Skin-Inspired Textile Electronics Enable Ultrasensitive Pressure Sensing.

Wearable pressure sensors have attracted great interest due to their potential applications in healthcare monitoring and human-machine interaction. However, it is still a critical challenge to simultaneously achieve high sensitivity, low detection limit, fast response, and outstanding breathability for wearable electronics due to the difficulty in constructing microstructure on a porous substrate. Inspired by the spinosum microstructure of human skin for highly-sensitive tactile perception, a biomimetic flexible pressure sensor is designed and fabricated by assembling MXene-based sensing electrode and MXene-based interdigitated electrode. The product biomimetic sensor exhibits good flexibility and suitable air permeability (165.6 mm s-1), comparable to the typical air permeable garments. Benefiting from the two-stage amplification effect of the bionic intermittent structure, the product bionic sensor exhibits an ultrahigh sensitivity (1368.9 kPa-1), ultrafast response (20 ms), low detection limit (1 Pa), and high-linearity response (R2 = 0.997) across the entire sensing range. Moreover, the pressure sensor can detect a wide range of human motion in real-time through intimate skin contact, providing essential data for biomedical monitoring and personal medical diagnosis. This principle lays a foundation for the development of human skin-like high-sensitivity, fast-response tactile sensors.

Metal-Phenolic Networks-Reinforced Extracellular Matrix Scaffold for Bone Regeneration via Combining Radical-Scavenging and Photo-Responsive Regulation of Microenvironment.

The limited regulation strategies of the regeneration microenvironment significantly hinder bone defect repair effectiveness. One potential solution is using biomaterials capable of releasing bioactive ions and biomolecules. However, most existing biomaterials lack real-time control features, failing to meet high regulation requirements. Herein, a new Strontium (Sr) and epigallocatechin-3-gallate (EGCG) based metal-phenolic network with polydopamine (PMPNs) modification is prepared. This material reinforces a biomimetic scaffold made of extracellular matrix (ECM) and hydroxyapatite nanowires (nHAW). The PMPNs@ECM/nHAW scaffold demonstrates exceptional scavenging of free radicals and reactive oxygen species (ROS), promoting HUVECs cell migration and angiogenesis, inducing stem cell osteogenic differentiation, and displaying high biocompatibility. Additionally, the PMPNs exhibit excellent photothermal properties, further enhancing the scaffold's bioactivities. In vivo studies confirm that PMPNs@ECM/nHAW with near-infrared (NIR) stimulation significantly promotes angiogenesis and osteogenesis, effectively regulating the microenvironment and facilitating bone tissue repair. This research not only provides a biomimetic scaffold for bone regeneration but also introduces a novel strategy for designing advanced biomaterials. The combination of real-time photothermal intervention and long-term chemical intervention, achieved through the release of bioactive molecules/ions, represents a promising direction for future biomaterial development.

Rehabilitation exercise-driven symbiotic electrical stimulation system accelerating bone regeneration.

Electrical stimulation can effectively accelerate bone healing. However, the substantial size and weight of electrical stimulation devices result in reduced patient benefits and compliance. It remains a challenge to establish a flexible and lightweight implantable microelectronic stimulator for bone regeneration. Here, we use self-powered technology to develop an electric pulse stimulator without circuits and batteries, which removes the problems of weight, volume, and necessary rigid packaging. The fully implantable bone defect electrical stimulation (BD-ES) system combines a hybrid tribo/piezoelectric nanogenerator to provide biphasic electric pulses in response to rehabilitation exercise with a conductive bioactive hydrogel. BD-ES can enhance multiple osteogenesis-related biological processes, including calcium ion import and osteogenic differentiation. In a rat model of critical-sized femoral defects, the bone defect was reversed by electrical stimulation therapy with BD-ES and subsequent bone mineralization, and the femur completely healed within 6 weeks. This work is expected to advance the development of symbiotic electrical stimulation therapy devices without batteries and circuits.

Bacterial Cellulose-Based Bandages with Integrated Antibacteria and Electrical Stimulation for Advanced Wound Management.

Bandages for daily wounds are the most common medical supplies, but there are still ingrained defects in their appearance, comfort, functions, as well as environmental pollution. Here, novel bandages based on bacterial cellulose (BC) membrane for wound monitoring and advanced wound management are developed. The BC membrane is combined with silver nanowires (AgNWs) by using vacuum filtration method to achieve transparent, ultrathin (≈7 µm), breathable (389.98-547.79 g m-2  d-1 ), and sandwich-structured BC/AgNWs bandages with superior mechanical properties (108.45-202.35 MPa), antibacterial activities against Escherichia coli and Staphylococcus aureus, biocompatibility, and conductivity (9.8 × 103 -2.0 × 105  S m-1 ). Significantly, the BC/AgNWs bandage is used in the electrical stimulation (direct current, 600  microamperes for 1 h every other day) treatment of full-thickness skin defect in rats, which obviously promotes wound healing by increasing the secretion of vascular endothelial growth factor (VEGF). The BC bandage is used for monitoring wounds and achieve a high accuracy of 94.7% in classifying wound healing stages of hemostasis, inflammation, proliferation, and remodeling, by using a convolutional neural network. The outcomes of this study not only provide two BC-based bandages as multifunctional wound management, but also demonstrate a new strategy for the development of the next generation of smart bandage.

Effective degradation of anthraquinones in Folium Sennae with Monascus fermentation for toxicity reduce and efficacy enhancement.

Folium Sennae are widely used around the world, mainly in purging and removal of endogenous active substances, such as anthraquinone and its derivatives. However, the potential toxicity of anthraquinones to the liver, kidney, and intestinal limits the application of Folium Sennae. In this study, we aimed at safe regulation of Folium Sennae to degrade anthraquinones, boosting medicinal properties and reducing toxicity and potency with Monascus fermentation. Monascus strains H1102 for Folium Sennae fermentation were selected as the initial strain which was capable of producing high yields of functional pigment and low yields of hazardous citrinin. The anthraquinone degradation rate reached 41.2%, with 212.2 U mL-1 of the pigment and approximately 0.038 mg L-1 of the citrinin under optimal fermentation conditions followed by response surface streamlining, which met the requirements of reducing toxicity, increasing efficiency of Monascus fermented Folium Sennae. Furthermore, the Monascus/Folium Sennae culture had no observable toxic effect on HK-2 and L-02 cells in vitro and further inhibited cell apoptosis and necrosis. Overall, our results showed that Monascus fermentation could provide an alternative strategy for toxicity reduction of herbal medicines as well as efficacy enhancement.

The Different Welding Layers and Heat Source Energy on Residual Stresses in Swing Arc Narrow Gap MAG Welding.

In this paper, in order to reduce the time cost of prediction experiments in industry, a new narrow gap oscillation calculation method is developed in ABAQUS thermomechanical coupling analysis to study the distribution trend of residual weld stresses in comparison with conventional multi-layer welding processes. The blind hole detection technique and thermocouple measurement method verify the reliability of the prediction experiment. The results show that the experimental and simulation results have a high degree of agreement. In the prediction experiments, the calculation time of the high-energy single-layer welding experiments is 1/4 of the traditional multi-layer welding. Two welding processes of longitudinal residual stress and transverse residual stress distribution trends are the same. The high-energy single-layer welding experiment stress distribution range and transverse residual stress peak are smaller, but the longitudinal residual stress peak is slightly higher, which can be effectively reduced by increasing the preheating temperature of the welded parts. This implies that in the specific case of increasing the initial temperature of the workpiece, the use of high-energy single-layer welding instead of multi-layer welding to study the residual stress distribution trend not only optimizes the weld quality but also reduces the time cost to a large extent.

[Health Risk Assessment of Heavy Metals in Soil and Wheat Grain in the Typical Sewage Irrigated Area of Shandong Province].

Sewage irrigation is a common alternative to make up for the shortage of agricultural irrigation in intensive agricultural areas. Abundant organic matter and nutrients in sewage can improve soil fertility and crop yield, but hazardous materials, such as heavy metals, will damage the soil environmental quality and threaten human health. To better understand the characteristics of heavy metal enrichment and potential health risk in a sewage irrigated soil-wheat system, a total of sixty-three pairs of topsoil and wheat grain samples were collected from the sewage irrigated area of Longkou City in Shandong Province. The contents of Cr, Cu, Ni, Pb, Zn, As, Cd, and Hg were determined to analyze heavy metal contamination and calculate bio-accumulation factor (BAF), estimated daily absorption (EDA), as well as hazard quotient (HQ). The results showed that the average contents of the eight heavy metals were 61.647, 30.439, 29.769, 36.538, 63.716, 8.058, 0.328, and 0.028 mg·kg-1, respectively, which all exceeded the background values of corresponding heavy metals in the eastern Shandong Province. Especially, the average content of Cd was higher than the current standard value of soil environmental quality of agricultural land soil pollution risk control, indicating the apparent soil contamination. However, the correlations between the heavy metal contents in soil and wheat grains were not significant, suggesting that it is difficult to conclude the enrichment degree of heavy metals in wheat grains merely by the heavy metal contents in soil. The results of BAF showed that the high enrichment capacity of wheat grain was primarily obtained with Zn, Hg, Cd, and Cu. According to the national food safety limit standard, the over-limit ratios of Ni (100%) and Pb (96.8%) in wheat grains were the most serious. As a result, under the current consumption of local wheat flour, the EDAs of Ni and Pb were high, accounting for 28.278% and 1.955% of the acceptable daily intakes (ADI) for adults and 131.980% and 9.124% of the ADIs for children. The results of the health risk assessment exhibited that As and Pb were the main sources causing health risks, accounting for approximately 80% of the total risk. Although the sums of the HQ of the eight heavy metals for adults and children were below 10, the total HQ of children was 1.245 times higher than that of adults. The food safety of children should receive more attention. When considering spatial characteristics, the health risk in the southern study area was higher than that in the northern part of the study area. The prevention and control of heavy metal contamination in the southern area should be strengthened in the future.

Management for Benign Ureteral Stricture: Comparison of Robot-Assisted Laparoscopy, Conventional Laparoscopy, and Balloon Dilation.

Purpose: Robot-assisted laparoscopy (RALP), conventional laparoscopy (LP), and balloon dilation (BD) have all been identified as common treatments for benign ureteral stricture (BUS). The purpose of the research would be to compare the safety and efficacy differences in the three groups. Patients and Methods: Patients who received RALP, LP, or BD for BUS were studied retrospectively from January 2016 through December 2020. Professional and experienced surgeons performed all operations. We collect and analyze baseline characteristics, stricture details, and perioperative and follow-up information. Results: The results showed no statistically significant difference between the three groups for baseline characteristics and stricture details. No statistical difference was also found between RALP and LP in specific surgical techniques. The average operative time was longer in the LP group than RALP and BD groups (178 minutes vs 150 minutes vs 67 minutes, respectively, p < 0.001). BD had lower estimated blood loss than RALP and LP (14 mL vs 40 mL vs 32 mL, p < 0.001) and similar between the RALP and LP groups (p = 0.238). The BD group had the shortest postoperative hospital stay compared with the RALP and LP groups (2.95 days vs 5.25 days vs 6.52 days, p < 0.001), and no statistically significant difference existed between the RALP and LP groups (p = 0.098). RALP had considerably greater hospitalization expenses than both LP (p < 0.001) and BD (p < 0.001). Complications and short-term success rates (6 months) were similar. The BD group had poorer long-term success (12 and 24 months) than the RALP and LP groups, whereas there was no statistically significant difference between the RALP and LP groups. Conclusions: For the management of BUS, RALP, LP, and BD are all safe and effective, with equivalent complication rates and short-term success. In long-term success rates, BD is low than RALP and LP.

Spatial Pattern Characteristics and Factors for the Present Status of Rural Settlements in the Lijiang River Basin Based on ArcGIS.

In China, rural settlements have undergone significant changes in response to dramatic socioeconomic shifts. However, there has not been any report on rural settlements in the Lijiang River Basin. In this study, ArcGIS 10.2 (including hot spot analysis and kernel density estimation) and Fragstats 4.2 (such as the landscape pattern index) software were used to analyze the spatial pattern and causes of rural settlements in the Lijiang River Basin. The Lijiang River Basin is mainly dominated by micro- and small-sized rural settlements with small areas. Moreover, the results of a hot spot analysis showed that micro- and small-sized rural settlements were mainly located in the upper reaches, and medium- and large-sized rural settlements were mainly located in the middle and lower reaches. The kernel density estimation results showed that the distribution characteristics of the rural settlements in the upper, middle, and lower reaches were significantly different. The spatial forms of rural settlements were affected by physiographic factors such as elevation and slope, karst landforms, and river trunk channels as well as the national policy system, tourism economic development, town distribution, historical heritage, and minority culture. This study is the first to systematically elaborate on the rural settlement pattern and its internal logic from the perspective of the Lijiang River Basin, providing a basis for the optimization and construction of the rural settlement pattern.

Associations of COVID-19 Hospitalizations, ICU Admissions, and Mortality with Black and White Race and Their Mediation by Air Pollution and Other Risk Factors in the Louisiana Industrial Corridor, March 2020-August 2021.

Louisiana ranks among the bottom five states for air pollution and mortality. Our objective was to investigate associations between race and Coronavirus Disease 2019 (COVID-19) hospitalizations, intensive care unit (ICU) admissions, and mortality over time and determine which air pollutants and other characteristics may mediate COVID-19-associated outcomes. In our cross-sectional study, we analyzed hospitalizations, ICU admissions, and mortality among positive SARS-CoV-2 cases within a healthcare system around the Louisiana Industrial Corridor over four waves of the pandemic from 1 March 2020 to 31 August 2021. Associations between race and each outcome were tested, and multiple mediation analysis was performed to test if other demographic, socioeconomic, or air pollution variables mediate the race-outcome relationships after adjusting for all available confounders. Race was associated with each outcome over the study duration and during most waves. Early in the pandemic, hospitalization, ICU admission, and mortality rates were greater among Black patients, but as the pandemic progressed, these rates became greater in White patients. However, Black patients were disproportionately represented in these measures. Our findings imply that air pollution might contribute to the disproportionate share of COVID-19 hospitalizations and mortality among Black residents in Louisiana.

A Single Electronic Tattoo for Multisensory Integration.

Wearable electronics are garnering growing interest in various emerging fields including intelligent sensors, artificial limbs, and human-machine interfaces. A remaining challenge is to develop multisensory devices that can conformally adhere to the skin even during dynamic-moving environments. Here, a single electronic tattoo (E-tattoo) based on a mixed-dimensional matrix network, which integrates two-dimensional  MXene nanosheets and one-dimensional cellulose nanofibers/Ag nanowires, is presented for multisensory integration. The multidimensional configurations endow the E-tattoo with excellent multifunctional sensing capabilities including temperature, humidity, in-plane strain, proximity, and material identification. In addition, benefiting from the satisfactory rheology of hybrid inks, the E-tattoos are able to be fabricated through multiple facile strategies including direct writing, stamping, screen printing, and three-dimensional printing on various hard/soft substrates. Especially, the E-tattoo with excellent triboelectric properties also can serve as a power source for activating small electronic devices. It is believed that these skin-conformal E-tattoo systems can provide a promising platform for next-generation wearable and epidermal electronics.

Versatile Electronic Textile Enabled by a Mixed-Dimensional Assembly Strategy.

Electronic textiles (e-textiles) hold great promise for serving as next-generation wearable electronics owing to their inherent flexible, air-permeable, and lightweight characteristics. However, these e-textiles are of limited performance mainly because of lacking powerful materials combination. Herein, a versatile e-textile through a simple, high-efficiency mixed-dimensional assembly of 2D MXene nanosheets and 1D silver nanowires (AgNWs) are presented. The effective complementary actions of MXene and AgNWs endow the e-textiles with superior integrated performances including self-powered pressure sensing, ultrafast joule heating, and highly efficient electromagnetic interference (EMI) shielding. The textile-based self-powered smart sensor systems obtained through the screen-printed assembly of MXene-based supercapacitor and pressure sensor are flexible and lightweight, showing ultrahigh specific capacitance (2390 mF cm-2 ), robust areal energy density (119.5 µWh cm-2 ), excellent sensitivity (474.8 kPa-1 ), and low detection limit (1 Pa). Furthermore, the interconnected conductive MXene/AgNWs network enables the e-textile with ultrafast temperature response (10.4 °C s-1 ) and outstanding EMI shielding effectiveness of ≈66.4 dB. Therefore, the proposed mixed-dimensional assembly design creates a multifunctional e-textile that offers a practical paradigm for next-generation smart flexible electronics.

Sensitivity analysis for assumptions of general mediation analysis.

Mediation analysis is widely used to identify significant mediators and estimate the mediation (direct and indirect) effects in causal pathways between an exposure variable and a response variable. In mediation analysis, the mediation effect refers to the effect transmitted by mediator intervening the relationship between an exposure variable and a response variable. Traditional mediation analysis methods, such as the difference in the coefficient method, the product of the coefficient method, and counterfactual framework method, all require several key assumptions. Thus, the estimation of mediation effects can be biased when one or more assumptions are violated. In addition to the traditional mediation analysis methods, Yu et al. proposed a general mediation analysis method that can use general predictive models to estimate mediation effects of any types of exposure variable(s), mediators and outcome(s). However, whether this method relies on the assumptions for the traditional mediation analysis methods is unknown. In this paper, we perform series of simulation studies to investigate the impact of violation of assumptions on the estimation of mediation effects using Yu et al.'s mediation analysis method. We use the R package mma for all estimations. We find that three assumptions for traditional mediation analysis methods are also essential for Yu et al.'s method. This paper provides a pipeline for using simulations to evaluate the impact of the assumptions for the general mediation analysis.

Risk factors among Black and White COVID-19 patients from a Louisiana Hospital System, March, 2020 - August, 2021.

Objectives: To investigate relationships between race and COVID-19 hospitalizations, intensive care unit (ICU) admissions, and mortality over time and which characteristics, may mediate COVID-19 associations. Methods: We analyzed hospital admissions, ICU admissions, and mortality among positive COVID-19 cases within the ten-hospital Franciscan Ministries of Our Lady Health System around the Mississippi River Industrial Corridor in Louisiana over four waves of the pandemic from March 1, 2020 - August 31, 2021. Associations between race and each outcome were tested, and multiple mediation analysis was performed to test if other demographic, socioeconomic, or air pollution variables mediate the race-outcome relationships. Results: Race was associated with each outcome over the study duration and during most waves. Early in the pandemic, hospitalization, ICU admission, and mortality rates were greater among Black patients, but as the pandemic progressed these rates became greater in White patients. However, Black patients were still disproportionately represented in these measures. Age was a significant mediator for all outcomes across waves, while comorbidity and emissions of naphthalene and chloroprene acted as mediators for the full study period. Conclusions: The role of race evolved throughout the pandemic in Louisiana, but Black patients bore a disproportionate impact. Naphthalene and chloroprene air pollution partially explained the long-term associations. Our findings imply that air pollution might contribute to the increased COVID-19 hospitalizations and mortality among Black residents in Louisiana but likely do not explain most of the effect of race.

Mediators of weight change in underserved patients with obesity: exploratory analyses from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) cluster-randomized trial.

BACKGROUND: Intensive lifestyle interventions (ILIs) stimulate weight loss in underserved patients with obesity, but the mediators of weight change are unknown. OBJECTIVES: We aimed to identify the mediators of weight change during an ILI compared with usual care (UC) in underserved patients with obesity. METHODS: The PROPEL (Promoting Successful Weight Loss in Primary Care in Louisiana) trial randomly assigned 18 clinics (n = 803) to either an ILI or UC for 24 mo. The ILI group received an intensive lifestyle program; the UC group had routine care. Body weight was measured; further, eating behaviors (restraint, disinhibition), dietary intake (percentage fat intake, fruit and vegetable intake), physical activity, and weight- and health-related quality of life constructs were measured through questionnaires. Mediation analyses assessed whether questionnaire variables explained between-group variations in weight change during 2 periods: baseline to month 12 (n = 779) and month 12 to month 24 (n = 767). RESULTS: The ILI induced greater weight loss at month 12 compared with UC (between-group difference: -7.19 kg; 95% CI: -8.43, -6.07 kg). Improvements in disinhibition (-0.33 kg; 95% CI: -0.55, -0.10 kg), percentage fat intake (-0.25 kg; 95% CI: -0.50, -0.01 kg), physical activity (-0.26 kg; 95% CI: -0.41, -0.09 kg), and subjective fatigue (-0.28 kg; 95% CI: -0.46, -0.10 kg) at month 6 during the ILI partially explained this between-group difference. Greater weight loss occurred in the ILI at month 24, yet the ILI group gained 2.24 kg (95% CI: 1.32, 3.26 kg) compared with UC from month 12 to month 24. Change in fruit and vegetable intake (0.13 kg; 95% CI: 0.05, 0.21 kg) partially explained this response, and no variables attenuated the weight regain of the ILI group. CONCLUSIONS: In an underserved sample, weight change induced by an ILI compared with UC was mediated by several psychological and behavioral variables. These findings could help refine weight management regimens in underserved patients with obesity.This trial was registered at clinicaltrials.gov as NCT02561221.

Bioinspired MXene-Based User-Interactive Electronic Skin for Digital and Visual Dual-Channel Sensing.

User-interactive electronic skin (e-skin) that could convert mechanical stimuli into distinguishable outputs displays tremendous potential for wearable devices and health care applications. However, the existing devices have the disadvantages such as complex integration procedure and lack of the intuitive signal display function. Here, we present a bioinspired user-interactive e-skin, which is simple in structure and can synchronously achieve digital electrical response and optical visualization upon external mechanical stimulus. The e-skin comprises a conductive layer with a carbon nanotubes/cellulose nanofibers/MXene nanohybrid network featuring remarkable electromechanical behaviors, and a stretchable elastomer layer, which is composed of silicone rubber and thermochromic pigments. Furthermore, the conductive nanohybrid network with outstanding Joule heating performance can generate controllable thermal energy under voltage input and then achieve the dynamic coloration of silicone-based elastomer. Especially, such an innovative fusion strategy of digital data and visual images enables the e-skin to monitor human activities with evermore intuition and accuracy. The simple design philosophy and reliable operation of the demonstrated e-skin are expected to provide an ideal platform for next-generation flexible electronics.

Ti3C2Tx MXene-Coated Electrospun PCL Conduits for Enhancing Neurite Regeneration and Angiogenesis.

An electrical signal is the key basis of normal physiological function of the nerve, and the stimulation of the electric signal also plays a very special role in the repair process of nerve injury. Electric stimulation is shown to be effective in promoting axonal regeneration and myelination, thereby promoting nerve injury repair. At present, it is considered that electric conduction recovery is a key aspect of regeneration and repair of long nerve defects. Conductive neural scaffolds have attracted more and more attention due to their similar electrical properties and good biocompatibility with normal nerves. Herein, PCL and MXene-PCL nerve guidance conduits (NGCs) were prepared; their effect on nerve regeneration was evaluated in vitro and in vivo. The results show that the NGCs have good biocompatibility in vitro. Furthermore, a sciatic nerve defect model (15 mm) of SD rats was made, and then the fabricated NGCs were implanted. MXene-PCL NGCs show similar results with the autograft in the sciatic function index, electrophysiological examination, angiogenesis, and morphological nerve regeneration. It is possible that the conductive MXene-PCL NGC could transmit physiological neural electric signals, induce angiogenesis, and stimulate nerve regeneration. This paper presents a novel design of MXene-PCL NGC that could transmit self-originated electric stimulation. In the future, it can be combined with other features to promote nerve regeneration.

Photothermal-triggered immunogenic nanotherapeutics for optimizing osteosarcoma therapy by synergizing innate and adaptive immunity.

Inadequate immune response remains a critical cause of immunotherapy failure in various tumor treatments. Herein, we offer a new approach to achieve a cross-talk between innate and adaptive immune responses based on a new nanoplatform for photothermal therapeutics. The nanoplatform was formed by linking titanium carbide MXene with Mn2+-contained ovalbumin (OVA), where it can trigger efficient mt-DNA presentation and the release of OVA and Mn2+ upon the irradiation of near-infrared laser. More importantly, the released mt-DNA and Mn2+ synergistically activate innate immunity via the cGAS-stimulator of the interferon genes signaling pathway, and the OVA and protein antigens from tumor cells enhance adaptive immunity. Furthermore, in an osteosarcoma model, we observed that the proposed nanoplatform leads to the effective presentation of tumor antigens, which boost the maturation of dendritic cells (DCs) to the hilt and thus improve the infiltration of cytotoxic T lymphocyte in primary and distant tumors. Collectively, our work not only demonstrates a method for constructing a new nanoplatform for photothermal therapeutics but also provides a general strategy for synchronously activating innate and adaptive immunities to promote the maturation of DCs for antimetastasis tumor therapy.

Dosimetry study of nasopharyngeal carcinoma based on Halcyon accelerator fixed-field intensity-modulated radiation therapy.

OBJECTIVE: Halcyon accelerator applies the flattening filter (FF)-free mode instead of the lead gate and FF treatment mode for traditional C-type accelerators. We aimed at comparing and analyzing the quality and delivery of nasopharyngeal carcinoma (NPC) plans between Halcyon and VitalBeam (VB) accelerators in fixed-field intensity-modulated radiation therapy (IMRT). METHODS: The IMRT plans for thirty patients with NPC who had received radiotherapy were optimized using the VB (Plan VB) and Halcyon (Plan H) accelerators. Quality assurance verification was then conducted. The dose coverage of the planning target volume (PTV) and organs at risk (OARs), monitor units (MUs), and delivery time were analyzed for each plan. RESULTS: All PTV and OAR indexes of Plan H and Plan VB met the clinical requirements. In the exposure dose of bilateral optic nerves between Plan H and Plan VB, no difference was found. The maximum dose of the lens, brainstem, spinal cord were 1.13 Gy, 1.36 Gy, 1.35 Gy, 2.82 Gy lower than the plan using VB , and the mean dose of the parotid glands were 3.82 Gy, 5.56 Gy lower than the plan using VB respectively, and an insignificant difference was found in the brainstem (P > 0.05). The MU for Plan H (22.92 ± 1.58 Gy) was higher than that for Plan VB (19.69 ± 4.52 Gy), and the difference was significant (P < 0.05). CONCLUSIONS: The treatment plans designed by Halcyon can meet clinical requirements with better protection for OARs and show advantages over VB in the dosimetry of NPC IMRT plans.

Quantifying Mediators of Racial Disparities in Knee Osteoarthritis Outcome Scores: A Cross-Sectional Analysis.

Studies on symptomatic osteoarthritis suggest that Black patients report worse pain and symptoms compared with White patients with osteoarthritis. In this study, we aimed to quantify the relationship among variables such as overall health and socioeconomic status that may contribute to disparities in patient-reported outcomes. METHODS: A total of 223 patients were enrolled. A mediation analysis was used to evaluate cross-sectional associations between race and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire, which was administered to patients prior to undergoing primary total knee arthroplasty. RESULTS: Black patients had worse KOOS pain, symptoms, and activities of daily living subscale scores than White patients. In our cohort, Black patients were younger, more likely to be female, and more likely to report lower educational status. We identified age, sex, Charlson Comorbidity Index, and education as partial mediators of racial disparities in KOOS subscale scores. Insurance status, deformity, radiographic (Kellgren-Lawrence) grade, C-reactive protein level, marital status, body mass index, and income did not show mediating effects. We found that, if age and sex were equal in both cohorts, the racial disparity in KOOS symptom scores would be reduced by 20.7% and 9.1%, respectively (95% confidence intervals [CIs], -5.1% to 47% and -5.5% to 26.3%). For KOOS pain scores, age and education level explained 18.9% and 5.1% of the racial disparity (95% CIs, -0.6% to 37% and -10.8% to 22.9%). Finally, for KOOS activities of daily living scores, education level explained 3.2% of the disparity (95% CI, -19.4% to 26.6%). CONCLUSIONS: No single factor in our study completely explained the racial disparity in KOOS scores, but our findings did suggest that several factors can combine to mediate this disparity in outcome scores. Quantification of variables that mediate racial disparity can help to build models for risk adjustment, pinpoint vulnerable populations, and identify primary points of intervention. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.