Radiographic Control Research Articles

Defining the Position of [177Lu]Lu-PSMA Radioligand Therapy in the Treatment Landscape of Metastatic Castration-Resistant Prostate Cancer: A Meta-analysis of Clinical Trials.

In recent years, theranostics has become a promising approach for treating metastatic castration-resistant prostate cancer (mCRPC), with trials investigating targeted radioligand therapy, particularly using prostate-specific membrane antigen labeled with lutetium-177 ([177Lu]Lu-PSMA). The proper position of [177Lu]Lu-PSMA in the therapeutic algorithm of mCRPC is yet to be identified. We conducted a systematic review and meta-analysis of phase II/III randomized controlled trials to assess the efficacy of [177Lu]Lu-PSMA in treating mCRPC. Study endpoints included radiographic progression-free survival (rPFS), prostate-specific antigen-PFS, objective response rate, and overall survival. Data were extracted according to the PRISMA statement. Summary hazard ratios (HRs) were calculated using random- or fixed-effects models. Statistical analyses were performed with RevMan software (v.5.2.3). [177Lu]Lu-PSMA reduced the risk of rPFS (HR 0.55; 95% confidence interval [CI] 0.43-0.71; p < 0.00001) and prostate-specific antigen-PFS (HR 0.53; 95% CI 0.41-0.67; p < 0.00001), and improved the objective response rate compared with control therapies (response rate 3.55; 95% CI 1.91-6.60; p < 0.0001), whereas no significant cumulative effect on overall survival was documented (HR 0.92; 95% CI 0.65-1.31; p = 0.63). Notably, in a dedicated subanalysis, comparable effects on rPFS were observed when [177Lu]Lu-PSMA was compared with active therapy. [177Lu]Lu-PSMA has a favorable impact on the radiographic and biochemical control of mCRPC and represents a potential treatment in a scenario where other valuable options are available. Further efforts are required to identify clinical and molecular markers necessary for proper patient stratification.

Stereotactic radiosurgery for fourth ventricle brain metastases: tumor control outcomes and the need for CSF diversion. Patient series.

Stereotactic radiosurgery is a favorable alternative to surgery for intracranial cerebral metastases. Fourth ventricle (V4) metastases are challenging because of the location and surrounding structures, with a high risk for obstructive hydrocephalus and brainstem compression. Here, the authors evaluate the effectiveness in terms of safety, tumor control rates, and permanent cerebrospinal fluid (CSF) diversion of primary Gamma Knife radiosurgery (GKRS) in treating V4 metastases. Eleven of 1060 patients had V4 brain metastases. No patients had pre-GKRS hydrocephalus. The mean tumor volume was 3.3 cm3, treatment dose was 18 Gy to the 50.5% isodose line (average 14 shots), conformity index was 1.4, and volume of brainstem receiving greater than 12 Gy was 0.2 cm3. Eight patients had radiographic and clinical follow-ups. The average time to initial follow-up was 3.1 months. Karnofsy Performance Status did not change from the initial consultation to the post-GKRS follow-up. No patients developed hydrocephalus or required permanent CSF diversion. One patient required transient external ventricular drain placement; however, neurological symptoms resolved with steroid therapy. Seven patients received steroid therapy post-GKRS. Seven patients had radiographic disease control at the 6-month follow-up. One patient had tumor progression at 6 months and underwent surgery. Primary GKRS for V4 metastases with a close follow-up is safe and optimizes quality of life for patients with significant cancer burden. https://thejns.org/doi/10.3171/CASE24293.

Mixed Gangliocytoma-Pituitary Adenoma: A Systematic Review of Diagnostic Features, Clinical Management, and Surgical Outcomes

ObjectiveMixed gangliocytoma-pituitary adenomas (MGPAs) are very rare sellar neoplasms. Contemporary understanding of their natural history, clinical characteristics, optimal management strategies, and prototypical outcomes remains poorly understood. MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, EMBASE, Web of Science, and Cochrane were searched to include studies of patients with histologically confirmed Mixed Gangliocytomas (MGPAs). Clinical features, management strategies, and outcomes were analyzed. Results33 studies reporting 78 patients met study criteria and were included. Median age at diagnosis was 47 years, with a female predominance (71%). Common presenting symptoms included headache (49%), acromegaly (43%), and visual disturbance (20%). Growth hormone (GH) and prolactin were the most commonly elevated hormones. Magnetic resonance imaging (MRI) identified local infiltration in 86% of patients, most frequently in the cavernous sinus. Transsphenoidal resection was the primary treatment strategy, which achieved a gross total resection (GTR) in 43%. Postoperative pituitary function was normal in 92%. Median follow-up was 21 months, during which time 14% of patients required secondary intervention for persistent hormonal hypersecretion. Following these secondary interventions and as of last follow-up, radiographic and/or biochemical control was confirmed in all patients, with an overall survival rate of 97%. ConclusionMGPAs are rare, slow-growing tumors that present with a combination of endocrinological and neurological symptoms. MGPAs are optimally managed with transsphenoidal resection, which appears to achieve favorable rates of symptomatic relief and local control, despite the high incidence of local infiltration and relatively low attendant GTR rate.

Treatment outcomes in patients with papillary thyroid cancer undergoing radiofrequency ablation of metastatic lymph nodes.

Lymph node metastases in papillary thyroid cancer (PTC) increases recurrence risk and negatively impact survival. Traditional treatments like re-operation and radioactive iodine (RAI) have downsides. Radiofrequency ablation (RFA) is an emerging non-surgical therapeutic option, but there is seldom data on its efficacy and safety specifically for metastatic lymph nodes. We aimed to evaluate clinical outcomes of RFA applied to cervical lymph nodes in patients with PTC metastasis in North American population. This was a single-institution retrospective analysis of 68 PTC patients with lymph nodes who underwent percutaneous RFA from January 2020 to December 2022. Volume reduction ratio (VRR), changes in thyroglobulin (Tg) levels, lymph node regrowth rate, and complications were assessed. Treatment response and outcomes were analyzed. Median lymph node maximum diameter was 12.9 mm and median volume was 0.27 mL at baseline. After RFA, median VRR was 79.5% [interquartile range (IQR), 50-89.7%]. Post-RFA, Tg to an average of 0.2 ng/mL (IQR, 0-0.6 ng/mL). In the 19 patients (27.9%) with undetectable Tg after RFA, median VRR was 86% (IQR, 73-94%). Quantitative Tg decrease strongly correlated with VRR percentage (r=0.82, P<0.001). Lymph node regrowth was seen in 5 patients (7.4%) over median 18 months follow-up. Only one patient experienced transient thermal injury associated with Horner's syndrome and symptoms resolved within 1 month. In patients with PTC and metastatic cervical lymph nodes, RFA provided marked volume reduction and meaningful biochemical response without major complications. Excellent radiographic control was achieved in most patients. RFA demonstrates early promise as an emerging non-surgical therapeutic option for PTC patients with metastatic lymph nodes.

Standardized Ultrasound Protocol for Peripherally Inserted Central Catheters in Neonates: A Retrospective, X-ray Controlled Observational Study.

Objectives: Ultrasound (US) has been reported to be a reliable imaging modality for locating the tip of peripherally inserted central venous catheters (PICC) in neonates. However, its use requires a certain level of expertise, which may limit its application. Standardization of US examinations using designed protocols may improve their efficiency and ease of use. The objective of our study is to evaluate the effectiveness of introducing a standardized US protocol for PICC guidance. Methods: An expert panel was formed in order to develop a standardized US protocol for PICC assessment. Institutional review board agreement was obtained. This protocol was then used by participating clinicians to assess PICC position. Every assessment was followed by a radiographic control. The study group consisted of 262 US examinations of PICC lines in a level III neonatal intensive care unit (NICU) performed according to the designed protocol. Subsequent statistical analysis was made with the RStudio software, R version 4.3.1 (2023-06-16 ucrt). Results: Compared to the X-ray control, standardized US examinations showed 100% sensitivity, 81% specificity, an accuracy of 98% and a 98% precision for assessing catheter placement. The Cohen's Kappa value for the comparison of X-ray and US studies was 0.88, indicating good agreement between the two methods. Conclusions: Standardized US examinations have shown similar potential for evaluating the location of PICC lines when compared with radiographic studies. Implementing a standardized protocol in the NICU may facilitate the ultrasound assessment of PICC lines and reduce exposure to ionizing radiation.

Improved Automated Quality Control of Skeletal Wrist Radiographs Using Deep Multitask Learning.

Radiographic quality control is an integral component of the radiology workflow. In this study, we developed a convolutional neural network model tailored for automated quality control, specifically designed to detect and classify key attributes of wrist radiographs including projection, laterality (based on the right/left marker), and the presence of hardware and/or casts. The model's primary objective was to ensure the congruence of results with image requisition metadata to pass the quality assessment. Using a dataset of 6283 wrist radiographs from 2591 patients, our multitask-capable deep learning model based on DenseNet 121 architecture achieved high accuracy in classifying projections (F1 Score of 97.23%), detecting casts (F1 Score of 97.70%), and identifying surgical hardware (F1 Score of 92.27%). The model's performance in laterality marker detection was lower (F1 Score of 82.52%), particularly for partially visible or cut-off markers. This paper presents a comprehensive evaluation of our model's performance, highlighting its strengths, limitations, and the challenges encountered during its development and implementation. Furthermore, we outline planned future research directions aimed at refining and expanding the model's capabilities for improved clinical utility and patient care in radiographic quality control.

Ridge Preservation Combined With Open Barrier Membrane Technique in Case of Postextractive Oroantral Communication: A Case Series Retrospective Study.

After dental extraction, a physiological phenomenon of reabsorption of the dentoalveolar process is triggered, especially if periradicular lesions are present, which can sometimes be associated with oroantral communication in the upper posterior maxilla. To investigate a minimally invasive approach, 19 patients undergoing tooth extraction in the posterosuperior maxilla were recruited. All cases presented an oroantral communication with a diameter of 2-5 mm after tooth extraction and the alveolar process and, in some cases, with a partial defect of 1 or more bony walls. In these cases, a single surgical procedure was used to preserve the alveolar ridge using an open barrier technique with an exposed dense polytetrafluoroethylene membrane. The bottom of the extraction socket was filled with a collagen fleece. The residual bone process was reconstructed using a biomaterial based on carbonate-apatite derived from porcine cancellous bone. After 6 months, all patients were recalled and subjected to radiographic control associated with an implant-prosthetic rehabilitation plan. Data relating to the sinus health status and the average height and thickness of the regenerated bone were collected. Radiographic evaluation verified the integrity of the maxillary sinus floor with new bone formation, detecting a vertical bone dimension between 3.1 mm and 7.4 mm (average 5.13 ± 1.15 mm) and a horizontal thickness between 4.2 mm and 9.6 mm (average 6.86 ± 1.55 mm). The goal of this study was to highlight the advantage of managing an oroantral communication and, simultaneously, obtain the preservation and regeneration of the alveolar bone crest. The open barrier technique appears to be effective for the minimally invasive management of oroantral communication up to 5 mm in diameter in postextraction sites, with a good regeneration of hard and soft tissue.

Incorporation of technology in endodontic treatment of a patient with chronic non-progressive encephalopathy: case report

Objective: This work aims to describe the endodontic treatment performed in a single session in a patient with chronic non-progressive encephalopathy under general anesthesia, using technological devices. Method: A 31-year-old male patient diagnosed with chronic non-progressive encephalopathy, sought dental treatment due to tooth pain. He presented ataxia, atrophy of the upper and lower limbs and involuntary spasms. In the intraoral examination a generalized excessive occlusal wear and temporary restoration on tooth 46 was seen. Periapical radiograph showed increased periodontal space and periapical bone rarefaction. The indication was for endodontic treatment of tooth 46 under general anesthesia. After surgical risk assessment and pre-anesthetic evaluation, endodontic treatment was performed under general anesthesia, using an apical locator, mechanized instrumentation and digital radiography. The tooth restauration was performed in the same clinical moment, without complications. Result: The 8-month follow-up showed absence clinical signs and symptoms and radiographic control without periapical changes. Conclusion: In this case, the incorporation of technology in the endodontic treatment of a patient with chronic non-progressive encephalopathy ensured a safe and effective treatment for the patient and the staff, with case resolution, promotion of oral health and quality of life.

Computed tomographic‐planned repair of short incomplete sagittal fractures of the proximal phalanx

SummaryBackgroundShort incomplete sagittal fractures of the proximal phalanx are common in racehorses. Configurations vary; surgical planning has been performed using radiography which has limited ability to differentiate between common configurations. Computed tomographic (CT) imaging accurately maps fracture configuration and may be contributory to case management.Objectives(i) Describe a surgical technique for CT‐planned repair of short incomplete sagittal fractures of the proximal phalanx and (ii) report case outcomes.Study designRetrospective case series (2019–2023).MethodsCT‐planned surgical repair of short incomplete sagittal fractures of the proximal phalanx was performed under radiographic control. Following repair, screw position was assessed with CT. Case records, radiographic and CT images were reviewed. Follow‐up information was obtained from referring veterinarians, race records and owner/trainers.ResultsTen fractures were confined to the dorsal cortex and subchondral bone. One fracture extended the full dorsoplantar depth of the bone. One fracture was confined to the subchondral bone centrally. Screw repair was planned using CT, to cross the fracture, or to position as close as possible while avoiding penetration of the articular surface. Surgery was performed under radiographic control, and subsequent CT examination confirmed screw placement as planned. Fractures healed radiographically in all 10 imaged cases. All horses were sound at follow‐up examination. One horse was retired to stud after surgery. Eleven horses returned to full training and 10 raced.Main limitationsThe case outcomes reported are only relevant to similar populations of Thoroughbred racehorses. The lack of a cohort of control horses limits conclusions that can be drawn relating to the contribution of this surgery to case management.ConclusionsCT planned repair of short incomplete sagittal fractures of the proximal phalanx, with screws positioned according to fracture location, can be reliably performed and is associated with good outcomes.

Feasibility of implementation of the early tumor shrinkage as a potential predictive marker to daily clinical practice in patients with RAS wild type metastatic colorectal cancer, treated with cetuximab - a non-interventional observational study.

With the aim to show the feasibility of early tumor shrinkage (ETS) concept implementation into daily clinical practice in the Czech Republic, a non-interventional, multicentric, single arm, prospective study in real world set-up was performed. The study objectives were to explore the time interval from the treatment starting date to the date of the first radiographic control (TFRC) and evaluate the proportion of patients who achieved ≥ 20% tumor regression within the first 8 weeks of first-line therapy, in the real-world settings. The medians of TFRC in all individual participating centers were &gt; 12 weeks (range 14.0-36.4 weeks). TFRC ≤ 8 weeks was reported for only 3% of patients in the cohort with first-line therapy, and there were only 3 patients (1%) who achieved tumor regression of ≥ 20% by day 60 (8.6 weeks). These findings indicate that the basic time parameter of ETS could not realistically be employed in routine oncology care of patients with metastatic colorectal cancer (mCRC) in the Czech Republic, unless there would be a strict request to perform TRFC by week 8 since the initiation of the therapy. In addition, the frequency of objective tumor response to first-line therapy with cetuximab + chemotherapy was evaluated. Based on the relative regression in the sum of diameters of measurable metastatic lesions, unconfirmed partial responses were achieved in 42.4 % and unconfirmed complete response in 8.6% of patients, altogether corresponding to the overall response rate of 51% with first-line therapy. The frequency of responses was higher among patients with left than right sided primary tumors. It seems that the regimen of cetuximab/FOLFOX might be more active in frontline therapy of right sided RAS wild type mCRC than cetuximab/FOLFIRI.

Evaluating the Efficacy and Safety of CyberKnife for Meningiomas: A Systematic Review.

This systematic review aims to evaluate CyberKnife (Accuray, Madison, WI, USA) radiosurgery's efficacy, safety, and outcomes in treating meningiomas, focusing on tumour control rates, symptom relief, survival rates, quality of life, and adverse events. A comprehensive literature search was conducted across PubMed, EMBASE, Web of Science, Google Scholar, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), covering studies published in the last 20 years and available in English. The inclusion criteria targeted studies involving patients with meningioma treated with CyberKnife radiosurgery, reporting on specific outcomes of interest. Quality assessment was performed using the Newcastle-Ottawa Scale for observational studies, and a narrative synthesis approach was adopted for data analysis. Twenty-one studies met the inclusion criteria, encompassing various design types and patient demographics. The review highlights CyberKnife's effectiveness in managing benign and atypical meningiomas and specific challenging cases like perioptic lesions and large cranial base tumours. Key findings include high tumour control rates, preservation or improvement of visual functions in perioptic lesions, and promising results in benign spinal tumours and supratentorial meningiomas. Comparative analyses suggest better radiographic tumour control and a lower incidence of post-treatment complications with stereotactic radiotherapy over stereotactic radiosurgery. Long-term outcomes and safety profiles underline the viability of CyberKnife as a treatment option, with minimal permanent side effects reported. CyberKnife radiosurgery is a highly effective and safe treatment modality for meningiomas. It offers significant benefits in tumour control, symptom relief, and maintaining the quality of life with minimal adverse effects. The precision and adaptability of CyberKnife technology make it a valuable addition to the treatment arsenal for meningiomas. It necessitates further research and adoption in clinical practice, especially in regions like the United Arab Emirates, where its use is emerging.

Comparisons between Assembly Technologies by Welding and Brazing of Aluminium Alloys from the Sight of Assembly Quality

Aluminum and its alloys are finding use in more and more industrial fields. Since the early 1970s, when many companies in the automotive, pharmaceutical and aeronautical industries replaced the classic components of iron alloys with those of aluminum alloys, they faced various difficulties in the non-removable assembly of designed components.The first assembly technologies used were welding, followed in the 1980s by brazing. Due to its economic advantages, in many cases brazing technologies are preferred by manufacturers. The present paper aims to make a comparative study, based on experimental data, between the non-removable assembly technology by welding and brazing for aluminum alloys of group 6000. Due to the high costs of materials and labor, it is preferable to use relevant non-destructive control methods that can indicate any discontinuities that may occur in welded or brazed structures. These defects can provide valuable information and may indicate either non-compliance with the required technological conditions or the wrong choice of assembly method. Non-destructive testing methods that can highlight interior defects, such as radiographic control with penetrating radiation and ultrasound will be used, as well as less expensive equipment and labor methods that may highlight surface defects or which communicates with the surface such as the method of control with penetrating liquids. Thus, the joint areas of the base and filler materials will be analyzed, as well as the areas in the immediate vicinity that have been thermally influenced. The experimental results will be able to lead to pertinent conclusions in the way of choosing the non-removable assembly technology, results that can be easily generalized in the industrial fields. Thus, each company will be able to choose according to the conditions imposed by the product specifications a certain technology that will satisfy its requirements.

Three-dimensional printed models can reduce costs and surgical time for complex proximal humeral fractures: preoperative planning, patient satisfaction, and improved resident skills

BackgroundProximal humeral fractures (PHFs) are still controversial with regards to treatment and are difficult to classify. The study’s objective is to show that preoperative planning performed while handling a three-dimensional (3D) printed anatomical model of the fracture can ensure a better understanding of trauma for both surgeons and patients.Materials and methodsTwenty patients (group A, cases) with complex PHF were evaluated preoperatively by reproducing life-size, full-touch 3D anatomical models. Intraoperative blood loss, radiographic controls, duration of surgery, and clinical outcomes of patients in group A were compared with 20 patients (group B, controls) who underwent standard preoperative evaluation. Additionally, senior surgeons and residents, as well as group A patients, answered a questionnaire to evaluate innovative preoperative planning and patient compliance. Cost analysis was evaluated.ResultsIntraoperative radiography controls and length of operation were significantly shorter in group A. There were no differences in clinical outcomes or blood loss. Patients claim a better understanding of the trauma suffered and the proposed treatment. Surgeons assert that the planning of the definitive operation with 3D models has had a good impact. The development of this tool has been well received by the residents. The surgery was reduced in length by 15%, resulting in savings of about EUR 400 for each intervention.ConclusionsFewer intraoperative radiography checks, shorter surgeries, and better patient compliance reduce radiation exposure for patients and healthcare staff, enhance surgical outcomes while reducing expenses, and lower the risk of medicolegal claims.Level of evidenceLevel I, prospective randomized case–control study.

Fixation of Posterior Malleolus in Trimalleolar Ankle Fractures: Anteroposterior Screw or Posterolateral Plate?

Background: The treatment of the third malleolus has evolved in recent years, and surgical treatment can be carried out with traditional percutaneous osteosynthesis using anteroposterior screws or ORIF with a posterolateral plate. Methods: Our study included 54 patients divided into two groups based on the intervention type (screw or plate). Instrumental assessments comprised pre- and post-operative X-rays and pre-operative CT scans to evaluate joint step-off. The mean follow-up duration was 1 year and 9 months. Results: Radiographic control revealed no loss of reduction or mobilization of the synthesis devices, and all patients achieved fracture healing. Articular step-off &gt; 2 mm was observed in 21 patients (38.9%), including 4 in the plate group and 17 in the screw group, with a statistically significant likelihood of step-off presence in the latter. The mean AOFAS score was 90 points, negatively correlated with age, and lower in patients with joint step-off and a 15° reduction in ROM. Conclusions: The management of posterior malleolus fractures has changed with anatomical studies and an understanding of ankle stability through CT scans. ORIF with a posterior plate is advantageous for anatomical reduction of the tibial plafond but is disadvantageous in terms of surgical invasiveness and technical difficulty.

Hemiarthroplasty in Proximal Humerus Fractures: Does Modular Metaphyseal Stem Design Lead to Better Results? An Analysis of 24 Cases.

Anatomic hemiarthroplasty (aHA) is a treatment option for non-reconstructable constructable multifragment proximal humeral fractures that preserves range of motion. Our study aims to evaluate the radiographic and clinical outcomes of patients who received a modular aHA with anatomical sizing of the tubercle-bearing metaphyseal components. The medical records of thirty-nine consecutive patients were reviewed. Patients were treated at a single institution with aHA as first-line treatment following a non-reconstructable constructable proximal humeral fracture. Tubercle resorption and cranialization of the aHA were analyzed using radiographic controls. Patient clinical function was assessed using the Constant Murley Score (CS). Twenty-four patients (62%) were available for clinical follow-up, with a mean CS of 54 points after a mean 56-month follow-up period. There was no significant difference in functional outcome on average between patients with healed tubercles (CS = 57) and resorbed tubercles (CS = 51). Radiographic follow-up was available in 33 patients (85%), demonstrating healed tubercles in 33% of the patients. Patients with resorbed tubercles had significant smaller acromio-humeral distances (AHD) than patients with healed tubercles (p = 0.043). A positive correlation was observed between greater AHD and increased constant scores (p = 0.022). The final patient outcome measures demonstrated a positive correlation with a greater acromio-humeral distance and tubercle healing rates. However, the modular stem design with sizing of the metaphyseal components did not result in superior outcomes when compared with the literature.

Влияние режимов дуговой автоматической сварки на геометрические параметры шва стыковых соединений из низкоуглеродистой стали, выполненных с применением экспериментального флюса

Introduction. The metallurgical industry in the territory of the Russian Federation has accumulated a significant amount of slags obtained during the smelting of steels and cast iron. The presence of slag dumps adversely affects the ecology of regions with metallurgical enterprises. When reducing iron from slags, the by-product becomes an oxide agglomerate, which can be considered as a flux composition for arc welding/surfacing under a layer of flux, fillers of powder wires, coatings of welding stick electrodes. The purpose of the work is to establish the possibility of arc welding using the flux obtained by the authors and to determine the optimal welding modes with the condition of achieving the geometric parameters of the seam according to GOST 8713-79 and the quality of the welded joint (absence of internal defects). In this paper, butt welded joints of sheet steel VSt3sp with a thickness of 5 mm obtained by automatic welding under a layer of flux at direct current with forced formation of a root roller on ceramic linings using flux from recycled metallurgical slag of an electric steelmaking enterprise are investigated. Automatic welding of flat specimens was carried out on a tractor-type ADF-1250 machine with a wire with a diameter of 3 mm, at a constant welding speed of 54 cm/min with varying current and arc voltage within 400–600 A and 27–37 V. The methods of investigation: Visual measuring and radiographic control, determination of deformation of specimens by laser scanning and computer processing of 3D models were used to evaluate the quality of welded joints. Statistical modeling in the form of a two-factor experiment was also used in the work, with obtaining adequate regression equations of the influence of welding modes on the geometric parameters of the seam: the height of reinforcement and the width of the seam on the front and back of the joint. Results and discussion. The possibility of obtaining welding fluxes from metallurgical slags of an electric steelmaking enterprise and its use for creating welded joints is shown. Optimal modes of arc welding of thin-walled sheet parts made of low-carbon steel with forced formation of a root roller on ceramic linings is established, ensuring the absence of internal defects in the form of pores, cracks and lacks of penetration, a minimum of residual deformations and compliance of the weld size with the requirements of the existing standard. The nominal values of the geometric parameters of the seam according to GOST 8713-79-C4 correspond to welding mode: welding speed 54 cm/min, welding current 550 A, arc voltage 30 V. The results of the work can be applied in metallurgical electric steelmaking enterprises producing low-carbon steel in the development of technologies for the use of welding materials from slag.

Standardized reduction and palmar plating of dorsally displaced distal radius fractures for safe and atraumatic reconstruction of the anatomy of the radius

Standardization of palmar plate osteosynthesis in order to consequently achieve physiologic anatomy of the distal radius end. Unstable dorsally displaced distal radius fractures or fractures that should be treated functionally. Severe intraarticular joint depression that cannot be reduced with either apalmar or arthroscopic assisted approach. Patient in supine position with the forearm supinated on arm table. Radiopalmar incision along the radial border of the flexor carpi radialis tendon. Detachment of the pronator quadratus muscle from radial to ulnar. Gross reduction with eventual correction of adorsal or radial shift. Placement of the angular stable plate and preliminary fixation with anonangular stable cortical screw in the long hole at the radius shaft. Fluoroscopic control of axial alignment in the anteroposterior view and of correct distal position of the plate in the lateral view under reduction condition. Placement of one or two angular stable screws at the shaft. Under subtle reduction with flexion, ulnar deviation and axial traction placement of two K‑wires via the holes at the distal edge of the plate. These wires mostly keep reduction maintained while reduction maneuver can be paused. Fluoroscopic control in two planes. Replacement of the wires by distal angular stable screws with the help of the wires as an orientation. In case of insufficient reduction, reduction maneuver can be repeated while the first angular stable screw is locked. Final fluoroscopic control in two planes and ulnar deviation, eventually also in tangential view and clinical testing for stability of the distal radioulnar joint. Wound closure only by skin suture. Application of asterile dressing and apalmar cast. Arm consequently in upright position and active and complete movement of fingers. Palmar below-elbow cast for 2weeks, then movement of wrist without exertion. After regular radiographic control 4-5weeks postoperatively, increase of axial load to normal and, if needed, physiotherapy. Clinical control for irritation of tendons by plate or screws after 1year and eventual plate removal.

Peripherally Inserted Central Catheter Safety and Efficacy in Acute Lymphoblastic Leukemias: A 16-Years Monocentric Experience

Background: Acute lymphoblastic leukemia (ALL) is a cancer of lymphoid cells and organs that requires immunochemotherapy combined with hematopoietic stem cell transplantation (HSCT) according to minimal residual disease. Recently, cell therapy and targeted drugs have been added to the treatment algorithm. Supportive care, and local treatment such as intrathecal chemotherapy are also recommended due to complications related to disease and therapy. Introduction: The Peripherally Inserted Central Catheters (PICC )may be a safe and useful tool for the treatment of ALL patients because it is easier to implant with a lower risk of complications than Centrally Inserted Central Catheters (CICC), and is effective in outpatient settings. Methods: Since its introduction in our medical oncology department, a PICC team consisting of a hematology physician and three dedicated nurses has conducted a prospective study to evaluate the efficacy and complication rate of the PICC system in inpatients and outpatients ALL. Inclusion criteria included all ALL patients who required chemotherapy, supportive care, or HSCT, regardless of white blood cell (WBC) count. A platelet count (PLT) greater than 20000/mm 3 and normal coagulation tests were required for implantation. In all patients, the vascular anatomy of the arms was previously examined by ultrasound. All implantations were performed under ultrasound control, followed by radiographic control. Results: From March 2007 to April 2023, 87 PICC implantations were performed in 75 patients, including 39 men and 36 women. The mean age was 44 years (range 15-80). The majority of implantations were performed in hospitalized ALL patients (81-93%). Seventy-one PICCs (82%) were used for chemotherapy, eleven (13%) for supportive care, two (2%) for autologous HSCT, 4 (5%) for allogeneic HSCT. No PICC was lost to follow-up. At the time of this analysis, only one PICC (1%) was still in situ and in use. Total PICC survival was 13683 days (median, 121; range, 1-1257). The reasons for removal are listed in Table1. Of note, most PICCs were removed because of end of therapy (61%) and exitus (17%), and only 1 in 3 (33%) had suspected catheter-related bloodstream infection confirmed by microbiological testing. Complications recorded in the overall populations are described in the Table.2 No complications occurred in 68% of PICCs. There were 16 episodes of confirmed PICC-related systemic infection recorded (18%; 1.1/1000 days/PICC). The pathogens isolated in blood cultures and in analysis of PICC spikes were: Staphylococcus Epidermidis, Staphylococcus Hominis, Pseudomonas Aeruginosa, Escherichia Coli, Enterococcus Faecium, Klebsiella Pneumoniae, Candida spp. Only 1 of 16 confirmed PICC-related systemic infections (6%) required removal of the devices, whereas in the other 15 cases (94%), PICC were allowed to remain after resolution of the infection with systemic antibiotic therapy. No cases of symptomatic thrombotic complications associated with PICC were recorded. Conclusions: These data suggest that the use of PICC can be considered the device of choice in the treatment of ALL patients because it is easy to insert, safe to use, durable, and associated with a low complication rate, even in the case of PICC-related systemic infections.

CTNI-01. LONG-TERM RESULTS FROM A PHASE 1 TRIAL OF SPINE SBRT IN INOPERABLE PATIENTS WITH CORD COMPRESSION

Abstract PURPOSE/OBJECTIVE We seek to establish the feasibility of using spine stereotactic radiosurgery (SSRS) allowing for spinal cord dose constraint relaxation as the primary management of metastatic epidural spinal cord compression (MESCC) in inoperable patients monitoring for radiation myelopathy (RM) and radiographic local control (LC). MATERIAL/METHODS Patients with radiation naïve MESCC were enrolled on this prospective Phase 1 trial. Single fraction SSRS was delivered to a dose of 18 or 24 Gy. Spinal cord constraint relaxation was performed in sequential cohorts from an initial allowable Dmax cohort of 10 Gy up to 16 Gy only if tumor progression occurred without RM. RESULTS Thirty two patients enrolled on the trial of which 4, 12, 8 and 8 were in the 10 Gy, 12 Gy, 14 Gy and 16 Gy cord Dmax cohorts, respectively. At baseline, there were 10 sites with MESCC Grade 1B, 10 sites with Grade 1C, 9 sites with Grade 2, 2 sites with Grade 1A, and 1 site with Grade 3 disease. Of the 28 evaluable patients, the median overall survival was 32.3 months (range 5.8-122.6 mo). The 1-year and 5-year LC was 84.5% and 79.5%. The 2-year LC did not statistically differ between the 14-16 Gy cord Dmax combined cohorts and the 10-12 Gy cord Dmax combined cohorts (92.9% vs. 62.9%, p = 0.15). With a median clinical follow-up of 22.7 months (range 3-122.3 mo), there were no cases of RM including in the 13 patients who survived at least 3 years. In the cohort receiving a cord Dmax of 16 Gy, there were no cases of RM with a median follow-up of 18.6 mo (range 9.0-97.1 mo). CONCLUSION With long-term follow-up, these data demonstrate that SSRS is a safe and effective tool in patients with MESCC. Cord constraint relaxation may be considered in inoperable patients with MESCC.

Peripherally Inserted Central Catheter Safety and Efficacy in Acute Myeloid Leukemia: A Monocentric Experience from the Hematology of Cagliari

Background: Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow cells that requires intensive chemotherapy combined with hematopoietic stem cell transplantation in fit patients and less intensive treatment in elderly patients. Supportive care is also advised due to disease and therapy-related cytopenia that can lead to life-threatening systemic infections, bleeding, and hypoxemia. Introduction: The Peripherally Inserted Central Catheter (PICC) may be a safe and useful tool for the treatment of AML patients because it is easier to implant and has a lower rate of infectious complications than the Centrally Inserted Central Catheters (CICC). Methods: Since its establishment in our medical oncology department, a PICC team consisting of a hematology physician and three dedicated nurses has conducted a prospective study to evaluate the efficacy and complication rate of the PICC device in inpatient and outpatient AML patients. Inclusion criteria included all AML patients who required chemotherapy, supportive care, and HSCT, regardless of white blood cell (WBC) count. A platelet count greater than 20000/mm 3 and normal coagulation tests were required for implantation. In all patients, the vascular anatomy of the arms was previously examined by ultrasound. All implantations were performed under ultrasound guidance followed by radiographic control. Results: From March 2007 to April 2023, 216 PICC implantations were performed in 186 patients (110 men and 76 women), including 13 patients with acute promyelocytic leukemia, after the conclusion of the induction phase. Median age 60 years (range 22-79). The majority of implantations were performed in hospitalized AML patients (193 - 89%). One hundred ninety-three PICCs (81%) were used for chemotherapy, thirty (14%) for supportive care, four (2%) for autologous HSCT, five (3%) for allogeneic HSCT. Only two PICCs were lost to follow-up in the AML population. Therefore, the analysis of duration and complications was performed on 214 devices. At the time of this analysis, 13 of 214 PICCs (6%) are still in situ and in use. The total duration of PICC life was 26289 days (median, 103; range, 0-959). The reasons for removal in the two populations are shown in Table1. Of note, most PICCs were removed because of end of therapy (40%) and exitus (31%), and only one in five (20%) had suspected catheter-related bloodstream infection confirmed by microbiological testing. Complications recorded in the global populations are described in the Table.2 No complications occurred in 68% of PICCs. There were 34 episodes of confirmed PICC-related septicemia recorded (16%; 1.3/1000 days/PICC). The pathogens isolated in blood cultures and PICC tip analysis were: Staphylococcus Epidermidis, Staphylococcus Hominis, Staphylococcus Warneri, Pseudomonas Aeruginosa, Escherichia Coli, Enterococcus Faecium, Enterococcus Fecalis, Stenotrophomonas Maltophila, Bacillus Cereus, Klebsiella Pneumoniae, Candida spp. In only 11 of 34 confirmed PICC-related septicemias (32%) did the devices need to be removed, whereas in the other 23 cases (68%), PICC were left in place after the infection resolved with systemic antibiotic therapy. There were only 4 (2%; 0.15/1000 days/PICC) cases of symptomatic thrombotic complications related to PICC without the need for removal. Conclusions: These data indicate that the use of PICC can be considered a safe and useful tool in the treatment of AML patients because it is easy to insert, safe to use, long lasting, and has a low complication rate, even in the case of PICC-related systemic infections.