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Summary: A 73‐year‐old woman underwent an awake craniotomy for the resection of a supratentorial brain tumour. We provided sedation for the surgery using a dexmedetomidine target controlled infusion using the Dyck pharmacokinetic model. Using a target controlled infusion allowed more rapid titration to the desired plasma level compared with a manual infusion, without any unexpected cardiovascular, respiratory or other complications. Rapid titration of sedation during awake craniotomy is desirable, allowing deeper sedation during stimulating parts of the surgery, followed by lighter sedation – or absence of sedation – during cortical mapping. While this can be performed manually, we found utilising the Dyck model in this case simple and quick to use, avoiding the need to manually calculate infusion rates. We believe this is the first report of using a target controlled infusion model to administer dexmedetomidine for awake craniotomy, and suggest it could be considered as an alternative to administering a manual infusion. [ABSTRACT FROM AUTHOR]

The article discusses the challenges of pain assessment and management in the intensive care unit (ICU). It highlights the complexity of the issue due to the variation in patient presentations, management options, and cultural practices. The study emphasizes the need for improved training on pain assessment tools for physicians and the importance of nursing staff in identifying patients in pain. The authors call for increased emphasis on pain medicine training in postgraduate curricula to ensure that future ICU consultants have the necessary tools and knowledge. They also stress the importance of prioritizing pain management for the overall well-being of ICU patients. [Extracted from the article]

The impact of increasing temperatures on the population dynamics of the soil‐dwelling nematode Globodera pallida, a persistent and economically important pest of potatoes, was investigated. The reproductive factor (final population⁄initial population) and length of life cycle were found to be temperature sensitive. Pot experiments performed over 4 months allowed comparison of the effect on development of G. pallida of two temperature regimes: an average temperature comparable to current field conditions (14.3 °C) and an average temperature above current field conditions (17.3 °C). A larger second generation of juveniles was observed at 17.3 °C compared to 14.3 °C. Multiplication of G. pallida at field sites in Shropshire and East Lothian (average soil temperatures of 15.5 and 14.1 °C, respectively, during potato cropping) was also examined. A quantitative PCR assay and visual examination of roots were used to monitor the dynamics of the G. pallida populations in both field sites at 4‐weekly intervals. Four cultivars, Desirée, Cara, Maris Piper and Estima, were grown with and without nematicide treatments. Nematicide treatments suppressed population increases at both sites. Females were observed on the roots of cvs Cara and Desirée at the end of the growing season in Shropshire, but not at East Lothian, and are likely to represent a second generation. [ABSTRACT FROM AUTHOR]

The aim of this paper is to detail the experience obtained in implementing an image-guided radiation therapy program at the Northern Sydney Cancer Centre. This required retrofitting a Varian Clinac 21EX with an on-board imager. The commissioning and quality assurance procedures, organisation of a multidisciplinary image guided radiation therapy group, and the development of clinical protocols for orthogonal kV and cone beam computed tomography implementation are described. Reassessment of the image-guided radiation therapy program has continued as new equipment and software versions were made available in the department. [ABSTRACT FROM AUTHOR]

The aims were to determine the median survival and prognostic factors of patients with central nervous system (CNS) metastases managed with whole-brain radiation therapy (WBRT), and to explore selection criteria in recently published clinical trials using aggressive interventions in CNS metastases. A retrospective audit was performed on patients managed with WBRT for CNS metastases. Potential prognostic factors were recorded and analysed for their association with survival duration. The proportion of patients with these factors was also compared with those of patients managed under three recently reported studies investigating aggressive interventions, such as radiosurgery and chemotherapy for CNS metastases. Seventy-three patients were treated with WBRT for cerebral metastases over a 12-month period. The median survival of the population was 3.4 months (95% confidence interval: 2.7–4.1), with 6- and 12-month survival rates of 30 and 18%, respectively. Significant prognostic factors for prolonged median survival were Eastern Cooperative Oncology Group status 0–2 ( P = 0.015), Medical Research Council neurological functional status 0–1 ( P = 0.006), and Recursive Partitioning Analysis Class 2 versus Class 3 ( P = 0.020). On multivariate analysis, younger patient age ( P = 0.02) and better performance status ( P < 0.01) were associated with improved outcome. When comparing these characteristics with selected published studies, our study cohort demonstrated a higher proportion of patients with poor performance status, a greater number of metastases per patient and a higher incidence of extracranial disease. This reflects the selected nature of patients in these published studies. Central nervous system metastases confer a poor prognosis and, for the majority of patients, aggressive interventions are unlikely to improve survival. The use of potentially toxic and expensive treatments should be reserved for those few in whom these studies have shown a potential benefit. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the relationship of posterior fossa radiation therapy duration (PFRTD) and relapse-free survival (RFS) following adjuvant craniospinal RT for childhood medulloblastoma. A retrospective audit was performed assessing all children aged <18 years managed with adjuvant craniospinal RT for medulloblastoma in Australia and New Zealand in 1980–1993. Children receiving prolonged (>180 days) pre-RT chemotherapy were excluded. Data were obtained for potential prognostic factors in domains of patient, tumour and treatment factors. Radiation therapy time factors assessed were PFRTD and time interval from surgery to commencement of RT (SRTD). The end-point assessed was RFS and analysis was performed using Cox regression and Kaplan–Meier survival. One hundred and eighty-nine children were identified from 10 oncology units, with data available from 182 children for analysis. Median follow up was 5.3 years. Seventy-three per cent of children presented with disease confined to the cerebellum; 13% had initial neuraxis disease. Macroscopic resection was described in 54%; 42% received adjuvant chemotherapy. Median RT dose and RT duration to PF was 55 Gy and 45 days, respectively. Seventy-eight relapses occurred with a 10-year actuarial RFS of 58.2% (standard error ± 4%). On univariate analysis, increasing PF dose ( P = 0.002), age >5 years ( P = 0.006), and more thorough extent of surgical resection ( P = 0.043) were associated with improved RFS; PFRTD ( P = 0.20) and SRTD ( P = 0.51) were not associated with RFS. On multivariate analysis, although both PF dose ( P = 0.004) and extent of surgery ( P = 0.045) remained strongly significant, RT duration was now associated with RFS ( P = 0.049). Other factors assessed that did not reach significance were patient age, local tumour extent, presence of internal shunt and use of chemotherapy. The importance of local treatment factors was confirmed in this audit with established prognostic factors such as primary tumour macroscopic resection and adequate PF RT dose being associated with RFS. A treatment time effect is weakly suggested, although less significant than RT dose delivered. [ABSTRACT FROM AUTHOR]

An outpatient radiotherapy department assessed how precautions implemented during the severe acute respiratory syndrome (SARS) outbreak affected patient satisfaction with doctor–patient interaction and explored variables potentially influencing satisfaction. The information obtained would help prepare us for future infectious disease outbreaks. Outpatients seen during the outbreak completed a validated questionnaire assessing satisfaction with doctor–patient interaction. Additional items assessed included patients’ perception of SARS measures and patient demographics. Of 149 patients, 97% had heard of SARS, 92% believed SARS precautions necessary, and 54% believed contracting SARS was possible despite the precautions. Patients were satisfied with doctors wearing masks (97%), temperature checks (97%), and patients wearing masks (96%). Despite the high satisfaction levels with SARS precautions, 24% believed it had adversely affected doctor–patient interaction. With regards to doctor–patient interaction, 94% of patients were satisfied. Patients were most satisfied with the ‘information exchange’ domain (mean score 3.23 out of 4) compared to other domains ( P < 0.0001, 100.00% confidence) and were less satisfied with the ‘empathy’ domain compared to other domains ( P < 0.0001, 100.00% confidence). Patients were most satisfied with understanding their treatment plan (100%), doctor being honest (97%) and being understood (96%). Patients were least satisfied with information about caring for their illness (61%), that the visit could be better (59%), and the doctor showing more interest (58%). On multivariate analysis, patients who were less satisfied with SARS measures were significantly less satisfied with doctor–patient interaction ( P = 0.0001). Dissatisfaction with SARS measures was associated with significant dissatisfaction for questions in all domains. Older age and non-breast cancer patients were also less satisfied with doctor–patient interaction. Most (94%) of patients were satisfied with doctor–patient interaction, despite implementation of infectious disease prevention measures. However, patients who were dissatisfied with the SARS precautions had poorer satisfaction. In particular, physician empathy appeared to be most adversely affected. The results have relevance to any radiotherapy department preparing contingency plans in the event of infectious disease outbreaks. [ABSTRACT FROM AUTHOR]

The New South Wales Breast Radiation Oncology Group has completed a prospective multicentre study of the impact of radiation therapy (RT) on acute toxicity and quality of life (QoL) in women with early breast cancer treated with breast conservation therapy. The patient group received adjuvant breast tangential RT after wide local excision of breast cancer. Acute toxicity and cosmesis was assessed quantitatively and qualitatively. European Organization of Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30) and Perceived Adjustment to Chronic Illness Scale (PACIS) were the QoL instruments used. Of 175 women, 34.3% described lethargy leading to a significant disruption to normal activity during RT. At week 6, this had reduced to 7.5% reporting significant lethargy. No negative effects on QoL were noted over the time period of RT; EORTC demonstrated no difference (P = 0.79). PACIS recorded a significant improvement in functioning (P < 0.001) from baseline to week 6. Univariate analysis on potential predictive patient, tumour and treatment factors demonstrated an association of baseline pre-RT breast discomfort with worse lethargy (P = 0.03), EORTC (P < 0.01) and PACIS (P < 0.01) measures. This study confirms the minimal impact of RT on patient functioning at 6 weeks post-treatment. [ABSTRACT FROM AUTHOR]

This review discusses the mechanisms underlying synergistic interactions between phytophagous nematodes and soilborne pathogens, and identifies biotic and abiotic factors affecting these interactions. Approaches towards the resolution and management of nematode–pathogen complexes are considered and discussed. [ABSTRACT FROM AUTHOR]

Discusses means of introducing high-dose chemotherapeutic strategies into the adjuvant management of high-risk breast cancer in Australasia. Current status of high-risk breast cancer therapy; Role of radiation therapy in high-dose chemotherapy protocols; Toxicity of high-dose chemotherapy.

An obituary for Dr. Pat Haydock, a specialist in plant nematology, is presented.

A letter to the editor is presented in response to the article "Multicentre quality assurance of intensity-modulated radiotherapy planning: Beware the benchmarker" by M. Back, L. Oliver, R. Bromley, and T. Eade that was published in the previous issue.

Objective: Various biomaterials have been successfully applied in alveolar bone regeneration, however, the reconstruction of extensive osseous defects remains challenging and is often unfeasible with granular grafting materials. Several studies have outlined allogenic bone blocks as valid alternative to autologous block grafting., Clinical Considerations: In this report, we demonstrate the regeneration of two large osseous defects in the maxilla with allogenic bone blocks made from human donor bone. The bone blocks were customized using the CAD/CAM technology in order to enable the insertion of four dental implants., Conclusions: Both blocks perfectly matched the defect geometry, showed limited resorption, led to the formation of sufficient amounts of mineralized bone in both horizontal and vertical dimensions and enabled the installation of implants according to the treatment plan. The implementation of innovative technologies for individualization of allogenic bone blocks simplifies the restoration of complex and extensive osseous defects and poses great benefits for both practitioners and patients., Clinical Significance: The here presented procedure demonstrates the successful regeneration of two extensive osseous defects in a patient suffering from hypodontia using two CAD/CAM manufactured allogenic bone blocks, rendering the procedure far less invasive as compared to guided bone regeneration carried out with autologous transplants. Furthermore, to the best of our knowledge, this is the first case report that radiographically demonstrates the new formation of a cortical bone layer following block grafting with solely cancellous bone blocks., (© 2019 Wiley Periodicals, Inc.)

We present an endovascular technique to repair an ascending aortic pseudoaneurysm in a patient with multiple previous sternotomies using access via the right common carotid artery., (© 2019 Wiley Periodicals, Inc.)

Objective: The use of allogeneic bone grafts for alveolar ridge reconstruction has become an often-discussed alternative to augmentation procedures using autografts. Nevertheless, there still is a lack of literature concerning long-time experiences of allografts for alveolar ridge reconstruction. Especially the results of the use of allogeneic bone blocks for mandible reconstructions need to be further investigated., Clinical Considerations: In this case report, we present the use of customized allogenic bone blocks in Guided Bone Regeneration (GBR) procedures for severely deficient mandibulary bones, the implantation after a healing period of 5 month and the 24-month follow-up data., Conclusions: Customized allogeneic bone blocks seem to be a successful alternative to augmentations with autologous bone blocks reconstructing highly resorbed mandibulary alveolar ridges, showing highest volume stability and no signs of bone resorption after implant loading., Clinical Significance: The application of customized allogeneic bone blocks has shown to be a successful augmentation technique even compared with with autologous bone blocks reconstructing highly resorbed mandibulary alveolar ridges demonstrating no compromises regarding clinical outcome, functionality and esthetics., (© 2018 Wiley Periodicals, Inc.)

A method is reported for assessing the compositional fluctuations in a ceramic sample, based only on the determination of the crystalline lattice parameters. Pure tetragonal phase partially stabilized zirconia powders are synthesized through the co-precipitation method by incorporating 4% Eu(3+). The powder is subjected to compression cycles to promote the tetragonal-to-monoclinic transformation. The Rietveld analysis of the X-ray powder diffraction patterns, recorded after each compression cycle, gives information about the lattice parameters and monoclinic phase content. The determination of europium content in the residual tetragonal phase is accomplished considering the unit cell volume of t-ZrO2 using Vegard's law. Using this information the compositional fluctuations over the sample were determined by considering two possible distributions of lanthanide ion content in the powders: a Gaussian and a Log-normal one. It was found that the Gaussian distribution better fits the experimental data. It was eventually demonstrated that these results are physically meaningful.