There were no significant differences in patient characteristics or venous coupler size used in venous anastomosis. Although the number of operating room take backs for venous insufficiency was not significantly different between two groups, the free flaps with inset change had significantly higher complications that required later surgical intervention (p = 0.0464). CONCLUSION  Surgeons should be aware that intraoperative coupler signal loss can be associated with poor clinical outcomes postoperatively and these flaps may require more perfusion imaging, flap debulking, or even additional venous anastomosis. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.This study aimed to propose automated treatment planning approaches based on similar cases with beam angle optimizations using water equivalent path length (WEPL) to avoid lung and rib doses for lung stereotactic body radiation therapy (SBRT). Similar cases to an objective case were defined as cases, which were close to the objective case with respect to the Euclidean distances based on geometrical features. Initial similar-case-based (ISC) plans were generated by applying lung SBRT plans of similar cases to objective cases. Similar cases were selected using the Euclidean distances based on lung shape and geometrical features from a radiation treatment planning database with 174 cases. Beam angles of the ISC plans were optimized using a greedy algorithm based on a cost function to include absorbed doses in the lung and ribs in the WEPL. The 12 dose evaluation indices for the planning target volume, lung, spinal cord, and ribs were evaluated in the original plans, ISC plans, and optimized similar-case-based (OSC) plans with and without WEPL for 20 test cases to investigate its dosimetric impact. These findings revealed that V10 and the mean dose for the lung and V20, V30, and V40 for the ribs in the OSC plan with WEPL improved more significantly than those in the original and ISC plans. This study indicates a potential of similar cases, whose beam angle configurations were optimized with WEPL to avoid lung and rib doses in lung SBRT plans.In this study, we aim to evaluate the comprehensive geometric accuracy of proton rotating gantries by performing an end-to-end test using a cone-shaped scintillator screen detector, known as XRV-124. The XRV-124 comprises a cone-shaped sheet-like scintillator and charge-coupled device camera that detects the scintillation light. First, the results of the Winston-Lutz and end-to-end XRV-124 tests performed on a conventional linear accelerator were compared to confirm the reliability of the XRV-124, and the snout position dependency of the geometric accuracy was evaluated for the proton rotating gantry as a pre-verification process. Thereafter, an end-to-end test including computed tomography imaging and irradiation in 30° steps from 0° to 330° for two proton rotating gantries, which have the same specifications, was performed. The results of the pre-verification indicated that sufficient accuracy was obtained for the end-to-end test of the proton rotating gantry. The end-to-end test results showed a peak-to-peak deviation of up to 2 mm for some of the coordinate axes. The two gantries exhibited almost similar results in terms of the absolute quantity; however, a few trends were different. Thus, the beam axis deviations were confirmed to be within the safety margin, as expected in clinical practice. Based on the results of this study, the XRV-124 can be used as a comprehensive end-to-end constancy test tool, as it enables a comparative verification of multiple rotating gantries and geometric accuracy verification of different treatment modalities.Multiple pathways contribute to the pathogenesis of atopic dermatitis (AD), and various targeted topical, biologic, and oral systemic agents have subsequently been developed. This review examines the mechanism of action and study designs of agents that have failed trials for AD to identify lessons that may shed light on reasons for their failure. Clinicaltrials.gov was searched for completed, placebo-controlled phase II and III studies assessing agents for AD that did not meet the primary endpoint, specifically reduction of AD severity. PubMed was then searched for further data on the agents identified with known mechanism of actions. Only phase II trials met inclusion criteria. Analyses of the mechanisms of action, study design, and patient demographics of the failed clinical trials for the following agents are presented apremilast and roflumilast (PDE-4 inhibitors), fevipiprant and temapiprant (CRTH2 inhibitors), and tezepelumab and ustekinumab (monoclonal antibodies). Agents that did not meet their trial endpoints for AD may still hold therapeutic value in certain subpopulation groups or other diseases. Validating phase II trials based off subgroup analyses from previous trials may be warranted as our understanding of the pathophysiology of AD continues to grow.BACKGROUND AND OBJECTIVE Early management of traumatic brain injury (TBI) is essential. We aimed to evaluate the efficacy of vitamin D over early clinical outcome and serum cytokine levels in patients with moderate to severe brain injury. METHODS Thirty-five patients with moderate to severe traumatic brain injury who were admitted to the ICU unit were recruited into the study. Subjects were randomly allocated to a treatment regimen comprising either a one-time oral dose of 120,000 IU (two tablets of 60,000 IU each) of vitamin D (n = 20) or 8 mg of saccharide (two tablets of 4 g each) as placebo (n = 15).  https://www.selleckchem.com/products/a1874.html  The main parameters evaluated included duration of mechanical ventilation and ICU stay, Glasgow Coma Scale (GCS) and cytokine levels (interleukin (IL)-6, tumour necrosis factor (TNF)-α, interferon (IFN)-γ, IL-2). RESULTS The results indicated an improvement in the level of consciousness after 7 days in the vitamin D-treated group compared with placebo. An elevation in GCS score by 3.86 units in the vitamin D-treated group with a 0.19-unit descent in the control group was recorded. Duration of mechanical ventilation was reduced in the vitamin D-treated group compared with the control group (4.7 days vs. 8.2 days, p value 0.0001). A noticeable reduction was recorded in inflammatory biomarkers (cytokines) in the vitamin D-treated group (IL-6 p = 0.08, TNF-α p = 0.02, IL-2 p = 0.36) with notable elevation in IFN-γ (p = 0.65) compared to the control group. CONCLUSION In the acute phase of moderate to severe traumatic brain injury, vitamin D supplementation plays a vital role and has a favourable effect on the consciousness level of patients. Clinical trial Registry (CTRI) No. CTRI/2019/05/019259.