Chronic effects of simultaneous electromyostimulation and vibration on leg blood flow in spinal cord injury.

STUDY DESIGN: Randomized two-group parallel. OBJECTIVES: The objective of this study was to analyze the adaptations on the popliteal artery (mean blood velocity (MBV), peak blood velocity (PBV), arterial resting diameter (RD) and blood flow (BF)) induced by 12 weeks of simultaneous application of whole-body vibration and electromyostimulation (WBV+ES) in patients with spinal cord injury (SCI). Secondarily, the musculoskeletal effects of this therapy on the gastrocnemius muscle thickness (MT) and femoral neck bone mineral density (BMD) were analyzed. SETTING: Valladolid, Spain. METHODS: Seventeen SCI patients (American Spinal Injury Association (ASIA) A or B) were randomly assigned to the experimental group (EG=9) or the control group (CG=8). Each subject was assessed in four different occasions: at baseline, after 6 weeks (Post-6) and 12 weeks of the treatment (Post-12) and 8 weeks after the end of the treatment (Post-20). Subjects in the EG performed 30 10-min sessions of WBV+ES during 12 weeks. RESULTS: In the EG, RD increased compared with the baseline value at Post-6 (9.5%, P<0.01), Post-12 (19.0%, P<0.001) and Post-20 (16.7%, P<0.001). Similarly, in the EG, BF increased compared with the baseline value and with CG only at Post-12 ((33.9%, P<0.01) and (72.5%, P<0.05), respectively). Similarly, WBV+ES increased the MT of the gastrocnemius. BMD of both hips remained invariable during the study. CG showed no change at any point. CONCLUSIONS: WBV+ES improved popliteal artery BF, RD and MT after 12 weeks in SCI patients. This increase in RD remained above baseline after 8 weeks. The combination of WBV and ES could be considered a promising alternative to reverse the musculoskeletal atrophy and improve peripheral vascular properties in SCI patients.

A track length estimator method for dose calculations in low-energy X-ray irradiations: implementation, properties and performance.

The track length estimator (TLE) method, an "on-the-fly" fluence tally in Monte Carlo (MC) simulations, recently implemented in GATE 6.2, is known as a powerful tool to accelerate dose calculations in the domain of low-energy X-ray irradiations using the kerma approximation. Overall efficiency gains of the TLE with respect to analogous MC were reported in the literature for regions of interest in various applications (photon beam radiation therapy, X-ray imaging). The behaviour of the TLE method in terms of statistical properties, dose deposition patterns, and computational efficiency compared to analogous MC simulations was investigated. The statistical properties of the dose deposition were first assessed. Derivations of the variance reduction factor of TLE versus analogous MC were carried out, starting from the expression of the dose estimate variance in the TLE and analogous MC schemes. Two test cases were chosen to benchmark the TLE performance in comparison with analogous MC: (i) a small animal irradiation under stereotactic synchrotron radiation therapy conditions and (ii) the irradiation of a human pelvis during a cone beam computed tomography acquisition. Dose distribution patterns and efficiency gain maps were analysed. The efficiency gain exhibits strong variations within a given irradiation case, depending on the geometrical (voxel size, ballistics) and physical (material and beam properties) parameters on the voxel scale. Typical values lie between 10 and 10(3), with lower levels in dense regions (bone) outside the irradiated channels (scattered dose only), and higher levels in soft tissues directly exposed to the beams.

Where do we stand with IPF treatment?

Despite receiving 'weak no' recommendations in the updated guidelines on treating patients with Idiopathic Pulmonary Fibrosis (IPF), two key treatment options are pirfenidone and N-acetylcysteine (NAC), and both are used in clinical practice. The efficacy of pirfenidone is supported by a number of Phase III trials as well as a Cochrane meta-analysis. Tolerability data are also provided by clinical trials and a long-term extension phase of these studies. Pirfenidone is approved in Europe for the treatment of patients with mild-to-moderate IPF. NAC-based therapy has no such approval, but is commonly used to treat patients. A Phase III trial suggested some benefit of the NAC, prednisone and azathioprine regimen for IPF patients, but the study had many limitations. A further study to investigate this regimen, compared with a placebo alone arm, was recently stopped due to increased mortality in the triple-therapy arm. Discussion of these data and recent findings highlight the importance of a further update to the existing guidelines, so that IPF specialists can provide the most up-to-date advice and treatment to patients in clinical practice.

Simulation of dose deposition in stereotactic synchrotron radiation therapy: a fast approach combining Monte Carlo and deterministic algorithms.

A hybrid approach, combining deterministic and Monte Carlo (MC) calculations, is proposed to compute the distribution of dose deposited during stereotactic synchrotron radiation therapy treatment. The proposed approach divides the computation into two parts: (i) the dose deposited by primary radiation (coming directly from the incident x-ray beam) is calculated in a deterministic way using ray casting techniques and energy-absorption coefficient tables and (ii) the dose deposited by secondary radiation (Rayleigh and Compton scattering, fluorescence) is computed using a hybrid algorithm combining MC and deterministic calculations. In the MC part, a small number of particle histories are simulated. Every time a scattering or fluorescence event takes place, a splitting mechanism is applied, so that multiple secondary photons are generated with a reduced weight. The secondary events are further processed in a deterministic way, using ray casting techniques. The whole simulation, carried out within the framework of the Monte Carlo code Geant4, is shown to converge towards the same results as the full MC simulation. The speed of convergence is found to depend notably on the splitting multiplicity, which can easily be optimized. To assess the performance of the proposed algorithm, we compare it to state-of-the-art MC simulations, accelerated by the track length estimator technique (TLE), considering a clinically realistic test case. It is found that the hybrid approach is significantly faster than the MC/TLE method. The gain in speed in a test case was about 25 for a constant precision. Therefore, this method appears to be suitable for treatment planning applications.

Dose distribution from x-ray microbeam arrays applied to radiation therapy: an EGS4 Monte Carlo study.

We present EGS4 Monte Carlo calculations of the spatial distribution of the dose deposited by a single x-ray pencil beam, a planar microbeam, and an array of parallel planar microbeams as used in radiation therapy research. The profiles of the absorbed dose distribution in a phantom, including the peak-to-valley ratio of the dose distribution from microbeam arrays, were calculated at micrometer resolution. We determined the dependence of the findings on the main parameters of photon and electron transport. The results illustrate the dependence of the electron range and the deposited in-beam dose on the cut-off energy, of the electron transport, as well as the effects on the dose profiles of the beam energy, the array size, and the beam spacing. The effect of beam polarization also was studied for a single pencil beam and for an array of parallel planar microbeams. The results show that although the polarization effect on the dose distribution from a 3 cm x 3 cm microbeam array inside a water phantom is large enough to be measured at the outer side of the array (16% difference of the deposited dose for x-ray beams of 200 keV), it is not detectable at the array's center, thus being irrelevant for the radiation therapy purposes. Finally we show that to properly compare the dose profiles determined with a metal oxide semiconductor field emission transistor detector with the computational method predictions, it is important to simulate adequately the size and the material of the device's Si active element.

Small hepatocellular carcinoma treated with percutaneous RF ablation: MR imaging follow-up.

OBJECTIVE: The purpose of our study was to determine the usefulness of MR imaging in the follow-up evaluation of small hepatocellular carcinoma lesions treated with RF ablation. SUBJECTS AND METHODS: The study group included 37 patients with a single hepatocellular carcinoma lesion less than 3 cm in diameter. A strict protocol required follow-up MR imaging every 6 months after RF treatment. At each follow-up visit, the findings on unenhanced and dynamic gadolinium-enhanced MR images were correlated with those on contrast-enhanced CT images and with results of fine-needle aspiration biopsy. In five patients who underwent surgical resection after the 6-month follow-up examination, comparison with histologic findings of surgical specimens was also performed. RESULTS: Correct diagnosis of complete or partial tumor necrosis was made in 32 (86%) of the 37 patients with the use of unenhanced and dynamic gadolinium-enhanced MR images. Hypointensity on T2-weighted images and loss of enhancement on dynamic MR images corresponded to completely necrotic lesions in all patients. Conversely, intratumoral regions of hyperintensity on T2-weighted images and enhancement on dynamic MR images did not always correlate to residual viable tumor. MR imaging and CT findings agreed in the evaluation of therapeutic response in all patients. CONCLUSION: Our experience confirms that MR imaging is useful for evaluating the effectiveness of RF therapy in achieving tumor regression.

Differential SP220K expression in renal carcinoma and oncocytoma cells.

SP220K is a newly described serine proteinase which displays guanidinobenzoatase activity in its inactive form and gelatinolytic activity in its active form. SP220K expression was studied in 20 renal clear-cell carcinomas and in a series of renal oncocytomas, a rare benign tumor derived from the kidney tubule epithelium. We provide evidence that SP220K expression, as assessed by guanidinobenzoatase activity, gelatin zymography and Western blot immunodetection, was increased markedly in cancer basolateral membranes compared to kidney cortex controls, whereas no signal was detectable in basolateral membranes from the 5 renal oncocytomas studied. Cytoplasms of carcinoma cells were immunodetected consistently, whereas no expression was seen in oncocytic cells from any of the oncocytomas studied (12/12). Endothelial cells were immunodetected in all 3 tissue types. Our data favor a potential mechanistic relationship between expression of the matrix proteinase SP220K and invasive phenotype in kidney epithelium proliferative processes.

Biological activity of particle exhaust emissions from light-duty diesel engines.

Whole diesel exhaust has been classified recently as a probable carcinogen, and several genotoxicity studies have found particulate exhaust to be clearly mutagenic. Moreover, genotoxicity of diesel particulate is greatly influenced by fuel nature and type of combustion. In order to obtain an effective environmental pollution control, combustion processes using alternative fuels are being analyzed presently. The goal of this study is to determine whether the installation of exhaust after treatment-devices on two light-duty, exhaust gas recirculation (EGR) valve-equipped diesel engines (1930 cc and 2500 cc) can reduce the mutagenicity associated with particles collected during U.S.A. and European driving cycles. Another interesting object was to compare the ability of alternative biodiesel and conventional diesel fuels to reduce the mutagenic activity associated with collected particles from two light duty diesel engines (both 1930 cc) during the European driving cycle. SOF mutagenicity was assayed using the Salmonella/microsome test (TA 98 and TA 100 strains, +/- S9 fraction). In the first part of our study, the highest mutagenicity was revealed by TA98 strain without enzymatic activation, suggesting a direct-acting mutagenicity prevalence in diesel particulate. The 2500 cc engine revealed twofold mutagenic activity compared with the 1930 cc engine (both EGR valve equipped), whereas an opposite result was found in particulate matter amount. The use of a noncatalytic ceramic trap produced a decrease of particle mutagenic activity in the 2500 cc car, whereas an enhancement in the 1930 cc engine was found. The catalytic converter and the electrostatic filter installed on the 2500 cc engine yielded a light particle amount and an SOF mutagenicity decrease. A greater engine stress was obtained using European driving cycles, which caused the strongest mutagenicity/km compared with the U.S.A. cycles. In the second part of the investigation, even though a small number of assays were available, exhaust emission generation by biodiesel fuel seemed to yield a smaller environmental impact than that of the referenced diesel fuel. The results point out the usefulness of mutagenicity testing in the research of both newer, more efficient automotive aftertreatment devices and less polluting fuels.

[Importance of echography in the study of urinary tract infections in childhood]. / L'importanza dell'ecografia nello studio delle infezioni delle vie urinarie nell'infanzia.

One hundred and twenty-one children with a clinical diagnosis of urinary tract infection (UTI) were examined with sonography (US), ivp and voiding cystourethrography (VCUG). In 84 patients neither US nor radiographic findings were found of pathological significance; in 16 out of 37 patients with pathological findings both US and ivp were negative, whereas VCUG was decisive for a correct diagnosis. VCUG demonstrated vesicoureteric reflux in 10 patients, posterior urethral valves in 1 patient, and small diverticula of the urinary bladder in 5 patients. In 17 of the remaining 21 cases, there was agreement between US and urographic findings, whereas in 4 cases US provided us with false positives, with images of apparent renal scarring. The mistake was caused by an incorrect US detection of unilateral duplication of the collecting systems. The authors conclude by stressing the importance of ivp in the evaluation of urinary tract infections in children, even in case of negative VCUG and US results, and suggest comparing US measurements of renal length to the distance between three contiguous lumbar vertebrae in order to obtain measurements comparable to body growth.