A synthetic single crystal diamond detector (SCDD) is commercially available and is characterized for radiation dosimetry in various radiation beams in this study. The characteristics of the commercial SCDD model 60019 (PTW) with 6- and 15-MV photon beams, and 208-MeV proton beams, were investigated and compared with the pre-characterized detectors: Semiflex (model 31010) and PinPoint (model 31006) ionization chambers (PTW), the EDGE diode detector (Sun Nuclear Corp) and the SFD Stereotactic Dosimetry Diode Detector (IBA). To evaluate the effects of the pre-irradiation, the diamond detector, which had not been irradiated on the day, was set up in the water tank, and the response to 100 MU was measured every 20 s. The depth-dose and profiles data were collected for various field sizes and depths. For all radiation types and field sizes, the depth-dose data of the diamond chamber showed identical curves to those of the ionization chambers. The profile of the diamond detector was very similar to those of the EDGE and SFD detectors, although the Semiflex and PinPoint chambers showed volume-averaging effects in the penumbrae region. The temperature dependency was within 0.7% in the range of 4-41°C. A dose of 900 cGy and 1200 cGy was needed to stabilize the chamber to the level within 0.5% and 0.2%, respectively. The PTW type 60019 SCDD detector showed suitable characteristics for radiation dosimetry, for relative dose, depth-dose and profile measurements for a wide range of field sizes. However, at least 1000 cGy of pre-irradiation will be needed for accurate measurements.

Inhaled corticosteroids for asthma treatment have become mainstay of therapy for patients with persistent asthma. Numerous inhaled corticosteroids are available but to date no prospective cost-effectiveness studies have been reported using exclusively US patients and costs. The purpose of this study was to examine the cost-effectiveness of HFA-bectomethasone (QVAR) compared to CFC-beclomethasone (Vanceril) using data from a year-long prospective randomized, open label, parallel multicenter trial. Eligibility criteria required patients to have been on a stable dose of CFC-BDP prior to enrollment. Patients were randomized to either HFA-BDP at approximately half their previous daily dose of CFC-BDP or to continue CFC-BDP Effectiveness data, in terms of symptom-free days (SFDs), were used in a cost-effectiveness analysis conducted from the viewpoint of managed care. Patients receiving HFA-BDP reported a greater increase (median = 22.1) in the number of SFDs than those receiving CFC-BDP (median = 14.3) (P = 0.03). Total costs of care were less for patients taking HFA-BDP (median = dollars 668) compared to CFC-BDP (median = dollars 977). The median incremental cost-effectiveness ratio was dollars -5.77 (95% CI: dollars -68.08 to dollars -4.08). The results of this analysis indicate that HFA-BDP was a dominant therapy (more effective, less costly) compared to CFC-BDP.

BACKGROUND

Assessment of symptoms and rescue medication use are well-established endpoints for clinical trials evaluating asthma treatment.

OBJECTIVE

To evaluate the measurement properties of an asthma symptom and rescue medication use (ASRMU) diary for clinical trials involving asthma patients aged ≥12 years.

METHODS

Interviews with 35 patients were conducted to confirm the importance of key concepts in the ASRMU diary. Scores of symptom and rescue medication use were converted to symptom-free days (SFD) and rescue-free days (RFD). Test-retest reliability and equivalence (based on intra-class correlation coefficients [ICCs]) between paper-and-pencil and electronic (eDiary) versions were evaluated in a prospective study in 47 patients. Responsiveness of the ASRMU diary was evaluated through differences in percentage of SFD and of RFD by treatment group in eight asthma clinical trials that assessed inhaled corticosteroids (ICS) and long-acting β2-agonists (LABA), alone or in combination. A ninth placebo-controlled study calculated effect sizes. Minimal important differences (MID) were determined using anchor-based methods from two trials and by interviewing 11 patients.

RESULTS

Patient interviews supported content validity for the ASRMU diary. Test-retest reliability was acceptable for SFD (ICC:0.70-0.75), but varied for RFD (ICC:0.58-0.78). Paper-and-pencil and eDiary modes of administration were equivalent (SFD, ICC=0.84; RFD, ICC=0.70). ICS/LABA had the largest percentage of SFD and RFD, followed by monotherapy and then placebo. MIDs were 7.7-14.7% for SFD and 8.4-15.6% for RFD.

CONCLUSIONS

The ASRMU diary captures the disease-specific concepts of greatest importance to asthma patients and provides important information for asthma diagnosis and treatment evaluation.

BACKGROUND

Few data are available on the usefulness of short term treatment with low-medium dose of inhaled corticosteroids (ICS) in pre-school children with wheezing exacerbations.

METHODS

To compare the efficacy of one week treatment with 400 μg b.i.d. nebulized beclomethasone dipropionate (BDP), plus nebulized 2500 μg prn salbutamol (BDP group), versus nebulized b.i.d. placebo, plus nebulized prn 2500 μg salbutamol (placebo group), a post-hoc analysis was performed on data obtained in 166 pre-school children with multiple-trigger wheezing, recruited during an acute wheezing episode.

RESULTS

The percentage of symptom-free days (SFDs) was significantly higher in the BDP group (54.7%) than in the placebo group (40.5%; p = 0.012), with a 35% relative difference. Day-by-day analysis showed that the percentage of SFDs was already higher in the BDP group after 2 days (7.4%), the difference reaching statistical significance at day 6 (12.3%; p = 0.035). Cough score was also reduced in the BDP group (0.11) as compared with the placebo group (0.39; p = 0.048), the difference reaching statistical significance after 5 days of treatment (0.18 and 0.47 respectively; p = 0.047). The mean number of nebulizations per day of prn salbutamol was lower in the BDP group as compared to the placebo group (0.26 and 0.34, respectively), but the difference was not significant (p = 0.366). There were no differences in positive effects of BDP treatment between children with and without risk factors for asthma.

CONCLUSIONS

A 1-week treatment with nebulized BDP and prn salbutamol is effective in increasing SFDs and improving cough in children with wheezing, providing a clinical rationale for the short term use of ICS in episodic wheeze exacerbations in pre-school children.

Composite end points may represent more meaningful assessments of asthma control compared with traditional discrete measures. The effects of budesonide inhalation suspension (BIS) on composite measures of asthma control have not been investigated. The purpose of this study was to assess changes from baseline in percentages of asthma control days (ACDs; days without asthma symptoms and rescue medication use; primary outcome), symptom-free days (SFDs), and rescue medication-free days (RFDs) with BIS treatment. We retrospectively analyzed separately data from three randomized, double-blind, placebo-controlled, 12-week studies (N = 1018) of BIS. Study I patients (4-8 years) were dependent on daily inhaled corticosteroids (ICS; n = 178). Study II patients (6 months to 8 years) were using one or more asthma medications (n = 481). Study III patients (6 months to 8 years) were using daily non-ICS asthma medication (n = 359). Patients treated with BIS showed substantial improvements from baseline in all composite variables (ACDs, 21-31% versus placebo [PBO], 10-18%; SFDs, 20-29% versus PBO, 11-18%; RFDs, 24-47% versus PBO, 12-28%). In study I, each BIS regimen statistically significantly improved all three asthma control measures versus PBO. In study II, BIS 0.5 mg twice daily (b.i.d.) improved ACDs, BIS 0.25 mg b.i.d. and 0.5 mg b.i.d. improved SFDs, and all BIS regimens improved RFDs statistically significantly. In study III, BIS 0.25 mg once daily (q.d.) improved all three measures, BIS 0.5 mg q.d. improved SFDs, and 1.0 mg q.d. improved RFDs statistically significantly. In conclusion, BIS improved composite measures of asthma control in children.

Prospective study.

To identify relationships between spinopelvic parameters and health-related quality of life in rheumatoid arthritis (RA).

Little data are available on relationships between sagittal spinopelvic parameters and health-related quality of life in RA.

The study and control groups comprised 120 RA patients and 60 controls. All subjects underwent anteroposterior and lateral radiography of the whole spine, including hip joints, and all completed clinical questionnaires. The radiographic parameters examined were: sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, C7/sacrofemoral distance ratio (C7/SFD), and spinosacral angle (SSA). Quality of life was assessed using a Visual Analog Scale for back pain, the Oswestry disability index questionnaire, and the Scoliosis Research Society (SRS-22) questionnaire. Statistical analysis was performed to identify significant differences between the study and control groups. In addition, correlations between radiologic parameters and clinical questionnaires were sought.

The patients and controls were found to be significantly different in terms of sacral slope, pelvic tilt, lumbar lordosis, thoracic kyphosis, C7/SFD, and SSA, but not for pelvic incidence (P>0.05). Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. Multiple regression analysis was performed to identify predictors of clinical outcome, and the results obtained revealed that C7/SFD significantly predicted Visual Analog Scale score and SSA predicted Oswestry disability index and SRS-22 scores.

Sagittal spinopelvic parameters were found to be significantly different in RA patients and normal controls. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. In particular, C7/SFD and SSA were found to be significant predictors of clinical outcomes in RA.

The purpose of this study was to validate the use of a single shaped filter (SF) for computed tomography (CT) using variable source-to-filter distance (SFD) for the examination of different object diameters.A SF was designed by performing simulations with the purpose of achieving noise homogeneity in the reconstructed volume and dose reduction for arbitrary phantom diameters. This was accomplished by using a filter design method thats target is to achieve a homogeneous detector noise, but also uses a correction factor for the filtered back projection process. According to simulation results, a single SF designed for one of the largest phantom diameters meets the requirements for all diameters when SFD can be adjusted. To validate these results, a SF made of aluminium alloy was manufactured. Measurements were performed on a CT scanner with polymethyl methacrylate (PMMA) phantoms of diameters from 40-100 mm. The filter was positioned at SFDs ranging from 97-168 mm depending on the phantom diameter. Image quality was evaluated for the reconstructed volume by assessing CT value accuracy, noise homogeneity, contrast-to-noise ratio weighted by dose (CNRD) and spatial resolution. Furthermore, scatter distribution was determined with the use of a beam-stop phantom. Dose was measured for a PMMA phantom with a diameter of 100 mm using a calibrated ionization chamber.The application of a single SF at variable SFD led to improved noise uniformity and dose reduction: noise homogeneity was improved from 15% down to about 0%, and dose was reduced by about 37%. Furthermore, scatter dropped by about 32%, which led to reduced cupping artifacts and improved CT value accuracy. Spatial resolution and CNRD was not affected by the SF.By means of a single SF with variable SFD designed for CT, significant dose reduction can be achieved and image quality can be improved by reducing noise inhomogeneity as well as scatter-induced artifacts.

OBJECTIVE

To measure puerperal symphysis fundus distance (SFD) by two manual methods and to calculate individual normal values.

METHODS

Prospective cohort study including women after single pregnancy without special problems in uterine involution.

METHODS

SFD was daily measured on the 1(st)-5(th) postpartum days by counting the number of midwife's fingers put horizontally on the mother's abdomen and by a paper tape, respectively. Linear mixed model analysis was performed to determine SFD normal values.

RESULTS

Independent variables determining the SFD on different days after delivery were the gestational age and the delivery mode (finger method) and the maternal age, body mass index (BMI), delivery mode and birth weight (tape method). Individual normal values were calculated by regression equation including the coefficients for the independent variables.

CONCLUSIONS

Puerperal SFD values measured by tape have more independent variables than those measured by fingers and reflect better the actual situation of the patient. It should be verified whether values deviating from normal values of tape measurements may prevent postpartum complications.

Strict one-dimensional diffusion, due to geometrical confinement in a nanopore, of an assembly of particles forbids overtaking by each other, giving rise to single-file diffusion (SFD). Smooth carbon nanotube is the epitome of SFD. However, natural nanoporous materials are far from smooth; morphologically, the nanopores' inner surface may provide an inhomogeneous environment for diffusion to occur, giving rise to subnormal diffusion even for an isolated particle diffusing through this fractal landscape. The realm of fractional diffusion (FD) falls under this paradigm. In order to understand the characteristics of SFD through inhomogeneous nanopores, here, we introduce a fractional SFD (FSFD) formalism that deals with a combination of these two phenomena, namely, SFD of particles, each of which are moving subdiffusively in one dimension. For an infinite system, we obtain the mean square displacement (MSD) of the combined entity and our analysis is based on FD equation for particles moving in concert where the single-file correlation is established through reflection principle. For a finite system, we calculate the transport probabilities based on continuous time random walk model. While both the diffusion mechanisms (SFD and FD) acting separately are responsible for slow dynamics at long times, their combined effect leads to ultraslow diffusion. For example, while the long time asymptote of MSD of SFD scales as sqr rt of t, that for FSFD is sqr rt of t(alpha), where alpha is the measure of the extent of inhomogeneity. These findings, which are believed to occur in a natural inhomogeneous nanopore, is also important for design and fabrication of nanofluidic devices through which the fluid delivery can be engineered.

BACKGROUND

Sorsby's fundus dystrophy (SFD) is a degenerative retinopathy characterised by accumulation of mutant TIMP-3 protein in Bruch's membrane.

OBJECTIVE

To compare the stability of matrix bound SFD mutant TIMP-3s with wild type TIMP-3.

METHODS

COS-7 cells were transfected with plasmids containing wild type, Ser 181, Gly-167, Ser-156, and Tyr-168 TIMP-3 cDNA. The cells and their matrices were subsequently harvested and homogenised. After measuring the bound wild type and SFD mutant TIMP-3 concentrations by ELISA, aliquots of the homogenates were heated to 100 degrees C. The rates of denaturation of the TIMP proteins at this temperature were monitored by reverse zymography.

RESULTS

Over a period of 24 h at 100 degrees C the biological activity of both wild type and SFD mutant TIMP-3 was lost. Over a period of 6 h at this temperature the biological activity of the SFD mutant TIMP-3s was fully retained whereas that of the wild type TIMP-3 was lost.

CONCLUSIONS

Matrix bound SFD mutant TIMP-3s are thermodynamically more stable than wild type. This may explain why SFD starts earlier in life than age related macular degeneration.

The effects of social class on birthweight, and its interactions with other maternal factors, were examined in groups of women bearing small-for-dates (SFD), average-for-dates (AFD) and large-for-dates (LFD) babies. The relative risk of a lower social class woman having an SFD baby steadily decreased from 1.75 to 1.20 as adjustment was cumulatively made for smoking, hypertension, maternal age and height. The subsequent addition of weight and weight-for-height made little change. The unadjusted risk of a lower social class woman having a LFD baby was very close to unity (0.99). Adjustment for other maternal factors, in the same order as at the other extreme, showed a steady rise to a significant level (1.45) when height was included; but there was a sharp reversal to a non-significant risk of 1.12 when weight was added. The large contribution of obesity in the lower classes seems to counterbalance those for height, age and smoking in the upper classes in the LFD group. The interactional effects of other maternal factors and social class are not operating to an equal and opposite degree at the two extremes of the birthweight range.

The homozygous factor V Leiden mutation is associated with enhanced venous thrombotic risk. Obesity is a major risk factor for development of thrombotic cardiovascular disease. It was the objective of this study to investigate whether obesity affects the thrombotic risk associated with the mutation. Male mice with homozygous factor V Leiden mutation (Arg 504 to Gln) (FVQ/Q) and corresponding wild-type (WT) mice were kept on a standard fat diet (SFD) or high fat diet (HFD) for 14 weeks, and femoral artery thrombosis was induced by FeCl3 treatment. As compared to SFD, HFD feeding for 14 weeks resulted in significantly higher body weight and fat mass associated with adipocyte hypertrophy, which were, however, similar for both genotypes. In the FeCl3-induced arterial thrombosis model, FVQ/Q mice kept on SFD had a 40% shorter occlusion time (p = 0.015) and 40% lower blood flow (p = 0.03), as compared to WT mice. However, on HFD the occlusion time and blood flow were not significantly different for both genotypes. This finding could not be explained by differential changes of coagulation factors in either genotype fed on SFD or HFD. In conclusion, on SFD, but not on HFD, the factor V Leiden mutation is associated with enhanced thrombotic tendency after FeCl3 injury of the femoral artery, suggesting that in this model obesity rescues the increased thrombotic risk associated with the factor V Leiden mutation.

The effect of cluster of differentiation (CD)36 on regulatory T cells (Treg) was investigated in gonadal (GN) adipose tissues and mesenteric lymph nodes (MLN) of wild-type (WT) and CD36 deficient (CD36(-/-)) mice kept on standard fat (SFD, lean) or on high fat diet (HFD, obese). GN adipose tissue mass was smaller, but MLN size larger for obese CD36(-/-) versus obese WT mice. Overall, the reduction of Treg cells in GN adipose tissue and MLN after a HFD is much more prominent in WT than CD36(-/-) mice. Moreover, CD36(-/-) mice may be protected against obesity-related chronic inflammation.

OBJECTIVE

The clinical guidelines reported by the French-Speaking Diabetes Society (Société francophone du diabète) include updated recommendations for preconceptual planning and care in the management of pregnancy in women with type 1 diabetes mellitus (T1DM).

METHODS

The working group included diabetologists, as well as an obstetrician, a nurse and a dietician. A review of the literature was performed using PubMed and Cochrane databases. Guidelines published by foreign diabetes societies were also consulted.

RESULTS

In women with T1DM, pregnancy increased the risks of hypoglycaemia, diabetic ketoacidosis, pregnancy-induced hypertension, infections and worsening of diabetic microvascular disease. Moreover, T1DM during pregnancy had an impact on the embryo and the fetus, and may have increased the risk of spontaneous miscarriages, malformations, premature births, and fetal and neonatal complications. However, intensive glycaemic control and preconceptual care have been shown to decrease the rate of fetal demise and malformations. Also, the use of insulin analogues during pregnancy is now regarded as safe. Tight glucose control and frequent follow-up are recommended throughout pregnancy in women with T1DM. Their obstetric management should take place in a maternity hospital with an appropriate perinatal environment and in close collaboration with diabetologists.

CONCLUSIONS

Pregnancy planning and adequate management during pregnancy are mandatory for improving the outcomes of women with T1DM.

In an array of closely spaced magnetic islands as in patterned media, magnetostatic interactions play a major role in widening the switching field distribution and reducing the thermal stability. Patterned antiferromagnetically coupled (AFC) media provide interesting systems for studying the effect of magnetostatic interactions on the reversal of closely spaced AFC bits in an array, as AFC structure helps to reduce the remanent magnetization (M(r)), leading to reduced magnetostatic interactions. Here, we study the magnetic reversal of single domain-patterned AFC CoCrPt:oxide bilayer system with perpendicular magnetic anisotropy, by imaging the remanence state of the bits after the application of a magnetic field with magnetic force microscopy (MFM). The influence of magnetostatic fields from the neighboring bits on the switching field distribution (SFD) for an entity in a patterned media is studied by varying the stabilizing layer thickness of the AFC structure and bit spacing. We observe a distinct increase in stability and coercivity with an increase in stabilizing layer thickness for the 40 nm spaced bits. This demonstrates the effectiveness of the AFC structure for reducing magnetostatic interactions in patterned media, such that high thermal stability can be achieved by the reduced M(r), without writability issues.

Optimization of the ultrafiltration (UF) process to remove colloidal substances from a paper mill's treated effluent was investigated in this study. The effects of four operating parameters in a UF system (transmembrane pressure (TMP), cross-flow velocity (CFV), temperature and molecular weight cut-off (MWCO)) on the average permeate flux (J_v), organic matter chemical oxygen demand (COD) rejection rate and the cumulative flux decline (SFD), was investigated by robust experimental design using the Taguchi method. Analysis of variance (ANOVA) for an L₉ orthogonal array were used to determine the significance of the individual factors, that is to say, to determine which factor has more and which less influence over the UF response variables. Analysis of the percentage contribution (P%) indicated that the TMP and MWCO have the greatest contribution to the average permeate flux and SFD. In the case of the COD rejection rate, the results showed that MWCO has the highest contribution followed by CFV. The Taguchi method and the utility concept were employed to optimize the multiple response variables. The optimal conditions were found to be 2.0 bar of transmembrane pressure, 1.041 m/s of the cross-flow velocity, 15 °C of the temperature, and 100 kDa MWCO. The validation experiments under the optimal conditions achieved J_v, COD rejection rate and SFD results of 81.15 L·m^-2·h^-1, 43.90% and 6.01, respectively. Additionally, SST and turbidity decreased by about 99% and 99.5%, respectively, and reduction in particle size from around 458-1281 nm to 12.71-24.36 nm was achieved. The field-emission scanning electron microscopy images under optimal conditions showed that membrane fouling takes place at the highest rate in the first 30 min of UF. The results demonstrate the validity of the approach of using the Taguchi method and utility concept to obtain the optimal membrane conditions for the wastewater treatment using a reduced number of experiments.

Keywords: DoE; Taguchi method; fouling; optimization; paper mill treated effluent; ultrafiltration.

Pathogenic fungi are increasingly associated with epidemics in wildlife populations. Snake fungal disease (SFD) is an emerging threat to snakes, taxa that are elusive and difficult to sample. Thus, assessments of the impacts of SFD on populations have rarely occurred. We used a field technique to enhance detection, Passive Integrated Transponder (PIT) telemetry, and a multistate capture-mark-recapture model to assess SFD effects on short-term (within-season) survival, movement, and surface activity of two wild snake species, Regina septemvittata (Queensnake) and Nerodia sipedon (Common Watersnake). We were unable to detect an effect of disease state on short-term survival for either species. However, we estimated Bayesian posterior probabilities of >0.99 that R. septemvittata with SFD spent more time surface-active and were less likely to permanently emigrate from the study area. We also estimated probabilities of 0.98 and 0.87 that temporary immigration and temporary emigration rates were lower in diseased R. septemvittata. We found evidence of elevated surface activity and lower temporary immigration rates in diseased N. sipedon, with estimated probabilities of 0.89, and found considerably less support for differences in permanent or temporary emigration rates. This study is the first to yield estimates for key demographic and behavioral parameters (survival, emigration, surface activity) of snakes in wild populations afflicted with SFD. Given the increase in surface activity of diseased snakes, future surveys of snake populations should explore longer-term demographic consequences of SFD and recognize that disease prevalence in surface-active animals may exceed that of the population as a whole.

Keywords: Ophidiomyces ophiodiicola; capture-mark-recapture; disease; fungi; reptile.

The 3D structural design of solar evaporators has been considered as one of the most promising approaches toward enhancing photothermal performance by improving light absorption and available evaporation area. Herein, polypyrrole-decorated 3D array structural sunflower discs (PPy-SFD) were prepared for solar-steam generation, thereby turning SFD biomass waste into valuable materials. The SFD can absorb a majority of incident light because of numerous light reflections from each natural 3D array structural unit, and therefore behaves similar to a blackbody. Moreover, a facile pyrrole polymerization method was introduced to further improve SFD light absorption and enhance the photothermal performance of SFD. This circumvents expensive consumption fabrication processes. The black PPy-decorated SFD shows a light absorption of 99.3% across the entire solar spectrum coupled with mechanical stability. During photothermal evaporation, the increased evaporation area of the 3D array structural SFD could effectively reduce heat loss to the environment because the inherent microporous structure of the SFD leaves and cellulose hydrophilicity provide channels for water transport. The PPy-SFD-based evaporator could reach an evaporation rate of 1.74 kg m-2 h-1 under one sun. Thus, the 3D array structural PPy-SFD is a possible candidate for high-efficiency photothermal evaporators.

BACKGROUND

Rheumatoid arthritis (RA) is a chronic autoimmune disease leading to destructive changes in peripheral joints and their irreversible deformity. The influx of chemoattractant-mediated inflammatory cells to the joints is one of the main features of RA.

OBJECTIVE

The aim of this study was to investigate the effect of a knockdown of caveolin-1 (CAV1), a known regulator of multiple cell signaling pathways, on chemokine (C-C motif) ligand 2/monocyte chemoattractant protein-1 (CCL2/MCP-1) expression in synovial fluid-derived fibroblast-like synoviocytes (sfd-FLSs) obtained from patients with RA.

METHODS

Primary cell cultures of sfd-FLSs were established from RA synovial fluids. Cells were transiently transfected with small interfering RNA (siRNA) specific for CAV1, and then incubated with interleukin (IL)-1β to induce CCL2 expression. The expression levels of CAV1 and CCL2 were assessed at transcript level, using quantitative polymerase chain reaction (qPCR) and at protein level by enzyme-linked immunosorbent assay (ELISA) and western blotting analysis.

RESULTS

A transient CAV1 knockdown in sfd-FLSs resulted in a decrease in the IL-1β-induced CCL2 mRNA expression level vs non-transfected cells and cells transfected with non-targeting siRNA. The concentration of secreted CCL2 was not affected significantly.

CONCLUSIONS

Our study demonstrates that CCL2 expression in sfd-FLSs is CAV1-dependent, but only at transcript level. As the function of CAV1 has not been unequivocally determined, more studies are needed to confirm the role of CAV1 in inflammatory processes related to RA.

Universal consensus on the diagnosis methods and thresholds has long been lacking. The recently published Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study has been used to confirm the link between hyperglycemia and materno-fetal complications. Consequently, in France, the Société francophone du diabète (SFD) and the Collège national des gynécologues et obstétriciens français (CNGOF) proposed an expert consensus on gestational diabetes mellitus for clinical practice. Fasting blood glucose should be measured at the first visit during early pregnancy for women with risk factors to identify the women with pregestational diabetes. It is proposed a selective screening on risk factors rather than universal screening. Specific treatment of gestational diabetes reduced materno-fetal complications compared to the absence of therapy. Women with a history of gestational diabetes mellitus are characterized by a high risk of type 2 diabetes mellitus.

Patients with somatoform disorder (SFD) are characterized by the presence of chronic physical complaints that are not fully explained by a general medical condition or another mental disorder. Insecure attachment patterns are common in this patient group, which are often associated with interpersonal difficulties. In the present study, the mediational role of two types of alexithymia and negative affectivity (NA) was examined in the association between attachment styles and interpersonal problems in a group of 120 patients with SFD. Patients were requested to fill out several self-report questionnaires for the assessment of attachment strategies, alexithymia, NA, and interpersonal problems. Cognitive alexithymia (i.e., the inability to identify and verbalize emotions) mediated the relationship between avoidant attachment patterns and interpersonal problems, even after controlling for NA. Preliminary findings also suggested that NA acted as a moderator of the mediator cognitive alexithymia. These results have important implications for clinical practice, as this study clearly shows that interpersonal problems do not automatically follow from insecure attachment strategies, but are contingent upon alexithymic features. It is recommended to target alexithymic features in patients with SFD, particularly in the context of negative emotions. Therefore, cognitive alexithymia may be an important therapeutic focus, specifically in the treatment of avoidant ptients with SFD.

OBJECTIVE

Dosimetry of small fields defined by stereotactic cones remains a challenging task. In this work, we report the results of commissioning measurements for the new Elekta stereotactic conical collimator system attached to the Elekta VersaHD linac and present the comparison between the measured and Monte Carlo (MC) calculated data for the 6 MV FFF beam. In addition, relative output factor (ROF) dependence on the stereotactic cone aperture variation was studied and penumbra comparison for small MLC-based and cone-based fields was performed.

METHODS

Cones with nominal diameters of 15 mm, 12.5 mm, 10 mm, 7.5 mm, and 5 mm were employed in our study. Percentage depth dose (PDD), off-axis ratios (OAR), and ROF were measured using a stereotactic field diode (SFD). BEAMnrc code was used for MC simulations.

RESULTS

MC calculated and measured PDDs for all cones agreed within 1%/0.5 mm, and OAR profiles agreed within 1%/0.5 mm. ROF obtained from the measurements and MC calculations agreed within 2% for all cone sizes. Small-field correction factors for the SFD detector Kfield,3 × 3 (SFD) were derived using MC calculations as a baseline and were found to be 0.982, 0.992, 0.997, 1.015, and 1.017 for the 5, 7.5, 10, 12.5, and 15-mm cones respectively. The difference in ROF was about 10%, 6%, 3.5%, 3%, 2.5%, and 2% for ±0.3 mm variations in 5, 7.5, 10, 12.5, and 15-mm cone aperture respectively. In case of single static field, cone-based collimation produced a sharper penumbra compared to the MLC-based.

CONCLUSIONS

Accurate MC simulation can be an effective tool for verification of dosimetric measurements of small fields. Due to the very high sensitivity of output factors on the cone diameter, manufacture-related variations in cone size may lead to considerable variations in dosimetric characteristics of stereotactic cones.