Comparative study on clinical outcomes and cost-effectiveness of chronic subdural hematomas treated by middle meningeal artery embolization and conventional treatment: a national cross-sectional study.

BACKGROUND: The authors compared the efficacy and cost-effectiveness of middle meningeal artery embolization (MMAE) and conventional treatment for chronic subdural hematomas (cSDH). METHODS: The Nationwide Readmissions Database of 9963 patients (27.2% women) with cSDH between 2016 and 2020 was analyzed. Finally, 9532 patients were included (95.7%, treated conventionally; 4.3%, treated with MMAE). Baseline demographics, comorbidities, adverse events, treatment strategies, and outcomes were compared between patients treated with MMAE and conventional treatment. After propensity score matching, the authors compared primary outcomes, including the 90-day treatment rate, functional outcome, length of hospital stays, and cost. A Markov model estimated lifetime costs and quality-adjusted life years (QALYs) associated with different treatments. The incremental cost-effectiveness ratio (ICER) was calculated to evaluate the base-case scenario. One-way, two-way, and probabilistic sensitivity analyses were performed to evaluate the uncertainty in the results. RESULTS: After propensity score matching, MMAE had a lower 90-day retreatment rate (2.6 vs. 9.0%, P =0.001), shorter length of hospital stays (4.61±6.19 vs. 5.73±5.76 days, P =0.037), similar functional outcomes compared (favorable outcomes, 80.9 vs. 74.8%, P =0.224) but higher costs ($119 757.71±90 378.70 vs. $75 745.55±100 701.28, P <0.001) with conventional treatment. MMAE was associated with an additional cost of US$19 280.0 with additional QALY of 1.3. Its ICER was US$15199.8/QALY. CONCLUSION: MMAE is more effective in treating cSDH than conventional treatment. Based on real-world data, though MMAE incurs higher overall costs, the Markov model showed it to be cost-effective compared to conventional treatment under the American healthcare system. These comparative and economic analyses further support the consideration of a paradigm shift in cSDH treatment.

Laparoscopic single-layer running "trapezoid-shaped" suture versus mechanical stapling for esophagojejunostomy after total gastrectomy for gastric cancer: cost-effect analysis of propensity score-matched study cohorts.

OBJECTIVES: Totally laparoscopic total gastrectomy has been developed with difficulty in intracorporeal esophagojejunostomy. Although mechanical stapling has been widely used for intracorporeal esophagojejunostomy, manual suture holds great promise with the emergence of high-resolution 3D vision and robotic surgery. After exploration of how to improve the safety and efficiency of intracorporeal suture for esophagojejunostomy, we recommended the technique of single-layer running "trapezoid-shaped" suture. The cost-effectiveness was analyzed by comparing with conventional mechanical stapling. METHODS: The study retrospectively reviewed the patients undergoing laparoscopic gastrectomy for gastric cancer from January 2010 to December 2021. The patients were divided into two cohorts based on the methods of intracorporeal esophagojejunostomy: manual suture versus stapling suture. Propensity score matching was performed to match patients from the two cohorts at a ratio of 1:1. Then group comparison was made to determine whether manual suture was non-inferior to stapling suture in terms of operation time, anastomotic complications, postoperative hospital stay, and surgical cost. RESULTS: The study included 582 patients with laparoscopic total gastrectomy. The manual and stapling suture for esophagojejunostomy were performed in 50 and 532 patients, respectively. In manual suture cohort, the median time for the whole operation and digestive tract reconstruction were 300 min and 110 min. There was no anastomotic bleeding and stenosis but two cases of anastomotic leak which occurred at 3 days after surgery. The median length of postoperative hospital stay was 11 days. After propensity score matching, group comparison yielded two variables with statistical significance: time for digestive tract reconstruction and surgery cost. The manual suture cohort spent less money but more time for esophagojejunostomy. Intriguingly, the learning curve of manual suture revealed that the time for digestive tract reconstruction was declined with accumulated number of operations. CONCLUSIONS: Laparoscopic single-layer running "trapezoid-shaped" suture appears safe and cost-effective for intracorporeal esophagojejunostomy after total gastrectomy. Although the concern remains about prolonged operation time for beginners of performing the suture method, adequate practice is expected to shorten the operation time based on our learning curve analysis.

Comprehensive assessment of intelligent unmanned vehicle techniques in pesticide application: A case study in pear orchard.

The intelligent pesticide application techniques in orchards have grown rapidly worldwide due to the decrease in agricultural populations and the increase in labor costs. However, whether and how intelligent pesticide application techniques are better than conventional pesticide application remains unclear. Here, we evaluated the performance of the unmanned aircraft vehicle (UAV) and unmanned ground vehicle (UGV) on pesticide application, ecological environment protection, and human's health protection compared to conventional manual methods. We quantified characteristics from the aspects of working effectiveness, efficiency, environmental pollution, water saving and carbon dioxide reduction. The results showed that the UAV application has the advantages of a higher working efficiency and less environmental pollution and natural resource consumption compared to the UGV and conventional manual methods despite of its worse spray performance The UGV application techniques could improve spray performance at the cost of high environmental pollution. The conventional spray gun technique was unfriendly to environmental and resource protection although it showed a better spray performance. Thus, the balance of improving spray performance and controlling environmental pollution is the key to improve the performance of UAV and UGV technology in the future. The study could be useful in the development of intelligent pesticide application techniques and provide scientific support for the transition of intelligent management in orchards.

In vivo assessment of the safety of standard fractionation Temporally Feathered Radiation Therapy (TFRT) for head and neck squamous cell carcinoma: An R-IDEAL Stage 1/2a first-in-humans/feasibility demonstration of new technology implementation.

INTRODUCTION: Prior in silico simulations of studies of Temporally Feathered Radiation Therapy (TFRT) have demonstrated potential reduction in normal tissue toxicity. This R-IDEAL Stage 1/2A study seeks to demonstrate the first-in-human implementation of TFRT in treating patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: Patients with HNSCC treated with definitive radiation therapy were eligible (70 Gy in 35 fractions) were eligible. The primary endpoint was feasibility of TFRT planning as defined by radiation start within 15 business days of CT simulation. Secondary endpoints included estimates of acute grade 3-5 toxicity. RESULTS: The study met its accrual goal of 5 patients. TFRT plans were generated in four of the five patients within 15 business days of CT simulation, therefore meeting the primary endpoint. One patient was not treated with TFRT at the physician's discretion, though the TFRT plan had been generated within sufficient time from the CT simulation. For patients who received TFRT, the median time from CT simulation to radiation start was 10 business days (range 8-15). The average time required for radiation planning was 6 business days. In all patients receiving TFRT, each subplan and every daily fraction was delivered in the correct sequence without error. The OARs feathered included: oral cavity, each submandibular gland, each parotid gland, supraglottis, and posterior pharyngeal wall (OAR pharynx). Prescription dose PTV coverage (>95%) was ensured in each TFRT subplan and the composite TFRT plan. One of five patients developed an acute grade 3 toxicity. CONCLUSIONS: This study demonstrates the first-in-human implementation of TFRT (R-IDEAL Stage 1), proving its feasibility in the modern clinical workflow. Additionally, assessments of acute toxicities and dosimetric comparisons to a standard radiotherapy plan were described (R-IDEAL Stage 2a).

Assessment of spray deposition, drift and mass balance from unmanned aerial vehicle sprayer using an artificial vineyard.

Under the rapid development of unmanned aerial vehicle (UAV) plant protection products (PPP) application in Asian countries, the drift risk of UAV sprayer operation in orchard or vineyard is fairly high because of the much finer droplets generated and the higher height than ground sprayers, increasing threats to non-targeted crop, human and environment. However, there is few of comprehensive experimental study on the effects of UAV type and nozzle type on spray deposition and drift from UAV sprayer. The objectives of this study were to compare the spray performance of three different typical commercial UAV types (helicopter, 6-rotor and 8-rotor) with two nozzles types (hollow cone nozzle, HCN and air-injector flat fan nozzle, AIN) in vineyard. An artificial vineyard and three vertical collection frames, designed and built by ourselves, were applied for collecting droplets together with PVC collectors, petri dishes and rotary samples. The characteristics of deposition, drift and mass balance of UAV aerial spraying in vineyard were analyzed. As a result, under the crosswind speed of 3.11-3.79 m/s, AIN promoted spray deposition and uniformity and reduced drift significantly compared to HCN for all tested UAVs, improving of the utilization of PPP. The fitted regression functions of the sedimenting and airborne drift were obtained, respectively, and the drift percentage reduction values of AIN compared to HCN determined based on those functions varied from 81% to 95%. With HCN, 49.3%-73.4% of measured droplets drifted into non-targeted area and the highest proportion of drift loss was found for the airborne spray drift. According to the principle of more deposition and less drift, the spray performance of the three UAVs can be ranked in an order of 6-rotor, 8-rotor and helicopter, and two main reasons causing the difference in spray performance were the vortex airflow and the nozzle arrangement.

Preliminary Application of a Quantitative Collateral Assessment Method in Acute Ischemic Stroke Patients With Endovascular Treatments: A Single-Center Study.

Objectives: To develop an efficient and quantitative assessment of collateral circulation on time maximum intensity projection CT angiography (tMIP CTA) in patients with acute ischemic stroke (AIS). Methods: Eighty-one AIS patients who underwent one-stop CTA-CT perfusion (CTP) from February 2016 to October 2020 were retrospectively reviewed. Single-phase CTA (sCTA) and tMIP CTA were developed from CTP data. Ischemic core (IC) volume, ischemic penumbra volume, and mismatch ratio were calculated. The Tan scale was used for the qualitative evaluation of collateral based on sCTA and tMIP CTA. Quantitative collateral circulation (CCq) parameters were calculated semi-automatically with software by the ratio of the vascular volume (V) on both hemispheres, including tMIP CTA VCCq and sCTA VCCq. Spearman correlation analysis was used to analyze the correlation of collateral-related parameters with final infarct volume (FIV). ROC and multivariable regression analysis were calculated to compare the significance of the above parameters in clinical outcome evaluation. The analysis time of the observers was also compared. Results: tMIP CTA VCCq (r = 0.61, p < 0.01), IC volume (r = 0.66, p < 0.01), Tan score on tMIP CTA (r = 0.52, p < 0.01) and mismatch ratio (r = 0.60, p < 0.01) showed moderate negative correlations with FIV. tMIP CTA VCCq showed the best prognostic value for clinical outcome (AUC = 0.93, p < 0.001), and was an independent predictive factor of clinical outcome (OR = 0.14, p = 0.009). There was no difference in analysis time of tMIP CTA VCCq among observers (p = 0.079). Conclusion: The quantitative evaluation of collateral circulation on tMIP CTA is associated with clinical outcomes in AIS patients with endovascular treatments.

Identification of Predictors for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke After Endovascular Therapy Using the Decision Tree Model.

PURPOSE: This study aimed to identify independent predictors for the risk of hemorrhagic transformation (HT) in arterial ischemic stroke (AIS) patients. METHODS: Consecutive patients with AIS due to large artery occlusion in the anterior circulation treated with mechanical thrombectomy (MT) were enrolled in a tertiary stroke center. Demographic and medical history data, admission lab results, and Circle of Willis (CoW) variations were collected from all patients. RESULTS: Altogether, 90 patients were included in this study; among them, 34 (37.8%) had HT after MT. The final pruned decision tree (DT) model consisted of collateral score and platelet to lymphocyte ratios (PLR) as predictors. Confusion matrix analysis showed that 82.2% (74/90) were correctly classified by the model (sensitivity, 79.4%; specificity, 83.9%). The area under the ROC curve (AUC) was 81.7%. The DT model demonstrated that participants with collateral scores of 2-4 had a 75.0% probability of HT. For participants with collateral scores of 0-1, if PLR at admission was <302, participants had a 13.0% probability of HT; otherwise, participants had an 75.0% probability of HT. The final adjusted multivariate logistic regression analysis indicated that collateral score 0-1 (OR, 10.186; 95% CI, 3.029-34.248; p < 0.001), PLR (OR, 1.005; 95% CI, 1.001-1.010; p = 0.040), and NIHSS at admission (OR, 1.106; 95% CI, 1.014-1.205; p = 0.022) could be used to predict HT. The AUC for the model was 0.855, with 83.3% (75/90) were correctly classified (sensitivity, 79.4%; specificity, 87.3%). Less patients with HT achieved independent outcomes (mRS, 0-2) in 90 days (20.6% vs. 64.3%, p < 0.001). Rate of poor outcomes (mRS, 4-6) was significantly higher in patients with HT (73.5% vs. 19.6%; p < 0.001). CONCLUSION: Both the DT model and multivariate logistic regression model confirmed that the lower collateral status and the higher PLR were significantly associated with an increased risk for HT in AIS patients after MT. PLR may be one of the cost-effective and practical predictors for HT. Further prospective multicenter studies are needed to validate our findings.

Multichannel bacterial discrimination based on recognition and disintegration disparity of short antimicrobial peptides.

In this paper, we present a facile and rapid multichannel approach for the simultaneous detection and discrimination of multiple bacterial species. The proposed assay employed four short antimicrobial peptides (SAMPs) for recognition due to their disparity in antibacterial activity against different bacterial strains, and utilized fluorescence measurements to explicate the bacterial recognition and disintegration disparity of the SAMPs. Then, linear discriminant analysis (LDA) was used to effectively discriminate and classify the observed characteristic fluorescence patterns of SAMPs towards target bacteria, exhibiting excellent bacterial discrimination and classification accuracy. This is the first report on the use of SAMPs as recognition units for simultaneous multiple bacterial detection and discrimination. The presented approach was simple, fast, highly repeatable, and required no labelling processes. According to the corresponding LDA discriminant results, six different target bacterial species could be effectively identified and discriminated within 30 min.

Dosimetric differences between local failure and local controlled non-small cell lung cancer patients treated with stereotactic body radiotherapy: A matched-pair study.

INTRODUCTION: Concerns were raised about the accuracy of pencil beam (PB) calculation and potential underdosing of medically inoperable non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). From our institutional series, we designed a matched-pair study where each local failure and controlled patient was matched based upon several clinical factors, to investigate the dose difference between the matched-pair. METHODS: Eighteen pairs of NSCLC patients, treated with 50 Gy in five fractions, were selected. These patients were matched based on treatment intent, tumour size, histology and clinical follow-up. All PB calculated clinical plans were retrospectively recalculated with a MC algorithm. The D99 and DMean of the gross tumour volume (GTV) and D95 and DMean of the planning tumour volume (PTV) from PB and Monte Carlo (MC) calculation were compared between local failures and controls using the Mann-Whitney test. RESULTS: The mean PB calculated D95 of PTV was 50.4 Gy for both failures and controls (P = 0.85), indicating no planning differences between the groups. From MC calculations, the mean (±SD) of GTV D99 , GTV DMean , PTV D95 , PTV DMean were 47.6 ± 2.6/46.3 ± 2.4, 50.4 ± 2.1/49.8 ± 1.6, 44.4 ± 2.7/43.6 ± 3.1, 48.7 ± 2.4/48.2 ± 2.4 Gy for failure/controlled groups, respectively, and there was no significant difference between two groups (all P > 0.1). The dose differences between MC and PB calculations were in agreement with other literatures and there was no significant difference between two groups. CONCLUSIONS: While PB algorithms may overestimate tumour doses relative to MC algorithms, our matched-pair study did not find dose differences between local failure and local controlled cases.

Shape Sensing Techniques for Continuum Robots in Minimally Invasive Surgery: A Survey.

Continuum robots provide inherent structural compliance with high dexterity to access the surgical target sites along tortuous anatomical paths under constrained environments and enable to perform complex and delicate operations through small incisions in minimally invasive surgery. These advantages enable their broad applications with minimal trauma and make challenging clinical procedures possible with miniaturized instrumentation and high curvilinear access capabilities. However, their inherent deformable designs make it difficult to realize 3-D intraoperative real-time shape sensing to accurately model their shape. Solutions to this limitation can lead themselves to further develop closely associated techniques of closed-loop control, path planning, human-robot interaction, and surgical manipulation safety concerns in minimally invasive surgery. Although extensive model-based research that relies on kinematics and mechanics has been performed, accurate shape sensing of continuum robots remains challenging, particularly in cases of unknown and dynamic payloads. This survey investigates the recent advances in alternative emerging techniques for 3-D shape sensing in this field and focuses on the following categories: fiber-optic-sensor-based, electromagnetic-tracking-based, and intraoperative imaging modality-based shape-reconstruction methods. The limitations of existing technologies and prospects of new technologies are also discussed.

[Study on the best detector-distance of noninvasive biochemical examination by Monte Carlo simulation].

The present paper studies the best detector-distance to improve the near-infrared spectrum signal intensity of the dermis layer and eliminate the interference of the epidermis and subcutaneous layer. First, we analyzed the organizational structure of the skin and calculated the tissue optical parameters of different layers. And we established the Monte Carlo model with the example of glucose absorption peak at 2 270 nm. Then, we used the Monte Carlo method to simulate the light transmission rules in the skin, obtaining the average path length, the average visit depth and the fractions of absorbed energy at each layer with the change in critical angle and detector-distance. The results show that when the photons are incident at an angle less than 45 degrees, you can ignore the effect of the incident angle on photon transmission path, and when the detector-distance is 1 mm, the fraction of absorbed photon energy by the dermis layer is the largest, while it can ensure more energy received by detector. We determined that the best detector-distance is 1mm, which successfully avoids the interference of the epidermis spectral information and obtains large amounts of blood in the dermis layer, which is conducive to the near-infrared non-invasive measurement of biochemical components and the subsequent experiments.

Dose calculation differences between Monte Carlo and pencil beam depend on the tumor locations and volumes for lung stereotactic body radiation therapy.

Stereotactic body radiation therapy (SBRT) has been increasingly used as an efficacious treatment modality for early-stage non-small cell lung cancer. The accuracy of dose calculations is compromised due to the presence of inhomogeneity. For the purpose of a consistent prescription, radiation doses were calculated without heterogeneity correction in several RTOG trials. For patients participating in these trials, recalculations of the planned doses with more accurate dose methods could provide better correlations between the treatment outcomes and the planned doses. Using a Monte Carlo (MC) dose calculation algorithm as a gold standard, we compared the recalculated doses with the MC algorithm to the original pencil beam (PB) calculations for our institutional clinical lung SBRT plans. The focus of this comparison is to investigate the volume and location dependence on the differences between the two dose calculations. Thirty-one clinical plans that followed RTOG and other protocol guidelines were retrospectively investigated in this study. Dosimetric parameters, such as D1, D95, and D99 for the PTV and D1 for organs at risk, were compared between two calculations. Correlations of mean lung dose and V20 of lungs between two calculations were investigated. Significant dependence on tumor size and location was observed from the comparisons between the two dose calculation methods. When comparing the PB calculations without heterogeneity correction to the MC calculations with heterogeneity correction, we found that in terms of D95 of PTV: (1) the two calculations resulted in similar D95 for edge tumors with volumes greater than 25.1 cc; (2) an average overestimation of 5% in PB calculations for edge tumors with volumes less than 25.1 cc; and (3) an average overestimation of 9% or underestimation of 3% in PB calculations for island tumors with volumes smaller or greater than 22.6 cc, respectively. With heterogeneity correction, the PB calculations resulted in an average reduction of 23.8% and 15.3% in the D95 for the PTV for island and edge lesions, respectively, when compared to the MC calculations. For organs at risks, very small differences were found among all the comparisons. Excellent correlations for mean dose and V20 of lungs were observed between the two calculations. This study demonstrated that using a single scaling factor may be overly simplified when accounting for the effects of heterogeneity correction. Accurate dose calculations, such as the Monte Carlo algorithms, are highly recommended to understand dose responses in lung SBRT.

[Progress in National Institutes of Health roadmap initiatives].

National Institutes of Health (NIH) released the biomedical research project NIH Roadmap Initiatives, including 3 themes, new pathways to discovery, research teams of the future, and re-engineering the clinical research enterprise. The purpose of the project is to catalyze to transform our new scientific knowledge into tangible benefits for people. Now, mostly of the project have begin to carry into practice.