Three-dimensional MRI-based treatment planning approach for non-invasive ocular proton therapy.

PURPOSE: To develop a high-resolution three-dimensional (3D) magnetic resonance imaging (MRI)-based treatment planning approach for uveal melanomas (UM) in proton therapy. MATERIALS/METHODS: For eight patients with UM, a segmentation of the gross tumor volume (GTV) and organs-at-risk (OARs) was performed on T1- and T2-weighted 7 Tesla MRI image data to reconstruct the patient MR-eye. An extended contour was defined with a 2.5-mm isotropic margin derived from the GTV. A broad beam algorithm, which we have called πDose, was implemented to calculate relative proton absorbed doses to the ipsilateral OARs. Clinically favorable gazing angles of the treated eye were assessed by calculating a global weighted-sum objective function, which set penalties for OARs and extreme gazing angles. An optimizer, which we have named OPT'im-Eye-Tool, was developed to tune the parameters of the functions for sparing critical-OARs. RESULTS: In total, 441 gazing angles were simulated for every patient. Target coverage including margins was achieved in all the cases (V95%  > 95%). Over the whole gazing angles solutions space, maximum dose (Dmax ) to the optic nerve and the macula, and mean doses (Dmean ) to the lens, the ciliary body and the sclera were calculated. A forward optimization was applied by OPT'im-Eye-Tool in three different prioritizations: iso-weighted, optic nerve prioritized, and macula prioritized. In each, the function values were depicted in a selection tool to select the optimal gazing angle(s). For example, patient 4 had a T2 equatorial tumor. The optimization applied for the straight gazing angle resulted in objective function values of 0.46 (iso-weighted situation), 0.90 (optic nerve prioritization) and 0.08 (macula prioritization) demonstrating the impact of that angle in different clinical approaches. CONCLUSIONS: The feasibility and suitability of a 3D MRI-based treatment planning approach have been successfully tested on a cohort of eight patients diagnosed with UM. Moreover, a gaze-angle trade-off dose optimization with respect to OARs sparing has been developed. Further validation of the whole treatment process is the next step in the goal to achieve both a non-invasive and a personalized proton therapy treatment.

Solitary dilated duct visualised by mammography: ultrasound and anatomopathological correlation.

AIM: To correlate solitary dilated ducts (SDDs) detected by mammography with ultrasound and histopathological findings of intraductal lesions and evaluate the association with invasive or in situ breast carcinoma. The secondary goal was to evaluate the prevalence of SDDs in screening and diagnostic mammography. MATERIALS AND METHODS: This prospective study of consecutive screening and diagnostic mammograms from March 2016 to March 2017 at a referral centre for the diagnosis and treatment of breast cancer was registered at clinicatrials.gov (NCT03161392). SDDs were recorded prospectively on mammography, and regardless of the findings' stability, the participants were recalled for targeted ultrasound to evaluate the intraductal content, which was submitted to histopathological analysis when heterogeneous content or masses were found. SDD stability was evaluated for 2 years. The categorical data are shown as frequency and percentage, and the comparisons were conducted using the chi-squared test. RESULTS: A total of 9,035 mammograms were evaluated. SDDs were identified in 130 (1.43%) mammograms and 94 targeted ultrasound were conducted. In 22 cases, histological analysis were performed, and the main findings were fibrocystic changes (n = 14) and papilloma (n = 8). The main clinical and imaging characteristics associated with statistical significance (p < 0.05) were the presence of nipple discharge, intraductal masses, and calcifications on mammography. CONCLUSION: SDDs visualised using mammography and without other associated findings should be complemented with targeted ultrasound to evaluate the intraductal content that shows benign histopathological results when papilloma is the most relevant finding. No cases of invasive or in situ breast carcinoma were found in this study.

Ovulatory status of overweight women without Polycystic Ovary Syndrome.

OBJECTIVE: Obesity is one of the extra hypothalamic-pituitary-ovarian axis factors that can influence ovulation. The isolated impact of obesity on ovulation without other comorbidities needs to be further studied. Our goal is to evaluate the association between the anovulation in the ultrasonographic monitoring of the ovulation cycle and the body mass increase of infertile patients without polycystic ovaries of a university service. METHODS: Case-control study performed at the Human Reproduction Laboratory of the University Hospital. We evaluated 1,356 ultrasound monitoring reports of ovulation between January 2011 and December 2015. We named case those patients who ovulated on the monitored cycle. After applying the exclusion criteria, we consolidated a total of 110 cases and 118 controls. The exposure variables were normal BMI or patients classified with a BMI above normal. Data analysis was performed using SPSS 22.0. Differences in proportions were assessed by X2 test Pearson, Fisher and Wilcoxon test. The value of p<0.05 was considered statistically significant. RESULTS: The groups were comparable in age, age at menarche, number of pregnancies, deliveries, cesarean sections and abortions, number of antral follicles, FSH, prolactin and TSH values. Among the anovulatory patients, 57 (51.82%) were overweight, while among ovulatory patients, 44 (37.29%) were in this same BMI category. The odds ratio was 1.8655, with a significant p value (p<0.05). CONCLUSION: There was an association between anovulation and increase in the Body Mass Index, with an increased risk of anovulation in patients with BMI above normal.

Microcrystalline cellulose as reinforcing agent in silicone elastomers.

Cellulose is commonly used as filler for the reinforcement of polymer materials but data in the case of silicones remain rare. In this work we report the modification of microcrystalline cellulose (MCC) fibers from cotton linters by propargyl bromide, in aqueous medium without alteration of the crystalline domains. The analysis evidenced the efficient grafting of alkyne functions at the surface of the fibers, the DS being 0.5. The resulting MCC-Alkyne fibers were introduced within a bi-component reactive silicone formulation (up to 20wt%), allowing the formation of network through hydrosilylation reaction in which MCC-Alkyne played the role of a reactive fillers. Comparison between the properties of composites prepared with unmodified MCC and MCC-Alkyne highlighted a densification of the network and an enhancement of mechanical and thermal properties when coupling reactions occurred. Mechanical properties of silicone elastomers were better if the load of MCC-Alkyne remains low.

Há alteração do dia da ovulação em pacientes com sobrepeso ou obesidade? Estudo transversal / Are there change in ovulation day in patients with overweight or obesity? Cross­sectional study

Introdução: A função primordial do ciclo menstrual é promover a capacidade reprodutiva da mulher e alterações nesse ciclo impactam na fertilidade feminina. A obesidade é frequentemente associada a alterações do ciclo menstrual. Objetivo: Avaliar se existe diferença do dia da ovulação entre pacientes com índice de massa corpórea (IMC) normal e aquelas com sobrepeso ou obesidade em pacientes inférteis que não apresentam síndrome de ovários policísticos. Métodos: Estudo transversal feito em ambulatório de reprodução humana. Foram avaliados dois grupos, um com 71 pacientes com IMC normal e outro de 45 pacientes com IMC que indicava sobrepeso/obesidade. Foi analisado a seguir o dia da ovulação das pacientes de cada grupo. As amostras incluíram pacientes de 18 a 38 anos, sem síndrome de ovários policísticos, com as variáveis que pudessem interferir na ovulação pareadas, o que garantia a homogeneidade dos grupos. Resultados: As pacientes com sobrepeso ou obesidade tiveram a ovulação em média no 14,62◦ dia do ciclo e as pacientes com IMC normal em média no 14, 21◦ dia. Não houve significância estatística entre os grupos. Conclusão: Não houve diferença estatística do dia da ovulação entre as pacientes com IMC normal e aquelas com sobrepeso ou obesidade, que não apresentavam outras comorbidades que pusessem afetar a fertilidade.(AU)

Background: The primary function of the menstrual cycle is to promote the reproductive capacity of women and changes in this cycle impact on female fertility. Obesity is often associated with changes in the menstrual cycle. Objective: Assess whether there is difference between ovulation's day in patients with normal BMI and those with overweight or obesity in infertile patients without Polycystic Ovary Syndrome. Methods: Cross-sectional study in Human Reproduction Outpatient Clinic. Two groups, one with 71 patients with normal BMI and the other with 45 patients with a BMI indicating overweight/obesity. It was next analyzed the day of ovulation of patients in each group. The samples included patients 18-38 years without Polycystic Ovary Syndrome, whith the variables that could interfere with ovulation, matched, ensuring the homogeneity of the groups. Results: Patients with overweight or obese had an average ovulation in 14.62◦ day of the cycle, and patients with normal BMI average at 14.21◦ day, with no statistical significance between groups. Conclusion: there was no statistical difference of day of ovulation among patients with normal BMI and those with overweight or obesity, which had no other comorbidities that would put affect fertility.

Pmarg-pearlin is a matrix protein involved in nacre framework formation in the pearl oyster Pinctada margaritifera.

The shell of pearl oysters is organized in multiple layers of CaCO(3) crystallites packed together in an organic matrix. Relationships between the components of the organic matrix and mechanisms of nacre formation currently constitute the main focus of research into biomineralization. In this study, we characterized the pearlin protein from the oyster Pinctada margaritifera (Pmarg); this shares structural features with other members of a matrix protein family, N14/N16/pearlin. Pmarg pearlin exhibits calcium- and chitin-binding properties. Pmarg pearlin transcripts are distinctively localized in the mineralizing tissue responsible for nacre formation. More specifically, we demonstrate that Pmarg pearlin is localized within the interlamellar matrix of nacre aragonite tablets. Our results support recent models for multidomain matrix protein involvement in nacreous layer formation. We provide evidence here for the existence of a conserved family of nacre-associated proteins in Pteriidae, and reassess the evolutionarily conserved set of biomineralization genes related to nacre formation in this taxa.

[Study of left ventricular function at rest and post-exercise with thallium-201 myocardial scintigraphy synchronized with ECG]. / Etude de la fonction ventriculaire gauche au repos et dans le post-effort par la tomoscintigraphie myocardique au thallium-201 synchronisée à l'ECG.

ECG-gated Thallium 201 myocardial scintigraphy provides a simultaneous evaluation of left ventricular perfusion and function. The aims of this study were to determine the changes in left ventricular ejection fraction (LVEF) after exercise and at rest 4 hours after exercise and to compare the results with changes in myocardial perfusion and the severity of the coronary artery disease. Sixty-four men with myocardial ischaemia on scintigraphy who had undergone coronary angiography showing significant lesions within 3 months, were compared with 38 normal men. The ejection fraction was calculated with a validated programme (QGS). The change in LVEF between the post-exercise and resting measurement 4 hours after exercise (delta LVEF) was compared in the normal and ischaemic groups (+7 +/- 6.8% vs -5.6 +/- 5%, p < 0.001). The extent of the ischaemia (percentage myocardium unperfused) was significantly greater in the 34 patients who had an over 5% reduction in LVEF on exercise compared with the 30 others who has a less than 5% reductionin LVEF (11.8 vs 6.3%, p < 0.001). There was a linear correlation between the degree of ischaemia and delta LVEF in the 30 patients without a history of infarction (r = -0.76, p < 0.01). The delta LVEF also correlated with the number and site of the coronary lesions. The authors conclude that in this male population, ECG-gated Thallium 201 myocardial scintigraphy can demonstrate a decrease in LVEF after exercise in ischaemic coronary patients whereas it increases in normal subjects. This decrease in LVEF on exercise is correlated with the extent of ischaemia and the severity of the coronary disease and should therefore be taken into account in patient management.

[Comparative study of left ventricular ejection fraction and volume by 2 isotopic methods and contrast angiography]. / Etude comparative des fractions d'éjection et volumes ventriculaires gauches obtenus par deux méthodes isotopiques et par l'angiographie de contraste.

The tomographic mode has replaced the planar mode for radióisotopic studies of myocardial perfusion but not for the study of systolic ventricular function. The aim of this study was to compare monophotonic emission tomography (MPET), the planar mode (PM) and contrast angiography (Angio). The left ventricular volumes and ejection fractions were measured in 111 patients by the tomographic and planar modes and by biplane angiography in 70 of them. The MPET algorithm (QBS software) identified the ventricular endocardium in 96 of the 111 procedures (86%). The mean left ventricular ejection fractions (LVEF) were 57 +/- 17% (MPET, N = 96), 55 +/- 15% (PL, N = 96) and 57 +/- 15% (Angio, N = 70). There was a good correlation of LVEF between MPET and PL and MPET and Angio with negligible bias of 3 +/- 6% and 2 +/- 4% respectively and high correlation coefficients, r = 0.94 (MPET = 1.05*PL-0.2) and r = 0.93 (MPET = 1.1 x Angio-3). The differences between the 95% confidence intervals between MPET and PL and MPET and Angio may be explained by an overestimation of normal LVEF by MPET, especially in patients with low end systolic volumes. In these cases, the difference in LVEF by MEPT and the average LVEF from the 3 techniques was greater: 6 +/- 4% (< or = 20 ml) vs 0 +/- 3% (> 20 ml) (p < 0.0001). The authors conclude that, with the reserve that a high percentage of investigations could not be analysable. MPET seems to be a method of choice for assessing left ventricular systolic function.

Cerebral non-Hodgkin's lymphoma discovered when treating Hodgkin's disease.

Case report of the appearance of a highly malignant cerebral non-Hodgkin's lymphoma of a diffuse large cell type, type B, occurring at the immediate onset of chemotherapy for a stage IV (mediastino-pulmonary) Hodgkin's disease (nodular sclerosis) diagnosed in a 16-year-old boy. The treatment of this cerebral lymphoma associated primary chemotherapy with high dose methotrexate, high dose aracytine, etoposide, and ifosfamide. The chemotherapy proved to be highly efficient, producing complete remission. Thoracic and abdominal irradiation for Hodgkin's disease was performed concomitantly with chemotherapy for the non-Hodgkin's lymphoma. This treatment was followed by 36 Gy of cerebral irradiation. Thirty-six months after the discovery of the cerebral non-Hodgkin's lymphoma the patient was still disease-free and doing well.

[Acrylic denture base materials in dentistry. The influence of immersion of bases on the palatal gap]. / Les matériaux acryliques des bases prothétiques en odontologie. Influence de l'immersion des bases sur le hiatus palatin.

The method of experimental design, we used, is versatile enough to allow the study of immersion in water at 37 degrees C during 15 days after curing, as a new parameter able to influence the deformation of denture bases, without any additional experiment. According to the experimental conditions used to make up denture bases, this parameter can, in some cases, modify appreciably the deviation in the palate region.

[Acrylic materials for denture bases in dentistry. Study of measurement variations and the influence of three new parameters on construction of bases and their deformation]. / Les matériaux acryliques des bases prothétiques en odontologie. Etudes de la variance des mesures et de l'influence de trois nouveaux paramètres d'élaboration des bases sur leur déformation.

A further study of the variance of deviation measurements of denture bases in the palate region shows that the variability of measurements is not essentially due to measuring, but also to the variability of denture processing. No more than the other previously studied parameters, the heating and cooling rates as well as the mode of insertion of resin in the cast have no effect on the dimensional accuracy of denture bases after curing.

Squamous cell carcinoma of the esophagus. Treatment by combined vincristine-methotrexate plus folinic acid rescue and cisplatin before radiotherapy.

From January to November, 1981, 28 patients with unresectable squamous cell carcinoma of the esophagus were treated with two cycles of chemotherapy combining vincristine (V), methotrexate (M), folinic acid rescue, and cisplatin (P) on days 1 and 21. Split-course radiation therapy was delivered thereafter from day 42 on. Hematologic, renal, and neurologic tolerance was acceptable, but most of the patients experienced nausea and vomiting. Results evolution at day 40 showed a 61% partial response (PR) rate and a 7% complete response (CR) rate. One month after the end of radiation therapy, 43% PR and 32% CR were obtained. Median response duration was 8 months. Median survival was 11.6 months for patients overall, yielding 12.9 months for responders and 5.9 months for nonresponders. Based on the response rate obtained with combined chemotherapy, a randomized trial of VMP initial chemotherapy is currently being undertaken by our cooperative group to study whether such an initial treatment could improve resectability and radiation-mediated local control along with survival rate.