Quantifying Health Utilities in Patients Undergoing Stereotactic Body Radiation Treatment for Liver Metastases for Use in Future Economic Evaluations.

AIM: Stereotactic body radiation therapy (SBRT) is increasingly used as an option for those with liver metastases. In order to facilitate future economic impact of health technologies, health utility scores may be used. The EuroQOL-5D-3L (EQ-5D) preference-based healthy utility instrument was used to evaluate the impact of treatment with SBRT on health utility scores. MATERIALS AND METHODS: Between August 2013 and October 2014, 31 patients treated with 3-5 fractions of SBRT for liver metastases were enrolled in this study. The EQ-5D instrument was administered at baseline, during and up to 6 months post-SBRT. RESULTS: Mean EQ-5D score at baseline was 0.857, which remained stable across the entire study time period. Transient increases in difficulties with mobility (9.7% reported at baseline to 16.1% on the last day of treatment) and usual activities (3.2% reported at baseline to 34.5% on day two) were found during the course of treatment; these returned to baseline levels subsequently. The mean visual analogue score at baseline was 65.8 and remained unchanged throughout treatment and follow-up. CONCLUSIONS: The stability of health utility scores and problems reported by patients undergoing treatment indicate that SBRT for liver metastases does not impart a significant adverse effect on quality of life. These results may be used for future economic evaluation of SBRT.

Shear Wave Elastography--A New Quantitative Assessment of Post-Irradiation Neck Fibrosis.

PURPOSE: Shear wave elastography (SWE) is a new technique which provides quantitative assessment of soft tissue stiffness. The aim of this study was to assess the reliability of SWE stiffness measurements and its usefulness in evaluating post-irradiation neck fibrosis. MATERIALS AND METHODS: 50 subjects (25 patients with previous radiotherapy to the neck and 25 sex and age-matched controls) were recruited for comparison of SWE stiffness measurements (Aixplorer, Supersonic Imagine). 30 subjects (16 healthy individuals and 14 post-irradiated patients) were recruited for a reliability study of SWE stiffness measurements. SWE stiffness measurements of the sternocleidomastoid muscle and the overlying subcutaneous tissues of the neck were made. The cross-sectional area and thickness of the sternocleidomastoid muscle and the overlying subcutaneous tissue thickness of the neck were also measured. The post-irradiation duration of the patients was recorded. RESULTS: The intraclass correlation coefficients for the intraoperator and interoperator reliability of deep and subcutaneous tissue SWE stiffness ranged from 0.90-0.99 and 0.77-0.94, respectively. The SWE stiffness measurements (mean +/- SD) of deep and subcutaneous tissues were significantly higher in the post-irradiated patients (64.6 ± 46.8 kPa and 63.9 ± 53.1 kPa, respectively) than the sex and age-matched controls (19.9 ± 7.8 kPa and 15.3 ± 8.37 respectively) (p < 0.001). The SWE stiffness increased with increasing post-irradiation therapy duration in the Kruskal Wallis test (p < 0.001) and correlated with muscle atrophy and subcutaneous tissue thinning (p < 0.01). CONCLUSION: SWE is a reliable technique and may potentially be an objective and specific tool in quantifying deep and subcutaneous tissue stiffness, which in turn reflects the severity of neck fibrosis.

In-room assessment of cerebral blood volume for guidance during intra-arterial thrombolytic therapy.

In acute ischemic stroke, the ability to estimate the penumbra and infarction core ratio helps to triage those who will potentially benefit from thrombolytic therapies. Flat-panel post-contrast DynaCT imaging can provide both vasculature and parenchymal blood volume within the angio room to monitor hemodynamic changes during the endovascular procedures. We report on an 80-year-old woman who suffered from an acute occlusion of the right distal cervical internal carotid artery. She was transferred to the angio room where in-room post-contrast flat-panel DynaCT imaging (syngo Neuro PBV IR) was performed to access the ischemic tissue, followed by successful mechanical thrombolytic therapy.

Assessment of non-alcoholic fatty liver disease using serum total cell death and apoptosis markers.

BACKGROUND: The diagnosis of non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) and fibrosis relies on liver biopsy. Non-invasive assessments are urgently needed. AIM: To evaluate cell apoptotic marker cytokeratin-18 M30 and total cell death markers cytokeratin-18 M65/M65ED for the assessment and monitoring of NAFLD. METHODS: A cohort of 147 patients with biopsy-proven NAFLD and 73 controls were enrolled, including 51 patients who received paired liver biopsies 36 months apart. Biomarkers were determined by enzyme-linked immunosorbent assay. RESULTS: M30, M65 and M65ED increased in a stepwise fashion in control subjects, patients with non-NASH, NAFLD and NASH (all P < 0.001). All biomarkers had similarly high accuracy over 0.9 in predicting NAFLD and moderate accuracy around 0.7 in predicting NASH. Among patients with paired liver biopsies, changes in M30, M65 and M65ED positively correlated with disease progression (rho = 0.42, 0.32 and 0.39; P = 0.002, 0.023 and 0.005 respectively), and only changes in M65 and M65ED correlated with fibrosis progression (rho = 0.29, 0.34; P = 0.038, 0.015 respectively). Both M30 and M65 had area under receiver-operating characteristics curve above 0.8 in predicting disease progression. At cut-off of 236 U/L, changes of M65ED had 88% NPV and 59% PPV to exclude and predict fibrosis progression. CONCLUSIONS: Cytokeratin-18 M30 and M65/M65ED have moderate accuracy in detecting non-alcoholic steatohepatitis. Changes in the biomarkers also correlate with histological progression. However, development of new biomarkers is still required to improve the diagnostic accuracy.

Optimization of an accelerator-based epithermal neutron source for neutron capture therapy.

A modeling investigation was performed to choose moderator material and size for creating optimal epithermal neutron beams for BNCT based on a proton accelerator and the (7)Li(p,n)(7)Be reaction as a neutrons source. An optimal configuration is suggested for the beam shaping assembly made from polytetrafluoroethylene and magnesium fluorine to be placed on high current IPPE proton accelerator KG-2.5. Results of calculation were experimentally tested and are in good agreement with measurements.

A simplified risk-based approach for process screening in municipal wastewater reclamation and reuse.

Reuse of municipal wastewater has become a promising solution to relieve the tension of increasing fresh water demand in many metropolitans. Although different advanced technologies are available to reclaim wastewater into premium quality, associated health effects are usually not properly assessed in reclamation process selection. A simplified risk-based approach developed for process screening and adaptation of health impacts as a consideration in reclamation process selection is discussed in this paper. This approach can be used to screen out unqualified processes and those with poor cost benefits. As a result, the design of wastewater reclamation could be enhanced to control the associated health impacts in wastewater reuse.

Upgrading the conventional grease trap using a tube settler.

Grease traps are widely used by most restaurants and food processing industries in Hong Kong to reduce oil and grease to an acceptable level before it can be discharged to public sewers. To meet demanding effluent standards in the future, it is necessary to polish the effluent by upgrading the conventional trap design. This study evaluated the possibility of upgrading traditional grease traps by installing tube settlers inside the trap. Their efficiency of removing chemical oxygen demand (COD) and oil/grease was examined to justify the performance. It was found that installing a tube settler is a feasible and cheap way to upgrade the conventional grease trap, since it improved oil/grease removal efficiency by 8-10% compared to the conventional design. In addition, a remarkable improvement in COD removal was observed following a very short hydraulic detention time after the installation of tube settlers. This ensured acceptable effluent quality under peak flowrates. Two mathematical models were also proposed to facilitate trap design.

Limb-length discrepancy measured with computerized axial tomographic equipment.

A simple, rapid, and accurate method for measuring limb-length discrepancies with computerized axial tomographic equipment is described. With this method less irradiation is delivered and some of the errors of computation are eliminated, compared with conventional methods. The costs of the technique are comparable with those of scanograms. The method is particularly applicable in the patient who has contracture of a joint.