Lexicographic ordering: intuitive multicriteria optimization for IMRT

Optimization problems in IMRT inverse planning are inherently multicriterial since they involve multiple planning goals for targets and their neighbouring critical tissue structures. Clinical decisions are generally required, based on tradeoffs among these goals. Since the tradeoffs cannot be quantitatively determined prior to optimization, the decision-making process is usually indirect and iterative, requiring many repetitive optimizations. This situation becomes even more challenging for cases with a large number of planning goals. To address this challenge, a multicriteria optimization strategy called lexicographic ordering (LO) has been implemented and evaluated for IMRT planning. The LO approach is a hierarchical method in which the planning goals are categorized into different priority levels and a sequence of sub-optimization problems is solved in order of priority. This prioritization concept is demonstrated using two clinical cases (a simple prostate case and a relatively complex head and neck case). In addition, a unique feature of LO in a decision support role is discussed. We demonstrate that a comprehensive list of planning goals (e.g., ∼23 for the head and neck case) can be optimized using only a few priority levels. Tradeoffs between different levels have been successfully prohibited using the LO method, making the large size problem representations simpler and more manageable. Optimization time needed for each level was practical, ranging from ∼26 s to ∼217 s. Using prioritization, the LO approach mimics the mental process often used by physicians as they make decisions handling the various conflicting planning goals. This method produces encouraging results for difficult IMRT planning cases in a highly intuitive manner.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58100/2/pmb7_7_006.pd

Real-Time Test-Bed System Development Using Power Hardware-in-the-Loop (PHIL) Simulation Technique for Reliability Test of DC Nano Grid

Since various power sources such as renewable energy and energy storage systems (ESSs) are connected to the DC grid, the reliability of the grid system is significant. However, the configuration of an actual DC grids for testing the reliability of the grid system is inconvenient, expensive and dangerous. In this paper, a test-bed system made up of a 20-kW DC nano grid and a control algorithm considering an external grid based on Power Hardware-in-the-Loop (PHIL) simulation are proposed to demonstrate the reliability of the DC grid. Using the PHIL simulation technique, target grids can be safely implemented with laboratory-level instruments and simulated by real-time simulators, which emulates grid operations that are similar to the actual grid. In addition, using the proposed control algorithm, the operations of grid-connected converters are demonstrated according to the grid-connected or islanding modes. Finally, the reliability of the simulated DC nano grid and the effectiveness of the grid-connected converter are verified using the PHIL simulation system with 3-kW prototype converters

Analysis and Design of Three-Phase Buck Rectifier Employing UPS to Supply High Reliable DC Power

In the DC distribution system, to step down the DC voltage level from the AC grid voltage, the conventional topologies require multiple power conversion stages and bulky line-frequency transformers, which degrade their power density and cost-effectiveness. In addition, the conventional topologies suffer from a shoot-through problem resulting in their low system reliability. In this paper, to overcome the above issues, systematic design approaches of a three-phase buck rectifier with an uninterruptible power supply (UPS) and a protection algorithm are proposed to obtain the high reliability of the DC distribution system, which can deal with fault conditions and can regulate the output voltage level. It only requires a single stage of the three-phase buck rectifier. Also, a thyristor switch is added without any commutation circuits to cut off the output from the fault circuit. The shoot-through faults do not occur in the buck rectifier, leading to high reliability. A dual-active-bridge (DAB) DC-DC converter is applied as the UPS to supply the electric power from the battery when the buck rectifier is shut down under the fault conditions. Finally, the protection algorithm is proposed to detect the fault conditions and to regulate the output voltage level

DHP-Derivative and Low Oxygen Tension Effectively Induces Human Adipose Stromal Cell Reprogramming

BACKGROUND AND METHODS: In this study, we utilized a combination of low oxygen tension and a novel anti-oxidant, 4-(3,4-dihydroxy-phenyl)-derivative (DHP-d) to directly induce adipose tissue stromal cells (ATSC) to de-differentiate into more primitive stem cells. De-differentiated ATSCs was overexpress stemness genes, Rex-1, Oct-4, Sox-2, and Nanog. Additionally, demethylation of the regulatory regions of Rex-1, stemnesses, and HIF1alpha and scavenging of reactive oxygen species were finally resulted in an improved stem cell behavior of de-differentiate ATSC (de-ATSC). Proliferation activity of ATSCs after dedifferentiation was induced by REX1, Oct4, and JAK/STAT3 directly or indirectly. De-ATSCs showed increased migration activity that mediated by P38/JUNK and ERK phosphorylation. Moreover, regenerative efficacy of de-ATSC engrafted spinal cord-injured rats and chemical-induced diabetes animals were significantly restored their functions. CONCLUSIONS/SIGNIFICANCE: Our stem cell remodeling system may provide a good model which would provide insight into the molecular mechanisms underlying ATSC proliferation and transdifferentiation. Also, these multipotent stem cells can be harvested may provide us with a valuable reservoir of primitive and autologous stem cells for use in a broad spectrum of regenerative cell-based disease therapy

X-ray imaging with amorphous silicon active matrix flat-panel imagers (AMFPIs)

Recent advances in thin-film electronics technology have opened the way for the use of flat-panel imagers in a number of medical imaging applications. These novel imagers offer real time digital readout capabilities ( ∼ 30(∼30 frames per second), radiation hardness (>106 cGy),(>106cGy), large area (30×40 cm2)(30×40cm2) and compactness ( ∼ 1 cm).(∼1cm). Such qualities make them strong candidates for the replacement of conventional x-ray imaging technologies such as film-screen and image intensifier systems. In this report, qualities and potential of amorphous silicon based active matrix flat-panel imagers are outlined for various applications such as radiation therapy, radiography, fluoroscopy and mammography. © 1997 American Institute of Physics.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87833/2/241_1.pd

Potential for doseâ escalation and reduction of risk in pancreatic cancer using IMRT optimization with lexicographic ordering and gEUDâ based cost functions

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135067/1/mp6403.pd

TDP1 and TOP1 Modulation in Olaparib-Resistant Cancer Determines the Efficacy of Subsequent Chemotherapy

The aim of this study was to elucidate the carryover effect of olaparib to subsequent chemotherapy and its underlying mechanisms. We generated olaparib-resistant SNU-484, SNU-601, SNU-668, and KATO-III gastric cancer cell lines and confirmed their resistance by cell viability and colony forming assays. Notably, olaparib-resistant cell lines displayed cross-resistance to cisplatin except for KATO-III. Inversely, olaparib-resistant SNU-484, SNU-668, and KATO-III were more sensitive to irinotecan than their parental cells. However, sensitivity to paclitaxel remained unaltered. There were compensatory changes in the ATM/ATR axis and p-Chk1/2 protein expression. ERCC1 was also induced in olaparib-resistant SNU-484, SNU-601, and SNU-668, which showed cross-resistance to cisplatin. Olaparib-resistant cells showed tyrosyl-DNA phosphodiesterase 1 (TDP1) downregulation with higher topoisomerase 1 (TOP1) activity, which is a target of irinotecan. These changes of TOP1 and TDP1 in olaparib-resistant cells was confirmed as the underlying mechanism for increased irinotecan sensitivity through manipulated gene expression of TOP1 and TDP1 by specific plasmid transfection and siRNA. The patient-derived xenograft model established from the patient who acquired resistance to olaparib with BRCA2 mutation showed increased sensitivity in irinotecan. In conclusion, the carryover effects of olaparib to improve antitumor effect of subsequent irinotecan were demonstrated. These effects should be considered when determining the subsequent therapy with olaparib.

Subarachnoid Hemorrhage Mimicking Leakage of Contrast Media After Coronary Angiography

We report a patient who developed subarachnoid hemorrhage (SAH) just after coronary angiography (CAG) with non-ionic contrast media (CM) and minimal dose of heparin. The 55-year-old man had a history of acute ST elevation myocardial infarction that had been treated with primary percutaneous coronary intervention and was admitted for a follow-up CAG. The CAG was performed by the transradial approach, using 1000 U of unfractionated heparin for the luminal coating and 70 mL of iodixanol. At the end of CAG, he complained of nausea and rapidly became stuporous. Brain CT showed a diffusely increased Hounsfield unit (HU) in the cisternal space, similar to leakage of CM. The maximal HU was 65 in the cisternal space. No vascular malformations were detected on cerebral angiography. The patient partially recovered his mental status and motor weakness after 2 days. Two weeks later, subacute SAH was evident on magnetic resonance imaging. The patient was discharged after 28 days

A Gartner duct cyst of the vagina causing dysuria and dyschezia in a Yorkshire Terrier

A 5 year-old, intact female Yorkshire terrier was referred for dysuria and dyschezia. The radiographic and ultrasound examination showed a round shaped mass caudal to the urinary bladder that contained anechoic fluid within the thin walls. During surgery, the cyst was noted to be attached to the outer wall of the vagina, not connected to the vaginal lumen. Cystic fluid was removed and the cystic wall was resected. Then the remaining cystic wall was omentalized to prevent a recurrence