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Abstract Background Concurrent chemoradiotherapy has been standard of care for unresectable esophageal carcinoma. There were no reports on proton radiotherapy (PRT) plus carbon-ion radiotherapy (CIRT) with pencil beam scanning (PBS) for esophageal carcinoma. This study evaluated the tolerability and efficiency of proton and sequential carbon-ion boost radiotherapy for esophageal carcinoma. Methods From April 2017 to July 2020, 20 patients with primary esophageal carcinoma at stages II–IV were treated with PRT plus sequential CIRT with PBS. A median relative biological effectiveness-weighted PRT dose of 50 Gy in 25 fractions, and a sequential CIRT dose of 21 Gy in 7 fractions were delivered. Respiratory motion management was used if the tumor moved > 5 mm during the breathing cycle. A dosimetric comparison of photon intensity-modulated radiotherapy (IMRT), PRT, and CIRT was performed. The median times and rates of survivals were estimated using the Kaplan–Meier method. Comparison of the dose-volume parameters of the organs at risk employed the Wilcoxon matched-pairs test. Results Twenty patients (15 men and 5 women, median age 70 years) were included in the analysis. With a median follow-up period of 25.0 months, the 2-year overall survival and progression-free survival rates were 69.2% and 57.4%, respectively. The patients tolerated radiotherapy and chemotherapy well. Grades 1, 2, 3, and 4 acute hematological toxicities were detected in 25%, 30%, 10%, and 30% of patients, respectively. Grades 3–5 acute non-hematological toxicities were not observed. Late toxicity events included grades 1, 2, and 3 in 50%, 20%, and 10% (pulmonary and esophageal toxicity in each) of patients. Grades 4–5 late toxicities were not noted. PRT or CIRT produced lower doses to organs at risk than did photon IMRT, especially the maximum dose delivered to the spinal cord and the mean doses delivered to the lungs and heart. Conclusions PRT plus CIRT with PBS appears to be a safe and effective treatment for esophageal carcinoma. PRT and CIRT delivered lower doses to organs at risk than did photon IMRT. Further investigation is warranted.

Ammonia energy can be potentially used for substituting fossil energies and it has a close relationship with renewable energy sources; therefore, promoting the application of ammonia energy is expected to enable China to achieve a certain degree of energy independence, which is significant for the future development of energies. In this study, the strategic significance in developing ammonia energy is analyzed from the perspectives of its energy-storage and fuel properties and basic industrial conditions. The ammonia energy application status is reviewed from four aspects: ammonia internal combustion engines, ammonia gas turbines, ammonia-burning boilers, and ammonia-hydrogen fuel cells. Moreover, the status quo of the synthetic ammonia industry, development trend of the ammonia energy industry, and development plans of the industry in China and abroad are examined. Furthermore, we suggest that the ammonia energy industry in China should be promoted steadily by stages. First, the research on novel green ammonia synthesis technologies should be strengthened, laws/regulations and carbon market mechanisms should be improved, and green ammonia demonstration projects should be implemented. Second, an ammonia energy technology system with independent intellectual property rights should be established, and a low-cost ammonia energy supply chain and a high-efficiency ammonia energy utilization chain should be built to achieve large-scale promotion of the energy. Third, the ammonia energy industrial structure should be reshaped according to a green circular economy route that integrates green production, economical transportation, and carbon-free application of ammonia, thereby supporting the carbon peaking and carbon neutralization goals.

Abstract Purpose This study aimed to compare the adverse reactions of conventional-dose and hypofractionated dose of proton therapy for breast cancer. Materials and methods Breast cancer patients treated with proton radiotherapy in conventional-dose or hypofractionated dose were studied retrospectively. Result From January 2017 to December 2019, our center treated 50 patients following lumpectomy with proton radiotherapy. According to the AJCC 8th Edition standard, there were stage I in 26 patients, stage II in 22 patients, and stage III in 2 patients. A total of 14 patients received intensity-modulated proton therapy at a dose of 50 Gy in 25 fractions, followed by a 10 Gy 4 fractionated boost to the lumpectomy cavity, while 36 received 40.05 Gy in 15 fractions, simultaneous integrated boost (SIB) 48 Gy to the lumpectomy cavity. Median follow-up time for 40.05 Gy group was 35.6 months (15–43 months). Median follow-up time for 50 Gy group was 46.8 months (36–68 months). For acute toxicity, the grade 1 and 2 radiodermatitis in conventional-dose group were 35.7% and 57.1%, respectively. In hypofractionated dose group, the grade 1 and 2 radiodermatitis were 91.7% and 8.3%, respectively. The radiodermatitis is hypofractionneted dose better than conventional-dose significantly. Grade 1 radiation-induced esophagitis in conventional-dose group and hypofractionated dose group were 85.71% and 60%, respectively. For late toxicity, no patients developed radiation-induced pneumonitis and rib fracture in conventional-dose group. Three patients presented grade 1 pneumonitis; one patient presented graded 2 pneumonitides and two patients presented rib fracture in hypofractionated dose group. One presented hypothyroidism in hypofractionated dose group. All patients were satisfied with breast shape. The one- and two-year OS and DFS for conventional-dose group were 100 and 100; 100 and 92.9%, respectively. The one- and two-year OS and DFS for hypofractionated dose group were 100 and 100; 100 and 100%, respectively. Conclusion Proton radiation therapy can significantly reduce the normal tissue dose in breast cancer patients' hearts, lungs, and other organs. Hypofractionated proton therapy shortens the treatment course with mild radiation-related adverse effects, and has a better effect on addressing the acute adverse reactions than conventional proton radiotherapy.

Since its inception, cellular plasticity has undergone many iterations. Today we define it as the ability of mature, terminally differentiated cells to change their identity, meaning lineage change of the cells by transdifferentiation, dedifferentiation and reprogramming. This process does not involve a single DNA sequence change or a mutation. We now know that the behavior of a cell is profoundly affected by the surrounding environment. There is a perpetual pressure placed on the genetic expression of the cells. The external environment and specifically the microenvironment of the cells greatly influences the genotype. There is a never-ending dynamic interplay between the genotype and the phenotype. Incremental phenotypic adjustments are continuously occurring to yield improved cell survival. These changes are beneficial to the cells at a given moment. As the environmental condition declines, then more extensive phenotypic transformation (via transdifferentiation and dedifferentiation) can follow. When the cellular environment further deteriorates, cellular plasticity can trigger a pathologic sequence that eventually leads to cancers/diseases. These modifications are all part of an adaptive process that enhances the survival of the cells. They can offer short term advantages, but they can also lead to diseases. Oxygen level plays a pivotal role in the development of chronic diseases. Cellular response to hypoxia is mediated through hypoxia inducible factor (HIF). HIF is an oxygen sensor that is closely involved in the pathophysiologic adaptation to hypoxia. Our hypothesis centers on hypoxia as the major stressor initiating cellular plasticity and restoring normoxia is an essential step in the healing process. This theory could be tested using chronic pathological processes in animal models whereby achieving an adequate cellular oxygen level could improve or halt both plastic change and diseases.

BackgroundThe etiology of autism spectrum (ASD) and Attention Deficit/Hyperactivity (ADHD) disorders are multifactorial. Epidemiological studies have shown associations with environmental pollutants, such as plasticizers. This study focused on two of these compounds, the Bisphenol-A (BPA) and Diethylhexyl Phthalate (DEHP). The major pathway for BPA and DEHP excretion is via glucuronidation. Glucuronidation makes insoluble substances more water-soluble allowing for their subsequent elimination in urine.HypothesisDetoxification of these two plasticizers is compromised in children with ASD and ADHD. Consequently, their tissues are more exposed to these two plasticizers.MethodsWe measured the efficiency of glucuronidation in three groups of children, ASD (n = 66), ADHD (n = 46) and healthy controls (CTR, n = 37). The children were recruited from the clinics of Rutgers-NJ Medical School. A urine specimen was collected from each child. Multiple mass spectrometric analyses including the complete metabolome were determined and used to derive values for the efficiency of glucuronidation for 12 varied glucuronidation pathways including those for BPA and MEHP.Results(1) Both fold differences and metabolome analyses showed that the three groups of children were metabolically different from each other. (2) Of the 12 pathways examined, only the BPA and DEHP pathways discriminated between the three groups. (3) Glucuronidation efficiencies for BPA were reduced by 11% for ASD (p = 0.020) and 17% for ADHD (pConclusionASD and ADHD are clinically and metabolically different but share a reduction in the efficiency of detoxification for both BPA and DEHP with the reductions for BPA being statistically significant.

Academic stress may be the single most dominant stress factor that affects the mental well-being of college students. Some groups of students may experience more stress than others, and the coronavirus disease 19 (COVID-19) pandemic could further complicate the stress response. We surveyed 843 college students and evaluated whether academic stress levels affected their mental health, and if so, whether there were specific vulnerable groups by gender, race/ethnicity, year of study, and reaction to the pandemic. Using a combination of scores from the Perception of Academic Stress Scale (PAS) and the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), we found a significant correlation between worse academic stress and poor mental well-being in all the students, who also reported an exacerbation of stress in response to the pandemic. In addition, SWEMWBS scores revealed the lowest mental health and highest academic stress in non-binary individuals, and the opposite trend was observed for both the measures in men. Furthermore, women and non-binary students reported higher academic stress than men, as indicated by PAS scores. The same pattern held as a reaction to COVID-19-related stress. PAS scores and responses to the pandemic varied by the year of study, but no obvious patterns emerged. These results indicate that academic stress in college is significantly correlated to psychological well-being in the students who responded to this survey. In addition, some groups of college students are more affected by stress than others, and additional resources and support should be provided to them.

ObjectivesThis study aimed to investigate the tolerance and effect of proton plus carbon-ion radiotherapy with concurrent chemotherapy in limited-stage small cell lung cancer using the pencil beam scanning technique.Materials and MethodsFrom March 2017 to April 2020, 25 patients with limited-stage small cell lung cancer treated with combined proton and carbon-ion radiotherapy were analyzed. The primary lesions and involved lymph nodes were irradiated using 2–4 portals. Proton and sequential carbon-ion beams were delivered with a median dose of 67.1 (range, 63–74.8) GyE as fraction doses of 2.0–2.2 GyE with proton beams in 20–23 fractions and 3.0–3.8 GyE with carbon ions in 5–8 fractions. Chemotherapy was delivered concurrently with radiotherapy in all patients.ResultsAt the last follow-up, the 2-year overall and locoregional progression-free survival rates were 81.7% and 66.7%, respectively. Radiochemotherapy was well tolerated, with grade 1, 2, and 3 acute toxicities occurring in 12.0%, 68.0%, and 20.0% of patients, respectively. All grade 3 acute toxicities were hematologically related changes. One patient experienced grade 3 acute non-hematological toxicity in the esophagus, and one other patient had grade 3 bronchial obstruction accompanied by obstructive atelectasis as a late side effect.ConclusionProton plus carbon-ion radiotherapy using pencil beam scanning yielded promising survival rates and tolerability in patients with limited-stage small cell lung cancer. A prospective clinical study is warranted to validate the therapeutic efficacy of particle radiotherapy in combination with chemotherapy in limited-stage small cell lung cancer.

Abstract This study aimed to develop prognosis signatures through a radiomics analysis for patients with nasopharyngeal carcinoma (NPC) by their pretreatment diagnosis magnetic resonance imaging (MRI). A total of 208 radiomics features were extracted for each patient from a database of 303 patients. The patients were split into the training and validation cohorts according to their pretreatment diagnosis date. The radiomics feature analysis consisted of cluster analysis and prognosis model analysis for disease free-survival (DFS), overall survival (OS), distant metastasis-free survival (DMFS) and locoregional recurrence-free survival (LRFS). Additionally, two prognosis models using clinical features only and combined radiomics and clinical features were generated to estimate the incremental prognostic value of radiomics features. Patients were clustered by non-negative matrix factorization (NMF) into two groups. It showed high correspondence with patients’ T stage (p

To study the signal transmission mechanism in the human body, the channel characteristics are generally analyzed by modeling. In current modeling methods, the human body is considered quasi-static and the human tissues isotropic, for simplifying the model and its calculation; however, this does not consider the effect of the human tissues on electric signal transmission, resulting in considerable deviations between the calculated results and the measured values. To reduce model errors and improve precision, a channel modeling method with human muscular-tissue characteristics is proposed in this study. In this method, Maxwell's equations is used as the governing equation and a galvanic-coupling intra-body communication channel model with human-tissue characteristics is built in the cylindrical coordinate system. By building a numerical model with the same parameters as in the analytical model, the analytical solution is proved to be correct. By comparing the different-sample anisotropic models and the isotropic models with the experimental results, it is concluded that the anisotropic model with muscular-tissue characteristics is superior to the isotropic model without muscular-tissue characteristics, with respect to the curve variation tendency and error between the model calculations and the experimental results. The precision of this anisotropic model is enhanced by 200%; hence, it is more accurate. At last, in order to study the optimal communication frequency of the channel, we select 50 healthy persons as the subjects of this experiment, we find that the optimal communication frequency band of the human arm is 10 kHz to 50 kHz. Within this frequency band, the channel gain is the largest, and the mean deviation of samples is less than 2dB, which is very beneficial to signal transmission in human body.

Most cases of COVID-19 in children and adolescents are mild or asymptomatic, but a small number of individuals may develop severe disease, requiring PICU admission and/or mechanical ventilation. We assessed the factors associated with negative short-term outcomes of COVID-19 in 82 pediatric patients at three hospitals within the United States during the spring and summer of 2020 using medical records, laboratory data, and imaging studies of all patients admitted with a positive RT-PCR test for SARS-CoV-2. We found that older patients were more likely to have an extended hospital stay, and those with high BMIs (over 25) were more likely to be admitted to the PICU during the early pandemic. In addition, older patients, those with high BMIs, and those with underlying medical conditions, were more likely to receive respiratory support. Given the association of age, BMI, and underlying medical conditions with more severe COVID-19, clinicians should keep these factors in mind when treating patients.

Objective: Vagus nerve stimulation (VNS) is a treatment option for patients with drug-resistant seizures, but it is also associated with sleep-disordered breathing (SDB). We present four patients with VNS who underwent polysomnography (PSG) concurrently with VNS stimulation monitoring and adjustment, and positive airway pressure (PAP) treatment. We demonstrate the importance of sleep apnea screening prior to VNS placement and the dilemma of optimizing VNS settings. Background: VNS is a common adjunct therapy for refractory epilepsy. Despite its low side effect profile, complications of VNS include delayed arrhythmias, laryngopharyngeal dysfunction, obstructive sleep apnea, and tonsillar pain mimicking glossopharyngeal neuralgia. Risk of developing or exacerbating existing obstructive sleep apnea (OSA) limits the VNS settings, as there appears to be a dose dependent effect. OSA can further cause sleep fragmentation and cause hypoxia, potentially worsening seizures. Methods: Four patients with drug-resistant epilepsy with VNS underwent PSG with concurrent VNS leads to monitor correlation of SDB and VNS. AHI was calculated to quantify SDB, and it was scored as non-VNS related when the VNS was off, and VNS-induced when the onset of SDB corresponded to VNS activation. Subsequent PAP and VNS adjustment was performed to treat the SDB episodes. Results: Three out of four patients had non-VNS associated SDB, which improved with PAP treatment. All four patients had VNS-induced SDB episodes but none improved with PAP. The VNS-induced SDB events decreased in a dose dependent manner, when VNS was adjusted down and disappeared when turned off completely. Conclusion: Our case series provides further evidence of VNS-induced SDB secondary to VNS. PAP treatment alone is ineffective for VNS-induced SDB. Screening for OSA before VNS implant is crucial; further research is needed to establish optimal VNS parameters for prevention andminimization of VNS-induced SDB along with other possible treatments. Keywords: Epilepsy, Vagus nerve stimulation, Sleep apnea, Positive airway pressure, Titration

In order to predict and analyze mining subsidence in Longdong Coal Mine, prediction model of main cross section mining subsidence was established by use of probability integration method, and distribution law of surface subsidence deformation of main cross section was predicted in combination with prediction parameters of coal mine surface subsidence. According to the prediction model of subsidence deformation of any point in goaf, subsidence, inclination, horizontal deformation value at any point in goaf were calculated by use of VB program, then damage degree of mining subsidence land was classified. The results show that subsidence deformation shape of the goaf surface is 'bowl', shape of basin center is flat, subsidence value decreases gradually from the basin center to basin edge, moderate damage land area is 13.1 hm2, accounting for 57.9% of total subsidence area.