Search results for: environmental cases
10290 Endocrine Therapy-Induced Alopecia in Patients with Breast Cancer in Tunisia
Authors: Aref Zribi, Sonia Ben Nasr, Sana Fendri, Mahdi Balti, Abderazzek Haddaoui
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Background: Despite their benefit, Endocrine therapies (ET) are known to have substantial adverse events (AEs) such as hot flashes, mood disorders and osteoarticular pain. ET induced alopecia(EIA) is less frequently noted by patients and is less reported in the literature. The aim of our study was to report ET alopecia characteristics and their influence on patient and treatment observance. Method: We conducted a retrospective study including luminal BC patients treated in the oncology department of the military hospital of Tunis between January 2015 and December 2020. Patients treated with previous chemotherapy-inducing alopecia were excluded. Results: 145 female patients were included. The median age was 59 years. EIA was reported in 44% of cases. Alopecia was attributed to aromatase inhibitors in 53% and tamoxifen in 21%. Severity was grade 1 in 80% and grade 2 in the remaining cases. ET discontinuation because of alopecia was noted in 6.5 % of patients. Moderate improvement of alopecia was observed with topical minoxidil and Thallium metallicum 9CH homeopathy during ET in 60% of patients. Conclusions: EIA is frequent in BC patients and should be considered to improve treatment observance and patients’ quality of life.Keywords: endocrine therapy, alopecia, breast cancer, Tunisia
Procedia PDF Downloads 12610289 Multi-Label Approach to Facilitate Test Automation Based on Historical Data
Authors: Warda Khan, Remo Lachmann, Adarsh S. Garakahally
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The increasing complexity of software and its applicability in a wide range of industries, e.g., automotive, call for enhanced quality assurance techniques. Test automation is one option to tackle the prevailing challenges by supporting test engineers with fast, parallel, and repetitive test executions. A high degree of test automation allows for a shift from mundane (manual) testing tasks to a more analytical assessment of the software under test. However, a high initial investment of test resources is required to establish test automation, which is, in most cases, a limitation to the time constraints provided for quality assurance of complex software systems. Hence, a computer-aided creation of automated test cases is crucial to increase the benefit of test automation. This paper proposes the application of machine learning for the generation of automated test cases. It is based on supervised learning to analyze test specifications and existing test implementations. The analysis facilitates the identification of patterns between test steps and their implementation with test automation components. For the test case generation, this approach exploits historical data of test automation projects. The identified patterns are the foundation to predict the implementation of unknown test case specifications. Based on this support, a test engineer solely has to review and parameterize the test automation components instead of writing them manually, resulting in a significant time reduction for establishing test automation. Compared to other generation approaches, this ML-based solution can handle different writing styles, authors, application domains, and even languages. Furthermore, test automation tools require expert knowledge by means of programming skills, whereas this approach only requires historical data to generate test cases. The proposed solution is evaluated using various multi-label evaluation criteria (EC) and two small-sized real-world systems. The most prominent EC is ‘Subset Accuracy’. The promising results show an accuracy of at least 86% for test cases, where a 1:1 relationship (Multi-Class) between test step specification and test automation component exists. For complex multi-label problems, i.e., one test step can be implemented by several components, the prediction accuracy is still at 60%. It is better than the current state-of-the-art results. It is expected the prediction quality to increase for larger systems with respective historical data. Consequently, this technique facilitates the time reduction for establishing test automation and is thereby independent of the application domain and project. As a work in progress, the next steps are to investigate incremental and active learning as additions to increase the usability of this approach, e.g., in case labelled historical data is scarce.Keywords: machine learning, multi-class, multi-label, supervised learning, test automation
Procedia PDF Downloads 13410288 Sustainable Environmental Management through the Comparative Study of Two Recreational Parks in Nigeria
Authors: Oluwagbemiga Paul Agboola, Cornelius Olatunji Omojola, Dayo Martins Oyeshomo
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The role of a recreational park in human and environmental development has attracted much interest in the recent time. Recreation parks' development could act as an effective planning strategy to enhance environmental sustainability, social cohesiveness, and users' quality of life. Similarly, parks enhance neighbourhood's aesthetics, refresh the air and enhance humans' contact with nature. In this connection, recreation parks create natural surroundings of rural areas for leisure, relaxation, recreation, psychological and physical comfort of the people. The purpose of this paper is to investigate the effectiveness of the two recreational parks' development as a strategy for neighbourhood's environmental improvement, sustainability and the recreationists' cohesiveness. A total number of 158 survey questionnaires were distributed to the tourists at Ikogosi cold and warm spring in Ekiti state as well as Olumirin waterfalls, Erin-Ijesa, Osun State, in South-West, Nigeria. The quantitative results of the analyzed data with Relative Importance Index (RII) revealed that recreation parks provide optimum opportunities for users' social cohesiveness and well-being while parks' sustainable environment could be enhanced base on the provision of essential facilities, services, and future developmental plans. It is recommended that for recreation parks to realize their full potential in environmental sustainability, adequate maintenance and provision of essential facilities becomes imperative.Keywords: environmental sustainability, neighbourhood development, recreational park, Nigeria
Procedia PDF Downloads 23510287 Linguistic Misinterpretation and the Dialogue of Civilizations
Authors: Oleg Redkin, Olga Bernikova
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Globalization and migrations have made cross-cultural contacts more frequent and intensive. Sometimes, these contacts may lead to misunderstanding between partners of communication and misinterpretations of the verbal messages that some researchers tend to consider as the 'clash of civilizations'. In most cases, reasons for that may be found in cultural and linguistic differences and hence misinterpretations of intentions and behavior. The current research examines factors of verbal and non-verbal communication that should be taken into consideration in verbal and non-verbal contacts. Language is one of the most important manifestations of the cultural code, and it is often considered as one of the special features of a civilization. The Arabic language, in particular, is commonly associated with Islam and the language and the Arab-Muslim civilization. It is one of the most important markers of self-identification for more than 200 million of native speakers. Arabic is the language of the Quran and hence the symbol of religious affiliation for more than one billion Muslims around the globe. Adequate interpretation of Arabic texts requires profound knowledge of its grammar, semantics of its vocabulary. Communicating sides who belong to different cultural groups are guided by different models of behavior and hierarchy of values, besides that the vocabulary each of them uses in the dialogue may convey different semantic realities and vary in connotations. In this context direct, literal translation in most cases cannot adequately convey the original meaning of the original message. Besides that peculiarities and diversities of the extralinguistic information, such as the body language, communicative etiquette, cultural background and religious affiliations may make the dialogue even more difficult. It is very likely that the so called 'clash of civilizations' in most cases is due to misinterpretation of counterpart's means of discourse such as language, cultural codes, and models of behavior rather than lies in basic contradictions between partners of communication. In the process of communication, one has to rely on universal values rather than focus on cultural or religious peculiarities, to take into account current linguistic and extralinguistic context.Keywords: Arabic, civilization, discourse, language, linguistic
Procedia PDF Downloads 22110286 Diffraction-Based Immunosensor for Dengue NS1 Virus
Authors: Harriet Jane R. Caleja, Joel I. Ballesteros, Florian R. Del Mundo
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The dengue fever belongs to the world’s major cause of death, especially in the tropical areas. In the Philippines, the number of dengue cases during the first half of 2015 amounted to more than 50,000. In 2012, the total number of cases of dengue infection reached 132,046 of which 701 patients died. Dengue Nonstructural 1 virus (Dengue NS1 virus) is a recently discovered biomarker for the early detection of dengue virus. It is present in the serum of the dengue virus infected patients even during the earliest stages prior to the formation of dengue virus antibodies. A biosensor for the dengue detection using NS1 virus was developed for faster and accurate diagnostic tool. Biotinylated anti-dengue virus NS1 was used as the receptor for dengue virus NS1. Using the Diffractive Optics Technology (dotTM) technique, real time binding of the NS1 virus to the biotinylated anti-NS1 antibody is observed. The dot®-Avidin sensor recognizes the biotinylated anti-NS1 and this served as the capture molecule to the analyte, NS1 virus. The increase in the signal of the diffractive intensity signifies the binding of the capture and the analyte. The LOD was found to be 3.87 ng/mL while the LOQ is 12.9 ng/mL. The developed biosensor was also found to be specific for the NS1 virus.Keywords: avidin-biotin, diffractive optics technology, immunosensor, NS1
Procedia PDF Downloads 33110285 A Software Tool for Computer Forensic Investigation Using Client-Side Web History Visualization
Authors: Francisca Onaolapo Oladipo, Peter Afam Ugwu
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Records of user activities which are valuable for forensic investigation purposes are provided by web browsers -these records in most cases are not in visual formats that are easily understood, thereby requiring some extra processes. This paper describes the implementation of a software tool for client-side web history visualization providing suitable forensic evidence for investigative purposes. Visual C#, Perl and gnuplot were deployed on Windows Operating System (OS) environment to implement the system and the resulting tool parses and transforms a web browser history into a visual format that enables an investigator to quickly and efficiently explore, understand, and interpret the user online activities in the context of a specific investigation. The system was tested using two forensic cases: the client-side web history files generated by Mozilla Firefox browser was extracted using MozillaHistoryView utility, then parsed and visualized using bar and stacked column charts. From the visual representation, results of user web activities across various productive and non-productive websites were obtained.Keywords: history, forensics, visualization, web activities
Procedia PDF Downloads 29810284 Ibrutinib and the Potential Risk of Cardiac Failure: A Review of Pharmacovigilance Data
Authors: Abdulaziz Alakeel, Roaa Alamri, Abdulrahman Alomair, Mohammed Fouda
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Introduction: Ibrutinib is a selective, potent, and irreversible small-molecule inhibitor of Bruton's tyrosine kinase (BTK). It forms a covalent bond with a cysteine residue (CYS-481) at the active site of Btk, leading to inhibition of Btk enzymatic activity. The drug is indicated to treat certain type of cancers such as mantle cell lymphoma (MCL), chronic lymphocytic leukaemia and Waldenström's macroglobulinaemia (WM). Cardiac failure is a condition referred to inability of heart muscle to pump adequate blood to human body organs. There are multiple types of cardiac failure including left and right-sided heart failure, systolic and diastolic heart failures. The aim of this review is to evaluate the risk of cardiac failure associated with the use of ibrutinib and to suggest regulatory recommendations if required. Methodology: Signal Detection team at the National Pharmacovigilance Center (NPC) of Saudi Food and Drug Authority (SFDA) performed a comprehensive signal review using its national database as well as the World Health Organization (WHO) database (VigiBase), to retrieve related information for assessing the causality between cardiac failure and ibrutinib. We used the WHO- Uppsala Monitoring Centre (UMC) criteria as standard for assessing the causality of the reported cases. Results: Case Review: The number of resulted cases for the combined drug/adverse drug reaction are 212 global ICSRs as of July 2020. The reviewers have selected and assessed the causality for the well-documented ICSRs with completeness scores of 0.9 and above (35 ICSRs); the value 1.0 presents the highest score for best-written ICSRs. Among the reviewed cases, more than half of them provides supportive association (four probable and 15 possible cases). Data Mining: The disproportionality of the observed and the expected reporting rate for drug/adverse drug reaction pair is estimated using information component (IC), a tool developed by WHO-UMC to measure the reporting ratio. Positive IC reflects higher statistical association while negative values indicates less statistical association, considering the null value equal to zero. The results of (IC=1.5) revealed a positive statistical association for the drug/ADR combination, which means “Ibrutinib” with “Cardiac Failure” have been observed more than expected when compared to other medications available in WHO database. Conclusion: Health regulators and health care professionals must be aware for the potential risk of cardiac failure associated with ibrutinib and the monitoring of any signs or symptoms in treated patients is essential. The weighted cumulative evidences identified from causality assessment of the reported cases and data mining are sufficient to support a causal association between ibrutinib and cardiac failure.Keywords: cardiac failure, drug safety, ibrutinib, pharmacovigilance, signal detection
Procedia PDF Downloads 13010283 Removal of Brilliant Green in Environmental Samples by Poly Ethylene Terephthalate Granule
Authors: Homayon Ahmad Panahi, Nika Shakerin, Farahnaz Zolriasatain, Elham Moniri
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In this research, poly-ethylene terephthalate granule was prepared from Tak Corporation. The granule was characterized by fourier transform infra-red spectroscopy. Then the effects of various parameters on brilliant green sorption such as pH, contact time were studied. The optimum pH value for sorption of brilliant green was 6. The sorption capacity of the granule for brilliant green was 4.6 mg g−1. The profile of brilliant green uptake on this sorbent reflects a good accessibility of the chelating sites in the poly-ethylene terephthalate granule. The developed method was utilized for the determination of brilliant green in environmental water samples by UV/Vis spectrophotometry with satisfactory results.Keywords: poly-ethylene terephthalate granule, brilliant green, environmental sample, removal
Procedia PDF Downloads 43310282 On Demand Transport: Feasibility Study - Local Needs and Capabilities within the Oran Wilaya
Authors: Nadjet Brahmia
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The evolution of urban forms, the new aspects of mobility, the ways of life and economic models make public transport conventional collective low-performing on the majority of largest Algerian cities, particularly in the west of Algeria. On the other side, the information and communication technologies (ICT) open new eventualities to develop a new mode of transport which brings together both the tenders offered by the public service collective and those of the particular vehicle, suitable for urban requirements, social and environmental. Like the concrete examples made in the international countries in terms of on-demand transport systems (ODT) more particularly in the developed countries, this article has for objective the opportunity analysis to establish a service of ODT at the level of a few towns of Oran Wilaya, such a service will be subsequently spread on the totality of the Wilaya if not on the whole of Algeria. In this context, we show the different existing means of transport in the current network whose aim to illustrate the points of insufficiency accented in the present transport system, then we discuss the solutions that may exhibit a service of ODT to the problem studied all around the transport sector, to carry at the end to highlight the capabilities of ODT replying to the transformation of mobilities, this in the light of well-defined cases.Keywords: mobility, on-demand transport, public transport collective, transport system
Procedia PDF Downloads 35910281 Comparative Life Cycle Assessment of Roofing System for Abu Dhabi
Authors: Iyasu Eibedingil
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The construction industry is one of the major factors responsible for causing a negative impact on the environment. It has the largest share in the use of natural resources including land use, material extraction, and greenhouse gases emissions. For this reason, it is imperative to reduce its environmental impact through the construction of sustainable buildings with less impact. These days, it is possible to measure the environmental impact by using different tools such as the life cycle assessment (LCA) approach. Given this premise, this study explored the environmental impact of two types of roofing systems through comparative life cycle assessment approach. The tiles were analyzed to select the most environmentally friendly roofing system for the villa at Khalifa City A, Abu Dhabi, United Arab Emirates. These products are available in various forms; however, in this study concrete roof tiles and clay roof tiles were considered. The results showed that concrete roof tiles have lower environmental impact. In all scenarios considered, manufacturing the roof tiles locally, using recovered fuels for firing clay tiles, and using renewable energy (electricity from PV plant) showed that the concrete roof tiles were found to be excellent in terms of its embodied carbon, embodied the energy and various other environmental performance indicators.Keywords: clay roof tile, concrete roof tile, life cycle assessment, sensitivity analysis
Procedia PDF Downloads 39210280 Poetry as Valuable Tool for Tackling Climate Change and Environmental Pollution
Authors: Benjamin Anabaraonye
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Our environment is our entitlement, and it is our duty to guard it for the safety of our society. It is, therefore, in our best interest to explore the necessary tools required to tackle the issues of environmental pollution which are major causes of climate change. Poetry has been discovered through our study as a valuable tool for tackling climate change and environmental pollution. This study explores the science of poetry and how important it is for scientists and engineers to develop their creativity to obtain relevant skills needed to tackle these global challenges. Poetry has been discovered as a great tool for climate change education which in turn brings about climate change adaptation and mitigation. This paper is, therefore, a clarion and urgent call for us to rise to our responsibility for a sustainable future.Keywords: climate change, education, environment, poetry
Procedia PDF Downloads 20610279 Environmental Effect of Empty Nest Households in Germany: An Empirical Approach
Authors: Dominik Kowitzke
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Housing constructions have direct and indirect environmental impacts especially caused by soil sealing and gray energy consumption related to the use of construction materials. Accordingly, the German government introduced regulations limiting additional annual soil sealing. At the same time, in many regions like metropolitan areas the demand for further housing is high and of current concern in the media and politics. It is argued that meeting this demand by making better use of the existing housing supply is more sustainable than the construction of new housing units. In this context, targeting the phenomenon of so-called over the housing of empty nest households seems worthwhile to investigate for its potential to free living space and thus, reduce the need for new housing constructions and related environmental harm. Over housing occurs if no space adjustment takes place in household lifecycle stages when children move out from home and the space formerly created for the offspring is from then on under-utilized. Although in some cases the housing space consumption might actually meet households’ equilibrium preferences, frequently space-wise adjustments to the living situation doesn’t take place due to transaction or information costs, habit formation, or government intervention leading to increasing costs of relocations like real estate transfer taxes or tenant protection laws keeping tenure rents below the market price. Moreover, many detached houses are not long-term designed in a way that freed up space could be rent out. Findings of this research based on socio-economic survey data, indeed, show a significant difference between the living space of empty nest and a comparison group of households which never had children. The approach used to estimate the average difference in living space is a linear regression model regressing the response variable living space on a two-dimensional categorical variable distinguishing the two groups of household types and further controls. This difference is assumed to be the under-utilized space and is extrapolated to the total amount of empty nests in the population. Supporting this result, it is found that households that move, despite market frictions impairing the relocation, after children left their home tend to decrease the living space. In the next step, only for areas with tight housing markets in Germany and high construction activity, the total under-utilized space in empty nests is estimated. Under the assumption of full substitutability of housing space in empty nests and space in new dwellings in these locations, it is argued that in a perfect market with empty nest households consuming their equilibrium demand quantity of housing space, dwelling constructions in the amount of the excess consumption of living space could be saved. This, on the other hand, would prevent environmental harm quantified in carbon dioxide equivalence units related to average constructions of detached or multi-family houses. This study would thus provide information on the amount of under-utilized space inside dwellings which is missing in public data and further estimates the external effect of over housing in environmental terms.Keywords: empty nests, environment, Germany, households, over housing
Procedia PDF Downloads 17310278 Does Trade and Institutional Quality Play Any Significant Role on Environmental Quality in Sub-Saharan Africa?
Authors: Luqman Afolabi
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This paper measures the impacts of trade and institutions on environmental quality in Sub-Saharan Africa (SSA). To examine the direction and the magnitude of the effects, the study employs the pooled mean group (PMG) estimation technique on the panel data obtained from the World Bank’s World Development and Governance Indicators, between 1996 and 2018. The empirical estimates validate the environmental Kuznets curve hypothesis (EKC) for the region, even though there have been inconclusive results on the environment – growth nexus. Similarly, a positive coefficient is obtained on the impact of trade on the environment, while the impact of the institutional indicators produce mixed results. A significant policy implication is that the governments of the SSA countries pursue policies that tend to increase economic growth, so that pollutants may be reduced. Such policies may include the provision of incentives for sustainable growth-driven industries in the region. In addition, the governance infrastructures should be improved in such a way that appropriate penalties are imposed on the pollutants, while advanced technologies that have the potentials to reduce environmental degradation should be encouraged. Finally, it is imperative from these findings that the governments of the region should promote their trade relations and the competitiveness of their local industries in order to keep pace with the global markets.Keywords: environmental quality, institutional quality sustainable development goals, trade
Procedia PDF Downloads 14410277 Assessment of Prevalent Diseases Caused by Mining Activities in the Northern Part of Mindanao Island, Philippines
Authors: Odinah Cuartero-Enteria, Kyla Rita Mercado, Jason Salamanes, Aian Pecasales, Sherwin Sabado
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The northern part of Mindanao Island, Philippines has sizable reserve of mineral resources. Years ago, mining activities have been flourishing which resulted to both local economic gain but with environmental concerns. This study investigates the prevalent diseases by mining activities in these areas. The study was done using the secondary data gathered from the Rural Health Units (RHU) of the selected areas. The study further determined the prevalent diseases that existed in the three areas from years 2005, 2010 and 2015 indicating before the mining activities and when mining activities are present. The results show that areas which are far from mining activities have fewer cases of patients suffering from air-borne diseases. The top ten most common diseases such as pneumonia, tuberculosis, influenza, upper respiratory tract infection (URTI) and skin diseases were caused by air-borne due to air pollution. Hence, the places where mining activities are present contribute to the prevalent diseases. Thus, addressing the air pollution caused by mining activities is very important.Keywords: Philippines, Mindanao Island, mining activities, pollution, prevalent diseases
Procedia PDF Downloads 47310276 Postoperative Radiotherapy in Cancers of the Larynx: Experience of the Emir Abdelkader Cancer Center of Oran, about 89 Cases
Authors: Taleb Lotfi, Benarbia Maheidine, Allam Hamza, Boutira Fatima, Boukerche Abdelbaki
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Introduction and purpose of the study: This is a retrospective single-center study with an analytical aim to determine the prognostic factors for relapse in patients treated with radiotherapy after total laryngectomy with lymph node dissection for laryngeal cancer at the Emir Abdelkader cancer center in Oran (Algeria). Material and methods: During the study period from January 2014 to December 2018, eighty-nine patients (n=89) with squamous cell carcinoma of the larynx were treated with postoperative radiotherapy. Relapse-free survival was studied in the univariate analysis according to pre-treatment criteria using Kaplan-Meier survival curves. We performed a univariate analysis to identify relapse factors. Statistically significant factors have been studied in the multifactorial analysis according to the Cox model. Results and statistical analysis: The average age was 62.7 years (40-86 years). It was a squamous cell carcinoma in all cases. Postoperatively, the tumor was classified as pT3 and pT4 in 93.3% of patients. Histological lymph node involvement was found in 36 cases (40.4%), with capsule rupture in 39% of cases, while the limits of surgical excision were microscopically infiltrated in 11 patients (12.3%). Chemotherapy concomitant with radiotherapy was used in 67.4% of patients. With a median follow-up of 57 months (23 to 104 months), the probabilities of relapse-free survival and five-year overall survival are 71.2% and 72.4%, respectively. The factors correlated with a high risk of relapse were locally advanced tumor stage pT4 (p=0.001), tumor site in case of subglottic extension (p=0.0003), infiltrated surgical limits R1 (p=0.001), l lymph node involvement (p=0.002), particularly in the event of lymph node capsular rupture (p=0.0003) as well as the time between surgery and adjuvant radiotherapy (p=0.001). However, in the subgroup analysis, the major prognostic factors for disease-free survival were subglottic tumor extension (p=0.001) and time from surgery to adjuvant radiotherapy (p=0.005). Conclusion: Combined surgery and postoperative radiation therapy are effective treatment modalities in the management of laryngeal cancer. Close cooperation of the entire cervicofacial oncology team is essential, expressed during a multidisciplinary consultation meeting, with the need to respect the time between surgery and radiotherapy.Keywords: laryngeal cancer, laryngectomy, postoperative radiotherapy, survival
Procedia PDF Downloads 10610275 Acute Renal Failure Associated Tetanus Infection: A Case Report from Afghanistan
Authors: Shohra Qaderi
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Introduction: Tetanus is a severe infection characterized by the spasm of skeletal muscles that often progresses toward respiratory failure. Acute Renal failure (ARF) is an important complication associated Tetanus infection, occurring in 15%-39% of cases. Presentation of cases: A previous healthy 14-year-old boy was admitted to the Tetanus ward of a hospital in Kabul, presenting with severe muscle spasms. On day four of admission, he started having cola-colored urine with decreased urine output. Due to lack of peritoneal dialysis, he went under hemodialysis in view of rapidly raising in blood urea (from baseline 32 mg/dl to 150 mg/dl) and creatinine from (baseline 0.9 mg/dl to 6.2g/dl). Despite all efforts, he had a sudden cardiac arrest and passed away on day 6 of admission. Discussion: ARF is a complication of tetanus, reported to be mild and non-oliguric. Suggested pathological mechanisms include autonomic dysfunction and rhabdomyolysis, owing to uncontrolled muscle spasms. Autonomic dysfunction, most evident in the first two weeks of infection. Conclusion: The prevalence and mortality of tetanus is high in Afghanistan. Physicians and pediatricians need to be aware of this complication of tetanus so as to take appropriate preventive measures and recognize and manage it early.Keywords: afghanistan, acute renal failure, child, mortality
Procedia PDF Downloads 18810274 Cosmetic Dermatology Procedures: Survey Results of American Society for Dermatologic Surgery
Authors: Marina S. Basta, Kirollos S. Basta
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Cosmetic dermatology procedures have witnessed exponential growth and diversification over the last 10 years. Thus, the purpose of this study was to collect data about the latest trends for cosmetic procedures reported by dermatologists during the year 2018. This study was performed by American Society for Dermatologic Surgery (ASDS) in 2018 through sending survey invitations to 3,358 practicing dermatologists in the U.S. containing streamline questions as well as statistical questions targeted to specific analysis of cosmetic dermatology trends. Out of the targeted physicians, only 596 dermatologists reply to the survey invitation (15% overall response rate). It was noted that data collected from that survey was generalized to represent all ASDS members. Results show that there is an increase in cosmetic dermatology procedures since 12.5 million procedures were reported for 2018 compared to only 7.8 million for 2012. Injectable neuromodulators and soft tissue fillers have topped the list with a 3.7 million procedure count. Body sculpting, chemical peeling, hair transplantation, and microneedling procedures were reported to be 1.57 million cases combined. Also, the top two procedures using laser were represented in wrinkle treatment as well as sun damage correction, while the lowest two trends for laser usage were for treatments of tattoos and birthmarks. Cryolipolysis was found to be at the head of body sculpting procedures with 287,435 cases, while tumescent liposuction was reported as the least performed body sculpting procedure (18,286 cases). In conclusion, comparing the procedural trends for the last 7 years has indicated that there has been a 78% increase in soft tissue filler treatment compared to 2012. In addition, it was further noted that laser procedures scored 74% increase in the last 7 years while body contouring procedures have had four folds increase in general compared to 2012.Keywords: cosmetic dermatology, ASDS procedure survey, laser, body sculpting
Procedia PDF Downloads 12510273 Imaging Spectrum of Central Nervous System Tuberculosis on Magnetic Resonance Imaging: Correlation with Clinical and Microbiological Results
Authors: Vasundhara Arora, Anupam Jhobta, Suresh Thakur, Sanjiv Sharma
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Aims and Objectives: Intracranial tuberculosis (TB) is one of the most devastating manifestations of TB and a challenging public health issue of considerable importance and magnitude world over. This study elaborates on the imaging spectrum of neurotuberculosis on magnetic resonance imaging (MRI) in 29 clinically suspected cases from a tertiary care hospital. Materials and Methods: The prospective hospital based evaluation of MR imaging features of neuro-tuberculosis in 29 clinically suspected cases was carried out in Department of Radio-diagnosis, Indira Gandhi Medical Hospital from July 2017 to August 2018. MR Images were obtained on a 1.5 T Magnetom Avanto machine and were analyzed to identify any abnormal meningeal enhancement or parenchymal lesions. Microbiological and Biochemical CSF analysis was performed in radio-logically suspected cases and the results were compared with the imaging data. Clinical follow up of the patients started on anti-tuberculous treatment was done to evaluate the response to treatment and clinical outcome. Results: Age range of patients in the study was between 1 year to 73 years. The mean age of presentation was 11.5 years. No significant difference in the distribution of cerebral tuberculosis was noted among the two genders. Imaging findings of neuro-tuberculosis obtained were varied and non specific ranging from lepto-meningeal enhancement, cerebritis to space occupying lesions such as tuberculomas and tubercular abscesses. Complications presenting as hydrocephalus (n= 7) and infarcts (n=9) was noted in few of these patients. 29 patients showed radiological suspicion of CNS tuberculosis with meningitis alone observed in 11 cases, tuberculomas alone were observed in 4 cases, meningitis with parenchymal tuberculomas in 11 cases. Tubercular abscess and cerebritis were observed in one case each. Tuberculous arachnoiditis was noted in one patient. Gene expert positivity was obtained in 11 out of 29 radiologically suspected patients; none of the patients showed culture positivity. Meningeal form of the disease alone showed higher positivity rate of gene Xpert (n=5) followed by combination of meningeal and parenchymal forms of disease (n=4). The parenchymal manifestation of disease alone showed least positivity rates (n= 3) with gene xpert testing. All 29 patients were started on anti tubercular treatment based on radiological suspicion of the disease with clinical improvement observed in 27 treated patients. Conclusions: In our study, higher incidence of neuro- tuberculosis was noted in paediatric population with predominance of the meningeal form of the disease. Gene Xpert positivity obtained was low due to paucibacillary nature of cerebrospinal fluid (CSF) with even lower positivity of CSF samples in parenchymal form of the manifestation. MRI showed high accuracy in detecting CNS lesions in neuro-tuberculosis. Hence, it can be concluded that MRI plays a crucial role in the diagnosis because of its inherent sensitivity and specificity and is an indispensible imaging modality. It caters to the need of early diagnosis owing to poor sensitivity of microbiological tests more so in the parenchymal manifestation of the disease.Keywords: neurotuberculosis, tubercular abscess, tuberculoma, tuberculous meningitis
Procedia PDF Downloads 17310272 Simultaneous Determination of p-Phenylenediamine, N-Acetyl-p-phenylenediamine and N,N-Diacetyl-p-phenylenediamine in Human Urine by LC-MS/MS
Authors: Khaled M. Mohamed
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Background: P-Phenylenediamine (PPD) is used in the manufacture of hair dyes and skin decoration. In some developing countries, suicidal, homicidal and accidental cases by PPD were recorded. In this work, a sensitive LC-MS/MS method for determination of PPD and its metabolites N-acetyl-p-phenylenediamine (MAPPD) and N,N-diacetyl-p-phenylenediamine (DAPPD) in human urine has been developed and validated. Methods: PPD, MAPPD and DAPPD were extracted from urine by methylene chloride at alkaline pH. Acetanilide was used as internal standard (IS). The analytes and IS were separated on an Eclipse XDB- C18 column (150 X 4.6 mm, 5 µm) using a mobile phase of acetonitrile-1% formic acid in gradient elution. Detection was performed by LC-MS/MS using electrospray positive ionization under multiple reaction-monitoring mode. The transition ions m/z 109 → 92, m/z 151 → 92, m/z 193 → 92, and m/z 136 → 77 were selected for the quantification of PPD, MAPPD, DAPPD, and IS, respectively. Results: Calibration curves were linear in the range 10–2000 ng/mL for all analytes. The mean recoveries for PPD, MAPPD and DAPPD were 57.62, 74.19 and 50.99%, respectively. Intra-assay and inter-assay imprecisions were within 1.58–9.52% and 5.43–9.45% respectively for PPD, MAPPD and DAPPD. Inter-assay accuracies were within -7.43 and 7.36 for all compounds. PPD, MAPPD and DAPPD were stable in urine at –20 degrees for 24 hours. Conclusions: The method was successfully applied to the analysis of PPD, MAPPD and DAPPD in urine samples collected from suicidal cases.Keywords: p-Phenylenediamine, metabolites, urine, LC-MS/MS, validation
Procedia PDF Downloads 35510271 The 10,000 Fold Effect of Retrograde Neurotransmission, a New Concept for Stroke Revival: Use of Intracarotid Sodium Nitroprusside
Authors: Vinod Kumar
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Background: Tissue Plasminogen Activator (tPA) showed a level 1 benefit in acute stroke (within 3-6 hrs). Intracarotid sodium nitroprusside (ICSNP) has been studied in this context with a wide treatment window, fast recovery and affordability. This work proposes two mechanisms for acute cases and one mechanism for chronic cases, which are interrelated, for physiological recovery. a)Retrograde Neurotransmission (acute cases): 1)Normal excitatory impulse: at the synaptic level, glutamate activates NMDA receptors, with nitric oxide synthetase (NOS) on the postsynaptic membrane, for further propagation by the calcium-calmodulin complex. Nitric oxide (NO, produced by NOS) travels backward across the chemical synapse and binds the axon-terminal NO receptor/sGC of a presynaptic neuron, regulating anterograde neurotransmission (ANT) via retrograde neurotransmission (RNT). Heme is the ligand-binding site of the NO receptor/sGC. Heme exhibits > 10,000-fold higher affinity for NO than for oxygen (the 10,000-fold effect) and is completed in 20 msec. 2)Pathological conditions: normal synaptic activity, including both ANT and RNT, is absent. A NO donor (SNP) releases NO from NOS in the postsynaptic region. NO travels backward across a chemical synapse to bind to the heme of a NO receptor in the axon terminal of a presynaptic neuron, generating an impulse, as under normal conditions. b)Vasospasm: (acute cases) Perforators show vasospastic activity. NO vasodilates the perforators via the NO-cAMP pathway. c)Long-Term Potentıatıon (LTP): (chronic cases) The NO–cGMP-pathway plays a role in LTP at many synapses throughout the CNS and at the neuromuscular junction. LTP has been reviewed both generally and with respect to brain regions specific for memory/learning. Aims/Study Des’gn: The principles of “generation of impulses from the presynaptic region to the postsynaptic region by very potent RNT (10,000-fold effect)” and “vasodilation of arteriolar perforators” are the basis of the authors’ hypothesis to treat stroke cases. Case-control prospective study. Mater’als And Methods: The experimental population included 82 stroke patients (10 patients were given control treatments without superfusion or with 5% dextrose superfusion, and 72 patients comprised the ICSNP group). The mean time for superfusion was 9.5 days post-stroke. Pre- and post-ICSNP status was monitored by NIHSS, MRI and TCD. Results: After 90 seconds in the ICSNP group, the mean change in the NIHSS score was a decrease of 1.44 points, or 6.55%; after 2 h, there was a decrease of 1.16 points; after 24 h, there was an increase of 0.66 points, 2.25%, compared to the control-group increase of 0.7 points, or 3.53%; at 7 days, there was an 8.61-point decrease, 44.58%, compared to the control-group increase of 2.55 points, or 22.37%; at 2 months in ICSNP, there was a 6.94-points decrease, 62.80%, compared to the control-group decrease of 2.77 points, or 8.78%. TCD was documented and improvements were noted. Conclusions: ICSNP is a swift-acting drug in the treatment of stroke, acting within 90 seconds on day 9.5 post-stroke with a small decrease after 24 hours. The drug recovers from this decrease quickly.Keywords: brain infarcts, intracarotid sodium nitroprusside, perforators, vasodilatıons, retrograde transmission, the 10, 000-fold effect
Procedia PDF Downloads 30910270 The Implications of Population Dynamics on the Environmental Issues: A Case behind Global Change in Climate
Authors: Simiso Fisokuhle Nyandeni
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The environment is one of the major components of intergenerational equity under sustainability; however, this component has been facing a lot of issues/crises, which include those that are caused by natural systems due to the actions of humans. Although some of those environmental issues may occur from natural causes, however, climate change effects have shown to increase rapidly due to human behavior, which led to the increase in greenhouse emissions and the over-exploitation of natural resources that maintain an ecological balance in our environment. Based on the recent projections, the growing population tends to outstrip the environmental resources, and as a result, the rapid depletion of natural resources that maintain ecological balance within the environment has resulted in such environmental issues. This paper has adopted desktop analysis to address the main objective, which seeks to address the effects of population dynamics on environmental issues and what needs to be done to maintain the ecological balance between the growing population and the limited resources that are available; thus, the collective data sources were used to justify the literature in order to get adequate results to influence the potential findings. The major findings postulate that there is an ecological imbalance between limited resources available and the growing population; as a result, the environment is taking action against humanity through climate change impacts. Hence findings further outline that in order to prevent such impacts, there should be drastic interventions by the governments (all stakeholders should be involved in decision-making; Governmental or non-governmental institutions, scientists, researchers, etc.) around the world to maintain this ecological balance and also to prioritize the adaptation measures. Therefore, this paper seeks to examine the implications of population dynamics on the environmental issues and what needs to be done in order to maintain this ecological balance between the growing population and environmental resources; hence, this review will be based on the climate change context.Keywords: population dynamics, climate change, environment, sustainability
Procedia PDF Downloads 13310269 Ethnobotanical Study on the Usage of Toxic Plants in Traditional Medicine in the City Center of Tlemcen, Algeria
Authors: Nassima Elyebdri, Asma Boumediou, Soumia Addoun
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Traditional medicine has been part of the Algerian culture for decades. In particular, the city of Tlemcen still retains practices based on phytotherapy to the present day, as this kind of medicine fulfills the needs of its followers among the local population. The toxic plants contain diverse natural substances which supplied a lot of medicine in the pharmaceutical industry. In order to explore new medicinal sources among toxic plants, an ethnobotanical study was carried out on the use of these plants by the population, at Emir Abdelkader Square of the city of Tlemcen, a rather busy place with a high number of traditional health practitioners and herbalists. This is a descriptive and transversal study aimed at estimating the frequency of using toxic plants among the studied population, for a period of 4 months. The information was collected, using self-anonymous questionnaires, and analyzed by the IBM SPSS Statistics software used for statistical analysis. A sample of 200 people, including 120 women and 80 men, were interviewed. The mean age was 41 ± 16 years. Among those questioned, 83.5% used plants; 8% of them used toxic plants and 35% used plants that can be toxic under certain conditions. Some improvements were observed in 88% of the cases where toxic plants were used. 80 medicinal plants, belonging to 36 botanical families, were listed, identified and classified. The most frequent indications for these plants were for respiratory diseases in 64.7% of cases, and for digestive disorders in 51.5% of cases. 11% of these plants are toxic, 26% could be toxic under certain conditions. Among toxics plants, the most common ones are Berberis vulgaris with 5.4%, indicated in the treatment of uterine fibroids and thyroid, Rhamnus alaternus with 4.8% for hepatic jaundice, Nerium oleander with 3% for hemorrhoids, Ruta chalepensis with 1.2%, indicated for digestive disorders and dysmenorrhea, and Viscum album with 1.2%, indicated for respiratory diseases. The most common plants that could be toxic are Mentha pulegium (15.6%), Eucalyptus globulus (11.4%), and Pimpinella anisum (10.2%). This study revealed interesting results on the use of toxic plants, which are likely to serve as a basis for further ethno-pharmacological investigations in order to get new drug sources.Keywords: ethnobotany, phytotherapy, Tlemcen, toxic plants
Procedia PDF Downloads 32310268 European Environmental Policy for Road Transport: Analysis of the Perverse Effects Generated and Proposals for a Good Practice Guide
Authors: Pedro Pablo Ramírez Sánchez, Alassane Ballé Ndiaye, Roberto Rendeiro Martín-Cejas
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The aim of this paper is to analyse the different environmental policies adopted in Europe for car emissions, to comment on some of the possible perverse effects generated and point out these policies which are considered more efficient under the environmental perspective. This paper is focused on passenger cars as this category is the most significant in road transport. The utility of this research lies in this being the first step or basis to improve and optimise actual policies. The methodology applied in this paper refers to a comparative analysis from a practical and theoretical point of view of European environmental policies in road transport. This work describes an overview of the road transport industry in Europe pointing out some relevant aspects such as the contribution of road transport to total emissions and the vehicle fleet in Europe. Additionally, we propose a brief practice guide with the combined policies in order to optimise their aim.Keywords: air quality, climate change, emission, environment, perverse effect, road transport, tax policy
Procedia PDF Downloads 16210267 Development of an Automatic Monitoring System Based on the Open Architecture Concept
Authors: Andrii Biloshchytskyi, Serik Omirbayev, Alexandr Neftissov, Sapar Toxanov, Svitlana Biloshchytska, Adil Faizullin
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Kazakhstan has adopted a carbon neutrality strategy until 2060. In accordance with this strategy, it is necessary to introduce various tools to maintain the environmental safety of the environment. The use of IoT, in combination with the characteristics and requirements of Kazakhstan's environmental legislation, makes it possible to develop a modern environmental monitoring system. The article proposes a solution for developing an example of an automated system for the continuous collection of data on the concentration of pollutants in the atmosphere based on an open architecture. The Audino-based device acts as a microcontroller. It should be noted that the transmission of measured values is carried out via an open wireless communication protocol. The architecture of the system, which was used to build a prototype based on sensors, an Arduino microcontroller, and a wireless data transmission module, is presented. The selection of elementary components may change depending on the requirements of the system; the introduction of new units is limited by the number of ports. The openness of solutions allows you to change the configuration depending on the conditions. The advantages of the solutions are openness, low cost, versatility and mobility. However, there is no comparison of the working processes of the proposed solution with traditional ones.Keywords: environmental monitoring, greenhouse gases emissions, environmental pollution, Industry 4.0, IoT, microcontroller, automated monitoring system.
Procedia PDF Downloads 5110266 Recycling Strategies of Construction Waste in Egypt
Authors: Hanan Anwar
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All systems recycle. The construction industry has not only become a major consumer of natural materials along with a source of pollution. Environmental integrated production, reusing and recycling is of great importance in Egypt nowadays. Governments should ensure that the technical, environmental and economic feasibility of alternative systems is considered and is taken into account before construction starts. Hereby this paper focuses on the recycle of building materials as a way for environment protection and sustainable development. Environmental management integrates the requirements of sustainable development. There are many methods used to reduce waste and increase profits through salvage, reuse, and the recycling of construction waste. Sustainable development as a tool to continual improvement cycle processes innovations to save money.Keywords: environment, management, reuse, recycling, sustainable development
Procedia PDF Downloads 31510265 Retrofitting of Asymmetric Steel Structure Equipped with Tuned Liquid Column Dampers by Nonlinear Finite Element Modeling
Authors: A. Akbarpour, M. R. Adib Ramezani, M. Zhian, N. Ghorbani Amirabad
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One way to improve the performance of structures against of earthquake is passive control which requires no external power source. In this research, tuned liquid column dampers which are among of systems with the capability to transfer energy between various modes of vibration, are used. For the first time, a liquid column damper for vibration control structure is presented. After modeling this structure in design building software and performing the static and dynamic analysis and obtaining the necessary parameters for the design of tuned liquid column damper, the whole structure will be analyzed in finite elements software. The tuned liquid column dampers are installed on the structure and nonlinear time-history analysis is done in two cases of structures; with and without dampers. Finally the seismic behavior of building in the two cases will be examined. In this study the nonlinear time-history analysis on a twelve-story steel structure equipped with damper subject to records of earthquake including Loma Prieta, Northridge, Imperiall Valley, Pertrolia and Landers was performed. The results of comparing between two cases show that these dampers have reduced lateral displacement and acceleration of levels on average of 10%. Roof displacement and acceleration also reduced respectively 5% and 12%. Due to structural asymmetric in the plan, the maximum displacements of surrounding structures as well as twisting were studied. The results show that the dampers lead to a 10% reduction in the maximum response of structure stories surrounding points. At the same time, placing the dampers, caused to reduce twisting on the floor plan of the structure, Base shear of structure in the different earthquakes also has been reduced on the average of 6%.Keywords: retrofitting, passive control, tuned liquid column damper, finite element analysis
Procedia PDF Downloads 41410264 Medical Examiner Collection of Comprehensive, Objective Medical Evidence for Conducted Electrical Weapons and Their Temporal Relationship to Sudden Arrest
Authors: Michael Brave, Mark Kroll, Steven Karch, Charles Wetli, Michael Graham, Sebastian Kunz, Dorin Panescu
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Background: Conducted electrical weapons (CEW) are now used in 107 countries and are a common law enforcement less-lethal force practice in the United Kingdom (UK), United States of America (USA), Canada, Australia, New Zealand, and others. Use of these devices is rarely temporally associated with the occurrence of sudden arrest-related deaths (ARD). Because such deaths are uncommon, few Medical Examiners (MEs) ever encounter one, and even fewer offices have established comprehensive investigative protocols. Without sufficient scientific data, the role, if any, played by a CEW in a given case is largely supplanted by conjecture often defaulting to a CEW-induced fatal cardiac arrhythmia. In addition to the difficulty in investigating individual deaths, the lack of information also detrimentally affects being able to define and evaluate the ARD cohort generally. More comprehensive, better information leads to better interpretation in individual cases and also to better research. The purpose of this presentation is to provide MEs with a comprehensive evidence-based checklist to assist in the assessment of CEW-ARD cases. Methods: PUBMED and Sociology/Criminology data bases were queried to find all medical, scientific, electrical, modeling, engineering, and sociology/criminology peer-reviewed literature for mentions of CEW or synonymous terms. Each paper was then individually reviewed to identify those that discussed possible bioelectrical mechanisms relating CEW to ARD. A Naranjo-type pharmacovigilance algorithm was also employed, when relevant, to identify and quantify possible direct CEW electrical myocardial stimulation. Additionally, CEW operational manuals and training materials were reviewed to allow incorporation of CEW-specific technical parameters. Results: Total relevant PUBMED citations of CEWs were less than 250, and reports of death extremely rare. Much relevant information was available from Sociology/Criminology data bases. Once the relevant published papers were identified, and reviewed, we compiled an annotated checklist of data that we consider critical to a thorough CEW-involved ARD investigation. Conclusion: We have developed an evidenced-based checklist that can be used by MEs and their staffs to assist them in identifying, collecting, documenting, maintaining, and objectively analyzing the role, if any, played by a CEW in any specific case of sudden death temporally associated with the use of a CEW. Even in cases where the collected information is deemed by the ME as insufficient for formulating an opinion or diagnosis to a reasonable degree of medical certainty, information collected as per the checklist will often be adequate for other stakeholders to use as a basis for informed decisions. Having reviewed the appropriate materials in a significant number of cases careful examination of the heart and brain is likely adequate. Channelopathy testing should be considered in some cases, however it may be considered cost prohibitive (aprox $3000). Law enforcement agencies may want to consider establishing a reserve fund to help manage such rare cases. The expense may stay the enormous costs associated with incident-precipitated litigation.Keywords: ARD, CEW, police, TASER
Procedia PDF Downloads 34710263 Techno-Economic Assessment of Aluminum Waste Management
Authors: Hamad Almohamadi, Abdulrahman AlKassem, Majed Alamoudi
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Dumping Aluminum (Al) waste into landfills causes several health and environmental problems. The pyrolysis process could treat Al waste to produce AlCl₃ and H₂. Using the Aspen Plus software, a techno-economic and feasibility assessment has been performed for Al waste pyrolysis. The Aspen Plus simulation was employed to estimate the plant's mass and energy balance, which was assumed to process 100 dry metric tons of Al waste per day. This study looked at two cases of Al waste treatment. The first case produces 355 tons of AlCl₃ per day and 9 tons of H₂ per day without recycling. The conversion rate must be greater than 50% in case 1 to make a profit. In this case, the MSP for AlCl₃ is $768/ton. The plant would generate $25 million annually if the AlCl₃ were sold at $1000 per ton. In case 2 with recycling, the conversion has less impact on the plant's profitability than in case 1. Moreover, compared to case 1, the MSP of AlCl₃ has no significant influence on process profitability. In this scenario, if AlCl₃ were sold at $1000/ton, the process profit would be $58 million annually. Case 2 is better than case 1 because recycling Al generates a higher yield than converting it to AlCl₃ and H₂.Keywords: aluminum waste, aspen plus, process modelling, fast pyrolysis, techno-economic assessment
Procedia PDF Downloads 9310262 Interleukin-6 and Tumor Necrosis Factor-α Levels in Tear Film of Keratoconus Patients
Authors: Mazdak Ganjalikhani, Mohamad Namgar, Alireza Peyman
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Introduction: The present study was carried out to measure the levels of inflammatory markers Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in tear of keratoconus patients and investigate their relationship with the severity of keratoconus. Materials and Methods: This study was performed on 81 patients with keratoconus (cases) and 85 healthy individuals (controls) who were selected through the convenience sampling method from patients visiting the Feiz Ophthalmology Hospital affiliated with the Isfahan University of Medical Sciences. Tear levels of IL-6 and TNF-α were measured after collecting the patient's tears from the lower eyelid through the Schirmer I method using a filter paper (Schirmer tear test strip) without anesthesia. Findings: The mean levels of IL-6 and TNF-α were 26.77±8.16 and 34.58±9.82 in the control group and 103.22±51.94, and 183.76±54.61 in the case group, respectively, indicating a significant difference between two groups (p<0.05). In addition, there was a significant relationship between the severity of the keratoconus and the mean levels of TNF-α and IL-6 in the case group (p<0.05). Conclusion: According to the results, the mean levels of IL-6 and TNF-α were higher in keratoconus cases than in the controls, and the disease severity was significantly associated with the levels of inflammatory markers IL-6 and TNF-α.Keywords: keratoonus, cataract, tumor necrotic factor, interleukin 6
Procedia PDF Downloads 1010261 Progress Towards Optimizing and Standardizing Fiducial Placement Geometry in Prostate, Renal, and Pancreatic Cancer
Authors: Shiva Naidoo, Kristena Yossef, Grimm Jimm, Mirza Wasique, Eric Kemmerer, Joshua Obuch, Anand Mahadevan
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Background: Fiducial markers effectively enhance tumor target visibility prior to Stereotactic Body Radiation Therapy or Proton therapy. To streamline clinical practice, fiducial placement guidelines from a robotic radiosurgery vendor were examined with the goals of optimizing and standardizing feasible geometries for each treatment indication. Clinical examples of prostate, renal, and pancreatic cases are presented. Methods: Vendor guidelines (Accuray, Sunnyvale, Ca) suggest implantation of 4–6 fiducials at least 20 mm apart, with at least a 15-degree angular difference between fiducials, within 50 mm or less from the target centroid, to ensure that any potential fiducial motion (e.g., from respiration or abdominal/pelvic pressures) will mimic target motion. Also recommended is that all fiducials can be seen in 45-degree oblique views with no overlap to coincide with the robotic radiosurgery imaging planes. For the prostate, a standardized geometry that meets all these objectives is a 2 cm-by-2 cm square in the coronal plane. The transperineal implant of two pairs of preloaded tandem fiducials makes the 2 cm-by-2 cm square geometry clinically feasible. This technique may be applied for renal cancer, except repositioned in a sagittal plane, with the retroperitoneal placement of the fiducials into the tumor. Pancreatic fiducial placement via endoscopic ultrasound (EUS) is technically more challenging, as fiducial placement is operator-dependent, and lesion access may be limited by adjacent vasculature, tumor location, or restricted mobility of the EUS probe in the duodenum. Fluoroscopically assisted fiducial placement during EUS can help ensure fiducial markers are deployed with optimal geometry and visualization. Results: Among the first 22 fiducial cases on a newly installed robotic radiosurgery system, live x-ray images for all nine prostatic cases had excellent fiducial visualization at the treatment console. Renal and pancreatic fiducials were not as clearly visible due to difficult target access and smaller caliber insertion needle/fiducial usage. The geometry of the first prostate case was used to ensure accurate geometric marker placement for the remaining 8 cases. Initially, some of the renal and pancreatic fiducials were closer than the 20 mm recommendation, and interactive feedback with the proceduralists led to subsequent fiducials being too far to the edge of the tumor. Further feedback and discussion of all cases are being used to help guide standardized geometries and achieve ideal fiducial placement. Conclusion: The ideal tradeoffs of fiducial visibility versus the thinnest possible gauge needle to avoid complications needs to be systematically optimized among all patients, particularly in regards to body habitus. Multidisciplinary collaboration among proceduralists and radiation oncologists can lead to improved outcomes.Keywords: fiducial, prostate cancer, renal cancer, pancreatic cancer, radiotherapy
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