UNASSIGNED: Low motivation and suboptimal cognitive skills are common among forensic psychiatric patients. By focusing on doing and experiencing, innovative technologies could offer an alternative to existing treatment for this patient group. One promising technology is DEEP, a VR biofeedback game that teaches diaphragmatic breathing, which has shown its potential in reducing stress in other populations. This exploratory study aimed at identifying if, how and for whom DEEP can be of added value in forensic mental healthcare.
UNASSIGNED: This study used a qualitative approach. Six focus groups with 24 healthcare providers and 13 semi-structured interviews with forensic psychiatric inpatients were conducted in two Dutch forensic mental healthcare organizations. All healthcare providers and patients experienced DEEP before participating. The data were coded inductively, using the method of constant comparison.
UNASSIGNED: The data revealed six themes with accompanying (sub)codes, including (1) the possible advantages and (2) disadvantages of DEEP, (3) patient characteristics that could make DEEP more or (4) less suitable and beneficial, (5) ways DEEP could be used in current treatment, and (6) conditions that need to be met to successfully implement DEEP in forensic mental healthcare. The results showed that DEEP can offer novel ways to support forensic psychiatric patients in coping with negative emotions by practicing diaphragmatic breathing. Its appealing design might be suitable to motivate a broad range of forensic psychiatric patient groups. However, DEEP cannot be personalized, which might decrease engagement and uptake of DEEP long-term. Regarding its place in current care, DEEP could be structurally integrated in existing treatment programs or used ad hoc when the need arises. Finally, this study showed that both healthcare providers and patients would need practical support and information to use DEEP.
UNASSIGNED: With its experience-based and gamified design, DEEP could be useful for forensic mental healthcare. It is recommended that patients and healthcare providers are included in the evaluation and implementation from the start. Besides, a multilevel approach should be used for formulating implementation strategies. If implemented well, DEEP can offer new ways to provide forensic psychiatric patients with coping strategies to better control their anger.

Endoscopic procedures are routinely applied to cancer screening programs and surveillance. The preferred technique is usually deep sedation with propofol being a convenient agent allowing for a quicker patient recovery while maintaining a similar safety profile compared to traditional agents. However, adverse events, including respiratory depression and consequent undesirable cardiovascular side effects, may occur. The goal of this work is to evaluate the patient safety impact of adding capnography during endoscopic procedures under deep propofol sedation. Data were retrospectively collected from patients undergoing deep, procedural sedation for gastrointestinal (GI) endoscopy in October 2019 to January 2021 in a single Turkish university hospital. Included in the analysis were all adult patients classified by the American Society of Anesthesiologists (ASA) as I-IV, who were scheduled for GI endoscopy utilizing propofol alone or in combination. Data on 1840 patients were collected, of whom 1610 (730 pre- and 880 post-capnography implemention) met inclusion criteria. The primary outcome was a change in the composite incidence of mild oxygen desaturation (SpO2 75-90% for <60 s), severe oxygen desaturation (SpO2 < 75% anytime or <90% for >60 s), bradycardia (<60 ppm), and tachycardia (>25% from baseline). Without capnography, on average, 7.5 events of the primary endpoint were observed per 100 procedures and 2.9 with additional capnography monitoring (p < 0.001). A significant reduction was observed for mild oxygen desaturation, with a resulting odds ratio of 0.25 (95% CI 0.14 to 0.46). ASA I patients had the highest difference in combined incidence of any oxygen desaturation of 5.85% in the pre-capnography group and 0.64% in the post-capnography group. Although procedural sedation using propofol is not associated with severe adverse events, the incidence of composite adverse events could be reduced with the addition of capnography monitoring.

Progressive organ-level disorders in the human body are often correlated with diseases in other body parts. For instance, liver diseases can be linked with heart issues, while cancers can be linked with brain diseases (or psychological conditions). Defining such correlations is a complex task, and existing deep learning models that perform this task either showcase lower accuracy or are non-comprehensive when applied to real-time scenarios. To overcome these issues, this text proposes design of an augmented bioinspired deep learning-based multidomain body parameter analysis via heterogeneous correlative body organ analysis. The proposed model initially collects temporal and spatial data scans for different body parts and uses a multidomain feature extraction engine to convert these scans into vector sets. These vectors are processed by a Bacterial Foraging Optimizer (BFO), which assists in identification of highly variant feature sets, which are individually classified into different disease categories. A fusion of Inception Net, XCeption Net, and GoogLeNet Models is used to perform these classifications. The classified categories are linked with other disease types via temporal analysis of blood reports. The temporal analysis engine uses Modified Analytical Hierarchical Processing (MAHP) Model for calculating inter-organ disease dependency probabilities. Based on these probabilities, the model is able to generate a patient-level correlation map, which can be used by clinical experts to suggest remedial treatments, due to which the model was able to identify correlations between brain disorders and kidneys, heart diseases and lungs, heart diseases and liver, brain diseases and different types of cancers with high efficiency when evaluated under clinical scenarios. When validated on MITBIH, DEAP, CT Kidney, RIDER, and PLCO data samples, it was observed that the proposed model was capable of improving accuracy of correlation by 8.5%, while improving precision and recall by 3.2% when compared with existing correlation models under similar clinical scenarios.

A 39-year-old male presented with deep venous thrombosis in the right lower limb. He had been experiencing increasing abdominal girth over several years, but this went undetected at the initial examination. Eighteen months later, a computed tomography was conducted, showing a huge retroperitoneal cyst (25 × 23 × 16 cm) lifting the right external iliac vessels. Complete surgical excision of the cyst was performed. The cyst was unilocular and contained 5 l of clear fluid. Histopathology examination found a thin cyst wall consisting of fibrous stromal tissue with a single-layer epithelium lining. Immunohistochemical staining revealed positivity for endothelial cell markers, CD31 and CD34, but negativity for the lymphatic marker podoplanin (D2-40), corresponding to a vascular origin, likely a venous malformation.

UNASSIGNED: To evaluate the safety and efficacy of a novel wireless localization technique that uses radiofrequency identification markers for small and deep lung lesions.
UNASSIGNED: Preliminary use of the device was retrospectively evaluated in 2 Japanese centers. Under general anesthesia, a marker was placed as close as possible to the tumor via computed tomography-guided bronchoscopy in a hybrid operation theater. Surgeons located the marker without lung palpation using a detection probe the tone of which changed to indicate the marker-probe distance. Efficacy was defined as functional marker placement (bronchoscopy time and marker position) and deep margin distance.
UNASSIGNED: Twelve markers were placed for 11 lesions (mean size, 6.8 ± 2.7 mm) located at a mean depth from the pleura of 11.4 ± 8.4 mm (range = 0-26.0 mm). Of 12 markers, 7 markers (58.3%) were placed within 10 mm from the lesion in 25.5 ± 14.4 minutes. For the 11 wedge resections, markers were placed at a mean distance of 6.7 mm (range, 0-13.0 mm) from the lesion and a mean distance of 14.4 mm (range, 3.0-42.0 mm) from the pleura. All markers were recovered without complications, and all tumors were resected with negative margins. For 5 lesions >10 mm deep to the pleura (mean depth, 18.9 ± 5.5 mm; range, 11.0-26.0 mm), the median depth of the surgical margin was 11.6 ± 2.1 mm (range, 9.0-14.0 mm).
UNASSIGNED: Radiofrequency identification marking was safe and precisely localized small lung lesions, including their depth.

Background: Early adversities negatively impact children\'s growth and development, putatively mediated by chronic physiological stress resulting from these adverse experiences. We aimed to estimate the associations between prospectively measured cumulative early adversities with growth and cognition outcomes in rural Indian preschool children and to explore if hair cortisol concentration (HCC), a measure of chronic physiological stress, mediated the above association. Methods: Participants were recruited from the SPRING cRCT in rural Haryana, India. Adversities experienced through pregnancy and the first year of life were measured in 1304 children at 12-months. HCC was measured at 12-months in 845 of them. Outcome measures were height-for-age-z-score (HAZ), weight-for-age-z-score (WAZ) and cognition, measured in 1124 children followed up at 3-years. Cognition was measured using a validated tablet-based gamified tool named DEEP. Results: Cumulative adversities at 12-months were inversely associated with all outcomes measures at 3-years. Each unit increase in adversity score led to a decrease of 0·08 units [95% confidence interval (CI):-0·11,-0·06] in DEEP-z-score; 0·12 units [-0·14,-0·09] in HAZ and 0·11 units [-0·13,-0·09] in WAZ. 12-month HCC was inversely associated with DEEP-z-score (-0·09 [-0·16,-0·01]) and HAZ (-0·12 [-0·20,-0·04]), but the association with WAZ was not significant (p = 0·142). HCC marginally mediated the association between cumulative adversities and HAZ (proportion mediated = 0·06, p = 0·014). No evidence of mediation was found for the cognition outcome. Conclusions: Cumulative early adversities and HCC measured at 12-months have persistent negative effects on child growth and cognition at 3-years. The association between adversities and these two child outcomes were differentially mediated by HCC, with no evidence of mediation observed for the cognitive outcome. Future studies should focus on other stress biomarkers, and alternate pathways such as the immune, inflammation and cellular ageing pathways, to unpack key mechanisms underlying the established relationship between early adversities and poor child outcomes.

Background  The ideal skin substitute should be more similar to normal skin function while causing fewer reactions. The purpose of this study was to assess the effect of radiotherapy on minimizing acute rejection and enhancing wound healing in children with deep burns. Patients and Methods  A prospective randomized control study included 34 children admitted to the burn unit with deep burns under the age of 12 years. Through the tomotherapy device, a skin homograft from a related living donor was exposed to a local dose of radiotherapy of 500 centigray (cGy). It was immediately used for coverage of the prepared bed after the irradiation was completed. Results  The mean values of the laboratory parameters (ESR, CRP, IL-6, and TNF) for all burn patients in the study showed a significant difference, with p  < 0.001. The mean ± standard deviation (SD) of the time from homograft coverage to the appearance of rejection was 9.62 ± 1.45 in group 1 and 14.35 ± 2.8 in group 2, with p  < 0.001 (highly significant difference), indicating that exposure to radiotherapy can reduce graft rejection. Conclusions  The exposure of skin homografts from related living donors to a local low dose of radiotherapy can reduce a graft\'s ability to initiate inflammatory and immunological reactions, thereby minimizing rejection of a graft and enhancing epithelialization in children with deep second- and third-degree burns.

OBJECTIVE: To establish the relationship between hematoma sites of involvement and hematoma expansion (HE) in patients with deep intracerebral hemorrhage (ICH).
METHODS: Eligible patients with deep ICH admitted to hospital within 6 hours of onset between 2018 and 2020 were included in this retrospective multi-center study. Individuals with secondary ICH were excluded. The volume of HE was evaluated based on admission and follow-up computed tomography scans. Associations between deep ICH sites of involvement and HE were examined using multivariable logistic regression analysis while adjusting for confounding covariates of HE.
RESULTS: We enrolled 583 individuals from three stroke centers. Data from a final total of 460 patients were used in the analysis; of these patients, 159 (34.6%) had HE. In the crude model without adjustment, external capsule, anterior limb of the internal capsule, and posterior limb of the internal capsule (PLIC) involvement were correlated with HE. After fully adjusted models for sex, age, intraventricular hemorrhage, Glasgow Coma Scale admission score, baseline ICH volume, and time from onset to initial computed tomography, multivariable logistic regression revealed that the PLIC is a robust predictor of HE in patients with deep ICH (adjusted odds ratio = 2.73; 95% confidence interval = 1.75-4.26; p < 0.001).
CONCLUSIONS: Involvement of the posterior limb of the internal capsule in deep hemorrhage could be a promising predictor of HE.

UNASSIGNED: To investigate retinal layers\' thickness and vascular density after successful scleral buckle surgery using the optical coherence tomography angiography (OCTA) method.
UNASSIGNED: In this prospective interventional case-control study, 24 patients with macular-off rhegmatogenous retinal detachment (RRD) were included after performing successful reattachment by scleral buckling. Retinal layers\' thickness and vascular density were assessed in the patients using the OCTA method compared to normal fellow eyes as controls 10 months postoperation.
UNASSIGNED: Inner retinal layers showed no significant difference, but there was a significant reduction in outer central 1-mm retinal layers\' thickness. Outer plexiform-Bruch\'s membrane (153.1 ± 24.3 μm vs. 166.2 ± 15.1 μm, P = 0.003) and ellipsoid zone to Bruch\'s membrane (51.25 ± 9.3 μm vs. 57.35 ± 3.8 μm, P = 0.009) were thinner in the operated eyes compared to fellow eyes. Vascular density within a 300 μm wide region around the foveal avascular zone (FAZ) (foveal density-300) was significantly lower in the detached eyes (46.28% ± 7.12% vs. 51.01% ± 4.73%, P = 0.016), however, there was no difference in superficial and deep vascular density at 1-mm central circle. Superficial parafoveal vascular density was lower in the operated eyes (46.24% ± 5.30% vs. 49.52% ± 5.93%, P = 0.026) with no significant difference in deep parafoveal vascular density (49.93 ± 4.29% vs. 51.88% ± 4.79%, P = 0.137). There was no difference in FAZ area and perimeter between the two groups.
UNASSIGNED: Complete recovery of retinal thickness and vascular density did not achieve in the patients with RRD even after 10 months of reattachment by scleral buckling surgery. Superficial capillary vascular density was more affected than deep vascular density almost in the parafoveal area.

BACKGROUND: For advanced breast cancer with lymph node involvement, adjuvant radiotherapy (RT) with regional nodal irradiation (RNI) has been indicated to reduce cancer recurrence and mortality. However, an extensive RT volume is associated with normal organ exposure, which increases the toxicity and affects patient outcomes. Modern arc RT techniques can improve normal organ sparing compared with conventional techniques. The aim of this study was to explore the optimal technique for left-breast RT with RNI.
METHODS: We retrospectively reviewed patients receiving RT with RNI for left-breast cancer. We used modern arc RT techniques with either volumetric-modulated arc therapy (VMAT) or helical tomotherapy (HT) with a novel block technique, and compared differences in dosimetry parameters between the two groups. Subgroup analysis of RNI with or without internal mammary node (IMN) volume was also performed.
RESULTS: A total of 108 eligible patients were enrolled between 2017 and 2020, of whom 70 received VMAT and 38 received HT. The median RT dose was 55 Gy. No significant differences were found regarding the surgery, RT dose, number of fractions, target volume, and RNI volume between the VMAT and HT groups. VMAT reduced the heart mean dose more than HT (3.82 vs. 5.13 Gy, p < 0.001), as well as the cardiac parameters of V5-V20, whole-lung mean dose, lung parameters of V5-V20, and contralateral-breast and esophagus mean dose. In the subgroup analysis of RNI with IMNs, the advantage of VMAT persisted in protecting the heart, lung, contralateral breast, and esophagus. HT was beneficial for lowering the thyroid mean dose. For RNI without IMN, VMAT improved the low-dose exposure of the heart and lung, but HT was similar to VMAT in terms of heart, whole-lung, and contralateral-breast mean dose.
CONCLUSIONS: For patients with left-breast cancer receiving adjuvant RT with RNI, VMAT reduced the exposure dose to the heart, lung, contralateral breast, and esophagus compared with HT. VMAT was superior to HT in terms of normal organ sparing in the patients who underwent RNI with IMN irradiation. Considering the reduction in normal organ exposure and potential toxicity, VMAT is the optimal technique for patients receiving RNI when deep inspiration breath-hold is not available.