Boron neutron capture therapy (BNCT) is a promising cancer treatment; however, it poses the risk of soft errors in cardiac implantable electronic devices (CIEDs). This study aimed to assess the occurrence of soft errors in CIEDs during BNCT and to correlate these errors with the neutron flux. A field-programmable gate array (FPGA) was used as a surrogate for CIED to measure the soft errors under thermal and epithermal neutron irradiation. The neutron flux at the FPGA position was assessed using gold wire activation, and the effective soft-error cross-section was calculated. The neutron flux exhibited a clear inverse relationship with distance from the irradiation center. The number of soft errors observed in the FPGA mirrored this trend, showing a significant reduction as the distance from the beam center increased. A strong linear correlation was identified between the thermal neutron flux and soft-error rate, and a consistent reaction cross-section was derived. This study provides foundational data on soft-error risks in electronic devices during BNCT. Our findings indicate that increasing the distance from the beam center significantly reduces the soft-error rate. These insights are crucial for developing robust radiotherapy safety guidelines for patients with implanted electronic devices.
Background Reliable biomarkers for prognostication and recurrence surveillance in esophageal squamous cell carcinoma (ESCC) remain limited. The authors therefore investigated the potential clinical utility of exosomal DNA, which has emerged as a promising component of liquid biopsy. Methods This study screened 54 patients with ESCC. After exclusions, 210 blood samples from 21 patients underwent mutation-specific droplet digital polymerase chain reaction assays of plasma exosomal DNA (exoDNA) and circulating tumor DNA (ctDNA) before and after treatment. Kaplan-Meier and receiver operating characteristic analyses were performed to examine associations with overall survival (OS), disease-specific survival (DSS), relapse-free survival (RFS), and recurrence. Results Pretreatment exoDNA positivity was significantly associated with shorter DSS (p = 0.035) and shorter RFS (p = 0.048). Post-treatment exoDNA positivity was significantly associated with shorter OS (p = 0.0008), DSS (p = 0.0001), and RFS (p = 0.0001). Post-treatment ctDNA positivity was associated with shorter DSS (p = 0.038). Conclusions In ESCC, exoDNA demonstrated prognostic and predictive value, supporting its potential role as a complementary biomarker for postoperative surveillance.
Anterior impaction pilon fractures (AIPs) are a distinct subtype of tibial pilon fractures caused by axial loading of the ankle in dorsiflexion and are associated with severe anterior plafond comminution, anterior talar subluxation, and a high risk of post-traumatic osteoarthritis (PTOA). Optimal surgical strategies for AIP remain unclear. This retrospective case series included 23 consecutive patients with AIP treated surgically between 2013 and 2023 with a minimum follow-up of one year. The treatment strategy consisted of anatomical reduction of the impacted anterior tibial plafond and rafting fixation using an anterolateral distal tibial plate, with supplementary fixation and bone grafting as required. Anterior talar subluxation was assessed using the lateral talar station (LTS) as the difference between injured and contralateral ankles immediately postoperatively (ΔLTS-1) and at one year (ΔLTS-2). Clinical outcomes included bone union, the American Orthopaedic Foot Ankle Society (AOFAS) Ankle–Hindfoot score, ankle range of motion, PTOA graded by the modified Kellgren–Lawrence scale, and complications. Mean ΔLTS-1 and ΔLTS-2 were 0.77 ± 1.8 mm and 0.5 ± 2.3 mm, respectively, with no significant difference (p = 0.33). Bone union was achieved in all cases. PTOA developed in 9 patients, with a mean modified Kellgren–Lawrence grade of 0.8 ± 1.2. The mean AOFAS score was 91.6 ± 9.6. Deep infection occurred in three patients, and five required soft-tissue reconstruction. Anatomical reduction of the anterior plafond combined with stable anterolateral rafting fixation maintained talar alignment and produced favourable short-term clinical outcomes in patients with AIP.
Popliteal artery injury (PAI) associated with proximal tibial fracture (PTF) is rare but limb-threatening, and its morphological characteristics remain poorly defined. This study aimed to investigate the fracture patterns, associated vascular and soft tissue injuries, and clinical outcomes of PTF with PAI. We retrospectively reviewed cases of PTF with PAI treated at a single institution. Based on previous reports and our experience, fractures were classified into isolated medial tibial plateau fracture (IMTPF), hyperextension bicondylar tibial plateau fracture (HBTPF), metaphyseal shearing fracture (MSF), and others. Clinical characteristics, treatment strategies, and outcomes were analyzed. Among 336 patients with PTF, nine (2.7
Redo transcatheter aortic valve replacement (TAVR) when implanting a second transcatheter valve within a tall-frame self-expanding valve can be challenging because of unfavorable coronary-related anatomy. However, computed tomography (CT)-based data in Asian patients with smaller aortic root dimensions remain limited.This study aimed to evaluate the CT-based geometric coronary constraints by simulating implantation of a balloon-expandable SAPIEN 3 (S3) within a previously implanted self-expanding Evolut valve in Asian patients. Consecutive patients who underwent TAVR using Evolut at a single center between May 2021 and May 2023 and had post-procedural CT were analyzed. Virtual S3-in-Evolut implantation was simulated at three depths (node 4: low; node 5: intermediate; node 6: high). Geometric coronary constraint was assessed based on the relationship between the neo-skirt plane and coronary ostia and the valve-to-aorta distance. Among 113 patients, the distribution of geometric coronary constraint differed by simulated S3 implantation depth. With high S3 implantation (node 6), severe, intermediate, and low constraint were observed in 63.7%, 23.9%, and 12.4% of patients, respectively; with intermediate implantation (node 5), in 31.0%, 29.2%, and 39.8%; and with low implantation (node 4), in 3.5%, 16.8%, and 79.6%. In multivariable analysis, smaller sino-tubular junction diameter was independently associated with severe geometric coronary constraint.Geometric coronary constraints that may affect coronary access after redo TAVR with S3-in-Evolut configurations depend on the implantation depth of both the index Evolut and the simulated S3. However, the hemodynamic significance and clinical impact of these geometric findings require validation through flow studies.
