Objective:To evaluate the efficacy of reduction robot system combined with minimally invasive, microenvironmental protection, micro-stress shielding fixator (short for "3M fixator") for Sanders types II and III calcaneal fractures.Methods:A retrospective case series study was conducted to analyze the clinical data of 26 patients (26 feet) with calcaneal fractures admitted to Fourth Affiliated Central Hospital of Tianjin Medical University from June 2022 to June 2024, including 21 males and 5 females, aged 27-69 years [(46.5±2.5)years]. Among them, 10 patients had fractures in the left foot and 16 in the right. According to the Sanders classification, the fractures were classified as type II in 16 patients and type III in 10. All the patients were treated with the close reduction with reduction robot system combined with 3M fixator in a minimally invasive procedure. The surgical waiting time, operative duration, and fracture healing time were recorded. The length, width and height of the calcaneus, B?hler′s angle and Gissane′s angle were compared before operation and at 1, 3 months after operation. The visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score before operation and at 1, 3 months after operation and at the last follow-up were detected. The postoperative complications were recorded.Results:All the patients were followed up for 6-12 months [(9.7±1.1)months]. The surgical waiting time was 1-4 days [(2.0±0.8)days]. The operative duration was 36-66 minutes [(53.2±9.5)minutes]. All the fractures achieved primary union with a healing period of 3-4 months [(3.2±0.4)months]. At 1, 3 months after operation, the length of the calcaneus [(83.3±3.7)mm and (83.6±3.6)mm], width of the calcaneus [(44.3±5.8)mm and (44.3±5.7)mm], height of the calcaneus [(50.1±3.8)mm and (50.3±3.6)mm], B?hler′s angle [(29.8±2.9)° and (29.8±3.0)°], and Gissane angle [(121.1±6.7)° and (123.9±5.9)°] were significantly improved compared with those before operation [(79.3±4.5)mm, (53.6±4.1)mm, (46.2±3.7)mm, (18.9±3.8)°, (109.0±7.5)°, respectively] ( P<0.05), with no significant differences between those indicators at 1, 3 months after operation ( P>0.05). The VAS scores were (3.2±0.6)points, (1.9±0.5)points, and (1.6±0.3)points at 1, 3 months after operation and at the last follow-up, which were lower than (7.1±0.5)points preoperatively and decreased with the prolongation of follow-up time ( P<0.05). The AOFAS scores were (73.5±6.9)points, (90.1±4.3)points, and (92.0±3.6)points, which were higher than (32.0±4.6)points preoperatively and increased with the follow-up time ( P<0.05). One patient had lateral calcaneal pain after operation, and was alleviated after rehabilitation. No complications such as infection or nonunion were found after operation. Conclusion:The reduction robot system combined with 3M fixator for Sanders types II and III calcaneal fractures demonstrates significant clinical advantages, such as reduced surgical waiting time and operative duration, promoted fracture healing, early alleviated pain, enhanced ankle joint functional recovery, and decreased complication occurrence.

Objective:To analyze and compare the interfractional setup errors between two body posi-tioning fixation methods(lithotomy position with carbon fiber full-body fixation frame vs.conventional carbon fiber body fixation frame combined with thermoplastic membrane)in radical radiotherapy for pros-tate cancer,and to calculate the clinical target volume(CTV)to planning target volume(PTV)margin(MPTV)for both methods to optimize immobilization techniques and radiotherapy workflows.Methods:A retrospective analysis was conducted on 37 consecutive patients who underwent radical prostate radio-therapy at Peking University First Hospital between August 2021 and March 2023.The patients were di-vided into two groups based on the immobilization method:Group A(18 patients,450 CBCT image sets)used a carbon fiber whole-body fixator in the lithotomy position,while Group B(19 patients,461 CBCT image sets)used a conventional carbon fiber fixator combined with a thermoplastic mask.All the patients underwent daily cone-beam computed tomography(CBCT)image guidance.Bone registration combined with manual registration was used to obtain the setup error data in the left-right(X),cranio-caudal(Y)and anterior-posterior(Z)directions.The positioning errors of the two groups were compared by using the independent sample t-test,the Mann-Whitney U test and the chi-square test.The average positioning error,systematic positioning error(Σ)and random positioning error(δ)were calculated,and the CTV-PTV extension distance was calculated by using the(MPTV=2.5Σ+0.7δ).Results:The analysis of the setup errors in the three-dimensional direction showed significant differences between the two groups(all P＜0.01).Specifically,the median(quartile)absolute values of the errors in the X,Y,and Z di-rections of group A were[0.40(0.20,0.70)cm,0.50(0.30,0.80)cm,and 0.35(0.20,0.60)cm],respectively.In group B,the corresponding values were significantly reduced to[0.20(0.10,0.40)cm,0.40(0.20,0.70)cm and 0.20(0.10,0.40)cm].The results of Mann-Whitney U test showed that the differences in each direction were highly statistically significant(X:z=-6.86;Y:z=-2.76;Z:z=-5.71).The cumulative distribution ratio of the setup error displacement within 0.5 cm in the X,Y,and Z directions in group A and group B were 297(66.0％)and 408(88.5％)(P＜0.01),250(55.6％)and 285(61.8％)(P=0.055),308(68.4％)and 391(84.8％)(P＜0.01),re-spectively.The CTV-PTV margins in three directions were X 0.66 cm in group A and 0.35 cm in group B;Y0.67 cm and 0.45 cm;Z 0.54 cm and 0.42 cm.Conclusion:Conventional carbon fiber human body fixator combined with thermoplastic film can significantly reduce the setup error.However,the car-bon fiber whole-body fixator in the lithotomy position demonstrated larger setup errors in the X,Y,and Z directions compared with the conventional fixator combined with a thermoplastic mask,indicating the need for further workflow optimization.Given that the lithotomy position is essential for transperineal ultrasound-guided techniques,further research and improvements are required to achieve higher positioning accuracy.

Objective To design a Five-Elements Music Software based on Traditional Chinese Medicine's(TCM)theory of five elements music therapy and music emotion classification.The software is intended to provide appropriate music selections tailored to the negative emotional states of cancer patients and evaluate its effectiveness in psychological rehabilitation.Methods ①Music screening and classification:Qualitative analysis was used by six experts in TCM,psychology,nursing,and musicology to screen five elements music and classify corresponding emotional categories.②Software design and development:Based on screening and classification of music materials,design and develop a"Five Elements Music Software Based on Emotion Classification".③Software application evaluation:Recruit 50 cancer patients from the"Beijing Anti Cancer Paradise"as participants to have a trial listening experience with music software,and fill out a satisfaction questionnaire to evaluate its application effect.Results This study established a music database containing 150 pieces of five-elements musical tunes and completed the classification of emotional categories.Among the included subjects,80%of the recruited objects were satisfied with the experience of the five elements music software,of which the application experience of female patients was significantly better than that of male patients,and breast cancer patients were better than other cancer patients,with a statistically significant difference(P<0.05).The five elements music Software in clinic showed comparing with other two groups after four weeks,there was a significant difference for HAMD when comparing five elements music software group and the other two groups(P<0.05).Conclusion The five-element music software designed based on emotion classification effectively meets the psychological rehabilitation needs of cancer patients.It provides appropriate music selections and convenient listening method to regulate cancer-related negative emotions,extending psychological rehabilitation from the hospital to the home.

Objective:To explore the clinical application value of transoral robotic surgery (TORS) in the treatment of tonsil squamous cell carcinoma (TSCC).Methods:A retrospective analysis was conducted. The clinical data of 157 TSCC patients were collected who received TORS at five medical centers, namely, the Sun Yat-sen University Cancer Center, Sun Yat-sen Memorial Hospital, Eye Ear Nose and Throat Hospital of Fudan University, the First Affiliated Hospital of China Medical University, and Tongji Hospital of Tongji Medical College, from January 1 2017 to July 31 2022. There were 130 males and 27 females, aged 24-85 years. All patients were followed-up at least for 2 years (2-year group), among them, 99 patients had a follow-up of 3 years (3-year group). The overall survival (OS), progression-free survival (PFS), clinical stage, human papillomavirus (HPV) infection status were analyzed. SPSS 25.0 and SAS 9.4 were used for statistical analysis.Results:The OS and PFS of the 2-year group were 91.7% and 87.9%, respectively. The OS and PFS of the 3-year group were 85.9% and 82.8%, respectively. The prognosis of patients with locally early-stage was better than that of locally advanced patients, with the OS of 94.4% for T1-2 vs. 78.0% for T3 ( P=0.005) and the PFS of 91.2% for T1-2 vs. 75.0% for T3 ( P=0.011) in the 2-year group; the OS of 91.1% for T1-2 vs. 65.0% for T3 ( P=0.004) and the PFS of 88.6% for T1-2 vs. 60.0% for T3 ( P=0.002) in the 3-year group; and also, the OS of 90.0% for stage Ⅰ-Ⅱ vs. 79.5% for stage Ⅲ-Ⅳ ( P=0.204) and the PFS of 86.7% for stage Ⅰ-Ⅱ vs. 76.9% for stage Ⅲ-Ⅳ ( P=0.188) in the 3-year group. The prognosis of HPV-positive TSCC patients was better than that of HPV-negative patients in the 3-year group, with the OS of 90.9% for HPV-positive vs. 80.5% for HPV-negative ( P=0.045) and the PFS of 90.9% for HPV-positive vs. 75.6% for HPV-negative ( P=0.047). The average time of postoperative tracheal cannula indwelling was 25.1 days. The indwelling rate and average indwelling time of the postoperative nasogastric tube were 94.3% (148/157) and 8.5 days, respectively. Conclusion:TORS has outstanding survival benefits for TSCC patients. HPV-positive TSCC patients have a better prognosis than HPV-negative patients. TORS treatment of TSCC patients has advantages in postoperative recovery and quality of life.

Objective To investigate the correlation between skeletal muscle fat content and diabetic peripheral neuropathy(DPN)in patients with type 2 diabetes mellitus(T2DM).Methods 290 patients with T2DM admitted to our hospital were enrolled in this study from January 2023 to February 2024 and divided into two groups according to whether they were complicated with DPN:simple T2DM group(T2DM,n=98)and T2DM with DPN group(DPN,n=192).The general data,biochemical indexes and fat distribution indexes measured based on quantitative CT were compared between the two groups.Spearman correlation was used to analyze the relationship between fat distribution indexes and DPN,logistic regression analysis of influencing factors of T2DM complicated with DPN.Results Age,DM duration,WHR,FIns,insulin resistance index(HOMA-IR)and FF were higher in DPN group than in T2DM group(P<0.05).Ca,subcutaneous abdominal fat area(SFA)and liver fat content were lower in DPN group than in T2DM group(P<0.05).Spearman correlation analysis showed that DPN was negatively correlated with SFA and liver fat content(r=-0.127,-0.123,P<0.05),and positively correlated with FF(r=0.117,P<0.05).Logistic regression analysis showed that without adjusting for confounding factors and adjusting for DM duration,WHR,HOMA-IR,Ca,SFA and liver fat content,FF was an influential factor for DPN in T2DM patients.Conclusions Skeletal muscle FF was associated with DPN in patients with T2DM.

Objective To analyze the association between glutamyl transpeptidase(GGT)and the risk of newly diagnosed diabetes mellitus(DM)in middle aged and elderly population.Methods A retrospective cohort study was conducted,with baseline data sourced from the Beijing sub center population of the"Risk Evaluation of Cancersin Chinese Diabetic Individuals:A Longitudinal Study(REACTION)".A total of 6425 non DM individuals were enrolled in this study.All the participantswere divided into four groups according to GGT levels:G1(GGT<14.6 U/L,n=1601),G2(14.6 U/L≤GGT<19.3 U/L,n=1601),G3(19.3 U/L≤GGT<27.3 U/L,n=1613)and G4(GGT≥27.3 U/L,n=1610)group.They were followed up for 3.2 years.Results During follow-up,556 new DM cases were found,with a cumulative incidence rate of 8.7%.Logistic regression analysis showed that GGT was an independent risk factor for new DM in the non DM population,the risk of new DM in the G3,G4 groups was 1.730 times(95%CI 1.321～2.265,P<0.001)and 1.960 times(95%CI 1.493～2.587,P<0.001)of G1 group,respectively.GGT is also an independent risk factor for new DM in the impaired glucose regulation(IGR),the risk of new DM was 1.530 times higher in the G3 group(95%CI 1.123～2.094,P=0.008),and 1.750 times higher in the G4 group(95%CI 1.271～2.415,P=0.001)than in the G1 group.GGT is not an independent risk factor for new DM in participants with normal glucose tolerance(P>0.05).Conclusions GGT is a risk factor for new onset DM in IGR population.

Objective:To study the epidemic characteristics and clinical symptoms of patients with Hashimoto's thyroiditis (HT) in Shandong Province, and to provide a basis for further optimizing the clinical treatment strategies for HT.Methods:Data on HT patients admitted to Shandong Provincial Center for Disease Control and Prevention from January 2018 to December 2023 were collected. A retrospective analysis was conducted to analyze their epidemiological characteristics, clinical symptoms, and auxiliary examination results.Results:A total of 192 HT patients' data were included, comprising 42 males (21.87%) and 150 females (78.13%). The average age of patients was 40.38 years old, ranging from 9 to 74 years old. Most patients resided in urban areas (129 cases, 67.19%). HT cases occurred throughout the year in every mouth, with higher incidence in June (32 cases, 16.7%) and July (20 cases, 10.4%), lower incidence in March (8 cases, 4.2%) and April (10 cases, 5.2%), and sporadic cases in other months. Based on clinical manifestations, among all HT patients, there were 66 cases (34.38%) of Hashitoxicosis type, 11 cases (5.73%) of pseudothyrotoxicosis type, 7 cases (3.65%) of exophthalmic type, 5 cases (2.60%) of subacute thyroiditis-like type, 3 cases (1.56%) of juvenile type, 35 cases (18.23%) of fibrous type, 39 cases (20.31%) of thyroid adenoma or carcinoma type, and 26 cases (13.54%) of other autoimmune diseases type. Based on disease progression, among all HT patients, there were 61 cases (31.77%) in the hyperthyroid phase, 16 cases (8.33%) in the hyperthyroid-hypothyroid coexisting phase, and 115 cases (59.90%) in the hypothyroid phase. Based on clinical symptoms, among all HT patients,there were 78 cases(40.62%) of neck mass symptoms, 101 cases (52.60%) of digestive system symptoms, and 95 cases (49.48%) of low metabolic symptoms. Laboratory tests revealed that 144 cases had elevated levels of both thyroglobulin antibody and thyroid peroxidase antibody. Color ultrasound examination showed strip-like echoes in the thyroid in 99 cases (51.56%) and grid-like echoes in 43 cases (22.40%). After treatment with antithyroid drugs or appropriate thyroid hormone supplementation, all 192 HT patients experienced symptom relief.Conclusions:HT patients in Shandong Province were predominantly female and urban residents. Common clinical symptoms included anterior neck swelling, constipation, fever, and weight gain. Early detection, diagnosis, and treatment could delay disease progression.

Objective:To analyze and compare the interfractional setup errors between two body posi-tioning fixation methods(lithotomy position with carbon fiber full-body fixation frame vs.conventional carbon fiber body fixation frame combined with thermoplastic membrane)in radical radiotherapy for pros-tate cancer,and to calculate the clinical target volume(CTV)to planning target volume(PTV)margin(MPTV)for both methods to optimize immobilization techniques and radiotherapy workflows.Methods:A retrospective analysis was conducted on 37 consecutive patients who underwent radical prostate radio-therapy at Peking University First Hospital between August 2021 and March 2023.The patients were di-vided into two groups based on the immobilization method:Group A(18 patients,450 CBCT image sets)used a carbon fiber whole-body fixator in the lithotomy position,while Group B(19 patients,461 CBCT image sets)used a conventional carbon fiber fixator combined with a thermoplastic mask.All the patients underwent daily cone-beam computed tomography(CBCT)image guidance.Bone registration combined with manual registration was used to obtain the setup error data in the left-right(X),cranio-caudal(Y)and anterior-posterior(Z)directions.The positioning errors of the two groups were compared by using the independent sample t-test,the Mann-Whitney U test and the chi-square test.The average positioning error,systematic positioning error(Σ)and random positioning error(δ)were calculated,and the CTV-PTV extension distance was calculated by using the(MPTV=2.5Σ+0.7δ).Results:The analysis of the setup errors in the three-dimensional direction showed significant differences between the two groups(all P＜0.01).Specifically,the median(quartile)absolute values of the errors in the X,Y,and Z di-rections of group A were[0.40(0.20,0.70)cm,0.50(0.30,0.80)cm,and 0.35(0.20,0.60)cm],respectively.In group B,the corresponding values were significantly reduced to[0.20(0.10,0.40)cm,0.40(0.20,0.70)cm and 0.20(0.10,0.40)cm].The results of Mann-Whitney U test showed that the differences in each direction were highly statistically significant(X:z=-6.86;Y:z=-2.76;Z:z=-5.71).The cumulative distribution ratio of the setup error displacement within 0.5 cm in the X,Y,and Z directions in group A and group B were 297(66.0％)and 408(88.5％)(P＜0.01),250(55.6％)and 285(61.8％)(P=0.055),308(68.4％)and 391(84.8％)(P＜0.01),re-spectively.The CTV-PTV margins in three directions were X 0.66 cm in group A and 0.35 cm in group B;Y0.67 cm and 0.45 cm;Z 0.54 cm and 0.42 cm.Conclusion:Conventional carbon fiber human body fixator combined with thermoplastic film can significantly reduce the setup error.However,the car-bon fiber whole-body fixator in the lithotomy position demonstrated larger setup errors in the X,Y,and Z directions compared with the conventional fixator combined with a thermoplastic mask,indicating the need for further workflow optimization.Given that the lithotomy position is essential for transperineal ultrasound-guided techniques,further research and improvements are required to achieve higher positioning accuracy.

Objective To design a Five-Elements Music Software based on Traditional Chinese Medicine's(TCM)theory of five elements music therapy and music emotion classification.The software is intended to provide appropriate music selections tailored to the negative emotional states of cancer patients and evaluate its effectiveness in psychological rehabilitation.Methods ①Music screening and classification:Qualitative analysis was used by six experts in TCM,psychology,nursing,and musicology to screen five elements music and classify corresponding emotional categories.②Software design and development:Based on screening and classification of music materials,design and develop a"Five Elements Music Software Based on Emotion Classification".③Software application evaluation:Recruit 50 cancer patients from the"Beijing Anti Cancer Paradise"as participants to have a trial listening experience with music software,and fill out a satisfaction questionnaire to evaluate its application effect.Results This study established a music database containing 150 pieces of five-elements musical tunes and completed the classification of emotional categories.Among the included subjects,80%of the recruited objects were satisfied with the experience of the five elements music software,of which the application experience of female patients was significantly better than that of male patients,and breast cancer patients were better than other cancer patients,with a statistically significant difference(P<0.05).The five elements music Software in clinic showed comparing with other two groups after four weeks,there was a significant difference for HAMD when comparing five elements music software group and the other two groups(P<0.05).Conclusion The five-element music software designed based on emotion classification effectively meets the psychological rehabilitation needs of cancer patients.It provides appropriate music selections and convenient listening method to regulate cancer-related negative emotions,extending psychological rehabilitation from the hospital to the home.

Objective To investigate the correlation between skeletal muscle fat content and diabetic peripheral neuropathy(DPN)in patients with type 2 diabetes mellitus(T2DM).Methods 290 patients with T2DM admitted to our hospital were enrolled in this study from January 2023 to February 2024 and divided into two groups according to whether they were complicated with DPN:simple T2DM group(T2DM,n=98)and T2DM with DPN group(DPN,n=192).The general data,biochemical indexes and fat distribution indexes measured based on quantitative CT were compared between the two groups.Spearman correlation was used to analyze the relationship between fat distribution indexes and DPN,logistic regression analysis of influencing factors of T2DM complicated with DPN.Results Age,DM duration,WHR,FIns,insulin resistance index(HOMA-IR)and FF were higher in DPN group than in T2DM group(P<0.05).Ca,subcutaneous abdominal fat area(SFA)and liver fat content were lower in DPN group than in T2DM group(P<0.05).Spearman correlation analysis showed that DPN was negatively correlated with SFA and liver fat content(r=-0.127,-0.123,P<0.05),and positively correlated with FF(r=0.117,P<0.05).Logistic regression analysis showed that without adjusting for confounding factors and adjusting for DM duration,WHR,HOMA-IR,Ca,SFA and liver fat content,FF was an influential factor for DPN in T2DM patients.Conclusions Skeletal muscle FF was associated with DPN in patients with T2DM.