Standard Plan Research Articles

Unraveling Glioblastoma: TME Implication and Gene Therapy Advances.

Glioblastoma is a malignant manifestation of a solid brain tumour with a very dismal prognosis due to an overall median survival of 14 months. The currently administered Standard treatment plan, the STUPP regimen, is not very effective in tackling this neoplasia. A major concern that affects the development of new drug formulations, specifically for Glioma, is the inherent sub-clonal heterogeneity, which includes the dynamic and intricate nature of the Tumour Microenvironment (TME). Targeting the cellular niche using personalized medication for glioma specifically gene therapy, seems to be promising, with most studies in preclinical models yielding optimistic results. This paper analyses the great headways made in glioma gene therapy in the last 10 years while looking into different therapeutic strategies. That said, certain challenges do plague the clinical use of gene therapy which have been highlighted in the hopes that future researchers will address these concerns and further propel gene therapy in its journey from the Lab to the bedside.

Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures.

The incidence of limb fractures in patients living with HIV (PLWH) is increasing. However, due to their immunodeficiency status, the operation and rehabilitation of these patients present unique challenges. Currently, it is urgent to establish a standardized perioperative rehabilitation plan based on the concept of enhanced recovery after surgery (ERAS). This study aimed to validate the effectiveness of ERAS in the perioperative period of PLWH with limb fractures. A total of 120 PLWH with limb fractures, between January 2015 and December 2023, were included in this study. We established a multidisciplinary team to design and implement a standardized ERAS protocol. The demographic, surgical, clinical, and follow-up information of the patients were collected and analyzed retrospectively. Compared with the control group, the ERAS group had a shorter operating time, hospital stay, preoperative waiting time, postoperative discharge time, less intraoperative blood loss, and higher albumin and haemoglobin on the first postoperative day. The time to removal of the urinary catheter/drainage tube was shortened, and the drainage volume was also significantly reduced in the ERAS group. There was no significant difference in the visual analogue scale (VAS) scores on postoperative return to the ward, but the ERAS group had lower scores on the first, second, and third postoperative days. There were no significant differences in the incidence of complications, other than 10% more nausea and vomiting in the control group. The limb function scores at one-year follow-up were similar between the two groups, but time to radiological fracture union and time to return to physical work and sports were significantly reduced in the ERAS group. The implementation of a series of perioperative nursing measures based on the concept of ERAS in PLWH with limb fracture can significantly reduce the operating time and intraoperative blood loss, reduce the occurrence of postoperative pain and complications, and accelerate the improvement of the functional status of the affected limb in the early stage, which is worthy of applying in more medical institutions.

Defining the potential for sexual structures-sparing for prostate cancer external beam radiotherapy: A dosimetric study

PurposeThe purpose of the study was to evaluate the dosimetric impact of sexual-sparing radiotherapy for prostate cancer, with magnetic resonance-only treatment planning. Material and methodsFifteen consecutive patients receiving prostate cancer radiotherapy were selected. A synthetic CT was generated with a deep learning method from each T2-weighted MRI performed at the time of treatment planning. For each patient, two plans were performed: standard treatment planning and sexual-structures sparing treatment planning. The treatment plan was designed to deliver a dose of 78Gy to the prostate and 50Gy to the seminal vesicles in 2Gy daily fractions, using volumetric arc therapy. Dose–volume histograms were computed to compare treatment plans. ResultsAll plans fulfilled dosimetric objectives and were equivalent regarding planning target volume coverage. The doses delivered to both rectum, bladder, and femoral heads were similar between plans (P=0.20). Sexual-sparing plans enabled to decrease all dosimetric parameters on sexual organs-at-risk. The mean penile bulb dose in sexual-sparing plans was significantly reduced (21.1Gy±20.7 versus 13.4Gy±14.0, P<0.01), however with large variability observed between individuals. The mean dose delivered to the corpora cavernosa was also significantly reduced within sexual-sparing plans (13.1Gy±16.7 versus 8.6Gy±10.4, P<0.01). A significant reduction was also observed in the highest doses delivered to internal pudendal arteries (D10%: 48.4Gy±8.3 versus 33.1Gy±4.6, P<0.05; D5%: 52.0Gy±8.7 versus 36.8Gy±5.5, P<0.05). ConclusionSparing of sexual structures appears feasible, without compromising neither planning target volume coverage nor doses delivered to non-sexual organs at risk. The clinical significance of this dose-reduction requires prospective evaluation.

A Bronze Age town in the Khaybar walled oasis: Debating early urbanization in Northwestern Arabia.

Recent exploration of the Khaybar oasis by the Khaybar Longue Durée Archaeological Project (AFALULA-RCU-CNRS) has led to the discovery of an exceptional Bronze Age fortified site called al-Natah. For the first time in Northwestern Arabia, the characteristics of a third/second-millennium-BCE settlement can be assessed over a large area. Preliminary archaeological survey and soundings have revealed a fortified 2.6-hectares town built around 2400-2000 BCE which lasted until at least 1500 BCE and possibly 1300 BCE-but with possible interruptions-, functionally subdivided into a residential area, a probable decision-making zone and a necropolis. The nucleated dwellings were constructed following a standard plan and were connected by small streets. By comparison with neighboring oasis centers, we suggest that Northwestern Arabia during the Bronze Age-largely dominated by pastoral nomadic groups and already integrated into long-distance trade networks-was dotted with interconnected monumental walled oases centered around small fortified towns. And by comparison with the contemporary situation in the Southern Levant, we also envisage that the archaeological record bears witness to a 'low urbanization' (or 'slow urbanism'), indigenous to North Arabia, evidencing weak but increasing social complexity through the Early and Middle Bronze Ages.

Recommendations and future perspective for follow-up and rehabilitation after surviving cardiac arrest

Cardiac arrest (CA) survivorship is associated with risk of cognitive deficits, emotional and social consequences. Early recognition of these symptoms and referral to rehabilitation is considered to be the fifth link in the chain of survival. This review highlights the need for a national standardized care plan for CA survivors based on a multidisciplinary approach. A patient-tailored law-bound rehabilitation form is essential to proper services in Denmark and should be mandatory. Further research within different rehabilitation areas following CA is warranted to support clinical practice.

Simulation of lunar soil compressive strength performance test based on grey correlation analysis

Detecting water ice in the permanent shadow area of the lunar south pole is an important task of China's Chang'e-7. For this purpose, a simulation study was carried out under the earth environment, and a test sample of polar water-containing simulated lunar soil was prepared. The mechanical properties of the lunar soil simulant were tested under ultra-low temperature conditions, and the changes in water content, relative density, temperature, loading rate, and base material ratio with compressive strength were analyzed. The results show that the compressive strength of the frozen lunar soil simulant increases with the increase of water content, increases with the increase of density, and increases with the decrease of temperature. It is less affected by the change of loading rate. The order of compressive strength affected by different base material ratios is: 100%anorthosite, &lt;90%anorthosite, +10%basalt &lt;70%, +30%anorthosite &lt;100%, basalt, lunar soil simulant. Finally, the correlation between the basic physical properties of lunar soil simulant such as water content, relative density, temperature, loading rate, and ratio and compressive strength is explored through grey correlation analysis. The correlation order is: water content&gt; density&gt; temperature&gt; ratio&gt; loading rate. This paper prepared and tested the mechanical properties of hydrated lunar soil, and proposed a more systematic and standardized implementation plan. It serves as the basis for studying the properties of hydrated lunar soil in the polar region, and provides a theoretical basis and reference for subsequent lunar soil simulation research.

Clinical and pathological characteristics of gastric large cell neuroendocrine carcinoma: A report of 2 cases series and literature review.

Gastric large cell neuroendocrine carcinoma (LCNEC) is a rare, aggressive neuroendocrine carcinoma that arises from the stomach and with high malignancy. Patients with gastric LCNEC usually have a poor prognosis. The standard treatment plan has not been established and its curative effect is poor. The present study described 2 cases diagnosed with gastric LCNEC and reviewed in depth the literature to improve our understanding more about this uncommon tumor and further to provide more experience to diagnose and treat this disease. The present study reported 2 cases of gastric LCNEC in male patients aged 51 and 73 years old, respectively. Both patients had epigastric discomfort, pain, acid reflux and heartburn. The medical history was unremarkable. The ulcerative lesion located at gastric was examined in the 2 patients by taking the esophagogastroduodenoscopy (EGO), computed tomography (CT) and digital gastrointestinal radiography (GI), that both were suspected gastric malignancy. Endoscopic biopsies of the tumor led to the initial diagnosis of gastric cancer. Postoperative pathological and immunohistochemical examinations of the surgical specimens confirmed that 1 case had mixed adeno-neuroendocrine carcinoma (MANEC) and the other had LCNEC. Both patients underwent surgical resection and received etoposide-cisplatin combination chemotherapy following surgery. The operation was successful. Both patients had uneventful recoveries following surgery, and had been followed-up regularly. The general condition was satisfactory, and no tumor metastasis was observed at present.

Treating Anxiety-Based Cognitive Distortions Pertaining to Somatic Perception for Better Chronic Pain Outcomes: A Recommendation for Better Practice in the Present Day and the Cyber Age of Medicine.

Anxiety-based cognitive distortions pertaining to somatic perception (ABCD-SPs)-primarily catastrophizing, fear avoidance, and kinesiophobia-have been repeatedly linked to worsening chronic, non-cancer pain (CNCP) outcomes of increased disability, amplified pain, ineffective opioid use, and opioid misuse. Several studies have suggested that treating ABCD-SPs can improve pain outcomes, yet identification and targeting of ABCD-SPs are not part of the standard medical pain assessment and treatment plan. Utilizing a narrative review of proposed mechanisms, published patient perspectives, and study correlations connecting these cognitive distortions with CNCP outcomes, an approach for better practice in the delivery of standard medical CNCP care can be deduced and formulated into a Belief and Behavior Action Plan (BBAP) for medical clinicians treating CNCP to implement into initial and maintenance care planning. These recommendations require relatively few resources to implement and have the potential to disseminate more effective CNCP treatment on a large scale now and in the future with the new frontier of cognitive computing in medicine.

Optimizing Stroke Care Transitions: A Patient-Centered Discharge Program for Caregivers

Inadequate discharge planning can worsen long-term outcomes for patients with stroke, delaying their recovery. Equipping caregivers with the knowledge to manage rehabilitation needs is crucial for facilitating a smooth hospital-to-home transition. The study aims to assess the effectiveness of a “Patient-Centered Discharge Program for Caregivers” on the comprehensiveness and clarity of discharge advice provided to caregivers of stroke survivors. Using a quasi-experimental design, the study compared a control group receiving standard discharge planning and an experimental group receiving the “Patient-Centered Discharge Program for Caregivers.” 62 caregivers of stroke survivors formed the participant pool. The program focused on various comprehensive discharge advice domains delivered to the caregivers. The discharge advice, knowledge, and skills of caregivers regarding stroke care were assessed on the day of discharge through questionnaires and checklists. Compared to the control group, the discharge instructions of the experimental group became more comprehensive and clear, with a significant improvement in knowledge and skills regarding stroke care ( p &lt; .05). The knowledge scores of the caregivers showed a statistically significant difference from the control group, with a mean difference of 8.78. ( p &lt; .05). The experimental group demonstrated good skills in nearly all procedures compared to the control group, including oral care, range of motion exercises, feeding, suctioning, and back care ( p &lt; .05). The “Patient-Centered Discharge Program for Caregivers” led to the delivery of more comprehensive discharge instructions, subsequently increasing caregivers’ knowledge. It highlights the benefits of such programs in equipping caregivers for effective discharge planning, with future research needed to evaluate long-term benefits. Trial/Protocol Registration: Clinical Trials Registry India (CTRI) CTRI/2023/07/055602 Link: https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=89913&amp;EncHid=35558.64662&amp;modid=1&amp;compid=19

The Digital Lives of the Poor: Entertainment Traps and Information Isolation

Smartphones have enabled the delivery of life-improving information services to base-of-the-pyramid (BOP) consumers. However, little is known about how the poor interact with the digital world. Through a novel app we developed to investigate real-time smartphone usage, we identify an unnoticed barrier to digital information access by the poor—data shortages. By analyzing over 9.4 million minutes of smartphone usage data from 929 residents of a Mumbai settlement, we find that entertainment consumes 61% of their phone time. Our data reveal that under universally adopted monthly data plans, low-income individuals binge on YouTube and social media, resulting in data shortages and information isolation in the late-plan period. We offer a practical operational solution to this problem—shorter data-replenishment cycles—which serve as a commitment device to curb binge usage. We randomly assign participants to a “capped plan”—with daily data usage caps—or a standard (monthly) plan. Assignment to the capped plan increases late-plan access of invites to health camps sent via WhatsApp, increases attendance at these in-person camps by 27%, and reduces social media binge usage. Most participants (particularly those with low self-control and high fear of missing out) prefer the capped plan, even when costlier—clearly signaling demand. Because capped plans are inherently cheaper to provide, offering them could enable providers to increase BOP customer value and expand access. Our results suggest an opportunity to amplify the impact of life-improving services targeted at the poor by leveraging users’ interactions with smartphone technology. This paper was accepted by Victor Martínez de Albéniz, operations management. Funding: Financial support from The Wheeler Institute for Business &amp; Development is gratefully acknowledged. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2024.4989 .

Research on the Modular Design Method and Application of Prefabricated Residential Buildings

As one of the key ways to realize the industrialization and green development of construction, prefabricated construction is conducive to saving resources and energy and improving labor productivity and quality. Aiming to solve the problem of the lack of standardization in the design of prefabricated residential buildings, which leads to the components not being universally used and the industrial characteristics not being fully embodied, while excessive standardization leads to a lack of personalization and flexibility, the modular design theory is applied to the standardized design of prefabricated residential buildings in this study. The application route of modular design theory in the standardized design is constructed, that is, “system decomposition—module design—module combination”. Taking residential buildings within a height of 54 m as an example, each basic functional module is standardized and combined into standard plans. At the same time, the functional space module design based on modular coordination and the module combination design based on the trinity of “modulus, pattern, and mode” are discussed. This research is of great significance for giving full play to the comprehensive benefits of prefabricated concrete structures in quality improvement, cost reduction, and rapid assembly.

General dentists’ treatment plans in response to cosmetic complains; a field study using unannounced-standardized-patient

BackgroundThis field study explored general dentists' treatment plans in response to the request for cosmetic services of an unannounced standardized patient (USP) in Mashhad, Iran. MethodsThe researcher, as a USP, visited 24 and 23 offices in a high-income and a low-income area, respectively. The primary complaint was that, according to her friend's comments, a dental student, her smile was "crooked and yellow" due to the congenitally missing tooth number 10 and peg-shaped tooth number 8. The dentists' treatment plans for teeth color and form and the cosmetic services expenses were recorded. The treatment plans of the two areas were compared. ResultsFor dental form, most dentists' treatment plans were categorized as "No intervention" (privileged area: 37.5 %, less-privileged area: 56.53 %, and total: 46.80 %). The percentage of dentists in the privileged area who prescribed cosmetic services was twice that of the less-privileged area (33.33 % versus 17.39 %). The intervention for dental form varied from placing 1 unit of composite veneer to 10 units of ceramic laminates or orthodontics with a wide range of treatment costs ($42.09 to $1079.14). For tooth color, most dentists (privileged area: 62.50 %, less-privileged area: 30.43 %, and total: 46.80 %) were categorized as "Interventionists." For tooth color, the treatment plans varied from scaling and root planing, bleaching, and composite veneer with various costs ($7.19 to $197.84). ConclusionCosmetic treatment plans and expenses varied significantly for a single USP, with many not aligning with the standard treatment plan. Some dentists offered treatments even without a chief complaint from the patient. Dentists in privileged areas were twice as likely to prescribe cosmetic treatments compared to those in less privileged areas. Therefore, cosmetic services necessitate monitoring, establishing clear diagnostic criteria, and implementing educational interventions.

Development of a 3D-printed phantom for total skin electron therapy dose assessment.

Total skin electron therapy (TSET) is a complex radiotherapy technique, posing challenges in commissioning and quality assurance (QA), especially due to significant variability in patient body shapes. Previous studies have correlated dose with factors such as obesity index, height, and gender. However, current treatment planning systems cannot simulate TSET plans, necessitating heavy reliance on QA methods using standardized anthropomorphic phantoms and in-vivo dosimetry. Given the relatively few studies on rotational techniques, comprehensive data in commissioning could streamline the process. Developing a full-body phantom would enable a more thorough TSET commissioning process, including testing for position-specific dose distributions and comprehensive measurements across all body surfaces, unlike the typical torso-only phantoms. This was created using digital modeling software, fabricated using 3D-printing FDM technology, and filled with tissue-equivalent gelatine. The phantom was positioned at an SSD of 340cm and irradiated with a standard rotational TSET plan using the 6E HDTSE mode on a Varian TrueBeam linac at gantry angles of±18° from the horizontal. The dose was measured at over 50 points across the surface using Gafchromic EBT3 film. Dose distributions were generally consistent with existing literature values from in-vivo dosimetry, with several position-specific differences identified, including the hands and scalp compared to conventional positions. Hotspots were observed for the mid-dorsum of the foot and nose, with areas under 80% of the dose identified as the soles of the feet, perineum, vertex of the scalp, top of the shoulder, and palm of the hand. Additionally, analysis using an interpolated dose heatmap found that 90% of the pixel area received a dose within 10% of the prescribed dose, indicating good uniformity with the commissioned technique. With high agreement with the current literature, a 3D-printed phantom proves effective for measuring doses in areas typically unmeasurable in TSET commissioning.

A novel multi-channel applicator with a U-shaped channel for vaginal intracavity brachytherapy.

Endometrial cancer is one of the most common gynecological malignancies in the world. Vaginal brachytherapy is an important postoperative adjuvant treatment for endometrial cancer. However, a common problem with existing applicators is insufficient dose at the vaginal apex. This study describes the Hangzhou (HZ) cylinder, a novel 3D printed vaginal intracavity brachytherapy applicator, detailing its characteristics, dose distribution, and clinical applications. The HZ cylinder is distinguished by its unique structure: a U-shaped channel with a 2mm diameter, a straight central axis channel of the same diameter, and 10 parallel straight channels. For comparison, standard plans were employed, designed to ensure that a minimum of 95% of the prescribed dose reached 5mm beneath the mucosal surface. We conducted comparative analyses of mucosal surface doses and doses at a 5mm depth below the mucosa between the HZ cylinder and a conventional single-channel cylinder across various treatment schemes. Additionally, the study examined dose differences in target volume and organs at risk (OARs) between actual HZ cylinder plans and hypothetical single-channel plans. In the standard plans, mucosal surface doses at the apex of the vagina were 209.32% and 200.61% of the prescribed dose with the HZ and single-channel cylinders, respectively. The doses on the left and right wall mucosal surfaces varied from 149.26% to 178.13% and 142.98% to 180.75% of the prescribed dose, and on the anterior and posterior wall mucosal surfaces varied from 128.87% to 138.50% and 142.98% to 180.75% of the prescribed dose. Analysis of 24 actual treatment plans revealed that when the vaginal tissue volume dose covering 98% (vaginal D98%) was comparable between the HZ cylinder and virtual single-channel plans (6.74±0.07Gy vs. 6.69±0.10Gy, p=0.24), rectum doses of HZ cylinder plans were significantly lower than those of single-channel plans (D1cc, 5.96±0.56Gy vs. 6.26±0.71Gy, p=0.02 and D2cc, 5.26±0.52Gy vs. 5.56±0.62Gy, p=0.02). The HZ cylinder demonstrates a reduction in dose to the rectum and bladder while maintaining adequate target volume coverage. Its mucosal surface dose is comparable to that of the traditional single-channel cylinder. These findings suggest that the HZ cylinder is a viable and potentially safer alternative for vaginal brachytherapy, warranting further investigation with larger sample sizes.

Inpatient Management of Pain Episodes in Children with Sickle Cell Disease: A Review.

Sickle cell disease (SCD) is the most common hemoglobinopathy in the world. Sickle cell vaso-occlusive episodes (VOEs) are very painful acute events and the most common complication as well as reason for hospitalization. SCD pain is best evaluated holistically with a pain functional assessment to aid in focusing pain management on reducing pain in addition to improving function. Patients with SCD have long endured structural racism and negative implicit bias surrounding the management of pain. Thus, it is important to approach the management of inpatient pain systematically with the use of multi-modal medications and nonpharmacologic treatments. Furthermore, equitable pain management care can be better achieved with standardized pain plans for an entire system and individualized pain plans for patients who fall outside the scope of the standardized pain plans. In this article, we discuss the best practices to manage SCD VOEs during an inpatient hospitalization.

An open label randomized controlled trial of the effects of rice bran oil on cardiometabolic risk factors, lipid peroxidation and antioxidant status in overweight/obese adults with metabolic syndrome

IntroductionWe previously documented the beneficial effects of rice bran oil (RBO) on cardiac function and atherogenic cardiometabolic factors in men with coronary artery disease. Therefore, the existing evidence in this area aims to be expanded by investigating the impact of adding RBO to a daily standard diet on emerging insulin resistance surrogate markers, lipid peroxidation, antioxidant status, and metabolic disturbances in individuals with metabolic syndrome (MetSyn) through an open-label controlled trial.MethodsA total of 50 overweight/obese adults (mean body mass index (BMI) = 31.08 kg/m2) with at least 3 MetSyn components were randomly allocated to either the control group, which received a standard diet plan, or the intervention group, which was supplemented with 30 g/d RBO for 8 weeks. BMI, MetSyn components, metabolic score for insulin resistance (METS-IR), triglyceride‒glucose‒BMI (TyG‒BMI), malondialdehyde (MDA), total antioxidant capacity (TAC), and plasma polyphenol levels were measured before and after this open-label trial.ResultsAnalysis of covariance (ANCOVA) adjusted for baseline values revealed that, compared with patients who received only a standard diet, those who were supplemented with 30 g/d RBO presented significantly lower total cholesterol (P value = 0.005; effect size (ES):-0.92), LDL-cholesterol (P value = 0.048; ES:-0.62), fasting blood glucose (P value = 0.014; ES:-0.77), MDA (P value = 0.002; ES: -1.01), METS-IR (P value < 0.001; ES: -1.24), and TyG-BMI (P value = 0.007; ES:-0.85) after 8 weeks. Additionally, RBO consumption resulted in significantly higher levels of HDL-C (P value = 0.004; ES:0.94) and TAC (P value < 0.0001; ES:2.05). However, no significant changes were noted in BMI, waist circumference, serum triglycerides, plasma polyphenols, or blood pressure.ConclusionAlthough the current findings suggest that the hypocholesterolemic, antihyperglycemic, and antioxidative effects of 30 g/d RBO seem to be promising for MetSyn patients, they should be considered preliminary. Therefore, further well-designed clinical trials with larger sample sizes and longer durations are needed to confirm these findings.

Automatic Generation of Standard Nursing Unit Floor Plan in General Hospital Based on Stable Diffusion

Automatic Generation of Standard Nursing Unit Floor Plan in General Hospital Based on Stable Diffusion

A comparison between 3D printed models and standard 2D planning in the use of metal block augments in revision knee arthroplasty.

The study focused on the ability to predict the need and size of femoral and tibial augmentation using standard two-dimensional (2D) templates and models created with three-dimensional (3D) printing in surgical planning. This observational cohort study included 28 consecutive patients (22 females, 6 males; mean age: 71±7.3 years; range, 54 to 82 years) with periprosthetic joint infection recruited between March 2021 and September 2023 undergoing revision total knee arthroplasty revision (TKA). Standard planning was made using calibrated X-ray images. The 3D planning started with computed tomography scans to generate a 3D template of the distal femur and proximal tibia. The model was exported to a 3D printer to produce a patient-specific phantom. The surgery was then simulated on the 3D phantom using revision knee arthroplasty instrumentation to evaluate the appropriate augmentation to use until a correct alignment was obtained. Three-dimensional planning predicted the need for femoral and tibial augments in 22 (78.6%) cases at both the tibial and femoral components, while 2D planning correctly predicted the need for augmentation in 17 (60.7%) for the tibial side and 18 (64.3%) for the femoral side. The Cohen's kappa demonstrated a significant agreement between the 3D planning for the femoral metal block and the intraoperative requirement (kappa=0.553), whereas 2D planning showed only nonsignificant poor agreement (kappa=0.083). In contrast, the agreement between 2D or 3D preoperative planning for tibial augment and the intraoperative requirement was nonsignificant (kappa=0.130 and kappa=0.158, respectively). On the femoral side, 2D planning showed only a fair nonsignificant correlation (r=0.35, p=0.069), whereas 3D planning exhibited substantial agreement with the actual thickness of the implanted augment (r=0.65, p<0.001). On the tibial side, 3D and 2D planning showed substantial agreement with the actual size of implanted augments (3D planning, r=0.73, p<0.001; 2D planning, r=0.69, p<0.001). Prediction based on 3D computed tomography segmentation showed significant agreement with the intraoperative need for augmentations in revision TKA. The results suggest that planning with 3D printed models represents a stronger aid in this kind of surgery rather than standard 2D planning, providing greater accuracy in the prediction of the required augmentation in revision TKA.

Reducing Length of Stay in Reconstructive Head and Neck Surgery Patients: A Quality Improvement Initiative.

To investigate whether a new preoperative education and discharge planning protocol reduced unexpected discharge delays for patients undergoing reconstructive surgery for head and neck cancer. A quality improvement (QI) intervention was implemented in January 2021 with several components to address historically prolonged observed lengths of stay (LOS) with head and neck cancer patients. The intervention added a preoperative educational visit with a head and neck cancer advanced practice provider, a standardized preoperative speech and swallow assessment, a personalized patient care plan document, discussion of inpatient hospital stay expectations, and early discharge planning. The intervention group included patients who underwent the preoperative education protocol from February to December 2021. For comparison, an age and sex-matched control group was constructed from inpatients who had been admitted for similar procedures in the 2 years prior to the QIintervention (2019-2020) and received standard of care counseling. Our study demonstrated a significant reduction in observed to expected LOSratio after implementation of the intervention (1.24 ± 0.74 control, 0.95 ± 0.52 intervention; P = .012). We discuss a preoperative education QI intervention at our institution. Our findings demonstrate that our intervention was associated with decreased LOS for patients undergoing head and neck reconstructive surgeries. This QI study shows the benefit of a new standardized preoperative education and discharge planning protocol for patients undergoing head and neck reconstructive surgeries.

Cervical metastasis of breast cancer: A case report and literature review.

Cervical metastasis of breast cancer is rare and its clinical manifestations are similar to those of primary cervical cancer. It is thus easy to misdiagnose, with diagnosis mainly depending on pathology and immunohistochemistry. There have been few studies on its treatment and there is thus no standard treatment plan. This is a 64-year-old female patient presented with a 2-month history of abnormal postmenopausal vaginal discharge, who had previous history of breast cancer. Based on the gynecological examination, imaging results, pathology, and immunohistochemical results, a diagnosis of metastatic carcinoma of the cervix and breast cancer was confirmed. She received computed tomography-guided 3-dimensional high-dose-rate brachytherapy in combination with chemotherapy. She achieved complete response locally. This case provides a new local treatment option for patients with inoperable localized cervical metastases. We hope that this report and the accompanying review help to enrich the literature pertaining to the treatment of rare cervical metastases, providing a foundation for the improved survival of affected patients.