Commissioning and Assessment of Radiation Field and Dose Inhomogeneity for a Dual X-ray Tube Cabinet Irradiator: To Ensure Accurate Dosimetry in Radiation Biology Experiments.

Purpose: Standardization of x-ray cabinet irradiator dose, geometry, and calibration reporting is an ongoing process. Multi-tube designs have been introduced into the preclinical market and give a theoretical benefit but have not been widely assessed for use in preclinical irradiation conditions. The aim of this study was to report our experience commissioning a dual x-ray source cabinet irradiator (CIXD, Xstrahl Limited, United Kingdom) and assess the dose distribution for various experimental conditions.

Rectal deformation management with IGRT in prostate radiotherapy: Can it be managed with rigid alignment alone?

Purpose: It is challenging to achieve appropriate target coverage of the prostate with Image Guided Radiation Therapy (IGRT) while simultaneously constraining rectal doses within planned values when there is significant variability in rectal filling and shape. We investigated if rectum planning goals can be fulfilled using rigid CBCT-based on-board alignment to account for interfraction rectal deformations.

Methods: Delivered rectal doses corresponding to prostate alignment ("PR") and anterior rectum alignment ("AR") for 239 daily treatments from 13 patients are reported.

Higher and bigger: How riparian bats react to climate change.

The altitudinal distribution of animals and changes in their body size are effective indicators of climate change. Bats are sensitive to climate change due to their dependence on temperature during critical life stages. However, long-term studies documenting responses over extended periods are rare.

Review and Practical Excursus of the Propensity Score: Low Protein Diet Compared to Mediterranean Diet in Patients With Chronic Kidney Disease.

Although Randomized clinical trials (RCT) represent the gold standard to compare two or more treatments, the impact of observational studies cannot be ignored. Obviously, these latter are performed on unbalanced sample, and differences among the compared groups could be detected. These differences could have an impact on the estimated association between our allocation and our outcome.

Shallow kinetics induced by a metronome (SKIM): A novel contactless respiratory motion management.

Objectives: As an alternative to conventional compression amidst the COVID-19 pandemic, we developed a contactless motion management strategy. By increasing the patient's breathing rate to induce shallow breathing with the aid of a metronome, our hypothesis is that the motion magnitude of the target may be minimized without physical contact or compression.

Methods: Fourteen lung stereotactic body radiation therapy (SBRT) patients treated under fast shallow-breathing (FSB) were selected for inclusion in this retrospective study.

Bioprosthetic versus mechanical valves for mitral valve replacement in patients < 70 years: an updated pairwise meta-analysis.

Background: The ideal conduit for mitral valve replacement (MVR) remains elusive, particularly among younger patients due to increased life expectancy. We perform a pairwise meta-analysis comparing the use of bioprosthetic valves (BPV) and mechanical mitral valves (MMV) in patients < 70 years old undergoing MVR.

Methods: We comprehensively searched medical databases to identify studies comparing the use of BPV and MMV in patients < 70 years old undergoing MVR.

Opioid-free anesthesia versus opioid-based anesthesia in patients undergoing cardiovascular and thoracic surgery: a meta-analysis and systematic review.

Background: Despite their extensive clinical use, opioids are characterized by several side effects. These complications, coupled with the ongoing opioid epidemic, have favored the rise of opioid-free-anesthesia (OFA). Herein, we perform the first pairwise meta-analysis of clinical outcomes for OFA vs opioid-based anesthesia (OBA) in patients undergoing cardiovascular and thoracic surgery.

IAmHero: Preliminary Findings of an Experimental Study to Evaluate the Statistical Significance of an Intervention for ADHD Conducted through the Use of Serious Games in Virtual Reality.

The use of new technologies, such as virtual reality (VR), represents a promising strategy in the rehabilitation of subjects with attention-deficit/hyperactivity disorder (ADHD). We present the results obtained by administering the IAmHero tool through VR to a cohort of subjects with ADHD between 5 and 12 years of age. The trial time was approximately 6 months.

CRISIS AFAR: an international collaborative study of the impact of the COVID-19 pandemic on mental health and service access in youth with autism and neurodevelopmental conditions.

Background: Heterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services.

A Novel Workflow with a Customizable 3D Printed Vaginal Template and a Direction Modulated Brachytherapy (DMBT) Tandem Applicator for Adaptive Interstitial Brachytherapy of the Cervix.

A novel clinical workflow utilizing a direction modulated brachytherapy (DMBT) tandem applicator in combination with a patient-specific, 3D printed vaginal needle-track template for an advanced image-guided adaptive interstitial brachytherapy of the cervix. The proposed workflow has three main steps: (1) pre-treatment MRI, (2) an initial optimization of the needle positions based on the DMBT tandem positioning and patient anatomy, and a subsequent inverse optimization using the combined DMBT tandem and needles, and (3) rapid 3D printing. We retrospectively re-planned five patient cases for two scenarios; one plan with the DMBT tandem (T) and ovoids (O) with the original needle (ND) positions (DMBT + O + ND) and another with the DMBT T&O and spatially reoptimized needles (OptN) positions (DMBT + O + OptN).

Effect of initial levothyroxine dose on neurodevelopmental and growth outcomes in children with congenital hypothyroidism.

Objectives: We designed a multicentre open prospective randomized trial to evaluate the risk-benefit profile of two different initial treatment schemes with levothyroxine (L-T4), 10-12.5 μg/kg/day vs 12.6-15 μg/kg/day, on growth and neurodevelopmental outcomes in children with congenital hypothyroidism (CH) detected by neonatal screening to identify the best range dose to achieve optimal neurocognitive development.

A comprehensive quality assurance procedure for 4D CT commissioning and periodic QA.

Purpose: The 4D computed tomography (CT) simulation is an essential procedure for tumors exhibiting breathing-induced motion. However, to date there are no established guidelines to assess the characteristics of existing systems and to describe meaningful performance. We propose a commissioning quality assurance (QA) protocol consisting of measurements and acquisitions that assess the mechanical and computational operation for 4D CT with both phase and amplitude-based reconstructions, for regular and irregular respiratory patterns.

A New Potential Dietary Approach to Supply Micronutrients to Physically Active People through Consumption of Biofortified Vegetables.

Micronutrients are required in many reactions involved in physical activity and exercise. Most physically active people do not meet the body's needs in terms of micronutrients through diet. The novelty of the present manuscript is the use of an innovative dietary approach to supply micronutrients to physically active people through biofortified food.

Intensity Modulated High Dose Rate (HDR) Brachytherapy Using Patient Specific 3D Metal Printed Applicators: Proof of Concept.

Purpose: In high-dose-rate (HDR) brachytherapy, an anisotropic dose distribution may be desirable for achieving a higher therapeutic index, particularly when the anatomy imposes challenges. Several methods to deliver intensity-modulated brachytherapy (IMBT) have been proposed in the literature, however practical implementation is lacking due to issues of increased delivery times and complicated delivery mechanisms. This study presents the novel approach of designing a patient-specific inner shape of an applicator with 3D metal printing for IMBT using an inverse plan optimization model.

Data-Driven Dose-Volume Histogram Prediction.

Purpose: To evaluate dose-volume histogram (DVH) prediction from prior radiation therapy data.

Methods And Materials: An Oncospace radiation therapy database was constructed including images, structures, and dose distributions for patients with advanced lung cancer. DVH data was queried for total lungs, esophagus, heart, and external body contours.

Cognitive Function in Children With Idiopathic Subclinical Hypothyroidism: Effects of 2 Years of Levothyroxine Therapy.

Background: Long-term consequences of mild subclinical hypothyroidism (SH) in children are still unclear, and the need for levothyroxine (L-T4) supplementation remains controversial. We designed a 2-year, case-control, prospective study of a cohort of children with SH to evaluate the effects of L-T4 therapy on neurocognitive outcome.

Methods: Thirty-four children, age 9.

Hem-o-Lok clip migration into the duodenum after laparoscopic digestive surgery: a systematic review.

Introduction: The wide use of hemoclips during laparoscopic surgery has led to a variety of unusual complications, among these, there is the migration of Hem-o-Lok clip into the duodenum. We performed a literature review of all cases of Hem-o-Lok clip migration into the duodenum after laparoscopic digestive surgery reported in literature.

Evidence Acquisition: All relevant articles were extracted up to June 2019 based on the results of searches in MEDLINE, PubMed, Scopus, Web of Science and Google Scholar.

Intraoperative Local Ablative Therapies Combined with Surgery for the Treatment of Bilobar Colorectal Liver Metastases.

Aim: To investigate the role of intraoperative local ablation techniques (LATs) in bilobar colorectal liver metastases (bCRLM).

Patients And Methods: Among patients who underwent LAT for CRLM between 2005 and 2015, we selected 33 patients with bilobar disease submitted to thermal ablation alone or associated to liver resection. Primary end-point was complete local response at one month (CLR).

Note on the Use of Diametrical Compression to Determine Tablet Tensile Strength.

The diametrical compression (DC) test, as defined in United States Pharmacopeia <1217> and in American Society for Testing and Materials testing standard D 3967, has been used extensively to derive the tensile strength (TS) of pharmaceutical tablets from the measured breaking force. DC-derived TSs provide a good approach to measuring the consistency of tablet mechanical properties from one batch to the next. For these quality control type applications, method precision is required, but accuracy is not.

Notes of robotic surgical technique: four ways to mobilize splenic flexure.

Splenic flexure mobilization is a challenging surgical procedure, but is it necessary to safely perform left colon and rectal resections. This paper is a technical focus detailing the four ways to mobilize splenic flexure in robotic surgery. The medial approach involves an extensive dissection of the medial plane separating descending mesocolon form Toldt fascia; the sovramesocolic approach starts with gastrocolic ligament section; the lateral approach starts with coloparietal detachment and the "one inch-one inch" approach starts with section of transverse mesocolon.

Monitoring blend potency in a tablet press feed frame using near infrared spectroscopy.

A near-infrared (NIR) probe was installed into the feed frame of a rotary tablet press to monitor API concentration as a function of time. A series of step change experimental trials were completed, where a placebo blend was initially charged into the feed frame, and an active blend was layered above. The compression process was initiated, and process parameters, such as mass throughput rate, and feed frame paddle wheel speed were systematically varied.

A framework for in-silico formulation design using multivariate latent variable regression methods.

A comprehensive Quality by Design development paradigm should consider the impact of raw materials and formulation on the final drug product. This work proposes a quantitative approach to simultaneously predict particle, powder, and compact mechanical properties of a pharmaceutical blend, based on that of the raw materials. A new, two-step, multivariate modeling method, referred to as the weighted scores PLS, was developed to address the challenge of predicting the properties of a powder blend while enabling process understanding.

Linear growth and intellectual outcome in children with long-term idiopathic subclinical hypothyroidism.

Objective: The treatment of children with subclinical hypothyroidism (SH) is controversial for TSH values between 4.5 and 10 mU/l. The aim of this cross-sectional, controlled study was to evaluate growth and intellectual outcome in children with persistent SH who have never been treated with levothyroxine.