Treatment Techniques Research Articles

Full robotic versus open ALPPS: a bi-institutional comparison of perioperative outcomes

BackgroundIn primarily unresectable liver tumors, ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) may offer curative two-stage hepatectomy trough a fast and extensive hypertrophy. However, concerns have been raised about the invasiveness of the procedure. Full robotic ALPPS has the potential to reduce the postoperative morbidity trough a less invasive access. The aim of this study was to compare the perioperative outcomes of open and full robotic ALPPS.MethodsThe bicentric study included open ALPPS cases from the University Hospital Zurich, Switzerland and robotic ALPPS cases from the University of Modena and Reggio Emilia, Italy from 01/2015 to 07/2022. Main outcomes were intraoperative parameters and overall complications.ResultsOpen and full robotic ALPPS were performed in 36 and 7 cases. Robotic ALPPS was associated with less blood loss after both stages (418 ± 237 ml vs. 319 ± 197 ml; P = 0.04 and 631 ± 354 ml vs. 258 ± 53 ml; P = 0.01) as well as a higher rate of interstage discharge (86% vs. 37%; P = 0.02). OT was longer with robotic ALPPS after both stages (371 ± 70 min vs. 449 ± 81 min; P = 0.01 and 282 ± 87 min vs. 373 ± 90 min; P = 0.02). After ALPPS stage 2, there was no difference for overall complications (86% vs. 86%; P = 1.00) and major complications (43% vs. 39%; P = 0.86). The total length of hospital stay was similar (23 ± 17 days vs. 26 ± 13; P = 0.56).ConclusionRobotic ALPPS was safely implemented and showed potential for improved perioperative outcomes compared to open ALPPS in an experienced robotic center. The robotic approach might bring the perioperative risk profile of ALPPS closer to interventional techniques of portal vein embolization/liver venous deprivation.

Non-invasive treatments improve patient outcomes in chronic tinnitus: a systematic review and network meta-analysis

ObjectiveTo investigate the relative effectiveness of various Non-Invasive Treatment Techniques (NITs) in chronic tinnitus management. MethodsWe searched PubMed, Embase and Cochrane Library databases from the time of data construction to December 31, 2022. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, NITs were evaluated, including Aacceptance and commitment therapy (A), Cognitive behavioral therapy (C), Sound therapy (S), Transcranial magnetic stimulation (T), Electrical stimulation therapy (E), Virtual reality therapy (V), tinnitus Retraining therapy (R), general psychotherapy (D), and Placebo (P). The outcome indicators included the Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire (TQ), Hospital Anxiety and Depression Scale-anxiety-Depression (HADS-D), Insomnia Severity Index (ISI), Visual Analogue Scales-Loudness (VAS-L), and Visual Analogue Scales-Distress (VAS-D). Statistical analysis was performed using Stata 14.0 for NMA. ResultsThis systematic review and meta-analysis included 22 randomized controlled trials comprising 2,354 patients. The treatment effects varied on each scale. For THI, S (86.9%) was the most effective, whereas P (6.5%) was the worst. For TQ, C (89.5%) was the most effective, whereas D (25.4%) was the worst. For HADS-D, A (82.4%) was the most effective, whereas D (9.47%) was the worst. For ISI, A (83.2%) was the most effective, whereas R (20.6%) was the worst. For VAS-L, S (73.5%) was the most effective, whereas E (18.9%) was the worst. For VAS-D, C (84.7%) was the most effective, whereas P (18.1%) was the worst. ConclusionsThe combination of acoustics and cognitive behavioral therapy may be an effectively treat patients with chronic tinnitus. Level of evidenceHow common is the problem? Level 2.Is this diagnostic or monitoring test accurate? (Diagnosis) Level 1.What will happen if we do not add a therapy? (Prognosis) Level 1.Does this intervention help? (Treatment Benefits) Level 1.What are the COMMON harms? (Treatment Harms) Level 1.What are the RARE harms? (Treatment Harms) Level 1.Is this (early detection) test worthwhile? (Screening) Level 1I.

Factors predicting the outcome of arthroscopic debridement and microfracture technique in treatment of osteochondral lesions of talus

Aims and Scope: Osteochondral lesions of the talus (OLT) are common injuries that occur following ankle sprains and fractures. Surgical management, either through open or arthroscopic technique, is required to eliminate the pain and restore the ankle’s function. This study aims to evaluate the prognostic significance of demographic variables and lesion’s characteristics. Method and Techniques: In this study, 40 ankle (40 patients), who underwent arthroscopic debridement and microfracture technique to treat osteochondral lesion of the talus, were evaluated retrospectively after two years. The functional outcome of the ankle joint was assessed by using foot – ankle disability score, (FADS), pain analysing scale score (PASS), American orthopaedic foot and ankle society (AOFAS) score, and Ogilvie-Harris scaling system. Then the association between patients’ age and gender, and the lesions’ characteristics, including size, grade, and location, were evaluated. Results: Outcome results varied according to the scoring system, but all patients achieved satisfied outcome and pain relieve. Younger patients with smaller lesions achieved a better clinical result. All measures including PASS, AOFAS, Ogilvie-Harris, FADS appeared to be significantly better in smaller lesions. (P-value <0.05) PASS and Ogilvie-Harris scales showed better results in younger patients. Ogilvie-Harris test result was notably superior in the lateral lesions. Conclusion: The patient’s age and size of the lesion are two prognostic factors of arthroscopic debridement and microfracture of OLTs. We believe arthroscopic management can be associated with a better outcome in lesions smaller than 1.5 cm in diameter and patients younger than 40-years-old. Level of Clinical Evidence: Level 2 – prognostic study

A Systematic Review of Loco-Sedative Anesthesia for Urologic Surgery

ObjectiveTo perform a systematic review of the characteristics and outcomes of conscious sedation and local anesthesia for various urologic procedures. Urologic care has much to gain from the routine integration of ambulatory surgery via loco-sedative anesthetic techniques for both surgeon and patient. MethodsA comprehensive systematic literature search was conducted on PubMed, and Scopus databases following PRISMA criteria from June to August 2021. Articles were included if they were English, prospective, randomized, or non-randomized controlled trials that used local anesthetic or conscious sedation for urologic interventions in adult patients. Additionally, included studies provided primary data on the use loco-sedative anesthesia and the efficacy and complications. All studies included were further reviewed to assess the biases and conflicts of interests. Results32 studies with 6897 patients were included in the review. Mean patient age was 46.4 years. The most common anesthetic and analgesic relief was the use of local anesthetic with 1% lidocaine. The majority used lidocaine as an injection, whereas the second most common route of administration was a topical cream. However, there was significant heterogeneity in the type of local or conscious sedation method and whether a combination was used. 44.4% of the studies used the visual analog scale as their primary endpoint. All the studies reported an 83% to 100% successful procedure rate without note of significant sedation-related complications. ConclusionsGiven the high efficacy rates, loco-sedative anesthesia is a promising technique for urologic interventions and should be further investigated to determine whether it may become be the standard of care.

Effects of different irrigation activation methods on root canal treatment of primary teeth.

There is currently a lack of research on the application of newly developed irrigation techniques in root canal treatment of primary teeth. This study aimed to evaluate the effects of various irrigation activation techniques on two key parameters: apical debris extrusion (ADE) and dentinal tubule penetration depth (DTPD) of the root canal filling material. A total of 96 primary mandibular second molars were randomly divided into 4 groups: Group 1-Conventional Needle Irrigation (CNI), Group 2-XP-Endo Finisher (XPF), Group 3-EndoActivator (EA), and Group 4-Passive Ultrasonic Irrigation (PUI). In all groups, the One Reci single-file system was used for root canal preparation. For ADE measurement, each group was rinsed with distilled water. For DTPD assessment, sodium hypochlorite (NaOCl) was applied. ADE quantification was performed by collecting debris in pre-weighed Eppendorf tubes. A combination of fluorescent dye and root canal filling material (DiaPex Plus) was used for root canal filling. In order to examine DTPD, horizontal cross-sections of the coronal and apical regions of the teeth were taken with a thickness of 1 mm. The maximum and mean DTPD was examined by confocal laser scanning microscopy. Data were analyzed using the Kruskal-Wallis, One-way ANOVA, and Mann-Whitney U tests (p = 0.05). As a result, PUI had the highest mean ADE and CNI had the lowest mean ADE, while CNI had the highest mean DTPD in both the coronal and apical regions, whereas PUI had the lowest mean DTPD in the coronal region, and EA had the lowest mean DTPD in the apical region. There were no statistically significant differences in DTPD and ADE among the four groups. Comparing intragroup maximum DTPD across all groups, it was significantly higher in the coronal region than in the apical region (p < 0.05). ADE and DTPD of root canal filling materials in primary teeth did not differ significantly among CNI, XPF, EA and PUI irrigation activation techniques.

Effectiveness and safety of a ventricular septal occluder device for the treatment of Gastro-tracheal fistula

Gastro-tracheal fistula (GTF) is one of the most serious complications after esophagogastrostomy and radiotherapy, with very high disability and mortality rates. To evaluate the effectiveness and safety of ventricular septal occluder devices (VSOD) for the treatment of Gastro-tracheal fistula (GTF). From January 2020 to May 2022, 14 patients with GTF underwent VSOD under real-time fluoroscopy. The technical success, complications, quality of life (QoL), Eastern Cooperative Oncology Group (ECOG) score, Karnofsky score, and median overall survival (mOS) were recorded and analyzed. Technical success, and major complication rates were 71.4%, and 14.3%, respectively. Both the ECOG and the Karnofsky score showed significant improvement at the 2-month evaluation compared with the pretreatment value (p<0.05). For QoL, general health, physical function, vitality, role physical, and social function all improved at the 2-month evaluation (p<0.05), but bodily pain, role emotion, and mental health showed no significant difference (P>0.05). During the mean follow-up of 9.6 months, eight patients were alive, and the mOS was 11.4 months (95% CI, 8.5-14.3). VSOD is a simple and safe technique for GTF treatment, but long-term observation is needed at multiple centers to confirm our findings.

A novel technique of percutaneous transhepatic treatment of biliary-enteric anastomotic occlusive strictures with compliant balloon-occluded distal cholangiography and large-bore catheter: a retrospective case series.

Endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary balloon dilatation (PTBD) is a challenge in resolving biliary-enteric anastomotic occlusive strictures (BEAOS) and/or coexisting stones. The biliary-enteric anastomosis (BEA) often cannot be seen because of the surgically altered gastrointestinal anatomy. Here, a technique that combined percutaneous compliant-occluded distal cholangiography and the maintenance of a large-bore catheter is described to resolve this issue. A retrospective review of 10 patients who presented with BEAOS with/without coexisting stones who were treated with percutaneous compliant balloon-occluded distal cholangiography, bile duct stone removal, and the maintenance of a large-bore catheter between February 2017 and January 2021 was performed. Treatment response, laboratory examinations, including hepatic function tests, routine blood tests, and blood electrolytes, complications, and imaging data were evaluated. Paired t-tests were used to investigate the difference of laboratory examinations before and after the procedure. All 10 cases were technically successful. A total of 9 stones in 6 patients were successfully removed by the compliant balloon. All catheters were removed after the patency of the stricture was confirmed by percutaneous transhepatic cholangiography (PTHC) 6 months later. No severe adverse events occurred during the perioperative period. There were 2 patients who experienced episodes of cholangitis during the follow-up period (mean, 17 months; range, 4-24 months), and neither BEAOS nor bile duct stones recurred within 2 years after the procedure. White blood cells (WBC), total bilirubin (TB), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were (6.0±1.4)×109/L and (6.0±1.6)×109/L (P=0.91), 31.4±15.7 and 29.6±10.3 µmol/L (P=0.74), 50.8±20.0 and 85.8±67.0 U/L (P=0.16), and 42.6±15.2 and 71.8±44.9 U/L (P=0.09) pre and postintervention, respectively. Percutaneous transhepatic compliant balloon-occluded distal cholangiography and the maintenance of a large-bore catheter probably provide an effective and safe alternative method for resolving BEAOS and/or coexisting stones.

Clinical comparison of silver diamine fluoride (SDF) or silver-modified atraumatic restorative technique (SMART) on hypomineralised permanent molars with initial carious lesions: 3-year results of a prospective, randomised trial

ObjectivesThis study aimed to assess the clinical outcomes of utilizing silver diamine fluoride + potassium iodide (SDF + KI) treatment and Silver-Modified Atraumatic Restorative Technique (SMART/SDF + KI + Glass Ionomer Cement) over a three-year period on hypomineralised permanent molars with initial carious lesions. Methods112 hypomineralised permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF + KI and SMART (SDF + KI + GIC) groups (n = 56 teeth/group) in a split-mouth design. Hypersensitivity and caries development were evaluated in both groups. Schiff Cold Air Sensitivity Scale (SCASS) was used for evaluation of hypersensitivity, and the modified USPHS criteria were utilised for clinical assessments of SMART sealants at 1,6,12,18,24 and 36 months. Fisher's Exact test, Kaplan-Meier Survival Curves, Log-rank test, Mann Whitney U test, and Friedman test was performed for the statistical analysis. ResultsThe caries preventive effect was 100 %, 67.9 % and 65.4 % for SDF + KI-treated teeth; and 100 %, 97.6 % and 94.7 % for SMART(SDF + KI + GIC)-treated teeth at 12, 24 and 36 months, respectively. The mean survival probabilities for caries-preventive effect were significantly lower in SDF + KI-treated teeth (31.01 months) than SMART-treated teeth (35.61 months), (p < 0.001). Twenty-six molars with initial hypersensitivity due to hypomineralization demonstrated a significant reduction at all evaluation periods compared to baseline SCASS scores (p < 0.001). Additionally, there was no significant difference in hypersensitivity scores between the groups during the re-call periods, and none of the teeth exhibited hypersensitivity at the 18-month and beyond evaluations. ConclusionsDuring the three-year assessment, both groups demonstrated effectiveness in reducing sensitivity in hypomineralised molars. However, SMART (SDF + KI + GIC) sealants offered better protection against tooth decay over time, despite experiencing gradual retention loss. Clinical significanceBoth SMART (SDF + KI + GIC) sealants and SDF + KI proved effective in alleviating hypersensitivity in hypomineralised molars for up to three years. SMART (SDF + KI + GIC) sealants showed greater caries-preventive effect compared to SDF + KI. However, continuous long-term monitoring is crucial due to the gradual decline in retention of SMART (SDF + KI + GIC) sealants. ClinicalTrials registration numberNCT03862014.

Glycomacropeptide: A comprehensive understanding of its major biological characteristics and purification methodologies.

Glycomacropeptide (GMP) is a bioactive peptide derived from whey protein, consisting of 64 amino acids. It is a phenylalanine-free peptide, making it a beneficial dietary option for individuals dealing with phenylketonuria (PKU). PKU is an inherited metabolic disorder characterized by high levels of phenylalanine in the bloodstream, resulting from a deficiency of phenylalanine dehydrogenase in affected individuals. Consequently, patients with PKU require lifelong adherence to a low-phenylalanine diet, wherein a significant portion of their protein intake is typically sourced from a phenylalanine-free amino acid formula. GMP has several nutritional values, numerous bioactivity properties, and therapeutic effects in various inflammatory disorders. Despite all these features, the purification of GMP is an imperative requirement; however, there are no unique methods for achieving this goal. Traditionally, several methods have been used for GMP purification, such as thermal or acid treatment, alcoholic precipitation, ultrafiltration (UF), gel filtration, and membrane separation techniques. However, these methods have poor specificity, and the presence of large amounts of impurities can interfere with the analysis of GMP. More efficient and highly specific GMP purification methods need to be developed. In this review, we have highlighted and summarized the current research progress on the major biological features and purification methodologies associated with GMP, as well as providing an extensive overview of the recent developments in using charged UF membranes for GMP purification and the influential factors.

Maintenance treatment of immunotherapy after microwave ablation plus drug-eluting bead bronchial arterial chemoembolization for advanced non-small cell lung cancer: a retrospective single-center cohort study.

The combination therapy of immunotherapy and drug-eluting bead bronchial artery chemoembolization (DEB-BACE) or microwave ablation (MWA) has been attempted as an effective and safe approach for advanced non-small cell lung cancer (NSCLC). However, the outcomes of immunotherapy plus multiple interventional techniques for advanced NSCLC remain unclear. This retrospective study thus aimed to investigate the effectiveness and safety of the maintenance treatment of programmed cell death protein 1 (PD-1) blockade after MWA plus DEB-BACE for advanced NSCLC. This retrospective cohort study consists of 95 patients with advanced NSCLC who were treated with DEB-BACE between April 2017 and October 2022 and who were allocated to three groups: group A (MWA + DEB-BACE + PD-1 blockade; n=15), group B (MWA + DEB-BACE; n=25), and group C (DEB-BACE alone; n=55). The adverse events (AEs) were compared between the three groups. The outcomes were compared via Kaplan-Meier methods, including median progression-free survival (PFS) and overall survival (OS). Survival analyses were performed via the univariate and multivariate analyses to investigate the prognostic predictors. The overall incidence of AEs in the groups A-C was 53.3% (8/15), 36.0% (9/25), and 32.7% (18/55), respectively, which did not represent a significant difference (P=0.42). No severe AEs (SAEs) occurred. Group A, compared with group B and group C, had a significantly longer estimated median PFS (33.0 vs. 7.0 vs. 3.0 months; P<0.001) and OS (33.0 vs. 13.0 vs. 6.0 months; P=0.002). PD-1 blockade (P=0.006), tumor number (P=0.01), and DEB-BACE/bronchial artery infusion (BAI) chemotherapy cycles (P=0.04) were identified as the predictors of PFS, while the predictors of OS were PD-1 blockade (P<0.001), number of metastases (P<0.001), tumor diameter (P<0.001), and DEB-BACE/BAI cycles (P=0.02). Compared with that of advanced NSCLC treated with MWA plus DEB-BACE or DEB-BACE alone, the maintenance treatment of immunotherapy after MWA plus DEB-BACE might provide a superior prognosis without increasing the risk of AEs.

Dosimetric Comparison Between Proton and Photon Radiation Therapies for Pediatric Neuroblastoma

PurposeThe aim of this study is to determine the most beneficial radiation treatment technique for pediatric patients with thoracic and abdominal neuroblastoma (NBL), through a dosimetric comparison between photon Volumetric Modulated Arc Therapy and proton Intensity-Modulated Proton Therapy treatment plans. Materials and MethodsA retrospective analysis was conducted on a multicentre case series of 19 patients with thoracic and/or abdominal NBL who underwent radiation therapy, following the recommendations of the European protocol for high-risk NBL (HR-NBL2/SIOPEN). The prescribed dose was 21.6 Gy in 12 fractions (1.8 Gy/fraction) delivered over the preoperative disease volume. The dose volume histograms were analyzed for each patient, and a Wilcoxon signed-rank test with a significance level of 0.01 was employed to assess statistical differences between the dosimetric parameters investigated. Two homogeneity indices (HI and newHI) were compared to evaluate the uniformity in dose, delivered to the adjacent vertebrae (VBs_Adj). ResultsBoth radiation techniques conform to the protocol regarding CTV/PTV coverage for every location. Proton therapy resulted in statistically significant dose sparing for the heart and lungs in supradiaphragmatic locations and for the contralateral kidney, liver, spleen, and bowel in subdiaphragmatic locations. For both techniques, sparing the non-adjacent vertebrae (VBs_NAdj) results more challenging, although promising results were obtained. Furthermore, the dose delivered to the VBs_Adj was not statistically different, in terms of homogeneity, for the 2 radiation techniques that both met the protocol’s requirements. ConclusionThis dosimetric analysis highlights the potential of protons to reduce radiation dose to healthy tissue. These findings apply to all the investigated patients, regardless of primary tumor location, making proton therapy a valuable option for the treatment of neuroblastoma. However, a multidisciplinary assessment of each case is essential to ensure the selection of the most effective and suitable treatment modality.

Development of TRIP phenomenon using power refining of retained austenite by niobium

AbstractThe illustrations above demonstrate that as the percentage of niobium increases, the grain size decreases, leading to an increase in the stability of transformation induced plasticity steel. This, in turn, results in improved mechanical strength. The optimal volume fraction of retained austenite for a significant transformation induced plasticity effect to occur is reported to be in the range of 10 vol. %–20 vol. %. The volume fraction of retained austenite directly determines the carbon content and grain size of the retained austenite, its two main stabilization factors. The stability of the retained austenite dictates when the strain‐induced martensite transformation (SIMT) occurs during straining of transformation induced plasticity high strength steel. Unstable retained austenite transforms almost immediately upon deformation, increasing work hardening rate and formability during the stamping process. At the appropriate stability of the retained austenite, the Strain‐Induced Martensite Transformation begins only at strain levels beyond those produced during stamping and forming, and the retained austenite is still present in the final part; it can transform into martensite in the event of a crash, providing greater crash energy absorption. The tensile strength level of micro‐alloyed transformation induced plasticity steels may exceed 1 GPa. Grain refinement mechanism is considered as the most applied mechanism used in increasing of steel strength without deterioration of ductility and toughness. Recently, it was proposed that the grain refinement could act positively on promoting the transformation induced plasticity effect of advanced high strength steel through improving the stability of retained austenite. In this research, quenching and partitioning heat treatment technique was applied to four grades of low carbon steel with different percentage of niobium. Then, the effect of niobium on grain refinement has been detected by microstructure observations. Mechanical properties and strain hardening properties of investigated steel have been determined. In addition, by using x‐ray diffraction, as well as a new electric resistance‐based sensor, it was possible to characterize the stability of the retained austenite through the plastic deformation of steel. Grain refinement by using of niobium has a great impact on promoting the stability of retained austenite against the plastic stress at the plastic deformation zone.

Measurement of laser shock peening induced residual stress by nanoindentation and comparison with XRD technique

Laser shock peening (LSP) is an innovative surface treatment technique successfully used to improve fatigue performance of metallic components. It is based on the application of high intensity laser and suitable overlays with the aim to generate high pressure shock waves on the surface of the mechanical part to be treated. Shock waves generate severe plastic deformations and, consequently, compressive residual stresses (RS). An accurate measurement of these latter is crucial for predicting the resistance of treated parts under service loads and to assess the effectiveness of LSP process.In this paper, a non-destructive method, based on the nanoindentation technique and finite element analysis (FEA), was developed to measure the RS generated by LSP process on AA-7050-T451 samples. In particular, the methodology is based on the analysis of the nanoindentation peak load variation generated by the presence of residual stresses on a component. Obtained results were compared, for validation, with the measurements carried out by the most consolidated X-ray diffractometer (XRD) technique. The results showed a satisfactory agreement between the two techniques, revealing nanoindentation as a promising and reliable method for characterizing RS induced by LSP.

Treatment Related Acute Toxicities Between Treatment with 3D-CRT and IMRT in Localised Prostate Cancer.

To compare the acute toxicities of two radiation treatment techniques, intensity modulated radiation therapy (IMRT), and 3-dimensional conformal radiation therapy (3D-CRT) in localised prostate adenocarcinoma. Descriptive study. Place and Duration of the Study:Department of Oncology, Dr. Ziauddin Hospital, Karachi, Pakistan, from July 2016 to June 2022. Patients with localised prostate adenocarcinoma who underwent treatment using two different advanced radiotherapy techniques i.e., IMRT and 3D-CRT were recruited during the study period. They were followed up for six months for acute gastrointestinal (GI) and genitourinary (GU) adverse events (acute toxicities) related to both treatment modalities according to Modified radiation therapy oncology group (RTOG) criteria. The acute toxicities were assessed at the 2nd, 4th, and 6th week during treatment and at the 3rd and 6th month after treatment. There were 78 patients, with 39 patients in each group. The mean age was 68 ± 10 years in the 3D-CRT and 68 ± 07 years in the IMRT group. Patients in the IMRT group exhibited markedly lower treatment-related acute GI and GU effects at the end of 4th and 6th weeks for anorectal pain (p = 0.04) and (p = 0.01) and burning micturition (p = 0.003) and (p = 0.01), respectively. Furthermore, at 3 months anorectal pain (p = 0.02), loose stools (p = 0.005), and burning micturition (p = 0.01) were present and at 6 months anorectal pain was (p = 0.01) still present. Radiation therapy modalities 3D-CRT and IMRT both showed acceptable toxicity profile in the management of localised prostate cancer, while IMRT group exhibited significantly lower treatment-related acute GI and GU effects. 3D-CRT (3-Dimensional Conformal Radiation Therapy), IMRT (Intensity-Modulated Radiation Therapy), Radiation toxicity.

Study on one-step fast CRN mechanism for preparing fine AlON powder using carbon coated γ-Al2O3/C precursor

By pre-milling in glucose aqueous solution, γ-Al2O3 particles were uniformly mixed with carbon via hydrothermal treatment technique. Then, directly heating the γ-Al2O3/C precursor at 50 °C/min to 1775 °C for 15–30 min in N2, single phase AlON powder was fast obtained through one-step carbothermal reduction and nitridation (CRN). By approaching the evolution of phase assemblages and morphology during heating and dwelling, the one-step fast CRN mechanism for preparing fine AlON powder was revealed. The carbon around γ-Al2O3 particles delayed the phase transformation of Al2O3 from γ phase to α one. The undesired particle aggregation and growth before formation of AlON was also auxiliarily inhibited by swiftly achieving AlON formation temperature via high heating speed. Further elevating synthesis temperature enabled high reaction kinetics to boost the speed of AlON formation. By these ways, CRN reactions were quickly completed to fast obtain pure AlON powder with small primary particles due to limited particle aggregation and growth. The as-prepared fine AlON powder was easy to be ball-milled to prepare highly transparent AlON ceramics by pressureless sintering.

TEAM participation in the irradiation of IROC phantoms for cooperative group clinical trials

The participation of radiation oncology team members in the irradiation of Imaging and Radiation Oncology Core (IROC) phantom for cooperative group clinical trials is essential to comply with the latest quality management philosophy. Medical dosimetrists are expected to develop treatment plans for the irradiation of IROC phantoms. For advanced treatment techniques, such as three-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT), the irradiation of the IROC phantoms serves as quality audit. If successful, the irradiation processes demonstrate that the institution has the knowledge of the protocol, and has the appropriate equipment to comply with the protocol requirements. This article describes three IROC phantoms used for credentialing external beam photon beam therapy, delivered using conventional medical linear accelerators, to the medical dosimetry community. Guidance and strategies for the development of treatment plans are discussed. Our institutional irradiation of the three IROC phantoms, delivered using the Truebeam medical linear accelerator, resulted in consistent dose accuracy to within ±1%. The participation of the team members may reduce the overall published failing rate stated to be about one-third of all participating institutions.

Advanced Lightweight Structural Materials for Automobiles: Properties, Manipulation, and Perspective

The key drivers for automotive manufacturers to develop vehicles with decreased weight are the growing requirements for improved fuel efficiency. This endeavor not only tackles the issues related to fuel efficiency but also aligns with the objectives of enhanced recyclability and overall performance of the vehicle, encompassing factors like driving efficiency, braking characteristics, and collision safety. Herein, a successful strategy entails investigating and utilizing lightweight materials with superior performance as substitutes for conventional automotive materials such as cast iron and steel. This article provides a thorough analysis of the lightweight materials that are currently being researched and available for use in the production of next-generation cars. These materials include composites, light alloys, high-strength steel, and other innovative materials. The review covers all aspects of the life cycle of automotive materials, examining their mechanical and physical characteristics, production processes, characterization strategies, and their uses. Both the merits and limitations of these materials are analyzed, leading to a nuanced understanding of suitable scenarios for their application. In anticipation of future challenges, the study suggests that advancements in versatile materials or enhancements in manufacturing and treatment techniques hold promise for overcoming potential obstacles, ultimately facilitating the creation of more capable, safer, durable, and environmentally friendly vehicles.

Efficacy of Cognitive Behavioral Intervention in Improving Executive Function of Children with High Functioning Autism Spectrum Disorder: A Meta-analysis

This meta-analysis examines the efficacy of the cognitive behavioral approach to interventions toward the improvement of executive function for children/adolescents with high-functioning autism spectrum disorder (HF-ASD). This meta-analysis paper has identified ten studies involving 437 participants with high-functioning autism spectrum disorder aged between 5 and 18. All the participants reported IQs were at or above 70. A random effect meta-analysis yielded a moderately significant effect (Hedge g = 0.72) with significant heterogeneity [Q(10) = 228.36, p &lt; .001]. There were considerable variations in the executive function domain, i.e., working memory (hedge g = 1.23) and inhibition (g = 0.47), showing significant treatment effects. On the other hand, cognitive flexibility (g = -0.51) and planning (g = -0.07) show non-significant effects toward cognitive behavioral interventions. The finding suggests that the cognitive behavioral approach to intervention demonstrates efficacy in improving executive function in children or adolescents with high-functioning autism spectrum disorder. All the cognitive behavioral intervention studies were conducted in developed countries, so differences between the approaches between developed and developing countries were inconclusive. Future studies are needed to investigate the effectiveness of cognitive behavioral techniques in intervention for low-functioning autism spectrum disorder children.

Oncoplastic Surgical Techniques in Treatment of Central Breast Cancer

Oncoplastic Surgical Techniques in Treatment of Central Breast Cancer

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Calligraphy has been emphasized as an art that goes beyond mere functional acquisition, but expressing one’s temperament, character, personality, and emotions. It has evolved from the human nature theory that calligraphy represents one’s heart, establishes a close relationship between calligraphy and emotions, leads to the theory that calligraphy reflects one’s personality. Through the calligraphy theory and narrative activities, clinical experiments have shown that the calligraphy therapy plays a complementary role in treatment of adult diseases, depression, mental disorders, dementia, and autism, and effectively alleviates those symptoms. Therefore, this paper aims to explore therapeutic approaches by examining the relationship between calligraphy and mind, comparing from the stage before holding the brush to the stage at the end of the calligraphy writing with the mind-study methodology of pausing, breathing, observing, recognizing, putting down, and discovering grace. Therefore, this paper examined the process of preparing calligraphy, the process of writing by Phil-bub, the psychological effect according to the calligraphy, and the psychological purification effect through letters, sentences, and famous phrases, which are the contents of calligraphy. It confirmed that calligraphy can serve as an intervention technique in mind therapy beyond its aspects of discipline theory of body and mind. Engaging in calligraphy involves experiences of pause in the process of organizing one’s surroundings and gathering one’s mind before writing It enhances attention through breath control while using Mo-phil, finds peace of mind through concentration during overlapping strokes, and increases sense of accomplishment. Calligraphy is not only good for self-esteem recovery and strengthening immune system but also maximizing physiological activities, and promoting brain function. practicing calligraphy significantly contributes to health promotion.