Clinical Viability of an Active Spot Scanning Beam Delivery System With a Newly Developed Carbon-Ion Treatment Planning System.

Purpose: Although active spot scanning irradiation technique is theoretically superior to passive-scattered broad beam irradiation with respect to normal tissue sparing, corroborations of the clinical benefit of carbon-ion spot scanning have remained scarce. This study aims to investigate the feasibility and clinical implementation of an active spot scanning beam calculation algorithm in a homemade carbon-ion treatment planning system by comparing it with a conventional passive uniform scanning technique. Methods and Materials: Carbon-ion plans were initially formulated using spot/uniform scanning methods in 22 participants enrolled in a prospective observational clinical trial. Subsequently, 2 additional plans were designed, resulting in 3 carbon-ion plans for each participant: uniform and spot scanning with miniridge filters of 2 mm and 4 mm, respectively. Results: The findings revealed no significant differences in dose homogeneity; however, significant differences in dose conformity were found between the active and passive scanning plans. For dose drop-off outside the target volume, the average gradient index values were 1.94 (95% CI, 1.79%-2.09%), 1.87 (95% CI, 1.73%-2.01%), and 3.20 (95% CI, 2.80%-3.61%) for the miniridge filters of 2 mm and 4 mm, and uniform scanning plans, respectively. The pretreatment tumor volume was 124.7 cm3 (range, 54.2-234 cm3), and the average shrinkage observed was 38.4% (95% CI, 17.6%-59.4%). Seven participants experienced grade 1 acute toxicity, and 4 experienced grade 2 acute toxicity. However, none of the patients developed grade 3 acute toxicity. Conclusions: Increasing evidence suggests that potential clinical advantages of spot scanning delivery underlie its technical characteristics. As one among the few institutions currently using carbon-ion radiation therapy, the investigation also provides promising safety and efficacy outcomes from the initial groups of treated participants, thereby contributing to the established clinical evidence supporting the effectiveness and superiority of carbon-ion therapy.

Application of a linear interpolation algorithm in radiation therapy dosimetry for 3D dose point acquisition.

Air-vented ion chambers are generally used in radiation therapy dosimetry to determine the absorbed radiation dose with superior precision. However, in ion chamber detector arrays, the number of array elements and their spacing do not provide sufficient spatial sampling, which can be overcome by interpolating measured data. Herein, we investigated the potential principle of the linear interpolation algorithm in volumetric dose reconstruction based on computed tomography images in the volumetric modulated arc therapy (VMAT) technique and evaluated how the ion chamber spacing and anatomical mass density affect the accuracy of interpolating new data points. Plane measurement doses on 83 VMAT treatment plans at different anatomical sites were acquired using Octavius 729, Octavius1500, and MatriXX ion chamber detector arrays, followed by the linear interpolation to reconstruct volumetric doses. Dosimetric differences in planning target volumes (PTVs) and organs at risk (OARs) between treatment planning system and reconstruction were evaluated by dose volume histogram metrics. The average percentage dose deviations in the mean dose (Dmean) of PTVs reconstructed by 729 and 1500 arrays ranged from 4.7 to 7.3% and from 1.5 to 2.3%, while the maximum dose (Dmax) counterparts ranged from 2.3 to 5.5% and from 1.6 to 7.6%, respectively. The average percentage dose/volume deviations of mixed PTVs and OARs in the abdomen/gastric and pelvic sites were 7.6%, 3.5%, and 7.2%, while mediastinum and lung plans showed slightly larger values of 8.7%, 5.1%, and 8.9% for 729, 1500, and MatriXX detector arrays, respectively. Our findings indicated that the smaller the spacing between neighbouring detectors and the more ion chambers present, the smaller the error in interpolating new data points. Anatomical regions with small local mass density inhomogeneity were associated with superior dose reconstruction. Given a large mass density difference in the various human anatomical structures and the characteristics of the linear interpolation algorithm, we suggest that an alternative data interpolation method should be used in radiotherapy dosimetry.

The value of different imaging methods in the diagnosis of breast cancer: A protocol for network meta-analysis of diagnostic test accuracy.

BACKGROUND: : Breast cancer (BC) is the most common cancer in women all over the world and the second most common cause of cancer-related mortality. Imaging examination plays an important role in the diagnosis of early breast cancer. Due to different imaging principles and methods, all kinds of examinations have their advantages and disadvantages. It is particularly important for clinicians to choose these examination methods reasonably to achieve the best diagnostic effect. The objectives of this systematic review and NMA are to determine the diagnostic accuracy of imaging technologies for breast cancer and to compare the diagnostic accuracy of different index tests and to support guidelines development and clinical practice. METHODS: : PubMed, Embase.com, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and SinoMed will be searched to identify relevant studies up to August 31, 2021. We will include random controlled trials, cross-sectional studies, case-control studies, and cohort studies that evaluate the diagnostic accuracy of different imaging diagnostic methods for breast cancer. The Quality Assessment of Diagnostic Accuracy Studies 2 quality assessment tool will be used to assess the risk of bias in each study. Standard pairwise meta-analysis and NMA will be performed using STATA V.12.0, MetaDiSc 1.40, and R 3.4.1 software to compare the diagnostic efficacy of different imaging diagnostic methods. Subgroup analyses and sensitivity analyses will be conducted to investigate the sources of heterogeneity. RESULTS: : The results of this study will be published in a peer-reviewed journal. CONCLUSION: : This study will comprehensively evaluate the accuracy of different imaging diagnostic methods in the diagnosis of breast cancer. The results of this study will provide high-quality evidence to support clinical practice and guidelines development.

MFAP2 promotes epithelial-mesenchymal transition in gastric cancer cells by activating TGF-ß/SMAD2/3 signaling pathway.

INTRODUCTION: Microfibril-associated protein 2 (MFAP2) is an extracellular matrix protein that interacts with fibrillin to modulate the function of microfibrils. MFAP2 has been reported to play a significant role in obesity, diabetes, and osteopenia, and has been shown to be upregulated in head and neck squamous cell carcinoma. However, the molecular function and prognostic value of MFAP2 have never been reported in gastric cancer (GC) or any other tumors. METHODS: The current study investigated the expression patterns, prognostic significance, functional role, and possible mechanisms of MFAP2 in GC. RESULTS: We demonstrated that MFAP2 was overexpressed in GC tissues, and its overexpression was significantly correlated with poor overall and disease-free survival in patients with GC. Moreover, we found that MFAP2 promoted the proliferation, migration, invasion, and epithelial-mesenchymal transition (EMT) phenotype in GC cells. MFAP2 might modulate EMT of GC cells by activating the TGF-ß/SMAD2/3 signaling pathway. CONCLUSION: These findings provide novel evidence that MFAP2 plays a crucial role in the progression of GC. Therefore, MFAP2 may be a promising prognostic marker and a potent anticancer agent.

MACC1 facilitates chemoresistance and cancer stem cell­like properties of colon cancer cells through the PI3K/AKT signaling pathway.

With regards to colon cancer, resistance to 5­fluorouracil (5­FU)­based chemotherapy and cancer stem cells (CSCs) are considered important factors underlying therapy failure. Metastasis­associated colon cancer 1 (MACC1) has been associated with poor prognosis and the promotion of metastasis within several types of cancer. However, the biological behavior of MACC1 in chemoresistance and CSC­like properties remains unclear. In the present study, various methods including gene knockdown, gene overexpression, western blotting, quantitative polymerase chain reaction and MTT assay, have been adopted. According to the results of the present study, MACC1 was depleted in two colon cancer cell lines resistant to 5­FU; subsequently, CSC­like properties and 5­FU sensitivity were investigated. Within 5­FU­resistant cells, cell death was facilitated by MACC1 knockdown. Furthermore, sphere formation and the expression levels of pluripotent markers, including cluster of differentiation (CD) 44, CD133 and Nanog were reduced due to MACC1 depletion. Additionally, it was indicated that the phosphoinositide 3­kinase/protein kinase B signaling pathway may be associated with 5­FU resistance and CSC­like properties via MACC1.

Genetic diversity of the endemic and medicinally important plant Rheum officinale as revealed by Inter-Simpe Sequence Repeat (ISSR) Markers.

Rheum officinale Baill., an important but endangered medicinal herb, is endemic to China. Inter-simple sequence repeat (ISSR) markers were employed to investigate the genetic diversity and differentiation of 12 populations of R. officinale. Thirteen selected primers yielded 189 bright and discernible bands, with an average of 14.54 per primer. The genetic diversity was low at the population level, but pretty high at the species level (H = 0.1008, I = 0.1505, PPB = 28.95% vs. H = 0.3341, I = 0.5000, PPB = 95.24%, respectively) by POPGENE analysis. Analysis of molecular variance (AMOVA) showed that the genetic variation was found mainly among populations (74.38%), in line with the limited gene flow (N(m) = 0.2766) among populations. Mantel test revealed a significant correlation between genetic and geographic distances (r = 0.5381, P = 0.002), indicating the role of geographic isolation in shaping the present population genetic structure. Both Bayesian analysis and UPGMA cluster analysis demonstrated the similar results. Our results imply that the conservation efforts should aim to preserve all the extant populations of this endangered species, and cultivation is proposed in this study.

Genetic variation in Rheum palmatum and Rheum tanguticum (Polygonaceae), two medicinally and endemic species in China using ISSR markers.

AIMS: Both Rheum palmatum and R. tanguticum are important but endangered medicinal plants endemic to China. In this study, we aimed to (i) investigate the level and pattern of genetic variability within/among populations of those species; (ii) evaluate genetic differentiation between both species and its relationships and ascertain whether both species are consistent with their current taxonomical treatment as separate species; and (iii) discuss the implications for the effective conservation of two species. METHODS: Total 574 individuals from 30 populations of R. palmatum and R. tanguticum were collected, covering the entire distribution range of two species in China. The genetic variation within and among 30 populations was evaluated using inter-simple sequence repeat (ISSR) markers. IMPORTANT FINDINGS: Twelve selected ISSR primers generated a total of 175 fragments, 173 (98.86%) of which were polymorphic. The Nei's gene diversity (H) and Shannon's index (I) of both species were high at species level (H = 0.3107, I = 0.4677 for R. palmatum; H = 0.2848, I = 0.4333 for R. tanguticum). But for both species, the genetic diversity was low at population level, and average within-population diversity of R. palmatum was H = 0.1438, I = 0.2151, and that of R. tanguticum was H = 0.1415, I = 0.2126. The hierarchical AMOVA revealed high levels of among-population genetic differentiation in both species, in line with the gene differentiation coefficient and the limited among-population gene flow (R. palmatum: Φ(st) = 0.592, G(st) = 0.537, N(m) = 0.432; R. tanguticum: Φ(st) = 0.567, G(st) = 0.497, N(m) = 0.507). By contrast, only 6.52% of the total genetic variance was partitioned between R. palmatum and R. tanguticum. Bayesian analysis, UPGMA cluster analysis, and PCoA analysis all demonstrated the similar results. A significant isolation-by-distance pattern was revealed in R. palmatum (r = 0.547, P = 0.010), but not in R. tanguticum (r = 0.241, P = 0.100). Based on these results, effective conservation strategies were proposed for these two species. The small molecular variance between R. palmatum and R. tanguticum revealed that they had a common ancestor, and we considered that these two species might not be good species.