High Dose Rate Brachytherapy for Inoperable Endometrial Cancer: a Case Series and Systematic Review of the Literature.

Endometrial cancer is a common gynaecological cancer, is typically early stage and treated with surgery. For patients where surgery is difficult or dangerous, definitive radiation therapy is the next best option. This study included a single institution case series (step 1) and a systematic review of the literature (step 2). In step 1, all endometrial cancer cases that were treated with definitive image-guided brachytherapy at a single institution from 2008 to 2020 were retrospectively analysed. In step 2, a systematic review of Medline (PubMed) from 1975 to 2020 was carried out using the key words around endometrial cancer and brachytherapy, followed by a narrative synthesis. In total, in step 1, 31 cases were included in this study, stages I-IV, with 96.7% receiving external beam radiation. All patients received three fractions of 7.5 Gy or five fractions of 6 Gy high dose rate brachytherapy, with a median EQD2 of 75.55 (40-84.3). The 2-year Kaplan-Meier (KM) local control was 83.1% and the 2-year KM overall survival was 77.4%. There was no late toxicity ≥grade 3. In step 2, 19 articles were included in the final analysis, with between six and 280 patients. The local control ranged from 70 to 100%, with low toxicity. Definitive radiation therapy with image-guided brachytherapy seems to have good local control with low toxicity for patients who are poor surgical candidates.

Disintegration of Flower-Like MoS2 to Limply Allied Layers on Spherical Nanoporous TiO2: Enhanced Visible-Light Photocatalytic Degradation of Methylene Blue.

MoS2/TiO2 heterostructure with enhanced photocatalytic activity was successfully synthesized by hydrothermal method. The segmentation of flower-like MoS2 structure resulted, during the hydrothermal condition in the presence of spherical nanoporous TiO2 as a growing matrix. A pool of larger spherical TiO2 particle induces a strain effect, which restricted the size of MoS2. Meanwhile, the applied hydrothermal pressure leads the segmentation of the bundle-like structure of MoS2 to individual layer. The obtained heterostructure was characterized by X-ray diffraction, Scanning, and Transmission electron microscopy, X-ray photoelectron spectroscopy, DRS-UV Visible spectra, Photoluminescence, Raman spectroscopy and BET surface area analysis. The photocatalytic activity of these synthesized materials was evaluated for the decomposition of methylene blue (MB) under visible light. The results indicated that MoS2/TiO2 heterostructure had higher photocatalytic activity than pristine MoS2 and TiO2 materials. After irradiation, the photocatalytic efficiency towards MB degradation was calculated as 67.4, 80.2 and 99.5% for MoS2, TiO2, and MoS2/TiO2, respectively. The formation of unique, distinct layers of MoS2 over TiO2 surface created more active sites for a photocatalytic response. These whole phenomena could enhance the absorption characteristics of dyestuff on the heterostructure and enhance the charge transport after conjugation, which improves MB degradation efficiency.

American Brachytherapy Society consensus guidelines for thoracic brachytherapy for lung cancer.

PURPOSE: To update brachytherapy recommendations for pretreatment evaluation, treatment, and dosimetric issues for thoracic brachytherapy for lung cancer. METHODS AND MATERIALS: Members of the American Brachytherapy Society with expertise in thoracic brachytherapy updated recommendations for thoracic brachytherapy based on literature review and clinical experience. RESULTS: The American Brachytherapy Society consensus guidelines recommend the use of endobronchial brachytherapy for disease palliation in patients with central obstructing lesions, particularly in patients who have previously received external beam radiotherapy. The use of interstitial implants after incomplete resection may improve outcomes and provide enhanced palliation. Early reports support the use of CT-guided intratumoral volume implants within clinical studies. The use of brachytherapy routinely after sublobar resection is not generally recommended, unless within the confines of a clinical trial or a registry. CONCLUSIONS: American Brachytherapy Society recommendations for thoracic brachytherapy are provided. Practitioners are encouraged to follow these guidelines and to develop further clinical trials to examine this treatment modality to increase the evidence base for its use.

Placement of MammoSite brachytherapy catheter under computed-tomography scan guidance.

Placement of the MammoSite breast brachytherapy catheter is most commonly performed either intraoperatively or under ultrasound-guided technique. Below, we present a case report of an alternate approach utilizing CT-scan guidance. This is the first reported case of a balloon brachytherapy catheter placement with this technique.

Contrast sensitivity evaluation after laser in situ keratomileusis.

OBJECTIVE: To determine the effects of laser in situ keratomileusis (LASIK) on best-corrected visual acuity (BCVA) and contrast sensitivity. DESIGN: Prospective, observational case series. PARTICIPANTS: One hundred twelve eyes, in 65 patients with myopia and myopia with astigmatism, who underwent LASIK. TESTING AND MAIN OUTCOME MEASURES: Best-corrected visual acuity using the Snellen visual acuity chart and contrast sensitivity using the CSV 1000 (Vector Vision, Dayton OH) was tested before surgery and 1 week, 1 month, and 3 months after surgery in patients who underwent LASIK. RESULTS: Contrast sensitivity was depressed for patient eyes with spherical equivalence (SE) between -1.25 diopters (D) and -13.75 D, at 12 cycles/degree for at least 3 months and at 18 cycles/degree for 1 week after LASIK. For patient eyes with SE between -1.25 D and -6.00 D, contrast sensitivity was depressed only at 12 cycles/degree for at least 3 months after LASIK. For patient eyes with SE between -6.00 D and -13.75 D, contrast sensitivity was depressed at 6, 12, and 18 cycles/degree 1 week after LASIK but returned toward preoperative levels by 1 month after surgery. Despite the slight decreases in contrast sensitivity, all scores were still within the range of normal values except for 12 cycles/degree for 3 months and 18 cycles/degree at 1 week after surgery in the high myopia group. Although highly myopic patients, compared with patients with low myopia, had slightly less BCVA before surgery, both groups maintained their preoperative BCVA at all postoperative visits. CONCLUSIONS: Based on this study, we conclude that LASIK has little effect on BCVA and contrast sensitivity for up to 3 months after surgery.

Pediatric third, fourth, and sixth nerve palsies: a population-based study.

PURPOSE: To determine the population-based incidence and cause of cranial nerve palsies affecting ocular motility in children in the circumscribed population of Olmsted County, Minnesota. METHODS: The Rochester Epidemiology Project medical records linkage system captures virtually all medical care provided to Olmsted County residents. By means of this database, all cases of third, fourth, and sixth cranial nerve palsy were identified among county residents less than 18 years of age from 1978 through 1992. Medical records were reviewed to confirm the diagnosis, determine the cause, and document county residency. Incidence rates were adjusted to the age and sex distribution of the 1990 white population in the United States. RESULTS: Over this 15-year period, 36 incidence cases of cranial nerve palsy were identified in 35 children in this defined population. The age-adjusted and sex-adjusted annual incidence of third, fourth, and sixth nerve palsies combined was 7.6 per 100,000 (95% confidence interval, 5.1 to 10.1). The most commonly affected nerve was the fourth (36%), followed by the sixth (33%), the third (22%), and multiple nerve palsies (9%). The most common cause was congenital for third and fourth nerve palsy, undetermined for sixth, and trauma for multiple nerve palsies. Although three cases were associated with neoplasia, a cranial nerve palsy was not present at the time of diagnosis in any case. CONCLUSIONS: Unlike many institutionally based referral series, our population-based study provides data on the incidence and cause of third, fourth, and sixth nerve palsies in a geographically defined population. In contrast to previous institutionally based series, nearly half the cases were congenital in origin, and in no case did intracranial neoplasia present as an isolated nerve palsy.

Spontaneous recovery rate in traumatic sixth-nerve palsy.

PURPOSE: To estimate the spontaneous recovery rate of isolated traumatic sixth-nerve palsy. METHOD: A retrospective chart review over a 24-year period at a single institution, excluding patients who were first seen more than 6 weeks after injury, to reduce bias toward nonrecovery. RESULTS: The Kaplan-Meier survival estimate of spontaneous recovery at 6 months was 27% (95% confidence interval [CI], 5% to 44%) in unilateral traumatic sixth-nerve palsy and 12% (95% CI, 0% to 33%) in bilateral traumatic sixth-nerve palsy. CONCLUSION: Spontaneous recovery from isolated traumatic sixth-nerve palsy may be lower than previously reported. A prospective study is needed to provide a more accurate estimate of recovery rate.

Catching up.

The medical school I (S.M.) attended did not require dissection of a cadaver to fulfill the requirements of the anatomy curriculum. I had "learned" human anatomy through lectures, text books, and an atlas, but did no dissection. Although it was difficult doing anatomy that way, I passed basic science exams with high marks and did well on the board exams (NBME). I graduated from medical school with distinction and thought I was well prepared for residency. To my surprise, dissection of the orbit and periorbital regions and cranial cavity were included in my ophthalmology residency and were to pose a challenge for me. I requested the aid of a medical school anatomist to help me face this challenge. Not only did I learn the art of dissection, I gained considerable knowledge in anatomy (much of it clinically relevant), acquired better skill with surgical instruments and enhanced my logical and critical thinking ability. This viewpoint is based upon a diary I kept during my dissection experience.

Mycobacterium fortuitum endophthalmitis.

PURPOSE: The authors report the first known case of mycobacterium fortuitum endophthalmitis. METHOD: The authors use the documentation of clinical course. RESULTS: A postoperative cataract patient received a diagnosis of mycobacterium fortuitum endophthalmitis 1 month after uncomplicated cataract surgery. The endophthalmitis responded to intraocular amikacin. CONCLUSIONS: When mycobacteria are recovered from patients with endophthalmitis, amikacin should be included in the therapeutic regimen until speciation and in vitro susceptibility testing documents equally effective alternatives.