Ninjaflex vs Superflab: A comparison of dosimetric properties, conformity to the skin surface, Planning Target Volume coverage and positional reproducibility for external beam radiotherapy.

BACKGROUND AND PURPOSE: When planning and delivering radiotherapy, ideally bolus should be in direct contact with the skin surface. Varying air gaps between the skin surface and bolus material can result in discrepancies between the intended and delivered dose. This study assessed a three-dimensional (3D) printed flexible bolus to determine whether it could improve conformity to the skin surface, reduce air gaps, and improve planning target volume coverage, compared to a commercial bolus material, Superflab. MATERIALS AND METHODS: An anthropomorphic head phantom was CT scanned to generate photon and electron treatment plans using virtual bolus. Two 3D printing companies used the material Ninjaflex to print bolus for the head phantom, which we designated Ninjaflex1 and Ninjaflex2. The phantom was scanned a further 15 more times with the different bolus materials in situ allowing plan comparison of the virtual to physical bolus in terms of planning target volume coverage, dose at the prescription point, skin dose, and air gap volumes. RESULTS: Superflab produced a larger volume and a greater number of air gaps compared to both Ninjaflex1 and Ninjaflex2, with the largest air gap volume of 12.02 cm3 . Our study revealed that Ninjaflex1 produced the least variation from the virtual bolus clinical goal values for all modalities, while Superflab displayed the largest variances in conformity, positional accuracy, and clinical goal values. For PTV coverage Superflab produced significant percentage differences for the VMAT and Electron3 plans when compared to the virtual bolus plans. Superflab also generated a significant difference in prescription point dose for the 3D conformal plan. CONCLUSION: Compared to Superflab, both Ninjaflex materials improved conformity and reduced the variance between the virtual and physical bolus clinical goal values. Results illustrate that custom-made Ninjaflex bolus could be useful clinically and may improve the accuracy of the delivered dose.

Automated Analysis of Aggregated Datasets to Identify Climatic Predictors of Botrytis Bunch Rot in Wine Grapes.

Botrytis bunch rot (BBR), caused by Botrytis cinerea, results in serious losses to wine-grape production in some seasons during the preharvest period. In order to predict seasons that are at risk from BBR, datasets consisting of 25 disease, weather and vine phenology variables were aggregated from 101 SiteYears across seven regions and nine growing seasons. Automated analyses were used to compare a range of statistical methods for their ability to predict BBR epidemics, including the Kruskal-Wallis test, logistic regression, receiver operating characteristic analysis, and skill-scores. Variables based on relative humidity and surface-wetness duration were significant and consistent predictors of BBR epidemics across the range of analyses applied. Variables integrating temperature and wetness duration, including the Bacchus and Broome models, also demonstrated high predictive ability; however, they did not outperform their constituent components in all analyses. Automation of data analyses was an effective way to compare a wide range of statistical methods and a large number of variables with minimal user input, following initial code development. Significant time was needed to check input data and software code, but a greater return on investment would occur should the analytical process be applied to new datasets, including those from other pathosystems.

Anterior cruciate ligament reconstruction: the short-term recovery using the Knee Injury and Osteoarthritis Outcome Score (KOOS).

PURPOSE: The use of patient reported outcome measures has gained increasing prominence in reporting surgical outcomes following primary anterior cruciate ligament reconstruction (ACLR). Many peer-reviewed journals now require 'end-result' outcomes in excess of 24 months following surgery for publication. As such, there is less focus on early recovery when the greatest rate of change is experienced and when key rehabilitation decisions are made relating to restricted activity and return to sports. We sought to examine the early recovery profile of patients following primary ACLR, determine the presence of any plateau effect of recovery and establish a source of reference for future study. METHOD: One hundred and sixty-five patients undergoing primary ACLR were identified from a prospective database. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was recorded pre-operatively and at the 3-, 6- and 12-month follow-up reviews. Mean scores were developed to plot a standard 'recovery profile' of statistical analysis for the presence of any plateau effect. RESULTS: There were significant improvements in all mean KOOS domains at 12 months following ACLR (P < 0.001) and between each recording point (P < 0.003), discounting any plateau effect. Rates of graft rupture and other surgical complications were low (1.2 and 1.8 %). The recovery profile of mean KOOS scores illustrated a reduced rate of recovery over time with sports/recreation and knee-related quality of life KOOS domains demonstrating the greatest sensitivity to change. CONCLUSIONS: This study profiles the early recovery of patients following primary ACLR using the KOOS demonstrating continued recovery of function throughout the full first 12 months with no evidence of a plateau effect. The early results in ACLR have not previously been reported in a study of this size and provide important data upon which key rehabilitation decisions can be based. LEVEL OF EVIDENCE: Therapeutic study-case series with no comparison group, Level IV.

Achilles tendon rupture with open distal tibia and fibula fracture.

The authors present a previously unreported case of an open fracture of the distal tibia and fibula with associated Achilles tendon rupture in a 27-year-old motorcyclist. Management followed established trauma principles of wound exploration, debridement, and stabilization of the fracture with reamed locked intramedullary nailing of the tibia. The injury to the Achilles tendon was not identified until surgical exploration for fixation of the fracture. This required a 2-stage operative approach, involving initial debridement and fracture fixation followed by Achilles tendon repair during the second-look wound review procedure. The authors believe this to be the first reported case of Achilles tendon rupture in association with an open transverse distal tibia fracture. Prior to surgical exploration of the wound, Achilles tendon rupture was not suspected, emphasizing the need for clinical suspicion, thorough examination, and adequate wound exploration at operation for fracture fixation.