Commissioning a standalone adaptive radiotherapy linac in a multi-vendor environment.

Current radiotherapy machines intended to perform streamlined online adaptive therapy are designed to be standalone, which makes it challenging to integrate them with the rest of the clinic. This work describes the installation of a standalone CT-guided online adaptive system, the Varian Ethos, in a busy clinic utilizing products from multiple vendors, including RayStation as the treatment planning system (TPS) and MOSAIQ as the oncology information system (OIS). The aim was to develop solutions that minimized workload increases for staff using redundant systems and to implement this new technology safely, with no increase in safety reports resulting from its integration into the clinic.

Small Arteries From Old Spontaneously Hypertensive Rats Exhibit Enhanced Endothelium-Independent Vasodilatory Capacity and Reduced Stiffness.

Objective: In conduit arteries, aging and hypertension are associated with stiffening characterized by increased cytoskeletal F-actin and endothelial dysfunction. Herein, we determined if this also happens at the level of the resistance vasculature.

Methods: We retrospectively compared the mechanical and structural characteristics of small arteries isolated from older hypertensive and younger normotensive (64.

Assessing the costs and savings of telemedicine: Insights from the consolidated framework for implementation research.

Cost reduction is an often-cited reason to use telemedicine. In assessing telemedicine's cost and value, providers often turn to published cost analyses in the scientific literature for guidance. In this commentary on existing telemedicine cost analysis literature, we discuss the generalizability of these analyses and identify the Consolidated Framework for Implementation Research framework to help assess the applicability of a given cost analysis using inner- and outer-setting constructs.

LIM kinases in cardiovascular health and disease.

The Lim Kinase (LIMK) family of serine/threonine kinases is comprised of LIMK1 and LIMK2, which are central regulators of cytoskeletal dynamics via their well-characterized roles in promoting actin polymerization and destabilizing the cellular microtubular network. The LIMKs have been demonstrated to modulate several fundamental physiological processes, including cell cycle progression, cell motility and migration, and cell differentiation. These processes play important roles in maintaining cardiovascular health.

Predicting type 2 diabetes and testosterone effects in high-risk Australian men: development and external validation of a 2-year risk model.

Objective: We have shown that men aged 50 years+ at high risk of type 2 diabetes treated with testosterone together with a lifestyle program reduced the risk of type 2 diabetes at 2 years by 40% compared to a lifestyle program alone. To develop a personalized approach to treatment, we aimed to explore a prognostic model for incident type 2 diabetes at 2 years and investigate biomarkers predictive of the testosterone effect.

Design: Model development in 783 men with impaired glucose tolerance but not type 2 diabetes from Testosterone for Prevention of Type 2 Diabetes; a multicenter, 2-year trial of Testosterone vs placebo.

Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial.

Introduction: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries.

Methods: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020.

Impact of dietary supplementation of glycocalyx precursors on vascular function in type 2 diabetes.

Degradation of the endothelial glycocalyx in type 2 diabetes (T2D) is thought to contribute to impaired shear stress mechanotransduction, leading to endothelial dysfunction and the development of cardiovascular disease. Herein, we tested the hypothesis that restoration of the endothelial glycocalyx with dietary supplementation of glycocalyx precursors (DSGPs, containing glucosamine sulfate, fucoidan, superoxide dismutase, and high-molecular weight hyaluronan) improves endothelial function and other indices of vascular function in T2D. First, in db/db mice, we showed that treatment with DSGP (100 mg/kg/day) for 4 wk restored endothelial glycocalyx length, as assessed via atomic force microscopy in aortic explants.

PAI-1 Regulates the Cytoskeleton and Intrinsic Stiffness of Vascular Smooth Muscle Cells.

Background: Plasma concentration of PAI-1 (plasminogen activator inhibitor-1) correlates with arterial stiffness. Vascular smooth muscle cells (SMCs) express PAI-1, and the intrinsic stiffness of SMCs is a major determinant of total arterial stiffness. We hypothesized that PAI-1 promotes SMC stiffness by regulating the cytoskeleton and that pharmacological inhibition of PAI-1 decreases SMC and aortic stiffness.

Factors that influence surgical decision-making for geriatric displaced femoral neck fractures: Bullet Health Analysis (BHA) I : Worldwide Orthopaedic Research Collaboration: Leveraging Big Data (WORLD) I.

Purpose: The management of geriatric femoral neck fractures, which includes options like hemiarthroplasty (HA), total hip arthroplasty (THA), and fixation, exhibits regional and healthcare setting variations. However, there is a lack of information on global variations in practice patterns and surgical decision factors for this injury.

Methods: Survey data were collected from April 2020 to June 2023 via Orthobullets Case Studies, a global clinical case collaboration platform hosted on a prominent orthopedic educational website.

Neuraminidase-induced externalization of phosphatidylserine activates ADAM17 and impairs insulin signaling in endothelial cells.

Endothelial insulin resistance represents a causal factor in the pathogenesis of type 2 diabetes (T2D) and vascular disease, thus the need to identify molecular mechanisms underlying defects in endothelial insulin signaling. We previously have shown that a disintegrin and metalloproteinase-17 (ADAM17) is increased while insulin receptor α-subunit (IRα) is decreased in the vasculature of patients with T2D, leading to impaired insulin-induced vasodilation. We have also demonstrated that ADAM17 sheddase activity targets IRα; however, the mechanisms driving endothelial ADAM17 activity in T2D are largely unknown.

Neuraminidase inhibition improves endothelial function in diabetic mice.

Neuraminidases cleave sialic acids from glycocalyx structures and plasma neuraminidase activity is elevated in type 2 diabetes (T2D). Therefore, we hypothesize circulating neuraminidase degrades the endothelial glycocalyx and diminishes flow-mediated dilation (FMD), whereas its inhibition restores shear mechanosensation and endothelial function in T2D settings. We found that compared with controls, subjects with T2D have higher plasma neuraminidase activity, reduced plasma nitrite concentrations, and diminished FMD.

Operative Management Improves Near-term Survival of Patients With Odontoid Type II Fractures: A Propensity-matched National Registry Analysis.

Study Design: National Trauma Data Bank (NTDB) review and propensity-matched analysis.

Objective: To evaluate differences in clinical outcomes by operative management.

Summary Of Background Data: Odontoid type II fractures are the most prevalent cervical fracture.

Registered Reports: A new chapter at .

Ecology & Evolution has published its first Registered Report and offers the perspective of the editor, author, and student on the publication process.

Outcomes among trauma patients with duodenal leak following primary versus complex repair of duodenal injuries: An Eastern Association for the Surgery of Trauma multicenter trial.

Background: Duodenal leak is a feared complication of repair, and innovative complex repairs with adjunctive measures (CRAM) were developed to decrease both leak occurrence and severity when leaks occur. Data on the association of CRAM and duodenal leak are sparse, and its impact on duodenal leak outcomes is nonexistent. We hypothesized that primary repair alone (PRA) would be associated with decreased duodenal leak rates; however, CRAM would be associated with improved recovery and outcomes when leaks do occur.

Spontaneously ruptured endometriomas presenting with symptoms and imaging findings worrisome for carcinomatosis: A case report.

Introduction And Importance: Endometriomas are the most common presenting subtype of endometriosis. Although most endometriomas are asymptomatic, patients can rarely present acutely with spontaneous rupture causing diffuse peritonitis and severe systemic inflammatory response.

Case Presentation: Here we describe a case of ruptured endometriomas in a 26-year-old nulligravid female with a history of heavy menses, progressive abdominal distension, and a recent urinary tract infection.

Predictive Value of MRSA Nares Colonization in Diabetic Foot Infections: A Systematic Review and Bivariate Random Effects Meta-Analysis.

The primary objective of this study was to assess the negative predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs in MRSA diabetic foot infections. MEDLINE and Cochrane Library were searched from inception to May 1, 2020. The following search string was used: (methicillin-resistant S.

Border-fence falls versus domestic falls at a South Texas trauma center.

Objectives: Falling from height may lead to significant injuries and time hospitalized; however, there are few studies comparing the specific mechanism of fall. The purpose of this study was to compare injuries from falls after attempting to cross the USA-Mexico border fence (intentional) with injuries from domestic falls (unintentional) of comparable height.

Methods: This retrospective cohort study included all patients admitted after a fall from a height of 15-30 ft to a level II trauma center between April 2014 and November 2019.

Correlation between intracranial pressure monitoring for severe traumatic brain injury with hospital length of stay and discharge disposition: a retrospective observational cohort study.

Objectives: Intracranial pressure (ICP) monitoring is recommended for severe traumatic brain injuries (TBI) but some data suggests it may not improve outcomes. The objective was to investigate the effect of ICP monitoring among TBI.

Methods: This retrospective observational cohort study (1/1/2015-6/1/2020) included severe TBI patients.

Treatment decision-making and care among older adults with kidney failure: protocol for a multicentre, prospective observational cohort study with nested substudies and linked qualitative research (the Elderly Advanced CKD Programme).

Introduction: Shared treatment decision-making and planning of care are fundamental in advanced chronic kidney disease (CKD) management. There are limited data on several key outcomes for the elderly population including survival, quality of life, symptom burden, changes in physical functioning and experienced burden of healthcare. Patients, caregivers and clinicians consequently face significant uncertainty when making life-impacting treatment decisions.

Evaluation of therapy in traumatic elderly falls to return autonomy and functional status.

Background: Traumatic falls among the elderly (≥ 65 years old) are the leading cause of injury, morbidity and mortality are increasing with rising medical costs.

Methods: This is a retrospective medical record review of elderly mechanical fall patients (288 patients) admitted to an American College of Surgeons level II trauma center from January 2016 to January 2021. Demographics and comorbidities were determined, and physical/occupational therapy used to predict subsequent fall readmissions.

Computer Vision and Machine Learning-Based Gait Pattern Recognition for Flat Fall Prediction.

Background: Gait recognition has been applied in the prediction of the probability of elderly flat ground fall, functional evaluation during rehabilitation, and the training of patients with lower extremity motor dysfunction. Gait distinguishing between seemingly similar kinematic patterns associated with different pathological entities is a challenge for the clinician. How to realize automatic identification and judgment of abnormal gait is a significant challenge in clinical practice.