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As a neurodegenerative disorder, Parkinson’s disease (PD) is characterized by a combination of premotor, motor, and nonmotor symptoms. PD is commonly accompanied by psychosis, which is one of the commonest symptoms in the long run. As a result of Parkinson’s disease psychosis (PDP), symptoms can range from minor consequences of the disease (illusions, passage hallucinations, and presence hallucinations), to visual and nonvisual hallucinations and delusions. PDP is associated with a reduction in function and a reduction in quality of life as well. It is commonly believed that PDP is related to economic burden, and it has a significant impact on the utilization of long-term care services. The main focus should be on diagnosing, classifying, and managing PDP in an appropriate manner. As a first step in the management of PDP patients, the emphasis should be on identifying and treating any contributing medical factors, reducing or discontinuing medications that could cause or worsen psychosis, as well as nonpharmacological strategies and considering acetylcholinesterase inhibitors for treatment when dementia is present. A number of medications are being considered for use in PDP, including pimavanserin, quetiapine, and clozapine. The purpose of the current review is to provide a comprehensive understanding of the disorder in the general population with PD, including epidemiology, psychotic symptoms, risk factors, triggers, neuro-signaling pathways, diagnosis, and treatment of PDP.

Background: Myxedema is an extreme manifestation seen in patients with untreated hypothyroidism. It is a lethal endocrine emergency, which arises when a precipitating cause overwhelms the compensatory mechanisms of the hypothyroid state.Objectives: This case report aims to present a case of myxedema coma secondary to cretinism. It also aims to discuss how hypothyroidism leads to hypoventilation and eventually respiratory failure, as well as to discuss the epidemiology, pathophysiology, clinical manifestation, diagnosis, and management of a child with myxedema coma.Case presentation: This is a case of a 7-year-old female, diagnosed with congenital hypothyroidism at 5 months of age, but eventually was lost to follow-up. She came back after 7 years presenting with difficulty of breathing. She was seen hypothermic, obtunded, and in severe respiratory distress. She was severely stunted and underweight with coarse facial features. Initial laboratory work-up showed elevated Thyroid Stimulating Hormone (TSH) as well as decreased tri-iodothyronine (FT3) and thyroxine (FT4). She was immediately started on levothyroxine, with noted resolution of the edema and improvement in sensorium. There was also noted improvement in the patient’s ventilation and was sent home on Continuous Positive Airway Pressure (CPAP) while asleep.Conclusion: This case highlights the importance of having a high index of suspicion of its clinical manifestations, which could lead to earlier intervention thereby preventing further complications. A multidimensional approach is essential in managing this case, as various organ systems are involved in this condition.

One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). Despite incentives that provide reimbursements to hospitals and healthcare providers for adopting EHR technology, there is a large number of barriers that preclude its implementation. EHR has a great impact on a variety of healthcare outcomes, mainly favoring its use. Consequently, the development of effective implementation strategies is essential in modern healthcare society.

Introduction: Pneumothorax is defined as air in the pleural cavity, the iatrogenic cause happens after invasive procedures as thoracic needle aspiration, central line placement, pacemaker placement, etc. Nevertheless, it is possible to be found in non-medical procedures, such as alternative medicine, more specifically acupuncture. There are medications used against aging that FDA has warned to be used only in its first objective, an example is procaine hydrochloride.Case: A 63 y/o female, Mexico City resident, with anxiety, came to a follow-up appointment for an aging cohort, where CT, PFT, and laboratories are made for pulmonary healthy subjects to investigate normal lung aging and how other environmental factors can affect the lungs; at physical examination, we did not find any pleuropulmonary syndrome, but in the CT a left Iatrogenic pneumothorax was found; we re-asked for antecedents and she described that 15 days before the date she had 2 punctures in the middle clavicular line to apply procaine hydrochloride as an anti-aging treatment.Discussion: There is diverse evidence of adverse effects associated with acupuncture, and even if pneumothorax has a small percentage of incidence, in some cases it can be severe and can even cause fatalities.Conclusion: The pneumothorax in this case was iatrogenic due to the thoracic puncture for an anti-aging treatment, with a total resolution with conservative treatment, however we as health professionals have the responsibility to inform our patients that initiatives of administration ways can cause important complications.

Introduction: In the present study we evaluated and compared RBC parameters, iron status, and ferritin for discriminating between patients with iron deficiency anemia and anemia of chronic disease. Anemia that accompanies infection, inflammation, and cancer, is commonly termed anemia of chronic disease (ACD). Methods: We compared the ability of serum ferritin concentration, using the microplate immunoenzymometric assay method with other, more traditional indicators of iron status like total iron binding capacity [TIBC], mean corpuscular volume [MCV], percent transferrin saturation [%TS], RBC distribution width [RDW], and serum iron concentration [SIC]. The ferritin concentration was determined in 80 serum samples selected from men and women above the age of 18 years. The patients were assigned to IDA and ACD groups based on serum ferritin concentration.Observation: By studying the ROC Curve for various red cell parameters for the diagnosis of IDA and ACD, we found that diagnostic accuracy of various indicators was as follows TIBC>TS%>MCV>MCH>SI>MCHC for anemia of chronic diseases, and TIBC>MCH>MCV>MCHC>TS%>SI for iron deficiency anemia. When both the value of AUCs (Area under Curve) of ROC were compared it is apparent that TIBC, TS%, MCV, and MCH are important discriminating factors between IDA and ACD. Conclusion: Conventional laboratory parameters play an important role in distinguishing overt causes of IDA and ACD. MCV, MCH, and TIBC were found to be (p -value < .05) significantly discriminated against IDA and ACD. Serum ferritin is an important diagnostic tool with reasonable accuracy for the detection and differentiation of iron deficiency anemia and anemia of chronic disease.

Aerobic capacity of young men (19 years - 24 years) is high, but can be influenced by many factors like physical activity, smoking, and air pollution with environmental PM 2.5. Objectives: (a) - to estimate the aerobic capacity in young men (smokers and non-smokers) living in areas with higher PM 2.5 using Queen’s College Step Test (QCT). (b) - to find whether aerobic capacity is associated with the International Physical Activity Questionnaire (IPAQ)’ three classes, for smokers and non-smokers. Methods: In a cross-sectional study using criteria-based sampling a total of N = 60 smokers & non-smokers were included from the Delhi NCR region. IPAQ, Peak Expiratory Flow Rate (PEFR), Heart Rate, Systolic Blood Pressure, Diastolic Blood Pressure, and PM 2.5 and PM 10 levels were recorded. A comparison of smokers and non-smokers was performed using z test. Smokers and non-smokers were divided into three classes using physical activity levels and compared for aerobic capacity. The correlation of aerobic capacity with variables was seen using Pearson’s correlation coefficient. Multiple R was checked to study the model of cause and effect for aerobic capacity. Results: Significant difference is seen between smokers and non-smokers in the aerobic capacity (Mean ± SD smokers - 65.22 ± 8.73 ml/kg/min; Mean ± SD non-smokers 60.04 ± 7.7 ml/kg/min p value = 0.00). For non-smokers, a low level of physical activity shows a strong correlation with aerobic capacity (r = 0.78; p = < 0.05). No correlation of aerobic capacity is seen with physical activity levels among smokers. Aerobic capacity shows a significant negative and moderate correlation with PM 2.5 (r = -3.1; p = 0.016). The multiple R coefficient value for the model of cause and effect is 6.99 with a p - value of 0.0449 for this. Conclusion: Smoking affects aerobic capacity significantly for young men. High and moderate levels of outdoor physical activity do not increase aerobic capacity in areas with high PM 2.5, whereas low levels show a positive correlation among non-smokers only. 

Introduction: Aluminum Phosphide (AlP) poisoning is a life-threatening condition that commonly occurs in developing countries, often resulting in cardiac, respiratory, and metabolic complications, leading to multi-organ failure and mortality. Extracorporeal Membrane Oxygenation (ECMO) has been proposed as a potential therapy for severe AlP poisoning cases refractory to conventional management, though its use remains controversial. Methodology: for this literature review, we conducted a comprehensive analysis of existing literature concerning the utilization of ECMO in patients with severe AlP poisoning. We meticulously examined available publications to explore the relationship between ECMO initiation and patient outcomes. Discussion: The review reveals that early ECMO initiation within 6 hours of presentation is associated with better outcomes and higher survival rates in severe AlP poisoning cases. However, uncertainties persist regarding the optimal timing and duration of ECMO support, and potential complications, including bleeding, acute renal injury, and ventilator-associated pneumonia, need careful consideration. Conclusion: Despite promising results in certain cases, the risks and benefits of ECMO in AlP poisoning require meticulous evaluation. Ethical considerations, encompassing resource allocation and implications for other patients, necessitate appropriate patient selection criteria.

Background: Stroke occurs in 11% of patients with SCA before 20 years of age. In Northwestern Tanzania, the prevalence of stroke among children living with SCA under the age 15 years is 16.9%, of which might be attributed to the absence of routine screening for the risk of stroke by using Transcranial Doppler Ultrasound (TCD). Screening with TCD allows preventive measures such as chronic blood transfusion to be done which has led to the reduction of stroke by 92%.Methods: This was a prospective analytical cross sectional study which enrolled 267 SCA children aged 2 to 16 years attending Bugando Medical Centre Pediatric Sickle Cell Clinic from July 2019 to June 2020. Assessment of factors associated with elevated TCD included a clinical history of stroke in sibling, death in sibling, temperature, oxygen saturation in room air, blood pressure, hemoglobin level and total white blood cell count. TCD was done by accessing transtemporal window and recording the highest time average mean of maximum velocity (TAMMV) of major vessels mainly, middle cerebral artery (MCA) and distal internal carotid artery (dICA).Results: The median age of enrolled was 6.6 (IQR: 4-9) years. The prevalence of elevated TCD (> 170 cm/s)was found to be 21% (56/267). By multivariate logistic regression, low oxygen saturation in room air, p - value = 0.037, OR 1.08 [95% CI 1.00-1.17] and low hemoglobin level, p - value = 0.001, OR 1.76 [95% CI 1.26-2.45] were statistically significantly associated with elevated TCD among children living with SCA.Conclusion: The high prevalence of elevated TCD velocity, with low hemoglobin and low oxygen saturation in room air as associated factors under multivariate logistic regression, warrants routine TCD screening for children with SCA aged 2 to 16 years.

Introduction: Nursing theories are critical as they drive nursing education, practice, and research. Neuman Systems Model (NSM) considers a person a complete system with integrated psychological, physiological, spiritual, social, and developmental components. Nurses give their patients physical, emotional, and psychological assistance and are subjected to mental and physical pressure due to these responsibilities, impacting their health, psychological well-being, and interpersonal relationships. This paper aims to perform a concept analysis of stressors proposed in NSM about lines of defense and the level of preventive interventions that can affect a person’s well-being. Further, this paper discusses knowledge generation through NSM’s applicability to preventing exhaustion and burnout among nurses. Methodology: This theoretical attempt is carried out using the theory analysis approach suggested by Walker and Avant (2019).Discussion: Nursing is a career that requires a great deal of dedication and personal engagement. Nurses are subjected to recurrent stresses due to technological advances and rising demands. Burnout occurs when nurses get discouraged and have less compassion for the patients due to recurrent burdens. Stress and burnout are two of the most common reasons for nurses to quit hospitals. The NSM is concerned with stresses that may affect a person’s health and well-being (prediction). Nurses assist patients at the most vulnerable and challenging times, such as surgical procedures, traumas and personal and physical losses.Conclusion: The NSM enables the investigation of preventative and protective treatments. Because of the model’s flexibility, it may be used in a wide range of nursing situations. Administrative, hospitals, clinics, and other nurses can benefit from this paradigm. Evaluating the many distinct elements contributing to burnout is also feasible. The model’s client factors of physiological, sociocultural, developmental, and spiritual characteristics are used to achieve this. Viewing the individual as an open system that responds to environmental stimuli encourages the existence of stressors that might lead to burnout.

The study aimed to investigate the threats to the biodiversity of ethnomedicinal plants and to find consensus information on conservation and management practices of ethnomedicinal plants to contribute sustainable utilization of ethnomedicinal plants in Kore district, Southeastern Ethiopia. The result of the survey revealed that sixty-one medicinal plants were reported by the informants from the study area. These plants are distributed in 59 genera and 37 families. Family Lamiaceae and Asteraceae were represented by 5 (8.2%) species for each family and this is the highest number of species and followed by 4 (6.5%) species of Solanaceae and Fabaceae for each family. Preference ranking analysis shows that Eucalyptus globulus scored 47, indicating that it is the most used plant for firewood in the community, followed by Olea europaea (45) and the least used plant for firewood is Juniperus procera scored 36. Paired comparison analysis showed that Olea Europeae ranked first followed by Podocarpus falcatus for the use of charcoal production in the study area. The major purposes of plant species in the study area were construction, Charcoal, Firewood, Furniture, and Fences as well as for medicinal uses. Based on direct matrix ranking analysis Juniperus procera, Eucalyptus globulus, Podocarpus falactus, Olea europaea, Hagenia abyssinica, Croton macrostachyus, and Cordia africana were the most preferred medicinal plants by local people in the study area. The analysis's findings indicated that anthropogenic influences are endangering medicinal plants. In this study area, only about 13% of medicinal plants are collected from home gardens. This shows that the effort made by the community to conserve medicinal plants is not satisfactory. Therefore, encouraging NGOs and Government offices to participate in the conservation of medicinal plants to encourage the local people to plant indigenous trees for domestic use is necessary.

A critical component of the radiation regimen for treating cancer patients is the precise dose delivery to the treatment organ while minimizing the dose to the healthy tissue. This study aims to evaluate in-field organ dose and dose distribution outside the target organs to estimate the excess lifetime risk of second cancer. The study was carried out with a male Alderson Rando Phantom. 20 sets of thermoluminescence dosimeters (MTS-100) were used in this study. The in-field organs absorbed dose was measured by inserting TLDs at different geometrical depths of the left lung, right lung, and stomach, and for peripheral organs skin dose TLDs were placed at the surface of the corresponding organs. Target organs were irradiated at 100 cGy and 200 cGy by a 60Co teletherapy unit, and irradiated TLDs were read out by a RE-2000 TLD reader. For precise dose delivery to the cancerous organs by 60Co teletherapy, the depth dose correction factor for lung cancer treatment is 0.8667 ± 0.01, and for the stomach is 0.7856 ± 0.017. In the case of the treatment for the lung and stomach, the closest organs received significant doses compared to the other distant organs. Thus, the risk of second cancer due to the peripheral dose is obtained. The stomach is at the highest risk when the lung is the target and the liver is at the highest risk when the stomach is the targeted organ.

Background: This retrospective study examines the importance of preoperative cardiology consultations in optimizing patient care and anesthesia surgical perioperative management.Methods: The study includes 7,756 patients from the Department of Anesthesiology at Mohammed V Military Teaching Hospital. Out of these, 122 patients were referred to cardiology consultations. Demographics, surgical specialties, reasons for referral, diagnostic tests, and interventions were analyzed.Results: Referred patients (average age 61.45 years) were mainly over 65 years old, with 59.01% being male. Common surgical specialties seeking consultations were abdominal surgery (30.327%), orthopedic surgery (26.230%), and urological surgery (19.672%). Hypertension, dyslipidemia, and diabetes were prevalent risk factors. Most patients were classified as ASA II (50%) or ASA III (27.04%), with NYHA I (61.5%) or NYHA II (31.2%) classifications. Referrals were due to ECG abnormalities (41.0%), routine evaluation (19.7%), and history of myocardial infarction or previous coronary angiography (39.3%).Discussion: Preoperative cardiology consultations accounted for 1.57% of all pre-anesthesia clinic patients. They were vital in assessing and managing cardiovascular risks, consistent with previous studies. The impact of these consultations was evident in optimizing patient management through treatment plan adjustments and interventions.Conclusion: Preoperative cardiology consultations play a crucial role in identifying and managing cardiovascular risks, contributing significantly to patient care and improving perioperative management. Further research should evaluate long-term outcomes and cost-effectiveness across different patient populations.

Ethnomedicine, synonymous with traditional medicine, is a crucial healthcare system practiced by various ethnic groups worldwide, especially among those with limited access to modern Western medicine. This study explores the rich bio-cultural diversity of the North Central Western Ghats in Karnataka, India, which harbors diverse ethnomedicinal practices. The region's tropical forests are home to an extensive array of plant species, with over 600 endemic to southern India and 95 exclusively endemic to Karnataka. The research focuses on documenting and analyzing the traditional knowledge of local communities regarding the use of plants for treating various human diseases. However, this task presents significant challenges and requires collaborative efforts from the government, NGOs, and Herbal Drug Companies. Over the last decade, ethnomedicinal studies have seen a rise, but there is still limited understanding of ethnomedicine's role in the traditional healthcare system in India. The forests of North Central Western Ghats, including Agumbe, Arbail Ghat, Chorla Betta, and others, exhibit a combination of deciduous and evergreen vegetation. These forests hold a variety of medicinal plants, adding to the region's bio-cultural richness. Scientific validation of the locally used ethnomedicinal plants further supports the development of herbal drug formulations with the support of the Ministry of Ayush, enabling the conservation and sustainable utilization of threatened and endangered species. The study emphasizes the importance of preserving traditional healers' knowledge and promoting collaboration for the preservation of ethnomedicinal practices in the region.

Introduction: Cardiac tamponade is an emergency syndrome that requires fast diagnosis and treatment; otherwise patient follows obstructive shock and cardiac arrest. Case report: A 70-year-old female was brought to the emergency department with hypoxemia. She had a history of progressive dyspnea over the past three weeks. Past medical history includes smoking. On physical examination: tachypnea, hypoxemia (SaO2 89%), jugular venous distention, arterial pressure 220/100 mmHg, heart rate rhythmic of 82 bpm. On pulmonary auscultation: diffuse and bilateral crackles. Lung ultrasound showed a bilateral B line and the echocardiogram demonstrated a pericardial effusion with signs of tamponade. A pericardiocentesis evacuated 620 ml of hemorrhagic fluid and the patient was transferred to the intensive care unit, hemodynamically stable, with SaO2 95%. At the ICU the echocardiogram, showed resolution of the cardiac tamponade and a tumor adhered to the lateral wall of the left ventricle. Chest CT demonstrated: a left lung tumor, infiltrating the pericardial sac. A pericardium biopsy demonstrated undifferentiated carcinoma. Discussion: Cardiac tamponade diagnosis requires a high level of suspicion. Respiratory failure, chest pain, and shock, observed in cardiac tamponade, are also present in different diseases. The most common finding of cardiac tamponade is dyspnea (78% of cases). Our patient had dyspnea due to pulmonary edema, secondary to left ventricle diastolic dysfunction caused by the tamponade. A bedside echocardiogram made the diagnosis of cardiac tamponade and guided the effective pericardiocentesis. Conclusion: Cardiac tamponade must be suspected in all cases of acute dyspnea. Echocardiogram is the method of choice for the diagnosis and for guiding the pericardiocentesis.

Heat transfer is one of the most important aspects of large-scale industries and machines, linking importantly to the efficiency associated with different mechanisms while also emphasizing the importance of sustainable, low-cost methods of heat transfer. One such method is the use of ferrofluids. Through this paper, it is clearly explained that the conductivity of ferrofluids has vast applications across industries and using its magnetic and thermal properties, it can be a cost-effective solution as well. Previously researched works in this field ferrofluids are also acknowledged and furthered as per experimental data.

In the current study, the blood flow through an inclined cylindrical tube subjected to an external magnetic field is evaluated. The blood flow has been considered under the consequence of a transverse magnetic field. Previously the mathematical model was solved by using Caputo-Fabrizio (CF) fractional order derivative with a non-singular kernel which has the limitations like it fails to satisfy the fundamental theorem of fractional calculus. Whereas, in the present study Adomian Decomposition Method (ADM) which is suitable for all types of linear and non-linear differential equations is used. The flow of magnetized blood in an inclined cylindrical tube has been studied by using the ADM. An external magnetic field and an oscillating pressure gradient drove the blood flow. ADM algorithm has been developed and used to find the Adomian solution. Computer software MATHEMATICA has been used to visualize the influence of various flow characteristics such as Hartmann number (Ha), different radial locations and angle of inclination on the Adomian velocity. Due to the Lorentz effect and central radial location, the results show that the magnetic field diminishes the velocities of blood. Meanwhile, progressive inclination angle enhanced the blood flow.

A detailed knowledge of the drying properties of blood is important for a more complete understanding of the forensic information that may exist at a crime location. Although the effect of relative humidity on the general properties of blood drying has been evaluated, relatively little information exists regarding the alterations of blood serum distribution that may occur during the drying process. Moreover, the influence of humidity on the ability of dried blood drops to transfer from skin to absorbent material has never been studied. The data in the current report show that blood serum pattern formation is distinctly altered by increased humidity in drying drops of blood. In addition, these data document that high humidity conditions were sufficient to remoisten dried blood drops such that they were able to transfer to the absorbent material, with the original bloodstain pattern maintained.

Photobiomodulation (PBM) is an effective method for treating neuropsychiatric diseases, yet its universal acceptance and utilization remain constrained. In this Letter to the Editor/Expert Opinion, we address the challenges confronting PBM researchers and pioneers, striving to establish universal confidence in its exclusive application for neuropsychiatric patient care. Despite encouraging animal experiments and selecting positive human clinical trial outcomes, PBM’s widespread acceptance of PBM is hindered by factors including limited clinical studies and clashes with established therapies, such as drug therapy and psychotherapy.To overcome these obstacles and broaden PBM’s adoption and application of PBM in neuropsychiatry, we propose a combinatorial therapy approach. By integrating PBM with interventions such as Cognitive Behavioral Therapy (CBT) or drug therapy, a cumulative effect can be attained, benefiting both patients and therapists. Patients gain access to diverse treatment options and experience synergistic effects of combined therapies, thereby enhancing outcomes. Therapists benefit from expanded intervention choices and improved quality of patient care.This study introduces a novel strategy of amalgamating PBM with recognized interventions, such as CBT and drug therapy, to address existing challenges. This combined approach offers a practical solution to augment PBM acceptance and usage in the realm of neuropsychiatry.To endorse this strategy, a shift in the research direction is imperative. Future studies should investigate the amalgamated use of PBM with other neurointerventions, such as CBT or drug therapy. Robust clinical trials contrasting groups like “PBM + CBT” and “PBM (sham) + rTMS” are vital to persuade clinicians and patients toward embracing combined PBM therapies.Although PBM’s eventual autonomy as a neuropsychiatric treatment is an overarching goal, the present combination therapy approach proves practical, inevitable, and mutually beneficial. By bridging conventional therapies with PBM, this strategy may facilitate wider acceptance and utilization in neuropsychiatry.

Introduction: The organization of medical support for the implementation of the standards of the All-Russian physical culture and sports complex “Ready for Labor and Defense” (“RLD”) in children’s clinics on the territory of the Republic of Komi (RK) is carried out in order to develop a physical culture among the population.Patients and methods: The analysis of the results of 2652 medical examinations of children and adolescents to comply with the standards of the “RLD” in the State budgetary healthcare institution of the Republic of Komi “Syktyvkar Children’s Clinic No. 3” (“SChCl No. 3”) in 2016-2022 was carried out. The significance of differences in quantitative characteristics between groups with a normal distribution of quantitative variables was calculated using Student’s t-tests for independent samples. The threshold value of the probability of error for statistically significant differences was set at a level equal to 0.05. The frequency ratio was calculated per 10,000-child population. The depth of the study was 7 years.Results: Among patients who applied for examination only 2604 people (98.85 ± 0.21%) were allowed to pass sports standards. The FC of those who applied was 138.44 per 10,000 children, and the FC of those admitted was 135.94. The proportion of patients of “SChCl No. 3”, who were assigned the main medical group for physical education ranged over the years from 87.37 ± 1.47% in 2017 to 98.86 ± 0.34% in 2019 and on average for 7 years amounted to 94.19 ± 0.45%. That is, almost 90% of those examined are children without health and physical development disorders, but with possible functional disorders that do not lag behind their peers in physical development and physical fitness. They are allowed to study in full according to the curriculum of physical education using preventive technologies, preparation, and passing tests of individual physical fitness.Conclusion: The average annual quantitative indicator of those who applied for certification to pass the standards of the “RLD” is a statistical tool, on the one hand, to determine the current and future workload of medical personnel and determine the forces and means of medical support, on the other hand, an indirect indicator of the interest of children and adolescents in systematic physical education and sports, instilling in schoolchildren the skills of a healthy lifestyle and the prospects for the physical development of the nation. The frequency of examinations per 10,000 of the child population should be considered as an indirect marker for assessing the physical development of children and adolescents since it is not the result of a continuous, but only selective (at the request of those who applied) research. The voluntary surrender of the “RLD” standards by children and adolescents should be approached as an indicator of physical readiness and high personal self-esteem, including psychological readiness for competitive relations in the school and adolescent environment and psychological maturity.

Background and aim: Preclinical in vitro and in vivo experiments suggest that radiation-induced tumour cell death can be enhanced 10- to 40-fold when combined with focused-ultrasound (FUS)-stimulated microbubbles (MB). The acoustic exposure of MB in the tumour volume causes vasculature perturbation, activation of the acid sphingomyelinase (ASMase) ceramide pathway, and resultant endothelial cell apoptosis. When the tumour is subsequently treated with radiation, there is increased endothelial cell death and anoxic tumour killing. Here we describe a first-in-human experience treating patients with magnetic resonance (MR)-guided FUS-stimulated MB (MRgFUS+MB) radiation enhancement.Case presentation: A head and neck cancer patient with recurrent disease underwent radiotherapy for 5 separate sites of locoregional disease followed by systemic therapy. The first consisted of a course of 45 Gy in 5 fractions alone, the second of 30 Gy in 5 fractions with hyperthermia, and the three others of 20-30 Gy in 5 fractions along with MRgFUS+MB treatment. The treatment methodology used an MR-coupled FUS-device operating at 500 KHz and 540 kPa peak negative pressure with an insonification time of 750 ms spread over 5 minutes to stimulate intravenously administered MB within tumour target. All sites treated with stimulated MB had a complete radiological response, and subsequently, the patient’s other cutaneous metastatic disease disappeared. The patient has been under surveillance for over two years without active treatment or disease progression.Discussion: MRgFUS+MB was well-tolerated with no reported treatment-related adverse events, which can be attributed to the capability of FUS to selectively stimulate MB within the tumour volume while sparing the surrounding normal tissue. Sustained local control at all target sites aligns with earlier preclinical findings suggesting the radiation enhancement potential of FUS+MB.Conclusion: MRgFUS+MB represents a novel and promising therapy for enhancing radiation efficacy and improving therapeutic index with potential improvements in disease control.