Objective:To investigate the differences in dosimetric impacts of the systematic errors induced by the leaf positions of a multi-leaf collimator (MLC) on the volumetric modulated arc therapy (VMAT) for patients with different T stages of nasopharyngeal carcinoma (NPC).Methods:A total of 44 patients with T 1-4N 1M 0 NPC were selected to design the VMAT plans using the Pinnacle planning system as the initial plans. The prescribed doses to the primary gross tumor volume (PGTV) were 68-70 Gy in 33 fractions for patients with T 1 and T 2 stage NPC and 71 Gy in 33 fractions for patients with T 3 and T 4 stage NPC. The prescribed doses to other target volumes were identical. In the initial plan files, a systematic error ranging from ±0.2 to ±1 mm was introduced to the position of each MLC leaf, leading to an increase or decrease in the subfield area. Then, potential error plans at the positions of MLC leaves during VMAT treatment were simulated. Dose evaluation indices involved target volumes and organs at risk (OARs). The indices related to target volumes consisted of the D98% of PGTV and PGTVnd, while those concerning OARs included the D0.1 cm 3 of the brainstem, spinal cord, and optic chiasm. Results:After the systematic errors induced by the positions of MLC leaves were introduced, the sensitivity range of each dose index range was (3.87%-9.87%)/mm ( R2 = 0.932-0.998, P < 0.01). Specifically, patients with stage T 4 NPC displayed higher sensitivity to the D98% of PGTV than those with stage T 1, T 2 and T 3 NPC ( Z = -3.12, -2.86, -2.59, P < 0.05), patients with stage T 3 NPC exhibited lower sensitivity to the D0.1 cm 3 of optic chiasm than those with stage T 1 and T 2 NPC ( Z = -2.92, -2.72, P < 0.05), and patients with stage T 4 NPC manifested lower sensitivity to the D0.1 cm 3 of chiasma than those with stage T 1 and T 2 NPC ( Z = -3.51, -3.25, P < 0.05). The relationship between the sensitivity of MU/Gy and PGTV D98% was y=-3.020+ 0.025 x ( r = 0.80, P < 0.05). Conclusion:The MU/Gy in the plans increased with the T stage of NPC, and the D98% of PGTV was more significantly affected by the systematic errors induced by the positions of MLC leaves. After the systematic errors induced by the positions of MLC leaves were introduced into the VMAT plans, doses to patients with T 4 stage NPC changed more significantly than those to patients with other T stages of NPC. Therefore, stricter quality control of leaf positions is required for patients with T 4 stage NPC, and it is recommended that the systematic errors should be less than 0.42 mm.

Objective:To investigate the clinical value of open abdomen therapy in non-traumatic critically patients.Methods:The retrospective cohort study was conducted. The clinical data of 23 non-traumatic critically patients who underwent open abdomen therapy in 5 hospitals in China from July 2015 to July 2024 were collected. There were 17 males and 6 females, aged 70(range, 24-84)years. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Repeated measurement data were analyzed using the repeated ANOVA, and pairwise comparison within groups was conducted using the least significant difference method. The Boruta algorithm was applied for analyzing variables related to survival outcomes. Results:(1) Treatment of patients undergoing open abdomen therapy. ① The intra-abdominal pressure, lactate, heart rate, central venous pressure, mean arterial pressure, sequential organ failure assessment score of 23 patients from preoperation to postoperative day 3 were changed from (19.7±5.4)mmHg (1 mmHg=0.133 kPa), (6.1±1.9)mmol/L, (120±14)beats/minutes, (13.1±4.3)cmH 2O (1 cmH 2O=0.098 kPa), (58.8±6.8)mmHg, 13.2±1.8 to (10.6±1.3)mmHg, (2.3±0.6)mmol/L, (95±10)beats/minutes, (8.8±2.0)cmH 2O, (75.2±8.5)mmHg, 10.1±1.6, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=46.40, 29.19, 24.91, 11.84, 27.81, 11.71, P<0.05). ② The oxygenation index, total intake, total output of 23 patients from preoperation to postoperative day 3 were changed from (255.0±54.2)mmHg, (5388±1562)mL, (2 520±630)mL to (291.7±25.0)mmHg, (2 886±866)mL, (3 221±923)mL, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=7.61, 13.83, 2.97, P<0.05). ③The daily caloric intake, daily protein supplementation of 23 patients from preoperation to postoperative day 3 were changed from (465±116)kcal, (18±5)g to (1 628±472)kcal, (60±18)g, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=40.31, 41.23, P<0.05). (2) Patients outcomes after open abdomen therapy. Of 23 patients, 18 cases survived and 5 cases died. The duration of intensive care unit stay and duration of hospital stay of 23 patients were 26(range, 5-82)days and 40(range, 5-98)days. Twelve of 23 patients received renal replacement therapy for 12 (range, 5-32)days. Time of pain and sedation management, mechanical ventilation, antimicrobial therapy, vasopressor therapy of 23 patients were 13(range, 5-74)days, 12(range, 5-74)days,20(range, 5-50)days, 6(range, 2-35)days. (3) Analysis of variables related to survival outcomes for patients after open abdomen therapy. Results of Boruta analysis showed that postoperative high-output enteric fistula, postoperative bile fistula, postoperative intra-abdominal hemorrhage, postoperative enteric air fistula, and preoperative mean arterial pressure were significantly associated with survival outcomes. Conclusions:Open abdomen therapy is effective in the treatment of non-traumatic critically patients. Postoperative high-output enteric fistula, postoperative bile fistula, postoperative intra-abdominal hemorrhage, postoperative enteric air fistula, and preoperative mean arterial pressure reduction are significantly associated with survival outcomes.

Objective:To investigate the clinical value of open abdomen therapy in non-traumatic critically patients.Methods:The retrospective cohort study was conducted. The clinical data of 23 non-traumatic critically patients who underwent open abdomen therapy in 5 hospitals in China from July 2015 to July 2024 were collected. There were 17 males and 6 females, aged 70(range, 24-84)years. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Repeated measurement data were analyzed using the repeated ANOVA, and pairwise comparison within groups was conducted using the least significant difference method. The Boruta algorithm was applied for analyzing variables related to survival outcomes. Results:(1) Treatment of patients undergoing open abdomen therapy. ① The intra-abdominal pressure, lactate, heart rate, central venous pressure, mean arterial pressure, sequential organ failure assessment score of 23 patients from preoperation to postoperative day 3 were changed from (19.7±5.4)mmHg (1 mmHg=0.133 kPa), (6.1±1.9)mmol/L, (120±14)beats/minutes, (13.1±4.3)cmH 2O (1 cmH 2O=0.098 kPa), (58.8±6.8)mmHg, 13.2±1.8 to (10.6±1.3)mmHg, (2.3±0.6)mmol/L, (95±10)beats/minutes, (8.8±2.0)cmH 2O, (75.2±8.5)mmHg, 10.1±1.6, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=46.40, 29.19, 24.91, 11.84, 27.81, 11.71, P<0.05). ② The oxygenation index, total intake, total output of 23 patients from preoperation to postoperative day 3 were changed from (255.0±54.2)mmHg, (5388±1562)mL, (2 520±630)mL to (291.7±25.0)mmHg, (2 886±866)mL, (3 221±923)mL, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=7.61, 13.83, 2.97, P<0.05). ③The daily caloric intake, daily protein supplementation of 23 patients from preoperation to postoperative day 3 were changed from (465±116)kcal, (18±5)g to (1 628±472)kcal, (60±18)g, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=40.31, 41.23, P<0.05). (2) Patients outcomes after open abdomen therapy. Of 23 patients, 18 cases survived and 5 cases died. The duration of intensive care unit stay and duration of hospital stay of 23 patients were 26(range, 5-82)days and 40(range, 5-98)days. Twelve of 23 patients received renal replacement therapy for 12 (range, 5-32)days. Time of pain and sedation management, mechanical ventilation, antimicrobial therapy, vasopressor therapy of 23 patients were 13(range, 5-74)days, 12(range, 5-74)days,20(range, 5-50)days, 6(range, 2-35)days. (3) Analysis of variables related to survival outcomes for patients after open abdomen therapy. Results of Boruta analysis showed that postoperative high-output enteric fistula, postoperative bile fistula, postoperative intra-abdominal hemorrhage, postoperative enteric air fistula, and preoperative mean arterial pressure were significantly associated with survival outcomes. Conclusions:Open abdomen therapy is effective in the treatment of non-traumatic critically patients. Postoperative high-output enteric fistula, postoperative bile fistula, postoperative intra-abdominal hemorrhage, postoperative enteric air fistula, and preoperative mean arterial pressure reduction are significantly associated with survival outcomes.

Ischemic stroke (IS) is a kind of cerebrovascular disease caused by temporary or permanent decrease in local cerebral blood flow. The research of this disease by revealing its pathophysiological process and exploring new therapeutic targets from the cellular and molecular levels has always been the hot spot. In recent years, the competing endogenous RNA (ceRNA) regulatory network mediated by long non-coding RNA (lncRNA) has been proved to play a key role in the pathology and physiology of IS, which can effectively improve the diagnosis, treatment and prognosis of IS. This article aims to describe the mechanism of micro RNA (miRNA) and lncRNA in IS and the role of lncRNA as miRNA's ceRNA in the cell apoptosis, cell viability, angiogenesis, inflammatory response, oxidative stress, and neuroprotection of IS patients, in order to broaden the vision of the occurrence and development of IS and provide new ideas for its diagnosis and treatment.

Objective To explore the clinical effect and safety of bedside hand jejunal nutrition tube placement in the treatment of severe acute pancreatitis. Methods The clinical data of 120 patients with severe acute pancreatitis treated in Dazhou Central Hospital from December 2014 to December 2016 were retrospectively analyzed. The patients in the control group(60 cases) were treated with nasogastric tube enteral nutrition on the basis of routine treatment. The patients in the observation group(60 cases) were treated with bedside bare hands on the basis of routine treatment, placement of jejunal feeding tube for jejunal nutrition treatment. The changes of gastrointestinal function,blood and urine amylase content,ICU stay time and the incidence of complications such as reflux and aspiration pneumonia were observed. Results In the observation group,the success rate was 96. 7％ (52 / 60),and the catheterization time was (23. 5 ± 8. 4)min,without any adverse reactions. The recovery time of bowel sounds and anal defecation time of the observation group were (2. 01 ± 0. 47)d and (2. 69 ± 0. 42)d,respectively,which were significantly shorter than those of the control group[(3. 63 ± 1. 52)d and (3. 96 ± 1. 36)d],and the differences were statistically significant(t = 7. 887, 6. 911,all P < 0. 01). There was no statistically significant difference in serum amylase level between the two groups before treatment(t = 1. 364,P > 0. 05). After treatment,the serum amylase level in the observation group was (163 ± 104)IU/ L,which was lower than that in the control group[(302 ± 136)IU/ L](t = 6. 289,P < 0. 01). The recovery time of urinary amylase and the stay time in ICU in the observation group were (9. 28 ± 1. 25)d,(11. 24 ± 0. 84)d, respectively,which were shorter than those in the control group[(16. 32 ± 3. 26) d,(18. 35 ± 2. 42) d],and the differences were statistically significant(t = 15. 619,21. 499,all P < 0. 01). Conclusion Enteral nutrition by beside manual placement of jejunal feeding tube in the treatment of patients with severe acute pancreatitis is simple and safe. It can effectively promote the recovery of intestinal function and shorten the time for ICU. It is worthy of application in clinical practice.

Objective To explore the optimization of intubations for severe brain injury patients in ICU. Methods Seventy-six severe brain injury patients were divided into research group and traditional group through the envelop method, with 38 patients in each group. Patients in research group was induced by dexmedetomidine, while patients in traditional group was induced by midazolam or propofol. Throat and intratrachea surface anesthesia was taken with 3 ml of 1%lidocaine on two groups before intubation, and they were intubated through direct laryngoscope. Patients were connected with breathing machines after intubation, and the arterial carbondioxide partial pressure was maintained at 30-35 mmHg (1 mmHg=0.133 kPa). Intubations time, one-time success rate, cardiovascular reaction index, myocardial damage and heart failure biomarkers, adverse reaction, patients comfort and intubationists satisfaction of the two groups were compared. Results The intubation time on research group was significantly shorter than that on traditional group [(27.1 ± 14.2) s vs. (42.2 ± 18.7) s], and there was statistical significance (P<0.01). The one-time success rates in two groups was not statistically significant (P>0.05). The heart rates and mean arterial pressure (MAP) at pre-intubation, post-intubation, 5 min after intubation and 10 min after intubation in research group were significantly lower than those in traditional group:heart rate:(77.8 ± 8.5) bpm vs. (85.1 ± 7.6) bpm, (85.3 ± 9.1) bpm vs. (106.4 ± 12.5) bpm, (84.4 ± 10.4) bpm vs. (96.4 ± 11.9) bpm, (80.5 ± 12.1) bpm vs. (89.0 ± 10.5) bpm;MAP: (82.6 ± 10.1) mmHg (1 mmHg = 0.133 kPa) vs. (93.2 ± 14.3) mmHg, (88.3 ± 13.2) mmHg vs. (113.7 ± 15.1) mmHg, (85.4 ± 14.0) mmHg vs. (101.3 ± 9.9) mmHg, (83.7 ± 10.7) mmHg vs. (90.3 ± 13.4) mmHg, and there were statistical significances (P<0.05). There was no statistical significance of SpO2 between groups at every time point (P>0.05). For 6 and 12 h after intubation, creatine kinase isoenzyme MB (CK-MB), cardiac troponin T (cTnT) and brain natriuretic peptide (BNP) levels in research group were significantly lower than those in traditional group:CK-MB:(30.5 ± 7.2) U/L vs. (35.2 ± 10.1) U/L, (25.7 ± 5.7) U/L vs. (27.7 ± 6.5) U/L;cTnT:(0.6 ± 0.2) μg/L vs. (0.8 ± 0.1) μg/L, (0.5 ± 0.2) μg/L vs. (0.6 ± 0.2) μg/L;BNP:(152.6 ± 13.7) pg/L vs. (189.4 ± 19.3) pg/L, (89.7 ± 27.5) pg/L vs. (111.8 ± 20.4) pg/L, and there were statistical significances (P<0.05). There were no significant adverse reactions in two groups after topical anesthesia. The comfort and intubationists satisfaction scores in research group were significantly higher than those in traditional group: (2.5 ± 0.4) scores vs. (1.8 ± 0.5) scores and (8.8 ± 1.1) scores vs. (7.1 ± 0.9) scores, and there were statistical significance (P<0.01). Conclusions Combining dexmedetomidine induction with topical anesthesia to intubate is safe and effective, which is the optimization of tracheal intubations to severe brain injury patients.

Objective To study the clinical effect of different tracheal intubation in patients with severe brain injury.Methods 82 patients with severe brain injury were selected and randomly divided into observation group and control group,each group had 41 cases.The observation group was given the dexmedetomidine induction combined with surface anesthesia on the basis of endotracheal intubation,and the control group was given traditional endotracheal intubation.The effects of the two groups were compared.Results The intubation time of the observation group was (26.7 ±13.8)s,which was significantly lower than (41.6 ±17.9)s of the control group(t =4.221,P =0.000).There were no differences in cardiovascular response indices between the two groups before intubation(t =0.122,P =0.903;t =0.296,P =0.768;t =1.128,P =0.263).After 10min,HR and MAP levels were significantly lower in the observation group than those in the control group(t =3.326,P =0.0.001;t =2.354,P =0.021).In the observation group,HR,MAP after intubation were lower than before intubation(t =2.548,P =0.013;t =3.626,P =0.000),the SpO2 of the two groups was higher than that before intubation(t =30.622,P =0.000;t =38.797,P =0.000),there were no differences in HR and MAP before and after intubation in the control group(t =0.846,P =0.400;t =1.824,P =0.072).There were no differences between the two groups before intubation(t =0.183,P =0.856;t =0.000,P =1.000;t =1.132,P =0.261),CK -MB,cTnT,BNP were significantly lower than those in the control group after 12h,respectively(t =2.030,P =0.046;t =2.264,P =0.026;t =3.785,P =0.000).CK -MB, cTnT,BNP were significantly lower than the control group after intubation in the two groups(t =7.845,P =0.000;t =8.591,P =0.000;t =22.757,P =0.000;t =5.525,P =0.000;t =2.264,P =0.000;t =22.149,P =0.000).The BCS and SS scores in the observation group were significantly higher than those in the control group(t =5.739,P =0.000;t =5.264,P =0.000).Conclusion The dexmedetomidine induction combined with topical anesthesia based uplink tracheal intubation scheme has significant effect,safety is good,it is worth of clinical application.

Digital image processing and magnetic resonance imaging from magnetic resonance image processing technique. This technique will not only promote MRI's research and development, but also bring new challenges for digital image processing. Because the information in the MRI is very important to medical treatment, it is a primary task that how to decrease noise from MRI by use of PC and digital image processing. In this paper, we analyzed the noises from a variety of sources, and introduced all kinds of techniques to reduce these noises.
Algorithms ; Image Processing, Computer-Assisted ; methods ; Magnetic Resonance Imaging ; methods

Objective To study the feasibility of preoperative acute hypervolemic hemodilution for decreasing perioperative blood use. Methods Thirty two patients(ASAI-II) undergoing spinal surgery were randomized into AHH group and control group. After anesthesia 6% HES(200/0.5) was given through internal jugular vein for AHH. The blood volume was increased by about 25%. During the operation, blood loss was replaced by HES in equal volume. Blood was transfused when the Hct dropped below 25%. The HR, MAP, CVP, SPO2, Hb, Hct., Plt, FIB, APTT, PT, amount of blood loss, blood transfused and urine output, volume of drainage 24h after operation and VAS score (0 means no effect, 10 means maximal effect) were observed before AHH, at the end of AHH, at the end of operation, and 24h after the operation. Blood volume expansion was calculated. Results (1) HR increased significantly in both groups(P

Objective To compare the effects of three different plasma substitutes, 6% hydroxyethyl starch (HES 200/0.5), 4% Gelofusine and 5% Polygeline, on blood coagulation and arterial blood gases and electrolytes during acute hypervolemic hemodilution (AHHD) . Methods Seventy ASA Ⅰ - Ⅱ adult patients undergoing elective orthopedic surgery with the intraoperative blood loss predicted to exceed 500 ml were entered in this study. Radial artery was cannulated for BP monitoring and blood sampling before induction of anesthesia. Anesthesia was induced with fentanyl 3 ?g?kg-1, propofol 2 mg?kg-1 and atracurium 0.5 mg? kg-1 and maintained with enflurane (1-2 MAC) . The patients were mechanically ventilated ( VT= 10 ml? kg-1 , RR = 12 bpm) after tracheal intubation. Internal jugular vein was cannulated after induction of anesthesia for CVP monitoring. After induction of anesthesia the patients were randomized to receive 20 ml?kg-1 of either 6% HES (group H, n = 20), 4% Gelofusine (group G, n = 20), 5% Polygeline (group P, n = 20) or lactated Ringer's solution (group R, n = 10) within 20-40 min. Arterial blood samples were taken before AHHD, at the end of and 30 min after the infusion of substitute for determination of activated coagulation time (ACT), thromboelastography (TEG) , blood gas analysis and plasma electrolytes. Blood volume expansion rate was calculated [ blood volume expansion rate = (Hct before AHHD - Hct after AHHD) / Hct before AHHD] .Results The four groups were comparable with respect to sex, age and body weight. Lactated Ringer' s solution was significantly less efficient in expanding intravascular blood volume than the 3 plasma substitutes, but there was no significant difference in blood volume expansion rate among group H, G and P. CVP increased significantly after AHHD compared with the baseline value before AHHD in group H, G and P (P