Assessment of clinically relevant dose distributions in pelvic IOERT using Gafchromic EBT3 films

PurposeIn IOERT a single dose of radiation is delivered to the tumour site during surgery. Manual dose calculations are used and the irradiation target volume, electron energy and applicator are decided on site by the radiation oncologist. This work assesses the effect that irregular and curved surfaces, typical of pelvic IOERT, may have on the expected dose distribution.MethodsThe feasibility of using Gafchromic EBT3 films and a slab phantom to obtain 2D dose distributions was investigated. Different set-ups were tested by comparison with water tank measurements, applying the gamma function analysis with 2% and 2 mm criteria. The validated set-up was then used to obtain reference dose distributions, which were converted to colour-coded graphical representations. Phantoms with step-like and curved surfaces were created to simulate typical pelvic IOERT irradiation surfaces, and the dose distributions were obtained and compared with the reference distributions.ResultsGood agreement with water tank measurements was obtained for all applicators below 2 mm, using the chosen setup in reference conditions. In non-reference conditions, the presence of a step-like surface creates an adjacent hotspot, followed by a quick reduction of the dose in depth. With curved surfaces, the dose distribution is shifted forward, becoming curved and deeper, but when the applicator is larger than the hole, hotspots are also observed.ConclusionsThe shape of the irradiation surfaces alters the dose distribution. Visualization of these effects is important to assess target coverage and interpret in vivo measurements in pelvic IOERT.     

Endometrial mesenchymal stem cells as a cell based therapy for pelvic organ prolapse

Pelvic organ prolapse(POP) occurs when the pelvic organs(bladder, bowel or uterus) herniate into the vagina, causing incontinence, voiding, bowel and sexual dysfunction, negatively impacting upon a woman's quality of life. POP affects 25% of all women and results from childbirth injury. For 19% of all women, surgical reconstructive surgery is required for treatment, often augmented with surgical mesh. The surgical treatment fails in up to 30% of cases or results in adverse effects, such as pain and mesh erosion into the bladder, bowel or vagina. Due to these complications the Food and Drug Administration cautioned against the use of vaginal mesh and several major brands have been recently been withdrawn from market. In this review we will discuss new cell-based approaches being developed for the treatment of POP. Several cell types have been investigated in animal models, including a new source of mesenchymal stem/stromal cells(MSC) derived from human endometrium. The unique characteristics of endometrial MSC, methods for their isolation and purification and steps towards their development for good manufacturing practice production will be described. Animal models that could be used to examine the potential for this approach will also be discussed as will a rodent model showing promise in developing an endometrial MSC-based therapy for POP. The development of a preclinical large animal model for assessing tissue engineering constructs for treating POP will also be mentioned.     

Reduction of forest floor respiration by fertilization on both carbon dioxide-enriched and reference 17-year-old loblolly pine stands

Elevated atmospheric carbon dioxide (CO₂^e) increases soil respiration rates in forest, grassland, agricultural and wetland systems as a result of increased growth, root biomass and enhanced biological activity of soil microorganisms. Less is known about how forest floor fluxes respond to the combined effects of elevated CO₂ and nutrient amendments; until now no experiments have been in place with large forest trees to allow even preliminary investigations. We investigated changes in forest floor respiration (S_ff) in a Pinus taeda L. plantation fumigated with CO₂ by using free‐air CO₂ enrichment (FACE) technology and given nutrient amendments. The prototype FACE apparatus (FACEp; 707 m²) was constructed in 1993, 10 years after planting, on a moderate fertility site in Duke Forest, North Carolina, USA, enriching the stand to 55 Pa (CO₂^e). A nearby ambient CO₂ (CO₂^a) plot (117 m²) was designated at the inception of the study as a reference (Ref). Both FACEp and Ref plot were divided in half and urea fertilizer was applied to one half at an annual rate of 11.2 g N m^?2 in the spring of 1998, 1999 and 2000. Forest floor respiration was monitored continuously for 220 days – March through November 2000 – by using two Automated Carbon Efflux Systems. Thirty locations (491 cm² each) were sampled in both FACEp and Ref, about half in each fertility treatment. Forest floor respiration was strongly correlated with soil temperature at 5 cm. Rates of S_ff were greater in CO₂^e relative to CO₂^a (an enhancement of ～178 g C m^?2) during the measurement period. Application of fertilizer resulted in a statistically significant depression of respiration rates in both the CO₂^a and CO₂^e plots (a reduction of ～186 g C m^?2). The results suggest that closed canopy forests on moderate fertility sites cycle back to the atmosphere more assimilated carbon (C) than similar forests on sites of high fertility. We recognize the limitations of this non‐replicated study, but its clear results offer strong testable hypotheses for future research in this important area.     

Influence of Tree Species on Forest Nitrogen Retention in the Catskill Mountains, New York, USA

This study examines the effect of four tree species on nitrogen (N) retention within forested catchments of the Catskill Mountains, New York (NY). We conducted a 300-day ¹⁵N field tracer experiment to determine how N moves through soil, microbial, and plant pools under different tree species and fertilization regimes. Samples were collected from single-species plots of American beech (Fagus grandifolia Ehrh.), eastern hemlock (Tsuga canadensis L.), red oak (Quercus rubra L.), and sugar maple (Acer saccharum Marsh). Using paired plots we compared the effects of ambient levels of N inputs (11 kg N/ha/y) to additions of 50 kg N/ha/y that began 1.5 years prior to and continued throughout this experiment. Total plot ¹⁵N recovery (litter layer, organic and mineral soil to 12 cm, fine roots, and aboveground biomass) did not vary significantly among tree species, but the distribution of sinks for ¹⁵N within the forest ecosystem did vary. Recovery in the forest floor was significantly lower in sugar maple stands compared to the other species. ¹⁵Nitrogen recovery was 22% lower in the fertilized plots compared to the ambient plots and red oak stands had the largest drop in ¹⁵N recovery as a result of N fertilization. Aboveground biomass became a significantly greater ¹⁵N sink with fertilization, although it retained less than 1% of the tracer addition. These results indicate that different forest types vary in the amount of N retention in the forest floor, and that forest N retention may change depending upon N inputs.     

骨盆骨折患者住院日及预测因子分析

目的:分析上海市某三甲医院创伤中心骨盆骨折患者住院日及其预测因子。方法:抽取上海市第一人民医院南院创伤中心2013年全部62名骨盆骨折住院患者病历,对住院日进行单因素分析、相关分析和有序logistic回归。结果:研究对象中位住院日为19.00天。单因素分析显示受伤原因、骨盆骨折数、患侧和是否输血是住院日的预测因子(P0.05)。相关分析显示手术次数、手术时长、输血量、手术失血、检验次数、CT检查次数和超声检查次数分别与住院日存在相关关系(P0.05)。有序logistic回归表明手术次数、CT检查次数和手术失血量是住院日的独立预测因子(P0.05)。结论:骨盆骨折住院患者平均住院时间长,住院日主要受手术次数、CT检查次数和手术失血量影响,减少不必要的影像学检查和术中出血可缩短住院日。     

生物反馈联合电刺激在女性盆底功能障碍性疾病治疗中的临床应用

目的:分析生物反馈联合电刺激对女性盆底功能障碍性疾病(PFD)的治疗效果。方法:选择2011年1月至2016年3月我院收治的1000例PFD患者为研究对象,按随机数字表法分为实验组和对照组,每组各500例。实验组给予生物反馈联合电刺激,对照组给予功能性电刺激治疗。比较两组治疗前后盆底肌肉肌力分级的变化,测定盆底功能相关指标的改善及患者治疗前后排尿情况。结果:治疗后2组盆底肌力分级均呈明显上升趋势(Z=52.587,37.581;P0.001),且观察组改善效果优于对照组(Z=27.588,P0.001);治疗后实验组盆底肌肉肌力正常率高于对照组,差异有统计学意义(x~2=68.323,P0.05);治疗后实验组最大收缩压、持续收缩压提升幅度较大,膀胱颈移动度明显减小,与对照组各项指标对比差异有统计学意义(P0.05),且治疗后两组排尿情况均有所好转,实验组效果优于对照组(P0.05)。结论:生物反馈联合电刺激对女性PFD具有较好的效果,能提高患者盆底最大收缩压、持续收缩压,减小膀胱颈移动度,改善患者排尿功能。     

A Proposed Set of Ethical Practice Guidelines in the Assessment and Treatment of Pelvic Floor Disorders

The treatment of pelvic floor disorders using biofeedback, behavioral therapies, and other applied psychophysiological treatments has been well documented as effective. Practitioners must take due care to ensure that they practice within the boundaries of what is common practice for their discipline and within the scope of practice allowed by their professional license as outlined by the appropriate state licensing law(s), the ethical principles and practice guidelines and standards for their discipline, and those of the Association of Applied Psychophysiology and Biofeedback if using a biofeedback assessment or treatment. Being competent to provide a particular treatment does not necessarily make it legal and/or ethical. This paper provides a set of recommended practice guidelines for use in the assessment and treatment of pelvic floor disorders. Please note that they have not at this time been endorsed as an official position of the Association of Applied Psychophysiology and Biofeedback or any other professional organization.     

The Imprint of Land-use History: Patterns of Carbon and Nitrogen in Downed Woody Debris at the Harvard Forest

Few data sets have characterized carbon (C) and nitrogen (N) pools in woody debris at sites where other aspects of C and N cycling are studied and histories of land use and disturbance are well documented. We quantified pools of mass, C, and N in fine and coarse woody debris (CWD) in two contrasting stands: a 73-year-old red pine plantation on abandoned agricultural land and a naturally regenerated deciduous forest that has experienced several disturbances in the past 150 years. Masses of downed woody debris amounted to 40.0 Mg ha⁻¹ in the coniferous stand and 26.9 Mg ha⁻¹ in the deciduous forest (20.4 and 13.8 Mg C ha⁻¹, respectively). Concentrations of N were higher and C:N ratios were lower in the deciduous forest compared to the coniferous. Pools of N amounted to 146 kg N ha⁻¹ in the coniferous stand and 155 kg N ha⁻¹ in the deciduous forest; both are larger than previously published pools of N in woody debris of temperate forests. Woody detritus buried in O horizons was minimal in these forests, contrary to previous findings in forests of New England. Differences in the patterns of mass, C, and N in size and decay classes of woody debris were related to stand histories. In the naturally regenerated deciduous forest, detritus was distributed across all size categories, and most CWD mass and N was present in the most advanced decay stages. In the coniferous plantation, nearly all of the CWD mass was present in the smallest size class (less than 25 cm diameter), and a recognizable cohort of decayed stems was evident from the stem-exclusion phase of this even-aged stand. These results indicate that heterogeneities in site histories should be explicitly included when biogeochemical process models are used to scale C and N stocks in woody debris to landscapes and regions. Received 27 April 2001; accepted 4 January 2002.     

The effects of gap disturbance on nitrogen cycling and retention in late-successional northern hardwood–hemlock forests

Late-successional forests in the upper Great Lakes region are susceptible to nitrogen (N) saturation and subsequent nitrate (NO₃⁻) leaching loss. Endemic wind disturbances (i.e., treefall gaps) alter tree uptake and soil N dynamics; and, gaps are particular susceptible to NO₃⁻ leaching loss. Inorganic N was measured throughout two snow-free periods in throughfall, forest floor leachates, and mineral soil leachates in gaps (300–2,000 m², 6–9 years old), gap-edges, and closed forest plots in late-successional northern hardwood, hemlock, and northern hardwood–hemlock stands. Differences in forest water inorganic N among gaps, edges, and closed forest plots were consistent across these cover types: NO₃⁻ inputs in throughfall were significantly greater in undisturbed forest plots compared with gaps and edges; forest floor leachate NO₃⁻ was significantly greater in gaps compared to edges and closed forest plots; and soil leachate NO₃⁻ was significantly greater in gaps compared to the closed forest. Significant differences in forest water ammonium and pH were not detected. Compared to suspected N-saturated forests with high soil NO₃⁻ leaching, undisturbed forest plots in these late-successional forests are not losing NO₃⁻ (net annual gain of 2.8 kg ha⁻¹) and are likely not N-saturated. Net annual NO₃⁻ losses were observed in gaps (1.3 kg ha⁻¹) and gap-edges (0.2 kg ha⁻¹), but we suspect these N leaching losses are a result of decreased plant uptake and increased soil N mineralization associated with disturbance, and not N-saturation.     

Anatomy of the bony pelvis of a relatively large-bodied strepsirrhine primate from the late middle Eocene Pondaung Formation (central Myanmar)

Recent survey of the fossiliferous variegated mudstones of the PK1 locality (Sabapondaung) in the late middle Eocene Pondaung Formation (central Myanmar) has led to the recovery of a partial right innominate of a relatively large-bodied primate. Given its size and provenance, this bone probably belongs to the same individual represented by the NMMP 20 primate partial skeleton described previously from the same locality. The new fossil, which preserves the region around the acetabulum and the adjacent part of the ilium, clearly exhibits strepsirrhine rather than anthropoid affinities. This addition to our knowledge of the NMMP 20 partial skeleton allows us to reassess the different locomotor interpretations that have been proposed for this specimen. Aspects of pelvic morphology suggest that the NMMP 20 partial skeleton documents a primate that probably engaged in active arboreal quadrupedalism similar to that practiced by medium-sized Malagasy lemurids rather than lorislike slow moving and climbing. Given the conflicting phylogenetic signals provided by NMMP 39 (a talus showing anthropoid affinities) and NMMP 20 (a partial skeleton bearing adapiform affinities), it appears that two higher-level taxonomic groups of relatively large-bodied primates are documented in the Pondaung Formation. The recent discovery of two taxa of sivaladapid adapiforms from the Pondaung Formation indicates that the assumption that the NMMP 20 partial skeleton belongs to an amphipithecid can no longer be sustained. Instead, this specimen apparently documents a third large-bodied sivaladapid species in the Pondaung Formation.