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Vaginal cancer is a rare malignancy that poses a challenge to treat and cure, as surgical excision requires life-changing procedures because of the proximity and involvement of rectum, bladder and anus. We report in this case study the successful delivery of stereotactic ablative radiotherapy (SABR) for a patient with vaginal cancer after previous radiotherapy.
A 71-year-old white female who presented with dyspareunia and irritative urinary symptoms proven by biopsy was our candidate patient. Subsequent PET/CT revealed a hypermetabolic 3 cm lesion at the 12–1 o’clock position in the distal vagina involving the clitoris. The patient was initially treated with volumetric-modulated arc therapy (VMAT) with simultaneous integrated boost technique to the involved nodes, and later upon recurrence treated with SABR using 30 Gy in six fractions.
To our knowledge, this is the first report of a vaginal cylinder used to physically distance organs at risk from the treatment target and also as a localising device with image guidance for the delivery of SABR using an external beam.
A fever clinic within a hospital plays a vital role in pandemic control because it serves as an outpost for pandemic discovery, monitoring and handling. As the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan was gradually brought under control, the fever clinic in the West Campus of Wuhan Union Hospital introduced a new model for construction and management of temporary mobile isolation wards. A traditional battlefield hospital model was combined with pandemic control regulations, to build a complex of mobile isolation wards that used adaptive design and construction for medical operational, medical waste management and water drainage systems. The mobile isolation wards allowed for the sharing of medical resources with the fever clinic. This increased the capacity and efficiency of receiving, screening, triaging and isolation and observation of patients with fever. The innovative mobile isolation wards also controlled new sudden outbreaks of COVID-19. We document the adaptive design and construction model of the novel complex of mobile isolation wards and explain its characteristics, functions and use.
Functional design is regarded as a design activity primarily aimed at clarifying customer needs, and developing the functional architecture and solution concepts for a system under development. Existing functional design approaches are mainly focused on how to assist designers in searching for solution principles for desired products, which, however, do not adequately take into account the interactions between a smart system under development and its environment, and cannot explicitly represent the complex functional logic of the system, resulting in that they cannot effectively assist designers in the functional design of smart systems. Therefore, this paper proposes a scenario-integrated approach for functional design of smart systems to address the above issues. Based on the concept of scenario in software engineering, the proposed approach explicitly elaborates how to employ scenarios to express subjective customer needs and how to generate the functional architectures and the corresponding solution concepts through a structured process. The functional design of the automated doors-unlocking system of a smart vehicle is employed to illustrate the proposed approach, which also demonstrates that the proposed approach is suitable for functional design of smart systems.
Hypertension represents one of the most common pre-existing conditions and comorbidities in Coronavirus disease 2019 (COVID-19) patients. To explore whether hypertension serves as a risk factor for disease severity, a multi-centre, retrospective study was conducted in COVID-19 patients. A total of 498 consecutively hospitalised patients with lab-confirmed COVID-19 in China were enrolled in this cohort. Using logistic regression, we assessed the association between hypertension and the likelihood of severe illness with adjustment for confounders. We observed that more than 16% of the enrolled patients exhibited pre-existing hypertension on admission. More severe COVID-19 cases occurred in individuals with hypertension than those without hypertension (21% vs. 10%, P = 0.007). Hypertension associated with the increased risk of severe illness, which was not modified by other demographic factors, such as age, sex, hospital geological location and blood pressure levels on admission. More attention and treatment should be offered to patients with underlying hypertension, who usually are older, have more comorbidities and more susceptible to cardiac complications.
The epidemic of coronavirus disease 2019 (COVID-19) began in China and had spread rapidly to many other countries. This study aimed to identify risk factors associated with delayed negative conversion of SARS-CoV-2 in COVID-19 patients. In this retrospective single-centre study, we included 169 consecutive patients with confirmed COVID-19 in Zhongnan Hospital of Wuhan University from 15th January to 2nd March. The cases were divided into two groups according to the median time of SARS-CoV-2 negative conversion. The differences between groups were compared. In total, 169 patients had a median virus negative conversion time of 18 days (interquartile range: 11–25) from symptom onset. Compared with the patients with short-term negative conversion, those with long-term conversion had an older age, higher incidence of comorbidities, chief complaints of cough and chest distress/breath shortness and severer illness on admission, higher level of leucocytes, neutrophils, aspartate aminotransferase, creatine kinase and erythrocyte sedimentation rate (ESR), lower level of CD3+CD4+ lymphocytes and albumin and more likely to receive mechanical ventilation. In multivariate analysis, cough, leucocytes, neutrophils and ESR were positively correlated with delayed virus negative conversion, and CD3+CD4+ lymphocytes were negatively correlated. The integrated indicator of leucocytes, neutrophils and CD3+CD4+ lymphocytes showed a good performance in predicting the negative conversion within 2 weeks (area under ROC curve (AUC) = 0.815), 3 weeks (AUC = 0.804), 4 weeks (AUC = 0.812) and 5 weeks (AUC = 0.786). In conclusion, longer quarantine periods might be more justified for COVID-19 patients with cough, higher levels of leucocytes, neutrophils and ESR and lower levels of CD3+CD4+ lymphocytes.
The disease burden of infectious diarrhea cannot be underestimated. Its seasonal patterns indicate that weather patterns may play an important role and have an important effect on it. The objective of this study was to clarify the relationship between temperature and infectious diarrhea, and diarrhea-like illness.
Distributed lag non-linear model, which was based on the definition of a cross-basis, was used to examine the effect.
Viral diarrhea usually had high incidence in autumn-winter and spring with a peak at -6°C; Norovirus circulated throughout the year with an insignificant peak at 8°C, while related bacteria usually tested positive in summer and peaked at 22°C. The lag-response curve of the proportion of diarrhea-like cases in outpatient and emergency cases revealed that at -6°C, with the lag days increasing, the proportion increased. Similar phenomena were observed at the beginning of the curves of virus and bacterial positive rate, showing that the risk increased as the lag days increased, peaking on days 16 and 9, respectively. The shape of lag-response curve of norovirus positive rate was different from others, presenting m-type, with 2 peaks on day 3 and day 18.
Weather patterns should be taken into account when developing surveillance programs and formulating relevant public health intervention strategies.
The FNDC5 gene encodes the fibronectin type III domain-containing protein 5 that is a membrane protein mainly expressed in skeletal muscle, and the FNDC5 rs3480 polymorphism may be associated with liver disease severity in non-alcoholic fatty liver disease (NAFLD). We investigated the influence of the FNDC5 rs3480 polymorphism on the relationship between sarcopenia and the histological severity of NAFLD. A total of 370 adult individuals with biopsy-proven NAFLD were studied. The association between the key exposure sarcopenia and the outcome liver histological severity was investigated by binary logistic regression. Stratified analyses were undertaken to examine the impact of FNDC5 rs3480 polymorphism on the association between sarcopenia and the severity of NAFLD histology. Patients with sarcopenia had more severe histological grades of steatosis and a higher prevalence of significant fibrosis and definite non-alcoholic steatohepatitis than those without sarcopenia. There was a significant association between sarcopenia and significant fibrosis (adjusted OR 2·79, 95 % CI 1·31, 5·95, P = 0·008), independent of established risk factors and potential confounders. Among patients with sarcopenia, significant fibrosis occurred more frequently in the rs3480 AA genotype carriers than in those carrying the FNDC5 rs3480 G genotype (43·8 v. 17·2 %, P = 0·031). In the association between sarcopenia and liver fibrosis, there was a significant interaction between the FNDC5 genotype and sarcopenia status (P value for interaction = 0·006). Sarcopenia is independently associated with significant liver fibrosis, and the FNDC5 rs3480 G variant influences the association between sarcopenia and liver fibrosis in patients with biopsy-proven NAFLD.
The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.
In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.
From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.
A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.
This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
Microcomputers play an increasingly important role in the delivery of radiation therapy. Exposure to neutron irradiation can produce undesirable effects in modern microcomputers. The objective of this study is to measure acute and cumulative effects of neutron exposure of Intel-based microcomputers in photon and proton therapy treatment environments.
Materials and methods:
Multiple computers were irradiated with neutrons produced from MEVION S250 passive scattering proton therapy and from Varian 21EX Linear Accelerator photon therapy systems. The energy of the proton beam was 232 MeV and the photon beam energies were 6 and 18 MV. Rates of fatal errors in computer processing unit (CPU) cores were measured.
Varying rates of fatal system errors due to upsets in the CPU cores were observed. Post-exposure routine stress testing revealed no permanent hardware defects in the random access memory (RAM) or hard disk drive (HDD) of any tested systems. Microchip manufacturers fit increasingly high numbers of transistors in the same volume and the susceptibility to radiation thus increases.
This work explores if the process size of a microchip is the dominant factor and also looked at the short- and long-term effects of neutron irradiation on modern microprocessors in a clinical environment. Additionally, methods of effective shielding are proposed.
Trichosporon is a yeast-like basidiomycete, a conditional pathogenic fungus that is rare in the clinic but often causes fatal infections in immunocompromised individuals. Trichosporon asahii is the most common pathogenic fungus in this genus and the occurrence of infections has dramatically increased in recent years. Here, we report a systematic literature review detailing 140 cases of T. asahii infection reported during the past 23 years. Statistical analysis shows that T. asahii infections were most frequently reported within immunodeficient or immunocompromised patients commonly with blood diseases. Antibiotic use, invasive medical equipment and chemotherapy were the leading risk factors for acquiring infection. In vitro susceptibility, clinical information and prognosis analysis showed that voriconazole is the primary drug of choice in the treatment of T. asahii infection. Combination treatment with voriconazole and amphotericin B did not show superiority over either drug alone. Finally, we found that the types of infections prevalent in China are significantly different from those in other countries. These results provide detailed information and relevant clinical treatment strategies for the diagnosis and treatment of T. asahii infection.
This technical note describes a quantitative assessment of the production of radioactive materials during a year-long clinical operation of a Mevion S250i Hyperscan proton therapy system. The production of accumulated radioactive materials plays an important role in determining radiation safety in and around the proton therapy facilities.
We have conducted a weekly room survey, every week for a year, during normal clinical operation.
Results and conclusions:
We estimated the accumulated activity from secondary neutron activation on aluminium structures at 3 m away from isocentre in the beamline to be less than 300 μCi.
The satellite constellation with automatic dependent surveillance-broadcast on-board is of great importance for air traffic surveillance due to its multiple advantages compared with traditional methods. Although some research has been conducted on satellite constellation design based on coverage performance, the findings cannot entirely satisfy all the requirements of air traffic surveillance owing to the lack of analysis on inter-satellite links and network transmission. This paper presents a novel design of a low earth orbit satellite constellation network to solve this problem. Based on the requirements of space-based surveillance, an evaluation model of constellation performance is proposed concerning coverage, link and transmission. The simulation results show that the evaluation model can reflect the performance of a satellite constellation network designed for a space-based surveillance system, and a 55-satellite constellation design scheme with fairly good performance can fulfil the function of global real-time air traffic surveillance.
As the number of proton therapy facilities has steadily increased, the need for the tool to provide precise dose simulation for complicated clinical and research scenarios also increase. In this study, the treatment head of Mevion HYPERSCAN pencil beam scanning (PBS) proton therapy system including energy modulation system (EMS) and Adaptive Aperture™ (AA) was modelled using TOPAS (TOolkit for PArticle Simulation) Monte Carlo (MC) code and was validated during commissioning process.
Materials and methods:
The proton beam characteristics including integral depth doses (IDDs) of pristine Bragg peak and in-air beam spot sizes were simulated and compared with measured beam data. The lateral profiles, with and without AA, were also verified against calculation from treatment planning system (TPS).
All beam characteristics for IDDs and in-air spot size agreed well within 1 mm and 10% separately. The full width at half maximum and penumbra of lateral dose profile also agree well within 2 mm.
The TOPAS MC simulation of the MEVION HYPERSCAN PBS proton therapy system has been modelled and validated; it could be a viable tool for research and verification of the proton treatment in the future.
Anxiety and depression are distinct clinical entities associated with mortality in haemodialysis (HD) patients.
This study aims to identify the prevalence of anxiety and depression in HD patients and uncover the association of anxiety and depression in relation to the dialysis adequacy and nutritional status.
This would help reinforce early detection and treatment to improve quality of life and patient's outcome in HD treatment.
Forty HD patients were assessed for anxiety and depression with the Generalised Anxiety Disorder Assessment (GAD-7 and Patient Health Questionaire [PHQ-9]). The scores of GAD-7 and PHQ-9 were correlated with the demographic, clinical and laboratory variables and nutritional status assessed by a dietician through the Subjective Global Assessment (SGA).
Out of the 40 HD patients, 7 (17.5%) were anxious and 15 (37.5%) were depressed. Patients were more anxious and less depressed with better nutrition. They were less anxious and depressed with increasing albumin levels, Charlston comorbidity index based on combined condition and age-related score and Kt/V. The univariate logistic regression analysis showed only a significant inverse correlation between depression and albumin level (P = 0.041, OR = 0.88 [95% CI = 0.78 to 0.99]) and Kt/V (P = 0.054, OR = 0.03 [95% CI = 0.01 to 1.07]).
Depression is more prevalent than anxiety in HD patients. The risk of depression also increases with poorer dialysis adequacy and nutritional status. Thus, by improving dialysis adequacy and nutritional status, we can reduce the incidence of depression. However, a significant correlation cannot be drawn for anxiety.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Compared to their heterosexual peers, youth who identify as lesbian, gay or bisexual (LGB) tend to suffer higher rates of peer victimisation from bullying. However, studies of LGB adolescents' participation as bullies are scarce. We aimed to examine the possible association of sexual minority identity and the heightened risk of not only being bullied but bullying others as well. We also explored the effect of one's sexual identity on their involvement in bullying through the mediation of coping strategies and mood states.
A total of 12 218 students were recruited from 18 secondary schools in China. The demographic information, positive and negative coping strategies, mood state (anxiety, depression and hypomania) and information related to bullying and being bullied were collected. Multinomial regression was used to assess the heightened risk of sexual minority groups in comparison to their heterosexual adolescents' counterparts. A structural equation model (SEM) was used to test the mediating role of coping strategy and mood state between one's sex, sexual identity and bullying experience.
Two trends could be observed: (1) LGB groups reported heightened risks of being bullied and bullying others at school than heterosexual peers. However, being a sexual-undeveloped girl seemed to have a protective effect on bullying-related problems. (2) Birth-assigned males were more likely to be bullied as well as bullying others at school when compared to birth-assigned females. SEM analysis revealed that being a sexual minority was directly associated with a higher frequency of being bullied (B = 0.16, 95% CI [0.10, 0.22], p < 0.001) but not bullying others (B = 0.02, 95% CI [−0.02, 0.06], p = 0.398) when compared to the heterosexual group. Negative coping, hypomania, anxiety and depression were associated with a higher frequency of being bullied, while positive coping was associated with a lower frequency of being bullied. Moreover, negative coping, hypomania and depression were associated with a higher frequency of bullying others, while positive coping was associated with a reduced likelihood of bullying others. In addition, being bullied and bullying others were significantly correlated in the SEM model.
This novel research investigated the dynamic nature of the interaction between victim and bullying of LGB school adolescents in China, with a specific exploration of the psychological mechanism behind the pattern of being bullied and bullying others. School-level interventions aimed at teaching positive coping strategies to lower psychological distress are recommended to support sexual minority students.
In this paper, a sandwiched type frequency selective surface (FSS) is designed and analyzed. The design procedure and operating principle is given based on the equivalent circuit model. The proposed FSS includes two identical layers of periodic metallic arrays, which are separated by a foam layer. In each layer of the periodic array, the unit cell is composed of a gridded-triple square loop structure. The FSS provides three pass-bands, in which a flat band response is presented. Three bands are separated by one or two transmission zeros, which leads to a sharp rejection on both sides of each pass-band. The central frequencies of the three pass-bands are 7.0, 10.9 and 14.0 GHz. To verify the simulated results, a prototype of the FSS is fabricated and measured. The simulated results agree well with the measured ones. This work can be used in area of a radar stealth or satellite communication system.
This article overviews the ultrasonic welding process, a solid-state joining method, using the example of welding of a magnesium alloy as well as the joining of magnesium alloys in general. In situ high-speed imaging and infrared thermography were utilized to study interfacial relative motion and heat generation during ultrasonic spot welding of AZ31B magnesium (Mg) alloys. A postweld ultrasonic nondestructive evaluation was performed to study the evolution of local bond formation at the faying interface (contact surface of the joint between the top and bottom Mg sheets) at different stages of the welding process. Two distinct stages were observed as the welding process progresses. In the early stage, localized reciprocating sliding occurred at the contact faying interface between the two Mg sheets, resulting in localized rapid temperature rise from the localized frictional heating. Microscale (submillimeter) bonded regions at the Mg–Mg faying surface started to form, but the overall joint strength was low. The early-stage localized bonds were broken during the subsequent vibrations. In the later stage, no relative motion occurred at any points of the faying interface. Localized bonded regions coalesced into a macroscale joint that was strong enough to prevent the Mg–Mg interface from further breakage and sliding. With increasing welding time, the bonded area continued to increase.