Taphrina deformans is the causal agent of leaf curl, a serious peach disease which causes significant losses in peach production worldwide. Nowadays, in order to control plant diseases, it is necessary to adopt novel and low-cost alternatives to conventional chemical fungicides. These promising strategies are targeted at eliciting host defense mechanisms via priming the host through the consecutive application of plant immunity inducers prior to pathogen challenge. In this study, we investigated whether chitosan or yeast cell wall extracts could provide enhanced tolerance against leaf curl in two-season field trials. Furthermore, we addressed the possible molecular mechanisms involved beyond the priming of immune responses by monitoring the induction of key defense-related genes. The efficacy of spraying treatments against peach leaf curl with both inducers was significantly higher compared to the untreated control, showing efficacy in reducing disease severity of up to 62.6% and 73.9% for chitosan and yeast cell wall extracts, respectively. The application of chitosan in combination with copper hydroxide was more efficient in reducing disease incidence and severity, showing efficacy values in the range of 79.5–93.18%. Peach plantlets were also spray-treated with immunity inducers three times prior to leaf inoculation with T. deformans blastospores in their yeast phase. The relative expression levels of nine key defense and priming genes, including those encoding members of pathogenesis-related (PR) proteins and hub genes associated with hormone biosynthesis, were monitored by RT-qPCR across three days after inoculation (dai). The results indicate that pre-treatments with these plant immunity inducers activated the induction of genes involved in salicylic acid (SA) and jasmonate (JA) defense signaling pathways that may offer systemic resistance, coupled with the upregulation of genes conferring direct antimicrobial effects. Our experiments suggest that these two plant immunity inducers could constitute useful components towards the effective control of T. deformans in peach crops. Full article

Despite the excellent oxygen barrier and biodegradability of polyvinyl alcohol (PVA), its poor physical properties owing to its inherent hydrophilicity limit its application. In this paper, we report a novel surface modification technique for PVA films, involving the control of the predrying conditions (i.e., amount of residual solvent) of the coated PVA film and adjusting the electrospinning process of hydrophobic polycaprolactone (PCL) nanofibers onto the PVA films. The residual solvent of the coated PVA film was varied by changing the predrying time. A shorter predrying time increased the residual solvent content significantly (p < 0.05) and the flexibility of the coated PVA film. Moreover, scanning electron microscopy depicted the improved physical binding of hydrophobic PCL nanofibers to the hydrophilic PVA surface with increased penetration depth to the PVA film with shorter drying times. The PVA/PCL composite films with different predrying times and electrospun PCL nanofibers exhibited an apparent increase in the contact angle from 8.3° to 95.1°. The tensile strength of the pure PVA film increased significantly (p < 0.05) from 7.5 MPa to 77.4 MPa and its oxygen permeability decreased from 5.5 to 1.9 cc/m²·day. Therefore, our newly developed technique is cost-effective for modifying the surface and physical properties of hydrophilic polymers, broadening their industrial applications. Full article

This study optimized the input processing factors, namely compression force, pressing speed, heating temperature, and heating time, for extracting oil from desiccated coconut medium using a vertical compression process by applying a maximum load of 100 kN. The samples’ pressing height of 100 mm was measured using a vessel chamber of diameter 60 mm with a plunger. The Box–Behnken design was used to generate the factors’ combinations of 27 experimental runs with each input factor set at three levels. The response surface regression technique was used to determine the optimum input factors of the calculated responses: oil yield (%), oil expression efficiency (%), and energy (J). The optimum factors’ levels were the compression force 65 kN, pressing speed 5 mm min⁻¹, heating temperature 80 °C, and heating time 52.5 min. The predicted values of the responses were 48.48%, 78.35%, and 749.58 J. These values were validated based on additional experiments producing 48.18 ± 0.45%, 77.86 ± 0.72%, and 731.36 ± 8.04 J. The percentage error values between the experimental and the predicted values ranged from 0.82 ± 0.65 to 2.43 ± 1.07%, confirming the suitability of the established regression models for estimating the responses. Full article

All over the world, especially in Western societies, table salt intake that is inordinately higher than the acceptable level has been observed. An excess of Na in the human diet, mostly from processed foods, is becoming the “number one killer”, leading to increased blood pressure. Therefore, the food industry is faced with a need to reduce Na in human nutrition in an effort to raise public health protection to a higher level. In this study, a commercially available combination of Na/K salts (COMB) at different concentrations was used as a NaCl substitute in the production of a modified, healthier, Na-reduced cheese. Samples of the modified low-Na white soft-brined cheese (WSBC) were produced by adding four different concentrations of COMB to production lots PL-1 to PL-4, and the control (CON) samples were prepared by salting with the usual, non-reduced concentration of NaCl. The effects of NaCl replacement on the physical–chemical parameters, major- and micro-elements, and microstructural and sensory properties of the WSBC were investigated. The obtained results indicated that there was no significant influence on the ash content, pH, and a_w. The Na and K levels differed among treatments (p < 0.001). The lowest Na level in this study was recorded in PL-4 (only COMB was added) and was 334.80 ± 24.60 mg/100 g. According to the Na content, WSBC PL4 can be labeled with the nutrient claim “reduced amount of Na”. A significant difference (p < 0.05) was noticed in overall acceptance between the CON and PL-4, with no statistically significant difference found amongst other WSBC production lots. The replacement of NaCl resulted in a slightly greater firmness of the WSBC. The results confirm the possibility of producing low-Na WSBC when optimal amounts of a suitable mineral salt are used as a substitute for NaCl, thus reducing the risk of high Na intake in the human body through the consumption of evaluated cheese. Full article

Formula feeding, obesity and the gut microbiota are closely related. The present investigation explored the profiles of the intestinal microbiota in obese children over 5 years old with formula feeding in early life. We identified functional bacteria with anti-obesity potential through in vitro and in vivo experiments, elucidating their mechanisms. The results indicated that, in the group of children over 5 years old who were fed formula in early life, obese children exhibited distinct gut microbiota, which were characterized by diminished species diversity and reduced Bifidobacterium levels compared to normal-weight children. As a result, Lactobacillus acidophilus H-68 (H-68) was isolated from the feces of the N-FF group and recognized as a promising candidate. H-68 demonstrated the ability to stimulate cholecystokinin (CCK) secretion in STC-1 cells and produce bile salt hydrolase. In vivo, H-68 promoted CCK secretion, suppressing food intake, and regulated bile acid enterohepatic circulation, leading to increased deoxycholic acid and lithocholic acid levels in the ileum and liver. This regulation effectively inhibited the diet-induced body weight and body fat gain, along with the liver fat deposition. In conclusion, H-68 was recognized for its prospective anti-obesity impact, signifying an auspicious pathway for forthcoming interventions targeted at averting pediatric obesity in formula-fed children. Full article

The expected huge number of connected devices in Internet of Things (IoT) applications characterizes the massive machine-type communication (mMTC) scenario, one prominent use case of beyond fifth-generation (B5G) systems. To meet mMTC connectivity requirements, grant-free (GF) random access (RA) protocols are seen as a promising solution due to the small amount of data that MTC devices usually transmit. In this paper, we propose a GF RA protocol based on a multi-agent reinforcement learning approach, applied to aid IoT devices in selecting the least congested RA pilots. The rewards obtained by the devices in collision cases resemble the congestion level of the chosen pilot. To enable the operation of the proposed method in a realistic B5G network scenario and aiming to reduce signaling overheads and centralized processing, the rewards in our proposed method are computed by the devices taking advantage of a large number of base station antennas. Numerical results demonstrate the superior performance of the proposed method in terms of latency, network throughput, and per-device throughput compared with other protocols. Full article

Residual film pollution and excessive nitrogen fertilizer have become limiting factors for agricultural development. To investigate the feasibility of replacing conventional plastic film with biodegradable plastic film in cold and arid environments under nitrogen application conditions, field experiments were conducted from 2021 to 2022 with plastic film covering (including degradable plastic film (D) and ordinary plastic film (P)) combined with nitrogen fertilizer 0 (N0), 160 (N1), 320 (N2), and 480 (N3) kg·ha⁻¹. The results showed no significant difference (p > 0.05) in dry matter accumulation, photosynthetic gas exchange parameters, soil enzyme activity, or yield of spring maize under degradable plastic film cover compared to ordinary plastic film cover. Nitrogen fertilizer is the main factor limiting the growth of spring maize. The above-ground and root biomass showed a trend of increasing and then decreasing with the increase in nitrogen application level. Increasing nitrogen fertilizer can also improve the photosynthetic gas exchange parameters of leaves, maintain soil enzyme activity, and reduce soil pH. Under the nitrogen application level of N2, the yield of degradable plastic film and ordinary plastic film coverage increased by 3.74~42.50% and 2.05~40.02%, respectively. At the same time, it can also improve water use efficiency and irrigation water use efficiency, but it will reduce nitrogen fertilizer partial productivity and nitrogen fertilizer agronomic use efficiency. Using multiple indicators to evaluate the effect of plastic film mulching combined with nitrogen fertilizer on the comprehensive growth of spring maize, it was found that the DN2 treatment had the best complete growth of maize, which was the best model for achieving stable yield and income increase and green development of spring maize in cold and cool irrigation areas. Full article

Soil-borne Trichoderma spp. have been extensively studied for their biocontrol activities against pathogens and growth promotion ability in plants. However, the beneficial effect of Trichoderma on inducing resistance against insect herbivores has been underexplored. Among diverse Trichoderma species, consistent with previous reports, we showed that root colonization by T. virens triggered induced systemic resistance (ISR) to the leaf-infecting hemibiotrophic fungal pathogens Colletotrichum graminicola. Whether T. virens induces ISR to insect pests has not been tested before. In this study, we investigated whether T. virens affects jasmonic acid (JA) biosynthesis and defense against fall armyworm (FAW) and western corn rootworm (WCR). Unexpectedly, the results showed that T. virens colonization of maize seedlings grown in autoclaved soil suppressed wound-induced production of JA, resulting in reduced resistance to FAW. Similarly, the bacterial endophyte Pseudomonas chlororaphis 30-84 was found to suppress systemic resistance to FAW due to reduced JA. Further comparative analyses of the systemic effects of these endophytes when applied in sterile or non-sterile field soil showed that both T. virens and P. chlororaphis 30-84 triggered ISR against C. graminicola in both soil conditions, but only suppressed JA production and resistance to FAW in sterile soil, while no significant impact was observed when applied in non-sterile soil. In contrast to the effect on FAW defense, T. virens colonization of maize roots suppressed WCR larvae survival and weight gain. This is the first report suggesting the potential role of T. virens as a biocontrol agent against WCR. Full article

We introduce a compact core model for double-gate (DGFET) and surrounding-gate (SGFET) MOSFETs designed for circuit simulations. Despite its high precision, the model is crafted to retain the same analytic formulation of the industry standard Pennsylvania State and Philips (PSP). Instead of linearizing the drain current as in the PSP model, we employ a quadratic symmetric polynomial interpolation of the charge in the channel. This eliminates the need for cumbersome derivatives, simplifications, and intricate coding when integrating into a circuit simulator, thereby preventing singularities during numerical iterations. Moreover, thanks to its mathematical formulation equivalent to PSP, this model simplifies the coding of terminal charges, capacitances, potentials, and electric fields in the channel within circuit simulators. We validate the accuracy of the model through comparisons with numerical solutions and experiments from the literature. Full article

Technological advancements are propelling medical technology towards automation through the application and widespread use of automatic control, sensing, and Internet of Things (IoT) technologies. Currently, IoT technology has been extensively applied in medical devices, aiming to ensure patient safety through more real-time detection and more effective management. In the monitoring of intravenous infusion, accurately sensing the infusion conditions in real time is particularly important. This article introduces a low-cost smart infusion device based on IoT technology, which controls the infusion rate with a peristaltic pump and monitors the volume of fluid delivered. It uses an improved, self-calibrating weighing sensor to achieve the real-time closed-loop control of the flow rate, ensuring patient safety. Additionally, the Blynk dashboard can be used for monitoring and controlling the flow rate and infusion volume. Full article

Coccolithophores play a significant role in marine calcium carbonate production and carbon cycles, attributing to their unique feature of producing calcareous plates, coccoliths. Coccolithophores also possess a haplo-diplontic life cycle, presenting distinct morphology types and calcification states. However, differences in nutrient acquisition strategies and mixotrophic behaviors of the two life phases remain unclear. In this study, we conducted a series of phagocytosis experiments of calcified diploid and non-calcified haploid strains of coccolithophore Gephyrocapsa huxleyi under light and dark conditions. The phagocytosis capability of each strain was examined based on characteristic fluorescent signals from ingested beads using flow cytometry and fluorescence microscopy. The results show a significantly higher phagocytosis percentage on fluorescent beads in the bacterial prey surrogates of the non-calcified haploid Gephyrocapsa huxleyi strain, than the calcified diploid strain with or without light. In addition, the non-calcified diploid cells seemingly to presented a much higher phagocytosis percentage in darkness than under light. The differential phagocytosis capacities between the calcified diploid and non-calcified haploid Gephyrocapsa huxleyi strains indicate potential distinct nutritional strategies at different coccolithophore life and calcifying stages, which may further shed light on the potential strategies that coccolithophore possesses in unfavorable environments such as twilight zones and the expanding coccolithophore niches in the natural marine environment under the climate change scenario. Full article

Background: Platelets were shown to be relevant for liver regeneration. In particular, platelet-stored serotonin (5-HT) proved to be a pro-regenerative factor in this process. The present study aimed to investigate the perioperative course of 5-HT and evaluate associations with patient and graft outcomes after othotopic liver transplantation (OLT). Methods: 5-HT was quantified in plasma and serum of 44 OLT recipients perioperatively, and in their respective donors. Olthoff’s criteria for early allograft dysfunction (EAD) were used to evaluate postoperative outcomes. Results: Patients with higher donor intra-platelet 5-HT per platelet (IP 5-HT PP) values had significantly lower postoperative transaminases (ASAT POD1: p = 0.006, ASAT POD5: p = 0.006, ASAT POD10: p = 0.02, ALAT POD1: p = 0.034, ALAT POD5: p = 0.017, ALAT POD10: p = 0.04). No significant differences were seen between postoperative 5-HT values and the occurrence of EAD. A tendency was measured that donor IP 5-HT PP is lower in donor-recipient pairs that developed EAD (p = 0.07). Conclusions: Donor IP 5-HT PP might be linked to the postoperative development of EAD after OLT, as higher donor levels are correlated with a more favorable postoperative course of transaminases. Further studies with larger cohorts are needed to validate these findings. Full article

(1) Background: This study investigated the effects of sequenced electromagnetic fields, modulated at extremely low frequencies and intensities, in the treatment of drug-resistant Escherichia coli (E. coli)-induced chronic bacterial cystitis. (2) Methods: A total of 148 female participants, aged 18 to 80 years diagnosed with chronic bacterial cystitis caused by drug-resistant E. coli, were recruited for this study. Participants were randomly assigned to two groups: an experimental group (n = 74) with osteopathic palpation and assessment treated with a sequence of electromagnetic fields, and a control group (n = 74) receiving a placebo treatment. Both groups were assessed at this study’s outset, 4 weeks after eight applications, and at 12 weeks for symptomatic presentation and laboratory parameters. (3) Results: After 4 weeks of treatment, a significant difference was observed between the two groups regarding D-DIMER levels, IL-6 levels, erythrocyte levels, leukocyte levels, and E. coli levels (p < 0.001). By the 12th week, the experimental group continued to exhibit a significant reduction in the examined parameters compared to the control group (p < 0.001). Additionally, the treatment did not induce any side effects in the patients in the experimental group. (4) Conclusions: Treatment with coherently sequenced electromagnetic fields, modulated at an extremely low frequency and intensity, not only appears to provide an effective alternative for the symptoms of chronic bacterial cystitis caused by drug-resistant E. coli but also demonstrates a potent antibacterial effect. Full article

Objectives: This study aimed to explore the impact of irritating sounds on the postural control of healthy adults, considering both linear and nonlinear parameters, subjective assessments, and gender differences. Methods: Thirty-four young participants (17 females, 17 males) completed three 30 s bipedal standing stability tests on a balance platform: one with visual control (EO), another without visual control (EC), and a third without visual control but accompanied by irritating sounds (ECS). Additionally, participants filled out a questionnaire evaluating their sound sensitivity. Linear and nonlinear parameters from each balance test were considered for statistical analysis. Results: The findings reveal significant gender-based variations in sensitivity to sound, with women exhibiting higher sensitivity. No statistically significant differences in postural control were observed between males and females, except for a notable increase in irregularity (SampEn values) in the anterior–posterior direction for females in the ECS trial. Correlation analyses revealed a moderate and statistically significant correlation between SampEn values in the AP direction and SE scores. Conclusions: This study highlights the intricate relationship between sensory stimuli, attention, and the body’s ability to maintain balance. The presence of irritating sounds led to increased irregularity in postural control, particularly in the absence of visual control. Full article

Watchman Nee’s anthropology has been widely debated and polarized in academic fields. However, Watchman Nee’s concept of human and the problem of ecclesiastical practices have often been overlooked in contemporary Chinese mainland churches. In the first three sections, this paper will start from different Chinese mainland denominations’ interpretation of Nee’s concept of human and their corresponding ecclesiastical practices. On the one hand, through the interpretive attitudes of different denominations toward the “concept of human” and their related ecclesiastical practices, we can see the situation of acceptance of Nee’s anthropology in different contemporary Chinese denominations. On the other hand, we can also provide feedback for the academic research on Nee’s anthropology from the reality of contemporary Chinese mainland churches. Then, this paper will make a comparison of anthropologies between Luther and Watchman Nee, referring to the current study of Martin Luther and the Third Enlightenment in China. The comparative study of these two men will not only open up new avenues for the study of their theologies but will also serve Chinese mainland churches by utilizing the results of the research on Nee’s thoughts and Martin Luther and the Third Enlightenment. Full article

Background: Follow-up after radical cystectomy (RC) for bladder cancer can be divided into oncological and functional surveillance. It remains unclear how follow-up after RC should ideally be scheduled. The aim of this report was to gain insight into the organization of follow-up after RC in Europe, for which we conducted a roundtable inventory within the EAU Young Academic Urologists Urothelial Cancer working group. Methods: An inventory semi-structured survey was performed among urologists of the EAU Young Academic Urologists Urothelial Cancer working group to describe the organization of follow-up. The surveys were analyzed using a deductive approach. Similarities and differences in follow-up after RC for bladder cancer were described. Results: The survey included 11 urologists from six different European countries. An institutional follow-up scheme was used by six (55%); three (27%) used a national or international guideline, and two (18%) indicated that there was no defined follow-up scheme. Major divergent aspects included the time points of follow-up, the frequency, and the end of follow-up. Six centers (55%) adopted a risk-adapted follow-up approach tailored to (varying) patient and tumor characteristics. Laboratory tests and CT scans were used in all cases; however, the intensity and frequency varied. Functional follow-up overlapped with oncological follow-up in terms of frequency and duration. Patient-reported outcome measures were only used by two (18%) urologists. Conclusions: Substantial variability exists across European centers regarding the follow-up after RC for bladder cancer. This highlights the need for an international analysis focusing on its organization and content as well as on opportunities to improve patients’ needs during follow-up after RC. Full article

Background/Objective: Pudendal neuralgia is a distressing condition that presents with pain in the perineum. While a positive anesthetic pudendal nerve block is one of the essential criteria for diagnosing this condition, this block can also provide a therapeutic effect for those afflicted with pudendal neuralgia. There are multiple ways in which a pudendal nerve block can be performed. The objective of this study is to share our results and follow-up of fluoroscopy-guided transgluteal pudendal nerve blocks. Methods: This is a retrospective case series. Included were 101 patients who met four out of the five Nantes criteria (pain in the anatomical territory of the pudendal nerve, pain worsened by sitting, pain that does not wake the patient up at night, and no objective sensory loss on clinical examination) who did not respond to conservative treatment and subsequently underwent a fluoroscopy-guided transgluteal pudendal nerve block. Therapeutic success was defined as a 30% or greater reduction in pain. Success rates were calculated, and the duration over which that success was sustained was recorded. Results: For achieving at least 30% relief of pain, using worst-case analysis, the success rate at two weeks was 49.4% (95% CI: 38.5%, 60.3%). In addition to pain relief, patients experienced other therapeutic benefits, such as reductions in medication use and improvements in activities of daily living. Conclusions: Fluoroscopy-guided transgluteal pudendal nerve block appears to be effective in patients who have pudendal neuralgia that is resistant to conservative therapy, with good short-term success. Full article

Premature ventricular complexes (PVCs) are commonly encountered problems in clinical settings. The range of symptoms can be from asymptomatic to palpitations, fatigue, or heart failure symptoms. A higher burden of PVCs is a risk factor for development of PVC-induced cardiomyopathy (PIC). Rhythm evaluation by 12-lead ECG and an ambulatory monitoring device are essential. Currently, several imaging modalities, such as echocardiography and cardiac magnetic resonance imaging, are utilized to evaluate the underlying structure that may be related to PIC. Beta blockers and antiarrhythmic drugs are typically part of the initial management strategy. If these fail, catheter ablation of PVCs is typically the next step. The purpose of this article is to summarize the current evidence/knowledge about PIC. Full article

Background: The natural history of spinal muscular atrophy (SMA) is well understood, with progressive muscle weakness resulting in declines in function. The development of contractures is common and negatively impacts function. Clinically, joint hypermobility (JH) is observed but is poorly described, and its relationship with function is unknown. Methods: Lower-limb ROM (range of motion) assessments of extension and flexion at the hip, knee, and ankle were performed. ROMs exceeding the published norms were included in the analysis. The functional assessments performed included the six-minute walk test (6 MWT) and the Hammersmith Functional Motor Scale—Expanded (HFMSE). Results: Of the 143 participants, 86% (n = 123) had at least one ROM measure that was hypermobile, and 22% (n = 32) had three or more. The HFMSE scores were inversely correlated with hip extension JH (r = −0.60, p = 0.21; n = 6) and positively correlated with knee flexion JH (r = 0.24, p = 0.02, n = 89). There was a moderate, inverse relationship between the 6 MWT distance and ankle plantar flexion JH (r = −0.73, p = 0.002; n = 15). Conclusions: JH was identified in nearly all participants in at least one joint in this study. Hip extension, knee flexion and ankle plantar flexion JH was associated with function. A further understanding of the trajectory of lower-limb joint ROM is needed to improve future rehabilitation strategies. Full article

The therapeutic landscape of the management of stage III non-small cell lung cancer (NSCLC) has drastically evolved with the incorporation of immunotherapy and targeted therapy. Stage III NSCLC accounts for one-third of the cases and the treatment strategy of these locally advanced presentations are diverse, ranging from surgical to non-surgical options; with the incorporation of chemo-immunotherapy, radiation, and targeted therapies wherever applicable. The staging of this disease has also changed, and it is essential to have a strong multidisciplinary approach to do justice to patient care. In this article, we aim to navigate the nuanced approaches in the diagnosis and treatment of stage III NSCLC and expand on the evolution of the management of this disease. Full article

Background: Postpartum hemorrhage (PPH) represents one of the principal causes of maternal mortality and morbidity worldwide. Uterine balloon tamponade (UBT) is recommended for the treatment of postpartum hemorrhage due to uterine atony in women who do not respond to pharmacological first-line treatment. The success of UBT in bleeding control is related to the correct positioning of the device, since incorrect insertion can be associated with ineffectiveness and requires time-consuming repositioning maneuvers, with a further increase in blood loss. The use of ultrasound (US) during UBT may increase the success rate by preventing wrong positioning. This study aims to demonstrate the role of US guidance during UBT and to assess whether US guidance can ease positioning and reduce insertion times, preventing additional repositioning maneuvers, in comparison with a US check carried out after balloon insertion. Methods: This was a retrospective study including 370 women who underwent vaginal delivery, had PPH caused by uterine atony and required UBT at Sant’Anna Hospital from 2015 to 2019. The exclusion criteria were an abnormal placental site, vaginal or cervical trauma, coagulation defects, uterine anomalies, previous postpartum hemorrhage and previous caesarean section. Included subjects were divided into two groups: the US-guided group (n = 200) underwent Bakri balloon positioning under US guidance, and the non-guided group (n = 170) received a US check only after balloon insertion. The primary outcome was the success rate of the procedure, expressed as the percentage of cases with bleeding control without the need for balloon repositioning; the secondary outcomes were the length of the procedure and some parameters related to blood loss. Results: The success rate was 99% for the US-guided group vs. 86% for the non-guided group. None of the patients required hysterectomy. In the US-guided group with respect to the non-guided group, we observed a significant reduction in blood loss (1100 ± 450 vs. 1500 ± 600 mL; p < 0.001), Δhemoglobin level (1.8 ± 1.1 vs. 2.7 ± 2.0 g/dL, p < 0.001) and time required for the procedure (8 vs. 13 min, p < 0.001). Conclusions: Our data suggest that the use of US guidance for placement of UBT was associated with reduced need for balloon repositioning, lower blood loss, and faster resolution of postpartum hemorrhage. Full article

Introduction: The rate of isolated locoregional recurrence after surgery for pancreatic adenocarcinoma (PDAC) approaches 25%. Ablative radiation therapy (A-RT) has improved outcomes for locally advanced disease in the primary setting. We sought to evaluate the outcomes of salvage A-RT for isolated locoregional recurrence and examine the relationship between subsequent patterns of failure, radiation dose, and treatment volume. Methods: We conducted a retrospective analysis of all consecutive participants who underwent A-RT for an isolated locoregional recurrence of PDAC after prior surgery at our institution between 2016 and 2021. Treatment consisted of ablative dose (BED10 98–100 Gy) to the gross disease with an additional prophylactic low dose (BED10 < 50 Gy), with the elective volume covering a 1.5 cm isotropic expansion around the gross disease and the circumference of the involved vessels. Local and locoregional failure (LF and LRF, respectively) estimated by the cumulative incidence function with competing risks, distant metastasis-free and overall survival (DMFS and OS, respectively) estimated by the Kaplan–Meier method, and toxicities scored by CTCAE v5.0 are reported. Location of recurrence was mapped to the dose region on the initial radiation plan. Results: Among 65 participants (of whom two had two A-RT courses), the median age was 67 (range 37–87) years, 36 (55%) were male, and 53 (82%) had undergone pancreaticoduodenectomy with a median disease-free interval to locoregional recurrence of 16 (range, 6–71) months. Twenty-seven participants (42%) received chemotherapy prior to A-RT. With a median follow-up of 35 months (95%CI, 26–56 months) from diagnosis of recurrence, 24-month OS and DMFS were 57% (95%CI, 46–72%) and 22% (95%CI, 14–37%), respectively, while 24-month cumulative incidence of in-field LF and total LRF were 28% (95%CI, 17–40%) and 36% (95%CI 24–48%), respectively. First failure after A-RT was distant in 35 patients (53.8%), locoregional in 12 patients (18.5%), and synchronous distant and locoregional in 10 patients (15.4%). Most locoregional failures occurred in elective low-dose volumes. Acute and chronic grade 3–4 toxicities were noted in 1 (1.5%) and 5 patients (7.5%), respectively. Conclusions: Salvage A-RT achieves favorable OS and local control outcomes in participants with an isolated locoregional recurrence of PDAC after surgical resection. Consideration should be given to extending high-dose fields to include adjacent segments of at-risk vessels beyond direct contact with the gross disease. Full article