Objectives: . The prognostic value of the pretreatment albumin-to-alkaline phosphatase ratio (AAPR) in head and neck cancer (HNC) remains uncertain. This meta-analysis aimed to evaluate the predictive role of AAPR for survival outcomes in patients with HNC. Methods: . A comprehensive search of the Cochrane Library, PubMed, and Embase databases was conducted to identify relevant studies published up to July 30, 2024. We included studies on AAPR and survival outcomes in HNC patients. Results: . Eight studies comprising 1,737 HNC patients were analyzed using random-effects models. Lower AAPR values were significantly correlated with worse overall survival (hazard ratio [HR], 2.08), progression-free survival (HR, 2.00), and disease-free survival (HR, 2.18). Sensitivity analyses confirmed the robustness of these results, with no significant publication bias detected. Conclusion . Our findings suggest that pretreatment AAPR could serve as a valuable and cost-effective prognostic indicator in HNC, potentially aiding clinicians in risk stratification and treatment decision-making. However, additional validation studies are warranted to confirm its clinical applicability.

Background: Despite the fact that an increasing number of studies have focused on developing therapies for acute lung injury, managing acute respiratory distress syndrome (ARDS) remains a challenge in intensive care medicine.Whether the pathology of animal models with acute lung injury in prior studies differed from clinical symptoms of ARDS, resulting in questionable management for human ARDS. To evaluate precisely the therapeutic effect of trans‑ planted stem cells or medications on acute lung injury, we developed an animal model of severe ARDS with lower lung function, capable of keeping the experimental animals survive with consistent reproducibility. Establishing this animal model could help develop the treatment of ARDS with higher efficiency. Results: In this approach, we intratracheally delivered bleomycin (BLM, 5 mg/rat) into rats’ left trachea via a needle connected with polyethylene tube, and simultaneously rotated the rats to the left side by 60 degrees. Within sevendays after the injury, we found that arterial blood oxygen saturation ­(SpO2 ) significantly decreased to 83.7%, partial pressure of arterial oxygen ­(PaO2 ) markedly reduced to 65.3 mmHg, partial pressure of arterial carbon dioxide ­(PaCO2 )amplified to 49.2 mmHg, and the respiratory rate increased over time. Morphologically, the surface of the left lung appeared uneven on Day 1, the alveoli of the left lung disappeared on Day 2, and the left lung shrank on Day 7. A his‑ tological examination revealed that considerable cell infiltration began on Day 1 and lasted until Day 7, with a larger area of cell infiltration. Serum levels of IL-5, IL-6, IFN-γ, MCP-1, MIP-2, G-CSF, and TNF-α substantially rose on Day 7. Conclusions This modified approach for BLM-induced lung injury provided a severe, stable, and one-sided (left-lobe) ARDS animal model with consistent reproducibility. The physiological symptoms observed in this severe ARDS animal model are entirely consistent with the characteristics of clinical ARDS. The establishment of this ARDS animal model could help develop treatment for ARDS.

Objective:To assess intrafractional errors of the deformation of clinical target volumes (CTVs) during online adaptive radiotherapy (OART) for prostate cancer patients, aiming to provide a basis for online plan optimization.Methods:A retrospective analysis was conducted for 13 prostate cancer patients who received 1.5 T magnetic resonance imaging (MRI)-guided OART (8 Gy × 5 fractions, totaling 65 fractions) at the Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. The MRI images were collected at the beginning and end of various treatment fractions. Then, the CTVs and organs at risk (OARs) were delineated by the same radiation oncologist. After rigid registration and triangle mesh generation, the surface vertices were extracted. The deformable registration for the CTV surfaces was performed using the thin-plate spline robust point matching (TPS-RPM) algorithm, yielding vertex correspondences. Last, both systematic and random intrafractional errors of CTV deformation were calculated.Results:The average Hausdorff distance (HD) for deformable registration of treatment fractions was (1.68 ± 0.28) mm. The intrafractional systematic errors of CTV deformation were (0.25 ± 3.18) mm (anterior-posterior direction; A-P), (0.89 ± 3.85) mm (left-right direction, L-R), and (-1.98 ± 6.69) mm (superior-inferior direction, S-I). The intrafractional random errors of CTV deformation were determined at (-0.26 ± 1.89) mm (A-P), (-0.08 ± 0.88) mm (L-R), and (-0.04 ± 1.86) mm (S-I).Conclusions:During OART, CTV deformations primarily occur in the S-I direction. Therefore, it is necessary to consider the expanded size of margins in this direction during OART for prostate cancer.

Background: Despite the fact that an increasing number of studies have focused on developing therapies for acute lung injury, managing acute respiratory distress syndrome (ARDS) remains a challenge in intensive care medicine.Whether the pathology of animal models with acute lung injury in prior studies differed from clinical symptoms of ARDS, resulting in questionable management for human ARDS. To evaluate precisely the therapeutic effect of trans‑ planted stem cells or medications on acute lung injury, we developed an animal model of severe ARDS with lower lung function, capable of keeping the experimental animals survive with consistent reproducibility. Establishing this animal model could help develop the treatment of ARDS with higher efficiency. Results: In this approach, we intratracheally delivered bleomycin (BLM, 5 mg/rat) into rats’ left trachea via a needle connected with polyethylene tube, and simultaneously rotated the rats to the left side by 60 degrees. Within sevendays after the injury, we found that arterial blood oxygen saturation ­(SpO2 ) significantly decreased to 83.7%, partial pressure of arterial oxygen ­(PaO2 ) markedly reduced to 65.3 mmHg, partial pressure of arterial carbon dioxide ­(PaCO2 )amplified to 49.2 mmHg, and the respiratory rate increased over time. Morphologically, the surface of the left lung appeared uneven on Day 1, the alveoli of the left lung disappeared on Day 2, and the left lung shrank on Day 7. A his‑ tological examination revealed that considerable cell infiltration began on Day 1 and lasted until Day 7, with a larger area of cell infiltration. Serum levels of IL-5, IL-6, IFN-γ, MCP-1, MIP-2, G-CSF, and TNF-α substantially rose on Day 7. Conclusions This modified approach for BLM-induced lung injury provided a severe, stable, and one-sided (left-lobe) ARDS animal model with consistent reproducibility. The physiological symptoms observed in this severe ARDS animal model are entirely consistent with the characteristics of clinical ARDS. The establishment of this ARDS animal model could help develop treatment for ARDS.

Objective:To construct a general deep learning dose prediction model applicable to radiotherapy for head and neck tumors, establish design methods for artificial intelligence (AI)-assisted radiotherapy plan and evaluate the accuracy of prediction.Methods:Radiotherapy plans of 818 patients who received radiotherapy for head and neck cancers from January 2018 to June 2021 in Cancer Hospital of Chinese Academy of Medical Sciences were enrolled. Patients involved 17 types of common head and neck cancers, and the prescribed dose covered 5 kinds of dose gradients ranging from 54 Gy to 73.92 Gy. And 1-2 cases per each cancer type (31 cases in total) were randomly selected as the validation set, and the remaining 787 cases were used as the training set to build a deep learning head and neck radiotherapy generalized dose prediction model. Then based on the dose prediction results of this model, a program was written to automatically generate inverse optimization condition scripts, which were sent back to the treatment planning system to achieve AI-assisted radiotherapy plan design. Among the patients who received radiotherapy in our hospital from June 2021 to January 2022, 1 patient for each disease type (17 cases in total) was selected to evaluate the AI-assisted plan design program and evaluate its clinical feasibility using paired t-test. Results:Dose prediction model accuracy evaluation revealed that in the 31-case validation set, there was no statistical difference in the evaluation metrics of clinical concern for organs at risks, except for the D 1 cm3 prediction for spinal cord planning risk volume, which was statistically different compared with the clinical reference plan. The AI-assisted plan design program had higher plan quality metric scores (37.88±6.42) than manual plans (35.00±7.63) in 17 test cases ( t=-1.00, P=0.166). The number of manual adjustments to the inverse optimization conditions was reduced from (5.47±2.97) times to (2.76±1.00) times for the AI-assisted plan compared to the manual-only plan ( t=4.12, P<0.001). And the number of outlined dose shaping structures was reduced from 7.35±3.98 to 3.12±1.18 ( t=5.61, P<0.001). Conclusions:The unified universal model of dose prediction established for different head and neck cancers has high accuracy in dose prediction for all types of head and neck tumor plans. The AI-assisted planning method established in this pattern can reduce the clinical workload of physicists and improve the efficiency of their work.

Artificial intelligence (AI) technologies are being widely applied in radiotherapy. However, the integration of AI into clinical workflows of radiotherapy faces a series of challenges, such as poor model interpretability, domain shifts between clinical application and training data, and the inherent model uncertainties. Therefore, case-specific quality assurance (QA) is essential before deploying AI models in clinical practice. This paper reviews and summarizes QA methodologies for the application of AI models in radiotherapy across four key areas: image registration, image generation, region of interest segmentation, and treatment planning.

Background: Despite the fact that an increasing number of studies have focused on developing therapies for acute lung injury, managing acute respiratory distress syndrome (ARDS) remains a challenge in intensive care medicine.Whether the pathology of animal models with acute lung injury in prior studies differed from clinical symptoms of ARDS, resulting in questionable management for human ARDS. To evaluate precisely the therapeutic effect of trans‑ planted stem cells or medications on acute lung injury, we developed an animal model of severe ARDS with lower lung function, capable of keeping the experimental animals survive with consistent reproducibility. Establishing this animal model could help develop the treatment of ARDS with higher efficiency. Results: In this approach, we intratracheally delivered bleomycin (BLM, 5 mg/rat) into rats’ left trachea via a needle connected with polyethylene tube, and simultaneously rotated the rats to the left side by 60 degrees. Within sevendays after the injury, we found that arterial blood oxygen saturation ­(SpO2 ) significantly decreased to 83.7%, partial pressure of arterial oxygen ­(PaO2 ) markedly reduced to 65.3 mmHg, partial pressure of arterial carbon dioxide ­(PaCO2 )amplified to 49.2 mmHg, and the respiratory rate increased over time. Morphologically, the surface of the left lung appeared uneven on Day 1, the alveoli of the left lung disappeared on Day 2, and the left lung shrank on Day 7. A his‑ tological examination revealed that considerable cell infiltration began on Day 1 and lasted until Day 7, with a larger area of cell infiltration. Serum levels of IL-5, IL-6, IFN-γ, MCP-1, MIP-2, G-CSF, and TNF-α substantially rose on Day 7. Conclusions This modified approach for BLM-induced lung injury provided a severe, stable, and one-sided (left-lobe) ARDS animal model with consistent reproducibility. The physiological symptoms observed in this severe ARDS animal model are entirely consistent with the characteristics of clinical ARDS. The establishment of this ARDS animal model could help develop treatment for ARDS.

Background: Despite the fact that an increasing number of studies have focused on developing therapies for acute lung injury, managing acute respiratory distress syndrome (ARDS) remains a challenge in intensive care medicine.Whether the pathology of animal models with acute lung injury in prior studies differed from clinical symptoms of ARDS, resulting in questionable management for human ARDS. To evaluate precisely the therapeutic effect of trans‑ planted stem cells or medications on acute lung injury, we developed an animal model of severe ARDS with lower lung function, capable of keeping the experimental animals survive with consistent reproducibility. Establishing this animal model could help develop the treatment of ARDS with higher efficiency. Results: In this approach, we intratracheally delivered bleomycin (BLM, 5 mg/rat) into rats’ left trachea via a needle connected with polyethylene tube, and simultaneously rotated the rats to the left side by 60 degrees. Within sevendays after the injury, we found that arterial blood oxygen saturation ­(SpO2 ) significantly decreased to 83.7%, partial pressure of arterial oxygen ­(PaO2 ) markedly reduced to 65.3 mmHg, partial pressure of arterial carbon dioxide ­(PaCO2 )amplified to 49.2 mmHg, and the respiratory rate increased over time. Morphologically, the surface of the left lung appeared uneven on Day 1, the alveoli of the left lung disappeared on Day 2, and the left lung shrank on Day 7. A his‑ tological examination revealed that considerable cell infiltration began on Day 1 and lasted until Day 7, with a larger area of cell infiltration. Serum levels of IL-5, IL-6, IFN-γ, MCP-1, MIP-2, G-CSF, and TNF-α substantially rose on Day 7. Conclusions This modified approach for BLM-induced lung injury provided a severe, stable, and one-sided (left-lobe) ARDS animal model with consistent reproducibility. The physiological symptoms observed in this severe ARDS animal model are entirely consistent with the characteristics of clinical ARDS. The establishment of this ARDS animal model could help develop treatment for ARDS.

Objective:To assess intrafractional errors of the deformation of clinical target volumes (CTVs) during online adaptive radiotherapy (OART) for prostate cancer patients, aiming to provide a basis for online plan optimization.Methods:A retrospective analysis was conducted for 13 prostate cancer patients who received 1.5 T magnetic resonance imaging (MRI)-guided OART (8 Gy × 5 fractions, totaling 65 fractions) at the Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. The MRI images were collected at the beginning and end of various treatment fractions. Then, the CTVs and organs at risk (OARs) were delineated by the same radiation oncologist. After rigid registration and triangle mesh generation, the surface vertices were extracted. The deformable registration for the CTV surfaces was performed using the thin-plate spline robust point matching (TPS-RPM) algorithm, yielding vertex correspondences. Last, both systematic and random intrafractional errors of CTV deformation were calculated.Results:The average Hausdorff distance (HD) for deformable registration of treatment fractions was (1.68 ± 0.28) mm. The intrafractional systematic errors of CTV deformation were (0.25 ± 3.18) mm (anterior-posterior direction; A-P), (0.89 ± 3.85) mm (left-right direction, L-R), and (-1.98 ± 6.69) mm (superior-inferior direction, S-I). The intrafractional random errors of CTV deformation were determined at (-0.26 ± 1.89) mm (A-P), (-0.08 ± 0.88) mm (L-R), and (-0.04 ± 1.86) mm (S-I).Conclusions:During OART, CTV deformations primarily occur in the S-I direction. Therefore, it is necessary to consider the expanded size of margins in this direction during OART for prostate cancer.