• Rowland Gunter opublikował 5 miesięcy, 1 tydzień temu

    Completing the COVID-19 callbacks decreased some of the clinical burden on the department. Patients, too, were grateful for the follow-up.Purpose To investigate the inconsistency of recent literature on the effect of magnetic field on the response of radiochromic films, we studied the influence of 0.35 T magnetic field on dosimetric response of EBT3 and EBT-XD GafchromicTM films. Methods Two different models of radiochromic films, EBT3 and EBT-XD, were investigated. Pieces of films samples from two different batches for each model were irradiated at different dose levels ranging from 1 Gy to 20 Gy using 6 MV flattening filter free (FFF) x-rays generated by a clinical MR-guided radiotherapy system (B = 0.35 T). Film samples from the same batch were irradiated at corresponding dose levels using 6 MV FFF beam from a conventional linac (B = 0) for comparison. The net optical density was measured 48 h post-irradiation using a flatbed scanner. The absorbance spectra were also measured over 500 nm -700 nm wavelength range using a fiber-coupled spectrometer with 2.5 nm resolution. To study the effect of fractionated dose delivery to EBT3 (/EBT-XD) films, 8 (/16) Gy dose was delivered in four 2 (/4) Gy fractions with 24 h interval between fractions. Results No significant difference was found in the net optical density and net absorbance of the films irradiated with or without the presence of magnetic field. No dependency on the orientation of the film during irradiation with respect to the magnetic field was observed. The fractionated dose delivery resulted in the same optical density as delivering the whole dose in a single fraction. Conclusions The 0.35 T magnetic field employed in the ViewRay® MR-guided radiotherapy system did not show any significant influence on the response of EBT3 and EBT-XD GafchromicTM films.Purpose Volumetric pancreas segmentation can be used in the diagnosis of pancreatic diseases, the research about diabetes and surgical planning. Since manual delineation is time-consuming and laborious, we develop a deep learning based framework for automatic pancreas segmentation in 3D medical images. Methods A two-stage framework is designed for automatic pancreas delineation. In localization stage, a Square Root Dice loss is developed to handle the trade-off between sensitivity and specificity. In refinement stage, a novel 2.5D slice interaction network with slice correlation module is proposed to capture the non-local cross-slice information at multiple feature levels. Also a self-supervised learning based pre-training method, slice shuffle, is designed to encourage the inter-slice communication. To further improve the accuracy and robustness, ensemble learning and a recurrent refinement process are adopted in the segmentation flow. Results The segmentation technique is validated in a public dataset (NIH Pancreas-CT) with 82 abdominal contrast enhanced 3D CT scans. Four-fold cross-validation is performed to assess the capability and robustness of our method. The Dice similarity coefficient, sensitivity and specificity of our results are 8621±437%, 8749±638% and 8511 ± 649% respectively, which is the state-of-the-art performance in this dataset. Conclusions We proposed an automatic pancreas segmentation framework and validate in an open dataset. It is found that 2.5D network benefits from multi-level slice interaction and suitable self-supervised learning method for pre-training can boost the performance of neural network. This technique could provide new image findings for the routine diagnosis of pancreatic disease.Purpose Vitamin D is primarily known for its role in bone health. However, it has a much more diverse role in the human metabolism. Specifically, deficiency of vitamin D has recently been studied for its possible role in adverse pregnancy outcomes such as preeclampsia, gestational diabetes and preterm birth. Vitamin D levels largely depend on exposure to the sun and are influenced by nutritional habits at only a minimal level. In Switzerland, it is estimated that 40–50% of the population is vitamin D deficient. No specific data on pregnant women is available. The recommendations of the Swiss Federal Commission for Nutrition include a supplement of 600 IU of vitamin D to all pregnant women, despite the lack of data for this population in Switzerland. The primary aim of this study was to determine the prevalence of vitamin D deficiency among the population of pregnant women receiving prenatal care and giving birth at our clinic. We assumed that the prevalence of vitamin D deficiency in pregnant women in Switzerth weight and length. Conclusion We performed a retrospective analysis of serum 25(OH)D concentrations in pregnant Swiss women and found a mean serum 25(OH)D level of about 37 nmol/l and that one third of the overall study population had a serum 25(OH)D level below 25 nmol/l, and were thus seriously vitamin D deficient. Furthermore, the data demonstrate that vitamin D deficiency is associated with gestational diabetes. The current recommendations of vitamin D supplementation of 600 IU in pregnant women are therefore insufficient, and novel strategies, such as general screening for vitamin D deficiency, pre-conceptional timing of the supplementation and individually tailored dosing of vitamin D supplementation seem mandatory, potentially leading to improved maternal health and benefits to children’s long-term health in Switzerland and worldwide. (trial registration ClinicalTrial.gov. Identifier NCT02904720).Malaria due to Plasmodium falciparum (Pf) may be missed if patients present with symptoms outside of the expected incubation period. We describe two patients who developed Pf malaria more than one year after visiting malaria-endemic countries. Both worked at an international airport, but no source of infection was identified.Background The appropriate treatment of alar rim deformities, such as alar pinching or concavity, and soft triangle notching, is essential for perfecting nasal aesthetics. Objective We introduce the „mono-unit alar rim graft” technique as a treatment option for these abnormalities. Methods A case series of 29 rhinoplasties conducted by the senior author between May 2017 and June 2019 using the mono-unit alar rim graft technique was retrospectively reviewed. The surgical technique involved an open approach with costal cartilage harvesting. The cortical portion of the harvested costal cartilage was sectioned into a 1 mm thick strip and soaked with saline for about 15 minutes to let the natural warping occur. The curved cartilage graft was then trimmed, and the midportion was sutured to the tip in an onlay fashion. Both ends of the graft were housed in the vestibular pocket. Patient demographic data and pre- and postoperative facial photos were reviewed. Results Among the 29 cases analyzed, 14 (48.3%) were men and 15 (51.7%) were women. Ten (34.5%) patients had a preoperative parenthesis deformity but a near-complete correction was achieved in 8 (80.0%) cases. An alar concavity from the basal view was found in 16 patients, 15 (93.8%) of whom had a partial or near-complete correction. Eleven patients had soft triangle notching, 9 (81.8%) of whom had a partial or near-complete correction. There were no technique-related complications in this patient series. Conclusions The mono-unit alar rim graft technique is a viable option for treating various alar rim deformities.Background Substantial limitations have been imposed on passenger air travel to reduce transmission of SARS-CoV-2 between regions and countries. However, as case numbers decrease, air travel will gradually resume. We considered a future scenario in which case numbers are low and air travel returns to normal. Under that scenario, there will be a risk of outbreaks in locations worldwide due to imported cases. We estimated the risk of different locations acting as sources of future COVID-19 outbreaks elsewhere. Methods We use modelled global air travel data and population density estimates from locations worldwide to analyse the risk that 1364 airports are sources of future COVID-19 outbreaks. We use a probabilistic, branching-process based approach that considers the volume of air travelers between airports and the reproduction number at each location, accounting for local population density. Results Under the scenario we model, we identify airports in East Asia as having the highest risk of acting as sources of future outbreaks. Moreover, we investigate the locations most likely to cause outbreaks due to air travel in regions that are large and potentially vulnerable to outbreaks India, Brazil and Africa. We find that outbreaks in India and Brazil are most likely to be seeded by individuals travelling from within those regions. We find that this is also true for less vulnerable regions, such as the United States, Europe, and China. However, outbreaks in Africa due to imported cases are instead most likely to be initiated by passengers travelling from outside the continent. Conclusions Variation in flight volumes and destination population densities create a non-uniform distribution of the risk that different airports pose of acting as the source of an outbreak. Accurate quantification of the spatial distribution of outbreak risk can therefore facilitate optimal allocation of resources for effective targeting of public health interventions.Background Tobacco smoking is a leading public health concern and is the most preventable cause of morbidity and mortality worldwide. Sportspeople are no exception and those who smoke are predisposed to the same hazardous health effects as the general public, in addition to the potential effects it may have on their sporting performance. Aims We aimed to ascertain the prevalence of tobacco consumption in a sporting population. We also endeavoured to quantify the use of E-cigarettes and assess exposure to passive smoking. Design Observational study. Methods A web-based e-questionnaire was distributed to participants from various sports across Ireland between November 2017 and January 2018, and data was analysed using SPSS. Results 546 sportspeople completed the survey with more than twice as many male respondents. 16% of participants were current smokers, with males significantly more likely to smoke (p less then 0.001). 26% of Rugby players were current smokers which was significantly higher compared to other sports (p less then 0.01). 10% of all participants were exposed to second-hand smoke for more than 1 hour per day. 2% of all participants were current users of E-cigarettes. Conclusions The prevalence of smoking in our study population was higher than other literature reports. Further studies are essential to evaluate the potential negative effects this may be having on sporting performance, career progression and indeed injury occurrence/rehabilitation. It is imperative to address the matter of smoking in athletes, not only for public health concerns but also considering they are important role models in our society.Background The adjuvanted recombinant zoster vaccine (RZV) is highly immunogenic and efficacious in adults ≥50 years (Y) of age (YOA). We evaluated (1) long-term immunogenicity of an initial 2-dose RZV schedule by following-up adults vaccinated at ≥60 YOA and by modeling, and (2) immunogenicity of 2 additional doses administered 10Y post-initial vaccination. Methods Persistence of humoral and cell-mediated immune (CMI) responses to 2 initial RZV doses was assessed through 10Y post-initial vaccination, and modeled through 20Y using a Piecewise, Power law and Fraser model. Immunogenicity and safety of 2 additional RZV doses were also evaluated (NCT02735915). Results Seventy adults were enrolled. Ten years post-initial vaccination, humoral and CMI responses were ~6-fold and ~3.5-fold above pre-initial vaccination levels, respectively. Predicted immune persistence through 20Y post-initial vaccination was similar across the 3 models. Sixty-two participants (82.6±4.4 YOA) received at least 1 additional RZV dose. Strong anamnestic humoral and CMI responses were elicited by 1 additional dose, without further increases after a second additional dose.

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