8%, rectum by 3.2%, sigmoid by 2.1%, right femoral head by 3.5%, and left femoral head by 3.9%. The split and open techniques showed comparable bladder results and were superior over the limited method. The monitor units were highest with the split method leading to increased treatment times. The split x-jaw planning technique should be used with Varian linear accelerators to produce superior volumetric modulated arc radiotherapy plans for planning target volumes larger than the maximum extent of the multileaf collimator in the x-jaw direction. BACKGROUND Locomotive syndrome (LS) is a condition of decreased mobility caused by disorders of the locomotive organs. Lumbar spinal stenosis (LSS) is a LS disorder. The Japanese Orthopaedic Association score (JOA score) and the Zurich Claudication Questionnaire (ZCQ) are international evaluation tools for LSS. However, the relationship between LS and JOA score or ZCQ is unknown. This study aimed to clarify the correlations between LS progression and the values/parameters of the JOA score or ZCQ and to determine the critical cutoff point of the JOA score or ZCQ that indicates LS progression. METHODS We recruited preoperative LSS patients (n = 82). Patients’ mean age was 73.4 years. The study participants were evaluated using the 25-question Geriatric Locomotive Function Scale (GLFS), JOA score, and ZCQ (which consists of symptom severity and physical function), and the patients’ health-related quality of life was assessed using EuroQoL-5 dimension (EQ-5D) utility values and the EuroQoL-visual analog scale (EQ-VAS). We investigated the correlations between the 25-question GLFS and each clinical variable and evaluated the critical cutoff point of each international evaluation tool to detect LS. RESULTS There was a statistically significant correlation between 25-question GLFS and each clinical evaluation tool. LSS patients with LS showed significantly worse scores in the evaluation tools than LSS patients without LS. Moreover, we found that critical cutoff points of 17.5 on JOA score, 3.1 on ZCQ-symptom, and 2.3 on ZCQ-function could detect LS. CONCLUSIONS A statistically significant correlation exists between the 25-question GLFS and the JOA score or ZCQ. It might be important to perform decompression surgery for LSS patients before they reach the cutoff values of the several clinical evaluation tools to avoid LS progression. STUDY DESIGN Clinical prospective case-control study. INTRODUCTION Measures of subglottal pressure (Ps), phonation threshold pressure (PTP), and laryngeal resistance (LR) can be used as indicators of vocal cord disorders. The gold standard non-invasive measurement uses labial interruption, which has been shown to have reliability inconsistencies. Mechanical interruption methods have demonstrated promise in measurement reliability. The goal of the present study is to compare retest reliability of labial and mechanical interruption methods. METHODS 55 subjects aged 18-69 participated. Ten trials were performed for each method. For labial interruption, subjects produced five labial plosives at comfortable and quiet volumes. For mechanical interruption, subjects produced a sustained /α/ while a balloon valve interrupted phonation five times. Thirty subjects completed a second study visit identical to the first approximately two weeks (15 days ± 3.76) after the first visit. Ps, PTP, mean airflow rate, and LR were determined for each subject and retest reliability forsting and intra-subject variability. Continued work to improve mechanical interruption techniques is warranted as these methods offer higher reliability and consistency than the labial interruption methods. BACKGROUND Unilateral vocal fold paralysis (UVFP) often leads to significant morbidity that may include dysphonia, swallowing problems and aspiration. The best timing for medialization procedures is still controversial. Published data suggest that early intracordal injection positively affects long-term outcomes. OBJECTIVES To critically review current literature in order to determine if early treatment of acute UVFP influences clinical outcomes of the patients. TYPE OF REVIEW Nonsystematic literature review. METHODS A literature review was performed, using the Pubmed database. All relevant articles published in English addressing the effect of early treatment in acute unilateral focal fold paralysis were analyzed. Twenty-six articles were included due to their scientific interest. RESULTS Published literature suggests that early intracordal injection in patients with UVFP reduces pulmonary infections, hospital length of stay and improves voice parameters. Also, patients who receive early intracordal injection seem to be less likely to undergo subsequent medialization thyroplasty. CONCLUSIONS Early intracordal injection should be offered to patients with newly diagnosed UVFP since it promotes a satisfactory position of the vocal fold and seems to improve clinical outcomes. More investigation, with long-term follow up data and treatment randomization, is necessary to develop clinical consensus for these patients. Due to an aging population and the related growing number of less physically fit patients with multiple comorbidities, adequate perioperative care is a new and rapidly developing clinical science that is becoming increasingly important. This narrative review focuses on enhanced recovery after surgery (ERAS®) programmes and the growing interest in prehabilitation programmes to improve patient- and treatment-related outcomes in older patients undergoing hepatopancreatobiliary (HPB) surgery. Future steps required in the further development of optimal perioperative care in HPB surgery are also discussed. Multidisciplinary preoperative risk assessment in multiple domains should be performed to identify, discuss, and reduce risks for optimal outcomes, or to consider alternative treatment options. Prehabilitation should focus on high-risk patients based on evidence-based cut-off values and should aim for (partly) supervised multimodal prehabilitation tailored to the individual patient’s risk factors. The program should be executed in the living context of these high-risk patients to improve the participation rate and adherence, as well as to involve the patient’s informal support system. Developing tailored (multimodal) prehabilitation programmes for the right patients, in the right context, and using the right outcome measures is important to demonstrate its potential to further improve patient- and treatment-related outcomes following HPB surgery. INTRODUCTION The role of surgery for breast cancer liver metastases (BCLM) remains controversial. This study aimed to analyze survival in patients treated with hepatectomy plus systemic therapy or systemic therapy alone for BCLM and to determine selection factors to guide surgical therapy. MATERIALS AND METHODS Patients who underwent hepatectomy plus systemic therapy (n = 136) and systemic therapy alone for isolated BCLM (n = 763) were compared. Overall survival (OS) was analyzed after propensity score matching. Intrinsic subtypes were defined as luminal A (estrogen receptor [ER]+ and/or progesterone receptor positive [PR]+, human epidermal growth factor receptor 2 [HER2]-), luminal B (ER and/or PR+, HER2+), HER2-enriched (ER and PR-, HER2+), and basal-like (ER, PR, HER2-). RESULTS After hepatectomy, independent predictors of poor OS were number and size of liver metastases, and intrinsic subtype (hazard ratios, 1.11, 1.16, and 4.28, respectively). Median OS was 75 and 81 months among patients with luminal B and HER2-enriched subtypes, compared with 17 and 53 months among patients with basal-like and luminal A subtypes (P  less then  .001). Median progression-free survival (PFS) was 60 months with the HER2-enriched subtype, compared with 17, 16, and 5 months with luminal A, luminal B, and basal-like subtypes, respectively (P  less then  .001). After propensity score matching, 5-year OS rates were 56% vs. 40% in the surgery vs. systemic therapy alone groups (P = .018). CONCLUSION Surgical resection of BCLM yielded higher OS compared with systemic therapy alone and prolonged PFS among patients with the HER2-enriched subtype. These findings support the use of surgical therapy in appropriately selected patients, based on intrinsic subtypes. The increasing rates of resistance to β-lactams have made it more challenging for clinicians to select appropriate antibiotic treatment for bloodstream infections (BSIs) caused by suspected Enterobacteriaceae. The objective of this analysis was to determine the optimal dosage regimens of β-lactams for treatment of BSIs based on analysis of 19,334 Enterobacteriaceae collected from blood specimens. Monte Carlo simulation using pharmacokinetic parameters of infected patients was performed to determine the probability of overall pharmacokinetic/pharmacodynamic (PK/PD) target attainment (OPTA). E. coli, K. pneumoniae, and E. cloacae were the 3 most common species. Nine of the 16 tested regimens had optimal OPTAs (>90%) for Enterobacteriaceae overall (meropenem 2g q8h, 3 h infusion; meropenem 2g q8h, 0.5h; meropenem 1g q8h, 0.5h; piperacillin/tazobactam 4.5g q8h, 3h; ceftazidime 2g q8h, 3h; imipenem 0.5g q6h, 0.5h; imipenem 1g q8h, 0.5h; piperacillin/tazobactam 3.375g q6h, 0.5h; ceftazidime 2g q8h, 0.5h). Four other regimens had sub-optimal OPTAs of 80 to 90% (piperacillin/tazobactam 4.5g q8h, 0.5h; ceftazidime 1g q8h, 0.5h; cefepime 2g q12h, 3h; and cefepime 2g q12h, 0.5h). Although there are high antibiotic MICs among Enterobacteriaceae in Shandong Province, carbapenem- , ceftazidime- and piperacillin/tazobactam- based regimens provide the optimal treatment. BACKGROUND It is commonly stated that Candida in the vagina prefers a low pH to develop infection. However, mixed infections of Candida with bacterial vaginosis (BV) and aerobic vaginitis (AV) are rather common and may challenge the rule that Candida should only be looked for in low vaginal pH settings. In this study we tested whether the vaginal pH in acute vaginal candidosis is lower than in women successfully treated to prevent Candida recurrences. METHODS Vaginal pH and microscopy findings of vaginal microbiota were recorded during 12 visits over 1.5 years in 117 patients medically monitored during a degressive fluconazole maintenance regimen for proven recurrent vulvovaginal candidosis (ReCiDiF trial). The fluctuation of the mean pH of and microscopic findings of the vaginal smears were studied before, during and after the treatment. RESULTS The mean vaginal pH of women with acute infection before or after ending maintenance treatment was (4.7±0.8 and 4.8 ±1.0, respectively, p>0.05). During maintenance tinfection is related to low pH. Over the last 60 years, success rates in treating childhood cancers have grown dramatically from 10% to greater than 85%. Negative effects of treatments, however, place survivors at risk for neurocognitive deficits that can make school challenging. Evidence shows that receiving special education services can benefit affected children. However, communication and knowledge gaps among families and service providers can present access challenges. This mini-review considers the literature on communication between medical providers, families, and school professionals and identifies recommended tools for improving success and efficiency. Additional recommendations are made regarding improving access and adoption of such tools including the need for adaptations and expansions of available resources to address health disparity concerns for an increasingly linguistically and culturally diverse population.