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Objective — to evaluate the compliance of gonorrhoea diagnostics in regional skin and venereological dispensaries (RSVD) in Ukraine during 2013—2014 to World Health Organization (WHO) laboratory recommendations and identify areas for its improvement. Materials and methods. The study analyzed statistics data regarding the number of performed laboratory tests and their positive results for the detection of gonococci, the collection of biological samples and the use of laboratory methods for N. gonorrhoeae identification obtained from 14 RSVD of Ukraine by questionnaire. Results and discussion. Dispensary laboratories performed microscopy, culture and point-of-care-tests in 100, 85.7 and 7.1 % of patients, respectively. Gonococci were found in 2.3 % of the patients, equally by the results of microscopy (1740/76 348) and by culture (1322/56 273). Dispensary laboratories did not perform nucleic acid amplification tests. Sampling of biological material from three anatomical sites (urogenital, pharyngeal and rectal specimens) in heterosexual patients with symptoms of sexually transmitted infection was performed by 25 % of respondents, from two sites (urogenital and pharyngeal) — by 41.7 %, and from one site (urogenital sample) — by 33.3 % of dispensaries. External quality control of laboratory tests for the detection of N. gonorrhoeae was performed by 50 % of the respondents. Non-selective nutrient media for isolation of N. gonorrhoeae was used by 16.7 % of dispensaries, and prepared nutrient media in test tubes instead of the recommended Petri dishes, were used in 58.3 % of dispensaries. The vast majority of respondents (78.6 %) had an experience of determining gonococcal sensitivity to antibiotics. Two institutions (14.3 %) participated in an international pilot project to determine the antibiotic resistance of gonococci. Conclusions. Diagnostics of gonococcal infection in Ukraine is not optimal and needs improvement by using quality-tested bacteriological cultures and point-of-care-tests, implementation of nucleic acid amplification tests, monitoring of gonococcal sensitivity to antibiotics, collection of extragenital biological samples. Adherence to evidence-based international guidelines and adapted national guidelines for the diagnostics of gonorrhoea is an essential factor of the controlling of gonococcal infection.

Muscular metastases (MMs) form an infrequent entity, and their physiopathology is still not well-defined. In this study, we estimated the incidence of MMs that were detected by 18F-fluorodeoxyglucose positron emission tomography/computed tomography and also specified their metabolic characteristics. This study includes 13 patients with MMs from a remotely located primary tumor. The results of this study showed an incidence of MMs at about 1%, with the most frequently involved muscles being iliopsoas and paraspinal. Lung cancer seems to be the most common tumor that causes MMs. Furthermore, these MMs vary in size and physiological uptake; they seem to be out of the ordinary and easily detected. They are often associated with other extra muscular locations and frequently involve the trunk muscles. Their detection in the course of the evolution of a specific neoplasia testifies to their aggressiveness and portends an unfavorable prognosis. The data in our series confirm that in the literature regarding the underlying primary tumors and anatomical sites involved by MMs.

Dynamization of fixation has long been used as a strategy to promote fracture healing. Which clinical scenarios would benefit from dynamization, how and when to introduce it and its effectiveness remains to be elucidated. A systematic review of the literature reporting on the use of dynamization in fracture healing using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis was conducted. The primary outcome was time to union and union rate of fractures across all anatomical sites, including adult and pediatric populations. A total of 19 studies fulfilled the inclusion criteria of which 14 studies evaluated the use of dynamization using intramedullary nails, while five studies evaluated external fixator dynamization. The diversity of dynamization strategies, variation in timing of dynamization and contradictory results precludes definitive conclusions. Further research is needed before recommendations for the use of dynamization to improve fracture healing can be considered.

SummaryAim: to analyze the mechanism, nature of injuries, including localization andconcomitant injuries, in patients with injuries of the large vessels during the Joint Forceoperation (JFO) in eastern Ukraine for the period 2014–2020.Materials and methods. We analyzed 234 cases of gunshot wounds of the largevessels during the JFO in the East of Ukraine in the period from February 2014 toFebruary 2020, who were treated at the Military Medical Clinical Centers of Ukraine atthe stages of medical evacuation.Results and conclusions: 1. The most cases of injuries of large vessels wererecorded in 2014, which is 24.8% of all identified such cases, the least – in 2020, whichis 3.5%. 2. When studying the mechanism of trauma, the greatest number of injuries ofthe large vessels was registered with shrapnel wounds, accounting for 37.6%, and withmine-explosive injury – 25.6%. 3. When studying the frequency of vascular lesions, thegreatest number of injuries of the large vessels was recorded in trauma of the vessels ofthe lower extremities, namely, the femoral-popliteal segment – in 68.4% as well asvessels of the upper extremities – in 27.8%, of which the largest proportion was forartery damage – 47% of the total structure of such injury. 4. 70.5% studied cases areassociated with damage of bones and nerves. In 38.5%, the wounds are multiple andcover wounds of other anatomical sites. 5. The success of the treatment of injuries of thelarge vessels depends on the time factor. The best results were recorded in patients withthe shortest time from injury to specialized medical care.

BACKGROUND: Thrombosis is simply the inappropriate activation of clotting factors that occurs in veins. Venous thromboembolism (VTE) is a common medical problem in hospitalized patients that might progress into serious lethal complications. Provoked VTE is associated with well-known risk factors, while unprovoked VTE remains idiopathic. OBJECTIVES: The aim of this study is to describe the anatomical sites, clinical characteristics, and factors associated with recurrence of the thrombotic event within 5 years. METHODS: This retrospective cross-sectional study was conducted in King Abdulaziz Medical City (KAMC), which included 351 hospitalized patients consecutively. We included all Saudi adults diagnosed with initial VTE in 2006–2017 at KAMC. Patients with incomplete medical charts were excluded. The data collected from electronic charts were analyzed using SAS-9.4. RESULTS: Among the 351 participants, 52% were female and two-thirds (62.4%) exceeded the normal body mass index. Provoked VTE (53.5%) was slightly more prevalent than unprovoked VTE (46.4%), but unprovoked VTE was more frequent in populations with recurrent VTE at 19.1%. The most common VTE sites were the left lower limb (38.5%) followed by right lower limb (20.5%) then bilateral lower limbs (12.2%). Only pulmonary embolisms (

AIMS This study assessed the use of matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry as an alternative method to identify species associated with the thanatomicrobiota and epinecrotic communities. METHODS AND RESULTS The study was conducted on 10 murine cadavers, and microbiological swabs were collected from five external anatomical sites (eyes, ears, nose, mouth and rectum) and four internal organs (brain, spleen, liver, heart), during 16 and 30 days, for the thanatomicrobiota and epinecrotic communities, respectively. Our results revealed that the postmortem microbiota associated with the external cavities showed changes over time and reduced taxonomic diversity. The internal organs, initially sterile, showed signs of microbial invasion at 3 and 10 days postmortem for the liver-spleen and heart-brain, respectively. The postmortem microbiota was mainly dominated by Firmicutes and Proteobacteria. CONCLUSIONS MALDI-TOF is a promising method for estimating postmortem interval (PMI), associated with rapid sample handling, good reproducibility and high productivity. SIGNIFICANCE AND IMPACT OF THE STUDY This study investigated microbial changes during the decomposition process and proposed a simple strategy for PMI estimation. Results introducing the application of the MALDI-TOF method in the field of forensic.

Tissue engineered bone solutions aim to overcome the limitations of autologous and allogeneic grafts. Decellularised tissues are produced by washing cellular components from human or animal tissue to produce an immunologically safe and biocompatible scaffold, capable of integration following implantation. A decellularisation procedure utilising low concentration sodium dodecyl sulphate (0.1% w/v) was applied to trabecular bone from human femoral heads (FH) and tibial plateaus (TP). Biological (histology, DNA quantification), biomechanical (compression testing) and structural (μCT) comparisons were made between decellularised and unprocessed cellular tissue. Total DNA levels of decellularised FH and TP bone were below 50 ng mg-1 dry tissue weight and nuclear material was removed. No differences were found between cellular and decellularised bone, from each anatomical region, for all the biomechanical and structural parameters investigated. Differences were found between cellular FH and TP and between decellularised FH and TP. Decellularised FH had a higher ultimate compressive stress, Young's modulus and 0.2% proof stress than decellularised TP (p = 0.001, 0.002, 0.001, Mann Whitney U test, MWU). The mineral density of cellular and decellularised TP bone was significantly greater than cellular and decellularised FH bone respectively (cellular: p = 0.001, decellularised: p < 0.001, MWU). The bone volume fraction and trabecular thickness of cellular and decellularised FH bone were significantly greater than cellular and decellularised TP bone respectively (cellular: p = 0.001, 0.005; decellularised: p < 0.001

Endometriosis is a common disease with an estimated prevalence between 5 and 15% in women of reproductive age (Giudice and Kao 2004). The most common anatomical sites of endometriosis are pelvic or...

Toxoplasma gondii is a widespread protozoan parasite infecting approximately one third of the world population. After proliferation of tachyzoites during the acute stage, the parasite forms tissue cysts in various anatomical sites and establishes chronic infection. Nowadays the nature of the interplay between the protozoan and its human host remains elusive. This is clearly evident in ocular toxoplasmosis, in which the parasite establishes an ambivalent relationship with the eye, manipulating the immune response and inducing variable initial lesions and further relapses. This review will focus on epidemiology and environmental, parasite and host related risk factors, clinical manifestations and laboratory findings, treatment and prophylaxis approaches in ocular toxoplasmosis. An image collection of patients referred to the Unit of Ophthalmology of Pisa's Hospital will be presented, too.

Studies in recent years have uncovered the crucial function of neuroimmune interactions in maintaining tissue homeostasis and protection. Immune and neuronal cells are often colocalized at defined anatomical sites, forming neuroimmune cell units, where both cell types coordinate their responses. In addition, even when located at distant sites, neuronal cells can receive signals from and provide signals to peripheral immune cells. As such, neuroimmune interactions are found across multiple organs and have recently emerged as important regulators of physiology. In this Review, we focus on the impact of bidirectional neuroimmune interactions in tissue biology, organ physiology and embryonic development. Finally, we explore how this fast-evolving field is redefining the tenets of inter-organ and intergenerational communications. Immune cells and neural cells interact in numerous tissues and organs and can have local and far-reaching physiological effects. Understanding these intimate bidirectional interactions is providing insight into the gut–brain axis, as well as the maternal gut–fetal brain axis.

Background Mohs micrographic surgery (MMS) is often the treatment of choice for skin cancer removal as it maximizes normal tissue sparing and can be paired with a reconstructive approach that optimizes function and cosmesis. Many tumors on the eyelid, nose, ear, and genitals are particularly well suited for MMS but can be challenging for the dermatologic surgeon. Objective To review the complex anatomy, as well as the authors' approach to executing and interpreting Mohs layers, at each of these anatomical sites. Methods A review of the literature on MMS of the eyelid, nose, ear, and genitals was performed using the PubMed database and relevant search terms. Conclusion These sites present potential pitfalls for tumor resection and reconstruction, but with the proper technique, the dermatologic surgeon can minimize tumor recurrence and MMS complications. Warning signs for potentially difficult tumor resection can signify when an interdisciplinary approach is warranted.

Nasal pathogen detection sensitivities can be as low as 70% despite advances in molecular diagnostics. This may be linked to the choice of sampling method. A diagnostic test accuracy review for sensitivity was undertaken to compare sensitivity of swabbing to the nasopharynx and extracting nasal aspirates, using the PRISMA protocol, Cochrane rapid review methodology, and QUADAS-2 risk of bias tools, with meta-analysis of included studies. Sensitivities were calculated by a consensus standard of positivity by either method as the ‘gold standard.’ Insufficient sampling methodology, cross sectional study designs, and studies pooling samples across anatomical sites were excluded. Of 13 subsequently eligible studies, 8 had ‘high’ risk of bias, and 5 had ‘high’ applicability concerns. There were no statistical differences in overall sensitivities between collection methods for eight different viruses, and this did not differ with use of PCR, immunofluorescence, or culture. In one study alone, Influenza H1N1(2009) favored nasopharyngeal swabs, with aspirates having 93.3% of the sensitivity of swabs (p > 0.001). Similarly equivocal sensitivities were noted in reports detecting bacteria. The chain of sampling, from anatomical site to laboratory results, features different potential foci along which sensitivity may be lost. A fair body of evidence exists that use of a different sampling method will not yield more respiratory pathogens.

Background No studies have yet reported the effect of prevention and control measures, which were implemented to combat COVID-19, on the prevention and control of common HAIs. We aimed to examine the effect of the “Normalized Epidemic Prevention and Control Requirements” (implemented in May 2020) by comparison of hospital-acquired infections (HAIs) and community-acquired infections (CAIs) in China during 2018, 2019, and 2020. Methods Data of inpatients before and after implementation of new requirements were retrospectively analyzed, including infection rate, use of alcohol-based hand cleaner, anatomical sites of infections, pathogen species, infection by multi-drug resistant species, and use of different antibiotics. Results The HAI rate was significantly higher in 2020 than in 2018 and 2019 (P P P P P P Conclusions The new prevention and control requirements provided important benefits during the COVID-19 pandemic. However, their effects on HAIs were not obvious.

In clinical practice, intestinal autologous diseases, ailments and organ transplants can cause severe congestive damage to the intestinal tract. However, after the etiological factor is gotten rid of and blood flow is free without any hinderance, further damage to the intestinal wall often occurs, causing other related organ dysfunctions. This ultimately results in intestinal congestion reperfusion injury (ICRI). When the structure and function of the intestine are destroyed, bacteria, metabolites and endotoxins in the intestinal tract perfuse and enter the portal vein through the already compromised intestinal mucosa, to the other organs via the liver. Nevertheless, this gives rise to further aggravation of the injury, and reperfusion injury syndrome occurs. ICRI is a very common complication encountered by clinicians, and its harm is more severe and serious as compared to that caused by ischemic-reperfusion. Quite a a few number of studies on ICRI have been reported to date. The exact mechanism of the injury is still idiopathic, and effective treatment strategies are still limited. Based on recent studies, this article is aimed at reviewing the destruction, damage mechanisms resulting from intestinal congestion reperfusion injury to the intestinal anatomical sites and distant organs. It is geared towards providing new ideas for the prevention and therapeutic approaches of intestinal congestion reperfusion injury.

Currently, various protocols regarding the site of waist circumference (WC) measurement are in place. This study aimed to analyse the effect of the site of WC measurement on visceral adipose tissue (VAT) estimation. WC was obtained at 7 anatomical sites in 211 German volunteers (103 males) aged 23–81 years using three-dimensional photonic body scanning (PBS). At one site, WC was additionally measured by tape. The quantity of VAT was assessed by MRI. Models to estimate VAT based on WC were developed; the precision of the estimation is represented by R2. The influence of the applied method of WC assessment (tape v. PBS) on the estimations is reported. Results show that the amount of estimated VAT and the precision of VAT estimation were dependent on the site of measurement. VAT was estimated most precisely by WC taken at the level of the lowest rib (WCrib: R2 = 0·75 females; 0·79 males), the minimum circumference (WCmin: R2 = 0·75 females; 0·77 males) and at the narrowest part of the torso (WCnar: R2 = 0·76 females; 0·77 males), and least precisely by WC assessed at the top of iliac crest (WCiliac: R2 = 0·61 females; 0·60 males). VAT estimates based on WC obtained by PBS were smaller and estimations were slightly less precise compared to estimates based on tape measures. Our results indicate that the method and the site of waist measurement should be considered when estimating VAT based on WC. The implementation of a standardised protocol using either WCrib, WCmin or WCnar could improve the precision of VAT estimation.

Background. Healthcare-associated infections (HAIs) are a persistent clinical challenge caused primarily by bacteria on the skin. Proper utilization of optimized antiseptic skin preparation solutions helps reduce the prevalence and impact of HAIs by decreasing patient skin microorganisms preoperatively. The purpose of this study was to evaluate the efficacy of two antimicrobial solutions containing iodine and isopropyl alcohol (IPA): Povidone iodine (PVP-I) with IPA (i.e., PVP-I+IPA, PurPrep™) and Iodine Povacrylex+IPA (DuraPrep™). Methods. The antimicrobial activity of the test solutions was evaluated in vitro by determinations of minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) against 1105 diverse microbial isolates and a time-kill assay to evaluate efficacy against 120 strains of Gram-positive and Gram-negative bacteria and yeasts. Peel tests were performed between skin samples treated with test solutions and representative drape/dressing materials to determine effects of test solutions on the biomechanical adhesion properties. Finally, an Institutional Review Board (IRB)-approved, randomized, controlled, single-center, partially blinded in vivo study was performed to assess the immediate and persistent antimicrobial activity of the test solutions on the abdomen and groin. Results. Both PVP-I+IPA and Iodine Povacrylex+IPA solutions demonstrated broad-spectrum antimicrobial activity with MIC and MBC at less than 1% of the full-strength concentration of each product against a wide variety of microorganisms. In the time-kill tests, both solutions were able to successfully reduce all microbial populations by 99.99% (i.e., 4log10) at the contact times of 30 seconds, 2 minutes and 10 minutes. The two solutions showed relatively similar adhesion results when tested with three representative operating room materials. Both PVP-I+IPA and Iodine Povacrylex+IPA met the expected Food and Drug Administration (FDA) efficacy requirements at 10 minutes and 6 hours post-treatment for both anatomical sites (i.e., groin and abdomen) in the clinical study, with no safety issues or adverse events. Conclusions. Analysis of the in vitro antimicrobial activity, biomechanical adhesive strength, and in vivo efficacy of PVP-I+IPA demonstrated similar results compared to Iodine Povacrylex+IPA. Both products were efficacious at reducing or eliminating a wide range of clinically-relevant microorganisms in lab-based and clinical settings, supporting their use as antiseptic skin preparation solutions to reduce bacteria on the skin that can cause infection.

Background: The estimation of fetal epidermal thickness has clinical significance for dermatological investigation and diagnosis of fetal prematurity. Objective: We aimed to collect baseline data of fetal epidermal thickness and secondarily to study the correlation of gestational age (GA) from epidermal thickness. Materials and Methods: Thirty fetuses were selected for the study aged from 11 to 40 weeks. They were divided into six groups at a 4-week interval. The mean epidermal thickness was measured at four sites such as the abdomen, interscapular region, scalp, and palm. The histometric analysis was done with the help of amscope 5MP Aptina MT9P001. Results: The mean age of gestation was 25.67 ± 8.45 weeks. The mean epidermal thickness of the abdominal, interscapular, scalp, and palmar region was 21.9 ± 12.9 µm (3.41–42.48), 111.21 ± 74.39 µm (7.9–214.51), 27.58 ± 13.26 µm (11.7–46.2), and 139.73 ± 96.40 µm (7.3–280.51), respectively. The growth pattern of the epidermis of the different region was significantly variable based on the ANOVA (P = 1.98E-13 P < 0.05 significant) and paired t-test of interregional comparison. Conclusions: The epidermal thickness has a significant positive correlation with GA and anatomical sites. We emphasize that epidermal thickness is a newborn maturity marker at birth.

Background Technologies have been developed to monitor changes in dermal oedema, indicative of the early signs of pressure ulcers. However, there is limited information on the effects of regional differences in tissue morphology on these sub-epidermal moisture (SEM) parameters. This study was designed to investigate the absolute SEM readings across different anatomical sites using a commercial device. Methods Twenty-four healthy participants were recruited to evaluate basal SEM values at different bony prominences, sampled by an experienced operator. Results Distinct differences were observed in unloaded SEM values across different anatomical sites, notably between the upper and lower extremities. A high degree of variability was observed in particular sites, such as the heels. Moreover, SEM values at certain locations revealed significant relationships with age, BMI and gender (p Conclusion The study revealed a high level of variability between and within anatomical sites in a healthy cohort of participants. Determining the changes in local skin and sub-dermal tissue status using SEM may require consideration of both site specific and individual demographic factors, with further research needed in cohorts at risk of pressure ulcers.

IntroductionIt has been hypothesized that gut and oral dysbiosis may contribute to the development of primary Sjögren’s syndrome (pSS). The aim of this systematic review was to assemble available data regarding the oral and gut microbiota in pSS and to compare them to data from healthy individuals and patients with dry symptoms without a diagnosis of Sjögren’s syndrome or lupus disease to identify dysbiosis and discuss the results.MethodologyUsing the PRISMA guidelines, we systematically reviewed studies that compared the oral and gut microbiota of Sjögren’s patients and controls. The PubMed database and Google Scholar were searched.ResultsTwo-hundred and eighty-nine studies were found, and 18 studies were included: 13 referred to the oral microbiota, 4 referred to the gut microbiota, and 1 referred to both anatomical sites. The most frequent controls were healthy volunteers and patients with sicca symptoms. The most common analysis method used was 16S-targeted metagenomics. The results were mostly heterogeneous, and the results regarding diversity were not always in accordance. Dysbiosis in pSS was not confirmed, and reduced salivary secretion seems to explain more microbial changes than the underlying disease.ConclusionThese heterogeneous results might be explained by the lack of a standardized methodology at each step of the process and highlight the need for guidelines. Our review provides evidence that sicca patients seem to be more relevant than healthy subjects as a control group.

Background/aim Ewing sarcomas most commonly arise in the bones, but can also manifest as extraskeletal tumours in soft tissues. Metastases from extraskeletal Ewing sarcomas occur in more diverse anatomical sites than skeletal tumours, and have poorer survival rates. Few animal models replicate the extraskeletal form of Ewing sarcoma, and those that have been developed do not reflect the widespread metastatic spread of these cancers. Materials and methods Luciferase-expressing Ewing sarcoma cells derived from a muscle tumour were intramuscularly or intravenously injected into nude mice. Results Both models achieved metastatic spread to numerous sites including the lungs, liver, kidneys, and brain. We characterized the cellular composition of primary and metastatic tumours, observing a greater level of immune cell infiltration in metastases compared to primary intramuscular tumours. Conclusion These pre-clinical models will hopefully facilitate the evaluation of novel therapies and contribute to better understanding the disease progression of metastatic extraskeletal Ewing sarcoma.

Histopathologic assessment routinely provides rich microscopic information about tissue structure and disease process. However, the sections used are very thin, and essentially capture only 2D representations of a certain tissue sample. Accurate and robust alignment of sequentially cut 2D slices should contribute to more comprehensive assessment accounting for surrounding 3D information. Towards this end, we here propose a two-step diffeomorphic registration approach that aligns differently stained histology slides to each other, starting with an initial affine step followed by estimating a deformation field. It was quantitatively evaluated on ample (n = 481) and diverse data from the automatic non-rigid histological image registration challenge, where it was awarded the second rank. The obtained results demonstrate the ability of the proposed approach to robustly (average robustness = 0.9898) and accurately (average relative target registration error = 0.2%) align differently stained histology slices of various anatomical sites while maintaining reasonable computational efficiency (&lt, 1 min per registration). The method was developed by adapting a general-purpose registration algorithm designed for 3D radiographic scans and achieved consistently accurate results for aligning high-resolution 2D histologic images. Accurate alignment of histologic images can contribute to a better understanding of the spatial arrangement and growth patterns of cells, vessels, matrix, nerves, and immune cell interactions.

We studied COVID-19 associated mucormycosis based on 17 cases reported nationwide and assessed the differences with India. They differed by frequencies of diabetes mellitus (47% in France versus 95% in India), hematological malignancies (35% versus 1%), anatomical sites (53% lung versus >80% rhino-orbito-cerebral) and prognosis (>80% mortality versus

Atopic dermatitis (AD) and psoriasis are highly prevalent, complex, chronic inflammatory skin diseases that immensly affect the patient’s quality of life. While there is no definitive cure for these conditions, suppressive medications aim at managing the symptoms of these diseases. The application of emollients accompanied by symptomatic anti-inflammatory therapy consisting of topical corticosteroids (TCS) is extensively employed for controlling the symptoms among general practitioners making this therapeutic class an indispensable pillar of dermatotherapeutics. The first TCS, hydrocortisone (HC) introduced in the early 1950s led to the development of different steroidal moieties of varying potencies by inducing chemical modifications to the basic steroid structure. The wide spectrum of the available range of formulations and potency provides flexibility to treat all patient groups, different phases of the diseases, and different anatomical sites. Conventional TCS therapy suffers from drawbacks such as low drug permeation and retention rate. Thus, novel nanoformulations have been developed to overcome these problems. This review provides an insight into the current state of nanocarrier-mediated topical delivery of corticosteroids monotherapy and combination therapy with special emphasis on targeting psoriasis and AD., Highlights Psoriasis and atopic dermatitis (AD) are highly prevalent and chronic skin disorders. Topical corticosteroids (TCS) is extensively utilized as a drug of choice for such diseases. Extensive research has been conducted to formulate and evaluate a nanocarrier-based drug delivery system. These TCS nanoformulations in combination therapy involving other therapeutic classes of drugs is also been extensively researched for effective disease management. This manuscript gives an insight into the nanotechnology-based topical formulations of corticosteroids intended for AD and psoriasis therapy.

Background Neisseria gonorrhoeae can be cultured from saliva in men with pharyngeal gonorrhoea and could theoretically be transmitted from the pharynx to the urethra when saliva is used as a lubricant for masturbation. To explore this issue, we developed mathematical models for the transmission of Neisseria gonorrhoeae at each of oropharynx, urethra and anorectum among men who have sex with men (MSM). Methods Model 1 included transmission routes (oral sex, anal sex, rimming, kissing, and three sequential sex practices) we have previously validated. In Model 2, we added masturbation to model 1. In Model 3, we included masturbation but excluded the three sequential sex practices. We calibrated our data to six international studies. We evaluated the model performance using the Root Mean Squared Error (RMSE) and Cohen’s d statistic. Results Model 2 has significantly higher RMSE than model 1 (p-value 0.8) compared with Model 1. This suggests performance of Model 1 and Model 2 are similar. In contrast, Model 3 has significantly higher RMSE than both Model 1 and Model 2 (p-value 0.8 for all six datasets) compared with the two models. This suggests performance of Model 3 is significantly worse than Model 1 and Model 2. Conclusion Our findings indicate that masturbation plays a moderate role in the transmission of Neisseria gonorrhoeae. Our model also suggests that sequential sexual practices may be more important than masturbation for explaining the site-specific prevalence in men with multi-site infection. Our model predicted that about 1 in 4 cases of urethral gonorrhoea might arise from masturbation if it transmits gonorrhoea.

Cannulation of the subclavian vein has many advantages when compared to other anatomical sites for central venous access. Difficulty in its ultrasonic visualisation, and the perceived consequent ‘higher’ complication rate, mean that this approach has fallen out of favour. This barrier, however, may now have disappeared. In this article, we discuss the indications, contraindications and complications associated with subclavian vein cannulation, and present an ultrasound-guided approach to infraclavicular subclavian cannulation.

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated disease with fibroinflammatory lesions that can occur at nearly all anatomical sites. Both the diagnosis and treatment strategy hav...

The purpose of this pilot in vivo study was to investigate corneocyte size and transepidermal water loss (TEWL) in facial cheek and volar forearm skin as a function of consecutive tape stripping. Changes in corneocyte size and transepidermal water loss (TEWL) were measured as a function of stratum corneum (SC) depth at both anatomical sites. To our knowledge, this is the first published quantitative comparison based on these parameters. This work complements our previously published studies on face skin barrier recovery at 24 h and 4 weeks post-tape stripping [Gorcea et al., Skin Res. Technol., 19, 2013, e375-e382; Gorcea et al., Int. J. Cosmet. Sci. 35, 2013, 250].Transepidermal water loss in vivo measurements of forearm and facial skin sites were taken before tape stripping commenced (baseline) and after each tape was collected. Optical microscopy and image analysis techniques were employed to characterize corneocyte size as a function of skin depth (tape strip number) for both anatomical sites.Transepidermal water loss increased significantly from baseline with sequential tape stripping at both anatomical skin sites. Volar forearm skin required approximately three times as many tapes to 'damage' the SC barrier (arbitrarily defined as twice baseline TEWL) compared to facial cheek skin demonstrating significant differences in barrier properties between cheeks and forearms (P 0.05). Corneocyte size decreased significantly with depth for both sites (P 0.001). Corneocytes from face skin were significantly smaller than corneocytes from volar forearm skin.Statistically significant differences between facial and body skin stratum corneum cell morphology and transepidermal water loss were demonstrated and quantitatively measured as a function of tape stripping.L’objectif de cette étude pilote in vivo était d’étudier la taille des cornéocytes et la perte d’eau transépidermique (TEWL) dans la peau des joues et des avant-bras comme en fonction de l’épilation par bandelettes. Les modifications de la taille des cornéocytes et de la perte d’eau transépidermique (TEWL) ont été mesurées en fonction de la profondeur du stratum corneum (SC) au niveau des deux sites anatomiques. À notre connaissance, il s’agit de la première comparaison quantitative publiée sur la base de ces paramètres. Ce travail complète nos études publiées antérieurement sur la récupération de la barrière cutanée du visage 24 h et 4 semaines après l’application des bandelettes. [Gorcea et al., Skin Res. Technol., 19, 2013, e375-e382; Gorcea et al., Int. J. Cosmet. Sci. 35, 2013, 250]. MÉTHODES: Les mesures de la perte d’eau transépidermique in vivo au niveau des sites cutanés des avant-bras et du visage ont été effectuées avant le début du retrait des bandelettes (référence) et après le prélèvement de chaque bandelette. Des techniques de microscopie optique et d’analyse d’images ont été utilisées pour caractériser la taille des cornéocytes en fonction de la profondeur de la peau (numéro de bandelette) pour les deux sites anatomiques. RÉSULTATS: La perte d’eau transépidermique a augmenté de façon significative par rapport à la référence lors du retrait séquentiel des bandelettes au niveau des deux sites anatomiques de la peau. La peau de l’avant-bras a nécessité environ trois fois plus de bandelettes pour « endommager » la barrière du SC (définie arbitrairement comme deux fois la TEWL de base) que la peau des joues du visage, ce qui démontre des différences significatives dans les propriétés barrières entre les joues et les avant-bras (P 0,05). La taille des cornéocytes a diminué de façon significative avec la profondeur pour les deux sites (P 0,001). Les cornéocytes de la peau du visage étaient significativement plus petits que les cornéocytes de la peau de l’avant-bras.Des différences statistiquement significatives de morphologie et de perte d’eau transépidermique entre les cellules du stratum corneum de la peau du visage et celles du corps ont été démontrées et mesurées quantitativement en fonction du retrait des bandelettes.

ObjectivesPharyngeal gonorrhoea disproportionately affects men who have sex with men (MSM). We explored temporal trends in pharyngeal gonorrhoea positivity among MSM compared with anorectal and urogenital positivity.MethodsData (2011–2015) were extracted from 41 publicly funded sexual health clinics participating in a national surveillance network. Positivity was defined as the proportion of first-visit testing occasions where gonorrhoea was detected. Logistic regression explored trends in positivity and correlates of positive pharyngeal tests.ResultsFrom 2011 to 2015, 24 792 MSM tested (16 710 pharyngeal, 19 810 urogenital and 15 974 anorectal first-visit tests). Pharyngeal positivity increased by 183% from 139/3509 (4.0%) in 2011 to 397/3509 (11.3%) in 2015, p-trend ConclusionTemporal increases in gonorrhoea positivity occurred at all anatomical sites, with the greatest increase in the pharynx. Risk factors could be used to help to develop testing and prevention strategies among MSM at highest risk. Strengthening sexual health service delivery, testing and surveillance remain priorities for pharyngeal gonorrhoea control.

Patients who are stationary endure prolonged pressures and shear loads at contact areas between their body and the support surface, which over time may cause pressure ulcers (PUs). Donut-shaped gel head supports are commonly used to protect the occiput, which is among the most common anatomical sites for PUs; however, the biomechanical efficacy of these devices is unclear. To investigate their effects on scalp tissues, we have used our three-dimensional anatomically realistic finite element model of an adult head, to which we have added a donut-shaped gel head support. We then compared the occipital scalp tissue loads' occurrence while the donut-shaped gel head support is in use with those associated with a fluidised head positioner and a standard medical foam. The donut-shaped gel head support inflicted the greatest exposure to tissue mechanical stresses, particularly to the high (and therefore dangerous) stress domain, when compared to the other positioners. We concluded that while the donut-shaped gel head support is designed to avert tissue loads away from the occiput and disperse them to the surroundings, in practice, it fails to do so. In fact, the donut-shaped gel head support imposes the head-weight forces to transfer through a relatively narrow ring of scalp tissues, hence increasing the risk of developing occipital PUs. KEY MESSAGES: a donut-shaped gel head support is meant to reduce the occurrence of pressure ulcers in scalp tissues to investigate the effects of donut-shaped gel head support on scalp tissues, we have used our anatomically realistic computational model of an adult head the donut-shaped gel head support imposes the head-weight forces to transfer through a relatively narrow ring of scalp tissues the highly distorted and deformed tissues at that ring are at a high risk for injury.

The results of studies on the rational use of various anatomical sites of the rabbit carcass are presented. The current state of rabbit breeding on a global scale is considered. The data on the composition of tissues of various anatomical sites of rabbit carcasses are presented. It is proved that the meat of various parts of rabbit carcasses corresponds to the formula of a balanced diet in terms of amino acids, including essential ones. Recommendations on the allocation of cuts, as well as their use for the production of healthy foods. The improved schemes of cutting rabbit carcasses for the preparation of second courses, various types of baked, smoked and boiled and smoked products are presented. The technologies of production of hams rabbit " Holiday "of the hip and shoulder cuts, medallions of the longest back muscles, cutlets" Voronezh " of the hip, as well as smoked ribs and ribs in sauce for the second course. presented of the formulation emulsified and minced meat products mechanically separated meat. Indicators of quality of finished products, their amino acid composition, digestibility are defined. It is proved that the rational and purposeful use of different parts of rabbit carcasses in deep cutting allows to satisfy the needs of customers of all social strata. The absence of products from rabbit meat of deep cutting with a wide range of such products from pork and beef is shown in Russia. Noted that meat of different anatomic sites of the carcasses of rabbits covers more than 50% of the daily norm of consumption of animal protein, which can be attributed to the products of rabbit meat products of functional purpose without adding additional raw material sources.

OBJECTIVE To determine the lesion distribution patterns in different breeds of dogs affected by atopic dermatitis in South Australia. METHODS The presence or absence of erythematous skin lesions in 267 cases of canine atopic dermatitis (CAD) was recorded across 36 anatomical sites. Breeds represented by ≥ 9 dogs were included in the analysis. The percentage of dogs showing lesions at each of the body sites was calculated and illustrated on colour-coded diagrams. Variations in affected body sites within and between breeds were compared using Kruskal-Wallis ANOVA and Dunn's multiple comparison tests. RESULTS The prevalence of skin lesions at different body sites differed significantly both in the population as a whole and within breeds. The sites affected in ≥ 75% dogs were the dorsal and ventral aspects of the front and hind paws. The sites affected in 50-74% were the medial pinnae, axillae, ventral chest, abdomen and perineum. Sites affected in 25-49% of dogs included the face, periocular region and forelimb. Remaining body sites were affected in < 25% of dogs. Analysis at the breed level revealed some differences from this standard distribution pattern. CONCLUSION The results of this study confirmed the typical lesion distributions seen in CAD and highlighted some subtle differences in breeds commonly seen in South Australia. This will be useful for clinical practitioners in prioritising differential diagnoses for pruritic skin conditions.

Idiopathic ventricular arrhythmias occur in the absence of underlying structural heart disease and less commonly in the presence of coexistent, but mechanistically unrelated, myocardial scar. These arrhythmias originate from several anatomical sites in both ventricles, with a predilection in outflow tract structures. The 12-lead surface ECG is the initial mapping tool, which is widely used to identify their origin. Specific features can predict the site of idiopathic ventricular arrhythmias, thus differentiating right from left ventricular, as well as endocardial from epicardial origins. In this review, we aim to analyse electrocardiographic landmarks for determination of idiopathic ventricular arrhythmia sources, with specific emphasis on pertinent caveats and anatomical relationships.

BACKGROUND Increased gonorrhea detection highlights the need for additional prevention efforts. Gonorrhea may only be acquired when there is contact between infected and uninfected anatomical sites. With 3 sites of infection, this leads to 7 plausible routes of men who have sex with men (MSM) transmission: urethra-to-rectum, rectum-to-urethra, urethra-to-oropharynx, rectum-to-oropharynx, oropharynx-to-urethra, oropharynx-to-rectum, and oropharynx-to-oropharynx. We characterize the uncertainty and potential importance of transmission from each anatomical site using a deterministic compartmental mathematical model. METHODS We developed a model of site-specific gonococcal infection, where individuals are infected at 0, 1, 2, or all 3 sites. Sexual behavior and infection duration parameters were fixed similar to a recent model analysis of Australian MSM. Markov chain Monte Carlo methods were used to sample the posterior distribution of transmission probabilities that were consistent with site-specific prevalence in American MSM populations under specific scenarios. Scenarios were defined by whether transmission routes may or may not transmit by constraining specific transmission probabilities to zero rather than fitting them. RESULTS Transmission contributions from each site have greater uncertainty when more routes may transmit; in the most extreme case, when all routes may transmit, the oropharynx can contribute 0% to 100% of all transmissions. In contrast, when only anal or oral sex may transmit, transmission from the oropharynx can account for only 0% to 25% of transmission. Intervention effectiveness against transmission from each site also has greater uncertainty when more routes may transmit. CONCLUSIONS Even under ideal conditions (ie, when site-specific gonococcal prevalence, relative rates of specific sex acts, and duration of infection at each anatomical site are known and do not vary), the relative importance of different anatomical sites for gonococcal infection transmission cannot be inferred with precision. Additional data informing per act transmissibility are needed to understand site-specific gonococcal infection transmission. This understanding is essential for predicting population-specific intervention effectiveness.

Background Facial skin exhibits unique biophysical properties, which are influenced by anatomical regions and genders. The aim of this study was to comprehensively assess the regional and gender differences in facial skin biophysical parameters among Chinese population. Materials and methods The 12 skin biophysical parameters at four distinct facial skin sites (forehead, cheek, canthus and chin) were measured in a normal population (n = 212) with 42 males and 141 females aged 18-29 years living in Beijing. These parameters consisted of skin hydration, transepidermal water loss, sebum content, erythema/melanin indices, L*a*b* color, skin gloss and elasticity, all quantifying with non-invasive instruments. Results The results demonstrated that the characteristics of the facial skin were significantly different between the regions and genders. The forehead had weaker skin barrier function but secreted the most sebum content, while the cheek was the driest and brightest region on the face. The canthus was the most hydrated area and the chin displayed higher sebum secretion, darker skin color and less elastic. The females showed more hydrated, less oil, lighter and more elastic facial skin compared with males. Conclusion This study indicates that the young Chinese facial skin significantly varies with face anatomical regions and differs between genders.

The precise anatomy of the facial nerve branches innervating rat whisker pad and the distribution of their corresponding motor neurons in facial nucleus area were investigated. The extratemporal facial nerves of 6 rats were anatomically observed under a surgical microscope, and then the nerve specimens of facial nerve branches at 7 anatomical sites were taken and examined for the axons and myelin sheath using Luxol fast blue staining. The distribution of facial motor neurons innervating the facial branches was observed in 12 rats by retrograde labelling. The distal pes, a fusing architecture of the buccal and marginal mandibular branches, was found to furcate into superior, middle and inferior branches to innervate whisker pad. Histologically, the myelin sheath of each branch was morphologically consistent, and the nerve fiber bundles of facial nerve branches became increasingly thinner and scattered, particularly after crossing the distal pes site and innervating the whisker pad. The facial motor neurons innervating the buccal and marginal mandibular branches were clearly distributed in similar regions in facial nucleus. This study confirmed the highly spatial synergy between the buccal and marginal mandibular branches innervating the whisker pad from extratemporal anatomy and distribution of facial motor neurons.

Purpose: This study aimed to analyze the clinical characteristic of different foreign body injuries in children and offer the preventions. Methods: A retrospective study and the demographic information, injury causes, foreign body injury types and other clinical factors were recorded and analyzed. Results: Of the 2999 patients, 1877 (62.6%) were boys and 1122 (37.4%) were girls. The majority (72.8%, n= 2184) of the injuries were found in 1-3 years old children. The most common anatomical site was the respiratory tract (73.4%, n = 2201) followed by the digestive tract (18.6%, n = 558), the genitourinary tract (1.93%, n = 58) and other sites (6.07%, n = 182). There were 60.4% of the in-patients from rural areas and 53.2% of the patients without medical insurance, the rate of cost by medical insurance increased with age. The medians of length of hospital stay and hospitalization cost were four days and 4767.3 CNY respectively. Most of the patients had surgical treatment (90.6%, n = 2717) and 64.9% of them had the complications (n = 1946). The cure rates of the all foreign body injuries types were above 90%, especially in genitourinary tract (98.3%). Conclusion: Different types of the foreign body injuries had dissimilar clinical characteristics. The effective prevention and control measures should be taken according to the variety of high-risk population, incidence season and foreign body injury types. Key words: Children; Clinical characteristics; Different types; Foreign body injury

Tumor heterogeneity complicates biomarker development and fosters drug resistance in solid malignancies. In lymphoma, our knowledge of site-to-site heterogeneity and its clinical implications is still limited. Here, we profiled 2 nodal, synchronously acquired tumor samples from 10 patients with follicular lymphoma (FL) using single-cell RNA, B-cell receptor (BCR) and T-cell receptor sequencing, and flow cytometry. By following the rapidly mutating tumor immunoglobulin genes, we discovered that BCR subclones were shared between the 2 tumor sites in some patients, but in many patients, the disease had evolved separately with limited tumor cell migration between the sites. Patients exhibiting divergent BCR evolution also exhibited divergent tumor gene-expression and cell-surface protein profiles. While the overall composition of the tumor microenvironment did not differ significantly between sites, we did detect a specific correlation between site-to-site tumor heterogeneity and T follicular helper (Tfh) cell abundance. We further observed enrichment of particular ligand-receptor pairs between tumor and Tfh cells, including CD40 and CD40LG, and a significant correlation between tumor CD40 expression and Tfh proliferation. Our study may explain discordant responses to systemic therapies, underscores the difficulty of capturing a patient’s disease with a single biopsy, and furthers our understanding of tumor-immune networks in FL.

Perianal screening can be intrusive. The sensitivities of multianatomical, nonperianal surveillance were 92.3% for methicillin-resistant Staphylococcus aureus (MRSA), 58.7% for vancomycin-resistant enterococci (VRE), and 54.9% for resistant Gram-negative bacilli (R-GNB). Sensitivities improved upon adding environmental surveillance (95.5%, 82.9%, and 67.9%, respectively). Multianatomical, nonperianal screening and room environment surveillance may replace perianal screening and reduce healthy participant bias in nursing homes.

Among sexually active women, bacterial vaginosis is a common cause of vaginal infection and irregular vaginal discharge.From January to December 2018, the research was carried out in the department of Obstetrics and Gynecology at Vinayaka Missions Medical College and Hospital in Karaikal, Puducherry. The Main objective of this study is to determine the prevalence and the association of risk factors for bacterial vaginosis. All patients who came to the gynaecology OPD with vaginal discharge were tested for bacterial vaginosis.The features of women with bacterial vaginosis and those who do not are compared. Out of 5130 patients who attended the gynaecological OPD, 1534 came with complaints of vaginal discharge and 422 among them were positive for bacterial vaginosis by Amsel's criteria. 1112 women didn’t have. Among symptomatic patients with irregular vaginal discharge, the average prevalence of bacterial vaginosis was 27.5% Bacterial vaginosis is more common in women aged 30-40, who are illiterate, and who work as farmers. Contraceptive users on anatomical sites (IUCD and Barrier method) were more likely to contract bacterial vaginosis than those who did not. The higher prevalence of bacterial vaginosis indicates that periodic screening and prompt intervention to prevent adverse outcomes should be done. All women with irregular vaginal discharge should have their vaginal discharge checked for bacterial vaginosis on a regular basis to avoid long-term complications.

BackgroundThe spectrum of sexual practices that transmit Neisseria gonorrhoeae in men who have sex with men (MSM) is controversial. No studies have modelled potential Neisseria gonorrhoeae transmission when one sexual practice follows another in the same sexual encounter (‘sequential sexual practices’). Our aim was to test what sequential practices were necessary to replicate the high proportion of MSM who have more than one anatomical site infected with gonorrhoea (‘multisite infection’).MethodsTo test our aim, we developed eight compartmental models. We first used a baseline model (model 1) that included no sequential sexual practices. We then added three possible sequential transmission routes to model 1: (1) oral sex followed by anal sex (or vice versa) (model 2); (2) using saliva as a lubricant for penile–anal sex (model 3) and (3) oral sex followed by oral–anal sex (rimming) or vice versa (model 4). The next four models (models 5–8) used combinations of the three transmission routes.ResultsThe baseline model could only replicate infection at the single anatomical site and underestimated multisite infection. When we added the three transmission routes to the baseline model, oral sex, followed by anal sex or vice versa, could replicate the prevalence of multisite infection. The other two transmission routes alone or together could not replicate multisite infection without the inclusion of oral sex followed by anal sex or vice versa.ConclusionsOur gonorrhoea model suggests sexual practices that involve oral followed by anal sex (or vice versa) may be important for explaining the high proportion of multisite infection.

The aim of this work is to summarize and evaluate the current status of knowledge on flattening filter free (FFF) beams and their applications in stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). A PubMed search was undertaken in order to identify relevant publications using FFF and stereotactic radiotherapy as keywords. On a clinical aspect, lung tumors treated with FFF SBRT show promising results in terms of local control and overall survival with acute toxicities consistent with those that occur with standard radiotherapy. Beside lung, SBRT is suitable for different anatomical sites such as liver, prostate, cervix, etc. offering similar results: reduced treatment time, good tumor control and mild acute toxicities. Regarding brain tumors, the employment of SRS with FFF beams significantly reduces treatment time and provides notable normal tissue sparing due to the sharp dose fall-off outside the tumor. Refereed/Peer-reviewed

Background: Detection rates of [68Ga]Ga-PSMA-11 PET/CT on the restaging of prostate cancer (PCa) patients presenting with biochemical recurrence (BCR) have been well documented, but its performance and impact on patient management have not been evaluated as extensively. Methods: Retrospective analysis of PCa patients presenting with BCR and referred for [68Ga]Ga-PSMA-11 PET/CT. Pathological foci were classified according to six anatomical sites and evaluated with a three-point scale according to the uptake intensity. The impact of [68Ga]Ga-PSMA-11 PET/CT was defined as any change in management that was triggered by [68Ga]Ga-PSMA-11 PET/CT. The existence of a PCa lesion was established according to a composite standard of truth based on all clinical data available collected during the follow-up period. Results: We included 294 patients. The detection rate was 69%. Per-patient sensitivity and specificity were both 70%. Patient disease management was changed in 68% of patients, and [68Ga]Ga-PSMA-11 PET/CT impacted this change in 86% of patients. The treatment carried out on patient was considered effective in 89% of patients when guided by [68Ga]Ga-PSMA-11 PET/CT versus 61% of patients when not guided by [68Ga]Ga-PSMA-11 PET/CT (p &lt, 0.001). Conclusions: [68Ga]Ga-PSMA-11 PET/CT demonstrated high performance in locating PCa recurrence sites and impacted therapeutic management in nearly two out of three patients.

Rapid advances in synthetic biology are driving the development of genetically engineered microbes as therapeutic agents for a multitude of human diseases, including cancer. In particular, the immunosuppressive microenvironment of solid tumors creates a favorable niche for systemically administered bacteria to engraft in the tumor and release therapeutic payloads. However, such payloads can be harmful if released in healthy tissues where the bacteria also engraft in smaller numbers. To address this limitation, we engineer therapeutic bacteria to be controlled by focused ultrasound, a form of energy that can be applied noninvasively to specific anatomical sites such as solid tumors. This control is provided by a temperature-actuated genetic state switch that produces lasting therapeutic output in response to briefly applied focused ultrasound hyperthermia. Using a combination of rational design and high-throughput screening we optimized the switching circuits of engineered cells and connected their activity to the release of immune checkpoint inhibitors. In a clinically relevant cancer model, ultrasound-activated therapeutic microbes successfully turned on in situ and induced a marked suppression of tumor growth. This technology provides a critical tool for the spatiotemporal targeting of potent bacterial therapeutics in a variety of biological and clinical scenarios.

Purpose/Objective(s) Patients treated with proton beam therapy (PBT) undergo routine quality assurance CT (QACT) scans during their course of treatment, which determines whether the initial plan remains accurate for the whole course of treatment or needs to be re-planned based on the findings on their QACTs. The objective of this study is to optimize and reduce the QACT frequency, while maintaining the treatment quality. The benefits of reducing QACT frequency include reducing imaging dose and optimizing use of patient time and staff resources. Materials/Methods We performed a retrospective IRB-approved single-institution review of all patients of three anatomical sites (e.g., Brain, Prostate and Head and Neck [HN]), who were treated with PBT between July 2019 and July 2020. The number of patients treated for these three sites, number of QACTs performed, number of patients re-planned and number of re-plans are listed in the table. For each anatomic site, the QACT and re-planning pattern were analyzed to find the optimal frequency of QACTs needed. Results Brain: Out of 204 QACTs, 6 (2.9 %) were used for adaptive planning. One patient was re-planned twice. It was found that 3 out of 5 patients were re-planned due to weight loss or anatomical changes. All revision plans were delivered within 7-12 fractions of the treatment. One QACT per patient at the beginning of the second week of the treatment was proposed for the brain patients. Prostate: Out of 236 QACTs, 3 (3.6 %) were used for adaptive planning. All three revision plans were delivered within 17-29 fractions of their treatments. Hence, one QACT per patient during the middle of the treatment course was proposed for this group. HN: Out of 97 patients, 32 (33 %) underwent adaptive planning on their QACTs. A total of 37 revision plans were made on 437 QACTs, where 8.5% QACTs were used for adaptive planning. Out of 32 patients re-planned, 26 of them were due to either weight loss or anatomy change and/or tumor shrinkage, 4 patients were due to need for a new mask and the remainder due to air density changes within sinuses. The average time between a QACT and the revision plan delivery was five days. Bi-weekly QACTs were proposed for the HN patients. We found no adaptive planning occurred in the last week of treatment. Conclusion The above newly proposed quality assurance CT (QACT) patterns for these three anatomical sites are the optimal patterns, while maintaining the treatment quality. Following this analysis, we have adopted a new paradigm with decreased routine QACTs in these disease sites. To mitigate any risks due to the proposed QACT patterns, increasing the cone beam CT (CBCT) frequency during treatment is recommended.

OBJECTIVE: To assess the number of new cases of Extrapulmonary tuberculosis, by characterizing patients based on anatomical site. METHODS: This is a retrospective, descriptive study of diagnosed patients of EPTB of all age groups and was conducted in the MGM medical college and hospital, Aurangabad, a tertiary care hospital. Data for this study was obtained from JAN 2018 to DEC 2020. RESULTS: This study showed that out of all EPTB cases, the incidence of Lymph node T.B is higher followed by Pleural T.B. The incidence of EPTB is higher in younger population. CONCLUSION: Our study points out the population which is at higher risk of EPTB. Since diagnosing EPTB is difcult as the samples taken from the affected organs are paucibacillary giving rise to higher chance of misdiagnosing such patients. Astrong clinical suspicion plays a crucial role in the early diagnosis and treatment of such patients.