This paper aims to propose a noninvasive radiotherapy patient positioning system based on structured light surface imaging, and evaluate its clinical feasibility. First, structured light sensors were used to obtain the panoramic point clouds during radiotherapy positioning in real time. The fusion of different point clouds and coordinate transformation were realized based on optical calibration and pose estimation, and the body surface was segmented referring to the preset region of interest (ROI). Then, the global-local registration of cross-source point cloud was achieved based on algorithms such as random sample consensus (RANSAC) and iterative closest point (ICP), to calculate 6 degrees of freedom (DoF) positioning deviation and provide guidance for the correction of couch shifts. The evaluation of the system was carried out based on a rigid adult phantom and volunteers' body, which included positioning error, correlation analysis, and receiver operating characteristic (ROC) analysis. Using Cone Beam CT (CBCT) as the gold standard, the maximum translation and rotation errors of this system were (1.5 ± 0.9) mm along Vrt direction (chest) and (0.7 ± 0.3) ° along Pitch direction (head and neck). The Pearson correlation coefficient between results of system outputs and CBCT verification distributed in an interval of [0.80, 0.84]. Results of ROC analysis showed that the translational and rotational AUC values were 0.82 and 0.85, respectively. In the 4D freedom accuracy test on the human body of volunteers, the maximum translation and rotation errors were (2.6 ± 1.1) mm (Vrt direction, chest and abdomen) and (0.8 ± 0.4)° (Rtn direction, chest and abdomen) respectively. In summary, the positioning system based on structured light body surface imaging proposed in this article can ensure positioning accuracy without surface markers and additional doses, and is feasible for clinical application.
Humans ; Patient Positioning/methods* ; Phantoms, Imaging ; Cone-Beam Computed Tomography ; Algorithms ; Radiotherapy, Image-Guided/methods* ; Radiotherapy Planning, Computer-Assisted/methods*

Objective:To investigate the uptake patterns of 18F-fluorodeoxy glucose ( 18F-FDG) in the endometrium using positron emission tomography (PET) imaging and to differentiate these from stage IA endometrial cancer. Methods:From September 2022 to April 2024, a prospective inclusion of 354 women without gynecological diseases and no hormone usage who underwent 18F-FDG PET-CT examinations at the affiliated hospital of Qingdao University were set as the physiological group, while a group containing 42 cases of Stage IA endometrial carcinoma was also set. The physiological group was divided into five groups based on the menstrual cycle: menstrual period, proliferative phase, ovulatory phase, secretory phase, and menopausal phase. The images were analyzed using visual and quantitative measurements; quantitative analysis indicators were standardized uptake value maximum (SUVmax) and the region of interest/liver ratio (R/L value). Receiver operating characteristic (ROCs) curve was used to determine the optimal cutoff values for SUVmax and R/L value. A clinical model was established using binary logistic regression, and ROC curves were drawn to evaluate the predictive performance of the model. Results:The uptake of 18F-FDG in the endometrium exhibited cyclical variations throughout different physiological phases, with higher uptakes observed during the menstrual and ovulation phases (SUVmax values of 6.66±3.26 and 3.89±1.21, respectively), which are significantly higher than those in the proliferative phase [median SUVmax of 2.54 (2.02, 3.47)], secretory phase (SUVmax of 2.55±0.86), and menopausal phase [SUVmax median of 2.04 (1.69, 2.29)]. During the menstrual and ovulation phases, the radiotracer accumulation patterns were triangular in 105 cases, oval in 32 cases, and round-like in 2 cases. All 42 cases of endometrial cancer showed 18F-FDG uptake, with radiotracer accumulation patterns being round-like in 17 cases, oval in 10 cases, triangular in 9 cases, and irregular in 6 cases. There were statistically significant differences in the shapes of radiotracer concentration between the menstrual, ovulatory periods, and endometrial carcinoma (both P＜0.001). The SUVmax and R/L values in menstrual period and ovulatory period were significantly lower than that in endometrial carcinoma group ( P＜0.001). During the menstrual phase, the optimal cutoff values for SUVmax and R/L in distinguishing between endometrial and endometrial cancer were 12.59 and 3.81, respectively, with corresponding AUCs of 0.885 and 0.842. After incorporating endometrial uptake morphology into the model, the AUCs was improved to 0.969 and 0.948, respectively. During the ovulatory phase, the optimal cutoff values for SUVmax and R/L were 5.96 and 2.85, respectively, with AUCs of 0.984 and 0.968. After integrating endometrial uptake morphology into the model, the AUCs were increased to 0.999 and 0.998, respectively. Conclusions:The 18F-FDG PET imaging of the endometrium shows higher uptake during the menstrual and ovulatory periods, primarily triangular in shape; endometrial carcinoma uptake is significantly higher than the physiological uptake during the menstrual and ovulatory periods, mainly in circular, oval, and irregular shapes. When SUVmax≥5.96, R/L≥2.85, combined with the physiological cycle of the subjects and the morphological characteristics of the radiotracer concentration, it is possible to effectively differentiate between physiological uptake and Stage IA endometrial carcinoma.

Objective:To explore the value of a model combining 18F-FDG PET/CT radiomics and clinical factors in prediction of lymphovascular invasion (LVI) in rectal cancer. Methods:This retrospective cohort study was conducted on 120 patients (86 males and 34 females; age (62.2±11.6) years) with rectal adenocarcinoma from the Affiliated Hospital of Qingdao University between January 2017 and November 2023. Patients were divided into a training set ( n=96) and testing set ( n=24) at the ratio of 8∶2 using simple random sampling without replacement with a fixed random seed. An external validation cohort consisted of 31 patients (17 males and 14 females; age (61.2±8.2) years) with rectal adenocarcinoma from Affiliated Hospital of Jining Medical University and Linyi Cancer Hospital between January 2020 and June 2024 was obtained. PET/CT-derived features were selected to build radiomics model. The χ2 test and logistic regression were used to identify clinical predictors of LVI for clinical modeling. A combined radiomics-clinical nomogram was developed, after that ROC analysis was conducted to evaluate the predictive performance. Results:Significant differences were found between LVI-positive ( n=40) and LVI-negative ( n=56) subgroups in body weight, carbohydrate antigen (CA) 19-9, metabolic tumor volume (MTV), and peak of SUV (SUV peak) in the training set ( χ2 values: 4.01-13.64, all P<0.05). Binary logistic regression identified body weight (odds ratio ( OR)=0.320, 95% CI: 0.095-0.906, P=0.033), CA19-9 ( OR=0.402, 95% CI: 0.120-0.917, P=0.033), and MTV ( OR=0.192, 95% CI: 0.090-0.575, P=0.002) as independent predictors of LVI, forming the clinical model. Thirteen PET features and fifteen CT features were selected and a radiomics model was built. ROC curve analysis showed that AUCs for the clinical model in the training, testing, and external validation sets were 0.765, 0.567, and 0.777, respectively; AUCs for the radiomics model were 0.925, 0.881, and 0.823; AUCs for the joint model were 0.938, 0.889, and 0.841. Conclusion:The joint model of 18F-FDG PET/CT radiomics and clinical factors can effectively predict LVI in rectal cancer, guiding preoperative therapy and surgical planning.

The theory of "Yang transforming Qi while Yin constituting form" in the Huangdi's Internal Classic is derived from the application， transformation， movement， and balance of Tao. It is highly condensed， revealing the true meaning of Tao and guiding the changes and progress of all natural things， including diseases. Therefore， the appearance of various physical diseases is the manifestation of Yin-Yang Qi transformation. Sweat pore， formed by the Qi transformation of Yin and Yang， is the nourishing and regulating system. It serves as the hub and channel， assisting in the flow and transformation of Qi， facilitating the exchange of material， energy， and information with the outside world. With sweat pore as the hub and based on the macro-control and holistic thinking of "Yang transforming Qi while Yin constituting form"， this paper explores the microscopic mechanisms underlying chronic liver disease. In combination with the roles of mitochondria， exosomes， and the ultraliver sieve structure in the formation and progression of chronic liver disease， this paper elucidates the close internal relationship between the disease's initial quality， symptom signs， and its physiological and pathological functions under the guidance of this theory. Modern studies have shown that autophagy， intestinal flora disorders， glucose and lipid metabolism disturbances， activation of inflammatory factors， ferroptosis， and other microscopic pathological mechanisms are involved in the occurrence and development of chronic liver disease. The common connotation of the Yin-Yang concept in traditional Chinese medicine （TCM） and the pathological mechanisms in modern medicine is deeply analyzed. The corresponding relevant microscopic mechanisms and the guiding role of the theory of "Yang transforming Qi while Yin constituting form-sweat pore" in the management of chronic liver disease are summarized. Wind medicine promotes growth and transformation through sweat pore. The combination of pungent and sweet medicines facilitates Yang and disperse Yin. The formulas， combining the characteristics of wind medicine and pungent and sweet medicines， fit the principle of "Yang transforming Qi while Yin constituting form-sweat pore". This paper combines both macro and micro perspectives to explain the scientific connotation and microscopic mechanisms of chronic liver disease based on the theory of "Yang transforming Qi while Yin constituting form-sweat pore"， and explore the prevention and treatment of chronic liver disease through the principles， methods， prescriptions， and medicines featured by combination of pungent and sweet medicines， facilitating Yang， activating sweat pore， and dispersing Yin， providing new ideas and reference for the clinical treatment of chronic liver disease.

Objective:To develop a convolutional neural network model of whole slide imaging of cerebrospinal fluid cells for rapid and accurate identification and classification of tumor cells in cerebrospinal fluid.Methods:A total of 8 692 cerebrospinal fluid cytology smears from Huashan Hospital Affiliated to Fudan University from January 2nd, 2019, to December 27th, 2024. As randomly assigned, the training set included 4 941 benign and 1 745 malignant samples, while the validation set comprised of 1 368 benign and 638 malignant samples. Whole-slide digital images were acquired using a cytopathology scanner, cells (clusters) were annotated for classification, and a deep learning model was constructed via tiled image patches for cell detection and classification. Model performance was evaluated using accuracy, sensitivity, specificity, and other indicators. The classification efficiency of manual microscopy was compared.Results:The model achieved a mean precision of 96.75% for cerebrospinal fluid cell classification. For malignant tumor cells, the classification accuracy was 96.61% (mAP=98.36%, AUC=0.97). Subtype classification accuracies for epithelial/epithelioid tumors and small round cell tumors were 97.13% (AUC=0.98) and 95.58% (AUC=0.93), respectively. Compared with manual microscopy, which took (9.70±0.82) minutes for classifying 200 cells, (18.27±1.21) minutes for 500 cells, and often exceeded 60 minutes or infeasible for full slides, the AI model took (3.46±0.49) seconds for 200 cells, (6.76±0.82) seconds for 500 cells, and a median of 48.57 seconds for full slides ( P<0.001), representing an efficiency improvement of approximately 161-170 times, significantly enhancing diagnostic efficiency. Conclusion:This fully automated hierarchical deep learning model enables efficient and accurate tumor cell identification and classification in CSF, providing an effective auxiliary tool for the rapid diagnosis of meningeal carcinomatosis.

Anaplastic lymphoma kinase (ALK) rearranged renal cell carcinoma (ALK-RCC) is an exceedingly rare malignancy, recently classified as a distinct molecular entity in the 5th edition of the WHO classification for urinary and male genital tumors. Due to its non-specific clinical symptoms and diverse histopathological patterns, accurate diagnosis is difficult. This paper reports a case of ALK-RCC with morphology and immunophenotype resembling papillary renal cell carcinoma. After second-generation sequencing, EML4-ALK gene fusion was found, and positive staining for ALK was confirmed by immunohistochemistry subsequently. Following informed consent from the patient, targeted therapy with crizotinib was initiated. During a 17-month follow-up period, no recurrence or metastasis was observed.

Parkinson disease is a progressive neurodegenerative disease whose incidence increases year by year as the population ages.TCM compounds for the treatment of Parkinson disease has the characteristics of multiple components,targets,and pathways.Combined treatment with Western medicine can achieve synergistic effects and reduce adverse drug reactions.This article focused on the mechanism of TCM compounds for the treatment of Parkinson disease,reviewed relevant experimental studies in recent years.TCM compounds may exert therapeutic effects on Parkinson disease by regulating oxidative stress,mitochondrial dysfunction,neurotransmitters,neuroinflammation,abnormal protein aggregation,cell apoptosis,stem cell transplantation,neurotrophic factors,second messengers,and other mechanisms,in order to provide basis for clinical treatment of Parkinson disease.

Objective To explore the impact of remimazolam besylate combined with sufentanil for postoperative cognitive function and inflammatory factor levels in elderly patients underwent laparoscopic inguinal hernia surgery.Methods 100 elderly patients who underwent laparoscopic inguinal hernia surgery were selected and included from July 2022 to December 2023.Divide into a study group(n=50,remimazolam besylate combined with sufentanil anesthesia)and a control group(n=50,propofol combined with sufentanil anesthesia)using a random number table method.Compare the mean arterial pressure(MAP),heart rate(HR),plasma stress indicators[adrenaline(AD),norepinephrine(NE)and cortisol(Cor)],serum inflammatory factors[interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)],the mini mental state examination(MMSE)scale,Montreal cognitive assessment(MoCA)scale,visual analogue scale(VAS),Ramsay sedation scale,and adverse reactions between the two groups.Results There were differences in MAP and HR levels between the two groups in terms of time,inter group,and interaction effects(P＜0.05).At 24 h after surgery,compared with the control group,the study group had lower levels of AD,NE,Cor,IL-6,and TNF-α,higher levels of IL-10,MoCA and MMSE scales,the differences were statistically significant(P＜0.05).At 12 and 24 h after surgery,compared with the control group,the study group had lower VAS and higher Ramsay scales,the differences were statistically significant(P＜0.05).The additional dose of sufentanil in the study group was(7.44±1.35)μg,which was lower than that in the control group(8.25±1.43)μg,with statistical difference(t=2.91,P=0.004).There was no difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Remimazolam+sufentanil in elderly patients with laparoscopic inguinal hernia surgery can improve their cognitive function by reducing inflammation and with high safety.It is worthy of clinical application.

Parkinson disease is a progressive neurodegenerative disease whose incidence increases year by year as the population ages.TCM compounds for the treatment of Parkinson disease has the characteristics of multiple components,targets,and pathways.Combined treatment with Western medicine can achieve synergistic effects and reduce adverse drug reactions.This article focused on the mechanism of TCM compounds for the treatment of Parkinson disease,reviewed relevant experimental studies in recent years.TCM compounds may exert therapeutic effects on Parkinson disease by regulating oxidative stress,mitochondrial dysfunction,neurotransmitters,neuroinflammation,abnormal protein aggregation,cell apoptosis,stem cell transplantation,neurotrophic factors,second messengers,and other mechanisms,in order to provide basis for clinical treatment of Parkinson disease.

Objective To explore the impact of remimazolam besylate combined with sufentanil for postoperative cognitive function and inflammatory factor levels in elderly patients underwent laparoscopic inguinal hernia surgery.Methods 100 elderly patients who underwent laparoscopic inguinal hernia surgery were selected and included from July 2022 to December 2023.Divide into a study group(n=50,remimazolam besylate combined with sufentanil anesthesia)and a control group(n=50,propofol combined with sufentanil anesthesia)using a random number table method.Compare the mean arterial pressure(MAP),heart rate(HR),plasma stress indicators[adrenaline(AD),norepinephrine(NE)and cortisol(Cor)],serum inflammatory factors[interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)],the mini mental state examination(MMSE)scale,Montreal cognitive assessment(MoCA)scale,visual analogue scale(VAS),Ramsay sedation scale,and adverse reactions between the two groups.Results There were differences in MAP and HR levels between the two groups in terms of time,inter group,and interaction effects(P＜0.05).At 24 h after surgery,compared with the control group,the study group had lower levels of AD,NE,Cor,IL-6,and TNF-α,higher levels of IL-10,MoCA and MMSE scales,the differences were statistically significant(P＜0.05).At 12 and 24 h after surgery,compared with the control group,the study group had lower VAS and higher Ramsay scales,the differences were statistically significant(P＜0.05).The additional dose of sufentanil in the study group was(7.44±1.35)μg,which was lower than that in the control group(8.25±1.43)μg,with statistical difference(t=2.91,P=0.004).There was no difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Remimazolam+sufentanil in elderly patients with laparoscopic inguinal hernia surgery can improve their cognitive function by reducing inflammation and with high safety.It is worthy of clinical application.