5. Creating concave features via the use of avoidance structures. 6. Editing CDA multi-leaf collimator (MLC) to remove irregular hot spots.We aimed to analyze the effects of printing parameters on characterization of three-dimensional (3D) printed bolus used in external beam radiotherapy. Two sets of measurements were performed to investigate the dosimetric and physical characterization of 3D-printed bolus at different printing parameters. In the first step, boluses were produced at different infill-percentages, infill-patterns and printing directions. Two-dimensional (2D) dose measurements were performed in Elekta Versa HD linear accelerator using 6 MV photon energy. Measured 2D dose maps for both printed and reference bolus materials were compared using the 2D gamma analysis method. Additionally, patient-specific bolus was produced with defined optimum printing parameters for anthropomorphic head and neck phantom.  https://www.selleckchem.com/products/sp2509.html  Then, point dose measurements were performed to evaluate the feasibility of printed bolus in clinical use. In the second step, physical measurements were carried out to evaluate the printing accuracy, the mean hounsfield unit (HU) value and the weight of 3D-printed boluses. According to our measurement, infill-percentage, infill-pattern and printing direction significantly changed the dosimetric and physical properties of the 3D-printed bolus independently. Maximum gamma passing rate at 1.5 and 5 cm depths were found as 93.8% and 98.8%, respectively, for 60% infill-percentage, sunglass fill infill-pattern and horizontal printing direction. The printing accuracy of the products was within 0.4 mm. Dosimetric and physical properties of the printed bolus material changed significantly with the selected printing parameters. Therefore, it is important to note that each combination of these printing parameters that will be used in the production of patient-specific bolus should be investigated separately.The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P=0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.
  Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria. Our objective was to obtain population based reference values for peak oxygen uptake (V˙O
  ) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women.
 
  182 men and women, 20-85 years old, were included and exercised on cycle-ergometer to exhaustion. (V˙O
  ) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced.
 
  Height, sex and age resulted predictive of both V˙O
  peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas V˙O
  peak=0.017⋅height(cm)-0.023⋅age(years)+0.864⋅sex(female=0/male=1)±179lmin
  , and peak WR=1.345 · height (cm) - 2.074 · age (years)+76.54 · sex (female=0/male=1)±21.2W were the best compromise between accuracy and parsimony.
 
  This study provides new and accurate V˙O
  peak and WR rate reference values for individuals of European Spanish descent.
 This study provides new and accurate V˙O2 peak and WR rate reference values for individuals of European Spanish descent.Fabry disease is the second most frequent lysosomal storage disorder. It is a X-linked genetic disease secondary to alpha-galactosidase A enzyme deficiency. This is a progressive and systemic disease that affects both males and females. Classical symptoms and organ involvements are acral pain crisis, cornea verticillata, hypertrophic cardiomyopathy, stroke and chronic kidney disease with proteinuria. Nevertheless, organ damages can be missing or pauci-symptomatic and other common symptoms are poorly recognised, such as gastrointestinal or ear involvement. In classical Fabry disease, symptoms first appear during childhood or teenage in males, but later in females. Patients may have non-classical or late-onset Fabry disease with delayed manifestations or with single-organ involvement. Recognition of Fabry disease is important because treatments are available, but it may be challenging. Diagnosis is easy in males, with dosage of alpha-galactosidase A enzyme activity into leukocytes, but more difficult in females who can express normal residual activity. Other plasmatic biomarkers, such as lyso-globotriaosylceramide (lyso-Gb3), are interesting in females, but need to be associated with GLA gene analysis. In this review, we aimed at summarize the main clinical manifestations of Fabry disease and propose a practical algorithm to know how to diagnose this complex disease.Environmental remediation and restoration at hazardous waste sites is important for reducing risks and sustaining local economies. Navigating trade-offs between diverse and conflicting stakeholder perspectives to identify practical and affordable ways forward is important for sustaining objectives and goals. Differences in stakeholder perspectives are informed by their affiliations and roles and their views towards environmental, economic development, and public health issues. We used Q methodology, an approach that combines priority sorting and interviews, to elicit and interpret the perspectives of 28 stakeholders, representing government entities, non-profits, and industries at a mining-impacted Superfund site in the Coeur d'Alene Basin of Idaho, USA. Four primary perspectives were distinguished by their prioritization of 1) government intervention, 2) the Superfund remediation, 3) local concerns, and 4) public-private partnerships. Participants' roles and affiliations played an influential role in informing primary perspectives.