消癌平注射液联合表柔比星新辅助化疗对三阴性乳腺癌患者免疫功能、生活质量及血清肿瘤标志物的影响

摘要 目的：探讨消癌平注射液联合表柔比星新辅助化疗对三阴性乳腺癌（TNBC）患者免疫功能、生活质量及血清肿瘤标志物的影响。方法：选取TNBC患者89例,按照随机数字表法分为对照组和研究组,对照组（n=44）患者给予表柔比星新辅助化疗治疗,研究组（n=45）患者给予消癌平注射液联合表柔比星新辅助化疗。对比两组疗效、免疫功能、生活质量、血清肿瘤标志物及不良反应。结果：研究组治疗12周后的临床总有效率为91.11%（41/45）,高于对照组的63.64%（28/44）（P<0.05）。两组治疗12周后健康调查简表（SF-36）量表各维度评分升高,且研究组较对照组高（P<0.05）。两组治疗12周后CD4+CD25+Treg、Th17/ Treg均降低,且研究组较对照组低（P<0.05）,Th17升高,且研究组较对照组高（P<0.05）。两组治疗12周后癌胚抗原（CEA）、糖类抗原199（CA199）、糖类抗原125（CA125）均降低,且研究组较对照组低（P<0.05）。两组不良反应发生率对比未见差异（P>0.05）。结论：消癌平注射液联合表柔比星新辅助化疗治疗TNBC,具有确切的治疗效果,可降低血清肿瘤标志物水平,改善患者免疫功能和生活质量。     

四维子宫输卵管超声造影假阳性与假阴性的原因分析

目的:调查与分析四维子宫输卵管超声造影假阳性与假阴性的原因。方法:选择2015年6月到2019年8月在本院妇产科临床初步诊断为输卵管不孕症患者125例,所有患者都给予X线子宫输卵管碘油造影(Hysterosalp ingography,HSG)与四维子宫输卵管超声造影,记录诊断效果、不良反应,判断假阳性与假阴性的发生原因。结果:在125例患者中,HSG诊断输卵管通畅33例,通而不畅72例,阻塞20例;四维超声造影诊断为输卵管通畅33例,通而不畅74例,阻塞18例。将HSG检查作为金标准,四维超声造影检查输卵管阻塞准确率93.6%,Kappa值=0.929(P<0.05),出现假阳性与假阴性共8例。四维超声造影检查期间发生的阴道少量出血、造影剂过敏、恶心呕吐、腹痛等不良反应发生率为2.4%,显著低于HSG检查的13.6%(P<0.05)。单因素分析结果显示合并糖尿病、产次、初潮年龄、孕次与四维子宫输卵管超声造影的假阳性与假阴性显著相关(P<0.05);多因素Logistic回归分析结果显示合并糖尿病、产次、初潮年龄为导致四维子宫输卵管超声造影假阳性与假阴性的主要原因(P<0.05)。结论:四维子宫输卵管超声造影可实时动态观察输卵管通畅情况,应用安全性也比较好,但是也存在假阳性与假阴性情况,合并糖尿病、产次、初潮年龄为导致四维子宫输卵管超声造影假阳性与假阴性的主要原因。     

Prediction of multi-criteria optimization (MCO) parameter efficiency in volumetric modulated arc therapy (VMAT) treatment planning using machine learning (ML)

PurposeTo predict the impact of optimization parameter changes on dosimetric plan quality criteria in multi-criteria optimized volumetric-modulated-arc therapy (VMAT) planning prior to optimization using machine learning (ML).MethodsA data base comprising a total of 21,266 VMAT treatment plans for 44 cranial and 18 spinal patient geometries was generated. The underlying optimization algorithm is governed by three highly composite parameters which model a combination of important aspects of the solution. Patient geometries were parametrized via volume- and shape properties of the voxel objects and overlap-volume histograms (OVH) of the planning-target-volume (PTV) and a relevant organ-at-risk (OAR). The impact of changes in one of the three optimization parameters on the maximally achievable value range of five dosimetric properties of the resulting dose distributions was studied. To predict the extent of this impact based on patient geometry, treatment site, and current parameter settings prior to optimization, three different ML-models were trained and tested. Precision-recall curves, as well as the area-under-curve (AUC) of the resulting receiver-operator-characteristic (ROC) curves were analyzed for model assessment.ResultsSuccessful identification of parameter regions resulting in a high variability of dosimetric plan properties depended on the choice of geometry features, the treatment indication and the plan property under investigation. AUC values between 0.82 and 0.99 could be achieved. The best average-precision (AP) values obtained from the corresponding precision/recall curves ranged from 0.71 to 0.99.ConclusionsMachine learning models trained on a database of pre-optimized treatment plans can help finding relevant optimization parameter ranges prior to optimization.     

Comparison of the RayStation photon Monte Carlo dose calculation algorithm against measured data under homogeneous and heterogeneous irradiation geometries

PurposeThis work compares Monte Carlo dose calculations performed using the RayStation treatment planning system against data measured on a Varian Truebeam linear accelerator with 6 MV and 10 MV FFF photon beams.MethodsThe dosimetric performance of the RayStation Monte Carlo calculations was evaluated in a variety of irradiation geometries employing homogeneous and heterogeneous phantoms. Profile and depth dose comparisons against measurement were carried out in relative mode using the gamma index as a quantitative measure of similarity within the central high dose regions.ResultsThe results demonstrate that the treatment planning system dose calculation engine agrees with measurement to within 2%/1 mm for more than 95% of the data points in the high dose regions for all test cases. A systematic underestimation was observed at the tail of the profile penumbra and out of field, with mean differences generally <0.5 mm or 1% of curve dose maximum respectively. Out of field agreement varied between evaluated beam models.ConclusionsThe RayStation implementation of photon Monte Carlo dose calculations show good agreement with measured data for the range of scenarios considered in this work and is deemed sufficiently accurate for introduction into clinical use.     

Automatic VMAT technique to treat glioblastoma: A two years’ experience

PurposeThe present work aims to guide the physicist in order to start automated planning for the VMAT treatment of glioblastoma multiforme (GBM) by giving a recipe that was set up and tested during a long-term (two years) evaluation.MethodsAn automatic technique in AutoPlanning module of the Pinnacle3 (Philips Medical Systems, Fitchburg, WI) treatment planning system was created and validated by comparing dose distributions of automatic plans (APs) and manual plans (MPs) and by performing a blind AP-MP comparison on a cohort of 20 patients. Automatic technique was then applied to 145 patients and failures were recorded i.e. the number of times for which dose distributions produced by the automatic module were not suitable for treatment.ResultsEach of the 20 APs considered in the validation step was clinically acceptable and proved to be better (15 cases) or equal (5 cases) respect to MPs. A statistically significant improvement in brain stem, optic pathways, cochleae, pituitary gland and scalp sparing was observed for APs, while no statistically significant differences were recorded in target coverage or plan parameters. For only 5 cases out of the 145 plans the operator intervention was needed in order to obtain a clinical acceptable plan, while for the remaining 140 plans the automatic created solution was suitable.ConclusionsA straightforward automatic procedure has been created and tested in our clinic. The AutoPlanning technique proposed represents a reliable tool to improve treatment planning efficiency and the recipe, here presented, could be simply imported to every radiotherapy center.     

Integrating GIS and expert judgment in a multi-criteria analysis to map and develop a habitat suitability index: A case study of large mammals on the Malayan Peninsula

Many habitat patches in tropical landscapes have become less suitable for wildlife due to an increase in anthropogenic disturbances. An index of habitat suitability based on the ecological factors that collectively determine the suitability of an organism's habitat is important for conservation planning. However, a widely accepted and comprehensive multi-criteria habitat suitability index for umbrella species is still lacking, particularly in areas where information related to the biology and ecology of the species of interest is not available. Therefore we develop preliminary habitat maps and measure the degree of habitat suitability for large mammals, focusing on four umbrella species in the State of Selangor, Peninsular Malaysia: Panthera tigris jacksoni (Malayan tiger), Tapirus indicus (Malayan tapir), Helarctos malayanus malayanus (Malayan sun bear), and Rusa unicolor cambojensis (sambar deer). The former two are endangered and the latter two are vulnerable according to the IUCN Red List. The suitability of habitat patches for each species was measured across the entire study area as well as in nine wildlife protected areas by integrating GIS data and expert opinion. Expert opinions were used as the source of information regarding the stresses faced by the species because there was insufficient information available from ground surveys.We developed an index and maps of habitat suitability for each species, which were then integrated to represent a combined index (ranging from 0 to 27) and spatially explicit maps of the area's habitat suitability for large mammals. The average large mammal habitat suitability index value of the State of Selangor (9) indicates that many habitat patches have become unsuitable for such species. Of the nine wildlife protected areas, Fraser's Hill (22), Sungai Dusun (22), and Bukit Kutu (21) are very suitable; Klang Gate (20) and Templers Park (17) are suitable; and the remaining four are unsuitable for large mammals. We assume that this preliminary habitat suitability index and mapping are useful for conservation planning of wildlife habitats at both landscape and regional scales, as well as providing an initial foundation for revision by future research with significant new information.     

Functional imaging in radiation therapy planning for head and neck cancer

Functional imaging and its application to radiotherapy (RT) is a rapidly expanding field with new modalities and techniques constantly developing and evolving. As technologies improve, it will be important to pay attention to their implementation. This review describes the main achievements in the field of head and neck cancer (HNC) with particular remarks on the unsolved problems.     

Managing sun bears in a changing tropical landscape

Aim

Across the tropics, large‐bodied mammal species are threatened by rapid and widespread forest habitat conversion by either commercial logging or agricultural expansion. How such species use these habitats is an important area of research for guiding their future management. The tropical forest‐dwelling sun bear, Helarctos malayanus, is the least known of the eight bear species. Consequently, the IUCN/SSC Bear Specialist Group ranks research on this species as a top priority. This study aims to investigate landscape variables that influence sun bear habitat use in forests under varying levels of degradation and protection.

Location

A 20,998 km² Sumatra forest landscape covering Kerinci Seblat National Park (KSNP), Batang Hari Protection Forest (BHPF) and neighbouring logging and agricultural concessions.

Methods

An occupancy‐based sampling technique using detection/non‐detection data with 10 landscape covariates was applied in six study areas that operated a total of 125 camera traps. The potential differences between habitat use (ψ) of sun bears were first modelled with broad‐scale covariates of study area, land‐use types and forest type. Sun bear habitat use was then investigated with the finer‐scale landscape features associated within these areas.

Results

From 10,935 trap nights, sun bears were recorded at altitudes ranging from 365 to 1791 m. At a broad‐scale, habitat use increased with protection status, being highest in KSNP (0.688 ± 0.092, ± SE) and BHPF (0.621 ± 0.110) compared to production (0.418 ± 0.121) and convertible (0.286 ± 0.122) forests. Within these areas, sun bears showed a preference for forest that was further from public roads and villages and at a lower elevation.

Main conclusions

The habitat suitability model identified several high‐quality habitat patches outside of the priority conservation areas for immediate protection. Consequently, conservation management strategies should emphasize the importance of high conservation value forests and prohibit further conversion of threatened lowland forests.

     

Conservation implications of divergent global patterns of ant and vertebrate diversity

Aim

Global conservation planning is often oriented around vertebrates and plants, yet most organisms are invertebrates. To explore the potential conservation implications of this bias, we assessed how well patterns of diversity for an influential group of invertebrates, the ants, correspond with those of three vertebrate groups (birds, mammals and amphibians).

Location

Global.

Methods

We compiled data on the number of genera of ants and the three vertebrate groups for 370 political regions across the world. We then compared their correlations both for overall diversity and between subsets of genera likely to be of conservation concern. We also developed generalized additive models (GAM) to identify regions where vertebrates and ants diverged in their diversity patterns.

Results

While ant and vertebrate diversity do positively correlate, the correlations are substantially weaker for the ant lineages of the greatest conservation concern. Vertebrates also notably fail to predict ant diversity in specific geographic areas, including Australia and Southeast Asia, parts of Africa and Madagascar, and south‐western China. These failures may be genuine differences in diversity patterns, or they may indicate important gaps in our knowledge of ant and vertebrate diversity.

Main conclusions

We conclude that it is currently unwise to assume that global conservation priorities based on vertebrates will conserve ants as well. We suspect that this also applies to other invertebrates.