Clinical evaluation of deep learning-based clinical target volume three-channel auto-segmentation algorithm for adaptive radiotherapy in cervical cancer.

OBJECTIVES: Accurate contouring of the clinical target volume (CTV) is a key element of radiotherapy in cervical cancer. We validated a novel deep learning (DL)-based auto-segmentation algorithm for CTVs in cervical cancer called the three-channel adaptive auto-segmentation network (TCAS). METHODS: A total of 107 cases were collected and contoured by senior radiation oncologists (ROs). Each case consisted of the following: (1) contrast-enhanced CT scan for positioning, (2) the related CTV, (3) multiple plain CT scans during treatment and (4) the related CTV. After registration between (1) and (3) for the same patient, the aligned image and CTV were generated. Method 1 is rigid registration, method 2 is deformable registration, and the aligned CTV is seen as the result. Method 3 is rigid registration and TCAS, method 4 is deformable registration and TCAS, and the result is generated by a DL-based method. RESULTS: From the 107 cases, 15 pairs were selected as the test set. The dice similarity coefficient (DSC) of method 1 was 0.8155 ± 0.0368; the DSC of method 2 was 0.8277 ± 0.0315; the DSCs of method 3 and 4 were 0.8914 ± 0.0294 and 0.8921 ± 0.0231, respectively. The mean surface distance and Hausdorff distance of methods 3 and 4 were markedly better than those of method 1 and 2. CONCLUSIONS: The TCAS achieved comparable accuracy to the manual delineation performed by senior ROs and was significantly better than direct registration.

The "Warrior" system: a new useful emergency simulator to train clinical pharmacists in emergency medicine.

Clinical pharmacists are indispensable providers of emergency medical services. However, the training of Chinese clinical pharmacists in medical emergency skills is apparently insufficient.The current study aimed to evaluate the effect of the "Warrior" emergency simulator application in the emergency medical education of clinical pharmacy students (CP students).The "Warrior" system, which contains a pharmacokinetics/pharmacodynamics-linked model and a drug database, was successfully employed to train CP students and improve their capability to deal with various medical emergency situations. Both an objective (in-class) test and the subjective Dundee Ready Education Environment Measure (DREEM) were administered to 20 CP students, randomly divided into an intervention group and a control group, to estimate the teaching effect of the "Warrior" system.The scores of CP students from the intervention group were significantly higher (P < .01) in the in-class test than the scores of students from the control group due to the diverse situational teaching using the "Warrior" system. The results of the DREEM showed that CP students from the intervention group obtained considerably better (P < .01) marks for "students' perceptions of learning" and "students' perceptions of atmosphere" than those from the control group. Furthermore, the intervention group scored much higher (P < .01) than the control group on the total DREEM.The "Warrior" system provides an excellent training path for clinical pharmacists that supplies a more realistic clinical simulation experience and significantly improves the teaching effect. The "Warrior" system exhibits high potential for future development in emergency medical education.

[Therapeutic effect of exercise acupuncture and osteopathy on traumatic knee arthritis].

OBJECTIVE: To explore the clinical efficacy of exercise acupuncture and osteopathy in the treatment of traumatic knee arthritis. METHODS: Fifty-one patients with traumatic knee arthritis were divided into three groups:routine group, exercise acupuncture group and osteopathy group. In the routine group, there were 17 cases, 12 males and 5 females, with a mean age of (49.4±8.9) years old; the averaged course of disease was (4.89±1.52) years; total WOMAC score before treatment was 100.77±15.48. Seventeen patients (11 males and 6 females) in the exercise acupuncture group were aged (48.6±10.1) years old; the course of disease was (4.21±1.37) years; and the total WOMAC score before treatment was 106.16±14.95. In the osteopathy group, there were 17 cases, 8 males and 9 females, with a mean age of (52.3±8.4) years old; the average course of disease was (4.79±1.50) years; total WOMAC score before treatment was 103.87±10.14. The patients in the routine group were treated with routine rehabilitation; the patients in the exercise acupuncture group were treated with routine rehabilitation combined with exercise acupuncture, and the patients in the osteopathy group were treated with osteopathy combined with routine rehabilitation. The changes of WOMAC score and ROM in three groups were compared before treatment and 4 weeks after treatment. RESULTS: The overall effect of osteopathy group was better than that of routine group (Z=3.151, P=0.005). The scores of WOMAC before and after treatment:pain of 23.84±4.66, 11.98±2.66, stiffness of 10.44±1.71, 6.42±0.74, daily life of 66.49±11.85, 35.80±4.44 in the routine group; pain of 22.64±3.22, 8.90±2.19, stiffness of 11.82±2.57 , 6.03±1.06, daily life of 71.72±13.59, 32.94±4.73 in the exercise acupuncture group; pain of 22.38±3.68, 10.66±2.75, stiffness of 11.81±2.08, 5.63±1.69, daily life of 69.69±8.96, 28.84±5.76 in the osteopathy group. Compared with the other two groups after treatment, the improvement of pain score in the exercise acupuncture group was better than those in the other two groups. There were no significant differences in stiffness score among the three groups. The degree of difficulty in daily life in the osteopathy group was better than that in the other two groups. The total score of WOMAC in the exercise acupuncture group and the osteopathy group were better than that in the conventional group, but there was no significant difference between the two groups. CONCLUSIONS: On the basis of routine rehabilitation treatment, exercise needling and osteopathy have positive significance for the improvement of joint pain and dysfunction of joint movement in patients with traumatic knee arthritis, with certain popularlized value in the treatment of traumatic knee arthritis.

[Dynamics and Runoff Losses of Nitrogen in Paddy Field Surface Water Under Combined Application of Biochar and Slow/Controlled-Release Fertilizer].

Field experiments were conducted to investigate the effects of four fertilization treatments, that is, controlled-release fertilizer (CRF), biochar combined with controlled-release fertilizer (BC+ CRF), biochar combined with stabilized fertilizer (BC+ SF), and biochar combined with controlled-release fertilizer and stabilized fertilizer (BC+ CRF+ SF), on the dynamics of the pH and nitrogen mass concentration and runoff losses of nitrogen in paddy field surface water in the Taihu Lake Basin. The results show that the average pH of the surface water decreases by 3.16%-4.48% for BC+ CRF+ SF and is in the range of 5.64-8.15. The average total nitrogen (TN) mass concentration of surface water ranges from 19.05 to 25.23 mg·L-1. A significant decrease of 4.75%-6.58% in the TN mass concentration of surface water was observed for BC+ CRF+ SF. The average ammonium (NH4+-N) and nitrate (NO3--N) mass concentration of the surface water vary from 0.01-17.26 mg·L-1 and from 0.24-3.11 mg·L-1, respectively. Inorganic nitrogen is dominated by NH4+-N in surface water. Compared with individual CRF, other treatments significantly reduce the NH4+-N mass concentration of surface water by 35.89%-48.78% and the NO3--N mass concentration of surface water by 20.54%-37.01%. The BC+ SF combination shows a significant reduction in the NH4+-N and NO3--N mass concentration of the surface water, which greatly lowers the risk of inorganic nitrogen loss via runoff. The runoff losses of TN, NH4+-N, and NO3--N are in the range of 16.24-18.09, 1.76-2.22 and 0.76-1.38 kg·hm-2, respectively. Compared with the individual CRF, the runoff loss of TN, NH4+-N, and NO3--N of other treatments is reduced. The BC+ CRF+ SF combination shows a significant reduction in the runoff losses of nitrogen, which greatly lowers the risk of nitrogen nonpoint source pollution from paddy fields.

Clinical Effectiveness of Scapulothoracic Joint Control Training Exercises on Shoulder Joint Dysfunction.

The objective of this study was to examine the clinical effectiveness of scapulothoracic joint control training exercises on shoulder joint dysfunction. Forty patients with traumatic shoulder pain and joint dysfunction were randomized into the treatment or control group. Standard rehabilitation interventions included glenohumeral joint mobilization techniques, ultrasound therapy, traditional Chinese medicine, interference current therapy, and other comprehensive interventions. Patients received scapulothoracic joint control training exercises, including active and passive motions of the scapulothoracic joints, peri-joint muscle exercise, and joint stability exercises for 1 month. Patient status was evaluated by Constant-Murley scales before and after the prescribed interventions. The pain conditions, daily activities, range of movement, strength tests and total scores were significantly improved compared to prior treatment. Moreover, improvements in pain, daily activities, scope of activities, and total scores for patients in the treatment group were statistically significant when compared to the control group (P < 0.05). However, there was no inter-group difference in strength testing. The combination of standard rehabilitation interventions and scapulothoracic joint control training exercises are an effective treatment of the shoulder joint dysfunction. Moreover, the pain outcomes, scope of activities, and total scores were better in the treatment group.