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Purpose: This study aims to develop two piezoelectric textile devices formed from different weft knitted fabric rapports (Jersey and Pique) to be applied in the renewable energy's (RE) area. Design/methodology/approach: Two different weft knitted rapports were produced with polyester (PES). The device developed has five layers: a central of poly(vinylidene fluoride) (PVDF) nonwoven, involved by two insulating layers of PES knitted fabric; and two conductive external layers, made of polypyrrole-coated PES knitted fabric. The piezoelectric textile devices were joined by sewing the five layers of the device. Findings: The FTIR technique confirmed the β-phase in the PVDF nonwoven. This study produced and tested two different textiles devices with piezoelectric behavior, confirmed by the correlated pattern of voltage and tensile stress difference curves, showing the potential application in RE's and sustainable energies field as smart textiles, such as devices incorporated in garments in the areas of high movement (elbow, knee, foot, fingers and hands, among others), and as an energy generator device Originality/value: Textile materials with piezoelectric properties promise to advance RE's developments due to their high material flexibility and sensitivity to the electrical response. The knitted fabric technology presents flexibility due to its construction process. Comparative studies analyzing the electrical response between knitted and woven fabrics have already been realized. However, there is a gap in terms of research scientific research regarding the comparison of the piezoelectric effect in a material that presents different knitted fabric rapports. [ABSTRACT FROM AUTHOR]

Objective: Cognitive and psychiatric symptoms are frequently reported after SARS-CoV-2 infection, but their interplay has been only partially explored. We investigated frequency and severity of psychiatric symptoms in patients with persistent cognitive complaints after COVID-19. Methods: We conducted a cross-sectional study. Neurologists assessed 101 patients reporting cognitive symptoms after COVID-19. Patients were invited to fill a screening battery with self-reported psychometric scales (Depression Anxiety Stress Scales-21, Impact of Event Scale-Revised, Insomnia Severity Index). Patients scoring above validated cut-offs in ≥1 scale were referred to psychiatrists who administered the Mini-International Neuropsychiatric Interview (M.I.N.I.), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scales and asked to complete the Personality Inventory for DSM-5-Brief Form (PID-5-BF). Results: Out of the 57 referred patients, 38 (64.4%) accepted to undergo the psychiatric examination. Among these, 18 (47.4%) were diagnosed with adjustment disorder (23.7%), anxiety disorder (10.5%), major depressive disorder (7.9%), and post-traumatic stress disorder (2.6%). Pharmacologic treatment before post-COVID condition (present in 12 patients, 31.6%) was associated with a score above cut-off on the HAM-A and HAM-D scales. A longer duration of untreated psychiatric illness after COVID-19 was associated with worse scores on the same scales. Patients with a higher PID-5-BF total score had a higher probability of receiving a psychiatric diagnosis. Conclusion: Almost half of patients with post-COVID-19 conditions reporting cognitive symptoms were found to suffer from a psychiatric condition after psychiatric evaluation. The application of a psychiatric screening in a population suffering from long-term effects of COVID-19 can lead to early diagnosis and timely treatment. [ABSTRACT FROM AUTHOR]

Nocturnal hypoxemic burden has been shown to be a robust, independent predictor of all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF) and to occur in a severe form even in patients with low or negligible frequency of respiratory events (apneas/hypopneas). This suggests the existence of two components of hypoxemic burden: one unrelated to respiratory events and the other related. The aim of this study was to characterize these two components and to evaluate their prognostic value. Nocturnal hypoxemic burden was assessed in a cohort of 280 patients with HFrEF by measuring the percentage of sleep with an oxygen saturation (SpO 2) <90% (T90), and the area of the SpO 2 curve below 90% (Area90). Both indices were also recalculated within the sleep segments associated with respiratory events (event-related component: T90 Eve , Area90 Eve) and outside these segments (nonspecific component: T90 Nspec , Area90 Nspec). The outcome of the survival analysis (Cox regression) was all-cause mortality. During a median follow-up of 60 months, 87 patients died. T90, Area90, and their components were significant in univariate analysis (P <.05 all). However, when these indices were adjusted for known risk factors, T90, T90 Nspec , Area90, and Area90 Nspec remained statistically significant (P =. 018, hazard ratio (HR)=1.12, 95%CI=(1.02, 1.23); P =. 007, HR=1.20, 95% CI = [1.05, 1.37]; P =.020, HR = 1.05, 95% CI = [1.01, 1.10]; P =.0006, HR = 1.15, 95% CI = [1.06, 1.25]), whereas T90 Eve and Area90 Eve did not (P =.27, P =.28). These results were internally validated using bootstrap resampling. By demonstrating a significant independent association of nonspecific hypoxemic burden with all-cause mortality, this study suggests that this component of total nocturnal hypoxemic burden may play an important prognostic role in patients with HFrEF. [Display omitted] [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, health service practices underwent significant changes, impacting the occurrence of health care–associated infections (HAIs). This study presents the epidemiology of bacterial infections and compares clinical data on nosocomial infections in hospitalized patients before and during the pandemic. A unicentric, observational, retrospective cohort study was conducted with descriptive analyses on the microorganism identification and resistance profile. Patient's clinical data who had hospital-acquired infection (HAI), during their hospitalization in a tertiary hospital before and during the COVID-19 pandemic was compared by descriptive and inferential analyses. A total of 1,581 bacteria were isolated from 1,183 hospitalized patients. Among patients coinfected with COVID-19, there was a statistically significant increase in HAI-related deaths (P <.001) and HAI caused by multidrug-resistant organisms (P <.001), mainly by Acinetobacter baumannii and Staphylococcus aureus. A higher odds ratio of HAI-related deaths compared to the prepandemic period was observed (odds ratio 6.98 [95% confidence interval 3.97-12.64]). The higher incidence of multidrug-resistant bacteria and increased deaths due to HAI, especially in patients with COVID-19 coinfection, might be related to various factors such as increased workload, broad-spectrum antibiotic use, and limited resources. The pandemic has changed the profile of circulating bacteria and antimicrobial resistance. Prevention strategies should be considered to reduce the impact of these infections. • COVID-19 pandemic increased the incidence of Healthcare-Associated Infections. • Non-fermenting BGN and MRSA were more prevalent microorganisms of HAIs. • Patients with HAIs during the pandemic presented elevated risks of mortality. • Patients with at least one MDR infection exhibited a heightened risk of death. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to analyze the association between magnetic resonance imaging apparent diffusion coefficient map value and histopathological differentiation in patients who underwent eye enucleation due to retinoblastomas. Methods: An observational chart review study of patients with retinoblastoma that had histopathology of the lesion and orbit magnetic resonance imaging with apparent diffusion coefficient analysis at Hospital de Clínicas de Porto Alegre between November 2013 and November 2016 was performed. The histopathology was reviewed after enucleation. To analyze the difference in apparent diffusion coefficient values between the two major histopathological prognostic groups, Student’s t-test was used for the two groups. All statistical analyses were performed using SPSS version 19.0 for Microsoft Windows (SPSS, Inc., Chicago, IL, USA). Our institutional review board approved this retrospective study without obtaining informed consent. Results: Thirteen children were evaluated, and only eight underwent eye enucleation and were included in the analysis. The others were treated with photocoagulation, embolization, radiotherapy, and chemotherapy and were excluded due to the lack of histopathological results. When compared with histopathology, magnetic resonance imaging demonstrated 100% accuracy in retinoblastoma diagnosis. Optic nerve invasion detection on magnetic resonance imaging showed a 66.6% sensitivity and 80.0% specificity. Positive and negative predictive values were 66.6% and 80.0%, respectively, with an accuracy of 75%. In addition, the mean apparent diffusion coefficient of the eight eyes was 0.615 × 103 mm2/s. The mean apparent diffusion coefficient value of poorly or undifferentiated retinoblastoma and differentiated tumors were 0.520 × 103 mm2/s and 0.774 × 103 mm2/s, respectively. Conclusion: This study revealed that magnetic resonance imaging is useful in the diagnosis of retinoblastoma and detection of optic nerve infiltration, with a sensitivity of 66.6% and specificity of 80%. Our results also showed lower apparent diffusion coefficient values in poorly differentiated retinoblastomas with a mean of 0.520 × 103 mm2/s, whereas in well and moderately differentiated, the mean was 0.774 × 103 mm2/s. [ABSTRACT FROM AUTHOR]

The management of asymptomatic congenital lung malformations (CLM) is debated, and pulmonary function of patients with CLM is seldom discussed. Short-term respiratory outcome in patients operated for CLM was assessed in order to better define surgical impact. A retrospective study on patients operated for CLM between 2012 and 2021 was performed. Respiratory function was assessed with tidal breath analysis (TBA) in spontaneous sleep within 2 years of life. Patients with comorbidities affecting pulmonary function were excluded. Three variables were studied: tPTEF/tE (time to peak tidal expiratory flow/total expiratory time), tV (tidal volume), RR (respiratory rate). Results were assessed as z-score (normal ±1.64) and expressed as median (range). Pre- and post-operative results were compared, as well as post-operative results of disease and surgery type subgroups. Thirty-nine patients were included. Median pre- and post-operative tPTEF/tE were normal (pre: −0.32 (−2.12; +1.56); post: −0.18 (−1.62; +2.43)). Patients with extralobar sequestration had pre-operative high median RR, which improved after sequestrectomy (pre: +1.99 (−2.49; +7.43); post −0.22 (−3.01; +1.18)). All groups had reduced pre-operative median tV, which restored after surgery (pre: −2.15 (−9.75; +0.91); post: −0.35 (−6.65; +3.14)). Patients undergoing lobectomy and patients with intralobar sequestration showed greater improvement. Median post-operative TBA results were normal for all sub-groups except for reduced tV in patients operated with thoracotomy (−2.27 (−6.12; +5.26)). Patients with clinically asymptomatic CLM can have pathologic pulmonary function tests, which improve after surgery. These results add to the elements in favor of an interventional approach. III, Treatment study. • Management of asymptomatic CLM is debated. Pathologic pulmonary function in patients with asymptomatic CLM has been reported. Results on post-operative pulmonary function are contrasting. • This is the first study comparing pre- and post-operative pulmonary function in patients with CLM, and we show improvement of the studied parameters. [ABSTRACT FROM AUTHOR]

The thermo- or thermo-catalytic decomposition of methane, resulting in the concomitant production of CO 2 -neutral turquoise hydrogen and solid carbon is gaining importance as a technology capable of fostering the decarbonization of the chemical and energy industries. Methane pyrolysis is an intrinsically multiscale and multiphase process where the gas phase cracking is accompanied by the interactions with the carbon fragments and/or the catalyst surface. To achieve a fundamental understanding, it is required to develop modeling techniques capable of accounting for the complex fluid dynamics behavior and the mass/heat transfer along with the description of the homogeneous and heterogeneous chemistry. Such modeling approaches contribute to the interpretation of the experiments and provide in-depth insights into the reactor behavior, resulting in the rational design of the reactors during process development. This chapter provides an in-depth and up-to-date review of the different modeling approaches that have been adopted to couple the transport phenomena with reaction kinetics in the methane cracking reactors for the production of turquoise hydrogen. Different modeling strategies with growing levels of complexity (1D, 2D, homogeneous, heterogeneous, multiphase, CFD) are analyzed in the context of non-catalytic (tubular, stirred, plasma, molten media) and catalytic (chemical vapor deposition, fluidized bed, catalytic molten media) reactor configurations. The key features of the modeling approaches together with their assumptions, prediction capabilities and possible disadvantages are critically discussed. [ABSTRACT FROM AUTHOR]

In the perspective of decarbonizing the chemical and energy industries, the production of hydrogen from the thermal and thermo-catalytic pyrolysis of hydrocarbons has been highlighted as a potentially effective route. Indeed, the "turquoise" hydrogen pathway enables to fixate the carbon content of the feedstock in high-performance, durable and recyclable materials entirely avoiding CO 2 emissions. Such multiphase processes include chemical vapor deposition (CVD) and infiltration (CVI), diamond synthesis and the catalytic production of carbon nanotubes (CNTs). All the above involve a homogeneous gas-phase environment where feedstock cracking occurs together with heterogeneous interactions between gas-phase fragments and an active carbon (preform) or catalyst surface. Mechanistic models provide insights into gas-phase product distribution, untangling the competition between amorphous carbon formation (soot) in the gas-phase and structured carbon deposition. Once the models are developed and validated, kinetic analyses allow the identification of optimal conditions by relating process parameters (temperature, pressure, feedstock, catalyst morphology, etc.) to feedstock conversion, product yields and quality. This chapter provides an overview of relevant chemical kinetics aspects starting systematically from the description of reaction classes and reference rate parameters used to describe homogeneous gas-phase cracking. Then the formation mechanisms of polycyclic aromatic hydrocarbons and soot is addressed. The latter is a critical aspect as soot formation competes with the synthesis of highly structured and organized carbon materials through heterogeneous mechanisms. These are then discussed specifically focusing on CVD/CVI processes, diamond growth mechanisms and carbon nanotubes synthesis. [ABSTRACT FROM AUTHOR]

Background: Cognitive-motor dual-task (CMDT) is defined as the parallel processing of motor (eg, gait) and cognitive (eg, executive functions) activities and is an essential ability in daily life. Older adults living with frailty, chronic conditions (eg, neurodegenerative diseases), or multimorbidity pay high costs during CMDT. This can have serious consequences on the health and safety of older adults with chronic age-related conditions. However, CMDT rehabilitation can provide useful and effective therapies for these patients, particularly if delivered through technological devices. Objective: This review aims to describe the current technological applications, CMDT rehabilitative procedures, target populations, condition assessment, and efficacy and effectiveness of technology-assisted CMDT rehabilitation in chronic age-related conditions. Methods: We performed this systematic review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, on 3 databases (Web of Science, Embase, and PubMed). Original articles that were published in English; involved older adults (>65 years) with ≥1 chronic condition and/or frailty; and tested, with a clinical trial, a technology-assisted CMDT rehabilitation against a control condition were included. Risk of bias (Cochrane tool) and the RITES (Rating of Included Trials on the Efficacy-Effectiveness Spectrum) tool were used to evaluate the included studies. Results: A total of 1097 papers were screened, and 8 (0.73%) studies met the predefined inclusion criteria for this review. The target conditions for technology-assisted CMDT rehabilitation included Parkinson disease and dementia. However, little information regarding multimorbidity, chronicity, or frailty status is available. The primary outcomes included falls, balance, gait parameters, dual-task performance, and executive functions and attention. CMDT technology mainly consists of a motion-tracking system combined with virtual reality. CMDT rehabilitation involves different types of tasks (eg, obstacle negotiation and CMDT exercises). Compared with control conditions, CMDT training was found to be pleasant, safe, and effective particularly for dual-task performances, falls, gait, and cognition, and the effects were maintained at midterm follow-up. Conclusions: Despite further research being mandatory, technology-assisted CMDT rehabilitation is a promising method to enhance motor-cognitive functions in older adults with chronic conditions. [ABSTRACT FROM AUTHOR]

Smart textiles (ST) can be defined as materials capable of detecting an external stimulus, responding, and adapting its behavior according to the stimulus obtained. The field of study and development of these materials is extensive, and ST can be seen in areas such as health, transport, security, civil construction, and sports. Piezoelectric textiles are part of the ST category and are characterized due the ability to generate electrical energy from mechanical stimulus, and vice versa. Therefore, the main objective of this review is to present the current research on piezoelectric ST. In addition, the study highlights the process of obtaining materials with piezoelectric properties and the challenges and limitations, seeking to understand the contribution of the development of these materials in the field of wearable electronic devices. Thus, the main challenge in developing piezoelectric textiles is in the ability to supply energy to electronic devices to be applied in various fields such as motion detection, acoustics, impact absorption, among others. Moreover, piezoelectric ST is remarkably promising for the development of wearable electronic textiles (e-textiles) that consequently impact the creation of new functional materials that enable renewable sources to offer a positive contribution in the daily society. [ABSTRACT FROM AUTHOR]

There is no consensus on which test is more suited to outline the cognitive deficits of cerebral small vessel disease (cSVD) patients. We explored the ability of eight cognitive tests, selected in a previous systematic review as the most commonly used in this population, to differentiate among cSVD patients, controls, and other dementing conditions performing a meta‐analysis of 86 studies. We found that cSVD patients performed worse than healthy controls in all tests while data on the comparison to neurodegenerative diseases were limited. We outlined a lack of data on these tests' accuracy on the diagnosis. Cognitive tests measuring processing speed were those mostly associated with neuroimaging cSVD markers. There is currently incomplete evidence that a single test could differentiate cSVD patients with cognitive decline from other dementing diseases. We make preliminary proposals on possible strategies to gain information about the clinical definition of cSVD that currently remains a neuroimaging‐based one. [ABSTRACT FROM AUTHOR]

A peanut skin extract (PSE) was tested as a natural preservative for soybean oil mayonnaise during 6 months. Two treatments containing PSE at two different concentrations (1 and 2 mg PSE/g mayonnaise) were compared to two control treatments, one consisting of mayonnaise without any added antioxidant (CON1), and the other (CON2) containing a mixture of two common synthetic additives [butylated hydroxytoluene (BHT) + ethylene diamine tetraacetic acid (EDTA)]. As compared to the control treatments, the addition of PSE increased the overall color intensity but did not affect other sensory and physico-chemical properties tested (pH, a w , adhesiveness, firmness, spreadability, viscosity and droplet size parameters). Data from a storage test (6 month, 25 °C) showed lower rates of increase in primary oxidation indicators (peroxide, conjugated dienes and conjugated trienes) in the PSE treatments compared to the control treatments. Also, at the final storage time, the PSE treatments showed significantly lower values of secondary oxidation products (volatile an non-volatile carbonyl compounds) than the CON1 treatment. Taken together, findings regarding oxidative parameters indicate that the PSE may confer similar or greater stability to that achieved by the BHT + EDTA combination. Overall, the results suggest that the PSE could be suitable for obtaining a soybean oil mayonnaise with acceptable sensory properties and satisfactory shelf-life. [Display omitted] • Peanut skin extract (PSE) slows lipid oxidation in a soybean oil based mayonnaise. • PSE does not cause modifications in physico-chemical properties of the mayonnaise. • PSE only affected the final colour in the sensorial profile of the product. • Mayonnaise whit PSE shows better oxidative stability to that achieved with BHT + EDTA. [ABSTRACT FROM AUTHOR]

The constant arms race between bacteria and their parasites has resulted in a large diversity of bacterial defenses, with many bacteria carrying multiple systems. Here, we report the discovery of a phylogenetically widespread defense system, coined methylation-associated defense system (MADS), which is distributed across gram-positive and gram-negative bacteria. MADS interacts with a CRISPR-Cas system in its native host to provide robust and durable resistance against phages. While phages can acquire epigenetic-mediated resistance against MADS, co-existence of MADS and a CRISPR-Cas system limits escape emergence. MADS comprises eight genes with predicted nuclease, ATPase, kinase, and methyltransferase domains, most of which are essential for either self/non-self discrimination, DNA restriction, or both. The complex genetic architecture of MADS and MADS-like systems, relative to other prokaryotic defenses, points toward highly elaborate mechanisms of sensing infections, defense activation, and/or interference. [Display omitted] • Methylation-associated defense system (MADS) is a complex bacterial innate immune system • MADS function relies on nuclease, ATPase, kinase, and methyltransferase domains • MADS is distributed across gram-positive and gram-negative bacteria • MADS and CRISPR-Cas interplay provides strong and durable protection against phages The coevolution between bacteria and mobile genetic elements has resulted in a large diversity of defense systems. Maestri et al. describe an innate immune system, MADS (methylation-associated defense system), that interacts with CRISPR-Cas in its native host to provide strong and long-term protection against phages. [ABSTRACT FROM AUTHOR]

In a circular economy perspective, solid plastic wastes (SPW) can become a valuable source of chemicals, energy vectors and fuels. Catalytic and non-catalytic pyrolysis, gasification, and partial oxidation technologies can be employed to produce hydrogen, syngas, chemicals, fuels, or energy, providing more efficient and environmentally sound options compared to landfill disposal. Product distribution optimization, experiment, reactor, and process design as well as pollutant formation control can largely benefit from accurate and predictive reactor models. Chemical kinetic models constitute a core part of reactive flow modeling approaches, together with heat and mass transfer models. Mechanistic models provide insights into the degradation process of polymers and into the chemical dynamics involved in the transformation of a polymer or a polymer mixture in valuable products. Kinetic analysis of the pyrolysis of plastics is pivotal for understanding the optimal conditions of the cracking process improving reactor design and providing a solid basis for scale-up. Beyond global models mostly aiming at representing the overall conversion of the polymer backbone, theory-based detailed and semi-detailed models allow to explore with good predictive capability a wide range of conditions also tracking the product distribution. This chapter provides an overview of state-of-the-art kinetic modeling approaches from the molecular scale understanding of the occurring chemistry in both thermal and thermo-catalytic conversion, to the design, assembly and validation of integrated semi-detailed kinetic models. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to compare SURG vs SOR regarding the OS and progression-free survival (PFS) in a real-world clinical scenario. Background data: The treatment for advanced nonmetastatic HCC belonging to the Barcelona Clinic Liver Cancer stage C (BCLC C) is still controversial. Methods: BCLC C patients without extrahepatic spread and tumoral invasion of the main portal trunk were considered. Surgical patients were obtained from the HE.RC.O.LE.S. Register, whereas sorafenib patients were obtained from the ITA.LI.CA register The inverse probability weighting (IPW) method was adopted to balance the confounders between the 2 groups. Results: Between 2008 and 2019, 478 patients were enrolled: 303 in SURG and 175 in SOR group. Eastern Cooperative Oncological Group Performance Status (ECOG-PS), presence of cirrhosis, steatosis, Child-Pugh grade, hepatitis B virus and hepatitis C virus, alcohol intake, collateral veins, bilobar disease, localization of the tumor thrombus, number of nodules, alpha-fetoprotein, age, and Charlson Comorbidity index were weighted by IPW to create two balanced pseudo-populations: SURG = 374 and SOR = 263. After IPW, 1-3-5 years OS was 83.6%, 68.1%, 55.9% for SURG, and 42.3%, 17.8%, 12.8% for SOR (P < 0.001). Similar trends were observed after subgrouping patients by ECOG-PS = 0 and ECOG-PS >0, and by the intrahepatic location of portal vein invasion. At Cox regression, sorafenib treatment (hazard ratio 4.436; 95% confidence interval 3.19-6.15; P < 0.001) and Charlson Index (hazard ratio 1.162; 95% confidence interval 1.06-1.27; P = 0.010) were the only independent predictors of mortality. PFS at 1-3-5 years were 65.9%, 40.3%, 24.3% for SURG and 21.6%, 3.5%, 2.9% for SOR (P = 0.007). Conclusions: In BCLC C patients without extrahepatic spread but with intrahepatic portal invasion, liver resection, if feasible, was followed by better OS and PFS compared with sorafenib. [ABSTRACT FROM AUTHOR]

• Ion recombination, polarity and charge multiplication effect. • Carbon ions radiotherapy. • High dose per fraction proton eye treatments. • Dosimetry with small-gap plane-parallel ionization chamber. The aim of this work was the investigation of the ion recombination and polarity factors (k sat ad k pol) for a PTW Advanced Markus ionization chamber exposed to proton and carbon ion beams at the Centro Nazionale di Adroterapia Oncologica. Measurements with protons were specifically dedicated for ocular treatments, in the low energy range and for small, collimated scanning fields. For both protons and carbon ions, several measurements were performed by delivering a 2D single energy layer of 3x3 cm2 and homogeneous, biologically-optimized SOBPs. Data were collected at different depths in water, by varying the voltage values of the ionization chamber and for two different dose rates (the nominal one and one reduced to 20% of it). The k sat -values were determined from extrapolation of the saturation curves. Furthermore k pol -values were calculated using the recommendations from the International Atomic Energy Agency (IAEA) Technical Report Series (TRS)-398 Code of Practice. Results showed that the Advanced Markus performs optimally in this clinical scenario characterized by small treatment volumes and high dose gradients although for both particle types, but particularly for carbon ions, a charge multiplication effect up to 1.7% occurs at voltage higher than 150 V. For protons, both the ion recombination and polarity corrections were always smaller than 0.3%, for all the analysed cases and adopted dose rates, so not affecting the dosimetric measurements for clinical routine. For carbon ions the polarity effect can be neglected while ion recombination has to be carefully calculated and cannot be neglected since corrections even higher than 1% can be found, especially at high LET measuring points. [ABSTRACT FROM AUTHOR]

To generate virtual 4DCT from 4DMRI with field of view (FOV) extended to the entire involved patient anatomy, in order to evaluate its use in carbon ion radiation therapy (CIRT) of the abdominal site in a clinical scenario. The virtual 4DCT was generated by deforming a reference CT in order to (1) match the anatomy depicted in the 4DMRI within its FOV, by calculating deformation fields with deformable image registration to describe inter-fractional and breathing motion, and (2) obtain physically plausible deformation outside of the 4DMRI FOV, by propagating and modulating the previously obtained deformation fields. The implemented method was validated on a digital anthropomorphic phantom, for which a ground truth (GT) 4DCT was available. A CIRT treatment plan was optimized at the end-exhale reference CT and the RBE-weighted dose distribution was recalculated on both the virtual and GT 4DCTs. The method estimation error was quantified by comparing the virtual and GT 4DCTs and the corresponding recomputed doses. The method was then evaluated on 8 patients with pancreas or liver tumors treated with CIRT using respiratory gating at end-exhale. The clinical treatment plans adopted at the National Center for Oncological Hadrontherapy (CNAO, Pavia, Italy) were considered and the dose distribution was recomputed on all respiratory phases of the planning and virtual 4DCTs. By comparing the two datasets and the corresponding dose distributions, the geometrical and dosimetric impact of organ motion was assessed. For the phantom, the error outside of the 4DMRI FOV was up to 4.5 mm, but it remained sub-millimetric in correspondence to the target within the 4DMRI FOV. Although the impact of motion on the target D 95% resulted in variations ranging from 22% to 90% between the planned dose and the doses recomputed on the GT 4DCT phases, the corresponding estimation error was ≤2.2%. In the patient cases, the variation of the baseline tumor position between the planning and the virtual end-exhale CTs presented a median (interquartile range) value of 6.0 (4.9) mm. For baseline variations larger than 5 mm, the tumor D 95% variation between the plan and the dose recomputed on the end-exhale virtual CT resulted larger than 10%. Median variations higher than 10% in the target D 95% and gastro-intestinal OARs D 2% were quantified at the end-inhale, whereas close to the end-exhale phase, limited variations of relevant dose metrics were found for both tumor and OARs. The negligible impact of the geometrical inaccuracy in the estimated anatomy outside of the 4DMRI FOV on the overall dosimetric accuracy suggests the feasibility of virtual 4DCT with extended FOV in CIRT of the abdominal site. In the analyzed patient group, inter-fractional variations such as baseline variation and breathing variability were quantified, demonstrating the method capability to support treatment planning in gated CIRT of the abdominal site. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the incidence of hearing loss among adults stratified by the occurrence of hypertension, and to investigate the association between hypertension and hearing loss. METHODS: Longitudinal observational study, part of the Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil, Longitudinal Study on Adult's Health). Data from the first and second waves were analyzed, including information from audiological assessment and general health of the subjects. As outcome, we considered the presence of hearing loss (hearing thresholds above 25 dBHL at frequencies from 500 Hz to 8 kHz) and, as exposure variable, hypertension (report of medical diagnosis of hypertension; and/or use of drugs to treat hypertension; and/or pressure systolic blood pressure = 140 mmHg; or diastolic blood pressure = 90 mmHg). As covariables for adjustment were considered: sex, age, education, race / ethnicity, income, smoking, diabetes, and occupational exposure to noise. Poisson regression analysis was conducted, estimating the crude and adjusted relative risks, with 95% confidence intervals, in order to assess the factors associated with hearing loss. RESULTS: In crude analyses, the incidence of hearing loss was higher for subjects with hypertension (9.7% versus 5.4%). The crude relative risks for hearing loss was almost double (1.93; 95%CI: 1.10-3.39) for subjects with hypertension in the right ear. In the adjusted analyses, the relative risks was not significant for the hypertension variable (1.42; 95%CI: 0.75-2.67). Being 60 years or older (RR: 5.41; 95%CI: 2.79-10.50) showed a statistically significant association with hearing loss, indicating that older adults have higher relative risks for hearing loss. CONCLUSION: In the adjusted analyses controlled for multiple risk factors there was no association between hypertension and hearing loss. The dichotomous variable age (being 60 years or older), on the other hand, has shown a significant association with hearing loss. [ABSTRACT FROM AUTHOR]