A biological and chemical approach to restoring water quality: A case study in an urban eutrophic pond.

Efforts to improve water quality of eutrophic ponds often involve implementing changes to watershed management practices to reduce external nutrient loads. While this is required for long-term recovery and prevention, eutrophic conditions are often sustained through the recycling of internal nutrients already present within the waterbody. In particular, internal phosphorus bound to organic material and adsorbed to sediment has the potential to delay lake recovery for decades. Thus, pond and watershed management techniques are needed that not only reduce external nutrient loading but also mitigate the effects of internal nutrients already present. Therefore, our objective was to demonstrate a biological and chemical approach to remove and sequester nutrients present and entering an urban retention pond. A novel biological and chemical management technique was designed by constructing a 37 m2 (6.1 m × 6.1 m) floating treatment wetland coupled with a slow-release lanthanum composite inserted inside an airlift pump. The floating treatment wetland promoted microbial denitrification and plant uptake of nitrogen and phosphorus, while the airlift pump slowly released lanthanum to the water column over the growing season to reduce soluble reactive phosphorus. The design was tested at the microcosm and field scales, where nitrate-N and phosphate-P removal from the water column was significant (α = 0.05) at the microcosm scale and observed at the field scale. Two seasons of field sampling showed both nitrate-N and phosphate-P concentrations were reduced from 50 µg L-1 in 2020 to <10 µg L-1 in 2021. Load calculations of incoming nitrate-N and phosphate-P entering the retention pond from the surrounding watershed indicate the presented biological-chemical treatment is sustainable and will minimize the effects of nutrient loading from nonpoint source pollution.

Prostate cancer brachytherapy: SFRO guidelines 2021.

Prostate brachytherapy techniques are described, concerning both permanent seed implant and high dose rate brachytherapy. The following guidelines are presented: brachytherapy indications, implant procedure for permanent low dose rate implants and high dose rate with source projector, as well as dose and dose-constraints objectives, immediate postoperative management, post-treatment evaluation, and long-term follow-up.

Fractionated Stereotactic Radiation Therapy for Pituitary Adenomas: An alternative escalating protocol of hypofractionated stereotactic radiotherapy delivering 35Gy in 5 fractions.

PURPOSE: Evaluate efficacy and toxicity of hypofractionated stereotactic radiotherapy (HSRT) for patients treated for pituitary adenoma (PA) with an alternative HSRT escalating protocol delivering 35Gy in 5 fractions. MATERIAL AND METHODS: From June 2007 to March 2017, 29 patients with pituitary adenoma were treated in Antoine Lacassagne Cancer Centre with an alternative HSRT protocol. Prescribed dose was 35Gy in 5 fractions of 7Gy. Radiographic responses were assessed by annual MRI. Hormone blood samples were evaluated each year after HSRT. RESULTS: A total of 29 patients aged between 23 and 86 years (median 54 years) were included. Twelve patients received HSRT for recurrent cases and 12 received postoperative adjuvant HSRT, 5 patients did not have surgery. After a median follow-up period of 47 months local control rate was 96%. One patient presented an out-field tumor regrowth 73 months after HSRT. The majority of PA were endocrine-active (18 patients, 62%). After HSRT, 8 patients (44%) presented complete response on initial secretion, 4 patients (23%) presented partial response on initial secretion. Four patients (14%) presented grade 2 or more acute radiation toxicities. One grade 4 visual disorder was observed for one patient. CONCLUSIONS: HSRT delivering 35Gy in 5 fractions represents a feasible treatment and shows promising results to reduce hormonal overproduction and to improve local control in PA.

Brachytherapy boost for prostate cancer: A national survey from Groupe curiethérapie - Société française de radiothérapie oncologique.

PURPOSE: Brachytherapy can be used for the treatment of every localized prostate cancer, notably as boost for intermediate- and high-risk prostate cancer. With the incidence of prostate cancer increasing significantly during the next decades and brachytherapy developing, we conducted a descriptive survey to analyse the current status of prostate brachytherapy in France to see if the future demands could be met. MATERIAL AND METHODS: All radiotherapy centres that declared providing brachytherapy were found from the French national institute of cancer registry and they were asked to reply to an online form in April 2018. RESULTS: Fifty-two of the 54-brachytherapy centres (96%) replied the form and 34 centres did prostate brachytherapy. Among those centres, 32 performed iodine 125 low-dose rate brachytherapy as monotherapy, 19 provided brachytherapy boost (eight centres low-dose rate 125I; seven centres high-dose rate; four centres both). Among the centres not performing brachytherapy boost, 18 wanted to do, eight did not want and nine did not reply. The main reasons for reluctance towards brachytherapy boost were: organization constraints (three centres), refer patients to a nearby brachytherapy centre (one centre), technical issues (two centres) and lack of strong scientific evidences (two centres). In terms of human resources, the mean number of trained physicians and physicists were two (range: 1-6) and three (range: 1-5) respectively. CONCLUSION: In France, the future needs for prostate brachytherapy cannot be met by the current health supply. Health authorities should firstly reimburse brachytherapy boost and redefine an optimal training and organization of centres such that every patient with prostate cancer can receive optimal treatment.

Psychometric properties of Hope Scales: A systematic review.

INTRODUCTION: Hope is recognised as an important factor in health, illness, and well-being. Many scales to measure hope have been developed and used in various disciplines, yet, their psychometric properties have not been systematically reviewed. AIM: To systematically review the psychometric properties of hope scales. DESIGN: Systematic review. METHODS: Four electronic databases were searched followed by a hand search. The data were extracted and qualitatively evaluated by the COSMIN checklist, an instrument designed as a quality rating tool for systematic reviews of psychometric properties. RESULTS: From 1271 retrieved abstracts, 68 papers met the inclusion criteria. The most used scale was the Snyder Hope Scale (46%) followed by the Herth Hope Index (16%). All other scales (n = 16) were evaluated in less than 10% of the papers. Structural validity (91%), internal consistency (88%), and hypothesis testing (74%) were the most reported properties. Reliability (34%), cross-cultural validity (34%), content validity (25%), and criterion validity (15%) were reported in less than 50% of the papers. Only two (3%) studies reported responsiveness, and none reported measurement error. Less than 35% of the validation studies achieved excellent or good quality for any of the measurement properties. CONCLUSION: The results show that no robust and valid scale exists for measuring hope. It highlights important gaps in psychometric properties of hope scales. Despite more than 40 years of research and development of hope scales, the currently available scales do not meet the standards of psychometric evaluation. This calls for efforts to improve the quality of hope scales.

Delaying Ambulation Mode Transition Decisions Improves Accuracy of a Flexible Control System for Powered Knee-Ankle Prosthesis.

Powered lower limb prostheses can assist users in a variety of ambulation modes by providing knee and/or ankle joint power. This study's goal was to develop a flexible control system to allow users to perform a variety of tasks in a natural, accurate, and reliable way. Six transfemoral amputees used a powered knee-ankle prosthesis to ascend/descend a ramp, climb a 3- and 4-step staircase, perform walking and standing transitions to and from the staircase, and ambulate at various speeds. A mode-specific classification architecture was developed to allow seamless transitions at four discrete gait events. Prosthesis mode transitions (i.e., the prosthesis' mechanical response) were delayed by 90 ms. Overall, users were not affected by this small delay. Offline classification results demonstrate significantly reduced error rates with the delayed system compared to the non-delayed system (p < 0.001). The average error rate for all heel contact decisions was 1.65% [0.99%] for the non-delayed system and 0.43% [0.23%] for the delayed system. The average error rate for all toe off decisions was 0.47% [0.16%] for the non-delayed system and 0.13% [0.05%] for the delayed system. The results are encouraging and provide another step towards a clinically viable intent recognition system for a powered knee-ankle prosthesis.

[Prostate cancer brachytherapy]. / Curiethérapie des cancers de la prostate.

Prostate brachytherapy techniques are described, concerning both Iodine 125 high dose rate brachytherapy. The following parts are presented: brachytherapy indications, technical description, immediate postoperative management and post-treatment evaluation, and 4 to 6 weeks as well as long-term follow-up.

Whole-Body Hyperthermia for the Treatment of Major Depressive Disorder: A Randomized Clinical Trial.

IMPORTANCE: Limitations of current antidepressants highlight the need to identify novel treatments for major depressive disorder. A prior open trial found that a single session of whole-body hyperthermia (WBH) reduced depressive symptoms; however, the lack of a placebo control raises the possibility that the observed antidepressant effects resulted not from hyperthermia per se, but from nonspecific aspects of the intervention. OBJECTIVE: To test whether WBH has specific antidepressant effects when compared with a sham condition and to evaluate the persistence of the antidepressant effects of a single treatment. DESIGN, SETTING, AND PARTICIPANTS: A 6-week, randomized, double-blind study conducted between February 2013 and May 2015 at a university-based medical center comparing WBH with a sham condition. All research staff conducting screening and outcome procedures were blinded to randomization status. Of 338 individuals screened, 34 were randomized, 30 received a study intervention, and 29 provided at least 1 postintervention assessment and were included in a modified intent-to-treat efficacy analysis. Participants were medically healthy, aged 18 to 65 years, met criteria for major depressive disorder, were free of psychotropic medication use, and had a baseline 17-item Hamilton Depression Rating Scale score of 16 or greater. INTERVENTIONS: A single session of active WBH vs a sham condition matched for length of WBH that mimicked all aspects of WBH except intense heat. MAIN OUTCOMES AND MEASURES: Between-group differences in postintervention Hamilton Depression Rating Scale scores. RESULTS: The mean (SD) age was 36.7 (15.2) years in the WBH group and 41.47 (12.54) years in the sham group. Immediately following the intervention, 10 participants (71.4%) randomized to sham treatment believed they had received WBH compared with 15 (93.8%) randomized to WBH. When compared with the sham group, the active WBH group showed significantly reduced Hamilton Depression Rating Scale scores across the 6-week postintervention study period (WBH vs sham; week 1: -6.53, 95% CI, -9.90 to -3.16, P < .001; week 2: -6.35, 95% CI, -9.95 to -2.74, P = .001; week 4: -4.50, 95% CI, -8.17 to -0.84, P = .02; and week 6: -4.27, 95% CI, -7.94 to -0.61, P = .02). These outcomes remained significant after evaluating potential moderating effects of between-group differences in baseline expectancy scores. Adverse events in both groups were generally mild. CONCLUSIONS AND RELEVANCE: Whole-body hyperthermia holds promise as a safe, rapid-acting, antidepressant modality with a prolonged therapeutic benefit. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01625546.

Pharmacogenomic interaction between the Haptoglobin genotype and vitamin E on atherosclerotic plaque progression and stability.

OBJECTIVE: Homozygosity for a 1.7 kb intragenic duplication of the Haptoglobin (Hp) gene (Hp 2-2 genotype), present in 36% of the population, has been associated with a 2-3 fold increased incidence of atherothrombosis in individuals with Diabetes (DM) in 10 longitudinal studies compared to DM individuals not homozygous for this duplication (Hp 1-1/2-1). The increased CVD risk associated with the Hp 2-2 genotype has been shown to be prevented with vitamin E supplementation in man. We sought to determine if there was an interaction between the Hp genotype and vitamin E on atherosclerotic plaque growth and stability in a transgenic model of the Hp polymorphism. METHODS AND RESULTS: Brachiocephalic artery atherosclerotic plaque volume was serially assessed by high resolution ultrasound in 28 Hp 1-1 and 26 Hp 2-2 mice in a C57Bl/6 ApoE(-/-) background. Hp 2-2 mice had more rapid plaque growth and an increased incidence of plaque hemorrhage and rupture. Vitamin E significantly reduced plaque growth in Hp 2-2 but not in Hp 1-1 mice with a significant pharmacogenomic interaction between the Hp genotype and vitamin E on plaque growth. CONCLUSIONS: These results may help explain why vitamin E supplementation in man can prevent CVD in Hp 2-2 DM but not in non Hp 2-2 DM individuals.

[Brachytherapy for anal cancers]. / Curiethérapie du canal anal.

Low dose-rate brachytherapy as a boost after concomitant chemoradiation therapy is a standard of care for locally advanced anal carcinoma, providing a rigorous selection taking into account the initial staging and tumor response to external beam radiotherapy. Local control is likely to be superior when the boost is performed with brachytherapy than with external beam radiotherapy. The several steps of the brachytherapy procedure are described. The standard treatment scheme is a concomitant chemoradiation therapy, including 45 Gy (1,8 Gy × 5) pelvic external beam radiotherapy and two courses of 5-fluorouracil and mitomycin-C, followed by a 15 Gy brachytherapy boost with a gap limited to 2 to 3 weeks. Higher irradiation dose for the most advanced cases has not yet demonstrated a therapeutic gain in terms of colostomy free survival. Exclusive brachytherapy for in-situ carcinoma or invasive carcinoma less than 10mm is not recommended due to a high risk of local recurrence. Pulsed dose rate brachytherapy is an alternative to low dose rate brachytherapy (iridium wires) providing the respect of the recommended dose rate (0.5 to 1 Gy/hour). High dose rate brachytherapy is still under evaluation.

Prediction of distal arm joint angles from EMG and shoulder orientation for prosthesis control.

Current state-of-the-art upper limb myoelectric prostheses are limited by only being able to control a single degree of freedom at a time. However, recent studies have separately shown that the joint angles corresponding to shoulder orientation and upper arm EMG can predict the joint angles corresponding to elbow flexion/extension and forearm pronation/ supination, which would allow for simultaneous control over both degrees of freedom. In this preliminary study, we show that the combination of both upper arm EMG and shoulder joint angles may predict the distal arm joint angles better than each set of inputs alone. Also, with the advent of surgical techniques like targeted muscle reinnervation, which allows a person with an amputation intuitive muscular control over his or her prosthetic, our results suggest that including a set of EMG electrodes around the forearm increases performance when compared to upper arm EMG and shoulder orientation. We used a Time-Delayed Adaptive Neural Network to predict distal arm joint angles. Our results show that our network's root mean square error (RMSE) decreases and coefficient of determination (R(2)) increases when combining both shoulder orientation and EMG as inputs.

Target Achievement Control Test: evaluating real-time myoelectric pattern-recognition control of multifunctional upper-limb prostheses.

Despite high classification accuracies (~95%) of myoelectric control systems based on pattern recognition, how well offline measures translate to real-time closed-loop control is unclear. Recently, a real-time virtual test analyzed how well subjects completed arm motions using a multiple-degree of freedom (DOF) classifier. Although this test provided real-time performance metrics, the required task was oversimplified: motion speeds were normalized and unintended movements were ignored. We included these considerations in a new, more challenging virtual test called the Target Achievement Control Test (TAC Test). Five subjects with transradial amputation attempted to move a virtual arm into a target posture using myoelectric pattern recognition, performing the test with various classifier (1- vs 3-DOF) and task complexities (one vs three required motions per posture). We found no significant difference in classification accuracy between the 1- and 3-DOF classifiers (97.2% +/- 2.0% and 94.1% +/- 3.1%, respectively; p = 0.14). Subjects completed 31% fewer trials in significantly more time using the 3-DOF classifier and took 3.6 +/- 0.8 times longer to reach a three-motion posture compared with a one-motion posture. These results highlight the need for closed-loop performance measures and demonstrate that the TAC Test is a useful and more challenging tool to test real-time pattern-recognition performance.

A phase I study of chemoembolization with cisplatin, thiotepa, and lipiodol for primary and metastatic liver cancer.

Thirty patients with primary hepatocellular carcinoma or liver metastases were entered into a program of chemoembolization with cisplatin, lipiodol, and escalating doses of thiotepa. Doses of cisplatin were 100/m2, and thiotepa doses ranged from 9 mg/m2 to 24 mg/m2. Two of three patients with ocular melanoma had partial responses in the liver metastases for 3+ and 16 months. In patients with either hepatocellular carcinoma (15 patients) or primary cholangiocarcinoma of the liver (three patients), there were two partial responses, for 22 and 33 months. Five patients had minor responses: four with a 40% reduction in tumor and one with a mixed response. There were four early deaths, which involved sepsis in two patients, respiratory failure in one, and acute myocardial infarction in one. Otherwise, toxicity was tolerable and reversible and included abdominal pain and transient elevation of serum creatinine, bilirubin, and transaminases. Less common toxicities included ototoxicity and peripheral neuropathy. Chemoembolization of the liver with cisplatin, thiotepa, and lipiodol can produce responses, but toxicity can be significant. The recommended starting phase II dose for future studies is thiotepa 24 mg/m2 and cisplatin 100 mg/m2.

Changes in body composition during breast cancer chemotherapy with the CMF-regimen.

Weight gain is a reported problem associated with adjuvant chemotherapy for breast cancer and often generates psychosocial stress in women [1]. It also may affect prognosis and survival. Changes in body composition and weight during chemotherapy, particularly adjuvant treatment of breast carcinoma, have been previously reported [1-3]. Multiple reasons for this weight gain have been suggested though few theories have been scientifically validated [4]. The aim of this study was to investigate body composition and its relationship to weight change associated with the CMF-based breast cancer chemotherapy protocols. Total body nitrogen (TBN), body fat, total body water (TBW), and anthropometric measurements were conducted on 25 female out-patients (median age 47, range 26-70 years) receiving adjuvant CMF-based chemotherapy for breast cancer. Total body nitrogen was measured using the In Vivo Neutron Capture Analysis (IVNCA) technique (on day 1 of cycles 2-6) and TBP was calculated by multiplying TBN by 6.25 [5]. Nitrogen Index (NI) was calculated by expressing TBN as a percentage of normal. There was a significant increase in mean body weight during chemotherapy of 2.35 kg (p < 0.0001). Serial measurements showed no significant change in mean TBN, NI, or percentage body fat. Break down of body weight showed a significant increase in mean TBW of 0.79 kg (p = 0.003) and mean fat mass of 1.49 kg (p = 0.008). We conclude that weight gain observed during adjuvant chemotherapy for breast carcinoma is primarily due to an increase in fat and TBW.

Preliminary results of a phase II study of high-dose radiation therapy and neoadjuvant plus concomitant 5-fluorouracil with CDDP chemotherapy for patients with anal canal cancer: a French cooperative study.

BACKGROUND: Chemotherapy (5-fluorouracil-mitomycin C) concomitant with radiotherapy (RT) increases local control and colostomy-free survival in advanced anal canal carcinomas (ACC). The purpose of this prospective trial was to analyse the toxicity of and response to an induction chemotherapy combining 5-fluorouracil (5-FU) and CDDP administered concomitantly with irradiation. PATIENTS AND METHODS: Thirty patients (24 F/6 M, mean age 60, range 38-74) with an advanced ACC > 40 mm and/or with node involvement were prospectively treated (1 T1, 16 T2, 8 T3, 5 T4, 10 N1, 1 N2, 8 N3) from November 1994 to January 1996. Two induction and two concomitant cycles of 5-FU (800 mg/ m2 D1-4 infusion) and CDDP (80 mg/i.v./m2 at D1) were delivered. RT consisted of 45 Gy (1.8 Gy/fr, 5 fr/w) on pelvis +/- inguinal nodes or 30 Gy (3 Gy/fr, 4 fr/w) by direct perineal field. A boost (15-20 Gy) was delivered six weeks later. TOXICITY: one patient died of a pulmonary embolism on D4. The remaining 29 received the entire treatment, with reduced 5-FU doses in 11 patients because of acute toxicity. The RT boost was delayed for one patient (aplasia). In 109 cycles, 3 grade 4 and 17 grade 3 toxicities were observed; there were no toxic deaths. Tumor response: the complete response (CR) and partial response (PR) rates were, respectively, 11% and 61% after induction chemotherapy, 59% and 31% after concomitant radiochemotherapy and 96% and 0% two months after completion of the treatment. No tumor progression was observed. CONCLUSION: the treatment was well tolerated and there was good compliance. After induction chemotherapy, most of the patients were in PR, with some even in CR. After completion of the treatment all but one were in CR. The tumor response and the long term results of 50 patients will be analysed before initiation of a randomised trial is considered.

Twenty-four-hour blood pressure monitoring during treatment with extended-release felodipine versus slow-release nifedipine: cross-over study.

The lack of comparative studies of nifedipine and felodipine using 24-h blood pressure (BP) monitoring in the same patients led to the present study evaluating the antihypertensive efficacy and side effects of treatment with slow-release (SR) nifedipine (20 mg twice daily) and extended-release (ER) felodipine (10 mg once daily). In the double-blind study, subjects were randomly assigned to one of two treatment groups: 6 weeks of nifedipine SR (20 mg twice daily) followed by 6 weeks of felodipine (ER) (10 mg once daily with evening matched placebo), or vice versa. Twenty-four-hour ambulatory BP monitoring showed no significant differences in systolic BP (SBP) during the day. There were no significant differences in diastolic BP (DBP) throughout the 24 h, although the frequency of DBP recordings > 90 mm Hg was greater during nifedipine (33.1%) than felodipine (27.75%) treatment. The most common side effects were flushing, palpitations, headaches, and ankle edema; there were no adverse effect on lipid profile or glucose level.