Treatment Protocols Research Articles

Bilateral Corneal Endotheliitis Following Corneal Cross-linking with Riboflavin and Ultraviolet A

Abstract This case report aims to document a case of bilateral endotheliitis occurring shortly after riboflavin-assisted cross-linking (CXL) in a young male patient with progressive keratoconus. The objective is to identify potential risk factors, treatment strategies, and outcomes while considering relevant literature on similar cases. A male in his late adolescence with bilateral progressive keratoconus underwent bilateral CXL using riboflavin and ultraviolet A light exposure. Postoperatively, the patient received moxifloxacin drops, prednisolone acetate drops, and artificial tears. Seven days later, the patient presented with decreased vision, photophobia, and corneal findings consistent with endotheliitis. Treatment with prednisolone acetate and moxifloxacin eye drops was initiated. Two months later, visual acuity deteriorated, but anterior slit-lamp findings improved, and the intraocular pressure measurement was high. Prednisolone acetate was tapered, whereas loteprednol etabonate gel, brimonidine eye drops, and cyclosporine eye drops were initiated. After 7 months, visual acuity improved, and endotheliitis resolved, although mild residual central haze persisted. This case highlights the occurrence of acute idiopathic endotheliitis following routine CXL and its successful management. Although limited cases have been reported, a standardized treatment protocol is lacking. In our patient, the utilization of loteprednol etabonate gel, cyclosporine eye drops, brimonidine eye drops, and regular follow-up examinations led to improved clinical findings and visual acuity. Further studies are warranted to establish optimal treatment approaches for similar cases of endotheliitis following CXL.

Presentation and outcome of Gastric Cancer at a Tertiary Care Center

Introduction: Gastric cancer is the fifth most common cancer globally and the fourth leading cause of cancer-related deaths. Early-stage disease can be managed with endoscopic therapy or surgery, while advanced gastric cancer requires a multimodal treatment approach, including extensive lymphadenectomy. This study aims to evaluate the clinicodemographic profile and treatment outcomes of gastric cancer patients and to establish an effective therapeutic strategy. Methods: This retrospective descriptive cross-sectional study was conducted in the Department of Surgery at Shree Birendra Hospital. It included patients with gastric malignancies who had complete medical records. Data on patient history, AJCC staging, operative details, and postoperative findings were analyzed. Surgical choices were based on the clinical indication in each case. Clinicopathological characteristics and surgical outcomes were compared across tumor stages. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 24. Results: The study included 90 patients (62 males, 28 females) aged between 23 and 82 years. The most common clinical presentations were abdominal pain (58%), gastric outlet obstruction (18%), lump (5%), anemia (5%), and peritonitis (4%). Adenocarcinoma was the predominant histological type (87.78%). Curative surgery was performed on 73 patients (81.11%), while 17 patients (18.89%) underwent palliative procedures. Morbidity occurred in 16 patients (17.7%), primarily due to chest complications and sepsis, and mortality was recorded in 5 patients (5.5%). Conclusion: This study highlights the predominance of locally advanced gastric cancer in males, with distal gastric cancer and well-differentiated adenocarcinoma being the most common. Chest complications and sepsis were the leading causes of morbidity and mortality. No patients received perioperative chemotherapy, underscoring the need for updated treatment protocols to improve outcomes.

Variability of Loa loa microfilarial counts in successive blood smears and its potential implication in drug-related serious adverse events

BackgroundThe standard method to diagnose Loa loa infection and quantify microfilarial density (MFD) is the microscopic examination of calibrated thick blood smears (TBSs). In 1950, it was noticed that successive L. loa MFD samples from a single capillary puncture could exhibit up to 20% variation. Although loiasis treatment allocation is based on MFD to prevent serious adverse events (SAEs), data on this variability are scarce. There are also no guidelines supporting the collection and analysis of one or two TBSs.MethodsWe assessed the variability of two successive L. loa MFD samples (MFD1 and MFD2), collected from 255 patients. We analyzed the influence of sex, age, weight, heart rate, arterial pressure, body temperature, and sampling time on MFD variability, as well the impact of MFD variability on MFD thresholds relevant to loiasis treatment protocols.ResultsThe MFD2 was found to have increased in 63% (1145/1826) of TBS pairs and to have decreased in 37% (681/1826) of TBS pairs. The MFD2 were on average 28% higher than the MFD1. These variations drove a total of 333 (17.4%) changes in MFD classes according to loiasis treatment protocol, including 210 (11.3%) class increases. TBSs generated from blood samples from subjects with lower MFD (1–1000 mf/ml) or lower mean arterial pressure (MAP; 55–80 mmHg), or from blood samples collected at an earlier hour time-point (10:00–10:59 a.m.) were more subject to MFD2 variability in a multivariate analysis. The MFD relative change was not constant over time for a given person.ConclusionsWe observed a trend towards an increase in MFD2 with an important variability between samples that may impact loiasis treatment allocation. We suggest that systematically sampling at least two successive TBSs might allow better MFD assessments to prevent post-treatment SAEs. Further studies are needed to verify this variability in larger samples as well as confirm the potential explanatory variables identified.Graphical

Evaluation of the efficacy of NB-UVB phototherapy and topical decapeptide versus NB-UVB phototherapy, topical decapeptide, and carbon dioxide laser in the treatment of stable vitiligo

Background: Vitiligo is an acquired disorder of autoimmune destruction of melanocytes. The management challenges include stabilizing the disease and devising methods for inducing repigmentation. Phototherapy and laser therapy offer promising results, along with topical treatments such as Basic Fibroblast Growth Factor (bFGF)-related topical decapeptide. Aims: This prospective interventional study aimed to assess and compare the efficacy of a triple combination therapy of fractional CO2 laser, Narrow Band-Ultraviolet B (NB-UVB) phototherapy, and topical decapeptide with dual combination of NB-UVB phototherapy and topical decapeptide in the treatment of stable vitiligo. Methods: Patients with stable vitiligo were enrolled for 15 months and divided into two groups: one receiving dual combination therapy and the other the triple combination therapy. Lesions were evaluated using a quartile-grading scale at regular intervals over 16 weeks. Vitiligo noticeability scale (VNS) was used by an independent observer (who was not a part of the study) and by the patient/attendant to eliminate any observation bias. Statistical analysis was done using Pearson chi-square test. Results: Of the 32 enrolled patients, the triple combination therapy demonstrated superior repigmentation outcomes compared to dual therapy, with statistically significant differences observed at all assessment intervals. Side effects were mild and transient. Conclusion: The study highlights the efficacy of triple combination therapy in treating stable vitiligo, particularly for patients with refractory vitiligo. Further research with larger sample sizes and longer follow-up periods is warranted to validate these findings and optimize treatment protocols.

CONTRIBUIÇÕES DA FISIOTERAPIA AQUÁTICA: REABILITAÇÃO EM PACIENTES COM LESÃO MEDULAR ESPINHAL TRAUMÁTICA

Aquatic Physical Therapy (APT) has been reported as applicable in various specialties within the physiotherapy field, culminating in rehabilitation procedures, especially after Spinal Cord Injury (SCI), with beneficial results for individuals with this condition. It tends to be more effective in restoring some or all movement, initially with plegia, presenting a decrease and even absence of strength and balance post-trauma in the vertebral column region, leading to spinal cord injury. The aquatic environment provides the patient with a bombardment of sensory-motor stimuli, further activating neuroplasticity in rehabilitation, as well as reducing pain, providing relaxation of all muscles, and increasing blood supply to the muscles. In addition to being a therapy in a safe environment, an important factor is the reduction of joint impact and improvement in venous return, making it possible to recover movements. Objective: To understand the contributions of aquatic physiotherapy in functional rehabilitation in (SCI). Methodology: Based on bibliographic research, using the electronic databases Bireme, PubMed, and Scielo, with articles published from 2000 onwards. Conclusion: Aquatic physiotherapy and its benefits in health recovery, achieved through the physical properties of water, have been studied since the time of Hippocrates, which, combined with physiotherapy treatment protocols, promote better functional rehabilitation for patients with (SCI).

INFLUENCE OF POPLITEUS MUSCLE MANIPULATION AND QUADRICEPS STRENGTHENING ON ANTERIOR KNEE PAIN IN RUNNERS

Background: Anterior knee pain is prevalent among young athletes, with sports-related injuries accounting for 25–30% of cases. Patellofemoral pain syndrome (PFPS) contributes to up to 40% of knee disorders, with annual prevalence rates reported at 22.7% in the general population and 28.9% in adolescents. Among runners, the incidence of PFPS ranges from 37% to 56%. Objective: The popliteus muscle is primarily associated with anterior knee pain but may also influence posterior knee discomfort. This study aims to investigate the effects of soft tissue manipulation of the popliteus muscle combined with quadriceps strengthening exercises on anterior knee pain in athletic runners, addressing a gap in the literature regarding the interaction between these muscle groups. Methods: In this experimental study, 30 subjects with non-traumatic anterior knee pain were recruited. Baseline assessments included quadriceps strength and pain levels. Participants then underwent six sessions of popliteus manipulation alongside quadriceps strengthening exercises. Post-intervention, all parameters were reassessed. Results: A significant reduction in knee pain (P < 0.005) was observed after the six-week intervention, with more pronounced improvements in Group A compared to Group B. Conclusion: The results suggest that incorporating popliteus soft tissue manipulation can effectively reduce anterior knee pain while strengthening the quadriceps enhances muscle function. These findings support the integration of popliteus manipulation into treatment protocols for athletes experiencing anterior knee pain.

Magnetic resonance imaging-guided single-fraction preoperative radiotherapy for early-stage breast cancer (the RICE trial): feasibility study

BackgroundOver the past decade, the adoption of screening programs, digital mammography, and magnetic resonance imaging (MRI) has increased early-stage breast cancer diagnosis rates. Mortality rates have decreased due to early detection and improved treatments, including personalized therapies. Accelerated partial-breast irradiation (APBI) is emerging as a convenient and effective treatment for some patients, with studies exploring its preoperative use. Preoperative APBI, especially with MRI guidance, offers improved tumor targeting and potentially reduced side effects. Magnetic Resonance Imaging-Guided Single-Fraction Pre-Operative Radiotherapy for Early-Stage Breast Cancer (RICE trial) aims to assess the feasibility and efficacy of MRI-guided single-dose radiotherapy (RT) for early-stage breast cancer.MethodsThe RICE study is a prospective, single-arm study evaluating single-fraction preoperative, APBI treatment for patients with early-stage breast cancer using a magnetic resonance imaging linear accelerator (MRI linac). Eligible patients enrolled in this study will have a core biopsy to confirm estrogen receptor-positive and HER2-negative sub-type. RT planning will use a planning computed tomography (CT) co-registered with a MRI with the patient in either the supine or prone position. For the diagnostic workup, [18F] fluorodeoxyglucose positron emission tomography/CT ([18F] FDG PET/CT) and [18F] fluoroestradiol positron emission tomography/CT ([18F] FES PET/CT) will be performed prior to treatment. Thirty patients will receive a single ablative RT dose of 21 Gray to the tumor. Pre-treatment and post-treatment MRI scans will be acquired at baseline and 5 weeks post-RT respectively. Breast-conserving surgery will be scheduled for 6 weeks after APBI treatment using the MRI linac.The primary study endpoint is the successful administration of a single fraction of preoperative breast RT under the guidance of an MRI linac. Secondary endpoints include evaluating the utility of MRI, [18F] FDG PET/CT, and [18F] FES PET/CT as a non-invasive method for assessing treatment response in patients undergoing single-fraction preoperative APBI.ConclusionThe RICE trial represents a significant step in breast cancer treatment, offering insights that could lead to treatment protocols with minimized RT appointments and enhanced patient outcomes.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registered 31st of May 2021. Registration number: ACTRN12621000659808.

Biphenotypic Sinonasal Sarcoma: Literature Review of a Peculiar Pathological Entity—The Neurosurgical Point of View

Background: Biphenotypic sinonasal sarcoma (BSNS) is a low-grade tumor of the sinonasal tract with frequent extension to the orbit and skull base. Due to its rare incidence and recent histopathological and molecular characterization, little data are available in regard to its natural history, treatment and surveillance protocol. Methods: A comprehensive literature review in Embase online electronic databases on BSNS was made. The analyzed factors included the patients’ sex and age, presenting symptoms and signs, anatomical origin and pattern of growth of the tumor, immunohistochemical and molecular features, time to treatment, type of treatment, surgical approach, extent of resection, peri- and post-operative complications, adjuvant therapies, clinical outcome, recurrence and overall survival rates. Results: This literature review involved 34 studies for an overall series of 149 cases of BSNS. The female (66.9%) and middle-aged populations (median 54.88 years old) were mainly affected. The most frequent clinical onset was nasal obstruction (81%), followed by facial discomfort (44%), epistaxis (15.5%) and ocular impairment (14.3%). Ethmoid sinus (67.8%) and nasal cavity (45.4%) were the most common anatomical site of tumor origin, while an extension to the orbit and skull base was registered in 28.7% and 24.5% of cases. Surgery was the main treatment, especially in the form of endoscopic endonasal approach (56.9%), and allowed for gross total resection in 79% of cases. The recurrence rate was 26.2%; three cases of tumor-related death were reported. Median follow-up was 4.6 years. Conclusions: Biphenotypic sinonasal sarcoma is a rare and unique tumoral entity in terms of biological and clinical behavior. Based on the current knowledge, surgery plays the leading role in treatment, accounting for gross total tumor resection in most cases, allowing for clinical symptom and sign resolution and presenting a low rate of perioperative complications. The type of approach and the aim of surgery should be assessed case by case according to patient and pathology features and the surgeon’s experience, as well as the aim of the treatment. Further studies including large surgical series and with long follow-up are required to define prognostic factors and guidelines of treatment for this peculiar pathological entity.

The effect of cold atmospheric plasma on viability of osteoblasts and expression of RANKL and OPG genes in medium with bisphosphonates.

Medication-related osteonecrosis of the jaw is a rare but severe complication with challenging treatment protocols. Cold atmospheric plasma (CAP) has shown promising effects in wound healing, cell proliferation and viability. This study investigated the effect of CAP on osteoblasts in a culture medium containing bisphosphonates. Pilot study was designed to determine the optimal setting of CAP. MG-63 cells were exposed to zoledronic acid at a concentration of 10 micromolar for 72h. Study groups with the best MTT assay results, were chosen for assessing OPG and RANKL genes by RT-PCR. Cell viability was significantly higher in groups 9kV.1mm.90s, 10kV.1mm.60s, and 12kV.1mm.60s (P < 0.05). Expression of RANKL in these groups was significantly lower than the positive control group (medium culture without zoledronic and plasma treatment) and higher than the BP group (culture with zoledronic without plasma treatment), except for the 12kV.1mm.60s group, which did not differ significantly from the positive control group (P > 0.05). OPG decreased in all test groups compared to BP (p < 0.05), except for the 12kV.1mm.60s group, which did not significantly differ from BP (P > 0.05). RANKL/OPG ratio in groups 9kV.1mm.90s and 12kV.1mm.60s significantly increased compared to BP (P < 0.05).CAP treatment may enhance the viability of osteoblasts exposed to bisphosphonates, increase their activity levels, enhance osteoclast activity, and improve bone turnover rates.

HBsAg trajectories and key thresholds toward functional cure of hepatitis B

Chronic hepatitis B virus (HBV) infection remains a pivotal global health challenge. The pursuit of a functional cure for hepatitis B remains an ardent and intricate issue in clinical settings, as the current arsenal of nucleos(t)ide analogues (NAs) primarily achieves sustained suppression of HBV DNA but falls short in fully addressing clinical needs. The standalone use of Peg-interferon (PEG-IFN) or its combination with NAs still fails to satisfy the pressing clinical demands for functional cure. However, groundbreaking advancements in hepatitis B treatment have emerged through the research and development of antiviral agents with novel mechanisms, notably small nucleic acid drugs, which have ushered in a new era for functional cure prospects. Leveraging longitudinal data spanning multiple time points of HBsAg levels, we can now delineate the trajectory leading towards HBV functional cure and devise predictive models that refine clinical treatment protocols. Two pivotal thresholds of HBsAg levels emerge as crucial milestones, facilitating the selection of eligible participants for clinical trials. This refinement in screening enhances the personalized management of hepatitis B, tailoring interventions to individual patient needs and maximizing outcomes.

Psychology of nerve injury, repair, and recovery: a systematic review

BackgroundPeripheral nerve injuries (PNIs) are associated with significant physical and psychological challenges, impacting both functional recovery and quality of life. Despite the physical focus of traditional treatments, psychological factors play a crucial role in the outcomes of PNI repair and recovery.ObjectivesThis systematic review aims to evaluate the impact of psychological and social factors on the repair and recovery of peripheral nerve injuries.MethodsA comprehensive literature search was conducted in PubMed/Medline, EMBASE, and Cochrane databases, covering studies from January 1985 to December 2022. A total of 36,190 records were identified, and after screening with Rayyan AI and applying inclusion criteria, 111 articles were selected for review.ResultsThe review highlights that pre-existing psychological conditions, as well as psychological responses to the injury and treatment, significantly influence recovery outcomes in PNI patients. Psychological interventions, when integrated into standard care, may improve functional recovery and quality of life.ConclusionsPsychosocial factors are critical in the management of PNIs and should be incorporated into treatment algorithms to enhance patient outcomes. Future research should focus on developing and integrating psychological support strategies in PNI treatment protocols.

Objective assessment of docking site consolidation in bone transport: the role of pixel value ratio in predicting healing outcomes

BackgroundThe management of docking site healing in bone transport remains a significant challenge in orthopedic surgery. Traditional assessment methods rely heavily on qualitative radiographic evaluations. This study investigates the utility of pixel value ratio (PVR), an objective quantitative measure, in assessing bone healing at the docking site during bone transport.MethodsThis retrospective study included 47 patients who underwent bone transport for lower limb reconstruction between January 2015 and January 2020. Patients were categorized into bone union (n = 35) and nonunion (n = 12) groups based on docking site outcomes. PVR was calculated using two methods (PVR1 and PVR2) at six time points over 24 months post-docking. Subgroup analyses were performed based on gender, age, and surgical site.ResultsOf 47 patients, 35 achieved bone union and 12 experienced nonunion. Both PVR1 and PVR2 were consistently lower in the union group compared to the nonunion group at all time points (p < 0.001). In the union group, PVR1 ranged from 1.064 ± 0.050 to 1.108 ± 0.062, while PVR2 ranged from 0.926 ± 0.079 to 0.946 ± 0.062. In the nonunion group, PVR1 ranged from 1.204 ± 0.057 to 1.273 ± 0.020, and PVR2 from 1.039 ± 0.060 to 1.148 ± 0.022. Subgroup analyses revealed that males had significantly lower PVR values compared to females, and tibial cases had lower PVR values compared to femoral cases in both union and nonunion groups (p < 0.05). All juvenile patients achieved union, compared to 71.4% of adults (p < 0.01).ConclusionPVR demonstrates significant potential as an objective tool for assessing docking site healing in bone transport procedures. The distinct patterns observed between union and nonunion cases provide a foundation for developing clinical guidelines to monitor and predict healing outcomes. Integration of PVR assessment into clinical practice could improve decision-making and optimize treatment protocols in bone transport procedures.

Combined Nabpaclitaxel pressurized intraPeritoneal aerosol chemotherapy with systemic Nabpaclitaxel-Gemcitabine chemotherapy for pancreatic cancer peritoneal metastases: protocol of single-arm, open-label, phase II trial (Nab-PIPAC trial)

Abstract Objectives Current therapies show limited efficacy against peritoneal metastases (PM) from pancreatic cancer. Pressurized intra-peritoneal aerosol chemotherapy (PIPAC) has emerged as a novel intraperitoneal drug delivery method. Recently, a dose-escalation study identified the safe dose of Nabpaclitaxel for PIPAC administration, an ideal intraperitoneal chemotherapy agent against pancreatic cancer. Combining systemic NabPaclitaxel-Gemcitabine with NabPaclitaxel-PIPAC may enhance disease control in pancreatic cancer patients with PM. Methods The Nab-PIPAC trial is a single-center, prospective, open-label, phase II study (ClinicalTrials.gov identifier: NCT05371223). Its primary goal is to evaluate the antitumor activity of the combined treatment based on Disease Control Rate (DCR) using RECISTv.1.1 criteria. Secondary objectives include feasibility, safety, pathological response, progression-free and overall survival, nutritional status, quality of life, pharmacokinetics of NabPaclitaxel-PIPAC, and PM molecular evolution via translational research. The treatment protocol consists of three courses, each with two cycles of intravenous NabPaclitaxel-Gemcitabine and one cycle of NabPaclitaxel-PIPAC, with standard metastatic pancreatic cancer doses for the former and 112.5 mg/m2 for the latter. Sample size follows Simon’s two-stage design: 12 patients in stage one and 26 in stage two (80 % power, 0.1 alpha). Results Partial results will be available after first stage enrollment. Conclusions This trial aims to determine the antitumor efficacy and safety of combining NabPaclitaxel-PIPAC with systemic NabPaclitaxel-Gemcitabine in pancreatic cancer patients with PM.

Mathematical Exploration of Malaria Transmission Dynamics: Insights from Fractional Models and Numerical Simulation

AbstractThis study presents an innovative mathematical model denoted as the fractional SIP(H)–SI(M) model, which aims to analyze and understand the dynamics of malaria transmission and spread. This model is distinguished by incorporating memory effects through fractional differential equations, allowing for a more accurate and realistic analysis of disease spread compared to traditional models. The proposed model is applied to Algeria by estimating its parameters using recent health data (from 2000). The results revealed that the disease‐free equilibrium is stable only when the basic reproduction number is less than one, indicating that controlling the spread of malaria and possibly eradicating it can be achieved by implementing appropriate preventive measures. Simulations also demonstrated a direct correlation between the rate of infection transmission and an increase in the number of infected individuals, highlighting the need for swift action when signs of an outbreak emerge. Based on these findings, a set of preventive measures is recommended, including insecticide spraying programs, widespread distribution of insecticide‐treated bed nets, and implementation of effective treatment protocols for infected individuals. This study also emphasizes the importance of continuous monitoring of health data and updating model parameters to ensure the effectiveness and sustainability of preventive measures.

Biophysics of ACL injuries

Anterior Cruciate Ligament (ACL) injuries rank among the most prevalent and severe types of injuries, significantly impacting both athletes and non-athletes alike. These injuries not only result in immediate physical impairment, such as intense pain, substantial swelling, and a marked loss of mobility, but also carry long-term health consequences that can alter a person’s quality of life. Chronic pain, persistent instability, and an increased risk of developing osteoarthritis are among the lasting effects that can follow an ACL injury. An in-depth understanding of the biophysics behind ACL injuries is paramount for devising effective prevention and treatment protocols. Biophysics, which combines principles from physics with biological systems, provides crucial insights into the mechanical and structural integrity of the ACL and its susceptibility to injury under various conditions. This systematic review aims to collate and synthesize the current knowledge surrounding the biophysical mechanisms that underlie ACL injuries. The review encompasses a range of factors, including the biomechanical forces that place stress on the ligament, anatomical structures that may predispose individuals to injury, and physiological conditions that affect ligament health and resilience. Each of these factors plays a crucial role in the incidence and severity of ACL injuries. Biomechanical forces, for example, can involve sudden changes in direction or impact during physical activity, leading to excessive stress on the ACL. Anatomical factors might include variations in bone structure or ligament alignment that inherently increase the risk of injury. Additionally, physiological conditions such as muscle strength, flexibility, and overall ligament health can influence the likelihood and extent of an ACL injury. The findings of this review underscore the necessity of adopting integrated approaches in both injury prevention and rehabilitation. Such approaches must consider the multifaceted nature of ACL injuries, involving not only mechanical and anatomical aspects but also physiological and possibly even genetic factors. By emphasizing a multi-faceted understanding, interventions can be more effectively tailored to address the complex interplay of elements that contribute to ACL injuries. This holistic approach can lead to better outcomes for those at risk of or recovering from ACL injuries, enhancing the efficacy of prevention strategies and rehabilitation protocols.

Catalyzing IVF outcome prediction: exploring advanced machine learning paradigms for enhanced success rate prognostication

This study addresses the research problem of enhancing In-Vitro Fertilization (IVF) success rate prediction by integrating advanced machine learning paradigms with gynecological expertise. The methodology involves the analysis of comprehensive datasets from 2017 to 2018 and 2010–2016. Machine learning models, including Logistic Regression, Gaussian NB, SVM, MLP, KNN, and ensemble models like Random Forest, AdaBoost, Logit Boost, RUS Boost, and RSM, were employed. Key findings reveal the significance of patient demographics, infertility factors, and treatment protocols in IVF success prediction. Notably, ensemble learning methods demonstrated high accuracy, with Logit Boost achieving an accuracy of 96.35%. The implications of this research span clinical decision support, patient counseling, and data preprocessing techniques, highlighting the potential for personalized IVF treatments and continuous monitoring. The study underscores the importance of collaboration between gynecologists and data scientists to optimize IVF outcomes. Prospective studies and external validation are suggested as future directions, promising to further revolutionize fertility treatments and offer hope to couples facing infertility challenges.

Predictive Model of the Effects of Skin Phototype and Body Mass Index on Photobiomodulation Therapy for Orofacial Disorders

Monte Carlo techniques have been extensively used for planning laser-based clinical procedures such as photobiomodulation. However, the effects of several biological tissue characteristics regarding its morphological structure and physiological parameters have not been carefully addressed in many applications. Specifically, many questions remain concerning the effect of skin phototype and body mass index on the effectiveness of photobiomodulation for extraoral therapies. To address these questions, a Monte Carlo simulation model of the effects of body mass index-dependent skin structure on different Fitzpatrick skin types was developed, specifically tailored for the morphological characteristics of cheek tissue. The model describes the settings of a typical oral photobiomodulation treatment protocol for pain relief, namely the use of 660 nm and 808 nm laser wavelengths and a therapeutic dose of 2.0J/cm2 on the masseter muscle. The simulations were used to train a machine learning predictive model aimed at accelerating the treatment planning stage and assessing the importance of patient-specific parameters. A multiple-regression approach was adopted to predict muscle dose and treatment time for effective delivered dose. Body mass index had little effect on epidermal energy deposition, but an important impact on muscle dose parameters. Phototype also influenced muscle dose, but to a lesser extent than body mass index. The results of this study can be used to develop customized dosimetry phototherapy protocols to promote more effective and safe clinical outcomes.

Steam Treatment Controls Cyclamen Mite (Phytonemus pallidus) Without Compromising Strawberry Plant Survival, Growth and Yield

ABSTRACT Cyclamen mite is a pest of strawberry that is difficult to control due to its small size and preference for inhabiting concealed spaces in new plant growth. Steam treatment of transplants effectively reduces some strawberry pathogens and may be a valuable tool against cyclamen mite. Strawberry transplants (“Jewel” and “Annapolis”) that were artificially infested with cyclamen mite were steam-treated at 44°C for 1 h or at 48°C for 0.5 h. Both treatments reduced cyclamen mite numbers by > 99% compared to the control, and 44°C for 1 h had no negative effects on plant survival, growth or yield. In a second, similar, field experiment, transplants (“Jewel”) were categorized by crown size as small (6–8 mm) and large (10–13 mm) and steam-treated at 44°C for 1 or 4 h. Steam treatments reduced cyclamen mite numbers by 92–93% compared to the control, but in the 4 h treatment, survival of small crowns was 40%. Steam treatment of strawberry transplants at 44°C for 1 h is an effective tool and may reduce reliance on miticides for cyclamen mite control. Additional research is needed to determine the optimal steam treatment protocols for cyclamen mite control and to understand the effect of the steam treatment on strawberry transplants with different crown sizes.

Australian psychologists' attitudes towards psychedelic-assisted therapy and training following a world-first drug down-scheduling.

This study explores the attitudes of psychologists towards psychedelics and psychedelic-assisted therapy (PAT) following the world-first regulatory changes in 2023 in Australia which permitted psilocybin and 3,4-methylenedioxy-methamphetamine (MDMA) to be used in clinical services. A purposive sample of 20 Australian psychologists was recruited using snowball sampling. Semi-structured interviews were conducted which explored participants' attitudes, knowledge and concerns about PAT. Data were coded and analysed to identify and develop theme categories. Most psychologists exhibited positive attitudes towards psychedelics and their therapeutic potential, viewing them as promising for addressing chronic mental health conditions like depression. However, there was a notable concern regarding the limited evidence on efficacy and potential adverse experiences, as well as the complexity of the individualised treatment protocol. Despite enthusiasm, many psychologists had limited detailed knowledge about the interventions themselves. The need for comprehensive education and training programs, including exposure to psychedelic experiences and credible higher education institutions, was emphasised to ensure competence in administering PAT. Psychologists displayed notably positive attitudes towards PAT, likely reflecting both shifting perceptions of psychedelics and self-selection bias within the sample. Despite this optimism, concerns were raised about psychiatric risks and the necessity for comprehensive and reputable training and supervision. The cohort showed openness to both novel treatments and innovative training methods, underscoring the importance of enhancing educational frameworks to ensure effective implementation of PAT.

Enhancing outcomes of childhood acute lymphoblastic leukemia in workplace diversity in Thailand: multicenter study on behalf of the Thai Pediatric Oncology Group.

The Thai Pediatric Oncology Group (ThaiPOG) has adapted treatment regimens from the Children's Oncology Group (COG) to enhance outcomes for childhood acute lymphoblastic leukemia (ALL). This study examined the risk factors and treatment results of pediatric ALL in Thailand. This multicenter study included newly diagnosed children (< 18years) with ALL in 19 centers between January 1, 2015, and December 31, 2019. Most of the 1,157 patients (97.6%) were treated according to ThaiPOG protocols. The genetic testing was performed in 71% of patients. The patients were classified as standard (n = 539), high (n = 402), and very high (n = 130) risks. The 5-year event-free survival (EFS) and overall survival (OS) rates were 75% (95% confidence intervals (CI), 72%-77.8%) and 81.7% (95% CI, 78.9%-84.1%), respectively. The 5-year EFS rates of the standard-, high-, and very high-risk groups were 78.5% (95% CI, 74.1%-82.3%), 73.6% (95% CI, 68.5%-78%) (p = 0.761), and 65% (95% CI, 55.1%-73.3%) (p = 0.001), respectively, and the 5-year OS rates were 86.9% (95% CI, 83.1%-89.9%), 77.3% (95% CI, 72.5%-81.4%) (p = 0.001), and 73.1% (95% CI, 63.7%-80.4%) (p = 0.001), respectively. The independent risk factors for relapse and death were age ≥ 10years, white blood cells (WBCs) ≥ 50,000/mm3, M2 or M3 marrow status at the end of induction, and high-risk group. The overall outcome of Thai pediatric ALL has improved after the implementation of new modified COG treatment protocols. High-risk characteristics of ALL increased adverse outcome risk.