Objective To assess the prognostic significance of the Controlling Nutritional Status (CONUT) score in patients with non-small cell lung cancer (NSCLC) and its association with clinicopathological characteristics. Methods The relevant studies investigating the association between CONUT score and prognosis of NSCLC patients were systematically searched in the PubMed, Web of Science, EMbase, Cochrane Library, CNKI, Wanfang Database and other databases from their inception to July 2023. Two independent researchers screened the references according to predefined inclusion and exclusion criteria, extracted data and conducted quality assessment. The quality of included references was evaluated using New Castle-Ottawa Scale (NOS). The meta-analysis was performed using Stata 17.0 software, and a combined hazard ratio (HR) or odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the association of CONUT score with prognosis and clinicopathological characteristics in NSCLC patients. Results A total of 17 cohort studies, comprising 5182 NSCLC patients with stage Ⅰ-Ⅳ, were included in this analysis. All studies had a NOS≥6 points. The meta-analysis showed that there was a significant correlation between CONUT score and overall survival (OS) as well as disease-free survival (DFS) among NSCLC patients: the higher the score, the shorter the OS [HR=1.87, 95%CI (1.58, 2.21), P<0.001] and DFS [HR=1.91, 95%CI (1.63, 2.24), P<0.001]. These differences were statistically significant. Furthermore, CONUT score was significantly associated with age, smoking status, tumor stage, and N stage (P<0.05). Conclusion A higher CONUT score is associated with a poorer OS and DFS in patients with NSCLC, and CONUT score can be used as a potential predictor of NSCLC prognosis.

Objective:To evaluate the application value of robost optimization of brachytherapy for cervical cancer.Methods:Twenty patients who completed radical treatment were recruited in this study. The dose volume histogram (DVH) parameters were statistically compared between the conventional and robust optimization plans, and the robustness between the conventional and robust optimization plans was evaluated using DVH and DVH bands. The robust optimization method utilized the worst dose distribution to consider the dose in the presence of uncertainties. In each optimization iteration, the dose distributin when the radioactive source shifted along the X, Y, and Z directions (±2 mm), and the dose distribution when the radioactive source was not shifted were calculated. The worst dose distribution for each voxel was the lowest dose in the target and the highest dose outside the target under all circumstances. The iterative objective function was calculated by the worst dose distribution.Results:In the scenario of no shifting of radioactive source position, the mean value of robust optimization was significantly lower and that of V 150% was significantly higher than those of conventional optimization (both P<0.05). When considering the shifting of radioactive source position, the worst dosimetric parameters of multiple dose distributions were statistically compared. The mean HR-CTV D 100% values did not significantly differ between the robust and conventional optimization plans, whereas the mean D 90% value (range: 0.02-0.03 Gy) of robust optimization was significantly higher than that of conventional optimization ( P<0.05). Robust optimization increased the D 2cm 3 of the bladder and small intestine, and the rectum dose was increased with the shifting of the radioactive source position in the robust optimization. The DVH bands did not significantly differ between the conventional and robust optimization plans for all patients. Conclusions:Robust optimization based on the worst dose distribution fails to significantly improve the robustness of brachytherapy for cervical cancer. Alternative methods are required to minimize the dosimetric effect of uncertainties in brachytherapy.

Objective: To report an implementation method and results of an independent brachytherapy dose verification software (DVS). Methods: The DVS was developed based on Visual C+ + and the modular structure design was adopted. The DICOM RT files exported from the treatment planning system (TPS) were automatically loaded into the DVS. The TG-43 formalism was employed for dose calculation. Six cervical cancer patients who underwent brachytherapy were retrospectively selected to test the DVS. Different applicators were utilized for each patient. Dosimetric parameters and γ analysis (0.1cm, 5%) were used to evaluate the dose difference between the DVS and the TPS. Results: Compared with the TPS dose, the γ pass rates of the doses calculated by the DVS were higher than 98%. For CTV, the dosimetric differences were less than 0.29% and 0.53% for D_100% and D_90%. For bladder, rectum and sigmoid, the agreement of D_0.1cm³, D_1cm³ and D_2cm³ within a 0.5% level. Conclusion With minimal human-computer interactions, the DVS can verify the accuracy of dose calculated by TPS for brachytherapy.

Objective:To report an implementation method and result of an inverse dose optimization algorithm (GBPO) that can control the dwell time variation in three-dimensional brachytherapy.Methods:The GBPO used a quadratic objective function. A dwell time modulation item was added to the objective function to restrict the dwell time variation, and a DTMF (dwell time modulation factor) was used to adjust the dwell time variation. A retrospective study was made of 15 cervical cancer patients treated using the Fletcher applicator. The relationship between the DTMF and dwell time deviation was analyzed. Dose-volume histogram (DVH) parameters of HR-CTV ( D100%, V150%) and organs at risk (OARs) ( D0.1 cm 3, D1 cm 3, D2 cm 3) were used to evaluate the difference between the GBPO plans and the commercial treatment plan system (using the IPSA algorithm) plans. Results:When the DTMF was less than 20, the dwell time deviation decreased quickly. However, after the DTMF increased to 100, and the dwell time deviation had no remarkable change. The D100% of GBPO plan was higher than that of IPSA plan (3.63±0.36 vs. 3.53±0.34, t=2.45, P<0.05), and the difference in other dosimetric parameters between the GBPO plans and the IPSA plans was not statistically significant ( P>0.05). Conclusions:The method reported in this study to control the dwell time variation was feasible. The GBPO plans have a comparable quality as the IPSA plans for the studied cervical cancer cases. The GBPO algorithm could be integrated into a three-dimensional brachytherapy treatment planning system.

Objective:To explore an implementation method and results of an inverse dose optimization algorithm (gradient-based planning optimization, GBPO) in three-dimensional brachytherapy.Methods:A standard quadratic objective function was used in the GBPO. The optimization code of GBPO was performed based on LBFGS (Limited memory Broyden Fletcher Goldberg Shanno). Seven cervical cancer patients using different applicators and 15 cervical cancer patients using the Fletcher applicator (Nucletron part#189.730) were retrospectively analyzed. The plan quality of GBPO was firstly assessed by isodose lines, then dose-volume histogram (DVH) parameters of CTV(D 100%, V 150%) and organs at risk(D 0.1cm 3, D 1.0cm 3, D 2.0cm 3) were used to evaluate the difference among the GBPO, IPSA and Graphic plans. Results:For the 7 patients using different applicators, GBPO could optimize the conformal dose distribution, and the DVH parameters of the target and organs at risk were basically the same among the GBPO, IPSA and Graphic plans. For 15 patients using the Fletcher applicator, the difference in DVH parameters between the GBPO and IPSA plans was not statistically significant. There was no remarkable difference in the DVH parameters between the GBPO and Graphic plans, but the D 100% of the GBPO plan was significantly higher ( P<0.01), and the V 150% was significantly lower ( P<0.01) than that of the Graphic plan. Conclusions:The quality of the GBPO plan is similar to that of the IPSA plan in terms of target coverage and organ protection. The inverse dose optimization algorithm GBPO can be integrated into a three-dimensional brachytherapy treatment planning system.

Objective: To explore the influence of three-level collaboration network of pediatric burns in Anhui province on treatment effects of burn children. Methods: The data of medical records of pediatric burn children transferred from Lu′an People′s Hospital and Fuyang People′s Hospital to the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2015 and January 2016 to September 2017 (before and after establishing three-level collaboration network of pediatric burns treatment) were analyzed: percentage of transferred burn children to hospitalized burn children in corresponding period, gender, age, burn degree, treatment method, treatment result, occurrence and treatment result of shock, and operative and non-operative treatment time and cost. Rehabilitation result of burn children transferred back to local hospitals in 2016 and 2017. Data were processed with t test, chi-square test, Mann-Whitney U test, and Fisher′s exact test. Results: (1) Percentage of burn children transferred from January 2014 to December 2015 was 34.3% (291/848) of the total number of hospitalized burn children in the same period of time, which was close to 30.4% (210/691) of burn children transferred from January 2016 to September 2017 (χ²=2.672, P>0.05). (2) Gender, age, burn degree, and treatment method of burn children transferred from the two periods of time were close (χ²=3.382, Z=-1.917, -1.911, χ²=3.133, P>0.05). (3) Cure rates of children with mild, moderate, and severe burns transferred from January 2016 to September 2017 were significantly higher than those of burn children transferred from January 2014 to December 2015 (χ²=11.777, 6.948, 4.310, P<0.05). Cure rates of children with extremely severe burns transferred from the two periods of time were close (χ²=1.181, P>0.05). (4) Children with mild and moderate burns transferred from the two periods of time were with no shock. The incidence of shock of children with severe burns transferred from January 2014 to December 2015 was 6.0% (4/67), and 3 children among them were cured. The incidence of shock of children with severe burns transferred from January 2016 to September 2017 was 3.9% (2/51), and both children were cured. The incidences and cures of shock of children with severe burns transferred from the two periods of time were close (χ²=0.006, P>0.05). Incidence of shock of children with extremely severe burns transferred from January 2014 to December 2015 was 57.1% (32/56), significantly higher than that of burn children transferred from January 2016 to September 2017 [34.5% (10/29), χ²=3.925, P<0.05]. Shock of 25 children with extremely severe burns transferred from January 2014 to December 2015 were cured, and shock of 9 children with extremely severe burns transferred from January 2016 to September 2017 were cured. The cures of shock of children with extremely severe burns transferred from the two periods of time were close ( χ²=0.139, P>0.05). (5) Time of operative treatment of children with moderate, severe, and extremely severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 (t=2.335, 2.065, 2.310, P<0.05). Time of operative treatment of children with mild burns transferred from the two periods of time was close (Z=-0.417, P>0.05). Costs of operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were significantly more than those of burn children transferred from January 2016 to September 2017 (Z=-3.324, t=2.167, P<0.05). Costs of operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close (t=0.627, 0.808, P>0.05). (6)Time of non-operative treatment of children with mild, moderate, and severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 (t=2.335, Z=-2.095, t=2.152, P<0.05). Time of non-operative treatment of children with extremely severe burns transferred from the two periods of time was close (t=0.450, P>0.05). Costs of non-operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were obviously higher than those of burn children transferred from January 2016 to September 2017 (Z=-2.164, t=2.040, P<0.05). Costs of non-operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close (t=0.146, 1.235, P>0.05). (7) Sixty-seven burn children transferred from January 2016 to September 2017 were transferred back to local hospitals for rehabilitation under the guidance of experts of the First Affiliated Hospital of Anhui Medical University, with 25 patients in 2016 and 42 patients in 2017. Effective rehabilitation rates of burn children transferred back to local hospitals for rehabilitation in 2016 and 2017 were both 100%. Conclusions The three-level collaboration network of pediatric burns treatment in Anhui province can effectively increase cure rate of children with mild, moderate, and severe burns, reduce incidence of shock of children with extremely severe burns, shorten time of operative treatment of burn children with moderate, severe, and extremely severe burns, and time of non-operative treatment of children with mild, moderate, and severe burns, reduce treatment costs of children with moderate and severe burns, and improve rehabilitation effectiveness of children transferred from Lu′an People′s Hospital and Fuyang People′s Hospital to the the First Affiliated Hospital of Anhui Medical University.

Objective To study the relationship between bronchial asthma and smoking status in Chinese people.Methods Asthma epidemiological survey and stratified-cluster-random method survey were performed in residents over 14 years in 8 provinces (cities) of China from February 2010 to August 2012.Asthma was diagnosed based upon case history,clinical signs and lung function test.Smoking status was investigated by questionnaire.Results Sampling population was 180 099 and 164 215 were valid.A total of 2 034 subjects were diagnosed as asthma including 79 692 men and 84 523 women.The overall prevalence rate of asthma was 1.24％ (2 034/164 215).Smokers were 23.8％ (39 137/164 215) in the whole population.Smokers were 34.5％ (702/2 034) in asthmatic patients,compared with 23.7％ (38 435/ 162 181) in no-asthmatic population.The incidence of asthma was 1.79％ and 1.06％ in smokers and nonsmokers respectively (P ＜0.001),suggesting that OR of smoking was 1.70 (95％ CI 1.55-1.86,P ＜ 0.001).According to asthma control test (ACT) score,the level of asthma control in non smoking group was higher than that in smoking group(43.2％ vs 35.3％).The times of hospitalization due to acute exacerbations (0.51 vs 0.41 events/person/year),total hospitalization rate (27.35 ％ vs 20.12％),annual emergency room visits (0.80 vs 0.60 events/person/year) and emergency room visit rate (31.77％ vs 24.47％) were all much higher in smoking asthmatic patients than those in non smoking asthmatic patients,indicating that the level of asthma control in smoking patients was significantly worse than in non smoking patients.Conclusions The smoking rate in Chinese people over 14 years is still high.The prevalence rate of asthma in smokers is significantly higher than that of non-smokers.The level of asthma control in smokers is significantly worse than that in non smokers.

Objective To develop double-arc volumetric modulated arc therapy ( VMAT) plans using standard phantom and standard target volume in AAPM119 report, and to investigate the dosimetric parameters of Agility and MLCi2 leafs according to the requirements for target dose in AAPM119 report. Methods The Cshape, Head and Neck, Prostate, and Multitarget structures for standard target volume delineation in AAPM119 report were used.The Elekta Agility multi-leaf collimator was used to develop plans, and then with other parameters remaining unchanged, Elekta MLCi2 was used for plan optimization and dose calculation.The target dose in AAPM119 report was used as the standard to analyze the differences in target volume and dose-volume parameters of organs at risk between the four structures for target volume delineation.Results According to the mean dose in AAPM119 report, in the Cshape, Head and Neck, and Multitarget target volumes, the radiotherapy plans developed with Agility had better dosimetric parameters compared with those developed with MLCi2.In the prostate target volume, the radiotherapy plans developed with MLCi 2 had better dosimetric parameters compared with those developed with Agility .Conclusions With the structures for target volume delineation, plan designing personnel, designing parameters, and evaluation criteria remaining the same, Elekta Agility can achieve the dose target better than Elekta MLCi2 in the aspect of strict dose limit.

Objective To investigate the feasibility of the virtual source model in Monte Carlo dose calculation for clinical radiotherapy.Methods The Monte Carlo simulation was used to obtain the phase space files which recorded the physical properties of the particles emitted by a medical linear accelerator, and the information on the type, energy spectrum, and distribution of particles were extracted from these files and analyzed to establish the semi-empirical model of virtual two-photon source.The GMC dose calculation engine was used to obtain the 3 cm×3 cm, 5 cm×5 cm, 10 cm×10 cm, 20 cm×20 cm, and 30 cm×30 cm fields of radiotherapy and the results of Monte Carlo simulation of dose distribution in three-dimensional water phantom in 2 intensity-modulated radiotherapy ( IMRT) plans.These results were compared with the results of water phantom measurement or the results of Elekta Monaco planning system to verify the accuracy of Monte Carlo dose calculation based on a virtual source.Results As for the percentage depth-dose distribution curves of the central axis of the water phantom and the off-axis dose curves at different depths in the five fields for radiotherapy, the difference between the results of Monte Carlo simulation and the results of measurement was within 1%.As for the two IMRT plans, the three-dimensional passing rates of Monaco calculation results and Monte Carlo simulation results were 98.9%and 99.4%, respectively, for 3%/3 mm, and 95.1%and 95.4%, respectively, for 2%/2 mm.Conclusions Monte Carlo simulation based on the virtual source model can obtain accurate results of radiotherapy dose calculation.

Objective To understand the status of the radiation therapy in sichuan province, analysis the development level of radiotherapy in the past five years in sichuan province,provide reference for the rational allocation of radiotherapy resources in the province, promote the healthy development of radiotherapy. Methods With reference to the surveys carried out by other provinces and the survey of sichuan province in 2009,to determine the survey schemes,survey projects. The survey covers all medical units of radiation therapy in the province, adopt the way of combination of questionnaire and on?the?spot visiting. Results There is a big progress in basic condition, treatment equipment, auxiliary equipment, verification equipment,personnel and application of new technologies. Compared with 2009 survey,multiple projects achieve a 50% or even more than 100% growth. Conclusions The rapid development of radiation oncology in sichuan province will ultimately benefit a large number of tumor patients in sichuan province. Patients will be treated with better environment,treatment technology and quality. At the same time,higher requirement of quality control for the entire province is put forward to us.