[Dosimetric Impact of Titanium Alloy Implant in Spinal IMRT Plan].

The purpose of this study is to establish and apply a correction method for titanium alloy implant in spinal IMRT plan, a corrected CT-density table was revised from normal CT-density table to include the density of titanium alloy implant. Dose distribution after and before correction were calculated and compared to evaluate the dose deviation. Plans were also copied to a spinal cancer simulation phantom. A titanium alloy fixation system for spine was implanted in this phantom. Plans were recalculated and compared with the measurement result. The result of this study shows that the max dose of spinal cord showed significant difference after correction, and the deviation between calculation results and measurement results was reduced after correction. The method for expanding the range CT-density table, which means that the density of titanium alloy was included, can reduce the error in calculation.

Combined Network Pharmacology and Cytology Experiments to Identify Potential Anti-Breast Cancer Targets and Mechanisms of Delphinidin.

Delphinidin is a type of anthocyanin monomer with antioxidant, anti-inflammatory, and anti-tumor effects. However, the biological mechanisms underlying its anti-breast cancer activity have not been thoroughly studied. We further studied the effect of delphinidin on breast cancer cells through comprehensive network pharmacology, cellular and molecular experiments. We acquired the know therapeutic targets of delphinidin and obtained differentially expressed genes (DEGs) of breast cancer using RTCGA. We used topological analysis to screen out the 106 core targets of delphinium anti-breast cancer and performed functional analysis. These genes were mainly enriched in the pathways in cancer, Progesterone-mediated oocyte maturation and cell cycle. Then, by taking the intersection of the three analyzed data sets, important core targets (EGFR, TOP2A and PTGS2) were obtained and molecular-docking was performed to validate the result. Additionally, In Vitro experiments, MCF-7 and BT-474 cell proliferation was inhibited in a dose-dependent manner by delphinidin and the expressions of EGFR, TOP2A and PTGS were reduced. Moreover, delphinidin influenced cell cycle, the expressions of cdk1 and cyclin B1 were reduced. Furthermore, delphinidin induced apoptosis by activating the MAPK-Signaling pathway. Collectively, our findings suggested that delphinidin may offer effective approaches in breast cancer prevention and therapy.Supplemental data for this article is available online at http://dx.doi.org/10.1080/01635581.2021.2012582.

Are simple IMRT beams more robust against MLC error? Exploring the impact of MLC errors on planar quality assurance and plan quality for different complexity beams.

This study investigated the impact of beam complexities on planar quality assur-ance and plan quality robustness by introducing MLC errors in intensity-modulate radiation therapy. Forty patients' planar quality assurance (QA) plans were enrolled in this study, including 20 dynamic MLC (DMLC) IMRT plans and 20 static MLC (SMLC) IMRT plans. The total beam numbers were 150 and 160 for DMLC and SMLC, respectively. Six different magnitudes of MLC errors were introduced to these beams. Gamma pass rates were calculated by comparing error-free fluence and error-induced fluence. The plan quality variation was acquired by comparing PTV coverage. Eight complexity scores were calculated based on the beam flu-ence and the MLC sequence. The complexity scores include fractal dimension, monitor unit, modulation index, fluence map complexity, weighted average of field area, weighted average of field perimeter, and small aperture ratio (< 5 cm2 and < 50cm2). The Spearman's rank correlation coefficient was calculated to analyze the correlation between these scores and gamma pass rate and plan quality varia-tion. For planar QA, the most significant complexity index was fractal dimension for DMLC (p = -0.40) and weighted segment area for SMLC (p = 0.27) at low magnitude MLC error. For plan quality, the most significant complexity index was weighted segment perimeter for DMLC (p = 0.56) and weighted segment area for SMLC (p= 0.497) at low magnitude MLC error. The sensitivity of planar QA was weakly associated with the field complexity with low magnitude MLC error, but the plan quality robustness was associated with beam complexity. Plans with simple beams were more robust to MLC error.

Eating Styles Profiles and Correlates in Chinese Postpartum Women: A Latent Profile Analysis.

Postpartum women present a high risk of disordered eating behaviors, but the heterogeneity between groups was not identified. This cross-sectional study aimed to identify eating styles profiles in postpartum women and explore the correlates based on demographic characteristics and psychosocial factors. Questionnaires were administered to 507 Chinese postpartum women. Latent profile analysis (LPA) was conducted to identify eating styles profiles. Multinomial logistic regression was used to investigate the correlates of these profiles among postpartum women. The LPA identified three eating styles profiles: postpartum women with low emotional, external, and restrained eating (Profile 1, 6.9%); postpartum women with medium emotional, external, and restrained eating (Profile 2, 66.1%); and postpartum women with high emotional, external, and restrained eating (Profile 3, 27.0%). Compared to Profile 1, higher postpartum depression (PPD) and body mass index (BMI) were more likely to be associated with Profile 2 and Profile 3, whereas higher postpartum weight retention (PPWR) was more likely to be associated with Profile 1. Compared to Profile 2, higher PPD and BMI were more likely associated with Profile 3. Disordered eating behaviors in postpartum women with three eating styles were associated with BMI, PPD, and PPWR. This study can guide healthcare professionals in developing targeted interventions to improve maternal and child health globally.

Multiple roles of baicalin and baicalein in the regulation of colorectal cancer.

The prevalence of colorectal cancer is increasing worldwide, and despite advances in treatment, colorectal cancer (CRC) remains in the top three for mortality due to several issues, including drug resistance and low efficiency. There is increasing evidence that baicalin and baicalein, novel small molecule inhibitor extracts of the Chinese herb Scutellaria baicalensis, have better anti-colorectal cancer effects and are less likely to induce drug resistance in cancer cells. The present review article explains the anti-proliferative properties of baicalin and baicalein in the context of against CRC. Additionally, it explores the underlying mechanisms by which these compounds modulate diverse signaling pathways associated with apoptosis, cell proliferation, tumor angiogenesis, invasion, metastasis, and tumor microenvironment. Moreover, this review article highlights the inhibitory effect of colorectal inflammatory-cancer transformation and the near-term therapeutic strategy of using them as adjuvant agents in chemotherapy.

Inter-fractional portability of deep learning models for lung target tracking on cine imaging acquired in MRI-guided radiotherapy.

MRI-guided radiotherapy systems enable beam gating by tracking the target on planar, two-dimensional cine images acquired during treatment. This study aims to evaluate how deep-learning (DL) models for target tracking that are trained on data from one fraction can be translated to subsequent fractions. Cine images were acquired for six patients treated on an MRI-guided radiotherapy platform (MRIdian, Viewray Inc.) with an onboard 0.35 T MRI scanner. Three DL models (U-net, attention U-net and nested U-net) for target tracking were trained using two training strategies: (1) uniform training using data obtained only from the first fraction with testing performed on data from subsequent fractions and (2) adaptive training in which training was updated each fraction by adding 20 samples from the current fraction with testing performed on the remaining images from that fraction. Tracking performance was compared between algorithms, models and training strategies by evaluating the Dice similarity coefficient (DSC) and 95% Hausdorff Distance (HD95) between automatically generated and manually specified contours. The mean DSC for all six patients in comparing manual contours and contours generated by the onboard algorithm (OBT) were 0.68 ± 0.16. Compared to OBT, the DSC values improved 17.0 - 19.3% for the three DL models with uniform training, and 24.7 - 25.7% for the models based on adaptive training. The HD95 values improved 50.6 - 54.5% for the models based on adaptive training. DL-based techniques achieved better tracking performance than the onboard, registration-based tracking approach. DL-based tracking performance improved when implementing an adaptive strategy that augments training data fraction-by-fraction.

Efficacy of endoscopic nasobiliary drainage for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis and cholangitis after repeated clearance of common bile duct stones: experience from a Chinese center.

BACKGROUND: The aim of the present study was to investigate whether it is reasonable to insert an endoscopic nasobiliary drainage (ENBD) tube in patients with endoscopic sphincterotomy (EST) and repeated clearance of common bile duct (CBD) stones. PATIENTS AND METHODS: Patients with choledocholithiasis who underwent EST and CBD stone clearance at our center from January 2010 to May 2012 were reviewed. The following parameters were evaluated: (i) serum amylase 2 and 24 h after ERCP; (ii) incidence of endoscopic retrograde cholangiopancreatography (ERCP)-related pancreatitis and cholangitis; (iii) time elapsed to normalization of total serum bilirubin levels for those with jaundice before ERCP; and (iv) length of hospital stay. RESULTS: Compared with the no-ENBD group, the ENBD group presented a significantly lower postoperative serum amylase of 2 and 24 h (81.3 ± 31.8 U/L vs 90.8 ± 31.2 U/L, 107.0 ± 51.1 U/Lvs 132.3 ± 100.8 U/L, respectively). The incidence of post-ERCP pancreatitis and cholangitis was also lower in the ENBD group, although the differences were not significant (1% vs 4.4%, 0 vs 4.5%, respectively). Time elapsed to normalization of total serum bilirubin levels and length of hospital stay was shorter in the ENBD group (4.3 days ± 0.6 days vs 4.5 days ± 0.7 days, P > 0.05; 4.8 days ± 2.1 days vs 6.3 days ± 2.8 days, respectively, P < 0.01). CONCLUSIONS: ENBD significantly reduces the incidence of hyperamylasemia and decreases the length of hospital stay in patients with EST and repeated stone extraction. ENBD should be considered for patients with large or multiple CBD stones.

miR-150 as a potential biomarker associated with prognosis and therapeutic outcome in colorectal cancer.

BACKGROUND: MicroRNAs (miRNA) have potential as prognostic biomarkers and therapeutic targets in cancer. A study was undertaken to investigate the association between miRNA expression patterns and the prognosis and therapeutic outcome of colorectal cancer (CRC). METHODS: miRNA expression profiling in tumour, adenoma and normal colorectal tissues was performed to identify tumour-related miRNAs in the course of colorectal malignant changes. Quantitative reverse transcription PCR (qRT-PCR) assays were used to measure tumour-related miRNA and to assess its association with survival and response to adjuvant chemotherapy in 239 patients. In addition, to validate the findings, associations of the tumour-related miRNA with clinical characteristics of CRC were analysed in 185 patients by in situ hybridisation (ISH) analysis. RESULTS: Only one miR-150 was found to show a decrease in expression levels in the three tissue groups (normal, adenoma and cancer tissue) in parallel with increasing carcinogenesis of the colorectal tissue. In both ISH and qRT-PCR analysis, tumour tissue had reduced levels of miR-150 expression compared with paired non-cancerous tissue, which indicated that the levels of miR-150 expression were associated with CRC. Moreover, patients whose tumours had low miR-150 expression had shorter survival and a worse response to adjuvant chemotherapy than patients whose tumours had high miRNA expression. CONCLUSIONS: The miR-150 expression status of patients with CRC is associated with survival and response to adjuvant chemotherapy. It is suggested that miR-150 should be considered as a potential biomarker associated with the prognosis and therapeutic outcome in CRC.

Shared decision-making in the treatment of adolescents diagnosed with depression: A cross-sectional survey of mental health professionals in China.

WHAT IS ALREADY KNOWN?: SDM improves clinical outcomes by increasing attendance and treatment adherence in adolescents diagnosed with depression. SDM could reduce treatment disagreements and enhance consumers' and their families' satisfaction with mental healthcare services. Healthcare professionals are a critical part of SDM. However, MHPs' practices of SDM in the daily management of adolescents diagnosed with depression need to be clarified. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: From the viewpoints of MHPs, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. MHPs who trust their consumers and have received training related to SDM are more likely to practice SDM in the daily management of adolescents diagnosed with depression. The positive preferences for providing information and family involvement in treatment decision-making are facilitators; working in closed inpatient mental health wards and open inpatient mental health wards are hindering factors for MHPs' practices of SDM. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: MHPs should encourage information sharing with consumers and their family members to help them participate in treatment decision-making actively. A trusting and friendly therapeutic relationship with consumers should be maintained in the daily management of adolescents diagnosed with depression. SDM-related training should be encouraged for MHPs to promote widespread SDM. ABSTRACT: INTRODUCTION: Shared decision-making (SDM) is an ideal model for a therapeutic relationship that can improve health outcomes. Healthcare professionals are a critical part of SDM, and they play an important role in the practices of SDM in the clinical setting. Evidence suggests that adolescents diagnosed with depression can benefit substantially from SDM. However, mental health professionals' (MHPs) practices of SDM for adolescents diagnosed with depression in China are not well-documented. AIM: This study aimed to investigate the practices of SDM for adolescents diagnosed with depression from the viewpoints of MHPs in China. METHOD: In this cross-sectional study, we recruited a total of 581 MHPs by convenience sampling. The Shared Decision-Making Questionnaire-Physician Version (SDM-Q-Doc) was used to evaluate the MHPs' practices of SDM for adolescents diagnosed with depression. RESULTS: The mean SDM-Q-Doc was 80.47 (±16.31). Within the six specific decision-making situations, most MHPs selected non-SDM (52.7%-71.6%). Substantial numbers of respondents believed that MHPs made the final decision, especially with regard to the development (37%) and adjustment of medication regimens (42%). The practice of SDM was predicted by MHPs' preference for providing information, their trust in consumers, preference for family involvement in treatment decision-making, working in an outpatient clinic and receiving SDM training (F = 23.582; p = .000; R2 = .198; adjusted R2 = .189). DISCUSSION: Although the MHPs' self-rated score of SDM-Q-Doc was high, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. Thus, SDM needs to be further promoted by enhancing SDM-related training for MHPs, thereby actively promoting the involvement of families, facilitating the information sharing for consumers and families, and building an active, trusting consumer-practitioner relationship. IMPLICATIONS FOR PRACTICE: MHPs should prioritise information sharing with consumers and families, as well as build trusting and friendly therapeutic relationships. Family involvement in treatment decisions should be encouraged when adolescents diagnosed with depression are in need. Actively participating in training related to SDM is also important. Future high-quality evidence is still needed to explore the facilitators and barriers to SDM practices from a tripartite perspective of MHPs, adolescents diagnosed with depression and their families.

Toward real-time automatic treatment planning (RTTP) with a one-step 3D fluence map prediction method and (nonorthogonal) convolution technique.

PURPOSE: To establish and evaluate a (quasi) real-time automated treatment planning (RTTP) strategy utilizing a one-step full 3D fluence map prediction model based on a nonorthogonal convolution operation for rectal cancer radiotherapy. METHODS: The RTTP approach directly extracts 3D projections from volumetric CT and anatomical data according to the beam incident direction. A 3D deep learning model with a nonorthogonal convolution operation was established that takes projections in cone beam space as input, extracts the features along and around the ray-trace path, and outputs a predicted fluence map (PFM) for each beam. The PFM is then converted to the MLC sequence with deliverable MUs to generate the final treatment plan. A total of 314 rectal adenocarcinoma patients with 2198 projection data samples were used in model training and validation. An extra 20 patients were used to test the feasibility of the RTTP method by comparing the plan quality, efficiency, deliverability performance, and physician blinded review results with the manual plans. RESULTS: Overall, the RTTP plans met the clinical dose criteria for target coverage, conformity, homogeneity, and organ-at-risk dose sparing. Compared to manual plans, the RTTP plans showed increases in PTV D1% by only 2.33% (p < 0.001) and a decrease in PTV D99% by 0.45% (p < 0.05). The RTTP plans showed a dose increase in the bladder, with a V50 of 14.01 ± 11.75% vs. 10.74 ± 8.51%, respectively, and no significant increases in the femoral head with the mean dose. The planning efficiency was improved in RTTP planning, with 39 s vs. 944 s in fluence map generation; the deliverability performance was saved by 1.91% (p < 0.001) in total MU. According to the blinded plan review by our physician, 55% of RTTP plans can be directly used in clinical radiotherapy treatment. CONCLUSION: The quasi RTTP method improves the planning efficiency and deliverability performance while maintaining a plan quality close to that of the optimized manual plans in rectal radiotherapy.

Comprehensive gene and microRNA expression profiling reveals the crucial role of hsa-let-7i and its target genes in colorectal cancer metastasis.

Accumulating evidence has demonstrated that miRNAs play important roles in the occurrence and development of colorectal cancer (CRC). However, whether miRNAs are associated with the metastasis of CRC remains largely unexplored. The aim of the current study is to profile miRNAs in different CRC metastatic cell lines to identify the biomarkers in CRC metastasis. Gene and miRNA expression profiling was performed to analyze the global expression of mRNAs and miRNAs in the four human CRC cell lines (LoVo, SW480, HT29 and Caco-2) with different potential of metastasis. Expression patterns of mRNAs and miRNAs were altered in different CRC cell lines. By developing an integrated bioinformatics analysis of gene and miRNA expression patterns, hsa-let-7i was identified to show the highest degree in the microRNA-GO-network and microRNA-Gene-network. The expression level of hsa-let-7i was further validated by qRT-PCR in CRC cells. In addition, the targets of hsa-let-7i were predicted by two programs TargetScan and PicTar, and target genes were validated by expression profiling in the most epresentative LoVo and Caco-2 cell lines. Eight genes including TRIM41, SOX13, SLC25A4, SEMA4F, RPUSD2, PLEKHG6, CCND2, and BTBD3 were identified as hsa-let-7i targets. Our data showed the power of comprehensive gene and miRNA expression profiling and the application of bioinformatics tools in the identification of novel biomarkers in CRC metastasis.

A genetic variant in microRNA-196a2 is associated with increased cancer risk: a meta-analysis.

MicroRNAs (miRNAs) are small non-coding RNA molecules that function as negative regulators of gene expression. Common genetic variants (single nucleotide polymorphisms, SNPs) in miRNA genes may alter their expression or maturation resulting in varied functional consequences. Until now, several studies had evaluated the association between the polymorphisms in the hsa-miR-196a2 rs11614913 and cancer risk in diverse populations and in multiple types of cancer, with contradictory outcomes. Therefore, here we performed a meta-analysis to address the association between this polymorphism and cancer risk. A total of nine studies involving 6,540 cases and 7,562 controls were retrieved based on PubMed. Our analysis demonstrated that hsa-miR-196a2 rs11614913 CC genotype significantly increased the cancer risk in homozygote comparison model compared to TT genotype (OR=1.18; 95% CI, 1.01-1.68). Moreover, significant association of this polymorphism with breast cancer was found based on homozygote comparison model (OR=1.30; 95% CI, 1.01-1.26) and dominant model (OR=1.11; 95% CI, 1.01-1.23). In addition, hsa-miR-196a2 rs11614913 CC genotype was significantly associated with cancer risk in Chinese and Indian (OR=1.21; 95% CI, 1.05-1.40), but not in Caucasians (OR=1.03; 95% CI, 0.89-1.19). Taken together, our results indicate that the polymorphism of hsa-miR-196a2 rs11614913 is associated with cancer susceptibility, especially with breast cancer and in Chinese and Indian populations.

Delayed surgery for rectal cancer patients receiving neoadjuvant chemoradiotherapy: a promising method in its infancy.

BACKGROUND: Neoadjuvant chemoradiotherapy (nCRT) is used to downstage locally advanced rectal cancer before surgery. Accumulating data suggest that tumor response to nCRT is time dependent. A delay between nCRT and surgery may increase the proportion of patients that achieve a favorable response. However, delayed surgery beyond 6-8 weeks may increase the technical difficulty, and the risks of surgical complications and recurrence or metastasis. This article briefly reviews the relevant literature to evaluate the efficiency and safety of delayed surgery. METHODS: Two non-cohort studies and 10 cohort studies were reviewed. The results were analyzed and the limitations discussed. RESULTS: Although debatable, the findings of the included studies are promising. Delayed surgery may increase the proportion of favorable tumor response without compromising prognosis. However, most of the studies were retrospective, which introduces bias into the evaluation. CONCLUSION: Delayed surgery is potentially useful, but this needs to be verified by further well-designed prospective trials.

Endoscopic biliary stenting for irretrievable common bile duct stones: Indications, advantages, disadvantages, and follow-up results.

BACKGROUND: The advantages of endoscopic retrograde cholangiopancreatography (ERCP) over open surgery have made it the predominant method of treating patients with choledocholithiasis. After sphincterotomy, however, 10%-15% of common bile duct (CBD) stones cannot be removed with a basket or balloon. Methods for managing "irretrievable stones" include surgery; mechanical, intraductal shock wave, and extracorporeal shock wave lithotripsy; chemical dissolution; and biliary stenting. Endoscopic biliary stent insertion, which is frequently used in specific situations, has both advantages and disadvantages. To maximize the advantages and minimize the complications of biliary endoprosthesis, it is important to recognize its proper indications and to apply the technique in proper situations. DATA SOURCES: We reviewed all publications cited in Pubmed and published through July 2011 on biliary endoprosthesis in patients with irretrievable CBD stones. We analyzed the indications, advantages, disadvantages, and long-term follow-up results of this technique. RESULTS: Despite the occurrence of related complications, such as cholangitis, endoscopic placement of an endoprosthesis may reduce stone size, allowing later clearance of unextractable stones. Permanent biliary stenting may be a definitive treatment in selected elderly patients who are poor candidates for surgery. CONCLUSION: Endoscopic biliary stenting remains a simple and safe method for patients with stones difficult to manage by conventional endoscopic methods and those patients unfit for surgery or at high surgical risks.

Prevalence and Correlates of Weight Stigma among Postpartum Women in China.

Weight stigma is linked to a variety of psychological and health problems. In the postpartum period, women may be more likely to experience weight-based discrimination because of their changing social roles, weight, and the new functions their bodies fulfill. However, few studies have explored the issue of postpartum women's weight stigma. Thus, to investigate the prevalence and correlates of weight stigma for postpartum women in China, we conducted a cross-sectional study of 507 postpartum women. Results showed that almost one quarter (21.1%) of postpartum women claimed to have experienced perceived weight stigma (PWS). Two thirds (66.1%) scored at the mean and 14.8% at the highest levels of weight bias internalization (WBI). During the postnatal period, the conditions of those most likely to report experiences of weight-based discrimination included low income [b = -0.203, p = 0.004], occupation as a worker [b = 0.921, p = 0.017] or farmer [b = 0.826, p = 0.033], stress [b = 0.044, p = 0.035], depression [b = 0.057, p = 0.021], and higher WBIS [b = 0.018, p = 0.002]. In addition, postpartum women who lived alone [b = 7.511, p = 0.048], were overweight or obese [b = 5.443, p = 0.000], and had higher PWS [b = 0.897, p = 0.004] and anxiety symptoms [b = 0.219, p = 0.011] had higher levels of internalized weight stigma. Findings from this study provide a foundation to better understand characteristics of postpartum women in China who are at risk for weight stigma.

Human embryonic stem cells and metastatic colorectal cancer cells shared the common endogenous human microRNA-26b.

The increase in proliferation and the lack of differentiation of cancer cells resemble what occur in the embryonic stem cells during physiological process of embryogenesis. There are also striking similarities in the behaviour between the invasive placental cells and invasive cancer cells. In the present study, microarrays were used to analyse the global expression of microRNAs in a human embryonic stem cell line (i.e. HUES-17) and four colorectal cancer (CRC) cell lines (i.e. LoVo, SW480, HT29 and Caco-2) with different metastatic potentialities. Only the expression of miR-26b was significant decreased in HUES-17s and LoVo cells, compared with other three cell lines (P < 0.01). The quantitative real-time PCR analysis confirmed the results of the microarray analysis. Overexpression of miR-26b expression by miR-26 mimics transfection and led to the significant suppression of the cell growth and the induction of apoptosis in LoVo cells in vitro, and the inhibition of tumour growth in vivo. Moreover, the potential targets of miR-26b was predicted by using bioinformatics, and then the predicted target genes were further validated by comparing gene expression profiles between LoVo and NCM460 cell lines. Four genes (TAF12, PTP4A1, CHFR and ALS2CR2) with intersection were found to be the targets of miR-26b. MetaCore network analysis further showed that the regulatory pathways of miR-26b were significantly associated with the invasiveness and metastasis of CRC cells. These data suggest that miR-26b might serve as a novel prognostic factor and a potential therapeutic target for CRC.

Proteomics identification of desmin as a potential oncofetal diagnostic and prognostic biomarker in colorectal cancer.

Colorectal cancer (CRC) is the third most common cancer worldwide and has poor prognosis. To identify the oncofetal proteins involved in CRC carcinogenesis, differentially expressed proteins among fetal colorectal tissues, CRC, and the paired tumor-adjacent normal colorectal tissues were investigated by a two-dimensional gel electrophoresis and MALDI-TOF/TOF-based proteomics approach. 42 protein spots were differentially expressed among these tissues, and 22 proteins were identified by MS analysis. Desmin and zinc finger protein 829 were found to be elevated in CRC tissue and fetal colorectal tissue compared with normal colorectal tissue. The elevated expression of desmin in CRC tissue and different developmental stages of fetus colon was confirmed by RT-PCR and Western blot analysis. Immunohistochemical analysis showed that the elevated expression of desmin was correlated with the severity and differentiation of CRC and decreased survival rate of CRC patients. Finally by developing a highly sensitive immunoassay, desmin could be detected in human serum and was significantly elevated in CRC patients compared with healthy volunteers. We propose that desmin be considered a potential oncofetal serum tumor marker for CRC that may have significance in the detection of patients with CRC.

Synchronous colorectal cancers: a review of clinical features, diagnosis, treatment, and prognosis.

BACKGROUND/AIMS: With the development of early diagnostic technologies, more synchronous colorectal cancers (SCRCs) can be clinically detected. Although SCRCs are recognized as a significant clinical entity, their clinical features, diagnosis, treatment, and prognosis have yet to be definitively established. In order to obtain a comprehensive understanding of this disease and to establish an efficient profile by which to recognize individuals at high risk of developing SCRCs, we carried out a review of the relevant literature. METHODS: The PubMed database was searched for publications of 'synchronous colorectal carcinoma/cancer/adenocarcinoma' and 'multiple colorectal carcinomas'. All publications up to January 2011 were considered, and then only articles in English were retrieved for inclusion in this review. RESULTS: The incidence of SCRCs was found to be higher in older and male patients. The prognosis in patients with SCRCs was equivalent to that in patients with solitary CRC. The failure to diagnose synchronous lesions before and during the operation was associated with repeated surgery. CONCLUSION: SCRCs possess distinctive features compared to solitary CRC. While all colorectal patients should be carefully assessed to rule out the presence of concurrent colon adenomas, since missed lesions can result in additional surgery and poor prognosis, particular attention should be given to the high-risk group of older male patients.

Waldeyer's fascia: anatomical location and relationship to neighboring fasciae in retrorectal space.

PURPOSE: The term Waldeyer's fascia has caused confusion in surgery for rectal cancer. We have therefore dissected endopelvic fasciae to clarify the structure and location of Waldeyer's fascia, and to determine its anatomical relationships with adjacent fasciae. METHODS: Twenty cadavers (13 males and 7 females) were dissected. Each specimen was sectioned in the sagittal plane and both hemipelvises were examined. RESULTS: Waldeyer's fascia was observed in all specimens originating from the presacral fascia at the S2-S4 level and fusing with the posterior leaf of the mesorectal parietal fascia. Waldeyer's fascia divided the retrorectal space (RRS) into inferior and superior compartments, with the upper leaf constituting the floor of the superior compartment and the lower leaf constituting the dome of the inferior compartment. There were no nerves, blood vessels or lymphatic vessels within the two leaves. CONCLUSION: Waldeyer's fascia was located between the mesorectal parietal and presacral fasciae. Waldeyer's fascia included two leaves, which jointly divided the RRS into inferior and superior compartments. Waldeyer's fascia is a pivotal anatomical structure in the surgical treatment of rectal cancer.

The dosimetric impact of deep learning-based auto-segmentation of organs at risk on nasopharyngeal and rectal cancer.

PURPOSE: To investigate the dosimetric impact of deep learning-based auto-segmentation of organs at risk (OARs) on nasopharyngeal and rectal cancer. METHODS AND MATERIALS: Twenty patients, including ten nasopharyngeal carcinoma (NPC) patients and ten rectal cancer patients, who received radiotherapy in our department were enrolled in this study. Two deep learning-based auto-segmentation systems, including an in-house developed system (FD) and a commercial product (UIH), were used to generate two auto-segmented OARs sets (OAR_FD and OAR_UIH). Treatment plans based on auto-segmented OARs and following our clinical requirements were generated for each patient on each OARs sets (Plan_FD and Plan_UIH). Geometric metrics (Hausdorff distance (HD), mean distance to agreement (MDA), the Dice similarity coefficient (DICE) and the Jaccard index) were calculated for geometric evaluation. The dosimetric impact was evaluated by comparing Plan_FD and Plan_UIH to original clinically approved plans (Plan_Manual) with dose-volume metrics and 3D gamma analysis. Spearman's correlation analysis was performed to investigate the correlation between dosimetric difference and geometric metrics. RESULTS: FD and UIH could provide similar geometric performance in parotids, temporal lobes, lens, and eyes (DICE, p > 0.05). OAR_FD had better geometric performance in the optic nerves, oral cavity, larynx, and femoral heads (DICE, p < 0.05). OAR_UIH had better geometric performance in the bladder (DICE, p < 0.05). In dosimetric analysis, both Plan_FD and Plan_UIH had nonsignificant dosimetric differences compared to Plan_Manual for most PTV and OARs dose-volume metrics. The only significant dosimetric difference was the max dose of the left temporal lobe for Plan_FD vs. Plan_Manual (p = 0.05). Only one significant correlation was found between the mean dose of the femoral head and its HD index (R = 0.4, p = 0.01), there is no OARs showed strong correlation between its dosimetric difference and all of four geometric metrics. CONCLUSIONS: Deep learning-based OARs auto-segmentation for NPC and rectal cancer has a nonsignificant impact on most PTV and OARs dose-volume metrics. Correlations between the auto-segmentation geometric metric and dosimetric difference were not observed for most OARs.