Peanut Allergen Threshold Study (PATS): validation of eliciting doses using a novel single-dose challenge protocol

Background: The eliciting dose (ED) for a peanut allergic reaction in 5% of the peanut allergic population, the ED05, is 1.5 mg of peanut protein. This ED05 was derived from oral food challenges (OFC) that use graded, incremental doses administered at fixed time intervals. Individual patients’ threshold doses were used to generate population dose-distribution curves using probability distributions from which the ED05 was then determined. It is important to clinically validate that this dose is predictive of the allergenic response in a further unselected group of peanut-allergic individuals. Methods/Aims: This is a multi-centre study involving three national level referral and teaching centres. (Cork University Hospital, Ireland, Royal Children’s Hospital Melbourne, Australia and Massachusetts General Hospital, Boston, U.S.A.) The study is now in process and will continue to run until all centres have recruited 125 participates in each respective centre. A total of 375 participants, aged 1–18 years will be recruited during routine Allergy appointments in the centres. The aim is to assess the precision of the predicted ED05 using a single dose (6 mg peanut = 1.5 mg of peanut protein) in the form of a cookie. Validated Food Allergy related Quality of Life Questionnaires-(FAQLQ) will be self-administered prior to OFC and 1 month after challenge to assess the impact of a single dose OFC on FAQL. Serological and cell based in vitro studies will be performed. Conclusion: The validation of the ED05 threshold for allergic reactions in peanut allergic subjects has potential value for public health measures. The single dose OFC, based upon the statistical dose-distribution analysis of past challenge trials, promises an efficient approach to identify the most highly sensitive patients within any given food-allergic population.

Effect of automatic tube current modulation on radiation dose and image quality for low tube voltage multidetector row CT angiography: phantom study

RATIONALE AND OBJECTIVES: To evaluate the effect of automatic tube current modulation on radiation dose and image quality for low tube voltage computed tomography (CT) angiography. MATERIALS AND METHODS: An anthropomorphic phantom was scanned with a 64-section CT scanner using following tube voltages: 140 kVp (Protocol A), 120 kVp (Protocol B), 100 kVp (Protocol C), and 80 kVp (Protocol D). To achieve similar noise, combined z-axis and xy-axes automatic tube current modulation was applied. Effective dose (ED) for the four tube voltages was assessed. Three plastic vials filled with different concentrations of iodinated solution were placed on the phantom's abdomen to obtain attenuation measurements. The signal-to-noise ratio (SNR) was calculated and a figure of merit (FOM) for each iodinated solution was computed as SNR(2)/ED. RESULTS: The ED was kept similar for the four different tube voltages: (A) 5.4 mSv +/- 0.3, (B) 4.1 mSv +/- 0.6, (C) 3.9 mSv +/- 0.5, and (D) 4.2 mSv +/- 0.3 (P > .05). As the tube voltage decreased from 140 to 80 kVp, image noise was maintained (range, 13.8-14.9 HU) (P > .05). SNR increased as the tube voltage decreased, with an overall gain of 119% for the 80-kVp compared to the 140-kVp protocol (P < .05). The FOM results indicated that with a reduction of the tube voltage from 140 to 120, 100, and 80 kVp, at constant SNR, ED was reduced by a factor of 2.1, 3.3, and 5.1, respectively, (P < .001). CONCLUSIONS: As tube voltage decreases, automatic tube current modulation for CT angiography yields either a significant increase in image quality at constant radiation dose or a significant decrease in radiation dose at a constant image quality.

Effective Dose Estimation in Fast-kV Switch Dual Energy Computed Tomography

Purpose

The objective of our study was to test a new approach to approximating organ dose by using the effective energy of the combined 80kV/140kV beam used in fast kV switch dual-energy (DE) computed tomography (CT). The two primary focuses of the study were to first validate experimentally the dose equivalency between MOSFET and ion chamber (as a gold standard) in a fast kV switch DE environment, and secondly to estimate effective dose (ED) of DECT scans using MOSFET detectors and an anthropomorphic phantom.

Materials and Methods

A GE Discovery 750 CT scanner was employed using a fast-kV switch abdomen/pelvis protocol alternating between 80 kV and 140 kV. The specific aims of our study were to (1) Characterize the effective energy of the dual energy environment; (2) Estimate the f-factor for soft tissue; (3) Calibrate the MOSFET detectors using a beam with effective energy equal to the combined DE environment; (4) Validate our calibration by using MOSFET detectors and ion chamber to measure dose at the center of a CTDI body phantom; (5) Measure ED for an abdomen/pelvis scan using an anthropomorphic phantom and applying ICRP 103 tissue weighting factors; and (6) Estimate ED using AAPM Dose Length Product (DLP) method. The effective energy of the combined beam was calculated by measuring dose with an ion chamber under varying thicknesses of aluminum to determine half-value layer (HVL).

Results

The effective energy of the combined dual-energy beams was found to be 42.8 kV. After calibration, tissue dose in the center of the CTDI body phantom was measured at 1.71 ± 0.01 cGy using an ion chamber, and 1.73±0.04 and 1.69±0.09 using two separate MOSFET detectors. This result showed a -0.93% and 1.40 % difference, respectively, between ion chamber and MOSFET. ED from the dual-energy scan was calculated as 16.49 ± 0.04 mSv by the MOSFET method and 14.62 mSv by the DLP method.

Caracterização fitoquímica e avaliação da atividade anti-inflamatória e antinociceptiva do óleo fixo de Euterpe oleracea Mart.

Euterpe oleracea Mart. é uma típica palmeira da Amazônia, que cresce espontaneamente nos estados do Pará e Amapá, apreciada por sua atrativa beleza e valor nutricional. O fruto de Euterpe oleracea, comumente conhecido como açaí, tem demonstrado exibir significante capacidade anti-oxidante in vitro, o que pode ter benefícios à saúde. Estudos químicos revelaram a presença de ácidos graxos, antocianinas e esteroides. O objetivo deste trabalho foi caracterizar fitoquimícamente o óleo fixo dos frutos desta espécie (OEO) e avaliar em modelos inflamatórios e hiperalgésicos in vivo, o possível envolvimento dos compostos nas respostas inflamatória e analgésica. Para tanto, os modelos experimentais usados foram: teste de contorção induzida por ácido acético, edema de pata de rato, teste do granuloma em ratos, permeabilidade vascular em ratos, migração leucocitária em ratos e eritema de orelha induzida por óleo de cróton em camundongos. Doses orais de 500, 1000 e 1500 mg/kg de OEO inibiu o número de contorções em 33,67%, 45,88% e 55,58, respectivamente. O OEO produziu efeito dose-dependente, e a dose média efetiva encontrada foi de 1226,8mg/kg. Com a administração oral da dose de 1226,8 mg/kg, o OEO inibiu o processo inflamatório em 29,18% quando comparado ao grupo controle. A administração diária de OEO por 6 dias inibiu a formação do tecido granulomatoso em 36,66%. No eritema de orelha por óleo de cróton, o OEO provocou efeito inibitório significativo em 37,9%. No teste de permeabilidade vascular, o OEO inibiu a permeabilidade vascular em 54,5%. Na peritonite induzida por carragenina, o OEO reduziu o número de neutrófilos quando comparado ao grupo controle (inibição de 80,14%). A partir dos resultados obtidos, sugere-se que o OEO apresenta atividade anti-inflamatória, sobre os processos inflamatórios agudo e crônico, e atividade antinociceptiva, provavelmente de origem periférica.

Avaliação da atividade antinociceptiva e anti-inflamatória de Mikania lindleyana DC: validação do uso na medicina popular

Mikania lindleyana (Asteraceae), popularmente conhecida como sucuriju, é uma espécie nativa da região amazônica, cujo chá das folhas é a principal forma de uso popular para tratamento de gastrite, infecção, dor e inflamação. Para validar a forma e a alegação de uso decidiu-se avaliar a toxicidade aguda e as atividades antinociceptiva e anti-inflamatória do extrato bruto aquoso liofilizado de Mikania lindleyana devidamente identificada (EAML), bem como investigar sua composição química. Na análise fitoquímica do EAML detectou-se a presença de saponinas, proteínas, aminoácidos, fenóis, taninos, ácidos orgânicos e flavonoides. Por cromatografia em camada delgada (CCD) foram observadas zonas de fluorescência azul características de ácido o-cumárico. Por cromatografia liquida acoplada à espectrometria de massa (CLAE-DAD-EM) foram encontrados compostos altamente glicosilados. O EAML na dose de 5000mg/kg não provocou morte nos animais. No teste de contorções abdominais, o EAML (nas doses 125, 250, 500, 750, 1000 e 1500mg/kg) promoveu redução no número de contorções de maneira significante e dose-dependente. A dose efetiva mediana (DE₅₀) de 692,6 mg/kg não prolongou o tempo de latência sobre a placa quente. No teste de formalina, o EAML reduziu o tempo no qual os animais permaneceram lambendo a pata injetada com formalina nas duas fases sendo este efeito revertido pelo antagonista opioide naloxona. A dose de 692,6 mg/kg inibiu a formação de eritema, mas não o edema provocado por dextrana. A mesma dose inibiu a formação do edema por carragenina a partir da 2ª hora e reduziu a migração de neutrófilos para a cavidade peritonial. Estes resultados sugerem que o EAML, nas doses utilizadas, apresenta atividade antinociceptiva na qual pode haver a participação do sistema opioide e, apresenta atividade anti-inflamatória que pode ser atribuída à ação sobre mediadores inflamatórios, como PGs, e, ainda sobre moléculas de adesão, cuja participação de citocinas pode ser crucial.

Toxicidade in vitro e in vivo do ortobenzamol, análogo do paracetamol

O paracetamol (PAR) é um dos medicamentos de venda livre mais utilizado em todo o mundo. Entretanto, doses elevadas do PAR produzem toxicidade hepática e/ou renal. No intuito de minimizar a toxicidade do PAR e obter melhor atividade analgésica e anti-inflamatória, um estudo prévio realizou modificações na estrutura química do PAR por modelagem molecular, dando origem ao ortobenzamol (OBZ) – análogo do PAR. Assim, o OBZ foi sintetizado e avaliado em modelos de nocicepção e inflamação em animais. O estudo demonstrou atividade analgésica central do OBZ, com potência superior ao PAR. Além disso, nos testes de inflamação, essa droga apresentou inibição significativa no processo inflamatório. Entretanto, para que o OBZ possa ser considerado uma alternativa terapêutica nova e importante para o tratamento da dor e/ou da inflamação é necessário determinar sua toxicidade. Assim, este estudo objetivou avaliar a toxicidade in vitro e in vivo do OBZ e, compará-la com a do PAR. Para isso, a neurotoxicidade foi avaliada in vitro em culturas primárias de neurônios corticais, através de ensaios de viabilidade celular, determinação dos níveis de glutationa total e reduzida, assim como a possível capacidade neuroprotetora frente ao estresse oxidativo. Foram realizados estudos in vivo em camundongos, iniciados pela determinação da dose efetiva mediana (DE₅₀) do PAR, a fim de compará-la com a do OBZ nos modelos de toxicidade estudados. Determinou-se o estresse oxidativo hepático e cerebral pela análise dos níveis de peroxidação lipídica e nitritos. A possível disfunção hepática e renal foi determinada, por meio da análise dos níveis plasmáticos das enzimas aspartato aminotransferase (AST), de alanina aminotransferase (ALT), gama glutamiltransferase (GGT) e, da creatinina no sangue. Avaliaram-se alterações nos parâmetros clínicos através do hemograma, leucograma e plaquetograma e, realizou-se a determinação da toxicidade aguda. Os resultados obtidos neste estudo demonstraram que o ortobenzamol é mais seguro que o paracetamol. Registrou-se ao ortobenzamol ausência de neurotoxicidade, menor potencial hepatotóxico e hematotóxico, ausência de nefrotoxicidade e, ainda, foi classificado como um xenobiótico de baixa toxicidade após a avaliação da toxicidade aguda. Portanto, o ortobenzamol pode ser considerado como uma futura alternativa terapêutica segura ao paracetamol, no tratamento da dor e inflamação.

Hypervascular liver tumors: low tube voltage, high tube current multi-detector row CT for enhanced detection--phantom study

PURPOSE: To prospectively evaluate, for the depiction of simulated hypervascular liver lesions in a phantom, the effect of a low tube voltage, high tube current computed tomographic (CT) technique on image noise, contrast-to-noise ratio (CNR), lesion conspicuity, and radiation dose. MATERIALS AND METHODS: A custom liver phantom containing 16 cylindric cavities (four cavities each of 3, 5, 8, and 15 mm in diameter) filled with various iodinated solutions to simulate hypervascular liver lesions was scanned with a 64-section multi-detector row CT scanner at 140, 120, 100, and 80 kVp, with corresponding tube current-time product settings at 225, 275, 420, and 675 mAs, respectively. The CNRs for six simulated lesions filled with different iodinated solutions were calculated. A figure of merit (FOM) for each lesion was computed as the ratio of CNR2 to effective dose (ED). Three radiologists independently graded the conspicuity of 16 simulated lesions. An anthropomorphic phantom was scanned to evaluate the ED. Statistical analysis included one-way analysis of variance. RESULTS: Image noise increased by 45% with the 80-kVp protocol compared with the 140-kVp protocol (P < .001). However, the lowest ED and the highest CNR were achieved with the 80-kVp protocol. The FOM results indicated that at a constant ED, a reduction of tube voltage from 140 to 120, 100, and 80 kVp increased the CNR by factors of at least 1.6, 2.4, and 3.6, respectively (P < .001). At a constant CNR, corresponding reductions in ED were by a factor of 2.5, 5.5, and 12.7, respectively (P < .001). The highest lesion conspicuity was achieved with the 80-kVp protocol. CONCLUSION: The CNR of simulated hypervascular liver lesions can be substantially increased and the radiation dose reduced by using an 80-kVp, high tube current CT technique.

Misura ed elaborazione dei livelli di dose da radiazione diffusa su apparecchiature radiologiche in ambito sanitario

Obiettivo del presente lavoro consiste nell’elaborazione di curve di isodose relative ad alcuni apparecchi radiologici utilizzati in ambito medico partendo da misure effettuate sul campo in condizioni geometriche predefinite. Tali curve hanno consentito una mappatura dei campi di radiazione nei locali di impiego delle apparecchiature stesse, utili nelle valutazioni di radioprotezione degli operatori. In questo modo viene fornito al clinico uno strumento di consultazione per ottimizzare le proprie procedure da un punto di vista dell’esposizione al rischio delle radiazioni ionizzanti.

Suitability of diodes for point dose measurements in IMRT/VMAT beams

This study investigated a potential source of inaccuracy for diode measurements in modulated beams; the effect of diode housing asymmetry on measurement results. The possible effects of diode housing asymmetry on the measurement of steep dose gradients were evaluated by measuring 5x5 cm2 beam profiles, with three cylindrical diodes and two commonly used ionization chambers, with each dosimeter positioned in a 3D scanning water tank with its stem perpendicular to the beam axis (horizontal) and parallel to the direction of scanning. The resulting profiles were used to compare the penumbrae measured with the diode stem pointing into (equivalent to a “stem-first” setup) and out of the field (equivalent to a “stem-last” setup) in order to evaluate the effects of dosimeter alignment and thereby identify the effects of dosimeter asymmetry. The stem-first and stem-last orientations resulted in differences of up to 0.2 mm in the measured 20-80% penumbra widths and differences of up to 0.4 mm in the off axis position of the 90% isodose. These differences, which are smaller than previously reported for older model dosimeters, were apparent in the profile results for both diodes and small volume ionization chambers. As an extension to this study, the practical use of all five dosimeters was exemplified by measuring point doses in IMRT test beams. These measurements showed good agreement (within 2%) between the diodes and the small volume ionization chamber, with all of these dosimeters being able to identify a region 3% under-dosage which was not identified by a larger volume (6 mm diameter) ionization chamber. The results of this work should help to remove some of the barriers to the use of diodes for modulated radiotherapy dosimetry in the future.

Morphometric analysis of the thoracic intervertebral foramen osseous anatomy in adolescent idiopathic scoliosis using low dose computerized tomography

Introduction. The dimensions of the thoracic intervertebral foramen in adolescent idiopathic scoliosis (AIS) have not previously been quantified. During posterior approach scoliosis correction surgery pedicle screws may occasionally breach into the foramen. Better understanding of the dimensions of the foramen may be useful in surgical planning. This study describes a reproducible method for measurement of the thoracic foramen in AIS using computerized tomography (CT). Methods. In 23 pre-operative female patients with Lenke 1 type AIS with right side convexity major curves confined to the thoracic spine the foraminal height (FH), foraminal width (FW), pedicle to superior articular process distance (P-SAP) and cross sectional foraminal area (FA) were measured using multiplanar reconstructed CT. Measurements were made at entrance, midpoint and exit of the thoracic foramina from T1/T2 to T11/T12. Results were correlated with potential dependent variables of major curve Cobb Angle measured on X-ray and CT, Age, Weight, Lenke classification subtype, Risser Grade and number of spinal levels in the major curve. Results. The FH, FW, P-SAP and FA dimensions and ratios are all significantly larger on the convexity of the major curve and maximal at or close to the apex. Mean thoracic foraminal dimensions change in a predictable manner relative to position on the major thoracic curve. There was no significant correlation with the measured foraminal dimensions or ratios and the potential dependent variables. The average ratio of convexity to concavity dimensions at the apex foramina for entrance, midpoint and exit respectively are FH (1.50, 1.38, 1.25), FW (1.28, 1.30, 0.98), FA (2.06, 1.84, 1.32), P-SAP (1.61, 1.47, 1.30). Conclusion. Foraminal dimensions of the thoracic spine are significantly affected by AIS. Foraminal dimensions have a predictable convexity to concavity ratio relative to the proximity to the major curve apex. Surgeons should be aware of these anatomical differences during scoliosis correction surgery.

The bigger the better? or what we know and what we still need to learn about anthracycline dose per course, dose density and cumulative dose in the treatment of breast cancer.

Clinical Trial

The effects of quinpirole in eliciting 50 kHz calls from the rat nucleus accumbens /

Fifty kHz rat vocalizations are theorized to reflect a positive affective state, and index the reward value of stimuli (Knutson, Burgdorf & Panksepp, 2002; Panksepp & Burgdorf, 2003; Brudzynski,2005). Previous studies have identified the neurochemical substrate of this behaviour to be dependent on dopaminergic activity at the nucleus accumbens shell (Burgdorf, Knutson, Panksepp & Ikemoto, 2001; Thompson, Leonard & Brudzynski, 2006). The utilization of d-amphetamine (a non-selective dopamine agonist) in these studies does not address the specific dopamine receptor types involved. The present study aims to identify the role of the D2- like family of receptors in the nucleus accumbens shell in the production of 50 kHz vocalizations in adult rats. Single injections of quinpirole in a saline vehicle were administered to the nucleus accumbens shell of 57 rats, and the number of 50 kHz vocalizations were recorded. An inverted V-shaped relationship was found between quinpirole dose (0.5 ~g, 3 ~g, 6 ~g, 1 0 ~g and 20 ~g, all in 0.2~1 saline) and the mean number of 50 kHz calls produced. Quinpirole successfully elicited significantly more 50 kHz calls than did a saline control at the 6 ~g dose, as did 7 ~g/0.2 ~l of d-amphetamine injections into the same brain site. To test whether a selective D2 antagonist could reverse elicited 50 kHz calling, double injections were given that used either saline or raclopride as a pretreatment before quinpirole injections. Saline followed by 6 ~g/0.2 ~l of quinpirole elicited significantly more 50 kHz vocalizations than did a double injection of saline, while pretreatment with an equimolar dose of raclopride reduced elicited calls to control levels. Raclopride was also used as a pretreatment of 7 ~g/0.2 ~l d-amphetamine, which elicited significantly fewer 50 kHz vocalizations than saline followed by amphetamine, replicating the finding of Thompson, Leonard & Brudzynski (2006).Subcutaneous injections of 0.5 mg/kg and 1.5 mg/kg of quinpirole produced a similar number of 50 kHz vocalizations as subcutaneous injection of saline. Wider dose ranges may be explored in fiiture research. Thus, direct activation of the Da-like receptors in the nucleus accumbens shell was sufficient to elicit 50 kHz vocalizations in adult rats, an effect which was reversed with selective local antagonism of Da-like receptors. The Da-like receptor family also appears necessary for pharmacological activation of 50 kHz calling, as d-amphetamine was no longer able to effectively elicit these vocalizations from the nucleus accumbens shell when the Da-receptor family was antagonized with raclopride. The acoustic parameters of elicited vocalizations remained typical of rat 50 kHz calls. Detailed analyses of the acoustic characteristics of elicited calls indicated significant increases in call duration and peak frequency across drug injection groups, particularly among quinpirole dose groups. The implications of these findings are not yet clear, but may represent an important direction for future research into the coding of semiotic content into affective signals in rats.

Implantation et validation d’un modèle Monte Carlo du Cyberknife dans un outil de calcul de dose clinique

Le travail de modélisation a été réalisé à travers EGSnrc, un logiciel développé par le Conseil National de Recherche Canada.