[Dose Verification for Respiratory-gated VMAT-SBRT Using Real-time Tumor Tracking System].

Recently, the introduction of various novel technologies in clinical settings has improved the accuracy of radiation therapy. Stereotactic body radiation therapy (SBRT) involves the delivery of an accurate radiation dose to the tumor with a minimal impact on normal tissues using various measures to address changes in the tumor position due to respiratory displacement. The SyncTraX FX4 real-time tumor tracking system (Shimadzu Corporation) introduced in our hospital tracks the actual tumor location by radioscopically monitoring a metallic marker that is placed in the vicinity of the tumor. However, there have been no reports yet on respiratory-gated volumetric modulated arc therapy (VMAT)-SBRT using a real-time tumor tracking system. This study aimed to develop an irradiation procedure for respiratory-gated VMAT-SBRT using a real-time tumor tracking system and to evaluate radiation doses therein. In this study, we found that absolute doses with respiratory gating did not deviate by more than ±1.0% from those without respiratory gating. In addition, the pass rate in gamma analysis using GAFCHROMIC EBT3 was ³95% with the pass criteria in dose difference, distance to agreement, and threshold being 2%, 2 mm, and 10%, respectively. Furthermore, a trajectory log file analysis did not reveal any significant error causes. Thus, these data indicate that respiratory-gated VMAT-SBRT can be applied clinically.

Chronic Expanding Hematoma Following Abdominoplasty.

Chronic expanding hematoma (CEH) is a relatively rare complication of trauma or surgery. We report a patient with CEH as a late complication of abdominoplasty. A 58-year-old woman underwent conventional abdominoplasty and thereafter refused to use a compression binder, citing discomfort. One month postoperatively, she presented with a gradually enlarging, painful abdominal mass. The results of ultrasonography and computed tomography were highly suspicious for CEH. The lesion was completely removed, together with surrounding fibrous tissue. Histopathology revealed a chronic hemorrhage collection with a fibrous capsule, consistent with CEH. This condition as a late complication of abdominoplasty has not previously been reported in the literature. However, an online medical consultation site features several abdominoplasty patients asking about persistent hematomas that sound suspicious for CEH. CEH might be underdiagnosed by surgeons. Although a postoperative binder may increase the risk of skin necrosis and deep vein thrombosis, appropriate compression treatment is necessary to prevent hematoma formation. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The characteristics of healthy adults with hardly palpable vein--Relations between easy venous palpation and physical factors.

This study aimed to investigate relations between ease of venous palpation and various venous factors, and to elucidate characteristics of hardly palpable veins. Healthy adult volunteers (n = 110) were enrolled. The ease of venous palpation was scored from 0: impalpable to 3: well palpable. Venous factors, namely venous depth, elevation, area and minimal pressure that starts to collapse vein, were measured using an ultrasonography before and after tourniquet inflation at 60 mmHg for 60 s. Tourniquet inflation significantly increased the venous area and venous palpation score. The four venous factors correlated significantly with venous palpation score with the following correlation coefficient: Depth (r = -0.542), Elevation (0.486), area (0.258) and start-to-collapse pressure (-0.220). The characteristics of hardly palpable veins were small size, deep location and little elevation. Although vasodilatation facilitated venous palpation, venous depth and elevation were also important and should be included in future studies in which vasodilatation methods are evaluated.

[Evaluation of absorbed dose from kilovoltage cone-beam computed tomography by radiotherapy planning system: influence on the radiation therapy for prostate cancer].

Image-guided radiation therapy (IGRT) is increasingly being used in modern radiation therapy, and it is now possible to verify a patient's position using kilo-voltage cone-beam computed tomography (kV-CBCT). However, if kV-CBCT is used frequently, the dose absorbed by the body cannot be disregarded. A number of studies have been made on the absorbed dose of kV-CBCT, in which absorbed dose measurements were made using a computed tomography dose index (CTDI) or a thermoluminescent dosimeter (TLD). Other methods include comparison of the absorbed dose between a kV-CBCT and other modalities. These techniques are now in common use. However, dose distribution within the patient varies with the patient's size, posture and the part of the body to which radiation therapy is applied. The chief purpose of this study was to evaluate the dose distribution of kV-CBCT by employing a radiotherapy planning system (RTPS); a secondary aim was to examine the influence of a dose of kV-CBCT radiation when used to treat prostate cancer. The beam data of an on-board imager (OBI) was registered in the RTPS, after which modeling was performed. The radiation dosimetry was arranged by the dosimeter in an elliptical phantom. Rotational radiation treatment was used to obtain the dose distribution of the kV-CBCT within the patient, and the patient dose was evaluated based on the simulation of the dose distribution. In radiation therapy for prostate cancer, if kV-CBCT was applied daily, the dose increment within the planning target volume (PTV) and the organ in question was about 1 Gy.

Relationship between tourniquet pressure and a cross-section area of superficial vein of forearm.

This study investigated the appropriate tourniquet pressure (TP) and duration of tourniquet application for venipuncture by calculating the venous cross-section (VCS) area on ultrasonography. Twenty healthy volunteers without cardiovascular risk factors were enrolled in this study. A target vein (either a cephalic or median cubital vein) was selected on ultrasonography. The pneumatic tourniquet was inflated using a rapid cuff inflator system at setting pressure for 120 sec. TP strength was varied from 20 mmHg to 100 mmHg, in 20 mmHg increments. The order of TP was randomized. Comparisons among more than 3 groups were performed by one-way repeated-measures ANOVA and the Bonferroni method. The VCS area increased rapidly until 10 sec after tourniquet inflation. The VCS area then increased gradually until 30 sec after tourniquet inflation. After that, the VCS area did not increase remarkably. The VCS area increased with TP strength up to 80 mmHg, but the VCS area at TP 100 mmHg decreased to less than that at TP 40 mmHg. Based on these results, we recommend a tourniquet pressure of 60 mmHg, and duration of tourniquet application is 30 to 60 sec for venipuncture.

Butyric acid modulates periodontal nociception in Porphyromonas gingivalis-induced periodontitis.

PURPOSE: Periodontitis progresses with chronic inflammation, without periodontal pain. However, the underlying mechanisms are not well known. Here, the involvement of butyric acid (BA) in periodontal pain sensitivity in Porphyromonas gingivalis (P. gingivalis)-induced periodontitis was examined. METHODS: P. gingivalis was inoculated into the ligature which was tied around the molar (P. gingivalis-L) and the gingival mechanical head withdrawal threshold (MHWT) was measured. Following P. gingivalis-L, the expressions of orphan G protein-coupled receptor 41 (GPR41) in trigeminal ganglion (TG) neurons were examined. The amount of gingival BA was analyzed following the P. gingivalis-L and the changes in the MHWT in complete Freund's adjuvant (CFA)-injected gingival tissue by gingival BA were examined. The changes in the MHWT following P. gingivalis-L by gingival GPR41 antagonist (HA) were examined. RESULTS: No change in the MHWT was observed, GPR41-immunoreactive TG neurons were increased following P. gingivalis-L. The gingival BA amount increased following P. gingivalis-L, and the gingival BA suppressed the decrease in MHWT following CFA. HA decreased MHWT following P. gingivalis-L. CONCLUSION: Gingival BA modulates periodontal mechanical nociception via GPR41 signaling in P. gingivalis-L-induced periodontitis.

Association between three-dimensional measurements of the unilateral cleft lip nasal deformity and maxillary alveolar morphology: A retrospective study.

BACKGROUND: It is debatable whether rhinoplasty is necessary during a primary operation for cleft lip. However, many surgeons believe that rhinoplasty should be performed simultaneously for severe deformities. We investigated whether alveolar cleft severity is involved in nasal deformity. METHODS: Forty-three patients were assessed for alveolar cleft severity using maxillary plaster models prepared during primary cheiloplasty. We conducted morphological assessments of nasal deformities using three-dimensional photogrammetry. Patients were divided into two groups according to alveolar cleft severity: group A, overlap of the alveolar segments; group B, nonoverlap of the alveolar segments. Nasal asymmetry was assessed by measuring distances between landmarks around the nostrils and the columellar angle. These measurements were compared between the groups. The correlations between the columellar angle and the ratios of the five cleft side/non-cleft side distances and the correlation of each ratio were analyzed. RESULTS: Groups A and B included 21 and 22 patients, respectively. Group A demonstrated superior deviation of the alar base on the non-cleft side than that of the alar base on the cleft side (p < 0.05). No other statistically significant differences were observed. Group A had more severe nasal deformity. Columellar angle and nostril base width demonstrated correlation. CONCLUSION: In an uncorrected, unoperated unilateral cleft lip nasal deformity, alar base deformity is affected by deformity of the alveolar segments.

Surgically excising an intraoral schwannoma of the soft palate using a buccinator flap: A case report.

INTRODUCTION: Schwannomas are benign tumors derived from Schwann cells. However, schwannomas in the soft palate is considered rare. PRESENTATION OF CASE: We report a case of a 17-year-old girl who presented with a 20-mm nodular lesion in the soft palate. After surgical resection, a buccinator musculomucosal flap was used for soft palate reconstruction. At 6 months post-operation, velopharyngeal insufficiency was not observed. DISCUSSION: In this report, palatal muscles are examined, and the necessity of palatal muscle preservation and reconstruction of the defect in the soft palate mucosa after surgical resection of a schwannoma in the soft palate is presented. CONCLUSION: Following resection of an approximately 20 × 19-mm-sized schwannoma of the soft palate, which is a relatively rare site of occurrence for schwannomas, we performed reconstruction of the defect using a BMMF to prevent scar contracture. This was an effective method of reconstruction in consideration of velopharyngeal function.

Highly sensitive detection of influenza virus in saliva by real-time PCR method using sugar chain-immobilized gold nanoparticles; application to clinical studies.

A highly sensitive and convenient method for detecting influenza virus was developed using modified end-point melt curve analysis of a RT-qPCR SYBR Green method and influenza virus-binding sugar chain-immobilized gold-nanoparticles (SGNP). Because SGNPs capture influenza viruses, the virus-SGNP complex was separated easily by centrifugation. Viral RNA was detected at very low concentrations, suggesting that SGNP increased sensitivity compared with standard methods. This method was applied to clinical studies. Influenza viruses were detected in saliva of patients or inpatients who had been considered influenza-free by a rapid diagnostic assay of nasal swabs. Furthermore, the method was applied to a human trial of prophylactic anti-influenza properties of yogurt containing Lactobacillus acidophilus L-92. The incidence of influenza viruses in saliva of the L-92 group was found to be significantly lower compared to the control group. Thus, this method was useful for monitoring the course of anti-influenza treatment or preventive measures against nosocomial infection.