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Abstract Background Clear cell renal cell carcinoma is a prototypical tumor characterized by metabolic reprogramming, which extends beyond tumor cells to encompass diverse cell types within the tumor microenvironment. Nonetheless, current research on metabolic reprogramming in renal cell carcinoma mostly focuses on either tumor cells alone or conducts analyses of all cells within the tumor microenvironment as a mixture, thereby failing to precisely identify metabolic changes in different cell types within the tumor microenvironment. Methods Gathering 9 major single-cell RNA sequencing databases of clear cell renal cell carcinoma, encompassing 195 samples. Spatial transcriptomics data were selected to conduct metabolic activity analysis with spatial localization. Developing scMet program to convert RNA-seq data into scRNA-seq data for downstream analysis. Results Diverse cellular entities within the tumor microenvironment exhibit distinct infiltration preferences across varying histological grades and tissue origins. Higher-grade tumors manifest pronounced immunosuppressive traits. The identification of tumor cells in the RNA splicing state reveals an association between the enrichment of this particular cellular population and an unfavorable prognostic outcome. The energy metabolism of CD8+ T cells is pivotal not only for their cytotoxic effector functions but also as a marker of impending cellular exhaustion. Sphingolipid metabolism evinces a correlation with diverse macrophage-specific traits, particularly M2 polarization. The tumor epicenter is characterized by heightened metabolic activity, prominently marked by elevated tricarboxylic acid cycle and glycolysis while the pericapsular milieu showcases a conspicuous enrichment of attributes associated with vasculogenesis, inflammatory responses, and epithelial–mesenchymal transition. The scMet facilitates the transformation of RNA sequencing datasets sourced from TCGA into scRNA sequencing data, maintaining a substantial degree of correlation. Conclusions The tumor microenvironment of clear cell renal cell carcinoma demonstrates significant metabolic heterogeneity across various cell types and spatial dimensions. scMet exhibits a notable capability to transform RNA sequencing data into scRNA sequencing data with a high degree of correlation.

Online adaptive radiation is a new and exciting modality of treatment for gynecologic cancers. Traditional radiation treatments deliver the same radiation plan to cancers with large margins. Improvements in imaging, technology, and artificial intelligence have made it possible to account for changes between treatments and improve the delivery of radiation. These advances can potentially lead to significant benefits in tumor coverage and normal tissue sparing. Gynecologic cancers can uniquely benefit from this technology due to the significant changes in bladder, bowel, and rectum between treatments as well as the changes in tumors commonly seen between treatments. Preliminary studies have shown that online adaptive radiation can maintain coverage of the tumor while sparing nearby organs. Given these potential benefits, numerous clinical trials are ongoing to investigate the clinical benefits of online adaptive radiotherapy. Despite the benefits, implementation of online adaptive radiotherapy requires significant clinical resources. Additionally, the timing and workflow for online adaptive radiotherapy is being optimized. In this review, we discuss the history and evolution of radiation techniques, the logistics and implementation of online adaptive radiation, and the potential benefits of online adaptive radiotherapy for gynecologic cancers.

In online adaptive radiotherapy (ART), quick computation-based secondary dose verification is crucial for ensuring the quality of ART plans while the patient is positioned on the treatment couch. However, traditional dose verification algorithms are generally time-consuming, reducing the efficiency of ART workflow. This study aims to develop an ultra-fast deep-learning (DL) based secondary dose verification algorithm to accurately estimate dose distributions using computed tomography (CT) and fluence maps (FMs). We integrated FMs into the CT image domain by explicitly resolving the geometry of treatment delivery. For each gantry angle, an FM was constructed based on the optimized multi-leaf collimator apertures and corresponding monitoring units. To effectively encode treatment beam configuration, the constructed FMs were back-projected to $30$ cm away from the isocenter with respect to the exact geometry of the treatment machines. Then, a 3D U-Net was utilized to take the integrated CT and FM volume as input to estimate dose. Training and validation were performed on $381$ prostate cancer cases, with an additional $40$ testing cases for independent evaluation of model performance. The proposed model can estimate dose in ∼ $15$ ms for each patient. The average γ passing rate ( $3\% /2\,{\text{mm}}$ , $10\% $ threshold) for the estimated dose was 99.9% ± 0.15% on testing patients. The mean dose differences for the planning target volume and organs at risk were $0.07\% \pm 0.34\% $ and $0.48\% \pm 0.72\% $ , respectively. We have developed a geometry-resolved DL framework for accurate dose estimation and demonstrated its potential in real-time online ART doses verification.

IntroductionRecent advancements in radiotherapy (RT) have allowed for the integration of a Magnetic Resonance (MR) imaging scanner with a medical linear accelerator to use MR images for image guidance to position tumors against the treatment beam. Undersampling in MR acquisition is desired to accelerate the imaging process, but unavoidably deteriorates the reconstructed image quality. In RT, a high-quality MR image of a patient is available for treatment planning. In light of this unique clinical scenario, we proposed to exploit the patient-specific image prior to facilitate high-quality MR image reconstruction.MethodsUtilizing the planning MR image, we established a deep auto-encoder to form a manifold of image patches of the patient. The trained manifold was then incorporated as a regularization to restore MR images of the same patient from undersampled data. We performed a simulation study using a patient case, a real patient study with three liver cancer patient cases, and a phantom experimental study using data acquired on an in-house small animal MR scanner. We compared the performance of the proposed method with those of the Fourier transform method, a tight-frame based Compressive Sensing method, and a deep learning method with a patient-generic manifold as the image prior.ResultsIn the simulation study with 12.5% radial undersampling and 15% increase in noise, our method improved peak-signal-to-noise ratio by 4.46dB and structural similarity index measure by 28% compared to the patient-generic manifold method. In the experimental study, our method outperformed others by producing reconstructions of visually improved image quality.

Neointimal hyperplasia (NIH) is a complicated inflammatory process contributing to vascular restenosis. The present study aimed to explore whether chemokine‐like factor 1 (CKLF1) aggravates NIH via the nuclear factor‐kappa B (NF‐κB)/vascular cell adhesion molecule‐1 (VCAM‐1) pathway. We found the expression of CKLF1 and VCAM‐1 significantly increased in human carotid plaques compared to the control. In vivo, CKLF1 overexpression induced a thicker neointimal formation and VCAM‐1 expression was correspondingly upregulated. In vitro, CKLF1 activated NF‐κB and induced VCAM‐1 upregulation in human aortic smooth muscle cells (HASMCs). Functional experiments demonstrated that CKLF1 promoted monocyte adhesion and HASMC migration via VCAM‐1. These results suggest CKLF1 accelerates NIH by promoting monocyte adhesion and HASMC migration via the NF‐κB/VCAM‐1 pathway. Our findings contribute to a better understanding of the mechanisms underlying the causality of CKLF1 on NIH and could prove beneficial in designing therapeutic modalities with a focus on CKLF1.

Iodine contrast agent is widely used in liver cancer radiotherapy at CT simulation stage to enhance detectability of tumor. However, its application in cone beam CT (CBCT) for image guidance before treatment delivery is still limited because of poor image quality and excessive dose of contrast agent during multiple treatment fractions. We previously developed a multienergy element-resolved (MEER) CBCT framework that included x-ray projection data acquisition on a conventional CBCT platform in a kVp-switching model and a dictionary-based image reconstruction algorithm that simultaneously reconstructed x-ray attenuation images at each kilovoltage peak (kVp), an electron density image, and elemental composition images. In this study, we investigated feasibility using MEER-CBCT for low-concentration iodine contrast agent visualization. We performed simulation and experimental studies using a phantom with inserts containing water and different concentrations of iodine solution and the MEER-CBCT scan with 600 projections in a full gantry rotation, in which the kVp level sequentially changed among 80, 100, and 120 kVps. We included iodine material in the dictionary of the reconstruction algorithm. We analyzed iodine detectability as quantified by contrast-to-noise ratio (CNR) and compared results with those of CBCT images reconstructed by the standard filter back projection (FBP) method with 600 projections. MEER-CBCT achieved similar contrast enhancement as FBP method but significantly higher CNR. At 2.5% iodine solution concentration, FBP method achieved 170 HU enhancement and CNR of 2.0, considered the standard CNR for successful tumor visualization. MEER-CBCT achieved the same CNR but at ~6.3 times lower iodine concentration of 0.4%.

Ni/In2O3 was confirmed to be active for CO2 hydrogenation to methanol. Herein, the In2O3-ZrO2 solid solution was prepared to support the highly dispersed nickel catalyst by chemical reduction. A CO2 conversion of 17.9% with a space-time yield (STY) of methanol of 0.63 gMeOH gcat−1 h−1 was achieved at 300 °C and 5 MPa on Ni/In2O3-ZrO2 of 5 wt% Ni loading. The STY of methanol has a 43.2% increase, compared to Ni/In2O3. The use of ZrO2 optimizes the oxygen vacancies for CO2 activation. The highly dispersed Ni catalyst facilitates hydrogen spillover, which improves hydrogenation ability and the formation of oxygen vacancies.

Objectives To develop a model of in-hospital mortality using medical record front page (MRFP) data and assess its validity in case-mix standardisation by comparison with a model developed using the complete medical record data.Design A nationally representative retrospective study.Setting Representative hospitals in China, covering 161 hospitals in modelling cohort and 156 hospitals in validation cohort.Participants Representative patients admitted for acute myocardial infarction. 8370 patients in modelling cohort and 9704 patients in validation cohort.Primary outcome measures In-hospital mortality, which was defined explicitly as death that occurred during hospitalisation, and the hospital-level risk standardised mortality rate (RSMR).Results A total of 14 variables were included in the model predicting in-hospital mortality based on MRFP data, with the area under receiver operating characteristic curve of 0.78 among modelling cohort and 0.79 among validation cohort. The median of absolute difference between the hospital RSMR predicted by hierarchical generalised linear models established based on MRFP data and complete medical record data, which was built as ‘reference model’, was 0.08% (10th and 90th percentiles: −1.8% and 1.6%). In the regression model comparing the RSMR between two models, the slope and intercept of the regression equation is 0.90 and 0.007 in modelling cohort, while 0.85 and 0.010 in validation cohort, which indicated that the evaluation capability from two models were very similar.Conclusions The models based on MRFP data showed good discrimination and calibration capability, as well as similar risk prediction effect in comparison with the model based on complete medical record data, which proved that MRFP data could be suitable for risk adjustment in hospital performance measurement.

Located on the east side of China’s Qinghai–Tibet Plateau is the Western Sichuan Plateau, the courtyard adopts a passive design to withstand the harsh climate in cold areas, and its internal thermal environment has a direct impact on the productivity and activities of the residents. This paper takes a plateau village (3500 m above sea level) beside the Sichuan–Tibet line as the research area, and selects four typical local courtyard layouts and an outdoor reference point for the measurement and comparison of the thermal environment. By comparing the measured parameters inside and outside the courtyard, and the correlation analysis, it was deduced as follows. (1) In the cold winter, traditional plateau residential courtyards can create a stable internal micro-climate, but the cold resistance of the courtyards is closely related to its layout. (2) Except for wind speed, other thermal environment parameters of the courtyard are all affected by solar radiation (3) The correlation analysis of the various environmental parameters and physiologically equivalent temperature (PET) showed that the correlation coefficient between the mean radiation temperature (Tmrt) and all courtyard PET values is

Heavy metals in road dust pose a significant threat to human health. This study investigated the concentrations, patterns, and sources of eight hazardous heavy metals (Cr, Ni, Cu, Zn, As, Cd, Pb, and Hg) in the street dust of Zhengzhou city of PR China. Fifty-eight samples of road dust were analyzed based on three methods of risk assessment, i.e., Geo-Accumulation Index (Igeo), Potential Ecological Risk Assessment (RI), and Nemerow Synthetic Pollution Index (PIN). The results exhibited higher concentrations of Hg and Cd 14 and 7 times higher than their background values, respectively. Igeo showed the risks of contamination in a range of unpolluted (Cr, Ni) to strongly polluted (Hg and Cd) categories. RI came up with the contamination ranges from low (Cr, Ni, Cu, Zn, As, and Pb) to extreme (Cd and Hg) risk of contamination. The risk of contamination based on PIN was from safe (Cu, As, and Pb) to seriously high (Cd and Hg). The results yielded by PIN indicated the extreme risk of Cd and Hg in the city. Positive Matrix Factorization was used to identify the sources of contamination. Factor 1 (vehicular exhaust), Factor 2 (coal combustion), Factor 3 (metal industry), and Factor 4 (anthropogenic activities), respectively, contributed 14.63%, 35.34%, 36.14%, and 13.87% of total heavy metal pollution. Metal’s presence in the dust is a direct health risk for humans and warrants immediate and effective pollution control and prevention measures in the city.

An eight-ring radial helical array antenna based on a novel slot-coupled structure is designed and simulated. The novel coupling structure has the advantages of high power-handling capacity and excellent coupling ability. The simulation results of the array antenna agree well with theoretical calculations, and the aperture efficiency is about 78.1% when the beam is in the normal direction. The power-handling capacity is about 100 MW on vacuum condition. The simulation results also show that the gain is 30.7 dB and the main lobe’s axial ratio is 0.25 dB. Furthermore, the structure of the antenna is compact, and it may be applied to larger circular helical arrays to realize higher gain and higher power-handling capacity.

OBJECTIVES: Behcet’s disease is a form of systematic vasculitis that affects vessels of various sizes. Aortic pseudoaneurysm is one of the most important causes of death among patients with Behcet’s disease due to its high risk of rupture and associated mortality. Our study aimed to investigate the outcomes of Behcet’s disease patients with aortic pseudoaneurysms undergoing open surgery and endovascular aortic repair. METHODS: From January 2003 to September 2014, ten consecutive patients undergoing surgery for aortic pseudoaneurysm met the diagnostic criteria for Behcet’s disease. Endovascular repair was the preferred modality and open surgery was performed as an alternative. Systemic immunosuppressive medication was administered after Behcet’s disease was definitively diagnosed. RESULTS: Eight patients initially underwent endovascular repair and two patients initially underwent open surgery. The overall success rate was 90% and the only failed case involved the use of the chimney technique to reach a suprarenal location. The median follow-up duration was 23 months. There were 7 recurrences in 5 patients. The median interval between operation and recurrence was 13 months. No significant risk factors for recurrence were identified, but a difference in recurrence between treatment and non-treatment with preoperative immunosuppressive medication preoperatively was notable. Four aneurysm-related deaths occurred within the follow-up period. The overall 1-year, 3-year and 5-year survival rates were 80%, 64% and 48%, respectively. CONCLUSIONS: Both open surgery and endovascular repair are safe and effective for treating aortic pseudoaneurysm in Behcet’s disease patients. The results from our retrospective study indicated that immunosuppressive medication was essential to defer the occurrence and development of recurrent aneurysms.