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We demonstrate flat-top, sharp-edge, silicon add-drop filters using apodized grating-assisted contradirectional couplers (contra-DCs). Periodic sidewall corrugations are imposed on both sides of two asymmetric strip waveguides for contradirectional coupling between the first two TE supermodes of a two-waveguide system. Gaussian apodization is applied to suppress the sidelobes. By laterally shifting the positions of both waveguide Bragg gratings in a complementary manner, which is called complementary lateral-misalignment modulation, our devices avoid phase errors which impair the spectral responses for conventional lateral-misalignment modulated contra-DCs. We demonstrate a complementary lateral-misalignment modulated (CLMM) contra-DC that has a flat-top, rapid roll-off, drop-port spectral response with a sidelobe suppression ratio (SLSR) of 20 dB. We also demonstrate a series-cascaded CLMM contra-DCs that has a higher SLSR of 39 dB and a sharper filtering edge. ©

Background Previous studies have found that patients with subclinical interstitial lung disease (ILD) are highly susceptible to developing radiation pneumonitis (RP) after thoracic radiation therapy. In the present study we aimed to evaluate the incidence of and risk factors for RP after thoracic intensity-modulated radiation therapy in lung cancer patients with subclinical ILD. Methods We retrospectively analyzed data from lung cancer patients with subclinical ILD who were treated with thoracic intensity-modulated radiation therapy with a prescribed dose of ≥ 50 Gy in our institution between January 2016 and December 2017. Results Eighty-seven consecutive lung cancer patients with subclinical ILD were selected for the study. The median follow-up period was 14.0 months. The cumulative incidence of grades ≥ 2 and ≥ 3 RP at one year was 51.0% and 20.9%, respectively. In the multivariate analysis, a mean lung dose ≥ 12 Gy was a significant risk factor for grade ≥ 2 RP (p = 0.049). Chemotherapy with gemcitabine in the past, V5 ≥ 50%, and subclinical ILD involving ≥ 25% of the lung volume were significantly associated with grade ≥ 3 RP (p = 0.046, p = 0.040, and p = 0.024, respectively). Conclusion Mean lung dose is a significant risk factor for grade ≥ 2 RP. Lung cancer patients who have received chemotherapy with gemcitabine in the past, V5 ≥ 50%, and those with subclinical ILD involving ≥ 25% of lung volume have an increased risk of grade ≥ 3 RP in lung cancer patients with subclinical ILD.

Background The optimal dose and fractionation scheme of stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) remains unclear due to different tolerated liver volumes and degrees of cirrhosis. In this study, we aimed to verify the dose-survival relationship to optimize dose selection for treatment of HCC. Methods This multicenter retrospective study included 602 patients with HCC, treated with SBRT between January 2011 and March 2017. The SBRT dosage was classified into high dose, moderate dose, and low dose levels: SaRT (BED10 ≥ 100 Gy), SbRT (EQD2 > 74 Gy to BED10 2 Results The median tumor size was 5.6 cm (interquartile range [IQR] 1.1–21.0 cm). The median follow-up time was 50.0 months (IQR 6–100 months). High radiotherapy dose correlated with better outcomes. After classifying into the SaRT, SbRT, and ScRT groups, three notably different curves were obtained for long-term post-SBRT survival and intrahepatic control. On multivariate analysis, higher radiation dose was associated with improved OS, PFS, and intrahepatic control. Conclusions If tolerated by normal tissue, we recommend SaRT (BED10 ≥ 100 Gy) as a first-line ablative dose or SbRT (EQD2 ≥ 74 Gy) as a second-line radical dose. Otherwise, ScRT (EQD2

An integrated-optics, flat-top drop-filter with low excess loss, and high sidelobe suppression ratio (SLSR), is demonstrated. The filter is based on apodized multimode waveguide Bragg grating (AMWBG) developed on a silicon-on-insulator (SOI) platform. Antisymmetric periodic refractive-index perturbations are imposed on both sides of the waveguide to couple light contra-directionally between the fundamental (TE0) and the first-order transverse electric modes (TE1). To achieve a Gaussian apodization profile, the lateral-misalignment between the two sides of the waveguide is modulated by adjusting the positions of both sides of the grating features in a complementary manner. In this way, the undesired phase errors, which exist in conventional misalignment-modulated Bragg gratings and distort the grating responses, can be eliminated. Experimental results show that our AMWBG has a high-quality flat-top response, a high SLSR of >21 dB, a 3-dB bandwidth of 8 nm, a low excess loss of 0.24 dB, and a high roll-off rate at the filter edge. We also demonstrate a dual-stage filter that has a flat-top, drop-port response with a 3-dB bandwidth > 7.5 nm, a SLSR >40 dB, and an excess loss

OBJECTIVES To validate stage nodal (N)3 of the 8th edition American Joint Committee on Cancer (AJCC) staging system for nasopharyngeal carcinoma (NPC). METHODS This retrospective cohort study extracted NPC patients from the Surveillance, Epidemiology, and End Results database between 2004 and 2016. Pathologically confirmed patients with complete data of level IV, N3a, and N3b lymph node metastasis were investigated. The included patients were divided into level IV, N3a, and N3b groups. Five-year overall survival (OS) and cancer-specific survival (CSS) were compared among the three groups. RESULTS A total of 693 patients were included: 285 (41.13%) patients in the level IV group, 124 (17.89%) patients in the N3a group, and 284 (40.98%) patients in the N3b group. The 5-year OS (57.1%, 55.0%, and 55.2%) and CSS (64.4%, 63.5%, and 64.4%) were not different among the level IV, N3a, and N3b groups. Multivariate regression analysis revealed that N stage was not an independent prognostic factor for OS (hazard ratio [HR] = 1.03, 95% confidence interval [CI]: 0.91-1.17; P = .65) or CSS (HR = 1.03, 95% CI: 0.89-1.19; P = .70). CONCLUSION Stage N3 of the 8th edition AJCC staging system for NPC is reasonable. LEVEL OF EVIDENCE III Laryngoscope, 131:535-540, 2021.

To investigate the optimal longitudinal seismic energy dissipation system of straddle-type monorail-cum-road long-span cable-stayed bridges, the Niutianyang Bridge was selected as the engineering background, and the explicit time-domain dimension-reduced iteration method was adopted to carry out nonlinear time-history analysis. To consider the dynamic characteristics of longitudinal movable supports, the static and dynamic responses of four kinds of energy dissipation systems were studied, including longitudinal unconstrained, elastic cable, viscous damper, and speed lock-up devices. The damping effect of four types of schemes in which viscous dampers were installed at piers or towers was analysed, and the parameters of the viscous dampers were optimised. The influences of the straddle-type monorail train braking force and the running vibration of the straddle-type monorail traffic on the parameters of the viscous dampers were analysed. This study shows that the viscous damper system had the lowest bending moment at the bottom of the tower and a smaller displacement response, and the energy dissipation was the best. Each viscous damper had the highest energy dissipation efficiency when they are installed only at the main tower. The damping effect was better when the damping coefficient c ranged from 3500 to 5000 kN⋅m/s−α and the velocity exponent α ranged from 0.35 to 0.5. The static friction of the straddle-type monorail-cum-road long-span cable-stayed bridge support can resist the trains’ braking force, and the parameters of the viscous damper can be selected regardless of train braking. A suitably large value of velocity exponent α may be required to increase the working velocity of the viscous damper to reduce the damper’s participation in the process of the train crossing the bridge.

Background Influenced by various factors, endoscopists have shown differences in the detection rate of adenomas (ADR) during different periods of endoscopy every day. The purpose of this study is to observe whether AI-assisted endoscopy can bring an improvement in ADR and whether the increase is consistent in different periods. Methods We established a real-time AI-assisted colonoscopy system. The core of the system is a deep neural network for object detection, YOLOV3. The processing speed of this model was 60FPS. When polyps appear in the video of colonoscopy, the system can give a real-time warning on the monitor of the endoscope. We randomly divided the enrolled patients into four groups, which were arranged to receive colonoscopy in the first hour of the morning and the last hour of the morning, respectively. Meanwhile, we differentiated the AI-assisted group and the non-AI-assisted group. In order to remove the bias caused by the experience of the endoscopist, the trial was performed by two colonoscopists with comparable experience. Finally, the ADRs among the groups were compared. Results With or without AI, endoscopy scheduled in the first hour of the morning had higher ADRs than endoscopy scheduled in the last hour of the morning (23% Vs 18%). AI assistance had a positive effect on the increase in ADR, but it had a greater effect on endoscopy scheduled in the latter period. (0.5% Vs 4.2%). Conclusions The change of ADR detection rate in different time periods was mainly due to the change of attention of endoscopists, which had little correlation with the level of endoscopic operation. The use of artificial intelligence assistance can help endoscopic doctors improve their attention and ensure the stability of the ADR in different periods.

Double skin steel-concrete composite walls offer structural merits over conventional reinforced concrete walls in terms of high strength, good ductility and convenience for construction. The stability of the external steel faceplates is significantly influenced by the types of internal mechanical connectors and the ratio of connector spacing to plate thickness. In this paper, a new type of steel truss was proposed as the fastener to connect the two faceplates. Compressive tests were conducted on three full-scaled composite walls with different truss spacing. The structural response of the walls was comprehensively discussed in terms of failure modes, load-axial displacement response, buckling stress, stiffness, ductility, strength index, load versus out-of-plane displacement response, and load-strain curves. The influences of truss spacing on key parameters were explored in details. The test results showed that the truss spacing could considerably affect the buckling shapes, load-carrying capacity, stiffness and ductility of the specimens.

Background Child-Turcotte-Pugh (CTP) score extensively used to assess hepatic function, predicting postoperative outcome of hepatocellular carcinoma (HCC) patients. Lately, the albumin–bilirubin (ALBI) grade has been identified to be a predictor of overall survival of HCC patients. In this investigation, we compared the pre-SBRT ALBI and CTP scores with the prognosis of patients with HCC. Methods This cohort study included 594 HCC patients who treated with SBRT. Overall survival (OS) rates were measured from treatment date to death date or last follow-up. We compared ALBI score with the CTP score in predicting long-term survival. Results The average follow-up time was 21 months (1 to 82 months). The CTP and ALBI ratings have discriminatory for long-term survival across the groups. CTP class was significantly related to OS, with a median OS of 29.9 months in CTP-A, 11.5 in CTP-B (P 0.05). Conclusions To assess liver dysfunction in HCC patients before SBRT, traditional CTP classification is a necessary but imperfect tool for assessing HCC liver injury. The ALBI score is a more objective, discriminatory and evidence-based approach in CTP-A groups, and need to be validated in CTP ≥ B7 class.

Kai Xin San (KXS, containing ginseng, hoelen, polygala, and acorus), a traditional Chinese herbal compound, has been found to regulate cognitive dysfunction; however, its mechanism of action is still unclear. In this study, 72 specific-pathogen-free male Kunming mice aged 8 weeks were randomly divided into a vehicle control group, scopolamine group, low-dose KXS group, moderate-dose KXS group, high-dose KXS group, and positive control group. Except for the vehicle control group and scopolamine groups (which received physiological saline), the doses of KXS (0.7, 1.4 and 2.8 g/kg per day) and donepezil (3 mg/kg per day) were gastrointestinally administered once daily for 2 weeks. On day 8 after intragastric treatment, the behavioral tests were carried out. Scopolamine group and intervention groups received scopolamine 3 mg/kg per day through intraperitoneal injection. The effects of KXS on spatial learning and memory, pathological changes of brain tissue, expression of apoptosis factors, oxidative stress injury factors, synapse-associated protein, and cholinergic neurotransmitter were measured. The results confirmed the following. (1) KXS shortened the escape latency and increased residence time in the target quadrant and the number of platform crossings in the Morris water maze. (2) KXS increased the percentage of alternations between the labyrinth arms in the mice of KXS groups in the Y-maze. (3) Nissl and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling staining revealed that KXS promoted the production of Nissl bodies and inhibited the formation of apoptotic bodies. (4) Western blot assay showed that KXS up-regulated the expression of anti-apoptotic protein Bcl-2 and inhibited the expression of pro-apoptotic protein Bax. KXS up-regulated the expression of postsynaptic density 95, synaptophysin, and brain-derived neurotrophic factor in the cerebral cortex and hippocampus. (5) KXS increased the level and activity of choline acetyltransferase, acetylcholine, superoxide dismutase, and glutathione peroxidase, and reduced the level and activity of acetyl cholinesterase, reactive oxygen species, and malondialdehyde through acting on the cholinergic system and reducing oxidative stress damage. These results indicate that KXS plays a neuroprotective role and improves cognitive function through reducing apoptosis and oxidative stress, and regulating synapse-associated protein and cholinergic neurotransmitters.

BACKGROUND This study aimed to determine the value of the significant index in predicting symptomatic radiation pneumonitis (RP) in esophageal cancer patients, establish a nomogram prediction model, and verify the model. MATERIAL AND METHODS The patients enrolled were divided into 2 groups: a model group and a validation group. According to the logistic regression analysis, the independent predictors for symptomatic RP were obtained, and the nomogram prediction model was established according to these independent predictors. The consistency index (C-index) and calibration curve were used to evaluate the accuracy of the model, and the prediction ability of the model was verified in the validation group. Recursive partitioning analysis (RPA) was used for the risk stratification analysis. RESULTS The ratio of change regarding the pre-albumin at the end of treatment (P=0.001), platelet-to-lymphocyte ratio during treatment (P=0.027), and neutrophil-to-lymphocyte ratio at the end of treatment (P=0.001) were the independent predictors for symptomatic RP. The C-index of the nomogram model was 0.811. According to the risk stratification of RPA, the whole group was divided into 3 groups: a low-risk group, a medium-risk group, and a high-risk group. The incidence of symptomatic RP was 0%, 16.9%, and 57.6%, respectively. The receiver operating characteristic curve also revealed that the nomogram model has good accuracy in the validation group. CONCLUSIONS The developed nomogram and corresponding risk classification system have superior prediction ability for symptomatic RP and can predict the occurrence of RP in the early stage.

In this paper, we proposed the terahertz technique to measure the liquid level of Chinese liquor in sealed pots. We analyzed the transmission process of terahertz pulse in the sealed pots and established a model of the relationship between terahertz pulse interval and liquor level. The measurement results are in good agreement with the theoretical model. The results show that the terahertz technique can realize the high precision measurement of liquor level. The absolute and relative errors are less than ±40 μm and 0.014%, respectively. In addition, we also evaluated the influence of dewdrop on the measurement accuracy. The results show that dewdrop only leads to a deviation of 18 μm. The results prove the value of terahertz technology in the field of liquid level monitoring.

Background: It is unclear whether robotic stereotactic body radiotherapy (SBRT) is superior to intensity-modulated radiotherapy (IMRT) in advanced hepatocellular carcinoma (HCC). This study aimed to compare the long-term outcomes of SBRT with those of IMRT in HCCs with portal vein tumor thrombosis (PVTT). Methods: We retrospectively evaluated 287 HCC patients with PVTT who underwent radiotherapy between January 2000 and January 2017. Of them, 154 and 133 patients were treated with IMRT and SBRT, respectively. Overall survival (OS), progression-free survival (PFS), intrahepatic control (IC), and local control (LC) were evaluated in univariable and propensity-score matched analyses. Results: After matching, 102 well-paired patients were selected. There was no significant difference in the 6-, 12-, 24-, and 60-month cumulative OS (73.5, 42.9, 23.6, 7.6% vs. 72.4, 45.1, 29.8, 13.2%, P=0.151), PFS (53.9, 29.3, 21.8, 7.5% vs. 54.5, 19.3, 12.0, 9.6%, P=0.744) , IC (61.4, 45.7, 39.0, 26.8% vs. 75.1, 45.8, 35.9, 28.7%, P=0.144), and LC (85.2, 56.5, 52.1, 47.4% vs. 87.4, 65.2, 62.1, 62.1%, P=0.191) between the IMRT and SBRT groups. A biologically effective dose assumed at an a/b ratio of 10 (BED10) of ≥100 Gy was the optimal cutoff for predicting the OS, PFS, IC, and LC in the patients who received SBRT. Conclusions: When high-precision tracking technology is available, SBRT appears to be a safe and more time-efficient treatment, achieving comparable OS, PFS, IC and LC to IMRT for local advanced HCC with PVTT. A BED10≥100 Gy is recommended if tolerated by normal tissue.

The sandwich composite wall with truss connectors is a new type of double-steel-plate composite wall, which consists of two external steel plates, square steel tubes at both ends, and in-fill concrete. The external steel plates are constrained by the steel trusses, thereby possessing superior mechanical performance. In order to study the fire resistance of the sandwich composite wall, 4 full-scaled walls were tested under one-side ISO-834 standard fire, aiming to investigate the effects of axial compression ratio, truss spacing to thickness ratio, and steel plate thickness on the fire resistance of the walls. The temperature, axial displacement and transverse displacement of key parts of the walls were measured. Experimental results indicate that, the walls could maintain sufficient load-bearing capacity as specified by the Class I fire resistance rating of Chinese Code. The fire endurance of the wall was controlled by its thermal insulation. The deformation pattern of the walls under the fire was overall deflection toward the unexposed surface, and the steel plate exposed to the fire experienced obvious local buckling. The axial compression ratio and the truss spacing to thickness ratio had great effects on the deformation behavior of the walls. When the axial compression ratio was reduced from 0.5 to 0.3, the axial deformation of the wall was changed from compression-predominant to expansion-predominant deformation. A larger truss spacing to thickness ratio led to more obvious buckling of the steel plate exposed to the fire. It is recommended to restrict the truss spacing to thickness ratio of the wall in engineering design.

Light beams with helical phase-fronts are attractive for many optical applications, such as optical tweezers, particle manipulation, and other optical applications. A superoscillatory metalens has been designed for an azimuthally polarized wave at a wavelength λ = 632.8 nm. Numerical simulation demonstrates that a superoscillation hollow dark spot is generated. The transverse inner FWHM is 0.358λ overcoming the diffraction limit, while the sidelobe ratio can be compressed to 18.3%. More importantly, for such incidence with different orbital angular momentum (OAM) l = 1, 2, and 3, the proposed metalens also presents elegant subwavelength tight focusing performances (the FWHMs are 0.469λ, 0.352λ, and 0.737λ, respectively). Extensive investigations have been made to present the unique characteristics of the generated foci, the phase distribution patterns are given for different OAM values. Small size and ultrathin thickness make such lenses suitable for various optical applications.

To investigate the follow-up strategy of stage II NPC based on event dynamics.Stage II NPC patients were retrospectively assessed from January 2007 to December 2014 at Guangxi Medical University Cancer Hospital. Event dynamics for patterns of recurrence and metastasis were calculated based on the hazard rates.A total of 251 patients were included. After treatment, 10 (4.0%) patients developed recurrence and 6 (2.4%) patients developed metastasis. The hazard rate curve of recurrence showed a bimodal recurrence pattern. The maximum hazard rates were 0.048 and 0.072 at the intervals of 36-42 and 90-96 months, respectively. The maximum hazard rate was 0.036 at the interval of 48-54 months in the hazard rate curve of metastasis.Follow-up strategies of stage II NPC should be performed based on currently recommended guidelines. In the future, it should be modified to meet the needs of individual patients.

PURPOSE To identify whether chemoradiotherapy improves survival in patients with stage T3-4N0M0 nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS The data of patients with stage T3-4N0M0 NPC were extracted from the Surveillance, Epidemiology, and End Results database between 2004 and 2016. The patients were divided into radiotherapy and chemoradiotherapy groups. Overall survival (OS) and cancer-specific survival (CSS) were assessed using the Kaplan-Meier method and propensity score matching (PSM) analyses. RESULTS We examined 496 patients: 88 who received radiotherapy and 408 who received chemoradiotherapy. Before PSM, chemoradiotherapy was associated with a better 5-year OS (52.58% vs. 38.13%; P = .005) and similar CSS (63.62% vs. 59.26%; P = .196) compared to those associated with radiotherapy. However, chemoradiotherapy was not an independent prognostic factor for OS [hazard ratio (HR)=0.95, 95% confidence interval (CI): 0.68-1.32; P = .760] or CSS (HR = 1.02, 95% CI: 0.66-1.56; P = .935). After PSM, similar OS (45.15% vs. 42.78%; P = .626) and CSS (58.22% vs. 60.37%; P = .730) were found between the radiotherapy and chemoradiotherapy groups. CONCLUSION Radiotherapy and chemoradiotherapy are associated with similar OS and CSS in patients with stage T3-4N0M0 NPC.

This study aimed to evaluate whether the addition of oxaliplatin to a neoadjuvant chemoradiotherapy (CRT) regimen could improve survival benefit in locally advanced rectal cancer (LARC) patients. We retrospectively analysed 73 LARC patients (cT2-4 and/or cN1-2) who received preoperative CRT with capecitabine followed by surgery (arm A, 43 patients) or capecitabine plus oxaliplatin followed by surgery (arm B, 30 patients). The main endpoints of the study were pathologic complete response (pCR) rate, overall survival (OS) and disease-free survival (DFS). The secondary endpoints included the sphincter preservation rate and safety. The pCR for arms A and B were 28% and 17% (P = 0.267). In arms A and B, the mean OS was 84.287 months (95% CI 68.413–100.160) and 106.333 months (95% CI 99.281–113.386) (P = 0.185); the mean DFS was 72.812 months (95% CI 56.271–89.353) and 95.073 months (95% CI 83.392–106.754) (P = 0.310); and the sphincter preservation rates were 72% and 67%, respectively (P = 0.619). The incidence of grade 3 toxicity was much higher in arm B than in arm A (57% vs. 21%, P = 0.002). Adding oxaliplatin to a preoperative CRT regimen for LARC did not improve the survival benefits of patients or increase toxicity.

Background: Macroscopic vascular invasion (MVI) is a terminal manifestation of hepatocellular carcinoma (HCC) and carries an extremely poor prognosis. In Chinese and Korean HCC guidelines, transarterial chemoembolization (TACE), or/and radiotherapy (RT) is adopted for treatment of MVI. In the current study, we aimed to compare the long-term outcome of TACE + RT to that of RT alone in patients with local advanced HCC with MVI.Methods: In this retrospective study, 148 treatment-naive patients of HCC with MVI were enrolled. Of the patients enrolled, 49 received TACE + RT treatment, whereas 99 patients received RT alone as a monotherapy. Overall survival (OS), progression-free survival (PFS), and intrahepatic control were evaluated using univariable and propensity score–matched analyses.Results: During follow-up, 126 patients (85.1%) died. The median follow-up time was 55.0 months in the RT group and 57.0 months in the TACE + RT group. The TACE + RT group showed better OS and PFS than the RT group, but intrahepatic control was comparable in these two groups. Of 41 cases well-pairs after propensity score matching, the associations between TACE + RT and better OS and PFS remained (15.0 vs. 8.0 months, and 8.0 vs. 4.0 months, all P < 0.05). The 1-, 2-, 3-, and 5-years OS rates in the TACE + RT group were 56.1, 28.6, 20.8, and 15.7 vs. 31.5%, 13.1%, 9.8%, and 6.7% in the RT group, respectively (P = 0.017). The 6-, 12-, and 24-months rates in the TACE + RT group were 51.2, 39.0, and 23.1% vs. 36.6%, 13.9%, and 11.1% in the RT group, respectively (P = 0.04). Two patients (4.1%) experienced radiation-induced liver disease (RILD), and one (2.0%) experienced RT-related gastrointestinal (GI) bleed in the TACE + RT groups. Nine patients (9.1%) experienced RILD, and two (2.0%) experienced RT-related GI bleed in the RT groups.Conclusion: Transarterial chemoembolization + RT had well-complementarity with no more complications than RT alone, providing a better PFS and OS compared with RT-alone treatment for HCC with MVI.

Background: The value of maximal lymph nodal diameter in staging system of nasopharyngeal carcinoma (NPC) is not well established.Methods: NPC patients were extracted from SEER database between 2004 and 2016. Overall survival (OS) and cancer-specific survival (CSS) were compared among three groups based on the maximal lymph nodal diameter: ≤3.0 cm, >3.0-6.0 cm, and >6.0 cm. Included patients were randomly divided into training set and validated set with 1:1 ratio. In training set, X-tile plots were created by dividing maximal lymph nodal diameter into three populations. All possible divisions of the maximal lymph nodal diameter were assessed. Two cut-off values were calculated by the X-tile plots in training set. The two cut-off values were evaluated in validated set.Results: The 10-year OS and CSS were different between the three groups. Multivariate regression analysis revealed that maximal lymph nodal diameter >6.0 cm was an independent risk prognostic factor for OS (hazard ratio [HR]=1.91, 95% confidence interval [CI]: 1.51-2.43; PP5.0 cm was a risk prognostic factor for OS and CSS.Conclusions: The maximal lymph nodal diameter of 5.0 cm may be a reasonable cut-off value for N stage.

Background and Objective: It is unclear if stereotactic body radiation therapy (SBRT) or transarterial chemoembolization (TACE) is better for the treatment of inoperable early-stage hepatocellular carcinoma (HCC). This study aimed to retrospectively compare the efficacy of SBRT to TACE in patients with inoperable Barcelona Clinic Liver Cancer (BCLC)-A stage HCC. Materials and Methods: In this multi-institutional retrospective study, a total of 326 patients with inoperable BCLC-A stage HCC were enrolled. Totally, 167 patients initially received SBRT and 159 initially received TACE. Overall survival (OS), local control (LC), intrahepatic control (IC), and progression-free survival (PFS) were evaluated in univariable and propensity-score matched analyses. Results: There was a smaller median tumor size in the SBRT group than in the TACE group (3.4 cm vs. 7.2 cm, P < 0.001). After propensity score matching in the selection of 95 patient pairs, SBRT had better LC, IC, and PFS than TACE but showed comparable OS. The accumulative 1-, 3-, and 5-year OS rates were 85.7, 65.1, and 62.8% in the SBRT group and 83.6, 61.0, and 50.4% in the TACE group, respectively (P = 0.29). The accumulative 1-, 3-, and 5-year PFS were 63.4, 35.9, and 27.5% in the SBRT group and 53.5, 27.4, and 14.2% in the TACE group, respectively (P = 0.049). The accumulative 1-, 3-, and 5-year LC were 86.8, 62.5, and 56.9% in the SBRT group and 69.3, 53.3, and 36.6% in the TACE group, respectively (P = 0.0047). The accumulative 1-, 3-, and 5-year IC were 77.3, 45.9, and 42.4% in the SBRT group and 57.3, 34.1, and 17.7% in the TACE group, respectively (P = 0.003). On multivariate analysis, treatment (SBRT vs. TACE) was a significant covariate associated with local and intrahepatic control (HR = 1.59; 95% CI: 1.03–2.47; P = 0.04; HR = 1.61; 95% CI: 1.13–2.29; P = 0.009). Conclusions: SBRT was an alternative to TACE for inoperable BCLC-A stage HCC with better local and intrahepatic control. Controlled clinical trials are recommended to evaluate the actual effects of this novel regimen adequately.

Background and purposeThe optimal dose and fractionation scheme of stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) remains unclear due to different tolerated liver volumes and degrees of cirrhosis. We compared the effectiveness of stereotactic body radiation therapy dosing regimens for hepatocellular carcinoma (HCC).Methods and materialsThis single-center retrospective study included 604 patients treated during 2011-2017. Biologically effective dose (BED10) and equivalent dose in 2 Gym fractions (EQD2) were assumed at an α/β ratio of 10. Overall survival (OS), local recurrence-free rate (LRF), intrahepatic recurrence-free rate (IRF), and progression-free survival (PFS) was evaluated in univariable and propensity-score matched analyses.ResultsMedian tumor size was 5.2 cm (interquartile range [IQR], 1.1-21.0). Median follow-up was 31 months in surviving patients (IQR, 3-82). High radiotherapy dose correlated with better OS, PFS, LRF and IRF. Different post-SBRT OS, PFS, LRF and IRF rates were observed for stereotactic ablative radiotherapy (SART) with BED10 ≥100 Gy, SBRT with EQD2 ≥74 Gy to BED10 2 ConclusionsHigh radiotherapy dose correlated with better outcomes. If tolerated by normal tissue, we recommend SART as a first-line ablative dose or SBRT as a second-line radical dose. Otherwise, SCRT is recommended as palliative irradiation.

Background: Several epidemiological studies have been performed to evaluate the association of dietary intake of vitamin C-oriented foods (DIVCF) with risk of fracture and bone mineral density (BMD) loss, but the results remain controversial. Therefore, we conducted a systematic meta-analysis to assess this correlation. Methods: We searched EmBase, PubMed, Web of Science, and the Chinese database CNKI for relevant articles published up to August 2019. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using the random- or fixed-effects model. Discrepancies were resolved by consultation with a third expert. Results: A total of 13 eligible articles (including 17 studies) with 19,484 subjects were identified for the present meta-analysis. The pooled RR of hip fracture for the highest vs. lowest category was 0.66 (95% CI, 0.47–0.94) for DIVCF, i.e., people with a greater frequency of Vitamin C uptake had a 34% (95% CI, 6%−53%) lower prevalence of hip fracture. In subgroup analyses stratified by study design, gender, and age, the negative associations were statistically significant. Furthermore, the statistical analysis of the association between DIVCF and risk of osteoporosis (RR, 0.66; 95% CI, 0.48–0.92), BMD at the lumbar spine (pooled r, 0.15; 95% CI, 0.09–0.23), and BMD at the femoral neck (pooled r, 0.20; 95% CI, 0.11–0.34) showed beneficial effects of DIVCF. Conclusion: Our meta-analysis indicates that DIVCF is negatively associated with the risk of hip fracture, osteoporosis, and BMD loss, suggesting that DIVCF decreases the risk of hip fracture, osteoporosis, and BMD loss.

Workpiece deformation in stack drilling can lead to interlayer gaps and non-coaxiality, which bring adverse effects to the hole quality and assembly quality. Nowadays, large numbers of fasteners are required to assemble the stacks for satisfactory hole qualities, which will also lead to extreme low efficiency and high cost. This study aims to reveal the formation and quantitative evaluation of the non-coaxiality, and to explore how the pre-installed fasteners reduce the interlayer gaps and non-coaxiality, thus to contribute in designing more efficient layout of the fasteners. First, a simplified 2-D model that involves effects of the pre-installed fasteners in stack drilling is built and the deformation of the stacks is theoretically analysed. Based on the calculation results, three types of patterns of non-coaxiality are revealed and explained, i.e., Type I caused by pure bending, Type II caused by horizontal displacements and Type III caused by local deformations at the holes. With consideration of these characteristics, a combined evaluation criterion for non-coaxiality in stack drilling is proposed and a method of measuring the non-coaxiality is developed. Then, the outcomes of the pre-installed fasteners brought to the deformations of the stacks are explained using theoretical analysis for the simplified 2-D model. As the accurate deformations of the 3-D stacked structures cannot be obtained in 2-D model, finite element simulations are also adopted to study the non-coaxiality and the interlayer gaps quantitatively. Finally, the demonstration experiments of stack drilling are conducted and the results agree with the simulation results that the non-coaxiality of neighbouring holes of the fasteners can be reduced.

The non-coaxial stacked holes caused by cutting deformation is a common problem in stack drilling, particularly for low-rigidity structure, and the non-coaxiality in carbon-fibre-reinforced plastic and aluminium (CFRP/Al) stack drilling has not been studied. Because of the non-homogeneous behaviour and poor machinability of CFRP, the non-coaxiality in CFRP/Al stack drilling is significantly different from previous studies on Al/Al stack drilling. Focusing on the non-coaxiality in CFRP/Al stack drilling, this paper proposed the mechanism of the non-coaxiality through both experiments and numerical study. Severe non-coaxiality occurrences were observed in the CFRP/Al stack drilling experiments. To explain the observation, the macroscopic mechanics theory of composite was applied to obtain the engineering constants of composite laminates, which are necessary for the numerical model. This application leads to the development of an optimized simulation model to predict the interlayer gaps and non-coaxiality. The numerical results that predict the non-coaxiality are consistent with the experiments, which verified the rationality of simulation model. Furthermore, the effect of the thrust force and clamping force on both interlayer gaps and non-coaxiality were studied. The interlayer gaps gradually increase with the increase in thrust force but decrease with the clamping force. Moreover, the thrust force has a complicated effect on the non-coaxiality. The non-coaxiality first decreases and subsequently increases with the increase in thrust force, which can be attributed to the “tilt effect” in the lower layer. In addition, the non-coaxiality increases with the clamping force in the simulation experiment range. The work in this paper enables us to understand the particularity of the non-coaxiality in CFRP/Al stack drilling and select the appropriate cutting parameters for CFRP/Al stack drilling.

The deformation of thin-wall stacked structures with low stiffness has been a common problem in the aircraft assembly process, making it difficult to achieve tight tolerance of the countersink depth in one-shot stack drilling. This difficulty is attributed to the complex tool position relative to the workpiece during the machining process. In this paper, an approach to countersink depth control composed of real measurement of the workpiece deformation and compensation of the tool position is presented. The deformation of the workpiece is divided into the following two categories: the rotation angle perpendicular to the feed direction and the deformation along the feed direction. These types of deformation are analysed regarding their influence on the countersink depth error. Effective measures are taken to ensure the countersink depth accuracy; such measures include the adjustment of the normal vector of the drilling position after the clamping process, the error monitoring of the normal vector during machining, and the multi-level compensation during machining. Theoretical analysis and validation of the proposed solution via comparative experiments showed a clear understanding of the coupled interaction of the thrust force with the workpiece deformation and corresponding reduction in the countersink depth error. The compensation solution requires simple computation and is straightforward to implement in industrial automatic drilling applications.

The double skin composite wall (DSCW) with steel truss is an innovative lateral load resisting member which composed of two steel plates, core concrete, concrete-filled steel tubes (CFSTs) as boundary members, and steel truss connectors. The effects of the aspect ratio and the flange wall width on the seismic performance are investigated based on the quasi-static test of full-scale T-shaped DSCWs with steel truss. The failure mode, load-displacement response, shear strength, ductility, energy dissipation, shear deformation, and stress distribution of the specimens were analyzed. The test results showed that the failure mode of the T-shaped DSCW with steel truss specimens with aspect ratios of 2.0 and 2.5 was flexure-shear failure, which was characterized by shear buckling of the steel plate, local buckling, and fracture of the boundary members, and of crushing of core concrete. The T-shaped specimens with a small aspect ratio have a higher shear strength, ductility, energy dissipation capacity, and shear deformation proportion. The T-shaped specimen with a long flange wall also has a higher shear strength, but the ductility, energy dissipation capacity, and shear deformation proportion are small. The stress distribution indicates that the T-shaped specimen is more likely to failure due to the insufficient flexural strength of the boundary member. The theoretical formula for the flexural strength of T-shaped DSCW with steel truss is established, and the validation results show that the formula is accurate and safe.

Background and objectives: Automatic retinal vessel segmentation (RVS) in fundus images is expected to be a vital step in the early image diagnosis of ophthalmologic diseases. However, it is a challenging task to detect the retinal vessel accurately mainly due to the vascular intricacies, lesion areas and optic disc edges in retinal fundus images. Methods: In this paper, we propose a high resolution representation network with multi-path scale (MPS-Net) for RVS aiming to improve the performance of extracting the retinal blood vessels. In the MPS-Net, there exist one high resolution main road and two lower resolution branch roads where the proposed multi-path scale modules are embedded to enhance the representation ability of network. Besides, in order to guide the network focus on learning the features of hard examples in retinal images, we design a hard-focused cross-entropy loss function. Results: We evaluate our network structure on DRIVE, STARE, CHASE and synthetic images and the quantitative comparisons with respect to the existing methods are presented. The experimental results show that our approach is superior to most methods in terms of F1-score, sensitivity, G-mean and Matthews correlation coefficient. Conclusions: The promising segmentation performances reveal that our method has potential in real-world applications and can be exploited for other medical images with further analysis.

e16117 Combining radiation therapy with anti-PD-1 for patients with advanced hepatocellular carcinoma: an open-label, single-center, single-arm clinical study Jian-Xu Li, Ting-Shi Su, Xiao-Feng Lin, Yi-Tian Chen, Shi-Xiong Liang, Bang-De Xiang; Guangxi Medical University Cancer Hospital, Nanning, China Abstract Research Funding: Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China. Guangxi Medical and Health Appropriate Technology Development and Application Project (No. S2019039), Guangxi, China. Background: Based on the results of recent studies, the PD-1 monoclonal antibodies have been approved to treat the patients with advanced hepatocellular carcinoma (HCC) by the FDA. Radiation therapy (RT) can enhance responsiveness to PD-1 monoclonal antibody by potential mechanisms. A phase Ⅱa study was conducted to assess the safety and the efficacy of combining RT with anti-PD-1 for patients with advanced hepatocellular carcinoma. Methods: Patients with advanced HCC were eligible. Stereotactic body radiation therapy (SBRT) were adopted, and the dose of radiation were Dt-PGTV 30-50 Gy/10fractions. Camrelizumab (200mg) were given intravenously every 3 weeks since the first day of RT until disease progression, or intolerable toxicity. Adverse events (AEs) and objective response rate (ORR) were summarized to assess the safety and efficacy. Results: From April 2020 to November 2020, 17 patients were enrolled (median age 54, range 32-69). 15 (88%) patients were male. 14 (82%) had ECOG performance score of 0. All the patients had Child-Pugh score A. 16 patients staged as Barcelona Clinic Liver Cancer staging C or China Liver Cancer staging Ⅲ. Extrahepatic metastases were identified in 11 (65%) patients. 13 (77%) patients were Hepatitis B virus infected. 15 (88%) patients had previously 2 lines or more chemotherapy. 9 (53%) patients had Alpha-fetoprotein level≥400 ng/ml. The ORR was 47%. The best response assessed by RECIST 1.1 was partial response (8 patients). Four patients had grade 3 immune-related adverse events (irAEs), including increased aspartate aminotransferase and alanine transaminase (n =1)，decreased hemoglobin (n =1)，decreased platelet count (n =1)，decreased neutrophil count (n =1). All grade 3 irAEs were mitigated with proper treatment. None treatment-related deaths occurred. Conclusions: In this study, RT combined with anti-PD-1 had an acceptable safety profile and indicated an effective treatment option in patients with unresectable HCC. Clinical trial information: NCT04193696. Clinical trial information: NCT04193696.

e16155 Background: External beam radiation therapy has been used as a palliative to radical treatment of hepatocellular carcinoma (HCC) depending on different tumor status, liver function and patient's general state of health. The existing models of HCC staging cannot perfectly predict the prognosis of radiotherapy. In this study, we aimed to set up a new staging system for radiotherapy-based treatment by incorporating bilirubin-albumin (ALBI) grade and tumor status for the prognostic classifications of HCC. Methods: This multicenter cohort study included 878 HCC patients who received radiotherapy-based treatment. A new staging system was established: stage I, solitary nodule without macrovascular invasion or 2-3 nodules with no more than 3.0 cm each other and PS 0-2 (Ia: ALBI-1 grade; Ib: ALBI-2 or 3 grade); stage II: 2-3 nodules with anyone more than 3.0 cm or ≥4 nodules and PS 0-2 (IIa: ALBI-1 grade; IIb: ALBI-2 grade); stage III: macrovascular invasion or regional lymph node metastasis or distant metastasis and PS 0-2 (IIIa: ALBI-1 grade; IIIb:ALBI-2 grade); stage IV: ALBI-3 grade without stage I patient or/and PS score 3-4. The new modified staging system and the existing staging systems, such as the BCLC, TNM, CNLC staging systems were used for prognostic analysis. All patients were separated into different stages and substages. The long-term overall survival outcomes and time-dependent receiver operating characteristic (ROC) were analyzed. Results: A training cohort of 595 patients underwent stereotactic body radiotherapy (SBRT) from 2011 to 2017 and an external validation cohort of 283 patients underwent intensity-modulated radiotherapy (IMRT) from 2000 to 2013 were included into establishing and validating the new staging system. In the training cohort, the median follow-up time was 55 months (range, 6–100 months), and the new staging system had a good discriminatory ability to separate patients into different stages with 4 notably different curves and substages with 7 notably different curves. BCLC staging could not differentiate stage 0 to A, and stage C to D in these selected patients. TNM staging could not completely distinguish stage IIIb to IV, but also stage Ia to Ib. CNLC staging could not differentiate among stage IIIa, IIIb, and IV. In the external validation, the median follow-up time was 95 months (range, 9–120 months), and the new staging system also had a good discriminatory ability to separate patients into different stages with 4 notably different curves and substages with 7 notably different curves. The new staging system had a better area under curve of time-dependent ROC than BCLC, TNM and CNLC staging in both SBRT and IMRT cohorts. Conclusions: The new modified (Su’s) staging system could provide a good discriminatory ability to separate patients into different stages and substages after radiotherapy treatment. It may be used to supplement the other HCC staging systems.

e16115 Background: In the past clinical practice of radiotherapy for liver cancer, liver regeneration (LR) which is beneficial to the prevention or recovery of radiation-induced liver injury, has not received enough attention. In current study, we aimed to build and validate multivariate model for liver regeneration after radiation therapy for hepatocellular carcinoma (HCC) based on data from 2 prospective studies. Methods: Thirty patients treated with preoperative downstaging radiotherapy were prospectively included in the training cohort, and 21 patients treated with postoperative adjuvant radiotherapy were included in the validation cohort. Liver regeneration was defined as an increase of more than 10% of normal liver volume in the areas of the protected hepatic segment or lobe, without Child-Pugh class decreased and tumor progression compared to pre-radiotherapy. Model and nomogram of liver regeneration after radiotherapy were developed and validated. The cut-off points of each optimal predictors were obtained using receiver-operating characteristic analysis. Risk stratification based on the cut-off point was conducted to compare the proportion of patients with liver regeneration between subgroups. Results: After radiotherapy, 12 (40%) cases in the training cohort and 13 (61.9%) cases in the validation cohort experienced liver regeneration. The model and nomogram of liver regeneration based on SVs20 (standard residual liver volume spared from at least 20 Gy) and alanine aminotransferase (ALT) showed good prediction performance (AUC = 0.759) in training cohort and performed well (AUC = 0.808) in the validation cohort. The risk stratification according to the cutoffs of SVs20 with 303.4 mL and ALT with 43 U/L demonstrated clear differentiation in risk of liver regeneration between the training(P = 0.049) and entire cohort (P = 0.032). The proportion of patients with liver regeneration decrease progressively with 88.9% in high-probability group (ALT＜43 U/L and SVs20＜303.4 mL), 60% in high-intermediate probability group (ALT ≥43 U/L and SVs20＜303.4 mL), 43.75% in low-intermediate probability group (ALT＜43 U/L and SVs20≥303.4 mL) and 33% in low- probability group (ALT≥43 U/L and SVs20≥303.4 mL). Conclusions: SVs20 and ALT are optimal predictors for liver regeneration. This simple-to-use nomogram is beneficial to the constraints of normal liver outside the radiotherapy target area and make prognosis-based decision without complex calculations. Clinical trial information: ChiCTR1800015350. [Table: see text]

This paper describes an experimental study to investigate the seismic behavior of double skin composite walls (DSCWs) with steel truss. Based on the results of seven specimens tested at full-scale, the influence of aspect ratio, axial compression ratio, and truss spacing to thickness ratio on the seismic behavior of DSCW with steel truss are considered. The failure mode, load-displacement relationship, strength, ductility, stiffness, energy dissipation capacity, and shear deformation were analyzed. The results showed that the aspect ratio had the most significant influence on the failure mode and seismic behavior of the specimen. For specimens with an aspect ratio of 2.0, shear compression failure dominates, while for specimens with an aspect ratio over 2.0, flexure shear failure dominates. The strength and initial stiffness decreased with the increase of aspect ratio, but the ductility and energy dissipation became better with the increase of aspect ratio. The axial compression had a little positive effect on the strength, but the specimen with a smaller axial compression ratio had better ductility and energy dissipation. The large truss spacing to thickness ratio weakened the external restraint effect of the steel truss on the steel plates, leading to premature buckling and failure of the specimen.

// Zhi-Rui Zhou 1,2,3,* , Min Liu 3,* , Hui-Rong Lu 3 , Ye-Fei Li 3 , Shi-Xiong Liang 3,4 and Chun-Yan Zhang 5 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China 3 Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, P.R. China 4 Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China 5 Department of Experimental Research, Cancer Hospital of Guangxi Medical University, Nanning, P.R. China * These authors have contributed equally to this work Correspondence to: Shi-Xiong Liang, email: // Chun-Yan Zhang, email: // Keywords : hepatocellular carcinoma, radiotherapy, cancer staging Received : September 20, 2016 Accepted : January 16, 2017 Published : January 28, 2017 Abstract There is no consensus on predicting prognosis for hepatocellular carcinoma patients undergoing radiotherapy. This study aims to evaluate the validity of different staging systems. Overall, 249 hepatocellular carcinoma patients were evaluated retrospectively. All patients were classified by different staging systems. The cumulative survival rates were calculated using the Kaplan-Meier method, and survival curves were compared using the log-rank test. Harrell’s concordance index (c-index) was calculated. The 1-, 3-, and 5-year overall survival rates were 58%, 31% and 20%, respectively. Significant differences in overall survival were observed between stages I and II of the Okuda staging system ( p =0.004), between scores of 3 and 4 of Cancer of the Liver Italian Program prognostic score ( p =0.009), between Chinese University Prognostic Index low-risk and intermediate-risk groups ( p =0.01), between 1 and 2 points of the Japan Integrated Staging score ( p =0.037), between stages III and IV of American Joint Committee on Cancer 1997 TNM staging system ( p =0.011), between stages II and III of American Joint Committee on Cancer 2002 TNM staging system ( p =0.026) and between stages I and II of Guangzhou 2001 staging system ( p =0.000). In conclusion, the Okuda staging system, Chinese University Prognostic Index, and Chinese Guangzhou 2001 staging system were more discriminative than the other staging systems in the prognostic stratification for hepatocellular carcinoma patients undergoing radiotherapy.

Fei-Xiang Wu,1–3,* Hui-Rong Lu,4,* Shao-Liang Zhu,1,* Zi-Hui Li,1 Ling Zou,1 Tao Bai,1 Jie Chen,1 Tian-Bo Yang,1 Shi-Xiong Liang4,51Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 2Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, 3Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Shanghai, 4Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 5Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workObjective: The current study aimed to evaluate the efficacy and outcomes of three-dimensional conformal radiotherapy (3DCRT) combined with transarterial chemoembolization (TACE) for treating patients with hepatocellular carcinoma involving portal vein tumor thrombus.Methods: During 2000 and 2013, a total of 182 hepatocellular carcinoma patients with portal vein tumor thrombus were retrospectively analyzed: 68 patients were treated by 3DCRT alone (group A), 74 by TACE alone (group B), and 40 by a combination of 3DCRT + TACE (group C). The overall survival (OS) of the three groups was compared using the Kaplan–Meier method. The independent predictors of survival were identified using multivariate analysis.Results: The total effective rate (complete response + partial response) among all patients was 44% (80/182). The objective response rate (complete response + partial response) was higher in group C than in group A or B, but the differences were not significant. OS rates at 1, 2, and 3years were significantly higher in group C than in group A or B (P

Applying 3D micro-electrodes in micro-electrical discharge machining (micro-EDM) can process a 3D micro-structure with up and down reciprocating machining method. However, this method has some shortcomings, such as the formation of ridges on 3D micro-structure surface and a relatively low processing efficiency. To resolve these shortcomings, this study fabricated 3D micro-electrode and applied it in micro-electrochemical machining (micro-ECM). Based on the principle of electrolytic polishing, the ridges on the 3D micro-structure surface were basically eliminated and make the ridges have little influence on the 3D micro-structure surface. Moreover, with a feeding speed of 50 μm/min, it takes only 8 min to process a 3D micro-structure (360-μm depth) by using micro-ECM. With the improvement of surface quality and processing efficiency, it is believed that this study could improve the application possibility of 3D micro-electrodes in industrial fields.

// Zhi-Rui Zhou 1,2,3,* , Qing Han 3,* , Shi-Xiong Liang 3,4 , Xiao-Dong He 4 , Nu-Yun Cao 5 and Ying-Jie Zi 3 1 Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, P.R.China 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R.China 3 Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, P.R.China 4 Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R.China 5 College of Mathematics and Information Science, Guangxi University, Nanning, P.R.China * These authors have contributed equally to this paper Correspondence to: Shi-Xiong Liang, email: // Keywords : intensity modulated radiotherapy; normal tissue complication probability; radiation-induced lung injury; breast cancer Received : September 16, 2016 Accepted : October 24, 2016 Published : October 28, 2016 Abstract To investigate the relationship between dosimetric factors, including Lyman normal-tissue complication (NTCP) parameters and radiation-induced lung injury (RILI), in postoperative breast cancer patients treated by intensity modulated radiotherapy (IMRT). 109 breast cancer patients who received IMRT between January 2012 and December 2013 were prospectively enrolled. A maximum likelihood analysis yielded the best estimates for Lyman NTCP parameters. Ten patients were diagnosed with RILI (primarily Grade 1 or Grade 2 RILI); the rate of RILI was 9.17% (10/109). Multivariate analysis demonstrated that ipsilateral lung V 20 was an independent predictor ( P =0.001) of RILI. Setting V 20 =29.03% as the cut-off value, the prediction of RILI achieved high accuracy (94.5%), with a sensitivity of 80% and specificity of 96%. The NTCP model parameters for 109 patients were m=0.437, n =0.912, and TD 50 (1)=17.211 Gy. The sensitivity of the modified Lyman NTCP model to predict the RILI was 90% (9/10), the specificity was 69.7% (69/99), and the accuracy was 71.6% (78/109). The RILI rate of the NTCP 9.62% in patients with breast cancer was 23.08% (9/39), ( P =0.001). In conclusion, V 20 is an independent predictive factor for RILI in patients with breast cancer treated by IMRT; V 20 =29.03% could be a useful dosimetric parameter to predict the risk of RILI. The Lyman NTCP model parameters of the new value (m=0.437, n =0.912, TD50 (1) =17.211 Gy) can be used as an effective biological index to evaluate the risk of RILI.

Current evidence demonstrated certain beneficial effects of medicinal herbs as an adjuvant therapy for post-stroke depression (PSD) in China; Chai-hu (Chinese Thorowax Root, Radix Bupleuri) is an example of a medicinal plant for Liver-Qi regulation (MPLR) in the treatment of PSD. Despite several narrative reports on the antidepressant properties of MPLR, it appears that there are no systematic reviews to summarize its outcome effects. Therefore, the aim of this review was to assess the effectiveness and safety of MPLR adjuvant therapy in patients with PSD. Seven databases were extensively searched from January 2000 until July 2016. Randomized control trials (RCTs) involving patients with PSD that compared treatment with and without MPLR were taken into account. The pooled effect estimates were calculated based on Cochrane Collaboration's software RevMan 5.3. Finally, 42 eligible studies with 3612 participants were included. Overall, MPLR adjuvant therapy showed a significantly higher effective rate (RR = 1.23; 95% CI = 1.19, 1.27; p

Xerostomia is a common radiation-induced late complication after radiotherapy. Identifying predictive factors for xerostomia will lead to better treatments and improve the quality of life. This study was conducted to establish an effective predictive nomogram for xerostomia by assessing stage I-IVb (AJCC 7th edition) NPC patients between September 2015 and March 2016. Xerostomia was evaluated via the RTOG/EORTC system. The primary endpoint was grade 2-3 xerostomia 1 year after treatment. The predictive factors for xerostomia were analysed using logistic regression analysis. A nomogram was constructed based on combining the predictors and clinical variables. In total, 102 patients with grade 0-1 xerostomia and 93 patients with grade 2-3 xerostomia were included. The independent predictive factors for xerostomia were V25, V30, V35, and V45 of the ipsilateral parotid gland and mean dose of the contralateral parotid gland. The calibration plot for the probability of xerostomia showed good agreement between prediction by the nomogram and actual observation. The concordance index of the nomogram for predicting xerostomia was 0.796 (95% CI: 0.735-0.857, P

Purpose Chemotherapy use remains controversial for stage II nasopharyngeal carcinoma (NPC). This retrospective study was conducted to identify whether chemoradiotherapy was associated with better survival compared to radiotherapy. Materials and methods The Surveillance, Epidemiology, and End Results (SEER) database was queried for stage II NPC patients between 2004 and 2015. Patients were divided into radiotherapy and chemoradiotherapy groups. Overall survival (OS) and cancer-specific survival (CSS) were examined using the Kaplan-Meier method, Cox proportional hazards models, and propensity score matching analyses. Results This study examined 908 patients, including 102 receiving radiotherapy and 806 receiving chemoradiotherapy. Chemoradiotherapy was associated with 5-year OS (78.01% vs. 75.12%; p = 0.22) and CSS (78.92% vs. 78.26%; p = 0.40) rates comparable to those of radiotherapy. Propensity score matching analyses demonstrated similar OS (HR: 0.63, 95% CI: 0.36–-1.10; p = 0.10) and CSS (HR: 0.77, 95% CI: 0.41–1.48; p = 0.44) rates with radiotherapy. Age >60 years and non-Asian patients were associated with worse survival. Conclusion This study revealed that chemoradiotherapy showed similar survivals to stage II NPC patients compared with radiotherapy. Due to the limitations of SEER database, further studies should be performed to verify the results.

Background: Several epidemiological articles have reported the correlations between anti-osteoporosis medication and the risks of fractures in male and female subjects, but the specific efficacy of anti-osteoporosis medication for male subjects remains largely unexplored. Objective: The aim of this study was to evaluate the correlation between anti-osteoporosis medication and the risk of fracture in relation to low bone mass [including outcomes of osteoporosis, fracture, and bone mineral density (BMD) loss] in male subjects analyzed in studies within the updated literature. Methods: Randomized controlled trials (RCTs) that analyzed the effectiveness of a treating prescription for male subjects with osteoporosis (or low BMD) and that focused on the outcomes of fracture were included. Relevant studies from Embase, Web of Science, PubMed, and Chinese database of CNKI were retrieved from inception to January 30th, 2019. Two staff members carried out the eligibility assessment and data extraction. The discrepancies were settled by consultation with another researcher. We calculated the pooled relative risks (RRs) based on 95% confidence intervals (CIs). Results: Twenty-seven documents (28 studies) with 5,678 subjects were identified. For the category of bisphosphonates, significant results were observed in pooled analyses for decreased risk of the vertebral fracture domain (RR, 0.44 [95% CI, 0.31–0.62]), nonvertebral fracture domain (RR, 0.63 [95% CI, 0.46–0.87]), and clinical fracture domain (RR, 0.59 [95% CI, 0.48–0.72]) compared with those of controls. Participants with bisphosphonates had a 56% (95% CI = 38–69%) lower risk of vertebral fractures, 37% (95% CI = 13–54%) lower risk of nonvertebral fractures, and 41% (95% CI = 28–52%) lower risk of clinical fractures. Furthermore, meta-analyses also demonstrated a decreased risk of the vertebral fracture domain via treatment with risedronate (RR, 0.45 [95% CI, 0.28–0.72]) and alendronate (RR, 0.41 [95% CI, 0.23–0.74]), but not with calcitriol, calcitonin, denosumab, ibandronate, monofluorophosphate, strontium ranelate, teriparatide, or zoledronic acid, compared with that of controls. Conclusions: This systematic review confirms that bisphosphonates were connected with a decreased risk of vertebral fractures, nonvertebral fractures, and clinical fractures for male subjects with osteoporosis. Future research is needed to further elucidate the role of nonbisphosphonates in treating fractures of osteoporosis subjects.

Multimode waveguide Bragg gratings (MWBGs) are demonstrated on silicon-on-insulator (SOI) platform for on-chip applications, such as band-pass and band-rejection filter, add-drop filter, polarization beam splitter and mode multi/demultiplexers. The operating principle is based on the contra-directional coupling between the fundamental transverse electric mode and different higher-order modes, which depends on the symmetry or the asymmetry properties of the periodic refractive-index perturbations. The designs and experimental results of different MWBGs based devices are presented.

Objective The Dengzhan Shengmai (DZSM) capsule is a commercially available type of Chinese herbal medicine frequently administered to improve neurological impairment after stroke. Its ability to prevent recurrent stroke, however, has not been determined. This study therefore evaluated the ability of DZSM as an add-on to conventional secondary preventive agents to prevent recurrent ischemic stroke. Methods In this randomised, double-blind, placebo-controlled trial, conducted at 83 hospitals in Mainland China, 3143 patients in 14–180 days after the initial onset of ischemic stroke, were randomly allocated to the DZSM (0.36 g, twice daily for 12 months) or the placebo group. All patients in both groups received standard secondary preventive medications. The primary outcome was the 1-year incidence of stroke. Between group differences were assessed using the Cox proportional hazards model. Results Intent-to-treat analysis showed that 58 (3.8%) participants in the DZSM group and 82 (5.4%) in the placebo group experienced new stroke events (hazard ratio = 0.70, 95% confidence interval = 0.50–0.98, P = 0.036). The type and incidence of adverse events were similar in the DZSM and placebo groups. Conclusions The addition of DZSM capsules to standard secondary preventive agents provides additional benefits after the initial onset of ischemic stroke, reducing recurrent stroke without increasing severe adverse events. However, further study is needed to elucidate the role of DZSM on the updated practice of conventional secondary prevention for ischemic stroke.

The aim of this research was to study the pharmacokinetic characteristics of a slow-release 5-fluorouracil implant as well as to evaluate the clinical drug activity of this preparation in pancreatic cancer patients. Pharmacokinetic characteristics of the slow-release 5-fluorouracil implant were evaluated by examining the half-life time (T1/2) and apparent volume of distribution (Vd) in pancreatic cancer patients; the slow-release 5-fluorouracil implant was administered through interstitial chemotherapy (tumor interstitium implantation). In the drug activity study, 36 locally advanced unresectable pancreatic cancer patients were divided randomly into an experimental treatment group (n=18) and a standard treatment group (n=18). The experimental treatment group was treated with interstitial chemotherapy of a slow-release 5-fluorouracil implant combined with systemic chemotherapy of gemcitabine; the standard treatment group was treated with systemic chemotherapy of gemcitabine. An internal drainage procedure was used when biliary and/or gastrointestinal tract obstruction occurred in the two groups. Clinical benefit response, including pain (visual analogue scale), analgesic drug use, general conditions (Karnofsky performance score), weight changes, and survival status, was observed. T1/2 of the slow-release 5-fluorouracil implant was 5475.8±136.4 min, whereas Vd was 45275.0±1028.6 l. Clinical benefit response in the experimental treatment group was better than that in the standard treatment group. The experimental treatment group had longer median survival time compared with the standard treatment group. The slow-release 5-fluorouracil implant could deliver drugs mainly in the regional area of the tumor and prolong the drug action time; interstitial chemotherapy of a 5-fluorouracil implant combined with systemic chemotherapy of gemcitabine could improve the quality of life and survival status of pancreatic cancer patients. The method was promising and worthy of in-depth investigations.

Many publications have reported the growing application of complementary and alternative medicine, particularly the use of Chinese herbal medicine (CHM) in combination with routine pharmacotherapy (RP) for senile vascular dementia (SVD), but its efficacy remains largely unexplored. The purpose of this study is to evaluate the efficacy of CHM adjunctive therapy (CHMAT), which is CHM combined with RP, in the treatment of SVD. Publications in seven electronic databases were searched extensively, and 27 trials with a total of 1961 patients were included for analysis. Compared with RP alone, CHMAT significantly increased the effective rate [odds ratio (OR) 2.98, 95% confidence interval (CI) 2.30, 3.86]. In addition, CHMAT showed benefits in detailed subgroups of the Mini-Mental State Exam (MMSE) score from time of onset to 4 weeks (WMD 3.01, 95% CI 2.15, 3.87), 8 weeks (weighted mean difference (WMD) 2.30, 95% CI 1.28, 3.32), 12 weeks (WMD 2.93, 95% CI 2.17, 3.69), and 24 weeks (WMD 3.25, 95% CI 2.61, 3.88), and in the activity of daily living scale score from time of onset to 4 weeks (WMD -4.64, 95% CI -6.12, -3.17), 8 weeks (WMD -4.30, 95% CI -6.04, -2.56), 12 weeks (WMD -3.89, 95% CI -4.68, -3.09), and 24 weeks (WMD -4.04, 95% CI -6.51, -1.57). Moreover, CHMAT had positive effects on changes in the Hasegawa dementia scale, National Institutes of Health Stroke Scale, Clinical Dementia Rating, and Montreal Cognitive Assessment scores, as well as blood fat levels (total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and apolipoprotein E), platelet aggregation rate (1-min platelet aggregation rate, 5-min platelet aggregation rate, and maximal platelet aggregation rate), and blood rheology (whole-blood viscosity and hematocrit). No serious or frequently occurring adverse effects were reported. Weaknesses of methodological quality in most trials were assessed using the Cochrane risk of bias tool, while the quality level of Grades of Recommendations Assessment Development and Evaluation (GRADE) evidence classification indicated 'very low'. This systematic review suggests that CHM as an adjunctive therapy can improve cognitive impairment and enhance immediate response and quality of life in SVD patients. However, because of limitations of methodological quality in the included studies, further research of rigorous design is needed.

Sandwich composite walls are composed of two external steel faceplates and concrete infill and have been increasingly applied in infrastructure to resist either gravity or lateral loads. They combine the advantages of both steel and concrete and offer excellent structural behavior. In this paper, the performance of a new type of T-shaped sandwich composite walls with truss connectors was studied. Three full-scaled specimens with T-section were tested under eccentric compression. The failure mode was identified as the sectional strength failure. Load versus axial and out-of-plane displacement responses, buckling stress, axial stiffness, ductility, and strength utilization were discussed. Based on CECS 159, the interaction model between the compression and bending moment was proposed to estimate the sectional strength of sandwich composite walls under eccentric compression. The comparison between the test data and the proposed curve shows that the proposed method offers reasonable and conservative predictions on the strength of sandwich composite walls.

The feasibility of detecting circumferential defects of inner and outer walls of boiler tubes through the ultrasonic guided wave technology was verified through a test with probes with different guided wave modes and different frequencies in this paper. In addition, sampling inspection was performed to the T91 tube section of a high temperature reheater of the No. 1 furnace of the Power Plant in Youxian County at the infrastructure construction phase through ultrasonic guided wave detection, which verified that the detection technology has the advantages of small on-site grinding workload, low inspection workload and low work intensity on site.

Background Extranodal natural killer/T-cell lymphoma (ENKTL) is a rare lymphoid malignancy with diverse clinical features and prognoses. The aims of this study were to explore the pretreatment prognostic factors of ENKTL and develop a new individual prognostic model. Patients and Methods We retrospectively enrolled 81 ENKTL patients with newly diagnosed disease between June 2006 and August 2017 at the Affiliated Cancer Hospital of Guangxi Medical University. Survival analysis was used to assess the prognostic value of various factors. A nomogram was developed to predict overall survival (OS) based on the Cox proportional hazards model. Results The median survival time of the patients was 48 months, and the 5-year OS rate was 47.5%. Cox regression analysis showed that the prognostic factors of OS for ENKTL patients included Eastern Cooperative Oncology Group performance status, Ann Arbor stage, pretreatment albumin-to-globulin ratio, and platelet count. A prognostic nomogram was developed to predict the OS rate for ENKTL patients based on these factors. The calibration curve showed that the nomogram was able to predict OS accurately. The concordance index of the nomogram for OS prediction was 0.807. Conclusion Our proposed nomogram based on Eastern Cooperative Oncology Group performance status, Ann Arbor stage, albumin-to-globulin ratio, and platelet count provides an individualized risk estimate of OS in patients with ENKTL.

Surface Electromyography (sEMG) is a cumulated bioelectrical signal that represents the level of contraction in the musculature. The major muscles control the wrist and finger movements reside in the forearm. The surface EMG of the forearm muscles indicates the movement of wrist and fingers and leads to many applications, such as intelligent prostheses and exoskeletons. Wireless acquisition system has been recently used to collect the sEMG signal from the subject's forearm. In this study, raw EMG data is processed by a Time-Domain Auto-Regressive (TD-AR) model to extract its spatial features. We apply the Principal Component Analysis (PCA) method to reduce the dimensionality and then normalize the feature matrix. A Probabilistic Neural Network (PNN) model has been utilized to train the hand gesture predictor. Total 8 gestures from 5 subjects were selected to train and evaluate the model. The proposed identification model uses 6 channels and achieves stable recognition accuracy, including finger swinging motion. The average success rate of hand gestures identification is 92.2%. In order to visualize the experiment and simulate the control system, a finite state machine is built, which can be used to drive virtual hand or intelligent prostheses for future studies.