Reduce Patient Discomfort Research Articles

Outcomes and Safety of Suprapubic vs Urethral Catheterization Following Pelvic Fascia‒Sparing Robotic Prostatectomy.

Urethral catheter (UC) discomfort remains a burden following robotic-assisted radical prostatectomy (RARP). Suprapubic catheters (SPCs) may reduce patient discomfort and increase satisfaction. Pelvic fascia‒sparing (PFS) RARP reduces the technical challenges of intraoperative SPC placement. We examined postoperative outcomes of SPC vs UC placement following PFS-RARP. We conducted a retrospective review of a prospective institutional review board‒approved database of PFS-RARP patients from June 2020 to December 2022 receiving SPC (n = 108) or UC (n = 104) postoperatively. Demographics and clinical and perioperative outcomes were captured. Postoperative patient-reported quality of life was measured using EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice). Patients with intraoperative complications or intraoperative leaks or undergoing salvage prostatectomy were excluded. Univariate and multivariate regression analyses were performed to compare outcomes. No significant differences in demographics or oncologic outcomes existed. There were no differences in complications, including urethral stricture or anastomotic leak. Men receiving SPC vs UC had earlier return to continence (7 vs 16 days, P < .001) and higher continence rates at catheter removal (67.6% vs 43.3%, P = .0003). On adjusted analyses, SPC was an independent predictor of continence at catheter removal (OR 2.21, P = .023). There were no differences between groups in preoperative or postoperative EPIC-CP scores, including no differences in postoperative quality of life (P = .46). SPC after PFS-RARP is a safe and feasible alternative to UC. SPC is associated with an earlier return to continence and higher continence rates at catheter removal. Use of SPC may increase overall patient satisfaction following PFS-RARP.

Utility of Bone Marrow Biopsies for Basal Stratification and Response Assessment in a Large Series of Real Life Follicular Lymphoma Patients

Introduction: Bone marrow biopsies (BMB) are usually performed before/after therapy to confirm complete response (CR) in follicular lymphoma (FL) patients. Up to 60% of patients may have bone marrow infiltration, that can change Ann Arbor stage, assigning the highest disease stage. Also, BMB infiltration is included in several prognostic indexes such as FLIPI2 and PRIMA-PI. Persistence of bone marrow disease after treatment is associated with worse outcome. Aim: The main objective is to establish whether BMB adds value in assessing response or predicting progression-free survival (PFS) and overall survival (OS) in previously untreated FL subjects from a large, Spanish unicentric retrospective cohort. Results: From 2001-2022 we recorded data from 260 newly diagnosed FL grade 1-3A from Hospital 12 de Octubre.The median age at diagnosis was 64 years (range 27-90) and 34 patients (13%) had grade 3A FL. Most patients (67%) had advanced Ann-Arbor stage and 45,4% presented bone marrow infiltration (111/244). 104 (40%) patients were considered suitable for a watchful waiting policy; of them, 52 (50%) never required systemic treatment during follow-. 132 patients (61% of those receiving treatment) were treated with R-CHOP or R-CVP, 44 (21%) received R-bendamustine and 20 (10%) rituximab monotherapy. In 114 patients (55%) PET/CT was done at the moment of diagnosis and to evaluate the response after treatment. The other were evaluated by CT. Basal bone marrow biopsy was essential in the diagnostic of 3 patients that only presented FL in BM. In addition, BMB upgraded disease stage in 9 (3.7%) that presented &amp;lt;3 nodal areas involved, without other extranodal infiltration. Basal BMB positive was predictive of worse PFS and OS in univariate analysis (HR = 1.69; 95%CI 1.04-2.76 and HR = 1.98; 95%CI 1.10-3.60, respectively). Ten-years PFS was 72% in patients without BM involvement vs 51% in patients with BM infiltration (HR= 1.7, p=0.034) ( Figure 1) and, Ten-years OS was 82% vs 62%, respectively. In 82 of 104 patients (79%) with basal BM infiltration, a BMB was performed after finishing induction treatment. In the other 22 patients BMB was not performed because of evidence of progression (n=10) or because of unknown causes (n=12). 12 (15%) of 82 patients evaluated remained BMB positive by histology. Globally, and independent of the image response assessment, the reassessment of BM did not confer prognostic differences in patients in whom it was performed and in those who were not (p= 0.92). Nevertheless, patients with post-induction BM infiltration (n=12) showed worse outcomes than those without post-induction BM involvement (n=70) (HR=3.9, 95CI 1.8-8.5) ( Figure 2). Only 3 of 59 treated patients (5%) had positive baseline BMB, CR on imaging, and subsequent positive BMB, and therefore that affected response assessment. All 3 patients were evaluated by CT because they received treatment in 2004-2007. Of subjects with CR on imaging (n = 73), PFS and OS were not significantly different among those with negative BMB to confirm CR (n = 59) versus those without repeat BMB (n = 11); PFS: HR=1.12, 95%CI 0.38-3.31, p = 0.83; OS: HR=1.66 95%CI 0.46-6.07, p = 0.44) Conclusion: In a real-life study of newly diagnosed FL we conclude that BMB adds little value in the basal evaluation; with only 4.% of patients who were thought to have early stage disease before bone marrow evaluation. Besides, despite BM infiltration confers prognostic value, to date there are no differences in the management of these patients based on this finding. In relation to response assessment, BMB adds little value to response assessment. Only 3 patients (1.4%) in our series presented CR on imaging and BM infiltration postinduction. Moreover, none of them was evaluated by PET. With this data, we strongly recommend performing diagnostic BMB in FL in scenarios in which it may change management including confirmation of limited stage and assessment of cytopenias. Prospective studies are necessary to see its value during follow- up. Nevertheless, with new techniques as LiqBio MRD, removing this study from reassessment might be an option that would reduce patient discomfort and resource utilization.

Perks of intraoral scanner to prosthodontist: A review

Intraoral scanners (IOS) have been boon to dentistry since 1980 as it has variety of applications such as impression making, use in prosthodontics and orthodontics appliances, retainers. Digital impressions have many benefits over conventional impressions. The chief advantage is that reduced patient discomfort. Many patient factors such as anxiety and gag reflex are reduced with the help of intra oral scanners. Whereas the drawbacks of optical impressions are inability to detect deep areas of teeth such as in bleeding. High cost and its maintenance.

Label-free rapid detection of urinary tumor cells based on surface-enhanced Raman scattering and deep learning

In clinical practice, the primary objective of tumor detection is to acquire comprehensive diagnostic information while minimizing invasiveness and reducing patient discomfort. Urine cytology represents a non-invasive method frequently employed for urologic tumor detection. However, its sensitivity is limited. Enhancing the accurate identification of various urologic tumor cells and blood cells is crucial to improve the sensitivity of urine cytology. Surface-enhanced Raman spectroscopy (SERS), coupled with suitable machine learning algorithms, holds significant potential for rapid, sensitive, label-free, and non-destructive detection and identification of tumor cells. In this investigation, SERS spectra of urologic tumor cells and blood cells were acquired using an ordered substrate comprising Au-wrapped nanorod arrays. Notably, a remarkably high spectral resemblance was observed among the three distinct types of urologic tumor cells. Five machine learning algorithms were implemented for cell type differentiation and prediction. Among these, the classification network system integrating spatial attention mechanism with DenseNet exhibited the highest classification performance, yielding an accuracy rate of nearly 99%. Additionally, an attention heatmap was generated to highlight the wavenumber range that contributed the most in the SERS spectra, aiding in discriminating various cell species. This study demonstrates that SERS technology based on Au-wrapped nanorod arrays, in conjunction with deep learning algorithms, can promptly and accurately differentiate normal cells from tumor cells, thereby offering an effective approach to enhance the sensitivity of urine cytology tests.

Technical Tips to Reduce Implant Rippling in Staged Pre-pectoral Breast Reconstruction.

Pre-pectoral implant-based breast reconstruction (IBR) is becoming increasingly popular, permitting optimal implant positioning on the chest wall, prevention of animation deformity, and reduced patient discomfort. There are, however, concerns related to increased rates of breast implant rippling in pre-pectoral (versus submuscular) IBR, which can prompt a patient to seek revisionary surgery. The aim of this study is to identify factors that can be implemented to reduce implant rippling in the setting of pre-pectoral IBR. A literature review was conducted using the PubMed database to determine the rate of rippling in pre-pectoral IBR. Clinical studies in English were included. Further review was then performed to explore technical strategies associated with reduced rates of rippling in pre-pectoral two-stage breast reconstruction. Implant rippling has been reported with a rate varying from 0 to 53.8% in 25 studies of pre-pectoral IBR (including both direct-to-implant and two-stage IBR). The majority of studies reviewed did not demonstrate a significant association between BMI and rippling, suggesting that other factors, likely technical and device-related, contribute to the manifestation of implant rippling. Hence, we explored whether specific technical modifications could be implemented that would reduce the risk of rippling in patients undergoing pre-pectoral IBR. Specifically, we highlight the need for close attention to expansion protocol and pocket dimension, expander fill medium and implant characteristics, and the rationale behind adjunctive procedures to reduce implant rippling. Surgical modifications may reduce the incidence of rippling in pre-pectoral breast reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A comparative evaluation of photogrammetry software programs and conventional impression techniques for the fabrication of nasal maxillofacial prostheses

The fabrication of facial prostheses is complicated and time-consuming because of the need for accurate impressions of the facial defects and surrounding tissues. Inaccuracies can arise from soft-tissue compression, involuntary patient movements, and insufficient support for the impression material. Various 3-dimensional (3D) imaging and scanning techniques, including photogrammetry, have been introduced, but their accuracy remains insufficiently evaluated. The purpose of this in vitro study was to evaluate and compare the accuracy of 3D digital casts generated by 4 photogrammetry software programs (Agisoft Metashape, 3DF Zephyr, Meshroom, and Polycam) and casts from 2 conventional impression materials (alginate and polyvinyl siloxane [PVS]) for the fabrication of nasal maxillofacial prostheses. A stone cast of a patient's nose was used as the basis for generating a reference digital 3D cast and another 54 test 3D casts. The reference cast was created by scanning the stone cast using a FARO Optor Lab 3D scanner. The 54 test 3D casts were generated and divided into 6 test groups as follows: Agisoft group: 9 3D casts generated using Agisoft Metashape, a commercial personal computer (PC) software program; 3DF Zephyr group: 9 3D casts generated using 3DF Zephyr, a commercial PC software program; Meshroom group: 9 3D casts generated using Meshroom, a free PC software program; Polycam group: 9 3D casts generated using the Polycam, a commercial Android cloud application; PVS group: 9 3D casts generated indirectly by 3D scanning a gypsum cast made from a polyvinyl siloxane (PVS) impression of the stone nose cast; and Alginate group: 9 3D casts generated indirectly by scanning a master cast made using alginate impressions of the stone nose cast. Deviation measurements of the produced specimens were analyzed using the Geomagic Control X software program, and statistical comparisons were performed employing the Kruskal-Wallis test (α=.05). The results showed that the 3DF Zephyr group had the smallest deviation measurements (median: 0.057mm ±0.012) among the 4 photogrammetry software programs, while the alginate impression group had the largest deviations (median: 0.151mm ±0.094) of the 2 conventional impression materials. Significant differences were observed among the 4 photogrammetry software programs and the 2 conventional impression materials (H=39.41, df=5, P<.001). The casts generated by Agisoft Metashape were significantly more accurate than those produced by Meshroom, Polycam or the conventional impression materials (P=.024, P=.045, P<.001, respectively). The casts produced by 3DF Zephyr were significantly more precise than those created by Meshroom and the conventional impression materials (P=.037, P<.001, respectively). No significant differences were observed between the Agisoft Metashape and 3DF Zephyr groups (P>.05). Photogrammetry software programs, specifically Agisoft Metashape and 3DF Zephyr, demonstrated better accuracy than conventional impression materials in creating nasal digital casts. Photogrammetry has the potential to improve workflow and reduce patient discomfort during the fabrication of maxillofacial prostheses. Further research is needed to validate these findings in clinical settings.

Efficacy of Flap-based Posterior Trunk Reconstruction after Vertebrectomy and Radiation Therapy: A Retrospective Cohort Study.

Adjuvant radiation therapy following vertebrectomy is a major risk factor for local wound complications such as dehiscence, infection, and skin necrosis. In selected cases, well-vascularized coverage and modification of tension forces on the wound might reduce the risk of postoperative complications and reoperations. We aimed to demonstrate a reduction in general and specific complications in patients undergoing vertebral resection and flap coverage compared with vertebral resection alone. We retrospectively analyzed and collected data from patients diagnosed with a tumor involving the spine and requiring a total or partial posterior vertebrectomy between January 2012 and October 2022, referred to a single tertiary-level orthopedic and trauma center. We included only patients in whom primary closure of the wound was possible but judged to be under excessive tension. A total of 145 patients underwent partial or total vertebrectomy for oncological reasons at our tertiary-level trauma hospital. Among these, 73 patients were eventually included according to the inclusion and exclusion criteria: 53 in the orthopedic group and 20 in the orthoplastic group. Considering only patients undergoing radiation therapy, the orthoplastic group showed significantly lower rates of overall complications (33% versus 69%) than the orthopedic group. Primary flap coverage, especially in patients receiving RT, reduces the risk of postoperative complications and avoids a second reconstructive operation, consequently reducing patient discomfort, length of hospital stay, and healthcare costs.

Advantages of Dynamic Navigation in Prosthetic Implant Treatment in Terms of the Clinical Evaluation and Salivary Pro-Inflammatory Biomarkers: A Clinical Study

Successful implantation in augmented areas relies on adequate bone density and quality, along with thorough planning. The minimisation of the risks involved in the surgery and recovery phases is also of tremendous relevance. The aims of the present research were to clinically and biochemically evaluate the healing process after implant surgery (dental implants) using dynamic surgical navigation following prior bone augmentation. Thirty healthy patients who had implant treatment were analysed. The study participants (30 patients) were randomised between two groups. The 15 patients in the study group were treated with Navident dynamic navigation by using a flapless technique. The control group included 15 subjects in whom the implantation procedure was performed classically using the elevation flap full-thickness method. In all cases, the patient’s clinical condition, the patient’s subjective visual assessment of post-operative pain using the Visual Analogue Scale (VAS), and the levels of the salivary biomarkers interleukin 6 (IL 6) and C-reactive protein (CRP) immediately before surgery on the first post-operative day and on the seventh post-operative day were assessed. The healing process was shown to be faster in patients in the study group due to the low invasiveness of the treatment, which was confirmed by lower levels of pro-inflammatory cytokines in the study group versus the control group. The statistical analysis used Student’s t-test and Mann–Whitney test. The implementation of dynamic navigation and the application of the flapless technique reduced post-operative trauma, leading to a reduced risk of infection, reduced patient discomfort, and faster recovery.

Deep learning-based reconstruction for acceleration of lumbar spine MRI: a prospective comparison with standard MRI.

To compare the image quality and diagnostic performance between standard turbo spin-echo MRI and accelerated MRI with deep learning (DL)-based image reconstruction for degenerative lumbar spine diseases. Fifty patients who underwent both the standard and accelerated lumbar MRIs at a 1.5-T scanner for degenerative lumbar spine diseases were prospectively enrolled. DL reconstruction algorithm generated coarse (DL_coarse) and fine (DL_fine) images from the accelerated protocol. Image quality was quantitatively assessed in terms of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) and qualitatively assessed using five-point visual scoring systems. The sensitivity and specificity of four radiologists for the diagnosis of degenerative diseases in both protocols were compared. The accelerated protocol reduced the average MRI acquisition time by 32.3% as compared to the standard protocol. As compared with standard images, DL_coarse and DL_fine showed significantly higher SNRs on T1-weighted images (T1WI; both p < .001) and T2-weighted images (T2WI; p = .002 and p < 0.001), higher CNRs on T1WI (both p < 0.001), and similar CNRs on T2WI (p = .49 and p = .27). The average radiologist assessment of overall image quality for DL_coarse and DL_fine was higher on sagittal T1WI (p = .04 and p < .001) and axial T2WI (p = .006 and p = .01) and similar on sagittal T2WI (p = .90 and p = .91). Both DL_coarse and DL_fine had better image quality of cauda equina and paraspinal muscles on axial T2WI (both p = .04 for cauda equina; p = .008 and p = .002 for paraspinal muscles). Differences in sensitivity and specificity for the detection of central canal stenosis and neural foraminal stenosis between standard and DL-reconstructed images were all statistically nonsignificant (p ≥ 0.05). DL-based protocol reduced MRI acquisition time without degrading image quality and diagnostic performance of readers for degenerative lumbar spine diseases. The deep learning (DL)-based reconstruction algorithm may be used to further accelerate spine MRI imaging to reduce patient discomfort and increase the cost efficiency of spine MRI imaging. • By using deep learning (DL)-based reconstruction algorithm in combination with the accelerated MRI protocol, the average acquisition time was reduced by 32.3% as compared with the standard protocol. • DL-reconstructed images had similar or better quantitative/qualitative overall image quality and similar or better image quality for the delineation of most individual anatomical structures. • The average radiologist's sensitivity and specificity for the detection of major degenerative lumbar spine diseases, including central canal stenosis, neural foraminal stenosis, and disc herniation, on standard and DL-reconstructed images, were similar.

Modified Rectangular Loop Suture for Refractory Pupillary Optic Capture of Scleral Fixated Intraocular Lens

Purpose: To report a modified rectangular loop suture technique for patients with refractory pupillary optic capture after intraocular lens scleral fixation.Methods: A modified rectangular loop suture was performed in four patients with persistent pupillary capture despite medication and laser iridotomy. A loop suture pattern was designed in the two quadrants without the scleral fixation knot. A 2 mm loop suture point was marked 2 mm away from the corneal limbus. The suture point was similarly marked in the opposite quadrants. Small conjunctival incisions were made at a marked point and a non-absorbable 10-0 prolene long needle was passed. The needle was inserted at the 1 o’clock position through the conjunctival incision and passed between the intraocular lens and the iris plane. Then it was withdrawn using a 26-gauge (G) syringe from the 8 o’clock position in the opposite quadrant. Similarly, the needle was passed from the 7 o’clock position under the conjunctiva, and pulled out of the sclera at the 2 o’clock position. It was then passed to the 1 o’clock position under the conjunctiva and a knot was made and buried. The operation was completed without closure of the conjunctival incision.Results: In all four eyes, pupillary optic capture was corrected and remained stable without recurrence for an average of 7.25 months.Conclusions: The modified rectangular loop suture may be useful for refractory pupillary capture cases. The procedure is relatively simple and minimizes scleral exposure to the conjunctival suture. It is expected that this may reduce patient discomfort.

Effect of post-surgical flap position on soft tissue regrowth and keratinized tissue increase following fibre retention osseous resective surgery: a 6-month randomized study with multilevel analysis

BackgroundThe aim of this randomized split-mouth study was to assess the influence of primary flap position on the amount of coronal soft tissue regrowth and keratinized tissue (KT) 6 months after osseous resective surgery with fiber retention technique (FibReORS).Materials and methodsTwo contralateral posterior sextants in 16 patients were treated with FibReORS and randomly assigned to flap positioning either 2 mm below the bone crest (apical group) or at the level of bone crest (crestal group). Clinical parameters were recorded at 1, 3 and 6 months and patient-related outcomes during the first two post-operative weeks.ResultsHealing period was uneventful. Patient’s discomfort was similar in both groups. The overall soft tissue rebound was higher in the apical than in the crestal group (2.0 ± 1.3 mm versus 1.3 ± 0.7 mm), but the difference was statistically significant only interproximally (2.2 ± 1.3 mm versus 1.6 ± 0.8 mm). Multilevel analyses showed higher soft tissue rebound in sites with normal compared to thin phenotype (1.5 mm, p < 0.0001) and treated with flap positioned 2 mm apically to the bone crest (0.7 mm, p < 0.001). An additional 0.5 mm KT increase was observed at interdental sites in the apical group.ConclusionsApical flap positioning increases soft tissue rebound and KT width, mainly at the interdental sites, with reduced patient discomfort.Trial registrationThe trial was registered at ClinicalTrials.gov (ID: NCT05140681, Registration date: 1/12/2021, retrospectively registered).

Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysis.

The frameless linear accelerator (LINAC) based stereotactic radiosurgery (SRS) has been evolving with a reduction in patient discomfort. However, there was limited evidence comparing frame-based and frameless SRS for intracranial arteriovenous malformations (AVM). We aimed to compare the treatment outcomes between frame-based and frameless LINAC SRS. This retrospective cohort compared the outcomes of frame-based LINAC SRS (1998-2009) with frameless LINAC SRS (2010-2020). The primary outcome was the obliteration rate. The other outcomes included the neurological, radiological, and functional outcomes after SRS. A matched cohort was identified by propensity scores for further comparisons. A total of 65 patients were included with a mean follow-up time of 13.2years (158.5months). There were 40 patients in the frame-based group and 25 patients in the frameless group. The overall obliteration rate was comparable (Frame-based 82.5% vs Frameless 80.0%, p=0.310) and not significantly different over time (log-rank p=0.536). The crude post-SRS hemorrhage rate was 1.5% and the incidence was 0.3 per 100 person-years. There were 67.7% of patients with AVM obliteration without new persistent neurological deficits at the last visit and 56.9% of patients with AVM obliteration without any deficits (transient or persistent) during the entire follow-up period. Four patients (8.0%) developed late onset persistent adverse radiation effects (more than 96months after SRS) among 50 patients with more than 8-year surveillance. In the propensity-matched cohort of 42 patients, there was no significant difference in AVM obliteration (Frame-based vs Frameless, log-rank p=0.984). Frameless and frame-based LINAC SRS have comparable efficacy in intracranial AVM obliteration. A longer follow-up duration may further characterize the rate of late adverse radiation effects in frameless SRS.

Smart Smile: Revolutionizing Dentistry With Artificial Intelligence.

Artificial intelligence (AI) has emerged as a transformative technology in various industries, and its potential in dentistry is gaining significant attention. This abstract explores the future prospects of AI in dentistry, highlighting its potential to revolutionize clinical practice, improve patient outcomes, and enhance the overall efficiency of dental care. The application of AI in dentistry encompasses several key areas, including diagnosis, treatment planning, image analysis, patient management, and personalized care. AI algorithms have shown promising results in the automated detection and diagnosis of dental conditions, such as caries, periodontal diseases, and oral cancers, aiding clinicians in early intervention and improving treatment outcomes. Furthermore, AI-powered treatment planning systems leverage machine learning techniques to analyze vast amounts of patient data, considering factors like medical history, anatomical variations, and treatment success rates. These systems provide dentists with valuable insights and support in making evidence-based treatment decisions, ultimately leading to more predictable and tailored treatment approaches. While the potential of AI in dentistry is immense, it is essential to address certain challenges, including data privacy, algorithm bias, and regulatory considerations. Collaborative efforts between dental professionals, AI experts, and policymakers are crucial to developing robust frameworks that ensure the responsible and ethical implementation of AI in dentistry. Moreover, AI-driven robotics has introduced innovative approaches to dental surgery, enabling precise and minimally invasive procedures, and ultimately reducing patient discomfort and recovery time. Virtual reality (VR) and augmented reality (AR) applications further enhance dental education and training, allowing dental professionals to refine their skills in a realistic and immersive environment. AI holds tremendous promise in shaping the future of dentistry. Through its ability to analyze vast amounts of data, provide accurate diagnoses, facilitate treatment planning, improve image analysis, streamline patient management, and enable personalized care, AI has the potential to enhance dental practice and significantly improve patient outcomes. Embracing this technology and its future development will undoubtedly revolutionize the field of dentistry, fostering a more efficient, precise, and patient-centric approach to oral healthcare. Overall, AI represents a powerful tool that has the potential to revolutionize various aspects of society, from improving healthcare outcomes to optimizing business operations. Continued research, development, and responsible implementation of AI technologies will shape our future, unlocking new possibilities and transforming the way we live and work.

Planning Target Volume Margin Determination for Volumetric Modulated Arc Therapy Planning in Cervix Cancers Using an Empty Bladder Protocol

OBJECTIVE To evaluate the planning target volume (PTV) margin and bladder volume variation of volumetric modulated arc therapy (VMAT) in cervical cancer using an empty bladder protocol. METHODS Ten patients with cervical cancer who had indications to receive whole pelvic radiotherapy and who had been identified to receive whole pelvic irradiation with a dose of 46-55.2 Gy in 23 fractions planned by VMAT were included. International Commission on Radiation Units and Measurements (ICRU) Report 83 was used to report plan parameters. The empty bladder protocol is designed for use with all patients before simulation and irradiation. From June 2020 to February 2021, 215 fractions from the 10 patients were evaluated. The ‘all fraction’ set-up errors were recorded using cone-beam computed tomography (CBCT) and were interpreted as error margins using the Van Herk Formula. RESULTS The calculated PTV margins were 0.75, 0.84, and 0.98 cm on the X, Y, and Z-axes, respectively. The median volume of the bladder before irradiation was 40.6 cc, with an interquartile range of 31.9 to 59.2 cc. The average change in bladder volume from the planning volume was 23.56%. CONCLUSIONS Using the empty bladder protocol, the clinical target volume (CTV) to PTV margin was 1 cm following the Van Herk formula. No patients experienced side effects of grade 3 or greater. The empty bladder protocol is a method which can reduce target placement error and reduce patient discomfort without causing serious side effects. KEYWORDS PTV margin, VMAT, IGRT, Cervix cancer, Empty bladder

PD14 Audit of urgent phototherapy referrals

Abstract The British Association of Dermatologists’ (BAD) phototherapy guidelines state that patients referred urgently for phototherapy should start treatment within 3 weeks of referral and that if the patient is considered to require treatment urgently, then it should be started as soon as possible, to reduce patient discomfort and avoid the need for hospital admission. The prepandemic waiting time for urgent referrals, according to an audit in March 2021, was 6 weeks, but this time was even longer postpandemic. During the COVID-19 pandemic lockdown, the phototherapy service was suspended and then resumed in reduced capacity in our unit. The pandemic is also likely to have affected disease severity and patient’s concerns about treatment with systemic options. Our audit objective was to identify the time taken between referral to treatment start time for urgent referrals. Secondary objectives were to identify whether there was any prevalence of certain disease categories in deciding upon urgent referrals, and to identify if severity assessment scores were checked prior to urgent referrals by referring clinicians as per local guidelines. The audit was conducted retrospectively by including all urgent phototherapy referrals for 6 months between January and June 2022. Sixty-four urgent referral forms were analysed. The time taken between referral to treatment start time was 12 months. The majority of the urgent referrals (73%) were for eczema, 16% for psoriasis and 5% for mycosis fungoides. Other conditions such as polymorphic light eruptions, lichen planus and macular amyloidosis totalled 6% of referrals. Only 26% of referrals had documented disease severity scores. Thirty per cent of the referrals were &amp;lt; 18 years of age; young adults (19–25 years) accounted for 19% of referrals. Time taken between referral to treatment start time was 12 months, which significantly exceeded BAD standards. A number of factors affected this, including the impact of the COVID-19 lockdown on services and treatment capacity, patient choices and escalation of disease severity in lockdown, increased referrals with severe skin disease, preference in certain age groups such as children, and psychosocial factors. Patients with severe skin disease needing urgent treatment should be carefully triaged to receive treatment urgently, to avoid admission. Clinicians should assess this appropriately on a case-by-case basis and document disease severity scores and impact of skin disease in all urgent referrals.

Impact of Initial Filling Medium on Outcomes of Subpectoral, Two-Stage, Implant-Based Breast Reconstruction: Air versus Saline.

In two-stage expander-based breast reconstruction, the use of air as the initial filling medium has been suggested to confer clinical advantages over conventional saline, but this has not been demonstrated in a large series. This study aimed to evaluate the association between material type (air versus saline) for initial expander filling and postoperative outcomes. This retrospective study included patients who underwent immediate, subpectoral, tissue expander-based breast reconstruction between January of 2018 and March of 2021. The participants were categorized into two groups according to the material used for initial filling: saline-inflated expanders, which were used during the first 22 months consecutively, and air-inflated expanders, which were used during the latter 17 months consecutively. Complications including mastectomy flap necrosis and postoperative expansion profiles were compared. Multivariable analyses were performed to identify independent predictors of postoperative complications. A total of 443 breasts (400 patients), including 161 air-filled and 282 saline-filled breasts, were analyzed. The two groups had similar baseline characteristics. The air-filled group showed a significantly lower rate of mastectomy flap necrosis; this difference remained significant after adjustment for other variables in the multivariable analysis. The rates of other complications did not differ between the two groups. The air-filled group had fewer office visits and a shorter period to complete expansion. The use of air for initial expander filling could provide safe and reliable outcomes with reduced patient discomfort during postoperative expansion; thus, air-filled expanders might be an effective alternative to saline-filled expanders. Therapeutic, III.

Ventriculoperitoneal shunt survey in pediatric patients in an emergency setting: a comparison between ultra-low-dose CT using a tin filter and plain radiography.

The aim of this study was to investigate the diagnostic performance, effective radiation dose, and examination time of ventriculoperitoneal shunt evaluation using full-body ultra-low-dose CT (ULD CT) with a tin filter compared with digital plain radiography in a pediatric population. A retrospective cross-sectional study was conducted in an emergency setting. Data from 143 children were collected. Sixty were examined with ULD CT with a tin filter and 83 with digital plain radiography methods. Effective doses and times were compared between the two methods. Two observers in pediatric radiology evaluated the patient images. Clinical findings and results from shunt revision, if it was performed, were used to evaluate the diagnostic performance between modalities. An examination-room simulation was performed of the two methods to estimate representative examination times. The mean effective radiation dose for ULD CT with the tin filter was estimated to be 0.29 ± 0.16 mSv compared with 0.16 ± 0.19 mSv for digital plain radiography, with both examinations associated with a very low lifetime attributable risk (< 0.01%). The shunt tip could be more reliably located with ULD CT. ULD CT also allowed assessment of additional findings to explain patient symptoms, such as a cyst at the tip of the shunt catheter and the presence of an obstructing rubber nipple in the duodenum that could not have been observed on a plain radiograph. The examination time with ULD CT of the shunt was estimated to be 20 minutes. The examination time of the shunt with digital plain radiography, including the examination itself time and transfer of the patient between rooms, was estimated to be 60 minutes. ULD CT using a tin filter allows good visualization of the position or disruption of the shunt catheter that is comparable or superior to plain radiography, at a higher dose, while providing additional findings and reduced patient discomfort.

Ciprofol versus propofol for sedation in gastrointestinal endoscopy: protocol for a systematic review and meta-analysis

IntroductionPainless gastrointestinal endoscopy is being increasingly practised in the clinical field. The management and choice of sedation are important during the endoscopy procedure to reduce patient discomfort and facilitate high...

Study on quantitative analysis of bracket-induced nonlinear response of labio-cheek soft tissue during the orthodontic process

In the orthodontics process, intervention and sliding of an orthodontic bracket during the orthodontic process can arise large response of the labio-cheek soft tissue. Soft tissue damage and ulcers frequently happen at the early stage of orthodontic treatment. In the field of orthodontic medicine, qualitative analysis is always carried out through statistics of clinical cases, while quantitative explanation of bio-mechanical mechanism is lacking. For this purpose, finite element analysis of a three-dimensional labio-cheek-bracket-tooth model is conducted to quantify the bracket-induced mechanical response of the labio-cheek soft tissue, which involves complex coupling of contact nonlinearity, material nonlinearity and geometric nonlinearity. Firstly, based on the biological composition characteristics of labio-cheek, a second-order Ogden model is optimally selected to describe the adipose-like material of the labio-cheek soft tissue. Secondly, according to the characteristics of oral activity, a two-stage simulation model of bracket intervention and orthogonal sliding is established, and the key contact parameters are optimally set. Finally, the two-level analysis method of overall model and submodel is used to achieve efficient solution of high-precision strains in submodels based on the displacement boundary obtained from the overall model calculation. Calculation results with four typical tooth morphologies during orthodontic treatment show that: ① the maximum strain of soft tissue is distributed along the sharp edges of the bracket, consistent with the clinically observed profile of soft tissue deformation; ② the maximum strain of soft tissue is reduced as the teeth align, consistent with the clinical manifestation of common damage and ulcers at the beginning of orthodontic treatment and reduced patient discomfort at the end of treatment. The method in this paper can provide reference for relevant quantitative analysis studies in the field of orthodontic medical treatment at home and abroad, and further benefit to the product development analysis of new orthodontic devices.

A Case of Re-implantation at a Failed Site Using Alveolar Ridge Preservation with Open-healing Approach: A 5-year Follow-up

Immediate re-implantation after implant removal is ideal in terms of reduced treatment duration. However, in a case of severe peri-implantitis, it is difficult to predict three-dimensional changes after explantation. Alveolar ridge preservation (ARP) is an effective approach to avoid enormous soft and hard tissue augmentation. It can also reduce patient discomfort. A 55 year old patient had an implant with severe bone loss in the mandibular right first molar area. Implant removal and ARP with an open-healing approach were performed using xenogeneic bone graft and collagen membrane. The implant was placed four months after ARP. The 5-year follow-up revealed that the bone and implant conditions were maintained without any complications.