High-quality Treatment Research Articles

Mechanism of action of Nrf2 and its related natural regulators in rheumatoid arthritis.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovitis that can lead to joint deformities. To date, more than 18 million individuals worldwide have been diagnosed with RA, making it one of the most prevalent autoimmune diseases globally and posing a significant threat to public health and safety. Due to the complex pathogenesis of the disease, which involves autoimmunity, genetics, inflammation and oxidative stress in the body's tissues, the current drug therapy generally targets a single molecule, and effective and efficient drugs involving multiple levels and targets are lacking; thus, there is an urgent need for high-quality research and treatment in this field. Nuclear transcription factor erythroid 2-associated factor 2 (Nrf2) plays a crucial role in cellular resistance to oxidative stress and electrophilic attacks and is a potential pharmacological target for chronic disease treatment. While currently no drugs that target Nrf2 have been approved specifically for RA treatment, such an approach holds great significance. In recent years, the use of natural products to treat RA and other chronic conditions has become increasingly widespread because of their superior efficacy and minimal side effects. Therefore, this article provides a review of the mechanism of Nrf2 in RA and summarizes natural products that target Nrf2 and its associated pathways in the treatment of RA, aiming to offer new insights and strategies for the prevention and management of RA.

Sialic Acids and Cancer: Pathophysiological Association between Metastatic Progress and Treatment

Abstract: Neoplasm metastasis is a multi-step process with a high rate of cancer mortality (>60%). Several complex pathogenesis pathways and key therapeutic targets are unclear to us now. To change this scenario, effective drug targets and underlying mechanisms should be found, and high-quality metastasis treatment should be supported. Aberrant tumor sialylation was proposed as a putative drug target candidate to bridge the gaps between metastatic spread and drug responses (genetic, molecular, and animal models). More recently, several promising therapeutic mechanisms and benefits against neoplasm metastasis have been observed by potential association for the target of higher levels and diverse forms of sialic acids (sia) analogues, antigens, glycan, sialylation enzymes, and conjugates. Subsequently, sia-related pathophysiology in cancer diagnosis, prognosis, and therapeutic responses has been reviewed. New algorithms, computation, experimental evaluations, and modern technology might see breakthroughs in therapeutic targets, responses, and immune regulation via sialylation enzymes, associated genes, different glycol conjugates, and other hallmarks of cancer.

Community prevention and standardized clinical treatment jointly improve cancer outcome: Real-world evidence from an esophageal cancer patient cohort study

Extensive efforts have been put into reducing the heavy burden of esophageal squamous cell carcinoma (ESCC) in China. However, the joint impact of prevention and treatment on the long-term overall survival (OS) of ESCC patients remains largely unknown. We consecutively recruited 13,255 ESCC patients from two Chinese centers: the Northern center, located in a high-risk area with abundant screening programs; and the Southern center, situated in a non-high-risk area with improved clinical practices. Inter-center comparison, longitudinal intra-center comparison, and a simulation analysis were conducted to investigate the influence of tumor downstaging and high-quality clinical treatment on OS. During a follow-up period of 12.52 years, the Northern center exhibited higher median survival than the Southern center (6.22 vs. 3.15 years; HRadjusted = 0.73, 95% CI: 0.69–0.77). Mediation analysis demonstrated that its OS advantage was largely (77.7%) attributed to earlier TNM stage (stage 0–II: 51.3% vs. 24.6%). In temporal analyses, patient survival in the Southern center gradually improved (median survival during 2015–2018 vs. 2009–2014: 3.58 vs. 2.93 years; HRadjusted = 0.86, 95% CI: 0.79–0.94), coinciding with the progress of treatment-related indices (completeness of TNM staging in discharge diagnosis [from 53.7% to 99.6%], adoption of minimally invasive esophagectomy [from 0.0% to 51.1%] and right thoracic esophagectomy [from 12.4% to 86.4%], etc.). Simulation analysis further demonstrated that integrating both downstaging and high-quality treatment would lead to the best survival. Tumor downstaging and high-quality clinical treatment have a joint impact on ESCC patient survival. Establishing a comprehensive strategy that integrates cancer prevention with optimal clinical treatment is crucial for alleviating the ESCC burden.

Disparities, Inequities, and Injustices in Populations With Pain: An ASPMN Position Statement

Disparities, inequities, and injustices in populations with pain are historically pervasive and lead to deleterious patient outcomes and perpetuate systemic barriers to achieving equitable pain management. The American Society for Pain Management Nursing (ASPMN) upholds the principle that all persons with pain have equal rights to evidence-based, high quality pain assessment, management, and treatment. Intervening at multilevels (i.e., individual, interpersonal, community, societal) is necessary to ascertain that just and equitable pain care is provided to all populations.

Strengthening Capacity in Radiotherapy Skills to Deliver High-Quality Treatments in Low- and Middle-Income Countries: A Qualitative Study

Strengthening Capacity in Radiotherapy Skills to Deliver High-Quality Treatments in Low- and Middle-Income Countries: A Qualitative Study

A student trained convolutional neural network competing with a commercial AI software and experts in organ at risk segmentation

This retrospective, multi-centered study aimed to improve high-quality radiation treatment (RT) planning workflows by training and testing a Convolutional Neural Network (CNN) to perform auto segmentations of organs at risk (OAR) for prostate cancer (PCa) patients, specifically the bladder and rectum. The objective of this project was to develop a clinically applicable and robust artificial intelligence (AI) system to assist radiation oncologists in OAR segmentation. The CNN was trained using manual contours in CT-datasets from diagnostic 68Ga-PSMA-PET/CTs by a student, then validated (n = 30, PET/CTs) and tested (n = 16, planning CTs). Further segmentations were generated by a commercial artificial intelligence (cAI) software. The ground truth were manual contours from expert radiation oncologists. The performance was evaluated using the Dice-Sørensen Coefficient (DSC), visual analysis and a Turing test. The CNN yielded excellent results in both cohorts and OARs with a DSCmedian > 0.87, the cAI resulted in a DSC > 0.78. In the visual assessment, 67% (bladder) and 75% (rectum) of the segmentations were rated as acceptable for treatment planning. With a misclassification rate of 45.5% (bladder) and 51.1% (rectum), the CNN passed the Turing test. The metrics, visual assessment and the Turing test confirmed the clinical applicability and therefore the support in clinical routine.

Comparative analysis of the effectiveness of mechanical treatment of root canals by various Ni-Ti file systems

INTRODUCTION. One of the main stages of successful endodontic treatment is high-quality mechanical treatment of root canals. А large number of various rotary Ni-Ti files in the dental market poses a difficult choice for the doctor, especially in the context of import substitution. It is necessary to have knowledge about the effectiveness of different system of instruments in a particular clinical case. AIM. With the help of scanning electronic mycoroscopy and computer microtomography, to analyze the quality of mechanical treatment of the root canal with files of domestic and foreign production.MATERIALS AND METHODS. During the study, single-root and multi-root teeth with different root canal curvature were selected, which were distributed according to the Ni-Ti file system used: group 1 – RM files (RusMed), group 2 – ProTaper Universal (Dentsply Mallifier), group 3 – M-two (VDW).RESULTS. The analysis of scanning electron microscopy of tooth showed that the largest number of open dentine tubules is determined when treating the root canal with instruments of the group 1 (55.4±1.37) and group 3 (60.25±1.59). The centering ability with a curvature of the root canal of 20–25° had no significant differences between the tools used. With a curvature of the root canal of 40–45°, the value of this parameter decreased significantly in all groups of instruments, it was greatest in the groups 1 and 3.CONCLUSION. It was revealed that the best quality of mechanical treatment of the root canal was obtained using RM-files and Mtwo in samples with a channel curvature of up to 25°.

Quality of Life and Mental Development of Children with Acute Respiratory Infections Undergoing Hospital Treatment

Preserving the health of the younger generation is a priority multidisciplinary task. For a more comprehensive and individual assessment of the functioning of the child's body against the background of acute viral infections, a technique for determining the quality of life based on subjective perception was used, on the basis of which patients are classified into the first or second classes of quality of life. The paper examines the interrelationships of health, quality of life and mental development of preschool children with acute respiratory infections being treated in the pediatric department. Some children were found to have a reduced quality of life, not only in the group of children with acute respiratory infections, but also in the group of healthy children. There were significantly more patients with grade 2 quality of life in the main group. According to the results of correlation analysis using Spearmanʼs rank correlation coefficient, it was found that the quality of life is interrelated with psycho-emotional and the intellectual development of the child. Based on the study of the quality of life of patients in the pediatric department, it is possible to implement an individual approach to assessing the condition of the child as a whole and against the background of the disease, for high-quality further treatment and monitoring, for the organization of preventive measures.

Breast cancer statistics 2024.

This is the American Cancer Society's biennial update of statistics on breast cancer among women based on high-quality incidence and mortality data from the National Cancer Institute and the Centers for Disease Control and Prevention. Breast cancer incidence continued an upward trend, rising by 1% annually during 2012-2021, largely confined to localized-stage and hormone receptor-positive disease. A steeper increase in women younger than 50 years (1.4% annually) versus 50 years and older (0.7%) overall was only significant among White women. Asian American/Pacific Islander women had the fastest increase in both age groups (2.7% and 2.5% per year, respectively); consequently, young Asian American/Pacific Islander women had the second lowest rate in 2000 (57.4 per 100,000) but the highest rate in 2021 (86.3 per 100,000) alongside White women (86.4 per 100,000), surpassing Black women (81.5 per 100,000). In contrast, the overall breast cancer death rate continuously declined during 1989-2022 by 44% overall, translating to 517,900 fewer breast cancer deaths during thistime. However, not all women have experienced this progress; mortality remained unchanged since 1990 in American Indian/Alaska Native women, and Black women have 38% higher mortality than White women despite 5% lower incidence. Although the Black-White disparity partly reflects more triple-negative cancers, Black women have the lowest survival for every breast cancer subtype and stage except localized disease, with which they are 10% less likely to be diagnosed than White women (58% vs. 68%), highlighting disadvantages in social determinants of health. Progress against breast cancer could be accelerated by mitigating racial, ethnic, and social disparities through improved clinical trial representation and access to high-quality screening and treatment.

Head and Neck Cancer Treatment Delays in 2021: Estimating Distributional Effects by Site, Surgery, and p16-positivity

BackgroundFollowing decades of policies increasing access to high-quality cancer treatment, the COVID-19 pandemic upended the U.S. healthcare system. The pandemic’s disruption likely affected an often-overlooked dimension of quality cancer treatment: timely initiation. Timely treatment initiation is especially critical for head and neck cancer (HNC). We aimed to assess how the treatment interval (diagnosis to treatment initiation) changed in 2021 for different types of HNCs and treatment modalities. MethodologyWe analyzed Surveillance, Epidemiological, End Results (SEER) case data for years 2007-2021. Using ICD site codes, cancers were restricted to oropharynx, oral cavity, other pharynx, larynx. Oropharynx cancers were stratified by Human Papillomavirus (HPV) subtype based on p16-positivity codes. The outcome of interest was a variable measuring the number of days from diagnosis to treatment initiation. Cases were stratified by site and whether they received surgery as first course of treatment. To overcome validity threats from skewed treatment interval data and unobserved heterogeneity, we constructed an unconditional quantile regression model to estimate the effect of treatment in 2021 across the distribution of the treatment interval. Results155,273 patients in SEER initiated HNC treatment between 2007-2021. The median treatment interval was 29days (Interquartile Range = 2-48). Among patients not receiving surgery, 2021 was associated with delayed treatment for all sites except oral cavity. For patients receiving surgery, 2021 was only associated with delayed treatment for p16+ Oropharynx cancer. DiscussionHNC patients overall, but HPV+ Oropharynx cancer patients especially, experienced treatment delays in 2021. These delays, and their consequences, warrant policymaking attention.

Disparities in the utilization of supportive care medications among older adults with metastatic pancreatic ductal adenocarcinoma.

51 Background: Inequities in cancer care delivery can profoundly affect access to high-quality treatments and patient outcomes. Supportive care medication use is important for preserving quality of life in older adults with metastatic pancreatic ductal adenocarcinoma (PDAC). Whether there are differences in supportive care medication use by race and sex is unknown. Our objectives were to assess the racial/ethnic and biological sex inequities in use of treatments for pain, depression, and pancreatic insufficiency-related treatments (PERT) among older adults with PDAC. Methods: We used the Surveillance, Epidemiology, and End Results-Medicare linked database, to identify Medicare beneficiaries aged 65 and older diagnosed with metastatic PDAC from January 2008 to December 2019. We included those continuously enrolled in Medicare prescription drug benefits in the 6 months before and month of diagnosis. Any use of opioid pain medications, antidepressants, and PERT was identified from diagnosis to the end of the study period (at death, disenrollment, or 12 months). Multivariable regression was used to compare supportive care medications use by racial/ethnic and biological sex groups. Results: There were 29,509 individuals in our sample, with12.9% Black patients, 3.9% Hispanic patients, and 83.2% White patients. The mean age was 76.5 (SD: 7.4) years. Mean follow-up time was 135.4 (SD:117.7) days overall, with the shortest follow-up among Black patients 124 (SD:111.1) days and longest for White patients 137.5 (SD: 118.8) days. Antidepressants were used by 23.8%, opioids by 60.3%, and PERT by 12.4% overall. Within race groups there were limited differences in medication use by sex. However, we observed differences in supportive care treatment use by race and ethnicity. Specifically, relative to White individuals, those who identified as Black were 20% less likely (adjusted risk ratio [aRR]: 0.8, 95% CI:0.74-0.85) to receive antidepressants, 14% less likely to receive opioids (aRR: 0.86, 95% CI:0.84-0.89), and 41% less likely to receive PERT (aRR: 0.59, 95% CI:0.53-0.65). Similar patterns were observed for patients of Hispanic ethnicity, with those individuals being 12% less likely (adjusted risk ratio[aRR]: 0.88, 95% CI:0.89-0.98) to receive antidepressants, 9% less likely to receive opioids (aRR: 0.91, 95% CI:0.87-0.96), and 42% less likely to receive PERT (aRR: 0.58, 95% CI:0.47-0.70). Conclusions: Our preliminary data showed differences in the uptake of supportive care drugs among Black and Hispanic patients relative to White patients. Specifically, these individuals were less likely to start opioid pain medications, antidepressants, and pancreatic enzyme replacement therapy compared to their White counterparts. These findings highlight potential gaps in treatment use that may better support patients facing life-limiting illnesses.

Design and validation of AQUA CHILD-Pre-aquatic questionnaire assessing child development.

We developed a proxy questionnaire for parents of children with Developmental Delay (DD) to provide comprehensive information for instructors about the child's functioning before participating in aquatic activities. This dedicated information will enable a high-quality treatment plan to promote the child's functioning in everyday life. Based on the International Classification of Functioning, Disability, and Health (ICF) Coreset development and linking rules method, a set ofquestions was constructed in a preliminary process. A draft version was sent to instructors and parents in Israel. Seventy-five questionnaires from instructors and 25 from parents returned to the statistical analysis procedure. Reliability and face validity were analyzed by experts. The questionnaire showed high validity and reliability for its purposes and allowed self-completion by the parents.

Rehabilitation with removable dentures in adults and older people with partial or total edentulism: Chilean Public Health System Experience, 2017–2019

Statement of problemTooth loss is frequent among the Chilean population, particularly the poor and elderly. The Public's response is mostly via removable dentures (RDs), however there is limited evidence regarding its results. PurposeThe objective of this descriptive ecological study is to monitor and characterize the production of RDs within Chile's Public Health System. Material and methodsPublic records were obtained from the Department of Statistics and Health Information of Chile (DEIS) website. All records regarding RDs activities within the Public Health System for years 2017 to 2019 were retrieved and included in the analysis. ResultsBetween 2017 and 2019, the Public Health sector delivered an average of 342,261 RDs annually, which corresponds to 2.4 RD per 100 individuals. Overall, 70.3 % of beneficiaries were female, 63.2 % were for people between the ages of 20 to 64, and 35.3 % were for people aged 65 or older. Among RDs provided, 57 % were made at the primary level and 43 % at the secondary level of care. The program “More Smiles”, accounted for 52.3 % of primary healthcare RD delivery. At the secondary level, 14.9 % of RDs had metallic framework, while 85.1 % were acrylic. Older persons and males were more likely to receive acrylic RDs than their counterparts. ConclusionsRDs are regularly supplied in Chile's Public Healthcare System, mainly through primary care. The characterization regarding programs, type of RDs, gender and age of the recipients, may guide future hypothesis regarding the adequateness of the response to address tooth loss at a population level. Further investigation into the impact on patient satisfaction and RD quality is recommended to enhance understanding in this domain. Clinical implicationsThe study explores the scale and characteristics of removable prosthetic provision within Chile's Public Health System. This comprehensive overview enables the identification of areas requiring further attention to ensure the delivery of high-quality treatments and the efficient allocation of public resources.

Global burden of benign prostatic hyperplasia, urinary tract infections, urolithiasis, bladder cancer, kidney cancer, and prostate cancer from 1990 to 2021

BackgroundThe burden of common urologic diseases, including benign prostatic hyperplasia (BPH), urinary tract infections (UTI), urolithiasis, bladder cancer, kidney cancer, and prostate cancer, varies both geographically and within specific regions. It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases.MethodsWe obtained data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for the aforementioned urologic diseases by age, sex, location, and year from the Global Burden of Disease (GBD) 2021. We analyzed the burden associated with urologic diseases based on socio-demographic index (SDI) and attributable risk factors. The trends in burden over time were assessed using estimated annual percentage changes (EAPC) along with a 95% confidence interval (CI).ResultsIn 2021, BPH and UTI were the leading causes of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR), with rates of 5531.88 and 2782.59 per 100,000 persons, respectively. Prostate cancer was the leading cause of both age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR), with rates of 12.63 and 217.83 per 100,000 persons, respectively. From 1990 to 2021, there was an upward trend in ASIR, ASPR, ASMR, and ASDR for UTI, while urolithiasis showed a downward trend. The middle and low-middle SDI quintile levels exhibited higher incidence, prevalence, mortality, and DALYs related to UTI, urolithiasis, and BPH, while the high and high-middle SDI quintile levels showed higher rates for the three cancers. The burden of these six urologic diseases displayed diverse age and sex distribution patterns. In 2021, a high body mass index (BMI) contributed to 20.07% of kidney cancer deaths worldwide, while smoking accounted for 26.48% of bladder cancer deaths and 3.00% of prostate cancer deaths.ConclusionsThe global burden of 6 urologic diseases presents a significant public health challenge. Urgent international collaboration is essential to advance the improvement of urologic disease management, encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies.

Reducing treatment time for robotic radiosurgery by considering path efficiency during node selection.

Robotic radiosurgery treatments allow for precise non-coplanar beam delivery by utilizing a robot equipped with a linac that traverses through a set of predetermined nodes. High quality treatment plans can be produced but treatment times can grow large, with one substantial component being the robot traversal time. The aim of this study is to reduce the treatment time for robotic radiosurgery treatments by introducing algorithms for reducing the robot traversal time. The algorithms are integrated into a commercial treatment planning system. First, an optimization framework for robotic radiosurgery planning is detailed, including a heuristic optimization method for node selection. Second, two methods aimed at reducing the traversal time are introduced. One utilizes a centrality measure focusing on the structure of the node network, while the other is based on the direct computation of traversal times during optimization. A comparison between plans with and without the time-reducing algorithms is made for three brain cases and one liver case with basis in treatment time, plan quality, monitor units, and network structure of the selectednodes. Large decreases in traversal times are obtained by the traversal time reducing algorithms, with reductions of up to 49 % in the brain cases and 31 % in the liver case. The resulting reductions in treatment times are up to 30 % and 13 %, respectively. Small differences in plan quality are observed, with similar dose-volume histograms, dose distributions, and conformity/gradientindices. The total treatment time of the robotic radiosurgery treatments can be reduced by selecting nodes with more efficient robot traversal paths, while maintaining planquality.

A patient-specific auto-planning method for MRI-guided adaptive radiotherapy in prostate cancer

Background and purposeFast and automated generation of treatment plans is desirable for magnetic resonance imaging (MRI)-guided adaptive radiotherapy (MRIgART). This study proposed a novel patient-specific auto-planning method and validated its feasibility in improving the existing online planning workflow. Materials and methodsData from 40 patients with prostate cancer were collected retrospectively. A patient-specific auto-planning method was proposed to generate adaptive treatment plans. First, a population dose-prediction model (M0) was trained using data from previous patients. Second, a patient-specific model (Mps) was created for each new patient by fine-tuning M0 with the patient’s data. Finally, an auto plan was optimized using the parameters derived from the predicted dose distribution by Mps. The auto plans were compared with manual plans in terms of plan quality, efficiency, dosimetric verification, and clinical evaluation. ResultsThe auto plans improved target coverage, reduced irradiation to the rectum, and provided comparable protection to other organs-at-risk. Target coverage for the planning target volume (+0.61 %, P = 0.023) and clinical target volume 4000 (+1.60 %, P < 0.001) increased. V2900cGy (−1.06 %, P = 0.004) and V1810cGy (−2.49 %, P < 0.001) to the rectal wall and V1810cGy (−2.82 %, P = 0.012) to the rectum were significantly reduced. The auto plans required less planning time (−3.92 min, P = 0.001), monitor units (−46.48, P = 0.003), and delivery time (−0.26 min, P = 0.004), and their gamma pass rates (3 %/2 mm) were higher (+0.47 %, P = 0.014). ConclusionThe proposed patient-specific auto-planning method demonstrated a robust level of automation and was able to generate high-quality treatment plans in less time for MRIgART in prostate cancer.

Standards of Care for Peripheral Intravenous Catheters: Evidence-Based Expert Consensus

Highlights Abstract Background: The insertion of a peripheral intravenous catheter (PIVC) is the most commonly performed invasive procedure in healthcare. Despite its frequency in placement in hospitalized patients, PIVCs are generally perceived as being safe; however, the prevalence of failure ranges from 35%-50%. Additionally, complications are common and often deemed “acceptable” by clinicians. Healthcare provider and clinician foundational knowledge and competency is lacking nationally. Considering the mere volume of PIVCs placed, the failure and complication rates, the human impact is significant. Methods: The Association for Vascular Access (AVA) has led a collaborative effort with representatives from the Infusion Nurses Society (INS), the American Association of Critical Care Nurses (AACN), ECRI, and content experts representing nursing vascular access, infusion therapy, infection prevention, critical care, pediatrics, healthcare leadership, a physician, and a patient representative. Our aim is to provide concise guidance that will enhance and standardize practices related to peripheral intravenous catheters (PIVC). By consolidating current standards of practice into a comprehensive document, our framework seeks to advance the quality of care and improve patient safety. Results: This document has undergone meticulous scrutiny to ensure its quality; including incorporation of current standards, methodology for consensus from the expert panel, and input received from public comments. Conclusions: We anticipate that this work will have a significant impact on healthcare professionals, policymakers, and, most importantly, patients’ experiences by the promotion of consistent, high-quality treatment, safety, and comfort for patients receiving a PIVC.

Ensuring High Quality Treatment Plans with a Plan Quality Review Checklist

Treatment plan quality is a crucial component for a successful outcome of radiation therapy treatments. As the complexity of radiation therapy planning and delivery techniques increases, the role of the medical physicist in assessing treatment plan quality becomes more critical. Integrating plan quality review throughout the treatment planning process allows improvements without delaying treatment or rushing to produce changes at the last minute. In this work, we aim to provide practical check items for physicists to reference when assessing treatment plan quality with a critical eye, asking questions such as “is this the best dose distribution feasible for this patient?,” “could we change any planning parameters to improve plan quality?,” and “could we change the planning strategy for this particular patient or for future patients?”; and to work with planners and physicians to create a multidisciplinary collaborative culture that achieves the best plan feasible for every patient. We tabulate the features that affect plan quality in each process step and check details for individual items. This report is aimed at medical physicists, planners, radiation oncologists, and other professionals who are involved in treatment planning.

P035 SOCIAL DETERMINANTS OF HEALTH AND CONTROL OF HYPERTENSION

Background and Objectives: Recent national blood pressure (BP) survey data of adults in Canada and United States show a troubling decline in the control of hypertension, particularly in women, the elderly and those with low income, less education and under-using health services. Social determinants of health (SDH) can be important barriers to controlling hypertension. Studies assessing associations of BP control and SDH have focused on one or a few domains. Objectives of this study are to screen treated hypertensive patients for a wide range of SDH, test for correlations and assess the effects of high-quality treatment on SDH and BP control relationship. Method: We created and applied a screening tool to gather personal information on 14 SDH from consecutive consenting eligible patients attending a complex hypertension care clinic. Logistic regression was used to assess association of each SDH domain with BP control. Results: Of 90 patients enrolled, 88 completed the 6-month study. At baseline, mean age (standard deviation) was 64 (14) years, 64% male, 69% white, 25% experiencing financial hardship, mean BMI 30.4 kg/m2 (5.9), mean automated office BP 138/78 (23/14), mean number of co-morbid conditions 4.2 (2.0) and 55% had treatment-resistant hypertension. From baseline to exit, BP fell to 127/73 (17/12), p&lt;0.001, mean number of antihypertensive drug classes increased from 3.06 (1.43) to 3.23 (1.30), p=0.049 but BMI remained unchanged. There were no associations between uncontrolled hypertension and any of the 14 SDOH domains at baseline. However, at exit financial status was associated with uncontrolled hypertension on univariate analysis (p=0.022) and on multivariate analysis. Stress (p=0.063) and optimism status (p=0.085] showed a similar trend. These analyzes indicated better BP control among those with poorer financial status, higher stress levels or more pessimistic outlook. Conclusion: None of the SDOH were associated with uncontrolled hypertension at baseline. However good medical care and follow-up appeared to have improved BP control, noticeably in those experiencing financial hardship. Explanation of findings requires further study.

Model based deep learning method for focused ultrasound pathway scanning

The primary purpose of high-intensity focused ultrasound (HIFU), a non-invasive medical therapy, is to precisely target and ablate tumors by focusing high-frequency ultrasound from an external power source. A series of ablations must be performed in order to treat a big volume of tumors, as a single ablation can only remove a small amount of tissue. To maximize therapeutic efficacy while minimizing adverse side effects such as skin burns, preoperative treatment planning is essential in determining the focal site and sonication duration for each ablation. Here, we introduce a machine learning-based approach for designing HIFU treatment plans, which makes use of a map of the material characteristics unique to a patient alongside an accurate thermal simulation. A numerical model was employed to solve the governing equations of HIFU process and to simulate the HIFU absorption mechanism, including ensuing heat transfer process and the temperature rise during the sonication period. To validate the accuracy of this numerical model, a series of tests was conducted using ex vivo bovine liver. The findings indicate that the developed models properly represent the considerable variances observed in tumor geometrical shapes and proficiently generate well-defined closed treated regions based on imaging data. The proposed strategy facilitated the formulation of high-quality treatment plans, with an average tissue over- or under-treatment rate of less than 0.06%. The efficacy of the numerical model in accurately predicting the heating process of HIFU, when combined with machine learning techniques, was validated through quantitative comparison with experimental data. The proposed approach in cooperation with HIFU simulation holds the potential to enhance presurgical HIFU plan.