An audit of Grade III or more skin reactions in consecutively assessed patients at a modern radiation oncology center.

Purpose: Radiation dermatitis is most common and debilitating side effects of radiotherapy leading to treatment interruption, thereby compromising the local control, and effecting quality of life. With the invent of modern imaging and recent advances in megavoltage radiotherapy, radiation-related side effects have reduced. In this audit, we report the risk factors associated with Grade III dermatitis in modern centers. Materials and Methods: We analyzed 172 patients treated with volume modulated arc therapy (VMAT) and static field intensity-modulated radiotherapy (SFIMRT) at our center. All head and neck, breast, gynecological, GU malignancies, and sarcoma patients treated with a dose of >45 Gy from April 2018 to December 2019 were included in the study. On couch, treatment verification was done with cone-beam computer tomography (CBCT). Slice-by-slice verification of planning target volume (PTV) with CBCT was done in the first three fractions and weekly thereafter. Skin evaluation was done using CTCAE v. 5. Statistical analysis was done using SPSS v. 22. Results: Of the 172 patients treated with VMAT and SFIMRT, 15 patients (8.7%) had Grade III dermatitis. Grade III dermatitis was mostly seen in breast cancer followed by head-and-neck patients. More reactions were observed in patients with advanced stage disease. Treatment verification is important at the later course of treatment, especially in head-and-neck cases where the treatment volume is large and PTV may extend outside skin. Contributing factors of radiation dermatitis at modern radiotherapy center are gene mutation, use of concurrent chemoradiotherapy, and bolus. Conclusion: We hereby conclude that PTV mismatch in weekly treatment verification, genetic mutations, concurrent chemo-radiotherapy, use of thermoplastic mask, and bolus are the contributing factors for Grade III dermatitis in modern radiotherapy centers.

Challenges faced by female radiation oncologists (FRO) in South Asia.

AIM: This study was designed to evaluate the personal challenges, work environment, and financial satisfaction of female radiation oncologists (FRO) in South Asia. MATERIAL AND METHOD: A 28-point online survey was answered by 296 FRO from south Asia. The study comprised of seven sections: personal, professional, family, economic, workplace burnout, research/academic components, and challenges exclusive to being a working woman. RESULTS: The distribution of the participants was 73.4%, 14.8%, 7.9%, and 3.9% from India, Bangladesh, Nepal, and Pakistan, respectively. Age distribution was>50 y 12.1%, 30-50 y 61.1%, and<30 y 26.8%. Out of 296 respondents 206 (69.6%) and 176 (59.5%) were married and mothers respectively. 43.8% (77) of all mothers were denied maternity leave partially.45.9% (136) of all respondents and 68.7% (121) of all mothers found motherhood the principal obstacle to career growth. Total 60.1% encounter a gender bias in the department, and 34.8% reported they were either gained or lost a job/training because of their gender. 43.3%, 36.9%, 30.6%, and 25.5% of responders felt they could have done well in professional, financial, social, and academic perspectives, respectively, had they been of the opposite gender. 28.5%, 31%, and 16.4% FRO have income ½, equal and>1.5 times than their partners. 58.9% of FRO have a similar income to male colleagues in the city, and 43% of participants are financially satisfied. CONCLUSION: This study shows a fraction of FRO in south Asia faces a substantial gender disparity in the workplace. They are partially satisfied as a woman, as RO, as mother, and as lone-earner in the family. FROs need well deserved support for optimum delivery in their professional and personal lives.

Perfusion magnetic resonance imaging in contouring of glioblastoma patients: Preliminary experience from a single institution.

PURPOSE: T1-contrast and T2-flair images of magnetic resonance imaging (MRI) are commonly fused with computed tomography (CT) and used for delineation of postoperative residual tumor and bed after surgery in patients with glioblastoma multiforme (GBM). Our prospective study was aimed to see the feasibility of incorporating perfusion MRI in delineation of brain tumor for radiotherapy planning and its implication on treatment volumes. METHODS: Twenty-four patients with histopathologically proven GBM were included in the study. All patients underwent radiotherapy planning with a contrast CT scan. In addition to radiotherapy (RT) planning protocol, T1-perfusion MRI was also done in all patients in the same sitting. Perfusion imaging was processed on the in-house-developed JAVA-based software. The images of CT and MRI were sent to the iPlan planning system (Brainlab AG, GmbH) using a Digital Imaging and Communications in Medicine - Radiation Therapy (DICOM-RT) protocol. A structure of gross tumor volume (GTV)-perfusion (GTV-P) was delineated based only on the MRI perfusion images. Subsequently, GTV-P and GTV were fused together to make GTV-summated (GTV-S). Using existing guidelines, GTV-S was expanded to form clinical target volume-summated (CTV-S) and planning target volume-summated (PTV-S). The increment in each of the summated volumes as compared to baseline volume was noted. The common overlap volume (GTVO) between GTV and GTV-P was calculated using intersection theory (GTV n GTV-P = GTVO [Overlap]). RESULTS: Mean ± standard deviation (cc) for GTV, GTV-P, and GTVO was 46.3 ± 33.4 cc (range: 5.2 cc-108.0 cc), 26.0 ± 26.2 (range: 6.6 cc-10.3.0 cc), and 17.5 ± 22.3 cc (range: 10.0 cc-92 cc), respectively. Median volume (cc) for GTV, GTV-P, and GTVO was 40.8 cc, 17.2 cc, and 8.0 cc, respectively. Mean absolute and relative increments from GTV to that of GTV-S were 8.5 ± 8.2 cc and 27.2 ± 30.9%, respectively. Average CTV volume (cc) was 230.4 ± 115.3 (range: 80.8 cc-442.0 cc). Mean and median CTV-S volumes were 262.0 ± 126.3 cc (range: 80.8 cc-483.0 cc) and 221.0 cc, respectively. The increment in the mean CTV volume (with respect to CTV created from GTV-S) was 15.2 ± 15.9%. Mean and median PTV volumes created on the summated CTV were 287.1 ± 134.0 cc (range: 118.9 cc-576.0 cc) and 258.0 cc, respectively. Absolute and relative increments in PTV volume, while incorporating the perfusion volume, were 31.3 ± 28.9 cc and 12.5 ± 13.3%, respectively. Out of the total of 24 patients, perfusion scanning did not do any increment in GTV in five patients. CONCLUSIONS: Our study is the first to present the feasibility and the outcome of contouring on perfusion imaging and its overlay on regular MRI images. The implications of this on long-term outcome and control rates of glioblastoma patients need to be seen in future studies.

Maximum limit to the number of myosin II motors participating in processive sliding of actin.

In this work, we analysed processive sliding and breakage of actin filaments at various heavy meromyosin (HMM) densities and ATP concentrations in IVMA. We observed that with addition of ATP solution, the actin filaments fragmented stochastically; we then determined mean length and velocity of surviving actin filaments post breakage. Average filament length decreased with increase in HMM density at constant ATP, and increased with increase in ATP concentration at constant HMM density. Using density of HMM molecules and length of actin, we estimated the number of HMM molecules per actin filament (N) that participate in processive sliding of actin. N is solely a function of ATP concentration: 88 ± 24 and 54 ± 22 HMM molecules (mean ± S.D.) at 2 mM and 0.1 mM ATP respectively. Processive sliding of actin filament was observed only when N lay within a minimum lower limit (Nmin) and a maximum upper limit (Nmax) to the number of HMM molecules. When N < Nmin the actin filament diffused away from the surface and processivity was lost and when N > Nmax the filament underwent breakage eventually and could not sustain processive sliding. We postulate this maximum upper limit arises due to increased number of strongly bound myosin heads.

Cytokinin-dependent secondary growth determines root biomass in radish (Raphanus sativus L.).

The root serves as an essential organ in plant growth by taking up nutrients and water from the soil and supporting the rest of the plant body. Some plant species utilize roots as storage organs. Sweet potatoes (Ipomoea batatas), cassava (Manihot esculenta), and radish (Raphanus sativus), for example, are important root crops. However, how their root growth is regulated remains unknown. In this study, we characterized the relationship between cambium and radial root growth in radish. Through a comparative analysis with Arabidopsis root expression data, we identified putative cambium-enriched transcription factors in radish and analysed their expression in representative inbred lines featuring distinctive radial growth. We found that cell proliferation activities in the cambium positively correlated with radial growth and final yields of radish roots. Expression analysis of candidate transcription factor genes revealed that some genes are differentially expressed between inbred lines and that the difference is due to the distinct cytokinin response. Taken together, we have demonstrated for the first time, to the best of our knowledge, that cytokinin-dependent radial growth plays a key role in the yields of root crops.

Seeing the unseen: diagnosing acromegaly in a dental setup.

Acromegaly is a rare metabolic condition in adults caused due to over secretion of growth hormone mostly due to pituitary gland adenomas.Disproportionate skeletal, tissue and organ growth are characteristic of acromegaly but the changes may be so insidious that most of the times go unnoticed by the patient and family. Craniofacial soft tissue and skeletal changes including mandibular prognathism and disturbed occlusion are typical manifestations of the disease process. Dental professionals may be the first healthcare providers to be visited by these patients and thereby prove instrumental in early diagnosis. Here we report the diagnosis of a case of acromegaly in a dental setup.

Correction of class II division I malocclusion after extraction using Roth prescription.

A 19-year-old female patient with convex profile, posterior divergence having Angle's class II division 1 malocclusion with incompetent lips and rotations in various teeth was treated with fixed mechanotherapy. All the first premolars were extracted. Roth prescription of 0.022″ × 0.028″ slot was used. Proximal stripping was performed to correct a black triangle in the embrasure area in the upper anteriors. The entire treatment took about 15 months.

A clinically hidden but severely destructive entity.

The diagnosis' Aggressive Periodontitis' (AgP), defined by the International workshop for a classification of periodontal diseases and conditions in 1999, refers to the multifactorial, severe and rapidly progressive form of periodontitis, which primarily--but not exclusively--affects younger patients. Direct and indirect bacterial effects influencing the host immune response play a significant part in the aetiology of AgP comparable with chronic periodontitis. In addition to various virulence factors of specific periodontal pathogens, a genetic predisposition influences the outbreak and progression of the disease. This report describes the disciplinary treatment of AgP patient with progressing full-mouth bone resorption.

Fracture tooth fragment reattachment.

Coronal fractures of the anterior teeth are a common form of dental trauma and its sequelae may impair the establishment and accomplishment of an adequate treatment plan. Among the various treatment options, reattachment of a crown fragment is a conservative treatment that should be considered for crown fractures of anterior teeth. This clinical case reports the management of two coronal tooth fracture cases that were successfully treated using tooth fragment reattachment using glass-fibre-reinforced composite post.

Allogenous tooth fragment reattachment.

Coronal fractures of the anterior teeth are a common form of dental trauma and its sequelae may impair the establishment and accomplishment of an adequate treatment plan. Among the various treatment options, reattachment of a crown fragment obtained from a previously extracted tooth is a conservative treatment that should be considered for crown fractures of anterior teeth. This article reports reattachment of an allogenous tooth fragment in a fractured maxillary lateral incisor in a 38-year-old patient. It is suggested that allogenous reattachment in a fractured anterior tooth serves to be a better alternative and should be further researched. Aesthetic and functional rehabilitation of a fractured complicated anterior crown using allogenous tooth fragment is a better alternative to other more conventional treatment options.

Aesthetic management of a complicated crown fracture: a multidisciplinary approach.

A predictable aesthetic restoration is not limited to the restored teeth; it has to include the gingival unit and its interface with the teeth involved. Orthodontic forced eruption may be a suitable approach without risking the aesthetic appearance in tooth fracture below the gingival attachment or alveolar bone crest. It is a well-documented clinical method for altering the relation between a non-restorable tooth and its attachment apparatus, elevating sound tooth material from within the alveolar socket to create a ferrule effect which is considered to be crucial for the optimal biomechanical behaviour of restored teeth. This report presents the reconstruction of a traumatised and fractured left maxillary lateral incisor by building a cast core with a cast post to perform orthodontic extrusion before placing porcelain fused to metal crown as the final restoration.

An efficient method for correction of anterior crossbite without using bite plates.

In cases of anterior crossbite we need to disocclude the bite so as to initiate unrestricted pathway for the teeth to come into the arch. Various techniques have been advocated for this purpose but most of them are either costly, time consuming or not very effective. So, by the use of simple bondable Begg bracket and elastics we devised a method to disocclude the bite and help in correction of anterior crossbite. It is easy, economical, efficient and less time consuming.

Surgical removal of mandibular tori and its use as an autogenous graft.

While there is a hereditary component to tori, this does not explain all cases. Tori tend to appear more frequently during middle age of life. Certain ethnic groups are more prone to one torus or the other. Torus is mainly removed owing to prosthodontic reasons, as it may also be used as biomaterial, not only in periodontology, but also in implantology. This case report deals with the surgical removal of mandibular tori and is thereby improving clinical implications and serving as an adequate autogenous bone graft.

Phenytoin-induced gingival enlargement: a dental awakening for patients with epilepsy.

Drug-induced gingival enlargement is the term now used to describe medication-related gingival hypertrophy or hyperplasia, a condition commonly induced by three main classes of drugs: anticonvulsants, antihypertensive calcium channel blockers and the immunosuppressant cyclosporine. The pathogenesis of drug-induced gingival enlargement is uncertain and there appears to be no unifying hypothesis that links together the three commonly implicated drugs. Phenytoin-induced gingival overgrowth is a well known and frequently reported gingival lesion, which was first detected in 1939. This case report consists of phenytoin usage, duration and poor oral hygiene.