Two-week-wait referrals in otolaryngology in a tertiary centre: cross-sectional study of benign outcomes, with a systematic review.

OBJECTIVE: The two-week-wait referral is designed to improve early detection in cancer patients. This retrospective study analysed those ENT two-week-wait referrals to out-patient clinics in a tertiary head and neck oncology centre, from January to June 2018, which were not compliant with National Institute for Health and Care Excellence guidelines (2015 update). METHODS: Referral symptoms were statistically analysed against National Institute for Health and Care Excellence guidelines, with detailed analysis of reasons for non-compliance. In addition, a systematic review of similar previously published articles was conducted. RESULTS: There were 1107 patients referred through the two-week-wait pathway. Of these referrals, 52 per cent were compliant with National Institute for Health and Care Excellence 2015 guidelines. Six errors were identified for non-compliant referrals, most commonly inconsistencies in referral (e.g. globus sensation) and intermittent disease course (e.g. intermittent hoarseness). Of all patients referred, 93 per cent were diagnosed with benign conditions, with laryngopharyngeal reflux being the commonest. Twenty-two per cent of referred patients were discharged after the first visit. CONCLUSION: Two-week-wait referral is inappropriately overused. There are many non-compliant referrals, and most of the outcomes are benign.

Outcome of two-week head and neck cancer pathway for the otolaryngology department in a tertiary centre.

BACKGROUND: The two-week-wait head and neck cancer referral pathway was introduced by the Department of Health, and refined through National Institute for Health and Care Excellence guidelines which were updated in 2015. METHODS: A retrospective study was conducted of two-week-wait referrals to out-patient ENT from January to June 2018. The analysis included demographics, referral symptoms according to National Institute for Health and Care Excellence 2015 guidelines, cancer pick-up rates and positive predictive values. RESULTS: A total of 1107 patients were referred for suspected head and neck cancer over six months, with 6 per cent diagnosed with cancer. Neck lump, persistent hoarseness and throat pain were the most common presenting symptoms. Neck lump had the highest positive predictive value, followed by oral swelling. Oral bleeding and persistent unilateral sore throat showed significant positive predictive values. Investigation for metastatic head and neck cancer of an unknown primary or the involvement of other multidisciplinary teams could hinder the achievement of a 62-day treatment target. CONCLUSION: The cancer pick-up rate from two-week-wait referrals is only 1.5 times higher than routine referrals. The 'red flag' symptoms given in the 2015 National Institute for Health and Care Excellence update would benefit from further review.

Eco-friendly preparation of zinc oxide nanoparticles using Tabernaemontana divaricata and its photocatalytic and antimicrobial activity.

The present work reports the green synthesis of Zinc Oxide Nanoparticles (ZnO NPs) using aqueous Tabernaemontana divaricata green leaf extract. ZnO NPs have been characterized by X-ray diffraction (XRD), Ultra Violet-Visible (UV-Vis) studies, Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM) and Fourier Transform-Infra Red (FT-IR) analysis. XRD pattern analysis confirms the presence of pure hexagonal wurtzite crystalline structure of ZnO. The TEM images reveal the formation of spherical shape ZnO NPs with the sizes ranging from 20 to 50 nm. The FT-IR analysis suggests that the obtained ZnO NPs have been stabilized through the interactions of steroids, terpenoids, flavonoids, phenyl propanoids, phenolic acids and enzymes present in the leaf extract. Mechanism for the formation of ZnO NPs using Tabernaemontana divaricata as bioactive compound is proposed. As prepared ZnO NPs reveals antibacterial activity against three bacterial strains, Salmonella paratyphi, Escherichia coli and Staphylococcus aureus. The ZnO NPs shows higher antibacterial activity against S. aureus and E. coli and lesser antibacterial activity against S. paratyphi compared to the standard pharmaceutical formulation. Photocatalytic activity of synthesized ZnO NPs was analyzed for methylene blue (MB) dye degradation with sunlight. Almost complete degradation of dye occurred in 90 min. This nano-ZnO, prepared by eco-friendly method will be much useful for dye removal and bacterial decontamination.

Optical properties and ionic conductivity studies of an 8 MeV electron beam irradiated poly(vinylidene fluoride-co-hexafluoropropylene)/LiClO4 electrolyte film for opto-electronic applications.

The influence of 8 MeV energy electron beam (EB) irradiation on optical properties and ionic conductivity of PVDF-HFP/LiClO4 (90 : 10 PHL10) electrolyte film with 40, 80 and 120 kGy doses. The FT-IR results show that C[double bond, length as m-dash]O bond stretching at 1654 cm-1 is due to the degradation of polymer chains and the CH2 bond wagging intensity at 1405 cm-1 corresponds to C-H bond scissioning in the 120 kGy dose irradiated film. 1H and 13C NMR spectroscopy was performed and the 13C NMR spectra confirm the effect of EB irradiation of the PHL10 polymer electrolyte by sharpening and splitting the spectral lines with increasing EB dose and revealing a new spectral line at 162.80 ppm with a 120 kGy EB dose. The size and shape of the porous morphology was drastically changed, becoming deeply porous with a visible inner hollow shaped structure, suggesting increased amorphous character upon irradiation. The absorption band of the unirradiated film observed at 202 nm in the ultraviolet region is shifted to 274 nm after irradiation due to inter band transition of electrons from the valence band to the conduction band and the optical band gap decreasing from 3.49 eV in the unirradiated film to 2.64 eV with a 120 kGy EB dose. Segmental motion in the polymer matrix leads to a decrease in the local viscosity by increasing the mobility of ions upon irradiation. Nyquist plots show semicircles at high frequency due to Li-ion migration through the porous surface of the electrolyte film. A maximum ionic conductivity of 8.28 × 10-4 S cm-1 was obtained with a 120 kGy EB dose and the observed cyclic voltammetry of the irradiated polymer electrolyte suggests it is electrochemically stable.

Kinetics studies on the removal of Methyl ethyl ketone using cornstack based biofilter.

The performance of cornstack based biofilter inoculated with a mixed culture was evaluated for gas phase MEK removal under various operating conditions. Experiments were carried out at different flow rates (0.03-0.12m3h-1) and various initial concentrations (0.2-1.2g-3). A maximum elimination capacity (EC) of 35g-3h-1 was achieved at an inlet loading rate of 60g-3h-1 with a removal efficiency of 95%. High elimination capacity reached with this system could have been due to the dominant presence of filamentous fungi among others. The experimental results were compared with the values obtained from the Ottengraf-van den Oever model for zero-order diffusion-controlled region. The critical inlet concentration, critical inlet load and biofilm thickness were estimated using the model predictions.

RETRACTED: Green synthesis of zinc oxide nanoparticles using Moringa oleifera leaf extract and evaluation of its antimicrobial activity.

The development of semiconductor materials made a considerable progress of catalytic technologies. In the present study, a simple and eco-friendly chemical direction for the synthesis of zinc oxide nanoparticles (ZnO NPs) using leaf extract of Moringa oleifera has been used. The prepared ZnO NPs were characterized various techniques such as UV-Vis absorption spectroscopy, X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), energy dispersive X-ray analysis (EDX), Fourier transform infrared spectroscopy (FT-IR) and photoluminescence spectroscopy (PL). XRD analysis revealed the wurtzite hexagonal structure of ZnO NPs. FT-IR confirmed the presence of functional groups of both leaf extract and ZnO NPs. The particles size, morphology and topography determined from FE-SEM. The intense and narrow width of zinc and oxygen have high purity and crystalline were identified using EDX. UV-Vis absorption showed the characteristic absorption peak of ZnO NPs. The results of antimicrobial activities revealed that maximum zones of inhibition was observed Gram (+ve) positive bacteria and followed by the Gram (-ve) negative bacteria and fungal at concentration of 200µg/mL of ZnO NPs.

Green synthesis of silver nanoparticles using Croton sparsiflorus morong leaf extract and their antibacterial and antifungal activities.

Biologically synthesized nanoparticles have been widely used in the field of medicine. Especially, silver nanoparticles (Ag NPs) synthesized by the leaf extract lead the biological activity. In the present work, the synthesized Ag NPs by using the leaf extract of Croton sparsiflorus morong Ag NPs were characterized by using UV-Visible (UV-Vis) absorption spectroscopy, X-ray diffraction (XRD), Field Emission Scanning Electron Microscopy (FE-SEM) along with Energy Dispersive X-ray (EDX) Spectroscopy and Fourier Infrared (FT-IR) Spectroscopy, respectively. UV-Vis peak at 457 nm confirmed the Ag NPs due to the absorption. Cubic structural analysis and 16 nm particle size of the Ag NPs were calculated by using XRD analysis. The surface morphology along with the presence of Ag NPs was identified by using FE-SEM and EDX, respectively. The FT-IR study revealed with the functional groups of the Ag NPs. Finally, the present research has been explored to exhibit the significant antimicrobial activities.

RETRACTED: Facile, eco-friendly and template free photosynthesis of cauliflower like ZnO nanoparticles using leaf extract of Tamarindus indica (L.) and its biological evolution of antibacterial and antifungal activities.

In the present investigation, we chose the very simple and eco-friendly chemical method for synthesis of zinc oxide nanoparticles from leaf extract of Tamarindus indica (L.) (T. indica) and developed the new green route for synthesis of nanoparticles. Formed product has been studied by UV-vis absorption spectroscopy, Photoluminescence (PL) spectroscopy, X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), Field emission scanning electron microscopy (FE-SEM) and with corresponding energy dispersive X-ray analysis (EDX). Mainly, the present results depicted that the synthesized nanoproducts are moderately stable, hexagonal phase, roughly spherical with maximum particles in size range within 19-37 nm in diameter. The antibacterial and fungal activities of aqueous extracts of T. indica were ended with corresponding disk diffusion and Minimum Inhibitory Concentration (MIC). The highest mean zones of inhibition were observed in the ZnO NPs (200 µg/mL) against Staphylococcus aureus (13.1±0.28). Finally, it can be concluded that microbial activity of ZnO NPs has more susceptible S. aureus than the other micro organisms. Further, the present investigation suggests that ZnO NPs has the potential applications for various medical and industrial fields.

Synthesis of silver nanoparticles using A. indicum leaf extract and their antibacterial activity.

Green synthesis of silver nanoparticles has been achieved using environmentally acceptable plant extract. It is observed that Abutilon indicum leaf extract can reduce silver ions into silver nanoparticles within 15 min of reaction time. The formation and stability of the reduced silver nanoparticles in the colloidal solution were monitored by UV-Vis spectrophotometer analysis. The mean particle diameter of silver nanoparticles was calculated from the XRD pattern. FT-IR spectra of the leaf extract after the development of nanoparticles are determined to allow identification of possible functional groups responsible for the conversion of metal ions to metal nanoparticles. The AgNPs thus obtained showed highly potent antibacterial activity toward Gram-positive (Staphyloccocus aureus and Bacillus subtilis) and Gram-negative (Salmonella typhi and Escherichia coli) microorganisms.

Rapid biological synthesis of silver nanoparticles using Leucas martinicensis leaf extract for catalytic and antibacterial activity.

A novel green approach for the synthesis and stabilization of silver nanoparticles (AgNPs) using water extract of Leucas martinicensis leaf has been developed. As obtained, the nanoparticles are characterized by UV-visible (UV-Vis), transmission electron microscope (TEM), and X-ray diffraction (XRD). The crystalline nature of the AgNPs is confirmed by the prominent peaks in the XRD pattern. FTIR spectra suggest that the possible biomolecules are responsible for the efficient stabilization of the sample. The effects of leaf quantity on the biosynthesis of AgNPs are investigated by UV-Vis spectrophotometer. The synthesized AgNPs are observed to have a good catalytic activity on the reduction of methylene blue by L. martinicensis leaf. This is confirmed by the decrease in absorbance maximum values of methylene blue with respect to time through UV-Vis spectrophotometer. Moreover, the antibacterial activity of synthesized AgNPs against Staphylococcus aureus, Bacillus subtilis, Salmonella typhi, and Escherichia coli are screened.

Synthesis of silver nanoparticles from Melia dubia leaf extract and their in vitro anticancer activity.

Silver nanoparticles have a significant role in the pharmaceutical science. Especially, silver nanoparticles synthesized by the plant extracts lead a significant role in biological activities such as antimicrobial, antioxidant and anticancer. Keeping this in mind, the present work investigation has been taken up with the synthesized silver nanoparticles using the plant extract of Melia dubia and it characterizes by using UV-visible, XRD and SEM-EDS. The effect of the silver nanoparticles on human breast cancer (KB) cell line has been tested. Silver nanoparticles showed remarkable cytotoxicity activity against KB cell line with evidence of high therapeutic index value are the results are discussed.

Synthesis, characterization and catalytic activity of silver nanoparticles using Tribulus terrestris leaf extract.

Biomediated silver nanoparticles were synthesized with the aid of an eco-friendly biomaterial, namely, aqueous Tribulus terrestris extract. Silver nanoparticles were synthesized using a rapid, single step, and completely green biosynthetic method employing aqueous T. terrestris leaf extracts as both the reducing and capping agent. Silver ions were rapidly reduced by aqueous T. terrestris leaf extracts, leading to the formation of highly crystalline silver nanoparticles. An attempt has been made and formation of the silver nanoparticles was verified by surface plasmon spectra using an UV-vis (Ultra violet), spectrophotometer. Morphology and crystalline structure of the prepared silver nanoparticles were characterized by TEM (Transmission Electron Microscope) and XRD (X-ray Diffraction), techniques, respectively. FT-IR (Fourier Transform Infrared), analysis suggests that the obtained silver nanoparticles might be stabilized through the interactions of carboxylic groups, carbonyl groups and the flavonoids present in the T. terrestris extract.

Green synthesis of silver nanoparticles from Gloriosa superba L. leaf extract and their catalytic activity.

The present work focuses the use of aqueous extract of Gloriosa superba Linn. (Glory Lily) for producing silver nanoparticles (AgNPs) from silver nitrate aqueous solution. Phytochemical analysis of the extract revealed the presence of alkaloid, amino acids, carbohydrates and proteins in the extract and they serve as effective reducing and capping agents for converting silver nitrate to silver nanoparticles. The nanoparticles were characterised by UV (Ultra violet), FT-IR (Fourier Transform Infrared), XRD (X-ray diffraction), TEM (Transmission Electron Microscope) SEM-EDX (Scanning Electron Microscopy-Energy Dispersive X-ray), and PL (Photoluminescence) studies. Moreover, the catalytic activity of synthesized AgNPs in the reduction of methylene blue was studied by UV-vis spectrophotometer. The synthesized AgNPs are observed to have a good catalytic activity on the reduction of methylene blue by G. superba extract which is confirmed by the decrease in absorbance maximum values of methylene blue with respect to time using UV-vis spectrophotometer.

SU-E-T-130: IMAT Patient Specific Quality Assurance Using ArcCHECK Diode Array Detector.

PURPOSE: To evaluate the IMAT patient specific quality assurance (QA) performed using ArcCHECK detector array in reference with standard ion chamber for routine clinical use. METHODS: Twelve patient plans having different tumor sites chosen for this study. On Eclipse planning system,IMAT patient plans were calculated on ArcCHECK phantom inserted with Ion chamber using superposition algorithm. ArcCHECK is a cylindrical phantom with a three-dimensional array of 1386 diode detectors, arranged in a spiral pattern, with 10 mm diode spacing. These plans delivered from Clinac-iX linac equipped with 120 MLC. Point dose and Dose/fluence map were measured simultaneously with ion chamber (IC-15) and ArcCHECK diode array detector respectively. Point doses, dose/fluences map and dose at central axis (CAX) on ArcCHECK phantom were compared with their respective TPS calculated values. RESULTS: The ion chamber measurements are in good agreement with TPS calculated doses. Mean difference between them is 0.50% with standard deviation is 0.51%. Concordance correlation coefficient (CCC) obtained for ion chamber base absolute dose measurements is 0.9996. These results demonstrate a strong correlation between the absolute dose predicted by our TPS and the measured dose. The precision of the TPS software was 0.9999, and its accuracy was 0.9997.The agreement between ArcCHECK doses and TPS predictions on the CAX, shown CCC of 0.9978 (the mean difference in the central axis dose is 2.11%). The 95% Confidence Interval is from 0.9932 to 0.9995. In gamma analysis of dose/fluence map the mean passing rate was 98.53% for 3% dose difference and 3mm distance to agreement. CONCLUSIONS: The IMAT patient specific QA with Ion chamber and ArcCHECK phantom are consistent with the TPS calculated dose. Statistically good agreement observed between ArcCHECK measured and TPS calculated. Hence it can be used for routine IMAT QA.

SU-E-T-143: Effect of Physical and Virtual Wedges on the Surface Dose at Various SSD for 6 and 15 MV Photon Beam.

PURPOSE: To study the effect of the virtual wedge and physical wedge filters on the surface and build-up region doses for 6 and 15MV high-energy photon beams for different field sizes and various source to surface distance(SSD). METHODS: The measurements were made in water equivalent (PMMA) solid phantom in the build-up region at various SSD for various field sizes using virtual and physical wedge filters having different angles. A parallel-plate ion chamber (Markus) was used to measure the percent depth doses at surface and buildup region. Plane parallel ion chamber with fixed plate separation on the surface and buildup region would perturbate the dose measured, to get the proper dose over response correction factor was used. RESULTS: The percentage depth dose at surface (PDD0) increased as the field size increased for open, virtual, and physical wedged beams. For open, 30 degree physical, and virtual wedged beams, the surface doses were found to be 15.4%, 11.2%, and 15.2% with 6-MV photons and 11.2%, 9.4%, 11.2% with 15-MV photons, respectively, at 10 × 10 cm2 field size at 100cm SSD.As SSD increases percentage depth dose at surface (PDD0) decreases for open,physical and virtual wedge field. CONCLUSIONS: Percentage depth dose at surface (PDD0) of virtual wedged beams were similar to those of open beams. PDD0 of physical wedged beams were lower than those of open and virtual wedged beams. Surface doses for both PW and VW increases with field size and small increase in surface dose for both PW and VW fields as wedge angle increases especially for large fields.