data for all women who lived and died in the city of Nis in the given period. Survival was calculated according to the Kaplan-Meier method. The rates were calculated per 100,000 inhabitants (1991 census) and were not standardized. RESULTS: A total of 455 women in the city of Nis died of breast cancer during 1986-1999. The polynomial trend in mortality revealed an increasing (1986-1992) and decreasing (1993-1996) tendency, although the first period showed a lower average mortality (28.7) than did the second one (30.45). Survival rates were calculated for the periods 1986- 1993 and 1995-1998. The 12-month survival rate was 84.7% in the first and 92% in the second period; the 24-month survival rate for the first period was 76.6% and 87.9% for the second; the 36-month survival was 67.7% in the first and 80.5% in the second period; the 4-year survival rate for 1986-1993 was 64.1% and 78.1% for 1995-1999. CONCLUSION: The socio-economic and political crisis has proved to affect breast cancer patients in Serbia. Overall, the mortality rate increased. Calculated upon division of the whole period into two, mortality shows an upward trend in the first period (1986-1992) and a downward trend in the second. Although 1993-1999 was more difficult for the Serbian and Yugoslavian population (manifested in the therapy of all diseases, including breast cancer), the diagnosis of breast cancer improved and the disease was detected at earlier stages, the result of which were better survival rates in the 1986-1992 period.