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Background: During their training, pre-professional ballet students are confronted with physical stresses comparable to those of competitive sports. In competitive sports, there are mandatory and binding aptitude tests to ensure that the growing athlete meets the requirements. In ballet, there are no such mandatory examinations preceding the start of training. For adult professional dancers, musculoskeletal ideals could be isolated from the dance medicine literature. However, only a few studies describe musculoskeletal characteristics of pre-professional ballet students. It is neither known at what age a student should meet the ideal measurements for an adult nor what deviations from the ideal can be considered normal. This study aims to describe sociodemographic and musculoskeletal characteristics of pre-professional ballet students and discusses to what extent they already meet or deviate from dance-specific eligibility criteria for adult professional ballet dancers., Material and Methods: In this study, n = 414 female and n = 192 male students of John Cranko School (JCS) were seen by an experienced orthopaedist and dance physician. Mean age was 13.9 years (SD 3.5, range 5-22 years). Their medical history was taken (age; nationality; start of ballet/training) and a physical examination was performed (height/weight; symmetry of shoulder girdle, spine, waist triangles; pelvic tilt; tibial torsion; range of motion of base of index finger joint, spine, hips, ankle and base of great toe joint). Subsequently, the results of this study were compared with suitability criteria for adult professional ballet dancers that had been isolated from the dance medicine literature for a previous article., Results: Examinees were from 49 different nations. 34.6% of the female subjects (≥16 years) were between 165 and 170 cm and 33.3% of the male subjects (≥18 years) were between 178 and 185 cm tall. 45.0% of those examined showed low body weight (<10th percentile, BMI <18.5 kg/m²). The trunk of 61.0-84.8% of those examined was erect and symmetrical. 25.2% had scoliosis. Half (53.5%) were found to have a bilateral external rotation of the hips of at least 60°, and 68.7% had a bilateral internal rotation between 20 and 50°. 87.3% exhibited a bilateral tibial torsion between 15 and 40°. A bilateral en dehors of 90° was calculated for 25.0%. In 9.1% of those examined, the upper ankle joints presented a dorsiflexion of at least 25°, and in 70.2%, a plantarflexion of at least 70° was seen. In 88.0%, the metatarsophalangeal joint of the great toe was 90° (f) and 80° (m) on both sides., Conclusion: The results of this study showed that pre-professional ballet students fulfil many characteristics of adult professional ballet dancers. High values already among young age groups suggest a ballet-specific selection. Nevertheless, not all students fulfil the theoretical "ideal measurements" for professional classical ballet. These anatomical limits should be considered individually in training to protect the growing pre-professional ballet dancer. The high ballet-specific anatomical demands, but especially the large number of students with a low body weight, underline the necessity of mandatory aptitude tests at the beginning and regular check-ups in the course of training to avert compensatory mechanisms and their consequential damage and to screen for eating disorders and disorders of eating behaviour., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: Immune checkpoint inhibitors (ICIs) are an emerging tool in the treatment of brain metastases (BMs), Stereotactic radiosurgery (SRS), traditionally used for BMs, elicits an immune brain response and can act synergistically with ICIs. We aim to investigate the efficacy of ICI administered with SRS and determine the impact of timing on BM response., Methods: A systematical search was performed to identify potential studies concerning BMs managed with SRS alone or with SRS + ICI with relative timing administration (ICI concurrent with SRS, ICI nonconcurrent with SRS, SRS before ICI, SRS after ICI). The overall survival (OS), 12-month OS, local progression-free survival (LPFS), 12-month local brain control (LBC), distant progression-free survival (DPFS), 12-month distant brain control (DBC), and adverse events (intracranial hemorrhage, radionecrosis) were analyzed using the random-effects model., Results: A total of 16 retrospective studies with 1356 BM patients were included. Compared to nonconcurrent therapy, concurrent therapy revealed a significantly longer OS (HR= 1.43; p  = 0.008) and 12-months LBC (HR = 1.91; p  = 0.04), a similar 12-months DBC (HR = 1.12; p  = 0.547) and higher complication rate ( R  = 0.77; p  = 0.346). Concurrent therapy leads to a significantly higher OS compared to ICI before SRS (HR = 2.55; p  = 0.0003)., Conclusion: The combination of SRS with ICI improves patients' clinical and radiological outcomes. The effectiveness of the combination is subject to the identification of an optimal therapeutic window.

To determine the efficacy of stereotactic radiosurgery (SRS) in treating patients with brain metastases (BMs), a network meta-analysis (NMA) of randomized controlled trials (RCTs) and a direct comparison of cohort studies were performed. Relevant literature regarding the effectiveness of SRS alone and in combination with whole-brain radiotherapy (WBRT) and surgery was retrieved using systematic database searches up to April 2019. The patterns of overall survival (OS), one-year OS, progression-free survival (PFS), one-year local brain control (LBC), one-year distant brain control (DBC), neurological death (ND), and complication rate were analyzed. A total of 18 RCTs and 37 cohorts were included in the meta-analysis. Our data revealed that SRS carried a better OS than SRS+WBRT (p = 0.048) and WBRT (p = 0.041). Also, SRS+WBRT demonstrated a significantly improved PFS, LBC, and DBC compared to WBRT alone and SRS alone. Finally, SRS achieved the same LBC as high as surgery, but intracranial relapse occurred considerably more frequently in the absence of WBRT. However, there were not any significant differences in ND and toxicities between SRS and other groups. Therefore, SRS alone may be a better alternative since increased patient survival may outweigh the increased risk of brain tumor recurrence associated with it., Competing Interests: Declaration of Competing Interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Classical dance (ballet) is often compared to high-performance sport in terms of its demands on the body and psyche. During the last century, the physical requirements have increased to such an extent that artistic aptitude alone is no longer sufficient to start a professional training. If a professional training is started although the necessary musculoskeletal criteria are not fully met, the risk of injury, overload damage and associated drop-out of training increases. However, initial medical examinations and checkups accompanying the professional training are only optional and therefore not available in all professional training institutions. The role of a medical doctor in the qualifying examination is merely advisory for the institution. Regarding musculoskeletal eligibility, a distinction can be made between absolute (= not modifiable: e. g. fixed back stiffening, limited en dehors capability, rigid hollow foot) and relative (= up to individual decision: e. g. hyperflexibility, scoliosis, hip extension deficit) contraindications. At the same time, criteria can be defined that support aptitude. A standardised, mandatory medical fitness examination for the training of professional dance could help to protect adolescents from acute injuries and the consequences of chronic misuse or overload., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

To be used as a carrier of 68 Ga radioisotope for possible blood pool imaging studies, dialdehyde dextran thiosemicarbazone (DADTSC) Schiff base polymer with different thiosemicarbazone contents (TSCC) = 0.93, 2.43, and 3.4 mmol/g were synthesized and characterized by FT-IR, GPC, and CHNS. Although they were successfully radiolabeled at room temperature, stable radio-complexes were prepared at 60 °C. Effect of thiosemicarbazone content on the dissolution rate, cytotoxicity, coagulation and hemolysis activities, and radiolabeling efficiency of Schiff bases as well as on the in-vitro radio-complexes stability was investigated. DADTSC1 (TSCC = 0.93 mmol/g) showed a less cytotoxicity (cell viability, CV 50  = 490 μg/ml), a better solubility, suitable coagulation and hemolytic activities, and a sufficient radiolabeling efficiency (Radiochemical purity (RCP) > 95%) and formed a stable (RCP > 90%) radio-complex, which be chosen for in-vivo biodistribution study in healthy rats through tissue sampling and counting for radioactivity. Like blood pool imaging agents, 68 Ga-DADTSC1 presented a retention profile in blood circulation, though more studies, including imaging in larger mammals, are required., (Published by Elsevier B.V.)

Objectives: To develop an anthropomorphic phantom closely mimicking patient anatomy and to evaluate the phantom for the simulation of computed tomography (CT)-guided procedures., Methods: Patient CT images were printed with aqueous potassium iodide solution (1 g/mL) on paper. The printed paper sheets were stacked in alternation with 1-mm thick polyethylene foam layers, cut to the patient shape and glued together to create an anthropomorphic abdomen phantom. Ten interventional radiologists performed periradicular infiltration on the phantom and rated the phantom procedure regarding different aspects of suitability for simulating CT-guided procedures., Results: Radiopaque printing in combination with polyethylene foam layers achieved a phantom with detailed patient anatomy that allowed needle placement. CT-guided periradicular infiltration on the phantom was rated highly realistic for simulation of anatomy, needle navigation and overall course of the procedure. Haptics were rated as intermediately realistic. Participants strongly agreed that the phantom was suitable for training and learning purposes., Conclusions: A radiopaque 3D printed, anthropomorphic phantom provides a realistic platform for the simulation of CT-guided procedures. Future work will focus on application for training and procedure optimisation., Key Points: • Radiopaque 3D printing combined with polyethylene foam achieves patient phantoms for CT-guided procedures. • Radiopaque 3D printed, anthropomorphic phantoms allow realistic simulation of CT-guided procedures. • Realistic visual guidance is a key aspect in simulation of CT-guided procedures. • Three-dimensional printed phantoms provide a platform for training and optimisation of CT-guided procedures.

Introduction: Immobilization of patients in radiation therapy can be performed with a vacuum bag (VB). The aim of this study is to measure the effect of the VB in the surface and depth dose of patients in radiation therapy., Materials and Methods: The effect of the VB on the surface dose and depth dose is measured in clinical conditions. Various dosimeters were used in following measurements: parallel plate chamber for depth dose, farmer ionization chamber for various gantry angles, and Mapcheck2 dosimeter for various thicknesses of VB. The effect of VB cap, which may be placed in the beam path, is also measured using EDR2 film. The measurements were performed for 6 MV and 18 MV photons with an Oncor linac., Results: The increase of 30% and 25% in the surface dose with VB was observed for 6 MV and 18 MV, respectively. Though due to the use of VB, the reduction of the absorbed dose at a 5 cm depth is under 1% and can be ignored in MU calculation. For various thicknesses of VB, 8-14 cm, the attenuation of the primary beam were up to 2.5% for 6 MV and 1.2% for 18 MV photon. The presence of VB cap in the path of radiation reduced the depth dose up to 15% and 11% for 6 MV and 18 MV, respectively., Conclusion: The use of VB can increase the surface dose of the patient up to 30% and this fact should be considered in treatment planning. For some lateral fields the cap of the VB may interfere with radiation field. If the cap of VB is placed in the beam path, it can cause a cold spot in tumor., Discussion: The use of VB can increase the surface dose of the patient up to 30%. For some lateral fields, the cap of the VB might interfere with the radiation field. If the cap of VB is placed in the beam path, it can cause a cold spot in the tumor volume., Competing Interests: There are no conflicts of interest

Introduction: Small variations in trace element levels may cause important physiological changes in the human body. This study aims to evaluate five important trace elements in radiation workers., Method: In this study, 44 radiation workers and an equal number of non-radiation workers were selected as the case and control group, respectively. The concentrations of iron, magnesium, zinc, copper, and selenium in the serum of the participants were measured using an Atomic Absorption Spectrometry (AAS)., Results: The mean concentrations of iron, magnesium, zinc, copper, and selenium for the case group were 107.3 µg/dl, 2.3 mg/dl, 80.9 µg/dl, 112.6 µg/dl and 216.7 ng/ml, respectively. The results for the control group were 121.9 µg/dl, 2.3 mg/dl, 82.3 µg/dl, 112.8 µg/dl and 225.2 ng/ml, respectively., Conclusions: The mean concentration of iron in the case group was significantly lower than the control group (p-value = 0.012), while the concentrations of other elements in both of the groups were not significantly different. In the case group, except magnesium (p-value = 0.021), no significant relationship was found between age and the elemental concentrations. According to Spearman's test, there was a meaningful statistical correlation between the sex and concentration of iron, Mg, Zn, and Se. Also, the correlation between the concentration of magnesium and the weights of radiation workers was significant (p-value =0.044)., (© 2018 Old City Publishing, Inc.)

Successful implementation of treatment in cancer care partially depends on how patients' perspectives are taken into account, as preferences of health care professionals and patients may differ. Objectives of this exploratory research were (I) to identify patient preferences and values (PPVs) in cancer care as indicated by patient organizations (POs), (II) to determine how these PPVs are captured in cancer care guidelines and (III) to review how guidelines take into account these PPVs. Based on a survey developed and completed by 19 POs, a literature review was conducted to analyse how patient perspectives are incorporated in oncology treatment guidelines. Based on survey results traditional health technology assessment value propositions of oncology care, such as extended life, treatment-free remission and pain reduction, were also highly rated by POs. However, the heterogeneity of cancer PPVs were clearly reflected in the survey results. PPVs in cancer care guidelines were mostly limited to those micro-level aspects that are strictly related to health care provision, such as side-effects and comorbidities. Patient experience, emotional support and convenience of care were relatively neglected fields in the reviewed guidelines. Patient engagement was rarely presented in the guideline development phase. POs believe that patients should be encouraged to take an active role in their own care due to the heterogeneity of cancer patients and PPVs. Even if patient-centricity is a leading paradigm in cancer policy, based on our research it is not yet standard practice to include patients or POs at all appropriate levels of decision-making processes that are related to their health and well-being. Patient engagement should be an integral part of cancer care decision-making. This complexity must be reflected throughout policy making, avoiding a population level "one-size-fits-all" solution.