RESUMO
PURPOSE: Radiosurgery (SRS) is an effective treatment option for brain metastases (BMs). Long-term results of the first worldwide experience with a mono-isocentric, non-coplanar, linac-based stereotactic technique in the treatment of multiple BMs are reported. METHODS: patients with multiple BMs, life expectancy > 3 months, and good performance status (≤ 2) were treated with simultaneous SRS with volumetric modulated arc technique. Data were retrospectively evaluated. RESULTS: 172 patients accounting for 1079 BMs were treated at our institution from 2017 to 2020. The median number of treated metastases was 4 (range 2-22). Primary tumor histology was: lung (44.8%), breast (32%), and melanoma (9.4%). The 2-year LPFS was 71.6%, respectively. A biological effective dose (BED) ≥ 51.3 Gy10 correlated with higher local control. Uncontrolled systemic disease and melanoma histology were independent prognostic factors correlated with decreased iPFS. Patients with > 10 BMs had a trend towards shorter iPFS (p = 0.055). 31 patients received multiple SRS courses (2-7) in case of intracranial progression. The median iOS was 22.4 months. Brainstem metastases and total PTV > 7.1 cc correlated with shorter iOS. The 1- and 2-year WBRT-free survival was 83.2% and 61.1%, respectively. CONCLUSION: Long-term results in a large patient population treated with a mono-isocentric, dedicated technique demonstrated its effectiveness and safety also in the case of multiple courses. The shortened treatment time and the possibility to safely spare healthy brain tissue allows the safe treatment of patients with a large number of metastases and to deliver multiple courses of SRS. In selected cases, the administration of WBRT can be delayed.
Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Irradiação Craniana/métodos , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/mortalidade , Neoplasias da Mama/patologia , Estudos de Coortes , Irradiação Craniana/efeitos adversos , Irradiação Craniana/instrumentação , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/patologia , Masculino , Melanoma/radioterapia , Melanoma/secundário , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/radioterapia , Órgãos em Risco/efeitos da radiação , Intervalo Livre de Progressão , Lesões por Radiação/prevenção & controle , Radiocirurgia/efeitos adversos , Radiocirurgia/instrumentação , Dosagem Radioterapêutica , Eficiência Biológica Relativa , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
This work was carried out to study the nutritional quality of milk of cows fed palm oil (PAL) or coconut fat (COC), and the use of that milk as raw material for ice cream production. Three treatments were tested with 23 healthy cows: control (CON), PAL, and COC. The milk was collected at d 21 and 36 of the experimental diet. Proximate composition (moisture, ash, fat, protein, and carbohydrates) and fatty acid composition were evaluated on milk and ice cream, and sensorial analysis, color (lightness, green/red, and blue/yellow), overrun, and texture were evaluated on the ice cream. Fatty acids present in milk and ice cream were determined by gas chromatography. Sensory analysis results showed that the ice cream acceptability index was above 70%. No difference was observed for proximate composition in milk and ice cream. Chromatographic analysis showed an increase in saturated fatty acid concentration in CON and lower levels in PAL; polyunsaturated fatty acid concentration was higher in PAL and lower in CON, in milk and ice cream; monounsaturated fatty acid concentration in milk was higher in PAL and lower in CON but no difference was found in ice cream. Comparing n-3 content in milk and ice cream, we observed that PAL had higher levels than CON and COC. The results indicate that it is feasible to add sources of fat to the animal feed for fatty acid composition modulation of milk and ice cream.
Assuntos
Ração Animal/análise , Cocos/química , Ácidos Graxos/análise , Sorvetes/análise , Óleos de Plantas/química , Paladar , Animais , Cruzamento , Bovinos , Fenômenos Químicos , Cor , Comportamento do Consumidor , Dieta/veterinária , Feminino , Contaminação de Alimentos/análise , Manipulação de Alimentos , Microbiologia de Alimentos , Humanos , Sorvetes/microbiologia , Leite/química , Óleo de PalmeiraRESUMO
OBJECTIVE: To evaluate the pathogenicity of a recently discovered arthropod-transmitted bunyavirus (Toscana virus) on the CNS in children and to provide information on the epidemiologic and clinical aspects of Toscana virus infection. STUDY DESIGN: Case-series analysis of children hospitalized with clinical and cerebrospinal fluid examination compatible with a CNS disease of viral origin. METHODS: Cerebrospinal fluid, acute, and convalescent sera were investigated for conventional neurotropic viruses and for Toscana and tickborne encephalitis viruses. A clinical-epidemiologic analysis was carried out on confirmed Toscana virus cases to clarify the profile of Toscana virus infection in children. RESULTS: The study indicates that (1) Toscana virus has been endemic in the Siena province for at least 15 years; (2) the virus is responsible for at least 80% of acute viral infections of the CNS in children throughout the summertime; (3) the clinical signs and symptoms range from aseptic meningitis to meningoencephalitis; (4) infected children resided habitually or temporarily in rural or suburban areas of the Siena province, where ecological characteristics allow arthropods to be peridomestic in human settlements. CONCLUSIONS: Toscana virus is the most common viral agent involved in acute infections of CNS in children in central Italy.