Collapsed cone convolution and analytical anisotropic algorithm dose calculations compared to VMC++ Monte Carlo simulations in clinical cases

The purpose of this work was to study and quantify the differences in dose distributions computed with some of the newest dose calculation algorithms available in commercial planning systems. The study was done for clinical cases originally calculated with pencil beam convolution (PBC) where large density inhomogeneities were present. Three other dose algorithms were used: a pencil beam like algorithm, the anisotropic analytic algorithm (AAA), a convolution superposition algorithm, collapsed cone convolution (CCC), and a Monte Carlo program, voxel Monte Carlo (VMC++). The dose calculation algorithms were compared under static field irradiations at 6 MV and 15 MV using multileaf collimators and hard wedges where necessary. Five clinical cases were studied: three lung and two breast cases. We found that, in terms of accuracy, the CCC algorithm performed better overall than AAA compared to VMC++, but AAA remains an attractive option for routine use in the clinic due to its short computation times. Dose differences between the different algorithms and VMC++ for the median value of the planning target volume (PTV) were typically 0.4% (range: 0.0 to 1.4%) in the lung and -1.3% (range: -2.1 to -0.6%) in the breast for the few cases we analysed. As expected, PTV coverage and dose homogeneity turned out to be more critical in the lung than in the breast cases with respect to the accuracy of the dose calculation. This was observed in the dose volume histograms obtained from the Monte Carlo simulations.

Aromatase deficiency in a female who is compound heterozygote for two new point mutations in the P450arom gene: impact of estrogens on hypergonadotropic hypogonadism, multicystic ovaries, and bone densitometry in childhood

We report on a female who is compound heterozygote for two new point mutations in the CYP19 gene. The allele inherited from her mother presented a base pair deletion (C) occurring at P408 (CCC, exon 9), causing a frameshift that results in a nonsense codon 111 bp (37 aa) further down in the CYP19 gene. The allele inherited from her father showed a point mutation from G-->A at the splicing point (canonical GT to mutational AT) between exon and intron 3. This mutation ignores the splice site and a stop codon 3 bp downstream occurs. Aromatase deficiency was already suspected because of the marked virilization occurring prepartum in the mother, and the diagnosis was confirmed shortly after birth. Extremely low levels of serum estrogens were found in contrast to high levels of androgens. Ultrasonographic follow-up studies revealed persistently enlarged ovaries (19.5-22 mL) during early childhood (2 to 4 yr) which contained numerous large cysts up to 4.8 x 3.7 cm and normal-appearing large tertiary follicles already at the age of 2 yr. In addition, both basal and GnRH-induced FSH levels remained consistently strikingly elevated. Low-dose estradiol (E2) (0.4 mg/day) given for 50 days at the age of 3 6/12 yr resulted in normalization of serum gonadotropin levels, regression of ovarian size, and increase of whole body and lumbar spine (L1-L4) bone mineral density. The FSH concentration and ovarian size returned to pretreatment levels shortly (150 days) after cessation of E2 therapy. Therefore, we recommend that affected females be treated with low-dose E2 in amounts sufficient to result in physiological prepubertal E2 concentrations using an ultrasensitive estrogen assay. However, E2 replacement needs to be adjusted throughout childhood and puberty to ensure normal skeletal maturation and adequate adolescent growth spurt, normal accretion of bone mineral density, and, at the appropriate age, female secondary sex maturation.

Case-control analysis on metformin and cancer of the esophagus

PURPOSE Metformin use has been associated with decreased cancer risks, though data on esophageal cancer are scarce. We explored the relation between use of metformin or other anti-diabetic drugs and the risk of esophageal cancer. METHODS We conducted a case-control analysis in the UK-based general practice research database (GPRD, now clinical practice research datalink, CPRD). Cases were individuals with an incident diagnosis of esophageal cancer between 1994 and 2010 at age 40-89 years. Ten controls per case were matched on age, sex, calendar time, general practice, and number of years of active history in the GPRD prior to the index date. Various potential confounders including diabetes mellitus, gastro-esophageal reflux, and use of proton-pump inhibitors were evaluated in univariate models, and the final results were adjusted for BMI and smoking. Results are presented as odds ratios (ORs) with 95 % confidence intervals (CI). RESULTS Long-term use (≥30 prescriptions) of metformin was not associated with a materially altered risk of esophageal cancer (adj. OR 1.23, 95 % CI 0.92-1.65), nor was long-term use of sulfonylureas (adj. OR 0.93, 95 % CI 0.70-1.23), insulin (adj. OR 0.87, 95 % CI 0.60-1.25), or of thiazolidinediones (adj. OR 0.71, 95 % CI 0.37-1.36). CONCLUSION In our population-based study, use of metformin was not associated with an altered risk of esophageal cancer.

The impact of neural invasion severity in gastrointestinal malignancies: a clinicopathological study.

OBJECTIVES Because neural invasion (NI) is still inconsistently reported and not well characterized within gastrointestinal malignancies (GIMs), our aim was to determine the exact prevalence and severity of NI and to elucidate the true impact of NI on patient's prognosis. BACKGROUND The union internationale contre le cancer (UICC) recently added NI as a novel parameter in the current TNM classification. However, there are only a few existing studies with specific focus on NI, so that the distinct role of NI in GIMs is still uncertain. MATERIALS AND METHODS NI was characterized in approximately 16,000 hematoxylin and eosin tissue sections from 2050 patients with adenocarcinoma of the esophagogastric junction (AEG)-I-III, squamous cell carcinoma (SCC) of the esophagus, gastric cancer (GC), colon cancer (CC), rectal cancer (RC), cholangiocellular cancer (CCC), hepatocellular cancer (HCC), and pancreatic cancer (PC). NI prevalence and severity was determined and related to patient's prognosis and survival. RESULTS NI prevalence largely varied between HCC/6%, CC/28%, RC/34%, AEG-I/36% and AEG-II/36%, SCC/37%, GC/38%, CCC/58%, and AEG-III/65% to PC/100%. NI severity score was uppermost in PC (24.9±1.9) and lowest in AEG-I (0.8±0.3). Multivariable analyses including age, sex, TNM stage, and grading revealed that the prevalence of NI was significantly associated with diminished survival in AEG-II/III, GC, and RC. However, increasing NI severity impaired survival in AEG-II/III and PC only. CONCLUSIONS NI prevalence and NI severity strongly vary within GIMs. Determination of NI severity in GIMs is a more precise tool than solely recording the presence of NI and revealed dismal prognostic impact on patients with AEG-II/III and PC. Evidently, NI is not a concomitant side feature in GIMs and, therefore, deserves special attention for improved patient stratification and individualized therapy after surgery.

Improving Automaticity with Basic Addition Facts: Do Taped Problems Work Faster Than Cover, Copy, Compare?

This small pilot study compared the effectiveness of two interventions to improve automaticity with basic addition facts: Taped Problems (TP) and Cover, Copy, Compare (CCC), in students aged 6-10. Automaticity was measured using Mathematics Curriculum-Based Measurement (M-CBM) at pretest, after 10 days, and after 20 days of intervention. Our hypothesis was that the TP group will gain higher levels of automaticity more quickly than the CCC and control groups. However, when gain scores were compared, no significant differences were found between groups. Limitations to the study include low treatment integrity and a short duration of intervention.

Factores que afectan la emisión de escapo floral y producción de bulbillos aéreos en ajo (Allium sativum L.)

El ajo constituye el principal producto agrícola no transformado destinado a la exportación en Mendoza. En la Argentina, la ausencia de cultivares específicas de ajo y producción de semilla fiscalizada han sido unas de las principales debilidades del sistema exportador. Para que los materiales provenientes de los planes de mejoramiento y saneados lleguen rápidamente al productor es necesario acelerar la tasa de multiplicación de los mismos. Con esta finalidad, los bulbillos aéreos que se forman en el extremo del escapo de ajo tipo “colorado" (Grupo IV, Argentina) libre de virus, pueden ser utilizados como propágulos en la producción de ajo “semilla". El objetivo general del presente trabajo fue establecer la influencia del: genotipo, liberación de virus (OYDV y LYSV), tamaño de “diente" empleado como propágulo, fertilización nitrogenada y conservación de los escapos luego de la cosecha, en la producción de bulbillos aéreos. En Mendoza, Argentina, se evaluaron durante el ciclo 1994, 32 introducciones de ajo tipo “colorado" de distinto origen, por su hábito de floración y producción de bulbillos aéreos. Se llevaron a cabo durante los años 1995 y 1996 dos ciclos de ensayos, en los que se evaluó en una población clonal de ajo “colorado criollo" (AR-I-051) y una de ajo “ruso" (AR-I-033) el efecto del saneamiento viral sobre la floración y producción de bulbillos aéreos, trabajando con material crónicamente enfermo y libre de OYDV y LYSV. En AR-I-051 además se estudió el efecto del tamaño de “diente" (2; 3,5 y 5 g ó 1,2; 3,2 y 5,2 g) e influencia de la fertilización nitrogenada (0, 50 y 100 kg.ha-1 de N como SO4(NH4)2). Entre 1995 y 1998, se compararon diversas métodos de “curado" de los escapos luego de la cosecha de las plantas (en planta entera, cortados de distintas longitudes, mantenidos en seco o con inmersión de sus bases en agua o en solución nutritiva con o sin el regulador del crecimiento CCC). Se concluye que la producción de bulbillos aéreos depende del genotipo considerado. En ajo “colorado" se distinguen 5 grupos por su modalidad de floración y potencialidad de producción de bulbillos. La producción de bulbillos aéreos útiles (>2,4 mm de diámetro) depende del tiempo transcurrido entre floración y cosecha y no entre plantación y floración. Se puede predecir la cantidad de bulbillos aéreos útiles (Numa) sobre la base del diámetro de espata (espa) y la longitud de escapo (long) al momento de cosecha, según la ecuación: Numa = - 81,62 + 4,79 espa + 1,05 long (r2 = 0,88). v La capacidad de cada genotipo de emitir escapos, disminuye con la liberación de OYDV y LYSV, por lo que la producción por hectárea de bulbillos aéreos útiles es menor en el material saneado. El empleo de material saneado, “dientes" grandes, como la fertilización con N producen plantas de mayor tamaño y con mayor área foliar, lo que se traduce en un mayor rendimiento en la producción de bulbos. Sin embargo, la producción de bulbillos aéreos por hectárea disminuye, debido al menor porcentaje de plantas que emiten escapos y no a la disminución del número de bulbillos por planta. En cambio, todas aquellas condiciones que favorecen menor expresión vegetativa de las plantas aumentan la emisión de escapos. El “curado" de los escapos separados de la planta madre se puede llevar a cabo sin necesidad de realizar la inmersión de la base de los mismos en agua o en solución nutritiva con o sin CCC. La longitud a la cual se deben cortar los escapos, de manera de no afectar la producción de bulbillos, depende del grado de crecimiento de los bulbillos en el campo. La longitud de corte del escapo en ajo “criollo", con escaso crecimiento de los bulbillos aéreos en el campo, no debe ser inferior a 50 cm. En ajo “ruso", que presenta al momento de cosecha de las plantas un desarrollo avanzado de los bulbillos aéreos, los escapos pueden cortarse de menor longitud, sin afectar la producción de bulbillos aéreos. La longitud del escapo, en planta o separado de ella, afecta la producción de bulbillos aéreos en forma directamente proporcional.

アフリカにおける株式市場の発展とその経済効果

本稿では、アフリカにおいて発展しつつある株式市場が、アフリカの各国経済に与える影響を分析する。最初に、アフリカの株式市場が、世界と比較すれば金額では小さいものの、アフリカの中ですでに活用されており、国際投資家からも注目されているという現実を明らかにする。次に、Sugimoto, Matsuki and Yoshida［2014］を概説し、アフリカ主要7カ国の株式市場のリターン（収益率）は、2004年以降、グローバル市場の動きから最も影響を受けており、世界金融危機などの際には平時よりも大きなグローバルショックを受けていたことを示す。最後に、アフリカ16カ国における株式市場の域内相互依存度を、固定相関係数（CCC-GARCH）モデルを用いて比較し、2012年以降、各地域共通の証券取引所創設にむけて積極的に連携姿勢を示すアフリカ諸国の間で、株式市場の地域的な連動性が高まってきていることを確認する。