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OBJECTIVE: Glycemia management in critical care is posing a challenge in frequent measuring and adequate insulin dose adjustment. In recent years, continuous glucose measurement has gained accuracy and reliability in outpatient and inpatient settings. The aim of this study was to assess the feasibility and accuracy of real-time continuous glucose monitoring (CGM) in ICU patients after major abdominal surgery. RESEARCH DESIGN AND METHODS: We included patients undergoing pancreatic surgery and solid organ transplantation (liver, pancreas, islets of Langerhans, kidney) requiring an ICU stay after surgery. We used a Dexcom G6 sensor, placed in the infraclavicular region, for real-time CGM. Arterial blood glucose measured by the amperometric principle (ABL 800; Radiometer, Copenhagen, Denmark) served as a reference value and for calibration. Blood glucose was also routinely monitored by a StatStrip bedside glucose meter. Sensor accuracy was assessed by mean absolute relative difference (MARD), bias, modified Bland-Altman plot, and surveillance error grid for paired samples of glucose values from CGM and acid-base analyzer (ABL). RESULTS: We analyzed data from 61 patients and obtained 1,546 paired glucose values from CGM and ABL. Active sensor use was 95.1%. MARD was 9.4%, relative bias was 1.4%, and 92.8% of values fell in zone A, 6.1% fell in zone B, and 1.2% fell in zone C of the surveillance error grid. Median time in range was 78%, with minimum (

OBJECTIVE: To characterize the use and impact of radiation dose reduction techniques in actual practice for routine abdomen CT. METHODS: We retrospectively analyzed consecutive routine abdomen CT scans in adults from a large dose registry, contributed by 95 hospitals and imaging facilities. Grouping exams into deciles by, first, patient size, and second, size-adjusted dose length product (DLP), we summarized dose and technical parameters and estimated which parameters contributed most to between-protocols dose variation. Lastly, we modeled the total population dose if all protocols with mean size-adjusted DLP above 433 or 645 mGy-cm were reduced to these thresholds. RESULTS: A total of 748,846 CTs were performed using 1033 unique protocols. When sorted by patient size, patients with larger abdominal diameters had increased dose and effective mAs (milliampere seconds), even after adjusting for patient size. When sorted by size-adjusted dose, patients in the highest versus the lowest decile in size-adjusted DLP received 6.4 times the average dose (1680 vs 265 mGy-cm) even though diameter was no different (312 vs 309 mm). Effective mAs was 2.1-fold higher, unadjusted CTDIvol 2.9-fold, and phase 2.5-fold for patients in the highest versus lowest size-adjusted DLP decile. There was virtually no change in kV (kilovolt). Automatic exposure control was widely used to modulate mAs, whereas kV modulation was rare. Phase was the strongest driver of between-protocols variation. Broad adoption of optimized protocols could result in total population dose reductions of 18.6-40%. CONCLUSION: There are large variations in radiation doses for routine abdomen CT unrelated to patient size. Modification of kV and single-phase scanning could result in substantial dose reduction. CLINICAL RELEVANCE: Radiation dose-optimization techniques for routine abdomen CT are routinely under-utilized leading to higher doses than needed. Greater modification of technical parameters and number of phases could result in substantial reduction in radiation exposure to patients. KEY POINTS: • Based on an analysis of 748,846 routine abdomen CT scans in adults, radiation doses varied tremendously across patients of the same size and optimization techniques were routinely under-utilized. • The difference in observed dose was due to variation in technical parameters and phase count. Automatic exposure control was commonly used to modify effective mAs, whereas kV was rarely adjusted for patient size. Routine abdomen CT should be performed using a single phase, yet multi-phase was common. • kV modulation by patient size and restriction to a single phase for routine abdomen indications could result in substantial reduction in radiation doses using well-established dose optimization approaches.

BackgroundTremor in Parkinson's disease (PD) is commonly seen in the upper extremities and can involve the lower extremities and mouth. We present a case of a patient with idiopathic PD who presented with abdominal tremor.Case reportA 40-year-old man with a 2-year history of subjective weakness and stiffness in the right arm and leg, followed by emergence of a right hand tremor, subsequently developed abdominal tremor. Patient experienced marked improvement of both abdominal and hand tremor and mobility of the right limbs with levodopa.DiscussionOur case report serves as the second only published report of abdominal tremor in an idiopathic PD patient.HighlightsTremor in Parkinson's disease (PD) commonly affects the upper and lower extremities and mouth. We describe a 40-year-old man with PD who developed abdominal tremor which was brought under control with levodopa. This case is one of only two published reports of abdominal tremor in PD.

Introduction: Abdominal surgical emergencies have a high mortality rate. Effective management primarily relies on the early identification of patients at high risk of postoperative complications. The objective of our study was to determine the prognostic factors associated with poor outcomes from abdominal surgical emergencies in Senegal and to establish a predictive score for mortality for preoperative risk evaluation (NDAR (New Death Assessment Risk) score). Methodology: This was a retrospective national cross-sectional study conducted over one year in 14 regions of Senegal. Adult patients (aged > 15 years) who presented with a traumatic or non-traumatic abdominal surgical emergency were included. The studied variables included clinical and paraclinical data. The variable of interest was death within 30 days of the surgery. Logistic regression was used to identify the factors independently associated with mortality. Risk factors identified after logistic regression analysis were weighted using odds ratio (OR) values rounded to the nearest whole number. The predictive capacity of the score was evaluated by analyzing the ROC (Receiver Operating Characteristic) curve based on the area under the curve (AUC). Results: A total of 1114 patient records were included, with a mortality rate of 4.4%. Diagnoses were observed in patients included appendicitis in 39.8% of cases (n = 444), followed by peritonitis in 22.3% (n = 249), intestinal obstruction in 18.5% (n = 205), strangulated hernias in 10.5% (n = 117), and abdominal trauma in 6.1%. Logistic regression, established the following scores: age > 40 years (score 2), ASA status grade 2 or higher (score 1), presence of a positive QSIRS score (score 2), diagnosis of peritonitis (score 2), diagnosis of intestinal obstruction (score 1), and the presence of intestinal necrosis (score 3). The score is positive if the total is strictly greater than 5, indicating a 17.7% risk of mortality. This score had a high predictive capacity with an AUC of 0.7397. Conclusion: This study enabled the establishment of a score that allows for the early identification of at-risk patients, even in constrained resource settings, facilitating appropriate perioperative management and timely surgical intervention to reduce the risk of complications. This approach, focused on early recognition of high-risk patients, is crucial for improving clinical outcomes in abdominal surgical emergencies. [ABSTRACT FROM AUTHOR]

Tumors can induce systemic disturbances in distant organs, leading to physiological changes that enhance host morbidity. In Drosophila cancer models, tumors have been known for decades to cause hypervolemic "bloating" of the abdominal cavity. Here we use allograft and transgenic tumors to show that hosts display fluid retention associated with autonomously defective secretory capacity of fly renal tubules, which function analogous to those of the human kidney. Excretion from these organs is blocked by abnormal cells that originate from inappropriate activation of normally quiescent renal stem cells (RSCs). Blockage is initiated by IL-6- like oncokines that perturb renal water-transporting cells and trigger a damage response in RSCs that proceeds pathologically. Thus, a chronic inflammatory state produced by the tumor causes paraneoplastic fluid dysregulation by altering cellular homeostasis of host renal units. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions CT examinations commonly start with the acquisition of one or two localizer radiographs (2D localizers). Recently, a manufacturer introduced the option to perform a heavily filtrated low‐dose helical scan as a localizer acquisition. To compare the dose of one or two 2D localizer acquisitions to the dose of a 3D localizer acquisition, one cannot simply compare the CTDIs of the different acquisition techniques, because of the use of different geometries and spectra.To compare the organ and effective dose for various CT localizer acquisition techniques.A Geant4‐based Monte Carlo simulation, replicating a clinical wide‐area CT scanner was developed and validated. Various localizer acquisition strategies were simulated: Anterior‐posterior (AP) alone, PA alone, combined AP+lateral (LAT), and PA+LAT 2D localizers, and an Ag‐filtered 3D localizer acquisition. Validation was performed by measuring and simulating CTDI100 in both the periphery and the center of a CTDI phantom. The software was subsequently used to estimate organ and effective doses for localizers for chest, abdomen + pelvis, and the combined chest, abdomen, and pelvis exams. As representations of patients, eight ICRP computational phantoms (adult, 15‐, 10‐, and 5‐year, both male and female) and five female and five male XCAT phantoms with various BMIs were used. The dose of the various strategies was compared to the current clinically‐implemented AP+LAT localizers.CTDI100‐measurements and simulations within the CTDI‐phantom differs by a maximum of 8.1% and by an average of 0.9%. For chest, the average effective doses for AP, PA, AP+LAT, and the 3D localizer are 0.10, 0.07, 0.32, and 0.22 mSv, respectively. The organ dose to the breast varies the most across the various localizer strategies and is, on average, 0.17, 0.03, 0.44, and 0.33 mGy, in the same order. For abdomen, the average effective doses are 0.11, 0.07, 0.36, and 0.25 mSv for the AP, PA, AP+LAT and the 3D localizer, respectively. The organ dose to the stomach varies the most across the various localizers and is on average 0.14, 0.08, 0.58, and 0.30 mGy, in the same order. The PA‐only localizer results in the lowest organ dose to the most radiosensitive organs and the lowest effective dose. For the chest exam, compared to AP+LAT, the PA+LAT results in a 7 ± 2% effective dose reduction (mean ± standard deviation), while the 3D localizer results in a 21 ± 3% effective dose reduction. Using AP or PA only would result in 69 ± 2% and 76 ± 2% reduction, respectively. For the abdomen exam, also compared to AP+LAT, PA+LAT results in 6 ± 2% effective dose reduction, while the 3D localizer results in a 20 ± 5% reduction. Using AP or PA only would result in 69 ± 5% and 76 ± 4% reduction, respectively.Using a PA localizer results in a lower or equivalent organ dose in the most radiosensitive organs, and a lower effective dose compared to an AP localizer for both chest and abdomen+pelvis exams. Compared to a two‐localizer strategy, the 3D localizer results in a lower effective dose in both the chest and abdomen+pelvis region. [ABSTRACT FROM AUTHOR]

Cystic lymphangioma (CL) is a rare benign tumor of the lymphatic system, most commonly found in the neck, head, and armpits. The incidence of lymphangiomas in the abdominal cavity is less than 5%, and the incidence of retroperitoneal tumors is even lower. We report here a case of recurrent giant CL that recurred 20 years after the first complete surgical resection. Pelvic MRI at 6 months follow-up after the second complete surgical resection indicated a recurrence of the tumor. The main purpose of this article is to explore the treatment and follow-up strategies for recurrent lymphangioma. [ABSTRACT FROM AUTHOR]

Adnexal masses are uncommon in children but are increasingly recognized due to advancements in diagnostic facilities. Such masses in the pediatric population often raise concerns about malignancy. Typically, these masses are small and can resolve spontaneously; however, larger ones can pose a diagnostic dilemma due to their signs and symptoms, requiring clinicians to be particularly vigilant. Simple ovarian cysts are seen in 1 in 2500 live births. They are commonly diagnosed prenatally as intra-abdominal masses by ultrasonography. While there are no established guidelines for management, larger cysts are generally managed surgically (either open or laparoscopic) with the aim of protecting the ovaries and ensuring future fertility. Herein, we present a case of an unusually large congenital ovarian cyst in a newborn that mimicked an abdominal mass, leading to respiratory compromise. [ABSTRACT FROM AUTHOR]

Background: Renal quantitative measurements are important descriptors for assessing kidney function. We developed a deep learning-based method for automated kidney measurements from computed tomography (CT) images. Methods: The study datasets comprised potential kidney donors (n = 88), both contrast-enhanced (Dataset 1 CE) and noncontrast (Dataset 1 NC) CT scans, and test sets of contrast-enhanced cases (Test set 2, n = 18), cases from a photon-counting (PC)CT scanner reconstructed at 60 and 190 keV (Test set 3 PCCT, n = 15), and low-dose cases (Test set 4, n = 8), which were retrospectively analyzed to train, validate, and test two networks for kidney segmentation and subsequent measurements. Segmentation performance was evaluated using the Dice similarity coefficient (DSC). The quantitative measurements' effectiveness was compared to manual annotations using the intraclass correlation coefficient (ICC). Results: The contrast-enhanced and noncontrast models demonstrated excellent reliability in renal segmentation with DSC of 0.95 (Test set 1 CE), 0.94 (Test set 2), 0.92 (Test set 3 PCCT) and 0.94 (Test set 1 NC), 0.92 (Test set 3 PCCT), and 0.93 (Test set 4). Volume estimation was accurate with mean volume errors of 4%, 3%, 6% mL (contrast test sets) and 4%, 5%, 7% mL (noncontrast test sets). Renal axes measurements (length, width, and thickness) had ICC values greater than 0.90 (p < 0.001) for all test sets, supported by narrow 95% confidence intervals. Conclusion: Two deep learning networks were shown to derive quantitative measurements from contrast-enhanced and noncontrast renal CT imaging at the human performance level. Relevance statement: Deep learning-based networks can automatically obtain renal clinical descriptors from both noncontrast and contrast-enhanced CT images. When healthy subjects comprise the training cohort, careful consideration is required during model adaptation, especially in scenarios involving unhealthy kidneys. This creates an opportunity for improved clinical decision-making without labor-intensive manual effort. Key Points: Trained 3D UNet models quantify renal measurements from contrast and noncontrast CT. The models performed interchangeably to the manual annotator and to each other. The models can provide expert-level, quantitative, accurate, and rapid renal measurements. [ABSTRACT FROM AUTHOR]

Background: In liver computed tomography (CT), tailoring the contrast injection to the patient's specific characteristics is relevant for optimal imaging and patient safety. We evaluated a novel algorithm engineered for personalized contrast injection to achieve reproducible liver enhancement centered on 50 HU. Methods: From September 2020 to August 31, 2022, CT data from consecutive adult patients were prospectively collected at our multicenter premises. Inclusion criteria consisted of an abdominal CT referral for cancer staging or follow-up. For all examinations, a web interface incorporating data from the radiology information system (patient details and examination information) and radiographer-inputted data (patient fat-free mass, imaging center, kVp, contrast agent details, and imaging phase) were used. Calculated contrast volume and injection rate were manually entered into the CT console controlling the injector. Iopamidol 370 mgI/mL or Iohexol 350 mgI/mL were used, and kVp varied (80, 100, or 120) based on patient habitus. Results: We enrolled 384 patients (mean age 61.2 years, range 21.1–94.5). The amount of administered iodine dose (gI) was not significantly different across contrast agents (p = 0.700), while a significant increase in iodine dose was observed with increasing kVp (p < 0.001) and in males versus females (p < 0.001), as expected. Despite the differences in administered iodine load, image quality was reproducible across patients with 72.1% of the examinations falling within the desirable range of 40–60 HU. Conclusion: This study validated a novel algorithm for personalized contrast injection in adult abdominal CT, achieving consistent liver enhancement centered at 50 HU. Relevance statement: In healthcare's ongoing shift towards personalized medicine, the algorithm offers excellent potential to improve diagnostic accuracy and patient management, particularly for the detection and follow-up of liver malignancies. Key Points: The algorithm achieves reproducible liver enhancement, promising improved diagnostic accuracy and patient management in diverse clinical settings. The real-world study demonstrates this algorithm's adaptability to different variables ensuring high-quality liver imaging. A personalized algorithm optimizes liver CT, improving the visibility, conspicuity, and follow-up of liver lesions. [ABSTRACT FROM AUTHOR]

Objective: Knowing factors that impact catheter stay duration is important since removing drainage catheters too early or late can have significant consequences. We present a single center retrospective study that analyzes multiple variables, including abscess size, white blood cell count, and patient age, to see if a correlation between them and duration of catheter stay exists. The inclusion criteria were patients that had abdominal abscesses treated with percutaneous abscess drainage using a pigtail catheter, ≥ 18 years of age, and had available medical images and records. 44 patients were included. Results: Among white blood cell count, patient age, and abscess volume, the only significant relationship with duration of catheter stay was abscess size (R = 0.42, p-value = 0.0049). [ABSTRACT FROM AUTHOR]

Diet is one of the most important aspects of an animal's ecology, as it reflects direct interactions with other organisms and shapes morphology, behavior, and other life history traits. Modern birds (Neornithes) have a highly efficient and phenotypically plastic digestive system, allowing them to utilize diverse trophic resources, and digestive function has been put forth as a factor in the selectivity of the end-Cretaceous mass extinction, in which only neornithine dinosaurs survived. 1 Although diet is directly documented in several early-diverging avian lineages, 2 only a single specimen preserves evidence of diet in Enantiornithes, the dominant group of terrestrial Cretaceous birds. 3 Morphology-based predictions suggest enantiornithines were faunivores, 4,5,6 although the absence of evidence contrasts with the high preservation potential and relatively longer gut-retention times of these diets. Longipteryx is an unusual Early Cretaceous enantiornithine with an elongate rostrum; distally restricted dentition 7 ; large, recurved, and crenulated teeth 8 ; and tooth enamel much thicker than other paravians. 9 Statistical analysis of rostral length, body size, and tooth morphology predicts Longipteryx was primarily insectivorous. 4,5 Contrasting with these results, two new specimens of Longipteryx preserve gymnosperm seeds within the abdominal cavity interpreted as ingesta. Like Jeholornis , their unmacerated preservation and the absence of gastroliths indicate frugivory. 10 As in Neornithes, 11 complex diets driven by the elevated energetic demands imposed by flight, secondary rostral functions, and phylogenetic influence impede the use of morphological proxies to predict diet in early-diverging avian lineages. • Unusual enantiornithine Longipteryx with an elongate rostrum predicted to be a faunivore • Direct evidence indicates Longipteryx was a frugivore, eating gymnosperm "fruits" • Like crown birds, morphological proxies fail to predict diet in early birds Evidence of diet is rare, so morphological proxies are used to predict diet in fossils. These suggest the unusual enantiornithine bird, Longipteryx , was an insectivore. O'Connor et al. describe direct evidence it was a frugivore, indicating that, as in modern birds, the morphology of the rostrum cannot be used alone to predict diet in Mesozoic birds. [ABSTRACT FROM AUTHOR]

Worldwide, the increase in chronic-degenerative diseases, abdominal surgeries, and re-emerging diseases predispose to the formation of intra-abdominal abscesses. In most cases antibiotic treatment is sufficient, but in large collections or in those that do not respond to antibiotic treatment, surgical procedures for its drainage will be required, which leads to increased morbidity and mortality, and costs. Percutaneous management represents a safe and economical alternative since it can be curative in most cases or serve as bridging therapy. The objective of this article is to present the main indications, contraindications and complications according to the current literature to help the radiologist and related specialties to provide optimal management in each scenario. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) is caused by the interaction between the esophageal epithelium and acidic stomach contents, which dramatically impacts the patient's quality of life. A hiatal hernia is a contributing reason to reflux. A hiatus hernia is a medical disorder characterized by the protrusion of abdominal cavity tissues, often the stomach, through the oesophageal hiatus into the mediastinum. A hiatal hernia is a common detectable abnormality during upper gastrointestinal endoscopy. The sliding hiatal hernia, usually known as Type I hiatal hernia, constitutes around 95% of all hiatal hernias, whereas the remaining 5% are classified as paraesophageal hiatal hernias. Aim and Objectives: The objective of the research was to determine the prevalence of hiatal hernia (HH) in individuals diagnosed with Gastroesophageal reflux disease (GERD), establish a comparison between the acid reflux pattern in patients with and without HH, and investigate the correlation between erosive gastroesophageal reflux (GER) and HH. Materials and Methods: We analyzed a cohort of 64 individuals (30 male, 34 female) diagnosed with GERD. The patients who first reported upper gastrointestinal symptoms and subsequently underwent upper gastrointestinal endoscopy at SCB MCH, Cuttack. The time frame spanning from April 2022 until July 2023. This study investigated the occurrence rate of hiatal hernia (HH) in patients with gastroesophageal reflux disease (GERD), the acid reflux pattern, and the correlation between body mass index and erosive esophagitis with HH. RESULTS: Among the 64 patients including 30 men (46.875%) and 34 females (53.125%) who had upper gastrointestinal symptoms, 11 patients (17.19%) were diagnosed with hiatus hernia. Among the 11 instances described, 9 patients (81.81%) were diagnosed with sliding type hiatus hernia, whereas 2 patients (18.18%) had rolling type. The statistical mean age of the patients was 44.0 ± 9.6 years. The hernia size was seen to be small in 6 instances (54.54%), medium in 3 cases (27.27%), and big in 2 cases (18.18%). No substantial disparity in body mass indices was seen between individuals diagnosed with HH and GERD. Highly significant correlations were seen between HH and GERD (P≤ 0.05). Conclusion: there is a strong correlation of 17.19% between hiatal hernia and GERD. Early detection and prompt treatment or surgical intervention decrease the negative health outcomes linked to hiatus hernia and acid reflux. Therefore, it is recommended that all patients who have ongoing upper gastrointestinal symptoms should get upper GI endoscopy and have it handled appropriately. [ABSTRACT FROM AUTHOR]

Background: Preoperative identification of the bowel on imaging is essential in planning renal access during percutaneous nephrolithotomy (PCNL) and avoiding colonic injury. We aimed this study to assess which noncontrast computed tomography (NCCT) window setting provides the optimal colonic identification for PCNL preoperative planning. Methods: Ten urologic surgeons (four seniors, six residents) reviewed 22 images of NCCT scans in both abdomen and lung window settings in a randomized blinded order. Colonic area delineation in each image was performed using a dedicated, commercially available area calculator software. A comparison of the marked colonic area between the abdomen and lung window settings was performed. Results: Overall, the mean marked colonic area was greater in the lung window compared with the abdomen window (8.82 cm2 vs 7.4 cm2, respectively, p < 0.001). Switching the CT window from abdomen to lung increased the identified colonic area in 50 cases (50%). Intraclass correlation showed good agreement between the senior readers and among all readers (0.92 and 0.87, respectively). Similar measurements of the colonic area in both abdomen and lung windows were observed in 26/44 (60%) of the seniors cases and in 7/66 (10%) of the resident cases (p = 0.002). Conclusion: Lung window solely or in combination with abdomen window appears to provide the most accurate colonic identification for preoperative planning of PCNL access and potentially reduce the risk of colonic injury. This pattern is more evident among young urologists, and we propose to introduce it as a standard sequence in PCNL preplanning. [ABSTRACT FROM AUTHOR]

Background • Intraperitoneal chemotherapy is an effective way to kill free tumor cells in the abdominal cavity. The safety and efficacy of raltitrexed perfusion during radical surgery for elderly patients with colorectal cancer are still unclear. Methods • In accordance with computer-generated random allocation sequences, 116 elderly patients with colorectal cancer who received radical surgery were randomly grouped into the raltitrexed intraperitoneal perfusion group or the saline intraperitoneal perfusion group from January 2020 to December 2021 in the First Affiliated Hospital of Bengbu Medical University. t tests and χ² tests were used to analyze the difference between the two groups of the clinical characteristics, pathological features, perioperative parameters, and carcinoembryonic antigen mRNA in the peritoneal lavage fluid. Results • No statistically significant differences in postoperative complications after radical surgery were observed between the two groups. No statistically significant differences in peripheral blood indexes were observed between the two groups before surgery or on the first and third days after surgery. One day after radical surgery, the alanine transaminase (54.33 ± 4.93 vs 51.01 ± 5.56) and aspartate transaminase (49.28 ± 4.30 vs 50.99 ± 3.88) in the peripheral blood were higher in the raltitrexed intraperitoneal perfusion group than in the saline intraperitoneal perfusion group. At the same time, no significant difference was found on the third day after surgery. No significant differences in side effects of chemotherapy were observed between the two groups. The positive rate of carcinoembryonic antigen mRNA in the raltitrexed intraperitoneal perfusion group (8.47%) was significantly lower than that in the saline intraperitoneal perfusion group (22.81%) after surgery. Conclusion • Raltitrexed perfusion during radical surgery is safe and feasible for elderly patients with CRC and can reduce the positive rate of carcinoembryonic antigen mRNA in peritoneal lavage fluid, so it can be explored as a treatment option. [ABSTRACT FROM AUTHOR]

ABSTRACT The International System for Serous Fluid Cytopathology (TIS) is intended for reporting cytological specimens from serous cavities: pleural, abdominal and pericardial cavities. TIS is being adopted into practice in cytology laboratories worldwide. In this system, there are six diagnostic categories: non‐diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, malignant‐primary and malignant‐secondary. Malignant‐primary category almost always implies malignant mesothelioma and malignant‐secondary usually refers to metastasis from carcinoma but also to involvement of serous cavity by haematolymphoid and other malignancies. When evaluating effusion cytological specimen adequacy, the factors that must be considered are sample volume, cellular content and cellular preservation. In the diagnostic analysis and interpretation, it is helpful to consider systematically all basic cytomorphological components in a sample. The basic components are architecture, cell populations, cell size, cytoplasm, nuclei and background elements. One important requirement for a successful evaluation of an effusion cytological specimen is sufficient clinical and radiological information in a referral. Clinical information may guide ancillary testing. In the present review, we provide a practical and educational approach to reporting serous effusion cytology based on the TIS. [ABSTRACT FROM AUTHOR]

This paper presents information on the morphological, morphometric, and dental sex differences in the dwarf round ray Urotrygon nana. We recorded 12 morphological traits, sex, the distribution pattern of dermal denticles, the number of tooth rows, and the tooth shape of 466 individuals. The disc width of females ranged from 50 to 172 mm and that of males ranged from 53 to 135 mm. A neuronal classification model and a correspondence analysis showed that female disc width was 21.5% broader, and the distance from the rostrum to the anus was 17.7% longer than that of males, whereas males presented 19.5% greater distance between the nostrils, 9.7% greater preorbital snout length, 6.8% greater cloaca to caudal‐fin length, 2.7% greater interorbital distance, and 1.1% greater total length than females. The disc of adult males, including the abdominal cavity area, was densely covered with dermal denticles, which were slightly larger than those observed in females. Females presented homodont dentition with molariform teeth and a smooth lozenge‐shaped crown with rounded margins. Males exhibited homodonty but with tooth morphology variations in individuals of different sizes (from molariforms to sharper cusp teeth). There were changes in disc shape (from subcircular to oval), distribution and size of dermal denticles (more abundant and larger), and tooth shape (from molariform to monocuspid teeth) during male development, from neonates to adults. U. nana exhibited sexual dimorphism in size, disc shape, number and shape of teeth, and distribution and size of dermal denticles. [ABSTRACT FROM AUTHOR]

Background This study aimed to compare colorectal cancer (CRC) awareness between screening-eligible and ineligible individuals in Palestine. Methods Convenience sampling was utilized to recruit Palestinian adults from diverse settings, including hospitals, primary healthcare centers and public spaces across 11 governorates. The evaluation of CRC awareness in terms of signs/symptoms, risk factors and causation myths was conducted using Arabic-translated, modified versions of the validated instruments, the Bowel Cancer Awareness Measure and the Cancer Awareness Measure-Mythical Causes Scale. Results The final analysis included 2698 participants, with 2158 (80.9%) eligible for CRC screening and 540 (19.1%) ineligible for it. The most recognized CRC sign/symptom was 'lump in the abdomen' in both screening-eligible (n = 386, 71.5%) and ineligible (n = 1582, 73.3%) groups. 'Lack of physical activity' was the most recognized risk factor in both groups (eligible: n = 451, 83.5%; ineligible: n = 1766, 81.8%). The most reported causation myth in both groups was 'having a physical trauma' (eligible: n = 340, 63.0%; ineligible: n = 1353, 62.7%). In the screening-eligible group, only 210 participants (38.9%) demonstrated high awareness of CRC signs/symptoms, 213 participants (39.4%) showed high awareness of CRC risk factors and only 46 participants (8.5%) displayed high awareness of CRC causation myths. There were no significant associations between being eligible for screening colonoscopy and the awareness levels of CRC signs/symptoms, risk factors and causation myths. Conclusion Overall, awareness levels of CRC signs/symptoms, risk factors and causation myths were notably low among screening-eligible participants. There were no differences in awareness levels between individuals eligible for colonoscopy and those who were not. [ABSTRACT FROM AUTHOR]

Background: Excess body adiposity and skin irregularities represent a major problem in today's society. Currently, radiofrequency‐based devices constitute an increasingly popular medical‐aesthetic application and a powerful non‐invasive method to combat this problem. Objective: This study aims to determine the efficacy and safety of the high‐frequency device Zionic™ (Termosalud, Inc., Gijón, Spain) in reducing body contouring and improving skin appearance in the abdomen/flanks or thighs. Materials and Methods: Thirty nine individuals were treated with the Zionic™ device in the abdomen/flanks or thighs. A total of 8 sessions of 40–50 min each, 72/96 h apart were performed. At baseline, body measurements were taken including photographs, body contours, and ultrasound scans to assess dermal thickness, dermal echogenicity, and subcutaneous fat thickness. The measurements were repeated after the eight sessions for comparison and analysis. Quantitative data was complemented with a customized survey to evaluate participants satisfaction level. Results: At the follow‐up visit, a significant average reduction of 3% in abdomen/flanks circumferences and 2% in thighs contours was noticed. Abdomen/flanks and thighs subcutaneous fat layer thickness was significantly reduced by 8% and 6%, respectively. Dermal echogenicity changes, related to skin collagen content and organization, showed non‐significant increasing tendencies of 7% for abdomen/flanks and 8% for thighs. Thighs dermal thickness was significantly increased by 6%. Results were associated to a high satisfaction level (80%) and no severe adverse events. Conclusion: Zionic™ treatment is a safe, effective, and well‐tolerated noninvasive procedure for body contouring and improvement of skin properties in abdomen, flanks, and thighs. [ABSTRACT FROM AUTHOR]

Introduction: Contrast‐enhanced computed tomography (CECT) is an emergent diagnostic imaging modality to identify the bleeding site and survey the abdominal cavity. The diagnostic utility of CECT for ectopic pregnancy (EP) has not been well‐investigated. The objective of this study was to evaluate the characteristics of CECT findings in patients with EP and extract specific findings that could contribute to the identification of implantation sites. Method: We conducted a retrospective study, reviewing suspected EP cases between April 2015 and March 2018 in our hospital. Clinical symptoms, blood test results, transvaginal sonography findings, and surgical and pathologic findings from the medical records were assessed. CECT images were evaluated by a certified radiologist and gynecologist retrospectively in consensus. The following were selected as positive findings for specific determination of the ectopic implantation site: the ectopic gestational sac, lateralization of the hemoperitoneum around the adnexa on either side, and extravascular leakage of the contrast agent outside the uterine cavity. Results: CECT was performed in 41 women with an EP. The ectopic implantation site was detectable on CECT in 90.2% (37/41), whereas it was noted in 70.0% (32/41) on transvaginal ultrasonography (TVS). Of nine patients with an EP with an undetectable implantation site on TVS, six were positive for the specific determination of the ectopic implantation site on CECT. Conclusion: CECT has the potential to predict ectopic implantation sites with high‐level sensitivity. As CECT is an urgent diagnostic imaging tool to be used in an emergent setting, it may be a good option for EP diagnosis when the availability of magnetic resonance imaging is limited. Synopsis: Contrast‐enhanced computed tomography has the potential to predict ectopic implantation sites and is a useful imaging tool in emergency situations. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine whether the administration of a modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) could result in the blockade of the lateral cutaneous branches. This study focused on a newly discovered anatomical space/plane adjacent to the M-TAPA plane, which we termed "space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess: SEDIC." Methods: Thirteen sides of nine formalin-embalmed cadavers were macroscopically dissected to investigate the anatomical spaces related to the effects of M-TAPA. Furthermore, ten adult volunteers were administered 20 mL of 0.2% ropivacaine into the abdominal plane (corresponding to the M-TAPA plane) and the SEDIC, and a pinprick test was performed 1 h after the injection. Results: Cadaver macrodissection revealed the presence of the SEDIC adjacent to the M-TAPA plane. The SEDIC was completely spatially isolated from the M-TAPA plane by the presence of costal cartilage and/or tendinous structures. In the volunteer study, the administration of local anesthetics into the SEDIC effectively blocked the lateral cutaneous branches of T8–T12, in addition to the anterior branches. Conclusion: Our study revealed the presence of the SEDIC adjacent to the M-TAPA plane. Administration of local anesthetics into the SEDIC, named re-modified TAPA, may have the potential to enhance the analgesic effect in the abdominal region. [ABSTRACT FROM AUTHOR]

Objectives: To develop and validate an open-source artificial intelligence (AI) algorithm to accurately detect contrast phases in abdominal CT scans. Materials and methods: Retrospective study aimed to develop an AI algorithm trained on 739 abdominal CT exams from 2016 to 2021, from 200 unique patients, covering 1545 axial series. We performed segmentation of five key anatomic structures—aorta, portal vein, inferior vena cava, renal parenchyma, and renal pelvis—using TotalSegmentator, a deep learning-based tool for multi-organ segmentation, and a rule-based approach to extract the renal pelvis. Radiomics features were extracted from the anatomical structures for use in a gradient-boosting classifier to identify four contrast phases: non-contrast, arterial, venous, and delayed. Internal and external validation was performed using the F1 score and other classification metrics, on the external dataset "VinDr-Multiphase CT". Results: The training dataset consisted of 172 patients (mean age, 70 years ± 8, 22% women), and the internal test set included 28 patients (mean age, 68 years ± 8, 14% women). In internal validation, the classifier achieved an accuracy of 92.3%, with an average F1 score of 90.7%. During external validation, the algorithm maintained an accuracy of 90.1%, with an average F1 score of 82.6%. Shapley feature attribution analysis indicated that renal and vascular radiodensity values were the most important for phase classification. Conclusion: An open-source and interpretable AI algorithm accurately detects contrast phases in abdominal CT scans, with high accuracy and F1 scores in internal and external validation, confirming its generalization capability. Clinical relevance statement: Contrast phase detection in abdominal CT scans is a critical step for downstream AI applications, deploying algorithms in the clinical setting, and for quantifying imaging biomarkers, ultimately allowing for better diagnostics and increased access to diagnostic imaging. Key Points: Digital Imaging and Communications in Medicine labels are inaccurate for determining the abdominal CT scan phase. AI provides great help in accurately discriminating the contrast phase. Accurate contrast phase determination aids downstream AI applications and biomarker quantification. [ABSTRACT FROM AUTHOR]

Background: Despite increasing use of minimally invasive surgical (MIS) techniques for trauma, limited large-scale studies have evaluated trends, outcomes, and resource utilization at centers that utilize MIS modalities for blunt abdominal trauma. Methods: Operative adult admissions after blunt assault, falls, or vehicular collisions were tabulated from the 2016-2020 National Inpatient Sample. Patients who received diagnostic laparoscopy or other laparoscopic and robotic intervention were classified as MIS. Institutions with at least one MIS trauma operation in a year were defined as an MIS Performing Institution (MPI; rest: non-MPI). The primary endpoint was mortality, with secondary outcomes of reoperation, complication, postoperative length of stay (LOS), and hospitalization costs. Mixed regression models were used to determine the association of MPI status on the outcomes of interest. Results: Throughout the study period, the proportion of MIS operations and MPI significantly increased from 22.6 to 29.8% and 45.9 to 58.8%, respectively. Of an estimated 77,480 patients, 66.7% underwent care at MPI. After adjustment, MPI status was not associated with increased odds of mortality (adjusted odds ratio [AOR] 1.09, 95% confidence interval [CI] [.96,1.24]), reoperation (AOR 1.02, CI [.87,1.19]), or any of the tabulated complications. There was additionally no difference in adjusted LOS (β-.18, CI [-.85, +.49]) or costs (β+$1600, CI [-1600, +4800]), between MPI and non-MPI. Discussion: The use of MIS operations in blunt abdominal trauma has significantly increased, with performing centers experiencing no difference in mortality or resource utilization. Prospectively collected data on outcomes following MIS trauma surgery is necessary to elucidate appropriate applications. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) is a crucial modality for abdominal imaging evaluation of focal lesions and tissue properties. However, several obstacles, such as prolonged scan times, limitations in patients' breath-hold capacity, and contrast agent-associated artifacts, remain in abdominal MR images. Recent techniques, including parallel imaging, three-dimensional acquisition, compressed sensing, and deep learning, have been developed to reduce the scan time while ensuring acceptable image quality or to achieve higher resolution without extending the scan duration. Quantitative measurements using MRI techniques enable the noninvasive evaluation of specific materials. A comprehensive understanding of these advanced techniques is essential for accurate interpretation of MRI sequences. Herein, we therefore review advanced abdominal MRI techniques. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate a new motion correction method, named RT + NV Track, for upper abdominal DWI that combines the respiratory triggering (RT) method using a respiration sensor and the Navigator Track (NV Track) method using navigator echoes. Materials and methods: To evaluate image quality acquired upper abdominal DWI and ADC images with RT, NV, and RT + NV Track in 10 healthy volunteers and 35 patients, signal-to-noise efficiency (SNRefficiency) and the coefficient of variation (CV) of ADC values were measured. Five radiologists independently performed qualitative image-analysis assessments. Results: RT + NV Track showed significantly higher SNRefficiency than RT and NV (14.01 ± 4.86 vs 12.05 ± 4.65, 10.05 ± 3.18; p < 0.001, p < 0.001). RT + NV Track was superior to RT and equal or better quality than NV in CV and visual evaluation of ADC values (0.033 ± 0.018 vs 0.080 ± 0.042, 0.057 ± 0.034; p < 0.001, p < 0.001). RT + NV Track tends to acquire only expiratory data rather than NV, even in patients with relatively rapid breathing, and can correct for respiratory depth variations, a weakness of RT, thus minimizing image quality degradation. Conclusion: The RT + NV Track method is an efficient imaging method that combines the advantages of both RT and NV methods in upper abdominal DWI, providing stably good images in a short scan time. [ABSTRACT FROM AUTHOR]

Background: The sedentary aspects of many U.S. occupations and the amount of time American workers spend in the workplace make it an ideal location to implement health promotion programs. Methods: This study assessed the effectiveness of a free smartphone app with a goal-setting feature to increase physical activity (PA) and impact anthropometric, body mass (BM), and body composition (BC) changes among overweight and obese women within a community health workforce. Eighteen overweight and obese (body mass index [BMI] = 32.18 ± 4.48 kg/m2), adult (50.73 ± 8.76 years), female volunteers, tracked daily steps with a free smartphone app (StridekickTM) over an 8-week period. Pre- and post-program body composition (BC) measurements included: relative (%) body fat (BF), fat mass (FM), fat-free mass (FFM), and lean mass (LM), using dual X-ray absorptiometry (DEXA scan), and five anthropometric measurements (biceps, waist, abdomen, hips, and thigh). Findings: Pre- to post-program average daily steps resulted in significant anthropometric changes for biceps, hips, and thigh measures, with encouraging changes in FFM, LM, and relative (%) BF. The goal-setting feature of the app did not result in significant differences between the experimental and control groups. No differences were noted in FM, BMI, waist, and abdomen or step goals compared with steps completed. Conclusions: An occupational PA health promotion intervention program that tracked daily steps through the StridekickTM smartphone app resulted in anthropometric, BM, and BC changes. Application to Practice: The workplace is an ideal location to affect change in health behaviors via a free smartphone app to increase PA and improve health. [ABSTRACT FROM AUTHOR]

Background: Abdominal cutaneous nerve entrapment syndrome (ACNES) is characterized by severe, mostly refractory, chronic pain due to the entrapment of the cutaneous branches of the lower torso intercostal nerves at the lateral edge of the rectus abdominis muscle. ACNES is rare compared to other pregnancy-related peripheral neuropathies and is often overlooked as a differential diagnosis for abdominal pain, despite the diagnosis relying primarily on patient history and physical examination. Emergency physicians and other medical personnel's lack of exposure to such cases results in unnecessary laboratory requests, repeated visits, and increased fear and tension for the patient. Case presentation: A 26-year-old primigravida on her second trimester of pregnancy presented to our Emergency department with persistent localized right upper quadrant abdominal pain. Despite repeated visit to the nearby hospital, no diagnosis was settled and the pain persisted. At our ED after a thorough history, physical examination and diagnostic test no abnormality was found. Finally Abdominal cutaneous nerve entrapment syndrome (ACNES) was considered and a mixture of 1 ml 2% lidocaine with adrenaline and 1 ml dexamethasone (4 mg) was infiltrated into the fascial plane in a fanning fashion into the most tender area using a modified technique and the patient reported significant improvement in pain. Conclusion: Abdominal cutaneous nerve entrapment syndrome (ACNES) is a cause of abdominal pain in pregnancy that is often overlooked. The objective of this study is to describe a rare case of ACNES in a 26-year-old primigravida woman who presented to a low-resource emergency department to assist patient management. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness and the experience of infant abdominal massage on reducing the parental stress level. Methods: A clustered RCT was conducted, 160 parents were recruited from 10 mother groups. An infant abdominal massage class was given to those in the intervention group by a certified International Association of Infant Massage instructor. The Chinese Parenting Stress Index (PSI-SF) was used to measure parental stress levels at baseline and 4 weeks after the intervention. 8 parents from the intervention group were invited for an online interview to understand the experience of parents in participating the infant abdominal massage class. Thematic analysis was applied. Results: The parental stress level was significantly decreased among intervention group with a mean difference of -5.46 (95% CI = 0.72 to 10.2, p =.049). ITT analysis was adopted for compliance analysis. The overall compliance for the intervention was 66% and found to have a significant effect on parental stress level (p <.01). The total PSI-SF among fathers was slightly higher than that among mothers. Furthermore, no moderating factors were found to have a significant interaction effect on PSI-SF (p <.05).For qualitative data, an overarching theme was generated that infant abdominal massage brought a positive experience despite the uncertainties affecting the compliance. Four themes and nine sub-themes were identified. Which were: (1) receiving clear and informative infant abdominal massage classes; (2) The influence of uncertain conditions on compliance; (3) Improving parental satisfaction; and (4) feeling it was a worthwhile experience. Conclusion: This study provides a cost-effective method for parents to tackle their parental stress, the findings aid in the planning or adjustment of current postpartum depression screening while also helping to lower the risk of postpartum mood disorders. Trial registration: Clinical Trial Number (NCT05650424 || http://clinicaltrials.gov/study/NCT05650424), registered on December 1, 2022. and HKU Clinical Trails Registry (HKUCTR3008), registered on November 3, 2022. [ABSTRACT FROM AUTHOR]

Background: The changes in the elasticity of the abdominal skin, subcutaneous tissues and muscles after lipoabdominoplasty are still unknown. The aim of this study was to provide an objective assessment of tissue elasticity after lipoabdominoplasty using ultrasound elastography. Methods: A total of 21 female patients (31–41 years old) who underwent lipoabdominoplasty from Oct 2019 to Mar 2022 were included in this retrospective study. The elastography values of the skin, subcutaneous tissues and abdominal muscles were obtained with the ultrasound shear wave elasticity imaging system pre-operation (Pre) and 6 months post-operation (Post) at four different points. Results: Twenty-one female patients were included. The elasticity of the abdominal skin, subcutaneous tissues, rectus abdominis and external oblique abdominis significantly increased at 6 months post-operation. The improvements in abdominal soft tissue elasticity were not uniform across the examined points. Conclusions: Significant changes in the elasticity of the abdominal skin, subcutaneous tissues and muscles were observed after lipoabdominoplasty. Ultrasound elastographic assessment was objective and feasible for evaluating the effect of lipoabdominoplasty on abdominal soft tissue. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: A pancreatic duct rupture can lead to various complications such as a fistula, pseudocyst, ascites, or walled-off necrosis. Due to pleural effusion, pancreaticopleural fistula typically causes dyspnea and chest pain. Leaks of enzyme-rich pancreatic fluid forming a pleural effusion can be verified in a thoracocentesis following radiological imaging such as computed tomography or magnetic resonance tomography. While management strategies range from a conservative to endoscopic and surgical approach, we report a case with successful minimally invasive treatment of pancreaticopleural fistula and effusion. Case presentation: We present a case of a patient with pancreaticopleural fistula and successful minimally invasive surgical treatment. A 62-year old Caucasian man presented with acute chest pain and dyspnea. A computed tomography scan identified a left-sided cystoid formation, extending from the abdominal cavity into the left hemithorax with concomitant pleural effusion. Pleural effusion analysis indicated significantly elevated pancreatic enzymes. Magnetic resonance cholangiopancreatography revealed a rupture of the pancreatic duct and nearby fluid accumulation. Endosonography later confirmed proximity to the tail of the pancreas, suggesting a pancreatic pseudocyst with visible tract into the pancreas. We assumed a pancreatic duct rupture with a fistula from the tail of the pancreas transdiaphragmatically into the left hemithorax with a commencing pleural empyema. A visceral and parietal decortication on the left hemithorax and a laparoscopic distal pancreatectomy with splenectomy was performed. The suspected diagnosis of a fistula arising from the pancreatic duct was confirmed histologically. Conclusion: Pancreaticopleural fistulas often have a long course and may remain undiagnosed for a long time. At this point diagnostic management and therapy demand a high level of expertise. In instances of unclear symptomatic pleural effusion, considering an abdominal focus is crucial. If endoscopic treatment is not feasible, minimally invasive surgery should strongly be considered, especially when located in the distal pancreas. [ABSTRACT FROM AUTHOR]

Introduction While the 44-mm clay penetration criterion was developed in the 1970s for soft body armor applications, and the researchers acknowledged the need to conduct additional tests, the same behind the armor blunt trauma displacement limit is used for both soft and hard body armor evaluations and design considerations. Because the human thoraco-abdominal contents are heterogeneous, have different skeletal coverage, and have different functional requirements, the same level of penetration limit does not imply the same level of protection. It is important to determine the regional responses of different thoraco-abdominal organs to better describe human tolerance and improve the current behind armor blunt trauma standard. The purpose of this study was to report on the methods, procedures, and data collected from swine. Materials and Methods Live swine tests were conducted after obtaining approvals from the local institution and the Army Care and Use Review Office of the U.S. Department of Defense. Trachea tubes and an intravenous line were introduced before administering anesthesia. Pressure transducers were inserted into the lungs and aorta. An indenter simulating the backface deformation profiles produced by body armor from military-relevant ballistics to human cadavers was used to deliver impact loading to the liver region. A triaxial accelerometer was included in the indenter design. The animals were monitored for 6 hours, necropsies were performed, and injuries were identified. Biomechanical data of the energy, velocity, deflection, viscous criterion, force, and impulse variables were obtained for each test. Results Peak accelerations, velocities, deflections, forces, impulse, and energies ranged from 897 to 5,808 g, 21 to 59 m/s, 1.96 to 8.87 cm, 2.3 to 13.1 kN, 1.1 to 7.1 Ns, and 58 to 387 J, respectively. The peak viscous criterion ranged from 0.8 to 5.8 m/s. All animals survived the 6-hour survival period. Three animals responded with liver lacerations while the remaining 4 did not have any injuries. Conclusion The experimental design based on parallel tests with whole body human cadavers and cadaver swine was found to be successful in delivering controlled impacts to the liver region of live swine and reproducing liver injuries. Previously used biomechanical measures as potential candidates for injury criteria development were obtained. Using this proven model, tests with additional samples are needed to develop injury risk curves for liver impacts and obtain regional (liver) injury criteria. [ABSTRACT FROM AUTHOR]

Introduction High-rate non-penetrating blunt impacts to the thorax, such as from impacts to protective equipment, can lead to a wide range of thoracic injuries. These injuries can include rib fractures, lung contusions, and abdominal organ contusions. Ovine animals have been used to study such impacts, in a variety of ways, including in silico. To properly model these impacts in silico, it is imperative that the tissues impacted are properly characterized. The objective of this study is to characterize and validate two tissues impacted that are adjacent to the point of impact—costal cartilage and hide. Heretofore, these materials have not been characterized for use in computational models despite their nearly immediate engagement in the high-rate, non-penetrating loading environment. Materials and Methods Ovine costal cartilage and hide samples were procured from a local abattoir following USDA regulations. Costal cartilage samples were then cut into ASTM D638 Type V tensile coupons and compressive disks for testing. The cartilage tensile coupons were tested at 150 ε/s, and the compressive samples were tested at −150 ε/s. Identical coupons and disks were then simulated in LS-Dyna using a hyperelastic material model based on test data and experimental boundary conditions. Hide samples were shaved and cut into ASTM D638 Type V tensile coupons and validated in silico using identical boundary conditions and an Ogden rubber model based on test data. Results The structural responses of costal cartilage and hide are presented and exhibit typical behavior for biological specimens. The respective model fits in LS-Dyna were a hyperelastic- based "simplified rubber" for the costal cartilage and an Ogden rubber for the hide. The costal cartilage had a mean failure strain of 0.094 ± 0.040 in tension and −0.1755 ± 0.0642 in compression. The costal cartilage was also noted to have an order-of-magnitude difference in the stresses observed experimentally between the tensile and compressive experiments. Hide had a mean failure strain of 0.2358 ± 0.1362. The energies for all three simulations showed material stability. Conclusions Overall, we successfully characterized the mechanical behavior of the hide and costal cartilage in an ovine model. The data are intended for use in computational analogs of the ovine model for testing non-penetrating blunt impact in silico. To improve upon these models, rate sensitivity should be included, which will require additional mechanical testing. [ABSTRACT FROM AUTHOR]

Introduction Battlefield trauma necessitates prompt hemostatic intervention to mitigate fatalities resulting from critical blood loss. Insights from Operation Enduring Freedom and Operation Iraqi Freedom emphasize the limitations of conventional methods, such as tourniquets, especially in noncompressible torso hemorrhage. Despite advancements in hemostatic agents, the evolving dynamics of multidomain operations necessitate novel, lightweight strategies for hemorrhage control. This study investigates the Silicone-Based Polymer (SBP) Universal Combat Matrix (UCM) by SiOxMed, a multimodal matrix exhibiting efficacy in lethal hemorrhage models. The study evaluates UCM's multiday hemostatic capabilities in a noncompressible torso hemorrhage model, offering pivotal insights for potential deployment in battlefield trauma. Materials and Methods This research was performed under Institutional Animal Care and Use Committee approval and was designed to replicate austere conditions in an off-site enclosed facility. Yorkshire Hampshire swine underwent baseline assessments and anesthesia induction (n  = 3). A Grade IV liver injury was made by incising X-shaped lesions, each measuring 4 cm × 2.5 cm, into the diaphragmatic surface of the left and right middle lobes using a scalpel blade, resulting in a lesion region of approximately 3 cm × 6 cm × 3 cm, followed by 30 seconds of uncontrolled bleeding. The injuries were then treated with SBP. Intensive care unit monitoring for 1 hour ensured sustained hemostasis, followed by 48 hours of postanesthesia monitoring and then a return to the operating table to visualize sustained hemostasis. Posteuthanasia, liver tissue underwent histological assessments to evaluate the hemorrhagic interface and liver tissue reactivity. Results The average time to hemostatic control was 247.3 ± 71.3 seconds. Stable heart rate (81.3 ± 10.0) and respiratory rate (31.7 ± 16.5) were maintained during intensive care unit monitoring. All swine survived the 1-hour anesthesia monitoring period and the subsequent 48-hour monitoring (average survival time, 48.0 hours ± 0.0, n  = 3). Visualization of the abdominal cavity at 48 hours revealed no hemorrhage. Histological assessment demonstrated aligned red blood cells and stratified layers of fibrin at the hemorrhagic interface. Masson's Trichrome analysis demonstrated a reactive and regenerative scenario 48 hours postinjury, with a collagen membrane demarcating uninjured and exposed liver regions, along with a comprehensive stromal response. Conclusions In conclusion, our investigation into the SBP UCM hemostatic efficacy in a grade IV liver laceration model demonstrates its rapid and reliable action in controlling bleeding, showcasing practicality with an average mass of 4.0 ± 1.0 g. Silicone-Based Polymer sustained hemostasis without adverse physiological effects, as evidenced by stable parameters and the survival of all swine during and after anesthesia. Macroscopic examination at 48 hours revealed durable adherence with no indications of hemorrhage. Histological evaluations highlighted SBP's role in stable clot formation, fibrinogenesis, and tissue regeneration, indicating its potential as a multimodal wound dressing. Although promising, the study has limitations, emphasizing the need for future research with larger samples and controls. This work sets the stage for exploring SBP's clinical implications, particularly in scenarios where lightweight, multimodal technologies are crucial for addressing traumatic injuries and enhancing military medical capabilities. [ABSTRACT FROM AUTHOR]

Introduction Definitive management of non-compressible intra-abdominal hemorrhage (NCIAH) currently requires a surgeon and operating room capable of performing damage control surgery. In a wartime scenario or a geographically remote environment, these may not be readily available. In this study, we sought to test the safety of 2 emerging injectable hemostatic agents (CounterFlow and Fast Onset Abdominal Management, or FOAM, poloxamer component) versus normal saline control over a prolonged monitoring duration following administration by a non-surgical provider. Materials and Methods The Institutional Animal Care and Use Committee approved all research conducted in this study. We randomized male New Zealand white rabbits into 2 monitoring cohorts of 24 hours and 2 weeks. Each cohort contained 3 treatment groups (n  = 4 rabbits/group): CounterFlow, the testable poloxamer component of FOAM, and normal saline control. We injected each treatment intraperitoneally in the left lower abdominal quadrant. Doses were 15 mL/kg for CounterFlow, 6.3 mL/kg for the poloxamer component of FOAM, and 15 mL/kg for normal saline. We conducted all injections under isoflurane anesthesia monitored by trained veterinary staff. Animals were euthanized at each cohort end point, and a veterinary pathologist blinded to treatment type performed necropsy. The primary outcome was incidence of intra-abdominal adhesions at necropsy. Quantitatively, adhesions when present were graded by the veterinary pathologist on a 1 to 4 scale, where "1" represented adhesions involving from 1 to 25% of the examined abdomen, "2" represented from 26 to 50%, "3" represented from 51 to 75%, and "4" represented from 76 to 100%. Qualitatively, adhesions present were graded by degree ("1" = minimal, "2" = mild, "3" = moderate, and "4" = severe) and chronicity ("1" = acute, "2" = subacute, and "3" = chronic). We also drew d-dimer blood values and measured body weights for each animal. Statistical analysis included either repeated measures 2-way ANOVA or a mixed-effects model (in the case of missing data) with Geisser–Greenhouse correction. We adjusted multiple comparisons using Tukey statistical hypothesis tests. Results In the 2-week cohort, 3 CounterFlow animals showed adhesions judged to be "1" quantitatively. Qualitatively, 2 of these were assessed as "1" for degree of adhesions and the other demonstrated a "2." On the chronicity of adhesions scale, 1 animal demonstrated a "2" and 2 demonstrated a "3." No animals in other groups (FOAM and control) demonstrated adhesions. CounterFlow-treated animals showed a statistically significant rise in d-dimer values in the 24-hour cohort only. In the 2-week cohort, CounterFlow-treated animals showed a decrease in body weight at 24 hours after injection but returned to their baseline (normal) body weights at 7 days. Conclusions Findings from this study demonstrate that the tested ingredients of FOAM poloxamer component are safe for intraperitoneal injection and hold potential for further study directed toward prehospital non-compressible intra-abdominal hemorrhage management by non-surgical providers. Although CounterFlow produced abdominal adhesions in 3 of 4 rabbits in the 2-week cohort, these were determined to be "minimal" or "mild" in degree. [ABSTRACT FROM AUTHOR]

A foreign body is defined as any object coming from outside, foreign to the human body. In dentistry, cases of accidental aspiration or ingestion of orthodontic appliances or fragments, as well as instruments used during dental practice, have been described. If a sharp object pierces the esophagus, the consequences can be serious. Food and other esophageal contents can enter the chest cavity (mediastinum) and cause a life-threatening inflammation (mediastinitis). Sharp objects can also cause perforation of the stomach, intestines, colon or rectum. The perforation allows food, digestive juices, or intestinal contents, to leak into the abdomen. This leak is a medical emergency, as it can cause peritonitis (inflammation of the abdominal cavity) with fatal consequences. It passes more frequently into the digestive tract than into the respiratory tract. The biggest problems occur at the level of the esophagus and stomach. Abdominal radiographic studies are the initial approach and are very useful in determining the location of ingested foreign bodies, in addition to fiber ingestion for i ntestinal motility. [ABSTRACT FROM AUTHOR]

The diagnosis of intra-abdominal exsanguination in hemodynamically unstable blunt trauma patients is almost universally determined by Focused Assessment with Sonography in Trauma (FAST). However, FAST has been reported to have poor sensitivity and is therefore associated with false-negative examinations. Our institutional practice includes diagnostic peritoneal aspirate (DPA) following two negative FASTs to address the poor sensitivity. We hypothesized that serial FAST alone would be able to exclude clinically significant abdominal bleeding in an unstable blunt trauma patient. A retrospective cohort study was conducted between 2018 and 2020 at a major tertiary trauma referral hospital, including all blunt trauma patients who were hemodynamically unstable. Two groups were analyzed: 1. "FAST+": those who had a positive FAST scan and proceeded to a trauma laparotomy, and 2. "DPA": those who had serial negative FAST scans and proceeded to DPA. Of the 12 patients in the FAST+ group, 92% correctly identified the abdomen as the source of instability. Of the seventeen patients in the DPA group, only two (12%) had positive DPA. Both patients underwent laparotomies, but neither identified an abdominal source of hemodynamic instability. The most common cause of hemodynamic instability in the DPA group was pelvic bleeding from major pelvic ring disruption. The sensitivity and specificity of the serial FAST exam for clinically significant abdominal bleeding were 100% and 94%, respectively. These data suggests that two sequential negative FAST scans are adequate for excluding intra-abdominal bleeding as the source of instability, with further investigation with DPA not identifying any clinically significant sources of intra-abdominal bleeding. [ABSTRACT FROM AUTHOR]

In veterinary medicine, intra-abdominal foreign bodies are a possible secondary complication of surgical procedures. Gossypiboma is defined as a forgotten textile material after surgery and is considered rare in veterinary medicine because most cases go unreported. The objective of this work is to report the diagnosis of an intra-abdominal gossypiboma in a dog, secondary to theovaryhysterectomy procedure. A 10-year-old Labrador dog had been sterilized about eight years ago. During the clinical analysis, a firm-looking increase in volume was found in the right mesogastric region, without the presence of pain on palpation. For further investigation, the patient was referred for additional imaging tests, such as x-ray and ultrasound. During inspection of the abdominal cavity, a firm circular mass was observed adhered to the omentum and jejunum, caudal to the right kidney. Resection of the mass was performed, and then the mass sample was sent for histopathological examination, which revealed an encapsulated foreign body, consistent with surgical gauze. Gossypiboma is one of the possible complications in surgical procedures in the abdominal cavity, but it is rarely reported in the veterinary literature. [ABSTRACT FROM AUTHOR]

Introduction: A hiatal hernia (HH) can be defined as a condition in which elements from the abdominal cavity herniate through the oesophageal hiatus in the mediastinum and, in the majority of cases, parts of the proximal stomach. Today, the role of HHs within the complex entity of gastroesophageal reflux disease (GERD) is very important with regard to its pathophysiology, severity, and therapeutic and prognostic options. Despite this, the application and stringent use of the worldwide accepted classification (Skinner and Belsey: Types I–IV) are lacking. The aim of this study was to carry out a systematic review of the clinical applications of HH classifications and scientific documentation over time, considering their value in diagnosis and treatment. Methods: Following the PRISMA concept, all abstracts published on pubmed.gov until 12/2023 (hiatal hernia) were reviewed, and those with a focus and clear description of the application of the current HH classification in the full-text version were analysed to determine the level of classification and its use within the therapeutic context. Results: In total, 9342 abstracts were screened. In 9199 of the abstracts, the reports had a different focus than HH, or the HH classification was not used or was incompletely applied. After further investigation, 60 papers were used for a detailed analysis, which included more than 12,000 patient datapoints. Among the 8904 patients, 83% had a Type I HH; 4% had Type II; 11% had Type III; and 1% had Type IV. Further subgroup analyses were performed. Overall, the precise application of the HH classification has been insufficient, considering that only 1% of all papers and only 54% of those with a special focus on HH have documented its use. Conclusions: The application and documentation of a precise HH classification in clinical practice and scientific reports are decreasing, which should be rectified for the purpose of scientific comparability. [ABSTRACT FROM AUTHOR]

Gene regulatory networks specify the gene expression patterns needed for traits to develop. Differences in these networks can result in phenotypic differences between organisms. Although loss-of-function genetic screens can identify genes necessary for trait formation, gain-of-function screens can overcome genetic redundancy and identify loci whose expression is sufficient to alter trait formation. Here, we leveraged transgenic lines from the Transgenic RNAi Project at Harvard Medical School to perform both gain- and loss-of-function CRISPR/Cas9 screens for abdominal pigmentation phenotypes. We identified measurable effects on pigmentation patterns in the Drosophila melanogaster abdomen for 21 of 55 transcription factors in gain-of-function experiments and 7 of 16 tested by loss-of-function experiments. These included well-characterized pigmentation genes, such as bab1 and dsx , and transcription factors that had no known role in pigmentation, such as slp2. Finally, this screen was partially conducted by undergraduate students in a Genetics Laboratory course during the spring semesters of 2021 and 2022. We found this screen to be a successful model for student engagement in research in an undergraduate laboratory course that can be readily adapted to evaluate the effect of hundreds of genes on many different Drosophila traits, with minimal resources. [ABSTRACT FROM AUTHOR]

Background: Body condition score (BCS) is a subjective tool and the deposition of subcutaneous fat differs from the deposition of abdominal fat. Objective: The aim of this study was to evaluate by multivariate regression models and ultrasonography the amount of fat accumulated in different areas of the abdominal cavity in Jersey non‐pregnant non‐lactating cows and its association with their BCS. Methods: From a commercial farm, 21 non‐pregnant non‐lactating Jersey cows were selected at random. Cows were placed in a headlock line, and BCS was evaluated (scale 1–5 with a 0.25 unit increment) by the same assessor. Ultrasonographic evaluation was performed using a Sonosite machine in duplicate, considering key anatomical points of the body to predict total abdominal fat (AT), retroperitoneal fat (RT), omental fat (OT) and mesenteric fat (MT). A regression analysis for each abdominal fat depot and the BCS was run using SAS. Results: Models from the lowest to the largest r2 are reported. The r2 for the models were MT r2 = 0.023; RT r2 = 0.1047; OT r2 = 0.323 and AT r2 = 0.369. Correlation between BCS and abdominal fat depots was positive, lower for mesenteric and retroperitoneal fat, but higher for omental and total abdominal fat. Cows were divided on the basis of the median of BCS distribution to high (≥3.5) and low (≤3.25). Those with high BCS had significantly larger amounts of fat in different anatomical areas of abdominal cavity than cows with low BCS. Conclusion: BCS has a low‐to‐moderate association with abdominal fat depots, but a high variability exists within each BCS punctuation, which supports the notion that fat accumulation patterns and metabolic turnover between abdominal and subcutaneous fat differ from each other. [ABSTRACT FROM AUTHOR]

The mayfly Ephemera lota Navás, 1934 was described based on subimagines, and the imagines and nymphs have not been known so far. For the first time, we provide descriptions of adults and nymphs using recently collected material. Based on their morphology, the species diagnostic characters are imaginal abdomen without transverse line, penis with finger-like apex, hindwing without any dot; nymphal frons with deep anterior emargination, two mandibular tusks subequal in length. Significantly, forewings of this species have variable MP2 base: from independent to fusing with CuA in different specimens through the other characters and barcoding data confirm all specimens belong to the same species. Due to the holotype lost, a neotype of the species is designated and subimagines are re-described. [ABSTRACT FROM AUTHOR]

Introduction Hypothermia increases mortality in trauma populations and frequently occurs in military casualties due to the nature of combat environments. The association between hypothermia and the time of year when injured remains unclear. We sought to determine the association between seasonal changes in temperature and hypothermia among combat casualties. Materials and Methods This observational study was a secondary analysis of a previously described Department of Defense Trauma Registry dataset which included U.S. military and Coalition casualties who received prehospital care from January 2007 to March 2020 in Afghanistan and Iraq. We tested for associations between hypothermia (<36.2°C) and seasonal ambient temperatures by constructing multivariable logistic regression models. Summer was defined as June through August and winter as December through February. We assumed that the combat operations occurred in the area near the point of first contact with the deployed military treatment facilities. This study was determined to be exempt from Institutional Review Board oversight. Results There were 5,821 that met inclusion for this study. Within the multivariable logistic regression model, we adjusted for injury severity score, mechanism of injury, and imputed transport time, finding that combat casualties were 2.28 (odds ratio, 95% confidence interval 1.93-2.69) times more likely to develop hypothermia in the winter versus summer. When using temperature as a continuous outcome, casualties had a lower emergency department temperature during the winter (parameter estimate −0.133°C, P  < 0.001) after adjusting for confounders. In casualties experiencing hypothermia, mortality was higher (4% versus 1%, P  < 0.001), and composite median injury severity score values were higher (10 versus 5, P  < 0.001). Among hypothermic casualties, serious injuries were significantly more common (all P  < 0.001) to the head (15% versus 7%), thorax (15% versus 7%), abdomen (9% versus 6%), extremities (35% versus 22%), and skin (4% versus 2%). Conclusions We found a seasonal variation in the occurrence of hypothermia in a large cohort of trauma casualties. Despite adjustment for multiple known confounders, our findings substantiate probable ambient temperature variations to trauma-induced hypothermia. Furthermore, our findings, when taken in the context of other studies on the efficacy of current hypothermia prevention and treatment strategies, support the need for better methods to mitigate hypothermia in future cold-weather operations. [ABSTRACT FROM AUTHOR]

Introduction While previous studies have analyzed military surgeon experience within military–civilian partnerships (MCPs), there has never been an assessment of how well military providers are integrated within an MCP. The Center for Sustainment of Trauma and Readiness Skills, Cincinnati supports the Critical Care Air Transport Advanced Course and maintains the clinical skills of its staff by embedding them within the University of Cincinnati Medical Center. We hypothesized that military trauma surgeons are well integrated within University of Cincinnati Medical Center and that they are exposed to a similar range of complex surgical pathophysiology as their civilian partners. Materials and Methods After Institutional Review Board approval, Current Procedural Terminology (CPT) codes were abstracted from billing data for trauma surgeons covering University of Cincinnati Hospitals in 2019. The number of trauma resuscitations and patient acuity metrics were abstracted from the Trauma Registry and surgeon Knowledge, Skills, and Abilities clinical activity (KSA-CA) scores were calculated using their CPT codes. Finally, surgeon case distributions were studied by sorting their CPT codes into 23 categories based on procedure type and anatomic location. Appropriate, chi-squared or Mann–Whitney U-tests were used to compare these metrics between the military and civilian surgeon groups and the metrics were normalized by the group's full-time equivalent (FTE) to adjust for varying weeks on service between groups. Results Data were available for two active duty military and nine civilian staff. The FTEs were significantly lower in the military group: military 0.583-0.583 (median 0.583) vs. civilian 0.625-1.165 (median 1.0), P  = 0.04. Per median FTE and surgeon number, both groups performed a similar number of trauma resuscitations (civilian 214 ± 54 vs. military 280 ± 13, P  = 0.146) and KSA-CA points (civilian 55,629 ± 25,104 vs. military 36,286 ± 11,267; P  = 0.582). Although the civilian surgeons had a higher proportion of hernia repairs (P  < 0.001) and laparoscopic procedures (P  = 0.006), the CPT code categories most relevant to combat surgery (those relating to solid organ, hollow viscus, cardiac, thoracic, abdominal, and tissue debridement procedures) were similar between the surgeon groups. Finally, patient acuity metrics were similar between groups. Conclusion This is the first assessment of U.S. Air Force trauma surgeon integration relative to their civilian partners within an MCP. Normalized by FTE, there was no difference between the two groups' trauma experience to include patient acuity metrics and KSA-CA scores. The proportion of CPT codes that was most relevant to expeditionary surgery was similar between the military and civilian partners, thus optimizing the surgical experience for the military trauma surgeons within University of Cincinnati Medical Center. The methods used within this pilot study can be generalized to any American College of Surgeons verified Trauma Center MCP, as standard databases were used. [ABSTRACT FROM AUTHOR]

Photon-counting detector CT (PCD-CT) is a new technology that has multiple diagnostic benefits including increased spatial resolution, iodine signal, and radiation dose efficiency, as well as multi-energy imaging capability, but which also has unique challenges in abdominal imaging. The purpose of this work is to summarize key features, technical parameters, and terms, which are common amongst current abdominopelvic PCD-CT systems and to propose standardized terminology (where none exists). In addition, user-selectable protocol parameters are highlighted to facilitate both scientific evaluation and early clinical adoption. Unique features of PCD-CT systems include photon-counting detectors themselves, energy thresholds and bins, and tube potential considerations for preserved spectral separation. Key parameters for describing different PCD-CT systems are reviewed and explained. While PCD-CT can generate multi-energy images like dual-energy CT, there are new types of images such as threshold images, energy bin images, and special spectral images. The standardized terms and concepts herein build upon prior interdisciplinary consensus and have been endorsed by the newly created Society of Abdominal Radiology Photon-counting CT Emerging Technology Commission. [ABSTRACT FROM AUTHOR]

This article discusses the use of gonadotropin treatment as an alternative to surgery for adults with congenital hypogonadotropic hypogonadism (CHH) and cryptorchidism. CHH is a condition where there is a deficiency of certain hormones, leading to absent or incomplete puberty. Cryptorchidism, or undescended testis, is more common in individuals with CHH. The article presents three case studies of adult males with CHH and persistent cryptorchidism who were successfully treated with gonadotropin therapy. The findings suggest that this treatment can be a safe and effective alternative to surgery for correcting cryptorchidism in young adult males with CHH. Further research is needed to explore this treatment in larger patient groups. The report is authored by experts in the field and provides valuable insights for library patrons conducting research in this area. [Extracted from the article]

Rationale and objectives: Automated evaluation of abdominal computed tomography (CT) scans should help radiologists manage their massive workloads, thereby leading to earlier diagnoses and better patient outcomes. Our objective was to develop a machine-learning model capable of reliably identifying suspected bowel obstruction (BO) on abdominal CT. Materials and methods: The internal dataset comprised 1345 abdominal CTs obtained in 2015–2022 from 1273 patients with suspected BO; among them, 670 were annotated as BO yes/no by an experienced abdominal radiologist. The external dataset consisted of 88 radiologist-annotated CTs. We developed a full preprocessing pipeline for abdominal CT comprising a model to locate the abdominal-pelvic region and another model to crop the 3D scan around the body. We built, trained, and tested several neural-network architectures for the binary classification (BO, yes/no) of each CT. F1 and balanced accuracy scores were computed to assess model performance. Results: The mixed convolutional network pretrained on a Kinetics 400 dataset achieved the best results: with the internal dataset, the F1 score was 0.92, balanced accuracy 0.86, and sensitivity 0.93; with the external dataset, the corresponding values were 0.89, 0.89, and 0.89. When calibrated on sensitivity, this model produced 1.00 sensitivity, 0.84 specificity, and an F1 score of 0.88 with the internal dataset; corresponding values were 0.98, 0.76, and 0.87 with the external dataset. Conclusion: The 3D mixed convolutional neural network developed here shows great potential for the automated binary classification (BO yes/no) of abdominal CT scans from patients with suspected BO. Clinical relevance statement: The 3D mixed CNN automates bowel obstruction classification, potentially automating patient selection and CT prioritization, leading to an enhanced radiologist workflow. Key Points: • Bowel obstruction's rising incidence strains radiologists. AI can aid urgent CT readings. • Employed 1345 CT scans, neural networks for bowel obstruction detection, achieving high accuracy and sensitivity on external testing. • 3D mixed CNN automates CT reading prioritization effectively and speeds up bowel obstruction diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: A higher minimum monitor unit (minMU) for pencil‐beam scanning proton beams in intensity‐modulated proton therapy is preferred for more efficient delivery. However, plan quality may be compromised when the minMU is too large. This study aimed to identify the optimal minMU (OminMU) to improve plan delivery efficiency while maintaining high plan quality. Methods: We utilized clinical plans including six anatomic sites (brain, head and neck, breast, lung, abdomen, and prostate) from 23 patients previously treated with the Varian ProBeam system. The minMU of each plan was increased from the current clinical minMU of 1.1 to 3–24 MU depending on the daily prescribed dose (DPD). The dosimetric parameters of the plans were evaluated for consistency against a 1.1‐minMU plan for target coverage as well as organs‐at‐risk dose sparing. DPD/minMU was defined as the ratio of DPD to minMU (cGy/MU) to find the OminMU by ensuring that dosimetric parameters did not differ by >1% compared to those of the 1.1‐minMU plan. Results: All plans up to 5 minMU showed no significant dose differences compared to the 1.1‐minMU plan. Plan qualities remained acceptable when DPD/minMU ≥35 cGy/MU. This suggests that the 35 cGy/MU criterion can be used as the OminMU, which implies that 5 MU is the OminMU for a conventional fraction dose of 180 cGy. Treatment times were decreased by an average of 32% (max 56%, min 7%) and by an average of 1.6 min when the minMU was increased from 1.1 to OminMU. Conclusion: A clinical guideline for OminMU has been established. The minMU can be increased by 1 MU for every 35 cGy of DPD without compromising plan quality for most cases analyzed in this study. Significant treatment time reduction of up to 56% was observed when the suggested OminMU is used. [ABSTRACT FROM AUTHOR]

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