BackgroundWhole brain radiotherapy (WBRT) has been the treatment of choice for patients with brain metastases. However, change/decline of neurocognitive functions (NCFs) resulting from impaired hippocampal neurogenesis might occur after WBRT. It is reported that conformal hippocampal sparing would provide the preservation of NCFs. Our study aims to investigate the hippocampal dosimetry and to demonstrate the correlation between hippocampal dosimetry and neurocognitive outcomes in patients receiving hippocampal sparing during WBRT (HS-WBRT).MethodsForty prospectively recruited cancer patients underwent HS-WBRT for therapeutic or prophylactic purposes. Before receiving HS-WBRT, all participants received a battery of baseline neurocognitive assessment, including memory, executive functions and psychomotor speed. The follow-up neurocognitive assessment at 4 months after HS-WBRT was also performed. For the delivery of HS-WBRT, Volumetric Modulated Arc Therapy (VMAT) with two full arcs and two non-coplanar partial arcs was employed. For each treatment planning, dose volume histograms were generated for left hippocampus, right hippocampus, and the composite hippocampal structure respectively. Biologically equivalent doses in 2-Gy fractions (EQD2) assuming an alpha/beta ratio of 2 Gy were computed. To perform analyses addressing the correlation between hippocampal dosimetry and the change in scores of NCFs, pre- and post-HS-WBRT neurocognitive assessments were available in 24 patients in this study.ResultsScores of NCFs were quite stable before and after HS-WBRT in terms of hippocampus-dependent memory. Regarding verbal memory, the corresponding EQD2 values of 0, 10, 50, 80 % irradiating the composite hippocampal structure with <12.60 Gy, <8.81, <7.45 Gy and <5.83 Gy respectively were significantly associated with neurocognitive preservation indicated by the immediate recall of Word List Test of Wechsler Memory Scale-III. According to logistic regression analyses, it was noted that dosimetric parameters specific to left sided hippocampus exerted an influence on immediate recall of verbal memory (adjusted odds ratio, 4.08; p-value, 0.042, predicting patients’ neurocognitive decline after receiving HS-WBRT).ConclusionsFunctional preservation by hippocampal sparing during WBRT is indeed achieved in our study. Providing that modern VMAT techniques can reduce the dose irradiating bilateral hippocampi below dosimetric threshold, patients should be recruited in prospective trials of hippocampal sparing during cranial irradiation to accomplish neurocognitive preservation while maintaining intracranial control.Trial registrationCurrent Controlled Trials NCT02504788Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-015-0562-x) contains supplementary material, which is available to authorized users.

No abstract

This investigation suggested that EVLI was an independent predictor for in-hospital survival in medical ICU patients with severe sepsis. Measurement of EVLI may be used for risk stratification among those patients.

Objective: The specific 30‐bp deletion of the Epstein‐Barr virus (EBV)‐derived latent membrane protein‐1 gene has been suggested to be associated with the pathogenesis of nasopharyngeal carcinoma (NPC) and a more aggressive phenotype of some EBV‐associated malignancies. Methods: The authors conducted a retrospective cohort study. Between 1995 and 2001, 542 patients who had received complete courses of radiotherapy followed by at least 3 years of follow up were enrolled. Patients were divided into two groups according to the presence or absence of the 30‐bp deletion in their tumor samples. Results: A total of 446 (82.3%) patients were found to feature the 30‐bp deletion, whereas 88 (16.2%) did not. Interestingly, dual infection was found in eight (1.5%) patients. No statistical significance was found in age, gender, NPC‐presenting stage, radiosensitivity, and pathologic classification between the two groups. The actuarial 5‐year overall survival rate and the distant metastasis‐free rate for the 30‐bp deletion and nondeletion group were not statistically different (61.3% vs. 65.4% and 68.1% vs. 73.1%; P = .132 and .135, respectively). In multivariate analysis, older age, nasopharyngeal recurrence, advanced tumor stage, and the development of distant metastasis were shown to be poorer prognosticators for overall survival, whereas the presence of 30‐bp deletion was not. For distant metastasis, only advanced tumor stage was shown to be a poor prognosticator, whereas other variables, including the presence of 30‐bp deletion, had no statistical significance. Conclusions: In this retrospective cohort, we have demonstrated that this specific 30‐bp sequence deletion might be only the predominant variant rather than an NPC phenotype‐associated polymorphism. Additionally, dual infection is a rare but possible phenomenon in the endemic NPC tumors.

No abstract

Background: Whole brain radiotherapy (WBRT) is the treatment of choice for patients with brain metastases. However, neurocognitive functions (NCFs) decline due to impaired hippocampal neurogenesis might occur thereafter. It is hypothesized that conformal hippocampal avoidance during the course of WBRT (HA-WBRT) might provide meaningful NCF preservation. Our study aims to demonstrate the impact of delivering HA-WBRT on NCF changes in patients receiving WBRT. Methods:Twenty-five patients who were referred for prophylactic cranial irradiation (PCI) or treating oligometastatic brain disease were enrolled in the study. Before the HA-WBRT course, all participants should receive baseline neurocognitive assessment, including memory, executive functions, and psychomotor speed. The primary endpoint was delayed recall, as determined by the change/decline in verbal memory [Wechsler Memory Scale -3 rd edition (WMS III)-Word List score] from the baseline assessment to 4 months after the start of HA-WBRT. Results:Only three patients belonged to the clinical setting of PCI; the remaining 22 patients had oligometastatic brain disease. Regarding neurocognitive outcomes, no statistically significant differences were found between various NCF scores obtained at baseline and at post-radiotherapy intervals, in immediate verbal memory and non-verbal memory, except for delayed recall memory on Word List (F = 5.727, p = 0.048). Conclusions: Functional preservation by hippocampal sparing during WBRT could largely be achieved in this study, which also suggests that HA-WBRT should be a feasible technique preserving neurocognitive functions while maintaining intracranial control. (Biomed J 2015;38:439-449) Key words: brain metastasis, hippocampus, hippocampus avoidance during whole brain radiotherapy, neurocognitive function, whole brain radiotherapy

The heart is one of the human body’s vital organs. An electrocardiogram (ECG) provides continuous tracings of the electrophysiological activity originated from heart, thus being widely used for a variety of diagnostic purposes. This study aims to design and realize an artificial intelligence (AI)-based abnormal heart beat detection with applications for early detection and timely treatment for heart diseases. A convolutional neural network (CNN) was employed to achieve a fast and accurate identification. In order to meet the requirements of the modularity and scalability of the circuit, modular and efficient processing element (PE) units and activation function modules were designed. The proposed CNN was implemented using a TSMC 0.18 μm CMOS technology and had an operating frequency of 60 MHz with chip area of 1.42 mm2 and maximum power dissipation of 4.4 mW. Furthermore, six types of ECG signals drawn from the MIT-BIH arrhythmia database were used for performance evaluation. Results produced by the proposed hardware showed that the discrimination rate was 96.3% with high efficiency in calculation, suggesting that it may be suitable for wearable devices in healthcare.

No abstract