Objective To discuss the application of bidirectional dual loop technique in retrieving Aegisy inferior vena cava filters.Methods The clinical data of 12 patients with deep vein thrombosis in the lower limbs complicated by pulmonary embolism,who received mechanical thrombectomy and Aegisy inferior vena cava(IVC)filter implantation at the Zhoukou Municipal Central Hospital of China from January 2016 to November 2023,were retrospectively analyzed.The retrieval of Aegisy IVC filters beyond the time window was tried by standard methods,guide wire stripping,balloon dilatation,unidirectional single loop technique,unidirectional dual loop technique,etc.However,because of the difficulty in retrieval of filter,bidirectional dual loop technique had to be used.The indwelling time of the IVC filters was 30-365 days,with an average time of 105 days.Results The IVC filter was completely removed in 11 patients.Angiography showed that IVC was unobstructed,no contrast extravasation was observed,and the average operation time was 126 minutes.The retrieval of filter failed in one patient,and the patient had to receive anticoagulation therapy lifelong.No surgery-related complications occurred.Conclusion For retrieving Aegisy IVC filters beyond the time window,bidirectional dual loop technique is clinically safe and effective,and this technology is worthy of clinical promotion and application.

Objective To evaluate the prognosis of infants with common Hirschsprung's disease who undergo laparoscopic-assisted Soave procedure below 6 months of age,and to explore its feasibility.Methods A retrospective analysis was conducted on the clinical data of 82 cases of common Hirschsprung's disease admitted to our department from January 2018 to August 2022.The patients were divided into two groups based on their age at the time of surgery:Young surgical age group(＜6 months,50 cases)and Old surgical age group(≥ 6 months,32 cases).All patients underwent the treatment of laparoscopic-assisted Soave procedure.The surgical time,length of hospital stay,postoperative complications,and anal function were compared between the two groups.Results There were no significant differences between young surgical age group and old surgical age group in terms of surgical time[(145.04±11.21)min vs.(149.25±12.18)min,P=0.20],length of hospital stay[(13.56+0.93)d vs.(13.91±0.99)d,P=0.55],postoperative complications[22.00％(11/50)vs.28.13％(9/32),P=0.53],and Rintala score for anal function[(18.58±1.44)vs.(17.22±1.64),P=0.06].The main postoperative complications,including enterocolitis[10.00％(5/50)vs.12.50％(4/32),P=0.72],fecal/anal incontinence[6.00％(3/50)vs.6.25％(2/32),P=0.96],and constipation[4.00％(2/50)and 6.25％(2/32),P=0.65],showed no significant differences between the two groups(all P＞0.05).However,there was a statistically significant difference in terms of bleeding volume[(7.86±2.02)ml vs.(9.13±2.17)ml,P＜0.05].No deaths occurred in this study.Conclusion Laparoscopic-assisted Soave procedure is safe and effective for infants below 6 months of age with common congenital Hirschsprung's disease.It can achieve satisfactory anal function and reduce the incidence of adverse events during the waiting period for surgery.

Proton arc therapy (PAT), as an emerging radiation therapy technique, has attracted increasing widespread attention in the field of cancer radiotherapy in recent years. In this review, technological developments, clinical application potential, biological effects, dosimetric optimization, and current challenges of PAT were comprehensively summarized. A systematic analysis of recent studies indicates that PAT offers significant advantages in improving target coverage and sparing normal tissues, particularly in mitigating organ motion-induced uncertainties. However, PAT remains in the clinical validation stage and still faces challenges related to technical optimization and cost control. Further clinical studies are required to confirm its long-term efficacy and safety.

Objective To evaluate the prognosis of infants with common Hirschsprung's disease who undergo laparoscopic-assisted Soave procedure below 6 months of age,and to explore its feasibility.Methods A retrospective analysis was conducted on the clinical data of 82 cases of common Hirschsprung's disease admitted to our department from January 2018 to August 2022.The patients were divided into two groups based on their age at the time of surgery:Young surgical age group(＜6 months,50 cases)and Old surgical age group(≥ 6 months,32 cases).All patients underwent the treatment of laparoscopic-assisted Soave procedure.The surgical time,length of hospital stay,postoperative complications,and anal function were compared between the two groups.Results There were no significant differences between young surgical age group and old surgical age group in terms of surgical time[(145.04±11.21)min vs.(149.25±12.18)min,P=0.20],length of hospital stay[(13.56+0.93)d vs.(13.91±0.99)d,P=0.55],postoperative complications[22.00％(11/50)vs.28.13％(9/32),P=0.53],and Rintala score for anal function[(18.58±1.44)vs.(17.22±1.64),P=0.06].The main postoperative complications,including enterocolitis[10.00％(5/50)vs.12.50％(4/32),P=0.72],fecal/anal incontinence[6.00％(3/50)vs.6.25％(2/32),P=0.96],and constipation[4.00％(2/50)and 6.25％(2/32),P=0.65],showed no significant differences between the two groups(all P＞0.05).However,there was a statistically significant difference in terms of bleeding volume[(7.86±2.02)ml vs.(9.13±2.17)ml,P＜0.05].No deaths occurred in this study.Conclusion Laparoscopic-assisted Soave procedure is safe and effective for infants below 6 months of age with common congenital Hirschsprung's disease.It can achieve satisfactory anal function and reduce the incidence of adverse events during the waiting period for surgery.

Proton arc therapy (PAT), as an emerging radiation therapy technique, has attracted increasing widespread attention in the field of cancer radiotherapy in recent years. In this review, technological developments, clinical application potential, biological effects, dosimetric optimization, and current challenges of PAT were comprehensively summarized. A systematic analysis of recent studies indicates that PAT offers significant advantages in improving target coverage and sparing normal tissues, particularly in mitigating organ motion-induced uncertainties. However, PAT remains in the clinical validation stage and still faces challenges related to technical optimization and cost control. Further clinical studies are required to confirm its long-term efficacy and safety.

Objective To evaluate the feasibility of 4-channel functional electrical stimulation(FES)in the treatment of cerebral ischemic stroke sequelae using 3.0T magnetic resonance diffusion tensor imaging(DTI).Methods Patients with the sequelae of cerebral ischemic stroke who were admitted to Shandong Provincial Third Hospital from February 2020 to November 2022(n=100)were enrolled and divided into two groups at a ratio of 1:1 according to random numbers generated by Excel.Besides routine rehabilitation training,observation group was given 4-channel FES to stimulate the quadriceps muscle,tibialis anterior muscle,gastrocnemius muscle and hamstring muscle of the affected lower extremity by simulating the time series of muscle contraction of normal subjects when walking;while control group was treated with dual-channel FES,with electrodes placed on the muscle points of the tibialis anterior muscle and peroneus longus and brevis muscles of the affected lower extremity for stimulation.All patients received 3.0T MRI before and after treatment,and the relevant DTI parameters were recorded and compared.Meanwhile,Berg balance scale(BBS)and Fugl-Meyer assessment scale for lower extremity(FMA-LE)were used to evaluate the therapeutic efficacies in two groups of patients with the sequelae of cerebral ischemic stroke.The correlation of BBS/FMA-LE score with DTI parameters in observation group was also discussed.Results After treatment,both FMA-LE and BBS scores of control group and observation group showed increasing trends,and the increases in observation group were more obvious(P<0.05).After 2 weeks of treatment,compared with control group,observation group had higher FMA-LE score,BBS score,fractional anisotropy(FA),average diffusion coefficient(DCavg)and volume ratio anisotropy(VRA),but lower exponential attenuation(Exat)(all P<0.05).In observation group,FMA-LE score was positively correlated with FA,DCavg and VRA,but negatively correlated with Exat;while BBS score was positively correlated with FA and VRA,but negatively correlated with Exat,and had no significant correlation with DCavg.Conclusion DTI can be used to evaluate the therapeutic efficacy of 4-channel FES on the sequelae of cerebral ischemic stroke,and its parameters are significantly correlated with BBS score and FMA-LE score,suggesting that MRI can assist doctors in understanding the correlation between neurological impairments and neuropathological changes,and provide reference for accurate assessment of prognosis and formulation of individualized rehabilitation program.

At present, pancreatic cancer is a solid tumor with the worst prognosis. Compared with surgery and chemotherapy, radiotherapy plays an auxiliary role in the treatment of pancreatic cancer. In recent years, significant advances have been achieved in radiotherapy technology, which have been gradually applied in the diagnosis and treatment of pancreatic cancer. In this article, the progress in radiation therapy in the treatment of pancreatic cancer was reviewed, especially the clinical application of magnetic resonance imaging-guided radiation therapy in the treatment of pancreatic cancer, aiming to deepen the understand of the progress in radiation therapy for pancreatic cancer, and providing reference for improving the survival rate of pancreatic cancer patients.

Objective To observe the value of relative adverse reactions for predicting prognosis of ≥5 cm unresectable hepatocellular carcinoma(HCC)after treated with drug-eluting beads TACE(DEB-TACE)combined with low-dose apatinib.Methods Totally 172 patients with unresectable HCC≥5 cm who underwent DEB-TACE combined with low-dose apatinib.Apatinib-related adverse reactions were recorded and graded according to common terminology criteria for adverse events(CTCAE).Multivariate Cox regression model was performed to screen independent impact factors of apatinib-related adverse reactions for predicting survival time of patients after DEB-TACE combined with low-dose apatinib.Results Among 172 cases,apatinib-related adverse reactions included hand-foot syndrome and hypertension in each 147 cases(147/172,85.47％),loss of appetite in 91 cases(91/172,52.91％),diarrhea in 81 cases(81/172,47.09％),fatigue in 75 cases(75/172,43.60％),rashes in 38 cases(38/172,22.09％),oral mucositis in 20 cases(20/172,11.63％)and dysphonia in 18 cases(18/172,10.47％).After correction of baseline data,multivariate Cox regression model showed that grade 1-2 hand-foot syndrome and grade 2 oral mucocitis were all independent factors for predicting survival time after DEB-TACE combined with low-dose apatinib of unresectable HCC≥5 cm(all P＜0.05).Conclusion After DEB-TACE combined with low dose apatinib,patients with unresectable HCC≥5 cm who occurred grade CTCAE 1-2 hand-foot syndrome and grade 2 oral mucositis had better prognosis.

Objective To observe the value of relative adverse reactions for predicting prognosis of ≥5 cm unresectable hepatocellular carcinoma(HCC)after treated with drug-eluting beads TACE(DEB-TACE)combined with low-dose apatinib.Methods Totally 172 patients with unresectable HCC≥5 cm who underwent DEB-TACE combined with low-dose apatinib.Apatinib-related adverse reactions were recorded and graded according to common terminology criteria for adverse events(CTCAE).Multivariate Cox regression model was performed to screen independent impact factors of apatinib-related adverse reactions for predicting survival time of patients after DEB-TACE combined with low-dose apatinib.Results Among 172 cases,apatinib-related adverse reactions included hand-foot syndrome and hypertension in each 147 cases(147/172,85.47％),loss of appetite in 91 cases(91/172,52.91％),diarrhea in 81 cases(81/172,47.09％),fatigue in 75 cases(75/172,43.60％),rashes in 38 cases(38/172,22.09％),oral mucositis in 20 cases(20/172,11.63％)and dysphonia in 18 cases(18/172,10.47％).After correction of baseline data,multivariate Cox regression model showed that grade 1-2 hand-foot syndrome and grade 2 oral mucocitis were all independent factors for predicting survival time after DEB-TACE combined with low-dose apatinib of unresectable HCC≥5 cm(all P＜0.05).Conclusion After DEB-TACE combined with low dose apatinib,patients with unresectable HCC≥5 cm who occurred grade CTCAE 1-2 hand-foot syndrome and grade 2 oral mucositis had better prognosis.

OBJECTIVES: The automatic delineation of organs at risk (OARs) can help doctors make radiotherapy plans efficiently and accurately, and effectively improve the accuracy of radiotherapy and the therapeutic effect. Therefore, this study aims to propose an automatic delineation method for OARs in cervical cancer scenarios of both after-loading and external irradiation. At the same time, the similarity of OARs structure between different scenes is used to improve the segmentation accuracy of OARs in difficult segmentations. METHODS: Our ensemble model adopted the strategy of ensemble learning. The model obtained from the pre-training based on the after-loading and external irradiation was introduced into the integrated model as a feature extraction module. The data in different scenes were trained alternately, and the personalized features of the OARs within the model and the common features of the OARs between scenes were introduced. Computer tomography (CT) images for 84 cases of after-loading and 46 cases of external irradiation were collected as the train data set. Five-fold cross-validation was adopted to split training sets and test sets. The five-fold average dice similarity coefficient (DSC) served as the figure-of-merit in evaluating the segmentation model. RESULTS: The DSCs of the OARs (the rectum and bladder in the after-loading images and the bladder in the external irradiation images) were higher than 0.7. Compared with using an independent residual U-net (convolutional networks for biomedical image segmentation) model [residual U-net (Res-Unet)] delineate OARs, the proposed model can effectively improve the segmentation performance of difficult OARs (the sigmoid in the after-loading CT images and the rectum in the external irradiation images), and the DSCs were increased by more than 3%. CONCLUSIONS Comparing to the dedicated models, our ensemble model achieves the comparable result in segmentation of OARs for different treatment options in cervical cancer radiotherapy, which may be shorten time for doctors to sketch OARs and improve doctor's work efficiency.
Female ; Humans ; Image Processing, Computer-Assisted/methods* ; Machine Learning ; Organs at Risk/radiation effects* ; Radiotherapy Planning, Computer-Assisted/methods* ; Uterine Cervical Neoplasms/radiotherapy*