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Cardiovascular CT is required for planning transcatheter aortic valve implantation (TAVI). To compare image quality, suitability for TAVI planning, and radiation dose of photon-counting CT (PCCT) with that of dual-source CT (DSCT). Retrospective study on consecutive TAVI candidates with aortic valve stenosis who underwent contrast-enhanced aorto-ilio-femoral PCCT and/or DSCT between 01/2022 and 07/2023. Signal-to-noise (SNR) and contrast-to-noise ratio (CNR) were calculated by standardized ROI analysis. Image quality and suitability for TAVI planning were assessed by four independent expert readers (two cardiac radiologists, two cardiologists) on a 5-point-scale. CT dose index (CTDI) and dose-length-product (DLP) were used to calculate effective radiation dose (eRD). 300 patients (136 female, median age: 81 years, IQR: 76–84) underwent 302 CT examinations, with PCCT in 202, DSCT in 100; two patients underwent both. Although SNR and CNR were significantly lower in PCCT vs. DSCT images (33.0 ± 10.5 vs. 47.3 ± 16.4 and 47.3 ± 14.8 vs. 59.3 ± 21.9, P <.001, respectively), visual image quality was higher in PCCT vs. DSCT (4.8 vs. 3.3, P <.001), with moderate overall interreader agreement among radiologists and among cardiologists (κ = 0.60, respectively). Image quality was rated as "excellent" in 160/202 (79.2%) of PCCT vs. 5/100 (5%) of DSCT cases. Readers found images suitable to depict the aortic valve hinge points and to map the femoral access path in 99% of PCCT vs. 85% of DSCT (P < 0.01), with suitability ranked significantly higher in PCCT vs. DSCT (4.8 vs. 3.3, P <.001). Mean CTDI and DLP, and thus eRD, were significantly lower for PCCT vs. DSCT (22.4 vs. 62.9; 519.4 vs. 895.5, and 8.8 ± 4.5 mSv vs. 15.3 ± 5.8 mSv; all P <.001). PCCT improves image quality, effectively avoids non-diagnostic CT imaging for TAVI planning, and is associated with a lower radiation dose compared to state-of-the-art DSCT. Radiologists and cardiologists found PCCT images more suitable for TAVI planning. [ABSTRACT FROM AUTHOR]

Status epilepticus (SE) is a neurologic emergency defined as continued seizure activity greater than five minutes or recurrent seizure activity without return to baseline. Benzodiazepine-refractory SE is continuous seizure activity despite treatment with a benzodiazepine. Treatment of benzodiazepine-refractory SE includes levetiracetam with loading doses ranging from 20 mg/kg to 60 mg/kg up to a maximum dose of 4500 mg. While levetiracetam has minimal adverse effects, there is currently a lack of studies directly comparing the safety and efficacy of various loading doses of levetiracetam. The objective of this study was to evaluate the safety and efficacy of three loading doses of levetiracetam in the setting of benzodiazepine-refractory SE. This was a single center, retrospective cohort study of adult patients with benzodiazepine-refractory SE who were treated with levetiracetam from April 1, 2016, to August 31, 2023. Patients with documented hypersensitivity to levetiracetam, those who were pregnant or incarcerated and patients who received an alternative antiepileptic drug (AED) prior to levetiracetam were excluded. Patients with other identifiable causes of SE including hyperglycemia, hypoglycemia, hyponatremia or who were post cardiac arrest were also excluded. Patients were divided into three arms based on loading dose of levetiracetam administered (≤20 mg/kg [LEVlow], 21‐–39 mg/kg [LEVmed] or ≥40 mg/kg [LEVhigh]). The primary endpoint was the rate of seizure termination, defined as the lack of need for an additional AED within 60 min following levetiracetam administration. Secondary outcomes included the rate of intubation, and recurrent seizure activity 60 min to 24 h post seizure termination as defined by positive EEG results or need for an additional AED. Subgroup analyses were performed to assess the influence of adequate loading doses of benzodiazepines, and outpatient levetiracetam use. Overall, 740 patients were screened for inclusion, with 218 patients being included in the primary analysis. Patients were divided into three groups with an average levetiracetam loading dose of 14.5 mg/kg in the LEVlow group, 28.8 mg/kg in the LEVmed group, and 48.8 mg/kg in the LEVhigh group. There was no difference in rates of seizure termination at 60 min (92.9% LEVlow vs 89.3% LEVmed vs 84.7% LEVhigh; p = 0.377). Additionally, no difference was found in rates of recurrent seizure activity between 60 min and 24 h post levetiracetam loading dose (32.1% LEVlow vs 32.0% LEVmed vs 28.8% LEVhigh; p = 0.899). However, the LEVhigh group did have a higher rate of intubation (45.8%) compared to the LEVmed (28.2%) and LEVlow (26.8%) group (p = 0.040). The loading of levetiracetam did not result in a statistically significant difference in rate of seizure termination at 60 min nor did it appear to impact the rate of recurrent seizures at 24 h. However, we did find higher rates of intubation in patients who received levetiracetam >40 mg/kg. Further research is warranted to determine the optimal loading dose of levetiracetam in benzodiazepine-refractory SE. [ABSTRACT FROM AUTHOR]

Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in a variety of patients (athletes, older patients, and patients with predisposing conditions). Radiography is the imaging modality of choice for baseline diagnosis. MRI has greatly improved our ability to diagnose radiographically occult stress fractures. Nuclear medicine scintigraphy and CT may also be useful as diagnostic tools. Although fatigue and insufficiency fractures can be self-limited and go on to healing even without diagnosis, there is usually value in initiating prompt therapeutic measures as incomplete stress fractures have the potential to progress to completion, necessitating surgery. This is particularly important in the setting of stress fractures of the femoral neck. Accuracy in the identification of these injuries is also relevant because the differential diagnosis includes entities that would otherwise be treated differently (ie, metastatic disease). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Chronic hand and wrist pain is a common presenting complaint. The intricate anatomy results in a variety of pain generators—multiple bones, articular cartilage, intrinsic ligaments, triangular fibrocartilage complex, joint capsules and synovium, tendons and tendon sheaths, muscles, and nerves—in a compact space. The need for imaging and the choice of the appropriate imaging modality are best determined by the patient's presentation, physical examination, and the clinician's working differential diagnosis. Radiography is usually appropriate as the initial imaging study in the evaluation of chronic hand or wrist pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Prone positioning has become a standard therapy in acute respiratory distress syndrome to improve oxygenation and decrease mortality. However, little is known about prone positioning in lung transplant recipients. This large, singe-center analysis investigated whether prone positioning improves gas exchange after lung transplantation. Clinical data of 583 patients were analyzed. Prone position was considered in case of impaired gas exchange Pa o 2 /fraction of oxygen in inhaled air (<250), signs of edema after lung transplantation, and/or evidence of reperfusion injury. Patients with hemodynamic instability or active bleeding were not proned. Impact of prone positioning (n = 165) on gas exchange, early outcome and survival were determined and compared with patients in supine positioning (n = 418). Patients in prone position were younger, more likely to have interstitial lung disease, and had a higher lung allocation score. Patients were proned for a median of 19 hours (interquartile range,15-26) hours). They had significantly lower Pa o 2 /fraction of oxygen in inhaled air (227 ± 96 vs 303 ± 127 mm Hg, P =.004), and lower lung compliance (24.8 ± 9.1 mL/mbar vs 29.8 ± 9.7 mL/mbar, P <.001) immediately after lung transplantation. Both values significantly improved after prone positioning for 24 hours (Pa o 2 /fraction of oxygen ratio: 331 ± 91 mm Hg; lung compliance: 31.7 ± 20.2 mL/mbar). Survival at 90 days was similar between the 2 groups (93% vs 96%, P =.105). Prone positioning led to a significant improvement in lung compliance and oxygenation after lung transplantation. Prospective studies are needed to confirm the benefit of prone positioning in lung transplantation. [ABSTRACT FROM AUTHOR]

The United States is a nation of diverse racial and ethnic origins. Athletes represent the full spectrum of the nation's population. However, the orthopedic surgeons who serve as team physicians are Caucasian and male with staggeringly few exceptions. This manuscript provides an overview of the current status and barriers to diversity among orthopedic team physicians, along with strategies to address the issue. Specifically, pipeline initiatives implemented at one academic medical school and orthopedic surgery department are summarized as potential models that can be further developed by other institutions to enhance diversity in orthopedic surgery. [ABSTRACT FROM AUTHOR]

This article reviews evidence for performing various imaging studies in patients with total hip prostheses. Routine follow-up is generally performed with radiography. Radiographs are also usually the initial imaging modality for patients with symptoms related to the prosthesis. Following acute injury with pain, noncontrast CT may add information to radiographic examination regarding the presence and location of a fracture, component stability, and bone stock. Image-guided joint aspiration, noncontrast MRI, and white blood cell scan and sulfur colloid scan of the hip, are usually appropriate studies for patients suspected of having periprosthetic infection. For evaluation of component loosening, wear, and/or osteolysis, noncontrast CT or MRI are usually appropriate studies. Noncontrast MRI is usually appropriate for identifying adverse reaction to metal debris related to metal-on-metal articulations. For assessing patients after hip arthroplasty, who have trochanteric pain and nondiagnostic radiographs, ultrasound, or MRI are usually appropriate studies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty is the most commonly performed joint replacement procedure in the United States. This manuscript will discuss the recommended imaging modalities for six clinical variants; 1. follow-up of symptomatic or asymptomatic patients with a total knee arthroplasty. Initial imaging, 2. Suspected infection after total knee arthroplasty. Additional imaging following radiographs, 3. Pain after total knee arthroplasty. Infection excluded. Suspect aseptic loosening or osteolysis or instability. Additional imaging following radiographs, 4. Pain after total knee arthroplasty. Suspect periprosthetic or hardware fracture. Additional imaging following radiographs, 5. Pain after total knee arthroplasty. Measuring component rotation. Additional imaging following radiographs, and 6. Pain after total knee arthroplasty. Suspect periprosthetic soft-tissue abnormality unrelated to infection, including quadriceps or patellar tendinopathy. Additional imaging following radiographs. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Use of d,l-sotalol for rhythm control in patients with atrial fibrillation (AF) has raised safety concerns. Previous randomized studies are few and not designed for mortality outcome. The purpose of this study was to compare the incidences of mortality and ventricular arrhythmias in AF patients treated with d,l-sotalol for rhythm control vs matched control patients treated with cardioselective beta-blockers. This population-based cohort study included AF patients from the Swedish National Patient Registry (2006–2017) who underwent rhythm control after a second cardioversion. Incidence rates (IRs) and adjusted hazard ratios (aHRs) for mortality and a composite endpoint of cardiac arrest/death and ventricular arrhythmias were calculated for the overall cohort and a 1:1 propensity score matched cohort of d,l-sotalol vs beta-blocker treatment. Among patient treated with d,l-sotalol (n = 4987) and beta-blocker (n = 27,078) (mean follow-up 458 days), all-cause mortality was lower in patients treated with d,l-sotalol: IR 1.21; 95% confidence interval 0.95–1.52 vs 2.42 (2.26–2.60) deaths per 100 patient-years; aHR 0.66 (0.52–0.83). The difference in mortality persisted in the propensity score matched comparison (n = 4953 in each group): aHR 0.63 (0.48–0.86). No differences were observed in the composite outcome: IR in propensity cohorts 2.13 (1.78–2.52) vs 2.07 (1.73–2.53) events per 100 years; aHR 1.01 (0.78–1.29). There was no excess mortality with d,l-sotalol compared with cardioselective beta-blockers in patients undergoing rhythm control treatment for AF after a second cardioversion. Our results indicate that the risk associated with d,l-sotalol treatment for AF can be mitigated by careful patient selection and strict adherence to follow-up protocols. [Display omitted] [ABSTRACT FROM AUTHOR]

Major adverse cardiac events (MACE) are a leading cause of morbidity and mortality after orthotopic liver transplantation (OLT). Cirrhotic cardiomyopathy (CCM), initially described in 2005 and revised in 2019, is a source of MACE in patients after OLT. We sought to identify CCM-related predictors of MACE at one-year follow-up after OLT and assess for reversibility of CCM post-OLT. This is a retrospective study of adult patients who underwent OLT between 2009 and 2019. All patients had transthoracic echocardiography pre-and post-OLT. Patients with a left ventricular ejection fraction <50 % pre-OLT were excluded. MACE was defined as death, myocardial infarction, congestive heart failure hospitalization, or cardiac arrest. In total, 131 patients were included in this study, of whom 103 and 23 patients met the 2005 and 2019 criteria, respectively. During the follow-up period, 42 patients had MACE and these patients were more likely to have ascites (p = 0.003), hepatorenal syndrome (p = 0.019), and CCM per 2005 criteria (p = 0.023). There were no significant differences between pre-OLT CCM per 2019 criteria (19 % vs 17 %, p = 0.758) or MELD-Na score (21.24 vs 19.40, p = 0.166) for MACE post-OLT. Per the 2005 criteria, 35 of 103 patients recovered and these patients were less likely to have MACE post-OLT (p = 0.012). Per the 2019 criteria, 13 of 23 patients recovered post-OLT but this low number precluded further statistics. The 2005 Montreal criteria for CCM were an independent predictor of MACE at one-year follow-up post-OLT while the 2019 CCC criteria for CCM were not. In addition, the 2005 Montreal criteria were more prevalent when compared to 2019 CCC criteria. Finally, the 2005 Montreal criteria were reversible post-OLT 34 % of the time compared to the 2019 CCC criteria which were reversible 57 % of the time. [Display omitted] • Cirrhotic cardiomyopathy (CCM) predicts major adverse cardiac events (MACE). • CCM per 2005 criteria predicted MACE at 1 year, but CCM per 2019 criteria did not. • CCM is reversible in 34 % and 57 % of patients per 2005 and 2019 criteria respectively after orthotopic liver transplantation. • The 2005 criteria of CCM are more prevalent when compared to the 2019 criteria. [ABSTRACT FROM AUTHOR]

Peripheral nerve injury is a common sequela of lower extremity trauma. Injuries to lower extremity nerves range from contusions and stretch injuries that will often resolve without interventions to traumatic disruptions requiring surgical procedures, including neurolysis, repair or even nerve grafting. While clinical examination and tools such as electromyography will often help to localize the site of injury, imaging is a critical tool in determining the extent and degree of nerve injury in the setting of trauma. Modalities such as ultrasound and radiography are often useful, but MRI is considered the primary imaging modality for assessing the extent and degree of nerve injury. Specialized techniques such as MR neurography tailored to the needs of individual patients can provide important and detailed information in support of clinical decision making and presurgical planning. In this paper, we will review the anatomy of peripheral nerves of the lower extremity, mechanisms of injury affecting nerves and provide guidance for the use of MRI correlated with validated classification systems in assessing injuries affecting the nerves of the lower extremities. [ABSTRACT FROM AUTHOR]

Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity because there is significant overlap of imaging findings among the various types of arthritis. This document provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Chronic shoulder pain is an extremely common presenting complaint. Potential pain generators include the rotator cuff tendons, biceps tendon, labrum, glenohumeral articular cartilage, acromioclavicular joint, bones, suprascapular and axillary nerves, and the joint capsule/synovium. Radiographs are typically the initial imaging study obtained in patients with chronic shoulder pain. Further imaging may often be required, with modality chosen based on patient symptoms and physical examination findings, which may lead the clinician to suspect a specific pain generator. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Chronic hip pain is a frequent chief complaint for adult patients who present for evaluation in a variety of clinical practice settings. Following a targeted history and physical examination, imaging plays a vital role in elucidating the etiologies of a patient's symptoms, as a wide spectrum of pathological entities may cause chronic hip pain. Radiography is usually the appropriate initial imaging test following a clinical examination. Depending on the clinical picture, advanced cross-sectional imaging may be subsequently performed for further evaluation. This documents provides best practice for the imaging workup of chronic hip pain in patients presenting with a variety of clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Industrial control systems are distributed real-time applications deployed on field and controller devices, connected by fieldbuses. Their lack of interoperability, mutually and towards IT-systems, is a major obstacle for the digitalization. Converged networks are considered as the solution across industries with Time-Sensitive Networking (TSN) as the enabling technology. To ease the adoption of TSN for industrial automation, a modular framework was developed for future engineering tools. The core of the framework consists of a module management including interfaces and a YANG-based datastore, maintaining a system-wide data model. Modules are provided for network configuration implementing CUC-functions, monitoring and container-based application and deployment. [ABSTRACT FROM AUTHOR]

With the results of several recently published clinical trials, this guideline informs on the use of adjuvant radiation therapy (RT) and systemic therapy in the treatment of endometrial cancer. Updated evidence-based recommendations provide indications for adjuvant RT and the associated techniques, the utilization and sequencing of adjuvant systemic therapies, and the effect of surgical staging techniques and molecular tumor profiling. The American Society for Radiation Oncology convened a multidisciplinary task force to address 6 key questions that focused on the adjuvant management of patients with endometrial cancer. The key questions emphasized the (1) indications for adjuvant RT, (2) RT techniques, target volumes, dose fractionation, and treatment planning aims, (3) indications for systemic therapy, (4) sequencing of systemic therapy with RT, (5) effect of lymph node assessment on utilization of adjuvant therapy, and (6) effect of molecular tumor profiling on utilization of adjuvant therapy. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for quality of evidence grading and strength of recommendation. The task force recommends RT (either vaginal brachytherapy or external beam RT) be given based on the patient's clinical-pathologic risk factors to reduce risk of vaginal and/or pelvic recurrence. When external beam RT is delivered, intensity modulated RT with daily image guided RT is recommended to reduce acute and late toxicity. Chemotherapy is recommended for patients with International Federation of Gynecology and Obstetrics (FIGO) stage I to II with high-risk histologies and those with FIGO stage III to IVA with any histology. When sequencing chemotherapy and RT, there is no prospective data to support an optimal sequence. Sentinel lymph node mapping is recommended over pelvic lymphadenectomy for surgical nodal staging. Data on sentinel lymph node pathologic ultrastaging status supports that patients with isolated tumor cells be treated as node negative and adjuvant therapy based on uterine risk factors and patients with micrometastases be treated as node positive. The available data on molecular characterization of endometrial cancer are compelling and should be increasingly considered when making recommendations for adjuvant therapy. These recommendations guide evidence-based best clinical practices on the use of adjuvant therapy for endometrial cancer. [ABSTRACT FROM AUTHOR]

In highly standardized literate cultures, orthographic norms are perceived as socially binding, giving rise to negative evaluations of 'incorrect' writing, i.e., writing that deviates from the norm. This is evident in prescriptive practices in interactions on social media including direct corrections of a deviance (*you're) or comments more or less implicitly referring to it ("would be great if you knew how to spell"). In this study, we focus on a special type of corrections and the reactions to them: incorrect corrections. They are often corrected in so-called re-corrections, which frequently give rise to entire chains of corrections and comments that reflect diverse practices and attitudes both shaped by and towards normativity. By conducting an exploratory case study, we investigate (meta-)pragmatic strategies of stancetaking – such as mocking or doing being an expert – as well as their negotiation in (re-)corrections. Specifically, we focus on three posts taken from the public Facebook group People Incorrectly Correcting Other People consisting of, on the one hand, decontextualized screenshots showing an incorrect correction and ensuing re-corrections framed by the reaction of the poster posting them to the group. On the other hand, given the large number of group members, they include a myriad of additional comments discussing (re-)corrections at a meta-level. Our analysis suggests that re-correcting serves to criticize not a mistake but the positioning of correctors as superior. Thus, it implicitly challenges the normativity of standard language ideologies by exposing the hypocrisy of prescriptive practices. [ABSTRACT FROM AUTHOR]

Osteoporosis constitutes a significant public health risk. An estimated 10.2 million adults in the United States >50 years of age have osteoporosis, a systemic condition that weakens the bones increasing the susceptibility for fractures. Approximately one-half of women and nearly one-third of men >50 years of age will sustain an osteoporotic fracture. These fractures are associated with a decrease in quality of life, diminished physical function, and reduced independence. Dual-energy X-ray absorptiometry (DXA) is the primary imaging modality used to screen for osteoporosis in women >65 years of age and men >70 years of age. DXA may be used in patients <65 years of age to evaluate bone mass density if there are additional risk factors. In certain situations, vertebral fracture assessment and trabecular bone score may further predict fracture risk, particularly in patients who are not yet osteoporotic but are in the range of osteopenia. Quantitative CT is useful in patients with advanced degenerative changes in the spine. Given the proven efficacy of pharmacologic therapy, the role of imaging to appropriately identify and monitor high-risk individuals is critical in substantially reducing osteoporosis-associated morbidity and mortality, and reducing the considerable cost to the health care system. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Digital dental articulation for three-piece maxillary orthognathic surgery is challenging. The purpose of this proof-of-concept study was to evaluate the clinical feasibility of a newly developed mathematical algorithm to digitally establish the final occlusion for three-piece maxillary surgery. Five patients with jaw deformities who had undergone a three-piece double-jaw surgery that was planned virtually were randomly selected for this study. The final occlusion had been hand-articulated using stone casts, scanned into the computer and used in the surgery. These hand-articulated occlusions served as the control group. To form the experimental group, the three-piece maxillary dental arch was articulated again automatically from the patient's original occlusion using the mathematical algorithm. The hand- and algorithm-articulated occlusions were then evaluated qualitatively by two experienced orthodontists. A quantitative evaluation was also performed. The results of the qualitative evaluation showed that all of the three-piece occlusions, hand- and algorithm-articulated, were clinically acceptable based on the American Board of Orthodontics grading system. When compared, two of the algorithm-articulated occlusions were clearly better (40%), one was the same (20%), and two were slightly worse (40%) than the hand-articulated occlusions. All of the quantitative measurements were comparable between the two articulation methods. In conclusion, the results of this study demonstrate that it is clinically feasible to digitally articulate the three-piece maxillary arch to the intact mandibular dental arch. [ABSTRACT FROM AUTHOR]

The demand for semiconductors and microelectronic components is greater than ever and will continuously rise in the future due to increasing automation and digitalization. Also, there is a growing need for robust, high-temperature resistant electrical connections which are essential for the circuit function. Previous investigations have shown that laser-based droplet brazing can create high temperature stable joints e.g. on thin silver layers, without applying an external force on the micro-component to be joined. In order to expand the application field of this process, further combinations of different brazing and substrate materials are investigated. In this paper the influence of additionally induced thermal energy at the diffusion zone was analyzed via shear tests. The studies show, that using brazing alloy CuSn11 in combination with a substrate heating provides the most robust joints on the tested substrate material. [ABSTRACT FROM AUTHOR]

Remote ablation cutting with continuous wave laser radiation is a process commonly used for the surface pretreatment of large area metallic parts before joining of metal-polymer hybrid structures, due to their cost-effectiveness and high average powers when compared to short-pulsed lasers. The process requires high power-densities and multiple irradiations at high scanning speeds to achieve the desired kerf depth. In this work a fast modulated cw fiber laser is used to investigate the possibilities of increasing the material removal rate by periodically dropping the laser power and therefore modifying the recoil pressure at the vapor-liquid interface in the interaction zone to assist in melt expulsion. It was found that power modulation with frequencies in excess of 10 kHz can lead to an increased material removal rate when compared to continuous wave processing at comparable average and peak power levels, enabling higher kerf aspect ratios in a single irradiation. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is common, but there are limited data to guide selection of rate control medications (RCM). Reasons for selection are multivariable, and the impact on outcomes is unknown. We investigated prescribing patterns of RCM among patients with AF. Using a nationwide database, we identified 135,927 patients with AF. We stratified by baseline presence of heart failure with reduced ejection fraction (HFrEF) and examined prescription rates of RCM as a function of clinical variables. We also evaluated associations with clinical outcomes. Beta blockers (BB) were most commonly prescribed (44.6%), then calcium channel blockers (CCB) (14.0%) and digoxin (8.6%). Patients prescribed BB were more likely male (45.6% vs 43.4%, p < 0.0001), patients prescribed CCB were less likely male (12.0% vs 16.3%, p < 0.0001). There were higher rates of HF hospitalization (HFH) among females and those with Medicaid. Randomized trials are needed to define optimal choice of RCM. [ABSTRACT FROM AUTHOR]

To evaluate the effect of general anesthesia (GA) on severity of mitral regurgitation (MR) in patients undergoing transcatheter mitral valve repair (TMVR). Retrospective cohort study. Tertiary care university hospital. Fifty consecutive patients with symptomatic severe MR and extremely high surgical risk. TMVR under GA. Transesophageal echocardiography was performed during the preprocedural workup under conscious sedation and during TMVR under GA. After the parameters of MR were assessed, color-flow jet area (CJA), vena contracta (VC), effective regurgitant orifice area (EROA), regurgitant volume (RVOL), three-dimensional (3D) vena contracta area (VCA), and severity of MR were compared between the two examinations. In patients with primary MR (n = 11), there were no significant differences in CJA, VC, EROA, RVOL, or 3D-VCA between pre- and intraprocedural transesophageal echocardiography. In patients with secondary MR (n = 39), GA led to significant decreases of CJA (10 ± 7 v 7 ± 3 cm², p < 0.001), VC (5.5 ± 1.6 v 4.7 ± 1.5 mm, p = 0.002), EROA (30 ± 11 v 24 ± 10 mm², p < 0.001), and RVOL (47 ± 17 v 34 ± 13 mL/beat, p < 0.001). Consequently, GA led to a downgrade of regurgitation severity classification in 44% of patients when assessed by two-dimensional analysis. When evaluated by 3D analysis, GA also led to a significant but less extensive decrease of MR (3D-VCA: 66 ± 27 v 60 ± 29 mm², p = 0.002), and subsequent downgrade of MR classification in 20% of patients. GA underestimates regurgitation severity in patients with secondary, but not primary MR, undergoing TMVR. This effect must be considered when evaluating the immediate result of the procedure. [ABSTRACT FROM AUTHOR]

Purpose: A facial reference frame is a 3-dimensional Cartesian coordinate system that includes 3 perpendicular planes: midsagittal, axial, and coronal. The order in which one defines the planes matters. The purposes of this study are to determine the following: 1) what sequence (axial-midsagittal-coronal vs midsagittal-axial-coronal) produced more appropriate reference frames and 2) whether orbital or auricular dystopia influenced the outcomes.Methods: This study is an ambispective cross-sectional study. Fifty-four subjects with facial asymmetry were included. The facial reference frames of each subject (outcome variable) were constructed using 2 methods (independent variable): axial plane first and midsagittal plane first. Two board-certified orthodontists together blindly evaluated the results using a 3-point categorical scale based on their careful inspection and expert intuition. The covariant for stratification was the existence of orbital or auricular dystopia. Finally, Wilcoxon signed rank tests were performed.Results: The facial reference frames defined by the midsagittal plane first method was statistically significantly different from ones defined by the axial plane first method (P = .001). Using the midsagittal plane first method, the reference frames were more appropriately defined in 22 (40.7%) subjects, equivalent in 26 (48.1%) and less appropriately defined in 6 (11.1%). After stratified by orbital or auricular dystopia, the results also showed that the reference frame computed using midsagittal plane first method was statistically significantly more appropriate in both subject groups regardless of the existence of orbital or auricular dystopia (27 with orbital or auricular dystopia and 27 without, both P < .05).Conclusions: The midsagittal plane first sequence improves the facial reference frames compared with the traditional axial plane first approach. However, regardless of the sequence used, clinicians need to judge the correctness of the reference frame before diagnosis or surgical planning. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the impact of implementing Mental Health First Aid (MHFA) training in a doctor of pharmacy (PharmD) curriculum on student pharmacists' knowledge, attitudes, self-efficacy, and empathy towards people with mental health conditions and/or crises. Participants were third-year PharmD students enrolled in Patient Care Experience, a required communication and ethics course. A survey was administered pre- and post-intervention (i.e. MHFA training). Student pharmacist self-efficacy in assisting someone developing a mental health condition or in crisis was evaluated using confidence measures from the MHFA action plan. Knowledge was measured using Mental Health Knowledge Statements. Attitudes were assessed with the Index of Attitudes Towards Mental Illness, and stigma was evaluated using the Social Distancing Scale. Empathy was measured with the Kiersma-Chen Empathy Scale. Both pre- and post-intervention surveys were completed by 97 of 135 participants (71.9% response rate). MHFA training resulted in significantly increased self-efficacy and empathy. There were no significant differences in knowledge, attitudes, and stigma. MHFA training was associated with increases in student pharmacist empathy and self-efficacy in providing support to individuals with mental health crises. [ABSTRACT FROM AUTHOR]

This paper presents an approach to recognize problem related entities in production chats to structure the informal communication and include arising problems into digital shop floor management and its assistance functions. Requirements are derived from employee surveys, company surveys and from union experts. Based on annotated data that has been collected during a simulation in the process learning factory "Center for Industrial Productivity" (CiP) at the Technical University of Darmstadt, approaches for identifying and structuring problem recognition and solution in production chat logs are evaluated. Finally, a system design is suggested to utilize such an entity recognition in an industrial chat application to improve digital shop floor management systems. [ABSTRACT FROM AUTHOR]

No validated models for predicting the risk of radiation pneumonitis (RP) with proton beam therapy (PBT) currently exist. Our goal was to externally validate and recalibrate multiple established photon-based normal tissue complication probability models for RP in a cohort with locally advanced nonsmall cell lung cancer treated with contemporary doses of chemoradiation using PBT. The external validation cohort consisted of 99 consecutive patients with locally advanced nonsmall cell lung cancer treated with chemoradiation using PBT. RP was retrospectively scored at 3 and 6 months posttreatment. We evaluated the performance of the photon Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) pneumonitis model, the QUANTEC model adjusted for clinical risk factors, and the newer Netherlands updated QUANTEC model. A closed testing procedure was performed to test the need for model updating, either by recalibration-in-the-large (re-estimation of intercept), recalibration (re-estimation of intercept/slope), or model revision (re-estimation of all coefficients). There were 21 events (21%) of ≥grade 2 RP. The closed testing procedure on the PBT data set did not detect major deviations between the models and the data and recommended adjustment of the intercept only for the photon-based Netherlands updated QUANTEC model (intercept update: –1.2). However, an update of the slope and revision of the model coefficients were not recommended by the closed testing procedure, as the deviations were not significant within the power of the data. The similarity between the dose-response relationship for PBT and photons for normal tissue complications has been an assumption until now. We demonstrate that the preexisting, widely used photon based models fit our PBT data well with minor modifications. These now-validated and updated normal tissue complication probability models can aid in individualizing selection of the most optimal treatment technique for a particular patient. [ABSTRACT FROM AUTHOR]

Fiber lasers are increasingly replacing the commonly used diode lasers in laser transmission welding of plastics for challenging applications due to their superior beam quality and the ability to use long working distances and small spot sizes. At the same time, these smaller spot sizes increase the risk of thermal degradation. In this work, we investigate different scanning strategies that allow controlling the weld seam widths. These strategies are characterized regarding the demands on the performance of the scanner system, the risk of thermal degradation and the mechanical properties of the resulting welds. [ABSTRACT FROM AUTHOR]

The purpose of this study is to identify doctor of pharmacy and pharmaceutical sciences students' perceived barriers to mental health care and interest in mental health interventions and to assess student attitudes and perceptions of mental illness. A mixed-methods survey was given to 706 students participating in a doctor of pharmacy and pharmaceutical sciences curricula to assess students' perceived barriers to care, interest in mental health resources and interventions within their curricula, attitudes towards seeking treatment, and perceived stigma. The last section included free text responses in which students expressed additional comments unacknowledged by previous sections. Quantitative data was analyzed using descriptive statistics, and free text responses were analyzed using thematic coding. From February to March 2018, 256 responses were received out of 706 students with a response rate of 36%. The most cited barriers to seeking mental health treatment were lack of time, lack of finances, and stigma-related concerns (25%, 13%, and 11%, respectively) with the most desired interventions being the implementation of an onsite counselor and wellness space. A majority of participants (88%) believe professional help for mental illness is effective; however, 63% cited they were negatively impacted by internal stigma. Common themes addressed in the free text responses reinforced these ideas and included additional responses regarding the impact of school culture. Students within a doctor of pharmacy and pharmaceutical sciences program experience non-stigma and stigma-related barriers to seeking mental health treatment. [ABSTRACT FROM AUTHOR]

The ability to verify the geometrical quality of a machined workpiece on the machine tool itself can be a crucial advantage in ultra-precision diamond turning. This paper presents a new positioning procedure for optical one-dimensional (1D) probes integrated on diamond turning machines with two horizontal linear axes and one rotational axis. A tilted flat, mounted onto the spindle, is used to determine the offsets between the probe and the spindle axis in order to minimize measurement deviations referred to probe alignment errors. An estimation of the positioning uncertainty, which can be specified to be less than 0.3 µm, is given. [ABSTRACT FROM AUTHOR]

Tree fall onto railway lines puts passengers at risk and causes large economic losses due to disruption of train services and damage to infrastructure. Railway lines in Germany are vulnerable to tree fall because of the large number of trackside trees that exist in that country with approximately 70% of all railway lines being tree-lined. In this paper we first tested whether a hybrid-mechanistic tree wind damage model, ForestGALES, could identify the sections of the railway network affected by tree fall in two federal states of Germany, Northrhine-Westphalia (NRW) and Thuringia (TH). We secondly tested whether the model, in combination with meteorological forecast models, could predict where tree fall occurred during a damaging windstorm. We used information on tree characteristics derived from LiDAR and aerial photography along the railway line network in NRW and TH to calculate the critical wind speed (CWS) at which damage is expected to happen for every individual tree as a function of its size and species, and the underlying soil. The railway network was then divided into 500 m sections and the statistics of the CWS , tree height, and species composition (broadleaf/conifer mix) within each section were calculated. Analysis of past tree fall events recorded by Deutsche Bahn AG (DB) showed that there was a significantly lower minimum CWS and significantly greater maximum tree height in sections that had recorded damage. In a second step we compared the calculated CWS values for all trees against downscaled wind speed assessments across the two federal states during Storm Friederike (named Storm David internationally) on 18 January 2018 and tested the ability of the model to discriminate sections with recorded damage during the storm. Excellent model discrimination was found with an AUC value of 0.82 and an overall model accuracy of 74.2%. The first test showed that the ForestGALES model with precise individual tree information can identify the sections of a railway network most vulnerable to tree fall. The second analysis showed, for the one storm tested, that the ForestGALES model when combined with predicted storm wind speeds can identify the most probable sections of the railway network to experience tree fall during an approaching damaging storm. Such information could be of value in firstly planning remedial work along railway lines, and secondly preparing the railway network ahead of a major storm. • Tree fall is a major hazard to the railway network in Germany. • A mechanistic model could identify sections of a railway most at risk of tree fall. • The model identified sections likely to suffer tree fall prior to a storm. • Sections with tree fall had trees with significantly greater maximum heights. • The model can be used to identify sections requiring remedial action. [ABSTRACT FROM AUTHOR]

It has been reported that bond strength can be reversed to prebleached levels with the application of 10% alpha-tocopherol in a 2-hour time frame or by delaying bonding for 2 weeks. This study evaluated the effectiveness of a 5-minute application of 20% alpha-tocopherol to reverse the deleterious effects of nonvital bleaching on consequent bond strength. Thirty third molars were assigned to the following 3 groups: unbleached, bleached, and bleached followed by treatment with alpha-tocopherol. The bleached groups were exposed to sodium perborate (2 g/mL) for 7 days. The postbleach treatment group was subsequently treated with 20% alpha-tocopherol for 5 minutes, and then all groups were restored with composite resin. After 24 hours of storage at 37°C and 100% humidity, restored tooth specimens were sectioned into 1-mm2 dentin-composite beams. Six beams from each tooth were subjected to microtensile bond strength testing. Representative beams were further evaluated with Raman microspectroscopy and scanning electron microscopy. The mean bond strength values (MPa) for each group were as follows: unbleached control group = 26.2, bleached control group = 20.3, and post–bleach treatment group = 18.5. A 1-factor analysis of variance and Tukey post hoc test (α = 0.05) indicated that bleaching had a detrimental effect on bond strength and that short-term alpha-tocopherol treatments did not improve postbleach bond strength. Raman microspectroscopy and scanning electron microscopy revealed no noted improvement for the post–bleach treatment group.The application of 20% alpha-tocopherol in a clinically relevant time frame was not effective in counteracting the deleterious effect of bleaching on bond strength. Bonding procedures should be delayed after tooth bleaching. [ABSTRACT FROM AUTHOR]

• The photosensitizer removal with DW + US decreases the bond strength of GFPs + resin cement. • The use of US over EDTA and QMix improves the bond strength of GFPs + resin cement. • The type of resin cement do not influence the bond strength of GFPs. This study aimed to evaluate the influence of final irrigation protocols and type of resin cement on the bond strength of glass fiber posts (GFPs) in root dentin previously treated with photodynamic therapy (PDT). One hundred root canals were prepared up to #4 Gates Glidden drill to receive the GFPs. All samples were subjected to PDT, and randomly divided into five groups (n = 20) according to final irrigation protocol: distilled water + ultrasonic activation [US]; 17% EDTA; QMix; 17% EDTA + US; and QMix + US. Each group was randomly divided into 2 subgroups (n = 10) according to the type of resin cement used for cementation of GFPs: Rely-X ARC dual-resin; or Rely-X U200 (#M, St Paul, MN, USA) self-adhesive resin cement. Bond strength was evaluated using the push-out test. Failure patterns were observed under an optical microscope. Bond strengths were compared using two-way ANOVA, followed by the Tukey post-hoc test; failure modes were compared using the chi-squared test (α = 5%). The use of US over final irrigants improved the bond strength of GFPs, regardless of resin cement used (p < 0.05). The type of resin cement did not influence the bond strength of GFPs (p < 0.05). There was a higher predominance of cohesive failure in all groups, regardless of resin cement tested (p < 0.05). The use of US on final irrigation improved the bond strength of GFPs, while the type of resin cement (dual or self-adhesive) did not influence the bond strength of GFPs in root dentin previously treated with PDT. [ABSTRACT FROM AUTHOR]

• Inadequate removal of photosensitizer of PDT decreases the bond strength of root filling material. • The use of EDTA and QMix, regardless US, improves the bond strength of root filling material. • The use of epoxy resin-based AH Plus sealer improves the bond strength of root filling material. The aim of this study was to evaluate the influence of final irrigation protocols and endodontic sealer on bond strength of root filling material on root dentin previously treated with photodynamic therapy (PDT). One hundred root canals were prepared up to #F3 file of Pro-Taper system to receive the root filling material. All samples were submitted to PDT and randomly divided into five groups (n = 20) according to final irrigation protocols: Group 1-distilled water + ultrasonic activation (US); Group 2–17% EDTA; Group 3-QMix; Group 4–17% EDTA + US; Group 5-QMix + US. Each group was randomly divided into two subgroups (n = 10), according to the endodontic sealer used for cementation of gutta-percha points: AH Plus or MTA Fillapex. The bond strength was evaluated by a push-out test. The patterns of failure were observed under optical microscopy. The bond strength was evaluated using a two-way Anova followed by the Tukey post-hoc test, and the failure mode was evaluated using the chi-square test (α = 5%). The use of 17% EDTA and QMix associated or not to US improved the bond strength of root filling material with either endodontic sealer (p < 0.05). AH Plus showed higher bond strength than MTA Fillapex (p < 0.05). There was a higher predominance of cohesive failure in all groups, regardless of the tested final irrigation protocols and endodontic sealer (p < 0.05). The use of 17% EDTA and QMix, regardless of association with US, and the use of AH Plus improve the bond strength of the root filling material on root dentin previously treated with PDT. [ABSTRACT FROM AUTHOR]

Objective: As nurse practitioners (NPs) and physician assistants (PAs) become an integral part of delivering emergency medical services, we examined the involvement of NPs and PAs who billed independently in emergency departments (EDs).Methods: We used Medicare provider utilization and payment data from 2012 to 2016 to conduct a retrospective analysis. We examined the changes in the number of each clinician type who billed independently for four common emergency services (CPT codes: 99282-5), the change in their service volume, and the change in their average number of services billed.Results: Between 2012 and 2016, the proportion of NPs and PAs billing independently increased from 18% to 22% for ED visits of low severity (99282), 23% to 29% for visits with moderate severity (99283), 21% to 27% for visits with high severity (99284), 18% to 24% for visit with the highest severity (99285), and 23% to 29% across all four services. The proportion of services provided by emergency physicians decreased from 66% to 63% across all four services, and from 11% to 9% for internists and family physicians. The number of NPs, PAs billing independently, and emergency physicians increased by 65%, 35% and 12% respectively.Conclusions: NPs and PAs are increasingly billing emergency services of all levels of severity, independent of physicians. This trend is driven by a growing number of NPs and PAs independently billing services, despite a relatively stable number of emergency physicians (excepting the decline in rural areas), and diminished involvement of family physicians and internists in EDs. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Scientific computing jobs still have fixed resources (nodes/CPUs, memory, time). • The resulting resource waste can be avoided by malleable parallelism. • Our Java-RMI-based malleable parallelism is demonstrated for global structure optimization. • It does not need additional software, communication or scheduling. • We show full use of otherwise unusable resources on large and very large computers. Abstract In practice, standard scheduling of parallel computing jobs almost always leaves significant portions of the available hardware unused, even with many jobs still waiting in the queue. The simple reason is that the resource requests of these waiting jobs are fixed and do not match the available, unused resources. However, with alternative but existing and well-established techniques it is possible to achieve a fully automated, adaptive parallelism that does not need pre-set, fixed resources. Here, we demonstrate that such an adaptively parallel program can run productively on a machine that is traditionally considered "full" and thus can indeed fill all such scheduling gaps, even in real-life situations on large supercomputers in which a fixed-size job could not have started. [ABSTRACT FROM AUTHOR]

Abstract A 1 kW closed sorption Thermal Energy Storage (TES) system based on water absorption/desorption in a high-energy density sorbent like sodium hydroxide (sorbent, NaOH) is developed and tested at HSR-SPF. The overall concept of the 1 kW prototype system, based on the tube bundle and falling film model is presented. A modular design was chosen for the absorber/desorber unit with the aim of testing several types of tubes and liquid sorbent modifications. The influence of SiC foams with different porosity on the sorbent mass uptake, thus on the sorbent residence time in the water vapour is presented. The experiments have indicated that, although a better residence time can be obtained for ceramic samples with small pores size, a balance has to be found between ceramic clogging and gas-liquid area to achieve an efficient heat and mass exchange. The improved tube bundles are further tested in the 1 kW prototype. [ABSTRACT FROM AUTHOR]

Abstract In laser transmission welding of thermoplastics the optical properties of the transparent part have great influence on the weld seam quality. Especially scattering, for example at crystalline structures or additives, can significantly affect the intensity distribution of the radiation in the joining zone. Since scattering is a strongly wavelength dependent process the right choice of the laser wavelength can enable laser transmission welding even for challenging materials. It is shown that the necessary optical material properties needed to assess the weldability of scattering materials can be directly obtained from NIR-spectroscopy. [ABSTRACT FROM AUTHOR]

Abstract Laser transmission welding is widely used for the creation of strong, hermetic and optically appealing joints between thermoplastic parts. Amorphous polymers like polycarbonate and poly(methyl methacrylate) offer excellent optical properties, making them suitable for this joining technique and especially attractive for lighting and decorative applications, for example in the automotive industry. However, the rapid and non-uniform temperature changes during the process can lead to residual stresses, which can impair weld strength and result in part failure due to environmental stress cracking. In this work it was found, that the application of 2 µm laser radiation can lead to reduced stress-cracking-susceptibility compared to conventional laser transmission welding with wavelengths of ~1 µm. [ABSTRACT FROM AUTHOR]

Objective To study the impact of subtypes and comorbidities on breast cancer (BC) relapse and survival in the heterogeneous patients of the real world. Methods We identified patients diagnosed with BC between January 2003 and December 2005 from six population-based Swiss cancer registries. Clinicopathologic data was completed with information on locoregional and distant relapse and date and cause of death for over 10-years. We approximated BC subtypes using grade and the immunohistochemical panel for oestrogen, progesterone and human epidermal growth factor 2 (HER2) receptor status. We studied factors affecting relapse and survival. Results Luminal A-like subtype represented 46% of all newly diagnosed BC (N = 1831), followed by luminal B-like (N = 1504, 38%), triple negative (N = 436, 11%) and HER2 enriched (N = 204, 5%). We observed regional disparities in subtype prevalence that contribute to explain regional differences in survival formerly described. Disease relapse and BC specific mortality differed by subtype and were lower for luminal A like tumours than for other subtypes for any stage at diagnosis. After a median follow-up of 10.9 years, 1311 (33%) had died, half of them 647 (16%) due to another disease, showing the importance of comorbidities. Omission of systemic therapies in selected patients was not associated with poorer BC specific survival, BC subtype and life expectancy playing a role. Conclusions Information on tumour subtype is necessary for an adequate interpretation of population-based BC studies. Measures of comorbidity or frailty help in the evaluation of quality of care in the highly heterogeneous patients of the real world. [ABSTRACT FROM AUTHOR]

Background: Oxytocin (Oxt) and its receptor (Oxtr) gene system has been implicated in cardiomyogenesis and cardioprotection; however, effects of chronic activation of Oxtr are not known. We generated and investigated transgenic (TG) mice that overexpress Oxtr specifically in the heart.Methods and Results: Cardiac-specific overexpression of Oxtr was obtained by having the α-major histocompatibility complex promoter drive the mouse Oxtr gene (α-Mhc-Oxtr). Left ventricular (LV) function and remodeling were assessed by magnetic resonance imaging and echocardiography. In α-Mhc-Oxtr TG mice, LV ejection fraction was severely compromised at 14 weeks of age compared with wild-type (WT) littermates (25 ± 6% vs 63 ± 3%; P < .001). LV end-diastolic volume was larger in the TG mice (103 ± 6 µL vs 67 ± 5 µL; P < .001). α-Mhc-Oxtr TG animals displayed cardiac fibrosis, atrial thrombus, and increased expression of pro-fibrogenic genes. Mortality of α-Mhc-Oxtr TG animals was 45% compared with 0% (P < .0001) of WT littermates by 20 weeks of age. Most cardiomyocytes of α-Mhc-Oxtr TG animals but not WT littermates (68.0 ± 12.1% vs 5.6 ± 2.4%; P = .008) were positive in staining for nuclear factor of activated T cells (NFAT). To study if thrombin inhibitor prevents thrombus formation, a cohort of 7-week-old α-Mhc-Oxtr TG mice were treated for 12 weeks with AZD0837, a potent thrombin inhibitor. Treatment with AZD0837 reduced thrombus formation (P < .05) and tended to attenuate fibrosis and increase survival.Conclusions: Cardiac-specific overexpression of Oxtr had negative consequences on LV function and survival in mice. The present findings necessitate further studies to investigate potential adverse effects of chronic Oxt administration. We provide a possible mechanism of Oxtr overexpression leading to heart failure by nuclear factor of activated T cell signaling. The recapitulation of human heart failure and the beneficial effects of the antithrombin inhibitor render the α-Mhc-Oxtr TG mice a promising tool in drug discovery for heart failure. [ABSTRACT FROM AUTHOR]

Conducting scientific studies is an often frustrating and tedious task. To minimize recurring problems, such as lack of concentration or willingness to participate, and instead promote interest in the study, a smart mobile device assessment tool was developed focusing on educational studies. The tablet-based assessment tool offers a wide range of visual tasks that can be employed when conducting studies utilizing the European Framework of Visual Literacy (ENViL). Furthermore, the assessment tool is highly configurable in the field by using a centralized server and spreadsheet-based configuration files, thereby ensuring that no programming language is required to adapt the tasks on the mobile devices participating in the study. Finally, the presented framework and architecture adhere to the cross-platform and cross-device style and can be re-used and extended for any number of similar studies. [ABSTRACT FROM AUTHOR]

Poly( para -phenylene) (PPP) is a novel aromatic polymer with higher strength and stiffness than polyetheretherketone (PEEK), the gold standard material for polymeric load-bearing orthopaedic implants. The amorphous structure of PPP makes it relatively straightforward to manufacture different architectures, while maintaining mechanical properties. PPP is promising as a potential orthopaedic material; however, the biocompatibility and osseointegration have not been well investigated. The objective of this study was to evaluate biological and mechanical behavior of PPP, with or without porosity, in comparison to PEEK. We examined four specific constructs: 1) solid PPP, 2) solid PEEK, 3) porous PPP and 4) porous PEEK. Pre-osteoblasts (MC3T3) exhibited similar cell proliferation among the materials. Osteogenic potential was significantly increased in the porous PPP scaffold as assessed by ALP activity and calcium mineralization. In vivo osseointegration was assessed by implanting the cylindrical materials into a defect in the metaphysis region of rat tibiae. Significantly more mineral ingrowth was observed in both porous scaffolds compared to the solid scaffolds, and porous PPP had a further increase compared to porous PEEK. Additionally, porous PPP implants showed bone formation throughout the porous structure when observed via histology. A computational simulation of mechanical push-out strength showed approximately 50% higher interfacial strength in the porous PPP implants compared to the porous PEEK implants and similar stress dissipation. These data demonstrate the potential utility of PPP for orthopaedic applications and show improved osseointegration when compared to the currently available polymeric material. Statement of significance PEEK has been widely used in orthopaedic surgery; however, the ability to utilize PEEK for advanced fabrication methods, such as 3D printing and tailored porosity, remain challenging. We present a promising new orthopaedic biomaterial, Poly( para -phenylene) (PPP), which is a novel class of aromatic polymers with higher strength and stiffness than polyetheretherketone (PEEK). PPP has exceptional mechanical strength and stiffness due to its repeating aromatic rings that provide strong anti-rotational biaryl bonds. Furthermore, PPP has an amorphous structure making it relatively easier to manufacture (via molding or solvent-casting techniques) into different geometries with and without porosity. This ability to manufacture different architectures and use different processes while maintaining mechanical properties makes PPP a very promising potential orthopaedic biomaterial which may allow for closer matching of mechanical properties between the host bone tissue while also allowing for enhanced osseointegration. In this manuscript, we look at the potential of porous and solid PPP in comparison to PEEK. We measured the mechanical properties of PPP and PEEK scaffolds, tested these scaffolds in vitro for osteocompatibility with MC3T3 cells, and then tested the osseointegration and subsequent functional integration in vivo in a metaphyseal drill hole model in rat tibia. We found that PPP permits cell adhesion, growth, and mineralization in vitro. In vivo it was found that porous PPP significantly enhanced mineralization into the construct and increased the mechanical strength required to push out the scaffold in comparison to PEEK. This is the first study to investigate the performance of PPP as an orthopaedic biomaterial in vivo . PPP is an attractive material for orthopaedic implants due to the ease of manufacturing and superior mechanical strength. [ABSTRACT FROM AUTHOR]