Objective:To propose a new robust optimization method, known as modified worst case method, was proposed, which can enable users to control the trade-off between nominal plan quality and plan robustness.Methods:In each iteration of the plan optimization process, the dose value of each voxel in nine scenarios, which corresponded to a nominal scenario and eight perturbed scenarios with range or set-up uncertainties, were calculated and the maximum of deviations of each scenario voxel dose from that of the nominal scenario was included as an additive robust optimization term in the objective function. A weighting factor p robust was used to this robust optimization term to balance the nominal plan quality and plan robustness. Results:The robust optimization methods were implemented and compared in an in-house developed robust optimization module. When p robust=0.8, compared with conventional optimization, the ΔD 95% of CTV was reduced from 9.8 Gy to 7.6 Gy. When p robust was reduced from 1 to 0, ΔD 95% was increased from 7.0 Gy to 9.8 Gy, whereas the D 95% and D max of CTV, and the D 5% and D max of organs at risk (OAR) in the nominal scenario were reduced. Conclusions:The proposed modified worst case method can effectively improve the robustness of the plan to the range and set-up uncertainties. Besides, the weighting factor p robust in this method can be adopted to control the trade-off between nominal plan quality and plan robustness.

Objective     To analyze the clinical information of COVID-19 patients of Shanghai National Exhibition and Convention Center cabin hospital, and to explore the medical management strategy to provide thoughtful suggestions for other cabin hospitals and governments as valuable references. Methods     The clinical data of 174 308 patients confirmed COVID-19 in Shanghai National Exhibition and Convention Center cabin hospital from April 9 to May 31, 2022 were retrospectively reviewed. There were 103 539 male and 70 769 female patients, with an average age of 41.50±15.30 years. Medical and nursing management strategy was summarized. Results     Among the 174 308 patients, 71.5% (124 630 patients) were asymptomatic. The vaccination rate of patients with COVID-19 in the cabin hospital was 76.5% (133 338 patients), and the majority of none vaccinated patients were children under the age of 10 years and the elderly over the age of 60 years, the vaccination rate of whom was only 25.0% (1 322 patients) and 63.9% (13 715 patients), respectively. In addition, the proportion of mild symptom type in the patients not vaccinated was significantly higher than that in the vaccinated patients (P≤0.01). The average hospitalization time of patients in cabin hospital was 7.39±0.53 days, which was 7.01±2.12 days for patients under 60 years and 8.21±0.82 days for patients over 60 years. The hospitalization time of elderly patients was significantly longer (P≤0.01), and the hospitalization time of elderly patients at age over 60 years without vaccination was 8.94±1.71 days, which was significantly longer than the average hospitalization time and the time of elderly patients vaccinated (P≤0.01). The number of patients combined with basic diseases was 27 864 (16.0%), of which cardiovascular diseases accounted for 81.3% (22 653 patients). A total of 2 085 patients were transferred and treated in designated hospitals. Conclusion     Large scale cabin hospitals are helpful to cut off the source of infection. Attention shall be paid to the sorting of admission and timely transfer to other hospital during the patients management. Most of the patients have a good prognosis after treatment. The vaccination of key population and community-based screening will be the next step of focus.

Objective    To study the diagnosis and treatment of aortopulmonary window (APW) associated with severe pulmonary hypertension. Methods    The clinical data of 23 patients with APW undergoing surgical treatment in The First Affiliated Hospital of Air Force Medical University from 2010 to 2018 were retrospectively reviewed. There were 9 male and 14 female patients. The age was 3-132 (4.63±2.14) months. The weight was 3.3-35.0 (17.3±3.6) kg. Results    Windows were situated in the proximal of semilunar valve (type Ⅰ) in 8 patients, and distal of the aorta (type Ⅱ) in 14 patients, from proximal to distal (type Ⅲ) in only 1 patient. Eleven patients were isolated APW, the others were combined with cardiac defects. The mean pulmonary artery pressure was 68.4±7.5 mm Hg. All patients underwent surgical correction under general anesthesia and hypothermia cardiopulmonary bypass. All patients were discharged uneventfully, with an average follow-up time of 4 years. The patients showed good outcomes and no residual shunt after surgery, and the pulmonary artery pressure decreased to normal. Conclusion    APW is an uncommon congenital cardiac anomaly. The clinical presentation is an excessive left-to-right shunt, and most patients present early in life. Development of pulmonary hypertension and pulmonary vascular resistance is usually rapid. Operative treatment is indicated as soon as the diagnosis is established, regardless of the patient’s age, and most patients after surgery have a good long-term outcome.