Clinical Observation of Concurrent Radio-Chemotherapy Combined with Adjuvant Chemotherapy in Treating Locoregionally Advanced Nasopharyngeal Carcinoma

OBJECTIVE To investigate the efficacy and side effects of concurrent radiochemotherapy using the TP regimen （paclitaxel and cisplatin） combined with adjuvant treatment in treating patients with locoregionally advanced nasopharyngeal carcinoma （NPC）. METHODS A total of 82 patients with a confirmed diagnosis of locoregionally advanced stage-III and IVa NPC were randomly divided into 2 groups： the treatment group （TG） with concurrent radiochemotherapy combined with adjuvant chemotherapy （n = 44） and the control group （CG） with simple radiotherapy （RT） （n = 38）. A total dose of 68 - 74 Gy of conformal radiation （X-ray, 4 MV or 8 MV） was given to patients in both groups. In the TG, a regimen of paxlitaxel and cisplatin was given via intravenous infusion in the 1st and 6th week concurrently with RT. After a 2-week intermission following RT, these patients received 2 cycles of the same chemotherapeutic regimen triweekly. RESULTS The effective rates of the treatment were, respectively, 71.1% and 76.3% in the CG, and 88.6% and 95.5% in the TG, at the end of treatment and 3 months thereafter. The differences in the therapeutic efficacy between the 2 groups were statistically significant （P 〈 0.05）. The 1- and 2-year survival rates were 81.1% and 73%, and 95.2% and 90.5%, respectively in the CG and the TG, and the differences between the 2 groups were statistically significant （P 〈 0.05）. The grade I-II reactions in the gastrointestinal tract, skin and oral mucosa were higher in patients receiving concurrent radiochemotherapy combined with adjuvant chemotherapy than in patients receiving simple radiotherapy （P 〈 0.05）. The differences in the occurrence of grade III-IV side effects including gastrointestinal, dermal and oral mucosal discomfort, other side effects, and late radioactive damage between the 2 groups were not statistically significant. CONCLUSION Concurrent radiochemotherapy combined with adjuvant chemotherapy in treating patients with locoregionally advanced NPC can further improve short-term therapeutic effects and the overall survival. However, there is an increased trend in toxicity secondary to treatment.

Stage IV malignant transformation of mature cystic teratoma palliatively treated with concurrent chemoradiotherapy:A case report

BACKGROUND Malignant transformation(MT)of mature cystic teratoma(MCT)has a poor prognosis,especially in advanced cases.Concurrent chemoradiotherapy(CCRT)has an inhibitory effect on MT.CASE SUMMARY Herein,we present a case in which CCRT had a reduction effect preoperatively.A 73-year-old woman with pyelonephritis was referred to our hospital.Computed tomography revealed right hydronephrosis and a 6-cm pelvic mass.Endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)revealed squamous cell carci-noma.The patient was diagnosed with MT of MCT.Due to her poor general con-dition and renal malfunction,we selected CCRT,expecting fewer adverse effects.After CCRT,her performance status improved,and the tumor size was reduced;surgery was performed.Five months postoperatively,the patient developed dis-semination and lymph node metastases.Palliative chemotherapy was ineffective.She died 18 months after treatment initiation.CONCLUSION EUS-FNB was useful in the diagnosis of MT of MCT;CCRT suppressed the disea-se and improved quality of life.

Survival benefit of concurrent chemoradiotherapy for advanced ampulla of Vater cancer

BACKGROUND Currently,there is no standard adjuvant therapy for patients with resected ampulla of Vater(AoV)cancer.AIM To evaluate the effectiveness of adjuvant concurrent chemoradiotherapy(CCRT)in patients with advanced AoV cancer who underwent curative resection.METHODS This single-centered,retrospective study included 29 patients with advanced AoV cancer who underwent pancreaticoduodenectomy between 2006 and 2018.The impact of CCRT on advanced AoV cancer was analyzed.RESULTS The 1-,3-,and 5-yr recurrence-free survival(RFS)rates for patients with advanced AoV cancer were 82.8%,48.3%,and 40.8%,respectively,and the overall survival(OS)rates were 89.7%,62.1%,and 51.7%,respectively.Lymphovas-cular invasion was found to be a significant risk factor for RFS and OS in patients with advanced AoV cancer in the univariate analysis,whereas T stage and lymph node metastasis were significantly associated with OS in the multivariate analysis.Compared to the patients who did not receive adjuvant CCRT,those who received adjuvant CCRT did not show statistically significant improvements in the RFS and OS,although they had a significantly lower average age and significantly higher platelet-to-lymphocyte ratio.CONCLUSION Adjuvant CCRT did not improve survival outcomes in patients with advanced AoV cancer.These findings contribute to existing knowledge on the effectiveness of CCRT in this patient population and provide important insights for clinical decision-making.

Anthropogenic Influence on Decadal Changes in Concurrent Hot and Dry Events over China around the Mid-1990s

The frequency and duration of observed concurrent hot and dry events(HDEs) over China during the growing season(April–September) exhibit significant decadal changes across the mid-1990s. These changes are characterized by increases in HDE frequency and duration over most of China, with relatively large increases over southeastern China(SEC), northern China(NC), and northeastern China(NEC). The frequency of HDEs averaged over China in the present day(PD,1994–2011) is double that in the early period(EP, 1964–81);the duration of HDEs increases by 60%. Climate experiments with the Met Office Unified Model(MetUM-GOML2) are used to estimate the contributions of anthropogenic forcing to HDE decadal changes over China. Anthropogenic forcing changes can explain 60%–70% of the observed decadal changes,suggesting an important anthropogenic influence on HDE changes over China across the mid-1990s. Single-forcing experiments indicate that the increase in greenhouse gas(GHG) concentrations dominates the simulated decadal changes,increasing the frequency and duration of HDEs throughout China. The change in anthropogenic aerosol(AA) emissions significantly decreases the frequency and duration of HDEs over SEC and NC, but the magnitude of the decrease is much smaller than the increase induced by GHGs. The changes in HDEs in response to anthropogenic forcing are mainly due to the response of climatological mean surface air temperatures. The contributions from changes in variability and changes in climatological mean soil moisture and evapotranspiration are relatively small. The physical processes associated with the response of HDEs to GHG and AA changes are also revealed.

Programmed cell death 1 inhibitor sintilimab plus concurrent chemoradiotherapy for locally advanced pancreatic adenocarcinoma

BACKGROUND Pancreatic adenocarcinoma,a malignancy that arises in the cells of the pancreas,is a devastating disease with unclear etiology and often poor prognosis.Locally advanced pancreatic cancer,a stage where the tumor has grown significantly but has not yet spread to distant organs,presents unique challenges in treatment.This article aims to discuss the current strategies,challenges,and future directions in the management of locally advanced pancreatic adenocarcinoma(LAPC).AIM To investigate the feasibility and efficacy of programmed cell death 1(PD-1)inhibitor sintilimab plus concurrent chemoradiotherapy for LAPC.METHODS Eligible patients had LAPC,an Eastern cooperative oncology group performance status of 0 or 1,adequate organ and marrow functions,and no prior anticancer therapy.In the observation group,participants received intravenous sintilimab 200 mg once every 3 wk,and received concurrent chemoradiotherapy(concurrent conventional fractionated radiotherapy with doses planning target volume 50.4 Gy and gross tumor volume 60 Gy in 28 fractions and oral S-140 mg/m2 twice daily on days 1-14 of a 21-d cycle and intravenous gemcitabine 1000 mg/m2 on days 1 and 8 of a 21-d cycle for eight cycles until disease progression,death,or unacceptable toxicity).In the control group,participants only received concurrent chemoradiotherapy.From April 2020 to November 2021,64 participants were finally enrolled with 34 in the observation group and 30 in the control group.RESULTS Thirty-four patients completed the scheduled course of chemoradiotherapy,while 32(94.1%)received sintilimab plus concurrent chemoradiotherapy with 2 patients discontinuing sintilimab in the observation group.Thirty patients completed the scheduled course of chemoradiotherapy in the control group.Based on the Response Evaluation Criteria in Solid Tumors guidelines,the analysis of the observation group revealed that a partial response was observed in 11 patients(32.4%),stable disease was evident in 19 patients(55.9%),and 4 patients(11.8%)experienced progressive disease;a partial response was observed in 6(20.0%)patients,stable disease in 18(60%),and progressive disease in 6(20%)in the control group.The major toxic effects were leukopenia and nausea.The incidence of severe adverse events(AEs)(grade 3 or 4)was 26.5%(9/34)in the observation group and 23.3%(7/30)in the control group.There were no treatment-related deaths.The observation group demonstrated a significantly longer median overall survival(22.1 mo compared to 15.8 mo)(P<0.05)and progression-free survival(12.2 mo vs 10.1 mo)(P<0.05)in comparison to the control group.The occurrence of severe AEs did not exhibit a statistically significant difference between the observation group and the control group(P>0.05).CONCLUSION Sintilimab plus concurrent chemoradiotherapy was effective and safe for LAPC patients,and warrants further investigation.

Phase Ⅰ/Ⅱ study of gemcitabine and oxaliplatin chemotherapy in combination with concurrent 3-D conformal radiotherapy for locally advanced non-small cell lung cancer

Background and objective Recent studies have showed that combination of chemotherapy and radiotherapy might result in better outcome for locally advanced non-small cell lung cancer (NSCLC). The aim of this study is to determine the maximal tolerance dose (MTD) and efficacy of full-dose gemcitabine and oxaliplatin when given concurrently with 3-dimentional radiation therapy (3D-RT) for locally advanced NSCLC. Methods Oxaliplatin was administered at a fixed dose of 130mg/m^2, and gemcitabine was administered at a starting dose of 800mg/m^2 with an incremental dose gradient of 200mg/m^2 for 3 dose levels. MTD was defined as the immediate dose level lower than the dose at which dose-limiting toxicity (DLT) occurred in more than one-third of the patients. The chemotherapy was administered at 3-week cycle. The RT was given as 3-D conformal manner at a single daily dose of 2Gy for 5 days per week. Results Twenty-two patients were evaluable and distributed to three different dose levels: 6 at level 1, 8 at level 2 and 8 at level 3. Pulmonary toxicity, esophageal and hematologic toxicity were the main DLT. Grade Ⅲ acute pulmonary toxicity occurred in one patient each at level 2 and level 3, both with V20>20%, and grade Ⅲ esophagitis in two patients at level 3. The MTD of gemcitabine in this study was 1000mg/m^2. The overall response rate was 75.0% (9/12). The 1- and 2-year survival rate was 70.0% and 30.5% respectively. The median time to progression was 8.7 months (range 5--11.8 months). Conclusion With reduced radiation volume, gemcitabine of 1000mg/m^2 in combination with oxaliplatin of 130mg/m^2 was effective and could be safely administered for NSCLC.

COOPERATIVE DESIGN UNDER CONCURRENT ENGINEERING ENVIRONMENT

This paper outlines a concurrent engineering environment that supports interaction between members of a geographically dispersed multidisciplinary team who is engaged in engineering design activities. Some ideas of engineering design, especially conceptual design are reviewed. A deeper scientific analysis of intelligent design is discussed. A new problem solving strategy and methodologies to implement cooperative design are proposed. Finally, a conceptual model of a blackboard system for accomplishing conceptual design automation is presented. Its fundamental principles, system organization and key implementation techniques are investigated in detail.

Accessory Breast Cancer Occurring Concurrently with Bilateral Primary Invasive Breast Carcinomas:A Report of Two Cases and Literature Review

The development of accessory breast tissue,which is found anywhere along the milk line,is attributed to the failure of milk line remnants to regress during embryogenesis.Primary tumors may arise from any ectopic breast tissue.Accessory breast cancer occurring concurrently with primary invasive breast cancer is extremely rare.Two such cases were reported in this article.One was a 43-year-old Chinese female who exhibited bilateral breast cancer(invasive ductal carcinoma,not otherwise specified,IDC-NOS) and an accessory breast carcinoma(IDC-NOS) incidentally identified in her left axilla.The ectopic breast tissue in her right axilla presented with adenosis.The patient was surgically treated,followed by postoperative docetaxel epirubicin(TE) chemotherapy.The second case was a 53-year-old Chinese female with bilateral breast cancer(apocrine carcinoma) accompanied by an accessory breast carcinoma(IDC-NOS) in her right axilla that was also incidentally identified.The patient was surgically treated after three doses of cyclophosphamide epirubicin docetaxel(CET) neoadjuvant chemotherapy,followed by adjuvant chemotherapy of the same regimen.

Data Concurrent Transmission MAC Protocol for Application Oriented Underwater Acoustic Sensor Networks

With the increasing demand for marine exploration, underwater acoustic sensor networks (UASNs) are prone to have the characteristics of large-scale, long term monitoring, and high data traffic load. Underwater media access control (MAC) protocols, which allow multiple users to share the common medium fairly and efficiently, are essential for the performance of UASNs. However, the design of MAC protocols is confronted with the challenges of spatial unfairness, data eruption, and low energy efficiency. In this paper, we propose a novel data concurrent transmission (DCT) MAC protocol, which is able to exploit long propagation delay and conduct concurrent transmission. Specifically, we present the theoretical performance analysis of the proposed MAC protocol in detail and give an analytical solution of the success concurrent transmission probability between nodes. In addition, simulation results are provided to demonstrate that our proposed protocol is appropriate for UASNs and can significantly improve the performance in terms of network throughput and energy consumption. Finally, we give some typical future applications of UASNs and discuss the demands on MAC protocol design.

Integrated Assembly Structure Design Within Concurrent Engineering

Taking a microwave product as an example, a system of integrated assembly structure design is presented. Getting design constraints from the upstream design section through product data management(PDM), the system generates the assembly scheme using the case? based method, then assigns the design requirements into each component of the assembly. The detail design for each component can be performed under these design constraints. In order to practise concurrent design, the system sends the final design result to the upstream section and downstream section through PDM to achieve information sharing and integration.

MODELING METHOD FOR CROSSCUTTING CONCERNS IN CONCURRENT SOFTWARE SYSTEM

A method for modeling crosscutting concerns in the concurrent software system is presented based on the aspect-oriented（A-O） technique and the statechart of unified modeling language （UML）. Modeled with UML statechart diagrams, the primary system functions and corresponding traversal features are enveloped into various orthogonal regions of a composite state. The mutual relationships between orthogonal regions are implied by the orders of broadcast events. Using a modular transition system as a basic computational model, the formalization description of A-O statechart models is proposed. The precise semantics of model elements and modeling procedures is given. The example study indicates that the separation strategy of crosscutting concerns is implemented in the design phase of the concurrent software system with this method. Meanwhile, the software modeling method has advantages of loose coupling, adaptability and traceability.

Effect of concurrent precipitation on recrystallization textures in commercial Al-Mn alloys

The effect of concurrent precipitation on recrystallization textures in AA 3003 aluminum alloys was investigated using X-ray diffraction and electron backscattering diffraction（EBSD） analyses. A weak recrystallization texture was observed in the AA 3003 alloy annealed at 783 K due to the high annealing temperature. Under the same conditions, extremely high P {011 } （ 111 ） recrystallization textures were detected in the AA 3003 alloy added with 0. 39% Sc. Based on the EBSD results, no intensely preferential orientation nucleation of recrystallization grains was observed in the early stage of recrystallizafion for both alloys. However, concurrent precipitation strongly retarded the growth of recrystallization grains, except for P nucleation sites, thereby conferring an apparent initial growth advantage for P nucleation sites compared with other nucleation sites. Therefore, a sharp P {011 } 〈 111 〉 texture appeared in concurrently precipitated AA 3003 alloys.

QUANTITATIVE APPROACH TO REAL TIME STARTUP TIME DETERMINATION OF DOWNSTREAM PHASES IN CONCURRENT ENGINEERING

Implementation of simultaneous execution phases in the concurrent engineering (CE) needs careful planning when the downstream phase could be activated as the upstream phase developed to a certain point. The determination of startup time of overlapping jobs in CE has long been a disturbance in manufacturing industry implementing CE programs. A novel model based on both fuzzy logic and neural network is proposed to mathematically formulate the inter-connective information between the two coupled phases in CE projects, and to determine the startup time of downstream phases in real time. The information transferring between the two coupled phases is quantified by using the negative Shannon entropy. Based on this algorithm, a PDM-based framework is proposed to narrow the gap between pro-duct design and manufacture, in which five modules are built to monitor, reshuffle and implement the simultaneous executing processes. Finally, an example is given to illustrate applications of the algorithm in the real world.

Process Environment Oriented Concurrent Tolerance Analysis

Tolerance analysis is investigated under an environment of concurrent design in order to lead to optimized tolerance, as traditional tolerance analysis is often inefficient and liable to mistakes. Making full use of knowledge in manufacturing tolerance analysis combined with the beta distribution model is introduced and applied. The use of beta distribution reflects fully actual capabilities in manufacture. Concurrent tolerance design is a manufacturing environment oriented design process paying more attention to influences or restraints on product design caused by such factors as the manufacturing process, machine capabilities, economy in manufacturing, etc. Process environment oriented tolerance analysis is more flexible making the designed results more practical and effective.

China Foundry Week 2017 and CHINACAST 2017 open concurrently in Suzhou city

China Foundry Week 2017＆the China Foundry Expo（CHINACAST）2017,hosted by the Foundry Institution of Chinese Mechanical Engineering Society（FICMES）and the State Key Laboratory of Light Aloy Casting Technology for High-end Equipment,were successfully held November 14-17,2017 in Suzhou International Expo Centre,Jiangsu Province, China.

Comment on concurrent removal of intravitreal lens fragments after phacoemulsification with pars plana vitrectomy prevents development of retinal detachment

I read with interest the article entitled ＂Concurrent removal of intravitreal lens fragments afterphacoemulsification with pars plana vitrectomy prevents development of retinal detachment＂ by Chalam et al . In this study, none of the patients developed retinal detachment （RD） during the one-year follow-up after concurrent removal lens fragments following phacoemulsification with pars plana vitrectomy （PPV）. The authors suggested that concurrent PPV for retained lens fragments after cataract surgery might prevent development of rhegmatogenous retinal detachment （RRD）, because early PPV prevents development of intraocular inflammation and inhibits vitreous contraction, a common cause of retinal tears and detachment.

EFFECT OF ACUPUNCTURE ON PLASMA STRESS HORMONE LEVELS OF HYPOTHALAMUS-PITUITARY-ADRENAL AXIS IN TYPE II DIABETES WITH CONCURRENT ACUTE CEREBRAL INFARCTION PATIENTS

Objective: To observe the effect of acupuncture on the contents of stress hormones of the hypothalamus pituitary adrenal axis (HPA) in treatment of type II diabetes with concurrent acute cerebral infarction patients. Methods: 60 cases of inpatients were randomly and evenly divided into treatment group (conventional medication plus acupuncture) and control (conventional mediation) group. Plasma corticotropin releasing hormone (CRH), adrenocorticotropin hormone (ACTH) and corticosteroid (CS) contents before and after treatment were measured using radioimmunoassay (RIA) and compared with those of healthy subject group (n=30). Results: Plasma CRH, ACTH and CS levels in patients of both treatment group and control group at admission were significant higher than those of normal subject group (P<0.05). After treatment for 15～30 days, results showed that plasma CRH, ACTH and CS levels in both treatment and control groups lowered significantly in comparison with those of pre treatment (P<0.05 or 0.01); while those of treatment group were even more lower (being closer to the normal values) than those of control group (P<0.05 or 0.01). Conclusion: Acupuncture therapy can reduce the stress state of HPA in type II diabetes with concurrent acute cerebral infarction patients, i.e. regulate the neuroendocrine immunological net, which may be one of the mechanisms for acupuncture treatment of cerebral stroke.

Analysis of preoperative concurrent chemoradiotherapy for superior sulcus lung tumor

Objective： To compare the clinical effect and toxicities of preoperative concurrent chemoradiotherapy （CT/RT） with radiotherapy （RT） alone in patients with superior sulcus lung tumor. Methods： Fifty-six patients with superior sulcus lung tumor were divided randomly into two groups： twenty-six patients received concurrent chemoradiotherapy, the other thirty patients received only radiotherapy. For both groups, the same radiation technic was given with the convention fraction. The total dose was 45 Gy/25 Fr/5 Wk. For the CT/RT group, the patients were also given with concurrent chemotherapy （navelbine 15-18 mg/m^2 on the 1st and 8th day, cisplatin 60 mg/m^2 on the 1st day）. Results： The rate of complete resection in the CT/RT group was significantly higher than that in the RT group （92.3% vs 80%, P 〈 0.05）. The complete pathological response rate and 2-year survival rate in the CT/RT group were significantly higher than those in the RT group （P 〈 0.01, P 〈 0.01）. The incidences of grades Ill-IV radiation esophagitis and leukopenia in the CT/RT group were significantly higher than those in the RT group （23.1% and 23.1% vs 6.7% and 0, P 〈 0.01, P 〈 0.01）. Conclusion： Preoperative concurrent chemoradiotherapy has the potential of improving the survival rate of superior sulcus lung tumors. Though this treatment regimen also increases the acute toxic effect, all patients can tolerate it. It is expected to be a new ＂standard treatment＂ for this malignant tumor.

A Concurrent Security Monitoring Method for Virtualization Environments

Recently,virtualization technologies have been widely used in industry.In order to monitor the security of target systems in virtualization environments,conventional methods usually put the security monitoring mechanism into the normal functionality of the target systems.However,these methods are either prone to be tempered by attackers or introduce considerable performance overhead for target systems.To address these problems,in this paper,we present a concurrent security monitoring method which decouples traditional serial mechanisms,including security event collector and analyzer,into two concurrent components.On one hand,we utilize the SIM framework to deploy the event collector into the target virtual machine.On the other hand,we combine the virtualization technology and multi-core technology to put the event analyzer into a trusted execution environment.To address the synchronization problem between these two concurrent components,we make use of Lamport's ring buffer algorithm.Based on the Xen hypervisor,we have implemented a prototype system named COMO.The experimental results show that COMO can monitor the security of the target virtual machine concurrently within a little performance overhead.

Detection of dengue NS1 antigen,alongside IgM plus IgG and concurrent platelet enumeration during an outbreak

During the late incubation period or initial phase of dengue virus infection,laboratory confirmation is through viral isolation in cell culture and/or molecular investigations, or immunofluorescence,or immunohistochemistry[1].The dengue virus non-structural antigen NSl that would develop before the appearance of dengue IgM and/or IgG is emerging as a suitable option for dengue diagnosis[2].Platelet therapy is a standard clinical practice for dengue patients with severe thrombocytopenia[3].However,during introductory screening,platelet count is not being done in many cases. This results in delays of platelet therapy. In the course of the current(2010) spurt of dengue in New Delhi[4],simultaneous screening for NSl,IgM and IgG and platelet enumeration has been introduced at the