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Optimal fractionation in radiotherapy with multiple normal tissues 多个正常组织放射治疗的最佳分割
Pub Date : 2016-06-01 DOI: 10.1093/imammb/dqv015
Fatemeh Saberian;Archis Ghate;Minsun Kim
The goal in radiotherapy is to maximize the biological effect (BE) of radiation on the tumour while limiting its toxic effects on healthy anatomies. Treatment is administered over several sessions to give the normal tissue time to recover as it has better damage-repair capabilities than tumour cells. This is termed fractionation. A key problem in radiotherapy involves finding an optimal number of treatment sessions (fractions) and the corresponding dosing schedule. A major limitation of existing mathematically rigorous work on this problem is that it includes only a single normal tissue. Since essentially no anatomical region of interest includes only one normal tissue, these models may incorrectly identify the optimal number of fractions and the corresponding dosing schedule. We present a formulation of the optimal fractionation problem that includes multiple normal tissues. Our model can tackle any combination of maximum dose, mean dose and dose-volume type constraints for serial and parallel normal tissues as this is characteristic of most treatment protocols. We also allow for a spatially heterogeneous dose distribution within each normal tissue. Furthermore, we do not a priori assume that the doses are invariant across fractions. Finally, our model uses a spatially optimized treatment plan as input and hence can be seamlessly combined with any treatment planning system. Our formulation is a mixed-integer, non-convex, quadratically constrained quadratic programming problem. In order to simplify this computationally challenging problem without loss of optimality, we establish sufficient conditions under which equal-dosage or single-dosage fractionation is optimal. Based on the prevalent estimates of tumour and normal tissue model parameters, these conditions are expected to hold in many types of commonly studied tumours, such as those similar to head-and-neck and prostate cancers. This motivates a simple reformulation of our problem that leads to a closed-form formula for the dose per fraction. We then establish that the tumour-BE is quasiconcave in the number of fractions; this ultimately helps in identifying the optimal number of fractions. We perform extensive numerical experiments using 10 head-and-neck and prostate test cases to uncover several clinically relevant insights.
放射治疗的目标是使放射对肿瘤的生物效应(BE)最大化,同时限制其对健康解剖的毒性作用。治疗分几期进行,给正常组织时间恢复,因为它比肿瘤细胞有更好的损伤修复能力。这被称为分馏。放射治疗的一个关键问题是找到最佳的治疗次数(分数)和相应的给药计划。在这个问题上,现有的数学严谨的工作的一个主要限制是,它只包括一个单一的正常组织。由于基本上没有一个感兴趣的解剖区域只包括一个正常组织,这些模型可能不正确地识别最佳分数和相应的给药计划。我们提出了一个公式的最优分馏问题,包括多个正常组织。我们的模型可以处理串行和并行正常组织的最大剂量、平均剂量和剂量-体积类型约束的任何组合,因为这是大多数治疗方案的特征。我们还允许在每个正常组织内的空间不均匀剂量分布。此外,我们不先验地假设剂量在各个分数之间是不变的。最后,我们的模型使用空间优化的治疗计划作为输入,因此可以与任何治疗计划系统无缝结合。我们的公式是一个混合整数,非凸,二次约束的二次规划问题。为了简化这个具有计算挑战性的问题而不失去最优性,我们建立了等剂量或单剂量分馏是最优的充分条件。根据对肿瘤和正常组织模型参数的普遍估计,这些条件预计在许多类型的常见肿瘤中都存在,例如类似于头颈癌和前列腺癌的肿瘤。这促使我们对问题进行简单的重新表述,从而得出每组分剂量的封闭形式公式。然后我们建立了肿瘤- be在分数数上是准凹形的;这最终有助于确定分数的最佳数量。我们使用10个头颈和前列腺测试案例进行了广泛的数值实验,以揭示几个临床相关的见解。
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引用次数: 39
Improving Bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer by adding interleukin 2 (IL-2): a mathematical model 加入白细胞介素2 (IL-2)改善卡介苗免疫治疗膀胱癌的数学模型
Pub Date : 2016-06-01 DOI: 10.1093/imammb/dqv007
Svetlana Bunimovich-Mendrazitsky;Sarel Halachmi;Natalie Kronik
One of the treatments offered to non-invasive bladder cancer patients is BCG instillations, using a well-established, time-honoured protocol. Some of the patients, however, do not respond to this protocol. To examine possible changes in the protocol, we provide a platform for in silico testing of alternative protocols for BCG instillations and combinations with IL-2, to be used by urologists in planning new treatment strategies for subpopulations of bladder cancer patients who may benefit from a personalized protocol. We use a systems biology approach to describe the BCG-tumour-immune interplay and translate it into a set of mathematical differential equations. The variables of the equation set are the number of tumour cells, bacteria cells, immune cells, and cytokines participating in the tumour-immune response. Relevant parameters that describe the system's dynamics are taken from a variety of independent literature, unrelated to the clinical trial results assessed by the model predictions. Model simulations use a clinically relevant range of initial tumour sizes (tumour volume) and tumour growth rates (tumour grade), representative of a virtual population of fifty patients. Our model successfully retrieved previous clinical results for BCG induction treatment and BCG maintenance therapy with a complete response (CR) rate of 82%. Furthermore, we designed alternative maintenance protocols, using IL-2 combinations with BCG, which improved success rates up to 86% and 100% of the patients, albeit without considering possible side effects. We have shown our simulation platform to be reliable by demonstrating its ability to retrieve published clinical trial results. We used this platform to predict the outcome of treatment combinations. Our results suggest that the subpopulation of non-responsive patients may benefit from an intensified combined BCG IL-2 maintenance treatment.
提供给非侵袭性膀胱癌患者的治疗方法之一是卡介苗注射,使用一种完善的、历史悠久的方案。然而,一些患者对该方案没有反应。为了检查方案中可能的变化,我们提供了一个平台,对卡介苗灌注和IL-2联合的替代方案进行计算机测试,供泌尿科医生用于规划可能从个性化方案中受益的膀胱癌亚群患者的新治疗策略。我们使用系统生物学方法来描述bcg -肿瘤-免疫相互作用,并将其转化为一组数学微分方程。方程组的变量是参与肿瘤免疫反应的肿瘤细胞、细菌细胞、免疫细胞和细胞因子的数量。描述系统动力学的相关参数取自各种独立文献,与模型预测评估的临床试验结果无关。模型模拟使用临床相关的初始肿瘤大小(肿瘤体积)和肿瘤生长速率(肿瘤分级)范围,代表50名患者的虚拟人群。我们的模型成功地检索了以前卡介苗诱导治疗和卡介苗维持治疗的临床结果,完全缓解率(CR)为82%。此外,我们设计了替代的维持方案,使用IL-2联合卡介苗,提高了成功率高达86%和100%的患者,尽管没有考虑可能的副作用。我们通过展示其检索已发表临床试验结果的能力,证明了我们的模拟平台是可靠的。我们使用这个平台来预测联合治疗的结果。我们的研究结果表明,无应答患者亚群可能受益于强化联合卡介苗-2维持治疗。
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引用次数: 30
Front matter 前页
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引用次数: 0
Revisiting a two-patch SIS model with infection during transport 重新审视运输过程中感染的双补丁SIS模型
Pub Date : 2016-03-01 DOI: 10.1093/imammb/dqv001
Julien Arino;Chengjun Sun;Wei Yang
We incorporate parameter heterogeneity in a two-patch susceptible-infectious-susceptible (SIS) epidemic model with infection during transport and prove that the disease-free and endemic equilibria are globally asymptotically stable when the basic reproduction number $mathscr {R}_0 < 1$ and $mathscr {R}_0>1$, respectively. We find that infection during transport increases the possibility that the disease persists in both patches and amplifies prevalence when disease is present. We then study the effect of a perfect unilateral exit screening programme. Finally, we compare numerically the effects of using different incidence functions for infection within and while travelling between patches, and find that using mass action incidence to model infection during transport has the effect of maintaining disease prevalence at a higher level compared with when standard incidence is used.
我们将参数异质性引入到具有运输过程中感染的两斑块易感-感染-易感(SIS)流行病模型中,并证明当基本繁殖数$mathscr {R}_0 <1$和$mathscr {R}_0>1$。我们发现,运输过程中的感染增加了疾病在两个斑块中持续存在的可能性,并在存在疾病时扩大了患病率。然后,我们研究了一个完美的单边出境筛查计划的效果。最后,我们在数值上比较了使用不同的发生率函数在斑块内部和斑块之间旅行时的感染效果,并发现使用质量作用发生率来模拟运输过程中的感染与使用标准发生率相比,具有将疾病流行率保持在更高水平的效果。
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引用次数: 16
Front matter 前页
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引用次数: 0
Modelling cholesterol effects on the dynamics of the hypothalamic–pituitary–adrenal (HPA) axis 模拟胆固醇对下丘脑-垂体-肾上腺(HPA)轴动力学的影响
Pub Date : 2016-03-01 DOI: 10.1093/imammb/dqu020
Vladimir M. Marković;Željko Čupić;Stevan Maćešić;Stevan Maćešić;Vladana Vukojević;Ljiljana Kolar-Anić
A mathematical model of the hypothalamic–pituitary–adrenal (HPA) axis with cholesterol as a dynamical variable was derived to investigate the effects of cholesterol, the primary precursor of all steroid hormones, on the ultradian and circadian HPA axis activity. To develop the model, the parameter space was systematically examined by stoichiometric network analysis to identify conditions for ultradian oscillations, determine conditions under which dynamic transitions, i.e. bifurcations occur and identify bifurcation types. The bifurcations were further characterized using numerical simulations. Model predictions agree well with empirical findings reported in the literature, indicating that cholesterol levels may critically affect the global dynamics of the HPA axis. The proposed model provides a base for better understanding of experimental observations, it may be used as a tool for designing experiments and offers useful insights into the characteristics of basic dynamic regulatory mechanisms that, when impaired, may lead to the development of some modern-lifestyle-associated diseases.
以胆固醇为动力学变量,推导了下丘脑-垂体-肾上腺(HPA)轴的数学模型,以研究胆固醇(所有类固醇激素的主要前体)对HPA轴超昼夜活动的影响。为了开发该模型,通过化学计量网络分析系统地检查了参数空间,以确定超二次振荡的条件,确定动态转变(即分叉)发生的条件,并确定分叉类型。使用数值模拟进一步表征了分叉。模型预测与文献中报道的经验结果一致,表明胆固醇水平可能严重影响HPA轴的全球动态。所提出的模型为更好地理解实验观察提供了基础,它可以用作设计实验的工具,并对基本动态调节机制的特征提供了有用的见解,这些机制在受损时可能导致一些现代生活方式相关疾病的发展。
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引用次数: 27
Numerical resolution of a model of tumour growth 肿瘤生长模型的数值分辨率
Pub Date : 2016-03-01 DOI: 10.1093/imammb/dqv004
Ana I. Muñoz
We consider and solve numerically a mathematical model of tumour growth based on cancer stem cells (CSC) hypothesis with the aim of gaining some insight into the relation of different processes leading to exponential growth in solid tumours and into the evolution of different subpopulations of cells. The model consists of four hyperbolic equations of first order to describe the evolution of four subpopulations of cells. A fifth equation is introduced to model the evolution of the moving boundary. The coefficients of the model represent the rates at which reactions occur. In order to integrate numerically the four hyperbolic equations, a formulation in terms of the total derivatives is posed. A finite element discretization is applied to integrate the model equations in space. Our numerical results suggest the existence of a pseudo-equilibrium state reached at the early stage of the tumour, for which the fraction of CSC remains small. We include the study of the behaviour of the solutions for longer times and we obtain that the solutions to the system of partial differential equations stabilize to homogeneous steady states whose values depend only on the values of the parameters. We show that CSC may comprise different proportions of the tumour, becoming, in some cases, the predominant type of cells within the tumour. We also obtain that possible effective measure to detain tumour progression should combine the targeting of CSC with the targeting of progenitor cells.
我们考虑并数值求解基于肿瘤干细胞(CSC)假设的肿瘤生长数学模型,目的是深入了解导致实体肿瘤指数增长的不同过程之间的关系以及不同细胞亚群的进化。该模型由四个一阶双曲方程组成,描述了四个细胞亚群的进化。引入第五个方程来模拟运动边界的演化。模型的系数表示反应发生的速率。为了对四个双曲方程进行数值积分,提出了一个用总导数表示的公式。采用有限元离散法对模型方程进行空间积分。我们的数值结果表明,在肿瘤的早期阶段,存在一个伪平衡状态,在这个状态下,CSC的比例仍然很小。我们研究了长时间解的行为,得到了偏微分方程组的解稳定于齐次稳态,其值仅与参数的值有关。我们表明CSC可能包含肿瘤的不同比例,在某些情况下,成为肿瘤内的主要细胞类型。我们还发现,将靶向CSC和靶向祖细胞结合起来可能是阻止肿瘤进展的有效措施。
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引用次数: 3
Back matter 背景材料
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引用次数: 0
Mathematical modelling of decline in follicle pool during female reproductive ageing 女性生殖老化过程中卵泡池下降的数学模型
Pub Date : 2016-03-01 DOI: 10.1093/imammb/dqv006
Alagu Thilagam
The factors which govern the subtle links between follicle loss and mammalian female reproductive ageing remain unclear despite extensive studies undertaken to understand the critical physiological and biochemical mechanisms that underly the accelerated decline in follicle numbers in women older than 37 years. It is not certain whether there is a sole control by the ovary or whether other factors which affect ageing also intersect with the ovarian effect. There is convincing experimental evidence for an interplay of several processes that seem to influence the follicle loss-female reproductive ageing links, with specific hormones (follicle-stimulating hormone, anti-Müllerian hormone, dehydroepiandrosterone) noted to play important roles in follicular dynamics and ovarian ageing. In this work, we examine the subtle links between the rate of follicular decline with ageing and the role of hormones via a series of non-autonomous equations. Simulation results based on the time evolution of the number of ovarian follicles and biochemical changes in the ovarian environment influenced by hormone levels is compared with empirical data based on follicle loss-reproductive ageing correlation studies.
尽管进行了大量研究,以了解37岁以上女性卵泡数量加速下降的关键生理和生化机制,但控制卵泡丧失与哺乳动物女性生殖衰老之间微妙联系的因素仍不清楚。目前尚不确定是否只有卵巢对衰老起唯一的控制作用,或者是否其他影响衰老的因素也与卵巢的作用相交叉。有令人信服的实验证据表明,几个过程的相互作用似乎影响卵泡损失-女性生殖衰老的联系,特定激素(促卵泡激素,抗勒勒激素,脱氢表雄酮)在卵泡动力学和卵巢衰老中发挥重要作用。在这项工作中,我们通过一系列非自主方程研究了卵泡下降率与衰老和激素作用之间的微妙联系。基于卵巢卵泡数量随时间的变化以及激素水平对卵巢环境生化变化的影响的模拟结果与基于卵泡损失-生殖衰老相关性研究的经验数据进行比较。
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引用次数: 7
Conduction of feedback-mediated signal in a computational model of coupled nephrons 耦合肾元计算模型中反馈介导信号的传导
Pub Date : 2016-03-01 DOI: 10.1093/imammb/dqv005
Ioannis Sgouralis;Anita T. Layton
The nephron in the kidney regulates its fluid flow by several autoregulatory mechanisms. Two primary mechanisms are the myogenic response and the tubuloglomerular feedback (TGF). The myogenic response is a property of the pre-glomerular vasculature in which a rise in intravascular pressure elicits vasoconstriction that generates a compensatory increase in vascular resistance. TGF is a negative feedback response that balances glomerular filtration with tubular reabsorptive capacity. While each nephron has its own autoregulatory response, the responses of the kidney's many nephrons do not act autonomously but are instead coupled through the pre-glomerular vasculature. To better understand the conduction of these signals along the pre-glomerular arterioles and the impacts of internephron coupling on nephron flow dynamics, we developed a mathematical model of renal haemodynamics of two neighbouring nephrons that are coupled in that their afferent arterioles arise from a common cortical radial artery. Simulations were conducted to estimate internephron coupling strength, determine its dependence on vascular properties and to investigate the effect of coupling on TGF-mediated flow oscillations. Simulation results suggest that reduced gap-junctional conductances may yield stronger internephron TGF coupling and highly irregular TGF-mediated oscillations in nephron dynamics, both of which experimentally have been associated with hypertensive rats.
肾脏中的肾元通过几种自我调节机制来调节其液体流动。两种主要机制是肌源性反应和小管肾小球反馈(TGF)。肌源性反应是肾小球前血管系统的一种特性,其中血管内压力升高引起血管收缩,从而产生代偿性血管阻力增加。TGF是平衡肾小球滤过和小管重吸收能力的负反馈反应。虽然每个肾单位都有自己的自我调节反应,但肾脏的许多肾单位的反应并不是自主的,而是通过肾小球前血管系统相互作用。为了更好地理解这些信号沿肾小球前小动脉的传导以及肾素偶联对肾素血流动力学的影响,我们建立了两个相邻肾素肾血流动力学的数学模型,这两个相邻肾素的传入小动脉来自一个共同的皮质桡动脉。研究人员进行了模拟,以估计干扰素耦合强度,确定其对血管特性的依赖,并研究耦合对tgf介导的血流振荡的影响。模拟结果表明,减少的间隙连接电导可能会产生更强的肾细胞间TGF耦合和高度不规则的TGF介导的肾细胞动力学振荡,这两种情况在实验中与高血压大鼠有关。
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引用次数: 8
期刊
Mathematical medicine and biology : a journal of the IMA
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