Association Between Three-Dimensional Transrectal Ultrasound Findings and Tumor Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer: An Observational Study

BackgroundThere is a significant demand for the development of non-surgical methods for the evaluation of complete response to tumor therapy. Predicting ability and image quality of routine imaging has not been satisfactory. To avoid the deficiencies, we assessed the capability of three-dimensional transrectal ultrasound in predicting the response to neoadjuvant chemoradiotherapy in rectal cancer patients.MethodsThe inclusion criteria were patients with locally advanced rectal adenocarcinoma, receiving capecitabine-based neoadjuvant chemoradiotherapy, distance from anal verge (≤6 cm), clinical stage T3-4 and/or N+ without evidence of distant metastasis, and restaging ycT0-3a (T3a <5 mm) after the end of neoadjuvant chemoradiotherapy. Three-dimensional transrectal ultrasound was performed 7 weeks after neoadjuvant chemoradiotherapy to discern the patients with complete response from the others. Eight main parameters were obtained from three-dimensional transrectal ultrasound: thickness of muscularis on the residual side, thickness of contralateral muscularis, angle of residual arc, regularity of the shape, integrity of the mucosal layer, blurring of the margin, internal echo, and posterior echo. The association between tumor response and three-dimensional transrectal ultrasound parameters was analyzed, and a model was developed by logistic regression.ResultsBetween 2014 and 2019, 101 patients were recruited; 72 cases received total mesorectal excision, and 29 cases underwent watch-and-wait. Among the three-dimensional transrectal ultrasound parameters, the adjusted-thickness of the muscularis (P<0.01), angle of the residual arc (P<0.01), and regularity of the residual shape (P<0.01) were strongly associated with tumor response. In the dataset with total mesorectal excision cases (TME dataset), the residual adjusted-thickness (odds ratio [OR]=4.88, 95% confidence interval [CI]=1.44–16.6, P=0.01) and regularity of the residual shape (OR=5.00, 95% CI=1.13–22.2, P=0.03) were kept in the final logistic model. The area under the curve of the logistic model was 0.84. Among these parameters, residual adjusted-thickness correlated significantly with tumor response. Additionally, we observed similar results in the whole population of 101 cases (whole dataset) and in the cross-validation.ConclusionThree-dimensional transrectal ultrasound model is a valuable method for predicting tumor response in rectal cancer patients undergoing neoadjuvant chemoradiotherapy, which should be included as a factor for evaluating clinical complete response.Trial RegistrationThis trial was registered with ClinicalTrials.gov, number NCT02605265. Registered 9 November 2015 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT0260526

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Cartesian Impedance Control on Five-Finger Dexterous Robot Hand DLR-HIT II with Flexible Joint

This paper presents an impedance controller for five-finger dexterous robot hand DLR-HIT II, which is derived in Cartesian space. By considering flexibility in finger joints and strong mechanical couplings in differential gear-box, modeling and control of the robot hand are described in this paper. The model-based friction estimation and velocity observer are carried out with an extended Kalman filter, which is implemented with parameters estimated by Least Squares Method. The designed estimator demonstrates good prediction performance, as shown in the experimental results. Stability analysis of the proposed impedance controller is carried out and described in this paper. Impedance control experiments are conducted with the five-finger dexterous robot hand DLR-HIT II in Cartesian coordinates system to help study the effectiveness of the proposed controller with friction compensation and hardware architecture

Flexible FPGA-Based Controller Architecture for Five-fingered Dexterous Robot Hand with Effective Impedance Control

Several practical issues associated with achieving effective impedance performance in the finger joint space and stable grasping on a five-fingered dexterous hand are investigated in this work. A Multiprocessor structure based on field programming gate array (FPGA) is proposed to realize the high-level hand impedance controller. The key feature of the hardware system is a dual-processor architecture based controller, one of which is used for data communication control and the other for joint and object level control. High speed (200μs cycle time) multipoint low-voltage differential signaling (LVDS) serial data bus communication between each finger and the controller, Ethernet communication between monitor PC and controller, are all implemented on a single FPGA chip. Experimental results and simulation with a five-fingered dexterous robot hand demonstrate that the controller architecture is able to achieve the desired robot hand impedance control performance and effective stable grasping

Asymptotic behavior of a regime-switching SIR epidemic model with degenerate diffusion

Abstract In this paper, we consider a stochastic SIR epidemic model with regime switching. The Markov semigroup theory will be employed to obtain the existence of a unique stable stationary distribution. We prove that, if Rs0 $\mathcal{R}^{s}>0$ and β(i)>α(i)(ε(i)+γ(i)) $\beta(i)>\alpha(i)(\varepsilon(i)+\gamma(i))$, i∈S $i\in\mathbb{S}$, the densities of the distributions of the solution can converge in L1 $L^{1}$ to an invariant density

Research on Hand-Transmitted Vibration Prediction Model of the Handheld EVA Power Tool

The hand-transmitted vibration generated by extravehicular activity (EVA) power tools has an important impact on the health of astronauts and the efficient completion of maintenance tasks when astronauts use EVA power tools for on-orbit maintenance. Based on the hand-transmitted vibration zero-gravity simulation test platform to measure the vibration response of the EVA power tool to human hands. Given the influence of the length of the operating rod and the number of non-detaching fastening devices on daily vibration exposure when astronauts wear extravehicular spacesuit gloves, a second-order polynomial model and a quadratic cumulative nonlinear model of daily vibration exposure are established. The experimental results show that the second-order polynomial model is more explanatory and predictive of the test data in the scope of the test. The R-values of the palm and opisthenar prediction model are 0.9930 and 0.9940 respectively, and the RMSEs are 7.973×10−4 m/s2 and 1.034×10−3 m/s2. The quadratic cumulative nonlinear model can accurately predict the vibration exposure of the hand outside the scope of the test. This study can provide theoretical reference and data support for the prediction of vibration exposure generated by astronauts using the EVA power tools during on-orbit maintenance

Effect of heating rate during annealing on microstructure and texture evolution of AA8021 aluminum foil

The microstructure and texture evolution of AA8021 aluminum foil during annealing at 270 °C with heating rates of 10 °C h ^−1 and 40 °C h ^−1 were investigated by the optical microscope (OM), microhardness tester, field emission scanning electron microscope (FE-SEM) and x-ray diffractometer (XRD). The results show that the microhardness of aluminum foil gradually decreases during the heating process, and the microhardness of aluminum foil with the heating rate of 40 °C h ^−1 is higher than that of 10 °C h ^−1 . After annealing at 270 °C for 16 h, the average grain size of aluminum foil with the heating rate of 10 °C h ^−1 is 13.0 μ m and the maximum grain size does not exceed 35 μ m, while the average grain size with the heating rate of 40 °C h ^−1 is 14.6 μ m and its fraction of the grain area of greater than or equal to 40 μ m is 2.4%. The slow heating rate is beneficial to grain refinement of AA8021 aluminum foil due to the release of most deformation energy in the low temperature stage during heating, which leads to the decrease of driving force for crystal nuclei growth. Under the two heating rates, the texture components of the material after annealing are basically the same, mainly the recrystallized Cube, R textures and the residual rolling textures