bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transmission of cytomegalovirus to extremely preterm infants through breast milk
Authors: Omarsdottir Soley , Casper Charlotte , Zweygberg Wirgart Benita , Grillner Lena , Vanpée Mireille 
Published: April 2008

AbstractAim: To evaluate the rate and clinical expression of postnatal cytomegalovirus (CMV) infection transmitted through breast milk in extremely preterm infants.Methods: Ten extremely preterm infants and their six mothers were included. Maternal CMV serology was determined. Breast milk samples and urine samples from the infants were screened for CMV. Symptoms and laboratory findings of CMV infected infants were documented. All infants received partly fresh and/or defrosted breast milk.Results: CMV‐DNA was found in breast milk in four of five CMV‐seropositive mothers. Two infants were infected by CMV. They were the only infants fed with breast milk positive for viral culture. One infant developed hepatic affection concurrent with viral excretion in urine. This infant was later diagnosed with cystic fibrosis.Conclusion: This study supports that CMV transmission through breast milk can aggravate the clinical course in extremely preterm infants with preexisting hepatic conditions.
Acute and recurrent pancreatitis in children: etiological factors
Authors: Sánchez‐Ramírez Carmen A , Larrosa‐Haro Alfredo , Flores‐Martínez Silvia , Sánchez‐Corona José , Villa‐Gómez Alejandra , Macías‐Rosales Rocío 
Published: April 2008

AbstractObjectives: To describe the clinical picture and outcome, and to assess the etiological factors of acute and recurrent pancreatitis in children.Methods: Thirty‐six (65.5%) patients with acute and 19 (34.5%) with recurrent pancreatitis were studied. Mean age was 126 (41.3 SD) months; 27 (49.1%) were females. Setting: a pediatric referral hospital. Period: 2000–2005. Design: cross‐sectional. Variables: clinical and laboratory data and etiological factors. Statistics: χ2‐test, Fisher test, OR, confidence interval, Student t‐test and Mann–Whitney U‐test.Results: The most frequent symptom in acute and recurrent pancreatitis was abdominal pain, followed by vomiting and ileus. The severity of pancreatitis and complications were similar in both groups. Biliary stones, family history of pancreatitis, drug ingestion and hypercalcemia occurred in both groups. Abdominal trauma and acute hepatitis A occurred in patients with acute pancreatitis; triglyceride >5.65 mmol/L, pancreas divisum and ΔF508 mutation occurred in patients with recurrent pancreatitis. No difference was observed when frequency factors between study groups were compared.Conclusions: The clinical picture and etiological factors were similar in both groups. Since one out of every three children with acute pancreatitis in this series presented recurrences, it was not considered to be a ‘benign disease'. Fifteen different etiological factors were identified in two‐thirds of the cases.
Recurrent abdominal pain in school children: effect of obesity and diet
Authors: Malaty Hoda M. , Abudayyeh Suhaib , Fraley Ken , Graham David Y. , Gilger Mark A. , Hollier David R. 
Published: April 2008

AbstractAims: To study the epidemiology and some of the risk factors of childhood recurrent abdominal pain (RAP) in school age children.Methods: We used a questionnaire concerning socioeconomic parameters, intensity, frequency, duration, nature of RAP and anthropometric measures. We used several criteria to identify RAP and the Wong‐Baker FACES scale for pain intensity and calculated the gender/age‐specific body mass index (BMI) Z‐score using NCHS standards. Obesity was defined as a BMI ≥95th percentile for age and gender.Results: A total of 925 children mean age of 9.5 years completed and returned the questionnaires. The prevalence of RAP was 24%; 22% among boys versus 26% among girls (p = 0.28) and reached its peak among children aged 7–9 (29%) years. Children with BMI ≥95% percentile reported more RAP compared to those not obese (33.3% vs. 22.5%) (OR = 1.8, p = 0.01). There was an inverse correlation between fruit consumption and RAP prevalence with 20% among children reporting more than three serving of fruit per week compared to 40% of those who did not consume any fruits (p < 0.002). Logistic regression analysis confirmed BMI ≥95th percentile and low consumption of fruits are significant risk factors for RAP.Conclusions: There is a significant association between RAP and obesity and both conditions are prevalent among children in this population. Understanding more about the co‐morbidity between RAP and obesity could have important implications on RAP management and treatment.
Practicing Women: The Matter of Women in Medieval English Literature
Authors: Robertson Elizabeth Ann 
Published: April 2008

AbstractThis essay provides a survey of women in medieval English literature through the lens of the various ways matter signifies for an understanding of the representation of women in literature of the period and their identity as authors. The Aristotelian cultural assumption that women are associated with matter rather than form profoundly influences the ways in which women are represented in medieval literary works. That cultural assumption is unsettled by the changing material conditions of women in late medieval England and even further complicated when women become authorial subjects. Finally, textual representations are materially influenced by the increasingly prominent role women play in the production and consumption of texts.
Postmastectomy reconstruction with extended latissimus dorsi myocutaneous flap for Hong Kong Chinese
Authors: Chow Tam‐Lin , Chan Tony Tung‐Fei , Chan Sharon Wing‐Wai , Lam Siu‐Ho 
Published: April 2008

Objective:  Because of the smaller breast size of Chinese women, postmastectomy reconstruction without prosthesis by extended latissimus dorsi (LD) flap is potentially more applicable in the Chinese population.Methods:  Patients who had undergone immediate postmastectomy breast reconstruction by extended latissimus dorsi flap without prosthesis were retrospectively studied. Surgical complications, aesthetic result and patient satisfaction were evaluated.Results:  Ten Asian patients (nine Chinese and one Filipino) underwent extended LD flap for breast reconstruction after mastectomy. There was no total or partial flap failure. Operative complications included seroma in one patient and minor wound edge slough at back wounds in two patients. Simultaneous seroma and minor donor wound slough occurred in another patient. Aesthetic outcome was excellent (n = 5), good (n = 4) and poor (n = 1). Patient satisfaction with the procedure was very satisfied in four, satisfied in four and dissatisfied in two, respectively. All but two patients would recommend the same procedure to their friends or relatives.Conclusion:  Extended LD flap can reliably achieve pleasing results with low morbidity. It has more potential to become a competitive alternative to transverse abdominis myocutaneous flap in most Chinese women for postmastectomy reconstruction.
Recurrence and survival for hepatocellular carcinoma after curative resection: Tertiary centre experience
Authors: Li Wing‐Hong , Cheung Moon‐Tong 
Published: April 2008

Aim:  The aim of the present paper was to determine the pattern of recurrence and prediction for survival after primary curative surgical resection of hepatocellular carcinoma (HCC).Methods:  This was a retrospective single institutional review. During 2002–2005, 197 patients had hepatectomies at Queen Elizabeth Hospital The total number of patients with primary curative liver resection was 113, and 103 patients were included in this survival analysis.Results:  The recurrence rate was 49/103 (47.6%). The operative mortality rate was 4/113 (3.5%). The median time for recurrence was 13.5 months (range, 1–60 months). The mean follow‐up period was 26.03 months (range, 1–60 months).Overall survival was 90%, 72% and 50%, at 1, 3 and 5 years, respectively, and disease‐free survival was 55%, 48% and 42%, at 1, 3 and 5 years, respectively. On univariate analysis, tumour > 10 cm, close (≤ 1 mm)/focally involved/involved resection margin, operative blood loss > 2500 mL, presence of satellite tumour nodules, vascular invasion and poor tumour differentiation were found to be associated with recurrence. On multivariate analysis presence of multiple satellite tumour nodules and presence of vascular invasion predicted poor disease‐free survival whereas vascular invasion was the only predictor for overall survival.Conclusion:  Patients who had curative surgical resection for HCC should be considered for adjuvant therapy when these high‐risk factors are present.
Intrahepatic cholangiocarcinoma: A diagnostic and therapeutic challenge
Authors: Lee Kit‐Fai , Cheung Yue‐Sun , Tsang Yvonne Yee‐Yan , Ng Wilson Wing‐Chi , Wong John , Lai Paul Bo‐San 
Published: April 2008

Objectives:  Intrahepatic cholangiocarcinoma (ICC) is a rare tumor of the liver. The diagnosis and treatment of it are difficult. The present study reviewed the diagnostic pathways and operative results for ICC.Methods:  A retrospective analysis was made of the clinical presentation, diagnostic pathways, and operative results of 20 patients with ICC who underwent hepatectomy from 1997 to 2004 in our institute.Results:  The patients were predominantly female (female : male = 15:5), and ranged in age from 41 to 74 years (median 59.8). Abdominal pain was the main presenting symptom, and hepatomegaly was the commonest physical sign. Diagnosis relied mainly on ultrasound or computed tomography. Without biopsy, only two patients were correctly diagnosed with ICC before surgery. The median size of the tumor was 6 cm (range 1.6–12 cm). Major hepatectomy was carried out in 80% of patients. The operative mortality and morbidity were 15% and 40%, respectively. The median follow up was 18.3 months. Thirteen patients (65%) had recurrences at one or more sites, including, in decreasing frequency, the liver, abdominal lymph node, lung, bone, or skin. The median survival was 17.3 months and the 1‐year, 3‐year, and 5‐year survival rates were 60%, 45%, and 10%, respectively.Conclusions:  The poor survival of patients with ICC was mainly due to the delay in diagnosis and the aggressive nature of the disease. The diagnosis of ICC relies on a high index of suspicion as there is no reliable tumor marker and imaging results are usually inconclusive. Radical hepatectomy remains the only chance of cure for ICC. The role of lymph node dissection, liver transplantation, and adjunctive chemotherapy in the treatment of patients with ICC remains to be determined.
Arterial stiffness acutely decreases after whole‐body vibration in humans
Authors: Otsuki T. , Takanami Y. , Aoi W. , Kawai Y. , Ichikawa H. , Yoshikawa T. 
Published: April 2008

AbstractBackground:  Increased arterial stiffness is a well‐established cardiovascular risk factor. Mechanical stimuli to artery, such as compression, elicit vasodilation and acutely decrease arterial stiffness. As whole‐body vibration (WBV)‐induced oscillation is propagated at least to lumbar spine, WBV mechanically stimulates abdominal and leg arteries and may decrease arterial stiffness. WBV is feasible in vulnerable and immobilized humans. Therefore, it is worthwhile to explore the possibility of WBV as a valuable adjunct to exercise training.Aim:  The aim of this study was to investigate the acute effects of WBV on arterial stiffness.Methods:  Ten healthy men performed WBV and control (CON) trials on separate days. The WBV session consisted of 10 sets of vibration (frequency, 26 Hz) for 60 s with an inter‐set rest period of 60 s. Subjects maintained a static squat position with knees bent on a platform. In the CON trial, WBV stimulation was not imposed. Blood pressure, heart rate and brachial‐ankle pulse wave velocity (baPWV), an index of arterial stiffness, were measured before and 20, 40 and 60 min after both trials.Results and conclusion:  Heart rate and blood pressure did not change from baseline after both trials. Although baPWV did not change in the CON trial (baseline vs. after 20, 40 and 60 min; 1144 ± 35 vs. 1164 ± 41, 1142 ± 39, and 1148 ± 34 cm s−1), baPWV decreased 20 and 40 min after the WBV trial and recovered to baseline 60 min after the trial (1137 ± 28 vs. 1107 ± 30, 1108 ± 28, and 1128 ± 25 cm s−1). These results suggest that WBV acutely decreases arterial stiffness.
Clinical and dosimetric experience with MammoSite‐based brachytherapy under the RTOG 0413 protocol
Authors: Wojcicka Jadwiga B. , Lasher Donette E. , Malcom Ronald , Fortier Gregory 
Published: April 2008

MammoSite balloon brachytherapy is a relatively new technique for partial breast irradiation. The present paper focuses on the treatment planning, dosimetry, and quality assurance aspects of that treatment, based on the Radiation Therapy Oncology Group 0413 randomized prospective trial (RTOG 0413) protocol. We investigate the usefulness of evaluating implants for treatment appropriateness according to the full set of RTOG criteria as compared with the manufacturer's guidelines. We describe our methods to improve MammoSite balloon implants that would otherwise not comply with the protocol. The initially acquired computed tomography (CT) images are evaluated for tissue conformance, balloon surface–to–skin distance, and balloon symmetry. If the implant fails to meet the foregoing criteria, corrective action such as delay in the CT scan, balloon manipulation, or fluid volume adjustment is taken, and the patient is re‐scanned. If the corrective action appears to be successful, three dimensional treatment planning and dose–volume histogram analysis is performed to evaluate the geometric and dosimetric parameters with regard to the RTOG 0413 protocol. The evaluated parameters include• volume ratio of the lumpectomy cavity to the ipsilateral breast,• target volume coverage,• tissue–balloon conformance,• balloon symmetry,• minimal balloon surface–to–skin distance,• maximum skin dose, and• normal breast tissue dose–volume parameters V150 and V200.Among our implants, 21.7% did not initially meet the RTOG 0413 acceptance criteria. Asymmetry and poor conformance values reduce the target volume coverage, and so an implant with moderate conformance and asymmetry can be within the manufacturer's guidelines, but still not meet the RTOG criteria. Our intervention corrected all but one of the implants that failed to meet the criteria. Manipulating the cavity and adjusting the balloon volume may salvage an implant and meet the strict geometric and dosimetric criteria imposed by the RTOG 0413 protocol.PACS number: 7.53.Jw
Verification procedure for isocentric alignment of proton beams
Authors: Ciangaru George , Yang James N. , Oliver Patrick J. , Bues Martin , Zhu Mengping , Nakagawa Fumio , Chiba Hitoshi , Nakamura Shin , Yoshino Hirofumi , Umezawa Mosumi , Smith Alfred R. 
Published: April 2008

We present a technique—based on the Lutz, Winston, and Maleki test used in stereotactic linear accelerator radiosurgery—for verifying whether proton beams are being delivered within the required spatial coincidence with the gantry mechanical isocenter. Our procedure uses a proton beam that is collimated by a circular aperture at its central axis and is then intercepted by a small steel sphere rigidly supported by the patient couch. A laser tracker measurement system and a correction algorithm for couch position assures precise positioning of the steel sphere at the mechanical isocenter of the gantry. A film‐based radiation dosimetry technique, chosen for the good spatial resolution it achieves, records the proton dose distribution for optical image analysis. The optical image obtained presents a circular high‐dose region surrounding a lower‐dose area corresponding to the proton beam absorption by the steel sphere, thereby providing a measure of the beam alignment with the mechanical isocenter. We found the self‐developing Gafchromic EBT film (International Specialty Products, Wayne, NJ) and commercial Epson 10000 XL flatbed scanner (Epson America, Long Beach, CA) to be accurate and efficient tools. The positions of the gantry mechanical and proton beam isocenters, as recorded on film, were clearly identifiable within the scanning resolution used for routine alignment testing (0.17 mm per pixel). The mean displacement of the collimated proton beam from the gantry mechanical isocenter was for the gantry positions tested, which was well within the maximum deviation of 0.50 mm accepted at the Proton Therapy Center in Houston.PACS numbers: 87.53.Xd, 87.53.Oc, 87.56.‐v, 87.66.‐a, 87.56.Fc
The use of LiF (TLD‐100) as an out‐of‐field dosimeter
Authors: Kry Stephen F. , Price Michael , Followill David , Mourtada Firas , Salehpour Mohammad 
Published: April 2008

The commonly used thermoluminescent dosimeter TLD‐100 (Harshaw Chemical Company, Solon, OH) responds not only to photons and electrons, but also to neutrons that are produced during high‐energy therapies. As a result, TLD‐100 measurements outside of the treatment field are suspect when high‐energy radiation is used. Although alternatives such as TLD‐700 do not respond to neutrons, specialty dosimeters of this kind are expensive and are not routinely used in most clinics. In the current study, we examined the accuracy of TLD‐100 in measuring the out‐of‐field photon dose as a function of treatment energy.To determine the accuracy of TLD‐100 as compared with TLD‐700, TLD‐100 was irradiated outside of the treatment field by medical accelerators operated at 6, 10, 15, and 18 MV. In an effort to eliminate the response of TLD‐100 to neutrons, TLD capsules were encased in varying thicknesses of cadmium foil (0.25 – 0.75 mm) before being irradiated at 18 MV. The out‐of‐field TLD‐100 was found to be accurate at 6 MV and 10 MV, but to be substantially over‐responsive at 15 MV and 18 MV (by up to 1063% relative to TLD‐700). By wrapping the TLD‐100 in up to 0.75 mm of cadmium, it was possible to drastically reduce (down to 39% on average) the over‐response of the TLD‐100; however, total removal of the over‐responsiveness was not possible. Although TLD‐100 is well suited for measuring out‐of‐field dose at energies as high as 10 MV, at higher energies (15 MV or greater), this dosimeter over‐responds substantially and should not be used. Although encasing the TLD in cadmium minimized over‐response to a degree, the reduction was not sufficient to make TLD‐100 viable for measuring out‐of‐field dose at high treatment energies.PACS numbers: 87.52.‐g, 87.53.‐j, 87.53.‐Dq
Quality assurance device for four‐dimensional IMRT or SBRT and respiratory gating using patient‐specific intrafraction motion kernels
Authors: Nelms Benjamin E. , Ehler Eric , Bragg Henry , Tomé Wolfgang A. 
Published: April 2008

Emerging technologies such as four‐dimensional computed tomography (4D CT) and implanted beacons are expected to allow clinicians to accurately model intrafraction motion and to quantitatively estimate internal target volumes (ITVs) for radiation therapy involving moving targets. In the case of intensity‐modulated (IMRT) and stereotactic body radiation therapy (SBRT) delivery, clinicians must consider the interplay between the temporal nature of the modulation and the target motion within the ITV. A need exists for a 4D IMRT/SBRT quality assurance (QA) device that can incorporate and analyze customized intrafraction motion as it relates to dose delivery and respiratory gating. We built a 4D IMRT/SBRT prototype device and entered (X, Y, Z)(T) coordinates representing a motion kernel into a software application that

transformed the kernel into beam‐specific two‐dimensional (2D) motion “projections,”
previewed the motion in real time, and
drove a precision X–Y motorized device that had, atop it, a mounted planar IMRT QA measurement device.
The detectors that intersected the target in the beam's‐eye‐view of any single phase of the breathing cycle (a small subset of all the detectors) were defined as “target detectors” to be analyzed for dose uniformity between multiple fractions. Data regarding the use of this device to quantify dose variation fraction‐to‐fraction resulting from target motion (for several delivery modalities and with and without gating) have been recently published. A combined software and hardware solution for patient‐customized 4D IMRT/ SBRT QA is an effective tool for assessing IMRT delivery under conditions of intrafraction motion. The 4D IMRT QA device accurately reproduced the projected motion kernels for all beam's‐eye‐view motion kernels. This device has been proved to• effectively quantify the degradation in dose uniformity resulting from a moving target within a static planning target volume, and• integrate with a commercial respiratory gating system to ensure that the system is working effectively.Such a device is discussed as a potential tool to optimize the gating duty cycle to maximize delivery efficiency while minimizing dose variability.PACS numbers: 87.50.Gi, 87.53.Dq, 87.53.Kn, 87.53.Mr, 87.53.Tf, 87.56.Fc, 87.58.Sp
Study of the uncertainty in the determination of the absorbed dose to water during external beam radiotherapy calibration
Authors: Castro Pablo , García‐Vicente Feliciano , Mínguez Cristina , Floriano Alejandro , Sevillano David , Pérez Leopoldo , Torres Juan J. 
Published: April 2008

To achieve a good clinical outcome in radiotherapy treatment, a certain accuracy in the dose delivered to the patient is required. Therefore, it is necessary to keep the uncertainty in each of the steps of the process inside some acceptable values, which implies as low a global uncertainty as possible. The work reported here focused on the uncertainty evaluation of absorbed dose to water in the routine calibration for clinical beams in the range of energies used in external‐beam radiotherapy. With this aim, we considered various uncertainty components (corrected electrometer reading, calibration factor, beam quality correction factor, and reference conditions) associated with beam calibration. Results show a typical uncertainty in the determination of absorbed dose to water during beam calibration of approximately 1.3% for photon beams and 1.5% for electron beams ( in both cases) when the formalism is used and is calculated theoretically. These values may vary depending on the uncertainty provided by the standards laboratory for calibration factor, which is shown in the work. For primary standards based on clinical linear accelerator beam energies, the uncertainty in this step of the process could be placed close to 1.0%. We also discuss the possibility of an uncertainty reduction with the adoption of the absorbed dose to water formalism as compared with the air kerma formalism.PACS numbers: 87.53.Dq, 87.53.Hv
Verifying monitor unit calculations for tangential whole‐breast fields in three‐dimensional planning
Authors: Kay Ian , Meyer Tyler 
Published: April 2008

Verification of the accuracy of monitor unit calculations is an essential component of quality assurance in radiation therapy. For tangential breast fields, monitor unit differences between primary calculations and second checks are usually larger than would be considered acceptable at other anatomic sites. Here, we present a simple model to reconcile the differences between sophisticated and simple algorithms, based on estimating the volume irradiated by the field, replacing the breast contour with a rectangular block having an equal volume, but using a new field width that provides almost equivalent scatter to the prescription point. This analysis can also assist the treatment planning physicist in selecting a tolerance window for verifying monitor unit calculations for tangential breast fields.PACS numbers: 87.53.Kn, 87.53.Tf, 87.53.Xd