Nodal Volume Research Articles

TransAnaNet: Transformer-based anatomy change prediction network for head and neck cancer radiotherapy.

Adaptive radiotherapy (ART) can compensate for the dosimetric impact of anatomic change during radiotherapy of head-neck cancer (HNC) patients. However, implementing ART universally poses challenges in clinical workflow and resource allocation, given the variability in patient response and the constraints of available resources. Therefore, the prediction of anatomical change during radiotherapy for HNC patients is of importance to optimize patient clinical benefit and treatment resources. Current studies focus on developing binary ART eligibility classification models to identify patients who would experience significant anatomical change, but these models lack the ability to present the complex patterns and variations in anatomical changes over time. Vision Transformers (ViTs) represent a recent advancement in neural network architectures, utilizing self-attention mechanisms to process image data. Unlike traditional Convolutional Neural Networks (CNNs), ViTs can capture global contextual information more effectively, making them well-suited for image analysis and image generation tasks that involve complex patterns and structures, such as predicting anatomical changes in medical imaging. The purpose of this study is to assess the feasibility of using a ViT-based neural network to predict radiotherapy-induced anatomic change of HNC patients. We retrospectively included 121 HNC patients treated with definitive chemoradiotherapy (CRT) or radiation alone. We collected the planning computed tomography image (pCT), planned dose, cone beam computed tomography images (CBCTs) acquired at the initial treatment (CBCT01) and Fraction 21 (CBCT21), and primary tumor volume (GTVp) and involved nodal volume (GTVn) delineated on both pCT and CBCTs of each patient for model construction and evaluation. A UNet-style Swin-Transformer-based ViT network was designed to learn the spatial correspondence and contextual information from embedded image patches of CT, dose, CBCT01, GTVp, and GTVn. The deformation vector field between CBCT01 and CBCT21 was estimated by the model as the prediction of anatomic change, and deformed CBCT01 was used as the prediction of CBCT21. We also generated binary masks of GTVp, GTVn, and patient body for volumetric change evaluation. We used data from 101 patients for training and validation, and the remaining 20 patients for testing. Image and volumetric similarity metrics including mean square error (MSE), peak signal-to-noise ratio (PSNR), structural similarity index (SSIM), Dice coefficient, and average surface distance were used to measure the similarity between the target image and predicted CBCT. Anatomy change prediction performance of the proposed model was compared to a CNN-based prediction model and a traditional ViT-based prediction model. The predicted image from the proposed method yielded the best similarity to the real image (CBCT21) over pCT, CBCT01, and predicted CBCTs from other comparison models. The average MSE, PSNR, and SSIM between the normalized predicted CBCT and CBCT21 are 0.009, 20.266, and 0.933, while the average Dice coefficient between body mask, GTVp mask, and GTVn mask is 0.972, 0.792, and 0.821, respectively. The proposed method showed promising performance for predicting radiotherapy-induced anatomic change, which has the potential to assist in the decision-making of HNC ART.

Longitudinal assessment of diffusion-weighted imaging during magnetic resonance-guided radiotherapy in head and neck cancer

BackgroundFor radiotherapy of head and neck cancer (HNC) magnetic resonance imaging (MRI) plays a pivotal role due to its high soft tissue contrast. Moreover, it offers the potential to acquire functional information through diffusion weighted imaging (DWI) with the potential to personalize treatment. The aim of this study was to acquire repetitive DWI during the course of online adaptive radiotherapy on an 1.5 T MR-linear accelerator (MR-Linac) for HNC patients and to investigate temporal changes of apparent diffusion coefficient (ADC) values of the tumor and subvolume levels.Methods27 patients treated with curative RT on the 1.5 T MR-Linac with at least weekly DWI in treatment position were included into this prospective analysis and divided in four risk groups (HPV-status and localisation). Tumor and lymph node volumes (GTV-P/GTV-N) were delineated on b = 500 s/mm2 images while ADC maps were calculated using b = 150/200 and 500 s/mm2 images. Absolute and relative temporal changes of mean ADC values, tumor volumes and a high-risk subvolume (HRS) defined by low ADC tumor voxels (600 < ADC < 900 × 10−6 mm2/s) were analyzed. Relative changes of mean ADC values, tumor volumes and HRS were statistically tested using Wilcoxon-signed-rank test.ResultsMedian pretreatment ADC value for all patients resulted in 1167 × 10−6 mm2/s for GTV-P and 1002 × 10−6 mm2/s for GTV-N while absolute pretreatment tumor volume yielded 9.1 cm3 for GTV-P and 6.0 cm3 for GTV-N, respectively. Pretreatment HRS volumes were 1.5 cm3 for GTV-P and 1.3 cm3 for GTV-P and GTV-N. Median ADC values increase during 35 fractions of RT was 49% for GTV-P and 24% for GTV-N during RT. Median tumor volume decrease was 68% and 52% for GTV-P and GTV-N with a median HRS decrease of 93% and 87%. Significant differences from 0 for mean ADC were observed starting from week 1, for tumor volumes from week 2 for GTV-P and week 1 for GTV-N and for HRS in week 1 for GTV-P and week 2 for GTV-N.ConclusionLongitudinal DWI acquisition in HNC is feasible on a MR-Linac during the course of online adaptive MR-guided radiotherapy. Changes in ADC and volumes can be assessed, but future work needs to explore the potential for biologically guided treatment individualization.Trial registration: NCT04172753, actual study start: 09.05.2018.

Long-Term Outcome in Cervical Lymph Node-Positive Nasopharyngeal Carcinoma Following Intensity Modulated Radiation Therapy With One-Step Cervical Nodal Clinical Target Volume Delineation by Geometric-Anatomic Expansion From Nodal Gross Target Volume: A Double-Center Experience.

To report long-term results of patients with cervical node-positive (CLN+) nasopharyngeal carcinoma (NPC) treated with intensity modulated radiation therapy with one-step nodal clinical target volume (CTVn) delineation by geometric-anatomic expansion from the nodal gross target volume (GTVn). Patients with CLN+ NPC treated with the same one-step-CTVn delineation in two Chinese academic centers were pooled for this study. GTVn was prescribed to 70 Gy equivalent, CTVn1 was omitted, CTVn2 was prescribed to 45 to 55 Gy equivalent, and defined as GTVn + 3 mm geometric expansion (5 mm if radiological extranodal extension-positive [rENE+]) + elective nodal regions defined by anatomic boundary of cervical nodal levels. Regional control (RC) and overall survival (OS) were analyzed. Fifteen randomly selected cases were recontoured for CTVn according to the 2018 International Guidelines (2018-IG). Dose/volume was compared between the two clinical target volume delineation methods. A total of 807 patients were included (center 1, n = 459; center 2, n = 348). Five-year RC and OS were 95.8% and 86.2%, respectively. Thirty-four patients developed regional failure, and 13/34 (38%) were outside CTVn2: level VIII (parotid node) (9/13), Ib (4/13), and IV (2/13). Seven out of these 9 level VIII failures had pre-existing "equivocal" nodes. All 4 level 1b failures had "equivocal" nodes with very advanced rENE or large (>5 cm) nodal mass in level II. Compared with the 2018-IG, our strategy resulted in significant reduction in nodal volumes received therapeutic (V70) (mean, 100.7 vs. 27.5 cc; P < .001) and prophylactic (V45) (mean, 343.5 vs. 261.2 cc; P < .001) doses and further dose reduction in surrounding organs at risks. Our one-step-CTVn delineation by geometric-anatomic expansion from GTVn appears to be a safe and efficient approach in CLN+ NPC, with excellent RC and potential dosimetric benefits in selected patients. Caution is needed for parotid sparing in patients with pre-existing "equivocal" nodes or level Ib sparing in cases with advanced rENE or large (>5 cm) nodal mass in level II.

Defining Optimal Nodal Dose for Stage IIIC Cervical Cancer: An Institutional Audit of Patients Treated with Simultaneous Integrated Nodal Boost

ObjectiveTo assess radiation dose-response relationship for individual lymph nodes in patients with stage IIIC cervical cancer who are treated with simultaneous integrated boost (SIB).MethodsThis is a retrospective study in which patients with stage IIIC cervical cancer treated with (chemo)radiation who received simultaneous integrated nodal boost (SIB) and brachytherapy were evaluated with the primary aim of determining in-field nodal control. Secondary aims included estimation of local control (LC), disease free survival (DFS) and adverse events. Univariate analysis and multivariate analysis was performed for factors impacting nodal control, LC and DFS.ResultsOne hundred and fifty-one (151) nodes in 65 patients were included. The median number of lymph nodes and nodal volume was 2 (1–6) and 3.4 cc (1.8–6.8 cc) respectively. Median SIB dose was 55Gy/25# (53.7–55.0 Gy). At a median follow-up of 43 months the in-field nodal control was 99.3% (1/151). The 5-year LC, DFS and regional nodal control was 88.7, 66 and 85.6% respectively. The 5-year DFS for FIGO stage IIIC1 was 67.7% versus 43.5% for stage IIIC2 (p = 0.03) and lymph node volume >3cc was associated with reduced 5-year DFS (80.8% vs. 55%, p = 0.03) on univariate analysis. No factor was statistically significant on multivariate analysis. A vast majority of lymph node recurrences were observed in elective nodal regions outside the true pelvis that received lower contribution from brachytherapy.ConclusionNodal SIB doses of up to 55Gy/25#/ 5 weeks administered during chemoradiation are associated with 99.3% 5-year infield nodal control. A vast majority of nodal recurrences were observed in elective volumes that received a lower contribution from brachytherapy.

Management of unilateral neck irradiation in elderly patients with head and neck cancer: Which place for hypofractionation? A single-centre experience of 43 patients

Purpose of the studyThe purpose of the study was to evaluate retrospectively the acute toxicity and efficacy in terms of locoregional control of a cervical lymph node irradiation using a hypofractionated regimen in frail elderly patients. Material and methodsPatients receiving unilateral hypofractionated cervical lymph node irradiation at the Institut de cancérologie de Lorraine (France) were retrospectively included. The treatment regimen consisted of delivering 54Gy in 18 fractions to the high-risk tumour or lymph node volume and 45Gy to the prophylactic volume using the technique of simultaneous integrated-boost without concomitant systemic treatment. Toxicity data according to the Common Terminology Criteria for Adverse Events version 4 and survival data were collected. ResultsForty-three patients were treated between January 2013 and July 2021. The median age was 83 years (range: 78–86.5 years), 32 patients (74.4 %) were male and 25.6 % had WHO status ≥ 2. Histological types were cutaneous squamous cell carcinoma (39 patients), salivary gland carcinoma (three patients) and Merkel cell carcinoma (one patient). The mean duration of treatment was 27 days. Seventeen patients (39.5 %) received radiotherapy alone. Acute toxicity events of grade ≥ 2 at the end of radiotherapy in the 43 patients were described as follows: 58.1 % radiodermatitis (25 patients), 24.6 % mucositis (11 patients), and 18.1 % xerostomia (eight patients). Seven patients (16.3 %) experienced grade ≥ 2 odynodysphagia, with four patients (9.3 %) requiring enteral nutrition. No grade 3 toxicity events were reported at 3 months, 6 months or 1 year. After a median follow-up of 9.2 months (range: 6–18.5 months), 11 patients (25.6 %) of those treated by exclusive irradiation had a complete locoregional response as assessed by CT-scan 3 months. At 6 months, two of 20 patients retained grade 2 xerostomia and only four of 20 patients reported residual grade 1 pain. ConclusionModerately hypofractionated unilateral cervical lymph node radiotherapy appears to be well tolerated in frail elderly patients with an acceptable locoregional control rate, potentially providing an alternative to palliative strategies.

Effectiveness of minimally invasive methods (laser-induced interstitial thermotherapy and percutaneous ethanol sclerotherapy) in the treatment of Plummer’s disease

Background. The purpose of the study was to investigate the effectiveness of minimally invasive methods, such as laser-induced interstitial thermotherapy (LITT) and its combination with percutaneous ethanol ablation (PEA), in treating toxic thyroid adenomas. To determine the multiplicity of the LITT procedure and parameters of laser radiation to achieve a stable positive therapeutic effect. Materials and methods. Between 2020 and 2024, 24 patients with Plummer's disease who did not receive previous thyrostatic therapy before the LITT session were treated and were divided into 2 groups. Patients of the first group with a predominantly parenchymal structure of the node received LITT monotherapy (16 patients), patients of the second group with an existing cystic component received percutaneous ethanol sclerotherapy followed by LITT (8 patients). Patients underwent ultrasound and hormonal follow-up after laser ablation at 2, 4, and 6 months. Study endpoints: percent nodal volume reduction compared to pretreatment volume (VRR), thyroid-stimulating hormone (TSH), free thyroxine, free triiodthyronine, TSH-receptor antibodies. Results. All patients had a positive result of treatment. The average nodal volume reduction ratio (VRR) for patients in the first group was 88.3 ± 7.9 % (min — 71.5, max — 95.4), and for patients in the second group — 72 % (min — 59.5, max — 85.4). The percen­tage of patients in whom the euthyroid status was recorded after the first session ranged from 100 % for nodes of smaller volume (up to 4 cm3) to 63 % for nodes of maximum volume (up to 13 cm3). After the completed treatment (the maximum number of LITT sessions — 4), all patients had a stable euthyroid status. The effective specific ener­gy for solid nodules is ≈ 900 J/ml, for mixed cystic-parenchymal nodules the specific energy is lower and ≈ 790 J/ml (for the volume of the nodule after PEA). Complications: one case of bleeding was recorded, and a moderate pain syndrome: 6 points on the Visual Analog scale. Conclusions. Laser thermal ablation of toxic thyroid adenomas under ultrasound guidance offers an additional safe and effective minimally invasive treatment option. Reduction of solid thyroid nodules is effective over time if the specific energy exceeds 900 J/ml (for the primary nodule volume). The reduction of mixed cystic-parenchymal nodules is effective under the condition of the effectiveness of ethanol, the specific energy for such nodules is less than ≈ 790 J/ml (for the volume of the nodule after PEA). The total energy for the course of treatment should not be less than the calculated (Е∑ ≈ Espec × Vnode). Clinical outcomes are significantly more favorable in small toxic adenomas than in large nodes

Lymph nodal volume in head and neck malignancy: can adding a third dimension improve the detection of nodal metastasis?

BackgroundTo compare the diagnostic utility of computed tomography (CT) and ultrasonography (USG) for preoperative determination of metastatic lymph nodes.MethodsHead and neck squamous cell carcinoma (HNSCC) cases planned for neck dissection were included. All underwent preoperative neck USG and CT followed by histopathological evaluation after surgery. Sensitivity, specificity, positive and negative predictive value along with accuracy was calculated for each outcome variable. Efficacy was calculated by comparing these to postoperative histopathology. Both imaging modalities were compared with lymph nodal volume.ResultsEighty-seven lymph nodes were selected from 30 patients. Median volume on CT was 5412.15 mm3 for metastatic and 237.7 mm3 for benign nodes and on ultrasound, 4168.92 mm3 for metastatic and 233.1 mm3 for benign nodes (p < 0.001). Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for volume on USG were 81.8%, 98.7%, 96.6%, 90%, and 97.4% and on CT were 81.8%, 100%, 97.7%, 100%, and 97.4% respectively.ConclusionsLymph nodal volume had higher sensitivity and specificity for detection of metastatic cervical lymphadenopathy and individually or in combination should be included as one of the criteria in preoperative assessment of HNSCC.

Computed tomography-based radiomics nomogram for prediction of lympho-vascular and perineural invasion in esophageal squamous cell cancer patients: a retrospective cohort study

PurposeLympho-vascular invasion (LVI) and perineural invasion (PNI) have been established as prognostic factors in various types of cancers. The preoperative prediction of LVI and PNI has the potential to guide personalized medicine strategies for patients with esophageal squamous cell cancer (ESCC). This study investigates whether radiomics features derived from preoperative contrast-enhanced CT could predict LVI and PNI in ESCC patients.Methods and materialsA retrospective cohort of 544 ESCC patients who underwent esophagectomy were included in this study. Preoperative contrast-enhanced CT images, pathological results of PNI and LVI, and clinical characteristics were collected. For each patient, the gross tumor volume (GTV-T) and lymph nodes volume (GTV-N) were delineated and four categories of radiomics features (first-order, shape, textural and wavelet) were extracted from GTV-T and GTV-N. The Mann–Whitney U test was used to select significant features associated with LVI and PNI in turn. Subsequently, radiomics signatures for LVI and PNI were constructed using LASSO regression with ten-fold cross-validation. Significant clinical characteristics were combined with radiomics signature to develop two nomogram models for predicting LVI and PNI, respectively. The area under the curve (AUC) and calibration curve were used to evaluate the predictive performance of the models.ResultsThe radiomics signature for LVI prediction consisted of 28 features, while the PNI radiomics signature comprised 14 features. The AUCs of the LVI radiomics signature were 0.77 and 0.74 in the training and validation groups, respectively, while the AUCs of the PNI radiomics signature were 0.69 and 0.68 in the training and validation groups. The nomograms incorporating radiomics signatures and significant clinical characteristics such as age, gender, thrombin time and D-Dimer showed improved predictive performance for both LVI (AUC: 0.82 and 0.80 in the training and validation group) and PNI (AUC: 0.75 and 0.72 in the training and validation groups) compared to the radiomics signature alone.ConclusionThe radiomics features extracted from preoperative contrast-enhanced CT of gross tumor and lymph nodes have demonstrated their potential in predicting LVI and PNI in ESCC patients. Furthermore, the incorporation of clinical characteristics has shown additional value, resulting in improved predictive performance.

Development and comprehensive evaluation of a national DBCG consensus-based auto-segmentation model for lymph node levels in breast cancer radiotherapy

Background and purposeThis study aimed at training and validating a multi-institutional deep learning (DL) auto segmentation model for nodal clinical target volume (CTVn) in high-risk breast cancer (BC) patients with both training and validation dataset created with multi-institutional participation, with the overall aim of national clinical implementation in Denmark. Materials and methodsA gold standard (GS) dataset and a high-quality training dataset were created by 21 BC delineation experts from all radiotherapy centres in Denmark. The delineations were created according to ESTRO consensus delineation guidelines. Four models were trained: One per laterality and extension of CTVn internal mammary nodes. The DL models were tested quantitatively in their own test-set and in relation to interobserver variation (IOV) in the GS dataset with geometrical metrics, such as the Dice Similarity Coefficient (DSC). A blinded qualitative evaluation was conducted with a national board, presented to both DL and manual delineations. ResultsA median DSC > 0.7 was found for all, except the CTVn interpectoral node in one of the models. In the qualitative evaluation ‘no corrections needed’ were acquired for 297 (36 %) in the DL structures and 286 (34 %) for manual delineations. A higher rate of ‘major corrections’ and ‘easier to start from scratch’ was found in the manual delineations. The models performed within the IOV of an expert group, with two exceptions. ConclusionDL models were developed on a national consensus cohort and performed on par with the IOV between BC experts and had a comparable or higher clinical acceptance than expert manual delineations.

Vulvar Paget’s Disease with Inguinal Lymph Node Metastasis: A Case Report

Vulvar Paget's disease is a clinical condition with an invariable course affecting women of advanced age, and is associated with a significant rate of recurrence and dissemination, especially in its invasive form, which has a high metastatic potential. Here we present details of a unique case involving a 77-year-old woman with a history of disease progression over more than a decade. She initially presented with an erythematous lesion in the vulvar region, which was later diagnosed as adenocarcinoma in situ. During follow-up, the affected area extended to the perineal and gluteal regions, indicating an invasive aspect of the tumor. Due to surgical oncology recommendations, tissue resection was not feasible. The pacient experienced a significant worsening of symptoms, including local peeling of the affected region, and a biopsy confirmed Paget's disease in the vulvar region. Subsequently, imaging tests indicated changes in the volume of the inguinal lymph nodes. The patient underwent lymphadenectomy for histological analysis and to prevent systemic dissemination. Indicators of lymph node metastasis, suggestive of a gynecological primary site, were observed. Our case provides valuable insights for pathologists to consider the differential diagnosis of vulvar lesions.

CORRELATION OF INGUINAL LYMPH NODE NUMBER AND VOLUME WITH LOWER EXTREMITY LYMPHEDEMA SEVERITY

There are very limited studies on the relationship of inguinal lymph node number and volume correlated with lower extremity lymphedema severity. In this IRB-approved retrospective study, patients who obtained an MRI for lower extremity lymphedema and who did not have lymph node resection or biopsy were identified. The MRI images were used to determine the number and volume of inguinal lymph nodes for each limb in addition to fat and fluid-based scoring using a validated grading system. Wilcoxon signed-rank tests were used to compare the greater-affected limbs with the lesser-affected limbs. The spearman- rank correlation was performed on a ‘per limb’ basis for MRI-based scoring and clinical parameters with ipsilateral lymph node number and volume and for differences between the limbs. A total of 32 patients were included. The greater-affected limb had higher MRI fluid scores (median (interquartile range) = 3 (3 - 3) vs. 0 (0 - 1), (p &amp;lt; 0.01) relative to the contralateral limb and had a median fat asymmetry score of 2 (1 - 3). On the per-limb analysis, lymph node number and volume inversely correlated with total MRI scores (ρ = -0.47, p &amp;lt; 0.01 for node number and volume). The difference of lymph node number and volume correlated with MRI score difference (node number: ρ = -0.66, p &amp;lt; 0.01; node volume: ρ = - 0.64, p &amp;lt; 0.01) and perometer difference (node number: ρ = -0.58, p &amp;lt; 0.01; node volume: ρ = - 0.59, p &amp;lt; 0.01). Inguinal lymph node number and volume inversely correlate with lower extremity edema presence and severity.

Microwave ablation for lymph node metastasis in thyroid cancer: the impact of lymph node diameter.

To explore the impact of lymph node diameter on the efficacy and safety of ultrasound-guided microwave ablation (MWA) in the treatment of cervical metastatic lymph nodes (CMLNs) from thyroid cancer. A total of 32 patients with 58 CMLNs from thyroid cancer underwent ultrasound-guided MWA and were included in the retrospective study. Patients were divided into three groups based on the mean largest diameter of the CMLNs: Group A (diameter ≤10mm), Group B (10mm < diameter ≤20mm), and Group C (diameter >20mm). The research involved comparing changes in cervical metastatic lymph nodes and serum thyroglobulin (sTg) levels, as well as the incidence of complications, before and after microwave ablation across three groups of patients. The technical success rate of this study was 100% (32/32), and they showed no major complications. Compared with measurements taken before MWA, the mean largest diameter and volume of CMLNs, as well as the sTg level, showed significant reductions (p <0.05) at the last follow-up in all three patient groups. Group A and B exhibited higher lymph node volume reduction rates and complete disappearance rates compared to Group C. However, the recurrence rate in the three groups were in the following order: Group C > Group B > Group A. The occurrence rate of mild complications was Group A > Group C > Group B. MWA is a safe and effective method for treating CMLNs, with advantages for localized nodes but limitations for larger ones. Careful consideration and personalized plans are advised, based on comprehensive evidence assessment.

POST-NATAL DEVELOPMENT OF PRESCAPULAR LYMPH NODE IN ONE-HUMPED CAMEL (Camelus dromedarius): A MORPHOMTRIC STUDY

The study aimed at forming a base line data on prescapular lymph node of one- humped camel (Camelus dromedarius) at post-natal stage of development and determination of the role of the lymph node in disease resistance of the animal species. A morphometric study was conducted on the prescapular lymph nodes of thirty camels (15 each from male and female) collected from Sokoto metropolitan abattoir over a period of three weeks at different post-natal ages. The approximate age of the camels was estimated using rostral dentition. The morphologic observations revealed that the lymph nodes were relatively large elongated, pinkish, palpable structures situated in the caudal and ventral part of the neck, cranial to the shoulder joint and between the superficial pectoral and the sternocephalic muscles. There is a progressive increase in length, width, weight and volume of the lymph nodes with advancement in age in both sexes. These biometrical variables are relatively higher in male than in female.

Immunological mechanism of Ermiao Powder improving inflammation in rats with collagen-induced arthritis through α7nAChR-JAK2/STAT3 pathway

This study investigated the immunological mechanisms of Ermiao powder in the treatment of rheumatoid arthritis rats through the alpha 7 nicotinic acetylcholine receptor(α7nAChR)-Janus kinases 2(JAK2)/signal transducer and activator of transcription 3(STAT3) signaling pathway. A total of 56 female Wistar rats were randomly divided into the normal group(HG, n=8), collagen-induced arthritis(CIA) model group(CM, n=8), vagotomy group(VA, n=8), sham group(SH, n=8), Ermiao Powder treatment model group(EM, n=8), Ermiao Powder treatment for vagotomy group(EV, n=8) and Ermiao Powder treatment for sham group(ES, n=8). Following the establishment of CIA models in all groups except the HG group, the rats underwent unilateral vagotomy and sham operation(only the vagus nerve was separated). Drug treatment was started 7 days after surgery and continued for 35 days. The body weight and joints of rats were recorded, the pathological changes of the spleen of rats were observed, the contents of interleukin-6(IL-6), interleukin-1β(IL-1β) and tumor necrosis factor-α(TNF-α) in serum were detected by enzyme-linked immunosorbent assay(ELISA), and the mRNA and protein expression of α7nAChR-JAK2/STAT3 pathway core genes in spleen were detected by qRT-PCR, Western blot and immunohistochemistry. RESULTS:: showed that CM group(compared with HG group) and VA group(compared with CM group and SH group) had significantly decreased body weight(P&lt;0.05, P&lt;0.01), increased arthritis score(P&lt;0.05, P&lt;0.01), swollen ankle joints with deformity, and increased and enlarged lymph nodes in the spleen. There were also notable increases in the serum levels of IL-6, IL-1β and TNF-α(P&lt;0.05, P&lt;0.01), and in the mRNA expressions of JAK2 and STAT3 in the spleen(P&lt;0.05, P&lt;0.01). The protein levels of phosphorylated JAK2(p-JAK2)/JAK2 and phospho-STAT3(p-STAT3)/STAT3 were significantly increased(P&lt;0.05, P&lt;0.01), and the number of JAK2, p-JAK2, STAT3 and p-STAT3 cells increased(P&lt;0.05, P&lt;0.01). EM group(compared with CM group) and ES group(compared with SH group) exhibited significantly increased body weight(P&lt;0.01), decreased arthritis scores(P&lt;0.05, P&lt;0.01), reduced swelling of ankle joint, and decreased number and volume of lymph nodes in the spleen. Furthermore, serum levels of IL-6, IL-1β, and TNF-α decreased(P&lt;0.05, P&lt;0.01), the mRNA expression of JAK2 and STAT3 in spleen decreased(P&lt;0.05, P&lt;0.01), the protein levels of p-JAK2/JAK2 and p-STAT3/STAT3 decreased(P&lt;0.05, P&lt;0.01), and the number of JAK2, p-JAK2, STAT3 and p-STAT3 cells decreased(P&lt;0.05, P&lt;0.01), whereas the mRNA and protein expressions of α7nAChR were significantly increased(P&lt;0.01). Compared with the VA group, there was no significant differences in weight gain and arthritis scores in the EV group. The number of lymph nodes in the spleen was not significantly reduced and the volume was still large, suggesting the inflammation was not significantly improved. The serum levels of IL-6, IL-1β and TNF-α were not significantly different, and there were no significant differences in α7nAChR, JAK2, and STAT3 mRNA expression in the spleen. The protein expression levels of p-JAK2/JAK2 and α7nAChR in spleen were lower(P&lt;0.05, P&lt;0.01), while p-STAT3/STAT3 protein expression was not significantly different. Besides, the two groups had no significant difference in the number of JAK2, p-JAK2, STAT3, and p-STAT3 cells. The results suggested that unilateral vagotomy promoted the increase of phosphorylated JAK2 and STAT3 expressions and exacerbated inflammation. In contrast, Ermiao Powder alleviated the inflammation in rheumatoid arthritis rats by activating the α7nAChR-mediated JAK2/STAT3 pathway through the vagus nerve, suggesting that the α7nAchR-JAK2/STAT3 pathway may be a potential target for the treatment of rheumatoid arthritis.

A high-throughput flowless microfluidic single and multi-solute concentration gradient generator: Design and parametric study.

Microfluidic concentration gradient generators (μ-CGGs) are critical in various biochemical assays, including cell migration, drug screening, and antimicrobial susceptibility testing. However, current μ-CGGs rely on integration with flow systems, limiting their scalability and widespread adoption owing to limited infrastructure and technical expertise. Hence, there is a need for flowless diffusional gradient generators capable of standalone operation, thereby improving throughput and usability. In this study, we model such a diffusional μ-CGG as an infinite source-sink system to capture two characteristic timescales: (i) gradient generation dictated by the diffusion timescale and (ii) stability determined by the rate of change in reservoir concentrations. Through finite-element simulations, we explored the influence of various geometric parameters such as the channel length, cross-sectional area, node and reservoir volumes, and the solute diffusivity on these timescales, along with experimental confirmation using fluorescent tracer diffusion. Our results show that while the gradient stability strongly depends on the reservoir volumes, diffusion length, and solute diffusion coefficient, they are independent of the node shape or the shape of the channel cross section. However, gradient profiles were found to be the strong functions of the diffusion length, solute diffusivity, and the geometric pattern of the microfluidic grid. Additionally, we showcased the versatility of the design by generating discrete gradient profiles and combinatorial gradients of two and three solutes, thus improving throughput in a wide range of on-chip biological assays. These findings underscore the potential of our microfluidic device as an easy-to-use, inexpensive, efficient, and high-throughput platform for various on-chip biological assays.

Dosimetric comparison of nodal clinical target volume for locally advanced non‑small cell lung cancer: Options for geometric expansion vs. lymph node stations.

The purpose of the present retrospective study was to evaluate whether dosimetric differences existed in nodal clinical target volume (CTV) using options for geometric expansion and lymph node (LN) stations based on the European Society for Radiotherapy and Oncology guideline for locally advanced non-small cell lung cancer (NSCLC). In the treatment planning computed tomographic images of 17 patients with cT4N2M0 NSCLC, nodal CTVs were contoured based on the guideline options of: i) Geometric expansion, with CTV including the nodal gross tumor volume plus 5 mm margin; and ii) LN stations, with CTV including the affected LN stations. Treatment planning of 60 Gy in 30 fractions was performed using volumetric modulated arc therapy; Dmean was the mean irradiated dose to the structure; and VnGy was the volume of the structure receiving ≥n Gy. Dose-volume parameters were compared between the two options. Consequently, the option of geometric expansion was associated with a significantly lower V60Gy and Dmean of the esophagus, V20Gy, V5Gy and Dmean of the lungs, and Dmean of the heart than the option of LN stations in all patients (P=0.017, P<0.001, P<0.001, P<0.001, P<0.001 and P=0.029, respectively). For the V20Gy of the lungs, the 8 patients (47%) with LN metastases in stations 2 or 3 had significantly larger differences in the values between the two options than the 9 patients (53%) without those metastases; the median values of the difference of V20Gy of the lungs between the two options were 2.8% (range, 0.2 to 9.6%) with LN metastases in stations 2 or 3 and 0.5% (range, -0.2 to 5.0%) without these metastases (P=0.027). In conclusion, using the option for geometric expansion might help reduce the V60Gy and Dmean of the esophagus, V20Gy, V5Gy and Dmean of the lungs, and Dmean of the heart in all patients, and the V20Gy of the lungs in patients with LN metastases in stations 2 or 3.

A 6-year single-center prospective follow-up study of the efficacy of radiofrequency ablation for thyroid nodules.

Radiofrequency ablation (RFA) is an alternative modality for thyroid nodules (TNs) and many studies have also confirmed its favorable efficacy and safety. The scope of RFA increases in clinical practice and the aim of our study was to evaluate the efficacy of RFA. We conducted a prospective study to evaluate the efficacy of RFA for thyroid nodules between January 2017 and December 2022 at our institution. We assessed the change in nodal volume, volume reduction ratio (VRR), technique effective (TE) rate, complete ablation (CA) rate, and nodal regrowth rate and time after RFA. We performed RFA for 1703 patients with TNs between January 2017 and December 2022, of which a total of 970 eligible patients were enrolled in the study. The preoperative volume of TNs was 6.23 ± 8.11ml, with 821 benign and 149 malignant nodules. The post-RFA TE and adjusted TE rate were 80% and 88.8%, respectively. CA was achieved in 145 (14.9%) patients with a mean time of 18.32± 12.98 months; nodal regrowth occurred in 15 (1.5%) patients with a mean time of 29.80 ± 12.47 months. TNs volume and VRR changed significantly at years 1 and 2 after RFA and stabilized after 5 years. A serious postoperative adverse event occurred in one patient with cervical sympathetic chain injury resulting in Horner's syndrome. A transient or permanent damage of the recurrent laryngeal nerve could not be evaluated due to the lack of postoperative laryngoscopy, and this is a significant limitation of the study. The expanded RFA indications were also effective for TNs, with no significant change in long-term efficacy.

Multi-modality imaging parameters that predict rapid tumor regression in head and neck radiotherapy

Background and purposeVolume regression during radiotherapy can indicate patient-specific treatment response. We aimed to identify pre-treatment multimodality imaging (MMI) metrics from positron emission tomography (PET), magnetic resonance imaging (MRI), and computed tomography (CT) that predict rapid tumor regression during radiotherapy in human papilloma virus (HPV) associated oropharyngeal carcinoma. Materials and methodsPre-treatment FDG PET-CT, diffusion-weighted MRI (DW-MRI), and intra-treatment (at 1, 2, and 3 weeks) MRI were acquired in 72 patients undergoing chemoradiation therapy for HPV+ oropharyngeal carcinoma. Nodal gross tumor volumes were delineated on longitudinal images to measure intra-treatment volume changes. Pre-treatment PET standardized uptake value (SUV), CT Hounsfield Unit (HU), and non-gaussian intravoxel incoherent motion DW-MRI metrics were computed and correlated with volume changes. Intercorrelations between MMI metrics were also assessed using network analysis. Validation was carried out on a separate cohort (N = 64) for FDG PET-CT. ResultsSignificant correlations with volume loss were observed for baseline FDG SUVmean (Spearman ρ = 0.46, p < 0.001), CT HUmean (ρ = 0.38, p = 0.001), and DW-MRI diffusion coefficient, Dmean (ρ = -0.39, p < 0.001). Network analysis revealed 41 intercorrelations between MMI and volume loss metrics, but SUVmean remained a statistically significant predictor of volume loss in multivariate linear regression (p = 0.01). Significant correlations were also observed for SUVmean in the validation cohort in both primary (ρ = 0.30, p = 0.02) and nodal (ρ = 0.31, p = 0.02) tumors. ConclusionsMultiple pre-treatment imaging metrics were correlated with rapid nodal gross tumor volume loss during radiotherapy. FDG-PET SUV in particular exhibited significant correlations with volume regression across the two cohorts and in multivariate analysis.

Physical networks as network-of-networks

Physical networks are made of nodes and links that are physical objects embedded in a geometric space. Understanding how the mutual volume exclusion between these elements affects the structure and function of physical networks calls for a suitable generalization of network theory. Here, we introduce a network-of-networks framework where we describe the shape of each extended physical node as a network embedded in space and these networks are bound together by physical links. Relying on this representation, we introduce a minimal model of network growth and we show for a general class of physical networks that volume exclusion induces heterogeneity in both node volume and degree, with the two becoming correlated. These emergent properties strongly affect the dynamics on physical networks: by calculating their Laplacian spectrum as a function of the coupling strength between the nodes we show that degree-volume correlations suppress the role of hubs as early spreaders in diffusive dynamics. We apply the network-of-networks framework to describe several real systems and find properties analog to the minimal model networks. The prevalence of these properties points towards general growth mechanisms that do not depend on the specifics of the systems.

Clinical value of nano-carbon lymphatic tracer for regional lymph node dissections of rectal cancer after neoadjuvant chemoradiotherapy.

Regional lymph node (LN) volume decreases after neoadjuvant therapy, requiring a tracer for more accurate detection. Nano-carbon tracer is a third-generation tracer with several advantages, but its use for LN detection after neoadjuvant chemoradiotherapy for middle and low rectal cancer remains unclear. Therefore, this study investigated the effects and safety of anoscope-guided subrectal injections of nano-carbon suspension in this patient population. This study retrospectively reviewed the medical records of 45 patients with middle and low rectal cancer admitted to our institution from March 2019 to March 2022. All patients received preoperative neoadjuvant chemotherapy and radiotherapy and were divided into nano-carbon injection (n=23; anoscope-guided injections of nano-carbon suspension in the rectal submucosa 2cm above the dentate line 24h preoperatively) and control (n=22; directly underwent surgery) groups. The LN detection and complication rates were compared between the groups. The total and mean numbers of LNs and small LNs and the number of patients with>12 LNs were significantly higher in the nano-carbon injection group than in the control group. The total number of positive LNs and LN metastasis did not differ between the groups, nor did the anastomotic leakage, bleeding, stenosis, and abscess occurrence rates. Anoscope-guided nano-carbon lymphatic tracing increased the LN detection rate, caused less trauma, and resulted in fewer postoperative complications than the direct surgical procedure. Thus, it is an effective, safe, and practical method that may improve dissections and the postoperative pathological staging accuracy.