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Lu M, Ding J, Zhang Y, Gu X, Liu J, Wang Q, Qiu X, Yu H, Du F, Zhang W. Fe-coordinated carbon dots with single atom nanozyme catalytic activity for synergistic catalytic/chemo-therapy in breast cancer. Int J Biol Macromol 2024; 283:137776. [PMID: 39577541 DOI: 10.1016/j.ijbiomac.2024.137776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 11/06/2024] [Accepted: 11/15/2024] [Indexed: 11/24/2024]
Abstract
Single atom nanozyme (SAzyme) based on carbon dots (CDs) has showed great potential in oncotherapy via ultrasmall size-reinforced atomically dispersed catalytic sites. However, its curative effect is still unsatisfactory due to complex tumor microenvironment and intrinsic resistance. Herein, a coordinated carbon dots (CCDs)-integrated ZIF-8 nanoassembly (Ru/CCDs-PTX@ZIF) was constructed by loading paclitaxel and coating with rutin for synergistic catalytic/chemotherapy. Benefiting from inherited metal-polyphenol coordination, the CCDs exhibited superior peroxidase-like (POD) activity and served as a SAzyme to produce large amounts of hydroxyl radical, resulting in radical-dependent cell cycle arrest. With the assistance of GLUT receptor-mediated endocytosis, the Ru/CCDs-PTX@ZIF triggered the tumor-targeted killing and migration inhibition to suppress tumor progression. This study highlights a promising avenue to broaden the design and applications of CDs-based SAzyme in tumor treatment.
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Dang XZ, Gao Y, Gu X, Ju Y, Yi DS, Lin H, Ren Y, Yuan XJ, Song HP. [Prospective multicenter cohort study on breast cancer screening using an automated breast ultrasound with remote reading]. ZHONGHUA ZHONG LIU ZA ZHI [CHINESE JOURNAL OF ONCOLOGY] 2024; 46:1067-1075. [PMID: 39622739 DOI: 10.3760/cma.j.cn112152-20240204-00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
Objective: To construct a remote screening network for breast cancer based on automated breast ultrasound (ABUS) and explore the value of ABUS with remote reading for breast cancer screening. Methods: We constructed a remote breast cancer screening network including one remote reading center and 48 image-acquisition centers. We recruited women to participate in breast cancer screening at one of these image-acquisition centers from January 2021 to January 2023. The technicians collected the whole breast images using the ABUS. The images were then sent to the reading center through the PVBUS System and interpreted independently by two radiologists using the Breast Imaging Reporting and Data System (BI-RADS). BI-RADS categories 1 and 2 indicate negative screening results, and women diagnosed with these categories were recommended for annual breast ultrasound screening. BI-RADS categories 3, 4, and 5 indicate positive results. Women with BI-RADS category 3 lesions were recommended for follow-up examinations every 6 months using ABUS or handheld ultrasound, while those with BI-RADS 4 and 5 lesions were suggested to undergo pathological examinations. Results: In our study, we enrolled 10 344 women who completed the ABUS screening and were followed up for more than 12 months. After remote reading, 6 164 women were diagnosed with BI-RADS category 1 and 2 626 woman were within BI-RADS category 2. In contrast, 1 404 women were within BI-RADS category 3, a total of 135 women were within BI-RADS category 4, and 15 women were within BI-RADS category 5. The positive screening rate of ABUS was 15.0% (1 554/10 344). The ABUS with remote reading had a detection rate of 3.7/1 000 (38/10 344) for breast cancer screening, with a sensitivity of 97.4% (38/39) and a specificity of 85.3% (8 789/10 305). Among the 38 breast cancer cases detected, 92.1% (35/38) were invasive carcinomas, and 63.2% (24/38) were stage 0 or Ⅰ breast cancers. Conclusions: Breast cancer screening based on ABUS with remote reading provided an efficient and feasible solution to the problem of unevenly distributed medical resources and medical staff levels in various regions of China, enabling the decentralization of high-quality medical resources and improving the accessibility of high-quality screening services. It has provided an alternative for breast cancer screening in China.
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Kaltsouni E, Gu X, Wikström J, Hahn A, Lanzenberger R, Sundström-Poromaa I, Comasco E. White matter integrity upon progesterone antagonism in individuals with premenstrual dysphoric disorder: A randomized placebo-controlled diffusion tensor imaging study. Prog Neuropsychopharmacol Biol Psychiatry 2024; 136:111179. [PMID: 39454851 DOI: 10.1016/j.pnpbp.2024.111179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 09/04/2024] [Accepted: 10/20/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND Premenstrual dysphoric disorder (PMDD) is a depressive disorder triggered by fluctuations of progesterone and estradiol during the luteal phase of the menstrual cycle. Selective progesterone receptor modulation (SPRM), while exerting an antagonistic effect on progesterone and maintaining estradiol on moderate levels, has shown beneficial effects on the mental symptoms of PMDD. Progesterone is also known for its neuroprotective effects, while synthetic progestins have been suggested to promote myelination. However, the impact of SPRM treatment on white matter microstructure is unexplored. METHODS Diffusion tensor imaging was employed to collect data on white matter integrity in patients with PMDD, before and after treatment with ulipristal acetate (an SPRM) or placebo, as part of a double-blind randomized controlled-trial. Tract based spatial statistics were performed to investigate SPRM treatment vs. placebo longitudinal effects on fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD), on the whole white matter skeleton. RESULTS Voxel-wise analyses indicated no change over time in any white matter microstructure metrics in individuals treated with SPRM versus placebo. Improvement in PMDD symptoms did not correlate with changes in white matter microstructure. In secondary, exploratory, cross-sectional comparisons during treatment, the SPRM group displayed lower FA and higher MD, RD, and AD than the placebo group in several tracts. CONCLUSION The main findings suggest that SPRM treatment did not impact white matter microstructure compared with placebo. However, secondary exploratory analyses yielded between-group differences after treatment, which call for further investigation on the tracts potentially impacted by progesterone antagonism. CLINICAL TRIAL REGISTRATION EUDRA-CT 2016-001719-19; "Selective progesterone receptor modulators for treatment of premenstrual dysphoric disorder. A randomized, double-blind, placebo-controlled study."; https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-001719-19/SE.
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Gu X, Guo XB, Li WH, Jiang YP, Liu QX, Tang XG. High-Entropy Materials for Application: Electricity, Magnetism, and Optics. ACS APPLIED MATERIALS & INTERFACES 2024; 16:53372-53392. [PMID: 39324826 DOI: 10.1021/acsami.4c11898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
High-entropy materials (HEMs) have recently emerged as a prominent research focus in materials science, gaining considerable attention because of their complex composition and exceptional properties. These materials typically comprise five or more elements mixed approximately in equal atomic ratios. The resultant high-entropy effects, lattice distortions, slow diffusion, and cocktail effects contribute to their unique physical, chemical, and optical properties. This study reviews the electrical, magnetic, and optical properties of HEMs and explores their potential applications. Additionally, it discusses the theoretical calculation methods and preparation techniques for HEMs, thereby offering insights and prospects for their future development.
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Lin Y, Luo Z, Gu X, Deng Y, Guo P, Chen G, Wang W, Wang M. Optimizing mangrove afforestation: Mollusc biodiversity comparisons reveal optimal mudflat-mangrove area ratio. Ecol Evol 2024; 14:e70330. [PMID: 39310728 PMCID: PMC11416864 DOI: 10.1002/ece3.70330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/31/2024] [Accepted: 09/08/2024] [Indexed: 09/25/2024] Open
Abstract
In recent decades, mangrove wetlands globally have suffered from human activities and climate change, leading to issues like area reduction, degraded ecological functions and declining biodiversity. Restoration efforts, primarily through mangrove afforestation (i.e. mangrove plantation in mudflats), have been widespread, yet they often overlook the significance of unvegetated mudflats. In addition, under the condition that the total area of suitable mudflats is limited, the problem of what is the threshold of mangrove forests and unvegetated mudflats to better protect mangrove biodiversity has not been solved. Therefore, this study conducted a field survey of molluscs in mangrove wetlands in Hainan Island in China and explored the relative importance of mangroves and unvegetated mudflats through taxonomic alpha diversity and functional diversity. The results showed that (1) mollusc abundance of unvegetated mudflats was notably higher than this of mangrove forests, and the species richness, functional richness and functional vulnerability were significantly lower than those of mangrove forests; (2) the abundance and functional vulnerability of molluscs were mainly affected by sediment properties (pH, interstitial water salinity, median diameter, total nitrogen, C/N ratio), while the species richness and functional richness of molluscs were primarily influenced by vegetation structure (plant density); and (3) retaining at least 20% of the unvegetated mudflat area could well protect the biodiversity of mangrove wetlands. To our knowledge, our study is the first to propose the proportion of mangrove forests and unvegetated mudflats on the basis of benthic biodiversity, providing theoretical support and decision-making reference for mangrove protection and restoration.
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Gu X, Yang M. Abstracts of the 34th World Congress on Ultrasound in Obstetrics and Gynecology, 15-18 September 2024, Budapest, Hungary. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64 Suppl 1:96. [PMID: 39249350 DOI: 10.1002/uog.27986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
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Gu X, Wu D, Zhang Z, Peng G, Ni A, Wang B, Xiong X, Liu Y, Wang L. Public Attitudes towards and Management Strategies for Community Cats in Urban China. Animals (Basel) 2024; 14:2301. [PMID: 39199835 PMCID: PMC11350748 DOI: 10.3390/ani14162301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 09/01/2024] Open
Abstract
Managing community cats in urban China is a contentious and emerging issue, with debates centering on the most effective and humane approaches. This study aimed to investigate public attitudes towards community cats and various management strategies. A survey was conducted involving 5382 urban residents in China. Their attitudes towards the positive and negative roles of community cats in urban areas and their support for different management methods were examined, including trap-and-kill, taking no action, centralized management, and trap-neuter-return (TNR) and its variations. Results indicated that 63% of participants were willing to coexist with community cats, 71% opposed trap-and-kill, and 61% agreed or strongly agreed with the TNR method and its variations. Older residents or those with higher incomes were more likely to support coexistence with community cats. In contrast, younger or lower-income residents were more likely to support non-coexistence. Residents in first- or second-tier cities (e.g., Beijing, Hangzhou, and Jinan Cities in China) were more inclined to support trap-and-kill and less likely to support coexistence than their counterparts in fourth-tier cities (e.g., county-level cities in China). Moreover, those with lower education or incomes were more supportive of trap-and-kill and taking no action as the methods to manage community cats than those with relatively higher education or incomes. Those with higher incomes held more positive attitudes towards community cats and were more supportive of TNR and its variations than their counterparts with lower incomes. Males were more inclined to support trap-and-kill and taking no action and less inclined to support centralized management and TNR than females. The implications of the findings on TNR with adoption programs in urban China are discussed. These novel findings underscore the need for targeted educational campaigns to promote humane and effective management strategies, addressing public concerns and community cats' welfare. The study's insights are critical for informing policy and improving community cat management in urban China.
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Guo P, Lin Y, Sheng Y, Gu X, Deng Y, Zhang Y, Wang W, Wang M. Comparison of the coexistence pattern of mangrove macrobenthos between natural and artificial reforestation. Ecol Evol 2024; 14:e70069. [PMID: 39091331 PMCID: PMC11289789 DOI: 10.1002/ece3.70069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/30/2024] [Accepted: 07/11/2024] [Indexed: 08/04/2024] Open
Abstract
The abandoned pond-to-mangrove restoration project provides greater advantages than tidal flats afforestation in restoring mangrove ecosystem services and will be the primary method for mangrove restoration in the future. The existing methods for abandoned pond-to-mangrove restoration include artificial restoration through 'dike-breaking, filling with imported soil and tree planting' and natural restoration through 'dike-breaking and natural succession'. However, little is known about which restoration strategy (natural or artificial restoration) provides more benefits to the biodiversity of mangrove macrobethos. Given a prevailing view suggested that artificial restoration should be the preferred approach for accelerating recovery of biodiversity and vegetation structure in tropical regions, we hypothesised higher macrobenthic biodiversity and more complex community structure in artificial restoration than in natural restoration. To test this hypothesis, macrobenthic biodiversity and ecological processes were monitored in a typical abandoned pond-to-mangrove area of Dongzhaigang Bay, China, where artificial and natural restoration methods were used concurrently. Differences in macrobenthic biodiversity, community structure and ecological processes were compared using diversity indices, complex network analysis and null models. Similar species composition and ecological niche overlap and width among macrobenthos were observed at artificial and natural restoration sites. The biotic heterogeneity and interaction among macrobenthos were higher at the natural restoration sites than at the artificial restoration sites. Macrobenthos community assembly at natural and artificial restoration sites was both determined by deterministic processes, with environmental filtering dominating, which explained 52% and 54% of the variations in macrobenthic community structures respectively. Although our findings did not validate the research hypothesis, higher biotic heterogeneity and species interaction among macrobenthos could support natural restoration as the primary method for abandoned pond-to-mangrove projects, because it is a nature-based solution for mangrove restoration.
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Wang Q, Gu X, Yang L, Jiang Y, Zhang J, He J. Emerging perspectives on precision therapy for Parkinson's disease: multidimensional evidence leading to a new breakthrough in personalized medicine. Front Aging Neurosci 2024; 16:1417515. [PMID: 39026991 PMCID: PMC11254646 DOI: 10.3389/fnagi.2024.1417515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
PD is a prevalent and progressive neurodegenerative disorder characterized by both motor and non-motor symptoms. Genes play a significant role in the onset and progression of the disease. While the complexity and pleiotropy of gene expression networks have posed challenges for gene-targeted therapies, numerous pathways of gene variant expression show promise as therapeutic targets in preclinical studies, with some already in clinical trials. With the recognition of the numerous genes and complex pathways that can influence PD, it may be possible to take a novel approach to choose a treatment for the condition. This approach would be based on the symptoms, genomics, and underlying mechanisms of the disease. We discuss the utilization of emerging genetic and pathological knowledge of PD patients to categorize the disease into subgroups. Our long-term objective is to generate new insights for the therapeutic approach to the disease, aiming to delay and treat it more effectively, and ultimately reduce the burden on individuals and society.
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Liu XQ, Wang L, Gu X, Shan X, Xie J, Gao WY, Gu YH, Zhang Y, Gu DM. The Experience of Cervical Cancer Patients Undergoing Hysterectomy: A Qualitative Study. J Transcult Nurs 2024; 35:263-270. [PMID: 38634631 DOI: 10.1177/10436596241246976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Due to different social and cultural backgrounds, cervical cancer patients' experience of the treatment process and quality of life after treatment will be different. This study sought to gain in-depth understanding of the experiences of Chinese cervical cancer patients as regards their quality of life and physical symptoms. METHODOLOGY Semi-structured interviews were used to collect data. We recruited 15 women with cervical cancer in eastern China for in-depth interviews. All data were entered into the NVivo 12 software program for analysis. RESULTS Four themes emerged from the data: (a) uncertainty; (b) physical suffering; (c) psychological pressure; and (d) challenges of marriage and family. DISCUSSION Cervical cancer patients showed concerns about the disease itself and the physical discomfort it causes, as well as changes in social relations. Health professionals need to talk about these issues and develop strategies to address them accordingly.
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Chen G, Gu X, Mo Y, Cui B. Monospecific mangrove reforestation changes relationship between benthic mollusc diversity and biomass: Implication for coastal wetland management. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2024; 353:120140. [PMID: 38290263 DOI: 10.1016/j.jenvman.2024.120140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/24/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
Anthropogenic causes are overtaking natural factors to reshape patterns of biodiversity and ecosystem functioning. Mangrove reforestation aimed at reversing losses of mangroves has been conducted worldwide for several decades. However, how reforestation influences the link between ecological processes that shape community diversity and the consequent effects on ecosystem functions such as biomass production is less well known. Here we used data collected before and after mangrove planting to examine the effects of reforestation on molluscan species richness and biomass production by testing the changes in species richness, compositional similarities, distance-decay effects (community similarity decreases with increasing geographical distance) in metacommunity across a regional scale of 480 km (23-27 °N) in southeast Chinese coasts. Additionally, we further detected the impact of landscape configuration caused by different intensities of reforestation on the mollusc community. After the mangrove reforestation, mollusc species richness and biomass increased significantly. The increases in species richness and biomass of mollusc community were mediated by reducing distance-decay effect, indicating an increase in relationship strength between species richness and biomass might be associated with a decrease in distance-decay effect with rising mangrove habitat. We highlight the importance of considering the effects of anthropogenic changes on the relationship between biodiversity and ecosystem functioning. Quantifying the distance-decay effect of these influences enables management decisions about coastal restoration to be based upon ecological mechanisms rather than wishful thinking or superficial appearance.
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Gu X, Zhang Z, Peng G, Ni A, Wang B, Xiong X, Liu Y, Wang L. A Survey of Public Opinion on Community Cats' General Health and Relationship Quality with Residents in Urban China. Animals (Basel) 2024; 14:525. [PMID: 38338168 PMCID: PMC10854670 DOI: 10.3390/ani14030525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
The management and coexistence of community cats in urban areas is a growing concern amid global urbanization. Through a survey-based investigation, we examine the residents' perceptions of the general health of community cats and human-cat relationships in urban China. The data from 5382 participants revealed that approximately 70% of participants perceived community cats as being in good health, and 60% reported harmonious or non-conflict coexistence between residents and these cats. Around 45% of the participants rescued or helped community cats, 38% expressed their intention to adopt, and 18% complained about the issues of community cats to management staff. Linear, logistic, and multilevel-logistic regressions were employed to examine the associations between the types of cities and communities or the participants' socio-demographics and the perceived well-being of community cats or human-cat relationships. The results show that the cats in fourth-tier cities (e.g., county-level cities) had poorer living conditions than in first-tier cities (e.g., Beijing), while the cats in urban village communities (e.g., villages in the city) were less likely to exhibit good health than in ordinary commercial housing communities. The results also show that socio-demographic variables, such as educational attainment, marital status, and income level, predicted participants' relationships with community cats. This study is the first of its kind. It provides valuable insights for stakeholders to develop effective policies and interventions on cat management, emphasizing the need for tailored strategies in diverse urban settings and populations.
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Zhang Y, Liu Y, Gu X, Wang N, Wan J, Zhang Y, Chen L. [Epidemiological and clinical features of newly reported advanced schistosomiasis cases in Sichuan Province from 2011 to 2022]. ZHONGGUO XUE XI CHONG BING FANG ZHI ZA ZHI = CHINESE JOURNAL OF SCHISTOSOMIASIS CONTROL 2024; 35:621-625. [PMID: 38413023 DOI: 10.16250/j.32.1374.2023148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To analyze the epidemiological characteristics of newly reported advanced schistosomiasis cases in Sichuan Province, so as to provide the evidence for analyzing the causes and formulating targeted control measures of newly reported advanced schistosomiasis cases. METHODS Individual case investigation forms for advanced schistosomiasis cases were collected from the Sichuan Provincial Epidemic Annual Report System from 2011 to 2022, and patients' demographics, previous medical history and liver parenchymal grading were retrieved. All advanced schistosomiasis cases' medical records were reviewed, and the subtypes of schistosomiasis-endemic villages where the cases' household registration were, floating population, survival and death and time of death were collected. RESULTS A total of 321 newly reported advanced schistosomiasis cases were found in Sichuan Province from 2011 to 2022, with a male to female ratio of 0.99 to 1. There were 274 cases at ages of over 50 years (85.4%), with the highest proportion seen at ages of 60 to 69 years (87 cases, 27.1%), and splenomegaly was the most common type (180 cases, 56.1%), with no dwarfism type detected. The highest number of cases was reported in 2011 (78 cases), followed by in 2022 (74 cases), and the highest number of cases were reported in Meishan City (199 cases, 62.0%), Dongpo District (131 cases, 40.8%), and hilly subtype areas (136 cases, 42.4%). As of the end of 2022, there were 111 deaths due to advanced schistosomiasis, with the highest number of deaths seen in 2018 (25 deaths), and the highest mortality was seen among patients with the ascites type (41.2%). There were 47 (37.3%), 40 (59.5%) and 4 (23.5%) cases with grade III liver parenchyma among patients with splenomegaly, ascites, and colonic proliferation types, respectively, and there was a significant difference in the grading of III liver parenchyma among three types of patients (H = 12.092, P < 0.05), with more severe liver parenchyma injuries seen among patients with the ascites type than among those with splenomegaly and colonic proliferation type (Z = 24.262 and 44.738, both Padjusted values < 0.05). CONCLUSIONS There have been newly reported advanced schistosomiasis cases in Sichuan Province during recent years, and patients with the ascites type should be given a high priority among advanced schistosomiasis cases in Sichuan Province. Intensified clue surveys are needed for early identification and treatment of advanced schistosomiasis cases, so as to increase the survival rate and improve the quality of life.
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Gu X, Zheng H, Tse CS. Contact with nature for emotion regulation: the roles of nature connectedness and beauty engagement in urban young adults. Sci Rep 2023; 13:21377. [PMID: 38049530 PMCID: PMC10695948 DOI: 10.1038/s41598-023-48756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023] Open
Abstract
Contact with nature has emotional benefits, but the psychological mechanism and potential moderator underlying the association between nature contact and emotion regulation remain unclear. The present study investigated how self-reported frequency of nature contact is associated with the use of emotion regulation strategies and explored the mediating role of nature connectedness (i.e., psychological connection to nature) and the moderating role of engagement with natural beauty. Employing mediation and moderated mediation analyses, in a cross-sectional sample of 2097 young adults aged 18-35 years old (M = 24.01, SD = 4.80) residing in urban China, we obtained three major findings. First, nature connectedness mediated the associations between direct/indirect nature contact and cognitive reappraisal as well as expressive suppression. Second, engagement with natural beauty moderated the path from direct/indirect nature contact to cognitive reappraisal in the mediation models. Third, engagement with natural beauty moderated the path from indirect nature contact to nature connectedness in the mediation models. Our study is the first to reveal mediating and moderating factors in the relationships among direct/indirect contact with nature, nature connectedness, engagement with natural beauty, and emotion regulation strategies. These findings provide support for the emotional health of nature contact and have implications for nature-based education and urban planning.
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Gu X, Shan X, Wang L, Gao WY, Liu XQ. Prevalence of psychological problems among caregivers of children and adolescents with neurodevelopmental disorders during the COVID-19 pandemic: A meta-analysis and systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 143:104632. [PMID: 37976983 DOI: 10.1016/j.ridd.2023.104632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/18/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The COVID-19 pandemic impacted children and adolescents with neurodevelopmental disorders, which caused difficulties and increased caregivers' burden. AIM The objective of this study was to assess the prevalence of psychological problems among caregivers of children and adolescents with neurodevelopmental disorders. Methods and procedures We searched the PubMed, Embase and Web of Science databases for relevant studies published from December 2019 to March 2023. Random effects models were used to calculate the pooled prevalence of psychological problems among caregivers. Subgroup analyses were used to detect potential heterogeneity and sensitivity analyses were performed to evaluate the robustness of the included studies. Egger's and Begg's tests were used to examine publication bias. Outcomes and results Twenty studies involving 14,743 participants were included in this systematic review and meta-analysis. The main psychological problems among caregivers were anxiety (36.6%, 95% confidence interval [CI] 19.6-53.7%), depression (41.1%, 95%CI 35.4-46.8%), and stress (58.9%, 95%CI 45.1-72.7%). There were differences in prevalence by study year, national economic level, continent, and sample size. Conclusions and implications Our study showed that caregivers of children and adolescents with neurodevelopmental disorders had a high prevalence of anxiety, depression, and stress during the COVID-19 pandemic. Therefore, the psychological problems of these caregivers should not be overlooked. We recommend that the government should provide caregivers with more medical and financial assistance. What this paper adds? The current study is the first systematic review and meta-analysis focusing on parents whose children have neurodevelopmental disorders during the COVID-19 pandemic. The results show that the prevalence of psychological problems among caregivers of children with neurodevelopmental disorders is particularly prevalent, which suggests that we should attach importance to the parenting pressure and mental health of this special group.
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Jing S, Dai Z, Wu Y, Liu X, Ren T, Liu X, Zhang L, Fu J, Chen X, Xiao W, Wang H, Huang Y, Qu Y, Wang W, Gu X, Ma L, Zhang S, Yu Y, Li L, Han Z, Su X, Qiao Y, Wang C. Prevalence and influencing factors of depressive and anxiety symptoms among hospital-based healthcare workers during the surge period of the COVID-19 pandemic in the Chinese mainland: a multicenter cross-sectional study. QJM 2023; 116:911-922. [PMID: 37561096 DOI: 10.1093/qjmed/hcad188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/06/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND From November 2022 to February 2023, the Chinese mainland experienced a surge in COVID-19 infection and hospitalization, and the hospital-based healthcare workers (HCWs) might suffer serious psychological crisis during this period. This study aims to assess the depressive and anxiety symptoms among HCWs during the surge of COVID-19 pandemic and to provide possible reference on protecting mental health of HCWs in future infectious disease outbreaks. METHODS A multicenter cross-sectional study was carried out among hospital-based HCWs in the Chinese mainland from 5 January to 9 February 2023. The PHQ-9 (nine-item Patient Health Questionnaire) and GAD-7 (seven-item Generalized Anxiety Disorder Questionnaire) were used to measure depressive and anxiety symptoms. Ordinal logistic regression analysis was performed to identify influencing factors. RESULTS A total of 6522 hospital-based HCWs in the Chinse mainland were included in this survey. The prevalence of depressive symptoms among the HCWs was 70.75%, and anxiety symptoms was 47.87%. The HCWs who perceived higher risk of COVID-19 infection and those who had higher work intensity were more likely to experience depressive and anxiety symptoms. Additionally, higher levels of mindfulness, resilience and perceived social support were negatively associated with depressive and anxiety symptoms. CONCLUSION This study revealed that a high proportion of HCWs in the Chinese mainland suffered from mental health disturbances during the surge of the COVID-19 pandemic. Resilience, mindfulness and perceived social support are important protective factors of HCWs' mental health. Tailored interventions, such as mindfulness practice, should be implemented to alleviate psychological symptoms of HCWs during the COVID-19 pandemic or other similar events in the future.
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Gu X, Li K, Zhang M, Chen Y, Zhou J, Yao C, Zang Y, He J, Wan J, Guo B. Aspartyl-tRNA synthetase 2 orchestrates iron-sulfur metabolism in hematopoietic stem cells via fine-tuning alternative RNA splicing. Cell Rep 2023; 42:113264. [PMID: 37838946 DOI: 10.1016/j.celrep.2023.113264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/10/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
Aspartyl-tRNA synthetase 2 (Dars2) is involved in the regulation of mitochondrial protein synthesis and tissue-specific mitochondrial unfolded protein response (UPRmt). The role of Dars2 in the self-renewal and differentiation of hematopoietic stem cells (HSCs) is unknown. Here, we show that knockout (KO) of Dars2 significantly impairs the maintenance of hematopoietic stem and progenitor cells (HSPCs) without involving its tRNA synthetase activity. Dars2 KO results in significantly reduced expression of Srsf2/3/6 and impairs multiple events of mRNA alternative splicing (AS). Dars2 directly localizes to Srsf3-labeled spliceosomes in HSPCs and regulates the stability of Srsf3. Dars2-deficient HSPCs exhibit aberrant AS of mTOR and Slc22a17. Dars2 KO greatly suppresses the levels of labile ferrous iron and iron-sulfur cluster-containing proteins, which dampens mitochondrial metabolic activity and DNA damage repair pathways in HSPCs. Our study reveals that Dars2 plays a crucial role in the iron-sulfur metabolism and maintenance of HSPCs by modulating RNA splicing.
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Gonçalves M, Khera T, Otu HH, Narayanan S, Dillon ST, Shanker A, Gu X, Jung Y, Ngo LH, Marcantonio ER, Libermann TA, Subramaniam B. Multivariable model of postoperative delirium in cardiac surgery patients: proteomic and demographic contributions. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.30.23289741. [PMID: 37333093 PMCID: PMC10274980 DOI: 10.1101/2023.05.30.23289741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Delirium following cardiac surgery is common, morbid, and costly, but may be prevented with risk stratification and targeted intervention. Preoperative protein signatures may identify patients at increased risk for worse postoperative outcomes, including delirium. In this study, we aimed to identify plasma protein biomarkers and develop a predictive model for postoperative delirium in older patients undergoing cardiac surgery, while also uncovering possible pathophysiological mechanisms. Methods SOMAscan analysis of 1,305 proteins in the plasma from 57 older adults undergoing cardiac surgery requiring cardiopulmonary bypass was conducted to define delirium-specific protein signatures at baseline (PREOP) and postoperative day 2 (POD2). Selected proteins were validated in 115 patients using the ELLA multiplex immunoassay platform. Proteins were combined with clinical and demographic variables to build multivariable models that estimate the risk of postoperative delirium and bring light to the underlying pathophysiology. Results A total of 115 and 85 proteins from SOMAscan analyses were found altered in delirious patients at PREOP and POD2, respectively (p<0.05). Using four criteria including associations with surgery, delirium, and biological plausibility, 12 biomarker candidates (Tukey's fold change (|tFC|)>1.4, Benjamini-Hochberg (BH)-p<0.01) were selected for ELLA multiplex validation. Eight proteins were significantly altered at PREOP, and seven proteins at POD2 (p<0.05), in patients who developed postoperative delirium compared to non-delirious patients. Statistical analyses of model fit resulted in the selection of a combination of age, sex, and three proteins (angiopoietin-2 (ANGPT2); C-C motif chemokine 5 (CCL5); and metalloproteinase inhibitor 1 (TIMP1); AUC=0.829) as the best performing predictive model for delirium at PREOP. The delirium-associated proteins identified as biomarker candidates are involved with inflammation, glial dysfunction, vascularization, and hemostasis, highlighting the multifactorial pathophysiology of delirium. Conclusion Our study proposes a model of postoperative delirium that includes a combination of older age, female sex, and altered levels of three proteins. Our results support the identification of patients at higher risk of developing postoperative delirium after cardiac surgery and provide insights on the underlying pathophysiology. ClinicalTrials.gov ( NCT02546765 ).
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Yang Z, Zamarud A, Marianayagam N, Park D, Yener U, Soltys SG, Chang SD, Meola A, Lu W, Gu X. Overall Survival Prediction in Stereotactic Radiosurgery Patients with Glioblastoma Via a Deep-Learning Approach. Int J Radiat Oncol Biol Phys 2023; 117:e159. [PMID: 37784752 DOI: 10.1016/j.ijrobp.2023.06.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Accurate and automated early survival prediction is critical for glioblastoma (GBM) patients as their poor prognosis requires timely treatment decision-making. We have developed a deep learning (DL)-based GBM overall survival (OS) prediction model based on a multi-institutional public dataset using only pre-operative basic structural multi-parametric magnetic resonance images (MRIs). The purpose of this study is to evaluate this DL-based OS prediction model with an institutional stereotactic radiosurgery (SRS) clinical trial dataset. MATERIALS/METHODS The task of this study is to classify GBM patients into 3 OS classes: long-survivors (>15 months), mid-survivors (between 10 and 15 months) and short-survivors (< 10 months). The proposed OS prediction model is an ensemble of a ResNet-based classifier and a K-NN classifier. The ResNet-based classifier is trained in a Siamese fashion to explore inter-class differences. During testing, training sample features are implemented with a K-NN classifier to ensemble with the ResNet-based classifier. A public dataset from Medical Image Computing and Computer Assisted Intervention (MICCAI) Brain Tumor Segmentation (BraTS) challenge 2020 (235 patients) were used for model establishing and initial validation. Then the validated model was evaluated on 19 GBM patients from an institutional SRS clinical trial. Each data entry consists of pre-operative basic structural multi-parametric MRIs and survival days, as well as patient ages for BraTS data and basic clinical characteristics for institutional data. GBM sub-regions, including contrast-enhancing tumor, peri-tumoral edema, and necrotic/non-enhancing tumor core, were segmented in the multi-parametric MRIs by an in-house DL model for both datasets. The OS prediction model was trained on 90% of the segmented BraTS data and validated on the rest 10%, then further evaluated on the institutional data. The model performance was assessed by prediction accuracy (ACC) and the area under the curve (AUC). RESULTS For this 3-class OS classification task, our DL-based prediction model achieved an ACC of 65.22% and an AUC of 0.81 on the BraTS dataset compared with the top-ranked result from the BraTS challenge 2020 (Rank 1st: ACC 61.7%), and an ACC of 52.63% and an AUC of 0.69 on the institutional dataset. Further analysis of the institutional dataset found that the predicted OS class had a statistically significant correlation with treatment volume (p = 0.012) and age (p = 0.006), which matches the analysis that the patients' ground truth OS class is statistical significantly correlated with treatment volume (p = 0.045). CONCLUSION Our DL-based OS prediction model for GBM using basic structural multi-parametric pre-operative MRIs has demonstrated promising performance in both public and institutional dataset with minimal manual processing requirements. This OS prediction model can be potentially applied to assist timely clinical decision-making.
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Montalvo SK, Ravella R, Zhang-Velten ER, Li X, Desai NB, Dan T, Timmerman RD, Jiang SB, Gu X, Parsons DDM, Kumar KA. Cardiac Sparing with Volumetric Modulated Arc Therapy Enabled Total Body Irradiation (CS VMAT-TBI). Int J Radiat Oncol Biol Phys 2023; 117:e477-e478. [PMID: 37785513 DOI: 10.1016/j.ijrobp.2023.06.1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Volumetric modulated arc therapy (VMAT) enabled total body irradiation (TBI) has replaced conventional TBI in our institution given the improved treatment accuracy, patient comfort, and dose modulation ability. The risk of cardiovascular disease is several folds higher among transplant patients who receive TBI, likely related to dose to the heart. We hypothesize that a cardiac-sparing (CS) VMAT-TBI technique is feasible and can meaningfully reduce dose to the heart while still adequately covering nearby lymphatic tissue. MATERIALS/METHODS VMAT-TBI is delivered via multi-isocentric external beams in a frame-based setup. Heart is contoured as per published guidelines. A lymph node contour, which includes tonsils, neck nodal stations, mediastinal, abdominal, retroperitoneal, and pelvic nodes is created. Coverage of the lymph node contour is prioritized over organ-sparing during inverse optimization; with a goal of V90% greater than 99.5% and mean dose less than 800 cGy for the lymph nodes and heart, respectively. An IRB-approved retrospective review was performed with mean heart dose collected for all patients treated with CS VMAT-TBI and compared to a representative cohort of five patients treated with VMAT-TBI without cardiac sparing. RESULTS Thirty-one patients were treated with CS VMAT-TBI between 2020-2022 with a median follow up time of 11.5 months. Mean heart dose was 796 ± 71 cGy in the CS VMAT-TBI compared to 1247 ± 29 cGy in the VMAT-TBI group without cardiac sparing (p < 0.001). Of those treated with CS VMAT-TBI, three patients relapsed; one relapse occurred in bone marrow only, one relapse occurred in bone marrow and cervical, thoracic, and intra-abdominal lymphoid tissues, and one patient was simulated but never received induction therapy due to overt progression. 100-day relapse-free survival and overall survival were 82.5% and 86.2%, respectively. Median survival time has not been met. CONCLUSION Cardiac sparing is feasible in VMAT-TBI and is associated with significant decrease in mean heart dose of ∼450 cGy. This is estimated to confer a 33.3% decreased absolute risk for lifetime major coronary events compared to patients treated with VMAT-TBI without cardiac sparing. Although limited by short follow-up time, there does not appear to be a significant risk for early relapse despite de-escalating cardiac tissue, likely due to prioritizing coverage of lymph nodes. Prospective clinical studies are needed to further validate cardiac and other organ at risk sparing VMAT-TBI techniques.
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Jiang H, Fu J, Melemenidis S, Viswanathan V, Dutt S, Lau B, Soto LA, Manjappa R, Skinner L, Yu SJ, Surucu M, Graves EE, Casey K, Rankin E, Lu W, Loo BW, Gu X. An Online AI-Powered Interactive Histological Image Annotation Platform for Analyzing Intestinal Regenerating Crypts in Post-Irradiated Mice. Int J Radiat Oncol Biol Phys 2023; 117:e676. [PMID: 37785993 DOI: 10.1016/j.ijrobp.2023.06.2130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The goal of this project is to build an online AI-powered interactive annotation platform to accurately and efficiently annotate intestinal regenerating crypts in histological images of mice after abdominal irradiation. MATERIALS/METHODS The proposed platform is developed by the seamless integration of a front-end web client and a back-end server. Such client/server design allows the users to access the platform without software installation on local computers. Our front-end client is developed with SvelteJS + WebGL technology stack, allowing access from any common web browsers and enabling user interaction, such as image importing/visualization, interactive crypt annotating, and annotation saving/deleting. The back-end server is responsible for executing the tasks requested from the web client, for instance, image pre-processing, AI-based crypts automatic identification, and database management. The image preprocessing is designed to extract a single cross section image using morphological operations because multiple hematoxylin and eosin (H&E) stained jejunum cross sections from post-irradiated mice are scanned within one slide. The auto-crypt identification is powered by a trained and validated AI engine U-Net, classifying image grid tiles into two groups with and without regenerating crypts. The database is implemented with the self-contained SQLite to support recording and indexing the annotated grid tiles with regenerating crypts. The workflow for crypt analysis on this interactive platform has 5 steps: 1) manually import a whole H&E slide image; 2) auto-preprocess the slide by extracting single cross-section images; 3) auto-identify regenerating crypts with an AI engine; 4) interactively annotate (add, delete, modify) auto-identified crypt markers; 5) save and/or output the annotation to the database or the local drive. RESULTS The performance of the developed interactive crypt analysis platform was evaluated in aspects of accuracy and efficiency. The AI-powered crypt auto-identification accuracy was assessed by computing the mean absolute error (MAE) on crypt number per cross section between manual and auto annotation using a testing dataset containing 80 cross sections. It achieved an MAE of 3.5±4.8 crypts per cross section, and 81.25% of the cross sections have no more than 5 crypts difference. The efficiency was assessed under two conditions with the server on the cloud and a local computer. It took about 2-3 minutes to finish the entire workflow on the cloud, while 1-2 minutes on the local by saving ∼1 minute on image uploading. CONCLUSION The developed web client/server platform enables online automatic identification and interactive annotation of mice crypts in minutes. It is a convenient tool that allows accurate and efficient crypt analysis and can be extended for other histologic image analyses.
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Cai S, Xie L, Li M, Gu X, Tian Y. Green Tea Derivative (-)-Epigallocatechin-3-Gallate (EGCG) for Prevention of Acute Radiation-Induced Intestinal Injury: A Prospective Phase II Clinical Study in Pelvic Cancer Patients. Int J Radiat Oncol Biol Phys 2023; 117:e505. [PMID: 37785584 DOI: 10.1016/j.ijrobp.2023.06.1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation-induced intestinal injury (RIII) remains the most common dose-limiting toxicity following radiotherapy (RT) for pelvic malignancies. However, few efficient and safe methods for the prevention of RIII are available in the clinical practice. Our previous study proved that the green tea polyphenol (-)-epigallocatechin-3-gallate (EGCG) efficiently attenuates radiation-induced intestinal injury (RIII) in animal level. Therefore, this prospective phase II clinical study (ChiCTR2100053703) evaluated the efficacy of EGCG in the prevention of RIII. MATERIALS/METHODS Cervical or endometrial cancer patients who received adjuvant or radical RT in our department were enrolled, 400mg EGCG was taken daily, and RIII was evaluated weekly according to the RTOG criteria. RESULTS Between February 2022 to January 2023, 37 patients were enrolled (30 were cervical cancer and the other 7 were endometrial cancer), and were followed-up regularly. Among them, the majority patients (75.7%, 28 patients) developed grade 0 or 1 RIII, for which no medical intervention was required. Meanwhile, the occurrence of grade 2 RIII was 24.3% (9 patients), which was significantly lower than that in the historical controls (usually 60% to 80%). Besides that, no patients developed grade 3 or worse RIII. CONCLUSION In this phase II clinical trial, compared to historical controls, the prophylactic use of EGCG significantly reduced the incidence and severity of RIII in patients receiving pelvic RT. Therefore, EGCG has the potential to become a novel medical countermeasure for the prevention of RIII for pelvic cancer patients.
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Rahimi AS, Kim N, Leitch M, Gu X, Parsons DDM, Nwachukwu CR, Alluri PG, Lu W, Nichols EM, Becker SJ, Ahn C, Zhang Y, Spangler A, Farr D, Wooldridge R, Bahrami S, Stojadinovic S, Lieberman M, Neufeld S, Timmerman RD. Multi-Institutional Phase II Trial Using Dose Escalated Five Fraction Stereotactic Partial Breast Irradiation (S-PBI) with GammaPod TM for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e203. [PMID: 37784857 DOI: 10.1016/j.ijrobp.2023.06.1082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We report on our early experience of a multi-institutional phase II study of dose escalated five fraction stereotactic partial breast irradiation (S-PBI) for early-stage breast cancer after partial mastectomy using the GammaPodTM stereotactic radiation system. MATERIALS/METHODS Patient eligibility included DCIS or invasive epithelial histologies, AJCC clinical stage 0, I, or II with tumor size < 3 cm, and negative margins. Prior safety of Phase I dose escalation has been reported. Dose was 40 Gy delivered in 5 fractions to the CTV, and minimum dose 30 Gy in 5 fractions to the PTV. CTV margin was 1 cm and PTV margin 3 mm. For PTV cavities larger than 100cc, dose was reduced to 35Gy in 5 fractions to the CTV and 30 Gy in 5 fractions to the PTV. Primary endpoint of the study is to determine the 3-year patient global cosmesis score (4-point scale excellent, good, fair, or poor) and adverse cosmesis using a dose escalated approach with smaller PTV margins than conventional methods. Both patients and physicians completed baseline and subsequent cosmesis outcome questionnaires. Treatment related toxicity was graded using the NCI version 4.0 and RTOG/EORTC late radiation scale. RESULTS From 3/2019-10/2021, 74 patients were treated respectively. Of these, 38 were treated to 40Gy and 36 were treated to 35 Gy. Median follow up (f/u) was 24 months (mo), range (r) 3-39mo. Median age was 63 years (r 43-77). Histology included 28 DCIS, and 46 invasive carcinomas. 45/46 invasive tumors were ER+. 60/74 (81%) patients received endocrine therapy, and 7/74 patient received chemotherapy. There were 221 acute grade 1 toxicities, and 28 Grade 2 toxicities. No grade 3 or higher acute toxicities were reported (< 90 days). The most common Grade 2 toxicities were radiation dermatitis (10), breast pain (8), blister (4), skin infection (2), nipple discharge (2), and fatigue (2). In the late period, there were 54 Grade 1 late toxicities, 4 Grade 2 late toxicities, and no Grade 3 or higher late toxicities. Grade 2 toxicities included fibrosis (2), and pain (2). Two patients developed grade 1 asymptomatic nonpalpable fat necrosis both diagnosed at 12 months after radiation treatments. The most common grade 1 late toxicities were breast pain (14), hyperpigmentation (8), fibrosis (10), and fatigue (5). Physicians scored cosmesis excellent or good 70/73 (95.8%), 58/60 (96.7%), 36/36 (100%),17/17(100%) respectively at baseline, 12 months, 24 months, and 36months post SBRT, while patients scored the same periods 62/71 (83.7%), 53/59 (89.8%), 33/36 (91.6%), 17/18 (94.4%). There have been no reports of disease recurrences. CONCLUSION Results at 24-month median follow-up, of our dose escalated stereotactic partial breast 5 fraction regimen, has low acute and late toxicity, while maintaining high proportion of excellent/good cosmetic outcomes. Continued analysis of all cohorts is in progress. CLINICAL TRIALS gov identifier is NCT03581136.
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Fu J, Jiang H, Melemenidis S, Viswanathan V, Dutt S, Lau B, Soto LA, Manjappa R, Skinner L, Yu SJ, Surucu M, Graves EE, Casey K, Rankin E, Lu W, Loo BW, Gu X. Deep Learning-Based Pipeline for Automatic Identification of Intestinal Regenerating Crypts in Mouse Histological Images. Int J Radiat Oncol Biol Phys 2023; 117:S117-S118. [PMID: 37784305 DOI: 10.1016/j.ijrobp.2023.06.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A classical approach for evaluating normal tissue radiation response is to count the number of intestinal regenerating crypts in mouse histological images acquired after abdominal radiation. However, manual counting is time-consuming and subject to inter-observer variations. The goal of this study is to build a deep learning-based pipeline for automatically identifying intestinal regenerating crypts to facilitate high-throughput studies. MATERIALS/METHODS Sixty-six healthy C57BL/6 female mice underwent 16 MeV whole abdominal electron irradiation. The small bowel was collected from each mouse 4 days post-irradiation, and 9 jejunal cross-sections from each were processed together in a single slide. The slides were stained with hematoxylin and eosin (H&E) and subsequently scanned (x20), providing one electronic histological image per mouse. Regenerating crypts, consisting of more than 10 basophilic crypt epithelial cells, were manually identified using point annotations in histological images. The pipeline was built to take the input of the image containing 9 cross sections and automatically identify the regenerating crypts on each cross section. It mainly consists of two components, cross section segmentation using intensity thresholding and morphological operations and crypt identification using a UNet. The dataset was randomly split into 46, 10, and 10 slide images for UNet training, validation, and testing. Each slide image was split into grid tiles with a voxel size of 200 × 200, and 40 × 40 square masks were placed with centers at manual point annotations on tiles with regenerating crypts. 5203/5198 tiles (w/wo crypt mask) were extracted to train UNet by minimizing dice loss. The mask probability map generated by the UNet was post-processed to identify the crypt position. Postprocessing hyperparameters were tuned using the validation dataset. The model accuracy was evaluated using the testing dataset by computing the mean absolute error (MAE) of the crypt number averaged across all cross sections. RESULTS The number of regenerating crypts on testing cross sections ranges from 1 to 63. The testing cross-section-wise MAE achieved by the platform is 3.5±4.8 crypts. 81.25% of testing cross sections have absolute number differences less than or equal to 5 crypts. CONCLUSION Our established deep learning-based pipeline can accurately count the number of regenerating crypts in mouse intestinal histological images. We have integrated it into an online platform that enables automatic crypt identification and allows users to interactively modify auto-identified crypt annotations. The acquired annotations from the platform will be used to finetune the deep learning model to achieve better identification performance.
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Yang Z, Fu J, Melemenidis S, Viswanathan V, Dutt S, Lau B, Soto LA, Manjappa R, Skinner L, Yu SJ, Surucu M, Casey K, Rankin E, Lu W, Jr BWL, Gu X. Equivalent Dose Estimation in FLASH Irradiation with a Deep Learning Approach. Int J Radiat Oncol Biol Phys 2023; 117:e272. [PMID: 37785029 DOI: 10.1016/j.ijrobp.2023.06.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Ultra-high dose rate (FLASH) irradiation has been reported to provide decreased normal tissue toxicity without compromising tumor control compared with conventional (CONV) irradiation. However, a comprehensive understanding of the FLASH biological effect requires precise quantification of radiobiology. The study is to explore whether deep learning (DL) can tackle the task. As a proof of concept, we investigate a DL model for estimating FLASH dose to its equivalent CONV dose. MATERIALS/METHODS Healthy C57Bl/6 female mice underwent FLASH (200Gy/s; n = 43) or CONV (0.12Gy/s; n = 41) whole abdominal irradiation using ∼16 MeV electron beams with a dose escalation scheme of 5 groups (n = 8 or 9) at 1Gy increments: 12-16Gy FLASH, 11-15Gy CONV. 4 days post-irradiation, 9 jejunum cross-sections per mouse were H&E stained for histological analysis. Each cross-section image was processed to remove lumen background and oversampled into multiple large-scale and small-scale patches along jejunal circumference. In CONV dataset, we randomly selected the data of 32 mice (80%) for model training and the rest (20%) for model validation. A ResNet101-based DL model, pre-trained with an unsupervised contrastive learning scheme, was retrained with only CONV training set to estimate corresponding CONV dose. For comparison, a crypt counting (CC) approach was implemented by manually counting the number of regenerating crypts on each cross-section image. An exponential function of dose vs crypt number was fitted with the CONV training set and used for dose estimation on the testing set. Mean squared error (MSE) was used to assess the accuracy of DL and CC approaches in estimating dose levels in CONV irradiation. The validated DL model was applied to the FLASH set to project FLASH dose into corresponding CONV dose that results in equivalent biological response. RESULTS The CONV dose estimated by DL and CC approaches and DL-estimated FLASH equivalent dose were summarized in Table 1. The DL model achieved an MSE of 0.21 Gy2 on CONV testing set compared with 0.32 Gy2 of the CC approach. FLASH equivalent dose estimated by DL model for 12, 13, 14, 15 and 16Gy were 12.16±0.40, 12.53±0.32, 12.72±0.24, 12.85±0.20 and 13.04±0.27 Sv, respectively. CONCLUSION Our proposed DL model can accurately estimate the CONV dose based on histological images. The DL predictions of FLASH dataset demonstrate that FLASH may reduce normal tissue toxicity with a lower equivalent dose, especially at high irradiated dose levels. Our study indicates that deep learning can be potentially used to assess the equivalent dose of FLASH irradiation to normal tissue.
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