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关键词： DIEP   Pelvic exenteration   Perforator flap   Vaginal reconstruction  

摘要： Immediate vaginal reconstruction is usually offered following pelvic exenteration for recurrent cervical cancer in women previously treated with radiotherapy or with severe radiation-induced fistulae. Introduction of muscle-sparing flaps, such as the pedicled vertical deep inferior epigastric perforator (DIEP) flap, provides viable tissues for vaginal reconstruction and is associated with reduced donor-site morbidity. This report describes the surgical technique, which is one of the procedures of choice for vaginal reconstruction. It is safe and beneficial, especially for women with gynecologic cancer who have undergone pelvic exenteration after failed radiation therapy. (C) 2020 Elsevier Masson SAS. All rights reserved.

关键词： Covid-19   Radiotherapy   Hypofractionation   Cervical cancer  

摘要： Cervical cancer is a deadly disease and the COVID-19 pandemic has the potential to further impact its lethality. Hypofractionated radiotherapy could mitigate this impact, however robust data in cervical cancer setting still is lacking. Information provided here could help institutions in reducing radiotherapy fractions for cervical cancer patients. (C) 2020 Elsevier B.V. All rights reserved.

关键词： Covid-19   aerosol generation   open reduction and internal fixation  

关键词： Percutaneous endoscopic lumbar discectomy   Unilateral transforaminal approach   Lumbar disc herniation   Bilateral symptoms  

摘要： Purpose In this study, the authors described the technical notes of percutaneous transforaminal endoscopic lumbar discectomy (PTELD) through unilateral approach and compared PTELD through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms. Methods A prospective randomized clinical study was performed from June 2014 to October 2016. A total of 71 patients with lumbar disc herniation (L3/4 or L4/5) and bilateral symptoms were divided randomly into Unilateral-Approach group (n = 35) or Bilateral-Approach group (n = 36). Operation time, blood loss, intraoperative fluoroscopy and recurrences were recorded and analyzed statistically. Visual Analogue Scale scores, Oswestry Disability Index and the MacNab standard were used to analyze the clinical outcomes of the two groups. Results The baseline data of the two groups were statistically similar. There was significant postoperative improvement in VAS and ODI scores in both the groups, and clinical outcomes are comparable according to the MacNab standard. However, VAS score of back pain at 1 day after surgery in Unilateral-Approach group was significantly lower than that in Bilateral-Approach group (P < 0.05). Moreover, operation time and cumulative time of intraoperative fluoroscopy of Unilateral-Approach group were significantly shorter than that of Bilateral-Approach group (P < 0.05). Conclusion For L3/4 or L4/5 LDH with bilateral symptoms, PTELD through unilateral approach is effective, with advantage of shorter operation time, shorter cumulative time of intraoperative fluoroscopy and milder postoperative short-term back pain compared to bilateral approach. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

关键词： hyperpolarized pyruvate   metabolic imaging   MRI  

摘要： Purpose Metabolic magnetic resonance imaging (MRI) using hyperpolarized [1-C-13]-pyruvate offers unprecedented new insight into disease and response to therapy. C-13-enriched reference standards are required to enable fast and accurate calibration for C-13 studies, but care must be taken to ensure that the reference is compatible with both C-13 and H-1 acquisitions. The goal of this study was to optimize the composition of a C-13-urea reference for a dual-tuned C-13/H-1 endorectal coil and minimize imaging artifacts in metabolic and multiparametric MRI studies involving hyperpolarized [1-C-13]-pyruvate. Methods Due to a high amount of Gd doping for the purpose of reducing the spin-lattice relaxation time (T-1) of urea, the H-1 signal produced by a reference of C-13-urea in normal water was rapidly relaxed, resulting in severe artifacts in heavily T-1-weighted images. Hyperintense ringing artifacts in H-1 images were mitigated by reducing the H-1 concentration in a C-13-urea reference via deuteration and lyophilization. Several references were fabricated and their SNR was compared using H-1 and C-13 imaging sequences on a 3T MRI scanner. Finally, H-1 prostate phantom imaging was conducted to compare image quality and H-1 signal intensity of normal and deuterated urea references. Results The deuterated C-13-urea reference provides strong C-13 signal for calibration and an attenuated H-1 signal that does not interfere with heavily T-1-weighted scans. Deuteration and lyophilization were fundamental to the reduction in H-1 signal and hyperintense ringing artifacts. There was a 25-fold reduction in signal intensity when comparing the nondeuterated reference to the deuterated reference, while the C-13 signal was unaffected. Conclusion A deuterated reference reduced hyperintense ringing artifacts in H-1 images by reducing the H-1 signal produced from the C-13-urea in the reference. The deuterated reference can be used to improve anatomical image quality in future clinical H

关键词： Sheet erosion   Interrill erosion   Raindrop impact   Shallow flows  

摘要： Soil material lifted by raindrop impacting flows a few millimetres deep are transported downstream as they fall back to the soil surface. That occurs not only with material that is lifted and remains in the flow, but also material lifted into the air that falls onto the surface of the flow. The amount lifted into the air varies with flow depth and the effect of the input from airborne material on sediment discharged by rain-impacted flows is not normally taken into account in experiments on, or models of, sheet and interrill erosion where flows are more than 1 mm deep. However, in very shallow flows, the airborne input to rain-impacted flows is high and the dominant transport mechanisms the operate in deeper flows no longer operate effectively. Further research into the mechanisms that operate in transporting sediment by rain-impacted flows on slopes with high gradient is warranted.

摘要： Securing an endotracheal tube in a child with a facial burn is crucial but often challenging. The traditional method of using a facial apparatus or tape tied around the lower face is not suitable in the setting of open facial wounds as it limits wound care and, if necessary, skin grafting. We describe a straightforward, quick method to secure the endotracheal tube by means of a modified ivy loop in a pediatric patient. (C) 2020 American Association of Oral and Maxillofacial Surgeons

关键词： Bragg peak   commissioning   halo   integral depth dose   proton   scanning  

摘要： Purpose The goal was to develop and test a large diameter parallel plate ionization chamber capable of intercepting at least 98% of the proton beamlets tested with the system. Methods A commercial synchrotron proton therapy system was used for the study (Hitachi, Ltd, Hitachi City, Japan;Model: Probeat-V). The energies investigated were in the range of 100 to 192 MeV. Three beam spot options available from the system were used. A PTW Bragg peak IC of diameter 84 mm (BP84) (Model PTW34070) was employed for comparison in a scanning water phantom. A prototype of 150 mm diameter was produced (PTW, Freiburg, Germany;model: T34089) and used for the testing. Monte Carlo calculations were also performed with FLUKA to guide the BP150 design and for comparison to the radiological measurements. For comparison, a 40 cm diameter ideal virtual detector was included in the Monte Carlo model. Results The measured proton range R90 agrees between the BP84 and BP150 ionization chambers within +0.06/-0.27 mm across the energies 100-192 MeV, which is less than the daily experimental setup uncertainty of 0.4 mm. The differences in the absolute integral depth dose curves (IDDs) between the BP84 and BP150 ranged from 0.3% to 1.0% for the spot sizes and beam energies tested. As predicted by the Monte Carlo modeling, the greatest differences were found in the plateau region of the IDDs. Also, the IDDs measured with the BP150 were very similar to those of the ideal 40 cm diameter detector Monte Carlo simulations. Conclusions We conclude that the BP150 offers a small, but a useful reduction in uncertainty from the nuclear halo effect for the system under test.

关键词： Absolute values   dependency   diversification   linear   misinterpretation   negative rates   RPANDA  

摘要： Condamine et al. (2019;22: 1900-1912) fitted linear and exponential functions of time-dependent, diversity-dependent and temperature-dependent diversification to investigate diversification dynamics of tetrapod families. Here I highlight potential misinterpretations when using linear diversification dependencies and provide some clarifications.