Logistical Advantages Research Articles

A comparative study of pulmonary toxicity between hypofractionated and conventionally fractionated radiation therapy in postmastectomy carcinoma breast

Background: Hypofractionated schedule has multiple advantages over conventional fractionation radiation therapy in terms of logistics and patient compliance. However, pulmonary toxicity is a major concern in breast cancer radiotherapy about which there are limited data comparing these two radiation regimens. Objective: This study aimed at comparing these two radiation schedules in terms of acute pulmonary toxicity and parameters of pulmonary function. Materials and Methods: Postmodified radical mastectomy patients with nonmetastatic carcinoma breast were randomized into two groups: study-arm patients received hypofractionated radiotherapy with 42.5 Gy in 16 fractions, over 3.5 weeks, whereas control-arm patients received conventionally fractionated radiotherapy with 50 Gy in 25 fractions, over 5 weeks. Patients underwent pulmonary function test (PFT) before radiotherapy (baseline), then at one and 3 months after completion of radiotherapy for changes in parameters of PFT and acute toxicities. Results: PFT changes were comparable in both the arms at day 30 and day 90 postradiation. Incidences of cough 1 month after radiotherapy and 3 months after radiotherapy were comparable (P = 0.3 and 0.07). Higher grade dyspnea at 3 months posttreatment, though numerically was higher in the study arm, was not significant (P = 0.44). In study arm at 90 days postradiation, Grade 2 and Grade 3 radiation pneumonitis were numerically more (15% vs. 3% and 3.5% vs. 0%), but not statistically significant (P = 0.08). Conclusion: Both conventional and hypofractionated arms showed almost similar results in terms of acute pulmonary toxicity and change in PFT parameters. Hence, considering the logistic advantages, the hypofractionated schedule can be considered an effective alternative to conventional radiotherapy for postmastectomy breast cancer patients.

Diagnosis and staging of lung cancer using transesophageal ultrasound: Training and assessment.

Diagnosis and staging of lung cancer using transesophageal ultrasound: Training and assessment.

ОСОБЛИВОСТІ РОЗВИТКУ ЛОГІСТИКИ ТУРИСТИЧНИХ ПОСЛУГ В УКРАЇНІ

The article reveals the peculiarities of the development of logistics of tourist services from the standpoint of the practical aspect. It is determined that the introduction of logistics tools for tourism services management, namely the provision of integrated tourism services, is to create effective mechanisms for managing the flow of tourists, transport, information, financial resources, services and logistics of tourism services. The logistics of the tourism process have been found to reduce costs and improve customer service. It is established that to improve the quality of tourist services it is necessary to increase the level of security and service, to provide additional services to consumers of tourist products. The introduction and use of logistics technologies in the tourism industry allows to achieve high results, mainly due to the fact that the application process is consistent with the domestic economic policy of tourism organizations and complements it. The analysis of statistical data showed that in 2021 compared to 2020, the volume of realized tourist services in Ukraine increased significantly, in particular those services provided by travel agencies and tour operators. It is proved that the leaders-providers of tourist services are Lviv and Ivano-Frankivsk regions. It is determined that the share of tourists who use leisure and recreation services is significant in the structure of tourist services. It has been proven that logistics management, which takes into account the details of the travel services market, should: ensure or balance demand, or provide maximum satisfaction as much as possible; constantly research the needs of customers and collect information about their negative evaluations of travel services; provide for the formation of a long-term logistics chain of tourism participants; provide travel companies with a competitive logistical advantage in terms of time, service and cost; provide for the search for a mechanism by which the territory in which tourist activities are carried out is adapted to the conditions of national legislation related to tourist activities, etc. In the future, it is planned to reveal the features of the development of logistics of tourist services in Ukraine during the war.

Cost of supply and ventilation concepts in shield-driven tunnelling in due consideration of the engine type and drive technology

Supply logistics as a supporting sub-process of tunnel driving is significantly responsible for a smooth construction process and, thus, for the desired project success. The main task of supply logistics is to provide the required logistical goods for the tunnel-boring machine. Available are track-bound and tyre-bound systems, which are driven by conventional diesel engines or alternatively by hybrid or electric motors. A multitude of regulations set exhaust emission limits, which can only be met by sufficiently dimensioned ventilation. In particular, the use of diesel engines can result in high costs for ventilation, which must not be neglected for an economic optimization of the supply concept. In order to compare the economic efficiency of different systems, a calculation concept is presented, which shows possible economic, but also ecological and logistical advantages of the individual systems by quantifying relevant factors. The costs for the different types of vehicles are examined separately for chassis and drive train, as well as for ventilation. The information and results obtained with the calculation provide a basis for the decision-making process when choosing an optimal logistics concept. Due to the quantities of logistical goods involved, the focus is on supply logistics in shield tunnelling.

Альтернативные направления экспорта-импорта по МТК «Север – Юг» в условиях экономических санкций

Due to economic anti-Russian sanctions, there is a large-scale reorientation of European and Baltic routes to the east (with a sharp increase in the load on the eastern polygon of Russian railways) and the role of the North - South transport and logistics corridor being formed is being revised. Such corridors modernize global logistics, especially with regard to transportation of raw materials, energy, semi-finished products and food products. The development of all routes of the North - South corridor will provide direct access to the producers of goods of export-oriented industries of the Eurasian Economic Union to the growing markets of Iran, Pakistan, India, the Middle East and East Africa. The article provides the overview and analysis of economic and logistical advantages of new routes tending to the International transport corridor «North - South» (ITC NS), to substantiate new trends in macro-statistics of export-oriented logistics flows of specialized products of the Urals and Siberia industries. The development of new directions for the export of raw materials and finished products in combination with modern logistics technologies will allow exporters of the Urals and Siberia to increase export volumes and its profitability, neutralize the negative impact of anti-Russian economic sanctions. The Kazakhstan - Turkmenistan - Iran route with the possibility of further transportation of products to Pakistan and India through the Chabahar port under construction and the existing ports of Bandar Abbas and Gwadar will be especially promising for Ural and West Siberian exporters of mineral raw materials and finished products.

Based on COVID-19, Analysis of the development strategy of China's self-operated e-commerce --JD.com as an example

With the development of China's economy, more and more Chinese companies are developing and growing out of China to connect with the world. In the field of e-commerce industry, a lot of research has been conducted by scholars. However, the research on self-operated e-commerce in the context of the COVID-19 is still a blank. As the largest self-operated e-commerce platform in China, JD's development is significantly representative for the whole field. This paper focuses on SWOT analysis combined with specific data and the current situation of the e-commerce industry to analyze the current development of JD.com and draw conclusions. While JD.com continues to invest in maintaining its existing warehousing and logistics advantages, it is not enough for the development of emerging live markets and sinking markets. At this stage, Chinese companies are increasingly going global, and whether they can seize the development of policy and communication technology is a decisive factor in whether self-operated e-commerce can become bigger and stronger. At the same time, it is found that JD.com's marketing model at this stage is lacking in sustained innovation. This paper enriches the post-epidemic era for the development of China's self-operated e-commerce research has positive implications for the development of this industry

Application of Visual Sensing Image Processing Technology under Digital Twins to the Intelligent Logistics System

Since the founding of the People’s Republic of China, the advantages of logistics are neglected, and the scale operation and the welfare in the industry are difficult to achieve due to the influence of the economic system and social environment. Therefore, a new intelligent logistics distribution management system based on machine vision and visual sensor image processing technology is constructed to respond to the shortcomings of the traditional system, including slow efficiency, huge cost, complex data, and low degree of informatization. Through the analysis and research on the visual sensor image processing technology and the order processing, receipt management, distribution management, scheduling management, and return management that affect logistics distribution, a simulation experiment is used to verify that the visual sensor image processing technology is rigorous, intelligent, and efficient and has high precision. The intelligent logistics distribution management system can effectively solve the problems existing in the traditional logistics distribution management. The experimental results show that the visual sensor image processing technology can collect and analyze the target image and effectively track and monitor it in the logistics distribution process. The average distribution precision of the intelligent logistics distribution management system reaches more than 99.5%, which is greatly improved compared with 90% of the traditional logistics distribution. And it can greatly improve the distribution efficiency, which increases by about 26.5%. The study realizes the information management of the logistics system and automatically completes all the work according to the designed program, so that the real-time dynamic distribution can be transmitted to the urban logistics distribution at any time.

Logistics as a competitive advantage in retail organizations

Retail plays an important role in the trade sector of the Brazilian economy, with net operating revenues of nearly BRL 1.7 trillion and more than 7 million workers in 2018, according to the latest Annual Trade Survey from the Brazilian Institute of Geography and Statistics. The entry of large multinational companies into the Brazilian retail market, where it is worth highlighting Amazon, has negatively impacted the market of Brazilian retail companies, which still use archaic methods and disqualified labor in their operations and processes. Amazon provides better logistics services that directly add value to the quality of products offered through a leaner and more profitable supply chain. Additionally, the behavioral changes brought about by Covid-19 have made consumers more satisfied with online shopping experiences than with visits to physical stores. The increase in internet shopping and the reduction of visits to sales outlets has caused a migration of consumption to digital media, which may generate long-term transformations in the strategies of companies. Thus, the objective of this research is to provide a conceptual proposal of the use of logistics as a competitive advantage in retail organizations, considering the best management practices for the logistics sector. As a research methodology, a systematic literature review was adopted, based on the PRISMA protocol, allowing the identification of 94 records, 12 of which were included in the literature review, due to their adherence to the researched theme. The main contribution of this paper is the development of a conceptual proposal for the use of logistics as a competitive advantage in retail organizations, comprising five aspects: Information Systems, Application of KPIs aligned with the Strategic Objectives of the Organization, Creating Value for Products, Modern Management Concept and, Need for Organizations to recognize the Benefits and Advantages of Logistics.

An efficient, non-invasive approach for in-vivo sampling of hair follicles: design and applications in monitoring DNA damage and aging.

In accordance with the 3 Rs principle (to replace, reduce and refine) animal models in biomedical research, we have developed and applied a new approach for sampling and analyzing hair follicles in various experimental settings. This involves use of a convenient device for non-invasive collection of hair follicles and processing methods that provide sufficient amounts of biological material to replace stressful and painful biopsies. Moreover, the main components of hair follicles are live cells of epithelial origin, which are highly relevant for most types of malignant tumors, so they provide opportunities for studying aging-related pathologies including cancer. Here, we report the successful use of the method to obtain mouse hair follicular cells for genotyping, quantitative PCR, and quantitative immunofluorescence. We present proof of concept data demonstrating its utility for routine genotyping and monitoring changes in quality and expression levels of selected proteins in mice after gamma irradiation and during natural or experimentally induced aging. We also performed pilot translation of animal experiments to human hair follicles irradiated ex vivo. Our results highlight the value of hair follicles as biological material for convenient in vivo sampling and processing in both translational research and routine applications, with a broad range of ethical and logistic advantages over currently used biopsy-based approaches.

Therapeutic applications of extracellular vesicles

Extracellular vesicles, secreted spontaneously or in response to stress by all cell types, are proposed as alternative biotherapies to cellular therapies and to synthetic nanomedicines. Their logistical advantages (storage, stability, availability, tolerance), their ability to cross biological barriers, to deliver their contents (proteins, lipids and nucleic acids) in order to modify their target cells, as well as their immunomodulatory and regenerative activities, are of growing interest for a very wide spectrum of diseases. Here we review the challenges to bring these biotherapies to the clinic and discuss some promising applications in cancer and regenerative medicine.

Outcome of Haploidentical Peripheral Blood Allografts Using Post-Transplantation Cyclophosphamide Compared to Matched Sibling and Unrelated Donor Bone Marrow Allografts in Pediatric Patients with Hematologic Malignancies: A Single-Center Analysis

The introduction of post-transplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis has made haploidentical (haplo) hematopoietic stem cell transplantation (HSCT) a common approach in adults, but pediatric experience is limited. Based on the encouraging adult data and with the aim of decreasing the risk of graft failure, our center is increasingly using peripheral blood stem cells (PBSCs) from haplo donors with PTCy. Here we compare outcomes of bone marrow (BM) transplantation with traditional donor choices, including matched sibling donors (MSDs) and 10/10 HLA matched unrelated donors (MUDs), with those of haplo PBSC grafts in pediatric patients with hematologic malignancies. In this retrospective single-center study, the primary endpoint was the comparison of GVHD-free relapse-free survival (GRFS; defined as absence of acute GVHD [aGVHD] grade III-IV, relapse, death, or chronic GVHD [cGVHD] requiring systemic therapy) for the 3 cohorts. Secondary endpoints included overall survival (OS), relapse-free survival (RFS), nonrelapse mortality (NRM), and incidence of aGVHD and cGVHD). A total of 104 consecutive patients underwent first allogeneic (allo)-HSCT for a hematologic malignancy or myelodysplastic syndrome between January 2014 and December 2020 using a haplo family donor (PBSCs; n=26), an MSD (BM; n=31), or an MUD (BM; n=47). Patient demographic and transplantation characteristics were not significantly different across the cohorts, apart from remission status, with the haplo cohort having more patients in third or later complete remission before HSCT (P < .01). The median duration of follow-up for the entire cohort was 573 days. The cumulative incidence of aGVHD (grade II-IV or grade III-IV) was not significantly different among the cohorts; however, the cumulative incidence of cGVHD at 18 months was highest in the MUD cohort (31.7%, versus 10.0% in the MSD cohort and 9.2% in the haplo cohort; P=.02). There were no differences in the 18-month cumulative incidence of relapse or NRM. OS and RFS at 18 months were 80.7% (95% confidence interval [CI], 61.7% to 100%) and 73.8% (95% CI, 55.5% to 98.1%) for the haplo cohort, 83.4% (95% CI, 72.8% to 95.5%) and 70.3% (95% CI, 57.9% to 85.3%) for the MUD cohort, and 80.9% (95% CI, 66.9% to 97.7%) and 66.5% (95% CI, 50.5% to 87.5%) for the MSD cohort, with no statistically significant differences among the cohorts. GRFS at 18 months was 61% (95% CI, 43.3% to 85.9%) for the haplo cohort, 44.6% (95% CI, 31.8% to 62.5%) for the MUD cohort, and 62.1% (95% CI, 45.7% to 84.3%) for the MSD cohort (P=.26). Haploidentical PBSC HSCT with PTCy had comparable outcomes to MSD and MUD BM HSCT and less cGVHD compared with MUD BM HSCT in children. The logistical advantages and lower resource burden of haplo HSCT with PBSCs make it a feasible alternative to MUD HSCT in children with hematologic malignancies. Given that this is a retrospective comparison of transplantation platforms rather than donor types, further prospective studies are warranted. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

Salivary oxytocin after play with parents predicts behavioural problems in preschool children

BackgroundOxytocin (OXT) has attracted research interest for its potential involvement in many of the behavioural problems observed in childhood. Due to its logistical advantages, saliva is an attractive fluid to quantify neuropeptides in children. Salivary OXT has been suggested as a potential biomarker for psychopathology during childhood. However, several questions still remain about the extent to which, and under what conditions, concentrations of OXT in saliva can be reliably measured and are related to behavioural problems in preschool age children. MethodsSeven samples of saliva from 30 preschool children (17 girls) were collected in five different days at their homes. Three of the samples were collected by the children's parents at baseline daily routine conditions, and four of the samples were collected by researchers during two home-visits: before and after two 15-minute dyadic play sessions (one with mothers and one fathers) between each individual parent and the child. Oxytocin concentrations were quantified by Radioimmunoassay with prior extraction. Children's behavioural problems were assessed by the Caregiver-Teacher Report Form (C-TRF) questionnaire, completed by the child's’ preschool teacher. ResultsSalivary OXT measured in baseline samples could not predict any of the behavioural problems measured by the C-TRF. However, when measured after playing with parents salivary OXT showed a stronger pattern of negative correlations, specially with the depression and opposition scales of the C-TRF. Furthermore, salivary OXT was unlikely to be reliably measured using single sampling, but acceptable reliabilities were achieved when averaging several samples. Finally, the single measures of salivary OXT evoked after an episode of play with parents showed better reliabilities than collected at baseline. ConclusionMeasurements of OXT evoked after positive affect interactions with parents seem to capture aspects of the OXT system in young children that might be relevant for understanding the role of this system in children’s social behaviour.

Reproductive aging and menopause-like transition in the menstruating spiny mouse (Acomys cahirinus).

Does the naturally menstruating spiny mouse go through menopause? Our study is the first to show a natural and gradual menopausal transition in a rodent. Age-related depletion of the human ovarian reserve (OvR) leads to menopause, the permanent cessation of menstruation and reproduction. Current rodent models of menopause are inappropriate for inferences of the human condition, as reproductive senescence is abrupt or induced through ovariectomy. The spiny mouse is the only confirmed rodent with a naturally occurring menstrual cycle. Histological assessment of virgin spiny mice occurred in females aged 6 months (n = 14), 1 year (n = 7), 2 years (n = 13), 3 years (n = 9) and 4 years (n = 9). Endocrinology was assessed in a further 9 females per age group. Five animals per group were used for ovarian stereology with additional ovaries collected at prenatal Day 35 (n = 3), day of birth (n = 5), postnatal Days 35 (n = 5) and 100 (n = 5) and 15 months (n = 5). Morphological changes in the reproductive system were examined using hematoxylin and eosin stains. Proliferating cell nuclear antigen immunohistochemistry assessed endometrial proliferation and sex steroids estradiol and testosterone were assayed using commercial ELISA kits. The proportion of females actively cycling was 86% at 6 months, 71% at 1 year, 69% at 2 years, 56% at 3 years and 44% at 4 years. Uterine and ovarian weights declined steadily from 1 year in all groups and corresponded with loss of uterine proliferation (P < 0.01). Estradiol was significantly decreased at 1 and 2 years compared to 6-month-old females, before becoming erratic at 3 and 4 years, with no changes in testosterone across any age. Fully formed primordial follicles were observed in prenatal ovaries. Aging impacted on both OvR and growing follicle numbers (P < 0.001-0.0001). After the age of 3 years, the follicle decline rate increased more than 5-fold. N/A. This is a descriptive study in a novel research rodent whereby reagents validated for use in the spiny mouse were limited. The gradual, rather than sudden, menopausal transition suggests that the spiny mouse is a more appropriate perimenopausal model than the current rodent models in which to examine the neuroendocrine pathways that encompass all hormonal interactions in the hypothalamic-pituitary-gonadal axis. The logistic, ethical and economic advantages of such a model may reduce our reliance on primates in menopause research and enable more thorough and invasive investigation than is possible in humans. Hudson Institute is supported by the Victorian State Government Operational Infrastructure Scheme. The authors declare no competing interests.

Assessment of bovine respiratory disease progression in calves challenged with bovine herpesvirus 1 and Mannheimia haemolytica using point-of-care and laboratory-based blood leukocyte differential assays.

Blood leukocyte differentials can be useful for understanding changes associated with bovine respiratory disease (BRD) progression. By improving turnaround time, point-of-care leukocyte differential assays (PCLD) may provide logistical advantages to laboratory-based assays. Our objective was to assess BRD progression in steers challenged with bovine herpesvirus 1 and Mannheimia haemolytica using point-of-care and laboratory-based blood leukocyte differentials. Thirty Holstein steers (average body weight of 211 kg + 2.4 kg) were inoculated intranasally on day 0 with bovine herpesvirus 1 and intrabronchially on day 6 with Mannheimia haemolytica. Blood leukocytes differentials were measured using both assays from study days 0 to 13. Linear mixed models were fitted to evaluate the associations between: (1) the type of assay (laboratory-based or PCLD) with respect to leukocyte, lymphocyte, and neutrophil concentrations; (2) study day with cell concentrations; and (3) cell concentrations with lung consolidation measured at necropsy. Point-of-care leukocyte, lymphocyte, and neutrophil concentrations were significantly associated (P < 0.05) with the respective cell concentrations obtained from the laboratory-based leukocyte differential. Cell concentrations reported by both assays differed significantly (P < 0.05) over time, indicating shifts from healthy to viral and bacterial disease states. Lymphocyte concentrations, lymphocyte/neutrophil ratios obtained from both assays, and band neutrophil concentrations from the laboratory-based assay were significantly associated (P < 0.05) with lung consolidation, enhancing assessments of disease severity. The PCLD may be a useful alternative to assess BRD progression when laboratory-based leukocyte differentials are impractical.

The association of prothrombin complex concentrates with postoperative outcomes in cardiac surgery: an observational substudy of the FIBRES randomized controlled trial

PurposeThe mainstay of therapy for coagulation factor deficiency in cardiac surgical patients is frozen plasma (FP); however, prothrombin complex concentrates (PCCs) may offer logistical and safety advantages. As there is limited comparative evidence, we conducted this study to explore the association of comparable PCC or FP doses with transfusion and outcomes.MethodsThis was a post hoc analysis of a multicentre randomized trial comparing fibrinogen concentrate with cryoprecipitate (FIBRES trial) in bleeding cardiac surgical patients. This analysis included 415 patients who received only PCC (n = 72; 17%) or only FP (n = 343; 83%) for factor replacement. The main outcomes of interest were red blood cell (RBC) and platelet transfusion within 24 hr of cardiopulmonary bypass. Secondary outcomes included postoperative adverse events. Associations were examined by hierarchical generalized estimating equation models adjusted for demographic and surgical characteristics.ResultsThe median [interquartile range (IQR)] PCC dose was 1,000 [1,000–2,000] units, while the median [IQR] FP dose was 4 [2–6] units. Each unit of FP was independently associated with increased adjusted odds of RBC (1.60; 95% confidence interval [CI], 1.36 to 1.87; P < 0.01) and platelet transfusion (1.40; 95% CI, 1.15 to 1.69; P < 0.01) while each 500 units of PCC was independently associated with reduced adjusted odds of RBC (0.67; 95% CI, 0.50 to 0.90; P < 0.01) and platelet transfusion (0.80; 95% CI, 0.70 to 0.92; P < 0.01). Adverse event rates were comparable.ConclusionsIn cardiac surgical patients with post-cardiopulmonary bypass bleeding, PCC use was associated with lower RBC and platelet transfusion than FP use was. Prospective, randomized clinical trials comparing FP with PCC in this setting are warranted.

Russian LNG Aims High, Leveraging Big Reserves and Logistical Advantages

Russia’s market influence as an exporter of liquefied natural gas (LNG) is growing, possessing the world’s largest reserves of natural gas and the logistical options to deliver it at competitive prices to Asia and Europe along the now-navigable Northern Sea Route (NSR). The country became a player in the LNG market when it shipped its first cargo in 2009 to Japan from what was then Russia’s first offshore gas project, Sakhalin-2 in the Far East, operated by Sakhalin Energy Investment Company Ltd. and owned by Russia’s pipe-line gas monopoly Gazprom (50% plus one share), Shell (27.5% minus one share), and Japan’s Mitsui (12.5%) and Mitsubishi (10%). Sakhalin Energy operates three oil and gas platforms producing its current resource base from the Piltun-Astokhskoye oil field and the Lunskoye gas field off the northeastern coast of Sakhalin. To date, Sakhalin Energy has sold all the LNG produced at its 11.49-mtpa-capacity Prigorodnoye LNG production complex on the southern tip of Sakhalin Island, under long-term contracts to buyers in the Asia Pacific and North America, according to Shell’s website. In 2024–2026, the partners say they will add a third train to expand capacity by 5.4 mtpa, though they have repeatedly delayed this expansion for years due to a lack of investment capital to develop a new resource base and low gas prices in Asia. The same holds true for Gazprom’s plan for an LNG plant near Vladivostok. However, the market has now changed with rising demand for gas to replace coal, giving gas producers an incentive to invest into new E&amp;P gas projects and mid-to-downstream megaprojects like those for producing LNG. https://jpt.spe.org/compared-to-last-year-gas-prices-are-looking-good In 2018 and again this past January, European spot gas prices spiked on Gasunie’s leading TTF (title transfer facility) virtual trading platform and other European trading hubs when Asian gas markets began offering high premiums to divert LNG cargos from Europe, according to the EU Commission’s latest European Gas Market report. The Rise of a Russian IOC—Novatek in Yamal Russia’s largest independent natural gas producer Novatek was Russia’s second entrant into the LNG market when its Yamal LNG project rose above the permafrost atop an estimated 65,000 piles on the Yamal Peninsula, home to Russia’s largest gas deposits and the source of Russian pipeline gas sold into Europe. Yamal LNG shipped its first cargo (170000 m3) in December 2017. It then upped the ante with exports from a second train in August 2018, and added a third train in November 2018, according to Novatek’s website. Situated on the South Tambeyskoye field on the coast of Ob Bay, the plant boasts a capacity of 17.4 mtpa.

Multicentre evaluation of magnetic technology for localisation of non-palpable breast lesions and targeted axillary nodes.

Magseed technology is a recently introduced localisation technique for impalpable breast lesions with possible advantages over traditional techniques. These include improved theatre logistics, flexibility in incision placement and improved patient experience. This multicentre study evaluates the experience of introducing Magseed technology into routine surgical practice. A prospective multicentre study of Magseed localised procedures was performed. Insertion data were recorded by the radiologist including lesion characteristics and Magseed insertion accuracy. The surgical team recorded time from insertion to operation, operating time and surgical satisfaction. Pathology results were reviewed for specimen weight and margins. Between February 2019 and June 2020, 100 patients were enrolled. Magseed localised procedures included 18 excisional biopsies, 23 wide local excisions (WLE), 50 WLE with axillary surgery and four cases of Magseed localised breast WLE with Magseed localised axillary surgery. There were three therapeutic mammoplasties and two cases of Magseed localised targeted axillary node dissection alone. A total of 90% of Magseeds were radiologically placed within 5 mm of the target lesion/node. Time between incision and specimen removal was 17 min (range 6-40 min). All breast and axillary Magseeds were successfully identified and retrieved during surgery. The target lesion was identified in the specimen in all cases. A total of 10% of cases required further surgery for pathologically positive margins. Overall, surgeons reported that Magseed localisation was "easy" or "very easy" in 77% of cases. Magseed is a reliable, safe and accurate surgical technique that provides logistical advantages and flexibility of surgical approach. The method was well-accepted by all users.

Gynecologic oncology patients are ready for telemedicine in routine care: results from a pre-COVID survey

<h3>Objectives:</h3> We aimed to assess the telemedicine readiness and attitudes of gynecologic oncology patients with attention to groups at risk for difficulty in accessing care, such as increased distance to care and rural populations. <h3>Methods:</h3> Gynecologic oncology patients at all stages of disease and treatment (primary, recurrence, surveillance) were asked to complete an anonymous survey during in-person outpatient appointments at an academic comprehensive cancer center. Surveys were entered into RedCAP; SPSS was used for statistical analysis. This survey was conducted prior to the COVID-19 pandemic, before the introduction of telemedicine in this practice. <h3>Results:</h3> Of 180 patients approached, 170 completed the survey. Mean age was 59.6 years; 73.4% identified as White, 23.7% as Black, and 2.9% as other race. The majority of patients had ovarian cancer (41.2%), followed by endometrial (27.1%), cervical (20.6%), vaginal/vulvar (7.1%), and other (1.2%.) The majority of patients traveled greater than 50 miles for appointments (63.8%); these patients were more likely to be from rural counties and incurred a significantly higher cost for travel per visit ($60.77 vs $37.98, p=0.026.) The majority of patients expressed interest in using telemedicine appointments (75.7%) or a smartphone app (87.5%) as a component of their cancer care. Patients with difficulty attending appointments (88.9 vs 70.2%, p=0.02), or those from rural areas (88.7% vs 69.6%, p=0.03), were especially interested in telemedicine; those with both characteristics reported 100% interest in telemedicine. The majority of patients in both urban and rural counties had the ability to access the internet and telemedicine services from home, via smart phone or computer. Patients from rural and urban counties used the internet at similarly high rates (at least daily use, 79% vs 75%.) <h3>Conclusions:</h3> Telemedicine is acceptable and attractive to the majority of patients even prior to the COVID-19 pandemic, and may offer financial and logistical advantages for patients who live far from gynecologic oncology care. Overall, patients have high rates of internet use and express comfort with using technology for their healthcare. Disparities in cancer outcomes for rural patients, including survival and clinical trials enrollment, have been associated with increased distance to providers and difficulty accessing care. In our study, these patients were universally interested in telemedicine. Telemedicine should be incorporated into standard practice beyond the current COVID-19 pandemic to reduce healthcare disparities related to care access.

A pilot study on feasibility, toxicity and efficacy of a novel hypofractionated radiation therapy in advanced non-nasopharyngeal head and neck carcinoma treated with palliative intent

Introduction: For palliative treatment in patients with advanced inoperable stage IV head and neck cancer hypofractionated radiotherapy is an efficient, cost-effective option, providing logistic advantage. Though there are multiple regimens prescribed, no standard of care has been confirmed. In this study a novel hypofractionated regimen has been tested for feasibility and toxicity along with assessment of objective treatment response and survival along with self–reported quality of life. Patients and methods: 30 Patients, having pathologically proven advanced and metastatic non-nasopharyngeal squamous cell carcinoma of Head and Neck (Stage IV) attending Radiotherapy Department of Hospital were allocated to the prescribed hypofractionation regime with 35 Gray in 7 fractions, given as 2 days a week (total 3.5 weeks). In patients with good response and tolerability 10 Gray boost in 2 fractions were given. Patients were followed up at regular intervals for at least 1 year. Results: The regimen faced a 97% treatment completion rate. Mean time to completion (from first contact) is 5.8 (95% CI = 5.7–6.0) weeks. The toxicity of this treatment regimen was tolerable with 23.3% acute and 33.3% incidence of chronic grade 3/4 toxicities. Objective response rate of this study was 66.7% (p = 0.001) with further 16.7% patients having stable disease. After one month of treatment significant improvement of quality of life was reported in terms of global health score, functional score and symptoms score. Mean progression free survival is 34.4 (95% CI = 27.8–41.1) weeks with 49.4 (95% CI = 44.3–54.5) weeks of overall survival in 1 year follow up period. Conclusions: The regimen is well tolerated and is highly feasible and has provided good response rate and improved quality of life immediately after treatment along with better one year overall survival rate.

Digital Logistics as a Factor of Increasing the Volume and Quality of Transport Services

In this article, the advantages of digital logistics in transport activity, the hierarchy of digitization of railway transport, the importance of the level of Internet access in the Republic in the organization of services through e-commerce areas of structural subdivisions of its lower stage, the effectiveness of digital logistics are given information.