text:
Korean/Lesson I4

Colors
As well as having two sets of numbers, Korean also uses two sets of colors, one being the native Korean set, the other being derived from Chinese characters hanja 한자 (漢字).

Native Korean set
Various like dozens of Korean words represent similar colors but express the different impression of colors. The following Korean words about color are the most neutral and normal words.

Korean colors may be followed by native word, 빛 or 빛깔, or followed by 색 (色) which is derived from Chinese characters. Each word means color.

Examples

 * 빨간 입술 red lips
 * 파란 하늘 blue sky
 * 푸른 초원 green grassland
 * 노란 병아리 yellow chick
 * 흰 눈 white snow
 * 검은 눈동자 black pupil

Chinese character set

 * 백인 (白人) white person
 * 흑인 (黑人) black person
 * 흑백필름 (黑白 film) black & white film
 * 적색신호 (赤色信號) red light signal
 * 청바지(靑바지) blue jeans

<>

title: Korean/Lesson I4


text:
User talk:222.154.7.139

We've had our fun now, haven't we?

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: User talk:222.154.7.139


text:
Coding Cookbook

This book features all kinds of short coding samples, often called code snippets. It is not a reference for any specific coding language, or a command reference.

Like an ordinary cookbook, you are not looking for a recipe that can be made from a certain ingredient or using a certain utensil, but you are looking to perform a specific task.

Often, these snippets are multi-disciplinary. Especially with web programming languages, you often use a combination of HTML, CSS, JavaScript and possibly server-side languages to perform a certain task. Also, the same result can often be achieved using different languages. Each task can list solutions in several languages.

By Task - By Language - |Alphabetic listing

 * See also other Cookbooks.

title: Coding Cookbook


text:
Coding Cookbook/Resizable Window

Dynamic HTML solution
window.onload  = updateLayout; window.onresize = updateLayout; function updateLayout { var vpWidth, vpHeight // 1. Bepaal viewport (venster) afmetingen if(self.innerHeight) { // all except Explorer vpWidth = self.innerWidth; vpHeight = self.innerHeight; } else if (document.documentElement &&    document.documentElement.clientHeight) { // IE6 Strict vpWidth = document.documentElement.clientWidth; vpHeight = document.documentElement.clientHeight; } else if (document.body) { // other Explorers vpWidth = document.body.clientWidth; vpHeight = document.body.clientHeight; } // 2. Geef elementen juiste pixel-formaat document.getElementById('main' ).style.height = ((vpHeight < 50) ? 0 : vpHeight - 50) + 'px'; document.getElementById('footer').style.top   = ((vpHeight < 50) ? 0 : vpHeight - 50) + 'px'; } HTML, BODY {height: 100%; width: 100%;} HTML {overflow: hidden;} BODY {margin: 0px;} overflow: auto;} width: 100%; overflow: hidden;} Main contents here Footer contents here
 * 1) main {position: absolute; left: 0px; top: 0px; height: 550px; width: 100%;
 * 1) footer {position: absolute; left: 0px; top: 550px; height: 50px;

title: Coding Cookbook/Resizable Window


text: Category:CodeCook/Tasks/Layout

title: Category:CodeCook/Tasks/Layout


text: Category:CodeCook/Languages/JavaScript

title: Category:CodeCook/Languages/JavaScript


text:
Category:CodeCook/Tasks

< Coding Cookbook

title: Category:CodeCook/Tasks


text:
Category:CodeCook/Languages

< Coding Cookbook

title: Category:CodeCook/Languages


text: Category:Book:Coding Cookbook

title: Category:Book:Coding Cookbook


text: Category:CodeCook/Languages/HTML

title: Category:CodeCook/Languages/HTML


text:
Coding Cookbook/Tabbar

Dynamic HTML solution
 window.onload = function { activatePage("Pagelet1"); } function activatePage(sSectionName) { var nodeElem = document.getElementById("li"+sSectionName); var nodeList = nodeElem.parentNode.parentNode.childNodes; for (var i = 0; i < nodeList.length; i++) { var node = nodeList[i]; if (node.nodeName == "LI") { node.childNodes[0].className = ""; var nodeDiv = document.getElementById("div" + node.childNodes[0].id.substr(2)); nodeDiv.style.display = "none"; }     }    document.getElementById("div"+sSectionName).style.display = ""; document.getElementById("li"+sSectionName).className = "active"; document.getElementById("li"+sSectionName).blur; } UL.tabbar {margin: 0; margin-top: 1em; margin-bottom: 3px; padding: 0; padding-left: 1em; line-height: 19px;} UL.tabbar LI {display: inline; white-space: nowrap; } UL.tabbar A {border: solid 1px silver; background-color: rgb(238,238,238); padding: 3px 1em 6px 1em; position: relative; z-index: 1;} UL.tabbar A.active {border-bottom-color: white; background-color: white;} .pagelet {border: solid 1px silver; padding: 1em;}   Pagelet 1  Pagelet 2  foo bar

title: Coding Cookbook/Tabbar


text: Category:CodeCook/Languages/CSS

title: Category:CodeCook/Languages/CSS


text:
Coding Cookbook/Pop-up Window

JavaScript solution
pop-up

title: Coding Cookbook/Pop-up Window


text: Category:CodeCook/Tasks/Window

title: Category:CodeCook/Tasks/Window


text:
Coding Cookbook/Escape from encapsulation

JavaScript solution
Escape from frame encapsulation

if (top != self) { top.location.replace(document.location.href); };


text:
Coding Cookbook/Statusbar Ticker

JavaScript solution
var init_msg = "This text will be repeatedly build up on the statusbar.              "

var str = "" var msg = "" var leftmsg = ""

function setMessage { if (msg == "") { str = " " msg = init_msg leftmsg = "" }	if (str.length == 1) { while (msg.substring(0, 1) == " ") { leftmsg = leftmsg + str str = msg.substring(0, 1) msg = msg.substring(1, msg.length) }		leftmsg = leftmsg + str str = msg.substring(0, 1) msg = msg.substring(1, msg.length) for (var ii = 0; ii < 120; ii++) {str = " " + str} }	else { str = str.substring(10, str.length) }	window.status = leftmsg + str window.setTimeout('setMessage',10) }

title: Coding Cookbook/Statusbar Ticker


text:
Coding Cookbook/Inline If

Not every language offers an Inline If function.

title: Coding Cookbook/Inline If


text: Category:CodeCook/Languages/VBScript

title: Category:CodeCook/Languages/VBScript


text: Category:CodeCook/Tasks/Programming

title: Category:CodeCook/Tasks/Programming


text:
Coding Cookbook/Change Query Parameter

Change parameters in an URL querystring (for example "param1=foo&param2=bar").

VBScript solution
function ChangeQueryParameter (Query, Parameter, Value) dim sTemp dim SubstringStart ' Starting position of Parameter within Query dim SubstringEnd  ' Ending position of Parameter within Query if (Query = "") then ChangeQueryParameter = "" else sTemp = "&" & Query ' Let every parameter start with '&'

SubstringStart = InStr (LCase(sTemp), "&" & LCase(Parameter) & "=") if (SubstringStart = 0) then ' Parameter was not yet included ChangeQueryParameter = sTemp else ' Parameter already existed ChangeQueryParameter = Left (sTemp, SubstringStart-1) SubstringEnd = InStr (SubstringStart+1, sTemp, "&") if not (SubstringEnd = 0) then ' Parameter was not last in query ChangeQueryParameter = ChangeQueryParameter & Mid(sTemp, SubstringEnd) end if     end if    end if

if not (Value = "") then _ ChangeQueryParameter = ChangeQueryParameter & "&" & Parameter & "=" & Value ' If an empty value has been giving, the parameter will be removed

if not (ChangeQueryParameter = "") then _ ChangeQueryParameter = Mid(ChangeQueryParameter, 2)

end function

strQuery = "param1=foo&param2=bar" strQuery = ChangeQueryParameter( strQuery, "param1", "foobar" ) ' Result: "param1=foobar&param2=bar" strQuery = ChangeQueryParameter( strQuery, "param1", "" ) ' Result: "param2=bar"

title: Coding Cookbook/Change Query Parameter


text: Category:CodeCook/Tasks/Strings/Querystrings


text: Category:CodeCook/Tasks/Strings

title: Category:CodeCook/Tasks/Strings


text:
Coding Cookbook/Validate Email Address

Regular Expressions?
There are many many proposed regular expression solutions to this problem, however the e-mail address format is so complicated that it is difficult to do with a regular expression alone. On the other hand, the vast majority of email addresses that people actually use fall into a small subset of the standard, and thus various usable regular expressions can be found of varying degrees accuracy scattered widely across the internet. If you want to look at a cool regular expression that performs a subset of the email validation process, stare at this for a while; there are also some quick not-quite-perfect solutions here.

Practical solution
Because parsing an email address is so difficult, it makes little sense to even attempt it; particularly as it would be trivial for someone to give you a correctly formatted email address that still didn't work. This means that the best way to detect whether an email address is valid is to simply send it an email. If you can verify that the email was received, then you know for certain that the email address is valid (though it doesn't guarantee this for any length of time, as many services exist giving out temporary email addresses).

The most common way of doing this is to send someone an email containing a link to an http service with a long random string attached to it, only the email and your server contain the random key, so someone would have to read the email to find the correct link.

The purpose of the random string is to reduce the possibility that someone can make the server believe that the email address exists, while in fact it does not. For example, suppose that the link sent in the email is of the form http://myserver.com/validateemail?address=example@yourserver.com. Someone could use an existing, valid email address to see the pattern, and subsequently call the server with any random email address, even without receiving the actual mail containing the link.

Some servers require authentication when opening the link. For example, the user claiming the email address must supply his user id and password when validating it. While this is useful for confidentiality of the data shown on the validation page (including the statement that the address has been validated as an existing address), it does not prevent registering non-existent addresses. Only a long random string used as described above can do that.

Note also that the string must be random only from the client perspective, not necessarily from the server perspective. For example, the server can digitally sign the url, and validate the signature. In this case, the server does not need to store the random key to be able to validate it.

For further reading

 * JavaScript/Best Practices has some email validation tips.

title: Coding Cookbook/Validate Email Address


text: Category:CodeCook/Languages/Regular Expression


text:
User:Pbb

Welcome to Wikibooks! --kwhitefoot 12:25, 22 March 2006 (UTC)

title: User:Pbb


text:
Coding Cookbook/HTML Encode

Convert an object (commonly a string) to HTML-safe code.

VBScript solution
Can convert strings and recordsets (converted to tables).

function HTMLEncode (vInput) dim i if IsNull(vInput) then HTMLEncode = vInput exit function end if select case TypeName(vInput) case "Recordset" HTMLEncode = _ " " & vbNewLine case else HTMLEncode = vInput HTMLEncode = Replace(HTMLEncode, chr(0), "") HTMLEncode = Trim(Server.HTMLEncode(HTMLEncode)) HTMLEncode = Replace (HTMLEncode, "'", "&#39;") HTMLEncode = Replace (HTMLEncode, "<", "&lt;") HTMLEncode = Replace (HTMLEncode, ">", "&gt;") HTMLEncode = Replace (HTMLEncode, " ", "&nbsp; ") HTMLEncode = Replace (HTMLEncode, chr(10), " " ) end select end function

title: Coding Cookbook/HTML Encode


text:
User talk:Pbb

Coding Cookbook
This surely overlaps with the http://en.wikisource.org/wiki/Wikisource:Source_code which is also much more extensive and has more comments attached to the code. Without explanatory comments it surely doesn't qualify as a textbook or even an instruction manual. Is there any point in having both? --kwhitefoot 12:25, 22 March 2006 (UTC)
 * Good question! Well, to begin with, before I started I searched to find a similar project and didn't find anything. I haven't search Wikisource, since (quote from Help:How to start a book) "Original, finished work should go to Wikisource. Wikibooks is a place to develop books", and this seems to me something that will never be finished. I have taken a quick look at Source code and must say I'm a bit overwhelmed by all the missing links and unclear structure... -- Peter 12:46, 22 March 2006 (UTC)

 * I do agree with your opinion of the structure of Source code and also that the Wikisource guidelines are far from clear. In fact there was request to have Source code deleted, see Proposed_deletions.  I suggested it should go to Wikibooks instead but the fuss seems to have died down now.  People are still sporadically contributing to the book so perhaps you might have more impact if you try to improve that book rather than write a new one.  Unfortunately there seem to be two versions: Source code and    --kwhitefoot 22:26, 22 March 2006 (UTC)

title: User talk:Pbb


text:
Muggles' Guide to Harry Potter/Places/Shrieking Shack

General Overview
The Shrieking Shack is famed as the most haunted place in Britain. It is a small house, set well away from Hogsmeade village, is fenced off, and has all its windows and doors boarded up.

Prisoner of Azkaban
The Shrieking Shack gained its reputation some ten or twenty years before our story begins, when loud howls and shrieks emanated from the building at odd times.

In Harry Potter and the Prisoner of Azkaban, we learn that the Shrieking Shack is reached via a tunnel starting beneath the Whomping Willow, an animate willow tree with a nasty temper. The shrieks and howls were actually produced by Remus Lupin, who is a Werewolf. When Lupin was a boy, the Shack was used to contain him during his monthly transformations, allowing him to attend Hogwarts. Once transformed while in the Shrieking Shack, he was unable to escape, and no one could enter without knowing the secret of the Whomping Willow, thus ensuring everyone's safety. Additionally, as the Shack is so remote from the Hogwarts grounds, nobody is likely to connect the sounds from the Shack with an absent Hogwarts student, thus allowing Lupin to keep his lycanthropy a secret.

These revelations are made inside the Shrieking Shack near the end of Harry Potter and the Prisoner of Azkaban. Harry and Hermione follow the tunnel to rescue Ron, who was dragged there by a large black dog. The dog is actually the Animagus form of Sirius Black, who was attempting to catch Scabbers, Ron's pet rat. Scabbers is unmasked as Peter Pettigrew, another Animagus who betrayed Harry's parents to Voldemort, then framed Sirius Black for a crime he never committed. The group is joined by Lupin, who explains his, Black's and Pettigrew's relationship to Harry's father, and about the Whomping Willow and the secret passage under it.

Deathly Hallows
The Shrieking Shack makes another appearance in Harry Potter and the Deathly Hallows, where Voldemort makes it his headquarters for the first assault on Hogwarts. Voldemort has uncovered a window to watch the battle. He is apparently unaware of the secret passage to Hogwarts; Harry, Ron, and Hermione use it spy on him, and also witness Snape's death from its concealment.

Analysis
The Shrieking Shack, and its secret connection to the school, are an interesting way of rendering the werewolf Lupin safe within the student body at Hogwarts. The Wizarding world must, of course, be more aware of the existence of magical transformations like lycanthropy, and similarly must have some sort of way of planning for these occurrences. It seems perhaps a bit primitive to deal with what is evidently a disease by isolation, but that does seem to be a way of minimizing the risk to others, and Dumbledore's willingness to go to this extent to allow Lupin to be educated at Hogwarts is an indicator of the sort of efforts he is willing to make on behalf of his charges. One could see Phineas Nigellus Black, for instance, faced with this same sort of situation, simply denying admission to any potential werewolf student.

Greater Picture
The connection between the Shrieking Shack and Hogwarts, and the reputation of the Shack, very likely had nothing to do with Voldemort's selection of the building for use as a command post in the battle for Hogwarts at the conclusion of the final book. We can assume that, as Tom Riddle was long gone from Hogwarts when Lupin arrived, the Shrieking Shack holds no fears for Voldemort, and may have seemed only a conveniently-located vacant building he could use as an observation post. Additionally, he was probably unaware that the tunnel existed, as even though both Wormtail (Peter Pettigrew) and Severus Snape had used it, they would have seen little point in mentioning it to Voldemort. We note that Snape seems unsurprised to see Harry in the Shack after Voldemort has dealt him a fatal blow, near the end of the final book. Snape's earlier use of the tunnel may have been a factor in his lack of apparent surprise at Harry's sudden appearance, though Snape being very near death at that moment may have had more to do with that – he may simply have not been capable of much surprise at that point.

Also of interest are the author's reasons for selecting the Shrieking Shack as Voldemort's command post. While it is not necessary that any command post be in direct line of sight from the school, as Voldemort presumably could use magical means, including Legilimency, to observe the battle progress from a distance, it should be close enough that he can dispatch messengers like Lucius Malfoy. The author, however, knew that this would be the place where Snape died, and the place where he transferred his memories to Harry; it is safe to assume that she had planned the revelation of Snape's motivations from the start of the series, and the plot had carried things to the point where this had to be done. Thus, Voldemort's command post had to be close enough to the school for Harry to reach it, despite the intervening battle lines, yet far enough away that Voldemort did not feel that he was putting himself in danger; and it had to be somewhere that Harry, looking through Voldemort's eyes, would recognize. Finally, it had to be relatively private. This last requirement rules out almost every building in Hogsmeade, despite the likely partial abandonment of the village during the Death Eater occupation and Hogwarts attack; Hogsmeade residents and Death Eaters would still be wandering around most buildings. About the only place that meets all these requirements is the Shrieking Shack, with its protected tunnel that secretly crosses the battle lines.


text:
Talk:Coding Cookbook

Is this okay?
So, I started writing this set of documents, based on lots of code I've got lying around in various places. After some time, I got a remark that this book has got a lot in common with the Source Code project on Wikisource. I checked that location, and after recovering from the shock of so many missing links and such lack of structure, I see that some of the articles there would fit the criteria for this book.

But I am confused. Isn't Wikisource for finished books? It says so on help:How to start a book. While, with the development speed of computer systems, there will always be new "common tasks" to be performed and new practices to perform them. And why is that book there in the Wikisource namespace?

I wouldn't mind delving into that Wikisource project to restructure it, if there is any viability in that. (Since the project is already proposed for deletion.) Is there enough overlap in the two projects? For example, I wouldn't think the various "Hello World" programs have a place in this project, since they don't perform any usable function apart from letting the reading study the language in question.

Any input is appreciated!

-- Peter 13:29, 22 March 2006 (UTC)

 * I don't know what the Wikisource code project was — it seems to have been deleted long ago, as I write this — but I agree this doesn't seem like a Wikisource thing. --Pi zero (discuss • contribs) 13:35, 18 December 2016 (UTC)

categories
I started to rearrange the categories for this book, but I think what I've done so far is less than ideal, and I also think we might do better with the book main page. The state of things so far: Likely things to do, moving forward: --Pi zero (discuss • contribs) 15:21, 19 December 2016 (UTC)
 * Our modern conventional practice on Wikibooks is that categories associated with a book become subpages of the book category. Doubtless this is far more firmly established now than when this book was started.  It seems the categories were set up in a naming hierarchy with root , though afaics the book was always called.
 * I treated the old Category:CodeCook as if it were being treated as the book category; recategorized its subcategories under the book category (which I still think was okay), and recategorized pages from Category:CodeCook to the book category — but that was perhaps not ideal.
 * The main page claims an alphabetical listing of code snippets, so perhaps we should have a subcategory called /Alphabetical containing all the snippets but not the book-organization pages. That would be the same list that the old Category:CodeCook had.
 * The other two hierarchies ought to be moved, imho, to help with project organization, from under root name  to under the root name of the book category.  As I write this, the book category name is , but there are plans to rename the book categories, so at some point the book category name may become  .  That might, or might not, be a sufficient reason to postpone renaming the other category hierarchies so they can be moved just once, instead of twice.
 * The main page might use DPLs to good effect.

title: Talk:Coding Cookbook


title: User:Karmafist~enwikibooks/Sandbox1


text:
General Astronomy/The Giant Planets

The giant planets are so called for their size. They are also called the gas planets because they consist mainly of hydrogen, or the Jovian planets for Jupiter. These planets each have a large system of moons and rings of varying size made of small particles, moonlets and dust.

There are four such planets in the Solar System: Jupiter, Saturn, Uranus and Neptune. They are all made mainly of fluids, like supercritical fluids, liquid and to a lesser extent gas. These envelope solid cores of rock and ice. All the planets have relatively fast rotation; the slowest rotator, Uranus, has a rotation rate of 17 hours and 14 minutes. This and the radiated heat generated from the crushing pressure within these planets give these planets wild wind speeds, and all of these planets experience storms at certain times.

The Gas Giants
The gas giants are the planets composed of hydrogen and helium. They are much larger than the ice giants and have liquid mantles. They are composed mainly of hydrogen and helium, with small amounts of methane, ammonia, water vapor and other compounds. Their atmospheres are gaseous, but they gradually transition into a liquid mantle. They have solid cores and layers of metallic hydrogen.

Jupiter

Jupiter is the innermost of the gas giants. It has a mass of 1.9 x 1027 kg (approx. 318x the mass of Earth) and is 142,800 kilometers (88,736 miles) in equatorial diameter. Jupiter has much metallic hydrogen. When the pressure is so high that the hydrogen atoms are broken up and the electrons are freed so that the resulting atoms consist of bare protons. This produces a state in which the hydrogen becomes metallic. Fluid motions in this metallic conducting layer produce Jupiter's powerful magnetic field. Under all of this is thought to be a somewhat solid, but diffuse core of rock and ice.

Jupiter has a very dynamic weather system. Fluid motions are organized by the planet's rapid rotation into a series of dark belts and bright zones around the planet. The visible cloud layers are made of frozen ammonia, while deeper cloud layers are thought to contain ammonium hydrosulfide and water. Jupiter's "Great Red Spot" is a rotating storm system that has been observed for hundreds of years.

Jupiter possesses seventy-nine known satellites, four of which - Callisto, Europa, Ganymede and Io - are round were first discovered by Galileo in 1610 and are commonly referred to as the Galilean Moons. It also has very faint and very small rings made of dust knocked from its moons.

Saturn
Saturn's mass is 5.688 x 1026 kg (approx. 95x the mass of Earth) and its equatorial diameter is 119,300 kilometers (74,130 miles). Saturn is the only planet less dense than water (about 30 percent less). It has a big and rich system of (mostly) icy rings of small to tiny pieces of dust and ice.. It has eight round moons: Titan, Rhea, Dione, Mimas, Enceladus, Thethys and Iapetus, the largest being Titan, which is unique among moons for having a significant atmosphere and bodies of liquid on its surface. Saturn has more than a hundred smaller moons. It is composed mainly of hydrogen (96% by volume) and (4% by volume) helium, with small amounts of methane, ammonia, water vapor and other compounds. Saturn is differentiated similarly to Jupiter, though it has much less metallic hydrogen and its core is more rigid than Jupiter's. It has the second highest wind speeds of these planets. It has an axial tilt of 26.73 degrees, and it has the most eccentric orbit of the giant planets. Saturn's bands are fainter than those of Jupiter's due to it being further from the Sun. It has a hexagonal cloud pattern at its North Pole, which may be a jet stream. This "hexagon" contains its northern vortex. Periodically, so-called Great White Spots occur. They are large enough to be seen from Earth and can span a whole latitude.

The Ice Giants
The ice giants are so called because they are mostly made of "ices", substances with a freezing point above ~100 K or ~-175 degrees Celsius. They have thick atmospheres above supercritical mantles; that means their mantles are made of a state of matter compressible like a gas, but dense like a liquid; dense enough for the molecules to interact. This state of matter fills its container, like a gas. Under these are liquid cores, which may produce their magnetic fields.

Uranus
Uranus' mass is 8.686 x 1025 kg (~14.5x the mass of Earth ). Its equatorial diameter is 51,800 kilometers (32,190 miles). It also has a dark faint ring system somewhat comparable to Saturn's. Its rotational axis is tilted 98 degrees, so it appears at times as if it is rolling on its orbit. This produces extreme seasons, which plunge almost one half of Uranus is darkness and another in permanent daylight. This is also why its polar regions are lighter in colour than the rest of the planet. Uranus's has 29 moons, 5 of which are round. Its magnetic field is tilted 60 degrees to its rotational axis, and off center. It is the coldest planet in the Solar System, being 6 degrees Celsius colder than Neptune, which is much further fromt he Sun. Uranus is somewhat inert compared to the other giant planets, likely due to its low thermal flux. It is the only giant planet to receive more radiation from the Sun than it gives off.

Neptune
Neptune is the outermost planet of the gas giants. Its mass is 1,024 x 1026 kg (approx. 17x the mass of Earth). It has an equatorial diameter of 49,500 kilometers (30,760 miles). It has one round moon, Triton (the coolest known object in our Solar system - around -235 °C) as well as various smaller moons including Nereid. Neptune has four known, highly inclined and faint rings. It has the fastest wind speeds of any planet, and they are notable for being faster than the speed of sound on Earth. Its strong gravity influences trans-Neptunian Objects, and many of them are locked in an orbital resonance with it. For example, when Neptune orbits thrice, Pluto orbits twice.

title: General Astronomy/The Giant Planets


text:
Coding Cookbook/JavaScript Encode

Encode special characters in a string, so that it can be displayed using JavaScript

VBScript solution
function JSEncode (sInput) JSEncode = sInput JSEncode = Replace (JSEncode, chr(0), "") JSEncode = Replace (JSEncode, "'", "\'") JSEncode = Replace (JSEncode, """", "\""") JSEncode = Replace (JSEncode, "&", "\x26") end function

title: Coding Cookbook/JavaScript Encode


text:
Coding Cookbook/SQL Encode

Encode various datatypes for safe usage in SQL commands.

VBScript solution
function SQLEncode (vInput) dim CurrentLocale select case VarType(vInput) case 0,1 ' empty, null SQLEncode = "NULL" case 2,3 ' integer, longint SQLEncode = vInput case 4,5 ' single, double CurrentLocale = GetLocale SetLocale ("en-us") SQLEncode = CStr(vInput) SetLocale (CurrentLocale) case 7   ' date SQLEncode = "#" & _ DatePart("yyyy", vInput) & "-" & _ DatePart("m",   vInput) & "-" & _ DatePart("d",   vInput) & " " & _ DatePart("h",   vInput) & ":" & _ DatePart("n",   vInput) & ":" & _ DatePart("s",   vInput) & "#" case 8   ' string SQLEncode = vInput SQLEncode = Replace (SQLEncode, chr(0), "") SQLEncode = Replace (SQLEncode, "'", "''") SQLEncode = "'" & SQLEncode & "'" end select

end function

title: Coding Cookbook/SQL Encode


text:
Coding Cookbook/URL Encode

Encode special characters in a string, so that it can be used in an URL

VBScript solution
function URLEncode (sInput) if IsNull(sInput) then URLEncode = "" exit function end if URLEncode = sInput URLEncode = Replace(URLEncode, chr(0), "") URLEncode = Replace(URLEncode, "%", "%25") URLEncode = Replace(URLEncode, " ", "%20") URLEncode = Replace(URLEncode, """", "%22") URLEncode = Replace(URLEncode, "&", "%26") URLEncode = Replace(URLEncode, "'", "%27") URLEncode = Replace(URLEncode, "/", "%2F") URLEncode = Replace(URLEncode, "?", "%3F") URLEncode = Replace(URLEncode, "\", "%5C") end function

function URLEncode (sInput) Escape(sInput) end function

title: Coding Cookbook/URL Encode


text:
Radiation Oncology/Toxicity/Heart

Consequences of Radiotherapy to the Heart
 * See also: RT toxicity from Breast

Pericardial Effusion

 * MD Anderson; 2008 (2001-2003) PMID 18191334 -- "Risk factors for pericardial effusion in inoperable esophageal cancer patients treated with definitive chemoradiation therapy." (Wei X, Int J Radiat Oncol Biol Phys. 2008 Mar 1;70(3):707-14. Epub 2008 Jan 11.)
 * Retrospective. 101 patients, inoperable esophageal CA, treated with concurrent chemo-RT. RT dose 45-50.4 Gy. Pericardium defined as 0.5 cm radial expansion to cardiac contour
 * Outcome: crude rate 28%, median time-to-onset 5.3 months (1-17 months)
 * Predictors: no clinical factors; dosimetric V30 >46%, mean dose >26 Gy
 * Conclusion: High-dose RT to pericardium may increase risk of pericardial effusion

Breast cancer

 * HERA HER2+ Trial; 2022 PMID 34986381 -- "Evaluation of Cardiotoxicity in HER-2-Positive Breast Cancer Patients Treated With Radiation Therapy and Trastuzumab" (Bachir B, Int J Radiat Oncol Biol Phys. 2022 May 1;113(1):135-142. doi: 10.1016/j.ijrobp.2021.12.159. Epub 2022 Jan 2.)
 * Post hoc analysis. 3321 patients. HERA trial, mastectomy, adjuvant chemotherapy, adjuvant maintenance trastuzumab. PMRT as per clinical decision. Group 1) Trastuzumab + Left PMRT vs Group 2) Trastuzumab + Right PMRT vs Group 3) Trastuzumab and no PMRT. Median F/U 11 years
 * Outcome: LVEF decline by echo 9.2% vs 9.0% vs 8.8% (NS). Cardiovascular events 1.1% vs 0.9% vs 0.6% (NS). On multivariate analysis, no difference between left and right PMRT
 * Conclusion: PMRT does not significantly increase risk of cardiotoxicity in HER2+ patients treated with Herceptin

 * Oxford; 2013 (1958-2001) PMID 23484825 -- "Risk of ischemic heart disease in women after radiotherapy for breast cancer." (Darby SC, N Engl J Med. 2013 Mar 14;368(11):987-98.)
 * Case-control study. Pts treated in Sweden or Denmark.
 * Study population consisted of all women (ages < 75) with breast cancer who received RT (both right and left); excluded pts with metastatic dz at diagnosis or prior thoracic RT.
 * Cases (n=963) consisted of pts who had a major coronary event (MCE) -- MI, coronary revascularization, or death from ischemic heart disease -- that occurred after the diagnosis of breast cancer but before any recurrence or diagnosis of a 2nd malignancy.
 * Controls (n=1205) were selected at random from all pts in the study population; matched to country of residence, age at breast cancer diagnosis, and year of diagnosis. Had all received RT and had no recurrence of breast cancer and no 2nd cancer and no major coronary event before the index date.
 * Radiation dosimetry was estimated. Reconstructed the radiation plan (using a diagram or photograph of the original RT fields and the original dose plan when available) on a CT scan of a patient with typical anatomy. Constructed DVH for the whole heart and LAD artery. Computed equivalent doses (EQD2) in 2-Gy fractions, using an alpha/beta ratio of 2 Gy. Note: 3D planning dosimetry was not available for the treated patients.
 * Major coronary events: 44% at < 10 yrs from ca diagnosis, 33% at 10-19 yrs, and 23% at 20 or more years. 54% of case pts died from ischemic heart disease.
 * RT:
 * Lt-sided RT associated with higher rates of MCE (rate ratio = 1.32). No other association between MCE and other tumor characteristics or treatment factors, such as use of chemotherapy; trend for positive nodes (p=0.06, rate ratio 1.20).
 * Average mean heart dose: 6.6 Gy (left breast), 2.9 Gy (right breast), 4.9 Gy (overall). The rate of MCE increased by 7.4% for each increase of 1 Gy. The mean heart dose was a better predictor than the dose to the LAD.
 * For dose ranges (mean heart dose): < 2 Gy, 10% increase; 2-4 Gy, 30%; 5-9 Gy, 40%; 10 or more Gy, 116%.
 * Patient-related factors: positive history of ischemic heart disease (rate ratio 6.67); also: circulatory disease, diabetes, COPD, current smoker, obesity, analgesic medication use.
 * The percentage increase in risk of MCE is similar for women with and without ischemic heart disease. Absolute radiation-related risks are greater in those with preexisting cardiac risk factors.
 * Example: 50 yr old women with no cardiac risk factors. Mean heart dose: 3 Gy. Increase risk of death from ischemic heart disease from 1.9% to 2.4% (absolute increase of 0.5%). Increase risk of having at least one acute coronary event from 4.5% to 5.4% (increase of 0.9%).
 * Conclusion: "Exposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent rate of ischemic heart disease. The increase is proportional to the mean dose to the heart, begins within a few years after exposure, and continues for at least 20 years. Women with preexisting cardiac risk factors have greater absolute increases in risk from radiotherapy than other women."

 * Uppsala University; 2012 (1970-2003) PMID 22203772 -- "Distribution of coronary artery stenosis after radiation for breast cancer." (Nilsson G, J Clin Oncol. 2012 Feb 1;30(4):380-6. Epub 2011 Dec 27.)
 * Retrospective cohort. Linked breast cancer and coronary angiography registries. 199 patients. Two hotspots defined as proximal RCA and mid/distal LAD
 * Outcome: Odds ratio for left-sided radiation for grade 3-5 stenosis LAD 4.4 (SS), grade 4-5 stenosis 7.2 (SS)
 * Conclusion: Increase in stenosis in mid/distal LAD in irradiated left-sided breast cancer; risk increases for severe stenosis
 * U Penn; 2007 (1977-1995) PMID 17634481 -- "Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer." (Correa CR, J Clin Oncol. 2007 Jul 20;25(21):3031-7.)
 * Retrospective. 961 patients with Stage I-II BCA, conventional tangents. Screened with stress tests and cardiac cath
 * 10-year risk of CAD: right and left 7% (NS)
 * 12-year risk of cath abnormalities: right 8% vs. left 59% (SS); 70% in LAD territory
 * Conclusion: Left-sided RT as component of BCS causes increased risk of later coronary damage

 * Duke; 2005 (1998-2001) PMID 16111592 — "The incidence and functional consequences of RT-associated cardiac perfusion defects." Marks LB et al. Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):214-23.
 * 114 pts. Breast cancer. Pts imaged with technetium 99m sestamibi or tetrofosmin pre- and post-RT.
 * 42% incidence of perfusion defects at 24 months.

 * Danish trials 82b/82c
 * 1999: PMID 10543669 — "Morbidity and mortality of ischaemic heart disease in high-risk breast-cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials." Hojris I et al. Lancet. 1999 Oct 23;354(9188):1425-30.
 * No increased risk of ischemic heart disease at 12 yrs.

Hodgkin Disease

 * Zurich, 2007 PMID 17512861 -- "Radiotherapy and the heart." (Bramkamp M, Lancet. 2007 May 19;369(9574):1762.)
 * Case report. 47M with CAD, s/p mantle field to 40 Gy for HD in his teens

Non-Hodgkin's Lymphoma

 * SEER/Colorado; 2010 (1988-2004) PMID 19515509 -- "Cardiac mortality in patients with stage I and II diffuse large B-cell lymphoma treated with and without radiation: a surveillance, epidemiology, and end-results analysis." (Pugh TJ, Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3):845-9. Epub 2009 Jun 8.)
 * SEER analysis. 15,454 patients, Stage I-II DLBCL, treated with anthracycline-based chemo, anti-CD20 antibody. RT given in 39%. Primary outcome cardiac-specific mortality (CSM). Median F/U 3 years
 * Cardiac-specific mortality: 5-year RT+ 4.3% vs RT- 5.9%; 10-years 9.0% vs 10.8%; 15-years 13.8% vs 16.1% (HR 1.3, SS)
 * Conclusion: Increased anthracycline exposure in patients treated only with chemo may result in increase in cardiac deaths

Childhood disease

 * INSERM; 2010 (1942-1986) PMID 20142603 -- "Role of cancer treatment in long-term overall and cardiovascular mortality after childhood cancer." (Tukenova M, J Clin Oncol. 2010 Mar 10;28(8):1308-15. Epub 2010 Feb 8.)
 * Retrospective. 4,122 5-year survivors of childhood cancer in France and UK. Chemotherapy and RT info collected; RT heart dose estimate. Average F/U 27 years
 * Outcome: Overall standardized mortality ratio 8.3 compared to general population. Cardiac death SMR 5.0, if anthracycline >360 mg/m2 RR 4.4 (SS), if RT dose 5-15 Gy RR 12.5, if RT dose >15 Gy RR 25. Linear relationship between heart dose and risk of cardiac mortality, estimated RR 60% at 1 Gy
 * Conclusion: Relationship between RT dose to heart and long-term cardiac mortality

title: Radiation Oncology/Toxicity/Heart


text:
Radiation Oncology/Breast/RT technique

Anatomy: Regional LNs
Surgical lymphatic drainage
 * PMID 14745331 (Full text) (2004), Netherlands — "Lymphatic drainage patterns from the breast." Estourgie SH et al. Ann Surg. 2004 Feb;239(2):232-7.
 * Lymphatic mapping using sentinal lymph node technique. Provides maps of lymphatic drainage from each of 5 quadrants of the breast.

CT-based anatomy
 * Netherlands; 2004 PMID 15172144 -- "Loco-regional conformal radiotherapy of the breast: delineation of the regional lymph node clinical target volumes in treatment position." (Dijkema IM, Radiother Oncol. 2004 Jun;71(3):287-95.)

 * Michigan; 2001 PMID 11687672 -- "Definition of the supraclavicular and infraclavicular nodes: implications for three-dimensional CT-based conformal radiation therapy." (Madu CN, Radiology. 2001 Nov;221(2):333-9.)

 * Boundaries and anatomy of axilla - from Gray's anatomy

 * Axillary clearance - surgical approach from Royal College of Surgeons of Edinburgh

 * Lateral Pharyngeal Region - cadaveric sections, useful for identifying scalene muscles

Multifield breast technique
The patient lies on a breast board that is inclined to ensure that the sternum is horizontal. The arm on the ipsilateral side is abducted to 90 degrees and is supported by arm supports on the breast board.

Tangential fields to the breast/chest wall The chest wall or breast is treated isocentrically and is covered by a pair of wedged tangential fields. The posterior beam edges are parallel to reduce divergence into the lung. The superior beam edges are also parallel to allow matching of the fields to any supraclavicular or axillary fields. The whole breast is included to ensure any residual or microscopic disease is irradicated.

Borders Superior: suprasternal notch Inferior: 1 - 2 cm inferior of the inframammary fold, enough to ensure full breast coverage Medial: anatomical midline Lateral: midaxillary line (may be moved posteriorly to ensure complete coverage of breast tissue) Anterior: about 1cm anterior of breast, to ensure coverage during normal breathing Posterior: to cover chest wall, with a maximum lung depth of 2cm

Prescriptions 50Gy to isocentre in 25# daily over 5 weeks, 6 or 10 MV photons 40Gy to isocentre in 15# daily over 3 weeks, 6 or 10 MV photons Both prescriptions are widely used in the UK.

Supraclavicular field If the supraclavicular and/or axillary nodes are involved then a supraclavicular field will be used. This field is matched to the tangential fields of the breast to prevent any overdose to the junction of the fields. Shielding (from either lead or MLCs) is used to shield the shoulder joint (preventing fibrosis of the joint) and the apex of the lung.

Borders Medial: 1cm ipsilateral to anatomical midline (to avoid the oesophagus) Lateral: insertion of pectoralis major; lateral border of the coracoid process to cover insertion of pectoralis minor Inferior: to match breast tangentials Superior: to cover

Prescription The dose is prescribed to the depth of the supraclavicular nodes. The prescriptions are generally the same as for the breast.

IM or Medial Field

PAB If coverage of deep nodes lymph node levels is desired or dose coverage for supraclavicular field provides inadequate coverage due to axillary node separation, then a posterior axillary boost may be prescribed to provide optimal dose distribution.

Borders Medial: 1.5-2.0 cm of lung Lateral: Lateral posterior axillary fold Inferior: to match breast tangentials Superior: splits clavicle Prescription Anterior SCV field and the posterior PAB field overlap varies from patient to patient. Dose is prescribed such that the combined dose distribution is optimal and provides coverage of nodal volumes. Additional edits may be made to borders of PAB to block high dose regions due to overlap with SCV field.

RT Prescription

 * North Puget, 2000 PMID 10837972 -- "The impact of dose-specification policies upon nominal radiation dose received by breast tissue in the conservation treatment of breast cancer." (Kantorowitz DA, Int J Radiat Oncol Biol Phys. 2000 Jun 1;47(3):841-8.)
 * Absorbed dose normalized as a function of different prescription methods. Idealized breast slice, RT dose 46 Gy + 20 Gy boost = 66 Gy
 * Results: for 66 Gy prescription, absorbed dose varied from 66 Gy (100% isodose line for both breast and boost) to 76.11 Gy (breast 90% isodose line and boost 80% isodose line); difference of 13%
 * Recommendation: use ICRU 50, with Breast PTV1 = whole breast + 1-2 cm margin, specified at tangent beam intersection on the central plane, or 2/3 distance from dorsal beam edge to skin along perpendicular breast bisector. Boost PTV2 = lumpectomy cavity + 1-3 cm margin, specified at 90% with electron energy sufficient to provide 85% isodose coverage

Target Delineation

 * RTOG Breast Cancer Atlas

 * RTOG; 2009 PMID 19215827 -- "Variability of target and normal structure delineation for breast cancer radiotherapy: an RTOG Multi-Institutional and Multiobserver Study." (Li XA, Int J Radiat Oncol Biol Phys. 2009 Mar 1;73(3):944-51.)
 * Prospective. 9 breast radiation oncologists, target and organ at risk delineation, 3 representative BCA patients
 * Outcome: Substantial variability, structure overlaps as low as 10%, standard deviations of up to 60%. Differences both due to target/organ boundaries, incorporation of setup uncertainty, and dosimetric limitations
 * Conclusion: Differences clinically and dosimetrically significant; consensus highly desirable

 * Netherlands Cancer Institute, The Netherlands; 2001 PMID 11483349 -- "Variability in target volume delineation on CT scans of the breast." (Hurkmans CW, Int J Radiat Oncol Biol Phys. 2001 Aug 1;50(5):1366-72.)
 * Retrospective. 7 patient scans, 4 radiation oncologists, 3 sets of contours per patient
 * Outcome: Average deviations posterior (4.2 cm), anterior (0.6 cm), cranial (2.8 cm), caudal (1.5 cm), medial (2.4 cm), lateral (0.8 cm). Intraobserver variation in volume 5.5%, interobserver variability 17.5%, overall agreement 0.43
 * Conclusion: Large intra- and inter-observer variation in delineation of breast target on CT scan

Accelerated Partial Breast Irradiation

 * Please see the APBI page for clinical outcomes

Seroma cavity delineation

 * British Columbia; 2009 PMID 18692322 -- "3D ultrasound can contribute to planning CT to define the target for partial breast radiotherapy." (Berrang TS, Int J Radiat Oncol Biol Phys. 2009 Feb 1;73(2):375-83. Epub 2008 Aug 7.)
 * Prospective. 20 women, early BCA, candidate for APBI. 3D ultrasound at CT-sim. 3 RT oncologists contoured volumes on CT and U/S image sets. Coregistration within 2mm in 95%
 * Outcome: Improved interobserver consistency in U/S over CT in 40% cases, mainly in low CT seroma clarity or heterogenous/dense breast parenchyma
 * Conclusion: 3D ultrasound can be useful adjuct to CT planning

IMRT
Randomized
 * Canada (2003-2005) -- 2D vs. IMRT
 * Randomized. 331 patients, early-stage BCA (no >=4 LN+) treated with breast-only RT. Arm 1) 2D tangent + wedge vs. Arm 2) IMRT. RT dose 50/25 + optional 16 Gy electron boost.
 * 2008 PMID 18285602 -- "A Multicenter Randomized Trial of Breast Intensity-Modulated Radiation Therapy to Reduce Acute Radiation Dermatitis." (Pignol JP, J Clin Oncol. 2008 Feb 19 [Epub ahead of print])
 * IMRT associated with decreased moist desquamation ), in inframammary fold (26% vs 43%). The breast volume (V95) is associated with acute skin toxicity.
 * Outcome: Dose distribution: IMRT better. Moist desquamation anywhere in breast: IMRT 31% vs 2D 48% (SS), 26% vs. 43% (SS), no difference in pain 23% vs. 25% (NS) or QoL
 * Conclusion: Breast IMRT reduced occurrence of moist desquamation

 * Royal Marsden -- 2D vs. IMRT
 * Randomized. 240/306 patients. Early stage. Treated with Arm 1) IMRT vs. Arm 2) 2D using standard wedges. Dose 50/25 + boost 11.1/5.
 * 2007 PMID 17224195 -- "Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy." (Donovan E, Radiother Oncol. 2007 Mar;82(3):254-64.) Minimum F/U 5 years
 * Change in breast: IMRT 40% vs. 2D 58% (SS); significantly fewer developed palpable induration. No difference in pain, hardness, or QoL
 * Conclusion: Minimisation of inhomogeneity reduces late adverse effects

Retrospective
 * Pittsburgh; 2009 PMID 19624420 -- "Initial outcomes analysis for large multicenter integrated cancer network implementation of intensity modulated radiation therapy for breast cancer." (Bhatnagar AK, Breast J. 2009 Sep-Oct;15(5):468-74. Epub 2009 Jul 13.)
 * Retrospective. 495 patients, IMRT after BCS, large integrated cancer center network (7 community centers and 2 academic centers). Centralized IMRT planning. IMRT 50/25 + 10 Gy boost
 * Outcome: Erythema Grade 1 55%, 2 28%, 3 1%; skin desquammation 20%, 4%, 1%. No difference between community and academic centers
 * Conclusion: IMRT can be safely and effectively administered in a large health system

 * Toronto, 2006 PMID 16457966 -- "Body radiation exposure in breast cancer radiotherapy: impact of breast IMRT and virtual wedge compensation techniques." (Woo TC, Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):52-8.)
 * Evaluation of radiation body exposure, given higher risk of leukemia for BCA patients receiving adjuvant anthracycline. 120 women, measurements taken during RT
 * Standard 50 Gy: abdomen 0.45 Gy (0.06-1.55 Gy). Physical wedges result in 3x more exposure compared to IMRT

 * Fox Chase, 2006 PMID 16462506 -- "Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer." (Freedman GM, Am J Clin Oncol. 2006 Feb;29(1):66-70.)
 * Matched case control. 73 women with IMRT vs. 60 women with conventional planning.
 * Acute toxicity: no difference using CTC grading. Degree of desquamation greater for conventional patients. Large breasts worse
 * Conclusion: IMRT decreases severity of acute desquamation; CTC grading not sensitive

Active Breath Hold

 * William Beaumont, 2003 PMID 12788176 -- "Initial clinical experience with moderate deep-inspiration breath hold using an active breathing control device in the treatment of patients with left-sided breast cancer using external beam radiation therapy." (Remouchamps VM, Int J Radiat Oncol Biol Phys. 2003 Jul 1;56(3): 704-15.)
 * Moderate deep-inspiration breath hold (75% of max inspiration) with active breathing control device. Goal to reduce heart dose in L BCA. 5 patients where >2% of heart received >30 Gy on free breath
 * RT: during breath hold; durations ranging 18-26 seconds; 2-3 per beam. Step-and-shoot IMRT. 45 Gy or 50.4 Gy. Interfraction setup max 3.2mm, intrafraction max 2mm
 * Outcome: V30 reduction of 3.6% and NTCP reduction of 1.5%; however increased lung V20
 * Comment: not clear if this will translate into a meaningful clinical difference with modern RT techniques, and especially with more patients potentially receiving APBI

Axilla

 * MD Anderson
 * Match Line; 2009 PMID 18676090 -- "Effects of variable placement of superior tangential/supraclavicular match line on dosimetric coverage of level III axilla/axillary apex in patients treated with breast and supraclavicular radiotherapy." (Garg AK, Int J Radiat Oncol Biol Phys. 2009 Feb 1;73(2):370-4.)
 * Treatment planning. 20 patients, w/p surgery and Level I-II axillary dissection. Match line placed caudal, bisecting, and cranial to ipsilateral clavicular head. Nodal volume coverage evaluated.
 * Outcome: Mean volume of Level III LN covered by 90% isodose line caudal 100% vs. bisecting 92% vs. cranial 68% (SS)
 * Conclusion: Placement of match line should be caudal to clavicular head
 * SLN; 2001 PMID 11597808 — "Relationship of sentinel and axillary level I-II lymph nodes to tangential fields used in breast irradiation." Schlembach PJ et al. Int J Radiat Oncol Biol Phys. 2001 Nov 1;51(3):671-8.
 * Retrospective. Analyzed simulation films of pts treated with sentinel lymph node biopsy (in 65 pts) and pts with clips marking the extent of axillary dissection (39 pts).
 * With the cranial field edge 2 cm below humeral head, the sentinel LN was included in the field in 95% of cases and the entire extent of axillary dissection (level I-II) was included in 43% of cases and covered 80% of the axillary dissection field in the rest of patients.
 * Conclusion: By extending the tangent field edge to 2 cm below the humeral head and 2 cm deep to the chest wall - lung interface, the RT fields will include the SLN and most of level I and II axilla.

 * Colorado; 2008 PMID 17967511 -- "Evaluation of breast sentinel lymph node coverage by standard radiation therapy fields." (Rabinovitch R, Int J Radiat Oncol Biol Phys. 2008 Apr 1;70(5):1468-71. Epub 2007 Oct 29.)
 * Retrospective. 106 data sets. Patients who underwent SLN biopsy and had surgical clips placed.
 * Outcome: SLN clips varied in vertebral level position between T2-T7 (most common T4). Within standard tangents 90% (below head of clavicle), within standard SCV field in 10% (above head of clavicle)
 * Conclusion: Standard axillary fields do not encompass lymph nodes at highest risk of containing tumor, but 90% are included in standard tangents

 * University of Washington; 2005 PMID 15667953 — "Axillary lymph node dose with tangential breast irradiation." (Reed DR et al. Int J Radiat Oncol Biol Phys. 2005 Feb 1;61(2):358-64.)
 * Retrospective. 50 consecutive patients with standard tangents. Dose distribution to axillary Level I and II evaluated
 * Outcome: 95% isodose line encompassed 55% (23-87%) of anatomic Level I-II volume; it encompassed 81% (58-98%) of surgical clips
 * Conclusion: Standard tangents failed to deliver a therapeutic dose to axillary Level I-II anatomic volume

 * Stanford; 1999 - PMID 9885612 — "Utility of three-dimensional planning for axillary node coverage with breast-conserving radiation therapy: early experience." Smitt MC et al. Radiology. 1999 Jan;210(1):221-6.

SCV field

 * Mayo; 2015 PMID 25936809 -- "Delineation of Supraclavicular Target Volumes in Breast Cancer Radiation Therapy." (Brown LC, Int J Radiat Oncol Biol Phys. 2015 Jul 1;92(3):642-9.)
 * Map the location of gross supraclavicular metastases in patients with breast cancer
 * Conclusion: "coverage of the posterior triangle and the lateral low supraclavicular region should be considered. For women with known supraclavicular disease, extension of neck coverage superior to the cricoid cartilage may be warranted."

 * MD Anderson
 * SCV failure location; 2008 PMID 18164831 -- "Risk of subclinical micrometastatic disease in the supraclavicular nodal bed according to the anatomic distribution in patients with advanced breast cancer." (Reed VK, Int J Radiat Oncol Biol Phys. 2008 Jun 1;71(2):435-40. Epub 2007 Dec 31.)
 * Retrospective. 33 patients with advanced/metastatic BCA, PET+ in SCV LN. 52 LN identified. Locations mapped onto 4 separate planning CT done previously for SCV field (2 SCV+ and 2 SCV- by biopsy).
 * Outcome: 10% in H&N Level III, 63% in H&N Level IV, 21% in H&N Level V (in 5 patients posterior to vertebral transverse process), 6% Axilla Level III. Close proximity to medial border in several patients
 * Conclusion: Distribution of LNs identified. Increased coverage medially and posteriorly may be warranted with locally advanced disease
 * SCV depth; 2007 PMID 17889264 -- "Treatment Optimization Using Computed Tomography-Delineated Targets Should be Used for Supraclavicular Irradiation for Breast Cancer." (Liengsawangwong R, Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):711-5.)
 * Retrospective. 32 patients, plan adequacy evaluated for depth of SC and Level III LNs. Plans evaluated were 6 MV @ 1.5cm, 6 MV @ 3.0 cm, 18 MV @ 3.3 cm, and mixed beam to optimize target volume to 90%
 * Outcome: mean depth SC 3.2 cm (1.4-6.7 cm), mean depth LIII 3.1 cm (1.7-5.8 cm); significant variance with BMI. CT plans better than standard 3cm prescription
 * Conclusion: CT-based treatment planning should be used for SC fields vs. traditional 3cm prescription depth

PAB field

 * Duke, 2000 - PMID 10837961 — "Variability of the depth of supraclavicular and axillary lymph nodes in patients with breast cancer: is a posterior axillary boost field necessary?" Bentel GC et al. Int J Radiat Oncol Biol Phys. 2000 Jun 1;47(3):755-8.
 * PAB field was used historically based on the assumption that the axillary LNs lie deeper than the SCLV nodes (based on pre-CT era). This study shows that the dose to the axillary LN is within 90% of the SCLV dose. Suggests that the role of the PAB field needs to be refined.

IMN irradiation

 * MD Anderson; 2009 PMID 19564530 -- "Internal mammary node radiation: a proposed technique to spare cardiac toxicity." (Oh JL, J Clin Oncol. 2009 Nov 1;27(31):e172-3; author reply e174. Epub 2009 Jun 29.)
 * Technique description: matched 2 electron fields to IM nodes, with shallow tangents

 * Danish BCCG; 2008 PMID 18465333 -- "Post-mastectomy radiotherapy in Denmark: from 2D to 3D treatment planning guidelines of The Danish Breast Cancer Cooperative Group." (Thomsen MS, Acta Oncol. 2008;47(4):654-61.)
 * Dosimetric comparison of photon/electron (3F) technique vs partial wide tangent (PWT) technique
 * Conclusion: PWT technique superior, appropriate choice for future RT. Guideline developed

 * Michigan; 2002 PMID 11955732 -- "Postmastectomy radiotherapy of the chest wall: dosimetric comparison of common techniques." (Pierce LJ, Int J Radiat Oncol Biol Phys. 2002 Apr 1;52(5):1220-30.)
 * Dosimetric comparison. Seven techniques (standard tangents; electron CW and IMN; cobalt; reverse hockey stick; 30/70 photon electron mix angled; 20/80 photon/electron mix AP, partial wide tangent fields). Dose 50/25
 * Outcome: Standard tangents significantly less IMN dose than all others, then reverse hockey stick and cobalt, then all others, which were statistically similar. Partial wide tangents smallest heart V30
 * Conclusion: No one technique best CW and IMN coverage, with minimal heart and lung complication probabilities. Partial wide tangents most appropriate balance

 * Medical College of Virginia; 2000 PMID 10924983 -- "Internal mammary node coverage: an investigation of presently accepted techniques." (Arthur DW, Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):139-46.)
 * Dosimetric comparison. Four techniques (standard tangents/SCV, wide tangents, partial wide tangents, medial electron/shallow tangents). Dose 50/25
 * Conclusion: Significant anatomic variation, need to use CT planning. Partial wide tangent best choice

 * Duke; 1994 PMID 8040041 -- "To treat or not to treat the internal mammary nodes: a possible compromise." (Marks LB, Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):903-9.)
 * Dosimetric technique. 15 patients. Partial wide tangential fields irradiating 1st/2nd/3rd IM intercostal spaces

 * NIH; 1983 PMID 6404865 -- "Dose to lung in primary breast irradiation." (Roberson PL, Int J Radiat Oncol Biol Phys. 1983 Jan;9(1):97-102.)
 * Dosimetric technique. Five techniques (standard tangents, wide tangents, medial IMN AP/shallow tangent, medial IMN 20 degree/shallow tangent, medial IMN angled to match shallow tangent)
 * Conclusion: No technique best for all patients, depends on patient anatomy

Postmastectomy IMRT

 * Memorial Sloan Kettering
 * Expander/implant; 2010 (2004-2007) PMID 20096946 -- "Postmastectomy intensity modulated radiation therapy following immediate expander-implant reconstruction." (Koutcher L, Radiother Oncol. 2010 Jan 21. [Epub ahead of print])
 * Retrospective. 41 patients, s/p mastectomy with immediate expander/implant reconstruction. Left-sided 56%, PMRT with IMRT to 50-50.4 Gy. SCV in 100%, PAB in 29%, IMN in 17% (deep tangents)
 * Outcome: Chest wall coverage adequate 73%, 1 border inadequate 22%. Mean lung V20 13% (3-32%), mean heart Dmean 2.8 Gy (0.5-9.6). Specific numbers provided for left vs right and IMN+ vs IMN-
 * Conclusion: In women with expanders/implants, PMRT can have acceptable heart and lung doses, even when IMN are being treated
 * Isocentric 3F technique; 2005 PMID 15990027 -- "Intensity-modulated radiotherapy technique for three-field breast treatment." (Chui CS, Int J Radiat Oncol Biol Phys. 2005 Jul 15;62(4):1217-23.)
 * Treatment planning. 15 patients. Isocentric 3 field technique described

Proton Therapy

 * Please see the partial breast irradiation page for APBI proton studies

Clinical

 * Harvard; 2013 PMID 23523326 -- "Proton therapy for breast cancer after mastectomy: early outcomes of a prospective clinical trial." (Macdonald SM, Int J Radiat Oncol Biol Phys. 2013 Jul 1;86(3):484-90. doi: 10.1016/j.ijrobp.2013.01.038. Epub 2013 Mar 21.)
 * Prospective. 12 patients (5 permanent implants and 7 no reconstruction), postmastectomy proton radiation therapy, 50.4 Gy to chest wall and regional lymphatics (SCL, axilla, IMN). Passive scatter. Feathering over 1 cm in 2 steps. No photon/electrons used
 * Toxicity: maximum skin grade 2 radiation dermatitis; maximum fatigue grade 3. No pneumonitis
 * Conclusion: Proton RT for postmastectomy RT is feasible and well tolerated.

Dosimetry

 * Harvard
 * Postmastectomy IMPT; 2013 PMID 23647751 -- "Intensity modulated proton therapy for postmastectomy radiation of bilateral implant reconstructed breasts: A treatment planning study." (Jimenez RB, Radiother Oncol. 2013 May;107(2):213-7. doi: 10.1016/j.radonc.2013.03.028. Epub 2013 May 3.)
 * Planning study. 5 patients with bilateral breast implants. IMPT, conformal photon/electron, and partial wide tangents. Dose 50.4 Gy, target 95% coverage of chest wall IMN, SCV, axilla
 * Outcome: IMPT comparable target coverage, better homogeneity, improved heart and lung mean doses
 * Conclusion: IMPT provides improved dosimetry
 * Postmastectomy; 2013 PMID 23521809 -- "Proton radiotherapy for chest wall and regional lymphatic radiation; dose comparisons and treatment delivery." (Macdonald SM, Radiat Oncol. 2013 Mar 24;8:71. doi: 10.1186/1748-717X-8-71.)
 * Planning study. 11 patients planned with protons, partial wide tangents, photon/electrons
 * Outcome: Reasonable coverage with all, but proton superior covereage with more homogenous plan and substantial cardiac / pulmonary sparing. Akimbo positioning was necessary in 1 patient
 * Conclusion: Proton RT feasible

 * Paul Scherrer Institute
 * 2010 PMID 19615828 -- "Postoperative proton radiotherapy for localized and locoregional breast cancer: potential for clinically relevant improvements?" (Ares C, Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3):685-97. Epub 2009 Jul 15.)
 * Treatment planning. 20 left-sided BCA. Three volumes: 1) whole breast or chest wall (PTV1) vs 2) WB/CW + level III axilla + SCV (PTV2) vs 3) WB/CW + SCV + IM. Comparison between 3DCRT vs IMRT vs IMPT
 * Outcome: Good coverage of PTV, except 3DCRT in PTV3 scenario, where all plans exceeded left lung V20. IMPTV reduced OAR vs 3DCRT and IMRT
 * Conclusion: Potential role of protons for extended locoregional RT of left breast cancer
 * 2006 PMID 16857055 -- "Radiation therapy planning with photons and protons for early and advanced breast cancer: an overview." (Weber DC, Radiat Oncol. 2006 Jul 20;1:22.)
 * Overview of evidence
 * Comment PMID 17476135
 * 2003 PMID 12573766 -- "Potential role of intensity-modulated photons and protons in the treatment of the breast and regional nodes." (Lomax AJ, Int J Radiat Oncol Biol Phys. 2003 Mar 1;55(3):785-92.)
 * Treatment plan comparison: standard photon/electron, IMRT, and forward planned protons. Target involved breast, axilla, SCV, and IM nodes.
 * Conclusion: IMRT can greatly improve target homogeneity, but proton plan had potential to also minimize dose delivered to organs at risk
 * 2002 PMID 11937240 -- "Critical appraisal of treatment techniques based on conventional photon beams, intensity modulated photon beams and proton beams for therapy of intact breast." (Fogliata A, Radiother Oncol. 2002 Feb;62(2):137-45.)
 * Treatment planning. 5 patients, highly concave breast tissue. 2 field conventional vs 2 field IMRT vs 3 field conventional vs 3 field IMRT and single field protons
 * Outcome: PTV comparable for photon techniques, improved with single field protons. Lung volume and cardiac volume better with protons
 * Conclusion: Geometrically difficult breast cancer patients benefited from proton therapy

 * Uppsala; 2002 PMID 12443804 -- "Node-positive left-sided breast cancer patients after breast-conserving surgery: potential outcomes of radiotherapy modalities and techniques." (Johansson J, Radiother Oncol. 2002 Nov;65(2):89-98.)
 * Treatment planning. 11 patients with left-sided node-positive breast cancer. Conventional plan vs. IMRT vs. protons
 * Conclusion: Proton plans significantly better for lung and heart dose

 * Indiana University; 1997 PMID 9240659 -- "Phantom assessment of lung dose from proton arc therapy." (Sandison GA, Int J Radiat Oncol Biol Phys. 1997 Jul 1;38(4):891-7.)
 * Chest wall irradiation of Rando phantom. 200 MeV beam, modulated to 4cm, 20x4 field size, rotated at 1 rpm. Comparison to 12 MeV electron arc therapy
 * Outcome: Reduced lung dose at all levels, 50% integral lung dose
 * Conclusion: Potential role for proton arc therapy in chest wall RT

Effect of surgery to radiotherapy interval (SRI)

 * See also: Chemotherapy section for effect of chemotherapy and radiotherapy sequencing

 * IBCSG Trials
 * Adjuvant chemotherapy; 2016 (1986-1993) PMID 27598802 -- "Timing of Radiation Therapy and Chemotherapy After Breast-Conserving Surgery for Node-Positive Breast Cancer: Long-Term Results From International Breast Cancer Study Group Trials VI and VII." (Karlsson P, Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2):273-279. doi: 10.1016/j.ijrobp.2016.06.2448.)
 * Retrospective, from 2 randomized trials (Trial VI: premenopausal randomized to 3 months vs 6 months CT followed by RT; Trial VII: postmenopausal no CT vs 3 months CT, followed by RT). Comparison of 718 patients. Median follow up > 15 years
 * Outcomes: Premenopausal LF HR 0.9 (NS) and 1.5 (NS). Also no difference in RF, DF, DFS
 * Conclusion: It is reasonable to delay RT after completion of standard chemotherapy
 * Adjuvant endocrine therapy; 2011 PMID 20729007 -- "Timing of radiotherapy and outcome in patients receiving adjuvant endocrine therapy." (Karlsson P, Int J Radiat Oncol Biol Phys. 2011 Jun 1;80(2):398-402. doi: 10.1016/j.ijrobp.2010.02.042. Epub 2010 Aug 21.)
 * Retrospective analysis from IBCSG trials. 964 patients treated with BCS, RT, and adjuvant endocrine therapy. Median RT start 77 days, correlated with age/menopause status, ER status
 * Outcomes: Adjusted HR for 77 days 0.94 (NS) for local recurrence, DFS, and OS
 * Conclusion: RT delay of <= 20 days no significantly associated with LR, DFS, or OS

 * Harvard; 2010 (1991-2002) PMID 20197326 -- "Impact of interval from breast conserving surgery to radiotherapy on local recurrence in older women with breast cancer: retrospective cohort analysis." (Punglia RS, BMJ. 2010 Mar 2;340:c845. doi: 10.1136/bmj.c845.)
 * Retrospective. SEER-Medicare linked database. 18,050 women, age >65, Stage 0-II BCA, treated with BCS + RT, no chemo.
 * Outcome: Median time surgery->RT 34 days. LR in 4%. Interval >6 weeks associated with 0.96% increase in LR at 5 years (SS). On continuous modeling, HR 1.005 per day (SS). Starting >6 weeks associated with LN+, comorbidity, low income, Hispanic/non-white, residence outside southern states
 * Conclusion: Continuous relationship between interval to RT and local recurrence in older women

 * Florence; 2009 PMID 18715726 -- "Radiotherapy timing in 4,820 patients with breast cancer: university of florence experience." (Livi L, Int J Radiat Oncol Biol Phys. 2009 Feb 1;73(2):365-9. Epub 2008 Aug 18.)
 * Retrospective. 4,820 patients, postop RT. surgery to start RT grouped <60 days, 61-120 days, 121-180 days, and >180 days
 * Outcome: Timing of RT not significant on multivariate analysis. Independent risk factors for poor outcome age, SM, and boost
 * Conclusion: Timing of RT itself doesn't affect local recurrence

 * British Columbia; 2008 (1989-2003) - PMID 19018080 — "Intervals Longer Than 20 Weeks From Breast-Conserving Surgery to Radiation Therapy Are Associated With Inferior Outcome for Women With Early-Stage Breast Cancer Who Are Not Receiving Chemotherapy." (Olivotto IA, J Clin Oncol. 2009 Jan 1;27(1):16-23. Epub 2008 Nov 17.)
 * Retrospective. 6428 patients, T1-2 N0-1. No chemotherapy. Intervals evaluated were <4, 4-8, 8-12, 12-16, 16-20, and >20 weeks. 23% patients >12 weeks interval. Median f/u 7.5 yrs.
 * Outcome: No significant difference in recurrence for groups treated with a surgery-to-RT interval up to 20 weeks. Increased relapse rate for interval >20 weeks vs 4-8 week reference group: 10-year LR 6% vs. 10% (HR 2.0, p=0.2), DM 9% vs. 23% (HR 1.9, SS), BCSS 93% vs. 82% (HR 2.1, SS)
 * Subset analysis: Similar HR for N0 subset, and patients not treated with hormone therapy. Patients treated >20 weeks still better local control compared to no RT at all (HR 2.3, p=0.08)
 * Conclusion: RT should start within 20 weeks of BCS; there is no impact on local control but significant benefit to distant control and breast cancer specific survival.

 * Cornell / SEER; 2008 (1991-99) PMID 18932243 -- "Correlates and effect of suboptimal radiotherapy in women with ductal carcinoma in situ or early invasive breast cancer." (Gold HT, Cancer. 2008 Dec 1;113(11):3108-15.)
 * SEER. DCIS or Stage I, women aged 66+. Of 7791 pts undergoing RT, 16% had delay in RT (>8 weeks post surgery if no chemo or >4 weeks post chemo), 3% had incomplete RT
 * More likely to experience subsequent breast event if had delay in RT (OR 1.14). Those with incomplete RT had higher overall mortality (OR 1.32). Longer RT delays (>12 weeks, or >8 weeks with chemo) had a strongly negative impact on evens (OR 3.94 for DCIS, 2.77 for invasive).
 * Conclusion: RT should be facilitated to ensure completion and timeliness.

 * British Columbia; 2000 (1989-93) - PMID 10661343 — "Effect of time interval between breast-conserving surgery and radiation therapy on ipsilateral breast recurrence." Froud PJ et al. Int J Radiat Oncol Biol Phys. 2000 Jan 15;46(2):363-72.
 * 1962 pts. No chemotherapy, but tamoxifen allowed.
 * Median f/u 71 mo. IBR in 3.9%. No significant difference in IBR for surgery to RT intervals, even after adjusting for tamoxifen use and tumor grade.

 * UT-Memphis, 1995 (1974-89) - PMID 8625076 — "Delaying the initiation of intact breast irradiation for patients with lymph node positive breast cancer increases the risk of local recurrence." Hartsell WF et al. Cancer. 1995 Dec 15;76(12):2497-503.
 * 474 pts. 84 pts with chemo for N+.
 * Median f/u 62 mo. 5-yr breast recurrence 2% ("early RT" - < 120 days) and 14% ("delayed RT" - > 120 days). No difference in OS or DFS.

Reviews:
 * 2003: PMID 12560449 - "Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review." Huang J et al. J Clin Oncol. 2003 Feb 1;21(3):555-63.
 * 5 yr LRR higher in pts treated more than 8 wks after surgery (odds ratio 1.62).

Boost dose may overcome

 * JCRT, 1994 (1968-1985) - PMID 8083111 — " The relation between the surgery-radiotherapy interval and treatment outcome in patients treated with breast-conserving surgery and radiation therapy without systemic therapy." Nixon AJ et al. Int J Radiat Oncol Biol Phys. 1994 Aug 30;30(1):17-21.
 * 673 pts, node negative, no chemo or hormonal therapy. All pts received a boost with > 60 Gy. 5-year breast failure rate was 13% for SRI of 0-4 weeks, 8% for 5-8 wks, 2% for 9-12 wks.

Effect of margins

 * Hartsell, 1995 - PMID 8625076 — "Delaying the initiation of intact breast irradiation for patients with lymph node positive breast cancer increases the risk of local recurrence." Hartsell WF et al. Cancer. 1995 Dec 15;76(12):2497-503.
 * In pts with negative margins (>2 mm) low risk of local failure if SRI 120 days. If margins close, positive, or unknown, lower risk for early radiotherapy (6%) vs delayed (24%).

 * JCRT - see discussion at Sequencing chemotherapy and radiotherapy (Recht, 1996) which discusses effect of margin status

Irradiation after breast augmentation

 * M.D.Anderson 1990 - PMID 2298621 - 11 pts followed 3-16 yrs after RT
 * Conclusions: 1) Better cosmetic outcome after RT for pts free of fibrotic changes in the augmented breast before RT, 2) 45 Gy to the whole breast preferred over higher doses, 3) irradiation immediately after reconstruction led to poorer cosmetic results.

Irradiation after breast reconstruction

 * Memorial Sloan Kettering 2004 (1995-2001) - PMID 15108879 - 156 pts (81 pts irradiated, 75 controls)
 * 68% of RT group developed capsular contracture vs 40% controls. Cosmesis good to excellent in 80% vs 88% (N.S.).

 * Mayo (Scottsdale) 2004 - PMID 15289733 - 15 pts, TRAM flaps
 * 13 of 15 had cosmesis rated as good or better

 * Fox Chase, 2004 (1987-2002) - PMID 15234042 — "Low complication rates are achievable after postmastectomy breast reconstruction and radiation therapy." Anderson PR et al. Int J Radiat Oncol Biol Phys. 2004 Jul 15;59(4):1080-7.
 * 85 pts. Tissue expander + implant, 50 pts; TRAM, 35 pts. Reconstruction first in 70 pts (RT at a median of 7 mos post-surgery), RT first in 15 (median interval 13 mos).

 * MDACC, 2001 (1988-98) - PMID 11420508 — "Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy." Tran NV et al. Plast Reconstr Surg. 2001 Jul;108(1):78-82.
 * 32 pts with immediate TRAM followed by RT, 70 with TRAM following RT.
 * No difference in early complications between groups. More late complications (87% vs 8%) for immediate reconstruction vs delayed group.

RT following TRAM:
 * Cleveland Clinic, 2000 (1985-99), PMID 10889371 — "The acute effects of postoperative radiation therapy on the transverse rectus abdominis myocutaneous flap used in immediate breast reconstruction." Hanks SH et al. Int J Radiat Oncol Biol Phys. 2000 Jul 15;47(5):1185-90.
 * 25 pts.
 * Conclusion: Postmastectomy radiation for TRAM flap reconstruction is well tolerated and is not associated with an increased incidence of acute side effects. Radiation technique and the use of preradiation chemotherapy do not appear to be correlated with an increased incidence of acute side effects.

RT Utilization

 * Multi-Institutional/SEER; 2010 (2005-2007) PMID 20351324 -- "Patterns and Correlates of Adjuvant Radiotherapy Receipt After Lumpectomy and After Mastectomy for Breast Cancer." (Jagsi R, J Clin Oncol. 2010 Mar 29. [Epub ahead of print])
 * Survey respondents and matched SEER data. For BCS, strong indications (LN+ or T3-T4) or weak indications (elderly). For mastectomy, strong indications (LN+ or T3-T4) or weak indications (T1N1, T2N1 or T3N0)
 * Outcome: Strong indications for RT actually received it BCS 96% vs mastectomy 78% (SS). Weak indications for RT actually received it BCS 80% vs mastectomy 47% (SS)
 * Predictors for RT: surgery type, indication strength, age, comorbidity, income, patient desire to avoid RT, level of surgeon involvement, and SEER site
 * Conclusion: RT after BCS high, lower after mastectomy

title: Radiation Oncology/Breast/RT technique


text: Georgia Water/External Links/People/Kathryn J. Hatcher


text:
Orthopaedic Surgery/Cubital Tunnel Syndrome

The second most common peripheral nerve compressive neuropathy, cubital tunnel syndrome has unique features clinically and anatomically which make it a more challenging problem to deal with.

From the standpoint of surgical intervention there are minimalists who favor in situ decompression and there are are those who might be characterized as traditionalists who favor submuscular transposition. The other options are intermediate, consisting of epicondylectomy, anterior subcutaneous transposition, usually accompanied by a fascial sling. Then there is the hybrid operation of sort which is referred to as an intramuscular transposition in which rotated flaps of muscle fascia form the roof of the tunnel, the floor is the fleshy muscle bellies left attached, while fibrous bands that might produce kinking or compression of the nerve within the muscular bed are released. With all the transposition options it has become customary to excise the distal aspect of the medial intermuscular septum. This tissue may be left attached distally and use to augment a fascial sling for a subcutaneous transposition, or the fascial roof of a submuscular or intramuscular transposition. When the flexor pronator origin is taken down it is desirable to reconstruct in a fashion that will allow for early motion at least through a limited arc to promote gliding of the nerve in its new bed and to avert stiffness in the elbow. From the standpoint of diagnostic criteria and surgical intervention there are those who contend that unless there are electical studies to document the problem then it is not cubital tunnel syndrome and certainly not a problem to be addressed by surgical intervention to decompress the ulnar nerve.

From the standpoint of pathophysiology there are those who consider this a nerve compression and those who emphasize the importance of local strain as a potential souce for symptoms. In the latter case, this is considered an additional rationale for anterior transposition over any method which may leave the nerve posterior to the flexion axis of the elbow where it will remain subject to more strain.

Causation with regard to work relatedness can be controversial and especially in cases wherein electrodiagnostic studies are negative but symptoms severe. A contentious situation can arise leading to protracted work loss and litigation. The situation is more difficult because an appropriately cautious surgeon will be reticent to embark upon surgical intervention in the absence of objective verification in the form of an abnormal electical study. The prudent surgeon will recognize that surgery for cubital tunnel has a mixed track record for success. In the event of an unsatisfactory outcome with surgical intervention followup electordiagnostic studies and likely and not unexpectedly may indeed show changes after a surgery where none were present before. This is liable to be characterized as an iatrogenic worsening of the condition. Despite this and other hazards having to do with the medico-legal and social issues surrounding the problem, it is widely held that early surgical intervention for cubital tunnel is associated with a more favorable outcome than late surgery. Ultimately insight in patient selection in conjunction with sound technique will allow successful navigation of these hazards.

The spectrum of clinical manifestations include patients with discreet sensory manifestations in the ulnar nerve distribution reporting diminished sensation in the small finger, ulnar half of the ring finger and the dorsal ulnar aspect of the hand. Other patients report mainly pain or an ache along the medial forearm, and poorly localizing tingling in the hand. Weakness can be due to pain or to the denervation of hand intrinsics and the FDP to the small finger. Pain as a dominant feature tends to lessen with greater severity.

The differential diagnosis becomes problematic as patients may describe pain at the shoulder or base of the neck, and sensory manifestations in the forearm. Both of these features invoke consideration of a cervical radiculopathy or neurogenic thoracic outlet, however either can accompany cubital tunnel with a retroaxonal pain pattern and forearm sensory manifestations due to direct irritation of the medial brachial or antebrachial cutaneous nerves. The latter may be especially likely wherein the pathological process is instigated by blunt trauma, or pathological subluxation of the ulnar nerve about the medial epicondyle.

Cubital Tunnel

In a significant minority of patients upper extremity complaints do not confine themselves to a single source. The first task for the surgeon is to discern what combination of pathologies are responsible for the complaints, which are linked and which are discreet and which might be reasonably addressed together, and which are best treated separately. Cubital tunnel commonly occurs in conjunction with carpal tunnel syndrome, or with tendinopathy of the common extensor origin. While it may be prudent to address the problems individually it is tempting to combine procedures to resolve the problem in one sitting. The latter approach requires keen insight or luck in selecting the right patient who can recover efficiently from a combined operation. The concern is that a morass of symptoms may be attributed to multiple compressive neuropathies and tendinopathies when in fact they are manifestations of a pain syndrome which is only aggravated by an ill conceived surgical intervention made all the worse by a multi-sight surgery. The desire to resolve the problem in one blow may be well intentioned, and is appealing for its potential efficiency from the standpoint of cost and down time, but if the surgery fails a nightmare of protracted disability can ensue.


text:
User talk:65.223.100.226

Come introduce yourself at the new users page. If you have any questions, you can ask there or contact me personally.

title: User talk:65.223.100.226


text:
Proteomics/Protein Chips

Presentation
Introduction:

Introduction

Protein chips, also referred to as protein arrays or protein microarrays, are modeled after DNA microarrays. The success of DNA microarrays in large-scale genomic experiments inspired researchers to develop similar technology to enable large-scale, high-throughput proteomic experiments. Protein chips enable researchers to quickly and easily survey the entire proteome of a cell within an organism. They also allow researchers to automate and parallelize protein experiments.

Protein chips were first developed in 2000 by researchers at Harvard University. Today there are many companies manufacturing protein chips using many types of techniques including spotting and gel methods. The types of protein chips available include "lab on a chip", antibody arrays and antigen arrays, as well as a wide range of chips containing "alternative capture agents" such as proteins, substrates and nucleic acids.

Analysis of protein chips comes with many challenges including dynamic protein concentrations, the sheer number of proteins in a cell's proteome, and the understanding of the probes for each protein. Steps include the reading of the protein levels off the chip, and then the use of computer software to analyze the massive amounts of data collected.

Applications of protein chip experiments include identifying biomarkers for diseases, investigating protein-protein interactions, and testing for the presence of antibodies in a sample. Protein chips have applications in cancer research, medical diagnostics, homeland security and proteomics.

This chapter will demonstrate why protein chips are changing the face of proteomics, and why they will have an even larger impact in the future.

Nucleic Acid Microarrays
The use of microarrays for gene expression profiling was first published in 1995. This technology allowed scientists to analyze thousands of mRNAs in a single experiment to determine whether expression is different in disease states. Unfortunately, mRNA levels within a cell are often poorly correlated with actual protein abundance. This can be due to many factors including degradation rate of mRNA versus proteins and post-transcriptional controls and modifications. Measuring the amount of protein directly would bypass any mRNA inconsistencies and give a true level of gene function, however traditional protein characterization methods were slow and cumbersome. These combined factors were the impetus behind the creation of protein chips.

Deficiency of Traditional Protein Characterization Methods

Before the advent of protein chips, protein measuring and characterization was done using two different methods: 2D gel electrophoresis coupled with mass spectrometry, and liquid chromatography. These methods can separate and visualize a large number of proteins per experiment, however they are time consuming when compared to protein chips. Their process is very low-throughput because of lack of automation. Reproducibility is also a factor because of the large amount of sample handling. A better, more standardized, higher-throughput method needed to be invented for protein measuring and characterization.

Protein Chip Precursors to Modern Day

Immunoassays, the precursor to protein chips available since the 1980s, exploit the interactions between antibodies and antigens in order to detect their concentrations in biological samples. Their creation, however, is tedious and expensive. As a response to this, researchers at Harvard University combined the technologies of immunoassays and DNA microarrays to develop the protein chip. In their landmark paper, published in 2000, "Printing Proteins as Microarrays for High-Throughput Function Determination," Gavin MacBeath and Stuart Schreiber described how to create protein chips and demonstrated three types of applications that would benefit from this new technology. The strengths of their approach were the use of readily available materials (i.e. glass slides, polyacrylamide gel), the relative ease of implementation (robotic microarray printers), and compatibility with standard instrumentation.

Within the past five years, many companies, including Biacore, Invitrogen, and Sigma-Aldrich, have begun production of industrial level protein array systems that can be used for drug discovery and basic biological research. Commercial entities have made protein chip research a streamlined and standardized process on the same level as DNA microarrays compared to its inception in 2000.

Academic research plays a huge role in the development and improvement of these technologies. The collaboration of academic research with systems such as the Affymetrix GeneChip and the Human Genome Initiative has allowed for friendly competition, resulting in the advancement of technologies. With more develops come a better understanding and encourages even more research towards these fields.

Affymetrix is a company that has been manufactures microarrays, named GeneChip, since 1992. They have 13 locations across the world with headquarters located in the US (California), UK, Japan, and China.

Next section: Manufacture

title: Proteomics/Protein Chips


text:
Animation:Master Features

Hash Inc. has packed tons of features into Animation:Master, and this page is dedicated to providing examples that explore everything Animation:Master has to offer. If there is a need for information that goes beyond the scope of this module, please visit the [http://www.hash.com/forums/index.php? A:M Forums].

Feature List

 * /Images/
 * /Sounds/
 * /Post Effects/
 * /Materials/
 * /Objects/
 * /Actions/
 * /Choreographies/
 * /Rendering/
 * /Radiosity/
 * /Volumetrics/
 * /Spline\Patch-based Modeling/
 * /Rigid Body Physics/

title: Animation:Master Features


text:
Talk:Animation:Master Features

(MattWBradbury 00:11, 23 March 2006 (UTC)) I have just created the Page, and the intention of this page is to be a HUB to every feature.

title: Talk:Animation:Master Features


text:
Animation:Master Features/Rendering

This Module is part of Animation:Master Features.

The way in which you render a scene can change the mood dramatically. This page will examine all of the different types of rendering Animation:Master has to offer.

Rendering
Quality Multi-Pass Motion Blur Depth of Field Shadows Reflections Draw Particles / Hair Fog Toon Render Field Render Stereo Plugin Shaders

title: Animation:Master Features/Rendering


text:
Talk:Animation:Master Features/Rendering

(MattWBradbury 00:31, 23 March 2006 (UTC))This page is the first of the other feature pages.


text:
Animation:Master Features/Rendering/Toon Render

Toon Render
Animation Master’s Toon Render has a lot to offer. This topic is dedicated to providing the Animation Master Community with an in depth examination of Toon Rendering.

Of the many properties for surfaces, Toon Lines and Toon Shading control how surfaces render when Toon Render is ON in the Rendering Options window.

To turn Toon Render ON, click Tools on the menu bar and select Options, or press Ctrl+P to bring up the Options window. Click on the Rendering tab, make sure that Advance is checked, and click on the OFF next to Toon Render to turn it to ON.

If you open up the Toon Render menu, you will see three different selections: Lines Only, Override Lines, and Override Shading.

Lines Only
If Lines Only is turned to ON, there will not be any shading for the scene that is being rendered. Lines Only cannot be used with Override Shading. If none of the models have Toon Line properties set, all of the lines in the scene will have default values.

For the examination of Toon Render, frame 175 of the project Toys will be used.

This is what is rendered when Lines Only is turned ON with default values for Toon Lines.

The outlines of surfaces are now the only visible definition of the original render. Lines Only is a very simple rendering option, and has no other features inside of itself.

Override Lines
When Override Lines is set to ON, every surface's lines will be rendered the same.

Note: When Lines Only is set to OFF and Override Lines is set to ON, an option called Render Lines appears in the Override Lines menu. If Render Lines is set to OFF, and then Lines Only is set to ON, the render will produce no visible lines.

There are three different settings for Override Lines: Color Method, Thickness, and Toon Line Bais.

Color Method
The Color Method sets what color the lines will render. There are two Color Methods: Specific and Percent Underlying. The default Color Method is Specific Color.

When Specified Color is selected, the Color Method menu shows a color value. Specified Color for the Lines Only image is set to black, but it can be set to any color. The background color is the color of the camera’s background color, so you can make any combination of color with them.

When Percent of Underlying is selected, the Color Method menu shows a Percent value that can range from 0%-100%.

The default value is 20%. This is what is rendered for Percent of Underlying.

This may look like the Lines Only render, but under a closer look, the lines are not the same color. This is what is rendered when the percentage is increased to 100%.

Now the lines are colored the exact color of their surface’s diffuse color. The blocks, spaceship, and crayon box have a white diffuse color, and that explains why they only have a grey outline of their edges.

Thickness
The Thickness sets the width of the lines. The value ranges from 0 to 20 with 2 as the default. This is what is rendered when the thickness is set to .5.

The lines are much finer, and details that had once been covered up by large lines have come into view. This is what is rendered when the thickness is set to 10.

The thick lines have covered up much of the detail in the scene. If the lines were any thicker, it would be difficult to tell what was in the scene.

Toon Line Bias
The Toon Line Bias sets the amount of line detail for a surface. The smaller the value of Toon Line Bias, the finer the detail that is rendered. The values range from .01 to 1000. This is what is rendered with a Toon Line Bias of 2.

The thickness of this render was set to .5. Far more detail is visible now with a lower value for Toon Line Bias. This is what is rendered for a Toon Line Bias of 500.

Only a small amount of detail is left around the outsides of the main models. This is what is rendered for a Toon Line Bias of .1.

An incredible amount of detail is now visible; however, because there is so much detail, the scene no longer has the look of Toon about it. This would be better used for a stylized look rather than a cartoon.

Override Shading
Override Shading does exactly what it says it does. It sets the shading for every surface. Remember that you must have Lines Only set to OFF in order to use Override Shading.

There are four different Methods for Override Shading: Standard, Toon, Toon with Fallof, and Toon Gradient Only.

Standard
The Standard method takes the original background, and simply overlays lines onto it. Here is what is rendered with Standard Method.

The Standard method does not have gradients like the other three methods, so the only thing left to do for renders using Standard is to adjust the Override Lines.

Toon
When you select one of the other three Methods, you get another option.

Gradients control how surfaces are shaded, but there is a lot to gradients, so those will be discussed in the next section. The Toon method, in version 12, only renders ambiance with lines, so if you want to use this method with little to know ambiance values, you will have to use lightly colored lines. Otherwise, you will have to turn on Global Ambiance, or set the individual Ambiance Intensity; there are faster ways to do this with other methods. This is what will render if you simply turn on the Toon method, and do not change the Specific Color Method Color.

The Spaceman is barely visible. This is what is rendered with any gradient will render with the Toon method that has a white color for the Specific Color Method.

Toon with Falloff
This Method is very similar to the Standard method, except that now you have a gradient that tells how the shading of surfaces will be rendered. Like the Standard method, Toon with Fallof method uses the diffuse color of models as well as the diffuse color of lights to create the color layer for a render.

This is what is rendered when you use the default Two-Tone (with line) gradient.

The render is much brighter now because of how the gradient is set up. There are also solid lines which indicate where the least amount of lighting is on models like the binoculars. Once again, an examination of gradients will be saved for the next section.

Toon Gradient Only
The Toon Gradient Only method does not use the diffuse color of lights to create the color layer of a mask. Instead, it relies on the setup of the gradient, and the diffuse color of the models.

This is what is rendered with the Toon Gradient Only method with the default Two-Tone (with line)gradient.

By selecting a different gradient, you can get a different shading style. This is what is rendered with changes to the line thicknesses, and gradient is now set to the Preset gradient of Two-Tone(Soft).

Gradients
Gradients control how shading is rendered in certain Shading Methods. Animation Master comes with five preset gradients. To select a preset gradient, right click on the gradient bar in the Method menu, and select Preset.

When a different gradient is selected, a new set of key points appears on the Gradient bar.

Each of the gradients renders differently because of the properties of each key point. The construction of a Gradient is not difficult. Start by deleting all of the key points on the gradient map. To delete a key point, first click on the key point, then right click on it, and select Delete Key.

I suggest saving the cleared gradient so you do not have to delete every key every time. To save a Gradient, right click on the Gradient bar, and select Preset, and then select Create at the bottom. Name this gradient CLEARED. If you look at the presets, the new gradient will appear.

Now that the gradient is cleared, new points can be added without being changed by preexisting points. To add a point, left click anywhere on the Gradient bar. The points you add will be set to the default value which is based on the percent the key point is at and creates a grey scale gradient. To look at the properties of the key point, first left click on the key point, then right click on the key point, and select Key Settings.

Position
At the top, you have the Position. This is the location of your key point on the gradient. Setting different values will move the point. The closer the percentage is to 100%, the farther right the key point is, and vice versa for percentages closer to 0%.

Color
The Color has two options: This Color, and Object Color.

This Color
If you select This Color, the Gradient will be set to that color at that point.

The Gradient will not change color until you press OK. To see how gradients are rendered, we will make a color spectrum Gradient.

There are five key points on this Gradient: The first one is set to 0% and has This Color set to Red, then there is 25% with Yellow, 50% with Green, 75% with Blue, and 100% with Violet. This is what is rendered with this Rainbow Gradient.

This Color has rendered the frame without any original surface or light color. From this render, it can be concluded that the right side of the Gradient bar controls highlights, the left side controls the darkness, and everywhere in between controls the mid tones.

This is rendered with This Color set to black at 0%, and white at 100%.

This Gradient has created somewhat of a matte white render with lines. This is what is rendered with This Color set to white at 0%, and black at 100%.

The highlights are now set to darkness, and the darkness is now set to highlights. If this frame is rendered with a Gradient with This Color set to White at 50%, it would look just like a renders in Override Shadding which do not have a gradients on them at all.

Object Color
Object Color sets the brightness of the tones based on the Gradient bar. A standard render would have the Position percent and the Object Color persent set to the same value. If the Object Color percent is set higher than the Position of the Key point, the render will have darker highlights. If the Object Color Percent is set lower than the Position of the Key point, the render will appear to have less darkness.

This is what is rendered when there is a Key point at 0% with a 0% Object Color, and a Key point at 100% with 100% Object Color with Toon Gradient Only.

If one does not want any lights or darks in the render, the Cartoon preset Gradient can be used. This is what is rendered with the Cartoon Gradient.

The Cartoon Gradient has one Key point set at 50% with Object Color set at 100%. If shadows are desired, the Anime Preset can be used with Toon Gradient Only. This is what the Anime preset will render.

The zig-zagging effect of the shadows in this render are caused by the use of Z-Buffered Shadows.

Mixing This Color and Object Color
Gradients can be made up of both This Color and Object Color settings. This opens many more possibilities for Gradients. One mixture in particular renders quite a stylized look. Create five Key points in the Gradient bar. Set the Positions to 0%, 25%, 50%, 75%, and 100%. Set the 0% Key point to This Color to Black, set the 25% to Object Color with 25%, set the 50% to Object Color with 50%, set the 75% to Object Color with 75%, and set 100% to This Color to White.

Now the mid tons have the only color in the scene, and the rest of the render is comprised of lights and darks. This is what is rendered when the Method is changed to Toon with Falloff.

This opens even more possibilities for Gradients and Toon render.

Conclusion
Hopefully all of these examinations of Toon Render open up some more creativity for future projects with Animation:Master. Toon render is not just used to make scenes look like cartoons; Toon render is also used to set the mood of the scene and can do a very good job of it.


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Talk:Animation:Master Features/Rendering/Toon Render

(MattWBradbury 00:45, 23 March 2006 (UTC))This is the first specific feature added.

(MattWBradbury 03:39, 23 March 2006 (UTC))I have pretty much finished up this feature. I will now start work on another feature.