Introduction: Within the development of brain-computer interface (BCI) systems, it is crucial to consider the impact of brain network dynamics and neural signal transmission mechanisms on electroencephalogram-based motor imagery (MI-EEG) tasks. However, conventional deep learning (DL) methods cannot reflect the topological relationship among electrodes, thereby hindering the effective decoding of brain activity. Methods: Inspired by the concept of brain neuronal forward-forward (F-F) mechanism, a novel DL framework based on Graph Neural Network combined forward-forward mechanism (F-FGCN) is presented. F-FGCN framework aims to enhance EEG signal decoding performance by applying functional topological relationships and signal propagation mechanism. The fusion process involves converting the multi-channel EEG into a sequence of signals and constructing a network grounded on the Pearson correlation coeffcient, effectively representing the associations between channels. Our model initially pre-trains the Graph Convolutional Network (GCN), and fine-tunes the output layer to obtain the feature vector. Moreover, the F-F model is used for advanced feature extraction and classification. Results and discussion: Achievement of F-FGCN is assessed on the PhysioNet dataset for a four-class categorization, compared with various classical and state-of-the-art models. The learned features of the F-FGCN substantially amplify the performance of downstream classifiers, achieving the highest accuracy of 96.11% and 82.37% at the subject and group levels, respectively. Experimental results affirm the potency of FFGCN in enhancing EEG decoding performance, thus paving the way for BCI applications.
Objective:To Explore the clinical characteristics,risk factors,and differences in risk factors for different types of congenital auricular deformities,in order to provide theoretical basis for precise prevention and control of congenital auriclar deformity. Methods:Full-term newborns born in the Second Affiliated Hospital of Zhengzhou University from May 2022 to January 2023 were screened for auricle malformation, general information and data were collected,,and high-risk factors were investigated withself-made questionnaire.Using a case-control study method,newborns with auriclar deformities were selected as the case group and those without auriclar deformities during the same period were selected as the control group.A case-control study was conducted to analyze the incidence rate,high-risk factors,and differences in high-risk factors for different types of auricle deformities. Results:A total of 1 758 newborns ï¼3 516 earsï¼ were included in this study,including 562 newbornsï¼927 earsï¼ with auriclar deformities,the incidence of congenital malformations of the auricle is 26.37%.Among them,289 ears ï¼8.22%ï¼ were helical rim deformity,244 ears ï¼6.94%ï¼ were lidding/lop ear,166 ears ï¼4.72%ï¼ were mixed deformities,131 ears ï¼3.73%ï¼ were prominent/cup ear,79 ears ï¼2.25%ï¼ were Stahl's ears,16 ears ï¼0.46%ï¼ were abnormal conchal crus,and 2 ears ï¼0.06%ï¼ were cryptotia.Maternal history of infection in early pregnancyï¼OR=1.513ï¼95%CI 1.119-2.045ï¼,previous miscarriage historyï¼OR=1.300ï¼95%CI 1.049-1.613ï¼,and abnormal pregnancyï¼OR=1.278ï¼95%CI 1.032-1.582ï¼ are risk factors for congenital auricular malformations.There was no statistically significant difference in the history of infectionï¼χ²=1.877ï¼P=0.391ï¼,previous miscarriageï¼χ²=4.706ï¼P=0.095ï¼,and abnormal pregnancyï¼χ²=5.026ï¼P=0.081ï¼ among mothers with helical rim deformity,lidding/lop ear,and mixed deformities. Conclusion:The incidence rate of congenital auricle deformity is high, with common malformations such as helical rim deformity, lidding/lop ear,and mixed deformities. Congenital auricular deformity is caused by various factors, the same risk factor has roughly the same impact on different types of morphological abnormalities.
Abortion, Spontaneous , Congenital Abnormalities , Ear Auricle , Female , Pregnancy , Infant, Newborn , Humans , Case-Control Studies , Ear, External/abnormalities , Ear Auricle/abnormalities , Medical History Taking , Congenital Abnormalities/epidemiology
Controversy exists regarding whether patients with low-risk papillary thyroid microcarcinoma (PTMC) should undergo surgery or active surveillance; the inaccuracy of the preoperative clinical lymph node status assessment is one of the primary factors contributing to the controversy. It is imperative to accurately predict the lymph node status of PTMC before surgery. We selected 208 preoperative fine-needle aspiration (FNA) liquid-based preparations of PTMC as our research objects; all of these instances underwent lymph node dissection and, aside from lymph node status, were consistent with low-risk PTMC. We separated them into two groups according to whether the postoperative pathology showed central lymph node metastases. The deep learning model was expected to predict, based on the preoperative thyroid FNA liquid-based preparation, whether PTMC was accompanied by central lymph node metastases. Our deep learning model attained a sensitivity, specificity, positive prediction value (PPV), negative prediction value (NPV), and accuracy of 78.9% (15/19), 73.9% (17/23), 71.4% (15/21), 81.0% (17/21), and 76.2% (32/42), respectively. The area under the receiver operating characteristic curve (value was 0.8503. The predictive performance of the deep learning model was superior to that of the traditional clinical evaluation, and further analysis revealed the cell morphologies that played key roles in model prediction. Our study suggests that the deep learning model based on preoperative thyroid FNA liquid-based preparation is a reliable strategy for predicting central lymph node metastases in thyroid micropapillary carcinoma, and its performance surpasses that of traditional clinical examination.
BACKGROUND: Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy cancer among the malignancies of thyroid. Despite of wide usages of proteomics in PTC, the profile of acetylated proteins in PTC remains unsettled, which is helpful for understanding the carcinogenesis mechanism and identifying useful biomarkers for PTC. METHODS: The surgically removed specimens of cancer tissues (Ca-T) and adjacent normal tissues (Ca-N) from 10 female patients pathological diagnosed as PTC (TNM stage III) were enrolled in the study. After preparing the pooled extracts of the whole proteins and the acetylated proteins from 10 cases, TMT labeling and LC/MS/MS methods were applied to the assays of global proteomics and acetylated proteomics separately. Bioinformatics analysis, including KEGG, gene ontology (GO) and hierarchical clustering were performed. Some differentially expressed proteins (DEPs) and differentially expressed acetylated proteins (DEAPs) were validated by individual Western blots. RESULTS: Controlled with the normal tissues adjacent to the lesions, 147 out of 1923 identified proteins in tumor tissues were considered as DEPs in global proteomics, including 78 up-regulated and 69 down-regulated ones, while 57 out of 311 identified acetylated proteins in tumor tissues were DEAPs in acetylated proteomics, including 32 up-regulated and 25 down-regulated, respectively. The top 3 up- and down-regulated DEPs were fibronectin 1, KRT1B protein and chitinase-3-like protein 1, as well as keratin, type I cytoskeletal 16, A-gamma globin Osilo variant and Huntingtin interacting protein-1. The top 3 up- and down-regulated DEAPs were ribosomal protein L18a-like protein, alpha-1-acid glycoprotein 2 and eukaryotic peptide chain release factor GTP-binding subunit ERF3A, as well as trefoil factor 3, thyroglobulin and histone H2B. Functional GO annotation and KEGG pathway analysis based on the DEPs and DEAPs showed completely different changing pictures. Contrary to the top 10 up- and -down regulated DEPs, most of which were addressed in PTC and other types of carcinomas, changes of the majority DEAPs were not mentioned in the literatures. CONCLUSIONS: Taken the profiling of the global and acetylated proteomics together will provide more broad view of protein alterations on the carcinogenesis and new direction for selecting biomarker for diagnosis of PTC.
Mastering nuclear fusion, which is an abundant, safe, and environmentally competitive energy, is a great challenge for humanity. Tokamak represents one of the most promising paths toward controlled fusion. Obtaining a high-performance, steady-state, and long-pulse plasma regime remains a critical issue. Recently, a big breakthrough in steady-state operation was made on the Experimental Advanced Superconducting Tokamak (EAST). A steady-state plasma with a world-record pulse length of 1056 s was obtained, where the density and the divertor peak heat flux were well controlled, with no core impurity accumulation, and a new high-confinement and self-organizing regime (Super I-mode = I-mode + e-ITB) was discovered and demonstrated. These achievements contribute to the integration of fusion plasma technology and physics, which is essential to operate next-step devices.
Anaplastic thyroid carcinoma (ATC) is a highly malignant tumor with invasive nature. Most patients present with locally advanced and/or distant metastatic diseases that are difficult to treat. We report a case of a previously inoperable patient with v-Raf murine sarcoma viral oncogene homolog B (BRAF) mutated ATC. After a trial of neoadjuvant Dabrafenib/Trametinib with immunotherapy, the tumor became operable, and surgical pathology indicated a pathologic complete response (pCR). We also reviewed cases from the literature that utilized neoadjuvant BRAF-directed therapy in ATCs. These cases emphasize that BRAF-and immune-directed therapy is a feasible option in patients with inoperable ATC and may lead to improved outcomes.
Thyroid Carcinoma, Anaplastic , Thyroid Neoplasms , Humans , Immunotherapy , Mutation , Neoadjuvant Therapy , Oncogenes , Protein Kinase Inhibitors , Proto-Oncogene Proteins B-raf/genetics , Thyroid Neoplasms/pathology
Objective: The central neck lymph node (LN) status is important for the treatment strategy of papillary thyroid cancer (PTC), while the diagnosis is difficult. This study aims to evaluate the diagnostic value of fine-needle aspiration (FNA) and its washout thyroglobulin (FNA-Tg) detection in central neck LN metastasis. Methods: Central neck LNs with FNA cytology (FNA-C) and FNA-Tg measurements from a tertiary hospital were included. Tg levels were correlated with histopathological or follow-up results. The diagnostic performance of FNA-C, FNA-Tg, and combining FNA-C and FNA-Tg for detecting LN metastasis was assessed. Results: A total of 132 LNs in the central neck from 129 patients were studied. The median FNA-Tg concentration of 74 metastatic LNs was 552.5 ng/mL, whereas, in 58 benign LNs, the median Tg concentration was 0.1 ng/mL (P < 0.001). Receiver operating characteristic analysis (area under the curve, 0.861) was used, and a cutoff value of 14.6 ng/mL was obtained. There was no significant increase in the diagnostic accuracy when FNA-Tg was used or combined with FNA-C, compared with FNA-C alone. The size, location of LNs, the presence of the ipsilateral thyroid gland, and Hashimoto's thyroiditis did not affect the incidence of misdiagnosis. Conclusions: FNA-C is the gold standard for evaluating central neck metastasis in PTC patients. Measurement of Tg levels in FNA washout does not improve the diagnostic accuracy any further.
PURPOSE: Although papillary thyroid cancer (PTC) has a low mortality rate, the rate of recurrence remains relatively high. This study aims to develop a molecular signature to predict the recurrence of PTC. METHODS: A total of 333 PTC patients' data from The Cancer Genome Atlas (TCGA) were included. We calculated tumor mutation burden (TMB) and analyzed the mutation status of BRAF and TERT promoter. RESULTS: Tumor recurrence occurred in 17 of 263 cases in TMB-L patients versus 14 of 70 cases in TMB-H patients (hazard ratio [HR], 3.55; 95% confidence interval [CI], 1.75-7.21; P < 0.001). The HR for recurrence in TMB-H patients remained significant after adjustment for classical clinicopathologic factors (patient age, gender, extrathyroidal extension and lymph node metastasis). These clinical factors had no effect on recurrence rate in TMB-L patients, but had a strong adverse effect on the prognosis of TMB-H patients. Compared with TMB-L patients lacking mutation, the HR (95% CI) of recurrence for TMB-H patients with coexisting BRAF V600E and/or TERT C228/250 T mutations was 6.68 (2.41-18.57), which remained significant after adjustment for clinicopathological factors. The mutation status of BRAF V600E and TERT C228/250 T had little effect on PTC recurrence in TMB-L patients. Either of the mutation was associated with high recurrence rate in TMB-H patients. CONCLUSIONS: The presence of BRAF V600E and/or TERT promoter mutations denotes a high risk of recurrence in TMB-H patients. This represents a powerful molecular prognostic genotype that can help predict patients with the highest risk of recurrence.
Telomerase , Thyroid Neoplasms , Humans , Thyroid Cancer, Papillary/genetics , Proto-Oncogene Proteins B-raf/genetics , Thyroid Neoplasms/pathology , Telomerase/genetics , Mutation , Prognosis , Risk Assessment
Fusion energy is a promising source of clean energy, which could solve energy shortages and environmental pollution. Research into controlled fusion energy has been ongoing for over half a century. China has created a clear roadmap for magnetic confinement fusion development, where superconducting tokamaks will be used in commercial fusion reactors. The Experimental Advanced Superconducting Tokamak (EAST) is the world's first fully superconducting tokamak with upper and lower divertors, which aims at long-pulse, steady-state, H-mode operation, and 101-s H-mode discharge had been achieved. In 2007, China joined the International Thermonuclear Experimental Reactor (ITER) and became one of its seven members. Thirteen procurement packages are undertaken by China, covering superconducting magnets, power supplies, plasma-facing components (PFCs), diagnostics, etc. To bridge the gap between the ITER and fusion demonstration power plants (DEMOs), China is planning to build the Chinese Fusion Engineering Testing Reactor (CFETR) to demonstrate related technologies and physics models. The engineering design of the CFETR was completed in 2020, and Comprehensive Research Facilities for Fusion Technology (CRAFT) are being constructed to explore the key technologies used in the CFETR.
Objective: This study aimed to describe the technique of surgeon-performed ultrasound (US)-guided fine-needle aspiration (FNA) of cervical retrovascular lymph nodes in papillary thyroid cancer (PTC) patients and analyze its efficacy. Methods: This study included consecutive patients with retrovascular suspicious lymph nodes who had FNA performed by surgeons. The technique and efficacy of four different puncture routes were assessed. Results: A total of 102 lymph node FNAs were performed on 100 patients. None yield insufficient aspiration, while 2% of FNA cytology result in an indeterminate diagnosis. No severe complication was observed. Cytologic testing plus thyroglobulin washout indicated sensitivity, specificity, positive predictive value, and negative predictive value in diagnosing nodal metastasis were 99%, 93%, 97%, and 97%, respectively. There was no significant difference in the test accuracy of FNA through different routes. Conclusions: In PTC patients, suspicious lymph nodes behind the big cervical vessels should not be considered a contraindication to FNA. They can be diagnosed safely and accurately using appropriate puncture routes.Level of evidence: 4.
BACKGROUND: The extent of neck dissection for patients with papillary thyroid carcinoma (PTC) metastasis in lateral cervical lymph nodes is still debated. Studies aiming to omit level IIb were generally based on postoperative histopathologic information. The purpose of this study was to evaluate the predictive value of fine-needle aspiration (FNA) for level II lymph nodes in identifying candidates for neck dissection sparing level IIb before surgery. METHODS: We prospectively enrolled 156 consecutive previously untreated PTC patients with lateral neck metastases who were subjected to 178 therapeutic lateral neck dissections (including level IIa, IIb, III, IV, and Vb) between June 2018 and August 2021. Ultrasound-guided FNA of suspicious lymph nodes at level II was preoperatively performed. The cytology of FNA and thyroglobulin (Tg) washout concentration with other clinical predictors was analyzed for lymph node metastases at level IIb. RESULTS: Preoperative ultrasonography revealed suspicious lymph nodes at level II in 118 cases, and fifty were positive on FNA results. Metastasis at level IIb was seen in 17 (9.6%) of the postoperative specimens. By univariate analysis, the rate of level IIb metastasis was significantly higher in patients with FNA-positive lymph nodes at level II (P<0.001, odds ratio = 16.899). The tumor sizes of the two FNA-negative level IIb metastatic lymph nodes were 0.4 mm and 3 mm. CONCLUSIONS: Level IIb lymph node dissection may be omitted in the treatment of N1b PTC patients if FNA to level II lymph nodes is negative.
Biopsy, Fine-Needle , Neck Dissection , Thyroid Cancer, Papillary/secondary , Thyroid Cancer, Papillary/surgery , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery , Adult , Cohort Studies , Female , Humans , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Predictive Value of Tests , Thyroglobulin/metabolism
AIM: Bowel dysfunction after sphincter-preserving proctectomy, also known as low anterior resection syndrome (LARS), has significant impact on survivors of rectal cancer. This study aimed to assess the temporal change of LARS beyond 2 years after proctectomy, which has not been fully studied. METHODS: We longitudinally enrolled consecutive patients who had received total mesorectal excision in a tertiary academic medical center, with preoperative neoadjuvant therapy if indicated. LARS score was longitudinally assessed by two serial follow-ups, with a fixed interval of 18 months. RESULTS: Overall, 107 patients responded for the first follow-up after a median of q20 months, 96 of whom responded for the second follow-up after a median of 38 months. At the first follow-up, 48 patients (44.9%) reported major LARS, compared with 23 (24.0%) at the second follow-up (p < 0.001). Mean LARS score improved from 27.3 to 18.6, mostly from "urgency" (12.2 vs. 6.2, p < 0.001) and "clustering of stools" (9.7 vs. 7.7, p = 0.001). Anastomosis less than 3 cm from the anal verge was independently associated with LARS improvement. CONCLUSION: Bowel dysfunction continues to improve 2 years after total mesorectal excision, with most symptom relief in urgency and stool clustering, especially in patients with lower anastomosis.
Adenocarcinoma/surgery , Fecal Incontinence/epidemiology , Postoperative Complications/epidemiology , Proctectomy/adverse effects , Rectal Neoplasms/surgery , Adenocarcinoma/pathology , Fecal Incontinence/diagnosis , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Middle Aged , Postoperative Complications/diagnosis , Rectal Neoplasms/pathology , Syndrome , Time Factors
Continuum robots with redundant degrees of freedom and postactuated devices are suitable for application in aerospace, nuclear facilities, and other narrow and multiobstacle special environments. The development of a snake-inspired continuum robot is presented in this study. The morphological skeleton structure of the snake body is simulated using underactuated continuum joints, which include several rigid-body joints in series. Each rigid-body joint is driven by the traction of a wire rope. Based on the layered-drive principle, angular synchronous motion can be realized in space with multiple rigid-body joints in a single continuous joint, which can considerably reduce the complexity of the inverse kinematics solution, terminal drive box, and control system. The static and dynamic characteristics of the snake-inspired robot are obtained through torque balance and an equivalent transformation. Finally, we demonstrate trajectory planning and load capacity testing in two robot prototypes with arm lengths of 1500 and 2300 mm (including two and four continuous joints, respectively). The rationality of the structure and the correctness of the control of the layered-drive snake-inspired robot are verified.
Robotics , Biomechanical Phenomena , Torque
OBJECTIVE: The extent of neck dissection in papillary thyroid carcinoma (PTC) patients with lateral neck metastasis is controversial. This work aims to screen the patients suitable for superselective neck dissections including only levels III-IV. STUDY DESIGN: Prospective observational cohort study. SETTING: The study was conducted in a high-volume tertiary care setting. METHODS: A total of 134 consecutive previously untreated PTC patients with lateral neck metastases and subjected to 154 therapeutic lateral neck dissections (including levels II, III, IV, and VB) between June 2018 and March 2021 were enrolled. Fine-needle aspiration was performed preoperatively at each suspicious neck level. Clinical predictors were analyzed for occult lymph node metastases at levels II and VB. RESULTS: As a result, 44.8% and 5.8% of neck specimens exhibited metastatic lymph nodes at levels II and VB. In addition, univariate and multivariate analyses showed that the primary tumor in the ipsilateral thyroid upper lobe (P = .016, odds ratio = 3.528) and clinically multiple metastatic lymph nodes in level III-IV (P = .005, odds ratio = 6.414) were independent predictive factors for occult level II metastases. All 3 (1.9%) occult metastases at level VB were found in necks with preoperative multiple lymph node metastases. CONCLUSIONS: A superselective lateral neck dissection including levels III to IV may be considered in patients with PTC when the preoperative evaluation identifies a single lymph node metastasis located at levels III to IV and the primary tumor is not in the upper lobe of the ipsilateral thyroid.
Carcinoma, Papillary , Thyroid Neoplasms , Carcinoma, Papillary/pathology , Carcinoma, Papillary/surgery , Humans , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Neck/pathology , Neck Dissection , Prospective Studies , Retrospective Studies , Thyroid Cancer, Papillary/pathology , Thyroid Cancer, Papillary/surgery , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery , Thyroidectomy
Laryngeal carcinoma (LC) is one of the common human cancer types. MicroRNAs (miRNAs) were reported to be the essential regulators in cancer diagnosis, treatment, and prognosis. It was reported that miR-206 expression was reduced in various neoplastic diseases. However, the role and functional mechanism of miR-206 in LC progression remain unclear. In this research, miR-206 was found to be associated with tumor-node-metastasis (TNM) staging. In addition, the area under the curve (AUC) of miR-206 was 0.902 for diagnosis of LC and 0.854 for differential diagnosis of stage I-II and stage III-IV patients. Low expression of miR-206 was associated with poor prognosis of LC patients. miR-206 expression was an independent factor affecting the prognosis of LC patients, as revealed by the Cox regression analysis. In vitro experiments demonstrated that miR-206 overexpression reduced cell multiplication, invasion, and migration and increased cell apoptosis in LC cells. Moreover, SOX9 was a target of miR-206, and miR-206 negatively regulated SOX9 expression. Collectively, miR-206 might be a promising biomarker with diagnostic and prognostic value for LC, and the miR-206/SOX9 axis might be a candidate target for LC therapy.
Carcinoma , Laryngeal Neoplasms/genetics , MicroRNAs , Biomarkers, Tumor/genetics , Carcinoma/genetics , Carcinoma/pathology , Cell Line, Tumor , Cell Proliferation/genetics , Gene Expression Regulation, Neoplastic , Humans , Laryngeal Neoplasms/pathology , MicroRNAs/genetics
Higher magnetic fields are always favoured in the magnetoplasmadynamic thruster (MPDT) due to its superior control of the plasma profile and acceleration process. This paper introduces the world's first integrated study on the 150 kW level AF-MPDT equipped with a superconductive coil. A completely new way of using superconducting magnet technology to confine plasma with high energy and extremely high temperatures is proposed. Using the PIC method of microscopic particle simulation, the plasma magnetic nozzle effect and performance of the MPDT under different magnetic-field conditions were studied. The integrated experiment used demonstrated that, in conjunction with the superconducting coil, greater homogeneity and a stronger magnetic field not only caused more even cathode ablation and improved its lifespan but also improved the performance of the MPDT (maximum thrust was 4 N at 150 kW, 0.56 T). Maximum thrust efficiency reached 76.6% and the specific impulse reached 5714 s.
BACKGROUND: Intraoperative neuromonitoring (IONM) reduces the risk of recurrent laryngeal nerve (RLN) injury during thyroid surgery. However, the use of neuromuscular blocking agents (NMBAs), which are essential to improve intubation conditions, may hinder the electromyographic response during IONM. The aim of this prospective, double-blind, randomized controlled trial was to explore the optimal dosage of cisatracurium to produce adequate muscle relaxation for tracheal intubation without significantly affecting evoked potentials of IONM during thyroidectomy. METHODS: Patients undergoing thyroidectomy with IONM in our institution, with an American Society of Anesthesiologists grade of I-II, aged 18-75 years, and with a body mass index below 32 kg/m2 were enrolled and randomly assigned (by random numbers) to receive 1× (group C1) or 2× (group C2) the effective dose (ED95) of cisatracurium for tracheal intubation. The patients, surgeons, and anesthesiologists in charge were blinded to group assignment. Anesthesia was induced with sufentanil, propofol, and cisatracurium (0.05 mg/kgin group C1, 0.1 mg/kg in group C2). Ease of intubation was evaluated with the intubation condition score (Cooper score) and the intubation difficulty scale (IDS). Amplitudes of evoked potentials during intermittent IONM were compared between groups. The primary outcomes were the Cooper score, the IDS score, and the evoked potentials of IONM. RESULTS: Fifty-three patients were randomized from October 2019 to November 2020, and 52 were analyzed (with 26 patients in each group). The Cooper score was significantly lower in group C1 [median, 8.0 (interquartile range, 7.0-8.3)] than in group C2 [9.0 (9.0-9.0), P<0.001]. The rate of difficult laryngoscopy without external laryngeal pressure was significantly higher in group C1 than in group C2 (61.5% vs. 11.5%, P<0.001). More patients in group C1 required assistance to complete tracheal intubation (16 vs. 4, P=0.001). The IDS score was significantly higher in group C1 [3.0 (0.0-4.0) vs. 1.0 (0.0-1.0), P=0.045]. There were no significant differences between groups in amplitudes of evoked potentials. No serious adverse events were observed. CONCLUSIONS: A dose of 2× ED95 of cisatracurium provided better intubation conditions and easier tracheal intubation than 1× ED95, without disturbing IONM. TRIAL PROTOCOL: Chinese Clinical Trial Registry (No. ChiCTR1900022884).
PURPOSE: To commission MCsquare (a multi-cores CPU-based dose calculation engine) for pencil beam scanning (PBS) proton therapy, integrate it into RayStation treatment plan system (TPS) to create a dedicated platform for fast independent dose verification. METHOD: A MCsquare-based independent dose verification platform (MC2InRS) was developed to realize automatic dose re-calculation for clinical use, including data preparation, dose calculation, 2D/3D gamma analysis. MCsquare was commissioned based on in-air lateral dose profiles, integrated depth dose, and the absolute dose of different beam energies for Proteus®ONE. MC2InRS was validated with measurement data using various targets and depths in a water phantom. This study also investigated 15 clinical cases to demonstrate the feasibility and effectiveness of MC2InRS platform in clinic practice. RESULTS: Between simulation and measurement, the distal range differences at 80% (R80) and 20% (R20) dose levels for each energy were below 0.05 mm, and 0.1 mm, respectively, and the absolute dose differences were below 0.5%. 29 out of 36 QA planes reached a 100% gamma passing rate (GPR) for 2%/2mm criteria, and a minimum of 98.3% gamma was obtained in water phantom between simulation and measurement. For the 15 clinical cases investigated, the average 2D GPR (2%/2mm) was 95.4%, 99.3% for MCsquare vs. measurement, MCsquare vs. TPS, respectively. The average 3D GPR (2%/2mm) was 98.9%, 95.3% for MCsquare vs. TPS in water, and computed tomography (CT), respectively. CONCLUSION: MC2InRS, a fast, independent dose verification platform, has been developed to perform dose verification with high accuracy and efficiency for Pencil Bream Scanning (PBS). Its potential to be applied in routine clinical practice has also been discussed.
Brain Neoplasms/radiotherapy , Head and Neck Neoplasms/radiotherapy , Prostatic Neoplasms/radiotherapy , Proton Therapy , Radiotherapy Planning, Computer-Assisted/methods , Algorithms , Computer Simulation , Feasibility Studies , Humans , Male , Phantoms, Imaging , Proton Therapy/methods , Radiotherapy Dosage , Tomography, X-Ray Computed , Water
BACKGROUND: Mediastinal lymph node metastases (MLNM) are not rare in thyroid cancer, but their treatment has not been extensively studied. This study aimed to explore the preliminary application of video mediastinoscopy-assisted superior mediastinal dissection in the diagnosis and treatment of thyroid carcinoma with mediastinal lymphadenopathy. MATERIALS AND METHODS: We retrospectively reviewed the clinical pathologic data and short-term outcomes of thyroid cancer patients with suspicious MLNM treated with video mediastinoscopy-assisted mediastinal dissection at our institution from 2017 to 2020. RESULTS: Nineteen patients were included: 14 with medullary thyroid carcinoma and five with papillary thyroid carcinoma. Superior mediastinal nodes were positive in nine (64.3%) patients with medullary thyroid carcinoma and in four (80.0%) patients with papillary carcinoma. No fatal bleeding occurred. There were three cases of temporary recurrent laryngeal nerve (RLN) palsy postoperatively, one of which was bilateral. Four patients had temporary hypocalcemia requiring supplementation, one had a chyle fistula, and one developed wound infection after the procedure. Postoperative serum molecular markers decreased in all patients. One patient died of cancer while the other 18 patients remained disease-free, with a median follow-up of 33 months. CONCLUSION: Video mediastinoscopy-assisted superior mediastinal dissection can be performed relatively safely in patients with suspicious MLNM. This diagnostic and therapeutic approach may help control locoregional recurrences.
Lymphadenopathy , Thyroid Neoplasms , Dissection , Humans , Lymph Node Excision , Lymph Nodes/pathology , Mediastinoscopy , Neck Dissection , Neoplasm Recurrence, Local , Neoplasm Staging , Retrospective Studies , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery
