Sociopsychological literatures can be linked with decision-making and cognitive capacity theory. When cognitive resources reach their limit during critical and uncertain moments of an operation, the consumption of resources by the pressures of reputation and ego might interfere with the thought processes needed to execute the task at hand. Recognizing the effects of external social pressures may help the surgeon better self-regulate, respond mindfully to these pressures, and prevent surgical error.
Variations in referral for a discussion of radiotherapy post-prostatectomy are not mainly explained by patient characteristics. After seeing radiation oncology, treatment decisions correlated most strongly with pathological findings. Understanding the reasons for the tremendous non-clinical variations in care is needed to ensure access to potentially curative radiotherapy post-prostatectomy for high-risk prostate cancer patients.
Limited literature is available regarding treatment strategies for three concurrent potentially curable malignancies, and only one case of primary breast cancer with bilateral primary lung cancers has been reported. There is no literature available on approaches to radiation treatment planning and delivery in this challenging scenario. We report a case of a 66-year-old female who underwent partial mastectomy and sentinel node biopsy for left-sided breast cancer, pT1cN1(mic). Metastatic work-up revealed bilateral primary lung cancers, biopsy-proven, each Stage cT1N0. Distinguishing synchronous primary tumours from metastatic disease can be challenging. The histological examination suggested three distinct primaries and each was potentially curable. Devising a treatment strategy required balancing the incremental benefits with the toxicity of combining each of the treatments. Stereotactic ablative radiotherapy was the treatment of choice for the patient's lung primaries, as she was deemed a high-risk surgical candidate. Tangential whole breast radiotherapy with regional nodal irradiation was deemed appropriate for her breast cancer. Treatment for all three sites was planned concurrently, taking into account any potential overlap of dose in the composite plan. Each lung lesion was treated with 48 Gy in 4 fractions with stereotactic ablative radiotherapy using volumetric modulated arc therapy technique. The breast and supraclavicular regions were treated with 50 Gy in 25 daily fractions using a field-in-field technique. Optimal clinical outcomes for patients with multiple primary cancers require optimal definitive management. In this unique case of triple primaries, curative-intent radiotherapy to both lungs, the left breast and regional nodes was planned to be given concurrently and treatment was successfully delivered without significant toxicity.
Mechanosensitive nonselective cation channels (NSC(ms)), protein kinase C (PKC), and Rho kinase (ROCK) are suggested as underlying mechanisms for the myogenic contractile response (MR) to luminal pressure (P(lum)). Here we compared relative contributions from these mechanisms using pharmacological inhibitors in rabbit middle cerebral (RbCA), rat middle cerebral (RtCA), rat femoral (RtFA), and rat mesenteric (RtMA) small arteries. Inner diameters of pressurized arteries under various P(lum) were video-analyzed. 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS, 10 microM) was used as a blocker of NSC(ms). In general, RbCA and RtCA showed higher P(lum) sensitivity of MR than RtFA and RtMA. Ten micromolars of DIDS commonly decreased MRs more effectively at low P(lum) (40-60 mmHg) in all tested arteries except RtCA. In RbCA, PKC inhibitors (100 nM of Go6976 or Go6983) decreased the MR at relatively high P(lum) (80-100 mmHg) whereas ROCK inhibitor (Y-27632, 1 microM) showed a P(lum)-independent inhibition. In RtMA and RtCA, PKC inhibitors (Go6976 and Go6983) had no significant effect whereas Y-27632 generally inhibited the MR. In RtFA, neither PKC inhibitor nor Y-27632 alone affected MRs. Interestingly, in the presence of 10 microM DIDS, Go6983 and Y-27632 decreased the MR of RtFA. In RtMA, it was notable that the MR decreased spontaneously on repeated protocol of P(lum) increase, and the 'run-down' could be effective reversed by maxi-K(+) channel blocker (tetraethylammonium or iberiotoxin). In summary, our study shows the variability of MRs according to the arterial types in terms of their pressure sensitivity and underlying mechanisms that are recruited according to P(lum).
Multi wall carbon nanotubes (MWCNTs) and diamond are renowned as superlative material due to their relatively high thermal conductivity and hardness while comparing with any bulk materials. In this research, polyacrylonitrile (PAN) solution incorporated with MWCNTs at an alteration of mass fractions (0 wt%, 0.6 wt%, 1 wt%, 2 wt%) were fabricated via electrospinning under optimized parameters. Dried composite nanofibers were stabilized and carbonized, after which water base polytrafluorethylene (PTFE) mixed with nano diamond powder solution was spin coated on them. Scanning electron microscopy, Raman spectroscopy, X-ray scattering and Laserflash thermal conductivity were used to characterize the composite nanofiber sheets. The result shows that the thermal conductivity increased to 4.825 W/m K from 2.061 W/mK. The improvement of thermal conductivities is suggesting the incorporation of MWCNTs.
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