Ultrasound-Guided Brachytherapy for Cervical Cancer - A Tool for Quality Improvement in Brachytherapy?

Nowadays, brachytherapy is one of the major components to treat inoperable cervical cancer. Brachytherapy yields a higher dose to the target (cervix) while sparing normal tissues. Developments of brachytherapy stepped forward in the previous decade by image-guided brachytherapy (IGBT) turning brachytherapy from point-based planning to volume-based planning and IGBT improves the treatment quality for cervical cancer. Magnetic resonance imaging (MRI) or computed tomography (CT) is utilized in brachytherapy and showed promising results internationally. However, in a limited-resource area, the implementation of IGABT is difficult due to many causes (manpower, equipment, or budgets). To improve the quality in limited resources, ultrasound is introduced. The utilization of ultrasound in brachytherapy practice is to prevent uterine perforation during application. With present data, measurement by ultrasound showed the correlation to MRI measurement in uterine dimensions. With these aspects, there are many researches using ultrasound to improve the quality of treatment in brachytherapy, for example, to guide contouring on CT or to support brachytherapy planning. The use of ultrasound improves the quality of brachytherapy in comparison to conventional planning and supports the improvement in brachytherapy for cervical cancer.

Analysis of biological methods for quarry wastewater treatment from nitrogen compounds

Деятельность горнодобывающих предприятий неотрывно сопряжена с ведением взрывных работ. В настоящее время наиболее распространенными взрывчатыми веществами являются эмульсионные взрывчатые вещества, граммониты, амоналы, аммониты и другие взрывчатые вещества, содержащие нитрат аммония, который в процессе взрывания переходит в сточные воды в форме нитрат- и нитрит-ионов, а также ионов аммония. Превышение предельно допустимой концентрации азотных соединений в водных объектах может приводить к эвтрофикации. В результате данного процесса происходит нарушение экологического баланса водоемов, а именно увеличение численности различных гидробионтов, уменьшение прозрачности воды и содержания растворенного кислорода. Помимо этого в водоемах осуществляется преобразование нитратной формы азота в нитритную, которая негативно воздействует на нервную и сердечно-сосудистую системы человека при употреблении воды из такого водоема. На данный момент существуют физико-химические, химические и биологические методы очистки вод от азотных соединений. Использование каждого из перечисленных методов обуславливается параметрами карьерных сточных вод и требованиями, предъявляемыми к качеству очистки. Цель работы. Целью работы является обзор методов биологической очистки, которые могут применяться для удаления соединений азота из карьерных сточных вод, а также определение наиболее перспективного метода при условии большого объема образования карьерных сточных вод. Методы исследования. Методы исследования включают в себя анализ и сравнение биологических методов очистки, которые могут использоваться для удаления азотных соединений из образующихся сточных вод в карьере. Результаты работы. Рассмотрены различные виды процессов и систем, включая процесс нитрификации и денитрификации, Anammox-процесс, фито-очистные системы, биоплато, биопруды и системы микроводорослей. Приведены факторы, влияющие на эффективность работы данных процессов и систем, а также дана сравнительная характеристика с выделением достоинств и недостатков каждого из них. Наиболее предпочтительным методом биологической очистки большого объема образующихся карьерных сточных вод признан метод комплексной очистки по типу constructedwetlands с комплексным применением видов высшей и низшей растительности. The activities of mining enterprises are inextricably linked with the conduct of blasting operations. Currently, the most common explosives are emulsion explosives, grammonites, amons, ammonites and other explosives containing ammonium nitrate, which, during the blasting process, passes into wastewater in the form of nitrate and nitrite ions, as well as ammonium ions. Exceeding the maximum permissible concentration of nitrogen compounds in water bodies can lead to eutrophication. As a result of this process, there is a violation of the ecological balance of reservoirs, as well as an increase in the number of various hydrobionts, a decrease in the transparency of water and the content of dissolved oxygen. In addition, the nitrate form of nitrogen is converted into nitrite in reservoirs, which negatively affects the nervous and cardiovascular system of a person when drinking water from such a reservoir. At the moment, there are physico-chemical, chemical and biological methods of water treatment from nitrogen. The use of each of these methods is determined by parameters of quarry wastewater and the requirements for treatment quality. Aim. The aim of the work is to review the methods of biological purification that are used for nitrogen compounds from quarry wastewater. Methods. The research methods include the analysis and comparison of biological treatment methods. Results. The factors affecting the efficiency of these processes and systems are presented, as well as these comparative characteristics, highlighting the advantages and disadvantages of each of them. The most preferred biological treatment method of a large volume of formed quarry wastewater is the recognized methods of complex treatment according to the type of constructed wetlands with the complex use of higher and lower plant species.

The active guidewire technique versus standard technique as different way to approach ureteral endoscopic stone treatment

Background: One of the greatest challenges in semi-rigid ureteroscopies, for both stones and tumors, is the control of endoscopic vision and the maintenance of low intracavitary liquid pressure. We present a comparison between two operative techniques: in the first method an ordinary guide wire (diameter 0.032'') is used for the procedure; in the second one a 5 Fr ureteral catheter replaces the guidewire (we called it “Active guidewire”) Methods We compared 50 semirigid ureteroscopies (sURS) performed using the active guidewire with another 50 procedures conducted with a classic guidewire. We evaluated the difference in operating times, quality of endoscopic vision, periprocedural infections rate and stone-free rate. Results: The use of active guidewire has considerably reduced the standardized operating times per unit stone-volume by about 39%. Vision quality has improved considerably thanks to the continuous flow in-and-out. Consequently, periprocedural infections decreased (3% vs 30%) and the stone-free rate rose from 86% to 92%. Discussion and conclusions: Employing an “active guidewire” instead of the standard guidewire, the risk of complications related to high pressures and operating time is considerably lower, as well as better treatment quality thanks to the cleaner vision. This technique has proven to be safe as well as easy to apply, and in our belief is to be preferred whenever the ureter accepts without forcing, both the presence of the catheter and the semi-rigid 7 F ureteroscope.

Validation analysis of the novel imaging-based prognostic radiomic signature in patients undergoing primary surgery for advanced high-grade serous ovarian cancer (HGSOC)

Background Predictive models based on radiomics features are novel, highly promising approaches for gynaecological oncology. Here, we wish to assess the prognostic value of the newly discovered Radiomic Prognostic Vector (RPV) in an independent cohort of high-grade serous ovarian cancer (HGSOC) patients, treated within a Centre of Excellence, thus avoiding any bias in treatment quality. Methods RPV was calculated using standardised algorithms following segmentation of routine preoperative imaging of patients (n = 323) who underwent upfront debulking surgery (01/2011-07/2018). RPV was correlated with operability, survival and adjusted for well-established prognostic factors (age, postoperative residual disease, stage), and compared to previous validation models. Results The distribution of low, medium and high RPV scores was 54.2% (n = 175), 33.4% (n = 108) and 12.4% (n = 40) across the cohort, respectively. High RPV scores independently associated with significantly worse progression-free survival (PFS) (HR = 1.69; 95% CI:1.06–2.71; P = 0.038), even after adjusting for stage, age, performance status and residual disease. Moreover, lower RPV was significantly associated with total macroscopic tumour clearance (OR = 2.02; 95% CI:1.56–2.62; P = 0.00647). Conclusions RPV was validated to independently identify those HGSOC patients who will not be operated tumour-free in an optimal setting, and those who will relapse early despite complete tumour clearance upfront. Further prospective, multicentre trials with a translational aspect are warranted for the incorporation of this radiomics approach into clinical routine.

Technical Quality Assessment of Root Canal Treatment on ETP by Pre-Clinical Students at Fatima Jinnah Dental College

Background: Students at pre clinical level at Fatima Jinnah Dental College are taught root canal treatment on endodontic typodonts. Technical quality of the root canal treatments performed by these students was assessed to determine success of teaching methodology and reinforcement of tooth morphology concepts. Methodology: In this cross-sectional study, obturation quality of 20 anterior and 30 posterior endodontic typodonts were evaluated on the parameters of length, density and taper. The collected data was evaluated using SPSS software, version 20.0. Chi square analysis was applied to compare the quality of root canal obturation between types of tooth. Kappa statistics was used for inter examiner reliability. Results: After assessing the three variables, adequate length control was observed in (92.9%), while 7.1% of under filling was seen in both groups. Percentage of teeth showed homogeneity in obturation density that is 30%, 60% teeth showed acceptable, whereas 10% showed unacceptable obturation homogeneity. 55.6% teeth showed perfect obturation taper and 4% showed acceptable. Conclusion: The obtained results showed root canal treatment quality done by Fatima Jinnah Dental College undergraduate dental students to be adequate on anterior endodontic typodont teeth as compared to posterior endodontic teeth. This will guide us in utilizing further demonstration hours and more practice time on posterior endodontic teeth. Our study also displayed the need of incorporating hands on practice of root canal treatments on extracted teeth before students are allowed to work on patients. Keywords: Root Canal Treatment, Endodontic Typodont, Obturation, Preclinical.

P-OGC03 Pancreatic enzyme supplementation improves quality of life in patients following surgery for upper GI cancer

Background Unpleasant abdominal symptoms are common following surgery for upper gastrointestinal (UGI) cancer and may occur secondary to pancreatic exocrine insufficiency (EPI). This study investigated symptoms of EPI in patients following surgery and assessed the effect of pancreatic enzyme supplementation (PERT) on these symptoms and the effect of supplementation on quality of life. Methods Patients were assessed for symptoms of EPI using a novel questionnaire. Patients who reported two or more symptoms suggestive of EPI were prescribed PERT. Abdominal symptoms were reassessed following treatment. Quality of life (QoL) was studied using the SF-36 questionnaire before and after treatment. Faecal elastase was also measured in a patient subgroup. Results Fifty-six out of 57 patients (98%) reported at least two symptoms of EPI. Following PERT every patient reported fewer abdominal symptoms; median 5 symptoms before treatment reduced to two symptoms following treatment (p < 0.0001; Wilcoxon rank). Reduced faecal elastase concentration was associated with more frequent abdominal symptoms; median 5 symptoms versus 3 symptoms (p = 0.043; Mann Whitney U test). PERT increased quality of life scores for every patient in each of the 5 principle health domains. Conclusions Symptoms of EPI are common among patients following UGI cancer surgery. PERT reduces unpleasant abdominal symptoms and this leads to significant improvements in quality of life across global health domains. PERT should be offered to all post-operative UGI cancer patients with symptoms suggestive of EPI.

Does the Identification of a Minimum Number of Cases Correlate With Better Adherence to International Guidelines Regarding the Treatment of Penile Cancer? Survey Results of the European PROspective Penile Cancer Study (E-PROPS)

BackgroundPenile cancer represents a rare malignant disease, whereby a small caseload is associated with the risk of inadequate treatment expertise. Thus, we hypothesized that strict guideline adherence might be considered a potential surrogate for treatment quality. This study investigated the influence of the annual hospital caseload on guideline adherence regarding treatment recommendations for penile cancer.MethodsIn a 2018 survey study, 681 urologists from 45 hospitals in four European countries were queried about six hypothetical case scenarios (CS): local treatment of the primary tumor pTis (CS1) and pT1b (CS2); lymph node surgery inguinal (CS3) and pelvic (CS4); and chemotherapy neoadjuvant (CS5) and adjuvant (CS6). Only the responses from 206 head and senior physicians, as decision makers, were evaluated. The answers were assessed based on the applicable European Association of Urology (EAU) guidelines regarding their correctness. The real hospital caseload was analyzed based on multivariate logistic regression models regarding its effect on guideline adherence.ResultsThe median annual hospital caseload was 6 (interquartile range (IQR) 3–9). Recommendations for CS1–6 were correct in 79%, 66%, 39%, 27%, 28%, and 28%, respectively. The probability of a guideline-adherent recommendation increased with each patient treated per year in a clinic for CS1, CS2, CS3, and CS6 by 16%, 7.8%, 7.2%, and 9.5%, respectively (each p < 0.05); CS4 and CS5 were not influenced by caseload. A caseload threshold with a higher guideline adherence for all endpoints could not be perceived. The type of hospital care (academic vs. non-academic) did not affect guideline adherence in any scenario.ConclusionsGuideline adherence for most treatment recommendations increases with growing annual penile cancer caseload. Thus, the results of our study call for a stronger centralization of diagnosis and treatment strategies regarding penile cancer.

Perception and practices of operative and endodontic specialists in Pakistan towards the use of dental magnification

BACKGROUND: The perceptions and trends of magnification use in dentistry need to be determined since magnification significantly enhances clinical practice. OBJECTIVE: To assess perception and practices of Operative and Endodontic specialists currently working in Pakistan, regarding use of magnification. METHODS: A structured questionnaire administered for this analytical cross-sectional study recorded demographics, trends of magnification devices used in practice and their perceived advantages and disadvantages by the specialists with close-ended questions and three-point Likert scale. RESULTS: Out of 91 forms, 77 responses were received (response rate of 84%). Most participants had 1–4 years’ practical experience, were employed at both faculty and clinical positions, were more interested in operative/restorative procedures and used TLL (through the lens loupes) at low magnification. Use of magnification devices was learnt mostly during post-graduate training and was used daily or weekly for complicated cases. Noteworthy perceptions included improved treatment quality and standard of care. However, they were also perceived as irritating, increasing treatment time, with adverse effect on eyesight with prolonged use. No statistically significant correlation was found between the variables recorded (p > 0.05). CONCLUSIONS: Most specialists used magnification devices in some form and were abreast with their advantages. Proper training and continued dental education courses can help dispel any observed misapprehensions.