Unusual Case of Acute Coronary Syndrome Due to Compression of the Left Main Coronary Artery From a Contained Aortic Root Perforation.

We present an intriguing and rare case of a 71-year-old male who presented with a non-ST elevation myocardial infarction (NSTEMI). Initial coronary angiography revealed severe and unusual systolic extrinsic compression of the left main coronary artery (LM), warranting further advanced imaging investigations. Computed tomography angiography (CTA) and transesophageal echocardiography (TEE) were employed to determine the underlying cause, which was identified as a contained aortic rupture leading to the formation of a pseudoaneurysm in the left coronary sinus of Valsalva and aortic root. This condition was found to be a sequela of previously undiagnosed endocarditis, likely secondary to lower extremity osteomyelitis and bacteremia, for which the patient received prolonged intravenous (IV) antibiotic therapy. This case highlights the critical role advanced imaging techniques play in accurately diagnosing and characterizing complex cardiovascular abnormalities, enabling early intervention and optimizing patient outcomes. Healthcare providers should remain vigilant for such atypical presentations to ensure timely and appropriate management.

Energy and electron transfer processes in polymeric nanoparticles.

We report herein a study on photoinduced electron transfer (eT) and energy transfer (ET) processes occurring between 9-methylanthracene-acrylate (A) and N,N-dimethylaniline-acrylate (D) derivatives incorporated into polymeric nanoparticles (NP). Five types of NPs were synthesized: PAD0, PAD25, PAD75, PD25, and PD75. All NPs are composed of a crosslinked polymer matrix of methyl methacrylate and ethylene glycol dimethacrylate. In addition, PAD0, PAD25 and PAD75 contain low doping levels of A. For PAD25 and PAD75, 25% and 75% of the mole fraction of methyl methacrylate is replaced by D, respectively. PD25 and PD75 were prepared as above but without A. NPs (diameter 6-9 nm) dispersed in organic solvents were characterized based on their UV-visible absorption, emission, excitation, and excitation anisotropy spectra and time dependent absorption and emission spectroscopy techniques. The emission decay profiles of A and D were always complex. Results indicate that A senses two distinct environments in all NPs. The emission quenching of PAD0 by DMA in DCM solutions is dynamic, and it is apparent that a significant fraction of A is inaccessible to the quencher. The emission of A is efficiently quenched by the presence of D in PAD25 and PAD75. The intra-NP photoinduced eT quenching mechanism has static and dynamic components. Selective excitation of D in PAD25 and PAD75 leads to the formation of the excited state of A via a singlet-singlet ET Föster type mechanism. Results indicate that both intra-NP eT and ET processes are more efficient in PAD75 due to the reduced average D*-A separation in these NPs.

Habitability in different Milky Way stellar environments: a stellar interaction dynamical approach.

Every Galactic environment is characterized by a stellar density and a velocity dispersion. With this information from literature, we simulated flyby encounters for several Galactic regions, numerically calculating stellar trajectories as well as orbits for particles in disks; our aim was to understand the effect of typical stellar flybys on planetary (debris) disks in the Milky Way Galaxy. For the solar neighborhood, we examined nearby stars with known distance, proper motions, and radial velocities. We found occurrence of a disturbing impact to the solar planetary disk within the next 8 Myr to be highly unlikely; perturbations to the Oort cloud seem unlikely as well. Current knowledge of the full phase space of stars in the solar neighborhood, however, is rather poor; thus we cannot rule out the existence of a star that is more likely to approach than those for which we have complete kinematic information. We studied the effect of stellar encounters on planetary orbits within the habitable zones of stars in more crowded stellar environments, such as stellar clusters. We found that in open clusters habitable zones are not readily disrupted; this is true if they evaporate in less than 10(8) yr. For older clusters the results may not be the same. We specifically studied the case of Messier 67, one of the oldest open clusters known, and show the effect of this environment on debris disks. We also considered the conditions in globular clusters, the Galactic nucleus, and the Galactic bulge-bar. We calculated the probability of whether Oort clouds exist in these Galactic environments.

Comprensión del suicidio desde la perspectiva del psicoanálisis de orientación lacaniana / Understantding suicide from a lacanian perspective

En el presente artículo se hace un análisis teórico sobre el suicidio desde la perspectiva del psicoanálisis propuesta por Jacques Lacan, a partir de un proceso de investigación que permitió comprender una serie de paradojas que no logran ser explicadas por otras perspectivas teóricas. La metodología utilizada fue la de revisión documental, con base en la interpretación de documentos psicoanalíticos, como fuente primaria y secundaria, así como textos que proponen diversos enfoques para entender el suicidio, investigaciones científicas actuales y fuentes estadísticas de apoyo. Se muestra que el psicoanálisis, con su concepción de un sujeto estructurado por el lenguaje y el develamiento de una estructura que logra ordenar lógicamente todas las manifestaciones suicidas y abarca un universo teórico de hechos asociados con el suicidio. Plantea una concepción de sujeto que conduce a introducir una dimensión ética en la que se desprende una responsabilización del sujeto frente a aquello que le acontece y propone, a su vez, una práctica clínica que le es específica.

This article proposes a theoretical approach to suicide from the perspective of psychoanalysis proposed by Jacques Lacan. It communicates the results of a research that used a documental analysis methodology. This research used as sample, like primary and secondary sources psychoanalytical texts; also it was used texts that propose different approaches to understanding suicide, current scientific research and data sources of support. As results, research process allows to understand a series of paradoxes that fail to be explained by other theoretical perspectives. Psychoanalysis with its conception of a subject structured as a language, and the unveiling of a structure which does sort of course all forms of suicide, it embraces a theoretical universe, a whole series of events associated with suicide. This conception of the subject raised by lacanian psychoanalysis, necessarily lead to introduce an ethical dimension, which inevitably follows a responsibility of the subject towards what happens to him, suggesting in turn an specific clinical practice to psychoanalysis.

Experimental and theoretical studies on the enantioselectivity of molecularly imprinted polymers prepared with a chiral functional monomer.

A comprehensive study on the enantioseparation of racemic bis[1-phenylethyl]amine (PEA) on a series of molecularly imprinted polymers (MIPs) prepared using the chiral functional monomer (S)-2-(2-methyl-acryloylamino)-3-phenyl propionic acid (MAPP) is reported. MIP-R, MIP-S and MIP-RS, were synthesized separately by imprinting the pure enantiomers (R-, S-PEA) and racemic PEA, respectively, MAPP, EDGMA as crosslinker and chloroform as the porogen. It was found that all MIPs prepared were able to resolve the PEA racemate. Residence times (t(r)) and enantioselectivity factors (α) were estimated from typical elution chromatography experiments. Frontal chromatography experiments were conducted to acquire the adsorption isotherms for both enantiomers on the different MIPs (and on the non-imprinted polymer, NIP). The adsorption isotherms were analyzed using the affinity spectrum (AS) and the expectation-maximization (EM) methods. The study also involved the theoretical evaluation of the MAPP/enantiomers interactions in the pre-polymer mixture. The EM method predicts mono- and bimodal distribution of affinity binding sites depending upon the polymer analyzed. Apparently, the enantioseparation process depends on relatively small differences in the stabilization of the diasteroisomeric ion-pairs PEA/MAPP complexes on the surface of the polymers.

Sensitivity of a helical diode array device to delivery errors in IMRT treatment and establishment of tolerance level for pretreatment QA.

The aim of this study is to determine the gantry angle and multileaf collimator (MLC) gap error-detection threshold of a diode helical array with an inserted micro-ionization chamber in order to use this device for the pretreatment quality assurance (QA) of intensity-modulated radiation therapy (IMRT) treatments. Implications on the dose-volume histograms (DVHs) of the patient treatments will also be considered for the establishment of a QA protocol with a reasonable tolerance level. Three dynamic IMRT HN (head and neck) and prostate treatments were studied. Random and systematic variations of gantry angle and systematic errors in MLC gap width of the clinical treatments were analyzed in order to establish the detection sensitivity of the array. The associated clinical significance was studied introducing the same errors in the treatment plan based on the patients' computed tomography (CT) and calculating the corresponding DVHs. The Gamma (3%/3 mm) presented a 4% variation in failure rate for a rotation error of 1° for both types of treatment. Both systematic and random errors in gantry rotation angle have little effect on the patients' DVHs. MLC gap width errors of 1 mm and 2 mm in the prostate treatments imply a mean variation in isocenter-measured absorbed dose of 2.1% and 4.1%, respectively. In the case of HN, these errors entail a change in measured isocenter dose of 4.7% and 8.6%, respectively. The variation observed in the DVHs of the patients was, basically, a global displacement of the curves proportional to the isocenter dose variation caused by the gap width error. According to the array sensitivity to the analyzed errors and its implication in patient DVHs, a tolerance of 95% point passing rate for the gamma criterion 3%/2 mm and an agreement of 2% in isocenter absolute dose have been established as tolerance criteria for our pretreatment IMRT QA protocol.

Study of the uncertainty in the determination of the absorbed dose to water during external beam radiotherapy calibration.

To achieve a good clinical outcome in radiotherapy treatment, a certain accuracy in the dose delivered to the patient is required. Therefore, it is necessary to keep the uncertainty in each of the steps of the process inside some acceptable values, which implies a global uncertainty as low as possible. This work is focused on the uncertainty evaluation of absorbed dose to water in the routine calibration for clinical beams, in the range of energies used in external radiotherapy. With this aim, different uncertainty components (corrected electrometer reading, calibration factor, beam quality correction factor and reference conditions) associated to beam calibration have been considered. Results show a typical uncertainty in the determination of absorbed dose to water during beam calibration around 1.3% for photon beams and 1.5% for electron beams (k=1 in both cases) when the N(D,w) formalism is used and is theoretically calculated. These values may be different depending on the uncertainty provided by the standards laboratory for calibration factor, which is shown in the work. If the total application of the N(D,w) formalism, that is to say, specific calibrations of each chamber in the user's beam qualities, is taken into account the uncertainty in this step of the process could be placed close to 1.0%. Furthermore, the possibility of an uncertainty reduction with the absorbed dose to water formalism adoption against the air kerma one is discussed.

Statistical analysis of dose-volume and dose-wall histograms for rectal toxicity following 3D-CRT in prostate cancer.

The purpose of this paper is to determine the correlation between dose-volume histogram (DVH) and dose wall-histogram (DWH) in the evaluation of rectal complications for prostate cancer patients treated with three-dimensional conformal radiotherapy (3D-CRT). A retrospective analysis of DVHs and DWHs of a subset of 25 prostate cancer patients treated with 3D-CRT was performed. For every patient the rectum and the rectal wall (inner and outer surface) were contoured. Median ICRU radiation dose of 79.4 Gy was administered. Correlation between DVHs and DWHs parameters was investigated by the nonparametric Spearman test and by linear regression analysis. The results showed a statistically significant linear correlation between pairs of DVH and DWH dosimetric parameters with Spearman correlation values (S) bigger than 0.8, with p values better than 0.0005 (two-sided) when the emptied rectum is considered. The variation of S and linear fit slope values [b(1)] showed a very similar functional shape with a minimum at 91% ICRU dose [S =0.83, b(1)=0.65]. The present study confirms a high correlation (>80%) between DVH and DWH of the rectum following 3D-CRT for prostate cancer. The derived advantage is that the contouring of inner surface of rectum could be obviated in almost 90% of patients when performing predictive models for rectal complications based on dosimetric variables under the standard treatment conditions specified in this study.

Clinical impact of the detector size effect in 3D-CRT.

OBJECTIVE: The detector size artificially increases the measured penumbra of radiotherapy fields. The aim of this work is to determine the influence of the detector size when planning three-dimensional conformal radiation therapy (3D-CRT) treatments. MATERIAL AND METHODS: Two anatomical sites of interest in 3D-CRT were studied: prostate and hypophysis chordoma. Conventional 3D-CRT treatments for two cases in these locations were planned with a FOCUS 4.0.0 (Computerized Medical Systems, USA) treatment planning system (TPS) equipped with Fast Fourier Transform Convolution (FFTC) and Multigrid Superposition (MGS) algorithms, making use of beams modelled from radiation profiles measured either with a 2.0 mm diameter detector (PFD(3G) diode) or with a 5.5 mm diameter detector (PTW-31002 ionisation chamber). These detectors cover up the range of detector sizes commonly used to measure radiation profiles for 3D-CRT. Dose-volume histograms (DVHs), radiobiological indexes, tumor control probability (TCP) and normal tissue complication probability (NTCP) were analysed and compared for planning target volumes (PTVs) and organs at risk (OAR) studied. RESULTS: Important differences in DVH were found. OAR received higher dose levels when a 5.5 mm detector was used to measure profiles compared to the case in which a 2.0 mm detector was used. A 2 Gy increment in the mean rectal dose was found when the larger detector was used. In the same way, NTCP of brain stem in hypophysis chordoma treatments was doubled when this detector was used. CONCLUSION: The current use of ionisation chambers of about 5 mm active diameter to get the necessary data to model treatment machines in radiotherapy treatment planning systems (TPS) implies a significant overirradiation of OAR close to the PTV in 3D-CRT treatments due to errors in the measured penumbra of beam profiles. To avoid this overirradiation, the measured profiles should either being acquired with a suitable detector size (2-3 mm active diameter) or being deconvoluted.

Impact of mean rectal dose on late rectal bleeding after conformal radiotherapy for prostate cancer: dose-volume effect.

PURPOSE: To identify the clinical and dosimetric factors predictive of a greater risk of Grade 2 or worse late rectal bleeding in patients with localized prostate cancer treated with three-dimensional conformal radiotherapy in a prospective dose-escalation study. METHODS AND MATERIALS: We performed a retrospective analysis of the clinical records and dose-volume histograms of 107 patients with Stage T1c-T3 prostate cancer treated at our institution with three-dimensional conformal radiotherapy who had a minimal follow-up of 1 year. Of the 107 patients, 21 were treated at dose level 1 (70.0 Gy), 57 at dose level 2 (72.0 Gy), and 29 at dose level 3 (75.6 Gy). The mean International Commission on Radiation Units and Measurements reference dose was 76.5 Gy (range, 69.8-82.6 Gy). RESULTS: The 4-year actuarial incidence of Grade 2 or worse late rectal bleeding was 7.7% +/- 2.5%. The results of the multivariate analysis indicated that the mean rectal dose (rectal D(mean); p = 0.003) and the percentage of rectum receiving >60 Gy (Vr(60); p = 0.002) correlated with Grade 2 or worse rectal bleeding. The receiver operating characteristic curve analysis showed that this logistic regression model using both Vr(60) and rectal D(mean) had good reliability to predict the risk of late rectal bleeding. The area under the curve for Vr(60) and rectal D(mean) was 0.889 and 0.892, respectively. CONCLUSION: The results of the present study provide clear evidence of a dose-volume effect and the importance of intermediate doses (60.0 Gy) on the risk of rectal bleeding at this prescription dose level. On the basis of these results, new constraints have been implemented in our institution to keep the risk of developing Grade 2 rectal bleeding reasonably low (rectal D(mean) 50.0 Gy and Vr(60) 42%).