Objective To evaluate a preliminary outcome of volar surgical treatment of dorsally displaced fractures of distal radius with open reduction and internal fixation with T shape locking compression plate.Methods From January 2009 to January 2012,32 cases with dorsally unstable distal radius fractures were treated with open reduction and internal fixation with T shape locking compression plate.Results All patients were followed; the average follow-up period was 12 (8-18) months.The patients all healed well.According to Dienst scoring system,the results were excellent in 23 cases,good in 7 cases,fair in 2 cases,the excellent and good rate was 93.75％(30/32).Conclusions The volar fixation of T shape locking compression plate for dorsally displaced fractures of distal radius has advantage of stable and reliable,high healing rate,low rate of complications and early motion.It is especially suitable for osteoporosis patients.

Objective:To evaluate the effect of radical image-guided radiotherapy (IGRT) on the target dose in cervical cancer and investigate the appropriate application mode.Methods:Twenty patients with cervical cancer treated with helical tomotherapy (HT) in Seventh Medical Center of PLA General Hospital from 2012 to 2016 were selected. A megavoltage CT (MVCT) scan was performed before each treatment. The obtained MVCT images were used for dose parameter in the adaptive module of HT to obtain the actual dose (Plan 1) and the non-image-guided dose parameter was simulated (Plan 2). Each single dose distribution and the corresponding fused CT images were transferred to the software Mimvista 6.5 to obtain the total radiation dose parameter by dose superposition.Results:The motion of CTV, uterus and GTV in Plan 2 was significantly larger than that of Plan 1(all P<0.05), and the largest changes were seen in the ventrodorsal and uterine direction. The V 45Gy, V 50Gy, D 98% and D mean of CTV and uterus and V 50Gy of GTV in Plan 2 were significantly decreased compared with those in Plan 1(all P<0.05). The left-right motion of Plan 1 was negatively correlated with D 2% and D 98% of CTV and uterus (both P<0.05). The head-foot motion was negatively associated with V 45Gy and V 50Gy of GTV (both P<0.05). The ventrodorsal motion was negatively correlated with D 98% of uterus ( P<0.05). The left-right motion of Plan 2 was negatively correlated with D 2% of CTV and V 50Gy of uterus (both P<0.05). The head-foot motion was negatively associated with D 98% of CTV, and D 98%, D mean, V 45Gy and V 50Gy of uterus (all P<0.05). The ventrodorsal motion was negatively correlated with D 98% of CTV, D 98%, D mean, V 45Gy and V 50Gy of uterus, and D mean and V 45Gy of GTV (all P<0.05). Conclusions:In intensity-modulated radiotherapy for cervical cancer, the uterine body displacement is large and the low CTV area is mainly located in the uterine body. IGRT can significantly reduce the dosimetric deviation induced by organ movement.

Objective To analyze the changes in volume and the planning volume of the bladder and rectum during helical tomotherapy (HT) treatment for cervical cancer,and to evaluate the impacts of bladder and rectum filling on their dosimetric parameters.Methods Twenty patients with cervical cancer who received HT in our hospital from 2012 to 2016 were enrolled as subjects.Before treatment,megavolt computed tomography (MVCT) and registration of planning CT images were preformed to recalculate the dose distribution,delineate the target volume,and measure the volume and position of the bladder and the rectum.Each MVCT image and the corresponding single dose were obtained by dose reconstruction using the Planned Adaptive module in HT planning workstation.The fused MVCT images and the corresponding single dose for each MVCT were loaded to MIM Maestro software 6.0 for dose stacking.The obtained total radiation dose was compared with that obtained by kilovolt CT.Between-group comparison was made by paired t-test or analysis of variance.Results If the volume change in the bladder was more than 400 ml or the rate of volume change was higher than 60％,the displacements of the bladder centroid toward the foot and dorsal sides were significantly increased;the Dmean and V50 were significantly increased (P＜0.05).If the volume change in the rectum was more than 30 ml or the rate of volume change was higher than 30％,the displacements of the rectum centroid toward the head and ventral sides were significantly increased;the V45 and V50 for the rectum were significantly increased (P＜0.05).Conclusions Although the bladder filling status has little effect on the radiation dose to the bladder,the volume change or the rate of volume change should be no more than 400 ml or 60％,respectively.Moderately filled bladder is recommended for positioning and treatment,which achieves satisfactory repeatability of the treatment.A volume change of more than 30 ml or a rate of volume change of higher than 30％ can result in an increase in the dose to the rectum.Empty rectum can effectively reduce the dose to the rectum.

Objective:To help clinicians simplify the post-processing operations of structures by developing rapid processing software for target area and organs at risk structures based on ESAPI.Methods:SmartStructure script software was developed based on ESAPI, verified and evaluated in clinical work. 10 cases of rectal cancer receiving neoadjuvant radiotherapy, 10 breast cancer treated with postoperative radiotherapy, 10 cervical cancer receiving postoperative radiotherapy, 10 nasopharyngeal carcinoma receiving radical radiotherapy and 10 lung stereotactic body radiotherapy (SBRT) were selected, and different types of tumors had different post-processing operations of structures. In each case, three methods were used for post-processing of structures. In the control group (manual group), normal manual processing was employed. In the experimental group 1(SmaStru-N group), scripts without templates were utilized. In the experimental group 2(SmaStru-P group). scripts combined with templates were adopted. The processing time of the three methods was compared. Clinicians scored the scripting software from multiple aspects and compared the feeling scores of scripting software and manual operation.Results:All three methods can be normally applied in clinical settings. The error rate in the manual group was 7.0%, 3.0% in the SmaStru-N group 0% in the SmaStru-P group, respectively. Compared with the manual method, SmaStru-N shortened the processing time of target area and organs at risk by 60.9% and 93.3% for SmaStru-P. In addition, SmartStructure was superior to manual method in terms of using feeling scores. Clinicians gave lower score for the" applicability" and" simplicity" , and higher score on the" accuracy" and" efficiency" .Conclusions:Compared with conventional manual structure processing method, SmartStructure software can rapidly and accurately process all structures of the target area and organs at risk, and its advantages become more obvious with the increasing number of structures that need to be processed. SmartStructure software can meet clinical requirements, reduce the error rate, elevate processing speed, improve the working efficiency of clinicians, providing basis for the development of adaptive radiotherapy.

Objective:To evaluate the robustness of fully automated adaptive planning for Ethos online adaptive radiotherapy (ART) based on the intelligent optimization engine (IOE).Methods:Clinical data of 11 stage ⅠB cervical cancer patients admitted to Peking Union Medical College Hospital between June 2021 and June 2022 were retrospectively analyzed. Original planning images and iterative cone-beam computed tomography (iCBCT) images of each radiotherapy treatment were acquired, and all patient data were imported into the Ethos simulator. IOE-based 9-field automatic plan generation was performed for 11 patients using Ethos, and the generated plans were sent to online adaptive radiotherapy simulation to obtain each online adaptive radiotherapy plan (273 fractions in total) and complete the simulated treatment. For comparison, manual plan design was performed based on the images and contoured structures used for online adaptive radiotherapy planning, and the manually plans created with evenly divided 9 fields. Dosimetric parameters, plan complexity parameters, and Mobius quality assurance (QA) pass rates were collected to compare and evaluate the robustness of the online adaptive radiotherapy plan in terms of organs at risk (OAR), target volume dosimetric parameters, and plan complexity by using paired t-test or rank sum test. Results:The online adaptive plan of cervical cancer had comparable planning target volume (PTV) coverage compared to the manual plan. For the clinical target volume (CTV) D 99%, online adaptive plan was significantly higher than the manual plan [(45.93±0.36) vs. (45.32±0.31) Gy, P<0.001]. For hot dose area, the maximum point dose (PTV D max) of adaptive plan was significantly higher than the manual plan [(49.89±1.25) vs. (48.48±0.77) Gy, P<0.001], but the PTV D 1% of adaptive plan was significantly lower than the manual plan [(47.22±0.29) vs. (47.59±0.48) Gy, P<0.001]. There was no statistical difference in the conformal index ( P=0.967). And there was significant difference in the homogeneity index, with same medians and less dispersion in adaptive plan ( P<0.001). For OAR dose, bladder D mean, rectal V 40 Gy, small intestine D mean of adaptive plan was slightly higher than that of the manual plan; the rectal D mean, small intestine D 2 cm3 of the adaptive plan was slightly lower than that of manual plan; dosimetric parameters of right and left femoral heads, spinal cord and bone marrow of the adaptive plan were better than those of manual plan. The adaptive plan had more monitor units (MU) than the manual plan, but the complexity of the adaptive plan was significantly lower than that of the manual plan (0.135±0.012 vs. 0.151±0.015, P<0.001). For Mobius γ pass rate (5%/3 mm), both adaptive and manual plans met clinical requirements. Conclusion:Ethos cervical cancer online adaptive plan, which is based on the IOE engine, demonstrates good robustness and ensures the quality of online adaptive plans generated for each treatment fraction.

Objective:To evaluate the automatic optimization performance and clinical feasibility of the intelligent optimization engine (IOE) in the Ethos online adaptive radiotherapy platform.Methods:Clinical data of 11 patients with postoperative cervical cancer treated with Halcyon accelerator were retrospectively analyzed. Manual planning was performed for all patients using the 4 full arc volumetric modulated arc therapy (VMAT) (Manual-4Arc) in Eclipse, with a prescription dose of 45 Gy/25F. Patient images and structures were imported into the Ethos simulator, and appropriate clinical goals were added based on clinical requirements. The target coverage was normalized to 95%. Automatic plan generation was conducted using IOE, resulting in 7, 9, and 12 field intensity modulated radiotherapy (IMRT) plans (IMRT-7F、IMRT-9F、IMRT-12F), as well as 2 and 3 arc VMAT plans (VMAT-2Arc、VMAT-3Arc). Dosimetric index comparisons were made between the Manual-4Arc plans and the 5 groups of IOE-generated plans through one-way analysis of variance. Based on the analysis results, Turky post hoc multiple comparisons were performed to evaluate the automatic optimization performance of IOE.Results:In terms of the high dose area, the IMRT-12F plans showed the lowest D 1% for the planning target volume (PTV), and there were significant differences compared to the Manual-4Arc plans ( P=0.004). Regarding target coverage, all groups produced clinical target volume (CTV) plans that met the clinical requirements. Although the Ethos online adaptive plans were normalized during planning, the PTV coverage was slightly insufficient. For organs at risk (OAR) close to the target, such as the bladder, there were significant differences in V 30 Gy, V 40 Gy, and D mean among the 6 groups of plans. The dose ranking for the bladder was generally as follows: IMRT-12F

Objective To analyze the effect of image guidance on the doses to the rectum and bladder in radical external beam radiotherapy for cervical cancer, and to investigate the reasonable application mode of image-guided radiotherapy (IGRT) in the treatment of cervical cancer. Methods A total of 20 patients with cervical cancer who underwent helical tomotherapy(HT) in PLA Army General Hospital from 2012 to 2016 were enrolled in this study. A megavoltage computed tomography(MVCT) scan was performed before each treatment. The obtained MVCT images were used for dose reconstruction in the adaptive module of HT to obtain the actual dose (Plan-1) and the non-image-guided dose was simulated (Plan-2). Each single dose distribution and the corresponding fused CT image were sent to the software MIM 6.0 to obtain the total radiation dose by dose superposition. The radiation doses and volumes of the rectum and bladder were compared between the two therapeutic plans. Results The radiation doses to the rectum and bladder in Plan-2 were significantly higher than those in Plan-1. There were significant differences in Dmaxand V50of the rectum and V50of the bladder between Plan-1 and Plan-2(P=0.040;P=0.000;P=0.047). Compared with Plan-1, there were statistical differences in inter-fractional Dmaxand V50during the initial treatment (P=0.047,0.037), and V50of the rectum within the 13thto 21stradiotherapy, respectively (P=0.009, 0.017, 0.028). Besides, differences regarding Vmaxand V50in the initial treatment and the 21stto 23rdradiotherapy were close to the statistical significance when compared to those in Plan-1, respectively (P= 0.061,0.053; P= 0.072,0.058). Conclusions IGRT can reduce the radiation doses and volumes of the rectum and bladder, especially the rectum. The therapeutic plan should be rescheduled when tumor retraction is evident at half of the total radiation dose (around 13thfraction) in external beam radiotherapy. If it is difficult to achieve image guidance in each treatment,selective image guidance could be performed to effectively reduce the injuries of the rectum and bladder.

Objective: To study the expression of Wnt2b protein and the epithelial-mesenchymal transition related markers in tissues of carcinoma of bile duct and normal bile duct to determine the clinical significance. The relationships between the expression levels and clinicopathological characteristics were analyzed, and the correlation between Wnt2b and epithelial interstitial transformation (EMT), tumor invasion and metastasis were studied. Methods: A total of 60 patients with cholangiocarcinoma and 30 patients with normal bile duct tissues admitted to the Affiliated Hospital of Qingdao University from December 2008 to December 2013 were studied. The expressions of Wnt2b, E-cadherin and Vimentin protein were detected by SP immunohistochemical staining. The patients were classified according to the expressions of these proteins. Analyses were conducted on the relationships of these proteins with clinical characteristics of the patients with cholangiocarcinoma. Results: The positive expression rate of Wnt2b protein in carcinoma of bile duct tissues was 90.0%, which was significantly higher than that in normal bile duct tissues (χ²=38.1, P<0.05). The positive expression rate of Wnt2b in T₃ + T₄ was significantly higher than that in T₁ + T₂ (P<0.05). There were no correlations of the expression with patients’ age, gender, tumor location and degree of tumor differentiation (P>0.05). Patients with lymph node metastasis had a significantly higher positive expression of Vimentin than patients with no lymph node metastasis, and the loss of E-cadherin expression was increased (all P<0.05). There were no relationship of the expressions of these proteins with patients’ age, gender, tumor location and degree of tumor differentiation (P>0.05). The increased expression of Wnt2b in bile duct cancer cells was related to increase in EMT marker of the positive expression of vimentin and the loss of E-cadherin expression (both P<0.05). Conclusions Wnt2b protein overexpression in cholangiocarcinoma correlated with epithelial-mesenchymal transition related markers. The Wnt2b protein was correlated with cholangiocarcinoma occurrence, development, invasion and metastasis. Wnt2b has the potential to develop into a new therapeutic target for carcinoma of bile duct.