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Liu B, Lin ZR, Luo SR, Fang X, Xiao XW, Xie ZW, Yan L, Li XZ, Dong N, Shang XM, Liu ZS, Wu HP. [Topography-guided transepithelial corneal collagen cross-linking by sequential ultraviolet A irradiation in different diameters for progressive keratoconus in adults]. [ZHONGHUA YAN KE ZA ZHI] CHINESE JOURNAL OF OPHTHALMOLOGY 2023; 59:791-804. [PMID: 37805413 DOI: 10.3760/cma.j.cn112142-20221216-00642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To compare the efficacy and safety of a novel customized topography-guided transepithelial corneal collagen cross-linking (TG-CXL) procedure by sequential ultraviolet A irradiation in different diameters and conventional transepithelial corneal collagen cross-linking (TE-CXL) in adult patients with progressive keratoconus. Methods: A prospective cohort study was conducted. Adult patients diagnosed with progressive keratoconus in the Affiliated Xiamen Eye Center of Xiamen University were continuously recruited and randomly assigned to receive the TG-CXL or TE-CXL procedure from March 2020 to March 2021. Patients in the TE-CXL group were irradiated in the central 9-mm zone of the cornea (total energy, 7.2 J/cm2; irradiance, 45 mW/cm2), while patients in the TG-CXL group were first irradiated with the protocol used in the TE-CXL group, and further irradiated in the central 6-mm zone (total energy, 3.6 J/cm2; irradiance, 9 mW/cm2). The subjective symptom of pain and corneal fluorescein sodium staining were scored within postoperative 3 days. Slit lamp examination, measurements of uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), corneal topography, anterior segment optical coherence tomography, in vivo corneal confocal microscopy, corneal endothelial cell count, and non-contact tonometry were performed before surgery and at 3, 6, and 12 months after surgery. Results: A total of 66 patients were enrolled (mean age, 23.0±3.3 years old), with 33 patients (33 eyes) in each group. No statistically significant differences were found in age, gender, and maximum keratometry (Kmax) between the two groups (P>0.05). On day 1 after surgery, the average pain score of the TG-CXL group (2.21±0.45) was significantly higher than that of the TE-CXL group (1.32±0.33) (P<0.05). The pain was rapidly alleviated in both groups on days 2 and 3. On days 1 and 2, the corneal fluorescein sodium staining scores in the TG-CXL group (4.15±0.83 and 2.21±0.60, respectively) were significantly higher than those in the TE-CXL group (1.76±0.56 and 0.85±0.51, respectively, P<0.001), while there was no significant difference between the two groups at day3 (P=0.184). The UCVA and BCVA of the TG-CXL group at 3, 6, and 12 months after surgery were significantly improved when compared with the baseline. At 3, 6, and 12 months, the BCVA (LogMAR) of the TG-CXL group (0.21±0.15, 0.22±0.16, and 0.22±0.16, respectively) were significantly improved when compared with those of the TE-CXL group(0.32±0.15, 0.34±0.15, and 0.36±0.16, respectively, P<0.01). However, there was no significant difference in UCVA between groups at any time point after surgery (P>0.05). The spherical and cylindrical power values of the TG-CXL group were improved when compared with the baseline (P<0.05). However, no significant difference in spherical power values was found between the two groups at any time point after surgery (P>0.05). Meanwhile, there were significant differences in cylindrical power values between the two groups at 6 and 12 months after surgery (P<0.05). The Kmax in the TG-CXL group was improved at all of the time points after surgery when compared with the baseline (P<0.001), while no significant difference in Kmax was found at any time point after surgery in the TE-CXL group when compared with the baseline (P>0.05). At 6 and 12 months after surgery, the Kmax values in the TG-CXL group were significantly lower than the TE-CXL group (P<0.05). No significant differences were found in flat keratomety, steep keratometry, the minimal thickness of the cornea, endothelial cell density, and intraocular pressure between the two groups at any time point after surgery (P>0.05). Within one month after surgery, optical coherence tomography revealed the increased density in the anterior stroma in both groups. In most patients in the TG-CXL group, a demarcation line was visible in the central and para-central corneal stroma, representing a clear and continuous, high-signal arc-shaped linear structure, which was deeper in the central cornea than the para-central cornea. In contrast, a demarcation line, fuzzy and focally discontinuous, was visible only in a few patients in the TE-CXL group, with an almost uniform depth in the central and the para-central cornea. Confocal microscopy demonstrated an apparent mesh-like cross-linked collagen structure in the superficial and intermediate corneal stroma at all time points after surgery in the TG-CXL group, with thickening stromal collagen fibers and an increased number of interconnections. In contrast, the mesh-like structure and number of interconnections in the superficial corneal stroma were significantly reduced at 12 months after surgery in the TE-CXL group, with no cross-linking structure in the intermediate corneal stroma at any time point after surgery. No serious complications such as corneal infection, sterile corneal ulcer, and persistent epithelial defect were observed in both groups during the follow-up of 12 months. Conclusions: The TG-CXL procedure by sequential irradiation in two different diameters with ultraviolet A light was effective and safe in the management of progressive keratoconus in adults, achieving significant refractive improvement. This might be a good technical alternative for refractive corneal cross-linking surgery.
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Ding S, Li JY, Liu H, Li Y, Wang B, Liu B, Liu M, Li R, Huang X. Dosimetric Advantages of Online Adaptative Radiotherapy for Cervical Cancer on 1.5T MR-Linac. Int J Radiat Oncol Biol Phys 2023; 117:e509. [PMID: 37785595 DOI: 10.1016/j.ijrobp.2023.06.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Online adaptative radiotherapy (ART) strategy can be applied to account for inter-fraction organ motion while limiting organ at risk (OAR) dose. This study aims to evaluate tumor target and OARs inter- and intrafraction motion using online MRI during the full course of MR-Linac radiotherapy fractions. Furthermore, quantify the dosimetric consequences of online adaptative compared with non-adaptative radiotherapy (non-ART) in cervical cancer. MATERIALS/METHODS Six cervix cancer patients were treated with 150 fractions on the 1.5 T Unity MR-Linac. Each fraction, pre-treatment MRI scans were obtained at the start of every treatment session, and post-treatment MRI scans were obtained at the end of every treatment session. A total 300 MR images were included in this study and the CTV, bladder and rectum were delineated on each MRI by the same radiation oncologist. The inter-fraction and intrafraction changes of contours were evaluated by dice similarity coefficient (DSC), Hausdorff distance (HD), volume difference (ΔV). The reference treatment plans were generated using step-and-shoot IMRT and utilized 9 beam groups on original CT. Then, the online adaptative treatment plans were obtained by re-optimizing based on the contours on daily pre-treatment MRI by "adapt to shape" workflow using the same beam parameters and optimization objectives from the reference plans. Non-ART plans for each patient were generated by recalculating the dose from the reference plans on daily online MRI by "adapt to position" workflow. CTV coverage and OARs constraints were used to compare ART and non-ART plans. RESULTS The results showed that large inter-fraction anatomical changes limited the efficacy of radiation therapy (CTV: DSC: 0.89±0.03, HD: 20.83±5.05mm, ΔV: 1.21%±5.44%; Bladder: DSC: 0.68±0.18, HD: 30.58±15.75mm, ΔV: -10.17%±61.19%; Rectum: DSC: 0.69±0.09, HD: 22.98±12.03mm, ΔV: 21.01%±20.59%).The intrafraction anatomical changes were smaller (CTV: DSC: 0.96±0.01, HD: 8.85±3.54mm, ΔV: -0.64%±1.90%; Bladder: DSC: 0.90±0.07, HD: 14.62±9.56mm, ΔV: 19.83%±21.71%; Rectum: DSC: 0.98±0.04, HD: 2.90±4.27mm, ΔV: 0.13%±5.04%) . Non-ART showed inadequate primary CTV coverage in 30% of the daily fractions. Online adaptative plans improved CTV coverage significantly (p<0.001) to 99%. Compared with non-ART, online ART decreased the fraction dose to bladder and rectum indicated by significant (p<0.001) improvements for daily D50%, D2% and Dmean. CONCLUSION In cervical cancer radiotherapy, a non-adaptive strategy led to inadequate target coverage for individual patients. Online adaptative radiotherapy corrected for day-to-day anatomical variations and resulted in adequate target coverage in all fractions. The dose to rectum and bladder was decreased significantly when applying online adaptative radiotherapy.
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Kim JH, Liu B, Liu A, Williams TM. Hippocampal Sparing Whole Brain Radiation Therapy: 2 Arc Coplanar and 4 Arc Noncoplanar Planning Comparison. Int J Radiat Oncol Biol Phys 2023; 117:e679. [PMID: 37786000 DOI: 10.1016/j.ijrobp.2023.06.2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Whole brain radiation therapy (WBRT) has been shown to provide palliation but with negative neurocognitive effects associated with radiation-induced damage to the hippocampus. Sparing of the hippocampus has been shown to reduce the risk of neurocognitive deficit. Hippocampal sparing WBRT plan optimization is commonly done using 2 arc coplanar technique. The purpose of this work is to show that 4 arc noncoplanar plans will improve hippocampal sparing without compromising PTV coverage. MATERIALS/METHODS Retrospective WBRT with hippocampal sparing using 2 arc coplanar and 4 arc noncoplanar VMAT technique were done on 10 patients previously treated for intracranial lesions. CT and MRI fused images were used to delineate the whole brain and hippocampus. Strictly following RTOG 0933 atlas guidelines, the hippocampus was manually delineated by a single Radiation Oncologist. Plans with prescription dose of 30 Gy in 10 fractions were generated using the 2 techniques. The 4 arc noncoplanar plan included 2 partial field arcs with couch angle at 90 degrees and 2 coplanar arcs. The 2 noncoplanar partial arcs consisted of a clockwise arc and a counterclockwise arc with gantry angles between 5 and 179 degrees. Lens were kept to < 7 Gy and pituitary gland to < 30 Gy. Dosimetric parameters from both techniques were compared by paired t-test. RESULTS Radiation dose to the hippocampus was significantly reduced using 4 arc noncoplanar plan when compared to 2 arc coplanar plan. While hippocampus D100% were similar (7.25 Gy vs 7.32 Gy, p = 0.557), the mean dose (9.46 Gy vs 9.87 Gy, p = 0.003) and D0.03cc (12.48 Gy vs 12.94 Gy, p < 0.001) were significantly reduced with 4 arc noncoplanar plans. Whole brain PTV coverage remained at V100% = 95% for both techniques. However, the 4 arc noncoplanar plans showed significantly improved D2% (32.56 Gy vs 32.97 Gy, P = 0.003), D98% (28.11 Gy vs 27.91 Gy, P = 0.01), and homogeneity index (0.141 vs 0.159, P < 0.001). CONCLUSION The 4 arc noncoplanar plans improved hippocampal sparing without compromising PTV coverage or compromise to other nearby organs at risk.
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Manzar GS, Rafei H, Kumar B, Shanley M, Acharya S, Liu B, Xu A, Wang XA, Islam S, Kaplan M, Basar R, Uprety N, Shrestha R, Garza LM, Li Y, Banerjee PP, Spiotto MT, Dabaja B, Rezvani K, Daher M. Radiation Therapy Sensitizes Head-and-Neck Cancer Cells to Killing by Chimeric Antigen Receptor (CAR)-NK Cells Targeting CD70. Int J Radiat Oncol Biol Phys 2023; 117:S167-S168. [PMID: 37784417 DOI: 10.1016/j.ijrobp.2023.06.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) CAR-T cell therapy is limited by toxicity, high cost, logistical manufacturing issues in the autologous setting and risk of GVHD in the allogeneic setting. Substitution of T cells with NK cells opens the possibility for an allogeneic off-the-shelf product with a better safety profile. However, the inadequate efficacy of CAR-NK cells against solid tumors can be extrapolated from experience with CAR-T cells. There is limited but promising preclinical evidence that radiation therapy (RT) enhances CAR-T cell tumoricidal activity against solid tumors. However, there is no data examining the potential synergy between RT and CAR-NK cell therapy. MATERIALS/METHODS We engineered CAR-NK cells with CD27 receptor as extracellular domain to target its natural ligand CD70, which is overexpressed in head-and-neck cancers (HNSCC). CAR-NK cell killing was assessed real-time through xCELLigence cytotoxicity assays. CD70+ OQ01 human HNSCCs were used for most experiments. FaDu is a CD70- HNSCC (negative ctrl). UMRC3 is a CD70+ kidney cancer cell line (positive ctrl). CD70 expression pre- and post-RT was assessed by flow cytometry and Western blot. Ionizing RT was compared at 5 doses: 0, 1.75, 3.5, 7, and 14 Gy. A single dose of 3.5 Gy was used for most experiments. Post-radiation effects were generally assessed at 3 days or 9 days post-RT. Intracellular staining was used to assess NK cell expression of IFN-γ, CD107a, and TNF-α by flow cytometry. CD27/CD70 interaction blockade was through α-CD27 pre-treatment of CAR-NK cells. RESULTS OQ01 HNSCCs heterogeneously express CD70 and are killed by CD70 CAR-NK cells in vitro. Pre-conditioning low-dose RT of 3.5 Gy applied to OQ01 HNSCCs 3 days prior to coculture with NK cells enhances CD70 CAR-NK cell killing, with ∼30% increased cytotoxicity against the tumor cells. Low-dose RT by itself did not induce acute cytolysis. As a possible mechanism for the increased sensitivity of irradiated OQ01 cells to CD70 CAR-NK cells, we found that RT enhances CD70 expression among HNSCCs in a dose-dependent manner. There was no increase in NK cell expression of IFN-γ, CD107a, and TNF-α with exposure to irradiated target cells. CD27/CD70 blockade does not solely abrogate RT-induced sensitization toward CAR-NK cell killing. Despite RT induction of transient increased expression of CD70, which normalizes by 9 days post-RT, there is persistent increase in RT-synergized target cell killing even at this later timepoint. Thus, altogether, RT sensitizes CD70-expressing HNSCC cells to CAR-NK cell killing in vitro. CONCLUSION This work represents the first preclinical study to identify the synergy of RT and CAR-NK cell therapy in solid tumors and is the first demonstration of CAR-NK cell activity against human HNSCCs. We show significantly enhanced potency of CAR-NK cells against irradiated tumor cells in vitro. Collectively, this research will be vital to guide efforts expanding into other target antigens and tumor types.
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He L, Yang J, Li R, Liu B, Pan L, Sun L, Peng Q. Effect of Anemia on Tumor Response to Preoperative Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e301. [PMID: 37785100 DOI: 10.1016/j.ijrobp.2023.06.2316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Preoperative neoadjuvant chemoradiotherapy (nCRT) and total rectal mesenteric resection (TME) are the primary treatment options for locally advanced rectal cancer (LARC), but their efficacy varies. This study aimed to investigate the impact of anemia on the tumor response of patients with LARC receiving preoperative neoadjuvant chemoradiotherapy. MATERIALS/METHODS This study was a retrospective analysis of clinical and pathological data from patients with LARC who underwent nCRT and TME from January 2019 to May 2022 at a single institution. The tumor response was evaluated based on the tumor regression grade (TRG) and T-stage change of the primary tumor. Hemoglobin concentration was measured and graded to determine the presence of anemia. Anemia was categorized into four groups based on the hemoglobin levels: mild anemia (90-120 g/L), moderate anemia (60-90 g/L), severe anemia (30-60 g/L), and extreme anemia (less than 30 g/L). Finally, tumor response was quantified histologically using the AJCC 8th edition tumor regression grading system for rectal cancer and pre- and post-treatment T-grading. RESULTS A total of 88 patients with LARC who received nCRT and TME were included in the study, with 17 females and 71 males. Of these patients, 9 were moderately anemic and 37 were mildly anemic. The radiation therapy regimen was administered at a dose of 1.8-2 Gy per fraction, five times a week, for a total dose of 45-50.4 Gy. Capecitabine chemotherapy was also administered orally (825 mg/m2, twice a day) on the days of radiation therapy. Other chemotherapy regimens included XELOX and mFOLFOX6. The TRG was significantly different in anemic patients compared to non-anemic patients (P = 0.039). Only 2 out of 46 anemic patients (4%) showed an excellent response (TRG0), while 8 out of 42 non-anemic patients (19%) showed an excellent response (p = 0.043). There was also a significant difference in the incidence of anemia between cT3 and cT4 stages (p = 0.048), with 44% of cT3 patients and 67% of cT4 patients being anemic. The number of patients with poor response (TRG2-3) decreased as the degree of anemia decreased, but no significant difference was found. The incidence of TRG3 was 11% in patients with moderate anemia and 7% in non-anemic patients (P = 0.863). There was no significant difference in postoperative pathological T-stage between anemic and non-anemic patients. 89% of anemic patients had a pathological stage of ypT3 or less after chemoradiotherapy, while 95% of non-anemic patients did (P = 0.167). The pre- and post-treatment pathological staging did not significantly differ between anemic and non-anemic patients. 67% of anemic patients had descending tumors, while 59.5% of non-anemic patients had descending tumors (p = 0.509). CONCLUSION Patients with LARC who have normal hemoglobin concentrations during nCRT have better tumor regression compared to patients with anemia. Additionally, the incidence of anemia was higher among patients with advanced T-stage prior to treatment.
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Ding S, Yin Y, Liu H, Liu B, Li Y, Wang B, Chen M, Liu M, Li R, Huang X, Chen Y. Inter-fractional Assessment during MR-guided Online Adaptive Radiotherapy for Glioblastoma. Int J Radiat Oncol Biol Phys 2023; 117:e99-e100. [PMID: 37786230 DOI: 10.1016/j.ijrobp.2023.06.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Magnetic resonance image (MRI) guided radiation therapy has the potential to improve outcomes for glioblastoma by adapting to tumor changes during radiation therapy. This study aimed to assess the feasibility and potential benefits of MR-guided online adaptive radiotherapy (MRgOART) for patients with glioblastoma. MATERIALS/METHODS Twenty consecutive patients with glioblastoma were treated with MRgOART of 60 Gy in 30 fractions by the 1.5 T MR-Linac. The MRgOART fractions employed daily MR scans and the contours were utilized to create each adapted plan. The gross tumor volume (GTV) and clinical target volume (CTV) were delineated on MRI of pre-treatment simulation (Fx0) and all fractions (Fx1, Fx2, Fx3 ... Fx30) to evaluate the inter-fractional changes. These changes were quantified using absolute/relative volume (∆V), Dice similarity coefficient (DSC) and Hausdorff distance (HD) metrics. The reference treatment plans were generated using step-and-shoot IMRT and utilized 7-9 beam groups on original CT. Before the treatment, a synthetic CT (sCT) quality assurance (QA) process was performed to assess the dose accuracy of bulk relative electron density (rED) assignment for online MRI based treatment plan in terms of gamma analysis, point dose comparison and dose volume histogram (DVH) parameters. Then, the online adaptative treatment plans were obtained by re-optimizing based on the contours on daily pre-treatment MRI by "adapt to shape" workflow. Non-adaptive plans for each patient were generated by recalculating the dose from the reference plans on daily online MRI by "adapt to position" workflow. GTV and CTV coverage and organ at risk (OAR) constraints were used to compare non-adaptive and adaptive plans. RESULTS For both criteria, the 1%/1mm (98.58%±0.15%) and 2%/2mm (99.88%±0.18%) gamma passing rate results were always clinically acceptable in sCT QA process. The differences on point dose and DVH parameters between the plans based on sCT and original CT were less than 1%. A total of 20 patients with 600 fractions were evaluated. The results showed that large inter-fractional changes for GTV limited the efficacy of radiation therapy (DSC: 0.78±0.08, HD: 20.94±3.64mm, ∆V: 2.92%±6.36%). The inter-fractional CTV changes were smaller (DSC: 0.91±0.04, HD: 15.31±3.09mm, ∆V: 1.41%±1.29%). GTV coverage of non-adaptive plans was below the prescribed coverage in 228/600 fractions (38%), with 90 (15%) failing by more than 10%. For CTV coverage of non-adaptive plans, the changes were less than 5%. Online adaptative plans improved GTV and CTV coverage significantly (p<0.001) to 99%. The adaptive plans also had lower dose to whole brain than non-adaptive plans (p<0.001). CONCLUSION Significant inter-fractional tumor changes could be found during radiotherapy in patients with glioblastoma treated by the 1.5 T MR-Linac. Daily MR-guided re-optimization of treatment plans corrected for day-to-day anatomical variations and resulted in adequate target coverage in all fractions.
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Ding S, Liu H, Li JY, Li Y, Wang B, Chen M, Liu B, Liu M, Li R, Huang X. Adaptive Auto-Segmentation for MRI-Guided Online Adaptive Radiotherapy of Cervical Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e659-e660. [PMID: 37785954 DOI: 10.1016/j.ijrobp.2023.06.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Accurate and efficient delineation of organs and targets on session images is critical in MRI-guided online adaptive radiotherapy (MRgOART). This study proposes a registration-guided deep learning image segmentation framework to assist online delineation of cervical carcinoma. MATERIALS/METHODS A total of 300 T2-weighted MR images were acquired for patients with cervical carcinoma treated by a 1.5T Unity MR-Linac. The CTV, bladder, rectum, pelvic bone and femoral joints were delineated on each MRI by the same radiation oncologist. To overcome these obstacles to online MRI segmentation, we propose a registration-guided DL (RgDL) segmentation framework that integrates image registration algorithms and DL segmentation models. Firstly, the DL segmentation model was trained using nnU-net. Then, for each treatment fraction, the deformable image registration (DIR) algorithm generates initial contours from previous treatment fraction, which were used as guidance by DL model to obtain the accurate current segmentation. The segmentation accuracy of alone DIR, DL and RgDL were evaluated by dice similarity coefficients (DSC) and other distance-based metrics. RESULTS Compared to the baseline approaches using the DIR and the DL alone, RgDL achieved a DSC of 91.12% on CTV, higher than DIR and DL alone by 15.54% and 10.13%. The DSC of RgDL were improved to 95.58%, 93.65%, 87.8% and 94.84% for bladder, pelvic bone, rectum and femoral joints, higher than DIR and DL alone by 9.61% on average. CONCLUSION The proposed adaptive auto-segmentation method can achieve accurate and efficient segmentation and potentially overcome these obstacles to MRgOART.
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Ding S, Liu H, Zhang L, Chen M, Li Y, Wang B, Liu B, Li R, Huang X. Influence of Eyes Movement on Lens Dose during MR-Guided Radiotherapy for Brain Tumor. Int J Radiat Oncol Biol Phys 2023; 117:e100. [PMID: 37784625 DOI: 10.1016/j.ijrobp.2023.06.868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Modern radiotherapy techniques achieve highly conformal target doses while avoiding organs at risk such as lens. The magnitude of eyes movement and its influence on lens dose is unclear. The lens dose is relevant for cataract formation. This study aims to evaluate the movement-range of lens and its influence on dose distribution during MR-guided radiotherapy for brain cancer patients. MATERIALS/METHODS Fifty patients with brain cancer who were treated with MR-guided radiotherapy on 1.5 T MR-Linac were included in this study. All patients underwent a pre-treatment MRI and post-treatment MRI for each fraction. The eyes and lens were delineated on each MR image by a radiation oncologist. The reference treatment plans based original CT were recalculated on each MRI by "adapt to position" workflow. Then, we created planning risk volume (PRV) for lens by adding population margin and reoptimized the reference plans to evaluate the dose changes for lens. Inter-fraction and intrafraction variability for eyes and lens were evaluated with the Dice similarity coefficient (DSC), the Hausdorff distance (HD) and mean distance to agreement (MDA). Differences in daily dose (Dmax and Dmean) for eyes and lens were assessed. RESULTS A total of 300 MR images were analyzed in this study. The eyes motion was observed (minimum DSC: 0.57; maximum HD: 10.53; maximum MDA: 3.13). And the obvious lens motion also was found (minimum DSC: 0.01; maximum HD: 10.78; maximum MDA: 5.68). The maximum dose changes for eyes were up to 34.1% and the mean dose changes were up to 18.1%. The maximum dose changes for lens were up to 97.9% and the mean dose changes for eyes were up to 89%. When the reoptimized plans were generated by PRV lens, the dose changes were decreased nearly to 0. CONCLUSION Eyes movements in all radiotherapy fractions result in higher lens doses and potentially increase cataract formation rate. Adding margin expansions in treatment planning, to account for eyes motion, is the feasible approach to limit lens dose.
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Zhuang Y, Xu X, Li H, Niu F, Yang M, Ge Q, Lu S, Deng Y, Wu H, Zhang B, Liu B. Megf10-related engulfment of excitatory postsynapses by astrocytes following severe brain injury. CNS Neurosci Ther 2023; 29:2873-2883. [PMID: 37081759 PMCID: PMC10493650 DOI: 10.1111/cns.14223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 04/22/2023] Open
Abstract
AIMS To investigate astrocyte-related phagocytosis of synapses in the ipsilateral hippocampus after traumatic brain injury (TBI). METHODS We performed controlled cortical impact to simulate TBI in mice. Seven days postinjury, we performed cognitive tests, synapse quantification, and examination of astrocytic phagocytosis in association with Megf10 expression. RESULTS During the subacute stage post-TBI, we found a reduction in excitatory postsynaptic materials in the ipsilateral hippocampus, which was consistent with poor performance in the cognitive test. The transcriptome data suggested that robust phagocytosis was responsible for this process. Coincidently, we identified phagocytic astrocytes containing secondary lysosomes that were wrapped around the synapses in the ipsilateral hippocampus. Moreover, a significant increase in the co-location of GFAP and PSD-95 in the CA1 region suggested astrocytic engulfment of excitatory postsynaptic proteins. After examining the reported phagocytic pathways, we found that both the transcription level and protein expression of Megf10 were elevated. Co-immunofluorescence of GFAP and Megf10 demonstrated that the expression of Megf10 was spatially upregulated in astrocytes, exclusively in the CA1 region, and was related to the astrocytic engulfment of PSD-95. CONCLUSION Our study elaborated that the Megf10-related astrocytic engulfment of PSD-95 in the CA1 region of the ipsilateral hippocampus aggravated cognitive dysfunction following severe TBI.
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Wong JYC, Liu B, Dandapani SV, Li YR, Glaser SM, Liu J, Chen Q, Qing K, Chen HK, Simpson J, Da Silva A, Leung D, Feghali K, Dorff TB, Liu A, Williams TM. Pilot Study of a Novel Ring Gantry-Based PET/CT Linear Accelerator in Patients with Prostate Cancer Receiving [18F]-DCFPyL for PSMA PET Imaging. Int J Radiat Oncol Biol Phys 2023; 117:e451. [PMID: 37785452 DOI: 10.1016/j.ijrobp.2023.06.1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The RefleXion X1® system is a hybrid PET imaging-radiotherapy system that uses real-time positron emissions from a PET tracer to deliver biologically guided radiotherapy (BgRT). This study (NCT05470699) evaluated the hypothesis that the X1 PET imaging subsystem would be able to detect [18F]-DCFPyL PSMA PET signal sufficient to generate a deliverable BgRT plan in patients with prostate cancer. MATERIALS/METHODS Patients with prostate cancer scheduled for a diagnostic [18F]-DCFPyL PSMA PET scan as part of standard of care were eligible. Upon completion of the diagnostic PSMA PET scan, images were transferred to the radiotherapy planning system for target identification and contouring. If at least one PET avid tumor lesion was identified, the patient was then scanned on the X1 unit. BgRT planning was performed on each X1 scanned patient. The target lesion volume, activity concentration (AC) and normalized target signal (NTS) were acquired. Successful and deliverable BgRT plans required that the target AC was ≥ 5 kBq/ml and NTS ≥ 2.7. RESULTS Twenty-six patients underwent [18F]-DCFPyL PET scans (13 with rising PSA after surgery or radiotherapy, 6 with known metastases and 7 with newly diagnosed high-risk prostate cancer). Median (range) PSA was 3.40 (0.04-122). In 16 patients a PET avid tumor was identified and contoured for planning (4 lymph nodes, 5 bone, 6 prostate gland, and 1 prostate bed). In 13 patients the target lesion was visualized on the X1 PET scan, while in 3 patients the target lesion was too close to the bladder to be clearly visualized. BgRT planning was feasible and met standard of care published SBRT organ dose constraints in 8 patients (3 prostate gland, 3 bone, 2 lymph nodes). BgRT planning was not feasible in 8 patients due to insufficient AC, low NTS or proximity of the target lesion to the PET avid bladder. The accompanying table compares median (range) target volume, AC and NTS for feasible versus not feasible plans. CONCLUSION This is the first study to investigate the feasibility of using [18F]-DCFPyL PET imaging for BgRT plan generation on the X1 system in patients with prostate cancer. Lesions that are relevant to radiotherapy of prostate cancer can be visualized including lymph node and bone metastases. A dedicated BgRT workflow with PSMA PET imaging on the X1 at 60 minutes post injection will result in higher target AC and will optimize BgRT planning. PET avid lesions < 1 cm or close to the bladder may make BgRT planning challenging. [18F]-DCFPyL-guided BgRT is technically feasible using the RefleXion X1. BgRT using targeted PET radiopharmaceuticals to biologically guide external beam radiotherapy represents a promising new dimension in radiation oncology and warrants further investigation.
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Yuan X, Liu B, Cuevas P, Brunski J, Aellos F, Petersen J, Koehne T, Bröer S, Grüber R, LeBlanc A, Zhang X, Xu Q, Helms J. Linking the Mechanics of Chewing to Biology of the Junctional Epithelium. J Dent Res 2023; 102:1252-1260. [PMID: 37555395 PMCID: PMC10626588 DOI: 10.1177/00220345231185288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
The capacity of a tissue to continuously alter its phenotype lies at the heart of how an animal is able to quickly adapt to changes in environmental stimuli. Within tissues, differentiated cells are rigid and play a limited role in adapting to new environments; however, differentiated cells are replenished by stem cells that are defined by their phenotypic plasticity. Here we demonstrate that a Wnt-responsive stem cell niche in the junctional epithelium is responsible for the capability of this tissue to quickly adapt to changes in the physical consistency of a diet. Mechanical input from chewing is required to both establish and maintain this niche. Since the junctional epithelium directly attaches to the tooth surface via hemidesmosomes, a soft diet requires minimal mastication, and consequently, lower distortional strains are produced in the tissue. This reduced strain state is accompanied by reduced mitotic activity in both stem cells and their progeny, leading to tissue atrophy. The atrophied junctional epithelium exhibits suboptimal barrier functions, allowing the ingression of bacteria into the underlying connective tissues, which in turn trigger inflammation and mild alveolar bone loss. These data link the mechanics of chewing to the biology of tooth-supporting tissues, revealing how a stem cell niche is responsible for the remarkable adaptability of the junctional epithelium to different diets.
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Zhu C, Hua Y, Zhang M, Wang Y, Li W, Ding Y, She Q, Zhang W, Si X, Kong Z, Liu B, Chen W, Wu J, Dang Y, Zhang G. A Multimodal Multipath Artificial Intelligence System for Diagnosing Gastric Protruded Lesions on Endoscopy and Endoscopic Ultrasonography Images. Clin Transl Gastroenterol 2023; 14:e00551. [PMID: 36434804 PMCID: PMC10584296 DOI: 10.14309/ctg.0000000000000551] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/11/2022] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION The aim of this study was to develop a novel artificial intelligence (AI) system that can automatically detect and classify protruded gastric lesions and help address the challenges of diagnostic accuracy and inter-reader variability encountered in routine diagnostic workflow. METHODS We analyzed data from 1,366 participants who underwent gastroscopy at Jiangsu Provincial People's Hospital and Yangzhou First People's Hospital between December 2010 and December 2020. These patients were diagnosed with submucosal tumors (SMTs) including gastric stromal tumors (GISTs), gastric leiomyomas (GILs), and gastric ectopic pancreas (GEP). We trained and validated a multimodal, multipath AI system (MMP-AI) using the data set. We assessed the diagnostic performance of the proposed AI system using the area under the receiver-operating characteristic curve (AUC) and compared its performance with that of endoscopists with more than 5 years of experience in endoscopic diagnosis. RESULTS In the ternary classification task among subtypes of SMTs using modality images, MMP-AI achieved the highest AUCs of 0.896, 0.890, and 0.999 for classifying GIST, GIL, and GEP, respectively. The performance of the model was verified using both external and internal longitudinal data sets. Compared with endoscopists, MMP-AI achieved higher recognition accuracy for SMTs. DISCUSSION We developed a system called MMP-AI to identify protruding benign gastric lesions. This system can be used not only for white-light endoscope image recognition but also for endoscopic ultrasonography image analysis.
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Liu B, Chen Q, Qing K, Dandapani SV, Li YR, Glaser SM, Chen HK, Da Silva A, Leung D, Feghali KAA, Simpson J, Liu J, Dorff TB, Liu A, Williams TM, Wong JYC. Dosimetric Plan Evaluation of Biology Guided Radiotherapy Using [18F]-DCFPyL PSMA Radiotracer in Patients with Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e688. [PMID: 37786022 DOI: 10.1016/j.ijrobp.2023.06.2158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The X1 system represents a cutting-edge solution in radiotherapy delivery, with its capability to perform Biology Guided Radiotherapy (BgRT). The system utilizes real-time positron emission tomography (PET) signal as biological fiducials to provide tracked dose delivery and is initially available for use with [18F]-Fluorodeoxyglucose (FDG). The aim of this research study is to assess the quality of BgRT treatment plans for prostate cancer using patients' PSMA PET images obtained on the X1 system. MATERIALS/METHODS Sixteen patients with at least one PET-avid tumor identified on their whole-body diagnostic PSMA PET scan were selected. These patients were scanned on X1 following their diagnostic scan without additional radiotracer administration. Based on the X1 PET images, a BgRT plan was created for each patient, with the prescription dose determined by the location of treatment sites. The planning objectives of organs-at-risk (OARs) were established in accordance with the 2018 Timmerman guidelines. Target coverage objective was the dose covering 95% (D95%) of the planning target volume (PTV) to be higher than 100%. The following parameters were analyzed: PTV D95%, the minimal dose (Dmin) of gross tumor volume (GTV), plan maximum dose (Dmax), conformity index (CI), gradient index (GI), and maximum point dose (D0.03cc) to the nearest OARs. The X1 BgRT planning system also generated dose volume histogram (DVH) bounds, which model variations in BgRT delivery. The low boundary of GTV Dmin, representing the minimum GTV dose in the worst-case scenario, was recorded. RESULTS BgRT plans were created for all patients, except for one where the target signal was indistinguishable from the bladder. The prescription dose was 2700 cGy or 3000 cGy in 3 fractions for lymph node lesions, 2400 cGy to 3000 cGy in 3 fractions for bone metastasis, and 4500 cGy in 5 fractions for lesions in prostate. All plans met the dose constraints for OARs as per the Timmerman guidelines. The Dmax of all plans was 129.9% ± 6.9% (mean ± standard deviation). The PTV D95% and GTV Dmin were 101.7% ± 1.0% and 111.0% ± 7.6%, respectively. The low boundary of GTV Dmin was 95.9% ± 5.8%. The CI and GI were 1.22 ± 0.11 and 9.40 ± 2.12, respectively. The D0.03cc to nearest OARs was 84.6% ± 25.4%. The estimated treatment time was 699 ± 228 seconds. CONCLUSION This study is a pioneering effort to evaluate the quality of BgRT plans for prostate cancer patients using the [18F]-DCFPyL PSMA radiotracer. Our results showed that all BgRT plans met the planning objectives defined in the Timmerman protocol. BgRT with [18F]-DCFPyL represents a promising treatment modality for patients with prostate cancer. Further research is needed to validate this approach, including a comprehensive assessment of the dosimetric and tracking accuracy through physical measurements.
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Yin Z, Zhang H, Zhang K, Ying H, Liu B. Radiotherapy Combined with PD-L1 Antibody Exerts a Synergistic Anti-tumor Effect in a Mouse Model of Esophageal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e273-e274. [PMID: 37785030 DOI: 10.1016/j.ijrobp.2023.06.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The combination of radiotherapy and immune checkpoint inhibitors (ICIs) has been shown to exert synergistic anti-tumor effects in various tumors. In esophageal squamous cell carcinoma (ESCC), several clinical trials of radiotherapy combined with ICIs are undergoing or have been finished. However, the efficacy and action mechanisms of radiotherapy combined with ICIs is still not clear in ESCC. Our study aimed to investigate whether radiotherapy improved the anti-cancer effect of PD-L1 antibody and the effect of this combination therapy on tumor-immune microenvironment. MATERIALS/METHODS The mouse esophageal cancer cell line mEC25 was implanted into the armpits of female C57 mice. When the tumor volume grew to 150-250 mm3, the mice were randomly divided into different groups including control group (administration of IgG antibody), radiotherapy group (12 Gy at 4 Gy per fraction), PD-L1 antibody group (200 mg/kg i.p. for three times) and combination group (fractionated radiation combined with PD-L1 antibody was delivered on day 1, day 4 and day 7, the day when fractionated radiation began was recorded as day 1).The mice were sacrificed on the 1st, 3rd and 7th day after the treatment was ended. The tumor, spleen and draining lymph nodes of the mice were collected and analyzed using flow cytometry (FCM), and the tumor volume and survival time of mice were calculated. RESULTS Compared with radiotherapy or PD-L1 antibody alone, the combination therapy significantly prolonged the survival time of mice and decreased the growth rate of xenograft tumors FCM analysis showed that the combination therapy significantly increased the infiltration and cytotoxicity of effector T cells and reduced the proportion of M2 macrophages in tumor, spleen and lymph nodes. In addition, in tumor and spleen, the proportion of regulatory T cells (Tregs) decreased in the group of combination therapy. In tumor, spleen, and lymph nodes, the proportion of central memory T cell (TCM) was increased in the group of combination therapy. CONCLUSION The anti-tumor effect of radiotherapy combined with PD-L1 antibody is superior to single treatment in the mouse model of esophageal cancer. Radiotherapy can shape tumor-immune microenvironment, allowing the infiltration of effector T cells and exclusion of immune-suppressive cells such as M2 macrophages and Tregs.
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Han C, Wong C, Oderinde OM, Watkins WT, Qing K, Liu B, Williams TM, Liu A. Comparison of AI-Based Auto-Segmentation Quality with Different Daily IGRT Imaging Modalities for Adaptive Radiotherapy Treatment Planning. Int J Radiat Oncol Biol Phys 2023; 117:e670. [PMID: 37785979 DOI: 10.1016/j.ijrobp.2023.06.2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Modern AI-based auto-segmentation tools may be applied on daily computed tomography (CT) images in an image-guided radiotherapy course to facilitate evaluation of anatomical variations and adaptive treatment planning. However, most AI auto-segmentation models are trained with high-quality diagnostic or planning CT image data. This study aims to evaluate and compare auto-segmentation quality by an AI-based auto-segmentation system with different daily CT imaging modalities. MATERIALS/METHODS We retrospectively retrieved daily IGRT images for sixty patients. Among them, twenty patients were treated on helical tomotherapy with daily megavoltage CT (MVCT) scans, twenty patients were treated on conventional Linacs with daily cone-beam CT (CBCT) scans, and twenty patients were treated on a biology-guided radiotherapy (BgRT)-capable machine with daily fan-beam kilovoltage CT (kVCT) scans. With each treatment modality, ten patients received daily CT scans in the pelvic region while the other ten received daily CT scans in the thoracic region. An auto-segmentation system using a convolutional neural network algorithm was trained in-house with historical treatment planning CT and contouring data to generate auto-segmentation models for the pelvic and thoracic regions, respectively. Normal organs were first delineated the auto-segmentation system on the daily CT images and then drawn by an experienced planner. A set of metrics including the dice similarity coefficient (DSC), Jaccard similarity index, and Hausdorff distance were used to evaluate the quality of the auto segmentation results compared with manual contours. RESULTS The auto-segmentation contours on the kVCT images showed higher average DSC compared to those on the MVCT and CBCT images for all the major organs in both the pelvic and thoracic regions including the bladder, rectum, bowel, left and right femurs, esophagus, heart, left and right lung, and spinal cord. With the kVCT images, the average DSC ranged from 0.52±0.22 to 0.996±0.005. In the pelvic region, the largest absolute difference in DSC was observed for the bowel volume with an average DSC of 0.69±0.16, 0.49±0.27, and 0.32±0.25 for the kVCT, MVCT, and CBCT images, respectively (p-value < 0.05 with unpaired t-tests between kVCT and the other two imaging modalities); in the thoracic region, the largest absolute difference in DSC was observed for the esophagus with an average DSC of 0.63±0.16, 0.22±0.08, and 0.15±0.18 for the kVCT, MVCT, and CBCT images, respectively (p-value < 0.05 with unpaired t-tests between kVCT and the other two imaging modalities). Similar results were observed with other metrics. CONCLUSION The AI-based auto segmentation system showed improved agreement with manual contouring when using kVCT images from the BgRT capable machine compared to MVCT or CBCT images. However, manual correction is necessary on auto-segmentation results from all imaging modalities especially for organs with limited contrast from surrounding tissues.
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Wei S, Liu K, Wu H, Hu J, He J, Li G, Liu B, Yang W. MT2 INHIBITS OSTEOCLASTOGENESIS BY SCAVENGING ROS. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2023; 19:447-455. [PMID: 38933247 PMCID: PMC11197834 DOI: 10.4183/aeb.2023.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Context and objective Reactive oxygen species (ROS) produced under oxidative stress is important for osteoclastogenesis. As a major member of the metallothionein (MT) family, metallothionein2 (MT2) can scavenge ROS in osteoblasts. However, the role of MT2 in osteoclastogenesis and ROS production in osteoclast precursors (OCPs) is unknown. Material and methods In this study, we first investigated MT2 expression level in osteoporotic model mice. Next, we explored the roles of MT2 in osteoclastic differentiation and ROS production in OCPs. Ultimately, via rescue assays based on hydrogen peroxide (H2O2), the significance of ROS in MT-2-regulated osteoclastic differentiation was further elucidated. Results Compared with sham operated (Sham) mice, ovariectomized (OVX) mice displayed bone marrow primary OCPs (Ly6C+CD11b-) having higher ROS levels and lower MT2 expression. MT2 overexpression inhibited the formation of mature osteoclasts, while MT2 knockdown was contrary. Moreover, MT2 overexpression inhibited ROS production in OCPs, while MT2 knockdown exhibited the opposite effects. Notably, the inhibitory effect of MT2 overexpression on osteoclastogenesis and ROS production was blocked by the addition of H2O2. Conclusion MT2 inhibits osteoclastogenesis through repressing ROS production in OCPs, which indicates that the strategy of upregulating MT2 in OCPs may be applied to the clinical treatment of osteoclastic bone loss.
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Yin Z, Zhang H, Zhang K, Ying H, Liu B. The Role of Esophagography in the Diagnosis of Orthotopic Esophageal Squamous Cell Carcinoma in a Mouse Mode. Int J Radiat Oncol Biol Phys 2023; 117:e274. [PMID: 37785034 DOI: 10.1016/j.ijrobp.2023.06.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Animal models play an irreplaceable role in pre-clinical studies of various tumors, mainly including xenogeneic/homograft subcutaneous tumor models. However, the subcutaneous transplanted tumor model is separated from the microenvironment of the primary tissue and fail to accurately simulate the growth of tumor cells in vivo. Therefore, orthotopic tumor models play an increasingly important role. For esophageal squamous cell carcinoma, chemotherapy-induced methods have successfully established mouse models of esophageal squamous cell carcinoma, but past experiments have found that it is still a challenge to confirm the success of the mouse model of esophageal cancer. The pathological diagnosis of the esophageal cancer tissue obtained from the killed mouse model remains the gold standard, but it also represents a lost opportunity to evaluate the efficacy of subsequent treatment. Notedly, esophagography is the primary examination for clinical patients with esophageal cancer. Therefore, the aim of this study is to evaluate whether esophagography can be used to establish a successful in situ mouse model of esophageal cancer. MATERIALS/METHODS Referring to previous literature, we used the chemical drug 4-Nitroquinoline N-oxide (4-NQO) to induce orthotopic tumor model: A certain amount of 4-NQO was dissolved in propylene glycol to make a 2% stock solution, and then dissolved in 200ml of sterile water for the daily drinking water of mice. The water was kept in the dark and replaced once a week. After 16 weeks of induction, the drinking water was replaced by the same volume of sterile water and continued to be fed for 12 weeks. The mice were subsequently subjected to esophagography: First, the mice were fixed on a plastic plate, and the gavage needle was slowly inserted into the stomach, then slowly withdrawn out and gradually injected with meglumine diphosphate, with a total amount of 0.1-0.2ml. Then the radiolucent film was taken immediately, and three positions were selected, including the plain film, the standing film and the lateral film. After that, the mice were sacrificed and the esophagus of the mice was isolated and embedded in sections for pathological and immunohistochemical diagnosis. Finally, the results were compared with the imaging results. RESULTS Based on the comparison of imaging and pathological results, we found that most of the esophageal segments with filling defects on esophagography were pathologically diagnosed as esophageal squamous cell carcinoma, and another part were diagnosed as esophageal papilloma. Compared with CT and MRI, esophagography has the advantages of simple operation and less consumable materials. CONCLUSION We found that esophagography is a new non-invasive auxiliary diagnostic method for the successful establishment of an orthotopic mouse model of esophageal squamous cell carcinoma.
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Wu YX, Wu DP, Ma X, Jiang SS, Hou MJ, Jing YT, Liu B, Li Q, Wang X, Wu YB, Hu XH. [Humanized anti-CD25 monoclonal antibody as a salvage therapy for steroid-refractory acute graft-versus-host disease after hematopoietic stem cell transplantation]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:755-761. [PMID: 38049320 PMCID: PMC10630582 DOI: 10.3760/cma.j.issn.0253-2727.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 12/06/2023]
Abstract
Objective: To investigate the efficacy of humanized anti-CD25 monoclonal antibody for steroid-refractory acute graft-versus-host disease (SR-aGVHD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Methods: A total of 64 patients with SR-aGVHD between June 2019 and October 2020 in Suchow Hopes Hematology Hospital were enrolled in this study. Humanized anti-CD25 monoclonal antibodies 1 mg·kg(-1)·d(-1) were administered on days 1, 3, and 8, and then once per week according to the disease progression. Efficacy was assessed at days 7, 14, and 28 after humanized anti-CD 25 treatment. Results: Of the 64 patients with a median age of 31 (15-63) years, 38 (59.4%) were male and 26 (40.6%) were female. The overall response (OR) rate of the humanized CD25 monoclonal antibody in 64 patients with SR-aGVHD on days 7, 14, and 28 were 48.4% (31/64), 53.1% (34/64), and 79.7% (51/64), respectively. Liver involvement is an independent risk factor for poor efficacy of humanized CD25 monoclonal antibody for SR-aGVHD at day 28 (OR=9.588, 95% CI 0.004-0.291, P=0.002). The median follow-up time for all patients was 17.1 (0.2-50.8) months from the start of humanized CD25 monoclonal antibody therapy. The 1- and 2-year OS rates were 63.2% (95% CI 57.1% -69.3%) and 52.6% (95% CI 46.1% -59.1%), respectively. The 1- and 2-year DFS rates were 58.4% (95% CI 52.1% -64.7%) and 49.8% (95% CI 43.4% -56.2%), respectively. The 1- and 2-year NRM rates were 28.8% (95% CI 23.1% -34.5%) and 32.9% (95% CI 26.8% -39.0%), respectively. The results of the multifactorial analysis showed that liver involvement (OR=0.308, 95% CI 0.108-0.876, P=0.027) and GVHD grade Ⅲ/Ⅳ (OR=9.438, 95% CI 1.211-73.577, P=0.032) were independent risk factors for OS. Conclusion: Humanized CD25 monoclonal antibody has good efficacy and safety for SR-aGVHD. This study shows that SR-aGVHD with pretreatment grade Ⅲ/Ⅳ GVHD and GVHD involving the liver has poor efficacy and prognosis and requires early intervention.
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Xia CM, Zhu M, Zhu LF, Ji PZ, Wu PF, Yang YL, Liu B, Ma YC. [Research progress in the regulation of tumor cell PD-L1 expression by N6-methyladenosine modification]. ZHONGHUA BING LI XUE ZA ZHI = CHINESE JOURNAL OF PATHOLOGY 2023; 52:976-980. [PMID: 37670637 DOI: 10.3760/cma.j.cn112151-20221201-01012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
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Tao S, Liu B. Enhanced heat transfer by medical gauze for cell vitrification with French straw. CRYO LETTERS 2023; 44:258-262. [PMID: 38032305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Film boiling occurs in the cooling process of samples with liquid nitrogen, which limits heat transfer and decreases the cooling rate. OBJECTIVE AND METHODS The study developed a method to enhance convective heat transfer by wrapping the French straw (FS) with a layer of medical gauze upon cooling to eliminate film boiling. A numerical model was used to study the thermodynamic mechanism in the method. RESULTS Numerical simulation based on heat transfer and crystallization equations indicated that wrapping the FS with medical gauze could suppress film boiling. Experimental verification showed the increased cooling rate and better cell survival when wrapped FS was used. CONCLUSION Numerical simulation and experimental verification demonstrated the efficacy of wrapping FS with medical gauze for better cell cryopreservation. Doi.org/10.54680/fr23510110312.
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Chen HX, Liu WJ, Liu B, Huang ZF, Zhang QP, Xiao XL, Lai W, Zheng SY. [Influence of work engagement and self-efficacy of nurses on clinical practice ability in burn intensive care unit]. ZHONGHUA SHAO SHANG YU CHUANG MIAN XIU FU ZA ZHI 2023; 39:779-786. [PMID: 37805790 DOI: 10.3760/cma.j.cn501225-20220905-00379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To analyze the influence of work engagement and self-efficacy of nurses on clinical practice ability in burn intensive care unit (BICU), and to explore its potential pathways of action. Methods: A cross-sectional survey was conducted. From May to October 2020, a total of 30 hospitals with BICU in China were selected by stratified sampling method. Among BICU nurses who met the inclusion criteria, their clinical practice ability, work engagement, and self-efficacy were evaluated by self-evaluation scale of oriented problem-solving behavior in nursing practice (OPSN), Utrecht work engagement scale (UWES), and general self-efficacy scale (GSES), respectively. The total scale scores of each index and the average item scores were recorded. The self-designed general data questionnaire was used to investigate the nurses' gender, age, marital status, education background, working years, professional title, and the economic region of the hospital that they belonged to. The total scale scores of the above-mentioned three evaluation indexes were compared after the classification of nurses according to general data, and the data were statistically analyzed with independent sample t test or one-way analysis of variance. Pearson correlation analysis was used to analyze the correlation between the total scale scores of the three evaluation indexes. Based on the total scale scores of the above-mentioned three evaluation indexes, a structural equation model was established, the mediation analysis of the relationship among the three evaluation indexes and the pathway analysis of the structural model were conducted, and the Bootstrap method was used to verify the pathways of action. Results: A total of 401 questionnaires were distributed, and 337 valid questionnaires were returned, with a valid return rate of 84.04%. The total scale scores of clinical practice ability, work engagement, and self-efficacy of 337 nurses were 98.2±11.7, 67.7±18.6, and 26.6±5.6, respectively, and the average item scores were 3.9±0.5, 4.5±1.2, and 2.7±0.6, respectively. Among the 337 nurses, the majority were female, aged 40 or below, married, and had a bachelor's degree with work experience of ≤10 years; both nurses with professional nurse title and nurses from the Southeast region accounted for about 50%. There were statistically significant differences in the total scale score of clinical practice ability among nurses with different ages, education backgrounds, working years, and professional titles (with F values of 3.26, 4.36, 3.12, and 2.80, respectively, P<0.05). There was statistically significant difference in the total scale score of work engagement among nurses with different working years (F=4.50, P<0.05). There were statistically significant differences in the total scale score of self-efficacy among nurses with different ages, working years, and professional titles (with F values of 4.91, 4.50, and 2.91, respectively, P<0.05). The total scale score of nurses' work engagement was significantly positively correlated with the total scale score of clinical practice ability and the total scale score of self-efficacy (with r values of 0.30 and 0.51, respectively, P<0.05). The total scale score of nurses' self-efficacy was significantly positively correlated with the total scale score of clinical practice ability (r=0.37, P<0.05). The model had good adaptability, and the intermediary model was established. Nurses' work engagement had a significantly positive effect on both self-efficacy and clinical practice ability (with β values of 0.54 and 0.16, respectively, P<0.05), and nurses' self-efficacy had a significantly positive effect on clinical practice ability (β=0.29, P<0.05). Work engagement had a direct effect on self-efficacy and clinical practice ability, and self-efficacy had a direct effect on clinical practice ability and played a mediating role between work engagement and clinical practice ability. Bootstrap validation showed that self-efficacy played a significantly mediating role in the influence of work engagement on clinical practice ability (with effect size of 0.16, with 95% confidence interval of 0.08-0.24, P<0.05), accounting for half of the total effect of work engagement on clinical practice ability (with effect size of 0.32). Conclusions: BICU nurses have an above-average level of clinical practice ability, a medium level of self-efficacy, and a high level of work engagement. Work engagement and self-efficacy are positively correlated with clinical practice ability. Work engagement can directly affect clinical practice ability or indirectly affect clinical practice ability through the mediating role of self-efficacy.
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Zhemchugov A, Zheng Z, Zhong D, Zhou B, Zhou C, Zhou H, Zhou N, Zhou Y, Zhu CG, Zhu C, Zhu HL, Zhu H, Zhu J, Zhu Y, Zhu Y, Zhuang X, Zhukov K, Zhulanov V, Zimine NI, Zinsser J, Ziolkowski M, Živković L, Zoccoli A, Zoch K, Zorbas TG, Zormpa O, Zou W, Zwalinski L. Strong Constraints on Jet Quenching in Centrality-Dependent p+Pb Collisions at 5.02 TeV from ATLAS. PHYSICAL REVIEW LETTERS 2023; 131:072301. [PMID: 37656838 DOI: 10.1103/physrevlett.131.072301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/04/2022] [Accepted: 11/17/2022] [Indexed: 09/03/2023]
Abstract
Jet quenching is the process of color-charged partons losing energy via interactions with quark-gluon plasma droplets created in heavy-ion collisions. The collective expansion of such droplets is well described by viscous hydrodynamics. Similar evidence of collectivity is consistently observed in smaller collision systems, including pp and p+Pb collisions. In contrast, while jet quenching is observed in Pb+Pb collisions, no evidence has been found in these small systems to date, raising fundamental questions about the nature of the system created in these collisions. The ATLAS experiment at the Large Hadron Collider has measured the yield of charged hadrons correlated with reconstructed jets in 0.36 nb^{-1} of p+Pb and 3.6 pb^{-1} of pp collisions at 5.02 TeV. The yields of charged hadrons with p_{T}^{ch}>0.5 GeV near and opposite in azimuth to jets with p_{T}^{jet}>30 or 60 GeV, and the ratios of these yields between p+Pb and pp collisions, I_{pPb}, are reported. The collision centrality of p+Pb events is categorized by the energy deposited by forward neutrons from the struck nucleus. The I_{pPb} values are consistent with unity within a few percent for hadrons with p_{T}^{ch}>4 GeV at all centralities. These data provide new, strong constraints that preclude almost any parton energy loss in central p+Pb collisions.
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Ye X, Yeletskikh I, Yexley MR, Yin P, Yorita K, Young CJS, Young C, Yuan M, Yuan R, Yue X, Zaazoua M, Zabinski B, Zacharis G, Zaid E, Zakareishvili T, Zakharchuk N, Zambito S, Zanzi D, Zaplatilek O, Zeißner SV, Zeitnitz C, Zeng JC, Zenger DT, Zenin O, Ženiš T, Zenz S, Zerradi S, Zerwas D, Zhang B, Zhang DF, Zhang G, Zhang J, Zhang K, Zhang L, Zhang M, Zhang R, Zhang S, Zhang X, Zhang X, Zhang Z, Zhao H, Zhao P, Zhao T, Zhao Y, Zhao Z, Zhemchugov A, Zheng Z, Zhong D, Zhou B, Zhou C, Zhou H, Zhou N, Zhou Y, Zhu CG, Zhu C, Zhu HL, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhukov K, Zhulanov V, Zieminska D, Zimine NI, Zimmermann S, Zinsser J, Ziolkowski M, Živković L, Zoccoli A, Zoch K, Zorbas TG, Zormpa O, Zou W, Zwalinski L. Search for Heavy Neutral Leptons in Decays of W Bosons Using a Dilepton Displaced Vertex in sqrt[s]=13 TeV pp Collisions with the ATLAS Detector. PHYSICAL REVIEW LETTERS 2023; 131:061803. [PMID: 37625051 DOI: 10.1103/physrevlett.131.061803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/08/2022] [Indexed: 08/27/2023]
Abstract
A search for a long-lived, heavy neutral lepton (N) in 139 fb^{-1} of sqrt[s]=13 TeV pp collision data collected by the ATLAS detector at the Large Hadron Collider is reported. The N is produced via W→Nμ or W→Ne and decays into two charged leptons and a neutrino, forming a displaced vertex. The N mass is used to discriminate between signal and background. No signal is observed, and limits are set on the squared mixing parameters of the N with the left-handed neutrino states for the N mass range 3 GeV
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Zenger DT, Zenin O, Ženiš T, Zenz S, Zerradi S, Zerwas D, Zhang B, Zhang DF, Zhang G, Zhang J, Zhang J, Zhang K, Zhang L, Zhang P, Zhang R, Zhang S, Zhang T, Zhang X, Zhang X, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao P, Zhao T, Zhao Y, Zhao Z, Zhemchugov A, Zheng X, Zheng Z, Zhong D, Zhou B, Zhou C, Zhou H, Zhou N, Zhou Y, Zhu CG, Zhu C, Zhu HL, Zhu H, Zhu J, Zhu Y, Zhu Y, Zhuang X, Zhukov K, Zhulanov V, Zimine NI, Zinsser J, Ziolkowski M, Živković L, Zoccoli A, Zoch K, Zorbas TG, Zormpa O, Zou W, Zwalinski L. Test of CP Invariance in Higgs Boson Vector-Boson-Fusion Production Using the H→γγ Channel with the ATLAS Detector. PHYSICAL REVIEW LETTERS 2023; 131:061802. [PMID: 37625052 DOI: 10.1103/physrevlett.131.061802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/03/2023] [Indexed: 08/27/2023]
Abstract
A test of CP invariance in Higgs boson production via vector-boson fusion has been performed in the H→γγ channel using 139 fb^{-1} of proton-proton collision data at sqrt[s]=13 TeV collected by the ATLAS detector at the LHC. The optimal observable method is used to probe the CP structure of interactions between the Higgs boson and electroweak gauge bosons, as described by an effective field theory. No sign of CP violation is observed in the data. Constraints are set on the parameters describing the strength of the CP-odd component in the coupling between the Higgs boson and the electroweak gauge bosons in two effective field theory bases: d[over ˜] in the HISZ basis and c_{HW[over ˜]} in the Warsaw basis. The results presented are the most stringent constraints on CP violation in the coupling between Higgs and weak bosons. The 95% C.L. constraint on d[over ˜] is derived for the first time and the 95% C.L. constraint on c_{HW[over ˜]} has been improved by a factor of 5 compared to the previous measurement.
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Zhang K, Liu Q, Liu B, Lin D. [Primary α-fetoprotein positive hepatoid adenocarcinoma of the lung: a case report]. ZHONGHUA JIE HE HE HU XI ZA ZHI = ZHONGHUA JIEHE HE HUXI ZAZHI = CHINESE JOURNAL OF TUBERCULOSIS AND RESPIRATORY DISEASES 2023; 46:700-707. [PMID: 37402661 DOI: 10.3760/cma.j.cn112147-20221103-00874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
This paper reports the data of a patient who was admitted to hospital for "cough with blood in sputum for 6 months" and diagnosed with α-fetoprotein(AFP) positive primary hepatoid adenocarcinoma of the lung. The patient was an 83-year-old male with a history of smoking for more than 60 years. Tumor indicators of patients were: AFP>3 000 ng/ml, carcinoembryonic antigen(CEA) 31.5 ng/ml, CA724 46.90 U/ml, Cyfra21-1 10.20 ng/ml, NSE 18.50 ng/ml, and the pathological findings of percutaneous lung biopsy showed that poorly differentiated cancer with significant necrosis. Combined with the results of immunohistochemistry and clinical laboratory examination, it is considered as metastatic hepatocellular carcinoma. PET-CT showed that FDG metabolism of multiple lymph nodes in the right lower lung, part of the pleura and mediastinum was increased, and the FDG metabolism in the liver or other systems/tissues was normal. Based on these results, it was diagnosed as AFP positive primary hepatoid adenocarcinoma of the lung, and the tumor stage was T4N3M1a(IVA). Through the data of the patient and the existing literature and reviews, we can get the tumor characteristics, diagnosis, treatment and prognosis of HAL, and improve the level of diagnosis and treatment of HAL by clinicians.
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