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Pal B, Pal A, Bag S, Ali MA, Das S, Palit S, Sarkar P, Mallik S, Goswami J, Das S, Manir KS, Sen A, Mondol M. Comparative performance analysis of 2D and 3D gamma metrics for patient specific QA in VMAT using Octavius 4D with 2D-Array 1500. Phys Med 2021; 91:18-27. [PMID: 34688208 DOI: 10.1016/j.ejmp.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Gamma pass percentage (GPP) is the predominant metric used for Patient Specific Quality Assurance (PSQA) in radiation therapy. The dimensionality of the measurement geometry in PSQA has evolved from 2D planar to 3D planar, and presently to state-of-the-art 3D volumetric geometry. We aim to critically examine the performance of the three-dimensional gammas vis-à-vis the older gamma metrics of lower dimensionality to determine their mutual fungibility in PSQA, using clinically approved Volumetric Arc Therapy (VMAT) plans. METHODS AND MATERIALS Gamma pass percentages derived from PSQA for VMAT plans using Octavius 4D phantom with 2D-Array 1500 and its proprietary software were recorded. 2D planar, 3D planar, and 3D volumetric gamma pass percentages were retrospectively extracted for multiple treatment plans at three sites, using three acceptance limits, and for two modes of normalization. The differences in mean pass percentages, and the pairwise correlation between geometries were calculated within limits of statistical significance. RESULTS A significant increase in mean pass rates was observed from 2D planar to 3D planar geometries. The difference was less pronounced from 3D planar to 3D volumetric. 2D planar v/s 3D planar showed a significant degree of correlation among themselves, which was not seen against most of the 3D volumetric pass rates. CONCLUSION The mean gamma pass rates show conclusive evidence of the benefits of shifting from 2D planar to higher dimensions measurement geometries, but the benefits of using 3D volumetric compared to 3D planar is not always unequivocal. The correlations show mixed results regarding the interdependence of pass percentages at different geometries.
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Affiliation(s)
- Bipasha Pal
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India.
| | - Angshuman Pal
- XLRI Xavier School of Management, Circuit House Area (East), Jamshedpur 831001, Jharkhand, India
| | - Santanu Bag
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Md Abbas Ali
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Suresh Das
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Soura Palit
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Papai Sarkar
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Suman Mallik
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Jyotirup Goswami
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Sayan Das
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Kazi Sazzad Manir
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Arijit Sen
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Monidipa Mondol
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
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Ferdinand S, Mondal M, Mallik S, Goswami J, Das S, Manir KS, Sen A, Palit S, Sarkar P, Mondal S, Das S, Pal B. Dosimetric analysis of Deep Inspiratory Breath-hold technique (DIBH) in left-sided breast cancer radiotherapy and evaluation of pre-treatment predictors of cardiac doses for guiding patient selection for DIBH. Tech Innov Patient Support Radiat Oncol 2021; 17:25-31. [PMID: 33681484 PMCID: PMC7930610 DOI: 10.1016/j.tipsro.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction The risk of radiotherapy-associated cardiovascular disease has been a concern for decades in breast cancer survivors. The objective of our study is to evaluate the dosimetric benefit of Deep Inspiratory Breath-hold technique (DIBH) on organs-at-risk (OAR) sparing in left-sided breast cancer radiotherapy and to find out pre-treatment predictors of cardiac doses for guiding patient selection for DIBH. Material and methods Pre-radiotherapy planning CT scans were done in Free Breathing (FB) and in DIBH [using Active Breathing Coordinator system (ABC™)] in 31 left sided breast cancer patients. 3DCRT plans were generated for both scans. Comparison of anatomical and dosimetric variables were done using paired t test and correlation was evaluated using Pearson correlation. Linear regression was used to get independent predictors of cardiac sparing and Receiver Operating Characteristic (ROC) curve analysis was done to find out the specific threshold of the predictors. Results There was a 39.15% reduction in mean heart dose in DIBH compared to FB (2.4 Gy vs 4.01 Gy) (p < 0.001), 19% reduction in maximum Left Anterior Descending (LAD) dose and a 9.9% reduction in ipsilateral lung mean dose (p = 0.036) with DIBH. A significant correlation was observed between reduction in Heart Volume in Field (HVIF) and Maximum Heart Depth (MHD) with reduction in mean heart dose. Reduction in HVIF (ΔHVIF) independently predicted cardiac sparing. Conclusion DIBH leads to significant reduction in OAR doses and is suggested for all patients of left-sided breast cancer undergoing radiotherapy. However, HVIF and MHD predicted for cardiac sparing and threshold criteria of ΔHVIF and ΔMHD may be used by centres with high workload to select patients for DIBH.
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Key Words
- 3DCRT, Three-Dimensional Conformal Radiation Therapy
- ABC™, Active Breathing Coordinator™
- AUC, Area under the curve
- BCS, Breast Conservation Surgery
- BMI, Body Mass Index
- Breast cancer
- CCD, Cardiac Contact Distance
- CD, Chest Depth
- CLD, Central Lung Distance
- CS, Chest Separation
- CT, Computer Tomography
- DIBH, Deep Inspiratory Breath-hold
- DVH, Dose Volume Histograms
- Deep inspiratory breath-hold
- Dosimetric predictors
- EORTC, European Organization for Research and Treatment of Cancer
- FB, Free Breathing
- HCWD, Heart Chest Wall Distance
- HCWL, Heart Chest Wall Length
- HH, Heart Height
- HV, Heart Volume
- HVIF, Heart Volume in Field
- IMC, Internal Mammary Chain
- LAD, Left Anterior Descending
- LOD, Lung Orthogonal Distance
- LV, Lung Volume
- MHD, Maximum Heart Depth
- MRM, Modified Radical Mastectomy
- NTCP, Normal Tissue Complications Probability
- OAR, Organs-at-risk
- PTV, Planning target volume
- RNI, Regional Nodal Irradiation
- ROC, Receiver Operating Characteristic
- RPM, Real-time Position Management
- RTOG, Radiation Therapy Oncology Group
- Radiotherapy
- SCF, Supraclavicular Fossa
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Affiliation(s)
- Soujanya Ferdinand
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Monidipa Mondal
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Suman Mallik
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Jyotirup Goswami
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Sayan Das
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Kazi S Manir
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Arijit Sen
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Soura Palit
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Papai Sarkar
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Subhayan Mondal
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Suresh Das
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Bipasha Pal
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
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Pal B, Pal A, Das S, Palit S, Sarkar P, Mondal S, Mallik S, Goswami J, Das S, Sen A, Mondol M. Retrospective study on performance of constancy check device in Linac beam monitoring using Statistical Process Control. Rep Pract Oncol Radiother 2020; 25:91-99. [PMID: 32617079 PMCID: PMC7315042 DOI: 10.1016/j.rpor.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/24/2019] [Accepted: 12/02/2019] [Indexed: 11/21/2022] Open
Abstract
AIM To examine the application of Statistical Process Control (SPC) and Ishikawa diagrams for retrospective evaluation of machine Quality Assurance (QA) performance in radiotherapy. BACKGROUND SPC is a popular method for supplementing the performance of QA techniques in healthcare. This work investigates the applicability of SPC techniques and Ishikawa charts in machine QA. MATERIALS AND METHODS SPC has been applied to recommend QA limits on the particular beam parameters using the QUICKCHECK webline QA portable constancy check device for 6 MV and 10 MV flattened photon beams from the Elekta Versa HD linear accelerator (Linac). Four machine QA parameters - beam flatness, beam symmetry along gun target direction and left-right direction, and beam quality factor (BQF) - were selected for retrospective analysis. Shewhart charts, Exponentially Weighted Moving Average (EWMA) charts and Cumulative Sum (CUSUM) charts were obtained for each parameter. The root causes for a failure in machine QA were broken down into an Ishikawa diagram enabling the user to identify the root cause of error and rectify the problem subsequently. RESULTS Shewhart charts and EWMA charts applied could detect loss in control in one variable in the 6 MV beams and in all four variables in 10 MV beams. CUSUM charts detected offsets in the readings. The Ishikawa chart exhaustively included the possible errors that lead to loss of control. CONCLUSION SPC is proven to be effective for detection of loss in control in machine QA. The Ishikawa chart provides the set of probable root causes of machine error useful while troubleshooting.
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Affiliation(s)
- Bipasha Pal
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Angshuman Pal
- Department of Mechanical Engineering, Jadavpur University, 188 Raja SC Mallick Road, Kolkata 700032, West Bengal, India
| | - Suresh Das
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Soura Palit
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Papai Sarkar
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Subhayan Mondal
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Suman Mallik
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Jyotirup Goswami
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Sayan Das
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Arijit Sen
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
| | - Monidipa Mondol
- Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah 711103, West Bengal, India
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Huber F, Kuhn B, Lannon E, Sturycz C, Payne M, Hellman N, Toledo T, Güereca Y, Demuth M, Palit S, Shadlow J, Rhudy J. (263) Less Efficient Endogenous Inhibition of Spinal Nociception Predicts Chronic Pain Onset: A Prospective Analysis from the Oklahoma Study of Native American Pain Risk (OK-SNAP). The Journal of Pain 2019. [DOI: 10.1016/j.jpain.2019.01.185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Güereca Y, Kuhn B, Lannon E, Palit S, Sturycz C, Payne M, Hellman N, Toledo T, Huber F, Demuth M, Shadlow J, Rhudy J. (265) The Relationship between Discrimination and Pain Tolerance and its Potential Mediation by Stress: Results from the Oklahoma Study of Native American Pain Risk (OK-SNAP). The Journal of Pain 2019. [DOI: 10.1016/j.jpain.2019.01.187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ehrhardt M, Gray K, Kuhn B, Lannon E, Palit S, Sturucz C, Güereca Y, Payne M, Hellman N, Toledo T, Hahn B, Shadlow J, Rhudy J. (185) A Qualitative Analysis of Pain Meaning: Results from the Oklahoma Study of Native American Pain Risk (OK-SNAP). The Journal of Pain 2019. [DOI: 10.1016/j.jpain.2019.01.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Palit S, Thin N, Knowles CH, Lunniss PJ, Bharucha AE, Scott SM. Diagnostic disagreement between tests of evacuatory function: a prospective study of 100 constipated patients. Neurogastroenterol Motil 2016; 28:1589-98. [PMID: 27154577 DOI: 10.1111/nmo.12859] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evacuatory dysfunction (ED) is a common cause of constipation and may be sub-classified on the basis of specialist tests. Such tests may guide treatment e.g., biofeedback therapy for 'functional' defecatory disorders (FDD). However, there is no gold standard, and prior studies have not prospectively and systematically compared all tests that are used to diagnose forms of ED. METHODS One hundred consecutive patients fulfilling Rome III criteria for functional constipation underwent four tests: expulsion of a rectal balloon distended to 50 mL (BE50 ) or until patients experienced the desire to defecate (BEDDV ), evacuation proctography (EP) and anorectal manometry. Yields and agreements between tests for the diagnosis of ED and FDD were assessed. KEY RESULTS Positive diagnostic yields for ED were: BEDDV 18%, BE50 31%, EP 38% and anorectal manometry (ARM) 68%. Agreement was substantial between the two balloon tests (k = 0.66), only fair between proctography and BE50 (k = 0.27), poor between manometry and proctography (k = 0.01), and there was no agreement between the balloon tests and manometry (k = -0.07 for both BE50 and BEDDV ). For the diagnosis of FDD, there was only fair agreement between ARM and EP (k = 0.23), ARM ± BE50 and EP (k = 0.18), ARM and EP ± BE50 (k = 0.30) and ARM ± BE50 and EP ± BE50 (k = 0.23). CONCLUSIONS & INFERENCES There is considerable disagreement between the results of various tests used to diagnose ED and FDD. This highlights the need for a reappraisal of both diagnostic criteria, and what represents the 'gold standard' investigation.
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Affiliation(s)
- S Palit
- National Centre for Bowel Research and Surgical Innovation (NCBRSI) and GI Physiology Unit (GIPU), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - N Thin
- National Centre for Bowel Research and Surgical Innovation (NCBRSI) and GI Physiology Unit (GIPU), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - C H Knowles
- National Centre for Bowel Research and Surgical Innovation (NCBRSI) and GI Physiology Unit (GIPU), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - P J Lunniss
- National Centre for Bowel Research and Surgical Innovation (NCBRSI) and GI Physiology Unit (GIPU), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A E Bharucha
- Division of Gastroenterology and Hepatology, Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - S M Scott
- National Centre for Bowel Research and Surgical Innovation (NCBRSI) and GI Physiology Unit (GIPU), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Palit S, Bhan C, Lunniss PJ, Boyle DJ, Gladman MA, Knowles CH, Scott SM. Evacuation proctography: a reappraisal of normal variability. Colorectal Dis 2014; 16:538-46. [PMID: 24528668 DOI: 10.1111/codi.12595] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 12/21/2013] [Indexed: 12/14/2022]
Abstract
AIM Interpretation of evacuation proctography (EP) images is reliant on robust normative data. Previous studies of EP in asymptomatic subjects have been methodologically limited. The aim of this study was to provide parameters of normality for both genders using EP. METHOD Evacuation proctography was prospectively performed on 46 healthy volunteers (28 women). Proctograms were independently analysed by two reviewers. All established and some new variables of defaecatory structure and function were assessed objectively: anorectal dimensions; anorectal angle changes; evacuation time; percentage contrast evacuated; and incidence of rectal wall morphological 'abnormalities'. RESULTS Normal ranges were calculated for all main variables. Mean end-evacuation time was 88 s (95% CI: 63-113) in male subjects and 128 s (95% CI: 98-158) in female subjects; percentage contrast evacuated was 71% (95% CI: 63-80) in male subjects and 65% (95% CI: 58-72) in female subjects. Twenty-six (93%) of 28 female subjects had a rectocoele with a mean depth of 2.5 cm (upper limit = 3.9 cm). Recto-rectal intussusception was found in nine subjects (approximately 20% of both genders); however, recto-anal intussusception was not observed. Only rectal diameter differed significantly between genders. Qualitatively, three patterns of evacuation were present. CONCLUSION This study defines normal ranges for anorectal dimensions and parameters of emptying, as well as the incidence and characteristics of rectal-wall 'abnormalities' observed or derived from EP. These ranges can be applied clinically for subsequent disease comparison.
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Affiliation(s)
- S Palit
- Academic Surgical Unit (GI Physiology Unit), Centre of Digestive Diseases, Blizard Institute, Queen Mary University London, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK
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Carrington EV, Brokjaer A, Craven H, Zarate N, Horrocks EJ, Palit S, Jackson W, Duthie GS, Knowles CH, Lunniss PJ, Scott SM. Traditional measures of normal anal sphincter function using high-resolution anorectal manometry (HRAM) in 115 healthy volunteers. Neurogastroenterol Motil 2014; 26:625-35. [PMID: 24628873 DOI: 10.1111/nmo.12307] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/23/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND High-resolution anorectal manometry (HRAM) is a relatively new method for collection and interpretation of data relevant to sphincteric function, and for the first time allows a global appreciation of the anorectum as a functional unit. Historically, traditional anal manometry has been plagued by lack of standardization and healthy volunteer data of variable quality. The aims of this study were: (i) to obtain normative data sets for traditional measures of anorectal function using HRAM in healthy subjects and; (ii) to qualitatively describe novel physiological phenomena, which may be of future relevance when this method is applied to patients. METHODS 115 healthy subjects (96 female) underwent HRAM using a 10 channel, 12F solid-state catheter. Measurements were performed during rest, squeeze, cough, and simulated defecation (push). Data were displayed as color contour plots and analysed using a commercially available manometric system (Solar GI HRM v9.1, Medical Measurement Systems). Associations between age, gender and parity were subsequently explored. KEY RESULTS HRAM color contour plots provided clear delineation of the high-pressure zone within the anal canal and showed recruitment during maneuvers that altered intra-anal pressures. Automated analysis produced quantitative data, which have been presented on the basis of gender and parity due to the effect of these covariates on some sphincter functions. In line with traditional manometry, some age and gender differences were seen. Males had a greater functional anal canal length and anal pressures during the cough maneuver. Parity in females was associated with reduced squeeze increments. CONCLUSIONS & INFERENCES The study provides a large healthy volunteer dataset and parameters of traditional measures of anorectal function. A number of novel phenomena are appreciated, the significance of which will require further analysis and comparisons with patient populations.
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Affiliation(s)
- E V Carrington
- GI Physiology Unit, The Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, London, UK; National Centre for Bowel Research and Surgical Innovation (NCRBSI), Barts and the London School of Medicine and Dentistry, London, UK
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Thin NN, Horrocks EJ, Hotouras A, Palit S, Thaha MA, Chan CLH, Matzel KE, Knowles CH. Systematic review of the clinical effectiveness of neuromodulation in the treatment of faecal incontinence. Br J Surg 2013; 100:1430-47. [PMID: 24037562 DOI: 10.1002/bjs.9226] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Over the past 18 years neuromodulation therapies have gained support as treatments for faecal incontinence (FI); sacral nerve stimulation (SNS) is the most established of these. A systematic review was performed of current evidence regarding the clinical effectiveness of neuromodulation treatments for FI. METHODS The review adhered to the PRISMA framework. A comprehensive search of the literature included PubMed, MEDLINE, Embase and Evidence-Based Medicine Reviews. Methodological quality assessment and data extraction were completed in a systematic fashion. RESULTS For SNS, 321 citations were identified initially, of which 61 studies were eligible for inclusion. Of studies on other neuromodulation techniques, 11 were eligible for review: seven on percutaneous tibial nerve stimulation (PTNS) and four on transcutaneous tibial nerve stimulation (TTNS). On intention-to-treat, the median (range) success rates for SNS were 63 (33-66), 58 (52-81) and 54 (50-58) per cent in the short, medium and long terms respectively. The success rate for PTNS was 59 per cent at the longest reported follow-up of 12 months. SNS, PTNS and TTNS techniques also resulted in improvements in Cleveland Clinic Incontinence Score and quality-of-life measures. Despite significant use of neuromodulation in treatment of FI, there is still no consensus on outcome reporting in terms of measures used, aetiologies assessed, length of follow-up or assessment standards. CONCLUSION Emerging data for SNS suggest maintenance of its initial therapeutic effect into the long term. The clinical effectiveness of PTNS is comparable to that of SNS at 12 months, although there is no evidence to support its continued effectiveness after this period. PTNS may be a useful treatment before SNS. The clinical effectiveness of TTNS is still uncertain owing to the paucity of available evidence. A consensus to standardize the use of outcome measures is recommended in order that further reports can be compared meaningfully.
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Affiliation(s)
- N N Thin
- National Centre for Bowel Research and Surgical Innovation, London, UK
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Abstract
The resonant elements that grant metamaterials their distinct properties have the fundamental limitation of restricting their useable frequency bandwidth. The development of frequency-agile metamaterials has helped to alleviate these bandwidth restrictions by allowing real-time tuning of the metamaterial frequency response. We demonstrate electrically controlled persistent frequency tuning of a metamaterial, which allows the lasting modification of its response by using a transient stimulus. This work demonstrates a form of memory capacitance that interfaces metamaterials with a class of devices known collectively as memory devices.
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Affiliation(s)
- T Driscoll
- Department of Physics, University of California at San Diego (UCSD), La Jolla, CA 92093, USA.
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Jokerst NM, Palit S, Royal M, Dhar S, Brooke M, Tyler T. Progress in chip-scale photonic sensing. IEEE Trans Biomed Circuits Syst 2009; 3:202-11. [PMID: 23853241 DOI: 10.1109/tbcas.2009.2020693] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Chip-scale integrated planar photonic sensing systems for portable diagnostics and monitoring are emerging, as photonic components are integrated into systems with silicon (Si), Si complementary metal-oxide semiconductor, and fluidics. This paper reviews progress in these areas. Medical and environmental applications, candidate photonic sensors, integration methodologies, integrated subsystem demonstrations, and challenges facing this emerging field are discussed in this paper.
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Abstract
AIM Significant side effects of tocolytic and uterotonic substances may be of concern to the anaesthesiologist. Recently, new drugs have been introduced having less side effects for both the mother and the neonate. METHODS A literature search was undertaken mainly focusing on meta-analyses, to review the possible side effects that might affect the course of anaesthesia and to suggest which precautions should be considered to prevent the occurrence of significant interactions with anaesthetic manipulations and drugs. RESULTS Magnesium sulphate has a proven benefit in lowering systolic blood pressure and preventing the occurrence of eclampsia, but not as a tocolytic. beta-adrenergic agonists are being abandoned due to the availability of tocolytic agents causing less side effects. Calcium channel blockers (CCB) are frequently used but can cause major maternal cardiovascular complications. Nitroglycerin seems to be appreciated as an acute tocolytic rather than a routine substance during pre-term labour. Cyclo-oxygenase-2 inhibitors are still under investigation but their tocolytic benefit is questionable mainly due to foetal side effects. Atosiban is considered the first-choice tocolytic. With respect to oxytocic drugs, oxytocine, prostaglandines and methylergometrine may all cause serious side effects especially when combined. The cardiovascular side effects of prostaglandins and methylergometrine can be life-threatening. Both oxytocin and carbetocin have a rather low risk for maternal complications. CONCLUSION Atosiban and CCB are at least as effective tocolytic agents as beta-mimetics but have significantly less side effects. Magnesium sulphate can cause neuromuscular blockade, especially when combined with CCB. Concerning oxytocic agents, short-acting oxyctocin and long-acting carbetocin have the least side effects as compared with prostaglandins and methylergometrine.
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Affiliation(s)
- M Vercauteren
- Department of Anaesthesia, Antwerp University and University Hospital, Antwerp, Belgium.
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Palit S, Williams A, Rhudy J, Russell J, Bartley E, Chandler M, Kerr K, McCabe K. Further validation of the Emotional Controls (ECON) paradigm: what types of emotional picture contents best modulate pain and nociception? The Journal of Pain 2009. [DOI: 10.1016/j.jpain.2009.01.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Palit S, Palit G, Vercauteren M, Jacquemyn Y. Regional anaesthesia for primary caesarean section in patients with preterm HELLP syndrome: a review of 102 cases. CLIN EXP OBSTET GYN 2009; 36:230-234. [PMID: 20101854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To determine the feasibility and the safety of combined spinal/epidural and spinal anaesthetic techniques for primary caesarean section in case of preterm HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. METHODS A retrospective study was carried out in a tertiary centre including all patients who underwent primary caesarean section for HELLP syndrome. The immediate preoperative and the lowest thrombocyte count, the method of anaesthesia and eventual complications were recorded. Patients were categorised as having antepartum or postpartum HELLP syndrome. RESULTS A total number of 102 charts was reviewed. Mean gestational age was 30.6 weeks (SD 2.7, range 23-36 weeks). There were seven (6.9%) patients with postpartum HELLP and 95 with antepartum HELLP. In case of antepartum HELLP in 37 (36.3%) general anaesthesia was selected; in 53 (52.0%) combined spinal epidural anaesthesia and in 12 (11.8%) single dose spinal anaesthesia. Preoperative thrombocyte count was significantly higher (p < 0.01) in the combined spinal epidural group (113,000/mm3) while there was no difference between general (88,000/mm3) and spinal anaesthesia (95,000/mm3). There were no cases of epidural haematoma. Two patients received a combined spinal epidural although their immediate preoperative thrombocyte count was < 50,000/mm3. CONCLUSIONS Our data demonstrate that combined spinal/epidural is feasible and safe in selected cases of HELLP syndrome.
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Affiliation(s)
- S Palit
- Department of Anaesthesiology, Antwerp University Hospital, UZA, Edegem, Belgium
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Palit S, Palit G, Vercauteren M, Jacquemyn Y. 58. The Choice of Anaesthetic Technique for C-Section in Patients With HELLP Syndrome: A Retrospective Analysis. Reg Anesth Pain Med 2008. [DOI: 10.1136/rapm-00115550-200809001-00234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hallmark B, Darton N, Han X, Palit S, Mackley M, Slater N. Observation and modelling of capillary flow occlusion resulting from the capture of superparamagnetic nanoparticles in a magnetic field. Chem Eng Sci 2008. [DOI: 10.1016/j.ces.2008.04.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dey G, Palit S, Banerjee R, Maiti BR. Purification and characterization of maltooligosaccharide-forming amylase from Bacillus circulans GRS 313. J Ind Microbiol Biotechnol 2002; 28:193-200. [PMID: 11986918 DOI: 10.1038/sj/jim/7000220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2000] [Accepted: 10/22/2001] [Indexed: 11/08/2022]
Abstract
A maltooligosaccharide-forming amylase that hydrolyzes starch into maltotriose and maltopentaose was found in the culture filtrate of a strain of Bacillus circulans GRS 313 isolated from local soil. The enzyme was purified by organic solvent fractionation, Sephadex G-100 gel filtration and CM-Sephadex column chromatography. Optimum pH and temperature of amylase were evaluated using response surface methodology (RSM) and were found to be 48 degrees C and 4.9, respectively. The enzyme was stable up to 60 degrees C and its pH stability was in the range of 5.0-8.0. The Km and Vmax of the amylase with starch were 11.66 mg/ml and 68.97 U, respectively, and the energy of activation, Ea, was 7.52 kcal/mol. Dextrin inhibited the enzyme competitively, with a Ki of 6.1 mg/ml, and glucose caused noncompetitive inhibition with a Ki of 9.5 mg/ml. The enzyme was inhibited by Hg2+, Mn2+, Fe3+ and Cu2+ and enhanced by Co2+ and Mg2+. EDTA reversed the inhibitory effect of the metals. Paper chromatographic and high-performance liquid chromatography analysis of the products of the amylolytic reaction showed the presence of maltotriose, maltotetraose, maltopentaose, maltose and glucose in the starch hydrolysate.
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Affiliation(s)
- G Dey
- Microbial Biotechnology and Downstream Processing Laboratory, Agricultural and Food Engineering Department, IIT-Kharagpur 721302, India
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Chowdhury AN, Sanyal D, Bhattacharya A, Dutta SK, De R, Banerjee S, Bhattacharya K, Palit S, Bhattacharya P, Mondal RK, Weiss MG. Prominence of symptoms and level of stigma among depressed patients in Calcutta. J Indian Med Assoc 2001; 99:20-3. [PMID: 11480952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A pilot study of 29 patients for research on clinical depression employed the framework of cultural epidemiology to examine illness-related experience, meaning, behaviour with a Bengali version of the explanatory Model Interview Catalogue (EMIC). This report examined patterns of distress and stigma with reference to the most troubling patient-specified symptom. All subjects were psychiatric outpatients in the Institute of Psychiatry, Calcutta, and met Diagnostic and Statistical Manual (DSM)-IV criteria for a major depressive episode. Only 5 patients (17.2%) identified sadness as the most troubling problem, and 48.3% specified pains and other somatic symptoms instead. An internally consistent stigma scale with Cronbach's alpha of .67, comprised 13 items, was used to assess stigma. In addition to the scale score for each subject, the contribution of each item was reported and compared. A suggestive, though not significantly lower value of the stigma score for patients reporting somatic symptoms as most troubling, compared with sadness, was consistent with findings from prior studies showing a positive relationship between the magnitude of depression and stigma. These findings are discussed with reference to their impact on recognition and help seeking among patients, and recognition and management of depression by general practitioner. Culturally distinctive presentations and social contexts of depression and other mental illnesses should be addressed in professional training and public health communications.
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Affiliation(s)
- A N Chowdhury
- Department of Psychiatry, Institute of Postgraduate Medical Education and Research, Calcutta
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Abstract
The extraction of fetal electrocardiogram (ECG) from the composite maternal ECG signal obtained from the abdominal lead is discussed. The proposed method employs singular value decomposition (SVD) and analysis based on the singular value ratio (SVR) spectrum. The maternal ECG (M-ECG) and the fetal ECG (F-ECG) components are identified in terms of the SV-decomposed modes of the appropriately configured data matrices, and elimination of the M-ECG and determination of F-ECG are achieved through selective separation of the SV-decomposed components. The unique feature of the method is that only one composite maternal ECG signal is required to determine the F-ECG component. The method is numerically robust and computationally efficient.
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Affiliation(s)
- P P Kanjilal
- Department of Electronics and ECE, Indian Institute of Technology, Kharagpur, India.
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De M, Ghosh S, Palit S, Ghosh A, Talukder G, Sharma A. Clastogenic effects in human samples following prolonged exposure in metal industry. Bull Environ Contam Toxicol 1995; 54:357-362. [PMID: 7749266 DOI: 10.1007/bf00195105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- M De
- Department of Botany, University of Calcutta, India
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Abstract
The effects of cobaltous chloride in inducing chromosomal aberrations were observed on laboratory bred mice in vivo after single oral administration of different fractions (1/10, 1/20, 1/40) of the lethal toxic dose of the salt. Bone marrow cells were flushed out and processed for chromosome studies following colchicine, hypotonic, giemsa, air drying procedure. The parameters screened were chromosomal aberrations, with and without gaps and break per cell. Slides were screened after the expiry of 6, 12, 18, and 24 h. Statistical analysis indicated the clastogenic effects of the salt. The degree of chromosome damage was directly related to the concentration, and also to the period after administration. The different stages of the cell cycle were affected.
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Affiliation(s)
- S Palit
- Human Genetics Unit, University of Calcutta, India
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Ghosh AK, Sen S, Palit S, Ghosh A, Sharma A, Talukder G. Comparative efficacy of chlorophyllin in reducing cytotoxicity of some heavy metals. Biol Met 1991; 4:158-61. [PMID: 1931434 DOI: 10.1007/bf01141307] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The potential of chlorophyllin in reducing clastogenicity was studied against two concentrations of each of three potent metallic clastogens (cesium chloride, mercuric chloride and cobalt chloride) in bone marrow cells of mice in vivo. The respective salts and chlorophyllin were administered orally to mice by gavaging in different combinations. Simultaneous administration of chlorophyllin with both concentrations of each salt reduced the clastogenic effects in the order Cs greater than Hg greater than Co. Chlorophyllin could not decrease the clastogenic effects when administered 2 h before the salts.
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Affiliation(s)
- A K Ghosh
- Department of Botany, Calcutta University, India
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Palit S, Ghosh AK, Sharma A, Talukder G. MODIFICATION OF THE CLASTOGENIC EFFECTS OF COBALT BY CALCIUM IN BONE MARROW CELLS OF MICE IN VIVO. CYTOLOGIA 1991; 56:373-377. [PMID: 30260327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/31/1992] [Indexed: 06/08/2023]
Abstract
THE INTERACTION BETWEEN COBALTOUS CHLORIDE AND CALCIUM CHLORIDE WAS OBSERVED USING AS ENDPOINTS MITOTIC INDEX AND FREQUENCY OF CHROMOSOMAL ABNORMALITIES. THE TWO SALTS WERE ADMINISTERED ORALLY TO LABORATORY-BRED MALE MICE IN VIVO SINGLY OR ONE FOLLOWED BY THE OTHER OR BOTH SIMULTANEOUSLY. CHROMOSOMES WERE STUDIED FROM BONE MARROW PREPARATIONS AFTER 24 HR. IN ALL CASES, THE ADMINISTRATION OF CACL2 TWO HOURS BEFORE COCL2 PROTECTED AGAINST THE CLASTOGENIC EFFECTS OF THE LATTER TO A SIGNIFICANT EXTENT. SIMULTANEOUS FEEDING OF THE TWO SALTS REDUCED THE DAMAGE BY COCL2 ONLY WHEN CACL2 WAS GIVEN IN A HIGHER CONCENTRATION. THE REDUCTION OF CLASTOGENICITY OF CATIONIC COBALT BY CALCIUM HAS BEEN ATTRIBITED TO THE COMPETITION BETWEEN THE TWO IONS. THIS REPORT OF THE USE OF CA(2+) IN REDUCING THE CLASTOGENICITY OF CO(2+) IS A NEW ONE.
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Affiliation(s)
- S Palit
- GENETIC TOXICOLOGY UNIT, CENTRE FOR ADVANCED STUDY IN CELL AND CHROMOSOME RESEARCH, DEPARTMENT OF BOTANY, UNIVERSITY OF CALCUTTA, CALCUTTA, INDIA
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Palit S, Dutta R, Sarkar G, Dube DK, Manna P, Chaudhuri RK. Nucleic acid synthesis by isolated plant nuclei. Indian J Biochem Biophys 1982; 19:91-4. [PMID: 6182093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
Nitrofurantoin (1-([(5-nitrofuran-2-yl)methylene]amino)imidazolidine-2,4-dione), a widely used drug and also a well-known bacterial mutagen, inhibits DNA synthesis in mitochondria from 48 h etiolated seedlings of Vigna sinensis (Linn.) Savi (snake bean). The effect appears at the level of the uptake of radioactive deoxynucleoside triphosphates by the plant mitochondria. Nitrofurantoin does not inhibit DNA synthesis in vitro by homogeneous Escherichia coli DNA polymerase I and DNA polymerase from avian-myeloblastosis virus. No specific nitroreductase activity could be detected in mitochondria.
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