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Current studies have found that cognitive training has a significant effect on the improvement of training task performance in the elderly, but the training effects are difficult to transfer to untrained cognitive tasks.Recent studies have found that adaptive cognitive training can obtain better transfer effects.This article focuses on the transfer and maintenance effects of adaptive cognitive training; reviews recent research on brain mechanisms related to adaptive cognitive training; analyzes existing problems in the field, and proposes further studies to explore ways for effective implementation of adaptive cognitive training with continuously challenging tasks and to elucidate the cognitive and neural mechanisms related to the transfer effects.
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Objective:To develope an automatic volumetric modulated arc therapy (VMAT) planning for rectal cancer based on a dose-prediction model for organs at risk(OARs) and an iterative optimization algorithm for objective parameter optimization.Methods:Totally 165 VMAT plans of rectal cancer patients treated in Peking University Cancer Hospital & Institute from June 2018 to January 2021 were selected to establish automatic VMAT planning. Among them, 145 cases were used for training the deep-learning model and 20 for evaluating the feasibility of the model by comparing the automatic planning with manual plans. The deep learning model was used to predict the essential dose-volume histogram (DVH) index as initial objective parameters(IOPs) and the iterative optimization algorithm can automatically modify the objective parameters according to the result of protocol-based automatic iterative optimization(PBAIO). With the predicted IOPs, the automatic planning model based on the iterative optimization algorithm was achieved using a program mable interface.Results:The IOPs of OARs of 20 cases were effectively predicted using the deep learning model, with no significantly statistical difference in the conformity index(CI) for planning target volume(PTV)and planning gross tumor volume(PGTV)between automatic and manual plans( P>0.05). The homogeneity index (HI) of PGTV in automatic and manual plans was 0.06 and 0.05, respectively( t=-6.92, P< 0.05). Compared with manual plans, the automatic plans significantly decreased the V30 for urinary bladder by 2.7% and decreased the V20 for femoral head sand auxiliary structure(avoidance)by 8.37% and 15.95%, respectively ( t=5.65, 11.24, P< 0.05). Meanwhile, the average doses to bladder, femoral heads, and avoidance decreased by 1.91, 4.01, and 3.88 Gy, respectively( t=9.29, 2.80, 10.23, P< 0.05) using the automatic plans. The time of automatic VMAT planning was (71.49±25.48)min in 20 cases. Conclusions:The proposed automatic planning based on dose prediction and an iterative optimization algorithm is feasible and has great potential for sparing OARs and improving the utilization rate of clinical resources.
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Objective:To assess the three-dimensional dose distribution in radiotherapy plans using the structural similarity index(SSIM), compare the performance of SSIM with commonly used quality assessment indices, and develop a SSIM-based quality assessment method of multiple prescribed doses.Methods:The SSIM was introduced to providea quality score of various voxels by comparing actual and ideal three-dimensional dose data and combining the spatial location information of the voxels. Then the average value in a region of interest (ROI) was calculated as the quality score of the region. Fifty-three cases of cervical cancer were selected to analyze the correlation of the SSIM with the uniformity index (HI), conformity index (CI) of the dose distribution in various ROIs and to explore the capability of the SSIM to reflect the uniformity and conformity of dose distribution.Two types of quality defects were individually introduced into two of 53 radiotherapy plans. Then the two plans were compared with normal plans to characterize the response of the SSIM.Results:There was no correlation between HI and SSIM in positive lymph nodes(PGTVnd) due to the decrease in the HI sensitivity, while there was a significant negative correlation between them in regions where PGTVnd was removed from the planning target volume(PTV, R=-0.86, P<0.01). Meanwhile, there was a significant positive correlation between CI and SSIM in PGTVnd ( R=0.83, P<0.01). Therefore, the SSIM can be used to identify the artificial design defects in plans by determining abnormal dose gradients. Conclusions:Apart from reducing the defects of previous assessment parameters, the SSIM has the capability to assess the quality of radiotherapy plans by combining the uniformity and conformity of dose distribution and can provide accurate feedback on the spatial locations of quality defects.
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Objective:To solve the problems in intensity-modulated radiation therapy (IMRT) planning, such as large labor cost and high dependence on the experience of physicists and great inconsistency in the quality of plan, and to discuss an unsupervised automatic treatment planning procedure of IMRT.Methods:The eclipse scripting application programming interface (ESAPI) within the Eclipse treatment planning system (TPS) 15.6 and optimization parameters tree search algorithm (OPTSA) were used to emulate and realize the whole planning process. Interacted with the TPS through ESAPI, relevant dosimetric parameters were input and output. The OPTSA evaluated the plan qualities based on dosimetric parameters of the targets and organs at risk (OARs) and iteratively adjusted the optimization objective parameters to achieve a progressively improving IMRT plan. In order to verify the effectiveness of the automatic planning, twenty historical rectum cancer cases were selected from the clinical database, and the dose distribution and specific dosimetric parameters were compared between the plans generated by the OPTSA and the manual plans under the same constraints.Results:All the auto plans have met clinical requirements. Furthermore, 90% and 10% of the auto plans were deemed as clinically improved and equally compared with the manual plans, respectively. The average CI for the PTV was 0.88 and 0.80 for the auto and manual plans respectively. Compared with the manual plans, the mean doses of all the OARs in the auto plans were reduced by 11% in average. The average elapsed time of automatic planning and manual planning was (28.15±3.61) and (36.7±4.6) min, respectively.Conclusions:The plans created by the proposed algorithm have been shown to be at least as good as the manual plans. In addition, this method can shorten the labor time in plan designing while ensuring the plan quality and consistency of the plan.
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Objective@#To investigate the expression of immunomarkers CK7, CK20, CK17, CDX2, MUC1 and MUC2 in primary adenocarcinoma of the ampulla of Vater, to explore the role of these markers in the histopathologic subclassification of ampullary carcinoma; and to provide biologic basis for precision treatment of patients with different types of ampullary carcinoma.@*Methods@#Forty-two cases of primary ampullary carcinoma were collected at Peking University People′s Hospital, from 2012 to 2018 year. There were 22 males and 20 females. Aged range 42 to 88 years old, with mean aged (62±11) years. Among the patients, 6 was high differentiation, 19 median differentiation, and 17 low differentiation. Immunohistochemical studies on the expression of CK7, CK20, CK17, CDX2, MUC1 and MUC2 were performed in 42 cases of primary ampullary carcinoma. The relationship between different ampullary carcinoma subtypes and clinicopathologic survival data was analyzed using SPSS 16.0 statistical software.@*Results@#Three histopathologic subtypes were observed. Among 42 cases, 8(19.0%)were classified as intestinal subtype, which showed a positive expression rate of 8/8 for both CK20 and CDX2, and 5/8 for MUC2. Both CK7 and CK17 were weakly expressed in one case (1/8). No expression was observed for MUC1 in this subtype. Twenty-two (52.4%,22/42) cases were classified as pancreaticobiliary subtype, which showed a positive expression rate of 100.0%(22/22) for both CK7 and MUC1, and 90.9% (20/22) for CK17. No expression was observed for CK20, CDX2 and MUC2.The remaining 12 (28.6%) cases were classified as mixed subtype, which showed variable expression patterns. The expression frequencies of these 6 immunomarkers in different subtypes of ampullary carcinoma did not correlate with various clinicopathologic factors such as patient gender and age, tumor size, histologic differentiation, pancreatic and bile duct invasion, or the depth of duodenal invasion. However, stage Ⅲ+Ⅳ diseases were more commonly seen in pancreaticobiliary type (63.6%,14/22) than intestinal type (2/8) and mixed type (3/9; χ2=6.508, P=0.039). Follow-up data showed a trend of better survival rate for patients with intestinal subtype than those with mixed and pancreaticobiliary subtypes.@*Conclusions@#Ampullary carcinoma can be subclassified into three different subtypes using a panel of six immunomarkers, especially for the identification of subtypes of poorly differentiated carcinoma. CK7, CK17 and MUC1 are major markers of pancreaticobiliary subtype, whereas CK20, CDX2 and MUC2 are useful markers for intestinal subtype. The mixed subtype variably expresses these markers. The prognosis of patients with intestinal subtype appears better than that of pancreaticobiliary and mixed subtypes. Accurate subtyping of ampullary carcinoma is clinically important to patient management and prognosis assessment.
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Objective To investigate the feasibility of using low volume of low concentration isotonic contrast medium for 320 row coronary CT angiography.Methods 64 patients whose heart rate 70 beats per minute or less,normal cardiac rhythm,BMI≤24 kg/m2 were scanned using a 320 row dynamic volume CT with the tube voltage of 100 kVp and injection of contrast medium with a concentration 270 mg I/mL.Prospective ECG gating technique and adaptive iterative dose reduction algorithm reconstruction were used.In group A,22 patients were injected 50 mL contrast medium by a rate of 5.0 mL/s.In group B,21 patients were injected with the dosage of contrast medium calculated by 0.7 mL/kg and injection rate was 4.5 mL/s.In group C,21 patients were injected with the dosage of contrast medium calculated by 0.6 mL/kg and the injection rate was 4.0 mL/s.The attenuation value,signal-to-noise(SNR),con-trast-to-noise ratio(CNR),image quality and iodine intake between three groups were compared using One-Way ANOVA .Results There was no significantly statistical difference of age,sex ratio,BMI,heart rate between the three groups (P >0.05).However,the dosage of the contrast agent and different injection time had statistical significance (P 0.05).The image quality,SNR and CNR in three groups did not have significant difference (P >0.05).The total iodine and iodine injection rate were lowest in group C.Conclusion In 320 row coronary CT angiography with 100 kVp tube voltage and iterative reconstruction algorithm,the patients whose heart rate 70 beats per minute or less,BMI≤24 kg/m2 injected the low concentration of contrast medium by 0.6 mL/kg dose injection can give a good image quality which can meet the diagnostic requirement.Mean-while,it can also reduce the iodine intake and the risk of contrast induced nephrology (CIN).
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Aim To explore the effect of connexin 43 ( Cx 4 3 ) on acquired gefitinib-resistance in human non small cell lung cancer ( NSCLC ) . Methods HCC827 GR, a gefitinib-resistant ( GR) NSCLC cell lines from their parental cells was established by gradually in-creasing the concentration of gefitinib. Gefitinib effica-cy in HCC827 and HCC827 GR cells was detected by MTT assay. Expression of Cx43 mRNA in HCC827 and HCC827 GR cells was determined by RT-PCR. The protein expressions of Cx43 and phospho-Akt ( p-Akt) in these cells were detected by Western blot. The func-tional gap junction intercellular communication ( GJIC ) was measured by parachute assay. The cellular locali-zation of Cx43 protein was evaluated by immunofluores-cence staining. Results MTT assay showed less ge-fitinib cytotoxicity in HCC827 GR cells than that in their parental cells with IC50 of (10. 84 ± 0. 021) μmol ·L-1 versus (0. 07 ± 0. 019) μmol·L-1 , respective-ly. Moreover, both mRNA and protein expressions of Cx43 in HCC827 GR cells were significantly lower than those in HCC827 cells ( P<0. 05 ) . However, the p-Akt protein in HCC827 GR cells was obviously higher than that in HCC827 cells ( P<0. 05 ) . Furthermore, treatment with LY294002 caused a significant reduced p-Akt expression, but a significant increased Cx43 ex-pression in HCC827 GR cells. Moreover, no detecta-ble GJIC was found in HCC827 and their GR cells with or without RA ( a well-defined GJIC enhancer ) treat-ment. Immunofluorescence staining clearly showed that Cx43 protein accumulated in the cytoplasm of HCC827 and their GR cells. Conclusion The down-regulation of Cx43 expression in cytoplasm of HCC827 GR cells may contribute to the acquired gefitinib resistance in NSCLC cells by GJIC-independent activation of PI3 K/Akt signaling pathway.
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BACKGROUND/AIMS: Campylobacter jejuni infection is a leading cause of acute gastroenteritis, which is a trigger for post-infectious irritable bowel syndrome (PI-IBS). Cytolethal distending toxin (CDT) is expressed by enteric pathogens that cause PI-IBS. We used a rat model of PI-IBS to investigate the role of CDT in long-term altered stool form and bowel phenotypes. METHODS: Adult Sprague-Dawley rats were gavaged with wildtype C. jejuni (C+), a C. jejuni cdtB knockout (CDT-) or saline vehicle (controls). Four months after gavage, stool from 3 consecutive days was assessed for stool form and percent wet weight. Rectal tissue was analyzed for intraepithelial lymphocytes, and small intestinal tissue was stained with anti-c-kit for deep muscular plexus interstitial cells of Cajal (DMP-ICC). RESULTS: All 3 groups showed similar colonization and clearance parameters. Average 3-day stool dry weights were similar in all 3 groups, but day-to-day variability in stool form and stool dry weight were significantly different in the C+ group vs both controls (P < 0.01) and the CDT- roup (P < 0.01), but were not different in the CDT- vs controls. Similarly, rectal lymphocytes were significantly higher after C. jejuni (C+) infection vs both controls (P < 0.01) and CDT-exposed rats (P < 0.05). The counts in the latter 2 groups were not significantly different. Finally, c-kit staining revealed that DMP-ICC were reduced only in rats exposed to wildtype C. jejuni. CONCLUSIONS: In this rat model of PI-IBS, CDT appears to play a role in the development of chronic altered bowel patterns, mild chronic rectal inflammation and reduction in DMP-ICC.
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Adult , Animals , Humans , Rats , Bacterial Toxins , Campylobacter Infections , Campylobacter jejuni , Colon , Gastroenteritis , Inflammation , Interstitial Cells of Cajal , Irritable Bowel Syndrome , Lymphocytes , Models, Animal , Phenotype , Rats, Sprague-Dawley , Weights and MeasuresABSTRACT
[Objective ] To investigate the improvement of the surgical treatment effect on cerebral palsy with spastic diplegia by performing modified surgeries since 2004. [Method ] Twenty-three cases of severe cerebral palsy with spastic diplegia were operated, 14 male, 9 female; age 3 ～ 12 years; the average age of 5.7 years; their main symptoms were unable to stand and walk independently, with severe hypermyotonia of both lower extremities, and a scissoring type of gait when standing, hip and knee flexing contracture, ankle and foot equinovarus. Physical examination: there was hypermyotonia of the iliopsoas, adductor musculus, hamstrings, triceps surae, anterior and posterior tibial muscle, flexor pollicis longus and flexor digitorum longus. The muscle tone was 3 ～4 grade according to Ashworth criterion. Treatment: The intramuscular tenotomy, fascial division or sliding elongation were performed, to lengthen the tendon of the joint flexion contracture, the lateral half of anterior tibial muscle tendon was transferred laterally to balance the muscle force at the foot. Finally, both lower extremities were fixed by a new designed external frame, to straigthen the articular genu, keep both ankles and feet in neutral position, both lower extremities abducting 30°, and to correct all joint deformities. Family rehabilitation programs started after the external frame was removed 6 weeks later. [Result] All cases were followed up in 1 ～3 years with the average 2. 2 years. The results were evaluated as excellent, good and ineffective, according to correction of the joint deformities, the ability to stand and walk, and parent's satisfaction to the treatment. Of them 21 cases were excellent, 2 cases good, and no ineffective case. [ Conclusion ] For the severe cerebral palsy with spastic diplegia in children, reasonable release of the tight tendons of the multi-joint flexion contracture, balance of muscle force at the foot, correction of all deformities and fixation of the lower extremities with the new external frame, and long term of family rehabilitation after the surgery, are more effective treatment.
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Objective To treat femur fracture in neonates using a new homemade harness designed and observe the effec of this harness. Methods Designed a new harness used in femur fracture in neonates,and used this harness in 7(8 femur fracture)csses,including 6 boys(7 femur fracture)and 1 girl,the age from 1 day to 12 days(average 4.7 days).Those cases included proximal thirds(2 cases)and middle thirds(6 cases)of femur fracture.The angle of fracture was from 44°to 83°(average 62.4°)before treatment. Results The angle of fracture was from 0°to 22°(average 14.0°)after treatment using the harness.Hespitalization was from 2 to 3 days.There were no skin sloughing or harness breaking off.All cases were followed up 6 to 36 months(average 21.3 months).All femur fracture healed in good alignment with leg-length discrepancy＜1 cm.Movement of hip and knee was normal. Conclusions The harness is a better method to treat femur fracture of the proximal and middle thirds in neonates.Advantages of it include simply operation,minimal hospitalization,minimal cost,and easy nursing.
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BACKGROUND: Recently,Illizarov external frame is commonly used to treat adult talipes equinovarus.However,its application is limited in infant and child due to amount of components,large volume and heavy weight. OBJECTIVE: A new three-dimensional external mini-frame was designed to observe its therapentical effects for congenital talipes equinovarus in infants. DESIGN,TIME AND SETTING: Retraspectively analysis of the therapentical effects of the three-dimensional external mini-frame for congenital talipes equinovarus in infants at the Department of Pediatric Orthopedics,Third Hospital of Hebei Medical University between January 2004 and June 2007. PARTICIPANTS: 106 infants (130 feet) with congenital talipes equinovarus,76 males and 30 females aged 1.6 years (range 0.5-3 years),including 80 left feet and 50 right feet,24 cases bilateral feet and 82 cases unilateral feet. Eighty-one cases underwent orthosis or cost treatment but were not cured; 10 cases underwent surgery in other hospitals but all failed,the other cases were not given any treatment. The new three-dimensional external mini-frame was designed by the authors and produced by Hebei Hengshui Kangda. METHODS: According to the age,degree of deformity,being operated or not and pathological changeS of the foot,different treatment methods were applied: Corrcetion and fixation of the foot directly with the new external mini-frame; Limited soft tissue release,followed by corrcetion and fixation of the foot with the mini-frame; Corrcetion and fixation of the foot with the mini-frame after more soft tissue realse on interior posterior foot; Corrcetion and fixation of the foot with the mini-frame after soft tissue release,tendon transfer and restore of muscle force balance. The postoperative external fixation lasted for about 3 mouths. MAIN OUTCOME MEASURES: Evaluatoin of therapentical effects according to Garceau standards. RESULTS: All cases were followed up for 2.5 years (range 0.5-3.5 years). Eighty-six cases (94 feet) were excellent: the foot looked near normal,the calcar pedis was erect,with plantigrade foot in walking,the range of the joint motion in foot was near normal. Seventeen cases (32 feet) were good: the foot deformity improved obviously,but a light adduction was remained in the forefoot,with plantigrade foot in walking,the range of joint motion in foot was good. Three cases (4 feet) were effective: the forefoot adduct lightly,with lightly calcaneus varus,the motion of foot was limitted partly. CONCLUSION: The new 3D external mini-frame shows favorable effects for congenital talipes equinovarus in infants.
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[Objective]To explore the effect on spinal growth and devetopment at different month-age of immature rabbits with spinal fusion and fixation;and to explain the mechanism of crankshaft phenomenon after child scoliosis treatment.[Method]Twenty-four 6-weeks-old rabbits and 24 15-weeks-old rabbits were randomly divided into 2 groups.Various lengths of lumbar vertebral region were fused posteriorly and fixed with wires,and the Cobbs angle in the frontal and saglttal planes were measured after the surgery.[Result]The lumbar spine of each group became lordosis with different degree.It was most obvious in the group which were fused in 7 lumbar vertebraes at 6-month-week age.The multiple linear regression outcomes show significance among different month-age,different lengths of fusion region and the Cobbs angle.[Conclusion]In the imature rabbits,if their lumbar vertebrae were posteriorly fixed only may be appeared and getting serious gradually due to the potential growth of anterior spinal column.There has significant correlation among the degree of skelecton immature,fused segment length and spine lordosis.
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[Objective]A new type of external frame for the treatment of club foot in three dimensions was reported.The characteristics of this frame and Illizarov frame were compared.[Method]The new frame was consisted of 3 couples with 6 metal rods.The rods have lengthening or compressing force on foot in three dimensions respectively through 4 Kire wires in tibia,calcaneus and tarsals.Sixty-two cases with 85 club feet followed more than 12 months were treated by the frame since Fabruary 2004.[Result]According to Gaeceau standerd and clinical appearance,function of the feet after the treatment,40 feet were excellent,40 feet were good,5 feet were improved,no poor case.[Conclusion]The new type of external frame is safe,effective and reliable for the treatment of club foot in three dimensions.Compared to Illizarov frame,it is more simple,comfortable,cheep and easy to be managed.
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36 rabbits were divided into control and experimental groups.In the experimen-tal group,the left renal artery was ligated or the left renal artery and vein wereligated simultaneously.All the animals were alive.After 3—8 months of the opera-tion,the rabbits were killed.The establishment of collateral circulation and theanatomical,histological and histochemical changes of the kidny were observed.The resultsobtained were as follows:1.Ligation of the left renal vessels causes atrophy of theleft kidney on account of the failure of collateral circulation establishment.Theright kidney of the experimental group showed obviously compensatory hypertrophy.The weight of the compensatory hypertrophied kidneys obviously increased.2.Thecompensatory hypertrophic growth of kidneys is due to the hypertrophy of existingn(?)phrons and the hyperplasia connective tissue.3.comparison of the controls,inthe JGI,PAS and AlP reactions with the compensatory hypertrophied kidneys,there were no striking differences.The results suggest that the compensatory hyper-trophied kidneys were normal at least on the renin secretion and reabsorption func-tion.