Objective:To evaluate the effect of intraoperative optimization of regional cerebral oxygen saturation(rSO 2C) intervention on postoperative delirium(POD) in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass(CPB). Methods:Two hundred and seventy-three pediatric patients of both sexes, aged 28 days-6 yr, with American Society of Anesthesiologists Physical Status classification ≤Ⅳ, scheduled for elective cardiac surgery under CPB, were divided into intervention group( n=136) and control group( n=137) based on the computer random coding. In intervention group, optimized intervention measures were given when rSO 2C was below 75% of the baseline value for more than 1 min. In control group, rSO 2C was not monitored during operation, and intraoperative management was performed according to the routine monitoring indicators of pediatric cardiac surgery under CPB. The occurrence of POD within 7 days after operation was evaluated, and the duration and first occurrence time of POD were recorded. Results:Compared with control group, no significant change was found in the incidence of POD( P>0.05), the first occurrence time of POD was significantly prolonged, and the duration of POD was shortened in intervention group( P<0.05). Conclusions:Intraoperative optimization of rSO 2C intervention can delay the time to the first occurrence of POD and shorten the duration in pediatric patients undergoing cardiac surgery under CPB.

Objective:To explore the value of an integrated modeling approach combining radiomics, dosiomics, and clinical factors in the prediction of the locoregional recurrence (LRR) risk after radiotherapy for patients with locoregionally advanced hypopharyngeal squamous cell carcinoma (HPSCC), in order to provide supplementary clinical evidence and decision-making basis for personalized treatment for this rare disease characterized by low incidence and poor prognosis.Methods:The clinical images and pathological data were retrospectively enrolled from 76 HPSCC patients treated at the Peking University Cancer Hospital from October 2011 to July 2020. The planning gross tumor volumes (PGTVs) were taken as the volumes of interest (VOIs). A total of 1 316 radiomic and dosiomic features were extracted from the planning CT and dose distribution images. After stability testing, feature dimensionality reduction was achieved using least absolute shrinkage and selection operator (LASSO) regression and principal component analysis (PCA), with radiomic principal components (RPCs) and dosiomic principal components (DPCs) obtained, respectively. Using various combinations of RPCs, DPCs, and clinical variables as predictors, multivariate Cox regression models were developed after 5-fold cross-validation 100 times. The model performance was evaluated based on the Akaike information criterion (AIC) and concordance index (C-index).Results:Using two RPCs and three DPCs selected, dosiomics and radiomic Cox proportional hazards models were constructed, with C-index values of 0.781 and 0.778 and AIC values of 94.44 and 92.27, respectively. The result indicated that one RPC and three DPCs showed significant associations in Cox regression ( P < 0.05). Other prediction models were established by integrating the clinical data of patients with radiomic features, dosiomic features, or both. The prediction result demonstrated that compared to models based on individual factors or dual components, the multi-omics model yielded the highest prediction accuracy (C-index: 0.823, AIC: 84.94). Conclusions:Integrated models that combine radiomic features, dosiomic features, and clinical factors demonstrate great potential for enhancing the accuracy of LRR risk prediction. These models are expected to provide decision-making support for devising personalized treatment strategies and ultimately improve the prognosis of HPSCC patients.

Objective:To evaluate the effect of intraoperative optimization of regional cerebral oxygen saturation(rSO 2C) intervention on postoperative delirium(POD) in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass(CPB). Methods:Two hundred and seventy-three pediatric patients of both sexes, aged 28 days-6 yr, with American Society of Anesthesiologists Physical Status classification ≤Ⅳ, scheduled for elective cardiac surgery under CPB, were divided into intervention group( n=136) and control group( n=137) based on the computer random coding. In intervention group, optimized intervention measures were given when rSO 2C was below 75% of the baseline value for more than 1 min. In control group, rSO 2C was not monitored during operation, and intraoperative management was performed according to the routine monitoring indicators of pediatric cardiac surgery under CPB. The occurrence of POD within 7 days after operation was evaluated, and the duration and first occurrence time of POD were recorded. Results:Compared with control group, no significant change was found in the incidence of POD( P>0.05), the first occurrence time of POD was significantly prolonged, and the duration of POD was shortened in intervention group( P<0.05). Conclusions:Intraoperative optimization of rSO 2C intervention can delay the time to the first occurrence of POD and shorten the duration in pediatric patients undergoing cardiac surgery under CPB.

Objective:To explore the value of an integrated modeling approach combining radiomics, dosiomics, and clinical factors in the prediction of the locoregional recurrence (LRR) risk after radiotherapy for patients with locoregionally advanced hypopharyngeal squamous cell carcinoma (HPSCC), in order to provide supplementary clinical evidence and decision-making basis for personalized treatment for this rare disease characterized by low incidence and poor prognosis.Methods:The clinical images and pathological data were retrospectively enrolled from 76 HPSCC patients treated at the Peking University Cancer Hospital from October 2011 to July 2020. The planning gross tumor volumes (PGTVs) were taken as the volumes of interest (VOIs). A total of 1 316 radiomic and dosiomic features were extracted from the planning CT and dose distribution images. After stability testing, feature dimensionality reduction was achieved using least absolute shrinkage and selection operator (LASSO) regression and principal component analysis (PCA), with radiomic principal components (RPCs) and dosiomic principal components (DPCs) obtained, respectively. Using various combinations of RPCs, DPCs, and clinical variables as predictors, multivariate Cox regression models were developed after 5-fold cross-validation 100 times. The model performance was evaluated based on the Akaike information criterion (AIC) and concordance index (C-index).Results:Using two RPCs and three DPCs selected, dosiomics and radiomic Cox proportional hazards models were constructed, with C-index values of 0.781 and 0.778 and AIC values of 94.44 and 92.27, respectively. The result indicated that one RPC and three DPCs showed significant associations in Cox regression ( P < 0.05). Other prediction models were established by integrating the clinical data of patients with radiomic features, dosiomic features, or both. The prediction result demonstrated that compared to models based on individual factors or dual components, the multi-omics model yielded the highest prediction accuracy (C-index: 0.823, AIC: 84.94). Conclusions:Integrated models that combine radiomic features, dosiomic features, and clinical factors demonstrate great potential for enhancing the accuracy of LRR risk prediction. These models are expected to provide decision-making support for devising personalized treatment strategies and ultimately improve the prognosis of HPSCC patients.

Objective To quantify the correlations between Elekta XVI cone beam CT dose and various scanning protocols,providing mathematical models to assess the protocol-dependency of imaging dose during imnage guided radiotherapy.Methods Based on standard protocols and various combinations of kVp and mA on an XVI mounted on an Elekta Versa HD accelerator,the air KERMA was measured at various positions in a standard PTW CTDI body phantom using calibrated PTW 30009 kV chamber and UNIDOS webline electrometer.Weighted CT dose index (CTDIw) was computed thereafter.SigmaPlot 10.0 was used to fit the measurements against mA and/or kVp yielding empirical functions.Results Under standard protocols,the CTDIw of Varian OBI was only 11.23％ (chest) and 9.15％ (pelvis) of Elekta XVI.Using the default and other 4 investigated kVp values,the central and peripheral KERMA were both proportional to mA,and vet the slope value a varied dramatically from 0.479 to 6.679.Major affecting factors included kVp settings,measurement locations,and dosimetric mnetrics,etc.None linear regressions were used to fit kVp against KERMA at various locations and CTDIw (R2 ＞ 0.997).The differences between all coefficients were statistically significant (P ＜ 0.05).The impact of changing both mA and kVp on the dose to phantom center can be described as mGy =(5.917-0.197 ×kVp+0.002 × kVp2-5.063 × 10-6 × kVp3) × mA.Conclusions Imaging dose of Elekta XVI is strongly dependent on scanning paraneters.The proposed mathematical models can be used as efficient and robust indicators of such dependency.

Objective　To investigate the systemic stress responses of laparoscopic cholecystectomy(LC). Methods　Seventy patients with cholecystolithiasis were randomly divided into two groups: LC and open cholecystectomy(OC). Peripheral blood samples were obtained during the preoperative day and 1, 3, 5, 7 day after operation. Serum cytokines levels (TNF-α, IL-1β and IL-6) and C-reactive protein(CRP) were measured. Results　Changes of TNF-α and IL-1β before or after surgery in both groups showed no significant difference(P>0.05). Serum concentrations of IL-6 and CRP after surgery in both groups were significantly higher than those before surgery(P<0.05); but there were no significant difference between the two groups(P>0.05). Conclusions　The systemic stress responses of LC have no significant difference comparing with OC.