RADIANCE-A planning software for intra-operative radiation therapy

In the last decades accumulated clinical evidence has proven that intra-operative radiation therapy (IORT) is a very valuable technique. In spite of that, planning technology has not evolved since its conception, being outdated in comparison to current state of the art in other radiotherapy techniques and therefore slowing down the adoption of IORT. RADIANCE is an IORT planning system, CE and FDA certified, developed by a consortium of companies, hospitals and universities to overcome such technological backwardness. RADIANCE provides all basic radiotherapy planning tools which are specifically adapted to IORT. These include, but are not limited to image visualization, contouring, dose calculation algorithms-Pencil Beam (PB) and Monte Carlo (MC), DVH calculation and reporting. Other new tools, such as surgical simulation tools have been developed to deal with specific conditions of the technique. Planning with preoperative images (preplanning) has been evaluated and the validity of the system being proven in terms of documentation, treatment preparation, learning as well as improvement of surgeons/radiation oncologists (ROs) communication process. Preliminary studies on Navigation systems envisage benefits on how the specialist to accurately/safely apply the pre-plan into the treatment, updating the plan as needed. Improvements on the usability of this kind of systems and workflow are needed to make them more practical. Preliminary studies on Intraoperative imaging could provide an improved anatomy for the dose computation, comparing it with the previous pre-plan, although not all devices in the market provide good characteristics to do so. DICOM.RT standard, for radiotherapy information exchange, has been updated to cover IORT particularities and enabling the possibility of dose summation with external radiotherapy. The effect of this planning technology on the global risk of the IORT technique has been assessed and documented as part of a failure mode and effect analysis (FMEA). Having these technological innovations and their clinical evaluation (including risk analysis) we consider that RADIANCE is a very valuable tool to the specialist covering the demands from professional societies (AAPM, ICRU, EURATOM) for current radiotherapy procedures.

Cystoid Macular Edema: Causes, Diagnosis and Treatment

The purpose of this paper is to conduct a review of studies on cystoid macular edema published in the last seven years. Cystoid macular edema is a major cause of loss of visual acuity. It is the final common pathway of many diseases and can be caused by numerous processes including inflammatory, vascular, adverse drug reactions, retinal dystrophy or intraocular tumors. These processes disrupt the blood-retinal barrier, with fluid extravasation to the macular parenchyma. Imaging tests are essential for both detection and monitoring of this pathology. Fluorescein angiography and autofluorescence show the leakage of liquid from perifoveal vessels into the tissue where it forms cystic spaces. Optical coherence tomography is currently the gold standard technique for diagnosis and monitoring. This allows objective measurement of retinal thickness, which correlates with visual acuity and provides more complete morphological information. Based on the underlying etiology, the therapeutic approach can be either surgical or medical with anti-inflammatory drugs. We found that disruption of the blood-retinal barrier for various reasons is the key point in the pathogenesis of cystoid macular edema, therefore we believe that studies on its treatment should proceed on this path.

Desarrollo y caracterización de dos materiales biocerámicos basados en β-CaSiO₃ (Wollastonita) para el tratamiento pulpar del diente temporal y permanente joven

El empleo de la wollastonita ha sido ampliamente documentado en la literatura como sustituto óseo, siendo un material accesible, económico, biocompatible, bioactivo y osteoinductivo. Los cementos en base a wollastonita se presentan mezclando una fase solida (polvo) con una fase líquida para formar una pasta manejable, la cual se transforma en una masa dura en pocos minutos (mediante fraguado o desecación). El objetivo de nuestro trabajo está enfocado a mejorar y desarrollar nuevos cementos donde se emplea la wollastonita como fuente de iones calcio y sílice, para una aplicación endodóntica. Primero, el nuevo cemento fraguable fue formulado. El cemento fraguable consiste en una mezcla de aluminatos cálcicos (mayenita, Ca12Al14O33 y aluminato tricálcico, Ca3Al2O6) como componente hidráulico. El aluminato de calcio, al igual que los silicatos de calcio que componen el agregado trióxido mineral (MTA), experimenta una reacción de hidratación al mezclarlo con agua que conduce al fraguado y endurecimiento, pero a diferencia de los silicatos de calcio lo hace mucho más rápidamente. Esta mezcla de aluminatos cálcicos fue obtenida en laboratorio mediante combustión. El rápido endurecimiento del aluminato de calcio fue regulado mediante la adición de ácido cítrico, el cual actúa como inhibidor retardando la reacción de fraguado mediante el secuestro de iones calcio. Su elección está justificada por ser un compuesto económico y disponible comercialmente, estando aprobado su uso por la Agencia de Alimentos y medicamentos (FDA por Federal Drug Administration) como excipiente. Para mejorar su manejo y plasticidad se estudian distintos agentes plastificantes (polivinilpirrolidona, polietilenglicol y carboximetilcelulosa). Estos agentes también actúan como retardantes (en nuestro caso un efecto desventajoso) al disminuir la velocidad de reacción de fraguado mediante el incremento de la viscosidad del medio (efecto deseado). Todos ellos son disponibles comercialmente, estando aprobado su uso como excipientes por la FDA...

Effect of Melatonin and Analogues on Corneal Wound Healing: Involvement of Mt2 Melatonin Receptor

Purpose: We have investigated the effect of melatonin and its analogues on rabbit corneal epithelial wound healing. Methods: New Zealand rabbits were anaesthetised and wounds were made by placing Whatman paper discs soaked in n-heptanol on the cornea. Melatonin and analogues (all 10 nmol) were instilled. Wound diameter was measured every 2 hours by means of fluorescein application with a Topcon SL-8Z slit lamp. Melatonin antagonists (all 10 nmol) were applied 2 hours before the application of the n-heptanol-soaked disc and then every 6 hours together with melatonin. To confirm the presence of MT2 receptors in corneal epithelial cells immunohistochemistry, Western blot and RT-PCR assays in native tissue and in rabbit corneal epithelial cells were performed. The tear components were extracted then processed by HPLC to quantify melatonin in tears. Results: Migration assays revealed that melatonin and particularly the treatment with the MT2 agonist IIK7, accelerated the rate of healing (p < 0.001). The application of the non-selective melatonin receptor antagonist luzindole and the MT2 antagonist DH97 (but not prazosin), prevented the effect of melatonin on wound healing (both p < 0.001). Immunohistochemistry, Western blot and RT-PCR assays showed the presence of MT2 melatonin receptor in corneal epithelial cells. In addition, we have identified melatonin in tears and determined its daily variations. Conclusions: These data suggest that MT2 receptors are implicated in the effect of melatonin on corneal wound healing regulating migration rate. This suggests the potential use of melatonin and its analogues to enhance epithelial wound healing in ocular surface disease.