Human-like intelligent automatic treatment planning of head and neck cancer radiation therapy

Automatic treatment planning of radiation therapy (RT) is desired to ensure plan quality, improve planning efficiency, and reduce human errors. We have proposed an Intelligent Automatic Treatment Planning framework with a virtual treatment planner (VTP), an artificial intelligence robot built using deep reinforcement learning (DRL), autonomously operating a treatment planning system (TPS). This study extends our previous successes in relatively simple prostate cancer RT planning to head-and-neck (H&N) cancer, a more challenging context even for human planners due to multiple prescription levels, proximity of targets to critical organs, and tight dosimetric constraints. We integrated VTP with a real clinical TPS to establish a fully automated planning workflow guided by VTP. This integration allowed direct model training and evaluation using the clinical TPS. We designed the VTP network structure to approach the decision-making process in RT planning in a hierarchical manner that mirrors human planners. The VTP network was trained via the Q-learning framework. To assess the effectiveness of VTP, we conducted a prospective evaluation in the 2023 Planning Challenge organized by the American Association of Medical Dosimetrists (AAMD). We extended our evaluation to include 20 clinical H&N cancer patients, comparing the plans generated by VTP against their clinical plans. In the prospective evaluation for the AAMD Planning Challenge, VTP achieved a plan score of 139.08 in the initial phase evaluating plan quality, and 15 min of planning time with the first place ranking in the adaptive phase competing for planning efficiency while meeting all plan quality requirements. For clinical cases, VTP-generated plans achieved an average VTP score of 125.33±11.12, which outperformed the corresponding clinical plans with an average score of117.76±13.56. We successfully integrated VTP with the clinical TPS to achieve a fully automated treatment planning workflow. The compelling performance of VTP demonstrated its potential in automating H&N RT planning.

Bioactivities of Phenolic Compounds from Kiwifruit and Persimmon

Fruit used in the common human diet in general, and kiwifruit and persimmon particularly, displays health properties in the prevention of heart disease. This study describes a combination of bioactivity, multivariate data analyses and fluorescence measurements for the differentiating of kiwifruit and persimmon, their quenching and antioxidant properties. The metabolic differences are shown, as well in the results of bioactivities and antioxidant capacities determined by ABTS, FRAP, CUPRAC and DPPH assays. To complement the bioactivity of these fruits, the quenching properties between extracted polyphenols and human serum proteins were determined by 3D-fluorescence spectroscopy studies. These properties of the extracted polyphenols in interaction with the main serum proteins in the human metabolism (human serum albumin (HSA), α-β-globulin (α-β G) and fibrinogen (Fgn)), showed that kiwifruit was more reactive than persimmon. There was a direct correlation between the quenching properties of the polyphenols of the investigated fruits with serum human proteins, their relative quantification and bioactivity. The results of metabolites and fluorescence quenching show that these fruits possess multiple properties that have a great potential to be used in industry with emphasis on the formulation of functional foods and in the pharmaceutical industry. Based on the quenching properties of human serum proteins with polyphenols and recent reports in vivo on human studies, we hypothesize that HSA, α-β G and Fgn will be predictors of coronary artery disease (CAD).

Predictors of the Effects of Flow Diversion in Very Large and Giant Aneurysms

BACKGROUND AND PURPOSE

The treatment paradigm for very large and giant aneurysms has recently changed to flow diversion, in light of the results of the Pipeline for Uncoilable or Failed Aneurysms trial. However, the effects of flow diversion were definitely unknown. We explored this topic and identified the predictors of such effects.

MATERIALS AND METHODS

We retrospectively reviewed 51 patients with unruptured aneurysms admitted to our institution for flow diversion between February 2014 and August 2019. Patients were categorized into an effect group (no filling or remnant entry) and a no-effect group (subtotal or total filling). We evaluated the aneurysm size and shape, incorporation vessel, parent artery stenosis and curvature, stagnation of contrast medium within the aneurysm, use of balloon angioplasty, and intra-aneurysm thrombus as potential predictors of the effects of flow diversion.

RESULTS

The effect group comprised 34 patients (66.7%, 34/51; no filling, 35.3%, 18/51; and remnant entry, 31.4%, 16/51). The no-effect group comprised 17 patients (33.3%, 17/51; subtotal filling, 29.4%, 15/51; and total filling, 3.9%, 2/51). An incorporation vessel and balloon angioplasty were independent risk factors for the no-effect group in multivariate logistic regression analyses (OR = 0.13 and 0.05; 95% confidence intervals, 0.02-0.62 and 0.00-0.32; P values, .021 and .004, respectively).

CONCLUSIONS

Flow diversion is effective for very large and giant aneurysms, but the outcomes require further improvement. The results of this study show that an incorporated vessel and excessive balloon angioplasty might compromise flow diversion. This finding can help improve the outcomes of flow diversion.

Convolutional neural network based proton stopping-power-ratio estimation with dual-energy CT: a feasibility study

Dual-energy computed tomography (DECT) has shown a great potential for lowering range uncertainties, which is necessary for truly leveraging the Bragg peak in proton therapy. However, analytical stopping-power-ratio (SPR) estimation methods have limitations in resolving the influence from the beam-hardening artifact, i.e. CT number variation of the same object scanned under different imaging conditions, such as different patient size and location in the field-of-view (FOV). We present a convolutional neural network (CNN)-based framework to estimate proton SPR that accounts for patient geometry variation and addresses CT number variation. The proposed framework was tested on both prostate and head-and-neck (HN) patient datasets. Simulated CT images were used in order to have a well-defined ground-truth SPR for evaluation. Two training scenarios were evaluated: training with patient CT images (ideal scenario) and training with computational phantoms (realistic scenario). For the training in ideal scenario, computational phantoms were created based on 120 kVp patient CT images using a custom-defined density and material translation curve. Then, 80 kVp and 150 kVp Sn DECT image pairs were obtained using ray-tracing simulation, and their corresponding SPR was calculated from the known density and elemental compositions. For the training in realistic scenario, computational phantoms were created based on the geometry of calibration phantoms. For both scenarios, evaluation was performed on the phantoms created from patient CT images. Compared to a conventional parametric model, U-net trained with computational phantoms (realistic scenario) reduced the SPR estimation uncertainty (95th percentile) of the prostate patient from 1.10% to 0.71%, and HN patient from 2.11% to 1.20%. With the U-net trained with patient images (ideal scenario) uncertainty values were 0.32% and 0.42% for prostate and HN patients, respectively. These results suggest that CNN has great potential to improve the accuracy of SPR estimation in proton therapy by incorporating individual patient geometry information.

Evaluation of an a priori scatter correction algorithm for cone-beam computed tomography based range and dose calculations in proton therapy

BACKGROUND AND PURPOSE

Scatter correction of cone-beam computed tomography (CBCT) projections may enable accurate online dose-delivery estimations in photon and proton-based radiotherapy. This study aimed to evaluate the impact of scatter correction in CBCT-based proton range/dose calculations, in scans acquired in both proton and photon gantries.

MATERIAL AND METHODS

CBCT projections of a Catphan and an Alderson phantom were acquired on both a proton and a photon gantry. The scatter corrected CBCTs (corrCBCTs) and the clinical reconstructions (stdCBCTs) were compared against CTs rigidly registered to the CBCTs (rigidCTs). The CBCTs of the Catphan phantom were segmented by materials for CT number analysis. Water equivalent path length (WEPL) maps were calculated through the Alderson phantom while proton plans optimized on the rigidCT and recalculated on all CBCTs were compared in a gamma analysis.

RESULTS

In medium and high-density materials, the corrCBCT CT numbers were much closer to those of the rigidCT than the stdCBCTs. E.g. in the 50% bone segmentations the differences were reduced from above 300 HU (with stdCBCT) to around 60-70 HU (with corrCBCT). Differences in WEPL from the rigidCT were typically well below 5 mm for the corrCBCTs, compared to well above 10 mm for the stdCBCTs with the largest deviations in the head and thorax regions. Gamma pass rates (2%/2mm) when comparing CBCT-based dose re-calculations to rigidCT calculations were improved from around 80% (with stdCBCT) to mostly above 90% (with corrCBCT).

CONCLUSION

Scatter correction leads to substantial artefact reductions, improving accuracy of CBCT-based proton range/dose calculations.

Beam angle optimization using angular dependency of range variation assessed via water equivalent path length (WEPL) calculation for head and neck proton therapy

PURPOSE

To investigate angular sensitivity of proton range variation due to anatomic change in patients and patient setup error via water equivalent path length (WEPL) calculations.

METHODS

Proton range was estimated by calculating WEPL to the distal edge of target volume using planning CT (pCT) and weekly scatter-corrected cone-beam CT (CBCT) images of 11 head and neck patients. Range variation was estimated as the difference between the distal WEPLs calculated on pCT and scatter-corrected CBCT (cCBCT). This WEPL analysis was performed every five degrees ipsilaterally to the target. Statistics of the distal WEPL difference were calculated over the distal area to compare between different beam angles. Physician-defined contours were used for the WEPL calculation on both pCT and cCBCT, not considering local deformation of target volume. It was also tested if a couch kick (10°) can mitigate the range variation due to anatomic change and patient setup error.

RESULTS

For most of the patients considered, median, 75% quantile, and 95% quantile of the distal WEPL difference were largest for posterior oblique angles, indicating a higher chance of overdosing normal tissues at distal edge with these angles. Using a couch kick resulted in decrease in the WEPL difference for some posterior oblique angles.

CONCLUSIONS

It was demonstrated that the WEPL change has angular dependency for the cohort of head and neck cancer patients. Selecting beam configuration robust to anatomic change in patient and patient setup error may improve the treatment outcome of head and neck proton therapy.

The Fate of Unruptured Intracranial Vertebrobasilar Dissecting Aneurysm with Brain Stem Compression According to Different Treatment Modalities

BACKGROUND AND PURPOSE

Unruptured intracranial vertebrobasilar dissecting aneurysms with brain stem compression are difficult to treat. In the present study, the clinical and radiologic outcomes of unruptured intracranial vertebrobasilar dissecting aneurysms with brain stem compression based on different treatment modalities were evaluated.

MATERIALS AND METHODS

This study included 28 patients with unruptured intracranial vertebrobasilar dissecting aneurysms with brain stem compression treated from January 2009 to December 2017. Treatment methods were observation (n = 6), stent-assisted coil embolization (n = 9), parent artery occlusion (n = 6), and flow diversion (n = 7). The data of baseline characteristics, change of aneurysm size, retreatment rate, stroke occurrence, and alteration of the mRS score were obtained from retrospective chart review.

RESULTS

The initial size of dissecting aneurysms was largest in the flow diversion group (22.5 ± 7.7 mm), followed by parent artery occlusion (20.3 ± 8.4 mm), stent-assisted coil embolization (11.7 ± 2.2 mm), and observation (17.8 ± 5.5 mm; P = .01) groups. The reduction rate of aneurysm size was highest in the parent artery occlusion group (26.7 ± 32.1%), followed by flow diversion (14.1% ± 28.7%), stent-assisted coil embolization (-17.9 ± 30.3%), and observation (-31.5 ± 30.8%; P = .007) groups. Additional treatment was needed in the observation (4/6, 66.7%) and stent-assisted coil embolization (3/9, 33.3%; P = .017) groups. Improvement of the mRS score on follow-up was observed in the flow diversion (6/7, 85.7%) and parent artery occlusion (4/6, 66.7%) groups but not in the stent-assisted coil embolization and observation groups. A worsened mRS score was most common in the observation group (4/6, 66.7%), followed by stent-assisted coil embolization (3/9, 33.3%), parent artery occlusion (2/6, 33.3%), and flow diversion (0/7, 0%) groups.

CONCLUSIONS

When treating intracranial vertebrobasilar dissecting aneurysms with brain stem compression, parent artery occlusion and flow diversion should be considered to reduce aneurysm size and improve the mRS score.

Microstructural Control for Characteristics of Biomedical Ti-39Nb-6Zr-0.45Al Alloy

Ti-39Nb-6Zr-0.45Al alloy was developed for biological applications as exchangeable hard tissue. This alloy has very low elastic modulus, but lower strength than Ti-6Al-4V alloy. This study was performed for improving the strength by various heat treatments and microstructural characteristics and mechanical properties of Ti-39Nb-6Zr-0.45Al alloy were investigated. Heat treatments were conducted at 350 °C, 400 °C, 450 °C, 500 °C, 550 °C and 600 °C, followed by water quenching. Microstructures of Ti-39Nb-6Zr-0.45Al alloy showed two types of different features. One of the features was not visible for grains at low temperature heat conditions (350 °C, 400 °C and 450 °C), because of the effect of cold swaging. On the contrast, at high temperature conditions (500 °C, 550 °C and 600 °C), the grains were visible. Tensile properties had similar tendency to hardness properties under all low temperature conditions. The samples showed high strength and low elongation under low temperatures, but showed the opposite results under high temperature conditions. These results were due to thermal ω phases and secondary α phases inside the matrix of this alloy. ω phases, which were precipitated under low temperature heat treatments, induce high strength and low elongation. In case of high temperature conditions, ω phases disappeared into the matrix and secondary α phases with fine size appeared. γoung's moduli of the samples under all the conditions were lower (about 60 GPa) than those of the as-swaged (about 70 GPa). Consequently, the heattreated Ti-39Nb-6Zr-0.45Al alloy had high strength and very low elastic modulus for biomedical applications.

Oligonol prevented the relapse of dextran sulfate sodium-ulcerative colitis through enhancing NRF2-mediated antioxidative defense mechanism

Repeated bouts of ulcerative colitis featured troublesome course of inflammatory bowel disease leading to fatal colitis-associated cancer, which is strongly associated with oxidative stress and sustained inflammation. Since oligonol, low molecular weighted polyphenol extracted from fruit lychee, showed antioxidative and anti-inflammatory actions, we hypothesized that oligonolcan prevent relapse of colitis. We compared oligonol with current gold standard therapeutics, sulfasalazine in preventive efficacy of relapse. First, dextran sulfate sodium (DSS)-induced colitis were made following pretreatment with oligonol, 10, 50, and 100 mg/kg for 7 days to measure therapeutic effect of oligonol and relapse model via repeated DSS administration was made following with either 50 mg/kg oligonol or 30 mg/kg sulfasalazine to explore relapse preventing action of oligonol in C57BL/6 mice. Detailed changes in colon were measured to explain molecular mechanisms. Pretreatment of 10, 50, 100 mg/kg oligonol (p.o.), significantly reduced DSS-induced colitis; total pathologic scores, colon length, and clinical symptom scores (P < 0.05). Oligonol pretreatment significantly decreased the levels of interleukin (IL)-1, IL-6, and tumor necrosis factor-α (TNF-α) as well as nuclear factor-κB (NF-κB), c-Fos, and c-Jun in affected colon tissues, but the expression of heme oxygenase-1 (HO-1) and NADH: quinone oxidoreductase-1(NQO-1) as well as total antioxidant concentration (P < 0.005) was significantly increased with oligonol. A relapse model established with repeated DSS administration led to high mortality. However, oligonol significantly ameliorated exacerbations of colitis, while sulfasalazine did not (P < 0.01). Significantly decreased expressions of cyclooxygenase-2 (COX-2), TNF-α, and macrophages inhibition were relapse preventing actions of oligonal, but significant action of oligonol relevant to relapse prevention was either significantly increased expressions of NQO-1 or significantly preserved mucin (P < 0.05). Concerted anti-inflammatory, antioxidative, and host defense enhancing actions of oligonol can be applied during maintenance therapy of IBD to prevent relapse of IBD.

ALK-positive anaplastic large-cell lymphoma with primary bone involvement: A rare case and review of the literature

Primary bone lymphoma (PBL) is an uncommon type of extranodal lymphoma involvement. An anaplastic large-cell lymphoma (ALCL) is an extremely rare type of PBL, and it remains unclear whether ALCLs that primarily involve the bone exhibit favourable or unfavourable biological behaviour, and whether they are similar to ALCLs in general, or not. We reported a case of ALK-positive ALCL with primary bone involvement, and reviewed the clinicopathological features of 22 previously reported cases. An ALCL with primary bone involvement mostly affects younger patients with a preponderant towards the involvement of axial-bone. The prognosis of an ALCL that primarily involves bone is unfavourable, compared with PBL generally. The ALK-positive ALCLs in PBLs had less decedents than the ALK-negative ALCLs with a statistical non-significance (p=0.198).

1H NMR and antioxidant profiles of polar and non-polar extracts of persimmon (Diospyros kaki L.) - Metabolomics study based on cultivars and origins

Persimmon (Diospyros kaki L.) is one of the most important fruits that has been consumed for its medicinal properties due to the presence of some active metabolites, particularly polyphenols and carotenoids. Previously described methods, including HPLC, were limited in the determination of metabolites in different persimmon varieties. The present study shows the evaluation and the differences among persimmon polar and non-polar extracts by ¹H NMR-based metabolomics approach. The hierarchical clustering analysis (HCA) based on score values of principal component analysis (PCA) model was used to analyze the important compounds in investigated fruits. The ¹H NMR spectrum of persimmon chloroform (CDCl₃) extracts showed different types of compounds as compared to polar methanol-water (CD₃OD-D₂O) ones. Persimmons growing in Israel were clustered different from those growing in Korea with the abundance of phenolic compounds (gallic, caffeic and protocathecuic acids), carotenoids (β-cryptoxanthin, lutein, and zeaxanthin), amino acids (alanine), maltose, uridine, and fatty acids (myristic and palmitoleic acids). Glucose, choline and formic acid were more prominent in persimmon growing in Korea. In CD₃OD-D₂O and CDCl₃ persimmon extracts, 43 metabolites were identified. The metabolic differences were shown as well on the results of bioactivities and antioxidant capacities determined by ABTS, FRAP, CUPRAC and DPPH assays. The presented methods can be widely used for quantitation of multiple compounds in many plant and biological samples especially in vegetables and fruits.

Measurement of levels of fractional exhaled nitric oxide in patients with pulmonary tuberculosis

SETTING

The role of fractional exhaled nitric oxide (FeNO) in the diagnosis and treatment of pulmonary tuberculosis (PTB) is uncertain.

OBJECTIVE

To examine the value of FeNO as a biomarker for PTB.

DESIGN

Baseline FeNO levels were compared in 69 PTB patients and 118 healthy controls. The correlation between baseline FeNO levels and clinical variables of tuberculosis were studied. FeNO levels were checked twice in the PTB group, at diagnosis and after 2 months of anti-tuberculosis medication, and factors affecting changes in FeNO levels after treatment were analysed.

RESULTS

FeNO levels were not significantly different in the PTB group and controls (mean ± standard deviation 27.7 ± 17.6 parts per billion [ppb] vs. 27.0 ± 10.8 ppb, P = 0.531). In a multivariate regression analysis, no variable was shown to affect FeNO levels at diagnosis. FeNO levels did not significantly change after 2 months of treatment (26.8 ± 18.3 ppb vs. 24.0 ± 10.7 ppb, P = 0.257). Only PTB with a high FeNO level (>25 ppb) was related to a decline in FeNO levels after 2 months of treatment.

CONCLUSION

FeNO levels do not appear to be affected in PTB patients.

Augmented reality in bone tumour resection: An experimental study

OBJECTIVES

We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model.

METHODS

We developed an AR-based navigation system for bone tumour resection, which could be used on a tablet PC. To simulate a bone tumour in the pig femur, a cortical window was made in the diaphysis and bone cement was inserted. A total of 133 pig femurs were used and tumour resection was simulated with AR-assisted resection (164 resection in 82 femurs, half by an orthropaedic oncology expert and half by an orthopaedic resident) and resection with the conventional method (82 resection in 41 femurs). In the conventional group, resection was performed after measuring the distance from the edge of the condyle to the expected resection margin with a ruler as per routine clinical practice.

RESULTS

The mean error of 164 resections in 82 femurs in the AR group was 1.71 mm (0 to 6). The mean error of 82 resections in 41 femurs in the conventional resection group was 2.64 mm (0 to 11) (p < 0.05, one-way analysis of variance). The probabilities of a surgeon obtaining a 10 mm surgical margin with a 3 mm tolerance were 90.2% in AR-assisted resections, and 70.7% in conventional resections.

CONCLUSION

We demonstrated that the accuracy of tumour resection was satisfactory with the help of the AR navigation system, with the tumour shown as a virtual template. In addition, this concept made the navigation system simple and available without additional cost or time.Cite this article: H. S. Cho, Y. K. Park, S. Gupta, C. Yoon, I. Han, H-S. Kim, H. Choi, J. Hong. Augmented reality in bone tumour resection: An experimental study. Bone Joint Res 2017;6:137-143.

Water equivalent path length calculations using scatter-corrected head and neck CBCT images to evaluate patients for adaptive proton therapy

Proton therapy has dosimetric advantages due to the well-defined range of the proton beam over photon radiotherapy. When the proton beams, however, are delivered to the patient in fractionated radiation treatment, the treatment outcome is affected by delivery uncertainties such as anatomic change in the patient and daily patient setup error. This study aims at establishing a method to evaluate the dosimetric impact of the anatomic change and patient setup error during head and neck proton therapy. Range variations due to the delivery uncertainties were assessed by calculating water equivalent path length (WEPL) to the distal edge of tumor volume using planning CT and weekly treatment cone-beam CT (CBCT) images. Specifically, mean difference and root mean squared deviation (RMSD) of the distal WEPLs were calculated as the weekly range variations. To accurately calculate the distal WEPLs, an existing CBCT scatter correction algorithm was used. An automatic rigid registration was used to align the planning CT and treatment CBCT images, simulating a six degree-of-freedom couch correction at treatments. The authors conclude that the dosimetric impact of the anatomic change and patient setup error was reasonably captured in the differences of the distal WEPL variation with a range calculation uncertainty of 2%. The proposed method to calculate the distal WEPL using the scatter-corrected CBCT images can be an essential tool to decide the necessity of re-planning in adaptive proton therapy.

Impact of Cultivation Conditions, Ethylene Treatment, and Postharvest Storage on Selected Quality and Bioactivity Parameters of Kiwifruit "Hayward" Evaluated by Analytical and Chemometric Methods

Organic, semiorganic, and conventional "Hayward" kiwifruits, treated with ethylene for 24 h and stored during 10 days, were assessed by UV spectrometry, fluorometry, and chemometrical analysis for changes in selected characteristics of quality (firmness, dry matter and soluble solid contents, pH, and acidity) and bioactivity (concentration of polyphenols via Folin-Ciocalteu and p-hydroxybenzoic acid assays). All of the monitored qualitative parameters and characteristics related to bioactivity were affected either by cultivation practices or by ethylene treatment and storage. Results obtained, supported by statistical evaluation (Friedman two-way ANOVA) and chemometric analysis, clearly proved that the most significant impact on the majority of the evaluated parameters of quality and bioactivity of "Hayward" kiwifruit had the ethylene treatment followed by the cultivation practices and the postharvest storage. Total concentration of polyphenols expressed via p-hydroxybenzoic acid assay exhibited the most significant sensitivity to all three evaluated parameters, reaching a 16.5% increase for fresh organic compared to a conventional control sample. As a result of postharvest storage coupled with ethylene treatment, the difference increased to 26.3%. Three-dimensional fluorescence showed differences in the position of the main peaks and their fluorescence intensity for conventional, semiorganic, and organic kiwifruits in comparison with ethylene nontreated samples.

Proton dose calculation on scatter-corrected CBCT image: Feasibility study for adaptive proton therapy

PURPOSE

To demonstrate the feasibility of proton dose calculation on scatter-corrected cone-beam computed tomographic (CBCT) images for the purpose of adaptive proton therapy.

METHODS

CBCT projection images were acquired from anthropomorphic phantoms and a prostate patient using an on-board imaging system of an Elekta infinity linear accelerator. Two previously introduced techniques were used to correct the scattered x-rays in the raw projection images: uniform scatter correction (CBCTus) and a priori CT-based scatter correction (CBCTap). CBCT images were reconstructed using a standard FDK algorithm and GPU-based reconstruction toolkit. Soft tissue ROI-based HU shifting was used to improve HU accuracy of the uncorrected CBCT images and CBCTus, while no HU change was applied to the CBCTap. The degree of equivalence of the corrected CBCT images with respect to the reference CT image (CTref) was evaluated by using angular profiles of water equivalent path length (WEPL) and passively scattered proton treatment plans. The CBCTap was further evaluated in more realistic scenarios such as rectal filling and weight loss to assess the effect of mismatched prior information on the corrected images.

RESULTS

The uncorrected CBCT and CBCTus images demonstrated substantial WEPL discrepancies (7.3 ± 5.3 mm and 11.1 ± 6.6 mm, respectively) with respect to the CTref, while the CBCTap images showed substantially reduced WEPL errors (2.4 ± 2.0 mm). Similarly, the CBCTap-based treatment plans demonstrated a high pass rate (96.0% ± 2.5% in 2 mm/2% criteria) in a 3D gamma analysis.

CONCLUSIONS

A priori CT-based scatter correction technique was shown to be promising for adaptive proton therapy, as it achieved equivalent proton dose distributions and water equivalent path lengths compared to those of a reference CT in a selection of anthropomorphic phantoms.

Complete Oxidation of Toluene Over Supported Palladium Catalysts: Effect of Support

The catalytic oxidation of toluene was carried out to investigate the effect of the support on the properties and performance of a supported palladium catalyst (1 wt% loading). γ-Al2O3), SiO2 and TiO2 were used as supports. The properties of the prepared catalysts were characterized by XRD, BET, PT, TPD, TPR, XPS and FE-TEM analyses. The experimental results showed that the order of catalytic performance was 1 wt% Pd/TiO2 > 1 wt% Pd/SiO2 > 1 wt% Pd/γ-Al2O3. A strong interaction between the palladium and support was found, which affected the palladium surface concentration and particle size. The higher catalytic activity of the Pd/TiO2 catalyst was attributed to the higher palladium surface concentration and larger particle size.

Synthesis of Dicyclopentadiene Oligomer Over Nanoporous Al-MCM-41 Catalysts

One step reaction composed of DCPD oligomerization and DCPD oligomer isomerization was investigated over nanoporous Al-MCM-41 catalysts. The effects of aluminum grafting over MCM-41 on the catalyst characteristics were studied with respect to the synthesis of TCPD isomer. Physical and chemical properties of the catalysts were analyzed by N2 adsorption, temperature-programmed desorption of ammonia, and infrared spectroscopy of adsorbed pyridine. The overall number of acid sites as well as the number of Lewis acid sites increased with increasing of aluminum content over MCM-41. When utilizing MCM-41 and Al-MCM-41 as the catalyst, DCPD oligomerization reaction activity greatly increased compared to the thermal reaction. The highest TCPD isomer selectivity over the Al-MCM-41 catalyst with the highest aluminum content could be ascribed to the largest amount of acid sites. This study showed an increased level of TCPD isomer selectivity by an increasing level of Lewis acid sites through aluminum addition over MCM-41.

Catalytic Fast Pyrolysis of Wild Reed Over Nanoporous SBA-15 Catalysts

Wild reed was pyrolyzed over two nanoporous SBA-15 catalysts with different acid characteristics: Si-SBA-15 and Al-SBA-15. Al was grafted on Si-SBA-15 to increase the acidity and enhance the catalytic activity. Fast pyrolysis was carried out using a pyrolysis-gas chromatography/mass spectrometry system at 550 degrees C for real-time analysis of the products. Significant improvement of the product bio-oil quality was attained by catalytic reforming over nanoporous Al-SBA-15. The fraction of total oxygenates was reduced because of the decrease in. the fraction of ketones, aldehydes, and carboxylates, which deteriorate the fuel quality of bio-oil. On the other hand, the fractions of furans and aromatics, which are the chemicals with high value-added, were increased by the catalytic reforming. The catalytic activity of Al-SBA-15 was considerably higher than that of Si-SBA-15 because the incorporation of Al increased the catalyst acidity.

Facile Synthesis of Iron Oxide/Graphene Nanocomposites Using Liquid Phase Plasma Method

Liquid phase plasma (LPP) method was applied, for the first time, to the impregnation of iron oxide nanoparticles onto graphene sheet. Iron oxide nanoparticles with the size of 50 nm were precipitated with uniform dispersion on the surface of graphene sheet. The amount of iron oxide nanoparticles precipitated on graphene sheets increased with increasing LPP process times. The XPS, Raman and EDX analyses showed that the iron oxide/graphene composites synthesized by the LPP process.

Application of Silver and Silver Oxide Nanoparticles Impregnated on Activated Carbon to the Degradation of Bromate

Silver and silver oxide nanoparticles were impregnated on the surface of powdered activated carbon (PAC) using a single-step liquid phase plasma (LPP) method. Spherical silver and silver oxide nanoparticles of 20 to 100 nm size were dipersed evenly on the surface of PAC. The impregnated PAC exhibited a higher activity for the decomposition of bromate than bare PAC. The XPS, Raman and EDX analyses showed that the Ag/PAC composites synthesized by the LPP process.

Catalytic Reforming of Lignin-Derived Bio-Oil Over a Nanoporous Molecular Sieve Silicoaluminophosphate-11

Catalytic pyrolysis of lignin, a major constituent of biomass, was performed. A nanoporous molecular sieve silicoaluminophosphate-11 (SAPO-11) was selected as catalyst. Thermogravimetric analysis showed that 500 degrees C was the optimal pyrolysis temperature. Pyrolyzer-gas chromatography/mass spectroscopy was used to investigate the pyrolysis product distribution. Production of phenolics, the dominant product from the pyrolysis of lignin, was promoted by the increase in the catalyst dose. In particular, low-molecular-mass phenolics were produced more over SAPO-11, while high-molecular-mass phenolics and double-bond-containing phenolics were produced less. The fraction of aromatic compounds, including benzene, toluene, xylene, and ethylbenzene, was also increased by catalytic reforming. The catalytic effects were more pronounced when the catalyst/biomass ratio was increased. The enhanced production of aromatic compounds by an acidic catalyst obtained in this study is in good agreement with the results of previous studies.

Investigation of cone-beam CT image quality trade-off for image-guided radiation therapy

It is well-known that projections acquired over an angular range slightly over 180° (so-called short scan) are sufficient for fan-beam reconstruction. However, due to practical imaging conditions (projection data and reconstruction image discretization, physical factors, and data noise), the short-scan reconstructions may have different appearances and properties from the full-scan (scans over 360°) reconstructions. Nevertheless, short-scan configurations have been used in applications such as cone-beam CT (CBCT) for head-neck-cancer image-guided radiation therapy (IGRT) that only requires a small field of view due to the potential reduced imaging time and dose. In this work, we studied the image quality trade-off for full, short, and full/short scan configurations with both conventional filtered-backprojection (FBP) reconstruction and iterative reconstruction algorithms based on total-variation (TV) minimization for head-neck-cancer IGRT. Anthropomorphic and Catphan phantoms were scanned at different exposure levels with a clinical scanner used in IGRT. Both visualization- and numerical-metric-based evaluation studies were performed. The results indicate that the optimal exposure level and number of views are in the middle range for both FBP and TV-based iterative algorithms and the optimization is object-dependent and task-dependent. The optimal view numbers decrease with the total exposure levels for both FBP and TV-based algorithms. The results also indicate there are slight differences between FBP and TV-based iterative algorithms for the image quality trade-off: FBP seems to be more in favor of larger number of views while the TV-based algorithm is more robust to different data conditions (number of views and exposure levels) than the FBP algorithm. The studies can provide a general guideline for image-quality optimization for CBCT used in IGRT and other applications.

Clinical commissioning of an in vivo range verification system for prostate cancer treatment with anterior and anterior oblique proton beams

The purpose of this work is the clinical commissioning of a recently developed in vivo range verification system (IRVS) for treatment of prostate cancer by anterior and anterior oblique proton beams. The IRVS is designed to perform a complete workflow for pre-treatment range verification and adjustment. It contains specifically designed dosimetry and electronic hardware and a specific software for workflow control with database connection to the treatment and imaging systems. An essential part of the IRVS system is an array of Si-diode detectors, designed to be mounted to the endorectal water balloon routinely used for prostate immobilization. The diodes can measure dose rate as function of time from which the water equivalent path length (WEPL) and the dose received are extracted. The former is used for pre-treatment beam range verification and correction, if necessary, while the latter is to monitor the dose delivered to patient rectum during the treatment and serves as an additional verification. The entire IRVS workflow was tested for anterior and 30 degree inclined proton beam in both solid water and anthropomorphic pelvic phantoms, with the measured WEPL and rectal doses compared to the treatment plan. Gafchromic films were also used for measurement of the rectal dose and compared to IRVS results. The WEPL measurement accuracy was in the order of 1 mm and after beam range correction, the dose received by the rectal wall were 1.6% and 0.4% from treatment planning, respectively, for the anterior and anterior oblique field. We believe the implementation of IRVS would make the treatment of prostate with anterior proton beams more accurate and reliable.

Antihypertensive Effects of Artemisia scoparia Waldst in Spontaneously Hypertensive Rats and Identification of Angiotensin I Converting Enzyme Inhibitors

We investigated the antihypertensive effects of Artemisia scoparia (AS) in spontaneously hypertensive rats (SHR). The rats were fed diets containing 2% (w/w) hot water extracts of AS aerial parts for 6 weeks. The AS group had significantly lower systolic and diastolic blood pressure levels than the control group. The AS group also had lower angiotensin I converting enzyme (ACE) activity and angiotensin II content in serum compared to the control group. The AS group showed higher vascular endothelial growth factor and lower ras homolog gene family member A expression levels in kidney compared to the control group. The AS group had significantly lower levels of plasma lipid oxidation and protein carbonyls than the control group. One new and six known compounds were isolated from AS by guided purification. The new compound was determined to be 4'-O-β-D-glucopyranoyl (E)-4-hydroxy-3-methylbut-2-enyl benzoate, based on its nuclear magnetic resonance and electrospray ionization-mass spectroscopy data.

Comparison of outcomes after laparoscopy-assisted and open total gastrectomy for early gastric cancer

BACKGROUND

The aim of this study was to compare the results of laparoscopy-assisted total gastrectomy with those of open total gastrectomy for early gastric cancer.

METHODS

Patients with gastric cancer who underwent total gastrectomy with curative intent in three Korean tertiary hospitals between January 2003 and December 2010 were included in this multicentre, retrospective, propensity score-matched cohort study. Cox proportional hazards regression models were used to evaluate the association between operation method and survival.

RESULTS

A total of 753 patients with early gastric cancer were included in the study. There were no significant differences in the matched cohort for overall survival (hazard ratio (HR) for laparoscopy-assisted versus open total gastrectomy 0.96, 95 per cent c.i. 0.57 to 1.65) or recurrence-free survival (HR 2.20, 0.51 to 9.52). The patterns of recurrence were no different between the two groups. The severity of complications, according to the Clavien-Dindo classification, was similar in both groups. The most common complications were anastomosis-related in the laparoscopy-assisted group (8.0 per cent versus 4.2 per cent in the open group; P = 0.015) and wound-related in the open group (1.6 versus 5.6 per cent respectively; P = 0.003). Postoperative death was more common in the laparoscopy-assisted group (1.6 versus 0.2 per cent; P = 0.045).

CONCLUSION

Laparoscopy-assisted total gastrectomy for early gastric cancer is feasible in terms of long-term results, including survival and recurrence. However, a higher postoperative mortality rate and an increased risk of anastomotic leakage after laparoscopic-assisted total gastrectomy are of concern.

Transcriptomic analysis of colistin-susceptible and colistin-resistant isolates identifies genes associated with colistin resistance in Acinetobacter baumannii

The emergence of colistin-resistant Acinetobacter baumannii is concerning, as colistin is often regarded as the last option for treating multidrug-resistant (MDR) A. baumannii infections. Using mRNA sequencing, we compared whole transcriptomes of colistin-susceptible and colistin-resistant A. baumannii strains, with the aim of identifying genes involved in colistin resistance. A clinical colistin-susceptible strain (06AC-179) and a colistin-resistant strain (07AC-052) were analysed in this study. In addition, a colistin-resistant mutant (06AC-179-R1) derived from 06AC-179 was also included in this study. High throughput mRNA sequencing was performed with an Illumina HiSeq TM 2000. In total, six genes were identified as associated with colistin resistance in A. baumannii. These six genes encode PmrAB two-component regulatory enzymes, PmrC (a lipid A phosphoethanolamine transferase), a glycosyltransferase, a poly-β-1,6-N-acetylglucosamine deacetylase, and a putative membrane protein. Matrix-assisted laser desorption/ionization time of flight mass spectrometry revealed that all three colistin-resistant strains used in this study had modified lipid A structure by addition of phosphoethanolamine. As genes found in our results are all associated with either lipopolysaccharide biosynthesis or electrostatic changes in the bacterial cell membrane, lipopolysaccharide modification might be one of the principal modes of acquisition of colistin resistance in some A. baumannii strains.

In vitro antioxidative and binding properties of phenolics in traditional, citrus and exotic fruits

Many polyphenols bind proteins, therefore our research was focused on the potential of protein binding to polyphenols of investigated fruits and their health-related effects. The contents of polyphenols and related antioxidant activities of traditional, citrus and exotic fruits were compared. The presence of polyphenols (flavonoids and phenolic acids) in the investigated samples and their interaction with human serum albumin (HSA) was studied by HPLC, Fourier Transform Infrared (FT-IR) and three dimensional fluorescence spectroscopy (3D-FL). The highest levels of polyphenols, antioxidant and binding capacities were found in red and blond grapefruits (citrus group), followed by strawberries and apples (traditional group) and mangosteen and kiwi fruit (exotic fruit), which also contained the highest levels of protocatechuic, p-coumaric, ferulic acids and quercetin. In conclusion, for the first time, the interaction of the polyphenols with human serum albumin was evaluated by fluorometry/FTIR. The obtained binding profiles allowed the comparison of three different groups of fruits. A mixture of these fruits can be recommended for consumption.

Gain Correction for an X-ray Imaging System With a Movable Flat Panel Detector and Intrinsic Localization Crosshair

Gain calibration for X-ray imaging systems with a movable flat panel detector and an intrinsic crosshair is a challenge due to the geometry-dependent heel effect and crosshair artifact. This study aims to develop a gain correction method for such systems by implementing the Multi-Acquisition Gain Image Correction technique. Flood field images containing crosshair and heel effect were acquired in 4 different flat panel detector positions at fixed exposure parameters. The crosshair region was automatically detected using common image processing algorithms and removed by a simple interpolation procedure, resulting in a crosshair-removed image. A large kernel-based correction was then used to remove the heel effect. Mask filters corresponding to each crosshair region were applied to the resultant heel effect-removed images to invalidate the pixels of the original crosshair region. Finally, a seamless gain map was composed with corresponding valid pixels from the processed images either by the sequential replacement or by the selective averaging techniques developed in this study. Quantitative evaluation was performed based on normalized noise power spectrum and detective quantum efficiency improvement factor for the flood field images corrected by the Multi-Acquisition Gain Image Correction-based gain maps. For comparison purposes, a single crosshair-removed gain map was also tested. As a result, it was demonstrated that the Multi-Acquisition Gain Image Correction technique achieved better image quality than the crosshair-removed technique, showing lower normalized noise power spectrum values over most of spatial frequencies. The improvement was more obvious at the priori-crosshair region of the gain map. The mean detective quantum efficiency improvement factor was 1.09 ± 0.06, 2.46 ± 0.32, and 3.34 ± 0.36 in the priori-crosshair region and 2.35 ± 0.31, 2.33 ± 0.31, and 3.09 ± 0.34 in the normal region, for crosshair-removed, Multi-Acquisition Gain Image Correction-sequential replacement, and Multi-Acquisition Gain Image Correction-selective averaging techniques, respectively. Therefore, this study indicates that the introduced Multi-Acquisition Gain Image Correction technique is an appropriate method for gain calibration of an imaging system associated with a moving flat panel detector and an intrinsic crosshair.

Isolated fallopian tube torsion during pregnancy: a case report

Isolated fallopian tube torsion is a rare pregnancy-related complication. It is frequently misdiagnosed as acute appendicitis or ovarian torsion owing to the lack of specific symptoms or signs. Here, the authors report a case of a 35-year-old primigravida at 30 weeks and six days of gestation who had presented with right isolated fallopian tube torsion and a history of right oophorectomy. The authors propose that isolated fallopian tube torsion should be included in the list of differential diagnosis when encountered with patients complaining of lower abdominal pain.

Bone regeneration at dental implant sites with suspended stem cells

During the maintenance of bone marrow-derived mesenchymal stem cells (BMMSCs), suspended cells are discarded normally. We noted the osteogenic potential of these cells to be like that of anchorage-dependent BMMSCs. Therefore, we characterized suspended BMMSCs from rabbit bone marrow by bioengineering and applied the suspended BMMSCs to double-canaled dental implants inserted into rabbits. After primary isolation of BMMSCs, we collected the suspended cells during primary culture on the third day. The cells were transferred and maintained on an extracellular-matrix-coated culture plate. The cells were characterized and compared with BMMSCs by colony-forming-unit fibroblast (CFU-f) and cell proliferation assay, fluorescence-activated cell sorter (FACS), in vitro multipotency, and reverse transcription polymerase chain reaction (RT-PCR). We also analyzed the osteogenic potential of cells mixed with hydroxyapatite/tricalcium phosphate (HA/TCP) and transplanted into immunocompromised mice. We compared the viability and proliferation of the suspended BMMSCs and BMMSCs on the titanium implant surface and observed cell morphology. Then, the cells mixed with HA/TCP were applied to the double-canaled implants during installation into rabbit tibia. Four weeks later, we analyzed bone formation inside the canal by histomorphometry. The suspended cells showed higher CFU-f on the extracellular matrix (ECM)-coated culture plate and similar results of proliferation capacity compared with BMMSCs. The cells also showed osteogenic, adipogenic, and chondrogenic ability. The suspended cells showed levels of attachment survival and proliferation on the surfaces of titanium implant discs to be higher than or similar to those of BMMSCs. The suspended cells as well as BMMSCs showed stronger bone formation ability in both upper and lower canals of the implants compared with controls on double-canaled implants inserted into rabbit tibia. In this study, we showed that suspended cells after primary BMMSC isolation have bone regeneration capacity like that of BMMSCs, not only in vitro but also in vivo. ECM was valuable for propagation of MSCs for cell-based bone regeneration. Therefore, the suspended cells could also be useful tools for bone regeneration after implant surgery.

Tumor differentiation is not a risk factor for lymph node metastasis in elderly patients with early gastric cancer

BACKGROUND

The aim of this study was to identify risk factors for lymph node metastasis in elderly patients (70 years or more) with early gastric cancer.

METHODS

We reviewed the prospectively collected database of 6893 patients with early gastric cancer who had undergone curative gastrectomy in 3 tertiary cancer centers between January 2003 and December 2009 in Korea. Patients were sorted into 4 groups according to age: less than 50, fifties, sixties, and 70 years or more. Risk factors for lymph node metastasis in early gastric cancer were analyzed.

RESULTS

One thousand and thirty five patients (15.0%) were 70 years or more. As age increased, the frequency of large differentiated tumor, lymphatic and submucosa invasion increased. Old age was associated with a lower risk for lymph node metastasis in patients with early gastric cancer (Odds ratio [OR], OR, 0.622; 95% CI, 0.5466-0.830, P = 0.010). Ulceration or differentiation of tumor was not associated with lymph node metastasis in elderly patients with early gastric cancer.

CONCLUSIONS

Elderly patients with undifferentiated type histology early gastric cancer without other risk factors for lymph node metastasis may be candidates for endoscopic resection.

A new plan quality index for dose painting radiotherapy

Dose painting radiotherapy is considered a promising radiotherapy technology that enables more targeted dose delivery to tumor rich regions while saving critical normal tissues. Obviously, dose painting planning would be more complicated and hard to be evaluated with current plan quality index systems that were developed under the paradigm of uniform dose prescription. In this study, we introduce a new plan quality index, named “index of achievement (IOA)” that assesses how close the planned dose distribution is to the prescribed one in a dose painting radiotherapy plan. By using voxel‐based comparison between planned and prescribed dose distributions in its formulation, the index allows for a single‐value evaluation regardless of the number of prescribed dose levels, which cannot be achieved with the conventional indices such as conventional homogeneity index. Benchmark calculations using patient data demonstrated feasibility of the index not only for contour‐based dose painting plans, but also for dose painting by numbers plans. Also, it was shown that there is strong correlation between the new index and conventional indices, which indicates a potential of the new index as an alternative to conventional ones in general radiotherapy plan evaluation.

PACS number: 87.55.D‐

Dosimetric effect of CT contrast agent in CyberKnife treatment plans

Background

To investigate the effect of computed tomography (CT) contrast enhancement (CE) on the 3D dose distributions of non-coplanar small field beams in the CyberKnife (CK) treatment planning system (TPS) for the stereotactic ablative radiotherapy (SABR).

Methods

Twenty-two pre-CE CT treatment plans were recruited to this retrospective plan study. Their post-CE CT plans were based on the pre-CE CT plan data and calculated using the same MU and beam paths in either Ray-Tracing or Monte Carlo (MC) algorithms. The differences in the doses of the beam path and the reference point between the pre- and post-CE CT plans were compared. The minimum, maximum, and mean doses in dose-volume histograms (DVHs) of target and organs-at-risk (OARs) were also compared.

Results

The dose differences between the pre- and post-CE plans in a single beam path were less than 1.05% in both calculation algorithms, with respect to the prescription dose. At the center of the target volume, it was 1.9% (maximum 6.2%) in Ray-Tracing and 1.6% (maximum 4.0%) in MC. The CA effect showed on average 1.2% difference in the OAR maximum dose (maximum 7.8% in Ray-Tracing and 7.2% in MC). In the lung cases, the CT CE resulted in a dose difference of 2.4% (from 1.0% to 6.5%) without the calculation algorithm effect (maximum 20.3%).

Conclusions

The CK treatment plan using the post-CE CT generally afforded less than 2% dose differences from the pre-CE CT plan. However, it could be up to 7.8% depending on the target positions in a body and be more than 20% with the calculation algorithms. Thus, the post-CE CT in CK treatment plans should be used with careful consideration for the CA effect, target position, and calculation algorithm factors.

Development of real-time motion verification system using in-room optical images for respiratory-gated radiotherapy

Phase‐based respiratory‐gated radiotherapy relies on the reproducibility of patient breathing during the treatment. To monitor the positional reproducibility of patient breathing against a 4D CT simulation, we developed a real‐time motion verification system (RMVS) using an optical tracking technology. The system in the treatment room was integrated with a real‐time position management system. To test the system, an anthropomorphic phantom that was mounted on a motion platform moved on a programmed breathing pattern and then underwent a 4D CT simulation with RPM. The phase‐resolved anterior surface lines were extracted from the 4D CT data to constitute 4D reference lines. In the treatment room, three infrared reflective markers were attached on the superior, middle, and inferior parts of the phantom along with the body midline and then RMVS could track those markers using an optical camera system. The real‐time phase information extracted from RPM was delivered to RMVS via in‐house network software. Thus, the real‐time anterior‐posterior positions of the markers were simultaneously compared with the 4D reference lines. The technical feasibility of RMVS was evaluated by repeating the above procedure under several scenarios such as ideal case (with identical motion parameters between simulation and treatment), cycle change, baseline shift, displacement change, and breathing type changes (abdominal or chest breathing). The system capability for operating under irregular breathing was also investigated using real patient data. The evaluation results showed that RMVS has a competence to detect phase‐matching errors between patient's motion during the treatment and 4D CT simulation. Thus, we concluded that RMVS could be used as an online quality assurance tool for phase‐based gating treatments.

PACS number: 87.55.Qr

Simple, direct drug susceptibility testing technique for diagnosis of drug-resistant tuberculosis in resource-poor settings

SETTING

The Korean Institute of Tuberculosis, Seoul, Republic of Korea.

OBJECTIVE

To develop a simple, direct drug susceptibility testing (DST) technique using Kudoh-modified Ogawa (KMO) medium.

DESIGN

The critical concentrations of isoniazid (INH), rifampicin (RMP), kanamycin (KM) and ofloxacin (OFX) for KMO medium were calibrated by comparing the minimal inhibitory concentrations (MICs) against clinical isolates of Mycobacterium tuberculosis on KMO with those on Löwenstein-Jensen (LJ). The performance of the direct KMO DST technique was evaluated on 186 smear-positive sputum specimens and compared with indirect LJ DST.

RESULTS

Agreement of MICs on direct vs. indirect DST was high for INH, RMP and OFX. KM MICs on KMO were ∼10 g/ml higher than those on LJ. The critical concentrations of INH, RMP, OFX and KM for KMO were therefore set at 0.2, 40.0, 2.0, and 40.0 g/ml. The evaluation of direct DST of smear-positive sputum specimens showed 100% agreement with indirect LJ DST for INH and RMP. However, the respective susceptible and resistant predictive values were 98.8% and 100% for OFX, and 100% and 80% for KM.

CONCLUSION

Direct DST using KMO is useful, with clear advantages of a shorter turnaround time, procedural simplicity and low cost compared to indirect DST. It may be most indicated in resource-poor settings for programmatic management of drug-resistant tuberculosis.

Analytical determination of bioactive compounds as an indication of fruit quality

The aim of this investigation was to determine the bioactive compounds in kiwifruit as an indication of quality after extraction using methanol and ethyl acetate. Using FTIR and three-dimensional fluorescence spectroscopy and electrospray ionization/MS, the contents of polyphenols, flavonoids, flavanols, and tannins, and the level of the antioxidant activity by 2, 2-azino-bis (3-ethyl-benzothiazoline-6-sulfonic acid) diammonium salt, 1, 1-diphenyl-2-picrylhydrazyl, ferric-reducing/ antioxidant power, and cupric reducing antioxidant capacity assays were determined and compared. It was found that the methanol extracts of kiwifruit showed significantly higher amounts of bioactive acetate extracts. The cultivar Bidan, in comparison compounds and antioxidant activities than the ethyl with the classic Hayward, showed significantly higher bioactivity. For the first time, Bidan organic kiwifruit was analyzed for its antioxidant activities and compared with the widely consumed Hayward organic based on its bioactive compounds and fluorescence properties. Relatively high content of bioactive compounds and positive antioxidant and antiproliferative properties of kiwifruit determined by the advanced analytical methods justify its use as a source of valuable antioxidants. The methods used are applicable for bioactivity determination, in general, for any food products.

Nutritional and pharmaceutical properties of bioactive compounds in organic and conventional growing kiwifruit

The bioactivity of two kiwifruit's cultivars growing under organic and conventional conditions were studied and compared. The bioactive compounds were extracted with water and ethanol using similar conditions which are applied in pharmaceutical applications and for daily fruit consumption such as tea drink. Antioxidant radical scavenging assays [ferric-reducing/antioxidant power (FRAP); cupric reducing antioxidant capacity (CUPRAC); 2, 2-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS)], fourier transform infrared (FT-IR) and ultraviolet spectroscopy, two (2D-FL) and three-dimensional (3D-FL) fluorometry were used for the detection of biologically active metabolites derived from kiwifruits (total phenols, flavonoids, chlorophylls, carotenoids and ascorbic acid). The correlation between the total phenol content (TPC) and other bioactive compounds, and their total antioxidant capacities (TAC) was calculated for studied kiwifruit's extracts. The interaction between drugs and human serum albumin (HSA) plays an important role in the distribution and metabolism of drugs. The properties of kiwifruit's phenol extracts showed their ability to quench HSA, forming the complexes similar to the ones between the proteins and pure flavonoids such as quercetin. The cultivar 'Bidan' exhibited significantly higher TAC than the classic 'Hayward'. In conclusion, for the first time 'Bidan' organic kiwifruit was analyzed and compared with widely consumed 'Hayward', using its bioactive and fluorescence properties. The influence of physiologically active kiwifruit's compounds on human health, through our investigations in vitro and scientifically proven information, was explained. Relatively high content of bioactive compounds, high antioxidant and fluorescence properties of kiwifruit justify its use as a source of valuable antioxidants.

Organic and conventional kiwifruit, myths versus reality: antioxidant, antiproliferative, and health effects

Comparison between organic and conventional kiwifruit cultivars 'Hayward' and 'Bidan', which was done by four radical scavenging assays, ESI-MS, and DSC measurements, showed significant differences between the cultivars. Such results were not estimated in kiwifruit growing under organic and conventional conditions. The extraction of bioactive compounds was done by two different methods: sequential extraction with ethyl acetate followed by methanol and maceration with methanol and ethyl acetate. The highest yield of polyphenols was found in the new cultivar 'Bidan' in comparison with the classic 'Hayward', by direct extraction with methanol. This is the first investigation of 'Bidan' kiwifruit cultivar, grown under organic conditions and compared with 'Hayward' organic. High contents of bioactive compounds and antioxidant and antiproliferative properties of the two kiwifruit cultivars justify their use as sources of valuable antioxidants. It is necessary to continue this study as a long-term experiment to eliminate the influence of seasonality.

Quasi-breath-hold technique using personalized audio-visual biofeedback for respiratory motion management in radiotherapy

PURPOSE

To introduce a respiratory motion management technique, so called quasi-breath-hold (QBH) technique and evaluate its feasibility. As a hybrid technique combining free-breathing-based gating (denoted as gating for convenience) and breath-hold (BH), the QBH is designed to overcome typical limitations existing in either one such as phase-shift, residual motion, complexity, and discomfort.

METHODS

The QBH is realized using an audio-visual biofeedback system (AVBFS) and a respiratory motion management program (RMMP). The AVBFS, consisting of two infra-red stereo cameras and a head mounted display, monitors respiratory motion and provides dynamic feedback to patients. The RMMP establishes a personalized respiration model based on deep free breathing. The model is further processed to generate a QBH model by inserting a short breath-hold period into the end point of the-end-of-expiration phase. Then the patient is guided to follow the QBH model through the AVBFS. A simulation study with ten volunteers was performed to evaluate the feasibility of the proposed technique. In the simulation, an in-house developed macro program automatically controlled the QBH procedure to virtually deliver an intensity modulated radiation therapy (IMRT) plan. For each volunteer subject, three QBH maneuvers with different breath-hold times of 3, 5, and 7s (denoted as QBH3s, QBH5s, and QBH7s, respectively) and a conventional gating maneuver with 30% duty cycle (for comparison purpose) were applied. External respiration motion signals obtained during the gating window were analyzed to obtain mean absolute error (MAE) between the measured and guiding curve, mean absolute deviation (MAD) of the measured curve, and an inverse uncertainty time histogram (IUTH).

RESULTS

Every volunteer successfully performed all of the four maneuvers (1 gating and 3 QBH patterns). The average treatment times were 466.8, 452.3, and 430.8 s for the QBH3s, QBH5s, and QBH7s, respectively, compared to 530.4 s for the gating technique. The mean absolute errors between measured and guiding curve during the gating window were 0.9 +/- 0.7, 0.8 +/- 0.6, 0.7 +/- 0.6, and 0.6 +/- 0.7 mm for the gating, QBH3s, QBH5s, and QBH7s, respectively. The mean absolute deviations of the measured curve during the gating window were 0.7 +/- 0.7, 0.5 +/- 0.5, 0.5 +/- 0.4, and 0.5 +/- 0.6 mm for the gating, QBH3s, QBH5s, and QBH7s, respectively. In the analysis of the IUTH during the gating window, the QBH simulations showed similar (QBH3s) or less (QBH5s and QBH7s) motion uncertainties compared to the gating simulation.

CONCLUSIONS

The proposed QBH technique with personalized audio-visual biofeedback was feasible for respiratory motion management. It showed equivalent or less motion uncertainty and shorter treatment time than the conventional free-breathing-based gating technique did. The technique is expected to optimally compromise between patient comfort and treatment efficiency.