Median Rib Research Articles

ThP7.5 - District General Hospital Management of Chest Trauma in Frail Adults: A Need for National Guidelines for Frailty in General Surgery

Abstract Annually, 16,000 adults face chest trauma, with blunt injuries in the elderly leading to high mortality rates. In TARN Chest trauma ranks as the second deadliest trauma in older adults, following head injuries. There's significant inconsistency, nationally, in the General Surgical management of these patients. Aims This study evaluates outcomes at a DGH to establish a basis for national guidelines Methods Single centre retrospective review of patients over the age of 65 presenting with chest trauma from Jan 2022 to Jan 2023. Results 114 Patients were included. Median age was 81 with a male predominance of 57.9%. Mortality was 17/109 (15.6%). Mechanisms of injury were fall from standing height (71.9%), fall from height >2m (18.8%) and RTA 9.3%. Median Rib fractures sustained were 4 (range 0 - >10). 51.8% of the patients had an associated pleural injury, 14 patients required a drain. 70 (61.4%) had isolated chest injuries, 29 (25.4%) had one other injured body region and 15 (13.2%) had three or more injured body regions. Median STUMBL score was 25 (9 – 52), 42.6% had a score of ≥ 27. 16.4% of patients were vulnerable and 51% were frail. Median Charlson co-morbidity index was 5 (range 2-11). 39% of patients had timely Geriatric review during admission and 14% were not referred. Conclusion DGH General Surgery teams admit high volumes of frail patients with chest trauma. Nationally there is an absence of general surgery chest trauma guidance (BOASTs now archived). These patients are complex requiring early support from Geriatricians to guide the goals of care. Careful consideration should be given to referral pathways, MDT and priorities of care.

Three New Species of Free-Living Marine Nematodes of the Order Enoplida Filipjev, 1929 (Nematoda) from the Yellow Sea, China

Three new nematode species belonging to the order Enoplida were discovered in the muddy and sandy sediment along the Shandong peninsula coast of the Yellow Sea during a biodiversity investigation of marine nematodes in the Yellow Sea. They are named Belbolla octobulba sp. nov., Ironella gracilis sp. nov. and Oxystomina longiseta sp. nov. Belbolla octobulba sp. nov. is characterized by having eight pharyngeal bulbs; spicules arcuate, broad and even; gubernaculum with a pair of dorso-caudal apophyses, about a third of the length of spicule; and two winged precloacal supplements. Ironella gracilis sp. nov. differs from known species by body slender, buccal cavity divided into conical vestibulum and cylindrical posterior portion, three sclerotized teeth located in the vestibulum; both circles of outer labial setae and cephalic setae 10 µm apart; elongated spicules weakly arcuate with central strip and cephalate proximal end; gubernaculum conical without apophysis; and a tubular precloacal supplement with a long seta at its anterior end. Oxystomina longiseta sp. nov. can be distinguished from other known species by the relatively long outer labial setae and cephalic setae; arcuate spicules expanded proximally with a median rib; gubernaculum small and oblong; and two unequal precloacal supplementary setae, anterior one short, posterior one very long. Updated keys to eighteen species of Belbolla and keys to four species of Ironella are given.

Middle Miocene “Giraffa” from the Chinji Formation of Siwaliks, Pakistan

A comprehensive record of unique and endemic species of “Giraffa” priscilla has been documented and reported from the Chinji Formation of Lower Siwaliks, Pakistan. The material comprises incisors, canines, premolars, molars, mandibular and maxillary fragments which have been recovered from the Middle Miocene localities of Dhok Bun Ameer Khatoon, Rakh Wasnal, Bhelomar, and Lawa, Punjab, Pakistan. “Giraffa” priscilla is a primitive species of giraffids, having a broad crown, strong styles, and median ribs.

The behavior of Tunisian students toward people with mental illness

IntroductionOver the years, several studies have shown the high rate of discrimination experienced in particular by mental health service users. Stigma is composed of three elements: knowledge, behaviors, and attitudes. Although behaviors are the core of discrimination, this element has often been overlooked or intertwined with the other components.ObjectivesOur study aimed to assess Tunisian students’ behavior toward people with mental illnessMethodsThis was a cross-sectional study conducted on 2501 Tunisian students who anonymously completed a form circulated online through social network groups and pages related to each academic institution. We have used the validated Arabic version of the “Reported and Intended Behaviour Scale” (RIBS) which assesses self-reported mental health behaviors and future intentions.ResultsThe median RIBS score was 15 out of 20, ranging from 4 to 20. Among the participants, 40% were living or have lived with someone with a mental health problem and 49.7% would be willing to live with someone with a mental health problem. Moreover, 24% were working or have worked with a person with a mental health problem and 53.4% would be willing to work with him or her. In addition, 34% were having or have had a neighbor with a mental illness and 58% would be willing to have a neighbor with a mental illness. Finally, 51% were having or have had a close friend with a mental health problem and 83.7% answered that they would be able to maintain a relationship with a friend who had developed a mental health problem.ConclusionsThe assessment of behavior toward people with mental illness is fundamental as it has the most impact on individuals. However, behavior may be mediated by knowledge. Thus, it would be interesting to evaluate mental health knowledge to study the relationships between these constructs and optimize anti-stigma interventions.Disclosure of InterestNone Declared

Bubble Dynamics and Heat Transfer Characteristics of Flow Boiling in a Single Pentagonal Rib Channel

Abstract Two-phase flow boiling is the preferred method for efficient heat dissipation in electronic equipment, so the bubble dynamics and heat transfer characteristics of flow boiling in a single pentagonal rib channel are numerically analyzed by the volume of fluid (VOF) model. Three typical rib structures are obtained, whose block ratios are 0.4, 0.75, and 0.25, and the corresponding length-diameter ratios are 1.72, 0.59, and 12.70, respectively. The Reynolds number is 14,000 and 28,000. The heat flux is set from 50 to 150 kW/m2. The results show that the starting position of the bubble is at the cone and sides of the rib, and its moving direction is related to the configuration of the rib, the heat flux, and fluid velocity. Additionally, the bubbles are shedding at the corner of the rib, and the short rib does not appear to be the vortex shedding phenomenon. The wall temperature and temperature fluctuation increase with the increase of heat flux and with the decrease of fluid velocity. The heat transfer coefficient decreases with the increase of heat flux and with the decrease of fluid velocity. The short rib channel has a higher heat transfer coefficient, approximately 14% and 50% higher than that of the median and long rib channels, respectively. Compared with the single-phase flow, the main frequency of the lift coefficient increases with the increase of the fluid velocity while decreasing with the increase of heat flux. The main frequency of the median rib without harmonic signal keeps constant, and that for long rib decreases by 38%. The study of the instantaneous characteristics of bubble growth in pentagonal rib channels is instructive to the efficient heat dissipation in electronic equipment.

Din colecțiile Muzeului Național al Banatului din Timișoara. II. Brățara de tip Regelsbrunn de la Ghilad (județul Timiș) / From the collections of the National Museum of Banat in Timișoara. II. The Regelsbrunn type bracelet from Ghilad (Timiș County).

In the collections of the National Museum of Banat from Timisoara there is a very nice multi-spiral bracelet made of bronze plate, belonging to the Regelsbrunn type. The piece from Ghilad (Timiș County) is decorated with a median rib, and on the edges is arranged a string of pearls, made in the au repoussé technique. One end of the piece ends with a volute, and the other with a spiral, consisting of five turns. The bracelet was discovered in 1867 next to a ceramic vessel in a burial grave. Based on analogies, it dated back to the Late Bronze Age II (Bz C2/D - beginning of Ha A1 Central European) ca. 1450-1250 BC. It probably circulated in the late Cruceni-Belegiš cultural environment, characteristic of the low plain of Banat.Also on this occasion is published the multi-spiral bronze bracelet from Gornea (Sichevița commune, Caraș-Severin county), located in the collections of the Vršac City Museum, belonging to the same Regelsbrunn type. Due to the full section, the bracelet was cast, and then the ends were hammered in the form of spirals. Later it was decorated on either side of the median rib with a string of pearls made in the au repoussé technique. The piece was acquired by the Vršac Museum in 1905 and seems to come from a hoard found in 1882 in Gornea „Păzăriște”, in the Romanian Banat. It is also dated to the Late Bronze Age II (Bz C2/D - beginning of Ha A1 Central European) ca. 1450-1250 BC. Along with other discoveries in the area of the Danube Iron Gates, it probably circulated in the late Dubovac-Žuto Brdo-Gârla Mare cultural environment.

Leaf Area Calculation Models for Vines Based on Foliar Descriptors.

In the case of foliar area studies on vines, with a large number of determinations, a simple, fast, sufficiently accurate and low-cost method is very useful. The typology of leaves on the vine is complex, characterized by several descriptive parameters: median rib; secondary venations of the first and second order; angles between the median rib and the secondary venations; sinuses; length and width of the leaf. The present study aimed to evaluate models for calculating the leaf area based on descriptive parameters and KA (KA as the surface constant used to calculate the leaf area) for six vine cultivars, ‘Cabernet Sauvignon’ (CS), ‘Muscat Iantarnîi’ (MI), ‘Muscat Ottonel’ (MO), ‘Chasselas’ (Ch), ‘Victoria’ (Vi) and ‘Muscat Hamburg’ (MH). The determined KA surface constants had subunit values (0.91 to 0.97), except for the cultivars ‘Muscat Iantarnîi’ and ‘Muscat Ottonel’ where the surface constant KA2 (in relation to the second-order secondary venations) had supraunitary values (1.07 and 1.08, respectively). The determination of the leaf area was possible under different conditions of statistical accuracy (R2 = 0.477, p = 0.0119, up to R2 = 0.988, p < 0.001) in relation to the variety and parametric descriptors considered. The models obtained from the regression analysis facilitated a more reliable prediction of the leaf area based on the elements on the left side of the leaf, in relation to the median rib, compared to those on the right. The accuracy of the results was checked on the basis of minimum error (ME) and confirmed by parameters R2, p and RMSE.

Anatomia foliar comparada de quatro espécies da família Lauraceae

The leaf anatomy of Ocotea paulensis Vatt., Ocotea odorifera (Vell.) J. G. Rohwer, Nectandra lanceolata Nees et Mart. ex Nees and Nectandra rigida (H.B.K) Nees was made, in order to identify anatomical characters that may assist in the identification of these species. The presence of trichomes, the type of stomata, the formation of the periderm in the petiole, the buttresses in the outer periclinal wall of the epidermal cells, the leaf edge conformation, the presence of hypodermis, the vascular system conformation in the median rib and venation pattern showed marked differences, allowing species separation based on these traits.

Leaf Area and Its Relationship with Leaf Descriptors Elements in Liquidambar styraciflua L.

This study aimed at determining the leaf area in Liquidambar styraciflua L. and at characterising the relationship between leaf area and leaf descriptors. The biological material was the species Liquidambar styraciflua L. We determined leaf area in 100 leaves (Figure 1) based on the size of median rib (L), leaf width at higher (W1) and lower (W2) lobe level, and on area constants (KA). The size of elements L, W1 and W2 were found by measuring with a precision of ±0.5 mm. Area constants in the species Liquidambar styraciflua L. were KA1 = 0.63, determined depending on leaf width at upper lobe width (W1), and KA2 = 0.81 in relation to the width W2 of the lower lobes. Between the scanned leaf area (SLA) and measured leaf area (MLA) and leaf descriptors (L, W1 and W2) we identified relations of interdependence statistically ensured: r = 0.960 to r = 0.971 for SLA; r = 0.951 to r = 0.981 for MLA W1, and r = 0.933 to r = 0.972 for MLA W2, respectively. Leaf descriptors L, W1 and W2 had a differentiated contribution in determining SLA and MLA. SLA was influenced by leaf length (L) with higher statistic safety (R2 = 0.963, p &lt;&lt; 0.001, F = 1277.2) than leaf width at upper lobe width W1 (R2 = 0.943; p&lt;&lt;0.001; F = 797.7) and leaf width at the extremities of the lower lobes W2 (R2= 0.927, p &lt;&lt; 0.001, F = 620.59).

Primary chest wall chondrosarcomas: results of surgical resection and analysis of prognostic factors

Wide surgical excision with tumour-free margins is the mainstay of therapy for primary chest wall chondrosarcoma (PCWC). Few studies on treatment outcome and prognostic factors of PCWC requiring chest wall resection are available. We analysed our experience on surgical treatment of PCWC with emphasis on survival and recurrence prognostic factors. From 1986 to 2012, 89 patients (65.2% males, median age 55 years) with PCWC were operated on. The median tumour maximum diameter was 7 cm (range 2-30 cm). We performed 23 sternectomies and 66 lateral chest wall resections (median ribs resected: 2; range 1-7). Resections were extended to lung (n = 19), diaphragm (n = 13), vertebral body (n = 6) or clavicle (n = 1). Negative margins were obtained in 85.4% of cases. Chest wall reconstruction was obtained mainly by prosthetic non-rigid or rigid materials and muscle flap coverage. In the last years, 3 patients received a sternal replacement with cadaveric allograft, and 2 had a chest wall reconstruction with titanium bars and 17 with a rib-like prosthesis. Perioperative mortality and morbidity rates were 0 and 12.4%, and 5- and 10-year overall and disease-free (on R0 resections) survival rates were 67.1 and 57.8%, and 70 and 52%, respectively. A favourable outcome (univariate analysis) was seen for G1 tumours (P < 0.0001), negative surgical margins (P < 0.0001), age ≤55 years (P = 0.005), no adjuvant treatment (P < 0.001) and diameter ≤6 cm (P = 0.005). Independent predictors of better survival (multivariate analysis) were negative surgical margins (P = 0.0001), G1 tumours (P = 0.02), age ≤55 years (P = 0.006) and diameter ≤6 cm (P = 0.006). A predictive risk factor for recurrence was histological grade. Surgical resection of PCWC leads to good oncological outcome. Wide surgical margins and G1 tumours predicted a better prognosis and a lower recurrence rate. The evolution of surgical technique and the introduction in clinical practice of new prosthetic materials allowed larger resections, and safe and anatomical reconstruction.

Abstract P4-16-09: Dosimetric feasibility and acute toxicity in a prospective trial of ultra-short course accelerated partial breast irradiation (APBI) using a multi-lumen balloon brachytherapy device

Abstract Background: Shorter courses of APBI with novel fractionation schedules are being investigated; a large randomized trial from Europe has recently shown the safety and efficacy of a single-fraction adjuvant approach (with limited follow-up). We designed a prospective trial to identify and address the potential radiobiological and logistical limitations of single-fraction, intraoperative APBI. Methods: We designed a single-arm, multi-institutional, prospective phase II trial that sequentially treats three cohorts of women (each n=30) with three progressively hypofractionated schedules. Eligible women were age ≥ 50 years with unifocal invasive or in situ tumors ≤ 3.0 cm, excised with negative margins, and with negative lymph nodes and positive hormone-receptors. Using a reference schedule of 60 Gy delivered in 2 Gy fractions, and assuming tumor parameters: a/b = 4 Gy; a = 0.27 Gy-1, and repopulation parameters of: Teff = 26 days; delay time = 0 days, the reference tumor BED is ∼ 86 Gy4. We began with a schedule of 4 fractions of 7 Gy delivered twice-daily using a Contura MLB multi-lumen device. We defined very conservative dosimetric criteria for acceptability: maximum skin and rib dose to not exceed 100% of prescription dose, and V150 and V200 to not exceed 40 cc and 10 cc, respectively. Subsequent schedules are 3 fractions of 8.25 Gy and 2 fractions of 10.25 Gy, both delivered over 2 days. The primary endpoint is to exclude a local failure rate exceeding 10% with the upper limit of a 95% confidence interval. Results: A total of 30 patients have been enrolled at the 7 Gy × 4 fractions dose-level and followed for a minimum of 6 months. The median skin dose as a percent of prescription dose (PD) was 84% (40–100) and the median rib dose was 71% (16–119). 96% of the PTV_eval received a median of 95% of PD (range 85–103). The V150 (range 14–48cc) and V200 (range 0–29cc) criteria were met in all cases. One breast infection occurred and was treated; 2 cases of symptomatic fat necrosis and 2 cases of symptomatic seromas occurred. No acute toxicities greater than CTCAE grade 2 have been observed. Conclusion: Short-course APBI is dosimetrically feasible using the Contura MLB and appears to be tolerable in terms of acute toxicities. Our approach is based on well-defined radiobiological parameters and allows for an abbreviated course of treatment that is guided by full pathological review and the ability to objectively achieve and validate acceptable dosimetric criteria in each case. We have opened enrollment to the next schedule of 8.25 Gy for three fractions. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-16-09.

Dosimetric Feasibility and Acute Toxicity in a Prospective Trial of Ultrashort-Course Accelerated Partial Breast Irradiation (APBI) Using a Multi-Lumen Balloon Brachytherapy Device

Shorter courses of APBI, including single-fraction intraoperative therapy, are under active investigation. We designed a prospective trial to identify and address the potential radiobiological and logistical shortcomings of single-fraction APBI. We designed a single-arm, multi-institutional, prospective phase II trial that sequentially treats 3 cohorts of women (each n=30) with 3 progressively hypofractionated schedules. Eligible women were age ≥50years with unifocal invasive or in situ tumors ≤3.0cm, excised with negative margins, and with negative lymph nodes and positive hormone receptors. We defined strict dosimetric criteria for appropriateness. A total of 30 patients were enrolled at the 7Gy×4 fractions dose-level and followed for 6months. The median skin dose as a percent of prescription dose (PD) was 84% (40-100), and the median rib dose was 71% (16-119). Also, 95% of the PTV_eval received a median of 95% of PD (range 85-103). The V150 (range 14-48cc) and V200 (range 0-29cc) criteria were met in all cases. One breast infection occurred and was treated; 2 cases of symptomatic fat necrosis and 2 cases of symptomatic seromas occurred. Short-course APBI is dosimetrically feasible using the Contura MLB and appears to be tolerable in terms of acute toxicities. Our approach is based on well-defined radiobiological parameters and allows for an abbreviated course of treatment that is guided by full pathological review and the ability to objectively achieve and validate acceptable dosimetric criteria in each case. We have opened enrollment to the next schedule of 8.25Gy for 3 fractions.

Initial clinical experience with multilumen brachytherapy catheters for accelerated partial breast irradiation

PurposeTo review the initial experience of three institutions using multilumen catheters to deliver accelerated partial breast irradiation (APBI) and evaluate dosimetric improvements. Methods and MaterialsPatients were eligible for this analysis if they met criteria for accelerated partial breast irradiation at their respective institution and were not enrolled on the national Phase III trial. Minimum guidelines for treatment planning from the National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 protocol were followed. Toxicities were coded using common toxicity criteria version 3.0 criteria. ResultsSixty-two patients were analyzed as part of this study. Median skin spacing was 11mm with a median skin dose of 86.9% (% of prescription dose [PD]). Median rib dose was 76.1% of the PD (range, 4.3–155.7%). The V90, V95, and V100 of the PD for the planning target volume evaluation was 95.4%, 95.2%, and 80.3%, respectively. Seven patients had both skin and rib spacing <7mm, with the median skin dose and rib dose being 113.4% and 130.9% of the PD. For these cases, the median V90, V95, and V100 of the PD was 99.2%, 94.3%, and 81.1%, respectively, whereas the median V150 and V200 were 22.5cc and 7.4cc. Overall, Grade I and II radiation dermatitis were noted in 41.9% and 6.5% of patients. ConclusionThe multilumen device led to improvements in target coverage and normal structure doses compared with traditionally accepted guidelines. Similar toxicities were seen compared with single-lumen devices, even in patients with skin and rib spacing <7mm.

Improvements in Critical Dosimetric Endpoints Using the Contura Multilumen Balloon Breast Brachytherapy Catheter to Deliver Accelerated Partial Breast Irradiation: Preliminary Dosimetric Findings of a Phase IV Trial

Dosimetric findings in patients treated with the Contura multilumen balloon (MLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) on a multi-institutional Phase IV registry trial are presented. Computed tomography-based three-dimensional planning with dose optimization was performed. For the trial, new ideal dosimetric goals included (1) ≥95% of the prescribed dose (PD) covering ≥90% of the target volume, (2) a maximum skin dose ≤125% of the PD, (3) maximum rib dose ≤145% of the PD, and (4) the V150 ≤50 cc and V200 ≤10 cc. The ability to concurrently achieve these dosimetric goals using the Contura MLB was analyzed. 144 cases were available for review. Using the MLB, all dosimetric criteria were met in 76% of cases. Evaluating dosimetric criteria individually, 92% and 89% of cases met skin and rib dose criteria, respectively. In 93% of cases, ideal target volume coverage goals were met, and in 99%, dose homogeneity criteria (V150 and V200) were satisfied. When skin thickness was ≥5 mm to <7 mm, the median skin dose was limited to 120.1% of the PD, and when skin thickness was <5 mm, the median skin dose was 124.2%. When rib distance was <5 mm, median rib dose was reduced to 136.5% of the PD. When skin thickness was <7 mm and distance to rib was <5 mm, median skin and rib doses were jointly limited to 120.6% and 142.1% of the PD, respectively. The Contura MLB catheter provided the means of achieving the imposed higher standard of dosimetric goals in the majority of clinical scenarios encountered.

Dosimetric Improvements in Balloon Based Brachytherapy Using the Contura® Multi-Lumen Balloon (MLB) Catheter to Deliver Accelerated Partial Breast Irradiation.

PurposePreliminary dosimetric findings in patients managed with the Contura® Multi-Lumen Balloon (MLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) on a multi-institutional phase IV registry trial were reviewed.Material and methodsCT-based 3D planning with dose optimization was performed for all patients. For the study, new ideal dosimetric goals were developed: 1) ≥ 95% of the prescribed dose (PD) covering ≥ 90% of the target volume (TV), 2) a maximum skin dose ≤ 125% of the PD, 3) maximum rib dose ≤ 145% of the PD, and 4) the V150 ≤ 50 cc and V200 ≤ 10 cc. The frequency of concurrently achieving these dosimetric goals using the Contura® MLB was investigated.Results194 cases were evaluable. Employing the MLB, all ideal dosimetric criteria were achieved in 76% of cases. Evaluating dosimetric criteria separately, 90% and 89% of cases met the new ideal skin and rib dose criteria, respectively. In 96%, ideal TV coverage goals were achieved and in 96%, dose homogeneity criteria (V150 and V200) were met. For skin spacing ≥ 5-7 mm, the median skin dose was 121% of the PD and when < 5 mm, the median skin dose was 124.4%. For rib distancees < 5 mm, the median rib dose was reduced to 136.4% of the PD. For skin spacing < 7 mm and distance to rib < 5 mm, the median skin and rib doses were concurrently limited to 121% and 142.8% of the PD, respectively.ConclusionsThe Contura® MLB catheter provides potential improvements in dosimetric capabilities (i.e., reduced skin and rib doses and improved TV coverage) in many clinical scenarios.

Railway vehicle wheel with elastic rubber suspension

The invention concerns a railway vehicle wheel with elastic rubber suspension designed in particular, but not exclusively, for low railway vehicles. In said railway vehicle, the wheel tyre (2) is connected to the wheel rim (3) via a rubber lining consisting of two flat rings (11, 12) substantially vertical relative to the wheel shaft. The rings (11, 12) are highly preloaded axially between an inner circumferential median rib (5) of the wheel tyre and two outer flanges (6, 8) of the rim (3). At least one of the flanges (8) is supported on the rim (3) by an adjusted seat (9) in a conical tight fit. The adjusted seat (9) is configured such that the cone of the flange (8) when free of tension has a tapering smaller than that of the cone of the rim (3) and when compressed, presses its entire surface on the cone of the rim (3) with a compressive surface as uniform as possible over the entire width of the adjusted seat (9). The flange (8) is thus securely maintained. Additional threaded screws (10) are therefor not necessary in the zone of the rings (11, 12) of the rubber lining, such that the space found between the rib (5) and the flanges (6, 8) can be exclusively used for the rubber lining.

Initial clinical experience with the Strut-Adjusted Volume Implant brachytherapy applicator for accelerated partial breast irradiation

Purpose Accelerated partial breast irradiation is becoming increasingly popular. The Cianna single-entry high-dose-rate applicator, Strut-Adjusted Volume Implant (SAVI, Cianna Medical, Aliso Viejo, CA), contains peripheral struts allowing greater planning flexibility for small-breasted women, technically easier insertion, and normal tissue exposure minimization. This study evaluates early clinical experience. Methods and Materials Thirty patients treated with the SAVI with a median followup of 12 months were evaluated. The median age was 59.5. Tumor size averaged 0.9 cm. Fifteen cancers were ductal carcinoma in situ (50%), 1 was invasive lobular (3.3%), 4 were tubular (6.7%), and the rest infiltrating ductal (40%). Most of them were estrogen receptor (ER) positive (90%). Nine women (30%) were premenopausal. Results Dosimetry was outstanding with median V90, V150, and V200 of 96.2%, 24.8, and 12.8 cc. There were no symptomatic seromas, and one report of asymptomatic fat necrosis seen on mammogram at 1 year. In patients who had skin spacing of less than 1 cm, the median skin dose was 245 cGy/fraction. The median rib and lung dose per fraction for those patients with either structure less than 1 cm was 340 and 255 cGy (75% of prescribed dose), respectively. There have been no local recurrences to date. Conclusions Early clinical experience with the SAVI demonstrates the ease of placement of a single-entry brachytherapy device combined with the increased dose modulation of interstitial brachytherapy. Dose to normal structures has remained exceedingly low. Almost half of evaluated patients were not candidates for other single-entry brachytherapy devices because of skin spacing or breast size, demonstrating an expansion of candidates for single-entry partial breast brachytherapy.

Description of Selenoportax vexillarius Molars from Dhok Pathan Village (Middle Siwaliks), Pakistan

Four molars of Selenoportax vexillarius are collected from village Dhok Pathan of the Middle Siwaliks. Out of four, two belong to upper dentition and the rest of two belong to lower dentition. The enamel plications vary owing to the ecological conditions and this feature can not be used for the comparison. The median basal pillars and median ribs are well developed in the molars and the comparative study is made with the type specimens of the species. The third molar of the species is broken anteriorly.

Bolandia (Asteraceae, Senecioneae): a New Genus Endemic to Southern Africa

The genus Bolandia (Asteraceae, Senecioneae) comprises two known species, B. pedunculosa and B. argillacea, previously included in Cineraria. Distinguishing features of Bolandia include the fusiform shape of the cypselae and strong median rib on the glabrous inner surface of the ray and outer disc cypselae, solitary ecalyculate capitula on long peduncles, and a truncate style apex with a central tuft of sweeping hairs. Bolandia occurs in the mountains of the Western Cape in southern Africa, with a disjunct population of B. pedunculosa in the Witteberg of the Eastern Cape and the nearby Drakensberg mountains in Lesotho. Bolandia argillacea is endemic to the mountains near Worcester in the Western Cape. Two forms of B. pedunculosa are informally recognized, a tomentose and a glabrescent form, the latter including plants previously known as C. albomontana.

Impact‐absorbing safety matting system for a helipad

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