Energy Dose Research Articles

Proton-Induced Thermoacoustic Process as Linear-Time-Invariant System

This article presents a cross-domain model that defines and sets the acoustic signal generation process due to the fast dose deposition induced by a proton beam penetrating an energy absorber. The proposed model reduces the complex iono-acoustic energy transformation process to a simple impulse-response of a linear-time-invariant (LTI) system and is validated by comparing LTI output simulation results (in both time and frequency domain) with experimental acoustic signals emitted by a physical proton beam at 20 MeV and 70–120-ns pulse time width. Thanks to the intrinsic simplicity of the system, it is possible to predict and estimate the effective acoustic power at the sensor and the resultant beam range measurement precision. More importantly, the information coming from LTI simulations provides well-defined methodologies that allow to increase acoustic signal amplitude from +3 up to +9 dB and to improve the measurement precision of the beam range localization (up to +/ − 0.3 mm versus +/ − 0.6 mm state of the art for 200-MeV energy and 75-mGy total dose).

Fabrication of Biomimetic 2D Nanostructures through Irradiation of Stainless Steel Surfaces with Double Femtosecond Pulses.

Femtosecond laser induced changes on the topography of stainless steel with double pulses is investigated to reveal the role of parameters such as the fluence, the energy dose and the interpulse delay on the features of the produced patterns. Our results indicate that short pulse separation (Δτ = 5 ps) favors the formation of 2D Low Spatially Frequency Laser Induced Periodic Surface Structures (LSFL) while longer interpulse delays (Δτ = 20 ps) lead to 2D High Spatially Frequency LIPSS (HSFL). The detailed investigation is complemented with an analysis of the produced surface patterns and characterization of their wetting and cell-adhesion properties. A correlation between the surface roughness and the contact angle is presented which confirms that topographies of variable roughness and complexity exhibit different wetting properties. Furthermore, our analysis indicates that patterns with different spatial characteristics demonstrate variable cell adhesion response which suggests that the methodology can be used as a strategy towards the fabrication of tailored surfaces for the development of functional implants.

Determining the Absorbed Dose of Alpha Radiation due to Inhalation Radon Gas and Its Derivatives in Human Lung Using MCNPX 2.6.0 Simulation Model by Jafari et al. In Khorasan Razavi, Summer 2019

Background & Objective: People who work in closed and underground environments such as mines get radioactive gases into their respiratory system due to the concentration in the air. These radioactive substances, after entering the body’s respiratory system, with radiating energetic particles, damage most of the live cells. The most damaged parts are in the alveolar air cells of the lung which may lead to cancer. Materials & Methods: The absorbed energy and annual effective dose due to the emitted alpha beam of radon and derivatives on alveolar air cells of the adult lung using MCNPX 2.6.0 simulation are determined. Color profiles are shown as a result of simulation of absorbed dose in the 27 alveoli of lung due to alpha radiation of radon and its derivatives. Results: The investigations show that polonium-210 (210Po), as one of the radon derivatives with long life, has the most annual effective absorbed dose in the human lung and as a result can cause the most damage to the living tissue of the alveolar air cells in comparison with the other radon derivatives. After this element, 218Po, 222Rn ,214Po and 214Bi have more the absorbed dose in the human lung, respectively. Conclusion: Most cancers from radon are generated by radon derivatives. They can play an important role in lung damage. Exposure to radon derivatives rises a person's lifetime risk of lung cancer. The risk increases in direct relationship with the length of exposure and the type of radon derivative. For reduction of 210Po is suggested the use of ventilation. It moves outdoor air into the building, and distributes the air within the building.

Heterogeneous Heat Absorption Is Complementary to Radiotherapy.

Simple SummaryThis review shows the advantages of heterogeneous heating of selected malignant cells in harmonic synergy with radiotherapy. The main clinical achievement of this complementary therapy is its extreme safety and minimal adverse effects. Combining the two methods opens a bright perspective, transforming the local radiotherapy to the antitumoral impact on the whole body, destroying the distant metastases by “teaching” the immune system about the overall danger of malignancy.(1) Background: Hyperthermia in oncology conventionally seeks the homogeneous heating of the tumor mass. The expected isothermal condition is the basis of the dose calculation in clinical practice. My objective is to study and apply a heterogenic temperature pattern during the heating process and show how it supports radiotherapy. (2) Methods: The targeted tissue’s natural electric and thermal heterogeneity is used for the selective heating of the cancer cells. The amplitude-modulated radiofrequency current focuses the energy absorption on the membrane rafts of the malignant cells. The energy partly “nonthermally” excites and partly heats the absorbing protein complexes. (3) Results: The excitation of the transmembrane proteins induces an extrinsic caspase-dependent apoptotic pathway, while the heat stress promotes the intrinsic caspase-dependent and independent apoptotic signals generated by mitochondria. The molecular changes synergize the method with radiotherapy and promote the abscopal effect. The mild average temperature (39–41 °C) intensifies the blood flow for promoting oxygenation in combination with radiotherapy. The preclinical experiences verify, and the clinical studies validate the method. (4) Conclusions: The heterogenic, molecular targeting has similarities with DNA strand-breaking in radiotherapy. The controlled energy absorption allows using a similar energy dose to radiotherapy (J/kg). The two therapies are synergistically combined.

Nutritional management of ICU patients receiving mechanical ventilation: A retrospective cohort study using a medical claims database

<h2>Summary</h2><h3>Background & aims</h3> Because nutritional therapy affects clinical outcomes in critically ill patients, the nutritional management of such patients must be appropriate. However, the nutritional management of critically ill patients in Japan has not been fully characterized. The aim of this study was to describe the nutritional management of inpatients admitted to Japanese intensive care units using a national medical claims database. <h3>Methods</h3> In this retrospective cohort study, we included mechanically ventilated adult patients who were admitted to an ICU in Japan from January 2010 through June 2020 and remained there ≥ 4 days. We determined when nutritional management (i.e., oral intake, enteral nutrition, or parenteral nutrition) was initiated and how that changed during days 1–30. We also identified the prescribed daily doses of parenteral energy, amino acids, and lipids during fasting period from days 1–30. <h3>Results</h3> Of 99147 patients, 28435 (28.7%) were aged ≥ 80 and 16737 (16.9%) had BMI < 18.5. The median (Q1, first quartile; Q3, third quartile) initiation of enteral nutrition was day 4 (2, 6). Of this cohort, 37240 (37.6%) and 73563 (74.2%) patients took food orally or received enteral nutrition on days 3 and 7, respectively; whereas, 89542 (90.3%) and 25584 (25.8%) patients received only parenteral nutrition or glucose/electrolyte infusions on days 1 and 7, respectively. For fasting patients, the prescribed parenteral energy dose began increasing on day 2 and the median (Q1, Q3) dose on day 7 was 10.7 (4.5, 18.9) kcal/kg; prescribed amino acid dose began increasing on day 5 and the median (Q1, Q3) dose on day 7 reached 0.32 (0.00, 0.62) g/kg; and median (Q1, Q3) prescribed lipid caloric proportion of non-protein energy was 8.0% (0.0%, 34.4%) on day 1 and 0.0% after that. <h3>Conclusions</h3> Fasting critically ill patients in Japan were prescribed inadequate doses of parenteral amino acids relative to doses recommended in nutritional guidelines, and almost all of these patients had no parenteral lipids prescribed. The results of this survey of nutritional management in real-world settings should serve as a foundation for future studies determining optimal nutritional management of critically ill patients. <h3>Trial registration</h3> UMIN clinical trial registry, the Japanese clinical trial registry (registration number: UMIN000042607). Registered 1 December 2020 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048553.

A0267 - Is it safe and effective to increase the energy dose accumulated in the lithiasis by increasing the number of shock waves per session in extracorporeal lithotripsy? New prospective and randomized study

A0267 - Is it safe and effective to increase the energy dose accumulated in the lithiasis by increasing the number of shock waves per session in extracorporeal lithotripsy? New prospective and randomized study

Comparison of ablation index versus time-guided radiofrequency energy dosing using normal and half-normal saline irrigation in a porcine left ventricular model.

Ablation Index (AI) is a multiparametric quality marker to assess the durability of radiofrequency (RF) lesions. The comparative effectiveness and safety of AI versus time-based energy dosing for ablation of ventricular arrhythmias are unknown. We compared AI and time-based RF dosing strategies in the left ventricles (LVs) of freshly harvested porcine hearts. Ablation was performed in vitro with an open-irrigated ablation catheter (Thermocool ST/SF), 40 W, contact force 10-15 g. Tissue samples were stained in triphenyltetrazolium chloride for the measurement of lesion dimensions. A total of 560 lesions were performed (AI-group: [n = 360]; time-group: [n = 200]). Using normal saline (NS) (n = 280), growth in lesion depth slowed after 30 s and AI > 550 in comparison to width, volume, and magnitude of impedance drops which continued to increase with longer RF duration. Risk of steam pop (SP) was higher for RF > 30 s (RF < 30 s:1 SP [2.5%] vs. RF > 30 s: 15 SP [25%];p = .002) or AI targets >550 (AI: 350-550: 2 SP [2%] vs. AI 600-750: 15 SP [19%];p = .001). Using half-normal saline (HNS) (n = 280), lesion dimension and impedance drops were larger and growth in lesion depth slowed earlier (AI: 500). Risk of SPs was higher above AI 550 (AI: 350-550: 7 [7%] SPs vs. AI 600-750: 28 [35%] SPs; p < .00001). While codependent variables, correlation between AI and time was modest-to-strong but decreased with longer RF duration. In this ex vivo study, AI was a better predictor of lesion dimensions than ablation time and magnitude of impedance drop in the LV using NS and HNS irrigation. AI targets above 550 led to a higher risk of SPs. Future trials are required to verify these findings.

System and method for applying physiotherapeutic focused ultrasound

Despite many years of clinical use of ultrasound, the results of different reviews of controlled trials on the efficacy of ultrasound physical therapy for different musculoskeletal injuries continue to question its efficacy.However, “in vitro” experiments with well-controlled cell cultures and experiments with animal models show positive results. The question is whether the commercial systems used by physiotherapists can deliver the required ultrasonic dose to the exact location on the body.The object of this work is the design, realization and testing of a new concept of ultrasound system for Physiotherapy capable of focusing the ultrasound beam to apply the required ultrasonic energy dose at the point targeted by the physiotherapist. The system is designed for non-thermal effects Physiotherapy. The system consists of conceptually new piezocomposite arrays with a metallic delay line, multi-pulser electronics for emission focusing, parallel robots for mechanical steering and positioning of the array transducers, and linear and angular encoders to allow the physiotherapist to direct the focus to the target.The multi-pulser and parallel robot angulation are controlled by the computer, using a graphical interface software.

Effect of pulsed electromagnetic field versus pulsed high intensity laser in the treatment of men with osteopenia or osteoporosis: a randomized controlled trial

Background: Osteoporosis has been related to a negative impact on several aspects of patient health, including physical, mental, and emotional well-being. The objective of this study was to examine the effects of pulsed electromagnetic fields (PEMF) and pulsed Nd-YAG laser therapy (HILT) on men with osteopenia or osteoporosis. Methods: Ninety-five men with osteopenia or osteoporosis (mean age, 52 years; mean height, 176 cm; mean weight, 83 kg; mean body-mass index (BMI), 26.86 kg/m2) took part in the study, and they were randomly assigned to one of three groups: Group 1 received PEMF and exercise program (PEMF +EX), Group 2 received HILT and exercise program (HILT+EX), and Group 3 received exercise program only (EX). PEMF was applied three times per week for 12 weeks using a full-body mat, while HILT was applied to the lower back and hip regions with a total dose of energy of 3000 J delivered in two treatment stages. Flexibility, aerobic exercise, strength, weight-bearing, and balance exercises are included in exercise program, which is followed by whole-body vibration training. Bone mineral density (BMD) of the total hip and lumbar spine, bone markers, health-related quality of life (HRQoL), and fall risk are all outcome measures. Results: There were no significant differences in the parameters between the groups at the baseline (P &gt; 0.05). Patients in all groups, however, showed significant improvements in all measured parameters following treatment (P&lt; 0.05), with Group 1 and Group 2 showing much greater improvements than Group 3. Conclusion: After 12-weeks of treatment, PEMF combined with exercise is more effective than HILT combined with exercise or exercise alone in increasing BMD and promoting bone formation, suppressing bone-resorption markers, and improving quality of life and fall risk, with the effects lasting up to six months. This study was registered in the ClinicalTrial.gov PRS (NCT05029440, 26/08/2021).

Patterning a cellulose based dual-tone photoresist via deep X-ray lithography

The desire to combine properties such as ready availability, low price and biodegradability makes cellulose derivatives such as Trimethylsilyl cellulose (TMSC) an ideal precursor suited to study different applications on the abundant material, cellulose. Here we introduce a lithographic approach to pattern the cellulose derivative, TMSC, via photoinduced X-ray conversion. Thin films of this biopolymer were irradiated by means of proximity deep X-ray lithography. With increasing energy dose, we found distinct structural and chemical changes resulting in two polarity transitions and related thereto material solubility alterations. Based on this, we demonstrate that positive and negative tone structures can be obtained in one single exposure at the same energy dose. Notably, the positive tone pattern is produced when applying Isopropyl alcohol (IPA) or purified water to dissolve the exposed surface. In contrast, the negative tone structure is produced with toluene. These findings suggest TMSC as a potential dual-tone photoresist applicable in microelectronics or surface chemistry where it can be applied as a dielectric layer, a pattern template, used in microfluidics or functionalized for bioassays.

Induction of Immunogenic Cell Death by Photodynamic Therapy Mediated by Aluminum-Phthalocyanine in Nanoemulsion.

Photodynamic therapy (PDT) has been clinically employed to treat mainly superficial cancer, such as basal cell carcinoma. This approach can eliminate tumors by direct cytotoxicity, tumor ischemia, or by triggering an immune response against tumor cells. Among the immune-related mechanisms of PDT, the induction of immunogenic cell death (ICD) in target cells is to be cited. ICD is an apoptosis modality distinguished by the emission of damage-associated molecular patterns (DAMP). Therefore, this study aimed to analyze the immunogenicity of CT26 and 4T1 treated with PDT mediated by aluminum-phthalocyanine in nanoemulsion (PDT-AlPc-NE). Different PDT-AlPc-NE protocols with varying doses of energy and AlPc concentrations were tested. The death mechanism and the emission of DAMPs–CRT, HSP70, HSP90, HMGB1, and IL-1β–were analyzed in cells treated in vitro with PDT. Then, the immunogenicity of these cells was assessed in an in vivo vaccination-challenge model with BALB/c mice. CT26 and 4T1 cells treated in vitro with PDT mediated by AlPc IC50 and a light dose of 25 J/cm2 exhibited the hallmarks of ICD, i.e., these cells died by apoptosis and exposed DAMPs. Mice injected with these IC50 PDT-treated cells showed, in comparison to the control, increased resistance to the development of tumors in a subsequent challenge with viable cells. Mice injected with 4T1 and CT26 cells treated with higher or lower concentrations of photosensitizer and light doses exhibited a significantly lower resistance to tumor development than those injected with IC50 PDT-treated cells. The results presented in this study suggest that both the photosensitizer concentration and light dose affect the immunogenicity of the PDT-treated cells. This event can affect the therapy outcomes in vivo.

Photobiomodulation effect in tumoral necrosis factor-alpha(TNF-α) on the viability of random skin flap in rats.

The aim of this study was to investigate the effect of red laser (660 nm) photobiomodulation (PBM) with different energies on tumor necrosis factor-alpha(TNF-α) expression for random skin flap viability in rats. Twenty-four Wistar rats were divided into three groups: sham group (SG), PBM laser group with an energy dose of 0.29 J (0.29G), and PBM laser group with an energy dose of 7.30 J (7.30G). A cranially based dorsal skin flap measuring 10 × 4 cm was raised and a plastic barrier was placed between the flap and its bed. PBM was applied in 3 timepoints: in the immediate postoperative period, in the 1st and in the 2nd postoperative days; the animals were euthanized on the 7th postoperative day. The assessments included: TNF-α expression of 3 different flap areas (proximal, medial and distal), by immunohistochemistry; percentage of skin flap necrosis area, by the paper template method. The statistical analysis was performed through the Kruskal-Wallis and Mann-Whitney tests, the level of significance adopted was 5% (p < 0.05). TNF-α expression was significantly lower for 7.30G in the proximal area, reduced for SG in the medial point, and larger for 7.30G in the distal area. The percentage of flap necrosis area was significantly reduced for 7.30G. Higher energy doses are more efficacious than lower energy doses for modulating TNF-α expression. PBM with an energy dose of 7.30 J was effective in reducing the expression of TNF-α and increase skin flap viability.

Fabrication of Nanopore in MoS2-Graphene vdW Heterostructure by Ion Beam Irradiation and the Mechanical Performance.

Nanopore structure presents great application potential especially in the area of biosensing. The two-dimensional (2D) vdW heterostructure nanopore shows unique features, while research around its fabrication is very limited. This paper proposes for the first time the use of ion beam irradiation for creating nanopore structure in 2D vdW graphene-MoS2 heterostructures. The formation process of the heterostructure nanopore is discussed first. Then, the influence of ion irradiation parameters (ion energy and ion dose) is illustrated, based on which the optimal irradiation parameters are derived. In particular, the effect of stacking order of the heterostructure 2D layers on the induced phenomena and optimal parameters are taken into consideration. Finally, uniaxial tensile tests are conducted by taking the effect of irradiation parameters, nanopore size and stacking order into account to demonstrate the mechanical performance of the heterostructure for use under a loading condition. The results would be meaningful for expanding the applications of heterostructure nanopore structure, and can arouse more research interest in this area.

Kinetic Energy Dose as a Unified Metric for Comparing Ball Mills in the Mechanocatalytic Depolymerization of Lignocellulose.

Mechanochemistry utilizes mechanical forces to activate chemical bonds. It offers environmentally benign routes for both (bio) organic and inorganic syntheses. However, direct comparison of mechanochemistry results is often very challenging. In mechanochemical synthetic protocols, ball mill setup (mechanical design and grinding vessel geometry) in addition to experimental parameters (milling frequency, duration, ball count and size) vary broadly. This fact poses a severe issue to further progress in this exciting research area because ball mill setup and experimental parameters govern how much kinetic energy is transferred to a chemical reaction. In this work, we address the challenge of comparing mechanochemical reaction results by taking the energy dose provided by ball mills as a unified metric into account. In this quest, we applied kinematic modeling to two ball mills functioning under distinct working principles to express the energy dose as a mathematical function of the experimental parameters. By examining the effect of energy dose on the extent of the mechanocatalytic depolymerization (MCD) of lignocellulosic biomass (beechwood), we found linear correlations between yield of water-soluble products (WSP) and energy dose for both ball mills. Interestingly, when a substrate layer is formed on the grinding jar wall and/or grinding medium, a weak non-linear correlation between water-soluble products yield and energy dose is identified. We demonstrate that the chemical reaction’s best utilization of kinetic energy is achieved in the linear regime, which presents improved WSP yields for given energy doses. In the broader context, the current analysis outlines the usefulness of the energy dose as a unified metric in mechanochemistry to further the understanding of reaction results obtained from different ball mills operating under varied experimental conditions.

Evaluation of silicon strip detectors in transmission mode for online beam monitoring in microbeam radiation therapy at the Australian Synchrotron.

Successful transition of synchrotron-based microbeam radiation therapy (MRT) from pre-clinical animal studies to human trials is dependent upon ensuring that there are sufficient and adequate measures in place for quality assurance purposes. Transmission detectors provide researchers and clinicians with a real-time quality assurance and beam-monitoring instrument to ensure safe and accurate dose delivery. In this work, the effect of transmission detectors of different thicknesses (10 and 375 µm) upon the photon energy spectra and dose deposition of spatially fractionated synchrotron radiation is quantified experimentally and by means of a dedicated Geant4 simulation study. The simulation and experimental results confirm that the presence of the 375 µm thick transmission detector results in an approximately 1-6% decrease in broad-beam and microbeam peak dose. The capability to account for the reduction in dose and change to the peak-to-valley dose ratio justifies the use of transmission detectors as thick as 375 µm in MRT provided that treatment planning systems are able to account for their presence. The simulation and experimental results confirm that the presence of the 10 µm thick transmission detector shows a negligible impact (<0.5%) on the photon energy spectra, dose delivery and microbeam structure for both broad-beam and microbeam cases. Whilst the use of 375 µm thick detectors would certainly be appropriate, based upon the idea of best practice the authors recommend that 10 µm thick transmission detectors of this sort be utilized as a real-time quality assurance and beam-monitoring tool during MRT.

Improving the efficiency of convective grain drying by using low-intensity RF radiation

Drying (dewatering) of plant products is widely used in various technologies of their processing, transportation and storage. Existing dewatering processes and equipment are very diverse in design and application; their technical and economic performance also varies significantly. The effectiveness of the dewatering process of vegetable raw materials depends on the range of initial and final humidity and a number of physical, mechanical, chemical and other properties of the product, the drying method, technology and technical characteristics of the equipment. characteristics of the equipment. It is particularly difficult to ensure efficient, relatively low-energy drying of grain products, the seeds of which contain moisture in a bound form and are separated from the external environment by a dense seed shell. Currently, the volume of drying and processing of such seeds is increasing and amounts to millions of tons per season. Dried seeds are used to make flour, food additives, spices, medicinal oils and other natural products. The article studies the ways to reduce energy consumption in the main drying method-convective dewatering of commercial grain with low initial humidity. It is shown that the injection of small doses of microwave energy into the drying process - 1-5% of the total convective heating power - can reduce the overall energy intensity of the process by 25-27%.

Rhodotron and Rotating Target: A Solution Towards Micro-Spot for High Energy and High Dose Rate Bremsstrahlung Sources

Rhodotron and Rotating Target: A Solution Towards Micro-Spot for High Energy and High Dose Rate Bremsstrahlung Sources

Immediate effect of Nd:YAG laser monotherapy on subgingival periodontal pathogens: a pilot clinical study.

PurposeThis pilot study assessed the immediate in vivo effect of high peak pulse power neodymium-doped yttrium aluminum garnet (Nd:YAG) laser monotherapy on selected red/orange complex periodontal pathogens in deep human periodontal pockets.MethodsTwelve adults with severe periodontitis were treated with the Laser-Assisted New Attachment Procedure (LANAP®) surgical protocol, wherein a free-running, digitally pulsed, Nd:YAG dental laser was used as the initial therapeutic step before mechanical root debridement. Using a flexible optical fiber in a handpiece, Nd:YAG laser energy, at a density of 196 J/cm2 and a high peak pulse power of 1,333 W/pulse, was directed parallel to untreated tooth root surfaces in sequential coronal-apical passes to clinical periodontal probing depths, for a total applied energy dose of approximately 8–12 joules per millimeter of periodontal probing depth at each periodontal site. Subgingival biofilm specimens were collected from each patient before and immediately after Nd:YAG laser monotherapy from periodontal pockets exhibiting ≥6 mm probing depths and bleeding on probing. Selected red/orange complex periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Fusobacterium nucleatum, Parvimonas micra, and Campylobacter species) were quantified in the subgingival samples using established anaerobic culture techniques.ResultsAll immediate post-treatment subgingival biofilm specimens continued to yield microbial growth after Nd:YAG laser monotherapy. The mean levels of total cultivable red/orange complex periodontal pathogens per patient significantly decreased from 12.0% pre-treatment to 4.9% (a 59.2% decrease) immediately after Nd:YAG laser monotherapy, with 3 (25%) patients rendered culture-negative for all evaluated red/orange complex periodontal pathogens.ConclusionsHigh peak pulse power Nd:YAG laser monotherapy, used as the initial step in the LANAP® surgical protocol on mature subgingival biofilms, immediately induced significant reductions of nearly 60% in the mean total cultivable red/orange complex periodontal pathogen proportions per patient prior to mechanical root instrumentation and the rest of the LANAP® surgical protocol.

The Effect of Fluence on Neutrophil Kinetics in Zebrafish Wounds Using Real-time In Vivo Imaging

Background: Neutrophils participate in a cooperative defense strategy with macrophages following tissue injury. Application of low dose electromagnetic radiation via 635 nm wavelength can enhance macrophage recruitment to the wound, decrease tissue levels of ROS and speed healing. The impact of this wavelength on neutrophil activity in vivo is not well-described. Given that wound healing can be enhanced if collateral damage by neutrophils within the wound is decreased, we investigated how neutrophil kinetics changed during these accelerated reparative responses. Methods: Zebrafish, transgenic for the fluorescent neutrophil marker, mpx-dendra2, underwent defined fin tissue injury, and were randomized to one of two laser treatment groups, 3 J/cm2 (n=57), or 18 J/cm2 (n=69) or to the control group, 0 J/cm2 (n=164). Electromagnetic wave exposures were administered by a 635-nm continuous 5mW He:Ne laser with recipients randomized by dose delivered. Fish were three-dimensionally time-lapse imaged 30-120 minutes post injury (mpi) and wound healing documented at 24 hours post-injury. Individual neutrophil movement was tracked according to distance from wound center. Results: The lower treatment fluence, 3 J/cm2, significantly decreased neutrophil migration speed into the wound, increased reverse migration, and promoted stasis outside the adjacent wound area when compared to control and higher energy doses. The 3 J/cm2 treatment groups also exhibited more rapid wound closure when compared to control or higher fluence. Conclusions: Unlike our previous work in macrophages in which low fluence treatment enhanced the speed of forward directed migration into the wound, the response of neutrophils was decreased speed into the wound, increased reverse migration, and stasis outside the areas of the wound edges. These findings advance the notion that low fluence treatments reduce neutrophil inflammatory responses within the wound by their reduced presence within the wound. Reduced neutrophil-mediated collateral damage may work in concert with enhanced macrophage wound activity to promote faster wound healing.

Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition.

This guideline updates recommendations from the 2016 American Society for Parenteral and Enteral Nutrition (ASPEN)/Society of Critical Care Medicine (SCCM) critical care nutrition guideline for five foundational questions central to critical care nutrition support. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) process was used to develop and summarize evidence for clinical practice recommendations. Clinical outcomes were assessed for (1) higher vs lower energy dose, (2) higher vs lower protein dose, (3) exclusive isocaloric parenteral nutrition (PN) vs enteral nutrition (EN), (4) supplemental PN (SPN) plus EN vs EN alone, (5A) mixed-oil lipid injectable emulsions (ILEs) vs soybean oil, and (5B) fish oil (FO)-containing ILE vs non-FO ILE. To assess safety, weight-based energy intake and protein were plotted against hospital mortality. Between January 1, 2001, and July 15, 2020, 2320 citations were identified and data were abstracted from 36 trials including 20,578 participants. Patients receiving FO had decreased pneumonia rates of uncertain clinical significance. Otherwise, there were no differences for any outcome in any question. Owing to a lack of certainty regarding harm, the energy prescription recommendation was decreased to 12-25 kcal/kg/day. No differences in clinical outcomes were identified among numerous nutrition interventions, including higher energy or protein intake, isocaloric PN or EN, SPN, or different ILEs. As more consistent critical care nutrition support data become available, more precise recommendations will be possible. In the meantime, clinical judgment and close monitoring are needed. This paper was approved by the ASPEN Board of Directors.