Objective:To compare the effects of different automatic normal tissue objective(NTO)weights(WNTO)of Eclipse planning system on intensity modulated radiation therapy(IMRT)of fixed field for abdominal tumor.Methods:Twenty patients with rectal cancer and twenty patients with cervical cancer who received radiotherapy in The Second People's Hospital of Huludao from September 2022 to January 2024 were selected.5 groups of different plans[WNTO20,40,60,80 and 100]were respectively formulated for each patient.Among of them,the WNTO20 plan was control group,and other 4 groups were respectively WNTO40 group,WNTO60 group,WNTO80 group and WNTO100 group.Then,the differences in dosimetry and monitor units(MU)among 5 groups of plans were compared.Results:In the WNTO 80 and 100 groups of patients with rectal cancer,the conformation index(CI)values of target regions of them were respectively 1.02±0.04 and 1.00±0.03,all of which approached to 1,and the CI values of two groups were lower than that of control group,and the differences were statistically significant(t=15.986,18.422,P<0.05).The homogeneity index(HI)of WNTO 80 and 100 groups were respectively 0.09±0.12 and 0.10±0.14,which were higher than that of control group,and the differences were statistically significant(t=-1.371,-1.463,P<0.05).The 52Gy dose volume(Vmax52)of small intestine of the two groups were respectively(4.48±14.49)and(4.77±10.47)cm3,which were higher than that of control group,and the differences were statistically significant(t=-1.360,-2.005,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the right femoral heads of the two groups were respectively(12.28±4.57)%and(10.96±4.17)%,which were lower than that of control group,and the differences were statistically significant(t=6.893,6.75,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the left femoral head of the two groups were respectively(11.57±4.41)%and(10.17±3.78)%,which were lower than that of control group,and the differences were statistically significant(t=6.782,5.963,P<0.05).The MU value of WNTO100 group was(1254±93)MU,which was higher than that of control group,and the difference was statistically significant(t=-3.741,P<0.05).In the WNTO 80 and 100 groups of patients with cervical cancer,the CI values of target regions of them were respectively 1.03±0.32 and 1.02±0.03,all of which approached to 1,and the CI values of the two groups were lower than those of control group,and the differences were statistically significant(t=20.069,19.475,P<0.05).The HI values of them were respectively 0.07±0.05 and 0.08±0.01,which were higher than that of control group,and the differences were statistically significant(t=-12.445,-19.478,P<0.05).The V30 Gy values of the right femoral heads of the two groups were respectively(16.11±4.71)%and(14.90±4.56)%,which were lower than that of control group,and the differences were statistically significant(t=7.875,8.020,P<0.05).The V30 Gy values of the left femoral head of the two groups were respectively(15.21±3.71)%and(13.93±3.77)%,which were lower than that of control group,and the differences were statistical significance(t=7.617,7.436,P<0.05).The Vmax52 of small intestine of the two groups were respectively(0.82±1.10)and(4.47±8.81)cm3,which were higher than that of control group,and the difference was statistically significant(t=-2.985,-2.388,P<0.05).Conclusion:The WNTO80 is recommended for IMRT plan of radiotherapy on abdominal tumor,which can more quickly and better meet the assessment conditions of IMRT plan.

Objective:To explore the potential causal relationships between major depressive disorder(MDD),anxiety disorder(AD)and various highly prevalent cancers from the genetic perspective.Methods:Sum-mary statistics from large-scale genome-wide association studies(GW AS)were analyzed using a bidirectional two-sample Mendelian randomization(MR)approach.The inverse variance weighting method(IVW)was usedas the main analytical approach.The intercept term of MR-Egger regression and the MR-PRESSO method were adopted for the pleiotropy test.Results:The IVW analysis revealed potential causal relationships between MDD and breast cancer[OR(95％CI):1.11(1.01-1.22),P＜0.05],AD and lung cancer[OR(95％CI):1.30(1.02-1.65),P＜0.05],and between colon cancer and MDD[OR(95％CI):1.05(1.00-1.11),P＜0.05].The results of the pleiotropy test showed that the intercept terms of the MR-Egger regression were not statistically significant,indica-ting the absence of pleiotropy.The MR-PRESSO method detected outliers only in the relationship between MDD and breast cancer.The association between MDD and breast cancer remained significant after correction for outliers[OR(95％CI):1.10(1.03-1.17),P＜0.05].Conclusion:The study suggests that MDD may be a risk factor for breast cancer,AD may increase the risk factor for lung cancer,and colon cancer may elevate the risk factor of MDD.Moreover,the possibility of reverse causal relationships has been excluded in all these cases.

Objective:To explore the potential causal relationships between major depressive disorder(MDD),anxiety disorder(AD)and various highly prevalent cancers from the genetic perspective.Methods:Sum-mary statistics from large-scale genome-wide association studies(GW AS)were analyzed using a bidirectional two-sample Mendelian randomization(MR)approach.The inverse variance weighting method(IVW)was usedas the main analytical approach.The intercept term of MR-Egger regression and the MR-PRESSO method were adopted for the pleiotropy test.Results:The IVW analysis revealed potential causal relationships between MDD and breast cancer[OR(95％CI):1.11(1.01-1.22),P＜0.05],AD and lung cancer[OR(95％CI):1.30(1.02-1.65),P＜0.05],and between colon cancer and MDD[OR(95％CI):1.05(1.00-1.11),P＜0.05].The results of the pleiotropy test showed that the intercept terms of the MR-Egger regression were not statistically significant,indica-ting the absence of pleiotropy.The MR-PRESSO method detected outliers only in the relationship between MDD and breast cancer.The association between MDD and breast cancer remained significant after correction for outliers[OR(95％CI):1.10(1.03-1.17),P＜0.05].Conclusion:The study suggests that MDD may be a risk factor for breast cancer,AD may increase the risk factor for lung cancer,and colon cancer may elevate the risk factor of MDD.Moreover,the possibility of reverse causal relationships has been excluded in all these cases.

Objective:To compare the effects of different automatic normal tissue objective(NTO)weights(WNTO)of Eclipse planning system on intensity modulated radiation therapy(IMRT)of fixed field for abdominal tumor.Methods:Twenty patients with rectal cancer and twenty patients with cervical cancer who received radiotherapy in The Second People's Hospital of Huludao from September 2022 to January 2024 were selected.5 groups of different plans[WNTO20,40,60,80 and 100]were respectively formulated for each patient.Among of them,the WNTO20 plan was control group,and other 4 groups were respectively WNTO40 group,WNTO60 group,WNTO80 group and WNTO100 group.Then,the differences in dosimetry and monitor units(MU)among 5 groups of plans were compared.Results:In the WNTO 80 and 100 groups of patients with rectal cancer,the conformation index(CI)values of target regions of them were respectively 1.02±0.04 and 1.00±0.03,all of which approached to 1,and the CI values of two groups were lower than that of control group,and the differences were statistically significant(t=15.986,18.422,P<0.05).The homogeneity index(HI)of WNTO 80 and 100 groups were respectively 0.09±0.12 and 0.10±0.14,which were higher than that of control group,and the differences were statistically significant(t=-1.371,-1.463,P<0.05).The 52Gy dose volume(Vmax52)of small intestine of the two groups were respectively(4.48±14.49)and(4.77±10.47)cm3,which were higher than that of control group,and the differences were statistically significant(t=-1.360,-2.005,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the right femoral heads of the two groups were respectively(12.28±4.57)%and(10.96±4.17)%,which were lower than that of control group,and the differences were statistically significant(t=6.893,6.75,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the left femoral head of the two groups were respectively(11.57±4.41)%and(10.17±3.78)%,which were lower than that of control group,and the differences were statistically significant(t=6.782,5.963,P<0.05).The MU value of WNTO100 group was(1254±93)MU,which was higher than that of control group,and the difference was statistically significant(t=-3.741,P<0.05).In the WNTO 80 and 100 groups of patients with cervical cancer,the CI values of target regions of them were respectively 1.03±0.32 and 1.02±0.03,all of which approached to 1,and the CI values of the two groups were lower than those of control group,and the differences were statistically significant(t=20.069,19.475,P<0.05).The HI values of them were respectively 0.07±0.05 and 0.08±0.01,which were higher than that of control group,and the differences were statistically significant(t=-12.445,-19.478,P<0.05).The V30 Gy values of the right femoral heads of the two groups were respectively(16.11±4.71)%and(14.90±4.56)%,which were lower than that of control group,and the differences were statistically significant(t=7.875,8.020,P<0.05).The V30 Gy values of the left femoral head of the two groups were respectively(15.21±3.71)%and(13.93±3.77)%,which were lower than that of control group,and the differences were statistical significance(t=7.617,7.436,P<0.05).The Vmax52 of small intestine of the two groups were respectively(0.82±1.10)and(4.47±8.81)cm3,which were higher than that of control group,and the difference was statistically significant(t=-2.985,-2.388,P<0.05).Conclusion:The WNTO80 is recommended for IMRT plan of radiotherapy on abdominal tumor,which can more quickly and better meet the assessment conditions of IMRT plan.

Objective: To investigate the causal relationship between gut microbiota and constipation using Mendelian randomization (MR) method. Methods: Genetic variation data of gut microbiota were obtained from the MiBioGen Consortium database. The genetic variation data of constipation were sourced from the IEU Open GWAS database. A forward MR analysis was performed using the inverse-variance weighted (IVW) method with 2 511 SNPs associated with gut microbiota as instrumental variables, and constipation as study outcome, and a reverse MR analysis was performed with 13 microbiota-associated SNPs as instrumental variables and gut microbiota as study outcome. The heterogeneity was assessed using the Cochran test, reverse causation of SNP were examined using MR Steiger test, and the horizontal pleiotropy was assessed using the MR-PRESSO test and MR-Egger regression. In addition, the robustness of the results was verified with the leave-one-out. Results: Forward MR analysis results showed that an increased abundance of genus Coprococcus1 driven by host genetics was associated with a decreased risk of constipation (OR=0.791, 95%CI: 0.709-0.884), and increased abundance of phylum Bacteroidetes driven by host genetics was associated with an increased risk of constipation (OR=1.240, 95%CI: 1.102-1.394). Cochran test detected no heterogeneity (both P>0.05), MR Steiger test was not revealed reverse causation of SNP, and neither the MR-PRESSO test nor the MR-Egger regression revealed horizontal pleiotropy of instrumental variables (all P>0.05), and the leave-one-out method confirmed the robustness of results. Reverse MR analysis showed no association between gut microbiota and constipation (both P>0.05). Conclusion Genus Coprococcus1 and phylum Bacteroidetes in the gut microbiota are associated with constipation.

OBJECTIVE: To carry out genetic analysis for a fetus with confined placental mosaicism (CPM) for trisomy 2 (T2) in conjunct with fetal uniparental disomy (UPD). METHODS: Amniocentesis and chromosomal karyotyping was carried out for a pregnant woman with a high risk for chromosome 2 anomalies indicated by non-invasive prenatal testing (NIPT). Single nucleotide polymorphism array (SNP-array) and trio-whole exome sequencing (Trio-WES) were carried out. Ultrasonography was used to closely monitor the fetal growth. Multifocal sampling of the placenta was performed after delivery for copy number variation sequencing (CNV-seq). RESULTS: The fetus was found to have a normal chromosomal karyotype. SNP-array has revealed multiple regions with loss of heterozygosity (LOH) on chromosome 2. Trio-WES confirmed the presence of maternal UPD for chromosome 2. Ultrasonography has revealed intrauterine growth restriction and oligohydramnios. Intrauterine fetal demise had occurred at 23⁺⁴ weeks of gestation. Pathological examination had failed to find salient visceral abnormality. The placenta was proved to contain complete T2 by CNV-seq. CONCLUSION T2 CPM can cause false positive result for NIPT and may be complicated with fetal UPD, leading to adverse obstetric outcomes such as intrauterine growth restriction, oligohydramnios and intrauterine fetal demise.
Female ; Humans ; Pregnancy ; Amniocentesis ; Chromosomes, Human, Pair 2/genetics* ; DNA Copy Number Variations ; Fetal Death ; Fetal Growth Retardation/genetics* ; Fetus ; Mosaicism ; Oligohydramnios ; Placenta ; Trisomy/genetics* ; Uniparental Disomy/genetics*

Transcatheter tricuspid valve intervention is the new frontier of interventional cardiology. The LuX-Valve is a radial force-independent orthotopic tricuspid valve replacement device developed in China. The LuX-Valve Plus transcatheter tricuspid valve replacement (TTVR) system is changed from the trans-atrial to the transjugular approach, which further reduces trauma and pulmonary complications compared with the first generation LuX-Valve. The first-in-human study has been completed at Zhongshan Hospital, Fudan University and an exploratory multicentre clinical study is underway. Echocardiography plays an important role in pre-TTVR screening, intraoperative guidance and postoperative evaluation and follow-up, especially two-dimensional transoesophageal echocardiography (2D-TEE) and three-dimensional transoesophageal echocardiography (3D-TEE). However, there is a lack of appropriate intraoperative guidance and assessment protocols. In this study, we briefly described the protocols and imaging considerations for intraoperative 2D-TEE and 3D-TEE to ensure the successful implantation of TTVR.

Objective:To investigate the effect of instantaneous flow rate on the consistency of diagnostic accuracy of severe degenerative mitral regurgitation (DMR) using proximal isovelocity surface area (PISA).Methods:From June 2019 to June 2021, 75 patients with DMR who underwent echocardiography in Department of Echocardiography of Zhongshan Hospital, Fudan University were prospectively enrolled. The instantaneous flow rate of DMR during the systolic phase was calculated using M-mode PISA(PISA M-mode), and a time-integrated curve was plotted. Regurgitant volume (RVol) and effective regurgitant orifice area (EROA) were calculated by traditional PISA (PISA max), pair PISA (PISA pair), and PISA M-mode, respectively. RVol acquired from cardiac magnetic resonance (CMR) volumetric method in 22 patients of the enrolled patients. The correlation and consistency of RVol acquired between the three PISA methods and CMR were compared. Agreement of diagnostic accuracy of severe mitral regurgitation (sMR) acquired between the three PISA methods and multi-parameter algorithm by American Society of Echocardiography (ASE) was analyzed using Cohen′s Kappa analysis. Results:The curve of instantaneous flow rate of DMR showed unimodal pattern with the peak at mid-late systolic phase. The correlation of RVol acquired between PISA methods and CMR was moderate for PISA max and PISA pair ( r=0.77, 0.80, both P<0.001), whereas PISA M-mode presented strong correlation with CMR ( r=0.87, P<0.001). RVol acquired from PISA max was larger than that of CMR[(69.1±37.1) ml vs (49.0±29.0)ml, P=0.002]. Both PISA max and PISA pair were shown moderate agreement of diagnostic accuracy of sMR with ASE multi-parameters algorithm (RVol: κ=0.496, 0.525, both P<0.001; EROA: κ=0.570, 0.578, both P<0.001), while PISA M-mode presented strong agreement (RVol: κ=0.867 and EROA: κ=0.802, both P<0.001). Conclusions:Based on the unimodal pattern of instantaneous flow rate in patients with DMR, PISA max may significantly overestimate RVol, exposing a significant proportion of patients with DMR to unnecessary MR surgery. PISA M-mode presents better correlation and consistency with CMR on the quantification of RVol compared with PISA max and PISA pair, and may improve the diagnostic accuracy of quantification of sMR using PISA.

Objective To use feature selection and Likert grading method to quantify the data of lung cancer medical records,to construct a deep extreme learning machine model optimized by the sparrow search algorithm,to classify and predict the syndrome types of traditional Chinese medicine medical record data of lung cancer,and to provide scientific and effective research on syndrome type classification of traditional Chinese medicine.means.Methods The medical records of 497 cases diagnosed with lung cancer from January 2015 to December 2021 were collected from the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine,and 412 medical records were screened as the research objects.Syndromic factors of different syndromes were summarized by feature selection and feature importance ranking,and the syndrome factors were quantified by Likert grading method.Build a deep extreme learning machine optimized based on the sparrow search algorithm,and train and test the model.Finally,the model built in this paper is compared with other machine learning models according to three evaluation criteria.Results The average classification accuracy of the SSA-DELM model established in this paper was 88.44%,while the average accuracy of the support vector machine and Bayesian network was 83.39%and 84.53%,respectively.The recall rate and F1 value of the SSA-DELM model on the five syndrome types are mostly above 80%,which is also better than other traditional machine learning models.Conclusion The results of the study show that the use of feature selection combined with Likert grading method to quantify the lung cancer medical record data,compared with the 0-1 processing data,can show the characteristics of the data,improve the accuracy of the classification model,SSA-DELM new Compared with other traditional machine learning classification models,the model has better representation learning ability and learning speed.This model not only provides a scientific and technical means for the clinical treatment of lung cancer,but also provides a useful reference for the informatization and intelligent development of TCM syndrome differentiation and treatment.

Objective:To evaluate the value of lymph node regional sorting in radical colorectal cancer surgery.Methods:Between Jan 2021 and Mar 2022, A total of 307 colorectal cancer patients undergoing radical surgery at the Tianjin Medical University General Hospital were retrospectively included and assigned to either the lymph node regional sorting group (123) or no-sorting group (184) according to the lymph node examination methods.Results:There was a significant difference between the two groups in the number of total lymph nodes and negative lymph nodes (26.74±13.08 vs. 16.80±4.87, t=9.381, P<0.001; 25.65±13.25 vs. 16.04±4.87, t=8.979, P<0.001). The number of positive lymph nodes of lymph node regional sorting group increased compared with no-sorting group (1.09±2.28 vs. 0.76±1.34, t=1.589, P=0.113). A total of 52 cases in the lymph node regional sorting group showed metastasis, of which 10 showed lymph node skip metastases. There was no significant difference in tumor location and TNM stage between skip and non-skip lymph node metastasis patients. Conclusions:The lymph node regional sorting increase the number of examined lymph nodes. The method can determine the positive lymph node distribution and ensure the accuracy of staging.