A Review on Ocular Nanoformulation Based Formulations with Highlights on Pediatric Ocular Pharmacokinetics.

The potential use of nanoparticle-based formulations is being explored rapidly for drug delivery in ocular treatment. Despite having several advancements in the area of ocular therapy, the pharmacokinetics-based formulation development for pediatric ocular treatment is still not in proper focus. There are an inadequate number of degenerative ocular ailments with childhood onset. The purpose of this review is to focus on the pharmacokinetics studies of nanoparticle- based formulations for treating ocular diseases and problems associated with the ocular treatment of the pediatric population. Recent studies on pharmaceutical modeling of ocular formulations have also been discussed. Nanoparticle-based formulations were collected by conducting a literature survey on PubMed, Science Direct, and other portals. In this review, we have explored in detail the explanation behind the inequality among available ocular treatment regimens for youngsters as well as adults by specifically focusing on those diseases that can be distressing for children. Latest innovative developments and advancements in drug delivery systems and challenges in their usage particularly for young infant patients were also discussed. It can be concluded that the bioavailability of ocular formulations and their effect on ocular cells can be further enhanced manifolds by the development of nanoparticles-based formulations.

Atomically dispersed single-atom catalysts (SACs) and enzymes (SAzymes): synthesis and application in Alzheimer's disease detection.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and memory loss. Conventional diagnostic methods, such as neuroimaging and cerebrospinal fluid analysis, typically detect AD at advanced stages, limiting the efficacy of therapeutic interventions. Early detection is crucial for improving patient condition by enabling timely administration of treatments that may decelerate disease progression. In this context, single-atom catalysts (SACs) and single-atom nanozymes (SAzymes) have emerged as promising tools offering highly sensitive and selective detection of Alzheimer's biomarkers. SACs, consisting of isolated metal atoms on a support surface, deliver unparalleled atomic efficiency, increased reactivity, and reduced operational costs, although certain challenges in terms of stability, aggregation, and other factors persist. The advent of SAzymes, which integrate SACs with natural metalloprotease catalysts, has further advanced this field by enabling controlled electronic exchange, synergistic productivity, and enhanced biosafety. Particularly, M-N-C SACs with M-Nx active sites mimic the selectivity and sensitivity of natural metalloenzymes, providing a robust platform for early detection of AD. This review encompasses the advancements in SACs and SAzymes, highlighting their pivotal role in bridging the gap between conventional enzymes and nanozyme and offering enhanced catalytic efficiency, controlled electron transfer, and improved biosafety for Alzheimer's detection.

Mycobacteria that cause tuberculosis have retained ancestrally acquired genes for the biosynthesis of chemically diverse terpene nucleosides.

Mycobacterium tuberculosis (Mtb) releases the unusual terpene nucleoside 1-tuberculosinyladenosine (1-TbAd) to block lysosomal function and promote survival in human macrophages. Using conventional approaches, we found that genes Rv3377c and Rv3378c, but not Rv3376, were necessary for 1-TbAd biosynthesis. Here, we introduce linear models for mass spectrometry (limms) software as a next-generation lipidomics tool to study the essential functions of lipid biosynthetic enzymes on a whole-cell basis. Using limms, whole-cell lipid profiles deepened the phenotypic landscape of comparative mass spectrometry experiments and identified a large family of approximately 100 terpene nucleoside metabolites downstream of Rv3378c. We validated the identity of previously unknown adenine-, adenosine-, and lipid-modified tuberculosinol-containing molecules using synthetic chemistry and collisional mass spectrometry, including comprehensive profiling of bacterial lipids that fragment to adenine. We tracked terpene nucleoside genotypes and lipid phenotypes among Mycobacterium tuberculosis complex (MTC) species that did or did not evolve to productively infect either human or nonhuman mammals. Although 1-TbAd biosynthesis genes were thought to be restricted to the MTC, we identified the locus in unexpected species outside the MTC. Sequence analysis of the locus showed nucleotide usage characteristic of plasmids from plant-associated bacteria, clarifying the origin and timing of horizontal gene transfer to a pre-MTC progenitor. The data demonstrated correlation between high level terpene nucleoside biosynthesis and mycobacterial competence for human infection, and 2 mechanisms of 1-TbAd biosynthesis loss. Overall, the selective gain and evolutionary retention of tuberculosinyl metabolites in modern species that cause human TB suggest a role in human TB disease, and the newly discovered molecules represent candidate disease-specific biomarkers.

Surgically targeted radiation therapy versus stereotactic radiation therapy: A dosimetric comparison for brain metastasis resection cavities.

PURPOSE: Surgically targeted radiation therapy (STaRT) with Cesium-131 seeds embedded in a collagen tile is a promising treatment for recurrent brain metastasis. In this study, the biological effective doses (BED) for normal and target tissues from STaRT plans were compared with those of external beam radiotherapy (EBRT) modalities. METHODS: Nine patients (n = 9) with 12 resection cavities (RCs) who underwent STaRT (cumulative physical dose of 60 Gy to a depth of 5 mm from the RC edge) were replanned with CyberKnifeⓇ (CK), Gamma KnifeⓇ (GK), and intensity modulated proton therapy (IMPT) using an SRT approach (30 Gy in 5 fractions). Statistical significance comparing D95% and D90% in BED10Gy (BED10Gy95% and BED10Gy90%) and to RC + 0 to + 5 mm expansion margins, and parameters associated with radiation necrosis risk (V83Gy, V103Gy, V123Gy and V243Gy) to the normal brain were evaluated by a Wilcoxon-signed rank test. RESULTS: For RC + 0 mm, median BED10Gy 90% for STaRT (90.1 Gy10, range: 64.1-140.9 Gy10) was significantly higher than CK (74.3 Gy10, range:59.3-80.4 Gy10, p = 0.04), GK (69.4 Gy10, range: 59.8-77.1 Gy10, p = 0.005), and IMPT (49.3 Gy10, range: 49.0-49.7 Gy10, p = 0.003), respectively. However, for the RC + 5 mm, the median BED10Gy 90% for STaRT (34.1 Gy10, range: 22.2-59.7 Gy10) was significantly lower than CK (44.3 Gy10, range: 37.8-52.4 Gy10), and IMPT (46.6 Gy10, range: 45.1-48.5 Gy10), respectively, but not significantly different from GK (34.1 Gy10, range: 22.8-47.0 Gy10). The median V243Gy was significantly higher in CK (11.7 cc, range: 4.7-20.1 cc), GK(6.2 cc, range: 2.3-11.9 cc) and IMPT (19.9 cc, range: 11.1-36.6 cc) compared to STaRT (1.1 cc, range: 0.0-7.8 cc) (p < 0.01). CONCLUSIONS: This comparative analysis suggests a STaRT approach may treat recurrent brain tumors effectively via delivery of higher radiation doses with equivalent or greater BED up to at least 3 mm from the RC edge as compared to EBRT approaches.

Unveiling the impact of dyes on aquatic ecosystems through zebrafish - A comprehensive review.

Dye industry plays an essential role in industrial development, contributing significantly to economic growth and progress. However, its rapid expansion has led to significant environmental concerns, especially water pollution and ecosystem degradation due to the discharge of untreated or inadequately treated dye effluents. The effluents introduce various harmful chemicals altering water quality, depleting oxygen levels, harming aquatic organisms, and disrupting food chains. Dye contamination can also persist in the environment for extended periods, leading to long-term ecological damage and threatening biodiversity. Therefore, the complex effects of dye pollutants on aquatic ecosystems have been comprehensively studied. Recently, zebrafish (Danio rerio) has proved to be an effective biomedical model for this study due to its transparent embryos allowing real-time observation of developmental processes and genetic proximity (approx. 87%) to humans for studying diverse biological responses. This review highlights the various toxicological effects of industrial dyes, including cardiovascular toxicity, neurotoxicity, genotoxicity, hepatotoxicity, and developmental toxicity. These effects have been observed at different developmental stages and dye concentrations in zebrafish. The review underscores that the structure, stability and chemical composition of dyes significantly influence toxicological impact, emphasizing the need for detailed investigation into dye degradation to better understand and mitigate the environmental and health risks posed by dye pollutants.

Asparagus officinalis Herb-Derived Carbon Quantum Dots: Luminescent Probe for Medical Diagnostics.

The utilization of natural materials for the synthesis of highly fluorescent carbon quantum dots (CQDs) presents a sustainable approach to overcome the challenges associated with traditional chemical precursors. Here, we report the synthesis of novel S,N-self-doped CQDs (S,N@CQDs) derived from asparagus officinalis herb. These S,N@CQDs exhibit 16.7 % fluorescence quantum yield, demonstrating their potential in medical diagnostics. We demonstrate the efficacy of S,N@CQDs as luminescent probes for the detection of anti-pathogenic medications metronidazole (MTZ) and nitazoxanide (NTZ) over concentration ranges of 0.0-180.0 µM (with a limit of detection (LOD) of 0.064 µM) and 0.25-40.0 µM (LOD of 0.05 µM), respectively. The probes were successfully applied to determine MTZ and NTZ in medicinal samples, real samples, and spiked human plasma, with excellent recovery rates ranging from 99.82 % to 103.03 %. Additionally, S,N@CQDs demonstrate exceptional efficacy as diagnostic luminescent probes for hemoglobin (Hb) detection over a concentration range of 0-900 nM, with a minimal detectability of 9.24 nM, comparable to commercially available medical laboratory diagnostic tests. The eco-friendly synthesis and precise detection limits of S,N@CQDs meet necessary analytical requirements and hold promise for advancing diagnostic capabilities in clinical settings. This research signifies a significant step towards sustainable and efficient fluorescence-based medical diagnostics.

Silk Fibroin and Its Nanocomposites for Wound Care: A Comprehensive Review.

For most individuals, wound healing is a highly organized, straightforward process, wherein the body transitions through different phases in a timely manner. However, there are instances where external intervention becomes necessary to support and facilitate different phases of the body's innate healing mechanism. Furthermore, in developing countries, the cost of the intervention significantly impacts access to treatment options as affordability becomes a determining factor. This is particularly true in cases of long-term wound treatment and management, such as chronic wounds and infections. Silk fibroin (SF) and its nanocomposites have emerged as promising biomaterials with potent wound-healing activity. Driven by this motivation, this Review presents a critical overview of the recent advancements in different aspects of wound care using SF and SF-based nanocomposites. In this context, we explore various formats of hemostats and assess their suitability for different bleeding situations. The subsequent sections discuss the primary causes of nonhealing wounds, i.e., prolonged inflammation and infections. Herein, different treatment strategies to achieve immunomodulatory and antibacterial properties in a wound dressing were reviewed. Despite exhibiting excellent pro-healing properties, few silk-based products reach the market. This Review concludes by highlighting the bottlenecks in translating silk-based products into the market and the prospects for the future.

Nickel-doped magnetic carbon aerogel derived from xanthan gum: a competent catalyst for the degradation of single and binary dye-based water pollutants.

Toxic organic dyes (colorants) are one of the main causes of water pollution that releases destructive effluents in the environment. To overcome this issue, a fundamental need to produce a novel, efficient catalyst for the degradation and mineralization of dye mixtures has arisen. The objective of this research is to develop an eminent Ni-doped magnetic carbon aerogel (Ni-MCA) catalyst using graft co-polymerization method having xanthan gum as backbone doped with Ni-magnetic nanoparticles (Ni-MNPs), that do not show agglomeration and easy to separate. The examination revealed that Ni-MCA provided exceptional magnetic characteristics (Ms = 52.75 emu/g) and potent catalytic activity for the degradation of mono- as well as binary-dye solutions of Congo red (CR) and methyl green (MG) dyes. The formation was verified by various characterization techniques such as FTIR, VSM, XRD, XPS, SEM, TEM, and EDX mapping. Interestingly, Ni-MCA shows faster result on anionic dye CR up to 97% with degradation rate of 5.647 × 10-1 min-1, and MG dye shows degradation of 95.7% with the degradation rate of 2.169 × 10-1 min-1, while dye mixture is showing 90% degradation with rate of 2.159 × 10-1 min-1.

Corrigendum: A single-institution experience with 177Lu RPT workflow improvements and qualifying the SPECT/CT imaging for dosimetry.

[This corrects the article DOI: 10.3389/fonc.2024.1331266.].

Circulating serotypes and genotypes of dengue virus in North India: An observational study.

BACKGROUND OBJECTIVES: This study reports observation on circulating serotypes and genotypes of Dengue Virus in North India. METHODS: Serum samples were obtained from suspected cases of dengue referred to the virus diagnostic laboratory during 2014 to 2022. All samples were tested for anti-dengue virus IgM antibodies and NS1Ag by ELISA. NS1Ag positive samples were processed for serotyping and genotyping. RESULTS: Total 41,476 dengue suspected cases were referred to the laboratory of which 12,292 (29.6%) tested positive. Anti-Dengue Virus IgM antibodies, NS1Ag, both IgM and NS1Ag, were positive in 7007 (57.4%); 3200 (26.0%) and 2085 (16.0%) cases respectively. Total 762 strains were serotyped during 9-year period. DENV-1, DENV-2, DENV-3 and DENV-4 serotypes were found in 79 (10.37%), 506 (66.40%), 151 (19.82%) and 26 (3.41%) cases respectively. DENV-1, DENV-2 and DENV-3 were in circulation throughout. Total 105 strains were genotyped. Genotype IV of DENV-1 serotype was circulating till 2014 which was later replaced by genotype V. A distinct seasonality with increase in number of cases in post-monsoon period was seen. INTERPRETATION CONCLUSION: DENV-1, DENV-2 and DENV-3 were found to be in circulation in North India. Predominant serotype/genotype changed at times, but not at regular intervals.

A single-institution experience with 177Lu RPT workflow improvements and qualifying the SPECT/CT imaging for dosimetry.

Background and purpose: Implementing any radiopharmaceutical therapy (RPT) program requires a comprehensive review of system readiness, appropriate workflows, and training to ensure safe and efficient treatment delivery. A quantitative assessment of the dose delivered to targets and organs at risk (OAR) using RPT is possible by correlating the absorbed doses with the delivered radioactivity. Integrating dosimetry into an established RPT program demands a thorough analysis of the necessary components and system fine-tuning. This study aims to report an optimized workflow for molecular radiation therapy using 177Lu with a primary focus on integrating patient-specific dosimetry into an established radiopharmaceutical program in a radiation oncology setting. Materials and methods: We comprehensively reviewed using the Plan-Do-Check-Act (PDCA) cycle, including efficacy and accuracy of delivery and all aspects of radiation safety of the RPT program. The GE Discovery SPECT/CT 670DR™ system was calibrated per MIM protocol for dose calculation on MIM SurePlan™ MRT software. Jaszcak Phantom with 15-20 mCi of 177Lu DOTATATE with 2.5 µM EDTA solution was used, with the main energy window defined as 208 keV ±10% (187.6 to 229.2 keV); the upper scatter energy window was set to 240 keV ±5% (228 to 252 keV), while the lower scatter energy window was 177.8 keV ±5% (168.9 to 186.7 keV). Volumetric quality control tests and adjustments were performed to ensure the correct alignment of the table, NM, and CT gantry on SPECT/CT. A comprehensive end-to-end (E2E) test was performed to ensure workflow, functionality, and quantitative dose accuracy. Results: Workflow improvements and checklists are presented after systematically analyzing over 400 administrations of 177Lu-based RPT. Injected activity to each sphere in the NEMA Phantom scan was quantified, and the MIM Sureplan MRT reconstruction images calculated activities within ±12% of the injected activity. Image alignment tests on the SPECT/CT showed a discrepancy of more than the maximum tolerance of 2.2 mm on any individual axis. As a result of servicing the machine and updating the VQC and COR corrections, the hybrid imaging system was adjusted to achieve an accuracy of <1 mm in all directions. Conclusion: Workflows and checklists, after analysis of system readiness and adequate training for staff and patients, are presented. Hardware and software components for patient-specific dosimetry are presented with a focus on hybrid image registration and correcting any errors that affect dosimetric quantification calculation. Moreover, this manuscript briefly overviews the necessary quality assurance requirements for converting diagnostic images into dosimetry measurement tools and integrating dosimetry for RPT based on 177Lu.

Etiology of Meningoencephalitis in children aged less than 5 years.

BACKGROUND: The incidence of meningoencephalitis (ME) in India is poorly understood, and the exact etiological diagnosis is often not possible. This study was planned to elucidate the bacterial and viral etiological diagnosis of ME in children less than 5 years of age. MATERIALS AND METHODS: The present study was conducted in Virus Research and Diagnostic Laboratory (VRDL), Department of Microbiology, King George's Medical University, Lucknow, from July 2020 to June 2022. Serum, cerebrospinal fluid (CSF), and nose/throat swabs were collected from all the enrolled cases of meningoencephalitis in children below 5 years of age and tested for various etiological agents by ELISA and/or real-time PCR. RESULTS: Of 130 enrolled cases, 50 (38.5%) cases tested positive for one or more etiological agents. Etiological agents of ME detected were Japanese encephalitis virus (JEV) (8.46%), adenovirus (6.92%), influenza virus (5.38%), dengue virus (3.85%), Parvo B-19 virus (3.08%), Orientia tsutsugamushi (3.08%), Herpes Simplex Virus-1 (HSV-1) (1.54%), measles virus (1.54%), and Varicella-Zoster Virus (VZV) (1.54%). Rubella virus, Chikungunya virus (CHKV), Mumps virus, Enteroviruses, Parecho virus, John Cunningham virus (JC), BK virus, Nipah virus, Kyasanur Forest Disease virus (KFD), Chandipura virus, Herpes Simplex Virus (HSV-2), SARS CoV-2, N. Meningitides , and H. Influenzae were tested but not detected in any of the cases. CONCLUSION: We identified the etiological agents in 50/130 (38.5%) suspected ME cases in children less than 5 years of age, using molecular and ELISA-based diagnostic methods. The four most common pathogens detected were JEV, adenovirus, influenza virus, and dengue virus.

Harnessing fluorescent carbon quantum dots from natural resource for advancing sweat latent fingerprint recognition with machine learning algorithms for enhanced human identification.

Nowadays, it is fascinating to engineer waste biomass into functional valuable nanomaterials. We investigate the production of hetero-atom doped carbon quantum dots (N-S@MCDs) to address the adaptability constraint in green precursors concerning the contents of the green precursors i.e., Tagetes erecta (marigold extract). The successful formation of N-S@MCDs as described has been validated by distinct analytical characterizations. As synthesized N-S@MCDs successfully incorporated on corn-starch powder, providing a nano-carbogenic fingerprint powder composition (N-S@MCDs/corn-starch phosphors). N-S@MCDs imparts astounding color-tunability which enables highly fluorescent fingerprint pattern developed on different non-porous surfaces along with immediate visual enhancement under UV-light, revealing a bright sharp fingerprint, along with long-time preservation of developed fingerprints. The creation and comparison of latent fingerprints (LFPs) are two key research in the recognition and detection of LFPs, respectively. In this work, developed fingerprints are regulated with an artificial intelligence program. The optimum sample has a very high degree of similarity with the standard control, as shown by the program's good matching score (86.94%) for the optimal sample. Hence, our results far outperform the benchmark attained using the conventional method, making the N-S@MCDs/corn-starch phosphors and the digital processing program suitable for use in real-world scenarios.

Dynamic flux balance analysis of high cell density fed-batch culture of Escherichia coli BL21 (DE3) with mass spectrometry-based spent media analysis.

Dynamic flux balance analysis (FBA) allows estimation of intracellular reaction rates using organism-specific genome-scale metabolic models (GSMM) and by assuming instantaneous pseudo-steady states for processes that are inherently dynamic. This technique is well-suited for industrial bioprocesses employing complex media characterized by a hierarchy of substrate uptake and product secretion. However, knowledge of exchange rates of many components of the media would be required to obtain meaningful results. Here, we performed spent media analysis using mass spectrometry coupled with liquid and gas chromatography for a fed-batch, high-cell density cultivation of Escherichia coli BL21(DE3) expressing a recombinant protein. Time course measurements thus obtained for 246 metabolites were converted to instantaneous exchange rates. These were then used as constraints for dynamic FBA using a previously reported GSMM, thus providing insights into how the flux map evolves through the process. Changes in tri-carboxylic acid cycle fluxes correlated with the increased demand for energy during recombinant protein production. The results show how amino acids act as hubs for the synthesis of other cellular metabolites. Our results provide a deeper understanding of an industrial bioprocess and will have implications in further optimizing the process.

Is antero-lateral complex of knee joint of critical importance in restoring rotational instability in patients with anterior cruciate ligament tear?

Antero-lateral ligament complex (ALC) is a vital structure for maintaining rotational stability of the knee. Evaluation of ALC radiologically (MRI) is still unpopular in setting of anterior cruciate ligament injury. A dire necessity exists for the orthopedic surgeons in outdoor patient department settings to rule out involvement of ALC. So, that it can be addressed during operating for Anterior Cruciate Ligament injury. The authors have formulated an algorithm on a personal level and have implemented this screening program and initiated screening of young to middle aged patients reporting with rotational knee instability for ALC involvement before recommending final operative plan. This screening program which uses specifically devised physical tests have significantly reduced the number of underdiagnosed Antero Lateral Ligament tear.

Xanthan gum-based copper nano-magnetite doped carbon aerogel: A promising candidate for environmentally friendly catalytic dye degradation.

In this work, a novel copper nano-magnetite doped carbon aerogel (CXMCA) was created utilizing a simple graft co-polymerization approach with xanthan gum (XG) as a template to tackle the agglomeration problem caused by magnetic nanoparticle magnetism. The results indicated that the XG based CXMCA exhibited outstanding magnetic properties (Ms = 36.52 emu/g) as well as strong catalytic activity for the degradation of cationic and anionic dyes. Among all organic dyes, methylene blue and crystal violet (MB, CV) as cationic dyes, as well as congo red and methyl orange (CR, and MO) as anionic dyes, CXMCA demonstrated an exceptional dye degradation rate (8.06 × 10-3 s-1-1.12 × 10-2 s-1) and was highly competent for cationic dyes with degradation (90 %-98 %) as compared to its unsupported magnetic nanoparticles. The formation of CXMCA catalyst is clearly confirmed by the FTIR, XRD, XPS, VSM, SEM & TEM analyses. We report a very effective xanthan gum-based copper nano-magnetite doped carbon aerogel dye scavenger with application in percentage dye degradation and kinetic investigations, as well as a remarkable reusability assay up to 7 repetition cycles. The findings suggested that using biological macromolecules like xanthan gum as a foundation to generate magnetic aerogels might be a good choice for evaluating environmental aspects.

Luminous Insights: Exploring Organic Fluorescent "Turn-On" Chemosensors for Metal-Ion (Cu+2, Al+3, Zn+2, Fe+3) Detection.

There are several metal ions that are vital for the growth of the environmental field as well as for the biological field but only up to the maximum limit. If they are present in excess, it could be hazardous for the human health. With the growing technology, a series of various detection techniques are employed in order to recognize those metal ions, some of them include voltammetry, electrochemical methods, inductively couples, etc. However, these techniques are expensive, time consuming, requires large storage, advanced instrumentation, and a skilled person to operate. So, here comes the need of a sensor and it is defined as a miniature device which detects the substance of interest by giving response in the form of energy change. So, from past few decades, many sensors have been formulated for detecting metal ions with some basic characteristics like selectivity, specificity, sensitivity, high accuracy, lower detection limit, and response time. Detecting various metal ions by employing chemosensors involves different techniques such as fluorescence, phosphorescence, chemiluminescence, electrochemical, and colorimetry. The fluorescence technique has certain advantages over the other techniques. This review mainly focuses on the chemosensors that show a signal in the form of fluorescence to detect Al+3, Zn+2, Cu+2, and Fe+3 ions.

Surgically targeted radiation therapy (STaRT) for recurrent brain metastases: Initial clinical experience.

PURPOSE: This study evaluates the outcomes of recurrent brain metastasis treated with resection and brachytherapy using a novel Cesium-131 carrier, termed surgically targeted radiation therapy (STaRT), and compares them to the first course of external beam radiotherapy (EBRT). METHODS: Consecutive patients who underwent STaRT between August 2020 and June 2022 were included. All patients underwent maximal safe resection with pathologic confirmation of viable disease prior to STaRT to 60 Gy to a 5-mm depth from the surface of the resection cavity. Complications were assessed using CTCAE version 5.0. RESULTS: Ten patients with 12 recurrent brain metastases after EBRT (median 15.5 months, range: 4.9-44.7) met the inclusion criteria. The median BED10Gy90% and 95% were 132.2 Gy (113.9-265.1 Gy) and 116.0 Gy (96.8-250.6 Gy), respectively. The median maximum point dose BED10Gy for the target was 1076.0 Gy (range: 120.7-1478.3 Gy). The 6-month and 1-year local control rates were 66.7% and 33.3% for the prior EBRT course; these rates were 100% and 100% for STaRT, respectively (p < 0.001). At a median follow-up of 14.5 months, there was one instance of grade two radiation necrosis. Surgery-attributed complications were observed in two patients including pseudomeningocele and minor headache. CONCLUSIONS: STaRT with Cs-131 presents an alternative approach for operable recurrent brain metastases and was associated with superior local control than the first course of EBRT in this series. Our initial clinical experience shows that STaRT is associated with a high local control rate, modest surgical complication rate, and low radiation necrosis risk in the reirradiation setting.