Radiation Oncology

Results: In this study, 9.8% cases of all hospitalization bills were deducted. The highest rates of under reimbursement bills was in Afshar hospital (12.7%), followed by burn hospital (12.5% ), Shahid Sadoughi hospital (10%), and Shahid Rahnemoon hospital (8.2%). The highest ...

This systematic review with meta-analysis sought to determine the impact of posterior pericardiotomy on incidences of atrial fibrillation and supraventricular arrhythmias, pericardial effusion, pleural effusion, tamponade, and the length of hospital stay after cardiac surgery. We searched for randomized controlled trials, using Medline, Embase, Elsevier and Sciences online databases as well as Google Scholar literature. The effect sizes measured were odds ratio for categorical variables and standard mean difference with 95% confidence interval for calculating differences between mean values of hospital stay in intervention and control groups. A value of p < 0.1 for Q test or I 2 > 50% indicated significant heterogeneity between the studies. The literature search of all major databases retrieved 20 studies. After screening, 12 suitable trials were identified, which reported outcomes of 2052 patients undergoing cardiac surgery. Posterior pericardiotomy had an odds ratio of 0.33 [95% confidence interval: 0.18-0.61] p < 0.001 for atrial fibrillation; odds ratio 0.32 [0.15-0.67] p ¼ 0.003 for supraventricular arrhythmias; odds ratio 0.09 [0.04-0.19] p ¼ 0.000 for early pericardial effusion and odds ratio 0.04 [0.02-0.08] p < 0.001 for late pericardial effusion; odds ratio 1.64 [1.23-2.20] p ¼ 0.001 for pleural effusion, odds ratio 0.07 [0.02-0.27] p < 0.001 for tamponade, and standard mean difference ¼ 0.01 [À0.12 to 0.14] p ¼ 0.8 for hospital stay. Posterior pericardiotomy is a simple intraoperative technique that can improve postoperative clinical outcomes. However, the incidence of pleural effusion associated with posterior pericardiotomy might be higher.

This systematic review with meta-analysis sought to determine the impact of antioxidants (N-acetylcysteine [NAC], polyunsaturated fatty acids [PUFAs] and vitamins) on incidence of postoperative atrial fibrillation (POAF) and duration of length of hospital stay. Medline, Embase, Elsevier, Sciences online database and Google Scholar literature search was made for studies in randomized controlled trials. The effect sizes measured were odds ratio (OR) for categorical variable and standard mean difference (SMD) with 95% confidence interval (CI) for calculating differences between mean values of duration of hospitalization in intervention and control groups. A value of P < 0.1 for Qtest or I 2 > 50% indicated significant heterogeneity between the studies. Literature search of all major databases retrieved 355 studies. After screening, a total of 23 trials were identified that reported outcomes of 4278 patients undergoing cardiac surgery. Pooled effects estimates on POAF showed a significant reduction after NAC (OR: 0.56, 95% CI: 0.40-0.77, P < 0.001), PUFA (OR: 0.84, 95% CI: 0.71-0.99, P = 0.03) and vitamin C treatment (OR: 0.50, 95% CI: 0.27-0.91, P = 0.02). Hospital length of stay was not reduced after NAC therapy (SMD: 0.082, 95% CI −0.09 to 0.25, P = 0.3), but could be decreased with PUFA (SMD: −0.185, 95% CI: −0.35 to −0.018, P = 0.03) and vitamin C (SMD: −0.325, 95% CI −0.50 to −0.14, P < 0.01). In conclusion, perioperative antioxidant supplementations with NAC, PUFA and vitamin C prevent atrial fibrillation after cardiac surgery. Moreover, PUFA and vitamin C are capable to reduce hospital stay, whereas NAC lacks this capacity.

Major depressive disorder, a common debilitating illness, is one of the leading causes of disability and disease worldwide. Different drugs for the treatment of patients with major depression can be used. Vortioxetine for the treatment of major depressive disorder was approved by the Food and Drug Administration (FDA) in 2013. This study aimed to evaluation efficacy and safety Vortioxetine 20 mg/d compared placebo in major depressive disorder. To conduct this study, we searched Pub Med, Cochrane library, Scopus, and Central Register of Controlled Trials. This study by including randomized controlled trials (RCTs) that evaluated this study by including randomized controlled trials (RCTs) that evaluated Vortioxetine 20 mg/d in patients with major depressive disorder. Data analysis was conducted by standard mean different ratios (SMD) with 95% confidence intervals (CIs), P values and odds ratios (ORs) for adverse events with 95% confidence intervals (CIs) and P values; heterogeneity testing and sensitivity analysis was also performed in this study. We found that 4 articles met the inclusion criteria and were finally used for this meta-analysis. Results showed statistical significance in the MADRS (Montgomery-Åsberg Depression Rating Scale), SMD = −4.75 * Corresponding author. M. Behzadifar et al. 222 with 95% CI [−6.84, −2.65] and P value < 0.00001), for Clinical Global Impression Scale-Improvement (CGI-I) SMD was −4.34 with 95% CI [−6.41, −2.27] and P value < 0.00001, and for Sheehan Disability Scale (SDS) SMD was −2.62 with 95% CI [−3.99, −1.25] and P value < 0.00001. The pooled analysis for safety demonstrated for diarrhea OR = 0.92 with 95% CI [0.46, 1.83] , P value = 0.09, for dry mouth OR = 1.74 with 95% CI [1.07, 2.83] , P value = 0.80, for dizziness OR = 1.62 with 95% CI [0.72, 3.66] , P value = 0.05, for fatigue OR = 1.17 with 95% CI [0.34, 4.08], P value = 0.07, for headache OR = 1.28 with 95% CI [0.91, 1.79], P value = 0.60 and for nausea OR = 4.78 with 95% CI [3.43, 6

The critical role of the learner in the language learning process has been stressed within recent approaches in the humanities and language studies. For this reason the term learner autonomy is now a very fashionable word in the fields of language learning and teaching. On a general note, there are two dominant approaches to knowledge and learning, each of which adopts a different stance on learner autonomy. These two opposing camps are usually referred to as positivism and constructivism. Although learner autonomy is welcomed by many educators, there is not a broad consensus of opinion on its definition. In this article attempts have been made to show that learner autonomy is a dual conceptualization which incorporates the notions of dependence and independence. The ideology driving the view of learner autonomy presented here has been that learner autonomy should be achieved through the tenets of the scaffolding theory proposed by Bruner (1988). Additionally, the authors will highlight the factors involved in building up autonomy in students. It is hoped that the way we go about dealing with this concept may shed some light on the labyrinth that we are all in, namely the field of ELT.

The main purpose of this paper is to assess the translation quality of a political literary text, i.e. Orwell's Animal Farm, from the viewpoint of critical discourse analysis (CDA) and explore the degree to which ideology and power relations play major roles in the two Persian translations. Adopting the CDA framework of Van Dijk under Lefevere's notion of ideology, change and power in literature and society, this paper examined two different English-Persian translations of an excerpt from Animal Farm, The Seven Commandments, to pinpoint the interwoven relation between ideology, change and power and translation. To discover the impact of these phenomena on each other, a detailed contrastive/comparative study at the micro/macro-level in terms of fore/back-grounding mechanisms was conducted to examine, describe and subsequently interpret the patterns in the source text (ST) and its target texts (TTs). The findings of the study illuminated that too significant ideological distortions and manipulation were made in the translations to consider them as adequate translations.

The purpose of this study was to investigate the concurrent effects of tandem length and bladder volume on dose to pelvic organs at risk (OARs) in HDR intracavitary brachytherapy treatment of cervical cancer. Twenty patients with locally advanced cervical cancer were selected for brachytherapy using Rotterdam applicators. The patients were CT scanned twice with empty and full bladder. Two treatment plans were prepared on each of the image sets. Patients were categorized into two groups; those treated with a tandem length of 4 cm or smaller (T ≤ 4 cm) and those with tandem length larger than 4 cm (T > 4 cm). Only one tandem tip angle of 30° was studied. Dose-volume histograms (DVHs) of OARs were calculated and compared. Bladder dose was significantly affected by both bladder volume and tandem physical length for T ≤ 4 cm. This was reflected on the values obtained for D 2cm³ , D 1cm³ , and D 0.1cm³ for both empty and full bladder cases. When T > 4 cm, no correlation could be established between variations in bladder dose and bladder volume. Rectum dose was generally lower when the bladder was empty and T > 4 cm. Dose to sigmoid was increased when T > 4 cm; this increase was larger when the bladder was full. Our results suggest that, for tandems longer than 4 cm, keeping the bladder empty may reduce the dose to rectum and sigmoid. This is contrary to cases where a shorter than 4 cm tandem is used in which a full bladder (about 50-120 cm³) tends to result in a lower dose to rectum and sigmoid. Attention should be given to doses to sigmoid with long tandem lengths, as a larger tandem generally results in a larger dose to sigmoid.

Purpose: To analyze the optimum organ filling point for organs at risk (OARs) dose in cervical cancer high-doserate (HDR) brachytherapy. Material and methods: In a retrospective study, 32 locally advanced cervical cancer patients (97 insertions) who were treated with 3D conformal external beam radiation therapy (EBRT) and concurrent chemotherapy during 2010-2013 were included. Rotterdam HDR tandem-ovoid applicators were used and computed tomography (CT) scanning was performed after each insertion. The OARs delineation and GEC-ESTRO-based clinical target volumes (CTVs) contouring was followed by 3D forward planning. Then, dose volume histogram (DVH) parameters of organs were recorded and patients were classified based on their OARs volumes, as well as their inserted tandem length. Results: The absorbed dose to point A ranged between 6.5-7.5 Gy. D 0.1cm³ and D 2cm³ of the bladder significantly increased with the bladder volume enlargement (p value < 0.05). By increasing the bladder volume up to about 140 cm 3 , the rectum dose was also increased. For the cases with bladder volumes higher than 140 cm 3 , the rectum dose decreased. For bladder volumes lower than 75 cm 3 , the sigmoid dose decreased; however, for bladder volumes higher than 75 cm 3 , the sigmoid dose increased. The D 2cm³ of the bladder and rectum were higher for longer tandems than for shorter ones, respectively. The divergence of the obtained results for different tandem lengths became wider by the extension of the bladder volume. The rectum and sigmoid volume had a direct impact on increasing their D 0.1cm³ and D 2cm³ , as well as decreasing their D 10 , D 30 , and D 50. Conclusions: There is a relationship between the volumes of OARs and their received doses. Selecting a bladder with a volume of about 70 cm 3 or less proved to be better with regards to the dose to the bladder, rectum, and sigmoid.

The purpose of this study was to investigate the concurrent effects of tandem length and bladder volume on dose to pelvic organs at risk (OARs) in HDR intracavitary brachytherapy treatment of cervical cancer. Twenty patients with locally advanced cervical cancer were selected for brachytherapy using Rotterdam applicators. The patients were CT scanned twice with empty and full bladder. Two treatment plans were prepared on each of the image sets. Patients were categorized into two groups; those treated with a tandem length of 4 cm or smaller (T ≤ 4 cm) and those with tandem length larger than 4 cm (T &gt; 4 cm). Only one tandem tip angle of 30° was studied. Dose-volume histograms (DVHs) of OARs were calculated and compared. Bladder dose was significantly affected by both bladder volume and tandem physical length for T ≤ 4 cm. This was reflected on the values obtained for D2cm³, D1cm³, and D0.1cm³ for both empty and full bladder cases. When T &gt; 4 cm, no correlation could be establis...

Radiotherapy (RT) as an adjuvant treatment for breast cancer (BC), has caused a reduction of recurrences and BC-related deaths. But it has also induced cardiovascular mortality. Oxidative stress is the principle mediator of RT-induced heart disease, similar to many conventional cardiovascular risk factors. The aggregate effect of cardiovascular conditions, RT of heart substructures, implied techniques, and population cardiac mortality rates is not well understood. Due to uncertainties in this field, this article aims to briefly review the recommended strategies for risk assessment, plan optimization, and screening for prevention of RT-induced heart disease in BC patients.

Background Materials with high atomic numbers are part of the composition of dental implant systems. In radiotherapy of oral cavity cancers, an implant can cause dose perturbations that affect target definition, dose calculation, and dose distribution. In consequence, this may result in poor tumor control and higher complications. In this study, we evaluated dose homogeneity when a dental implant replaced a normal tooth. We also aimed to evaluate the concordance of dose calculations with dose measurements. Materials and methods In this study, 2 sets of planning CT scans of a phantom with a normal tooth and the same phantom with the tooth replaced by a Z1 TBR dental implant system were used. The implant system was composed of a porcelain-fused-to-metal crown and titanium with a zirconium collar. Three radiotherapy plans were designed when the density of the implant material was corrected to match their elements, or when all were set to the density of water, or when using the default ...

Background: Despite the high prevalence of acute radiation dermatitis (ARD) in breast radiation treatment, data about its prevention is inconsistent. We conducted the present research to investigate whether the use of topical corticosteroids with different potencies or moisturizing cream could prevent ARD. Method: In this double-blind randomized trial, 120 patients, who had undergone breast conserving surgery for breast cancer, were randomly assigned to use Mometasone 0.1% cream or hydrocortisone 1% cream or moisturizing base cream from the first day of radiotherapy (RT) throughout the entire course. CTCAE v. 4 scale was utilized to score the grade of ARD. The outcomes were analysed with relevant statistical methods. Results: 105 subjects were analysed. Mometasone delayed the incidence of grade 1 ARD in a week. However, no differences were observed among the groups concerning the incidence of the maximum ARD grade. 𝜒2 (6, N= 104)=8.12, P=0.2. Moreover, the timing of the maximum ARD ...

Background: Executive dysfunction has been proposed as a fundamental impairment in children with autism spectrum disorder (ASD), however, existing findings are inconsistent. Objectives: The present study aimed at evaluating the behavioral profile for executive functions (EF) in adolescents compared to healthy individuals using the Farsi translation of the behavior rating inventory of executive function (BRIEF). Methods: In this study, 34 participants (aged 5-16) with ASD were compared to 36 age and gender matched typically developing (TD) children using the BRIEF and childhood autism rating scale (CARS), and raven progressive matrices (RPM). Results: All subscales of the BRIEF were significantly higher in children and adolescents with ASD. Working memory was impaired in 88% of the ASD group, and the inhibition subscale had the highest mean score. The visual response subscale of CARS correlated significantly with the metacognition index (MCI) and global executive composite (GEC) of the BRIEF. A slight negative significant correlation was found between the BRIEF planning/organization T-score and age in the group with ASD. Conclusions: Adolescents with ASD have difficulties in every day executive functioning, mostly in working memory and inhibition. These deficits are related to some aspects of social and sensory impairments seen in ASD.

Radiotherapy is frequently used in treatment approaches of pelvic malignancies. Nevertheless, it has some known systemic effects on blood cells and the immune system that possibly results in their susceptibility to infection. Probiotics are live microbial food ingredients that provide a health advantage to the consumer. Honey has prebiotic properties. The aim of this clinical trial was to investigate probable effects of probiotic or probiotics plus honey on blood cell counts and serum IgA levels in patients receiving pelvic radiotherapy. Sixty-seven adult patients with pelvic cancer were enrolled. Patients were randomized to receive either: (1) Probiotic capsules (including: Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus bulgaricus, Bifidobacterium breve, Bifidobacterium longum, and Streptococcus thermophiles) (n = 22), (2) probiotic capsules plus honey (n = 21) or (3) placebo capsules (n = 24) all for 6 weeks. Blood and serum samples were col...

Delivering radiotherapy to the postmastectomy chest wall can be achieved using matched electron fields. Surgical defects of the chest wall change the dose distribution of electrons. In this study, the improvement of dose homogeneity using simple, nonconformal techniques of thermoplastic bolus application on a defect is evaluated. The proposed phantom design improves the capability of film dosimetry for obtaining dose profiles of a patient's anatomical condition. A modeled electron field of a patient with a postmastectomy inward surgical defect was planned. High energy electrons were delivered to the phantom in various settings, including no bolus, a bolus that filled the inward defect (PB0), a uniform thickness bolus of 5 mm (PB1), and two 5 mm boluses (PB2). A reduction of mean doses at the base of the defect was observed by any bolus application. PB0 increased the dose at central parts of the defect, reduced hot areas at the base of steep edges, and reduced dose to the lung and heart. Thermoplastic boluses that compensate a defect (PB0) increased the homogeneity of dose in a fixed depth from the surface; adversely, PB2 increased the dose heterogeneity. This study shows that it is practical to investigate dose homogeneity profiles inside a target volume for various techniques of electron therapy.