Objective:To explore the method of constructing automatic delineation model for clinical target volume (CTV) and partially organs at risk (OAR) of postoperative radiotherapy for prostate cancer based on convolutional neural network, aiming to improve the clinical work efficiency and the unity of target area delineation.Methods:Postoperative CT data of 117 prostate cancer patients manually delineated by one experienced clinician were retrospectively analyzed. A multi-class auto-delineation model was designed based on 3D UNet. Dice similarity coefficient (DSC), 95% Hausdorf distance (95%HD), and average surface distance (ASD) were used to evaluate the segmentation ability of the model. In addition, the segmentation results in the test set were evaluated by two senior physicians. And the CT data of 78 patients treated by other physicians were also collected for external validation of the model. The automatic segmentation of these 78 patients by CTV-UNet model was also evaluated by two physicians.Results:The mean DSC for tumor bed area (CTV1), pelvic lymph node drainage area (CTV2), bladder and rectum of CVT-UNet auto-segmentation model in the test set were 0.74, 0.82, 0.94 and 0.79, respectively. Both physicians' scoring results of the test set and the external validation showed more consensus on the delineation of CTV2 and OAR. However, the consensus of CTV1 delineation was less.Conclusions:The automatic delineation model based on convolutional neural network is feasible for CTV and related OAR of postoperative radiotherapy for prostate cancer. The automatic segmentation ability of tumor bed area still needs to be improved.

Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Although the World Health Organization (WHO) has required all states parties to strengthen core capacities to respond to public health emergencies under the International Health Regulations (2005), the actions of most countries to combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This cross-sectional study aimed to examine the health system resilience of selected countries and analyze their strategies and measures in response to the COVID-19 pandemic.Methods: This study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K., and the U.S., based on the severity of the national epidemic, the geographical location, and the development level. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure the severity of the impact of the pandemic in each country; WHO State Parties Self-Assessment Annual Reporting (SPAR) Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience; and research articles and press materials were summarized to identify the strategies and measures adopted by countries during response to COVID-19. This study applied the resilient health systems framework to analyze health system resilience in the selected countries from five dimensions, including awareness, diversity, self-regulation, integration and adaptation. Results: The SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and the U.S. were above the global and regional averages; the SPAR Scores of Iran were above the global average while the GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. invested more health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategy of extensive testing and identification of suspected patients. In terms of specific measures, all the five countries adopted measures such as restrictions on entry and international travel, closure of schools and industries, lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied across countries, based on the response strategies. Conclusion: Although SPAR Scores and GHS Index have evaluated the national core capacities for preparedness and response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries still do not build resilient health systems in response to public health emergencies. Health system strengthening and health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach to developing resilient health systems.

Background/Aims: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is widely accepted as a radical surgery for refractory ulcerative colitis (UC). Definite results on the appropriate pouch length for an evaluation of the risk-to-benefit ratio regarding technical complications and long-term quality of life (QOL) are still scarce. Methods: Data on UC patients who underwent IPAA from 2008 to 2022 in four well-established pouch centers affiliated to China UC Pouch Center Union were collected. Results: A total of 208 patients with a median follow-up time of 6.0 years (interquartile range, 2.3 to 9.0 years) were enrolled. The median lengths of the patients’ short and long pouches were 14.0 cm (interquartile range, 14.0 to 15.0 cm) and 22.0 cm (interquartile range, 20.0 to 24.0 cm), respectively. Patients with a short J pouch configuration were less likely to achieve significantly improved long-term QOL (p=0.015) and were prone to develop late postoperative complications (p=0.042), such as increased defecation frequency (p=0.003) and pouchitis (p=0.035). A short ileal pouch was an independent risk factor for the development of late postoperative complications (odds ratio, 3.100; 95% confidence interval, 1.519 to 6.329; p=0.002) and impaired longterm QOL improvement (odds ratio, 2.221; 95% confidence interval, 1.218 to 4.050, p=0.009). Conclusions The length of the J pouch was associated with the improvement in long-term QOL and the development of late post-IPAA complications. A long J pouch configuration could be a considerable surgical option for pouch construction.

OBJECTIVETo investigate the prevalence and risk factors of diabetic nephropathy in Ningbo Yinzhou district.

METHODSNephropathy screening was conducted among patients with type 2 diabetes mellitus (T2DM) registered in Ningbo Yinzhou district. Demographic information, clinical examination information, diabetes complications and behavioral risk factors of enrolled patients were collected. Logistic regression model was used to identify possible risk factors for the occurrence of diabetic nephropathy.

RESULTSAmong 10 604 T2DM patients included in this study, there were 3744 cases of diabetic nephropathy(35.31%). Univariate analysis showed that gender, age, education level, diabetes duration, glycemic control, hypertension, stroke, smoking and waist circumference were associated with diabetic nephropathy (<0.05 or <0.01). Multivariate logistic regression analysis showed that male, elders, long diabetes duration, hypertension and smoking were independent risk factors of diabetic nephropathy (<0.05 or <0.01).

CONCLUSIONSsDiabetic nephropathy is of high prevalence in T2DM patients. Male patients, elders, and those with long diabetes duration, hypertension and smoking habits are more likely to have diabetic nephropathy.

China ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Humans ; Hypertension ; Logistic Models ; Male ; Prevalence ; Risk Factors ; Surveys and Questionnaires

Objective: To compare the hyoid bone position among patients with different sagittal skeletal malocclusions to provide a reference for clinicians to formulate treatment plans. Methods: Lateral cephalograms of 284 orthodontic patients were selected. According to ANB angles, the types of skeletal malocclusion of patients were determined as follows: Class Ⅰ (1° ≤ ANB ≤ 5°), Class Ⅱ (ANB>5°) and Class Ⅲ (ANB<1°). Ten parameters were used to determine hyoid positions. After comparing the hyoid positions of the three groups, stratified analyses based on sex and age were conducted. Results : No significant differences in demographic and vertical facial type features among skeletal Classes Ⅰ, Ⅱ and Ⅲ patients were observed (P>0.05). The angle between the Gonion-hyoid point line and the hyoid point-Menton line (Go-Hy-Me) of Class Ⅱ patients was significantly smaller than that of Class Ⅰ patients, and the angle between the most anterior and inferior point of the third cervical vertebra-hyoid point line and the hyoid point-Sella line (C3-Hy-S) of Class Ⅲ patients was smaller than that of Class I patients (P<0.05). Age-stratified analysis showed that in the juvenile group, the C3-Hy-S of Class Ⅲ patients was significantly smaller than that of Class Ⅰ patients in males and females (P<0.05). In the adult female group, the Go-Hy-Me of Class Ⅱ patients was significantly smaller, and the distance from the hyoid point to the mandibular plane (Hy-MP) was larger than that noted in Class Ⅰ patients (P<0.05); no significant difference in hyoid position between male Class Ⅱ and I patients was observed (P>0.05). Conclusions Compared with Class Ⅰ patients, the hyoid bone of Class Ⅱ patients in adult females was farther away from the mandible and that of Class Ⅲ patients in juveniles was farther away from the cervical vertebra and posterior cranial base.