Feasibility of automatic segmentation of CTV and OARs in postoperative radiotherapy for cervical cancer using AccuLearning / 实用医学杂志

Objective To explore the feasibility of automatic segmentation of clinical target volume(CTV)and organs at risk(OARs)for cervical cancer using AccuLearning(AL)based on geometric and dosimetric indices.Methods Seventy-five CT localization images with manual contouring data of postoperative cervical cancer were enrolled in this study.Sixty cases were randomly selected to trained to generate automatic segmentation model by AL,and the CTV and OARs of the remaining 15 cases were automatically contoured.Radiotherapy plans on the automatic segmentation contours were imported on the CT images of manual contours.The efficiency,Dice similarity coefficient(DSC),Hausdorff distance(HD)and dosimetric parameters were compared between the two methods.Results The time of automatic segmentation was significantly shorter than that of the manual contour(P<0.05).The DSC of all structures were≥0.87.The HD of bowel bag and rectum were about 10 mm,and that of the rest of OARs were less than 5 mm.CTV(D98,V90% ,V95% ,Dmean,HI),bowel bag(V50)and bladder(V50)had significant differences in dosimetric comparison(P<0.05).Conclusion The automatic segmentation model based on AL can improve the efficiency of radiotherapy.Automatic segmentation of OARs has the potential of clinical application,while that of CTV still needs to be further modified.

Tumor volume affects the short-term efficacy of cervical cancer and brachytherapy / 中华放射肿瘤学杂志

Objective:To evaluate the effect of tumor volume on the radiation dose and efficacy of locally advanced cervical cancer patients undergoing radical radiotherapy and chemotherapy.Methods:Clinical data of 126 patients who were diagnosed with cervical cancer (stage ⅡB-ⅣA) and underwent radical concurrent chemoradiotherapy in Guangxi Medical University Cancer Hospital from November 2019 to November 2022 were retrospectively analyzed. The cut-off values of tumor volume before (pre-TV) and after (post-TV) external radiotherapy and tumor volume reduction rate (TVRR) were calculated by Jamovi software. The effects of pre-TV, post-TV and TVRR on short-term efficacy, progression-free survival (PFS), brachytherapy (BT) mode , high-risk clinical target volume (HR-CTV) and organs at risk (OAR) dose were investigated by univariate and multivariate analyses.Results:Pre-TV≥67.03 cm 3 and post-TV≥14.88 cm 3 were poor prognostic factors for 6-month PFS and objective response rate (ORR) (both P<0.05), and post-TV was an independent prognostic factor. In the TVRR≥73.0% and <73.0% groups, no statistical differences were observed in the 6-month PFS and ORR. In the pre-TV≥67.03 cm 3 group, the cases number of intracavitary brachytherapy (ICBT) and intracavitary / interstitial brachytherapy (IC/IS-BT) was 36 (50.0%), while in the pre-TV<67.03 cm 3 group, the cases number of ICBT and IC/IS-BT was 41 (76%) and 13 (24%), respectively ( P=0.003). In the post-TV≥14.88 cm3 group, the cases number of ICBT and IC/IS-BT was 28 (47%) and 32 (53%), while 49 (72%) and 17 (26%) in the post-TV<14.88 cm3 group, respectively ( P=0.002). The dose of HR-CTV D 90% in the TVRR≥73.0% group was significantly higher than that in the TVRR<73.0% group ( P=0.014), but there was no significant difference in the dose of bladder D 2 cm3, rectal D 2 cm3 and small intestine D 2 cm3 (all P>0.05). The dose of HR-CTV D 90% in the post-TV<14.88 cm 3 group was significantly higher than that in post-TV≥14.88 cm 3 group ( P<0.001), and the dose of bladder D 2 cm3 in the post-TV≥14.88 cm 3 group was higher than that in the post-TV<14.88 cm 3 group ( P<0.05). There was no significant difference in the dose of rectal D 2 cm3 and small intestinal D 2 cm3 between two groups (both P>0.05). The number of concurrent chemotherapy (≥4 times vs.<4 times) had no statistical difference for 6-month PFS and TVRR. Conclusions:Pre-TV and post-TV are the influencing factors of short-term efficacy and BT mode selection for locally advanced cervical cancer. Post-TV is an independent prognostic factor and also indirectly affects the dose of HR-CTV D 90% and bladder D 2 cm3 Increasing the number of concurrent chemotherapy (≥4 times) does not improve TVRR and short-term efficacy.

Risk analysis of hypertension among community-dwellers at risk for high blood pressure in Minhang District of Shanghai / 上海预防医学

ObjectiveTo investigate the incidence of hypertension and its influencing factors in community-dwellers at risk for high blood pressure in Minhang District of Shanghai， and to provide scientific evidence for the community management. MethodsA retrospective cohort study was conducted using the electronic health records of community-dwellers at risk for high blood pressure in Minhang District， Shanghai from January 1， 2011 to December 31， 2017. The study end-point was the occurrence of hypertension，and the followup was finished in December 2021. A total of 17 265 community-dwellers at risk for high blood pressure were enrolled in our study. Log-rank test and Cox regression analysis were used to determine the influencing factors. ResultsAfter 6.04 years of follow-up， the hypertension incidence among community-dwellers at risk for high blood pressure in Minhang District of Shanghai was 25.5%. Family history of hypertension （HR=1.250， 95%CI： 1.168‒1.338）， family history of stroke （HR=1.295， 95%CI： 1.080‒1.553）， history of diabetes （HR=1.203， 95%CI： 1.076‒1.345）， daily smoking （HR=1.187， 95%CI： 1.087‒1.296）， overweight （HR=1.393， 95%CI：1.308‒1.484）， obesity（HR=1.903， 95%CI： 1.719‒2.106）， high values of normal blood pressure （HR=1.275， 95%CI： 1.195‒1.359） and advanced age （HR=1.033， 95%CI： 1.030‒1.036） were all risk factors. Emaciation （HR=0.649， 95%CI： 0.500‒0.840） was a protective factors. ConclusionBlood pressure monitoring should be strengthened for people elderly， with family history of hypertension， family history of stroke， diabetes or high values of normal blood pressure， so as to diagnose hypertension early. Timely intervention measures should be taken for community-dwellers with unhealthy lifestyles such as smoking， overweight and obesity.

Stigma of ultra-high risk for psychosis: an updated systematic review

Objective: To determine whether the stigma associated with schizophrenia has also been directed towards people at ultra-high risk of psychosis (UHR), the present review aimed to synthetize the literature to update and extend our understanding of this topic. Methods: A systematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in the PubMed, EMBASE, Cochrane, and Web of Science databases for articles published until April 30, 2023, using a combination of search terms describing at-risk mental states for psychosis, stigma, and related terms. Results: Thirty-eight studies were included. Twenty-nine addressed individuals with UHR directly, and nine conducted interviews with non-patients regarding UHR. A total of 2,560 individuals with UHR were assessed, with a mean sample size of 88.3 participants. Most were quantitative non-randomized/observational studies with young adults, 71.4% used the Structured Interview for Psychosis-Risk Syndromes, and 25% used the Comprehensive Assessment of At-Risk Mental States. Overall, the studies mainly involved patients of UHR clinics from high-income Western countries. The described stigma can be grouped into five forms, the most frequently explored of which was perceived public stigma, followed by public stigma, self-stigma/internalized stigma, stigma stress, and associative stigma. Quantitative nonrandomized studies predominated: only one was an interventional study. Most of the results confirmed the presence of stigma toward individuals with UHR. Conclusion: Despite the knowledge gaps and scarcity of research on UHR-related stigma, the results suggest that stigma toward people with UHR exists and that it is already present at early stages of psychosis. Registration number: PROSPERO CRD42022332037.

Effect of couch rotation angle on non-coplanar static intensity-modulated radiotherapy plan for gastric cancer / 中国辐射卫生

Objective To investigate the effect of couch rotation angle on non-coplanar static intensity-modulated radiotherapy (IMRT) plan for gastric cancer and to provide a reference for clinical planning. Methods A retrospective analysis was conducted on patients who recently underwent postoperative IMRT for gastric cancer. Twenty patients who received radiotherapy in the centre of Radiation Oncology of Huanggang Central Hospital from August 2022 to January 2023 were selected. That were selected to receive a seven-field coplanar static IMRT plan based on a couch rotation angle of 0° as the control group. Then, based on the coplanar IMRT plan, only the couch rotation angle of gantry angles 30° and 330° was changed to 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, and 90°, respectively, and nine different non-coplanar plans were established. The homogeneity index (HI), conformity index (CI) of the target volume, and monitor unit (MU), as well as Dmean, V20, and V30 of the left and right kidneys, Dmax, Dmean, V10, V20, and V30 of the spinal cord, and Dmax, Dmean, V10, V20, V30, and V40 of the small intestine and liver were compared among the 10 plans. The MU and the dosimetric parameters of the target volumes and When the couch rotation angle was 60°, the minimum HI and maximum CI of the target volume were 0.0714±0.0089 and 0.9271±0.0108, respectively, and the minimum MU was 438±26, with the best homogeneity and conformity in the target volume and the shortest machine treatment time (P＜0.05). When the couch rotation angle was 10°, the Dmax of the small intestine was lowest, being (4620.73±99.27) cGy. When the couch rotation angle was 60°, the Dmean of the left and right kidneys was lowest, being (1246.30±130.35) cGy and (1001.52±103.33) cGy, respectively; the V20 of the left and right kidneys was lowest, being 22.87±6.29 and 19.69±1.84, respectively; the V10 and V30 of the spinal cord were lowest, being 40.08±4.92 and 1.68±0.34, respectively (P＜0.05). Conclusion The couch rotation angle has some influence on the postoperative treatment planning for patients with gastric cancer. In the design of non-coplanar plan for gastric cancer, the couch rotation angle of 60° contributes to establishing a better radiotherapy plan.

The effects of different dose calculation grid size by Monaco planning system on the dosimetry of T 4 nasopharyngeal carcinoma / 国际肿瘤学杂志

Objective:To analyze the effects of different dose calculation grid size of Monaco system on the physical and biological dosimetry of target area and organ at risk (OAR) in T 4 nasopharyngeal carcinoma. Methods:A total of 18 patients with stage T 4 nasopharyngeal carcinoma who received radiotherapy in the Department of Radiotherapy of Yunnan Cancer Hospital from October 2020 to April 2022 were selected to complete the delineation of target areas and OAR in the Monaco 5.11.03 system, and the volumetric intensity modulated arc therapy (VMAT) plan was developed on the 3 mm grid with the optimization mode of target area priority. The 3 mm grid group plan was replicated without changing any other parameters, and the physical plan was re-established on the 1, 2, 4 and 5 mm grids, and then the five plans were normalized to the prescription dose to cover 95% of the target volume. The planning time, D 2%, D 50%, D 98%, conformity index (CI), homogeneity index (HI), gradient index (GI), tumor control probability (TCP), D 2% and D mean of important OAR around the target area were calculated and statistically analyzed. Results:Planning primary tumor gross target volume (PGTVp) : The D 2% of 1, 2, 3, 4 and 5 mm groups were (76.94±0.66), (75.98±0.76), (75.56±0.67), (75.67±0.73) and (75.94±0.85) Gy, respectively, with a statistically significant difference ( F=9.86, P<0.001). The CI of 1, 2, 3, 4 and 5 mm groups were 0.75±0.05, 0.78±0.04, 0.78±0.05, 0.79±0.04 and 0.78±0.04, respectively, with a statistically significant difference ( F=2.61, P=0.041). There were statistically significant differences in D 50%, D 98%, HI, equivalent uniform dose (EUD) and tumor control probability (TCP) among the groups ( H=17.14, P=0.002; F=9.35, P<0.001; H=25.43, P<0.001; F=5.85, P<0.001; H=17.65, P=0.001). There was no statistically significant difference in GI among the groups ( P>0.05). Pairwise comparison showed that D 2% in 2, 3, 4, 5 mm groups compared with 1 mm group, D 50% in 5 mm group compared with 2, 3 mm groups, D 98% in 4 mm group compared with 1, 2 mm groups, D 98% in 5 mm group compared with 1, 2, 3 mm groups, CI in 5 mm group compared with 1 mm group, HI in 2, 3, 4, 5 mm groups compared with 1 mm group, EUD in 3 mm group was compared with 1 mm group, EUD in 5 mm group compared with 2, 3 mm groups, TCP in 3 mm group compared with 1 mm group, and TCP in 5 mm group compared with 3 mm group, there were statistically significant differences (all P<0.05). Planning nodal gross target volume (PGTVn) : The D 2% of 1, 2, 3, 4 and 5 mm groups were (76.36±0.59), (75.36±0.62), (75.04±0.68), (75.25±0.72) and (75.39±0.77) Gy, respectively, with a statistically significant difference ( F=10.32, P<0.001). The HI of 1, 2, 3, 4 and 5 mm groups were 1.08 (1.08, 1.08), 1.07 (1.06, 1.07), 1.06 (1.06, 1.07), 1.06 (1.06, 1.07), 1.06 (1.06, 1.07), 1.06 (1.06, 1.08), respectively, with a statistically significant difference ( H=22.00, P<0.001) ; There were statistically significant differences in D 50%, D 98% and EUD among the groups ( H=11.79, P=0.019; H=20.49, P<0.001; F=12.14, P=0.016). Pairwise comparison showed that there were statistically significant differences in D 2% between 2, 3, 4, 5 mm groups and 1 mm group, D 98% between 4 mm group and 1 mm group, D 98% between 5 mm group and 1, 2 mm groups, HI between 2, 3, 4 mm groups and 1 mm group, and EUD between 3 mm group and 1 mm group (all P<0.05). Planning primary tumor clinical target volume 1 (PCTVp1) : The D 2% of 1, 2, 3, 4 and 5 mm groups were (76.59±0.63), (75.64±0.65), (75.64±0.98), (75.41±0.70) and (75.71±0.84) Gy, respectively, with a statistically significant difference ( F=9.53, P<0.001). The D 50% of 1, 2, 3, 4, 5 mm groups were (72.09±0.34), (71.85±0.39), (71.82±0.45), (72.04±0.56), (72.43±0.66) Gy, respectively, with a statistically significant difference ( F=4.20, P=0.019). There was no statistically significant difference in the other indexes among the groups (all P>0.05). Pairwise comparison showed that there were statistically significant differences in D 2% between 2, 3, 4, 5 mm groups and 1 mm group, and in D 50% between 2, 3 mm groups and 1 mm group (all P<0.05). Planning nodal clinical target volume 1 (PCTVn1) : There were no statistically significant differences in all indexes among the groups (all P>0.05). Planning clinical target volume 2 (PCTV2) : The D 2% of 1, 2, 3, 4 and 5 mm groups were (75.57±0.50), (74.87±0.67), (74.51±0.51), (74.61±0.63) and (75.00±0.74) Gy, respectively, with a statistically significant difference ( F=8.27, P<0.001). Pairwise comparison showed that the D 2% of the 2, 3, 4 mm groups were significantly different from that of the 1 mm group (all P<0.05). The calculation time of physical plan in 1, 2, 4 and 5 mm groups was 987.00 (848.00, 1 091.00), 120.50 (99.75, 134.00), 26.00 (24.00, 34.25) and 21.50 (18.75, 34.75) s, respectively, with a statistically significant difference ( H=61.62, P<0.001). Pairwise comparison showed that there were statistically significant differences in the calculation time between 4 mm group and 1, 2 mm groups, 5 mm group and 1, 2 mm groups (all P<0.05). There was no statistically significant difference in the dosimetric parameters of OAR around the target area among the groups (all P>0.05) . Conclusion:The physical dose and biological dose of the important OAR around the target area and the target area change with the change of dose calculation grid size when formulating the physical plan of radiotherapy for T 4 nasopharyngeal carcinoma. Considering the quality of the physical plan and the calculation time, when the Monaco system formulates the VMAT plan for T 4 nasopharyngeal carcinoma patients, the plan can be optimized on the 3 mm computing grid and copied to the 1 mm computing grid for recalculation.

A comparative study of automatic delineation of organs at risk for prostate cancer based on deep learning and atlas library / 中华放射医学与防护杂志

Objective:To compare the effect of uPWS R15 software based on deep learning with MIM-Maestro 6.9 software based on atlas library to automatically delineate the organs at risk of prostate cancer in order to provide a reference for clinical application.Methods:The CT data of 90 prostate cancer patients admitted to the Department of Oncology Radiotherapy of the Affiliated Hospital of North Sichuan Medical College from 2018 to 2022 were retrospectively selected. Based on the uPWS R15 software developed by Shanghai United Imaging Medical Technology Company and the MIM-Maestro 6.9 software developed by Beijing Mingwei Vision Medical Software Company, the effects of uPWS and MIM software on automatic delineation of organs at risk were evaluated according to five parameters, including delineation time (T), Dice similarity coefficient (DSC), Jaccard similarity coefficient (JSC), Hausdorff distance (HD) and the mean distance to agreement (MDA).Results:The sketching time of uPWS software was less than that of MIM software. There were no significant differences in the sketching effect of femoral head and skin between the two software (all P>0.05). The delineation of right kidney ( tMDA=-3.43, zDSC=-4.03, zJSC=-4.16, P<0.05), left kidney ( tMDA=-3.87, zDSC=-4.18, zJSC=-4.41, P<0.05), small intestine ( tMDA=-8.57, zDSC=-9.99, tJSC=14.21, P<0.05) and rectum ( zMDA=-4.00, tDSC=-9.98, tJSC= 9.72, P< 0.05) except HD, was statistically different. The bladder ( z=-7.88, -9.00, -8.17, -8.74, P<0.05) and spinalcord ( z=-3.87, -4.43, 4.03, 3.05, P<0.05) were also delineated with significant differences. The DSC automatically delineated by uPWS software was >0.7, while the DSC automatically delineated by MIM software was >0.7 for all other organs at risk except small intestine and rectum. In addition, the HD, MDA and JSC values of the organs at risk (bilateral femoral head, bilateral kidneys, spinal cord, bladder, skin, rectum and small intestine) automatically delineated by uPWS software were generally better than those with MIM software. Conclusions:The uPWS software outlines better than the MIM software, but the MIM software can also be used clinically with modifications to the small bowel and rectum, saving a great deal of time in preparation for radiation therapy.

Study of radiotherapy dose effect of neoadjuvant chemotherapy versus concurrent chemoradiotherapy in cervical cancer / 中华放射肿瘤学杂志

Objective:To compare the effect of neoadjuvant chemotherapy vs. concurrent chemoradiotherapy on the target volume and organs at risk for locally advanced bulky (>4 cm) cervical cancer. Methods:From March 1, 2019 to June 30, 2021, 146 patients pathologically diagnosed with cervical cancer were selected and randomly divided into two groups using random number table method: the neoadjuvant chemotherapy (NACT) + concurrent chemoradiotherapy (CCRT) group ( n=73) and CCRT group ( n=73). Patients in the NACT+CCRT group received 2 cycles of paclitaxel combined with cisplatin NACT, followed by CCRT, the chemotherapy regimen was the same as NACT. In the CCRT group, CCRT was given. Statistical description of categorical data was expressed by rate. The measurement data between two groups were compared by Wilcoxon rank-sum test for comparison of two independent samples, and the rate or composition ratio of two groups was compared by χ2 test. Results:Before radiotherapy, GTV in the NACT+CCRT group was (31.95±25.96) cm 3, significantly lower than (71.54±33.59) cm 3 in the CCRT group ( P<0.01). Besides, CTV and PTV in the NACT+CCRT group were also significantly lower compared with those in the CCRT group (both P<0.05). In terms of target volume dosimetry, D 100GTV, D 95CTV, V 100GTV, V 100CTV and V 95PTV in the NACT+CCRT group were significantly higher than those in the CCRT group (all P<0.05). The complete remision (CR) rates in the NACT+CCRT and CCRT groups were 86.3% and 67.6%, with statistical significance between two groups ( P<0.01) . Regarding organs at risk, NACT+CCRT group significantly reduced the dose to the bladder, rectum, small intestine and urethra compared with CCRT group (all P<0.05). Conclusions:NACT can reduce the volume of tumors in patients with large cervical masses, increase the radiation dose to tumors, reduce the dose to organs at risk, and make the three-dimensional brachytherapy easier. Therefore, NACT combined with CCRT may be a new choice for patients with locally advanced cervical cancer with large masses.

Automatic-delineation model construction for prostate cancer target volume of postoperative radiotherapy based on artificial intelligence / 中华放射肿瘤学杂志

Objective:To explore the method of constructing automatic delineation model for clinical target volume (CTV) and partially organs at risk (OAR) of postoperative radiotherapy for prostate cancer based on convolutional neural network, aiming to improve the clinical work efficiency and the unity of target area delineation.Methods:Postoperative CT data of 117 prostate cancer patients manually delineated by one experienced clinician were retrospectively analyzed. A multi-class auto-delineation model was designed based on 3D UNet. Dice similarity coefficient (DSC), 95% Hausdorf distance (95%HD), and average surface distance (ASD) were used to evaluate the segmentation ability of the model. In addition, the segmentation results in the test set were evaluated by two senior physicians. And the CT data of 78 patients treated by other physicians were also collected for external validation of the model. The automatic segmentation of these 78 patients by CTV-UNet model was also evaluated by two physicians.Results:The mean DSC for tumor bed area (CTV1), pelvic lymph node drainage area (CTV2), bladder and rectum of CVT-UNet auto-segmentation model in the test set were 0.74, 0.82, 0.94 and 0.79, respectively. Both physicians' scoring results of the test set and the external validation showed more consensus on the delineation of CTV2 and OAR. However, the consensus of CTV1 delineation was less.Conclusions:The automatic delineation model based on convolutional neural network is feasible for CTV and related OAR of postoperative radiotherapy for prostate cancer. The automatic segmentation ability of tumor bed area still needs to be improved.

Automatic segmentation of organs at risk in head and neck carcinoma from radiation therapy using multi-scale fusion and attention based mechanisms / 中华放射肿瘤学杂志

Objective:To develop a multi-scale fusion and attention mechanism based image automatic segmentation method of organs at risk (OAR) from head and neck carcinoma radiotherapy.Methods:We proposed a new OAR segmentation method for medical images of heads and necks based on the U-Net convolution neural network. Spatial and channel squeeze excitation (csSE) attention block were combined with the U-Net, aiming to enhance the feature expression ability. We also proposed a multi-scale block in the U-Net encoding stage to supplement characteristic information. Dice similarity coefficient (DSC) and 95% Hausdorff distance (HD) were used as evaluation criteria for deep learning performance.Results:The segmentation of 22 OAR in the head and neck was performed according to the medical image computing computer assisted intervention (MICCAI) StructSeg2019 dataset. The proposed method improved the average segmentation accuracy by 3%-6% compared with existing methods. The average DSC in the segmentation of 22 OAR in the head and neck was 78.90% and the average 95%HD was 6.23 mm.Conclusion:Automatic segmentation of OAR from the head and neck CT using multi-scale fusion and attention mechanism achieves high segmentation accuracy, which is promising for enhancing the accuracy and efficiency of radiotherapy in clinical practice.

Research on multi-Atlas segmentation based on feature clustering / 中华放射肿瘤学杂志

Objective:To study the improvement of normal tissue region of interest (ROI) segmentation based on clustering-based multi-Atlas segmentation method, thereby achieving better delineation of organs at risk.Methods:CT images of 100 patients with cervical cancer who had completed treatment in Zhejiang Cancer Hospital during 2019-2020 were selected as the Atlas database. According to the volume characteristic parameters of the organs at risk (bladder, rectum and outer contour), the Atlas database was divided into several subsets by k-means clustering algorithm. The image to be segmented was matched to the corresponding Atlas library for multi-Atlas segmentation. The dice similarity coefficient (DSC) was used to evaluate the segmentation results.Results:Using 30 patients as the test set, the sub-Atlas generated by different clustering methods were compared for the improvement of image segmentation results. Compared with general multi-Atlas segmentation methods, clustering-based multi-Atlas segmentation method significantly improve the segmentation accuracy for the bladder (DSC=0.83±0.09 vs. 0.69±0.15, P<0.001) and the rectum (0.7±0.07 vs. 0.56±0.16, P<0.001), but no statistical significance was observed for left and right femoral head (0.92±0.04, 0.91±0.02) and bone marrow (0.91±0.06). The average segmentation time of clustering-based multi-Atlas segmentation method was shorter than that of the general multi-Atlas segmentation method (2.7 min vs. 6.3 min). Conclusion:The clustering-based multi-Atlas segmentation method can not only reduce the number of Atlas images registered with the image to be segmented, but also can be expected to improve the segmentation effect and obtain higher accuracy.

Socio-demographic Characteristics and Nutritional Status of Adults at Risk of Type 2 Diabetes Mellitus in Kuala Nerus, Terengganu

@#Introduction: In Malaysia, the undiagnosed diabetes prevalence has increased. Socio-demographic characteristics and nutritional status play a crucial role in prediabetes development. Hence, this cross-sectional study aimed to identify the socio-demographic characteristics and nutritional status of adults at risk of T2DM in Kuala Nerus, Terengganu. Methods: A total of 30 participants at risk of T2DM aged 18 to 59 years old were recruited from Kuala Nerus using a convenience sampling method. Information on socio-demographic, anthropometric, fasting plasma glucose (FPG) level, clinical profile, Finnish Type 2 Diabetes Risk Assessment Tool (FINDRISC) score, dietary intake, and physical activity level were obtained. Results: The participants (mean age: 36.1 ± 8.7 years) were mostly female (76.7%), Malay (96.7%), married (43.3%), had a tertiary degree (60.0%), and were working (83.3%) with a monthly salary of less than RM 1000. Half of the participants were from the obese class I category. Their FPG level was 5.6 ± 0.5 mmol/L and half of them were classified as having optimal blood pressure. Also, they had a mean FINDRISC score of 6.3 ± 1.8. The participants consumed 2073 ± 247 kcal/day, which was comprised of 50.8% carbohydrate, 16.1% protein, and 33.1% fat. Most of them (63.3%) were minimally active. Conclusion: The participants had moderate T2DM risk with normal FPG level, blood pressure, and heart rate. They had excessive energy and fat intake with insufficient dietary fibre intake. It is vital to examine the socio-demographic characteristics and nutritional status, which can provide important information for planning future cost-effective T2DM preventive strategies.

Translation and cross-cultural adaptation to Brazilian Portuguese of two brief screening tools for youth at risk of psychosis: the Prodromal Questionnaire (PQ-16) and the PRIME-Screen

Abstract Introduction Prodromal characteristics of psychosis have been described for more than a century. Over the last three decades, a variety of studies have proposed methods to prospectively identify individuals (and youth in particular) who are at high risk of developing a psychotic disorder. These studies have validated various screening instruments and made them available in several languages. Here, we describe the translation into Brazilian Portuguese and cross-cultural adaptation of two such screening tools - the Prodromal Questionnaire-16 (PQ-16) and the Prevention through Risk Identification, Management, and Education (PRIME)-Screen. Method Two bilingual native speakers of Brazilian Portuguese translated the questionnaires from English. A native English speaker then performed back-translations into English. These back-translated versions were submitted to the original authors. They provided feedback and later approved the final versions. Results After translation and cross-cultural adaptation, no items needed to be changed in the adapted PQ-16 and four items were revised in the PRIME-Screen. After the peer-review process, we included two suggestions in the PQ-16 to facilitate use of the tool in our cultural and social contexts. The PRIME-Screen did not need further changes. Conclusion These new instruments can help screen Brazilian Portuguese-speaking patients who are at risk of psychosis in primary care.

Foot-at-Risk among adult outpatients with diabetes mellitus in Bowen University Teaching Hospital, Ogbomoso, Nigeria

Introduction: the rising prevalence of diabetes mellitus (DM) around the world has dramatically increased the number of people bearing the complications of this potentially incapacitating disease. One of these complications is foot ulcers that may result in amputation. This study sets out to determine the profiles of the "foot-at-risk" for ulceration and the associated socio-medical factors in DM patients. Methods: this study was conducted at Bowen University Teaching Hospital, Ogbomoso, Southwest, Nigeria. This was a descriptive cross-sectional study comprising 299 outpatient adults aged 18 years and above with diabetes mellitus of at least 6 months in duration. Comprehensive Foot Examination and Risk Assessment tool was used to identify the foot-at-risk categories of the participants. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 20. Results: the prevalence of foot-at-risk among the participants was 64.9% (194). Among the 194 participants with foot-at-risk, 35.1% (105) belonged to the foot-at-risk categories 0, 37.8% (113) in category 1, 16.1% (48) in category 2, and 11.0% (33) in category 3. Other factors that had a statistically significant association with foot-at-risk included; age, religion, level of education, duration of diabetes, history of smoking, and glycemic control. Conclusion: foot-at-risk was found to have an alarming prevalence among the participants. In addition, the level of glycemic control in this group was unacceptably poor. Clinicians need to intensify preventive measures like foot screening and health education to prevent foot ulcerations, which may result in limb amputation in DM patients.

Cost-Effectiveness of Photoscreeners in Screening at-Risk Amblyopia in Indian Children

Objectives: Amblyopia is the most common cause of preventable vision impairment in children. This study tried to evaluate the cost-effectiveness of photoscreeners in identifying refractive errors making children at risk of amblyopia. Materials and Methods: This was designed as a prospective, open?label, randomized controlled study to compare the cost?effectiveness of photoscreeners (2WIN Adaptica and Plusoptix) versus autorefractor and Mohindra retinoscopy to identify the at?risk amblyopia. This study was conducted from October 2018 to December 2018 in coordination with Nanna Kannu school screening project and children in the age group of 5–11 years were included in the study. The photoscreening was done by lay screeners. Asupervising ophthalmologist collated all data. Cost-effectiveness was calculated for the individual instruments and compared. The average time is taken for each instrument to record the refractive error was calculated and compared with the Mohindra retinoscopy. Results: Number of children included in this study was 2910. The mean age of the children was 7.82 + 0.65 years. The mean time taken for 2WIN Adaptica was 6 sec, Topcon –10 s, and Plusoptix –4 s. Plusoptix showed the minimal time for screening a child when compared to all other methods. The Plusoptix and 2WIN Adaptica were shown to be cost?effective when compared to Mohindra retinoscopy (P < 0.05). Conclusion: Photoscreening using Plusoptix and 2WIN Adaptica with lay screeners was < seven times the cost incurred and five times faster than the trained optometrists using either autorefractor or Mohindra retinoscopy and thus more cost?effective in screening a large number of young children with at-risk amblyopia at the community level.

Correlation between serum 25(OH)D levels and target organ damage in older adult patients with essential hypertension / 中国基层医药

Objective:To measure serum 25-hydroxyvitamin D (25(OH)D) levels in older adult patients with essential hypertension and correlate serum 25(OH)D levels with target organ damage.Methods:The general data and laboratory test results of 163 older adult patients with essential hypertension who received treatment in Zhejiang Veteran Hospital between January 2019 and April 2021 were collected for this study. The included patients were divided into different groups according to the number of injured target organs, serum 25(OH)D level, and single target organ damage site. Two variables were correlated using the Pearson correlation analysis. The factors that affect target organ damage were analyzed using multivariate logistic regression analysis.Results:There were significant differences in age, course of the disease, serum 25(OH)D level, systolic blood pressure, and diastolic blood pressure among patients with different numbers of damaged target organs ( F = 16.95, 14.39, 14.95, 33.18, 20.88, all P < 0.001). There were significant differences in serum triacylglycerol level and 25(OH)D level among the patients who had different serum 25(OH)D levels ( F = 2.31, 178.48, both P < 0.05). There was a negative correlation between serum 25(OH)D levels and serum triacylglycerol levels. Serum 25(OH)D level was significantly lower in patients with damage to a single target organ heart, kidney, or carotid artery than in patients without target organ damage ( t = 9.24, 6.15, 6.09, all P < 0.05). There was no significant difference in serum 25(OH)D level between patients with damage to a single target organ ( P > 0.05). Older age, long course of disease, high systolic and diastolic blood pressure, and low serum 25(OH)D level were the independent risk factors for target organ damage (all P < 0.05). Conclusion:There is a correlation between serum 25(OH)D levels and target organ damage in older adult patients with essential hypertension. However, the evidence of vitamin D deficiency and target organ damage in essential hypertension is still insufficient, and further investigation is needed. This study is highly innovative and scientific.

Effects of different bladder filling volumes on target area and organs at risk during three-dimensional brachytherapy of postoperative early cervical cancer / 中华放射医学与防护杂志

Objective:To investigate the optimal bladder filling volume in the 3D brachytherapy of postoperative cervical cancer.Methods:Totally 111 early cervical cancer patients with positive incisal margins or insufficient safety boundaries were included. The normal saline 50, 60, 70, 80, 90, and 100 ml were filled into their bladders, and accordingly six groups were determined, and 66, 69, 66, 69, 72, 56 person-times in each group, respectively. The CT-based simulation positioning was performed. According to the ICRU 89 report, high-risk clinical target volume and organs at risk such as bladder and rectum were delineated. The Oncentra planning system was used to prepare the treatment program. The high-risk clinical target volume (HR-CTV), D90, and the D2 cm 3 and D1 cm 3 of organs at risk under different volumes were recorded. Results:Compared to the 60 ml group, the volume and dosage of HR-CTV in the groups of 50, 70, 80, 90, and 100 ml had no significant difference ( P>0.05). The D2 cm 3 and D1 cm 3 of the bladder and rectum of patients in these groups significantly decreased, and the difference was statistically significant ( tbladder = 3.21, 5.83, 2.89, 12.95, 7.96, Pbladder = 0.031, 0.010, 0.041, 0.000, 0.001; trectum = 2.94, 4.66, 2.53, 5.89, 4.13, Prectum = 0.037, 0.024, 0.049, 0.005, 0.028). The pairwise comparison among these groups except for the 60 ml group showed that the volume and dosage of HR-CTV and the D2 cm 3 and D1 cm 3 of bladder and rectum had no significant difference ( P > 0.05). Moreover, the D2 cm 3 and D1 cm 3 of sigmoid colon and small intestine of these groups had no significant difference ( P > 0.05). Conclusions:In the 3D brachytherapy of postoperative early cervical cancer, a bladder filling volume of 60 ml can ensure the volume and dose of HR-CTV and can protect the bladder and rectum compared with other filling volumes.

Dosimetry of organs at risk between involved field radiation and extended field radiation in patients with thoracic esophageal cancer / 中国辐射卫生

Objective To study the irradiation dose of organs at risk (OAR) in involved field radiation and extended field radiation in patients with thoracic esophageal cancer who received intensity modulated radiotherapy (IMRT). Methods A total of 40 patients with thoracic esophageal cancer were treated with IMRT. The involved field, extended field, and OAR were outlined to generate IMRT plans. The conformity index (CI) and homogeneity index (HI) of planning target volume (PTV) and the irradiation parameters of OAR were evaluated for the two plans. Paired t-test was used for comparison of irradiation parameters. Results The PTV of both plans received the prescribed dose. There were no significant differences in CI and HI of PTV between the two groups (P = 0.317, 0.130). There were significant differences in average lung dose, lung V5, lung V20, lung V30, spinal cord Dmean, heart Dmean, heart Dmax, heart V30, heart V40, and heart V60 between the two groups (P < 0.01). Conclusion Compared with the extended field, the involved field can reduce the irradiation dose of ORA in patients with thoracic esophageal cancer, thus reducing the risk of radiation.

Influence of migration on the thought process of individuals at ultra-high risk for psychosis

Objective: To assess the influence of migration on the psychopathological presentation of individuals at ultra-high risk for psychosis (UHR) in São Paulo, Brazil. Methods: This study is part of the Subclinical Symptoms and Prodromal Psychosis (SSAPP) project, a cohort study in São Paulo, Brazil, designed to follow individuals at UHR. After screening with the Prodromal Questionnaire (PQ) and a clinical interview, the Global Assessment of Functioning (GAF) was administered, a neuropsychological assessment was performed, sociodemographic and migration data were obtained. We then analyzed UHR individuals who had migration data to see if migration had any effect on their cognition and psychopathology. Chi-square tests were used for categorical variables, and Student's t test or analysis of variance (ANOVA) were used for nonparametric and parametric distributions, respectively. Results: The sample was composed of 42 at-risk subjects, of whom 5 had a migration history in the past two generations. Those with migration history showed significantly more formal thought disturbances (p = 0.012) and sleeping problems (p = 0.033) compared to those without. Conclusions: Our data reinforce migration as a risk factor for psychosis in developing countries as well, and highlights the importance of studying the specific effect of this factor in UHR psychopathology.

Estrés postraumático luego de siniestros viales: una revisión sistemática / Post-traumatic stress disorder after road traffic accidents: a systematic review

Resumen Las lesiones físicas y los trastornos psicológicos que se producen como consecuencia de un siniestro de tránsito (ST) constituyen un grave problema de salud pública. En este trabajo se realiza una revisión sistemática y actualización de estudios sobre prevalencia y variables predictoras de estrés postraumático (TEPT) luego de un ST. Se realizó una búsqueda en bases de datos incluyendo Medline, PsycINFO, Scopus, y Elsevier de artículos entre 2015 y 2019, siguiendo las directrices PRISMA. La búsqueda inicial mostró un total de 1062 artículos, de los cuales 28 cumplieron criterios de inclusión. La literatura disponible es heterogénea en cuanto a objetivos y metodología. La prevalencia oscila entre 2,39 y 62%. Entre los predictores más robustos de TEPT se incluyen: sexo femenino, percepción de riesgo de vida en el ST, falta de apoyo social, secuelas físicas, y problemas emocionales previos. Se destaca la importancia de la detección temprana para prevenir secuelas psicológicas.

Abstract Physical injuries and psychological disorders following a road traffic accident (RTAs) are a serious public health problem. The objective of this work was to conduct a systematic review and update of studies on the prevalence and predictive variables of post-traumatic stress disorder (PTSD) after RTAs. A systematic search was performed in databases including Medline, PsycINFO, Scopus and Elsevier, of articles published between January 2015 and August 2019, following PRISMA guidelines. Initial search showed a total of 1062 articles, and 28 met inclusion criteria. The available literature is heterogeneous in regards to aims and methodology. Prevalence rates ranged from 2,39 % to 62%. The most robust predictors of PTSD include: female gender, perceived threat to life, lack of social support, persistent physical problems and previous emotional problems. The importance of early detection to prevent psychological sequelae is highlighted.