A longevity level-oriented wellness target area identification method: a case study of Yunnan Province, China.

Background: Aging, as a global demographic issue, is characterized by its rapid growth, which drives an increase in people's healthcare awareness. The emergence of wellness bases caters to this market demand. Therefore, the identification of potential areas suitable for wellness activities and the construction of wellness bases, referred to as Wellness Target Areas (WTAs), becomes a crucial first step. Currently, commonly used identification methods are mostly based on traditional statistical approaches, which are often complex, cumbersome, and subject to potential risks of subjective assumptions, affecting the reliability of WTAs identification results. Longevity level serves as a comprehensive indicator reflecting the natural and socio-economic environment of a region, making it the most indicative of the regional wellness environment status. Methods: This study proposes using longevity level as the benchmark for WTAs identification to simplify the identification process and reduce the impact of subjective bias on the results. The study focuses on 129 county-level units in Yunnan Province. Firstly, the Geodetector (GD) is utilized to explore the complex interaction between the longevity level and the geographical environment to determine regional wellness factors. Secondly, using ArcGIS and geographical weighted regression (GWR), the study investigates the role of different wellness factors, ultimately classifying and grading the WTAs. Results: The longevity level in Yunnan Province exhibits a pattern of multi-point clustering, forming three major longevity regions. Factors that significantly influence longevity level include annual average precipitation, sunshine duration, PM2.5 content, per capita disposable income, density of tourist attractions, and distance from residential areas to hospitals. Based on the degree of longevity and the contribution rate of influencing factors, Yunnan Province's WTAs are classified into three levels and two types (natural and comprehensive). Conclusion: Our study aims to establish a connection between longevity level and the selection of wellness bases, exploring regional wellness factors through the relationship between longevity phenomena and geographical environment, identifying potential construction areas for wellness bases (i.e., WTAs), providing new insights for the precise selection of wellness bases, effectively enhancing the scientificity of site selection, promoting population health, and contributing to the global aging process with better health.

An Exploratory Study of Laser Scribing Quality through Cross-Section Scribing Profiles.

This article presents a novel approach for evaluating laser scribing quality through cross-section profiles generated from a three-dimensional optical profiler. Existing methods for assessing scribing quality only consider the width and depth of a scribe profile. The proposed method uses a cubic spline model for cross-section profiles. Two quality characteristics are proposed to assess scribing accuracy and consistency. Accuracy is measured by the ratio of the actual laser-scribed area to the target area (RA), which reflects the deviation from the desired profile. The mean square error (MSE) is a measure of how close each scribed cross-section under the same scribing conditions is to the fitted cubic spline model. Over 1370 cross-section profiles were generated under 171 scribing conditions. Two response surface polynomial models for RA and MSE were built with 18 scribing conditions with acceptable scribing depth and RA values. Both RA and MSE were considered simultaneously via contour plots. A scatter plot of RA and MSE was then used for Pareto optimization. It was found that the cross-sectional profile of a laser scribe could be accurately represented by a cubic spline model. A multivariate nonlinear regression model for RA and MSE identified pulse energy and repetition rate as the two dominant laser parameters. A Pareto optimization analysis further established a Pareto front, where the best compromised solution could be found.

Target area distillation and section attention segmentation network for accurate 3D medical image segmentation.

3D medical image segmentation has an essential role in medical image analysis, while attention mechanism has improved the performance by a large margin. However, existing methods obtained the attention coefficient in a small receptive field, resulting in possible performance limitations. Radiologists usually scan all the slices first to have an overall idea of the target, and then analyze regions of interest in multiple 2D views in clinic practice. We simulate radiologists' recognition process and propose to exploit the 3D context information in a deeper manner for accurate 3D medical images segmentation. Due to the similarity of human body structure, medical images of different populations have highly similar shape and location information, so we use target region distillation to extract the common segmented region information. Particularly, we proposed two optimizations including Target Area Distillation and Section Attention. Target Area Distillation adds positions information to the original input to let the network has an initial attention of the target, while section attention performs attention extraction in three 2D sections thus with large range of receptive field. We compare our method against several popular networks in two public datasets including ImageCHD and COVID-19. Experimental results show that our proposed method improves the segmentation Dice score by 2-4% over the state-of-the-art methods. Our code has been released to the public (Anonymous link).

Unexpected air pollutants with potential human health hazards: Nitrification inhibitors, biocides, and persistent organic substances.

To better understand the influence of land use and meteorological parameters on air pollutants, we deployed passive air samplers in 15 regions with different land use in eastern Austria. The samplers consisted of polyurethane PUF and polyester PEF filter matrices, which were analyzed for 566 substances by gas-chromatography/mass-spectrometry. In a previous article, we highlighted a widespread contamination of ambient air with pesticides that depends on the surrounding land use and meteorological parameters. Here we report that, in addition to agricultural pesticides, eight other substances were frequently detected in ambient air: Nitrapyrin, a nitrification inhibitor used to increase nitrogen use efficiency of fertilizers and banned in Austria since 1993; biocides against insects (DEET and transfluthrin) used mainly outside agriculture; piperonyl butoxide (PBO), a synergist mixed into pesticide formulations; and four industrially used polychlorinated biphenyls (PCBs), long banned worldwide. Concentrations of the detected substances were positively related to air temperature, but only slightly related to agricultural land use in the sampler's vicinity. The city center showed the highest concentrations of biocides, PCBs and PBO, but also medium concentrations of nitrapyrin. Four sites had no air contamination with these substances; including two national parks dominated by grassland or forest, but also two sites with mixed land use. The potential human toxicity of the detected substances based on globally harmonized hazard classifications was high: seven substances had specific organ toxicity, six were cancerogenic, and two were acutely toxic; however, several substances had incomplete information of hazard profiles. Moreover, all substances were acutely and chronically toxic to aquatic life. We recommend that substances of different origins be included in the air pollution monitoring portfolio to comprehensively assess the potential hazards to humans and the environment.

Presence of pesticides in the environment, transition into organic food, and implications for quality assurance along the European organic food chain - A review.

The use of synthetic pesticides is not allowed in organic production, but traces of synthetic pesticides are regularly detected in organic food. To safeguard the integrity of organic production, organic certifiers are obliged to investigate the causes for pesticide residues on organic food, entailing high costs to the organic sector. Such residues can have various origins, including both fraud and unintentional contamination from the environment. Because the knowledge about contamination from environmental sources is scattered, this review provides an overview of pathways for unintentional and technically unavoidable contamination of organic food with synthetic pesticides in Europe. It shows that synthetic pesticides are widely present in all environmental compartments. They originate from applications in the region, in distant areas or from historical use. Transition into the food chain has been demonstrated by various studies. However, large uncertainties remain regarding the true pesticide contamination of the environment, their dynamics and the contamination risks for the food chain. Organic operators can take certain measures to reduce the risks of pesticide contamination of their products, but a certain extent of pesticide contamination is technically unavoidable. The present paper indicates that (i) a potential risk for pesticide residues exists on all organic crops and thus organic operators cannot meet a 'zero-tolerance' approach regarding pesticide residues at the moment. (ii) Applying a residue concentration threshold to distinguish between cases of fraud and unavoidable contamination for all pesticides is not adequate given the variability of contamination. More reliable answers can be obtained with a case-by-case investigation, where evidence for all possible origins of pesticide residues is collected and the likelihood of unavoidable contamination and fraud are estimated. Ultimately, for organic certification bodies and control authorities it will remain a challenge to determine whether a pesticide residue is due to neglect of production rules or technically unavoidable.

Chronic Chemogenetic Activation of the Superior Colliculus in Glaucomatous Mice: Local and Retrograde Molecular Signature.

One important facet of glaucoma pathophysiology is axonal damage, which ultimately disrupts the connection between the retina and its postsynaptic brain targets. The concurrent loss of retrograde support interferes with the functionality and survival of the retinal ganglion cells (RGCs). Previous research has shown that stimulation of neuronal activity in a primary retinal target area-i.e., the superior colliculus-promotes RGC survival in an acute mouse model of glaucoma. To build further on this observation, we applied repeated chemogenetics in the superior colliculus of a more chronic murine glaucoma model-i.e., the microbead occlusion model-and performed bulk RNA sequencing on collicular lysates and isolated RGCs. Our study revealed that chronic target stimulation upon glaucomatous injury phenocopies the a priori expected molecular response: growth factors were pinpointed as essential transcriptional regulators both in the locally stimulated tissue and in distant, unstimulated RGCs. Strikingly, and although the RGC transcriptome revealed a partial reversal of the glaucomatous signature and an enrichment of pro-survival signaling pathways, functional rescue of injured RGCs was not achieved. By postulating various explanations for the lack of RGC neuroprotection, we aim to warrant researchers and drug developers for the complexity of chronic neuromodulation and growth factor signaling.

Progress in Radiotherapy for Cholangiocarcinoma.

Cholangiocarcinoma (CCA) originates from the epithelium of the bile duct and is highly malignant with a poor prognosis. Radical resection is the only treatment option to completely cure primary CCA. Due to the insidious onset of CCA, most patients are already in an advanced stage at the time of the initial diagnosis and may lose the chance of radical surgery. Radiotherapy is an important method of local treatment, which plays a crucial role in preoperative neoadjuvant therapy, postoperative adjuvant therapy, and palliative treatment of locally advanced lesions. However, there is still no unified and clear recommendation on the timing, delineating the range of target area, and the radiotherapy dose for CCA. This article reviews recent clinical studies on CCA, including the timing of radiotherapy, delineation of the target area, and dose of radiotherapy. Further, we summarize large fraction radiotherapy (stereotactic body radiotherapy [SBRT]; proton therapy) in CCA and the development of immunotherapy and the use of targeted drugs combined with radiotherapy.

Pesticides in ambient air, influenced by surrounding land use and weather, pose a potential threat to biodiversity and humans.

Little is known about (i) how numbers and concentrations of airborne pesticide residues are influenced by land use, interactions with meteorological parameters, or by substance-specific chemo-physical properties, and (ii) what potential toxicological hazards this could pose to non-target organisms including humans. We installed passive air samplers (polyurethane PUF and polyester PEF filter matrices) in 15 regions with different land uses in eastern Austria for up to 8 months. Samples were analyzed for 566 substances by gas-chromatography/mass-spectrometry. We analyzed relationships between frequency and concentrations of pesticides, land use, meteorological parameters, substance properties, and season. We found totally 67 pesticide active ingredients (24 herbicides, 30 fungicides, 13 insecticides) with 10-53 pesticides per site. Herbicides metolachlor, pendimethalin, prosulfocarb, terbuthylazine, and the fungicide HCB were found in all PUF samplers, and glyphosate in all PEF samplers; chlorpyrifos-ethyl was the most abundant insecticide found in 93% of the samplers. Highest concentrations showed the herbicide prosulfocarb (725 ± 1218 ng sample-1), the fungicide folpet (412 ± 465 ng sample-1), and the insecticide chlorpyrifos-ethyl (110 ± 98 ng sample-1). Pesticide numbers and concentrations increased with increasing proportions of arable land in the surroundings. However, pesticides were also found in two National Parks (10 and 33 pesticides) or a city center (17 pesticides). Pesticide numbers and concentrations changed between seasons and correlated with land use, temperature, radiation, and wind, but were unaffected by substance volatility. Potential ecotoxicological exposure of mammals, birds, earthworms, fish, and honeybees increased with increasing pesticide numbers and concentrations. Human toxicity potential of detected pesticides was high, with averaged 54% being acutely toxic, 39% reproduction toxic, 24% cancerogenic, and 10% endocrine disrupting. This widespread pesticide air pollution indicates that current environmental risk assessments, field application techniques, protective measures, and regulations are inadequate to protect the environment and humans from potentially harmful exposure.

Research on automatic delineation of nasopharyngeal carcinoma target area based on generative adversarial network / 中华放射肿瘤学杂志

Objective:To propose a deep learning network model 2D-PE-GAN to automatically delineate the target area of nasopharyngeal carcinoma and improve the efficiency of target area delineation.Methods:The model adopted the architecture of generative adversarial networks which used a UNet similar structure as the generator, and 2D-PE-block was added after each layer of convolution operation of the generator to improve the accuracy of delineation. The experimental data included CT images from 130 cases of nasopharyngeal carcinoma. The images were preprocessed before model training. In addition, three models of UNet, GAN, and GAN with an attention mechanism were compared, and Dice similarity coefficient, Hausdorff distance, accuracy, Matthews correlation coefficient, Jaccard distance were employed to evaluate network performance.Results:Compared with UNet, GAN and GAN with the attention mechanism, the average Dice similarity coefficient of 2D-PE-GAN network segmentation of CTV was increased by 26%, 4% and 2%. The average Dice similarity coefficient of GTV segmentation was increased by 21%, 4%, 2%, respectively. Compared with the GAN network with the attention mechanism, the parameters and time of 2D-PE-GAN were reduced by 0.16% and 18%, respectively.Conclusions:Compared with the above three networks, 2D-PE-GAN network can increase the segmentation accuracy of nasopharyngeal carcinoma target area delineation. At the same time, compared with the attention mechanism with similar reasons, 2D-PE-GAN network can reduce the occupation of computing resources when the segmentation accuracy is not much different.

Effects of cervical region Ⅱ and oral target area optimization on salivary gland function and oral mucosal response during radiotherapy for oropharyngeal carcinoma / 肿瘤研究与临床

Objective:To observe the effects of cervical region Ⅱ and oral target area optimization on therapeutic efficacy, salivary gland function and oral mucosal response during intensity modulated radiation therapy (IMRT) for oropharyngeal cancer.Methods:A total of 50 patients with oropharyngeal squamous cell carcinoma in Xuzhou Cancer Hospital from January 2012 to May 2017 were collected. According to the random number table, they were divided into normal radiotherapy group (the control group), oral and cervical target area optimization group (the observation group), 25 cases in each group. Both groups were treated with IMRT and platinum-chemotherapy. The control group received bilateral cervical region Ⅱ-Ⅳ lymphatic drainage area irradiation (the positive side of the cervical lymph node included Ⅰ B region), and bilateral cervical region Ⅱ was given a tumor dose of 60 Gy (positive lymph nodes were given intensified irradiation); the observation group was optimized for the target area, and the contralateral cervical region Ⅱ B (the side with no positive lymph node) was given a tumor dose of 50 Gy; the observation group's oral structure was delineated as an organ at risk and the average radiation dose (D mean) was limited to <32 Gy. The differences in radiation dose of parotid gland, acute oral mucosal reaction and long-term xerostomia (6 months after the end of radiotherapy), objective remission rate (ORR), local recurrence rate (LRR), 3-year overall survival (OS) were compared between the two groups. Results:In the control group, the contralateral parotid gland D mean was (29±4) Gy, the proportion of irradiation volume exposed to 34 Gy (V 34) was (48±5)%; in the observation group, contralateral parotid gland D mean was (23±3) Gy, V 34 was (41±5)%, and there are statistically significant differences between the two groups ( t values were 6.14, 4.98, all P < 0.05). In the control group, oral D mean was (35±6) Gy, the proportion of volume exposed to 30 Gy (V 30) was (36±5)%; in the observation group oral D mean was (29±4) Gy, V 30 was (28±4)%, and there were statistically significant differences between the two groups ( t values were 4.11, 5.98, all P < 0.05). The incidence of ≥ grade Ⅱ acute oral mucosal adverse reaction and the duration time of oral mucosal ≥ 2 weeks was 64% (16/25) and 76% (19/25), respectively in the control group, 36% (9/25) and 40% (10/25), respectively in the observation group; and the differences were statistically significant ( χ2 values were 3.92, 6.65; P values were 0.048, 0.009). The incidence of ≥ grade Ⅱ long-term xerostomia reaction was 72% (18/25) and 44% (11/25), respectively in the control group and the observation group, and the difference between the two groups was statistically significant ( χ2 = 4.02, P = 0.044). The ORR, LRR, and 3-year OS rates were 80%, 28%, 48% in the control group, and 76%, 24%, 44% in the observation group. There was no statistically significant difference in the OS between the two groups ( χ2 = 0.04, P = 0.849). Conclusions:Optimization of the target area of the oral and cervical region Ⅱ during IMRT for oropharyngeal carcinoma can improve the function of salivary glands, thereby reducing dry mouth and oral mucosal reactions, improving the quality of life of patients; and it does not affect the efficacy of tumor treatment.

[Pharmacokinetic study on five components in phthalide target areas of Chaxiong and its ß-CD inclusion compounds based on UPLC-MS/MS].

This study aims to establish a method for the determination of the concentration of five main components of phthalide target areas of Chaxiong(CPTA) and its inclusion of ß-CD in the plasma of rats, and determine the pharmacokinetic parameters, absolute bioavailability and relative bioavailability of CPTA/ß-CD inclusion compound in vivo. The plasma concentrations of senkyunolide A, N-butylphthalide, new osthol lactone, Z-ligustilide and butenyl phthalide were determined with UPLC-MS/MS. The content determination was conducted at the chromatographic conditions as follows: Shim-pack GIST C_(18)-AQ HP column(2.1 mm×100 mm, 3 µm), mobile phase of 0.1% formic acid solution(A)-acetonitrile(B), gradient elution, flow rate of 0.3 mL·min~(-1), column temperature of 35 ℃ and injection volume of 2 µL. The mass spectra were obtained with electrospray ion source(ESI), positive ion mode and multi reaction monitoring. CPTA/ß-CD inclusion compound was prepared by grinding method, DAS 2.0 software was used to model the data, and the absolute bioavailability of CPTA and relative bioavailability of inclusion compound were calculated. Finally, the methods for the determination of five components of senkyunolide A, N-butylphthalide, new osthol lactone, Z-ligustilide and butenyl phthalide in CPTA, were successfully established. The linear relationship among the five components was good within their respective ranges, r>0.99. The absolute bioavailability of the five components in rats was 22.30%, 16.32%, 21.90%, 10.16% and 12.43%, respectively. After CPTA/ß-CD inclusion was prepared, the relative bioavailability of the five components was 138.69%, 198.39%, 218.01%, 224.54% and 363.55%, respectively, significantly improved. This method is rapid, accurate and sensitive, so it is suitable for the pharmacokinetic study of extracts in traditional Chinese medicine and their preparations.

The Application of Contrast Enhanced Ultrasound for Core Needle Biopsy of Subpleural Pulmonary Lesions: Retrospective Analysis in 92 Patients.

The purpose of this study was to investigate the role of contrast-enhanced ultrasound (CEUS) in determining the viable target area in patients with subpleural pulmonary lesions before ultrasound-guided transthoracic core biopsy. In this retrospective study, we analyzed 92 patients with subpleural pulmonary lesions (63 males and 29 females; mean age: 65.17 ± 11.72 y). All patients underwent B-mode ultrasound, color Doppler and CEUS. Color Doppler was performed to identify the major vessels. The time to enhancement of the contrast agents, homogeneity of enhancement and the presence of areas without enhancement were recorded after administration of the contrast agents. The viable target areas were defined as regions showing enhancement relative to those without enhancement and regions showing delayed enhancement in reference to peripheral lung tissues showing early enhancement. Afterward, real-time ultrasound-guided transthoracic core needle (18 gauge) biopsies were performed and the complication rate, success rate and diagnostic accuracy were calculated. With CEUS, the needle pathways of these lesions were readjusted the biopsy strategy in 40/92 patients (43.5%). It was determined that the satisfactory rate of the subsequent biopsy specimen was 100%. The histologic diagnostic accuracy of the biopsy was 97.83%. No serious complications occurred during the biopsy. In conclusion, the application of CEUS before biopsy was able to depict the viable target areas of the lesion to readjust the biopsy routes. With the help of CEUS, ultrasound-guided core biopsy could obtain adequate samples, improve the diagnostic accuracy and reduce the complication rates of biopsies.

Pharmacokinetic study on five components in phthalide target areas of Chaxiong and its β-CD inclusion compounds based on UPLC-MS/MS / 中国中药杂志

This study aims to establish a method for the determination of the concentration of five main components of phthalide target areas of Chaxiong(CPTA) and its inclusion of β-CD in the plasma of rats, and determine the pharmacokinetic parameters, absolute bioavailability and relative bioavailability of CPTA/β-CD inclusion compound in vivo. The plasma concentrations of senkyunolide A, N-butylphthalide, new osthol lactone, Z-ligustilide and butenyl phthalide were determined with UPLC-MS/MS. The content determination was conducted at the chromatographic conditions as follows: Shim-pack GIST C_(18)-AQ HP column(2.1 mm×100 mm, 3 μm), mobile phase of 0.1% formic acid solution(A)-acetonitrile(B), gradient elution, flow rate of 0.3 mL·min~(-1), column temperature of 35 ℃ and injection volume of 2 μL. The mass spectra were obtained with electrospray ion source(ESI), positive ion mode and multi reaction monitoring. CPTA/β-CD inclusion compound was prepared by grinding method, DAS 2.0 software was used to model the data, and the absolute bioavailability of CPTA and relative bioavailability of inclusion compound were calculated. Finally, the methods for the determination of five components of senkyunolide A, N-butylphthalide, new osthol lactone, Z-ligustilide and butenyl phthalide in CPTA, were successfully established. The linear relationship among the five components was good within their respective ranges, r>0.99. The absolute bioavailability of the five components in rats was 22.30%, 16.32%, 21.90%, 10.16% and 12.43%, respectively. After CPTA/β-CD inclusion was prepared, the relative bioavailability of the five components was 138.69%, 198.39%, 218.01%, 224.54% and 363.55%, respectively, significantly improved. This method is rapid, accurate and sensitive, so it is suitable for the pharmacokinetic study of extracts in traditional Chinese medicine and their preparations.

Dosimetric differences between volumetric modulated arc therapy plans with different arc numbers for cervical cancer / 医疗卫生装备

Object To study the effects of the number of arcs in the treatment of cervical cancer with volumetric modulated arc therapy (VMAT) on the treatment plan, and to provide reference for the selection of the number of arcs in the clinical application.Methods CT images of 10 patients with cervical cancer were selected, it's the radiation therapist that delineated the target area and organs, the prescribed dose was 5040 cGy per 28 times to the target area, and single arc (Arc1), double arc (Arc2) and three (Arc3) plan were designed by RayStation planning system to compare the differences with the dosimetry characteristics of target and organs. The time required for planning optimization was recorded, and the difference between the monitor unit and the delivery time in the three plans was analyzed. A dose validation tool for PTW was used to verify the dose to analyze the influence of the number of arc on the passing rate of gamma verification.Results Single arc plan (Arc1), double arc plan (Arc2) and three arc plan (Arc3) for 10 cases of cervical cancer all proved to meet the clinical requirements. With the increase of arc number, the target area distribution got improved, V40, V45 and Dmean in the organs at risk of rectum, bladder, and femoral head gradually decreased in case of doses of 40 and 45 Gy, and V35, V40 and V45 in the normal tissue were lowered in case of the doses of 35, 40 and 45 Gy. With the increase of the arc number, the optimization time and the delivery time of the plan increased, while the difference between the monitor unit of the three plans was smaller. The passing rate of the three plans was more than 99.5％, and the difference was small.Conclusion Cervical cancer VMAT plan has the target dose distribution and the protection of organs at risk enhanced with the increase of the number of arcs, while the treatment time and cost increased. Therefore, it is necessary to take comprehensive considerations on the number of VMAT plan arcs.

Abdominal lymph node recurrence after radical surgery in patients with middle thoracic esophageal squamous cell carcinoma:risk factors and guidance for postoperative radiotherapy / 中华放射肿瘤学杂志

Objective To analyze the risk factors for abdominal lymph node recurrence after radical surgery in patients with middle thoracic esophageal squamous cell carcinoma (TE-SCC),and to design the target volume for postoperative radiotherapy based on the results.Methods A retrospective study was performed among 913 patients with middle TE-SCC undergoing radical surgery who were admitted to our hospital from 2007 to 2012.Influencing factors were analyzed for abdominal lymph node recurrence after treatment.The efficacy was compared between different treatment methods in the high-risk population.Comparison of categorical data was made by chi-square test.The overall survival rates (OS) were calculated by the Kaplan-Meier method and analyzed by the univariate log-rank analysis.The influencing factors for abdominal lymph node recurrence were analyzed by the multivariate logistic regression equation.Results After treatment,37 patients had abdominal lymph node recurrence,yielding a recurrence rate of 4.1％.A total of 53 recurrent sites were found.The univariate analysis showed that no/low differentiation,pT3+4 stage,no less than 3 positive postoperative lymph nodes,and positive postoperative abdominal lymph nodes were influencing factors for abdominal lymph node recurrence (P =0.032,0.001,0.009,0.000).The multivariate regression analysis showed that pathological T staging and positive postoperative abdominal lymph nodes were influencing factors for abdominal lymph node recurrence (P=0.011,0.000).For patients with pT3+4 stage disease and positive postoperative abdominal lymph nodes,postoperative radiotherapy improved OS and local control rates but failed to reduce the distant metastasis-free rate.Conclusions T staging and positive postoperative abdominal lymph nodes are important risk factors for abdominal lymph node recurrence after radical surgery in patients with middle TE-SCC.Postoperative adjuvant therapy is recommended for patients with pT3+4 stage disease and positive postoperative abdominal lymph nodes.

Failure patterns of radical surgery in patients with T1-4N0-1M0 thoracic esophageal squamous cell carcinoma: implications for the target area design of postoperative therapy / 中华放射医学与防护杂志

Objective To analyze the failure patterns and prognostic factors of radical surgery in patients with T1-4N0-1M0 thoracic esophageal squamous cell carcinoma (TESCC),and the implications for the target area design of postoperative therapy.Methods We retrospectively analyzed 1 191 patients with TESCC who underwent radical surgery at our institution.The failure patterns,the prognostic factors,as well as the effects of lesion locations and N stage on the failure patterns were analyzed.Results The thoracic-region recurrence rate and the distant metastasis rate was 31.7％ and 16.4％ in all patients.The multivariate analysis showed that the lesion locations,the degree of inflammatory adhesion,T staging,N staging and the rate of lymph nodes metastasis were independent factors affecting the regional recurrence (P ＜ 0.05).Gender,tumor differentiation and the rate of lymph nodes metastasis were independent factors affecting distant metastasis (P ＜ 0.05).The intrathoracic lymph nodes recurrence rate of upper/middle TESCC was significantly higher than that of the lower TESCC (x2 =6.179,P =0.046),while the abdomen lymph nodes recurrence rate of the lower was significantly higher than that of upper/middle TESCC (x2 =15.853,P ＜ 0.05).The recurrence rate and distant metastasis rate of stage N1 patients were significantly higher than that of N0 patients (x2 =7.764-56.495,P ＜ 0.05).The abdomen lymph nodes recurrence rate of stage N1 patients was significantly higher than that of N0 in upper TESCC (x2 =7.905,P ＜0.05).The supraclavicular and intrathoracic lymph nodes recurrence rates of stage N1 patients were significantly higher than that of N0 patients in middle TESCC (x2 =12.506,18.436,P ＜ 0.05).The supraclavicular lymph nodes,anastomosis and abdomen lymph node recurrence rates of stage N1 were significantly higher than that of N0 patients in lower TESCC (x5 =5.272,4.878,18.006,P ＜ 0.05).The anastomotic recurrence rate of stage T3+4 was higher than that of T1+2 in middle/lower TESCC (x2 =4.341,7.154,P ＜ 0.05),and the abdominal lymph nodes recurrence rate of stage T3 +4 was higher than that of T1 +2 in lower TESCC (x2 =5.366,P ＜ 0.05).Conclusions The lymphatic drainage regions for postoperative radiotherapy (PORT) are selective.We suggest that abdominal lymph nodes drainage area should be noted for the stage N1 patients with upper TESCC,and the supraclavicular lymph nodes drainage area should be noted for the N1 patients with lower TESCC.In addition,the anastomosis is suggested to be included in PORT target area for stage T3/T4 middle/lower TESCC patients.

Impact of target area selection in 125 Iodine seed brachytherapy on locoregional recurrence in patients with non-small cell lung cancer.

BACKGROUND: Computed tomography (CT)-guided percutaneous implantation of 125 Iodine radioactive seeds requires the precise arrangement of seeds by tumor shape. We tested whether selecting target areas, including subclinical areas around tumors, can influence locoregional recurrence in patients with non-small cell lung cancer (NSCLC). METHOD: We divided 82 patients with NSCLC into two groups. Target areas in group 1 (n = 40) were defined along tumor margins based on lung-window CT. Target areas in group 2 (n = 42) were extended by 0.5 cm in all dimensions outside tumor margins. Preoperative plans for both groups were based on a treatment plan system, which guided 125 I seed implantation. Six months later, patients underwent chest CT to evaluate treatment efficacy (per Response Evaluation Criteria in Solid Tumors version 1). We compared locoregional recurrences between the groups after a year of follow-up. We then used the treatment plan system to extend target areas for group 1 patients by 0.5 cm (defined as group 3 data) and compared these hypothetical group 3 planned seeds with the actual seed numbers used in group 1 patients. RESULTS: All patients successfully underwent implantation; none died during the follow-up period. Recurrence was significantly lower in group 2 than in group 1 ( P < 0.05). Group 1 patients and group 3 data significantly differed in seed numbers ( P < 0.01). CONCLUSION: Our results imply that extending the implantation area for 125 I seeds can decrease recurrence risk by eradicating cancerous lymph-duct blockades within the extended areas.

Effects of magnetic resonance diffusion weighted image on the target volume delineation of advanced esophageal cancer / 西安交通大学学报(医学版)

Objective To investigate the value of DWI imaging combined with T2WI imaging and CT image fusion technology and explore the role of DWI imaging in the determination of target areas in radiotherapy for advanced esophageal cancer.Methods Twenty-three patients with locally advanced esophageal cancer were included in this study.All the patients were fixed by a heat plastic device.Each patient was examined by CT,T2WI and DWI scan in the same position as the radiotherapy treatment.Images obtained from the three sequences were transmitted to the Eclipse 11.0 treatment planning system.All images were registered at Eclipse workstation as to normalized mutual information registration.The target areas were delineated by the clinical radiation physicians in the CT imaging,and CT and DWI fusion images.The target areas of the two kinds of image were evaluated using fusion function and statistical function of the treatment planning system.Results Target parameters differed significantly between CT base and CT/MRI fusion base.The results of the target volume outline closer by CT and MRI fusion image base in the three groups of clinicians.Conclusion The target volume between the groups is closer by using CT and DWI fusion image.DWI image has a good assisting effect in determining the target area of locally advanced esophageal cancer.

Extracorporeal shock wave lithotripsy effect on non-target areas in various renal stones / 实用医学杂志

Objective To observe the effect of extracorporeal shock wave lithotripsy on non target areas for various renal calculi. Methods Six thousand,one hundred and forty-nine cases of renal calculi patients were divided into 3 groups based on the calculi positions ,including the superior renal calices group ,the middle renal calices group and the inferior renal calices group. We compared the renal CT perfusion parameters in the non target areas of renal stones,successful rates of removing stones and complications. Results Extracorporeal shock wave lithotripsy had renal injures on both target areas and non target areas. When the extracorporeal energy is greater than 11 kV,the kidney damages became severe rapidly. When the E < 9,lithotripsy successful rate was signifi-cantly higher than that of E≥9;when E≥11 ,the energy wave lithotripsy complication rates were less than that of E<11 energy wave lithotripsy. Conclusions When the shock wave energy is in the range of 9~11 kV,there is not only low injuries on non target areas ,but also low successful rates of removing stones and complication rates. So the shock wave energy in a range of 9~11 kV is the best choice of energy regimen in treatment of patients with renal stones.

Modern radiation therapy for nodal non-Hodgkin lymphom-target definition and dose guidelines from the international lymphoma radiation oncology group / 中华放射肿瘤学杂志

The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles of reduced volume and reduced doses are addressed,integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era,combined-modality treatment with systemic therapy is appropriate. A new concept,involved-site RT,defines the clinical target volume. For indolent NHL,often treated with RT alone,larger fields should be considered. Newer treatment techniques,including intensity modulated RT,breath holding,image guided RT,and 4-dimensional imaging,should be implemented,and their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control.