Risk of false conformity decisions due to measurement uncertainty of Active Pharmaceutical Ingredient: A multiparametric evaluation

Abstract Medicines must be subject to physical, chemical, and biological analysis to guarantee their quality, safety, and effectiveness. Despite the efforts to ensure the reliability of analytical results, some uncertainty will always be associated with the measured value, which can lead to false decisions regarding conformity/non-conformity assessment. This work aims to calculate the specific risk of false decisions regarding conformity/non-conformity of acetaminophen oral solution dosage form. The acetaminophen samples from five different manufacturers (A, B, C, D, and E) were subject to an active pharmaceutical ingredient assay, density test, and dose per drop test according to the official compendia. Based on measured values and their respective uncertainties, the risk values were calculated using the Monte Carlo method implemented in an MS Excel spreadsheet. The results for two acetaminophen oral solution samples (C and D) provided an increased total risk value of false acceptance (33.1% and 9.6% for C and D, respectively). On the other hand, the results for the other three acetaminophen samples (A, B, and E) provided a negligible risk of false acceptance (0.004%, 0.025%, and 0.045% for A, B, and E, respectively). This indicates that measurement uncertainty is very relevant when a conformity assessment is carried out, and information on the risks of false decisions is essential to ensure proper decisions.

Multivariate guard-bands and total risk assessment on multiparameter evaluations with correlated and uncorrelated measured values

Abstract The quality, efficacy, and safety of medicines are usually verified by analytical results. Measurement uncertainty is a critical aspect for the reliability of these analytical results. The pharmacopeial compendia usually adopt a simple acceptance rule that does not consider information from measurement uncertainty. In this work, we compared decision-making using simple acceptance and decision rules with the use of guard-band for multiparameter evaluation of ofloxacin ophthalmic solution and acyclovir topical cream. Ciprofloxacin ophthalmic solution and acyclovir topical cream samples were subject to pharmacopeial tests and assays. Multivariate guard-band widths were calculated by multiplying the standard uncertainty (u) by an appropriate multivariate coverage factor (k'). The multivariate coverage factor (k') was obtained by the Monte Carlo method. According to the simple acceptance rule, all the results obtained for ciprofloxacin ophthalmic solution and acyclovir topical cream are within the specification limits. However, the risk of false conformity decisions increases for ciprofloxacin tests. Decisions made using the simple acceptance rule and decision rules with the use of guard-band may differ. The simple acceptance rule may increase the risk of false conformity decisions when the measured value is close to the regulatory specification limits and/or when the measurement uncertainty value is inappropriately high. Nevertheless, the guard-band decision rule will always reduce the risk of false conformity decisions. Therefore, using information on measurement uncertainty in conformity assessment is highly recommended to ensure the proper efficacy, safety, and quality of medicines.

Conformity evaluation of afinion 2 analyzer maintainability: Compliance practicality for Philippine National Standard PNS ISO 15189:2013 Accreditation

Objectives@#The implementation of Philippine National Standard PNS ISO 15189:2013 to support the medical laboratory to produce competent results is a recognised challenge. It is apparent that the approach of ensuring the equipment availability can be specifically optimised. No known research has focused on exploring on the conduct of conformity evaluation of Afinion 2 Analyzer maintainability for the PNS ISO 15189:2013 accredited medical laboratory. The aim of the current study was to develop a practical tool for the medical laboratory to support the internal audit process by determining the compliance status of Afinion 2 Analyzer maintainability. @*Methods@#The relevant conformance requirements in Clauses 4 (Management requirements) and 5 (Technical requirements) of PNS ISO 15189:2013, manufacturer requirements and specific requirements for accreditation from 70/101 (69%) accreditation bodies in 80/249 (32%) countries were identified as specific audit criteria for Afinion 2 Analyzer conformity evaluation checklists for the maintenance and reference equipment.

Brain Systems Underlying Fundamental Motivations of Human Social Conformity / 神经科学通报·英文版

From birth to adulthood, we often align our behaviors, attitudes, and opinions with a majority, a phenomenon known as social conformity. A seminal framework has proposed that conformity behaviors are mainly driven by three fundamental motives: a desire to gain more information to be accurate, to obtain social approval from others, and to maintain a favorable self-concept. Despite extensive interest in neuroimaging investigation of social conformity, the relationship between brain systems and these fundamental motivations has yet to be established. Here, we reviewed brain imaging findings of social conformity with a componential framework, aiming to reveal the neuropsychological substrates underlying different conformity motivations. First, information-seeking engages the evaluation of social information, information integration, and modification of task-related activity, corresponding to brain networks implicated in reward, cognitive control, and tasks at hand. Second, social acceptance involves the anticipation of social acceptance or rejection and mental state attribution, mediated by networks of reward, punishment, and mentalizing. Third, self-enhancement entails the excessive representation of positive self-related information and suppression of negative self-related information, ingroup favoritism and/or outgroup derogation, and elaborated mentalizing processes to the ingroup, supported by brain systems of reward, punishment, and mentalizing. Therefore, recent brain imaging studies have provided important insights into the fundamental motivations of social conformity in terms of component processes and brain mechanisms.

Dose effect of fluence-smoothing on intensity modulated planning after rectal cancer surgery / 中国辐射卫生

Objective To compare the dosimetric differences of four fluence smoothing (FS) levels of the Monaco system in intensity-modulated radiation therapy (IMRT) after rectal cancer surgery, and to provide a reference for FS selection in clinical practice. Methods A total of 15 postoperative patients with rectal cancer admitted in 2020 were selected. Under the same optimal conditions, FS was set to Off, Low, Medium, and High for IMRT planning. The data were analyzed by SPSS 20.0 software. The dosimetric parameters of planning target volume and organs at risk (OARs), the number of Segments, the number of monitor units (MUs), the estimated total delivery time (ETDT), and the gamma pass rate were compared between the four FS levels. Results The four FS levels resulted in clinically acceptable dosimetric parameters of the planning target volume and OARs, and there was no significant difference in dose distribution between FS levels. From FS-Off to FS-High, number of Segments, number of Mus, and ETDT decreased by 15.2%, 11.8%, and 6.7%, respectively, whereas gamma pass rate increased by 1.6%. Conclusion The IMRT plans at four FS levels can meet the clinical requirements. Considering the planning quality and execution efficiency, FS-High is recommended for postoperative IMRT of patients with rectal cancer.

An Experimental Investigation into the Influence of Illness-Related Emotions on Indicators of Conformity

Background: The COVID-19 pandemic represents a massive global health crisis which has produced significant psychological fear in individuals. Fear, a survival-related emotion studied in evolutionary psychology, leads people to place importance on conformity to group norms in terms of attitudes and behaviours, leading to better odds of survival. This study strives to explore the relationship between Illness- related emotions and the indicators of conformity. Methodology: The study employed an experimental design. Participants in the experimental group were primed by arousing disease-related threat in them, whereas the control group was not primed. Participants' tendency to endorse conformity in hypothetical situations were examined with the help of four measures- three choice-based tasks and one self-report questionnaire. Results: The research findings revealed that illness-related fear/anxiety has an impact on behavioural conformity with the majority opinion, but this impact was not significant on other three dependent measures of conformity- Valuation of Obedience, Self- reported Conformist attitudes and Liking for people with Conformist Traits. Conclusion: The study has implications in understanding the antecedent of conformity and the psychology of threat in the collectivistic culture of India, especially in the face of a pandemic.

False reports of an accomplice in a crime scene: conformity effects on memory confidence and accuracy / Relatos falsos sobre um cúmplice na cena do crime: efeitos da conformidade na confiança e na acurácia da memória / Informes falsos de un cómplice en la escena del crimen: efectos de conformidad en la confianza y precisión de la memoria

The memory reports of a given individual may be altered by preceding memory reports of another individual, a phenomenon termed memory conformity. To investigate this phenomenon, 58 undergraduate students were separated in two groups which watched one of two slightly different movies of a crime scene (one included an accomplice). Subsequently, pairs containing one participant from each group discussed the movie, and then participants responded individually whether there was an accomplice in the scene. The frequency of false reports and their confidence for the presence/absence of the accomplice were analyzed. Only false reports of seeing an accomplice were produced (by 31% of those who saw no accomplice), and confidence were as high for these responses as for correct "no-accomplice" responses. The data is consistent with prior findings, and show that confidence on false reports can be high when involving "insertion" of elements to witnessed events. (AU)

O relato sobre fatos vivenciados por um indivíduo pode ser alterado por relatos anteriores apresentados por outro indivíduo, fenômeno denominado conformidade de memória. Para investigar esse fenômeno, 58 estudantes de graduação foram separados em dois grupos, os quais assistiram cada um a um vídeo ligeiramente diferente de um mesmo crime (em um havia um cúmplice). Posteriormente, foram formados pares de discussão contendo participantes que assistiram às diferentes versões do vídeo, para, em seguida, responderem individualmente sobre se havia um cúmplice na cena testemunhada. A frequência de relatos incorretos e a confiança na presença/ausência do cúmplice foi analisada. Somente relatos falsos da presença do cúmplice foram verificados (por 31% daqueles que não viram o cúmplice no vídeo), e a confiança foi tão alta quanto as respostas corretas. Os resultados confirmam experimentos anteriores e mostram que a confiança em relatos falsos pode ser alta quando se trata de "inserção" de elementos em um evento testemunhado. (AU)

El informe de memoria sobre hechos vividos por un determinado individuo pueden ser modificados por informes de memoria de otro individuo, este fenómeno es denominado conformidad de memoria. Para investigar este fenómeno, 58 estudiantes universitarios fueron divididos en dos grupos, cada uno vio una película de una misma escena del crimen con sutiles diferencias (una de las versiones incluía un cómplice). Posteriormente, se conformaron parejas de discusión con un participante de cada grupo, y luego, de forma individual, cada persona contestó sí hubo un cómplice en la escena presenciada. Fue analizado la frecuencia de los informes falsos y su confianza en la presencia / ausencia del cómplice. Solo fueron analizados los informes falsos de la existencia del cómplice (por el 31% de los que no vieron el cómplice en el video), y la confianza fue tan alta para estas respuestas, como para las respuestas correctas de "no cómplices". Los resultados confirman los experimentos anteriores y muestran que la confianza en los informes falsos puede ser alta cuando se trata de "insertar" elementos en los eventos atestiguados. (AU)

Dosimetric investigation of non-coplanar field technology in static intensity-modulated radiation therapy for gastric carcinoma / 中国辐射卫生

Objective To compare the dosimetric characteristics of non-coplanar and coplanar field technology in static intensity-modulated radiotherapy of gastric cancer patients, so as to provide a reference for clinical radiotherapy plan selection. Methods Thirty-six patients with gastric cancer were selected to receive intensity-modulated radiotherapy in Huanggang Central Hospital, which was designed plan A and B. Group A used 7-field coplanar technology, while Group B used 7-field non-coplanar technology. We compared the differences of the optimized monitor unit, the dosimetry of organs at risk and target areas between group A and group B. Results Both group A and B could meet the requirements of doctors. The homogeneity index (0.14 ± 0.02), the conformity index (0.98 ± 0.01), Dmin (4315.21 ± 16.74) cGy、Dmean (4679.28 ± 28.39) cGy and Dmax(4952.30 ± 33.26) cGy of target areas in group B were better than those of group A. Moreover, the monitor unit of group B was much lower than that of group A, and the difference was statistically significant (P < 0.05). The Dmax, Dmean, V15, V20 and V30 of the left and right kidneys in group B were lower than those of group A. The Dmax (3408.57 ± 46.03) cGy, Dmean (1250.32 ± 14.27) cGy and V20 (44.91% ± 6.67%) of spinal cord and the Dmax (3408.57 ± 46.03) cGy, Dmean (1720.55 ± 17.42) cGy, V20 (25.31% ± 7.78%) and V30 (18.52% ± 1.56%) of small intestine were also lower than those of group A. The differences were statistically significant (P < 0.05). Conclusion The non-coplanar field radiation plan has more advantages in terms of target dose distribution and protection of organs so that it can be more considerably used in the process of planning and design.

Conformidade em Memória de Reconhecimento: Revisão Breve e Potenciais Direções de Pesquisa / Memory Conformity in Recognition: Brief Review and Research Directions

Resumo Conformidade de memória é o fenômeno em que relatos de memória de uma pessoa são modificados após exposição aos relatos de outra pessoa. Estudos sobre conformidade de memória são importantes tanto no âmbito puro quanto aplicado, especialmente quando os estímulos são carregados emocionalmente. No entanto, estudos de conformidade de memória com estímulos emocionais ainda são escassos. Além disso, os poucos estudos sobre o tema apresentam resultados contraditórios. Nesta revisão, apresentamos um breve resumo de pesquisas sobre conformidade de memória em tarefas de reconhecimento e avaliamos o papel moderador da emocionalidade na conformidade. Sugerimos como possível direção de pesquisas futuras a avaliação de duas variáveis, intervalo de retenção e distintividade dos estímulos, que podem ser cruciais para elucidar as inconsistências empíricas.

Abstract Memory conformity refers to the phenomenon in which memory reports from one person are modified by memory reports from another person. The study of memory conformity is important both in basic and applied settings, especially when the stimuli are emotionally-laden. Research on memory conformity for emotional stimuli, however, is surprisingly scarce. Here we briefly review research on memory conformity in recognition tasks and assess the modulatory role of emotionality on conformity effects. We also propose further research based on the manipulation of two variables, retention interval and stimulus distinctiveness, that could help to reconcile the discrepant findings in the literature.

Indústria cultural: o pensar cristalizado / Cultural industry: crystallized thinking / Industria cultural: el pensar cristalizado

Este artigo discute como a indústria cultural, tal como conceituada por Adorno e Horkheimer, se consolidou como um dos elementos socializadores mais importantes na contemporaneidade, pois tem um papel formativo na subjetividade dos indivíduos e na conservação do sistema capitalista de produção. Nesse sentido, discorremos sobre a indústria cultural e a obra de arte autêntica, e suas relações com a organização subjetiva do indivíduo contemporâneo. Para explicitar como esses conceitos operam, recorremos ao exemplo do Jornalismo Policial televisivo, que encarna muitos dos processos apontados pela crítica à indústria cultural. A partir destas considerações, conclui- se que a indústria cultural, ao colonizar os mais diversos aspectos da vida individual, promove uma profunda reificação da personalidade. O indivíduo que assim se produz é o contrário do sujeito autônomo e independente, pois é incapaz de um julgamento crítico sobre sua própria condição.

This article discusses how the cultural industry, as conceptualized by Adorno and Horkheimer, has consolidated itself as one of the most important socializing elements in contemporary times, since it has a formative role in the subjectivity of individuals and in the conservation of the capitalist system of production. In this sense, we discuss the cultural industry and the authentic work of art, and its relations with the subjective organization of the contemporary individual. To explain how these concepts operate we resort to the example of television police journalism, which embodies many processes pointed out by critics of the cultural industry. From these considerations, it is concluded that the cultural industry, by colonizing the most diverse aspects of the individual life, promotes a deep reification of the personality. The individual thus produced is the opposite of the autonomous and independent subject, for he is incapable of a critical judgment on his own condition.

Este artículo discute cómo la industria cultural, tal como lo conceptualizan Adorno y Horkheimer, se ha consolidado como uno de los elementos de socialización más importantes en los tiempos contemporáneos, ya que tiene un papel formativo en la subjetividad de los individuos y en la conservación del sistema de producción capitalista. En este sentido, discutimos la industria cultural y la auténtica obra de arte, y sus relaciones con la organización subjetiva del individuo contemporáneo. Para explicar cómo operan estos conceptos, recurrimos al ejemplo del periodismo policial televisivo, que encarna varios procesos señalados por los críticos de la industria cultural. De estas consideraciones, se concluye que la industria cultural, al colonizar los aspectos más diversos de la vida individual, promueve una profunda reificación de la personalidad. El individuo así producido es lo opuesto al sujeto autónomo e independiente, ya que es incapaz de un juicio crítico sobre su propia condición.

Aspectos teóricos e implicações práticas da conformidade de memória: uma revisão / Theoretical aspects and practical implications of memory conformity: a review / Aspectos teóricos e implicaciones prácticas de la conformidad de memoria: una revisión

A conformidade de memória consiste em alterações dos relatos de memória de um indivíduo provocadas por relatos de memória de outro(s) indivíduo(s). Considerando a importância deste fenômeno no âmbito forense, especialmente na entrevista de testemunhas oculares, o objetivo do presente estudo é compreender melhor o fenômeno da conformidade de memória, e discutir suas implicações nas práticas de inquérito policial. Para isto, realizamos uma revisão narrativa de estudos de laboratório sobre conformidade de memória e de estudos sobre práticas de inquérito. A literatura indica que embora a investigação científica da conformidade de memória tenha apresentado grande avanço nas últimas duas décadas, a incorporação destes achados na prática forense brasileira ainda é lenta. No Brasil, a adoção de práticas de entrevista de testemunhas baseadas em evidência ainda depende de infraestrutura adequada, além de alterações legislativas e em procedimentos administrativos, policiais e jurídicos.

Memory conformity consists of changes in the memory reports of an individual caused by the memory reports of another individual. Considering the importance of this phenomenon to forensic practices, especially to eyewitness testimony interview, the goal of the present study was to discuss the current scientific knowledge about this phenomenon, and to consider its implications to public inquiry practices. For this purpose, the current narrative review included laboratory studies on memory conformity and studies on public inquiry practices. The literature suggests that although the scientific investigation on memory conformity has made great progress in the last two decades, the inclusion of the knowledge produced by this progress in Brazilian forensic practices remains scant. That is, the adoption of evidence-based eyewitness interview practices in Brazil still depends on infrastructure improvements, as well as changes on legislation and on several legal procedures.

La conformidad de memoria consiste en cambios en los informes de memoria de un individuo causados por los informes de memoria de otro individuo. Considerando la importancia de este fenómeno en la esfera forense, especialmente en la entrevista de testigos, el objetivo del presente estudio es mejor comprender el fenómeno de conformidad de memoria y discutir sus implicaciones en las prácticas de investigación policial. Para este propósito, llevamos a cabo una revisión narrativa en estudios de laboratorio sobre la conformidad de memoria y estudios sobre las prácticas de investigación. La literatura indica que, aunque la investigación científica de la conformidad de memoria ha avanzado mucho en las últimas dos décadas, la incorporación de estos hallazgos en la práctica forense brasileña aún es lenta. En Brasil, la adopción de prácticas de entrevista a testigos presentadas en este artículo todavía depende de una infraestructura adecuada, además de los cambios legislativos y los procedimientos administrativos, policiales y legales.

Evaluating different radiotherapy treatment plans, in terms of critical organ scoring index, conformity index, tumor control probability, and normal tissue complication probability calculations in early glottic larynx carcinoma

Purpose: In this study, it is aimed to compare three different radiotherapy treatment planning techniques in terms of critical organ scoring index (COSI), two different conformity index (CI), tumor control probability (TCP), and normal tissue complication probability (NTCP) calculations in early (T1) glottic larynx carcinoma (T1GL). Furthermore, it is aimed to investigate these parameters compliance with dose-volume histograms (DVH) parameters. Materials and Methods: Ten T1GL patients were immobilized in a supine position with a head and neck thermoplastic mask. Treatment plans were created with opposed lateral fields (OLAFs) and intensity-modulated radiation therapy (IMRT) techniques with a total dose of 66 Gy in 33 fraction with 2 Gy/day. IMRT fields were selected as five fields (5IMRT) and seven fields (7IMRT). Dosimetric evaluation of three different treatment plans for T1GL carcinoma was performed in two consequential steps. First step was the assessment of planning target volume (PTV), all organs at risks (OARs), and normal tissue (NT) dose calculations according to given dose constraint directions and comparing the plans via DVH. In the second step, for PTV, the compatibility of DVH data with CIs-TCP was investigated where COSI-NTCP was compared with DVH for OARs. The DVH data were considered as reference in all evaluations. Results: The CIRTOG mean values were significantly closer to 1 with IMRT plans when compared to OLAF plans (P = 0.005). The CIPADDICK mean values revealed that OLAF plans were significantly worse than IMRT plans (P = 0.005). No statistically significant difference was found between all three plans in terms of homogeneity index mean values (P = 0.076). The calculated mean TCP values were significantly better for 7IMRT plans when compared to OLAF and 5IMRT plans (P = 0.007 and P = 0.017, respectively). Both NTCP and COSI evaluations, which is compatible with DVH, significantly favored OLAF plan for spinal cord and 7IMRT for thyroid gland. The COSI evaluations, which are compatible with DVH, significantly favored 7IMRT plan for carotid arteries and 5IMRT plan for NT. Conclusion: Our results demonstrated that CIPADDICK-TCP calculations for PTV and COSI-NTCP calculations for OARs were compatible with DVH in T1 GL plans. Therefore, we suggest such parameters as valuable tools for choosing the feasible one among multiple plans and even with different treatment machines

Conformity evaluation of afinion 2 analyzer maintainability: Compliance practicality for Philippine National Standard PNS ISO 15189:2013 accreditation

Objectives@#The implementation of Philippine National Standard PNS ISO 15189:2013 to support the medical laboratory to produce competent results is a recognised challenge. It is apparent that the approach of ensuring the equipment availability can be specifically optimised. No known research has focused on exploring on the conduct of conformity evaluation of Afinion 2 Analyzer maintainability for the PNS ISO 15189:2013 accredited medical laboratory. The aim of the current study was to develop a practical tool for the medical laboratory to support the internal audit process by determining the compliance status of Afinion 2 Analyzer maintainability.

Adherence to fibromyalgia treatment: challenges and impact on the quality of life / Adesão ao tratamento da fibromialgia: desafios e impactos na qualidade de vida

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia is a chronic and idiopathic syndrome, characterized by a general distributed pain, more prevalent in women. Its pathophysiology remains unclear. Its chronicity implies an exclusively symptomatic treatment, often unsatisfactory. The lack of adherence to the established treatment is quite common. The objective of this study is to present a review of the adherence to the fibromyalgia syndrome treatment. CONTENTS: The concept of adherence to the fibromyalgia syndrome treatment, its classification, the identification of its measurement options, and the detection of its causes are detailed, revised and updated. CONCLUSION: The review of the literature regarding the adherence to the fibromyalgia syndrome treatment points to a large number of nonconformity of prescription, in general with the prevalence of the adoption of the reduction of the recommended dose and the interruption of the treatment, over possible overdoses and self-medication. The study of the causes that led to the non-adherence to the treatment elects the characteristics of the syndrome as the great villain for its occurrence. However, other associated factors such as the age of the subject with fibromyalgia, the intensity of the pain, the established polypharmacy, the quality of the doctor-patient relationship and the socioeconomic variables were also listed. The patient's quality of life was always higher in patients with higher adherence to treatment and persistence. Patients' quality of life indices may indicate the level of commitment to treatment adherence, and vice versa.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fibromialgia é uma síndrome crônica e idiopática, caracterizada por queixa dolorosa de distribuição generalizada, mais prevalente em mulheres. A sua fisiopatologia continua não totalmente esclarecida. Sua cronicidade implica em tratamento exclusivamente sintomático e muitas vezes insatisfatório. A falta de adesão ao tratamento instituído é bastante comum. O objetivo deste estudo foi apresentar uma revisão sobre a adesão do tratamento da síndrome fibromiálgica. CONTEÚDO: O conceito de adesão ao tratamento da síndrome fibromiálgica, sua classificação, a identificação das opções de sua mensuração, e a detecção de suas causas são detalhados, revisados e atualizados. CONCLUSÃO: A revisão da literatura referente à adesão ao tratamento da síndrome fibromiálgica mostra um grande contingente de inconformidade de prescrição, em geral predominando a adoção da redução da dose orientada e a interrupção do próprio tratamento, sobre possíveis sobredoses e automedicações. O estudo das causas que levaram à falta de adesão ao tratamento elege as características da própria síndrome como a grande vilã para sua ocorrência; embora, tenham sido também elencados outros fatores associados como a idade do portador da síndrome fibromiálgica, a intensidade da dor, a polifarmácia instituída, a qualidade da relação médico-paciente, e as variáveis socioeconômicas. A qualidade de vida dos pacientes sempre foi maior naqueles cuja adesão e persistência ao tratamento foram maiores. Os índices de qualidade vida dos pacientes podem indicar o nível de comprometimento com a adesão ao tratamento, e vice-versa.

Search of an ideal location of isocenter in intensity-modulated radiotherapy treatment plans: A dosimetrical approach

Aim: The aim of this study is to identify an ideal location of isocenter in intensity-modulated radiotherapy (IMRT) treatment plans. Materials and Methods: A total of 28 clinical target volumes and 4 English capital letters (C, L, T, and H) target volumes were considered in this study. Two IMRT treatment plans were generated for each target volume in the ECLIPSETM treatment planning system (TPS), first one with isocenter automatically placed (ISOAUTO) by TPS and the second one with geometric center-based isocenter (ISOGEOM). The geometric center of a cuboid volume, which was formed encompassing around the target volume in sagittal, transverse, and frontal planes, is considered as the geometric center of the target volume as well as the isocenter (ISOGEOM) of the IMRT plans. While performing the IMRT treatment plans using the beam angle optimization and dose volume optimization, the normal tissue objectives and target volume objectives were kept similar in both the plans. The dosimetrical parameters between the two groups of plans were compared. Results: The distance between ISOGEOM and ISOAUTO ranged from 0.16 cm to 3.04 cm with a mean and median of 0.85 cm and 0.69 cm, respectively. The ISOGEOM-based IMRT plans exhibited statistically significant advantages in total monitor units reduction (100% of cases, P ≤ 0.001), total number of field reduction (66% of cases, P ≤ 0.001), and reduction of patient mean dose (69% of cases, P ≤ 0.001) over ISOAUTO-based IMRT plans. The conformity index, homogeneity index and target mean dose were comparable between both group of plans. Conclusion: Significant dosimetrical advantages may be observed, when the geometric centroid of target volume is considered as isocenter of IMRT treatment plan.

Applied anatomy of the compression of the proper plantar digital nerves of the medial great toe / 中华显微外科杂志

Objective To identify the routes and branches of the proper plantar digital nerves(PPDN) in the medial of the great toe and its adjoining relationship among the surrounding fascia tissues and organs,which was expected to provide accurate localization of the nerve impingement and possible relevant of anatomical basis for the treatment of nerve entrapment in clinical utility.Methods From December,2016 to January,2019,a total of 54 formalin fixed feet were collected.Fifty of them were performed conventional anatomical procedure,the other 4 were prepared with sectional anatomical technique.The seats and branches of the PPDN in the medial of the great toe were observed;The width and thickness of the nerve were measured at the first metatarpophalangeal joint(FMPJ),along with its proximal and distal sides 0.5 cm.The origin and origin of fascia were observed by foot dissection.Masson staining was used to observe the tissue changes of the nerves in the FMPJ.Results The PPDN of the medial great toe run between the flexor pollicis longus tendon and the abductor pollicis tendon at the proximal,issued (4.21±0.12) final branches.And governed the sensation of the medial half of the great toe.The width of the nerve at the FMPJ was (3.50±0.09) mm,which was significantly increased compared with that of the near [(1.58±0.04) mm] and far [(1.56± 0.03) mm] from the joint.The difference was statistically significant (P＜0.05);The thickness of the nerve in the proximal segment was (0.83±0.04) mm,and that in the distal segment was (0.82±0.03) mm.Compared with that in the FMPJ [(0.67±0.02) mm],the difference was statistically significant (P＜0.05).A deep fascia was observed on the superficial surface of the PPDN at medial great toe,which was stretched between the tendon sheath of the flexor pollicis longus tendon and the tendon of the abductor pollicis muscle.Masson staining showed obvious proliferation of nerve outer mem brane fibers at the metatarpophalangeal joint,the number of nerve fiber bundles increased,and obvious thickening of nerve fiber bundles and nerve fascia.Conclusion Long-term compression can lead to thickening of the epineurium and perineurium,and the superficial fascia is an important factor of thumb pain and numbness caused by the compression of the PPDN at medial of the great toe.

Study on fast prediction of film coating terminal point of Tianshu Tablets by near- infrared spectroscopy / 中草药

Objective: To investigate how to rapidly predict coating terminal point in the thin film coating of Tianshu Tablets by near-infrared spectroscopy (NIRS). Methods: Firstly, synergy interval partial least square (siPLS) was used to optimize the modeling intervals and the pretreatment methods were screened. Secondly, according to the optimal modeling parameters, the conformity test and similarity matching were used to establish calibration models based on the established reference spectra library. Subsequently, by comparing the similarities between the test spectra and the reference spectra, the threshold value was set. The relation among the similarities, threshold value and the coating end point was obtained. Finally, the performance of the calibration model was verified by the validation set. Results: During the coating process, the similarities between the test spectra and the reference spectra were gradually increasing until the similarities of continuous test spectra exceeded the threshold, thus, indicating the end point. Conclusion: Conformity test and similarity matching can sensitively monitor the change of similarities among spectra and the corresponding trend. Both models have high performance, which can accurately predict the coating terminal point. It’s of great significance to reduce batch-to-batch variation in film coating and the loss of coating materials, and improve the coating efficiency and the quality uniformity of solid preparation.

Género no conforme y medicina / Gender non-conformityand medicine

El concepto de género no conforme o más conocido como transgénero, corresponde a un grupo de personas que no se identifican con el género asignado al nacer y/o aquellos cuya expresión de género no cae en la definición de masculino o femenino. Desde el punto de vista médico, debemos considerar que la población transgénero es un grupo de riesgo, ya que padecen mayores comorbilidades, principalmente por patología psiquiátrica y riesgo social. Desde la perspectiva de la atención en salud, existen sin duda barreras que van desde las aseguradoras que ofrecen nula o poca cobertura de prestaciones tales como terapia hormonal, apoyo psicológico y cirugía de reconstitución, hasta la atención del personal de salud, conllevando esto a que un 30% de los pacientes transgénero pospone o no consulta por temor a ser discriminado. Específicamente en los programas de residencia de ginecología y obstetricia en EE.UU, un estudio reportó que sólo un 51% contemplaba en su programa de educación el cuidado de pacientes transgénero. La mayoría de los residentes considera que se trata de un tema importante que debe ser incluido en los programas de formación.

Transgender people, also known as gender non-conforming people, are those who do not identify with the gender assigned to them at birth and/or those whose gender expression cannot be defined as feminine or masculine. The transgender population has more comorbidity, mainly psychiatric, and has higher social risk, making them a risk group from a medical point of view. There are doubtless barriers to health care ranging from lack of health insurance coverage for hormonal therapy, psychological support and reconstructive surgery to the attitude of healthcare professionals which results in 30% of transgender patients not attending healthcare for fear of being discriminated against. In the U.S.A only 51% of gynecological and obstetric residence programs address the care of transgender patients. Most residents consider it an important issue which should be included in training programs.

Extrato de tomate: características físico-químicas e microscópicas

O tomate está entre os frutos mais consumidos mundialmente, devido à diversidade de produtos derivados, sendo os principais suco, molho, ketchup e extrato de tomate. Este trabalho teve como objetivo analisar as características físico-químicas e microscópicas de extratos de tomate. Sete marcas de extratos de tomate, totalizando 21 amostras, foram analisadas quanto aos teores de sólidos solúveis totais (SST), pH, acidez total titulável (ATT), umidade, cinzas, cloreto de sódio, coloração e determinação de matérias estranhas. Foram verificadas diferenças significativas entre as amostras para os SST, porém, todas as amostras apresentaram teores superiores a 6%, estando de acordo com a legislação. Os demais parâmetros físico-químicos, mostram-se semelhantes aos encontrados na literatura. Na análise microscópica, somente uma amostra não estava conforme a legislação vigente, apresentando fragmentos de insetos acima do limite de tolerância.

Tomato is among the most consumed fruits worldwide, due to diversity of products produced, including juice, sauce, ketchup and tomato extract. The work has as objective analyze the physico-chemical characteristics and microscopic of tomato extracts. Seven brands of tomato extracts, totaling 21 samples, were analyzed as to the levels of total soluble solids (TSS), pH, titratable total acidity (TTA), moisture, ashes, sodium chloride, coloring and determination of foreign material. Significant differences were found between samples for TSS, however, all samples presented levels higher than 6%, being in accordance with the legislation. The other physicalchemical parameters are similar to those found in the literature. In microscopic analysis, only one brand was not compliant with the current legislation, presenting insect fragments above the tolerance limit.

Extrato de tomate: características físico-químicas e microscópicas

O tomate está entre os frutos mais consumidos mundialmente, devido à diversidade de produtos derivados, sendo os principais suco, molho, ketchup e extrato de tomate. Este trabalho teve como objetivo analisar as características físico-químicas e microscópicas de extratos de tomate. Sete marcas de extratos de tomate, totalizando 21 amostras, foram analisadas quanto aos teores de sólidos solúveis totais (SST), pH, acidez total titulável (ATT), umidade, cinzas, cloreto de sódio, coloração e determinação de matérias estranhas. Foram verificadas diferenças significativas entre as amostras para os SST, porém, todas as amostras apresentaram teores superiores a 6%, estando de acordo com a legislação. Os demais parâmetros físico-químicos, mostram-se semelhantes aos encontrados na literatura. Na análise microscópica, somente uma amostra não estava conforme a legislação vigente, apresentando fragmentos de insetos acima do limite de tolerância

Tomato is among the most consumed fruits worldwide, due to diversity of products produced, including juice, sauce, ketchup and tomato extract. The work has as objective analyze the physico-chemical characteristics and microscopic of tomato extracts. Seven brands of tomato extracts, totaling 21 samples, were analyzed as to the levels of total soluble solids (TSS), pH, titratable total acidity (TTA), moisture, ashes, sodium chloride, coloring and determination of foreign material. Significant differences were found between samples for TSS, however, all samples presented levels higher than 6%, being in accordance with the legislation. The other physicalchemical parameters are similar to those found in the literature. In microscopic analysis, only one brand was not compliant with the current legislation, presenting insect fragments above the tolerance limit