Objective:To establish an automatic segmentation network based on different receptive fields for gross target volume (GTV) and organs at risk in patients with nasopharyngeal carcinoma.Methods:Radiotherapy data of 100 cases of nasopharyngeal carcinoma including CT images and GTV and organs at risk delineated by the physicians were collected. Ninety plans were randomly selected as the training dataset, and the other 10 plans as the validation dataset. Firstly, the images were subject to three data augmentation methods including center cropping, vertical flipping and rotation (-30°to 30°), and then input into MA_net networks proposed in this study for training. The model performance of networks was assessed by the number of network parameters (NP), floating-point number (FPN), the running memory (RM) and Dice index (DI), and eventually compared with DeeplabV3+ , PSP_net, UNet+ + and U_Net networks.Results:When the input image was in the size of 240×240, MA_net had a NP of 23.20%, 20.10%, 25.55% and 27.11% of these 4 networks, 50.02%, 19.86%, 6.37% and 13.44% for the FPN, 40.63%, 23.60%, 11.58% and 14.99% for the RM, respectively. For the DI of GTV, MA_net was 1.16%, 2.28%, 1.27% and 3.59% higher than these 4 networks. For the average DI of GTV and OAR, MA_net was 0.16%, 1.37%, 0.30% and 0.97% higher than these 4 networks.Conclusion:Compared with those four networks, the proposed MA_net network has slightly higher Dice index with fewer parameters, lower FPN and smaller RM.

EGFR tyrosine kinase inhibitors (TKIs) treatment has been established as standard therapy for EGFR-mutated adenocarcinomas. In the studies which published prospective randomized trials comparing EGFR TKIs with chemotherapy, a very low percentage of EGFR-mutated non-adenocarcinomas was enrolled in clinical trials. The efficacy of TKIs treatment for EGFR-mutated non-adenocarcinomas and their relationship with clinicopathological characteristics remain debatable. The results of retrospective studies show that the frequency of EGFR mutation is lower in non-adenocarcinoma than that of adenocarcinoma and efficacy of TKIs treatment for non-adenocarcinoma is inferior to adenocarcinoma. Smoking status is significantly associated with the efficacy of TKIs treatment for EGFR-mutated non-adenocarcinomas. The EGFR mutation rate and efficacy of TKIs treatment in adenosquamous cell carcinoma are higher than those of squamous cell carcinoma or large cell lung carcinoma. It may be concluded that the incidence of EGFR mutations in patients with non-adenocarcinoma NSCLC from mainland China is not very low and it is reasonable that EGFR TKIs could be an option for the treatment of EGFR-mutated non-adenocarcinoma NSCLC, especially for patients with adenosquamous histology and non-smokers. It is necessary to conduct a large-sample prospective study to understand the clinicopathological characteristics of non-adenocarcinomas and to evaluate the efficacy of EGFR TKI treatment or/and chemotherapy for EGFR-mutated non-adenocarcinoma NSCLC.

Objective:To observe any effect of electroacupuncture applied to the Jialianquan points in treating post-stroke oropharyngeal dysphagia.Methods:Forty-five stroke survivors with oropharyngeal dysphagia were randomly divided into an electroacupuncture group ( n=15), a neuromuscular electrical stimulation group ( n=15) and a control group ( n=15). All groups received 30 minutes of routine swallowing function training 5 times a week for 3 weeks. The electroacupuncture group was additionally provided with 30 minutes of electroacupuncture applied to the Jialianquan (CV23) points, and the neuromuscular electrical stimulation group instead received 30 minutes of neuromuscular electrical stimulation over the bilateral submental muscles. Videofluoroscopic swallowing studies were performed before and after the 3 weeks of treatment. Standardized swallowing assessment was conducted producing functional oral intake scale ratings, modified barium swallow impairment profiles and the penetration-aspiration scale scores. Surface electromyography was also employed to evaluate submental muscle functioning through measuring the swallowing time, average EMG (AEMG) value and peak amplitude. Results:After the treatment, significant improvement was observed in all of the evaluations with both groups, but the average scores were significantly better in the electroacupuncture and neuromuscular electrical stimulation groups compared with the control group and significantly better in the electroacupuncture group than in the neuromuscular electrical stimulation group.Conclusion:Electroacupuncture at the Jialianquan point can significantly improve the swallowing of stroke survivors with oropharyngeal dysphagia. It is more effective than neuromuscular electric stimulation.

Objective:To investigate the clinical characteristics and the risk of major adverse cardiac events within 1 year of middle-aged and elderly in-patients with acute decompensated and mid-range ejection fraction heart failure(HF)in the medical alliance setting.Methods:A retrospective cohort study was conducted among a total of 180 in-patients with acute decompensated heart failure in Cardiovascular Hexi Hospital Consulting Area of Tianjin Chest Hospital.According to ejection fraction measured by echocardiogram, the in-patients were classified into three groups: heart failure with reduced ejection fraction(HFrEF)group(n=70, 38.9%), HFmEF group(n=50, 27.8%), and heart failure with preserved ejection fraction(HFpEF)group(n=60, 33.3%). Clinical feature and 1-year prognosis between different groups were compared.Results:Univariate Cox regression analysis of 1-year all-cause death and cardiovascular death showed that there was no significant difference between HFrEF group and HFmEF group, HFpEF group and HFmEF group(all P>0.05); 1-year readmission analysis of heart failure showed that 47.1%(33 cases)of HFrEF group was higher than 24.0%(12 cases)of HFmEF group, 48.3%(29 cases)of HFpEF group was higher than HFmEF group( HR=2.307, 2.368, 95% CI: 0.187-4.480, 1.207-4.644, respectively, all P<0.05); The major 1-year cardiovascular events were 57.1%(40 cases)higher in the HFrEF group than 34.0%(17 cases)in the HFmEF group( HR=2.053, 95% CI: 0.187-4.408, P< 0.05). Multivariate analysis showed that the 1-year risk of major cardiovascular events was significantly different between HFmEF group and HFpEF group( HR=0.477, 95% CI: 0.241-0.941, P< 0.05). Pulmonary heart disease( P< 0.05), atrial flutter and/or atrial fibrillation( P< 0.01), New York Cardiology class Ⅳ( P< 0.01)were risk factors for death.Hypertension and cor pulmonale were the risk factors for readmission in patients with heart failure(all P< 0.01). Conclusions:The clinical characteristics of inpatients with HFmEF in the medical alliance setting tended to be consistent with those with HFrEF, while the feature of ischemic heart disease was more prominent in HFmEF.The 1-year risk of heart failure readmission in HFmEF group was significantly lower than that in HFpEF and HFrEF group, and the risk of all-cause mortality and cardiovascular mortality at 1 year was not significantly different among the three groups.

Objective:To study the effects of immunity index and blood inflammatory markers pre- and post-radiotherapy on prognosis of esophageal cancer patients with clinical stage Ⅲ.Methods:A total of 84 esophageal cancer patients with clinical stage Ⅲ (T 4N 1M 0) in Fourth Hospital of Hebei Medical University were analyzed, from May 2010 to April 2012. Intensity-modulated radiotherapy was delivered with a dose of 56-66 Gy/1.8-2.0 Gy per fraction. Flow cytometry was used to analyze the distribution of T-lymphocyte subsets (CD3, CD4, CD8, CD4/CD8) and natural killer cells (CD56) in the peripheral blood pre- and post- radiotherapy. Neutrophil-lymphocyte ratio (NLR) pre- and post- radiotherapy were also tested. The correlation of immunity index and blood inflammatory markers with prognosis was analyzed by univariate and multivariate analysis. Results:For all patients, the 1-, 3- and 5-year overall survival (OS) rates were 78.57%, 34.52% and 19.59%, respectively. The median OS time was 22.60 months. The 1-, 3- and 5-year progression free survival (PFS) rates were 69.05%, 27.38% and 12.09%, respectively. The median PFS time was 21.20 months. The objective response rate was 61.90%, with 11 patients of complete remission (CR) and 41 patients of partial remission (PR). Univariate analysis revealed that NLR before radiotherapy, T-lymphocyte subsets (CD3, CD4 and CD4/CD8) after radiotherapy were significantly associated with OS and PFS (OS: χ 2=7.851, 4.443, 8.381, 5.972, P<0.05, PFS: χ 2= 7.475, 6.290, 9.659, 8.738, P<0.05). Multivariate COX regression analysis showed that NLR before radiotherapy, T-lymphocyte subsets (CD4, CD4/CD8) after radiotherapy were independent prognostic factors for OS (χ 2=10.464, 4.292, 5.507, P<0.05). The NLR before radiotherapy and CD4/CD8 after radiotherapy were independent prognostic factors for PFS (χ 2=10.835, 8.545, P<0.05). Conclusions:Radiotherapy may influence the immune function. NLR before radiotherapy and CD4/CD8 after radiotherapy are of great value in predicting the prognosis of esophageal cancer patients.

Objective:To compare the accuracy and generalized robustness of three predictive models of knowledge-based treatment strategies for radiotherapy for optimized model selection.Methods:The clinical radiotherapy plans of 45 prostate cancer (PC) cases and 25 nasopharyngeal cancer (NPC) cases were collected, and analyzed using three models (Z, L and S model), proposed by Zhu et al, Appenzoller et al and Shiraishi et al, respectively, to predict the dose-volume histogram (DVH) of bladder and rectum on PC cases and that of left and right parotid on NPC cases. The prediction error was measured by the difference of area under the predicted DVH and the clinical DVH curves (|V (pre_DVH)-V (clin_DVH)|), where a smaller prediction error implies a greater prediction accuracy. The accuracies of these three models were compared on the single organ at risk (OAR), and the generalized robustness of models was evaluated and compared by calculating the standard deviation of the prediction accuracy on different OAR. Results:For bladder and rectum, the prediction error of L model (0.114 and 0.163, respectively) was significantly higher than those values of Z and S models (≤0.071, P<0.05); for left parotid gland, the predicted error of S model (0.033) did not present significant difference from those values of Z and L models (≤0.025, P>0.05); for right parotid gland, S model (0.033) demonstrated significantly higher prediction error than those of Z and L models (≤0.028, P<0.05). Regarding different OAR, S model showed a lower standard deviation of prediction accuracy when comparing to Z and L models (0.016, 0.018 and 0.060, respectively). Conclusions:In the prediction of DVH in bladder and rectum of PC, Z and S models were more accurate than L model. In contrast, Z and L models demonstrated higher accuracy than S model in the prediction of left and right parotid glands of NPC. In respect to different OAR, the generalized robustness of S model was superior than the other two models.

Objective:To investigate the role of three-dimensional dose distribution-based deep learning model in predicting distant metastasis of head and neck cancer.Methods:Radiotherapy and clinical follow-up data of 237 patients with head and neck cancer undergoing intensity-modulated radiotherapy (IMRT) from 4 different institutions were collected. Among them, 131 patients from HGJ and CHUS institutions were used as the training set, 65 patients from CHUM institution as the validation set, and 41 patients from HMR institution as the test set. Three-dimensional dose distribution and GTV contours of 131 patients in the training set were input into the DM-DOSE model for training and then validated with validation set data. Finally, the independent test set data were used for evaluation. The evaluation content included the area under receiver operating characteristic curve (AUC), balanced accuracy, sensitivity, specificity, concordance index and Kaplan-Meier survival curve analysis.Results:In terms of prognostic prediction of distant metastasis of head and neck cancer, the DM-DOSE model based on three-dimensional dose distribution and GTV contours achieved the optimal prognostic prediction performance, with an AUC of 0.924, and could significantly distinguish patients with high and low risk of distant metastasis (log-rank test, P<0.001). Conclusion:Three-dimensional dose distribution has good predictive value for distant metastasis in head and neck cancer patients treated with IMRT, and the constructed prediction model can effectively predict distant metastasis.

Objective To investigate the regulatory effects of plasma-derived exosomal microRNA-1306-5p(miR-1306-5p)on inflammation,apoptosis and oxidative stress in intestinal mucosal epithelial cells in sepsis,and to explore the potential mechanisms.Methods Sepsis plasma-derived exosomes and healthy plasma exo-somes were separated and divided into healthy plasma exosomes group and sepsis plasma-derived exosomes group.The exosomes were observed by electron microscopy,the physical parameters of the two groups of exo-somes were analyzed,and the expression of miR-1306-5p in the exosomes was detected.Intestinal mucosal epi-thelial cells were divided into control group,negative control group of miR-1306-5p mimic(mimic-NC group),miR-1306-5p mimic group(mimic group),mimic combined with overexpression of PLK1 empty vector group(mimic-PLK1-EV group),and mimic combined with overexpression of Polo-like kinase 1(PLK1)group(mimic+PLK1-OE group).Real-time fluorescent quantitative PCR was used to detect the mRNA expressions of miR-1306-5p and PLK1 in each group,and protein imprinting was used to detect the expressions of miR-1306-5p target genes PLK1,caspase 3,B lymphoblastoma-2(Bcl-2)and Bcl2-associated X protein(Bax).Dual luciferase reporter gene assay was used to detect the binding effect of miR-1306-5p and PLK1,and flow cytom-etry was used to detect apoptosis.The expressions of tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-6 and IL-8 in the supernatant of cultured cells were detected by enzyme-linked immunosorbent assay.The expressions of reactive oxygen species(ROS),malondialdehyde(MDA),glutathione(GSH)and superoxide dismutase(SOD)were detected by kit method.Results The plasma derived exosomes of sepsis and healthy plasma were ellipsoid in shape,and there was no significant difference in physical parameters(P＞0.05).Compared with the healthy plasma exosomes group,the expression of miR-1306-5p was up-regulated in the plasma derived exosomes of sepsis group(P＜0.05).PLK1 was identified as the target gene of miR-1306-5p by double luciferase reporter method.Compared with mimic-NC group,the expressions of miR-1306-5p,TNF-α,IL-6,IL-8,IL-1β,caspase3,Bax,ROS and MDA were up-regulated,the apoptosis rate was increased,and the expressions of PKL1,Bcl-2,GSH and SOD were down-regulated in mimic group(all P＜0.05).Compared with mimic+PLK1-EV group,the expressions of TNF-α,IL-6,IL-8,IL-1β,caspase3,Bax,ROS,and MDA were significantly down-regulated,the apoptosis rate was decreased,and the expressions of PKL1,Bcl-2,GSH and SOD were up-regulated in mimic+PLK1-OE group(all P＜0.05).Conclusion Plasma derived exosome miR-1306-5p in sepsis promotes inflammation,apoptosis and oxidative stress damage of intestinal mucosal epi-thelial cells by targeting PKL1 inhibition.

Objective:To investigate the differences between convolutional neural network (CNN) measurements and manual measurements of prosthetic angles and leg length discrepancies after total hip arthroplasty (THA).Methods:Data were collected from 100 patients who underwent unilateral THA at the Department of Orthopaedics, Fourth Medical Center of PLA General Hospital, between January and March 2024. Fifty patients received a ceramic-lined hip prosthesis, and 50 received a polyethylene-lined hip prosthesis. The cohort included 58 males and 42 females, with an average age of 51.6±12.71 years. The left hip was affected in 45 cases, and the right hip in 55 cases. The Attention UNet network was used to segment the prostheses and identify key points, from which the acetabular prosthesis abduction angle, anteversion angle, and leg length discrepancy were calculated. The CNN measurements of anteversion angle, abduction angle, and leg length discrepancy were compared with manual measurements. The consistency between the two methods was evaluated using the Bland-Altman method.Results:CNN measurements of the abduction angle, anteversion angle, and leg length discrepancy for the 100 prostheses were 40.55°±4.76°, 21.5°(19.0°, 27.0°), and 3.6(1.7, 6.8) mm, respectively, while manual measurements were 40.58°±4.93°, 21.0° (17.6°, 23.2°), and 3.0 (2.0, 7.0) mm, respectively. There was a statistically significant difference in anteversion angle between the two methods ( Z=-2.189, P=0.029), but no significant differences in abduction angle or leg length discrepancy ( P>0.05). For the 50 cases with polyethylene-lined prostheses, CNN-measured abduction and anteversion angles were 40.31°±4.70° and 20.0°(18.0°, 22.0°), respectively, while manual measurements were 40.49°±4.92° and 20.0°(17.0°, 21.5°); there were no statistically significant differences ( P>0.05). For the 50 ceramic-lined prostheses, CNN-measured abduction and anteversion angles were 40.79°±4.86° and 26.5°(20.8°, 33.0°), respectively, while manual measurements were 40.68°±4.98° and 20.0°(18.0°, 22.0°), with a significant difference in anteversion angle ( Z=-3.426, P=0.001) but not in abduction angle ( t=0.994, P=0.325). Bland-Altman analysis showed a difference of 0.031°±1.091° for the abduction angle of the 100 prostheses between the two methods, 0.178°±1.296° for the polyethylene-lined prostheses, and -0.116°±0.825° for the ceramic-lined prostheses. For the anteversion angle, the difference was -3.280°±6.920° for the 100 prostheses, -0.002°±1.471° for the polyethylene-lined prostheses, and -6.560°±8.523° for the ceramic-lined prostheses. The difference in leg length discrepancy was -0.101±0.947 mm. Conclusion:CNN measurements of acetabular prosthesis abduction angle, polyethylene-lined prosthesis anteversion angle, and leg length discrepancy after THA showed no significant differences from manual measurements. However, CNN and manual measurements of ceramic-lined prosthesis anteversion angle differed. Bland-Altman analysis indicates that the two methods have good consistency when measuring the abduction angle, the lower limb discrepancy, and the anteversion angle of the polyethylene liner prosthesis.

Objective:To investigate the clinical efficacy of induced membrane technique in the staged treatment of adult chronic hematogenous osteomyelitis (CHOM) of long bone.Methods:The clinical data were retrospectively analyzed of the 22 adult patients with CHOM of long bone who had been admitted to the 920th Hospital, Joint Logistics Support Force of PLA from January 2016 to December 2019. There were 18 males and 4 females, aged from 16 to 56 years (average, 31.81 years). Their disease duration ranged from 0.6 to 42.0 years, averaging 18.4 years. By the Cierny-Mader anatomical classification, 4 cases were type Ⅰ, 6 cases Type Ⅲ, and 12 cases type Ⅳ. In the first stage, the bone defects were filled with antibiotic bone cement after thorough debridement. In the second stage when the infection had been controlled, the bone defects were repaired with bone grafts after removal of the bone cement. Bone healing time and complications were followed up. The treatment effects were evaluated by comparisons of the infection control indexes [including clinical manifestations like local redness, swelling, pus, and pain, and blood white blood cell count, C-Reactive protein (CRP), and erythrocyte sedimentation rate (ESR) as well] before the primary surgery, before the secondary surgery and at the last follow-up.Results:The volumes of the bone defects after stage-one debridement ranged from 54 cm 3 to 176 cm 3 (mean, 90.9 cm 3). All patients were followed up for 20 to 51 months (mean, 30.1 months) after surgery. All bone defects healed after 4 to 11 months (mean, 6.6 months). Postoperatively, infection developed at the bone extraction site of the posterior superior iliac spine in 3 cases and pain was observed at the donor site in one case, but the conditions were relieved after symptomatic treatment. Fracture and plate breakage occurred at the bone defect site in one case who had fallen down 7 months after operation, but responded to reoperation. The last follow-up revealed such symptoms as redness, swelling and pus discharge in none of the patients. The white blood cell count [(5.70 ± 1.57) × 10 9/L and (5.65 ± 1.58) × 10 9/L], CRP [(7.56 ± 2.57) mg/L and (7.25 ± 3.83) mg/L] and ESR [(9.64 ± 2.90) mm/h and (10.55 ± 5.23) mm/h] before the secondary surgery and at the last follow-up were significantly lower than those before the primary surgery [(8.24 ± 2.18) × 10 9/L, (49.54 ± 19.56) mg/L, and (42.68 ± 13.77) mm/h] (all P < 0.05). However, there were no significant differences between the indexes before the secondary surgery and at the last follow-up ( P > 0.05). Conclusion:In the staged treatment of adult CHOM of long bone, the induced membrane technique can effectively control infection, achieve repair of bone defects, and reduce complications.