Role In Medical Practice Research Articles

Formulation Development of Mucoadhesive Vaginal Gel of Secnidazole and Voriconazole.

Purpose: Over the preceding decades, developing conventional drug delivery in to modified form has acquired importance in the pharmaceutical industry. Vaginal drug delivery system offers localized drug administration of drug and also avoids unwanted side effects of oral drug delivery. Vaginal drug delivery system has significant role in medical practice. Even though VDDS has a lot of advantages over the other routes of administration. The goal of developing the Mucoadhesive Vaginal Gel was to achieve the synergistic effect of voriconazole and secnidazole in the treatment of bacterial and fungal vaginal infections. Method: Mucoadhesive antimicrobial vaginal gel was optimised using Design expert software using Carbopol 934, HPMC K4M polymers. Result: Formulation was evaluated for various rheological parameters ,antimicrobial activity, invitro drug release and stability study. The spreadability and pH was found to be 5.5 to 7.4 cm and 4.12. Its compatible with vaginal pH. The selected optimized F8 formulation is the best formulation and the drug ratio is 2:1. and optimum gel viscosity is 1874 cps. antimicrobial study revealed that faster drug release of test formulation was compared to marketed product. It indicates as inhibition zone. Conclusion: The combination of drugs can serves as better option for treating vaginitis, compared to single drug formulation. Mucoadesion increases contact time of drug with affected area which rendered formulation more effective.

Unlocking the Intrathecal Route: A Comprehensive Review

The intrathecal route of administration, which involves the direct delivery of therapeutic agents into the cerebrospinal fluid (CSF) via lumbar or cervical puncture, has gained increasing prominence in the field of healthcare and neurology. This review provides a comprehensive overview of the intrathecal route as a mode of drug delivery, focusing on its applications, advantages, challenges, and safety considerations. Intrathecal administration offers a unique advantage by bypassing the blood-brain barrier, allowing for precise and targeted drug delivery to the central nervous system. This approach has proven effective in managing a variety of conditions, including chronic pain, spasticity, infections, and neoplastic diseases. Furthermore, it has shown promise in the treatment of neurodegenerative disorders, such as amyotrophic lateral sclerosis (ALS) and multiple sclerosis. Despite its potential benefits, intrathecal therapy presents challenges related to its invasive nature, the risk of infection, and the need for specialized equipment and personnel. Careful patient selection and ongoing monitoring are essential to mitigate these risks. In addition, ongoing research is focused on improving drug formulations and delivery techniques to enhance the safety and efficacy of intrathecal therapy1 . This review consolidates key findings from recent studies, clinical trials, and expert opinions, shedding light on the current state of intrathecal administration and its evolving role in medical practice. By exploring the latest advancements and addressing critical considerations, this review aims to provide valuable insights to healthcare professionals, researchers, and clinicians working with intrathecal drug delivery. Key words: Intrathecal therapy, Cerebrospinal fluid (CSF), Drug delivery, Neurological disorders, Central nervous system, Blood-brain barrier.

Student and Educator Experiences of an Integrated Medical Imaging Curriculum.

Medical imaging is integrated across all years in the medical programs at the Medical School, in our country. Little is known about this pedagogical approach from the perspective of those who participate in it. This study investigated how students and educators experience an integrated medical imaging curriculum. One-on-one interviews were conducted with nine educators and three undergraduate medical students and analyzed using a reflexive thematic approach. Educators included radiologists, non-radiologists clinicians, and scientists and health professionals from the medical program. The integrated medical imaging curriculum appears to be incoherently experienced by educators and students as learning opportunities that were 'everywhere and nowhere'. Teaching events were 'repetitive and patchy' and featured a transmission-oriented pedagogy emphasizing 'exposure and absorption'. Educators expressed paradoxical views of their responsibility for teaching medical imaging reflected in this sentiment: 'I don't teach medical imaging… (but I do)'. When medical imaging is integrated into learning resources and course work across the undergraduate program, it may lose its visibility and importance as a distinct learning area despite its crucial role in medical practice. An integrated curriculum may inadvertently separate knowing about medical imaging from learning to apply medical imaging knowledge in clinical practice. Further work is required to construct an integrated medical imaging curriculum that explicitly emphasizes medical imaging learning outcomes, so they are experienced coherently and consistently by medical students and those who prepare them for practice as doctors.

Clinical Chemistry Education for Medical Students

Clinical chemistry plays an important role in medical practice. Approximately 60% to 70% of medical decisions rely on laboratory test results, justifying the need for physicians to have sufficient knowledge of clinical chemistry. However, recent studies have shown that medical students’ knowledge of clinical chemistry is inadequate, and many are unable to interpret the meaning of laboratory parameter results. This implies that the study of clinical chemistry in the curriculum is currently insufficient. There are several related problems, namely a lack of a formal or structured clinical chemistry curriculum, limited time allocated for these studies, a lack of teaching experts and the failure of stakeholders to acknowledge the importance of clinical chemistry. This review discusses problems in the current clinical chemistry education of medical students and provides solutions. A structured search strategy in PubMed and Google Scholar for publications in English was applied using the search terms “clinical chemistry”, “clinical pathology”, “laboratory” and “laboratory medicine” in combination with one of the following keywords: “education”, “medical student”, “curriculum”, “guideline”, “undergraduate”, “medical school” and “training”. The extracted literature focused on research studies, review articles and meta-analyses. Background information and details about the current status of clinical chemistry/ laboratory medicine education were extracted from review articles, while research articles were used to analyse and evaluate the current conditions in the medical schools regarding clinical chemistry/ laboratory medicine education.

Machine learning reveals sex differences in clinical features of acute exacerbation of chronic obstructive pulmonary disease: A multicenter cross-sectional study.

Intrinsically, chronic obstructive pulmonary disease (COPD) is a highly heterogonous disease. Several sex differences in COPD, such as risk factors and prevalence, were identified. However, sex differences in clinical features of acute exacerbation chronic obstructive pulmonary disease (AECOPD) were not well explored. Machine learning showed a promising role in medical practice, including diagnosis prediction and classification. Then, sex differences in clinical manifestations of AECOPD were explored by machine learning approaches in this study. In this cross-sectional study, 278 male patients and 81 female patients hospitalized with AECOPD were included. Baseline characteristics, clinical symptoms, and laboratory parameters were analyzed. The K-prototype algorithm was used to explore the degree of sex differences. Binary logistic regression, random forest, and XGBoost models were performed to identify sex-associated clinical manifestations in AECOPD. Nomogram and its associated curves were established to visualize and validate binary logistic regression. The predictive accuracy of sex was 83.930% using the k-prototype algorithm. Binary logistic regression revealed that eight variables were independently associated with sex in AECOPD, which was visualized by using a nomogram. The AUC of the ROC curve was 0.945. The DCA curve showed that the nomogram had more clinical benefits, with thresholds from 0.02 to 0.99. The top 15 sex-associated important variables were identified by random forest and XGBoost, respectively. Subsequently, seven clinical features, including smoking, biomass fuel exposure, GOLD stages, PaO2, serum potassium, serum calcium, and blood urea nitrogen (BUN), were concurrently identified by three models. However, CAD was not identified by machine learning models. Overall, our results support that the clinical features differ markedly by sex in AECOPD. Male patients presented worse lung function and oxygenation, less biomass fuel exposure, more smoking, renal dysfunction, and hyperkalemia than female patients with AECOPD. Furthermore, our results also suggest that machine learning is a promising and powerful tool in clinical decision-making.

Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice.

Stem cells are types of cells that have unique ability to self-renew and to differentiate into more than one cell lineage. They are considered building blocks of tissues and organs. Over recent decades, they have been studied and utilized for repair and regenerative medicine. One way to classify these cells is based on their differentiation capacity. Totipotent stem cells can give rise to any cell of an embryo but also to extra-embryonic tissue as well. Pluripotent stem cells are limited to any of the three embryonic germ layers; however, they cannot differentiate into extra-embryonic tissue. Multipotent stem cells can only differentiate into one germ line tissue. Oligopotent and unipotent stem cells are seen in adult organ tissues that have committed to a cell lineage. Another way to differentiate these cells is based on their origins. Stem cells can be extracted from different sources, including bone marrow, amniotic cells, adipose tissue, umbilical cord, and placental tissue. Stem cells began their role in modern regenerative medicine in the 1950's with the first bone marrow transplantation occurring in 1956. Stem cell therapies are at present indicated for a range of clinical conditions beyond traditional origins to treat genetic blood diseases and have seen substantial success. In this regard, emerging use for stem cells is their potential to treat pain states and neurodegenerative diseases such as Parkinson's and Alzheimer's disease. Stem cells offer hope in neurodegeneration to replace neurons damaged during certain disease states. This review compares stem cells arising from these different sources of origin and include clinical roles for stem cells in modern medical practice.

Recent medical graduates’ attitudes towards nutrition education and its role in medical practice

The objective of this study was to investigate recent Dalhousie Medical School graduates’ perceptions of nutrition in three domains: attitudes towards its use in medical practice generally, learned body of knowledge in medical school and residency, and satisfaction with how undergraduate and postgraduate medical education aligned their attitudes and knowledge of nutrition in medicine. Graduates of Dalhousie University’s undergraduate medical program from 2013 to 2018 were contacted to complete an internet-based questionnaire of 13 five-point Likert scale questions about attitudes, knowledge, and satisfaction with nutrition education in their undergraduate medical studies and medical practice. Responses ranged from one, “strongly disagree” to five, “strongly agree”. Most respondents (90.2%) agreed that ‘nutrition counseling can make a positive difference to patient outcomes’ and 80.5% agreed that ‘physicians can influence patient behavior related to nutrition’. However, fewer (61.0%) agreed that ‘physicians play a key role in improving patients’ nutritional habits.’ Even fewer participants agreed that nutritional assessment (34.1%) and nutritional counselling (41.5%) should be a routine part of care, regardless of specialty. The mean (standard deviation) overall score of participants with regards to their attitudes about nutrition assessment, counselling, and role in patient health, was 3.60 (0.633). Scores ranged from 1 to 5 with higher score indicating morepositive attitude. Mean overall knowledge and satisfaction scores were 3.76 (0.702) and 2.70 (0.898), respectively. There is a lack of consensus regarding the role of physicians in delivering nutrition care to patients, despite its perceived importance to patient health, requiring further exploration.

Amalgamation of comparative protein modeling with quantitative structure-retention relationship for prediction of the chromatographic behavior of peptides

Peptide therapeutics plays a prominent role in medical practice. Both peptides and proteins have been used in several disease conditions like diabetes, cancer, bacterial infections etc. The optimization of a peptide library is a time consuming and expensive chore. The tools of computational chemistry offer a way to optimize the properties of peptides. Quantitative Structure Retention (Chromatographic) Relationships (QSRR) is a powerful tool which statistically derives relationships between chromatographic parameters and descriptors that characterize the molecular structure of analytes. In this paper, we show how Comparative Protein ModelingQuantitative Structure Retention Relationship (acronym ComProM-QSRR) can be used to predict the retention time of peptide sequences. This formalism is founded on our earlier published QSAR methodology HomoSAR. ComProM-QSRR can recognize and distinguish the contribution of amino acids at specific positions in the peptide sequences to the retention phenomena through their related physicochemical properties. This study firmly establishes the fact that this approach can be pragmatically used to predict the retention time to all classes of peptides regardless of size or sequence.

Profiles of Whole Blood Transfusion Recipients at a Teaching Hospital in Lahore, Pakistan.

BackgroundBlood transfusion plays a vital role in medical practice. Evaluation of blood utilization in a blood bank is a crucial step in good transfusion practice. It is the inception towards assessing the present and future demands for blood and also avoiding unnecessary transfusions.MethodsRetrospective analysis of one-year data, available in the blood bank of Gulab Devi Hospital Lahore, was done to study blood transfusion practice. Issue registers were accessed to retrieve the required information such as gender, age, blood group, pre-transfusion Hemoglobin level, ward, clinical diagnosis, and indication for the transfusion. The data was analyzed using SPSS version 20 software. Frequency and percentages were used to summarize categorical demographics and clinical variables.ResultsA total of 1181 units were requested from the hospital during our study period. Majority of the requests were for the female patients (69%) of the reproductive age group (21 to 30 years). Blood group B positive was most frequent in our study population. Maximum requests were from reproductive health departments (39.9%). Surgery was the major diagnostic category to require blood transfusions (31.8%). Elective surgery constituted the major indication requiring blood transfusion at our hospital (41.3%).ConclusionBlood utilization patterns vary significantly within geographical regions, hospital to hospital, and according to clinical practices as well as patients’ clinical findings. Moreover, diseases burden, level of organization, and advancement of healthcare facilities in various settings contribute to the significant contrast in blood utilization trends.

Concepts of Experience in Royalist Recipe Collections

This essay explores the idea of experience and its epistemological and practical role in maintaining the health of a household among early modern English Royalists. A number of prominent royalists during the mid-seventeenth century British Civil Wars expended quite some effort in the collection of medical recipes, including Queen Henrietta Maria herself, as well as William and Margaret Cavendish, and the Talbot sisters—Elizabeth Grey and Alethea Howard. This essay looks at these Royalists and four of their collections: three published (Henrietta Maria, Grey, Howard), and one manuscript (the Caven­dishes), in order to determine how they conceptualized experience and its role in medical practice. The claim that such recipe collections represent a new, anti-Aristotelian idea of experience as a specific, particular event is disputed through a quantitative and qualitative analysis of these collections. Instead, it is argued that there a number of related conceptions of experience found in these Royalist recipe collections, but the basic idea is one where experience indicates long experience or expertise, an idea that can traced back at least to humanist medicine of the Renaissance, and likely back to Galen.

551 Patient Satisfaction with Telephone Consultations in A One-Stop Breast Clinic During COVID-19 Pandemic

Abstract Aim Telemedicine has gained an important role in medical practice lately, particularly in the outpatient setting. In our unit, virtual consultations were previously used for results clinics only. However, the first wave of COVID-19 pandemic necessitated change of practice to address issues of triage, infection control, cancer target times, and decreased capacity in the face of maintained demand. New patients underwent a telephone consultation followed by a clinic visit one week afterwards to complete triple assessment. We aimed to assess patient satisfaction with the phone consultation and subsequent care. Method Patients referred from general practice to the Breast Unit at West Middlesex University Hospital, who had a telephone appointment in the period 15/04/2020 to 15/07/2020, were included. The study was registered with the Clinical governance department. Patients received text messages with anonymised links to an online survey and were contacted over the telephone to explain the survey. Results 219 successful phone calls were made to eligible patients, and 126 patients responded to the survey (57.5%). 78% felt that they were able to express all or most of their concerns over the phone. 86% spent less than 2 hours in clinic. 87% felt social distancing and safety measures were adequate. More than 75% were overall satisfied with their care. Conclusions We further discuss responses to this survey. Patients were largely satisfied; however, areas of improvement were identified, and changes need to be made to ensure telemedicine is used to its full potential and is appropriately incorporated in the post COVID-19 practice.

P–722 Role of medical practices in early drop-out in infertility care

Abstract Study question What is the burden of early infertility care drop-out in the context of full reimbursement of infertility care and are medical practices associated with drop-out? Summary answer Medical practices seem associated with early infertility care drop-out whose burden remains high despite the equality of care policy in France What is known already More than half of couples drop out of their infertility treatment before pregnancy. Direct costs of infertility care are widely cited as the major barrier to continuation of care. In France, infertility treatments are fully reimbursed. Data from US IVF centres have shown a high estimated drop-out from the beginning and at each step of infertility treatment. Some studies have suggested a difference in medical practices during infertility care between couples who have dropped out and couples who have continued care Study design, size, duration Cohort study of all women aged 18–49 years who started infertility treatment between January–August 2016 in mainland France with a private practitioner and who had not been successfully treated at a 24-month follow-up. Participants/materials, setting, methods The cohort was based on the French national health insurance and hospital databases that exhaustively record reimbursed healthcare. Infertility treatment included ovarian induction by gonadotropin and clomifene. Outcome was infertility care drop-out within 3 months after starting treatment. Stratified analyses were performed based on the first treatment prescribed, with three categories: clomifene prescribed by a general practitioner, clomifene by a gynaecologist or gonadotropin by a gynaecologist Main results and the role of chance Among women unsuccessfully treated by ovarian induction, 31.1% dropped out of infertility care within 3 months. Women who started treatment with a general practitioner were more frequently socially disadvantaged (40.6%), less closely monitored (ultrasound and hormonal tests had not been done in 53.6% and 64.8%, respectively) and dropped out more frequently (46.8%). Where the prescriber of treatment was a gynaecologist, older age (35–39 and 40–43 years) was associated with higher probability of early drop-out with OR 1.5 (95% CI 1.3–1.7) and 2.2 (95% CI 1.9–2.5) for gonadotropins and 1.2 (95% CI 1.1–1.3) and 1.9 (95% CI 1.7–2.2) for clomifene. Disadvantaged social status was associated with higher early infertility care drop-out, whereas good monitoring was associated with a lower probability of early drop-out in all three categories of treatments and prescribers Limitations, reasons for caution These medical and administrative data did not allow us to explore medical practices in greater depth, notably the doctor-patient relationship Wider implications of the findings: This is the first estimation of early infertility care drop-out in a general population where treatment is fully reimbursed, exploring the implication of medical practices in early drop-out. Better access to good medical practices is needed for less socially advantaged people, beyond the current equality of care policy in France. Trial registration number N/A

Survey on Heart Disease Anticipation Through Genetic Algorithm and BP-Neural Network

Medical Diagnosis Systems play a vital role in medical practice and are used by medical practitioners for diagnosis and treatment. In this paper, a medical diagnosis system is presented for predicting the risk of cardiovascular disease. This system is built by combining the relative advantages of genetic algorithm and neural network. Multilayered feed forward neural networks are particularly suited to complex classification problems. The weights of the neural network are determined using genetic algorithm because it finds acceptably good set of weights in less number of iterations. The dataset provided by University of California, Irvine (UCI) machine learning repository is used for training and testing. It consists of 303 instances of heart disease data each having 14 attributes including the class label. First, the dataset is preprocessed in order to make them suitable for training. Genetic based neural network is used for training the system. The final weights of the neural network are stored in the weight base and are used for predicting the risk of cardiovascular disease. The classification accuracy obtained using this approach is 94.17%.

The Use of Virtual Reality in Pharmacy Education in Hong Kong: Lessons Learnt

Virtual reality (VR) refers to an artificial environment which is experienced through sensory stimuli (such as sights and sounds) provided by a computer and in which one's actions partially determine what happens in the environment (Merriam-Webster.com Dictionary, Merriam-Webster, 2020). In recent years, VR is increasingly used in different fields, and its role in medical practice is expanding quickly (Darekar et al., 2015; Chirico et al., 2016). One important feature of VR technology is its reproducibility (Ramnanan and Pound, 2017; Cao and Cerfolio, 2019). Practitioners can rehearse a procedure on a virtual patient or simulated tissue as many times as they wish before performing it on real patients. In medical education, VR allows students to see through body tissues and visualize the underneath areas (Cao and Cerfolio, 2019; Yu et al., 2019; Siyar et al., 2020). Practice experience is an essential element in pharmacy education (Teramachi et al., 2018). It is effective in boosting students' communication skills and problem-solving skills, which are both crucial for the provision of patient-centered care in a team-based approach (Lang et al., 2019). Unfortunately, actual practice experience can be limited by various factors, such as the policies at attachment sites, patients' preference, and availability of teaching staff (Wartman, 2019; Shrestha et al., 2020). Therefore, institutions are looking for alternative channels for students to practice their skills. One strategy is to adopt simulated patient cases (Kurup et al., 2017; Willemsen-Dunlap et al., 2018; Silva et al., 2019). In this paper, we share our experience of using VR learning tools in pharmacy education in a Hong Kong university. We will discuss the opportunities, challenges, and suggestions for future development of VR in pharmacy education.

A Clinical Decision Support System for Predicting Invasive Breast Cancer Recurrence: Preliminary Results

The mortality associated to breast cancer is in many cases related to metastasization and recurrence. Personalized treatment strategies are critical for the outcomes improvement of BC patients and the Clinical Decision Support Systems can have an important role in medical practice. In this paper, we present the preliminary results of a prediction model of the Breast Cancer Recurrence (BCR) within five and ten years after diagnosis. The main breast cancer-related and treatment-related features of 256 patients referred to Istituto Tumori “Giovanni Paolo II” of Bari (Italy) were used to train machine learning algorithms at the-state-of-the-art. Firstly, we implemented several feature importance techniques and then we evaluated the prediction performances of BCR within 5 and 10 years after the first diagnosis by means different classifiers. By using a small number of features, the models reached highly performing results both with reference to the BCR within 5 years and within 10 years with an accuracy of 77.50% and 80.39% and a sensitivity of 92.31% and 95.83% respectively, in the hold-out sample test. Despite validation studies are needed on larger samples, our results are promising for the development of a reliable prognostic supporting tool for clinicians in the definition of personalized treatment plans.

PharmKG: a dedicated knowledge graph benchmark for bomedical data mining.

Biomedical knowledge graphs (KGs), which can help with the understanding of complex biological systems and pathologies, have begun to play a critical role in medical practice and research. However, challenges remain in their embedding and use due to their complex nature and the specific demands of their construction. Existing studies often suffer from problems such as sparse and noisy datasets, insufficient modeling methods and non-uniform evaluation metrics. In this work, we established a comprehensive KG system for the biomedical field in an attempt to bridge the gap. Here, we introduced PharmKG, a multi-relational, attributed biomedical KG, composed of more than 500000 individual interconnections between genes, drugs and diseases, with 29 relation types over a vocabulary of ~8000 disambiguated entities. Each entity in PharmKG is attached with heterogeneous, domain-specific information obtained from multi-omics data, i.e. gene expression, chemical structure and disease word embedding, while preserving the semantic and biomedical features. For baselines, we offered nine state-of-the-art KG embedding (KGE) approaches and a new biological, intuitive, graph neural network-based KGE method that uses a combination of both global network structure and heterogeneous domain features. Based on the proposed benchmark, we conducted extensive experiments to assess these KGE models using multiple evaluation metrics. Finally, we discussed our observations across various downstream biological tasks and provide insights and guidelines for how to use a KG in biomedicine. We hope that the unprecedented quality and diversity of PharmKG will lead to advances in biomedical KG construction, embedding and application.

COVID-19 pandemic through the lens of a gastroenterology fellow: looking for the silver lining

COVID-19 pandemic through the lens of a gastroenterology fellow: looking for the silver lining

Evaluation of curricular relevance and actual integration of sex/gender and cultural competencies by final year medical students: effects of student diversity subgroups and curriculum.

Background: Diversity issues play a key role in medical practice and have recently been more explicitly integrated into undergraduate medical curricula in Europe and worldwide. However, research on students´ perspectives on the relevance and curricular integration of diversity issues, such as sex/gender and culture-sensitive competencies, is still limited.Methods: The Charité Berlin (Germany) ran in parallel a traditional and a competency-based medical program. Diversity perspectives, especially sex and gender aspects, were systematically integrated into the new curriculum. In 2016, an online questionnaire was sent to all medical students in their final clerkship year of both programs. Students provided diversity-related information (sex/gender, age, number of children, migration background or disability) and rated the relevance of sex/gender and culture-sensitive competencies and the integration into their study program. They also rated their preparedness for the final year clerkships and for working as a physician.Results: The included 184 students considered sex/gender and culture-sensitive competencies to be very relevant or relevant (62%; 73%). The ratings of the relevance are independent of the curriculum and significantly higher in female students. Regarding curricular integration, 69% of the students of the traditional curriculum evaluated the degree of implementation as minor, whereas 83% students of the new curriculum rated the degree of implementation as extensive. Degrees of preparedness for the workplace were significantly higher in students from the new curriculum, with no significant effects by sex/gender. Age group, having a child, migration background or a disability had separate effects on the students’ ratings.Conclusions: Medical students in their final clerkship year rated sex/gender and culture-sensitive competencies as relevant; this was independent from their study program. Their ratings provide complementary evidence that our systematic approach to implementation resulted in a successful curricular integration.

Study of Physical and Chemical Properties of Zincas and Feras and Its Influence on the Processes of Rat’s Fetus Development

Acetylcysteine (ACC) helps people with pulmonary fibrosis and it is preferred treatment for the often deadly adult respiratory distress syndrome. ACC is a precursor in the formation of the glutathione antioxidant in the body. Compounds of zinc (II) and iron (II) with ACC and mucolytic medications play an important role in medical practice for the prevention of respiratory diseases. The present article is about determining the embryotoxicity of the new coordination compounds of Zincas and Feras, which are synthesized by the interaction of zinc (II) and iron (II) sulfates with acetylcysteine in an aqueous solution and have mucolytic properties in relation to diseases, bronchial asthma with a predominance of an infectious-dependent component of the course, chronic asthmatic bronchitis and chronic obstructive bronchitis. Daily administration of a feed or a high dose of 0.60 ml / kg inside the gastric suspension for 3 weeks to pregnant rats and the result of observation of the 13th week of life did not have a marked effect on the fetal development process. With the introduction of Feras and Zincas in a therapeutic dose for 1-3 weeks of pregnancy, the death of rat pups in the first month of life was comparable with the control values. The physical development of the offspring proceeded without any deviations from the norm. All pups were born normal, responded to external irritants well, with а good appetite and led an active lifestyle.

3D Printing in Radiation Oncology: A Systematic Review of the Literature

3D printing is an adaptable technology that is playing an increasing role in medical practice and innovation.Although 3D printing is gaining recognition as an effective clinical and educational tool in procedurally-intensive specialties, it has a nascent role in radiation oncology. The goal of this investigation, therefore, is to clarify the extent to which 3D printing applications are currently being used in radiation oncology through a systematic review of the literature. A search protocol was defined according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using the Population, Intervention, Control, Outcomes (PICO) framework for identification of eligible studies. Two independent reviewers searched PubMed with combinations of predetermined Medical Subject Headings and generic search terms. Any study using 3D printing technology in relation to the delivery or study of radiotherapy was included. In-press articles from radiation oncology and medical physics journals were searched. Article references were examined for identification of any remaining publications. Included articles were evaluated using parameters of interest including: year/country of publication, experimental design, sample size for clinical studies, radiation oncology topic, reported outcomes, and implementation barriers or safety concerns. 103 publications met inclusion criteria. The most commonly described 3D printing applications included quality assurance phantoms (26%), brachytherapy applicators (20%), bolus (17%), preclinical animal irradiation (10%), compensators (7%), and immobilization devices (5%). Most studies were pre-clinical feasibility studies (63%), with few clinical investigations such as case reports or series (13%) or cohort studies (11%). The most common applications evaluated in clinical studies included brachytherapy applicators (42%) and bolus (27%). Furthermore, sample sizes for clinical investigations were small (median 10, range 1-42). A minority of articles described basic or translational research (11%) and workflow or cost evaluation studies (3%). Number of articles increased yearly, as follows (P<0.0001): 2012 (1%), 2013 (0), 2014 (6%), 2015 (14%), 2016 (18%), 2017 (27%), 2018 (31%). While outcomes were varied, the majority of studies reported successful implementation of accurate and cost-effective 3D printing methods. 3D printing is rapidly growing in radiation oncology and has been implemented effectively in a diverse array of applications. Although the number of 3D printing publications has steadily risen, the majority of current reports are pre-clinical in nature and the few clinical studies that do exist report on small sample sizes. Further investigation describing the clinical application and evaluation of developed 3D printing technologies in larger cohorts is warranted.