Multi-centre real-world validation of automated treatment planning for breast radiotherapy.

PURPOSE: To present the results of the first multi-centre real-world validation of autoplanning for whole breast irradiation after breast-sparing surgery, encompassing high complexity cases (e.g. with a boost or regional lymph nodes) and a wide range of clinical practices. METHODS: The 24 participating centers each included 10 IMRT/VMAT/Tomotherapy patients, previously treated with a manually generated plan ('manplan'). There were no restrictions regarding case complexity, planning aims, plan evaluation parameters and criteria, fractionation, treatment planning system or treatment machine/technique. In addition to dosimetric comparisons of autoplans with manplans, blinded plan scoring/ranking was conducted by a clinician from the treating center. Autoplanning was performed using a single configuration for all patients in all centres. Deliverability was verified through measurements at delivery units. RESULTS: Target dosimetry showed comparability, while reductions in OAR dose parameters were 21.4 % for heart Dmean, 16.7 % for ipsilateral lung Dmean, and 101.9 %, 45.5 %, and 35.7 % for contralateral breast D0.03cc, D5% and Dmean, respectively (all p < 0.001). Among the 240 patients included, the clinicians preferred the autoplan for 119 patients, with manplans preferred for 96 cases (p = 0.01). Per centre there were on average 5.0 ± 2.9 (1SD) patients with a preferred autoplan (range [0-10]), compared to 4.0 ± 2.7 with a preferred manplan ([0,9]). No differences were observed regarding deliverability. CONCLUSION: The automation significantly reduced the hands-on planning workload compared to manual planning, while also achieving an overall superiority. However, fine-tuning of the autoplanning configuration prior to clinical implementation may be necessary in some centres to enhance clinicians' satisfaction with the generated autoplans.

[Prolonged exposure to urban pollutants and arterial blood pressure: a whole evaluation of our researches]. / Esposizione protratta ad inquinanti urbani e pressione arteriosa: una valutazione d'insieme delle nostre ricerche

AIM: A significant relationship between exposure to cadmium and PAHs from urban air pollution and blood pressure has already been found. The aim of the study is to evaluate if other urban pollutants maintain a similar relationship in outdoor workers. MATERIALS AND METHODS: 349 subjects of both sexes were enrolled in the study; we evaluated values of environmental and biological monitoring of respirable dust, arsenic, lead, benzene, toluene, xylene and we measured blood pressure (BP) in upright and in supine position; to analyze data we used multiple linear regression. Also we valued our results in the light of those we have obtained in previous research. RESULTS: Multiple linear regression showed no significant results that demonstrate a relationship between BP and these pollutants. CONCLUSIONS: The results of our study lead to assume that exposure to urban pollutants studied has not connection with blood pressure, and to retain valid the relationship previously observed for cadmium and PAHs, which seem to be the only pollutants that can affect blood pressure.

Thyroid hormones in male workers exposed to urban stressors.

BACKGROUND: The occupational exposure to urban pollution may induce adverse effects on the human health. METHODS: Plasma levels of thyrotropin stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) of 50 outdoor workers and 50 indoor workers were compared. RESULTS: In the outdoor workers the TSH levels were significantly higher than in the control subjects (p =0.02) while the average of FT3 and FT4 values, was not significantly different compared to the controls (p > 0.05). CONCLUSIONS: The differences found for TSH levels between outdoor and indoor workers, though not high, suggest that, due to greater exposure to environmental pollutants, the outdoor workers are more susceptible to the development of function abnormalities of the thyroid gland compared to indoor workers.

Coal plant: risk, disease and prevention with on environmental impact.

Urban pollution is a current problem, constituting a serious health risk. Many pollutants are present in the urban atmosphere, they are mainly anthropogenic, resulting from the combustion of coal. Several studies have shown the harmful effects of these pollutants, particularly on the respiratory system. Through a library review, we want to explore the effects on the health of general population and of outdoor workers exposed to the products resulting from the combustion of coal, in order to compare them with the estimated effects of the pollutants from the new generation coal plants, certainly less harmful to the environment. In recent years investments in "clean technologies" have resulted in a rapid and significant reduction of all polluting emissions: sulfur dioxide, dust, oxides of nitrogen, ash and gypsum resulting from the desulfurization process. To conclude in the light of the scientific literature we can say that the activation of coal plants based on technologies for the maximum containment and optimal treatment of the production cycle is essential to defend both the environment and the health of the population. Nevertheless it remains necessary to ensure a systematic monitoring of the environment of sanitation and food processing of the population living in the area, with a long-term follow-up.

[Assessment of otoacustic emissions efficiency in diagnosis of hearing loss in workers exposed to airport stressors]. / [Valutazione della validità delle emissioni otoacustiche nella diagnostica del danno uditivo in lavoratori esposti a stressor aeroportuali].

OBJECTIVES: Otoacoustic emissions are signals that originate from the cochlea, measuring them can be considered an objective method in the assessment of auditory function. In our study we wanted to examine their efficiency among normal audiological exams. MATERIALS AND METHODS: We examined 14 workers exposed to continuous aircraft noise. They underwent ENT examination, metric eardrum test, hearing test tone audiometry system powered by 1 dB, spontaneous otoacoustic emissions and evoked otoacoustic emissions. For inclusion in the study the patients had to show bilateral normoacusia at the audiometry. RESULTS: The variation of the audiometric tracks was statistically significant (p <0.05) at a frequency of 4 kHz. As to SNR parameter (relationship between sound/noise) we noticed a tendency of the transient-evoked otoacustic emission (TEOAE) to shift their spectral content, in particular a decrease in the high frequency response and on the other hand an increase at low frequencies. A similar trend for shifting in latency of otoacoustic waves emissions after exposure to chronic noise. CONCLUSIONS: The measurement of evoked transient otoacoustic emissions is well tolerated by the workers and provides objective results, so it is a more effective and objective method then the tone audiometry.

Perceived stress and stress-related parameters.

BACKGROUND: The purpose of this study is to evaluate, using a questionnaire developed by our research group, whether occupational exposure to physical, chemical and psychosocial urban stressors can lead to alterations in perceived stress in a group of both male and female outdoor workers. The study also examines possible correlations between the levels of stress as inferred from the scores of the questionnaire and the levels of certain stress-related parameters (prolactin levels, consumption of coffee, chocolate, alcohol and cigarette smoking). METHODS: We evaluated a final sample of 480 subjects (342 male and 138 female). All workers included in the study were divided into three groups on the basis of scores of the questionnaire. RESULTS: About 60% of workers showed a moderate or severe stress condition, with a statistically significant prevalence of female workers and younger subjects. There was a statistically significant correlation between the questionnaire score and the mean levels of stress-related parameters. The increase of perceived stress increases significantly the mean levels of prolactin and the consumption of coffee, chocolate and cigarettes. There was no statistically significant differences for alcohol consumption. CONCLUSIONS: The results show that exposure to chemical physical and psycho-social urban stressors can influence perceived stress in outdoor workers. The questionnaire used in our research could be an useful instruments for physicians during the health surveillance visits

Occupational exposure to traffic pollutants and peripheral blood counts.

Aim of the study is to evaluate whether occupational exposure to low doses of pollutants present in the air of the city selected for the study could cause alterations in peripheral blood counts in workers of the Municipal Police with outdoor tasks vs workers with indoor tasks. 279 non smoker males were enrolled and divided on the basis of their different kind of task. The dosage of air pollutants was carried out through the use of personal air samplers on a representative group of workers. Data obtained were subject to statistical evaluation consisting of Homogeneity of variance test, ANOVA univariate test with post hoc Bonferroni correction, Jonckheere-Terpstra test and multiple linear regression analysis. The differences were considered statistically significant when p values were lower than 0.05. Mean levels of RBC, HB, MCHC, WBC and neutrophil cells were significantly higher in traffic policemen and police drivers compared to controls (workers with indoor tasks). Mean levels of MCV, MCH and lymphocytes were significantly lower in traffic policemen and police drivers compared to controls. These results were confirmed by Multiple linear regression test and Jonckheere-Terpstra test. The results suggest that prolonged occupational exposure to low doses of traffic pollutants can alter some lines of the hematopoietic system in exposed workers.

Teaching forensic psychiatry to psychiatric residents.

This study outlines current trends in the education of psychiatric residents in forensic psychiatry. As general psychiatrists are more frequently confronted with issues pertaining to psychiatry and the law, residency training in these areas becomes increasingly important. In order to study the educational experience of psychiatric residents in forensic psychiatry, a survey was sent to all residency training directors in the United States and Canada. The findings of the study included a description of didactics and experiential rotations in forensic psychiatry, the background of those teaching forensics, inclusion of key topics in the curriculum, and the training directors' opinions of both the importance of forensic education and the inclusion of these specific topics in the curriculum.

Microcavity transverse coherence length and microlaser threshold.

The concept of transverse coherence length in an active microscopic cavity is investigated with regard to the threshold of the microlaser action. This physical parameter is related to the linear spatial extent, or the effective radius, of the transverse lasing mode operating in a plane Fabry-Perot microcavity. This problem is analyzed by means of a full semiclassical theory, by which the microlaser threshold is expressed as a function of the relevant parameters of the thresholdless microlaser and of the extension of the active pumped zone. Experimental results are in satisfactory agreement with the theoretical predictions.