Comparison Between the Stereoscopic Virtual Reality Display System and Conventional Computed Tomography Workstation in the Diagnosis and Characterization of Cerebral Arteriovenous Malformations.

It is difficult to accurately understand the angioarchitecture of cerebral arteriovenous malformations (CAVMs) before surgery using existing imaging methods. This study aimed to evaluate the ability of the stereoscopic virtual reality display system (SVRDS) to display the angioarchitecture of CAVMs by comparing its accuracy with that of the conventional computed tomography workstation (CCTW). Nineteen patients with CAVM confirmed on digital subtraction angiography (DSA) or during surgery were studied. Computed tomography angiography images in the SVRDS and CCTW were retrospectively analyzed by two experienced neuroradiologists using a double-blind method. Angioarchitectural parameters, such as the location and size of the nidus, type and number of the arterial feeders and draining veins, and draining pattern of the vessels, were recorded and compared. The diameter of the nidus ranged from 1.1 to 9 cm. Both CCTW and SVRDS correctly diagnosed the location of the nidus in 19 patients with CAVM. Among the 19 patients, 35 arterial feeders and 25 draining veins were confirmed on DSA and during surgery. With the DSA and intraoperative results as the gold standard bases, the CCTW misjudged one arterial feeder and one draining vein and missed three arterial feeders and two draining veins; meanwhile, the SVRDS missed only two arterial feeders. SVRDS had some advantages in displaying nidus, arterial branches, and draining veins of the CAVM compared with CCTW, as well as SVRDS could more intuitively display the overall angio-architectural spatial picture of CAVM.

Potential Biomedical Limitations of Graphene Nanomaterials.

Graphene-family nanomaterials (GFNs) possess mechanical stiffness, optical properties, and biocompatibility making them promising materials for biomedical applications. However, to realize the potential of graphene in biomedicine, it must overcome several challenges that arise when it enters the body's circulatory system. Current research focuses on the development of tumor-targeting devices using graphene, but GFNs accumulated in different tissues and cells through different pathways, which can cause toxic reactions leading to cell apoptosis and body dysfunction when the accumulated amount exceeds a certain limit. In addition, as a foreign substance, graphene can induce complex inflammatory reactions with immune cells and inflammatory factors, potentially enhancing or impairing the body's immune function. This review discusses the biomedical applications of graphene, the effects of graphene materials on human immune function, and the biotoxicity of graphene materials.

Effects of Treadmill Exercise on Liver Apoptosis in Fluoride-Exposed Mice.

Hepatotoxicity induced by excessive fluoride (F) exposure has been extensively studied in both humans and animals. Chronic fluorosis can result in liver apoptosis. Meanwhile, moderate exercise alleviates apoptosis caused by pathological factors. However, the effect of moderate exercise on F-induced liver apoptosis remains unclear. In this research, sixty-four three-week-old Institute of Cancer Research (ICR) mice, half male and half female, were randomly divided into four groups: control group (distilled water); exercise group (distilled water and treadmill exercise); F group [100 mg/L sodium fluoride (NaF)]; and exercise plus F group (100 mg/L NaF and treadmill exercise). The liver tissues of mice were taken at 3 months and 6 months, respectively. Hematoxylin-eosin (HE) staining and situ terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) results showed that nuclear condensation and apoptotic hepatocytes occurred in the F group. However, this phenomenon could be reversed with the intervention of treadmill exercise. The results of QRT-PCR and western blot displayed NaF- induced apoptosis via tumor necrosis factor recpter 1 (TNFR1) signaling pathway, while treadmill exercise could restore the molecular changes caused by excessive NaF exposure.

Th2 cell regulatory and effector molecules single nucleotide polymorphisms and periodontitis.

To investigate the association between T helper 2 (Th2) cell regulatory and effector molecules' genetic polymorphisms and periodontitis. Single nucleotide polymorphisms (SNPs) of 11 Th2 cell regulatory or effector molecules genes (CD28, CTLA4, IL4, IL5, IL6, IL9, IL10, IL13, IL4R, GATA3, STAT6, and rs1537415; total 130 SNPs) were studied in Chinese nonsmokers (163 periodontitis-free controls, 141 periodontitis patients) using Sequenom iPlex assays. SNPs potentially associated with periodontitis (adjusted allelic P < 0.1) in this cross-sectional study were further investigated via meta-analysis. Allele G of rs4553808 in promoter of CTLA4 was more frequently detected in periodontitis than controls (P < 0.005), but did not remain significant after age and gender adjustment. Haplotype (GTT) in a block of three CTLA4 SNPs (rs4553808, rs16840252, rs5742909) was significantly associated with periodontitis. Meta-analysis of SNPs identified indicated allele T of CTLA4 rs5742909 (3 studies; 461 control, 369 periodontitis) and allele G of IL6 rs1800796 (18 studies; 2760 control, 2442 periodontitis) were significantly associated with periodontitis (OR = 1.44 and OR = 1.30, respectively). Within limitations of this study, a haplotype of CTLA4 concerning Th2 cell regulation, may be associated with periodontitis in Chinese nonsmokers followed. Meta-analysis indicated rs5742909 of CTLA4 and rs1800796 of IL6 appeared significantly associated with periodontitis.

Real-time monitoring system with accelerator controlling: An improvement of radiotherapy monitoring based on binocular location and classification.

Real-time monitoring and amendment of patient position is important for the radiotherapy. However, using electronic portal imaging device (EPID) and cone beam computer tomography (CBCT) in the clinical practice generate different degrees of delay, so that they cannot achieve the purpose of real-time application. Meanwhile, a few products come with the function of the real-time monitoring and amendment, such as CyberKnife, which is too expensive for the common people. The objective of this study is to develop and test a novel independent system to monitor treatment center and amend the position of patient, which is applicable to most accelerators, based on binocular location. The system monitors the treatment center by tracking the markers attached to the patient. Once the treatment center shifts, the system uses the magic finger, which is developed to control the treatment bet automatically to adjust the treatment bed position. To improve the monitoring accuracy, we trained the data collected from the clinic based on SVM (Support Vector Machine). Thus, the training results assist users to adjust the feasible degree of the monitoring. The experiment results showed that using this new monitoring system, the monitoring resolution reached 0.5 mm, and the error ratio of the judgment was less than 1.5%.

Comparison between Dual Arc VMAT and 7F-IMRT in the protection of hippocampus for patients during whole brain radiotherapy.

PURPOSE: The purpose of this study was to compare the dosimetric characteristics for protection of the hippocampus between dual arc VMAT (volumetric modulated arc therapy) and 7 fields intensity-modulated radiation therapy (7F-IMRT) for patients with brain metastases from lung cancer under the whole brain radiotherapy. METHODS: Based on ten cases with brain metastases from lung cancer, two types of radiotherapy plans were designed, namely, dual arc VMAT and 7F-IMRT. Provided that the clinical requirements were satisfied, the comparisons of target dose distribution, conformity index (CI), homogeneity index (HI), dose of organs at risk (OARs), monitor units (MU) and treatment time between dual arc VMAT and 7F-IMRT were investigated for their dosimetric difference. RESULTS: Both treatment plans met the requirements of clinical treatments. However, the PTV-HA conformity and homogeneity of dual arc VMAT were superior to those of 7F-IMRT (P < 0.05). As to OARs, the mean maximum doses (Dmax) of hippocampus, eyes and optic nerves in the dual arc VMAT plan were all lower than those in 7F-IMRT plan (P < 0.05), but the result had no statistical significance (P < 0.05) for the maximum dose of lens. Compared with 7F-IMRT, dual arc VMAT reduced the average number of MU by 67% and the average treatment time by 74%. Therefore, treatment time was shortened by dual arc VMAT. CONCLUSION: With regards to the patients with brain metastases from lung cancer under the whole brain radiotherapy, the PTV-HA conformity and homogeneity of dual arc VMAT were superior to those of 7F-IMRT under the precise of meeting the clinical requirements. In addition, dual arc VMAT remarkably reduced the irradiation dose to OARs (hippocampus, eyes and optic nerves), MU and treatment time, as well, guaranteed patients with better protection.

Analysis of the setup errors of medical image registration-based cone-beam CT for lung cancer.

PURPOSE: This study aimed to investigate the feasibility of efficiently using a rigid image registration (RIR) algorithm or a deformable image registration (DIR) algorithm to match medical images and evaluate the impact of setup errors on intensity modulated radiation therapy of lung cancer patients. METHODS: Ten lung cancer patients were chosen randomly each day and were subjected to image-guided radiotherapy. The clinical registration between cone-beam computed tomography (CBCT) images and treatment planning system CT images was performed by applying both RIR and DIR; the clinical registration was evaluated on the basis of the contour index, including dice similarity coefficient, sensitivity, and positive predictive value; the optimal scheme of image registration was selected to ensure that the actual irradiation isocenter was consistent with the treatment planning isocenter. In each patient, the translational errors in the right-left (x), superior-inferior (y), and anterior-posterior (z) directions and the rotational errors in the u, υ, and w directions formed by the x, y, and z directions were calculated and analyzed daily in the whole course of treatment; margins were calculated according to this equation: M = 2.5∑+ 0.7δ. RESULTS: The tumors and the surrounding soft tissues of the patients are shown more clearly in the CBCT images than in the CT images. DIR can be applied more efficiently than RIR to determine the morphological and positional changes in the organs shown in the images with the same or different modalities in the different period. The setup errors in translation in the x, y and z axes were 0.05±0.16, 0.09±0.32 and -0.02±0.13 cm, respectively; by contrast, the setup errors in rotation in u, υ and w directions were (0.41±0.64)°, (-0.08±0.57)° and (-0.03±0.62)°, respectively. The setup errors in the x, y and z axes of the patients indicated that the margins expansions were 0.82, 1.15 and 0.72 cm, respectively. CONCLUSION: CBCT with DIR can measure and correct the setup errors online; as a result, setup errors in lung cancer treatments can be significantly reduced and the accuracy of radiotherapy can be enhanced.

Salvia miltiorrhiza induces VEGF expression and regulates expression of VEGF receptors in osteoblastic cells.

This study investigated in vitro whether Salvia Miltiorrhiza Bunge (SM) induces vascular endothelial growth factor (VEGF) expression and regulates expression of VEGF receptors 1 (VEGFR-1) and 2 (VEGFR-2) on osteoblasts. MC3T3-E1 cells were cultured with SM and VEGF at points 24, 48 and 72 h. A blank control was included. The mRNA expression of VEGF, VEGFR-1 and VEGFR-2 was examined using real-time polymerase chain reaction. VEGF protein expression was examined using enzyme linked immunosorbent assay. SM increased VEGF mRNA expression by 21% at 24 h (p < 0.05), 5% (p < 0.05) at 48 h and 74% (p < 0.001) at 72 h, while external VEGF intervention decreased the internal VEGF expression by 51% at 24 h (p < 0.001) and increased it by 126% at 72 h (p < 0.001). SM increased VEGF protein at 72 h (p < 0.05). VEGFR-1 mRNA expression, in response to SM, decreased by 8% (p < 0.05) at 72 h and decreased following VEGF at 24 and 72 h by 20% (p < 0.001) and 15%, respectively, (p < 0.001). VEGFR-2 mRNA expression increased following SM at 24 and 48 h by 25% (p < 0.05) and 73% (p < 0.05), respectively, and decreased at 72 h by 13% (p < 0.05). It was concluded that SM modulated expression of VEGF and its receptors in MC3T3-E1 cells.

[Treatment of intra-articular calcaneal fractures with unilateral external fixator combined with limited internal fixation].

OBJECTIVE: To study the clinical effects of the unilateral external fixator combined with limited internal fixation such as cannulated lag screws for the treatment of intra-articular calcaneal fractures. METHODS: From May 2007 to February 2012,52 patients (58 feet) with intraarticular calcaneal fractures were treated with unilateral external fixator and limited internal fixation such as lag screws. Forty-five patients (51 feet) were male,7 patients (7 feet) were female,ranging in age from 18 to 64 years,averaged 36.5 years. Time from injury to surgery was 4 to 13 (6.2 +/- 0.8) days. According to Sanders classification, there were 36 cases (40 feet) with type II fractures, 13 cases (15 feet) with type III fractures, 3 cases (3 feet) with type IV fractures. All patients were examed with X-ray and CT. Böhler angle, Gissane angle, length, width, height were measured on the radiographs, respectively. The function of the feet was assessed by the Maryland grading system. RESULTS: Fifty-one patients(57 feet) were followed up for 5 to 16 months,with an average of 7.2 months. Calcaneal Böhler angle increased from (12.65 +/- 5.32) degrees preoperatively to (30.63 +/- 4.28) degrees postoperatively. The calcaneal Gissane angle decreased from (129.87 +/- 6.25) degrees preoperatively to (122.11 +/- 4.89) degrees postoperatively. The calcaneal length increased from (64.5 +/- 7.1) mm preoperatively to (71.3 +/- 5.7) mm postoperatively. The calcaneal width decreased from (34.6 +/- 5.7) mm preoperatively to (28.2 +/- 6.1) mm postoperatively. The calcaneal height increased from (30.2 +/- 5.2) mm preoperatively to (39.3 +/- 6.4) mm postoperatively. All of the comparison between preoperative and postoperative measurements revealed statistically significant (P < 0.05). The length,width, height, Böhler angle and Gissane angle were improved significantly (P < 0.05). According to the Maryland grading system, the result was excellent in 20 feet, good in 31 feet, fair in 4 feet, pour in 2 feet,excellent and good rate was 89.5%. Three feet with wound infection or flap necrosis were healed after wound debridement and dressing exchange. CONCLUSION: The unilateral external fixation combined with limited internal fixation is a satisfactory treatment for intra-articular calcaneal fractures in short term with less damage, few complications and good functional recovery.

Effects of medicinal herb salvia miltiorrhiza on osteoblastic cells in vitro.

Sufficient osteoinduction is essential for the success and effectiveness of bone grafting. It was previously found that Salvia Miltiorrhiza (SM), a commonly used Chinese herb increased osteogenesis in vivo. The aim of this study is to investigate the effects of SM on bone cells in vitro, in an attempt to get a better understanding on how SM can promote bone remodeling. MC3T3-E1, an osteoblastic cell line, was cultured with SM for different time intervals (24, 48, and 72 h), whereas the control group consisted of cells cultured without any intervention. The mRNA expression of alkaline phosphatase (ALP), osteocalcin (OCN), osteoprotegerin (OPG), and the receptor activator of nuclear factor kappa B ligand (RANKL) were examined by real-time polymerase chain reaction (qPCR). The expression of ALP showed an early increase at 24 h by 50% (p < 0.001) and at 48 h by 13% (p < 0.001). OCN was decreased by 22% at 24 h (p < 0.001) but increased by 50% and 88% at 48 and 72 h, respectively (p < 0.001). RANKL showed an early increase at the first two time points of 24 and 48 h by 45% (p < 0.001) and 36% (p < 0.01), respectively, while OPG was up-regulated at the latter two time points by 10% at 48 h (p < 0.01) and 68% at 72 h (p < 0.001). Thus, OPG/RANKL was down-regulated first, and then up-regulated. SM enhances bone remodeling by regulating the gene expression of ALP, OCN, OPG, and RANKL. It is a potential medicinal herb to be utilized in the application that requires stimulation in bone cell activities.