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BackgroundWe aimed to investigate the efficacy of a novel regimen, external beam radiation (RT) combined with trans arterial chemoembolization (TACE) and lenvatinib (LEN), in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus.MethodsWe prospectively observed 102 participants from three tertiary medical centers in China between October 2018 and October 2020, who chose either RT plus TACE and LEN (RT-TACE-LEN) or TACE and LEN (TACE-LEN). LEN (12 mg or 8 mg daily) was administrated orally and continued until progression or intolerable side effects were noted. TACE was given one day after administration of LEN, and RT began within 4 weeks after the first TACE. The median dose/fraction of RT was 50 Gy/25 fractions (range: 45-60 Gy/25 fractions). Overall survival and progression free survival were compared between two groups, and complications were assessed.ResultsBoth 51 patients received RT-TACE-LEN and TACE-LEN, respectively. Most patients had tumor size> 5 cm (73.8%) and tumor number≥ 2 (69.9%). The overall incidence of toxicities was significantly higher in RT-TACE-LEN group than TACE-LEN group (100% vs. 64.7%, p< 0.001), but incidences of grade 3-4 toxicities were comparable (54.9% vs. 49.0%, p= 0.552). Both median overall survival (22.8 vs. 17.1 months, p= 0.031) and median progression-free survival (12.8 vs. 10.5 months, p= 0.035) were significantly longer after RT-TACE-LEN treatment than TACE-LEN.ConclusionsThe addition of RT to TACE and LEN was safe, and might improve clinical outcomes of patients with advanced HCC, which needs conformation from further studies.

Abstract Treatment options specifically for patients with locally advanced pancreatic adenocarcinoma (LAPC) are scare and chemotherapy alone delivers limited efficacy. Immunotherapy and radiotherapy are potential effective treatments for LAPC, and both of them may synergize with chemotherapy. Therefore, in this prospective cohort study, we compared the efficacy and safety of nab-paclitaxel plus gemcitabine combined with anti-programmed cell death (PD-1) immunotherapy and radiotherapy (hereafter, combination treatment) versus nab-paclitaxel plus gemcitabine (chemotherapy alone) in the treatment of LAPC. In the combination group, participants received conventional fractionated radiotherapy with doses ranging from 54 to 63 Gy in 28 fractions, intravenous camrelizumab 200 mg once every 3 weeks, and intravenous nab-paclitaxel plus gemcitabine on day 1 and 8 of a 21-day cycle for eight cycles until disease progression, death or unacceptable toxicity. In the chemotherapy group, participants received intravenous nab-paclitaxel plus gemcitabine on day 1 and 8 of a 21-day cycle for eight cycles. From April, 2020 to December, 2021, 96 participants with LAPC were prospectively enrolled with 32 received combination treatment and 64 received chemotherapy alone at a single center. The combination treatment yielded significantly longer median overall-survival (22.3 months vs. 18.6 months, P = 0.031) and progression-free survival (12.0 months vs. 10.5 months, P = 0.043) than chemotherapy alone did. And the incidence of severe adverse events was not significantly different between the combination group and chemotherapy group (P = 0.856). In conclusion, nab-paclitaxel plus gemcitabine combined with anti-PD-1 immunotherapy and radiotherapy was effective and safe for LAPC patients, and it warrants further investigation in larger randomized trials.

Few studies have calculated the magnitude of the modal accessibility gap between public and private transportation (MAG) by taking into account both population characteristics and time-varying characteristics. To incorporate the aforementioned characteristics, this study computed MAG within each population grid using the anticipated travel time between two grids in real time. Moreover, a representative case study focuses on the MAG in the urban area of Xi'an during three time periods. Research results indicate that the average travel time for private transportation in the study area is significantly lower than that of public transportation. Further, the subway line has an obvious impact on improving MAG. In addition, the development of public transportation in the peripheral regions lags behind that of the city center, and the subway network is inadequately serviced. As a result of utilizing the MAG method presented in this paper, the problem related to urban transportation planning can be addressed by incorporating both the population and time-varying factors. At the end of the paper, the limitations and future works are discussed.

The rescheduling of train timetables is a crucial task in the scheduling of railway transport, known as the Train Timetable Rescheduling (TTR) problem. In order to increase passenger satisfaction with transfer and reduce the impact of delayed trains on transfer succession and railway operation, a high-speed railway multiobjective optimization model for train timetable rescheduling is constructed with station operating time, transfer station track utilization rate, and train operating time as constraints, and maximizing passenger satisfaction, minimizing total train delay time, and minimizing the number of failed passengers in transfer as optimization objectives. A multiobjective solution algorithm based on hierarchical sequence theory was designed, and finally, the model was solved using Gurobi. Taking the example of the railway network comprising of Beijing-Shanghai high-speed railway and Xuzhou-Lanzhou high-speed railway, two adjustment strategies have been formulated to validate the model. The results show that the train timetable rescheduling model considering transfer passenger satisfaction can significantly reduce the delay time of transfer passengers and the possibility of transfer failure while maintaining high transfer passenger satisfaction, which provides a new idea for real-time train operation scheduling considering transfer succession. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the efficacy of a novel regimen, external beam radiation (RT) combined with trans arterial chemoembolization (TACE) and lenvatinib (LEN), in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus. Methods: We prospectively observed 102 participants from three tertiary medical centers in China between October 2018 and October 2020, who chose either RT plus TACE and LEN (RT-TACE-LEN) or TACE and LEN (TACE-LEN). LEN (12 mg or 8 mg daily) was administrated orally and continued until progression or intolerable side effects were noted. TACE was given one day after administration of LEN, and RT began within 4 weeks after the first TACE. The median dose/fraction of RT was 50 Gy/25 fractions (range: 45-60 Gy/25 fractions). Overall survival and progression free survival were compared between two groups, and complications were assessed. Results: Both 51 patients received RT-TACE-LEN and TACE-LEN, respectively. Most patients had tumor size> 5 cm (73.8%) and tumor number≥ 2 (69.9%). The overall incidence of toxicities was significantly higher in RT-TACE-LEN group than TACE-LEN group (100% vs. 64.7%, p< 0.001), but incidences of grade 3-4 toxicities were comparable (54.9% vs. 49.0%, p= 0.552). Both median overall survival (22.8 vs. 17.1 months, p= 0.031) and median progression-free survival (12.8 vs. 10.5 months, p= 0.035) were significantly longer after RT-TACE-LEN treatment than TACE-LEN. Conclusions: The addition of RT to TACE and LEN was safe, and might improve clinical outcomes of patients with advanced HCC, which needs conformation from further studies. [ABSTRACT FROM AUTHOR]

Reinforced concrete members under impact loading stress may be destroyed in a split period. Because of the need to investigate the impact resistance of reinforced concrete members, this issue remains a much-debated topic. This study investigates the response of reinforced concrete (RC) square members under an unequal lateral impact force. The performance of RC members under the effect of impact load is examined using a drop hammer impact test system. The importance of unequal lateral impact load is highlighted and addressed by examining RC members' failure mode and dynamic response characteristics. Four types of RC members are experimentally investigated in detail. A finite element method (FEM) modeling is proposed to predict the impact responses of the RC members. Moreover, the effects of the impact position, height, and hammer mass on the dynamic response characteristics under an impact force are evaluated. The predictions of the proposed numerical model are validated against experimental results, emphasizing impact force history, deflection time history, and failure modes. Results indicate the viability of the FEM model. The findings from the experimental and numerical studies can improve the impact-resistant performance of reinforced concrete members. [ABSTRACT FROM AUTHOR]