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Background and purposesThis study compared VMAT and IMRT plans for intact breast radiotherapy for left sided breast cancer and evaluated the irradiated dose of planning target volume and OARs, especially focusing on heart and coronary artery.Materials and methodsEleven patients with left sided breast cancer whose breast was relatively smaller (the mean volumes is 296 cc) treated with breast-conserving surgery were prescribed radiotherapy of 50 Gy in 25 fractions using two or four-field step and shoot IMRT (2 or 4-F IMRT), and one or two-arc VMAT (1 or 2-arc VMAT). The 10 Gy electron boost to the tumor bed after delivery of 50 Gy was not included in the analysis. Multiple planning parameters for the PTV and the PRV-OARs were measured and analyzed.ResultsTreatment plans generated using VMAT had better PTV homogeneity than the IMRT plans. For the PRV-OARs, the 1-arc VMAT had significantly higher Dmean and V5 for left lung and heart, and showed worse Dmean for liver, esophagus, spinal cord, contralateral lung and breast. In contrast, the 2-arc VMAT and the 2-F or 4-F IMRT plans showed better results for the PRV-OARs than the 1-arc VMAT. However, for the heart and coronary artery, the 1-arc VMAT showed better V20 and V40 compared with the other plans. Moreover, the 2 F-IMRT had specially advantage on V5 and V20 for heart and V5 for coronary arteries, the 2-F IMRT also showed a greater MU and treatment times. Using the table of quality score to evaluate the plans, we found that 2-F IMRT had the highest scores of 13, followed by the 2-arc VMAT plan (10 points) and 1-arc VMAT plan (8 points), and finally the 4-F IMRT plan (6 points). Moreover, when a dose comparison for heart minus coronary artery was calculated, the V20 and V40 for the rest of heart in all plans were very small and closed, indicating the dose to the coronary artery contributed dramatically to the high dose volumes for the entire heart.ConclusionsCompared to other plans, the 2-F IMRT plan with fewer monitor units and shorter delivery time is an appropriate technique for left sided breast cancer, which achieved good PTV coverage and sparing of organs at risk besides for the heart and coronary artery.

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Despite the early excitement surrounding business-to-business (B2B) e-marketplaces during the Internet boom, many exchanges have since closed, citing their inability to generate sufficient revenue from thin transaction volumes. Discussions with industry participants revealed that many firms were carefully watching developments, but were reluctant to commit serious trading volumes to online channels. For the near future at least, many firms intend to continue to conduct the majority of their strategic transactions through traditional relationship-based contracting. Surviving e-marketplaces are trying hard to come up with compelling value propositions for participants. In this survey we explore the difficulties faced by e-marketplaces and discuss potential sources of value that will encourage their adoption by preserving and complementing long-term B2B relationships. We focus on the role of e-marketplaces in B2B transactions, where long-term relationships between buyers and sellers are important, as is the case in many supply chains. Our objective is to present an industry perspective that will help a business-oriented reader to develop an understanding of the opportunities and issues associated with e-marketplaces. In addition, we use realworld examples to motivate future research and applications in this area. Along with the Internet boom came high expectations for the role of e-marketplaces and their potential to enhance supply chain efficiency. 1 From 1998 to 2000, business-to-business (B2B) e-commerce was heralded as the next major innovation in business, and analysts projected that trillions of dollars would flow through B2B exchanges by 2004. Legions of exchanges sprang up virtually overnight, supported by a new industry of e-business software vendors providing tools for everything from dynamic pricing to collaborative commerce. This brief but meteoric rise came to a sudden halt by the end of 2000. In the two-month period following the peak, many e-marketplaces failed or merged. Firms reevaluated their e-business strategies and reduced their investments in B2B activities. Investors lost confidence in B2B-related stocks. Within a year, Ariba and Commerce One, two key B2B e-commerce

The purposes of this review were to give the optimal cutoffs of the Montreal Cognitive Assessment (MoCA) by comparing sensitivity and specificity under different cutoffs and compare the MoCA with other screening tools in post-stroke cognitive impairment (PSCI) determined by a neuropsychological evaluation. Articles were derived from a systematic search in PubMed, Web of science, Embase, and CINAHL and were assessed for internal validity by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The figure of risk of bias was made by Review Manager 5.3, and data of selected studies were synthesized by MetaDisc 1.4. Twelve diagnostic studies, involving 2130 patients, were included. The area under the curve (AUC) under cutoffs of 20v19, 21v20, and 26v25 are 0.90, 0.90, and 0.95, showing high predictive validity for PSCI screening within 1 month. When the sensitivity and specificity are equal important, the optimal cutoff is 20v19 (Youden Index = 0.58). Compared to the Mini-Mental State Examination (MMSE), the MoCA has higher sensitivity but lower specificity. The optimal cutoff differs in different stages of stroke. Both the MMSE and MoCA are appropriate screening tools for PSCI, and the use of these two tools should be in accordance with the aim of screening. The Addenbrooke's Cognitive Examination-Revised (ACE-R) can act as a supplement for the MoCA.

Background Tumor mutation burden (TMB) is an important determinant and biomarker for response of targeted therapy and prognosis in patients with lung cancer. The present study aimed to determine whether radiomics signature could non‐invasively predict the TMB status and driver mutations in patients with resectable early stage lung adenocarcinoma (LUAD). Methods A total of 61pulmonary nodules (PNs) from 51 patients post‐operatively diagnosed LUAD were enrolled for analysis. Two datasets were divided according to two‐thirds of patients from different commercial Comprehensive Genomic Profiling (CGP) panels: a training cohort including 41 PNs and a testing cohort including rest 20PNs. We sequenced all tumor specimens and paired blood cells using next generation sequencing (NGS), so as to detect TMB status and somatic mutations. We collected 718 quantitative 3D radiomics features extracted from segmented volumes of each PNs and 78 clinical and pathological features retrieved from medical records as well. Support vector machine methods were performed to establish the predictive model. Results We established an efficient fusion‐positive tumor prediction model that predicts TMB status and EGFR/TP53 mutations of early stage LUAD. The radiomics signature yielded a median AUC value of 0.606, 0.604, and 0.586 respectively. Combining radiomics with the clinical information can further improve the prediction performance, which the median AUC values are 0.671 for TMB, 0.697 and 0.656 for EGFR/TP53 respectively. Conclusion It is feasible and effective to facilitate TMB and somatic driver mutations prediction by using the radiomics signature and NGS data in early stage LUAD.

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BackgroundTo determine the effect of surgery on the survival status of patients with locally advanced cervical cancer after radiotherapy/chemoradiotherapy.MethodsPubMed, Web of Science, ProQuest and Medline were searched using the key words “cervical cancer”, “locally advanced disease”, “radiotherapy” and “surgery or hysterectomy”. Eight articles were selected and analysed using the STATA 12.0 software package. The log hazard ratio (HR) and its standard error for overall survival were calculated to assess the effect of surgery on patients with locally advanced cervical cancer after radiotherapy/chemoradiotherapy.ResultsIn total, 2176 patients with locally advanced cervical cancer were identified. The pooled HR for overall survival was 1.13 (95% confidence interval (CI) 0.906–1.409), and there were no differences among the eight manuscripts (z = 1.08, p = 0.278). In the subgroup analysis, the pooled HR for overall survival was 1.169 (95% CI 0.924–1.480), and no differences among patients with stage IB-IIB disease were found in six articles (z = 1.30, p = 0.193). There was no publication bias regarding overall survival or stage IB-IIB disease.ConclusionsThis meta-analysis suggested that surgery had no effect on overall survival after radiotherapy/chemoradiotherapy; therefore, it is not recommended for patients with locally advanced cervical cancer.