A.T. Still University (ATSU) is a private medical school based in Kirksville, Missouri, with a second campus in Arizona and third campus in Santa Maria, California. It was founded in 1892 by Andrew Taylor Still and was the world's first osteopathic medical school. It is accredited by the Higher Learning Commission. ATSU includes three campuses on 200 acres with seven schools and colleges.T.T.T.T.T.T.
BACKGROUND Microsatellite instability (MSI) of colorectal cancer (CRC) is an important biomarker for treatment response to immune checkpoint inhibitor therapy. Traditionally, this has been identified using histological methods, but more recently, radiomics techniques have been applied to computed tomography (CT) images showing ability to differentiate MSI tumors. However, the variable techniques and scanner noise may limit broad application of the technique. Identifying visible, macroscopic imaging features may present a more invariant technique to identify MSI tumors on imaging.AIM To identify CT-based imaging features without radiomics to differentiate between MSI status in CRC. METHODS Imaging features of 109 subjects (58 male, 51 female) from 2011 to 2018 were stratified based on MSI status using CT scan images and pathological records. These variables included primary tumor location, primary tumor size, initial cancer stage, metastatic locations, primary attenuation compared to the liver, primary tumor growth pattern, primary tumor content, tumor margin, tumor density, and the presence or absence of mesenteric infiltration for primary tumor. Statistical analysis was performed using chi 2, t tests, and Mann-Whitney U tests. RESULTS Four clinical characteristics were statistically significant for MSI-high (MSI-H). Although the MSI-H mass is larger (P < 0.001), the MSI-H tumors have a lower cancer stage at initial diagnosis (P = 0.012) as the MSI-H CRC tends to have regional metastasis than distant metastasis (P < 0.001). MSI-H CRC tends to be right-sided while MSI-low CRC tends to be left-sided (P < 0.001). The Hounsfield unit SD was lower in the MSI-H than the MSI-low CRC, P = 0.002. The remaining primary imaging characteristics (tumor attenuation relative to the liver, tumor content, tumor growth pattern, and tumor margin) were not statistically different. Both classes of tumors were more likely to be well-defined with mucosal growth and hypoattenuating relative to the liver on portovenous phase imaging. CONCLUSION Four clinical and one imaging characteristics were statistically significant for MSI-H CRC tumors. Larger and prospective trials would be needed to assess clinical applicability of these findings.
Women remain underrepresented in physical medicine and rehabilitation, comprising only 36%-39% of residents despite evidence that diverse teams improve patient outcomes. Limited early exposure and systemic barriers may contribute to this disparity. In this cross-sectional study, we surveyed 1101 US premedical students from 198 colleges across 40 states and territories to assess perceptions of physical medicine and rehabilitation and identify effective early intervention strategies. While respondents included all gender identities, the analysis focused on the 870 female-identifying students (78.8%) due to the study's primary aim of addressing gender equity in physical medicine and rehabilitation. Only 30.6% were familiar with physical medicine and rehabilitation, with exposure primarily through social media (42.6%) and personal connections (31.1%); just 9.0% had shadowed a physical medicine and rehabilitation physician. Financial concerns were prevalent, with 68.6% citing medical education costs and 66.4% citing application fees as deterrents. Despite these barriers, 60.6% expressed interest in learning more about physical medicine and rehabilitation. Preferred engagement strategies included shadowing (81.8%), interactive workshops (76.6%), mentorship programs (60.1%), and gender-specific events such as "Women in PM&R" (62.8%). These findings underscore the need for targeted, early outreach initiatives that address both informational and financial barriers, aiming to foster greater awareness and representation of women in physical medicine and rehabilitation and ultimately support a more inclusive physician workforce.
Systematic and effective control parameter tuning is critical to achieving the desired control performance. However, existing automated tuning methods, such as evolutionary algorithms and machine learning techniques, are often time-consuming, data-dependent, and difficult to generalize across different control methods. This paper introduces a novel approach that applies model predictive control (MPC) for control parameter tuning for various systems. Unlike traditional MPC practices that are designed to directly generate control inputs, the proposed framework uses MPC to optimize control parameters, leveraging the inherent stability and feasibility of predesigned controllers. Additionally, an event-triggered MPC strategy is proposed, where an activation trigger improves computational efficiency by activating the MPC optimizer only under critical conditions, such as significant state deviations or large time intervals. Two examples are given to validate the proposed tuning approach: the lookahead distance optimization in pure pursuit control for individual dynamic systems and flocking control parameter calibrations for multi-agent dynamic systems. Simulation results demonstrate that the proposed method can optimize control parameters to achieve better control performance, such as faster convergence and more robust, while maintaining the intrinsic properties of the predesigned controllers.
PURPOSE:This study confirms the presence of accessory foramina in the orbito-sphenoid region, reinforcing their potential impact on neurovascular injury and surgical outcomes. Continued data collection will enhance accuracy and generalizability, emphasizing the need for presurgical visualization to optimize patient safety and surgical success. METHODS:This study examined variations in the orbito-sphenoidal region using donor skulls (n=10) from A.T. Still University's Gift of Body Program. Careful dissection exposed the optic canal and superior orbital fissure, and cranial variations were analyzed. RESULTS:Three donor skulls exhibited accessory foramina: two with bilateral accessory foramina and one with a single foramen in the left orbit. Foramina diameters ranged from 0.687 mm to 1.204 mm, with a mean of 1.015 mm. These findings suggest that cranial remodeling often results in variations such as accessory foramina, emphasizing the importance of preoperative visualization to reduce the risk of neurovascular damage. Further research in larger, more diverse populations is needed to better understand the clinical implications of these variations. CONCLUSION:This study confirms the presence of accessory foramina in the orbito-sphenoid region, reinforcing the need for presurgical visualization to minimize neurovascular risks. Continued research will improve accuracy and generalizability, aiding in safer surgical planning.
In this case report, we present the treatment of a 28-year-old patient with lip incompetence and vertical maxillary excess (VME), using a combination of a midpalatal miniscrew-anchored cantilever clip appliance and submerged buccal shelf miniscrews. The patient exhibited a convex profile, long face, gummy smile, and protrusion, with a Class II skeletal relationship and mentalis strain. The patient declined conventional orthognathic surgery, leading to an orthodontic camouflage treatment plan involving extraction of four first premolars, maximum retraction, and active vertical control with skeletal anchorage devices. Treatment included the use of infrazygomatic crest miniscrews, anterior subapical miniscrews, and a cantilever clip appliance for molar intrusion, resulting in significant improvement in facial profile, reduction of gummy smile, resolution of lip incompetence, and alleviation of mentalis strain. This case demonstrates the effectiveness of a nonsurgical orthodontic intervention in managing a complex case of VME and lip incompetence.
