ABSTRACT
Objective:To evaluate the robustness of fully automated adaptive planning for Ethos online adaptive radiotherapy (ART) based on the intelligent optimization engine (IOE).Methods:Clinical data of 11 stage ⅠB cervical cancer patients admitted to Peking Union Medical College Hospital between June 2021 and June 2022 were retrospectively analyzed. Original planning images and iterative cone-beam computed tomography (iCBCT) images of each radiotherapy treatment were acquired, and all patient data were imported into the Ethos simulator. IOE-based 9-field automatic plan generation was performed for 11 patients using Ethos, and the generated plans were sent to online adaptive radiotherapy simulation to obtain each online adaptive radiotherapy plan (273 fractions in total) and complete the simulated treatment. For comparison, manual plan design was performed based on the images and contoured structures used for online adaptive radiotherapy planning, and the manually plans created with evenly divided 9 fields. Dosimetric parameters, plan complexity parameters, and Mobius quality assurance (QA) pass rates were collected to compare and evaluate the robustness of the online adaptive radiotherapy plan in terms of organs at risk (OAR), target volume dosimetric parameters, and plan complexity by using paired t-test or rank sum test. Results:The online adaptive plan of cervical cancer had comparable planning target volume (PTV) coverage compared to the manual plan. For the clinical target volume (CTV) D 99%, online adaptive plan was significantly higher than the manual plan [(45.93±0.36) vs. (45.32±0.31) Gy, P<0.001]. For hot dose area, the maximum point dose (PTV D max) of adaptive plan was significantly higher than the manual plan [(49.89±1.25) vs. (48.48±0.77) Gy, P<0.001], but the PTV D 1% of adaptive plan was significantly lower than the manual plan [(47.22±0.29) vs. (47.59±0.48) Gy, P<0.001]. There was no statistical difference in the conformal index ( P=0.967). And there was significant difference in the homogeneity index, with same medians and less dispersion in adaptive plan ( P<0.001). For OAR dose, bladder D mean, rectal V 40 Gy, small intestine D mean of adaptive plan was slightly higher than that of the manual plan; the rectal D mean, small intestine D 2 cm3 of the adaptive plan was slightly lower than that of manual plan; dosimetric parameters of right and left femoral heads, spinal cord and bone marrow of the adaptive plan were better than those of manual plan. The adaptive plan had more monitor units (MU) than the manual plan, but the complexity of the adaptive plan was significantly lower than that of the manual plan (0.135±0.012 vs. 0.151±0.015, P<0.001). For Mobius γ pass rate (5%/3 mm), both adaptive and manual plans met clinical requirements. Conclusion:Ethos cervical cancer online adaptive plan, which is based on the IOE engine, demonstrates good robustness and ensures the quality of online adaptive plans generated for each treatment fraction.
ABSTRACT
Objective:To evaluate the automatic optimization performance and clinical feasibility of the intelligent optimization engine (IOE) in the Ethos online adaptive radiotherapy platform.Methods:Clinical data of 11 patients with postoperative cervical cancer treated with Halcyon accelerator were retrospectively analyzed. Manual planning was performed for all patients using the 4 full arc volumetric modulated arc therapy (VMAT) (Manual-4Arc) in Eclipse, with a prescription dose of 45 Gy/25F. Patient images and structures were imported into the Ethos simulator, and appropriate clinical goals were added based on clinical requirements. The target coverage was normalized to 95%. Automatic plan generation was conducted using IOE, resulting in 7, 9, and 12 field intensity modulated radiotherapy (IMRT) plans (IMRT-7F、IMRT-9F、IMRT-12F), as well as 2 and 3 arc VMAT plans (VMAT-2Arc、VMAT-3Arc). Dosimetric index comparisons were made between the Manual-4Arc plans and the 5 groups of IOE-generated plans through one-way analysis of variance. Based on the analysis results, Turky post hoc multiple comparisons were performed to evaluate the automatic optimization performance of IOE.Results:In terms of the high dose area, the IMRT-12F plans showed the lowest D 1% for the planning target volume (PTV), and there were significant differences compared to the Manual-4Arc plans ( P=0.004). Regarding target coverage, all groups produced clinical target volume (CTV) plans that met the clinical requirements. Although the Ethos online adaptive plans were normalized during planning, the PTV coverage was slightly insufficient. For organs at risk (OAR) close to the target, such as the bladder, there were significant differences in V 30 Gy, V 40 Gy, and D mean among the 6 groups of plans. The dose ranking for the bladder was generally as follows: IMRT-12F<IMRT-9F<Manual-4Arc<IMRT-7F<VMAT-3Arc<VMAT-2Arc. There were significant statistical differences in V 30 Gy and D mean for the rectum, and the dose ranking was generally consistent with that of the bladder, except for a switch between the IMRT-7F and Manual-4Arc plans. There were no significant differences in rectal V 40 Gy, small intestine D max, and D mean among the 6 groups of plans. For OAR distant from the target, such as the left and right femoral heads, spinal cord, and bone marrow, the dose ranking was generally as follows: IMRT-12F<IMRT-9F<IMRT-7F<VMAT-2Arc<VMAT-3Arc<Manual-4Arc. Conclusion:The plans automatically generated by Ethos IOE in postoperative patients with cervical cancer can achieve similar performance to manual plans, and the automatically generated IMRT-12F and IMRT-9F plans are recommended for clinical use.
ABSTRACT
A series of [1,3]dioxolo[4,5-f]isoindolone derivatives were designed, synthesized and evaluated as inhibitors of acetylcholinesterases (AChE). Furthermore, their effects on memory impairment of mice induced by scopolamine were investigated with step-through test. The results suggested that most of the target compounds exhibited potential inhibition on AChE with IC50 values at micromolar range. Compounds I1 (IC50 value of 0.086 μmol · L(-1)) and I2 (IC50 value of 0.080 μmol · L(-1)) showed the strongest AChE inhibitory activity, which are equipotent to donepezil (IC50 value of 0.094 μmol · L(-1)). Moreover, compounds I1-I4 could improve the memory impairment induced by scopolamine in mice.
ABSTRACT
Objective To study the effects of ischemic postconditioning and ischemic preconditioning on cerebral ischemia-reperfusion injury following middle cerebral artery occlusion in rats.Methods A reversible focal cerebral ischemia-reperfusion injury was modeled using middle cerebral artery occlusion. Thirty male Sprague-Dawley rats were randomized into three groups (n = 10 in each group) : a cerebral ischemia-reperfusion group, an ischemic postconditioning group and an ischemic preconditioning group. The impairment of neurological function was scored and the infarct volume, the activity of superoxide dismutase and malondiadehyde (MDA) content were measured after the operation.Results In the ischemic postconditioning and preconditioning groups the neurological function was better and the infarction volume was significantly smaller compared with the model group. In the preconditioning group both infarction volume and neurological function were significantly better than in the postconditioning group. In the brain tissues of the preconditioning and postconditioning groups MDA content was lower, while the activity of superoxide dismutase was significantly higher than in the model group.Conclusions lschemic postconditioning can attenuate pathological injury induced by focal cerebral ischemia and repedusion. The neuroprotective effect induced by ischemic preconditioning is stronger than that induced by ischemic postconditioning.
ABSTRACT
Objective To investigate the clinical characteristics and treatment strategies of primary lactase deficiency in infants.Methods The clinical data of 26 infants with primary lactase deficiency in Shenzhen Chidlren's hospital from October 2009 to February 2011 were analyzed retrospectively and the diagnoses were confirmed by dietary therapy.Results The patients were consisted of 19 males and 7 females,whose ages of onset ranged from 1 to 2 months,persisting 1 to 4 months.Breast feeding,mixed feeding and formula feeding were given in 10 cases,8 cases and 8 cases,respectively.The main clinical manifestations were persistent or chronic diarrhea,with watery and or foamy stools,4 to 8 times per day.Nineteen patients had received antibiotics but without improvement.Lactose free formula and oral probiotics improved the symptoms within 1 week in all 26 cases,but recurrence of symptoms followed reintroduction of dairy foods.Conclusion The clinical manifestations of primary lactase deficiency in infants are persistent or chronic diarrhea.Lactose free formula can be used to confirm the diagnosis and to improve the symptoms.
ABSTRACT
@#The personnel training mode of school-enterprise cooperation, interaction of study and work is the inevitable trend of senior vocational education reform and development at present. The Changsha Social College cooperates closely with rehabilitation agencies and implements the personnel training mode of the “love to help people with disabilities, interaction of study and work, integration of courses and certificate” for training professionals of rehabilitation therapy, has gained some experience and achievements.
ABSTRACT
Objective To evaluate the relationship between relative perfusion rate assessed with power Doppler imaging (PDI) and microvessel density (MVD), as well as expression of vascular endothelial growth factor (VEGF) in bladder carcinoma. Methods The transrectal ultrasound (TRUS) blood flow signal of bladder carcinoma was preoperatively detected with color Doppler imaging in 45 patients, and the relative perfusion rates were obtained for analysis. MVD and the expression of VEGF of excised tumor were assessed immunohistochemically. Results There were correlation between relative perfusion rate and MVD, the expression of VEGF. MVD and the expression of VEGF were related to pathologic grade and the invasiveness of tumor tissues. The expression of VEGF in bladder carcinoma was positively correlated to the tumor interstitial vascular density. Conclusion Combination of PDI and immunohistochemical parameters is useful for evaluating the angiogensis of bladder carcinoma from a different point of view.
ABSTRACT
Objective To investigate expressions of vascular endothelial growth factor (VEGF) and nm23 proteins and microvessel density in HCC,simultaneously,their relation with metastasis was also studied.Methods The expression of VEGF and nm23 and CD34 protein in 56 HCCs were detected by immunohistochemical technique.Results Of 56 HCCs, the intensity of VEGF expression in HCCs with metastasis was significantly higher than that in HCCs without metastasis (P