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Luisa Altabella, Sara Broggi, Paola Mangili, Gian Marco Conte, Valentina Pieri, Antonella Iadanza, Antonella Del Vecchio, Nicoletta Anzalone, Nadia di Muzio, Riccardo Calandrino, Andrea Falini, Antonella Castellano
INTRODUCTION: Fractionated radiotherapy in brain tumors is commonly associated with several detrimental effects, largely related to the higher radiosensitivity of the white matter (WM) with respect to gray matter. However, no dose constraints are applied to preserve WM structures at present. Magnetic Resonance (MR) Tractography is the only technique that allows to visualize in vivo the course of WM eloquent tracts in the brain. In this study, the feasibility of integrating MR Tractography in tomotherapy treatment planning has been investigated, with the aim to spare eloquent WM regions from the dose delivered during treatment...
October 9, 2018: Physica Medica: PM
Elizabeth A Rapp van Roden, Robert Tyler Richardson, Stephanie A Russo, William C Rose, Kristen F Nicholson, Ross S Chafetz, Peter G Gabos, Suken A Shah, Amer F Samdani, James G Richards
BACKGROUND: Nonsurgically treated patients with AIS demonstrate altered scapular kinematics and decreased patient-reported shoulder function compared with typically developing adolescents. It is unknown whether surgical correction of the spine deformity has beneficial or detrimental effects on scapulothoracic joint function, as previous assessments of shoulder function following surgery have only focused on humerothoracic motion. The objective of this study was to perform a comprehensive analysis of scapular kinematics before and after PSF and compare postoperative scapular kinematics in AIS to those of a typically developing cohort...
October 11, 2018: Journal of Pediatric Orthopedics
Ruchi Shah, Ravi P Jagani
Endometriosis is characterized as the ectopic presence of endometrium in various locations within the abdominal cavity, such as the fallopian tube, the pouch of Douglas, the ovaries, outside the ovaries, and more. The inner lining of the uterus, endometrium, is a dynamic tissue that undergoes morphological and functional changes cyclically. The proliferation of endometrial cells during menstruation is influenced by increasing circulating estrogen levels. Adult progenitor stem cells are likely responsible for this remarkable regenerative capacity and hence, enhanced capacity to generate endometriosis...
2018: Critical Reviews in Biomedical Engineering
Tariq Jawadi, Feras AlShomer, Muhammed Al-Motairi, Abdullah Al-Qahtani, Mohammad Alfowzan, Obaid Almeshal
Background: Fibro-osseous pseudotumor (FOPD) of the digit is a rare benign lesion of subcutaneous tissue characterized by fibroblastic proliferation and osteoid formation. Herein, we present a case of massive FOPD lesion in the base of ring finger with extensive involvement of the neurovascular bundles with challenging surgical approach. Case description: A 27-year old female patient, presented with 7-months history of a progressively enlarging mass on her left hand...
November 2018: Annals of Medicine and Surgery
Shingo Nakai, Tetsuro Uchida, Yoshinori Kuroda, Azumi Hamasaki, Atsushi Yamashita, Ken Nakamura, Jun Hayashi, Daisuke Watanabe, Mitsuaki Sadahiro
A 75-year-old woman was referred to our hospital for surgical treatment of a left ventricular mass. Echocardiography demonstrated a mobile left ventricular mass originating from the apex of the anteroseptal wall. Cardiac magnetic resonance imaging showed low signal intensity on T1 images and high signal intensity on T2 images. A right 4th intercostal thoracotomy with a small skin incision was performed, and cardiopulmonary bypass was established via the right femoral artery and vein and the right jugular vein...
October 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Vinay P Rao, Jianhua Wu, Richard Gillott, M Wazir Baig, Pankaj Kaul, Jonathan A T Sandoe
OBJECTIVES: Surgery is often required for acute infective endocarditis (IE) to repair or replace damaged heart valves. Traditionally, long courses of antibiotic treatment have been prescribed after surgery for active IE for fear of infecting newly implanted/repaired valves, but the need for this, in the present era of enhanced antimicrobial stewardship, has been questioned. In our institution, the choice and duration of antimicrobial therapy is tailored to individual patients by a multidisciplinary team with an interest in IE...
October 10, 2018: European Journal of Cardio-thoracic Surgery
Taichi Tenkumo, Takeshi Fuji, Motohide Ikawa, Shigeru Shoji, Hiromi Sasazaki, Yoko Iwamatsu-Kobayashi, Yayoi Okuyama, Hiroyuki Matsui, Naru Shiraishi, Toshi Furuuchi, Keisuke Higuchi, Wataru Hashimoto, Yasuhisa Takeuchi, Hidetoshi Simauchi, Keiichi Sasaki
OBJECTIVE: The objective of the present study was to evaluate the effectiveness of introducing integrated jaw models, rubric criteria and homework tasks to a total clinical simulation training course to improve the clinical competence of preclinical dental students. METHODS: A total simulation training course, which involved six clinical dentistry departments, was held for 110 preclinical students in 2014 and 2015. We prepared integrated jaw models having several morbidities along with corresponding medical information and homework tasks...
October 11, 2018: European Journal of Dental Education: Official Journal of the Association for Dental Education in Europe
Sophie C Huijskens, Irma W E M van Dijk, Jorrit Visser, Brian V Balgobind, Coen R N Rasch, Tanja Alderliesten, Arjan Bel
BACKGROUND: In adults, a single pre-treatment four-dimensional CT (4D-CT) acquisition is often used to account for respiratory-induced target motion during radiotherapy. However, studies have indicated that a 4D-CT is not always representative for respiratory motion. Our aim was to investigate whether respiratory-induced diaphragm motion in children on a single pre-treatment 4DCT can accurately predict respiratory-induced diaphragm motion as observed on cone beam CTs (CBCTs). METHODS: Twelve patients (mean age 14...
October 11, 2018: Radiation Oncology
Darrick Beckman, Jana Wardian, Tom J Sauerwein, Mark W True
RATIONALE: Since there are only 33 endocrinologists within the Department of Defence and over 150 000 beneficiaries with diabetes, most patients with diabetes will be treated by primary care providers (PCPs). Comprehensive diabetes care visits are extensive and the clinical practice guidelines (CPGs) routinely change; thus, providing current evidence-based care is difficult. Most professional development courses aim to update PCPs on CPGs but are often inadequate as they focus on only the PCPs (not the interdisciplinary team) without a plan to implement changes into practice...
October 10, 2018: Journal of Evaluation in Clinical Practice
James H Liu, David Soper, Andrea Lukes, Phyllis Gee, Thomas Kimble, Robin Kroll, Madhuja Mallick, Anna Chan, Patrick Gillard, Amanda Harrington, Vilma Sniukiene, Lee P Shulman
OBJECTIVE: To assess the efficacy and tolerability of ulipristal acetate, a selective progesterone receptor modulator, for treatment of symptomatic uterine leiomyomas. METHODS: This phase 3, double-blind, double-dummy, placebo-controlled trial randomized premenopausal women (18-50 years) with uterine leiomyomas and abnormal uterine bleeding to once-daily 5 mg ulipristal, 10 mg ulipristal, or placebo in two 12-week treatment courses separated by a drug-free interval of two menses...
October 5, 2018: Obstetrics and Gynecology
Danielle D DeCourcey, Melanie Silverman, Adeolu Oladunjoye, Joanne Wolfe
OBJECTIVES: For children, adolescents, and young adults with complex chronic conditions advance care planning may be a vital component of optimal care. Advance care planning outcomes research has previously focused on seriously ill adults and adolescents with cancer where it is correlated with high-quality end-of-life care. The impact of advance care planning on end-of-life outcomes for children, adolescents, and young adults with complex chronic conditions is unknown, thus we sought to evaluate parental preferences for advance care planning and to determine whether advance care planning and assessment of specific family considerations during advance care planning were associated with differences in parent-reported end-of-life outcomes...
October 9, 2018: Critical Care Medicine
Devin Heinze Kehoe, Selvi Aybulut, Mazyar Fallah
Previous behavioral and physiological research has demonstrated that as the behavioral relevance of potential saccade goals increases, they elicit more competition during target selection processing as evidenced by increased saccade curvature and neural activity. However, these effects have only been demonstrated for lower-order feature singletons and it remains unclear whether more complicated featural differences between higher-order objects also elicit vector modulation. Therefore, we measured human saccades curvature elicited by distractors bilaterally flanking a target during a visual search saccade task and systematically varied subsets of features shared between the two distractors and the target, referred to as objective similarity (OS)...
October 10, 2018: Journal of Neurophysiology
Alexandra Blair, Arjumand Siddiqi, John Frank
Addressing social determinants of health (SDoH) has been acknowledged as an essential objective for the promotion of both population health and health equity. Extant literature has identified seven potential areas of investment to address SDoH: investments in sexual and reproductive health and family planning, early learning and child care, education, universal health care, as well as investments to reduce child poverty, ensure sustainable economic development, and control health hazards. The aim of this paper is to produce a 'report card' on Canada's success in reducing socioeconomic and health inequities pertaining to these seven policy domains, and to assess how Canadian trends compare to those in the United Kingdom (UK), a country with a similar health and welfare system...
December 2018: SSM—Population Health
Francisco Bonin-Font, Jordi Lalucat, Gabriel Oliver-Codina, Miquel Massot-Campos, Eric Guerrero Font, Pep Lluis Negre Carrasco
Environmental studies that use small Autonomous Underwater Vehicles (AUVs) can survey wider and deeper areas, compared to traditional methods, at a reasonable cost. Thanks to the precise vehicle navigation systems, the data collected can be accurately geolocalized. Besides, lightweight vehicles can be deployed from the shore or from small boats and programmed by means of user-friendly graphical interfaces, thus reducing and simplifying the need of human resources and infrastructures. Based on such a technology, this paper presents a framework to assess the environmental impact of a marine sewage outfall set in the Bay of Palma (Mallorca, Spain)...
October 2018: Marine Pollution Bulletin
Michael Wilson, Richard Simman
Deep tissue injuries (DTIs) are the manifestation of multiple layers of tissue necrosis and are often secondary to chronic mechanical stress to an area of bony prominence. The prevalence of these injuries among the chronically ill and patients in long-term care require a strong understanding of their etiology and a highly sensitive identification algorithm. Although the National Pressure Ulcer Advisory Panel (NPUAP) has released new guidelines with accurate descriptions as to how these injuries present, there is a significant segment of patients that present atypically and, as such, the treatment plan and prognosis are difficult to predict based on physical presentation, which can lead to either delays in necessarily aggressive care or conversely an overzealous treatment plan in hopes of addressing a pathology that may be self-limiting...
October 2018: Wounds: a Compendium of Clinical Research and Practice
George A Mandelaris, Luigi V Stefanelli, Bradley S DeGroot
Over the course of several decades implant dentistry has evolved to include 3-dimensionally (3D) planned and guided surgery. One of the latest innovations is dynamic navigation, which may allow surgeons to place implants with accuracy similar to stereolithographic guides based on 3D, prosthetically directed plans. Benefits of dynamically guided surgery include real-time feedback, a streamlined digital workflow, improved surgical visualization, and adaptability to intraoperative findings. This article discusses the technology and workflow of dynamic navigation and its application for guided implant placement...
October 2018: Compendium of Continuing Education in Dentistry
Davide Zattoni, Isacco Montroni, Nicole Marie Saur, Anna Garutti, Maria Letizia Bacchi Reggiani, Caterina Galetti, Pietro Calogero, Valeria Tonini
OBJECTIVES: To determine whether the Flemish version of the Triage Risk Screening Tool (fTRST) can be used to accurately assess frailty in an emergency setting. DESIGN: Prospective observational study. SETTING: of a tertiary referral hospital. PATIENTS: All individuals aged 70 and older consecutively admitted to the emergency surgery unit with an urgent need for abdominal surgery between December 2015 and May 2016 who met inclusion criteria (N=110)...
October 9, 2018: Journal of the American Geriatrics Society
Eleonora Farina, Gabriella Macchia, Milly Buwenge, Giambattista Siepe, Alice Zamagni, Silvia Cammelli, Savino Cilla, Tigeneh Wondemagegnhu, Aynalem A Woldemariam, A F M Kamal Uddin, Mostafà Aziz Sumon, Francesco Cellini, Francesco Deodato, Alessio G Morganti
The main clinical goal for patients with advanced or metastatic thoracic cancer is palliation of tumor-related symptoms and improvement of quality of life. The aim of this phase I-II trial was to define the maximum tolerated dose (MTD) of a short-course of palliative radiotherapy (RT) and to evaluate its efficacy in terms of palliative response. A phase I trial was planned with escalating dose increments. Total doses ranged from 16 to 20 Gy delivered (BID) in two consecutive days. Dose limiting toxicity was defined as any acute grade ≥ 3 toxicity based on the RTOG scale...
October 8, 2018: Clinical & Experimental Metastasis
Caitlin H Douglass, Alisa Pedrana, Jeffrey V Lazarus, Ellen F M 't Hoen, Radi Hammad, Ricardo Baptista Leite, Andrew Hill, Margaret Hellard
Direct-acting antivirals (DAAs) have dramatically changed the landscape of hepatitis C treatment and prevention. The World Health Organization has called for the elimination of hepatitis C as a public health threat by 2030. However, the discrepancy in DAA prices across low-, middle- and high-income countries is considerable, ranging from less than US$ 100 to approximately US$ 40,000 per course, thus representing a major barrier for the scale-up of treatment and elimination. This article describes DAA pricing and pathways to accessing affordable treatment, providing case studies from Australia, Egypt and Portugal...
October 9, 2018: BMC Medicine
David A James, Jennifer Ng, Jiawei Wei, Marc Vandemeulebroecke
We present a case study for developing clinical trial scenarios in a complex progressive disease with multiple events of interest. The idea is to first capture the course of the disease in a multistate Markov model, and then to simulate clinical trials from this model, including a variety of hypothesized drug effects. This case study focuses on the prevention of graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (HSCT). The patient trajectory after HSCT is characterized by a complex interplay of various events of interest, and there is no established best method of measuring and/or analyzing treatment benefits...
September 17, 2018: Biometrical Journal. Biometrische Zeitschrift
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