Construction and validation of a risk-prediction model for chemotherapy-related cognitive impairment in patients with breast cancer.

PURPOSE: To identify risk factors of chemotherapy-related cognitive impairment (CRCI) and construct and validate a visual prediction model of such for patients with breast cancer. METHODS: A multicenter, descriptive, and cross-sectional design was adopted. Data were collected from ten public tertiary hospitals in China. Cognitive function was assessed by using Functional Assessment of Cancer Therapy-cognitive function. Socio-demographic, clinical, psychological, and physical indicators were also assessed. The logistic prediction model was constructed by fivefold cross-validation. Then, a nomogram was utilized to visualize the prediction model, which was also evaluated via discrimination, calibration, and decision curve analysis. RESULTS: A total of 71 breast cancer patients had CRCI with a prevalence of 9.58%. This visual prediction model was constructed based on education background, exercise frequency, chemotherapy times, and fatigue and demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.882. The calibration curve indicated good agreement between experimental and projected values, and the decision curve proved good clinical applicability. CONCLUSION: Education background, exercise frequency, chemotherapy times, and fatigue were associated with high incidence of CRCI. The prediction model exhibits superior performance and has promise as a useful instrument for assessing the likelihood of CRCI in breast cancer patients. IMPLICATIONS FOR CANCER SURVIVORS: Our findings could provide breast cancer survivors with risk screening based on CRCI predictors to implement prevention and early intervention, and help patients integrate into society and achieve comprehensive recovery.

Effects of a 12-week exercise-based intervention on weight management in overweight or obese breast cancer survivors: a randomized controlled trial.

PURPOSE: Breast cancer survivors face dual challenges: long-term sequelae of treatment and the risk of recurrent disease. Furthermore, obesity and a sedentary lifestyle can complicate both challenges. We aimed to assess the effect of a 12-week exercise-based weight-management program in overweight/obese breast cancer survivors. METHODS: A two-arm, single-blinded, randomized controlled trial was conducted among 60 overweight/obese, stage 0-III breast cancer survivors. During the 12-week program, the intervention group received weekly information support, fortnightly exercise prescriptions, including aerobic and resistance exercises to perform at home, and one dietary instruction. The control group received information support about weight management and exercise. Weight, body composition, and physical fitness data were collected at baseline, postintervention, and the 3-month follow-up. RESULTS: The intervention group showed significant improvements in body weight and all adiposity indices, including body mass index, waist circumference, and %body fat, in comparison with baseline (P < 0.001) and the control group (P < 0.05). Both groups showed no significant changes in fat-free mass during the 6-month period (P > 0.05). International Physical Activity Questionnaire scores and left grip strength increased significantly in the intervention group in comparison with the baseline (P < 0.01) and the control group (P < 0.05). Right grip strength, lower-body strength, and aerobic endurance showed no significant intergroup differences (P > 0.05). CONCLUSIONS: A combination of exercise prescription and weight-loss interventions yielded clinically meaningful weight loss in overweight/obese breast cancer survivors. These findings may facilitate the incorporation of home-based exercise and weight management into breast cancer treatment and survivorship care.

Source term estimation for continuous plume dispersion in Fusion Field Trial-07: Bayesian inference probability adjoint inverse method.

In scenarios involving sudden releases of unidentified gases or concealed pollution emergencies, source control emerges as a critical procedure to safeguard residential air quality. Appropriate inverse source tracking methodology depending on diverse measurement data could be utilized to promptly identify pollutant source parameters. In this study, source term estimation (STE) method, i.e., jointly combining probability adjoint method with the Bayesian inference method, has been proposed. General form of the pollutant inverse transport equation was firstly established. Subsequently, the pollution source information, assumed from single continuous point releases during Fusion Field Trials 2007 under an unsteady wind field, was identified using the Bayesian inference probability adjoint inverse method. Metropolis-Hastings Markov Chain Monte Carlo (MH-MCMC) and Differential Evolution Markov Chain Monte Carlo (DE-MCMC) were then compared as sampling methods for Bayesian inference. Results indicated that the DE-MCMC algorithm has superior convergence and could present higher accuracy of pollutant source information than that of MH-MCMC algorithm, particularly for highly nonlinear and multi-modal distribution systems. Furthermore, the integration of Union standard Adjoint Location Probability (UALP) as prior information into the Bayesian inference probability adjoint inverse method effectively narrowed the sampling range, enhancing both the accuracy and robustness of the proposed approach. Finally, the impact of the covariance matrix on the inverse identification accuracy was explored. Overall, this research has provided insights into the future applicability of this Bayesian inference inversion technique for point source identification.

Air exchange rate and pollutant dispersion inside compact urban street canyons with combined wind and thermal driven natural ventilations: Effects of non-uniform building heights and unstable thermal stratifications.

In the present work, a delicate CFD research of a multi-street canyon model with varying thermal stratifications and non-uniformities of buildings was conducted to investigate the street ventilation and pollutant dispersion between the compact urban blocks. Non-isothermal turbulent wind flow, temperature field and pollutant dispersion in a two-dimensional computational domain were solved by the Renormalization Group (RNG) k-ε turbulence model along with the enhanced wall treatment. Present numerical results indicated that the variation of ground heating intensity has a significant influence on the airflow pattern in the step-down case, and the distribution of pollutants in the street canyons mainly depends on the variation of the upper clockwise vortex. The canyon ventilation performance became better as the unstable thermal stratification strengthened. Similarly, the increase of ground heating intensity could reduce ADF (atmospheric dispersion factor) in the step-down case and ADF became the lowest when Ri = -3.92 was maintained. Additionally, the increase of building unevenness further complicated the canyon airflow structure, which aggravated the pollution of the canyon. In the step-down configuration, as the standard deviation of adjacent building height gradually increases, canyon ventilation could be further enhanced. For the step-up configuration, the best ventilation performance was found at σH = 16.7 %. ADF of adjacent canyons also varied greatly. When σH = 33.3 % was maintained, the peak and bottom values of ADF were discovered in the step-up and step-down cases, respectively. Present research has provided a theoretical reference for guiding urban design and improve living environment in modern compact cities.

Wind-driven pumping flow ventilation of highrise buildings: Effects of upstream building arrangements and opening area ratios.

Periodic vortex shedding around a building could play an important role in wind-driven single-sided ventilation especially when two free openings are mounted on the leeward wall, in which case "pumping" flow dominates the natural ventilation. In this paper, we investigated the characteristics of vortex shedding and "pumping" flow affected by the arrangements of upstream buildings and opening area ratio of ports on the downstream target building. Computational fluid dynamics (CFD) simulations have been used to predict the instantaneous and mean flow fields. Numerical results indicate that the strength of "pumping" flow could be intensively weakened by two upstream buildings. Vortex shedding from the inner shear layers dominates the vortex shedding from the target building and constrains that from both upstream buildings except at W/B = 0.5, in which case the gap flow is weak and the St is close to that of a single building. The increase of upstream building length leads to decrease of the vortex shedding frequency at the wake of all buildings and ventilation rate of the downstream building. An increase of opening area ratio on the rear wall of the downstream building will raise the Strouhal number but have no positive correlation with ventilation rate. "Pumping" flow oscillating frequency does not have clear correlation with the ventilation rate. Our study on the wake vortex shedding flow across building clusters could benefit the future green design of urban buildings.

Fluid mechanical dispersion of airborne pollutants inside urban street canyons subjecting to multi-component ventilation and unstable thermal stratifications.

The pedestrian level pollutant transport in street canyons with multiple aspect ratios (H/W) is numerically investigated in the present work, regarding of various unstable thermal stratification scenarios and plain surrounding. Non-isothermal turbulent wind flow, temperature field and pollutant spread within and above the street canyons are solved by the realizable k-ε turbulence model along with the enhanced wall treatment. One-vortex flow regime is observed for shallow canyons with H/W=0.5, whereas multi-vortex flow regime is observed for deep canyons with H/W=2.0. Both one-vortex and multi-vortex regimes could be observed for the street canyons with H/W=1.0, where the secondary vortex could be initiated by the flow separation and intensified by unstable thermal stratification. Air exchange rate (AER) and pollutant retention time are adopted to respectively evaluate the street canyon ventilation and pollutant removal performance. A second-order polynomial functional relationship is established between AER and Richardson number (Ri). Similar functional relationship could be established between retention time and Ri, and it is only valid for canyons with one-vortex flow regime. In addition, retention time could be prolonged abruptly for canyons with multi-vortex flow regime. Very weak secondary vortex is presented at the ground level of deep canyons with mild stratification, where pollutants are highly accumulated. However, with the decrease of Ri, pollutant concentration adjacent to the ground reduces accordingly. Present research could be applied to guide the urban design and city planning for enhancing pedestrian environment.

The effects of Bleomycin A5 on infantile maxillofacial haemangioma.

OBJECTIVE: To examine the effects of bleomycin A5 on infantile maxillofacial haemangiomas. METHODS: Bleomycin A5 was given by multiple intralesinoal injections and the dosage was given according to the age of the patient and size of the lesion. Parts of patients were accompanied by prednisone treatment (2-5 mg/kg, po, QOD. RESULTS: All the haemangiomas involutes completely after treated with bloemycin A5 with better recovery of skin color and less scar forming in small haemangiomas. CONCLUSION: Infantile haemangioma could be effectively treated with bleomycin A5 without serious side effects.

[A preliminary study of murine hemangioma model by delivery of recombinant adeno-associated virus mediated human vascular endothelial growth factor-121 gene].

OBJECTIVE: To investigate the feasibility of establishing a murine hemangioma model with injection of recombinant adeo-associated virus mediated human vascular endothelial growth factor-121 (rAAV-hVEGF(121)) gene. METHODS: rAAV-hVEGF(121) was constructed, identified and then implanted to the left back ear of each mouse (1.0 x 10(11)VG in 50 microl per mouse and 10 nude mice received the injection), the rights served as controls with an injection of the same volume of phosphate buffered solution (PBS). The skin color and swelling of left back ear were observed every other day. Histological examination was carried out after mice were sacrificed 2, 4, 6, 8, 12 weeks after injection. RESULTS: The rAAV-hVEGF(121) was correctly constructed and confirmed by restriction endonuclease analysis, polymerase chain reaction and DNA sequencing analysis. The skin of left back ear became red 2 weeks after injection and gradually exhibited a red lump which was at its utmost 12 weeks after injection. Such phenomena were not observed in right back ear. Histological examinations showed aggregates of endothelial cells by 2 weeks and at 8 weeks the swollen tissue contained many cysts filled with a mass of red cells. CD-34 staining suggested most of the newly-formed cells were endothelial cells. CONCLUSIONS: A hemangioma model was established in mice with injection of recombinant rAAV-hVEGF(121) gene.

[Diagnosis and therapy on hemangiomas and vascular malformation in view of the new classification].

Vascular birthmarks are the most common disease. The morbidity is about 2.5%, most of the lesions occur in oral and maxillofacial regions which accounts for 40%-60% of the total lesions. In 1982, Mulliken and Glowacki proposed a biologic classification of vascular birthmarks on the basis of their clinical manifestations, histopathological features, and natural history. They defined hemangiomas as vascular tumors with a growth phase, marked by endothelial proliferation and hypercellularity, and an involutional phase. They recognized that many entities referred to as hemangiomas are actually structural malformations of the vasculature, derived from capillaries, veins, lymph vessels, or arteries or from a combination of these sources. The classification was confirmed and issued by International Society for the study of vascular anomaly (ISSVA) in 1988. Waner and Suen amended the above category in 1995. This paper presents the new classification of vascular birthmarks and the developments in this field in recent years, including the pathology, clinical features and the therapy. For example, the classification of venular malformation categorized by Waner in 1989; the classification of lymphous malformation by Waner and Suen in 1995; and the treatments according to above classifications.

[Therapeutic effects of Avastin on the murine hemangioendothelioma].

OBJECTIVE: Investigated the efficacy of Avastin on murine hemangioendothelioma in vitro and in vivo using a mouse hemangioendothelioma-derived cell line----EOMA. METHODS: The in vitro effect of Avastin on cell proliferation of EOMA cell line was measured by CCK-8 assay at 0, 50, 100, 200 mg/L concentration of Avastin. When tumors produced by subcutaneous injection of EOMA cells reached a volume of 100 mm(3), animals were treated by intra-tumor injection with Avastin (1 mg/kg body weight) or with vehicle alone (PBS) twice a week. Mice were weighted and tumors were measured three times weekly. At the end of the experiment, the mice were sacrificed and their tumors were excised and processed for histology. Immunohistochemical study of apoptosis was conducted using a TUNEL kit, tumor cell proliferation was assessed with anti-proliferating cell nuclear antigen (PCNA) antibody. Cardiac puncture was performed under deep anesthesia for collection of serum, serum vascular endothelial growth factor (VEGF) level was tested by VEGF-ELISA assay. RESULTS: Avastin exhibited cell inhibited rate of 24.21%, 26.26% and 34.58% at 50, 100 and 200 mg/L, respectively. When experiment was terminated, the tumor volume in the PBS-treated mice was (1 860.10+/-146.96) mm3, being significantly larger than that in the mice that were treated by Avastin [(681.45+/-63.01) mm3, P<0.01]. Avastin-treated tumors showed decreased tumor cell proliferation and increased cell apoptosis. The VEGF level in mice treated with Avastin [(594.65+/-118.79) ng/L] was significantly lower than that in PBS-treated mice [(802.24+/-238.41) ng/L, P<0.05]. CONCLUSION: The results suggest that topically applied Avastin provides an effective and safe approach to treat hemangioendotheliomas and might be used as a novel treatment of angiomatous diseases in the future.

Reconstruction of a huge oral maxillofacial defect caused by necrotic fasciitis secondary to leukaemia.

SUMMARY: An 8-year-old boy who was diagnosed with 'acute non-lymphoblastic leukaemia (M2)', contracted secondary oral maxillofacial necrotic fasciitis. The wound was cleaned with 3% hypertonic saline, and then covered with iodoform gauze every day for about 3 weeks before and after necrotic tissue debridement. The local infection was controlled, and plenty of new healthy granular tissue had grown. The patient was left with a huge defect including the mouth floor, submental area, submandibular area and right cheek when the necrotic tissue was removed. Reconstruction of the defect was very difficult because of the patient's pre-existing leukaemia condition and severe inflammatory local condition. We successfully reconstructed the defect by using the new healthy granular tissue and a trapezius myocutaneous flap. During 9 years of follow up, in order to improve quality of life, the patient underwent scar modification surgery and orthodontic treatment, and facial appearance and oral functions were deemed satisfactory.

Evaluation of near infrared spectroscopy in monitoring postoperative regional tissue oxygen saturation for fibular flaps.

The ability of near infrared spectroscopy (NIRS) to predict vascular compromise in vascular free flaps postoperatively has been assessed, and the extent of regional tissue oxygen saturation (rSO(2)) after fibular flap transplantation was investigated quantitatively. To validate the sensibility and precision of the technique, the following methods were used. (1) Forearm vessel obstructive tests were conducted in four healthy volunteers. (2) Measurement and analysis of bilateral rSO(2) at the mandibular body and ramus were performed in 40 healthy volunteers by NIRS in the morning and afternoon. (3) Measurement and analysis of rSO(2) in transplanted fibular flaps for 41 cases with mandibular reconstruction were performed by NIRS at postoperative days 1-6. The results were: NIRS had high sensibility and precision in monitoring rSO(2) of living tissues. No significant difference in the values of rSO(2) was found across different times or areas in the normal mandible. However, rSO(2) in the transplanted fibular flaps was reduced compared to the value on the control side. rSO(2) decreased gradually 4-12 hours postoperatively. After that period, rSO(2) increased gradually and approached the value of the control side at 20 h after the operation. It can be concluded that NIRS is a reliable noninvasive method for monitoring blood circulation in transplanted tissues, particularly for buried flaps.

A preliminary study of angiographic classification and its correlation to treatment of central arteriovenous malformation in the jaw.

OBJECTIVE: To elaborate on the classification of central arteriovenous malformations (AVMs) in the jaw based on angioarchitecture and to evaluate the correlation of this classification with treatment options. STUDY DESIGN: X-ray films and digital subtraction angiograms (DSA) of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of bone resorption, feeding arteries, nidus of the malformations, and draining veins. Based on the findings a classification of angioarchitecture was recommended. Furthermore, the treatment results of these cases were reviewed to assess the correlation of this classification system with treatment options. RESULTS: The angiographic pictures of 25 cases with central AVMs could be divided into 5 types: Type I (n = 5) had diffused microarteriovenous fistulas (AVFs); type II (n = 8) had 1 large venous pouch with all the feeding arteries draining into it; type III (n = 7) had a large venous pouch as well as diffused microAVFs (I+II); type IV (n = 2) had multiple venous pouches; and type V (n = 3) had multiple venous pouches and diffused microAVFs (I + IV). The angioarchitecture corresponded well to the x-ray appearance in all cases except 1 (96%). With respect to the treatment outcomes, type II, III, and IV AVMs gained clinical cure in 100% of the cases, whereas type I and type V AVMs obtained clinical cure only in 60% and 33.3% of the cases, respectively. CONCLUSIONS: Central AVMs in the jaw contained variant patterns of angioarchitecture and could be divided into 5 types. This angiographic classification was helpful for decision making about appropriate therapy.

[Diagnosis and management of 49 cases of hemangiomas in infants and children].

OBJECTIVE: To observe the management results of hemangioma in infants and children. METHODS: Forty-nine cases of hemangioma in infants and children managed from 1986 to 2004 were reviewed. During the management period, the incidence and first visit age and sex were recorded. The location and volume of the lesions were photographed and followed up at an interval of 3 to 12 months until the complete involution of the tumor. The treatment modalities used included local injection of prednisone in 16 cases, surgery in 6 cases, and the remaining 33 cases were observed without treatment. RESULTS: Thirty-three cases receiving no treatment involuted naturally. The complete involution age was found from 9 months to 10 years with average age of 5.4 years. The cosmetic results after involution were good. CONCLUSIONS: Most hemangiomas do not need treatment and can involute naturally. However, in cases with severe complications such as expansion, destruction and obstructive or congestive heart failure, treatment is indicated.

[A preliminary study of angiographic classification and treatment of central arteriovenous malformations in jaws].

OBJECTIVE: To elaborate on the angiographic classification of central arteriovenous malformations (AVMs) in jaws, and to evaluate the correlation between this classification and treatment options. METHODS: X-ray films and angiograms of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of radiolucency, feeding arteries, nidus of the malformations and draining veins. Based on the findings a classification of angioarchitecture was recommended. Furthermore, the treatment results of these cases were reviewed to assess the correlation between this classification and treatment options. RESULTS: The angiographic pictures of 25 cases with central AVMs could be divided into five types: type I (n = 5) was with merely diffused micro-arteriovenous fistulas (AVFs); type II (n = 8) demonstrated a large venous pouch, all the feeding arteries drained into it; type III (n = 7) had a large venous pouch together with diffused micro-AVFs (I + II); type IV (n = 2) had multiple venous pouches; type V (n = 3) had multiple venous pouches and diffused micro-AVFs (I + IV). The angioarchitecture corresponded well to the radiographic appearance in all except one case. With respect to the treatment, type II, III, IV AVMs gained clinical cure in 100% of cases, whereas type I and type V AVMs obtained clinical cure only in 3 of 5 and 1 of 3 cases respectively. CONCLUSIONS: Central AVMs in jaws exhibited variant patterns of angioarchitecture, which could be divided into five types. Elaboration of this classification was helpful for decision-making on choosing appropriate therapy.