Efficient computational modeling of electronic stopping power of organic polymers for proton therapy optimization.

This comprehensive study delves into the intricate interplay between protons and organic polymers, offering insights into proton therapy in cancer treatment. Focusing on the influence of the spatial electron density distribution on stopping power estimates, we employed real-time time-dependent density functional theory coupled with the Penn method. Surprisingly, the assumption of electron density homogeneity in polymers is fundamentally flawed, resulting in an overestimation of stopping power values at energies below 2 MeV. Moreover, the Bragg rule application in specific compounds exhibited significant deviations from experimental data around the stopping maximum, challenging established norms.

K-shell X-ray production cross sections of Ti, Cr, Ni and Zn induced by chlorine ions.

In this work we report on the results of the total K-shell X-ray production cross sections of Ti, Cr, Ni and Zn induced by Cl4+ and Cl5+ ions with energies ranging from 4 MeV to 10 MeV. The experimental results were compared with Atomic Orbitals Coupled-Channels (CC) calculations based on the independent electron model. The experimental X-ray production cross sections vary from about 10-2 barns for Zn up to 102 barns for Ti. The results obtained for Ti indicate that the present CC calculations underestimate the experimental cross sections up to two orders of magnitude at 10 MeV chlorine bombarding energy. However, the discrepancy between CC calculations and experimental results decreases as both bombarding energy and the atomic number of the target species increase. The dependency of the experiment-theory agreement on the asymmetry and adiabaticity parameters α and η respectively is discussed.

[Home-based devices for the treatment of female urinary incontinence: A literature review]. / Auto-rééducation pour le traitement de l'incontinence urinaire féminine : revue de la littérature.

OBJECTIVE: Literature review on the home-based options for the conservative management of stress urinary incontinence including biofeedback and weighted vaginal cones.. METHODS: Research was conducted in the Cochrane Library and Pubmed to find articles, published until March 2020, dealing with the conservative management of incontinence. RESULTS: A total of 9 randomized controlled trials were included, 4 concerning biofeedback and 5 concerning vaginal cones. Most of them highlighted the superiority of these three methods compared to the absence of treatment but were not superior compared to the pelvic floor muscles training in the clinic setting. CONCLUSION: Home-based devices for female stress urinary incontinence is a safe and effective treatment for female urinary incontinence. It has not shown superiority to physiotherapist-guided pelvic floor muscle reinforcement and needs more evidence to gain its place as a first line therapeutic option.

Accessory articulation of elongated anterior transverse process: a rare anatomical variant of the cervical spine depicted with CT and post-processing techniques.

There are several described anatomical variants of the cervical spine, ranging from common to extremely rare, which may have different clinical implications. We present the case of an extremely rare anatomical variant of the cervical spine, in a symptomatic patient, consisting of a unilateral accessory articulation between the 5th and 6th cervical vertebrae, due to elongated anterior transverse processes. Our search found only three cases in the English literature describing similar findings to the case here reported. Our case is, to our knowledge, the first report of this anatomical variant imaged with computed tomography including post-processing images (volume rendering technology and multiplanar reformations), which contribute greatly to a better understanding and depiction of the anatomical variant.

Confinement effects of ion tracks in ultrathin polymer films.

We show direct experimental evidence that radiation effects produced by single MeV heavy ions on a polymer surface are weakened when the length of the ion track in the material is confined into layers of a few tens of nanometers. Deviation from the bulk (thick film) behavior of ion-induced craters starts at a critical thickness as large as ∼40 nm, due to suppression of long-range additive effects of excited atoms along the track. Good agreement was found between the experimental results, molecular dynamic simulations, and an analytical model.

Certificación en calidad, conforme a la Norma ISO 9001: 2008, de un programa interdisciplinar de tratamiento del dolor / ISO 9001:2008 Quality Certification of a multidisciplinary pain program

Introducción y objetivos: el tratamiento del dolor constituye un desafío de gestión en todo tipo de establecimientos clínicos. Las Normas ISO 9001 pueden ser un método eficaz para integrar los diferentes componentes de un programa multidisciplinar integral. Los citados estándares internacionales aseguran que los productos y servicios son seguros, fiables y de buena calidad. Se muestra la experiencia de aplicar las Normas ISO 9001 para la gestión eficaz del dolor en un hospital universitario de gran tamaño. Métodos: se constituyó una comisión multidisciplinar de lucha contra el dolor (Comisión “Hospital sin Dolor”) en un hospital universitario de 1.400 camas en Madrid. Diecinueve médicos de 17 especialidades, 3 enfermeras, un farmacéutico y un miembro de la dirección del centro se integraron en seis grupos de trabajo con el objetivo de implementar los pasos necesarios para la certificación en calidad de la organización conforme a la Norma ISO 9001. Se diseñó un mapa de procesos, se identificaron los procedimientos operativos y se eligieron indicadores de calidad representativos de la actividad desarrollada. Se elaboraron un manual de calidad y un manual de bienvenida para los profesionales, se desarrollaron las políticas de gestión de riesgos y de protección de datos, y se creó un registro de incidentes críticos. La planificación y el desarrollo de las diferentes fases del proyecto requirieron aproximadamente un año y medio de trabajo. Resultados: tras la implementación de las recomendaciones de la Norma ISO, la gestión por procesos se adoptó como la metodología de trabajo habitual en las diferentes áreas integradas en el programa institucional de lucha contra el dolor. Un comité de calidad monitorizó tanto el cumplimiento de las normas como los datos derivados del sistema de gestión de la calidad. Una vez el comité constató la adecuación del sistema, una agencia externa acreditada (Bureau Veritas) fue la encargada de realizar la auditoría externa. El Certificado de Calidad fue otorgado en marzo de 2013. Conclusiones: los estándares internacionales de calidad de la Norma ISO 9001 pueden ser utilizados eficazmente en un programa multidisciplinar de lucha contra el dolor en un hospital de tercer nivel. La gestión por procesos constituye una metodología de trabajo adecuada para asegurar la eficiencia, la seguridad y la calidad (AU)

Background and aims: Pain management constitutes an organisational challenge in all types of clinical establishments. The ISO 9001 Norms can be an effective way of integrating the different components of a comprehensive multidisciplinary programme. ISO 9001 International Standards ensure that products and services are safe, reliable and of good quality. The experience of applying the ISO 9001 norms for the effective management of pain in a large university hospital is shown here. Methods: A Multidisciplinary Pain Committee was created in a 1,400-bed university hospital in Madrid (Spain). Nineteen doctors from 17 specialties, 3 nurses, one pharmacist and one of the hospital directors were integrated in six working groups with the objective of implementing the necessary steps leading to the ISO 9001 Quality Certification of the organisation. A process map was designed, operating procedures were developed and quality indicators were chosen. A quality manual and a welcome manual were written, policies for risk management and data protection were outlined, and a critical incidents registry was created. Setting up the process and completing the tasks took around one and a half years. Results: After the effective implementation of all of the ISO 9001 recommendations, process management became the regular methodology for work in the different areas integrated in the institutional pain programme. A quality committee monitored both the compliance with the norms and the data derived from the quality indicators. Once the committee was satisfied with the results, an accredited agency (Bureau Veritas Certification) for the external audit was chosen. The ISO 9001 Quality Certificate was awarded in March 2013. Conclusions: ISO 9001 international standards can be effectively applied to a multidisciplinary pain programme in a tertiary care hospital. Process management can be a useful methodology for work leading to efficiency, safety and quality (AU)

Citrus pulp as a dietary source of antioxidants for lactating holstein cows fed highly polyunsaturated Fatty Acid diets.

The effects of feeding pelleted citrus pulp (PCP) as a natural antioxidant source on the performance and milk quality of dairy cows fed highly polyunsaturated fatty acid (FA) diets were evaluated. Four lactating Holstein cows were assigned to a 4×4 Latin-square. Treatments, on a dry matter (DM) basis, were i) control diet; ii) 3% soybean oil; iii) 3% soybean oil and 9% PCP and; iv) 3% soybean oil and 18% PCP. When cows fed on citrus pulp, the DM intake tended to decrease. The total tract apparent digestibility of DM and ether extract decreased when cows fed on the control diet compared to other diets. Cows fed PCP had higher polyphenols and flavonoids content and higher total ferric reducing antioxidant power (FRAP) in milk compared to those fed no pelleted citrus pulp. Cows fed 18% PCP showed higher monounsaturated FA and lower saturated FA in milk fat compared with cows fed the other diets. The lowest n-6 FA proportion was in milk fat from cows fed control. The present study suggests that pelleted citrus pulp added to 9% to 18% DM increases total polyphenols and flavonoids concentration, and the FRAP in milk.

Severe traumatic brain injury management and clinical outcome using the Lund concept.

This review covers the main principles of the Lund concept for treatment of severe traumatic brain injury. This is followed by a description of results of clinical studies in which this therapy or a modified version of the therapy has been used. Unlike other guidelines, which are based on meta-analytical approaches, important components of the Lund concept are based on physiological mechanisms for regulation of brain volume and brain perfusion and to reduce transcapillary plasma leakage and the need for plasma volume expanders. There have been nine non-randomized and two randomized outcome studies with the Lund concept or modified versions of the concept. The non-randomized studies indicated that the Lund concept is beneficial for outcome. The two randomized studies were small but showed better outcome in the groups of patients treated according to the modified principles of the Lund concept than in the groups given a more conventional treatment.

Prevalence of acute cardiac disorders in patients with suspected ST-segment elevation myocardial infarction and non-significant coronary artery disease.

BACKGROUND AND PURPOSE: We aimed to study the prevalence of acute cardiac disorders in patients with suspected ST-segment elevation myocardial infarction (STEMI) and non-significant coronary artery disease (CAD). METHODS: From January to October 2012 we consecutively included patients admitted with suspected STEMI and non-significant CAD (coronary artery stenosis diameter <50%). Patients were diagnosed with acute cardiac disorder in the presence of elevated cardiac biomarkers (troponin T >50ng/l or creatine kinase MB >4µg/l) or dynamic ECG changes (ST-segment changes or T-wave inversion). RESULTS: Of the 871 patients admitted with suspected STEMI, 11% (n=95) had non-significant CAD. Of these, 67% (n=64) had elevated cardiac biomarkers or dynamic ECG changes and were accordingly diagnosed with acute cardiac disorders. In the remaining 33% (n=31) of patients, cardiac biomarkers were normal and ECG changes remained stationary. CONCLUSIONS: Acute cardiac disorders were diagnosed in two thirds of patients with suspected STEMI and non-significant CAD.

Oxygen self-diffusion in HfO2 studied by electron spectroscopy.

High-resolution measurement of the energy of electrons backscattered from oxygen atoms makes it possible to distinguish between (18)O and (16)O isotopes as the energy of elastically scattered electrons depends on the mass of the scattering atom. Here we show that this approach is suitable for measuring oxygen self-diffusion in HfO2 using a Hf(16)O2 (20 nm)/Hf(18)O2 bilayers (60 nm). The mean depth probed (for which the total path length equals the inelastic mean free path) is either 5 or 15 nm in our experiment, depending on the geometry used. Before annealing, the elastic peak from O is thus mainly due to electrons scattered from (16)O in the outer layer, while after annealing the signal from (18)O increases due to diffusion from the underlying Hf(18)O2 layer. For high annealing temperatures the observed interdiffusion is consistent with an activation energy of 1 eV, but at lower temperatures interdiffusion decreases with increasing annealing time. We interpret this to be a consequence of defects, present in the layers early on and enhancing the oxygen diffusivity, disappearing during the annealing process.

Bladder cancer: innovative approaches beyond the diagnosis.

Bladder carcinoma (BC) is the most common urinary malignant tumor. In the light of the unsuccessful current therapies and their side effects, new pharmacological strategies are needed. In addition to the well known therapeutic possibilities described in the first section, we focused our attention on very recent and innovative tools to approach this target (new drug candidates from epigenetic modulators to endothelin receptor inhibitors, improved technological formulations, active principles from plants, and dietary components). Then, in the last paragraph, we analyzed the etiology of recurrent BC, with particular attention to cellular microenvironment. In fact, the incidence of recurrence is up to 90%, and 25% of tumours show progression towards invasiveness.

Infusion rate and plasma volume expansion of dextran and albumin in the septic guinea pig.

BACKGROUND: Intravenous fluid treatment of hypovolaemia in states of increased capillary permeability, e.g. sepsis, is often accompanied by adverse oedema formation. A challenge is therefore to achieve and maintain normovolaemia using as little plasma volume substitution as possible to minimise interstitial oedema. In the present study, we evaluated the importance of infusion rate for the plasma volume expanding effects of 6% dextran 70 and 5% human albumin in a guinea pig sepsis model. METHODS: In this prospective, randomised study, 50 anaesthetised adult male Dunkin-Hartley guinea pigs were used. After laparotomy, sepsis was induced by caecal ligation and incision. Three hours later, an infusion (12 ml/kg) of one of the studied fluids was given either over 15 min (bolus group) or over 3 h (continuous group). A sham group underwent the same surgical procedure but did not receive any fluid. RESULTS: At the end of the experiment 3 h after the start of infusion, plasma volumes in the continuous group and the bolus group, respectively, were: 47.2 ± 5.3 ml/kg and 36.5 ± 3.9 ml/kg (P < 0.001) for 6% dextran 70, and 47.3 ± 7.5 ml/kg and 39.7 ± 2.8 ml/kg (P < 0.01) for 5% albumin. Plasma volume for the sham group at the same time point was 29.9 ± 3.3 ml/kg. CONCLUSIONS: The study performed on a guinea pig sepsis model showed that the plasma volume expanding effects of fixed volumes of 6% dextran 70 and 5% albumin were greater when given at a slow than at a fast infusion rate.

Laparoscopic partial nephrectomy for endophytic hilar tumors: feasibility and outcomes.

OBJECTIVE: To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients. METHODS: This is a single centre retrospective study. From May 2009 to September 2011, 208 LPNs were performed at our institution. Overall 11 (5.2%) elective LPNs were for hilar tumors not visible on kidney surface. Hilar tumor was defined as a mass located in the renal hilum and in contact with a major renal vessel on preoperative imaging. Procedures were carried out by a single experienced surgeon (G.G.) via retroperitoneal approach by clamping the only main renal artery. RESULTS: Mean (range) age of patients was 45.3 years (38.2-64.1), tumor size 1.6 cm (1.2-2.0), warm ischemia time 24 min (19-32), operative time 140 min (110-200) and estimated blood loss 270 ml (100-750). Two collecting system injuries were observed and repaired intraoperatively. No conversion to open surgery was required. Final pathological examination revealed 10 renal cell carcinomas and 1 oncocytoma. A negative surgical margin was obtained in 10/11 (91%) patients. Renal function and serum hemoglobin were nearly unaltered pre and post-surgery. No tumor recurrence was observed at mean (range) follow-up of 34 months (15-43). CONCLUSIONS: In experienced hands, LPN represents a feasible, safe and effective treatment for selected patients diagnosed with endophytic hilar masses. A larger number of patients and longer follow-up are required to draw definitive conclusions.

Genetically elevated bilirubin and risk of ischaemic heart disease: three Mendelian randomization studies and a meta-analysis.

BACKGROUND: Elevated plasma levels of bilirubin, an endogenous antioxidant, have been associated with reduced risk of ischaemic heart disease (IHD) and myocardial infarction (MI). Whether this is a causal relationship remains unclear. OBJECTIVE: We tested the hypothesis that elevated plasma bilirubin is causally related to decreased risk of IHD and MI. DESIGN: We used a Mendelian randomization approach and three independent studies from Copenhagen, Denmark. We measured bilirubin in 43 708 white individuals from the general population, and genotyped rs6742078 G>T in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene in 67 068 individuals, of whom 11 686 had IHD. RESULTS: Third versus first tertile of baseline bilirubin levels was associated with 134% increased bilirubin levels, with sex- and age-adjusted hazard ratios (HRs) of 0.86 [95% confidence interval (CI), 0.76-0.98; P = 0.02] for IHD and 0.81 (95% CI, 0.66-0.99; P = 0.04) for MI, but with corresponding multifactorially adjusted HRs of 0.93 (95% CI, 0.82-1.06; P = 0.29) and 0.90 (95% CI, 0.73-1.12; P = 0.35). UGT1A1 rs6742078 TT versus GG genotype was associated with 95% increased bilirubin levels (P < 0.001); TT versus GG genotype was associated with odds ratios (ORs) of 1.03 (95% CI, 0.96-1.11; P = 0.73) for IHD and 1.01 (95% CI, 0.92-1.12; P = 0.68) for MI. Finally, in a meta-analysis of the present three studies and eight previous studies including a total of 14 711 cases and 60 324 controls, the random effects OR for ischaemic cardiovascular disease for genotypes with approximately 100% increased bilirubin levels versus reference genotypes was 1.01 (95% CI, 0.88-1.16). CONCLUSION: These data suggest that plasma bilirubin is not causally associated with risk of IHD.

Avaliação da carcaça de cabritos Saanen alimentados com dietas com grãos de oleaginosas / Carcass evaluation of Saanen kids fed oilseeds diets

Foram utilizados 16 cabritos Saanen não castrados dos 15,16±1,60kg até 30,61±0,33kg de peso vivo, distribuídos em delineamento inteiramente ao acaso, alimentados com dietas (tratamentos) com grãos de linhaça, girassol ou canola. A dieta-controle foi formulada com feno de aveia, farelo de soja, milho moído e suplemento vitamínico-mineral. Os pesos da carcaça quente e fria e os rendimentos da carcaça e de cortes comerciais não foram modificados pelos tratamentos. A dieta com grãos de canola resultou em maior perda por resfriamento da carcaça e menor proporção de gordura no lombo, e a proporção de osso no lombo foi maior para os animais que receberam linhaça ou canola. Os teores de umidade, proteína, lipídios totais e cinzas do músculo Longissimus dorsi não foram alterados com a adição dos grãos de oleaginosas. A dieta com grãos de linhaça resultou em aumento do teor de ômega-3 no músculo, e o teor de colesterol e a razão ômega-6/ômega-3 foram menores nos tratamentos que continham linhaça, girassol e canola. A inclusão dos grãos de oleaginosas nas dietas não alterou as características quantitativas da carcaça de cabritos Saanen, mas melhorou a qualidade da carne, que apresentou menos colesterol e mais ômega-3, com o uso de linhaça.

Sixteen non-castrated Saanen kids from 15.16±1.60kg to 30.61±0.33kg of body weight, allotted into completely randomized experimental design, were fed experimental diets (treatments) containing flaxseed, sunflower, or canola oilseeds, and a control diet based on oat hay, soybean meal, ground corn, and vitamin-mineral supplement. Hot and cold carcass weight, carcass and commercial cuts yields were not modified by treatments. Canola seed in diets resulted in greater weight loss by cooling and lower loin fat proportion. Loin bone proportion was higher for kids fed flaxseed or canola. The moisture, protein, lipid, and ash contents in the Longissimus dorsi were not affected by oilseeds inclusion. Flaxseed in the diet increased the omega-3 content in muscle. Cholesterol content and omega-6/omega-3 ratio were lower to the treatments with flaxseed, sunflower, and canola. Oilseeds in diets of Saanen kids did not alter the carcass quantitative traits, but improved the quality of meat, with less cholesterol and more omega-3 using flaxseed.

Mutation in APOA1 predicts increased risk of ischaemic heart disease and total mortality without low HDL cholesterol levels.

OBJECTIVES: To determine whether mutations in APOA1 affect levels of high-density lipoprotein (HDL) cholesterol and to predict risk of ischaemic heart disease (IHD) and total mortality in the general population. BACKGROUND: Epidemiologically, risk of IHD is inversely related to HDL cholesterol levels. Mutations in apolipoprotein (apo) A-I, the major protein constituent of HDL, might be associated with low HDL cholesterol and predispose to IHD and early death. DESIGN: We resequenced APOA1 in 190 individuals and examined the effect of mutations on HDL cholesterol, risk of IHD, myocardial infarction (MI) and mortality in 10 440 individuals in the prospective Copenhagen City Heart Study followed for 31 years. Results were validated in an independent case-control study (n = 16 035). Additionally, we determined plasma ratios of mutant to wildtype (WT) apoA-I in human heterozygotes and functional effects of mutations in adenovirus-transfected mice. RESULTS: We identified a new mutation, A164S (1 : 500 in the general population), which predicted hazard ratios for IHD, MI and total mortality of 3.2 [95% confidence interval (CI): 1.6-6.5], 5.5 (95% CI: 2.6-11.7) and 2.5 (95% CI: 1.3-4.8), respectively, in heterozygotes compared with noncarriers. Mean reduction in survival time in heterozygotes was 10 years (P < 0.0001). Results for IHD and MI were confirmed in the case-control study. Furthermore, the ratio of mutant S164 to WT A164 apoA-I in plasma of heterozygotes was reduced. In addition, A164S heterozygotes had normal plasma lipid and lipoprotein levels, including HDL cholesterol and apoA-I, and this finding was confirmed in adenovirus-transfected mice. CONCLUSIONS: A164S is the first mutation in APOA1 to be described that predicts an increased risk of IHD, MI and total mortality without low HDL cholesterol levels.

La Comisión «Hospital sin Dolor» en la estructura de gestión de la calidad de un hospital universitario / The pain committee within the structure of total quality management in a university hospital

El tratamiento del dolor a nivel hospitalario sigue constituyendo una oportunidad de mejora. La existencia de unidades del dolor y de nuevas terapias y medicamentos, eficaces para el paciente individual, no necesariamente conlleva una disminución en la prevalencia del problema en el conjunto de los pacientes hospitalizados. Las comisiones clínicas son un elemento importante en la estructura de gestión de la calidad hospitalaria y una de sus misiones es establecer prioridades asistenciales y organizativas. Se presenta aquí la experiencia de la implantación de un «Hospital sin Dolor» a través de la labor de una comisión clínica encaminada a la formación y concienciación de todos los profesionales en la importancia del dolor y su correcto tratamiento en todo tipo de pacientes. Entre las actividades desarrolladas, se destaca la distribución de cinco mil escalas de medición del dolor, la institucionalización del registro del dolor como quinta constante, el desarrollo de numerosas actividades formativas y la elaboración y publicación de documentos informativos. La Comisión «Hospital sin Dolor» puede ser una herramienta útil para facilitar la concienciación y la colaboración de todos los profesionales para reconocer el alivio del dolor como un objetivo de calidad institucional. Esta iniciativa puede ser desarrollada en diferentes tipos de centros sanitarios (AU)

Inadequately managed pain is still common in hospitals. The existence of pain units and new therapies and drugs can be effective for the individual patient but do not necessarily improve the prevalence of pain in the majority of hospitalised patients. Clinical committees are an important component of the structure for quality management in hospitals, and they can set clinical and organisational priorities. The project “Hospital sin Dolor” (Hospital without Pain) has been developed by a clinical committee aimed at increasing the awareness of all professionals on the importance of pain and its management in all types of patients. Among the activities developed, five thousand pain scales have been distributed throughout the hospital, pain is now formally registered as a fifth vital sign, a number of educational activities have been organised, and informative leaflets have been designed and distributed. Pain Committees can be a useful quality tool to facilitate the awareness and the collaboration of all professionals towards the institutional goal of pain relief. This experience can be implemented in other clinical centres (AU)

Energy loss of argon in a laser-generated carbon plasma.

The experimental data presented in this paper address the energy loss determination for argon at 4 MeV/u projectile energy in laser-generated carbon plasma covering a huge parameter range in density and temperature. Furthermore, a consistent theoretical description of the projectile charge state evolution via a Monte Carlo code is combined with an improved version of the CasP code that allows us to calculate the contributions to the stopping power of bound and free electrons for each projectile charge state. This approach gets rid of any effective charge description of the stopping power. Comparison of experimental data and theoretical results allows us to judge the influence of different plasma parameters.

Evidence for an ultrafast breakdown of the BeO band structure due to swift argon and xenon ions.

Auger-electron spectra associated with Be atoms in the pure metal lattice and in the stoichiometric oxide have been investigated for different incident charged particles. For fast incident electrons, for Ar7+ and Ar15+ ions as well as Xe15+ and Xe31+ ions at velocities of 6% to 10% the speed of light, there are strong differences in the corresponding spectral distributions of Be-K Auger lines. These differences are related to changes in the local electronic band structure of BeO on a femtosecond time scale after the passage of highly charged heavy ions.