Objective To investigate the impact of statistical uncertainty per control point(SUpCP)on dose calculation on volumetric modulated arc therapy(VMAT)for rectum cancer,and to analyze the accuracy and efficiency of calculation.Methods 19 patients with rectum cancer undergoing radiotherapy were selected.The initial VMAT plans were generated on Monaco TPS using SUpCP=3,then changed SUpCP in the dose calculation process as follow:10 SUpCPs(1～10)for each patient,and totally190 VMAT dose distributions were obtained.For plan evaluation,Dmax,Dmean,D95%,V50,homogeneity index(HI),conformity index(CI)of the planning target volume(PTV),dissymmetric variations of bladder,small intestine and femoral head,and time calculation(Time)were analyzed.Patient specific quality assurance(PSQA),dose deviation of isocenter(ΔDISO)and passing rate of three-dimensional dose distribution(γ33,γ32,γ22)between calculated and delivered radiation doses were measured.Results AsSUpC increased,Dmax and HI of PTV,Dmax of bladder were increased,but D95%and V50 of PTV,Time,γ32 and γ22 were decreased(P<0.05).Dmax and CI of PTV,Dmean of bladder,Dmax and Dmean of small intestine and femoral head,ΔDISO and γ33 showed no statistical significance(P>0.05).When ΔDISO<1%,gamma passing rate>90%for all VMAT plan.When SUpCP<6,Dmax of PTV<110%of the prescribed dose was obtained;while SUpCP>2,time for dose calculation was less than 5 min.Conclusion For VMAT plan of rectum cancer on Monaco TPS using XVMC algorithm,3%～5%of statistical uncertainty per control point for dose calculation,and 3%2 mm or 2%2 mm gamma criteria for three-dimensional dose verification is recommended.This study provides clinical application basis for precise dose calculation of VMAT plan of rectum cancer.

Objective:To screen the main characteristic variables affecting the incidence of cardiovascular and cerebrovascular diseases,and to construct the Bayesian network model of cardiovascular and cerebrovascular disease incidence risk based on the top 10 characteristic variables,and to provide the reference for predicting the risk of cardiovascular and cerebrovascular disease incidence.Methods:From the UK Biobank Database,315 896 participants and related variables were included.The feature selection was performed by categorical boosting(CatBoost)algorithm,and the participants were randomly divided into training set and test set in the ratio of 7∶3.A Bayesian network model was constructed based on the max-min hill-climbing(MMHC)algorithm.Results:The prevalence of cardiovascular and cerebrovascular diseases in this study was 28.8％.The top 10 variables selected by the CatBoost algorithm were age,body mass index(BMI),low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC),the triglyceride-glucose(TyG)index,family history,apolipoprotein A/B ratio,high-density lipoprotein cholesterol(HDL-C),smoking status,and gender.The area under the receiver operating characteristic(ROC)curve(AUC)for the CatBoost training set model was 0.770,and the model accuracy was 0.764;the AUC of validation set model was 0.759 and the model accuracy was 0.763.The clinical efficacy analysis results showed that the threshold range for the training set was 0.06-0.85 and the threshold range for the validation set was 0.09-0.81.The Bayesian network model analysis results indicated that age,gender,smoking status,family history,BMI,and apolipoprotein A/B ratio were directly related to the incidence of cardiovascular and cerebrovascular diseases and they were the significant risk factors.TyG index,HDL-C,LDL-C,and TC indirectly affect the risk of cardiovascular and cerebrovascular diseases through their impact on BMI and apolipoprotein A/B ratio.Conclusion:Controlling BMI,apolipoprotein A/B ratio,and smoking behavior can reduce the incidence risk of cardiovascular and cerebrovascular diseases.The Bayesian network model can be used to predict the risk of cardiovascular and cerebrovascular disease incidence.

ObjectiveThe type 2C protein phosphatases （PP2C） are involved in numerous plant signal transduction pathways. They mainly participate in plant stress response and regulate second metabolites biosynthesis via negatively regulating MAPK signaling pathway. Herein，we were to identify and analyze PP2C （CsPP2C） gene family from hemp genome，in hope of providing comprehensive insights for studying CsPP2C function during the development of hemp. MethodMolecular Evolutionary Genetics Analysis （MAGA）-X was used to construct phylogenetic tree. Expert Protein Analysis System （ExPASy），WoLF PSORT，Multiple EM for Motif Elicitation （MEME），Batch Conserved Domain Search （Batch-CD-Search），PlantCare，and TBtools were used，respectively，to predict CsPP2C physicochemical properties，subcellular localization，conserved motifs，protein structure，cis-element in promoter and collinearity with Arabidopsis PP2C. Cannabis sativa transcriptome and Real-time polymerase chain reaction（Real-time PCR） were used to analyze and verify gene expressions，respectively. ResultFifty-two CsPP2C with conserved domains were identified from the entire genome of hemp，encoding proteins ranging from 244 to 1 089 aa in length and with molecular weights ranging from 26.76 to 122.53 kDa. Those genes were mainly distributed in the nucleus，cytoplasm and chloroplast. The 47 CsPP2C were divided into 10 subfamilies，and the remaining 5 were not clustered. Seven pairs of homologous genes between hemp and Arabidopsis thaliana were identified according to collinear analysis. The light-responsive elements and abscisic acid elements are most abundant in the prediction. The gene expression heat map showed varied expression pattern of CsPP2C in different tissues. Real-time PCR results of three CsPP2C were consistent with transcriptome data. Moreover，alternative splicing analysis showed that some CsPP2C had alternative-splicing genes during evolution. ConclusionWe predicted and analyzed CsPP2C gene family in genomic scale and showed that CsPP2C are involved in many biological processes，whereby provides foundation for CsPP2C functional study.

Objective:To investigate the feasibility of early treatment of congenital giant melanocytic nevus (CGMN).Methods:From October 2013 to December 2021, the clinical data of children with giant nevus treated with skin soft tissue expansion in the Plastic Surgery Department of Sun Yat-sen Memorial Hospital were analyzed retrospectively. A renal expander was implanted in the first stage, including single and repeated expansion. The giant nevus was removed and repaired in the second stage with an expanded skin flap. The occurrence of complications, such as wound infection, expander exposure, expander rupture, and flap congestion, were recorded. Children’s mental health problems and their parents’ satisfaction were also analyzed. The χ2 between children of different ages and the infection rate between children with an internal and external pot. Results:A total of 58 children, 24 males and 34 females, aged from 3 months to 3 years, with an average age of 1.45 years, were enrolled. A total of 190 expanders were implanted. The patients were followed for 5 to 106 months, averaging 42.43 months. In the first stage, 29 cases of wound infection, 41 cases of expander exposure, two cases of flap congestion, and 6 cases of expander rupture occurred. The flap transfers were not affected by these complications after appropriate treatment. The comparison of complication rates among 3 months~<1 year、1~<2 years、2~<3 years、3 years was 37.34%(31/83)、56.75% ((21/37) ), 33.33% (13/39) and 41.94%(13/31), respectively, No statistically significant difference ( χ2=5.21, P=0.157). The incidence of wound infection was 16.67% (6/36) and 14.94% (23/154), respectively, for the internal and external dilators. There was no significant difference in the location of the dilator pot and the incidence of wound infection ( χ2=0.07, P=0.795). The appearance of all children has been significantly improved. Thirty-nine children’s families are particularly satisfied, and 20 are generally satisfied with the treatment effect, and no mental health problems were found. Conclusions:Skin and soft tissue expansion is a reliable method for early treatment of congenital giant nevus.

Objective:To investigate the feasibility of early treatment of congenital giant melanocytic nevus (CGMN).Methods:From October 2013 to December 2021, the clinical data of children with giant nevus treated with skin soft tissue expansion in the Plastic Surgery Department of Sun Yat-sen Memorial Hospital were analyzed retrospectively. A renal expander was implanted in the first stage, including single and repeated expansion. The giant nevus was removed and repaired in the second stage with an expanded skin flap. The occurrence of complications, such as wound infection, expander exposure, expander rupture, and flap congestion, were recorded. Children’s mental health problems and their parents’ satisfaction were also analyzed. The χ2 between children of different ages and the infection rate between children with an internal and external pot. Results:A total of 58 children, 24 males and 34 females, aged from 3 months to 3 years, with an average age of 1.45 years, were enrolled. A total of 190 expanders were implanted. The patients were followed for 5 to 106 months, averaging 42.43 months. In the first stage, 29 cases of wound infection, 41 cases of expander exposure, two cases of flap congestion, and 6 cases of expander rupture occurred. The flap transfers were not affected by these complications after appropriate treatment. The comparison of complication rates among 3 months~<1 year、1~<2 years、2~<3 years、3 years was 37.34%(31/83)、56.75% ((21/37) ), 33.33% (13/39) and 41.94%(13/31), respectively, No statistically significant difference ( χ2=5.21, P=0.157). The incidence of wound infection was 16.67% (6/36) and 14.94% (23/154), respectively, for the internal and external dilators. There was no significant difference in the location of the dilator pot and the incidence of wound infection ( χ2=0.07, P=0.795). The appearance of all children has been significantly improved. Thirty-nine children’s families are particularly satisfied, and 20 are generally satisfied with the treatment effect, and no mental health problems were found. Conclusions:Skin and soft tissue expansion is a reliable method for early treatment of congenital giant nevus.

Objective:To explore and summarize the feasibility and effect of repairing Achilles tendon exposure after repair of Achilles tendon rupture with retrograde sural neurovascular flap.Methods:The clinical data of patients with Achilles tendon exposure after repair of Achilles tendon rupture admitted to the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2016 to February 2019 were analyzed retrospectively. Under epidural anesthesia, the necrotic skin and soft tissue were removed entirely, and only the liquefied and necrotic surface of the Achilles tendon was removed. The previous surgical suture of the Achilles tendon was retained. After debridement, the wound surface was covered with a retrograde sural nerve flap. The blood supply and shape of the flap, foot sensation, and ankle function were observed after the operation.Results:The present study included seven patients (four males and three females, aged from 24 to 69 years old, with an average of 45.7 years old). The size of the skin and soft tissue defect at the exposed Achilles tendon was about 2.0 cm × 5.0 cm-5.0 cm × 7.0 cm, and the area of the flap was about 4.0 cm × 7.0 cm-6.5 cm × 9.0 cm. The wounds in the flap donor site of seven patients in this group were closed directly, while one patient whose blood supply of about distal 1 cm of the flap was unsatisfactory ten days after the operation. The patient received a dressing change for 21 days and the wound healed with scar. The other flaps transferred from other patients had a good blood supply, and all wounds in the flap donor site and the defect site healed well. All patients were followed up for 10 to 14 months. The color and texture of the flap were good without obvious bloating. The scar in the operation area was mild, and the heel movement was good. Mild numbness was still felt in the lateral part of the foot in four patients, but no paresthesia was noticed in other patients. The Kofoed ankle score was 78-97, with an average score of 88.3. There were six excellent cases and one good case.Conclusions:The sural neurovascular flap is adjacent to the defect area of Achilles tendon exposure. Although the open repair of Achilles tendon rupture has a certain influence on the skin soft tissue and blood circulation around the Achilles tendon area, it can still form a retrograde sural neurovascular flap with a slightly higher pedicle to repair the Achilles tendon exposure. The donor site can be closed directly with minor trauma. The technique is simple and effective as well.

Objective:To investigate the method, feasibility and clinical effect of scrotal flap in the immediate repair of penoscrotal Paget disease after excision.Methods:From January 2008 to September 2018, a total of 21 patients (age 42-74) diagnosed with penile scrotal Paget disease were admitted and treated in our department. All patients underwent local expanded resection, and intraoperative frozen section examination confirmed a negative margin. All patients used the scrotal flap or scrotal flap combined with other surgical methods to repair the defect.Results:Scrotal flaps were used in ten cases, scrotal flaps combined with other flaps in seven cases, and scrotal flaps combined with skin grafting in four cases. All the scrotal flaps had good blood supply, two cases had small partial skin graft necrosis, and one case had delayed healing of the flap donor area, and all the others had good wound healing. All patients were followed up for six months to 60 months, with an average follow-up time of 30.6 months. Most of the patients (95.2%, 20/21) were satisfied with the appearance of the penis and scrotum, and all the transferred flaps showed no edema. Local recurrence occurred in four patients within two years. Local recurrence and inguinal lymph node metastasis occurred in one patient within three years with a total local recurrence rate of 23.8% (5/21). Due to the small local recurrence lesion, the recurrence lesion was successfully repaired with the adjacent scrotal flap after expanding local excision, and the patients with inguinal lymph node metastasis received ipsilateral inguinal lymph node dissection.Conclusions:The scrotal flap has the characteristics of a large cutting area, flexible design, convenient transfer of flap, enough blood supply, simple, safe, and effective. Using this method can obtain a satisfactory shape of the penis and scrotum after the operation. Those defects that are difficult to use scrotal flap for a complete repair can be repaired with other flaps or skin grafts. A good therapeutic effect can be obtained as well. For the majority of recurrent lesions, scrotal skin flap can be reapplied.

Objective:To summarize the methods and effects of utilizing the ilioinguinal flap in repairing the defect after the extended resection of the middle and lower abdominal wall or the groin region’s dermatofibrosarcoma protuberans.Methods:From November 2011 to October 2018, nine patients (including five males) with the middle and lower abdominal wall or groin region’s dermatofibrosarcoma protuberans received extended resection procedures in the Department of Plastic and Reconstructive Surgery of Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The age distribution of patients was 27-60 years old with a mean age of 44.3 years old. The defect area following the extended resection of the tumor ranged from 9.5 cm × 10.5 cm to 15.0 cm × 18.0 cm, and the size of the ilioinguinal flap ranged from 6.0 cm × 11.0 cm to 8.0 cm × 15.0 cm. Either an axial flap or a V-Y advancement flap was used to repair the defect. Five patients were treated with the unilateral ilioinguinal flap, two with the bilateral ilioinguinal flap combination flap, one with the ilioinguinal flap combined with the tensor fascia lata myocutaneous flap, and one with the ilioinguinal flap combined with the anterolateral thigh flap.Results:All defects were covered by flaps completely, and all donor sites were closed directly. Eight flaps survived completely without necrosis, while one case of ilioinguinal flap faced the distal necrosis, which was debrided and repaired with full-thickness skin grafting in the second stage. The postoperative follow-up period ranged from 1.0 to 8.5 years. No local recurrence or other distant metastases occurred. All reconstructed regions had a good outline and ordinary sense function.Conclusions:Almost all defects after the extended resection of dermatofibrosarcoma protuberans in the middle and lower abdominal wall or the groin region could be repaired with a unilateral or bilateral ilioinguinal flap, whose blood supply is stable and reliable. Moreover, the operation presented is simple, less time-consuming, safe, reliable, and with a satisfactory postoperative appearance.

Objective:To explore and summarize the feasibility and effect of repairing Achilles tendon exposure after repair of Achilles tendon rupture with retrograde sural neurovascular flap.Methods:The clinical data of patients with Achilles tendon exposure after repair of Achilles tendon rupture admitted to the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2016 to February 2019 were analyzed retrospectively. Under epidural anesthesia, the necrotic skin and soft tissue were removed entirely, and only the liquefied and necrotic surface of the Achilles tendon was removed. The previous surgical suture of the Achilles tendon was retained. After debridement, the wound surface was covered with a retrograde sural nerve flap. The blood supply and shape of the flap, foot sensation, and ankle function were observed after the operation.Results:The present study included seven patients (four males and three females, aged from 24 to 69 years old, with an average of 45.7 years old). The size of the skin and soft tissue defect at the exposed Achilles tendon was about 2.0 cm × 5.0 cm-5.0 cm × 7.0 cm, and the area of the flap was about 4.0 cm × 7.0 cm-6.5 cm × 9.0 cm. The wounds in the flap donor site of seven patients in this group were closed directly, while one patient whose blood supply of about distal 1 cm of the flap was unsatisfactory ten days after the operation. The patient received a dressing change for 21 days and the wound healed with scar. The other flaps transferred from other patients had a good blood supply, and all wounds in the flap donor site and the defect site healed well. All patients were followed up for 10 to 14 months. The color and texture of the flap were good without obvious bloating. The scar in the operation area was mild, and the heel movement was good. Mild numbness was still felt in the lateral part of the foot in four patients, but no paresthesia was noticed in other patients. The Kofoed ankle score was 78-97, with an average score of 88.3. There were six excellent cases and one good case.Conclusions:The sural neurovascular flap is adjacent to the defect area of Achilles tendon exposure. Although the open repair of Achilles tendon rupture has a certain influence on the skin soft tissue and blood circulation around the Achilles tendon area, it can still form a retrograde sural neurovascular flap with a slightly higher pedicle to repair the Achilles tendon exposure. The donor site can be closed directly with minor trauma. The technique is simple and effective as well.

Objective:To investigate the method, feasibility and clinical effect of scrotal flap in the immediate repair of penoscrotal Paget disease after excision.Methods:From January 2008 to September 2018, a total of 21 patients (age 42-74) diagnosed with penile scrotal Paget disease were admitted and treated in our department. All patients underwent local expanded resection, and intraoperative frozen section examination confirmed a negative margin. All patients used the scrotal flap or scrotal flap combined with other surgical methods to repair the defect.Results:Scrotal flaps were used in ten cases, scrotal flaps combined with other flaps in seven cases, and scrotal flaps combined with skin grafting in four cases. All the scrotal flaps had good blood supply, two cases had small partial skin graft necrosis, and one case had delayed healing of the flap donor area, and all the others had good wound healing. All patients were followed up for six months to 60 months, with an average follow-up time of 30.6 months. Most of the patients (95.2%, 20/21) were satisfied with the appearance of the penis and scrotum, and all the transferred flaps showed no edema. Local recurrence occurred in four patients within two years. Local recurrence and inguinal lymph node metastasis occurred in one patient within three years with a total local recurrence rate of 23.8% (5/21). Due to the small local recurrence lesion, the recurrence lesion was successfully repaired with the adjacent scrotal flap after expanding local excision, and the patients with inguinal lymph node metastasis received ipsilateral inguinal lymph node dissection.Conclusions:The scrotal flap has the characteristics of a large cutting area, flexible design, convenient transfer of flap, enough blood supply, simple, safe, and effective. Using this method can obtain a satisfactory shape of the penis and scrotum after the operation. Those defects that are difficult to use scrotal flap for a complete repair can be repaired with other flaps or skin grafts. A good therapeutic effect can be obtained as well. For the majority of recurrent lesions, scrotal skin flap can be reapplied.