Critical Evaluation of Secondary Cancer Risk After Breast Radiation Therapy with Hybrid Radiotherapy Techniques

Background

As hybrid radiotherapy technique can effectively balance dose distribution between targets and organs, it is necessary to evaluate the late effects related to radiotherapy. The aim of the study was to calculate and provide individual estimates of the risks for hybrid radiotherapy techniques in breast cancer patients.

Methods

Whole-breast irradiation was performed in 43 breast cancer patients by using 3D conformal, intensity-modulated and hybrid techniques. The excess absolute risk (EAR), lifetime attributable risk (LAR) and normal tissue complication probability (NTCP) were calculated to estimate risks in organs. The risk variability in contralateral breast was assessed by using the patient's anatomic parameters.

Results

Compared with IMRT and FinF, hybrid techniques achieved satisfactory dose distribution and comparable or lower estimated risks in organs. The LAR was estimated to be up to 0.549% for contralateral lung with advantages of tangential techniques over H-VMAT. For ipsilateral lung, the LAR was estimated to be up to 9.021%, but lower in H-VMAT and FinF without significant difference. The risk of thyroid was negligible in overall estimation. For contralateral breast, the LAR was estimated to be up to 0.865% with advantages of MH-IMRT and H-VMAT over TF-IMRT. The fraction of individual variability could be explained by using anatomic parameters of minimum breast distance (MBD) and minimum target concave angle (θ_MTCA). NTCP for all analyzed endpoints was significantly higher in TF-IMRT relative to FinF and hybrid techniques, while TH-IMRT and H-VMAT were presenting lower toxicity risk. However, MH-IMRT presented a higher probability of toxicity in lung. For most cases, H-VMAT demonstrated a benefit for contralateral breast, heart and lung sparing.

Conclusion

The optimal treatment should be performed individually according to anatomic parameters and balances between EAR and NTCP. Individual assessment may assist in achieving optimal balances between targets and organs as well as supporting clinical decision-making processes.

The use of Hybrid Techniques in Whole-Breast Radiotherapy: A Systematic Review

Objectives The development of new techniques in radiotherapy (RT) provides a better planned target volume (PTV) dose distribution while further improving the protection of organs at risk (OARs). The study aims to present the dosimetric results of studies using hybrid techniques in whole-breast radiotherapy (WBRT). Methods: This systematic literature review was conducted by scanning the relevant literature in PubMed, Scopus, and Web of Science following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Among the parameters are dose values for PTV and OARs beam contribute ratios, the value of monitors, and treatment times for different RT techniques. Initially, 586 articles were identified; 196 duplicate articles were removed leaving 391 articles for screening. Three-hundred and thirty-seven irrelevant articles were excluded, leaving 54 studies assessed for eligibility. A total of 22 articles met the search criteria to evaluate dosimetric results of hybrid and other RT techniques in WBRT. Results: According to the dosimetric data of the studies, hybrid intensity-modulated RT (H-IMRT) and hybrid volumetric-modulated arc therapy (H-VMAT) techniques give dosimetrically advantageous results in WBRT compared to other RT techniques. Conclusion: Hybrid techniques using appropriate beams contribute value and show great promise in improving dosimetric results in WBRT. However, there is a need for new studies showing the long-term clinical results of hybrid RT.

Current Challenges for Biological Treatment of Pharmaceutical-Based Contaminants with Oxidoreductase Enzymes: Immobilization Processes, Real Aqueous Matrices and Hybrid Techniques

The worldwide access to pharmaceuticals and their continuous release into the environment have raised a serious global concern. Pharmaceuticals remain active even at low concentrations, therefore their occurrence in waterbodies may lead to successive deterioration of water quality with adverse impacts on the ecosystem and human health. To address this challenge, there is currently an evolving trend toward the search for effective methods to ensure efficient purification of both drinking water and wastewater. Biocatalytic transformation of pharmaceuticals using oxidoreductase enzymes, such as peroxidase and laccase, is a promising environmentally friendly solution for water treatment, where fungal species have been used as preferred producers due to their ligninolytic enzymatic systems. Enzyme-catalyzed degradation can transform micropollutants into more bioavailable or even innocuous products. Enzyme immobilization on a carrier generally increases its stability and catalytic performance, allowing its reuse, being a promising approach to ensure applicability to an industrial scale process. Moreover, coupling biocatalytic processes to other treatment technologies have been revealed to be an effective approach to achieve the complete removal of pharmaceuticals. This review updates the state-of-the-art of the application of oxidoreductases enzymes, namely laccase, to degrade pharmaceuticals from spiked water and real wastewater. Moreover, the advances concerning the techniques used for enzyme immobilization, the operation in bioreactors, the use of redox mediators, the application of hybrid techniques, as well as the discussion of transformation mechanisms and ending toxicity, are addressed.

Hybrid and Deep Learning Approach for Early Diagnosis of Lower Gastrointestinal Diseases

Every year, nearly two million people die as a result of gastrointestinal (GI) disorders. Lower gastrointestinal tract tumors are one of the leading causes of death worldwide. Thus, early detection of the type of tumor is of great importance in the survival of patients. Additionally, removing benign tumors in their early stages has more risks than benefits. Video endoscopy technology is essential for imaging the GI tract and identifying disorders such as bleeding, ulcers, polyps, and malignant tumors. Videography generates 5000 frames, which require extensive analysis and take a long time to follow all frames. Thus, artificial intelligence techniques, which have a higher ability to diagnose and assist physicians in making accurate diagnostic decisions, solve these challenges. In this study, many multi-methodologies were developed, where the work was divided into four proposed systems; each system has more than one diagnostic method. The first proposed system utilizes artificial neural networks (ANN) and feed-forward neural networks (FFNN) algorithms based on extracting hybrid features by three algorithms: local binary pattern (LBP), gray level co-occurrence matrix (GLCM), and fuzzy color histogram (FCH) algorithms. The second proposed system uses pre-trained CNN models which are the GoogLeNet and AlexNet based on the extraction of deep feature maps and their classification with high accuracy. The third proposed method uses hybrid techniques consisting of two blocks: the first block of CNN models (GoogLeNet and AlexNet) to extract feature maps; the second block is the support vector machine (SVM) algorithm for classifying deep feature maps. The fourth proposed system uses ANN and FFNN based on the hybrid features between CNN models (GoogLeNet and AlexNet) and LBP, GLCM and FCH algorithms. All the proposed systems achieved superior results in diagnosing endoscopic images for the early detection of lower gastrointestinal diseases. All systems produced promising results; the FFNN classifier based on the hybrid features extracted by GoogLeNet, LBP, GLCM and FCH achieved an accuracy of 99.3%, precision of 99.2%, sensitivity of 99%, specificity of 100%, and AUC of 99.87%.

Complex aortaaneurysmák kezelési lehetőségei - saját tapasztalatok

Összefoglaló. Complex aortaaneurysmáról beszélünk, ha az több, egymástól anatómiailag nem elválasztható aortaszegmentumra terjed, és/vagy az aneurysma egy vagy több életfontosságú mellékág szájadékát is magában foglalja. Kettős vagy többszörös aortaaneurysmák egymástól sebészileg jól szeparálható elváltozásokat jelentenek. Míg a complex elváltozások egy ülésben vagy időben, egymást néhány nappal követő beavatkozással kezelendők, addig a kettős/többszörös aneurysmák szeparált megoldásokkal uralhatók. E kiterjedt elváltozások kezelése jelentős javallati és technikai kihívásokkal társul. A kezelési lehetőségek széles spektrumával rendelkezünk. Korábban a nagy sebészi traumával, jelentős morbiditással és mortalitással járó nyitott műtétek nagy rizikóval terhelt betegeken siker reményében nem voltak elvégezhetők. Napjainkban a sebészi és endograft technikákkal végzett hybrid műtétek, illetve a tisztán endovascularis megoldások a kiterjedt elváltozások kezelésének javallatát jelentősen kiszélesítették. Dolgozatunkban ismertetjük a lehetséges, és az általunk már alkalmazott technikákat, valamint azokat a lehetőségeket, amelyeket a rohamos technikai fejlődés kínál. Summary. Complex aortic aneurysms extend to more aortic segments, and/or include one or more orifices of highly important side branches. Meanwhile complex aneurysms need reconstructive solutions in one sitting or hybrid procedures timely close to each other, multiple aneurysms can be treated technically and timely separated. Previously, open surgery was the only opportunity to intervene, which was associated with significant surgical trauma and was not suitable for high risk patients when devastating complications were likely. Recently combination of lower risk surgery with endovascular treatment options - the so called hybrid techniques - resulted in that indications for treatment remarkably widened. In addition, permanent technical progress made available pure endovascuar solutions, so a wide range of surgical procedures provide number of options for treatment. In this paper we report on the treatment options of complex aortic aneurysms, and present our own relevant experience.

[Treatment of a patient with Crawford type III thoracoabdominal aortic aneurysm]

Presented herein is a clinical case report regarding hybrid techniques successfully used in a patient suffering from a Crawford type III thoracoabdominal aortic aneurysm and DeBakey type IIIB aortic dissection. The first stage consisted in endoprosthetic reconstruction of the descending portion of the thoracic aorta, with the second stage including visceral debranching with endoprosthetic reconstruction of the thoracoabdominal portion of the aorta. As the final stage, the patient was subjected to debranching of brachiocephalic arteries, followed by endoprosthetic repair of the aortic arch. The chosen approach made it possible to avoid the use of extracorporeal circulation, aortic occlusion, and, consequently, prolonged postoperative recovery.

Hybrid: Evolving techniques in laparoscopic ventral hernia mesh repair

Introduction

Laparoscopic repair is now the treatment of choice for most cases of ventral/incisional hernia. Although the technique has undergone many refinements, there is no standard technique for difficult or complicated hernias.

Aim

The aim of this study was to show the different innovative methods used to treat difficult ventral hernia through hybrid techniques.

Materials and Methods

A total of 75 (n = 75) patients underwent Laparoscopic Ventral Hernia Hybrid Mesh Repair (LVHHMR) by our surgical unit between January 2014 and December 2016. Three different techniques of repairing the defects were used. Mesh fixation time, post-operative pain score (visual analogue score) and follow-up for pain and recurrence (at 6 months, 12 months and 24 months) were recorded and analysed.

Results

Out of 75 patients (20 men and 55 women), the median age was 45 years and body mass index of the patients was 25-35. Types of hernias operated were paraumbilical hernias, incisional and recurrent hernias. The techniques used were (1) laparoscopic adhesiolysis, open sac excision with closure of defect and laparoscopic mesh placement, (2) laparoscopic adhesiolysis, omphalectomy with closure of defect and laparoscopic mesh placement and (3) open adhesiolysis, sac excision with closure of defect and laparoscopic mesh placement. Five patients required analgesics for 48 h. No patients complained of pain at follow-ups (1 month, 6 months, 12 months and 24 months). Mean hospital stay postoperatively was 2-3 days.

Conclusion

LVHHMR is safe and feasible approach for complicated/difficult ventral hernias. However, further larger studies are required to establish these methods as gold standard.

Hybrid Analytical Platform Based on Field-Asymmetric Ion Mobility Spectrometry, Infrared Sensing, and Luminescence-Based Oxygen Sensing for Exhaled Breath Analysis

The reliable online analysis of volatile compounds in exhaled breath remains a challenge, as a plethora of molecules occur in different concentration ranges (i.e., ppt to %) and need to be detected against an extremely complex background matrix. Although this complexity is commonly addressed by hyphenating a specific analytical technique with appropriate preconcentration and/or preseparation strategies prior to detection, we herein propose the combination of three different detector types based on truly orthogonal measurement principles as an alternative solution: Field-asymmetric ion mobility spectrometry (FAIMS), Fourier-transform infrared (FTIR) spectroscopy-based sensors utilizing substrate-integrated hollow waveguides (iHWG), and luminescence sensing (LS). By carefully aligning the experimental needs and measurement protocols of all three methods, they were successfully integrated into a single compact analytical platform suitable for online measurements. The analytical performance of this prototype system was tested via artificial breath samples containing nitrogen (N₂), oxygen (O₂), carbon dioxide (CO₂), and acetone as a model volatile organic compound (VOC) commonly present in breath. All three target analytes could be detected within their respectively breath-relevant concentration range, i.e., CO₂ and O₂ at 3-5 % and at ~19.6 %, respectively, while acetone could be detected with LOQs as low as 165-405 ppt. Orthogonality of the three methods operating in concert was clearly proven, which is essential to cover a possibly wide range of detectable analytes. Finally, the remaining challenges toward the implementation of the developed hybrid FAIMS-FTIR-LS system for exhaled breath analysis for metabolic studies in small animal intensive care units are discussed.

Pulmonary Regurgitation- Is the Future Percutaneous or Surgical?

For decades, surgical replacement of the pulmonary valve has been seen as the gold-standard technique. Until the advent of Medtronic's Melody valve, it was the only option. Whilst radical changes in surgical techniques have not been forthcoming, rapid and substantial developments in the techniques and available technology for percutaneous valves now cause us to ask if the gold-standard moniker now belongs in the cath lab. This manuscript explores the recent history and future of a revolution in this large area of congenital cardiac practice.

Fast hybrid multi-dimensional NMR methods based on ultrafast 2D NMR

Conventional multi-dimensional (nD) NMR experiments are characterized by inherent long acquisition durations, while ultrafast (UF) NMR makes it possible to reduce to a few hundreds of milliseconds the overall acquisition duration of a complete nD NMR dataset. Although extremely promising for a number of specific applications, the UF strategy suffers from significant limitations compared with its conventional counterpart. The main limitations concern the sensitivity, the resolution, and the accessible spectral width. However, when the targeted applications are compatible with an acquisition duration between a few seconds and a few minutes, hybrid UF techniques can be used to improve the performance of UF nD NMR while remaining faster than conventional acquisitions. Much better results in terms of signal-to-noise ratio can be achieved with the multi-scan single-shot approach or with interleaved acquisitions. Even more, for the same experimental duration, and in the case of homonuclear 2D NMR, the multi-scan single-shot approach has a much higher precision than conventional 2D NMR. Interleaved 2D NMR overcomes the drawbacks of single-scan UF NMR in terms of spectral width and provides spectra for which the quality is not significantly different from that obtained with conventional 2D NMR. Finally, high spectral qualities have been demonstrated from hybrid conventional/UF 3D approaches capable of recording a whole 3D spectrum in the time needed to record a conventional 2D spectrum. This mini-review aims at describing the principles, the recent advances and the latest applications of these hybrid techniques. Copyright © 2015 John Wiley & Sons, Ltd.