ProCure (United States)

Background: Knee ultrasonography is a key diagnostic and research tool for evaluating joint effusion, synovitis, tendon, and ligament integrity. Despite its widespread use, methodological inconsistencies across studies—ranging from patient positioning to probe settings—limit reproducibility and cross-study comparability. Objective: To outline a standardized, evidence-based procedure for knee joint ultrasound suitable for research applications, aligning with international guidelines to ensure methodological rigor and reproducibility. Methods: A comprehensive research framework was developed incorporating standardized participant selection, equipment calibration, scanning parameters, patient positioning, and both static and dynamic maneuvers Results: Implementing standardized ultrasound protocols minimizes measurement variability, improves the accuracy of synovial and vascularity assessment, and enhances longitudinal monitoring of therapeutic responses. Conclusion: Methodological standardization in knee ultrasound strengthens data validity, promotes reproducibility, and facilitates integration of imaging biomarkers into clinical and translational musculoskeletal research. The outlined framework serves as a template for future multicenter and longitudinal ultrasound studies.

The integration of traditional acupuncture systems with modern biomedical technologies offers promising avenues for therapeutic innovation. This study explores the efficacy of superficial galvanic stimulation applied to Master Tung acupuncture points, aiming to evaluate its potential in enhancing clinical outcomes. Master Tung’s points, renowned for their precision and systemic effects, were selected as stimulation sites to bridge classical theory with contemporary practice. Through structured patient selection, point identification, device application, and subsequent data analysis, the intervention was assessed for its impact on symptom modulation and physiological response. Findings suggest that superficial galvanic stimulation not only reinforces the therapeutic relevance of Master Tung’s system but also demonstrates measurable benefits when interpreted through modern clinical frameworks. This approach highlights the potential of bridging tradition and modernity to create innovative, evidence-based pathways in integrative medicine.

6066 Background: Osteoradionecrosis (ORN) is a late complication of head and neck radiotherapy (RT) that negatively impacts survivorship. Although there is an abundance of literature reporting on ORN for photon-based RT, few studies have investigated the correlation between proton therapy and ORN; also, the current literature on ORN incorporates a broad mix of head and neck subsites. Therefore, we report our 10-year institutional experience to assess rates of ORN in a homogenous and consecutive cohort of patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with curative-intent radiotherapy, representing the largest available institutional series. Methods: A consecutive cohort of 1564 OPSCC patients (1344 definitive, 220 post-operative) who received at least 50Gy were treated at our institution between 2013 and 2023 were included in this study. Patients were treated with either IMRT or proton therapy. CTCAE version 5 was used for ORN grading. Results: Overall ORN rate was 4.35%. Of 1389 patients who underwent IMRT, 56 (4.03%) developed ORN, vs 12/175 (6.86%) treated with proton therapy (hazard ratio [HR] 2.62, 95%CI 1.39–4.93, P=0.003). Median time to ORN in the IMRT arm was 25mo (range, 2mo–91mo). Median time to ORN in the proton arm was 23.5mo (2mo–45mo). Post-operative vs definitive treatment setting was not associated with the rate of ORN (univariate Cox HR 1.00, 95% CI 0.51–1.95, P=0.99). On subset analysis of the 1344 patients treated in the definitive setting, 47/1210 (3.88%) patients treated definitively with IMRT developed ORN as compared to 11/134 (8.21%) patients treated definitively with protons (univariable Cox HR 3.62, 95% CI 1.85–7.09, P<0.001). On multivariable analysis including treatment modality and use of chemotherapy, proton therapy was associated with increased hazard of ORN (HR 2.75, 95%CI 1.46–5.19, P=0.002). Concurrent chemotherapy was also independently associated with increased hazard of ORN (HR 3.34, 95%CI 1.05–10.65, P=0.041). A total of 10 out of 1564 (0.64%) patients developed CTCAE grade 3 ORN. The rates of grade 3 ORN were 2/175 (1.14%) in the proton cohort and 8/1389 (0.58%) in the IMRT cohort. This difference was not statistically significant on univariable Cox analysis (HR 2.44, 95%CI 0.51–11.60, P=0.26). Conclusions: The overall prevalence of ORN was 4.35%; the prevalence of >/= grade 3 ORNs was 0.64% in this consecutive cohort of patients with OPSCC treated with either IMRT or proton therapy. The overall prevalence of ORN of any grade was statistically higher for protons versus IMRT, a difference that was more pronounced in the definitive setting. Given the uncertainties with relative biological effectiveness calculations in proton therapy, avoidance of hot-spots, frequent replanning, and use of empirical proton-specific normal tissue constraints may help to reduce rates of ORN. Future work should explore the role of combination proton and photon treatment, especially in the definitive setting.

For localized disease (N=60), 50 patients received focal RT and 10 received CSI. The original article has been corrected. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.