Node Chain Research Articles

Geometrical and dosimetrical evaluation of different interpretations of the ESTRO delineation guidelines for the internal mammary lymph node chain in breast cancer patients

Geometrical and dosimetrical evaluation of different interpretations of the ESTRO delineation guidelines for the internal mammary lymph node chain in breast cancer patients

205. MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY WITH TOTAL MEDIASTINAL LYMPHADENECTOMY FOR THORACIC ESOPHAGEAL CANCER: SHORT- AND LONG-TERM OUTCOMES IN 139 PATIENTS

Abstract Background The McKeown approach is a standard surgery for thoracic esophageal cancer in Japan, as lymph node dissection of upper mediastinum and neck is mandatory. The thoracoscopic approach allows access to the lymph node chain along the laryngeal nerves from the chest and led us to introduce minimally invasive Ivor Lewis esophagectomy (MIILE) with radical lymphadenectomy for middle and lower esophageal cancer. Although circular-stapled anastomosis is popular in MIILE, the frequency of anastomotic complications has been reported to be high. We introduced MIILE with linear-stapled anastomosis in 2010. Methods To evaluate the short- and long-term outcomes of MIILE with radial lymphadenectomy and linear stapled anastomosis, we performed a retrospective cohort study of 139 consecutive patients. The endpoints included overall complications, anastomotic leak rate, nutritional status at 12 months after MIILE, and 5-year overall survival, and disease-free survival. Surgical Procedure After laparoscopic gastric tube construction, thoracoscopic or robotic esophagectomy with total mediastinal lymphadenectomy was done in the prone position. ICG angiography was used to assess gastric tube viability and sacrifice the ischemic portion in recent cases. Esophago-gastric anastomosis was performed using a linear stapler. The opening was closed with interrupted sutures and covered with the omentum to secure the anastomosis. Results There was 122 male and 17 female patients with median age of 69 years. Preoperative diagnosis was stage I/II/III/IV in 44/46/37/12 patients. Pathology results were SCC in 108 cases. Tumor location was middle/lower/EGJ in 58/64/17 patients. Preoperative chemotherapy or CRT was administered in 77 patients. Median thoracic surgery time was 297 minutes and blood loss was 53 mL. Median hospital stay was 17 days. The short-term complication rate of grade IIIa or higher was 8.7%. Anastomotic leak occurred in 8 patients (5.8%), three of whom required intervention. No leakage occurred after introduction of intraoperative ICG angiography. 90-day mortality was 0.7%. With a median follow-up of 41 months, 5-year overall survival rate was 68.3% and disease-free survival rates was 56.7%. For the 65 SCC patients with clinical stage II/III disease, 5-year OS rate was 58.7%. During follow-up period, 2 patients (1.4%) required balloon dilatation due to anastomotic stenosis. At 12 months after MIILE, the mean weight loss was 11.6% and the mean albumin level was 3.9. Discussion Compared to benchmark complication rates reported by the international Esophagectomy Complication Consensus Group (ECCG), the overall complication rate (47% vs. 59%) was not significantly lower, but the anastomotic leak rate was significantly lower (5.8 vs. 11.4%). Overall survival, disease-free survival, and nutritional outcomes were similar to those reported in Japanese clinical trials. Conclusions MIILE with linear-stapled anastomosis is a safe procedure with a low rate of serious complications. Survival and nutritional outcomes were excellent. It may be recommended as a standard procedure for lower and middle esophageal cancer. https://www.dropbox.com/scl/fi/z6zyllnmie9qh3zhz2wd5/Okabe_ISDE.wmv?rlkey=4mig28fv5z2vhaui31tbk0mr9&dl=0

First-in-man study of the PSMA Minibody IR800-IAB2M for molecularly targeted intraoperative fluorescence guidance during radical prostatectomy

PurposeProstate-specific membrane antigen (PSMA) is increasingly used to image prostate cancer in clinical practice. We sought to develop and test a humanised PSMA minibody IAB2M conjugated to the fluorophore IRDye 800CW-NHS ester in men undergoing robot-assisted laparoscopic radical prostatectomy (RARP) to image prostate cancer cells during surgery.MethodsThe minibody was evaluated pre-clinically using PSMA positive/negative xenograft models, following which 23 men undergoing RARP between 2018 and 2020 received between 2.5 mg and 20 mg of IR800-IAB2M intravenously, at intervals between 24 h and 17 days prior to surgery. At every step of the procedure, the prostate, pelvic lymph node chains and extra-prostatic surrounding tissue were imaged with a dual Near-infrared (NIR) and white light optical platform for fluorescence in vivo and ex vivo. Histopathological evaluation of intraoperative and postoperative microscopic fluorescence imaging was undertaken for verification.ResultsTwenty-three patients were evaluated to optimise both the dose of the reagent and the interval between injection and surgery and secure the best possible specificity of fluorescence images. Six cases are presented in detail as exemplars. Overall sensitivity and specificity in detecting non-lymph-node extra-prostatic cancer tissue were 100% and 65%, and 64% and 64% respectively for lymph node positivity. There were no side-effects associated with administration of the reagent.ConclusionIntraoperative imaging of prostate cancer tissue is feasible and safe using IR800-IAB2M. Further evaluation is underway to assess the benefit of using the technique in improving completion of surgical excision during RARP.RegistrationISCRCTN10046036: https://www.isrctn.com/ISRCTN10046036.

Internal mammary lymphadenopathy in breast cancer: a narrative review and update.

While the axillary nodal basin is the most common lymphatic drainage pathway of the breast, the internal mammary (IM) lymph node chain plays a significant role in breast cancer staging and treatment. It has been identified as sentinel nodal drainage in approximately 13-37% of patients. Despite this, the data is still limited with regard to diagnosis and management when there is suspicion or confirmation of IM lymph node (IMLN) involvement by metastatic breast cancer. The objective of this publication is to provide a comprehensive assessment of the current body of literature surrounding the diagnosis, management and prognostic value of IMLNs in breast cancer treatment. Review of the literature published regarding IMLN diagnosis, significance, and management was completed in PubMed. Additional focus was placed on reviewing articles published within the past 10 years as foundation for an update regarding the current practice and future directions in this space. Improved imaging techniques, with positron emission tomography-computed tomography and magnetic resonance imaging, have led to increase in the identification of IM lymphadenopathy, yielding surgical staging of the IM nodes nearly obsolete. While IM nodal metastases may play a role in overall survival (OS), it has not been demonstrated to be an independent risk factor for increased locoregional recurrence. IM nodal irradiation (IMNI) therapy has been a mainstay in the treatment of IM disease in the context of breast cancer. IMNI has demonstrated improvement in OS and risk of distant recurrence. Wide variations in radiation practices for patients with IM lymphadenopathy exist internationally, highlighting the lack of clear data driven consensus guidelines. Herein, we provide an updated assessment of the current diagnosis, clinical significance, and management of IM lymphadenopathy for breast cancer patients.

Subcapsular sinus macrophages maximize germinal center development in non-draining lymph nodes during blood-borne viral infection.

Lymph node (LN) germinal centers (GCs) are critical sites for B cell activation and differentiation. GCs develop after specialized CD169+ macrophages residing in LN sinuses filter antigens (Ags) from the lymph and relay these Ags into proximal B cell follicles. Many viruses, however, first reach LNs through the blood during viremia (virus in the blood), rather than through lymph drainage from infected tissue. How LNs capture viral Ag from the blood to allow GC development is not known. Here, we followed Zika virus (ZIKV) dissemination in mice and subsequent GC formation in both infected tissue-draining and non-draining LNs. From the footpad, ZIKV initially disseminated through two LN chains, infecting LN macrophages and leading to GC formation. Despite rapid ZIKV viremia, non-draining LNs were not infected for several days. Non-draining LN infection correlated with virus-induced vascular leakage and neutralization of permeability reduced LN macrophage attrition. Depletion of non-draining LN macrophages significantly decreased GC B cells in these nodes. Thus, although LNs inefficiently captured viral Ag directly from the blood, GC formation in non-draining LNs proceeded similarly to draining LNs through LN sinus CD169+ macrophages. Together, our findings reveal a conserved pathway allowing LN macrophages to activate antiviral B cells in LNs distal from infected tissue after blood-borne viral infection.

The Rise and Fall of the Thoracoabdominal Incision in Urological Oncology

Objectives The thoraco-abdominal incision (TAI) has been used to provide maximal surgical exposure in the management of combined supra- and infra-diaphragmatic pathologic processes such as levels III or IV thrombi of the IVC. The TAI was once a cornerstone of urological oncology but is becoming increasingly uncommon in the era of robotic approaches to the renal hilum, suprahilar lymph node chain, and minimal access chest surgery to the supradiaphragmatic IVC. We wished to explore the complete history of the TAI, from first description to its height of popularity and its current utilization by contemporary urologic oncologists. Methods Primary source material included an interview with Donald Skinner, an early proponent of the TAI. We conducted a novel survey of active urologists in contemporary practice to investigate the usage of the TAI in practice. We reviewed documents from the Second Auxiliary Surgical Group (SASG) from 1941-1944; reports by military surgeon DF Marshall, recognized as performing the first TAI for a genitourinary indication during World War II; and records of the 8055th US Army (MASH) Unit in Korea, credited with improving the battlefield usage of the TAI; and secondary sources from the AUA’s WP Didusch Archive, PubMed, and Googlescholar. Results The thoraco-abdominal incision (TAI) can originally be traced back to French civilian usage in the latter 19th century, but the TAI was not adopted for battlefield trauma surgery until the Second World War. The safety and effectivness of the TAI increased greatly during the Korean War with teaching, organized outcomes analyses, and improvement efforts. Trauma indications during these conflicts allowed for later adoption in the field of urologic oncology due to the incision’s excellent exposure and became the hallmark of at least one fellowship in urologic oncology. Fewer than 15% of surveyed urologists in the contemporary era have used the TAI in the past 5 years. Conclusions The thoracoabdominal incision’s later adoption by the civilian population is a testament to the ingenuity and resourcefulness of military surgeons in the former part of the twentieth century. Their contributions should not be forgotten as urological surgery moves towards minimally invasive approach.

Anti-Eavesdropping by Exploiting the Space–Time Coupling in UANs

Due to the space–time coupling access, we find that anti-eavesdropping opportunities exist in underwater acoustic networks (UANs), where packets can be successfully received only by the intended receiver, but collide at the unintended receivers. These opportunities are highly spatially dependent, and this paper studies the case that linearly deployed sensor nodes directly report data toward a single collector. We found an eavesdropping ring centered around these linearly deployed sensor nodes, where the eavesdropper could steal all the reported data. Since the typical receiving-alignment-based scheduling MAC (TRAS-MAC) will expose the relative spatial information among the sensor nodes with the collector, the eavesdropper can locate the eavesdropping ring. Although moving the collector into the one-dimensional sensor node chain can degrade the eavesdropping ring to a point that constrains the eavesdropping risk, the collector’s location will be subsequently exposed to the eavesdropper. To efficiently protect the reported data and prevent the exposure of the collector’s location, we designed a slotted- and receiving-alignment-based scheduling MAC (SRAS-MAC). The NS-3 simulation results showed the effectiveness of the SRAS-MAC and the TRAS-MAC in protecting data from eavesdropping, which protect 90% of the data from eavesdropping in the one-eavesdropper case and up to 80% of data from eavesdropping in ten-eavesdropper cases. Moreover, unlike TRAS-MAC, which will expose the collector’s location, SRAS-MAC provides multiple positions for the collector to hide, and the eavesdropper cannot distinguish where it is.

Metastasis of skin squamous cell carcinoma in kidney transplant recipients.

Cutaneous squamous cell carcinoma (cSCC) is the most common skin malignancy in kidney transplant recipients (KTRs) as a result of immunosuppression. A worldwide increase in kidney transplantation justifies the determination of prognostic biomarkers by collecting detailed patient data on metastasis development. This study aims to characterize the clinical, epidemiological, and histopathological profiles of KTRs who developed metastasis of cSCC. We conducted a retrospective single-center study on 18 KTRs and 21 immunocompetent patients (ICs) with metastatic cSCC, using data from 2004 to 2021. ICs were older (median age 70.5 years) than KTRs (median age: 59.5 years). Both groups were predominantly male with Fitzpatrick skin phototype I/II. The primary tumor appeared around 83.5 months post-transplant, usually in sun-exposed areas (61.1%), though some non-exposed areas in ICs (23.8%) contradicted literature findings. KTRs took longer to develop metastasis (median: 11.0 months) compared to ICs (median: 5.5 months). The mean size of the primary tumor was smaller in KTRs (2.50 cm2) compared to ICs (4.55 cm2). The main lymph node chain affected by metastasis wasparotid lymph nodes in KTRs (27.8%) and cervical/axillar lymph nodes in ICs (both 19.0%). Both groups exhibited similar primary tumor grades and metastasis evolution, but KTRs had a higher prevalence of lymphovascular invasion. Metastasis of cSCC was more common in males with low skin phototype, in KTRs, particularly on the head and neck. The study suggests a possible link between lymphovascular invasion and metastasis development in KTRs.

A Hands-on Guide to AmoePy - a Python-Based Software Package to Analyze Cell Migration Data.

Amoeboid cell motility is fundamental for a multitude of biological processes such as embryogenesis, immune responses, wound healing, and cancer metastasis. It is characterized by specific cell shape changes: the extension and retraction of membrane protrusions, known as pseudopodia. A common approach to investigate the mechanisms underlying this type of cell motility is to study phenotypic differences in the locomotion of mutant cell lines. To characterize such differences, methods are required to quantify the contour dynamics of migrating cells. AmoePy is a Python-based software package that provides tools for cell segmentation, contour detection as well as analyzing and simulating contour dynamics. First, a digital representation of the cell contour as a chain of nodes is extracted from each frame of a time-lapse microscopy recording of a moving cell. Then, the dynamics of these nodes-referred to as virtual markers-are tracked as the cell contour evolves over time. From these data, various quantities can be calculated that characterize the contour dynamics, such as the displacement of the virtual markers or the local stretching rate of the marker chain. Their dynamics is typically visualized in space-time plots, the so-called kymographs, where the temporal evolution is displayed for the different locations along the cell contour. Using AmoePy, you can straightforwardly create kymograph plots and videos from stacks of experimental bright-field or fluorescent images of motile cells. A hands-on guide on how to install and use AmoePy is provided in this chapter.

Dose to Organ at Risk and its Characteristic Variation with the Clinically Used Different Prescription Levels for Early-stage Left-sided Breast Cancer

AimsTo evaluate the organ at risk (OAR) dose and its characteristic variation with different clinically usable prescription doses (RxD) for breast and chest wall radiotherapy in patients with early-stage left-sided breast cancer. Materials and methodsIn total, 145 patients with early-stage breast cancers (T1N0M0-T2N0M0) on the left side were treated with radiotherapy after a modified radical mastectomy or breast conservation surgery, with a mean age of 45.1 ± 21.6 years. The patient received 4050 cGy of field-in-field (three-dimensional conformal radiotherapy) treatment limited to the breast or chest wall, excluding the supraclavicular node, axillary node and internal mammary chain, over 15 fractions. Additional plans of 5000 cGy/25 fractions, 4500 cGy/20 fractions and 2600 cGy/5 fractions were created with no or minor changes to the original plan. Mathematical modelling was used to study the distinctive change in the dose–volume characteristics for various OARs as a function of the RxD. OAR dosages, both absolute and normalised, were expressed in terms of the RxD. The mathematical (functional) relationship between OAR doses and different prescription levels was deduced by the least squares fit method. ResultThe left lung mean dose, V5Gy (%), V10Gy (%) and V20Gy (%) and the heart mean dose, V10Gy (%) and V20Gy (%) were evaluated. The dose–volume parameters showed a parabolic variation (x2) with the RxD. Prescription normalised OAR doses showed a linear relationship with the RxD; relative dose increased with diminishing RxD. Normalised lung and heart mean doses exhibited saturation (linear relationship) with RxD variation. Paired sample t-test results between RxD versus all evaluated parameters were found to be statistically significant (P = 0.004). The Pearson correlation coefficient between different prescription levels for left lung mean dose (range 0.942–1.0), heart mean dose (range 1.0–1.0), left lung V5Gy (%) (range 0.987–1.0), left lung V10Gy (%) (range 0.991–0.999), heart V10Gy (%) (range 0.998–1.0). ConclusionThe functional form of absolute OAR dose–volume parameters versus RxD is parabolic and the RxD normalised OAR dose–volume parameter versus RxD is a straight line with a negative slope as RxD increases. This indicates an increase in the relative OAR dose–volume parameters if the RxD is reduced. This study is the first of its kind to compare the OAR doses as a function of clinically used degenerate prescription levels. These data will help to comprehend the OAR doses while adopting a new dose fractionation regimen and reviewing the radiotherapy treatment plans.

A novel block-chain based secure cross-domain interaction approach for intelligent transportation systems

In the Intelligent Transportation System (ITS), secure and efficient data communication among vehicles, road testing equipment, computing nodes, and transportation agencies is important for building a smart city integrated transportation system. However, the traditional centralized processing approach may face threats in terms of data leakage and trust. The use of distributed, tamper-proof blockchain technology can improve the decentralized storage and security of data in the ITS network. However, the cross-trust domain devices, terminals, and transportation agencies in the heterogeneous blockchain network of the ITS still face great challenges in trusted data communication and interoperability. In this paper, we propose a heterogeneous cross-chain interaction mechanism based on relay nodes and identity encryption to solve the problem of data cross-domain interaction between devices and agencies in the ITS. First, we propose the ITS cross-chain communication framework and improve the cross-chain interaction model. The relay nodes are interconnected through LibP2P to form a relay node chain, which is used for cross-chain information verification and transmission. Secondly, we propose a relay node secure access scheme based on identity-based encryption (IBE) to provide reliable identity authentication for relay nodes. Finally, we build a standard cross-chain communication protocol and cross-chain transaction lifecycle for this mechanism. We use Hyperledger Fabric and FISCO BCOS blockchain to design and implement this solution, and verify the feasibility of this cross-chain interaction mechanism. The experimental results show that the mechanism can achieve a stable data cross-chain read throughput of 2,000 transactions per second (TPS), which can meet the requirements of secure and efficient cross-chain communication and interaction among heterogeneous blockchains in the ITS, and has high application value.

Coexistence of Granuloma Annulare and Castleman’s Disease: A Case Report

Granuloma annulare (GA) is a self-limited disorder that may present as localized or general. Localized GA, the most common form, presents as an erythematous annular plaque without scale. The generalized form of GA presents as widespread erythematous papules and plaques over the trunk and extremities. A cross-sectional study in the United States found a female to male prevalence ratio of 3:1 with a higher prevalence in the fifth decade of life.1 The etiology of GA is largely unknown; however, a number of potential inciting factors have been reported including viral infections, drug exposure, trauma, and insect bites.
 Castleman’s Disease is a rare heterogenous lymphoproliferative disorder that encompasses a spectrum of clinicopathologic manifestations. Unicentric disease affects one lymph node or chain of lymph nodes with primarily hyaline vascular changes. The multicentric form affects multiple chains of lymph nodes with primarily plasmacytic changes. The pathogenesis is related to hypercytokinemia due to dysregulated interleukin-6 (IL-6) activity in unicentric disease and dysregulated IL-6 and human herpes virus-8 in multicentric disease.
 We report a case of concomitant granuloma annulare and Castleman’s Disease.

Statistics of remote regions of networks

We delve into the statistical properties of regions within complex networks that are distant from vertices with high centralities, such as hubs or highly connected clusters. These remote regions play a pivotal role in shaping the asymptotic behaviours of various spreading processes and the features of associated spectra. We investigate the probability distribution P≥m(s) of the number s of vertices located at distance m or beyond from a randomly chosen vertex in an undirected network. Earlier, this distribution and its large m asymptotics 1/s2 were obtained theoretically for undirected uncorrelated networks (Dorogovtsev et al., 2003). Employing numerical simulations and analysing empirical data, we explore a wide range of real undirected networks and their models, including trees and loopy networks, and reveal that the inverse square law is valid even for networks with strong correlations. We observe this law in the networks demonstrating the small-world effect and containing vertices with degree 1 (so-called leaves or dead ends). We find the specific classes of networks for which this law is not valid. Such networks include the finite-dimensional networks and the networks embedded in finite-dimensional spaces. We notice that long chains of nodes in networks reduce the range of m for which the inverse square law can be spotted. Interestingly, we detect such long chains in the remote regions of the undirected projection of a large Web domain.

Intelligent monitoring and diagnosis of telescope image quality

ABSTRACT The imaging quality of a telescope directly affects the reliability of astronomical research. Through the monitoring and diagnosis of imaging quality, the cause of the deterioration of imaging quality can be found in time, which is essential for ensuring the peaking performance of the telescope and high-quality imaging. Moreover, these operations are complex and crucial for achieving high-quality imaging of future giant telescope systems involving active optics, adaptive optics, and other advanced techniques. We propose a three-component method based on cutting-edge artificial intelligence technology to real-time monitor and efficiently diagnose the telescope image quality. The first component, an image quality monitoring system, monitors and outputs the telescope’s image quality. The second component is a query system with a knowledge graph, which outputs the node chains as the possible cause of poor image quality based on the input. The third component, a final estimator, uses the node parameter, which contains historical fault data and real-time updated data from sensors, to give the probability of each node chain. We construct and test the system in the Large Sky Area Multi-Object Fiber Spectroscopy Telescope.

Wide Tangent Photon Field Versus Electron Field in the Treatment of Internal Mammary Lymph Nodes in Patients With Left Breast Cancer: A Decision-Making Flowchart

This study of internal mammary lymph node chain (IMC) irradiation in patients with left breast cancer aimed at comparing the merits of using, on one hand, a dedicated direct IMC electron field versus a wide tangent photon field covering both breast and IMC on the other. The objective was to produce guidelines allowing clinicians to readily determine the preferred method for each patient. For 19 patients with cancer of the left breast/chest wall, we produced 2 treatment plans each using a different technique: the electron technique using 2 standard opposed photon tangents covering only the breast or chest wall along with a matching adjacent electron field targeting the IMC only or the wide tangent technique using 2 opposed wide tangents covering simultaneously IMC and breast or chest wall. All plans were then optimized for acceptable target coverage. For patients where the left anterior descending coronary artery (LAD) was located outside of the wide tangent fields (13 patients), the wide tangent technique resulted in lower dose to the LAD, left lung, and heart. When the LAD was inside the wide tangents (6 patients), dose was lower with the electron technique for LAD and heart. In all cases, regardless of LAD location, the wide tangent technique returned strictly superior dose homogeneity but much higher right (contralateral) breast dose. A flowchart was produced based on LAD location that allows the clinician to readily determine the preferred technique for each patient without having to perform and compare 2 treatment plans, thus saving valuable planning time.

Subcapsular sinus macrophage infection after viral dissemination to distal lymph nodes maximizes germinal center responses

Abstract Neutralizing antibodies are a hallmark of protective humoral response against many viral infections. Microanatomical structures called germinal centers (GCs) within the secondary lymphoid organs are the sites where B cells get differentiated into high affinity antibody secreting, class switched and long-lasting plasma and memory B cells. Most studies of antigen movement leading to B cell activation have been performed using subcutaneous injection, mimicking the natural route of infection. Under this condition, virus infects sinusoidal lymph node macrophages which relay the antigen to B cells to drive the GC responses. However, not much is known about antigen movement during the generation of GCs in the non-draining (or distal lymph nodes) after systemic viral dissemination. Using ZIKV infection of mice, we have mapped virus dissemination through two separate lymph node chains. Surprisingly, GCs efficiently formed in distal LNs, although with delayed kinetics compared to those directly draining the infection site. Remarkably, virus in the blood alone was not sufficient to produce GCs. Instead, virus still reached the LNs through the lymphatics and infected LN sinusoidal macrophages. This coincided with virus-induced vascular permeability in the tissue. Thus, GC formation still proceeds through sinusoidal LN macrophages even when virus is spread through the blood. Our findings reveal a conserved mechanism for antiviral B cell development in LNs distal from the site of infection.

Simultaneous multicolor imaging of lymph node chains using hydroporphyrin-doped near-infrared-emitting polymer dots.

Aim: Evaluation of lymphatic drainage can be challenging to differentiate between separate drainage basins because only one 'color'is typically employed in sentinel node studies. This study aimed to test the feasibility of multicolor in vivo lymphangiography using newly developed organic polymer dots. Materials & methods: Biocompatible, purely organic, hydroporphyrin-doped near-infrared-emitting polymer dots were developed and evaluated for in vivo multicolor imaging in mouse lymph nodes. Results & conclusion: The authors demonstrated successful multicolor in vivo fluorescence lymphangiography using polymer dots, each tuned to a different emission spectrum. This allows minimally invasive visualization of at least four separate lymphatic drainage basins using fluorescent nanoparticles, which have the potential for clinical translation.

Internal Guidelines for Reducing Lymph Node Contour Variability in Total Marrow and Lymph Node Irradiation.

The total marrow and lymph node irradiation (TMLI) target includes the bones, spleen, and lymph node chains, with the latter being the most challenging structures to contour. We evaluated the impact of introducing internal contour guidelines to reduce the inter- and intraobserver lymph node delineation variability in TMLI treatments. A total of 10 patients were randomly selected from our database of 104 TMLI patients so as to evaluate the guidelines' efficacy. The lymph node clinical target volume (CTV_LN) was recontoured according to the guidelines (CTV_LN_GL_RO1) and compared to the historical guidelines (CTV_LN_Old). Both topological (i.e., Dice similarity coefficient (DSC)) and dosimetric (i.e., V95 (the volume receiving 95% of the prescription dose) metrics were calculated for all paired contours. The mean DSCs were 0.82 ± 0.09, 0.97 ± 0.01, and 0.98 ± 0.02, respectively, for CTV_LN_Old vs. CTV_LN_GL_RO1, and between the inter- and intraobserver contours following the guidelines. Correspondingly, the mean CTV_LN-V95 dose differences were 4.8 ± 4.7%, 0.03 ± 0.5%, and 0.1 ± 0.1%. The guidelines reduced the CTV_LN contour variability. The high target coverage agreement revealed that historical CTV-to-planning-target-volume margins were safe, even if a relatively low DSC was observed.

Particulate matter resuspension from simulated urban green floors using a wind tunnel-mounted closed chamber.

Green areas are thought to reduce particulate matter (PM) concentrations in urban environments. Plants are the key to PM reduction via various mechanisms, although most mechanisms do not lead to the complete removal of PM. Ultimately, PM falls into the soil via wind and rainfall. However, the fallen PM can re-entrain the atmosphere, which can affect plants capacity to reduce PM. In this study, we simulated an urban green floor and measured the resuspension of PM from the surface using a new experimental system, a wind tunnel-mounted closed chamber. The developed system is capable of quantifying the resuspension rate at the millimeter scale, which is measured by using the 1 mm node chain. This is adequate for simulating in situ green floors, including fallen branches and leaves. This addressed limitations from previous studies which focused on micrometer-scale surfaces. In this study, the surfaces consisted of three types: bare sand soil, broadleaves, and coniferous leaves. The resuspended PM was measured using a light-scattering dust detector. The resuspension rate was highest of 14.45×10-4 s-1 on broad-leaved surfaces and lowest on coniferous surfaces of 5.35×10-4 s-1 (p<0.05) and was not proportional to the millimeter-scale surface roughness measured by the roller chain method. This might be due to the lower roughness density of the broad-leaved surface, which can cause more turbulence for PM resuspension. Moreover, the size distribution of the resuspended PM indicated that the particles tended to agglomerate at 2.5 µm after resuspension. Our findings suggest that the management of fallen leaves on the urban green floor is important in controlling PM concentrations and that the coniferous floor is more effective than the broadleaved floor in reducing PM resuspension. Future studies using the new system can be expanded to derive PM management strategies by diversifying the PM types, surfaces, and atmospheric conditions.

Benign Intranodal Thyroid Tissue Similar to Nodal Metastasis of Thyroid Papillary Carcinoma: A Rare Case Report.

In patients with thyroid nodules, if the cervical lymph nodes gradually enlarge, a histological confirmation is required to rule out malignancy. Here is a case of benign intranodal thyroid tissue with cystic changes resembling lymph node metastasis of a papillary thyroid carcinoma. A 47-year-old man received ethanol sclerotherapy because of repeated enlargement of the thyroid gland 2 years prior to presentation. Subsequently, the patient underwent abscess removal from the deep neck and partial lobectomy of the attached left thyroid gland. Two months before the visit, extensive cervical lymphadenopathy was detected on ultrasonography (US) and computed tomography (CT). Total thyroidectomy and cervical lymph node dissection were performed to differentiate between metastatic papillary carcinoma of the thyroid gland and benign thyroid inclusions. Microscopic examination revealed multiple variable-sized nodules of benign thyroid follicles with cystic changes in both thyroid glands and bilateral cervical lymph nodes. An occult papillary microcarcinoma strongly positive for HBME-1 was also observed in the left thyroid lobe. However, the benign intranodal thyroid tissue was negative in both the real-time PCR-based BRAF V600E mutation test and HBME-1 immunohistochemical stain. Similarly, benign intranodal thyroid tissue can be enlarged by multiple cystic changes in a large number of lymph nodes along the neck node chain. For the differentiation of metastatic thyroid papillary carcinoma, real-time PCR-based BRAF V600E mutation test and HBME-1 immunohistochemical staining in addition to histological examination are helpful.