Individualized Treatment Plans Research Articles

Establishment of a Prediction Model Based on Preoperative MRI Radiomics for Diffuse Astrocytic Glioma, IDH-Wildtype, with Molecular Features of Glioblastoma.

In 2021, the WHO central nervous system (CNS) tumor classification criteria added the diagnosis of diffuse astrocytic glioma, IDH wild-type, with molecular features of glioblastoma, WHO grade 4 (DAG-G). DAG-G may exhibit the aggressiveness and malignancy of glioblastoma (GBM) despite the lower histological grade, and thus a precise preoperative diagnosis can help neurosurgeons develop more refined individualized treatment plans. This study aimed to establish a predictive model for the non-invasive identification of DAG-G based on preoperative MRI radiomics. Patients with pathologically confirmed glioma in Huashan Hospital, Fudan University, between September 2019 and July 2021 were retrospectively analyzed. Furthermore, two external validation datasets from Wuhan Union Hospital and Xuzhou Cancer Hospital were also utilized to verify the reliability and accuracy of the prediction model. Two regions of interest (ROI) were delineated on the preoperative MRI images of the patients using the semi-automatic tool ITK-SNAP (version 4.0.0), which were named the maximum anomaly region (ROI1) and the tumor region (ROI2), and Pyradiomics 3.0 was applied for feature extraction. Feature selection was performed using a least absolute shrinkage and selection operator (LASSO) filter and a Spearman correlation coefficient. Six classifiers, including Gauss naive Bayes (GNB), K-nearest neighbors (KNN), Random forest (RF), Adaptive boosting (AB), and Support vector machine (SVM) with linear kernel and multilayer perceptron (MLP), were used to build the prediction models, and the prediction performance of the six classifiers was evaluated by fivefold cross-validation. Moreover, the performance of prediction models was evaluated using area under the curve (AUC), precision (PRE), and other metrics. According to the inclusion and exclusion criteria, 172 patients with grade 2-3 astrocytoma were finally included in the study, and a total of 44 patients met the diagnosis of DAG-G. In the prediction task of DAG-G, the average AUC of GNB classifier was 0.74 ± 0.07, that of KNN classifier was 0.89 ± 0.04, that of RF classifier was 0.96 ± 0.03, that of AB classifier was 0.97 ± 0.02, that of SVM classifier was 0.88 ± 0.05, and that of MLP classifier was 0.91 ± 0.03, among which, AB classifier achieved the best prediction performance. In addition, the AB classifier achieved AUCs of 0.91 and 0.89 in two external validation datasets obtained from Wuhan Union Hospital and Xuzhou Cancer Hospital, respectively. The prediction model constructed based on preoperative MRI radiomics established in this study can basically realize the prospective, non-invasive, and accurate diagnosis of DAG-G, which is of great significance to help further optimize treatment plans for such patients, including expanding the extent of surgery and actively administering radiotherapy, targeted therapy, or other treatments after surgery, to fundamentally maximize the prognosis of patients.

Perioperative Care and Outcomes of Patients with Brain Tumors Undergoing Elective Craniotomy: Experience from an Ethiopian Tertiary-Care Hospital

To describe patients, perioperative care, and outcomes undergoing supratentorial and infratentorial craniotomy for brain tumor resection in a tertiary-care hospital in Ethiopia. A retrospective cohort study of patients consecutively admitted between January 1, 2021, and December 31, 2021, was performed. We characterized patients, perioperative care, and outcomes. The final sample comprised 153 patients; 144 (94%) were 18years and over, females (n=48, 55%) with primarily American Society of Anesthesiologists physical class II (n= 97, 63.4%) who underwent supratentorial (n=114, 75%), or infratentorial (n= 39, 25%) tumor resection. Patients were routinely admitted (95%) to floor/wards before craniotomy; Inhaled anesthetic (isoflurane 88%/halothane 12%) was used for maintenance of general anesthesia. Propofol (n= 93, 61%), mannitol (n= 73, 48%), and cerebrospinal fluid drain (n= 28, 18%), were used to facilitate intraoperative brain relaxation, while the use of hyperventilation was rare (n= 1). The average estimated blood loss was 1040±727ml; 37 (24%) patients received tranexamic acid, and 57 (37%) received a blood transfusion. Factors associated with extubation were a) infratentorial tumor location: relative risk (RR) 0.45 (95% confidence interval [CI] 0.29-0.69), preoperative hydrocephalus: RR 0.51, (95% CI 0.34-0.79), shorter total anesthesia duration: 277.8+8.8 versus 426.77+13.1minutes, P<0.0001, lower estimated blood loss: 897+68ml versus 1361.7+100ml, P= 0.0002, and cerebrospinal fluid drainage to facilitate brain relaxation: RR 0.52, 95% CI 0.32-0.84). Approximately one in ten patients experienced postoperative obstructive hydrocephalus, surgical site infections, or pneumonia. These findings suggest that certain factors may impact patient outcomes following craniotomy for tumor resection. By identifying these factors, health care providers may be better equipped to develop individualized treatment plans and improve patient outcomes. Additionally, the study highlights the importance of postoperative monitoring and management to prevent complications.

Prognostic significance of the Gustave Roussy immune (GRIm) score in cancer patients: a meta-analysis

Background The prognostic value of the Gustave Roussy immune (GRIm) score in cancer patients has been widely reported but remains inconsistent. The aim of this study is to systematically investigate the relationship between the GRIm score and survival outcomes in cancer patients. Methods Relevant literature was identified using electronic databases including Web of Science, PubMed, and Embase from the inception to March 2023. The primary endpoints were long-term oncological outcomes. Subgroup analysis and sensitivity analysis were conducted during the meta-analysis. Results Fifteen studies (20 cohorts) including 4997 cancer patients were enrolled. The combined results revealed that patients in the high GRIm group had a deteriorated overall survival (HR = 2.07 95%CI: 1.73–2.48; p < 0.0001; I2 = 62%) and progression-free survival (HR = 1.42; 95%CI: 1.22–1.66; p < 0.0001; I2 = 36%). The prognostic values of GRIm on overall survival and progression-free survival were observed across various tumour types and tumour stages. Sensitivity analysis supported the stability and reliability of the above results. Conclusion Our evidence suggested that the GRIm score could be a valuable prognostic marker in cancer patients, which can be used by clinicians to stratify patients and formulate individualized treatment plans.

Pharmacist Involvement in Mental Health Treatment

Mental health disorders constitute a significant public health concern, with a growing recognition of the need for integrated, comprehensive approaches to their management and treatment. Pharmacists, as essential members of the healthcare team, have a unique opportunity to contribute to the care of patients with mental health conditions. This review critically examines the multifaceted role of pharmacists in mental health treatment, encompassing their involvement in medication management, patient education, and collaborative care models. Pharmacists play a pivotal role in ensuring the safe and effective use of psychotropic medications, offering expertise in drug selection, dosing, monitoring, and assessing medication adherence. Their involvement in medication reconciliation and management of drug interactions can significantly enhance patient safety and optimize treatment outcomes. Moreover, pharmacists can provide valuable education to patients and caregivers regarding medication adherence, potential side effects, and strategies for managing adverse reactions, thereby promoting medication compliance and improving overall treatment efficacy. Furthermore, the integration of pharmacists within collaborative care teams has demonstrated promising outcomes in the delivery of holistic mental health services. Through their interdisciplinary collaboration, pharmacists facilitate effective communication among healthcare providers, enabling comprehensive treatment planning and the identification of potential pharmacotherapeutic interventions. This collaborative approach fosters a patient- centered care model, emphasizing the importance of individualized treatment plans tailored to each patient’s unique needs and preferences. Additionally, the expanding role of pharmacists in mental health screenings, early intervention initiatives, and community-based support programs serves to promote mental health awareness and reduce the stigma associated with mental illness. By actively engaging with patients and communities, pharmacists contribute to the development of accessible mental health services and resources, thereby fostering a more inclusive and supportive healthcare environment.

A comparison of PTSD and traumatic event rates in a clinical sample of non-refugee immigrants and native-born individuals with a psychotic disorder: a case-control study

ABSTRACT Background: Migration is a multi-stage social process linked to traumatic event exposure and a notably increased risk of psychosis. Although these conditions affect refugee and non-refugee immigrants, prior trauma research has focused mainly on the refugee population. Objective: To compare and describe the rate and the clinical characterization of PTSD and traumatic events between non-refugee immigrants and native-born individuals with psychotic disorder. Methods: 99 immigrants and 99 native-born individuals (n = 198) with at least one psychotic episode according to DSM-5 criteria were compared on the rate of PTSD diagnosis and traumatic events, using standardized and validated trauma scales. Results: In the non-refugee immigrant group, 31% met diagnostic criteria for PTSD compared to only 7.1% in the native-born group. Total scores in childhood trauma and last year stressful events were 1.5 and 2 times higher in non-refugee immigrants, respectively. Likewise, cumulative lifetime trauma was three times higher in non-refugee immigrants. Finally, non-refugee immigrants reported more violent and life-threatening traumatic events than native-born individuals. Conclusions: These results are relevant since they highlight that non-refugee immigrants with psychotic disorders are highly trauma-exposed, meaning a routine trauma assessment and a trauma-focused intervention for this population should be included in individualized treatment plans.

Biological risk based on preoperative serum CA19-9 and histological grade predicts prognosis and improves accuracy of classification in patients with pancreatic ductal adenocarcinoma.

Carbohydrate antigen (CA) 19-9 and histological grade can serve as indicators of the biological characteristics of pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to investigate the combined impact of preoperative CA19-9 levels and histological grade on prognosis and classification accuracy in PDAC patients. A retrospective cohort study was conducted on 612 patients with PDAC who underwent curative pancreatectomy, and a biological risk model based on preoperative CA19-9 levels and histology grade was established. The prognostic importance of the biological risk model was evaluated, and its validity was confirmed through a validation cohort of 218 patients. The survival of patients with PDAC was independently associated with preoperative CA19-9 levels and histology grade, indicating a biological risk. This biological risk was incorporated into the eighth edition of the TNM staging system, leading to the development of a modified TNM (mTNM) staging system. Receiver operating characteristic (ROC) curves demonstrated that the mTNM staging system had a significantly larger area under the curve (AUC) than the TNM staging system. The discriminatory capacity of the mTNM staging system was further validated in an independent cohort. Biological risk based on preoperative CA19-9 and histological grade could predict the survival of patients with PDAC. The incorporation of biological risk into the TNM staging system has the potential to enhance the accuracy of patient classification in PDAC, predicting patient survival and enabling the development of individualized treatment plans.

Application of Inflatable Video-Assisted Mediastinoscopic Transhiatal Esophagectomy in Individualized Treatment of Esophageal Cancer.

Surgery is a crucial treatment option for patients with resectable esophageal cancer. The emergence of minimally invasive esophageal techniques has led to the popularity of video-assisted thoracoscopic esophagectomy, which has proven to be more advantageous than traditional thoracotomy. However, some patients with esophageal cancer may not benefit from this procedure. Individualized treatment plans may be necessary for patients with varying conditions and tolerances to anesthesia, making conventional surgical methods unsuitable. Inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) has emerged as a promising treatment option for esophageal cancer because it does not require one-lung ventilation, reduces postoperative complications, and expands surgical indications. This technique also provides surgical opportunities for patients with impaired pulmonary function or thoracic lesions. It is crucial to have a comprehensive understanding of the advancements and limitations of IVMTE to tailor treatment plans and improve outcomes in patients with esophageal cancer. Understanding the advantages and limitations of this surgical method will help specific patients with esophageal cancer. We conducted a thorough review of the relevant literature to examine the importance of IVMTE for individualized treatment of this disease.

Nomogram for predicting survival in patients with mucinous breast cancer undergoing chemotherapy and surgery: a population-based study

BackgroundThe prognosis of patients with mucinous breast cancer (MuBC) is affected by several factors, but the low incidence of MuBC makes it difficult to conduct extensive and in-depth studies. This study was designed to establish a prognostic model and verify its accuracy in patients with MuBC after chemotherapy and surgery to help develop personalized treatment strategies.Materials and methodsPatients with MuBC who underwent chemotherapy and surgery from 2004 to 2015 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. The prognostic factors of patients with MuBC were investigated using a Cox proportional hazards regression analysis. Based on the identified factors, a nomogram was constructed to forecast the overall survival (OS) of patients at 3, 5, and 10 years. Internal (from SEER) and external (from Yunnan Cancer Center, YNCC) verification queues were used to verify the nomogram and demonstrate the predictive capacity of this model.ResultsThe study comprised 1668 MuBC patients from the SEER database and 107 from the YNCC. The nomogram included four characteristics: age, anatomical stage, surgical method, and radiotherapy. The concordance indices in the training, internal verification, and external verification queues were 0.680, 0.768, and 0.864, respectively. The calibration curves for the nomogram showed excellent agreement between the predictions and observations. This nomogram has good clinical application value according to the decision curve analysis.ConclusionsThe prognosis of patients with MuBC who have undergone chemotherapy and surgery can be forecasted using this nomogram, which would be beneficial to help create individualized treatment plans for the affected patients.

Risk factors for cervical lymph node metastasis in the central or lateral cervical region in medullary thyroid carcinoma: a systematic review and meta-analysis.

Compared with other types of thyroid carcinoma, patients with medullary thyroid carcinoma (MTC) are more likely to develop cervical lymph node metastasis. This study was conducted to clarify the risk factors for cervical lymph node metastasis (central lymph node metastasis or lateral cervical lymph node metastasis) in MTC by meta-analysis, and to provide evidence-based basis for the treatment and prognosis of MTC. The literatures related to cervical lymph node metastasis in medullary thyroid carcinoma were searched in PubMed, Embase, Web of Science, Cochrane, CNKI and Wanfang databases, and statistical analysis was performed using Revman 5.3 and Stata 14.0 software. A total of 28 papers were included in this paper, and meta-analysis showed that the occurrence of central lymph node metastasis (CLNM) in MTC patients was significantly associated with tumor size (OR = 3.07, 95%CI: 2.04-4.63, P < 0.00001), multifocality (OR = 0.29, 95%CI: 0.19-0.44, P < 0.00001), bilaterality (OR = 3.75, 95% CI: 1.95-7.14, P < 0.0001), capsular invasion (OR = 9.88, 95% CI: 5.93-16.45, P < 0.00001) and extrathyroidal extension (OR = 5.48, 95% CI: 2.61-11.51, P < 0.00001). While the occurrence of lateral cervical lymph node metastasis (LLNM) in MTC patients was strongly correlated with gender (OR = 2.97, 95%CI: 2.46-3.58, P < 0.00001), tumor size (OR = 3.88, 95%CI: 1.90-7.92, P = 0.0002 < 0.05), multifocality (OR = 0.43, 95%CI: 0.35-0.51, P < 0.00001), bilaterality (OR = 2.93, 95% CI: 1.72-4.98, P < 0.0001), capsular invasion (OR = 8.44, 95% CI: 6.11-11.64, P < 0.00001), extrathyroidal extension (OR = 7.04, 95% CI: 5.54-8.94, P < 0.00001), margin of the tumor (OR = 4.47, 95% CI: 2.37-8.44, P < 0.00001), shape of the tumor (OR = 6.81, 95% CI: 3.64-12.73, P < 0.00001), preoperative calcitonin level (SMD = 1.39, 95% CI: 0.98-1.80, P < 0.00001), preoperative carcinoembryonic antigen level (SMD = 0.97, 95% CI: 0.74-1.20, P < 0.00001) and CLNM (OR = 19.70, 95% CI: 14.16-27.43, P < 0.00001). Tumor size, multifocality, bilaterality, capsular invasion and extrathyroidal extension are the main risk factors for developing CLNM in MTC patients; And risk factors for developing LLNM in MTC patients include: gender, tumor size, multifocality, bilaterality, capsular invasion, extrathyroidal extension, margin of the tumor, shape of the tumor, preoperative calcitonin level, preoperative carcinoembryonic antigen level and central lymph node metastasis. These risk factors can guide the individualized treatment plan and improve the prognosis of MTC patients.

THU362 A Diagnostic Dilemma: Type 1 Diabetes Vs. Pancreatic Diabetes

Abstract Disclosure: U. Rafat: None. R. Alshantti: None. M. Kim: None. J.L. Gilden: None. Background: Several presentations of diabetes mellitus (DM) do not fit the classic descriptions. Type 1 DM, characterized by immune-mediated destruction of insulin-secreting cells of the pancreas, typically appears before age 40. The first antibodies described associated with development of Type 1 DM were islet cell autoantibodies, and later antibodies to insulin, glutamic acid decarboxylase, protein tyrosine phosphatase, and Zinc transporter 8. Pancreatic DM or type 3c, is characterized by functional deficiency of the pancreas to secrete insulin and maintain glucose homeostasis. It may be caused by acute or chronic pancreatitis, trauma, neoplasia, hemochromatosis, fibrocalculous pancreatopathy, genetics, or idiopathic, and is commonly misdiagnosed as type 2 DM. Case Presentation: We present a 73-year-old Caucasian male with Type 1 DM and retinopathy, neuropathy, hypertension, hyperlipidemia, benign prostatic hyperplasia, obstructive sleep apnea. He was diagnosed with Type 1 DM at age 33 with BMI=29 and hospitalization for diabetic ketoacidosis, and symptoms of polyuria, weight loss, and visual disturbances. He was started with insulin injections. Antibodies were not measured, as they were not widely available at that time. Family history: MI in father and brother and type 2 DM in grandfather. He later started using insulin pump at age 58 for wide fluctuations in blood glucose levels. At age 64, he presented to our endocrine clinic for continued management of assumed autoimmune Type 1 DM. Physical examination: BMI 36, abdominal lipodystrophy, abnormal monofilament with decreased sensations in the left foot. Laboratory: HbA1c=6.7%. c-peptide was low (0.09 ng/mL; normal range: 0.81 - 3.85) with a concomitant BG of 243 mg/dL suggestive of low insulin reserves. After several years, with the development of increased trust, the patient felt confident to reveal a hidden history of extensive alcohol abuse in his 20s, resulting in recurrent episodes of symptoms suggestive of pancreatitis, which required extensive rehabilitation for his drinking problem. He admitted that he had not divulged this history previously. This additional history proved critical to acquiring a correct diagnosis. With this in mind, we deduced that it is highly probable this patient's recurrent bouts of subacute pancreatitis due to alcohol consumption resulted in development of pancreatic DM. Conclusion: Our patient initially presented with the diagnosis of autoimmune type 1 DM. However, after many visits, he first admitted to a past history of long-standing alcohol abuse, which now suggests that he actually has pancreatic DM. Correctly classifying DM can prove crucial to formulating an individualized treatment plan. It is important to note that the classification of DM is not always clear-cut and involves a periodic review of the medical history and clinical characteristics, besides review of laboratory data. Presentation: Thursday, June 15, 2023

Exploring sensory processing abilities in adults with acquired hearing loss.

This study aimed to evaluate the sensory processing abilities of adults with acquired hearing loss and determine whether their sensory processing patterns differ from those of the general population and adults with normal hearing. The study evaluated the sensory processing functions of 30 adults with acquired hearing loss using the Adolescent/Adult Sensory Profile and compared them with the sensory processing functions of 30 adults with normal hearing. The results showed that individuals with hearing loss have a significantly higher sensitivity to stimuli related to motion, vision, activity and touch, exhibiting a low-registration sensory pattern and a sensation-avoiding pattern that differed from those of most individuals. Assessing sensory processing profiles can help identify specific sensory difficulties and inform individualised treatment plans. The study highlights the importance of considering sensory processing patterns in the management of hearing loss to improve overall well-being and quality of life for adults with hearing loss.

The hidden pandemic: a qualitative study on how middle-aged women make sense of managing their long COVID symptoms.

A relapsing and remitting illness, long COVID can be challenging and debilitating. A person living with long COVID can feel like they are getting better and recovering only to relapse again. The aim of the research was to explore how non-hospitalized middle-aged women who contracted COVID in the first wave of the pandemic, from March 2020, are managing their long COVID symptoms. A qualitative research study with an interpretative phenomenological analysis approach was used to explore how the women made sense of managing their condition and health seeking behaviours. Participants were recruited from long COVID Facebook groups and semi-structured interviews were conducted remotely by Teams audio; these were digitally recorded and transcribed by hand with prior informed consent. Nine women were interviewed and four themes and eight sub-themes emerged from the data. The four emerging themes were: inequality and inconsistent medical treatment; uncertainty and ambiguity of managing long COVID symptoms; managing other people's expectations and perceptions of long COVID; and the changing identity. Overall, these results indicated a general mistrust in health care services to provide adequate support and individualized treatment plans leading women to self-advocacy and to seek alternative support and treatment. This study raised questions about the possible unfair treatment of women seeking medical attention for their long COVID symptoms; how ambiguous symptoms are misattributed to anxiety and discrimination from health care professionals contributes towards stigma. The study concludes with recommendations for service improvement such as the compassionate validation of patients' pain and the use of evidence-based therapeutic practices such as mindfulness.

Pathways to Anxiety and Depression in Autistic Adolescents and Adults

Individuals diagnosed with autism spectrum disorder (autism) commonly experience co-occurring anxiety and depression, which are significantly associated. These mental health conditions are also variously associated with increased autistic traits, insomnia, intolerance of uncertainty (IU), sensory sensitivity, and autonomic symptoms. However, no research has explored the relationships between IU, sensory sensitivity, autonomic symptoms, insomnia, and autistic traits and how they might be associated with anxiety and depression in autism. This study took a transdiagnostic approach to explore the relationships between anxiety, depression, autistic traits, insomnia, IU, sensory sensitivities, and autonomic arousal in 222 autistic people aged 15-80 years (55.7% female) using path analysis. Four plausible, theoretical models were tested, with model 1 providing best fit and explaining 48% of variance in depression, 37% of variance in anxiety, and 29% of variance in insomnia. Autistic traits and IU were directly associated with anxiety and indirectly associated with depression through anxiety. Anxiety, insomnia, IU, and sensory sensitivity were all directly associated with depression; autonomic arousal and sensory sensitivity were also indirectly associated with depression through insomnia. Thus, multiple pathways can lead to anxiety and depression in autism, not only via known paths such as insomnia and IU but additionally via autonomic arousal and sensory sensitivities which are also elevated in autism. These findings suggest that careful clinical evaluation and individualised treatment plans are needed for autistic adults with anxiety or depression. When considering prevention, programs that help autistic adults reduce arousal, maintain good sleep, and reduce IU may prove fruitful.

Heart Disease Prediction under Machine Learning and Association Rules under Neutrosophic Environment

&#x0D; Early identification and precise prediction of heart disease have important implications for preventative measures and better patient outcomes since cardiovascular disease is a leading cause of death globally. By analyzing massive amounts of data and seeing patterns that might aid in risk stratification and individualized treatment planning, machine learning algorithms have emerged as valuable tools for heart disease prediction. Predictive modeling is considered for many forms of heart illness, such as coronary artery disease, myocardial infarction, heart failure, arrhythmias, and valvar heart disease. Resource allocation, preventative care planning, workflow optimization, patient involvement, quality improvement, risk-based contracting, and research progress are all discussed as management implications of heart disease prediction. The effective application of machine learning-based cardiac disease prediction models requires collaboration between healthcare organizations, providers, and data scientists. This paper used three tools such as the neutrosophic analytical hierarchy process (AHP) as a feature selection, association rules, and machine learning models to predict heart disease. The neutrosophic AHP method is used to compute the weights of features and select the highest features. The association rules are used to give rules between values in all datasets. Then, we used the neutrosophic AHP as feature selection to select the best feature to input in machine learning models. We used nine machine learning models to predict heart disease. We obtained the random forest (RF) and decision tree (DT) have the highest accuracy with 100%, followed by Bagging, k-nearest neighbors (KNN), and gradient boosting have 99%, 98%, and 97%, then AdaBoosting has 89%, then logistic regression and Naïve Bayes have 84%, then the least accuracy is support vector machine (SVM) has 68%.&#x0D;

Dosimetric comparison between stereotactic body radiotherapy and carbon-ion radiation therapy for prostate cancer.

Prostate cancer rates have been steadily increasing in recent years. As high-precision radiation therapy methods, stereotactic body radiation therapy (SBRT) and carbon-ion radiation therapy (CIRT) have unique advantages. Analyzing the dosimetric differences between SBRT and CIRT in the treatment of localized prostate cancer can help provide patients with more accurate, individualized treatment plans. We selected computed tomography positioning images and the contours of target volumes of 16 patients with localized prostate cancer who received radiotherapy. We delineated the organs at risk (OARs) on the CyberKnife (CK) treatment planning system (TPS) MultiPlan4.0, which were imported into the CIRT uniform scanning TPS HIMM-1 ci-Plan. Two treatment plans, SBRT and CIRT, were designed for the same patient, and we used SPSS 22.0 for the statistical analysis of data. Both SBRT and CIRT plans met the prescribed dose requirements. In terms of target volume exposure dose, D2 (P<0.001), D5 (P<0.001), D50 (P<0.001), D90 (P=0.029), D95 (P<0.001), D98 (P<0.001), and Dmean (P<0.001) under SBRT were significantly higher than those under CIRT; the conformity index (CI) under SBRT was significantly better than that under CIRT (P<0.001); the target volume coverage rate (V95%) and dose homogeneity index (HI) under CIRT were significantly better than those under SBRT (P<0.001). In terms of OAR exposure dosage, the Dmax of the bladder and rectum under SBRT was significantly lower than that under CIRT (P<0.001), but Dmean was in the other direction; the exposure dose of the intestinal tract under CIRT was significantly lower than that under SBRT (P<0.05); Dmax of the femoral head under CIRT was significantly lower than that under SBRT (P<0.05), and there was no statistical difference between them at other doses. In this study, we found that when CIRT was used for treating localized prostate cancer, the dose distribution in target volume was more homogeneous and the coverage rate was higher; the average dose of OARs was lower. SBRT had a better CI and higher dose in target volume; the dose hotspot was lower in OARs. It is important to comprehensively consider the dose relationship between local tumor and surrounding tissues when selecting treatment plans.

Behavioral psychology combined with Morita therapy for the treatment of anxiety disorder in library administrators

BackgroundAnxiety disorders are a common mental health problem, especially in highly stressful work environments, such as librarians, who need to cope with large amounts of information and the population. Librarians are important players responsible for organizing and managing library resources, and they face many challenges, including handling complex tasks, meeting user needs, and interacting with different individuals. Because of these professional characteristics, librarians may face persistent stress and anxiety.Subjects and MethodsLibrarians who met the study criteria were recruited from different libraries as study participants, and participants were randomized into the experimental group and the control group. The experimental group received behavioral psychology and Morita treatment intervention, while the control group received conventional treatment or waiting treatment. Finally, the effects of behavioral psychology and Morita treatment on anxiety levels were analyzed using the SPSS 23.0 software.ResultsThe analysis found that the incidence of anxiety disorders decreased by 45.87% after receiving the behavioral psychology intervention and Morita therapy intervention. 73.23% of the patients showed significant disease improvement. In the control group, only 22.36% of participants with anxiety disorders improved. It was 20.87% lower than the experimental group.ConclusionsDuring the treatment, the therapist works with the librarian to develop an individualized treatment plan and provide support and guidance. This integrated treatment approach can help librarians establish healthier mental states and coping mechanisms. Through cognitive reconstruction, exposure exercises, behavioral experiments and other methods, they can gradually face and deal with anxiety triggers and develop more positive and adaptive coping strategies.

Prognostic role of the controlling nutritional status (CONUT) score in patients with biliary tract cancer: a meta-analysis

Background Previous reports have not reached consistent results regarding the prognostic significance of the controlling nutritional status (CONUT) score in biliary tract cancer (BTC). Therefore, the present meta-analysis was conducted to investigate the precise role of the CONUT score in predicting the prognosis of BTC. Methods Electronic platforms including Web of Science, PubMed, Cochrane Library, and Embase were comprehensively searched up to May 2, 2023. We also determined combined hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate the role of the CONUT score in predicting the prognosis of patients with BTC. Results Ten studies involving 1,441 patients were included in the present study. Nine studies treated patients with surgical resection, and one study used percutaneous transhepatic biliary stenting (PTBS) plus 125I seed intracavitary irradiation. Based on the combined data, a higher CONUT score significantly predicted dismal overall survival (OS) (HR = 1.94, 95%CI = 1.41–2.66, p < 0.001), inferior recurrence-free survival (RFS) (HR = 1.79, 95%CI = 1.48–2.17, p < 0.001) in BTC, and low differentiation (OR = 1.57, 95%CI = 1.15–2.14, p = 0.004). Nonetheless, the CONUT score was not related to sex, lymph node metastasis, microvascular invasion, perineural invasion, distant metastasis, TNM stage, or tumor number in patients with BTC. Conclusion Higher CONUT scores significantly predicted worse OS and RFS in patients with BTC. Moreover, BTC patients with high CONUT scores tended to have poor tumor differentiation. The CONUT score could help clinicians stratify high-risk patients with BTC and devise individualized treatment plans.

Rapid eye movement sleep behaviour disorder in brain injury: A complex case requiring close coordination of care.

Neurorehabilitation is interdisciplinary and cross-sectorial, requiring the coordinated effort of diverse sectors, professions, patients and communities to manage complex condition-related disabilities. A more holistic approach to experimental rehabilitation can incorporate individualized treatment plans into rehabilitation research to improve overall clinical care. This case aims to highlight the benefit of collaboration between neurology, psychiatry, physiatry and rehabilitation therapists to successfully rehabilitate complex patients. A 72-year-old gentleman with history of depression, anxiety and sleep difficulties presented to our institution one year after a stroke for help managing exacerbations of his premorbid conditions. The patient had a hemorrhagic stroke which required craniectomy and led to seizures. Past history was unclear regarding what workups had been done but was suggestive of rapid eye movement (REM) sleep behavior disorder (RBD). Given the numerous medications patient had tried in the past and since his stroke, a true multidisciplinary team was needed and his case required close coordination to successfully diagnose the reason for each of his symptoms and to provide treatments and rehabilitation. The correct diagnosis was only achieved by clear communication among team members which allowed for optimal treatment and improvement with therapies.

Transcending boundaries: Unleashing the potential of multi-organ point-of-care ultrasound in acute kidney injury.

Acute kidney injury (AKI) is a clinical syndrome characterized by a rapid increase in serum creatinine levels or a decrease in urine output or both. In spite of thorough history-taking, physical examination, and laboratory analysis, there are limitations in the diagnostic process and clinical monitoring of AKI. Point-of-care ultrasonography (POCUS), a limited ultrasound study performed by clinicians at the bedside, has emerged as a valuable tool in different clinical settings. In this discussion, we explore the potential of POCUS performed by nephrologists to address specific questions encountered in the diagnosis and management of AKI patients. POCUS not only aids in excluding hydronephrosis but also provides real-time insights into hemodynamics, enabling formulation of individualized treatment plans. Further studies are required to assess the impact of multi-organ POCUS on pragmatic patient outcomes related to AKI, as well as its potential in risk stratification and identification of different levels of AKI severity and pathophysiological signatures.

Update in diagnosis and management of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by a lack of structural or biochemical abnormalities. The current diagnosis of IBS is based on the Rome IV criteria, and it is recommended to approach IBS patients using a multidimensional clinical profile (MDCP). The pathophysiology of IBS is multifactorial and involves motility disorders, genetic factors, immune responses, visceral hypersensitivity, brain-gut dysregulation, and altered intestinal microbiota. The management of IBS includes both nonpharmacologic and pharmacologic therapies. Nonpharmacologic therapy options include physical activity, low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet, as well as cognitive behavioral therapy. Pharmacologic therapy options include probiotics, antidepressants, antispasmodics, and new agents. In clinical practice, a multidisciplinary strategy, including nonpharmacologic or/and pharmacologic treatment for IBS, is emphasized. Therefore, clinicians should carefully consider the underlying pathophysiology before selecting an appropriate therapeutic option for the treatment of IBS. In other words, individualized treatment plans are necessary for managing IBS.