[Analysis on the consciousness of the early cancer treatment and its influencing factors among urban residents in China from 2015 to 2017]

Objective: To understand the consciousness of the cancer early treatment and its demographic and socioeconomic factors. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China (CanSPUC) from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The questionnaire collected personal information, the consciousness of the cancer early treatment and relevant factors. The Chi square test was used to compare the difference between the consciousness of the cancer early treatment and relevant factors among the four groups. The logistic regression model was used to analyze the influencing factors related to the consciousness of the cancer early treatment. Results: With the assumption of being diagnosed as precancer or cancer, 89.97% of community residents, 91.84% of cancer risk assessment/screening population, 93.00% of cancer patients and 91.52% of occupational population would accept active treatments (P<0.001). If the immediate family members were diagnosed as precancer or cancer, people who would encourage their family members to receive early treatment in the four groups accounted for 91.96%, 91.94%, 92.44% and 91.55%, respectively (P<0.001). The company employees, annual household income with 40 000 yuan and more and other three groups had a relatively better consciousness of the cancer early treatment (P<0.05). Male, widowed, unemployed and from the central and western regions had a relatively worse consciousness of the cancer early treatment (P<0.05). Conclusion: Residents in urban China participants had a good consciousness of the cancer early treatment. The marital status, occupation, annual household income and residential regions were major factors related to the consciousness of the cancer early treatment.

[Analysis on the age of onset of malignant tumors in cancer registration areas in Zhejiang Province from 2000 to 2015]

Objective: To study the age of onset of malignant tumors in cancer registration areas in Zhejiang province from 2000 to 2015. Methods: Based on the incidence data of cancer from 14 national cancer registration areas in Zhejiang province between 2000 and 2015, the incidence rate, average/standardized average age of onset, and age-specific incidence proportion were calculated, and standardized by Segi's world population. The population was divided into 7 age groups (0-29, 30-39, 40-49, 50-59, 60-69, 70-79, ≥80 years old). The average age of onset and age-specific incidence proportion were analyzed by using a linear regression. The change trend of the proportion; the average annual percent change (AAPC) of the incidence rate was calculated by using the Joinpoint log-linear regression model. The birth cohort was constructed by using the standardized incidence rate and the year of onset of cancer, and the distribution characteristics of the age groups were described. Results: From calendar year 2000 to 2015, the average age of onset of malignant tumors in Zhejiang Province decreased from 59.7 to 57.6, with an average annual percent decrease of 0.09 year (P=0.033). After the merge of age groups, the standardized incidence proportion of 30-49 and ≥60 years old group standardization increased by an average annual change of 0.38% and decreased by an average annual change of 0.39%, respectively (both P values <0.001). The results of the log-linear regression model showed that the standardized incidence rate of the 30-39 and 40-49 years old age groups increased rapidly, with the AAPC (95%CI) about 5.2% (4.4%-6.0%) and 3.4% (2.5%-4.3%), respectively. The incidence rate of female increased rapidly, especially for 30-39 and 40-49 years old age groups with the AAPC about 6.2% (5.1%-7.2%) and 4.9% (4.0%-5.9%), respectively. The results of the birth cohort analysis showed that the population with different birth years in the same age groups saw an increasing trend with the increase of the birth year. Conclusion: The age of onset of malignant tumors in the cancer registration areas in Zhejiang Province is getting younger. The incidence rate and number of people with malignant tumors in 30-49 years old age group is evident. These characteristics are more obvious in female than that in male.

MiR-154 promotes myocardial fibrosis through β-catenin signaling pathway

OBJECTIVE

To discover the mechanisms of miR-154 affecting myocardial fibrosis.

PATIENTS AND METHODS

Human cardiac fibroblasts (CFs) were cultured in medium containing 10% serum for 48 h. The expression of miRNA-154 in human CFs was detected by Real-time quantitative polymerase chain reaction (qRT-PCR). The miRNA-154 mimics and inhibitors were synthesized and transfected into fibroblasts, respectively. Cell proliferation rate was determined by cell counting kit-8 (CCK8). Collagen I and collagen III, myofibroblast marker (a-SMA) and β-catenin were detected by Western blotting. Transwell migration assay was used to detect the changes of invasiveness of CFs. After the overexpression vector or siRNA of glycogen synthase kinase-3β (GSK-3β) was transfected into fibroblasts, we performed Western blot to detect a-SMA and β-catenin expression.

RESULTS

MiR-154 was overexpressed in cardiomyocytes, and when miR-154 was inhibited, the expression of collagen I, collagen III, a-SMA, β-catenin, and the invasiveness of CFs decreased. Therefore, we considered that miR-154 could promote myocardial fibrosis by inhibiting the expression of GSK-3β.

CONCLUSIONS

MiR-154 can inhibit GSK-3β expression by activating Wnt/β-catenin signaling pathway, which promotes myocardial fibrosis.

[Clinical outcome of postchemotherapy retroperitoneal lymph node dissection and predicting retroperitoneal histology in advanced nonseminomatous germ cell tumours of the testis]

Objective: To explore the clinical outcome of advanced testicular nonseminomatous germ cell cancer patients undergoing post chemotherapy retroperitoneal lymph node dissection (PC-RPLND), and to analyze the relevant prognostic factors of lymph node pathological. Methods: A total of 43 consecutive testicular nonseminomatous germ cell cancer patients underwent PC-RPLND between March 2001 and December 2014 in Department of Urology at Sun Yat-sen University Cancer Center were retrospectively reviewed. The average age of the patients was (29.0±11.5) years (ranging from 12 to 58 years). Before PC-RPLND, 22 patients were classified as phase Ⅱ, while 21 were phase Ⅲ. Primary tumor histology revealed seminomatous elements in 19 cases, embryonal cell carcinoma in 22 cases, yolk sac tumor in 13 cases, chorionic carcinoma in 3 cases, mature teratomatous elements in 11 and immature teratomatous elements in 2 cases. Patients were treated with cisplatin-based chemotherapy after orchectomy and then underwent surgical resection of retroperitoneal lymph nodes.After PC-RPLND, all patients underwent a periodic review including the blood routine, biochemistry routine and computed tomography or ultrasonograph of the chest, the abdomen and the pelvis. The association of pathological data with patient's clinic features and the correlations between molecular features detected with each other were assessed by the t test, χ(2) and Fisher's exact test. Multivariate logistic regression were used to assess prognostic factors. Results: The median operative time was 278 minutes (ranging from 50 to 715 minutes). Median blood loss was 425 ml (ranging from 50 to 5 000 ml). Eight patients received blood transfusion intra-operatively, 2 patients underwent adjunctive surgical procedures, 4 patients developed ileus and 4 had an ascites chylosus following PC-RPLND, 1 patient had a postoperative hyperthermia and retrograde ejaculation was present in 10 patients. The transverse diameter of the residual tumor in patients ranged from 0.8 to 18.2 cm. Necrosis, teratoma and viable germ cell tumors were found in 15, 17 and 11 of all patients. The median follow-up time was 46 months (ranging from 6 to 169 months). There were 39 patients had no tumor recurrence, 7 patients were found recurrence after PC-RPLND, 5 died of malignant germ cell tumor. The normal serum lactate dehydrogenase (LDH) level before chemotherapy (HR=25.811, 95%CI: 0.678 to 982.624, P=0.017) and relative changes more than 50% in retroperitoneal lymph node size (HR=0.016, 95%CI: 0 to 0.698, P=0.032) were statistically significant prognostic factors of the presence of necrosis. Conclusions: Since most residual masses are not sensitive to chemotherapy, PC-RPLND is still an essential part of the treatment of metastatic testicular nonseminomatous germ cell cancer. Patients with the normal serum LDH level before chemotherapy and a shrinkage of 50% or more in retroperitoneal mass have a considerably chance of having necrosis in the retroperitoneum resection. This may help to refine the selection of candidates for PC-RPLND.

[Surgical treatment for inflammatory myofibroblastic tumor in genito-urinary system: a study of 15 cases]

Objective: To present 15 cases of inflammatory myofibroblastic tumor (IMT) in genitor-urinary system, and analyze the characteristics, diagnosis and treatment of the disease. Methods: The diagnostic and therapeutic process of 15 confirmed cases admitted to Sun Yat-sen University Cancer Center between March 2009 and September 2017 were retrospectively analyzed. Of the total cases, 11 cases were diagnosed with cystic IMT with a maximum diameter of 1.0-4.5 cm, 8 cases underwent transurethral resection of bladder tumor(TURBT)and 4 of them underwent partial cystectomy after TURBT and 3 underwent partial cystectomy directly. Two cases were renal IMT with a maximum diameter of 4.0-9.0 cm, one underwent partial nephrectomy and the other accepted radical nephrectomy. One case who was diagnosed with prostatic IMT with a maximum diameter of 3.4 cm underwent transurethral resection of the prostate (TURP) and postoperative radiotherapy. One case who was diagnosed with perineal IMT with a maximum diameter of 2.1 cm underwent tumor resection. Results: The patients were followed up for 10-32 months with a median time of 27 months. No cases relapsed during the follow-up. Conclusion: Surgery is the preferred method for treating IMT in genitor-urinary system. Retrospective study shows a good prognosis in IMT patients, but a long-term follow-up is still required.

[Expression of anaplastic lymphoma kinase fusion gene in patients with lung sarcomatoid carcinoma and treatment analysis]

Objective: To investigate the expression status of anaplastic lymphoma kinase (ALK) fusion gene in lung sarcomatoid carcinoma (LSC) and the role of ALK inhibitors for treatment. Methods: Total of 84 cases of LSC confirmed by histopathology were detected for ALK fusion gene from January 2011 to December 2014 in the Cancer Hospital of Chinese Academy of Medical Science&Peking Union Medical College and Shandong Zibo Wanjie Cancer Hospital. All patients were primarily treated by the multi-disciplinary mode in combination with chemotherapy or targeted therapy based on surgery. Postoperative adjuvant chemotherapy was given on platinum based two-drug combination regimen. In ALK fusion gene (+ ) patients with recurrence or metastasis, crizotinib target therapy was prefered. Chi-square test was applied for the comparison of 1, 3, 5-year survival rates between the two groups. Results: Eighty-two cases completed the follow-up. ALK fusion gene was found in 9(10.7%) patients. After application of crizotinib, 1 case was evaluated as complete remission, 6 cases as partial response, 2 cases as stable disease; the 1, 3, 5-year survival rate was 100% (9/9), 100% (9/9) and 88.9% (8/9) for the patients with ALK fusion gene, and it was 65.8% (48/73), 15.1% (11/73) and 6.8% (5/73) respectively for patients without ALK fusion gene. There was significant difference in the survival rate between the two groups (χ(2)=1.56, 1.56, 0.83, all P<0.05). Conclusion: ALK fusion gene maybe expressed in LSC patients. Compared with conventional chemotherapy, crizotinib can significantly prolong the survival time of patients with ALK fusion gene.

[Establishment and preliminary application of a laryngomalacia larynx three-dimension model]

Objective:To establish and preliminarily apply a laryngomalacia larynx three-dimension finite element model. Method:The MIMCS software was employed to deal with the Dicom images of larynx CT scan by means of distinguishing material gray threshold of different tissues. 3D visualization model of larynx was also built by this software. Hyermesh software was used to handle the grid layout of larynx finite element model. Laryngeal structure parameter were added, and laryngeal mechanical analysis were carried out by Abaqus software in order to get von Mises stress. Result:A 3D model，which finely represent the morphological characteristics of laryngomalacia larynx was built using the finite element technology. Peak von Mises stress was observed to be higher in more severe laryngomalacia case. Conclusion:The 3D finite element model of the laryngomalacia larynx provides the foundation for further study．Peak von Mises stress may be a useful indicator of laryngomalacia severity assessment.

[Constituent and workload of service providers engaged in cancer screening: findings and suggestions from a multi-center survey in China]

Objective: To understand the constituent and workload of service providers engaged in cancer screening in China and provide evidence for the assessment of the sustainability of national cancer screening project. Methods: Using either questionnaire or online approach, the survey was conducted in 16 provinces, where Cancer Screening Program in Urban China (CanSPUC) was conducted, from 2014 to 2015. The medical institutes surveyed included hospitals [71.1% were class Ⅲ(A) hospitals], centers for disease control and prevention (CDCs) and community centers where cancer screening was undertaken during 2013-2015. The questionnaire survey was conducted among the staffs responsible for the overall coordination, management and implementation of the screening project to collect the information about the allocation, workload and compensation of the service providers from different specialties. Results: A total of 4 626 staffs were surveyed in this study, their average age was (37.7±9.5) years, and males accounted for 31.0%. Human resources allocated differed with province. The number of senior staff ranged from 6 (Chongqing) to 43 (Beijing) among the 8 comparable provinces. Among the staffs surveyed, 2 192 were from hospitals, 431 were from CDCs and 1 990 were from community centers, and the staffs who complained heavy workload accounted for 19.9%, 24.6% and 34.1% respectively (P<0.001). Among 227 staffs for overall coordination, 376 management staffs and 3 908 staffs for implementation, those who complained heavy workload accounted for 23.6%, 22.3% and 28.2% respectively (P<0.001). A total of 3 244 staffs (73.8%) got compensations for heavy workload. The compensation types were manly labor fee linked with workload (67.5%) and labor fee regardless workload (26.6%). Conclusion: The province specific differences in human resources allocation indicated the differences in screening project's organizing pattern and capability. It is suggested to conduct routine cancer screening (using specialized staffs), reduce the workload of the first line and community staffs and increase the compensation for the service providers for the sustainability of cancer screening project in China.

[Willingness of potential service suppliers to provide cancer screening in urban China]

Objective: Based on the investment for potential suppliers of cancer screening services, we assessed the reasons that affecting their participation motivation related to the long-term sustainability of cancer screening in China. Methods: Hospitals that had never been involved in any national level cancer screening project were selected by using the convenient sampling method within the 16 project cities of Cancer Screening Program in Urban China (CanSPUC) with 1 or 2 hospitals for each city. All the managers from the institutional/department level and professional staff working and providing screening services in these hospitals, were interviewed by paper-based questionnaire. SAS 9.4 was used for logical verification and data analysis. Results: A total of 31 hospitals (18 hospitals at the third level and, 13 hospitals at the second level) and 2 201 staff (508 hospital and clinic unit managers, 1 693 professional staff) completed the interview. All the hospitals guaranteed their potential capacity in service providing. 92.5% hospital managers showed strong willingness in providing cancer screening services, while 68.3% of them declared that the project fund-raising function was the responsibility of the government. For professional staff, their prospect gains from providing screening service would include development on professional skills (72.4%) and material rewards (46.8%). Their main worries would include extra work for CanSPUC might interfere their routine work (42.1%) plus inadequate compensation (41.8%). Medians of the prospect compensation for extra work ran between 20 to 90 Chinese Yuan per screening item respectively. For all the screening items, workers from the third-level hospitals expected their compensation to be twice as much of those working at the second level hospitals. Conclusion: Professional capacity building and feasible material incentive seemed to be the two key factors that influenced the sustainability and development of the programs.

[Potential demand on cancer screening service in urban populations in China: a cross-sectional survey]

Objective: To understand the acceptance and personal demand for cancer screening service among the urban residents who had never been involved in any national level cancer screening programs in China and identify the key factors influencing the sustainability of cancer screening. Methods: A questionnaire survey was conducted among the local people aged 40-69 years selected through convenience sampling in 16 provinces of China to collect the general information about their demands for the screening service and others. Results: A total of 16 394 qualified questionnaires were completed. The average age of the people surveyed was (53.8±8.0) years, and men accounted for 44.6%. Without concerning the cost, 4 831 people (29.5%) had no demands for cancer screening services, the reasons are as follow: they would like to go to see doctors only when they were ill (61.8%); they had already received similar medical examinations (36.8%) and they would like to receive cancer screening directly without pre-health risk assessment (33.0%). Among the people surveyed, 10 795 (65.8%) had demands for cancer screening services, but they had choice on the screening settings, 43.7% wanted to receive the service in a general hospitals, while 36.5% would like to go to cancer-specialized hospitals. As for the level of medical institutes providing cancer screening service, 61.4% of the people surveyed would choose a higher level one, while 36.4% would choose an ordinary one. On screening procedures, 61.5% of the people surveyed would accept the mode of "clinical examination after questionnaire-assessment" . Conclusion: Most people surveyed had demands for cancer screening services and they would like to receive the screening services in higher level medical institutes. It is suggested to spread cancer screening know ledge, and strengthen the capability building of screening in grass root medical institutes to attract more people to receive cancer screening.

[Preference on screening frequency and willingness-to-pay for multiple-cancer packaging screening programs in urban populations in China]

Objective: From an actual cancer screening service demanders' perspective, we tried to understand the preference on screening frequency and willingness-to-pay for the packaging screening program on common cancers and to evaluate its long-term sustainability in urban populations in China. Methods: From 2012 to 2014, a multi-center cross-sectional survey was conducted among the actual screening participants from 13 provinces covered by the Cancer Screening Program in Urban China (CanSPUC). By face-to-face interview, information regarding to preference to screening frequency, willingness-to-pay for packaging screening program, maximum amount on payment and related reasons for unwillingness were investigated. Results: A total of 31 029 participants were included in this survey, with an average age as (55.2±7.5) years and median annual income per family as 25 000 Chinese Yuan. People's preference to screening frequency varied under different assumptions ( " totally free" and "self-paid" ). When the packaging screening was assumed totally free, 93.9% of residents would prefer to take the screening program every 1 to 3 years. However, the corresponding proportion dropped to 67.3% when assuming a self-paid pattern. 76.7% of the participants had the willingness-to-pay for the packaging screening, but only 11.2% of them would like to pay more than 500 Chinese Yuan (the expenditure of the particular packaging screening were about 1 500 Chinese Yuan). The remaining 23.3% of residents showed no willingness-to-pay, and the main reasons were unaffordable expenditure (71.7%) and feeling'no need'(40.4%). Conclusions: People who participated in the CanSPUC program generally tended to choose high-frequency packaging screening program, indicating the high potential acceptance for scale-up packaging screening, while it needs cautious assessments and rational guidance to the public. Although about seven in ten of the residents were willing to pay, the payment amount was limited, revealing the necessity of strengthening individual's awareness of his or her key role in health self-management, and a reasonable payment proportion should be considered when establishing co-compensation mechanism.

[Willingness and preferences of actual service suppliers regarding cancer screening programs: a multi-center survey in urban China]

Objective: From the perspective of actual service suppliers regarding cancer screening, this study aimed to assess the long-term sustainability of cancer screening programs in China. Methods: Based on a Cancer Screening Program in Urban China (CanSPUC), our survey focused on all the hospitals, centers for disease control and prevention (CDC) and community service centers across 16 provinces in China which participated in the programs between 2013 and 2015. All the managers (institutional/department level) and professional staff involved in the program were interviewed using either paper-based questionnaire or online approach. Results: A total of 4 626 participants completed the interview. It showed that the main gains from providing screening service emphasized promotion in social value (63.6%), local reputation (35.9%), and professional skills (30.6%), whereas difficulties encountered included inadequate compensation (30.9%) and discordance among information systems (28.3%). When the service remuneration amounts to about 50 Chinese Yuan per screening item, those professional staff self-reported that they would like to work overtime. More than half (63.7%) of the staff expressed willingness to provide routine screening service, the main expectations were to promote their reputation to the local residents (48.7%) and to promote professional skills (43.1%). Those who were not willing to provide screening services were worried about the potential heavy workload (59.8%) or being interfered with their routine work (49.8%). Further detailed results regarding the different organization types and program roles were presented in the following detailed report. Conclusions: Findings of gains and difficulties showed that if cancer screening is expected to become a long-term running, incentive mechanism from the program, external promotion and advocacy as well as capacity building should be strengthened; furthermore, rewards to staff's screening services should be raised according to the local situations. Results regarding the "willingness to provide service" showed that management of the program should also be strengthened, including information system building and inter-agency and inter-department coordination at the government levels.

[Platysma myocutaneous flaps in reconstruction of defects caused by hypopharyngeal cancer resection]

Objective:To study the method and feasibility in reconstruction of platysma myocutaneous flap of defects caused by hypopharyngeal cancer resection. Method:Twelve cases underwent reconstruction with the platysma myocutaneous flap of hypopharyngeal soft defect were investigated. All cases received 2 times preoperative induction chemotherapy followed by hypopharyngeal cancer resection with laryngeal function preservation and the neck lymph node dissection. Platysma myocutaneous flap was used to repair the hypopharyngeal soft tissue defect. Result:All the flaps survived. Three weeks after surgery, all patients can eat without pharyngeal fistula and dysphagia, but pharyngeal foreign body sensation. Three cases of cough after surgery, improved after training. After postoperative radiotherapy, flap survived without secondary necrosis. Laryngeal function of all cases was retained, and only one case with cannula maintained. Conclusion:Preoperative induction program can effectively reduce the lesion. The placenta myocutaneous flap has rich blood supply, strong anti-infectivity. It is an effective method to repair the hypopharyngeal tissue defect with the placenta myocutaneous flap.

[Value of non-invasive models of liver fibrosis in judgment of treatment timing in chronic hepatitis B patients with ALT < 2×upper limit of normal]

Objective: To investigate the value of non-invasive liver fibrosis models, FIB-4, S index, aspartate aminotransferase to platelet ratio index(APRI), globulin-platelet(GP)model, aspartate aminotransferase/platelet/gamma-glutamyl transpeptidase/alpha-fetoprotein(APGA), and platelet/age/phosphatase/alpha-fetoprotein/aspartate aminotransferase(PAPAS), in the diagnosis of marked liver fibrosis in chronic hepatitis B(CHB)patients with ALT < 2×upper limit of normal(ULN), as well as treatment timing for this population. Methods: A total of 389 CHB patients with ALT < 2×ULN who were admitted to Beijing Ditan Hospital and whose treatment timing was difficult to judge were enrolled. Transdermal liver biopsy was performed to obtain pathological results, and routine serological tests were performed, including routine blood test, serum biochemical parameters, hepatitis B virus(HBV)markers, and HBV DNA. According to liver pathology, the patients were divided into non-marked liver fibrosis group(S < 2)with 324 patients and marked liver fibrosis group(S≥2)with 65 patients. The non-invasive models for predicting liver fibrosis was established with reference to original articles. SPSS 19.0 software was used for statistical analysis, and the receiver operating characteristic(ROC)curve was used to compare the value of different non-invasive models in predicting marked liver fibrosis in this population. Results: All the non-invasive models had a certain diagnostic value for liver fibrosis degree in these patients, and the areas under the ROC curve for APRI, FIB-4, APGA, S index, PAPAS, and GP model were 0.718, 0.691, 0.758, 0.729, 0.673, and 0.691, respectively. APGA had the largest area under the ROC curve(0.758, 95% CI 0.673-0.844), and gamma-glutamyl transpeptidase was significantly positively correlated with liver fibrosis degree. Conclusion: The non-invasive models of liver fibrosis can identify marked liver fibrosis in CHB patients with ALT < 2×ULN in whom it is difficult to judge treatment timing and help to determine treatment timing for them. APGA model has the highest value and can reduce the need for liver biopsy to the certain degree.

The difference in medical costs between carbapenem-resistant Acinetobacter baumannii and non-resistant groups: a case study from a hospital in Zhejiang province, China

This retrospective study aims to compare differences in the medical costs between inpatients infected/colonised with carbapenem-resistant (CRAB) and carbapenem-susceptible (CSAB) Acinetobacter baumannii in a hospital in Zhejiang province, China. Because the patient population was large, we randomly selected 60% of all inpatients with clinical specimens between 2013 and 2015. We classified the A. baumannii cases as CRAB or CSAB based on antibiotic susceptibility testing. Univariate and multivariate analyses were used to identify factors associated with the total medical cost (TMC). Those included in the study totalled 2980 inpatients, 71.3% of whom had CRAB infection/colonisation. Differences in the TMC between the CRAB and CSAB groups were lower by multivariate analyses than the differences obtained by univariate analyses. Carbapenem resistance was significantly associated with an approximately 1.5-fold increase in the TMC after accounting for confounding factors. Our study highlights the heavy financial burden imposed by A. baumannii and carbapenem resistance on the Chinese healthcare system.

Optimization of rotational arc station parameter optimized radiation therapy

PURPOSE

To develop a fast optimization method for station parameter optimized radiation therapy (SPORT) and show that SPORT is capable of matching VMAT in both plan quality and delivery efficiency by using three clinical cases of different disease sites.

METHODS

The angular space from 0° to 360° was divided into 180 station points (SPs). A candidate aperture was assigned to each of the SPs based on the calculation results using a column generation algorithm. The weights of the apertures were then obtained by optimizing the objective function using a state-of-the-art GPU based proximal operator graph solver. To avoid being trapped in a local minimum in beamlet-based aperture selection using the gradient descent algorithm, a stochastic gradient descent was employed here. Apertures with zero or low weight were thrown out. To find out whether there was room to further improve the plan by adding more apertures or SPs, the authors repeated the above procedure with consideration of the existing dose distribution from the last iteration. At the end of the second iteration, the weights of all the apertures were reoptimized, including those of the first iteration. The above procedure was repeated until the plan could not be improved any further. The optimization technique was assessed by using three clinical cases (prostate, head and neck, and brain) with the results compared to that obtained using conventional VMAT in terms of dosimetric properties, treatment time, and total MU.

RESULTS

Marked dosimetric quality improvement was demonstrated in the SPORT plans for all three studied cases. For the prostate case, the volume of the 50% prescription dose was decreased by 22% for the rectum and 6% for the bladder. For the head and neck case, SPORT improved the mean dose for the left and right parotids by 15% each. The maximum dose was lowered from 72.7 to 71.7 Gy for the mandible, and from 30.7 to 27.3 Gy for the spinal cord. The mean dose for the pharynx and larynx was reduced by 8% and 6%, respectively. For the brain case, the doses to the eyes, chiasm, and inner ears were all improved. SPORT shortened the treatment time by ∼1 min for the prostate case, ∼0.5 min for brain case, and ∼0.2 min for the head and neck case.

CONCLUSIONS

The dosimetric quality and delivery efficiency presented here indicate that SPORT is an intriguing alternative treatment modality. With the widespread adoption of digital linac, SPORT should lead to improved patient care in the future.

Serum sPD-L1, Upregulated in Sepsis, May Reflect Disease Severity and Clinical Outcomes in Septic Patients

We aimed to find the correlation between serum sPD-L1 (soluble programmed cell death L-1 ligand) and sepsis. Totally 91 consecutive patients with sepsis were performed in a 15-bed medical intensive care unit (ICU) of the second affiliated hospital, Xi'an Jiaotong University in Xi'an, China, between February 2015 and May 2016. Healthy controls (HC) consisted of 29 healthy volunteer. Baseline demographic data were recorded. Blood samples were collected through an indwelling central venous or by peripheral venipuncture. Serum sPD-L1 and sPD-1 levels were determined with enzyme-linked immunosorbent assay kits (Elabscience Biotechnology Co. Ltd, Wuhan, China). SPSS19.0 software (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis. Kaplan-Meier survival analysis and Cox regression analysis were also performed. Serum sPD-L1 levels and sPD-1 levels were significantly increased in septic patients compared with HC (P = 0.000). Serum sPD-L1 levels were significantly increased in non-survivors compared with survivors (P < 0.05), but there was no statistically difference on serum sPD-1 levels between non-survivors and survivors (P > 0.05). Serum sPD-L1 levels were correlated with absolute lymphocyte (ALC), platelets and SOFA scores. Serum sPD-L1/sPD-1 levels were negatively correlated with ALC and platelets, and SOFA scores. The prognostic accuracy of the sPD-L1 level to predict 28-day mortality was similar to that of the APACHE-II scores and SOFA scores. Cox regression analysis showed that sPD-L1 was an independent prognostic factor. Serum sPD-L1 is upregulated in sepsis and may reflect disease severity and clinical outcomes in patients. Serum sPD-L1 may be an independent prognostic factor for sepsis.

Note: Self-biased voltage to suppress secondary electrons by a ZnO varistor in a compact pulsed neutron generator

A large amount of back streaming electrons will bring about a part of current drain on power supply, cause sparking or high-voltage breakdowns, and affect the neutron yield and waveform for a compact sealed-tube pulsed neutron generator. A novel idea which uses a ZnO varistor to provide a constant self-biased voltage to suppress the secondary electrons is introduced. The I-V curve for the ZnO varistor was measured in the experiment. The effects of suppressing the secondary electrons were investigated using a ZnO varistor, linear resistors, and an independent power supply, respectively. The results show that the secondary electrons are suppressed effectively by the compact ZnO varistor, while not increasing the size and the component of the device. It is a promising design for compact sealed-tube neutron generators.

ANRIL rs2383207 polymorphism and coronary artery disease (CAD) risk: a meta-analysis with observational studies

Some studies investigated the association of antisense non-coding RNA in the INK4 locus (ANRIL) rs2383207 polymorphism with coronary artery disease (CAD) risk. However, the result was still inconsistent. The aim of this study was to investigate whether there is an association between the ANRIL rs2383207 polymorphism and CAD risk. We carried out a PubMed (Medline), EMBASE database search covering all published articles. The strength of association between ANRIL rs2383207 polymorphism and CAD risk was assessed by calculating OR with 95% CI. A total of 13 case-control studies involving 6796 cases and 9956 controls were included in this meta-analysis. ANRIL rs2383207polymorphism was associated with a significantly an increased risk of CAD (OR=1.47; 95%CI, 1.33-1.62). We also found that this polymorphism increased CAD risk in Caucasians (OR=1.51; 95%CI, 1.28-1.77) and Asians (OR=1.42; 95%CI, 1.26-1.61). In the subgroup analysis according to gender, both women and men were significantly associated with the increased risk of CAD (OR=1.36; 95%CI, 1.03-1.79 and OR=1.58; 95%CI, 1.20-2.09). In the subgroup analysis by age, ANRIL rs2383207 polymorphism showed significant results in old CAD patients and young CAD patients (OR=1.32; 95%CI, 1.20-1.44 and OR=1.53; 95%CI, 1.32-1.77). Furthermore, this polymorphism also influenced myocardial infarction risk (OR=1.75; 95%CI, 1.24-2.47). Even the studies with adjustment for age, gender, smoking were included, the significant association was also observed (OR=1.43; 95%CI, 1.26-1.62). In conclusion, this meta-analysis suggested that ANRIL rs2383207 polymorphism is associated with CAD risk.