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Proficient speakers of a second language (L2) show similar processing of affective content as native speakers, but reduced magnitude, later latency, and a less differentiated emotional neural response (e.g., Hsu et al., 2015). Because language and culture are intertwined, this study examined whether cultural relevance of short stories affects immersion during reading, independent of language proficiency. Hong Kong (HK) and Mainland Chinese (MLC) readers were exposed to identical short stories featuring events and traditions related to either culture. Their level of attention, transportation and emotional engagement after each story was measured using the Story World Absorption Scale (Kuijpers et al., 2014). Preliminary results show that HK participants were significantly more immersed in HK cultural stories than in MLC stories, especially when they described modern events. Instead, MLC participants showed no difference in immersion. The results will be discussed considering historical common origins and modern stark distinction between the two cultures.

A 10 years old girl was referred with the complaints of “per vaginal bleeding and a mass after cycling”. During the first 2 weeks of symptoms, she had visited three different doctors with possible delayed recognition of her diagnosis. Clinical examination revealed an underweight, non-dysmorphic, prepubertal girl with vulvitis and an inflamed interlabial bleeding mass with ulceration. Imaging revealed a subcentimetre arteriovenous fistula and haematoma in the vagina. After one more week (total 3 weeks) of medical therapy, the indication for surgery was worsening of symptoms and failure of medical management. Examination under anaesthesia and cystoscopy revealed a complete urethra prolapse. Dilute adrenaline was injected into the prolapsed mucosa. The prolapse was excised in elliptical segments, and the edges closed with interrupted absorbable sutures. Sub-centimetre segments of mucosa were left between the excised specimens. Bipolar diathermy was used only for hemostasis and circumferential coagulation on the mucosa was avoided. These measures prevent an iatrogenic stenosis. The urethra prolapse was reduced, with no recurrence demonstrated on Valsalva maneuver. Post-operatively, her symptoms resolved. Oral antibiotics, sitz baths, antimicrobial cream and topical estrogen were administered. There was no recurrent urethra prolapse or stricture. The aim of this case report is to increase awareness of the urethral prolapse in the paediatric population and its management.

Abstract Background hRad9 is a cell cycle checkpoint gene that is up-regulated in breast cancer. We have previously shown that the mRNA up-regulation correlated with tumor size and local recurrence. Immunohistochemical studies were made to better define the role of hRad9 in breast carcinogenesis. Methods Localisation of hRad9 protein were performed on paired tumor and normal breast tissues. Immunoblotting with and without dephosphorylation was used to define the protein isolated from breast cancer cells. Results Increased hRad9 protein was observed in breast cancer cells nucleus compared to non-tumor epithelium. This nuclear protein existed in hyperphosphorylated forms which may be those of the hRad9-hRad1-hHus1 complex. Conclusion Finding of hyperphosphorylated forms of hRad9 in the nucleus of cancer cells is in keeping with its function in ameliorating DNA instability, whereby it inadvertently assists tumor growth.

Proper function of the female pelvic floor requires intact pelvic floor muscles (PFMs). The prevalence of pelvic floor disorders (PFDs) increases substantially with age, in part due to clinically identified deterioration of PFM function with age. However, the etiology of this decline remains largely unknown. We previously demonstrated that PFMs undergo age-related fibrotic changes. This study sought to determine whether aging also impacts PFMs' passive mechanical properties that are largely determined by the intramuscular extracellular matrix. Biopsies from younger (≤52y) and older (>52y) female cadaveric donors were procured from PFMs, specifically coccygeus (C) and two portions of the levator ani - iliococcygeus (IC) and pubovisceralis (PV), and the appendicular muscles - obturator internus (OI) and vastus lateralis (VL). Muscle bundles were subjected to a passive loading protocol, and stress-sarcomere length (Ls) relationships calculated. Muscle stiffness was compared between groups using 2-way ANOVA and Sidak pairwise comparisons, α

Background. Length of stay (LOS) during index solid organ transplant impacts morbidity and healthcare costs. To date, there are no studies evaluating characteristics and outcomes of simultaneous liver-kidney transplant (SLKT) index hospitalization. We examined factors associated with LOS and mortality during index SLKT admission. Methods. Adult SLKT recipients between 2002 and 2017 at 6 transplant centers across 6 UNOS regions were retrospectively enrolled in the US-Multicenter SLKT Consortium. Multivariable regression analyses assessed predictors of SLKT LOS and death during index admission. Results. Median age of cohort (N = 570) was 58 y (interquartile range: 51–64); 63% male, 75% White, 32.3% hepatitis C, 23.3% alcohol-related, 20.1% nonalcoholic steatohepatitis with median MELD-Na at SLKT 28 (23–34). Seventy-one percent were hospitalized at the time of SLKT with median LOS pretransplant of 10 d. Majority of patients were discharged alive (N = 549; 96%)‚ and 36% were discharged to subacute rehab facility. LOS for index SLKT was 19 d (Q1: 10, Q3: 34 d). Female sex (P = 0.003), Black race (P = 0.02), advanced age (P = 0.007), ICU admission at time of SLKT (P = 0.03), high MELD-Na (P = 0.003), on cyclosporine during index hospitalization (P = 0.03), pre-SLKT dialysis (P 2 wk and affected overall patient survival. Further investigation is needed to optimize healthcare resources for these patients in a financially strained healthcare landscape.

Radiomics is a rapidly growing field that quantitatively extracts image features in a high-throughput manner from medical imaging. In this study, we analyzed the radiomics features of the whole pancreas between healthy individuals and pancreatic cancer patients, and we established a predictive model that can distinguish cancer patients from healthy individuals based on these radiomics features. Methods: We retrospectively collected venous-phase scans of contrast-enhanced computed tomography (CT) images from 181 control subjects and 85 cancer case subjects for radiomics analysis and predictive modeling. An attending radiation oncologist delineated the pancreas for all the subjects in the Varian Eclipse system, and we extracted 924 radiomics features using PyRadiomics. We established a feature selection pipeline to exclude redundant or unstable features. We randomly selected 189 cases (60 cancer and 129 control) as the training set. The remaining 77 subjects (25 cancer and 52 control) as a test set. We trained a Random Forest model utilizing the stable features to distinguish the cancer patients from the healthy individuals on the training dataset. We analyzed the performance of our best model by running 5-fold cross-validations on the training dataset and applied our best model to the test set. Results: We identified that 91 radiomics features are stable against various uncertainty sources, including bin width, resampling, image transformation, image noise, and segmentation uncertainty. Eight of the 91 features are nonredundant. Our final predictive model, using these 8 features, has achieved a mean area under the receiver operating characteristic curve (AUC) of 0.99 ± 0.01 on the training dataset (189 subjects) by cross-validation. The model achieved an AUC of 0.910 on the independent test set (77 subjects) and an accuracy of 0.935. Conclusion: CT-based radiomics analysis based on the whole pancreas can distinguish cancer patients from healthy individuals, and it could potentially become an early detection tool for pancreatic cancer.

Benign parotid lesions can grow to be a cosmetic deformation with psychological sequelae for a patient. Although surgical resection is the treatment of choice, cyst aspiration has also been attempted. This, however, has been shown to recur, requiring repeat intervention. An alternative therapeutic method not as widely recognized, but which has been reported to be both effective and less invasive than surgery for treating parotid cyst lesions, is sclerotherapy. Here we describe a report of a patient with a benign, localized, cystic neck mass refractory to 2 trials of fine needle aspiration. After the patient refused surgical resection, a trial of sterile ethanol sclerotherapy was performed. Our patient tolerated the procedure well with a significant reduction in the size of the lesion.

Objective: The goal is to evaluate avelumab, an anti-PD-L1 monoclonal immunoglobulin G antibody labeled with zirconium-89 in human PD-L1-expressing cancer cells and mouse xenografts for clinical translation. Methods: [ 89 Zr]Zr-DFO-PD-L1 monoclonal antibody (mAb) was synthesized using avelumab conjugated to desferrioxamine. In vitro binding studies and biodistribution studies were performed with PD-L1+MDA-MB231 cells and MDA-MB231 xenograft mouse models, respectively. Biodistributions were determined at 1, 2, 3, 5, and 7 days post coinjection of [ 89 Zr]Zr-DFO-PD-L1 mAb without or with unlabeled avelumab (10, 20, 40, and 400 µg). Results: [ 89 Zr]Zr-DFO-PD-L1 mAb exhibited high affinity (K d ∼ 0.3 nM) and detected moderate PD-L1 expression levels in MDA-MB231 cells. The spleen and lymph nodes exhibited the highest [ 89 Zr]Zr-DFO-PD-L1 mAb uptakes in all time points, while MDA-MB231 tumor uptakes were lower but highly retained. In the unlabeled avelumab dose escalation studies, spleen tissue–muscle ratios decreased in a dose-dependent manner indicating specific [ 89 Zr]Zr-DFO-PD-L1 mAb binding to PD-L1. In contrast, lymph node and tumor tissue–muscle ratios increased 4- to 5-fold at 20 and 40 µg avelumab doses. Conclusions: [ 89 Zr]Zr-DFO-PD-L1 mAb exhibited specific and high affinity for PD-L1 in vitro and had target tissue uptakes correlating with PD-L1 expression levels in vivo. [ 89 Zr]Zr-DFO-PD-L1 mAb uptake in PD-L1+tumors increased with escalating doses of avelumab.

The unique physical characteristic of Bragg Peak allows proton therapy (PT) to deliver high conformal dose to the target with a sharp drop at exit dose. In PT, immobilisation serves not only the purpose of reproducibility as for other radiotherapy techniques, but also to minimize the proton range uncertainty. This study aims to share our strategies and challenges encountered in PT setup. "Less-is-more" was our fundamental principle used in PT setup to mitigate the proton range uncertainty. Small shifts between patient and immobilisation device along the beam pathway can increase range uncertainty. To address this, we minimized the number of immobilisation devices used along the beam pathway. In breast and prostate PT, body Vaclok was avoided to clear the pathway for lateral beams. Wingboard with arm-only Vaclok was used for breast, while knee and foot support were used for prostate. Challenges arose, in head and neck(H&N) and craniospinal irradiation (CSI) cases, where Vaclok and thermocast were unavoidably used. The presence of sharp edges and non-uniformity in these immobilisation devices could significantly increase range uncertainty. Additional measures were taken, such as bevelling the edges of customized neck cushion for H&N case or avoiding folds in potential beam pass-through areas of Vaclok. In CSI cases, Vaclok-only CT was performed to assess its uniformity before patient's planning CT. A total number of sixty-nine patients underwent PT successfully using these setups. Daily translational and rotational shifts, recorded from pre-treatment kV images, were well within acceptable ranges. No significant setup deviations required replanning. PT immobilisation poses distinct challenges as it can have a negative impact on its depth dose distribution and range uncertainty. Our strategy addresses these challenges and achieves successful PT treatments. Further research and refinement of immobilisation techniques in PT are warranted to optimize treatment efficiency. [ABSTRACT FROM AUTHOR]

Magnetic Resonance Imaging (MRI) produces detailed images of specific anatomical regions without the use of ionising radiation. It is an examination which takes approximately 30 minutes to an hour. Due to the long duration, patients may move, leading to poor quality images obtained, hence affecting radiologists' interpretation of them. In Sengkang General Hospital (SKH), patients are routinely given a verbal explanation of their examination during positioning. Between October to December 2021, MRI radiographers encountered 90 cases where patients were noncompliant, resulting in multiple repeated acquisitions of images. The prolonged scan time led to operational inefficiency. Root-cause analysis was performed using the "cause and effect" diagram, and the "5 Whys" analytical technique identified poor patient awareness as the root cause. The study team came up with the idea of creating an MRI patient education video as an intervention to improve patient awareness. The Plan-Do-Study-Act (PDSA) quality improvement tool was subsequently selected to test the intervention. Plan - brainstorming on the creation and content of an MRI patient education video; Do - creating the video with emphasis on patient's cooperation and showing the final product to patients; Study - data collection and analysis of pre and post implementation of the patient education video; Act - reassess the suitability of implementing the patient education video for a long term. With the implementation of the patient education video, the percentage of patients who were noncompliant during their MRI examination fell significantly by 80%. The result suggests that by implementing an MRI patient education video, patients become more aware of the MRI examination requirements, leading to a reduction in repeated image acquisitions. [ABSTRACT FROM AUTHOR]

Adjuvant radiotherapy is a common treatment regime for breast cancer patients. Immobilization of breast is challenging because of its deformity. In 2019, a commercial FDA-approved bra(Bra) is available for breast immobilization during radiotherapy. Our hospital has used Bra for oncologist-initiated or pendulous patients since then. This work aims to share our clinical experiences and findings from some retrospective studies using Bra in terms of reproducibility, dosimetry, and acute radiation dermatitis (ARD). A pilot study was conducted to evaluate the reproducibility of Bra prior to clinical implementation. With the promising result, a designated team was trained to standardize the usage of Bra, from sizing, fitting to treatment reproducibility. In the initial cases with 2-field tangential conformal radiotherapy (Tang), 2 treatment plans were compared with and without Bra to select the plan with better dosimetric outcomes. Pre-treatment image verified setup accuracy. A separate reproducibility evaluation study was conducted for patients underwent Tomotherapy, utilizing volumetric information provided by pre-treatment CT. ARD was assessed weekly using Radiation Therapy Oncology Group(RTOG) acute radiation morbidity scoring criteria(Grade 0-4). Twenty-nine patients underwent breast radiotherapy (Tang: 23, VMAT: 2, Tomotherapy:4) had used Bra and completed the course with zero dropout rate. For the first nine cases, the plan with Bra had a significant 3.6% decrease in V20 of ipsilateral lung and 1Gy decrease in heart mean dose. The mean translational(mm) and rotational(°) shifts were -0.51±3.08 (Left-Right), 0.94±4.25(Superior-Inferior), 0.02±4.87(Anterior-Posterior) and 0.30±1.05(roll). No patient with Bra suffered from grade 3 or 4 ARD. 8 patients with Bra experienced grade 2 at the last treatment. Our experience has demonstrated dosimetric benefits with promising reproducibility and manageable ARD in using Bra. A trained dedicated team is essential to its implementation. [ABSTRACT FROM AUTHOR]

The effects of ketone salt supplementation on repeated short-distance running time trial (TT) performance in well-trained subjects remain unknown. To determine the effects of 10-day exogenous ketone salt supplementation on two consecutive 800 m running TTs in endurance-trained subjects. Male and female subjects were randomly allocated to one of the following groups: Ketone (KET) (n = 16) or placebo (CON) (n = 16) (8 m, 8f per group). Subjects underwent two consecutive 800 m TTs before and after a 10-day treatment on a self-propelled treadmill. Time-to-completion of the first (TT1) and second (TT2) TT, the average time-to-completion (TTAVG), and blood lactate response during each TT was measured pre-post-treatment. Changes in blood ketone levels in response to a single dosing were measured pre- and post-treatment. Data was analyzed with a mixed factorial ANOVA with significance set to p < 0.05. KET demonstrated a faster TTAVG from pre- to post-treatment (-6.1 ± 8.9 s; p = 0.02) while CON showed no change. At pre- and post-treatment, CON showed no acute changes in blood ketones after a single-dosing while KET demonstrated a significant increases (Pretreatment = +0.4 ± 0.3 mmol/L; p < 0.001; Post-Treatment = +0.4 ± 0.4 mmol/L; p < 0.001). These acute single-dosing responses in blood ketone levels for KET did not change between pre- and post-treatment. There were no interactions for blood lactate response to exercise or fatigue index. In trained subjects, 10 days of ketone salt supplementation does not affect performance in an initial bout of short-distance running, such as during TT1. However, ergogenic effects may be observed under fatigue conditions for example during a repeated running bout. [ABSTRACT FROM AUTHOR]