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1.
Strahlenther Onkol ; 200(2): 151-158, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37889301

RESUMO

PURPOSE: Modern digital teaching formats have become increasingly important in recent years, in part due to the COVID-19 pandemic. In January 2021, an online-based webinar series was established by the German Society for Radiation Oncology (DEGRO) and the young DEGRO (yDEGRO) working group. In the monthly 120-minute courses, selected lecturers teach curricular content as preparation for the board certification exam for radiation oncology. METHODS: The evaluation of the 24 courses between 01.2021 and 12.2022 was performed using a standardized questionnaire with 21 items (recording epidemiological characteristics of the participants, didactic quality, content quality). A Likert scale (1-4) was used in combination with binary and open-ended questions. RESULTS: A combined total of 4200 individuals (1952 in 2021 and 2248 in 2022) registered for the courses, and out of those, 934 participants (455 in 2021 and 479 in 2022) later provided evaluations for the respective courses (36% residents, 35% specialists, 21% medical technicians for radiology [MTR], 8% medical physics experts [MPE]). After 2 years, 74% of the DEGRO Academy curriculum topics were covered by the monthly webinars. The overall rating by participants was positive (mean 2021: 1.33 and 2022: 1.25) and exceeded the curriculum offered at each site for 70% of participants. Case-based learning was identified as a particularly well-rated method. CONCLUSION: The DEGRO webinar expands the digital teaching opportunities in radiation oncology. The consistently high number of participants confirms the need for high-quality teaching and underlines the advantages of e­learning methods. Optimization opportunities were identified through reevaluation of feedback from course participants. In its design as a teaching format for a multiprofessional audience, the webinar series could be used as a practice model of online teaching for other disciplines.


Assuntos
COVID-19 , Radioterapia (Especialidade) , Humanos , Radioterapia (Especialidade)/educação , Pandemias , Currículo , COVID-19/epidemiologia , Sociedades Médicas
2.
Photochem Photobiol Sci ; 22(3): 615-630, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36471235

RESUMO

The previously not studied photochemical degradation of sulfamethoxazole (SMX) to the isomer of SMX (ISO) was measured via a polychromatic (Xe) and a monochromatic (Hg) light source and accompanied by quantum chemical DFT calculations. In addition to the [Formula: see text] of ISO, tautomer-dependent properties such as the [Formula: see text] were measured and theoretically confirmed by DFT. The kinetics in solutions below and above the [Formula: see text] of SMX were studied for the available and quantifiable products SMX, ISO, 3-amino-5-methylisoxazole (AMI), 2-amino-5-methyloxazole (AMO), and sulfanilic acid (SUA). The quantum yields of the neutral ([Formula: see text]) and anionic [Formula: see text]) forms of SMX ([Formula: see text], [Formula: see text]) and ISO ([Formula: see text] and [Formula: see text]) were found to be wavelength-independent. In a competitive reaction to the formation of ISO from SMX, the degradation product TP271 is formed. Various proposed structures for TP271 described in the literature have been studied quantum mechanically and can be excluded for thermodynamic reasons. In real samples in a northern German surface water in summer 2021 mean concentrations of SMX were found in the range of 120 ng/L. In agreement with the pH-dependent yields, concentrations of ISO were low in the range of 8 ng/L.

3.
Environ Sci Technol ; 56(1): 379-391, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34931808

RESUMO

Octanol/water (KOW), octanol/air (KOA), and hexadecane/air (KHdA) partition coefficients are calculated for 67 organic compounds of environmental concern using computational chemistry. The extended CRENSO workflow applied here includes the calculation of extensive conformer ensembles with semiempirical methods and refinement through density functional theory, taking into account solvation models, especially COSMO-RS, and thermostatistical contributions. This approach is particularly advantageous for describing large and nonrigid molecules. With regard to KOW and KHdA, one can refer to many experimental data from direct and indirect measurement methods, and very good matches with results from our quantum chemical workflow are evident. In the case of the KOA values, however, good matches are only obtained for the experimentally determined values. Larger systematic deviations between data computed here and available, nonexperimental quantitative structure-activity relationship literature data occur in particular for phthalic acid esters and organophosphate esters. From a critical analysis of the coefficients calculated in this work and comparison with available literature data, we conclude that the presented quantum chemical composite approach is the most powerful so far for calculating reliable partition coefficients because all physical contributions to the conformational free energy are considered and the structure ensembles for the two phases are generated independently and consistently.


Assuntos
Relação Quantitativa Estrutura-Atividade , Água , Octanóis/química , Água/química
4.
Chemistry ; 27(3): 1046-1056, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33058253

RESUMO

The chemical background of olfactory perception has been subject of intensive research, but no available model can fully explain the sense of smell. There are also inconsistent results on the role of the isotopology of molecules. In experiments with human subjects it was found that the isotope effect is weak with acetone and D6 -acetone. In contrast, clear differences were observed in the perception of octanoic acid and D15 -octanoic acid. Furthermore, a trained sniffer dog was initially able to distinguish between these isotopologues of octanoic acid. In chromatographic measurements, the respective deuterated molecule showed weaker interaction with a non-polar liquid phase. Quantum chemical calculations give evidence that deuterated octanoic acid binds more strongly to a model receptor than non-deuterated. In contrast, the binding of the non-deuterated molecule is stronger with acetone. The isotope effect is calculated in the framework of statistical mechanics. It results from a complicated interplay between various thermostatistical contributions to the non-covalent free binding energies and it turns out to be very molecule-specific. The vibrational terms including non-classical zero-point energies play about the same role as rotational/translational contributions and are larger than bond length effects for the differential isotope perception of odor for which general rules cannot be derived.


Assuntos
Deutério/análise , Deutério/química , Odorantes/análise , Percepção Olfatória , Compostos Orgânicos/análise , Compostos Orgânicos/química , Olfato , Acetona/análise , Acetona/química , Animais , Caprilatos/análise , Caprilatos/química , Cães , Cães Trabalhadores
5.
Photochem Photobiol Sci ; 17(7): 964-974, 2018 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-29915836

RESUMO

Dark and photolysis reactions in solution were investigated for 9-acridinecarboxaldehyde (ACL). ACL reacts in the dark at T = 20 °C and pH = 7.0 in an air saturated solution to the main product 9-acridinecarboxylic acid (ACA) and to the minor product 9-acridinemethanol (ACM) with a lifetime of τ = 4.3 days. The dissociation constant of the base ACLH+ was determined to be pKa ± σ = 4.38 ± 0.04. The photolysis of ACL was investigated using a polychromatic Xe-light source. The quantum yield in aqueous solution at T = 20 °C in a concentration range of c0(ACL) = 0.18-16.6 µM for pH > pKa and for nitrogen, air and oxygen aerated solutions was found to be Φ ± σ = (0.015 ± 0.003) mol/mol, independent from concentration. The quantum yield of ACLH+, i.e. for pH ≪ pKa, is by a factor of 2 higher (Φ = 0.029 mol/mol). Quantum yields in methanol and isopropanol are slightly lower compared to water and in acetone lower by about a factor of 20. In acetonitrile ACL was found to be practically photostable. Minimum lifetimes in sunlight for a measurement on September 5, 2017 were in the range of τ = 5-10 minutes. The diurnal photolysis of ACL in sunlight was satisfactory explained using the mean quantum yield, the absorption spectrum and photon fluxes with suitable corrections for cloudiness and the dimensions of the setup. For low concentrations ACR is formed with a yield of practically 100% in the photolysis reaction. However, with increasing concentration of ACL yields of ACR decrease and yields of ACA increase. 9(10H)-Acridinone and ACM were always detected as minor products with yields below 2%. 9-Methylacridine was never detected in any reaction of ACL. Strong indications are presented of a photolysis reaction of ACL in a river located in Lower Saxony (Germany) with a corresponding equimolar formation of ACR. ACL is therefore a direct precursor of ACR in natural surface water.

6.
Strahlenther Onkol ; 193(1): 46-54, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27812732

RESUMO

PURPOSE: This project compares the different patient-related quality assurance systems for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques currently used in the central Germany area with an independent measuring system. MATERIALS AND METHODS: The participating institutions generated 21 treatment plans with different combinations of treatment planning systems (TPS) and linear accelerators (LINAC) for the QUASIMODO (Quality ASsurance of Intensity MODulated radiation Oncology) patient model. The plans were exposed to the ArcCHECK measuring system (Sun Nuclear Corporation, Melbourne, FL, USA). The dose distributions were analyzed using the corresponding software and a point dose measured at the isocenter with an ionization chamber. RESULTS: According to the generally used criteria of a 10 % threshold, 3 % difference, and 3 mm distance, the majority of plans investigated showed a gamma index exceeding 95 %. Only one plan did not fulfill the criteria and three of the plans did not comply with the commonly accepted tolerance level of ±3 % in point dose measurement. CONCLUSION: Using only one of the two examined methods for patient-related quality assurance is not sufficiently significant in all cases.


Assuntos
Neoplasias/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/normas , Radioterapia (Especialidade) , Planejamento da Radioterapia Assistida por Computador/normas , Radioterapia Conformacional/instrumentação , Radioterapia Conformacional/normas , Análise de Falha de Equipamento , Alemanha , Fidelidade a Diretrizes/normas , Humanos , Assistência Centrada no Paciente/normas , Dosagem Radioterapêutica , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
7.
Strahlenther Onkol ; 193(10): 780-790, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28567503

RESUMO

PURPOSE: The aim was to evaluate stereotactic body radiation therapy (SBRT) treatment planning variability for early stage nonsmall cell lung cancer (NSCLC) with respect to the published guidelines of the Stereotactic Radiotherapy Working Group of the German Society for Radiation Oncology (DEGRO). MATERIALS AND METHODS: Planning computed tomography (CT) scan and the structure sets (planning target volume, PTV; organs at risk, OARs) of 3 patients with early stage NSCLC were sent to 22 radiotherapy departments with SBRT experience: each department was asked to prepare a treatment plan according to the DEGRO guidelines. The prescription dose was 3 fractions of 15 Gy to the 65% isodose. RESULTS: In all, 87 plans were generated: 36 used intensity-modulated arc therapy (IMAT), 21 used three-dimensional conformal radiation therapy (3DCRT), 6 used static field intensity-modulated radiation therapy (SF-IMRT), 9 used helical radiotherapy and 15 used robotic radiosurgery. PTV dose coverage and simultaneously kept OARs doses were within the clinical limits published in the DEGRO guidelines. However, mean PTV dose (mean 58.0 Gy, range 52.8-66.4 Gy) and dose conformity indices (mean 0.75, range 0.60-1.00) varied between institutions and techniques (p ≤ 0.02). OARs doses varied substantially between institutions, but appeared to be technique independent (p = 0.21). CONCLUSION: All studied treatment techniques are well suited for SBRT of early stage NSCLC according to the DEGRO guidelines. Homogenization of SBRT practice in Germany is possible through the guidelines; however, detailed treatment plan characteristics varied between techniques and institutions and further homogenization is warranted in future studies and recommendations. Optimized treatment planning should always follow the ALARA (as low as reasonably achievable) principle.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Fidelidade a Diretrizes/estatística & dados numéricos , Neoplasias Pulmonares/radioterapia , Radiocirurgia/estatística & dados numéricos , Radiocirurgia/normas , Planejamento da Radioterapia Assistida por Computador/estatística & dados numéricos , Planejamento da Radioterapia Assistida por Computador/normas , Benchmarking , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Alemanha/epidemiologia , Fidelidade a Diretrizes/normas , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Prevalência , Dosagem Radioterapêutica , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do Tratamento
8.
Ecol Lett ; 15(7): 732-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22548792

RESUMO

Differences in herbivory among woody species can greatly affect the functioning of forest ecosystems, particularly in species-rich (sub)tropical regions. However, the relative importance of the different plant traits which determine herbivore damage remains unclear. Defence traits can have strong effects on herbivory, but rarely studied geographical range characteristics could complement these effects through evolutionary associations with herbivores. Herein, we use a large number of morphological, chemical, phylogenetic and biogeographical characteristics to analyse interspecific differences in herbivory on tree saplings in subtropical China. Unexpectedly, we found no significant effects of chemical defence traits. Rather, herbivory was related to the plants' leaf morphology, local abundance and climatic niche characteristics, which together explained 70% of the interspecific variation in herbivory in phylogenetic regression. Our study indicates that besides defence traits and apparency to herbivores, previously neglected measures of large-scale geographical host distribution are important factors influencing local herbivory patterns among plant species.


Assuntos
Herbivoria , Árvores , Animais , Biodiversidade , China , Clima , Insetos , Folhas de Planta/química , Densidade Demográfica
10.
Phys Med Biol ; 67(6)2022 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-35226890

RESUMO

Objective. The aim of this work is an AI based approach to reduce the volume effect of ionization chambers used to measure high energy photon beams in radiotherapy. In particular for profile measurements, the air-filled volume leads to an inaccurate measurement of the penumbra.Approach. The AI-based approach presented in this study was trained with synthetic data intended to cover a wide range of realistic linear accelerator data. The synthetic data was created by randomly generating profiles and convolving them with the lateral response function of a Semiflex 3D ionization chamber. The neuronal network was implemented using the open source tensorflow.keras machine learning framework and a U-Net architecture. The approach was validated on three accelerator types (Varian TrueBeam, Elekta VersaHD, Siemens Artiste) at FF and FFF energies between 6 MV and 18 MV at three measurement depths. For each validation, a Semiflex 3D measurement was compared against a microDiamond measurement, and the AI processed Semiflex 3D measurement was compared against the microDiamond measurement.Main results. The AI approach was validated with dataset containing 306 profiles measured with Semiflex 3D ionization chamber and microDiamond. In 90% of the cases, the AI processed Semiflex 3D dataset agrees with the microDiamond dataset within 0.5 mm/2% gamma criterion. 77% of the AI processed Semiflex 3D measurements show a penumbra difference to the microDiamond of less than 0.5 mm, 99% of less than 1 mm.Significance. This AI approach is the first in the field of dosimetry which uses synthetic training data. Thus, the approach is able to cover a wide range of accelerators and the whole specified field size range of the ionization chamber. The application of the AI approach offers an quality improvement and time saving for measurements in the water phantom, in particular for large field sizes.


Assuntos
Inteligência Artificial , Radioterapia (Especialidade) , Aprendizado de Máquina , Imagens de Fantasmas , Fótons/uso terapêutico
11.
Sci Rep ; 12(1): 10909, 2022 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-35764679

RESUMO

This study aims to identify key anatomic features that govern the individual variability of lung doses from breast-cancer radiotherapy. 3D conformal, intensity-modulated and hybrid techniques with 50.4 Gy whole-breast dose were planned for 128 patients. From their CT images, 17 anatomic measures were assessed and tested as predictors for lung dose-volume characteristics. Tangential techniques yielded mean ipsilateral lung doses in the range of 3-11 Gy. This inter-patient variability was explained to almost 40% by central lung distance, and to almost 60% if this measure was complemented by midplane lung width and maximum heart distance. Also the variability in further dose-volume metrics such as volume fractions receiving 5, 20 or 40 Gy could be largely explained by the anatomy. Multi-field intensity-modulated radiotherapy reduced high-exposed lung volumes, but resulted in higher mean ipsilateral lung doses and larger low-dose burden. Contralateral lung doses ranged from 0.3 to 1 Gy. The results highlight that there are large differences in lung doses among breast-cancer patients. Most of this inter-individual variability can be explained by a few anatomic features. The results will be implemented in a dedicated software tool to provide personalized estimates of long-term health risks related to breast-cancer radiotherapy. The results may also be used to identify favourable as well as problematic anatomies, and serve as a quick quantitative benchmark for individual treatment plans.


Assuntos
Neoplasias da Mama , Radioterapia Conformacional , Mama/diagnóstico por imagem , Neoplasias da Mama/radioterapia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Conformacional/métodos
12.
Environ Sci Process Impacts ; 24(11): 2153-2166, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36222641

RESUMO

The vapor pressure is a specific and temperature-dependent parameter that describes the volatility of a substance and thus its driving force for evaporation or sublimation into the gas phase. Depending on the magnitude of the vapor pressure, there are different methods for experimental determination. However, these are usually associated with a corresponding amount of effort and become less accurate as the vapor pressure decreases. For purposes of vapor pressure prediction, algorithms were developed that are usually based on quantitative structure-activity relationships (QSAR). The quantum mechanical (QM) approach followed here applies an alternative, much less empirical strategy, where the change in Gibbs free energy for the transition from the condensed to the gas phase is obtained from conformer ensembles computed for each phase separately. The results of this automatic, so-called CRENSO workflow are compared with experimentally determined vapor pressures for a large set of environmentally relevant compounds. In addition, comparisons are made with the single structure-based COSMO-RS QM approach, linear-free-energy relationships (LFER) as well as results from the SPARC program. We show that our CRENSO workflow is superior to conventional prediction models and provides reliable vapor pressures for liquids and sub-cooled liquids over a wide pressure range.


Assuntos
Compostos Orgânicos Voláteis , Pressão de Vapor , Transição de Fase , Temperatura , Algoritmos
13.
Int J Radiat Oncol Biol Phys ; 113(1): 214-227, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35074434

RESUMO

PURPOSE: Our purpose was to investigate whether liver stereotactic body radiation therapy treatment planning can be harmonized across different treatment planning systems, delivery techniques, and institutions by using a specific prescription method and to minimize the knowledge gap concerning intersystem and interuser differences. We provide best practice guidelines for all used techniques. METHODS AND MATERIALS: A multiparametric specification of target dose (gross target volume [GTV]D50%, GTVD0.1cc, GTVV90%, planning target volume [PTV]V70%) with a prescription dose of GTVD50% = 3 × 20 Gy and organ-at-risk (OAR) limits were distributed with computed tomography and structure sets from 3 patients with liver metastases. Thirty-five institutions provided 132 treatment plans using different irradiation techniques. These plans were first analyzed for target and OAR doses. Four different renormalization methods were performed (PTVDmin, PTVD98%, PTVD2%, PTVDmax). The resulting 660 treatments plans were evaluated regarding target doses to study the effect of dose renormalization to different prescription methods. A relative scoring system was used for comparisons. RESULTS: GTVD50% prescription can be performed in all systems. Treatment plan harmonization was overall successful, with standard deviations for Dmax, PTVD98%, GTVD98%, and PTVDmean of 1.6, 3.3, 1.9, and 1.5 Gy, respectively. Primary analysis showed 55 major deviations from clinical goals in 132 plans, whereas in only <20% of deviations GTV/PTV dose was traded for meeting OAR limits. GTVD50% prescription produced the smallest deviation from target planning objectives and between techniques, followed by the PTVDmax, PTVD98%, PTVD2%, and PTVDmin prescription. Deviations were significant for all combinations but for the PTVDmax prescription compared with GTVD50% and PTVD98%. Based on the various dose prescription methods, all systems significantly differed from each other, whereas GTVD50% and PTVD98% prescription showed the least difference between the systems. CONCLUSIONS: This study showed the feasibility of harmonizing liver stereotactic body radiation therapy treatment plans across different treatment planning systems and delivery techniques when a sufficient set of clinical goals is given.


Assuntos
Neoplasias Hepáticas , Radiocirurgia , Radioterapia de Intensidade Modulada , Benchmarking , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/radioterapia , Radiocirurgia/métodos , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos
14.
Waste Manag Res ; 29(1): 59-68, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20937619

RESUMO

A comprehensive study was conducted to examine the performance and possible changes in the effectiveness of landfill surface covers. Three different profiles of mineral landfill caps were examined. The results of precipitation and flow measurements show distinct seasonal differences which are typical for middle-European climatic conditions. In the case of the simple landfill cap design consisting of a thick layer of loamy sand, approximately 100-200 L m(-2) of annual seepage into the landfill body occurs during winter season. The three-layer systems of the two other test fields performed much better. Most of the water which percolated through the top soil profile drained sideways in the drainage layer. Only 1-3% of precipitation percolated through the sealing layer. The long-term effectiveness of the mineral sealing layer depended on the ability of the top soil layer to protect it from critical loss of soil water/critical increase of suction. In dry summers there was even a loss in soil water content at the base of the 2.0 m thick soil cover. The results of this study demonstrate the importance of the long-term aspect when assessing the effectiveness of landfill covers: The hydraulic conductivity at the time of construction gives only an initial (minimum) value. The hydraulic conductivity of the compacted clay layer or of the geosynthetic clay liner may increase substantially, if there is no long-lasting protection against desiccation (by a thick soil cover or by a geomembrane). This has to be taken into account in landfill cover design.


Assuntos
Poluentes do Solo/análise , Gerenciamento de Resíduos/métodos , Poluentes Químicos da Água/análise , Poluição da Água , Silicatos de Alumínio/química , Argila , Dessecação/instrumentação , Alemanha , Solo/análise , Gerenciamento de Resíduos/instrumentação , Movimentos da Água
15.
Radiat Oncol ; 16(1): 241, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930360

RESUMO

PURPOSE: Cardiac effects after breast cancer radiation therapy potentially affect more patients as survival improves. The heart's heterogeneous radiation exposure and composition of functional structures call for establishing individual relationships between structure dose and specific late effects. However, valid dosimetry requires reliable contouring which is challenging for small volumes based on older, lower-quality computed tomography imaging. We developed a heart atlas for robust heart contouring in retrospective epidemiologic studies. METHODS AND MATERIALS: The atlas defined the complete heart and geometric surrogate volumes for six cardiac structures: aortic valve, pulmonary valve, all deeper structures combined, myocardium, left anterior myocardium, and right anterior myocardium. We collected treatment planning records from 16 patients from 4 hospitals including dose calculations for 3D conformal tangential field radiation therapy for left-sided breast cancer. Six observers each contoured all patients. We assessed spatial contouring agreement and corresponding dosimetric variability. RESULTS: Contouring agreement for the complete heart was high with a mean Jaccard similarity coefficient (JSC) of 89%, a volume coefficient of variation (CV) of 5.2%, and a mean dose CV of 4.2%. The left (right) anterior myocardium had acceptable agreement with 63% (58%) JSC, 9.8% (11.5%) volume CV, and 11.9% (8.0%) mean dose CV. Dosimetric agreement for the deep structures and aortic valve was good despite higher spatial variation. Low spatial agreement for the pulmonary valve translated to poor dosimetric agreement. CONCLUSIONS: For the purpose of retrospective dosimetry based on older imaging, geometric surrogate volumes for cardiac organs at risk can yield better contouring agreement than anatomical definitions, but retain limitations for small structures like the pulmonary valve.


Assuntos
Neoplasias da Mama/radioterapia , Coração/efeitos da radiação , Relação Dose-Resposta à Radiação , Estudos de Avaliação como Assunto , Feminino , Humanos , Variações Dependentes do Observador , Órgãos em Risco , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
16.
Front Neurol ; 12: 701927, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34434162

RESUMO

Introduction: Diagnosing non-traumatic spinal cord injury (NTSCI) is often challenging. However, clear discrimination from non-spinal pathologies, e.g., "myelopathy-mimics" (MMs), is critical in preventing long-term disability and death. In this retrospective study we (1) investigated causes of NTSCI, (2) identified clinical markers associated with NTSCI and (3) discuss implications for NTSCI management. Methods: Our sample consisted of 5.913 consecutive neurological and neurosurgical patients who were treated in our emergency department during a one-year period. Patients with a new or worsened bilateral sensorimotor deficit were defined as possible NTSCI. We then compared clinical and imaging findings and allocated patients into NTSCIs and MMs. Results: Of ninety-three included cases, thirty-six (38.7%) were diagnosed with NTSCI. Fifty-two patients (55.9%) were classified as MMs. In five patients (5.4%) the underlying pathology remained unclear. Predominant causes of NTSCI were spinal metastases (33.3%), inflammatory disorders (22.2%) and degenerative pathologies (19.4%). 58.6% of NTSCI patients required emergency treatment. Presence of a sensory level (p = <0.001) and sphincter dysfunction (p = 0.02) were the only significant discriminators between NTSCI and MMs. Conclusion: In our study, one-third of patients presenting with a new bilateral sensorimotor deficit had NTSCI. Of these, the majority required emergency treatment. Since there is a significant clinical overlap with non-spinal disorders, a standardized diagnostic work-up including routine spinal MRI is recommended for NTSCI management, rather than an approach that is mainly based on clinical findings.

17.
Scand J Trauma Resusc Emerg Med ; 29(1): 15, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436034

RESUMO

BACKGROUND: Management of patients with coma of unknown etiology (CUE) is a major challenge in most emergency departments (EDs). CUE is associated with a high mortality and a wide variety of pathologies that require differential therapies. A suspected diagnosis issued by pre-hospital emergency care providers often drives the first approach to these patients. We aim to determine the accuracy and value of the initial diagnostic hypothesis in patients with CUE. METHODS: Consecutive ED patients presenting with CUE were prospectively enrolled. We obtained the suspected diagnoses or working hypotheses from standardized reports given by prehospital emergency care providers, both paramedics and emergency physicians. Suspected and final diagnoses were classified into I) acute primary brain lesions, II) primary brain pathologies without acute lesions and III) pathologies that affected the brain secondarily. We compared suspected and final diagnosis with percent agreement and Cohen's Kappa including sub-group analyses for paramedics and physicians. Furthermore, we tested the value of suspected and final diagnoses as predictors for mortality with binary logistic regression models. RESULTS: Overall, suspected and final diagnoses matched in 62% of 835 enrolled patients. Cohen's Kappa showed a value of κ = .415 (95% CI .361-.469, p < .005). There was no relevant difference in diagnostic accuracy between paramedics and physicians. Suspected diagnoses did not significantly interact with in-hospital mortality (e.g., suspected class I: OR .982, 95% CI .518-1.836) while final diagnoses interacted strongly (e.g., final class I: OR 5.425, 95% CI 3.409-8.633). CONCLUSION: In cases of CUE, the suspected diagnosis is unreliable, regardless of different pre-hospital care providers' qualifications. It is not an appropriate decision-making tool as it neither sufficiently predicts the final diagnosis nor detects the especially critical comatose patient. To avoid the risk of mistriage and unnecessarily delayed therapy, we advocate for a standardized diagnostic work-up for all CUE patients that should be triggered by the emergency symptom alone and not by any suspected diagnosis.


Assuntos
Coma/etiologia , Auxiliares de Emergência , Médicos , Fatores Etários , Idoso , Serviço Hospitalar de Emergência , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
18.
Chemosphere ; 262: 127716, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32799137

RESUMO

For the first time the occurrence of 25 organic micropollutants (OMPs) including; 11 personal care products (PCPs), six phthalate ester plasticizers (PEPs) and eight organophosphorus flame retardants (OPFRs) was investigated in 72 water samples obtained from five bays in the Uganda sector of Lake Victoria. In addition, an assessment of the potential ecotoxic risk of the target OMPs to aquatic organisms was conducted. Water samples were analyzed for the target OMPs using gas chromatography coupled with mass spectrometry (GC/MS). All the target PCPs were found in all the water samples with the exception of musk ketone and 2,6-di-tert-butylphenol. Triclosan (89-1400 ng L-1), benzophenone (36-1300 ng L-1), and 4-methylbenzylidine camphor (21-1500 ng L-1) were the most predominant PCPs. All the six plasticizers were found in all the water samples with dibutyl phthalate (350-16 000 ng L-1), and bis-(2-ethylhexyl) phthalate (210-23 000 ng L-1) detected at the highest concentrations. Five OPFRs out of the eight targeted were found in all the water samples. Tricresyl phosphate (25-8100 ng L-1), tris-(2-chloroethyl) phosphate (24-6500 ng L-1) and triphenyl phosphate (54-4300 ng L-1) were the most dominant OPFRs. The highest concentrations of OMPs were recorded in Murchison and Thurston Bays, presumably due to industrial wastewater effluents from the highly industrialized localities of the two Bays. Ecotoxicological risk assessment showed that PCPs (triclosan, musk ketone, and 4-MBC), plasticizers (dibutyl phthalate, bis-(2-ethylhexyl) adipate and bis-(2-ethylhexyl) phthalate) and OPFRs (tricresyl phosphate, triphenyl phosphate and tris-(2-chloroethyl) phosphate) pose a high ecotoxic risk to lives of aquatic organisms (risk quotients, RQ > 1).


Assuntos
Cosméticos/análise , Retardadores de Chama/análise , Lagos/análise , Compostos Organofosforados/análise , Plastificantes/análise , Poluentes Químicos da Água/análise , Animais , Cosméticos/toxicidade , Ecotoxicologia/métodos , Retardadores de Chama/toxicidade , Cromatografia Gasosa-Espectrometria de Massas/métodos , Compostos Organofosforados/toxicidade , Plastificantes/toxicidade , Medição de Risco , Análise Espaço-Temporal , Uganda , Águas Residuárias/química , Poluentes Químicos da Água/toxicidade
19.
Rofo ; 193(7): 778-786, 2021 Jul.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33327031

RESUMO

BACKGROUND: The exposure of a pregnant woman to X-rays is an event that can cause uncertainty for all concerned. This review provides guidance on how to assess such a situation and how to determine the dose to the unborn child. In general, the use of X-rays in pregnant women in radiology should be avoided. If possible, alternatives should be used, or examinations postponed to a time after the pregnancy. This review gives a summary of the procedure for determining the radiation exposure of a pregnant woman. METHOD: Based on the previous report of 2002 and the literature on prenatal radiation exposure published thereafter, the DGMP/DRG report on the procedure for the assessment of prenatal radiation exposure was adapted to the current state of science and technology. RESULTS: Typically, only relatively low radiation exposures of less than 20 mSv occur for the unborn child in X-ray diagnostics in the vast majority of cases. At these dose level the additional risk of damage to the embryo or fetus caused by the radiation is low and therefore only a rough conservative estimate using tabulated values are made. Only in a few types of examination (CT and interventional radiology) higher doses values might occur in the uterus. Instead of dose estimates (step 1 in the two-step model) in these cases the calculation of dose (step 2) are required and further action by the physician may be necessary. CONCLUSIONS: During the assessment, it is useful to initially use simple conservative estimation procedures to quickly determine whether a case falls into this large group less than 20 mSv, where there is a very low risk to the unborn child. If this is the case, the pregnant woman should be informed immediately by the doctor who performed the examination/treatment. This avoids a psychological burden on the patient. The DGMP/DRG report suggests a relatively simple, clearly structured procedure with advantages for all parties involved (physician, medical physics experts, MTRA and patient). KEY POINTS: · The DGMP/DRG report on prenatal radiation exposure describes the procedure for calculating radiation exposures and the associated risks for the unborn child.. · Using the two-step model, only a simple assessment based on the first step is necessary for most prenatal radiation exposures.. · With the given tables it is possible to estimate individual risks for the unborn child taking into account the radiation exposure.. · Only in the rare case that the first estimate results in a uterine dose larger 20 mSv a more accurate calculation is necessary.. CITATION FORMAT: · Fiebich M, Block A, Borowski M et al. Prenatal radiation exposure in diagnostic and interventional radiology. Fortschr Röntgenstr 2021; 193: 778 - 786.


Assuntos
Feto/efeitos da radiação , Doses de Radiação , Exposição à Radiação/efeitos adversos , Radiologia Intervencionista , Relação Dose-Resposta à Radiação , Feminino , Humanos , Gravidez , Exposição à Radiação/análise
20.
Am J Physiol Endocrinol Metab ; 298(2): E362-71, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19903863

RESUMO

The anaplerotic odd-medium-chain triglyceride triheptanoin is used in clinical trials for the chronic dietary treatment of patients with long-chain fatty acid oxidation disorders. We previously showed (Kinman RP, Kasumov T, Jobbins KA, Thomas KR, Adams JE, Brunengraber LN, Kutz G, Brewer WU, Roe CR, Brunengraber H. Am J Physiol Endocrinol Metab 291: E860-E866, 2006) that the intravenous infusion of triheptanoin increases lipolysis traced by the turnover of glycerol. In this study, we tested whether lipolysis induced by triheptanoin infusion is accompanied by the potentially harmful release of long-chain fatty acids. Rats were infused with heptanoate +/- glycerol or triheptanoin. Intravenous infusion of triheptanoin at 40% of caloric requirement markedly increased glycerol endogenous R(a) but not oleate endogenous R(a). Thus, the activation of lipolysis was balanced by fatty acid reesterification in the same cells. The liver acyl-CoA profile showed the accumulation of intermediates of heptanoate beta-oxidation and C(5)-ketogenesis and a decrease in free CoA but no evidence of metabolic perturbation of liver metabolism such as propionyl overload. Our data suggest that triheptanoin, administered either intravenously or intraduodenally, could be used for intensive care and nutritional support of metabolically decompensated long-chain fatty acid oxidation disorders.


Assuntos
Adipócitos/metabolismo , Ácidos Graxos/metabolismo , Lipólise/fisiologia , Triglicerídeos/administração & dosagem , 3-Hidroxiacil-CoA Desidrogenases/metabolismo , Acetil-CoA C-Aciltransferase/metabolismo , Animais , Isomerases de Ligação Dupla Carbono-Carbono/metabolismo , Enoil-CoA Hidratase/metabolismo , Nutrição Enteral , Esterificação/fisiologia , Glucose/metabolismo , Heptanoatos/administração & dosagem , Infusões Intravenosas , Lipase/metabolismo , Fígado/enzimologia , Masculino , Racemases e Epimerases/metabolismo , Ratos , Ratos Sprague-Dawley , Triglicerídeos/metabolismo
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