Objective To explore the use of Swedish medical company CMS 4.6.4 radiotherapy XIO system for the design process of cervical cancer postoperative IMRT plans in different iterative times of the same case,and to observe the Segment Weight Optimization(SWO)effect generated after the plan results.Methods Ten cases of cervical cancer patients were chosen ,the use of XIO 4.6.4 CMS treatment system was performed for the development of the intensity modulated radiation therapy .In the SWO process , iterative times were used to generate different plans ,without affecting the clinical dose target area requirements , and compared the organs at risk( OAR) by determining whether there were differences between dose and the number of segments ,monitor units (MU).Results For the same patients,different iterative times within a certain range of SWO IMRT plan were selected to compare the different iterative times plan ,femoral head,rectum and the bladder dose did not change the basic plan.The total number of segments and MU did not change significantly (P>0.05).Conclusion IM-RT plans in the use of CMS XIO 4.6.4 design of cervical cancer after operation in the process of using the itera-tive times below 100 times for SWO is the most suitable method for ensuring the organ dosimetry in radiotherapy . The total number of segments and the MU reduces the radiotherapy plan time so as to improve work efficiency .

Objective:To evaluate the relationship between postoperative delirium and preoperative frailty in elderly patients undergoing non-cardiac surgery.Methods:Elderly patients undergoing non-cardiac surgery at our hospital from March 2019 to July 2022 were collected and their age, comorbidities, gender, smoking history, type of surgery, preoperative albumin, duration of surgery, duration of anesthesia, postoperative hypotension, educational level, nutritional status, American Society of Anesthesiologists (ASA) Physical Status classification, postoperative admission to ICU or not, intraoperative bleeding and preoperative frailty status were collected. The patients were divided into delirium group and non-delirium group according to whether postoperative delirium occurred. The risk factors for postoperative delirium were analyzed by multivariate logistic regression analysis, and the receiver operating characteristic curve was drawn to analyze the value of risk factors in predicting postoperative delirium.Results:There were 74 cases in delirium group and 321 cases in non-delirium group, and the incidence of postoperative delirium was 18.7%. There were statistically significant differences in terms of age ≥70 yr, education level of junior high school and below, poor nutritional status, ASA Physical Status classification Ⅲ, postoperative admission to ICU, proportion of frailty and intraoperative bleeding volume between delirium group and non-delirium group ( P<0.05). The results of logistic regression analysis showed that age, educational level, nutritional status, ASA Physical Status classification, intraoperative bleeding and frailty were all independent risk factors for delirium ( P<0.05). The area under the receiver operating characteristic curve of preoperative frailty predicting postoperative delirium was 0.672 (95% confidence interval 0.605-0.740). Conclusions:Preoperative frailty is an independent risk factor for postoperative delirium in elderly patients undergoing noncardiac surgery, which can predict the occurrence of postoperative delirium to some extent.

BackgroundRumination can play a certain degree role of psychological adjustment in cancer patients. Previous studies have focused on studying the level of rumination in a single type of cancer patient， but there is a lack of comprehensive investigation and influencing factor research on rumination levels in different types of cancer patients. ObjectiveTo explore the level of rumination and its influencing factors among middle-advanced cancer inpatients， so as to provide certain guidance for targeted psychological care in clinical practice. MethodsFrom January 2021 to December 2022， a systematic sampling technique was used to recruit 346 patients with TNM stage III or above tumors hospitalized in Nuclear Industry 416 Hospital， Chengdu Sixth People's Hospital and the First People's Hospital of Yibin. All individuals were assessed using Perceived Social Support Scale （PSSS） and the Chinese version of Event-Related Ruminant Inventory （C-ERRI）， and Logistic regression analysis was utilized to identify the influencing factors of rumination. ResultsIn terms of C-ERRI， patients scored （15.59±5.61） on intrusive rumination and （14.59±5.43） on deliberate rumination. Education levels of junior high school/high school/vocational training school （OR=0.817， P<0.01） and junior college and above （OR=0.579， P<0.05） were the protective factors of intrusive rumination， whereas annual personal incomes of <10 000 yuan （OR=4.918， P<0.01） or 10 000~50 000 yuan （OR=2.076， P<0.01） and low （OR=6.882， P<0.01） or middle （OR=3.114， P<0.01） level of social support were the risk factors of intrusive rumination. For deliberate rumination， education levels of junior high school/high school/vocational training school （OR=0.574， P<0.01） and junior college and above （OR=0.449， P<0.05） were the protective factors， and low （OR=1.391， P<0.01） or middle （OR=1.161， P<0.05） levels of social support were the risk factors. ConclusionThe level of intrusive rumination of inpatients with middle-advanced cancer is related to education level， economic status and social support， furthermore， the level of deliberate rumination is related to the educational level and social support. ［Funded by Medical Research Project of Chengdu Health Commission （ number， 2020119）］

Objective: To determine the optimal dose of dexmedetomidine required to prevent nausea and vomiting when used for postoperative analgesia after gynecological laparoscopic surgery. Methods: A total of 135 patients, aged 18-60 yr, weighing 52-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective gynecological laparoscopic surgery, were divided into 3 groups (n=45 each) using a random number table method: control group (group C), dexmedetomidine 1 μg/kg group (group D₁) and dexmedetomidine 2 μg/kg group (group D₂). Immediately after anesthesia induction, dexmedetomidine 0.4 μg·kg^-1·h^-1 was injected intravenously until 30 min before the end of surgery in all the patients.When the patient was fully awake at the end of surgery, the tracheal tube was removed, and patients were sent to postanesthesia care unit and received patient-controlled intravenous analgesia (PCIA). The PCIA solution contained sufentanil 1.2 μg/kg and dezocine 20 mg in 100 ml of 0.9% normal saline.The PCIA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h.Dexmedetomidine 1 and 2 μg/kg were added to PCIA solution in group D₁ and group D₂, respectively.The occurrence of nausea and vomiting was recorded in postanesthesia care unit stay period (P₁) and in 0-12 h (P₂), 12-24 h (P₃), 24-36 h (P₄) and 36-48 h (P₅) periods after patients returned to the ward.Ramsay sedation score was recorded at 12, 24, 36 and 48 h after patients returned to the ward.When visual analogue scale score >3, patients were told to press PCIA.Patients were followed up for 48 h after surgery, and patients′ satisfaction, pressing times of PCIA and occurrence of pruritus, respiratory depression, bradycardia and dizziness were recorded. Results: Compared with group C, the incidence of nausea was significantly decreased in P₂ period, and the pressing times of PCIA were reduced in P_{2, 3} period in D₁ and D₂ groups (P<0.05). There was no significant difference in Ramsay sedation score at each time point, patients′ satisfaction and incidence of bradycardia among the three groups (P>0.05). No patients developed pruritus, respiratory depression or dizziness in the three groups. Conclusion The optimal dose of dexmedetomidine required to prevent nausea and vomiting is 1 μg/kg when used for postoperative analgesia after gynecological laparoscopic surgery.