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摘要： Purpose/Objective(s) The recurrence risk for head and neck (H&N) cutaneous squamous cell carcinoma (cSCC) is higher than other sites, and current National Cancer Comprehensive Network (NCCN) and American Society of Radiation Oncology (ASTRO) guidelines encourage considering adjuvant radiation therapy (RT) for high-risk patients. Actuarial recurrence rates following R0 Mohs micrographic surgery have to our knowledge not yet been reported for high risk cSCC H&N patients, and we hypothesized that recurrence rates would be low for these patients regardless of the addition of RT. Materials/Methods Between 1/2011 and 1/2020, 362 consecutive H&N cSCC tumors in 325 patients underwent R0 Mohs also with eligibility criteria of size > 2 cm, 10 of whom underwent adjuvant RT (median 52.5 Gy/25 fractions & 6 with elective nodal RT). Kaplan-Meier analyses were performed to evaluate recurrence outcomes, and log-rank was used to compare survival distributions of 2 samples with P ≤0.05 considered significant. Results Median follow-up from Mohs was 33.4 months, and mean pre-operative size was 3.0 cm with scalp the most common site. Median age was 80.0 years, and 3-year overall survival for all patients was 52.2% with only 4 deaths attributable to cSCC. There were 24 cSCC with perineural invasion (PNI), 32 poorly differentiated, 50 with deep invasion defined as > 6 mm or through subcutaneous fat, 72 with immunosuppression, and 109 with high-risk location defined as ear/lip/temple. No patient received adjuvant systemic therapy and none had a distant failure. The hazard ratios and 95% confidence intervals for locoregional recurrence with classic high-risk features were: PNI (2.68; 0.55 – 12.9), deep invasion (3.02; 0.96 – 9.53), poorly differentiated (vs. well/moderately) (2.20; 0.52 – 9.32), immunosuppression (1.36; 0.50 – 3.69), and high-risk location (0.91; 0.39 – 2.14). High risk tumors defined as AJCC T3 (vs. T1-T2) (3.39; 1.49 – 7.75) and BWH classification T2b-T3 (vs. T2a) (3.16;

关键词： 桥梁工程   车-缝-桥模型   试验验证   模数式伸缩缝   参数分析  

摘要： 伸缩缝劣化对车-桥耦合动力响应规律影响显著。为考虑伸缩缝参数变化对车-桥耦合动力响应的影响,结合车-桥耦合动力响应分析方法及车轮过缝的力学特性,提出了车轮过缝单点接触时变力模型。并采用伸缩缝局部振动模态提取法及模态综合法建立了考虑伸缩缝参数影响的车-桥耦合动力响应分析模型(车-缝-桥耦合动力响应分析模型)及其数值求解方法,并基于实测数据验证。进而以实测三跨连续梁桥为对象,探究了车辆过缝与否,伸缩缝高差、间隙,车速、车辆布置、车质量等参数对车-缝-桥耦合动力响应的参数影响规律。结果表明:端部支座外侧设置伸缩缝,会降低连续梁桥主梁跨中位移响应,但会增加桥梁端部的车致冲击作用;相同桥长条件下,车辆过缝会增大桥梁的位移和加速度响应,且加速度响应增大更为明显;伸缩缝高差会降低第一跨的竖向位移响应,但会增大其他两跨的竖向位移响应,伸缩缝高差对不同区域的车致冲击作用(系数)影响显著;伸缩缝附近车致冲击作用随伸缩缝间隙的增大而增大;车速较低时,主梁竖向峰值位移和冲击系数波动较小,并在80 km/h车速附近出现峰值;主梁各跨跨中的动位移均随着车辆数目的增多而增大,但各跨跨中的位移冲击系数不一定增加;桥梁冲击系数随车质量的增加而减小。在桥梁设计时应考虑伸缩缝参数变化对桥梁不同区域车致冲击作用变化的影响。

摘要： Purpose/Objective(s) Approximately 30-40% of patients irradiated for HNSCC will develop locoregional recurrence or second primary tumors (RSPT). Treatment of RSPT originating within a previously radiated field presents a technical challenge and typically portends worse outcomes than an initial course of RT. Anti-PD-1 therapy has shown promise in the treatment of advanced HNSCC. CA209-9KY aimed to investigate the potential benefit of nivo during and after IMRT based re-irradiation in RSPT. We report here the toxicity and QOL data for 44 enrolled patients. Materials/Methods Following IRB approval at 3 participating institutions, patients were enrolled if they had RSPT arising in a previously irradiated field (> 40 Gy) and met criteria for reirradiation classes I or II (Ward et al, IJROBP 2018); prior salvage resection was allowed regardless of HPV status provided patients had positive margins, extranodal extension, gross residual disease, N2/3 or T3/4 disease, multifocal perineural invasion, and/or lymphovascular space invasion. IMRT reirradiation with photons was delivered in 60-66 Gy in 30-33 daily fractions over 6-6.5 weeks with Nivo (240 mg) two weeks prior to and every 2 weeks during IMRT for a total of 5 doses then at 480 mg every 4 weeks for a total of 52 weeks. The Functional Assessment of Cancer Therapy (FACT-G) (Version 4) was assessed pre-therapy and weeks 6, 18, 30 and 52. The sum of FACT-G subscales (SUMQOL) score was also computed. Median and interquartile range (IQR) for each subscale and SUMQOL were recorded per cycle visit. FACT-HN was assessed at the same time intervals. Internal consistency reliability was measured using Cronbach's alpha and reported for each FACT sub-scale at each cycle Results As of 1/2021, a total of 44 patients have completed IMRT with nivolumab with a median follow up duration of 6.3 mos [95% CI (4.5-11.2)]. The most common toxicities of any grade-(CTCAE version 4.0) were fatigue (77%), dermatitis (54%), and dysphagia (52%). Gr

关键词： 大脚趾   阳台   袜子  

摘要： 立冬后的这个周末,我盘坐在床上,拿起针穿上黑色的细线,缝娃娃的书包带子、翻穿的衣兜、大脚趾处破了洞的袜子。和煦的阳光从阳台洒进屋里,让我想起了母亲坐在炕上缝缝补补的样子。小时候,入冬前,母亲总会早早做好我们上学穿的暖鞋。她先要做格精,把破旧的衣裤剪开,用面粉打好的d糊把布片一片一片平粘在墙上,再往布上刷一层糅糊粘另一层布,贴墙上晾干之后,咨精就做好了。

关键词： 伸缩缝施工技术   公路桥梁   动荷载因素  

摘要： 公路桥梁是我国重要的交通设施之一,其施工质量关乎社会公共安全及当地经济发展。伸缩缝是公路桥梁施工中的一项关键技术,直接影响公路桥梁的施工质量。为切实保证公路桥梁施工质量,早日实现“建设交通强国”战略目标,主要对公路桥梁伸缩缝施工技术的作用及其具体应用进行研究,为公路桥梁施工提供有益参考。

关键词： 屋顶绿化   植物选择   植物配置   植物管养  

摘要： 分析不同屋顶绿化类型环境在植物选择上的要求,结合厦门城市屋顶绿化现状,探讨适合该地区屋顶绿化的植物选择原则、适宜品种、配置方式和养护管理措施等,为厦门市屋顶绿化植物应用提供一定的参考。

摘要： Purpose/Objective(s) Prediction of extranodal extension (ENE) status of the involved lymph nodes has been shown to be an important factor in the prognosis and treatment of patients with Oropharyngeal Squamous Cell Carcinomas (OPSCC). Official diagnosis of ENE occurs pathologically at the time of surgery, and typically necessitates aggressive adjuvant treatment with radiation and concurrent chemotherapy. Due to higher toxicity with trimodality therapy, definitive chemoradiation can be a preferred treatment option up front instead of surgery if there is high clinical suspicion of ENE. This study investigates the potential value of radiomic features extracted from pre-treatment primary gross tumor volume (GTV) and clinical target volume (CTV) on diagnostic contrast enhanced Computed Tomography (CE-CT) images for prediction of ENE in patients with OPSCC. Materials/Methods For this study we identified 26 patients with pathologically confirmed OPSCC who went on to receive surgery and neck nodal dissection. Out of this group 13 were p16 positive, 13 were p16 negative, 7 were pathologic ENE positive, and 19 pathologic ENE negative. We contoured the primary tumor GTV on their pre-surgery CE-CT and added a 1 cm to create the CTV for radiomic analysis. For each patient, two sets of IBSI (Image Biomarker Standardization Initiative) validated radiomic features (N = 192 features from 11 different feature categories) were extracted from primary GTV and CTV on the diagnostic CE-CT images. Levene and Kolmogorov-Smirnov's (KS, P < 0.05) tests with confidence level of 95% along with absolute biserial correlation (|BSC|) with a threshold of > 0.2 were used to statistically reveal significant associations between ENE status and radiomics features. The Belsley collinearity diagnostics test was applied on the discriminant radiomic features for removing highly correlated features. Eight different Generalized-Linear Models (GLMs) were trained and tested using each individual feature along w

摘要： Purpose/Objective(s) High stage cutaneous squamous cell carcinoma (CSCC) has an elevated risk of recurrence (5-25%). Current staging systems stratify patients rely on tumor factors only. We sought to develop an RPA incorporating patient-, tumor-, disease-, and treatment-related factors to identify prognostic subgroups for high-stage CSCC patients receiving definitive therapy. Materials/Methods All high-stage CSCCs, defined as Brigham & Women's Hospital (BWH) tumor (T) staging system T2B and T3, treated with curative intent were included. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared by log rank test. Recursive partitioning analysis (RPA) was performed to identify prognostic factors for RFS and OS. Results A total of 444 patients (76% male, 95% Caucasian, median age 74 years) with 523 primary tumors were included. Median follow up was 31 months (range 1-194). 31% of patients were immunosuppressed (organ transplant 13%, chronic lymphocytic leukemia (CLL) 14%, and other reasons 3%). 432 tumors were BWH T2b and 91 were BWH T3, of whom 12% were node-positive, 32% node-negative, and 56% unknown nodal status. 33% of patients experienced recurrence. Immunosuppression, recurrent tumor, perineural invasion (PNI), and lymphovascular space invasion (LVSI) were associated with significantly worse RFS (median RFS 23 months, 95% CI, 19-28), while immunosuppression, lymph node positivity, and extranodal extension (ENE) were associated with significantly worse OS (median OS 40 months, 95% CI, 33-46). RPA identified 4 prognostic subgroups with distinct RFS patterns (P < 0.0001): class I included age < 77 years without LVSI (N = 212, 2-year RFS: 63%; 95% CI, 56-70%), class II included age ≥ 77 years without PNI (N = 132, 2-year RFS: 44%, 95% CI, 36-55%), class III included age < 77 years with LVSI (N = 36, 2-year RFS: 29%; 95% CI, 17-50%), and class IV included age ≥ 77 years with PNI (N = 60, 2-year RFS: 25%; 95% CI

关键词： 规划结构   建筑设计   交通流线   功能分区   材料构造   有机生长  

摘要： 在城市化进程中,校园建筑始终是最重要的建筑类型之一。地域性校园设计并非简单的模仿和流于表面形式,其回归理性的建筑创作,既可以成为一张城市名片,代表城市发展的水平和经济实力,又可以丰富校园教育生活,提升独特地域的文化特征。校园建筑主要包括学校的空间组织结构和校园的人文环境,结合温州工贸职业技术学院实例,针对其学校建筑的规划结构进行分析,交通流线设计,结构及立面外围护结构设计,校园内的环境设计等内容进行了分析研究,对一些设计中的难点问题提出了设计立意及应对策略,以期为类似设计提供一些借鉴。

关键词： 门窗品质   门窗设计   品质提升  

摘要： 为提高门窗设计的设计品质问题,对门窗的设计进行概要论述,并从门窗的型材、五金、密封材料、玻璃、节能设计五个维度探究门窗品质设计的关键内容,为同类门窗设计提供技术参考。