Finding the optimal dose combination in two-agent dose-finding trials is challenging due to limited sample sizes and the extensive range of potential doses.Unlike traditional chemotherapy or radiotherapy,which primari...Finding the optimal dose combination in two-agent dose-finding trials is challenging due to limited sample sizes and the extensive range of potential doses.Unlike traditional chemotherapy or radiotherapy,which primarily focuses on identifying the maximum tolerated dose(MTD),therapies involving targeted and immune agents facilitate the identifica-tion of an optimal biological dose combination(OBDC)by simultaneously evaluating both toxicity and efficacy.Cur-rently,most approaches to determining the OBDC in the literature are model-based and require complex model fittings,making them cumbersome and challenging to implement.To address these challenges,we developed a novel model-as-sisted approach called uTPI-Comb.This approach refines the established utility-based toxicity probability interval design by integrating a strategically devised zone-based local and global candidate set searching strategy,which can effectively optimize the decision-making process for two-agent dose escalation or de-escalation in drug combination trials.Extensive simulation studies demonstrate that the uTPI-Comb design speeds up the dose-searching process and provides substantial improvements over existing model-based methods in determining the optimal biological dose combinations.展开更多
The purpose of this study was to grasp current potential problems of dose error in intensity-modulated proton therapy (IMPT) plans. We were interested in dose differences of the Varian Eclipse treatment planning syste...The purpose of this study was to grasp current potential problems of dose error in intensity-modulated proton therapy (IMPT) plans. We were interested in dose differences of the Varian Eclipse treatment planning system (TPS) and the fast dose calculation method (FDC) for single-field optimization (SFO) and multi-field optimization (MFO) IMPT plans. In addition, because some authors have reported dosimetric benefit of a proton arc therapy with ultimate multi-fields in recent years, we wanted to evaluate how the number of fields and beam angles affect the differences for IMPT plans. Therefore, for one brain cancer patient with a large heterogeneity, SFO and MFO IMPT plans with various multi-angle beams were planned by the TPS. Dose distributions for each IMPT plan were calculated by both the TPS’s conventional pencil beam algorithm and the FDC. The dosimetric parameters were compared between the two algorithms. The TPS overestimated 400 - 500 cGy (RBE) for minimum dose to the CTV relative to the dose calculated by the FDC. These differences indicate clinically relevant effect on clinical results. In addition, we observed that the maximum difference in dose calculated between the TPS and the FDC was about 900 cGy (RBE) for the right optic nerve, and this quantity also has a possibility to have a clinical effect. The major difference was not seen in calculations for SFO IMPT planning and those for MFO IMPT planning. Differences between the TPS and the FDC in SFO and MFO IMPT plans depend strongly on beam arrangement and the presence of a heterogeneous body. We advocate use of a Monte Carlo method in proton treatment planning to deliver the most precise proton dose in IMPT.展开更多
Objective This study aims to investigate the dosimetric differences among four planning methods of physical and biological optimization in hypofractionated radiation therapy for non-small cell lung cancer(NSCLC).Metho...Objective This study aims to investigate the dosimetric differences among four planning methods of physical and biological optimization in hypofractionated radiation therapy for non-small cell lung cancer(NSCLC).Methods Ten NSCLC patients receiving radiation therapy were chosen for this retrospective study.Volumetric modulated arc treatment plans for each patient were remade with dose-volume(DV)functions,biological-physical functions,and biological functions,using the same constraint parameters during optimization.The dosimetric differences between the four types of plans were calculated and analyzed.Results For the target,equivalent uniform dose(EUD)of the EUD and EUD+DV groups was approximately 2.8%–3.6%and 3.2%–3.7%higher than those of the DV and DV+EUD groups,respectively.The average tumor control probability(TCP)of the EUD and EUD+DV groups was also significantly higher than those of the other two groups(P<0.05).The difference in heterogeneity index(HI)among the four groups was also statistically significant(P<0.05),while the difference of conformity index(CI)was not significant(P>0.05).For the organs at risk,the differences of EUD,V5,V10,V20,V30 of normal lung tissues were not statistically significant(P>0.05);however,the mean lung dose of the EUD and EUD+DV groups was slightly lower than those of the other two groups.Conclusion The biological optimization method has obvious advantages of improving EUD and TCP of the target,while decreasing the exposed dose of normal lung.This result is meaningful in choosing plan optimization methods in routine work.展开更多
Background and Objective: Nowadays, Computer Tomography is one of the best radiological imaging technics which can give right diagnostic information, among the detection of multiphasic adenomas, the detection of cardi...Background and Objective: Nowadays, Computer Tomography is one of the best radiological imaging technics which can give right diagnostic information, among the detection of multiphasic adenomas, the detection of cardiac, cerebral and vascular abnormalities. Although these good qualities, this technic is too radiant for the patient. In this paper, we based on the irradiation doses delivered from the current protocols to find a practical method of their optimization during the pediatric cranial scan. Materials and Methods: This work relies on a collection of data from patients in the hospitals, so that analyze them, give the conclusions and, propose an optimal practical method to decrease the irradiation doses. To collect data, we performed a prospective study of seventeen months (from December 2017 to May 2019) carried out simultaneously in three hospitals of the city: The Centre Medical la Cathédrale (H1), the Yaoundé Central Hospital (H2) and the Yaoundé Gyneaco-Obstetric and pediatric hospital (H3). This study included a total of 192 cases of cerebral trauma, of which 11 cases excluded for incomplete information. The dosimetry quality control (CTDIvol) using the PMMA phantoms of 16 cm and 32 cm fulfilled. The scanographic parameters of the patient acquisition protocol were recorded and analyzed. Some of those parameters were modified and entered the CT with the help of a biomedical engineer to reduce the delivered dose. The relationship between CTDIvol and kV is statistically significant (p Results: Among patients, 172 are boys, and the remaining 9 are girls all were in the 0 to 15 age group. CTDIvol values varied from 34.2 mGy to 107.8 mGy and PDLs from 107.8 mGy.cm to 2214.5 mGy.cm in H1. In H2, CTDIvol varied from 5.8 mGy to 44 mGy and PDLs from 91.4 mGy.cm to 665.5 mGy.cm. CTDIvol varied between 9.34 mGy to 92.81 mGy and PDLs from 162.38 mGy.cm to 2713.67 mGy.cm in H3. All values are taken at 75th percentile, with or without contrast injection. Conclusion: The implementation of the optimization of protocols requires the display of the CT parameters to use and to respect during the traumatic brain tests. With displaying and respecting protocol, the CTDIvol decreased by almost 50 per cent.展开更多
In the present study, we aimed to investigate the optimal dosage regimens of piperacillin/tazobactam in patients with chronic kidney disease according to their different classes of renal function based on bacterial re...In the present study, we aimed to investigate the optimal dosage regimens of piperacillin/tazobactam in patients with chronic kidney disease according to their different classes of renal function based on bacterial resistance. A total of 2700 simulationswere applied based on a published population pharmacokinetic and pharmacodynamic model using nonlinear mixed effects modeling (NONMEM) software. Permissible optimal dosage regimens were defined as those associated with a less than 10% of patients whose probabilities of target attainment (PTA) were not attain target. For patients with mild to moderate renal injury, 4/0.5 g of piperacillin/tazobactam every 12 h in 30 min intermittent infusion could attain the target. If the MIC (minimum inhibitory concentration) for the pathogen was 8 mg/L or 16 mg/L, either an 8-h or 6-h dosing interval or extended 2–6 h infusion regimen had to be used to achieve the outcome of the therapy. Regarding MIC was up to above 32 mg/L, a high dose of piperacillin (12–24 g/d) in continuous infusion was the only approach that could achieve the effective target in patients with renal dysfunction. A low dose with extended 4–6 h infusion regimen was recommended for patients with severe renal injury. Our study identified permissible optimal piperacillin/tazobactam dosage regimens for patients with renal dysfunction with an MIC up to 64 mg/L. The findings of this study would be helpful for precise administration of piperacillin/tazobactam in clinical practice.展开更多
Aim: To prospectively evaluate the acute toxicity of 3D conformal radiotherapy with dose optimization in patients with carcinoma cervix. Materials and Methods: Carcinoma cervix patients stage IIB to IIIB (n = 30) trea...Aim: To prospectively evaluate the acute toxicity of 3D conformal radiotherapy with dose optimization in patients with carcinoma cervix. Materials and Methods: Carcinoma cervix patients stage IIB to IIIB (n = 30) treated during November 2011 to May 2013 at the institution with 3D conformal chemo-radiation were included in the study. They received weekly Cisplatin 40 mg/m<sup>2</sup> for a maximum of 5 cycles. They received 46 Gy/23 fractions, 5 fractions per week of external beam radiation. In these patients dose optimization was done in order to achieve a tumor maximum dose (D<sub>max</sub>) around 105%. Various techniques were used for dose optimization which included the use of sub fields, adjusting the weightages, using wedges and the use of mixed energies. EBRT (External Beam Radiotherapy) was followed by two fractions of high dose rate intracavitary brachytherapy of 9 Gy each. Acute RTOG toxicity was assessed weekly during EBRT and 1 week post EBRT. Results: The median age of the patients was 45 (range: 30 - 55 years). All the patients completed EBRT;63.3% of the patients received all 5 cycles of chemotherapy while 26.6% of the patients received 4 cycles of chemotherapy and 10% of the patients received 3 cycles of chemotherapy. The most predominant toxicity seen was GI toxicity, diarrhea being the most common GI toxicity followed by vomiting. Neutropenia was the most common hematological toxicity. Most patients had grade 0 and grade 1 toxicity. None of the patients had grade 4 toxicity while few had grade 2 and 3 toxicity. Conclusion: 3D conformal concurrent chemo radiotherapy with D<sub>max</sub>around 105% reduces acute RTOG toxicity particularly grade 3 and 4 and improves patient compliance for concurrent chemo-radiotherapy.展开更多
Children’s creative art curriculum is a professional course supported by art materials and techniques and facilitated through creative activities,aiming at cultivating students’ability to organize creative art activ...Children’s creative art curriculum is a professional course supported by art materials and techniques and facilitated through creative activities,aiming at cultivating students’ability to organize creative art activities using various art materials and techniques.In light of the evolving focus in China’s colleges and universities from“what to know”to“how to apply,”the pivotal question for educators is how to maximize the value of children’s creative art curriculum.Based on this,this article takes“Sanquan education”as the starting point,combines factual and theoretical arguments,and analyzes the teaching optimization path of children’s creative art curriculum under the perspective of Sanquan education,to improve the quality and efficiency of teaching.展开更多
Prescriptions for radiation therapy are given in terms of dose-volume constraints (DVCs). Solving the fluence map optimization (FMO) problem while satisfying DVCs often requires a tedious trial-and-error for selecting...Prescriptions for radiation therapy are given in terms of dose-volume constraints (DVCs). Solving the fluence map optimization (FMO) problem while satisfying DVCs often requires a tedious trial-and-error for selecting appropriate dose control parameters on various organs. In this paper, we propose an iterative approach to satisfy DVCs using a multi-objective linear programming (LP) model for solving beamlet intensities. This algorithm, starting from arbitrary initial parameter values, gradually updates the values through an iterative solution process toward optimal solution. This method finds appropriate parameter values through the trade-off between OAR sparing and target coverage to improve the solution. We compared the plan quality and the satisfaction of the DVCs by the proposed algorithm with two nonlinear approaches: a nonlinear FMO model solved by using the L-BFGS algorithm and another approach solved by a commercial treatment planning system (Eclipse 8.9). We retrospectively selected from our institutional database five patients with lung cancer and one patient with prostate cancer for this study. Numerical results show that our approach successfully improved target coverage to meet the DVCs, while trying to keep corresponding OAR DVCs satisfied. The LBFGS algorithm for solving the nonlinear FMO model successfully satisfied the DVCs in three out of five test cases. However, there is no recourse in the nonlinear FMO model for correcting unsatisfied DVCs other than manually changing some parameter values through trial and error to derive a solution that more closely meets the DVC requirements. The LP-based heuristic algorithm outperformed the current treatment planning system in terms of DVC satisfaction. A major strength of the LP-based heuristic approach is that it is not sensitive to the starting condition.展开更多
OBJECTIVE: To investigate the optimal dosage ratio of chlorogenic acid and gardenia glycosides in treating the rates with fatty liver disease induced by high-fat feed.METHODS: A rat model of non-alcoholic fatty liver ...OBJECTIVE: To investigate the optimal dosage ratio of chlorogenic acid and gardenia glycosides in treating the rates with fatty liver disease induced by high-fat feed.METHODS: A rat model of non-alcoholic fatty liver disease(NAFLD) was established by using a high-fat diet. According to mathematical model "uniform design", varying doses of chlorogenic acid and gardenia glycosides have been combined to form 6 medications for the treatment of NAFLD.Samples were then taken to observe pathological changes of the liver tissue(HE staining); changes in the fat metabolism pathway e.g. triglyceride(TG)and free fatty acid(FFA) content; alterations in liver function, i.e. serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST) activity; and differences in Malondialdehyde(MDA) and superoxide dismutase(SOD) content in the liver tissue. Multiple regression analysis was conducted to test the optimal dosage ratio of chlorogenic acid and gardenia glycosides.RESULTS: Fatty degeneration and vacuole-like changes of different degrees occurred in hepatic cells of the model group. Markers for fat metabolism, serum ALT and AST activities, and expression of MDA in liver tissue significantly increased, while SOD decreased. Combination of 90 mg chlorogenic acid and 90 mg Gardenia glycosides was the optimal dosage ratio of chlorogenic acid and gardenia glycosides in the treatment of rats with fatty liver induced by high-fat diet.CONCLUSION: Chlorogenic acid of 90 mg plus gardenia glycosides of 90 mg was the best combination in the treatment of fatty liver disease in rats induced by high-fat feed.展开更多
Objective:To investigate the value of application of low-dose and optimized length CT scan on puncture results,complications and patients’radiation dosage during CT-guided percutaneous biopsy of pulmonary nodules(PTN...Objective:To investigate the value of application of low-dose and optimized length CT scan on puncture results,complications and patients’radiation dosage during CT-guided percutaneous biopsy of pulmonary nodules(PTNB).Methods:A total of 231 patients with PTNB under CT guidance were collected.Low dose scanning utilized tube current of 20 mA as compared with 40 mA in conventional dosage.Optimized length in CT is defined as intentionally narrowing the range of CT scanning just to cover 25 mm(5 layers)around the target layer during needle adjustment.According to whether low-dose scans and optimized length scans techniques were utilized,patients were divided into three groups:conventional group(conventional sequence+no optimization),optimized length group(conventional sequence+optimized length),and low-dose optimized length group(low dose sequence+optimized length).The ED(effective dose),the DLP(dose length product),the average CTDIvol(Volume CT dose index),total milliampere second between subgroups were compared.Results:Compared with the conventional group,ED,intraoperative guidance DLP,total milliseconds and operation time in the optimized length group were reduced by 18.2%(P=0.01),37%(P=0.003),17.5%(P=0.013)and13.3%(P=0.021)respectively.Compared with the optimized length group,the ED was reduced by 87%,preoperative positioning,intraoperative guidance and postoperative review DLP were also reduced by 88%,total milliampere second was reduced by 79%,with an average CTDIvol was reduced by 86%,in the low-dose optimized length group(P<0.001 for all).Conclusion:Optimizing the length during CT scanning can effectively reduce the intraoperative radiation dose and reduce the operation time compared with conventional plan;low-dose and optimized length CT scan can further reduce the total radiation dose compared with optimized length group with no differences on intraoperative complications,biopsy results and operation time.展开更多
BACKGROUND With the improvement of economy and living standards,the attention paid to short stature in children has been increasingly highlighted.Numerous causes can lead to short stature in children,among which growt...BACKGROUND With the improvement of economy and living standards,the attention paid to short stature in children has been increasingly highlighted.Numerous causes can lead to short stature in children,among which growth hormone deficiency(GHD)is a significant factor.AIM To investigate the long-term efficacy and safety of different doses of long-acting polyethylene glycol recombinant human growth hormone(PEG-rhGH)in the treatment of GHD in children.METHODS We selected 44 pediatric patients diagnosed with GHD who were treated at Wuhu First People's Hospital from 2014 to 2018.Total 23 patients were administered a high dose of long-acting PEG-rhGH at 0.2 mg/kg subcutaneously each week,forming the high-dose group.Meanwhile,21 patients were given a lower dose of long-acting PEG-rhGH at 0.14 mg/kg subcutaneously each week,establishing the low-dose Group.The total treatment period was 2 years,during which we monitored the patients’height,annual growth velocity(GV),height standard deviation score(HtSDS),chronological age(CA),bone age(BA),and serum levels of insulin-like growth factor-1(IGF-1)and insulin-like growth factor-binding protein-3(IGFBP-3)before treatment and at 6 mo,1 year,and 2 years after treatment initiation.We also monitored thyroid function,fasting plasma glucose,fasting insulin,and other side effects.Furthermore,we calculated the homeostatic model assessment for insulin resistance.RESULTS After 1 year of treatment,the GV,HtSDS,IGF-1,BA,and IGFBP-3 in both groups significantly improved compared to the pre-treatment levels(P<0.05).Moreover,when comparing GV,HtSDS,IGF-1,BA,and IGFBP-3 between the two groups,there were no statistically significant differences either before or after the treatment(P>0.05).During the treatment intervals of 0-1.0 years and 1.0-2.0 years,both patient groups experienced a slowdown in GV and a decline in HtSDS improvement(P<0.05).CONCLUSION The use of PEG-rhGH in treating GHD patients was confirmed to be effective,with similar outcomes observed in both the high-dose group and low-dose groups,and no significant differences in the main side effects.展开更多
The plasma-derived reactive oxygen and nitrogen species(RONS)enable cold atmospheric plasma(CAP)to combat cancer and infectious wounds.Achieving therapeutic outcomes with CAP necessitates precise treatment doses.Curre...The plasma-derived reactive oxygen and nitrogen species(RONS)enable cold atmospheric plasma(CAP)to combat cancer and infectious wounds.Achieving therapeutic outcomes with CAP necessitates precise treatment doses.Current CAP devices are constrained by their capability of delivering a single dose to a single sample,limiting dose optimization.We propose a novel“one exposure,multiple-dose delivery”strategy by programming gas flows.This approach facilitates efficient screening of optimal CAP dose by distributing feed gas through boundary-conditioned transport channels to generate multiple,flux-varied gas streams,which ignite plasmas with diverse chemical compositions and dose gradients across samples.Our developed demonstration device,capable of administering three doses to sixteen samples,significantly reduces experimental complexity,particularly when handling large candidate doses or samples for treatment.Leveraging multiplexed treatment,we capably optimize the CAP dose to effectively eradicate the liver cancer cell line of Huh7 and bacteria of S.aureus within one exposure.Furthermore,we find manipulating gas flow velocities allows targeted generation of short-lived species.This approach disentangles the roles of short-lived and long-lived RONS in therapeutic applications,offering critical insights into their bio-functional mechanisms.The concept of multiplexed dose treatment with fluidic manipulation promises to catalyze the development of high-efficiency CAP devices and advance research in CAP-based therapies.展开更多
Cystic fibrosis(CF)is the most common autosomal recessive disease of the Caucasian population worldwide,with respiratory disease remaining the most relevant source of morbidity and mortality.Computed tomography(CT)is ...Cystic fibrosis(CF)is the most common autosomal recessive disease of the Caucasian population worldwide,with respiratory disease remaining the most relevant source of morbidity and mortality.Computed tomography(CT)is frequently used for monitoring disease complications and progression.Over the last fifteen years there has been a six-fold increase in the use of CT,which has lead to a growing concern in relation to cumulative radiation exposure.The challenge to the medical profession is to identify dose reduction strategies that meet acceptable image quality,but fulfil the requirements of a diagnostic quality CT.Dose-optimisation,particularly in CT,is essential as it reduces the chances of patients receiving cumulative radiation doses in excess of 100 m Sv,a dose deemed significant by the United Nations Scientific Committee on the Effects of Atomic Radiation.This review article explores the current trends in imaging in CF with particular emphasis on new developments in dose optimisation.展开更多
Purpose: Children are sometimes examined with Computed Tomography protocols designed for adults, leading to radiation doses higher than necessary. Lack of optimisation could lead to image quality higher than what is n...Purpose: Children are sometimes examined with Computed Tomography protocols designed for adults, leading to radiation doses higher than necessary. Lack of optimisation could lead to image quality higher than what is needed for diagnostic purposes with associated high doses to patients. Optimising the protocols for paediatric head trauma CT imaging will reduce radiation dose. Objective: The study aimed to optimise radiation dose and assess the image quality for a set of protocols by evaluating noise, a contrast to noise ratio, modulation transfer function and noise power spectrum. Methods: Somaton Sensation 64 was used to scan the head of an anthropomorphic phantom with a set of protocols. ImageJ software was used to analyse the paediatric head image from the scanner. IMPACTSCAN dosimeter software was used to evaluate the radiation dose to the various organs in the head. MATLAB was used to analyse the Modulation Transfer Function and the Noise Power. Results: The estimated Computed Tomography Dose Index volume (CTDI<sub>vol</sub>) increased with increasing tube current and tube voltage. The high pitch of 0.9 gave a lower dose than the 0.5 pitch. The eye lens received the highest radiation dose (39.2 mGy) whiles the thyroid received the least radiation dose (13.7 mGy). There was an increase in noise (62.46) when the H60 kernel was used and a lower noise (8.829) was noticed when the H30 kernel was used. Conclusion: The results obtained show that the H30 kernel (smooth kernel) gave higher values for noise and contrast to noise ratio (CNR) than the H60 kernel (sharp kernel). The H60 kernel produced high values for the modulation transfer function (MTF) and noise power spectrum (NPS). The eye lens received the highest radiation dose.展开更多
Intensity-modulated particle therapy(IMPT)with carbon ions is comparatively susceptible to various uncertainties caused by breathing motion,including range,setup,and target positioning uncertainties.To determine relat...Intensity-modulated particle therapy(IMPT)with carbon ions is comparatively susceptible to various uncertainties caused by breathing motion,including range,setup,and target positioning uncertainties.To determine relative biological effectiveness-weighted dose(RWD)distributions that are resilient to these uncertainties,the reference phase-based four-dimensional(4D)robust optimization(RP-4DRO)and each phase-based 4D robust optimization(EP-4DRO)method in carbon-ion IMPT treatment planning were evaluated and compared.Based on RWD distributions,4DRO methods were compared with 4D conventional optimization using planning target volume(PTV)margins(PTV-based optimization)to assess the effectiveness of the robust optimization methods.Carbon-ion IMPT treatment planning was conducted in a cohort of five lung cancer patients.The results indicated that the EP-4DRO method provided better robustness(P=0.080)and improved plan quality(P=0.225)for the clinical target volume(CTV)in the individual respiratory phase when compared with the PTV-based optimization.Compared with the PTV-based optimization,the RP-4DRO method ensured the robustness(P=0.022)of the dose distributions in the reference breathing phase,albeit with a slight sacrifice of the target coverage(P=0.450).Both 4DRO methods successfully maintained the doses delivered to the organs at risk(OARs)below tolerable levels,which were lower than the doses in the PTV-based optimization(P<0.05).Furthermore,the RP-4DRO method exhibited significantly superior performance when compared with the EP-4DRO method in enhancing overall OAR sparing in either the individual respiratory phase or reference respiratory phase(P<0.05).In general,both 4DRO methods outperformed the PTV-based optimization in terms of OAR sparing and robustness.展开更多
Radiation therapy plans are optimized as a single treatment plan, but delivered over 30 - 50 treatment sessions (known as fractions). This paper proposes a new mixed-integer linear programming model to simultaneously ...Radiation therapy plans are optimized as a single treatment plan, but delivered over 30 - 50 treatment sessions (known as fractions). This paper proposes a new mixed-integer linear programming model to simultaneously incorporate fractionation and cumulative constraints in Intensity Modulated Radiation Therapy (IMRT) planning optimization used in cancer treatment. The method is compared against a standard practice of posing only cumulative limits in the optimization. In a prostate case, incorporating both forms of limits into planning converted an undeliverable plan obtained by considering only the cumulative limits into a deliverable one within 3% of the value obtained by ignoring the fraction size limits. A two-phase boosting strategy is studied as well, where the first phase aims to radiate primary and secondary targets simultaneously, and the second phase aims to escalate the tumor dose. Using of the simultaneous strategy on both phases, the dose difference between the primary and secondary targets was enhanced, with better sparing of the rectum and bladder.展开更多
Introduction: Vaccination of children has experienced delays due to paucity of information regarding safety, effectiveness, immunogenicity, and reactogenicity. Age wise approval prioritized 12 - 17 years and later 5 -...Introduction: Vaccination of children has experienced delays due to paucity of information regarding safety, effectiveness, immunogenicity, and reactogenicity. Age wise approval prioritized 12 - 17 years and later 5 - 11 years. Those below 5 years possess na?ve immunity and not considered. In Lake Region Economic Bloc children aged 12 - 17 variably received 1, 2, and 3 doses of vaccine. This analysis looks into effectiveness of the doses administered. Method: Data providers from 84 LREB facilities submitted patients’ vaccination data to Power BI supported dashboard between June 24, 2021 and July 30, 2022. Data of 12 - 17 years old was mined, analyzed and visualized. Sample sizes considered for analysis were 0 dose, n = 8132;1 dose, n = 271;2 doses, n = 402, and 3 doses, n = 90. Data used in the analysis was facility operational and not from experimental design. Relative risk analysis of children who received 0, 1, 2, and 3 doses was done using Odds Ratio run on R software. Results: The relative risk of infection to a child with one dose against unvaccinated counterpart is 0.92 (95% CI, 0.61 - 1.43). Likewise the relative risk of infection to a child aged 12 - 17 years with 2 doses against another who received no dose is 0.87 (95% CI, 0.63 - 1.24). A child with 3 doses is 46% (95% CI, 27% - 84%) less likely to get infected compared to another not vaccinated. Also, the relative risk between having 2 doses and 1 dose for a child aged 12 - 17 years is 0.95 (95% CI, 0.55 - 1.6). For the same age group the relative risk of having 3 doses of vaccines against 1 dose is 51% (95% CI, 26% - 100%). In addition, a child who receives 3 doses of vaccine is 53% (95% CI, 28% - 100%) less likely to experience breakthrough infection compared to another with 2 doses. Whereas 1<sup>st</sup> dose offers (5%) marginal protection advantage over the 2<sup>nd</sup> dose, the 3r dose offers 49% and 47% more protection over 1<sup>st</sup> and 2<sup>nd</sup> doses, respectively, because of incremental reduced risk of infection gained from previous doses. During the period, 15 children at risk were admitted with COVID-19 infections in various regional hospitals, one had 3 doses but confounded with severe comorbidity. Conclusion: We found that 2<sup>nd</sup> dose had marginal protection over the 1<sup>st</sup> dose. However, the 3<sup>rd</sup> dose offers extensive protection compared to 1<sup>st</sup> and 2<sup>nd</sup> doses, and protects more against hospitalization. Children at risk should receive 3 doses of vaccines.展开更多
Objective: to observe the application effect of detail optimization puncture technique when using disposable scalp needle in childrens scalp intravenous infusion. Methods: 200 children with scalp venous infusion were ...Objective: to observe the application effect of detail optimization puncture technique when using disposable scalp needle in childrens scalp intravenous infusion. Methods: 200 children with scalp venous infusion were received from January 2021 to January 2022, and standardized grouping operation was carried out randomly. The control group applied routine puncture technique to 100 cases included, and the observation group applied detail optimized puncture technique to 100 cases included. The pain score, puncture condition, adverse condition and family satisfaction were compared between groups. Results: the scores of the former group were lower than that of the latter group (P < 0.05). The success rate of one-time puncture was 94.00% in the observation group and 76.00% in the control group. The former group was higher than the latter group, and the puncture time in the former group was lower (P < 0.05);the adverse situation of the children included in the observation group was evaluated as 2.00%, and that of the control group was evaluated as 14.00%. The former group was lower than the latter group (P < 0.05);the satisfaction of the family members of the children included in the observation group was 100.00%, and the satisfaction of the family members of the control group was 90.00%. The former group was higher than the latter group (P < 0.05). Conclusion: the implementation of detail optimization puncture technique in scalp vein infusion with one-time scalp needle puncture can improve the success rate of one-time puncture, reduce the pain of children and make the family satisfied.展开更多
Introduction: The relationship between religion and health has been a topic of interest in the past, and in recent years it has become increasingly visible in the social, behavioural, and health sciences. This work ai...Introduction: The relationship between religion and health has been a topic of interest in the past, and in recent years it has become increasingly visible in the social, behavioural, and health sciences. This work aims to study the influence of religion on the “zero-dose” vaccination status of children aged 12 - 23 months in Benin and Togo. Methods: This was a cross-sectional study which consisted in carrying out secondary analyzes using the databases of the most recent editions of the Demographic and Health Surveys in Benin and the Multiple Indicator Cluster Surveys (MICS) in Togo. We extracted data concerning the vaccination status (“1 = zero-dose”, “0 = vaccinated”) of the children, the religious affiliation of the head of the household or the mother and other variables related to the child, the mother, the household and the environment. By means of a logistic regression, the adjusted effect of the religious affiliation of the head of the household or of the mother on the vaccination status at “zero-dose” was determined. Results: A total of 2430 and 933 children were respectively included in the study on behalf of Benin and Togo. The prevalence of “zero-dose” vaccination status in children aged 12 - 23 months was 33.91% (95% CI = 31.67 - 36.23) in Benin and this prevalence was 26.88% (95% CI = 23.50 - 30.55) in Togo. In Benin, there is no evidence in favour of the influence of the religious affiliation of the mother on the “zero-dose” vaccination status of children. In Togo, children living in households whose head was Muslim (ORa = 3.44;95% CI = 1.29 - 9.13) were more likely to be “zero-dose” than those coming from households run by individuals with no religious beliefs. Conclusion: Further research is needed to understand the basis for the excess risk of “zero-dose” vaccination status in children that appears to be associated with the Muslim religion.展开更多
基金This work was supported by the Natural Science Foundation of Anhui Province(2022AH050703)the National Natural Science Foundation of China(11671375).
文摘Finding the optimal dose combination in two-agent dose-finding trials is challenging due to limited sample sizes and the extensive range of potential doses.Unlike traditional chemotherapy or radiotherapy,which primarily focuses on identifying the maximum tolerated dose(MTD),therapies involving targeted and immune agents facilitate the identifica-tion of an optimal biological dose combination(OBDC)by simultaneously evaluating both toxicity and efficacy.Cur-rently,most approaches to determining the OBDC in the literature are model-based and require complex model fittings,making them cumbersome and challenging to implement.To address these challenges,we developed a novel model-as-sisted approach called uTPI-Comb.This approach refines the established utility-based toxicity probability interval design by integrating a strategically devised zone-based local and global candidate set searching strategy,which can effectively optimize the decision-making process for two-agent dose escalation or de-escalation in drug combination trials.Extensive simulation studies demonstrate that the uTPI-Comb design speeds up the dose-searching process and provides substantial improvements over existing model-based methods in determining the optimal biological dose combinations.
文摘The purpose of this study was to grasp current potential problems of dose error in intensity-modulated proton therapy (IMPT) plans. We were interested in dose differences of the Varian Eclipse treatment planning system (TPS) and the fast dose calculation method (FDC) for single-field optimization (SFO) and multi-field optimization (MFO) IMPT plans. In addition, because some authors have reported dosimetric benefit of a proton arc therapy with ultimate multi-fields in recent years, we wanted to evaluate how the number of fields and beam angles affect the differences for IMPT plans. Therefore, for one brain cancer patient with a large heterogeneity, SFO and MFO IMPT plans with various multi-angle beams were planned by the TPS. Dose distributions for each IMPT plan were calculated by both the TPS’s conventional pencil beam algorithm and the FDC. The dosimetric parameters were compared between the two algorithms. The TPS overestimated 400 - 500 cGy (RBE) for minimum dose to the CTV relative to the dose calculated by the FDC. These differences indicate clinically relevant effect on clinical results. In addition, we observed that the maximum difference in dose calculated between the TPS and the FDC was about 900 cGy (RBE) for the right optic nerve, and this quantity also has a possibility to have a clinical effect. The major difference was not seen in calculations for SFO IMPT planning and those for MFO IMPT planning. Differences between the TPS and the FDC in SFO and MFO IMPT plans depend strongly on beam arrangement and the presence of a heterogeneous body. We advocate use of a Monte Carlo method in proton treatment planning to deliver the most precise proton dose in IMPT.
基金Supported by a grant from thek Project of Beijing Municipal Science&Technology Commission(No.Z181100001718011)
文摘Objective This study aims to investigate the dosimetric differences among four planning methods of physical and biological optimization in hypofractionated radiation therapy for non-small cell lung cancer(NSCLC).Methods Ten NSCLC patients receiving radiation therapy were chosen for this retrospective study.Volumetric modulated arc treatment plans for each patient were remade with dose-volume(DV)functions,biological-physical functions,and biological functions,using the same constraint parameters during optimization.The dosimetric differences between the four types of plans were calculated and analyzed.Results For the target,equivalent uniform dose(EUD)of the EUD and EUD+DV groups was approximately 2.8%–3.6%and 3.2%–3.7%higher than those of the DV and DV+EUD groups,respectively.The average tumor control probability(TCP)of the EUD and EUD+DV groups was also significantly higher than those of the other two groups(P<0.05).The difference in heterogeneity index(HI)among the four groups was also statistically significant(P<0.05),while the difference of conformity index(CI)was not significant(P>0.05).For the organs at risk,the differences of EUD,V5,V10,V20,V30 of normal lung tissues were not statistically significant(P>0.05);however,the mean lung dose of the EUD and EUD+DV groups was slightly lower than those of the other two groups.Conclusion The biological optimization method has obvious advantages of improving EUD and TCP of the target,while decreasing the exposed dose of normal lung.This result is meaningful in choosing plan optimization methods in routine work.
文摘Background and Objective: Nowadays, Computer Tomography is one of the best radiological imaging technics which can give right diagnostic information, among the detection of multiphasic adenomas, the detection of cardiac, cerebral and vascular abnormalities. Although these good qualities, this technic is too radiant for the patient. In this paper, we based on the irradiation doses delivered from the current protocols to find a practical method of their optimization during the pediatric cranial scan. Materials and Methods: This work relies on a collection of data from patients in the hospitals, so that analyze them, give the conclusions and, propose an optimal practical method to decrease the irradiation doses. To collect data, we performed a prospective study of seventeen months (from December 2017 to May 2019) carried out simultaneously in three hospitals of the city: The Centre Medical la Cathédrale (H1), the Yaoundé Central Hospital (H2) and the Yaoundé Gyneaco-Obstetric and pediatric hospital (H3). This study included a total of 192 cases of cerebral trauma, of which 11 cases excluded for incomplete information. The dosimetry quality control (CTDIvol) using the PMMA phantoms of 16 cm and 32 cm fulfilled. The scanographic parameters of the patient acquisition protocol were recorded and analyzed. Some of those parameters were modified and entered the CT with the help of a biomedical engineer to reduce the delivered dose. The relationship between CTDIvol and kV is statistically significant (p Results: Among patients, 172 are boys, and the remaining 9 are girls all were in the 0 to 15 age group. CTDIvol values varied from 34.2 mGy to 107.8 mGy and PDLs from 107.8 mGy.cm to 2214.5 mGy.cm in H1. In H2, CTDIvol varied from 5.8 mGy to 44 mGy and PDLs from 91.4 mGy.cm to 665.5 mGy.cm. CTDIvol varied between 9.34 mGy to 92.81 mGy and PDLs from 162.38 mGy.cm to 2713.67 mGy.cm in H3. All values are taken at 75th percentile, with or without contrast injection. Conclusion: The implementation of the optimization of protocols requires the display of the CT parameters to use and to respect during the traumatic brain tests. With displaying and respecting protocol, the CTDIvol decreased by almost 50 per cent.
基金Peking University Third Hospital research funding(Grant No.7476-01)
文摘In the present study, we aimed to investigate the optimal dosage regimens of piperacillin/tazobactam in patients with chronic kidney disease according to their different classes of renal function based on bacterial resistance. A total of 2700 simulationswere applied based on a published population pharmacokinetic and pharmacodynamic model using nonlinear mixed effects modeling (NONMEM) software. Permissible optimal dosage regimens were defined as those associated with a less than 10% of patients whose probabilities of target attainment (PTA) were not attain target. For patients with mild to moderate renal injury, 4/0.5 g of piperacillin/tazobactam every 12 h in 30 min intermittent infusion could attain the target. If the MIC (minimum inhibitory concentration) for the pathogen was 8 mg/L or 16 mg/L, either an 8-h or 6-h dosing interval or extended 2–6 h infusion regimen had to be used to achieve the outcome of the therapy. Regarding MIC was up to above 32 mg/L, a high dose of piperacillin (12–24 g/d) in continuous infusion was the only approach that could achieve the effective target in patients with renal dysfunction. A low dose with extended 4–6 h infusion regimen was recommended for patients with severe renal injury. Our study identified permissible optimal piperacillin/tazobactam dosage regimens for patients with renal dysfunction with an MIC up to 64 mg/L. The findings of this study would be helpful for precise administration of piperacillin/tazobactam in clinical practice.
文摘Aim: To prospectively evaluate the acute toxicity of 3D conformal radiotherapy with dose optimization in patients with carcinoma cervix. Materials and Methods: Carcinoma cervix patients stage IIB to IIIB (n = 30) treated during November 2011 to May 2013 at the institution with 3D conformal chemo-radiation were included in the study. They received weekly Cisplatin 40 mg/m<sup>2</sup> for a maximum of 5 cycles. They received 46 Gy/23 fractions, 5 fractions per week of external beam radiation. In these patients dose optimization was done in order to achieve a tumor maximum dose (D<sub>max</sub>) around 105%. Various techniques were used for dose optimization which included the use of sub fields, adjusting the weightages, using wedges and the use of mixed energies. EBRT (External Beam Radiotherapy) was followed by two fractions of high dose rate intracavitary brachytherapy of 9 Gy each. Acute RTOG toxicity was assessed weekly during EBRT and 1 week post EBRT. Results: The median age of the patients was 45 (range: 30 - 55 years). All the patients completed EBRT;63.3% of the patients received all 5 cycles of chemotherapy while 26.6% of the patients received 4 cycles of chemotherapy and 10% of the patients received 3 cycles of chemotherapy. The most predominant toxicity seen was GI toxicity, diarrhea being the most common GI toxicity followed by vomiting. Neutropenia was the most common hematological toxicity. Most patients had grade 0 and grade 1 toxicity. None of the patients had grade 4 toxicity while few had grade 2 and 3 toxicity. Conclusion: 3D conformal concurrent chemo radiotherapy with D<sub>max</sub>around 105% reduces acute RTOG toxicity particularly grade 3 and 4 and improves patient compliance for concurrent chemo-radiotherapy.
文摘Children’s creative art curriculum is a professional course supported by art materials and techniques and facilitated through creative activities,aiming at cultivating students’ability to organize creative art activities using various art materials and techniques.In light of the evolving focus in China’s colleges and universities from“what to know”to“how to apply,”the pivotal question for educators is how to maximize the value of children’s creative art curriculum.Based on this,this article takes“Sanquan education”as the starting point,combines factual and theoretical arguments,and analyzes the teaching optimization path of children’s creative art curriculum under the perspective of Sanquan education,to improve the quality and efficiency of teaching.
文摘Prescriptions for radiation therapy are given in terms of dose-volume constraints (DVCs). Solving the fluence map optimization (FMO) problem while satisfying DVCs often requires a tedious trial-and-error for selecting appropriate dose control parameters on various organs. In this paper, we propose an iterative approach to satisfy DVCs using a multi-objective linear programming (LP) model for solving beamlet intensities. This algorithm, starting from arbitrary initial parameter values, gradually updates the values through an iterative solution process toward optimal solution. This method finds appropriate parameter values through the trade-off between OAR sparing and target coverage to improve the solution. We compared the plan quality and the satisfaction of the DVCs by the proposed algorithm with two nonlinear approaches: a nonlinear FMO model solved by using the L-BFGS algorithm and another approach solved by a commercial treatment planning system (Eclipse 8.9). We retrospectively selected from our institutional database five patients with lung cancer and one patient with prostate cancer for this study. Numerical results show that our approach successfully improved target coverage to meet the DVCs, while trying to keep corresponding OAR DVCs satisfied. The LBFGS algorithm for solving the nonlinear FMO model successfully satisfied the DVCs in three out of five test cases. However, there is no recourse in the nonlinear FMO model for correcting unsatisfied DVCs other than manually changing some parameter values through trial and error to derive a solution that more closely meets the DVC requirements. The LP-based heuristic algorithm outperformed the current treatment planning system in terms of DVC satisfaction. A major strength of the LP-based heuristic approach is that it is not sensitive to the starting condition.
基金Supported by the General Project of National Natural Science Foundation of China,Research of the Ratio Optimization between Chlorogenic Acid and Geniposide for Non-alcoholic Fatty Liver Disease,the Mechanism of Action for Epithelial-Mesenchymal Transition(No.81274155),Mechanism of Chlorogenic Acid and Geniposide for NASH by Regulating Kupffer Cells Polarization Based on Gut-liver Axis(No.81673660),the Youth Project of National Natural Science Foundation of China,Research on the mechanism of compound prescription of Chinese traditional medicine regulating endocannabinoid system in non-alcoholic steatohepatitis(No.81503529),Mechanism of treatment of nonalcoholic fatty liver disease by"HJJB"compound of Chinese traditional medicine based on insulin transduction(No.81503404)the Pilot Project of Science and Technology of Fujian Province,Study of Compound Prescription of Chinese Traditional Medicine on Fibrosis Based on Endocannabinoid System(No.2016D012)+1 种基金the TCM Project of Fujian Health Department,Clinic Research of Chinese Traditional Medicine for Nonalcoholic Fatty Liver(No.wzpw201308)the General Project of Xiamen Science and Technology Program Grant,Research of Chinese Traditional Medicine with IFNαTreatment on CHB(No.3502Z20134020)
文摘OBJECTIVE: To investigate the optimal dosage ratio of chlorogenic acid and gardenia glycosides in treating the rates with fatty liver disease induced by high-fat feed.METHODS: A rat model of non-alcoholic fatty liver disease(NAFLD) was established by using a high-fat diet. According to mathematical model "uniform design", varying doses of chlorogenic acid and gardenia glycosides have been combined to form 6 medications for the treatment of NAFLD.Samples were then taken to observe pathological changes of the liver tissue(HE staining); changes in the fat metabolism pathway e.g. triglyceride(TG)and free fatty acid(FFA) content; alterations in liver function, i.e. serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST) activity; and differences in Malondialdehyde(MDA) and superoxide dismutase(SOD) content in the liver tissue. Multiple regression analysis was conducted to test the optimal dosage ratio of chlorogenic acid and gardenia glycosides.RESULTS: Fatty degeneration and vacuole-like changes of different degrees occurred in hepatic cells of the model group. Markers for fat metabolism, serum ALT and AST activities, and expression of MDA in liver tissue significantly increased, while SOD decreased. Combination of 90 mg chlorogenic acid and 90 mg Gardenia glycosides was the optimal dosage ratio of chlorogenic acid and gardenia glycosides in the treatment of rats with fatty liver induced by high-fat diet.CONCLUSION: Chlorogenic acid of 90 mg plus gardenia glycosides of 90 mg was the best combination in the treatment of fatty liver disease in rats induced by high-fat feed.
基金supported by grants from National Natural Science Foundation of China(No.81801804).
文摘Objective:To investigate the value of application of low-dose and optimized length CT scan on puncture results,complications and patients’radiation dosage during CT-guided percutaneous biopsy of pulmonary nodules(PTNB).Methods:A total of 231 patients with PTNB under CT guidance were collected.Low dose scanning utilized tube current of 20 mA as compared with 40 mA in conventional dosage.Optimized length in CT is defined as intentionally narrowing the range of CT scanning just to cover 25 mm(5 layers)around the target layer during needle adjustment.According to whether low-dose scans and optimized length scans techniques were utilized,patients were divided into three groups:conventional group(conventional sequence+no optimization),optimized length group(conventional sequence+optimized length),and low-dose optimized length group(low dose sequence+optimized length).The ED(effective dose),the DLP(dose length product),the average CTDIvol(Volume CT dose index),total milliampere second between subgroups were compared.Results:Compared with the conventional group,ED,intraoperative guidance DLP,total milliseconds and operation time in the optimized length group were reduced by 18.2%(P=0.01),37%(P=0.003),17.5%(P=0.013)and13.3%(P=0.021)respectively.Compared with the optimized length group,the ED was reduced by 87%,preoperative positioning,intraoperative guidance and postoperative review DLP were also reduced by 88%,total milliampere second was reduced by 79%,with an average CTDIvol was reduced by 86%,in the low-dose optimized length group(P<0.001 for all).Conclusion:Optimizing the length during CT scanning can effectively reduce the intraoperative radiation dose and reduce the operation time compared with conventional plan;low-dose and optimized length CT scan can further reduce the total radiation dose compared with optimized length group with no differences on intraoperative complications,biopsy results and operation time.
文摘BACKGROUND With the improvement of economy and living standards,the attention paid to short stature in children has been increasingly highlighted.Numerous causes can lead to short stature in children,among which growth hormone deficiency(GHD)is a significant factor.AIM To investigate the long-term efficacy and safety of different doses of long-acting polyethylene glycol recombinant human growth hormone(PEG-rhGH)in the treatment of GHD in children.METHODS We selected 44 pediatric patients diagnosed with GHD who were treated at Wuhu First People's Hospital from 2014 to 2018.Total 23 patients were administered a high dose of long-acting PEG-rhGH at 0.2 mg/kg subcutaneously each week,forming the high-dose group.Meanwhile,21 patients were given a lower dose of long-acting PEG-rhGH at 0.14 mg/kg subcutaneously each week,establishing the low-dose Group.The total treatment period was 2 years,during which we monitored the patients’height,annual growth velocity(GV),height standard deviation score(HtSDS),chronological age(CA),bone age(BA),and serum levels of insulin-like growth factor-1(IGF-1)and insulin-like growth factor-binding protein-3(IGFBP-3)before treatment and at 6 mo,1 year,and 2 years after treatment initiation.We also monitored thyroid function,fasting plasma glucose,fasting insulin,and other side effects.Furthermore,we calculated the homeostatic model assessment for insulin resistance.RESULTS After 1 year of treatment,the GV,HtSDS,IGF-1,BA,and IGFBP-3 in both groups significantly improved compared to the pre-treatment levels(P<0.05).Moreover,when comparing GV,HtSDS,IGF-1,BA,and IGFBP-3 between the two groups,there were no statistically significant differences either before or after the treatment(P>0.05).During the treatment intervals of 0-1.0 years and 1.0-2.0 years,both patient groups experienced a slowdown in GV and a decline in HtSDS improvement(P<0.05).CONCLUSION The use of PEG-rhGH in treating GHD patients was confirmed to be effective,with similar outcomes observed in both the high-dose group and low-dose groups,and no significant differences in the main side effects.
基金supported by the following funding:National Science Foundation of China(NSFC)(62373259)Natural Science Foundation of Top Talent of SZTU(Grant No.GDRC202303)+4 种基金Foundation of Education Department of Guangdong Province,China(Grant No.2022ZDJS115)National Natural Science Foundation of China(NSFC)(52035009,52005243)NSFC Excellent Yong Scientists Fund(Hong Kong and Macao,China)(21922816)Science and Technology Innovation Committee of Shenzhen Municipality(JCYJ20200109141003910,JCYJ20210324120402007,KQTD20170810110250357)Platform Technology Funding from the University of Hong Kongsupported in part by the Croucher Foundation through the Croucher Senior Research Fellowship.
文摘The plasma-derived reactive oxygen and nitrogen species(RONS)enable cold atmospheric plasma(CAP)to combat cancer and infectious wounds.Achieving therapeutic outcomes with CAP necessitates precise treatment doses.Current CAP devices are constrained by their capability of delivering a single dose to a single sample,limiting dose optimization.We propose a novel“one exposure,multiple-dose delivery”strategy by programming gas flows.This approach facilitates efficient screening of optimal CAP dose by distributing feed gas through boundary-conditioned transport channels to generate multiple,flux-varied gas streams,which ignite plasmas with diverse chemical compositions and dose gradients across samples.Our developed demonstration device,capable of administering three doses to sixteen samples,significantly reduces experimental complexity,particularly when handling large candidate doses or samples for treatment.Leveraging multiplexed treatment,we capably optimize the CAP dose to effectively eradicate the liver cancer cell line of Huh7 and bacteria of S.aureus within one exposure.Furthermore,we find manipulating gas flow velocities allows targeted generation of short-lived species.This approach disentangles the roles of short-lived and long-lived RONS in therapeutic applications,offering critical insights into their bio-functional mechanisms.The concept of multiplexed dose treatment with fluidic manipulation promises to catalyze the development of high-efficiency CAP devices and advance research in CAP-based therapies.
文摘Cystic fibrosis(CF)is the most common autosomal recessive disease of the Caucasian population worldwide,with respiratory disease remaining the most relevant source of morbidity and mortality.Computed tomography(CT)is frequently used for monitoring disease complications and progression.Over the last fifteen years there has been a six-fold increase in the use of CT,which has lead to a growing concern in relation to cumulative radiation exposure.The challenge to the medical profession is to identify dose reduction strategies that meet acceptable image quality,but fulfil the requirements of a diagnostic quality CT.Dose-optimisation,particularly in CT,is essential as it reduces the chances of patients receiving cumulative radiation doses in excess of 100 m Sv,a dose deemed significant by the United Nations Scientific Committee on the Effects of Atomic Radiation.This review article explores the current trends in imaging in CF with particular emphasis on new developments in dose optimisation.
文摘Purpose: Children are sometimes examined with Computed Tomography protocols designed for adults, leading to radiation doses higher than necessary. Lack of optimisation could lead to image quality higher than what is needed for diagnostic purposes with associated high doses to patients. Optimising the protocols for paediatric head trauma CT imaging will reduce radiation dose. Objective: The study aimed to optimise radiation dose and assess the image quality for a set of protocols by evaluating noise, a contrast to noise ratio, modulation transfer function and noise power spectrum. Methods: Somaton Sensation 64 was used to scan the head of an anthropomorphic phantom with a set of protocols. ImageJ software was used to analyse the paediatric head image from the scanner. IMPACTSCAN dosimeter software was used to evaluate the radiation dose to the various organs in the head. MATLAB was used to analyse the Modulation Transfer Function and the Noise Power. Results: The estimated Computed Tomography Dose Index volume (CTDI<sub>vol</sub>) increased with increasing tube current and tube voltage. The high pitch of 0.9 gave a lower dose than the 0.5 pitch. The eye lens received the highest radiation dose (39.2 mGy) whiles the thyroid received the least radiation dose (13.7 mGy). There was an increase in noise (62.46) when the H60 kernel was used and a lower noise (8.829) was noticed when the H30 kernel was used. Conclusion: The results obtained show that the H30 kernel (smooth kernel) gave higher values for noise and contrast to noise ratio (CNR) than the H60 kernel (sharp kernel). The H60 kernel produced high values for the modulation transfer function (MTF) and noise power spectrum (NPS). The eye lens received the highest radiation dose.
基金supported by National Key Research and Development Program of China(No.2022YFC2401503)National Natural Science Foundation of China(Nos.11875299,61631001,U1532264,and 12005271).
文摘Intensity-modulated particle therapy(IMPT)with carbon ions is comparatively susceptible to various uncertainties caused by breathing motion,including range,setup,and target positioning uncertainties.To determine relative biological effectiveness-weighted dose(RWD)distributions that are resilient to these uncertainties,the reference phase-based four-dimensional(4D)robust optimization(RP-4DRO)and each phase-based 4D robust optimization(EP-4DRO)method in carbon-ion IMPT treatment planning were evaluated and compared.Based on RWD distributions,4DRO methods were compared with 4D conventional optimization using planning target volume(PTV)margins(PTV-based optimization)to assess the effectiveness of the robust optimization methods.Carbon-ion IMPT treatment planning was conducted in a cohort of five lung cancer patients.The results indicated that the EP-4DRO method provided better robustness(P=0.080)and improved plan quality(P=0.225)for the clinical target volume(CTV)in the individual respiratory phase when compared with the PTV-based optimization.Compared with the PTV-based optimization,the RP-4DRO method ensured the robustness(P=0.022)of the dose distributions in the reference breathing phase,albeit with a slight sacrifice of the target coverage(P=0.450).Both 4DRO methods successfully maintained the doses delivered to the organs at risk(OARs)below tolerable levels,which were lower than the doses in the PTV-based optimization(P<0.05).Furthermore,the RP-4DRO method exhibited significantly superior performance when compared with the EP-4DRO method in enhancing overall OAR sparing in either the individual respiratory phase or reference respiratory phase(P<0.05).In general,both 4DRO methods outperformed the PTV-based optimization in terms of OAR sparing and robustness.
文摘Radiation therapy plans are optimized as a single treatment plan, but delivered over 30 - 50 treatment sessions (known as fractions). This paper proposes a new mixed-integer linear programming model to simultaneously incorporate fractionation and cumulative constraints in Intensity Modulated Radiation Therapy (IMRT) planning optimization used in cancer treatment. The method is compared against a standard practice of posing only cumulative limits in the optimization. In a prostate case, incorporating both forms of limits into planning converted an undeliverable plan obtained by considering only the cumulative limits into a deliverable one within 3% of the value obtained by ignoring the fraction size limits. A two-phase boosting strategy is studied as well, where the first phase aims to radiate primary and secondary targets simultaneously, and the second phase aims to escalate the tumor dose. Using of the simultaneous strategy on both phases, the dose difference between the primary and secondary targets was enhanced, with better sparing of the rectum and bladder.
文摘Introduction: Vaccination of children has experienced delays due to paucity of information regarding safety, effectiveness, immunogenicity, and reactogenicity. Age wise approval prioritized 12 - 17 years and later 5 - 11 years. Those below 5 years possess na?ve immunity and not considered. In Lake Region Economic Bloc children aged 12 - 17 variably received 1, 2, and 3 doses of vaccine. This analysis looks into effectiveness of the doses administered. Method: Data providers from 84 LREB facilities submitted patients’ vaccination data to Power BI supported dashboard between June 24, 2021 and July 30, 2022. Data of 12 - 17 years old was mined, analyzed and visualized. Sample sizes considered for analysis were 0 dose, n = 8132;1 dose, n = 271;2 doses, n = 402, and 3 doses, n = 90. Data used in the analysis was facility operational and not from experimental design. Relative risk analysis of children who received 0, 1, 2, and 3 doses was done using Odds Ratio run on R software. Results: The relative risk of infection to a child with one dose against unvaccinated counterpart is 0.92 (95% CI, 0.61 - 1.43). Likewise the relative risk of infection to a child aged 12 - 17 years with 2 doses against another who received no dose is 0.87 (95% CI, 0.63 - 1.24). A child with 3 doses is 46% (95% CI, 27% - 84%) less likely to get infected compared to another not vaccinated. Also, the relative risk between having 2 doses and 1 dose for a child aged 12 - 17 years is 0.95 (95% CI, 0.55 - 1.6). For the same age group the relative risk of having 3 doses of vaccines against 1 dose is 51% (95% CI, 26% - 100%). In addition, a child who receives 3 doses of vaccine is 53% (95% CI, 28% - 100%) less likely to experience breakthrough infection compared to another with 2 doses. Whereas 1<sup>st</sup> dose offers (5%) marginal protection advantage over the 2<sup>nd</sup> dose, the 3r dose offers 49% and 47% more protection over 1<sup>st</sup> and 2<sup>nd</sup> doses, respectively, because of incremental reduced risk of infection gained from previous doses. During the period, 15 children at risk were admitted with COVID-19 infections in various regional hospitals, one had 3 doses but confounded with severe comorbidity. Conclusion: We found that 2<sup>nd</sup> dose had marginal protection over the 1<sup>st</sup> dose. However, the 3<sup>rd</sup> dose offers extensive protection compared to 1<sup>st</sup> and 2<sup>nd</sup> doses, and protects more against hospitalization. Children at risk should receive 3 doses of vaccines.
文摘Objective: to observe the application effect of detail optimization puncture technique when using disposable scalp needle in childrens scalp intravenous infusion. Methods: 200 children with scalp venous infusion were received from January 2021 to January 2022, and standardized grouping operation was carried out randomly. The control group applied routine puncture technique to 100 cases included, and the observation group applied detail optimized puncture technique to 100 cases included. The pain score, puncture condition, adverse condition and family satisfaction were compared between groups. Results: the scores of the former group were lower than that of the latter group (P < 0.05). The success rate of one-time puncture was 94.00% in the observation group and 76.00% in the control group. The former group was higher than the latter group, and the puncture time in the former group was lower (P < 0.05);the adverse situation of the children included in the observation group was evaluated as 2.00%, and that of the control group was evaluated as 14.00%. The former group was lower than the latter group (P < 0.05);the satisfaction of the family members of the children included in the observation group was 100.00%, and the satisfaction of the family members of the control group was 90.00%. The former group was higher than the latter group (P < 0.05). Conclusion: the implementation of detail optimization puncture technique in scalp vein infusion with one-time scalp needle puncture can improve the success rate of one-time puncture, reduce the pain of children and make the family satisfied.
文摘Introduction: The relationship between religion and health has been a topic of interest in the past, and in recent years it has become increasingly visible in the social, behavioural, and health sciences. This work aims to study the influence of religion on the “zero-dose” vaccination status of children aged 12 - 23 months in Benin and Togo. Methods: This was a cross-sectional study which consisted in carrying out secondary analyzes using the databases of the most recent editions of the Demographic and Health Surveys in Benin and the Multiple Indicator Cluster Surveys (MICS) in Togo. We extracted data concerning the vaccination status (“1 = zero-dose”, “0 = vaccinated”) of the children, the religious affiliation of the head of the household or the mother and other variables related to the child, the mother, the household and the environment. By means of a logistic regression, the adjusted effect of the religious affiliation of the head of the household or of the mother on the vaccination status at “zero-dose” was determined. Results: A total of 2430 and 933 children were respectively included in the study on behalf of Benin and Togo. The prevalence of “zero-dose” vaccination status in children aged 12 - 23 months was 33.91% (95% CI = 31.67 - 36.23) in Benin and this prevalence was 26.88% (95% CI = 23.50 - 30.55) in Togo. In Benin, there is no evidence in favour of the influence of the religious affiliation of the mother on the “zero-dose” vaccination status of children. In Togo, children living in households whose head was Muslim (ORa = 3.44;95% CI = 1.29 - 9.13) were more likely to be “zero-dose” than those coming from households run by individuals with no religious beliefs. Conclusion: Further research is needed to understand the basis for the excess risk of “zero-dose” vaccination status in children that appears to be associated with the Muslim religion.
