Intrabronchial schwannoma with right lower lobe obstructive bronchiectasis and organizing pneumonia: A case report.

We present the case of a 60-year-old female patient with no prior history of any systemic disease. She suffered from a prolonged cough that lasted more than 3 months, associated with poor appetite and weight loss of 5 kg. The pathology report of the pre-operative transbronchial needle biopsy was consistent with a neurogenic tumour. Chest computed tomography (CT) revealed a right lower lobe (RLL) mass-like consolidation of 8.67 cm with obstructive pneumonitis and suspicious posterior mediastinal invasion. The tumour was surgically resected with bronchial reconstruction, and the pathological diagnosis was intrabronchial schwannoma located inside the bronchus, a rare tumour that should be included as one of the differential diagnoses of primary bronchial tumours. The possibility of a surgical completed resection should be considered in patients with airway obstruction symptoms.

A piezoresistive-based 3-axial MEMS tactile sensor and integrated surgical forceps for gastrointestinal endoscopic minimally invasive surgery.

In robotic-assisted surgery (RAS), traditional surgical instruments without sensing capability cannot perceive accurate operational forces during the task, and such drawbacks can be largely intensified when sophisticated tasks involving flexible and slender arms with small end-effectors, such as in gastrointestinal endoscopic surgery (GES). In this study, we propose a microelectromechanical system (MEMS) piezoresistive 3-axial tactile sensor for GES forceps, which can intuitively provide surgeons with online force feedback during robotic surgery. The MEMS fabrication process facilitates sensor chips with miniaturized dimensions. The fully encapsulated tactile sensors can be effortlessly integrated into miniature GES forceps, which feature a slender diameter of just 3.5 mm and undergo meticulous calibration procedures via the least squares method. Through experiments, the sensor's ability to accurately measure directional forces up to 1.2 N in the Z axis was validated, demonstrating an average relative error of only 1.18% compared with the full-scale output. The results indicate that this tactile sensor can provide effective 3-axial force sensing during surgical operations, such as grasping and pulling, and in ex vivo testing with a porcine stomach. The compact size, high precision, and integrability of the sensor establish solid foundations for clinical application in the operating theater.

Chronic low-grade inflammation associated with higher risk and earlier onset of cardiometabolic multimorbidity in middle-aged and older adults: a population-based cohort study.

Evidence regarding the role of chronic low-grade inflammation in the progression of cardiometabolic diseases (CMDs) and cardiometabolic multimorbidity (CMM) is currently limited. This prospective cohort study, utilising data from the UK Biobank, included 273,804 adults aged 40-69 years initially free of CMD at baseline. CMM was defined as the coexistence of two or more CMDs, such as coronary artery disease, type 2 diabetes mellitus, hypertension and stroke. The aggregated inflammation score (INFLA-score), incorporating C-reactive protein, white blood cell count, platelet count and granulocyte-to-lymphocyte ratio, quantified chronic low-grade inflammation. Absolute risks (ARs), hazard ratios (HRs) and 95% confidence intervals (CIs) assessed the association of increased INFLA-score with the risk of CMMs and CMDs. The accelerated failure time model explored the effect of INFLA-score on the time to CMM onset, and a restricted cubic spline characterised the dose-dependent relationship between INFLA-score and CMM risk. After a median follow-up of 166.37 months, 13,755 cases of CMM were identified. In quartiles with increasing INFLA-score levels, CMM ARs were 4.41%, 4.49%, 5.04% and 6.01%, respectively; HR increased by 2%, 15% and 36%, respectively, compared to the lowest quartile. The INFLA-score and CMM risk relationship was nonlinear (P for nonlinear < 0.001), exhibiting a significant risk trend change at a score of 9. For INFLA-score < 9, CMM risk increased by 1.9% for each 1-point increase; for INFLA-score ≥ 9, the risk increased by 5.9% for each 1-point increase. Additionally, a higher INFLA-score was associated with an earlier onset of CMM (P < 0.001). Compared to the first INFLA-score quartile, the AFT model revealed adjusted median times to CMM occurrence were 2.92, 6.10 and 13.19 months earlier in the second, third and fourth quartile groups, respectively. Chronic low-grade inflammation is associated with a higher risk of cardiometabolic multimorbidity and earlier onset among middle-aged and older adults. Monitoring and screening the INFLA-score in adults without CMDs may improve early prevention of CMM.

Optical conductivity of the Majorana mode at the s- and d-wave topological superconductor edge.

The Majorana fermion offers fascinating possibilities such as non-Abelian statistics and nonlocal robust qubits, and hunting it is one of the most important topics in current condensed matter physics. Most of the efforts have been focused on the Majorana bound state at zero energy in terms of scanning tunneling spectroscopy searching for the quantized conductance. On the other hand, a chiral Majorana edge channel appears at the surface of a three-dimensional topological insulator when engineering an interface between proximity-induced superconductivity and ferromagnetism. Recent advances in microwave spectroscopy of topological edge states open a new avenue for observing signatures of such Majorana edge states through the local optical conductivity. As a guide to future experiments, we show how the local optical conductivity and density of states present distinct qualitative features depending on the symmetry of the superconductivity, that can be tuned via the magnetization and temperature. In particular, the presence of the Majorana edge state leads to a characteristic nonmonotonic temperature dependence achieved by tuning the magnetization.

Effects of oscillatory positive expiratory pressure therapy in patients undergoing thoracic or upper abdominal surgery: A systematic review and meta-analysis.

Background: Preventing postoperative complications and accelerating patient recovery are critical issues in clinical treatment and nursing care. This meta-analysis aimed to evaluate the effects of oscillatory positive expiratory pressure therapy (OPEPT) in patients undergoing thoracic or abdominal surgery. Methods: We searched PubMed, the Cochrane Library, Web of Science, EBSCO, SinoMed, Weipu, WanFang, and China National Knowledge Infrastructure (CNKI) for randomized controlled trials (RCTs) on the role of OPEPT on patients undergoing thoracic and upper abdominal surgeries. Two researchers independently conducted literature screening, quality assessment, and data extraction based on the inclusion and exclusion criteria, and used the RevMan 5.4 software to perform the meta-analysis. Results: A total of 13 RCTs involving 1166 patients undergoing thoracic or abdominal surgery were included. The meta-analysis results showed that the decreases in FEV1[MD = 0.30, 95%CI (0.22, 0.38), P < 0.001] and FVC levels [MD = 0.38, 95%CI (0.26, 0.49), P < 0.001] were statistically less in the OPEPT group than those in the control group. OPEPT could increase the postoperative drainage volume [MD = 91.53, 95%CI (57.55, 125.50), P < 0.001] and reduce the length of hospital stay [MD = -1.85, 95%CI (-3.42, -0.28), P = 0.02]. no significant effects on the FEV1/FVC [MD = 2.60, 95%CI (-0.46, 5.67), P = 0.10] and the indwelling time of drainage tube [MD = -1.39, 95%CI (-3.18, 0.41), P = 0.13] between patients undergoing OPEPT and routine care. No publication bias was detected amongst the synthesized outcomes (all P > 0.05). Conclusion: OPEPT, with its promising therapeutic approach, has shown to positively influence the recovery process for patients undergoing thoracic and upper abdominal surgeries. More high-quality, large-sample studies are needed in the future to explore the efficacy and safety of OPEPT.

Integrating Complaint Analysis into Hospital Management: A Comparative Study of Surgical and Non-Surgical Complaints.

Aims/Background: In an era where patient-centred care is paramount, effectively managing and analyzing hospital complaints is crucial for improving service quality and patient satisfaction. This study examines hospital complaints to enhance management practices by differentiating between surgery-related and non-surgery-related grievances. By identifying patterns in complaint types and outcomes, we aim to inform targeted quality improvement strategies that address specific patient concerns and boost operational efficiency. Methods: The study utilized data from an internal complaint management system over one year. Complaints were categorized as either surgery-related or non-surgery-related. Descriptive statistics and cross-tabulation analysis were employed to examine the data. The sample comprised 132 complaints, with 67 being surgery-related and 65 non-surgery-related. Results: The analysis revealed that surgery-related complaints frequently involved issues with 'Patient Communication' and 'Surgical Error', while non-surgery-related complaints were primarily about the 'Medical Treatment Process'. The Surgery Department received the highest number of complaints, indicating a critical area for intervention. Additionally, the correlation between complaint types and outcomes provided insights into potential areas for improvement. Conclusion: The findings highlight the need for targeted communication training and procedural enhancements in surgical departments. Non-surgical departments should focus on improving treatment protocols and transparency. These strategies can reduce complaints and improve patient satisfaction. Future research should develop and test interventions based on these insights to further enhance healthcare quality.

Bio-Based Polyurethane-Urea with Self-Healing and Closed-Loop Recyclability Synthesized from Renewable Carbon Dioxide and Vanillin.

Developing recyclable and self-healing non-isocyanate polyurethane (NIPU) from renewable resources to replace traditional petroleum-based polyurethane (PU) is crucial for advancing green chemistry and sustainable development. Herein, a series of innovative cross-linked Poly(hydroxyurethane-urea)s (PHUUs) were prepared using renewable carbon dioxide (CO2) and vanillin, which displayed excellent thermal stability properties and solvent resistance. These PHUUs were constructed through the introduction of reversible hydrogen and imine bonds into cross-linked polymer networks, resulting in the cross-linked PHUUs exhibiting thermoplastic-like reprocessability, self healing, and closed-loop recyclability. Notably, the results indicated that the VL-TTD*-50 with remarkable hot-pressed remolding efficiency (nearly 98.0%) and self-healing efficiency (exceeding 95.0%) of tensile strength at 60 °C. Furthermore, they can be degraded in the 1M HCl and THF (v:v = 2:8) solution at room temperature, followed by regeneration without altering their original chemical structure and mechanical properties. This study presents a novel strategy for preparing cross-linked PHUUs with self-healing and closed-loop recyclability from renewable resources as sustainable alternatives for traditional petroleum-based PUs.

Analysis of combined probability and nonprobability samples: A simulation evaluation and application to a teen smoking behavior survey.

In scientific studies with low-prevalence outcomes, probability sampling may be supplemented by nonprobability sampling to boost the sample size of desired subpopulation while remaining representative to the entire study population. To utilize both probability and nonprobability samples appropriately, several methods have been proposed in the literature to generate pseudo-weights, including ad-hoc weights, inclusion probability adjusted weights, and propensity score adjusted weights. We empirically compare various weighting strategies via an extensive simulation study, where probability and nonprobability samples are combined. Weight normalization and raking adjustment are also considered. Our simulation results suggest that the unity weight method (with weight normalization) and the inclusion probability adjusted weight method yield very good overall performance. This work is motivated by the Buckeye Teen Health Study, which examines risk factors for the initiation of smoking among teenage males in Ohio. To address the low response rate in the initial probability sample and low prevalence of smokers in the target population, a small convenience sample was collected as a supplement. Our proposed method yields estimates very close to the ones from the analysis using only the probability sample and enjoys the additional benefit of being able to track more teens with risky behaviors through follow-ups.

Water-soluble biodegradable polyesters with pH and ionic responsivity.

The synthesis of novel water-soluble polymers with biodegradability is an effective way to mitigate their negative environmental impacts. In this study, semi-aromatic copolyester poly(butylene succinate-co-butylene terephthalate) (PBST) with exceptional biodegradability is used as the resin matrix. Anionic sodium 1-3-isophthalate-5-sulfonate (SIPA) is introduced as a fourth monomer to prepare random poly(butylene succinate-co-butylene terephthalate-co-butylene 5-sodiosulfoisophthalate) (PBSTS) copolyesters by melt copolymerization. The incorporation of ionic groups enhances the hydrophilicity and water absorption of the copolyesters, resulting in water-soluble materials that exhibit ionic and temperature responsivity. Furthermore, the ionized biodegradable copolyesters demonstrate distinct pH-dependent degradation, which is accelerated at pH = 5.5 and 8.5 but inhibited at pH = 7.2. Degradation assessments in simulated body fluids reveal that the PBSTS copolyesters exhibit significant degradation in gastric fluids at pH = 1.5 with minimal degradation in intestinal fluids at pH = 6.8 and in body fluids at pH = 7.0. This unique degradation performance highlights the potential of these materials for addressing the challenges associated with selective drug delivery and localized controlled release in the human body.

Exploring the ED50 and ED95 of Remimazolam for Laryngeal Mask Airway Insertion During General Anesthesia in Pediatric Strabismus Correction Surgery.

AIM: Remimazolam, known for its rapid onset, quick metabolism, and short recovery time from sedation, offers significant advantages in clinical anesthesia. Previous studies have primarily investigated its application in adult surgical anesthesia, with less focus on its utilization in pediatric patients. Therefore, we aimed to explore the 50% effective dose (ED50) and 95% effective dose (ED95) of remimazolam for laryngeal mask airway (LMA) insertion during general anesthesia in pediatric strabismus correction surgery and investigate its dose-response relationship, thereby providing valuable reference data for safer and more rational clinical use of remimazolam. METHODS: This study included 32 patients aged 3-12 years undergoing strabismus correction surgery at Ningbo Aier Guangming Eye Hospital in 2024. The dosage of remimazolam was determined according to the Dixon 'up-and-down' sequential method: the starting induction dose was 0.2 mg/kg, with a step dose of 0.05 mg/kg. In cases of positive anesthetic effect, the subsequent patient received a reduced step dose, while in cases of negative anesthetic effect, the next subject received an increased step dose. The trial was terminated upon observing seven "positive-negative" crossover points. Furthermore, the ED50 and ED95, along with their 95% confidence intervals (95% CI) were calculated using the Probit regression analysis. Additionally, vital signs of the patients, such as peripheral oxygen (SpO2), heart rate, and blood pressure, along with the incidence of adverse events, were monitored. RESULTS: The ED50 of remimazolam for LMA insertion in pediatric strabismus correction surgery was 0.300 mg/kg (95% CI 0.276-0.323 mg/kg), and the ED95 was 0.369 mg/kg (95% CI 0.324-0.414 mg/kg). Throughout the surgery, SpO2, heart rate, and blood pressure remained stable without any significant fluctuations. CONCLUSIONS: The ED50 and ED95 of remimazolam for LMA insertion in pediatric strabismus correction surgery are 0.300 mg/kg and 0.369 mg/kg, respectively. This study demonstrates that remimazolam is both safe and effective for LMA insertion during general anesthesia in pediatric strabismus correction surgery.

Ionized copolyesters with pH-responsive degradability: Accelerated degradation in specific environments.

The development of environmentally responsive biodegradable polymers is a promising solution for balancing the stability and degradability of biodegradable plastics. In this study, a commercial biodegradable polyester, poly(butylene adipate-co-butylene terephthalate) (PBAT), was used as the substrate and was synthetically modified with a small amount of anionic sodium 1-3-isophthalate-5-sulfonate (SIPA) to obtain the ionized random poly(butylene adipate-co-butylene terephthalate-co-butylene 5-sodiosulfoisophthalate) (PBATS). The introduction of the sodium sulfonate ionic group enhanced the mechanical and heat-resistant properties of the material, while significantly improving the hydrophilicity and water absorption of the copolyesters of PBATSs and endowing them with special pH-responsive degradation properties. Compared with PBAT, PBATS copolyesters could accelerate degradation in acidic or alkaline buffer solutions and natural seawater, while degradation was inhibited in neutral buffer solutions at pH 7.2. Degradation experiments in simulated gastric, intestinal, and body fluids revealed that the copolyester showed specific and rapid degradation in acidic gastric fluids. This environmentally-responsive degradable material greatly expands the special applications of biodegradable polyesters in the fields of environmental remediation and medical applications.

A new strain of Rhodococcus indonesiensis T22.7.1T and its functional potential for deacetylation of chitin and chitooligsaccharides.

Introduction: Chitin, abundant in marine environments, presents significant challenges in terms of transformation and utilization. A strain, T22.7.1T, with notable chitin deacetylation capabilities, was isolated from the rhizosphere of Acanthus ebracteatus in the North Sea of China. Comparative 16S rDNA sequence analysis showed that the new isolate had the highest sequence similarity (99.79%) with Rhodococcus indonesiensis CSLK01-03T, followed by R. ruber DSM 43338T, R. electrodiphilus JC435T, and R. aetherivorans 10bc312T (98.97%, 98.81%, and 98.83%, respectively). Subsequent genome sequencing and phylogenetic analysis confirmed that strain T22.7.1T belongs to the R. indonesiensis species. However, additional taxonomic characterization identified strain T22.7.1T as a novel type strain of R. indonesiensis distinct from CSLK01-03T. Methods: This study refines the taxonomic description of R. indonesiensis and investigates its application in converting chitin into chitosan. The chitin deacetylase (RiCDA) activity of strain T22.7.1T was optimized, and the enzyme was isolated and purified from the fermentation products. Results: Through optimization, the RiCDA activity of strain T22.7.1T reached 287.02 U/mL, which is 34.88 times greater than the original enzyme's activity (8.0 U/mL). The natural CDA enzyme was purified with a purification factor of 31.83, and the specific activity of the enzyme solution reached 1200.33 U/mg. RiCDA exhibited good pH and temperature adaptability and stability, along with a wide range of substrate adaptabilities, effectively deacetylating chitin, chitooligosaccharides, N-acetylglucosamine, and other substrates. Discussion: Product analysis revealed that RiCDA treatment increased the deacetylation degree (DD) of natural chitin to 83%, surpassing that of commercial chitosan. Therefore, RiCDA demonstrates significant potential as an efficient deacetylation tool for natural chitin and chitooligosaccharides, highlighting its applicability in the biorefining of natural polysaccharides.

Enhanced IDOL segmentation framework using personalized hyperspace learning IDOL.

BACKGROUND: Adaptive radiotherapy (ART) workflows have been increasingly adopted to achieve dose escalation and tissue sparing under shifting anatomic conditions, but the necessity of recontouring and the associated time burden hinders a real-time or online ART workflow. In response to this challenge, approaches to auto-segmentation involving deformable image registration, atlas-based segmentation, and deep learning-based segmentation (DLS) have been developed. Despite the particular promise shown by DLS methods, implementing these approaches in a clinical setting remains a challenge, namely due to the difficulty of curating a data set of sufficient size and quality so as to achieve generalizability in a trained model. PURPOSE: To address this challenge, we have developed an intentional deep overfit learning (IDOL) framework tailored to the auto-segmentation task. However, certain limitations were identified, particularly the insufficiency of the personalized dataset to effectively overfit the model. In this study, we introduce a personalized hyperspace learning (PHL)-IDOL segmentation framework capable of generating datasets that induce the model to overfit specific patient characteristics for medical image segmentation. METHODS: The PHL-IDOL model is trained in two stages. In the first, a conventional, general model is trained with a diverse set of patient data (n = 100 patients) consisting of CT images and clinical contours. Following this, the general model is tuned with a data set consisting of two components: (a) selection of a subset of the patient data (m < n) using the similarity metrics (mean square error (MSE), peak signal-to-noise ratio (PSNR), structural similarity index (SSIM), and the universal quality image index (UQI) values); (b) adjust the CT and the clinical contours using a deformed vector generated from the reference patient and the selected patients using (a). After training, the general model, the continual model, the conventional IDOL model, and the proposed PHL-IDOL model were evaluated using the volumetric dice similarity coefficient (VDSC) and the Hausdorff distance 95% (HD95%) computed for 18 structures in 20 test patients. RESULTS: Implementing the PHL-IDOL framework resulted in improved segmentation performance for each patient. The Dice scores increased from 0.81 ± $ \pm $ 0.05 with the general model, 0.83 ± 0.04 $ \pm 0.04$ for the continual model, 0.83 ± 0.04 $ \pm 0.04$ for the conventional IDOL model to an average of 0.87 ± 0.03 $ \pm 0.03$ with the PHL-IDOL model. Similarly, the Hausdorff distance decreased from 3.06 ± 0.99 $ \pm 0.99$ with the general model, 2.84 ± 0.69 $ \pm 0.69$ for the continual model, 2.79 ± 0.79 $ \pm 0.79$ for the conventional IDOL model and 2.36 ± 0.52 $ \pm 0.52$ for the PHL-IDOL model. All the standard deviations were decreased by nearly half of the values comparing the general model and the PHL-IDOL model. CONCLUSION: The PHL-IDOL framework applied to the auto-segmentation task achieves improved performance compared to the general DLS approach, demonstrating the promise of leveraging patient-specific prior information in a task central to online ART workflows.

The value of serum PCT/ALB and CRP/ALB ratios in evaluating the condition and prognosis of craniocerebral trauma.

INTRODUCTION: The aim of the study was to explore the value of serum procalcitonin to albumin (PCT/ALB) and C-reactive protein to albumin (CRP/ALB) ratios in evaluating the condition and prognosis of craniocerebral trauma (CT). MATERIAL AND METHODS: 158 patients with CT admitted to the emergency department of our hospital from January 2020 to June 2022 were selected as the study subjects. According to the Glasgow coma scale (GCS) score, 158 patients with CT were grouped in a mild group (GCS score 13-15 points, n = 68), a moderate group (GCS score 9-12 points, n = 61), and a severe group (GCS score 3-8 points, n = 29). Besides, according to the patient's Glasgow prognosis (GOS) score, 158 patients with CT were divided into a good prognosis group (GOS score 4-5 points, n = 110) and a poor prognosis group (GOS score 1-3 points, n = 48). Serum PCT/ALB and CRP/ALB levels of different groups were compared. The correlation between PCT/ALB and CRP/ALB ratios and the score of GCS and GOS was explored using Pearson correlation analysis. Prognosis-related influencing factors were found out through multivariate logistic regression. The value of serum PCT/ALB and CRP/ALB ratios in evaluating the condition and prognosis of CT was evaluated by the ROC curve. RESULTS: Patients in the moderate and severe groups had much higher ratios of PCT/ALB and CRP/ALB and sharply lower GCS scores than those in the mild group ( p < 0.001). Compared with the patients in the moderate group, those in the severe group had much higher PCT/ALB and CRP/ALB ratios and obviously lower GCS scores ( p < 0.001). Patients with poor prognosis had markedly higher PCT/ALB and CRP/ALB ratios and memorably lower GOS score than the patients with good prognosis ( p < 0.001). A negative correlation between PCT, CRP, PCT/ALB ratio, CRP/ALB ratio and GCS scores ( r = -0.821, -0.857, -0.750, -0.766, p < 0.001) and GOS scores ( r = -0.636, -0.628, -0.595, -0.628, p < 0.001) was revealed by Pearson correlation analysis. ALB was correlated positively with GCS score and GOS score ( r = 0.381, 0.413, p < 0.001). Multivariate logistic regression analysis exhibited that PCT/ALB ratio and CRP/ALB ratio were related to poor prognosis of CT patients ( p < 0.05). ROC curve analysis showed that the combined PCT/ALB ratio and CRP/ALB area under the curve (AUC) were 0.883 and 0.860, respectively, which were used to assess the severity and predict prognosis of patients with CT. CONCLUSIONS: PCT/ALB and CRP/ALB ratios were positively correlated with the severity and prognosis of patients with CT, and were risk factors for poor prognosis. Early determination of changes in PCT/ALB and CRP/ALB ratios had a certain clinical value for evaluating the condition and prognosis of CT patients.

Indications and adverse events of teriparatide: based on FDA adverse event reporting system (FAERS).

Background: Teriparatide is approved for osteoporosis. Post-marketing surveillance is critical given its widespread use. Objective: To investigate adverse events (AEs) associated with teriparatide using the FAERS database, compare association strengths for key AEs, and explore potential applications to provide clinical reference. Methods: FAERS data from 2004 to 2023 were analyzed. Reports where teriparatide was the primary suspect drug were included. Adverse events were mapped to System Organ Classes and Preferred Terms. Disproportionality analysis using ROR, PRR, BCPNN and EBGM algorithms was conducted to detect safety signals. Results: Out of 107,123 reports with teriparatide as the primary suspect, key AEs identified included pain in extremity (PRR: 4.54), muscle spasms (PRR: 5.11), fractures (PRR range: 17.67-552.95), and increased calcium levels (PRR: 50.73). Teriparatide exhibited a stronger association with increased calcium levels (PRR: 50.73) compared to fractures (PRR range: 17.67-552.95). Notably, only 10.86% of AE reports were submitted by physicians and another 10% by other health professionals. Subset analyses showed a higher consistency of reported AEs from health professionals compared to the general dataset. Off-label uses were noted in conditions such as arthritis (0.57%) and cancer (0.12%). For osteoporosis, main AEs were pain (18.2%), fractures (12.4%), muscle spasms (7.7%), and nausea (6.5%), while glucocorticoid-induced osteoporosis AEs included fractures (24.1%), pain (13.2%), decreased bone density (9.8%), and nausea (5.1%). Conclusion: Our findings provide real-world safety data on teriparatide, revealing key AEs and their association strengths. The low proportion of reports by healthcare professionals suggests the need for cautious interpretation. Continuous vigilance and further research are imperative to guide teriparatide's clinical use.

Innovative 3D printing and molding process for secondary-skin-collimator fabrication.

Purpose. Secondary skin collimation (SSC) is essential for shielding normal tissues near tumors during electron and orthovoltage radiation treatments. Traditional SSC fabrication methods, such as crafting in-house lead sheets, are labor-intensive and produce SSCs with low geometric accuracy. This study introduces a workflow that integrated 3D scanning and 3D printing technologies with an in-house mold process, enabling the production of patient-specific SSCs within six hours.Methods. An anthropomorphic head phantom was scanned with a handheld 3D scanner. The resulting scan data was imported into 3D modeling software for design. The completed model was exported to a 3D printer as a printable file. Subsequently, molten Cerrobend was poured into the mold and allowed to set, completing the SSC production. Geometric accuracy was assessed using CT images, and the shielding effectiveness was evaluated through film dosimetry.Results. The 3D printed mold achieved submillimeter accuracy (0.5 mm) and exhibited high conformity to the phantom surface. It successfully endured the weight and heat of the Cerrobend during pouring and curing. Dosimetric analysis conducted with radiochromic film demonstrated good agreement between the measured and expected attenuation values of the SSC slab, within ±3%.Conclusions. This study presents a proof of concept for novel mold room workflows that produce patient-specific SSCs within six hours, a significant improvement over the traditional SSC fabrication process, which takes 2-3 days. The submillimeter accuracy and versatility of 3D scanning and printing technologies afford greater design freedom and enhanced delivery accuracy for cases involving irregular geometries.

Comparing musculoskeletal and connective tissue disorder risks of teriparatide and abaloparatide in osteoporosis: an analysis based on FDA adverse event reporting system (FAERS).

BACKGROUND: Osteoporosis (OP), characterized by low bone mass and increased fracture risk, is a prevalent skeletal disorder. Teriparatide (TP) and abaloparatide (ABL) are anabolic agents that may reduce fracture incidence, but their impact on musculoskeletal and connective tissue disorders (MCTD) risk is uncertain. RESEARCH DESIGN AND METHODS: A retrospective, observational disproportionality analysis was conducted utilizing FAERS data from Q1 2004 to Q3 2023, where TP or ABL was identified as the primary suspect drug. Multiple data mining algorithms, including reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and multi-item gamma Poisson shrinker (MGPS), were employed to detect MCTD safety signals. RESULTS: A total of 366,747 TP-related and 422,377 ABL-related cases were identified, predominantly among female patients aged ≥45 years. The top specific AEs involved musculoskeletal, connective tissue, and administration site disorders. Comparative analysis revealed a higher frequency of AEs related to the nervous, cardiovascular, and gastrointestinal systems for ABL compared to TP. Both drugs exhibited strong signals for arthralgia, limb pain, back pain, muscle spasms, bone pain, muscle pain, and muscle weakness. CONCLUSION: The analysis suggests a potential MCTD risk with TP and ABL treatment in OP patients, highlighting the need for AE monitoring and management in clinical practice. This contributes to a better understanding of the safety profiles of these anabolic medications.

An automation of Monte Carlo workflow for dosimetry study of an Elekta LINAC delivery system in radiotherapy.

Purpose: This study aims to automate the Monte Carlo (MC) workflow utilized for radiotherapy dosimetry, focusing on an Elekta LINAC delivery system. It addresses the challenge of integrating MC simulations into routine clinical practice, making this accurate yet complex method more accessible and efficient for radiotherapy dosimetry. Methods and Materials: We developed a user-friendly software featuring a graphical user interface (GUI) that integrates EGSnrc for MC simulations. The software streamlines the process from retrieving Digital Imaging and Communications in Medicine (DICOM) data to executing dose calculations and comparing dose distributions. To validate our proposed tool, we compared its computed doses for IMRT and VMAT plans from the Pinnacle TPS for an Elekta Versa HD linear accelerator against MC simulation results. This comparison utilized our in-house software and GUI as the tool, covering various treatment sites and prescriptions. Results: The automated MC workflow demonstrated high accuracy in dose calculations and streamlined integration with clinical workflows. The comparison between the MC-simulated and TPS-calculated doses revealed excellent agreement, highlighting the reliability of MC for independent dose verification in complex treatment scenarios. Conclusions: The automated MC workflow developed represents a substantial improvement in the practicality and efficiency of MC simulations in radiotherapy. This advancement not only simplifies the dosimetry process but also ensures high accuracy, establishing it as a valuable tool for routine patient-specific quality assurance and the development of specialized treatment procedures.

Determination of the effective dose of remimazolam combined with sufentanil for inhibiting body movement during surgical abortion: An up-and-down sequential allocation trial.

BACKGROUND: Remimazolam, a recently developed anesthetic characterized by its rapid and ultra-short-acting properties, exhibits pharmacological attributes that make it potentially suitable for painless surgical abortion procedures. The objective of this study was to determine the effective dose of remimazolam when administered in combination with sufentanil, with the intention of inhibiting body movement during surgical abortion. Additionally, a secondary objective was to assess the recovery profile from general anesthesia. METHODS: The study enrolled a total of 25 healthy women aged 20 to 40, with a body mass index between 18 and 28 kg/m2, in their first trimester of pregnancy (up to 12 weeks), and American Society of Anesthesiologists status I and II. Anesthesia induction was initiated by administering sufentanil at a dose of 0.1 µg/kg. The modified Dixon up-and-down method was employed to determine the induction dose of remimazolam for each patient. RESULTS: The 50% and 95% effective dose of remimazolam for inhibitory effects of body movement was estimated using centered isotonic regression to be 0.145 mg/kg (95% CI: 0.115, 0.207), and 0.242 mg/kg (95% CI: 0.232, 0.620), respectively. Five out of 25 (20%) experienced hiccups, with 1 patient having persistent hiccups until the end of the surgery. The mean time to first eye-opening was 51.4 ±â€…20.5 seconds, and the time to obey verbal command was 54.5 ±â€…20.6 seconds. Upon arrival at the postanesthesia care unit, 95.7% of the patients achieved a Modified Aldrete score ≥ 9. CONCLUSIONS: The 50% and 95% effective dose of remimazolam for inhibiting body movement during surgical abortion when used in combination with 0.1 µg/kg of sufentanil were 0.145 mg/kg and 0.242 mg/kg, respectively.