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Endoscopy plays a key role in diagnosis, monitoring of disease activity, assessment of treatment response, dysplasia surveillance, postoperative evaluation, and interventional therapy for patients with inflammatory bowel disease (IBD). Clinical practice patterns in the endoscopic management of IBD vary. A panel of experts consisting of IBD specialists, endoscopists, and GI pathologists participated in virtual conferences and developed this modified Delphi-based consensus document to address endoscopic aspects of IBD management. [ABSTRACT FROM AUTHOR]

The phase 3 Veterans Affairs Lung Cancer Surgery Or Stereotactic Radiotherapy study implemented centralized quality assurance (QA) to mitigate risks of protocol deviations. This report summarizes the quality and compliance of the first 100 participants treated with stereotactic body radiation therapy (SBRT) in this study. A centralized QA program was developed to credential and monitor study sites to ensure standard-of-care lung SBRT treatments are delivered to participants. Requirements were adapted from protocols established by the National Cancer Institute's Image and Radiation Oncology Core, which provides oversight for clinical trials sponsored by the National Cancer Institute's National Clinical Trials Network. The first 100 lung SBRT treatment plans were reviewed from April 2017 to October 2022. Tumor contours were appropriate in all submissions. Planning target volume (PTV) expansions were less than the minimum 5 mm requirement in 2% of cases. Critical organ-at-risk structures were contoured accurately for the proximal bronchial tree, trachea, esophagus, spinal cord, and brachial plexus in 75%, 92%, 100%, 100%, and 95% of cases, respectively. Prescriptions were appropriate in 98% of cases; 2 central tumors were treated using a peripheral tumor dose prescription while meeting organ-at-risk constraints. PTV V100% (the percentage of target volume that receives 100% or more of the prescription) values were above the protocol-defined minimum of 94% in all but 1 submission. The median dose maximum (Dmax) within the PTV was 125.4% (105.8%-149.0%; SD ± 8.7%), where values reference the percentage of the prescription dose. High-dose conformality (ratio of the volume of the prescription isodose to the volume of the PTV) and intermediate-dose compactness [R50% (ratio of the volume of the half prescription isodose to the volume of the PTV) and D2cm (the maximum dose beyond a 2 cm expansion of the PTV expressed as a percentage of the prescription dose)] were acceptable or deviation acceptable in 100% and 94% of cases, respectively. The first 100 participants randomized to SBRT in this study were appropriately treated without safety concerns. A response to the incorrect prescriptions led to preventative measures without further recurrences. The program was developed in a health care system without prior experience with a centralized radiation therapy QA program and may serve as a reference for other institutions. [ABSTRACT FROM AUTHOR]

Despite increasing use of long-acting reversible contraception (LARC) among U.S. adolescents, there is limited literature on factors affecting intrauterine device (IUD) or subdermal implant use. This study aimed to describe statewide rates, and associated patient and provider factors of adolescent IUD or implant initiation and continuation. This retrospective cohort study used N.C. Medicaid claims data. 10,408 adolescents were eligible (i.e., 13–19 years, female sex, continuous Medicaid enrollment, had an IUD or implant insertion or removal code from January 1, 2013, to October 1, 2015). Bivariate analyses assessed differences in adolescents using IUD versus implant. Kaplan-Meier curves were created to assess IUD or implant discontinuation through December 31, 2018. Adolescents initiated 8,592 implants and 3,369 IUDs (N = 11,961). There were significant differences in nearly all provider and patient factors for those who initiated implants versus IUDs. 16% of implants and 53% of IUDs were removed in the first year. Younger (i.e., age <18 years old), Hispanic, and Black adolescents had higher adjusted continuation of implants compared with older and White adolescents, respectively (both p <.001). Those whose IUD was inserted by an obstetrician/gynecologist provider had lower continuation of IUDs compared with non-obstetrician/gynecologist providers (p <.001). We found that age-related, racial, and ethnic disparities exist in both implant and IUD continuation. Practice changes to support positive adolescent experiences with implant and IUD insertion and removals are needed, including patient-centered health care provider training in contraception counseling, LARC initiation and removal training for adolescent-facing providers, and broader clinic capacity for LARC services. [ABSTRACT FROM AUTHOR]

Reproducible methods for determining adequate bone densities for stemless anatomic total shoulder arthroplasty (aTSA) are currently lacking. The purpose of this study was to evaluate the utility of preoperative computed tomography (CT) imaging for assessing the bone density of the proximal humerus for supportive differentiation in the decision making for stemless humeral component implantation. It was hypothesized that preoperative 3-dimensional (3-D) CT bone density measures provide objective classifications of the bone quality for stemless aTSA. A 3-part study was performed that included the analysis of cadaveric humerus CT scans followed by retrospective application to a clinical cohort and classification with a machine learning model. Thirty cadaveric humeri were evaluated with clinical CT and micro-CT (μCT) imaging. Phantom-calibrated CT data were used to extract 3-D regions of interest and defined radiographic scores. The final image processing script was applied retrospectively to a clinical cohort (n = 150) that had a preoperative CT and intraoperative bone density assessment using the "thumb test," followed by placement of an anatomic stemmed or stemless humeral component. Postscan patient-specific calibration was used to improve the functionality and accuracy of the density analysis. A machine learning model (Support vector machine [SVM]) was utilized to improve the classification of bone densities for a stemless humeral component. The image processing of clinical CT images demonstrated good to excellent accuracy for cylindrical cancellous bone densities (metaphysis [ICC = 0.986] and epiphysis [ICC = 0.883]). Patient-specific internal calibration significantly reduced biases and unwanted variance compared with standard HU CT scans (P <.0001). The SVM showed optimized prediction accuracy compared with conventional statistics with an accuracy of 73.9% and an AUC of 0.83 based on the intraoperative decision of the surgeon. The SVM model based on density clusters increased the accuracy of the bone quality classification to 87.3% with an AUC of 0.93. Preoperative CT imaging allows accurate evaluation of the bone densities in the proximal humerus. Three-dimensional regions of interest, rescaling using patient-specific calibration, and a machine learning model resulted in good to excellent prediction for objective bone quality classification. This approach may provide an objective tool extending preoperative selection criteria for stemless humeral component implantation. [ABSTRACT FROM AUTHOR]

[Display omitted] • Novel insights into thermal evolution of São Francisco Craton and adjacent orogens. • Contrasting rheology exert fundamental control on Apatite Fission Track ages. • The Abrolhos Magmatic Province influence on the youngest AFT ages of the data set. • Rift shoulder erosion, fault reactivation and volcanism shape lithospheric dynamics. The South American Platform encompasses the São Francisco Craton (SFC) and the Araçuaí-Ribeira orogenic system (AROS) located in the eastern Brazil. These geologic domains hold records of differential exhumation, sedimentation, volcanic activity, and post-rift reactivation of faults and shear zones. Therefore, these terranes provide outstanding opportunities for studying the dynamics of lithospheric processes, particularly in their interaction zones, characterized by the transition from cratonic to orogenic lithosphere. To investigate the processes involved in the contrasting behavior of the upper crust, we provide 23 new apatite fission track (AFT) ages and thermal histories from the northern segment of the AROS and from the eastern area of the SFC. The AFT ages range from 154.4 ± 20.1 and 37.1 ± 3.0 Ma and the mean track lengths range from 10.9 and 13.2 μm. We compiled thermal information from previous thermochronological analysis from 357 sites and constructed inverse distance weighted maps that depict the spatial distribution of AFT ages and the temperature evolution from 360 to 30 Ma. The results indicate that the SFC experienced its final exhumation within the apatite partial annealing zone (APAZ) at temperatures ranging from 110 °C to 60 °C during the late Paleozoic. In contrast, the AROS went through its last cooling within the APAZ during the Mesozoic or even in the Cenozoic. This suggests that reactivation and reheating, possibly associated with the South Atlantic rift, influenced the orogenic basement of the passive margin. We highlight that the reheating associated to the Abrolhos magmatic province in the northern segment of the AROS caused the youngest AFT ages of the study area. Our work demonstrates the importance of considering contrasting rheology when analyzing regional exhumation patterns, the structural fabric of orogens through reactivation of crustal discontinuities generating heating and exhumation, and how volcanism can disrupt the thermal record, inducing crustal reheating. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common heart arrhythmia and considered to be a progressive chronic disease associated with increased morbidity and mortality. Recent data suggest a link between inflammation, oxidative stress, and AF, although the underlying mechanisms are not fully understood. Because oxidized lipoproteins cause structural damage and electrophysiologic changes in cardiomyocytes, it is feasible that the transformation of atheroprotective high-density lipoprotein (HDL) into dysfunctional HDL contributes to the development of AF. The purpose of this study was to determine whether a reduced antioxidant function of HDL is associated with the presence of AF. In this multicenter cross-sectional cohort study, we assessed HDL function in sera of 1206 participants. Patients were divided into groups according to the presence of AF (n = 233) or no AF (n = 973). A validated cell-free biochemical assay was used to determine reduced HDL antioxidant function as assessed by increased normalized HDL lipid peroxide content (nHDL ox). Participants with AF had a 9% higher mean relative nHDL ox compared to persons without AF (P =.025). nHDL ox was strongly associated with AF in all models of logistic regression, including the analysis adjusted for age, sex, and risk factors for AF (all P ≤.01). Reduced antioxidant HDL function is associated with the presence of AF, which supports growing evidence that impaired lipoprotein function is linked to electrophysiological changes in cardiomyocytes. nHDL ox is one of several contributors to the initiation and perpetuation of AF. [Display omitted] [ABSTRACT FROM AUTHOR]

Periprosthetic joint infections occur in 1%-4% of primary total shoulder arthroplasties (TSAs). Cutibacterium acnes is the most commonly implicated organism and has been shown to persist in the dermis despite use of preoperative antibiotics and standard skin preparations. Studies have shown decreased rates of cultures positive for C acnes with use of preoperative benzoyl peroxide or hydrogen peroxide (H 2 O 2), but even with this positive deep cultures remain common. We sought to determine whether an additional application of H 2 O 2 directly to the dermis following skin incision would further decrease deep culture positivity rates. We performed a randomized controlled trial comparing tissue culture results in primary TSA in patients who received a standard skin preparation with H 2 O 2 , ethanol, and ChloraPrep (CareFusion, Leawood, KS, USA) vs. an additional application of H 2 O 2 to the dermis immediately after skin incision. Given the sexual dimorphism seen in the shoulder microbiome regarding C acnes colonization rates, only male patients were included. Bivariable and multivariable analyses were performed to compare rates of positive cultures based on demographic and surgical factors. Dermal cultures were found to be positive for C acnes at similar rates between the experimental and control cohorts for the initial (22% vs. 28%, P =.600) and final (61% vs. 50%, P >.999) dermal swabs. On bivariable analysis, the rate of positive deep cultures for C acnes was lower in the experimental group, but this difference was not statistically significant (28% vs. 44%, P =.130). However, patients who underwent anatomic TSA were found to have a significantly greater rate of deep cultures positive for C acnes (57% vs. 28%, P =.048); when controlling for this on multivariable analysis, the experimental cohort was found to be associated with significantly lower odds of having positive deep cultures (odds ratio, 0.37 [95% confidence interval, 0.16-0.90], P =.023). There were no wound complications in either cohort. An additional H 2 O 2 application directly to the dermis following skin incision resulted in a small but statistically significant decrease in the odds of having deep cultures positive for C acnes without any obvious adverse effects on wound healing. Given its cost-effectiveness, use of a post-incisional dermal decontamination protocol may be considered as an adjuvant to preoperative use of benzoyl peroxide or H 2 O 2 to decrease C acnes contamination. [ABSTRACT FROM AUTHOR]

To examine the analgesic efficacy of postoperative deep parasternal intercostal plane (DPIP) blocks for patients having cardiac surgery via median sternotomy. This single-center retrospective study compared patients receiving bilateral DPIP blocks with a matched cohort of patients not receiving DPIP blocks. Large quaternary referral center. Adult patients admitted to the authors' institution from January 1, 2016, to August 14, 2020, for elective cardiac surgery via median sternotomy. Patients received ultrasound-guided bilateral DPIP blocks. A total of 113 patients received a DPIP block; 3,461 patients did not. The estimated multiplicative change in cumulative opioid consumption through 24 hours was 0.42 (95% CI 0.32-0.56; p < 0.001), indicating that patients receiving DPIP blocks required 60% fewer opioids than patients who did not. Proportional odds ratios for the average pain score on postoperative day (POD) 0 was 0.46 (95% CI 0.32-0.65; p < 0.001), and POD 1 was 0.67 (95% CI 0.47-0.94; p = 0.021), indicating lower pain scores for patients receiving blocks. The exploratory analysis identified an inverse correlation between DPIP blocks and atrial fibrillation incidence (2% v 15%; inverse probability of treatment weighting odds ratio 0.088, 95% CI 0.02-0.41; p = 0.002). The use of DPIP blocks in patients undergoing cardiac surgery via median sternotomy was associated with less opioid use and improved pain scores in the early postoperative period compared with patients not receiving blocks. Prospective randomized controlled studies should further elucidate the efficacy and risks of DPIP blocks in cardiac surgery. [Display omitted] [ABSTRACT FROM AUTHOR]

Although outpatient thyroidectomy has become common, few large-scale studies have examined post-thyroidectomy emergency department use, readmission, and encounters not resulting in readmission, known as "treat-and-release" encounters. We evaluated post-outpatient thyroidectomy emergency department use and readmission and characterized associated factors. Using the Healthcare Cost and Utilization Project databases, we identified adult outpatient (same-day or <24-hour discharge) thyroidectomies performed in Florida, Maryland, and New York from 2016 to 2017. We identified the procedures linked with emergency department treat-and-release encounters and readmissions within 30 days postoperatively and the factors associated with post-thyroidectomy emergency department use and readmission. Of the 17,046 patients who underwent outpatient thyroidectomy at 374 facilities, 7.5% had emergency department treat-and-release encounters and 2.3% readmissions. The most common reasons for emergency department treat-and-release encounters (9.9%) and readmissions (22.2%) were hypocalcemia–related diagnoses. Greater odds of treat-and-release were associated with identifying as non-Hispanic Black (adjusted odds ratio: 1.5, 95% confidence interval: 1.3–1.8) or Hispanic race/ethnicity (adjusted odds ratio: 1.4, 95% CI: 1.1–1.6), having Medicaid insurance (adjusted odds ratio: 2.7, 95% CI: 2.3–3.2), and living in non-metropolitan areas (adjusted odds ratio: 1.6, 95% CI: 1.1–2.2). We observed no associations between these factors and the odds of readmission. Emergency department use after outpatient thyroidectomy is common. Racial, ethnic, socioeconomic, and geographic disparities are associated with treat-and-release encounters but not readmissions. Standardization of perioperative care pathways, focusing on identifying and addressing specific issues in vulnerable populations, could improve care, reduce disparities, and improve patient experience by avoiding unnecessary emergency department visits after outpatient thyroidectomy. [ABSTRACT FROM AUTHOR]

Carbon-fiber reinforced (CFR) polyetheretherketone hardware is an alternative to traditional metal hardware used for spinal fixation surgeries before postoperative radiation therapy for patients with spinal metastases. CFR hardware's radiolucency decreases metal artifact, improving visualization and accuracy of treatment planning. We present the first clinical use and proof of principle of CFR spinal hardware with tantalum markers used for successful tracking of intrafraction motion (IM) using Varian TrueBeam IMR (Intrafraction Motion Review) software module during postoperative spine stereotactic radiation. A 63-year-old woman with history of endometrial cancer presented with acute back pain. Imaging demonstrated pathologic T12 vertebral fracture with cord compression. She underwent T12 vertebrectomy with circumferential decompression and posterior instrumented T10-L2 fusion at our facility using CFR-polyetheretherketone hardware with tantalum screw markers followed by postoperative stereotactic body radiation therapy to 3000 cGy in 5 fractions delivered to T11-T12. Tantalum screw markers were used for IMR tracking. During irradiation, 260 kV images were acquired, and IMR software was able to identify and track markers. During the entire treatment, the IM motions were less than 3 mm. This is the first presented case of CFR spinal hardware with tantalum markers used for successful IMR tracking of IM during daily spine stereotactic treatment. Future work will be needed to improve workflow and create a spine-specific IMR protocol. [ABSTRACT FROM AUTHOR]

Non-technical skills, such as communication and situation awareness, are vital for patient care and effective surgical team performance. Previous research has found that residents' perceived stress is associated with poorer non-technical skills; however, few studies have investigated the relationship between objectively assessed stress and non-technical skills. Accordingly, the purpose of this study was to assess the relationship between objectively assessed stress and non-technical skills. Emergency medicine and surgery residents voluntarily participated in this study. Residents were randomly assigned to trauma teams to manage critically ill patients. Acute stress was assessed objectively using a chest-strap heart rate monitor, which measured average heart rate and heart rate variability. Participants also evaluated perceived stress and workload using the 6-item version of the State-Trait Anxiety Inventory and the Surgery Task Load Index. Non-technical skills were assessed by faculty raters using the non-technical skills scale for trauma. Pearson's correlation coefficients were used to examine relationships between all variables. Forty-one residents participated in our study. Heart rate variability (where higher values reflect lower stress) was positively correlated with residents' non-technical skills overall and leadership, communication, and decision-making. Average heart rate was negatively correlated with residents' communication. Higher objectively assessed stress was associated with poorer non-technical skills in general and nearly all non-technical skills domains of the T-NOTECHS. Clearly, stress has a deleterious effect on residents' non-technical skills during trauma situations, and given the importance of non-technical skills in surgical care, educators should consider implementing mental skills training to reduce residents' stress and optimize non-technical skills during trauma situations. [ABSTRACT FROM AUTHOR]

This study examined the postoperative analgesic efficacy of single-injection pectoral fascial plane (PECS) II blocks compared to paravertebral blocks for elective robotic mitral valve surgery. A single-center retrospective study that reported patient and procedural characteristics, postoperative pain scores, and postoperative opioid use for patients undergoing robotic mitral valve surgery. This investigation was performed at a large quaternary referral center. Adult patients (age ≥18) admitted to the authors' hospital from January 1, 2016, to August 14, 2020, for elective robotic mitral valve repair who received either a paravertebral or PECS II block for postoperative analgesia. Patients received an ultrasound-guided, unilateral paravertebral or PECS II nerve block. One hundred twenty-three patients received a PECS II block, and 190 patients received a paravertebral block during the study period. The primary outcome measures were average postoperative pain scores and cumulative opioid use. Secondary outcomes included hospital and intensive care unit lengths of stay, need for reoperation, need for antiemetics, surgical wound infection, and atrial fibrillation incidence. Patients receiving the PECS II block required significantly fewer opioids in the immediate postoperative period than the paravertebral block group, and had comparable postoperative pain scores. No increase in adverse outcomes was noted for either group. The PECS II block is a safe and highly effective option for regional analgesia for robotic mitral valve surgery, with demonstrated efficacy comparable to the paravertebral block. [ABSTRACT FROM AUTHOR]

Platynosomosis is a parasitic disease caused by a trematode of the genus Platynosomum , a bile duct and gallbladder fluke that has been described in captive neotropical primates (New World primates; NWPs) and causes high morbidity and variable mortality. Although it is a major concern for ex-situ conservation of these animals, there are only a few studies of platynosomosis in free-ranging NWPs. Therefore, the aim of this study was to characterize platynosomosis in a free-ranging population of marmosets (Callithrix spp) from the Brazilian Atlantic Forest, focusing on the epidemiological and pathological aspects of the disease. A total of 1,001 marmosets were evaluated and on the basis of clinicoepidemiological data, histopathology, histochemistry and immunohistochemistry, we concluded that Platynosomum spp infection has a prevalence of 8.9% (confidence interval: 7.3–10.8%) in free-ranging marmosets, with a higher frequency in the Metropolitan Region of Rio de Janeiro. Infection was associated with fibrosing and proliferative cholangiohepatitis associated with biliary lithiasis (3.0% of cases) and secondary bacterial infections (14.6% of cases). [ABSTRACT FROM AUTHOR]

Postoperative complications after breast cancer surgery may be associated with decreased quality of life. It remains unclear whether oncoplastic breast-conserving surgery or mastectomy with reconstruction lead to more postoperative complications than conventional breast surgery (CBS). As delayed wound healing (DWH) is one of the most frequent minor complications, we sought to investigate the significance of DWH for patient-reported outcomes after oncoplastic, reconstructive, and CBS. Our study is a retrospective cohort study of consecutive patients with stage I-II breast cancer who underwent oncoplastic or CBS performed by three breast surgeons at a single tertiary referral hospital from June 2011 until May 2019. Patient-reported outcomes were evaluated postoperatively using the BREAST-Q questionnaire. Comparisons were made between patients with and without DWH. A total of 229 patients who met the inclusion criteria and 28 (12%) of them developed DWH, 27/158 (17%) in the oncoplastic breast-conserving surgery and reconstruction group and 1/71 (1%) in the CBS group. The mean time from surgery to BREAST-Q assessment was comparable in both groups (29 months in the DWH vs. 33 months in the normal wound healing group). No statistically significant difference for any BREAST-Q scale was detected between patients with and without DWH. This includes physical (p = 0.183), psychosocial (p = 0.489), sexual well-being (p = 0.895), and satisfaction with breasts (p = 0.068). Our study confirms that oncoplastic breast-conserving surgery and mastectomy with reconstruction lead to significantly more DWH than CBS. However, neither quality of life nor patient-reported outcomes following state-of-the-art reconstructive or oncoplastic breast-conserving surgery at a specialized center seem to be compromised. [ABSTRACT FROM AUTHOR]

Necrotizing Enterocolitis (NEC) is a serious intestinal disease that affects premature neonates, causing high mortality, despite the technological development in neonatal intensive care, with antibiotics, parenteral nutrition, surgery, and advanced life support. The correction of dysbiosis with fecal microbiome transplantation (FMT) has shown beneficial effects in experimental models of the disease. The different forms of administration and conservation of FMT and mixed results depending on several factors lead to questions about the mechanism of action of FMT. This study aimed to compare the effectiveness of fresh, sterile FMT and probiotic treatment under parameters of inflammation, oxidative stress, and tissue damage in a neonatal model of NEC. One-day-old Wistar rats were used to induce NEC model. Animals were divided in five groups: Control + saline; NEC + saline; NEC + fresh FMT; NEC + sterile FMT and NEC+ probiotics. Parameters of inflammatory response and oxidative damage were measured in the gut, brain, and serum. It was also determined gut histopathological alterations. Proinflammatory cytokines were increased in the NEC group, and IL-10 levels decreased in the gut, brain, and serum. Fresh and sterile FMT decreased inflammation when compared to the use of probiotics. Oxidative and histological damage to the intestine was apparent in the NEC group, and both FMT treatments had a protective effect. Fresh and sterile FMT effectively reduced the inflammatory response, oxidative damage, and histological alterations in the gut and brain compared to an experimental NEC model. [ABSTRACT FROM AUTHOR]

This study aims to compare patient-reported outcomes (PROs) after different types of oncoplastic surgery (OPS) procedures and correlate the results with previously published normative data from women with no prior history of breast cancer (BC) and breast surgery. Cross-sectional study of patients with stage I-II BC undergoing a specific selection of OPS procedures from 04/2012 to 12/2018 by three breast surgeons at a single tertiary referral hospital in Switzerland. PROs were evaluated using the postoperative BREAST-Q questionnaire. One hundred twenty-seven patients met the inclusion criteria and were surveyed. All OPS techniques achieved comparably elevated scores in satisfaction with breasts, psychosocial, and sexual well-being. Compared to normative data of healthy women, all OPS groups postoperatively achieved significantly better satisfaction with breasts, psychosocial, and sexual well-being. This study shows high PROs across all types of OPS, which were superior to normative data from healthy women. Our findings confirm that OPS is associated with high quality of life and patient satisfaction. [ABSTRACT FROM AUTHOR]

Solar radiation is a major driver of forest ecosystems and affects the hydrological cycle and energy balance. The vitality of trees strongly depends on the amount of light input to individual trees, and successful forest regeneration demands a certain level of solar radiation. Therefore, characterization of the light regime inside a plant canopy (i.e., quantification and timing of light penetration) is of particular importance. Because these parameters greatly depend on the 3D structure of the forest canopy, Light Detection and Ranging (LiDAR) systems provide suitable technology for solving this task. In this study, an algorithm was developed to estimate the amount of potential solar radiation reaching the forest floor from a point cloud collected in a temperate mixed forest located in Lanzenkirchen (Lower Austria) using terrestrial LiDAR. The path length through the canopy was calculated for 40 forest inventory plots as the distance between the first and last canopy hit along a sun ray, that is, for each day during the vegetation period at an hourly resolution. This distance was easily derived from the z-coordinates of the point cloud after transforming the latter into a coordinate system in which the z-axis ran parallel to the sun rays. Applying Beer's law, the amount of solar radiation on the forest floor was expressed as a function of the solar radiation above the canopy and the path length through the canopy. To validate the results, we used two sets of reference data: (1) hemispherical photographs taken at the same plots, using a camera on a self-levelling mount, which were processed with the HemiView software, and (2) data from a Solariscope survey. Both the Solariscope and HemiView software calculate below-canopy radiation as a percentage of above-canopy radiation, joining direct and diffuse radiation (Total Site Factor, TSF). The TSF values obtained from our modeling procedure were consistent with the Solariscope (R² = 0.61) and HemiView (R² = 0.71) results for the entire growing season. Because modern LiDAR-based forest inventories provide all the necessary data for our light modeling approach (the point cloud, the geographical position, and a record of the occurring tree species) without additional requirements, together with the easy applicability of the algorithm, this tool is a promising asset for ecological and silvicultural activities. • Personal Laser Scanning is suitable for an estimation of below-canopy light regime. • Results from HemiView and LiDAR-based approach were highly correlated. • LiDAR-based approaches are less susceptible to errors caused by subjectiveness. [ABSTRACT FROM AUTHOR]

The fall armyworm, Spodoptera frugiperda , situation in Africa remains a priority threat despite significant efforts made since the first outbreaks in 2016 to control the pest and thereby reduce yield losses. Field surveys in Benin and Mali reported that approximately one-week post-emergence of maize plants, the presence of fall armyworm (egg/neonates) could be observed in the field. Scouting for fall armyworm eggs and neonates is, however, difficult and time consuming. In this study, we therefore hypothesized that the optimum timeframe for the fall armyworm female arriving to lay eggs in sown maize fields could be predicted. We did this by back-calculating from interval censored data of egg and neonates collected in emerging maize seedlings at young leaf developmental stage. Early time of ovipositing fall armyworm after sowing was recorded in field experiments. By using temperature-based models to predict phenological development for maize and fall armyworm, combined with analytical approaches for time-to-event data with censored status, we estimated that about 210 accumulated Degree Days (DD) is needed for early detection of neonate larvae in the field. This work is meant to provide new insights on timely pest detection and to guide for precise timing of control measures. • The use of the interval censored data to estimate the timing of FAW early oviposition in a maize field. • Linear-mixed model to explore the effects of spatial variation on the maize heat accumulation until early FAW infestations. • Temperature-based model using Degree-day estimation and backward-calculation to predict FAW early oviposition in maize field. • The use of the Kaplan-Meier evaluate the probability of early detection of FAW eggs and neonates in a maize field. • A modelling framework for integration into decision support system toward an integrated FAW management. [ABSTRACT FROM AUTHOR]

In forestry, colored spray paint is used for different purposes, such as marking trees that are chosen for the next harvest or that will be promoted by future silvicultural activities, or for the demarcation of skid/cable roads. Numerous studies have demonstrated the application of Terrestrial Laser Scanners (TLS) and Personal Laser Scanners (PLS) for the acquisition of tree parameters (diameters, heights, and tree positions) in a forest inventory context. However, no studies have included classification based on spectral information by applying colored markings to trees. When a laser scanner is combined with a camera, the color information can be mapped onto the laser point cloud, allowing for additional analysis of spectral information. In this study, we have tested the analysis of joint information from imagery and 3D point clouds in two different settings: (i) PLS point cloud data from a GeoSLAM ZEB Horizon were complemented with spectral information from images collected with a NCTech iSTAR Pulsar 360-degree camera, (ii) TLS point cloud data from a RIEGL VZ-400i were combined with imagery from a Nikon D850 digital single lens reflex (DSLR) camera with 14 mm fisheye lens. The major objective was to automatically classify trees that were marked with colored sprays automatically identify the numbers sprayed on the trees. The marked trees could be classified correctly with a balanced accuracy of 77.26% for PLS and 98.01% for the data collected with the TLS system using a support vector machine (SVM) model. The numbers written on the trees were classified from the TLS data using a YOLOv8 model. The accuracy of the digit classification reached up to 97.30%. In conclusion, it is possible to automatically detect marked trees and to automatically recognize the numbers spayed on these trees from colored point cloud data. However, accuracy strongly depends on the selected combination of scanner and camera. The findings of future research on this subject might differ with the ongoing development of PLS systems and could be enhanced by creating a large dataset of handwritten numbers collected using laser scanning systems. • Selecting marked trees is essential for using digital twins in forest management. • Colorized PLS and TLS point clouds enable automatic identification of marked trees. • Recognizing numbers sprayed on trees is possible from TLS data using a YOLOv8 model. • The performance of the classification is affected by scanner technology. • Reliable predictions of numbers require a large dataset collected by laser scanning. [ABSTRACT FROM AUTHOR]

We here assessed whether typical pathogens of laboratory mice affect the development of diet-induced obesity and glucose intolerance, and whether colonization affects the efficacy of the GLP-1R agonist liraglutide and of the GLP-1/GIP co-agonist MAR709 to treat obesity and diabetes. Male C57BL/6J mice were experimentally infected with Helicobacter hepaticus, Rodentibacter pneumotropicus and Staphylococcus aureus and compared to a group of uninfected specific and opportunistic pathogen free (SOPF) mice. The development of diet-induced obesity and glucose intolerance was monitored over a period of 26 weeks. To study the influence of pathogens on drug treatment, mice were then subjected for 6 days daily treatment with either the GLP-1 receptor agonist liraglutide or the GLP-1/GIP co-agonist MAR709. Colonized mice did not differ from SOPF controls regarding HFD-induced body weight gain, food intake, body composition, glycemic control, or responsiveness to treatment with liraglutide or the GLP-1/GIP co-agonist MAR709. We conclude that the occurrence of H. hepaticus , R. pneumotropicus and S. aureus does neither affect the development of diet-induced obesity or type 2 diabetes, nor the efficacy of GLP-1-based drugs to decrease body weight and to improve glucose control in mice. • Bacteria do not affect development of diet-induced obesity or glucose intolerance in mice. • Bacteria do not compromise the beneficial effect of incretin-analogues on body weight or glucose control. • Macro- and microscopic changes do not differ between uninfected and infected groups. [ABSTRACT FROM AUTHOR]

• Scalp cooling significantly reduced chemotherapy-induced-alopecia in breast cancer patients. • No significant effect regarding regrowth after chemotherapy in scalp cooling group. • Scalp cooling is more effective in preventing alopecia in patients receiving taxane monotherapy. [ABSTRACT FROM AUTHOR]

Evidence is accumulating that liver sinusoidal endothelial cells are involved in the pathogenesis of non-alcoholic fatty liver disease. Previous studies have suggested that the endothelial biomarker soluble E-selectin (sE-selectin) is to an important extent liver-derived. To study the relationship of intrahepatic lipid (IHL) content with sE-selectin at the population level. This study was conducted in participants of The Maastricht Study (n = 1,634), a population-based cohort study enriched with patients with type 2 diabetes. We assessed the cross-sectional association between IHL content, quantified by MRI, and sE-selectin via multivariable regression with adjustment for age, sex, type 2 diabetes, educational level, BMI, Dutch Healthy Diet index, physical activity, and the Matsuda index. Standardized IHL content was associated with (log) sE-selectin (age-, sex- and type 2 diabetes-adjusted regression coefficient [B]: 0.048 [95%CI:0.038;0.058], p <0.001), even after full adjustment (B: 0.030 [0.019;0.042], p <0.001). Such an association was not observed for soluble vascular cell adhesion molecule 1 (sVCAM-1) levels. IHL content is an independent determinant of sE-selectin at the population level. These findings support further studies to unravel the involvement of liver sinusoidal endothelial cells in the different stages of non-alcoholic fatty liver disease and the specific role of E-selectin herein. [ABSTRACT FROM AUTHOR]

The use of Nitinol compression staples has increased in foot and ankle procedures due to their ease of delivery and ability to offer sustained, dynamic compression. Prior biomechanical studies have predominantly examined mechanical performance in healthy bone models without investigating the effect of unicortical versus bicortical fixation. The purpose of this study was to examine the effect of bone quality and staple leg depth on the biomechanical performance of Nitinol staples in a bicortical bone model. Two-legged Nitinol staples were implanted in bicortical sawbone of 2 densities. Two different leg depths were tested to simulate unicortical versus bicortical fixation. Interfacial compressive forces, interfacial compression area, torsional strength, and shear strength were measured for each group. The effect of leg depth was minimal compared to the effect of sawbone density on the mechanical performance of Nitinol staples. Interfacial compressive force and interfacial compression areas were greater in the low density bone model, while torsional strength and shear strength were greater in the normal density bone model. Nitinol staple's mechanical performance is highly dependent upon bone quality and less dependent on whether staple legs terminate in cancellous versus cortical bone. Low density bone allows for a higher compressive interfacial area to be imparted by the staple. Staples in normal density bone are able to resist torsion and shear deformation more readily than staples in low density bone. Bone density may have a greater effect on the Nitinol staple's stability and compressive capability in vivo as compared to unicortical versus bicortical leg fixation. [ABSTRACT FROM AUTHOR]

Morphologic analysis of the proximal humerus has been performed to provide information about regions of best bone quality for stemless implant fixation. However, implant design-related bone analysis regarding primary fixation strength has not been reported. The purpose of this study was to investigate bone volume fraction (BV/TV) and bone mineral density (BMD) in the spatial vicinity of humeral implant fixation and biomechanical performance following placement of two different stemless RSA designs. It was hypothesized that peripheral expandable implant fixation (PEF) would result in residual peri-implant bone with higher BMD and BV/TV and higher fixation strength compared to a central-hexagonal impaction fixation (CHIF) design. Overall 25 human cadavers were prepped for stemless RSA using either a CHIF (n = 5) or PEF design (n = 20). Micro computed tomography scans were obtained post-preparation to analyze overall BV/TV and BMD in the anchoring region of 2 stemless implant designs. Bone volumes of paired specimens (each group n = 5) were further segmented and divided into three even planar subsections along the implantation direction with four additional radial sectors, each according to their anterior-posterior and medial-lateral direction. Following implantation, biomechanical testing was performed to evaluate ultimate failure load and stiffness of the 2 implants. Postpreparation paired humeral bone analysis revealed significantly greater residual peri-implant BMD (P <.026) and higher BV/TV for PEF. Overall linear correlation between residual BMD and BV/TV showed good coefficients of determination (R2 > 0.69) with significantly higher bone density for PEF (P =.003). Further division in proximal to distal planar subsections of paired specimens showed overall statistically higher BMD and BV/ TV for PEF (at least P <.002). Except from the posterior sector, BMD and BV/TV of overall and specific radial sectors within planar subvolumes were significantly higher for PEF. Biomechanical testing revealed increased ultimate loads (−818 ± 282 N vs. −535 ± 144 N; P =.081) and stiffness (898 ± 106 N/mm vs. 431 ± 121 N/mm; P <.001) with smaller tilting angles at failure for PEF compared to CHIF. A linear relationship between normalized failure load by the implant size and combined bone parameter (BV/TV*BMD) provided an accuracy in the order of R2 > 0.89 with significantly higher primary stability for PEF (P =.046). Implant design in stemless RSA affects residual bone quality in the anchoring region and primary fixation strength. Peripheral implant anchoring along the insertion direction provides significantly higher residual peri-implant BMD and BV/TV to achieve improved primary fixation with a radial expandable anchoring implant compared to a central-hexagonal impacted design. Basic Science Study; Anatomy Study; Imaging; Biomechanics [ABSTRACT FROM AUTHOR]

We describe real-world experience with cannabidiol (CBD) in adults with Dravet Syndrome (DS) via GW Pharma early access programme at two UK neurology centres. Adults with genetically-confirmed DS had CBD added to existing therapy, titrated up to 20 mg/kg, as tolerated. The primary outcome measure was percentage reduction in convulsive seizures. Secondary outcome measures included changes in myoclonic seizures, and in cognition and quality of life as assessed by the Caregiver Global Impression of Change (CGIC), and incidence of adverse events (AEs). 18 adults (7 female; median age 27.5 years; range 20-51) were included. Median follow-up was 176 days. In one, another antiseizure drug, clobazam, was introduced during the programme. 3/17 (17.6%) had >30% reduction in convulsive seizures (range: 87.5-100%). AEs occurred in all, the most common being transaminitis (52.9%). Behavioural AEs led to discontinuation in 3/18 (16.7%), including a seizure-free responder. In 7/18, CBD was stopped due to lack of effect. 8/18 continue on treatment. Improvements in CGIC were reported in 41.2% and 47.1% by physicians and families, respectively. 17.6% achieved sufficient reduction in convulsive seizure frequency to qualify for NHS funding. AEs led to withdrawal in only 16.7%. Close monitoring and dose adjustments of other antiseizure drugs were necessary. [ABSTRACT FROM AUTHOR]

This study aimed to demonstrate the superiority of cryocompression over cryotherapy alone in the prevention of chemotherapy-induced peripheral neuropathy (CIPN) grade 2 or above. This prospective randomized study was conducted between May 2020 and January 2023 in Innsbruck. Eligible patients had a diagnosis of gynecological cancer and received a minimum of 3 cycles of taxane-based CT (neoadjuvant, adjuvant or palliative therapy). Patients were randomized 1:1 to receive either cryotherapy or cryocompression on their upper extremities during chemotherapy (CT). We performed temperature measurements, two QoL questionnaires and neurological tests during CT and at follow-up 3 and 6–9 months after the completion of CT. CIPN was assessed using the CTCAE score. Of 200 patients recruited, both groups showed a lower prevalence of CIPN in this study compared to recent literature. In the group receiving cryotherapy, the prevalence of grade 1 CIPN was 30.1 %, and that of grade 2 CIPN or above was 13.7 %; in the group treated with cryocompression, the prevalence of grade 1 CIPN was 32.8 %, and that of grade 2 or above CIPN was 17.2 %. We found a significant reduction in temperature in the cryotherapy and cryocompression groups. Regarding the two QOL questionnaires as well as the neurological tests no significant differences were found between the two groups. Our study suggests that cryotherapy as well as cryocompression is a safe and effective way to cool patients' extremities to lower the prevalence of CIPN. Cryocompression was not more effective than cryotherapy alone in the prevention of CIPN. • Patients receiving cryotherapy or cryocompression developed remarkably rarely CIPN compared to recent literature. • No severe side effects were observed using cryotherapy as well as cryocompression. • Cryotherapy and cryocompression achieved a significant reduction in temperature. • During follow-up a "coasting" phenomenon was observed. [ABSTRACT FROM AUTHOR]

Actors experience considerable uncertainty when developing and realizing mobility innovations that can contribute in the transition to a sustainable transport system. Although the role of uncertainty and its handling is mentioned as important in the literature on transitions and innovations, there is a lack of understanding how uncertainty affects decision-making processes and actors themselves. This paper investigates the interplay of uncertainty competencies and governance settings in four innovation cases of Mobility as a Service (MaaS). Our findings demonstrate it is difficult to sustain MaaS beyond a research trial, because actors experience too much uncertainty about governance questions of long-term responsibilities and role distribution. Although individual actors possess effective project management skills and willingness to innovate in a trial context, they are unable to bring MaaS to a next level because MaaS is not seen as a part of a larger design quest in which stakeholders experiment and play with uncertainty through different institutional configurations. • Exploring innovation processes through actors' experience of uncertainty enables to explain why they (do not) move forward. • In uncertain innovation trials, uncertainty is often translated by actors as risk that should be reduced. • Innovation trials are good at resolving uncertainties on a project level. • Full implementation of mobility innovations requires broader experimentation with actor responsibilities and legislative configurations. [ABSTRACT FROM AUTHOR]

[Display omitted] • Ligand binding domains of the NMDA receptor were surface displayed on E. coli. • Displaying cells are applicable for binding assays to identify novel binders. • Fluorescent compound 8 binds to the same binding site as GluN2A selective TCN-201. • Compound 8 is applicable for staining of recombinant and native NMDA receptors. • Compound 8 exhibits selectivity for GluN2A over GluN2B containing receptors. [ABSTRACT FROM AUTHOR]

After the American Board of Surgery announcement of the Flexible Endoscopy Curriculum requirement in 2014, we implemented a dedicated endoscopy rotation at the post graduate year (PGY)2 level including a simulation curriculum for Fundamentals of Endoscopic Surgery skills. Here we evaluate the outcomes of this implementation. Beginning in 2015, we developed a clinical endoscopy and simulation-based rotation to prepare for Fundamentals of Endoscopic Surgery testing. Originally, our curriculum was based on the published Texas Association of Surgical Skills Laboratories curriculum using the GI Mentor and transitioned to a mastery learning curriculum using the Endoscopy Training System in 2016. We evaluated the success of the curriculum in terms of first-time pass rates, training time required, and comparison to previously published benchmarks based on clinical experience. Since 2015, a total of 37 general surgery residents in our program were Fundamentals of Endoscopic Surgery tested (PGY2 = 24, PGY3 = 4, PGY5 = 9); 84% (31) completed the Endoscopy Training System curriculum. At the time of testing, 73% (27) had performed <25 esophagogastroduodenoscopies, and 46% had performed <25 colonoscopies. Ninety-two percent (34) spent 10 hours or less completing the curriculum. The first-time pass rate for those completing the Endoscopy Training System curriculum was 97% vs 67% for those not completing the Endoscopy Training System curriculum (P =.01). For residents completing the Endoscopy Training System curriculum, total Fundamentals of Endoscopic Surgery scores were discernibly higher (472 vs 389, P <.01), as were 3/5 task scores (Nav1 80 vs 67, P =.02; Loop2 36 vs 8, P =.02; Retro3 89 vs 71, P =.02). Despite clinical inexperience (<25 esophagogastroduodenoscopies and <50 colonoscopies), PGY2s yielded a mean score of 454 and a pass rate of 92%. This was similar to PGY5s (427, 89%; P =.3) and compares to benchmark data of endoscopists with >300 cases. Early implementation of flexible endoscopy training with a simulation-based curriculum results in Fundamentals of Endoscopic Surgery performance equal to a clinical experience not often gained during surgical residency. Often requiring <10 hours, this represents a fantastic return on investment for this training. [ABSTRACT FROM AUTHOR]

To state that the new coronavirus SARS-CoV-2 has broadly and deeply impacted our lives is an understatement. Since it first showed up on our radar in December 2019, the new coronavirus has wreaked havoc on virtually all businesses and industries across the globe. The impact is equally felt in developing, developed, industrialized, rural, rich, and poor countries and communities, irrespective of how well-prepared those countries and communities felt they were 9 months ago. To this day we are still learning to prepare for, respond to, and adapt to the broad and deep impact of this virus. This essay presents different perspectives on the impact of the novel coronavirus to dentistry, through the lenses of a private practice-based general dentist, a nursing home-based public health dentist, and a school of dentistry clinical director. The goal of the essay is to share our experiences and challenges, as well as highlight our capacity to respond to a crisis with resilience, determination, creativity, inventivity, and, most importantly, humility and altruism. [ABSTRACT FROM AUTHOR]

Background: In response to rising harms with prescription opioids, recent attention has focused on how to better utilise community pharmacists to monitor outcomes with opioid medicines.Objective: This pilot aimed to test the implementation of software-facilitated Routine Opioid Outcome Monitoring (ROOM).Methods: Community pharmacies in Victoria and New South Wales, Australia, were recruited to an open-label single-arm observational implementation-effectiveness pilot study. Pharmacists completed baseline and follow up interviews to measure change in knowledge and confidence following training on, and implementation of ROOM. Paired t-tests compared pre-post scores. Patients that participated were invited to complete a brief evaluation survey. Measures of feasibility and acceptability were collected.Results: Sixty-four pharmacists from 23 pharmacies were recruited and trained to conduct ROOM. Twenty pharmacies (87%) were able to implement ROOM, with four pharmacies completing the target of 20 screens. Pharmacists completed ROOM with 152 patients in total. Forty-four pharmacists provided baseline and follow-up data which demonstrated significant improvements in confidence identifying and responding to unmanaged pain, depression and opioid dependence. Despite increases, low to moderate confidence for these domains was reported at follow-up. Responses from pharmacists and patients indicated that implementation of ROOM was feasible and acceptable.Conclusions: Pharmacists' confidence in identifying and responding to opioid-related problems significantly increased from baseline to follow up across several domains, however scores indicated that there is still significant scope to further increase confidence in responding to opioid-related problems. ROOM is feasible and acceptable, though more extensive pharmacist training with opportunity to practice skills may assist in developing confidence and skills in this challenging clinical area. [ABSTRACT FROM AUTHOR]

Background: The MARVEL (Micra Atrial TRacking Using a Ventricular AccELerometer) 2 study assessed the efficacy of atrioventricular (AV) synchronous pacing with a Micra leadless pacemaker. Average atrioventricular synchrony (AVS) was 89.2%. Previously, low amplitude of the Micra-sensed atrial signal (A4) was observed to be a factor of low AVS.Objective: The purpose of this study was to identify predictors of A4 amplitude and high AVS.Methods: We analyzed 64 patients enrolled in MARVEL 2 who had visible P waves on electrocardiogram for assessing A4 amplitude and 40 patients with third-degree AV block for assessing AVS at rest. High AVS was defined as >90% correct atrial-triggered ventricular pacing. The association between clinical factors and echocardiographic parameters with A4 amplitude was investigated using a multivariable model with lasso variable selection. Variables associated with A4 amplitude together with premature ventricular contraction burden, sinus rate, and sinus rate variability (standard deviation of successive differences of P-P intervals [SDSD]) were assessed for association with AVS.Results: In univariate analysis, low A4 amplitude was inversely related to atrial function assessed by E/A ratio and e'/a' ratio, and was directly related to atrial contraction excursion (ACE) and atrial strain (Ɛa) on echocardiography (all P ≤.05). The multivariable lasso regression model found coronary artery bypass graft history, E/A ratio, ACE, and Ɛa were associated with low A4 amplitude. E/A ratio and SDSD were multivariable predictors of high AVS, with >90% probability if E/A <0.94 and SDSD <5 bpm.Conclusion: Clinical parameters and echocardiographic markers of atrial function are associated with A4 signal amplitude. High AVS can be predicted by E/A ratio <0.94 and low sinus rate variability at rest. [ABSTRACT FROM AUTHOR]

Background: The Heart Rhythm Society, the European Heart Rhythm Association, the Asia Pacific Heart Rhythm Society, the Latin American Heart Rhythm Society expert consensus statement on optimal implantable cardioverter-defibrillator programming recommends burst antitachycardia pacing (ATP) for the treatment of ventricular tachycardia (VT) up to high rates. The number of bursts is not specified, and treatment by ramps or low-energy shocks is not recommended.Objectives: We investigated the efficacy and safety of progressive therapies for VTs between 150 and 200 beats/min. After 3 failed bursts, we compared 3 ramps vs 3 bursts followed by a low-energy shock vs high-energy shock.Methods: Using remote monitoring, we included monomorphic VT episodes treated with ≥1 burst.Results: A total of 1126 VT episodes were included. A single burst was as likely to terminate VT between 150 and 200 beats/min as VT between 200 and 230 beats/min (63% vs 64%; P=.41), but was more likely to accelerate the latter (3.2% vs 0.25%; P<.01). For VT <200 beats/min, the likelihood of ATP success increased progressively (73% with 2 bursts, 78% with 3 bursts). Three additional bursts further increased VT termination to 89%, similar to the success rate with 3 additional ramps (88%; P=.17). Programming 6 bursts is associated with the probability of acceleration requiring shock of 6.6%. A low-energy first shock was less successful than a high-energy shock (66% vs 86%; P<.01) and more likely to accelerate VT (17% vs 0%; P<.01).Conclusion: Programming up to 6 burst ATP therapies for VTs 150-200 beats/min can avoid implantable cardioverter-defibrillator shocks in most patients. Ramp ATP after failed bursts were similarly effective. Low-energy shocks are less effective and more arrhythmogenic than high-energy shocks. [ABSTRACT FROM AUTHOR]

This phase I/II, multi-institutional trial explored the tolerance and efficacy of stepwise increasing hypofractionation (HPFX) radiation therapy regimens for fraction sizes up to 4.3 Gy in localized prostate cancer. Three escalating dose-per-fraction schedules were designed to yield similar predicted tumor control while maintaining equivalent predicted late toxicity. HPFX levels I, II, and III were carried out sequentially and delivered schedules of 64.7 Gy/22 fx/2.94 Gy, 58.08 Gy/16 fx/3.63 Gy, and 51.6 Gy/12 fx/4.3 Gy, respectively with next level escalations contingent upon acceptable gastrointestinal (GI) toxicity. The primary endpoints were biochemical control and toxicity. A total of 347 patients were recruited by 5 institutions with 101, 111, and 135 patients treated on HPFX levels I, II, and III with median follow-ups of 100, 85.5, and 61.7 months, respectively (83.2 months combined). The National Comprehensive Cancer Network low- or intermediate-risk group distribution was 46% and 54%, respectively. Sixteen percent of patients, primarily intermediate risk, received 6 months of androgen deprivation therapy. The 8-year nadir + 2 actuarial biochemical control rates for HPFX levels I, II, and III were 91.1% ± 3.0%, 92.7% ± 2.7%, and 88.5% ± 4.6%, respectively (Kaplan-Meier log rank, 0.903). Among clinical covariates, only Gleason score reached near significance in multivariate analysis (P =.054). Twenty-six patients failed biochemically (crude incidence of 7.5%), and there were 5 cause-specific deaths. GI and genitourinary toxicities were acceptable and similar across the 3 HPFX levels. The combined actuarial cumulative incidence of grade 2+ GI and genitourinary toxicities at 7 years were 16.3% ± 2.1% and 22.1% ± 2.4%, respectively. HPFX employing fraction sizes extending into the 3.6 to 4.3 Gy/fraction range can be delivered with excellent oncologic outcomes. Such schedules, positioned between moderate and ultra-HPFX, may provide additional options for patients wishing to avoid prolonged treatment schedules associated with conventionally fractionated radiation therapy for prostate cancer. [ABSTRACT FROM AUTHOR]

Refractory ventricular arrhythmias (VAs) carry high mortality rates despite electrical and pharmacologic therapy utilization. These patients often require aggressive hemodynamic support, including mechanical circulatory devices such as extracorporeal membrane oxygenation because of progressive hemodynamic and metabolic deterioration. Sympathetic nervous system stimulation and neuronal remodeling after myocardial insults have been implicated as drivers of refractory VAs. This understanding has led to interest in and a growing body of experience with percutaneous blockade of the stellate ganglion as a means of interrupting the vicious cycle of refractory VAs. A number of techniques have been described for stellate ganglion blockade, including landmark-driven approaches, fluoroscopy-assisted blockade, and ultrasound guidance. Herein, the literature is evaluated and the authors' experience with stellate ganglion blockade using ultrasound guidance for refractory VAs is described. [ABSTRACT FROM AUTHOR]

There is controversy about the role of pre-emptive thoracic endovascular aortic repair (TEVAR) in uncomplicated type B aortic dissection (TBAD). The aim was to understand expert opinions and the factors influencing decision making. In 2018, surgeons from Australia/New Zealand (ANZ) and Europe (EUR) were contacted to participate in an online survey which comprised questions about preferences for pre-emptive TEVAR, followed by five case scenarios, and two ranking questions for anatomical and technical risk factors respectively. Case 1 was designed to favour TEVAR in a hypertensive patient with partial false lumen thrombosis and large diameter (aortic ≥ 40 mm, false lumen ≥ 22 mm). Case 2 had no risk factors mandating TEVAR, according to current evidence. Cases 3, 4, and 5 were designed to test one risk factor respectively, large entry tear on the inner aortic curvature (≥10 mm), partial false lumen thrombosis, and large diameter alone. There were 75 responses, 42 from EUR and 33 from ANZ. Almost half of surgeons (49.3%) endorsed pre-emptive TEVAR with 82.3% preferring to perform TEVAR in the subacute phase. In Case 1 and 5, 58.3% and 52.8% of surgeons respectively chose TEVAR, the highest rates obtained in the survey. Cases 1 and 5 included large diameters ≥40 mm, which were ranked the highest in importance when surgeons considered anatomical risk factors. Surgeons who recommend pre-emptive TEVAR were more likely to choose TEVAR in both Case 1 (83.3% vs. 33.3%, p <.001, 95% CI 27.6%–65.8%) and Case 5 (69.4% vs. 38.2%, p =.008, 95% CI 8.2%–50.0%). In this survey about uncomplicated TBAD, about half of surgeons recommended pre-emptive TEVAR in selected cases. The surgeon's predisposition towards intervention and large diameters appear to be the most influential factors in decision making. These findings underline the uncertainty in today's practice and emphasise the need for better predictive tools. [ABSTRACT FROM AUTHOR]

To describe changes in the racial and ethnic diversity of the membership of a national academic health professional organization, the Academic Pediatric Association (APA) from 2009 to 2018. Administrative data from the APA was used for the study. Our sample was limited to dues-paying members of the APA with complete profile information. Data on race/ethnicity was collected by self-report and categorized as White, Hispanic, Black, Asian, or other. Gender was obtained by self-report (male/female). Membership type included physician, non-physician, or trainee and was provided by self-report. Age was calculated by subtracting the dues year from the year of birth. Descriptive statistics were used. Log-linear models were used to describe changes in membership race/ethnicity and expressed as relative risk. Three thousand one hundred and ninety-six unique individuals were included. Enrollment in the APA increased from 1429 in 2009 to 1803 in 2018. Females represented 68% of the sample. Six percent of the sample identified as Black, 5% as Hispanic, 12% as Asian, and 74% as White. Using log-linear models, the proportion of members identifying as Black increased from 4% to 6% (P <.001), Asian 8% to 13% (P <.001) and Hispanic increased 4% to 5% (P =.17). The APA has increased the representation of underrepresented racial and ethnic minorities in medicine within its membership. The APA and other academic pediatric professional organizations, can build on these current trends by continuing to invest in programming focused on increasing racial/ethnic minority groups underrepresented in medicine. [ABSTRACT FROM AUTHOR]

A direct relationship has been reported between yttria concentration and translucency in zirconia restorations. However, increased yttria concentration also increases the cubic phase of the zirconia, which reduces its strength. The effect of increased yttria content on the fracture resistance of zirconia as a function of material thickness after fatigue testing requires evaluation. The purpose of this in vitro study was to use the biaxial flexural test to evaluate the effect of yttria concentration on the mean fracture load (N) before and after fatiguing and thermocycling as a function of zirconia thickness. Disk-shaped specimens of 5 mol% yttria partially stabilized zirconia (5Y-PSZ, BruxZir Anterior Solid Zirconia) and 3 mol% yttria partially stabilized zirconia (3Y-PSZ, BruxZir Shaded Zirconia) were prepared to thicknesses of 1.2 and 0.7 mm. For each thickness, the biaxial flexural test was used to measure the fracture load (N) before and after fatigue testing, with 1.2 million cycles at a 110-N load and simultaneous thermocycling at 5 °C to 55 °C (n=20). The data were analyzed by repeated-measures ANOVA (α=.05). Yttria concentration, thickness, and exposure to fatiguing had a statistically significant effect on the mean biaxial flexural load (yttria concentration: P <.001; thickness: P <.001; fatiguing: P =.004 for the 3Y-PSZ). One of the major findings in this study was that 30% of the 1.2-mm-thick 5Y-PSZ specimens and 80% of the 0.7-mm-thick 5Y-PSZ specimens fractured during fatiguing. All specimens of the 3Y-PSZ groups survived the fatiguing protocol. The 3Y-PSZ groups had statistically significant higher flexural loads than the 5Y-PSZ groups. The 1.2-mm thickness groups had statistically significant higher flexural loads than the 0.7-mm thickness groups. Yttria concentration had a significant effect on the strength of zirconia. 5Y-PSZ was considerably less resistant to fracture before and after fatigue testing than 3Y-PSZ. Decreasing the thickness of zirconia reduces its fracture resistance, regardless of the zirconia type. [ABSTRACT FROM AUTHOR]