Voluntary deep inspiration breath-hold with volumetric modulated arc therapy in pediatric patients with mediastinal Hodgkin lymphoma.

Background: Deep inspiration breath-hold (DIBH) has been established to decrease normal tissue radiation dose in breast cancer. Methods: Forty-nine patients had two CT scans during DIBH or free breathing. Chest-wall position, setup verification and breath-hold monitoring were performed. Cone-beam CT and a surface image system were used for verification. Results: A total of 1617 breath-holds were analyzed in 401 fractions. The mean time bit was 6.01 min. The mean breaths-holds per fraction was 4.96. The median for intra-breath hold variability was 3 mm. No patient stopped treatment for intolerance. Clinical target volume margins were calculated as 0.36, 0.36 and 0.32 for the three translational positions. The mean saved volume was 26.3%. Conclusion: Voluntary DIBH is feasible, tolerable and easy to apply for children with Hodgkin lymphoma involving the mediastinum.

Deep inspiration breath-hold (DIBH) is a radiotherapy maneuver to decrease the exposure of normal tissues during the radiation of the target organ. It was developed for the treatment of breast cancer, both intact breast and chest wall, after mastectomy. For mediastinal Hodgkin lymphoma, especially in children and adolescents, DIBH will benefit in decreasing the radiation dose to the lungs and heart in this category of patients who still have normal growing tissues. We treated 49 pediatric and adolescent patients with DIBH and precise radiotherapy (volumetric modulated arc therapy) to augment the benefit of lowering the dose to normal tissues. All patients were trained and coached to breath-hold for more than 20 s. No patient stopped treatment due to poor tolerance or discomfort. Only one breath-hold was required for CT simulation in all populations (100%). The mean number of breath-holds per treatment fraction was 5.1 ± 1.8. The mean treatment time was 6 ± 1.8 min. DIBH is feasible, tolerable and easy to apply for children and adolescents with Hodgkin lymphoma involving the mediastinum. A considerable dose volume could be saved, hence decreasing the rate of side effects.

Prognostic factors affecting infantile medulloblastoma outcomes in the molecular era: a 12-year single-center experience from Egypt.

Aims: To assess the clinical, pathological and molecular characteristics (Sonic hedgehog and group 3/4 molecular subtypes expression) and treatment modalities for infantile medulloblastoma in correlation with outcomes. Materials & methods: A retrospective study of 86 medulloblastoma patients (≤3 years) was conducted. M0 patients <2.5 years received four cycles of chemotherapy followed by focal radiotherapy (FRT) and chemotherapy. Between 2007 and 2015, Metastatic patients <2.5 years received craniospinal irradiation (CSI) after the end of chemotherapy. After 2015, metastatic patients <2.5 years received CSI postinduction. Results: The hazard ratio for death was significantly higher in the FRT (HR = 2.8) group compared with the CSI group (hazard ratio = 1). Metastatic disease significantly affected the overall survival of the Sonic hedgehog group and the overall survival and event-free survival of group 3/4. Conclusion: Metastatic disease had a significant impact on outcomes. FRT is not effective in treating infantile medulloblastoma.

This study aimed to analyze the management of and prognostic factors affecting the outcomes of 86 young children (<3 years of age at presentation) diagnosed with medulloblastoma, an aggressive brain tumor that is commonly seen in this age group. All children had surgical operations aiming at resecting their tumors, followed by chemotherapy and irradiation. Study results showed that disease disseminated into the nervous system was associated with poorer outcomes compared with localized disease. Administration of local irradiation to the primary tumor site in the brain only, without exposing the spinal cord to radiotherapy, was associated with a higher risk of death.

Developing Improved Corrosion-Resistant AA5083-BN/WC Composites for Tribological Applications.

In this study, corrosion-resistant AA5083-BN/WC composites were developed for tribological applications through adequate control of the reinforcement content (WC and BN) in the matrix (AA5083 alloy). The effects of 6% and 12% tungsten carbide (WC) as well as 6% and 12% boron nitride (BN) additions on the corrosion behavior of AA5083 aluminum composite in 3.5% NaCl solution were carried out. Electrochemical techniques such as cyclic potentiodynamic polarization (CPP), changes in the chronoamperometric current with time (CCT), and electrochemical impedance spectroscopy (EIS) were utilized. The polarization results showed that the addition of 6% WC to the AA5083 alloy matrix improved its resistance to corrosion (RP). Rp exhibited an additional increase by adding 12% WC to the matrix. The values of RP were observed to increase for the AA5083 composite when adding 6% BN, and the highest RP values were recorded for the composite that contains 12% BN. The results obtained by the CPP method were confirmed by CCT and EIS measurements, where the presence of WC and BN protected the developed AA5083- BN/WC composites against corrosion. The corrosion resistance revealed an additional improvement with an increase in WC and BN content from 6% to 12%. The results also confirm that pitting corrosion decreased in the presence of WC and BN in the fabricated composites.

Effect of Al2O3 (x = 0, 1, 2, and 3 vol.%) in CrFeCuMnNi-x High-Entropy Alloy Matrix Composites on Their Microstructure and Mechanical and Wear Performance.

This work aims to study the influence of Al2O3 in CrFeCuMnNi high-entropy alloy matrix composites (HEMCs) on their microstructure, phase changes, and mechanical and wear performances. CrFeCuMnNi-Al2O3 HEMCs were synthesized via mechanical alloying (MA) followed by hot compaction (550 °C at 550 MPa), medium frequency sintering (1200 °C), and hot forging (1000 °C at 50 MPa). The XRD results demonstrate the formation of both FCC and BCC phases in the synthesized powders, which were transformed into major stable FCC and minor ordered B2-BCC phases, as confirmed by HRSEM. The microstructural variation of HRSEM-EBSD, in terms of the coloured grain map (inverse pole figures), grain size distribution, and misorientation angle, was analysed and reported. The grain size of the matrix decreased with the increase in Al2O3 particles owing to the higher structural refinement by MA and zener pinning of the incorporated Al2O3 particles. The hot-forged CrFeCuMnNi-3 vol.% Al2O3 sample exhibited an ultimate compressive strength of 1.058 GPa, which was 21% higher than that of the unreinforced HEA matrix. Both the mechanical and wear performance of the bulk samples increased with an increase in Al2O3 content due to solid solution formation, high configurational mixing entropy, structural refinement, and the effective dispersion of the incorporated Al2O3 particles. The wear rate and coefficient of friction values decreased with the increase in Al2O3 content, indicating an improvement in wear resistance owing to the lower domination of abrasive and adhesive mechanisms, as evidenced by the SEM worn surface morphology.

Synthesis, Microstructure Investigation, Mechanical and Tribological Behaviour of the AA5083-WC Composite.

In this study, AA5083-WC composites were developed by ball milling followed by hot consolidation. The microstructures of the developed composites were investigated using XRD, SEM, EDX, and EBSD. The developed composites exhibited a homogeneous dispersion of WC particulates in the AA5083 matrix without any interactions at the matrix/reinforcement interface. The results confirmed the development of a refined equiaxed grain structure of AA5083-WC composites where the EBSD results revealed an average grain size of 4.38 µm and 3.32 µm for AA5083-6%WC (AW-6) and AA5083-12%WC (AW-12) composites, respectively. The results showed that incorporating WC particulates in the AA5083 alloy matrix significantly improved the compressive stress-strain behaviour and considerably enhanced the resistance to wear and friction. The AA5083-12%WC (AW-12) composite displayed the maximum strength and the highest resistance to wear and friction, whereas the as-milled AA5083 alloy (AW-0) exhibited the lowest strength and the least resistance to wear and friction. The AA5083-12%WC (AW-12) composite exhibited the optimum mechanical and tribological behaviour of the developed composites, making it a promising candidate for tribological applications.

Comparing biological and physical cost functions in VMAT planning for pediatric nasopharyngeal cancer.

BACKGROUND: Volumetric Modulated Arc Therapy (VMAT) is an option for the delivery of Radiotherapy treatment technique for pediatric nasopharyngeal cancer, VMAT is the most common treatment technique for pediatric nasopharyngeal cancer. The use of a combination of both biological and physical parameters in VMAT planning optimization may produce better target coverage and sparing of critical organs. This work was to compare Biological Cost Functions (BCFs) and Physical Cost Functions (PCFs) in the VMAT of pediatric nasopharyngeal cancer patients. METHOD: VMAT plans for 20 nasopharyngeal pediatric cancer patients were created using Monaco 5.11® treatment planning system (TPS). Three VMAT plans were retrospectively generated for each patient using BCFs, PCFs and mixed plan with a total dose of 61.2 Gy in 34 fractions to planning target volume (PTV). All plans were adjusted to deliver 95% of the prescribed dose to 95% of the PTV. The calculated plans were qualitatively and quantitatively evaluated using the dose-volume histogram (DVH). RESULTS: The coverage of the target and the maximum dose for the three plans were nearly the same, and better sparing was achieved in the serial organs (spinal cord and brain stem) with PCFs. On the contrary, more dose spring was observed using the BCFs in the organs at risk (OARs) that were not involved in the dose optimization, such as the optic nerve maximum dose, with a significant p-value (0.035 and 0.0001) respectively. Using the PCFs, both parotids received a lower mean dose, but not for the oral cavity, which had a lower mean dose using BCFs (p=<0.0001). The same values of tumor control probability (TCP) were found for both cost functions in PTVs and normal tissue complications probability (NTCP) (99%). The values reported were as follows: spinal cord = 0.5%, brain stem = 19.1%, and brain = 90.7% for BCFs, compared to spinal cord = 0.3%, brain stem = 14.9%, and brain = 90.7% for PCFs. The delivery time was found to be less in BCFs (p=0.005). CONCLUSION: The BCFs are superior to the PCFs in conformity index and time of radiation delivery. However, PCFs were better at dose sparing for the serial organs and achieving a sharper falloff dose around the involved volumes. A patient-specific clinical compromise is recommended to gain the best plan that meets the clinical goals.

Evaluation of the biocompatibility, antibacterial and anticancer effects of a novel nano-structured Fe-Mn-based biodegradable alloys in-vitro study.

Scientific backgrounds: Development of nanostructured biodegradable alloys has generated a great deal of interest in the recent years as they offer promising bioactive materials for reconstruction of bony defects following traumatic fractures or surgical excision of tumors. Objectives: The aim of the current study was to investigate the biocompatibility of Iron-Manganese -based alloys (Fe-Mn) with addition of copper (Cu), Tungsten (W) and cobalt (Co) to obtain 3 different alloys namely, Fe-Mn-Cu, Fe-Mn-W, and Fe-Mn-Co on normal oral epithelial cell line,and their possible anticancer effect on MG-63: osteosarcoma cell line. Materials and methods: The sulforhodamine B (SRB) assay was used to assess cell viability percentage of both cell lines after exposure to discs of the proposed experimental alloys. Moreover, the antibacterial effect of such alloys against Escherichia coli (E. coli) was tested using disc diffusion susceptibility (Kirby-Bauer method) and colony suspension method. Results: The cell viability percentage of oral epithelial cell line showed a significant increase in all the experimental groups in comparison to the control group. The highest percentage was observed in Fe-Mn-Co group, followed by Fe-Mn-W then Fe-Mn-Cu, at 24 and 72-h intervals, respectively. While the cell viability percentage of osteosarcoma cell line showed significant increase in all the experimental groups at 24-h intervals, it showed a significant drop in all the study groups at 72-h intervals. The lowest percentage was observed in Fe-Mn-Cu group, followed by Fe-Mn-W then Fe-Mn-Co. Moreover, all the examined study groups didn't show any inhibition zones against E. coli reference culture. Conclusions: The novel nanostructured biodegradable Fe-Mn-Cu, Fe-Mn-W, and Fe-Mn-Co metal alloys exhibit good biocompatibility on oral epithelial cell lines with the enhancement of cell proliferation in a time-dependent manner that favors bone regeneration. On the other hand, all the alloys manifested possible anticancer activity against MG-63: osteosarcoma cell line. Furthermore, our study sheds the light on the importance of Co, W and Cu as promising alloying elements. However, the antibacterial activity of the examined alloys is still questionable. Clinical relevance: The novel nanostructured biodegradable Fe-Mn-Cu, Fe-Mn-W, and Fe-Mn-Co metal alloys offer promising bioactive materials for reconstruction of bony defects following traumatic fractures or surgical excision of tumors, In addition, they could be excellent alternatives for undegradable or non-resorbable alloys that are commonly used. Moreover, they could be used as beneficial 3D printing materials to obtain patient-specific medical implants that favor bone regeneration in addition to manufacturing of plates and screws suitable for fracture fixation.

Investigation of the Microstructure and Compressibility of Biodegradable Fe-Mn-Cu/W/Co Nanostructured Alloy Powders Synthesized by Mechanical Alloying.

In this research work, the nanostructured Fe-Mn (BM0), Fe-Mn-Cu (BM1), Fe-Mn-W (BM2), and Fe-Mn-Co (BM3) biodegradable alloys were successfully synthesized using mechanical alloying. The microstructure of the synthesized alloys was examined using XRD, SEM equipped with EDS, and HRTEM techniques. The results obtained based on these techniques confirmed the development of nanostructured BM0, BM1, BM2, and BM3 alloys and homogenous solid solutions with an even elemental dispersion. The compressibility of the synthesized alloys was investigated experimentally and empirically in the as-milled conditions and after applying a stress relief treatment (150 °C for 1 h). The load applied for compaction experiments ranged from 25-1100 MPa with a rate of 1 mm/min. According to the experimentation performed in the current study, the relative density of the as-milled BM0, BM1, BM2, and BM3 alloys was 72.90% and 71.64%, 72.32%, and 72.03%, respectively. After applying the stress relief treatment, the density was observed to increase to 75.23%, 77.10%, 72.65%, and 72.86% for BM0-S, BM1-S, BM2-S and BM3-S samples, respectively. A number of compaction models were tested to identify the optimum models for predicting the compressibility behavior of nanostructured Fe-Mn, Fe-Mn-Cu, Fe-Mn-W, and Fe-Mn-Co alloys in the as-milled and stress-relieved conditions.

Noninvasive assessment of human jawbone using ultrasonic guided waves.

The problem of detecting defects in jawbones is an important problem. Existing methods based on Xrays are invasive and constrain the achievable image quality. They also may carry known risks of cancer generation or may be limited in accurate diagnosis scope. This work is motivated by the lack of current imaging modalities to accurately predict the mechanical properties and defects in jawbone. Ultrasonic guided waves are sensitive to changes in microstructural properties and thus have been widely used for noninvasive material characterization. Using these waves may provide means for early diagnosis of marrow ischemic disorders via detecting focal osteoporotic marrow defect, chronic nonsuppurative osteomyelitis, and cavitations in the mandible (jawbone). Guided waves propagating along the mandibles may exhibit dispersion behavior that depends on material properties, geometry, and embedded cavities. In this work, we present the first study in the theoretical and experimental analysis of guided wave propagation in jawbone. Semianalytical, finite-element (SAFE) method is used to analyze dispersion behavior of guided waves propagating in human mandibles. The geometry of the cross section is obtained by segmenting the computed tomography (CT) images of the jawbone. The cross section of the mandible is divided in two regions representing the cortical and trabecular bones. Each region is modeled as a linear Hookean material. The material properties for both regions are adopted from the literature. The experimental setup for the guided waves experiment is described. The results from both numerical analysis and guided waves experiment exhibit variations in the group velocity of the first arrival signal and in the dispersion behavior of healthy and defected mandibles. These results shall provide a means to noninvasively characterize the jawbone and accurately assess the bone mechanical properties. Our study is not aimed at characterizing the bone density in human mandibles. Rather, it is aimed to assess bone mechanical properties and defects that cannot be diagnosed by X-ray or other imaging modalities. This work may pave the way to the development of inexpensive noninvasive devices to detect small defects in human mandibles.