Objective:To compare the effects of different automatic normal tissue objective(NTO)weights(WNTO)of Eclipse planning system on intensity modulated radiation therapy(IMRT)of fixed field for abdominal tumor.Methods:Twenty patients with rectal cancer and twenty patients with cervical cancer who received radiotherapy in The Second People's Hospital of Huludao from September 2022 to January 2024 were selected.5 groups of different plans[WNTO20,40,60,80 and 100]were respectively formulated for each patient.Among of them,the WNTO20 plan was control group,and other 4 groups were respectively WNTO40 group,WNTO60 group,WNTO80 group and WNTO100 group.Then,the differences in dosimetry and monitor units(MU)among 5 groups of plans were compared.Results:In the WNTO 80 and 100 groups of patients with rectal cancer,the conformation index(CI)values of target regions of them were respectively 1.02±0.04 and 1.00±0.03,all of which approached to 1,and the CI values of two groups were lower than that of control group,and the differences were statistically significant(t=15.986,18.422,P<0.05).The homogeneity index(HI)of WNTO 80 and 100 groups were respectively 0.09±0.12 and 0.10±0.14,which were higher than that of control group,and the differences were statistically significant(t=-1.371,-1.463,P<0.05).The 52Gy dose volume(Vmax52)of small intestine of the two groups were respectively(4.48±14.49)and(4.77±10.47)cm3,which were higher than that of control group,and the differences were statistically significant(t=-1.360,-2.005,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the right femoral heads of the two groups were respectively(12.28±4.57)%and(10.96±4.17)%,which were lower than that of control group,and the differences were statistically significant(t=6.893,6.75,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the left femoral head of the two groups were respectively(11.57±4.41)%and(10.17±3.78)%,which were lower than that of control group,and the differences were statistically significant(t=6.782,5.963,P<0.05).The MU value of WNTO100 group was(1254±93)MU,which was higher than that of control group,and the difference was statistically significant(t=-3.741,P<0.05).In the WNTO 80 and 100 groups of patients with cervical cancer,the CI values of target regions of them were respectively 1.03±0.32 and 1.02±0.03,all of which approached to 1,and the CI values of the two groups were lower than those of control group,and the differences were statistically significant(t=20.069,19.475,P<0.05).The HI values of them were respectively 0.07±0.05 and 0.08±0.01,which were higher than that of control group,and the differences were statistically significant(t=-12.445,-19.478,P<0.05).The V30 Gy values of the right femoral heads of the two groups were respectively(16.11±4.71)%and(14.90±4.56)%,which were lower than that of control group,and the differences were statistically significant(t=7.875,8.020,P<0.05).The V30 Gy values of the left femoral head of the two groups were respectively(15.21±3.71)%and(13.93±3.77)%,which were lower than that of control group,and the differences were statistical significance(t=7.617,7.436,P<0.05).The Vmax52 of small intestine of the two groups were respectively(0.82±1.10)and(4.47±8.81)cm3,which were higher than that of control group,and the difference was statistically significant(t=-2.985,-2.388,P<0.05).Conclusion:The WNTO80 is recommended for IMRT plan of radiotherapy on abdominal tumor,which can more quickly and better meet the assessment conditions of IMRT plan.

Objective:To analyze the breast cancer-related parameters and the ultrasonic features of positive axillary lymph nodes,to discuss the risk factors for axillary lymphnode metastatic burden,and to provide basis for preoperative evaluation of breast cancer patients.Methods:The ultrasonic and clinicopathological data of 574 breast cancer patients with axillary lymph node metastasis confirmed by surgery and pathology were retrospectively analyzed.According to the status of axillary lymphnode metastasis,the patients were divided into low nodal burden(LNB)group(n=283)and high nodal burden(HNB)group(n=291).The affected side,tumor quadrant,distance to skin,maximum diameter,internal echogenicity,shape,margin,calcification,blood supply,posterior echo,lymphnode long diameter,lymphnode short diameter,lymphnode aspect ratio,number of suspicious metastases,intranodal blood supply,lymphnode hilum morphology,age,pathological type,histological grade,molecular subtype,and the expressions of estrogen receptor(ER),progesterone receptor(PR),Ki-67,human epidermal growth factor receptor 2(HER2),and P53 were compared between two groups.Logistic regression was used to analyze the risk factors for axillary lymph node metastatic burden in the breast cancer patients;receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive value.Results:The univariate analysis results showed that there were statistically significant differences in tumor quadrant,distance to skin,molecular subtype,HER2 positive expression,lymphnode long diameter,lymph node short diameter,lymph node aspect ratio,number of suspicious metastases,and lymphnode hilum morphology between two groups(P<0.05).The multivariate Logistic regression analysis results showed that tumor located in the upper outer quadrant(OR=0.648,P=0.021),distance to skin<5 mm(OR=0.283,P=0.016),Luminal A(OR=1.564,P=0.044),lymphnode long diameter≥20 mm(OR=2.050,P<0.01),lymphnode short diameter≥8.6 mm(OR=2.430,P<0.01),lymph node aspect ratio<2(OR=1.585,P<0.01),and indistinct lymphnode hilum structure(OR=2.092,P<0.01)were the independent risk factors for axillary lymphnode metastatic burden.The ROC curve analysis results showed that compared with the ultrasonic features of positive axillary lymph nodes,the AUC of the combination of breast cancer-related parameters and ultrasonic features of positive axillary lymphnodes was larger(Z=2.72,P=0.006 5),and it had higher predictive value for axillary lymphnode metastatic burden.Conclusion:The tumor quadrant,distance to skin,molecular subtype,lymphnode long diameter,lymph node short diameter,lymphnode aspect ratio,and lymphnode hilum structure are the independent risk factors for axillary lymphnode metastatic burden,and they have certain predictive value for axillary lymphnode metastatic burden.

Objective:To compare the effects of different automatic normal tissue objective(NTO)weights(WNTO)of Eclipse planning system on intensity modulated radiation therapy(IMRT)of fixed field for abdominal tumor.Methods:Twenty patients with rectal cancer and twenty patients with cervical cancer who received radiotherapy in The Second People's Hospital of Huludao from September 2022 to January 2024 were selected.5 groups of different plans[WNTO20,40,60,80 and 100]were respectively formulated for each patient.Among of them,the WNTO20 plan was control group,and other 4 groups were respectively WNTO40 group,WNTO60 group,WNTO80 group and WNTO100 group.Then,the differences in dosimetry and monitor units(MU)among 5 groups of plans were compared.Results:In the WNTO 80 and 100 groups of patients with rectal cancer,the conformation index(CI)values of target regions of them were respectively 1.02±0.04 and 1.00±0.03,all of which approached to 1,and the CI values of two groups were lower than that of control group,and the differences were statistically significant(t=15.986,18.422,P<0.05).The homogeneity index(HI)of WNTO 80 and 100 groups were respectively 0.09±0.12 and 0.10±0.14,which were higher than that of control group,and the differences were statistically significant(t=-1.371,-1.463,P<0.05).The 52Gy dose volume(Vmax52)of small intestine of the two groups were respectively(4.48±14.49)and(4.77±10.47)cm3,which were higher than that of control group,and the differences were statistically significant(t=-1.360,-2.005,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the right femoral heads of the two groups were respectively(12.28±4.57)%and(10.96±4.17)%,which were lower than that of control group,and the differences were statistically significant(t=6.893,6.75,P<0.05).The 30 Gy dose volume percentage(V30 Gy)values of the left femoral head of the two groups were respectively(11.57±4.41)%and(10.17±3.78)%,which were lower than that of control group,and the differences were statistically significant(t=6.782,5.963,P<0.05).The MU value of WNTO100 group was(1254±93)MU,which was higher than that of control group,and the difference was statistically significant(t=-3.741,P<0.05).In the WNTO 80 and 100 groups of patients with cervical cancer,the CI values of target regions of them were respectively 1.03±0.32 and 1.02±0.03,all of which approached to 1,and the CI values of the two groups were lower than those of control group,and the differences were statistically significant(t=20.069,19.475,P<0.05).The HI values of them were respectively 0.07±0.05 and 0.08±0.01,which were higher than that of control group,and the differences were statistically significant(t=-12.445,-19.478,P<0.05).The V30 Gy values of the right femoral heads of the two groups were respectively(16.11±4.71)%and(14.90±4.56)%,which were lower than that of control group,and the differences were statistically significant(t=7.875,8.020,P<0.05).The V30 Gy values of the left femoral head of the two groups were respectively(15.21±3.71)%and(13.93±3.77)%,which were lower than that of control group,and the differences were statistical significance(t=7.617,7.436,P<0.05).The Vmax52 of small intestine of the two groups were respectively(0.82±1.10)and(4.47±8.81)cm3,which were higher than that of control group,and the difference was statistically significant(t=-2.985,-2.388,P<0.05).Conclusion:The WNTO80 is recommended for IMRT plan of radiotherapy on abdominal tumor,which can more quickly and better meet the assessment conditions of IMRT plan.

Objective:To explore the application value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in preoperative screening of different residual types of atrial septal defect (ASD) occlusion.Methods:A retrospective analysis was conducted on the clinical data of 120 ASD patients who received interventional treatment for atrial septal defect at the Second People′s Hospital of Liaocheng from January 2020 to December 2021. Patients underwent TTE and TEE examinations before surgery, and were divided into two groups based on the results of the preoperative TTE examination: those with strong echogenicity of the defect margin and swing amplitude<5 mm were classified as group A ( n=60); Patients with fine echoes and a swing amplitude of ≥5 mm at the defect margin were classified as group B ( n=60). The study compared the differences in measuring the maximum diameter of atrial septal defect between two groups of patients using TTE and TEE, and evaluated the correlation between the maximum diameter of the defect measured by these two methods and the waist diameter of the occluder. Results:There was no statistically significant difference in the maximum diameter of atrial septal defect measured by TTE and TEE in group A ( P>0.05), while there was a statistically significant difference in group B ( P<0.01). In group A patients, the correlation between the maximum diameter of ASD measured by TTE and TEE and the diameter of the occluder waist was good ( r=0.993, 0.991); In group B patients, the correlation between the maximum diameter of ASD measured by TEE and the diameter of the occluder waist was higher ( r=0.995), significantly greater than the correlation with TTE measurements ( r=0.897). The difference between the waist diameter of the occluder and the values measured by TTE and TEE in group A patients was small and not statistically significant ( P>0.05); The difference between the waist diameter of the occluder and the TEE measurement value in group B patients was significantly smaller than the difference with the TTE measurement value ( P<0.01). Conclusions:For patients with atrial septal defect with strong residual echo and small amplitude of oscillation, TTE and TEE have considerable application value and can be used instead of TEE in case screening; For patients with atrial septal defect with thin residual echoes and large oscillation amplitude, further TEE examination is needed to help surgeons more accurately select suitable occluders.

Objective:To investigate the effect of instantaneous flow rate on the consistency of diagnostic accuracy of severe degenerative mitral regurgitation (DMR) using proximal isovelocity surface area (PISA).Methods:From June 2019 to June 2021, 75 patients with DMR who underwent echocardiography in Department of Echocardiography of Zhongshan Hospital, Fudan University were prospectively enrolled. The instantaneous flow rate of DMR during the systolic phase was calculated using M-mode PISA(PISA M-mode), and a time-integrated curve was plotted. Regurgitant volume (RVol) and effective regurgitant orifice area (EROA) were calculated by traditional PISA (PISA max), pair PISA (PISA pair), and PISA M-mode, respectively. RVol acquired from cardiac magnetic resonance (CMR) volumetric method in 22 patients of the enrolled patients. The correlation and consistency of RVol acquired between the three PISA methods and CMR were compared. Agreement of diagnostic accuracy of severe mitral regurgitation (sMR) acquired between the three PISA methods and multi-parameter algorithm by American Society of Echocardiography (ASE) was analyzed using Cohen′s Kappa analysis. Results:The curve of instantaneous flow rate of DMR showed unimodal pattern with the peak at mid-late systolic phase. The correlation of RVol acquired between PISA methods and CMR was moderate for PISA max and PISA pair ( r=0.77, 0.80, both P<0.001), whereas PISA M-mode presented strong correlation with CMR ( r=0.87, P<0.001). RVol acquired from PISA max was larger than that of CMR[(69.1±37.1) ml vs (49.0±29.0)ml, P=0.002]. Both PISA max and PISA pair were shown moderate agreement of diagnostic accuracy of sMR with ASE multi-parameters algorithm (RVol: κ=0.496, 0.525, both P<0.001; EROA: κ=0.570, 0.578, both P<0.001), while PISA M-mode presented strong agreement (RVol: κ=0.867 and EROA: κ=0.802, both P<0.001). Conclusions:Based on the unimodal pattern of instantaneous flow rate in patients with DMR, PISA max may significantly overestimate RVol, exposing a significant proportion of patients with DMR to unnecessary MR surgery. PISA M-mode presents better correlation and consistency with CMR on the quantification of RVol compared with PISA max and PISA pair, and may improve the diagnostic accuracy of quantification of sMR using PISA.

Objective To explore the relationship between Nestin expression level and prognosis in osteosarcoma,and to provide a new idea for treatment.Methods Thirty patient with osteosarcoma who had received treatment were included this study according to the criteria.HE staining was applied to evaluate the response to chemotherapy,meanwhile immunohistochemistry was applied to evaluate Nestin expression levels before and after chemotherapy.Kaplan Meier survival curve was drawn to analyze the outcomes.Results The response of chemotherapy was good in 17 patients and poor in 13.24 cases were strongly positive in Nestin staining,five were weakly positive,and one was negative.The expression level of Nestin in osteosarcona was correlated to the chemotherapy response and prognosis (P ＜ 0.05),while higher level of Nestin expression referred to poorer response of chemotherapy and lower overall survival rate.Conclusions The expression level of Nestin in osteosarcoma tissue is associated with the effect of chemotherapy and prognosis;higher expression level of Nestin indicates poorer prognosis and efficacy of chemotherapy.

Objective To evaluate the curative effectiveness and safety of human chorionic gonadotropin(HCG) treatment on children with microphallic hypospadias.Methods A total of 48 consecutive children with microphalic hypospadias were enrolled in the study,and the children were randomized into the experiment group(HCG treatment) and the control group with the research randomizer.The patients in experiment group were treated with HCG prior to surgery,and the control group did not received any hormone therapy preoperatively.All children in the experiment group and the control group underwent hypospadias repair by using transverse preputial island flap (Duckett technique) urethroplasty.Penile length,diameter of glans penis,bone age,serum testosterone level,and secondary effects were recorded before and after therapy in the experiment group.Postoperative complications were assessed with respect to fistulas,urethral strictures,diverticula,meatal stenosis,and glanular dehiscence in both groups.Results (1)Mean penile length and diameter of the experiment group increased significantly by (1.08±0.47) cm (t=-5.196,P<0.05) and (0.31±0.06) cm and there was a significant difference between before and after treatment (t=-5.080,P<0.05).(2)Urethrocutaneous fistulas were observed in 8 patients in the control group compared to 2 patients in the experiment group with a statistically significant difference (χ2=4.547,P<0.05).There was a significant difference between the overall reoperation rates of control group (9 patients) and the experiment group (3 patients,χ2=4.000,P<0.05).The penile tissue of the patients in the experiment group was soft and able to be easily separated and released during the operation and the flap had more blood supply.Conclusions Pretreatment with HCG therapy prior to hypospadias repair is beneficial to children with microphallic hypospadias.Significant penile growth was seen in the children treated with HCG and there was no obvious side effect.Moreover,pretreatment with HCG is beneficial to decrease the complications and reoperation rates of hypospadias repair which proves to be effective and safe.

Objective To investigate the clinical value of transthyretin (TTR) from patients with early rheumatoid arthritis (ERA). Methods 58 patients with ERA , 34 patients with later RA (LRA) and 34 healthy control (HC) were included in the research. TTR was analyzed by ELISA, whose variance was analyzed. TTR density, disease activity score28 (DAS28) score and rheumatoid factor (RF) were tested, and their correlation with TTR was analyzed. Results Serum level of TTR with ERA significantly increased compared with that with LRA and HC (P < 0.05), no statistical significance with LRA group and HC. TTR level was no correlation with the number of swelling and tender joints, disease activity score 28, RF, ESR, CRP, anti-cyclic citrylinated peptide antibody and anti-keratin antibodies, hemoglobin, thrombocyte and albumin. Conclusion Serum level of TTR significantly increased with ERA patients, contributing to early diagnosis for RA.

BACKGROUND:Integrated Traditional Chinese and Western Medicine minimaly invasive treatment for halux valgus based on wrapped curtain method with “8”-shaped bandage and sub toe pad external fixation has been used for a long time in the clinic. This method abandons the internal implant fixationandexternal plaster fixation. After surgery, patients could take care of themselves. However, theactivity of the broken end may cause fracture nonunion, which once aroused scholars’ question. Recently, with the continuous improvement of foot biomechanics research, foot finite element model and applications become a reality.
OBJECTIVE:To evaluate thestability of osteotomy after the operation of wrapped curtain method with“8”-shaped bandage and sub toe pad external fixation on the basis of static finite element method.
METHODS:A young female volunteer with halux valgus was selected, whose body weight was 58 kg, and right foot halux abductor valgus angle was 24°; intermetatarsal angle was 13°; proximal articulator set angle was 7°; distal articulator set angle was 7°. CT was used to scan the right foot. ABAQUS software was applied to establish a finite element model of right foot halux valgus bone, and model of the first metatarsal neck minimaly invasive osteotomy was simulated based on wrapped curtain method with external fixation. Von Mises stress and displacement at the osteotomy endwere calculated.
RESULTS AND CONCLUSION:(1) The maximum stress was 0.067 MPa without external fixation, and the maximum stress was 1.258 MPa with the external fixation. Stress was mainly distributed in the outer edge of the osteotomy. (2) The maximum absolute displacement was 0.363 mm without external fixation, and the maximum absolute displacement was 0.716 mm with external fixation. The two largest displacements were both in the Z-axis direction. Statistical analysis confirmed that the four nodes absolute displacement and stress were significantly different (P< 0.01). (3) The maximum relative displacement was 0.101 mm. The maximum relative displacement was 0.046 mm with external fixation. The maximum relative displacement without external fixation was-0.102 mm and occurred in the Z-axis. The maximum relative displacement with external fixation was 0.110 mm and occurred in the Y-axis. (4) One-way analysis of variance confirmed that the four nodes relative displacements were not statisticaly significant in X-axisand Y-axis (P> 0.05). The four nodes relative displacements were statisticaly significant in Z-axis (P< 0.05). (5) These findings suggest that the external fixation based on wrapped curtain method after halux valgus surgery could effectively reduce osteotomy displacement. The moderate stress and elastic fixation are conducive to fracture healing.

Objective To investigate the clinical efifcacy of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treatment of liver metastasis of colon cancer. Methods A total of 68 patients with liver metastasis of colon cancer in the Sixth Affiliated Hospital of Sun Yat-sen University from June 2007 to May 2011 were enrolled in this prospective study. The informed consents of all patients were obtained and local ethical committee approval had been received. There were 43 males and 25 females with a mean age of (59±4) years old. The patients were divided into RFA group and Control group with 34 cases in each group according to random number table method. Patients in both groups underwent TACE ifrstly and patients in RFA group underwent RFA 3 weeks after TACE treatment. Cluster of differentiation (CD) 3+, CD4+, CD8+positive cell percentage and CD4+/CD8+ratio were deifned by flow cytometry before and after treatments in two groups. The tumor diameter after treatments and general efifcacy were observed. The patients were followed up and the tumor recurrence and survival of the patients were observed. The comparisons of tumor diameter and immune function between two groups were conducted using t test. The comparison of efifcacy between two groups was conducted using rank sum test. The survival analysis was conducted using Log-rank test and Z test. Results The CD4+, CD8+percentage and CD4+/CD8+ratio were (42±4)%, (13±3)%, 2.9±0.9 in RFA group after treatment and were (33±4)%, (17±3)%, 2.3±0.9 in Control group, where signiifcant differences were observed (t=5.483,-6.488, 9.321;P<0.05). The tumor diameter in RFA group after treatment [(0.9±0.1) cm] was significantly smaller than that in Control group [(1.9±0.2) cm] (t=-4.573, P<0.05). The total effective rate in RFA group was 62%(21/34) and was 35%(12/34) in Control group. The treatment efifcacy of RFA group was better than that of Control group (Z=4.769, P<0.05). The 2-, 3-year survival rates in RFA group (38.2%, 23.5%) were significantly higher than those in Control group (14.7%, 5.9%) (Z=4.836, 4.221; P<0.05). Conclusions TACE combined with RFA is a safe and effective regimen in treating liver metastasis of colon cancer. The efifcacy may be associated with the improvement of the body’s immune function.