Objective:To explore the dosimetric characteristics of proton and photon radiotherapy in the treatment of breast cancer.Methods:Four female breast cancer patients who needed radiotherapy at Shandong Cancer Hospital and Institute from January 2024 to May 2024 were selected as the research subjects. The target area ranges of 4 patients were left-sided breast cancer with lymph node involvement, left-sided breast cancer with lymph node involvement and internal mammary node, right-sided breast cancer with lymph node involvement and internal mammary node and synchronous bilateral breast cancer. Intensity modulated proton therapy (IMPT) and intensity modulated radiation therapy (IMRT) plans were designed respectively based on the prescribed dose in the target area and the limits of organs at risk (tomotherapy plan for bilateral breasts). The conformity index (CI), homogeneity index (HI), gradient index (GI) and organs at risk doses were evaluated. The dosimetric characteristics of IMPT and photon radiotherapy were compared.Results:Both IMPT and photon radiotherapy plans of the 4 breast cancer cases met the clinical dose requirements. The HI value of IMPT plans (0.10-0.14) was comparable to that of photon radiotherapy plans (0.10-0.12), and the average CI of the photon radiotherapy plans was 0.10 higher than that of the IMPT plans, and the average GI was 0.55 lower than that of the IMPT plans. The D mean of ipsilateral lung and heart of IMPT was lower, especially in the low-dose area (V 0-3), which was significantly lower than the photon radiotherapy plans, D mean of ipsilateral lung was reduced by 12.2%, 6.1%, 16.1% and 34.8%, respectively, D mean of heart was reduced by 47.2%, 57.0%, 72.4% and 83.0%, respectively. The ipsilateral lung V 20 of IMPT was not lower than photon radiotherapy plans (unilateral breast: IMPT was 30.0%-34.0%, IMRT was 29.0%-35.9%) . Conclusions:IMPT significantly reduces the D mean to the ipsilateral lung and heart while ensuring dose coverage of the target in breast cancer, preventing more volume of surrounding normal tissues from being irradiated. However, IMPT does not show much more advantage than photon radiotherapy plans in the ipsilateral lung V 20.

Objective:To evaluate the effect of age factor on the sedative potency of ciprofol.Methods:In this prospective study, patients of either sex, aged 40-80 yr, undergoing elective surgery under general anesthesia at the First Affiliated Hospital of Zhengzhou University, were selected and divided into middle-aged group (40-<65 yr) and elderly group (65-80 yr) based on their age. Effective sedation was defined as the Modified Observer′s Assessment of Alertness/Sedation scale score ≤1 and the bispectral index value ≤60 within 3 min following ciprofol administration. The initial dose of ciprofol was 0.4 mg/kg. The dose of ciprofol was determined by using the modified Dixon′s up-and-down method (increment or decrement of 0.04 mg/kg). The experiment was terminated after observing 8 transitions from effective sedation to ineffective sedation, starting from the initial transition event. The probit method was used to determine the median effective dose (ED 50) and 95% confidence interval of ciprofol for sedation. Results:A total of 61 patients was finally included in this study, with 35 in middle-aged group and 26 in elderly group. The ED 50 of ciprofol (95% confidence interval) was 0.296 (0.206-0.359) mg/kg in middle-aged group and 0.224 (0.185-0.257) mg/kg in elderly group. The ED 50 of ciprofol was significantly higher in middle-aged group than in elderly group ( u=181.00, P<0.001). Conclusions:Age can affect the sedative potency of propofol, with enhanced potency observed in elderly patients than in middle-aged patients.

[Purpose]To explore the association between body weight change and long-term risk of esophageal cancer mortality based on Linxian General Population Nutrition Intervention study.[Methods]A total of 21 028 healthy residents aged 40～69 years old at baseline in Linxian of Henan Province were recruited as the study cohort,their body weight were measured in late 1985 and early 1991,and the esophageal cancer mortality was prospectively followed up until March 2016.The cohort was divided into four groups according to weight difference between the two measure-ments,the body weight maintenance group(change＜2 kg)was used as the reference group.The Cox proportional risk model was used to estimate the hazard ratio(HR)and 95％confidence inter-val(CI)for death from esophageal cancer in the weight loss ≥2 kg group,weight gain 2～5 kg group and weight gain ≥5 kg group.[Results]A total of 1 681 esophageal cancer deaths oc-curred during the follow-up after the last weight measurement.After adjusting for baseline age and sex,the risk of esophageal cancer death was 13％(HR=0.87,95％CI:0.77～1.00)and 16％(HR=0.84,95％CI:0.72～1.00)lower in the weight gain 2～5 kg and ≥5 kg groups compared to the weight maintenance group,respectively.The risk of esophageal cancer death was 23％higher in the weight loss ≥2 kg group than in the weight maintenance group(HR=1.23,95％CI:1.09～1.38).After adjusting for age,sex,baseline BMI group,smoking status,alcohol consumption,family history of cancer,education level,commune and nutritional intervention arms,weight loss ≥2 kg was still associated with a significantly increased risk of esophageal cancer death(HR=1.19,95％CI:1.06～1.34).Subgroup analysis showed there was no statistically significant interaction between changes in body weight and age,sex,and baseline BMI status on the risk of esophageal cancer death.[Conclusion]Weight loss is associated with an increased risk of esophageal cancer death.People in the high incidence area of esophageal squamous cell carcinoma should maintain their current weight or gain weight appropriately while maintaining a healthy weight state to reduce the risk of esophageal cancer death.

Based on the Political Economic Social Technological(PEST)-Strengths Weakness Opportunity Threats(SWOT)model,by sorting out the macro-environmental factors such as politics,economy,society and technology,and combining the internal strengths and weaknesses of the hospital as well as the external opportunities and threats,it puts forward the strategies to optimize the comprehensive budget management.It is found that hospitals face problems in total budget management such as disconnection between budgeting and strategy,and low level of informatization,but they also have advantages such as resource optimization and support for decision-making.The external environment provides opportunities such as health insurance reform and financing channel expansion,while there are threats such as industry competition and data security.It is suggested to improve the budget management level and promote the high-quality development of hospitals by expanding funding sources,strengthening cost control,and promoting the integration of industry and finance.

Objective:To evaluate the effect of age factor on the sedative potency of ciprofol.Methods:In this prospective study, patients of either sex, aged 40-80 yr, undergoing elective surgery under general anesthesia at the First Affiliated Hospital of Zhengzhou University, were selected and divided into middle-aged group (40-<65 yr) and elderly group (65-80 yr) based on their age. Effective sedation was defined as the Modified Observer′s Assessment of Alertness/Sedation scale score ≤1 and the bispectral index value ≤60 within 3 min following ciprofol administration. The initial dose of ciprofol was 0.4 mg/kg. The dose of ciprofol was determined by using the modified Dixon′s up-and-down method (increment or decrement of 0.04 mg/kg). The experiment was terminated after observing 8 transitions from effective sedation to ineffective sedation, starting from the initial transition event. The probit method was used to determine the median effective dose (ED 50) and 95% confidence interval of ciprofol for sedation. Results:A total of 61 patients was finally included in this study, with 35 in middle-aged group and 26 in elderly group. The ED 50 of ciprofol (95% confidence interval) was 0.296 (0.206-0.359) mg/kg in middle-aged group and 0.224 (0.185-0.257) mg/kg in elderly group. The ED 50 of ciprofol was significantly higher in middle-aged group than in elderly group ( u=181.00, P<0.001). Conclusions:Age can affect the sedative potency of propofol, with enhanced potency observed in elderly patients than in middle-aged patients.

Based on the Political Economic Social Technological(PEST)-Strengths Weakness Opportunity Threats(SWOT)model,by sorting out the macro-environmental factors such as politics,economy,society and technology,and combining the internal strengths and weaknesses of the hospital as well as the external opportunities and threats,it puts forward the strategies to optimize the comprehensive budget management.It is found that hospitals face problems in total budget management such as disconnection between budgeting and strategy,and low level of informatization,but they also have advantages such as resource optimization and support for decision-making.The external environment provides opportunities such as health insurance reform and financing channel expansion,while there are threats such as industry competition and data security.It is suggested to improve the budget management level and promote the high-quality development of hospitals by expanding funding sources,strengthening cost control,and promoting the integration of industry and finance.

[Purpose]To explore the association between body weight change and long-term risk of esophageal cancer mortality based on Linxian General Population Nutrition Intervention study.[Methods]A total of 21 028 healthy residents aged 40～69 years old at baseline in Linxian of Henan Province were recruited as the study cohort,their body weight were measured in late 1985 and early 1991,and the esophageal cancer mortality was prospectively followed up until March 2016.The cohort was divided into four groups according to weight difference between the two measure-ments,the body weight maintenance group(change＜2 kg)was used as the reference group.The Cox proportional risk model was used to estimate the hazard ratio(HR)and 95％confidence inter-val(CI)for death from esophageal cancer in the weight loss ≥2 kg group,weight gain 2～5 kg group and weight gain ≥5 kg group.[Results]A total of 1 681 esophageal cancer deaths oc-curred during the follow-up after the last weight measurement.After adjusting for baseline age and sex,the risk of esophageal cancer death was 13％(HR=0.87,95％CI:0.77～1.00)and 16％(HR=0.84,95％CI:0.72～1.00)lower in the weight gain 2～5 kg and ≥5 kg groups compared to the weight maintenance group,respectively.The risk of esophageal cancer death was 23％higher in the weight loss ≥2 kg group than in the weight maintenance group(HR=1.23,95％CI:1.09～1.38).After adjusting for age,sex,baseline BMI group,smoking status,alcohol consumption,family history of cancer,education level,commune and nutritional intervention arms,weight loss ≥2 kg was still associated with a significantly increased risk of esophageal cancer death(HR=1.19,95％CI:1.06～1.34).Subgroup analysis showed there was no statistically significant interaction between changes in body weight and age,sex,and baseline BMI status on the risk of esophageal cancer death.[Conclusion]Weight loss is associated with an increased risk of esophageal cancer death.People in the high incidence area of esophageal squamous cell carcinoma should maintain their current weight or gain weight appropriately while maintaining a healthy weight state to reduce the risk of esophageal cancer death.

Objective:To establish a multi-factor prediction model for vascular aging based on psychological behavior and physical exercise using nomogram and structural equation method.Methods:A total of 701 inpatients or physical examination patients who underwent carotid ultrasound examination in the Affiliated Hospital of Qingdao University from October 2021 to March 2023 were selected by cross-sectional method. The subjects were randomly divided into training queue( n=492) and verification queue( n=209) according to the ratio of 7∶3.The psychological and behavioral factors, lifestyle, demography and accompanying diseases data were collected. Multi-factor binary Logistic regression method in SPSS 25.0 software was used to screen independent influencing factors of vascular aging, R 4.2.2 software was used to build a nomogram prediction model of vascular aging, and the ROC curve, calibration chart and decision curve analysis were used to evaluate the nomogram, and AMOS software was used to build a structural equation model of vascular aging. Results:Multivariate Logistic regression analysis showed that type A behavior( B=1.757, OR(95% CI)=5.790(2.750-12.210), P<0.001), physical exercise( B=-3.019, OR(95% CI)=0.050(0.020-0.100), P<0.001), high-fat diet( B=0.679, OR(95% CI)=1.970(1.350-2.880), P<0.001), sleep quality( B=-1.451, OR(95% CI)=0.230(0.120-0.460), P<0.001), tea drinking habits( B=-2.349, OR(95% CI)=0.100(0.050-0.200), P<0.001), age( B=0.061, OR(95% CI)=1.060(1.020-1.110), P=0.005), sex( B=-1.263, OR(95% CI)=0.280(0.140-0.570), P<0.001), hyperlipidemia( B=0.679, OR(95% CI)=1.970(1.350-2.880), P<0.001) and diabetes( B=0.838, OR(95% CI)=2.310(1.140-4.700), P=0.021)were independent influencing factors of vascular aging. The nomogram model showed that type A behavior, physical exercise, high-fat diet, sleep quality, tea drinking habits, age, sex, hyperlipidemia and diabetes were independent influencing factors of vascular aging.Advanced age, type A behavior, hyperlipidemia, diabetes and the score of high-fat diet were risk factors for vascular aging, while better sleep quality, tea drinking habit and the score of physical exercise were protective factors for vascular aging.Men were more prone to vascular aging than women. Structural equation model showed that type A behavior had the strongest direct positive effect on vascular aging (the effect coefficient=0.197, P<0.01), and physical exercise had the strongest direct negative effect on vascular aging (the effect coefficient=-0.452, P<0.01), which could indirectly affect vascular aging through various factors. Conclusions:The nomogram model shows the independent influencing factors of vascular aging and has certain predictive value.Structural equation model shows that many factors such as psychological behavior and lifestyle can directly or indirectly affect the occurrence of vascular aging, among which type A behavior and physical exercise have more extensive effects.

Background::Whether the dynamic weight change is an independent risk factor for mortality remains controversial. This study aimed to examine the association between weight change and risk of all-cause and cause-specific mortality based on the Linxian Nutrition Intervention Trial (NIT) cohort.Methods::Body weight of 21,028 healthy residents of Linxian, Henan province, aged 40-69 years was measured two times from 1986 to 1991. Outcome events were prospectively collected up to 2016. Weight maintenance group (weight change <2 kg) or stable normal weight group was treated as the reference. Cox proportional hazard model was performed to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) to estimate the risk of mortality.Results::A total of 21,028 subjects were included in the final analysis. Compared with the weight maintenance group, subjects with weight loss ≥2 kg had an increased risk of death from all-cause (HR All-cause = 1.14, 95% CI: 1.09-1.19, P <0.001), cancer (HR Cancer = 1.12, 95% CI: 1.03-1.21, P = 0.009), and heart disease (HR Heart diseases = 1.21, 95% CI: 1.11-1.31, P <0.001), whereas subjects with weight gain ≥5 kg had 11% (HR Cancer = 0.89, 95% CI: 0.79-0.99, P = 0.033) lower risk of cancer mortality and 23% higher risk of stroke mortality (HR Stroke = 1.23,95% CI: 1.12-1.34, P <0.001). For the change of weight status, both going from overweight to normal weight and becoming underweight within 5 years could increase the risk of total death (HR Overweight to normal = 1.18, 95% CI: 1.09-1.27; HR Becoming underweight = 1.35, 95% CI: 1.25-1.46) and cancer death (HR Overweight to normal = 1.20, 95% CI: 1.04-1.39; HR Becoming underweight = 1.44, 95% CI: 1.24-1.67), while stable overweight could increase the risk of total death (HR Stable overweight = 1.11, 95% CI: 1.05-1.17) and death from stroke (HR Stable overweight = 1.44, 95% CI: 1.33-1.56). Interaction effects were observed between age and weight change on cancer mortality, as well as between baseline BMI and weight change on all-cause, heart disease, and stroke mortality (all Pinteraction <0.01). Conclusions::Weight loss was associated with an increased risk of all-cause, cancer, and heart disease mortality, whereas excessive weight gain and stable overweight were associated with a higher risk of stroke mortality. Efforts of weight management should be taken to improve health status.Trial registration::https://classic.clinicaltrials.gov/, NCT00342654.

Objective To investigate the impact of the precise dissection and reconstruction of the prostate apex and bladder neck urethra during radical prostatectomy on the improvement in postoperative urinary control in patients with prostate cancer.Methods A retrospective study was conducted.A total of 131 prostate cancer patients who underwent robot-assisted radical prostatectomy at our institution between January 1,2023 and December 31,2023 were enrolled.The subjects were divided into two groups,with 64 in the experimental group and 67 in the control group.Patients in the experimental group underwent radical prostatectomy in a modified approach,while those in the control group underwent conventional radical prostatectomy.Propensity score matching was employed to match the two groups at a 1-to-l ratio based on age,body mass index(BMI),preoperative prostate specific antigen(PSA),prostate volume,Prostate Imaging Reporting and Data System(PI-RADS)scores,biopsy Gleason score,and preoperative urinary control status.After matching,we compared the preoperative baseline data,surgical margin positivity rates,and urinary control status at 3 months post operation between the two groups.Urinary control was assessed before and after surgery using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form(ICIQ-UI SF)scale.Results A total of 56 pairs of patients were successfully matched between the experimental group and the control group through 1-to-l propensity score matching.At 3 months after surgery,the median score for ICIQ-SF scale of the experimental group was 7.0 points,while that of the control group was 9.5 points,with the difference being statistical significant(P＜0.05).There was no significant difference in the positive rate of incision margins between the experimental group and the control group.Multiple linear regression analysis showed that both the prostate volume and the Gleason score in the experimental group were positively correlated with the ICIQ-UI SF scores 3 months after surgery(P＜0.05),while the age of patients in the control group was positively correlated with ICIQ-UI SF score 3 months after surgery(P＜0.05).Conclusion Precise dissection and reconstruction of the prostate apex and bladder neck urethra during radical prostatectomy significantly improve the postoperative urinary control of patients at 3 months after surgery.