Specimen Volume Research Articles

The potential promise and pitfalls of point-of-care viral load monitoring to expedite HIV treatment decision-making in rural Uganda: a qualitative study

BackgroundHIV treatment programs in Africa have implemented centralized testing for routine viral load monitoring (VLM), which may result in specimen processing delays inhibiting timely return of viral load results. Decentralized, point-of-care (PoC) VLM is a promising tool for expediting HIV clinical decision-making but remains unavailable in most African settings. We qualitatively explored the perceived feasibility and appropriateness of PoC VLM to address gaps along the viral load monitoring continuum in rural Uganda.MethodsBetween May and September 2022, we conducted 15 in-depth interviews with HIV clinicians (facility in-charges, clinical officers, nurses, counselors) and six focus group discussions with 47 peer health workers from three south-central Ugandan districts. Topics explored centralized VLM implementation and opportunities/challenges to optimizing routine VLM implementation with PoC testing platforms. We explored perspectives on PoC VLM suitability and feasibility using iterative thematic analysis. Applying the Framework Method, we then mapped salient constraints and enablers of PoC VLM to constructs from the Consolidated Framework for Implementation Research.ResultsClinicians and peers alike emphasized centralized viral load monitoring’s resource-intensiveness and susceptibility to procedural/infrastructural bottlenecks (e.g., supply stockouts, testing backlogs, community tracing of clients with delayed VLM results), inhibiting timely clinical decision-making. Participants reacted enthusiastically to the prospect of PoC VLM, anticipating accelerated turnarounds in specimen processing, shorter and/or fewer client encounters with treatment services, and streamlined efficiencies in HIV care provision (including expedited VLM-driven clinical decision-making). Anticipated constraints to PoC VLM implementation included human resource requirements for processing large quantities of specimens (especially when machinery require repair), procurement and maintenance costs, training needs in the existing health workforce for operating point-of-care technology, and insufficient space in lower-tier health facilities to accommodate installation of new laboratory equipment.ConclusionsAnticipated implementation challenges, primarily clustering around resource requirements, did not diminish enthusiasm for PoC VLM monitoring among rural Ugandan clinicians and peer health workers, who perceived PoC platforms as potential solutions to existing inefficiencies within the centralized VLM ecosystem. Prioritizing PoC VLM rollout in facilities with available resources for optimal implementation (e.g., adequate physical and fiscal infrastructure, capacity to manage high specimen volumes) could help overcome anticipated barriers to decentralizing viral load monitoring.

Image-Guided Breast Conserving Surgery

Background: Breast-conserving surgery (BCS) has gained wide acceptance as the treatment of choice for early-stage breast cancer. One of the primary goals of BCS is to obtain tumor-free resection margins. In practice, the excision of a palpable breast carcinoma is guided by preoperative diagnostic images and the intraoperative tactile skills of the surgeon. The somewhat ‘blind’ approach of using palpation-guided surgery is known to be highly inaccurate, with studies worldwide reporting positive resection margins in up to 41% of patients. In recent years, ultrasonography has emerged as an effective guidance tool during surgery and ultrasound-guided surgery has been introduced into breast cancer surgery as a method of excising nonpalpable breast cancer. Objective: The aim of this study is comparing ultrasound-guided vs palpation-guided conservative breast surgery in obtaining tumor-free resection margins. Methods: This study was a prospective randomized controlled clinical trial where patients with early breast cancer (T1-T2) and eligible for breast conserving surgery are randomly assigned (1:1) into two arms. Arm A: included the patients who will undergo ultrasound-guided breast conserving surgery. Arm B: included the patients who will undergo the conventional palpation-guided breast conserving surgery. Results: Overall, 142 patients undergoing breast conserving surgery were enrolled: 71 were allocated to the Ultrasound-guided (US) group (Arm A) and 71 to the Palpation-guided (PG) group (Arm B). Patient and tumor characteristics were comparable between the two groups. Age, Body mass index, tumor laterality, tumor location and tumor stage were comparable in both groups and statistically insignificant. Despite that the final tumor size was comparable between both groups, IOUS significantly reduced the main specimen volume and the least negative margin width (p<0.001). The median operative time was significantly longer in the US group bey around 27 min than in the PG group and this was statistically significant in favor of the PG surgery (p<0.001). The involved resection margin rate was significantly higher in the PG group and thus the need for reoperation (p<0.001). Conclusion: IOUS is the only method allowing a true real-time visualization and continuous control of resection margins during all phases of BCS. In our single-institution study, IOUS demonstrated clear superiority over palpation-guided surgery in both oncological and surgical outcomes except for the operative time (smaller excision volume yet, with optimum resection margins). IOUs provides much better tumor localization in small breasts with dense fibroadenosis. Since all the other available localization techniques (including palpation) limit the surgeon’s visual guidance during BCS, IOUS could be regarded as one of the most significant modern technological innovations in the field of breast cancer surgery, restoring sight to the breast surgeon. Our findings strongly suggests that the integration of IOUS in breast conserving surgery could be regarded as a highly beneficial surgical approach.

Road to automated urinalysis analyzer: Validation of Sysmex UN-3000 to supplant manual urinalysis

Abstract Introduction/Objective Traditionally, urinalysis encompasses the chemical analysis of urine by dipstick and manual microscopy for formed elements. High specimen volume and varying subjectivity among individuals performing microscopic analysis make the practice both imprecise and inefficient. Implementation of Sysmex UN- Series™Automated Urinalysis (Sysmex Corporation, Kobe, Japan) fulfilled our need for automation, addressing both issues at hand. Automated urinalysis offers a solution for laboratories to meet the growing demand for faster result turn around times(TAT) with ever increasing specimen volumes. We expect greater sensitivity and reproducibility in terms of comparison to manual microscopy, as well as quicker TAT with the change in methodology. Methods/Case Report Using both unpreserved and preserved urine tubes, a macroscopic comparative study between Clinitek Advantus(manual) and Clinitek Novus (automated) methods was carried out on 141 urines with greater than 60 abnormal patients. Similarly, a microscopic study between the laboratory’s manual microscopy procedure and the Sysmex UF-5000 was carried out on 112 urines with greater than 60 abnormal patients. RBCs, WBCs, Epithelial cells were evaluated under high power field(40X); casts and crystals were evaluated under lower power field(10X). The Reference Range Interval for both chemical and microscopic was verified using 44 normal patient specimens. The quantified values are converted to high and low power field (hpf/lpf), analogous to the current system in the laboratory. Results (if a Case Study enter NA) Most parameters had >90% agreement between manual and automated method. Parameters falling below 90% were checked to see if discrepancies fell within 1 degree. Automated system is more sensitive than manual and our average TAT for urinalysis dropped 50%. Conclusion The automated urinalysis technology enabled us to focus only on samples requiring intervention based on pathological criteria, resulting in reduced overall TAT and workload burden, and improved consistency in reporting across specimens.

B-168 Development and Validation of a Quantitative Ultra-Performance Liquid Chromatography Quadrupole Time-of-Flight (UPLC-QToF) Method for Urine Organic Acid Analysis

Abstract Background Urine organic acid (UOA) analysis is essential for the diagnosis of inborn errors of metabolism (IEMs). Traditionally, UOA analysis is performed with gas chromatography-mass spectrometry (GC-MS) and requires time-consuming sample preparation steps including liquid-liquid extraction and derivatization. The rapid development of Ultra-Performance Liquid Chromatography Tandem Mass Spectrometry (UPLC-MS/MS) in the past few years provides the opportunity to perform UOA analysis with a dilute-and-shoot methodology. We describe the development and validation of a quantitative Ultra-Performance Liquid Chromatography Quadrupole Time-of-Flight (UPLC-QToF) method for UOA analysis. Methods Urine specimens were diluted to normalize creatinine concentrations to 1 mmol/L. 20 µL of urine specimen (diluted), calibrator, or quality control (QC) material was mixed with 400 µL of mobile phase A (0.05% formic acid in water) and a mixture of isotope-labeled internal standards. After centrifugation, 10 µL of the supernatant was analyzed using a Xevo G3 QTOF mass spectrometer (Waters) with a ACQUITYTM Premier HSS T3 1.8 µm VanGuardTM FIT 2.1 x 150 mm column (Waters). Data collection was performed with negative electrospray ionization (ESI) mode using the MSE method to produce fragment ions when applicable. Repeatability, reproducibility, and carryover were assessed using the QC materials. The analytical measuring range (AMR) was assessed using synthetic urine spiked with increasing concentrations of each organic acid. Accuracy was assessed by method comparison with the UOA test performed at Mayo Clinic Laboratory and by spike-recovery study using a pooled urine specimen. Matrix effect was also evaluated with matrix dilution study. Results An optimized LC method was used to enable high-resolution separation of selected UOAs (N = 29) and isomers. Total analytical time was 20 min per injection. Both linear and quadratic regressions were used to build the calibration curves. AMR and correlation coefficients of a few representative UOAs were: orotic acid (3.4 to 214.2 mmol/mol creatinine, R^2 = 0.99, linear regression); 2-methylcitric acid (4 to 189 mmol/mol creatinine, R^2 = 0.99, linear regression); 3-methylcrotonylglycine (0.3 to 18.0 mmol/mol creatinine, R^2 = 0.99, linear regression). Repeatability and reproducibility were mostly <=10% CV and no carryover was observed. Spike-recovery study demonstrated recoveries between 80% and 120%, and method comparison study demonstrated no discrepancies with results from Mayo Clinic Laboratory. Conclusions We have developed and validated a novel UPLC-QTOF method for UOA analysis to support the diagnosis of IEMs with acceptable analytical and clinical performances. Compared with the traditional GC-MS method, the UPLC-QTOF method requires a very small specimen volume and does not require laborious and time-consuming sample preparation steps. Continued optimization of the method will be pursued to measure more UOAs to support the diagnosis of more IEMs.

Utility and performance of cell blocks in cerebrospinal fluid cytology: Experience at two teaching hospitals.

Cytology cell blocks (CBs) are not routinely made for cerebrospinal fluid (CSF) specimens. The goal of this study was to identify when CSF CB preparation improves diagnostic performance. Under institutional review board approval, a retrospective review of CSF cytology cases was conducted at a tertiary university-based hospital and an affiliated county hospital. Patient history, CSF volume, final diagnosis, use of stains, and whether the CB was contributory was determined from the cytopathology report. CSF nucleated cell count data was obtained from the medical record. A total of 69 CSF specimens with CBs from January 2006 to March 2023 were identified from 61 patients. The median CSF volume was 8mL (interquartile range, 4-13mL; range, 1-800mL), with immunohistochemical stains performed on 29 (42%) cases. Per cytology report, CB was contributory in 23 cases (33%), not contributory in 34 cases (49%), and not discussed in 12 cases (17%). The median volume was 8mL for cases in which CB was contributory, not contributory, or not discussed. There was no difference in average nucleated cell counts between cases in which CB was contributory versus not contributory (73.9 vs. 40.0, p=.175). CBs for CSF samples were contributory in a subset (33%) of cases. The authors were unable to identify any specific pre-analytic factors, including specimen volume and average nucleated cell counts, for cases in which CB was contributory. Further evaluation is needed to identify if there are scenarios in which CSF CBs should be routinely prepared.

Improved ground truth annotation by multimodal image registration from 3D ultrasound to histopathology for resected tongue carcinoma.

This study's objectives are (1) to investigate the registration accuracy from intraoperative ultrasound (US) to histopathological images, (2) to assess the agreement and correlation between measurements in registered 3D US and histopathology, and (3) to train a nnUNet model for automatic segmentation of 3D US volumes of resected tongue specimens. Ten 3D US volumes were acquired, including the corresponding digitalized histopathological images (n = 29). Based on corresponding landmarks, the registrations between 3D US and histopathology images were calculated and evaluated using the target registration error (TRE). Tumor thickness and resection margins were measured based on three annotations: (1) manual histopathological tumor annotation (HTA), manual 3D US tumor annotation, and (2) the HTA registered in the 3D US. The agreement and correlation were computed between the measurements based on the HTA and those based on the manual US and registered HTA in US. A deep-learning model with nnUNet was trained on 151 3D US volumes. Segmentation metrics quantified the model's performance. The median TRE was 0.42mm. The smallest mean difference was between registered HTA in US and histopathology with 2.16mm (95% CI - 1.31; 5.63) and a correlation of 0.924 (p < 0.001). The nnUNet predicted the tumor with a Dice similarity coefficient of 0.621, an average surface distance of 1.15mm, and a Hausdorff distance of 3.70mm. Multimodal image registration enabled the HTA's registration in the US images and improved the agreement and correlation between the modalities. In the future, this could be used to annotate ground truth labels accurately.

The Reopening of the Hyogo Herbarium (HYO) and the Relocation of the Vascular Plant Specimens After Construction of the New Building

The new collection building named Collectionarium*1 (CN) of the Museum of Nature and Human Activities, Hyogo, (HYO), Hitohaku*2 Japan, which opened in October 2022, contains ca. 600,000 vascular plant specimens, including 10% that were not mounted. Here, we describe the process of specimen moving to the CN, including integration with ca. 250,000 herbarium specimens of Shoei Junior College (known as SHO). At the same time, the collection sequence has been updated from the new Engler system (Melchior 1964) to the Angiosperm Phylogeny Group (APG) III system. The storage rooms of natural history museums are full everywhere across the world, and extensions are necessary. When collections spaces are enlarged, it creates opportunities to relocate specimens. We hope that our experiences will be useful to other institutions. The Status of the HYO Collection in 2020 When the construction of the CN started in early 2020, we had 600,000 plant specimens: ca. 350,000 on 220 shelves and the other 250,000 in ca. 1,500 cardboard boxes. The 250,000 specimens, donated by the SHO in 2012, were kept in boxes as existing shelves were too short to house them. Based on an estimated capacity of 1,000–2,000 specimens per shelf, the new storage consisting of 525 shelves would not have the capacity to store all the specimens. Therefore, it was necessary to estimate the total volume of specimens more accurately. The classification system also needed updating. Change From Engler to APG At the time of its opening in 1992, HYO specimens were arranged according to the new Engler system. However, the APG system began to be adopted more recently. The new Engler and APG systems are quite distinct, treating dicots in a different way, and some families have disappeared and new ones arisen. The plant picture books published recently in Japan all adopt the APG system. The younger generation studying plants never learned the new Engler system, making it impossible for them to find specimens arranged in this way. Therefore, we decided to change the arrangement of the specimens to the APG III system whilst relocating the herbarium. For pteridophytes, we decided to adopt the Pteridophyte Phylogeny Group (PPG) I system (PPG I 2016). In order to plan the placement of specimens, it was necessary to know the number of specimens at the genus level and to investigate how much space each family would need. We measured the thickness of all genus covers containing specimens, regardless of whether they were in shelves or boxes. Based on these results, we planned the layout. Next we packed the specimens into cardboard boxes following the APG system, and two surfaces of each box was labeled with the room number (=1 or 2) in the CN with locations in the room. All the boxes were moved to the Holonpia Hall (the Hall) from December 2021 to January 2022. Then, 220 empty specimen shelves were transported to the CN in February 2022. After the shelves were moved, ca. 4,000 boxes stored in the Hall were carried back into old repository in March 2022 to wait for moving. Moving to the new storage Gases, e.g., ammonia, are released from concrete buildings for a while after construction. Since these gases are harmful to specimens, it is necessary to wait until the gas concentration decreases to a safe level, before storing the specimens there. Beginning in April 2022, the ammonia concentration was measured once a month in the two new storage rooms at the CN. Rooms were ventilated nearly every day. In November 2022, the concentration of ammonia in both rooms fell to 30 ppb or less and it was finally safe to move the specimens in. Moving was carried out during the regular maintenance closure in January 2023. First, we carried the boxes to the exhibition area on the first floor of the CN because we needed enough space for unpacking and sorting. We opened boxes one by one for each family to combine the HYO and SHO specimens, sorted them in alphabetical order, re-packed them into boxes, brought the boxes up to the storage rooms on the second floor, and placed them onto the shelves. Two teams of people, three or four for each storage room, worked with this system for six days until all the specimens were placed, properly arranged, and on the shelves by late January. Specimens are now arranged according to the APG system, and ready to be examined. Please contact the authors for herbarium study requests.

Scaling cervical cancer screening in Mozambique: analysis of loop electrosurgical excision procedure (LEEP) specimens

ObjectivesAs cervical cancer screening programs are implemented and expanded, an increasing number of women require loop electrosurgical excision procedure (LEEP) for treatment of pre-invasive cervical disease. Our objective was to...

Enhanced differentiation between 3-hydroxyglutaric and 2-hydroxyglutaric acids facilitates diagnostic testing for glutaric aciduria type 1.

Glutaric aciduria type 1 (GA1) is an inherited neurometabolic disorder, in which deficiency of glutaryl-CoA dehydrogenase leads to accumulation of glutaric acid (GA) and 3-hydroxyglutaric acid (3-HG). Some low excretors may exhibit only slight elevation of urinary 3-HG, with normal urinary GA, yet are at significant risk of severe clinical disease. Accurate quantitation of urinary 3-HG is crucial in diagnostic workup for GA1, but in this context, current gas chromatography-mass spectrometry (GC-MS) methods have inherent analytical challenges. Co-elution and spectral similarities of the 3-HG and 2-HG structural isomers can cause difficulties in quantitation of slightly elevated 3-HG. Our laboratory recently acquired a gas chromatography system coupled to a triple quadrupole mass spectrometer (GC-MS/MS), and we took advantage of its increased sensitivity and specificity to improve our existing GC-MS method. A stable isotope dilution process is used, with sample treatment consisting of a double liquid-liquid extraction followed by a trimethylsilyl derivatization. The transitions m/z 349 → 333 for 3-HG and m/z 349 → 321 for 2-HG were selected to differentiate these two isobaric molecules based on their characteristic fragments, thus minimizing interferences despite co-elution. Method validation demonstrated satisfactory precision and accuracy. Using GC-MS/MS instead of GC-MS allowed us to decrease the required specimen volume, number of sample processing steps, chromatographic run time, and instrument maintenance. This enhanced assay facilitates clinical laboratory testing for GA1, both in confirmatory protocols following positive newborn screening and in diagnostic investigation of patients with suggestive signs or symptoms.

An improvement in the method of correcting indirect radial strain measurements during triaxial strength tests in rocks

The present article provides an improvement in the method to correct indirect strain measurements in triaxial compressive strength tests through axial displacement and hydraulic fluid volume change measurements. The improvement focused on reducing the parameters of the formula proposed for indirect volumetric strain in the original method, thereby facilitating the development of a simpler formula in which the radial strain depends on only two parameters: the initial volume of the rock specimen and the volume changes of the hydraulic fluid for each instant. The comparison between the improvement proposed, and original method resulted in a mean absolute difference of 0.003.•This improvement does not depend on the axial strain, unlike the original method, which requires correcting the indirect axial strain measurements before correcting the indirect radial strain measurements.•This improvement can be useful for research on the stress-strain behavior of intact rock under laboratory conditions, such as in the study of the post-peak state.

Different impact of recovery annealing and thermal pressure treatments on the microstructure and mechanical properties of rejuvenated Cu64Zr36 metallic glasses: A molecular dynamics study

The interpenetrating connection of icosahedra network (ICOIN) was termed as structural skeleton, which could quantify the strength and ductility of MGs. The impact of different rejuvenation methods on medium-range order (MRO) alterations was rarely studied. This work employed molecular dynamics simulations to examine the difference in MRO evolution of metallic glasses treated by recovery annealing and thermal-pressure treatment during uniaxial tension. All of the specimens obtain enhanced ductility due to improved potential energy. During tension, ICOI of all rejuvenated specimens exhibits an increased destruction rate and a decreased transformation rate. However, there are some converse characteristics in the specimens under different rejuvenation methods. The rejuvenated specimens treated by recovery annealing exhibit increased free volume and decreased ICOIN density. After thermal-pressure treatment, the rejuvenated specimens demonstrated decreased free volume and enhanced ICOIN density. During tension, the enhancement of icosahedral free volume in specimens treated by thermal pressure largely decreased the ICOIN density, thereby increasing the ductility. After tension, the rejuvenated specimens under high pressure have a significant reduction in ICOIN density compared to those under recovery annealing. The significance of this work is to accurately regulate the ICOIN density of rejuvenated specimens.

The Predictive Factors of Combined Implant Application for Breast Cancer Patients Receiving Immediate Breast Reconstruction with a Pedicled Omental Flap.

Whether a laparoscopically harvested omental flap is adequate for total breast reconstruction could not be determined preoperativaly due to lack of reliable assessment methods. This study aimed to establish a statistical model to predict the probability of omental flap insufficiency. In this study, 200 female patients with breast cancer receiving immediate breast reconstruction with pure pedicled omental flaps or pedicled omental flaps combined with implants after nipple-areolar complex-sparing mastectomy were divided into two groups depending on whether implants were needed or not. The clinical characteristics of these two groups were compared. Correlation of body mass index (BMI) and omental volume was analyzed. Binary logistic regression was performed to predict the probability of implant requirement based on clinical parameters, showing significant differences between the two groups. The patients who needed implants in adjunct treatment were younger. In addition, they had larger breast specimens and smaller omental volumes than the others whose omental flaps were sufficient for total breast reconstruction. Body mass index and omental volume showed a moderately positive correlation. Age, specimen volume, and BMI all were entered into the logistic regression equation. For the patients with a BMI lower than 24.0kg/m2, the probability of requiring implants was 5.467 times that of comparable patients with a BMI of 24.0kg/m2 or higher. At the cutoff of 0.61, the regression equation yielded a sensitivity of 84.2% and a specificity of 72.1% in recognizing subjects with the necessity of implant application. The combination of BMI, age, and volume of breast specimen could predict with high accuracy whether implants are required for breast cancer patients receiving pedicled omental flap-based breast reconstruction.

ImmunoglobulinE in nasal secretions

Diagnosis of allergic disease is primarily verified by IgE blood serum analysis. Determination in nasal secretions is technically more difficult, particularly due to alow specimen volume and the method of sample collection. Nasal secretions are frequently collected by lavage, which allows qualitative diagnostics, whereas swabs with defined amounts of mucus enable quantitative analyses. In the case of negative skin and serum tests, detection of IgE in nasal mucus combined with nasal provocation testing aids differentiation between local allergic and nonallergic rhinitis.

Decreasing Blood Transfusions in Premature Infants Through Quality Improvement.

Packed red blood cell transfusions (pRBCT) in preterm infants have been associated with significant morbidity. Although infants <26 weeks' gestational age typically require several pRBCT, preterm infants born between 26 and 34 weeks' gestational age may also require pRBCT during their hospitalization that are potentially preventable. We aimed to reduce pRBCT in this population by 20%. This quality improvement project was conducted in the Duke University Hospital NICU between July 2018 and February 2023. Interventions included the implementation of evidence-based transfusion thresholds, supporting bone marrow erythropoiesis, and reducing laboratory specimen volumes by increasing capillary test panels. The rates per 1000 patient days for pRBCT (outcome measure), number of new patients initiated on erythropoietin (process measure), number of basic metabolic panels (process measure), and total capillary panels (process measure) were monitored during the project period. Statistical process control charts were used to observe trends over time. Among infants born between 26 0/7 and 34 6/7 weeks' gestational age, the rate of pRBCT decreased from an average of 23.8 to 12.7 transfusions per 1000 patient days, which is a 46.6% decrease. Increases in the use of erythropoietin and capillary panels were observed, along with a decrease in the use of basic metabolic panels. There was no change in mortality or the rate of necrotizing enterocolitis. Improvement was sustained for 24 months after implementation. pRBCT can be decreased in preterm infants born between 26 and 34 completed weeks' gestation through a combination of strategies utilizing quality improvement methodology.

Fabrication and structural characterisation of ZrC-W cermet by spark plasma sintering: Application in ballistical projection

This paper describes the effect of addition of tungesten (W) when was introduced into ZrC composite forming ceramic metal-composite (MMC) and (FGMS) to improve the fracture toughness (KIC) and hardeness (Hv) of the composite ceramic-metal. ZrC and ZrC with addition of 20 % of tungesten (ZrC-W) were prepared by vacuum sintering FAST-SPS-FCT technology at the temperatures in the range of 1700–1800 °C for 400 s under pressure of 50 Mpa. Microtructural properties were investigated by X-ray diffraction and energy-dispersive spectrometry in addition scanning electron miroscopy. The investigations shows that the phase separation of the as-sintered ZrC and ZrC-20 wt%W into two phases: ZrC (dark) and (C)W (bright) indicating that the as-sintered (ZrC)W was thoroughly decomposed in tree phases ZrC, W2C and WC. The effect of the W is already illustrated. X-ray diffraction and energy-dispersive spectrometry results indicate that bright grains are W, (W)C and dark ZrC solid solution. The relative density increases with the reinforcement by W into ZrC. Fully dense ZrC and ZrC-20 vol% W ceramic metal-composite with a relative density of more than 98.8 % were obtained. The Vickers hardennes (HV), fracture toughness (KIC) and Raman spectroscopy will be performed in the near future. In addition, ballistic performance (dynamic properties by projectil persing resistance) . A finite element simulation will used to optimise the vol% W addition to obtain better mechanical properties and ballistical performance. The Analyzer of the termo-mechanical evolution within the volume of ZrC and ZrC-W specimens subjected to FAST-SPS-FCT platform (thermo-mechanical modeling under ABAQUS). Also, the ballistic performance will be evaluated using the Rosenberg model and compared with the experimental results in order to better understand the dynamic shock behavior of ceramic metal-composite (ZrC and ZrC-W) by the projectile that to be applied for body armor.

Influence of the as-built surface and a T6 heat treatment on the fatigue behavior of additively manufactured AlSi10Mg

As the fatigue strength of materials manufactured via lase-based powder bed fusion (PBF-LB) is highly influenced by process-induced defects and the “as-built” surface, in this work fatigue tests at specimens made of AlSi10Mg with “as-built” and polished surface condition were conducted. In this context also the defect tolerance of the material, and hence its ability to counteract process-induced notch effects, was analyzed. For this, specimens in a not heat-treated and an artificially aged (T6) condition were tested. For the not heat-treated specimens, a high reduction of the fatigue strength due to the “as-built” surface is observed, while the heat-treated specimens exhibit no influence of the surface condition. Using the √area approach, it is demonstrated that the smaller fatigue strength due to “as-built” surface observed for the not heat-treated condition results from process-related residual tensile stresses, which are removed by T6 heat treatment and polishing, respectively. Moreover, the results show that the “as-built” surface leads to similar stress concentrations than defects in the specimen volume, and thus, polishing had no influence on the fatigue performance after heat treatment. In addition to these findings, an increased fatigue strength after T6 heat treatment was observed, which is caused by an increased defect tolerance.

Simultaneous LC-MS/MS Method for the Quantitation of Probenecid, Albendazole, and Its Metabolites in Human Plasma and Dried Blood Spots

Millions of individuals throughout the world suffer from lymphatic filariasis (LF), which is a morbid disease caused by Wuchereria bancrofti, Brugia malayi, and Brugia timori. These infections belong to tissue-invading nematodes and are one of the major neglected tropical diseases that often result in permanent and enduring disability among individuals in endemic regions. Due to combination therapy, LF eradication has drastically decreased infections globally. The development of blood micro-sampling techniques allowing precise quantitation of drugs in blood would facilitate pharmacokinetic (PK) studies in remote populations. Therefore, an LC-MS/MS bioanalytical method was utilized to analyze albendazole (ABZ), albendazole sulfone (ABZ-ON), albendazole sulfoxide (ABZ-OX), and probenecid (PR) in plasma and dried blood spots. Solid-phase extraction was utilized to extract the analyte from both plasma and blood-spiked DBS. Analytes of interest were eluted with a gradient mobile system using 0.05% formic acid in water (A) and 0.05% formic acid in methanol (B) and separated using a reversed-phase Acquity ®BEH C18 UPLC column (100 × 2.1 mm, 1.7 µm). Precision and accuracy at each QC level were within the acceptable limit, i.e., ±15% for all analytes in both the matrices. Tests for stability under laboratory and storage conditions indicated that no notable changes were observed for plasma and DBS. The LC-MS/MS method demonstrated its capability to consistently identify all target analytes (ABZ, ABZ-ON, ABZ-OX, and PR) at low concentrations, even at the small specimen volumes obtained from DBS cards. This confirms the efficacy and durability of DBS cards as a micro-sampling technique. Moreover, it enhances collection efforts for therapeutic drug monitoring in remote locations for patients infected with lymphatic filariasis.

Long-Term Safety of Level II Oncoplastic Surgery after Neoadjuvant Treatment for Locally Advanced Breast Cancer: A 20-Year Experience.

Background: Oncoplastic surgery (OPS) reliability in the post-neoadjuvant chemotherapy (NACT) setting is still debated due to weak scientific evidences in such scenarios. Methods: Our analysis aims to report results obtained in a retrospective series of 111 patients consecutively treated with level II OPS after NACT at the Multidisciplinary Breast Center of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS between 1998 and 2018. The surgical endpoints were the mean specimen volume, rates of positive margins (PMR), re-excision (RR), conversion to mastectomy (CMR), and complications (CR). The oncological endpoints were overall survival (OS), disease-free survival (DFS), and local recurrence (LR). To evaluate the impact of NACT on surgical and oncological outcomes at 302 months, we conducted a propensity score matching, pairing patients in post-NACT and upfront surgery groups. Results: The mean sample volume was 390,796 mm3. We registered a 3.6% of PMR, 1.8% RR, 0.9% CMR, 5% CR. The 10-year OS and 10-year DFS with a median follow-up of 88 months (6-302) were 79% and 76%, respectively, with an LR recurrence rate of 5%. The post-NACT group received significantly larger excised volumes and lower PMR. NACT did not affect surgical and oncological outcomes. Conclusions: Level II OPS can be considered a reliable alternative to mastectomy even in the post-NACT setting.

Laboratory testing consolidation and total laboratory automation improves service efficiency and effectiveness: a study of a medical center in Taiwan.

Test consolidation and total laboratory automation (TLA) were implemented in a core laboratory with a high volume of specimens in a medical center in Taiwan to reduce the costs of laboratory services and improve laboratory workflow and performance. Using a retrospective research approach, 5 stat and 7 routine tests were used to analyze the in-laboratory to report turnaround time (IR-TAT). Mean, SD, medium, 90th percentile, outlier percentage of IR-TAT, full-time equivalents, productivity, tube touch moment (TTM), and financial impact were determined and compared pre- and post-TLA. The mean IR-TAT of overall stat chemical tests for inpatient and outpatient were 32.8% and 11.9% reductions, respectively. The productivity of each medical technologist increased by 32.4% per month, and there was a reduction of 5 medical technologists compared with the number required to complete the same tests before consolidation. The TTM of staff per year post-TLA decreased by 74.1% tube touches. The efficiency of laboratory services was improved by consolidation to the core laboratory along with TLA implementation coupled with logic rules such as delta-check and autoverification. Effectiveness was improved as measured by an increase in productivity, labor reduction, staff safety, and cost reduction.

Automatic segmentation of MRI in prospective breast volume evaluation: Comparison of different assessments for immediate breast reconstruction

Assessment of breast volume is essential in preoperative planning of immediate breast reconstruction (IBR) surgery to achieve satisfactory cosmetic outcome. This study introduced a breast volume measurement tool that can be used to perform automatic segmentation of magnetic resonance images (MRI) and calculation of breast volume. We compared the accuracy and reliability of this measurement method with four other conventional modalities. Patients who were scheduled to undergo mastectomy with IBR between 2016 and 2021 were enrolled in the study. Five different breast volume assessments, including automatic segmentation of MRI, manual segmentation of MRI, 3D surface imaging, mammography, and the BREAST-V formula, were used to evaluate different breast volumes. The results were validated using water displacement volumes of the mastectomy specimens. In this pilot study, a total of 50 female patients met the inclusion criteria and contributed 54 breast specimens to the volumetric analysis. There was a strong linear association between the MRI and water displacement methods (automatic segmentation: r=0.911, p<0.001; manual segmentation: r=0.924, p<0.001), followed by 3D surface imaging (r=0.858, p<0.001), mammography (r=0.841, p<0.001), and Breast-V formula (r=0.838, p<0.001). Breast volumes measured using automatic and manual segmentation of MRI had lower mean relative errors (30.3%±22.0% and 28.9%±19.8, respectively) than 3D surface imaging (38.9%±31.2), Breast-V formula (44.8%±25.8), and mammography (60.3%±37.6). Breast volume assessment using the MRI methods had better accuracy and reliability than the other methods used in our study. Breast volume measurement using automatic segmentation of MRI could be more efficient compared to the conventional methods.