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Sample records for mace head local

  1. Carbon monoxide measurements at Mace Head, Ireland

    Science.gov (United States)

    Doddridge, Bruce G.; Dickerson, Russell R.; Spain, T. Gerard; Oltmans, Samuel J.; Novelli, Paul C.

    1994-01-01

    The North Atlantic Ocean is bordered by continents which may each, under the influence of seasonal weather patterns, act as sources of natural and anthropogenic trace gas and particulate species. Photochemically active species such as carbon monoxide (CO) react to form ozone (O3), a species of critical importance in global climate change. CO is sparingly soluble in water, and the relatively long lifetime of CO in the troposphere makes this species an ideal tracer of air masses with origin over land. We have measured CO using a nondispersive infrared gas filter correlation analyzer at Mace Head on the west coast of Ireland nearly continuously since August 9, 1991. Measurements of CO were acquired at 20-sec resolution and recorded as 60-sec averages. Daily, monthly, and diurnal variation data characteristics of CO mixing ratios observed at this site are reported. Depending on source regions of air parcels passing over this site, 60-min concentrations of CO range from clean air values of approximately 90 ppbv to values in excess of 300 ppbv. Data characterizing the correlation between 60-min CO and O3 mixing ratio data observed at this site are reported also.

  2. A five year record of high-frequency in situ measurements of non-methane hydrocarbons at Mace Head, Ireland

    Directory of Open Access Journals (Sweden)

    A. Grant

    2011-05-01

    Full Text Available Continuous high-frequency in situ measurements of a range of non-methane hydrocarbons have been made at Mace Head since January 2005. Mace Head is a background Northern Hemispheric site situated on the eastern edge of the Atlantic. Five year measurements (2005–2009 of six C2–C5 non-methane hydrocarbons have been separated into baseline Northern Hemispheric and European polluted air masses, among other sectors. Seasonal cycles in baseline Northern Hemispheric air masses and European polluted air masses arriving at Mace Head have been studied. Baseline air masses show a broad summer minima between June and September for shorter lived species, longer lived species show summer minima in July/August. All species displayed a winter maxima in February. European air masses showed baseline elevated mole fractions for all non-methane hydrocarbons. Largest elevations (of up to 360 ppt for ethane maxima from baseline data were observed in winter maxima, with smaller elevations observed during the summer. Analysis of temporal trends using the Mann-Kendall test showed small (<6 % yr−1 but statistically significant decreases in the butanes and i-pentane between 2005 and 2009 in European air. No significant trends were found for any species in baseline air.

  3. Quantitative trace analysis of polyfluorinated alkyl substances (PFAS) in ambient air samples from Mace Head (Ireland): A method intercomparison

    Science.gov (United States)

    Jahnke, Annika; Barber, Jonathan L.; Jones, Kevin C.; Temme, Christian

    A method intercomparison study of analytical methods for the determination of neutral, volatile polyfluorinated alkyl substances (PFAS) was carried out in March, 2006. Environmental air samples were collected in triplicate at the European background site Mace Head on the west coast of Ireland, a site dominated by 'clean' westerly winds coming across the Atlantic. Extraction and analysis were performed at two laboratories active in PFAS research using their in-house methods. Airborne polyfluorinated telomer alcohols (FTOHs), fluorooctane sulfonamides and sulfonamidoethanols (FOSAs/FOSEs) as well as additional polyfluorinated compounds were investigated. Different native and isotope-labelled internal standards (IS) were applied at various steps in the analytical procedure to evaluate the different quantification strategies. Field blanks revealed no major blank problems. European background concentrations observed at Mace Head were found to be in a similar range to Arctic data reported in the literature. Due to trace-levels at the remote site, only FTOH data sets were complete and could therefore be compared between the laboratories. Additionally, FOSEs could partly be included. Data comparison revealed that despite the challenges inherent in analysis of airborne PFAS and the low concentrations, all methods applied in this study obtained similar results. However, application of isotope-labelled IS early in the analytical procedure leads to more precise results and is therefore recommended.

  4. Comparisons of continuous atmospheric CH4, CO2 and N2O measurements - results from a travelling instrument campaign at Mace Head

    International Nuclear Information System (INIS)

    Vardag, S.N.; Hammer, S.; Levin, I.; O'Doherty, S.; Spain, T.G.; Wastine, B.; Jordan, A.

    2014-01-01

    A 2-month measurement campaign with a Fourier transform infrared analyser as a travelling comparison instrument (TCI) was performed at the Advanced Global Atmospheric Gases Experiment (AGAGE) and World Meteorological Organization (WMO) Global Atmosphere Watch (GAW) station at Mace Head, Ireland. The aim was to evaluate the compatibility of atmospheric methane (CH 4 ), carbon dioxide (CO 2 ) and nitrous oxide (N 2 O) measurements of the routine station instrumentation, consisting of a gas chromatograph (GC) for CH 4 and N 2 O as well as a cavity ring-down spectroscopy (CRDS) system for CH 4 and CO 2 . The advantage of a TCI approach for quality control is that the comparison covers the entire ambient air measurement system, including the sample intake system and the data evaluation process. For initial quality and performance control, the TCI was run in parallel with the Heidelberg GC before and after the measurement campaign at Mace Head. Median differences between the Heidelberg GC and the TCI were well within the WMO inter-laboratory compatibility target for all three greenhouse gases. At Mace Head, the median difference between the station GC and the TCI were -0.04 nmol mol -1 for CH 4 and -0.37 nmol mol -1 for N 2 O (GC-TCI). For N 2 O, a similar difference (-0.40 nmol mol -1 ) was found when measuring surveillance or working gas cylinders with both instruments. This suggests that the difference observed in ambient air originates from a calibration offset that could partly be due to a difference between the WMON2O X2006a reference scale used for the TCI and the Scripps Institution of Oceanography (SIO-1998) scale used at Mace Head and in the whole AGAGE network. Median differences between the CRDS G1301 and the TCI at Mace Head were 0.12 nmol mol -1 for CH 4 and 0.14 μmol mol -1 for CO 2 (CRDS G1301 - TCI). The difference between both instruments for CO 2 could not be explained, as direct measurements of calibration gases show no such difference. The CH 4

  5. Chemical and physical characteristics of aerosol particles at a remote coastal location, Mace Head, Ireland, during NAMBLEX

    Directory of Open Access Journals (Sweden)

    H. Coe

    2006-01-01

    Full Text Available A suite of aerosol physical and chemical measurements were made at the Mace Head Atmospheric Research Station, Co. Galway, Ireland, a coastal site on the eastern seaboard of the north Atlantic Ocean during NAMBLEX. The data have been used in this paper to show that over a wide range of aerosol sizes there is no impact of the inter-tidal zone or the surf zone on measurements made at 7 m above ground level or higher. During the measurement period a range of air mass types were observed. During anticyclonic periods and conditions of continental outflow Aitken and accumulation mode were enhanced by a factor of 5 compared to the marine sector, whilst coarse mode particles were enhanced during westerly conditions. Baseline marine conditions were rarely met at Mace Head during NAMBLEX and high wind speeds were observed for brief periods only. The NAMBLEX experiment focussed on a detailed assessment of photochemistry in the marine environment, investigating the linkage between the HOx and the halogen radical cycles. Heterogeneous losses are important in both these cycles. In this paper loss rates of gaseous species to aerosol surfaces were calculated for a range of uptake coefficients. Even when the accommodation coefficient is unity, lifetimes due to heterogeneous loss of less than 10 s were never observed and rarely were they less than 500 s. Diffusional limitation to mass transfer is important in most conditions as the coarse mode is always significant. We calculate a minimum overestimate of 50% in the loss rate if this is neglected and so it should always be considered when calculating loss rates of gaseous species to particle surfaces. HO2 and HOI have accommodation coefficients of around 0.03 and hence we calculate lifetimes due to loss to particle surfaces of 2000 s or greater under the conditions experienced during NAMBLEX. Aerosol composition data collected during this experiment provide representative information on the input aerosol

  6. Peroxy radical chemistry and the control of ozone photochemistry at Mace Head, Ireland during the summer of 2002

    Directory of Open Access Journals (Sweden)

    Z. L. Fleming

    2006-01-01

    Full Text Available Peroxy radical (HO2+ΣRO2 measurements, using the PEroxy Radical Chemical Amplification (PERCA technique at the North Atlantic Marine Boundary Layer EXperiment (NAMBLEX at Mace Head in summer 2002, are presented and put into the context of marine, boundary-layer chemistry. A suite of other chemical parameters (NO, NO2, NO3, CO, CH4, O3, VOCs, peroxides, photolysis frequencies and meteorological measurements, are used to present a detailed analysis of the role of peroxy radicals in tropospheric oxidation cycles and ozone formation. Under the range of conditions encountered the peroxy radical daily maxima varied from 10 to 40 pptv. The diurnal cycles showed an asymmetric shape typically shifted to the afternoon. Using a box model based on the master chemical mechanism the average model measurement agreement was 2.5 across the campaign. The addition of halogen oxides to the model increases the level of model/measurement agreement, apparently by respeciation of HOx. A good correlation exists between j(HCHO.[HCHO] and the peroxy radicals indicative of the importance of HCHO in the remote atmosphere as a HOx source, particularly in the afternoon. The peroxy radicals showed a strong dependence on [NO2] with a break point at 0.1 ppbv, where the radicals increased concomitantly with the reactive VOC loading, this is a lower value than seen at representative urban campaigns. The HO2/(HO2+ΣRO2 ratios are dependent on [NOx] ranging between 0.2 and 0.6, with the ratio increasing linearly with NOx. Significant night-time levels of peroxy radicals were measured up to 25 pptv. The contribution of ozone-alkenes and NO3-alkene chemistry to night-time peroxy radical production was shown to be on average 59 and 41%. The campaign mean net ozone production rate was 0.11±0.3 ppbv h-1. The ozone production rate was strongly dependent on [NO] having linear sensitivity (dln(P(O3/dln(NO=1.0. The results imply that the N(O3 (the in-situ net photochemical rate of ozone

  7. The phase-in and phase-out of European emissions of HCFC-141b and HCFC-142b under the Montreal Protocol: Evidence from observations at Mace Head, Ireland and Jungfraujoch, Switzerland from 1994 to 2004

    Science.gov (United States)

    Derwent, R. G.; Simmonds, P. G.; Greally, B. R.; O'doherty, S.; McCulloch, A.; Manning, A.; Reimann, S.; Folini, D.; Vollmer, M. K.

    The mixing ratios of HCFC-141b (1,1-dichlorofluoroethane) and HCFC-142b (1-chloro-1,1-difluoroethane) have been rising steadily in baseline air at Mace Head, Ireland over the 10-year period from 1994 to 2004. These HCFCs are widely used replacements for the chlorofluorocarbons phased out under the Montreal Protocol and its subsequent amendments. Analysis of the HCFC content of regionally-polluted air arriving at Mace Head from the European continent shows that European emissions reached a peak during 2000-2001 and have declined subsequently, following the phase-out in their usage. European emissions of HCFC-141b have been further constrained by observations at the High-Alpine Jungfraujoch site. The reductions are consistent with the phase-out of HCFC production and use from the year 2001 onwards mandated by European regulations designed to exceed the requirements of the Montreal Protocol.

  8. Unifying Learning Object Repositories in MACE

    NARCIS (Netherlands)

    Prause, Christian; Ternier, Stefaan; De Jong, Tim; Apelt, Stefan; Scholten, Marius; Wolpers, Martin; Eisenhauer, Markus; Vandeputte, Bram; Specht, Marcus; Duval, Erik

    2007-01-01

    Prause, C., Ternier, S., De Jong, T., Apelt, S., Scholten, M., Wolpers, M., et al. (2007). Unifying Learning Object Repositories in MACE. In D. Massart, J.-N. Colin & F. V. Assche (Eds.). Proceedings of the First International Workshop on Learning Object Discovery & Exchange (LODE'07). September,

  9. Calculated trends and the atmospheric abundance of 1,1,1,2-tetrafluoroethane, 1,1-dichloro-1-fluoroethane, and 1-chloro-1,1-difluoroethane using automated in-situ gas chromatography-mass spectrometry measurements recorded at Mace Head, Ireland, from October 1994 to March 1997

    Science.gov (United States)

    Simmonds, P. G.; O'Doherty, S.; Huang, J.; Prinn, R.; Derwent, R. G.; Ryall, D.; Nickless, G.; Cunnold, D.

    1998-01-01

    The first in-situ measurements by automated gas chromatograph-mass spectrometer are reported for 1,1,1,2-tetrafluoroethane (HFC-134a), 1,1-dichloro-1-fluoroethane, (HCFC-141b), and 1-chloro-1,1-difluoroethane, (HCFC-142b). These compounds are steadily replacing the chlorofluorocarbons (CFCs) as refrigerants, foam-blowing agents, and solvents. The concentrations of all three compounds are shown to be rapidly increasing in the atmosphere, with 134a increasing at a rate of 2.05±0.02 ppt yr-1 over the 30 months of observations. Similarly, 141b and 142b increased at rates of 2.49±0.03 and 1.24±0.02 ppt yr-1, respectively, over the same period. The concentrations recorded at the atmospheric research station at Mace Head, Ireland, on January 1, 1996, the midpoint of the time series, were 3.67 ppt (134a), 7.38 ppt (141b), and 8.78 ppt (142b). From these observations we optimally estimate the HCFC and HFC emissions using a 12-box global model and OH concentrations derived from global 1,1,1-trichloroethane (CCl3CH3) measurements. Comparing two methods of estimating emissions with independent industry estimates shows satisfactory agreement for 134a and 141b, while for 142b, industry estimates are less than half those required to explain our observations.

  10. Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer

    International Nuclear Information System (INIS)

    Lee, Jeong Eun; Eun; Kim, Jae Chul; Park, In Kyu; Yea, Ji Woon

    2010-01-01

    The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patients especially with the risk factor of neck node dissection.

  11. Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Eun; Eun; Kim, Jae Chul; Park, In Kyu [Kyungpook National Yonsei University School of Medicine, Daegu (Korea, Republic of); Yea, Ji Woon [Dongguk University Gyeongju Hospital, Gyeongju (Korea, Republic of)

    2010-11-15

    The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patients especially with the risk factor of neck node dissection.

  12. Melt coolability modeling and comparison to MACE test results

    International Nuclear Information System (INIS)

    Farmer, M.T.; Sienicki, J.J.; Spencer, B.W.

    1992-01-01

    An important question in the assessment of severe accidents in light water nuclear reactors is the ability of water to quench a molten corium-concrete interaction and thereby terminate the accident progression. As part of the Melt Attack and Coolability Experiment (MACE) Program, phenomenological models of the corium quenching process are under development. The modeling approach considers both bulk cooldown and crust-limited heat transfer regimes, as well as criteria for the pool thermal hydraulic conditions which separate the two regimes. The model is then compared with results of the MACE experiments

  13. Use MACES IVA Suit for EVA Mobility Evaluations

    Science.gov (United States)

    Watson, Richard D.

    2014-01-01

    The use of an Intra-Vehicular Activity (IVA) suit for a spacewalk or Extra-Vehicular Activity (EVA) was evaluated for mobility and usability in the Neutral Buoyancy Lab (NBL) environment. The Space Shuttle Advanced Crew Escape Suit (ACES) has been modified (MACES) to integrate with the Orion spacecraft. The first several missions of the Orion MPCV spacecraft will not have mass available to carry an EVA specific suit so any EVA required will have to be performed by the MACES. Since the MACES was not designed with EVA in mind, it was unknown what mobility the suit would be able to provide for an EVA or if a person could perform useful tasks for an extended time inside the pressurized suit. The suit was evaluated in multiple NBL runs by a variety of subjects including crewmembers with significant EVA experience. Various functional mobility tasks performed included: translation, body positioning, carrying tools, body stabilization, equipment handling, and use of tools. Hardware configurations included with and without TMG, suit with IVA gloves and suit with EVA gloves. Most tasks were completed on ISS mockups with existing EVA tools. Some limited tasks were completed with prototype tools on a simulated rocky surface. Major findings include: demonstration of the ability to weigh-out the suit, understanding the need to have subjects perform multiple runs prior to getting feedback, determination of critical sizing factors, and need for adjustment of suit work envelop. The early testing has demonstrated the feasibility of EVA's limited duration and limited scope. Further testing is required with more flight like tasking and constraints to validate these early results. If the suit is used for EVA, it will require mission specific modifications for umbilical management or PLSS integration, safety tether attachment, and tool interfaces. These evaluations are continuing through calendar year 2014.

  14. Amifostine - a radioprotector in locally advanced head and neck tumors

    International Nuclear Information System (INIS)

    Schoenekaes, K.G.; Wagner, W.; Prott, F.J.

    1999-01-01

    Purpose: There are some preliminary informations about the beneficial use of amifostine in avoiding side effects in patients with head and neck tumors who underwent radiotherapy. Patients and method: Amifostine was given as daily intravenous application (500 mg) 10 to 15 minutes prior to radiotherapy in 20 patients. The results were compared with another collective of patients which was similar. Results: According to the WHO score mucositis became manifest in 10 patients (Grade I) and 4 patients (Grade II) in the amifostine group vs 9 patients (Grade II), 6 patients (Grade III) and 1 patient (Grade IV) in the control group. Xerostomia has been seen in 15 patients (Grade I) and 5 patients (Grade II) after administration of amifostine. Without the drug 2 patients suffered from xerostomia (Grade I), 8 patients (Grade II) and 8 patients (Grade III), respectively. Administering amifostine had been feasible and non problematic. Only a small rate of toxic side effects like nausea (11%) or emesis (4%) was documented. Conclusions: Amifostine is an effective radioprotector decreasing acute and late side effects in patients with head and neck tumors. (orig.) [de

  15. Sound localization with head movement: implications for 3-d audio displays.

    Directory of Open Access Journals (Sweden)

    Ken Ian McAnally

    2014-08-01

    Full Text Available Previous studies have shown that the accuracy of sound localization is improved if listeners are allowed to move their heads during signal presentation. This study describes the function relating localization accuracy to the extent of head movement in azimuth. Sounds that are difficult to localize were presented in the free field from sources at a wide range of azimuths and elevations. Sounds remained active until the participants’ heads had rotated through windows ranging in width of 2°, 4°, 8°, 16°, 32°, or 64° of azimuth. Error in determining sound-source elevation and the rate of front/back confusion were found to decrease with increases in azimuth window width. Error in determining sound-source lateral angle was not found to vary with azimuth window width. Implications for 3-d audio displays: The utility of a 3-d audio display for imparting spatial information is likely to be improved if operators are able to move their heads during signal presentation. Head movement may compensate in part for a paucity of spectral cues to sound-source location resulting from limitations in either the audio signals presented or the directional filters (i.e., head-related transfer functions used to generate a display. However, head movements of a moderate size (i.e., through around 32° of azimuth may be required to ensure that spatial information is conveyed with high accuracy.

  16. Amifostine - a radioprotector in locally advanced head and neck tumors

    Energy Technology Data Exchange (ETDEWEB)

    Schoenekaes, K.G.; Wagner, W. [Paracelsus-Strahlenklinik, Osnabrueck (Germany); Prott, F.J. [Muenster Univ. (Germany). Inst. fuer Strahlenonkologie

    1999-11-01

    Purpose: There are some preliminary informations about the beneficial use of amifostine in avoiding side effects in patients with head and neck tumors who underwent radiotherapy. Patients and method: Amifostine was given as daily intravenous application (500 mg) 10 to 15 minutes prior to radiotherapy in 20 patients. The results were compared with another collective of patients which was similar. Results: According to the WHO score mucositis became manifest in 10 patients (Grade I) and 4 patients (Grade II) in the amifostine group vs 9 patients (Grade II), 6 patients (Grade III) and 1 patient (Grade IV) in the control group. Xerostomia has been seen in 15 patients (Grade I) and 5 patients (Grade II) after administration of amifostine. Without the drug 2 patients suffered from xerostomia (Grade I), 8 patients (Grade II) and 8 patients (Grade III), respectively. Administering amifostine had been feasible and non problematic. Only a small rate of toxic side effects like nausea (11%) or emesis (4%) was documented. Conclusions: Amifostine is an effective radioprotector decreasing acute and late side effects in patients with head and neck tumors. (orig.) [German] Zielsetzung: Bisher gibt es nur wenige Informationen ueber den Nutzen von Amifostin bezueglich der Verminderung oder Vermeidung von Nebenwirkungen einer Radiatio bei Patienten mit Tumoren im HNO-Trakt. Patienten und Methode: Amifostin wurde als intravenoese Kurzinfusion mit einer Dosis von 500 mg zehn bis 15 Minuten vor der Bestrahlung bei 20 Patienten appliziert. Die unter Radiatio aufgetretenen Nebenwirkungen wurden nach WHO bzw. nach dem Oral Assessment Guide nach Eilers ausgewertet und mit einem entsprechenden historischen Kollektiv der Klinik verglichen. Ergebnisse: In der Amifostin-Gruppe wurde bei zehn Patienten eine Mukositis Grad I und bei vier Patienten eine Mukositis Grad II nach WHO beobachtet. Grad-III- und Grad-IV-Nebenwirkungen traten nicht auf. In der Kontrollgruppe waren dagegen bei neun

  17. Improved local and regional control with radiotherapy for Merkel cell carcinoma of the head and neck.

    Science.gov (United States)

    Strom, Tobin; Naghavi, Arash O; Messina, Jane L; Kim, Sungjune; Torres-Roca, Javier F; Russell, Jeffery; Sondak, Vernon K; Padhya, Tapan A; Trotti, Andy M; Caudell, Jimmy J; Harrison, Louis B

    2017-01-01

    We hypothesized that radiotherapy (RT) would improve both local and regional control with Merkel cell carcinoma of the head and neck. A single-institution institutional review board-approved study was performed including 113 patients with nonmetastatic Merkel cell carcinoma of the head and neck. Postoperative RT was delivered to the primary tumor bed (71.7% cases) ± draining lymphatics (33.3% RT cases). Postoperative local RT was associated with improved local control (3-year actuarial local control 89.4% vs 68.1%; p = .005; Cox hazard ratio [HR] 0.18; 95% confidence interval [CI] = 0.06-0.55; p = .002). Similarly, regional RT was associated with improved regional control (3-year actuarial regional control 95.0% vs 66.7%; p = .008; Cox HR = 0.09; 95% CI = 0.01-0.69; p = .02). Regional RT played an important role for both clinical node-negative patients (3-year regional control 100% vs 44.7%; p = .03) and clinical/pathological node-positive patients (3-year regional control 90.9% vs 55.6%; p = .047). Local RT was beneficial for all patients with Merkel cell carcinoma of the head and neck, whereas regional RT was beneficial for clinical node-negative and clinical/pathological node-positive patients. © 2016 Wiley Periodicals, Inc. Head Neck 39: 48-55, 2017. © 2016 Wiley Periodicals, Inc.

  18. Case Report: Down-staging locally advanced head and neck cancer ...

    African Journals Online (AJOL)

    Case Report: Down-staging locally advanced head and neck cancer in an HIV infected patient in a limited resource setting. L Masamba, D Nkosi, D Kumiponjera. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals ...

  19. Cetuximab in locally advanced head-and-neck cancer: defining the population

    Science.gov (United States)

    Ho, C.

    2010-01-01

    Encouraging data for targeted therapy in head-and-neck squamous cell carcinoma are opening new options for treatment. Phase III trials of cetuximab, an antibody directed against the epidermal growth factor receptor (egfr) have demonstrated benefit in the locally advanced and metastatic settings. Recognizing the importance of emerging therapies, Cancer Care Ontario published guideline recommendations for egfr-targeted therapy in stage iii and iv head-and-neck cancer. The present paper takes a further look at the population for whom an offer of cetuximab therapy may be appropriate. PMID:20697514

  20. A MODEL OF MIRA'S COMETARY HEAD/TAIL ENTERING THE LOCAL BUBBLE

    International Nuclear Information System (INIS)

    Esquivel, A.; Raga, A. C.; RodrIguez-Gonzalez, A.; Lopez-Camara, D.; Velazquez, P. F.; Canto, J.; De Colle, F.

    2010-01-01

    We model the cometary structure around Mira as the interaction of an asymptotic giant branch stellar wind from Mira A with a streaming environment. Our simulations introduce the following new element: we assume that after 200 kyr of evolution in a dense environment, Mira entered the Local Bubble (low-density coronal gas). As Mira enters the bubble, the head of the comet expands quite rapidly, while the tail remains well collimated for a >100 kyr timescale. The result is a broad-head/narrow-tail structure that resembles the observed morphology of Mira's comet. The simulations were carried out with our new adaptive grid code WALICXE, which is described in detail.

  1. Palliative radiotherapy in locally advanced head and neck cancer-A prospective trial

    Directory of Open Access Journals (Sweden)

    Ghoshal Sushmita

    2004-01-01

    Full Text Available AIM: To evaluate the role of palliative radiotherapy for symptom control in patients with locally advanced head and neck cancer. MATERIALS AND METHODS: 25 patients with stage 3 and stage 4 head and neck cancer were treated with a short course of palliative radiotherapy (30 Gray (Gy in 10 fractions over 2 weeks. Baseline symptoms were assessed using a 11 point numerical scale for pain, dysphagia, cough, insomnia and dyspnoea. The primary end point was relief of symptoms in the fourth week after radiotherapy. Percentage symptom relief was quantified by the patient using a rupee scale. RESULTS: All 22 patients with pain and 90% of patients with dysphagia, dyspnoea and disturbed sleep had greater than 50% relief in symptoms after radiotherapy. Cough was relieved in sixty percent of cases. CONCLUSION: A short course of radiation can be an effective method of symptom palliation in head and neck cancers.

  2. The influence of head frame distortions on stereotactic localization and targeting

    Energy Technology Data Exchange (ETDEWEB)

    Treuer, H; Hunsche, S; Hoevels, M; Luyken, K; Maarouf, M; Voges, J; Sturm, V [Department of Stereotaxy and Functional Neurosurgery, University of Cologne, 50924 Cologne (Germany)

    2004-09-07

    A strong attachment of a stereotactic head frame to the patient's skull may cause distortions of the head frame. The aim of this work was to identify possible distortions of the head frame, to measure the degree of distortion occurring in clinical practice and to investigate its influence on stereotactic localization and targeting. A model to describe and quantify the distortion of the Riechert-Mundinger (RM) head frame was developed. Distortions were classified as (a) bending and (b) changes from the circular ring shape. Ring shape changes were derived from stereotactic CT scans and frame bending was determined from intraoperative stereotactic x-ray images of patients with implanted {sup 125}I-seeds acting as landmarks. From the examined patient data frame bending was determined to be 0.74 mm {+-} 0.32 mm and 1.30 mm in maximum. If a CT-localizer with a top ring is used, frame bending has no influence on stereotactic CT-localization. In stereotactic x-ray localization, frame bending leads to an overestimation of the z-coordinate by 0.37 mm {+-} 0.16 mm on average and by 0.65 mm in maximum. The accuracy of patient positioning in radiosurgery is not affected by frame bending. But in stereotactic surgery with an RM aiming bow trajectory displacements are expected. These displacements were estimated to be 0.36 mm {+-} 0.16 mm (max. 0.74 mm) at the target point and 0.65 mm {+-} 0.30 mm (max. 1.31 mm) at the entry point level. Changes from the circular ring shape are small and do not compromise the accuracy of stereotactic targeting and localization. The accuracy of CT-localization was found to be close to the resolution limit due to voxel size. Our findings for frame bending of the RM frame could be validated by statistical analysis and by comparison with an independent patient examination. The results depend on the stereotactic system and details of the localizers and instruments and also reflect our clinical practice. Therefore, a generalization is not possible

  3. AFSC/RACE/MACE: Results of 2014 Pollock Acoustic-Trawl Survey Shelikof- DY1403

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Midwater Assessment and Conservation Engineering (MACE) Program of the Alaska Fisheries Science Center's (AFSC) Resource Assessment and Conservation Engineering...

  4. AFSC/RACE/MACE: Results of 2013 acoustic trawl survey Gulf of Alaska DY1307

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Scientists from the Midwater Assessment and Conservation Engineering (MACE) Program of the Alaska Fisheries Science Center (AFSC) Resource Assessment and...

  5. AFSC/RACE/MACE: Results of 2014 acoustic trawl survey Bogoslof DY1402

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Scientists from the Midwater Assessment and Conservation Engineering (MACE) Program of the Alaska Fisheries Science Center (AFSC) regularly conduct acoustic-trawl...

  6. AFSC/RACE/MACE: Results of 2013 Pollock Acoustic/Trawl Survey Shelikof 201303

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Scientists from the Midwater Assessment and Conservation Engineering (MACE) Program of the Alaska Fisheries Science Center's (AFSC) Resource Assessment and...

  7. AFSC/RACE/MACE: Results of 2016 acoustic trawl survey Shumagins/Sanak DY1602

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Scientists from the Midwater Assessment and Conservation Engineering (MACE) Program of the Alaska Fisheries Science Center's (AFSC) Resource Assessment and...

  8. AFSC/RACE/MACE: Results of 2008 pollock acoustic trawl survey Shelikof DY0803

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Scientists from the Midwater Assessment and Conservation Engineering (MACE) Program of the Alaska Fisheries Science Center's (AFSC) Resource Assessment and...

  9. AFSC/RACE/MACE: Results of 2006 Pollock Acoustic-Trawl Survey Bering Sea- DY0606

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Scientists from the Alaska Fisheries Science Center’s (AFSC) Midwater Assessment and Conservation Engineering (MACE) Program conduct biennial echo...

  10. AFSC/RACE/MACE: Results of 2012 acoustic trawl survey Shelikof DY1203

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Scientists from the Midwater Assessment and Conservation Engineering (MACE) Program of the Alaska Fisheries Science Center (AFSC) Resource Assessment and...

  11. AFSC/RACE/MACE: Results of 2011 acoustic trawl survey Gulf of Alaska DY1103

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Scientists from the Midwater Assessment and Conservation Engineering (MACE) Program of the Alaska Fisheries Science Center (AFSC) Resource Assessment and...

  12. Local Control After Intensity-Modulated Radiotherapy for Head-and-Neck Rhabdomyosarcoma

    International Nuclear Information System (INIS)

    Curtis, Amarinthia E.; Okcu, M. Fatih; Chintagumpala, Murali; Teh, Bin S.; Paulino, Arnold C.

    2009-01-01

    Purpose: To examine the patterns of failure in patients treated with intensity-modulated radiotherapy (IMRT) for head-and-neck rhabdomyosarcoma (RMS). Methods and Materials: Between 1998 and 2005, 19 patients with a diagnosis of head-and-neck RMS received IMRT at The Methodist Hospital. There were 11 male and 8 female patients, with a median age of 6 years at time of irradiation. Tumor location was parameningeal in 7, orbital in 6, and other head-and-neck RMS in 6. Chemotherapy was given to all patients, with vincristine, actinomycin D, and cyclophosphamide being the most common regimen (n = 18). The median prescribed dose was 5040 cGy. The clinical target volume included the gross tumor volume with a 1.5-cm margin. The median duration of follow-up for surviving patients was 56 months. Results: The 4-year overall survival and local control rates were 76% and 92.9%, respectively. One patient developed a local failure in the high-dose region of the radiation field; there were no marginal failures. Distant metastasis was seen in 4 patients. Overall survival was 42.9% for parameningeal sites and 100% for other sites (p < 0.01). Late toxicities were seen in 7 patients. Two secondary malignancies occurred in 1 child with embryonal RMS of the face and a p53 mutation. Conclusions: Local control was excellent in patients receiving IMRT for head-and-neck RMS. Patterns of local failure reveal no marginal failures in this group of patients

  13. Results of MACE tests M0 and M1

    International Nuclear Information System (INIS)

    Spencer, B.W.; Farmer, M.T.; Armstrong, D.R.; Kilsdonk, D.J.; Aeschlimann, R.W.; Fischer, M.

    1992-01-01

    This document discusses the Melt Attack and Coolability Experiment (MACE) Program underway at Argonne National Laboratory under ACE/EPRI sponsorship. The program addresses the efficacy of water to terminate an accident situation if melt progression were to result in a molten core/concrete interaction (MCCI) in the reactor containment. Large-scale experiments are being conducted in parallel with related modeling efforts, involving the addition of water to an MCI already underway. The experiments utilize UO 2 /ZrO 2 /Zr corium mixtures, direct electrical heating for simulation of decay heating, and various types of concrete basemats. Currently the tests involve 430 kg corium mass, 25 cm depth, in a 50 cm square test section. Test MO was a successful scoping test, but the first full size test, Ml, failed to achieve melt-water contact owing to existence of a preexisting bridge crust of corium charge. A heat flux of 3.5 MW/m 2 was measured in MO which removed energy from the corium pool equivalent to its entire heat of solidification prior to abatement by formation of an interfacial crust. The crust subsequently limited heat extraction to 600 kW/m 2 and less. Both tests MO and Ml revealed physical evidence of large pool swelling events which resulted in extrusion (and ejection) of melt into water above the crust, significantly increasing the overall quench and reducing the remaining melt in contact with the concrete. Furthermore, test Ml provided evidence of occasional ''burst mode'' ablation events and one additional important benefit of overlying water -- aerosol capture

  14. Utilizing Chinese Admission Records for MACE Prediction of Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Danqing Hu

    2016-09-01

    Full Text Available Background: Clinical major adverse cardiovascular event (MACE prediction of acute coronary syndrome (ACS is important for a number of applications including physician decision support, quality of care assessment, and efficient healthcare service delivery on ACS patients. Admission records, as typical media to contain clinical information of patients at the early stage of their hospitalizations, provide significant potential to be explored for MACE prediction in a proactive manner. Methods: We propose a hybrid approach for MACE prediction by utilizing a large volume of admission records. Firstly, both a rule-based medical language processing method and a machine learning method (i.e., Conditional Random Fields (CRFs are developed to extract essential patient features from unstructured admission records. After that, state-of-the-art supervised machine learning algorithms are applied to construct MACE prediction models from data. Results: We comparatively evaluate the performance of the proposed approach on a real clinical dataset consisting of 2930 ACS patient samples collected from a Chinese hospital. Our best model achieved 72% AUC in MACE prediction. In comparison of the performance between our models and two well-known ACS risk score tools, i.e., GRACE and TIMI, our learned models obtain better performances with a significant margin. Conclusions: Experimental results reveal that our approach can obtain competitive performance in MACE prediction. The comparison of classifiers indicates the proposed approach has a competitive generality with datasets extracted by different feature extraction methods. Furthermore, our MACE prediction model obtained a significant improvement by comparison with both GRACE and TIMI. It indicates that using admission records can effectively provide MACE prediction service for ACS patients at the early stage of their hospitalizations.

  15. Family history predicts major adverse cardiovascular events (MACE) in young adults with psoriasis

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Bruun, Louise E; Mallbris, Lotus

    2016-01-01

    BACKGROUND: Patients with psoriasis may have increased risk of major adverse cardiovascular (CV) events (MACE), and a family history of CV disease (CVD) is an independent risk factor for MACE. OBJECTIVE: We investigated the risk of first-time MACE in patients with psoriasis with or without a fami....... The findings call for increased focus on a family history of CVD in CV risk assessment of patients with psoriasis.......BACKGROUND: Patients with psoriasis may have increased risk of major adverse cardiovascular (CV) events (MACE), and a family history of CV disease (CVD) is an independent risk factor for MACE. OBJECTIVE: We investigated the risk of first-time MACE in patients with psoriasis with or without a family...... history of CVD. METHODS: Between January 1, 1997, and December 31, 2011, we identified 2,722,375 individuals, including 25,774 and 4504 patients with mild and severe psoriasis, through administrative registers. Incidence rate ratios were estimated by Poisson regression. RESULTS: Mean baseline age was 26...

  16. Boron Neutron Capture Therapy in the Treatment of Locally Recurred Head and Neck Cancer

    International Nuclear Information System (INIS)

    Kankaanranta, Leena; Seppaelae, Tiina; Koivunoro, Hanna; Saarilahti, Kauko; Atula, Timo; Collan, Juhani; Salli, Eero; Kortesniemi, Mika; Uusi-Simola, Jouni; Maekitie, Antti; Seppaenen, Marko; Minn, Heikki; Kotiluoto, Petri; Auterinen, Iiro; Savolainen, Sauli; Kouri, Mauri; Joensuu, Heikki

    2007-01-01

    Purpose: Head and neck carcinomas that recur locally after conventional irradiation pose a difficult therapeutic problem. We evaluated safety and efficacy of boron neutron capture therapy (BNCT) in the treatment of such cancers. Methods and Materials: Twelve patients with inoperable, recurred, locally advanced (rT3, rT4, or rN2) head and neck cancer were treated with BNCT in a prospective, single-center Phase I-II study. Prior treatments consisted of surgery and conventionally fractionated photon irradiation to a cumulative dose of 56-74 Gy administered with or without concomitant chemotherapy. Tumor responses were assessed using the RECIST (Response Evaluation Criteria in Solid Tumors) criteria and adverse effects using the National Cancer Institute common toxicity grading v3.0. Intravenously administered boronophenylalanine-fructose (BPA-F, 400 mg/kg) was used as the boron carrier. Each patient was scheduled to be treated twice with BNCT. Results: Ten patients received BNCT twice; 2 were treated once. Ten (83%) patients responded to BNCT, and 2 (17%) had tumor growth stabilization for 5.5 and 7.6 months. The median duration of response was 12.1 months; six responses were ongoing at the time of analysis or death (range, 4.9-19.2 months). Four (33%) patients were alive without recurrence with a median follow-up of 14.0 months (range, 12.8-19.2 months). The most common acute adverse effects were mucositis, fatigue, and local pain; 2 patients had a severe (Grade 3) late adverse effect (xerostomia, 1; dysphagia, 1). Conclusions: Boron neutron capture therapy is effective and safe in the treatment of inoperable, locally advanced head and neck carcinomas that recur at previously irradiated sites

  17. Image quality and localization accuracy in C-arm tomosynthesis-guided head and neck surgery

    International Nuclear Information System (INIS)

    Bachar, G.; Siewerdsen, J. H.; Daly, M. J.; Jaffray, D. A.; Irish, J. C.

    2007-01-01

    The image quality and localization accuracy for C-arm tomosynthesis and cone-beam computed tomography (CBCT) guidance of head and neck surgery were investigated. A continuum in image acquisition was explored, ranging from a single exposure (radiograph) to multiple projections acquired over a limited arc (tomosynthesis) to a full semicircular trajectory (CBCT). Experiments were performed using a prototype mobile C-arm modified to perform 3D image acquisition (a modified Siemens PowerMobil). The tradeoffs in image quality associated with the extent of the source-detector arc (θ tot ), the number of projection views, and the total imaging dose were evaluated in phantom and cadaver studies. Surgical localization performance was evaluated using three cadaver heads imaged as a function of θ tot . Six localization tasks were considered, ranging from high-contrast feature identification (e.g., tip of a K-wire pointer) to more challenging soft-tissue delineation (e.g., junction of the hard and soft palate). Five head and neck surgeons and one radiologist participated as observers. For each localization task, the 3D coordinates of landmarks pinpointed by each observer were analyzed as a function of θ tot . For all tomosynthesis angles, image quality was highest in the coronal plane, whereas sagittal and axial planes exhibited a substantial decrease in spatial resolution associated with out-of-plane blur and distortion. Tasks involving complex, lower-contrast features demonstrated steeper degradation with smaller tomosynthetic arc. Localization accuracy in the coronal plane was correspondingly high, maintained to tot ∼30 deg. , whereas sagittal and axial localization degraded rapidly below θ tot ∼60 deg. . Similarly, localization precision was better than ∼1 mm within the coronal plane, compared to ∼2-3 mm out-of-plane for tomosynthesis angles below θ tot ∼45 deg. . An overall 3D localization accuracy of ∼2.5 mm was achieved with θ tot ∼ 90 deg. for most

  18. Four cases with localized brain-stem lesion on CT scan following closed head injury

    International Nuclear Information System (INIS)

    Saeki, Naokatsu; Odaki, Masaru; Oka, Nobuo; Takase, Manabu; Ono, Junichi.

    1981-01-01

    Cases of primary brain-stem injury following closed head injury, verified by a CT scan, have been increasingly reported. However, most of them have other intracranial lesions in addition to the brain stem, resulting in a poor outcome. The CT scan of 200 cases with severe head injury-Araki's classification of types 3 and 4 - were analysed. Four cases out of them had localized brain-stem lesion without any other significant intracranial injury on a CT scan at the acute stage and had a better outcome than had previously been reported. In this analysis, these 4 cases were studied, and the CT findings, prognosis, and pathogenesis of the localized brain-stem injury were discussed. Follow-up CT of three cases, and taken one month or more later, showed diffuse cortical atrophy. This may indicate the presence of diffuse cerebral injury which could not be seen on CT scans at the acute stage. This atrophic change may also be related with the mechanism of posttraumatic conscious impairment and posttraumatic neurological deficits, such as mental symptoms and impairment of the higher cortical function. Shearing injury is a probable pathogenesis for this diffuse cortical injury. On the other hand, one case did not have any cortical atrophy on a follow-up CT scan. Therefore, this is a case with a localized primary brain-stem injury. Coup injury against the brain stem by a tentorial margin in a case with a small tentorial opening is a possible mechanism producing the localized brain-stem injury. (J.P.N.)

  19. Treatment of locally advanced adenoid cystic carcinoma of the head and neck with neutron radiotherapy

    International Nuclear Information System (INIS)

    Douglas, James G.; Laramore, George E.; Austin-Seymour, Mary; Koh Wuijin; Stelzer, Keith; Griffin, Thomas W.

    2000-01-01

    Purpose: To examine the efficacy of fast neutron radiotherapy for the treatment of locally advanced and/or recurrent adenoid cystic carcinoma of the head and neck and to identify prognostic variables associated with local-regional control and survival. Methods and Materials: One hundred fifty-nine patients with nonmetastatic, previously unirradiated, locally advanced, and/or recurrent adenoid cystic carcinoma (ACC) of the head and neck region were treated with fast neutron radiotherapy during the years 1985-1997. One hundred fifty-one patients had either unresectable disease, or gross residual disease (GRD) after an attempted surgical extirpation. Eight patients had microscopic residual disease and were analyzed separately. Sixty-two percent of patients had tumors arising in minor salivary glands, 29% in major salivary glands, and 9% in other sites such as the lacrimal glands, tracheal-bronchial tree, etc. Fifty-five percent of patients were treated for postsurgical recurrent disease and 13% of patients had lymph node involvement at the time of treatment. The median duration of follow-up was 32 months (range 3-142 months). Actuarial curves for survival, cause-specific survival, local-regional control, and the development of distant metastases are presented for times out to 11 years. Results: The 5-year actuarial local-regional tumor control rate for the 151 patients with GRD was 57%; the 5-year actuarial overall survival rate was 72%; and the 5-year actuarial cause-specific survival rate was 77%. Variables associated with decreased local-regional control in the patients with GRD as determined by multivariate analysis included base of skull involvement (p < 0.01) and biopsy only versus an attempted surgical resection prior to treatment (p = 0.03). Patients without these negative factors had an actuarial local-regional control rate of 80% at 5 years. Patients with microscopic residual disease (n = 8) had a 5-year actuarial local-regional control rate of 100%. Base of

  20. Accelerated superfractionated radiotherapy with concomitant boost for locally advanced head-and-neck squamous cell carcinomas

    International Nuclear Information System (INIS)

    Morris, Monica M.; Schmidt-Ullrich, Rupert K.; DiNardo, L.; Manning, Matthew A.; Silverman, L.; Clay, L.; Johnson, Christopher R.; Amir, Cyrus

    2002-01-01

    Purpose: A growing body of evidence supports the efficacy of accelerated superfractionated radiotherapy with concomitant boost for advanced head-and-neck carcinomas. This study represents a single-institution experience, performed to identify the factors influencing tumor control, survival, and toxicity. Methods and Materials: Between 1988 and 1999, 133 patients with primary squamous cell head-and-neck carcinoma underwent accelerated superfractionated radiotherapy using a concomitant boost. The concomitant boost in this regimen was delivered using reduced fields delivered 3 times weekly in a twice-daily schedule during the final phase. The total radiation dose ranged from 64.8 Gy to 76.5 Gy (mean 71.1). Patients were evaluated in follow-up for local control and late toxicity. Multivariate analysis of treatment and patient parameters was performed to evaluate their influence on toxicity, local control, and overall survival. Results: With a mean follow-up of 37 months, the actuarial overall survival rate for the entire group at 5 years was 24% and the local control rate was 57%. The tumor volume was the most significant predictor of local control, such that each 1-cm 3 increase in volume was associated with a 1% decrease in local control. For patients with tumor volumes ≤30 cm 3 vs. >30 cm 3 , the 5-year disease-specific survival rate was 52% and 27% (p = 0.004) and locoregional control rate was 76% and 26% (p<0.001), respectively. Seventy-six patients with a minimum of 12 months and median of 39 months toxicity follow-up were studied for late effects. None of these patients experienced Grade 4 or 5 toxicity. The actuarial rate of significant toxicity (Grade III or greater) was 32% at 5 years. Of the toxicities observed, xerostomia (19%) was the most common. Multivariate analysis revealed N stage and dose as independent predictors of Grade 3 effects. Conclusion: The locoregional control and survival for patients in this institutional experience compare favorably to

  1. Salvage Reirradiaton With Stereotactic Body Radiotherapy for Locally Recurrent Head-and-Neck Tumors

    International Nuclear Information System (INIS)

    Cengiz, Mustafa; Ozyigit, Goekhan; Yazici, Goezde; Dogan, Ali; Yildiz, Ferah; Zorlu, Faruk; Guerkaynak, Murat; Gullu, Ibrahim H.; Hosal, Sefik; Akyol, Fadil

    2011-01-01

    Purpose: In this study, we present our results of reirradiation of locally recurrent head-and-neck cancer with image-guided, fractionated, frameless stereotactic body radiotherapy technique. Methods and Materials: From July 2007 to February 2009, 46 patients were treated using the CyberKnife (Accuray, Sunnyvale, CA) at the Department of Radiation Oncology, Hacettepe University, Ankara, Turkey. All patients had recurrent, unresectable, and previously irradiated head-and-neck cancer. The most prominent site was the nasopharynx (32.6%), and the most common histopathology was epidermoid carcinoma. The planning target volume was defined as the gross tumor volume identified on magnetic resonance imaging and computed tomography. There were 22 female and 24 male patients. Median age was 53 years (range, 19-87 years). The median tumor dose with stereotactic body radiotherapy was 30 Gy (range, 18-35 Gy) in a median of five (range, one to five) fractions. Results: Of 37 patients whose response to therapy was evaluated, 10 patients (27%) had complete tumor regression, 11 (29.8%) had partial response, and 10 (27%) had stable disease. Ultimate local disease control was achieved in 31 patients (83.8%). The overall survival was 11.93 months in median (ranged, 11.4 - 17.4 months), and the median progression free survival was 10.5 months. One-year progression-free survival and overall survival were 41% and 46%, respectively. Grade II or greater long-term complications were observed in 6 (13.3%) patients. On follow-up, 8 (17.3%) patients had carotid blow-out syndrome, and 7 (15.2%) patients died of bleeding from carotid arteries. We discovered that this fatal syndrome occurred only in patients with tumor surrounding carotid arteries and carotid arteries receiving all prescribed dose. Conclusions: Stereotactic body radiotherapy is an appealing treatment option for patients with recurrent head-and-neck cancer previously treated with radiation to high doses. Good local control with

  2. [Planned neck dissection in the treatment of locally advanced head and neck squamous cell carcinoma].

    Science.gov (United States)

    Jiang, L; Lou, J L; Wang, K J; Fang, M Y; Fu, Z F

    2018-02-07

    Objective: To investigate the value of planned neck dissection combined with induction chemotherapy and concurrent chemoradiotherapy in regional control and the outcome of locally advanced head and neck squamous cell carcinoma. Methods: A prospective randomized controlled study totally enrolled sixty-four patients of head and neck squamous cell carcinomas(include oropharynx, hypopharynx, and larynx) in stages Ⅳa-Ⅳb with lymph node metastase was were N2-N3. All patients firstly received 2-3 cycles of induction chemotherapy(ICT), then divided into two groups randomly, according to the efficacy of ICT. Group A(the study group) received planned neck dissection(PND) and concurrent chemoradiotherapy(CCRT). Group B(the control group) received concurrent chemoradiotherapy(CCRT). The differences in clinicopathologic features, local recurrence(LR), regional recurrence(RR), disease-free survival(DFS), and overall survival(OS) between the two groups were estimated. SPSS 19.0 software was used to analyze the data. Results: Group A enrolled twenty-one patients, and group B enrolled forty-three patients.The follow-up of all patients were 4-55 months, median follow-up time was 22 months. In study group, two-year OS and DFS were 80.9% and 68.3%, respectively. In control group, two-year OS and DFS were 90.7% and 67.1%, respectively. There was no significant difference in gender( P =0.215), age( P =0.828), primary tumor site( P =0.927), LR( P =0.126), DFS( P =0.710), and OS( P =0.402) between the two groups, while the RR(χ(2)=5.640, P squamous cell carcinoma.

  3. Comparison of the 2MACE and TIMI-AF Scores for Composite Clinical Outcomes in Anticoagulated Atrial Fibrillation Patients

    DEFF Research Database (Denmark)

    Pastori, Daniele; Rivera-Caravaca, José Miguel; Esteve-Pastor, María Asunción

    2018-01-01

    BACKGROUND: Two risk scores have been developed to predict composite outcomes in atrial fibrillation (AF): the 2MACE and TIMI-AF scores. The aim of this study was to compare the predictive ability of these scores in 2 separate warfarin-treated cohorts (one 'real world', one clinical trial) of AF...... patients.Methods and Results:The 2MACE and TIMI-AF scores were calculated in the 'real-world' ATHERO-AF cohort (n=907), and in the randomized controlled AMADEUS trial (n=2,265). Endpoints were major adverse cardiovascular events (MACEs), net clinical outcomes (NCO) and a combination of them, namely...... showed that the 2MACE and TIMI-AF scores had modest but significant predictive ability for composite outcomes in AF. The clinical usefulness of both scores was similar, but the 2MACE score may be simpler and easy to use....

  4. Nanostructured silicon via metal assisted catalyzed etch (MACE): chemistry fundamentals and pattern engineering

    Science.gov (United States)

    Toor, Fatima; Miller, Jeffrey B.; Davidson, Lauren M.; Nichols, Logan; Duan, Wenqi; Jura, Michael P.; Yim, Joanne; Forziati, Joanne; Black, Marcie R.

    2016-10-01

    There are a range of different methods to generate a nanostructured surface on silicon (Si) but the most cost effective and optically interesting is the metal assisted wet chemical etching (MACE) (Koynov et al 2006 Appl. Phys. Lett. 88 203107). MACE of Si is a controllable, room-temperature wet-chemical technique that uses a thin layer of metal to etch the surface of Si, leaving behind various nano- and micro-scale surface features or ‘black silicon’. MACE-fabricated nanowires (NWs) provide improved antireflection and light trapping functionality (Toor et al 2016 Nanoscale 8 15448-66) compared with the traditional ‘iso-texturing’ (Campbell and Green 1987 J. Appl. Phys. 62 243-9). The resulting lower reflection and improved light trapping can lead to higher short circuit currents in NW solar cells (Toor et al 2011 Appl. Phys. Lett. 99 103501). In addition, NW cells can have higher fill factors and voltages than traditionally processed cells, thus leading to increased solar cell efficiencies (Cabrera et al 2013 IEEE J. Photovolt. 3 102-7). MACE NW processing also has synergy with next generation Si solar cell designs, such as thin epitaxial-Si and passivated emitter rear contact (Toor et al 2016 Nanoscale 8 15448-66). While several companies have begun manufacturing black Si, and many more are researching these techniques, much of the work has not been published in traditional journals and is publicly available only through conference proceedings and patent publications, which makes learning the field challenging. There have been three specialized review articles published recently on certain aspects of MACE or black Si, but do not present a full review that would benefit the industry (Liu et al 2014 Energy Environ. Sci. 7 3223-63 Yusufoglu et al 2015 IEEE J. Photovolt. 5 320-8 Huang et al 2011 Adv. Mater. 23 285-308). In this feature article, we review the chemistry of MACE and explore how changing parameters in the wet etch process effects the resulting

  5. Determinants of Patient-Centered Financial Stress in Patients With Locally Advanced Head and Neck Cancer.

    Science.gov (United States)

    de Souza, Jonas A; Kung, Sunny; O'Connor, Jeremy; Yap, Bonnie J

    2017-04-01

    To prospectively estimate patient-centered financial stress and its relationship with health care utilization in patients with head and neck cancer. This was a survey-based, longitudinal, prospective study of treatment-naïve patients with stage III, IVa, or IVb locally advanced head and neck cancer at a single-institution tertiary care hospital from May 2013 to November 2014. With 121 patients approached, 73 (60%) agreed to participate. Self-reported data were collected on demographics, income, wealth, cost-coping strategies, out-of-pocket costs, supportive medication compliance, and perceived social isolation. Health care utilization was measured by hospital admissions and outpatient appointments on a 6-month timeline. Logistic regression models were constructed to identify factors associated with use of cost-coping strategies. Covariates included all demographics, measures of income, wealth, out-of-pocket costs, indirect costs, and perceived social isolation. Fifty-one patients (69%) relied on at least one coping strategy. On multivariable analysis, Medicaid patients were more likely than privately insured patients to use cost-coping strategies (odds ratio, 42.3; P = .0042). Decreased wealth ( P = .002) and higher total out-of-pocket costs ( P = .003) were independently associated with using cost-coping strategies. Patients with high perceived social isolation were also more likely to use cost-coping strategies (odds ratio, 11.5; P = .01). Patients with high perceived social isolation were more likely to report nonadherence to supportive medications (21.4 v 5.45 days over 6 months; P = .0278) and missed appointments (seven v three; P = .0077). A majority of patients used at least one cost-coping strategy during their treatment, highlighting the financial stress that patients experience. Perceived social isolation is an important social determinant of increased medication nonadherence, missed appointments, and use of cost-coping strategies. Interventions should

  6. Radiochemotherapy With Cetuximab, Cisplatin, and Amifostine for Locally Advanced Head and Neck Cancer: A Feasibility Study

    International Nuclear Information System (INIS)

    Koukourakis, Michael I.; Tsoutsou, Pelagia G.; Karpouzis, Antonios; Tsiarkatsi, Maria; Karapantzos, Ilias; Daniilidis, Vassilios; Kouskoukis, Constantinos

    2010-01-01

    Purpose: Radiotherapy (RT) combined with cisplatin or cetuximab is the standard of care for patients with locally advanced head/neck cancer (LA-HNC). The feasibility of radiochemotherapy with cisplatin and cetuximab, supported with amifostine, was herein investigated. Methods and Materials: Forty-three patients with LA-HNC were recruited. Conformal hypofractionated/accelerated RT with amifostine cytoprotection (2.7 Gy/fraction, 21 fractions in 4 weeks) was combined with cisplatin (30 mg/m 2 /week) and cetuximab (standard weekly regimen) therapy. The dose of amifostine was individualized according to tolerance. Results: A high daily amifostine dose (750-1,000 mg) was tolerated by 41.8% of patients, and a standard dose (500 mg) was tolerated by 34.9% of patients. A high amifostine dose was linked to reduced RT delays (p = 0.0003). Grade 3 to 4 (3-4) mucositis occurred in 7/43 (16.2%) patients, and fungal infections occurred in 18/43 (41.8%) patients. Radiation dermatitis was not aggravated. Interruption of cetuximab due to acneiform rash was necessary in 23.3% of patients, while amifostine-related fever and rash were not observed. Severe late radiation sequelae consisted of laryngeal edema (9% laryngeal cases) and cervical strictures (33% of hypopharyngeal cases). Good salivary function was preserved in 6/11 (54.5%) nasopharyngeal cancer patients. The complete response rate was 68.5%, reaching 77.2% in patients with minor radiotherapy delays. The 24-month local control and survival rates were 72.3% and 91%, respectively (median follow-up was 13 months.). Conclusions: In this feasibility study, weekly administration of cisplatin and cetuximab was safely combined with accelerated RT, supported with amifostine, at the cost of a high incidence of acneiform rash but a reduced incidence of amifostine-related fever/rash. A high daily dose of amifostine allows completion of therapy with minor delays.

  7. Very accelerated radiation therapy: preliminary results in locally unresectable head and neck carcinomas

    Energy Technology Data Exchange (ETDEWEB)

    Bourhis, Jean; Fortin, Andre; Dupuis, Olivier; Domenge, Christian; Lusinchi, Antoine; Marandas, Patrick; Schwaab, Guy; Armand, Jean Pierre; Luboinski, Bernard; Malaise, Edmond; Eschwege, Francois; Wibault, Pierre

    1995-06-15

    Purpose: To report preliminary results of a very accelerated radiation therapy Phase I/II trial in locally advanced head and squamous cell carcinomas (HNSCC). Methods and Materials: Between 01/92 and 06/93, 35 patients with an unresectable HNSCC were entered in this study. Thirty-two (91%) had Stage IV, and 3 had Stage III disease. The mean nodal diameter, in patients with clinically involved nodes (83%), was 6.3 cm. The median Karnovsky performance status was 70. The treatment consisted of a twice daily schedule (BID) giving 62 Gy in 20 days. Results: In all cases, confluent mucositis was observed, which started about day 15 and resolved within 6 to 10 weeks. Eighty percent of patients had enteral nutritional support. The nasogastric tube or gastrostomy was maintained in these patients for a mean duration of 51.8 days. Eighteen patients (53%) were hospitalized during the course of treatment due to a poor medical status or because they lived far from the center (mean 25 days). Nineteen patients (56%) (some of whom were initially in-patients) were hospitalized posttreatment for toxicity (mean 13 days). Five patients (15%) were never hospitalized. During the follow-up period, 12 local and/or regional failures were observed. The actuarial 18-month loco-regional control rate was 59% (95% confidence interval, 45-73%). Conclusions: The dramatic shortening of radiation therapy compared to conventional schedules in our series of very advanced HNSCC resulted in: (a) severe acute mucosal toxicity, which was manageable but required intensive nutritional support in all cases; and (b) high loco-regional response rates, strongly suggesting that the time factor is likely to be critical for tumor control in this type of cancer.

  8. Risk prediction models for major adverse cardiac event (MACE) following percutaneous coronary intervention (PCI): A review

    Science.gov (United States)

    Manan, Norhafizah A.; Abidin, Basir

    2015-02-01

    Five percent of patients who went through Percutaneous Coronary Intervention (PCI) experienced Major Adverse Cardiac Events (MACE) after PCI procedure. Risk prediction of MACE following a PCI procedure therefore is helpful. This work describes a review of such prediction models currently in use. Literature search was done on PubMed and SCOPUS database. Thirty literatures were found but only 4 studies were chosen based on the data used, design, and outcome of the study. Particular emphasis was given and commented on the study design, population, sample size, modeling method, predictors, outcomes, discrimination and calibration of the model. All the models had acceptable discrimination ability (C-statistics >0.7) and good calibration (Hosmer-Lameshow P-value >0.05). Most common model used was multivariate logistic regression and most popular predictor was age.

  9. APhoRISM FP7 project: the Multi-platform volcanic Ash Cloud Estimation (MACE) infrastructure

    Science.gov (United States)

    Merucci, Luca; Corradini, Stefano; Bignami, Christian; Stramondo, Salvatore

    2014-05-01

    APHORISM is an FP7 project that aims to develop innovative products to support the management and mitigation of the volcanic and the seismic crisis. Satellite and ground measurements will be managed in a novel manner to provide new and improved products in terms of accuracy and quality of information. The Multi-platform volcanic Ash Cloud Estimation (MACE) infrastructure will exploit the complementarity between geostationary, and polar satellite sensors and ground measurements to improve the ash detection and retrieval and to fully characterize the volcanic ash clouds from source to the atmosphere. The basic idea behind the proposed method consists to manage in a novel manner, the volcanic ash retrievals at the space-time scale of typical geostationary observations using both the polar satellite estimations and in-situ measurements. The typical ash thermal infrared (TIR) retrieval will be integrated by using a wider spectral range from visible (VIS) to microwave (MW) and the ash detection will be extended also in case of cloudy atmosphere or steam plumes. All the MACE ash products will be tested on three recent eruptions representative of different eruption styles in different clear or cloudy atmospheric conditions: Eyjafjallajokull (Iceland) 2010, Grimsvotn (Iceland) 2011 and Etna (Italy) 2011-2012. The MACE infrastructure will be suitable to be implemented in the next generation of ESA Sentinels satellite missions.

  10. Concurrent Cisplatin and Radiation Versus Cetuximab and Radiation for Locally Advanced Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Koutcher, Lawrence, E-mail: Koutchel@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Sherman, Eric; Fury, Matthew [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Wolden, Suzanne [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zhang Zhigang; Mo Qianxing [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Stewart, Laschelle; Schupak, Karen; Gelblum, Daphna [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Wong, Richard; Kraus, Dennis; Shah, Jatin [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zelefsky, Michael [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Pfister, David [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Lee, Nancy [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2011-11-15

    Purpose: To compare concurrent cisplatin (CDDP) and radiation (RT) with cetuximab (C225) and RT for locally advanced head-and-neck cancer (LAHNC). Methods and Materials: This study retrospectively compared 174 consecutive, newly diagnosed LAHNC patients definitively treated from March 1, 2006, to April 1, 2008, with single-agent CDDP/RT (n = 125) or C225/RT (n = 49). We excluded patients who received additional concurrent, induction, or adjuvant systemic therapy; weekly cisplatin; prior head-and-neck radiotherapy; or primary surgical resection. Outcomes were analyzed by the Kaplan-Meier method, Cox model, and competing-risks analysis tools. Results: The C225/RT patients were older and had decreased creatinine clearance. At a median follow-up of 22.5 months for living patients, the 2-year locoregional failure rate was 5.7% for CDDP/RT and 39.9% for C225/RT (p < 0.0001). The 2-year failure-free survival (FFS) and overall survival (OS) rates were 87.4% vs. 44.5% (p < 0.0001) and 92.8% vs. 66.6% (p = 0.0003), respectively, in favor of CDDP/RT. When the Cox proportional hazards model was used for multivariate analysis, treatment with CDDP/RT predicted for improved locoregional control (p < 0.0001), FFS (p < 0.0001), and OS (p = 0.01). Late Grade 3 or 4 toxicity or feeding tube dependence 9 months after completion of RT was observed in 21% of patients in the CDDP/RT cohort and 24% in the C225/RT cohort (p = 0.66). Conclusions: In this study of LAHNC patients, CDDP/RT achieved better locoregional control, FFS, and OS than C225/RT. Although the results were upheld on multivariate analysis, they must be interpreted cautiously because of the retrospective nature of the study and significant differences in patient selection. There was no statistically significant difference in late Grade 3 or 4 effects or feeding tube dependence.

  11. Patterns of Care for Elderly Patients With Locally Advanced Head and Neck Cancer.

    Science.gov (United States)

    Juarez, Jesus E; Choi, Jehee; St John, Maie; Abemayor, Elliot; TenNapel, Mindi; Chen, Allen M

    2017-07-15

    To compare patterns of care for elderly patients aged ≥70 years with locally advanced head and neck cancer versus those of younger patients treated for the same disease. The medical records of 421 consecutive patients over the age of 50 years treated at a single institution between April 2011 and June 2016 for stage III/IV squamous cell carcinoma of the head and neck were reviewed. The primary treatment approach was compared using a t test statistic among 3 age cohorts: 50 to 59 years (118 patients); 60 to 69 years (152 patients); and 70 years and older (151 patients). Logistical regression was used to determine variables that influenced the likelihood of receiving surgery versus nonsurgical treatment, as well as radiation alone versus chemoradiation. There was no difference in sex, T stage, N stage, Karnofsky performance status, or the number of chronic comorbid conditions among the 3 age cohorts (P>.05 for all). A greater proportion of elderly patients aged ≥70 years were treated by radiation alone compared with those aged 50 to 59 and 60 to 69 years (44% vs 16% and 24%, P=.01). Increasing age was associated with a greater likelihood of receiving primary nonsurgical versus surgical treatment (odds ratio 1.023, 95% confidence interval 1.004-1.042) and radiation alone compared with chemoradiation (odds ratio 1.054; 95% confidence interval 1.034-1.075). Ten chemotherapy regimens were used concurrently with radiation for patients aged ≥70 years, including carboplatin/paclitaxel (19%), carboplatin/cetuximab (19%), cisplatin (17%), and cetuximab (17%). Despite similar performance status and comorbidity burden compared with their younger counterparts, patients aged ≥70 years were more commonly treated with less-aggressive strategies, including radiation alone. The variability of concurrent chemotherapy regimens used further suggests that the standard of care remains to be defined for this population. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Dual-head gamma camera system for intraoperative localization of radioactive seeds

    International Nuclear Information System (INIS)

    Arsenali, B; Viergever, M A; Gilhuijs, K G A; De Jong, H W A M; Beijst, C; Dickerscheid, D B M

    2015-01-01

    Breast-conserving surgery is a standard option for the treatment of patients with early-stage breast cancer. This form of surgery may result in incomplete excision of the tumor. Iodine-125 labeled titanium seeds are currently used in clinical practice to reduce the number of incomplete excisions. It seems likely that the number of incomplete excisions can be reduced even further if intraoperative information about the location of the radioactive seed is combined with preoperative information about the extent of the tumor. This can be combined if the location of the radioactive seed is established in a world coordinate system that can be linked to the (preoperative) image coordinate system. With this in mind, we propose a radioactive seed localization system which is composed of two static ceiling-suspended gamma camera heads and two parallel-hole collimators. Physical experiments and computer simulations which mimic realistic clinical situations were performed to estimate the localization accuracy (defined as trueness and precision) of the proposed system with respect to collimator-source distance (ranging between 50 cm and 100 cm) and imaging time (ranging between 1 s and 10 s). The goal of the study was to determine whether or not a trueness of 5 mm can be achieved if a collimator-source distance of 50 cm and imaging time of 5 s are used (these specifications were defined by a group of dedicated breast cancer surgeons). The results from the experiments indicate that the location of the radioactive seed can be established with an accuracy of 1.6 mm  ±  0.6 mm if a collimator-source distance of 50 cm and imaging time of 5 s are used (these experiments were performed with a 4.5 cm thick block phantom). Furthermore, the results from the simulations indicate that a trueness of 3.2 mm or less can be achieved if a collimator-source distance of 50 cm and imaging time of 5 s are used (this trueness was achieved for all 14 breast phantoms which

  13. In vitro pediculicidal activity of herbal shampoo base on Thai local plants against head louse (Pediculus humanus capitis De Geer).

    Science.gov (United States)

    Rassami, Watcharawit; Soonwera, Mayura

    2013-04-01

    Head lice infestation, a worldwide head infestation caused Pediculus humanus capitis De Geer, is an important public health problem in Thailand. Several chemical pediculicides have lost in efficacy due to increasing resistance of lice against insecticide. Therefore, non-toxic alternative products, such as natural products from plants, e.g. plant extract pediculicides, are needed for head lice control. The aims of this study were to evaluate the potential of pediculicidal activity of herbal shampoo base on three species of Thai local plants (Accacia concinna (Willd.) DC, Averrhoa bilimbi Linn. and Tamarindus indica Linn.) against head lice and to compare them with carbaryl shampoo (Hafif shampoo®; 0.6% w/v carbaryl) and non-treatment control in order to assess their in vitro. Doses of 0.12 and 0.25 ml/cm2 of each herbal shampoo were applied to filter paper, and ten head lice were place on the filter paper. The mortalities of head lice on the filter paper were recorded at 1, 5, 10, 30 and 60 min by sterio-microscope. All herbal shampoos at 0.25 ml/cm2 were more effective pediculicide than carbaryl shampoo with 100% mortality at 5 min. The median lethal time (LT50) of all herbal shampoos at 0.25 ml/cm2 showed no significant differences over at 0.12 ml/cm2 (Pshampoo, followed by Av. bilimbi extract shampoo and Ac. concinna extract shampoo, with LT50 valuesshampoos have high potential of pediculicide to head lice treatments for schoolchildren.

  14. The New York Head-A precise standardized volume conductor model for EEG source localization and tES targeting.

    Science.gov (United States)

    Huang, Yu; Parra, Lucas C; Haufe, Stefan

    2016-10-15

    In source localization of electroencephalograpic (EEG) signals, as well as in targeted transcranial electric current stimulation (tES), a volume conductor model is required to describe the flow of electric currents in the head. Boundary element models (BEM) can be readily computed to represent major tissue compartments, but cannot encode detailed anatomical information within compartments. Finite element models (FEM) can capture more tissue types and intricate anatomical structures, but with the higher precision also comes the need for semi-automated segmentation, and a higher computational cost. In either case, adjusting to the individual human anatomy requires costly magnetic resonance imaging (MRI), and thus head modeling is often based on the anatomy of an 'arbitrary' individual (e.g. Colin27). Additionally, existing reference models for the human head often do not include the cerebro-spinal fluid (CSF), and their field of view excludes portions of the head and neck-two factors that demonstrably affect current-flow patterns. Here we present a highly detailed FEM, which we call ICBM-NY, or "New York Head". It is based on the ICBM152 anatomical template (a non-linear average of the MRI of 152 adult human brains) defined in MNI coordinates, for which we extended the field of view to the neck and performed a detailed segmentation of six tissue types (scalp, skull, CSF, gray matter, white matter, air cavities) at 0.5mm(3) resolution. The model was solved for 231 electrode locations. To evaluate its performance, additional FEMs and BEMs were constructed for four individual subjects. Each of the four individual FEMs (regarded as the 'ground truth') is compared to its BEM counterpart, the ICBM-NY, a BEM of the ICBM anatomy, an 'individualized' BEM of the ICBM anatomy warped to the individual head surface, and FEMs of the other individuals. Performance is measured in terms of EEG source localization and tES targeting errors. Results show that the ICBM-NY outperforms

  15. Exploiting Deep Neural Networks and Head Movements for Robust Binaural Localization of Multiple Sources in Reverberant Environments

    DEFF Research Database (Denmark)

    Ma, Ning; May, Tobias; Brown, Guy J.

    2017-01-01

    This paper presents a novel machine-hearing system that exploits deep neural networks (DNNs) and head movements for robust binaural localization of multiple sources in reverberant environments. DNNs are used to learn the relationship between the source azimuth and binaural cues, consisting...... of the complete cross-correlation function (CCF) and interaural level differences (ILDs). In contrast to many previous binaural hearing systems, the proposed approach is not restricted to localization of sound sources in the frontal hemifield. Due to the similarity of binaural cues in the frontal and rear...

  16. Genotyping of human lice suggests multiple emergencies of body lice from local head louse populations.

    Directory of Open Access Journals (Sweden)

    Wenjun Li

    Full Text Available BACKGROUND: Genetic analyses of human lice have shown that the current taxonomic classification of head lice (Pediculus humanus capitis and body lice (Pediculus humanus humanus does not reflect their phylogenetic organization. Three phylotypes of head lice A, B and C exist but body lice have been observed only in phylotype A. Head and body lice have different behaviours and only the latter have been involved in outbreaks of infectious diseases including epidemic typhus, trench fever and louse borne recurrent fever. Recent studies suggest that body lice arose several times from head louse populations. METHODS AND FINDINGS: By introducing a new genotyping technique, sequencing variable intergenic spacers which were selected from louse genomic sequence, we were able to evaluate the genotypic distribution of 207 human lice. Sequence variation of two intergenic spacers, S2 and S5, discriminated the 207 lice into 148 genotypes and sequence variation of another two intergenic spacers, PM1 and PM2, discriminated 174 lice into 77 genotypes. Concatenation of the four intergenic spacers discriminated a panel of 97 lice into 96 genotypes. These intergenic spacer sequence types were relatively specific geographically, and enabled us to identify two clusters in France, one cluster in Central Africa (where a large body louse outbreak has been observed and one cluster in Russia. Interestingly, head and body lice were not genetically differentiated. CONCLUSIONS: We propose a hypothesis for the emergence of body lice, and suggest that humans with both low hygiene and head louse infestations provide an opportunity for head louse variants, able to ingest a larger blood meal (a required characteristic of body lice, to colonize clothing. If this hypothesis is ultimately supported, it would help to explain why poor human hygiene often coincides with outbreaks of body lice. Additionally, if head lice act as a reservoir for body lice, and that any social degradation in

  17. The 'Maltreatment and Abuse Chronology of Exposure' (MACE scale for the retrospective assessment of abuse and neglect during development.

    Directory of Open Access Journals (Sweden)

    Martin H Teicher

    Full Text Available There is increasing interest in childhood maltreatment as a potent stimulus that may alter trajectories of brain development, induce epigenetic modifications and enhance risk for medical and psychiatric disorders. Although a number of useful scales exist for retrospective assessment of abuse and neglect they have significant limitations. Moreover, they fail to provide detailed information on timing of exposure, which is critical for delineation of sensitive periods. The Maltreatment and Abuse Chronology of Exposure (MACE scale was developed in a sample of 1051 participants using item response theory to gauge severity of exposure to ten types of maltreatment (emotional neglect, non-verbal emotional abuse, parental physical maltreatment, parental verbal abuse, peer emotional abuse, peer physical bullying, physical neglect, sexual abuse, witnessing interparental violence and witnessing violence to siblings during each year of childhood. Items included in the subscales had acceptable psychometric properties based on infit and outfit mean square statistics, and each subscale passed Andersen's Likelihood ratio test. The MACE provides an overall severity score and multiplicity score (number of types of maltreatment experienced with excellent test-retest reliability. Each type of maltreatment showed good reliability as did severity of exposure across each year of childhood. MACE Severity correlated 0.738 with Childhood Trauma Questionnaire (CTQ score and MACE Multiplicity correlated 0.698 with the Adverse Childhood Experiences scale (ACE. However, MACE accounted for 2.00- and 2.07-fold more of the variance, on average, in psychiatric symptom ratings than CTQ or ACE, respectively, based on variance decomposition. Different types of maltreatment had distinct and often unique developmental patterns. The 52-item MACE, a simpler Maltreatment Abuse and Exposure Scale (MAES that only assesses overall exposure and the original test instrument (MACE-X with

  18. Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Locally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Caudell, Jimmy J.; Schaner, Philip E.; Meredith, Ruby F.; Locher, Julie L.; Nabell, Lisle M.; Carroll, William R.; Magnuson, J. Scott; Spencer, Sharon A.; Bonner, James A.

    2009-01-01

    Purpose: The use of altered fractionation radiotherapy (RT) regimens, as well as concomitant chemotherapy and RT, to intensify therapy for locally advanced head-and-neck cancer can lead to increased rates of long-term dysphagia. Methods and Materials: We identified 122 patients who had undergone definitive RT for locally advanced head-and-neck cancer, after excluding those who had been treated for a second or recurrent head-and-neck primary, had Stage I-II disease, developed locoregional recurrence, had <12 months of follow-up, or had undergone postoperative RT. The patient, tumor, and treatment factors were correlated with a composite of 3 objective endpoints as a surrogate for severe long-term dysphagia: percutaneous endoscopic gastrostomy tube dependence at the last follow-up visit; aspiration on a modified barium swallow study or a clinical diagnosis of aspiration pneumonia; or the presence of a pharyngoesophageal stricture. Results: A composite dysphagia outcome occurred in 38.5% of patients. On univariate analysis, the primary site (p = 0.01), use of concurrent chemotherapy (p = 0.01), RT schedule (p = 0.02), and increasing age (p = 0.04) were significantly associated with development of composite long-term dysphagia. The use of concurrent chemotherapy (p = 0.01), primary site (p = 0.02), and increasing age (p = 0.02) remained significant on multivariate analysis. Conclusion: The addition of concurrent chemotherapy to RT for locally advanced head-and-neck cancer resulted in increased long-term dysphagia. Early intervention using swallowing exercises, avoidance of nothing-by-mouth periods, and the use of intensity-modulated RT to reduce the dose to the uninvolved swallowing structures should be explored further in populations at greater risk of long-term dysphagia

  19. Case Report: Down-staging locally advanced head and neck cancer ...

    African Journals Online (AJOL)

    big meta-analysis of chemotherapy in head and neck cancer. (MACH-NC) involving over ... and neck cancer of squamous cell histology, HIV infected who was down-staged ... of the submitted specimen confirmed ulcerated oral mucosa with an ...

  20. Postoperative radiation therapy following laser surgery in locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Pradier, O.; Schmidberger, H.; Christiansen, H.; Florez, R.; Hess, C.F.; Jackel, M.C.; Steiner, W.

    2002-01-01

    The results achieved with trans oral micro-surgery in advanced head and neck carcinoma with adjuvant radiotherapy are comparable to those with radical surgery. The haemoglobin level has an important role in the loco regional control and on survival. Split course radiation therapy regimen has not a place in the adjuvant situation. (author)

  1. Evaluation of the precision of portal-image-guided head-and-neck localization: An intra- and interobserver study

    International Nuclear Information System (INIS)

    Court, Laurence E.; Allen, Aaron; Tishler, Roy

    2007-01-01

    There is increasing evidence that, for some patients, image-guided intensity-modulated radiation therapy (IMRT) for head-and-neck cancer patients may maintain target dose coverage and critical organ (e.g., parotids) dose closer to the planned doses than setup using lasers alone. We investigated inter- and intraobserver uncertainties in patient setup in head-and-neck cancer patients. Twenty-two sets of orthogonal digital portal images (from five patients) were selected from images used for daily localization of head-and-neck patients treated with IMRT. To evaluate interobserver variations, five radiation therapists compared the portal images with the plan digitally reconstructed radiographs and reported shifts for the isocenter (∼C2) and for a supraclavicular reference point. One therapist repeated the procedure a month later to evaluate intraobserver variations. The procedure was then repeated with teams of two therapists. The frequencies for which agreement between the shift reported by the observer and the daily mean shift (average of all observers for a given image set) were less than 1.5 and 2.5 mm were calculated. Standard errors of measurement for the intra- and interobserver uncertainty (SEM intra and SEM inter ) for the individual and teams were calculated. The data showed that there was very little difference between individual therapists and teams. At isocenter, 80%-90% of all reported shifts agreed with the daily average within 1.5 mm, showing consistency in the ways both individuals and teams interpret the images (SEM inter ∼1 mm). This dropped to 65% for the supraclavicular point (SEM inter ∼1.5 mm). Uncertainties increased for larger setup errors. In conclusion, image-guided patient positioning allows head-and-neck patients to be controlled within 3-4 mm. This is similar to the setup uncertainties found for most head-and-neck patients, but may provide some improvement for the subset of patients with larger setup uncertainties

  2. Influence of low-dose daily cisplatin on the distant metastasis-free survival of patients with locally advanced nonmetastatic head and neck cancer treated with radiation therapy

    International Nuclear Information System (INIS)

    Jeremic, Branislav; Milicic, Biljana

    2008-01-01

    We investigated the impact of low dose daily cisplatin on distant metastasis-free survival (DMFS) in locally advanced head and neck cancer treated with hyperfractionated radiotherapy (77 Gy in 70 fractions in 35 treatment days). In locally controlled tumors cisplatin led to better DMFS (p = 0.0272); Cisplatin may have acted independently of micrometastasis in locally advanced H and N cancer

  3. Point of Care Neonatal Ultrasound - Head, Lung, Gut and Line Localization.

    Science.gov (United States)

    Rath, Chandra; Suryawanshi, Pradeep

    2016-10-08

    Knowledge and skills of heart, head, lung, gut and basic abdominal ultrasound is of immense utility to clinicians in their day-to-day patient management, and in acute events, in the absence of specialist service back-up. This review examines the potential role of clinician-performed ultrasound in the neonatal intensive care unit. The bibliographic search of English-language literature was performed electronically using PubMed and EMBASE databases for the different topics we have covered under this review. Bedside head ultrasound can be used to identify and screen for intraventricular hemorrhage, periventricular leukomalacia and post-hemorrhagic ventricular dilatation. It is also a useful adjuvant tool in the evaluation of hypoxic ischemic encephalopathy. The relatively new lung ultrasound technique is useful in identifying transient tachypnea, pneumonia, pneumothorax, fluid overload and pleural effusion. Gut ultrasound is useful in identifying necrotizing enterocolitis and probably is better than X-ray in prognostication. Ultrasound is also useful in identifying vascular line positions without radiation exposure. Ultrasound performed by the clinician has an extensive role in the neonatal intensive care unit. Basic ultrasound knowledge of head, lung and gut is a useful supplement to clinical decision-making.

  4. Long-Term Outcomes and Toxicity of Concurrent Paclitaxel and Radiotherapy for Locally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Citrin, Deborah; Mansueti, John; Likhacheva, Anna; Sciuto, Linda; Albert, Paul S.; Rudy, Susan F.; Cooley-Zgela, Theresa; Cotrim, Ana; Solomon, Beth; Colevas, A. Dimitrios; Russo, Angelo; Morris, John C.; Herscher, Laurie; Smith, Sharon

    2009-01-01

    Purpose: To report the long-term outcomes and toxicity of a regimen of infusion paclitaxel delivered concurrently with radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck. Patients and Methods: Between 1995 and 1999, 35 patients with nonmetastatic, Stage III or IV squamous cell carcinoma of the head and neck were treated with three cycles of paclitaxel as a 120-h continuous infusion beginning on Days 1, 21, and 42, concurrent with radiotherapy. The initial 16 patients received 105 mg/m 2 /cycle, and the subsequent 19 patients received 120 mg/m 2 /cycle. External beam radiotherapy was delivered to a dose of 70.2-72 Gy at five fractions weekly. Patients were followed to evaluate the disease outcomes and late toxicity of this regimen. Results: The median follow-up for all patients was 56.5 months. The median survival was 56.5 months, and the median time to local recurrence was not reached. Of the 35 patients, 15 (43%) developed hypothyroidism. Of the 33 patients who underwent percutaneous endoscopic gastrostomy tube placement, 11 were percutaneous endoscopic gastrostomy tube dependent until death or their last follow-up visit. Also, 5 patients (14%) required a tracheostomy until death, and 3 (9%) developed a severe esophageal stricture. All evaluated long-term survivors exhibited salivary hypofunction. Fibrosis in the radiation field occurred in 24 patients (69%). Conclusion: The results of our study have shown that concurrent chemoradiotherapy with a 120-h infusion of paclitaxel provides long-term local control and survival in patients with squamous cell carcinoma of the head and neck. Xerostomia, hypothyroidism, esophageal and pharyngeal complications, and subcutaneous fibrosis were common long-term toxicities; however, the vast majority of toxicities were grade 1 or 2.

  5. A randomized study of accelerated fractionation radiotherapy with and without mitomycin C in the treatment of locally advanced head and neck cancer

    DEFF Research Database (Denmark)

    Ezzat, M.; Shouman, T.; Zaza, K.

    2005-01-01

    Objectives: This single-institution study evaluates the feasibility of accelerated fractionation radiotherapy (AF) with and without mitomycin C (MMC) in the treatment of locally advanced head and neck cancer. Patients and Methods: Between May 1998 and October 2001, sixty patients with locally...... advanced stage III and IV of head and neck cancer were randomized into three treatment arms: (1) conventional fractionation radiotherapy (CF) (5 fractions per week); (2) accelerated fractionation radiotherapy (AF) (6 fractions per week); and (3) AF plus Mitomycin C (MMC). Results: The 2-year overall....... Key Words: Head and Neck cancer , Radiotherapy , Altered fractionation , Mitomycin C....

  6. Effect of Radiotherapy Interruptions on Survival in Medicare Enrollees With Local and Regional Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Fesinmeyer, Megan Dann; Mehta, Vivek; Blough, David; Tock, Lauri; Ramsey, Scott D.

    2010-01-01

    Purpose: To investigate whether interruptions in radiotherapy are associated with decreased survival in a population-based sample of head-and-neck cancer patients. Methods and Materials: Using the Surveillance, Epidemiology, and End Results-Medicare linked database we identified Medicare beneficiaries aged 66 years and older diagnosed with local-regional head-and-neck cancer during the period 1997-2003. We examined claims records of 3864 patients completing radiotherapy for the presence of one or more 5-30-day interruption(s) in therapy. We then performed Cox regression analyses to estimate the association between therapy interruptions and survival. Results: Patients with laryngeal tumors who experienced an interruption in radiotherapy had a 68% (95% confidence interval, 41-200%) increased risk of death, compared with patients with no interruptions. Patients with nasal cavity, nasopharynx, oral, salivary gland, and sinus tumors had similar associations between interruptions and increased risk of death, but these did not reach statistical significance because of small sample sizes. Conclusions: Treatment interruptions seem to influence survival time among patients with laryngeal tumors completing a full course of radiotherapy. At all head-and-neck sites, the association between interruptions and survival is sensitive to confounding by stage and other treatments. Further research is needed to develop methods to identify patients most susceptible to interruption-induced mortality.

  7. Detecting Large-Scale Brain Networks Using EEG: Impact of Electrode Density, Head Modeling and Source Localization

    Science.gov (United States)

    Liu, Quanying; Ganzetti, Marco; Wenderoth, Nicole; Mantini, Dante

    2018-01-01

    Resting state networks (RSNs) in the human brain were recently detected using high-density electroencephalography (hdEEG). This was done by using an advanced analysis workflow to estimate neural signals in the cortex and to assess functional connectivity (FC) between distant cortical regions. FC analyses were conducted either using temporal (tICA) or spatial independent component analysis (sICA). Notably, EEG-RSNs obtained with sICA were very similar to RSNs retrieved with sICA from functional magnetic resonance imaging data. It still remains to be clarified, however, what technological aspects of hdEEG acquisition and analysis primarily influence this correspondence. Here we examined to what extent the detection of EEG-RSN maps by sICA depends on the electrode density, the accuracy of the head model, and the source localization algorithm employed. Our analyses revealed that the collection of EEG data using a high-density montage is crucial for RSN detection by sICA, but also the use of appropriate methods for head modeling and source localization have a substantial effect on RSN reconstruction. Overall, our results confirm the potential of hdEEG for mapping the functional architecture of the human brain, and highlight at the same time the interplay between acquisition technology and innovative solutions in data analysis. PMID:29551969

  8. A phase II study of concomitant boost radiation plus concurrent weekly cisplatin for locally advanced unresectable head and neck carcinomas

    International Nuclear Information System (INIS)

    Medina, Jose Antonio; Rueda, Antonio; Sacchetti de Pasos, Antonio; Contreras, Jorge; Cobo, Manuel; Moreno, Paloma; Benavides, Manuel; Villanueva, Asuncion; Alba, Emilio

    2006-01-01

    Background and purpose: This phase II study evaluated the efficacy and toxicity of weekly cisplatin along with concomitant boost accelerated radiation regimen in patients with locally advanced unresectable head and neck carcinoma. Material and methods: A total of 94 patients (median age, 58 years) with UICC stage III (n=19) and IV (n=75) cancer of the oropharynx, larynx, hypopharynx and oral cavity were included. Patients received radiotherapy with a concomitant boost scheme (1.8 Gy on days 1-40 and 1.5 Gy boost on days 25-40 with a total dose of 72 Gy) and concurrent cisplatin, 40 mg/m 2 weekly, for the first 4 weeks. Results: Most patients (95%) received both radiation and chemotherapy according to protocol. Toxicity was manageable with grade III mucositis and pharyngeal-oesophageal toxicity in 85 and 50% of patients, respectively. Haematological toxicity was mild. Four patients (4%) died due to complications. With a median follow of 41 months, median overall survival and time to progression were 27 and 25 months, respectively. The estimated overall survival at 4 years was 41%. Conclusions: Concomitant boost accelerated radiation plus concurrent weekly cisplatin is a feasible schedule in patients with locally advanced unresectable head and neck carcinoma, with acceptable toxicity and survival data

  9. Five versus ten fractions per week radiotherapy in locally advanced head and neck cancer

    Directory of Open Access Journals (Sweden)

    Ramanjis Viranna Tallari

    2017-01-01

    Conclusions: After induction chemotherapy, HFRT seems to be more efficacious than CFRT in locally advanced HNSCC, by increasing significantly the probability of progression-free survival and locoregional control.

  10. Parenteral Nutrition for Patients Treated for Locally Advanced Inoperable Tumors of the Head and Neck

    Science.gov (United States)

    2018-03-28

    Squamous Cell Carcinoma of the Hypopharynx Stage III; Squamous Cell Carcinoma of the Hypopharynx Stage IV; Laryngeal Squamous Cell Carcinoma Stage III; Laryngeal Squamous Cell Carcinoma Stage IV; Oropharyngeal Squamous Cell Carcinoma Stage III; Oropharyngeal Squamous Cell Carcinoma Stage IV; Squamous Cell Carcinoma of the Oral Cavity Stage III; Squamous Cell Carcinoma of the Oral Cavity Stage IV; Locally Advanced Malignant Neoplasm

  11. Moving to get aHead: Local Mobility and Collaborative Work

    DEFF Research Database (Denmark)

    Bardram, Jacob Eyvind; Bossen, Claus

    2003-01-01

    Local mobility is a central aspect of collaborative work that is in need of close analysis. Between the face-to-face interaction of offices or control rooms and longdistance interaction facilitated through e.g. telephones, e-mail, the www or teleconferences lie a number of work-settings in which......, and the challenges that actors have to face to accomplish their work. Based on this ethnographic case, we propose a set of concepts for understanding local mobility as an intermediate field of distributed cooperation between centres of coordination and remote collaboration. Finally, we introduce the concept...... of ‘mobility work ’ as complementary to the concept of ‘articulation work’....

  12. Enhanced skin toxicity with concomitant cetuximab and radiotherapy in patients with locally advanced head and neck squamous cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Bujor, L.; Grillo, I.M.; Pimentel, N. [Hospital Santa Maria, Radioterapia, Lisboa (Portugal); Macor, C.; Catarina, M. [Hospital Santa Maria, ORL, Lisboa (Portugal); Ribeiro, L. [Hospital Santa Maria, Oncologia, Lisboa (Portugal)

    2009-10-15

    Purpose: When associated with radiotherapy the monoclonal antibodies such as cetuximab might be exacerbate skin toxicity. The aim of this study was to retrospectively analyze acute dermatological toxicity in ten consecutive patients with locally advanced head and neck squamous cell carcinoma treated from march 2008 to May 2009 according to Bonner protocol. Patients and methods: We have treated with radiotherapy and cetuximab ten patients with locally advanced head and neck squamous cell carcinoma of the oropharynx, hypopharynx, larynx or oral cavity, stage 3-4B and non metastatic. All our patients were 3D planned and scheduled for conventional fractionation 70 Gy/35 fractions over 47 days, five days weekly. Uninvolved neck received 50 Gy and gross nodal disease received 70 Gy as the primary tumor. Cetuximab was administered one week before radiotherapy at a loading dose of 400 mg per square meter of body surface area over 120 minutes, followed by weekly 60 minutes infusions at 250 mg per square meter for the duration of radiotherapy. Results: In eight patients (80%) grade 3 radiation dermatitis occurred as early as with 28 Gy at a median dose of 42 Gy (range 28-60 Gy). the median radiotherapy dose was 6 Gy with an overall treatment time of 57.7 days (range 41-70 days). were administered 78 cycles of cetuximab, one patient discontinued after five cycles due to infusion reactions. There was no correlation between toxicity and acne-like rash due to cetuximab. Conclusion: Our results albeit in disagreement with the original study are rather similar with the experience of other European centers that encounter grade 3-4 radiation dermatitis in 49% of their patients or Australian centers that reported 79% of same degree of toxicity. (authors)

  13. Enhanced skin toxicity with concomitant cetuximab and radiotherapy in patients with locally advanced head and neck squamous cell carcinoma

    International Nuclear Information System (INIS)

    Bujor, L.; Grillo, I.M.; Pimentel, N.; Macor, C.; Catarina, M.; Ribeiro, L.

    2009-01-01

    Purpose: When associated with radiotherapy the monoclonal antibodies such as cetuximab might be exacerbate skin toxicity. The aim of this study was to retrospectively analyze acute dermatological toxicity in ten consecutive patients with locally advanced head and neck squamous cell carcinoma treated from march 2008 to May 2009 according to Bonner protocol. Patients and methods: We have treated with radiotherapy and cetuximab ten patients with locally advanced head and neck squamous cell carcinoma of the oropharynx, hypopharynx, larynx or oral cavity, stage 3-4B and non metastatic. All our patients were 3D planned and scheduled for conventional fractionation 70 Gy/35 fractions over 47 days, five days weekly. Uninvolved neck received 50 Gy and gross nodal disease received 70 Gy as the primary tumor. Cetuximab was administered one week before radiotherapy at a loading dose of 400 mg per square meter of body surface area over 120 minutes, followed by weekly 60 minutes infusions at 250 mg per square meter for the duration of radiotherapy. Results: In eight patients (80%) grade 3 radiation dermatitis occurred as early as with 28 Gy at a median dose of 42 Gy (range 28-60 Gy). the median radiotherapy dose was 6 Gy with an overall treatment time of 57.7 days (range 41-70 days). were administered 78 cycles of cetuximab, one patient discontinued after five cycles due to infusion reactions. There was no correlation between toxicity and acne-like rash due to cetuximab. Conclusion: Our results albeit in disagreement with the original study are rather similar with the experience of other European centers that encounter grade 3-4 radiation dermatitis in 49% of their patients or Australian centers that reported 79% of same degree of toxicity. (authors)

  14. High precision localization of intracerebral hemorrhage based on 3D MPR on head CT images

    Science.gov (United States)

    Sun, Jianyong; Hou, Xiaoshuai; Sun, Shujie; Zhang, Jianguo

    2017-03-01

    The key step for minimally invasive intracerebral hemorrhage surgery is precisely positioning the hematoma location in the brain before and during the hematoma surgery, which can significantly improves the success rate of puncture hematoma. We designed a 3D computerized surgical plan (CSP) workstation precisely to locate brain hematoma based on Multi-Planar Reconstruction (MPR) visualization technique. We used ten patients' CT/MR studies to verify our designed CSP intracerebral hemorrhage localization method. With the doctor's assessment and comparing with the results of manual measurements, the output of CSP WS for hematoma surgery is more precise and reliable than manual procedure.

  15. Automatic localization of landmark sets in head CT images with regression forests for image registration initialization

    Science.gov (United States)

    Zhang, Dongqing; Liu, Yuan; Noble, Jack H.; Dawant, Benoit M.

    2016-03-01

    Cochlear Implants (CIs) are electrode arrays that are surgically inserted into the cochlea. Individual contacts stimulate frequency-mapped nerve endings thus replacing the natural electro-mechanical transduction mechanism. CIs are programmed post-operatively by audiologists but this is currently done using behavioral tests without imaging information that permits relating electrode position to inner ear anatomy. We have recently developed a series of image processing steps that permit the segmentation of the inner ear anatomy and the localization of individual contacts. We have proposed a new programming strategy that uses this information and we have shown in a study with 68 participants that 78% of long term recipients preferred the programming parameters determined with this new strategy. A limiting factor to the large scale evaluation and deployment of our technique is the amount of user interaction still required in some of the steps used in our sequence of image processing algorithms. One such step is the rough registration of an atlas to target volumes prior to the use of automated intensity-based algorithms when the target volumes have very different fields of view and orientations. In this paper we propose a solution to this problem. It relies on a random forest-based approach to automatically localize a series of landmarks. Our results obtained from 83 images with 132 registration tasks show that automatic initialization of an intensity-based algorithm proves to be a reliable technique to replace the manual step.

  16. Concurrent use of cisplatin or cetuximab with definitive radiotherapy for locally advanced head and neck squamous cell carcinomas

    International Nuclear Information System (INIS)

    Levy, Antonin; Blanchard, Pierre; Bellefqih, Sara; Brahimi, Nacera; Deutsch, Eric; Daly-Schveitzer, Nicolas; Tao, Yungan; Guigay, Joel; Janot, Francois; Temam, Stephane; Bourhis, Jean

    2014-01-01

    The goal of the present work was to compare outcomes of definitive concurrent cisplatin-based chemoradiotherapy (CRT) with cetuximab-based bioradiotherapy (BRT) in locally advanced head-and-neck squamous cell carcinoma (HNSCC). Between 2006 and 2012, 265 patients with locally advanced HNSCC were treated at our institution with CRT (n = 194; 73 %) with three cycles of cisplatin (100 mg/m 2 , every 3 weeks) or BRT (n = 71; 27 %) with weekly cetuximab. Patients receiving BRT had more pre-existing conditions (Charlson index ≥ 2) than the CRT group (p = 0.005). Median follow-up was 29 months. In all, 56 % of patients treated with CRT received the planned three cycles (92 % at least two cycles) and 79 % patients treated with BRT received six cycles or more. The 2-year actuarial overall survival (OS) and progression-free survival (PFS) were 72 % and 61 %, respectively. In the multivariate analysis (MVA), T4 stage, N2-3 stage, smoking status (current smoker as compared with never smoker), and non-oropharyngeal locations predicted for OS, whereas BRT association with OS was of borderline significance (p = 0.054). The 2-year actuarial locoregional control (LRC) and distant control (DC) rates were 73 and 79 %, respectively. CRT was independently associated with an improved LRC (2-year LRC: 76 % for CRT vs. 61 % for BRT) and DC (2-year LRC: 81 % for CRT vs. 68 % for BRT) in comparison with BRT (p [de

  17. Association of acute adverse effects with high local SAR induced in the brain from prolonged RF head and neck hyperthermia

    International Nuclear Information System (INIS)

    Adibzadeh, F; Verhaart, R F; Rijnen, Z; Franckena, M; Van Rhoon, G C; Paulides, M M; Verduijn, G M; Fortunati, V

    2015-01-01

    To provide an adequate level of protection for humans from exposure to radio-frequency (RF) electromagnetic fields (EMF) and to assure that any adverse health effects are avoided. The basic restrictions in terms of the specific energy absorption rate (SAR) were prescribed by IEEE and ICNIRP. An example of a therapeutic application of non-ionizing EMF is hyperthermia (HT), in which intense RF energy is focused at a target region. Deep HT in the head and neck (H and N) region involves inducing energy at 434 MHz for 60 min on target. Still, stray exposure of the brain is considerable, but to date only very limited side-effects were observed. The objective of this study is to investigate the stringency of the current basic restrictions by relating the induced EM dose in the brain of patients treated with deep head and neck (H and N) HT to the scored acute health effects. We performed a simulation study to calculate the induced peak 10 g spatial-averaged SAR (psSAR 10g ) in the brains of 16 selected H and N patients who received the highest SAR exposure in the brain, i.e. who had the minimum brain-target distance and received high forwarded power during treatment. The results show that the maximum induced SAR in the brain of the patients can exceed the current basic restrictions (IEEE and ICNIRP) on psSAR 10g for occupational environments by 14 times. Even considering the high local SAR in the brain, evaluation of acute effects by the common toxicity criteria (CTC) scores revealed no indication of a serious acute neurological effect. In addition, this study provides pioneering quantitative human data on the association between maximum brain SAR level and acute adverse effects when brains are exposed to prolonged RF EMF. (paper)

  18. Volumetric PET/CT parameters predict local response of head and neck squamous cell carcinoma to chemoradiotherapy

    International Nuclear Information System (INIS)

    Hanamoto, Atsushi; Tatsumi, Mitsuaki; Takenaka, Yukinori; Hamasaki, Toshimitsu; Yasui, Toshimichi; Nakahara, Susumu; Yamamoto, Yoshifumi; Seo, Yuji; Isohashi, Fumiaki; Ogawa, Kazuhiko; Hatazawa, Jun; Inohara, Hidenori

    2014-01-01

    It is not well established whether pretreatment 18 F-FDG PET/CT can predict local response of head and neck squamous cell carcinoma (HNSCC) to chemoradiotherapy (CRT). We examined 118 patients: 11 with nasopharyngeal cancer (NPC), 30 with oropharyngeal cancer (OPC), and 77 with laryngohypopharyngeal cancer (LHC) who had completed CRT. PET/CT parameters of primary tumor, including metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum and mean standardized uptake value (SUV max and SUV mean ), were correlated with local response, according to primary site and human papillomavirus (HPV) status. Receiver-operating characteristic analyses were made to access predictive values of the PET/CT parameters, while logistic regression analyses were used to identify independent predictors. Area under the curve (AUC) of the PET/CT parameters ranged from 0.53 to 0.63 in NPC and from 0.50 to 0.54 in OPC. HPV-negative OPC showed AUC ranging from 0.51 to 0.58, while all of HPV-positive OPCs showed complete response. In contrast, AUC ranged from 0.71 to 0.90 in LHC. Moreover, AUCs of MTV and TLG were significantly higher than those of SUV max and SUV mean (P < 0.01). After multivariate analysis, high MTV >25.0 mL and high TLG >144.8 g remained as independent, significant predictors of incomplete response compared with low MTV (odds ratio [OR], 13.4; 95% confidence interval [CI], 2.5–72.9; P = 0.003) and low TLG (OR, 12.8; 95% CI, 2.4–67.9; P = 0.003), respectively. In conclusion, predictive efficacy of pretreatment 18 F-FDG PET/CT varies with different primary sites and chosen parameters. Local response of LHC is highly predictable by volume-based PET/CT parameters

  19. Cross-cultural adaptation of the Maltreatment and Abuse Chronology of Exposure (MACE scale to Brazilian Portuguese

    Directory of Open Access Journals (Sweden)

    Bruno Kluwe-Schiavon

    2016-03-01

    Full Text Available Introduction : There is strong evidence to indicate that childhood maltreatment can negatively affect both physical and mental health and there is increasing interest in understanding the occurrence and consequences of such experiences. While several tools have been developed to retrospectively investigate childhood maltreatment experiences, most of them do not investigate the experience of witnessing family violence during childhood or bullying exposure. Moreover, the majority of scales do not identify when these experiences may have occurred, who was involved or the feelings evoked, such as helplessness or terror. The Maltreatment and Abuse Chronology of Exposure (MACE scale was developed to overcome these limitations. Objective : In view of the improvements over previous self-report instruments that this new tool offers and of the small number of self-report questionnaires for childhood maltreatment assessment available in Brazil, this study was conducted to conduct cross-cultural adaptation of the MACE scale for Brazilian Portuguese. Method : The following steps were performed: translation, back-translation, committee review for semantic and conceptual evaluation, and acceptability trial for equivalence. Results : Semantic and structural changes were made to the interview to adapt it for the Brazilian culture and all 75 of the items that comprise the longer version of MACE were translated. The results of the acceptability trial suggest that the items are comprehensible. Conclusion : The MACE scales may be useful tools for investigation of childhood maltreatment and make a valuable contribution to research in Brazil. Future studies should consider testing the availability and reliability of the three versions of the instrument translated into Brazilian Portuguese.

  20. Fractionated BNCT for locally recurrent head and neck cancer: Experience from a phase I/II clinical trial at Tsing Hua Open-Pool Reactor

    International Nuclear Information System (INIS)

    Wang, Ling-Wei; Chen, Yi-Wei; Ho, Ching-Yin; Hsueh Liu, Yen-Wan; Chou, Fong-In; Liu, Yuan-Hao; Liu, Hong-Ming; Peir, Jinn-Jer; Jiang, Shiang-Huei; Chang, Chi-Wei; Liu, Ching-Sheng; Wang, Shyh-Jen; Chu, Pen-Yuan; Yen, Sang-Hue

    2014-01-01

    To introduce our experience of treating locally and regionally recurrent head and neck cancer patients with BNCT at Tsing Hua Open-Pool Reactor in Taiwan, 12 patients (M/F=10/2, median age 55.5 Y/O) were enrolled and 11 received two fractions of treatment. Fractionated BNCT at 30-day interval with adaptive planning according to changed T/N ratios was feasible, effective and safe for selected recurrent head and neck cancer in this trial. - Highlights: • We treated 12 patients with recurrent Head and Neck (H and N) cancer after radical surgery and radiotherapy since 2010. • Four complete response (CR) and 3 partial response (PR) were found. Total response rate was 58%. • Two patients had local control longer than one year. • No grade 4 or higher toxicity was noted for both acute and chronic effects

  1. Low skeletal muscle mass is a predictive factor for chemotherapy dose-limiting toxicity in patients with locally advanced head and neck cancer

    NARCIS (Netherlands)

    Wendrich, Anne W; Swartz, Justin E; Bril, Sandra I; Wegner, Inge; de Graeff, Alexander; Smid, Ernst J; de Bree, Remco; Pothen, Ajit J

    OBJECTIVES: Low skeletal muscle mass (SMM) or sarcopenia is emerging as an adverse prognostic factor for chemotherapy dose-limiting toxicity (CLDT) and survival in cancer patients. Our aim was to determine the impact of low SMM on CDLT in patients with locally advanced head and neck squamous cell

  2. Phase II study of cetuximab plus concomitant boost radiotherapy in Japanese patients with locally advanced squamous cell carcinoma of the head and neck

    International Nuclear Information System (INIS)

    Okano, Susumu; Yoshino, Takayuki; Fujii, Masato

    2013-01-01

    We investigated the tolerability of cetuximab plus radiotherapy in Japanese patients with untreated locally advanced squamous cell carcinoma of the head and neck. Patients with epidermal growth factor receptor-expressing locally advanced squamous cell carcinoma of the head and neck received cetuximab (400 mg/m 2 initial dose then 250 mg/m 2 weekly) for 7 weeks plus concomitant boost radiotherapy (weeks 2-7: once daily [1.8 Gy] for 3.6 weeks, then twice daily [1.8 Gy morning and 1.5 Gy afternoon] for 2.4 weeks). The primary endpoint was treatment completion rate (the rate of treated patients completing ≥70% of the planned cetuximab dose and the full dose of radiotherapy within 2 weeks over the planned schedule). Twenty-two patients were evaluable. The treatment completion rate was 100% (95% confidence interval 85-100). The response rate 8 weeks post-radiotherapy was 82% (95% confidence interval 60-95). The most common grade 3/4 treatment-emergent adverse events were mucosal inflammation (73%); dermatitis (27%); and infection, radiation skin injury and stomatitis (23% each). Cetuximab plus concomitant boost radiotherapy can be safely administered to Japanese patients with locally advanced squamous cell carcinoma of the head and neck. Tolerability and efficacy were in line with those reported in the Phase III Bonner trial in a Western population of patients with locally advanced squamous cell carcinoma of the head and neck. (author)

  3. Local setup errors in image-guided radiotherapy for head and neck cancer patients immobilized with a custom-made device.

    Science.gov (United States)

    Giske, Kristina; Stoiber, Eva M; Schwarz, Michael; Stoll, Armin; Muenter, Marc W; Timke, Carmen; Roeder, Falk; Debus, Juergen; Huber, Peter E; Thieke, Christian; Bendl, Rolf

    2011-06-01

    To evaluate the local positioning uncertainties during fractionated radiotherapy of head-and-neck cancer patients immobilized using a custom-made fixation device and discuss the effect of possible patient correction strategies for these uncertainties. A total of 45 head-and-neck patients underwent regular control computed tomography scanning using an in-room computed tomography scanner. The local and global positioning variations of all patients were evaluated by applying a rigid registration algorithm. One bounding box around the complete target volume and nine local registration boxes containing relevant anatomic structures were introduced. The resulting uncertainties for a stereotactic setup and the deformations referenced to one anatomic local registration box were determined. Local deformations of the patients immobilized using our custom-made device were compared with previously published results. Several patient positioning correction strategies were simulated, and the residual local uncertainties were calculated. The patient anatomy in the stereotactic setup showed local systematic positioning deviations of 1-4 mm. The deformations referenced to a particular anatomic local registration box were similar to the reported deformations assessed from patients immobilized with commercially available Aquaplast masks. A global correction, including the rotational error compensation, decreased the remaining local translational errors. Depending on the chosen patient positioning strategy, the remaining local uncertainties varied considerably. Local deformations in head-and-neck patients occur even if an elaborate, custom-made patient fixation method is used. A rotational error correction decreased the required margins considerably. None of the considered correction strategies achieved perfect alignment. Therefore, weighting of anatomic subregions to obtain the optimal correction vector should be investigated in the future. Copyright © 2011 Elsevier Inc. All rights

  4. AFSC/RACE/MACE: Results of 2009 ACOUSTIC-TRAWL SURVEYS OF THE SHUMAGINS, SANAK TROUGH & WESTERN GULF OF ALASKA SHELFBREAK DY0901

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Scientists from the Midwater Assessment and Conservation Engineering (MACE) Program of the Alaska Fisheries Science Center's (AFSC) Resource Assessment and...

  5. Cisplatin-Based Chemotherapy versus Cetuximab in Concurrent Chemoradiotherapy for Locally Advanced Head and Neck Cancer Treatment

    Directory of Open Access Journals (Sweden)

    Ming-Hung Hu

    2014-01-01

    Full Text Available Background and Purpose. This study aimed to analyze survival, clinical responses, compliance, and adverse effects in locally advanced head and neck cancer (LAHNC patients treated with split-dose cisplatin-based concurrent chemoradiation therapy (SD-CCRT or cetuximab with concurrent radiation therapy (BioRT. Materials and Methods. We retrospectively evaluated 170 LAHNC patients diagnosed between January 1, 2009, and July 31, 2012: 116 received CCRT and 54 received BioRT. Results. Complete response rates were similar in the SD-CCRT and BioRT groups (63.8% versus 59.3%; P=0.807, and locoregional relapse rates were 18.1% and 13.0%, respectively (P=0.400. The 3-year relapse-free survival rate was 65.8% in the SD-CCRT group and 65.5% in the BioRT group, respectively (P=0.647. The 3-year overall survival rate was 78.5% in the SD-CCRT group and 70.9% in the BioRT group, respectively (P=0.879. Hematologic side effects were significantly more frequent in the SD-CCRT than in the BioRT group. Mucositis frequency was similar. Conclusions. Primary SD-CCRT and BioRT both showed good clinical response and survival. Hematologic toxicities were more frequent, but tolerable, in the SD-CCRT group. Both groups showed good compliance.

  6. Modified Weekly Cisplatin-Based Chemotherapy Is Acceptable in Postoperative Concurrent Chemoradiotherapy for Locally Advanced Head and Neck Cancer

    Science.gov (United States)

    Lu, Hsueh-Ju; Yang, Chao-Chun; Wang, Ling-Wei; Chu, Pen-Yuan; Tai, Shyh-Kuan; Chen, Ming-Huang; Yang, Muh-Hwa; Chang, Peter Mu-Hsin

    2015-01-01

    Background. Triweekly cisplatin-based postoperative concurrent chemoradiotherapy (CCRT) has high intolerance and toxicities in locally advanced head and neck cancer (LAHNC). We evaluated the effect of a modified weekly cisplatin-based chemotherapy in postoperative CCRT. Methods. A total of 117 patients with LAHNC were enrolled between December 2007 and December 2012. Survival, compliance/adverse events, and independent prognostic factors were analyzed. Results. Median follow-up time was 30.0 (3.1–73.0) months. Most patients completed the entire course of postoperative CCRT (radiotherapy ≥ 60 Gy, 94.9%; ≥6 times weekly chemotherapy, 75.2%). Only 17.1% patients required hospital admission. The most common adverse effect was grade 3/4 mucositis (28.2%). No patient died due to protocol-related adverse effects. Multivariate analysis revealed the following independent prognostic factors: oropharyngeal cancer, extracapsular spread, and total radiation dose. Two-year progression-free survival and overall survival rates were 70.9% and 79.5%, respectively. Conclusion. Modified weekly cisplatin-based chemotherapy is an acceptable regimen in postoperative CCRT for LAHNC. PMID:25793192

  7. Cisplatin-Based Chemotherapy versus Cetuximab in Concurrent Chemoradiotherapy for Locally Advanced Head and Neck Cancer Treatment

    Science.gov (United States)

    Hu, Ming-Hung; Wang, Ling-Wei; Lu, Hsueh-Ju; Chu, Pen-Yuan; Tai, Shyh-Kuan; Lee, Tsung-Lun; Chen, Ming-Huang; Yang, Muh-Hwa; Chang, Peter Mu-Hsin

    2014-01-01

    Background and Purpose. This study aimed to analyze survival, clinical responses, compliance, and adverse effects in locally advanced head and neck cancer (LAHNC) patients treated with split-dose cisplatin-based concurrent chemoradiation therapy (SD-CCRT) or cetuximab with concurrent radiation therapy (BioRT). Materials and Methods. We retrospectively evaluated 170 LAHNC patients diagnosed between January 1, 2009, and July 31, 2012: 116 received CCRT and 54 received BioRT. Results. Complete response rates were similar in the SD-CCRT and BioRT groups (63.8% versus 59.3%; P = 0.807), and locoregional relapse rates were 18.1% and 13.0%, respectively (P = 0.400). The 3-year relapse-free survival rate was 65.8% in the SD-CCRT group and 65.5% in the BioRT group, respectively (P = 0.647). The 3-year overall survival rate was 78.5% in the SD-CCRT group and 70.9% in the BioRT group, respectively (P = 0.879). Hematologic side effects were significantly more frequent in the SD-CCRT than in the BioRT group. Mucositis frequency was similar. Conclusions. Primary SD-CCRT and BioRT both showed good clinical response and survival. Hematologic toxicities were more frequent, but tolerable, in the SD-CCRT group. Both groups showed good compliance. PMID:25110705

  8. Modified Weekly Cisplatin-Based Chemotherapy Is Acceptable in Postoperative Concurrent Chemoradiotherapy for Locally Advanced Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Hsueh-Ju Lu

    2015-01-01

    Full Text Available Background. Triweekly cisplatin-based postoperative concurrent chemoradiotherapy (CCRT has high intolerance and toxicities in locally advanced head and neck cancer (LAHNC. We evaluated the effect of a modified weekly cisplatin-based chemotherapy in postoperative CCRT. Methods. A total of 117 patients with LAHNC were enrolled between December 2007 and December 2012. Survival, compliance/adverse events, and independent prognostic factors were analyzed. Results. Median follow-up time was 30.0 (3.1–73.0 months. Most patients completed the entire course of postoperative CCRT (radiotherapy ≥ 60 Gy, 94.9%; ≥6 times weekly chemotherapy, 75.2%. Only 17.1% patients required hospital admission. The most common adverse effect was grade 3/4 mucositis (28.2%. No patient died due to protocol-related adverse effects. Multivariate analysis revealed the following independent prognostic factors: oropharyngeal cancer, extracapsular spread, and total radiation dose. Two-year progression-free survival and overall survival rates were 70.9% and 79.5%, respectively. Conclusion. Modified weekly cisplatin-based chemotherapy is an acceptable regimen in postoperative CCRT for LAHNC.

  9. Taxane-containing induction chemotherapy followed by definitive chemoradiotherapy. Outcome in patients with locally advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Broemme, J.O.; Schmuecking, M.; Leiser, D.; Geretschlaeger, A.; Ghadjar, P.; Aebersold, D.M. [Bern Univ. Hospital and Bern Univ. (Switzerland). Dept. of Radiation Oncology; Arnold, A.; Giger, R. [Bern Univ. (Switzerland). Head and Neck Surgery; Rauch, D. [Bern Univ. (Switzerland). Medical Oncology; Plasswilm, L. [Kantonsspital, St. Gallen (Switzerland). Radiation Oncology

    2013-08-15

    Background: Induction chemotherapy followed by definitive chemoradiotherapy is an intensified treatment approach for locally advanced squamous cell carcinoma of the head and neck (HNSCC) that might be associated with high rates of toxicity. Materials and methods: The data of 40 consecutive patients who underwent induction chemotherapy with docetaxel-containing regimens followed by intensity-modulated radiotherapy (IMRT) and concomitant systemic therapy for unresectable locally advanced HNSCC were retrospectively analyzed. Primary objectives were RT-related acute and late toxicity. Secondary objectives were response to induction chemotherapy, locoregional recurrence-free survival (LRRFS), overall survival (OS), and influencing factors for LRRFS and OS. Results: The median follow-up for surviving patients was 21 months (range, 2-53 months). Patients received a median of three cycles of induction chemotherapy followed by IMRT to 72 Gy. Three patients died during induction chemotherapy and one during chemoradiotherapy. Acute RT-related toxicity was of grade 3 and 4 in 72 and 3 % of patients, respectively, mainly dysphagia and dermatitis. Late RT-related toxicity was mainly xerostomia and bone/cartilage necrosis and was of grade 3 and 4 in 15 % of patients. One- and 2-year LRRFS and OS were 72 and 49 % and 77 and 71 %, respectively. Conclusion: Induction chemotherapy followed by chemoradiotherapy using IMRT was associated with a high rate of severe acute and late RT-related toxicities in this selected patient cohort. Four patients were lost because of fatal complications. Induction chemotherapy did not compromise the delivery of full-dose RT; however, the use of three cycles of concomitant cisplatin was impaired. (orig.)

  10. 125I implants as an adjuvant to surgery and external beam radiotherapy in the management of locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Martinez, A.; Goffinet, D.R.; Fee, W.; Goode, R.; Cox, R.S.

    1983-01-01

    125 I seeds either individually placed or inserted into absorbable Vicryl suture carriers were utilized in conjunction with surgery and external beam radiotherapy in an attempt to increase local control rates in patients with advanced oropharyngeal and laryngopharyngeal cancers (T3-T4, N2-N3), massive cervical lymphadenopathy (N3) and an unknown primary site and locally recurrent head and neck cancers. Forty-eight patients were treated with 55 implants. The carotid artery was implanted in 15 patients, while seven patients had seeds inserted into the base of the skull region, and another three patients had implants near cranial nerves. Eighteen of the 48 patients were treated for cure. The actuarial survival at five years in this subgroup was 50%. The overall local control in the head and neck area was 58%. In this group no patients to date have had a local failure in the implanted volume. Seventeen patients with comparable stage of disease treated prior to 1974 with curative intent without 125 I implants were analyzed retrospectively for comparison with the implanted patients. The actuarial survival of these patients was 18% and the overall head and neck control was 21%. These differences are statistically significant at a P value of 0.01 and 0.007, respectively. Seventeen patients received implants for local recurrence. The local control in the head and neck area was 50%; however, the 2.5 year actuarial survival was only 17%. The complication rate was 11% (six of 55 implants). The improved survival, the high local control, and the minimal complication rates in this series makes the intraoperative implantation of 125 I seeds and effective adjunctive treatment to surgery and external beam irradiation

  11. The effect of core decompression on local expression of BMP-2, PPAR-γ and bone regeneration in the steroid-induced femoral head osteonecrosis

    Directory of Open Access Journals (Sweden)

    Wang Wei

    2012-08-01

    Full Text Available Abstract Background To investigate the efficacy of the sole core decompression surgery for the treatment of steroid-induced femoral head osteonecrosis. Methods The model was established by administration of steroids in combination with horse serum. The rabbits with bilateral femoral head osteonecrosis were randomly selected to do the one side of core decompression. The other side was used as the sham. Quantitative RT-PCR and western blot techniques were used to measure the local expression of BMP-2 and PPAR-γ. Bone tissues from control and operation groups were histologically analyzed by H&E staining. The comparisons of the local expression of BMP-2 and PPAR-γ and the bone regeneration were further analyzed between different groups at each time point. Results The expression of BMP-2 in the osteonecrosis femoral head with or without decompression was significantly lower than that in normal animals. BMP-2 expression both showed the decreasing trend with the increased post-operation time. No significant difference of BMP-2 expression occurred between femoral head osteonecrosis with and without decompression. The PPAR-γ expression in the femoral head osteonecrosis with and without core decompression both was significantly higher than that in control. Its expression pattern showed a significantly increased trend with increased the post-operation time. However, there was no significant difference of PPAR-γ expression between the femoral head osteonecrosis with and without decompression at each time point. Histopathological analysis revealed that new trabecular bone and a large number of osteoblasts were observed in the steroid-induced femoral head osteonecrosis with lateral decompression at 8 weeks after surgery, but there still existed trabecular bone fractures and bone necrosis. Conclusions Although decompression takes partial effect in promoting bone regeneration in the early treatment of femoral head osteonecrosis, such an effect does not

  12. Functional changes of the gustatory organ caused by local radiation exposure during radiotherapy of the head-and-neck region

    International Nuclear Information System (INIS)

    Kamprad, F.; Hildebrandt, G.; Ranft, D.; Weber, A.

    2008-01-01

    Purpose: The aim of this prospective study was to investigate how often and at which dose levels gustatory disturbances appear during radiotherapy of the tongue and to which extent permanent gustatory deficiencies occur. Patients and Methods: The study included 44 patients treated by definitive irradiation for malignant head-and-neck tumors. In 22 patients the posterior two thirds of the tongue (group 1), and in the other 22 patients the entire tongue (group 2) were exposed to radiation. The control group comprised 30 patients with non-small cell lung cancer receiving definitive radiation therapy (group 3). The dose distribution in the tongue area was calculated using CT-based three-dimensional planning. Before, during and after irradiation the gustatory function was determined by means of gustometry and correlated with the corresponding results of enoral inspection and the patients' subjective statements on gustatory function. Results: The gustatory ability of the control group was not affected, whereas patients in the locally irradiated groups in parallel with enoral mucositis suffered from loss of gustatory function after a total dose of 20 Gy with a maximum between 40 and 60 Gy. Supportive measures had little influence on acute side effects. The gustatory disturbances regressed within 8 weeks after radiotherapy in patients with partial-tongue irradiation and almost completely after 6 months in patients with entire-tongue irradiation. Conclusion: The severity of gustatory disturbances and the longer recovery time in patients with entire-tongue irradiation suggest an influence of the volume exposed. Therefore, reduction of the highly exposed tongue volume by intensity-modulated radiotherapy opens up possibilities for a reduction of this undesirable side effect. (orig.)

  13. Functional changes of the gustatory organ caused by local radiation exposure during radiotherapy of the head-and-neck region

    Energy Technology Data Exchange (ETDEWEB)

    Kamprad, F.; Hildebrandt, G. [University Hospital Leipzig AoeR (Germany). Dept. of Radiotherapy and Radiooncology; Ranft, D. [Universitaetsklinikum Greifswald GmbH (Germany). MVZ-Medizinisches Versorgungszentrum; Weber, A. [Sana Klinikum Remscheid (Germany). ENT Dept.

    2008-03-15

    Purpose: The aim of this prospective study was to investigate how often and at which dose levels gustatory disturbances appear during radiotherapy of the tongue and to which extent permanent gustatory deficiencies occur. Patients and Methods: The study included 44 patients treated by definitive irradiation for malignant head-and-neck tumors. In 22 patients the posterior two thirds of the tongue (group 1), and in the other 22 patients the entire tongue (group 2) were exposed to radiation. The control group comprised 30 patients with non-small cell lung cancer receiving definitive radiation therapy (group 3). The dose distribution in the tongue area was calculated using CT-based three-dimensional planning. Before, during and after irradiation the gustatory function was determined by means of gustometry and correlated with the corresponding results of enoral inspection and the patients' subjective statements on gustatory function. Results: The gustatory ability of the control group was not affected, whereas patients in the locally irradiated groups in parallel with enoral mucositis suffered from loss of gustatory function after a total dose of 20 Gy with a maximum between 40 and 60 Gy. Supportive measures had little influence on acute side effects. The gustatory disturbances regressed within 8 weeks after radiotherapy in patients with partial-tongue irradiation and almost completely after 6 months in patients with entire-tongue irradiation. Conclusion: The severity of gustatory disturbances and the longer recovery time in patients with entire-tongue irradiation suggest an influence of the volume exposed. Therefore, reduction of the highly exposed tongue volume by intensity-modulated radiotherapy opens up possibilities for a reduction of this undesirable side effect. (orig.)

  14. 18F-FDG PET for detecting recurrent head and neck cancer, local lymph node involvement and distant metastases. Comparison of qualitative visual and semiquantitative analysis

    International Nuclear Information System (INIS)

    Schmidt, M.; Schmalenbach, M.; Theissen, P.; Dietlein, M.; Eschner, W.; Schicha, H.; Jungehuelsing, M.; Schroeder, U.; Stennert, E.

    2004-01-01

    Aim: Assessment of the clinical value of 18 F-FDG-PET for detection of recurrent head and neck cancer, local lymph node involvement and distant metastases comparing a qualitative visual with a semiquantitative analysis (SUV values). Patients, methods: Retrospective evaluation of 73 18 F-FDG PET studies in 55 patients by use of a four-step qualitative visual grading system and calculation of standard uptake values in pathological lesions. Calculation of SUV values in normal regions for generating a map of physiological 18 F-FDG distribution. Correlation to histopathological findings and clinical follow-up. Results: 1. Qualitative visual analysis of 18 F-FDG PET studies: a) local recurrence sensitivity 79%, specificity 97%, positive predictive value 95%, negative predictive value 85%, and diagnostic accuracy 89%; b) local metastatic lymph nodes 100%, 95%, 85%, 100%, 96%; c) distant metastases 100%, 98%, 86%, 100%, 98%, respectively. 2. Semiquantitative analysis had only little incremental, non-significant value in comparison to qualitative visual analysis for the detection of a local recurrence in two patients: a) local recurrence: sensitivity 83%, specificity 100%, positive predictive value 100%, negative predictive value 88%, and diagnostic accuracy 93%; b) local metastatic lymph nodes or c) distant metastases did not change in comparison to qualitative visual analysis. Conclusion: 18 F-FDG PET is an effective tool for re-staging of patients with suspected recurrence after therapy for head and neck cancer. (orig.)

  15. The influence of quantitative tumor volume measurements on local control in advanced head and neck cancer using concomitant boost accelerated superfractionated irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Christopher R; Khandelwal, Shiv R; Schmidt-Ullrich, Rupert K; Ravalese, Joseph; Wazer, David E

    1995-06-15

    Purpose: Current methods to clinically define head and neck tumor bulk are qualitative and imprecise. Although the American Joint Committee on Cancer (AJCC) staging system is important for this purpose, limitations exist. This study will investigate the prognostic value of computed tomography (CT) derived tumor volume measurements in comparison to AJCC stage and other significant variables. Materials and Methods: Seventy-six patients with advanced head and neck squamous cell carcinoma were treated with concomitant boost accelerated superfractionated irradiation. Doses ranged from 68.4-73.8 Gy (median 70.2 Gy). Good quality pretherapy CT scans were available in 51 patients. Total tumor volume (TTV) estimates were derived from these scans using digital integration of primary tumor and metastatic lymphadenopathy. Actuarial and multivariate statistical techniques were applied to analyze local control. Results: Thirty-six-month local control was 63%. TTV ranged from 5-196 cm{sup 3} (median 35 cm{sup 3}) for all cases, 5-142 cm{sup 3} (median 17 cm{sup 3}) for those controlled, and 16-196 cm{sup 3} (median 47 cm{sup 3}) for local failures. There was a significant increase in failures above 35 cm{sup 3}. Univariate analysis found that TTV, T-stage, N-stage, and primary site were each significant prognostic variables. Local control for TTV {<=}35 cm{sup 3} was 92% at 36 months vs. 34% for TTV >35 cm{sup 3} (p = 0.0001). Multivariate analysis, however, found that TTV, primary site, and sex were important as independent variables; T and N stage were not independently significant unless TTV was removed from the model. Conclusions: This study demonstrates the prognostic significance of TTV in advanced carcinoma of the head and neck. This variable appears to be a more predictive than AJCC clinical stage. Quantitative tumor volume measurements may prove to be a useful parameter in future analyses of head and neck cancer.

  16. Impact of intensity-modulated and image-guided radiotherapy on elderly patients undergoing chemoradiation for locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Nguyen, N.P.; Chi, A.; Vock, J.

    2012-01-01

    Purpose: In this work, the treatment tolerance of elderly patients (≥ 70 years) undergoing intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) and chemotherapy for locally advanced head and neck cancer was assessed. Patients and methods: A retrospective review of 112 patients undergoing concurrent chemoradiation for locally advanced head and neck cancer was performed. Treatment toxicity, protocol violations, long-term complications, and survival were compared between 85 younger patients (< 70 years) and 27 older patients (≥ 70 years). Results: Grade 3-4 treatment toxicity was observed in 88.2% and 88.8% for younger and older patients, respectively. Mean weight loss and treatment break were 5.9 and 3.9 kg (p = 0.03) and 7.3 and 7.8 days (p = 0.8) for younger and older patients, respectively. Seven patients (8.2%) did not complete treatment in the younger group compared to 1 patient (3.7%) in the older group (p = 0.6). No significant differences in protocol violations and survival were found between the two groups. Conclusion: Compared to younger patients, elderly patients with locally advanced head and neck cancer tolerated chemoradiation with IMRT and IGRT well, and should not be denied curative treatment based solely on age. (orig.)

  17. Concurrent use of cisplatin or cetuximab with definitive radiotherapy for locally advanced head and neck squamous cell carcinomas

    Energy Technology Data Exchange (ETDEWEB)

    Levy, Antonin; Blanchard, Pierre; Bellefqih, Sara; Brahimi, Nacera; Deutsch, Eric; Daly-Schveitzer, Nicolas; Tao, Yungan [Gustave Roussy, Department of Radiation Oncology, Villejuif (France); Guigay, Joel [Gustave Roussy, Department of Medical Oncology, Villejuif (France); Janot, Francois; Temam, Stephane [Gustave Roussy, Department of Head and Neck Surgery, Villejuif (France); Bourhis, Jean [Gustave Roussy, Department of Radiation Oncology, Villejuif (France); University Hospital Lausanne, Department of Radiation Oncology, Lausanne (Switzerland)

    2014-09-15

    The goal of the present work was to compare outcomes of definitive concurrent cisplatin-based chemoradiotherapy (CRT) with cetuximab-based bioradiotherapy (BRT) in locally advanced head-and-neck squamous cell carcinoma (HNSCC). Between 2006 and 2012, 265 patients with locally advanced HNSCC were treated at our institution with CRT (n = 194; 73 %) with three cycles of cisplatin (100 mg/m{sup 2}, every 3 weeks) or BRT (n = 71; 27 %) with weekly cetuximab. Patients receiving BRT had more pre-existing conditions (Charlson index ≥ 2) than the CRT group (p = 0.005). Median follow-up was 29 months. In all, 56 % of patients treated with CRT received the planned three cycles (92 % at least two cycles) and 79 % patients treated with BRT received six cycles or more. The 2-year actuarial overall survival (OS) and progression-free survival (PFS) were 72 % and 61 %, respectively. In the multivariate analysis (MVA), T4 stage, N2-3 stage, smoking status (current smoker as compared with never smoker), and non-oropharyngeal locations predicted for OS, whereas BRT association with OS was of borderline significance (p = 0.054). The 2-year actuarial locoregional control (LRC) and distant control (DC) rates were 73 and 79 %, respectively. CRT was independently associated with an improved LRC (2-year LRC: 76 % for CRT vs. 61 % for BRT) and DC (2-year LRC: 81 % for CRT vs. 68 % for BRT) in comparison with BRT (p < 0.001 and p = 0.01 in the MVA). Subgroup analyses showed that T4 patients benefited significantly from CRT (vs. BRT) in LRC, while T1-3 did not. BRT patients had more G3-4 skin complications (p < 0.001) and CRT patients had higher rates of feeding tube placement (p = 0.006) and G3-4 gastrointestinal toxicities (p < 0.001). This retrospective analysis showed a better LRC in locally advanced HNSCC treated by cisplatin-based CRT than cetuximab-based BRT, and a nonsignificant trend towards an improved OS. (orig.) [German] Die Therapieeffektivitaet mit Platin

  18. A randomised controlled trial of the effect of a head-elevation pillow on intrathecal local anaesthetic spread in caesarean section.

    Science.gov (United States)

    Elfil, H; Crowley, L; Segurado, R; Spring, A

    2015-11-01

    A head-elevation pillow places a patient in a ramped posture, which maximises the view of the larynx during laryngoscopy, particularly in obese parturients. In our institution an elevation pillow is used pre-emptively for neuraxial anaesthesia. We hypothesised that head-elevation may impair cephalad spread of local anaesthetic before caesarean section resulting in a lower block or longer time to achieve a T6 level. We aimed to investigate the effect of head-elevation on spread of intrathecal local anaesthetics during anaesthesia for caesarean section. One-hundred parturients presenting for caesarean section under combined spinal-epidural anaesthesia were randomised to either the standard supine position with lateral displacement or in the supine position with lateral displacement on an head-elevation pillow. Each patient received intrathecal hyperbaric bupivacaine 11 mg, morphine 100 μg and fentanyl 15 μg. Patients were assessed for adequacy of sensory block (T6 or higher) at 10 min. Sensory block to T6 was achieved within 10 min in 65.9% of parturients in the Elevation Pillow Group compared to 95.7% in the Control Group (P<0.05). Compared to the Control Group, patients in the Elevation Pillow Group had greater requirements for epidural supplementation (43.5% vs 2.1%, P<0.001) or conversion to general anaesthesia (9.3% vs 0%, P<0.04). Use of a ramped position with an head-elevation pillow following injection of the intrathecal component of a combined spinal-epidural anaesthetic for scheduled caesarean section was associated with a significantly lower block height at 10min. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Peristeen anal irrigation as a substitute for the MACE procedure in children who are in need of reconstructive bladder surgery

    Science.gov (United States)

    Alenezi, Husain; Alhazmi, Hamdan; Trbay, Mahmoud; Khattab, Amna; Neel, Khalid Fouda

    2014-01-01

    Introduction: We evaluate the efficacy of the Peristeen (Coloplast A/S, Kokkedal, Denmark) transanal irrigation (TAI) system, as a stool cleansing mechanism, to gain stool continence in children who need reconstructive bladder surgery and have fecal incontinence. Methods: We prospectively evaluated children with neuropathic bladder and bowel dysfunction who were intended for reconstructive bladder surgery and the Malone antegrade continence enema (MACE) procedure. All patients were started on the Peristeen TAI system at least 3 months before surgery to assess their response. Each patient’s bowel function, frequency of using the system, satisfaction (and that of their parents) and diaper independency were evaluated before and after reconstructive surgery. Results: We included 18 patients (11 female, 7 male) who were evaluated from April 2006 to the present. The mean age of the group was 7.6 years (range: 4–15). Fifteen patients (83.3%) showed complete dryness from stools. Of the 15 patients, 8 (53.3%) were able to be diaper-free, while 6 continued wearing diapers due to fear of soiling and 1 due to urinary incontinence. The patients underwent reconstructive bladder surgery and continued to use the Peristeen TAI system with the same results postoperatively. The main limitation of this study is the small number of patients included, although this is a very specific patient group. Conclusion: Our initial results suggest that the Peristeen TAI system is a successful conservative substitute for the MACE procedure in children who require reconstructive bladder surgery. PMID:24454594

  20. Close or positive margins after surgical resection for the head and neck cancer patient: the addition of brachytherapy improves local control

    International Nuclear Information System (INIS)

    Beitler, Jonathan J.; Smith, Richard V.; Silver, Carl E.; Quish, Astrid; Deore, Shivaji M.; Mullokandov, Eduard; Fontenla, Doracy P.; Wadler, Scott; Hayes, Mary Katherine; Vikram, Bhadrasain

    1998-01-01

    Purpose: Microscopically positive or close margins after surgical resection results in an approximately 21-26% local failure rate despite excellent postoperative external radiation therapy. We sought to demonstrate improved local control in head and neck cancer patients who had a resection with curative intent, and had unexpected, microscopically positive or close surgical margins. Methods and Materials: Twenty-nine patients with microscopically close or positive margins after curative surgery were given definitive, adjuvant external radiation therapy and 125 I brachytherapy. All 29 patients had squamous cell cancer and tonsil was the most common subsite within the head and neck region. After external radiation therapy and thorough discussions with the attending surgeon and pathologists, the slides, gross specimens, and appropriate radiographs were reviewed and a target volume was determined. The target volume was the region of the margin in question and varied in size based on the surgery and pathologic results. Once the target volume was identified the patient was taken back to the operating room for insertion of 125 I seeds. Activity implanted (range 2.9-21.5 millicuries) was designed to administer a cumulative lifetime dose of 120-160 Gy. Results: Twenty-nine patients were followed for a median of 26 months (range 5-86 months). Two-year actuarial local control was 92%. Conclusion: 125 I, after external radiation therapy, is an excellent method to improve local control in the subset of patients with unexpectedly unsatisfactory margins

  1. Cetuximab Concomitant with Second-Line Radiation Therapy in Patients with Locally Advanced Recurrent Squamous Cell Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Muge Akmansu

    2010-12-01

    Full Text Available We presented 9 recurrent head and neck carcinoma patients. Priorly all of them had received radiochemotherapy. We used cetuximab and irradiation concomitantly. Overall survival analysis of the patients was performed using the Kaplan-Meier method on SPSS version 15.0. Based on this calculation, mean follow-up duration is 12.8 months. Mean survival time is 19.8 months and annual mean survival rate is 59.3%.

  2. A Phase II Study of Docetaxel, Cisplatin and 5- Fluorouracil (TPF) In Patients with Locally Advanced Head and Neck Carcinomas.

    Science.gov (United States)

    Ansari, M; Omidvari, S; Mosalaei, A; Ahmadloo, N; Mosleh-Shirazi, M A; Mohammadianpanah, M

    2011-03-01

    The combination of cisplatin and 5-fluorouracil (PF) is currently considered a standard and effective regimen for the treatment of advanced head and neck carcinomas. The aim of this study was to evaluate the efficacy and safety of docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with unresectable head and neck carcinomas. Forty-six patients with previously untreated non-metastatic stage IV head and neck carcinomas were enrolled. All patients received three cycles of induction chemotherapy with docetaxel (75 mg/m(2)), cisplatin (40 mg/m(2)) (days 1-2), and 5-FU (500 mg/m(2), days 1-3), repeated every 21 days. Following induction chemotherapy, all patients underwent concurrent chemoradiotherapy using weekly cisplatin (30 mg/m(2)) and a median total dose of 70 Gy was delivered. Clinical response rate and toxicity were the primary and secondary end-points of the study. There were 31 men and 15 women. All patients had non-metastatic stage IV (T2-3N2-3 or T4N0-3) of disease. Overall and complete response rates were 74% and 24% respectively. Advanced T4 classification was associated with poorer response rate (p value=0.042). The major (grade 3-4) treatment-related toxicities were myelosuppression (78%), anorexia (13%), diarrhea (7%), emesis (11%) and stomatitis/pharyngitis (24%). In comparison with the data of historical published trials of the PF regimen, the TPF regimen was more effective. However, the TPF regimen appears to be associated with a higher incidence of major toxicities. Therefore, our limited findings support the TPF regimen as an alternative chemotherapeutic regimen for advanced head and neck carcinomas.

  3. Radical chemo-irradiation using intensity-modulated radiotherapy for locally advanced head and neck cancer in elderly patients: Experience from a tertiary care center in South India.

    Science.gov (United States)

    Chalissery, J R; Sudheeran, P C; Varghese, K M; Venkatesan, K

    2016-01-01

    To assess the feasibility, tolerance and response of radical chemo irradiation using Intensity modulated Radiotherapy [IMRT] in elderly patients [age >65] with locally advanced head and neck cancer. Patients aged 65 and above [range 65 to 84years] registered in oncology outpatient unit in our institution between December 2011 to 2014, with stage III and IV head and neck cancer were treated with radical dose of radiotherapy using IMRT and concurrent chemotherapy with cisplatin 40mg/sq.m weekly. Response evaluation and toxicity profile assessment was done 6 to 8 weeks after completion of treatment and 3 monthly thereafter with median follow up of 3 years. Total number of patients analysed were 47. 43(91.5%) patients tolerated 66-.70Gy of radiotherapy and 4 or more cycles of weekly chemotherapy with cisplatin. First follow up evaluation at 6 to 8 weeks showed 81% patients having complete loco regional response. Grade III skin reaction and mucositis was noticed in 24% and 47% respectively. No grade III neutropenia observed. Median follow up of 3 years showed a complete local control in 53% and overall survival of 60%. Radical chemo irradiation with IMRT in elderly patients is a feasible option. Long term local control and overall survival benefits needs to be followed up.

  4. Cisplatin, hyperthermia, and radiation (trimodal therapy) in patients with locally advanced head and neck tumors: A phase I-II study

    International Nuclear Information System (INIS)

    Amichetti, M.; Graiff, C.; Fellin, G.; Pani, G.; Bolner, A.; Maluta, S.; Valdagni, R.

    1993-01-01

    Hyperthermia is now being widely used to treat clinical malignancies, especially combined with radiotherapy and more rarely with chemotherapy. The combination of heat, radiation, and chemotherapy (trimodality) can lead to potent interaction. The present Phase I-II study was conducted to evaluate the feasibility and acute toxicity of a combination of cisplantin, hyperthermia, and irradiation in the treatment of superficial cervical nodal metastases from head and neck cancer. Eighteen patients with measurable neck metastases from previously untreated squamous cell head and neck tumors were entered into the trial. Therapy consisted of a conventional irradiation (total dose 70 Gy, 2 Gy five times a week) combined with a weekly administration of 20 mg/m 2 iv of cisplatin and a total of two sessions of local external microwave hyperthermia (desired temperature of 42.5 degrees C for 30 min). Feasibility of the treatment was demonstrated. Acute local toxicity was mild; no thermal blisters or ulcerations were reported and only two patients experienced local pain during hyperthermia. Cutaneous toxicity appeared greater than in previous studies with irradiation plus hyperthermia and irradiation plus cisplatin. Systematic toxicity was moderate with major toxic effects observed in three patients (World Health Organization (WHO) grade 3 anaemia). Even though it was not an aim of the study to evaluate the nodal response, they observed a complete response rate of 72.2% (95% confidence interval 51-93.4%), 16.6% of partial response and 11.1% of no change. The study confirms the feasibility of the combination of cisplantin, heat, and radiation with an acceptable toxicity profile. The trimodal therapy deserves further evaluation as a way to enhance the efficacy of irradiation in the treatment of nodal metastases from head and neck tumors. 43 refs., 3 figs., 4 tabs

  5. Does pathologic node status affect local control in patients with carcinoma of the head and neck treated with radical surgery and postoperative radiotherapy?

    International Nuclear Information System (INIS)

    Rudoltz, Marc S.; Benammar, Alia; Mohiuddin, Mohammed

    1995-01-01

    Purpose: To evaluate the effect of pathologic lymph node status and nodal stage on local control at the primary site in patients with advanced squamous cell carcinomas of the head and neck, treated with radical surgery and postoperative irradiation. Methods and Materials: Fifty-seven patients with advanced squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx, larynx, and supraglottic larynx were analyzed. All patients underwent resection of the primary lesion, neck dissection, and postoperative radiotherapy. Minimum follow-up was 2 years. The median dose to the primary tumor bed was 60.4 Gray (range 39.7-72.0). Besides pathologic nodal status (pN0 vs. pN+) and nodal stage, the following factors were analyzed for their impact on local control: age, gender, T stage, tumor grade, resection margins, interval from surgery to irradiation, dose to the primary site, and overall treatment time. Results: The 3-year actuarial local control rate was 78%. When all patients were analyzed, nodal status (pN0 vs. pN+) did not affect control at the primary site (71% vs. 82%, p = 0.42). Nodal stage (pN0-N2a va. pN2b-N2c) was also not a significant factor for local control (74% vs. 82%, p = 0.57). When only patients with negative margins were analyzed, nodal status again did not impact on local control (79% vs. 90% for pN0 vs. pN+, p = 0.39). On univariate analysis, only tumor grade, margin status, and elapsed days were significant factors for local control. Local control was 85% for patients with negative margins vs. 60% for those with positive margins (p = 0.016). For patients with moderately and poorly differentiated tumors, local control was 86% as compared to 50% for patients with well-differentiated tumors (p = 0.007). When radiotherapy was completed within 50 days, local control was 93% as opposed to 63% for >50 days (p 0.016). On multivariate analysis, only margin status (p = 0.002) and tumor grade (p = 0.007) remained significant. Conclusion: We conclude that

  6. Does pathologic node status affect local control in patients with carcinoma of the head and neck treated with radical surgery and postoperative radiotherapy?

    Energy Technology Data Exchange (ETDEWEB)

    Rudoltz, Marc S; Benammar, Alia; Mohiuddin, Mohammed

    1995-02-01

    Purpose: To evaluate the effect of pathologic lymph node status and nodal stage on local control at the primary site in patients with advanced squamous cell carcinomas of the head and neck, treated with radical surgery and postoperative irradiation. Methods and Materials: Fifty-seven patients with advanced squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx, larynx, and supraglottic larynx were analyzed. All patients underwent resection of the primary lesion, neck dissection, and postoperative radiotherapy. Minimum follow-up was 2 years. The median dose to the primary tumor bed was 60.4 Gray (range 39.7-72.0). Besides pathologic nodal status (pN0 vs. pN+) and nodal stage, the following factors were analyzed for their impact on local control: age, gender, T stage, tumor grade, resection margins, interval from surgery to irradiation, dose to the primary site, and overall treatment time. Results: The 3-year actuarial local control rate was 78%. When all patients were analyzed, nodal status (pN0 vs. pN+) did not affect control at the primary site (71% vs. 82%, p = 0.42). Nodal stage (pN0-N2a va. pN2b-N2c) was also not a significant factor for local control (74% vs. 82%, p = 0.57). When only patients with negative margins were analyzed, nodal status again did not impact on local control (79% vs. 90% for pN0 vs. pN+, p = 0.39). On univariate analysis, only tumor grade, margin status, and elapsed days were significant factors for local control. Local control was 85% for patients with negative margins vs. 60% for those with positive margins (p = 0.016). For patients with moderately and poorly differentiated tumors, local control was 86% as compared to 50% for patients with well-differentiated tumors (p = 0.007). When radiotherapy was completed within 50 days, local control was 93% as opposed to 63% for >50 days (p 0.016). On multivariate analysis, only margin status (p = 0.002) and tumor grade (p = 0.007) remained significant. Conclusion: We conclude that

  7. Neurological abnormalities in localized scleroderma of the face and head: a case series study for evaluation of imaging findings and clinical course.

    Science.gov (United States)

    Lis-Święty, Anna; Brzezińska-Wcisło, Ligia; Arasiewicz, Hubert

    2017-09-01

    Localized scleroderma (LoS) of the face and head is often associated with neurological manifestations and/or imaging abnormalities in the central nervous system (CNS). We present an analysis of 20 cases of LoS affecting the face and head. The CNS symptoms and/or abnormalities in high-resolution computed tomography (HRCT) and/or magnetic resonance imaging (MRI) were observed in 12 patients (60%). In addition to the mild and unspecific disorders (e.g. headaches), serious neurological complications probably in the course of vasculitis were revealed: epilepsy (in two patients), epilepsy and pyramidal sings (in one patient). Neurological disorders and LoS occurred at the same time (in three patients) or at the course of the disease (nine patients) and no later than 29 years since the onset of the disease. No link between neurological disorders and the LoS clinical morphology, immunological and other laboratory parameters has been established. CNS involvement is not correlated with the clinical course of the facial and head LoS and may occur years after the disease initial symptomatology. Imaging follow-up is not required if there is not any emerging neurological symptom. In some cases, however, both HRCT and MRI are useful for monitoring disease evolution and addressing therapeutic choices.

  8. The predictive value of single-photon emission computed tomography/computed tomography for sentinel lymph node localization in head and neck cutaneous malignancy.

    Science.gov (United States)

    Remenschneider, Aaron K; Dilger, Amanda E; Wang, Yingbing; Palmer, Edwin L; Scott, James A; Emerick, Kevin S

    2015-04-01

    Preoperative localization of sentinel lymph nodes in head and neck cutaneous malignancies can be aided by single-photon emission computed tomography/computed tomography (SPECT/CT); however, its true predictive value for identifying lymph nodes intraoperatively remains unquantified. This study aims to understand the sensitivity, specificity, and positive and negative predictive values of SPECT/CT in sentinel lymph node biopsy for cutaneous malignancies of the head and neck. Blinded retrospective imaging review with comparison to intraoperative gamma probe confirmed sentinel lymph nodes. A consecutive series of patients with a head and neck cutaneous malignancy underwent preoperative SPECT/CT followed by sentinel lymph node biopsy with a gamma probe. Two nuclear medicine physicians, blinded to clinical data, independently reviewed each SPECT/CT. Activity within radiographically defined nodal basins was recorded and compared to intraoperative gamma probe findings. Sensitivity, specificity, and negative and positive predictive values were calculated with subgroup stratification by primary tumor site. Ninety-two imaging reads were performed on 47 patients with cutaneous malignancy who underwent SPECT/CT followed by sentinel lymph node biopsy. Overall sensitivity was 73%, specificity 92%, positive predictive value 54%, and negative predictive value 96%. The predictive ability of SPECT/CT to identify the basin or an adjacent basin containing the single hottest node was 92%. SPECT/CT overestimated uptake by an average of one nodal basin. In the head and neck, SPECT/CT has higher reliability for primary lesions of the eyelid, scalp, and cheek. SPECT/CT has high sensitivity, specificity, and negative predictive value, but may overestimate relevant nodal basins in sentinel lymph node biopsy. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  9. SU-F-J-13: Choosing An IMRT Technique in the Treatment of Head and Neck Cancer with Daily Localization Uncertainties

    Energy Technology Data Exchange (ETDEWEB)

    Lin, T; Wang, L; Galloway, T; Ma, C [Fox Chase Cancer Center, Philadelphia, PA (United States)

    2016-06-15

    Purpose: Head and Neck cancer treatment with IMRT/VMAT has two choices: split-filed IMRT(SFI), in which the LAN is treated with a separate anterior field and the extended whole-field IMRT(WFI) in which LAN is included with the IMRT/VMAT field. This study shows that under the same dose limit criteria, choosing the technique becomes a critical issue if daily localization and immobilization altered the dose distribution. Methods: Nine common head-and-neck cancer cases were chosen to illustrate how the daily localization and immobilization uncertainties affect to choose between SFI and WFI. Both SFI and WFI at upper target coverage were generated with VMAT. For each case, the same planning criteria were applied to the target and critical structures; therefore, similar target coverage and dose falloff can be observed in both techniques. Thirty days of kV cone beam CT(CBCT) images on each case were also delineated with contralateral and ipsilateral target as well as larynx as critical structure. About 300 CBCT images with daily delivered doses were analyzed and compared in a form of dose-volume histograms. Results: While both plans for SFI and WFI with VMAT planning utilized and meet the criteria of D95>prescription dose and for not-involved larynx with mean dose <35Gy and V55<10%, the daily localization and immobilization has a great contribution to the resulted dose delivery. With WFI, the better daily contralateral and ipsilateral neck target coverage can reflect a simpler or shorter localization; however, a much superior avoidance (WFI: mean dose a 42.5Gy; SFI: mean dose a 18.9Gy) of the non-involved larynx from the SFI is preferred. Conclusion: Dosimetrically, SFI and WFI are equally well for head and Neck cancer treatment with VMAT technique; however, if considering the contribution of daily localization(CBCT) method uncertainties, SFI is better with sparing non-involved larynx and WFI has better target coverage.

  10. Detection of Local Tumor Recurrence After Definitive Treatment of Head and Neck Squamous Cell Carcinoma: Histogram Analysis of Dynamic Contrast-Enhanced T1-Weighted Perfusion MRI.

    Science.gov (United States)

    Choi, Sang Hyun; Lee, Jeong Hyun; Choi, Young Jun; Park, Ji Eun; Sung, Yu Sub; Kim, Namkug; Baek, Jung Hwan

    2017-01-01

    This study aimed to explore the added value of histogram analysis of the ratio of initial to final 90-second time-signal intensity AUC (AUCR) for differentiating local tumor recurrence from contrast-enhancing scar on follow-up dynamic contrast-enhanced T1-weighted perfusion MRI of patients treated for head and neck squamous cell carcinoma (HNSCC). AUCR histogram parameters were assessed among tumor recurrence (n = 19) and contrast-enhancing scar (n = 27) at primary sites and compared using the t test. ROC analysis was used to determine the best differentiating parameters. The added value of AUCR histogram parameters was assessed when they were added to inconclusive conventional MRI results. Histogram analysis showed statistically significant differences in the 50th, 75th, and 90th percentiles of the AUCR values between the two groups (p Histogram analysis of AUCR can improve the diagnostic yield for local tumor recurrence during surveillance after treatment for HNSCC.

  11. Combined high-intensity local treatment and systemic therapy in metastatic head and neck squamous cell carcinoma: An analysis of the National Cancer Data Base.

    Science.gov (United States)

    Zumsteg, Zachary S; Luu, Michael; Yoshida, Emi J; Kim, Sungjin; Tighiouart, Mourad; David, John M; Shiao, Stephen L; Mita, Alain C; Scher, Kevin S; Sherman, Eric J; Lee, Nancy Y; Ho, Allen S

    2017-12-01

    There is increasing evidence that primary tumor ablation can improve survival for some cancer patients with distant metastases. This may be particularly applicable to head and neck squamous cell carcinoma (HNSCC) because of its tropism for locoregional progression. This study included patients with metastatic HNSCC undergoing systemic therapy identified in the National Cancer Data Base. High-intensity local treatment was defined as radiation doses ≥ 60 Gy or oncologic resection of the primary tumor. Multivariate Cox regression, propensity score matching, landmark analysis, and subgroup analysis were performed to account for imbalances in covariates, including adjustments for the number and location of metastatic sites in the subset of patients with this information available. In all, 3269 patients were included (median follow-up, 51.5 months). Patients undergoing systemic therapy with local treatment had improved survival in comparison with patients receiving systemic therapy alone in propensity score-matched cohorts (2-year overall survival, 34.2% vs 20.6%; P treatment, whereas those receiving lower-intensity local treatment had survival similar to that of patients receiving systemic therapy without local treatment. The impact of high-intensity local therapy was time-dependent, with a stronger impact within the first 6 months after the diagnosis (adjusted hazard ratio [AHR], 0.255; 95% confidence interval [CI], 0.210-0.309; P treatment warrants prospective evaluation for select patients with metastatic HNSCC. Cancer 2017;123:4583-4593. © 2017 American Cancer Society. © 2017 American Cancer Society.

  12. Effects of Treatment Intensification on Acute Local Toxicity During Radiotherapy for Head and Neck Cancer: Prospective Observational Study Validating CTCAE, Version 3.0, Scoring System

    International Nuclear Information System (INIS)

    Palazzi, Mauro; Tomatis, Stefano; Orlandi, Ester; Guzzo, Marco; Sangalli, Claudia; Potepan, Paolo; Fantini, Simona; Bergamini, Cristiana; Gavazzi, Cecilia; Licitra, Lisa; Scaramellini, Gabriele; Cantu', Giulio; Olmi, Patrizia

    2008-01-01

    Purpose: To quantify the incidence and severity of acute local toxicity in head and neck cancer patients treated with radiotherapy (RT), with or without chemotherapy (CHT), using the Common Terminology Criteria for Adverse Events, version 3.0 (CTCAE v3.0), scoring system. Methods and Materials: Between 2004 and 2006, 149 patients with head and neck cancer treated with RT at our center were prospectively evaluated for local toxicity during treatment. On a weekly basis, patients were monitored and eight toxicity items were recorded according to the CTCAE v3.0 scoring system. Of the 149 patients, 48 (32%) were treated with RT alone (conventional fractionation), 82 (55%) with concomitant CHT and conventional fractionation RT, and 20 (13%) with accelerated-fractionation RT and CHT. Results: Severe (Grade 3-4) adverse events were recorded in 28% (mucositis), 33% (dysphagia), 40% (pain), and 12% (skin) of patients. Multivariate analysis showed CHT to be the most relevant factor independently predicting for worse toxicity (mucositis, dysphagia, weight loss, salivary changes). In contrast, previous surgery, RT acceleration and older age, female gender, and younger age, respectively, predicted for a worse outcome of mucositis, weight loss, pain, and dermatitis. The T-score method confirmed that conventional RT alone is in the 'low-burden' class (T-score = 0.6) and suggests that concurrent CHT and conventional fractionation RT is in the 'high-burden' class (T-score = 1.15). Combined CHT and accelerated-fractionation RT had the highest T-score at 1.9. Conclusions: The CTCAE v3.0 proved to be a reliable tool to quantify acute toxicity in head and neck cancer patients treated with various treatment intensities. The effect of CHT and RT acceleration on the acute toxicity burden was clinically relevant

  13. MODFLOW–LGR—Documentation of ghost node local grid refinement (LGR2) for multiple areas and the boundary flow and head (BFH2) package

    Science.gov (United States)

    Mehl, Steffen W.; Hill, Mary C.

    2013-01-01

    This report documents the addition of ghost node Local Grid Refinement (LGR2) to MODFLOW-2005, the U.S. Geological Survey modular, transient, three-dimensional, finite-difference groundwater flow model. LGR2 provides the capability to simulate groundwater flow using multiple block-shaped higher-resolution local grids (a child model) within a coarser-grid parent model. LGR2 accomplishes this by iteratively coupling separate MODFLOW-2005 models such that heads and fluxes are balanced across the grid-refinement interface boundary. LGR2 can be used in two-and three-dimensional, steady-state and transient simulations and for simulations of confined and unconfined groundwater systems. Traditional one-way coupled telescopic mesh refinement methods can have large, often undetected, inconsistencies in heads and fluxes across the interface between two model grids. The iteratively coupled ghost-node method of LGR2 provides a more rigorous coupling in which the solution accuracy is controlled by convergence criteria defined by the user. In realistic problems, this can result in substantially more accurate solutions and require an increase in computer processing time. The rigorous coupling enables sensitivity analysis, parameter estimation, and uncertainty analysis that reflects conditions in both model grids. This report describes the method used by LGR2, evaluates accuracy and performance for two-and three-dimensional test cases, provides input instructions, and lists selected input and output files for an example problem. It also presents the Boundary Flow and Head (BFH2) Package, which allows the child and parent models to be simulated independently using the boundary conditions obtained through the iterative process of LGR2.

  14. Radiation therapy and concurrent cisplatin administration in locally advanced head and neck cancer. A Hellenic co-operative oncology group study

    International Nuclear Information System (INIS)

    Fountzilas, G.; Skarlos, D.; Kosmidis, P.; Samantas, E.; Kalogera-Fountzila, A.; Papaspyrou, S.; Tzitzikas, J.; Sridhar, K.S.; Makrantonakis, P.; Pantelakos, P.; Nikolaou, A.; Bacoyiannis, H.; Sinodinou, M.; Banis, C.; Daniilidis, J.

    1994-01-01

    In an attempt to improve local control of locally advanced head and neck cancer, radiation therapy was combined with cisplatin. Forty-eight patients entered into this study. All patients were irradiated with a 60 Co unit and according to the protocol they should receive 70 Gy in the tumor area and 45 Gy in the rest of neck. Cisplatin was administered at a dose of 100 mg/m 2 on days 2, 22 and 42. Thirty-seven (80%) patients received the total radiation dose as initially planned. Thirty-four (72%) patients achieved complete and 5 (10%) partial response. Grade 3-4 toxicities included vomiting (14%) stomatitis (4%), diarrhea (2%), myelotoxicity (14%), hoarseness (4%), dysphagia (30%), weight loss (32%), nephrotoxicity (4%) and dermatitis (2%). After a median follow-up of 26 (range, 18-33) months, 16 patients have died. Among the 35 complete responders 6 later on relapsed. Median relapse-free survival has not yet been reached. Combined radiation therapy and cisplatin appears to be a highly active treatment in patients with advanced head and neck cancer as far as primary locoregional response is concerned. (orig.)

  15. Comparison of the local dose of scattered radiation of a special dental - phantom and a real human head by using a Digital Volume Tomography (DVT)

    International Nuclear Information System (INIS)

    Neuwirth, J.; Hefner, A.

    2008-01-01

    Dental Radiography Digital Volume Tomography (DVT) gains more and more importance due to its possibility of three-dimensional imaging of teeth, jaw and visercoranium and the reduced radiation dose in comparison to conventional Computer Tomography (CT). Contrary to other, well documented radiographic procedures like dental panorama X-ray imaging there are no national or international guidelines or recommendations relating to DVT which regulate the designation of areas and standardize risk assessment. This study aims to assess the parameters necessary for local radiation protection in dental practices. Measurements were carried out in dental practices in order to evaluate the local dose resulting from different DVT devices. A special dental-phantom and a real human head were used in the irradiations in order to define the local dose of scattered radiation by nominal voltage. The dental-phantom was created for conventional dental panorama X-ray devices which make use of lower nominal voltages. This poses the question if the scatter performance of the special dental-phantom is comparable to a real human head and therefore applicable to the estimation of the radiation quality of a DVT when using 120 kV. The existing guidelines for dental panorama xray are analyzed and suggestions for future recommendations concerning the designation of areas and risk assessment for DVT are then deducted by comparing both sets of measurements. The results show that the special dental-phantom is absolutely suitable for the definition of the local dose resulting from the scattered radiation of a DVT. (author)

  16. Heads Up

    Science.gov (United States)

    ... Connect with Us HEADS UP Apps Reshaping the Culture Around Concussion in Sports Get HEADS UP on Your Web Site Concussion ... HEADS UP on your web site! Create a culture of safety for young athletes Officials, learn how you can ... UP to Providers HEADS UP to Youth Sports HEADS UP to School Sports HEADS UP to ...

  17. Pretreatment Apparent Diffusion Coefficient of the Primary Lesion Correlates With Local Failure in Head-and-Neck Cancer Treated With Chemoradiotherapy or Radiotherapy

    International Nuclear Information System (INIS)

    Hatakenaka, Masamitsu; Nakamura, Katsumasa; Yabuuchi, Hidetake; Shioyama, Yoshiyuki; Matsuo, Yoshio; Ohnishi, Kayoko; Sunami, Shunya; Kamitani, Takeshi; Setoguchi, Taro; Yoshiura, Takashi; Nakashima, Torahiko; Nishikawa, Kei; Honda, Hiroshi

    2011-01-01

    Purpose: This study was performed to evaluate whether the apparent diffusion coefficient (ADC) of a primary lesion correlates with local failure in primary head-and-neck squamous cell carcinoma (HNSCC) treated with chemoradiotherapy or radiotherapy. Methods and Materials: We retrospectively studied 38 patients with primary HNSCC (12 oropharynx, 20 hypopharynx, 4 larynx, 2 oral cavity) treated with chemoradiotherapy or radiotherapy with radiation dose to gross tumor volume equal to or over 60 Gy and who underwent pretreatment magnetic resonance imaging, including diffusion-weighted imaging. Ten patients developed local failure during follow-up periods of 2.0 to 9.3 months, and the remaining 28 showed local control during follow-up periods of 10.5 to 31.7 months. The variables that could affect local failure (age, tumor volume, ADC, T stage, N stage, dose, treatment method, tumor location, and overall treatment time) were analyzed using logistic regression analyses for all 38 patients and for 17 patients with Stage T3 or T4 disease. Results: In univariate logistic analysis for all 38 cases, tumor volume, ADC, T stage, and treatment method showed significant (p < 0.05) associations with local failure. In multivariate analysis, ADC and T stage revealed significance (p < 0.01). In univariate logistic analysis for the 17 patients with Stage T3 or T4 disease, ADC and dose showed significant (p < 0.01) associations with local failure. In multivariate analysis, ADC alone showed significance (p < 0.05). Conclusions: The results suggest that pretreatment ADC, along with T stage, is a potential indicator of local failure in HNSCC treated with chemoradiotherapy or radiotherapy.

  18. Randomized phase III trial of concurrent chemoradiotherapy vs accelerated hyperfractionation radiotherapy in locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Chitapanarux, Imjai; Kamnerdsupaphon, Pimkhuan; Pukanhapan, Nantaka; Tharavichitkul, Ekkasit; Vongtama, Roy

    2013-01-01

    The aim of this study was to compare the efficacy and safety of concurrent chemoradiotherapy (CCRT) vs accelerated hyperfractionation with concomitant boost (CCB) as a primary treatment for patients with Stage III-IV squamous cell carcinoma of head and neck (SCCHN). A total of 85 non-metastatic advanced SCCHN patients were accrued from January 2003 to December 2007. Of these, 48 and 37 patients received CCRT and CCB, respectively. The patients were randomized to receive either three cycles of carboplatin and 5-fluorouracil plus conventional radiotherapy (CCRT, 66 Gy in 6.5 weeks) or hybrid accelerated radiotherapy (CCB, 70 Gy in 6 weeks). The primary endpoint was determined by locoregional control rate. The secondary endpoints were overall survival and toxicity. With a median follow-up of 43 months (range, 3-102), the 5-year locoregional control rate was 69.6% in the CCRT arm vs 55.0% in the CCB arm (P = 0.184). The 5-year overall survival rate was marginally significantly different (P = 0.05): 76.1% in the CCRT arm vs 63.5% in the CCB arm. Radiotherapy treatment interruptions of more than three days were 60.4% and 40.5% in the CCRT arm and CCB arm, respectively. The median total treatment time was 55.5 days in the CCRT arm and 49 days in the CCB arm. The rate of Grade 3 - 4 acute mucositis was significantly higher in the CCB arm (67.6% vs 41.7%, P = 0.01), but no high grade hematologic toxicities were found in the CCB arm (27.2% vs 0%). CCRT has shown a trend of improving outcome over CCB irradiation in locoregionally advanced head and neck cancer. (author)

  19. Preventive sparing of spinal cord and brain stem in the initial irradiation of locally advanced head and neck cancers.

    Science.gov (United States)

    Farace, Paolo; Piras, Sara; Porru, Sergio; Massazza, Federica; Fadda, Giuseppina; Solla, Ignazio; Piras, Denise; Deidda, Maria Assunta; Amichetti, Maurizio; Possanzini, Marco

    2014-01-06

    Since reirradiation in recurrent head and neck patients is limited by previous treatment, a marked reduction of maximum doses to spinal cord and brain stem was investigated in the initial irradiation of stage III/IV head and neck cancers. Eighteen patients were planned by simultaneous integrated boost, prescribing 69.3 Gy to PTV1 and 56.1 Gy to PTV2. Nine 6 MV coplanar photon beams at equispaced gantry angles were chosen for each patient. Step-and-shoot IMRT was calculated by direct machine parameter optimization, with the maximum number of segments limited to 80. In the standard plan, optimization considered organs at risk (OAR), dose conformity, maximum dose < 45 Gy to spinal cord and < 50 Gy to brain stem. In the sparing plans, a marked reduction to spinal cord and brain stem were investigated, with/without changes in dose conformity. In the sparing plans, the maximum doses to spinal cord and brain stem were reduced from the initial values (43.5 ± 2.2 Gy and 36.7 ± 14.0 Gy), without significant changes on the other OARs. A marked difference (-15.9 ± 1.9 Gy and -10.1 ± 5.7 Gy) was obtained at the expense of a small difference (-1.3% ± 0.9%) from initial PTV195% coverage (96.6% ± 0.9%). Similar difference (-15.7 ± 2.2 Gy and -10.2 ± 6.1 Gy) was obtained compromising dose conformity, but unaffecting PTV195% and with negligible decrease in PTV295% (-0.3% ± 0.3% from the initial 98.3% ± 0.8%). A marked spinal cord and brain stem preventive sparing was feasible at the expense of a decrease in dose conformity or slightly compromising target coverage. A sparing should be recommended in highly recurrent tumors, to make potential reirradiation safer.

  20. LOCAL POLITICAL DYNAMICS IN THE GENERAL ELECTION DIRECTLY CONDUCTED TO VOTE FOR DISTRICT HEADS (PILKADA IN BADUNG REGENCY IN 2005

    Directory of Open Access Journals (Sweden)

    Anak Agung Gede Oka Wisnumurti

    2012-11-01

    Full Text Available The general election directly conducted to vote for the regent and vice regent(Pemilihan Kepala Daerah, abbreviated to Pilkada by the people in Badung Regency in2005 was the first one. The people’s direct involvement in the local political life movedhighly dynamically. The struggle for power by various strengths affected variousdimensions of the people’s lives; therefore, it is interesting to investigate the localpolitical dynamics in the Pilkada directly conducted in Badung Regency in 2005 in theperspective of cultural studies. There are three problems formulated in this study. Theyare (1 what was the dynamics of the Pilkada directly conducted in Badung Regency in2005 like?; (2 how the relation of strengths affected the local political dynamics in thePilkada directly conducted in Badung Regency in 2005?; (3 what were the implicationsand meanings of the local political dynamics of the Pilkada directly conducted in BadungRegency in 2005?The results of the study show that fluctuative changes took place continuouslywith regard to the form and functions of societal structure. Culturally, the people’sideology changed from being mono centric into being multi centric. The relation ofstrengths became segmented into three main strengths forming a new formation ofstrength referred to as trisula. This led to an institutional configuration, differentiation ofpower and locality sedimentation, and provided meanings to competition and tolerance,emancipatory, political comodification, adaptive leadership and local democratic culturalstrengthening.

  1. Very Late Local Relapse of Ewing's Sarcoma of the Head and Neck treated with Aggressive Multimodal Therapy

    Directory of Open Access Journals (Sweden)

    J. Thariat

    2008-01-01

    Full Text Available Ewing's sarcoma's relapse rarely occurs more than two years after the initial diagnosis. We report the case of a 26-year-old man with a history of Ewing's sarcoma of the left maxillary sinus at the age of 10 who presented with a very late local relapse, 16 years after the first occurrence of disease. Ultimate control was achieved after multimodal therapy including surgery, high-dose chemotherapy, and radiotherapy. This report indicates that local relapses of Ewing's sarcoma can be treated with curative intent in selected cases.

  2. Boron Neutron Capture Therapy in the Treatment of Locally Recurred Head-and-Neck Cancer: Final Analysis of a Phase I/II Trial

    Energy Technology Data Exchange (ETDEWEB)

    Kankaanranta, Leena [Department of Oncology, Helsinki University Central Hospital, Helsinki (Finland); Seppaelae, Tiina; Koivunoro, Hanna [Department of Physics, University of Helsinki, Helsinki (Finland); Boneca Corporation, Helsinki (Finland); Saarilahti, Kauko [Department of Oncology, Helsinki University Central Hospital, Helsinki (Finland); Atula, Timo [Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki (Finland); Collan, Juhani [Department of Oncology, Helsinki University Central Hospital, Helsinki (Finland); Salli, Eero; Kortesniemi, Mika [Helsinki and Uusimaa Hospital District Medical Imaging Center, Helsinki University Central Hospital, Helsinki (Finland); Uusi-Simola, Jouni [Department of Physics, University of Helsinki, Helsinki (Finland); Helsinki and Uusimaa Hospital District Medical Imaging Center, Helsinki University Central Hospital, Helsinki (Finland); Vaelimaeki, Petteri [Department of Physics, University of Helsinki, Helsinki (Finland); Boneca Corporation, Helsinki (Finland); Maekitie, Antti [Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki (Finland); Seppaenen, Marko [Turku PET Centre, Turku University Hospital, Turku (Finland); Minn, Heikki [Department of Oncology, Turku University Central Hospital, Turku (Finland); Revitzer, Hannu [Aalto University School of Science and Technology, Esopo (Finland); Kouri, Mauri [Department of Oncology, Helsinki University Central Hospital, Helsinki (Finland); Kotiluoto, Petri; Seren, Tom; Auterinen, Iiro [VTT Technical Research Centre of Finland, Espoo (Finland); Savolainen, Sauli [Department of Physics, University of Helsinki, Helsinki (Finland); Helsinki and Uusimaa Hospital District Medical Imaging Center, Helsinki University Central Hospital, Helsinki (Finland); Joensuu, Heikki, E-mail: heikki.joensuu@hus.fi [Department of Oncology, Helsinki University Central Hospital, Helsinki (Finland)

    2012-01-01

    Purpose: To investigate the efficacy and safety of boron neutron capture therapy (BNCT) in the treatment of inoperable head-and-neck cancers that recur locally after conventional photon radiation therapy. Methods and Materials: In this prospective, single-center Phase I/II study, 30 patients with inoperable, locally recurred head-and-neck cancer (29 carcinomas and 1 sarcoma) were treated with BNCT. Prior treatments consisted of surgery and conventionally fractionated photon irradiation to a cumulative dose of 50 to 98 Gy administered with or without concomitant chemotherapy. Tumor responses were assessed by use of the RECIST (Response Evaluation Criteria in Solid Tumors) and adverse effects by use of the National Cancer Institute common terminology criteria version 3.0. Intravenously administered L-boronophenylalanine-fructose (400 mg/kg) was administered as the boron carrier. Each patient was scheduled to be treated twice with BNCT. Results: Twenty-six patients received BNCT twice; four were treated once. Of the 29 evaluable patients, 22 (76%) responded to BNCT, 6 (21%) had tumor growth stabilization for 5.1 and 20.3 months, and 1 (3%) progressed. The median progression-free survival time was 7.5 months (95% confidence interval, 5.4-9.6 months). Two-year progression-free survival and overall survival were 20% and 30%, respectively, and 27% of the patients survived for 2 years without locoregional recurrence. The most common acute Grade 3 adverse effects were mucositis (54% of patients), oral pain (54%), and fatigue (32%). Three patients were diagnosed with osteoradionecrosis (each Grade 3) and one patient with soft-tissue necrosis (Grade 4). Late Grade 3 xerostomia was present in 3 of the 15 evaluable patients (20%). Conclusions: Most patients who have inoperable, locally advanced head-and-neck carcinoma that has recurred at a previously irradiated site respond to boronophenylalanine-mediated BNCT, but cancer recurrence after BNCT remains frequent. Toxicity was

  3. Low skeletal muscle mass is a predictive factor for chemotherapy dose-limiting toxicity in patients with locally advanced head and neck cancer.

    Science.gov (United States)

    Wendrich, Anne W; Swartz, Justin E; Bril, Sandra I; Wegner, Inge; de Graeff, Alexander; Smid, Ernst J; de Bree, Remco; Pothen, Ajit J

    2017-08-01

    Low skeletal muscle mass (SMM) or sarcopenia is emerging as an adverse prognostic factor for chemotherapy dose-limiting toxicity (CLDT) and survival in cancer patients. Our aim was to determine the impact of low SMM on CDLT in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) treated with primary radiochemotherapy (RCT). Consecutive patients diagnosed with LA-HNSCC and treated with primary RCT between 2007 and 2011 in our center were included. Clinical variables were retrospectively retrieved and SMM was measured at the level of the third cervical vertebra using pre-treatment head and neck CT-scans. After determining a cut-off value for low SMM, multivariate analysis was performed to identify prognostic factors for CDLT. Of 112 patients included, 30.4% experienced CDLT. The optimal cut-off value for low SMM as a predictor of CDLT was ≤43.2cm 2 /m 2 . Using this cut-off, 54.5% patients had low SMM. Patients with low SMM experienced CDLT more frequently than patients with normal SMM (44.3% vs. 13.7%, pSMM, p=0.044). At multivariate analysis, low SMM was independently inversely associated with CDLT (OR 0.93, 95%CI: 0.88-0.98). Patients experiencing CDLT had a lower overall survival than patients who did not (mean 36.6vs. 54.2months, p=0.038). Low SMM is an independent risk factor for CDLT in LA-HNSCC patients treated with primary RCT. Pre-therapeutic estimation of SMM using routine CT-scans of the head and neck region may identify patients at risk of CDLT. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Quantification of gross tumour volume changes between simulation and first day of radiotherapy for patients with locally advanced malignancies of the lung and head/neck.

    Science.gov (United States)

    Kishan, Amar U; Cui, Jing; Wang, Pin-Chieh; Daly, Megan E; Purdy, James A; Chen, Allen M

    2014-10-01

    To quantify changes in gross tumour volume (GTV) between simulation and initiation of radiotherapy in patients with locally advanced malignancies of the lung and head/neck. Initial cone beam computed tomography (CT) scans from 12 patients with lung cancer and 12 with head/neck cancer (head and neck squamous cell carcinoma (HNSCC)) treated with intensity-modulated radiotherapy with image guidance were rigidly registered to the simulation CT scans. The GTV was demarcated on both scans. The relationship between percent GTV change and variables including time interval between simulation and start, tumour (T) stage, and absolute weight change was assessed. For lung cancer patients, the GTV increased a median of 35.06% (range, -16.63% to 229.97%) over a median interval of 13 days (range, 7-43), while for HNSCC patients, the median GTV increase was 16.04% (range, -8.03% to 47.41%) over 13 days (range, 7-40). These observed changes are statistically significant. The magnitude of this change was inversely associated with the size of the tumour on the simulation scan for lung cancer patients (P lung cancer cases) did not correlate with degree of GTV change (P > 0.1). While the observed changes in GTV were moderate from the time of simulation to start of radiotherapy, these findings underscore the importance of image guidance for target localisation and verification, particularly for smaller tumours. Minimising the delay between simulation and treatment initiation may also be beneficial. © 2014 The Royal Australian and New Zealand College of Radiologists.

  5. Salvage Stereotactic Reirradiation With or Without Cetuximab for Locally Recurrent Head-and-Neck Cancer: A Feasibility Study

    Energy Technology Data Exchange (ETDEWEB)

    Comet, Benedicte [Department of Academic Radiotherapy, Centre Oscar Lambret and University Lille II, Lille (France); Kramar, Andrew [Department of Statistical Analysis, Centre Oscar Lambret and University Lille II, Lille (France); Faivre-Pierret, Mathieu [Department of Radiology, Centre Oscar Lambret and University Lille II, Lille (France); Dewas, Sylvain; Coche-Dequeant, Bernard [Department of Academic Radiotherapy, Centre Oscar Lambret and University Lille II, Lille (France); Degardin, Marian; Lefebvre, Jean-Louis [Department of Head and Neck Surgery, Centre Oscar Lambret and University Lille II, Lille (France); Lacornerie, Thomas [Department of Academic Radiotherapy, Centre Oscar Lambret and University Lille II, Lille (France); Lartigau, Eric F., E-mail: e-lartigau@o-lambret.fr [Department of Academic Radiotherapy, Centre Oscar Lambret and University Lille II, Lille (France)

    2012-09-01

    Purpose: Normal tissues tolerance limits the use of reirradiation for recurrent head-and-neck cancers (HNC). Stereotactic body radiotherapy (SBRT) could offer precise irradiation while sparing healthy tissues. Results of a feasibility study using SBRT with or without cetuximab are reported for reirradiation of recurrent primary HNC. Methods and Materials: Patients with inoperable recurrent, or new primary tumor, in a previously irradiated area were included. Reirradiation dose was 36 Gy in six fractions of 6 Gy to the 85% isodose line covering 95% of the planning target volume. Patients with squamous cell carcinoma received concomitant cetuximab. Results: Between June 2007 and January 2010, 40 patients were prospectively treated for 43 lesions. Median age was 60 and median tumor size was 29 mm. Fifteen patients received concomitant cetuximab and 1 received concomitant cisplatin. Median follow-up was 25.6 months with 34 patients evaluable for tumor response. Median overall survival was 13.6 months and response rate was 79.4% (15 complete and 12 partial responses). Grade 3 toxicity occurred in 4 patients. Conclusion: These results suggest that short SBRT with or without cetuximab is an effective salvage treatment with good response rate in this poor prognosis population with previously irradiated HNC. Treatment is feasible and, with appropriate care to limiting critical structure, acute toxicities are acceptable. A prospective multicenter Phase II trial of SRT and concomitant cetuximab in recurrent HNC squamous cell carcinoma is ongoing.

  6. Salvage Stereotactic Reirradiation With or Without Cetuximab for Locally Recurrent Head-and-Neck Cancer: A Feasibility Study

    International Nuclear Information System (INIS)

    Comet, Bénédicte; Kramar, Andrew; Faivre-Pierret, Mathieu; Dewas, Sylvain; Coche-Dequeant, Bernard; Degardin, Marian; Lefebvre, Jean-Louis; Lacornerie, Thomas; Lartigau, Eric F.

    2012-01-01

    Purpose: Normal tissues tolerance limits the use of reirradiation for recurrent head-and-neck cancers (HNC). Stereotactic body radiotherapy (SBRT) could offer precise irradiation while sparing healthy tissues. Results of a feasibility study using SBRT with or without cetuximab are reported for reirradiation of recurrent primary HNC. Methods and Materials: Patients with inoperable recurrent, or new primary tumor, in a previously irradiated area were included. Reirradiation dose was 36 Gy in six fractions of 6 Gy to the 85% isodose line covering 95% of the planning target volume. Patients with squamous cell carcinoma received concomitant cetuximab. Results: Between June 2007 and January 2010, 40 patients were prospectively treated for 43 lesions. Median age was 60 and median tumor size was 29 mm. Fifteen patients received concomitant cetuximab and 1 received concomitant cisplatin. Median follow-up was 25.6 months with 34 patients evaluable for tumor response. Median overall survival was 13.6 months and response rate was 79.4% (15 complete and 12 partial responses). Grade 3 toxicity occurred in 4 patients. Conclusion: These results suggest that short SBRT with or without cetuximab is an effective salvage treatment with good response rate in this poor prognosis population with previously irradiated HNC. Treatment is feasible and, with appropriate care to limiting critical structure, acute toxicities are acceptable. A prospective multicenter Phase II trial of SRT and concomitant cetuximab in recurrent HNC squamous cell carcinoma is ongoing.

  7. ATN-224 enhances antitumor efficacy of oncolytic herpes virus against both local and metastatic head and neck squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Ji Young Yoo

    Full Text Available Head and neck squamous cell carcinoma (HNSCC is the sixth most frequent cancer worldwide, and the 5-year survival rates are among the worst of the major cancers. Oncolytic herpes simplex viruses (oHSV have the potential to make a significant impact in the targeted treatment of these patients. Here, we tested antitumor efficacy of RAMBO, an oHSV armed with the antiangiogenic Vstat120, alone and in conjunction with ATN-224, a copper chelator against HNSCC in vitro and in vivo animal models. We found that all tested HNSCC cells responded well to virus treatment and were sensitive to RAMBO-mediated oncolytic destruction. In vivo, RAMBO had a significant antiangiogenic and antitumorigenic effect. Physiologic levels of copper inhibited viral replication and HNSCC cell killing. Chelation of copper using ATN-224 treatment significantly improved serum stability of RAMBO and permitted systemic delivery in HNSCC tumor xenografts models. Furthermore, our results show that the combination of ATN-224 and RAMBO strongly inhibits lung metastases in a mouse model of HNSCC. These findings suggest that combining ATN-224 with RAMBO has potential for clinical trials in both early and advanced HNSCC patients.

  8. Impact of weight loss on survival after chemoradiation for locally advanced head and neck Cancer: secondary results of a randomized phase III trial (SAKK 10/94)

    International Nuclear Information System (INIS)

    Ghadjar, Pirus; Hayoz, Stefanie; Zimmermann, Frank; Bodis, Stephan; Kaul, David; Badakhshi, Harun; Bernier, Jacques; Studer, Gabriela; Plasswilm, Ludwig; Budach, Volker; Aebersold, Daniel M

    2015-01-01

    To analyze the impact of weight loss before and during chemoradiation on survival outcomes in patients with locally advanced head and neck cancer. From 07/1994-07/2000 a total of 224 patients with squamous cell carcinoma of the head and neck were randomized to either hyperfractionated radiation therapy alone or the same radiation therapy combined with two cycles of concomitant cisplatin. The primary endpoint was time to any treatment failure (TTF); secondary endpoints were locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS). Patient weight was measured 6 months before treatment, at treatment start and treatment end. The proportion of patients with >5% weight loss was 32% before, and 51% during treatment, and the proportion of patients with >10% weight loss was 12% before, and 17% during treatment. After a median follow-up of 9.5 years (range, 0.1 – 15.4 years) weight loss before treatment was associated with decreased TTF, LRRFS, DMFS, cancer specific survival and OS in a multivariable analysis. However, weight loss during treatment was not associated with survival outcomes. Weight loss before and during chemoradiation was commonly observed. Weight loss before but not during treatment was associated with worse survival

  9. Local application of GM-CSF for treatment of chemoirradiation-induced mucositis in patients with advanced carcinoma of the head and neck: results of controlled clinical trial

    International Nuclear Information System (INIS)

    Reichtomann, K.A.

    2002-01-01

    Purpose: the study was designed to assess prospectively the efficacy of GM-CSF (granulocyte-macrophage colony-stimulating factor) mouthwash solution in the management of chemoirradiation induced oral mucositis for head and neck cancer patients. Methods and materials: thirty-five patients with advanced carcinoma of the head and neck were evaluated for mucositis during the first cycle of chemoirradiation therapy. GM-CSF 400 μg in 250 cc of water for 1 h of mouth washing was prescribed. Active comparator was a conventional mucositis therapy combination. The procedure started once mucositis grade 1 (using the WHO grading) was detected. Patients, examined twice a week, were evaluated for oral mucositis and oral infections. Assessment of subjective pain was provided using a visual analogue scale. Blood tests were taken weekly. Results: the results of statistical evaluation of mucositis using the WHO-grading showed no significant differences between the two treatment groups. Local application of GM-CSF significantly reduced subjective pain during the second week of chemoirradiation therapy. Statistical analysis of the leucocytes-, platelet count, haemoglobin level and development of oral infections revealed no significant differences between the two treatment groups. Conclusion: in combined chemoirradiation therapy schemes the RTOG/EORTC toxicity scale should be used. In selected cases of mucositis attended with severe pain, GM-CSF should be observed within the therapeutic considerations. Controlled clinical trials with larger patient population are required to evaluate the role of GM-CSF in this indication. (author)

  10. Hyperfractionated radiation in combination with local hyperthermia in the treatment of advanced squamous cell carcinoma of the head and neck: a phase I-II study

    International Nuclear Information System (INIS)

    Amichetti, Maurizio; Romano, Mario; Busana, Lucia; Bolner, Andrea; Fellin, Gianni; Pani, Giuseppe; Tomio, Luigi; Valdagni, Riccardo

    1997-01-01

    Twenty-seven patients with cervical metastases from squamous cell head and neck tumours were treated with hyperfractionated XRT (total dose 69.60-76.80 Gy, 1.2 Gy b.i.d. five times a week) combined with a total of two to six sessions of superficial external HT. Acute local toxicity was mild; as major acute side effects, only one ulceration was recorded. No severe late side effects were observed. Late toxicity was similar to that observed in our previous studies with the combination of heat and radiation. Nodal complete response was observed in 77% of patients, partial response was observed in 15% of patients and no change was observed in 8% of patients. Five-year actuarial nodal control was 64.5 ± 19% and 5-year actuarial survival was 24 ± 10%. The treatment of nodal metastases from head and neck tumours with the combination of HT and hyperfractionated XRT is feasible with an acceptable acute and late toxicity profile

  11. Treatment of locally advanced carcinomas of head and neck with intensity-modulated radiation therapy (IMRT) in combination with cetuximab and chemotherapy: the REACH protocol

    International Nuclear Information System (INIS)

    Habl, Gregor; Münter, Marc W; Jensen, Alexandra D; Potthoff, Karin; Uhl, Matthias; Hof, Holger; Hajda, Jacek; Simon, Christian; Debus, Jürgen; Krempien, Robert

    2010-01-01

    Primary treatment of carcinoma of the oro-/hypopharynx or larynx may consist of combined platinum-containing chemoradiotherapy. In order to improve clinical outcome (i.e. local control/overall survival), combined therapy is intensified by the addition of the EGFR inhibitor cetuximab (Erbitux ® ). Radiation therapy (RT) is carried out as intensity-modulated RT (IMRT) to avoid higher grade acute and late toxicity by sparing of surrounding normal tissues. The REACH study is a prospective phase II study combining chemoradiotherapy with carboplatin/5-Fluorouracil (5-FU) and the monoclonal epidermal growth factor-receptor (EGFR) antibody cetuximab (Erbitux ® ) as intensity-modulated radiation therapy in patients with locally advanced squamous-cell carcinomas of oropharynx, hypopharynx or larynx. Patients receive weekly chemotherapy infusions in the 1 st and 5 th week of RT. Additionally, cetuximab is administered weekly throughout the treatment course. IMRT is delivered as in a classical concomitant boost concept (bid from fraction 16) to a total dose of 69,9 Gy. Primary endpoint of the trial is local-regional control (LRC). Disease-free survival, progression-free survival, overall survival, toxicity, proteomic and genomic analyses are secondary endpoints. The aim is to explore the efficacy as well as the safety and feasibility of this combined radioimmunchemotherapy in order to improve the outcome of patients with advanced head and neck cancer. ISRCTN87356938

  12. Long-term functional and survival outcomes after induction chemotherapy and risk-based definitive therapy for locally advanced squamous cell carcinoma of the head and neck.

    Science.gov (United States)

    Hutcheson, Katherine A; Lewin, Jan S; Holsinger, F Christopher; Steinhaus, Ganene; Lisec, Asher; Barringer, Denise A; Lin, Heather Y; Villalobos, Sandra; Garden, Adam S; Papadimitrakopoulou, Vali; Kies, Merrill S

    2014-04-01

    The purpose of this study was to evaluate long-term outcomes after induction chemotherapy followed by "risk-based" local therapy for locally-advanced squamous cell carcinoma of the head and neck (SCCHN). Forty-seven patients (stage IV; ≥N2b) were enrolled in a phase II trial. Baseline and 24-month functional measures included modified barium swallow (MBS) studies, oropharyngeal swallow efficiency (OPSE), and the MD Anderson Dysphagia Inventory (MDADI). Functional status was assessed at 5 years. Five-year overall survival (OS) was 89% (95% confidence interval [CI], 81% to 99%). A nonsignificant 13% average reduction in swallowing efficiency (OPSE) was observed at 24 months relative to baseline (p = .191). MDADI scores approximated baseline at 24 months. Among 42 long-term survivors (median, 5.9 years), 3 patients (7.1%) had chronic dysphagia. The rate of final gastrostomy dependence was 4.8% (2 of 42). Sequential chemoradiotherapy achieved favorable outcomes among patients with locally advanced SCCHN, mainly of oropharyngeal origin. MBS and MDADI scores found modest swallowing deterioration at 2 years, and chronic aspiration was uncommon in long-term survivors. Copyright © 2013 Wiley Periodicals, Inc.

  13. Treatment of locally advanced carcinomas of head and neck with intensity-modulated radiation therapy (IMRT in combination with cetuximab and chemotherapy: the REACH protocol

    Directory of Open Access Journals (Sweden)

    Simon Christian

    2010-11-01

    Full Text Available Abstract Background Primary treatment of carcinoma of the oro-/hypopharynx or larynx may consist of combined platinum-containing chemoradiotherapy. In order to improve clinical outcome (i.e. local control/overall survival, combined therapy is intensified by the addition of the EGFR inhibitor cetuximab (Erbitux®. Radiation therapy (RT is carried out as intensity-modulated RT (IMRT to avoid higher grade acute and late toxicity by sparing of surrounding normal tissues. Methods/Design The REACH study is a prospective phase II study combining chemoradiotherapy with carboplatin/5-Fluorouracil (5-FU and the monoclonal epidermal growth factor-receptor (EGFR antibody cetuximab (Erbitux® as intensity-modulated radiation therapy in patients with locally advanced squamous-cell carcinomas of oropharynx, hypopharynx or larynx. Patients receive weekly chemotherapy infusions in the 1st and 5th week of RT. Additionally, cetuximab is administered weekly throughout the treatment course. IMRT is delivered as in a classical concomitant boost concept (bid from fraction 16 to a total dose of 69,9 Gy. Discussion Primary endpoint of the trial is local-regional control (LRC. Disease-free survival, progression-free survival, overall survival, toxicity, proteomic and genomic analyses are secondary endpoints. The aim is to explore the efficacy as well as the safety and feasibility of this combined radioimmunchemotherapy in order to improve the outcome of patients with advanced head and neck cancer. Trial registration ISRCTN87356938

  14. Chemoradiotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN)

    International Nuclear Information System (INIS)

    Katori, Hideaki; Tsukuda, Mamoru; Mochimatu, Izumi; Ishitoya, Junichi; Mikami, Yasukazu; Tanigaki, Yuji; Ikeda, Yoichi; Taguchi, Takahide

    2003-01-01

    This study evaluated the efficacy and toxicity of chemoradiotherapy using docetaxel (DOC), cisplatin (CDDP) and 5-fluorouracil (5-FU) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Nineteen patients with previously untreated stage III-IV SCCHN were entered onto this trial. Patients received two cycles of chemotherapy with TPF. Radiation was targeted to begin on the first day of chemotherapy, day 1. The total radiation dose was between 63.0 and 74.0 Gy. At least three patients were examined at each dose level before advancing to the next level. The maximum-tolerated dose (MTD) of this regimen was DOC 60, CDDP 60 and 5-FU 600 mg/m 2 /day. The main toxicities were mucositis, leukocytopenia, neutropenia, anemia, liver dysfunction and renal dysfunction. The overall response rate was 100%, including 84% complete responses (CR). The high complete response rate justifies further evaluation of this chemoradiotherapy modality in advanced SCCHN patients. (author)

  15. Summary of major radiation fractionation and chemotherapy trials for organ preservation therapy in locally advanced head and neck squamous cell carcinoma.

    Science.gov (United States)

    Parsons, James T; Greene, Bruce D

    2015-01-01

    To review radiation fractionation and chemotherapy trials for patients undergoing organ preservation therapy for locally advanced head and neck squamous cell carcinoma. Radiation therapy fractionation and chemotherapy trial results as well as historical evidence are systematically reviewed. Trial results, which involve nearly 30,000 patients, have been interpreted, compared, and presented in a structured manner to demonstrate the changing approaches in treatment over the years from the 1960s to the present. The review includes data from the split-course radiation therapy era, meta-analyses of chemotherapy and radiation therapy fractionation trials, cetuximab trials, "triple-drug trials," and modern trials of induction chemotherapy followed by concomitant chemotherapy and radiation therapy. This summary will be useful to clinicians making treatment decisions today and to investigators designing trials in the future. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  16. Prediction of clinical toxicity in locally advanced head and neck cancer patients by radio-induced apoptosis in peripheral blood lymphocytes (PBLs)

    International Nuclear Information System (INIS)

    Bordón, Elisa; Henríquez-Hernández, Luis Alberto; Lara, Pedro C; Ruíz, Ana; Pinar, Beatriz; Rodríguez-Gallego, Carlos; Lloret, Marta

    2010-01-01

    in locally advanced head and neck cancer patients. Anyhow, prospective studies with different cancer types and higher number of patients are needed to validate these results

  17. Hearing loss due to concurrent daily low-dose cisplatin chemoradiation for locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Zuur, Charlotte L.; Simis, Yvonne J.W.; Verkaik, Roxanna S.; Schornagel, Jan H.; Balm, Alfons J.M.; Dreschler, Wouter A.; Rasch, Coen R.N.

    2008-01-01

    Background and purpose: Cisplatin-based chemo-irradiation (CRT) is increasingly used for head and neck squamous cell carcinoma (HNSCC). We aimed to assess hearing deterioration due to low-dose cisplatin chemoradiation and to compare the observed hearing loss with hearing loss in our previously described high-dose cisplatin CRT cohort. Materials and methods: A prospective analysis of hearing thresholds at low and (ultra)-high frequencies obtained before and after treatment in 60 patients. Patients received low-dose cisplatin (6 mg/m 2 , daily infusions, 20-25 days) with concomitant accelerated radiotherapy (70 Gy). Results: Audiometry up to 16 kHz was performed before therapy and 31 days (median) post-treatment. The total incidence of ototoxicity in CTCAEv3.0 was 31% in audiograms up to 8 kHz, and 5% of ears tested qualified for HAs due to treatment. The mean hearing loss at speech frequencies was 2.6 dB (SD 5.7) and 2.3 dB (SD 9.2) at PTA 1-2-4 kHz air-conduction and bone-conduction, respectively. The mean hearing loss at ultra-high frequencies (PTA AC 8-10-12.5 kHz) was 9.0 dB (SD 8.1). Low-dose cisplatin CRT caused less acute hearing loss (CTCAE 31%), compared to high-dose cisplatin CRT (CTCAE 78%). Conclusions: Low-dose cisplatin chemo-irradiation for HNSCC is a relatively safe treatment protocol with respect to ototoxicity

  18. Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer.

    Science.gov (United States)

    Smith, A F; Hall, P S; Hulme, C T; Dunn, J A; McConkey, C C; Rahman, J K; McCabe, C; Mehanna, H

    2017-11-01

    A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective. Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results. PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective. This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect on outcome and toxicity in locally advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lambrecht, M.; Nevens, D.; Nuyts, S. [University Hospitals Leuven (Belgium). Dept. of Radiation Oncology

    2013-03-15

    Background and purpose: Intensity-modulated radiotherapy (IMRT) has rapidly become standard of care in the management of locally advanced head and neck squamous cell carcinoma (HNSCC). In this study, our aim was to retrospectively investigate the effect of the introducing IMRT on outcome and treatment-related toxicity compared to parotid-sparing 3D conformal radiotherapy (3DCRT). Material and methods: A total of 245 patients with stage III and IV HNSCC treated with primary radiotherapy between January 2003 and December 2010 were included in this analysis: 135 patients were treated with 3DCRT, 110 patients with IMRT. Groups were compared for acute and late toxicity, locoregional control (LRC), and overall survival (OS). Oncologic outcomes were estimated using Kaplan-Meier analysis and compared using a log-rank test. Acute toxicity was analyzed according to the Common Terminology Criteria for Adverse Events v3.0 and late toxicity was scored using the RTOG/EORTC late toxicity scoring system. Results: Median follow-up was 35 months in the IMRT group and 68 months in the 3DCRT group. No significant differences were found in 3-year LRC and OS rates between the IMRT group and 3DCRT group. Significantly less acute mucositis {>=} grade 3 was observed in the IMRT group (32% vs. 44%, p = 0.03). There was significantly less late xerostomia {>=} grade 2 in the IMRT group than in the 3DCRT group (23% vs. 68%, p < 0.001). After 24 months, there was less dysphagia {>=} grade 2 in the IMRT group although differences failed to reach statistical significance. Conclusion: The introduction of IMRT in the radiotherapeutic management of locally advanced head and neck cancer significantly improved late toxicity without compromising tumor control compared to a parotid-sparing 3D conformal radiotherapy technique. (orig.)

  20. High RAB25 expression is associated with good clinical outcome in patients with locally advanced head and neck squamous cell carcinoma

    International Nuclear Information System (INIS)

    Téllez-Gabriel, Marta; Arroyo-Solera, Irene; León, Xavier; Gallardo, Alberto; López, Montserrat; Céspedes, Maria V; Casanova, Isolda; López-Pousa, Antonio; Quer, Miquel; Mangues, Maria A; Barnadas, Agustí; Mangues, Ramón; Pavón, Miguel A

    2013-01-01

    Currently there are no molecular markers able to predict clinical outcome in locally advanced head and neck squamous cell carcinoma (HNSCC). In a previous microarray study, RAB25 was identified as a potential prognostic marker. The aim of this study was to analyze the association between RAB25 expression and clinical outcome in patients with locally advanced HNSCC treated with standard therapy. In a retrospective immunohistochemical study (n = 97), we observed that RAB25-negative tumors had lower survival (log-rank, P = 0.01) than patients bearing positive tumors. In an independent prospective mRNA study (n = 117), low RAB25 mRNA expression was associated with poor prognosis. Using classification and regression tree analysis (CART) we established two groups of patients according to their RAB25 mRNA level and their risk of death. Low mRNA level was associated with poor local recurrence-free (log-rank, P = 0.005), progression-free (log-rank, P = 0.002) and cancer-specific (log-rank, P < 0.001) survival. Multivariate Cox model analysis showed that low expression of RAB25 was an independent poor prognostic factor for survival (hazard ratio: 3.84, 95% confidence interval: 1.93–7.62, P < 0.001). Patients whose tumors showed high RAB25 expression had a low probability of death after treatment. We also found lower RAB25 expression in tumors than in normal tissue (Mann–Whitney U, P < 0.001). Moreover, overexpression of RAB25 in the UM-SCC-74B HNSCC cell line increased cisplatin sensitivity, and reduced cell migration and invasion. Our findings support a tumor suppressor role for RAB25 in HNSCC and its potential use to identify locally advanced patients with a high probability of survival after genotoxic treatment

  1. Differentiation of irradiation and cetuximab induced skin reactions in patients with locally advanced head and neck cancer undergoing radioimmunotherapy: the HICARE protocol (Head and neck cancer: ImmunoChemo and Radiotherapy with Erbitux) – a multicenter phase IV trial

    International Nuclear Information System (INIS)

    Habl, G; Potthoff, K; Haefner, MF; Abdollahi, A; Hassel, JC; Boller, E; Indorf, M; Debus, J

    2013-01-01

    In order to improve the clinical outcome of patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN) not being capable to receive platinum-based chemoradiation, radiotherapy can be intensified by addition of cetuximab, a monoclonal antibody that blocks the epidermal growth factor receptor (EGFR). The radioimmunotherapy with cetuximab is a feasible treatment option showing a favourable toxicity profile. The most frequent side effect of radiotherapy is radiation dermatitis, the most common side effect of treatment with cetuximab is acneiform rash. Incidence and severity of these frequent, often overlapping and sometimes limiting skin reactions, however, are not well explored. A clinical and molecular differentiation between radiogenic skin reactions and skin reactions caused by cetuximab which may correlate with outcome, have never been described before. The HICARE study is a national, multicenter, prospective phase IV study exploring the different types of skin reactions that occur in patients with LASCCHN undergoing radioimmun(chemo)therapy with the EGFR inhibitor cetuximab. 500 patients with LASCCHN will be enrolled in 40 participating sites in Germany. Primary endpoint is the rate of radiation dermatitis NCI CTCAE grade 3 and 4 (v. 4.02). Radioimmunotherapy will be applied according to SmPC, i.e. cetuximab will be administered as loading dose and then weekly during the radiotherapy. Irradiation will be applied as intensity-modulated radiation therapy (IMRT) or 3D-dimensional radiation therapy. The HICARE trial is expected to be one of the largest trials ever conducted in head and neck cancer patients. The goal of the HICARE trial is to differentiate skin reactions caused by radiation from those caused by the monoclonal antibody cetuximab, to evaluate the incidence and severity of these skin reactions and to correlate them with outcome parameters. Besides, the translational research program will help to identify and confirm novel

  2. local

    Directory of Open Access Journals (Sweden)

    Abílio Amiguinho

    2005-01-01

    Full Text Available The process of socio-educational territorialisation in rural contexts is the topic of this text. The theme corresponds to a challenge to address it having as main axis of discussion either the problem of social exclusion or that of local development. The reasons to locate the discussion in this last field of analysis are discussed in the first part of the text. Theoretical and political reasons are there articulated because the question is about projects whose intentions and practices call for the political both in the theoretical debate and in the choices that anticipate intervention. From research conducted for several years, I use contributions that aim at discuss and enlighten how school can be a potential locus of local development. Its identification and recognition as local institution (either because of those that work and live in it or because of those that act in the surrounding context are crucial steps to progressively constitute school as a partner for development. The promotion of the local values and roots, the reconstruction of socio-personal and local identities, the production of sociabilities and the equation and solution of shared problems were the dimensions of a socio-educative intervention, markedly globalising. This scenario, as it is argued, was also, intentionally, one of transformation and of deliberate change of school and of the administration of the educative territoires.

  3. The effectiveness of using WebCT in distance learning programmes in MACE, the University of Manchester

    Science.gov (United States)

    Ahmad, Rosman

    The World Wide Web impacted the educational model and became part of distance education early in this century. There were many changes taking place in higher education for political, economic and educational reasons." New goals and educational objectives were being set within educational institutions. There were particular emphases to produce a more effective delivery of learning methods for distance learning students. The use of Internet was seen as an important issue in the development of an understanding of the complex process of instilling knowledge to post graduates students. Well-established universities were re-examining their missions and looking for different ways of providing lifelong education. The School of Mechanical, Aerospace and Civil Engineering (MACE) was particularly keen to increase the use of web-based learning in its courses, which will increase the amount of students enrolled into these programmes and help them learn in a flexible and workable manner. This approach was reinforced by responses from a survey of MSc. degree students which suggested that the current distance learning programme were not being operated efficiently and did not develop adequate personal skills in relation to the requirements of prospective employers. One way of improving these programmes was to make use of the Virtual Learning Environment (VLE). A study was made and WebCT was found to be suitable. Five WebCT units were initially produced. The experience of designing and running the units was very useful in determining the effective use of the WebCT. From the analysis of students and staff surveys it has been demonstrated that these WebCT units are much more effective in achieving the project objectives in a wide number of areas which relate to students satisfaction, skills development and enhancing their interest into learning experience. The success of the WebCT units has stimulated interest in overseas establishments. It is hope that the success will follow in the

  4. Radiochemotherapy including cisplatin alone versus cisplatin + 5-fluorouracil for locally advanced unresectable stage IV squamous cell carcinoma of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Tribius, Silke; Kilic, Yasemin [Dept. of Radiation Oncology, Univ. Medical Center Hamburg-Eppendorf, Hamburg (Germany); Kronemann, Stefanie [Dept. of Radiation Oncology, Univ. Hospital Schleswig-Holstein, Campus Luebeck (Germany); Schroeder, Ursula [Dept. of Head and Neck Surgery, Univ. Hospital Schleswig-Holstein, Campus Luebeck (Germany); Hakim, Samer [Dept. of Oro-Maxillo-Facial Surgery, Univ. Hospital Schleswig-Holstein, Campus Luebeck (Germany); Schild, Steven E. [Dept. of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States); Rades, Dirk [Dept. of Radiation Oncology, Univ. Medical Center Hamburg-Eppendorf, Hamburg (Germany); Dept. of Radiation Oncology, Univ. Hospital Schleswig-Holstein, Campus Luebeck (Germany)

    2009-10-15

    Background and purpose: the optimal radiochemotherapy regimen for advanced head-and-neck cancer is still debated. This nonrandomized study compares two cisplatin-based radiochemotherapy regimens in 128 patients with locally advanced unresectable stage IV squamous cell carcinoma of the head and neck (SCCHN). Patients and methods: concurrent chemotherapy consisted of either two courses cisplatin (20 mg/m{sup 2}/d1-5 + 29-33; n = 54) or two courses cisplatin (20 mg/m{sup 2}/d1-5 + 29-33) + 5-fluorouracil (5-FU; 600 mg/m{sup 2}/d1-5 + 29-33; n = 74). Results: at least one grade 3 toxicity occurred in 25 of 54 patients (46%) receiving cisplatin alone and in 52 of 74 patients (70%) receiving cisplatin + 5-FU. The latter regimen was particularly associated with increased rates of mucositis (p = 0.027) and acute skin toxicity (p = 0.001). Seven of 54 (13%) and 20 of 74 patients (27%) received only one chemotherapy course due to treatment-related acute toxicity. Late toxicity in terms of xerostomia, neck fibrosis, skin toxicity, and lymphedema was not significantly different. The 2-year locoregional control rates were 67% after cisplatin alone and 52% after cisplatin + 5-FU (p = 0.35). The metastases-free survival rates were 79% and 69%, respectively (p = 0.65), and the overall survival rates 70% and 51%, respectively (p = 0.10). On multivariate analysis, outcome was significantly associated with performance status, T-category, N-category, hemoglobin level prior to radiotherapy, and radiotherapy break > 1 week. Conclusion: two courses of fractionated cisplatin (20 mg/m{sup 2}/day) alone appear preferable, as this regimen resulted in similar outcome and late toxicity as two courses of cisplatin + 5-FU, but in significantly less acute toxicity. (orig.)

  5. A phase I study of dose-escalated chemoradiation with accelerated intensity modulated radiotherapy in locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Guerrero Urbano, Teresa; Clark, Catharine H.; Hansen, Vibeke N.; Adams, Elizabeth J.; A'Hern, Roger; Miles, Elizabeth A.; McNair, Helen; Bidmead, Margaret; Warrington, Alan P.; Dearnaley, David P.; Harrington, Kevin J.; Nutting, Christopher M.

    2007-01-01

    Background and purpose: Intensity modulated radiotherapy (IMRT) allows the delivery of higher and more homogeneous radiation dose to head and neck tumours. This study aims to determine the safety of dose-escalated chemo-IMRT for larynx preservation in locally advanced head and neck cancer. Methods: Patients with T2-4, N1-3, M0 squamous cell carcinoma of the larynx or hypopharynx were treated with a simultaneous-boost IMRT. Two radiation dose levels (DL) were tested: In DL 1, 63 Gy/28F was delivered to primary tumour and involved nodes and 51.8 Gy/28F to elective nodes. In DL 2, the doses were 67.2 Gy/28F and 56 Gy/28F, respectively, representing a 9% dose escalation for the primary. All patients received 2 cycles of neoadjuvant cisplatin and 5-fluorouracil, and concomitant cisplatin. Acute (NCICTCv.2.0) and late toxicity (RTOG and modified LENTSOM) were collected. Results: Thirty patients were entered, 15 in each dose level. All patients completed the treatment schedule. In DL 1, the incidences of acute G3 toxicities were 27% (pain), 20% (radiation dermatitis), 0% (xerostomia) and 67% required gastrostomy tubes. For DL 2 the corresponding incidences were 40%, 20%, 7%, and 87%. G3 dysphagia and pain persisted longer in DL 2. With regard to mucositis, a prolonged healing time for DL 2 was found, with prevalence of G2 of 58% in week 10. No acute grade 4 toxicity was observed. At 6 months, 1 patient in DL 2 had G3 late toxicity (dysphagia). No dose limiting toxicity was found. Complete response rates were 80% in DL 1, and 87% in DL 2. Conclusion: Moderately accelerated chemo-IMRT is safe and feasible with good compliance and acceptable acute toxicity. Dose escalation was possible without a significant difference in acute toxicity. Longer follow-up is required to determine the incidence of late radiation toxicities, and tumour control rates

  6. Toll-like Receptor 5 Agonist Protects Mice From Dermatitis and Oral Mucositis Caused by Local Radiation: Implications for Head-and-Neck Cancer Radiotherapy

    International Nuclear Information System (INIS)

    Burdelya, Lyudmila G.; Gleiberman, Anatoli S.; Toshkov, Ilia; Aygun-Sunar, Semra; Bapardekar, Meghana; Manderscheid-Kern, Patricia; Bellnier, David; Krivokrysenko, Vadim I.; Feinstein, Elena; Gudkov, Andrei V.

    2012-01-01

    Purpose: Development of mucositis is a frequent side effect of radiotherapy of patients with head-and-neck cancer. We have recently reported that bacterial flagellin, an agonist of Toll-like receptor 5 (TLR5), can protect rodents and primates from acute radiation syndrome caused by total body irradiation. Here we analyzed the radioprotective efficacy of TLR5 agonist under conditions of local, single dose or fractionated radiation treatment. Methods and Materials: Mice received either single-dose (10, 15, 20, or 25 Gy) or fractioned irradiation (cumulative dose up to 30 Gy) of the head-and-neck area with or without subcutaneous injection of pharmacologically optimized flagellin, CBLB502, 30 min before irradiation. Results: CBLB502 significantly reduced the severity of dermatitis and mucositis, accelerated tissue recovery, and reduced the extent of radiation induced weight loss in mice after a single dose of 15 or 20 Gy but not 25 Gy of radiation. CBLB502 was also protective from cumulative doses of 25 and 30 Gy delivered in two (10 + 15 Gy) or three (3 × 10 Gy) fractions, respectively. While providing protection to normal epithelia, CBLB502 did not affect the radiosensitivity of syngeneic squamous carcinoma SCCVII grown orthotopically in mice. Use of CBLB502 also elicited a radiation independent growth inhibitory effect upon TLR5-expressing tumors demonstrated in the mouse xenograft model of human lung adenocarcinoma A549. Conclusion: CBLB502 combines properties of supportive care (radiotherapy adjuvant) and anticancer agent, both mediated via activation of TLR5 signaling in the normal tissues or the tumor, respectively.

  7. Can radiological changes in lymph node volume during treatment predict success of radiation therapy in patients with locally advanced head and neck squamous cell carcinoma?

    International Nuclear Information System (INIS)

    Mishra, Sanju; Hammond, Alexander; Read, Nancy; Venkatesan, Varagur; Warner, Andrew; Winquist, Eric; Nichols, Anthony

    2013-01-01

    Assessment of nodal response after radiotherapy (RT) for head and neck squamous cell carcinoma is difficult, as both CT and positron emission tomography scanning have limited predictive value for residual disease. We sought to measure changes in nodal volume during RT to determine whether such changes are predictive of nodal disease control. Patients with locally advanced head and neck squamous cell carcinoma treated with 70Gy of radical RT (±chemotherapy or anti-epidermal growth factor receptor (EGFR) antibodies) were eligible. Baseline pre-RT scans and cone-beam CT scans done at the outset of treatment and at weeks 3, 5 and 7 (cone-beam CTs 1, 2, 3 and 4, respectively) were deformably coregistered, and 3D nodal volumes were measured. Thirty-eight eligible patients were identified. The main primary tumour site was oropharyngeal; most patients had stage IVa disease. Twenty-seven patients received concurrent platinum-based chemotherapy, 10 received only an EGFR inhibitor with RT and one received RT alone. Twelve patients had a failure in the neck. After week 1 of treatment, a 4% mean decrease in nodal volume was observed, increasing to 40% at week 7. Platinum-based chemotherapy achieved significantly greater decreases in nodal volume than EGFR inhibitors (44 vs. 25%; P=0.026). Advanced tumour stage predicted neck failure (P=0.002), but nodal volumes did not correlate with neck control. Changes in nodal volume are minimal initially during RT but accelerate during the latter weeks of therapy. This study suggests that chemotherapy achieves a greater decrease in nodal volume than EGFR inhibitors and that nodal changes do not predict disease control in the neck.

  8. Toll-like Receptor 5 Agonist Protects Mice From Dermatitis and Oral Mucositis Caused by Local Radiation: Implications for Head-and-Neck Cancer Radiotherapy

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    Burdelya, Lyudmila G. [Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, NY (United States); Gleiberman, Anatoli S.; Toshkov, Ilia [Cleveland BioLabs, Inc., Buffalo, NY (United States); Aygun-Sunar, Semra [Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, NY (United States); Bapardekar, Meghana [Cleveland BioLabs, Inc., Buffalo, NY (United States); Manderscheid-Kern, Patricia; Bellnier, David [Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, NY (United States); Krivokrysenko, Vadim I.; Feinstein, Elena [Cleveland BioLabs, Inc., Buffalo, NY (United States); Gudkov, Andrei V., E-mail: andrei.gudkov@roswellpark.org [Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, NY (United States); Cleveland BioLabs, Inc., Buffalo, NY (United States)

    2012-05-01

    Purpose: Development of mucositis is a frequent side effect of radiotherapy of patients with head-and-neck cancer. We have recently reported that bacterial flagellin, an agonist of Toll-like receptor 5 (TLR5), can protect rodents and primates from acute radiation syndrome caused by total body irradiation. Here we analyzed the radioprotective efficacy of TLR5 agonist under conditions of local, single dose or fractionated radiation treatment. Methods and Materials: Mice received either single-dose (10, 15, 20, or 25 Gy) or fractioned irradiation (cumulative dose up to 30 Gy) of the head-and-neck area with or without subcutaneous injection of pharmacologically optimized flagellin, CBLB502, 30 min before irradiation. Results: CBLB502 significantly reduced the severity of dermatitis and mucositis, accelerated tissue recovery, and reduced the extent of radiation induced weight loss in mice after a single dose of 15 or 20 Gy but not 25 Gy of radiation. CBLB502 was also protective from cumulative doses of 25 and 30 Gy delivered in two (10 + 15 Gy) or three (3 Multiplication-Sign 10 Gy) fractions, respectively. While providing protection to normal epithelia, CBLB502 did not affect the radiosensitivity of syngeneic squamous carcinoma SCCVII grown orthotopically in mice. Use of CBLB502 also elicited a radiation independent growth inhibitory effect upon TLR5-expressing tumors demonstrated in the mouse xenograft model of human lung adenocarcinoma A549. Conclusion: CBLB502 combines properties of supportive care (radiotherapy adjuvant) and anticancer agent, both mediated via activation of TLR5 signaling in the normal tissues or the tumor, respectively.

  9. Prolonged radiation time and low nadir hemoglobin during postoperative concurrent chemoradiotherapy are both poor prognostic factors with synergistic effect on locally advanced head and neck cancer patients

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    Su NW

    2015-01-01

    Full Text Available Nai-Wen Su,1 Chung-Ji Liu,2 Yi-Shing Leu,3 Jehn-Chuan Lee,3 Yu-Jen Chen,4 Yi-Fang Chang1,51Division of Medical Oncology and Hematology, Department of Internal Medicine, 2Department of Oral and Maxillofacial Surgery, 3Department of Otorhinolaryngology, 4Department of Radiation Oncology, 5Good Clinical Research Center, Department of Medical Research, Mackay Memorial Hospital, Taipei, TaiwanBackground: Anemia, a common complication of head and neck cancer treatment, is regarded as a poor prognostic factor. We evaluated the impact of low hemoglobin (Hb levels, measured at different time points, on a consecutive cohort of patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN who underwent postoperative concurrent chemoradiotherapy (CCRT.Materials and methods: From 2002 to 2009, 140 patients were enrolled and reviewed retrospectively. Preoperative (pre-op Hb, pre-CCRT Hb, and nadir Hb during CCRT were measured and recorded. The three Hb parameters were analyzed against several well-established pathologic risk factors and radiation-associated variables. Prognostic impacts were investigated with multivariate analysis by Cox proportional hazards model.Results: On Cox regression analysis, significantly higher risk of death was associated with pre-op Hb %13 g/dL (hazard ratio [HR] =1.8; 95% confidence interval [CI], 1.1–3.1; P=0.023, nadir Hb %11 g/dL (HR =1.9; 95% CI, 1.1–3.3; P=0.020, radiation treatment time (RTT >7 weeks (HR =1.9; 95% CI, 1.1–3.3; P=0.022, and multiple positive lymph nodes (HR =2.1; 95% CI, 1.2–3.7; P=0.010, after adjusting for primary tumor site and pathologic lymphovascular invasion. Patients with poor prognosticators including low nadir Hb %11 g/dL and RTT >7 weeks had a higher risk of death (HR =4.0; 95% CI =1.6–10.2; P=0.004.Conclusion: In the treatment setting of LA-SCCHN patients who underwent postoperative CCRT, coexistance of lower nadir Hb during CCRT and prolonged RTT resulted in

  10. Multicriteria Optimization in Intensity-Modulated Radiation Therapy Treatment Planning for Locally Advanced Cancer of the Pancreatic Head

    International Nuclear Information System (INIS)

    Hong, Theodore S.; Craft, David L.; Carlsson, Fredrik; Bortfeld, Thomas R.

    2008-01-01

    Purpose: Intensity-modulated radiation therapy (IMRT) affords the potential to decrease radiation therapy-associated toxicity by creating highly conformal dose distributions. However, the inverse planning process can create a suboptimal plan despite meeting all constraints. Multicriteria optimization (MCO) may reduce the time-consuming iteration loop necessary to develop a satisfactory plan while providing information regarding trade-offs between different treatment planning goals. In this exploratory study, we examine the feasibility and utility of MCO in physician plan selection in patients with locally advanced pancreatic cancer (LAPC). Methods and Materials: The first 10 consecutive patients with LAPC treated with IMRT were evaluated. A database of plans (Pareto surface) was created that met the inverse planning goals. The physician then navigated to an 'optimal' plan from the point on the Pareto surface at which kidney dose was minimized. Results: Pareto surfaces were created for all 10 patients. A physician was able to select a plan from the Pareto surface within 10 minutes for all cases. Compared with the original (treated) IMRT plans, the plan selected from the Pareto surface had a lower stomach mean dose in 9 of 10 patients, although often at the expense of higher kidney dose than with the treated plan. Conclusion: The MCO is feasible in patients with LAPC and allows the physician to choose a satisfactory plan quickly. Generally, when given the opportunity, the physician will choose a plan with a lower stomach dose. The MCO enables a physician to provide greater active clinical input into the IMRT planning process

  11. Feasibility Study of Moderately Accelerated Intensity-Modulated Radiotherapy Plus Concurrent Weekly Cisplatin After Induction Chemotherapy in Locally Advanced Head-and Neck Cancer

    International Nuclear Information System (INIS)

    Morganti, Alessio G.; Mignogna, Samantha; Deodato, Francesco; Massaccesi, Mariangela; Cilla, Savino; Calista, Franco; Serafini, Giovanni; Digesu, Cinzia; Macchia, Gabriella; Picardi, Vincenzo; Caravatta, Luciana; Di Lullo, Liberato; Giglio, Gianfranco; Sallustio, Giuseppina; Piermattei, Angelo

    2011-01-01

    Purpose: To evaluate the feasibility and efficacy of moderately accelerated intensity-modulated radiation therapy (IMRT) along with weekly cisplatin, after induction chemotherapy, in patients with locally advanced unresectable head and neck cancer (HNC). Methods and Materials: Patients with Stage III or IV locally advanced HNC, without progressive disease after three courses of induction chemotherapy, received concurrent chemo-IMRT (weekly cisplatin 30 mg/m 2 plus simultaneous integrated boost IMRT). A total of 67.5 Gy in 30 fractions were delivered to primary tumor and involved nodes, 60 Gy in 30 fractions to high-risk nodal areas, and 55.5 Gy in 30 fractions to low-risk nodal areas. Results: In all, 36 patients (median age, 56 years) with International Union Against Cancer (UICC) Stage III (n = 5) and IV (n = 31) were included. Of the 36 patients, 17 had received CF (cisplatin and 5-fluorouracil (CF) and 19 had received docetaxel cisplatin and 5-fluorouracil (DCF). During concurrent chemoradiation, 11 of 36 patients (30.5%) experienced Grade III mucositis (CF, 47%; DCF, 15%; p < 0.04). Grade III pharyngeal-esophageal toxicity was observed in 5 of 19 patients (26.3%; CF, 0.0%; DCF, 26.3%; p = 0.02). Two patients died of complications (5.5%). After chemoradiation, the complete response rate was 63.8%. Two-year local control was 88.7%. Two-year progression free survival and overall survival were 74.5% and 60.9%, respectively. Conclusions: In our experience, a moderately accelerated chemo-IMRT was feasible after induction chemotherapy. However, a noteworthy early death rate of 5.5% was observed. Intensive supportive care strategies should be defined to better manage radiation-induced toxic effects. Longer follow-up is required to determine the incidence of late radiation toxicities and tumor control rates.

  12. Development of receptors for insulin and insulin-like growth factor-I in head and brain of chick embryos: Autoradiographic localization

    International Nuclear Information System (INIS)

    Bassas, L.; Girbau, M.; Lesniak, M.A.; Roth, J.; de Pablo, F.

    1989-01-01

    In whole brain of chick embryos insulin receptors are highest at the end of embryonic development, while insulin-like growth factor-I (IGF-I) receptors dominate in the early stages. These studies provided evidence for developmental regulation of both types of receptors, but they did not provide information on possible differences between brain regions at each developmental stage or within one region at different embryonic ages. We have now localized the specific binding of [125I]insulin and [125I]IGF-I in sections of head and brain using autoradiography and computer-assisted densitometric analysis. Embryos have been studied from the latter part of organogenesis (days 6 and 12) through late development (day 18, i.e. 3 days before hatching), and the binding patterns have been compared with those in the adult brain. At all ages the binding of both ligands was to discrete anatomical regions. Interestingly, while in late embryos and adult brain the patterns of [125I]insulin and [125I] IGF-I binding were quite distinct, in young embryos both ligands showed very similar localization of binding. In young embryos the retina and lateral wall of the growing encephalic vesicles had the highest binding of both [125I]insulin and [125I]IGF-I. In older embryos, as in the adult brain, insulin binding was high in the paleostriatum augmentatum and molecular layer of the cerebellum, while IGF-I binding was prominent in the hippocampus and neostriatum. The mapping of receptors in a vertebrate embryo model from early prenatal development until adulthood predicts great overlap in any possible function of insulin and IGF-I in brain development, while it anticipates differential localized actions of the peptides in the mature brain

  13. Efficacy of intensity-modulated radiotherapy combined with chemotherapy or surgery in locally advanced squamous cell carcinoma of the head-and-neck

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    Yang H

    2013-10-01

    Full Text Available Hua Yang,* Li-Qiong Diao,* Mei Shi, Rui Ma, Jian-Hua Wang, Jian-Ping Li, Feng Xiao, Ying Xue, Man Xu, Bin ZhouDepartment of Radiotherapy Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China*These authors contributed equally to this workObjectives: Long-term locoregional control following intensity-modulated radiotherapy (IMRT for locally advanced squamous cell carcinoma of the head-and-neck (SCCHN remains challenging. This study aimed to assess the efficacy and toxicity of IMRT with and without chemotherapy or surgery in locally advanced SCCHN.Materials and methods: Between January 2007 and January 2011, 61 patients with locally advanced SCCHN were treated with curative IMRT in the Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University; 28% underwent definitive IMRT and 72% postoperative IMRT, combined with simultaneous cisplatin-based chemotherapy in 58%. The mean doses of definitive and postoperative IMRT were 70.8 Gy (range, 66–74 Gy. Outcomes were analyzed using Kaplan–Meier curves. Acute and late toxicities were graded according to Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer radiation morbidity scoring criteria.Results: At a median follow-up of 35 months, 3-year local recurrence-free survival (LRFS, regional recurrence-free survival (RRFS, distant metastasis-free survival (DMFS, disease-free survival (DFS, and overall survival (OS were 83.8%, 86.1%, 82.4%, 53.2%, and 62%, respectively. Postoperative IMRT (n = 44, 72% had significantly higher LRFS/OS/DMFS than definitive IMRT (n = 17, 28%; P < 0.05. IMRT combined with chemotherapy (n = 35, 58% had significantly higher LRFS/OS/DMFS than IMRT alone (n = 26, 42%; P < 0.05. One year after radiotherapy, the incidence of xerostomia of grade 1, 2, or 3 was 13.1%, 19.7%, and 1.6%, respectively. No grade 4 acute or late toxicity was observed.Conclusion: IMRT combined with

  14. Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Dawson, Laura A.; Anzai, Yoshimi; Marsh, Lon; Martel, Mary K.; Paulino, Augusto; Ship, Jonathan A.; Eisbruch, Avraham

    2000-01-01

    Purpose: To analyze the patterns of local-regional recurrence in patients with head and neck cancer treated with parotid-sparing conformal and segmental intensity-modulated radiotherapy (IMRT). Methods and Materials: Fifty-eight patients with head and neck cancer were treated with bilateral neck radiation (RT) using conformal or segmental IMRT techniques, while sparing a substantial portion of one parotid gland. The targets for CT-based RT planning included the gross tumor volume (GTV) (primary tumor and lymph node metastases) and the clinical target volume (CTV) (postoperative tumor bed, expansions of the GTVs and lymph node groups at risk of subclinical disease). Lymph node targets at risk of subclinical disease included the bilateral jugulodigastric and lower jugular lymph nodes, bilateral retropharyngeal lymph nodes at risk, and high jugular nodes at the base of skull in the side of the neck at highest risk (containing clinical neck metastases and/or ipsilateral to the primary tumor). The CTVs were expanded by 5 mm to yield planning target volumes (PTVs). Planning goals included coverage of all PTVs (with a minimum of 95% of the prescribed dose) and sparing of a substantial portion of the parotid gland in the side of the neck at less risk. The median RT doses to the gross tumor, the operative bed, and the subclinical disease PTVs were 70.4 Gy, 61.2 Gy, and 50.4 Gy respectively. All recurrences were defined on CT scans obtained at the time of recurrence, transferred to the pretreatment CT dataset used for RT planning, and analyzed using dose-volume histograms. The recurrences were classified as 1) 'in-field', in which 95% or more of the recurrence volume (V recur ) was within the 95% isodose; 2) 'marginal', in which 20% to 95% of V recur was within the 95% isodose; or 3) 'outside', in which less than 20% of V recur was within the 95% isodose. Results: With a median follow-up of 27 months (range 6 to 60 months), 10 regional recurrences, 5 local recurrences

  15. Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer.

    Science.gov (United States)

    Dawson, L A; Anzai, Y; Marsh, L; Martel, M K; Paulino, A; Ship, J A; Eisbruch, A

    2000-03-15

    To analyze the patterns of local-regional recurrence in patients with head and neck cancer treated with parotid-sparing conformal and segmental intensity-modulated radiotherapy (IMRT). Fifty-eight patients with head and neck cancer were treated with bilateral neck radiation (RT) using conformal or segmental IMRT techniques, while sparing a substantial portion of one parotid gland. The targets for CT-based RT planning included the gross tumor volume (GTV) (primary tumor and lymph node metastases) and the clinical target volume (CTV) (postoperative tumor bed, expansions of the GTVs and lymph node groups at risk of subclinical disease). Lymph node targets at risk of subclinical disease included the bilateral jugulodigastric and lower jugular lymph nodes, bilateral retropharyngeal lymph nodes at risk, and high jugular nodes at the base of skull in the side of the neck at highest risk (containing clinical neck metastases and/or ipsilateral to the primary tumor). The CTVs were expanded by 5 mm to yield planning target volumes (PTVs). Planning goals included coverage of all PTVs (with a minimum of 95% of the prescribed dose) and sparing of a substantial portion of the parotid gland in the side of the neck at less risk. The median RT doses to the gross tumor, the operative bed, and the subclinical disease PTVs were 70.4 Gy, 61.2 Gy, and 50.4 Gy respectively. All recurrences were defined on CT scans obtained at the time of recurrence, transferred to the pretreatment CT dataset used for RT planning, and analyzed using dose-volume histograms. The recurrences were classified as 1) "in-field," in which 95% or more of the recurrence volume (V(recur)) was within the 95% isodose; 2) "marginal," in which 20% to 95% of V(recur) was within the 95% isodose; or 3) "outside," in which less than 20% of V(recur) was within the 95% isodose. With a median follow-up of 27 months (range 6 to 60 months), 10 regional recurrences, 5 local recurrences (including one noninvasive recurrence) and 1

  16. Chemoradiotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN)

    International Nuclear Information System (INIS)

    Katori, Hideaki; Ishitoya, Junichi; Ikeda, Yoichi; Kimura, Machiko; Hirose, Shouji; Sakuma, Yasunori; Yamamoto, Kaoru; Tsukuda, Mamoru

    2004-01-01

    The aim of this study was to evaluate the efficacy and toxicity of chemoradiotherapy using docetaxel (DOC), cisplatin (CDDP) and 5-fluorouracil (5-FU) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Nineteen patients with previously untreated stage III-IV SCCHN were entered onto this trial. Patients received 2 cycles of chemotherapy with TPF. Radiation was targeted to begin on the first day of chemotherapy, day 1. The total radiation dose was between 63.0 and 74.0 Gy At least three patients were examined at each dose level before advancing to the next level. The maximum-tolerated dose (MTD) of this regimen was that DOC 60, CDDP 60 and 5-FU 600 mg/m 2 /day. The main toxicities were mucositis, leukocytopenia, neutropenia, anemia, liver dysfunction and renal dysfunction. The overall response rate was 100%, including 84% complete responses (CR). The high complete response rate justifies further evaluation of this chemoradiotherapy modality in advanced SCCHN patients. (author)

  17. Evaluation of the prognostic role of tumor cell podoplanin expression in locally advanced squamous cell carcinoma of the head and neck

    International Nuclear Information System (INIS)

    Huttenlocher, Stefan; Seibold, Nina D.; Rades, Dirk; Gebhard, Maximilian P.; Noack, Frank; Thorns, Christoph; Hasselbacher, Katrin; Wollenberg, Barbara; Schild, Steven E.

    2014-01-01

    To investigate the potential prognostic role of tumor cell podoplanin expression in patients treated with resection followed by irradiation or chemoradiotherapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN). Podoplanin expression (≤10 % versus > 10 %) and 12 other factors were evaluated in 160 patients for their association with locoregional control (LRC), metastases-free (MFS) and overall survival (OS). Other factors were age, gender, Eastern Cooperative Oncology Group (ECOG) performance status, preradiotherapy (pre-RT) hemoglobin level, tumor site, histological grading, T category, N category, American Joint Committee on Cancer (AJCC) stage, human papillomavirus (HPV) status, extent of resection and concurrent chemotherapy. In multivariate analysis, ECOG performance status 0-1 (risk ratio, RR: 3.01; 95 % confidence interval, CI: 1.42-7.14; p = 0.003), pre-RT hemoglobin levels ≥ 7.45 mmol/l (12 g/dl; RR: 2.03; 95 % CI: 1.04-3.94; p = 0.038), oropharyngeal cancer (RR: 1.25; 95 % CI: 1.01-1.55; p = 0.038) and T category T1-2 (RR: 1.81; 95 % CI: 1.24-2.79; p = 0.002) were significantly associated with improved LRC. T category T1-2 (RR: 1.90; 95 % CI: 1.25-3.06; p = 0.002) and N category N0-2a (RR: 5.22; 95 % CI: 1.96-18.09; p 10 %. (orig.) [de

  18. A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck

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    Budach V

    2006-01-01

    Full Text Available Abstract Background Former meta-analyses have shown a survival benefit for the addition of chemotherapy (CHX to radiotherapy (RT and to some extent also for the use of hyperfractionated radiation therapy (HFRT and accelerated radiation therapy (AFRT in locally advanced squamous cell carcinoma (SCC of the head and neck. However, the publication of new studies and the fact that many older studies that were included in these former meta-analyses used obsolete radiation doses, CHX schedules or study designs prompted us to carry out a new analysis using strict inclusion criteria. Methods Randomised trials testing curatively intended RT (≥60 Gy in >4 weeks/>50 Gy in Results Thirty-two trials with a total of 10 225 patients were included into the meta-analysis. An overall survival benefit of 12.0 months was observed for the addition of simultaneous CHX to either CFRT or HFRT/AFRT (p Conclusion RT combined with simultaneous 5-FU, cisplatin, carboplatin, and mitomycin C as single drug or combinations of 5-FU with one of the other drugs results in a large survival advantage irrespective the employed radiation schedule. If radiation therapy is used as single modality, hyperfractionation leads to a significant improvement of overall survival. Accelerated radiation therapy alone, especially when given as split course radiation schedule or extremely accelerated treatments with decreased total dose, does not increase overall survival.

  19. Intensity-modulated radiotherapy using simultaneous-integrated boost for definitive treatment of locally advanced mucosal head and neck cancer: outcomes from a single-institution series

    International Nuclear Information System (INIS)

    Johnston, Meredith; Guo, Linxin; Hanna, Catherine; Back, Michael; Guminski, Alex; Lee, Adrian; Eade, Thomas; Veivers, David; Wignall, Andrew

    2013-01-01

    The study aims to report outcomes for patients treated using intensity-modulated radiotherapy (IMRT) with simultaneous-integrated boost and weekly cisplatin for American Joint Committee on Cancer stage III/IV mucosal head and neck squamous cell carcinomas (HNSCCs). Records for 67 patients treated definitively with IMRT for HNSCC were reviewed. By including only those treated with weekly cisplatin, 45 patients were eligible for analysis. Treatment outcomes, effect of patient, tumour and treatment characteristics on disease recurrence were analysed. All patients completed IMRT to 7000cGy in 35 fractions, with concurrent weekly cisplatin 40mg/m 2 (median 6 cycles). Median follow-up was 28 months for living patients. Two-year loco-regional recurrence-free, metastasis-free and overall survival were 85.4, 81.0 and 87.4%, respectively. Local recurrence occurred in three patients, and distant recurrence in eight patients. Our results show efficacy of IMRT and weekly cisplatin in the treatment of stage III/IV HNSCC at our institution with respect to loco-regional control.

  20. Predictive factors of local-regional recurrences following parotid sparing intensity modulated or 3D conformal radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Feng, Mary; Jabbari, Siavash; Lin, Alexander; Bradford, Carol R.; Chepeha, Douglas B.; Teknos, Theodoros N.; Worden, Francis P.; Tsien, Christina; Schipper, Matthew J.; Wolf, Gregory T.; Dawson, Laura A.; Eisbruch, Avraham

    2005-01-01

    Background and purpose: Predictive factors for local-regional (LR) failures after parotid-sparing, Intensity modulated (IMRT) or 3D conformal radiotherapy for head and neck (HN) cancers were assessed. Patients and methods: One hundred and fifty-eight patients with mostly stages III-IV HN squamous cell carcinoma underwent curative bilateral neck irradiation aimed at sparing the parotid glands. Patient, tumor, and treatment factors were analyzed as predictive factors for LR failure. Results: Twenty-three patients had LR recurrence (19 in-field and four marginal). No differences were found in the doses delivered to the PTVs of patients with or without in-field recurrences. In univariate analysis, tumor site was highly predictive for LR failure in both postoperative and definitive RT patients. In postoperative RT patients, pathologic tumor size, margin status, extracapsular extension (ECE) and number of lymph node metastases, were also significantly predictive. Multivariate analysis showed tumor site (oropharynx vs. other sites) to be a significant predictor in all patients, and involved margins and number of involved lymph nodes in postoperative patients. Conclusions: Clinical rather than dosimetric factors predicted for LR failures in this series, and were similar to those reported following standard RT. These factors may aid in the selection of patients for studies of treatment intensification using IMRT

  1. Feasibility and efficacy of accelerated weekly concomitant boost postoperative radiation therapy combined with concomitant chemotherapy in patients with locally advanced head and neck cancer.

    Science.gov (United States)

    Pehlivan, Berrin; Luthi, Francois; Matzinger, Oscar; Betz, Michael; Dragusanu, Daniela; Bulling, Shelley; Bron, Luc; Pasche, Philippe; Seelentag, Walter; Mirimanoff, René O; Zouhair, Abderrahim; Ozsahin, Mahmut

    2009-05-01

    The aim of this study was to assess feasibility and efficacy of weekly concomitant boost accelerated postoperative radiation therapy (PORT) with concomitant chemotherapy (CT) in patients with locally advanced head and neck cancer (LAHNC). Conformal or intensity-modulated 66-Gy RT was performed in 5.5 weeks in 40 patients. Cisplatin was given at days 1, 22, and 43. Median follow-up was 36 months. Grade 3 mucositis, dysphagia, and erythema was observed in ten (25%), nine (23%), and six (13%) patients, respectively. Grade 3 or more anemia was observed in two (6%) patients, and leukopenia in five (13%) patients. No grade 3 or 4 thrombocytopenia was observed. Grade 3 nephrotoxicity was observed in one patient (3%). No treatment-related mortality was observed. Grade 2 or more xerostomia and edema were observed in ten (25%) and one (3%) patient, respectively. Locoregional relapse occurred in eight patients, and seven patients developed distant metastases. Median time to locoregional relapse was 6 months. Three-year overall, disease-free survival, and locoregional control rates were 63%, 62%, and 81%, respectively. Multivariate analysis revealed that the only prognostic factor was nodal status. Reducing overall treatment time using accelerated PORT/CT by weekly concomitant boost (six fractions per week) combined with concomitant cisplatin CT is easily feasible with acceptable morbidity.

  2. Monitoring of Circulating Tumor Cells and Their Expression of EGFR/Phospho-EGFR During Combined Radiotherapy Regimens in Locally Advanced Squamous Cell Carcinoma of the Head and Neck

    Energy Technology Data Exchange (ETDEWEB)

    Tinhofer, Ingeborg, E-mail: ingeborg.tinhofer@charite.de [Translational Radiooncology Laboratory, Department of Radiooncology and Radiotherapy, Charite Campus Mitte, Charite Universitaetsmedizin Berlin, Berlin (Germany); Hristozova, Tsvetana; Stromberger, Carmen [Translational Radiooncology Laboratory, Department of Radiooncology and Radiotherapy, Charite Campus Mitte, Charite Universitaetsmedizin Berlin, Berlin (Germany); KeilhoIz, Ulrich [Department of Hematology and Oncology, Campus Benjamin Franklin, Charite Universitaetsmedizin Berlin, Berlin (Germany); Budach, Volker [Translational Radiooncology Laboratory, Department of Radiooncology and Radiotherapy, Charite Campus Mitte, Charite Universitaetsmedizin Berlin, Berlin (Germany)

    2012-08-01

    Purpose: The numbers of circulating tumor cells (CTCs) and their expression/activation of epidermal growth factor receptor (EGFR) during the course of combined chemo- or bioradiotherapy regimens as potential biomarkers of treatment efficacy in squamous cell carcinoma of the head and neck (SCCHN) were determined. Methods and Materials: Peripheral blood samples from SCCHN patients with locally advanced stage IVA/B disease who were treated with concurrent radiochemotherapy or induction chemotherapy followed by bioradiation with cetuximab were included in this study. Using flow cytometry, the absolute number of CTCs per defined blood volume as well as their expression of EGFR and its phosphorylated form (pEGFR) during the course of treatment were assessed. Results: Before treatment, we detected {>=}1 CTC per 3.75 mL blood in 9 of 31 patients (29%). Basal expression of EGFR was detected in 100% and pEGFR in 55% of the CTC+ cases. The frequency of CTC detection was not influenced by induction chemotherapy. However, the number of CTC+ samples significantly increased after radiotherapy. This radiation-induced increase in CTC numbers was less pronounced when radiotherapy was combined with cetuximab compared to its combination with cisplatin/5-fluorouracil. The former treatment regimen was also more effective in reducing pEGFR expression in CTCs. Conclusions: Definitive radiotherapy regimens of locally advanced SCCHN can increase the number of CTCs and might thus contribute to a systemic spread of tumor cells. Further studies are needed to evaluate the predictive value of the radiation-induced increase in CTC numbers and the persistent activation of the EGFR signalling pathway in individual CTC+ cases.

  3. Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer.

    Science.gov (United States)

    Cohen, Ezra E W; Karrison, Theodore G; Kocherginsky, Masha; Mueller, Jeffrey; Egan, Robyn; Huang, Chao H; Brockstein, Bruce E; Agulnik, Mark B; Mittal, Bharat B; Yunus, Furhan; Samant, Sandeep; Raez, Luis E; Mehra, Ranee; Kumar, Priya; Ondrey, Frank; Marchand, Patrice; Braegas, Bettina; Seiwert, Tanguy Y; Villaflor, Victoria M; Haraf, Daniel J; Vokes, Everett E

    2014-09-01

    Induction chemotherapy (IC) before radiotherapy lowers distant failure (DF) rates in locally advanced squamous cell carcinoma of the head and neck (SCCHN). The goal of this phase III trial was to determine whether IC before chemoradiotherapy (CRT) further improves survival compared with CRT alone in patients with N2 or N3 disease. Treatment-naive patients with nonmetastatic N2 or N3 SCCHN were randomly assigned to CRT alone (CRT arm; docetaxel, fluorouracil, and hydroxyurea plus radiotherapy 0.15 Gy twice per day every other week) versus two 21-day cycles of IC (docetaxel 75 mg/m(2) on day 1, cisplatin 75 mg/m(2) on day 1, and fluorouracil 750 mg/m(2) on days 1 to 5) followed by the same CRT regimen (IC + CRT arm). The primary end point was overall survival (OS). Secondary end points included DF-free survival, failure pattern, and recurrence-free survival (RFS). A total of 285 patients were randomly assigned. The most common grade 3 to 4 toxicities during IC were febrile neutropenia (11%) and mucositis (9%); during CRT (both arms combined), they were mucositis (49%), dermatitis (21%), and leukopenia (18%). Serious adverse events were more common in the IC arm (47% v 28%; P = .002). With a minimum follow-up of 30 months, there were no statistically significant differences in OS (hazard ratio, 0.91; 95% CI, 0.59 to 1.41), RFS, or DF-free survival. IC did not translate into improved OS compared with CRT alone. However, the study was underpowered because it did not meet the planned accrual target, and OS was higher than predicted in both arms. IC cannot be recommended routinely in patients with N2 or N3 locally advanced SCCHN. © 2014 by American Society of Clinical Oncology.

  4. Molecular and Clinical Responses in a Pilot Study of Gefitinib With Paclitaxel and Radiation in Locally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Van Waes, Carter; Allen, Clint T.; Citrin, Deborah; Gius, David; Colevas, A. Dimetrios; Harold, Nancy A.; Rudy, Susan; Nottingham, Liesl; Muir, Christine; Chen, Zhong; Singh, Anurag K.; Dancey, Janet; Morris, John C.

    2010-01-01

    Purpose: Epidermal growth factor receptor (EGFR) overexpression in head-and-neck squamous cell carcinoma (HNSCC) stimulates tumor cell proliferation, inhibits apoptosis, and increases chemotherapy and radiation resistance. We examined the toxicity, safety and the effects on EGFR signaling in tumor biopsy samples from patients with locally advanced HNSCC treated with the EGFR signaling inhibitor gefitinib (GEF) combined with weekly intravenous paclitaxel (PAC) and radiation therapy (RT). Methods and Materials: This was a pilot Phase I dose-escalation study. Eligibility included Stage III to IVB HNSCC, age ≥18 years, no prior RT or chemotherapy, adequate organ function, and informed consent. Endpoints included determination of maximum tolerated dose (MTD) and analysis of treatment effect on EGFR signaling, tumor cell proliferation, and apoptosis in biopsy samples. Results: Ten patients were treated. The MTD of this combination was GEF 250 mg/d with PAC 36 mg/m 2 intravenously weekly x 6 with concurrent RT. Grade 3/4 toxicities included prolonged (>8 weeks) stomatitis (7 patients), infection (2 patients), and interstitial pneumonitis (1 patient). There were five complete responses (CR) and two partial responses (PR). Of 7 patients undergoing serial biopsies, only 1 patient demonstrated a reduction in phosphorylated EGFR, decreased downstream signaling, and reduced cellular proliferation after initiating GEF. Conclusions: Inhibition of EGFR by GEF was observed in only one of seven tumors studied. The addition of GEF to PAC and RT did not appear to improve the response of locally advanced HNSCC compared with our prior experience with PAC and RT alone. This treatment appeared to delay recovery from stomatitis.

  5. Sampling locality is more detectable than taxonomy or ecology in the gut microbiota of the brood-parasitic Brown-headed Cowbird (Molothrus ater

    Directory of Open Access Journals (Sweden)

    Sarah M. Hird

    2014-03-01

    Full Text Available Brown-headed Cowbirds (Molothrus ater are the most widespread avian brood parasite in North America, laying their eggs in the nests of approximately 250 host species that raise the cowbird nestlings as their own. It is currently unknown how these heterospecific hosts influence the cowbird gut microbiota relative to other factors, such as the local environment and genetics. We test a Nature Hypothesis (positing the importance of cowbird genetics and a Nurture Hypothesis (where the host parents are most influential to cowbird gut microbiota using the V6 region of 16S rRNA as a microbial fingerprint of the gut from 32 cowbird samples and 16 potential hosts from nine species. We test additional hypotheses regarding the influence of the local environment and age of the birds. We found no evidence for the Nature Hypothesis and little support for the Nurture Hypothesis. Cowbird gut microbiota did not form a clade, but neither did members of the host species. Rather, the physical location, diet and age of the bird, whether cowbird or host, were the most significant categorical variables. Thus, passerine gut microbiota may be most strongly influenced by environmental factors. To put this variation in a broader context, we compared the bird data to a fecal microbiota dataset of 38 mammal species and 22 insect species. Insects were always the most variable; on some axes, we found more variation within cowbirds than across all mammals. Taken together, passerine gut microbiota may be more variable and environmentally determined than other taxonomic groups examined to date.

  6. Sampling locality is more detectable than taxonomy or ecology in the gut microbiota of the brood-parasitic Brown-headed Cowbird (Molothrus ater).

    Science.gov (United States)

    Hird, Sarah M; Carstens, Bryan C; Cardiff, Steven W; Dittmann, Donna L; Brumfield, Robb T

    2014-01-01

    Brown-headed Cowbirds (Molothrus ater) are the most widespread avian brood parasite in North America, laying their eggs in the nests of approximately 250 host species that raise the cowbird nestlings as their own. It is currently unknown how these heterospecific hosts influence the cowbird gut microbiota relative to other factors, such as the local environment and genetics. We test a Nature Hypothesis (positing the importance of cowbird genetics) and a Nurture Hypothesis (where the host parents are most influential to cowbird gut microbiota) using the V6 region of 16S rRNA as a microbial fingerprint of the gut from 32 cowbird samples and 16 potential hosts from nine species. We test additional hypotheses regarding the influence of the local environment and age of the birds. We found no evidence for the Nature Hypothesis and little support for the Nurture Hypothesis. Cowbird gut microbiota did not form a clade, but neither did members of the host species. Rather, the physical location, diet and age of the bird, whether cowbird or host, were the most significant categorical variables. Thus, passerine gut microbiota may be most strongly influenced by environmental factors. To put this variation in a broader context, we compared the bird data to a fecal microbiota dataset of 38 mammal species and 22 insect species. Insects were always the most variable; on some axes, we found more variation within cowbirds than across all mammals. Taken together, passerine gut microbiota may be more variable and environmentally determined than other taxonomic groups examined to date.

  7. TU-AB-BRA-10: Prognostic Value of Intra-Radiation Treatment FDG-PET and CT Imaging Features in Locally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Song, J; Pollom, E; Durkee, B; Aggarwal, S; Bui, T; Le, Q; Loo, B; Hara, W [Stanford University, Palo Alto, CA (United States); Cui, Y [Hokkaido University, Global Institute for Collaborative Research and Educat, Sapporo, Hokkaido (Japan); Li, R [Stanford University, Palo Alto, CA (United States); Hokkaido University, Global Institute for Collaborative Research and Educat, Sapporo, Hokkaido (Japan)

    2015-06-15

    Purpose: To predict response to radiation treatment using computational FDG-PET and CT images in locally advanced head and neck cancer (HNC). Methods: 68 patients with State III-IVB HNC treated with chemoradiation were included in this retrospective study. For each patient, we analyzed primary tumor and lymph nodes on PET and CT scans acquired both prior to and during radiation treatment, which led to 8 combinations of image datasets. From each image set, we extracted high-throughput, radiomic features of the following types: statistical, morphological, textural, histogram, and wavelet, resulting in a total of 437 features. We then performed unsupervised redundancy removal and stability test on these features. To avoid over-fitting, we trained a logistic regression model with simultaneous feature selection based on least absolute shrinkage and selection operator (LASSO). To objectively evaluate the prediction ability, we performed 5-fold cross validation (CV) with 50 random repeats of stratified bootstrapping. Feature selection and model training was solely conducted on the training set and independently validated on the holdout test set. Receiver operating characteristic (ROC) curve of the pooled Result and the area under the ROC curve (AUC) was calculated as figure of merit. Results: For predicting local-regional recurrence, our model built on pre-treatment PET of lymph nodes achieved the best performance (AUC=0.762) on 5-fold CV, which compared favorably with node volume and SUVmax (AUC=0.704 and 0.449, p<0.001). Wavelet coefficients turned out to be the most predictive features. Prediction of distant recurrence showed a similar trend, in which pre-treatment PET features of lymph nodes had the highest AUC of 0.705. Conclusion: The radiomics approach identified novel imaging features that are predictive to radiation treatment response. If prospectively validated in larger cohorts, they could aid in risk-adaptive treatment of HNC.

  8. Phase III Randomized Trial of Induction Chemotherapy in Patients With N2 or N3 Locally Advanced Head and Neck Cancer

    Science.gov (United States)

    Cohen, Ezra E.W.; Karrison, Theodore G.; Kocherginsky, Masha; Mueller, Jeffrey; Egan, Robyn; Huang, Chao H.; Brockstein, Bruce E.; Agulnik, Mark B.; Mittal, Bharat B.; Yunus, Furhan; Samant, Sandeep; Raez, Luis E.; Mehra, Ranee; Kumar, Priya; Ondrey, Frank; Marchand, Patrice; Braegas, Bettina; Seiwert, Tanguy Y.; Villaflor, Victoria M.; Haraf, Daniel J.; Vokes, Everett E.

    2014-01-01

    Purpose Induction chemotherapy (IC) before radiotherapy lowers distant failure (DF) rates in locally advanced squamous cell carcinoma of the head and neck (SCCHN). The goal of this phase III trial was to determine whether IC before chemoradiotherapy (CRT) further improves survival compared with CRT alone in patients with N2 or N3 disease. Patients and Methods Treatment-naive patients with nonmetastatic N2 or N3 SCCHN were randomly assigned to CRT alone (CRT arm; docetaxel, fluorouracil, and hydroxyurea plus radiotherapy 0.15 Gy twice per day every other week) versus two 21-day cycles of IC (docetaxel 75 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, and fluorouracil 750 mg/m2 on days 1 to 5) followed by the same CRT regimen (IC + CRT arm). The primary end point was overall survival (OS). Secondary end points included DF-free survival, failure pattern, and recurrence-free survival (RFS). Results A total of 285 patients were randomly assigned. The most common grade 3 to 4 toxicities during IC were febrile neutropenia (11%) and mucositis (9%); during CRT (both arms combined), they were mucositis (49%), dermatitis (21%), and leukopenia (18%). Serious adverse events were more common in the IC arm (47% v 28%; P = .002). With a minimum follow-up of 30 months, there were no statistically significant differences in OS (hazard ratio, 0.91; 95% CI, 0.59 to 1.41), RFS, or DF-free survival. Conclusion IC did not translate into improved OS compared with CRT alone. However, the study was underpowered because it did not meet the planned accrual target, and OS was higher than predicted in both arms. IC cannot be recommended routinely in patients with N2 or N3 locally advanced SCCHN. PMID:25049329

  9. Concomitant Cisplatin and Hyperfractionated Radiotherapy in Locally Advanced Head and Neck Cancer: 10-Year Follow-Up of a Randomized Phase III Trial (SAKK 10/94)

    International Nuclear Information System (INIS)

    Ghadjar, Pirus; Simcock, Mathew; Studer, Gabriela; Allal, Abdelkarim S.; Ozsahin, Mahmut; Bernier, Jacques; Töpfer, Michael; Zimmermann, Frank; Betz, Michael; Glanzmann, Christoph; Aebersold, Daniel M.

    2012-01-01

    Purpose: To compare the long-term outcome of treatment with concomitant cisplatin and hyperfractionated radiotherapy versus treatment with hyperfractionated radiotherapy alone in patients with locally advanced head and neck cancer. Methods and Materials: From July 1994 to July 2000, a total of 224 patients with squamous cell carcinoma of the head and neck were randomized to receive either hyperfractionated radiotherapy alone (median total dose, 74.4 Gy; 1.2 Gy twice daily; 5 days per week) or the same radiotherapy combined with two cycles of cisplatin (20 mg/m 2 for 5 consecutive days during weeks 1 and 5). The primary endpoint was the time to any treatment failure; secondary endpoints were locoregional failure, metastatic failure, overall survival, and late toxicity assessed according to Radiation Therapy Oncology Group criteria. Results: Median follow-up was 9.5 years (range, 0.1–15.4 years). Median time to any treatment failure was not significantly different between treatment arms (hazard ratio [HR], 1.2 [95% confidence interval {CI}, 0.9–1.7; p = 0.17]). Rates of locoregional failure-free survival (HR, 1.5 [95% CI, 1.1–2.1; p = 0.02]), distant metastasis-free survival (HR, 1.6 [95% CI, 1.1–2.5; p = 0.02]), and cancer-specific survival (HR, 1.6 [95% CI, 1.0–2.5; p = 0.03]) were significantly improved in the combined-treatment arm, with no difference in major late toxicity between treatment arms. However, overall survival was not significantly different (HR, 1.3 [95% CI, 0.9–1.8; p = 0.11]). Conclusions: After long-term follow-up, combined-treatment with cisplatin and hyperfractionated radiotherapy maintained improved rates of locoregional control, distant metastasis-free survival, and cancer-specific survival compared to that of hyperfractionated radiotherapy alone, with no difference in major late toxicity.

  10. Vascular risk levels affect the predictive value of platelet reactivity for the occurrence of MACE in patients on clopidogrel. Systematic review and meta-analysis of individual patient data.

    Science.gov (United States)

    Reny, Jean-Luc; Fontana, Pierre; Hochholzer, Willibald; Neumann, Franz Josef; Ten Berg, Jurriën; Janssen, Paul W; Geisler, Tobias; Gawaz, Meinrad; Marcucci, Rossella; Gori, Anna-Maria; Cuisset, Thomas; Alessi, Marie-Christine; Berdagué, Philippe; Gurbel, Paul A; Yong, Gerald; Angiolillo, Dominick J; Aradi, Dániel; Beigel, Roy; Campo, Gianluca; Combescure, Christophe

    2016-04-01

    Prior studies have shown an association between high on-clopidogrel platelet reactivity (PR) and the risk of major adverse cardiovascular events (MACE). However, large intervention trials on PR-tailored treatments have been neutral. The role and usefulness of PR with regard to levels of cardiovascular risk are unclear. We undertook a systematic review and meta-analysis of individual patient data on MACE outcomes (acute coronary syndromes (ACS), ischaemic strokes, and vascular deaths) in relation to PR and its interaction with cardiovascular risk levels. PR was determined using ADP-induced light transmission aggregometry with a primary concentration of 20 µM ADP. Thirteen prospective studies totaled 6,478 clopidogrel-treated patients who experienced 421 MACE (6.5 %) during a median follow-up of 12 months. The strength of the association between the risk of MACE and PR increased significantly (p=0.04) with the number of risk factors present (age> 75 years, ACS at inclusion, diabetes, and hypertension). No association was detected in patients with no risk factor (p=0.48). In patients presenting one risk factor, only high-PR was associated with an increased risk of MACE (HR 3.2, p=0.001). In patients presenting ≥ 2 risk factors, the increase of risk started from medium-PR (medium-PR: HR=2.9, p=0.0004; high-PR: HR=3.7, p=0.0003). PR allowed the reclassification of 44 % of the total population to a different risk level for the outcome of MACE, mostly in intermediate or high risk patients. In conclusion, the magnitude of the association between PR and MACE risk is strongly dependent on the level of cardiovascular risk faced by patients on clopidogrel.

  11. Results of an RTOG phase III trial (RTOG 85-27) comparing radiotherapy plus etanidazole with radiotherapy alone for locally advanced head and neck carcinomas

    Energy Technology Data Exchange (ETDEWEB)

    Dingjen, Lee; Cosmatos, Dennis; Marcial, Victor A; Fu, Karen K; Rotman, Marvin; Cooper, Jay S; Ortiz, Hernando G; Beitler, Jonathan J; Abrams, Ross A; Curran, Walter J; Coleman, C Norman; Wasserman, Todd H

    1995-06-15

    Purpose: The objectives of this study were to determine the efficacy and toxicity of Etanidazole (ETA), a hypoxic cell sensitizer, when combined with conventional radiotherapy (RT) in the management of advanced head and neck carcinomas. Methods and Materials: From March 1988 to September 1991, 521 patients who had Stage III or IV head and neck carcinomas were randomized to receive conventional RT alone (66 Gy in 33 fractions to 74 Gy in 37 fractions, 5 fractions per week) or RT + ETA (2.0 g/m{sup 2} thrice weekly for 17 doses), of whom 504 were eligible and analyzable. Treatment assignments were stratified before randomization according to the primary site (oral cavity + hypopharynx vs. supraglottic larynx + oropharynx + nasopharynx), T-stage (T1-3 vs. T4), and N-stage (N0-2 vs. N3). Pretreatment characteristics were balanced. In the RT-alone arm, 39% of patients had T3 and 34% had T4 disease, whereas in the RT + ETA arm, 42% of patients had T3 and 33% had T4 disease. Thirty-eight percent of the RT-alone patients and 37% of the RT + ETA patients had N3 disease. The median follow-up of surviving patients was 3.38 years, with a range between 0.96 and 5.63 years. Results: One hundred and ninety-four of the 252 (77%) RT + ETA patients received at least 14 doses of the drug. Overall RT protocol compliance rate was 82% in the RT-alone arm and 86% in the RT + ETA arm. No Grade 3 or 4 central nervous system or peripheral neuropathy was observed in the RT + ETA arm. Eighteen percent of the patients developed Grade 1 and 5% developed Grade 2 peripheral neuropathy. Other drug related toxicities included nausea/vomiting (27%), low blood counts (15%), and allergy (9%). Most of these toxicities were Grade 1 and 2. The incidence of severe acute and late radiation effects were similar between the two arms. The 2-year actuarial local-regional control rate (LCR) was 40% for the RT-alone arm and 40% for the RT + ETA arm. Two-year actuarial survival was 41% for the RT-alone arm and 43

  12. Results of an RTOG phase III trial (RTOG 85-27) comparing radiotherapy plus etanidazole with radiotherapy alone for locally advanced head and neck carcinomas

    International Nuclear Information System (INIS)

    Lee Dingjen; Cosmatos, Dennis; Marcial, Victor A.; Fu, Karen K.; Rotman, Marvin; Cooper, Jay S.; Ortiz, Hernando G.; Beitler, Jonathan J.; Abrams, Ross A.; Curran, Walter J.; Coleman, C. Norman; Wasserman, Todd H.

    1995-01-01

    Purpose: The objectives of this study were to determine the efficacy and toxicity of Etanidazole (ETA), a hypoxic cell sensitizer, when combined with conventional radiotherapy (RT) in the management of advanced head and neck carcinomas. Methods and Materials: From March 1988 to September 1991, 521 patients who had Stage III or IV head and neck carcinomas were randomized to receive conventional RT alone (66 Gy in 33 fractions to 74 Gy in 37 fractions, 5 fractions per week) or RT + ETA (2.0 g/m 2 thrice weekly for 17 doses), of whom 504 were eligible and analyzable. Treatment assignments were stratified before randomization according to the primary site (oral cavity + hypopharynx vs. supraglottic larynx + oropharynx + nasopharynx), T-stage (T1-3 vs. T4), and N-stage (N0-2 vs. N3). Pretreatment characteristics were balanced. In the RT-alone arm, 39% of patients had T3 and 34% had T4 disease, whereas in the RT + ETA arm, 42% of patients had T3 and 33% had T4 disease. Thirty-eight percent of the RT-alone patients and 37% of the RT + ETA patients had N3 disease. The median follow-up of surviving patients was 3.38 years, with a range between 0.96 and 5.63 years. Results: One hundred and ninety-four of the 252 (77%) RT + ETA patients received at least 14 doses of the drug. Overall RT protocol compliance rate was 82% in the RT-alone arm and 86% in the RT + ETA arm. No Grade 3 or 4 central nervous system or peripheral neuropathy was observed in the RT + ETA arm. Eighteen percent of the patients developed Grade 1 and 5% developed Grade 2 peripheral neuropathy. Other drug related toxicities included nausea/vomiting (27%), low blood counts (15%), and allergy (9%). Most of these toxicities were Grade 1 and 2. The incidence of severe acute and late radiation effects were similar between the two arms. The 2-year actuarial local-regional control rate (LCR) was 40% for the RT-alone arm and 40% for the RT + ETA arm. Two-year actuarial survival was 41% for the RT-alone arm and 43% for

  13. Post-treatment PET/CT and p16 status for predicting treatment outcomes in locally advanced head and neck cancer after definitive radiation

    Energy Technology Data Exchange (ETDEWEB)

    Awan, Musaddiq J.; Machtay, Mitchell; Yao, Min [Case Western Reserve University and University Hospitals, Department of Radiation Oncology, Cleveland, OH (United States); Lavertu, Pierre; Zender, Chad; Rezaee, Rod; Fowler, Nicole [University Hospitals, Department of Otolaryngology and Head and Neck Surgery, Cleveland, OH (United States); Karapetyan, Lilit; Gibson, Michael [University Hospitals, Department of Medical Oncology, Cleveland, OH (United States); Wasman, Jay [University Hospitals, Department of Pathology, Cleveland, OH (United States); Faulhaber, Peter [University Hospitals, Department of Nuclear Medicine and Radiology, Cleveland, OH (United States)

    2017-06-15

    To retrospectively review post-treatment (post-tx) FDG-PET/CT scans in patients with advanced head and neck squamous cell carcinoma (HNSCC) and known p16 status, treated with definitive (chemo)radiation (RT). A total of 108 eligible patients had N2A or greater HNSCC treated with chemoRT from August 1, 2008, to February 28, 2015, with post-tx PET/CT within 6 months after RT. Kaplan-Meier curves, log-rank statistics, and Cox proportional hazards regression were used for statistical analysis. Median follow-up was 2.38 years. Sixty-eight (63.0%) patients had p16+ and 40 (37.0%) had p16- status. Two-year overall survival and recurrence-free survival were 93.4% and 77.8%, respectively. The negative predictive value (NPV) of PET/CT for local recurrence (LR) was 100%. The NPV for regional recurrence (RR) was 96.5% for all patients, 100% for p16+ patients, and 88.5% for p16- patients. The positive predictive value (PPV) of PET/CT for recurrence was 77.3% for all patients, 50.0% for p16+, and 78.6% for p16-. The PPV for LR was 72.7% for all patients, 50.0% for p16+ patients, and 72.7% for p16- patients. The PPV for RR was 50.0% for all patients, 33% for p16+, and 66.6% for p16-. Post-tx PET/CT and p16 status were independent predictors of recurrence-free survival (p < 0.01). Post-tx PET/CT predicts treatment outcomes in both p16 + and p16- patients, and does so independently of p16 status. P16- patients with negative PET have a 10% risk of nodal recurrence, and closer follow-up in these patients is warranted. (orig.)

  14. High-grade acute organ toxicity as positive prognostic factor in primary radio(chemo)therapy for locally advanced, inoperable head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wolff, Hendrik Andreas; Bosch, Jan; Hennies, Steffen; Hess, Clemens F.; Christiansen, Hans [Dept. of Radiotherapy and Radiooncology, Univ. Medicine Goettingen (Germany); Jung, Klaus [Dept. of Medical Statistics, Univ. Medicine Goettingen (Germany); Overbeck, Tobias [Dept. of Haematology and Oncology, Univ. Medicine Goettingen (Germany); Matthias, Christoph; Roedel, Ralph M. [Dept. of Otorhinolaryngology, Univ. Medicine Goettingen (Germany)

    2010-05-15

    Purpose: to test for a possible correlation between high-grade acute organ toxicity during primary radio(chemo)therapy and treatment outcome in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Patients and methods: from 05/1994 to 01/2009, 216 HNSCC patients were treated with radio(chemo)therapy in primary approach. They received normofractionated (2 Gy/fraction) irradiation including associated nodal drainage sites to a cumulative dose of 70 Gy. 151 patients received additional concomitant chemotherapy (111 patients 5-fluorouracil/mitomycin C, 40 patients cisplatin-based). Toxicity during treatment was monitored weekly according to the Common Toxicity Criteria (CTC), and any toxicity grade CTC {>=} 3 of mucositis, dysphagia or skin reaction was assessed as high-grade acute organ toxicity for later analysis. Results: a statistically significant coherency between high-grade acute organ toxicity and overall survival as well as locoregional control was found: patients with CTC {>=} 3 acute organ toxicity had a 5-year overall survival rate of 4% compared to 8% in patients without (p < 0.01). Thereby, multivariate analyses revealed that the correlation was independent of other possible prognostic factors or factors that may influence treatment toxicity, especially concomitant chemotherapy and radiotherapy technique or treatment-planning procedure. Conclusion: these data indicate that normal tissue and tumor tissue may behave similarly with respect to treatment response, as high-grade acute organ toxicity during radio(chemo)therapy showed to be an independent prognostic marker in the own patient population. However, the authors are aware of the fact that a multivariate analysis in a retrospective study generally has statistical limitations. Therefore, their hypothesis should be further analyzed on biomolecular and clinical levels and other tumor entities in prospective trials. (orig.)

  15. Local recurrence of squamous cell carcinoma of the head and neck after radio(chemo)therapy. Diagnostic performance of FDG-PET/MRI with diffusion-weighted sequences

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Minerva; Varoquaux, Arthur D.; Rager, Olivier; Delattre, Benedicte M.A.; Katirtzidou, Eirini; Ratib, Osman; Zaidi, Habib; Becker, Christoph D. [Geneva University Hospitals (Switzerland). Div. of Radiology and Nuclear Medicine; Combescure, Christophe [Geneva University Hospitals (Switzerland). Centre for Clinical Research; Pusztaszeri, Marc; Burkhardt, Karim [Geneva University Hospitals (Switzerland). Div. of Clinical Pathology; Dulguerov, Pavel; Dulguerov, Nicolas [Geneva University Hospitals (Switzerland). Clinic of Otorhinolaryngology Head and Neck Surgery; Caparrotti, Francesca [Geneva University Hospitals (Switzerland). Div. of Radiation Oncology

    2018-02-15

    To determine the diagnostic performance of FDG-PET/MRI with diffusion-weighted imaging (FDG-PET/DWIMRI) for detection and local staging of head and neck squamous cell carcinoma (HNSCC) after radio(chemo)therapy. This was a prospective study that included 74 consecutive patients with previous radio(chemo)therapy for HNSCC and in whom tumour recurrence or radiation-induced complications were suspected clinically. The patients underwent hybrid PET/MRI examinations with morphological MRI, DWI and FDG-PET. Experienced readers blinded to clinical/histopathological data evaluated images according to established diagnostic criteria taking into account the complementarity of multiparametric information. The standard of reference was histopathology with whole-organ sections and follow-up ≥24 months. Statistical analysis considered data clustering. The proof of diagnosis was histology in 46/74 (62.2%) patients and follow-up (mean ± SD = 34 ± 8 months) in 28/74 (37.8%). Thirty-eight patients had 43 HNSCCs and 46 patients (10 with and 36 without tumours) had 62 benign lesions/complications. Sensitivity, specificity, and positive and negative predictive value of PET/DWIMRI were 97.4%, 91.7%, 92.5% and 97.1% per patient, and 93.0%, 93.5%, 90.9%, and 95.1% per lesion, respectively. Agreement between imaging-based and pathological T-stage was excellent (kappa = 0.84, p < 0.001). FDG-PET/DWIMRI yields excellent results for detection and T-classification of HNSCC after radio(chemo)therapy. (orig.)

  16. Exploring new potentials and generating hypothesis for management of locally advanced head neck cancer: Analysis of pooled data from two phase II trials

    Directory of Open Access Journals (Sweden)

    Chufal Kundan

    2010-01-01

    Full Text Available Background: To study the long term results of two phase II concurrent chemoradiotherapy protocols and conduct pooled data analysis with special emphasis on nodal density. Materials and Methods: In the period from April 2001 to May 2003, phase II Mitomycin C (MMC and late chemo-intensification (LCI protocols were started in the same institute, enrolling 69 and 74 patients respectively. Long term results for these individual trials are reported along with pooled data analysis. Results: Median follow-up time for whole group, MMC protocol and LCI protocol was 43.8 months (SD619.8, 55 months (SD 618.5 and 47.5 months (SD 620.9 respectively. LRFS, DFS and OS at five years for whole group was 59.4, 43.5 and 47.1% respectively, for MMC protocol was 59.9, 45.5 and 49.5% respectively and for LCI, protocol was 53.6%, 41.5% and 44.4% respectively. Subgroup analysis revealed that MMC protocol was more effective than LCI protocol in terms of DFS and OS in patients with hypo dense nodes while opposite was true for Isodense nodes. Multivariate analysis revealed nodal density as an independent variable that had an impact on treatment outcome. Risk of death in patients with hypo dense nodes was 2.91 times that of Isodense nodes. Conclusions: Innovative and pragmatic approach is required to address locally advanced head neck cancer. Long term results for MMC and LCI protocols are encouraging. Integrating the basic concepts of these protocols may help develop new protocols, which will facilitate the search for the optimal solution.

  17. Relationship Between Radiation Treatment Time and Overall Survival After Induction Chemotherapy for Locally Advanced Head-and-Neck Carcinoma: A Subset Analysis of TAX 324

    International Nuclear Information System (INIS)

    Sher, David J.; Posner, Marshall R.; Tishler, Roy B.; Sarlis, Nicholas J.; Haddad, Robert I.; Holupka, Edward J.; Devlin, Phillip M.

    2011-01-01

    Purpose: To analyze the relationship between overall survival (OS) and radiation treatment time (RTT) and overall treatment time (OTT) in a well-described sequential therapy paradigm for locally advanced head-and-neck carcinoma (LAHNC). Methods and Materials: TAX 324 is a Phase III study comparing TPF (docetaxel, cisplatin, and fluorouracil) with PF (cisplatin and fluorouracil) induction chemotherapy (IC) in LAHNC patients; both arms were followed by carboplatin-based chemoradiotherapy (CRT). Prospective radiotherapy quality assurance was performed. This analysis includes all patients who received three cycles of IC and a radiation dose of ≥ 70 Gy. Radiotherapy treatment time was analyzed as binary (≤ 8 weeks vs. longer) and continuous (number of days beyond 8 weeks) functions. The primary analysis assessed the relationship between RTT, OTT, and OS, and the secondary analysis explored the association between treatment times and locoregional recurrence (LRR). Results: A total of 333 (of 501) TAX 324 patients met the criteria for inclusion in this analysis. There were no significant differences between the treatment arms in baseline or treatment characteristics. On multivariable analysis, PF IC, World Health Organization performance status of 1, non-oropharynx site, T3/4 stage, N3 status, and prolonged RTT (hazard ratio 1.63, p = 0.006) were associated with significantly inferior survival. Performance status, T3/4 disease, and prolonged RTT (odds ratio 1.68, p = 0.047) were independently and negatively related to LRR on multivariable analysis, whereas PF was not. Overall treatment time was not independently associated with either OS or LRR. Conclusions: In this secondary analysis of the TAX 324 trial, TPF IC remains superior to PF IC after controlling for radiotherapy delivery time. Even with optimal IC and concurrent chemotherapy, a non-prolonged RTT is a crucial determinant of treatment success. Appropriate delivery of radiotherapy after IC remains essential

  18. Relationship Between Radiation Treatment Time and Overall Survival After Induction Chemotherapy for Locally Advanced Head-and-Neck Carcinoma: A Subset Analysis of TAX 324

    Energy Technology Data Exchange (ETDEWEB)

    Sher, David J., E-mail: dsher@partners.org [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, MA (United States); Posner, Marshall R. [Division of Hematology/Oncology, Mount Sinai School of Medicine, New York, NY (United States); Tishler, Roy B. [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, MA (United States); Sarlis, Nicholas J. [Sanofi-Aventis US, Bridgewater, NJ (United States); Haddad, Robert I. [Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women' s Hospital, Boston, MA (United States); Holupka, Edward J. [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA (Israel); Devlin, Phillip M. [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, MA (United States)

    2011-12-01

    Purpose: To analyze the relationship between overall survival (OS) and radiation treatment time (RTT) and overall treatment time (OTT) in a well-described sequential therapy paradigm for locally advanced head-and-neck carcinoma (LAHNC). Methods and Materials: TAX 324 is a Phase III study comparing TPF (docetaxel, cisplatin, and fluorouracil) with PF (cisplatin and fluorouracil) induction chemotherapy (IC) in LAHNC patients; both arms were followed by carboplatin-based chemoradiotherapy (CRT). Prospective radiotherapy quality assurance was performed. This analysis includes all patients who received three cycles of IC and a radiation dose of {>=} 70 Gy. Radiotherapy treatment time was analyzed as binary ({<=} 8 weeks vs. longer) and continuous (number of days beyond 8 weeks) functions. The primary analysis assessed the relationship between RTT, OTT, and OS, and the secondary analysis explored the association between treatment times and locoregional recurrence (LRR). Results: A total of 333 (of 501) TAX 324 patients met the criteria for inclusion in this analysis. There were no significant differences between the treatment arms in baseline or treatment characteristics. On multivariable analysis, PF IC, World Health Organization performance status of 1, non-oropharynx site, T3/4 stage, N3 status, and prolonged RTT (hazard ratio 1.63, p = 0.006) were associated with significantly inferior survival. Performance status, T3/4 disease, and prolonged RTT (odds ratio 1.68, p = 0.047) were independently and negatively related to LRR on multivariable analysis, whereas PF was not. Overall treatment time was not independently associated with either OS or LRR. Conclusions: In this secondary analysis of the TAX 324 trial, TPF IC remains superior to PF IC after controlling for radiotherapy delivery time. Even with optimal IC and concurrent chemotherapy, a non-prolonged RTT is a crucial determinant of treatment success. Appropriate delivery of radiotherapy after IC remains essential

  19. Relationship between radiation treatment time and overall survival after induction chemotherapy for locally advanced head-and-neck carcinoma: a subset analysis of TAX 324.

    Science.gov (United States)

    Sher, David J; Posner, Marshall R; Tishler, Roy B; Sarlis, Nicholas J; Haddad, Robert I; Holupka, Edward J; Devlin, Phillip M

    2011-12-01

    To analyze the relationship between overall survival (OS) and radiation treatment time (RTT) and overall treatment time (OTT) in a well-described sequential therapy paradigm for locally advanced head-and-neck carcinoma (LAHNC). TAX 324 is a Phase III study comparing TPF (docetaxel, cisplatin, and fluorouracil) with PF (cisplatin and fluorouracil) induction chemotherapy (IC) in LAHNC patients; both arms were followed by carboplatin-based chemoradiotherapy (CRT). Prospective radiotherapy quality assurance was performed. This analysis includes all patients who received three cycles of IC and a radiation dose of ≥70 Gy. Radiotherapy treatment time was analyzed as binary (≤8 weeks vs. longer) and continuous (number of days beyond 8 weeks) functions. The primary analysis assessed the relationship between RTT, OTT, and OS, and the secondary analysis explored the association between treatment times and locoregional recurrence (LRR). A total of 333 (of 501) TAX 324 patients met the criteria for inclusion in this analysis. There were no significant differences between the treatment arms in baseline or treatment characteristics. On multivariable analysis, PF IC, World Health Organization performance status of 1, non-oropharynx site, T3/4 stage, N3 status, and prolonged RTT (hazard ratio 1.63, p=0.006) were associated with significantly inferior survival. Performance status, T3/4 disease, and prolonged RTT (odds ratio 1.68, p=0.047) were independently and negatively related to LRR on multivariable analysis, whereas PF was not. Overall treatment time was not independently associated with either OS or LRR. In this secondary analysis of the TAX 324 trial, TPF IC remains superior to PF IC after controlling for radiotherapy delivery time. Even with optimal IC and concurrent chemotherapy, a non-prolonged RTT is a crucial determinant of treatment success. Appropriate delivery of radiotherapy after IC remains essential for optimizing OS in LAHNC. Copyright © 2011 Elsevier Inc

  20. Local recurrence of squamous cell carcinoma of the head and neck after radio(chemo)therapy: Diagnostic performance of FDG-PET/MRI with diffusion-weighted sequences.

    Science.gov (United States)

    Becker, Minerva; Varoquaux, Arthur D; Combescure, Christophe; Rager, Olivier; Pusztaszeri, Marc; Burkhardt, Karim; Delattre, Bénédicte M A; Dulguerov, Pavel; Dulguerov, Nicolas; Katirtzidou, Eirini; Caparrotti, Francesca; Ratib, Osman; Zaidi, Habib; Becker, Christoph D

    2018-02-01

    To determine the diagnostic performance of FDG-PET/MRI with diffusion-weighted imaging (FDG-PET/DWIMRI) for detection and local staging of head and neck squamous cell carcinoma (HNSCC) after radio(chemo)therapy. This was a prospective study that included 74 consecutive patients with previous radio(chemo)therapy for HNSCC and in whom tumour recurrence or radiation-induced complications were suspected clinically. The patients underwent hybrid PET/MRI examinations with morphological MRI, DWI and FDG-PET. Experienced readers blinded to clinical/histopathological data evaluated images according to established diagnostic criteria taking into account the complementarity of multiparametric information. The standard of reference was histopathology with whole-organ sections and follow-up ≥24 months. Statistical analysis considered data clustering. The proof of diagnosis was histology in 46/74 (62.2%) patients and follow-up (mean ± SD = 34 ± 8 months) in 28/74 (37.8%). Thirty-eight patients had 43 HNSCCs and 46 patients (10 with and 36 without tumours) had 62 benign lesions/complications. Sensitivity, specificity, and positive and negative predictive value of PET/DWIMRI were 97.4%, 91.7%, 92.5% and 97.1% per patient, and 93.0%, 93.5%, 90.9%, and 95.1% per lesion, respectively. Agreement between imaging-based and pathological T-stage was excellent (kappa = 0.84, p recurrence. • Prospective one-centre study showed excellent agreement between imaging-based and pathological T-stage. • 97.5% of positive concordant MRI, DWI and FDG-PET results correspond to recurrence. • 87% of discordant MRI, DWI and FDG-PET results correspond to benign lesions. • Multiparametric FDG-PET/DWIMRI facilitates planning of salvage surgery in the irradiated neck.

  1. Association of cytochrome P450 2C9 polymorphism with locally advanced head and neck squamous cell carcinoma and response to concurrent cisplatin-based radical chemoradiation

    Directory of Open Access Journals (Sweden)

    Sayan Paul

    2014-01-01

    Full Text Available Aims: The aim of the present study is to investigate the association between polymorphism of cytochrome P450 2C9 (CYP2C9 enzyme with head and neck squamous cell carcinoma (HNSCC and response in patients receiving cisplatin-based radical chemoradiation (CT-RT. Materials and Methods: Four hundred and sixty patients suffering from locally advanced HNSCC and an equal number of healthy controls were genotyped for CYP2C9FNx012 and CYP2C9FNx013, leading to poor metabolizers (PMs by polymerase chain reaction (PCR-based restriction fragment length polymorphism (RFLP. Each case was assessed thoroughly for treatment response as per the World Health Organization (WHO criteria. Results and Analysis: The frequency of heterozygous genotypes of both CYP2C9FNx012 (27.8% and CYP2C9FNx013 (25% were found to be significantly higher in the HNSCC cases as compared to the healthy controls. Tobacco intake in the form of chewing or smoking and alcohol intake resulted in several folds increase in the risk to HNSCC in the cases carrying variant genotypes of CYP2C9FNx012 or CYP2C9FNx013. Further, majority of the cases assessed for response (n = 436 carrying variant alleles of CYP2C9FNx012 (69.6% or CYP2C9FNx013 (65.2% were found to respond poorly to cisplatin-based radical CT-RT. Conclusion: The data suggests a significant association of the CYP2C9 polymorphism with HNSCC and treatment outcome underlining the importance of pretherapeutic genotyping in determining the treatment protocol.

  2. Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer. Results of a prospective study

    International Nuclear Information System (INIS)

    Tribius, Silke; Raguse, Marieclaire; Voigt, Christian; Petersen, Cordula; Kruell, Andreas; Muenscher, Adrian; Groebe, Alexander; Bergelt, Corinna; Singer, Susanne

    2015-01-01

    Patients with locally advanced head and neck cancer (LAHNC) undergo life-changing treatments that can seriously affect quality of life (QoL). This prospective study examined the key QoL domains during the first year after intensity-modulated radiotherapy (IMRT) and identified predictors of these changes in order to improve patient outcomes. A consecutive series of patients with LAHNC completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core module (QLQ-C30) and the HNC-specific QLQ-HN35 before (t0) and at the end (t1) of definitive or adjuvant IMRT, then at 6-8 weeks (t2), 6 months (t3), and 1 year (t4) after IMRT. Patients (n = 111) completing questionnaires at all five time points were included (baseline response rate: 99 %; dropout rate between t0 and t4: 5 %). QoL deteriorated in all domains during IMRT and improved slowly during the first year thereafter. Many domains recovered to baseline values after 1 year but problems with smelling and tasting, dry mouth, and sticky saliva remained issues at this time. Increases in problems with sticky saliva were greater after 1 year in patients with definitive versus adjuvant IMRT (F = 3.5, P = 0.05). QoL in patients with LAHNC receiving IMRT takes approximately 1 year to return to baseline; some domains remain compromised after 1 year. Although IMRT aims to maintain function and QoL, patients experience long-term dry mouth and sticky saliva, particularly following definitive IMRT. Patients should be counseled at the start of therapy to reduce disappointment with the pace of recovery. (orig.) [de

  3. Impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris at 6months follow-up.

    Science.gov (United States)

    Xia, Jinggang; Xu, Ji; Hu, Shaodong; Hao, Hengjian; Yin, Chunlin; Xu, Dong

    2017-08-01

    We explored the impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris (SAP) at 6months follow-up. From May 2015 to April 2016, a total of 746 patients with SAP were divided to high glycemic variability group (H group) (n=261) and low glycemic variability group (L group) (n=485). The primary end point was incidence of periprocedural myocardial infarction and MACE at 6months follow-up. The occurrence of periprocedural myocardial infarction occurred in 18.8% of patients in H group and in 12.4% in L group (P=0.03). The incidence of MACE at 6months follow-up was 9.6% in H group and 4.5% in L group (P=0.01). Multivariable analysis suggested that high glycemic variability conferred a 53% risk increment of 6months follow-up MACE (odds ratio 2.13, 95% confidence interval 1.85-5.38; P=0.01). The trial shows that higher blood glucose variability was correlated with higher incidence of periprocedural myocardial infarction and MACE at 6months follow-up. Copyright © 2017. Published by Elsevier B.V.

  4. Concurrent weekly docetaxel and concomitant boost radiation therapy in the treatment of locally advanced squamous cell cancer of the head and neck

    International Nuclear Information System (INIS)

    Tishler, Roy B.; Posner, Marshall R.; Norris, Charles M.; Mahadevan, Anand; Sullivan, Christopher; Goguen, Laura; Wirth, Lori J.; Costello, Rosemary; Case, MaryAnn; Stowell, Sara; Sammartino, Dan; Busse, Paul M.; Haddad, Robert I.

    2006-01-01

    Purpose: In a Phase I/II trial, we investigated concurrent weekly docetaxel and concomitant boost radiation in patients with locally advanced squamous cell cancer of the head and neck (SCCHN) after induction chemotherapy. Patients and Methods: Patients presented with American Joint Committee on Cancer Stage III/IV and were treated initially with induction chemotherapy using cisplatinum/5-fluorouracil (PF), carboplatinum-5-FU, or docetaxel-PF. Patients then received docetaxel four times weekly with concomitant boost (CB) radiation (1.8 Gy once-daily X20, 1.8/1.5 Gy twice a day). Fifteen patients each received 20 mg/M 2 and 25 mg/M 2 . Results: Thirty-one patients were enrolled and 30 were evaluable for response and toxicity. Median follow-up was 42 months (range, 27-63 months). Primary sites were: oropharynx 19, oral cavity 2, larynx/hypopharynx 5, and unknown primary 4. Eighty-seven percent of patients had N2/N3 disease; 60% had T3/T4 disease. Twenty percent of patients had a complete response (CR) to induction chemotherapy. After chemoradiotherapy, 21 of 30 patients had a CR, 2 had progressive disease, and 7 had partial response (PR). Nineteen of 26 patients presenting with neck disease had neck dissections, and 7 of 19 were positive. Ninety-three percent of all patients were rendered disease-free after all planned therapy. Treatment failed in 8 patients, and 7 have died of disease. An additional patient died with no evidence of disease. Twenty-one patients (70%) are currently alive with no evidence of disease. No acute dose-limiting toxicity was observed at either dose level. Conclusions: This intensive treatment regimen of concurrent docetaxel/concomitant boost radiation and surgery after induction chemotherapy in poor prognosis patients yields good local regional control and survival. Docetaxel/CB chemoradiotherapy represents an aggressive alternative regimen to platinum-based chemoradiotherapy or surgery in patients who have a poor response to induction

  5. Concurrent hyperfractionated accelerated radiotherapy with 5-FU and once weekly cisplatin in locally advanced head and neck cancer. The 10-year results of a prospective phase II trial

    Energy Technology Data Exchange (ETDEWEB)

    Budach, V.; Boehmer, D.; Badakhshi, H.; Jahn, U.; Stromberger, C. [Campus Virchow Klinikum, Charite Universitaetsmedizin Berlin, Department for Radiooncology, Clinic for Radiooncology, Berlin (Germany); Becker, E.T. [Charite Universitaetsmedizin, Department of Otorhinolaryngology, Berlin (Germany); Wernecke, K.D. [Sostana Statistics GmbH, Charite Universitaetsmedizin Berlin, Berlin (Germany)

    2014-03-15

    In this study, the acute toxicity and long-term outcome of a hyperfractionated accelerated chemoradiation regimen with cisplatin/5-fluorouracil (5-FU) in patients with locally advanced squamous cell carcinomas of head and neck were evaluated. From 2000-2002, 38 patients with stage III (5.3 %) and stage IV (94.7 %) head and neck cancer were enrolled in a phase II study. Patients received hyperfractionated-accelerated radiotherapy with 72 Gy in 15 fractions of 2 Gy followed by 1.4 Gy twice daily with concurrent, continuous infusion 5-FU of 600 mg/m{sup 2} on days 1-5 and 6 cycles of weekly cisplatin (30 mg/m{sup 2}). Acute toxicities (CTCAEv2.0), locoregional control (LRC), metastases-free (MFS), and overall survival (OS) were analyzed and exploratively compared with the ARO 95-06 trial. Median follow-up was 11.4 years (95 % CI 8.6-14.2) and mean dose 71.6 Gy. Of the patients, 82 % had 6 (n = 15) or 5 (n = 16) cycles of cisplatin, 5 and 2 patients received 4 and 3 cycles, respectively. Grade 3 anemia, leukopenia, and thrombocytopenia were observed in 15.8, 15.8, and 2.6 %, respectively. Grade 3 mucositis in 50 %, grade 3 and 4 dysphagia in 55 and 13 %. The 2-, 5-, and 10-year LRC was 65, 53.6, and 48.2 %, the MFS was 77.5, 66.7, and 57.2 % and the OS 59.6, 29.2, and 15 %, respectively. Chemoradiation with 5-FU and cisplatin seems feasible and superior in terms of LRC and OS to the ARO 95-06C-HART arm at 2 years. However, this did not persist at the 5- and 10-year follow-ups. (orig.) [German] Untersuchung der Akuttoxizitaet und des Langzeitueberlebens einer hyperfraktioniert-akzelerierten simultanen Radiochemotherapie mit Cisplatin/5-Fluorouracil (5-FU) bei Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren. Von 2000 bis 2002 wurden 38 Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region im Stadium III (5,3 %) und IV (94,7 %) eingeschlossen. Es erfolgte eine simultane hyperfraktionierte akzelerierte Radiochemotherapie mit 72 Gy in 15 Fraktionen a 2 Gy

  6. Preschool Facilities - MDC_HeadStart

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — A label (point) feature class of Head Start / Early Head Start/ Delegate Agencies/ Child Care Partnership & Family Day Care Homes Programs location in Miami-Dade...

  7. Continuous-Course Reirradiation With Concurrent Carboplatin and Paclitaxel for Locally Recurrent, Nonmetastatic Squamous Cell Carcinoma of the Head-and-Neck

    Energy Technology Data Exchange (ETDEWEB)

    Kharofa, Jordan [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Choong, Nicholas [Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Wang, Dian; Firat, Selim; Schultz, Christopher [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Sadasiwan, Chitra [Medical College of Wisconsin, Milwaukee, WI (United States); Wong, Stuart, E-mail: Swong@mcw.edu [Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)

    2012-06-01

    Purpose: To examine the efficacy and toxicity of continuous-course, conformal reirradiation with weekly paclitaxel and carboplatin for the treatment of locally recurrent, nonmetastatic squamous cell carcinoma of the head and neck (SCCHN) in a previously irradiated field. Methods and Materials: Patients treated with continuous course-reirradiation with concurrent carboplatin and paclitaxel at the Medical College of Wisconsin and the Clement J. Zablocki VA from 2001 through 2009 were retrospectively reviewed. Patients included in the analysis had prior radiation at the site of recurrence of at least 45 Gy. The analysis included patients who received either intensity-modulated radiotherapy (RT) or three-dimensional conformal RT techniques. All patients received weekly concurrent carboplatin (AUC2) and paclitaxel (30-50 mg/m{sup 2}). Results: Thirty-eight patients with nonmetastatic SCCHN met the entry criteria for analysis. The primary sites at initial diagnosis were oropharyngeal or laryngeal in most patients (66%). Median reirradiation dose was 60 Gy (range, 54-70 Gy). Acute toxicity included Grade 2 neutropenia (5%), Grade 3 neutropenia (15%), and Grade 1/2 thrombocytopenia (8%). No deaths occurred from hematologic toxicity. Chemotherapy doses held (50%) was more prevalent than radiation treatment break (8%). Sixty-eight percent of patients required a gastrostomy tube in follow-up. Significant late toxicity was experienced in 6 patients (16%): 1 tracheoesophageal fistula, 1 pharyngocutaneous fistula, 3 with osteoradionecrosis, and 1 patient with a lingual artery bleed. Patients treated with three-dimensional conformal RT had more frequent significant late toxicites than patients treated with intensity-modulated RT (44% and 7% respectively, p < 0.05). The median time to progression was 7 months and progression-free rates at 1, 2, and 5 years was 44%, 34%, and 29% respectively. The median overall survival was 16 months. Overall survival at 1, 3, and 5 years was 54

  8. Weekly Gemcitabine and Cisplatin in Combination With Radiotherapy in Patients With Locally Advanced Head-and-Neck Cancer: Phase I Study

    Energy Technology Data Exchange (ETDEWEB)

    Arruda Viani, Gustavo, E-mail: gusviani@gmail.com [Radiation Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil); Afonso, Sergio Luis [Clinical Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil); Cardoso Tavares, Vivian [Head and Neck Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil); Bernardes Godoi da Silva, Lucas; Stefano, Eduardo Jose [Radiation Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil)

    2011-11-15

    Purpose: To define the maximum tolerated dose by describing the dose-limiting toxicity (DLT) of weekly gemcitabine and cisplatin in patients with locally advanced head-and-neck (LAHN) cancer concomitant to irradiation. Methods and Materials: Patients with LAHN cancer were enrolled in a prospective, dose-escalation Phase I study. Toxicity was graded according to the Common Toxicity Criteria score. Maximum tolerated dose was defined when DLT developed in 2 of 6 patients. The starting dose of cisplatin was 20 mg/m{sup 2} and that of gemcitabine was 10 mg/m{sup 2} in 3 patients, with a subsequent dose escalation of 10 mg/m{sup 2} of cisplatin only for 3 new patients. In the next levels, only a dose escalation of gemcitabine with 10 mg/m{sup 2} for each new cohort was used (Level 1, 10 mg/m{sup 2} of gemcitabine and 20 mg/m{sup 2} of cisplatin; Level 2, 10 mg/m{sup 2} of gemcitabine and 30 mg/m{sup 2} of cisplatin; and Level 3, 20 mg/m{sup 2} of gemcitabine and 30 mg/m{sup 2} of cisplatin). Radiation therapy was administered by use of a conformal technique over a period of 6 to 7 weeks in 2.0-Gy daily fractions for 5 consecutive days per week to a total dose of 70 Gy. Results: From 2008 to 2009, 12 patients completing 3 dose levels were included in the study. At Dose Level 3, 1 of 3 patients had DLT with Grade 3 mucositis. Of the next 3 required patients, 2 showed DLT with Grade 3 dermatitis. At a follow-up of 3 months, 10 of 12 evaluable patients (83.3%) obtained a complete response and 1 patient (8.3%) obtained a partial response. Among the complete responders, at a median follow-up of 10 months (range, 6-14 months), 9 patients are alive and disease free. Conclusion: Gemcitabine at low doses combined with cisplatin is a potent radiosensitizer effective in patients with LAHN cancer. The recommended Phase II dose is 10 mg/m{sup 2} of gemcitabine and 30 mg/m{sup 2} of cisplatin with an acceptable tolerability profile.

  9. A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck

    International Nuclear Information System (INIS)

    Budach, W; Hehr, T; Budach, V; Belka, C; Dietz, K

    2006-01-01

    Former meta-analyses have shown a survival benefit for the addition of chemotherapy (CHX) to radiotherapy (RT) and to some extent also for the use of hyperfractionated radiation therapy (HFRT) and accelerated radiation therapy (AFRT) in locally advanced squamous cell carcinoma (SCC) of the head and neck. However, the publication of new studies and the fact that many older studies that were included in these former meta-analyses used obsolete radiation doses, CHX schedules or study designs prompted us to carry out a new analysis using strict inclusion criteria. Randomised trials testing curatively intended RT (≥60 Gy in >4 weeks/>50 Gy in <4 weeks) on SCC of the oral cavity, oropharynx, hypopharynx, and larynx published as full paper or in abstract form between 1975 and 2003 were eligible. Trials comparing RT alone with concurrent or alternating chemoradiation (5-fluorouracil (5-FU), cisplatin, carboplatin, mitomycin C) were analyzed according to the employed radiation schedule and the used CHX regimen. Studies comparing conventionally fractionated radiotherapy (CFRT) with either HFRT or AFRT without CHX were separately examined. End point of the meta-analysis was overall survival. Thirty-two trials with a total of 10 225 patients were included into the meta-analysis. An overall survival benefit of 12.0 months was observed for the addition of simultaneous CHX to either CFRT or HFRT/AFRT (p < 0.001). Separate analyses by cytostatic drug indicate a prolongation of survival of 24.0 months, 16.8 months, 6.7 months, and 4.0 months, respectively, for the simultaneous administration of 5-FU, cisplatin-based, carboplatin-based, and mitomycin C-based CHX to RT (each p < 0.01). Whereas no significant gain in overall survival was observed for AFRT in comparison to CFRT, a substantial prolongation of median survival (14.2 months, p < 0.001) was seen for HFRT compared to CFRT (both without CHX). RT combined with simultaneous 5-FU, cisplatin, carboplatin, and mitomycin C as

  10. Prospective, longitudinal, multi-modal functional imaging for radical chemo-IMRT treatment of locally advanced head and neck cancer: the INSIGHT study

    International Nuclear Information System (INIS)

    Welsh, Liam; Panek, Rafal; McQuaid, Dualta; Dunlop, Alex; Schmidt, Maria; Riddell, Angela; Koh, Dow-Mu; Doran, Simon; Murray, Iain; Du, Yong; Chua, Sue; Hansen, Vibeke; Wong, Kee H.; Dean, Jamie; Gulliford, Sarah; Bhide, Shreerang; Leach, Martin O.; Nutting, Christopher; Harrington, Kevin; Newbold, Kate

    2015-01-01

    Radical chemo-radiotherapy (CRT) is an effective organ-sparing treatment option for patients with locally advanced head and neck cancer (LAHNC). Despite advances in treatment for LAHNC, a significant minority of these patients continue to fail to achieve complete response with standard CRT. By constructing a multi-modality functional imaging (FI) predictive biomarker for CRT outcome for patients with LAHNC we hope to be able to reliably identify those patients at high risk of failing standard CRT. Such a biomarker would in future enable CRT to be tailored to the specific biological characteristics of each patients’ tumour, potentially leading to improved treatment outcomes. The INSIGHT study is a single-centre, prospective, longitudinal multi-modality imaging study using functional MRI and FDG-PET/CT for patients with LAHNC squamous cell carcinomas receiving radical CRT. Two cohorts of patients are being recruited: one treated with, and another treated without, induction chemotherapy. All patients receive radical intensity modulated radiotherapy with concurrent chemotherapy. Patients undergo functional imaging before, during and 3 months after completion of radiotherapy, as well as at the time of relapse, should that occur within the first two years after treatment. Serum samples are collected from patients at the same time points as the FI scans for analysis of a panel of serum markers of tumour hypoxia. The primary aim of the INSIGHT study is to acquire a prospective multi-parametric longitudinal data set comprising functional MRI, FDG PET/CT, and serum biomarker data from patients with LAHNC undergoing primary radical CRT. This data set will be used to construct a predictive imaging biomarker for outcome after CRT for LAHNC. This predictive imaging biomarker will be used in future studies of functional imaging based treatment stratification for patients with LAHNC. Additional objectives are: defining the reproducibility of FI parameters; determining robust

  11. Fractionated Boron Neutron Capture Therapy in Locally Recurrent Head and Neck Cancer: A Prospective Phase I/II Trial

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Ling-Wei, E-mail: lwwang@vghtpe.gov.tw [Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan (China); National Yang-Ming University, Taiwan (China); Chen, Yi-Wei [Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan (China); National Yang-Ming University, Taiwan (China); Ho, Ching-Yin [National Yang-Ming University, Taiwan (China); Department of Otolaryngology, Taipei Veterans General Hospital, Taiwan (China); Hsueh Liu, Yen-Wan [Institute of Nuclear Engineering and Science, National Tsing Hua University, Taiwan (China); Chou, Fong-In [Institute of Nuclear Engineering and Science, National Tsing Hua University, Taiwan (China); Nuclear Science and Technology Development Center, National Tsing Hua University, Taiwan (China); Liu, Yuan-Hao [Nuclear Science and Engineering Department, Nanjing University of Aeronautics and Astronautics, Nanjing (China); Liu, Hong-Ming; Peir, Jinn-Jer [Nuclear Science and Technology Development Center, National Tsing Hua University, Taiwan (China); Jiang, Shiang-Huei [Institute of Nuclear Engineering and Science, National Tsing Hua University, Taiwan (China); Chang, Chi-Wei [National Yang-Ming University, Taiwan (China); Department of Nuclear Medicine, Taipei Veterans General Hospital, Taiwan (China); Liu, Ching-Sheng [Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan (China); National Yang-Ming University, Taiwan (China); Lin, Ko-Han [Taoyuan Veterans Hospital, Taiwan (China); Wang, Shyh-Jen [National Yang-Ming University, Taiwan (China); Department of Nuclear Medicine, Taipei Veterans General Hospital, Taiwan (China); Chu, Pen-Yuan [National Yang-Ming University, Taiwan (China); Department of Otolaryngology, Taipei Veterans General Hospital, Taiwan (China); Lo, Wen-Liang; Kao, Shou-Yen [National Yang-Ming University, Taiwan (China); Department of Stomatology, Taipei Veterans General Hospital, Taiwan (China); and others

    2016-05-01

    Purpose: To investigate the efficacy and safety of fractionated boron neutron capture therapy (BNCT) for recurrent head and neck (H&N) cancer after photon radiation therapy. Methods and Materials: In this prospective phase 1/2 trial, 2-fraction BNCT with intravenous L-boronophenylalanine (L-BPA, 400 mg/kg) was administered at a 28-day interval. Before each fraction, fluorine-18-labeled-BPA–positron emission tomography was conducted to determine the tumor/normal tissue ratio of an individual tumor. The prescription dose (D80) of 20 Gy-Eq per fraction was selected to cover 80% of the gross tumor volume by using a dose volume histogram, while minimizing the volume of oral mucosa receiving >10 Gy-Eq. Tumor responses and adverse effects were assessed using the Response Evaluation Criteria in Solid Tumors v1.1 and the Common Terminology Criteria for Adverse Events v3.0, respectively. Results: Seventeen patients with a previous cumulative radiation dose of 63-165 Gy were enrolled. All but 2 participants received 2 fractions of BNCT. The median tumor/normal tissue ratio was 3.4 for the first fraction and 2.5 for the second, whereas the median D80 for the first and second fraction was 19.8 and 14.6 Gy-Eq, respectively. After a median follow-up period of 19.7 months (range, 5.2-52 mo), 6 participants exhibited a complete response and 6 exhibited a partial response. Regarding acute toxicity, 5 participants showed grade 3 mucositis and 1 participant showed grade 4 laryngeal edema and carotid hemorrhage. Regarding late toxicity, 2 participants exhibited grade 3 cranial neuropathy. Four of six participants (67%) receiving total D80 > 40 Gy-Eq had a complete response. Two-year overall survival was 47%. Two-year locoregional control was 28%. Conclusions: Our results suggested that 2-fraction BNCT with adaptive dose prescription was effective and safe in locally recurrent H&N cancer. Modifications to our protocol may yield more satisfactory results in the future.

  12. Head Lice

    Science.gov (United States)

    ... nits. You should also use hot water to wash any bed linens, towels, and clothing recently worn by the person who had head lice. Vacuum anything that can’t be washed, such as the couch, carpets, your child’s car seat, and any stuffed animals. Because head lice ...

  13. Photogrammetry-Based Head Digitization for Rapid and Accurate Localization of EEG Electrodes and MEG Fiducial Markers Using a Single Digital SLR Camera.

    Science.gov (United States)

    Clausner, Tommy; Dalal, Sarang S; Crespo-García, Maité

    2017-01-01

    The performance of EEG source reconstruction has benefited from the increasing use of advanced head modeling techniques that take advantage of MRI together with the precise positions of the recording electrodes. The prevailing technique for registering EEG electrode coordinates involves electromagnetic digitization. However, the procedure adds several minutes to experiment preparation and typical digitizers may not be accurate enough for optimal source reconstruction performance (Dalal et al., 2014). Here, we present a rapid, accurate, and cost-effective alternative method to register EEG electrode positions, using a single digital SLR camera, photogrammetry software, and computer vision techniques implemented in our open-source toolbox, janus3D . Our approach uses photogrammetry to construct 3D models from multiple photographs of the participant's head wearing the EEG electrode cap. Electrodes are detected automatically or semi-automatically using a template. The rigid facial features from these photo-based models are then surface-matched to MRI-based head reconstructions to facilitate coregistration to MRI space. This method yields a final electrode coregistration error of 0.8 mm, while a standard technique using an electromagnetic digitizer yielded an error of 6.1 mm. The technique furthermore reduces preparation time, and could be extended to a multi-camera array, which would make the procedure virtually instantaneous. In addition to EEG, the technique could likewise capture the position of the fiducial markers used in magnetoencephalography systems to register head position.

  14. Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer. Results of a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Tribius, Silke; Raguse, Marieclaire; Voigt, Christian; Petersen, Cordula; Kruell, Andreas [University Medical Center Hamburg-Eppendorf, Department of Radiation Oncology, Hamburg (Germany); Muenscher, Adrian [University Medical Center Hamburg-Eppendorf, Department of Otorhinolaryngology and Head and Neck Surgery, Hamburg (Germany); Groebe, Alexander [University Medical Center Hamburg-Eppendorf, Department of Maxillofacial Surgery, Hamburg (Germany); Bergelt, Corinna [University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg (Germany); Singer, Susanne [University Medical Center Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz (Germany)

    2015-03-08

    Patients with locally advanced head and neck cancer (LAHNC) undergo life-changing treatments that can seriously affect quality of life (QoL). This prospective study examined the key QoL domains during the first year after intensity-modulated radiotherapy (IMRT) and identified predictors of these changes in order to improve patient outcomes. A consecutive series of patients with LAHNC completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core module (QLQ-C30) and the HNC-specific QLQ-HN35 before (t0) and at the end (t1) of definitive or adjuvant IMRT, then at 6-8 weeks (t2), 6 months (t3), and 1 year (t4) after IMRT. Patients (n = 111) completing questionnaires at all five time points were included (baseline response rate: 99 %; dropout rate between t0 and t4: 5 %). QoL deteriorated in all domains during IMRT and improved slowly during the first year thereafter. Many domains recovered to baseline values after 1 year but problems with smelling and tasting, dry mouth, and sticky saliva remained issues at this time. Increases in problems with sticky saliva were greater after 1 year in patients with definitive versus adjuvant IMRT (F = 3.5, P = 0.05). QoL in patients with LAHNC receiving IMRT takes approximately 1 year to return to baseline; some domains remain compromised after 1 year. Although IMRT aims to maintain function and QoL, patients experience long-term dry mouth and sticky saliva, particularly following definitive IMRT. Patients should be counseled at the start of therapy to reduce disappointment with the pace of recovery. (orig.) [German] Die Therapie von Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren (LFKHT) geht mit einschneidenden Veraenderungen einher und beeinflusst die Lebensqualitaet (LQ) erheblich. Diese prospektive Studie untersucht die LQ waehrend des ersten Jahres nach intensitaetsmodulierter Strahlentherapie (IMRT) und hat Praediktoren dieser Veraenderungen herausgearbeitet, um

  15. Prognostic role of metabolic parameters of {sup 18}F-FDG PET-CT scan performed during radiation therapy in locally advanced head and neck squamous cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Min, Myo; Forstner, Dion [Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); University of New South Wales, Sydney, NSW (Australia); Ingham Institute of Applied Medical Research, Liverpool, NSW (Australia); Lin, Peter; Shon, Ivan Ho; Lin, Michael [University of New South Wales, Sydney, NSW (Australia); Liverpool Hospital, Department of Nuclear Medicine and Positron Emission Tomography, Liverpool, NSW (Australia); University of Western Sydney, Sydney, NSW (Australia); Lee, Mark T. [Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); University of New South Wales, Sydney, NSW (Australia); Bray, Victoria; Fowler, Allan [Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); Chicco, Andrew [Liverpool Hospital, Department of Nuclear Medicine and Positron Emission Tomography, Liverpool, NSW (Australia); Tieu, Minh Thi [Calvary Mater Newcastle, Department of Radiation Oncology, Newcastle, NSW (Australia); University of Newcastle, Newcastle, NSW (Australia)

    2015-12-15

    To evaluate the prognostic value of {sup 18}F-FDG PET-CT performed in the third week (iPET) of definitive radiation therapy (RT) in patients with newly diagnosed locally advanced mucosal primary head and neck squamous-cell-carcinoma (MPHNSCC). Seventy-two patients with MPHNSCC treated with radical RT underwent staging PET-CT and iPET. The maximum standardised uptake value (SUV{sub max}), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of primary tumour (PT) and index node (IN) [defined as lymph node(s) with highest TLG] were analysed, and results were correlated with loco-regional recurrence-free survival (LRFS), disease-free survival (DFS), metastatic failure-free survival(MFFS) and overall survival (OS), using Kaplan-Meier analysis. Optimal cutoffs (OC) were derived from receiver operating characteristic curves: SUV{sub max-PT} = 4.25 g/mL, MTV{sub PT} = 3.3 cm{sup 3}, TLG{sub PT} = 9.4 g, for PT, and SUV{sub max-IN} = 4.05 g/mL, MTV{sub IN} = 1.85 cm{sup 3} and TLG{sub IN} = 7.95 g for IN. Low metabolic values in iPET for PT below OC were associated with statistically significant better LRFS and DFS. TLG was the best predictor of outcome with 2-year LRFS of 92.7 % vs. 71.1 % [p = 0.005, compared with SUV{sub max} (p = 0.03) and MTV (p = 0.022)], DFS of 85.9 % vs. 60.8 % [p = 0.005, compared with SUV{sub max} (p = 0.025) and MTV (p = 0.018)], MFFS of 85.9 % vs. 83.7 % [p = 0.488, compared with SUV{sub max} (p = 0.52) and MTV (p = 0.436)], and OS of 81.1 % vs. 75.0 % [p = 0.279, compared with SUV{sub max} (p = 0.345) and MTV (p = 0.512)]. There were no significant associations between the percentage reduction of primary tumour metabolic parameters and outcomes. In patients with nodal disease, metabolic parameters below OC (for both PT and IN) were significantly associated with all oncological outcomes, while TLG was again the best predictor: LRFS of 84.0 % vs. 55.3 % (p = 0.017), DFS of 79.4 % vs. 38.6 % (p = 0.001), MFFS 86.4 % vs. 68.2 % (p = 0

  16. A phase I study of cabazitaxel in combination with platinum and 5-fluorouracil (PF) in locally advanced squamous cell carcinoma of head and neck (LA-SCCHN).

    Science.gov (United States)

    Camille, Nadia; Rozehnal, John; Roy, Elizabeth; Uczkowski, Dariusz; Olson, Ashely; Genden, Eric; Teng, Marita; Bakst, Richard; Gupta, Vishal; Posner, Marshall; Misiukiewicz, Krzysztof

    2017-08-01

    There is a clinical need to improve outcomes for patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN), especially in Human Papilloma Virus (HPV) negative and HPV positive subtypes with a significant history of tobacco use. In animal models bearing SCCHN, Cabazitaxel showed an excellent response rate compared to docetaxel and might prove useful in treatment of patients. The primary objective of this study was to determine the dose-limiting toxicity (DLT) and maximum tolerated dose (MTD) of cabazitaxel when combined with cisplatin and 5-fluorouracil (PF) in induction chemotherapy (IC) for patients with SCCHN. Cabazitaxel-PF IC administered in 3 cycles (each 21 days) followed by concurrent chemoradiation (CRT) or surgery has been evaluated to assess overall response rate (ORR) and progression-free survival (PFS) in this population. This phase I study employed a standard 3+3 design. DLT was defined as grade 4 or 5 toxicity or grade 3 toxicity lasting >7days. Out of 40 consented patients with stage IV, curable, previously untreated, LA-SCHHN and poor prognosis, 35 (32M, 3F) were enrolled and evaluated for toxicity: 19 oropharynx, 10 larynx, 2 oral cancer, 1 nasopharynx and 3 hypopharynx. Five dose levels of cabazitaxel (10, 12.5, 15, 17.5 and 20mg/m 2 ) were tested in combination with cisplatin 100mg/m 2 and 5-fluorouracil (5-FU) 800mg/m 2 /d×4days. Dose escalation for cabazitaxel was terminated upon the occurrences of 2 DLTs and the establishment of MTD. Cabazitaxel was then further escalated with cisplatin 75mg/m 2 and 5-FU 800mg/m 2 /d×4days in the subsequent 3 dose levels (17.5, 20 and 22.5mg/m 2 ). In the expansion cohort, 9 patients were enrolled at the 22.5mg/m 2 dose level. Following 3 cycles of IC, patients were evaluated for clinical, radiographic, and pathologic response to cabazitaxel-PF before beginning CRT or surgery. There were two DLTs (grade 4 hyperuricemia; neutropenic fever, sepsis, and grade 4 thrombocytopenia

  17. Head Injuries

    Science.gov (United States)

    ... a severe blow to the head can still knock the brain into the side of the skull ... following certain precautions and taking a break from sports and other activities that make symptoms worse. Playing ...

  18. The Anatomical Biological Value on Pretreatment (18)F-fluorodeoxyglucose Positron Emission Tomography Computed Tomography Predicts Response and Survival in Locally Advanced Head and Neck Cancer.

    Science.gov (United States)

    Ashamalla, Hani; Mattes, Malcolm; Guirguis, Adel; Zaidi, Arifa; Mokhtar, Bahaa; Tejwani, Ajay

    2014-05-01

    (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has become increasingly relevant in the staging of head and neck cancers, but its prognostic value is controversial. The objective of this study was to evaluate different PET/CT parameters for their ability to predict response to therapy and survival in patients treated for head and neck cancer. A total of 28 consecutive patients with a variety of newly diagnosed head and neck cancers underwent PET/CT scanning at our institution before initiating definitive radiation therapy. All underwent a posttreatment PET/CT to gauge tumor response. Pretreatment PET/CT parameters calculated include the standardized uptake value (SUV) and the anatomical biological value (ABV), which is the product of SUV and greatest tumor diameter. Maximum and mean values were studied for both SUV and ABV, and correlated with response rate and survival. The mean pretreatment tumor ABVmax decreased from 35.5 to 7.9 (P = 0.0001). Of the parameters tested, only pretreatment ABVmax was significantly different among those patients with a complete response (CR) and incomplete response (22.8 vs. 65, respectively, P = 0.021). This difference was maximized at a cut-off ABVmax of 30 and those patients with ABVmax < 30 were significantly more likely to have a CR compared to those with ABVmax of ≥ 30 (93.8% vs. 50%, respectively, P = 0.023). The 5-year overall survival was 80% compared to 36%, respectively, (P = 0.028). Multivariate analysis confirmed that ABVmax was an independent prognostic factor. Our data supports the use of PET/CT, and specifically ABVmax, as a prognostic factor in head and neck cancer. Patients who have an ABVmax ≥ 30 were more likely to have a poor outcome with chemoradiation alone, and a more aggressive trimodality approach may be indicated in these patients.

  19. Robust extraction of baseline signal of atmospheric trace species using local regression

    Science.gov (United States)

    Ruckstuhl, A. F.; Henne, S.; Reimann, S.; Steinbacher, M.; Vollmer, M. K.; O'Doherty, S.; Buchmann, B.; Hueglin, C.

    2012-11-01

    The identification of atmospheric trace species measurements that are representative of well-mixed background air masses is required for monitoring atmospheric composition change at background sites. We present a statistical method based on robust local regression that is well suited for the selection of background measurements and the estimation of associated baseline curves. The bootstrap technique is applied to calculate the uncertainty in the resulting baseline curve. The non-parametric nature of the proposed approach makes it a very flexible data filtering method. Application to carbon monoxide (CO) measured from 1996 to 2009 at the high-alpine site Jungfraujoch (Switzerland, 3580 m a.s.l.), and to measurements of 1,1-difluoroethane (HFC-152a) from Jungfraujoch (2000 to 2009) and Mace Head (Ireland, 1995 to 2009) demonstrates the feasibility and usefulness of the proposed approach. The determined average annual change of CO at Jungfraujoch for the 1996 to 2009 period as estimated from filtered annual mean CO concentrations is -2.2 ± 1.1 ppb yr-1. For comparison, the linear trend of unfiltered CO measurements at Jungfraujoch for this time period is -2.9 ± 1.3 ppb yr-1.

  20. Robust extraction of baseline signal of atmospheric trace species using local regression

    Directory of Open Access Journals (Sweden)

    A. F. Ruckstuhl

    2012-11-01

    Full Text Available The identification of atmospheric trace species measurements that are representative of well-mixed background air masses is required for monitoring atmospheric composition change at background sites. We present a statistical method based on robust local regression that is well suited for the selection of background measurements and the estimation of associated baseline curves. The bootstrap technique is applied to calculate the uncertainty in the resulting baseline curve. The non-parametric nature of the proposed approach makes it a very flexible data filtering method. Application to carbon monoxide (CO measured from 1996 to 2009 at the high-alpine site Jungfraujoch (Switzerland, 3580 m a.s.l., and to measurements of 1,1-difluoroethane (HFC-152a from Jungfraujoch (2000 to 2009 and Mace Head (Ireland, 1995 to 2009 demonstrates the feasibility and usefulness of the proposed approach.

    The determined average annual change of CO at Jungfraujoch for the 1996 to 2009 period as estimated from filtered annual mean CO concentrations is −2.2 ± 1.1 ppb yr−1. For comparison, the linear trend of unfiltered CO measurements at Jungfraujoch for this time period is −2.9 ± 1.3 ppb yr−1.

  1. Evaluation of the prognostic role of tumor cell podoplanin expression in locally advanced squamous cell carcinoma of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Huttenlocher, Stefan; Seibold, Nina D.; Rades, Dirk [University of Luebeck, Department of Radiation Oncology, Luebeck (Germany); Gebhard, Maximilian P.; Noack, Frank; Thorns, Christoph [University of Luebeck, Institute of Pathology, Luebeck (Germany); Hasselbacher, Katrin; Wollenberg, Barbara [University of Luebeck, Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Luebeck (Germany); Schild, Steven E. [Mayo Clinic Scottsdalel, Department of Radiation Oncology, Phoenix, AZ (United States)

    2014-11-15

    To investigate the potential prognostic role of tumor cell podoplanin expression in patients treated with resection followed by irradiation or chemoradiotherapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN). Podoplanin expression (≤10 % versus > 10 %) and 12 other factors were evaluated in 160 patients for their association with locoregional control (LRC), metastases-free (MFS) and overall survival (OS). Other factors were age, gender, Eastern Cooperative Oncology Group (ECOG) performance status, preradiotherapy (pre-RT) hemoglobin level, tumor site, histological grading, T category, N category, American Joint Committee on Cancer (AJCC) stage, human papillomavirus (HPV) status, extent of resection and concurrent chemotherapy. In multivariate analysis, ECOG performance status 0-1 (risk ratio, RR: 3.01; 95 % confidence interval, CI: 1.42-7.14; p = 0.003), pre-RT hemoglobin levels ≥ 7.45 mmol/l (12 g/dl; RR: 2.03; 95 % CI: 1.04-3.94; p = 0.038), oropharyngeal cancer (RR: 1.25; 95 % CI: 1.01-1.55; p = 0.038) and T category T1-2 (RR: 1.81; 95 % CI: 1.24-2.79; p = 0.002) were significantly associated with improved LRC. T category T1-2 (RR: 1.90; 95 % CI: 1.25-3.06; p = 0.002) and N category N0-2a (RR: 5.22; 95 % CI: 1.96-18.09; p < 0.001) were significantly associated with better MFS. Pre-RT hemoglobin levels ≥ 7.45 mmol/l (RR: 2.44; 95 % CI: 1.27-4.74; p = 0.007), T category T1-2 (RR: 1.97; 95 % CI: 1.36-3.04; p < 0.001) and N category N0-2a (RR: 2.87; 95 % CI: 1.37-6.61; p = 0.005) were significantly associated with improved OS. Podoplanin expression ≤ 10 % showed a trend towards improved OS on both univariate (p = 0.050) and multivariate analysis (RR: 1.86; 95 % CI: 0.96-3.59; p = 0.07). Treatment outcomes were significantly associated with performance status, pre-RT hemoglobin level, tumor site and tumor stage. Tumor cell expression of podoplanin ≤ 10 % showed a trend towards improved OS when compared to podoplanin expression of

  2. Locally Advanced Stage IV Squamous Cell Carcinoma of the Head and Neck: Impact of Pre-Radiotherapy Hemoglobin Level and Interruptions During Radiotherapy

    International Nuclear Information System (INIS)

    Rades, Dirk; Stoehr, Monika; Kazic, Nadja; Hakim, Samer G.; Walz, Annette; Schild, Steven E.; Dunst, Juergen

    2008-01-01

    Purpose: Stage IV head and neck cancer patients carry a poor prognosis. Clear understanding of prognostic factors can help to optimize care for the individual patient. This study investigated 11 potential prognostic factors including pre-radiotherapy hemoglobin level and interruptions during radiotherapy for overall survival (OS), metastases-free survival (MFS), and locoregional control (LC) after radiochemotherapy. Methods and Materials: Eleven factors were investigated in 153 patients receiving radiochemotherapy for Stage IV squamous cell head and neck cancer: age, gender, Karnofsky performance score (KPS), tumor site, grading, T stage, N stage, pre-radiotherapy hemoglobin level, surgery, chemotherapy type, and interruptions during radiotherapy >1 week. Results: On multivariate analysis, improved OS was associated with KPS 90-100 (relative risk [RR], 2.36; 95% confidence interval [CI], 1.20-4.93; p = .012), hemoglobin ≥12 g/dL (RR, 1.88; 95% CI, 1.01-3.53; p = .048), and no radiotherapy interruptions (RR, 2.59; 95% CI, 1.15-5.78; p = .021). Improved LC was significantly associated with lower T stage (RR, 2.17; 95% CI, 1.16-4.63; p = .013), hemoglobin ≥12 g/dL (RR, 4.12; 95% CI, 1.92-9.09; p 1 week. It appears important to avoid anemia and radiotherapy interruptions to achieve the best treatment results

  3. Head Start.

    Science.gov (United States)

    Greenman, Geri

    2000-01-01

    Discusses an art project in which students created drawings of mop heads. Explains that the approach of drawing was more important than the subject. States that the students used the chiaroscuro technique, used by Rembrandt and Caravaggio, in which light appears out of the darkness. (CMK)

  4. Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis

    Energy Technology Data Exchange (ETDEWEB)

    Cacicedo, Jon; Bilbao, Pedro [Cruces University Hospital, Radiation Oncology Department, Barakaldo, Bizkaia (Basque Country) (Spain); BioCruces Health Research Institute, Bizkaia, Basque Country (Spain); Fernandez, Iratxe [Cruces University Hospital, Nuclear Medicine Department, Barakaldo (Spain); Hoyo, Olga del; Hortelano, Eduardo [Cruces University Hospital, Radiation Oncology Department, Barakaldo, Bizkaia (Basque Country) (Spain); Dolado, Ainara [Cruces University Hospital, Radiodiagnostic and Medical Imaging Department, Barakaldo (Spain); Gomez-Suarez, Javier [Cruces University Hospital, Otolaryngology Department, Barakaldo (Spain); Sancho, Aintzane [Cruces University Hospital, Medical Oncology Department, Barakaldo (Spain); Pijoan, Jose I. [BioCruces Health Research Institute, Bizkaia, Basque Country (Spain); Cruces University Hospital, Clinical Epidemiology Unit, Barakaldo (Spain); CIBER de Epidemiologia y Salud Publica (CIBERESP), Madrid (Spain); Alvarez, Julio [Cruces University Hospital, Oral and Maxillofacial Surgery Department, Barakaldo (Spain); Espinosa, Jose M. [Cruces University Hospital, Medical Physics Department, Barakaldo (Spain); Gaafar, Ayman [Cruces University Hospital, Department of Pathology, Barakaldo (Spain)

    2015-08-15

    The objective of this study was to determine the incremental staging information provided by positron emission tomography/computed tomography (PET/CT) and its impact on management plans in patients with untreated stage III-IV head and neck squamous cell carcinoma (HNSCC). We prospectively studied, between September 2011 and February 2013, 84 consecutive patients [median age 63.5 years (39-84); 73 men] with histologically confirmed HNSCC. First, based on a conventional work-up (physical examination, CT imaging of the head, neck and chest), the multidisciplinary Head and Neck Tumour Board documented the TNM stage and a management plan for each patient, outlining the modalities to be used, including surgery, radiation therapy (RT), chemotherapy or a combination. After release of the PET/CT results, new TNM staging and management plans were agreed on by the multidisciplinary Tumour Board. Any changes in stage or intended management due to the PET/CT findings were then analysed. The impact on patient management was classified as: low (treatment modality, delivery and intent unchanged), moderate (change within the same treatment modality: type of surgery, radiation technique/dose) or high (change in treatment intent and/or treatment modality → curative to palliative, or surgery to chemoradiation or detection of unknown primary tumour or a synchronous second primary tumour). TNM stage was validated by histopathological analysis, additional imaging or follow-up. Accuracy of the conventional and PET/CT-based staging was compared using McNemar's test. Conventional and PET/CT stages were discordant in 32/84 (38 %) cases: the T stage in 2/32 (6.2 %), the N stage in 21/32 (65.7 %) and the M stage 9/32 (28.1 %). Patient management was altered in 22/84 (26 %) patients, with a moderate impact in 8 (9.5 %) patients and high impact in 14 (16.6 %) patients. PET/CT TNM classification was significantly more accurate (92.5 vs 73.7 %) than conventional staging with a p value < 0

  5. Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis

    International Nuclear Information System (INIS)

    Cacicedo, Jon; Bilbao, Pedro; Fernandez, Iratxe; Hoyo, Olga del; Hortelano, Eduardo; Dolado, Ainara; Gomez-Suarez, Javier; Sancho, Aintzane; Pijoan, Jose I.; Alvarez, Julio; Espinosa, Jose M.; Gaafar, Ayman

    2015-01-01

    The objective of this study was to determine the incremental staging information provided by positron emission tomography/computed tomography (PET/CT) and its impact on management plans in patients with untreated stage III-IV head and neck squamous cell carcinoma (HNSCC). We prospectively studied, between September 2011 and February 2013, 84 consecutive patients [median age 63.5 years (39-84); 73 men] with histologically confirmed HNSCC. First, based on a conventional work-up (physical examination, CT imaging of the head, neck and chest), the multidisciplinary Head and Neck Tumour Board documented the TNM stage and a management plan for each patient, outlining the modalities to be used, including surgery, radiation therapy (RT), chemotherapy or a combination. After release of the PET/CT results, new TNM staging and management plans were agreed on by the multidisciplinary Tumour Board. Any changes in stage or intended management due to the PET/CT findings were then analysed. The impact on patient management was classified as: low (treatment modality, delivery and intent unchanged), moderate (change within the same treatment modality: type of surgery, radiation technique/dose) or high (change in treatment intent and/or treatment modality → curative to palliative, or surgery to chemoradiation or detection of unknown primary tumour or a synchronous second primary tumour). TNM stage was validated by histopathological analysis, additional imaging or follow-up. Accuracy of the conventional and PET/CT-based staging was compared using McNemar's test. Conventional and PET/CT stages were discordant in 32/84 (38 %) cases: the T stage in 2/32 (6.2 %), the N stage in 21/32 (65.7 %) and the M stage 9/32 (28.1 %). Patient management was altered in 22/84 (26 %) patients, with a moderate impact in 8 (9.5 %) patients and high impact in 14 (16.6 %) patients. PET/CT TNM classification was significantly more accurate (92.5 vs 73.7 %) than conventional staging with a p value < 0

  6. Experimental analysis of considering the sound pressure distribution pattern at the ear canal entrance as an unrevealed head-related localization clue

    Institute of Scientific and Technical Information of China (English)

    TONG Xin; QI Na; MENG Zihou

    2018-01-01

    By analyzing the differences between binaural recording and real listening,it was deduced that there were some unrevealed auditory localization clues,and the sound pressure distribution pattern at the entrance of ear canal was probably a clue.It was proved through the listening test that the unrevealed auditory localization clues really exist with the reduction to absurdity.And the effective frequency bands of the unrevealed localization clues were induced and summed.The result of finite element based simulations showed that the pressure distribution at the entrance of ear canal was non-uniform,and the pattern was related to the direction of sound source.And it was proved that the sound pressure distribution pattern at the entrance of the ear canal carried the sound source direction information and could be used as an unrevealed localization cluc.The frequency bands in which the sound pressure distribution patterns had significant differences between front and back sound source directions were roughly matched with the effective frequency bands of unrevealed localization clues obtained from the listening tests.To some extent,it supports the hypothesis that the sound pressure distribution pattern could be a kind of unrevealed auditory localization clues.

  7. AHP 47: YELLOW-HEAD HORSE

    Directory of Open Access Journals (Sweden)

    Sangs rgyas bkra shis སངས་རྒྱས་བཀྲ་ཤིས།

    2017-04-01

    Full Text Available My family had a stallion we called Rta mgo ser 'Yellow-Head Horse'. Father and two of his brothers occasionally rode it. Father said that Yellow-Head was very wild when it was taken to join local horseraces. I didn't believe that because Yellow-Head was very gentle when Mother rode it to the local monastery and also when I rode it.

  8. TU-D-207B-03: Early Assessment of Response to Chemoradiotherapy Based On Textural Analysis of Pre and Mid-Treatment FDG-PET Image in Locally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Y; Pollom, E; Loo, B; Le, Q; Hara, W; Li, R [Stanford University, Palo Alto, CA (United States)

    2016-06-15

    Purpose: To evaluate whether tumor textural features extracted from both pre- and mid-treatment FDG-PET images predict early response to chemoradiotherapy in locally advanced head and neck cancer, and investigate whether they provide complementary value to conventional volume-based measurements. Methods: Ninety-four patients with locally advanced head and neck cancers were retrospectively studied. All patients received definitive chemoradiotherapy and underwent FDG-PET planning scans both before and during treatment. Within the primary tumor we extracted 6 textural features based on gray-level co-occurrence matrices (GLCM): entropy, dissimilarity, contrast, correlation, energy, and homogeneity. These image features were evaluated for their predictive power of treatment response to chemoradiotherapy in terms of local recurrence free survival (LRFS) and progression free survival (PFS). Logrank test were used to assess the statistical significance of the stratification between low- and high-risk groups. P-values were adjusted for multiple comparisons by the false discovery rate (FDR) method. Results: All six textural features extracted from pre-treatment PET images significantly differentiated low- and high-risk patient groups for LRFS (P=0.011–0.038) and PFS (P=0.029–0.034). On the other hand, none of the textural features on mid-treatment PET images was statistically significant in stratifying LRFS (P=0.212–0.445) or PFS (P=0.168–0.299). An imaging signature that combines textural feature (GLCM homogeneity) and metabolic tumor volume showed an improved performance for predicting LRFS (hazard ratio: 22.8, P<0.0001) and PFS (hazard ratio: 13.9, P=0.0005) in leave-one-out cross validation. Intra-tumor heterogeneity measured by textural features was significantly lower in mid-treatment PET images than in pre-treatment PET images (T-test: P<1.4e-6). Conclusion: Tumor textural features on pretreatment FDG-PET images are predictive for response to chemoradiotherapy

  9. Primary Tumor Volume Is an Important Predictor of Clinical Outcomes Among Patients With Locally Advanced Squamous Cell Cancer of the Head and Neck Treated With Definitive Chemoradiotherapy

    International Nuclear Information System (INIS)

    Strongin, Anna; Yovino, Susannah; Taylor, Rodney; Wolf, Jeffrey; Cullen, Kevin; Zimrin, Ann; Strome, Scott; Regine, William; Suntharalingam, Mohan

    2012-01-01

    Purpose: The tumor volume has been established as a significant predictor of outcomes among patients with head-and-neck cancer undergoing radiotherapy alone. The present study attempted to add to the existing data on tumor volume as a prognostic factor among patients undergoing chemoradiotherapy. Methods and Materials: A total of 78 patients who had undergone definitive chemoradiotherapy for Stage III-IV squamous cell cancer of the hypopharynx, oropharynx, and larynx were identified. The primary tumor volumes were calculated from the treatment planning computed tomography scans, and these were correlated to the survival and tumor control data obtained from the retrospective analysis. Results: The interval to progression correlated with the primary tumor volume (p = .007). The critical cutoff point for the tumor volume was identified as 35 cm 3 , and patients with a tumor volume 3 had a significantly better prognosis than those with a tumor volume >35 cm 3 at 5 years (43% vs. 71%, p = .010). Longer survival was also correlated with smaller primary tumor volumes (p = .022). Similarly, patients with a primary tumor volume 3 had a better prognosis in terms of both progression-free survival (61% vs. 33%, p = .004) and overall survival (84% vs. 41%, p = 3 larger than tumors without locoregional failure (p = .028) and 27.1-cm 3 larger than tumors that recurred as distant metastases (p = .020). Conclusion: The results of our study have shown that the primary tumor volume is a significant prognostic factor in patients with advanced cancer of the head and neck undergoing definitive chemoradiotherapy and correlated with the treatment outcomes better than the T or N stage.

  10. Evaluation of suspected local recurrence in head and neck cancer: A comparison between PET and PET/CT for biopsy proven lesions

    International Nuclear Information System (INIS)

    Halpern, Benjamin S.; Yeom, Kristen; Fueger, Barbara J.; Lufkin, Robert B.; Czernin, Johannes; Allen-Auerbach, Martin

    2007-01-01

    Background: 18 F-FDG PET has a high accuracy for re-staging of head and neck cancer. The purpose of this study was to determine whether the diagnostic accuracy can be further improved with integrated PET/CT. Materials and methods: Forty-nine patients with a mean age of 59 ± 18 years were studied retrospectively. Histo-pathological verification was available either from complete tumor resection with or without lymph node dissection (n = 27) or direct endoscopic biopsy (n = 16) or ultrasound guided biopsy (n = 6). Two reviewers blinded to the pathological findings read all PET images in consensus. An experienced radiologist was added for the interpretation of the PET/CT images. Results: Tissue verification was available for 110 lesions in 49 patients. Sixty-seven lesions (61%) were biopsy positive and 43 (39%) were negative for malignant disease. PET and PET/CT showed an overall accuracy for cancer detection of 84 and 88% (p = 0.06), respectively. Sensitivity and specificity for PET were 78 and 93% versus 84 (p = NS) and 95% (p = NS) with PET/CT. A patient-by-patient analysis yielded a sensitivity, specificity and accuracy for PET of 80, 56 and 76%, compared to 88% (p = NS), 78% (p = NS) and 86% (p = 0.06) for PET/CT. Conclusion: The results of this study indicate that PET/CT does not significantly improve the detection of recurrence of head and neck cancer. However, a trend towards improved accuracy was observed (p = 0.06)

  11. Fabrication of porous silicon nanowires by MACE method in HF/H2O2/AgNO3 system at room temperature

    Science.gov (United States)

    2014-01-01

    In this paper, the moderately and lightly doped porous silicon nanowires (PSiNWs) were fabricated by the ‘one-pot procedure’ metal-assisted chemical etching (MACE) method in the HF/H2O2/AgNO3 system at room temperature. The effects of H2O2 concentration on the nanostructure of silicon nanowires (SiNWs) were investigated. The experimental results indicate that porous structure can be introduced by the addition of H2O2 and the pore structure could be controlled by adjusting the concentration of H2O2. The H2O2 species replaces Ag+ as the oxidant and the Ag nanoparticles work as catalyst during the etching. And the concentration of H2O2 influences the nucleation and motility of Ag particles, which leads to formation of different porous structure within the nanowires. A mechanism based on the lateral etching which is catalyzed by Ag particles under the motivation by H2O2 reduction is proposed to explain the PSiNWs formation. PMID:24910568

  12. Interstitial hyperthermia and iridium-192 treatment alone vs. interstitial iridium-192 treatment/hyperthermia and low dose cisplatinum infusion in the treatment of locally advanced head and neck malignancies

    International Nuclear Information System (INIS)

    Schreiber, David P.; Overett, Thomas K.

    1995-01-01

    Purpose: To determine whether the addition of low dose platinum infusional chemotherapy adds to the effectiveness of interstitial hyperthermia/iridium-192 management of locally advanced head and neck malignancies. Methods and Materials: From 1987 to 1993, 36 patients with locally advanced head and neck malignancies were treated locally with interstitial hyperthermia and iridium-192 as part or all of their management. Twenty-two of the above-mentioned patients also received low dose infusional cisplatinum chemotherapy at 20 mg/M 2 per day during the time of the implant. No patient received greater than 100 mg/M 2 total dose. Implant times ranged from 38.5 to 134 h and total doses delivered with the radiation implants ranged from 15 to 39.9 Gy. Average implant volume was 50 cc. Twenty-three patients received external beam irradiation supplementation in a dose range from 25.2 to 64 Gy. Results: Median follow-up for the entire group was 8, months with 7 months for the chemotherapy group vs. 12 months for the no-chemotherapy group. Freedom from relapse rates for the chemotherapy group vs. the no-chemotherapy group were 70% at 41 months vs. 63% at 60 months, p not significant (p = NS). Overall survival by Life Table Analysis was 28% for the chemotherapy group at 41 months vs. 31% for the no-chemotherapy group at 60 months (p = NS). Complete response (CR) rates were 93% for the chemotherapy group vs. 86% for the no-chemotherapy group. Seven patients in the chemotherapy group had recurrent disease and four patients in the no-chemotherapy group were being treated for recurrent disease. Complication rates were similar in both groups, with two patients in the chemotherapy arm requiring hyperbaric oxygen treatments and one patient in the no-chemotherapy arm requiring hyperbaric oxygen treatments (for soft tissue necrosis). Conclusion: It appears that low dose platinum infusional chemotherapy can be added safely to patients receiving interstitial iridium-192 implants along with

  13. Prospective evaluation of patient-reported quality-of-life outcomes following SBRT ± cetuximab for locally-recurrent, previously-irradiated head and neck cancer

    International Nuclear Information System (INIS)

    Vargo, John A.; Heron, Dwight E.; Ferris, Robert L.; Rwigema, Jean-Claude M.; Wegner, Rodney E.; Kalash, Ronny; Ohr, James; Kubicek, Greg J.; Burton, Steven

    2012-01-01

    Purpose: Stereotactic body radiotherapy (SBRT) has emerged as a promising salvage strategy for unresectable, previously-irradiated recurrent squamous cell carcinomas of the head and neck (rSCCHN). Here-in, we report the first prospective evaluation of patient-reported quality-of-life (PR-QoL) following re-irradiation with SBRT ± cetuximab for rSCCHN. Materials and methods: From November 2004 to May 2011, 150 patients with unresectable, rSCCHN in a previously-irradiated field receiving >40 Gy were treated with SBRT to 40–50 Gy in 5 fractions ± concurrent cetuximab. PR-QoL was prospectively acquired using University of Washington Quality-of-Life Revised (UW-QoL-R). Results: Overall PR-QoL, health-related PR-QoL, and select domains commonly affected by re-irradiation progressively increase following an initial 1-month decline with statistically significant improvements noted in swallowing (p = 0.025), speech (p = 0.017), saliva (p = 0.041), activity (p = 0.032) and recreation (p = 0.039). Conclusions: Especially for patients surviving >1-year, improved tumor control associated with SBRT re-irradiation may ameliorate decreased PR-QoL resulting from rSCCHN. These improvements in PR-QoL transcend all measured domains in a validated PR-QoL assessment tool independent of age, use of cetuximab, tumor volume, and interval since prior irradiation.

  14. Re-irradiation combined with capecitabine in locally recurrent squamous cell carcinoma of the head and neck. A prospective phase II trial

    Energy Technology Data Exchange (ETDEWEB)

    Vormittag, L.; Kornek, G. [Medical Univ. Vienna (Austria). Div. of Clinical Oncology; Lemaire, C.; Radonjic, D.; Selzer, E. [Medical Univ. Vienna (Austria). Dept. for Radiotherapy and Radiobiology

    2012-03-15

    We performed a prospective phase II trial to investigate the safety and efficacy of radiotherapy combined with capecitabine in patients suffering from a recurrence of a squamous cell carcinoma of the head and neck (SCCHN) within a previously irradiated field. A total of 31 evaluable patients with recurrent SCCHN received re-irradiation with a total dose of 50 Gy (25 fractions over 5 weeks) up to a maximum of 60 Gy combined with 900 mg/m{sup 2}/day capecitabine given on the days of radiotherapy. The median time to relapse after the first course of radiotherapy was 15 months. The overall response rate in our study was 68% including 6 patients with a complete response. The median overall survival was 8.4 months. Grade 3 or 4 mucositis occurred in 4 patients and 1 patient, respectively. No grade 4 hematological toxicities were observed; 1 patient had grade 3 anemia. The cumulative median lifetime dose was 116 Gy. Capecitabine combined with re-irradiation is a well-tolerated treatment in patients with recurrent SCCHN. In light of its good tolerability, it appears to be a potential option for patients with a reduced performance status and may also serve as a basis for novel treatment concepts, such as in combination with targeted therapies.

  15. Phase I study of vandetanib with radiation therapy with or without cisplatin in locally advanced head and neck squamous cell carcinoma.

    Science.gov (United States)

    Papadimitrakopoulou, Vasiliki A; Frank, Steven J; Cohen, Ezra W; Hirsch, Fred R; Myers, Jeffrey N; Heymach, John V; Lin, Heather; Tran, Hai T; Chen, Changhu R; Jimeno, Antonio; Nedzi, Lucien; Vasselli, Joseph R; Lowe, Elizabeth S; Raben, David

    2016-03-01

    Vandetanib, added to cisplatin and radiation therapy (RT) overcomes chemoradiation therapy (CRT) and epidermal growth factor receptor (EGFR) inhibitor resistance in head and neck squamous cell carcinoma (HNSCC) lines and models. Patients with previously untreated HNSCC received vandetanib daily for 14 days (starting dose 100 mg) and then vandetanib + RT (2.2 Gy/day, 5 days/week) for 6 weeks (regimen 1) or vandetanib + RT (2 Gy/day, 5 days/week) + cisplatin (30 mg/m(2) weekly) for 7 weeks (regimen 2). The primary objective was the maximum tolerated dose (MTD) of vandetanib with RT +/- cisplatin. Of 33 treated patients, 30 completed therapy (regimen 1, n = 12; regimen 2, n = 18). MTD in regimen 2 was 100 mg (3 dose limiting toxicities [DLTs] at 200 mg), whereas regimen 1 was stopped because of poor recruitment (1 DLT at 200 mg). Most common grade ≥3 adverse events (AEs) were dysphagia (30%), stomatitis (33%), and mucosal inflammation (27%). Five patients discontinued vandetanib because of AEs. Vandetanib with CRT was feasible. © 2015 Wiley Periodicals, Inc.

  16. Flued head replacement alternatives

    International Nuclear Information System (INIS)

    Smetters, J.L.

    1987-01-01

    This paper discusses flued head replacement options. Section 2 discusses complete flued head replacement with a design that eliminates the inaccessible welds. Section 3 discusses alternate flued head support designs that can drastically reduce flued head installation costs. Section 4 describes partial flued head replacement designs. Finally, Section 5 discusses flued head analysis methods. (orig./GL)

  17. Mace-like hierarchical MoS2/NiCo2S4 composites supported by carbon fiber paper: An efficient electrocatalyst for the hydrogen evolution reaction

    Science.gov (United States)

    Sun, Lan; Wang, Tao; Zhang, Long; Sun, Yunjin; Xu, Kewei; Dai, Zhengfei; Ma, Fei

    2018-02-01

    The rational design and preparation of earth-abundant, stable and efficient electrocatalysts for hydrogen production is currently the subject in extensive scientific and technological researches toward the future of a clean-energy society. Herein, a mace-like MoS2/NiCo2S4 hierarchical structure is designed and synthesized on carbon fiber paper via a facile hydrothermal method, and evaluated as electrocatalyst for hydrogen evolution reaction. In the MoS2/NiCo2S4/carbon fiber paper hierarchical structures, MoS2 nanosheets are dispersively distributed on the surface of NiCo2S4 nanowires, which provides an enlarged surface area, abundant interfaces and catalytic active sites. As for hydrogen evolution reaction, such MoS2/NiCo2S4/carbon fiber paper heterostructures give rise to a hydrogen evolution reaction catalytic current density of 10 mA cm-2 with a lower overpotential of 139 mV and a smaller Tafel slope of 37 mV·dec-1 than those of MoS2/carbon fiber paper and NiCo2S4/carbon fiber paper counterparts, exhibiting a prominent electrocatalytic performance. Moreover, the electrocatalytic properties change little after 5000 CV cycles and continual electrolysis for 12 h without obvious decay, respectively, demonstrating high durability and stability. The excellent hydrogen evolution reaction performances endow the hierarchical configuration MoS2/NiCo2S4/carbon fiber paper with promising alternative in HER and other related renewable energy fields.

  18. Goniometer head

    International Nuclear Information System (INIS)

    Dzhazairov-Kakhramanov, V.; Berger, V.D.; Kadyrzhanov, K.K.; Zarifov, R.A.

    1994-01-01

    The goniometer head is an electromechanical instrument that performs the independent transfer of a testing sample on three coordinate axes (X, Y, Z) within limits of ±8 mm and independent rotation relative of these directions. The instrument comprises a sample holder, bellows component and three electrometer drives. The sample holder rotates around the axes X and Y, and is installed on the central arm which rotates around axis Z. One characteristic of this instrument is its independence which allows its use in any camera for researches in the field of radiation physics. 2 figs

  19. Head injury in children

    International Nuclear Information System (INIS)

    Sugiura, Makoto; Mori, Nobuhiko; Yokosuka, Reiko; Yamamoto, Masaaki; Imanaga, Hirohisa

    1981-01-01

    Findings of computerized tomography (CT) in 183 cases of head injury in children were investigated with special reference to CT findings of mild head injury. As was expected, CT findings of mild head injury fell within the normal range, in almost all cases. However, abnormal findings were noticed in 4 out of 34 cases (12%) in acute stage and 7 out of 76 cases (9%) in chronic stage. They were 3 cases of localized low density area in acute stage and 6 cases of mild cerebral atrophy in chronic stage, etc. There were some cases of mild head injury in which CT findings were normal while EEG examination revealed abnormality. Also in some cases, x-ray study demonstrated linear skull fracture which CT failed to show. These conventional techniques could be still remained as useful adjunct aid in diagnosis of head injury. CT findings of cases of cerebral contusion in their acute stage were divided as follows; normal, low density, small ventricle and ventricular and/or cisternal hemorrhage, frequency of incidence being 38, 17, 22, 11% respectively. These findings were invariably converted to cerebral atrophy from 10 days to 2 months after the impacts. In the cases with intracranial hematoma revealed by CT, only 32% of them showed clinical signs of Araki's type IV in their acute stage and 63% of them showed no neurological defects, that is Araki's type I and II. A case of extreme diffuse cerebral atrophy which followed acute subdural hematoma caused by tear of bridging veins without cortical contusion was presented. (author)

  20. Comparison of weekly administration of cisplatin versus three courses of cisplatin 100 mg/m2 for definitive radiochemotherapy of locally advanced head-and-neck cancers

    International Nuclear Information System (INIS)

    Rades, Dirk; Seidl, Daniel; Janssen, Stefan; Bajrovic, Amira; Karner, Katarina; Strojan, Primoz; Schild, Steven E

    2016-01-01

    To compare definitive radiochemotherapy with weekly administration of 30–40 mg/m 2 of cisplatin to 100 mg/m 2 of cisplatin on days 1, 22 and 43 for outcomes and toxicity in patients with squamous cell carcinoma of the head-and-neck. Seventy-five patients receiving radiochemotherapy with weekly cisplatin (30–40 mg/m 2 ) were compared to 58 patients receiving radiochemotherapy with 100 mg/m 2 cisplatin on days 1, 22 and 43. Radiochemotherapy regimen plus seven characteristics (age, gender, performance score, tumor site, T-/N-category, histologic grading) were evaluated for locoregional control (LRC), metastases-free survival (MFS) and overall survival (OS). Radiochemotherapy groups were compared for toxicity. On multivariate analysis, improved LRC was associated with cisplatin 100 mg/m 2 (hazard ratio [HR] 1.57; p = 0.008) and female gender (HR 4.37; p = 0.003). Radiochemotherapy regimen was not significantly associated with MFS on univariate analysis (p = 0.66). On multivariate analysis, better MFS was associated with ECOG performance score 0–1 (HR 5.63; p < 0.001) and histological grade 1–2 (HR 1.81; p = 0.002). On multivariate analysis, improved OS was associated with cisplatin 100 mg/m 2 (HR 1.33; p = 0.023), ECOG performance score 0–1 (HR 2.15; p = 0.029) and female gender (HR 1.98; p = 0.026). Cisplatin 100 mg/m 2 was associated with higher rates of grade ≥3 hematotoxicity (p = 0.004), grade ≥2 renal failure (p = 0.004) and pneumonia/sepsis (p = 0.033). Radiochemotherapy with 100 mg/m 2 of cisplatin every 3 weeks resulted in better LRC and OS than weekly doses of 30–40 mg/m 2 . Given the limitations of a retrospective study, 100 mg/m 2 of cisplatin appears preferable. Since this regimen was associated with considerable acute toxicity, patients require close monitoring

  1. Betel nut chewing history is an independent prognosticator for smoking patients with locally advanced stage IV head and neck squamous cell carcinoma receiving induction chemotherapy with docetaxel, cisplatin, and fluorouracil.

    Science.gov (United States)

    Su, Yan-Ye; Chien, Chih-Yen; Luo, Sheng-Dean; Huang, Tai-Lin; Lin, Wei-Che; Fang, Fu-Min; Chiu, Tai-Jan; Chen, Yen-Hao; Lai, Chi-Chih; Hsu, Cheng-Ming; Li, Shau-Hsuan

    2016-03-22

    Smoking and betel nut chewing are well-known risk factors for head and neck squamous cell carcinoma (HNSCC). Smoking is also a strong prognosticator for patients with locally advanced HNSCC receiving induction chemotherapy. Smoking with or without betel nut chewing is a common practice in Asia. However, little is known regarding whether betel nut chewing can serve as a prognostic factor for smoking patients with locally advanced HNSCC receiving induction chemotherapy. The aim of this study was to evaluate the prognostic impact of betel nut chewing in such patients receiving induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF). From January 2010 to December 2012, we retrospectively analyzed 162 smoking patients with locally advanced HNSCC who received induction chemotherapy with TPF at our institution. Background characteristics, including a history of betel nut chewing, were analyzed as potential prognostic factors. Among the 162 smoking patients, 131 patients (81%) were betel nut chewers, while 31 (19%) were non-betel nut chewers. One hundred fifty-six (96%) were men, and 6 (4%) were women. The median age was 53 years. The overall response rates to induction chemotherapy were 57 and 77% in patients with and without betel nut chewing history, respectively (P = 0.038). The 2-year progression survival rates were 37 and 67% in patients with and without betel nut chewing history, respectively (P = 0.004). The 2-year overall survival rates were 47 and 71% in patients with and without betel nut chewing history, respectively (P = 0.017). Betel nut chewing history was independently associated with a poor response to induction chemotherapy, an inferior progression-free survival rate, and a poor overall survival rate. Our results indicate that betel nut chewing history is independently associated with poor prognosis in smoking patients with locally advanced HNSCC receiving induction chemotherapy with TPF. Further investigation is warranted to

  2. Treatment results and complications in clinical combinations of radiation and chemotherapy in the treatment of localized cancer in the head and neck

    International Nuclear Information System (INIS)

    Masaki, Norie; Shigematsu, Yasushi

    1981-01-01

    By using chemotherapy combined with radiotherapy, significant improvements were achieved in treatment results of localized non-Hodgkin's lymphoma, intraoral cancer, and carcinoma of the maxillary sinus. Administering chemotherapy with radiation was given sumultaneously in the patients with intraoral cancer (BLM iv) and with carcinoma of the maxillary sinus (5-FU ia). In the patients with non-Hodgkin's lymphoma, chemotherapy (1 or 2 cycles of COPP) was administered and followed by radiotherapy. If radiation dose were reduced by about 50% in the intraoral cancer, 20% in carcinoma of the maxillary sinus, and 10% in non-Hodgkin's lymphoma, acute and/or chronic complications were within tolerable limits in this series of observations, although toxicity was dose-related for both chemotherapy and radiotherapy. (author)

  3. Gemcitabine and cisplatin in a concomitant alternating chemoradiotherapy program for locally advanced head-and-neck cancer: A pharmacology-guided schedule

    International Nuclear Information System (INIS)

    Numico, Gianmauro; Russi, Elvio G.; Vitiello, Raffele; Sorrentino, Raffaele; Colantonio, Ida; Cipolat, Marco; Taglianti, Riccardo Vigna; Pelissero, Antonio; Fea, Elena; Granetto, Cristina; Di Costanzo, Gianna; Gasco, Milena; Garrone, Ornella; Occelli, Marcella; Merlano, Marco

    2006-01-01

    Purpose: Administration of gemcitabine together with cisplatin at cytotoxic doses in a chemoradiotherapy regimen is hampered by a high degree of local toxicity. Using the pharmacologic properties of the drug we designed a modified schedule aimed at reducing toxicity while preserving activity. Methods and Materials: Patients with squamous cell carcinomas of the oral cavity, pharynx and larynx, bulky T4, and/or N2 to N3 were eligible. Gemcitabine was administered at a dose of 800 mg/m 2 on Days 1 and 12 and cisplatin at a dose of 20 mg/m 2 on Days 2 to 5, every 21 days for 3 courses. Radiotherapy, delivered with standard fractionation, was given on Days 8 to 12 and 15 to 19 and was repeated 3 times up to a total dose of ≥60 Gy. Results: A total of 28 patients were selected. Grade 3 to 4 stomatitis was recorded in 25 patients (89%). Thirteen patients (46%) experienced Grade 3 to 4 neutropenia. Febrile neutropenia occurred in 8 patients (29%) and in 2 was complicated by infection and death. The overall complete response rate was 79%. At a median follow up of 71 months, 11 patients had a locoregional relapse (3-year locoregional control, 64%); 6 patients had distant metastases, among whom only 2 were without locoregional recurrence. The 3-year progression-free survival is 39% and 3-year overall survival has been 43%. Conclusion: The schedule modification did not attenuate local toxicity. Moreover, infections and especially pneumonia, were a major problem. The high activity of gemcitabine when combined with radiotherapy would most likely be better exploited in the context of modified radiation schemes

  4. Hedgehog pathway inhibitor in combination with radiation therapy for basal cell carcinomas of the head and neck. First clinical experience with vismodegib for locally advanced disease

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, Bjoern; Roedel, Claus; Balermpas, Panagiotis [University Hospital Johann Wolfgang Goethe University, Department of Radiation Oncology, Frankfurt (Germany); Meissner, Markus [University Hospital Johann Wolfgang Goethe University, Department of Dermatology, Frankfurt (Germany); Ghanaati, Shahram [University Hospital Johann Wolfgang Goethe University, Department of Craniofacial and Plastic Surgery, Frankfurt (Germany); Burck, Iris [University Hospital Johann Wolfgang Goethe University, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany)

    2016-01-15

    Definitive radiotherapy and vismodegib, an oral inhibitor of the hedgehog pathway, are both established treatment options for locally advanced basal cell carcinomas (BCC). Both have shown good results in local tumor control; however, the effects concerning advanced tumors are often not of a lasting nature and to date no systematic data about the combination of the two modalities are available. We retrospectively analyzed four patients who received vismodegib and radiotherapy in combination. Radiation doses varied between 50.4 Gy and 66.0 Gy. Three patients had recurrent BCC. One patient had locoregional lymph node involvement. Vismodegib was taken once a day (150 mg) during the entire time of irradiation and beyond upon instructions of the attending dermatologist. In three cases a persistent complete response was observed, in one case the tumor remained stable for approximately 6 months until further tumor progression was documented. The combined therapy was well tolerated in all cases. No exceptional side effects pointing at a drug-radiation interaction were observed. The combination of vismodegib and radiation seems feasible and the initial results are promising. In our cohort, there was no increase in unexpected side effects. Further research is needed to evaluate the significance of this combined therapy. (orig.) [German] Sowohl definitive Radiotherapie als auch Vismodegib, ein oraler Inhibitor der Hedgehog-Signalkaskade, sind etablierte Behandlungsoptionen fuer lokal fortgeschrittene Basalzellkarzinome (BCC). Beide Therapien zeigen fuer sich gute Ansprechraten, aber die lokale Tumorkontrolle ist oft nicht dauerhaft und bis heute existieren kaum Daten ueber eine Kombination der beiden Modalitaeten. Wir analysierten retrospektiv vier Patientenfaelle nach simultaner Applikation von Vismodegib und Bestrahlung. Die Bestrahlungsdosis variierte zwischen 50,4 Gy und 66,0 Gy. Drei der Patienten hatten ein rezidiviertes BCC. Ein Patient hatte einen befallenen regionalen

  5. Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

    International Nuclear Information System (INIS)

    Rütten, Heidi; Pop, Lucas A.M.; Janssens, Geert O.R.J.; Takes, Robert P.; Knuijt, Simone; Rooijakkers, Antoinette F.; Berg, Manon van den; Merkx, Matthias A.; Herpen, Carla M.L. van; Kaanders, Johannes H.A.M.

    2011-01-01

    Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence–free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

  6. Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

    Energy Technology Data Exchange (ETDEWEB)

    Ruetten, Heidi, E-mail: h.rutten@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Pop, Lucas A.M.; Janssens, Geert O.R.J. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Takes, Robert P. [Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Knuijt, Simone [Department of Rehabilitation/Speech Pathology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Rooijakkers, Antoinette F. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Berg, Manon van den [Department of Gastroenterology-Dietetics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Merkx, Matthias A. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Herpen, Carla M.L. van [Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

    2011-11-15

    Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence-free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

  7. WE-EF-BRA-12: Magnetic Resonance- Guided High-Intensity Focused Ultrasound for Localized Ablation of Head and Neck Tissue Structures: A Feasibility Study in An Animal Model

    International Nuclear Information System (INIS)

    Partanen, A; Ellens, N; Noureldine, S; Tufano, R; Burdette, E; Farahani, K

    2015-01-01

    Purpose: High-intensity focused ultrasound (HIFU) ablation is feasible in the head and neck [1]. This study aims to expand upon these findings to assess the feasibility of treatment planning and monitoring via magnetic resonance imaging (MRI) guidance using a clinical MR-guided HIFU platform. Methods: Two 31 kg pigs were anaesthetized, shaved, and positioned prone on the HIFU table (Sonalleve, Philips Healthcare, Vantaa, Finland). The necks were acoustically coupled to the integrated transducer using gel pads and degassed water. MR imaging verified acoustic coupling and facilitated target selection in the thyroid and thymus. Targets were thermally ablated with 130–200 W of acoustic power over a period of 16 s at a frequency of 1.2 MHz while being monitored through real-time, multi-planar MR-thermometry. Contrast-enhanced MR imaging was used to assess treatment efficacy. Post-treatment, animals were euthanized and sonicated tissues were harvested for histology assessment. Results: MR-thermometry, post-contrast-imaging, and gross pathology demonstrated that the system was capable of causing localized thermal ablation in both the thyroid and the thymus without damaging the aerodigestive tract. In one animal, superficial bruising was observed in the ultrasound beam path. Otherwise, there were no adverse events. Analysis of the tissue histology found regions of damage consistent with acute thermal injury at the targeted locations. Conclusion: It is feasible to use a clinical MR-guided HIFU platform for extracorporeal ablation of porcine head and neck tissues. MR guidance and thermometry are sufficient to target and monitor treatment in the thyroid region, despite the presence of the inhomogeneous aerodigestive tract. Further study is necessary to assess efficacy and survival using a tumor model, and to examine what modifications should be made to the transducer positioning system and associated patient positioning aids to adapt it for clinical head and neck targets

  8. Re-irradiation in stereotactic conditions and cetuximab for local relapses of epidermoid carcinoma of head and neck; Reirradiation en conditions stereotaxiques et cetuximab pour des recidives locales de carcinome epidermoide de la tete et du cou

    Energy Technology Data Exchange (ETDEWEB)

    Vasseur, F.; Comet, B.; Faivre-Pierret, M.; Coche-Dequeant, B.; Degardin, M.; Lefebvre, J.L.; Lacornerie, T.; Lartigau, E. [Departement universitaire de radiotherapie, centre Oscar Lambret, 59 - Lille (France); Universite Lille-2, 59 (France)

    2010-10-15

    The authors report a work aimed at assessing the feasibility and toxicity of a re-irradiation treatment in stereotactic conditions using CyberKnife and cetuximab in the case of local relapses of epidermoid cancers of the ORL sphere. Thirty three patients have been submitted to this treatment between June 2007 and April 2009. Although six patients died by six months, this treatment seems to be a good alternative, and presents an acceptable short-term toxicity. Further studies are needed to compare this technique to other therapeutic techniques, and to assess the risk of long term complications. Short communication

  9. Is HEADS in our heads?

    DEFF Research Database (Denmark)

    Boisen, Kirsten A; Hertz, Pernille Grarup; Blix, Charlotte

    2016-01-01

    contraception], Safety, Self-harm) interview is a feasible way of exploring health risk behaviors and resilience. OBJECTIVE: The purpose of this study was to evaluate how often HEADS topics were addressed according to young patients and staff in pediatric and adult outpatient clinics. METHODS: We conducted...... care professionals participated. We found only small reported differences between staff and young patients regarding whether home, education, and activity were addressed. However, staff reported twice the rate of addressing smoking, alcohol, illegal drugs, sexuality, and contraception compared to young...... patients. Young patients reported that smoking, alcohol, illegal drugs, sexuality, and contraception were addressed significantly more at adult clinics in comparison to pediatric clinics. After controlling for age, gender and duration of illness, according to young patients, adjusted odds ratios...

  10. Fibroblast growth factor 2 is of prognostic value for patients with locally advanced squamous cell carcinoma of the head and neck

    International Nuclear Information System (INIS)

    Rades, D.; Seibold, N.D.; Gebhard, M.P.; Noack, F.; Schild, S.E.

    2014-01-01

    Patients with locally advanced SCCHN have a poor prognosis. This study investigated the prognostic value of the tumor cell expression of the fibroblast growth factor 2 (FGF-2) in patients treated with surgery followed by radiotherapy. The impact of FGF-2-expression and 11 additional potential prognostic factors on loco-regional control (LRC), metastases-free survival (MFS), and overall survival (OS) was retrospectively evaluated in 146 patients. Additional factors included age, gender, performance status, pre-radiotherapy hemoglobin levels, tumor site, histologic grade, T-category, N-category, human papilloma virus (HPV) status, extent of resection, and chemotherapy. Univariate analyses were performed with the Kaplan-Meier method and the log-rank test, multivariate analyses with the Cox proportional hazard model. On multivariate analysis, improved LRC was significantly associated with FGF-2-negativity [risk ratio (RR): 7.33; 95 %-confidence interval (CI): 2.88-19.05; p < 0.001], lower T-category (RR: 2.42; 95 %-CI: 1.47-4.33; p < 0.001), lower N-category (RR: 12.36; 95 %-CI: 3.48-78.91; p < 0.001), and pre-radiotherapy hemoglobin levels ≥12 g/dl (RR: 4.18; 95 %-CI: 1.73-10.53; p = 0.002). No factor was significantly associated with improved MFS. Lower T-category showed a trend (RR: 1.59; 95 %-CI: 0.97-2.82; p = 0.069). Better OS was significantly associated with FGF-2-negativity (RR: 5.10; 2.22-11.80; p < 0.001), lower T-category (RR: 2.17; 95 %-CI: 1.38-3.68; p < 0.001), lower N-category (RR: 3.86; 95 %-CI: 1.60-10.85; p = 0.002), and pre-radiotherapy hemoglobin levels ≥12 g/dl (RR: 3.20; 95 %-CI: 1.46-7.30; p = 0.004). HPV-positivity showed a trend (RR: 2.36; 95 %-CI: n.a.; p = 0.054). Tumor cell expression of FGF-2 proved to be an independent prognostic factor for LRC and OS. This factor can help personalize treatment and stratify patients in future trials. (orig.)

  11. Fibroblast growth factor 2 is of prognostic value for patients with locally advanced squamous cell carcinoma of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Rades, D.; Seibold, N.D. [University of Luebeck, Department of Radiation Oncology, Luebeck (Germany); Gebhard, M.P.; Noack, F. [University of Luebeck, Institute of Pathology, Luebeck (Germany); Schild, S.E. [Mayo Clinic Scottsdale, Department of Radiation Oncology, Scottsdale (United States)

    2014-01-15

    Patients with locally advanced SCCHN have a poor prognosis. This study investigated the prognostic value of the tumor cell expression of the fibroblast growth factor 2 (FGF-2) in patients treated with surgery followed by radiotherapy. The impact of FGF-2-expression and 11 additional potential prognostic factors on loco-regional control (LRC), metastases-free survival (MFS), and overall survival (OS) was retrospectively evaluated in 146 patients. Additional factors included age, gender, performance status, pre-radiotherapy hemoglobin levels, tumor site, histologic grade, T-category, N-category, human papilloma virus (HPV) status, extent of resection, and chemotherapy. Univariate analyses were performed with the Kaplan-Meier method and the log-rank test, multivariate analyses with the Cox proportional hazard model. On multivariate analysis, improved LRC was significantly associated with FGF-2-negativity [risk ratio (RR): 7.33; 95 %-confidence interval (CI): 2.88-19.05; p < 0.001], lower T-category (RR: 2.42; 95 %-CI: 1.47-4.33; p < 0.001), lower N-category (RR: 12.36; 95 %-CI: 3.48-78.91; p < 0.001), and pre-radiotherapy hemoglobin levels ≥12 g/dl (RR: 4.18; 95 %-CI: 1.73-10.53; p = 0.002). No factor was significantly associated with improved MFS. Lower T-category showed a trend (RR: 1.59; 95 %-CI: 0.97-2.82; p = 0.069). Better OS was significantly associated with FGF-2-negativity (RR: 5.10; 2.22-11.80; p < 0.001), lower T-category (RR: 2.17; 95 %-CI: 1.38-3.68; p < 0.001), lower N-category (RR: 3.86; 95 %-CI: 1.60-10.85; p = 0.002), and pre-radiotherapy hemoglobin levels ≥12 g/dl (RR: 3.20; 95 %-CI: 1.46-7.30; p = 0.004). HPV-positivity showed a trend (RR: 2.36; 95 %-CI: n.a.; p = 0.054). Tumor cell expression of FGF-2 proved to be an independent prognostic factor for LRC and OS. This factor can help personalize treatment and stratify patients in future trials. (orig.)

  12. Aggressive simultaneous radiochemotherapy with cisplatin and paclitaxel in combination with accelerated hyperfractionated radiotherapy in locally advanced head and neck tumors. Results of a phase I-II trial

    Energy Technology Data Exchange (ETDEWEB)

    Kuhnt, T.; Pigorsch, S.; Pelz, T.; Haensgen, G.; Dunst, J. [Dept. of Radiotherapy, Martin Luther Univ., Halle (Germany); Becker, A. [Dept. of Radiotherapy, Martin Luther Univ., Halle (Germany); Dept. of Radiotherapy, Municipial Hospital, Dessau (Germany); Bloching, M.; Passmann, M. [Dept. of Head and Neck Surgery, Martin Luther Univ., Halle (Germany); Lotterer, E. [Dept. of Internal Medicine I, Martin Luther Univ., Halle (Germany)

    2003-10-01

    of neutropenic infection. In one patient, a grade 2 nephrotoxicity appeared requiring cessation of cisplatin chemotherapy. 18/23 patients (78%) required blood transfusion (1-3 units) and 16/23 (70%) i.v. antibiotics. 14 patients (61%) achieved a complete and nine (39%) a partial remission, yielding an overall response rate of 100%. In summary, six patients died of local tumor progression (n = 2), distant metastases (n = 2), or therapy-related complications (n = 2) during follow-up. The 3-year overall survival was 71%. Tumor volume was not a risk factor for failure in this protocol. All patients have, so far, developed only slight late effects (fibrosis, lymphedema) with no grade 3-4 late sequelae.

  13. Aggressive simultaneous radiochemotherapy with cisplatin and paclitaxel in combination with accelerated hyperfractionated radiotherapy in locally advanced head and neck tumors. Results of a phase I-II trial

    International Nuclear Information System (INIS)

    Kuhnt, T.; Pigorsch, S.; Pelz, T.; Haensgen, G.; Dunst, J.; Becker, A.; Bloching, M.; Passmann, M.; Lotterer, E.

    2003-01-01

    . In one patient, a grade 2 nephrotoxicity appeared requiring cessation of cisplatin chemotherapy. 18/23 patients (78%) required blood transfusion (1-3 units) and 16/23 (70%) i.v. antibiotics. 14 patients (61%) achieved a complete and nine (39%) a partial remission, yielding an overall response rate of 100%. In summary, six patients died of local tumor progression (n = 2), distant metastases (n = 2), or therapy-related complications (n = 2) during follow-up. The 3-year overall survival was 71%. Tumor volume was not a risk factor for failure in this protocol. All patients have, so far, developed only slight late effects (fibrosis, lymphedema) with no grade 3-4 late sequelae

  14. Head Impact Laboratory (HIL)

    Data.gov (United States)

    Federal Laboratory Consortium — The HIL uses testing devices to evaluate vehicle interior energy attenuating (EA) technologies for mitigating head injuries resulting from head impacts during mine/...

  15. Predictors of severe late radiotherapy-related toxicity after hyperfractionated radiotherapy with or without concomitant cisplatin in locally advanced head and neck cancer. Secondary retrospective analysis of a randomized phase III trial (SAKK 10/94)

    International Nuclear Information System (INIS)

    Ghadjar, Pirus; Simcock, Mathew; Zimmermann, Frank; Betz, Michael; Bodis, Stephan; Bernier, Jacques; Studer, Gabriela; Aebersold, Daniel M.

    2012-01-01

    Background and purpose: This secondary analysis was performed to identify predictive factors for severe late radiotherapy (RT)-related toxicity after treatment with hyperfractionated RT +/− concomitant cisplatin in locally advanced head and neck cancer. Materials and methods: Patients were retrospectively analyzed from the previously reported randomized phase III trial: SAKK 10/94. Severe late RT-related toxicity was defined as late RTOG ⩾ grade 3 toxicity starting 3 months after end of RT and/or potential treatment-related death within 3 years of randomization. Results: Two hundred and thirteen randomized patients were analyzed; 84 (39%) experienced severe late RT-related toxicity. With median follow-up of 9.7 years (range, 0.4–15.4 years), median time to severe late RT-related toxicity was 9.6 years. In the univariate Cox proportional hazards model the following variables were associated with severe late RT-related toxicity: advanced N-classification (p < 0.001); technically unresectable disease (p = 0.04); weight loss ratio (p = 0.003); supportive measures (p = 0.009) and severe acute dysphagia (p = 0.001). In the subsequent multivariate analysis all variables except use of supportive measures remained statistically significant. Conclusions: Chemotherapy did not appear to affect severe late RT-related toxicity, but advanced N-classification, technically unresectable disease, weight loss ratio, and severe acute dysphagia were independent predictive factors for severe late RT-related toxicity.

  16. MMP9 but Not EGFR, MET, ERCC1, P16, and P-53 Is Associated with Response to Concomitant Radiotherapy, Cetuximab, and Weekly Cisplatin in Patients with Locally Advanced Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    George Fountzilas

    2009-01-01

    Full Text Available Concomitant administration of radiotherapy with cisplatin or radiotherapy with cetuximab appear to be the treatment of choice for patients with locally advanced head and neck cancer. In the present retrospective analysis, we investigated the predictive role of several biomarkers in an unselected cohort of patients treated with concomitant radiotherapy, weekly cisplatin, and cetuximab (CCRT. We identified 37 patients treated with this approach, of which 13 (35% achieved a complete response and 10 (27% achieved a partial response. Severe side effects were mainly leucopenia, dysphagia, rash, and anemia. Tumor EGFR, MET, ERCC1, and p-53 protein and/or gene expression were not associated with treatment response. In contrast, high MMP9 mRNA expression was found to be significantly associated with objective response. In conclusion, CCRT is feasible and active. MMP9 was the only biomarker tested that appears to be of predictive value in cetuximab treated patients. However, this is a hypothesis generating study and the results should not be viewed as definitive evidence until they are validated in a larger cohort.

  17. A matched-pair comparison of intensity-modulated radiation therapy with cetuximab versus intensity-modulated radiation therapy with platinum-based chemotherapy for locally advanced head neck cancer

    International Nuclear Information System (INIS)

    Huang, J.; Baschnagel, A.M.; Chen, P.; Ye, H.; Krauss, D.; Gustafson, G.; Jaiyesmi, I.; Folbe, M.; Akervall, J.

    2014-01-01

    We retrospectively compared the efficacy of intensity-modulated radiotherapy (IMRT) and cetuximab (IMRT/cetuximab) versus IMRT and platinum-based chemotherapy (IMRT/platinum) for locally advanced head neck squamous cell carcinoma (LAHNSCC). Thirty-one IMRT/cetuximab patients were matched 1:2 with 62 IMRT/platinum patients according to primary site and clinical stage. The primary endpoint was locoregional recurrence (LRR), and secondary endpoints included distant metastasis (DM), cause-specific survival (CSS), and overall survival (OS). Because of inherent selection bias, the IMRT/cetuximab cohort was significantly older and with a higher Charlson Comorbidity Index. IMRT/cetuximab and IMRT/platinum did not have significantly different LRR and DM (33 vs. 23% at 2 years, P=0.22; 17 vs. 11% at 2 years, P=0.40; respectively). IMRT/cetuximab had significantly worse CSS and OS (67 vs. 84%, P=0.04; 58 vs. 83%, P=0.001; respectively). However, for the subset of elderly patients ≥65 years old, there is no difference between the two cohorts for all endpoints (all P=NS). IMRT/platinum should remain the preferred choice of chemoradiotherapy for LAHNSCC, but IMRT/cetuximab may be a reasonable alternative for elderly patients. (author)

  18. Haemoglobin and creatinine values as prognostic factors for outcome of concurrent radiochemotherapy in locally advanced head and neck cancers. Secondary results of two European randomized phase III trials (ARO 95-06, SAKK 10/94)

    International Nuclear Information System (INIS)

    Ghadjar, Pirus; Stromberger, Carmen; Kaul, David; Wust, Peter; Budach, Volker; Poettgen, Christoph; Joos, Daniela; Hayoz, Stefanie; Baumann, Michael; Bodis, Stephan; Budach, Wilfried; Studer, Gabriela; Zimmermann, Frank; Plasswilm, Ludwig; Olze, Heidi; Bernier, Jacques; Aebersold, Daniel M.

    2016-01-01

    To determine the influence of baseline laboratory values on treatment outcome in patients with locally advanced head and neck cancer (HNSCC). Data of the randomized trials ARO 95 -06 (n = 384) and SAKK 10 /94 (n = 224) were pooled for a total sample size of 608 patients. Haemoglobin (Hb) and creatinine (Cr) were available at baseline and their association with locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS) was analyzed using univariable and multivariable Cox regression models. A total of 580 and 564 patients were available with baseline Hb and Cr values in the pooled analysis. Univariable analyses revealed that lower baseline Hb values were significantly associated with decreased LRRFS, DMFS, CSS and OS. This effect remained significant for OS when the treatment arms (radiotherapy [RT] alone vs. chemoradiation [CRT]) were analyzed separately. Higher baseline Cr was associated with improved OS in the pooled analysis. Interestingly, the prognostic value of baseline Cr appeared to be limited to the subgroup of 284 patients who were treated with CRT. In the multivariable Cox regression model lower baseline Hb remained associated with decreased OS both in the patients who received CRT (HR 0.79, 95 % CI 0.66-0.94, p = 0.009) and in those patients who underwent RT alone (HR 0.67, 95 % CI 0.58-0.78, p < 0.001). Increased baseline Cr remained significantly associated with improved OS in patients who underwent CRT (HR 0.79, 95 % CI 0.69-0.92, p = 0.002) but not in those patients who underwent RT alone. An association between lower baseline Hb and inferior treatment outcome was confirmed. Baseline Cr was introduced as a prognosticator of outcome after CRT for locally advanced HNSCC. (orig.) [de

  19. Prospective study of accelerated postoperative radiation therapy in patients with squamous-cell carcinoma of the head and neck; Radiotherapie externe acceleree postoperatoire des carcinomes epidermoides localement evolues de la sphere ORL: etude prospective de phase 2

    Energy Technology Data Exchange (ETDEWEB)

    Zouhair, A.; Coucke, P.A.; Azria, D.; Moeckli, R.; Mirimanoff, R.O.; Ozsahin, M. [Centre Hospitalier Universitaire Vaudois CHUV, Service de Radio-Oncologie, Lausanne (Switzerland); Azria, D. [Centre Regional de Lutte Contre le Cancer Val-d' Aurelle-Paul-Lamarque, Dept. d' Oncologie- Radiotherapie, 34 - Montpellier (France); Pache, P. [Centre Hospitalier Universitaire Vaudois CHUV, Service d' ORL, Lausanne (Switzerland); Stupp, R. [Centre hospitalier Universitaire Vaudois CHUV, Centre Pluridisciplinaire d' Oncologie Medicale, Lausanne (Switzerland)

    2003-08-01

    Purpose. - To assess the feasibility and efficacy of accelerated postoperative radiation therapy (RT) in patients with squamous-cell carcinoma of the head and neck (SCCHN). Patients and methods. - Between December 1997 and July 2001, 68 patients (male to female ratio: 52/16; median age: 60-years (range: 43-81)) with pT1-pT4 and/or pN0-pN3 SCCHN (24 oropharynx, 19 oral cavity, 13 hypopharynx, 5 larynx, 3 unknown primary, 2 maxillary sinus, and 2 salivary gland) were included in this prospective study. Postoperative RT was indicated because extra-capsular infiltration (ECT) was observed in 20 (29%), positive surgical margins (PSM) in 20 (29%) or both in 23 patients (34%). Treatment consisted of external beam R 66 Gy in 5 weeks and 3 days. Median follow-up was 15 months. Results. -According to CTC 2.0, acute morbidity was acceptable: grade 3 mucositis was observed in 15 (22%) patients, grade 3 dysphagia in 19 (28%) patients, grade 3 skin erythema in 21 (31%) patients with a median weight loss of 3.1 kg (range: 0-16). No grade 4 toxicity wa observed. Median time to relapse was 13 months; we observed only three (4%) local and four (6%) regional relapses, whereas eight (12%) patients developed distant metastases without any evidence of locoregional recurrence. The 2 years overall-, disease-free survival, an actuarial locoregional control rates were 85, 73 and 83% respectively. Conclusion.- The reduction of the overall treatment time using postoperative accelerated RT with weekly concomitant boost (six fraction per week) is feasible with local control rates comparable to that of published data. Acute RT related morbidity is acceptable. (author)

  20. Heading and head injuries in soccer.

    Science.gov (United States)

    Kirkendall, D T; Jordan, S E; Garrett, W E

    2001-01-01

    In the world of sports, soccer is unique because of the purposeful use of the unprotected head for controlling and advancing the ball. This skill obviously places the player at risk of head injury and the game does carry some risk. Head injury can be a result of contact of the head with another head (or other body parts), ground, goal post, other unknown objects or even the ball. Such impacts can lead to contusions, fractures, eye injuries, concussions or even, in rare cases, death. Coaches, players, parents and physicians are rightly concerned about the risk of head injury in soccer. Current research shows that selected soccer players have some degree of cognitive dysfunction. It is important to determine the reasons behind such deficits. Purposeful heading has been blamed, but a closer look at the studies that focus on heading has revealed methodological concerns that question the validity of blaming purposeful heading of the ball. The player's history and age (did they play when the ball was leather and could absorb significant amounts of water), alcohol intake, drug intake, learning disabilities, concussion definition and control group use/composition are all factors that cloud the ability to blame purposeful heading. What does seem clear is that a player's history of concussive episodes is a more likely explanation for cognitive deficits. While it is likely that the subconcussive impact of purposeful heading is a doubtful factor in the noted deficits, it is unknown whether multiple subconcussive impacts might have some lingering effects. In addition, it is unknown whether the noted deficits have any affect on daily life. Proper instruction in the technique is critical because if the ball contacts an unprepared head (as in accidental head-ball contacts), the potential for serious injury is possible. To further our understanding of the relationship of heading, head injury and cognitive deficits, we need to: learn more about the actual impact of a ball on the

  1. Treatment, patient and tumor characteristics impact quality of life (QOL) in patients with locally advanced head and neck cancer: Report of the radiation therapy oncology group (RTOG) trial 90-03

    International Nuclear Information System (INIS)

    Fisher, J.; Scott, C.; Fu, K.; Trotti, A.; Spencer, S.; Garden, A.; Phillips, T.; Movsas, B.; Byhardt, R.; Ang, K.

    2001-01-01

    Purpose: To determine factors that effect QOL in patients with locally advanced squamous cell cancer of the head and neck randomized to standard fractionation radiotherapy (SFX), hyperfractionation (HFX), Accelerated Fractionation with Split (AFX-S) and Accelerated Fractionation with Concomitant Boost (AFX-C). Materials and Methods: RTOG 90-03 used the Head and Neck Performance Status Scale (HNPSS) and the Functional Assessment of Cancer Therapy (FACT-H and N), version 2 to assess QOL. The HNPSS has three components Normalcy of Diet, Eating in Public, and Understandability of Speech. The FACT-H and N has two components: a global QOL questionnaire (FACT-G) consisting of 4 domains; Physical Well Being (PWB), Social Well Being (SWB), Emotional Well Being (EWB), Functional Well Being (FWB), and an additional H and N specific questionnaire (AC). Between 3/92 and 8/97, 1113 pts. were randomized; 718 completed a pretreatment FACT-H and N. Pts. completed the HNPSS and FACT-H and N; pretreatment, 4 weeks post-RT, every 3 months for 1 year. Results: Prior to the start of radiotherapy (RT) 48% of pts had normal diets, 64% had normal public eating, and 77% had normal speech. Age ( 60), KPS, tumor site (oral cavity vs. other), T-stage (T3+T4 vs. T1+T2+TX), N-stage (N0 vs. other), Race (Non-White vs. White), and marital status (single vs. married), FACT-G, PWB, EWB, FWB, AC, use of oral nutrient supplements, feeding tube, and parenteral nutrition predicted for pretreatment diet, public eating, and speech. During the acute toxicity phase diet, eating, and speech were related to the intensity of RT (HFX or AFX-C), marital status (single), tumor site (oral cavity), use of oral nutrient supplements, and feeding tube. At one-year oral cavity tumors, AFX-C, oral nutrient supplements, feeding tube, and single patients had worse diet, eating, and speech. Conclusion: Pretreatment patient and tumor characteristics impact on QOL prior to the initiation of therapy. Intensification of

  2. Head Trauma: First Aid

    Science.gov (United States)

    First aid Head trauma: First aid Head trauma: First aid By Mayo Clinic Staff Most head trauma involves injuries that are minor and don't require ... 21, 2015 Original article: http://www.mayoclinic.org/first-aid/first-aid-head-trauma/basics/ART-20056626 . Mayo ...

  3. Anti PD-L1 DUrvalumab combined with Cetuximab and RadiOtherapy in locally advanced squamous cell carcinoma of the head and neck: A phase I/II study (DUCRO).

    Science.gov (United States)

    Bonomo, Pierluigi; Desideri, Isacco; Loi, Mauro; Mangoni, Monica; Sottili, Mariangela; Marrazzo, Livia; Talamonti, Cinzia; Greto, Daniela; Pallotta, Stefania; Livi, Lorenzo

    2018-02-01

    Head and neck squamous cell carcinoma (HNSCC) has been increasingly recognized as an immune suppressive malignancy. The efficacy of immune checkpoint inhibitors (ICI's) in the context of recurrent/metastatic (R/M) setting anticipates the possible integration of immunotherapy into the therapeutic armamentarium of locally advanced disease. Durvalumab (DUR) is a humanized monoclonal IgG1, anti-PD-L1 antibody with promising data in R/M HNSCC. The aim of our study is to test the antitumor activity of a combined regimen incorporating an immune checkpoint inhibitor into a conventional bio-radiation strategy for the cure of unfavorable locally advanced HNSCC. In this open label, multi-center, single-arm, phase I/II study, enrolled patients will receive Radiotherapy (RT) (69.9 Gy/2.12 Gy in 33 fractions) with concurrent Cetuximab (CTX) (400 mg/m 2 1 week before RT start followed by 250 mg/m 2 weekly) and DUR (fixed dose of 1500 mg every 4 weeks starting from RT-CTX week 1) followed by adjuvant DUR (to a maximum of 6 months after completion of RT-CTX). Primary endpoint of the study is 2-year progression-free survival (PFS). A safety run-in is planned after the enrollment of first 12, 24 and 36 patients. Patients affected by high-risk (≥N2a or ≥T3, any N) larynx, hypopharynx and HPV negative oropharynx or HPV-positive oropharynx (≥T2, ≥N2b, ≥10 pack/years) will be eligible. Conventional intensification strategies failed to provide any benefit for the cure of locally advanced HNSCC. For the still prevalent HPV-negative population and the high risk-HPV positive disease, there is an unmet need for alternative treatment paradigms. Potentially, the inhibition of the PD-1/PD-L1 checkpoint may synergize with both CTX and RT through immunologic interplay, ultimately aiming to reverse the HNSCC-induced immune suppression. The DUCRO study will seek to demonstrate if such a strategy may be safe and active. NCT number: NCT03051906Eudract number: 2016-004668-20.

  4. Head and neck cancer

    International Nuclear Information System (INIS)

    Vogl, S.E.

    1988-01-01

    This book contains 10 chapters. Some of the titles are: Combined Surgical Resection and Irradiation for Head and Neck Cancers; Analysis of Radiation Therapy Oncology Group Head and Neck Database: Identification of Prognostic Factors and the Re-evaluation of American Joint Committee Stages; Combined Modality Approach to Head and Neck Cancer; Induction Combination Chemotherapy of Regionally Advanced Head and Neck Cancer; and Outcome after Complete Remission to Induction Chemotherapy in Head and Neck Cancer

  5. A network meta-analysis of the sequencing and types of systemic therapies with definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LASCCHN)☆.

    Science.gov (United States)

    Jerzak, Katarzyna J; Delos Santos, Keemo; Saluja, Ronak; Lien, Kelly; Lee, Justin; Chan, Kelvin K W

    2017-08-01

    The current standard therapy for locally advanced squamous cell carcinoma of the head and neck (LASCCHN) is platinum-based chemotherapy plus concurrent radiotherapy (CRT), but several systemic therapies have been evaluated. We performed a Bayesian network meta-analysis (NMA) with random effects to enable direct and indirect comparisons of all existing treatment modalities for LASCCHN simultaneously. A systematic review was conducted using MEDLINE, EMBASE, ASCO abstracts, ASTRO abstracts and the Cochrane Central of Registered Trials using Cochrane methodology to identify randomized controlled trials (RCTs) up to June 2016. Only abstracts that involved the same definitive radiotherapy in the arms for the RCT were included. Sixty-five RCTs involving 13,574 patients and 16 different treatment strategies were identified. Chemotherapy plus concurrent radiation (CRT) was superior to RT with a HR of 0.74 (95%CR 0.69-0.79) for OS in the NMA. Only 3 trials compared RT alone to concurrent therapy with an EGFR antibody (ERT), demonstrating a superior OS (HR 0.75, 95% CR 0.60-0.94), but this difference was not statistically significant when interpreted in a NMA (HR 0.84, 95%CR 0.65-1.08). ERT was not superior to CRT (HR 1.19, 95%CR 0.93-1.54), and the addition of neo-adjuvant taxane-based chemotherapy to CRT was not beneficial (HR 0.86, 95% CR 0.70-1.07). The addition of either adjuvant or neoadjuvant chemotherapy to the CRT backbone does not confer an OS benefit in the treatment of LASCCHN. Similarly, ERT does not confer an OS benefit for patients who are eligible for CRT. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. T.i.d. radiotherapy with or without alternating chemotherapy in patients with a locally advanced squamous cell carcinoma of the head or neck: an analysis of late toxicity

    International Nuclear Information System (INIS)

    Laszlo, A.; Rosset, A.; Ozsahin, M.; Zouhair, A.; Mirimanoff, R.O.; Laszlo, A.; Hermann, F.

    2001-01-01

    To assess late effects and quality of life in patients treated by three times daily (t.i.d.) radiotherapy with or without alternating chemotherapy for locally advanced squamous cell carcinoma of the head and neck. Between 1986 and 1991, 153 patients with locally advanced tumors have been included in a phase I/II study consisting of t.i.d. radiotherapy (4 h. between fractions) of 2 Gy/fraction to a total dose of 60 Gy, alternated or not with combination chemotherapy. The first group of patients received radiotherapy alone, the other group received combined modality. Ninety-two patients were eligible for late effect assessment: 61 in the combined modality group and 31 in the radiation therapy only group. The median follow-up was 45 months. All patients have been assessed according to the follow-up clinical records using the RTOG/EORTC classification. Twenty-nine patients, who were alive at the time of our study, received a questionnaire on their quality of life, and were invited for a clinical evaluation using the SOMA-LENT scale. Ninety percent of the patients treated by radiation therapy alone developed one or more late complications. Overall, 47% of the patients have developed severe complications (grade III and IV): 42% in the group treated by radiation therapy alone and 49% in the group treated with combined modality. In the group treated by radiation therapy alone, the most commonly damaged organs were the mucosa (83%), skin (51%) and salivary glands (42%). We observed one case of osteonecrosis and one case of radiation myelitis. In the combined modality group, 95% of patients developed one or more late sequelae, of which 79% had skin, 51% mucosa and 42% salivary gland late effects, respectively. We observed four cases of osteonecrosis. Quality of life and overall physical condition of the patients have been judged to be average by self-questionnaire. Assessment according to the SOMA-LENT scale showed serious late effects mainly at the level of the salivary

  7. Head injury - first aid

    Science.gov (United States)

    ... medlineplus.gov/ency/article/000028.htm Head injury - first aid To use the sharing features on this page, ... a concussion can range from mild to severe. First Aid Learning to recognize a serious head injury and ...

  8. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... the head uses special x-ray equipment to help assess head injuries, severe headaches, dizziness, and other ... aneurysm, bleeding, stroke and brain tumors. It also helps your doctor to evaluate your face, sinuses, and ...

  9. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... for Brain Tumors Radiation Therapy for Head and Neck Cancer Others American Stroke Association National Stroke Association ... Computer Tomography (CT) Safety During Pregnancy Head and Neck Cancer X-ray, Interventional Radiology and Nuclear Medicine ...

  10. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... When the image slices are reassembled by computer software, the result is a very detailed multidimensional view ... Safety Images related to Computed Tomography (CT) - Head Videos related to Computed Tomography (CT) - Head Sponsored by ...

  11. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... the limitations of CT Scanning of the Head? What is CT Scanning of the Head? Computed tomography, ... than regular radiographs (x-rays). top of page What are some common uses of the procedure? CT ...

  12. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... Physician Resources Professions Site Index A-Z Computed Tomography (CT) - Head Computed tomography (CT) of the head uses special x-ray ... What is CT Scanning of the Head? Computed tomography, more commonly known as a CT or CAT ...

  13. Usefulness of Interim FDG-PET After Induction Chemotherapy in Patients With Locally Advanced Squamous Cell Carcinoma of the Head and Neck Receiving Sequential Induction Chemotherapy Followed by Concurrent Chemoradiotherapy

    International Nuclear Information System (INIS)

    Yoon, Dok Hyun; Cho, Yoojin; Kim, Sang Yoon; Nam, Soon Yuhl; Choi, Seung-Ho; Roh, Jong-Lyel; Lee, Sang-wook; Song, Si Yeol; Lee, Jeong Hyun; Kim, Jae Seung; Cho, Kyung-Ja; Kim, Sung-Bae

    2011-01-01

    Purpose: Induction chemotherapy (ICT) has been used to select patients for organ preservation and determine subsequent treatments in patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN). Still, the clinical outcomes of LASCCHN patients who showed response to ICT are heterogeneous. We evaluated the efficacy of interim 18-fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) after ICT in this specific subgroup of LASCCHN patients who achieved partial response (PR) after ICT to predict clinical outcomes after concurrent chemoradiotherapy (CCRT). Methods and Materials: Twenty-one patients with LASCCHN who showed PR to ICT by Response Evaluation Criteria In Solid Tumors before definitive CCRT were chosen in this retrospective analysis. FDG-PET was performed before and 2-4 weeks after ICT to assess the extent of disease at baseline and the metabolic response to ICT, respectively. We examined the correlation of the metabolic response by the percentage decrease of maximum standardized uptake value (SUVmax) on the primary tumor or lymph node after ICT or a specific threshold of SUVmax on interim FDG-PET with clinical outcomes including complete response (CR) rate to CCRT, progression-free survival (PFS), and overall survival (OS). Results: A SUVmax of 4.8 on interim FDG-PET could predict clinical CR after CCRT (100% vs. 20%, p = 0.001), PFS (median, not reached vs. 8.5 mo, p < 0.001), and OS (median, not reached vs. 12.0 months, p = 0.001) with a median follow-up of 20.3 months in surviving patients. A 65% decrease in SUVmax after ICT from baseline also could predict clinical CR after CCRT (100% vs. 33.3%, p = 0.003), PFS (median, not reached vs. 8.9 months, p < 0.001) and OS (median, not reached vs. 24.4 months, p = 0.001) of the patients. Conclusion: These data suggest that interim FDG-PET after ICT might be a useful determinant to predict clinical outcomes in patients with LASCCHN receiving sequential ICT followed by CCRT.

  14. Nodal parameters of FDG PET/CT performed during radiotherapy for locally advanced mucosal primary head and neck squamous cell carcinoma can predict treatment outcomes: SUVmean and response rate are useful imaging biomarkers

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Peter [Liverpool Hospital, Department of Nuclear Medicine and PET, Liverpool BC, NSW (Australia); University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Western Sydney University, Sydney, NSW (Australia); Min, Myo; Forstner, Dion [University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); Ingham Institute of Applied Medical Research, Liverpool, NSW (Australia); Lee, Mark [University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); Holloway, Lois [University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Western Sydney University, Sydney, NSW (Australia); Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); Ingham Institute of Applied Medical Research, Liverpool, NSW (Australia); Bray, Victoria; Fowler, Allan [Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia)

    2017-05-15

    To evaluate the prognostic utility of nodal metabolic parameters derived from FDG PET/CT performed before radiotherapy (prePET) and during the third week of radiotherapy (iPET) in patients with mucosal primary head and neck squamous cell carcinoma (MPHNSCC). This analysis included 75 patients with newly diagnosed locally advanced node-positive MPHNSCC treated with radical radiotherapy and concurrent systemic therapy who underwent prePET and iPET: N1 11 patients, N2a 38, N2b 12, N2c 9, N3 5. The median follow-up was 28 months (9 - 70 months). The maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of the index lymph node (node with the highest TLG) and the combined total lymph nodes, and their percentage reductions on iPET were determined, and the results were correlated with 3-year Kaplan-Meier locoregional, regional and distant metastatic failure-free survival (FFS), disease-free survival (DFS) and overall survival (OS). Optimal cut-off values were derived from receiver operating characteristic curves. Cox regression univariate and multivariate analyses with clinical covariates were performed. Based on assessment of residual nodal metabolic burden during treatment, the iPET index node SUVmean (optimal cut-off value 2.95 g/ml) and the total node SUVmean (optimal cut-off value 3.25) were the best independent predictors of outcome in the multivariate analysis: index node SUVmean for DFS and OS p = 0.033 and 0.003, respectively, and the total node SUVmean for locoregional FFS, DFS and OS p = 0.028, 0.025 and 0.014, respectively. Based on the assessment of response rates during treatment, a reduction of more than 50 % in the total node TLG was the best biomarker for locoregional and regional FFS, DFS and OS in the multivariate analysis (p = 0.001, 0.016, 0.001 and 0.004, respectively), and reduction in the total node MTV for locoregional FFS, DFS and OS (p = 0.026, 0.003 and 0

  15. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ... Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ...

  16. Heading-vector navigation based on head-direction cells and path integration.

    Science.gov (United States)

    Kubie, John L; Fenton, André A

    2009-05-01

    Insect navigation is guided by heading vectors that are computed by path integration. Mammalian navigation models, on the other hand, are typically based on map-like place representations provided by hippocampal place cells. Such models compute optimal routes as a continuous series of locations that connect the current location to a goal. We propose a "heading-vector" model in which head-direction cells or their derivatives serve both as key elements in constructing the optimal route and as the straight-line guidance during route execution. The model is based on a memory structure termed the "shortcut matrix," which is constructed during the initial exploration of an environment when a set of shortcut vectors between sequential pairs of visited waypoint locations is stored. A mechanism is proposed for calculating and storing these vectors that relies on a hypothesized cell type termed an "accumulating head-direction cell." Following exploration, shortcut vectors connecting all pairs of waypoint locations are computed by vector arithmetic and stored in the shortcut matrix. On re-entry, when local view or place representations query the shortcut matrix with a current waypoint and goal, a shortcut trajectory is retrieved. Since the trajectory direction is in head-direction compass coordinates, navigation is accomplished by tracking the firing of head-direction cells that are tuned to the heading angle. Section 1 of the manuscript describes the properties of accumulating head-direction cells. It then shows how accumulating head-direction cells can store local vectors and perform vector arithmetic to perform path-integration-based homing. Section 2 describes the construction and use of the shortcut matrix for computing direct paths between any pair of locations that have been registered in the shortcut matrix. In the discussion, we analyze the advantages of heading-based navigation over map-based navigation. Finally, we survey behavioral evidence that nonhippocampal

  17. Non-invasive head fixation for external irradiation of tumors of the head and neck

    International Nuclear Information System (INIS)

    Bale, R.J.; Sweeney, R.; Nevinny, M.; Auer, T.; Bluhm, A.; Lukas, P.; Vogele, M.; Thumfart, W.F.

    1998-01-01

    Purpose: To fully utilize the technical capabilities of radiation diagnostics and planning, a precise and reproducible method of head fixation is a prerequisite. Method: We have adapted the Vogele-Bale-Hohner (VBH) head holder (Wellhoefer Dosimetrie, Schwarzenbruck, Germany), originally designed for frameless stereotactic operations, to the requirements of external beam radiotherapy. A precise and reproducible head fixation is attained by an individualized vacuum upper-dental cast which is connected over 2 hydraulic arms to an adjustable head- and rigid base-plate. Radiation field and patient alignment lasers are marked on a relocatable clear PVC localization box. Results: The possibility of craniocaudal adjustment of the head plate on the base plate allows the system to adapt to the actucal position of the patient on the raditherapy couch granting tensionless repositioning. The VBH head holder has proven itself to be a precise yet practicable method of head fixation. Duration of mouthpiece production and daily repositioning is comparable to that of the thermoplastic mask. Conclusion: The new head holder is in routine use at our hospital and quite suitable for external beam radiation of patients with tumors of the head and neck. (orig.) [de

  18. Evaluation of the impact of tumor HPV status on outcome in patients with locally advanced unresectable head and neck squamous cell carcinoma (HNSCC) receiving cisplatin, 5-fluorouracil with or without docetaxel: a subset analysis of EORTC 24971 study

    NARCIS (Netherlands)

    Psyrri, A.; Fortpied, C.; Koutsodontis, G.; Avgeris, M.; Kroupis, C.; Goutas, N.; Menis, J.; Herman, L.; Giurgea, L.; Remenar, E.; Degardin, M.; Pateras, I.S.; Langendijk, J.A.; Herpen, C.M.L. van; Awada, A.; Germa-Lluch, J.R.; Kienzer, H.R.; Licitra, L.; Vermorken, J.B.

    2017-01-01

    Background: EORTC 24971 was a phase III trial demonstrating superiority of induction regimen TPF (docetaxel, cisplatin, 5-fluorouracil) over PF (cisplatin/5-fluorouracil), in terms of progression-free (PFS) and overall survival (OS) in locoregionally advanced unresectable head and neck squamous cell

  19. Head CT scan

    Science.gov (United States)

    ... scan - orbits; CT scan - sinuses; Computed tomography - cranial; CAT scan - brain ... head size in children Changes in thinking or behavior Fainting Headache, when you have certain other signs ...

  20. Bottom head assembly

    International Nuclear Information System (INIS)

    Fife, A.B.

    1998-01-01

    A bottom head dome assembly is described which includes, in one embodiment, a bottom head dome and a liner configured to be positioned proximate the bottom head dome. The bottom head dome has a plurality of openings extending there through. The liner also has a plurality of openings extending there through, and each liner opening aligns with a respective bottom head dome opening. A seal is formed, such as by welding, between the liner and the bottom head dome to resist entry of water between the liner and the bottom head dome at the edge of the liner. In the one embodiment, a plurality of stub tubes are secured to the liner. Each stub tube has a bore extending there through, and each stub tube bore is coaxially aligned with a respective liner opening. A seat portion is formed by each liner opening for receiving a portion of the respective stub tube. The assembly also includes a plurality of support shims positioned between the bottom head dome and the liner for supporting the liner. In one embodiment, each support shim includes a support stub having a bore there through, and each support stub bore aligns with a respective bottom head dome opening. 2 figs

  1. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... Physician Resources Professions Site Index A-Z Computed Tomography (CT) - Head Computed tomography (CT) of the head uses special x-ray equipment ... story here Images × Image Gallery Patient undergoing computed tomography (CT) scan. View full size with caption Pediatric Content ...

  2. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... Computed tomography (CT) of the head uses special x-ray equipment to help assess head injuries, severe headaches, ... is a diagnostic medical test that, like traditional x-rays, produces multiple images or pictures of the inside ...

  3. Reactor head shielding apparatus

    International Nuclear Information System (INIS)

    Schukei, G.E.; Roebelen, G.J.

    1992-01-01

    This patent describes a nuclear reactor head shielding apparatus for mounting on spaced reactor head lifting members radially inwardly of the head bolts. It comprises a frame of sections for mounting on the lifting members and extending around the top central area of the head, mounting means for so mounting the frame sections, including downwardly projecting members on the frame sections and complementary upwardly open recessed members for fastening to the lifting members for receiving the downwardly projecting members when the frame sections are lowered thereto with lead shielding supported thereby on means for hanging lead shielding on the frame to minimize radiation exposure or personnel working with the head bolts or in the vicinity thereof

  4. Femoral head avascular necrosis

    International Nuclear Information System (INIS)

    Chrysikopoulos, H.; Sartoris, D.J.; Resnick, D.L.; Ashburn, W.; Pretorius, T.

    1988-01-01

    MR imaging has been shown to be more sensitive and specific than planar scintigraphy for avascular necrosis (AVN) of the femoral head. However, experience with single photon emission CT (SPECT) is limited. The authors retrospectively compared 1.5-T MR imaging with SPECT in 14 patients with suspected femoral head AVN. Agreement between MR imaging and SPECT was present in 24 femurs, 14 normal and ten with AVN. MR imaging showed changes of AVN in the remaining four femoral heads. Of these, one was normal and the other three inconclusive for AVN by SPECT. The authors conclude that MR imaging is superior to SPECT for the evaluation of AVN of the hip

  5. Protective head of sensors

    International Nuclear Information System (INIS)

    Liska, K.; Anton, P.

    1987-01-01

    The discovery concerns the protective heads of diagnostic assemblies of nuclear power plants for conductors of the sensors from the fuel and control parts of the said assemblies. A detailed description is presented of the design of the protective head which, as compared with the previous design, allows quick and simple assembly with reduced risk of damaging the sensors. The protective head may be used for diagnostic assemblies both in power and in research reactors and it will be used for WWER reactor assemblies. (A.K.). 3 figs

  6. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... you! Do you have a personal story about radiology? Share your patient story here Images × Image Gallery ... Pregnancy Head and Neck Cancer X-ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to ...

  7. Exploding head syndrome.

    Science.gov (United States)

    Sharpless, Brian A

    2014-12-01

    Exploding head syndrome is characterized by the perception of abrupt, loud noises when going to sleep or waking up. They are usually painless, but associated with fear and distress. In spite of the fact that its characteristic symptomatology was first described approximately 150 y ago, exploding head syndrome has received relatively little empirical and clinical attention. Therefore, a comprehensive review of the scientific literature using Medline, PsycINFO, Google Scholar, and PubMed was undertaken. After first discussing the history, prevalence, and associated features, the available polysomnography data and five main etiological theories for exploding head syndrome are summarized. None of these theories has yet reached dominance in the field. Next, the various methods used to assess and treat exploding head syndrome are discussed, as well as the limited outcome data. Finally, recommendations for future measure construction, treatment options, and differential diagnosis are provided. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... medically necessary because of potential risk to the baby. This risk is, however, minimal with head CT ... intravenous contrast indicate mothers should not breastfeed their babies for 24-48 hours after contrast medium is ...

  9. Early Head Start Evaluation

    Data.gov (United States)

    U.S. Department of Health & Human Services — Longitudinal information from an evaluation where children were randomly assigned to Early Head Start or community services as usual;direct assessments and...

  10. Computed Tomography (CT) -- Head

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    Full Text Available ... top of page Additional Information and Resources RTAnswers.org Radiation Therapy for Brain Tumors Radiation Therapy for ... Tomography (CT) - Head Sponsored by Please note RadiologyInfo.org is not a medical facility. Please contact your ...

  11. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... of the Head? Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic ... white on the x-ray; soft tissue, such as organs like the heart or liver, shows up ...

  12. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... microphone. top of page How does the procedure work? In many ways CT scanning works very much ... head CT scanning. Manufacturers of intravenous contrast indicate mothers should not breastfeed their babies for 24-48 ...

  13. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... rays). top of page What are some common uses of the procedure? CT scanning of the head ... is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. ...

  14. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... rays). top of page What are some common uses of the procedure? CT scanning of the head ... community, you can search the ACR-accredited facilities database . This website does not provide cost information. The ...

  15. Head Start Impact Study

    Data.gov (United States)

    U.S. Department of Health & Human Services — Nationally representative, longitudinal information from an evaluation where children were randomly assigned to Head Start or community services as usual;direct...

  16. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... Stroke Brain Tumors Computer Tomography (CT) Safety During Pregnancy Head and Neck Cancer X-ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to Computed Tomography (CT) - ...

  17. TCGA head Neck

    Science.gov (United States)

    Investigators with The Cancer Genome Atlas (TCGA) Research Network have discovered genomic differences – with potentially important clinical implications – in head and neck cancers caused by infection with the human papillomavirus (HPV).

  18. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... your doctor to evaluate your face, sinuses, and skull or to plan radiation therapy for brain cancer. ... typically used to detect: bleeding, brain injury and skull fractures in patients with head injuries. bleeding caused ...

  19. The exploding head syndrome.

    Science.gov (United States)

    Green, M W

    2001-06-01

    This article reviews the features of an uncommon malady termed "the exploding head syndrome." Sufferers describe terrorizing attacks of a painless explosion within their head. Attacks tend to occur at the onset of sleep. The etiology of attacks is unknown, although they are considered to be benign. Treatment with clomipramine has been suggested, although most sufferers require only reassurance that the spells are benign in nature.

  20. GPK heading machine

    Energy Technology Data Exchange (ETDEWEB)

    Krmasek, J.; Novosad, K.

    1981-01-01

    This article evaluates performance tests of the Soviet made GPK heading machine carried out in 4 coal mines in Czechoslovakia (Ostrava-Karvina region and Kladno mines). GPK works in coal seams and rocks with compression strength of 40 to 50 MPa. Dimensions of the tunnel are height 1.8 to 3.8 m and width 2.6 to 4.7 m, tunnel gradient plus to minus 10 degrees. GPK weighs 16 t, its conical shaped cutting head equipped with RKS-1 cutting tools is driven by an electric motor with 55 kW capacity. Undercarriage of the GPK, gathering-arm loader, hydraulic system, electric system and dust supression system (water spraying or pneumatic section) are characterized. Specifications of GPK heading machines are compared with PK-3r and F8 heading machines. Reliability, number of failures, dust level, noise, productivity depending on compression strength of rocks, heading rate in coal and in rocks, energy consumption, performance in inclined tunnels, and cutting tool wear are evaluated. Tests show that GPK can be used to drive tunnels in coal with rock constituting up to 50% of the tunnel crosscut, as long as rock compression strength does not exceed 50 MPa. In rocks characterized by higher compression strength cutting tool wear sharply increases. GPK is characterized by higher productivity than that of the PK-3r heading machine. Among the weak points of the GPK are: unsatisfactory reliability and excessive wear of its elements. (4 refs.) (In Czech)

  1. Evaluation of prognostic factors and two radiation techniques in patients treated with surgery followed by radio(chemo)therapy or definitive radio(chemo) therapy for locally advanced head-and-neck cancer

    International Nuclear Information System (INIS)

    Rades, D.; Stoehr, M.; Meyners, T.; Bohlen, G.; Nadrowitz, R.; Dunst, J.; Wroblewski, J.; Albers, D.; Schmidt, R.; Alberti, W.; Tribius, S.; University Medical Center Hamburg-Eppendorf, Hamburg

    2008-01-01

    Background and purpose: conventional radiotherapy (RT) still is the standard technique for head-and-neck cancer in many centers worldwide, whereas other centers replaced this technique by 3-D conformal RT, which is associated with more appropriate dose distributions. Comparative studies regarding outcome and toxicity are lacking. This study compared both techniques for overall survival (OS), metastases-free survival (MFS), loco-regional control (LC), and toxicity in stage III/IV head-and-neck cancer. Patients and methods: data of 345 patients irradiated for stage III/IV squamous cell head-and-neck cancer were retrospectively analyzed. Patients received conventional RT (group A, n = 166) or 3-D conformal RT (group B, n = 179). Both techniques were compared for outcomes and toxicity. Eleven further potential prognostic factors were investigated: age, gender, performance status, tumor site, grading, T-stage, N-stage, AJCC-stage, chemotherapy, surgery, pre-RT hemoglobin. Results: 3-year-OS was 62% in group A and 57% in group B (p = 0.15). 3-year-MFS was 67% and 76% (p = 0.46), 3-year-LC was 65% and 68%, respectively (p = 0.71). On multivariate analysis, gender (p = 0.005), performance status (p < 0.001), T-stage (p = 0.002), and N-stage (p < 0.001) were associated with OS. MFS was influenced by performance status (p < 0.001) and N-stage (p < 0.001), LC by gender (p = 0.021), T-stage (p < 0.001), and pre-RT hemoglobin level (≥ 12 better than < 12 g/dl, p = 0.004). Grade 2-3 xerostomia was less frequent with 3-D conformal RT (43% vs. 58%, p = 0.06). Otherwise, toxicities were similar. Conclusion: both RT techniques resulted in similar treatment outcomes. Because xerostomia was less with 3-D conformal RT, this technique appeared beneficial for patients, in whom one parotid gland can be spared. Outcome was associated with gender, performance status, tumor stage, and pre-RT hemoglobin. (orig.)

  2. Head circumference in Iranian infants

    Directory of Open Access Journals (Sweden)

    Mohammad Esmaeili

    2015-03-01

    Full Text Available Introduction: Head circumference (HC measurement is one of the important parameter for diagnosis of neurological, developmental disorders and dysmorphic syndromes. Recognition of different disorders requires an understanding of normal variation for HC size, in particular, in infancy period with most rapid growth of the brain. Because of international and interracial standard chart differences about anthropometric indices, some differences from local to local, generation to generation and changes in ethnic mix of population and socioeconomic factors, periodic revolution of HC size is suggested. The aims of our study were presenting local HC standard for an Iranian infant population and comparison with the American national center of health statistics (NCHS charts accepted by WHO. Methods: 1003 subjects aged from birth to 24 months apparently healthy normal children enrolled randomly in this cross sectional study. HC size were measured and recorded. Tables and graphs were depicted by Excel Microsoft Office 2007. We use two tailed t-student test for statistical analysis. Results: The mean of HC size in boys was larger than girls. The curves were followed a similar pattern to NCHS based on a visual comparison. Overall our subjects in both sexes at birth time had smaller HC size than NCHS. In other ages our children had larger HC size than those of NCHS. Conclusion: Because of international and interracial difference of HC size. We recommend in each area of the world, local anthropometric indices are constructed and used clinically. In addition more extensive and longitudinally design comprehensive studies is suggested.

  3. Head turning as a prominent motor symptom in status epilepticus.

    Science.gov (United States)

    Bauer, Gerhard; Broessner, Gregor; Unterberger, Iris; Walser, Gerald; Pfausler, Bettina; Trinka, Eugen

    2008-06-01

    Head and eye turning is frequently observed during seizures. Versions with tonic and/or clonic symptoms can be differentiated from smooth head deviations. Head turning as a prominent symptom of status epilepticus has not previously been reported. We present eight case reports, (7 women/1 man, mean age 41 years, median 41.5, range 10 to 74), of status epilepticus (SE), with head turning as a prominent motor symptom. Six were accompanied by continuous frontal, occipital and temporal ictal epileptiform discharges. Furthermore, two patients had absence status with rhythmic and clonic head versions. While the localizing significance of head turnings in SE is low, in our cases, the direction was away from the discharging hemisphere in all cases of focal SE regardless of whether the turning was classified as version (three cases) or deviation (three cases). In this small series of SE, the classical observation of a patient looking away from the discharging hemisphere is still valid.

  4. Magnetic Resonance Imaging (MRI) -- Head

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Head Magnetic resonance imaging (MRI) of the head uses a powerful ... the Head? What is MRI of the Head? Magnetic resonance imaging (MRI) is a noninvasive medical test that ...

  5. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Head Magnetic resonance imaging (MRI) of the head uses a powerful ... the Head? What is MRI of the Head? Magnetic resonance imaging (MRI) is a noninvasive medical test that ...

  6. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ...

  7. Head, Neck, and Oral Cancer

    Science.gov (United States)

    ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ...

  8. Ghost Head Nebula

    Science.gov (United States)

    1999-01-01

    Looking like a colorful holiday card, a new image from NASA's Hubble Space Telescope reveals a vibrant green and red nebula far from Earth. The image of NGC 2080, taken by Hubble's Wide Field and Planetary Camera 2, designed and built by NASA's Jet Propulsion Laboratory, Pasadena, Calif., is available online at http://www.jpl.nasa.gov/images/wfpc . Images like this help astronomers investigate star formation in nebulas. NGC 2080, nicknamed 'The Ghost Head Nebula,' is one of a chain of star-forming regions lying south of the 30 Doradus nebula in the Large Magellanic Cloud. 30 Doradus is the largest star-forming complex in the local group of galaxies. This 'enhanced color' picture is composed of three narrow-band-filter images obtained by Hubble on March 28, 2000. The red and blue light come from regions of hydrogen gas heated by nearby stars. The green light on the left comes from glowing oxygen. The energy to illuminate the green light is supplied by a powerful stellar wind, a stream of high-speed particles coming from a massive star just outside the image. The central white region is a combination of all three emissions and indicates a core of hot, massive stars in this star-formation region. Intense emission from these stars has carved a bowl-shaped cavity in surrounding gas. In the white region, the two bright areas (the 'eyes of the ghost') - named A1 (left) and A2 (right) -- are very hot, glowing 'blobs' of hydrogen and oxygen. The bubble in A1 is produced by the hot, intense radiation and powerful stellar wind from one massive star. A2 contains more dust and several hidden, massive stars. The massive stars in A1 and A2 must have formed within the last 10,000 years, since their natal gas shrouds are not yet disrupted by the powerful radiation of the newborn stars. The Space Telescope Science Institute is operated by the Association of Universities for Research in Astronomy, Inc., for NASA, under contract with the Goddard Space Flight Center, Greenbelt, Md. The

  9. Pre-trial quality assurance processes for an intensity-modulated radiation therapy (IMRT) trial: PARSPORT, a UK multicentre Phase III trial comparing conventional radiotherapy and parotid-sparing IMRT for locally advanced head and neck cancer.

    Science.gov (United States)

    Clark, C H; Miles, E A; Urbano, M T Guerrero; Bhide, S A; Bidmead, A M; Harrington, K J; Nutting, C M

    2009-07-01

    The purpose of this study was to compare conventional radiotherapy with parotid gland-sparing intensity-modulated radiation therapy (IMRT) using the PARSPORT trial. The validity of such a trial depends on the radiotherapy planning and delivery meeting a defined standard across all centres. At the outset, many of the centres had little or no experience of delivering IMRT; therefore, quality assurance processes were devised to ensure consistency and standardisation of all processes for comparison within the trial. The pre-trial quality assurance (QA) programme and results are described. Each centre undertook exercises in target volume definition and treatment planning, completed a resource questionnaire and produced a process document. Additionally, the QA team visited each participating centre. Each exercise had to be accepted before patients could be recruited into the trial. 10 centres successfully completed the quality assurance exercises. A range of treatment planning systems, linear accelerators and delivery methods were used for the planning exercises, and all the plans created reached the standard required for participation in this multicentre trial. All 10 participating centres achieved implementation of a comprehensive and robust IMRT programme for treatment of head and neck cancer.

  10. Head first Ajax

    CERN Document Server

    Riordan, Rebecca M

    2008-01-01

    Ajax is no longer an experimental approach to website development, but the key to building browser-based applications that form the cornerstone of Web 2.0. Head First Ajax gives you an up-to-date perspective that lets you see exactly what you can do -- and has been done -- with Ajax. With it, you get a highly practical, in-depth, and mature view of what is now a mature development approach. Using the unique and highly effective visual format that has turned Head First titles into runaway bestsellers, this book offers a big picture overview to introduce Ajax, and then explores the use of ind

  11. Head First Statistics

    CERN Document Server

    Griffiths, Dawn

    2009-01-01

    Wouldn't it be great if there were a statistics book that made histograms, probability distributions, and chi square analysis more enjoyable than going to the dentist? Head First Statistics brings this typically dry subject to life, teaching you everything you want and need to know about statistics through engaging, interactive, and thought-provoking material, full of puzzles, stories, quizzes, visual aids, and real-world examples. Whether you're a student, a professional, or just curious about statistical analysis, Head First's brain-friendly formula helps you get a firm grasp of statistics

  12. Silva as the Head

    DEFF Research Database (Denmark)

    Svabo, Connie

    2015-01-01

    The head of the performance design programme is substituted by a sister's academy delegate. this performance situation formed part of a week of semesterstart where the students and professors visited Sister's Academy, Malmø. I participated in the Sister's Academy as visiting researcher and here i...

  13. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Computed Tomography (CT) - Head ...

  14. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... are present in the paranasal sinuses. plan radiation therapy for cancer of the brain or other tissues. guide the ... RTAnswers.org Radiation Therapy for Brain Tumors Radiation Therapy for Head and Neck Cancer Others American Stroke Association National Stroke Association top ...

  15. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... full size with caption Pediatric Content Some imaging tests and treatments have special pediatric considerations. The teddy bear denotes child-specific content. Related Articles and Media Radiation Dose in X-Ray and CT Exams Blood Clots CT Perfusion of the Head CT Angiography ( ...

  16. The Twente humanoid head

    NARCIS (Netherlands)

    Reilink, Rob; Visser, L.C.; Bennik, J.; Carloni, Raffaella; Brouwer, Dannis Michel; Stramigioli, Stefano

    2009-01-01

    This video shows the results of the project on the mechatronic development of the Twente humanoid head. The mechanical structure consists of a neck with four degrees of freedom (DOFs) and two eyes (a stereo pair system) which tilt on a common axis and rotate sideways freely providing a three more

  17. Auditory Spatial Perception: Auditory Localization

    Science.gov (United States)

    2012-05-01

    body movements that affect localization performance are tipping the chin toward the chest, tilting the body, or pivoting the head toward one or the... Compensatory Strategies . Brain 2002, 125, 1039–1053. Lee, P. L.; Wang, J. H. The Simulation of Binaural Hearing Caused by a Moving Sound Source...during the listening task changes the listener’s 140 listening plane. With a tilted head , the listener is pointing in an oblique plane that

  18. Merkel cell carcinoma of the head and neck

    NARCIS (Netherlands)

    Takes, R. P.; Balm, A. J.; Loftus, B. M.; Baris, G.; Hilgers, F. J.; Gregor, R. T.

    1994-01-01

    Merkel cell carcinoma is a rare cutaneous tumour that typically arises in the head and neck area of elderly patients. The tumour often follows an aggressive course with frequent local recurrences and (regional) metastases, especially when localized above the clavicles. Five patients with a Merkel

  19. Head Rotation Detection in Marmoset Monkeys

    Science.gov (United States)

    Simhadri, Sravanthi

    Head movement is known to have the benefit of improving the accuracy of sound localization for humans and animals. Marmoset is a small bodied New World monkey species and it has become an emerging model for studying the auditory functions. This thesis aims to detect the horizontal and vertical rotation of head movement in marmoset monkeys. Experiments were conducted in a sound-attenuated acoustic chamber. Head movement of marmoset monkey was studied under various auditory and visual stimulation conditions. With increasing complexity, these conditions are (1) idle, (2) sound-alone, (3) sound and visual signals, and (4) alert signal by opening and closing of the chamber door. All of these conditions were tested with either house light on or off. Infra-red camera with a frame rate of 90 Hz was used to capture of the head movement of monkeys. To assist the signal detection, two circular markers were attached to the top of monkey head. The data analysis used an image-based marker detection scheme. Images were processed using the Computation Vision Toolbox in Matlab. The markers and their positions were detected using blob detection techniques. Based on the frame-by-frame information of marker positions, the angular position, velocity and acceleration were extracted in horizontal and vertical planes. Adaptive Otsu Thresholding, Kalman filtering and bound setting for marker properties were used to overcome a number of challenges encountered during this analysis, such as finding image segmentation threshold, continuously tracking markers during large head movement, and false alarm detection. The results show that the blob detection method together with Kalman filtering yielded better performances than other image based techniques like optical flow and SURF features .The median of the maximal head turn in the horizontal plane was in the range of 20 to 70 degrees and the median of the maximal velocity in horizontal plane was in the range of a few hundreds of degrees per

  20. Phase II Study Evaluating the Addition of Cetuximab to the Concurrent Delivery of Weekly Carboplatin, Paclitaxel, and Daily Radiotherapy for Patients With Locally Advanced Squamous Cell Carcinomas of the Head and Neck

    Energy Technology Data Exchange (ETDEWEB)

    Suntharalingam, Mohan, E-mail: msuntha@umm.edu [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD (United States); Kwok, Young [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD (United States); Goloubeva, Olga [University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD (United States); Parekh, Arti [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD (United States); Taylor, Rodney; Wolf, Jeffrey [Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, MD (United States); Zimrin, Ann [University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD (United States); Strome, Scott [Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, MD (United States); Ord, Robert [Department of Oral-Maxillo Facial Surgery, University of Maryland School of Medicine, Baltimore, MD (United States); Cullen, Kevin J. [University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD (United States)

    2012-04-01

    Purpose: To report the mature data of a prospective Phase II trial designed to evaluate the efficacy of an epidermal growth factor receptor inhibitor cetuximab (CTX) added to the concurrent therapy of weekly paclitaxel/carboplatin (PC) and daily radiation therapy (RT). Methods and Materials: From 2005 to 2009, a total of 43 patients were enrolled in the study. The median follow-up was 31 months (range, 9-59 months). All patients had Stage III/IV disease at presentation, and 67% had oropharyngeal primaries. The weekly IV dose schedules were CTX 250 mg/m{sup 2} (400 mg/m{sup 2} IV loading dose 1 week before RT), paclitaxel 40 mg/m{sup 2}, and carboplatin AUC 2. RT was given at 1.8 Gy per day to 70.2 Gy. Intensity-modulated RTwas used in 70% of cases. Results: All patients completed the planned RT dose, 74% without any treatment breaks. The planned CTX and PC cycles were completed in 70% (91% with at least seven of planned nine cycles) and 56% (93% with at least seven of planned eight cycles) of patients, respectively. Toxicity included Grade 3 mucositis (79%), rash (9%), leucopenia (19%), neutropenia (19%), and RT dermatitis (16%). The complete response (CR) rate at the completion of therapy was 84%. The estimated 3-year local regional control rate was 72%. Six patients with an initial CR subsequently experienced a local recurrence, 10 patients experienced distant progression. The median overall survival and disease-free survivals have not been reached. The 3-year actuarial overall survival and disease-free survival were 59% and 58%, respectively. Conclusions: The addition of CTX to weekly PC and daily RT was well tolerated and resulted in encouraging local control and survival rates.

  1. Phase II Study Evaluating the Addition of Cetuximab to the Concurrent Delivery of Weekly Carboplatin, Paclitaxel, and Daily Radiotherapy for Patients With Locally Advanced Squamous Cell Carcinomas of the Head and Neck

    International Nuclear Information System (INIS)

    Suntharalingam, Mohan; Kwok, Young; Goloubeva, Olga; Parekh, Arti; Taylor, Rodney; Wolf, Jeffrey; Zimrin, Ann; Strome, Scott; Ord, Robert; Cullen, Kevin J.

    2012-01-01

    Purpose: To report the mature data of a prospective Phase II trial designed to evaluate the efficacy of an epidermal growth factor receptor inhibitor cetuximab (CTX) added to the concurrent therapy of weekly paclitaxel/carboplatin (PC) and daily radiation therapy (RT). Methods and Materials: From 2005 to 2009, a total of 43 patients were enrolled in the study. The median follow-up was 31 months (range, 9–59 months). All patients had Stage III/IV disease at presentation, and 67% had oropharyngeal primaries. The weekly IV dose schedules were CTX 250 mg/m 2 (400 mg/m 2 IV loading dose 1 week before RT), paclitaxel 40 mg/m 2 , and carboplatin AUC 2. RT was given at 1.8 Gy per day to 70.2 Gy. Intensity-modulated RTwas used in 70% of cases. Results: All patients completed the planned RT dose, 74% without any treatment breaks. The planned CTX and PC cycles were completed in 70% (91% with at least seven of planned nine cycles) and 56% (93% with at least seven of planned eight cycles) of patients, respectively. Toxicity included Grade 3 mucositis (79%), rash (9%), leucopenia (19%), neutropenia (19%), and RT dermatitis (16%). The complete response (CR) rate at the completion of therapy was 84%. The estimated 3-year local regional control rate was 72%. Six patients with an initial CR subsequently experienced a local recurrence, 10 patients experienced distant progression. The median overall survival and disease-free survivals have not been reached. The 3-year actuarial overall survival and disease-free survival were 59% and 58%, respectively. Conclusions: The addition of CTX to weekly PC and daily RT was well tolerated and resulted in encouraging local control and survival rates.

  2. Brachytherapy in the treatment of head and neck cancer

    International Nuclear Information System (INIS)

    Yoo, Seong Yul

    1999-01-01

    Brachytherapy has been proved to be an effective method for the purpose of increasing radiation dose to the tumor and reducing the dose to the surrounding normal tissue. In head and neck cancer, the rationale of brachytherapy is as follows; Firstly, early small lesion is radiocurative and the major cause of failure is local recurrence. Secondly, it can diminish evidently the dose to the normal tissue especially masseteric muscle and salivary gland. Thirdly, the anatomy of head and neck is suitable to various technique of brachytherapy. On background of accumulated experience of LDR iridium brachytherapy of head and neck cancer for the last 15 years, the author reviewed the history of radioisotope therapy, the characteristics of radionuclides, and some important things in the method, clinical technique and treatment planning. The author analyzed the clinical result of 185 cases of head and neck cancer treated in the Korea Cancer Center Hospital. Finally the future prospect of brachytherapy of head and neck cancer is discussed

  3. Head and Neck Cancer Treatment

    Science.gov (United States)

    ... Professions Site Index A-Z Head and Neck Cancer Treatment Head and neck cancer overview What are my ... and neck cancer. For updated information on new cancer treatments that are available, you should discuss these issues ...

  4. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... for Brain Tumors Radiation Therapy for Head and Neck Cancer Others : American Stroke Association National Stroke Association ... MRA) Magnetic Resonance, Functional (fMRI) - Brain Head and Neck Cancer Treatment Brain Tumor Treatment Magnetic Resonance Imaging ( ...

  5. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... are the limitations of MRI of the Head? What is MRI of the Head? Magnetic resonance imaging ( ... brain) in routine clinical practice. top of page What are some common uses of the procedure? MR ...

  6. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed with ... and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed with ...

  7. Head Lice: Prevention and Control

    Science.gov (United States)

    ... and General Public. Contact Us Parasites Home Prevention & Control Language: English (US) Español (Spanish) Recommend on Facebook ... that can be taken to help prevent and control the spread of head lice: Avoid head-to- ...

  8. Cerebral localization in antiquity.

    Science.gov (United States)

    Rose, F Clifford

    2009-07-01

    Fragments of neurology can be found in the oldest medical writings in antiquity. Recognizable cerebral localization is seen in Egyptian medical papyri. Most notably, the Edwin Smith papyrus describes hemiplegia after a head injury. Similar echoes can be seen in Homer, the Bible, and the pre-Hippocratic writer Alcmaeon of Croton. While Biblical writers thought that the heart was the seat of the soul, Hippocratic writers located it in the head. Alexandrian anatomists described the nerves, and Galen developed the ventricular theory of cognition whereby mental functions are classified and localized in one of the cerebral ventricles. Medieval scholars, including the early Church Fathers, modified Galenic ventricular theory so as to make it a dynamic model of cognition. Physicians in antiquity subdivided the brain into separate areas and attributed to them different functions, a phenomenon that connects them with modern neurologists.

  9. MRI in head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Jin Kyo [Shin Wha Hospital, Seoul (Korea, Republic of)

    1986-02-15

    In the diagnosis of head injury, Magnetic Resonance Imaging (MRI), like CT, is an effective method of distinguishing between intracerebral and extracerebral lesions. In our experience of MRI, early hematomas are almost isointense by Saturation Recovery (SR) method, so these must be performed with Spin Echo (SE) method for better visualization of hematomas. Isodense subdural hematomas, which is a diagnostic dilemma on CT images, are clearly seen on MRI. Delayed hematomas or residual parenchymal lesions are better demonstrated on MRI than on CT. Direct cornal, sagittal images and multiplanar facility of MRI provides excellent visualization of the the location and shape of extracerebral collection of hematoma. For the screening of head traumas, SE method is a technique of choice because of its excellent sensitivity within limited time.

  10. Where is Russia heading?

    Directory of Open Access Journals (Sweden)

    Natalija Pliskevič

    1999-10-01

    Full Text Available The author examines the proceedings from the collection Where is Russia Heading? (= Куда идёт Россия?, published between 1994 and 1998 in connection with the international symposium held under this name each year in Moscow. The symposia and their proceeding, involving leading Russian and foreign experts, were significant in that they encompassed a wide range of themes – social, economic, political, legislative, cultural and other transformations that have been occurring in Russia during the past decades. The author, however, limits her review to contributions dealing with ethno-political and socio-cultural transformations in Russia. She concludes that the question – “Where is Russia heading?” – still remains open to answers.

  11. MRI in head trauma

    International Nuclear Information System (INIS)

    Hong, Jin Kyo

    1986-01-01

    In the diagnosis of head injury, Magnetic Resonance Imaging (MRI), like CT, is an effective method of distinguishing between intracerebral and extracerebral lesions. In our experience of MRI, early hematomas are almost isointense by Saturation Recovery (SR) method, so these must be performed with Spin Echo (SE) method for better visualization of hematomas. Isodense subdural hematomas, which is a diagnostic dilemma on CT images, are clearly seen on MRI. Delayed hematomas or residual parenchymal lesions are better demonstrated on MRI than on CT. Direct cornal, sagittal images and multiplanar facility of MRI provides excellent visualization of the the location and shape of extracerebral collection of hematoma. For the screening of head traumas, SE method is a technique of choice because of its excellent sensitivity within limited time.

  12. "Head versus heart"

    Directory of Open Access Journals (Sweden)

    Paul Rozin

    2007-08-01

    Full Text Available Most American respondents give ``irrational,'' magical responses in a variety of situations that exemplify the sympathetic magical laws of similarity and contagion. In most of these cases, respondents are aware that their responses (usually rejections, as of fudge crafted to look like dog feces, or a food touched by a sterilized, dead cockroach are not ``scientifically'' justified, but they are willing to avow them. We interpret this, in some sense, as ``heart over head.'' We report in this study that American adults and undergraduates are substantially less likely to acknowledge magical effects when the judgments involve money (amount willing to pay to avoid an ``unpleasant'' magical contact than they are when using preference or rating measures. We conclude that in ``head-heart'' conflicts of this type, money tips the balance towards the former, or, in other words, that money makes the mind less magical.

  13. Hyperfractionated accelerated radiation therapy plus cetuximab plus cisplatin chemotherapy in locally advanced inoperable squamous cell carcinoma of the head and neck. Final 5-year results of a phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Kuhnt, Thomas [University of Leipzig, Department of Imaging and Radiation Medicine, Clinic of Radiooncology, Leipzig (Germany); Schreiber, Andreas [Private Praxis for Radio Oncology Dresden, Dresden (Germany); Pirnasch, Anett [University of Rostock, Department of Radiation Oncology, Rostock (Germany); Hautmann, Matthias G. [University of Regensburg, Department of Radiotherapy, Regensburg (Germany); Hass, Peter [Otto von Guericke University of Magdeburg, Department of Radiotherapy, Magdeburg (Germany); Sieker, Frank P. [Martin Luther University of Halle-Wittenberg, Department of Radiotherapy, Halle (Saale) (Germany); Engenhart-Cabillic, Rita [Philipps University Marburg, Department of Radiotherapy, Marburg (Germany); Richter, Michael [Coordination Centre for Clinical Trials Halle, Halle (Saale) (Germany); Dellas, Kathrin; Dunst, Juergen [University of Kiel, Department of Radiation Oncology, Kiel (Germany)

    2017-09-15

    Cetuximab (CET) is a potent inhibitor of the epidermal growth factor receptor and has been shown to have activity in squamous cell carcinoma of the head and neck (SCCHN). We conducted a single-arm phase II trial of a combination therapy comprising cisplatin (CIS), CET and hyperfractionated accelerated radiotherapy (HART). Patients with UICC stage III or IVA/B, M0 SCCHN were enrolled and treated with an initial dose of CET (400 mg/m{sup 2}) and then with a weekly dosage of 250 mg/m{sup 2} during HART. HART was started with a prescribed dosage of 2.0 Gy per day for 3 weeks, followed by 1.4 Gy twice daily to a total dose of 70.6 Gy to the gross tumour volume. CIS (40 mg/m{sup 2}) was administered weekly (days 1, 8, 15, 22, 29 and 36). The primary objective of the phase II study was to determine the 2-year progression-free survival (PFS). Between November 2007 and November 2010, a total of 74 patients were enrolled in the study, of whom 65 were evaluable (83% were men). Median age was 56 years (range 37-69 years). An Oropharyngeal primary tumour was diagnosed in 49%, T4a,b in 65% and N2/3 in 96% of the patients. Of these patients, 85% were smokers or ex-smokers. Complete remission (CR) was observed in 23 patients (35%). The most common toxicity grade was ≥3, including mucositis (58%) and dysphagia (52%). The 2- and 5-year overall survival rates were 64 and 41%, the 2- and 5-year PFS rates were 45 and 32%, and the 2- and 5-year locoregional control rates were 47 and 33%, respectively. The combination of weekly CIS with HART plus CET is a feasible regimen for these unfavourable smoking-induced cancers. However, the parallel US study (RTOG 0522) showed no advantage of the enhanced triple therapy compared to chemoradiotherapy alone. (orig.) [German] Cetuximab (CET) ist ein potenter Inhibitor des epidermalen Wachstumsfaktor-Rezeptors, der schon bei Plattenepithelkarzinomen des Kopf-Hals-Bereichs (SCCHN) Wirkung gezeigt hat. Wir fuehrten eine prospektive, einarmige Phase

  14. [The exploding head syndrome].

    Science.gov (United States)

    Bongers, K M; ter Bruggen, J P; Franke, C L

    1991-04-06

    The case is reported of a 47-year old female suffering from the exploding head syndrome. This syndrome consists of a sudden awakening due to a loud noise shortly after falling asleep, sometimes accompanied by a flash of light. The patient is anxious and experiences palpitations and excessive sweating. Most patients are more than fifty years of age. Further investigations do not reveal any abnormality. The pathogenesis is unknown, and no therapy other than reassurance is necessary.

  15. Where are we heading

    International Nuclear Information System (INIS)

    Noto, L.A.

    1996-01-01

    The present paper deals with different aspects connected to the global petroleum industry by discussing the way of heading. The aspects cover themes like new frontiers, new relationships, sanctions, global climate change, new alliances and new technology. New frontiers and relationships concern domestic policy affecting the industry, and sanctions are discussed in connection with trade. The author discusses the industry's participation in the global environmental policy and new alliances to provide greater opportunity for developing new technology

  16. "Head versus heart"

    OpenAIRE

    Paul Rozin; Heidi Grant; Stephanie Weinberg; Scott Parker

    2007-01-01

    Most American respondents give ``irrational,'' magical responses in a variety of situations that exemplify the sympathetic magical laws of similarity and contagion. In most of these cases, respondents are aware that their responses (usually rejections, as of fudge crafted to look like dog feces, or a food touched by a sterilized, dead cockroach) are not ``scientifically'' justified, but they are willing to avow them. We interpret this, in some sense, as ``heart over head.'' We report in this ...

  17. Head segmentation in vertebrates

    OpenAIRE

    Kuratani, Shigeru; Schilling, Thomas

    2008-01-01

    Classic theories of vertebrate head segmentation clearly exemplify the idealistic nature of comparative embryology prior to the 20th century. Comparative embryology aimed at recognizing the basic, primary structure that is shared by all vertebrates, either as an archetype or an ancestral developmental pattern. Modern evolutionary developmental (Evo-Devo) studies are also based on comparison, and therefore have a tendency to reduce complex embryonic anatomy into overly simplified patterns. Her...

  18. Management of common head and neck masses.

    Science.gov (United States)

    Tracy, Thomas F; Muratore, Christopher S

    2007-02-01

    Head and neck masses are a common clinical concern in infants, children, and adolescents. The differential diagnosis for a head or neck mass includes congenital, inflammatory, and neoplastic lesions. An orderly and thorough examination of the head and neck with an appropriate directed workup will facilitate the diagnosis. The most common entities occur repeatedly within the various age groups and can be differentiated with a clear understanding of embryology and anatomy of the region, and an understanding of the natural history of a specific lesion. Congenital lesions most commonly found in the pediatric population include the thyroglossal duct cyst and the branchial cleft and arch anomalies. The inflammatory masses are secondary to local or systemic infections. The most common etiology for cervical adenopathy in children is reactive lymphadenopathy following a viral or bacterial illness. Persistent adenopathy raises more concerns, especially enlarged lymph nodes within the posterior triangle or supraclavicular space, nodes that are painless, firm, and not mobile, or a single dominant node that persists for more than 6 weeks should all heighten concern for malignancy. In this review, we discuss the current principles of surgical management of the most common head and neck masses that present to pediatricians and pediatric surgeons.

  19. Adaptive algorithm of magnetic heading detection

    Science.gov (United States)

    Liu, Gong-Xu; Shi, Ling-Feng

    2017-11-01

    Magnetic data obtained from a magnetic sensor usually fluctuate in a certain range, which makes it difficult to estimate the magnetic heading accurately. In fact, magnetic heading information is usually submerged in noise because of all kinds of electromagnetic interference and the diversity of the pedestrian’s motion states. In order to solve this problem, a new adaptive algorithm based on the (typically) right-angled corridors of a building or residential buildings is put forward to process heading information. First, a 3D indoor localization platform is set up based on MPU9250. Then, several groups of data are measured by changing the experimental environment and pedestrian’s motion pace. The raw data from the attached inertial measurement unit are calibrated and arranged into a time-stamped array and written to a data file. Later, the data file is imported into MATLAB for processing and analysis using the proposed adaptive algorithm. Finally, the algorithm is verified by comparison with the existing algorithm. The experimental results show that the algorithm has strong robustness and good fault tolerance, which can detect the heading information accurately and in real-time.

  20. Kinematics of the AM-50 heading machine cutting head

    Energy Technology Data Exchange (ETDEWEB)

    Sikora, W; Bak, K; Klich, R [Politechnika Slaska, Gliwice (Poland). Instytut Mechanizacji Gornictwa

    1987-01-01

    Analyzes motion of the cutter head of the AM-50 heading machine. Two types of head motion are comparatively evaluated: planar motion and spatial motion. The spatial motion consists of the head rotational motion and horizontal or vertical feed motion, while planar motion consists of rotational motion and vertical feed motion. Equations that describe head motion under conditions of cutter vertical or horizontal feed motion are derived. The angle between the cutting speed direction and working speed direction is defined. On the basis of these formulae variations of cutting speed depending on the cutting tool position on a cutter head are calculated. Calculations made for 2 extreme cutting tools show that the cutting speed ranges from 1,205 m/s to 3,512 m/s. 4 refs.

  1. Head First Web Design

    CERN Document Server

    Watrall, Ethan

    2008-01-01

    Want to know how to make your pages look beautiful, communicate your message effectively, guide visitors through your website with ease, and get everything approved by the accessibility and usability police at the same time? Head First Web Design is your ticket to mastering all of these complex topics, and understanding what's really going on in the world of web design. Whether you're building a personal blog or a corporate website, there's a lot more to web design than div's and CSS selectors, but what do you really need to know? With this book, you'll learn the secrets of designing effecti

  2. Head first C#

    CERN Document Server

    Stellman, Andrew

    2008-01-01

    Head First C# is a complete learning experience for object-oriented programming, C#, and the Visual Studio IDE. Built for your brain, this book covers C# 3.0 and Visual Studio 2008, and teaches everything from language fundamentals to advanced topics including garbage collection, extension methods, and double-buffered animation. You'll also master C#'s hottest and newest syntax, LINQ, for querying SQL databases, .NET collections, and XML documents. By the time you're through, you'll be a proficient C# programmer, designing and coding large-scale applications. Every few chapters you will come

  3. Head first C#

    CERN Document Server

    Stellman, Andrew

    2010-01-01

    You want to learn C# programming, but you're not sure you want to suffer through another tedious technical book. You're in luck: Head First C# introduces this language in a fun, visual way. You'll quickly learn everything from creating your first program to learning sophisticated coding skills with C# 4.0, Visual Studio 2010 and .NET 4, while avoiding common errors that frustrate many students. The second edition offers several hands-on labs along the way to help you build and test programs using skills you've learned up to that point. In the final lab, you'll put everything together. From o

  4. Head First Python

    CERN Document Server

    Barry, Paul

    2010-01-01

    Ever wished you could learn Python from a book? Head First Python is a complete learning experience for Python that helps you learn the language through a unique method that goes beyond syntax and how-to manuals, helping you understand how to be a great Python programmer. You'll quickly learn the language's fundamentals, then move onto persistence, exception handling, web development, SQLite, data wrangling, and Google App Engine. You'll also learn how to write mobile apps for Android, all thanks to the power that Python gives you. We think your time is too valuable to waste struggling with

  5. Head First Mobile Web

    CERN Document Server

    Gardner, Lyza; Grigsby, Jason

    2011-01-01

    Despite the huge number of mobile devices and apps in use today, your business still needs a website. You just need it to be mobile. Head First Mobile Web walks you through the process of making a conventional website work on a variety smartphones and tablets. Put your JavaScript, CSS media query, and HTML5 skills to work-then optimize your site to perform its best in the demanding mobile market. Along the way, you'll discover how to adapt your business strategy to target specific devices. Navigate the increasingly complex mobile landscapeTake both technical and strategic approaches to mobile

  6. Lower head integrity under steam explosion loads

    Energy Technology Data Exchange (ETDEWEB)

    Theofanous, T.G.; Yuen, W.W.; Angelini, S.; Freeman, K.; Chen, X.; Salmassi, T. [Center for Risk Studies and Safety, Univ. of California, Santa Barbara, CA (United States); Sienicki, J.J.

    1998-01-01

    Lower head integrity under steam explosion loads in an AP600-like reactor design is considered. The assessment is the second part of an evaluation of the in-vessel retention idea as a severe accident management concept, the first part (DOE/ID-10460) dealing with thermal loads. The assessment is conducted in terms of the Risk Oriented Accident Analysis Methodology (ROAAM), and includes the comprehensive evaluation of all relevant severe accident scenarios, melt conditions and timing of release from the core region, fully 3D mixing and explosion wave dynamics, and lower head fragility under local, dynamic loading. All of these factors and brought together in a ROAAM Probabilistic Framework to evaluate failure likelihood. The conclusion is that failure is `physically unreasonable`. (author)

  7. Reactor vessel head permanent shield

    International Nuclear Information System (INIS)

    Hankinson, M.F.; Leduc, R.J.; Richard, J.W.; Malandra, L.J.

    1989-01-01

    A nuclear reactor is described comprising: a nuclear reactor pressure vessel closure head; control rod drive mechanisms (CRDMs) disposed within the closure head so as to project vertically above the closure head; cooling air baffle means surrounding the control rod drive mechanisms for defining cooling air paths relative to the control rod drive mechanisms; means defined within the periphery of the closure head for accommodating fastening means for securing the closure head to its associated pressure vessel; lifting lugs fixedly secured to the closure head for facilitating lifting and lowering movements of the closure head relative to the pressure vessel; lift rods respectively operatively associated with the plurality of lifting lugs for transmitting load forces, developed during the lifting and lowering movements of the closure head, to the lifting lugs; upstanding radiation shield means interposed between the cooling air baffle means and the periphery of the enclosure head of shielding maintenance personnel operatively working upon the closure head fastening means from the effects of radiation which may emanate from the control rod drive mechanisms and the cooling air baffle means; and connecting systems respectively associated with each one of the lifting lugs and each one of the lifting rods for connecting each one of the lifting rods to a respective one of each one of the lifting lugs, and for simultaneously connecting a lower end portion of the upstanding radiation shield means to each one of the respective lifting lugs

  8. Quantifying Variation in Head Start Effects on Young Children's Cognitive and Socio-Emotional Skills Using Data from the National Head Start Impact Study

    Science.gov (United States)

    Bloom, Howard S.; Weiland, Christina

    2015-01-01

    This paper uses data from the Head Start Impact Study (HSIS), a nationally representative multisite randomized trial, to quantify variation in effects of Head Start during 2002-2003 on children's cognitive and socio-emotional outcomes relative to the effects of other local alternatives, including parent care. We find that (1) treatment and control…

  9. Radioprotective effect of local hypothermia

    International Nuclear Information System (INIS)

    Hong, Seong-Su; Ogawa, Yoshihiro; Higano, Shuichi; Nakamura, Mamoru; Hoshino, Fumihiko

    1985-01-01

    We attempted local hypothermia to prevent radiation dermatitis and stomatitis. With regard to parasternal skin reactions postoperatively irradiated breast cancer, dry and moist desquamation, which occasionally occurred with conventional irradiation was not observed in combination with local cooling. As for head and neck tumors, patients who complained of stomatitis decreased with the local cooling, and no one wanted a pause in irradiation before 40 Gy. As local hypothermia is free from danger and does not require special equipment, it was considered to be widely applicable. (author)

  10. CTOD-based acceptance criteria for heat exchanger head staybolts

    International Nuclear Information System (INIS)

    Lam, P.S.; Sindelar, R.L.; Barnes, D.M.; Awadalla, N.G.

    1992-01-01

    The primary coolant piping system of the Savannah River Site (SRS) reactors contains twelve heat exchangers to remove the waste heat from the nuclear materials production. A large break at the inlet or outlet heads of the heat exchangers would occur if the restraint members of the heads become inactive. The heat exchanger head is attached to the tubesheet by 84 staybolts. The structural integrity of the heads is demonstrated by showing the redundant capacity of the staybolts to restrain the head at design conditions and under seismic loadings. The beat exchanger head is analyzed with a three- dimensional finite element model. The restraint provided by the staybolts is evaluated for several postulated cases of inactive or missing staybolts, that is, bolts that have a flaw exceeding the ultrasonic testing (UT) threshold depth of 25% of the bolt diameter. A limit of 6 inactive staybolts is reached with a fracture criterion based on the maximum allowable local displacement at the active staybolts which corresponds to the crack tip opening displacement (CTOD) of 0.032 inches. An acceptance criteria methodology has been developed to disposition flaws reported in the staybolt inspections while ensuring adequate restraint capacity of the staybolts to maintain integrity of the heat exchanger heads against collapse. The methodology includes an approach for the baseline and periodic inspections of the staybolts. A total of up to 6 staybolts, reported as containing flaws with depths at or exceeding 25% would be acceptable in the heat exchanger

  11. Local Democracy in Myanmar

    DEFF Research Database (Denmark)

    Kyed, Helene Maria; Harrisson, Annika Pohl; McCarthy, Gerard

    Myanmar is undergoing a comprehensive political transition. In April this year the first democratically elected government in six decades came into power under the leadership of NLD, the pro-democracy party headed by Aung San Suu Kyi. The largest peace conference in the country’s history was held...... in early September, and Myanmar again made the international headlines a week later when Kofi Annan visited the country to head a commission for addressing communal violence. These national events are crucial to the democratization process in Myanmar and for ending the almost seven decades of civil war....... However, often overlooked in this larger picture of transition is the state of local democracy, including village level governance and everyday state-citizen engagements. Political changes at this level are equally crucial for the wider democratization process. This roundtable summary discusses the 2016...

  12. Representation of heading direction in far and near head space

    NARCIS (Netherlands)

    Poljac, E.; Berg, A.V. van den

    2003-01-01

    Manipulation of objects around the head requires an accurate and stable internal representation of their locations in space, also during movements such as that of the eye or head. For far space, the representation of visual stimuli for goal-directed arm movements relies on retinal updating, if eye

  13. Head trauma and CT

    International Nuclear Information System (INIS)

    Samejima, Kanji; Yoshii, Nobuo; Tobari, Chitoshi

    1979-01-01

    In our cases of acute and subacute subdural hematoma, the use of CT was evaluated. In our department of surgery, acute subdural hematoma was found in 46 of 388 patients of head trauma who underwent CT. Acute subdural hematoma, like epidural hematoma was usually visualized as a high-density area along the cranial inner table, and this was easily differenciated from epidural hematoma because of difference in shape from the other. The picture of acute subdural hematoma was occasionally confused with that of intracerebral hematoma or cerebral contusion. Single use of CT does not differenciate subacute subdural hematoma from chronic subdural hematoma. However, CT usually visualized acute hematoma as a high-density area, showing the extent of hematoma. Comparison of the thickness of hematoma with the axis deviation of the median part such as the 3rd cerebral ventricle suggested severity of cerebral edema. CT also revealed bilateral or multiple lesions of cerebral contusion or intracerebral hematoma. (Ueda, J.)

  14. Chryse 'Alien Head'

    Science.gov (United States)

    2005-01-01

    26 January 2004 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows an impact crater in Chryse Planitia, not too far from the Viking 1 lander site, that to seems to resemble a bug-eyed head. The two odd depressions at the north end of the crater (the 'eyes') may have formed by wind or water erosion. This region has been modified by both processes, with water action occurring in the distant past via floods that poured across western Chryse Planitia from Maja Valles, and wind action common occurrence in more recent history. This crater is located near 22.5oN, 47.9oW. The 150 meter scale bar is about 164 yards long. Sunlight illuminates the scene from the left/lower left.

  15. Lower head failure analysis

    International Nuclear Information System (INIS)

    Rempe, J.L.; Thinnes, G.L.; Allison, C.M.; Cronenberg, A.W.

    1991-01-01

    The US Nuclear Regulatory Commission is sponsoring a lower vessel head research program to investigate plausible modes of reactor vessel failure in order to determine (a) which modes have the greatest likelihood of occurrence during a severe accident and (b) the range of core debris and accident conditions that lead to these failures. This paper presents the methodology and preliminary results of an investigation of reactor designs and thermodynamic conditions using analytic closed-form approximations to assess the important governing parameters in non-dimensional form. Preliminary results illustrate the importance of vessel and tube geometrical parameters, material properties, and external boundary conditions on predicting vessel failure. Thermal analyses indicate that steady-state temperature distributions will occur in the vessel within several hours, although the exact time is dependent upon vessel thickness. In-vessel tube failure is governed by the tube-to-debris mass ratio within the lower head, where most penetrations are predicted to fail if surrounded by molten debris. Melt penetration distance is dependent upon the effective flow diameter of the tube. Molten debris is predicted to penetrate through tubes with a larger effective flow diameter, such as a boiling water reactor (BWR) drain nozzle. Ex-vessel tube failure for depressurized reactor vessels is predicted to be more likely for a BWR drain nozzle penetration because of its larger effective diameter. At high pressures (between ∼0.1 MPa and ∼12 MPa) ex-vessel tube rupture becomes a dominant failure mechanism, although tube ejection dominates control rod guide tube failure at lower temperatures. However, tube ejection and tube rupture predictions are sensitive to the vessel and tube radial gap size and material coefficients of thermal expansion

  16. NUMERICAL ANALYSIS OF INFLUENCE OF EXOGENOUS FIRE IN DOG HEADING ON PARAMETERS OF THE AIR STREAM FLOWING THROUGH THIS HEADING

    Directory of Open Access Journals (Sweden)

    Magdalena TUTAK

    2014-04-01

    Full Text Available Flow of ventilation air stream through the dog heading with a fire centre is the flow with complex character, during which as a result of emission of fire gases into the mining atmosphere, there occur to disturbances of its flow. In the paper there is presented a numerical analysis of an influence of exogenous fire in a dog heading, on the parameters of the ventilation air stream flowing through this heading. Modeling tests were carried out with a use of ANSYS software, basing on the Finite Volume Method. For the made assumptions, there were determined physical parameters of air stream flowing through the heading with a fire centre, and also changes in mass fraction of gases in this stream during its flow through the analyzed heading: oxygen, carbon monoxide and carbon dioxide. As a result of performed analysis over the fire centre, the local increase of velocity and temperature and violent decrease of static pressure were recorded. Model of heading presented in the paper gives possibilities for development, and then the analysis of more complicated problems in a range of ventilation of mining headings.

  17. Precise Head Tracking in Hearing Applications

    Science.gov (United States)

    Helle, A. M.; Pilinski, J.; Luhmann, T.

    2015-05-01

    The paper gives an overview about two research projects, both dealing with optical head tracking in hearing applications. As part of the project "Development of a real-time low-cost tracking system for medical and audiological problems (ELCoT)" a cost-effective single camera 3D tracking system has been developed which enables the detection of arm and head movements of human patients. Amongst others, the measuring system is designed for a new hearing test (based on the "Mainzer Kindertisch"), which analyzes the directional hearing capabilities of children in cooperation with the research project ERKI (Evaluation of acoustic sound source localization for children). As part of the research project framework "Hearing in everyday life (HALLO)" a stereo tracking system is being used for analyzing the head movement of human patients during complex acoustic events. Together with the consideration of biosignals like skin conductance the speech comprehension and listening effort of persons with reduced hearing ability, especially in situations with background noise, is evaluated. For both projects the system design, accuracy aspects and results of practical tests are discussed.

  18. The head-mounted microscope.

    Science.gov (United States)

    Chen, Ting; Dailey, Seth H; Naze, Sawyer A; Jiang, Jack J

    2012-04-01

    Microsurgical equipment has greatly advanced since the inception of the microscope into the operating room. These advancements have allowed for superior surgical precision and better post-operative results. This study focuses on the use of the Leica HM500 head-mounted microscope for the operating phonosurgeon. The head-mounted microscope has an optical zoom from 2× to 9× and provides a working distance from 300 mm to 700 mm. The headpiece, with its articulated eyepieces, adjusts easily to head shape and circumference, and offers a focus function, which is either automatic or manually controlled. We performed five microlaryngoscopic operations utilizing the head-mounted microscope with successful results. By creating a more ergonomically favorable operating posture, a surgeon may be able to obtain greater precision and success in phonomicrosurgery. Phonomicrosurgery requires the precise manipulation of long-handled cantilevered instruments through the narrow bore of a laryngoscope. The head-mounted microscope shortens the working distance compared with a stand microscope, thereby increasing arm stability, which may improve surgical precision. Also, the head-mounted design permits flexibility in head position, enabling operator comfort, and delaying musculoskeletal fatigue. A head-mounted microscope decreases the working distance and provides better ergonomics in laryngoscopic microsurgery. These advances provide the potential to promote precision in phonomicrosurgery. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

  19. Sheep head frame validation for CT and MRI studies

    Directory of Open Access Journals (Sweden)

    marco trovatelli

    2017-05-01

    Full Text Available Abstract   Introductions Aim of EDEN 2020 project’s Milestone 5 is the development of a steerable catheter for CED system in glioblastoma therapy. The VET group is involved in realization and validation of the proper animal model. Materials and methods In this part of the study two fresh sheep’s head from the local slaughter were used. The heads were located into an ad hoc Frame system based on anatomical measures and CT images, producted by Renishaw plc partner in this project. The frame was adapted and every components were checked for the ex vivo validation tests. CT imaging was taken in Lodi at Università degli studi di Milano, Facoltà di Medicina Veterinaria, with CT scanner and MRI imaging was taken in La Cittadina, Cremona Results System validation was approved by the ex vivo trial. The frame system doesn’t compromise the imaging acquisition in MRI and CT systems. Every system components are functional to their aims. Discussion The Frame system is adapted to the sheep head. It is composed by elements able to lock the head during the imaging acquisition. Frame system is characterized by a support base helpings the animals to keep the head straight forward during imaging time, under general anesthesia. The design of these device support the airways anatomy, avoiding damaging or obstruction of airflows during anesthesia period. The role of elements like mouth bar and ovine head pins is to lock the head in a stable position during imaging acquisition; fixing is guaranteed by V shape head pins, that are arranged against the zygomatic arches. Lateral compression forces to the cranium, and the V shape pins avoid the vertical shifting of the head and any kind of rotations. (fig. 1

  20. Modular reactor head shielding system

    International Nuclear Information System (INIS)

    Jacobson, E. B.

    1985-01-01

    An improved modular reactor head shielding system is provided that includes a frame which is removably assembled on a reactor head such that no structural or mechanical alteration of the head is required. The shielding system also includes hanging assemblies to mount flexible shielding pads on trolleys which can be moved along the frame. The assemblies allow individual pivoting movement of the pads. The pivoting movement along with the movement allowed by the trolleys provides ease of access to any point on the reactor head. The assemblies also facilitate safe and efficient mounting of the pads directly to and from storage containers such that workers have additional shielding throughout virtually the entire installation and removal process. The flexible shielding pads are designed to interleave with one another when assembled around the reactor head for substantially improved containment of radiation leakage

  1. Stereotactic Body Radiotherapy for Head and Neck Tumors

    Science.gov (United States)

    2016-04-18

    Squamous Cell Carcinoma of the Head and Neck; Nasopharyngeal Carcinoma; Salivary Gland Cancer; Head and Neck Sarcoma; Paraganglioma of Head and Neck; Chordoma of Head and Neck; Chondrosarcoma of Head and Neck; Angiofibroma of Head and Neck

  2. Nonparameningeal head and neck rhabdomyosarcoma in children and adolescents

    DEFF Research Database (Denmark)

    Orbach, Daniel; Mosseri, Veronique; Gallego, Soledad

    2017-01-01

    BACKGROUND: This article reports risk factors and long-term outcome in localized nonparameningeal head and neck rhabdomyosarcomas in children and adolescents from a combined dataset from 3 consecutive international trials. METHODS: Data from 140 children (9.3% of total) prospectively enrolled in ...

  3. Turbidity Current Head Mixing

    Science.gov (United States)

    Hernandez, David; Sanchez, Miguel Angel; Medina, Pablo

    2010-05-01

    A laboratory experimental set - up for studying the behaviour of sediment in presence of a turbulent field with zero mean flow is compared with the behaviour of turbidity currents [1] . Particular interest is shown on the initiation of sediment motion and in the sediment lift - off. The behaviour of the turbidity current in a flat ground is compared with the zero mean flow oscilating grid generated turbulence as when wave flow lifts off suspended sediments [2,3]. Some examples of the results obtained with this set-up relating the height of the head of the turbidity current to the equilibrium level of stirred lutoclines are shown. A turbulent velocity u' lower than that estimated by the Shield diagram is required to start sediment motion. The minimum u' required to start sediment lift - off, is a function of sediment size, cohesivity and resting time. The lutocline height depends on u', and the vorticity at the lutocline seems constant for a fixed sediment size [1,3]. Combining grid stirring and turbidty current head shapes analyzed by means of advanced image analysis, sediment vertical fluxes and settling speeds can be measured [4,5]. [1] D. Hernandez Turbulent structure of turbidity currents and sediment transport Ms Thesis ETSECCPB, UPC. Barcelona 2009. [2] A. Sánchez-Arcilla; A. Rodríguez; J.C. Santás; J.M. Redondo; V. Gracia; R. K'Osyan; S. Kuznetsov; C. Mösso. Delta'96 Surf-zone and nearshore measurements at the Ebro Delta. A: International Conference on Coastal Research through large Scale Experiments (Coastal Dynamics '97). University of Plymouth, 1997, p. 186-187. [3] P. Medina, M. A. Sánchez and J. M. Redondo. Grid stirred turbulence: applications to the initiation of sediment motion and lift-off studies Physics and Chemistry of the Earth, Part B: Hydrology, Oceans and Atmosphere. 26, Issue 4, 2001, Pages 299-304 [4] M.O. Bezerra, M. Diez, C. Medeiros, A. Rodriguez, E. Bahia., A. Sanchez-Arcilla and J.M. Redondo. Study on the influence of waves on

  4. Femoral head necrosis; Hueftkopfnekrose

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, J.; Scheurecker, G.; Scheurecker, A.; Stoeger, A.; Huber, A. [Roentgeninstitut am Schillerpark, Linz (Austria); Hofmann, S. [Orthopaedisches Landeskrankenhaus Stolzalpe (Austria)

    2009-05-15

    The epidemiology and pathohistogenesis of avascular femoral head necrosis has still not been clarified in detail. Because the course of the disease runs in stages and over a long time period nearly always culminates in the necessity for a total hip prosthesis, an exact radiological evaluation is of paramount importance for the treatment. There is a need for a common staging system to enable comparison of different therapy concepts and especially their long-term results. In this article the ARCO staging system is described in full detail, which includes all radiological modalities as well as histopathological alterations. (orig.) [German] Bei der avaskulaeren Femurkopfnekrose handelt es sich um ein Krankheitsbild, dessen Ursachen noch immer nicht vollstaendig geklaert sind. Da die Erkrankung stadienhaft verlaeuft und ueber einen laengeren Zeitraum betrachtet nahezu immer in einem prothetischen Hueftersatz muendet, ist eine genaue radiologische Abklaerung fuer die Behandlung von enormer Bedeutung. Um Langzeiterfolge verschiedener Therapiekonzepte vergleichen zu koennen, sind eine exakte Beschreibung und darauf basierend die Verwendung einer einheitlichen Stadieneinteilung wuenschenswert. In der vorliegenden Arbeit wird die ARCO-Stadieneinteilung im Detail beschrieben, die alle bildgebenden Methoden beruecksichtigt und histopathologische Veraenderungen mit einbezieht. (orig.)

  5. Head trauma and CT

    International Nuclear Information System (INIS)

    Samejima, Kanji; Yoshii, Nobuo; Tobari, Chitoshi

    1979-01-01

    It has been said that chronic subdural hematoma cannot be diagnosed by CT. In our cases, CT was used, and the results were described. According to the density of the picture, CT findings of chronic subdural hematoma could be classified into 3 types, those of higher density than that of the cerebral paranchyma, those of isodensity, and those of lower density than that of the cerebral parenchyma. The difference among them appeared to be due to variation in the fluid in hematoma, especially that in hemoglobin concentration. Chronic subdural hematoma was found in 27 of 388 cases of head trauma in which CT was undertaken in our department of surgery for last 2 years. It is difficult to differenciate this disease from subdural edema or subarachnoideal retention of the cerebrospinal fluid. In many cases, use of contrast medium added no change to the CT picture. Cerebral angiography is necessary for definite diagnosis of the disease. Chronic subdural hematoma gives more varieties of findings than other intracranial hematomas. However, if the film is very carefully read, CT is still useful for diagnosing this disease in spite of initially remarked difficulties. (Ueda, J.)

  6. Mummified trophy heads from Peru: diagnostic features and medicolegal significance.

    Science.gov (United States)

    Verano, John W

    2003-05-01

    Several forms of mummified human trophy heads were produced by prehistoric and historic native groups in South America. This paper describes the diagnostic features of trophy heads produced by the Nasca culture of ancient Peru. A growing interest in these mummified heads among collectors of Pre-Columbian art and antiquities has led to their illegal exportation from Peru, in violation of national and international antiquities laws. Requests from the Peruvian government to protect its cultural patrimony led the United States in 1997 to declare these heads as items subject to U.S. import restriction, along with six other categories of human remains. Despite such restrictions, Nasca trophy heads continue to reach private collectors outside of Peru and thus may be encountered by local, state, or federal law enforcement officials unfamiliar with their characteristic features and origin. The objective of this paper is to describe the features that allow Nasca trophy heads to be identified and distinguished from other archaeological and forensic specimens that may be submitted to a forensic anthropologist for identification.

  7. Radiotherapy plus cetuximab for the squamous cells carcinoma of head and neck

    International Nuclear Information System (INIS)

    Bonner, James A.; Harari, Paul M.; Giralt, Jordi; Azarnia, Nozar; Shin, Dong M.; Cohen, Roger B.; Jones, Cristopher U.; Sur, Ranjan; Raben, David; Jassem, Jacek; Ove, Roger; Kies, Merrill S.; Baselga, Jose; Youssoufian, Hagop; Amellal, Nadia; Rowinsky, Eric K.; Ang, K. Kian

    2006-01-01

    A multinational randomized study was realized, to compare radiotherapy alone with radiotherapy combined with cetuximab, a monoclonal antibody against the receiver epidermal growth factor in the treatment of squamous cell carcinoma of head and neck locally advanced [es

  8. Radioisotope scintigraphy after arterial catheterization in head-and neck tumors

    International Nuclear Information System (INIS)

    Serson, D.; Andrade Sobrinho, J. de; Oliveira Nunes, J.E. de; Rapoport, A.

    1983-01-01

    A new method with radioisotopes is presented to determine the first arterial regional supply, for localized intra-arterial treatment with antiblastic drugs. Cases of head and neck where the method was used presented [pt

  9. Anaphylaxis Due to Head Injury

    Directory of Open Access Journals (Sweden)

    Bruner, Heather C.

    2015-05-01

    Full Text Available Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury. [West J Emerg Med. 2015;16(3:435–437.

  10. Anaphylaxis due to head injury.

    Science.gov (United States)

    Bruner, Heather C; Bruner, David I

    2015-05-01

    Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury.

  11. Boxing-related head injuries.

    Science.gov (United States)

    Jayarao, Mayur; Chin, Lawrence S; Cantu, Robert C

    2010-10-01

    Fatalities in boxing are most often due to traumatic brain injury that occurs in the ring. In the past 30 years, significant improvements in ringside and medical equipment, safety, and regulations have resulted in a dramatic reduction in the fatality rate. Nonetheless, the rate of boxing-related head injuries, particularly concussions, remains unknown, due in large part to its variability in clinical presentation. Furthermore, the significance of repeat concussions sustained when boxing is just now being understood. In this article, we identify the clinical manifestations, pathophysiology, and management of boxing-related head injuries, and discuss preventive strategies to reduce head injuries sustained by boxers.

  12. Simulation of Cardiovascular Response to the Head-Up/Head-Down Tilt at Different Angles

    Science.gov (United States)

    Liu, Yang; Lu, Hong-Bing; Jiao, Chun; Zhang, Li-Fan

    2008-06-01

    The disappearance of hydrostatic pressure is the original factor that causes the changes of cardiovascular system under microgravity. The hydrostatical changes can be simulated by postural changes. Especially the head-down position can be used to simulate the effects of microgravity. The goal of this investigation was to develop a mathematical model for simulation of the human cardiovascular responses to acute and prolonged exposure under microgravity environment. We were particularly interested in the redistribution of transmural pressures, flows, blood volume, and the consequent alterations in local hemodynamics in different cardiovascular compartments during acute exposure and chronic adjustments. As a preliminary study, we first developed a multi-element, distributed hemodynamic model of human cardiovascular system, and verified the model to simulate cardiovascular changes during head up/down tilt at various angles.

  13. Head-positioning scintillation camera and head holder therefor

    International Nuclear Information System (INIS)

    Kay, T.D.

    1976-01-01

    A holder for immobilizing the head of a patient undergoing a vertex brain scan by a Gamma Scintillation Camera is described. The holder has a uniquely designed shape capable of comfortably supporting the head. In addition, this holder can be both adjustably and removably utilized in combination with the scintillation camera so as to enable the brain scan operation to take place while the patient is in the seated position

  14. Head and Neck Cancer

    International Nuclear Information System (INIS)

    Tomita, Toshiki; Imanishi, Yorihisa

    2008-01-01

    The limitation of concurrent chemo-radiotherapy (CCRT) in head and neck cancer (HNC) as the primary treatment is described based on recent findings. Limits in the application/indication involve factors of age, performance status (PS) and renal function. The first is that, as deaths in >71 years old patients are derived from other causes (41%) than HNC, CCRT is only useful for younger population; the second, patients with PS 0-1 or Karnofsky performance score >60-70 can be indicated; and third, contraindicated are those with creatinine clearance (CCr) <60 mL/min as the key drug cisplatin in CCRT has a high renal toxicity. It should be recognized that completion rates of chemotherapy and RT are as low as 66-85% and 84-92%, respectively, in CCRT. CCRT has such limiting adverse events as mucitis, dry mouth, dysohagia, weight loss, neutropenia, sepsis, etc., which are most important in CCRT application. CCRT is recommended for the primary cancers of larynx and hypopharynx because they are significantly better conserved than middle pharyngeal, oral and upper jaw cancers. Evidence of CCRT is poor for cancers in paranasal sinuses. Planned neck dissection (PND) is for the cervical metastatic lymph nodes and conducted 6-12 weeks after CCRT regardless to its outcome. In fluorodeoxyglucose-positron emission tomography (FDG-PET) negative cases, PND can be omitted. Necessity of PND is possibly inversely proportional to CCRT intensity performed. For control of remote metastasis, CCRT has obvious limits and inductive chemotherapy before it is currently considered. Salvage surgery post CCRT does not always yield a relief because of complication. Patients with advanced laryngeal cancer can be selected either to surgery or CCRT depending on results of the inductive chemotherapy. To predict the sensitivity to CCRT, some biomarkers like HPV, EGFR and VEGF have been suggested to be useful by retrospective studies. Understanding the limitation is as important as knowing the usefulness in

  15. Long-Term Results of Radiation Therapy Oncology Group 9903: A Randomized Phase 3 Trial to Assess the Effect of Erythropoietin on Local-Regional Control in Anemic Patients Treated With Radiation Therapy for Squamous Cell Carcinoma of the Head and Neck

    Energy Technology Data Exchange (ETDEWEB)

    Shenouda, George, E-mail: George.shenouda@muhc.mcgill.ca [McGill University, Montreal, Quebec (Canada); Zhang, Qiang [NRG Oncology Statistics and Data Management Center (United States); Ang, K. Kian [University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Machtay, Mitchell [University Hospitals of Cleveland, Cleveland, Ohio (United States); Parliament, Matthew B. [Cross Cancer Institute, Edmonton, Alberta (Canada); Hershock, Diane [University of Pennsylvania Medical Center, Philadelphia, Pennsylvania (United States); Suntharalingam, Mohan [University of Maryland Medical System, Baltimore, Maryland (United States); Lin, Alexander [University of Pennsylvania Medical Center, Philadelphia, Pennsylvania (United States); Rotman, Marvin [Brooklyn Minority-based Community Clinical Oncology Program, State University of New York Downstate Medical Center, Brooklyn, New York (United States); Nabid, Abdenour [Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke (Québec), Québec (Canada); Hong, Susan [Akron City Hospital, Akron, Ohio (United States); Shehata, Sarwat [Northeastern Ontario Regional Cancer Centre, Sudbury, Ontario (Canada); Cmelak, Anthony J. [Vanderbilt University Medical Center, Nashville, Tennessee (United States); Sultanem, Khalil [McGill University, Montreal, Quebec (Canada); Le, Quynh-Thu [Stanford University Medical Center, Stanford, California (United States)

    2015-04-01

    Purpose: This paper reports long-term results of RTOG 9903, to determine whether the addition of erythropoietin (EPO) would improve the outcomes of radiation therapy (RT) in mildly to moderately anemic patients with head and neck squamous cell carcinoma (HNSCCa). Methods and Materials: The trial included HNSCCa patients treated with definitive RT. Patients with stage III or IV disease received concomitant chemoradiation therapy or accelerated fractionation. Pretreatment hemoglobin levels were required to be between 9.0 and 13.5 g/dL (12.5 g/dL for females). EPO, 40,000 U, was administered weekly starting 7 to 10 days before RT was initiated in the RT + EPO arm. Results: A total of 141 of 148 enrolled patients were evaluable. The baseline median hemoglobin level was 12.1 g/dL. In the RT + EPO arm, the mean hemoglobin level at 4 weeks increased by 1.66 g/dL, whereas it decreased by 0.24 g/dL in the RT arm. With a median follow-up of 7.95 years (range: 1.66-10.08 years) for surviving patients and 3.33 years for all patients (range: 0.03-10.08 years), the 5-year estimate of local-regional failure was 46.2% versus 39.4% (P=.42), local-regional progression-free survival was 31.5% versus 37.6% (P=.20), and overall survival was 36.9% versus 38.2% (P=.54) for the RT + EPO and RT arms, respectively. Late toxicity was not different between the 2 arms. Conclusions: This long-term analysis confirmed that despite the ability of EPO to raise hemoglobin levels in anemic patients with HNSCCa, it did not improve outcomes when added to RT. The possibility of a detrimental effect of EPO could not be ruled out.

  16. Sports-related Head Injury

    Science.gov (United States)

    ... and head gear come in many sizes and styles for many sports and must properly fit to ... to play or practice." The "Concussion Diagnosis and Management" section details circumstances in which an athlete should ...

  17. Heater head for stirling engine

    Science.gov (United States)

    Corey, John A.

    1985-07-09

    A monolithic heater head assembly which augments cast fins with ceramic inserts which narrow the flow of combustion gas and obtains high thermal effectiveness with the assembly including an improved flange design which gives greater durability and reduced conduction loss.

  18. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... it may cause some medical devices to malfunction. Most orthopedic implants pose no risk, but you should ... a digital cloud server. Currently, MRI is the most sensitive imaging test of the head (particularly the ...

  19. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... and may add approximately 15 minutes to the total exam time. top of page What will I ... the limitations of MRI of the Head? High-quality images are assured only if you are able ...

  20. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... the head (particularly the brain) in routine clinical practice. top of page What are some common uses ... gadolinium contrast material except when absolutely necessary for medical treatment. See the MRI Safety page for more ...

  1. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... is not harmful, but it may cause some medical devices to malfunction. Most orthopedic implants pose no ... Head? Magnetic resonance imaging (MRI) is a noninvasive medical test that physicians use to diagnose medical conditions. ...

  2. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...

  3. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... top of page Additional Information and Resources RTAnswers.org : Radiation Therapy for Brain Tumors Radiation Therapy for ... Imaging (MRI) - Head Sponsored by Please note RadiologyInfo.org is not a medical facility. Please contact your ...

  4. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... It can also invite bacteria that lead to gum disease. Click here to find out more. Who We ... It can also invite bacteria that lead to gum disease. Click here to find out more. Oral, Head ...

  5. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... the head (particularly the brain) in routine clinical practice. top of page What are some common uses ... may follow your regular daily routine and take food and medications as usual. Some MRI examinations may ...

  6. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... practice. top of page What are some common uses of the procedure? MR imaging of the head ... gadolinium contrast, it may still be possible to use it after appropriate pre-medication. Patient consent will ...

  7. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... or headphones during the exam. MRI scanners are air-conditioned and well-lit. Music may be played ... the limitations of MRI of the Head? High-quality images are assured only if you are able ...

  8. Magnetic Resonance Imaging (MRI) -- Head

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    Full Text Available ... practice. top of page What are some common uses of the procedure? MR imaging of the head ... is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. ...

  9. American Head and Neck Society

    Science.gov (United States)

    ... research and insights. Comments This field is for validation purposes and should be left unchanged. This iframe ... and Announcements Copyright ©2016 · American Head and Neck Society · Privacy and Return Policy Managed by BSC Management, ...

  10. Magnetic Resonance Imaging (MRI) -- Head

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    Full Text Available ... practice. top of page What are some common uses of the procedure? MR imaging of the head ... for immediate assistance. Manufacturers of intravenous contrast indicate mothers should not breastfeed their babies for 24-48 ...

  11. Magnetic Resonance Imaging (MRI) -- Head

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    Full Text Available ... MRI) of the head uses a powerful magnetic field, radio waves and a computer to produce detailed ... there’s a possibility you are pregnant. The magnetic field is not harmful, but it may cause some ...

  12. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... by the interpreting radiologist. Frequently, the differentiation of abnormal (diseased) tissue from normal tissues is better with ... Tumor Treatment Magnetic Resonance Imaging (MRI) Safety Alzheimer's Disease Head Injury Brain Tumors Images related to Magnetic ...

  13. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... medically necessary. MRI may not always distinguish between cancer tissue and fluid, known as edema . MRI typically ... Brain Tumors Radiation Therapy for Head and Neck Cancer Others : American Stroke Association National Stroke Association top ...

  14. Magnetic Resonance Imaging (MRI) -- Head

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    Full Text Available ... a computer to produce detailed pictures of the brain and other cranial structures that are clearer and ... sensitive imaging test of the head (particularly the brain) in routine clinical practice. top of page What ...

  15. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... practice. top of page What are some common uses of the procedure? MR imaging of the head ... community, you can search the ACR-accredited facilities database . This website does not provide cost information. The ...

  16. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... MRI scanners are air-conditioned and well-lit. Music may be played through the headphones to help ... page Additional Information and Resources RTAnswers.org : Radiation Therapy for Brain Tumors Radiation Therapy for Head and ...

  17. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... teeth or become infected. It can also invite bacteria that lead to gum disease. Click here to find out ... and surgically treating cancer of the head, neck and mouth. The Oral Cancer Foundation estimates that close to ...

  18. Eye-based head gestures

    DEFF Research Database (Denmark)

    Mardanbegi, Diako; Witzner Hansen, Dan; Pederson, Thomas

    2012-01-01

    A novel method for video-based head gesture recognition using eye information by an eye tracker has been proposed. The method uses a combination of gaze and eye movement to infer head gestures. Compared to other gesture-based methods a major advantage of the method is that the user keeps the gaze...... mobile phone screens. The user study shows that the method detects a set of defined gestures reliably.......A novel method for video-based head gesture recognition using eye information by an eye tracker has been proposed. The method uses a combination of gaze and eye movement to infer head gestures. Compared to other gesture-based methods a major advantage of the method is that the user keeps the gaze...

  19. Topiramate Responsive Exploding Head Syndrome

    OpenAIRE

    Palikh, Gaurang M.; Vaughn, Bradley V.

    2010-01-01

    Exploding head syndrome is a rare phenomenon but can be a significant disruption to quality of life. We describe a 39-year-old female with symptoms of a loud bang and buzz at sleep onset for 3 years. EEG monitoring confirmed these events occurred in transition from stage 1 sleep. This patient reported improvement in intensity of events with topiramate medication. Based on these results, topiramate may be an alternative method to reduce the intensity of events in exploding head syndrome.

  20. Topiramate responsive exploding head syndrome.

    Science.gov (United States)

    Palikh, Gaurang M; Vaughn, Bradley V

    2010-08-15

    Exploding head syndrome is a rare phenomenon but can be a significant disruption to quality of life. We describe a 39-year-old female with symptoms of a loud bang and buzz at sleep onset for 3 years. EEG monitoring confirmed these events occurred in transition from stage 1 sleep. This patient reported improvement in intensity of events with topiramate medication. Based on these results, topiramate may be an alternative method to reduce the intensity of events in exploding head syndrome.

  1. CT and MR imaging of closed head trauma

    International Nuclear Information System (INIS)

    Park, Byung Moon; Kim, Wan Jin; Kim, Dae Ho; Lee, Hae Kyung; Chung, Moo Chan; Kwon, Kui Hyang; Kim, Ki Jeong

    1990-01-01

    The distribution and extent of traumatic lesions were evaluated with MR imaging in 40 patients with closed head injuries. The primary intraaxial lesions were classified into four main types, according to their topographical distribution within the brain ; cortical contusion (54%), diffuse axonal injury (35%), subcortical gray matter injury (4%), primary brain stem injury (7%). MR was found to be superior to CT and to be very useful in the detection of traumatic head lesions and T2WI were most useful for lesion detection. But T1WI proved to be also useful for detection of hemorrhage and anatomical localization

  2. Fossil plume head beneath the Arabian lithosphere?

    Science.gov (United States)

    Stein, Mordechai; Hofmann, Albrecht W.

    1992-12-01

    Phanerozoic alkali basalts from Israel, which have erupted over the past 200 Ma, have isotopic compositions similar to PREMA ("prevalent mantle") with narrow ranges of initial ɛ Nd(T) = +3.9-+5.9; 87Sr/ 86Sr(T)= 0.70292-0.70334; 206Pb/ 204Pb(T)= 18.88-19.99; 207Pb/ 204Pb(T)= 15.58-15.70; and 208Pb/ 204Pb(T)= 38.42-39.57. Their Nb/U(43 ± 9) and Ce/Pb(26 ± 6) ratios are identical to those of normal oceanic basalts, demonstrating that the basalts are essentially free of crustal contamination. Overall, the basalts are chemically and isotopically indistinguishable from many ordinary plume basalts, but no plume track can be identified. We propose that these and other, similar, magmas from the Arabian plate originated from a "fossilized" head of a mantle plume, which was unable to penetrate the continental lithosphere and was therefore trapped and stored beneath it. The plume head was emplaced some time between the late Proterozoic crust formation and the initiation of the Phanerozoic magmatic cycles. Basalts from rift environments in other continental localities show similar geochemistry to that of the Arabian basalts and their sources may also represent fossil plume heads trapped below the continents. We suggest that plume heads are, in general, characterized by the PREMA isotopic mantle signature, because the original plume sources (which may have HIMU or EM-type composition) have been diluted by overlying mantle material, which has been entrained by the plume heads during ascent. On the Arabian plate, rifting and thinning of the lithosphere caused partial melting of the stored plume, which led to periodic volcanism. In the late Cenozoic, the lithosphere broke up and the Red Sea opened. N-MORB tholeiites are now erupting in the central trough of the Red Sea, where the lithosphere has moved apart and the fossil plume has been exhausted, whereas E-MORBs are erupting in the northern and southern troughs, still tapping the plume reservoir. Fossil plumes, which are

  3. Local food:

    DEFF Research Database (Denmark)

    Sundbo, Donna Isabella Caroline

    2013-01-01

    are identified and then categorised according to whether they pertain to the food product itself or the production methods and facilities and whether they describe physical or social properties of local food. From this a model with four categories is developed. It is found that properties of the product are more......Recently there has been more focus on food in general and local food in particular. But what is local food? And what are the perceptions of this concept according to theory and to providers and consumers of local food? This article first summarises and compares three different theoretical...... perspectives on local food, namely experience economy, local food systems and what is termed pro-industrialism. These have differing and sometimes opposite conceptualisations and aims for the concept of local food. Using the perspective of experience economy as theoretical background, the concept of local food...

  4. Local island divertor experiments on LHD

    International Nuclear Information System (INIS)

    Morisaki, T.; Masuzaki, S.; Komori, A.; Ohyabu, N.; Kobayashi, M.; Feng, Y.; Sardei, F.; Narihara, K.; Tanaka, K.; Ida, K.; Peterson, B.J.; Yoshinuma, M.; Ashikawa, N.; Emoto, M.; Funaba, H.; Goto, M.; Ikeda, K.; Inagaki, S.; Kaneko, O.; Kawahata, K.; Kubo, S.; Miyazawa, J.; Morita, S.; Nagaoka, K.; Nagayama, Y.; Nakanishi, H.; Ohkubo, K.; Oka, Y.; Osakabe, M.; Shimozuma, T.; Shoji, M.; Takeiri, Y.; Sakakibara, S.; Sakamoto, R.; Sato, K.; Toi, K.; Tsumori, K.; Watababe, K.Y.; Yamada, H.; Yamada, I.; Yoshimura, Y.; Motojima, O.

    2005-01-01

    A local island divertor (LID) experiment has begun on LHD, with the aims of controlling edge recycling and improving the plasma confinement. The fundamental divertor functions of the LID have been demonstrated in the recent experiments. From the particle flux profile measurements on the LID head it was found that the particles diffusing out from the core region are well guided along the island separatrix to the LID head. Owing to the closed configuration around the LID head, evidence of the high efficient pumping was observed, together with a strong capacity to screen impurities. The first results of edge modeling using the EMC3-EIRENE code are also presented

  5. 3D realistic head model simulation based on transcranial magnetic stimulation.

    Science.gov (United States)

    Yang, Shuo; Xu, Guizhi; Wang, Lei; Chen, Yong; Wu, Huanli; Li, Ying; Yang, Qingxin

    2006-01-01

    Transcranial magnetic stimulation (TMS) is a powerful non-invasive tool for investigating functions in the brain. The target inside the head is stimulated with eddy currents induced in the tissue by the time-varying magnetic field. Precise spatial localization of stimulation sites is the key of efficient functional magnetic stimulations. Many researchers devote to magnetic field analysis in empty free space. In this paper, a realistic head model used in Finite Element Method has been developed. The magnetic field inducted in the head bt TMS has been analysed. This three-dimensional simulation is useful for spatial localization of stimulation.

  6. Local Content

    CSIR Research Space (South Africa)

    Gibberd, Jeremy

    2016-10-01

    Full Text Available Local content refers to materials and products made in a country as opposed those that are imported. There is an increasing interest in the concept of local content as a means of supporting local economies and providing jobs (Belderbos & Sleuwaegen...

  7. Magnetic domain wall gratings for magnetization reversal tuning and confined dynamic mode localization.

    Science.gov (United States)

    Trützschler, Julia; Sentosun, Kadir; Mozooni, Babak; Mattheis, Roland; McCord, Jeffrey

    2016-08-04

    High density magnetic domain wall gratings are imprinted in ferromagnetic-antiferromagnetic thin films by local ion irradiation by which alternating head-to-tail-to-head-to-tail and head-to-head-to-tail-to-tail spatially overlapping domain wall networks are formed. Unique magnetic domain processes result from the interaction of anchored domain walls. Non-linear magnetization response is introduced by the laterally distributed magnetic anisotropy phases. The locally varying magnetic charge distribution gives rise to localized and guided magnetization spin-wave modes directly constrained by the narrow domain wall cores. The exchange coupled multiphase material structure leads to unprecedented static and locally modified dynamic magnetic material properties.

  8. Cetuximab And The Head And Neck Squamous Cell Cancer.

    Science.gov (United States)

    Concu, Riccardo; Cordeiro, Maria Natalia Dias Soeiro

    2018-01-12

    The head and neck squamous cell cancer (HNSCC) is the most common type of head and neck cancer (more than 90%), and all over the world more than a half million people have been developing this cancer in the last years. This type of cancer is usually marked by a poor prognosis with a really significant morbidity and mortality. Cetuximab received early favor as an exciting and promising new therapy with relatively mild side effect, and due to this received authorization in the 2004 from the European Medicines Agency (EMA) and in the 2006 from the Food and Drug Association (FDA) for the treatment of patients with squamous cell cancer of the head and neck in combination with radiation therapy for locally advanced disease. In this work we will review the application and the efficacy of the Cetuximab in the treatment of the HNSCC. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  9. Use of the GPK cutter loader to drive headings. [USSR

    Energy Technology Data Exchange (ETDEWEB)

    Vasil' tsov, A.N.

    1985-01-01

    Mine drivage work is described at the Novovolynskaya mine of the Ukrzapadugol' organization with an output of 520,000 t/y, daily output 1457 t. Two seams 0.6-1.8 m thick are worked at depths of 360-380 m. There is a catagory I methane hazard and a hazard of coal dust explosions. Almost all heading drivage is performed using the GPK cutter loader. The AKP-3/9.2 yielding arch support is used in headings, with an interval of 0.8 m between arches. Local ventilation blowers provide air through 600 mm pipes. Suction dust collectors and spraying are used at the face. Details are given of work organization and maintenance procedures. No serious or fatal accidents were recorded during heading drivage between 1981 and 1984.

  10. Heading for a fall? Management of head injury in infants.

    LENUS (Irish Health Repository)

    Williamson, M

    2010-09-01

    Head injury is one of the commonest reasons for infants (< 1 year) to attend the Emergency Department (ED). Clinical management varies considerably and concern about non accidental injury results in a high admission rate in some hospitals. Information was obtained on 103 children under one year of age presenting to the ED with head injury in a prospective study. The average age was 6.7 months and 57% of patients were male. Twenty eight babies had skull x rays with 1 skull fracture diagnosed. None required CT brain scan. Ninety eight (94%) were discharged home from the ED. There were no unplanned returns, readmissions or adverse events. The incidence of traumatic brain injury in children under one year of age presenting with head injury is low and the majority can be safely discharged home.

  11. PET-NECK: a multicentre randomised Phase III non-inferiority trial comparing a positron emission tomography-computerised tomography-guided watch-and-wait policy with planned neck dissection in the management of locally advanced (N2/N3) nodal metastases in patients with squamous cell head and neck cancer.

    Science.gov (United States)

    Mehanna, Hisham; McConkey, Chris C; Rahman, Joy K; Wong, Wai-Lup; Smith, Alison F; Nutting, Chris; Hartley, Andrew Gj; Hall, Peter; Hulme, Claire; Patel, Dharmesh K; Zeidler, Sandra Ventorin von; Robinson, Max; Sanghera, Bal; Fresco, Lydia; Dunn, Janet A

    2017-04-01

    Planned neck dissection (ND) after radical chemoradiotherapy (CRT) for locally advanced nodal metastases in patients with head and neck squamous cell carcinoma (HNSCC) remains controversial. Thirty per cent of ND specimens show histological evidence of tumour. Consequently, a significant proportion of clinicians still practise planned ND. Fludeoxyglucose positron emission tomography (PET)-computerised tomography (CT) scanning demonstrated high negative predictive values for persistent nodal disease, providing a possible alternative paradigm to ND. Evidence is sparse and drawn mainly from retrospective single-institution studies, illustrating the need for a prospective randomised controlled trial. To determine the efficacy and cost-effectiveness of PET-CT-guided surveillance, compared with planned ND, in a multicentre, prospective, randomised setting. A pragmatic randomised non-inferiority trial comparing PET-CT-guided watch-and-wait policy with the current planned ND policy in HNSCC patients with locally advanced nodal metastases and treated with radical CRT. Patients were randomised in a 1 : 1 ratio. Primary outcomes were overall survival (OS) and cost-effectiveness [incremental cost per incremental quality-adjusted life-year (QALY)]. Cost-effectiveness was assessed over the trial period using individual patient data, and over a lifetime horizon using a decision-analytic model. Secondary outcomes were recurrence in the neck, complication rates and quality of life. The recruitment of 560 patients was planned to detect non-inferior OS in the intervention arm with a 90% power and a type I error of 5%, with non-inferiority defined as having a hazard ratio (HR) of no higher than 1.50. An intention-to-treat analysis was performed by Cox's proportional hazards model. Thirty-seven head and neck cancer-treating centres (43 NHS hospitals) throughout the UK. Patients with locally advanced nodal metastases of oropharynx, hypopharynx, larynx, oral or occult HNSCC receiving

  12. Photodynamic therapy in head and neck cancer

    Directory of Open Access Journals (Sweden)

    Kamil H Nelke

    2014-02-01

    Full Text Available Photodynamic therapy (PDT is a special type of treatment involving the use of a photosensitizer or a photosensitizing agent along with a special type of light, which, combined together, induces production of a form of oxygen that is used to kill surrounding cells in different areas of the human body. Specification of the head and neck region requires different approaches due to the surrounding of vital structures. PDT can also be used to treat cells invaded with infections such as fungi, bacteria and viruses. The light beam placed in tumor sites activates locally applied drugs and kills the cancer cells. Many studies are taking place in order to invent better photosensitizers, working on a larger scale and to treat deeply placed and larger tumors. It seems that PDT could be used as an alternative surgical treatment in some tumor types; however, all clinicians should be aware that the surgical approach is still the treatment of choice. PDT is a very accurate and effective therapy, especially in early stages of head and neck squamous cell carcinomas (HNSCC, and can greatly affect surgical outcomes in cancerous patients. We present a detailed review about photosensitizers, their use, and therapeutic advantages and disadvantages.

  13. San andreas fault zone head waves near parkfield, california.

    Science.gov (United States)

    Ben-Zion, Y; Malin, P

    1991-03-29

    Microearthquake seismograms from the borehole seismic network on the San Andreas fault near Parkfield, California, provide three lines of evidence that first P arrivals are "head" waves refracted along the cross-fault material contrast. First, the travel time difference between these arrivals and secondary phases identified as direct P waves scales linearly with the source-receiver distance. Second, these arrivals have the emergent wave character associated in theory and practice with refracted head waves instead of the sharp first breaks associated with direct P arrivals. Third, the first motion polarities of the emergent arrivals are reversed from those of the direct P waves as predicted by the theory of fault zone head waves for slip on the San Andreas fault. The presence of fault zone head waves in local seismic network data may help account for scatter in earthquake locations and source mechanisms. The fault zone head waves indicate that the velocity contrast across the San Andreas fault near Parkfield is approximately 4 percent. Further studies of these waves may provide a way of assessing changes in the physical state of the fault system.

  14. Wheelchair control by head motion

    Directory of Open Access Journals (Sweden)

    Pajkanović Aleksandar

    2013-01-01

    Full Text Available Electric wheelchairs are designed to aid paraplegics. Unfortunately, these can not be used by persons with higher degree of impairment, such as quadriplegics, i.e. persons that, due to age or illness, can not move any of the body parts, except of the head. Medical devices designed to help them are very complicated, rare and expensive. In this paper a microcontroller system that enables standard electric wheelchair control by head motion is presented. The system comprises electronic and mechanic components. A novel head motion recognition technique based on accelerometer data processing is designed. The wheelchair joystick is controlled by the system’s mechanical actuator. The system can be used with several different types of standard electric wheelchairs. It is tested and verified through an experiment performed within this paper.

  15. OCULAR MANIFESTATIONS OF HEAD INJURIES

    Directory of Open Access Journals (Sweden)

    Kanukollu Venkata Madusudana Rao

    2016-12-01

    Full Text Available BACKGROUND This prospective study aimed to evaluate the incidence of ocular manifestations in head injury and their correlation with the intracranial lesions. MATERIALS AND METHODS A total of 108 consecutive cases of closed head injury admitted in the neurosurgical ward of a tertiary teaching hospital underwent a thorough ophthalmic assessment. Clinical examination, radiological imaging and Glasgow Coma Scale (GCS were applied to grade the severity of injury. RESULTS Total number of 108 patients of head injury were examined of which 38 patients had ocular manifestations (35.18%. Of these, 85.18% were males, 84% of injuries were due to road traffic accidents and 16% were due to fall from a height. The ocular manifestations were as follows- Orbital complications were seen in 6 patients (15.8%. Anterior segment manifestations included black eyes seen in 10 patients (26.3%, subconjunctival haemorrhage in 10.5% of patients (4 patients, corneal involvement in 21% of patients (8 patients and pupillary involvement in 50% of patients (19 patients. Posterior segment manifestations were seen in 26.3% of patients (10 patients and were as follows- Purtscher’s retinopathy in 2 patients and optic atrophy in 5 patients. Cranial nerve palsies were seen in 15 patients (39.47% and supranuclear movement disorders were seen in 3 patients (8%. CONCLUSION Even though, neurosurgeons perform comprehensive clinical examination including eye examination, the main purpose is limited to aid topical diagnosis of neurological lesions. This study emphasises the importance of a detailed eye examination by an ophthalmologist to prevent irreversible visual loss in addition to aiding in the neurological diagnosis. Pupillary involvement, papilloedema and ocular motor paresis pointed to a more severe head injury. This observational prospective study helped us to correlate the severity of head injuries in association with ocular findings in patients admitted in neurosurgical ward

  16. Perineural spread in head and neck tumors.

    Science.gov (United States)

    Brea Álvarez, B; Tuñón Gómez, M

    2014-01-01

    Perineural spread is the dissemination of some types of head and neck tumors along nervous structures. Perineural spread has negative repercussions on treatment because it requires more extensive resection and larger fields of irradiation. Moreover, perineural spread is associated with increased local recurrence, and it is considered an independent indicator of poor prognosis in the TNM classification for tumor staging. However, perineural spread often goes undetected on imaging studies. In this update, we review the concept of perineural spread, its pathogenesis, and the main pathways and connections among the facial nerves, which are essential to understand this process. Furthermore, we discuss the appropriate techniques for imaging studies, and we describe and illustrate the typical imaging signs that help identify perineural spread on CT and MRI. Finally, we discuss the differential diagnosis with other entities. Copyright © 2013 SERAM. Published by Elsevier Espana. All rights reserved.

  17. Light water reactor lower head failure analysis

    International Nuclear Information System (INIS)

    Rempe, J.L.; Chavez, S.A.; Thinnes, G.L.

    1993-10-01

    This document presents the results from a US Nuclear Regulatory Commission-sponsored research program to investigate the mode and timing of vessel lower head failure. Major objectives of the analysis were to identify plausible failure mechanisms and to develop a method for determining which failure mode would occur first in different light water reactor designs and accident conditions. Failure mechanisms, such as tube ejection, tube rupture, global vessel failure, and localized vessel creep rupture, were studied. Newly developed models and existing models were applied to predict which failure mechanism would occur first in various severe accident scenarios. So that a broader range of conditions could be considered simultaneously, calculations relied heavily on models with closed-form or simplified numerical solution techniques. Finite element techniques-were employed for analytical model verification and examining more detailed phenomena. High-temperature creep and tensile data were obtained for predicting vessel and penetration structural response

  18. Head injury management guidelines for general practitioners

    Directory of Open Access Journals (Sweden)

    Jeremy C Ganz

    2011-01-01

    Full Text Available A complete examination of a head injured patient in the hospital requires a number of instruments. These include a stethoscope, sphygmomanometer, ophthalmoscope, otoscope, cotton wool, safety pin, tuning fork, reflex hammer and a small key to test the plantar response. Few of these are required at the accident scene. This is because, in the hospital, the aim is optimal definitive treatment. At the accident scene, the aim is prevention of secondary injury, rapid recording of the most important findings and safe efficient transport to the hospital. This short paper reviews how the local doctor should undertake a neurosurgical assessment of traumatic brain injury patients. Moreover, the primary management at accident scenes is described and the rationale behind the approach is outlined

  19. Head and neck cancer: metronomic chemotherapy

    International Nuclear Information System (INIS)

    De Felice, Francesca; Musio, Daniela; Tombolini, Vincenzo

    2015-01-01

    In the era of personalized medicine, head and neck squamous cell carcinoma (HNSCC) represents a critical oncologic topic. Conventional chemotherapy regimens consist of drugs administration in cycles near or at the maximum tolerated dose (MDT), followed by a long drug-free period to permit the patient to recover from acute toxicities. Despite this strategy is successful in controlling the cancer process at the beginning, a significant number of HNSCC patients tend to recurred or progress, especially those patients with locally advanced or metastatic disease. The repertoire of drugs directed against tumor cells has greatly increased and metronomic chemotherapy (MC) could be an effective treatment option. It is the purpose of this article to review the concept of MC and describe its potential use in HNSCC. We provide an update of ongoing progress and current challenges related to this issue

  20. Light water reactor lower head failure analysis

    Energy Technology Data Exchange (ETDEWEB)

    Rempe, J.L.; Chavez, S.A.; Thinnes, G.L. [EG and G Idaho, Inc., Idaho Falls, ID (United States)] [and others

    1993-10-01

    This document presents the results from a US Nuclear Regulatory Commission-sponsored research program to investigate the mode and timing of vessel lower head failure. Major objectives of the analysis were to identify plausible failure mechanisms and to develop a method for determining which failure mode would occur first in different light water reactor designs and accident conditions. Failure mechanisms, such as tube ejection, tube rupture, global vessel failure, and localized vessel creep rupture, were studied. Newly developed models and existing models were applied to predict which failure mechanism would occur first in various severe accident scenarios. So that a broader range of conditions could be considered simultaneously, calculations relied heavily on models with closed-form or simplified numerical solution techniques. Finite element techniques-were employed for analytical model verification and examining more detailed phenomena. High-temperature creep and tensile data were obtained for predicting vessel and penetration structural response.

  1. Head First 2D Geometry

    CERN Document Server

    Fallow), Stray

    2009-01-01

    Having trouble with geometry? Do Pi, The Pythagorean Theorem, and angle calculations just make your head spin? Relax. With Head First 2D Geometry, you'll master everything from triangles, quads and polygons to the time-saving secrets of similar and congruent angles -- and it'll be quick, painless, and fun. Through entertaining stories and practical examples from the world around you, this book takes you beyond boring problems. You'll actually use what you learn to make real-life decisions, like using angles and parallel lines to crack a mysterious CSI case. Put geometry to work for you, and

  2. Ophthalmic manifestations of head injury.

    Science.gov (United States)

    Kowal, L

    1992-02-01

    Head injuries are frequently associated with ophthalmic problems. The commonest problems seen in this series of 161 patients with head injury were problems with poor accommodation (16% of patients; 58% of these persisted), convergence (14% of patients; 35% of these persisted), pseudomyopia (19%; 55% persisted) and optic atrophy (26% of the patients; 78% of these were mild and easily missed on routine testing, and 22% were severe). Motility disorders were common, especially cranial nerve palsies. Other less frequent motility disturbances included apparent inferior oblique palsy, comitant esotropia, and exotropia which was often of the convergence insufficiency type.

  3. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... examination poses almost no risk to the average patient when appropriate safety guidelines are followed. If sedation is used, there ... have a personal story about radiology? Share your patient story here Images ... Disease Head Injury Brain Tumors Images related ...

  4. Womanhood in Bessie Head's fiction

    African Journals Online (AJOL)

    Rain Cloud~· Gather ( 1969), Maru ( 1972) and A Question of Power ( 1974 ),. Head addresses and ... Yet as is the case in most literature by black women from Africa and the. Caribbean .... womanhood comes into play in the principal's decision to get rid of her: "she ... which tl}e principal intends to use to his advantage.

  5. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... cancer of the head, neck and mouth. The Oral Cancer Foundation estimates that close to 42,000 Americans ... diagnosed with oral or pharyngeal cancer this year. Oral cancer’s mortality is particularly high, not because it is ...

  6. Blunt Head Trauma and Headache

    Directory of Open Access Journals (Sweden)

    Ana B Chelse

    2015-04-01

    Full Text Available Investigators from New York Presbyterian Morgan Stanley Children’s Hospital examined whether having an isolated headache following minor blunt head trauma was suggestive of traumatic brain injury (TBI among a large cohort of children 2-18 years of age.

  7. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... very early stage by mapping the motion of water molecules in the tissue. This water motion, known as diffusion, is impaired by most ... the limitations of MRI of the Head? High-quality images are assured only if you are able ...

  8. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... structures of the brain and can also provide functional information (fMRI) in selected cases. MR images of ... Articles and Media MR Angiography (MRA) Magnetic Resonance, Functional (fMRI) - Brain Head and Neck Cancer Treatment Brain ...

  9. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... of which shows a thin slice of the body. The images can then be studied from different angles by ... information please consult the ACR Manual on Contrast Media and its references. top of page What are the limitations of MRI of the Head? High-quality images are assured only if you are able to ...

  10. Return of the talking heads

    DEFF Research Database (Denmark)

    Reinecke Hansen, Kenneth; Bro, Peter; Andersson, Ralf

    2016-01-01

    . In order to analyze the latest development entering the third wave, we propose a theoretically based dramaturgical model for the television news item. The analysis concludes that, with the current ‘return’ of the talking heads format, the pre-produced and pre-packaged bulletin program about past events...

  11. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ... more. TMJ and Facial Pain TMJ and Facial ... Teeth Management Wisdom Teeth Management An impacted wisdom tooth can ...

  12. Head Start Center Design Guide.

    Science.gov (United States)

    Administration for Children, Youth, and Families (DHHS), Washington, DC. Head Start Bureau.

    This guide contains suggested criteria for planning, designing, and renovating Head Start centers so that they are safe, child-oriented, developmentally appropriate, beautiful, environmentally sensitive, and functional. The content is based on the U.S. General Services Administration's Child Care Center Design Guide, PBS-P140, which was intended…

  13. Analytical modelling of soccer heading

    Indian Academy of Sciences (India)

    ... game is that the players are permitted to use their head to direct the ball during ... method in assessing the cognitive functions that can be applied not only to ... It is attached to a spring (stiffness, k1) and a dashpot (damping coefficient, c1).

  14. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... the head uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the brain and other cranial structures that are clearer and more detailed than other imaging methods. This exam does not use ionizing radiation and may require an injection of a ...

  15. Local licensers and recovering in VP ellipsis

    Directory of Open Access Journals (Sweden)

    Sonia Cyrino

    2005-12-01

    Full Text Available The core properties of VP ellipsis in English and Portuguese may be captured assuming that the elliptical constituent is licensed under local c-command by a verbal element in a sentence functional head. However, the lack of VP ellipsis in most Romance languages and in German, despite the existence of verb movement to sentence functional projections in these languages, suggests that a parameter is involved. Empirical evidence indicates that this parametric variation should not be attributed to a specific functional head because the functional head occupied by the verbal licenser may vary across languages and language varieties. So we will claim that the existence vs. absence of VP ellipsis in the languages considered in this study is due to the features of the functional head that intervenes between the verbal licenser and the elliptical vP phase.

  16. Localized superconductors

    International Nuclear Information System (INIS)

    Ma, M.; Lee, P.A.

    1985-01-01

    We study the effects of Anderson localization on superconductivity by using a Bardeen-Cooper-Schrieffer (BCS)-type trial wave function which pairs electrons in exact time-reversed eigenstates of the single-particle Hamiltonian. Within this approximation, and neglecting localization effects on the effective Coulomb repulsion and the electron-phonon coupling, we find that superconductivity persists below the mobility edge. In fact, Anderson's theorem is valid in the localized phase as long as rhoΔ 0 L/sup d/ > 1 (rho is the density of states averaged over +- Δ 0 of the Fermi energy, Δ 0 the BCS gap parameter, and L the localization length). Hence the gap order parameter Δ(r) remains uniform in space at the BCS value Δ 0 . The superfluid density and response to electromagnetic perturbations, however, show marked differences from the ''dirty superconductor'' regime. For rhoΔ 0 L/sup d/ < 1, Δ(r) fluctuates spatially and eventually drops to zero. In the limit when states are site localized, the system crosses over into the ''Anderson negative-U glass.'' Considerations beyond the trial wave-function approximation will speed up the destruction of superconductivity. The superconductor formed from localized states has the property that its quasiparticle excitations are also localized. Such excitations can be probed by observing the normal current in a tunneling junction

  17. Localização especial de estímulos sonoros em indivíduos cegos congênitos: estudo comparativo da posição tridimensional da cabeça em adultos cegos congênitos e indivíduos videntes Spatial localization of sounds in blind individuals: comparative study of three dimensional position of the head in blind and non blind adults

    Directory of Open Access Journals (Sweden)

    Juliana Gonçalves da Silva Gerente

    2008-04-01

    Full Text Available A capacidade para localizar objetos fixos ou em movimento no espaço tridimensional depende da função visual. No indivíduo cego, as modalidades sensoriais remanescentes, nomeadamente a audição, poderiam compensar a visão na localização espacial. O objetivo deste estudo foi analisar o papel da audição no mecanismo de localização espacial por meio da habilidade de orientar de forma precisa a cabeça face à fonte sonora. Cinco adultos cegos congênitos foram comparados com cinco sujeitos videntes vendados. A tarefa consistiu na orientação da cabeça ao estímulo sonoro, emitido por sete fontes diferentes, com localização fixa. A posição tridimensional da cabeça e tronco foi registrada por um sistema de varredura eletromagnético (Flock of Birds System. Para cada som produzido foi calculado o "erro de localização". Esta medida correspondeu à diferença entre o registro da posição obtido durante o teste e durante uma posição de controle. Os resultados revelaram que nos indivíduos cegos congênitos a magnitude de erro de localização dos estímulos auditivos foi superior aos indivíduos videntes. Conclui-se que a representação mental formada com base na visão constitui um dos pré-requisitos para um bom desempenho nas tarefas espaciais.The ability to locate stationary or moving objects in space depends on visual function. It is thought that for blind individuals, the remaining sensory modalities, in particular hearing, will compensate for the absence of vision in spatial localization. This study aimed to analyze the role of hearing on the spatial localization mechanism by looking at the ability to accurately direct the head to the source of sound. Five congenitally blind adults were compared to five sighted people who wore blindfolds. The task consisted of turning the head toward the sound stimulus, coming from seven different fixed point sources. The three dimensional position of the head and trunk was registered by an

  18. Radiation therapy for head and neck cancers

    International Nuclear Information System (INIS)

    Gillette, S.M.; Gillette, E.L.

    1995-01-01

    Radiation therapy may be indicated for larger invasive tumors of the head and neck that may be difficult to surgically excise or for which surgery would be significantly disfiguring. Previous studies of oral squamous cell carcinomas indicate that it should be possible to control approximately 80% of all but the most advanced local or locoregional tumors. Aggressive radiation therapy to total doses of 56 Gy or greater may be required. That can be done by using smaller doses per fraction and gradually reducing the size of the field so that the highest dose is given only to the tumor with a relatively tight margin. Malignant melanomas can be controlled locally apparently with a few large fractions. Metastatic disease limits survival; therefore, some type of systemic therapy seems to be needed to improve survival of those patients. Canine oral fibrosarcomas require a very high dose for a reasonable probability of control. It seems that a dose of 56 Gy given in 3.3 Gy fractions might provide local control of 50% of the tumors. It is likely that a combination of surgery and radiation would significantly improve the probability for control. Oral squamous cell carcinomas of cats must also be treated very aggressively to improve local control. Tumors of the nasal cavity are usually very large and invasive at the time of diagnosis. Radiation therapy has been shown to be effective in some instances. It is possible that with better definition of the tumor through computerized tomography imaging and improved treatment planning, control of these difficult to manage nasal tumors can be improved

  19. Reinterpreting the Authority of Heads: Making Space for Values-Led School Improvement with the "Index for Inclusion"

    Science.gov (United States)

    Higham, Rupert; Booth, Tony

    2018-01-01

    To what extent can heads use an inclusive values-led approach to school development in the face of pressures from Ofsted and their Local Authority to focus almost exclusively on attainment outcomes? We explore leadership of school improvement in a qualitative study of 10 head teachers in the English county of "Preshire," who worked with…

  20. Localized Scleroderma

    Science.gov (United States)

    ... How Is Localized Scleroderma Diagnosed? Doctors who are familiar with scleroderma, or who are experts at examining ... systemic treatment with a medication or other treatment interventions (for example, ultraviolet light), are reserved for more ...

  1. Some thermalhydraulics of closure head adapters in a 3 loops PWR

    Energy Technology Data Exchange (ETDEWEB)

    Hoffmann, F.; Daubert, O.; Hecker, M. [EDF/DER/National Hydraulics Laboratory, Chatou (France)] [and others

    1995-09-01

    In 1993 a R&D action, based on numerical simulations and experiments on PWR`s upper head was initiated. This paper presents the test facility TRAVERSIN (a scale model of a 900 MW PWR adapter) and the calculations performed on the geometry of different upper head sections with the Thermalhydraulic Finite Element Code N3S used for 2D and 3D computations. The paper presents the method followed to bring the adapter and upper head study to a successful conclusion. Two complementary approaches are performed to obtain global results on complete fluid flow in the upper head and local results on the flow around the adapters of closure head. A validation test case of these experimental and numerical tools is also presented.

  2. Some thermohydraulics of closure head adapters in a 3 loops PWR

    International Nuclear Information System (INIS)

    Hofmann, F.; Daubert, O.; Bertrand, C.; Hecker, M.; Arnoux-Guisse, F.; Bonnin, O.

    1995-12-01

    In 1993 a R and D action, based on numerical simulations and experiments on PWR's upper head was initiated. This paper presents the test facility TRAVERSIN (a scale model of a 900 MW adapter) and calculations performed on the geometry of different upper head sections with the Thermalhydraulic Finite Element Code N3S used for 2D and 3D computations. The paper presents the method followed to bring the adapter and upper head study to a successful conclusion. Two complementary approaches are performed to obtain global results on complete fluid flow in the upper head and local results on the flow around the adapters of closure head. A validation test case of these experimental and numerical tools is also presented. (authors). 7 refs., 9 figs., 1 tab

  3. Heads Up to High School Sports

    Science.gov (United States)

    ... submit" value="Submit" /> HEADS UP to School Sports Recommend on Facebook Tweet Share Compartir To help ... organizations, developed the HEADS UP: Concussion in School Sports initiative and materials. Specific Concussion Information for... Coaches ...

  4. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... with HEADS UP & CDC's Injury Center HEADS UP Resources File Formats Help: How do I view different ... 6348 Email CDC-INFO U.S. Department of Health & Human Services HHS/Open USA.gov Top

  5. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Submit Button Connect with HEADS UP & CDC's Injury Center HEADS UP Resources File Formats Help: How do ... Page last updated: April 24, 2017 Content source: Centers for Disease Control and Prevention , National Center for ...

  6. Head and Neck Cancer—Patient Version

    Science.gov (United States)

    Head and neck cancers include cancers in the larynx (voice box), throat, lips, mouth, nose, and salivary glands. Start here to find information on head and neck cancer treatment in adults and children, causes and prevention, screening, research, and statistics.

  7. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Training course: This page has moved Recommend on Facebook Tweet Share Compartir This training course has been ... with HEADS UP & CDC's Injury Center HEADS UP Resources ... HHS/Open USA.gov Top

  8. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... extensively trained to appropriately administer local anesthesia, all forms of sedation and general anesthesia. Click here to ... extensively trained to appropriately administer local anesthesia, all forms of sedation and general anesthesia. Click here to ...

  9. Head stabilization in whooping cranes

    Science.gov (United States)

    Kinloch, M.R.; Cronin, T.W.; Olsen, Glenn H.; Chavez-Ramirez, Felipe

    2005-01-01

    The whooping crane (Grus americana) is the tallest bird in North America, yet not much is known about its visual ecology. How these birds overcome their unusual height to identify, locate, track, and capture prey items is not well understood. There have been many studies on head and eye stabilization in large wading birds (herons and egrets), but the pattern of head movement and stabilization during foraging is unclear. Patterns of head movement and stabilization during walking were examined in whooping cranes at Patuxent Wildlife Research Center, Laurel, Maryland USA. Four whooping cranes (1 male and 3 females) were videotaped for this study. All birds were already acclimated to the presence of people and to food rewards. Whooping cranes were videotaped using both digital and Hi-8 Sony video cameras (Sony Corporation, 7-35 Kitashinagawa, 6-Chome, Shinagawa-ku, Tokyo, Japan), placed on a tripod and set at bird height in the cranes' home pens. The cranes were videotaped repeatedly, at different locations in the pens and while walking (or running) at different speeds. Rewards (meal worms, smelt, crickets and corn) were used to entice the cranes to walk across the camera's view plane. The resulting videotape was analyzed at the University of Maryland at Baltimore County. Briefly, we used a computerized reduced graphic model of a crane superimposed over each frame of analyzed tape segments by means of a custom written program (T. W. Cronin, using C++) with the ability to combine video and computer graphic input. The speed of the birds in analyzed segments ranged from 0.30 m/s to 2.64 m/s, and the proportion of time the head was stabilized ranged from 79% to 0%, respectively. The speed at which the proportion reached 0% was 1.83 m/s. The analyses suggest that the proportion of time the head is stable decreases as speed of the bird increases. In all cases, birds were able to reach their target prey with little difficulty. Thus when cranes are walking searching for food

  10. JackIn Head: Immersive Visual Telepresence System with Omnidirectional Wearable Camera.

    Science.gov (United States)

    Kasahara, Shunichi; Nagai, Shohei; Rekimoto, Jun

    2017-03-01

    Sharing one's own immersive experience over the Internet is one of the ultimate goals of telepresence technology. In this paper, we present JackIn Head, a visual telepresence system featuring an omnidirectional wearable camera with image motion stabilization. Spherical omnidirectional video footage taken around the head of a local user is stabilized and then broadcast to others, allowing remote users to explore the immersive visual environment independently of the local user's head direction. We describe the system design of JackIn Head and report the evaluation results of real-time image stabilization and alleviation of cybersickness. Then, through an exploratory observation study, we investigate how individuals can remotely interact, communicate with, and assist each other with our system. We report our observation and analysis of inter-personal communication, demonstrating the effectiveness of our system in augmenting remote collaboration.

  11. Experimental test of spatial updating models for monkey eye-head gaze shifts.

    Directory of Open Access Journals (Sweden)

    Tom J Van Grootel

    Full Text Available How the brain maintains an accurate and stable representation of visual target locations despite the occurrence of saccadic gaze shifts is a classical problem in oculomotor research. Here we test and dissociate the predictions of different conceptual models for head-unrestrained gaze-localization behavior of macaque monkeys. We adopted the double-step paradigm with rapid eye-head gaze shifts to measure localization accuracy in response to flashed visual stimuli in darkness. We presented the second target flash either before (static, or during (dynamic the first gaze displacement. In the dynamic case the brief visual flash induced a small retinal streak of up to about 20 deg at an unpredictable moment and retinal location during the eye-head gaze shift, which provides serious challenges for the gaze-control system. However, for both stimulus conditions, monkeys localized the flashed targets with accurate gaze shifts, which rules out several models of visuomotor control. First, these findings exclude the possibility that gaze-shift programming relies on retinal inputs only. Instead, they support the notion that accurate eye-head motor feedback updates the gaze-saccade coordinates. Second, in dynamic trials the visuomotor system cannot rely on the coordinates of the planned first eye-head saccade either, which rules out remapping on the basis of a predictive corollary gaze-displacement signal. Finally, because gaze-related head movements were also goal-directed, requiring continuous access to eye-in-head position, we propose that our results best support a dynamic feedback scheme for spatial updating in which visuomotor control incorporates accurate signals about instantaneous eye- and head positions rather than relative eye- and head displacements.

  12. 29 CFR 1918.103 - Head protection.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 7 2010-07-01 2010-07-01 false Head protection. 1918.103 Section 1918.103 Labor... must ensure that head protection complies with any of the following consensus standards: (i) ANSI Z89.1... as head protection devices that are constructed in accordance with one of the above consensus...

  13. 29 CFR 1915.155 - Head protection.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 7 2010-07-01 2010-07-01 false Head protection. 1915.155 Section 1915.155 Labor... helmets. (1) Head protection must comply with any of the following consensus standards: (i) ANSI Z89.1... as head protection devices that are constructed in accordance with one of the above consensus...

  14. 29 CFR 1910.135 - Head protection.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 5 2010-07-01 2010-07-01 false Head protection. 1910.135 Section 1910.135 Labor... head protection. (1) Head protection must comply with any of the following consensus standards: (i... consensus standards will be deemed to be in compliance with the requirements of this section. [59 FR 16362...

  15. Small head size after atomic irradiation

    International Nuclear Information System (INIS)

    Miller, R.W.; Mulvihill, J.J.

    1975-01-01

    A study of children exposed to nuclear explosions in Hiroshima and Nagasaki showed small head size and mental retardation when exposure occurred less than 18 weeks of gestational age. Increased frequency of small head size occurred when maternal exposure was 10 to 19 rad. Tables and graphs are presented to show relationships between dose, gestational age, and frequency of small head size

  16. Health Coordination Manual. Head Start Health Services.

    Science.gov (United States)

    Administration for Children, Youth, and Families (DHHS), Washington, DC. Head Start Bureau.

    Part 1 of this manual on coordinating health care services for Head Start children provides an overview of what Head Start health staff should do to meet the medical, mental health, nutritional, and/or dental needs of Head Start children, staff, and family members. Offering examples, lists, action steps, and charts for clarification, part 2…

  17. 21 CFR 868.1930 - Stethoscope head.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Stethoscope head. 868.1930 Section 868.1930 Food... DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1930 Stethoscope head. (a) Identification. A stethoscope head is a weighted chest piece used during anesthesia to listen to a patient's heart, breath, and...

  18. 29 CFR 1926.100 - Head protection.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 8 2010-07-01 2010-07-01 false Head protection. 1926.100 Section 1926.100 Labor... § 1926.100 Head protection. (a) Employees working in areas where there is a possible danger of head... protected by protective helmets. (b) Helmets for the protection of employees against impact and penetration...

  19. Olímpia de Épiro: uma leitura dos Comportamentos Barbarescos da Rainha Macedônica na obra Vidas paralelas de Plutarco * Olympia of Epirus: reading the Aarbarian Acting of the Macedonian Queen in the work Parallel lives of Plutarch

    Directory of Open Access Journals (Sweden)

    DOMINIQUE VIEIRA COELHO DOS SANTOS

    2014-01-01

    Full Text Available Resumo: O objetivo deste artigo é analisar o papel que Olímpia de Épiro – mãe de Alexandre, o Grande – desempenha na narrativa plutarqueana dentro da obra Vidas Paralelas. Tal empreendimento pode nos auxiliar a compreender, por exemplo, como Plutarco aborda a dicotomia grego/bárbaro, pois quando descreve a rainha macedônica ele a caracteriza como detentora de uma natureza rude e comportamentos religiosos desviantes, sendo tão barbaresca quanto às mulheres Edômas e Trácias.  Palavras-chave: Plutarco – Alexandre – Religião – Barbárie – Olímpia de Épiro. Abstract: This paper aim is to analyze the role that Olympia of Epirus - mother of Alexander the Great - plays in the Plutarchian narrative in the work Parallel Lives. Such an effort can help us to understand, for example, how Plutarch discusses the dichotomy greek/barbarian, as when he describes the Macedonian Queen he characterizes her as having a tough nature and deviant religious behavior, being as barbaric as Edonian and Thracian women.Keywords: Plutarch – Alexander – Religion – Barbarism – Olympia of Epirus.

  20. Sound localization under perturbed binaural hearing.

    NARCIS (Netherlands)

    Wanrooij, M.M. van; Opstal, A.J. van

    2007-01-01

    This paper reports on the acute effects of a monaural plug on directional hearing in the horizontal (azimuth) and vertical (elevation) planes of human listeners. Sound localization behavior was tested with rapid head-orienting responses toward brief high-pass filtered (>3 kHz; HP) and broadband

  1. Fuel rod pellet loading head

    International Nuclear Information System (INIS)

    Howell, T.E.

    1975-01-01

    An assembly for loading nuclear fuel pellets into a fuel rod comprising a loading head for feeding pellets into the open end of the rod is described. The pellets rest in a perforated substantially V-shaped seat through which air may be drawn for removal of chips and dust. The rod is held in place in an adjustable notched locator which permits alignment with the pellets

  2. Bottom head failure program plan

    International Nuclear Information System (INIS)

    Meyer, R.O.

    1989-01-01

    Earlier this year the NRC staff presented a Revised Severe Accident Research Program Plan (SECY-89-123) to the Commission and initiated work on that plan. Two of the near-term issues in that plan involve failure of the bottom head of the reactor pressure vessel. These two issues are (1) depressurization and DCH and (2) BWR Mark I Containment Shell Meltthrough. ORNL has developed models for several competing failure mechanisms for BWRs. INEL has performed analytical and experimental work directly related to bottom head failure in connection with several programs. SNL has conducted a number of analyses and experimental activities to examine the failure of LWR vessels. In addition to the government-sponsored work mentioned above, EPRI and FAI performed studies on vessel failure for the Industry Degraded Core Rulemaking Program (IDCOR). EPRI examined the failure of a PWR vessel bottom head without penetrations, as found in some Combustion Engineering reactors. To give more attention to this subject as called for by the revised Severe Accident Research Plan, two things are being done. First, work previously done is being reviewed carefully to develop an overall picture and to determine the reliability of assumptions used in those studies. Second, new work is being planned for FY90 to try to complete a reasonable understanding of the failure process. The review and planning are being done in close cooperation with the ACRS. Results of this exercise will be presented in this paper

  3. Is Heading in Youth Soccer Dangerous Play?

    Science.gov (United States)

    O'Kane, John W

    2016-01-01

    Soccer is among the most popular youth sports with over 3 million youth players registered in the U.S. Soccer is unique in that players intentionally use their head to strike the ball, leading to concerns that heading could cause acute or chronic brain injury, especially in the immature brains of children. Pub Med search without date restriction was conducted in November 2014 and August 2015 using the terms soccer and concussion, heading and concussion, and youth soccer and concussion. 310 articles were identified and reviewed for applicable content specifically relating to youth athletes, heading, and/or acute or chronic brain injury from soccer. Soccer is a low-risk sport for catastrophic head injury, but concussions are relatively common and heading often plays a role. At all levels of play, concussions are more likely to occur in the act of heading than with other facets of the game. While concussion from heading the ball without other contact to the head appears rare in adult players, some data suggests children are more susceptible to concussion from heading primarily in game situations. Contributing factors include biomechanical forces, less developed technique, and the immature brain's susceptibility to injury. There is no evidence that heading in youth soccer causes any permanent brain injury and there is limited evidence that heading in youth soccer can cause concussion. A reasonable approach based on U.S. Youth Soccer recommendations is to teach heading after age 10 in controlled settings, and heading in games should be delayed until skill acquisition and physical maturity allow the youth player to head correctly with confidence.

  4. Locals Collection

    Directory of Open Access Journals (Sweden)

    Stephen Hastings-King

    2010-03-01

    Full Text Available A locals collection is a set of parameters that are used to delimit data-mining operations. This piece uses a collection of locals from around Essex Massachusetts to shape and delimit an interrogation of post-reality in contemporary America. It explores the notion of crisis, the possibility of a crisis of empire that may or may not emerge in a media-space that does not allow crisis of empire to be mentioned and relations this maybe-crisis to the various levels of economic dysfunction that have become evident since late 2008. But mostly this piece explores ways in which particular stories about particular people do and do not link/link to these larger-scale narratives. This is the first of a potential series of locals collections that will mine the American post-real.

  5. Streamer head structure: role of ionization and photoionization

    International Nuclear Information System (INIS)

    Nudnova, M M; Starikovskii, A Yu

    2008-01-01

    Results from experiments and numerical modelling of streamer propagation are presented. The 2D hydrodynamic numerical description of the pulsed discharge based on the local ionization and photoionization models adequately describes the streamer shape and dynamics over a wide range of pressures and voltages. This work presents a method for imaging the instantaneous emission distribution in the streamer head. A method for restoring the electrodynamic radius of the streamer head was developed on the basis of the streamer head images that were obtained with subnanosecond exposure time. The electrodynamic radius has been determined as the distance between the maxima of the electric field at the position where the streamer head transforms into the streamer channel. The dependence of the electrodynamic radius on voltage and pressure has been determined. We show that a 2D numerical model using hydrodynamic approximation predicts the streamer characteristics with an accuracy of about 15% in the 0.5-1 atmosphere pressure range and up to 40% in the 0.2-0.3 atmosphere pressure range for a voltage of U from 20 kV up to 40 kV in the 30 and 40 mm discharge gap.

  6. First Class Call Stacks: Exploring Head Reduction

    Directory of Open Access Journals (Sweden)

    Philip Johnson-Freyd

    2016-06-01

    Full Text Available Weak-head normalization is inconsistent with functional extensionality in the call-by-name λ-calculus. We explore this problem from a new angle via the conflict between extensionality and effects. Leveraging ideas from work on the λ-calculus with control, we derive and justify alternative operational semantics and a sequence of abstract machines for performing head reduction. Head reduction avoids the problems with weak-head reduction and extensionality, while our operational semantics and associated abstract machines show us how to retain weak-head reduction's ease of implementation.

  7. Porcine head response to blast.

    Science.gov (United States)

    Shridharani, Jay K; Wood, Garrett W; Panzer, Matthew B; Capehart, Bruce P; Nyein, Michelle K; Radovitzky, Raul A; Bass, Cameron R 'dale'

    2012-01-01

    Recent studies have shown an increase in the frequency of traumatic brain injuries related to blast exposure. However, the mechanisms that cause blast neurotrauma are unknown. Blast neurotrauma research using computational models has been one method to elucidate that response of the brain in blast, and to identify possible mechanical correlates of injury. However, model validation against experimental data is required to ensure that the model output is representative of in vivo biomechanical response. This study exposes porcine subjects to primary blast overpressures generated using a compressed-gas shock tube. Shock tube blasts were directed to the unprotected head of each animal while the lungs and thorax were protected using ballistic protective vests similar to those employed in theater. The test conditions ranged from 110 to 740 kPa peak incident overpressure with scaled durations from 1.3 to 6.9 ms and correspond approximately with a 50% injury risk for brain bleeding and apnea in a ferret model scaled to porcine exposure. Instrumentation was placed on the porcine head to measure bulk acceleration, pressure at the surface of the head, and pressure inside the cranial cavity. Immediately after the blast, 5 of the 20 animals tested were apneic. Three subjects recovered without intervention within 30 s and the remaining two recovered within 8 min following respiratory assistance and administration of the respiratory stimulant doxapram. Gross examination of the brain revealed no indication of bleeding. Intracranial pressures ranged from 80 to 390 kPa as a result of the blast and were notably lower than the shock tube reflected pressures of 300-2830 kPa, indicating pressure attenuation by the skull up to a factor of 8.4. Peak head accelerations were measured from 385 to 3845 G's and were well correlated with peak incident overpressure (R(2) = 0.90). One SD corridors for the surface pressure, intracranial pressure (ICP), and head acceleration are

  8. Nutriendo la Promesa: Materiales Para la Aplicacion de las Normas de Ejecucion del Programa Head Start. Guia Para la Utilizacion de los Materiales [y] Transparencias (Nurturing the Promise: Set of Training Materials on the Head Start Program Performance Standards. User's Guide [and] Set of Transparencies).

    Science.gov (United States)

    Educational Services, Inc., Washington, DC.

    Since 1975, the Head Start Program Performance Standards have defined the services that local programs are required to provide to enrolled children and families. With revisions effective in 1998, the Program Performance Standards translate the Head Start vision into quality practices implemented at the local level. This document is comprised of a…

  9. Local equilibrium

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1984-12-15

    From 3-6 September the First International Workshop on Local Equilibrium in Strong Interaction Physics took place in Bad-Honnef at the Physics Centre of the German Physical Society. A number of talks covered the experimental and theoretical investigation of the 'hotspots' effect, both in high energy particle physics and in intermediate energy nuclear physics.

  10. Initial treatment results using cyberknife for head and neck tumor

    International Nuclear Information System (INIS)

    Himei, Kengo; Katsui, Kuniaki; Yoshida, Atsushi; Takemoto, Mitsuhiro; Kobayashi, Mitsuru; Kuroda, Masahiro; Hiraki, Yoshio

    2002-01-01

    The CyberKnife, a medical device for stereotactic radiotherapy, is composed of a combination of a robot manipulator and LINAC. For the treatment of head and neck tumors, this system has been applied. Between June 2000 and January 2001, 18 patients with head and neck tumor were treated with this system because of tumor recurrence, difficulty in surgery or additional increase after external radiotherapy. The median age was 64 years. Primary lesions were skull base (4), nasopharynx (3), paranasal sinus (3), nasal cavity (2), lacrimal gland (1), oropharynx (1), oral floor (1), and buccul mucosa (1), metastatic lymph nodes were found in three. The prescribed dose was 12-38 Gy as for marginal dose. The response rate (CR+PR) was 44.4% and local control rate (CR+PR+NC) was 77.8%. The adverse effects were assessed by the NCI-CTC Version 2.0 and observed grade 3 in two cases. Our early experience indicates that this system could to be feasible for the treatment of locally advanced or recurrent head and neck tumor, and for the reduction of adverse effect and maintenance of useful QOL of patients. (author)

  11. Radiological symmetry of brain and head images: comparison and applications

    International Nuclear Information System (INIS)

    Hu, Qingmao; Nowinski, W.L.

    2006-01-01

    Most existing image-based approaches neglect the difference in radiological symmetry between the human brain and head. Thus, it is important to analyze and quantify the spatial relationship between the brain symmetry plane (BSP) and the head symmetry plane (HSP) on radiological images. The HSP and BSP were calculated through maximizing local symmetry within the head or cerebrum followed by outlier removal. The HSPs and BSPs for 145 diversified MRI datasets (80 normal, 23 pathological, and 42 synthesized) were extracted and compared. The average angular and distance deviations between the HSP and BSP were 0.49 and 1.65 mm, respectively. These deviations are dependent upon ethnicity and gender, being: (1) (0.56 , 1.85 mm) and (0.42 , 0.91 mm) for Caucasians and Asians, respectively; and (2) (0.33 , 1.17 mm) and (0.51 , 1.58 mm) for males and females, respectively. The HSP is generally different from the BSP on MR images. Statistically, they can be used interchangeably if accuracy of (0.49 , 1.65 mm) is acceptable. The BSP is preferred for a high accuracy Talairach transformation and localization of the anterior and posterior commissures. Either BSP or HSP can be used for medium accuracy Talairach transform. The HSP is preferred for detecting intracranial pathology. (orig.)

  12. Nonsurgical treatment of aggressive fibromatosis in the head and neck

    International Nuclear Information System (INIS)

    West, C.B. Jr.; Shagets, F.W.; Mansfield, M.J.

    1989-01-01

    Aggressive fibromatosis is a poorly defined, locally aggressive, yet histologically benign fibroblastic proliferative lesion that may occur in the head and neck. The lesion is highly cellular and locally infiltrative and has a propensity to invade and erode bone, compromising vital structures within the head and neck. However, it is not a true malignancy because it does not have malignant cytologic characteristics nor does it metastasize. We present two cases of aggressive fibromatosis occurring in young adult men. The first case involved a rapidly enlarging mass of the anterior maxilla that involved the upper lip, nasal alae, nasal septum, inferior turbinates, and hard palate. The patient underwent incisional biopsy to confirm the diagnosis. Because of difficulty in determining the actual margins of this extensive lesion and the significant morbidity that would have resulted from surgical resection, we elected to treat this patient with chemotherapy and radiation therapy. The second case was an extensive lesion involving the right temporal bone, pterygomaxillary space, and infratemporal, temporal, and middle cranial fossae. Incisional biopsy confirmed the diagnosis. Because of the lack of functional and cosmetic deficits and the unavoidable morbidity of a surgical resection, this patient was treated with radiation therapy. Although wide field resection is the most satisfactory form of treatment, in situations in which this modality would result in unacceptable morbidity or if surgical margins are positive, then radiation therapy and chemotherapy should be considered. Support for these therapeutic modalities is found in larger series of cases outside the head and neck

  13. Radiological symmetry of brain and head images: comparison and applications

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Qingmao; Nowinski, W.L. [Agency for Science, Technology and Research, Singapore (Singapore). Biomedical Imaging Lab.

    2006-08-15

    Most existing image-based approaches neglect the difference in radiological symmetry between the human brain and head. Thus, it is important to analyze and quantify the spatial relationship between the brain symmetry plane (BSP) and the head symmetry plane (HSP) on radiological images. The HSP and BSP were calculated through maximizing local symmetry within the head or cerebrum followed by outlier removal. The HSPs and BSPs for 145 diversified MRI datasets (80 normal, 23 pathological, and 42 synthesized) were extracted and compared. The average angular and distance deviations between the HSP and BSP were 0.49 and 1.65 mm, respectively. These deviations are dependent upon ethnicity and gender, being: (1) (0.56 , 1.85 mm) and (0.42 , 0.91 mm) for Caucasians and Asians, respectively; and (2) (0.33 , 1.17 mm) and (0.51 , 1.58 mm) for males and females, respectively. The HSP is generally different from the BSP on MR images. Statistically, they can be used interchangeably if accuracy of (0.49 , 1.65 mm) is acceptable. The BSP is preferred for a high accuracy Talairach transformation and localization of the anterior and posterior commissures. Either BSP or HSP can be used for medium accuracy Talairach transform. The HSP is preferred for detecting intracranial pathology. (orig.)

  14. Head position modulates optokinetic nystagmus.

    Science.gov (United States)

    Pettorossi, V E; Ferraresi, A; Botti, F M; Panichi, R; Barmack, N H

    2011-08-01

    Orientation and movement relies on both visual and vestibular information mapped in separate coordinate systems. Here, we examine how coordinate systems interact to guide eye movements of rabbits. We exposed rabbits to continuous horizontal optokinetic stimulation (HOKS) at 5°/s to evoke horizontal eye movements, while they were statically or dynamically roll-tilted about the longitudinal axis. During monocular or binocular HOKS, when the rabbit was roll-tilted 30° onto the side of the eye stimulated in the posterior → anterior (P → A) direction, slow phase eye velocity (SPEV) increased by 3.5-5°/s. When the rabbit was roll-tilted 30° onto the side of the eye stimulated in the A → P direction, SPEV decreased to ~2.5°/s. We also tested the effect of roll-tilt after prolonged optokinetic stimulation had induced a negative optokinetic afternystagmus (OKAN II). In this condition, the SPEV occurred in the dark, "open loop." Modulation of SPEV of OKAN II depended on the direction of the nystagmus and was consistent with that observed during "closed loop" HOKS. Dynamic roll-tilt influenced SPEV evoked by HOKS in a similar way. The amplitude and the phase of SPEV depended on the frequency of vestibular oscillation and on HOKS velocity. We conclude that the change in the linear acceleration of the gravity vector with respect to the head during roll-tilt modulates the gain of SPEV depending on its direction. This modulation improves gaze stability at different image retinal slip velocities caused by head roll-tilt during centric or eccentric head movement.

  15. Net Locality

    DEFF Research Database (Denmark)

    de Souza e Silva, Adriana Araujo; Gordon, Eric

    Provides an introduction to the new theory of Net Locality and the profound effect on individuals and societies when everything is located or locatable. Describes net locality as an emerging form of location awareness central to all aspects of digital media, from mobile phones, to Google Maps......, to location-based social networks and games, such as Foursquare and facebook. Warns of the threats these technologies, such as data surveillance, present to our sense of privacy, while also outlining the opportunities for pro-social developments. Provides a theory of the web in the context of the history...... of emerging technologies, from GeoCities to GPS, Wi-Fi, Wiki Me, and Google Android....

  16. Essential radiology for head injury

    International Nuclear Information System (INIS)

    Mok, D.W.H.; Kreel, L.

    1988-01-01

    The book covers the guidelines established by the Royal College of Radiologists for the radiographic evaluation of head injuries. It presents a chapter reviewing the normal radiologic anatomy of the skull in six different projections. The advantages and limitations of each projection are addressed. The third chapter, contains 43 radiographs dedicated to the calcified pineal gland and other intracranial calcifications. The book reports on specific types of fractures: linear fractures of the vault, depressed fractures of the vault, fractures in children, fractures of the base of the skull, and fractures of the facial bones

  17. Head First jQuery

    CERN Document Server

    Benedetti, Ryan

    2011-01-01

    Want to add more interactivity and polish to your websites? Discover how jQuery can help you build complex scripting functionality in just a few lines of code. With Head First jQuery, you'll quickly get up to speed on this amazing JavaScript library by learning how to navigate HTML documents while handling events, effects, callbacks, and animations. By the time you've completed the book, you'll be incorporating Ajax apps, working seamlessly with HTML and CSS, and handling data with PHP, MySQL and JSON. If you want to learn-and understand-how to create interactive web pages, unobtrusive scrip

  18. Local supertwistors

    International Nuclear Information System (INIS)

    Merkulov, S.A.

    1987-01-01

    Geometry of local supertwistors is investigated. It is proved that the Yang-Mills equations for the introduced ansatz for supertwistor connection are equivalent to free bach equations, describing the dynamics of N=1 conformal supergravity. Analogous interpretation of the dynamics of N=1 conformal supergravity coupled to a vector superfield is proposed. It is proved that any complex conformally right or left flat superspace automatically satisfies the Bach equations

  19. HEAD MOVEMENT DURING WALKING IN THE CAT

    Science.gov (United States)

    ZUBAIR, HUMZA N.; BELOOZEROVA, IRINA N.; SUN, HAI; MARLINSKI, VLADIMIR

    2016-01-01

    Knowledge of how the head moves during locomotion is essential for understanding how locomotion is controlled by sensory systems of the head. We have analyzed head movements of the cat walking along a straight flat pathway in the darkness and light. We found that cats' head left-right translations, and roll and yaw rotations oscillated once per stride, while fore-aft and vertical translations, and pitch rotations oscillated twice. The head reached its highest vertical positions during second half of each forelimb swing, following maxima of the shoulder/trunk by 20–90°. Nose-up rotation followed head upward translation by another 40–90° delay. The peak-to-peak amplitude of vertical translation was ~1.5 cm and amplitude of pitch rotation was ~3°. Amplitudes of lateral translation and roll rotation were ~1 cm and 1.5–3°, respectively. Overall, cats' heads were neutral in roll and 10–30° nose-down, maintaining horizontal semicircular canals and utriculi within 10° of the earth horizontal. The head longitudinal velocity was 0.5–1 m/s, maximal upward and downward linear velocities were ~0.05 and ~0.1 m/s, respectively, and maximal lateral velocity was ~0.05 m/s. Maximal velocities of head pitch rotation were 20–50 °/s. During walking in light, cats stood 0.3–0.5 cm taller and held their head 0.5–2 cm higher than in darkness. Forward acceleration was 25–100% higher and peak-to-peak amplitude of head pitch oscillations was ~20 °/s larger. We concluded that, during walking, the head of the cat is held actively. Reflexes appear to play only a partial role in determining head movement, and vision might further diminish their role. PMID:27339731

  20. MOVEMENT WITHIN THE LOCAL CIVIL SERVICE SYSTEM

    Directory of Open Access Journals (Sweden)

    Alen Rajko

    2016-01-01

    Full Text Available The author analyzes the current Croatian regulation of movement within the local and regional civil service system. This includes the institutes of transfer, promotion, appointment and removal of the heads of administrative bodies, as well as changes in the workplace that may occur in the process of reorganization of the administrative bodies, with additional references to the particularities related to the position of heads of administrative bodies and employees. The procedural context of these issues, related to the implementation of administrative procedure and administrative dispute, is also discussed. The author offers legal interpretation to resolve doubts arising in the practice of implementation of the mentioned civil service institutes.

  1. 45 CFR 1308.21 - Parent participation and transition of children into Head Start and from Head Start to public...

    Science.gov (United States)

    2010-10-01

    ... into Head Start and from Head Start to public school. 1308.21 Section 1308.21 Public Welfare... AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD START PROGRAM HEAD START... Standards § 1308.21 Parent participation and transition of children into Head Start and from Head Start to...

  2. Simultaneous head tissue conductivity and EEG source location estimation.

    Science.gov (United States)

    Akalin Acar, Zeynep; Acar, Can E; Makeig, Scott

    2016-01-01

    Accurate electroencephalographic (EEG) source localization requires an electrical head model incorporating accurate geometries and conductivity values for the major head tissues. While consistent conductivity values have been reported for scalp, brain, and cerebrospinal fluid, measured brain-to-skull conductivity ratio (BSCR) estimates have varied between 8 and 80, likely reflecting both inter-subject and measurement method differences. In simulations, mis-estimation of skull conductivity can produce source localization errors as large as 3cm. Here, we describe an iterative gradient-based approach to Simultaneous tissue Conductivity And source Location Estimation (SCALE). The scalp projection maps used by SCALE are obtained from near-dipolar effective EEG sources found by adequate independent component analysis (ICA) decomposition of sufficient high-density EEG data. We applied SCALE to simulated scalp projections of 15cm(2)-scale cortical patch sources in an MR image-based electrical head model with simulated BSCR of 30. Initialized either with a BSCR of 80 or 20, SCALE estimated BSCR as 32.6. In Adaptive Mixture ICA (AMICA) decompositions of (45-min, 128-channel) EEG data from two young adults we identified sets of 13 independent components having near-dipolar scalp maps compatible with a single cortical source patch. Again initialized with either BSCR 80 or 25, SCALE gave BSCR estimates of 34 and 54 for the two subjects respectively. The ability to accurately estimate skull conductivity non-invasively from any well-recorded EEG data in combination with a stable and non-invasively acquired MR imaging-derived electrical head model could remove a critical barrier to using EEG as a sub-cm(2)-scale accurate 3-D functional cortical imaging modality. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project

    DEFF Research Database (Denmark)

    Plaschke, Christina Caroline; Bertino, Giulia; McCaul, James A.

    2017-01-01

    Aim Electrochemotherapy is an effective local treatment for cutaneous tumours and metastases. In this prospective trial, six European institutions investigated electrochemotherapy in recurrent, mucosal head and neck tumours. Patient and methods Forty-three patients with recurrent mucosal head....... Primary end-point was local tumour response. Secondary end-points were safety and toxicity, overall and progression free survival, and quality-of-life. Results Thirty-seven patients were evaluable for tumour response, pain score, side-effects and quality of life questionnaires. Six patients were...

  4. Cryotherapy and radiotherapy combination in extensive and recurrent types of head and neck skin cancer treatment

    International Nuclear Information System (INIS)

    Pustynskij, I.N.; Paches, A.I.; Tkachev, S.I.; Tabolinovskaya, T.D.; Alieva, S.B.; Yagubov, A.S.; Slanina, S.V.; Bazhutova, G.A.

    2007-01-01

    The method of infiltrative skin cancer treatment based on different variants of radiotherapy and cryotherapy combination is described. During the period of 1988-2006 the Department of head and neck neoplasms of N. N. Blohin Russian Cancer Research Center provided radiation and cryogenic treatment of 94 patients with locally advanced head and neck epidermoid and basal cell cancer. For this purpose before every radiotherapy session the tumor was exposed to cryo cooling till freezing temperature (-5 degrees C). The total involution of tumors was observed at 91 patients. Residual tumors were removed surgically. The follow-up showed good functional and aesthetic results, retention of local tissues.

  5. Interventional neuroradiology of the head and neck.

    Science.gov (United States)

    Turowski, Bernd; Zanella, Friedhelm E

    2003-08-01

    Vascular interventions are important and helpful for treatment of various pathologies of the head and neck. Interventional neuroradiology of the head and neck includes image-guided biopsies, vessel occlusion, and local chemotherapy. Knowledge of anatomy, functional relationships between intra- and extracranial vessels, and pathology are the basis for therapeutic success. The interventional neuroradiologist is responsible for appropriate selection of patients based on clinical information, indications, and risk assessment. Neuroradiologic imaging, especially CT and MR imaging, and appropriate analysis of angiographic findings help ensure indication for treatment and plan an intervention. Technical equipment, including an angiographic unit, catheters, needles, embolizing materials, and so forth, are important. Knowledge of hemodynamics is relevant to avoid complications and to find the optimal technique for solving the clinical problem. Indications for image-guided biopsies are preverterbal fluid-collections, spinal and paraspinal inflammations and abscesses, deep cervical malignancies, vertebral body, and skull base tumors. Special care should be taken to preserve critical structures in this region, including spinal nerve roots, cervical plexus, main peripheral nerves, and vessels. Indications for vessel occlusion are emergency situations to stop bleeding in vascular lesions (traumatic, malformation, or tumors) by reduction of pressure, preoperative reduction of blood flow to minimize the surgical risk, palliative occlusion of feeding vessels to produce tumor necrosis, or potential curative (or presurgical) occlusion of vascular malformations. Pressure reduction to support normal coagulation, such as epistaxis, in hereditary hemorrhagic telangiectasia can be achieved by proximal vessel occlusion with large particles or platinum coils. Prevention of intraoperative bleeding requires occlusion of the microvascular bed with small particles. Examples of these

  6. A pre-Hispanic head.

    Directory of Open Access Journals (Sweden)

    Raffaella Bianucci

    Full Text Available This report on a male head revealed biologic rhythms, as gleaned from hydrogen isotope ratios in hair, consistent with a South-American origin and Atomic Mass Spectrometry radiocarbon dating (AMS compatible with the last pre-Hispanic period (1418-1491 AD, 95.4% probability. Biopsies showed exceptionally well-preserved tissues. The hair contained high levels of toxic elements (lead, arsenic and mercury incompatible with life. There was no evidence for lead deposition in bone consistent with post-mortem accumulation of this toxic element in the hair. We propose that the high content of metals in hair was the result of metabolic activity of bacteria leading to metal complexation in extra cellular polymeric substances (EPS. This is a recognized protective mechanism for bacteria that thrive in toxic environments. This mechanism may account for the tissues preservation and gives a hint at soil composition where the head was presumably buried. Our results have implications for forensic toxicology which has, hitherto, relied on hair analyses as one means to reconstruct pre-mortem metabolism and for detecting toxic elements accumulated during life. Our finding also has implications for other archaeological specimens where similar circumstances may distort the results of toxicological studies.

  7. A pre-Hispanic head.

    Science.gov (United States)

    Bianucci, Raffaella; Jeziorska, Maria; Lallo, Rudy; Mattutino, Grazia; Massimelli, Massimo; Phillips, Genevieve; Appenzeller, Otto

    2008-04-30

    This report on a male head revealed biologic rhythms, as gleaned from hydrogen isotope ratios in hair, consistent with a South-American origin and Atomic Mass Spectrometry radiocarbon dating (AMS) compatible with the last pre-Hispanic period (1418-1491 AD, 95.4% probability). Biopsies showed exceptionally well-preserved tissues. The hair contained high levels of toxic elements (lead, arsenic and mercury) incompatible with life. There was no evidence for lead deposition in bone consistent with post-mortem accumulation of this toxic element in the hair. We propose that the high content of metals in hair was the result of metabolic activity of bacteria leading to metal complexation in extra cellular polymeric substances (EPS). This is a recognized protective mechanism for bacteria that thrive in toxic environments. This mechanism may account for the tissues preservation and gives a hint at soil composition where the head was presumably buried. Our results have implications for forensic toxicology which has, hitherto, relied on hair analyses as one means to reconstruct pre-mortem metabolism and for detecting toxic elements accumulated during life. Our finding also has implications for other archaeological specimens where similar circumstances may distort the results of toxicological studies.

  8. Anatomy of the infant head

    International Nuclear Information System (INIS)

    Bosma, J.F.

    1986-01-01

    This text is mainly an atlas of illustration representing the dissection of the head and upper neck of the infant. It was prepared by the author over a 20-year period. The commentary compares the anatomy of the near-term infant with that of a younger fetus, child, and adult. As the author indicates, the dearth of anatomic information about postnatal anatomic changes represents a considerable handicap to those imaging infants. In part 1 of the book, anatomy is related to physiologic performance involving the pharynx, larynx, and mouth. Sequential topics involve the regional anatomy of the head (excluding the brain), the skeleton of the cranium, the nose, orbit, mouth, larynx, pharynx, and ear. To facilitate use of this text as a reference, the illustrations and text on individual organs are considered separately (i.e., the nose, the orbit, the eye, the mouth, the larynx, the pharynx, and the ear). Each part concerned with a separate organ includes materials from the regional illustrations contained in part 2 and from the skeleton, which is treated in part 3. Also included in a summary of the embryologic and fetal development of the organ

  9. Intention tremor after head injury

    International Nuclear Information System (INIS)

    Iwadate, Yasuo; Saeki, Naokatsu; Namba, Hiroki; Odaki, Masaru; Oka, Nobuo.

    1989-01-01

    Eight cases of intention tremor as a late complication of head injury were investigated. The patients ranged in age from 3 to 24 years. All received severe head injuries and lapsed into coma immediately afterward (Glasgow Coma Scale scores ≤8). Six patients exhibited decerebration or decortication. Hemiparesis was present in six cases and oculomotor nerve palsy in four. In the chronic stage, all patients displayed some degree of impairment of higher cortical function and five had dysarthria and/or ataxia. Initial computed tomography (CT) scans within 3 hours after the injury were obtained in five cases, of which four showed a hemorrhagic lesion in the midbrain or its surroundings. Other CT findings were diffuse cerebral swelling (four cases), intraventricular hemorrhage (three), and multiple hemorrhagic lesions (two). In the chronic stage, generalized cortical atrophy or ventricular enlargement was noted in five cases. These clinical features and CT findings indicate diffuse brain damage as well as midbrain damage and may reflect shearing injury. (author)

  10. Computing camera heading: A study

    Science.gov (United States)

    Zhang, John Jiaxiang

    2000-08-01

    An accurate estimate of the motion of a camera is a crucial first step for the 3D reconstruction of sites, objects, and buildings from video. Solutions to the camera heading problem can be readily applied to many areas, such as robotic navigation, surgical operation, video special effects, multimedia, and lately even in internet commerce. From image sequences of a real world scene, the problem is to calculate the directions of the camera translations. The presence of rotations makes this problem very hard. This is because rotations and translations can have similar effects on the images, and are thus hard to tell apart. However, the visual angles between the projection rays of point pairs are unaffected by rotations, and their changes over time contain sufficient information to determine the direction of camera translation. We developed a new formulation of the visual angle disparity approach, first introduced by Tomasi, to the camera heading problem. Our new derivation makes theoretical analysis possible. Most notably, a theorem is obtained that locates all possible singularities of the residual function for the underlying optimization problem. This allows identifying all computation trouble spots beforehand, and to design reliable and accurate computational optimization methods. A bootstrap-jackknife resampling method simultaneously reduces complexity and tolerates outliers well. Experiments with image sequences show accurate results when compared with the true camera motion as measured with mechanical devices.

  11. Head and neck position sense.

    Science.gov (United States)

    Armstrong, Bridget; McNair, Peter; Taylor, Denise

    2008-01-01

    Traumatic minor cervical strains are common place in high-impact sports (e.g. tackling) and premature degenerative changes have been documented in sports people exposed to recurrent impact trauma (e.g. scrummaging in rugby) or repetitive forces (e.g. Formula 1 racing drivers, jockeys). While proprioceptive exercises have been an integral part of rehabilitation of injuries in the lower limb, they have not featured as prominently in the treatment of cervical injuries. However, head and neck position sense (HNPS) testing and re-training may have relevance in the management of minor sports-related neck injuries, and play a role in reducing the incidence of ongoing pain and problems with function. For efficacious programmes to be developed and tested, fundamental principles associated with proprioception in the cervical spine should be considered. Hence, this article highlights the importance of anatomical structures in the cervical spine responsible for position sense, and how their interaction with the CNS affects our ability to plan and execute effective purposeful movements. This article includes a review of studies examining position sense in subjects with and without pathology and describes the effects of rehabilitation programmes that have sought to improve position sense. In respect to the receptors providing proprioceptive information for the CNS, the high densities and complex arrays of spindles found in cervical muscles suggest that these receptors play a key role. There is some evidence suggesting that ensemble encoding of discharge patterns from muscle spindles is relayed to the CNS and that a pattern recognition system is used to establish joint position and movement. Sensory information from neck proprioceptive receptors is processed in tandem with information from the vestibular system. There are extensive anatomical connections between neck proprioceptive inputs and vestibular inputs. If positional information from the vestibular system is inaccurate or

  12. Ulnar nerve entrapment complicating radial head excision

    Directory of Open Access Journals (Sweden)

    Kevin Parfait Bienvenu Bouhelo-Pam

    Full Text Available Introduction: Several mechanisms are involved in ischemia or mechanical compression of ulnar nerve at the elbow. Presentation of case: We hereby present the case of a road accident victim, who received a radial head excision for an isolated fracture of the radial head and complicated by onset of cubital tunnel syndrome. This outcome could be the consequence of an iatrogenic valgus of the elbow due to excision of the radial head. Hitherto the surgical treatment of choice it is gradually been abandoned due to development of radial head implant arthroplasty. However, this management option is still being performed in some rural centers with low resources. Discussion: The radial head plays an important role in the stability of the elbow and his iatrogenic deformity can be complicated by cubital tunnel syndrome. Conclusion: An ulnar nerve release was performed with favorable outcome. Keywords: Cubital tunnel syndrome, Peripheral nerve palsy, Radial head excision, Elbow valgus

  13. A customized head and neck support system

    International Nuclear Information System (INIS)

    Bentel, Gunilla C.; Marks, Lawrence B.; Sherouse, George W.; Spencer, David P.

    1995-01-01

    Purpose: To describe a customized head and neck immobilization system for patients receiving radiotherapy including a head support that conforms to the posterior contour of the head and neck. Methods: The system includes a customized headrest to support the posterior head and neck. This is fixed to a thermoplastic face mask that molds to the anterior head/face contours. The shape of these customized head and neck supports were compared to 'standard' supports. Results: This system is comfortable for the patients and appears to be effective in reproducing the setup of the treatment. Conclusions: The variability in the size and shape of the customized posterior supports exceeded that of 'standard' headrests. It is our clinical impression that the customized supports improve reproducibility and are now a standard part of our immobilization system. The quantitative analysis of the customized headrests and some commonly used 'standard' headrests suggests that the customized supports are better able to address variabilities in patient shape

  14. Local address and emergency contact details

    CERN Multimedia

    2013-01-01

    The HR Department would like to remind members of the personnel that they are responsible for ensuring that their personal data concerning local address and preferred emergency contact details remains valid and up-to-date.   Both are easily accessible via the links below: Local address: https://edh.cern.ch/Document/Personnel/LocalAddressChange   Emergency contacts: https://edh.cern.ch/Document/Personnel/EC   Please take a few minutes to check your details and modify if necessary. Thank you in advance. HR Department Head Office

  15. Local supertwistors

    International Nuclear Information System (INIS)

    Merkulov, S.A.

    1987-01-01

    The geometry of local supertwistors is investigated. An ansatz on the form of the supertwistor superconnection is introduced. Because of this restriction on the form of such a superconnection the Yang-Mills equations for the superconnection turn out to be equivalent to the free Bach equations describing the dynamics of simple conformal supergravity. It is shown that the equations of motion of conformal supergravity interacting with a vector superfield admit an analogous interpretation. It is proved that an arbitrary conformally right-flat or left-flat superspace is automatically a solution of the Bach equations

  16. Modeling heading and path perception from optic flow in the case of independently moving objects

    Science.gov (United States)

    Raudies, Florian; Neumann, Heiko

    2013-01-01

    Humans are usually accurate when estimating heading or path from optic flow, even in the presence of independently moving objects (IMOs) in an otherwise rigid scene. To invoke significant biases in perceived heading, IMOs have to be large and obscure the focus of expansion (FOE) in the image plane, which is the point of approach. For the estimation of path during curvilinear self-motion no significant biases were found in the presence of IMOs. What makes humans robust in their estimation of heading or path using optic flow? We derive analytical models of optic flow for linear and curvilinear self-motion using geometric scene models. Heading biases of a linear least squares method, which builds upon these analytical models, are large, larger than those reported for humans. This motivated us to study segmentation cues that are available from optic flow. We derive models of accretion/deletion, expansion/contraction, acceleration/deceleration, local spatial curvature, and local temporal curvature, to be used as cues to segment an IMO from the background. Integrating these segmentation cues into our method of estimating heading or path now explains human psychophysical data and extends, as well as unifies, previous investigations. Our analysis suggests that various cues available from optic flow help to segment IMOs and, thus, make humans' heading and path perception robust in the presence of such IMOs. PMID:23554589

  17. Modeling Heading and Path Perception from Optic Flow in the Case of Independently Moving Objects

    Directory of Open Access Journals (Sweden)

    Florian eRaudies

    2013-04-01

    Full Text Available Humans are usually accurate when estimating heading or path from optic flow, even in the presence of independently moving objects (IMO in an otherwise rigid scene. To invoke significant biases in perceived heading, IMOs have to be large and obscure the focus of expansion (FOE in the image plane, which is the point of approach. For the estimation of path during curvilinear self-motion no significant biases were found in the presence of IMOs. What makes humans robust in their estimation of heading or path using optic flow? We derive analytical models of optic flow for linear and curvilinear self-motion using geometric scene models. Heading biases of a linear least squares method, which builds upon these analytical models, are large, larger than those reported for humans. This motivated us to study segmentation cues that are available from optic flow. We derive models of accretion / deletion, expansion / contraction, acceleration / deceleration, local spatial curvature, and local temporal curvature, to be used as cues to segment an IMO from the background. Integrating these segmentation cues into our method of estimating heading or path now explains human psychophysical data and extends, as well as unifies, previous investigations. Our analysis suggests that various cues available from optic flow help to segment IMOs and, thus, make humans’ heading and path perception robust in the presence of such IMOs.

  18. Tridimensional pose estimation of a person head

    International Nuclear Information System (INIS)

    Perez Berenguer, Elisa; Soria, Carlos; Nasisi, Oscar; Mut, Vicente

    2007-01-01

    In this work, we present a method for estimating 3-D motion parameters; this method provides an alternative way for 3D head pose estimation from image sequence in the current computer vision literature. This method is robust over extended sequences and large head motions and accurately extracts the orientation angles of head from a single view. Experimental results show that this tracking system works well for development a human-computer interface for people that possess severe motor incapacity

  19. Remediation of attention deficits in head injury.

    OpenAIRE

    Nag S; Rao S

    1999-01-01

    Head injury is associated with psychological sequelae which impair the patient′s psychosocial functioning. Information processing, attention and memory deficits are seen in head injuries of all severity. We attempted to improve deficits of focused, sustained and divided attention. The principle of overlapping sources of attention resource pools was utilised in devising the remediation programme. Tasks used simple inexpensive materials. Four head injured young adult males with post conc...

  20. Posture of the head and pharyngeal swallowing

    International Nuclear Information System (INIS)

    Ekberg, O.

    1986-01-01

    Closure of the laryngeal vestibule during swallowing is important for protection of the airways. The present investigation included 53 patients with dysphagia examined cineradiographically with the head held in resting posture, flexion and extension. The ability to protect the airways by the downward movement of the epiglottis and by obliteration of the laryngeal vestibule was studied in different postures of the head. Of 35 patients with normal laryngeal obliteration with the head in resting position 10 showed a defective closure at swallowing in extension. In 18 patients with defective closure of the laryngeal vestibule in resting position 9 were improved on flexion and two on extension of the head. In one patient with defectie closure of the laryngeal vestibule in resting position swallowing in flexion showed an aggravated dysfunction. In our other patients the defective closure became more marked on extension. Four patients had less effective downward movement of the epiglottis with the head in extension. Of 10 patients with defective epiglottic movement with the head in resting position two were improved on tilting the head forwards. The results show that the position of the head influences the closure of the airways during swallowing. Patients with defective protection of the laryngeal vestibule should be instructed to swallow with the head tilted forwards. (orig.)

  1. Multi-head Watson-Crick automata

    OpenAIRE

    Chatterjee, Kingshuk; Ray, Kumar Sankar

    2015-01-01

    Inspired by multi-head finite automata and Watson-Crick automata in this paper, we introduce new structure namely multi-head Watson-Crick automata where we replace the single tape of multi-head finite automaton by a DNA double strand. The content of the second tape is determined using a complementarity relation similar to Watson-Crick complementarity relation. We establish the superiority of our model over multi-head finite automata and also show that both the deterministic and non-determinis...

  2. Primary circuit leak detection an application on PWR vessel head penetrations

    International Nuclear Information System (INIS)

    Loisy, F.; Germain, J.L.; Chauvel, L.

    1996-01-01

    In 1991, cracks were discovered and localized in the lower part of certain vessel head adapters in EDF PWR units. While awaiting the replacement of the vessel heads in question, EDF developed systems to enable continuous monitoring of vessel head penetration, by means of early detection of leaks. One of these systems in based on detection of water vapour in a confined space above the vessel head. The efficiency of the measurement chain is particularly dependent on dilution of the leakage in the confined space prior TO entry in the sampling circuit. The detection threshold for this method is on the order of 1.2 liters/hour for a dilution rate of 1500 rate of 1500 m 3 /h and a dew point of 22 deg C. This system has now been in operation on three 1300-MW PWR units for three years, and has proved to function satisfactorily. (authors)

  3. Radial head button holing: a cause of irreducible anterior radial head dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Su-Mi; Chai, Jee Won; You, Ja Yeon; Park, Jina [Seoul National University Seoul Metropolitan Government Boramae Medical Center, Department of Radiology, Seoul (Korea, Republic of); Bae, Kee Jeong [Seoul National University Seoul Metropolitan Government Boramae Medical Center, Department of Orthopedic Surgery, Seoul (Korea, Republic of)

    2016-10-15

    ''Buttonholing'' of the radial head through the anterior joint capsule is a known cause of irreducible anterior radial head dislocation associated with Monteggia injuries in pediatric patients. To the best of our knowledge, no report has described an injury consisting of buttonholing of the radial head through the annular ligament and a simultaneous radial head fracture in an adolescent. In the present case, the radiographic findings were a radial head fracture with anterior dislocation and lack of the anterior fat pad sign. Magnetic resonance imaging (MRI) clearly demonstrated anterior dislocation of the fractured radial head through the torn annular ligament. The anterior joint capsule and proximal portion of the annular ligament were interposed between the radial head and capitellum, preventing closed reduction of the radial head. Familiarity with this condition and imaging findings will aid clinicians to make a proper diagnosis and fast decision to perform an open reduction. (orig.)

  4. Head First WordPress

    CERN Document Server

    Siarto, Jeff

    2010-01-01

    Whether you're promoting your business or writing about your travel adventures, Head First WordPress will teach you not only how to make your blog look unique and attention-grabbing, but also how to dig into the more complex features of WordPress 3.0 to make your website work well, too. You'll learn how to move beyond the standard WordPress look and feel by customizing your blog with your own URL, templates, plugin functionality, and more. As you learn, you'll be working with real WordPress files: The book's website provides pre-fab WordPress themes to download and work with as you follow al

  5. CT of the neonatal head

    International Nuclear Information System (INIS)

    Mohan, S.; Rogan, E.A.; Batty, R.; Raghavan, A.; Whitby, E.H.; Hart, A.R.; Connolly, D.J.A.

    2013-01-01

    Computed tomography (CT) is used less often than other techniques on neonatal units. However, in the acute setting, CT can be invaluable in diagnosing or excluding potentially life-threatening conditions and guiding initial management in neonates. Common indications for scanning include trauma, suspected non-accidental injury, infection, or an acute hypoxic or metabolic event. The aim of this review is to provide an overview of the normal neonatal head at CT and compare this to the common pathological abnormalities. Several key features of each condition will be highlighted. It is important to note that some pathological conditions can have overlapping features at CT and, therefore, the clinical history and additional investigations are also of key importance in determining the diagnosis

  6. Low-head hydro power

    Science.gov (United States)

    Lemer, E. J.

    1980-11-01

    With a view toward increasing the U.S. electric output, the Army Corps of Engineers has estimated that 55 GW can be obtained immediately from new capacity at existing dams and 40 GW more over the long term. Given the long lead times needed to build new dams, most interest has centered on the existing dams. The Corps of Engineers has established that 21 GW can be obtained from hydroelectric and 34 GW from nonpower dams. Existing hydroelectric sites are being expanded by the utilities, but exploitation of the nonpower dams will require governmental encouragement, because the vast majority are low-head sites (dams less than 40 m high). In the present paper, the question of economics and national policy is examined. The advantages which would accrue from substituting axial turbines for the Kaplan turbine are noted.

  7. Natural head position: An overview.

    Science.gov (United States)

    Meiyappan, N; Tamizharasi, S; Senthilkumar, K P; Janardhanan, K

    2015-08-01

    Cephalometrics has given us a different perspective of interpreting various skeletal problems in the dentofacial complex. Natural head position (NHP) is a reproducible, physiologically determined aspect of function. To determine NHP, a horizontal or vertical reference line outside the crania was used, but preference was given generally to the horizontal. Various intra and extracranial cephalometric horizontal reference planes have been used to formulate diagnosis and plan individualized treatment for an integrated correction of the malocclusion cephalometrics is constantly undergoing refinements in its techniques and analyses to improve the clinical applications. Even though various methods for establishing NHP have been proposed, still it remains a challenge to the clinicians to implement the concept of NHP thoroughly in all the stages of treatment because of practical difficulties in the clinical scenario.

  8. We Develop Welfare Together - Locally

    DEFF Research Database (Denmark)

    Flindt, Helle; Carlsbæk, Poul Hornshøj

    information: Poul Carlsbæk:  Master of Science (MSc) in Political Science  Senior lecturer at Department of Management and Administration and head responsible for the interprofessional course We Develop Welfare Together – Locally.  Has taught adults at the Diploma programme in Public Administration for 26...... years  Former Information Manager in municipalities and Senior Executive Consultant in a Danish consultant firm and in a IT-firm's innovative department  Volunteer in e.g. DJØF (association for layers and economists) and DN (society for nature conservation) Helle Flindt:  Occupational Therapist.......  Master in Medical Anthropology  Senior lecturer at Department of physiotherapy and Occupational Therapy  Lecturer at the the interprofessional course We Develop Welfare Together – Locally. 'Equality in Health' depend on both interprofessional collaboration regarding the individual citizen...

  9. Radiotherapy of extramedullary plasmacytoma of the head and neck

    International Nuclear Information System (INIS)

    Harwood, A.R.; Knowling, M.A.; Bergsagel, D.E.

    1981-01-01

    The purpose of this study is to report the results of megavoltage irradiation with cobalt-60 in 23 previously unreported cases of extramedullary plasmacytoma of the head and neck. It has been found that 3500 cGy (rad) in three weeks provides good local control of disease with minimal morbidity and a significant proportion do not go on to multiple myeloma. Prognostic factors of significance with respect to subsequent development of multiple myeloma include site and presence or absence of bone destruction. The presence or absence of an M protein peak appears to be of no significance. (author)

  10. Avascular necrosis of the femoral head presenting as trochanteric bursitis.

    Science.gov (United States)

    Mandell, B F

    1990-01-01

    Five patients are described with avascular necrosis of the femoral head who presented with ipsilateral trochanteric bursitis, in the absence of clearcut hip joint disease. Avascular necrosis was indicated by magnetic resonance imaging. It is suggested that clinical trochanteric bursitis, especially when refractory to local corticosteroid treatment, may be the initial sign of hip disease. In the patient with risk factor(s) for avascular necrosis that diagnosis should be considered and evaluated with appropriate studies, such as magnetic resonance imaging, to prevent weight bearing at an early stage and permit possible surgical decompression in the hope of postponing or obviating the need for total hip replacement. PMID:2241294

  11. The neuroendocrine (Merkel cell) carcinoma of head and neck

    International Nuclear Information System (INIS)

    Weidauer, H.; Altmannsberger, H.M.

    1987-01-01

    The neuroendocrine carcinoma of the skin has its histogenetic origin in Merkel cells and a preference in head and neck area in the seventh decade of life. The definitive diagnosis can be made with a combination of electron microscopy and immunohistochemistry. Merkel cell carcinoma is a primary cutaneous neoplasma and is rarely found on the lips or gingiva. Operation and radiation are the therapy of choice. The value of an additional antineoplastic chemotherapy in the treatment of Merkel cell carcinoma is still controversial. Although long survival times had been described in literature the occurrence of local relapses and metastases demands for frequent controls. (orig.) [de

  12. Head trauma and CT with special reference to diagnosis of complications of head trauma

    International Nuclear Information System (INIS)

    Samejima, Kanji; Yoshii, Nobuo; Tobari, Chitose

    1979-01-01

    Cases in which CT was useful for the diagnosis of complications of head trauma were reported. First, complications of head trauma were given an outline, and then, cases of protrusion of the brain, traumatic pneumocephalus, and cerebro-vascular disorders caused by head trauma were mentioned. (Tsunoda, M.)

  13. Clinicopathological characteristics of head and neck Merkel cell carcinomas.

    Science.gov (United States)

    Knopf, Andreas; Bas, Murat; Hofauer, Benedikt; Mansour, Naglaa; Stark, Thomas

    2017-01-01

    There are still controversies about the therapeutic strategies and subsequent outcome in head and neck Merkel cell carcinoma. Clinicopathological data of 23 Merkel cell carcinomas, 93 cutaneous head and neck squamous cell carcinomas (HNSCCs), 126 malignant melanomas, and 91 primary parotid gland carcinomas were comprehensively analyzed. Merkel cell carcinomas were cytokeratin 20 (CK20)/neuron-specific enolase (NSE)/chromogranin A (CgA)/synaptophysin (Syn)/thyroid transcription factor-1 (TTF-1)/MIB1 immunostained. All Merkel cell carcinomas underwent wide local excision. Parotidectomy/neck dissection was performed in 40%/33% cutaneous Merkel cell carcinoma and 100%/100% in parotid gland Merkel cell carcinoma. Five-year recurrence-free interval (RFI)/overall survival (OS) was significantly higher in malignant melanoma (81/80%) than in cutaneous Merkel cell carcinoma/HNSCC. Interestingly, 5-year RFI/OS was significantly higher in Merkel cell carcinoma (61%/79%) than in HNSCC (33%/65%; p Merkel cell carcinoma and parotid gland carcinomas, nor in the immunohistochemical profile. Five-year RFI/OS was significantly better in cutaneous Merkel cell carcinoma when compared with TNM classification matched HNSCC. Five-year RFI/OS was comparable in parotid gland Merkel cell carcinoma and other primary parotid gland malignancies. © 2016 Wiley Periodicals, Inc. Head Neck 39: 92-97, 2017. © 2016 Wiley Periodicals, Inc.

  14. Head impact in a snowboarding accident.

    Science.gov (United States)

    Bailly, N; Llari, M; Donnadieu, T; Masson, C; Arnoux, P J

    2017-09-01

    To effectively prevent sport traumatic brain injury (TBI), means of protection need to be designed and tested in relation to the reality of head impact. This study quantifies head impacts during a typical snowboarding accident to evaluate helmet standards. A snowboarder numerical model was proposed, validated against experimental data, and used to quantify the influence of accident conditions (speed, snow stiffness, morphology, and position) on head impacts (locations, velocities, and accelerations) and injury risk during snowboarding backward falls. Three hundred twenty-four scenarios were simulated: 70% presented a high risk of mild TBI (head peak acceleration >80 g) and 15% presented a high risk of severe TBI (head injury criterion >1000). Snow stiffness, speed, and snowboarder morphology were the main factors influencing head impact metrics. Mean normal head impact speed (28 ± 6 km/h) was higher than equivalent impact speed used in American standard helmet test (ASTM F2040), and mean tangential impact speed, not included in standard tests, was 13.8 (±7 km/h). In 97% of simulated impacts, the peak head acceleration was below 300 g, which is the pass/fail criteria used in standard tests. Results suggest that initial speed, impacted surface, and pass/fail criteria used in helmet standard performance tests do not fully reflect magnitude and variability of snowboarding backward-fall impacts. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. 49 CFR 214.113 - Head protection.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Head protection. 214.113 Section 214.113 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... conform to the national consensus standards for industrial head protection (American National Standards...

  16. Systematic biases in human heading estimation.

    Directory of Open Access Journals (Sweden)

    Luigi F Cuturi

    Full Text Available Heading estimation is vital to everyday navigation and locomotion. Despite extensive behavioral and physiological research on both visual and vestibular heading estimation over more than two decades, the accuracy of heading estimation has not yet been systematically evaluated. Therefore human visual and vestibular heading estimation was assessed in the horizontal plane using a motion platform and stereo visual display. Heading angle was overestimated during forward movements and underestimated during backward movements in response to both visual and vestibular stimuli, indicating an overall multimodal bias toward lateral directions. Lateral biases are consistent with the overrepresentation of lateral preferred directions observed in neural populations that carry visual and vestibular heading information, including MSTd and otolith afferent populations. Due to this overrepresentation, population vector decoding yields patterns of bias remarkably similar to those observed behaviorally. Lateral biases are inconsistent with standard bayesian accounts which predict that estimates should be biased toward the most common straight forward heading direction. Nevertheless, lateral biases may be functionally relevant. They effectively constitute a perceptual scale expansion around straight ahead which could allow for more precise estimation and provide a high gain feedback signal to facilitate maintenance of straight-forward heading during everyday navigation and locomotion.

  17. Clinical features of the exploding head syndrome.

    Science.gov (United States)

    Pearce, J M

    1989-07-01

    Fifty patients suffering from the "exploding head syndrome" are described. This hitherto unreported syndrome is characterised by a sense of an explosive noise in the head usually in the twilight stage of sleep. The associated symptoms are varied, but the benign nature of the condition is emphasised and neither extensive investigation nor treatment are indicated.

  18. Clinical features of the exploding head syndrome.

    OpenAIRE

    Pearce, J M

    1989-01-01

    Fifty patients suffering from the "exploding head syndrome" are described. This hitherto unreported syndrome is characterised by a sense of an explosive noise in the head usually in the twilight stage of sleep. The associated symptoms are varied, but the benign nature of the condition is emphasised and neither extensive investigation nor treatment are indicated.

  19. The Role of the Primary School Head.

    Science.gov (United States)

    Davies, Lester

    1987-01-01

    This study uses Henry Mintzberg's structural observation method to examine British primary school head teachers' work patterns and determine the nature of their role. Head teachers' days were characterized by brevity, variety, and fragmentation similar to those discussed in findings of other empirical managerial studies. Leadership roles stressed…

  20. Elastic plastic buckling of elliptical vessel heads

    International Nuclear Information System (INIS)

    Alix, M.; Roche, R.L.

    1981-08-01

    The risks of buckling of dished vessel head increase when the vessel is thin walled. This paper gives the last results on experimental tests of 3 elliptical heads and compares all the results with some empirical formula dealing with elastic and plastic buckling