Clinical applications of custom-made vaginal cylinders constructed using three-dimensional printing technology.

PurposeThree-dimensional (3D) printing technology allows physicians to rapidly create customized devices for patients. We report our initial clinical experience using this technology to create custom applicators for vaginal brachytherapy.Material and methodsThree brachytherapy patients with unique clinical needs were identified as likely to benefit from a customized vaginal applicator. Patient 1 underwent intracavitary vaginal cuff brachytherapy after hysterectomy and chemotherapy for stage IA papillary serous endometrial cancer using a custom printed 2.75 cm diameter segmented vaginal cylinder with a central channel. Patient 2 underwent interstitial brachytherapy for a vaginal cuff recurrence of endometrial cancer after prior hysterectomy, whole pelvis radiotherapy, and brachytherapy boost. We printed a 2 cm diameter vaginal cylinder with one central and six peripheral catheter channels to fit a narrow vaginal canal. Patient 3 underwent interstitial brachytherapy boost for stage IIIA vulvar cancer with vaginal extension. For more secure applicator fit within a wide vaginal canal, we printed a 3.5 cm diameter solid cylinder with one central tandem channel and ten peripheral catheter channels. The applicators were printed in a biocompatible, sterilizable thermoplastic.ResultsPatient 1 received 31.5 Gy to the surface in three fractions over two weeks. Patient 2 received 36 Gy to the CTV in six fractions over two implants one week apart, with interstitial hyperthermia once per implant. Patient 3 received 18 Gy in three fractions over one implant after 45 Gy external beam radiotherapy. Brachytherapy was tolerated well with no grade 3 or higher toxicity and no local recurrences.ConclusionsWe established a workflow to rapidly manufacture and implement customized vaginal applicators that can be sterilized and are made of biocompatible material, resulting in high-quality brachytherapy for patients whose anatomy is not ideally suited for standard, commercially available applicators

Characterizing Protein Conformation Space

In this work, we propose a radical approach for exploring the space of all possible protein structures. We present techniques to explore the clash-free conformation space, which comprises all protein structures whose atoms are not in self-collision. Unlike energy based methods, this approach allows efficient exploration and remains general -- the benefits of characterization of the space apply to all proteins. We hypothesize that this conformation space branches into many small funnels as we sample compact conformations. We develop a compact representation the conformation space, and give experimental results that support our hypothesis. Potential applications of our method include protein folding as well as observing structural relationships between proteins.Singapore-MIT Alliance (SMA

Editorial : towards merging grid and pervasive computing

This special issue is in response to the increasing convergence between grids and pervasive computing, while different approaches exist, challenges and opportunities are numerous in this context (Parashar and Pierson, to appear). The research papers selected for this special issue represent recent progresses in the field, including works on mobile ad-hoc grids, service and data discovery, context-aware application building and context accuracy, and communication. All of these papers not only provide novel ideas and state-of-the-art techniques in the field, but also stimulate future research in the Pervasive Grid environment.<br /

A class of additive multiplicative graph functions

AbstractFor a fixed graph G, the capacity function for G, PG, is defined by PG(H) = limn→∞[γG(Hn)]1/n, where γG(H) is the maximum number of disjoint G's in H. In [2], Hsu proved that PK2 is multiplicative or not. In this paper, we prove that PG is multiplicative and additive for some graphs G which include K2. Some properties of PG are also discussed in this paper

The invariant manifold approach applied to nonlinear dynamics of a rotor-bearing system

The invariant manifold approach is used to explore the dynamics of a nonlinear rotor, by determining the nonlinear normal modes, constructing a reduced order model and evaluating its performance in the case of response to an initial condition. The procedure to determine the approximation of the invariant manifolds is discussed and a strategy to retain the speed dependent effects on the manifolds without solving the eigenvalue problem for each spin speed is presented. The performance of the reduced system is analysed in function of the spin speed

Postseismic deformation following the 1999 Chi-Chi earthquake, Taiwan: Implication for lower-crust rheology

On 1999 September 21, the Mw 7.6 Chi-Chi earthquake ruptured a segment of the Chelungpu Fault, a frontal thrust fault of the Western Foothills of Taiwan. The stress perturbation induced by the rupture triggered a transient deformation across the island, which was well recorded by a wide network of continuously operating GPS stations. The analysis of more than ten years of these data reveals a heterogeneous pattern of postseismic displacements, with relaxation times varying by a factor of more than ten, and large cumulative displacements at great distances, in particular along the Longitudinal Valley in eastern Taiwan, where relaxation times are also longer. We show that while afterslip is the dominant relaxation process in the epicentral area, viscoelastic relaxation is needed to explain the pattern and time evolution of displacements at the larger scale. We model the spatiotemporal behavior of the transient deformation as the result of afterslip on the décollement that extends downdip of the Chelungpu thrust, and viscoelastic flow in the lower crust and in the mid-crust below the Central Range. We construct a model of deformation driven by coseismic stress change where afterslip and viscoelastic flow are fully coupled. The model is compatible with the shorter relaxation times observed in the near field, which are due to continued fault slip, and the longer characteristic relaxation times and the reversed polarity of vertical displacements observed east of the Central Range. Our preferred model shows a viscosity of 0.5–1 X 10^(19) Pa s at lower-crustal depths and 5 X 10^(17) Pa s in the mid-crust below the Central Range, between 10 and 30 km depth. The low-viscosity zone at mid-crustal depth below the Central Range coincides with a region of low seismicity where rapid advection of heat due to surface erosion coupled with underplating maintain high temperatures, estimated to be between 300°C and 600°C from the modeling of thermo-chronology and surface heat flow data

Phase I study of dose escalation to dominant intraprostatic lesions using high-dose-rate brachytherapy.

PurposeRadiation dose escalation for prostate cancer improves biochemical control but is limited by toxicity. Magnetic resonance spectroscopic imaging (MRSI) can define dominant intraprostatic lesions (DIL). This phase I study evaluated dose escalation to MRSI-defined DIL using high-dose-rate (HDR) brachytherapy.Material and methodsEnrollment was closed early due to low accrual. Ten patients with prostate cancer (T2a-3b, Gleason 6-9, PSA &lt; 20) underwent pre-treatment MRSI, and eight patients had one to three DIL identified. The eight enrolled patients received external beam radiation therapy to 45 Gy and HDR brachytherapy boost to the prostate of 19 Gy in 2 fractions. MRSI images were registered to planning CT images and DIL dose-escalated up to 150% of prescription dose while maintaining normal tissue constraints. The primary endpoint was genitourinary (GU) toxicity.ResultsThe median total DIL volume was 1.31 ml (range, 0.67-6.33 ml). Median DIL boost was 130% of prescription dose (range, 110-150%). Median urethra V120 was 0.15 ml (range, 0-0.4 ml) and median rectum V75 was 0.74 ml (range, 0.1-1.0 ml). Three patients had acute grade 2 GU toxicity, and two patients had late grade 2 GU toxicity. No patients had grade 2 or higher gastrointestinal toxicity, and no grade 3 or higher toxicities were noted. There were no biochemical failures with median follow-up of 4.9 years (range, 2-8.5 years).ConclusionsDose escalation to MRSI-defined DIL is feasible. Toxicity was low but incompletely assessed due to limited patients' enrollment

Slip rates on the Chelungpu and Chushiang thrust faults inferred from a deformed strath terrace along the Dungpuna river, west central Taiwan

The Chelungpu fault produced the September 1999 M_w = 7.6 Chi-Chi earthquake, central Taiwan. The shortening rate accommodated by this structure, integrated over several seismic cycles, and its contribution to crustal shortening across the Taiwanese range have remained unresolved. To address the issues, we focus our study on the Chelungpu and Chushiang thrust faults within the southernmost portion of the Chi-Chi rupture area. Structural measurements and available seismic profiles are used to infer the subsurface geometry of structures. The Chushiang and Chelungpu faults appear as two splay faults branching onto a common ramp that further north connects only to the Chelungpu surface trace. We survey a deformed strath terrace along the Dungpuna river, buried under a 11,540 ± 309 years old fill deposit. Given this age, the dip angles of the faults, and the vertical throw determined from the offset of the strath terrace across the surface fault traces, we estimate slip rates of 12.9 ± 4.8 and 2.9 ± 1.6 mm/yr on the Chelungpu and Chushiang faults, respectively. These yield a total shortening rate of 15.8 ± 5.1 mm/yr to be absorbed on their common decollement at depth. This total value is an upper bound for the slip rate on the Chelungpu fault further north, where the Chushiang fault disappears and transfers shortening to adjacent faults. Combining these results with the recently constrained shortening rate on the Changhua blind thrust reveals that all these frontal faults presently absorb most of the long-term horizontal shortening across the Taiwanese range. They thus stand as the major sources of seismic hazards in this heavily populated area. The return period of earthquakes similar to the Chi-Chi event over a ∼80 km long stretch of the Western Foothills is estimated to be ~64 years. This value is an underestimate because it assumes that all the faults locked during the interseismic period slip only during such large events. Comparison with historical seismicity suggests that episodic aseismic deformation might also play a major role in accommodating shortening

A Change-Point Regression Approach for Efficacy Evaluation of Dietary Supplements

In clinical trials for dietary supplements and functional foods, the study population tends to be a mixture of healthy subjects and those who are not so healthy but are not definitely diseased (called “borderline subjects”). For such heterogeneous populations, the t-test and ANCOVA method often fail to provide the desired treatment efficacy. We propose an alternative approach for the efficacy evaluation of dietary supplements and functional foods based on a change-point linear regression model. The model does not require the assumption of a constant treatment effect and provides clinically interpretable results. By employing the AIC-based profile likelihood method, inferences can be made easily using standard statistical software. The proposed method was applied to the Garcinia study data, and the merit of the method was demonstrated by comparing it with traditional methods