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Radiotherapy and Oncology : Journal of... May 2022Image-guided adaptive brachytherapy (IGABT) is a key component in the treatment of cervical cancer, but the nature of the clinical workflow makes it vulnerable to...
BACKGROUND AND PURPOSE
Image-guided adaptive brachytherapy (IGABT) is a key component in the treatment of cervical cancer, but the nature of the clinical workflow makes it vulnerable to suboptimal plans, as the theoretical optimal plan depends heavily on organ configuration. Patient anatomy-based quality-assurance (QA) with overlap volume histograms (OVHs) is a promising tool to detect such suboptimal plans, and in this analysis its suitability as a multi-institutional clinical QA tool is investigated.
MATERIALS AND METHODS
A total of 223 plans of 145 patients treated in accordance with the current state-of-the-art IGABT protocols from UMC Utrecht (UMCU) and Erasmus MC (EMC) were included. Machine-learning models were trained to predict dose D to bladder, rectum, sigmoid and small bowel with the help of OVHs. For this strategy, points are sampled on the organs-at-risk (OARs), and the distances of the sampled points to the target are computed and combined in a histogram. Machine-learning models can then be trained to predict dose-volume histograms (DVHs) for unseen data. Single-center model robustness to needle use and applicator type and multi-center model translatability were investigated. Performance of models was assessed by the difference between planned (clinical) and predicted D values.
RESULTS
Intra-validation of UMCU data demonstrated OVH model robustness to needle use and applicator type. The model trained on UMCU data was found to be robust within the same protocol on EMC data, for all investigated OARs. Mean squared error between planned and predicted D values of OARs ranged between 0.13 and 0.40 Gy within the same protocol, indicating model translatability. For the former protocol cohort of Erasmus MC large deviations were found between the planned and predicted D values, indicating plan deviation from protocol. Mean squared error for this cohort ranged from 0.84 to 4.71 Gy.
CONCLUSION
OVH-based models can provide a solid basis for multi-institutional QA when trained on a sufficiently strict protocol. Further research will quantify the model's impact as a QA tool.
Topics: Brachytherapy; Female; Humans; Machine Learning; Organs at Risk; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Uterine Cervical Neoplasms
PubMed: 35219799
DOI: 10.1016/j.radonc.2022.02.022 -
Clinical Oral Investigations Jan 2022To compare the accuracy of implant placement performed with either a surgical motor or a torque wrench as part of a half-guided surgical protocol. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To compare the accuracy of implant placement performed with either a surgical motor or a torque wrench as part of a half-guided surgical protocol.
MATERIALS AND METHODS
Implant insertion with half-guided surgical protocol was utilized by surgical motor (machine-driven group) or torque wrench (manual group) in the posterior maxilla. After the healing period, accuracy comparison between planned and actual implant positions was performed based on preoperative cone beam computed tomography and postoperative digital intraoral scans. Coronal, apical, and angular deviations, insertion time, and insertion torque were evaluated.
RESULTS
Forty patients were treated with 1 implant each; 20 implants were inserted with a surgical motor and 20 implants with a torque wrench. Global coronal and apical deviations were 1.20 ± 0.46 mm and 1.45 ± 0.79 mm in the machine-driven group, and 1.13 ± 0.38 mm and 1.18 ± 0.28 mm in the manual group (respectively). The mean angular deviation was 4.82 ± 2.07° in the machine-driven group and 4.11 ± 1.63° in the manual group. Mean insertion torque was 21.75 ± 9.75 Ncm in the machine-driven group, compared to 18.75 ± 7.05 Ncm in the manual group. Implant placement duration was 9.25 ± 1.86 s in the machine-driven group at a speed of 50 rpm, and 36.40 ± 8.15 s in the manual group.
CONCLUSION
No significant difference was found between the two groups in terms of accuracy and mean insertion torque, while machine-driven implant placement was significantly less time-consuming.
CLINICAL RELEVANCE
Optimal implant placement accuracy utilized by half-guided surgical protocol can be achieved with both machine-driven and torque wrench insertion.
TRIAL REGISTRATION
ID: NCT04854239.
Topics: Cone-Beam Computed Tomography; Dental Implantation, Endosseous; Dental Implants; Humans; Maxilla; Prospective Studies; Surgery, Computer-Assisted
PubMed: 34401946
DOI: 10.1007/s00784-021-04087-0 -
Health Informatics Journal Sep 2020Medical care services can be organized into a network. Understanding the structure of this network cannot only help analyze common clinical protocols but can also help...
Medical care services can be organized into a network. Understanding the structure of this network cannot only help analyze common clinical protocols but can also help reveal previously unknown patterns of care. The objective of this research is to introduce the concept and methods for constructing and analyzing the network of medical care services. We start by demonstrating how to build the network itself and then develop algorithms, based on principal component analysis and social network analysis, to detect communities of services. Finally, we propose novel graphical techniques for representing and assessing patterns of care. We demonstrate the application of our algorithms using data from an Emergency Department in New York State. One of the implications of our research is that clinical experts could use our algorithms to detect deviations from either existing protocols of care or administrative norms.
Topics: Health Services; Humans; Network Meta-Analysis; New York
PubMed: 31735109
DOI: 10.1177/1460458219887047 -
Seminars in Cell & Developmental Biology Jul 2022Kidney organoid technology has led to a renaissance in kidney developmental biology. The complex underpinnings of mammalian kidney development have provided a framework...
Kidney organoid technology has led to a renaissance in kidney developmental biology. The complex underpinnings of mammalian kidney development have provided a framework for the generation of kidney cells and tissues from human pluripotent stem cells. Termed kidney organoids, these 3-dimensional structures contain kidney-specific cell types distributed similarly to in vivo architecture. The adult human kidney forms from the reciprocal induction of two disparate tissues, the metanephric mesenchyme (MM) and ureteric bud (UB), to form nephrons and collecting ducts, respectively. Although nephrons and collecting ducts are derived from the intermediate mesoderm (IM), their development deviates in time and space to impart distinctive inductive signaling for which separate differentiation protocols are required. Here we summarize the directed differentiation protocols which generate nephron kidney organoids and collecting duct kidney organoids, making note of similarities as much as differences. We discuss limitations of these present approaches and discuss future directions to improve kidney organoid technology, including a greater understanding of anterior IM and its derivatives to enable an improved differentiation protocol to collecting duct organoids for which historic and future developmental biology studies will be instrumental.
Topics: Adult; Animals; Cell Differentiation; Humans; Kidney; Mammals; Nephrons; Organogenesis; Organoids; Pluripotent Stem Cells
PubMed: 34627669
DOI: 10.1016/j.semcdb.2021.09.017 -
Cancer Jul 2022The European Organization for Research and Treatment of Cancer 22092-62092 STRASS trial failed to demonstrate the superiority of neoadjuvant radiotherapy (RT) over...
BACKGROUND
The European Organization for Research and Treatment of Cancer 22092-62092 STRASS trial failed to demonstrate the superiority of neoadjuvant radiotherapy (RT) over surgery alone in patients with retroperitoneal sarcoma. Therefore, an RT quality-assurance program was added to the study protocol to detect and correct RT deviations. The authors report results from the trial RT quality-assurance program and its potential effect on patient outcomes.
METHODS
To evaluate the effect of RT compliance on survival outcomes, a composite end point was created. It combined the information related to planning target volume coverage, target delineation, total dose received, and overall treatment time into 2 groups: non-RT-compliant (NRC) for patients who had unacceptable deviation(s) in any of the previous categories and RT-compliant (RC) otherwise. Abdominal recurrence-free survival (ARFS) and overall survival were compared between the 2 groups using a Cox proportional hazard model adjusted for known prognostic factors.
RESULTS
Thirty-six of 125 patients (28.8%) were classified as NRC, and the remaining 89 patients (71.2%) were classified as RC. The 3-year ARFS rate was 66.8% (95% confidence interval [CI], 55.8%-75.7%) and 49.8% (95% CI, 32.7%-64.8%) for the RC and NRC groups, respectively (adjusted hazard ratio, 2.32; 95% CI, 1.25-4.32; P = .008). Local recurrence after macroscopic complete resection occurred in 13 of 89 patients (14.6%) versus 2 of 36 patients (5.6%) in the RC and NRC groups, respectively.
CONCLUSIONS
The current analysis suggests a significant benefit in terms of ARFS in favor of the RC group. This association did not translate into less local relapses after complete resection in the RC group. Multidisciplinary collaboration and review of cases are critical to avoid geographic misses, especially for rare tumors like retroperitoneal sarcoma.
Topics: Disease-Free Survival; Guideline Adherence; Humans; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Proportional Hazards Models; Randomized Controlled Trials as Topic; Retroperitoneal Neoplasms; Sarcoma; Soft Tissue Neoplasms; Survival Rate
PubMed: 35536104
DOI: 10.1002/cncr.34239 -
Journal of Clinical Medicine Sep 2019Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies... (Review)
Review
Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies among physicians and real-world data have suggested that an evidence-practice gap exists in RA management. Investigating physician adherence to T2T, which requires a process measure, is difficult. Different practice patterns among physicians are observed, while adherence to protocolized treatment declines over time. Rheumatologist awareness, agreement, and claims of adherence to T2T guidelines are not always consistent with medical records. Comorbidities, a difficult disease course, communication barriers, and individual preferences may hinder an intensive, proactive treatment stance. Interpreting deviations from protocolized treatment/T2T guidelines requires sufficient clinical context, though higher adherence seems to improve clinical outcomes. Nonmedical constraints in routine care may consist of barriers in healthcare structure and socioeconomic factors. Therefore, strategies to improve the institution of T2T should be tailored to local healthcare. Educational interventions to improve T2T adherence among physicians may show a moderate, although beneficial effect. Meanwhile, a proportion of patients with inadequately controlled RA exists, while management decisions may not be in accordance with T2T. Physicians tend to be aware of current guidelines, but their institution in routine practice seems challenging, which warrants attention and further study.
PubMed: 31500394
DOI: 10.3390/jcm8091416 -
CoDAS 2023To analyse the relationship between the risk of dysphonia and vocal quality in undergraduate performing arts students. (Observational Study)
Observational Study
PURPOSE
To analyse the relationship between the risk of dysphonia and vocal quality in undergraduate performing arts students.
METHODS
Observational cross-sectional study with 38 undergraduate students in Performing Arts. We applied screening protocols for general and specific risk of dysphonia for actors and made recordings of sustained emission of the vowel /a/, spontaneous speech and reading a text, used for perceptual analysis performed by three evaluators using the GRBASI scale. After intra and inter-rater reliability tests it was obtained final classification of the general degree of vocal deviation parameter for each participant. Comparisons were made considering groups that had or did not have other profession/activity with the use of voice, and the groups were formed from the general grade.
RESULTS
Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild degree. Students who had another profession/activity with voice use scored higher in the specific protocol for actors, and in the sum of this protocol with the general screening protocol. There was no relationship between the degree of vocal alteration and the risk of dysphonia. Students who did not yet work professionally had more moderate or severe vocal alterations, and those who did work professionally had a higher frequency of mild vocal alterations.
CONCLUSION
Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild alteration. There was no relationship between the risk of dysphonia and the degree of vocal alteration.
Topics: Humans; Dysphonia; Voice Quality; Cross-Sectional Studies; Reproducibility of Results; Students
PubMed: 37610967
DOI: 10.1590/2317-1782/20232022036pt -
Kardiologia Polska 2018In-hospital sudden cardiac arrest (SCA) is an event that is linked to high mortality. Data analysis of SCA and the course of in-hospital cardiopulmonary resuscitation...
BACKGROUND
In-hospital sudden cardiac arrest (SCA) is an event that is linked to high mortality. Data analysis of SCA and the course of in-hospital cardiopulmonary resuscitation (CPR) allows for its better understanding and improvement.
AIM
Analysis of cases of SCA and the procedures taken by the medical staff of University Hospital.
METHODS
A retrospective analysis of 104 protocols of SCA, from May 2014 to December 2015. Actions taken by medical staff before the arrival of the resuscitation team (RT) and RT proceedings. Data are presented as median and mean ± standard deviation.
RESULTS
52.88% of cases were women, and their mean age was 70.82 ± 13.32 years. Resuscitation activities (basic life support: 48.08%, advance life support: 42.31%) were performed before the RT arrival, and no action was taken in 5.77% of cases. The cardiac arrest occurred most commonly in the afternoons hours, and the Emergency Room was the place of CPR in 41.35% of cases. The waiting time for RT was on average 4.47 ± 5.85 min. Non-defibrillation rhythms occurred in 79.80%, and the efficacy of resuscitation was 40%.
CONCLUSIONS
Resuscitation protocols should be registered not only as an important part of medical records, but also as a source of information during the CPR training of staff. The lack of rescue activities before the arrival of the RT indicates the urgent need to identify the cause of the problem and eliminate these negative behaviours.
Topics: Aged; Aged, 80 and over; Cardiopulmonary Resuscitation; Death, Sudden, Cardiac; Emergency Medical Services; Female; Humans; Male; Middle Aged; Poland; Retrospective Studies; Treatment Outcome
PubMed: 29131292
DOI: 10.5603/KP.a2017.0209 -
Journal of Dentistry Aug 2023To (1) validate the use of a post-operative intraoral scan (IOS) versus Cone Beam Computed Tomography (CBCT), gold standard, on its ability to measure the accuracy of...
OBJECTIVES
To (1) validate the use of a post-operative intraoral scan (IOS) versus Cone Beam Computed Tomography (CBCT), gold standard, on its ability to measure the accuracy of guided endodontics, and (2) present clinical data on the accuracy of guided endodontics.
METHODS
Four models, including 10 extracted teeth each, were created. Forty guided access cavities were planned on dentin to simulate pulp canal obliteration (PCO). Two operators performed guided access cavities. A post-operative CBCT and IOS were acquired. The coronal, apical, and angular deviations were measured with CBCT and IOS. Clinical accuracy was measured using an IOS acquired immediately after drilling the access cavity with the aid of a guide. Data analysis was performed using multiway Anova and corrected for simultaneous hypothesis testing according to Tukey. P ≤ 0.05 was considered statistically significant. Descriptive statistics on the clinical accuracy of guided endodontics were performed.
RESULTS
Thirty-eight cavities were assessed with a mean length of 13.8 mm. No statistical difference between operators and methods was found for all parameters (P > 0.05). Thirty-three patients were treated with guided endodontics and measured using an IOS. Results show an average coronal, apical, and angular deviation of 0.2 mm, 0.45 mm, and 1.91 respectively. The average length of the access cavities was 12.5 mm.
CONCLUSIONS
An IOS can be used to measure the accuracy of guided endodontics. Clinical data showed high accuracy of guided endodontics with a mean apical deviation smaller than 0.5 mm and a mean angular deviation of less than 2.
CLINICAL SIGNIFICANCE
The use of an IOS does not involve additional radiation exposure. A safety margin of at least 1 mm around the planned trajectory should be respected when planning the case to minimize the possibility of root perforation.
Topics: Humans; Dental Pulp Cavity; Endodontics; Dental Caries; Dental Pulp Diseases; Cone-Beam Computed Tomography
PubMed: 37263407
DOI: 10.1016/j.jdent.2023.104566 -
Cureus Oct 2022In today's world, the upper cross syndrome is growing more common and becoming very prevalent among dental undergraduate practitioners. One of the most important...
Measuring the Efficacy of Myofascial Rollers and Post-isometric Relaxation Technique in Relieving Pain Intensity and Postural Deviation Using Plumb Line Assessment for the Treatment of Upper Cross Syndrome in Dental Undergraduate (UG) Students.
BACKGROUND
In today's world, the upper cross syndrome is growing more common and becoming very prevalent among dental undergraduate practitioners. One of the most important conditions for which dentists seek physiotherapy treatment is neck pain. It is characterized by overactive pectoralis and trapezius muscles. It is frequently linked to poor posture in dental students' daily life, causing them to miss their work.
OBJECTIVES
The first objective of our study was to find the efficacy of myofascial rollers and post-isometric relaxation technique along with conventional therapy for pain relief and correction of postural deviation in undergraduate dental students. And, the second objective of the study was to compare the effect of myofascial rollers and post-isometric relaxation techniques in upper cross syndrome.
METHODS
The study was conducted with pre-test and post-test methods. The study consisted of 80 participants who were included based on our inclusion and exclusion criteria. The study sample was randomly assigned into two groups. Each group consisted of a total of 40 participants. Group A was treated using myofascial rollers and hot packs, and Group B was treated using the post-isometric relaxation technique and hot packs. Patients were asked to mark their intensity of pain on the Numerical Pain Rating Scale and an assessment of postural deviations (in mm) was noted through a plumb line in the posture grid. Posture assessment was done in lateral view. The protocol covered four weeks of treatment based on the defined protocol. Finally, the t-square test and Chi-square test were used to compare the difference in the result. Also, the level of significance was kept at <0.05.
RESULT
Statistical analysis was done using descriptive and inferential statistics using student paired, unpaired, and chi-square test. IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) was used. The Numerical Pain Rating Scale showed mean deviations of (4.15±1.29) for Group A and (3.30±1.01) for Group B. Plumb line assessment showed mean deviations of (9.09±4.31) for Group A and (6.33±2.36) for Group B. Also, Numerical Pain Rating Scale showed (t=3.26, p=0.002) and Plumb line deviation showed (t=3.57, p=0.001).
CONCLUSION
Through our study, we conclude that statistically no significant differences were found in pre-intervention and post-intervention, but myofascial rollers gave better results as compared to the post-isometric relaxation technique in alleviating pain and correcting postural deviation.
PubMed: 36337788
DOI: 10.7759/cureus.29831