The evaluation of the right inferior phrenic artery diameter in cirrhotic patients

Abstract

Purpose

The purpose of this study is to evaluate the relationship between right inferior phrenic artery diameter and portal hypertension in cirrhotic patients.

Methods

CT examinations of 38 patients with chronic liver disease (patient group) and 40 patients without any liver disease (control group) were evaluated. The right inferior phrenic artery diameter of the patient and control group were measured. CT findings of portal hypertension, which were accepted as ascites, collaterals, splenomegaly and portal vein diameter greater than 13 mm, were determined and scored in the patient group. Patients obtained scores between one and four with respect to portal hypertension findings, and the scores were compared with phrenic artery diameters. Child-Pugh and MELD scores of the patients were also calculated.

Results

The mean diameter of the right inferior phrenic artery in the patient group was larger than that in the control group (p < 0.001). The mean phrenic artery diameter of the patients with score 1 was significantly different from those with score 2 (p = 0.028), score 3 (p = 0.001) and score 4 (p = 0.005). We found a linear and moderate relationship between phrenic artery diameter values and Child-Pugh scores (p = 0.012, r = 0.405).

Conclusion

Dilatation of the right inferior phrenic artery in cirrhotic patients may be a nonspecific sign of developing portal hypertension.

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Influence of multi-leaf collimator leaf transmission on head and neck intensity-modulated radiation therapy and volumetric-modulated arc therapy planning

Abstract

The aim of this study was to quantify the effect of multi-leaf collimators (MLCs) with different leaf widths on the planning of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT). Toward this objective, dose transmission through a high-definition 120-leaf MLC (HD120MLC) and 120-leaf Millennium MLC (M120MLC) was investigated, using it with a test case and clinical case studies. In test case, studies with IMRT and VMAT plans, the difference in MLC leaf width had a limited effect on planning target volumes (PTVs). Organs at risk (OARs) were more affected by a reduction in dose transmission through the MLC than by a reduction in MLC leaf width. The results of the test case studies and clinical case studies were mostly similar. In the latter, the different MLCs had no effect on the PTV regardless of the treatment method; however, the HD120MLC plans achieved dose reductions to OARs similar to or larger than the dose reduction of the M120MLC plans. The similar results of the test case and clinical case studies showed that despite a limitation of the irradiation field size, the HD120MLC plans were superior.

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The influence of head-of-bed elevation in patients with obstructive sleep apnea

Abstract

Purpose

The purpose of this study is to test the effects of a mild degree of head-of-bed elevation (HOBE) (7.5°) on obstructive sleep apnea (OSA) severity and sleep quality.

Methods

OSA patients were recruited from a single sleep clinic (Criciúma, Santa Catarina, Brazil). Following a baseline polysomnography (PSG), all patients underwent a PSG with HOBE (within 2 weeks). In addition, a subset of patients performed a third PSG without HOBE.

Results

Fifty-two patients were included in the study (age 53.2 ± 9.1 years; BMI 29.6 ± 4.8 kg/m², neck circumference 38.9 ± 3.8 cm, and Epworth Sleepiness Scale 15 ± 7). Compared to baseline, HOBE significantly decreased the apnea-hypopnea index (AHI) from 15.7 [11.3–22.5] to 10.7 [6.6–16.5] events/h; p < 0.001 and increased minimum oxygen saturation from 83.5 [77.5–87] to 87 [81–90]%; p = 0.003. The sleep architecture at baseline and HOBE were similar. However, sleep efficiency increased slightly but significantly with HOBE (87.2 [76.7–90.7] vs 88.8 [81.6–93.3]; p = 0.005). The AHI obtained at the third PSG without HOBE (n = 7) returned to baseline values.

Conclusions

Mild HOBE significantly improves OSA severity without interfering in sleep architecture and therefore is a simple alternative treatment to ameliorate OSA.

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Quantum chemical computation by DFT application of NLO molecule 2-aminopyridinium p -toluenesulphonate

Abstract

In the present work, we have reported a theoretical study on molecular structure and vibrational spectra of organic nonlinear optical 2-aminopyridinium p-toluenesulphonate (APPTS). The molecular geometry, electrostatic potential surface and vibrational wave numbers with Raman intensities and infrared absorption intensities in the ground state have been calculated by density functional theory (DFT) method using various basis sets and Beckes three-parameter hybrid functional (B3LYP). Finally, the results were applied to simulate infrared and Raman spectra of the title compound. The assignments of the vibrational spectra have been carried out with the aid of normal coordinate analysis.

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Sentinel node biopsy for axillary management after neoadjuvant therapy for breast cancer: a single-center retrospective analysis with long follow-up

Abstract

Purpose

Sentinel node biopsy (SNB) after neoadjuvant therapy (NAT) for breast cancer remains controversial. We conducted a retrospective study of patients who underwent SNB after NAT to evaluate the effectiveness of this procedure.

Methods

A consecutive 105 women with locally advanced breast cancer (cT1–4, cN0–3, M0) were treated with NAT between 2006 and 2015. The subjects were 80 of these patients who became or remained clinically node-negative after NAT, 53 of whom had axillary management determined by SNB (group A) and the other 27 underwent axillary lymph node dissection (ALND) without SNB (group B). SNB was performed using a modified dye method.

Results

The sentinel node (SN) identification rate was 94.3% and the mean number of removed SNs was 2.4. ALND was avoided in 33 patients, who were confirmed as SN-negative. There was no difference in recurrence-free and overall survival rates between groups A and B (p = 0.71 and p = 0.46, respectively) during the median follow-up time of 63 months. Of the 33 patients who did not undergo ALND, 10 suffered recurrence (33%). One patient (3%) had recurrence in an axillary lymph node and four had recurrence in a supraclavicular lymph node.

Conclusion

Axillary SNB after NAT did not affect the axillary failure rate or the prognosis. SNB may be a reliable procedure, even after NAT.

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Management of Traumatic Hemothorax, Retained Hemothorax, and Other Thoracic Collections

Abstract

Purpose of Review

This review focuses on the various approaches for the treatment of post-traumatic hemothorax, retained hemothorax, and other thoracic collections.

Recent Findings

Early diagnosis and complete evacuation of post-traumatic hemothorax are essential to avoid complications. Incomplete evacuation of blood may result in retained hemothorax, fibrothorax, or empyema. Tube thoracostomy has been the most commonly used option for draining blood and other collections. Alternative options include image-guided placement of small-bore chest tubes, video-assisted thoracoscopic surgery (VATS), and thoracotomy. However, as data supporting safety and efficacy of image-guided placement of small-bore chest tubes have been increasingly published, the technique has been widely adopted as a primary treatment option for patients with various pleural collections after trauma.

Summary

Traumatic pleural collections have traditionally been treated with tube thoracostomy, VATS, or thoracotomy. However, recent data suggest that placement of small-bore chest tubes is similarly effective with a reduced rate of complication and should be considered as a viable option.

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Response to: systematic review of dietary, nutritional, and physical activity interventions for the prevention of prostate cancer progression and mortality by Hackshaw-McGeagh and Colleagues

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