[The related factors of postoperative recurrence in trigeminalneuralgia patients undergoing fully neuroendoscopic microvascular decompression]

Objective: To evaluate the related factors of postoperative recurrence intrigeminal neuralgia (TN) patients treated with fully neuroendoscopic microvascular decompression (MVD). Methods: The clinical baseline data and preoperative MRI imaging data of 112 patients with TN treated by neuroendoscopic MVD from December 2008 to December 2020 in the Department of Neurosurgery, Beijing Shijitan Hospital Affiliated to Capital Medical University were retrospectively analyzed, including: area ratio of cerebellopontine area (CPA)(healthy side/affected side), trigeminal nerve(TGN)length ratio(healthy side/affected side), TGN angle ratio(healthy side/affected side), and criminal vessel type. Multivariate Cox proportional hazards model was used to analyze the factors affecting postoperative recurrence. Results: Among the 112 patients in this group, there were 49 males and 63 females. The age ranged from 20 to 82 (59±9) years, and the course of disease was 0.05 to 30.00 (5.60±5.15) years. Pain was located on the left side in 43 cases (38.39%) and on the right side in 69 cases (61.61%), respectively. All patients were followed up for more than 1 year, with an average follow-up time of 21.5 months, and 11 cases recurred. Multivariate Cox regression analysis revealed that disease duration≥3 years(HR=9.34, 95%CI:1.12-39.07), CPA area ratio(healthy side/affected side)>1 (HR=27.47, 95%CI:1.69-44.20), criminal vessel type with vein(HR=35.39, 95%CI:1.26-18.60) and criminal vessel type with arteriovenous (HR=46.07, 95%CI: 2.74-27.75) were the main factors influencing recurrence of MVD surgery (all P<0.05). Conclusion: The disease duration≥3 years, CPA area ratio(healthy side/affected side)>1, and criminal vessel type with vein/arteriovenous are the relevant factors that affect the recurrence rate after the fully neuroendoscopic MVD treatment for trigeminal neuralgia.

[Safety and efficacy of humanized CD19-targeted CAR-T cells in patients with relapsed/refractory acute B cell lymphoblastic leukemia]

Objective: This study aimed to evaluate the safety and efficacy of humanized CD19-targeted chimeric antigen receptor T-cell (CAR-T) in patients with relapsed/refractory acute B cell lymphoblastic leukemia (R/R B-ALL) . Methods: The clinical data of 41 patients with R/R B-ALL treated with humanized CD19-targeted CAR-T cells in the First Affiliated Hospital of Zhejiang University School of Medicine from February 2020 to July 2021 were analyzed. Results: Cytokine release syndrome occurred in all patients, and 63.4% (26/41) were grades 1-2. Immune effector cell-associated neurotoxicity syndrome developed in three patients. On median day 15 (9-47) , the complete remission rate was 95.1% (39/41) , of which 38 patients tested negative for bone marrow minimal residual disease detected by flow cytometry. Among the 39 patients with complete remission, 17 patients did not receive further treatment, and 70.6% (12/17) remained in remission at the end of follow-up, with a progression-free survival of 11.6 months of the two patients with the earliest infusion. Another 17 patients underwent consolidation allogeneic hematopoietic stem cell transplantation (10 cases) or CD22 CAR-T cell sequential therapy (seven cases) after remission, and 76.5% (13/17) of the patients were still in remission at the end of follow-up. The remaining five patients who did not receive consolidation therapy relapsed at a median of 72 (55-115) days after CAR-T cell therapy. Conclusion: In patients with R/R B-ALL, the humanized CD19-targeted CAR-T cells had a high response and manageable toxicity.

[Clinical analysis of autoimmune diseases associated with interstitial lung diseases initially presented with idiopathic pulmonary fibrosis]

Objectives: To describe the clinical characteristics of patients with autoimmune diseases associated interstitial lung diseases (AID-ILD) initially presented with idiopathic pulmonary fibrosis (IPF) in a tertiary Chinese hospital. Methods: We conducted a retrospective analysis of 14 patients diagnosed with AID-ILD during the IPF follow-up between January 2016 and December 2021. Among the 14 enrolled AID-ILD cases, there were 13 males and 1 female, (69.71±9.07) years old (range from 55 y to 87 y). Results: Detailed clinical consultation and further laboratory analysis were performed during the follow-up when the IPF patients showed exaggerated dyspnea (7 cases), fever of unknown causes (6 cases), microscopic hematuria (5 cases), arthralgia and swelling (4 cases), arthralgia (2 cases), morning stiffness (2 cases) and renal failure (2 cases). Finally, 6 patients showed positive MPO-ANCA, one patient showed positive PR3-ANCA and 7 patients showed positive anti-CCP. During the IPF periods, 7 patients had received antifibrotic agents and 5 patients had been prescribed with N-acetylcysteine, and 1 patient had received antifibrotic agents after N-acetylcysteine. Among them, no medication was prescribed for one IPF patient. After they were diagnosed with AID-ILD, glucocorticoids and/or immunosuppressants were added for 13 of them. Thirteen of cases improved or stable after these treatments, but one didn't show significant changes. Conclusions: AID-UIP, especially ANCA-UIP, AAV-UIP or RA-UIP should be considered when the IPF patients showed fever of unknown origin, microscopic hematuria and/or arthritis related symptoms. They might benefit from the add-on glucocorticoids and/or immunosuppressants.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Experimental achievement and signatures of ignition at the National Ignition Facility

An inertial fusion implosion on the National Ignition Facility, conducted on August 8, 2021 (N210808), recently produced more than a megajoule of fusion yield and passed Lawson's criterion for ignition [Phys. Rev. Lett. 129, 075001 (2022)10.1103/PhysRevLett.129.075001]. We describe the experimental improvements that enabled N210808 and present the first experimental measurements from an igniting plasma in the laboratory. Ignition metrics like the product of hot-spot energy and pressure squared, in the absence of self-heating, increased by ∼35%, leading to record values and an enhancement from previous experiments in the hot-spot energy (∼3×), pressure (∼2×), and mass (∼2×). These results are consistent with self-heating dominating other power balance terms. The burn rate increases by an order of magnitude after peak compression, and the hot-spot conditions show clear evidence for burn propagation into the dense fuel surrounding the hot spot. These novel dynamics and thermodynamic properties have never been observed on prior inertial fusion experiments.

Design of an inertial fusion experiment exceeding the Lawson criterion for ignition

We present the design of the first igniting fusion plasma in the laboratory by Lawson's criterion that produced 1.37 MJ of fusion energy, Hybrid-E experiment N210808 (August 8, 2021) [Phys. Rev. Lett. 129, 075001 (2022)10.1103/PhysRevLett.129.075001]. This design uses the indirect drive inertial confinement fusion approach to heat and compress a central "hot spot" of deuterium-tritium (DT) fuel using a surrounding dense DT fuel piston. Ignition occurs when the heating from absorption of α particles created in the fusion process overcomes the loss mechanisms in the system for a duration of time. This letter describes key design changes which enabled a ∼3-6× increase in an ignition figure of merit (generalized Lawson criterion) [Phys. Plasmas 28, 022704 (2021)1070-664X10.1063/5.0035583, Phys. Plasmas 25, 122704 (2018)1070-664X10.1063/1.5049595]) and an eightfold increase in fusion energy output compared to predecessor experiments. We present simulations of the hot-spot conditions for experiment N210808 that show fundamentally different behavior compared to predecessor experiments and simulated metrics that are consistent with N210808 reaching for the first time in the laboratory "ignition."

SuperSonic shear imaging for the differentiation between benign and malignant thyroid nodules: a meta-analysis

PURPOSE

To assess the diagnostic value of SuperSonic shear imaging (SSI) for the differentiation between benign and malignant thyroid nodules through meta-analysis.

METHODS

Online database searches were performed on PubMed, EMBASE, the Cochrane Library, and the Web of Science until 31 July 2021. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the quality of the included studies. Three measures of diagnostic test performance were used to examine the value of SSI, including the summary area under the receiver operating characteristic curve (AUROC), the summary diagnostic odds ratio (DOR), and the summary sensitivity and specificity. Heterogeneity was explored using meta-regression and subgroup analyses.

RESULTS

Finally, 21 studies with 3376 patients were included in this study. There were a total of 4296 thyroid nodules, in which 1806 malignant nodules and 2490 benign ones were involved. Thyroid nodules exhibited a malignancy rate of 42.0% (range 5.6-79.8%), 95.1% of which were of papillary variant. SSI showed a summary sensitivity of 74% [95% confidence interval (CI) 67-79%], specificity of 82% (95% CI 77-87%) and AUROC of 0.85 (95% CI 0.82-0.88) for the differentiation between benign and malignant thyroid nodules. The summary positive likelihood ratio (LR), negative LR, and DOR were 4.2 (95% CI 3.3-5.3), 0.32 (95% CI 0.26-0.40), and 13 (95% CI 9-18), respectively.

CONCLUSIONS

SSI showed high accuracy in the diagnostic differentiation between benign and malignant thyroid nodules and can be served as a noninvasive and important adjunct for thyroid nodule evaluation.

Ultra-broadband long-wave-infrared pulse production using a chirped-pulse difference-frequency generation

We present a broadband light source based on near-infrared chirped-pulse difference-frequency mixing that is suitable for seeding long-wave-infrared (LWIR) optical parametric chirped-pulse amplification (OPCPA). A nitrocellulose pellicle is used in a Ti:sapphire regenerative amplifier to generate dual-frequency output pulses, which are subsequently mixed in a 0.4-mm thick AgGaS₂ crystal. LWIR pulses with ∼1 µm full width at half maximum (FWHM) bandwidth centered at 10.5 µm are generated by mixing transform-limited pulses. Assisted by genetic algorithm optimization, the bandwidth is broadened to ∼3 µm FWHM within the 8-12 µm atmospheric transmission window. The seed source paves the path towards tabletop ultrafast terawatt-class passively carrier-envelope-phase stabilized OPCPA in the LWIR region.

P-719 Effect of frozen and thawed embryo transfer on metabolism of children in early childhood

Study question

We aimed to investigate the metabolic profile at age 1.5 – 4 years in chidren conceived from FET.

Summary answer

Plasma concentration of ApoE , fasting insulin and 11 small molecule metabolities were different beween FET group and the NC group.

What is known already

Rencently,we showed that FET-conceived male mouse offspring presented glucose metabolism dysfunction mainly manifesting insulin resistance. Observations from human studies indicate that body fat composition in IVF children is disturbed and children conceived by IVF/ICSI have a less favourable glucose and cardiovascular metabolic profile in childhood when compared with naturally conceived. But human study emphasised on metabolic profile of children concieved from FET is limited, one follow-up study have suggested that children conceived by FET often show abnormal lipid metabolism.

Study design, size, duration

284 children at early childhood (1.5-4 years) conceived from FET or naturally conceived were recruited based on the data from electronic Case Report Forms (e-CRF) in the International Peace Maternity and Child Health Hospital (IPMCHH) from September 2018 to November 2019. A total of 147 children (with 118 born after FET and 29 conceived naturally) was included for biochemical examination and metabolomics analysis.

Participants/materials, setting, methods

The peripheral venous blood of 147 children aged 1.5 - 4 years (with 118 born after FET and 29 conceived naturally) was drawn in the fasting state (&gt;8h). FBG was measured using a glucometer, plasma concentrations of TC,TG, HDL , LDL were measured by chemistry analyzer, commercial ELISA kits were used for the measurment of Apolipoprotein, insulin, leptin, CRP,FT3, FT4, and TSH. Metabolomic analysis was performed on an UPLC-MS/MS system against 210 metabolites.

Main results and the role of chance

The results of present study revealed that the chidren conceived from FET have different metabolite profile than the naturally conceived children. Except for the higher BMI of chidren from FET group, ApoE and insulin were found respectivedly higher and lower in chidren from FET group than in NC group. As for metabolomic analysis,small metabolities which reflect intestinal fermentation such as second bile acid and short chain fatty acids was significantly higher in children conceived from FET; unsaturated fatty acids which are crucial for neurodevelopment was significanty lower in FET group.

Limitations, reasons for caution

Firstly, due to the small sample size, larger sample size and a longer follow-up period will be needed to observe the long-term metabolic profile and neurobehavioral performance of offspring conceived from FET. Secondly, we did not rule out other factors that may have influence on the metabolism of children.

Wider implications of the findings

To our knowledged, we demenstrated the metabolic profile of chidren born after FET in early childhood by metabolomic analysis for the first time.The fast insulin level was significant decreased in FET group than NC group, which is opposes to previous findings.

Trial registration number

2016YFC1000203

Probing ^{93m}Mo Isomer Depletion with an Isomer Beam

The isomer depletion of ^{93m}Mo was recently reported [Chiara et al., Nature (London) 554, 216 (2018)NATUAS0028-083610.1038/nature25483] as the first direct observation of nuclear excitation by electron capture (NEEC). However, the measured excitation probability of 1.0(3)% is far beyond the theoretical expectation. In order to understand the inconsistency between theory and experiment, we produce the ^{93m}Mo nuclei using the ^{12}C(^{86}Kr,5n) reaction at a beam energy of 559 MeV and transport the reaction residues to a detection station far away from the target area employing a secondary beam line. The isomer depletion is expected to occur during the slowdown process of the ions in the stopping material. In such a low γ-ray background environment, the signature of isomer depletion is not observed, and an upper limit of 2×10^{-5} is estimated for the excitation probability. This is consistent with the theoretical expectation. Our findings shed doubt on the previously reported NEEC phenomenon and highlight the necessity and feasibility of further experimental investigations for reexamining the isomer depletion under low γ-ray background.

Reference-free learning-based similarity metric for motion compensation in cone-beam CT

Purpose. Patient motion artifacts present a prevalent challenge to image quality in interventional cone-beam CT (CBCT). We propose a novel reference-free similarity metric (DL-VIF) that leverages the capability of deep convolutional neural networks (CNN) to learn features associated with motion artifacts within realistic anatomical features. DL-VIF aims to address shortcomings of conventional metrics of motion-induced image quality degradation that favor characteristics associated with motion-free images, such as sharpness or piecewise constancy, but lack any awareness of the underlying anatomy, potentially promoting images depicting unrealistic image content. DL-VIF was integrated in an autofocus motion compensation framework to test its performance for motion estimation in interventional CBCT.Methods. DL-VIF is a reference-free surrogate for the previously reported visual image fidelity (VIF) metric, computed against a motion-free reference, generated using a CNN trained using simulated motion-corrupted and motion-free CBCT data. Relatively shallow (2-ResBlock) and deep (3-Resblock) CNN architectures were trained and tested to assess sensitivity to motion artifacts and generalizability to unseen anatomy and motion patterns. DL-VIF was integrated into an autofocus framework for rigid motion compensation in head/brain CBCT and assessed in simulation and cadaver studies in comparison to a conventional gradient entropy metric.Results. The 2-ResBlock architecture better reflected motion severity and extrapolated to unseen data, whereas 3-ResBlock was found more susceptible to overfitting, limiting its generalizability to unseen scenarios. DL-VIF outperformed gradient entropy in simulation studies yielding average multi-resolution structural similarity index (SSIM) improvement over uncompensated image of 0.068 and 0.034, respectively, referenced to motion-free images. DL-VIF was also more robust in motion compensation, evidenced by reduced variance in SSIM for various motion patterns (σDL-VIF = 0.008 versusσgradient entropy = 0.019). Similarly, in cadaver studies, DL-VIF demonstrated superior motion compensation compared to gradient entropy (an average SSIM improvement of 0.043 (5%) versus little improvement and even degradation in SSIM, respectively) and visually improved image quality even in severely motion-corrupted images.Conclusion: The studies demonstrated the feasibility of building reference-free similarity metrics for quantification of motion-induced image quality degradation and distortion of anatomical structures in CBCT. DL-VIF provides a reliable surrogate for motion severity, penalizes unrealistic distortions, and presents a valuable new objective function for autofocus motion compensation in CBCT.

Oncology clinical trial disruption during the COVID-19 pandemic: a COVID-19 and cancer outcomes study

Background

COVID-19 disproportionately impacted patients with cancer as a result of direct infection, and delays in diagnosis and therapy. Oncological clinical trials are resource-intensive endeavors that could be particularly susceptible to disruption by the pandemic, but few studies have evaluated the impact of the pandemic on clinical trial conduct.

Patients and methods

This prospective, multicenter study assesses the impact of the pandemic on therapeutic clinical trials at two large academic centers in the Northeastern United States between December 2019 and June 2021. The primary objective was to assess the enrollment on, accrual to, and activation of oncology therapeutic clinical trials during the pandemic using an institution-wide cohort of (i) new patient accruals to oncological trials, (ii) a manually curated cohort of patients with cancer, and (ii) a dataset of new trial activations.

Results

The institution-wide cohort included 4756 new patients enrolled to clinical trials from December 2019 to June 2021. A major decrease in the numbers of new patient accruals (−46%) was seen early in the pandemic, followed by a progressive recovery and return to higher-than-normal levels (+2.6%). A similar pattern (from −23.6% to +30.4%) was observed among 467 newly activated trials from June 2019 to June 2021. A more pronounced decline in new accruals was seen among academically sponsored trials (versus industry sponsored trials) (P < 0.05). In the manually curated cohort, which included 2361 patients with cancer, non-white patients tended to be more likely taken off trial in the early pandemic period (adjusted odds ratio: 2.60; 95% confidence interval 1.00-6.63), and substantial pandemic-related deviations were recorded.

Conclusions

Substantial disruptions in clinical trial activities were observed early during the pandemic, with a gradual recovery during ensuing time periods, both from an enrollment and an activation standpoint. The observed decline was more prominent among academically sponsored trials, and racial disparities were seen among people taken off trial.

Simulation of Random Deformable Motion in Soft-Tissue Cone-Beam CT with Learned Models

Cone-beam CT (CBCT) is widely used for guidance in interventional radiology but it is susceptible to motion artifacts. Motion in interventional CBCT features a complex combination of diverse sources including quasi-periodic, consistent motion patterns such as respiratory motion, and aperiodic, quasi-random, motion such as peristalsis. Recent developments in image-based motion compensation methods include approaches that combine autofocus techniques with deep learning models for extraction of image features pertinent to CBCT motion. Training of such deep autofocus models requires the generation of large amounts of realistic, motion-corrupted CBCT. Previous works on motion simulation were mostly focused on quasi-periodic motion patterns, and reliable simulation of complex combined motion with quasi-random components remains an unaddressed challenge. This work presents a framework aimed at synthesis of realistic motion trajectories for simulation of deformable motion in soft-tissue CBCT. The approach leveraged the capability of conditional generative adversarial network (GAN) models to learn the complex underlying motion present in unlabeled, motion-corrupted, CBCT volumes. The approach is designed for training with unpaired clinical CBCT in an unsupervised fashion. This work presents a first feasibility study, in which the model was trained with simulated data featuring known motion, providing a controlled scenario for validation of the proposed approach prior to extension to clinical data. Our proof-of-concept study illustrated the potential of the model to generate realistic, variable simulation of CBCT deformable motion fields, consistent with three trends underlying the designed training data: i) the synthetic motion induced only diffeomorphic deformations - with Jacobian Determinant larger than zero; ii) the synthetic motion showed median displacement of 0. 5 mm in regions predominantly static in the training (e.g., the posterior aspect of the patient laying supine), compared to a median displacement of 3.8 mm in regions more prone to motion in the training; and iii) the synthetic motion exhibited predominant directionality consistent with the training set, resulting in larger motion in the superior-inferior direction (median and maximum amplitude of 4.58 mm and 20 mm, > 2x larger than the two remaining direction). Together, the proposed framework shows the feasibility for realistic motion simulation and synthesis of variable CBCT data.

AB0171 TOWARDS A BETTER IMPLEMENTATION OF TREAT-TO-TARGET STRATEGY IN RHEUMATOID ARTHRITIS: A COMPARISON OF TWO REAL-WORLD COHORTS

Background

Treat-to-target (T2T) strategy has been the core of rheumatoid arthritis (RA) management for over a decade, however implemented distinctly varied in real practices.

Objectives

We tried to investigate the differences in disease activity and target achievement of two cohorts with different T2T implementations.

Methods

We used data of the CENTRA (Collaboratively intENsive Treat-to-target in RA) and TARRA (Treat-to-TARget in RA) cohorts. The CENTRA is a RA cohort prospectively follow-up by a fixed team with tight control, while the TARRA is a longitudinal observational cohort follow-up by a rheumatologist with casual control. Patients from two cohorts were matched 1:3 by propensity score matching (PSM). The primary outcome was simplified disease activity index (SDAI) at 1-year follow-up.

Results

102 patients from the CENTRA cohort and 271 patients from the TARRA cohort were included. Both groups were comparable in terms of age, gender, disease course, and seropositivity. At the end of 1 year follow-up, the SDAI of patients in the CENTRA cohort was significantly lower than that of patients in the TARRA cohort (2.1 vs 3.4, p＜0.001). The follow-up interval of patients in the CENTRA cohort was significantly shorter than that in the TARRA cohort when patients have not achieved remission (3.1 vs. 3.3 months, p=0.019).

Conclusion

RA patients may benefit more from a tight control T2T strategy with closer follow-up and appropriate education compared with a casual T2T strategy.

Disclosure of Interests

None declared

POS0599 IMPACT OF TREAT-TO-TARGET THERAPY ON BONE MINERAL DENSITY LOSS IN PATIENTS WITH RHEUMATOID ARTHRITIS: A PROSPECTIVE COHORT STUDY

Background

Osteoporosis is a common comorbidity of rheumatoid arthritis (RA). Although RA disease activity has been demonstrated to be associated with bone loss in previous studies, most of them were cross-sectional studies and not in the context of treat-to-target (T2T) strategies.

Objectives

To evaluate the association of disease activity with bone mineral density (BMD) changes in the context of T2T strategies in a prospective RA cohort.

Methods

RA patients were enrolled from a prospective CENTRA cohort of Peking University First Hospital. BMD was repeated at baseline, 1-year and then every other year. Time-adjusted mean disease activity scores were adopted to reflect the overall disease activity during follow-up. The influence of univariable associations between predictors and BMD was investigated using linear regression.

Results

A total of 268 patients were included in our analysis. Their mean age was 50 (12.9) years old. At enrollment, the mean (SD) DAS28-ESR was 3.70 (1.17), and the median (IQR) CDAI and SDIA was 10 (14.45) and 10.30 (16.53), respectively. Osteoporosis at lumbar spine was observed in 23.1% patients and 9.3% at femoral neck at enrollment. Older age, higher SDAI score and lower BMI were found to be associated with osteoporosis at baseline. Reevaluations of BMD at 1 year was applied in 144 patients. Mean decreases of BMDs were 1.75 % at the lumbar spine and 1.40 % at femoral neck at 1 year form baseline, respectively. Patients who achieved remission had less yearly bone loss at lumbar spine (p=0.036). Female gender was identified as a risk factor in the multiple linear regression analyses, and lower disease activity and bisphosphonates were protective factors of continuous bone loss.

Conclusion

Disease activity is associated with bone loss in RA patients in the context of T2T strategies, and those who achieved remission had less yearly bone loss.

Disclosure of Interests

None declared

Context-Aware, Reference-Free Local Motion Metric for CBCT Deformable Motion Compensation

Deformable motion is one of the main challenges to image quality in interventional cone beam CT (CBCT). Autofocus methods have been successfully applied for deformable motion compensation in CBCT, using multi-region joint optimization approaches that leverage the moderately smooth spatial variation motion of the deformable motion field with a local neighborhood. However, conventional autofocus metrics enforce images featuring sharp image-appearance, but do not guarantee the preservation of anatomical structures. Our previous work (DL-VIF) showed that deep convolutional neural networks (CNNs) can reproduce metrics of structural similarity (visual information fidelity - VIF), removing the need for a matched motion-free reference, and providing quantification of motion degradation and structural integrity. Application of DL-VIF within local neighborhoods is challenged by the large variability of local image content across a CBCT volume, and requires global context information for successful evaluation of motion effects. In this work, we propose a novel deep autofocus metric, based on a context-aware, multi-resolution, deep CNN design. In addition to the inclusion of contextual information, the resulting metric generates a voxel-wise distribution of reference-free VIF values. The new metric, denoted CADL-VIF, was trained on simulated CBCT abdomen scans with deformable motion at random locations and with amplitude up to 30 mm. The CADL-VIF achieved good correlation with the ground truth VIF map across all test cases with R2 = 0.843 and slope = 0.941. When integrated into a multi-ROI deformable motion compensation method, CADL-VIF consistently reduced motion artifacts, yielding an average increase in SSIM of 0.129 in regions with severe motion and 0.113 in regions with mild motion. This work demonstrated the capability of CADL-VIF to recognize anatomical structures and penalize unrealistic images, which is a key step in developing reliable autofocus for complex deformable motion compensation in CBCT.

Measurements of Proton High-Order Cumulants in sqrt[s_{NN}]=3 GeV Au+Au Collisions and Implications for the QCD Critical Point

We report cumulants of the proton multiplicity distribution from dedicated fixed-target Au+Au collisions at sqrt[s_{NN}]=3.0  GeV, measured by the STAR experiment in the kinematic acceptance of rapidity (y) and transverse momentum (p_{T}) within -0.5<y<0 and 0.4<p_{T}<2.0  GeV/c. In the most central 0%-5% collisions, a proton cumulant ratio is measured to be C_{4}/C_{2}=-0.85±0.09 (stat)±0.82 (syst), which is 2σ below the Poisson baseline with respect to both the statistical and systematic uncertainties. The hadronic transport UrQMD model reproduces our C_{4}/C_{2} in the measured acceptance. Compared to higher energy results and the transport model calculations, the suppression in C_{4}/C_{2} is consistent with fluctuations driven by baryon number conservation and indicates an energy regime dominated by hadronic interactions. These data imply that the QCD critical region, if created in heavy-ion collisions, could only exist at energies higher than 3 GeV.

Measurements of _{Λ}^{3}H and _{Λ}^{4}H Lifetimes and Yields in Au+Au Collisions in the High Baryon Density Region

We report precision measurements of hypernuclei _{Λ}^{3}H and _{Λ}^{4}H lifetimes obtained from Au+Au collisions at sqrt[s_{NN}]=3.0  GeV and 7.2 GeV collected by the STAR experiment at the Relativistic Heavy Ion Collider, and the first measurement of _{Λ}^{3}H and _{Λ}^{4}H midrapidity yields in Au+Au collisions at sqrt[s_{NN}]=3.0  GeV. _{Λ}^{3}H and _{Λ}^{4}H, being the two simplest bound states composed of hyperons and nucleons, are cornerstones in the field of hypernuclear physics. Their lifetimes are measured to be 221±15(stat)±19(syst)  ps for _{Λ}^{3}H and 218±6(stat)±13(syst)  ps for _{Λ}^{4}H. The p_{T}-integrated yields of _{Λ}^{3}H and _{Λ}^{4}H are presented in different centrality and rapidity intervals. It is observed that the shape of the rapidity distribution of _{Λ}^{4}H is different for 0%-10% and 10%-50% centrality collisions. Thermal model calculations, using the canonical ensemble for strangeness, describes the _{Λ}^{3}H yield well, while underestimating the _{Λ}^{4}H yield. Transport models, combining baryonic mean-field and coalescence (jam) or utilizing dynamical cluster formation via baryonic interactions (phqmd) for light nuclei and hypernuclei production, approximately describe the measured _{Λ}^{3}H and _{Λ}^{4}H yields. Our measurements provide means to precisely assess our understanding of the fundamental baryonic interactions with strange quarks, which can impact our understanding of more complicated systems involving hyperons, such as the interior of neutron stars or exotic hypernuclei.

[The role of TNF-α/TNFR1 inhibiting autophagy of M1-type Kupffer cells in liver injury in trichloroethylene-sensitized mice]

Objective: To detect the expression levels of M1-type polarization and autophagy-related indicators in the liver of trichloroethylene (TCE) -sensitized mice, and to explore the role of liver tumor necrosis factor-α (TNF-α) and tumor necrosis factor receptor 1 (TNFR1) in regulating M1-type Kupffer cells autophagy in liver injury in TCE-sensitized mice. Methods: In November 2019, according to simple random grouping, 45 SPF grade BALB/c female mice (6-8 weeks old) were divided into 4 groups: blank control group (n=5) , solvent control group (n=5) , TCE treatment group (n=18) , TCE+R7050 (inhibitor) treatment group (n=17) . Transdermally sensitized mice, 24 h after the last challenge, the mice were divided into TCE sensitized group and TCE non-sensitized group according to the skin reaction score. The livers of mice were harvested, and the pathological changes of the livers were observed under light and electron microscopes. Western blotting was used to detect the expressions of TNF-α, TNFR1 and autophagy-related indexes. The expression of inducible nitric oxide synthase (iNOS) , a marker of M1-type Kupffer cells, was detected by immunohistochemistry, and the occurrence of autophagy in M1-type Kupffer cells was detected by immunofluorescence double-labeling method. Results: The sensitization rate of TCE treatment group was 38.9% (7/18) , and TCE+R7050 treatment group was 35.3% (6/17) , with no significant difference between the two groups (P=1.000) . Compared with the blank control group, mice in the TCE sensitized group had abnormal liver ocytes, obvious liver injury, reduced mitochondria and broken endoplasmic reticulum. Western blotting results showed that the expressions of TNF-α and TNFR1 protein in the liver of the mice in the TCE sensitized group increased, the expression of iNOS protein in M1-type Kupffer cells increased, and the expressions of autophagic microtubule-associated protein 1 light-chain 3 (LC3B) and Beclin1 protein were decreased (P<0.05) . The results of immunohistochemistry showed that iNOS was not significantly expressed in the blank control group and solvent control group, and a small amount of expression was found in the TCE non-sensitized group, the positive staining area was obvious in TCE sensitized group, and the expression of iNOS was significantly increased (P<0.05) . Immunofluorescence results showed that the iNOS protein levels in the blank control group, solvent control group and TCE non-sensitized group were lower, and only partially colocalized with P62; the colocalization of iNOS with P62 in the TCE sensitized group was significantly increased. Conclusion: TNF-α/TNFR1 signaling pathway may promote liver injury in TCE-sensitized mice by inhibiting autophagy of M1-type Kupffer cells.

[Evaluation of the effect of comprehensive prevention and management of diabetes mellitus of two cross-sectional surveys based on community population]

To investigate the prevalence of diabetes mellitus (DM) among residents in Chongchuan district, Nantong city in 2012 and 2018, and evaluate the effectiveness of community comprehensive management of DM. Based on the data of 17 780 and 13 382 residents in the cross-sectional surveys of the " National Demonstration Area for Comprehensive Prevention and Control of Chronic Diseases " project in Chongchuan District of Nantong City, Jiangsu Province in 2012 and 2018, 4 583 and 3 996 DM-related information were obtained. The population of Jiangsu Province in 2012 and 2018 was used as the reference for standardization. The rates of prevalence and management (including awareness, treatment, treatment of patients who knew their diabetic situation, control and control of patients under treatment) of DM in the two surveys were compared using chi-square test. The results showed that in 2012 and 2018, the prevalence rates of DM were 12.0% and 15.7% (χ²=24.25, P<0.05), and the standardized rates were 10.1% and 10.8% (χ²=1.05, P=0.306). The incidence rates were 5.7% and 2.3%, respectively (χ²=55.60, P<0.05). The standardized prevalence rates in the two surveys were 9.7% and 11.6% for males (χ²=3.66, P=0.056) and 10.5% and 9.9% for females (χ²=0.50, P=0.481), 7.2% and 6.5% (χ²=0.85, P=0.357) for people aged 18-59 years old and 20.6% and 21.9% (χ²=0.91, P=0.339) for people aged 60 years and over, respectively. The standardized rates of awareness, treatment, treatment of patients who knew their diabetic situation, control, and control of patients under treatment in 2018 were 84.4%, 80.3%, 95.2%, 58.4%, and 70.2%, respectively, higher than 47.2%, 23.4%, 44.8%, 30.4% and 59.4% in 2012 (χ²=183.33, χ²=380.65, χ²=282.99, χ²=93.24, χ²=6.22, all P<0.05). Among men, the standardized rates of awareness, treatment, treatment of patients who knew their diabetic situation, and control in 2018 were 85.8%, 78.8%, 91.8% and 62.7%, higher than 50.5%, 37.5%, 72.3% and 32.6% in 2012 (χ²=78.40, χ²=96.17, χ²=27.55, χ²=48.96, all P<0.05). Similarly, the standardized management rates in 2018 were 83.0%, 81.7%, 98.5%, 54.1% and 65.1%, higher than 44.0%, 10.0%, 18.3%, 28.2% and 48.8% in 2012 among women (χ²=105.52, χ²=326.36, χ²=317.22, χ²=43.34, χ²=3.87, all P<0.05). The standardized rates of awareness, treatment, treatment of patients who knew their diabetic situation, and control of people aged 18-59 and 60 years and over were 82.9%, 79.7%, 96.1%, 55.0% and 88.0%, 81.8%, 93.0% and 67.2%, higher than 42.6%, 19.8%, 42.2%, 27.5% and 63.9%, 36.8%, 53.9%, 40.8% in 2012 (χ²=44.51, χ²=102.17, χ²=57.78, χ²=21.65, all P<0.05; χ²=71.18, χ²=181.55, χ²=146.26, χ²=59.23, all P<0.05). The comprehensive prevention and control system of chronic diseases, which comprehensively covered the life of community residents, had good management effect on DM, and effectively promoted health education and health promotion.