Body Surface Research Articles

Blood conservation strategies in complex aortic surgery for a Jehovah's Witness: A case report.

Introduction: Complex aortic surgery involving Jehovah's Witness patients presents a significant challenge due to their refusal of blood products.Case report: This case report details the management of a 50-year-old female Jehovah's Witness with anaemia and a low body surface area, undergoing an urgent ascending aorta and hemi-arch replacement for a type A dissection. A broad range of blood conservation strategies were utilised in order to preserve haematocrit and clotting factors.Conclusions: This report highlights the importance of careful planning, team collaboration, and the meticulous application of blood conservation techniques in achieving a favourable postoperative outcome.

Effect of burn injury size on cardiovascular responses to exercise in the heat.

We tested the hypothesis that due to well recognized thermoregulatory impairments, resulting in greater thermal strain, adults with well healed burn injuries will have heightened cardiovascular responses to exercise in the heat. Adults with burn injuries covering 20-40% body surface area (n = 10), > 40% body surface area (n = 11), and non-burned controls (n = 10) performed 1h of treadmill walking at a fixed rate of metabolic heat production (~ 4.5 w/kg) in the heat (39°C, 40% relative humidity). Core temperature, heart rate, stroke volume, and blood pressure were obtained at rest and during exercise. The increase in core temperature was 0.89 ± 0.40°C for control, 0.92 ± 0.43°C for 20-40%, and 1.30 ± 0.58°C for > 40% (interaction: p = .08). Ending heart rate was greater in > 40% compared to control (142 ± 27 vs 118 ± 9bpm; p = .03), however there was no difference between 20-40% and control (128 ± 24 vs 118 ± 9bpm; p = .44). Ending rate pressure product was higher in the > 40% compared to control (21,326 ± 4327 vs 15,971 ± 2156mmHg*bpm; p = .007), however there was no difference between 20-40% and control (18,698 ± 3741 vs 15,971 ± 2156mmHg*bpm; p = .16). At 45-min into exercise, cardiac minute work was higher in the > 40% compared to control (577 ± 102 vs 467 ± 63 L/min*mmHg/m2; p = .02), but there was no difference between 20-40% and control (513 ± 82 vs 467 ± 63 L/min*mmHg/m2; p = .36). These findings show that well-healed burn survivors with large burn injuries, such as those covering > 40% of total body surface area, have increased cardiovascular strain during exercise heat stress.

Ibuprofen is Not Associated With an Elevated Bleeding Risk or Transfusion Requirement in Skin Grafting for Patients with Burn Injuries.

Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), can increase the risk of bleeding, a significant concern in burn surgery, which often involves substantial blood loss. This study aims to evaluate the safety of ibuprofen use in burn patients undergoing skin grafting. A retrospective case-control chart review was conducted for patients admitted with acute burn injury from 01/01/2024 to 07/31/2024 who underwent skin grafting. The primary outcome variables included perioperative transfusion requirement, bleeding, skin graft failure, and other complications. A total of 53 patients met inclusion criteria, 24 (45.2%) of whom received scheduled ibuprofen therapy during their hospitalization. The total body surface area affected was 12.3±9.3% for the non-ibuprofen group and 14.3±12.1% for the ibuprofen group (p=0.62). A total of 79.3% of patients in the non-ibuprofen group received meshed grafts compared to 79.2% in the ibuprofen group (p=0.734). Perioperative transfusion requirements were similar between the two cohorts, averaging 4.6±3.1 for the non-ibuprofen group and 3.2±2.8 units of packed red blood cells for the ibuprofen group (p=0.207). Skin graft failure (defined as need for re-grafting) occurred in 6.9% (n=2) of the non-ibuprofen cohort versus none (n=0) in the ibuprofen group (p=0.112). Postoperative complications did not vary significantly between the two groups for seroma (p=0.259), hematoma (p=0.498), and infection (p=0.568). There were no cases of hypersensitivity or gastrointestinal bleeding. There is likely no increased risk of bleeding or skin graft failure in burn injury patients taking ibuprofen, suggesting that these medications may be safe in this context.

Topographic anatomy of the spleen in children and adolescents according to intravital imaging

The aim of the study was to establish age and gender patterns of topographic anatomy of the spleen in children and adolescents based on intravital imaging data. Material and methods. Computed tomograms of the abdominal cavity of 88 children and adolescents without visible pathology of the abdominal organs were analyzed. The subjects were divided into 4 age groups: early, first and second childhood, and adolescence. The distance from the spleen to the median sagittal plane, the distance from the spleen to the abdominal organs, the skeletotopy of the spleen and the distance from the spleen to the surface of the body were determined. Results and discussion. A significant increase in the distance from the spleen to the median sagittal plane with age was found. In the first three age groups, the value of the indicator was higher for girls compared to boys, and lower in adolescence. A significant increase in the distance from the spleen to the liver, pancreas, aorta, inferior vena cava, and loops of the jejunum and ileum was determined from early childhood to adolescence; in individuals of the first and early childhood ages, the distance to the liver, pancreas, aorta, and inferior vena cava was the same, while in adolescents it was greater than in those examined in the second childhood. Within one group, no differences were found between the indicators for girls and boys. Skeletotopically, the spleen tended to be located lower with age. The upper pole of the spleen in the overwhelming majority of cases descended from ThIX to the intervertebral disc ThX–ThXI, the hilum of the spleen ‒ from ThXII to the intervertebral disc ThXII–LI, the lower pole ‒ from LI to the intervertebral disc LI–LII. The distance from the spleen to the body surface significantly increased from early childhood to adolescence along the anterior median, left middle axillary and left scapular lines; in individuals of the first and early childhood ages it was the same, in children of the second childhood and adolescence it increased in comparison with previous age periods. In the adolescent group, the indicator was higher among boys than among girls along the anterior median, left middle axillary and left scapular lines. Conclusions. The article presents the topographic and anatomical characteristics of the spleen in children and adolescents and establishes patterns of change taking into account the sex and age of the subjects.

Physiological and behavioral responses of sows under different shading structures in a tropical free-range system.

This study aimed to investigate the effect of different shade structures on the physiological and behavioral responses of sows in free-range systems in a tropical climate. Six non-pregnant DanBred sows were studied from November to December 2019 at the University of Brasília, Federal District, Brazil. The sows were distributed in a double 3 × 3 Latin square design in six paddocks, each containing one of the three artificial shade treatments, so that each artificial shade treatment was present in two paddocks. In each evaluated paddock there was a Caryocar Brasiliense, a native tree from Brazilian Cerrado with 6.0m mean height, as well as a mud pool, to allow the sows to perform natural behaviors. Treatments included shade provided by a black net (blocking 80% of radiation), shade provided by a heat-reflective net (blocking 80% of radiation), and both nets combined. Black globe, dry bulb, and wet bulb temperatures, relative humidity, and wind speed were measured at 1min intervals between 8:00 and 16:00h during 18 non-consecutive days. For behavioral observation, an ethogram was developed describing sows' site preferences, body posture and activities of interest. Vaginal and body surface temperatures were measured every 1min and respiratory rate every 20min. Micrometeorological and physiological data were analyzed using SAS software. The means were compared using Tukey's test with a significance level of 5%. Behavioral data were subjected to frequency analysis and chi-square tests at the 5% significance level. Shade treatments affected (p < 0.05) all meteorological, behavioral, and physiological variables. The combined use of heat-reflective and black nets provided the best meteorological results, being more frequently used by sows than tree shade. However, shade type did not physiologically influence internal body temperature, surface temperature, or respiratory rate, demonstrating the importance of behavioral expression for thermoregulation.

Immunization Against Chlamydia trachomatis Polymorphic Membrane Protein D Tetrapeptide Motifs Limits Early Female Reproductive Tract Infection in a Mouse Model

Background/Objectives: Chlamydia trachomatis (Ct) is a common pathogen causing urogenital, anal, oral, and ocular infections. Although extensive vaccine efforts have been underway for decades, there is no licensed vaccine available to prevent human Ct infection. Polymorphic membrane protein D (PmpD) is a highly conserved protein present on the surface of Ct elementary bodies, suggesting an important role Ct biology. Repetitive tetrapeptide motifs GGA(I,L,V) and FxxN are conserved across Pmps and are important for adhesion in the related Chlamydia pneumoniae Pmp21. Methods: Using bioinformatics approaches, we identified amino acids 270 to 294 of PmpD that included two GGA(I,L,V) motifs and an FxxN motif as vaccine targets. Synthetic peptides corresponding to these regions were chemically conjugated separately via the carboxy (C)- or amino (N)-terminus (FxxN 1.1 and FxxN 1.2) to the surface of Qβ virus-like particles (VLPs) and were tested for immunogenicity and protective capacity in mice. Results: Female mice immunized three times with a mixture of Qβ-FxxN 1.1 and Qβ-FxxN 1.2 vaccines without exogenous adjuvant elicited geometric-mean endpoint dilution titers near 104. Further, mice showed decreased infection at early time points when challenged vaginally with luciferase-expressing Chlamydia muridarum over 9 days and a faster time to undetectable infection compared to controls. Immunization with individual vaccines (Qβ-FxxN 1.1 or Qβ-FxxN 1.2) did not show the same degree of reduction. Conclusions: Vaccination against PmpD tetrapeptide motifs is a novel and promising approach for limiting initial Chlamydia infection and warrants further investigation to characterize the mechanism of protection.

Ambiance Preservation Augmenting for Semantic Segmentation of Pediatric Burn Skin Lesions

Burn injuries pose a significant threat to human life, with high morbidity and mortality rates. Accurate diagnosis, including the assessment of burn area and depth, is essential for effective treatment and can sometimes be lifesaving. However, access to specialized medical professionals is often limited, particularly in remote or underserved regions. To address this challenge and alleviate the burden on healthcare providers, researchers are investigating automated diagnostic tools. The severity of the burn and the affected body surface area are critical factors in diagnosis. From a computer vision perspective, this requires semantic segmentation of burn images to assess the affected area and determine burn severity. In collaboration with medical personnel, we have gathered a dataset of in situ images from a local children’s hospital annotated by specialist burn surgeons. However, due to the limited amount of data, we propose a two-step augmentation approach: training with synthetic burn images and controlling the encoder by ambiance preservation. The latter is a technique that forces the encoder to represent closely the embeddings of images that are similar and is a key contribution of this paper. The method is evaluated on the BAMSI database, demonstrating that the proposed augmentations lead to better performance compared with strong baselines and other potential algorithmic improvements.

Outcomes of BTD vs. BCD as initial treatment of renal amyloid light-chain amyloidosis: a retrospective cohort study in China

Objectives To compare the efficacy and safety of bortezomib with thalidomide and dexamethasone (BTD) and bortezomib with cyclophosphamide and dexamethasone (BCD) as the initial treatment for renal amyloid light chain (AL) amyloidosis in Chinese cohort. Methods A cohort of 174 patients with AL amyloidosis was studied in Guangdong Provincial People’s Hospital from January 2008 to August 2023. Propensity-score matching cases were applied to assess the outcomes of patients treated with BTD and BCD regimen. Primary outcomes were patients achieving hematologic response and organ responses, and the secondary endpoints were patients progressing to end-stage renal disease or all-cause death. Results 44 Patients were included. The hematologic complete response rate (CR) in the BTD group was comparable between the groups of BTD group and BCD. However, the time to achieve hematologic CR was significantly shorter in the BTD group compared to the BCD group (4.97 vs. 7.71 mon, p = 0.010). Furthermore, when reaching hematologic response, the cumulative dose of bortezomib that standardized by body surface area (BSA) was lower in BTD group than in the BCD group (10.4 vs. 15.6 mg/m2, p = 0.013). There was no significant difference of renal and cardiac response between groups. However, post-treatment proteinuria levels after treatment were significantly lower in the BTD group compared to those in the BCD group (747 mg/24h vs. 2928 mg/24h, p = 0.048). Conclusions Compared to BCD regimen for renal AL amyloidosis, initial treatment with BTD regimen demonstrated similar rates of hematologic CR but showed superior reduction in proteinuria, reduced cumulative dose of bortezomib and faster time-to-response.

Demographic and Injury Characteristics of Patients Injured in a Hailstorm.

The aim of this study was to describe the demographic characteristics, injury characteristics, and outcomes of individuals sustaining injuries during a hailstorm in Istanbul, Turkey. In this study, the medical records of 76 patients who presented to the emergency department (ED) of a tertiary hospital after incurring injuries due to hailstorms were retrospectively reviewed. Analyses were performed to identify hailstorm-associated injury profiles, injury mechanisms, patient demographics, and ED resource use. Of the 76 patients, 42 (55.3%) were male and 34 (44.7%) were female, with the ages of the patients ranging from five to 79 years. Of the patients, 93.4% presented to the ED within the first eight hours after a hailstorm. The most common injury mechanisms were the direct impact of hailstones on the body surface (36.8%) and slips and falls during escape (35.6%). The most frequently injured anatomical areas were skin (60.5%), head (44.7%), and extremities (16.7%). Significant injuries occurred in only 11.8% of the patients, of whom three were treated surgically and one died. The most common injuries were soft tissue and minor head injuries. Severe hailstorms often strike suddenly and can be difficult to predict. In response, EDs must handle a large number of injured patients in the aftermath of a hailstorm. It is important to remember that hailstorms, like other natural disasters, can cause serious injuries.

An Observational Study to Assess the Quality of Life in Patients with Superficial Dermatophytosis at Tertiary Care Center

Abstract Introduction: Superficial dermatophytosis is a common skin infection, having a recurrent and persisting course. The impact of disease is not only limited to skin but also affects the personal and social lives of these patients. Dermatology Life Quality Index (DLQI) and five-dimensional (5D) pruritus score are often been used to assess their impact on patient’s quality of life (QoL). Aims: The present study aims at measuring the impact of the disease on the QoL of the patients by DLQI score and 5D pruritus score and find the association of DLQI and 5D pruritus score with different variables in patients with superficial dermatophytosis. Methods: A cross-sectional observational study was conducted over 1 ½ years. The patients with superficial dermatophytosis attending the skin outpatient department were recruited after informed consent and were made to fill up the DLQI and 5D-pruritus scale questionnaires. Independent t-test and ANOVA were used to find statistical associations between mean DLQI scores and 5D-pruritus scores with the study variables. The Pearson’s correlation coefficient was calculated to compare the effect on the QoL as measured from DLQI and 5D-pruritus score. Results: A total of 570 patients were recruited, among which 179 and 234 patients had DLQI scores and 5D-pruritus scores, respectively, with moderate effect. A significant correlation was found between age (≤40 years) and DLQI scores (P &lt; 0.006) but not with 5D-pruritus score. The highest mean DLQI score was seen in &gt;6-month duration (9.2 ± 6.7) and &gt;10% body surface area involvement (BSAI) (11.8 ± 5.7). The highest mean 5D-pruritus score was seen in &gt;6-month duration (12.9 ± 4.1) and &gt; 10% BSAI (15.8 ± 2.9). The effect on QoL was estimated on the basis of the duration of the disease and BSAI, which correlated strongly with the DLQI scoring and disability scoring in the 5D-pruritus scale (P &lt; 0.001). Conclusions: Although considered previously as a simple fungal infection, now it has emerged as a social, psychological, and economic burden on society.

Benefits of Combined Therapies in Burn Lesions: Enzymatic Debridement and Other Modern Approaches—Our Clinical Experience

Background: In thermal injuries, enzymatic debridement is a viable option for treating partial- and full-thickness burns, allowing for rapid removal of damaged tissue with minimal bleeding and without sacrificing healthy dermis. Enzymatic debridement using Nexobrid® combined with negative wound pressure therapy (NWPT) appears to promote healing, as enzymatic debridement helps preserve healthy tissue integrity and epithelial reserves. We explored therapeutic alternatives following enzymatic debridement to assess healing outcomes and reduce reliance on skin grafts. Methods: 24 patients with deep or partially deep thermal burns on 5–40% of total body surface area (TBSA) underwent enzymatic debridement; then, half received NWPT and the other half were treated with topicals. Results: Enzymatic debridement effectively removed necrotic tissue and facilitated healing. Only three patients required skin grafts (&lt;10% TBSA). Enzymatic debridement combined with NWPT expedited daily healing, reduced hospitalization days, and eliminated wound secretion, as confirmed by bacteriological examination. This approach was more effective compared to enzymatic debridement followed by topical treatments. Conclusions: Nexobrid® in combination with NWPT is a promising alternative to surgical treatment, improving healing, reducing the need for skin grafts, and alleviating pain associated with dressing changes. It may be particularly useful in extensive burns, where epithelial reserves are limited.

Unveiling the Culprit: Psoriatic Erythroderma Responding to Anti-tubercular Therapy

Abstract Erythroderma is the generalized erythema and scaling of skin affecting at least 90% of body surface area. Understanding and correcting the underlying cause and precipitating factors are important in the management of erythroderma. Here, we report a case of treatment-resistant psoriatic erythroderma, which responded to anti-tubercular therapy (ATT). A 55-year-old male who is a known case of psoriasis presented with generalized erythema and scaling all over the body for 2 months, preceded by intake of herbal medications. On examination, erythroderma involving the trunk, upper and lower extremities, scalp, face, palms, and soles was present. Diagnosis of psoriatic erythroderma precipitated by herbal medications was made. The patient was started on cyclosporine and thereafter, acitretin was added, but there was a suboptimal response. We observed better response when prophylactic antibiotics were added, which gave a clue on a hidden infection triggering the erythroderma, that is yet to be addressed. On further evaluation, Mantoux test was positive and high-resolution computed tomography chest revealed lesions suggestive of pulmonary tuberculosis (TB). The patient was started on standard ATT and a Near-complete resolution of the erythroderma was observed in 2 weeks. To the best of our knowledge, there are not many reports of erythroderma in preexisting dermatosis triggered by TB in the literature. We put forward this case report as an attempt to stress the fact that a meticulous search for the precipitating factors is important in the management of erythroderma.

Delayed hepatic response and impaired cytokine dynamics in aged mice following burn injury: Implications for elderly patient care.

Burn injuries in elderly patients result in higher morbidity and mortality compared to younger individuals. This study investigates age-related differences in inflammatory hepatic responses to burn injuries. Young (8-10 weeks) and aged (20-21 months) female C57BL/6 mice were subjected to a 15% total body surface area burn or sham injury. Serum and liver samples collected at 3, 6-, 9-, 12-, and 24-hours post-injury were analyzed for serum amyloid A (SAA) levels, SAA1 and SAA2 hepatic gene expression, serum cytokines (IL-6, IL-1β, TNF-α, and IL-10), and hepatic STAT3 activation. Aged mice showed a delayed and dysregulated response. In young mice, SAA levels rose significantly at 6 hours postburn (5.09 ± 0.2-fold), while in aged mice, SAA increased at 12 hours (39.1 ± 2.06-fold), p < 0.01. Hepatic expression of SAA1 and SAA2 also peaked early in young mice (8.357 ± 1.257-fold and 5.91 ± 0.664-fold at 3 hours) but was delayed until 12 hours in aged mice. Young mice demonstrated early IL-6 peaks at 3 hours (990 ± 83.2 pg/ml), while aged mice reached a delayed, higher IL-6 peak at 24 hours (3804 ± 1408 pg/ml, p < 0.05). Similar age-related delays occurred for IL-1β and TNF-α. Aged mice had significantly elevated IL-10 at 6 hours (993.9 ± 99.41 pg/ml vs. 67.69 ± 6.635 pg/ml in young, p < 0.001). STAT3 activation peaked at 3 hours in young mice (2.686 ± 0.226-fold) but was delayed until 24 hours in aged mice (0.5958 ± 0.0368-fold, p < 0.05). This study identifies age-related variations in inflammatory markers and acute hepatic responses to burn injuries, with aged mice showing delayed and reduced inflammatory responses compared to younger counterparts. These findings underscore the importance of age-specific strategies in burn injury management to enhance outcomes for elderly burn patients.

Hemodynamic evaluation of Norwood aortic arch geometry compared to native arch controls.

The Norwood procedure creates a reconstructed neo-aorta to provide unobstructed systemic cardiac output (CO) for Hypoplastic Left Heart Syndrome (HLHS) patients. We used patient-specific computational fluid dynamics (CFD) simulations incorporating physiologic boundary conditions to quantify hemodynamics for reconstructed aortic arch geometries versus native aortic arches from a control group of single ventricle patients. We hypothesized that reconstructed arches from Norwood patients (n=5) would experience significant differences in time-averaged wall shear stress normalized to body surface area (TAWSSnBSA), oscillatory shear index (OSI), energy efficiency (Eeff), and energy loss (EL) versus controls (n=3). CFD simulations were conducted using 3T cardiac magnetic resonance imaging, blood flow and pressure data. Simulations incorporated downstream vascular resistance and compliance to replicate patient physiology. TAWSSnBSA and OSI were quantified longitudinally and circumferentially. Global differences in Eeff and EL were compared. Significance was assessed by Mann?Whitney U test. Norwood patients had higher TAWSSnBSA distal to the transverse arch (TA) at locations of residual narrowing presenting following coarctation correction, as well as higher OSI within ascending aorta (AAo) and TA regions (p<005). EL correlated with patient features including cardiac output (r=0.9) and BT-shunt resistance (r=-0.63) but did not correlate with arch measurements or morphology. These results indicate reconstructed arches from Norwood patients are exposed to altered WSS and energy indices linked to cellular proliferation and inefficiency in prior studies. These results may help clinicians further understand what constitutes an optimally reconstructed arch after confirmation in larger studies.

22 The incidence of perioperative hypothermia and the effect of normothermia measures in the era of new surgical approaches

Abstract Aim Although disruptive scientific evidence fueled the inclusion of perioperative normothermia measures in to the bundles to prevent hypothermia, data on the specific tools to adequate implement normothermia measures in patients at risk are lacking. Also, is unknown how the evolving new surgical devices devoted to facilitate both less invasive and precision surgical techniques influence on the efficacy of classical normothermia measures. Pragmatic prospective observational study was designed to clarify which surgical patients are at risk for perioperative hypothermia and the efficacy of the available physical normothermia measures in the era of evolving new surgical devices and techniques. Methods The study was approved by the Ethic Committee of the center. Adults patients submitted to major surgical procedures were included. Perioperative continuous core temperature (CT) monitoring has been assessed with the SpotOn system. Conventional normothermia measures applied during surgical procedures were registered. Warmed Body Surface Area (WBSA) Score was constructed following the rule of nine (burned patients). Surgical procedures were classified depending of the anatomical compartment involved: Articular, Head and Neck, Organ-Cavity and Trunk. Also, Organ-cavity surgical procedures were further classified depending on the type of surgical access: Open, laparoscopic and robotic. Variables were summarized as mean ± SD or 95% c.i. or as median and interquartile range, when appropriate. Differences in AUC below 35.5° among different anatomical compartment surgical procedures and depending on the operative access (open, laparoscopic and robotic), were analyzed by employing the non-parametric Kruskall Wallis test. Differences in mean CT throughout the time points among groups were tested using one-way analysis of variance. Multiple comparisons were performed using Scheffé’s test. We considered differences significant at P &amp;lt; 0.05. Results Eighty-nine patients were included for the final analysis, 51.7% (41.4 to 62) women with mean age of 62.9 (59.8 to 66.0) years and ASA II in 55.7% (49.4 to 69.7) of patients. Warmed forced air blanket was the most normothermia measure employed (100%, 84.6%; 91.7% and 100% in Organ-cavity, articular, Head and Neck and Trunk surgeries, respectively). Compared to open procedures, WBSA was significantly lower in both laparoscopic and robotic surgical procedures (54% versus 27% and 18%, respectively, P &amp;lt; 0.001). CT was assessed during each surgical procedure at the specific time points. CT dropped early on after anesthesia induction. Organ-Cavity surgical procedures persistently demonstrated significant lower CT values during the overall procedure. Head/Neck dropped sharply showing early recovery and finally achieving hyperthermia values. Also Time-weighted average CT was significantly lower in Organ/Cavity surgical procedures. We further explore CT variables in Organ-cavity group of patients, taking in to the account the technique of surgical access. Regarding CT relevant variables, we observed that endoscopic procedures showed lower mean CT values overall (non-significant), higher AUC below the threshold (35.5°C) (non-significant), a higher percentage of patients 35.5°C (significant), mainly in robotic access group Conclusion Perioperative hypothermia is not an homogenous adverse event. Despite endorsement of conventional normothermia measures, patients submitted to organ-cavity surgical procedures are at risk for perioperative hypothermia. New and adapted normothermia measures for endoscopic and robotic based surgery are urgent needed.

Construction of intelligent sports service platform and application of physiological index evaluation under VR background

With the continuous progress of VR (Virtual Reality) and biomedical sensing technology, traditional sports platforms have been significantly limited in many aspects. This article combines VR technology and biomedical equipment to innovatively build an intelligent and personalized sports service platform. The platform can use the user’s heart rate variability, body surface electrical muscle map, exercise trajectory, and biomechanical indicators including joint angle and muscle strength to conduct a comprehensive evaluation of the effect of sports services. OpenHMD technology is used to create a diverse and highly interactive virtual sports environment for users, while 3ds Max is used to carefully design training models to enhance the immersive experience. Through Kinect and heart rate monitors, we accurately collect users’ movements and biophysiological data, and use advanced algorithms for motion recognition. The data analysis module can dig deep into the user’s exercise characteristics and provide personalized exercise recommendations and physical fitness assessments. The results showed that the user’s heart rate fluctuated greatly in the early stages of training, but gradually stabilized, from 128 bpm in the first cycle to 120 bpm in the third cycle, indicating improved physical fitness and increased endurance. At the same time, the range of heart rate fluctuations gradually shrank, showing that the user’s adaptability improved. The comparison of the histogram shows that the cardiovascular burden is reduced and the physical fitness is significantly improved. The long-term trend chart shows that as training progresses, physical fitness gradually improves. Experiments have proved that the platform still performs well under high loads, and the analysis of biomechanical indicators verifies its rationality and practicality.

Hydrogel and scalp/skin conductivities impact dose from tumor treating fields.

Tumor Treating Fields (TTFields) are delivered by transducer arrays applied to scalp or body surface for treatment of multiple malignancies. Dermatologic complications are thought to be related to hydrogel situated between the electrodes and scalp or skin to facilitate electric field penetration. High intensity of TTFields on these surfaces may also be a contributing factor. We explored conductivity changes in the hydrogel and skin to improve TTFields coverage and penetration. Magnetic resonance imaging datasets from 12 glioblastoma patients and attenuation-corrected positron emission tomography-computed tomography datasets from 3 non-small cell lung and 2 ovarian carcinoma patients were used to segment anatomic structures. Finite element mesh models were generated and solved for distribution of applied electric fields, rate of energy deposition, and current density at the gross tumor volume (GTV) and clinical target volume (CTV). Electric field-volume, specific absorption rate-volume, and current density-volume histograms were generated, by which plan quality metrics were used to evaluate relative differences in field coverage between models at various hydrogel and skin conductivities. By varying conductivity of hydrogel, TTFields coverage at GTV or CTV increased up to 0.5S/m for head and 1.0S/m for thorax and pelvis models, and no additional increase was observed beyond these saturation points. Although scalp hotspots increased or decreased by +1.5%, -0.1%, and -0.9% in E5%, SAR5%, and CD5%, the skin hotspots increased by as much as +23.5%, +45.7%, and +20.6%, respectively. When altering conductivity of the entire scalp, TTFields coverage peaked near 1S/m at the GTV or CTV for the head models. TTFields coverage in both the GTV and scalp increased up to 1S/m for the head models but plateaued thereafter. Contouring under the scalp increased scalp hotspots by +316% in E5% at 1S/m compared to altering the conductivity of the entire scalp. GTV hotspots decreased by +17% in E5% at 1S/m. TTFields delivery can be modulated by the conductivity of hydrogel and scalp/skin at the transducer-scalp or transducer-skin interface. Optimizing this aspect of TTFields delivery may increase tumor control while minimizing toxicity at the scalp or skin.

Feasibility and population exposure of 5-fluorouracil using therapeutic drug monitoring (PREDICT-5FU): A multicentre clinical trial.

PREDICT-5FU aimed to document 5-fluorouracil (5FU) exposure in a cancer population and to evaluate the feasibility of 5FU and capecitabine therapeutic drug monitoring (TDM) in patients receiving standard doses and schedules. Multicentre, prospective, observational single-arm study. Eligible adult patients received 5FU (infusional ≥24 h) or capecitabine. Patients were treated for gastrointestinal, breast and head-and-neck cancers at four Australian hospitals. TDM was performed in consecutive cycles until target area under the curve (AUC) was reached. Pharmacogenetic testing was performed for all patients. Fifty patients (24 males, 26 females) were recruited. Median age was 63 years; common diagnoses were lower gastrointestinal cancers 40% (20/50) and metastatic disease 80% (40/50). The majority received 5FU (38/50, 76%) over 46 h. Only 36% of 5FU patients achieved target AUC when dosed based on body surface area; 61% were below and 3% above target range. Post TDM-adjusted dosing, target AUC was achieved in 58% of patients (22% absolute increase vs. BSA dosing, p = 0.03), within median three cycles (range 1-5). DPYD variant allele carriers (3/4) had upfront reduced dosing due to heterozygosity; all were below the target AUC and one experienced Grade 3 toxicity. There was no correlation between dihydrouracil: uracil ratio [UH2/U] or uracilemia [U] and DPYD genotype. TDM results were reported with an average of 4 days from sampling. TDM dosing is feasible and increases the proportion of patients reaching target AUC. Findings are relevant across all cancers treated with 5FU, and particularly for DPYD variant allele carriers receiving upfront dose reductions.

Renal functional reserve in living kidney donors

Abstract Background Factors associated with renal functional reserve (RFR)—presence or absence—are not completely clear and remain under-investigated. Methods In this observational study, we evaluated the characteristics associated with the presence or absence of RFR in healthy subjects—living kidney donors—before donation. Renal function was assessed with measured glomerular filtration rate (GFR)—the clearance of iohexol—and RFR with the infusion of amino acids. An increase in GFR &amp;gt; 10% after amino acid infusion indicated the presence of RFR. We defined a priori three groups of donors: without, with, and using RFR. Subject using RFR had baseline GFR &amp;gt;100 ml/min but without an increase in GFR after stimulation. Results Subjects without RFR were predominantly women (81%) with the lowest body surface area (BSA) (1.71 ± 0.17 m2), and basal GFR (85 ± 9 ml/min). Subjects with RFR were also mostly women (85%), with a higher BSA (1.83 ± 0.18 m2; p 0.039) and basal GFR (93 ± 15 ml/min). Subjects using RFR were mostly males (56%) and had the highest BSA (1.94 ± 0.18 m2; P &amp;lt; 0.0001 vs without RFR; p ns vs with RFR), basal GFR (123 ± 20 ml/min; P &amp;lt; 0.0001 vs subjects without RFR; P &amp;lt; 0.0001 vs with RFR), and weight (82.1 ± 13.2 Kg; P &amp;lt; 0.0001 vs without RFR; p ns vs with RFR). Conclusions The presence or absence of RFR was associated to differences in gender, weight, BMI, BSA, and basal GFR. Women with small BSA may have lower GFR and no RFR, indicating possibly a lower renal endowment even in the normal range of renal function. The use of RFR may indicate a response to a higher metabolic demand in subjects with higher renal endowment.

Indirect Comparison Between Bimekizumab and Brodalumab for the Management of Moderate to Severe Psoriasis: A 36-Week Real-Life Study.

Bimekizumab and brodalumab are characterized by a different mechanism of action if compared to the other anti-interleukin (IL)-17s which target IL-17A. Indeed, brodalumab acts on IL-17RA whereas bimekizumab acts on IL-17A, IL-17F, and IL-17AF cytokines. Currently, despite real-life data on the efficacy and safety of bimekizumab and brodalumab have been reported, data comparing these two drugs are absent. However, these data are mandatory to evaluate whether a different target of the same IL can be correlated with a different profile in terms of effectiveness and safety. Moreover, it should be underlined that bimekizumab and brodalumab stood out as the psoriasis treatments with the fastest onset of action, delivering quicker therapeutic responses compared to other drugs acting on IL-17. A monocentric retrospective study was carried out enrolling patients affected by moderate to severe psoriasis undergoing treatment with brodalumab or bimekizumab. At baseline, clinical demographic details were collected. Clinical improvement [Psoriasis Area Severity Index (PASI), body surface area (BSA)] was collected at weeks4, 16, and 36. Safety data were analyzed at the same timepoints. A total of 125 patients were enrolled in the study [bimekizumab: 53 (42.40%); brodalumab: 72 (57.6%)]. Psoriasis severity at baseline was similar between the two cohorts. Both PASI and BSA significantly reduced at each follow-up for both treatment cohorts. The bimekizumab group reached a higher percentage of PASI90/PASI100 response at each timepoint as compared to the brodalumab cohort. In particular, the percentage of PASI100 response was significantly higher in the bimekizumab group as compared to the brodalumab cohort at week4 (41.5% vs 23.6%, p < 0.05) and at week16 (67.9% vs 48.6%). Discontinuation for ineffectiveness was higher in the brodalumab cohort (8.3%) as compared to the bimekizumab group (3.8%), without statistical significance. As regards safety, two cases of eczematous reactions (bimekizumab: 2, brodalumab: 0), and five cases of candidiasis (bimekizumab: 4, brodalumab: 1) were collected. Overall, 3 (5.7%) and 1 (1.4%) patients discontinued bimekizumab and brodalumab because of adverse events, respectively. Our study confirmed the efficacy and safety of both bimekizumab and brodalumab, up to 36weeks of treatment. Although both drugs showed a significant improvement of the investigated scores from week4, some differences in terms of PASI90 and PASI100 responses (higher for bimekizumab at each follow-up, with only PASI100 response significantly higher at week4 and 16) were registered. No statistical significance was found for safety data and treatment failure.