Case report: Cervical brachytherapy technique for locally advanced cervical cancer in a patient with complete bicorporeal uterus

PurposeThe purpose of this study was to describe an approach to cervical brachytherapy for a patient with a complete bicorporeal uterus and locally advanced cervical cancer (LACC).Materials and methodsThe patient was a 53-year-old woman with a complete bicorporeal uterus, diagnosed with stage IIB cervical squamous cell carcinoma due to contact bleeding. The patient underwent concurrent chemoradiotherapy (CCRT), external beam pelvic radiotherapy with 45 Gy/25 fractions, and weekly cisplatin (40 mg/m2). Brachytherapy was administered following the completion of external beam radiotherapy.ResultsThe brachytherapy, which was CT (Computed Tomography)-guided using two CT-compatible tandems and two CT-compatible ovoids, delivered a prescription dose of HRCTV D90 was 6 Gy*5F, which achieved satisfactory dose coverage. The patient’s final HRCTV D90 EQD210 was 84.9 Gy, and IRCTV D90 EQD210 was 63.5 Gy. Rectum D2cc EQD23 was 66.03 Gy, bladder D2cc EQD23 was 75.57 Gy, sigmoid D2cc EQD23 was 63.93 Gy, and intestine D2cc EQD23 was 65.86 Gy. Follow-up at 1 year was CR.ConclusionsFor patients with cervical cancer and a complete bicorporeal uterus, using double tandems combined with double ovoids is a feasible treatment method to ensure adequate dose coverage without causing additional damage. This method is also applicable to patients with endometrial cancer

SD-Net: Symmetric-Aware Keypoint Prediction and Domain Adaptation for 6D Pose Estimation In Bin-picking Scenarios

Despite the success in 6D pose estimation in bin-picking scenarios, existing methods still struggle to produce accurate prediction results for symmetry objects and real world scenarios. The primary bottlenecks include 1) the ambiguity keypoints caused by object symmetries; 2) the domain gap between real and synthetic data. To circumvent these problem, we propose a new 6D pose estimation network with symmetric-aware keypoint prediction and self-training domain adaptation (SD-Net). SD-Net builds on pointwise keypoint regression and deep hough voting to perform reliable detection keypoint under clutter and occlusion. Specifically, at the keypoint prediction stage, we designe a robust 3D keypoints selection strategy considering the symmetry class of objects and equivalent keypoints, which facilitate locating 3D keypoints even in highly occluded scenes. Additionally, we build an effective filtering algorithm on predicted keypoint to dynamically eliminate multiple ambiguity and outlier keypoint candidates. At the domain adaptation stage, we propose the self-training framework using a student-teacher training scheme. To carefully distinguish reliable predictions, we harnesses a tailored heuristics for 3D geometry pseudo labelling based on semi-chamfer distance. On public Sil'eane dataset, SD-Net achieves state-of-the-art results, obtaining an average precision of 96%. Testing learning and generalization abilities on public Parametric datasets, SD-Net is 8% higher than the state-of-the-art method. The code is available at https://github.com/dingthuang/SD-Net

Improving the expression of recombinant pullulanase by increasing mRNA stability in Escherichia coli

Background: Pullulanase production in both wild-type strains and recombinantly engineered strains remains low. The Shine-Dalgarno (SD) sequence and stem-loop structure in the 5\u2032 or 3\u2032 untranslated region (UTR) are well-known determinants of mRNA stability. This study investigated the effect of mRNA stability on pullulanase heterologous expression. Results: We constructed four DNA fragments, pulA, SD-pulA, pulA-3t, and SD-pulA-3t,whichwere cloned into the expression vector pHT43 to generate four pullulanase expression plasmids. The DNA fragment pulA was the coding sequence (CDS) of pulA in Klebsiella variicola Z-13. SD-pulA was constructed by the addition of the 5\u2032 SD sequence at the 5\u2032 UTR of pulA. pulA-3t was constructed by the addition of a 3\u2032 stem-loop structure at the 3\u2032 UTR of pulA. SD-pulA-3t was constructed by the addition of the 5\u2032 SD sequence at the 5\u2032 UTR and a 3\u2032 stem-loop structure at the 3\u2032 UTR of pulA. The four vectors were transformed into Escherichia coli BL21(DE3). The pulA mRNA transcription of the transformant harboring pHT43-SD-pulA-3t was 338.6%, 34.9%, and 79.9% higher than that of the other three transformants, whereas the fermentation enzyme activities in culture broth and intracellularly were 107.0 and 584.1 times, 1.2 and 2.0 times, and 62.0 and 531.5 times the amount of the other three transformants (pulA, SD-pulA, and pulA-3 t), respectively. Conclusion: The addition of the 5\u2032 SD sequence at the 5\u2032 UTR and a 3\u2032 stem-loop structure at the 3\u2032 UTR of the pulA gene is an effective approach to increase pulA gene expression and fermentation enzyme activity

High Intensity Physical Rehabilitation Later Than 24 h Post Stroke Is Beneficial in Patients: A Pilot Randomized Controlled Trial (RCT) Study in Mild to Moderate Ischemic Stroke

Objective: Very early mobilization was thought to contribute to beneficial outcomes in stroke-unit care, but the optimal intervention strategy including initiation time and intensity of mobilization are unclear. In this study, we sought to confirm the rehabilitative effects of different initiation times (24 vs. 48 h) with different mobilization intensities (routine or intensive) in ischemic stroke patients within three groups.Materials and Methods: We conducted a randomized and controlled trial with a blinded follow-up assessment. Patients with ischemic stroke, first or recurrent, admitted to stroke unit within 24 h after stroke onset were recruited. Eligible subjects were randomly assigned (1:1:1) to 3 groups: Early Routine Mobilization in which patients received < 1.5 h/d out-of-bed mobilization within 24–48 h after stroke onset, Early Intensive Mobilization in which patients initiated ≥3 h/d mobilization at 24–48 h after the stroke onset, and Very Early Intensive Mobilization in which patients received≥3 h/d mobilization within 24 h. The modified Rankin Scale score of 0–2 was used as the primary favorable outcome.Results: We analyzed 248 of the 300 patients (80 in Early Routine Mobilization, 82 in Very Early Intensive Mobilization and 86 in Early Intensive Mobilization), with 52 dropping out (20 in Early Routine Mobilization, 18 in Very Early Intensive Mobilization and 14 in Early Intensive Mobilization). Among the three groups, the Early Intensive Mobilization group had the most favorable outcomes at 3-month follow-up, followed by patients in the Early Routine Mobilization group. Patients in Very Early Intensive Mobilization received the least odds of favorable outcomes. At 3 month follow up, 53.5%, (n = 46) of patients with Early Intensive Mobilization showed a favorable outcome (modified Rankin Scale 0–2) (p = 0.041) as compared to 37.8% (n = 31) of patients in the Very Early Intensive Mobilization.Conclusions: Post-stroke rehabilitation with high intensity physical exercise at 48 h may be beneficial. Very Early Intensive Mobilization did not lead to a favorable outcome at 3 months.Clinical Trial Registration:www.chictr.org.cn, identifier ChiCTR-ICR-15005992

Large vessel occlusion stroke outcomes in diabetic vs. non-diabetic patients with acute stress hyperglycemia

ObjectiveThis study assesses whether stress-induced hyperglycemia is a predictor of poor outcome at 3 months for patients with acute ischemic stroke (AIS) treated by endovascular treatment (EVT) and impacted by their previous blood glucose status.MethodsThis retrospective study collected data from 576 patients with AIS due to large vessel occlusion (LVO) treated by EVT from March 2019 to June 2022. The sample was composed of 230 and 346 patients with and without diabetes mellitus (DM), respectively, based on their premorbid diabetic status. Prognosis was assessed with modified Rankin Scale (mRS) at 3-month after AIS. Poor prognosis was defined as mRS>2. Stress-induced hyperglycemia was assessed by fasting glucose-to-glycated hemoglobin ratio (GAR). Each group was stratified into four groups by quartiles of GAR (Q1–Q4). Binary logistic regression analysis was used to identify relationship between different GAR quartiles and clinical outcome after EVT.ResultsIn DM group, a poor prognosis was seen in 122 (53%) patients and GAR level was 1.27 ± 0.44. These variables were higher than non-DM group and the differences were statistically significant (p < 0.05, respectively). Patients with severe stress-induced hyperglycemia demonstrated greater incidence of 3-month poor prognosis (DM: Q1, 39.7%; Q2, 45.6%; Q3, 58.6%; Q4, 68.4%; p = 0.009. Non-DM: Q1, 31%; Q2, 32.6%; Q3, 42.5%; Q4, 64%; p < 0.001). However, the highest quartile of GAR was independently associated with poor prognosis at 3 months (OR 3.39, 95% CI 1.66–6.96, p = 0.001), compared to the lowest quartile in non-DM patients after logistic regression. This association was not observed from DM patients.ConclusionThe outcome of patients with acute LVO stroke treated with EVT appears to be influenced by premorbid diabetes status. However, the poor prognosis at 3-month in patients with DM is not independently correlated with stress-induced hyperglycemia. This could be due to the long-term damage of persistent hyperglycemia and diabetic patients’ adaptive response to stress following acute ischemic damage to the brain

Potential TRIP/TWIP coupled effects in equiatomic CrCoNi medium-entropy alloy

High-entropy alloys (HEA) and medium-entropy alloys (MEA), containing multiple principal elements typ- ically with equiatomic or near-equiatomic ratios, have drawn considerable attention due to their unique and promising mechanical profiles, such as high tensile strength, superior ductility and exceptional frac- ture toughness. However, the elementary mechanisms controlling the deformation and fracture of this new class of alloys still need complementary analyses. In the present study, the nucleation and growth mechanisms of deformation bands in the medium-entropy CrCoNi alloy were investigated by atomic- resolution scanning transmission electron microscopy (STEM). It was revealed that planar dislocation slip is the dominant deformation mode in the early stages of deformation. With increasing strain, both de- formation twins and hexagonal close packed (HCP) lamella simultaneously appear. Careful analysis of the dislocations involved in these processes confirms that two different mechanisms are responsible for the nucleation of deformation bands in the CrCoNi alloy: the three-layer mechanism proposed by Mahajan et al. and the transformation from HCP phase to twin. Activation of multiple slip systems at larger de- formation levels leads to the activation of deviation-based mechanisms, which contribute to the twin growth. It was also observed that many HCP bands remain and overlap with nanoscale twins, leading to short range HCP-twin stackings, which contribute to the high work hardening rate of this alloy

Clustering behavior during natural aging and artificial aging in Al-Mg-Si alloys with different Ag and Cu addition

The effect of Ag and Cu addition on clustering behavior of Al-Mg-Si alloys during natural aging (NA) and artificial aging (AA) was investigated by hardness measurement, tensile test and atom probe tomography analysis. The results show that both Ag and Cu atoms could enter clusters and GP-zones, change the Mg/Si ratio and increase their volume fractions. Compared with the A1 base alloy, the clusters in the Ag/Cu-added alloys more easily transform to β″ phases for size and compositional similarity, and the strengthening ability of these particles is enhanced by the increased volume fraction and shear modulus. In NA condition, Cu is greater in improving the volume fraction of clusters than Ag and thus produces higher T4 temper hardness. In AA condition, in contrary, Ag is more effective in facilitating the formation and growth of particles than Cu due to the stronger Ag-Mg interaction and the high diffusivity of Ag atoms in Al matrix, leading to highest hardening response. Compared to the Cu-added alloy, the Ag-added alloy shows higher precipitation kinetics during AA treatment and maintains a lower T4 temper hardness

Evaluating the Impact of Institutional Performance and Government Trust on Farmers’ Subjective Well-Being: A Case of Urban–Rural Welfare Gap Perception and Family Economic Status in Shaanxi, Sichuan and Anhui, China

In the modern world, fostering comprehensive social sustainability has become one of the major concerns. Interestingly, rural livelihood may significantly comprise the compelling performance evaluations of governmental institutions’ performances. Governmental institutions’ performances in rural areas largely depend on whether they can gain relatively higher trust levels of marginal farmers. However, the critical interaction between these two prospects may foster farmers’ subjective well-being (SWB). Therefore, the study aims to model and test institutional performance, government trust, and farmers’ subjective well-being by utilising a survey of data from 963 farmer households in Shaanxi, Sichuan, and Anhui provinces, China. We have adopted structural equation modelling (SEM) to craft the study’s findings. However, in the literature, political performance is widely quantified by the urban–rural welfare and economic status gap; thus, in the core model, we have incorporated and measured the mediating role of the urban–rural welfare gap and household economic status. The results show that institutional performance, social insurance performance, and ecological livability performance have a significant and positive impact on institutional performance and government trust and eventually derive farmers’ SWB. However, the role of environmental livability performance is more substantial than social insurance performance in quantifying governmental trust and institutional performance. Moreover, it has a significant positive impact on the subjective well-being of farmers, and the effect of policy trust is not substantial. The results of further mediation and moderation effects show that social insurance performance and ecological livability performance can enhance the subjective well-being of farmers through the indirect transmission of institutional trust. In contrast, the mediating impact of policy trust is not significant. For farmers with higher economic status, institutional performance has a more substantial effect on the subjective well-being of farmers with a relatively smaller perception of the urban–rural welfare gap and lower family economic status