Two-dimensional assembly of gold nanoparticles grafted with charged-end-group polymers

HYPOTHESIS

Introducing charged terminal groups to polymers that graft nanoparticles enable Coulombic control over their assembly by tuning the pH and salinity of their aqueous suspensions.

EXPERIMENTS

Gold nanoparticles (AuNPs) are grafted with poly (ethylene glycol) (PEG) terminated with (charge-neutral), (negatively charged) or groups (positively charged), and characterized with dynamic light scattering, ζ-potential, and thermal gravimetric analysis. Liquid surface X-ray reflectivity (XR) and grazing incidence small-angle X-ray scattering (GISAXS) are used to determine the density profile and in-plane structure of the AuNPs assembly at the aqueous surface.

FINDINGS

Assembly of PEG-AuNPs at the liquid/vapor interface is tunable by adjusting pH or salinity for COOH but less for terminals. The distinct assembly behaviors are attributed to the overall charge of PEG-AuNPs as well as PEG conformation. COOH-PEG corona is more compact than those of the other terminal groups, leading to a crystalline structure with a smaller superlattice. The net charge per particle depends not only on the PEG terminal groups but also on the cation sequestration of PEG and the intrinsic negative charge of the AuNP surface. [1] The closeness to overall charge neutrality, and hydrogen bonding in play, brought by -PEG, drive -PEG-AuNPs to assembly and crystallinity without additives to the suspensions.

Electrochemical Detection of Viral Nucleic Acids by DNA Nanolock-Based Porous Electrode Device

Developing rapid, sensitive, and facile nucleic acid detection technologies is of paramount importance for preventing and controlling infectious diseases. Benefiting from the advantages such as rapid response, low cost, and simple operation, electrochemical impedance spectroscopy holds great promise for point-of-care nucleic acid detection. However, the sensitivity of electrochemical impedance spectroscopy for low molecular weight nucleic acids testing is still limited. This work presents a DNA nanolock-based porous electrode to improve the sensitivity of electrochemical impedance spectroscopy. Once the target nucleic acids are recognized by the DNA probes, the pore-attached DNA nanolock caused remarkable impedance amplification by blocking the nanopores. Taking SARS-CoV-2 nucleic acid as a model analyte, the detection limit of the porous electrode was as low as 0.03 fM for both SARS-CoV-2 RNA and DNA. The integration of a porous electrode with a wireless communicating unit generates a portable detection device that could be applied to direct SARS-CoV-2 nucleic acid testing in saliva samples. The portable device could effectively distinguish the COVID-19 positive and negative samples, showing a sensitivity of 100% and a specificity of 93%. Owing to its rapid, ultrasensitive, specific, and portable features, the as-designed DNA nanolock and porous electrode-based portable device holds great promise as a point-of-care platform for real-time screening of COVID-19 and other epidemics.

Analysis of the mechanism of enhanced heat transfer by nanofluids

CONTEXT

Industrial production and humans cannot exist without energy, but the low efficiency of the heat transfer in the excessive use of energy is the most significant aspect of energy saving and emission reduction. Molecular dynamics simulation methods are devoted to simulate the heat transfer efficiency of a nanofluid system with different particle sizes, and the heat transfer enhancement mechanism of the nanofluid is simulated and studied from a microscopic perspective. The analysis showed that as nanoparticle size increases, the thermal conductivity of the Al-Ar nanofluid tends to decrease, but all of them are still higher than the thermal conductivity of the liquid argon system. According to the findings of the density and radial distribution function analyses, it can be seen that the microstructure of the system changes after putting solid nanoparticles to the original fluid. This alteration in the system's microstructure is the primary component responsible for the increased heat transfer efficiency of nanofluids.

METHODS

In this paper, based on the theory of molecular dynamics, the simulation calculations were mainly performed using LAMMPS software, which is a commonly used open source computational program in the field of MD simulation research. VMD is used for visualization and analysis. The Lennard-Jones potential function was used in the simulation to accurately describe the forces acting between the atoms.

[Advances in the role of autoimmune mechanisms in chronic obstructive pulmonary disease]

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease whose pathogenesis mainly involves airway remodelling and alveolar destruction caused by inflammation, protease-antiprotease imbalance, oxidative stress, and imbalance between apoptosis and compensatory repair of lung tissue structure cells. In recent years, the role of the autoimmune response in COPD has attracted widespread attention, but there is still some controversy. This article reviewed the role of autoimmunity in COPD from different perspectives, starting with the relationship between autoimmunity and the pathogenesis of COPD.

Test of CP Symmetry in Hyperon to Neutron Decays

The quantum entangled J/ψ→Σ^{+}Σ[over ¯]^{-} pairs from (1.0087±0.0044)×10^{10}  J/ψ events taken by the BESIII detector are used to study the nonleptonic two-body weak decays Σ^{+}→nπ^{+} and Σ[over ¯]^{-}→n[over ¯]π^{-}. The CP-odd weak decay parameters of the decays Σ^{+}→nπ^{+} (α_{+}) and Σ[over ¯]^{-}→n[over ¯]π^{-} (α[over ¯]_{-}) are determined to be 0.0481±0.0031_{stat}±0.0019_{syst} and -0.0565±0.0047_{stat}±0.0022_{syst}, respectively. The decay parameter α[over ¯]_{-} is measured for the first time, and the accuracy of α_{+} is improved by a factor of 4 compared to the previous results. The simultaneously determined decay parameters allow the first precision CP symmetry test for any hyperon decay with a neutron in the final state with the measurement of A_{CP}=(α_{+}+α[over ¯]_{-})/(α_{+}-α[over ¯]_{-})=-0.080±0.052_{stat}±0.028_{syst}. Assuming CP conservation, the average decay parameter is determined as ⟨α_{+}⟩=(α_{+}-α[over ¯]_{-})/2=-0.0506±0.0026_{stat}±0.0019_{syst}, while the ratios α_{+}/α_{0} and α[over ¯]_{-}/α[over ¯]_{0} are -0.0490±0.0032_{stat}±0.0021_{syst} and -0.0571±0.0053_{stat}±0.0032_{syst}, where α_{0} and α[over ¯]_{0} are the decay parameters of the decays Σ^{+}→pπ^{0} and Σ[over ¯]^{-}→p[over ¯]π^{0}, respectively.

Measurement of Energy-Dependent Pair-Production Cross Section and Electromagnetic Form Factors of a Charmed Baryon

We study the process e^{+}e^{-}→Λ_{c}^{+}Λ[over ¯]_{c}^{-} at twelve center-of-mass energies from 4.6119 to 4.9509 GeV using data samples collected by the BESIII detector at the BEPCII collider. The Born cross sections and effective form factors (|G_{eff}|) are determined with unprecedented precision after combining the single and double-tag methods based on the decay process Λ_{c}^{+}→pK^{-}π^{+}. Flat cross sections around 4.63 GeV are obtained and no indication of the resonant structure Y(4630), as reported by Belle, is found. In addition, no oscillatory behavior is discerned in the |G_{eff}| energy dependence of Λ_{c}^{+}, in contrast to what is seen for the proton and neutron cases. Analyzing the cross section together with the polar-angle distribution of the Λ_{c}^{+} baryon at each energy point, the moduli of electric and magnetic form factors (|G_{E}| and |G_{M}|) are extracted and separated. For the first time, the energy dependence of the form factor ratio |G_{E}/G_{M}| is observed, which can be well described by an oscillatory function.

Within-person associations of cortisol, dehydroepiandrosterone, and testosterone hair hormone concentrations and psychological distress in pregnant and non-pregnant women

Prenatal hair cortisol concentration is inconsistently associated with maternal psychological distress. However, prior studies have not often measured hair cortisol and maternal psychological distress prospectively over time, examined within-person associations, nor concurrently considered the complex hormonal milieu in which cortisol operates during pregnancy. We addressed these limitations and tested associations against a similar non-pregnant comparison group. Participants included 68 women (34 pregnant and 34 non-pregnant; Mage = 29.14 and 83 % White) from the Midwestern United States. Pregnant women were assessed each trimester, at 12, 26, and 38 weeks and non-pregnant women were assessed three times on the same schedule. At each assessment, participants completed measures of psychological distress and provided hair samples. The first 3 cm (from the scalp) of hair was assayed using enzyme immune-assay kits to reflect cumulative levels within the given trimester/3-month time period of cortisol, dehydroepiandrosterone (DHEA) and testosterone. Within-person associations of hair cortisol and ratio of hair cortisol-to-DHEA and cortisol-to-testosterone with psychological distress were assessed using multilevel models. There were positive within-person associations of hair cortisol with cumulative psychological distress (γ = 0.01, s.e. = 0.003, p = .049), anxiety (γ = 0.09, s.e. = 0.04, p = .046), and pregnancy-related anxiety symptoms (γ = 0.10, s.e. = 0.05, p = .041) in the pregnant sample such that on occasions when hair cortisol was higher than average so were psychological distress symptoms. No within-person associations of hair cortisol were supported in non-pregnant women although there was a negative within-person association, such that on occasions of having lower testosterone level than typical, depression symptoms were higher. There were no within-person associations of psychological distress and cortisol-to-DHEA ratio or cortisol-to-testosterone ratio in either the pregnant or non-pregnant sample. At the between person-level for pregnant women, lower cortisol levels were associated with higher perceived stress (γ = -0.28, s.e. = 0.09, p = .003) and depression symptoms (γ = -0.11, s.e. = 0.06, p = .039), whereas higher cortisol levels were associated with higher psychological distress (γ = 0.03, s.e. = 0.01, p = .010), state anxiety (γ = 0.33, s.e. = 0.13, p = .010), and depression symptoms (γ = 0.23, s.e. = 0.09, p = .017) in non-pregnant women. Modeling hair cortisol at the within-person and between-person level revealed differential findings in pregnant and non-pregnant women. Hair cortisol concentration, psychological distress, pregnancy, hormone coupling, within-person associations.

Biomass carbon sink stability of conifer and broadleaf boreal forests: differently associated with plant diversity and mycorrhizal symbionts?

Forest biomass carbon stability is crucial in achieving carbon neutrality in the high-latitude northern hemisphere, and identifying the differences among forest types and decoupling their associations with plant traits and geoclimatic conditions is the basis for precise forest management. We conducted a large-scale field survey in state-owned forest areas in northeastern China, covering a total of 280,000 km2 forest area, 1275 arbor plots (30 m × 30 m), 5285 shrub plots (5 m × 5 m), and 7076 herb plots (1 m × 1 m). We hypothesized that the conifer and broadleaf forest differences in biomass carbon (C) storage and stability (environmental stability to climatic changes-ES and recalcitrant stability to be decomposed-RS) are associated with mycorrhizal abundance (EcM: ectomycorrhizal, AM: arbuscular mycorrhizal, NM-AM: non-mycorrhizal or arbuscular mycorrhizal), taxon diversity traits (richness, Simpson, Shannon-Wiener, and evenness), and structural differences (diameter, height, and density) in the arbor, shrub, and herb layers. Our results showed that (1) conifer forests had 13.1 Mg/ha higher C stocks and 30.9% higher RS, but 8.6% lower ES than broadleaf forests (p < 0.05). Trees in conifer forests had 1.5 m taller and 2.4 cm thicker trees, but 15% less tree density than those in broadleaf forests. Herbs in conifer forests were 14% shorter and 57% denser than in broadleaf forests. (2) The abundance of EcM-symbiont trees in conifer forests was 15% higher than in broadleaf forests, while their EcM-symbiont shrubs and AM-symbiont herbs were 5-6% lower (p < 0.05). Broadleaf forests had 7% higher tree richness and 19% higher herb richness but 9% lower shrub richness than conifer forests (p < 0.05). Tree and herb evenness was 5-6% higher in conifer forests (p < 0.05). (3) Variations of biomass C sink traits could be explained more by plant diversity in conifer forests (7%) than in broadleaf forests (3.4%). Mycorrhizal symbionts could explain more in broadleaf forests (9.7%) than conifer forests (6.7%). In conifer forests, fewer EcM trees (higher AM trees) and AM herbs, higher tree richness were accompanied by higher biomass C storage and ES. Broadleaf forests underwent similar changes, characterized by an elevation in both RS and ES. (4) Our research emphasized that variations in carbon sequestration between conifer and broadleaf forests could be attributed to mycorrhizal symbionts and species diversity besides tree size-related structural differences. Our findings support the precise management of boreal forests to achieve carbon neutrality based on leaf blade types, plant diversity, and mycorrhizal symbionts.

Development and validation of a nomogram for urinary tract infection in geriatric patients with hip fracture: a retrospective study

OBJECTIVE

This study aims to develop and validate a risk nomogram for urinary tract infections (UTIs) in geriatric patients with hip fractures.

PATIENTS AND METHODS

A total of 900 geriatric patients who underwent hip fracture surgery at Dandong Central Hospital between June 2017 and June 2023 were systematically collected. The cohort was randomly divided into a training set (70%, n=632) and a validation set (30%, n=268) for model development and validation, respectively. Univariate and multivariate logistic regression analyses were conducted to identify the independent risk factors associated with UTIs. Based on the results of the multivariate analysis, a UTI nomogram prediction model was developed and evaluated in the training and validation sets using the C-index, ROC curve, calibration curve, and decision curve analysis to assess discrimination, calibration, and clinical utility, respectively.

RESULTS

Out of the 900 participants, 24.6% were diagnosed with UTIs. The nomogram was developed based on 9 predictors that were found to be independently associated with UTI. The area under the curve (AUC) for predicting UTI in geriatric patients with hip fractures was 0.829 in the training set and 0.803 in the validation set. Following internal verification, the modified C-index remained at 0.829. Furthermore, the nomogram's calibration plot and decision curve analysis demonstrated good performance in both the training and validation sets.

CONCLUSIONS

The established and validated nomogram provides a reliable and convenient tool for predicting UTI risk in geriatric patients with hip fractures. This model facilitates the early identification of high-risk patients and offers guidance for implementing targeted preventive interventions.

Development and validation of preoperative proximal and distal lower limb deep vein thrombosis nomograms in geriatric hip fracture patients

OBJECTIVE

This study aimed to develop and validate a risk nomogram for preoperative proximal and distal deep vein thrombosis (DVT) in geriatric patients with hip fractures.

PATIENTS AND METHODS

The 970 collected geriatric hip fracture patients were randomly divided into a training set (70%, n=682) and a validation set (30%, n=288). Multivariate logistic regression analyses were used to optimize the predictive risk variables for proximal and distal preoperative lower extremity DVT in the training set, respectively, and the selected variables were finally incorporated to establish preoperative DVT nomogram prediction models. Receiver operating characteristic curves (ROC), calibration plots, and decision curve analysis (DCA) were performed to validate the nomograms in the training and validation sets, respectively.

RESULTS

Among the 970 patients, 125 (12.88%) were diagnosed with preoperative DVT. The area under the curve (AUC) for predicting preoperative proximal DVT was 0.888 in the training and 0.792 in the validation sets. The AUC for predicting preoperative distal DVT was 0.907 in the training and 0.790 in the validation sets. The calibration plots and decision curve analysis for preoperative proximal DVT performed well in the training set and slightly worse in the validation set. The calibration plots and decision curve analysis for preoperative distal DVT performed well in both the training and validation sets.

CONCLUSIONS

To construct nomograms for predicting the risk of proximal and distal preoperative lower extremity DVT in geriatric hip fracture patients. For patients at high risk, as assessed by this model, clinicians should intervene and treat them promptly before surgery.

Effects of L-theanine on intestinal morphology, barrier function, and MAPK signaling pathways in diquat-challenged piglets

This study aimed to explore the protective effects of L-theanine supplementation on the diquat-challenged weaned piglets. A total of 160 weaned piglets were randomly divided into 4 groups using a 2 × 2 two-factor design, there were 4 replicates per group and 10 pigs per replicate. Piglets were fed diets (with 1000 mg/kg L-theanine addition or not), then challenged with diquat or saline on day 7. 21 days after challenge, two pigs from each replicate were selected for sample collection. Results showed that supplement with 1000 mg/kg L-theanine down-regulated the diarrhea rate, serum D-lactate level, tumor necrosis factor-α, and phosphorylation of extracellular regulated protein kinases (ERK1/2), p38 mitogen-activated protein kinase (MAPK), and c-Jun N-terminal kinase (JNK) signaling in pigs without diquat challenge (p < 0.05). While for diquat-challenged piglets, L-theanine addition increased average daily gain, jejunum villus height, and interferon-γ level (p < 0.05). Meanwhile, L-theanine addition decreased the diarrhea rates and mortality, serum D-lactate level, and phosphorylation of ERK and JNK in diquat-challenged pigs (p < 0.05). These results demonstrate that L-theanine pretreatment could alleviate diquat-induced oxidative stress and improve intestinal barrier function in diquat-challenged weaned piglets, which can be attributed to suppression of MAPK phosphorylation signaling pathways.

MRI-based radiomics analysis of bladder cancer: prediction of pathological grade and histological variant

AIM

To develop magnetic resonance imaging (MRI)-based radiomics models for the prediction of the pathological grade and histological variant of bladder cancer.

MATERIALS AND METHODS

A total of 227 patients who underwent bladder MRI and had histopathologically confirmed grades and variants were included retrospectively from January 2017 to March 2022. They were assigned to a training set (n=131) and a testing set (n=96) based on the MRI system. MRI-based radiomics features were extracted from manually segmented volumes of interest from high-b-value DWI images and ADC maps. The radiomics models were trained with all possible pipelines in the training set. One optimal model was selected using the fivefold cross-validation method and verified by the testing set according to the pathological results. Univariate and multivariate analyses were performed to identify the significant clinical and imaging factors for developing clinical-radiomics models.

RESULTS

The radiomics model for grade prediction had area under the curve (AUC) values of 0.784, 0.786, and 0.733 in the training, cross-validation, and testing sets, respectively. The radiomics model for variant prediction had AUC values of 0.748, 0.757, and 0.789 in the training, cross-validation, and testing sets, respectively. The performance of the clinical-radiomics model was significantly improved compared with the radiomics models alone for the total dataset (AUC for grade: 0.846 versus 0.756; AUC for variant: 0.810 versus 0.757, p<0.05).

CONCLUSION

MRI-based radiomics models could be used to predict the pathological grade and histological variants of bladder cancer with relatively good performance.

The multi-media environmental behavior of heavy metals around tailings under the influence of precipitation

Precipitation can lead to significant leaching of heavy metals from abandoned tailings，resulting in a decline in the quality of the surrounding environment. This study aimed to simulate and quantify the migration patterns and fate of heavy metals in tailings caused by precipitation in various environmental media (tailings, air, water, soil, and sediments) using leaching tests, source apportionment, and a fugacity model. Results revealed that the average contents of Cd, Cu, As, Pb, Zn, and Cr in the un-weathered tailings were 3.43, 495.56, 160.70, 138.94, 536.57, and 69.52 mg/kg, respectively. The ecological risk factors in the tailings as well as in sediments and soils, were in the following order: Cd >Cu >As >Pb >Zn >Cr. A fugacity model based on the mass-balance methods was established, achieving a good agreement between simulation and measured values. The total amounts of Cd, Cu, As, Pb, and Zn leached from abandoned tailings over the 30-year evaluation period were estimated to be 1.09, 62.44, 0.16, 0.94, and 102.12 t, respectively. Soil and sediments are important reservoirs for heavy metals. The sum of the As, Cd, Cu, Pb, and Zn storage capacities in the soil and sediment accounted for 77.28%, 75.63%, 73.94%, 69.39%, and 57.80% of the total storage capacity, respectively. This study could provide the means for the establishment of a targeted pollution control plan, a guide for restoration projects, and will aid in controlling pollution risk and improving the surrounding environment.

Primary lipoblastic nerve sheath tumor in an inguinal lymph node mimicking metastatic tumor: a case report and literature review

Lipoblastic nerve sheath tumors of soft tissue are characterized as schwannoma tumors that exhibit adipose tissue and lipoblast-like cells with signet-ring morphology. They have been documented to arise in various anatomic locations, including the thigh, groin, shoulder, and retroperitoneum. However, to our knowledge, this tumor has not been previously reported as a lymph node primary. We present herein the first case of a benign primary lipoblastic nerve sheath tumor arising in an inguinal lymph node in a 69-year-old man. Microscopic examination revealed a multinodular tumor comprising fascicles of spindle cells, as well as adipocytic and lipoblast-like signet-ring cell component in the context of schwannoma. Despite the presence of some bizarre cells with nuclear atypia, no obvious mitotic activity or necrosis was observed. Immunohistochemical analysis showed strong and diffuse expression of S-100, SOX10, CD56, and NSE in the spindle cells as well as in the signet-ring lipoblast-like cells and the mature adipocytes. Sequencing analysis of the neoplasm identified six non-synonymous single nucleotide variant genes, specifically NF1, BRAF, ECE1, AMPD3, CRYAB, and NPHS1, as well as four nonsense mutation genes including MRE11A, CEP290, OTOA, and ALOXE3. The patient remained alive and well with no evidence of recurrence over a period of ten-year follow-up.

Integrated bulk and scRNA sequence identified anoikis-related diagnostic biomarkers and potential association with immune infiltration in type A aortic dissection

Type-A aortic dissection (TAAD) is common life-threatening cardiovascular diseases with high-morbidity and mortality but the concrete etiology of disease remains unclear, which might disturb or delay the early diagnosis for TAAD. Anoikis is a special form of programmed cell-death (PCD) induced by detachment of anchorage-dependent cells from the extracellular matrix (ECM) or neighboring cells, and has been widely applied to identify anoikis-related biomarkers for the prediction and prognosis in oncological fields. However, the specific roles of anoikis-related genes (ARGs) in TAAD remain unclear. In this study, we first identified and validated eight diagnostic ARGs for TAAD based on multiple RNA-sequence datasets, including CHEK2, HIF1A, HK2, HMGA1, SERPINA1, PTPN1, SLC2A1 and VEGFA. The comprehensive functional annotation was evaluated by the integrated functional enrichments analysis. We identified the activation of inflammatory-related pathways, metabolic reprogramming and angiogenesis, and the inhibition of cardiovascular development pathways in TAAD. Immune cell infiltration (ICI) analysis further demonstrated that innate immune-cells were more dominant than adaptive immune-cells in TAAD tissues, especially in macrophages, monocytes, activated-DC, NKT cells and CD56+dim NK cells. The cellular landscape was further validated by single-cell RNA sequence technology with significant associations with anoikis in TAAD patients. Four vital ARGs (HIF1A, HMGA1, SERPINA1 and VEGFA) were ultimately identified along with the changes of differentiation trajectory, and major expressions were conformably concentrated on Macro1-3, Mono1-2 and Mono4 subtypes. These findings provide a promising diagnostic biomarker for the accurately diagnosing the disease and would be helpful to further explore the potential pathogenesis with anoikis process for TAAD.

Measurement of the Sensitivity of Two-Particle Correlations in pp Collisions to the Presence of Hard Scatterings

A key open question in the study of multiparticle production in high-energy pp collisions is the relationship between the "ridge"-i.e., the observed azimuthal correlations between particles in the underlying event that extend over all rapidities-and hard or semihard scattering processes. In particular, it is not known whether jets or their soft fragments are correlated with particles in the underlying event. To address this question, two-particle correlations are measured in pp collisions at sqrt[s]=13  TeV using data collected by the ATLAS experiment at the LHC, with an integrated luminosity of 15.8  pb^{-1}, in two different configurations. In the first case, charged particles associated with jets are excluded from the correlation analysis, while in the second case, correlations are measured between particles within jets and charged particles from the underlying event. Second-order flow coefficients, v_{2}, are presented as a function of event multiplicity and transverse momentum. These measurements show that excluding particles associated with jets does not affect the measured correlations. Moreover, particles associated with jets do not exhibit any significant azimuthal correlations with the underlying event, ruling out hard processes contributing to the ridge.

Global, regional, and national burden of hypertensive heart disease among older adults in 204 countries and territories between 1990 and 2019: a trend analysis

BACKGROUND

Hypertensive heart disease (HHD) poses a public health challenge, but data on its burden and trends among older adults are scarce. This study aimed to identify trends in the burden of HHD among older adults between 1990 and 2019 at the global, regional, and national levels.

METHODS

Using the Global Burden of Diseases study 2019 data, we assessed HHD prevalence, death, and disability-adjusted life-year (DALY) rates for individuals aged 60-89 years at the global, regional, and national levels and estimated their average annual percentage changes (AAPCs) between 1990 and 2019 using joinpoint regression analysis.

RESULTS

In 2019, there were 14.35 million HHD prevalent cases, 0.85 million deaths, and 14.56 million DALYs in older adults. Between 1990 and 2019, the prevalence of HHD increased globally {AAPC, 0.38 (95% confidence interval [CI], 0.36, 0.41)} with decreases observed in mortality (AAPC, -0.83 [95% CI, -0.99, -0.66]) and the DALY rate (AAPC, -1.03 [95% CI, -1.19, -0.87]). This overall global trend pattern was essentially maintained for sex, age group, and sociodemographic index (SDI) quintile except for non-significant changes in the prevalence of HHD in those aged 70-74 years and in the middle SDI quintile. Notably, males had a higher HHD prevalence rate. However, HHD-related mortality and the DALY rate were higher in females. The middle SDI quintile experienced the largest decreases in mortality and the DALY rate, with a non-significant decline in prevalence between 1990 and 2019. There were significant discrepancies in the HHD burden and its trends across regions and countries.

CONCLUSIONS

In the past three decades, there has been an overall increasing trend in the prevalence of HHD among older adults worldwide despite decreasing trends in mortality and the DALY rate. Better management of hypertension, and prevention and control of HHD are needed in older adults.

Targeting mitochondrial degradation by chimeric autophagy-tethering compounds

The ability to regulate mitophagy in a living system with small molecules remains a great challenge. We hypothesize that adding fragments specific to the key autophagosome protein LC3 to mitochondria will mimic receptor-mediated mitophagy, thus engaging the autophagy-lysosome pathway to induce mitochondrial degradation. Herein, we develop a general biochemical approach to modulate mitophagy, dubbed mito-ATTECs, which employ chimera molecules composed of LC3-binding moieties linked to mitochondria-targeting ligands. Mito-ATTECs trigger mitophagy via targeting mitochondria to autophagosomes through direct interaction between mito-ATTECs and LC3 on mitochondrial membranes. Subsequently, autophagosomes containing mitochondria rapidly fuse with lysosomes to facilitate the degradation of mitochondria. Therefore, mito-ATTECs circumvent the detrimental effects related to disruption of mitochondrial membrane integrity by inducers routinely used to manipulate mitophagy, and provide a versatile biochemical approach to investigate the physiological roles of mitophagy. Furthermore, we found that sustained mitophagy lead to mitochondrial depletion and autophagic cell death in several malignant cell lines (lethal mitophagy). Among them, apoptosis-resistant malignant melanoma cell lines are particularly sensitive to lethal mitophagy. The therapeutic efficacy of mito-ATTECs has been further evaluated by using subcutaneous and pulmonary metastatic melanoma models. Together, the mitochondrial depletion achieved by mito-ATTECs may demonstrate the general concept of inducing cancer cell lethality through excessive mitochondrial clearance, establishing a promising therapeutic paradigm for apoptosis-resistant tumors.

Dynamic metabolism during early mammalian embryogenesis

Dynamic metabolism is exhibited by early mammalian embryos to support changing cell fates during development. It is widely acknowledged that metabolic pathways not only satisfy cellular energetic demands, but also play pivotal roles in the process of cell signalling, gene regulation, cell proliferation and differentiation. Recently, various new technological advances have been made in metabolomics and computational analysis, deepening our understanding of the crucial role of dynamic metabolism during early mammalian embryogenesis. In this Review, we summarize recent studies on oocyte and embryo metabolism and its regulation, with a particular focus on its association with key developmental events such as fertilization, zygote genome activation and cell fate determination. In addition, we discuss the mechanisms of certain metabolites that, in addition to serving as energy sources, contribute to epigenetic modifications.

Tree diversity, growth status, and spatial distribution affected soil N availability and N2O efflux: Interaction with soil physiochemical properties

Soil nitrogen (N) is an essential nutrient for tree growth, and excessive N is a source of pollution. This paper aims to define the effects of plant diversity and forest structure on various aspects of soil N cycling. Herein, we collected soils from 720 plots to measure total N content (TN), alkali-hydrolyzed N (AN), nitrate N (NO3--N), ammonium N (NH4+-N) in a 7.2 ha experimental forest in northeast China. Four plant diversity indices, seven structural metrics, four soil properties, and in situ N2O efflux were also measured. We found that: 1) high tree diversity had 1.3-1.4-fold NO3--N, 1.1-fold NH4+-N, and 1.5-1.8-fold N2O efflux (p < 0.05). 2) Tree growth decreased soil TN, AN, and NO3--N by more than 13%, and tree mixing and un-uniform distribution increased TN, AN, and NH4+-N by 11-22%. 3) Soil organic carbon (SOC) explained 34.3% of the N variations, followed by soil water content (1.5%), tree diameter (1.5%) and pH (1%), and soil bulk density (0.5%). SOC had the most robust linear relations to TN (R2 = 0.59) and AN (R2 = 0.5). 4) The partial least squares path model revealed that the tree diversity directly increased NO3--N, NH4+-N, and N2O efflux, and they were strengthened indirectly from soil properties by 1%-4%. The effects of tree size-density (-0.24) and spatial structure (0.16) were mainly achieved via their soil interaction and thus indirectly decreased NH4+-N, AN, and TN. Overall, high tree diversity forests improved soil N availability and N2O efflux, and un-uniform spatial tree assemblages could partially balance the soil N consumed by tree growth. Our data support soil N management in high northern hemisphere temperate forests from tree diversity and forest structural regulations.

Determination of Spin-Parity Quantum Numbers for the Narrow Structure near the pΛ[over ¯] Threshold in e^{+}e^{-}→pK^{-}Λ[over ¯]+c.c

A narrow structure in the pΛ[over ¯] system near the mass threshold, named as X(2085), is observed in the process e^{+}e^{-}→pK^{-}Λ[over ¯] with a statistical significance greater than 20σ. Its spin and parity are determined for the first time to be J^{P}=1^{+} in an amplitude analysis, with a statistical significance greater than 5σ over other quantum numbers (0^{-},1^{-} and 2^{+}). The pole positions of X(2085) are measured to be M_{pole}=(2084_{-2}^{+4}±9)  MeV and Γ_{pole}=(58_{-3}^{+4}±25)  MeV, where the first uncertainties are statistical and the second ones are systematic. The analysis is based on the study of the process e^{+}e^{-}→pK^{-}Λ[over ¯] and uses the data samples collected with the BESIII detector at the center-of-mass energies sqrt[s]=4.008, 4.178, 4.226, 4.258, 4.416, and 4.682 GeV with a total integrated luminosity of 8.35  fb^{-1}.

Observation of an Excess of Dicharmonium Events in the Four-Muon Final State with the ATLAS Detector

A search is made for potential ccc[over ¯]c[over ¯] tetraquarks decaying into a pair of charmonium states in the four muon final state using proton-proton collision data at sqrt[s]=13  TeV, corresponding to an integrated luminosity of 140  fb^{-1} recorded by the ATLAS experiment at LHC. Two decay channels, J/ψ+J/ψ→4μ and J/ψ+ψ(2S)→4μ, are studied. Backgrounds are estimated based on a hybrid approach involving Monte Carlo simulations and data-driven methods. Statistically significant excesses with respect to backgrounds dominated by the single parton scattering are seen in the di-J/ψ channel consistent with a narrow resonance at 6.9 GeV and a broader structure at lower mass. A statistically significant excess is also seen in the J/ψ+ψ(2S) channel. The fitted masses and decay widths of the structures are reported.

The Comfort and Measurement Precision-Based Multi-Objective Optimization Method for Gesture Interaction

As an advanced interaction mode, gestures have been widely used for human-computer interaction (HCI). This paper proposes a multi-objective optimization method based on the objective function JCP to solve the inconsistency between the gesture comfort JCS and measurement precision JPH in the gesture interaction. The proposed comfort model CS takes seventeen muscles and six degrees of freedom into consideration based on the data from muscles and joints, and is capable of simulating the energy expenditure of the gesture motion. The CS can provide an intuitive indicator to predict which act has the higher risk of fatigue or injury for joints and muscles. The measurement precision model ∆PH is calculated from the measurement error (∆XH,∆YH,∆ZH) caused by calibration, that provides a means to evaluate the efficiency of the gesture interaction. The modeling and simulation are implemented to analyze the effectiveness of the multi-objective optimization method proposed in this paper. According to the result of the comparison between the objective function JCS, based on the comfort model CS, and the objective function JPH, based on the measurement precision models ∆PH, the consistency and the difference can be found due to the variation of the radius rB_RHO and the center coordinates PB_RHOxB_RHO,yB_RHO,zB_RHO. The proposed objective function JCP compromises the inconsistency between the objective function JCS and JPH. Therefore, the multi-objective optimization method proposed in this paper is applied to the gesture design to improve the ergonomics and operation efficiency of the gesture, and the effectiveness is verified through usability testing.

Measurement of Ultra-High-Energy Diffuse Gamma-Ray Emission of the Galactic Plane from 10 TeV to 1 PeV with LHAASO-KM2A

The diffuse Galactic γ-ray emission, mainly produced via interactions between cosmic rays and the interstellar medium and/or radiation field, is a very important probe of the distribution, propagation, and interaction of cosmic rays in the Milky Way. In this Letter, we report the measurements of diffuse γ rays from the Galactic plane between 10 TeV and 1 PeV energies, with the square kilometer array of the Large High Altitude Air Shower Observatory (LHAASO). Diffuse emissions from the inner (15°10  TeV). The energy spectrum in the inner Galaxy regions can be described by a power-law function with an index of -2.99±0.04, which is different from the curved spectrum as expected from hadronic interactions between locally measured cosmic rays and the line-of-sight integrated gas content. Furthermore, the measured flux is higher by a factor of ∼3 than the prediction. A similar spectrum with an index of -2.99±0.07 is found in the outer Galaxy region, and the absolute flux for 10≲E≲60  TeV is again higher than the prediction for hadronic cosmic ray interactions. The latitude distributions of the diffuse emission are consistent with the gas distribution, while the longitude distributions show clear deviation from the gas distribution. The LHAASO measurements imply that either additional emission sources exist or cosmic ray intensities have spatial variations.

Precise Measurement of the e^{+}e^{-}→D_{s}^{*+}D_{s}^{*-} Cross Sections at Center-of-Mass Energies from Threshold to 4.95 GeV

The process e^{+}e^{-}→D_{s}^{*+}D_{s}^{*-} is studied with a semi-inclusive method using data samples at center-of-mass energies from threshold to 4.95 GeV collected with the BESIII detector operating at the Beijing Electron Positron Collider. The Born cross sections of the process are measured for the first time with high precision in this energy region. Two resonance structures are observed in the energy-dependent cross sections around 4.2 and 4.4 GeV. By fitting the cross sections with a coherent sum of three Breit-Wigner amplitudes and one phase-space amplitude, the two significant structures are assigned masses of (4186.8±8.7±30) and (4414.6±3.4±6.1)  MeV/c^{2}, widths of (55±15±53) and (122.5±7.5±8.1)  MeV, where the first errors are statistical and the second ones are systematic. The inclusion of a third Breit-Wigner amplitude is necessary to describe a structure around 4.79 GeV.

Comprehensive evaluation and advanced modification of polymethylmethacrylate cement in bone tumor treatment

Bone tumors are invasive diseases with a tendency toward recurrence, disability, and high mortality rates due to their grievous complications. As a commercial polymeric biomaterial, polymethylmethacrylate (PMMA) cement possesses remarkable mechanical properties, injectability, and plasticity and is, therefore, frequently applied in bone tissue engineering. Numerous positive effects in bone tumor treatment have been demonstrated, including biomechanical stabilization, analgesic effects, and tumor recurrence prevention. However, to our knowledge, a comprehensive evaluation of the application of the PMMA cement in bone tumor treatment has not yet been reported. This review comprehensively evaluates the efficiency and complications of the PMMA cement in bone tumor treatment, for the first time, and introduces advanced modification strategies, providing an objective and reliable reference for the application of the PMMA cement in treating bone tumors. We have also summarized the current research on modifications to enhance the anti-tumor efficacy of the PMMA cement, such as drug carriers and magnetic hyperthermia.

[Diagnosis and orthodontic treatment strategy of complete canine transposition]

Tooth transposition is a challenge for orthodontists, especially in correcting the order of teeth. At present, the literature on transposition canines mainly focuses on epidemiological studies and case reports, and no systematic treatment guidance has been formed. In this article, the definition and classification, epidemiology and etiology, imaging diagnosis, treatment and risk control of transposed canines are systematically described in order to provide reference for clinical practice.

[Development of auxiliary early predicting model for human brucellosis using machine learning algorithm]

Using machine learning algorithms to construct an early prediction model of brucellosis to improve the diagnosis efficiency of Brucellosis. This study was a case-control study. 2 381 brucellosis patients from Beijing Ditan Hospital affiliated to Capital Medical University were retrospectively collected as case group, and healthy people from Beijing Chaoyang Hospital affiliated to Capital Medical University were collected as control group from May 9, 2011 to November 29, 2021. The relevant clinical information and full blood count results of 13 257 data were collected and five algorithms of machine learning were used to construct an early predication model of brucellosis by using machine learning: random forest, Naive Bayes, decision tree, logistic regression and support vector machine;14 074 data (2 143 cases incase group and 11 931 cases in control group) were used to establish the early predication model of brucellosis, and 1 564 (238 cases in case group and 1 326 cases in control group) data were used to test the predication efficiency of the brucellosis model. The results showed that the support vector machine algorithm has the best predication performance by comparing the five machine learning models. The area under receiver curve (AUC) of receiver operating characteristic (ROC) was 0.991, and the accuracy, precision, specificity and Recall were 95.6%, 95.5%, 95.4% and 95.9%, respectively. Based on the SHAP plot, platelet distribution width (PDW) and basophil relative value (BASO%) results were low, and men with high coefficient of variation (R-CV), erythrocyte hemoglobin concentration (MCHC), and platelet volume (MPV) were predicted to be at high risk of brucellosis. Platelet distribution width (PDW) contributed the most to the prediction model, followed by red blood cell distribution width coefficient of variation (R-CV). In conclusion, the establishment of a high-precision early predication method of brucellosis based on machine learning may be of great significance for the early detection and treatment of brucellosis patients.

First Experimental Study of the Purely Leptonic Decay D_{s}^{*+}→e^{+}ν_{e}

Using 7.33  fb^{-1} of e^{+}e^{-} collision data taken with the BESIII detector at the BEPCII collider, we report the first experimental study of the purely leptonic decay D_{s}^{*+}→e^{+}ν_{e}. Our data contain a signal of this decay with a statistical significance of 2.9σ. The branching fraction of D_{s}^{*+}→e^{+}ν_{e} is measured to be (2.1_{-0.9_{stat}}^{+1.2}±0.2_{syst})×10^{-5}, corresponding to an upper limit of 4.0×10^{-5} at the 90% confidence level. Taking the total width of the D_{s}^{*+} [(0.070±0.028)  keV] predicted with the radiative D_{s}^{*+} decay from the lattice QCD calculation as input, the decay constant of the D_{s}^{*+} is determined to be f_{D_{s}^{*+}}=(214_{-46_{stat}}^{+61}±44_{syst})  MeV, corresponding to an upper limit of 354 MeV at the 90% confidence level.

Eriocitrin inhibits epithelial-mesenchymal transformation (EMT) in lung adenocarcinoma cells via triggering ferroptosis

INTRODUCTION

Lung adenocarcinoma (LUAD) is the most prevalent pathological subtype of non-small cell lung cancer (NSCLC), characterized by a high propensity for relapse and metastasis due to epithelial-mesenchymal transition (EMT) of cancer cells. Ferroptosis, a newly discovered regulated cell death modality, is interconnected with the EMT process in certain cancers. Eriocitrin, a natural flavonoid compound, exerts anti-inflammatory and anticancer effects.

OBJECTIVES

The aim of this study is to investigate the potential inhibitory effect of eriocitrin on lung adenocarcinoma metastasis and explore whether its underlying mechanism involves ferroptosis induction in cancer cells.

METHODS

The CCK8 assay and wound healing assay and transwell were conducted to determine the cell viability and migration ability of A549 and H1299 cells, respectively. EMT process was assessed by western blot and RT-PCR to detect protein and mRNA levels of EMT markers. ROS and cell iron were measured to determine ferroptosis level.

RESULTS

Eriocitrin treatment significantly inhibited cell viability and migration ability in a concentration-dependent manner. Furthermore, eriocitrin administration for 24 hours resulted in enhanced expression of E-cadherin, while downregulating vimentin, N-cadherin and snail expression, indicating marked repression of the EMT process. Additionally, eriocitrin significantly induced ferroptosis in A549 and H1299 cells, as evidenced by increased ROS levels, downregulation of Nrf-2, SLC7A11 and GPX4 expression, and enhanced cellular iron accumulation. Moreover, pretreatment with the ferroptosis inhibitor ferrostatin-1 effectively abrogated the inhibitory effects of eriocitrin on EMT.

CONCLUSIONS

Our findings further support the anti-cancer properties of eriocitrin, as evidenced by its ability to inhibit the EMT process in LUAD cells, which is partially mediated through induction of ferroptosis in cancer cells.

Efficacy of Postoperative Radiotherapy for Patients with New N2 Descriptors of Subclassification in Completely Resected Non-Small Cell Lung Cancer: A Real-World Study

PURPOSE/OBJECTIVE(S)

Patients with N2 non-small cell lung cancer (NSCLC) were heterogeneous groups and required further stratification. The International Society for the Study of Lung Cancer (IASLC) added new descriptors of three sub-stages for stage N2 NSCLC: N2 at a single station without N1 involvement (N2a1), N2 at a single station with N1 involvement (N2a2), and N2 at multiple stations (N2b). This study aimed to investigate the efficacy of postoperative radiotherapy (PORT) for patients with these N2 descriptors.

MATERIALS/METHODS

Patients with histologically confirmed NSCLC after complete resection and divided into PORT group and non-PORT group. The primary endpoint was DFS. The second endpoints were overall survival (OS) and locoregional recurrence-free survival (LRFS). Propensity-score matching (PSM) of baseline characteristics between the PORT and non-PORT groups was used for validation.

RESULTS

Totally 1832 patients were enrolled, including 308 N2a1 patients, 682 N2a2 patients, and 842 N2b patients. The median follow-up time was 50.1 months. The survival outcomes of the PORT and non-PORT groups before PSM were shown in Table 1. For patients with N2a1, PORT could not improve the DFS (median DFS of the PORT group and the non-PORT group: not reached vs. 46.8 months, P = 0.41), OS (P = 0.85), or LRFS (P = 0.32), which were consistent with the multivariate analysis and data after the PSM. For patients with N2a2, PORT significantly improved the DFS (median DFS 29.7 vs. 22.2 months, P = 0.02), OS (P = 0.03), and LRFS (P = 0.01). The multivariate analysis and data after the PSM confirmed the benefits in DFS and LRFS, but no benefit was observed in OS (multivariate analysis: HR 0.79, P = 0.18; median OS after PSM: 103.7 vs. 63.1 months, P = 0.34). For patients with N2b, PORT could not improve the DFS (median DFS 20.6 vs. 21.2 months, P = 0.39) but significantly improved the OS (P<0.001) and LRFS (P<0.001). However, the multivariate analysis showed that PORT significantly improved DFS (HR 0.81, P = 0.03), consistent with the data after the PSM (median DFS 20.6 and 17.6 months, P = 0.04).

CONCLUSION

PORT significantly improved the DFS and LRFS in patients with N2a2 and significantly improved the DFS, LRFS, and OS in patients with N2b. Patients with N2a1 could not benefit from PORT.

Timing of Postoperative Radiation Therapy for Early-Stage Endometrial Carcinoma: A 20-Year Single-Center Retrospective Cohort Experience in China

PURPOSE/OBJECTIVE(S)

To investigate the appropriate timing of radiotherapy (RT) after hysterectomy for women with early-stage endometrial carcinoma (EC).

MATERIALS/METHODS

Between 1999 and 2020, 1080 patients with I and II endometrial cancer received postoperative RT at our hospital. All patients underwent hysterectomy followed by RT. The optimal cut-off values for the surgery-RT interval (SRI) based on overall survival (OS) were determined using the R software. The disease-free survival (DFS), OS, locoregional recurrence free survival (LRFS), and distant metastasis free survival (DMFS) rates were estimated using the Kaplan-Meier method. Multivariate analyses were performed using Cox proportional hazards regression.

RESULTS

Median follow-up time was 52 months. Median SRI were 46 days. The optimal cut-off value for the surgery-RT interval (SRI) based on overall survival (OS) is 40 days. The group initiated RT within 40 days following surgery has higher OS (P = 0.004), higher LRFS (P = 0.002) and higher DMFS (P = 0.039). An SRI of ≤ 40 days was independently associated with higher OS (HR 0.454, 95% CI:0.261-0.788), higher LRFS (HR 0.487, 95% CI:0.304-0.779), and higher DMFS (HR 0.643, 95% CI:0.421-0.982) than SRI of >40 days. However, SRI had no significant effect on DFS.

CONCLUSION

The surgery-RT interval affects the patients' survival endpoints. Based on this analysis, the timing of the initiation of RT after hysterectomy is crucial for patients with early-stage endometrial carcinoma (EC). The postoperative radiation therapy for endometrial cancer should be initiated within 40 days following surgery.

Dosimetric Validation of 3D-Printed Bolus at Different Printing Infill Percentage in VMAT Plan

PURPOSE/OBJECTIVE(S)

The 3D printed bolus technology is rapidly evolving in external beam radiotherapy and printing parameters can have a significant impact on absorbed dose. In this study, a novel 3D printed bolus was designed to evaluate the time and material cost effects, dosimetry differences, and surface dose modulation capabilities in the volumetric-modulated arc therapy (VMAT) plan at different print filling percentages.

MATERIALS/METHODS

A hollow-type bolus, the middle 2.36 mm of 5 mm thickness infilled with different ratio, was designed and printed with polylactic acid (PLA). The ratio of printed material was defined by the infill percentage parameter ranging from 10% to 90%. For each bolus, two treatment plans were designed with AAA algorithm, considering the real computed tomography (CT) scan of the 3D printed bolus and modeling the 3D printed bolus as a virtual bolus structure. Percentage depth dose (PDD) profiles were calculated to build up the mapping equivalent CT value in treatment plan system (TPS). Measurement dose was performed by radiographic films. The PDD profiles were then compared between measured and calculated. A simulation VMAT treatment plan with planning target volume (PTV) close to the body surface was designed on a water-equivalent phantom, and the modulation capabilities of epidermal dose under different filling percentage was compared.

RESULTS

Compared with 100% percent infill 3D printed bolus, The maximum printing time could be reduced by 47.8% and material consumption could be reduced by 42.5%. The surface dose at single field irradiation can reach 69.6% to 85.8% of the maximum dose in different filling boluses. The PDD measurement and mapping equivalent CT calculation deviation was less than 3% when the infill percentage of the middle region is greater than 30%. The dose distribution of the VMAT plan is satisfying for infill percentages greater than 30%.

CONCLUSION

Using the 3D printing technology is possible to modulate the amount of shift of the build-up region by tuning the infill percentage of the 3D printed bolus. Patients could undergo CT simulation without bolus. Appropriate bolus could be selected according to the location of the PTV region and dose requirement.

Preoperative planning of three axis intersection surgical laparoscopic arm system based on characteristic parameters

PURPOSE

The application of robotics in the field of minimally invasive surgery solves some shortcomings of traditional minimally invasive surgery. Preoperative planning is an important prerequisite for the successful completion of robot-assisted surgery. The optimization of surgical incision position and the initial location of surgical robot are two important parts of preoperative planning. In this paper, a novel structure and preoperative planning method of a three-axis intersection surgical manipulator are proposed.

METHODS

Firstly, a mathematical model of human abdominal wall was established. Three characteristic parameters between the lesion and the incision are defined and used to optimize the surgical incisions. Then, the spatial position relationship between the laparoscopic arm and the incision was analyzed to obtain the effective solution groups of each passive joint of the laparoscopic arm. Lastly, the optimal initial location of the laparoscopic arm was determined by taking the total joint variables of the telecentric mechanism as the optimization index.

RESULTS

According to a given set of lesion parameters and the position of laparoscopic arm base, the optimal incision position was obtained using the surgical incision characteristic parameters and the optimal triangle criterion, and the positioning angles of the laparoscopic arm were optimized by using the Total Joint Variable (TJV) as the evaluation index.

CONCLUSIONS

The proposed preoperative planning method is verified by simulation. The proposed method can realize the preoperative planning process of the three axis intersection laparoscopic arm. The proposed method of preoperative planning will provide important reference to improve the intelligence of robot-assisted surgery.

Outcomes and Failure Patterns after Chemoradiotherapy for Locally Advanced Rectal Cancer with Positive Lateral Pelvic Lymph Nodes: A Propensity Score-Matched Analysis

PURPOSE/OBJECTIVE(S)

Locally advanced rectal cancer (LARC) combined with positive lateral pelvic lymph nodes (LPLN) tends to present worse prognosis. However, for those patients it remains unclear whether other combination high-risk factors affect the prognosis. This study aimed to use propensity score matching (PSM) to examine long-term outcomes and failure patterns in patients with positive vs. negative LPLN.

MATERIALS/METHODS

Patients with LARC were retrospectively divided into LPLN-positive and LPLN-negative groups. LPLN-positivity was defined as lymph node short diameter greater than or equal to 7 mm with specific morphological features. Clinical characteristics were compared between the groups using the chi-square test. PSM was applied to balance these differences. Progression-free survival (PFS) and overall survival (OS), and local-regional recurrence (LRR) and distant metastasis (DM) rates were compared between the groups using the Kaplan-Meier method and log-rank tests.

RESULTS

Prior to PSM, a total of 651 LARC patients were included. The LPLN-positive group had higher rates of lower location (53.1% vs. 43.0%, P = 0.025), mesorectal fascia (MRF)-positive (53.9% vs. 35.4%, P<0.001) and extramural venous invasion (EMVI)-positive (51.2% vs. 27.2%, P<0.001) disease than the LPLN-negative group. After PSM, there were 114 patients for each group along with the balanced clinical factors, and both groups had comparable surgery, pathologic complete response (pCR), and ypN stage rates. The median follow-up time was 45.9 months, 3-year OS (88.3% vs. 92.1%, P = 0.276) and LRR (5.7% vs. 2.8%, P = 0.172) rates were comparable between LPLN-positive and LPLN-negative groups. Meanwhile, despite no statistical difference, 3-year PFS (78.8% vs. 85.9%, P = 0.065) and DM (20.4% vs. 13.3%, P = 0.061) rates slightly differed between the groups. Among 10 patients with LRR, seven (70.0%) had lateral pelvic recurrence, among them, five patients were LPLN-positive, and four (80.0%) of these patients did not receive simultaneous integrated boost intensity-modulated radiotherapy (SIB- IMRT).45 patients were diagnosed with DM, 11 (40.7%) LPLN-positive and 3 (17.6%) LPLN-negative patients were diagnosed with oligometastases (P = 0.109).

CONCLUSION

Our study shows there is a tendency of worse PFS and DM in LPLN-positive than LPLN-negative patients, for LPLN-positive patients, oligometastases account for a large proportion of all distant metastases.

CBCT Guided Interfraction Absolute Displacement and Setup Error Assessment during Breast Prone Radiotherapy

PURPOSE/OBJECTIVE(S)

To calculate interfraction absolute displacement/shift and setup error using cone beam computed tomography (CBCT) during breast prone radiotherapy.

MATERIALS/METHODS

Fifty-nine patients undergoing prone whole breast-irradiation after breast-conserving surgery (BCS) were studied as part of an institutional review board- approved prospective trial. Setup precision was monitored using a daily online CBCT. Translational shifts in 3 axes (AP: anterior posterior; LR: left right; and SI: superior inferior) and 3 rotations (pitch, roll, and rtn) after CBCT were analyzed for 1062 treatment fractions. The random and systematic setup errors (SE) were calculated and were analyzed for time trends during the course of radiotherapy.

RESULTS

For absolute inter-fractional shifts, the numbers of fractions exceeding 10 mm in the AP, LR, and SI directions were 6.5%, 17.42% and 8.92%, respectively; 0%, 0% and 1.31% fractions exceeded 3°for pitch, roll, and Rtn, respectively. The population systematic errors were 1.89/2.91/1.98 mm in AP/SI/LR directions, while the random error were 2.72/3.99/3.31 mm. In pitch, roll, rtn rotations, the population systematic error were 0.64°/0.49°/0.46°, and 0.89°/0.90°/0.93° for the random error. Without correction these would correspond to a clinical to planning target volume margin of 6.64/10.08/7.26 mm in AP/SI/LR directions and 2.22°/1.79°/1.8° in pitch, roll, rtn rotations. The magnitude of inter-fraction motion was not correlated with patient treatment time accept in AP direction (P = 0.000).

CONCLUSION

SE was larger in prone position in breast cancer patients, attributable mostly to random errors, which emphasize the need for on-line imaging guidance in breast prone radiotherapy. 10mm margins would adequately cover the target volume and account for setup errors in the absence of IGRT.

Weekly Image Guidance in Patients with Cervical Cancer Treated with Intensity Modulated Radiation Therapy: Results of a Large Cohort Study

PURPOSE/OBJECTIVE(S)

Given the motion of the cervix, uterus, and organs at risk, image guidance is recommended for patients undergoing intensity modulated radiation therapy (IMRT) for cervical cancer. However, daily image guidance can be resource intensive, particularly in developing countries. In this study, we evaluated the feasibility of a weekly image-guidance pattern and analyzed the long-term outcomes in a large cohort of patients.

MATERIALS/METHODS

The study enrolled patients with stage IB-IVA cervical cancer who received concurrent chemotherapy between 2005 and 2015. IMRT was delivered at a dose of 50.4 Gy in 28 fractions, with weekly cone-beam CT scans for image guidance. Following the image guidance, physicians would advise patients on the suitability of rectum and bladder preparation to help them prepare on non-imaging days. When significant tumor regression was observed, a second CT simulation and re-planning were performed. Intracavitary brachytherapy was delivered at a dose of 30 Gy in 5 fractions. The concurrent chemotherapy regimen consisted of weekly cisplatin.

RESULTS

A total of 1,433 patients were included in the study. The median follow-up periods for all patients and surviving patients were 63 months (ranging from 2 to 125 months) and 70 months (ranging from 3 to 125 months), respectively. The 5-year overall survival (OS), disease-free survival (DFS), and local control (LC) rates were 79.6%, 73.2%, and 86.5%, respectively. The estimated 8-year OS, DFS, and LC rates were 75.6%, 69.2%, and 85.2%, respectively. For patients with stage IB1, IB2, IIA, IIB, IIIA, IIIB, and IVA diseases (according to the 2014 FIGO staging system), the 5-year OS and DFS rates were 90.2% and 86.7%, 95.1% and 86.5%, 87.9% and 79.8%, 82.2% and 75.5%, 64.3% and 58.2%, 61.8% and 57.4%, and 43.8% and 19.4%, respectively. For patients with squamous cell carcinoma and adenocarcinoma, the 5-year DFS rates were 75.1% and 57.3%, respectively. For patients with positive regional lymph nodes, the 5-year OS and DFS rates were 64.1% and 57.8%, respectively. A total of 66 patients (4.6%) experienced grade 3-5 chronic toxicities, including 38 patients (2.7%) with gastrointestinal toxicities and 36 patients (2.5%) with genitourinary toxicities.

CONCLUSION

IMRT with weekly image guidance resulted in high survival rates and acceptable toxicities. This indicates that weekly image guidance is acceptable in countries with limited medical resources.

Association of dietary oxidative balance score and sleep duration with the risk of mortality: prospective study in a representative US population

OBJECTIVE

We investigated the association between dietary oxidative balance score (DOBS) and mortality and whether this association can be modified by sleep duration.

DESIGN

We calculated DOBS to estimate the overall oxidative effects of the diet, with higher DOBS reflecting more antioxidant intake and less pro-oxidant intake. Cox proportional hazards models were employed to examine the associations between DOBS and all-cause, CVD and cancer mortality in the general population and people with different sleep durations.

SETTING

Prospective analysis was conducted using data from the US National Health and Nutrition Examination Survey (NHANES, 2005-2015).

PARTICIPANTS

A total of 15 991 US adults with complete information on dietary intake, sleep duration and mortality were included.

RESULTS

During a median follow-up of 7·4 years, 1675 deaths were observed. Participants in the highest quartile of DOBS were significantly associated with the lower risk of all-cause mortality (hazard ratio (HR) = 0·75; 95 % CI 0·61, 0·93) compared with those in the lowest. Furthermore, we found statistically significant interactions between DOBS and sleep duration on all-cause mortality (P interaction = 0·021). The inverse association between DOBS and all-cause mortality was significant in short sleepers (HR = 0·66, 95 % CI 0·48, 0·92), but not in normal and long sleepers.

CONCLUSIONS

Our study observed that higher DOBS was associated with lower all-cause mortality, and this association appeared to be stronger among short sleepers. This study provides nutritional guidelines for improving health outcomes in adults, especially for short sleepers.

Risk Stratification of Postoperative Adjuvant Therapy for Endometrial Cancer (POAT-ENDORISK) Based on Bayesian Network Model: A Development and Validation Study

PURPOSE/OBJECTIVE(S)

To establish a Bayesian network (BN) model for postoperative adjuvant treatment of early endometrial carcinoma (EC) patients.

MATERIALS/METHODS

We retrospectively analyzed the data of 1280 early EC patients treated by multiple institutions in China from 1999 to 2017. All patients received primary hysterectomy/bilateral salpingo-oophorectomy and adjuvant radiotherapy. The FIGO 2009 stage of all patients is stage I and stage II EC, and the median age is 57 years old. All patients are grouped according to the ESMO-ESGO-ESTRO risk stratification. The clinicopathologic factors, treatment-related factors, local regional recurrence, distant metastasis and cancer-specific survival rate (CSS) of all patients were reviewed. We divide the original data set into training set and Validation set according to the ratio of 7:3. The training of the Bayesian network model is completed on Netica, and the test of the model effect is finally completed on the test set.

RESULTS

After variable screening, a total of 14 characteristic variables entered the final model. A total of 896 patients were used for the development of BN model, and 384 patients were used for the validation of BN model. The results of the model showed that the factors directly related to CSS were locoregional failure (LRF), radiotherapy mode, distant metastasis (DM). Factors directly related to DM were chemotherapy, LRF, CSS. The factors directly related to LRF were risk stratification, preoperative serum CA125 and preoperative HB. The accuracy, sensibility, specificity, micro-f1, micro-f1, weighted-f1 and AUC of BN model in predicting DM and CSS were better than XGBoost model.

CONCLUSION

In this study, we integrated almost all clinical pathology and treatment information related to postoperative adjuvant treatment of early EC patients and established a BN model for personalized clinical decision-making of postoperative adjuvant treatment of early EC patients. The results showed the complex correlation among the variables, and the overall prediction ability and visualization effect of BN model was significantly better than XGBoost model. Prospective research is needed before clinical implementation.

Pretreatment with Kahweol Attenuates Sepsis-Induced Acute Lung Injury via Improving Mitochondrial Homeostasis in a CaMKKII/AMPK-Dependent Pathway

SCOPE

It is well-established that dysregulated mitochondrial homeostasis in macrophages leads to inflammation, oxidative stress, and tissue damage, which are essential in the pathogenesis of sepsis-induced acute lung injury (ALI). Kahweol, a natural diterpene extracted from coffee beans, reportedly possesses anti-inflammatory and mitochondrial protective properties. Herein, the study investigates whether Kahweol can alleviate sepsis-induced ALI and explore the underlying mechanisms.

METHODS AND RESULTS

C57BL/6J mice are intraperitoneally injected with lipopolysaccharide (LPS) for 12 h to induce ALI. Pretreatment with kahweol by gavage for 5 days significantly alleviates lung pathological injury, inflammation, and oxidative stress, accompanied by shifting the dynamic process of mitochondria from fission to fusion, enhancing mitophagy, and activating AMPK. To investigate the underlying molecular mechanisms, differentiated THP-1 cells are cultured in a medium containing Kahweol for 12 h prior to LPS exposure, yielding consistent findings with the in vivo results. Moreover, AMPK inhibitors abrogate the above effects, indicating Kahweol acts in an AMPK-dependent manner. Furthermore, the study explores how Kahweol activates AMPK and finds that this process is mediated by CamKK II.

CONCLUSION

Pretreatment with Kahweol attenuates sepsis-induced acute lung injury via improving mitochondrial homeostasis in a CaMKKII/AMPK-dependent pathway and may be a potential candidate to prevent sepsis-induced ALI.

Cost-Effectiveness of Short-Course Radiotherapy Based Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer in China

PURPOSE/OBJECTIVE(S)

The phase III STELLAR (NCT02533271) trial demonstrated that four cycles of chemotherapy after short-course radiotherapy (SCRT-TNT) were not inferior to the standard care of long-course concurrent radiotherapy (LCRT) in patients with locally advanced rectal cancer (LARC). This study assessed the cost-effectiveness of SCRT-TNT versus LCRT in locally advanced rectal cancer in China on the basis of the STELLAR trial.

MATERIALS/METHODS

A Markov model was used to synthesize the healthcare costs and benefits of LARC patients based on results from the STELLAR trial. The model assumes that LARC who meet the inclusion criteria of the STELLAR trial experience four possible states: No Evidence of Disease (NED), locally recurrence, distant metastases, or any death from rectal cancer or other unrelated causes, where local recurrence continues to be classified as resectable and unresectable. The transition status period is 3 month, and 5 years is used to calculate direct medical costs and health benefits. The probabilities of states transition after SCRT-TNT or LCRT were derived from the results of the STELLAR trial and previous published article (Table.1). Costs were evaluated from the Chinese payer's perspective reported in early 2022 US dollars (US$1 = 6.78 Chinese Yuan). Sensitivity analyses were performed for key variables. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefits. Effectiveness was defined as quality-adjusted life-years (QALYs). Willingness-to-pay (WTP) threshold was set at $43500/QALY. Data were collected from October 3, 2020, to September 20, 2021, and analyzed from November 15, 2020, to October 25, 2021.

RESULTS

During the 5-year horizon, for the base case scenario, SCRT-TNT incurred a lower total cost and higher QALYs compared with LCCRT. The total cost was $65767 and QALYs were 1.77 for SCRT-TNT; for LCCRT, the total cost was $72802 and QALYs were 1.64. This resulted in an ICER of -$ 55470.69 per QALY. Therefore, SCRT-TNT was a cost-saving and dominating treatment strategy compared with LCRT. Sensitivity analysis showed that ICERs were most sensitive to the parameters of distant metastases risk after treatment.

CONCLUSION

SCRT-TNT in locally advanced rectal cancer can be a cost-effective alternative to LCRT in China, and should be considered in appropriately selected patients.

4D-MRI Guided Stereotactic Body Radiation Therapy for Unresectable Colorectal Liver Metastases

PURPOSE/OBJECTIVE(S)

This study evaluated the feasibilities and outcomes following four-dimensional magnetic resonance imaging (4D-MRI) guided stereotactic body radiation therapy (SBRT) for unresectable colorectal liver metastases (CRLM).

MATERIALS/METHODS

From March 2018 to January 2022, we identified 76 unresectable CRLM patients with 123 lesions who received 4D-MRI guided SBRT in our institution. 4D-MRI simulation with or without abdominal compression was conducted for all patients. The prescription dose was 50-65 Gy in 5-12 fractions. The image quality of computed tomography (CT) and MRI were compared using the Clarity Score. Clinical outcomes and toxicity profiles were evaluated.

RESULTS

The 4D-MRI significantly improved the image quality compared with CT images (mean Clarity Score: 1.67 vs 2.88, P < 0.001). The abdominal compression significantly reduced motions in cranial-caudal direction (P = 0.03) with 2 phase T2 weighted images assessing tumor motion. The median follow-up time was 12.5 months. For 98 lesions assessed for best response, the complete response, partial response and stable disease rate were 57.1 %, 30.6 % and 12.2 %, respectively. The local control (LC) rate at 2 year was 97.3%. 46.1% of patients experienced grade 1-2 toxicities and only 2.6% patients experienced grade 3 hematologic toxicities.

CONCLUSION

The 4D-MRI technique allowed precise target delineation and motion tracking in unresectable CRLM patients. High LC rate and mild toxicities were achieved. This study provided evidence for using 4D-MRI guided SBRT as an alternative treatment in unresectable CRLM.

Reducing CTV to PTV Margins with Daily Adaptive Radiotherapy in the Postoperative Treatment of Endometrial and Cervical Cancer

PURPOSE/OBJECTIVE(S)

In the postoperative treatment of endometrial and cervical cancer, a PTV expansion of 1.5cm or greater would be generally recommended to ensure adequate coverage of CTV with no or minimal image guidance. Online adaptive radiotherapy (oART) has demonstrated to be feasible to reduce inter-fractional radiotherapy errors as it re-optimizes treatment plan every fraction. In this study, we hypothesized using daily cone-beam computed tomography (CBCT)-guided oART would reduce CTV to PTV margins in the postoperative treatment of endometrial and cervical cancer.

MATERIALS/METHODS

Seven patients from a single-center with postoperative endometrial and cervical cancer treated with daily CBCT-guided oART were retrospectively reviewed. A total dose of 45Gy is prescribed in CTV-vaginal cuff (CTV-V) and CTV- regional lymph nodes (CTV-N) with daily fractions of 1.8Gy for five fractions per week. A total of 175 radiotherapy fractions of daily pre-treatment CBCTs and post-treatment CBCTs scans were uploaded to oART emulator for CTV-V and CTV-N contouring by a single observer. CTVpre to PTVpre margins of 5, 7, 10, 12, 15mm was used in all directions. Each post-treatment CBCT was rigidly registered to the pre-treatment CBCT with respect to bony anatomy. The CTVpost was projected onto the PTVpre and assess required planning margins to encompass the CTVpost.

RESULTS

The average total treatment time (post-treatment CBCTs - pre-treatment CBCTs) was 23 min 14s (range: 18min 53s ∼ 28min 53s). For all fractions, the adapted plan was selected, and the volume of the PTV-V and PTV-N receiving 100% of the prescribed dose or more (V100%) was more than required 95%. A uniform three-dimensional CTV-Npre to PTV-Npre margin of 5mm could encompass CTV-Npost in all fractions (100%; 175/175f). A uniform three-dimensional CTV-Vpre to PTV-Vpre margin of 10mm could encompass CTV-Vpost in all fractions (100%; 175/175f) and 5mm could encompass 98% fractions (172/175f). In the fractions of 5mm margins that failed to encompass CTV-Vpost, the volume of CTV missed three times in anterior-posterior directions and once in lateral direction. Compared with scheduled plan, adapted plan with 5mm margins significantly reduced the mean dose to bladder (Dmean: 103.97 cGy vs 107.20 cGy, P<0.05) and rectum (Dmean: 117.82 cGy vs 123.67 cGy, P<0.05), and achieved better PTV-N (V100%: 97.8% vs 90.0%, P<0.05) and PTV-V (V100%:96.8% vs 85.4%, P<0.05) dose coverage in 175 fractions.

CONCLUSION

In this study, 5mm CTV to PTV margins was adequate to encompass 100% fractions of CTV-N and 98% fractions of the CTV-V. Adapted plan with 5mm margins significantly reduced the dose to critical organ at risks while improving target coverage.

Chemoradiotherapy Combined with Nab-Paclitaxel plus Cisplatin in Patients with Locally Advanced Borderline Resectable or Unresectable Esophageal Squamous Cell Carcinoma: A Phase I/II Study

PURPOSE/OBJECTIVE(S)

To evaluate the efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-PTX) plus cisplatin as the regimen of conversional chemoradiotherapy (cCRT) in locally advanced borderline resectable or unresectable esophageal squamous cell carcinoma (ESCC).

MATERIALS/METHODS

Patients with locally advanced ESCC (cT3-4, Nany, M0-1, M1 was limited to lymph node metastasis in the supraclavicular area) were enrolled. All the patients received the cCRT of nab-PTX plus cisplatin. After the cCRT, those resectable patients received esophagectomy; those unresectable patients continued to receive the definitive chemoradiotherapy (dCRT). The locoregional control (LRC), overall survival (OS), progression-free survival (PFS), distant metastasis free survival (DMFS), pathological complete response (pCR), R0 resection rate and adverse events (AEs) were calculated.

RESULTS

A total of 45 patients with ESCC treated from October 2019 to May 2021 were finally included. The median follow-up time was 30.3 months. The LRC, OS, EFS, DMFS at 1and 2 years were 81.5%, 86.6%, 64.3%, 73.2% and 72.4%, 68.8%, 44.8%, 52.7% respectively. 21 patients (46.7%) received conversional chemoradiotherapy plus surgery (cCRT+S). The pCR rate and R0 resection rate were 47.6% and 84.0%. The LRC rate at 1 and 2 years were 95.0%, 87.1% in cCRT+S patients and 69.3%, 58.7% in dCRT patients respectively (HR, 5.14; 95% CI, 1.10-23.94; P = 0.021). The OS rate at 1 and 2 years were 95.2% and 84.2% in resectable patients compared to 78.8% and 54.4% in unresectable patients (HR, 3.41; 95% CI, 1.10-10.61; P = 0.024). The toxicities during chemoradiotherapy were tolerated, the most common grade 3-4 toxicities were radiation esophagitis (15.6%).

CONCLUSION

Nab-PTX plus cisplatin were effective and safe as the regimen of conversional chemoradiotherapy of ESCC. The patients receiving conversional chemoradiotherapy plus surgery (cCRT+S) were prone to have a better survival.

Clinical Outcomes with Thoracic Radiotherapy for Extensive-Stage Small-Cell Lung Cancer in the Era of Immunotherapy: A Retrospective Analysis

PURPOSE/OBJECTIVE(S)

Chemo-immunotherapy has shown significant benefits for extensive-stage small-cell lung cancer (ES-SCLC), which prolonged overall survival (OS) of nearly 2-4.5 months compared with platinum-based chemotherapy alone. However, thoracic radiotherapy (TRT), was not allowed to be used in previous trials. This retrospective study aimed to evaluate the safety and efficiency of TRT for ES-SCLC patients in the era of Immunotherapy.

MATERIALS/METHODS

We retrospectively reviewed ES-SCLC patients treated with chemo-immunotherapy between 2017 and 2021 in our center. Patients who accepted consolidative or salvage TRT were included. The overall survival, progression-free survival (PFS), local progression-free survival (LPFS), and distant progression free-survival (DPFS) were calculated using the Kaplan-Meier method. Toxicity was recorded based on CTCAE 5.0 scale.

RESULTS

We finally enrolled 30 patients in our study. The median follow-up time was 26.0 months (95% confidence interval, 18.2-33.8 months). 26(86.7%) patients have undergone first-line chemotherapy and immunotherapy, while 4(13.3%) have undergone immunotherapy as a second-line agent. 23(76.6%) patients achieved CR/PR/SD to initial systematic therapy. All patients were treated with TRT with a median dose of 51 Gy (24-60.2 Gy). The median interval between TRT and immunotherapy was 35 days. Median OS was 26 months (95% confidence interval, 17.8-34.2 months) and median PFS was 8 months (95% confidence interval, 5.3-10.7 months). 2-year OS, PFS, and DPFS were 51.4%, 21.4%, and 27.4%, respectively. 18 months LPFS was 59.6%. There was no ≥ G3 radiation-related adverse event except 2(6.7%) G3 esophagitis. G1-2 pneumonitis was reported in 8(26.7%) patients.

CONCLUSION

TRT is well-tolerated and effective for selected ES-SCLC patients in the modern era of immunotherapy. Prospective trials are still needed to further evaluate the combination of TRT and immunotherapy for patients with ES-SCLC.

First Demonstration of the Commissioning of a New Multi-Modality Radiotherapy Platform

PURPOSE/OBJECTIVE(S)

A new multi-modality radiotherapy platform was developed and introduced into clinical application, which has received US FDA 510k(K210921) and National Medical Products Administration (NMPA) clearance in China (20223050973). This study, for the first time, presents the technological characteristics and commissioning results of the new platform.

MATERIALS/METHODS

The platform consists of 3 modules: linear accelerator, rotating gamma system, and a kV imaging system within an O-ring gantry. The O-ring gantry can rotate continuously achieved by using a slip ring. The Linac delivers a 6 MV FFF photon beam with a variable dose rate of 50 to 1400 MU/min. The delivery techniques include 3D-CRT, IMRT, and VMAT. The rotating gamma system utilizes 18 Co-60 sources with a reference dose rate of 350 cGy/min. The image-guided techniques consist of kV-kV pairs and kV-CBCT. The X-ray intensity-modulated radiotherapy and γ-ray stereotactic radiotherapy can be delivered on the same platform. The acceptance test and commissioning were performed following the vendor's customer acceptance tests (CAT) and several AAPM Task Group reports/guidelines. Regarding the Linac, all applicable validation tests recommended by the MPPG 5.a (basic photon beam model validation, IMRT/VMAT validation, E2E tests, and patient-specific QA) were performed. For the rotating gamma system, the absorbed doses were measured using a PTW31014 and PTW60016. EBT3 films were employed to measure the relative output factors (ROFs). The E2E tests were performed using a PTW31014 and EBT3 films. The coincidence between the imaging isocenter and the Linac/gamma treatment isocenter was investigated using EBT3 films. The image quality was evaluated regarding the contrast-to-noise ratio (CNR), spatial resolution, and uniformity.

RESULTS

All tests included in the CAT met the vendor's specifications. All MPPG 5.a tests complied with the tolerances. The confidence limits for IMRT/VMAT validation were achieved according to TG-119. The point dose differences were below 1.68% and gamma pass rates (3%/2 mm) were above 95.9% for the Linac E2E tests. All plans of patient-specific QA had point dose differences below 1.79% and gamma pass rates (3%/2 mm) above 96.1% suggested by TG-218. For the rotating gamma system, the differences between the calculated and measured absorbed doses were below 1.86%. The ROFs calculated by the TPS were independently confirmed within 2% using EBT3 films. The point dose differences were below 2.57% and gamma pass rates (2%/1 mm) were above 95.3% for the E2E tests. The coincidence between the imaging isocenter and the Linac/gamma treatment isocenter was within 0.5 mm. The image quality fully complied with the vendor's specifications regarding the CNR, spatial resolution, and uniformity.

CONCLUSION

This is the first report about the commissioning of a new multi-modality radiotherapy platform. The platform has been successfully commissioned and exhibits good performance in mechanical and dosimetry accuracy.

A Survey on Force Sensing Techniques in Robot-Assisted Minimally Invasive Surgery

Minimally invasive surgery (MIS) is commonly used in some robotic-assisted surgery (RAS) systems. However, many RAS lack the strength and tactile sensation of surgical tools. Therefore, researchers have developed various force sensing techniques in robot-assisted minimally invasive surgery (RMIS). This paper provides a systematic classification and review of force sensing approaches in the field of RMIS, with a particular focus on direct and indirect force sensing. In this survey, the relevant literature on various sensing principles, haptic sensor design standards, and sensing technologies between 2000 and 2022 is reviewed. This survey can also serve as a roadmap for future developments by identifying the shortcomings of the field and discussing the emerging trends in force sensing methods.