Comparison of modeling accuracy between Radixact®and CyberKnife®Synchrony®respiratory tracking system.

Synchrony Respiratory Tracking system adapted from CyberKnife has been introduced in Radixact to compensate the tumor motion caused by respiration. This study aims to compare the modeling accuracy of the Synchrony system between Radixact and CyberKnife. Two Synchrony plans based on fiducial phantoms were created for CyberKnife and Radixact, respectively. Different respiratory motion traces were used to drive a motion platform to move along the superoinferior and left-right direction. The cycle time and the amplitude of target/surrogate motion of one selected motion trace were scaled to investigate the dependence of modeling accuracy on the motion characteristic. The predicted target position, the correlation error, potential difference (Radixact only) and standard error (CyberKnife only) were extracted from raw data or log files of the two systems. The modeling accuracy was evaluated by calculating the root-mean-square (RMS) error between the predicted target positions and the input motion trace. A threshold T95 within which 95% of the potential difference or the standard error lay was defined and evaluated. Except for the motion trace with a small amplitude and a good (linear) correlation between target and surrogate motion, Radixact showed smaller RMS errors than CyberKnife. The RMS error of both systems increased with the motion amplitude and showed a decreasing trend with the increasing cycle time. No correlation was found between the RMS error and the amplitude of surrogate motion. T95 could be a good estimator of modeling accuracy for CyberKnife rather than Radixact. The correlation error defined in Radixact were largely affected by the number of fiducial markers and the setup error. In general, the modeling accuracy of the Radixact Synchrony system is better than that of the CyberKnife Synchrony system under unfavorable conditions.

Initial clinical experience of patient-specific QA of treatment delivery in online adaptive radiotherapy using a 1.5 T MR-Linac.

Purpose. This study aims to evaluate the performance of a commercial 1.5 T MR-Linac by analyzing its patient-specific quality assurance (QA) data collected during one full year of clinical operation.Methods and Materials. The patient-specific QA system consisted of offline delivery QA (DQA) and online calculation-based QA. Offline DQA was based on ArcCHECK-MR combined with an ionization chamber. Online QA was performed using RadCalc that calculated and compared the point dose calculation with the treatment planning system (TPS). A total of 24 patients with 189 treatment fractions were enrolled in this study. Gamma analysis was performed and the threshold that encompassed 95% of QA results (T95) was reported. The plan complexity metric was calculated for each plan and compared with the dose measurements to determine whether any correlation existed.Results. All point dose measurements were within 5% deviation. The mean gamma passing rates of the group data were found to be 96.8 ± 4.0% and 99.6 ± 0.7% with criteria of 2%/2mm and 3%/3mm, respectively. T95 of 87.4% and 98.2% was reported for the overall group with the two passing criteria, respectively. No statistically significant difference was found between adaptive treatments with adapt-to-position (ATP) and adapt-to-shape (ATS), whilst the category of pelvis data showed a better passing rate than other sites. Online QA gave a mean deviation of 0.2 ± 2.2%. The plan complexity metric was positively correlated with the mean dose difference whilst the complexity of the ATS cohort had larger variations than the ATP cohort.Conclusions. A patient-specific QA system based on ArcCHECK-MR, solid phantom and ionization chamber has been well established and implemented for validation of treatment delivery of a 1.5 T MR-Linac. Our QA data obtained over one year confirms that good agreement between TPS calculation and treatment delivery was achieved.

Correction to: Molecular characterization of Blastocystis sp. in captive wild animals in Qinling Mountains.

There were errors in Fig. 1 of the originally published article. Correct fig. 1 is presented here.

Association of left ventricular structural and functional abnormalities with aortic and brachial blood pressure variability in hypertensive patients: the SAFAR study.

Both brachial blood pressure (BP) level and its variability (BPV) significantly associate with left ventricular (LV) structure and function. Recent studies indicate that aortic BP is superior to brachial BP in the association with LV abnormalities. However, it remains unknown whether aortic BPV better associate with LV structural and functional abnormalities. We therefore aimed to investigate and compare aortic versus brachial BPV, in terms of the identification of LV abnormalities. Two hundred and three participants who underwent echocardiography were included in this study. Twenty-four-hour aortic and brachial ambulatory BP was measured simultaneously by a validated BP monitor (Mobil-O-Graph, Stolberg, Germany) and BPV was calculated with validated formulae. LV mass and LV diastolic dysfunction (LVDD) were evaluated by echocardiography. The prevalence of LV hypertrophy (LVH) and LVDD increased significantly with BPV indices (P⩽0.04) in trend tests. After adjustment to potential confounders, only aortic average real variability (ARV), but not brachial ARV or weighted s.d. (wSD, neither aortic nor brachial) significantly associated with LV mass index (P=0.02). Similar results were observed in logistic regression. After adjustment, only aortic ARV significantly associated with LVH (odds ratio (OR) and 95% confidence interval (CI): 2.28 (1.08, 4.82)). As for LVDD, neither the brachial nor the aortic 24-hour wSD, but the aortic and brachial ARV, associated with LVDD significantly, with OR=2.28 (95% CI: (1.03, 5.02)) and OR=2.36 (95% CI: (1.10, 5.05)), respectively. In summary, aortic BPV, especially aortic ARV, seems to be superior to brachial BPV in the association of LV structural and functional abnormalities.

Molecular characterization of Blastocystis sp. in captive wild animals in Qinling Mountains.

Blastocystis is one common protist inhabiting in gastrointestinal tracts of animals and humans. Examining the subtypes has important implications for assessing the zoonotic potential of Blastocystis and intestinal health of hosts. In the present study, a total of 497 fecal samples collected from 37 wild animal species in Qinling Mountains were investigated for the presence and subtypes of Blastocystis. Of them, 200 (40.2%) were positive for Blastocystis and 13 subtypes were found, including eight known subtypes (STs1-3, 5, 10, 12-14) and five possible novel subtypes (temporarily named as STs18-22), with ST10 as the predominate subtype and the subtype ST5 was detected in an ostrich for the first time. These findings indicated the wide distribution and specific subtype characteristics of Blastocystis in wild animals of Qinling Mountains.

Filmless methods for quality assurance of Tomotherapy using ArcCHECK.

PURPOSE: Tomotherapy delivers an intensity-modulated radiation therapy (IMRT) treatment by the synchronization of gantry rotation, multileaf collimator (MLC), and couch movement. This dynamic nature makes the quality assurance (QA) important and challenging. The purpose of this study is to develop some methodologies using an ArcCHECK for accurate QA measurements of the gantry angle and speed, MLC synchronization and leaf open time, couch translation per gantry rotation, couch speed and uniformity, and constancy of longitudinal beam profile for a Tomotherapy unit. METHODS: Four test plans recommended by AAPM Task Group 148 (TG148) and the manufacturer were chosen for this study. Helical and static star shot tests are used for checking the leaves opened at the expected gantry angles. Another helical test is to verify the couch traveled the expected distance per gantry rotation. The final test is for checking the couch speed constancy with a static gantry. ArcCHECK can record the detector signal every 50 ms as a movie file, and has a virtual inclinometer for gantry angle measurement. These features made the measurement of gantry angle and speed, MLC synchronization and leaf open time, and longitudinal beam profile possible. A shaping parameter was defined for facilitating the location of the beam center during the plan delivery, which was thereafter used to calculate the couch translation per gantry rotation and couch speed. The full width at half maximum (FWHM) was calculated for each measured longitudinal beam profile and then used to evaluate the couch speed uniformity. Furthermore, a mean longitudinal profile was obtained for constancy check of field width. The machine trajectory log data were also collected for comparison. Inhouse programs were developed in MATLAB to process both the ArcCHECK and machine log data. RESULTS: The deviation of our measurement results from the log data for gantry angle was calculated to be less than 0.4°. The percentage differences between measured and planned leaf open time were found to be within 0.5% in all the tests. Our results showed mean values of MLC synchronization of 0.982, 0.983, and 0.995 at static gantry angle 0°, 45°, and 135°, respectively. The mean value of measured couch translation and couch speed by ArcCHECK had less than 0.1% deviation from the planned values. The variation in the value of FWHM suggested the couch speed uniformity was better than 1%. The mean of measured longitudinal profiles was suitable for constancy check of field width. CONCLUSION: Precise and efficient methods for measuring the gantry angle and speed, leaf open time, couch translation per gantry rotation, couch speed and uniformity, and constancy of longitudinal beam profile of Tomotherapy using ArcCHECK have been developed and proven to be accurate compared with machine log data. Estimation of the Tomotherapy binary MLC leaf open time is proven to be precise enough to verify the leaf open time as small as 277.8 ms. Our method also makes the observation and quantification of the synchronization of leaves possible.

The complete mitochondrial genome of Pseudanoplocephala crawfordi and a comparison with closely related cestode species.

Pseudanoplocephala crawfordi is an important zoonotic cestode of economic significance and public health concern. In spite of its significance as a pathogen, the systematics, genetics, epidemiology and biology of this parasite remain poorly understood. In the present study, we sequenced and characterized the complete mitochondrial (mt) genome of P. crawfordi, which is 14,192 bp long and encodes 36 genes, including 12 protein-coding genes, 22 transfer RNA genes and two ribosomal RNA genes. Phylogenetic analysis of the concatenated amino acid sequences using the Bayesian inference (BI) method showed that P. crawfordi was closely related to the family Hymenolepididae. Considering that the taxonomic status of P. crawfordi has been controversial when based only on morphological features, the mt genome obtained here will provide novel molecular markers to ascertain the phylogenetic position of this parasite accurately.

Molecular approaches to differentiate three species of Nematodirus in sheep and goats from China based on internal transcribed spacer rDNA sequences.

Internal transcribed spacer (ITS) rDNA sequences of three Nematodirus species from naturally infected goats or sheep in two endemic provinces of China were analysed to establish an effective molecular approach to differentiate Nematodirus species in small ruminants. The respective intra-specific genetic variations in ITS1 and ITS2 rDNA regions were 0.3-1.8% and 0-0.4% in N. spathiger, 0-6.5% and 0-5.4% in N. helvetianus, and 0-4.4% and 0-6.1% in N. oiratianus from China. The respective intra-specific variations of ITS1 and ITS2 were 1.8-4.4% and 1.6-6.1% between N. oiratianus isolates from China and Iran, 5.7-7.1% and 6.3-8.3% between N. helvetianus samples from China and America. For N. spathiger, compared with samples from China, sequence differences in ITS1 rDNA were 0.3-2.4% in isolates from America, 0.3-2.9% in New Zealand and 2.1-2.4% in Australia. Genetic variations in ITS2 rDNA of N. spathiger were 0-0.4% between samples from China and America, and 0-0.8% between samples from China and New Zealand. Using mutation sites, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and specific PCR techniques were developed to differentiate these three Nematodirus species. The specific PCR assay allowed the accurate identification of N. oiratianus from other common nematodes with a sensitivity of 0.69 pg and further examination of Nematodirus samples demonstrated the reliability of these two molecular methods.

Effects of Adding Super Dose Phytase to the Phosphorus-deficient Diets of Young Pigs on Growth Performance, Bone Quality, Minerals and Amino Acids Digestibilities.

Two experiments were conducted to evaluate the efficacy of feeding an Escherichia coli (E. coli) derived phytase to pigs fed P deficient, corn-soybean meal diets. In Exp. 1, one hundred and twenty crossbred piglets (9.53±0.84 kg) were allocated to one of five treatments which consisted of four low P diets (0.61% Ca, 0.46% total P and 0.24% non-phytate P) supplemented with 0, 500, 1,000, or 20,000 FTU/kg E. coli phytase as well as a positive control formulated to be adequate in all nutrients (0.77% Ca, 0.62% total P and 0.42% non-phytate P). The treatments were applied to six pens with four pigs per pen for 28 days. In Exp. 2, ten crossbred pigs (19.66±1.16 kg) fitted with ileal T-cannula were used in a nutrient balance study. The pigs were assigned to treatments similar to those used in Exp. 1 in a doubly replicated 5×4 incomplete Latin square design (5 diets with 4 periods). Each period consisted of a 5-d adjustment period followed by a 3-d total collection of feces and urine and then a 2-d collection of ileal digesta. Supplementation with phytase linearly increased (p<0.05) weight gain, feed intake, feed efficiency, bone breaking strength and fat-free dry and ash bone weight. There were linear increases (p<0.01) in the apparent ileal digestibility (AID) of DM, GE, CP, Ca, total P, inositol hexaphosphate (IP6) and some AA with increasing dose of E. coli phytase. Pigs fed 20,000 FTU/kg had a greater (p<0.05) AID of IP6 (80% vs 59% or 64%, respectively) than pigs fed diets with 500 or 1,000 FTU/kg phytase. There were linear increases (p<0.05) in the total tract digestibility of Ca, total P, Na, K, Mg, and Zn as well as in the retention of Mg and Zn with increased phytase dose. The retention and utilization of Cu, and the total tract digestibility of CP and Cu quadratic increased (p<0.05) with increased phytase dose. In conclusion, supplementation of 500 FTU of phytase/kg and above effectively hydrolyzed phytate in low-P corn-soybean diets for pigs. In addition, a super dose of phytase (20,000 FTU/kg) hydrolyzed most of the IP6 and consequently further improved mineral use, protein utilization and performance.

Characterization of Oesophagostomum asperum and O. columbianum by internal transcribed spacers of nuclear ribosomal DNA.

In the present study, the internal transcribed spacers (ITS) of ribosomal DNA (rDNA) of Oesophagostomum asperum and O. columbianum were amplified and sequenced. The ITS-1, 5.8S and ITS-2 rDNA sequences of O. asperum were 374 bp, 153 bp and 259 bp in length, respectively, and the corresponding sequences of O. columbianum were 259, 153 and 218 bp in length, respectively. Sequence differences in the ITS-1 and ITS-2 rDNA between the two Oesophagostomum species were 9.5-10.2% and 12.7-13.9%, respectively. Sequence differences in the ITS-1 and ITS-2 rDNA among members of the genus Oesophagostomum were 2.5-11.6% and 6.8-22.3%, respectively. Based on genetic markers in the ITS rDNA, an effective polymerase chain reaction (PCR) approach was developed to differentiate O. columbianum from O. asperum with a sensitivity of 0.2 ng/µl DNA. Since accurate characterization of parasites at different taxonomic levels is essential for population genetic studies and control of parasitosis, the present findings have important implications for studying epidemiology, taxonomy and population biology, as well as for the control of oesophagostomiasis.

Characterization of Baylisascaris schroederi from Qinling subspecies of giant panda in China by the first internal transcribed spacer (ITS-1) of nuclear ribosomal DNA.

In the present study, a total of 20 nematode isolates, (including 10 male and 10 female worms) representing Baylisascaris schroederi from 5 Qinling subspecies of giant pandas (Ailuropoda melanoleuca) in Shaanxi Province of China, were characterized and grouped genetically by the first internal transcribed spacer (ITS-1) of nuclear ribosomal DNA (rDNA). The rDNA fragment spanning 3' end of 18S rDNA, complete ITS-1 rDNA, and 5' end of 5.8S rDNA were amplified and sequenced. The sequence variability in ITS-1 rDNA was examined within B. schroederi and among parasites in order Ascaridata available in GenBank™, and their phylogenetic relationships were also reconstructed. The sequences of ITS-1 rDNA for all the B. schroederi isolates were 427 bp in length, with no genetic variation detected among these isolates. Phylogenetic analyses based on the ITS-1 rDNA sequences revealed that all the male and female B. schroederi isolates sequenced in the present study were posited into the clade of genus Baylisascaris, sistered to zoonotic nematodes in genus Ascaris, and the ITS-1 rDNA sequence could distinguish different species in order Ascaridata. These results showed that the ITS-1 rDNA provides a suitable molecular marker for the inter-species phylogenetic analysis and differential identification of nematodes in order Ascaridata.

The comparison of the perioperative changes in lactate and prothrombin time between deceased versus living donor liver transplantation.

INTRODUCTION: The present study compared the functional capacity of the grafts by evaluating changes in lactate and PT after reperfusion among deceased donor liver transplantation (DDLT) versus living donor liver transplantation (LDLT). METHODS: We performed a retrospective analysis of primary adult liver transplantations (45 and 77 recipients in DDLT and LDLT, respectively) between January 2007 and December 2009. Lactate was recorded from 5 minutes after reperfusion of graft (R0) to intensive care unit admission (P0). PT expressed in international normalized ratio (INR) was recorded from R0 to postoperative day (POD) 5. These values were compared between two groups. RESULTS: The cold ischemia time (CIT), Child-Turcotte-Pugh score, Model for End-stage Liver Disease score, INR, and graft-to-recipient weight ratio were greater in the recipients of DDLT versus LDLT. Lactate and INR at R0 were similar between the two groups, but, the values showed a faster recovery from 1 hour after reperfusion until P0 for lactate and until POD 5 for INR among DDLT recipients. The fresh frozen plasma requirements during corresponding periods were similar between the two groups. CONCLUSION: The functional capacity of the graft measured by changes in lactate and PT after reperfusion showed faster recovery among DDLT versus LDLT recipients despite poorer graft quality (longer CIT) and the recipients' preoperative medical conditions-higher MELD and CTP scores.

Rarefied-gas heat transfer in micro- and nanoscale Couette flows.

The physics of the heat conduction and viscous dissipation in rarefied gases is analyzed and discussed. A heat transfer model valid for arbitrary Knudsen numbers, defined as the ratio of the molecular mean free path to the characteristic length of channels, is derived by treating the heat transfer behavior in the slip and transition regimes as an intermediate function of continuum heat transfer model and free molecular heat transfer model. Comparison studies reveal that this model not only shows good agreement with the numerical results based on the direct simulation Monte Carlo method, but also has some unique features that can overcome the deficiencies existing in the previous models. Therefore, this model is capable to study the heat transport phenomena in very dilute gas Couette flows through micro/nanochannels more accurately.

Resistance to adefovir dipivoxil in lamivudine resistant chronic hepatitis B patients treated with adefovir dipivoxil.

BACKGROUND: Adefovir dipivoxil (ADV) is a potent nucleotide analogue against both the wild-type and lamivudine (LMV) resistant hepatitis B virus (HBV). The cumulative incidence of ADV resistant mutations in the nucleoside/-tide treatment naive chronic hepatitis B patient (CHB) at weeks 48, 96, and 144 was 0, 0.8-3%, and approximately 5.9%, respectively. AIMS: The aim of this study was to characterise the genotypic and phenotypic mutation profiles to ADV in 67 LMV resistant CHB patients who were treated with ADV. METHODS: Serum HBV DNA was quantified by real time polymerase chain reaction. The ADV mutant was detected using matrix assisted laser desorption/ionisation time of flight mass spectrometry based genotyping assays, termed restriction fragment mass polymorphism (RFMP). RESULTS: RFMP analysis revealed that a total of 11 amino acid substitutions developed in the rt domain of the HBV polymerase in nine patients. The cumulative incidence of genotypic ADV resistance at months 12 and 24 was 6.4% and 25.4%, respectively. The rtA181V, rtN236T, and rtA181T mutations were detected in five, four, and two of the 67 patients at treatment months 12-17, 3-19, and 7-20, respectively. Serial quantification of serum HBV DNA revealed that two patients with the rtA181V mutation, with or without the rtN236T mutation, and one patient with the rtA181T mutation displayed HBV DNA rebound. CONCLUSION: Emergence of the ADV mutation in LMV resistant patients who are treated with ADV appeared to present earlier and more frequently than was reported in previous studies on nucleoside/-tide treatment naive patients.

Reduction of radiation dose to patients undergoing barium enema by dose audit.

Nowadays, new fluoroscopic machines are usually equipped with a dose-area product (DAP) meter for dose measurement. In our hospital, DAP meters have been used in the Diagnostic Radiology Department for dose audit since June 1997. Demographic patient data, name of radiologist, fluoroscopic duration and DAP readings of every case were recorded by radiographers. In early 1999, questionnaires were distributed to radiologists who had performed fluoroscopic examinations during the auditing period. 23 radiologists with varying years of experience completed the questionnaire and their practice was analysed. Since familiarization with the examination technique would affect radiologists' practice, these radiologists were divided into two groups for analysis. Radiologists with less than 3 years of experience were grouped together as junior radiologists, whilst others were grouped as senior radiologists. Results of the questionnaire indicated that radiologists generally found DAP meters useful for dose evaluation in the process of technique refinement. Radiologists aware of being under continuous surveillance of their practice showed significant reduction of doses (junior radiologists 25%, p<0.005; senior radiologists 36%, p<0.05) and fluoroscopic times (junior radiologists 36%, p<0.001; senior radiologists 18%, p<0.05) compared with radiologists who were unaware that they were under surveillance but with similar radiological experience. This effect is believed to be because of increased awareness of radiation dose through audit. In addition, this "audit effect" may also affect junior radiologists in decision-making regarding the number of radiographs (p<0.05), but no effect was found for senior radiologists (p>0.5).

MAPD--an objective way to select mAs for paediatric brain CT.

CT is an advanced imaging modality, but the imaging parameters are normally selected subjectively. For standard head examinations, most of the parameters used are consistent amongst different centres, with the exception of large variations in the selection of the tube current-exposure time product (mAs). As a result, CT images may contain unacceptable levels of noise, or the patient may receive excessive radiation. In this study, the maximum anteroposterior diameter (MAPD) was shown to be a good criterion for mAs selection, and could be measured in a pilot view. 200 paediatric brain CT studies were randomly selected to determine the MAPD at the mid brain level. With knowledge of MAPD distribution, a phantom study was performed to determine the relationship between MAPD and the mAs required for consistent and acceptable image noise. It was found that the required mAs increased linearly with MAPD. Assuming the manufacturer's recommended value is "appropriate" for the average MAPD, the appropriate mAs value could be estimated. Using this method, appropriate mAs values were calculated retrospectively for a group of 240 randomly selected paediatric brain CT studies and compared with the actual mAs subjectively determined by the radiographer. Although their average values were similar, the difference between the calculated and actual values deviated markedly in some cases. When the actual mAs was smaller than the calculated value, higher image noise was observed. However, reduction of image noise was barely observed when the applied mAs was larger than the calculated value. Thus, this method is more objective and appropriate for determination of the mAs value for paediatric brain CT than the traditional subjective method.

Idiopathic pulmonary artery aneurysm: digital subtraction pulmonary angiography grossly underestimates the size of the aneurysm.

Pulmonary artery aneurysm is a rare disease entity. The majority of cases are associated with congenital cardiovascular diseases, infection, and trauma; idiopathic pulmonary artery aneurysm is extremely rare. Although conventional and digital subtraction pulmonary angiography remains as the imaging modality of choice for the pulmonary vessels, it is invasive and sometimes may be inaccurate. With the advent of spiral computed tomographic angiography (CTA), pulmonary artery aneurysm can be diagnosed noninvasively and accurately. We report a case of a 68-year-old man with idiopathic pulmonary artery aneurysm of the descending branch of right pulmonary artery where the true caliber of the aneurysm was significantly underestimated in the digital subtraction pulmonary angiography. The literatures of this rare condition are reviewed with the emphasis on the application of CTA in this disease.

Experimental lung transplantation using non-penetrating vascular clips for anastomosis of the pulmonary artery.

BACKGROUND: Reliable and rapid anastomosis is critical in lung transplantation. The purpose of this study is to show the appropriateness of sutureless anastomosis of the pulmonary artery using a nonpenetrating vascular clipping device. METHODS: The left lung was excised and the cranial lobe was transplanted autologously in 9 dogs. The anastomosis of the left main pulmonary artery (PA) (1 cm) was performed using a vascular clipping system. RESULTS: PA anastomosis was performed in 7 dogs in 8 to 13 minutes. The endovascular surface of the anastomotic site was smooth, and passage of silicone rubber through the anastomosis was good 14 or 28 days after surgery. Microscopic examination of the anastomotic sites showed excellent healing without evidence of intimal hyperplasia. CONCLUSIONS: The vascular clipping system facilitates anastomosis of the PA in lung transplant surgery.