The effects of social determinants of health on anterior cruciate ligament injury recovery.

Context: Over 200,000 anterior cruciate ligament (ACL) injuries occur in the United States each year. While many patients choose to pursue ACL reconstruction (ACLR), the impact of social determinants of health (SDOH) on outcomes is unclear. Objective: The purpose of this study was to review and synthesize current literature to determine the impact of SDOH on outcomes following ACL reconstruction. Data sources: A systematic search of PubMed, CINAHL, Medline, PsychINFO, and Scopus was completed. Study selection: Articles reporting outcomes following ACLR were included if they discussed at least one SDOH and provided ACLR failure rates. Study design: Systematic review. Level of evidence: Level I. Results: After screening 712 studies, 13 were found that met inclusion criteria and were analyzed. Studies commonly examined the correlations between race, income, location, education, and insurance on outcomes following ACLR. Three studies found that the ACL revision risk for Black patients compared to White patients ranged from 0.23 to 0.78, while the revision risk for Hispanic patients compared to White patients ranged from 0.7 to 0.83. One study reported finding that the odds ratio of revision for the White patients was 1.32. Another study reported no difference in revision risk based on race. Patients living in urban areas were found to have improved outcomes compared to rural areas (Mean IKDC (Urban 85.3 vs Rural 81.87) and Tegner-Lysholm (Urban 88.26 vs Rural 84.82)). Lower socioeconomic status was correlated with decreased post-operative functional scores (KOOS, Marx and IKDC). Conclusion: Several SDOH such as White race, rural location, and low socioeconomic status may be independently correlated with worse ACLR outcomes in the form of increased revision rates or worse post-operative functional scores. However, further research is needed to better elucidate the degree of impact and interconnectedness of SDOH domains on ACLR patient outcomes.

Co-location analysis of pedestrian accident attributes for Ankara.

Even though accidents with pedestrians are more likely to have a severe or fatal outcome, most research concentrates on the vehicle part of the accidents. To make better policies and infrastructure decisions it is crucial to understand how and why such accidents happen. In this article, 2.588 pedestrian accidents from the year 2018 that resulted in injury or death in the city of Ankara, Türkiye are considered, and different attributes are analyzed co-location-wise. Three types of analysis will be undertaken for these accidents: temporal, natural environment, and pedestrian characteristics. The season of the year, weekend-weekday, and time of day will be explored for the temporal analysis. Visibility (daylight, twilight, and darkness) and rain are the natural surroundings of interest. The analyzed pedestrian characteristics are age group, gender, clothing colour, and nationality. Generally, the accident properties are evenly distributed and mostly the higher co-locations occur with themselves. Three important results stand out in this study. Firstly, the type of precaution appropriate to different time periods of the day should be applied, taking into account the locations that have the strongest co-location with themselves. Secondly, a seasonal approach should be adopted in determining places where pedestrian safety needs to be increased in the city. Lastly, pedestrian safety measures targeting especially both '0-14 and 65 + age groups' and 'foreign citizenship' should be prioritized in the identified locations. The results show that the co-location methodology is a good fit for analyzing pedestrian accidents and a wider use of this methodology for other accident types and in general might be beneficial.

Epidemiological Study of Track-and-Field Meets On-Field Medical Care.

BACKGROUND: Most epidemiological studies on track-and-field meets have been limited to the Olympics and world championships. These are meets in which only high-performance athletes participate at a certain time of the year. In contrast, epidemiological studies on athletes of various ages and across different seasons may provide health care providers with valuable insights into injury prevention and on-field medical care. The study aims to determine the trends and locations of injuries during track-and-field meets in athletes of various ages and seasons based on on-field medical care records. METHODS: The number and incidence of injuries requiring on-field medical care during or after the event were obtained from 39 track-and-field meets. Injuries were defined as cases that required on-field medical care. The incidence was defined as the number of injuries per 1000 athlete exposures wherein 1 athlete exposure is the athlete's participation in one event. We also recorded the number of injuries at each location and whether transportation to a medical station was required. RESULTS: A total of 191 injuries were reported. This study identified a population with a high incidence of injury (middle- and long-distance events, combined events, and athletes over the age of 19), areas within the stadium where injuries were more likely to occur (finish line and first turn), and a high rate of transport to the medical station (approximately 70%); most of them were transported to wheelchairs. CONCLUSION: The results provide insights into the trends, locations, and transport of injured athletes during track-and-field meets. Professionals will better understand the injuries occurring during track-and-field meets and can improve the efficiency of on-field medical care activities. They will also assist organizers in track-and-field meets to improve the safety of their meet operations.

An experimental investigation of the effect of barrier trench on vibration propagation on a laboratory scale model.

Vibration waves caused by construction or mining operations may cause damage to nearby structures or sensitive machinery and equipment. Some measures are implemented to eliminate or reduce this negative environmental effect of vibration. The barrier trench, one of these methods, aims to reduce the vibration by creating a suitable barrier between the structure and the vibration source on the ground. In this study, the effect of trench depth and distance from the source on vibration waves was simulated with a designed laboratory-scale test set-up to determine the effective parameters in barrier trench use. In addition, the effects of the superimposition of the source vibration wave with the reflected and refracted vibration waves from the trench, which has not been previously discussed in the literature, were also investigated. A laboratory scale gypsum-plaster block with dimensions of 200 cm × 90 cm x 70 cm was prepared and a Schmidt hammer was used as the impact energy source to generate vibration throughout the gypsum block. A trench barrier was opened at different depths on the test block and 588 vibration recordings were taken by the vibration monitor in different locations of the designed set-up. Statistical analyses were performed using vibration measurement results, trench source distance, and trench depths. As a result, vibration estimation equations depending on trench depth and the distance between the vibration source point and the trench were developed and how the presence of trench affects vibration propagation is revealed. It was found that vibrations increase due to the superposition of the source and reflected waves in front of the barrier trench. As the barrier depth increases, it is understood that the vibrations emanating from the near-surface vibration energy source are better blocked by the barrier. Thus, this study provides fundamental information on designing barrier trenches to avoid adverse effects of vibrations.

A New Approach to Ultra-Low Anterior Resection-Intersphincteric Dissection With Total Hiatal Ligament Excision for Very Low Rectal Cancer Located in the Posterior Wall of the Rectum: A More Satisfactory Technique for Local Recurrence Control.

BACKGROUND: The hiatal ligament, as the anatomical landmark for the completion of total mesorectal excision (TME) for ultra-low rectal cancer, represents a continuation of the longitudinal muscle of the rectum. It receives vascular supply from the median sacral artery and contains lymphatic vessels. In cases where ultra-low rectal cancer is located in the posterior rectal wall, the hiatal ligament may theoretically serve as an anatomical region susceptible to direct tumor cell spread or distant metastasis. OBJECTIVE: To evaluate the effect of circumferential tumor location (CTL) on postoperative survival of low rectal cancer and to determine the effect of total hiatal ligament excision (THLE) on the prognosis of patients with posterior rectal cancer. METHODS: Patients with ultra-low rectal cancer who underwent laparoscopic surgery between March 2014 and October 2021 were enrolled in this study. Propensity score matching (PSM) analysis was used to compare the clinicopathological characteristics and prognosis of patients in the posterior group and the non-posterior group. Prognostic factors were identified using COX regression. PSM analysis was also used in the posterior tumor subgroup to compare the clinicopathological characteristics and prognosis of patients in the hiatal ligament traditional transection (HLTT) and THLE groups. RESULTS: After PSM, OS, and DFS were comparable between the posterior and non-posterior groups. Similarly, no difference was noted in the local recurrence rate between the two groups (p = 0.23). The prognosis of ultra-low rectal cancer was not affected by CTL. However, the local recurrence rate was significantly lower in the THLE group compared with the HLTT group (p = 0.023). Multivariate analysis of the posterior group identified CRM, TNM stage III, and HLTT as independent risk factors for local recurrence-free survival. CONCLUSIONS: CTL is not a prognostic risk factor for low rectal cancer. In posterior wall tumors, THLE significantly reduces the local recurrence rate for low rectal cancer.

Enhanced Regulation of Selectivity by the Coupling Effects of Surface Acidity and Strain Effects via Precisely Controlling the Location of Pt.

Loading a sensitizer and constructing a rational nanostructure have been reported to be effective approaches for enhancing the catalytic/sensing performance. However, the impact of the precise loading position on the catalytic/sensing performance is always overlooked. Here, we discovered that precisely changing the location of Pt clusters from the outside of Al2O3-ZnO nanocoils (O-PtAlZnNCs) to the inner side of the nanocoils (I-PtAlZnNCs) could change the sensing performance of the sensor from H2S to acetone. Furthermore, precisely loading Pt inside of the confined space led to a high sensing performance and reduced the limit of detection (LOD) of acetone by a factor of 50 times (from 100 to 2 ppb). Combining X-ray photoelectron spectroscopy (XPS), NH3-diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS), in situ X-ray absorption spectroscopy (XAS), and density functional theory (DFT) simulations, the enhancement of sensitivity and regulation of sensing selectivity are attributed to the coupling effects from enrichment of confined space and Al2O3 acid-base active sites as well as the regulation of electronic structure by location-dominated strain effects. This work not only provides a novel sight to precisely regulate the selectivity and obtain ultrasensitive materials but also serves as a useful instruction for further understanding and precisely designing specific sensors and catalysts with high performance.

Real-Time Location Systems: Revolutionizing Porter Services for Improving Patient Care Efficiency.

BACKGROUND: Transport porters (TPTs) are essentially involved in supporting hospital operations and maintaining high-quality patient care. The traditional porter management lacks transmission of temporal and spatial information of the porters thus affecting porter operations. In this work, we investigate the barriers in traditional porter management and the impact of a real-time location system (RTLS) in improving time and cost efficiency for porter operations. METHODOLOGY: A six-month study was conducted at Medanta - The Medicity, Gurugram investigating the limitations of traditional management and efficiency of indoor porter tracking system (IPTS) on TPTs operational activities by assessing the waiting time and total turnaround time (TAT). The cost-effectiveness of IPTS was determined based on capital expenditure and return on investment (ROI) post-technology implementation. RESULTS: This study highlights that improvements are required in porter management as 175 out of 285 (62%) calls were unanswered by TPTs. Post deployment of IPTS, the TAT for A-wing was reduced from 28 minutes to 20 minutes, and for B-wing, it was reduced from 26 minutes to 18 minutes. Staff optimization of three and four porters was done for A-wing and B-wing, respectively. The capital expenditure was recovered by reduced wait time and optimization of staff, thereby anticipating a monthly saving of ₹0.18 million (US$ 2150). The effective outcome of IPTS porter management envisaged its expansion to inpatient medicine delivery with a substantial cost reduction of ₹8.0 million (US$ 96,000) over three years. CONCLUSION: The implementation of IPTS improved the operational activities of porters and improved staff utilization. Cost savings from staff optimization lays the groundwork for new technology integrations for long-term operational advancements.

Spatial Similarity of MRI-Visible Perivascular Spaces in Healthy Young Adult Twins.

PURPOSE: This study aimed to determine whether genetic factors affect the location of dilated perivascular spaces (dPVS) by comparing healthy young twins and non-twin (NT) siblings. MATERIALS AND METHODS: A total of 700 healthy young adult twins and NT siblings [138 monozygotic (MZ) twin pairs, 79 dizygotic (DZ) twin pairs, and 133 NT sibling pairs] were collected from the Human Connectome Project dataset. dPVS was automatically segmented and normalized to standard space. Then, spatial similarity indices [mean squared error (MSE), structural similarity (SSIM), and dice similarity (DS)] were calculated for dPVS in the basal ganglia (BGdPVS) and white matter (WMdPVS) between paired subjects before and after propensity score matching of dPVS volumes between groups. Within-pair correlations for the regional volumes of dVPS were also assessed using the intraclass correlation coefficient. RESULTS: The spatial similarity of dPVS was significantly higher in MZ twins [higher DS (median, 0.382 and 0.310) and SSIM (0.963 and 0.887) and lower MSE (0.005 and 0.005) for BGdPVS and WMdPVS, respectively] than in DZ twins [DS (0.121 and 0.119), SSIM (0.941 and 0.868), and MSE (0.010 and 0.011)] and NT siblings [DS (0.106 and 0.097), SSIM (0.924 and 0.848), and MSE (0.016 and 0.017)]. No significant difference was found between DZ twins and NT siblings. Similar results were found even after the subjects were matched according to dPVS volume. Regional dPVS volumes were also more correlated within pairs in MZ twins than in DZ twins and NT siblings. CONCLUSION: Our results suggest that genetic factors affect the location of dPVS.

Navigating Rehabilitation Transitions at Street Level: A Qualitative Analysis of Municipal Service Allocation to Individuals With Complex Needs.

The transition of patients with complex needs from hospital to municipal rehabilitation following moderate and severe brain injury is challenging. This qualitative study explored the municipal service allocation processes within such transitions. The caseworkers' comprehensive task of combining patients' preferences and needs, healthcare providers' recommendations and municipal guidelines and service allocation were analysed. Data comprised of patients' health records, meeting observations and semi-structured interviews with municipal staff, patients and next of kin. Results demonstrated that the issue of most concern was the location of where the patient was to continue municipal rehabilitation. Municipal caseworkers gathered extensive information, including recommendations from healthcare providers and preferences of patients and next of kin. These were frequently in contrast to the municipal guidelines' requirements and the services' organisational structure. The discrepancies led to tension, which was difficult to manoeuvre. This study indicates that incorporating individually tailored services into the daily service allocation practice can be demanding and even dilemmatic. The designated focus on the transition of patients with complex rehabilitation needs gives insights into how service allocation, user involvement and coordination policies are acted out in practice and may directly influence rehabilitation trajectories.

The temporal and spatial evolution characteristics of induced seismicity in the Changning shale gas field based on dense array.

In this paper, we performed microseismicity detection and location using the deep learning method and obtained a high-precision earthquake catalog in the Changning gas field, which is one of the largest shale gas production demonstration areas in China. We found that the spatial and temporal characteristics of seismicity in the region are indicative of its correlation with industrial operations. The distribution of earthquakes at depth reflected variations in reservoir depth and provided valuable constraints on it. The horizontal layered distribution of earthquakes at depth is due to the formation of fracture surfaces from interconnected fractures near the reservoir during hydraulic fracturing (HF) operations, which clearly demonstrates how HF operations impact seismicity. We suggested that the horizontally layered distribution was driven by two fundamental mechanisms: reactivation of pre-existing faults during HF and injection of high-pressure fluids into the reservoir, leading to fracture creation. Several ML ≥4 earthquakes, which did not occur on well-defined seismogenic faults, may have been triggered by pore elastic coupling resulting from regional stress accumulation and fluid injection. Significantly, the ML 4.9 seismic sequence occurring at the basement indicates that fracking has reactivated and promoted pre-existing faults, highlighting the need for further investigation into potential seismic hazards in the region.

Lamb Wave Probabilistic Damage Identification Based on the Exchanging-Element Time-Reversal Method.

The commonly used baseline-free Lamb wave damage identification methods often require a large amount of sensor data to eliminate the dependence on baseline signals. To improve the efficiency of damage localization, this paper proposes a new Lamb wave damage location method, namely the probabilistic exchanging-element time-reversal method (PEX-TRM), which is based on the exchanging-element time-reversal method (EX-TRM) and the probabilistic damage identification method. In this method, the influence of the damage wave packet migration on the correlation coefficient between the reconstructed signals of each sensing path and the initial excitation signal is analyzed, and the structure is divided into multiple regional units corresponding to the damage to locate damage. In addition, the influence of the number of sensing paths on the location accuracy is also analyzed. A method of damage probability imaging based on structural symmetry is proposed to enhance location accuracy in the case of sparse sensing paths. The experimental and simulation results verify that the method can achieve damage location with fewer excitation times. Moreover, this method can avoid the problem that the damage wave packet is difficult to extract, improve the efficiency of damage location, and promote the engineering application of the Lamb wave damage location method.

Outcomes of primary transobturator mid-urethral sling surgery in women of different ages.

INTRODUCTION: Older age is associated with greater likelihood of urinary incontinence and unmet care needs. It was hypothesized that age might influence clinical and ultrasound outcomes of transobturator mid-urethral sling (TOS) surgery. The aim of this study was to compare 1-year postoperative clinical and ultrasonographic outcomes of TOS surgery among women of different ages. METHODS: A retrospective analysis of a cohort of women who underwent primary and isolated TOS surgery for uncomplicated urodynamic stress incontinence was undertaken. All women underwent pre-operative and 1-year postoperative evaluations including clinical interview, pelvic examination, urodynamic studies and introital four-dimensional ultrasound. To be eligible for surgery, women needed to be independent in their daily life, and to have an acceptable level of surgical risk on pre-operative assessment. The primary outcome was the rate of stress urinary incontinence (SUI) after surgery. The secondary outcomes comprised postoperative adverse events and ultrasound findings. RESULTS: In total, 162, 213, 60 and 29 women aged <51, 51-64, 65-74 and ≥75 years, respectively, were included in this study. At 1-year postoperative assessment, older women were more likely to report SUI and bothersome SUI, while the severity of SUI and postoperative adverse events were similar in older women compared with other age groups. Ultrasound revealed that the sling tended to be looser and higher in older women. CONCLUSION: TOS surgery is effective and safe for women of all ages who are independent in their daily life and who have an acceptable level of surgical risk. The sling tended to be looser and higher in older women.

A semi-probabilistic Bayesian method to identify the number and location of potential sources in 3D unconfined aquifer using limited observed concentration.

Source identification of a contaminant has always been challenging for accurately modeling groundwater transport. Source identification problems are classified into several parts, such as identifying the location of contamination, the strength of contamination, the time the contaminant is introduced into the groundwater, and the duration of its activity. Identifying the sources considering all the parts as variables increases the computational complexity. Reducing the number of variables in source identification problems is necessary for a swift solution through optimization approaches. The most challenging variable in source identification modeling is the location of contamination, as it is a discrete variable for almost all the numerical solutions of groundwater models. In this research study, we have created a methodology to narrow the location of contamination from a random distribution throughout the aquifer to a reasonable number of probable locations. Although methods to identify the location of contamination were devised earlier, we have attempted an approach of combining a particle tracking approach with Bayesian method of updating the probabilities as a novel approach, where the observation data is limited. We have considered the aquifer parameters and observation well data and devised a method with a Lagrangian approach to particle movement to identify the potential source locations. We have refined the source locations to a narrower probability distribution using the Bayesian method of updating the probability through new information of refined grid space. We have tested the models to identify the potential sources with different hypothetical problems and identified the sources in advective dominant transport with an average probability of 0.53, diffusion dominant transport with an average probability of 0.62, heterogenous soils with an average probability of 0.99, anisotropic aquifer with an average probability of 0.91, and aquifer with irregular boundary with an average probability of 0.96 to identify the location nearest to the actual contaminant source. The results are satisfactory in identifying the number of potential sources with an accuracy of 88 % (15 identified out of 17 sources with a probability greater than 0.4) and their locations in the aquifer with a probability of 0.223 for exact location identification. The probability of finding a source nearest to the actual location is 0.745 at an average distance of 11.6 m from the actual source location.

Axillary pilonidal sinus: an unusual presentation: a case report with literature review.

Despite its rarity, pilonidal sinus (PNS) in atypical locations poses significant diagnostic challenges, underscoring the need for early identification and appropriate treatment strategies. This case highlights a rare occurrence of a PNS in the axilla, emphasizing the importance of recognizing uncommon presentations of common ailments. A 27-year-old male presented with a 13-year history of painless axillary discharge, diagnosed with PNS based on clinical evaluation. Surgical excision under local anesthesia successfully treated the condition, showcasing the effectiveness of tailored management in addressing rare presentations of PNS. Surgical therapy for axillary pilonidal sinus enables complete resection and provides precise histopathological diagnoses, making it a suitable treatment option, particularly for cases involving atypical locations.

Evaluation of the clinical application value of artificial intelligence in diagnosing head and neck aneurysms.

OBJECTIVE: To evaluate the performance of a semi-automated artificial intelligence (AI) software program (CerebralDoc® system) in aneurysm detection and morphological measurement. METHODS: In this study, 354 cases of computed tomographic angiography (CTA) were retrospectively collected in our hospital. Among them, 280 cases were diagnosed with aneurysms by either digital subtraction angiography (DSA) and CTA (DSA group, n = 102), or CTA-only (non-DSA group, n = 178). The presence or absence of aneurysms, as well as their location and related morphological features determined by AI were evaluated using DSA and radiologist findings. Besides, post-processing image quality from AI and radiologists were also rated and compared. RESULTS: In the DSA group, AI achieved a sensitivity of 88.24% and an accuracy of 81.97%, whereas radiologists achieved a sensitivity of 95.10% and an accuracy of 84.43%, using DSA results as the gold standard. The AI in the non-DSA group achieved 81.46% sensitivity and 76.29% accuracy, as per the radiologists' findings. The comparison of position consistency results showed better performance under loose criteria than strict criteria. In terms of morphological characteristics, both the DSA and the non-DSA groups agreed well with the diagnostic results for neck width and maximum diameter, demonstrating excellent ICC reliability exceeding 0.80. The AI-generated images exhibited superior quality compared to the standard software for post-processing, while also demonstrating a significantly reduced processing time. CONCLUSIONS: The AI-based aneurysm detection rate demonstrates a commendable performance, while the extracted morphological parameters exhibit a remarkable consistency with those assessed by radiologists, thereby showcasing significant potential for clinical application.

Multi-Regional Pelvic Floor Muscle Function Diagnosis System Based on Inflatable Stretchable Electrode Array.

BACKGROUND: Effective prevention and treatment of pelvic floor dysfunction (PFD) necessitates the identification of lesions within the complex pelvic floor muscle (PFM) groups associated with various symptoms. Here, we developed a multi-region pelvic floor muscle functional diagnosis system (MPDS) based on an inflatable stretchable electrode array, which aids in accurately locating areas related to PFD. METHODS: Clinical diagnostic experiments were conducted on 56 patients with postpartum stress urinary incontinence (PSUI) and 73 postpartum asymptomatic controls. MPDS collects pelvic floor electromyography from all participants. By assessing EMG parameters such as activation time differences (ATD) and using Jensen-Shannon (JS) divergence to verify, with the aim of locating target muscle groups with functional abnormalities. RESULTS: Clinical test results showed that by observing the AT sequence of the PSUI group and the control group, muscle groups with functional abnormalities in the Pubococcygeus muscle (PC) and Puborectalis muscle (PR) regions could be preliminarily diagnosed. In the assessment of regional muscle contribution values based on JS divergence, it was verified that the contribution values of rapid contraction in the PC and PR regions of the PSUI group were relatively lower compared to those of the control group, which correlated with urinary control dysfunction. CONCLUSIONS: These experiments demonstrate that the MPDS helps in accurately locating target muscle groups with functional abnormalities, showcasing its potential in precise assessment of complex muscle groups such as PFM, which may improve diagnostic precision and reliability.

Laparoscopic hepatectomy is a feasible and safe choice for primary hepatocellular carcinoma located at favorable location during the development period of a tertiary hospital: A case-control study.

Objectives: Laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC) has been well known for its advantages in the past 10 years, but little is known regarding its oncologic outcomes while the technique is being developed at an institution. This study aimed to evaluate the safety and effectiveness of LH for patients with primary HCC at favorable locations, focusing on postoperative short- and long-term outcomes during the development period. Materials and Methods: We retrospectively reviewed patients diagnosed with primary HCC who underwent hepatectomy between January 2013 and December 2019 at Hualien Tzu Chi Hospital. Patients with HCC at favorable locations (anterolateral segments) were collected and divided into laparoscopic and open hepatectomy (OH) groups. The data for long-term outcomes, as the primary endpoint, and postoperative outcomes, as the secondary endpoint, were collected. Results: The review included 159 patients, among which 42 and 44 patients in favorable locations underwent open and laparoscopic hepatectomies, respectively. There were no significant differences in intraoperative blood loss, major complication rate, and 90-day mortality rate between the two groups. The laparoscopic group had a lower transfusion rate, shorter postoperative hospital stay, and lower 90-day readmission rate. There were no significant differences in 12-, 36-, and 60-month overall survival and disease-free survival. Conclusion: LH for favorably located HCC is the preferred surgical approach compared to OH due to the decreased transfusion rate, shorter postoperative hospital stay, and lower 90-day readmission rate. LH did not compromise the 90-day mortality rate with sustained long-term overall and disease-free survival. LH for favorably located HCC is a safe and effective surgical approach even during the development period.

The unusual location of primary hydatid cyst: A case series study.

Background: Cystic echinococcosis mainly affects the liver and lungs, in which the larvae from the microvascular wall in the liver pass to the lungs and then to the blood circulation and settle in any tissue or organ. Objectives: The objective of this study was to report the unusual location of hydatid cysts in infected patients in Sulaimaniyah City, Iraq. Patients and methods: This retrospective case series study enrolled 13 patients. They underwent a surgical operation to excise their cyst after confirmed diagnosis with blood investigations, electrocardiogram, chest X-ray, computed tomography scan, and magnetic resonance imaging (when needed). After the operation, the cyst was confirmed with histopathological examination, and patients were advised to take an Albendazole tablet. Results: Most patients were females from rural areas, with a mean age of 38.93 ± 14.4 years. Patients presented with cysts on the skin of the anterior abdominal wall, gluteal region, mesenteric area, pericardium, tibia bone meta diaphysis, right inguinal region, right thigh, skin of the anterior neck, spleen, left suprarenal gland, right breast, and the iliopsoas muscle. Conclusions: The hydatid cyst can affect any body part with no site immune and often produces nonspecific symptoms.

Location-biased ß-arrestin conformations direct GPCR signaling.

ß-arrestins are multifunctional intracellular proteins that regulate the desensitization, internalization and signaling of over 800 different G protein-coupled receptors (GPCRs) and interact with a diverse array of cellular partners1,2. Beyond the plasma membrane, GPCRs can initiate unique signaling cascades from various subcellular locations, a phenomenon known as "location bias"3,4. Here, we investigate how ß-arrestins direct location-biased signaling of the angiotensin II type I receptor (AT1R). Using novel bioluminescence resonance energy transfer (BRET) conformational biosensors and extracellular signal-regulated kinase (ERK) activity reporters, we reveal that in response to the endogenous agonist Angiotensin II and the ß-arrestin-biased agonist TRV023, ß-arrestin 1 and ß-arrestin 2 adopt distinct conformations across different subcellular locations, which are intricately linked to differential ERK activation profiles. We also uncover a population of receptor-free catalytically activated ß-arrestins in the plasma membrane that exhibits insensitivity to different agonists and promotes ERK activation on the plasma membrane independent of G proteins. These findings deepen our understanding of GPCR signaling complexity and also highlight the nuanced roles of ß-arrestins beyond traditional G protein pathways.

The Patterns of Failure and Prognostic Impact of Tumor Location in Patients Undergoing Reirradiation for Glioblastoma.

Introduction  RTOG 1205 is the only randomized study to evaluate the safety and efficacy of reirradiation (reRT) in recurrent glioblastoma (GBM). While this study showed that reRT was safe and improves progression-free survival (PFS), an improved approach to reRT is still needed. In this study, we report on patterns of failure and outcomes in a cohort of patients with recurrent GBM who underwent reRT. We hypothesize that patients at high risk of leptomeningeal spread (LMS) are not good candidates for reRT due to the risk of treatment-related toxicity without clinical benefit. Methods In this retrospective study, patients with recurrent GBM who underwent reRT at a single institution from 2015-2023 were included. Sociodemographic, treatment, and outcomes data were collected via chart review. Time to progression was defined as the time from the start of reRT to progression per the Response Assessment in Neuro-Oncology (RANO) criteria. Overall survival (OS) was defined as the time from the start of reRT to death. PFS and OS were estimated using the Kaplan-Meier method. Results Thirteen patients with recurrent GBM who underwent reRT were identified. The median age at diagnosis was 58 years. Six patients (46.2%) had tumors that were O6-methylguanine-DNA methyltransferase (MGMT) methylated, four (30.8%) were MGMT unmethylated, and three (23.11%) had unknown MGMT status. Eight patients underwent repeat resection after recurrence and before reRT. Most patients (n=7) received 35 Gy in 10 fractions with concurrent bevacizumab, while other patients were treated with 25-40 Gy in 5-15 fractions with grade 1 or less acute toxicity. Three patients were treated with tumor-treating fields. The median follow-up was five months. Median PFS was three months [95% confidence interval (95% CI): one to four months] and median OS was five months (95% CI, 1-8 months) as compared to 7.1 months and 10.1 months, respectively, on RTOG 1205. Five patients developed LMS after reRT, one patient died before progression, and the remaining seven patients all developed progression within one centimeter of the recurrent tumor. Of the patients who developed LMS, all had tumors abutting the ventricles and three underwent resection 2-17 months before reRT. Conclusion Patterns of failure suggest a potential treatment selection approach for patients with recurrent GBM, in which patients at high risk of LMS (tumor abutting ventricles with or without recent surgery) should not undergo reRT, while patients at low risk of LMS are good candidates for reRT. Furthermore, reRT could be administered with reduced margins given that all non-LMS recurrences were within 1cm of the original tumor. Additional studies are needed to validate this approach.