Objective To investigate the influence of fixation of both lower limbs with negative pressure vacuum cushion and fixation of both ankles with self-made foam mat on setup errors in radiotherapy for rectal cancer.Methods A total of 12 patients with rectal cancer were enrolled in 2014 and randomly divided into group A (using negative pressure vacuum cushion) and group B (using self-made foam mat).An offline registration analysis was performed for the images of 108 times (A,B group of 54 times) of kilovoltage cone-beam CT (CBCT) before and after treatment.Grey scale translation error registration was used,and the results of registration were analyzed.The setup errors in x-axis (left-right direction),y-axis (cranial-caudal direction),and z-axis (anterior-posterior direction) were compared between the two groups.Results There was no significant difference in the absolute setup error in the y-axis between the two groups (2.13±0.64 mm vs.2.61±1.17 mm,P=0.399),while group A showed significantly lower absolute setup errors in the x-axis and z-axis than group B (x-axis:1.51±0.28 mm vs.2.70±1.05 mm,P=0.039;with an error rate of 7.41％ vs.42.59％;z-axis:1.10±0.29 mm vs.2.37±0.71 mm,P=0.002;with an error rate of 1.85％ vs.35.19％).Conclusions In the radiotherapy positioning for rectal cancer,fixation of both lower limbs with negative pressure vacuum cushion effectively avoids the translation and rotation of both lower limbs,reduces absolute setup errors,and has higher accuracy than fixation of both ankles with self-made foam mat.

Objective To discuss the application of microsurgery in the treatment of male infertility.Methods From March 2007 to March 2012,there were totally 853 infertile men received microsurgical treatments in our department.Among them,344 patients with unilateral or bilateral varicocele underwent microsurgical varicocelectomy,60 underwent vasovasostomy (VV) and 192 underwent vastoepidystomy (VE)in microsurgical methods due to obstructive azoospermia.257 non-obstructive azoospermia (NOA) patients were performed microdissection of testicular sperm extraction (MD-TESE),at the same time,pathologic examination was done.Results ①For the varicocele patients,the pre-operative sperm density was (10 ±6) × 106/ml,the progressive sperm percentage was (16 ± 9)％.The post-operative density was (15 ± 8) ×106/ml,the progressive sperm percentage was (28 ± 14)％.The natural pregnant rate was 10.8％ (37/344).②In 60 patients undergone VV,the patent rate was 80.0％ (48/60),the natural pregnant rate was 35.0％ (21/60).In 192 VE patients,the patent rate was 53.1％ (102/192),the natural pregnant rate was 19.8％ (38/192).③In 257 NOA patients,the testicular volume,sperm retrieval rate of MD-TESE was significantly higher than that of conventional testicular sperm extraction (60.3％ vs.38.1％).Conclusion The microsurgery techniques in male infertility treatments could have some advantages such as explicit effects and decreased injuries.

Background and purpose: Radiation therapy has entered the era of precise radiotherapy. Set-up error becomes important factor affecting the effects of radiotherapy. The aim of this study was to analyze the set-up accuracy of the in-house developed technique of body plate with vacuum cushion and thermoplastic mask (Group A) and the conventional technique of arm support (Group B) in thoracic tumor radiotherapy. Methods: A total of 19 patients with thoracic tumor were enrolled in this study and randomly separated into Group A and Group B. The patients of Group A underwent the secondary set-up: align the marker on vacuum cushion and patient's body to the room laser, cover the patient's body with thermoplastic mask and align the marker on the mask to the room laser. The patients of Group B were directly setup by aligning the marker on the patient's body to the room laser. The kilo-voltage cone beam computed tomography (KV-CBCT) was performed on each patient to collect the pre- and post-treatment CBCT images. The CBCT images were registered to the planning CT to analyze the translational error of Group A and Group B. Results: The pre-treatment set-up errors of Group A vs Group B were (1.06±0.58) vs (1.82±0.82) mm in left and right (LR) direction, (1.31±0.40) vs (2.18±1.20) mm in superior and inferior (SI) direction, and (1.28±0.66) vs (2.94±1.81) mm in anterior and posterior (AP) direction. The post-treatment set-up errors of Group A vs Group B were (0.86±0.54) vs (1.29±0.58) mm in LR direction, (1.07±0.58) vs (1.08±0.45) mm in SI direction, and (0.98±0.53) vs (1.56±0.63) mm in AP direction.Conclusion: The in-house developed immobilization technique of body plate with vacuum cushion and thermoplastic mask was more accurate and reproducible than the conventional immobilization technique of arm support in thoracic tumor radiotherapy.

Objective:To differentiate the methamphetamine users according to the developmental stages of addictive behavior, and explore the characteristics of different stages in order to provid a theoretical reference for our clinical intervention.Methods:Take the male methamphetamine users in compulsory detoxification institute whom were admitted from September 2018 to December 2019 as research objects.All the objects were asked to complete clinical diagnosis, interview and questionnaire evaluation in one week.According to the developmental stages of addictive behavior, the subjects were divided into occasional use group ( n=51), regular use group ( n=95) and compulsive use group ( n=157).All subjects were evaluated using visual analogue scale(VAS), Barrett impulsiveness scale(BIS)and CogState scale.SPSS 20.0 software was used for statistical analysis, AVOVA or Kruskal-Wallis H test was used for group comparison.Multiple Logistic regression analysis was used to explore the factors associated with the development of addictive behavior. Results:(1)The compulsive use group had higher cumulative duration(24(8, 48), 12(4, 24), 22(10, 36)), average dose(6.6±3.8, 2.8±1.4, 4.5±3.4) and craving score(1(0, 5), 0(0, 1), 1(0, 3)) than the other two groups(all P<0.05).And individuals in compulsive use group had more previous heroin use experience(20.4%, 9.8%, 14.8%, P<0.05).The regular use group had more withdrawal times than the other two groups(1(1, 3), 1(0, 1), 1(1, 2), P<0.05).The total scores of Barrett impulsiveness scale(42.8±13.3, 34.5±13.6, 36.1±14.9) and the scores in all dimensions in the compulsive use group were significantly higher than those in the other two groups(motor impulsiveness: 37.5±15.8, 27.8±13.4, 29.2±17.8; attentional impulsiveness: 43.2±18.0, 39.4±17.0, 37.2±18.1; non-planning impulsiveness: 47.2±19.8, 38.8±18.7, 40.7±20.8; P<0.05) .In the compulsive use users, the ISL(16.50±4.87, 19.30±4.78, 18.33±4.91) and SEC(0.76±0.21, 0.89±0.22, 0.81±0.21) scores about cognitive assessment were significantly lower than other two groups(both P<0.05).(2)The results of multiple Logistic regression analysis showed that cumulative duration ( β=0.022, OR=1.022, 95% CI: 1.003-1.042), dosage( β=0.625, OR=1.869, 95% CI: 1.196-2.921), craving ( β=0.194, OR=1.214, 95% CI: 1.002-1.215), the total scores of Barrett impulse scale( β=0.036, OR=1.037, 95% CI: 1.013-1.061), scores of non-planning impulsiveness( β=0.040, OR=1.041, 95% CI: 1.004-1.038), scores of motor impulsiveness( β=0.033, OR=1.214, 95% CI: 1.001-1.068) were associated with the periodic grouping of addictions. Conclusions:Addictive behavior is a progressive process and methamphetamine users at different stages have different characteristics in substance use, impulsiveness and cognitive function.The development of addictive behavior is associated with the time, dosage and craving of substance use, as well as the personality impulsivity of users.And the compulsive users suffered more cognitive impairment than the other two groups. The methamphetamine users should be identified dynamically and targeted therapeutic intervention measures should be carried out to block the addictive process to achieve the goal of harm reduction.

Objective To analyze the factors affecting the prognosis of patients with pulmonary sarcomatoid carcinoma (PSC) and construct a nomogram prediction model for the prognosis of PSC patients. Methods Based on the SEER database, 1671 patients diagnosed as PSC from 1988 to 2015 were collected and divided into modeling group and validation group according to the ratio of 7:3. Univariate and multivariate Cox regression analysis were performed in the modeling group to explore independent risk factors affecting the prognosis and construct a nomogram survival prediction model. The consistency index and calibration curve were used for verification in the modeling group and the test module respectively. Results Age, gender, histological type, TNM stage, tumor diameter > 50mm, surgery, radiotherapy and chemotherapy were independent factors that affected the prognosis of PSC patients. The nomogram prediction model was constructed and verified based on independent factors. The C indexes of the modeling group and the test model were 0.790 (95%CI: 0.776-0.804) and 0.781 (95%CI: 0.759-0.803), respectively. The calibration curves of the modeling group and the test model indicated that the predicted survival rate was basically the same as the actual survival rate. Conclusion The nomogram prediction model constructed based on the results of multivariate analysis can predict the prognosis of PSC patients, and has high accuracy and consistency.

Objective To investigate the clinical target volume (CTV)-planned target volume (PTV) setup margins during intensity-modulated radiotherapy (IMRT) for cervical cancer patients with different body mass index (BMI),aiming to provide reference for precise individual therapy.Methods Forty patients diagnosed with cervical cancer undergoing IMRT in Cancer Hospital of Fudan University between March and September 2017 were recruited and assigned into the BMI ≤ 18.4,18.5-23.9,24.0-27.9 and ≥ 28 kg/m2 groups according to the BMI classification criteria proposed by National Health and Family Planning Commission (NHFPC) of the People's Republic of China.Assisted with the bladder volume measurement device,9 cycles of kilo-voltage cone beam computed tomography (CBCT) images were subject to online registration and imaging analysis.CTV-PTV setup margins were calculated based on the formula of MPTV =2.5∑+0.7σamong four groups.Single factor variance analysis was performed.LSD test was utilized for two-group comparison.Results Among four groups,the CTV-PTV setup margins in the x,y and z directions were (6.87 mm,6.06 mm,8.49 mm),(3.13 mm,3.02 mm,3.14 mm),(4.70 mm,4.86 mm,5.31 mm) and (7.63 mm,8.28 mm,8.54 mm),respectively (P=0.038,0.048 and 0.004).Conclusions The setup errors in the BMI ≤ 18.4 and ≥28 kg/m2 groups are significantly larger compared with those in the remaining groups Consequently,CTV-PTV setup margins should be enlarged to certain extent for patients with BMI≤ 18.4 and ≥≥28 kg/m2.

Objective To explore the importance of head fixation in chest wall field combined with supraclavicular field radiotherapy for breast cancer by comparing the displacement error and dosimetric differences caused by multi-functional body board and breast bracket.Methods Thirty patients with breast cancer were randomly divided into groups A and B.In group A,patients were fixed with multi-functional body board and head thermoplastic film.In group B,patients were fixed with traditional breast brackets.Each patient received CBCT scan before and after radiotherapy.Both setup errors and intra-fractional displacements in the x-,y-and z-axis,V100 and V95 were calculated.Statistical analyses were performed using the independent sample t-test.Results The displacement errors in groups A and B before and after radiotherapy were (1.24± 0.42),(1.71± 0.61) and (2.25± 1.04) mm vs.(3.67± 2.05),(3.78± 1.74),(4.65±2.66) mm in the x-,y-and z-axis,respectively (P=0.033,0.027,0.020).The intra-fractional displacements in groups A and B were (1.10±0.66),(1.13±0.59),(1.11 ±0.62) mm vs.(2.48±0.88),(2.21 ±0.98),(3.53±2.01) mm in the x-,y-and z-axis,respectively (P=0.030,0.021,0.013).The V100 in groups A and B were (94.27± 3.20) ％ and (99.08± 0.60) ％ (P =0.065),and (89.48± 4.70) ％ and (96.53± 2.50) ％ for V95 (P =0.002),respectively.Conclusion The risk of displacement error is significantly reduced using multi-functional body board,which enhances the accuracy of radiation dose in chest wall and supraclavicular fields of breast cancer patients.

【Objective】 To develop an assay to determine β-lactam antibiotics using microcolumn gels and to study the β-lactam antibiotics present in the blood of patients and their clinical significances. 【Methods】 446 patients with a history of taking β-lactam antibiotics from January 2019 to June 2019 were randomly selected from Trauma Emergency Center, Department of Arthrosis, Department of Spine and Department of Bone Oncology of our hospital, and 4 mL(per capita) venous blood was collected. Irregular antibody screening, anti-globulin detection and drug antibody determination were performed by microcolumn gel method. The data of gender, age, disease, blood transfusion history and medication were collected. The test results and clinical data were retrospective analyzed. 【Results】 The yielding rate of antibody was 0.45%(2/446) in patients with a history of taking β -lactam antibiotics. 16.38%(73/446) of the samples were positive in direct antiglobulin test, and 64.38%(47/73) of them did not agglutinate with RBCs treated with drugs. The yielding rate of specific antibodies against drug was 4.93%(22/446), and the titer ranged from 2 to 128(8). 1 case of auto-IgM antibody, 1 case of blood group related antibody and 2 cases of non-specific protein adsorption were detected. The yielding rate of drug antibody in patients with blood transfusion history reached to 12.10 %(22/124), so it was also high in patients with bone tumor. 【Conclusion】 Direct antiglobulin assay is helpful for the detection of β-lactam antibodies. The negative results of antibody screening cannot completely exclude the presence of drug antibodies. The yielding rate of drug antibody can be greatly improved by specific drug antibody detection, and it was higher in transfused patients relative to non-transfused one.