Association of Internal and External Motion Based on Cine MR Images Acquired During Real-Time Treatment on MRI-Guided Linear Accelerator for Patients With Lung Cancer

Purpose

With the recent clinical implementation of magnetic resonance imaging (MRI)-guided linear accelerators, a large number of real-time planar MR images has been acquired during lung cancer treatment as a standard of care. In this study, associations among lung tumor, diaphragm, and external skin movement were studied based on MR cine imaging during the entire duration of each treatment fraction.

Methods and Materials

This retrospective study used 181,798 planar MRI frames acquired over 55 treatment/imaging sessions of 13 patients with lung cancer treated on 2 MRI-guided linear accelerators. From each planar MR image frame, in-house software automatically extracted 9 features: the superior-interior (SI) and posterior-anterior (PA) positions of a lung tumor; the area of the lung (Lung_Area); the posterior (Dia_Post), dome/apex (Dia_Dome), and anterior (Dia_Ant) points of a diaphragmatic curve; the diaphragm curve point (Dia_Max); and the chest (Chest) and belly (Belly) skin points experienced the maximum range of motions. Correlation analyses were performed among the 9 features for every session. Lung tumor motion range and standard deviations were calculated based on positions obtained in cine images and compared with motion ranges obtained from 4-dimensional computed tomography images.

Results

In the study, 177,009 frames of images were successfully analyzed. For all patients, correlation coefficients were as follows: 0.91 ± 0.10 between any 2 features among Lung_Area, Dia_Post, Dia_Dome, and Dia_Max; 0.82 ± 0.21 between SI and any feature among Lung_Area, Dia_Post, Dia_Dome, and Dia_Max; 0.75 ± 0.24 between SI and Belly. Six of 13 patients were considered large amplitude motion (patients with lung tumor SI motion standard deviation >5 mm). Furthermore, 92,956 frames of images were analyzed for the 6 large-amplitude motion patients. For this set, correlation coefficients were 0.93 ± 0.07 between any 2 features among Lung_Area, Dia_Post, Dia_Dome, and Dia_Max; 0.94 ± 0.06 between SI and any feature among Lung_Area, Dia_Post, Dia_Dome, and Dia_Max; and 0.90 ± 0.09 between SI and Belly.

Conclusions

Both belly and diaphragmatic motions as assessed by cine MRI are highly correlated with large amplitude lung tumor motion in the longitudinal axis.

Silva Classification System for HPV-Related EAC of Stage I ∼ IIIc1p Cervical Adenocarcinoma and Its Effect on Prognosis and Survival

PURPOSE/OBJECTIVE(S)

The proportion of adenocarcinoma in cervical cancer gradually increased and presented a younger trend. The previous pathological classification of cervical adenocarcinoma is difficult to provide reference for clinical treatment. In recent years, Silva classification, a new pathologic system for cervical adenocarcinoma, has been confirmed to be suitable for HPV-associated adenocarcinoma (HPVA), and has shown certain clinical application value in subsequent studies. Therefore, this study will retrospectively analyze the distribution of Silva typing system in patients with HPVA under standard treatment mode and its relationship with prognosis and survival.

MATERIALS/METHODS

From January 2010 to September 2021, 124 cervical adenocarcinoma patients with HPVA were retrospectively included, who underwent radical resection of cervical cancer. The HE staining sections of the patients were divided into SilvaA, SilvaB, and SilvaC types according to the Silva typing system. Kaplan-Meier calculation was used for single-factor analysis, and COX stepwise regression model was used for multi-factor analysis.

RESULTS

Of the 124 patients with HPVA who could be graded according to the Silva system, 16 (12.9%, 16/124) were SilvaA, 27 (21.7%, 27/124) SilvaB, and 81 (65.4%, 81/124) SilvaC. In Silva classification, FIGO staging of Silva A and B was stage I. And FIGO staging of Silva C was more significantly later than the staging of Silva A and B. All lymph node metastases and paruterine infiltrates were found only in Silva C. In addition, the patients with Silva C large mass accounted for a higher proportion (41.7%). SilvaA type cervical adenocarcinoma patients were in a survival state by the end of follow-up. Among Silva B, 3 patients died due to tumor, and the 5-year OS rate were 91.3%. Among SilvaC, 15 patients died due to tumor, and the 5-year OS rate were 76.5%. FIGO stage and lymph node invasion were the influencing factors for survival and prognosis of Silva classification (P <0.05). FIGO stage, tumor size, lymph node invasion, and paralegal invasion were the influencing factors for survival and prognosis of SilvaC patients (P <0.05).

CONCLUSION

Silva model classification system combined with clinicopathological features has certain clinical value for the prognostic guidance of HPVA patients. Among Silva classification, SilvaC had the worst prognosis. Late FIGO stage, lymph node metastasis, and paralegal infiltration are the influencing factors for survival and prognosis of SilvaC type.

A case of intramandibular epidermoid cyst and literature analysis

Epidermoid cysts are generally benign neoplastic lesions, the etiology of which is unclear and is mainly related to epithelial cells left in the tissues during the embryonic period and traumatically implanted in the tissues. The most common intraosseous sites are the phalanges and the skull. Epidermoid cysts occurring in the jaws are clinically rare. In this paper, we report a case of epidermoid cyst occurring in the mandible with embedded teeth and discuss the etiology, clinical manifestations, diagnosis, and treatment of epidermoid cysts in the jaws in the context of the relevant literature.

Factors of Dental Care Utilization in Foreign-Born Older Chinese Americans

Good oral health is essential for healthy aging. Regular dental care utilization is instrumental to good oral health. Older immigrants tend to experience poorer oral health and less dental care use as compared with their native-born counterparts in the host country. Older immigrants are particularly vulnerable to interrupted or lost social ties and acculturation challenges after immigration to a new country. This study examined whether and to what extent social relations, acculturation, and perceived oral health needs are associated with dental care utilization in foreign-born older Chinese Americans. Data came from the Population Study of Chinese Elderly in Chicago, which were collected between 2017 and 2019 (N = 3,000). Dental care utilization was dichotomized into "yes" versus "no" in the past 2 y. Social relations were measured by positive and negative relations with spouse, family, and friends. Acculturation was measured by length of stay, behavioral acculturation, and residence in Chinatown. Perceived oral health needs were measured by the presence of problems related to teeth, gums, or bleeding. As guided by the Andersen model, separate logistic regression models were used to investigate factors of dental care utilization. An overall 23.1% reported dental care utilization. Individuals with no negative relations with spouse, family, and friends were 31%, 36%, and 38% less likely to visit a dentist, respectively. Individuals with higher levels of behavioral acculturation were 4% more likely to visit a dentist; individuals living in Chinatown were 45% less likely; and individuals with perceived oral health needs were 2.5 times more likely. Findings illustrate the importance of understanding social relations, immigration-related factors, and perceived oral health needs in dental care utilization in older immigrants.

[Applied anatomical study and clinical application of the caudate lobe boundary and ductal system of the liver]

Objective: To explore the relationship between the hepatic caudate lobe boundary and the ductal system so as to guide the identification of the anatomical relationship during liver surgery. Methods: The specific parts were observed and the liver parenchyma was removed according to 41 cadaveric liver autopsy specimens. The critical relationship between the hepatic caudate lobe and other ducts was observed to explore the reticular duct structure. Results: The plane formed by the hepatic hilar plate and Arantius ligament served as the boundary between the caudate lobe and other hepatic lobes. The caudate lobe hepatic portal vein was composed of numerous small branches from its left and right branches. The portal vein adjacent to the vena cava was mainly derived from the left branch, and to a lesser extent from the right branch. Blood was drained straight from the caudate lobe vein into the inferior vena cava via the short hepatic vein. There were three or four bile duct branches in the caudate lobe. The main source of arterial blood flow were the left and right branches of the hepatic artery. An avascular zone of loose connective tissue was found between the caudate lobe and the retrohepatic inferior vena cava. Conclusion: The hepatic caudate lobe is an independent lobe. During hepatic caudate lobe surgery, the plane formed by the hepatic hilar plate and Arantius ligament can serve as the boundary between the caudate lobe and other hepatic lobes and be used for anatomical site identification. The duct system of the caudate lobe's is complicated, but it also has its own distinct regularity.

PlantcircBase 7.0: Full-length transcripts and conservation of plant circRNAs

Circular RNA (circRNA) is a special type of non-coding RNA that participates in diverse biological processes in both animals and plants. Five years ago, we developed a comprehensive plant circRNA database (PlantcircBase), which has attracted much attention from the plant circRNA community. Here, we report an updated PlantcircBase (v.7.0), which contains 171,118 circRNAs from 21 plant species. Over 31,000 of the circRNAs have full-length sequences constructed based on analysis of 749 bulk RNA sequencing (RNA-seq) datasets downloaded from the public domain and Nanopore long-read sequencing results of rice RNAs newly generated in this study. A plant multiple conservation score (PMCS), based on the conservation of both sequence and expression profiles, was calculated for each circRNA to quantify and compare the conservation of all circRNAs. A new parameter, plant circRNA confidence level (PCCL), is introduced to measure the identity reliability of each circRNA based on experimental validation results and the number of references that support the circRNA. All this information and other details of circRNAs can be browsed, searched, and downloaded from PlantcircBase 7.0, which also provides online bioinformatics tools for visualization and sequence alignment. PlantcircBase 7.0 is publicly and freely accessible at http://ibi.zju.edu.cn/plantcircbase/.

Association Between Internal Organ/Liver Tumor and External Surface Motion From Cine MR Images on an MRI-Linac

Purposes/Objectives

Historically, motion correlation between internal tumor and external surrogates have been based on limited sets of X-ray or magnetic resonance (MR) images. With the recent clinical implementation of MR-guided linear accelerators, a vast quantity of continuous planar real-time MR imaging data is acquired. In this study, information was extracted from MR cine imaging during liver cancer treatments to establish associations between internal tumor/diaphragm and external surface/skin movement.

Methods and Materials

This retrospective study used 305,644 MR image frames acquired over 118 treatment/imaging sessions of the first 23 liver cancer patients treated on an MRI-linac. 9 features were automatically determined on each MR image frame: Lung_Area, the posterior (Dia_Post), dome (Dia_Dome), and anterior (Dia_Ant) points of a diaphragmatic curve and the diaphragm curve point (Dia_Max), the chest (Chest) and the belly (Belly) skin points experiencing the maximum motion ranges; the superior-interior (SI) and posterior-anterior (PA) positions of a target. For every session, correlation analyses were performed twice among the 9 features: 1) over a breath-hold (BH) set and 2) on a pseudo free-breathing (PFB) generated by removing breath-holding frames.

Results

303,123 frames of images were successfully analyzed. For BH set analysis, correlation coefficients were as follows: 0.94 ± 0.07 between any two features among Dia_Post, Dia_Dome, Dia_Max, and Lung_Area; 0.95 ± 0.06 between SI and any feature among Dia_Post, Dia_Dome, Dia_Max, or Lung_Area; 0.76 ± 0.29 between SI and Belly (with 50% of correlations ≥ 0.87). The PFB set had 142,862 frames of images. For this set, correlation coefficients were 0.96 ± 0.06 between any two features among Dia_Post, Dia_Dome, Dia_Max, and Lung_Area; 0.95 ± 0.06 between SI and any feature among Dia_Post, Dia_Dome, Dia_Max, or Lung_Area; 0.80 ± 0.26 between SI and Belly (with 50% of correlations ≥ 0.91).

Conclusion

Diaphragmatic motion as assessed by cine MR imaging is highly correlated with liver tumor motion. Belly vertical motion is highly correlated with liver tumor longitudinal motion in approximately half of the cases. More detailed analyses of those cases displaying weak correlations are in progress.

Retrospective analysis of risk factors for bone metastasis in newly diagnosed prostate cancer patients

OBJECTIVE

The aim of the study was to analyze the clinical data of newly diagnosed prostate cancer (PCa) patients with bone metastasis and to explore the relevant risk factors.

PATIENTS AND METHODS

The clinical data of 251 patients with PCa, who were initially diagnosed in our hospital from February 2015 to October 2021, were retrospectively analyzed. According to the whole-body bone scan results, patients were divided into the bone metastasis group (n = 66) and the non-bone metastasis group (n = 185). The patient's age, total prostate-specific antigen (TPSA), free PSA (fPSA), prostate volume, alkaline phosphatase (ALP), Gleason score, erythrocyte sedimentation rate (ESR), and pelvic lymph node metastasis were collected. Univariate correlation and multivariate regression analyses, together with receiver operating characteristic curve, were used to analyze PCa bone metastasis-related factors.

RESULTS

The incidence of bone metastasis in newly diagnosed PCa was about 26.29% (66/251). Among them, the incidence of pelvic metastasis was the highest, at 78.78% (52/251), and multiple bone metastases were significantly higher than single bone metastasis (80.31% vs. 19.69%). Univariate correlation analysis indicated that age, Gleason score, ESR, TPSA, ALP, fPSA/PSA, capsular infiltration, and pelvic lymph node metastasis (p < 0.05) were highly correlated with PCa bone metastasis. Multivariate Logistic regression analysis showed that TPSA (95% CI: 0.977-1.284, p = 0.007), ALP (95% CI: 1.008-1.080, p = 0.016), Gleasons core (95% CI: 2.110-82.349, p = 0.006), ESR (95% CI: 1.062-1.104, p = 0.003), and pelvic lymph node metastasis (95% CI: 1.537--33.239, p = 0.012) were independent risk factors for bone metastasis of PCa. The cut-off values for TPSA, ALP, Gleason score, and ESR were 33.78 ng/ml, 73.65 U/L, 7.5, and 23.5 mm/h, respectively. Additionally, the respective sensitivities for TPSA, ALP, Gleason score, and ESR were 81.8%, 75.8%, 68.2% and 77.3%, and the respective specificities was 90.3%, 98.9%, 98.4%, and 74.6%.

CONCLUSIONS

TPSA, ALP, Gleason score, ESR and pelvic lymph node metastasis are independent risk factors for bone metastasis of PCa.

A validation study of a continuous automatic measurement of the mechanical power in ARDS patients

The mechanical power (MP) is the energy delivered into the respiratory system over time. It can be computed as a direct measurement of the inspiratory area of the airway pressure and volume loop during the respiratory cycle or calculated by "power equations". The absence of a bedside computation limited its widespread use. Recently, it has been developed an automatic monitoring system inside of a mechanical ventilator.

PURPOSE

Our aim was to investigate the repeatability and the accuracy of the measured MP at different PEEP values and tidal volume compared with the calculated MP.

MATERIAL AND METHODS

MP was measured and calculated in sedated and paralyzed ARDS patients at low and high tidal volume, at 5-10-15 cmH₂O of PEEP both in volume and pressure-controlled ventilation. The same measurements were performed twice.

RESULTS

Fifty ARDS patients were enrolled. MP was measured and calculated for a total of 300 measurements. The bias and limits of agreement were 0.38 from -1.31 to 2.0 J/min. The measured and calculated MP were similar in each ventilatory condition.

CONCLUSIONS

The mechanical power measured by a new automatic real time system implemented in a mechanical ventilator was repeatable and accurate compared with the computed one.

How does CBCT reconstruction algorithm impact on deformably mapped targets and accumulated dose distributions?

PURPOSE

We performed quantitative analysis of differences in deformable image registration (DIR) and deformable dose accumulation (DDA) computed on CBCT datasets reconstructed using the standard (Feldkamp-Davis-Kress: FDK_CBCT) and a novel iterative (iterative_CBCT) CBCT reconstruction algorithms.

METHODS

Both FDK_CBCT and iterative_CBCT images were reconstructed for 323 fractions of treatment for 10 prostate cancer patients. Planning CT images were deformably registered to each CBCT image data set. After daily dose distributions were computed, they were mapped to planning CT to obtain deformed doses. Dosimetric and image registration results based CBCT images reconstructed by two algorithms were compared at three levels: (A) voxel doses over entire dose calculation volume, (B) clinical constraint results on targets and sensitive structures, and (C) contours propagated to CBCT images using DIR results based on three algorithms (SmartAdapt, Velocity, and Elastix) were compared with manually delineated contours as ground truth.

RESULTS

(A) Average daily dose differences and average normalized DDA differences between FDK_CBCT and iterative_CBCT were ≤1 cGy. Maximum daily point dose differences increased from 0.22 ± 0.06 Gy (before the deformable dose mapping operation) to 1.33 ± 0.38 Gy after the deformable dose mapping. Maximum differences of normalized DDA per fraction were up to 0.80 Gy (0.42 ± 0.19 Gy). (B) Differences in target minimum doses were up to 8.31 Gy (-0.62 ± 4.60 Gy) and differences in critical structure doses were 0.70 ± 1.49 Gy. (C) For mapped prostate contours based on iterative_CBCT (relative to standard FDK_CBCT), dice similarity coefficient increased by 0.10 ± 0.09 (p < 0.0001), mass center distances decreased by 2.5 ± 3.0 mm (p < 0.00005), and Hausdorff distances decreased by 3.3 ± 4.4 mm (p < 0.00015).

CONCLUSIONS

The new iterative CBCT reconstruction algorithm leads to different mapped volumes of interest, deformed and cumulative doses than results based on conventional FDK_CBCT.

Biofertilizer-induced response to cadmium accumulation in Oryza sativa L. grains involving exogenous organic matter and soil bacterial community structure

The accumulation of cadmium (Cd) in Oryza sativa L., the world's most significant staple crop, is a health threat to millions of people. The objective of this study was to evaluate the effectiveness of commercially available biofertilizers (with high (BF2) and low organic matter (OM) content (BF1)) on Cd accumulation in two types of soils and to determine the bacterial community responses by high-throughput sequencing. The study was conducted in the form of pot experiment in greenhouse in 2018. Four treatments were set: BF1, BF2, organic fertilizer (OF), and control (CK) and the amendments were applied before the rice cultivation. The results showed that the addition of biofertilizers immobilized or mobilized Cd in soils, depending on the soil type and the OM content in biofertilizers. The exogenous OM in biofertilizers was the driving factor for the difference in pH and Cd accumulation in rice grains. The application of biofertilizers with high OM content was effective in reducing Cd accumulation in the rice grains (19.7% lower than CK) by significantly increasing soil pH (from 6.02 to 6.67) in acid silt loam soil (TZ). The consumption of acid fermentation products by soil chemoorganotrophs and the complexation of organic anions in the biofertilizer treatment tended to buffer the pH drop in the drainage and decrease the Cd availability. However, in the weak acid silty clay loam soil (SX), the addition of biofertilizer with high OM significantly increased Cd accumulation in rice grains (21.9% higher than CK), probably owing to the release of acid substances, resulting from the significant increase of the predominant bacteria Chloroflexi. The addition of biofertilizer with low OM content did not significantly change Cd accumulation in rice grains or affect the soil microbial structures in both soils. In conclusion, the effects of biofertilizer on rice Cd accumulation were related to the OM content and soil bacterial community. Biofertilizers with high organic matter may not be suitable for amendments in the paddy soils with high clay content to reduce Cd accumulation in rice grains.

Immigration and Oral Health in Older Adults: An Integrative Approach

The aim of this study was to develop an integrative framework on aging, immigration, and oral health. The methodology was a critical review that used immigration as a social determinant framework through which to evaluate its impact on the oral health of older immigrants. We reviewed recent empirical evidence on factors related to oral health in older immigrants. In a systematic search across multiple databases, we identified 12 eligible studies in this review. Among the eligible studies, most were conducted among East Asian immigrants (8 articles), followed by non-Hispanic White/European origin (2 articles), Mexican origins (1 article), and Iran and other Middle East regions (1 article). The research revealed knowledge gaps in the evidence base, including the dynamic relationship between acculturation and oral health, the role of environmental factors on oral health for immigrants, psychosocial stressors and their relationship with oral health, and oral health literacy, norms, and attitude to dental care utilization and oral hygiene practices. The development of the integrative framework suggests the pathways/mechanisms through which immigration exerts influences on oral health in later life. This provides opportunities for researchers, practitioners, and policy makers to gain greater insights into the complex associations between immigration and oral health among older adults.

Strigolactone GR24 improves cadmium tolerance by regulating cadmium uptake, nitric oxide signaling and antioxidant metabolism in barley (Hordeum vulgare L.)

Cadmium (Cd) in the food chain poses a serious hazard to human health. Therefore, a greenhouse hydroponic experiment was conducted to examine the potential of exogenously strigolactone GR24 in lessening Cd toxicity and to investigate its physiological mechanisms in the two barley genotypes, W6nk2 (Cd-sensitive) and Zhenong8 (Cd-tolerant). Exogenous application of 1 μM GR24 (strigol analogue) reduced the suppression of growth caused by 10 μM Cd, lowered plant Cd contents, increased the contents of other nutrient elements, protected chlorophyll, sustained photosynthesis, and markedly reduced Cd-induced H2O2 and malondialdehyde accumulation in barley. Furthermore, exogenous GR24 markedly increased NO contents and nitric oxide synthase activity in the Cd-sensitive genotype, W6nk2, effectively alleviating the Cd-induced repression of the activities of superoxide dismutase and peroxidase, increasing reduced glutathione (GSH) and ascorbic acid (AsA) pools and activities of AsA-GSH cycle including ascorbate peroxidase, glutathione peroxidase, glutathione reductase, dehydroascorbate reductase and monodehydroascorbate reductase. The findings of the present study indicate that GR24 could be a candidate for Cd detoxification by decreasing Cd contents, balancing nutrient elements, and protecting barley plants from toxic oxidation via indirectly eliminating reactive oxygen species (ROS), consequently contributing to reducing the potential risk of Cd pollution.

Technical Note: Comparison of the internal target volume (ITV) contours and dose calculations on 4DCT, average CBCT, and 4DCBCT imaging for lung stereotactic body radiation therapy (SBRT)

PURPOSE

To investigate the differences between internal target volumes (ITVs) contoured on the simulation 4DCT and daily 4DCBCT images for lung cancer patients treated with stereotactic body radiotherapy (SBRT) and determine the dose delivered on 4D planning technique.

METHODS

For nine patients, 4DCBCTs were acquired before each fraction to assess tumor motion. An ITV was contoured on each phase of the 4DCBCT and a union of the 10 ITVs was used to create a composite ITV. Another ITV was drawn on the average 3DCBCT (avgCBCT) to compare with current clinical practice. The Dice coefficient, Hausdorff distance, and center of mass (COM) were averaged over four fractions to compare the ITVs contoured on the 4DCT, avgCBCT, and 4DCBCT for each patient. Planning was done on the average CT, and using the online registration, plans were calculated on each phase of the 4DCBCT and on the avgCBCT. Plan dose calculations were tested by measuring ion chamber dose in the CIRS lung phantom.

RESULTS

The Dice coefficients were similar for all three comparisons: avgCBCT-to-4DCBCT (0.7 ± 0.1), 4DCT-to-avgCBCT (0.7 ± 0.1), and 4DCT-to-4DCBCT (0.7 ± 0.1); while the mean COM differences were also comparable (2.6 ± 2.2mm, 2.3 ± 1.4mm, and 3.1 ± 1.1mm, respectively). The Hausdorff distances for the comparisons with 4DCBCT (8.2 ± 2.9mm and 8.1 ± 3.2mm) were larger than the comparison without (6.5 ± 2.5mm). The differences in ITV D95% between the treatment plan and avgCBCT calculations were 4.3 ± 3.0% and -0.5 ± 4.6%, between treatment plan and 4DCBCT plans, respectively, while the ITV V100% coverages were 99.0 ± 1.9% and 93.1 ± 8.0% for avgCBCT and 4DCBCT, respectively.

CONCLUSION

There is great potential for 4DCBCT to evaluate the extent of tumor motion before treatment, but image quality challenges the clinician to consistently delineate lung target volumes.

[Endemic situation of schistosomiasis in national surveillance sites of Hunan Province from 2015 to 2019]

OBJECTIVE

To analyze the changes in the endemic situation of schistosomiasis in national surveillance sites of Hunan Province, so as to provide scientific basis for the development of the schistosomiasis elimination programme in the province.

METHODS

According to the requirements of the National Guidelines for Schistosomiasis Surveillance in China (2014 version), a total of 41 national schistosomiasis surveillance sites were assigned in all disease-endemic counties (districts) across Hunan Province. During the period between 2015 and 2019, Schistosoma japonicum infections were monitored in local residents, mobile populations and livestock, and snail status was monitored. The morbidity due to schistosomiasis and snail status was compared between years.

RESULTS

The sero-prevalence of S. japonicum infections was 2.57% and 1.56% in local residents and mobile populations in national surveillance sites of Hunan Province from 2015 to 2019, respectively, and the sero-prevalence appeared a tendency towards a decline over years. A higher sero-prevalence rate of S. japonicum infections was seen in men than in women (P < 0.01). During the 5-year study period, the sero-prevalence rate of human S. japonicum infections appeared a tendency towards a decline in the marshland, embankment, inner embankment and hilly types of endemic areas over years. There were 44 and 19 egg -positives detected in local residents and 5 and 1 egg-positives in mobile populations in 2015 and 2016 respectively. A total of 9 346 domestic animals were monitored from 2015 to 2019, and 6 egg-positives were detected in 2015 and 2016 (all were bovine). A total of 0.155 billion m² settings were surveyed from 2015 to 2019, and the mean density of living snails appeared a tendency towards a decline over years, with a 45.79% reduction in 2019 as compared to 2015. However, no S. japonicum infections were identified in snails during the 5-year period. A total of 1 469 mixed snail samples were detected using loop-mediated isothermal amplification (LAMP), and 6 positive snail samples were identified in 2015 (one sample) and 2017 (5 samples).

CONCLUSIONS

The overall endemic situation of schistosomiasis appears a tendency towards a decline in Hunan Province, and the prevalence of S. japonicum infections is at a low level in humans and livestock; however, there is still a risk of schistosomiasis transmission. Improvements of health education, intensification of schistosomiasis examinations in mobile populations and reinforcement of the surveillance-response system is required to consolidate the achievements of schistosomiasis control in Hunan Province.

Acupuncture for recurrent urinary tract infection in women: a systematic review and meta-analysis

BACKGROUND

Increasing antibiotic resistance has motivated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (rUTI).

OBJECTIVES

To conduct a systematic review of the current state of evidence of acupuncture for uncomplicated rUTI in women.

SEARCH STRATEGY

Nine databases (PubMed, Embase, CENTRAL, CINAHL, AMED, CBM, CNKI, CQVIP, Wanfang) were searched from inception to February 2019.

SELECTION CRITERIA

Randomised controlled trials (RCTs) evaluating the effects of acupuncture and related therapies for prophylaxis or treatment of uncomplicated rUTI in women were included.

DATA COLLECTION AND ANALYSIS

Risk of bias was assessed, and the quality and strength of evidence evaluated using the GRADE framework. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).

MAIN RESULTS

Five RCTs involving 341 participants were included. Methodological quality of studies and strength of the evidence were low to moderate. The chance of achieving a composite cure with acupuncture therapies was greater than that with antibiotics (three studies, 170 participants, RR 1.92, 95% CI 1.31-2.81, I²  = 38%). The risk of UTI recurrence was lower with acupuncture than with no treatment (two studies, 135 participants, RR 0.39, 95% CI 0.26-0.58, I²  = 0%) and sham acupuncture (one study, 53 participants, RR 0.45, 95% CI 0.22-0.92).

CONCLUSIONS

Acupuncture appeared to be beneficial for treatment and prophylaxis of rUTIs, noting the limitations of the current evidence. Given the growing challenge of antibiotic resistance, there is a need for high-quality RCTs of non-pharmacological interventions such as acupuncture.

TWEETABLE ABSTRACT

This review found that acupuncture may improve treatment and prevent recurrence of urinary tract infection in women.

Gefitinib promotes CXCR4-dependent epithelial to mesenchymal transition via TGF-β1 signaling pathway in lung cancer cells harboring EGFR mutation

PURPOSE

Epithelial to mesenchymal transition (EMT) plays an important role in acquired resistance to gefitinib in lung cancer. This study aimed to explore the underlying mechanism of gefitinib-induced EMT in lung adenocarcinoma cells harboring EGFR mutation.

METHODS

CXC chemokine receptor 4 (CXCR4) expression was determined through qRT-PCR, Western blot and flow cytometry assays in lung cancer cell line (PC9) bearing mutated EGFR. Functional role of CXCR4 was inhibited applying siRNAs as well as the specific antagonist AMD3100. The expression of EMT markers was determined, and the migration of PC9 cells was measured with transwell assay.

RESULTS

We found that gefitinib promoted the migratory capacity of PC9 cells in vitro, which correlated with EMT occurrence through upregulation of CXCR4. Blocking CXCR4 significantly suppressed gefitinib-induced enhancement of migration and EMT. Moreover, we determined that the upregulation of CXCR4 by gefitinib was dependent on TGF-β1/Smad2 signaling activity.

CONCLUSIONS

Our study suggested a potential mechanism by which gefitinib induced EMT in cells harboring EGFR mutation through a pathway involving TGF-β1 and CXCR4. Thus, the combination of CXCR4 antagonist and TGFβR inhibitors might provide an alternative strategy to overcome progression of lung cancer after gefitinib treatment.

Hexachlorocyclohexane exposure alters the microbiome of colostrum in Chinese breastfeeding mothers

Breast milk, especially colostrum, is not just a source of nutrients and immune factors for the newborn, but also accumulates environmental persistent pollutants and its diverse microbes affect the early colonization of the newborn's gut. Little is known about associations between environmental pollutants and the microbial composition of human colostrum. We assessed the influence of hexachlorocyclohexane (HCH), a persistent organic pollutant (POP), in colostrums on the microbial composition of human colostrum samples. HCH concentrations in 89 colostrum samples collected from a population living on the easternmost island of China were measured via gas chromatography equipped with mass spectrometer (GC-MS), HCH exposure risks for infants via dietary intake of breast milk were assessed, and for 29 colostrum samples the microbiota were profiled using 16S rRNA gene pyrosequencing to assess the association with HCH exposure levels. Our study confirmed high colostrum exposure levels of total HCHs (12.19 ± 13.68 μg L^-1) in this Chinese population. We predominantly identified Proteobacteria (67.6%) and Firmicutes (25.1%) in colostrum and microbial diversity at the genus level differed between samples with different HCH levels; e.g., Pseudomonas which contains several HCH degrading strains was found in significantly higher abundance in γ-HCH rich samples. Also, microbes that were statistically significantly associated with HCH levels were also highly correlated with each other (false discovery rate (FDR)＜0.01) and clustered in network analysis. Microbial diversity is associated with HCH levels in human colostrum and these associations might be attributable to their HCH degrading ability. These finding provide first insights into the role that environmental persistent pollutants may play in the microbial composition of human colostrum and the colonization of the infant gut.

Prevalence and distribution of HPV types in genital warts in Xi'an, China: a prospective study

OBJECTIVES

To characterise the prevalence and distribution of human papillomavirus (HPV) types in genital warts in Xi'an, China.

METHODS

This prospective study was conducted in Shaanxi Provincial Institute for Skin Disease and STD Control (SPISSC) between September 2014 and April 2017. Genital wart samples were obtained from 879 patients, including 512 men and 367 women. HPV genotyping was performed by using an automatic nucleic acid hybridisation system.

RESULTS

Of the 879 patients with genital warts, the detectable rates of low-risk, high-risk and total HPV types were 45.4%, 34.5% and 57.8%, respectively. The detectable rate of low-risk HPV types (45.4%) was significantly higher than that of high-risk HPV types (34.5%) (χ2=21.85, p<0.01). The detectable rate of low-risk HPV types of men (52.3%) was significantly higher than that of women (35.7%) (χ2=23.90, p<0.01). The detectable rates of one HPV type infection and two and three or more HPV type coinfections were 26.1%, 17.5% and 14.2%, respectively. HPV6 (24.9%), HPV11 (17.9%), HPV52 (9.9%) and HPV16 (7.3%) were the four most common HPV types.

CONCLUSIONS

The results of this study suggest that low-risk HPV types are major pathogens of genital warts, but high-risk HPV type infections and multiple HPV type coinfections are also common in genital warts. HPV6, 11, 52 and 16 are the four most common HPV types in genital wart in Xi'an, China.

Evaluation and Clinical Application of a Commercially Available Iterative Reconstruction Algorithm for CBCT-Based IGRT

Purpose:

We have quantitatively evaluated the image quality of a new commercially available iterative cone-beam computed tomography reconstruction algorithm over standard cone-beam computed tomography image reconstruction results.

Methods:

This iterative cone-beam computed tomography reconstruction pipeline uses a finite element solver (AcurosCTS)-based scatter correction and a statistical (iterative) reconstruction in addition to a standard kernel-based correction followed by filtered back-projection-based Feldkamp-Davis-Kress cone-beam computed tomography reconstruction. Standard full-fan half-rotation Head, half-fan full-rotation Head, and standard Pelvis cone-beam computed tomography protocols have been investigated to scan a quality assurance phantom via the following image quality metrics: uniformity, HU constancy, spatial resolution, low contrast detection, noise level, and contrast-to-noise ratio. An anthropomorphic head phantom was scanned for verification of noise reduction. Clinical patient image data sets for 5 head/neck patients and 5 prostate patients were qualitatively evaluated.

Results:

Quality assurance phantom study results showed that relative to filtered back-projection-based cone-beam computed tomography, noise was reduced from 28.8 ± 0.3 HU to a range between 18.3 ± 0.2 and 5.9 ± 0.2 HU for Full-Fan Head scans, from 14.4 ± 0.2 HU to a range between 12.8 ± 0.3 and 5.2 ± 0.3 HU for Half-Fan Head scans, and from 6.2 ± 0.1 HU to a range between 3.8 ± 0.1 and 2.0 ± 0.2 HU for Pelvis scans, with the iterative cone-beam computed tomography algorithm. Spatial resolution was marginally improved while results for uniformity and HU constancy were similar. For the head phantom study, noise was reduced from 43.6 HU to a range between 24.8 and 13.0 HU for a Full-Fan Head and from 35.1 HU to a range between 22.9 and 14.0 HU for a Half-Fan Head scan. The patient data study showed that artifacts due to photon starvation and streak artifacts were all reduced, and image noise in specified target regions were reduced to 62% ± 15% for 10 patients.

Conclusion:

Noise and contrast-to-noise ratio image quality characteristics were significantly improved using the iterative cone-beam computed tomography reconstruction algorithm relative to the filtered back-projection-based cone-beam computed tomography method. These improvements will enhance the accuracy of cone-beam computed tomography-based image-guided applications.

Direct imaging of ultrafast lattice dynamics

Under rapid high-temperature, high-pressure loading, lattices exhibit complex elastic-inelastic responses. The dynamics of these responses are challenging to measure experimentally because of high sample density and extremely small relevant spatial and temporal scales. Here, we use an x-ray free-electron laser providing simultaneous in situ direct imaging and x-ray diffraction to spatially resolve lattice dynamics of silicon under high-strain rate conditions. We present the first imaging of a new intermediate elastic feature modulating compression along the axis of applied stress, and we identify the structure, compression, and density behind each observed wave. The ultrafast probe x-rays enabled time-resolved characterization of the intermediate elastic feature, which is leveraged to constrain kinetic inhibition of the phase transformation between 2 and 4 ns. These results not only address long-standing questions about the response of silicon under extreme environments but also demonstrate the potential for ultrafast direct measurements to illuminate new lattice dynamics.

Improvements in CBCT Image Quality Using a Novel Iterative Reconstruction Algorithm: A Clinical Evaluation

Purpose

This study aimed to evaluate the clinical utility of a novel iterative cone beam computed tomography (CBCT) reconstruction algorithm for prostate and head and neck (HN) cancer.

Methods and Materials

A total of 10 patients with HN and 10 patients with prostate cancer were analyzed. For each patient, raw CBCT acquisition data were used to reconstruct images with a currently available algorithm (FDK_CBCT) and novel iterative algorithm (Iterative_CBCT). Quantitative contouring variation analysis was performed using structures delineated by several radiation oncologists. For prostate, observers contoured the prostate, proximal 2 cm seminal vesicles, bladder, and rectum. For HN, observers contoured the brain stem, spinal canal, right-left parotid glands, and right-left submandibular glands. Observer contours were combined to form a reference consensus contour using the simultaneous truth and performance level estimation method. All observer contours then were compared with the reference contour to calculate the Dice coefficient, Hausdorff distance, and mean contour distance (prostate contour only). Qualitative image quality analysis was performed using a 5-point scale ranging from 1 (much superior image quality for Iterative_CBCT) to 5 (much inferior image quality for Iterative_CBCT).

Results

The Iterative_CBCT data sets resulted in a prostate contour Dice coefficient improvement of approximately 2.4% (P = .029). The average prostate contour Dice coefficient for the Iterative_CBCT data sets was improved for all patients, with improvements up to approximately 10% for 1 patient. The mean contour distance results indicate an approximate 15% reduction in mean contouring error for all prostate regions. For the parotid contours, Iterative_CBCT data sets resulted in a Hausdorff distance improvement of approximately 2 mm (P < .01) and an approximate 2% improvement in Dice coefficient (P = .03). The Iterative_CBCT data sets were scored as equivalent or of better image quality for 97.3% (prostate) and 90.0% (HN) of the patient data sets.

Conclusions

Observers noted an improvement in image uniformity, noise level, and overall image quality for Iterative_CBCT data sets. In addition, expert observers displayed an improved ability to consistently delineate soft tissue structures, such as the prostate and parotid glands. Thus, the novel iterative reconstruction algorithm analyzed in this study is capable of improving the visualization for prostate and HN cancer image guided radiation therapy.

On the improvement of CBCT image quality for soft tissue-based SRS localization

Purpose

We explore the optimal cone‐beam CT (CBCT) acquisition parameters to improve CBCT image quality to enhance intracranial stereotactic radiosurgery (SRS) localization and also assess the imaging dose levels associated with each imaging protocol.

Methods

Twenty‐six CBCT acquisition protocols were generated on an Edge^® linear accelerator (Varian Medical Systems, Palo Alto, CA) with different x‐ray tube current and potential settings, gantry rotation trajectories, and gantry rotation speeds. To assess image quality, images of the Catphan 504 phantom were analyzed to evaluate the following image quality metrics: uniformity, HU constancy, spatial resolution, low contrast detection, noise level, and contrast‐to‐noise ratio (CNR). To evaluate the imaging dose for each protocol, the cone‐beam dose index (CBDI) was measured. To validate the phantom results, further analysis was performed with an anthropomorphic head phantom as well as image data acquired for a clinical SRS patient.

Results

The Catphan data indicates that adjusting acquisition parameters had direct effects on the image noise level, low contrast detection, and CNR, but had minimal effects on uniformity, HU constancy, and spatial resolution. The noise level was reduced from 34.5 ± 0.3 to 18.5 ± 0.2 HU with a four‐fold reduction in gantry speed, and to 18.7 ± 0.2 HU with a four‐fold increase in tube current. Overall, the noise level was found to be proportional to inverse square root of imaging dose, and imaging dose was proportional to the product of total tube current‐time product and the cube of the x‐ray potential. Analysis of the anthropomorphic head phantom data and clinical SRS imaging data also indicates that noise is reduced with imaging dose increase.

Conclusions

Our results indicate that optimization of the imaging protocol, and thereby an increase in the imaging dose, is warranted for improved soft‐tissue visualization for intracranial SRS.

[Outcomes of severe primary fetal hydrothorax treated by prenatal intervention]

Objective: To investigate the effect of intrauterine intervention on severe primary fetal hydrothorax. Methods: Twelve cases with severe fetal primary hydrothorax who underwent prenatal intervention from January 2014 to December 2017 in Guangdong Women and Children Hospital were retrospectively reviewed. Results: The median gestational age of prenatal diagnosis was 30.8 weeks (24.0-33.0 weeks) . All cases were excluded congenital chromosomal abnormalities by prenatal diagnosis, and had no complications of pregnancy during prenatal diagnosis and had hydrothorax. Three cases (3/12) were right hydrothorax, the other 9 cases (9/12) were bilateral. Thoracoamniotic shunting was performed in 7 cases (7/12) . Thoracentesis was performed in 5 cases (5/12) , and the hydrothorax reappeared soon after operation in 4 cases, shunt placement was performed again. The hydrothorax was dissolved in 2 cases, released in 6 cases.Tube falling off occurred in 1 case,treatment was abandoned in 1 case and intrauterine fetal death happened in 1 case, and 1 case wasn't rechecked by ultrasonic due to premature birth following thoracentesis. In 10 cases who had deliveries, 5 newborns (5/10) were premature, 6 newborns (6/10) underwent assisted mechanical ventilation, 8 newborns (8/10) underwent thoracic close drainage, all of them were discharged when hydrothorax resolved. Conclusions: Antenatal intervention may improve the chance of survival in severe primary fetal hydrothorax. Thoracoamniotic shunting is the first-choice for the primary severe fetal hydrothorax.