Therapy Procedures Research Articles

#2719 Hypoalbuminemia as a mortality risk factor in acute kidney injury

Abstract Background and Aims Preexisting hypoalbuminemia in many studies was an independent factor of mortality in patients with acute kidney injury (AKI). Albumin replacement in patients with AKI did not affect their survival. Each 1.0 g/l decrease in serum albumin was associated with an increased probability of developing AKI (OR 1.685). Also, it was shown that serum albumin level below 32 g/l is a significant risk factor for the occurrence of AKI. The mortality of patients with AKI is extremely high, approximately 50%, in patients with AKI who require dialysis treatment it is 50-70%, while in patients on supportive ventilation or with multisystem organ failure it is even 80-90%. Method The retrospective study included 280 patients diagnosed with AKI in the period from 2014 to 2018. Demographic, laboratory parameters and therapeutic procedures were analyzed in order to determine their influence on the treatment outcome. Binary logistic regression was used to test statistical significance to identify potential mortality factors. Results The incidence of AKI was 6.5%. The mean age was 67.8±13.8 years (19, 91) without statistically significant difference by gender (50.4% men) (p = 0.22). The most prevalent is prerenal AKI 57.1%, followed by renal 24.3% and postrenal 18.6%. Renal replacement therapy is required in 15.7% of patients. Intermittent HD was applied statistically significantly more often, 90.9%, and continuous renal replacement therapy (CRRT) procedures were applied in 9.1% of patients (p < 0.001). Mortality was 18.6%. With each increase in the patient's age by one year, the probability of a fatal outcome increases by 1.045 times (p = 0.000; OR: 1.045). Hypoproteinemia and hypoalbuminemia increase the probability of death. For each unit decrease in albumin by 1 g/l, the risk of death increases by 13% (p = 0.000; OR: 0.872), and each decrease in protein by 1 g/l increases the risk of death by 7% (p = 0.000 ; OR: 0.939). Among other factors that showed statistical significance are hyperphosphatemia (p = 0.001; OR: 1.990), acidosis (p = 0.007; OR: 0.002), inflammation (p = 0.029; OR: 1.003). Conclusion Acute kidney injury is accompanied by a high mortality rate. Low serum albumin levels at the time of diagnosis are a significant independent factor of acute kidney function impairment and death. Other risk factors that contribute to a poor outcome in patients with AOB are age, hyperphosphatemia, acidosis, and inflammation.

Interactions of Cardiac Proteins with Plasma-Synthesized Polypyrrole (PSPy) to Improve Adult Cardiomyocytes Culture.

Plasma-Synthesized Polypyrrole (PSPy) has been reported as a biomaterial suitable for cell growth in vitro and in vivo. An experimental duplicate was carried out that showed the growth of cardiomyocytes with PSPy, following a protocol previously reported by the working group. The cardiomyocytes cultured with the biomaterial retained their native morphological characteristics, a fundamental key to improving cardiac cell therapy procedures. Such observations motivated us to investigate the molecular characteristics of the biomaterial and the type of interactions that could be occurring (mainly electrostatic, hydrogen bonds, and non-polar). Additionally, PSPy has been studied to establish the probable mechanisms of action of the biomaterial, in particular, its action on a group of cell membrane proteins, integrins, which we know participate in the adhesion of cells to the extracellular matrix, in adhesion between cells and as bidirectional signal transducer mechanisms. In this work, we carried out studies of the interactions established between cardiac integrins α2β1 and α5β1 with different PSPy models by molecular docking studies and binding free energies (ΔGb) calculations. The models based on a previously reported PSPy molecule have three variable terminal chemical groups, with the purpose of exploring the differences in the type of interaction that will be established by modifying the position of an amino (-NH2), a hydroxyl (-OH), and a nitrile (C≡N) in (fixed) groups, as well as the length of the terminal chains (a long/short -NH2). A model with short chains for the -OH and -NH2 (lateral) group was the model with the best interactions with cardiac integrins. We experimentally verified the direct interaction of cardiomyocytes with the PSPy biomaterial observed in rat primary cultures, allowing us to validate the favorable interactions predicted by the computational analysis.

Posterior Reversible Leukoencephalopathy Syndrome (PRES) in a patient with post eclampsia with status epilepticus

Despite the limited number of instances and relatively low knowledge of Posterior Reversible Leukoencephalopathy Syndrome (PRES) among the population of Bangladesh, it is imperative to recognize the gravity of this health issue. The crucial aspect in achieving favorable results is the early detection of the condition, as it allows for the prompt elimination of the precipitating cause and the effective management of blood pressure. The present case study elucidates the significant discoveries pertaining to a patient with posterior reversible encephalopathy syndrome (PRES), as well as the diagnostic and therapeutic strategies used. A female individual who had just undergone a surgical operation known as a cesarean section exhibited symptoms including headache, recurrent convulsions, and loss of consciousness. Subsequent medical evaluation led to the diagnosis of posterior reversible encephalopathy syndrome (PRES). This section presents an examination of the diagnostic process using clinical and radiological characteristics, as well as an overview of the therapy plan. The fast diagnosis and timely beginning of therapy procedures have been identified as crucial factors for achieving early recovery and favorable functional outcomes. J Shaheed Suhrawardy Med Coll 2022; 14(2): 63-65

MANUAL THERAPY TECHNIQUES FOR THE ACROMIOCLAVICULAR JOINT DYSFUNCTION – A NARRATIVE REVIEW

INTRO/BACK GROUND Ac joint dysfunction is a prevalent cause of shoulder discomfort. As far as we are aware, there are currently no published studies focused on the manual therapy management of AC joint dysfunction. However, manual physical therapy has proven successful in treating various other shoulder conditions. To address this, recent research has started to investigate whether manual techniques are more effective in treating ac joint dysfunction. OBJECTIVE Aim of this study on the literature review pointing on the available evidence for the manual therapy interventions in acromioclavicular joint dysfunction patients. METHODS Research involved a computerized data base used for searching articles were Science direct, Pedro, PubMed, goggle scholar search pertaining to studies that include the manual therapy among acromioclavicular joint dysfunction Patients RESULTS: These 10 studies were based on the inclusion exclusion criteria were included in this review the methods used in all these studies were strengthening exercises , transverse friction massage, joint mobilization, myofascial release techniques, active passive motion exercises, scapulothoracic exercises, peri joint muscle exercises, joint stability exercises with different sets of exercises for muscle activation and range of motion and function these manual therapy techniques aims to alleviate inflammation recover the shoulder pain free rom and restore the proper function of soft tissue and joint. CONCLUSION: We conclude from this review that a variety of manual treatment procedures have been shown to be useful and effective in treating patients with AC joint dysfunction. There is, however, a dearth of data on the use of manual therapy procedures or interventions to treat ac joint dysfunction. More investigation is required to determine the precise role that manual therapy strategies may play in managing ac joint dysfunction.

Interventional therapy procedures in BPH

Interventional therapy procedures in BPH

A Review on Treatment Approaches for Chronic Low Back Pain via Mulligans Movement With Mobilization and Physical Therapy

Abstract One of the main causes of functional impairment is low back pain. Every one of all ages can have low back discomfort, and there are several ways to treat this condition. Physiotherapy's manual therapy is a specialist field that treats neuromuscular discomfort. The Mulligan technique, Maitland mobilisation technique, Active release technique, and many more are examples of manual therapy procedures. The primary focus of manual therapy is on the joint's osteokinematics and arthrokinematics. It is one of the primary methods for treating low back pain. Any ligamentous strain, muscular pathology, spinal dysfunction, or sacroiliac dysfunction can all produce low back discomfort. It is important to determine the reason of the low back discomfort and treat it appropriately. This review leads us to the conclusion that mobility combined with Mulligan mobilisation is a useful strategy for lowering low back pain. Checking the efficacy of manual therapy techniques in treating chronic low back pain requires more research

A retrospective study of postoperative adjuvant therapy following immunotherapy combined with targeted therapy and sequential curative surgical procedures for initially unresectable hepatocellular carcinoma

Objective: To report the clinical efficacy of adjuvant therapy based on pathological results following immunotherapy combined with targeted therapy and sequential curative surgical procedures in patients with initially unresectable hepatocellular carcinoma. Methods: This is a retrospective case series study. Data from 100 patients who underwent adjuvant therapy based on pathological results following immunotherapy combined with targeted therapy and sequential curative surgical procedures with long-term survival were collected from December 2018 to December 2022 at the Faculty of Hepato-Pancreato-Biliary Surgery, First Medical Center, Chinese People's Liberation Army General Hospital. According to inclusion and exclusion criteria, 47 cases were included, among which patients who met the discontinuation criteria and maintained a drug-free tumor-free status. Thirty-nine male and eight female patients were included, with an age of (54.2±18.8)years(range:38 to 73 years) at initial diagnosis. At the time of initial diagnosis, 43 cases (91.5%) were classified as Barcelona Clinic Liver Cancer(BCLC) stage C. Survival curves were made using Kaplan Meier method. Results: Forty-seven patients underwent R0 resection, all achieved a drug-free tumor-free state through postoperative adjuvant therapy based on pathological examination results. Thirty-six patients(76.6%) maintained a drug-free tumor-free survival status for more than 6 months,28 patients(59.6%) for more than 12 months,and 8 patients(17.0%) for more than 24 months. The longest drug-free tumor-free survival in this cohort reached 48 months. The median follow-up time in this study was 32 months. After diagnosis, the overall survival rates at 1- and 3- years were 97.7%(95%CI:93.4% to 100%) and 90.7%(95%CI:82.5% to 99.8%). The postoperative recurrence-free survival rates at 1- and 3- years were 91.0%(95%CI:83.0% to 99.8%) and 71.3%(95%CI:58.7% to 86.5%). Conclusions: The adjuvant therapy based on pathological results following immunotherapy combined with targeted therapy and sequential curative surgical approach provides long-term survival benefits for patients with initially unresectable hepatocellular carcinoma. Standardized adjuvant therapy maybe sustain long-term tumor-free status,and achieve drug-free tumor-free survival.

The effectiveness of iso principle mood modulation playlists in inpatient psychiatry: A post-hoc analysis

This post-hoc data analysis study investigates the impact of iso principle-informed mood modulation playlists (MMPLs) on mood ratings using a Likert scale. Pre- and post-listening mood ratings were collected as part of routine music therapy procedures in an inpatient psychiatric setting and de-identified for analysis. The study comprised 125 pairs of mood ratings. The results of the Wilcoxon signed-rank post-hoc analysis revealed a significant improvement in post-test mood ratings compared to pre-test mood ratings (mean rank = 8.34 vs 5.02, respectively, Z = -9.59, p = 0.001). These findings highlight the therapeutic value of individualized MMPLs facilitated by music therapists in enhancing patient mood. The utilization of MMPLs allows patients to purposefully modulate their mood in desirable ways, demonstrating the potential of music therapy as a valuable tool in improving well-being.

Effect of 5-aminolevulinic acid photodynamic therapy versus loop electrosurgical excision procedure for cervical intraepithelial neoplasia grade 2 treatment

BackgroundBoth the traditional loop electrosurgical excision procedure (LEEP) and the newly developed 5-aminolevulinic acid photodynamic therapy (ALA-PDT) are used to treat high-grade squamous intraepithelial lesions. However, the clinical efficacy and safety of these two therapies have rarely been compared. Thus, this study aimed to compare the clinical efficacy and safety of the two treatment regimens. MethodsOne hundred and twenty patients in two groups (60 + 60) with grade 2 cervical intraepithelial neoplasia (CIN2) were voluntary treated with photodynamic therapy or LEEP between June 2020 and December 2022. Follow-up was conducted at 3, 4–6, and 7–12 months after treatment. ResultsAlthough the total effective rate of LEEP was higher during the first 6 months after treatment, both the total effective rate of lesion degradation and the double-negative rate of high-risk HPV16/18 and liquid-based cervical cytology by ALA-PDT treatment increased with time and finally exceeded those of LEEP at 7–12 months. ConclusionsALA-PDT may be more promising than LEEP for treating patients with CIN2 because of the better CIN2 degradation and high-risk HPV negativity, less damage, and greater fertility conservation, especially after 6 months.

Operation Procedure and Precautions of Lingnan Fire-Needle Therapy in Osteoporosis Model Rats.

Compared to filiform needle therapy, fire-needle therapy has both the stimulation of needles and the warming effect of heat, making it have unexpected effects on some chronic diseases and incurable diseases. Osteoporosis (OP) has a high incidence in postmenopausal women and middle-aged and elderly men, and the treatment cycle is long. According to Traditional Chinese Medicine (TCM), Lingnan fire-needle therapy has shown potential in treating osteoporosis. However, there is still a long way to go before it can be widely used. This article focuses on the application of Lingnan fire-needle therapy in the intervention of OP in rats. It covers the selection of needle tools, acupuncture point selection, positioning of rats' bodies, and fixation methods. We also outline the steps and precautions to be taken during and after needling with fire needles. The experiment was done with three groups: a normal group, a model group, and a fire-needle group, each containing 10 rats. The rats in the fire-needle group were treated with fire-needle intervention for six sessions. After the intervention period, we collected femoral specimens and performed micro-CT scans. The results suggest that fire needling can enhance bone morphology and mineral density in OP rats. This information can serve as a methodological basis for conducting basic research on fire-needle therapy.

Evaluation of Cytotoxicity of Allium sativum (Garlic Extract) against Human Dental Pulp Fibroblasts.

Vital pulp therapy procedures in primary dentition focuses on preservation and maintenance of pulp tissue that has been compromised due to caries, trauma, etc. Several pulp dressing materials have been used in primary teeth and some natural materials from the field of traditional medicine have also been introduced as medicaments in vital pulp therapy. The understanding of biologic and cytotoxic properties of newer materials is important for safe clinical usage. The biologic compatibility of these newer materials is imperative to limit or avoid tissue irritation or degeneration. To evaluate the cytotoxic effects of Allium sativum on cultured human primary dental pulp fibroblasts. Primary pulp fibroblasts were cultured from the pulp tissue obtained from extracted deciduous primary canines and central incisor teeth. The freshly prepared concentrations of 1000, 500, 250, 125, and 62.5 µg/mL A. sativum extract were added to the 96-well plate in triplicates to which culture medium containing fourth passage cell suspension was added previously. Cells without treatment served as control, while cells treated with 5% dimethyl sulfoxide (DMSO) served as toxic control. After the addition of experimental and control agents, cells were incubated for 24 and 48 hours at 37°C in 5% CO2 atmosphere. After the incubation period, 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyltetrazolium bromide (MTT) assay was performed to determine the number of viable cells. Absorbance was read with a microplate reader at 570 nm wavelength and the relative viability of dental pulp fibroblasts at various concentrations was expressed as color intensity of the experimental wells relative to that of control. The percentage of cell viability was also calculated accordingly. The MTT assay results revealed that A. sativum extract, in all the concentrations tested at both the time intervals maintained a cell viability of greater than 90%. At 24 hours, the mean absorbance value of untreated control wells was recorded as 0.84400 ± 0.00916 with 100% cell viability. Among all the concentrations of garlic extract tested, highest mean absorbance value of 0.83933 ± 0.00550 with 99.44% cell viability was recorded for 62.5 µg/mL concentration. At 48 hours, the mean absorbance value of untreated control wells was recorded as 1.22767 ± 0.01106 with 100% cell viability, and the highest mean absorbance value of 1.22567 ± 0.01006 with 99.83% cell viability was recorded for 62.5 µg/mL concentration. The cell viability did not seem to be affected by the concentration of A. sativum extract at 24 hours. However, at 48 hours, the sensitivity of the cells was observed to be dependent on the concentration of A. sativum with a decrease in the viability of cells noted with the increase in concentration. A. sativum extract is noncytotoxic in nature and preserves the vitality of cultured human primary dental pulp fibroblasts making it a suitable material for use in vital pulp therapy procedures of primary teeth. Devaraju R, Reddy D, Paul ST, et al. Evaluation of Cytotoxicity of Allium sativum (Garlic Extract) against Human Dental Pulp Fibroblasts. Int J Clin Pediatr Dent 2024;17(2):143-148.

Perceptions of an acceptance-based weight management treatment among adults living in rural areas.

Obesity and obesity-related comorbidities disproportionately affect rural communities. Research has emerged in support of a novel acceptance-based behavioural weight management treatment (ABT) that integrates the principles and procedures of acceptance-commitment therapy (ACT) with traditional components of standard behavioural treatment (SBT). The current study assessed the perceptions of community stakeholders in rural areas to session materials of a commercially available ABT program. Surveys and focus groups were used to solicit feedback from three former interventionists with experience delivering SBTs in rural counties and from 17 former participants in these programs. Qualitative responses encompassed four overarching themes: (1) recommendations to support participant engagement, (2) comments about preferences for specific ABT and SBT strategies, (3) concerns about specific aspects of treatment delivery, and (4) requests for aesthetic changes to session materials to enhance clarity and engagement. Overall, participants viewed ABT materials and concepts favourably but believed it would be important to begin the intervention with rapport building and training in traditional SBT strategies prior to delving into ACT strategies. Future studies should investigate the efficacy of ABT for weight loss in adults with obesity living in rural communities and continue to solicit feedback from rural community stakeholders.

Passive Root Coverage Through Creeping Attachment of the Gingiva Before and After Scaling and Root Planning Therapy in the Mandibular Anterior Teeth: A Clinical Study.

Introduction Root coverage is one of the most imperative procedures in periodontal therapy. The demands from patients for aesthetics and sensitivity are some of the complaints in root exposure cases. Creeping attachment is a passive apical migration of the marginal gingiva and can be proposed as a noteworthy root coverage technique. The purpose of this study was to evaluate the position of the marginal gingiva and quantify the creeping attachment before and after the scaling and root planning (SRP) procedure. Materials and methods The present study was based on a single-centreclinical trial in which 30 sites from 10 patients were selected. Patients with Miller's class I gingival recession were selected. The plaque index, gingival biotype, and gingival margin position were measured at baseline and then at 10 and 21 days after SRP. The gingival biotype was measured with an endodontic file with a stopper and a digital vernier calliper. The gingival margin position was measured from the incisal surface of the tooth to the marginal gingiva with the help of a University of North Carolina (UNC) 15 periodontal probe. After recording the clinical parameters, a thorough SRP was performed using an ultrasonic scaler and manual instruments. Results The results were compared clinically at baseline and after 10 days and 21 days postoperatively. Statistical analysis was conducted for pre-SRP and post-SRP findings using the IBM SPSS Statistics for Windows, Version 19 (Released 2010; IBM Corp., Armonk, New York) software. A statistically significant improvement was seen in all the clinical parameters at baseline, at 10 days, andat 21 days postoperatively after the procedure (P < 0.01). Conclusion The position of the gingival margin was shifted towards the crown, and the creeping attachment was significantly observed from baseline to 10 and 21 days. Clinical significance Creeping attachment after the SRP procedure can be considered a significant root coverage technique. The genetic memory of the gingiva may playan important role in achieving root coverage. Once local irritants are removed, the gingiva attempts to regain its original position. In addition, the gingival phenotype plays an important role in gingival marginal positioning after basic therapy and root coverage procedures.

Super-resolution neural networks improve the spatiotemporal resolution of adaptive MRI-guided radiation therapy

BackgroundMagnetic resonance imaging (MRI) offers superb non-invasive, soft tissue imaging of the human body. However, extensive data sampling requirements severely restrict the spatiotemporal resolution achievable with MRI. This limits the modality’s utility in real-time guidance applications, particularly for the rapidly growing MRI-guided radiation therapy approach to cancer treatment. Recent advances in artificial intelligence (AI) could reduce the trade-off between the spatial and the temporal resolution of MRI, thus increasing the clinical utility of the imaging modality.MethodsWe trained deep learning-based super-resolution neural networks to increase the spatial resolution of real-time MRI. We developed a framework to integrate neural networks directly onto a 1.0 T MRI-linac enabling real-time super-resolution imaging. We integrated this framework with the targeting system of the MRI-linac to demonstrate real-time beam adaptation with super-resolution-based imaging. We tested the integrated system using large publicly available datasets, healthy volunteer imaging, phantom imaging, and beam tracking experiments using bicubic interpolation as a baseline comparison.ResultsDeep learning-based super-resolution increases the spatial resolution of real-time MRI across a variety of experiments, offering measured performance benefits compared to bicubic interpolation. The temporal resolution is not compromised as measured by a real-time adaptation latency experiment. These two effects, an increase in the spatial resolution with a negligible decrease in the temporal resolution, leads to a net increase in the spatiotemporal resolution.ConclusionsDeployed super-resolution neural networks can increase the spatiotemporal resolution of real-time MRI. This has applications to domains such as MRI-guided radiation therapy and interventional procedures.

Clinical Relevance of Pathological Diagnosis of Hirschsprung's Disease with Acetylcholine-Esterase Histochemistry or Calretinin Immunohistochemistry.

Hirschsprung disease (HD) manifests as a developmental anomaly affecting the enteric nervous system, where there is an absence of ganglion cells in the lower part of the intestine. This deficiency leads to functional blockages within the intestines. HD is usually confirmed or ruled out through rectal biopsy. The identification of any ganglion cells through hematoxylin and eosin (H&E) staining rules out HD. If ganglion cells are absent, further staining with acetylcholine-esterase (AChE) histochemistry or calretinin immunohistochemistry (IHC) forms part of the standard procedure for determining a diagnosis of HD. In 2017, our Institute of Pathology at University Hospital of Heidelberg changed our HD diagnostic procedure from AChE histochemistry to calretinin IHC. In this paper, we report the impact of the diagnostic procedure change on surgical HD therapy procedures and on the clinical outcome of HD patients. We conducted a retrospective review of the diagnostic procedures, clinical data, and postoperative progress of 29 patients who underwent surgical treatment for HD in the Department of Pediatric Surgery, University of Heidelberg, between 2012 and 2021. The patient sample was divided into two groups, each covering a treatment period of 5 years. In 2012-2016, HD diagnosis was performed exclusively using AChE histochemistry (AChE group, n = 17). In 2017-2021, HD diagnosis was performed exclusively using calretinin IHC (CR group, n = 12). There were no significant differences between the groups in sex distribution, weeks of gestation, birth weight, length of the aganglionic segment, or associated congenital anomalies. Almost half of the children in the AChE group, twice as many as in the CR group, required an enterostomy before transanal endorectal pull-through procedure (TERPT). In the AChE group, 4 patients (23.5%) required repeat bowel sampling to confirm the diagnosis. Compared to the AChE group, more children in the CR group suffered from constipation post TERPT. Elevated AChE expression is linked to hypertrophied extrinsic cholinergic nerve fibers in the aganglionic segment in the majority of patients with HD. The manifestation of increased AChE expression develops over time. Therefore, in neonatal patients with HD, especially those in the first 3 weeks of life, an increase in AChE reaction is not detected. Calretinin IHC reliably identifies the presence or absence of ganglion cells and offers multiple benefits over AChE histochemistry. These include the ability to perform the test on paraffin-embedded tissue sections, a straightforward staining pattern, a clear binary interpretation (negative or positive), cost-effectiveness, and utility regardless of patient age. The ability of calretinin IHC to diagnose HD early and time-independently prevented repeated intestinal biopsies in our patient population and allowed us to perform a one-stage TERPT in the first months of life, reducing the number of enterostomies and restoring colonic continuity early. Patients undergoing transanal pull-through under the age of 3 months require a close follow-up to detect cases with bowel movement problems.

Estimation of organ and effective doses of CBCT scans of radiotherapy using size-specific field of view (FOV): a Monte Carlo study.

The kV cone beam computed tomography (CBCT) is one of the most common imaging modalities used for image-guided radiation therapy (IGRT) procedures. Additional doses are delivered to patients, thus assessment and optimization of the imaging doses should be taken into consideration. This study aimed to investigate the influence of using fixed and patient-specific FOVs on the patient dose. Monte Carlo simulations were performed to simulate kV beams of the imaging system integrated into Truebeam linear accelerator using BEAMnrc code. Organ and size-specific effective doses resulting from chest and pelvis scanning protocols were estimated with DOSXYZnrc code using a phantom library developed by the National Cancer Institute (NCI) of the US. The library contains 193 (100 male and 93 female) mesh-type computational human adult phantoms, and it covers a large ratio of patient sizes with heights and weights ranging from 150 to 190cm and 40 to 125kg. The imaging doses were assessed using variable FOV of three sizes, small (S), medium (M), and large (L) for each scan region. The results show that the FOV and the patient size played a major role in the scan dose. The average percentage differences (PDs) for doses of organs that were fully inside the different FOVs were relatively low, all within 11% for both protocols. However, doses to organs that were scanned partially or near the FOVs were affected significantly. For the chest protocol, the inclusion of the thyroid in the scan field could give a dose of 1-7mGy/100mAs to the thyroid, compared to 0.4-1mGy/100mAs when it was excluded. Similarly, on average, testes doses could be 6mGy/100mAs for the male pelvis protocol compared to 3mGy/100mAs when it did not lie in the field irradiated. These dose differences resulted in an average increase of up to 27% in the size-specific effective dose of the protocols. Since changing the field size is possible for CBCT scans, the results suggest that patient-specific scanning protocols could be applied for each scan area in a manner similar to that used for CT scans. Adjustment of the FOV size should be subject to the clinical needs, and assist in improving the treatment accuracy. The patient's height and weight might be considered as the main factors upon which, the selection of the appropriate patient-specific protocol is based. This approach should optimize the imaging doses used for IGRT procedures by minimizing doses of a large ratio of patients.

Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review.

The presence of air in the peritoneal cavity (pneumoperitoneum) is often secondary to perforated viscus. Emergent operative intervention is typically warranted in non-cancer patients. Cancer patients present a unique challenge as they have an increased risk of pneumoperitoneum due to local tumour invasion, radiation therapy, and frequent endoscopic procedures. There is a paucity of literature on the management of patients undergoing chemotherapy who present with pneumoperitoneum. The authors conducted a scoping review to identify and synthesize preliminary evidence on the presentation, management, and outcomes of this patient population. A scoping review of cases of pneumoperitoneum in cancer patients from 1990 to 2022 was conducted using the Arksey and O'Malley five-stage approach. Inclusion criteria were a known diagnosis of cancer, chemotherapy within 6 months of presentation, and imaging confirmation of pneumoperitoneum. The authors' exclusion criteria were cancer diagnosis at the time of presentation, perforation secondary to local cancer invasion, and last chemotherapy session greater than 6 months prior to presentation. Thirty-four cases (8 paediatric, 26 adults) were identified. The median time from the last chemotherapy treatment to presentation with pneumoperitoneum was 14 days. Twenty-one patients were managed operatively, and 13 were managed non-operatively. The most common source of perforation was multiple sites along the bowel. Thirty-day mortality was 33.3% for the operative cohort and 23.1% for the non-operative group. Pneumoperitoneum in cancer patients remains a highly morbid condition with a mortality rate of approximately 30%, regardless of the treatment approach. Non-operative management should be pursued whenever possible.

Characterization of tracks from alpha-particles in PADC detectors for passive environmental monitoring of fast neutron radiation field

Fast neutron dosimetry is particularly crucial in the realm of radioprotection, as it significantly contributes to evaluating the radiation protection measures. This assessment aims to ensure and enhance the effectiveness of implemented safeguards and precautions, thereby minimizing the risks and potential harm associated with radiation exposure. Given the substantial biological damage that fast neutrons can inflict when interacting with living tissues, accurate dosimetry is indispensable for ensuring the safety of personnel in these environments and for optimizing radiation therapy treatments. Employing an indirect detector technique, this research focuses on characterizing the geometrical and optical properties of tracks produced by alpha particles resulting from boron-neutron reactions and distinguish them from the background made up of tracks generated from radon decay and impurities on the surface of the detector. This methodology holds potential utility particularly in situations where dosimeters are not adequately stored: while the idea of employing plastic or alternative materials to shield dosimeters from radon may appear straightforward, there are numerous factors complicating its effectiveness and universal applicability, for example when the radon proof encapsulations are not sealed perfectly. Through the development of a robust protocol for fast neutron dosimetry, we can not only differentiate between tracks produced by alpha particles of varying energy levels but also quantify the dose resulting from exposure to the neutron field. A solid-state nuclear track detector system (Politrack, Mi.am, Italy) was used to address the critical need for measuring exposure to fast neutrons, thermalized by polyethylene spheres. This advancement facilitates the implementation of more effective radioprotection strategies and contributes to the overall safety of radiation therapy procedures.

Pain Perception Following Periodontal Decontamination Treatment with Laser Therapies: Comparison between Oxygen High-Level Laser Therapy (OHLLT) and Laser-Assisted New Attachment Procedure (LANAP)

Introduction: Within the field of periodontology, there has been a proposal for the utilization of noninvasive laser therapy as a potential treatment for persistent periodontitis. The Laser-Assisted New Attachment Procedure (LANAP) employs an Nd:YAG laser as a specific technique. Through its interaction with endogenous chromophores, the Nd: YAG laser exhibits a selective effect on the evaporation of granulation tissue, therefore establishing a correlation with reduced bleeding. The study also examined Oxygen High-Level Laser Therapy (OHLLT). The OHLLT technique employs a high-power diode laser in combination with hydrogen peroxide solutions to facilitate the liberation of singlet oxygen, which possesses antibacterial attributes, within the periodontal pockets. The existing literature indicates their potential to promote the regeneration of tooth support tissues. Objective: The aim of this study is to assess the subjective pain levels reported by patients who have undergone surgery using the OHLLT protocol versus those who have undergone surgery using the LANAP technique. Methods: A total of 20 individuals with a stage III–IV periodontitis diagnosis were recruited for the study. The participants were randomly divided into two groups, each consisting of 10 individuals: Group 1, comprising patients treated according to the LANAP protocol, and Group 2, comprising patients treated according to the OHLLT protocol. After their initial session of nonsurgical periodontal therapy, individuals provided feedback regarding their level of pain, utilizing a Numerical Rating Scale (NRS) comprising time intervals of 0 h (T0), 6 h (T1), 12 h (T2), 24 h (T3), 48 h (T4), and 7 days (T5). The Wilcoxon–Mann–Whitney statistical test was employed to assess the variations in NRS scores between Group 1 and Group 2 at each recording period. (p ≤ 0.05). In addition, a microbiological assessment of the bacterial load in the periodontal region was conducted on all subjects using real-time PCR testing at two time points: prior to treatment (T0) and seven days post-treatment (T5). Results: The findings of this study indicate that the OHLLT group exhibited significantly lower pain levels compared to the LANAP group at all time intervals, except for the preoperative period, where no significant difference was observed (p &lt; 0.05). Group 2 exhibited a more rapid decrease in pain, as demonstrated by a score test approaching zero within 24 h. The quantity of periodontal bacteria seen seven days post-treatment was similar between the two groups and was found to be decreased compared to the pre-treatment levels. Conclusions: The OHLLT and LANAP regimens have demonstrated efficacy in the nonsurgical management of periodontal disease. Nevertheless, it should be noted that the OHLLT approach does not subject the patient to any thermal hazards, unlike the LANAP method. The postoperative discomfort experienced following the OHLLT procedure is indeed reduced, as this technique is characterized by lower invasiveness and reduced dependence on the operator.

Intensive Care Treatment of Pulmonary Embolism: An Update Based on the Revised AWMF S2k Guideline.

Acute pulmonary embolism (PE) remains a significant cause of morbidity and requires prompt diagnosis and management. The prognosis of affected patients depends on the clinical severity. Therefore, risk stratification is imperative for therapeutic decision-making. Patients with high-risk PE need intensive care. These include patients who have successfully survived resuscitation, with obstructive shock or persistent haemodynamic instability. Bedside diagnostics by means of sonographic procedures are of outstanding importance in this high-risk population. In addition to the treatment of hypoxaemia with noninvasive and invasive techniques, the focus is on drug-based haemodynamic stabilisation and usually requires the elimination or reduction of pulmonary vascular thrombotic obstruction by thrombolysis. In the event of a contraindication to thrombolysis or failure of thrombolysis, various catheter-based procedures for thrombus extraction and local thrombolysis are available today and represent an increasing alternative to surgical embolectomy. Mechanical circulatory support systems can bridge the gap between circulatory arrest or refractory shock and definitive stabilisation but are reserved for centres with the appropriate expertise. Therapeutic strategies for patients with intermediate- to high-risk PE in terms of reduced-dose thrombolytic therapy or catheter-based procedures need to be further evaluated in prospective clinical trials.