BACKGROUND:Physiotherapy is very important for the recovery after anterior cruciate ligament reconstruction.In recent years,many doctors are optimizing the physical rehabilitation program after anterior cruciate ligament reconstruction.However,there is still a lack of efficient rehabilitation training after anterior cruciate ligament reconstruction. OBJECTIVE:To investigate the effect of vibration therapy combined with suspension training on movement and knee joint function after anterior cruciate ligament reconstruction. METHODS:A total of 80 patients undergoing first unilateral anterior cruciate ligament reconstruction at the Affiliated Sport Hospital,Shanghai University of Sport were randomly divided into vibration therapy group(n=40)and vibration therapy+suspension training group(n=40).In the vibration therapy group,vibration therapy(10 minutes each,once a day,6 times per week)was performed at the 13th week after anterior cruciate ligament reconstruction.Patients in the vibration therapy+suspension training group were treated with vibration therapy(10 minutes each,once a day,6 times per week)and suspension training(twice a week)at the 13th week after anterior cruciate ligament reconstruction.Training in each group was performed for 8 weeks.Knee joint function was evaluated by knee joint Lysholm score before and 8 weeks after training.The symmetry index was evaluated by the isokinetic muscle strength evaluation training system.The balance test system was used to evaluate the average trace error difference of the bilateral multi-axes. RESULTS AND CONCLUSION:Compared with those before training,the knee Lysholm score and the knee extension and flexion symmetry indexes increased(P<0.05),and the average trace error difference decreased after training(P<0.05).Compared with the vibration therapy group,the knee Lysholm score in the vibration therapy+suspension training group increased(P<0.05),the knee extension and knee flexion symmetry index increased(P<0.05),and the average trace error difference decreased(P<0.05).To conclude,compared with vibration therapy training alone,vibration therapy combined with suspension training can significantly improve knee joint function,increase muscle strength and symmetry,and improve balance stability in patients undergoing anterior cruciate ligament reconstruction.

Objective : To analyze the relationship between tongue volume, tongue position, dental and skeletal parameters in adult patients with different skeletal malocclusions, providing references for the etiology, diagnosis, and treatment of skeletal malocclusions. Methods: This study has been reviewed and approved by the Ethics Committee, and informed consent has been obtained from patients. Cone-beam computed tomography (CBCT) and cephalometric radiographs were collected from 60 adult patients, divided into three groups based on ANB angle values: skeletal Class I (0° < ANB < 4°), II (ANB > 4°), and III (ANB < 0°), with 20 cases in each group. Dental and skeletal parameters were measured using Dolphin software. Mimics software was used for 3D reconstruction of the tongue, oral cavity, and upper airway to measure tongue position, tongue volume, oral cavity volume, and upper airway volume, followed by statistical analysis. Results: The skeletal Class III group had significantly larger tongue and oral cavity volumes than the skeletal Class I and Class II groups (P = 0.02). Tongue length in the skeletal Class III group was also greater than in the skeletal Class I and Class II groups (P = 0.016). There was no significant difference in the ratio of tongue volume/oral cavity capacity among the three skeletal malocclusion groups (P > 0.05). Tongue volume was positively correlated with U1-SN and negatively correlated with overbite and overjet (P < 0.05). Additionally, tongue volume showed a significant positive correlation with Go-Gn and Pg-Np (P < 0.01), as well as with maxillary and mandibular dental arch width and basal bone arch width (P < 0.01). Upper airway volume was positively correlated with TT-VRL and TP-VRL (P < 0.05). Conclusion Patients with skeletal Class III malocclusion have larger tongue volumes and longer tongues. Patients with larger tongue volumes may also have larger, more forward-positioned mandibles. Patients with more posterior tongue positions may have smaller upper airway volumes. When developing orthodontic or orthognathic treatment plans, it is crucial to consider the relationship between tongue position, tongue volume, the jaws, and the airway to ensure optimal outcomes for both dental and orofacial function.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective:To evaluate the diagnostic performances of plasma placental extracellular vesicles (pcEV) and their clearance protein (Lactadherin) in predicting adverse pregnancy outcomes in patients with severe preeclampsia (sPE).Methods:This is a retrospective case-control study. 60 patients aged 32 (29, 36) years diagnosed with sPE at 27-37 weeks of pregnancy, who underwent prenatal examinations and delivered between January 31 th, 2018 and January 31 th, 2019, were recruited. According to the occurrence of endpoint events (fetal distress and/or fetal growth restriction), sPE patients were further divided into an event group of 34 cases and a non event group of 26 cases. 33 healthy pregnant women of the same gestational age were selected as the control group, aged 31 (29, 36) years old. 25 non pregnant healthy women were selected as the healthy control group, aged 26 (25, 38) years old. Flow cytometry was used to detect placental alkaline phosphatase antibody positivity as pcEV, while membrane surface expression of phosphatidylserine, i.e. membrane associated protein V (AV) positivity as AV +pcEV. ELISA kits were used to detect the level of Lactadherin. Logistic regression was used to perform multiple correlation analysis. The performances of pcEV and Lactadherin in predicting adverse pregnancy outcomes were evaluated by the receiver operating characteristic (ROC) curve. Survival analyses were performed by the Kaplan Meier curve. The hazard ratios (HR) was calculated by the Cox proportional risk regression model. Results:The plasma AV +pcEV levels in sPE patients were 8 260 (4 991, 16 751)/μl, which were higher than 1 088 (784, 1 871)/μl of healthy pregnant women and 206 (116,256)/μl of healthy controls ( H=94.490, P<0.05). The plasma AV +pcEV levels in sPE patients with endpoint events were 11 225 (7 496, 20 599)/μl, which were higher than 5 199 (2 914, 8 347)/μl of patients without endpoint events ( U=178, P<0.05). The plasma levels of Lactadherin in sPE patients were 2 635 (1876, 3 137) pg/ml, which were higher than 1 597 (1 287, 1 818) pg/ml in healthy pregnant woman and 1 123 (749, 1 405) pg/ml in healthy controls ( H=54.307, P<0.05). ROC showed that the critical value of AV +pcEV predicting fetal distress and/or fetal growth restriction events within 77 days in sPE patients was 6 524/μl and area under the curve(AUC) was 0.799 (95% CI 0.680-0.917). The critical value of Lactadherin was 2 336.5 pg/ml and AUC was 0.702 (95% CI 0.564-0.841). Logistic regression analysis showed that there was a significant correlation between AV +pcEV levels in sPE patients and 24-hour urine protein quantification ( OR=9.288, 95% CI 1.993-43.293), as well as the need for combined antihypertensive therapy ( OR=18.690, 95% CI 1.919-182.077) ( P<0.05). Survival analysis showed that the cumulative probability of fetal distress and/or fetal growth restriction events within 77 days were significantly increased in sPE patients with AV +pcEV levels above the critical value (Log-rank χ 2=21.430, P<0.05). The Cox proportional regression model showed that the levels of AV +pcEV can independently identify fetal distress and/or fetal growth restriction events ( HR=7.983, P<0.05). Conclusions:The changes of pcEV in plasma of pregnant women in late pregnancy were related to the development of PE. High concentrations of pcEV suggested an increased risk of fetal distress and fetal growth restriction, and pcEV could serve as an effective marker for early warning of adverse pregnancy outcomes.

Objective To explore the effect of auto-segmentation based on deep learning(DL)and Atlas during online adaptive MRI-guided radiotherapy.Methods Totally 15 prostate cancer patients undergoing MRI-guided online adaptive radiotherapy at some hospital from January 2020 to September 2021 were selected and divided into a training set(12 cases)and a test set(3 cases)by random sampling method.With the training set data the models of clinical target volume(CTV)and organs at risk(OAR)by DL and Atlas segmentation were established,and with the test set data the two segmentation models were modified and the modification lengths were recorded.DL and Atlas segmentation methods were compared on segmentation efficiency and accuracy in terms of Dice similarity coefficient(DSC),Hausdorff distance(HD)and mean distance to agreement(MDA).A joint auto-segmentation scheme based on combined DL and Atlas was constructed with considerations on the advantages and characteristics of the two methods,which was compared with the schemes respectively based on DL or Atlas from the aspect of the time consumed for segmentation.Results Accuracy comparison showed Atlas segmentation model behaved better significantly than DL model for CTV(P＜0.05),while obviously worse than the latter for DSC and MDA in bladder and rectum(P＜0.05).The doctor took 9.4 min in average for CTV and OAR modification based on DL model and 12 min in average for Atlas-model-based modification.The joint auto-segmentation scheme only needed 8 min in average for CTV and OAR modification,which gained advantages over the schemes based on DL or Atlas.Conclusion The auto-segmentation based on combined DL and Atlas during online adaptive MRI-guided radiotherapy behaves well in low time consumption,high accuracy and efficiency.[Chinese Medical Equipment Journal,2024,45(6):59-64]

Objective To evaluate the effects of the multiple factors especially image geometric accuracy of the imaging system on the segmentations of target areas and organs-at-risk.Methods The study used phantoms to test the imaging performance of the 1.5T magnetic resonance(MR)linear accelerator system,including the assessments of MR image geometric distortion and the segmentation errors caused by factors such as image geometric distortion.Model 604-GS large field MR image distortion phantom was used to explore the geometric distortion of the MR images for MR-guided radiotherapy;and CIRS Model 008z upper abdominal phantom was used to analyze the segmentation errors of target areas and organs-at-risk.Results The average geometric distortion and maximum distortion of 3D T1WI-FFE images vs 3D T2WI-TSE images were 0.54 mm vs 0.53 mm and 1.96 mm vs 1.68 mm,respectively;and the control points of the large distortions were distributed at the edges of the phantom,which was consistent with the MR imaging characteristics previously reported.Compared with CT-based segmentation contour,the MDA was 1.17 mm and DSC was 0.91 for 3D T1WI-FFE,while MDA was 0.86 mm and DSC was 0.94 for 3D T2WI-TSE.Conclusion The study quantitatively assesses the geometric accuracy of the imaging system for MR-guided radiotherapy.The phantom-based contour analysis reveals that with CT image as gold standard,the segmentation error in MRI images meets the clinical requirements,and that 3D T2WI-TSE image is advantageous over 3D T1WI-FFE image in segmentation accuracy.

Using high-energy proton to image the region of interest can directly obtain the accurate estimation of the proton stopping power of the lesions,which is of great significance to reduce the range uncertainty in proton therapy.As a fundamental function of proton computed tomography(CT),radiographic imaging plays a crucial role in assisting clinical positioning.The study develops a compact proton CT detector based on an active array pixel CMOS chip in Monte-Carlo simulation toolkit Geant4,and evaluates the radiographic imaging capability of the system using 180 MeV protons.The angles of tracks are successfully reconstructed.CTP404,CTP528,and the CTP515 of specific materials are used for simulation,obtaining the spatial and density resolutions,and measuring the proton relative stopping power(RSP).The image signal-to-noise ratio is improved when using 2° proton scattering angle cut-off value.The spatial resolution is 3-4 lp/cm measured using CTP528 module.The density resolution is better than 0.05 g/cm3,and the RSP resolution is within 5%when CTP404 module is used.Through the imaging of CTP515 phantom of specific material,it is demonstrated that the system has potential for imaging common human tissues.

Objective:To evaluate the feasibility of using MRI-only simulation images for dose calculation of both photon and proton radiotherapy for nasopharyngeal carcinoma cases.Methods:T 1-weighted MRI images and CT images of 100 patients with nasopharyngeal carcinoma treated with radiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from January 2020 to December 2021 were retrospectively analyzed. MRI images were converted to generate pseudo-CT images by using deep learning network models. The training set, validation set and test set included 70 cases, 10 cases and 20 cases, respectively. Convolutional neural network (CNN) and cycle-consistent generative adversarial neural network (CycleGAN) were exploited. Quantitative assessment of image quality was conducted by using mean absolute error (MAE) and structural similarity (SSIM), etc. Dose assessment was performed by using 3D-gamma pass rate and dose-volume histogram (DVH). The quality of pseudo-CT images generated was statistically analyzed by Wilcoxon signed-rank test. Results:The MAE of the CNN and CycleGAN was (91.99±19.98) HU and (108.30±20.54) HU, and the SSIM was 0.97±0.01 and 0.96±0.01, respectively. In terms of dosimetry, the accuracy of pseudo-CT for photon dose calculation was higher than that of the proton plan. For CNN, the gamma pass rate (3 mm/3%) of the photon radiotherapy plan was 99.90%±0.13%. For CycleGAN, the value was 99.87%±0.34%. The gamma pass rates of proton radiotherapy plans were 98.65%±0.64% (CNN, 3 mm/3%) and 97.69%±0.86% (CycleGAN, 3 mm/3%). For DVH, the dose calculation accuracy in the photon plan of pseudo-CT was better than that of the proton plan.Conclusions:The deep learning-based model generated accurate pseudo-CT images from MR images. Most dosimetric differences were within clinically acceptable criteria for photon and proton radiotherapy, demonstrating the feasibility of an MRI-only workflow for radiotherapy of nasopharyngeal cancer. However, compared with the raw CT images, the error of the CT value in the nasal cavity of the pseudo-CT images was relatively large and special attention should be paid during clinical application.

Acylcarnitines are metabolic intermediates of fatty acids and branched-chain amino acids having vital biofunctions and pathophysiological significances.Here,we developed a high-throughput method for quantifying hundreds of acylcarnitines in one run using ultrahigh performance liquid chromatography and tandem mass spectrometry(UPLC-MS/MS).This enabled simultaneous quantification of 1136 acyl-carnitines(C0-C26)within 10-min with good sensitivity(limit of detection＜0.7 fmol),linearity(cor-relation coefficient＞0.992),accuracy(relative error＜20％),precision(coefficient of variation(CV),CV＜15％),stability(CV＜15％),and inter-technician consistency(CV＜20％,n=6).We also established a quantitative structure-retention relationship(goodness of fit＞0.998)for predicting retention time(tR)of acylcarnitines with no standards and built a database of their multiple reaction monitoring parameters(tR,ion-pairs,and collision energy).Furthermore,we quantified 514 acylcarnitines in human plasma and urine,mouse kidney,liver,heart,lung,and muscle.This provides a rapid method for quantifying acyl-carnitines in multiple biological matrices.

Objective:To verify the feasibility of using Elekta accelerated go live (AGL) standard process for the acceptance of multiple accelerators.Methods:The beams of three accelerators were adjusted by PTW Beamscan three-dimensional water tank to reach the AGL standard. Dose verification was performed for three accelerators that met AGL standards. A simple field test example from Cancer Hospital Chinese Academy of Medical Sciences was used to compare the MapCheck 3 surface dose measurement results with the surface dose calculated by the same accelerator model. Images of 10 patients including head and neck, esophagus, breast, lung and rectum were randomly selected. volumetric-modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) treatment techniques were used for planning design, and the measured dose of ArcCheck was compared with the planned dose calculated by the same accelerator model. One-way ANOVA was used to statistically analyze the passing rates of two-dimensional and three-dimensional dose verification.Results:The 6 MV X-ray percentage depth dose at 10 cm underwater (PDD 10) of three accelerators was 67.45%, 67.36%, 67.47%, and the maximum deviation between the three accelerators was 0.11%. The 6 MV flattenting filter free (FFF) mode X-ray PDD 10 was 67.33%, 67.20%, 67.20%, and the maximum deviation between the three accelerators was 0.13%. All required discrete point doses on each energy 30 cm×30 cm Profile spindle of the three accelerator X-rays deviated less than ±1% from the standard data. Absolute γ analysis was performed on the results of MapCheck 3 two-dimensional dose matrix validation. Under the 10% threshold of 2 mm/3% standard, the average passing rate of the test cases in Cancer Hospital Chinese Academy of Medical Sciences was above 99%, and the difference was not statistically significant ( P>0.05). Absolute γ analysis was performed on the ArcCheck verification results. Under the 10% threshold, the pass rate of 2 mm/3% was all above 95%, the maximum average passing rate of the three accelerators with different energy and different treatment techniques was 0.28% (6 MV, VMAT), 0.19%(6 MV FFF, VMAT), 0.56% (6 MV, IMRT) and 0.05% (6 MV FFF, IMRT), and the difference was not statistically significant ( P>0.05). Conclusion:Compared with traditional accelerator acceptance process, the acceptance time of each accelerator is shortened by 4-6 weeks by using the AGL standard process, and the radiotherapy plan of patients can be interchangeably executed among different accelerators.