Background and purpose:In recent years,deep inspiration breath hold(DIBH)based on surface-guided radiation therapy(SGRT)has emerged as one of the most promising techniques in breast cancer radiotherapy.Conventionally,cone-beam CT(CBCT)is used before treatment to verify and correct patient positioning deviations.However,patient position may change during treatment,and pre-fraction CBCT cannot fully reflect real-time positional deviations.Therefore,this study aimed to introduce intra-fraction CBCT into left-sided breast DIBH radiotherapy to monitor and correct real-time deviations,verify whether patients achieve the desired position during treatment,and evaluate the clinical value of intra-fraction CBCT in left-breast radiotherapy.Methods:Clinical data from postoperative left-sided breast cancer patients treated at Fudan University Shanghai Cancer Center between June 2023 and January 2024 were collected.Patients with satisfactory cardiopulmonary function and stable DIBH compliance were included.Pre-fraction CBCT scans were performed before treatment,and data were recorded.During treatment,the gantry was rotated to-180° to trigger kV-level intra-fraction CBCT scanning.After gantry repositioning to the starting angle of the tangential field,MV beam delivery commenced.Intra-fraction CBCT scans were acquired for positional registration,and deviations were compared with pre-fraction CBCT results.Results:A total of 30 eligible patients were included,with 150 pairs of pre-fraction and intra-fraction CBCT images analyzed per patient.The mean registration deviations for intra-fraction CBCT were 26%,52%,and 51%lower than pre-fraction CBCT in the X,Y,and Z axes,respectively(P＜0.05),demonstrating significantly reduced real-time deviations.The probability of intra-fraction deviations being＜6 mm was 100.0%,100.0%,and 99.3%for the X,Y,and Z axes,respectively.Correlation analysis revealed a weak correlation between intra-fraction and pre-fraction deviations in the X-axis(P＜0.05),while no significant correlation was observed for the Y and Z axes(P＞0.05).Conclusion:Intra-fraction CBCT effectively monitors and corrects real-time positional deviations in left-sided breast DIBH radiotherapy,serving as a valuable supplement to conventional pre-fraction CBCT.It minimally impacts treatment efficiency while significantly improving positional accuracy,offering clinical and practical benefits for left-breast cancer radiotherapy.

The concepts of manifestation-root cause,Yin-Yang balance,reinforcing-reducing for deficiency and excess should not only be focused on the traditional Chinese medicine formulations,but also be consistently applied in clinical practice of acupuncture treatment.The"Tongdu Qishen"acupuncture method,developed by Professor Li Zhigang based on years of experience in treating psychosis,demonstrates unique advantages in treating stroke sequela hemiplegia.From the three aspects of theoretical basis,classic medical records,acupoint selection and operation analysis,this study introduces the clinical application of"Tongdu Qishen"combined with manifestation-root cause Yin-Yang and reinforcing-reducing balance acupuncture in the treatment of stroke sequela hemiplegia,offering new insights and strategies for exploring effective clinical treatment with syndrome differentiation.

Objective:To compare the efficacy of three-dimensional visualization-assisted intermuscular versus conventional intermuscular cervical expansive open-door laminoplasty (CEOL) in the treatment of cervical spinal cord injury without fracture or dislocation (CSCIWFD).Methods:A retrospective cohort study was conducted to analyze the clinical data of 58 patients with CSCIWFD admitted to Zhengzhou Orthopedic Hospital from October 2021 to January 2024, including 39 males and 19 females, aged 36-77 years [(52.9±8.9)years]. Among them, 26 patients were treated with three-dimensional visualization-assisted intermuscular CEOL (three-dimensional visualization group), while 32 patients were treated with conventional intermuscular CEOL (conventional intermuscular group). All patients were treated with CEOL in 4 segments (C 3-C 6), comprising 104 surgical segments in the three-dimensional visualization group and 128 in the conventional intermuscular group. The following outcomes were compared between the two groups, including the operative duration, intraoperative blood loss, accuracy rate of open-door and hinge placement at the surgical levels, visual analogue scale (VAS) of the neck and shoulder and Japanese Orthopedic Association (JOA) score preoperatively, at 1 week, 1 month, 3 months, 6 months postoperatively and at the last follow-up, American Spinal Injury Association (ASIA) impairment scale preoperatively and at the last follow-up, and postoperative complication rate. Results:All patients were followed up for 12-24 months [(17.5±3.1)months]. The operative duration and intraoperative blood loss were (117.0±12.3)minutes and (151.3±30.9)ml in the three-dimensional visualization group, which were shorter or less than (131.9±15.0)minutes and (184.7±42.9)ml in the conventional intermuscular group ( P<0.01). The accuracy rate of open-door and hinge placement at the surgical levels was 94.2% (98/104) in the three-dimensional visualization group, significantly higher than 83.6% (107/128) in the conventional intermuscular group ( P<0.05). The VAS scores of the neck and shoulder preoperatively, at 1 week, 1 month, 3 months, 6 months postoperatively, and at the last follow-up were 6.0(5.0, 7.0)points, 3.5(3.0, 4.0)points, 3.0(2.0, 3.0)points, 2.0(1.0, 3.0)points, 2.0(1.0, 2.3)points, and 2.0(1.0, 2.0)points in the three-dimensional visualization group, which were not statistically different from 5.0(4.3, 6.8)points, 4.0(3.0, 4.0)points, 3.0(2.0, 3.0)points, 2.0(1.3, 2.0)points, 2.0(1.0, 2.8)points, and 2.0(1.0, 2.0)points in the conventional intermuscular group ( P>0.05). The VAS scores of the neck and shoulder in the two groups were significantly decreased at 1 week, 1 month and 3 months postoperatively from the preoperative values ( P<0.05), while they were stabilized at 6 months postoperatively and at the last follow-up compared with those at 3 months postoperatively, with no significant difference among them ( P>0.05). The JOA scores were (8.1±2.8)points, (10.0±2.6)points, (10.5±2.6)points, (11.6±2.3)points, (12.7±2.3)points, and (13.7±2.4)points in the three-dimensional visualization group, which were not statistically different from (8.8±2.2)points, (10.3±2.1)points, (10.8±2.0)points, (12.0±2.0)points, (12.9±2.0)points, and (13.8±2.1)points in the conventional intermuscular group ( P>0.05). The JOA scores of the two groups showed continuous improvement at 1 week, 1 month, 3 months, 6 months postoperatively and at the last follow-up in comparison with the preoperatively values ( P<0.05). Although no significant difference was observed between the two groups in ASIA grade preoperatively and at the last follow-up ( P>0.05), the ASIA grade at the last follow-up was significantly improved compared with that before surgery in both groups ( P<0.05). The postoperative complication rate was 12% (3/26) in the three-dimensional visualization group, significantly lower than 38% (12/32) in the conventional intermuscular group ( P<0.05). Conclusion:Compared with the conventional intermuscular approach, the three-dimensional visualization-assisted intermuscular CEOL offers advantages in reducing surgical trauma, improving surgical precision, and lowering the postoperative complication rate in the treatment of CSCIWFD.

Objective: To analyze the potential categories and influencing factors of the compliance trajectory of orthokeratology lenses (OK lens) in myopic children and adolescents, so as to provide a basis for dynamic and accurate intervention of OK lens compliance in myopic children and adolescents. Methods: From January to June 2024, 310 myopic children and adolescents wearing OK lens were selected as research subjects from the Ophthalmology Medical Center of Cangzhou Central Hospital using a convenient sampling method. Data were collected at four time points: when the glasses were first fitted (T0), 2 weeks after fitting (T1), 1 month later (T2), 3 months later (T3), and 6 months later (T4). The data collection methods included general information questionnaires, compliance surveys for OK lens wearers, the Behavior Rating Inventory of Executive Function-Self-report Version (BRIEF-SR), family support scales, and a self-made questionnaire on myopia control attitudes. A growth mixed model was used to identify the trajectory categories of compliance with OK lens wearing among myopic children and adolescents, and multiple Logistic regression analysis was employed to examine the influencing factors. Results: The compliance with OK lens among myopic children and adolescents were roughly divided into four developmental trajectories: C1 exemplary adherent (58 cases, 18.71%), C2 gradual progressor (130 cases, 41.94%), C3 fluctuating (85 cases, 27.42%), and C4 stubborn low follower (37 cases, 11.94%). Multivariate Logistic regression analysis showed that, with C1 group as the reference, age (C3, OR = 0.74 ), parental education level (C4, OR =0.67), executive function (C2, OR =0.69; C4, OR =0.44), family support (C3, OR =0.75) and myopia control attitude (C2, OR =0.39) were all influencing factors for the compliance trajectory of OK lens; with C2 group as the reference, age (C3, OR = 0.55 ), parental education level (C3, OR =0.34; C4, OR =0.64), executive function (C3, OR =0.77), and family support (C4, OR =0.58) were all influencing factors for the compliance trajectory of OK lens; with C3 group as the reference, age (C4, OR = 0.68 ), and myopia control attitude (C4, OR =0.44) were both influencing factors for the compliance trajectory of OK lens ( P <0.05). Conclusions The compliance of wearing OK lens in children and adolescents with myopia can be roughly divided into four trajectories, and there is group heterogeneity. Dynamic and precise compliance intervention strategies should be given based on different trajectories and influencing factors.

Objective:To evaluate the clinical efficacy of a novel reduction device in the treatment of A3N0/1 thoracolumbar fracture using navigation-assisted techniques.Methods:A retrospective analysis was conducted on 45 patients (29 males, 16 females; mean age 40.67±16.11 years, range 24-57) with thoracolumbar fractures who underwent fracture reduction and pedicle screw fixation via the Wiltse approach at Zhengzhou Orthopaedic Hospital between January 2022 and January 2023. Injury levels included: T 10 in 2 cases, T 11 in 5 cases, T 12 in 13 cases, L 1 in 20 cases, L 2 in 3 cases, L 3 in 2 cases. All patients underwent fracture reduction via the Wiltse approach using the spinal fracture reduction instrument for vertebral body reduction. Among them, 20 patients received O-arm navigation-assisted internal fixation and vertebral reduction (O-arm group), while 25 received C-arm fluoroscopy-guided internal fixation and vertebral reduction (C-arm group). Operative time, intraoperative blood loss, vertebral reduction time using the instrument, first-time screw placement success rate, screw placement accuracy, and complications were compared. Mid-vertebral body height ratio (MVBHr), local Cobb angle of the fractured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) were compared preoperatively, at 1 week postoperatively, 3 months postoperatively, and final follow-up. Results:All surgeries were successfully completed in both groups. Operative time was significantly shorter in the O-arm group (106.8±14.4 min) than in the C-arm group (119.1±16.4 min, P<0.05). All patients were followed up for a mean duration of 15.9±3.9 months (range 12-20 months). Vertebral reduction time was significantly shorter in the O-arm group (11.0±2.2 min) than in the C-arm group (20.4±5.7 min, P<0.05). The first-time screw placement success rate was significantly higher in the O-arm group (100%) than in the C-arm group (95.3%, P<0.05). Screw placement accuracy (Grade I) was significantly higher in the O-arm group (117 screws, 97.5%) than in the C-arm group (136 screws, 90.7%, P<0.05). No cases of wrong-level surgery, infection, or spinal cord/nerve injury occurred. Both groups showed significant improvements in MVBHr, Cobb angle, VAS, and ODI at all postoperative time points compared to preoperative values ( P<0.05). At final follow-up, the O-arm group demonstrated significantly better outcomes than the C-arm group in MVBHr (90.6%±4.5% vs. 86.4%±6.9%, P<0.05), Cobb angle (7.6°±1.8° vs. 10.1°±3.2°, P<0.05), VAS (1.3±0.4 vs. 1.7±0.6, P<0.05), and ODI (4.6%±1.9% vs. 7.7%±2.0%, P<0.01). Conclusion:O-arm navigation-assisted intrasegmental push reduction for A3N0/1 type thoracolumbar fractures demonstrates advantages including faster and more accurate screw placement, precise reduction with improved outcomes, and significant postoperative pain relief.

OBJECTIVE To investigate the expression levels of nucleotide-binding oligomerization domain-like recep-tor pyrin domain-associated protein 3(NLRP3)inflammasome pathway and toll-like receptors(TLRs)pathway in serofast patients with syphilis infection,and their correlation with helper T lymphocytes(Th)1/Th2.METHODS A total of 549 patients with syphilis admitted to Tianjin Chest Hospital and Tianjin Medical University General Hospital from Jan.2021 to Dec.2022 were selected.Among them,62 patients who had not received anti-syphilis treatment were assigned to the syphilis group,238 patients whose serum remained positive after anti-syphilis treatment were selected as the fixed group,249 patients whose serum turned negative after anti-syphilis treatment were selected as the negative conversion group,and another 565 healthy people who underwent medical examina-tion in the hospital during the same period were selected as the control group.TLR2,TLR4,nuclear factor(NF)-κB,NLRP3,apoptosis-associated speck-like protein(ASC),cysteinyl aspartate proteolytic enzyme 1(Caspase-1),in-terleukin(IL)-1β mRNA and interferon-γ(IFN-γ),IL-12,IL-13 and IL-10 levels were compared between each group.Pearson's analysis was used to analyze the correlation between the mRNA expression of TLR2,TLR4,NF-κB,NLRP3,ASC,Caspase-1,and IL-1β and the levels of IFN-γ,IL-12,IL-13,and IL-10 in serologically fixed patients with syphilis.RESULTS Compared with the control group,the mRNA expression of TLR2,TLR4,NF-κB,NLRP3,ASC,Caspase-1 and IL-1β was elevated in the negative conversion and the syphilis groups,and the expres-sion of the above indicators was decreased in the fixed group(P＜0.05).Compared with negative conversion group,mR-NA expressions of TLR2,TLR4,NF-κB,NLRP3,ASC,Caspase-1 and IL-1β were increased in syphilis group,while the expression of the above indicators was decreased in fixed group(P＜0.05).Compared with fixed group,mRNA ex-pressions of TLR2,TLR4,NF-κB,NLRP3,ASC,Caspase-1 and IL-1β in syphilis group were increased in the syphilis group(P＜0.05).Compared with the control group,IFN-γ and IL-12 levels were decreased in the negative conversion group,syphilis group and fixed group,and IL-13 and IL-10 levels were increased(P＜0.05).Compared with the nega-tive conversion group,IFN-γ and IL-12 levels in the syphilis group and fixed group were decreased,while IL-13 and IL-10 levels were increased(P＜0.05).Compared with the fixed group,the levels of IFN-γ and IL-12 in syphilis group were increased,while the levels of IL-13 and IL-10 were decreased(P＜0.05).The mRNA levels of TLR2,TLR4,NF-κB,NLRP3,ASC,Caspase-1 and IL-1β were positively correlated with the levels of IFN-γ and IL-12 in serum fixed patients with syphilis infection(r=0.698,0.602,0.636,0.702,0.645,0.617,0.583 and 0.669,and 0.693,0.641,0.702,0.623,0.618 and 0.647,respectively,all P＜0.05),and negatively correlated with the levels of IL-13 and IL-10(r=-0.639,-0.705,-0.614,-0.590,-0.598,-0.651 and-0.628,and-0.704,-0.649,-0.606,-0.655,-0.650,-0.641 and-0.539,respectively,all P＜0.05).CONCLUSION The NLRP3 inflammasome pathway and TLRs pathway are abnormally expressed in sero-fast patients with syphilis infection,positively correlated with the expression of Th1 cytokines IFN-γ and IL-12,and negatively correlated with the expression of Th2 cytokines IL-13 and IL-10.

The concepts of manifestation-root cause,Yin-Yang balance,reinforcing-reducing for deficiency and excess should not only be focused on the traditional Chinese medicine formulations,but also be consistently applied in clinical practice of acupuncture treatment.The"Tongdu Qishen"acupuncture method,developed by Professor Li Zhigang based on years of experience in treating psychosis,demonstrates unique advantages in treating stroke sequela hemiplegia.From the three aspects of theoretical basis,classic medical records,acupoint selection and operation analysis,this study introduces the clinical application of"Tongdu Qishen"combined with manifestation-root cause Yin-Yang and reinforcing-reducing balance acupuncture in the treatment of stroke sequela hemiplegia,offering new insights and strategies for exploring effective clinical treatment with syndrome differentiation.

Objective:To compare the efficacy of O-arm navigation-assisted and conventional posterior cervical expansive open-door laminoplasty (CEOL) via the intermuscular approach in the treatment of cervical spinal cord injury without fracture-dislocation (CSCIWFD).Methods:A prospective cohort study was conducted to analyze the clinical data of 60 CSCIWFD patients who were admitted to Zhengzhou Orthopedic Hospital from May 2021 to May 2023, with compression at C3-C6. Patients were randomly divided into two groups: 30 patients underwent O-arm navigation-assisted intermuscular approach CEOL (navigation-assisted group) and 30 patients underwent conventional intermuscular approach CEOL (conventional surgery group). Surgical duration, intraoperative blood loss, postoperative drainage volume, and total surgical blood loss were compared between the two groups. At 2 weeks postoperatively, CT scan was performed to evaluate the accuracy of hinge or open-door position preparation of the surgical segments. Visual analogue scale (VAS) for neck and shoulder pain and Japanese Orthopedic Association (JOA) scores were compared between the two groups preoperatively, at 2 weeks, 6 months postoperatively, and at the last follow-up. Complication rates were also evaluated.Results:A total of 60 patients with CSCIWFD were included, comprising 35 males and 25 females, aged 35-77 years [(50.9±8.6)years]. All the patients were followed up for 12-24 months [(16.9±3.1)months]. The surgical duration and intraoperative blood loss were (121.6±17.9)minutes and (144.7±44.2)ml in the navigation-assisted group, shorter or less than (132.3±14.6)minutes and (178.7±48.7)ml in the conventional surgery group ( P<0.05). There were no statistically significant differences in postoperative drainage volume and total surgical blood loss between the two groups ( P>0.05). CT scan reviewed at 2 weeks postoperatively revealed that the accuracy rate of hinge and open-door position preparation of the surgical segments in the navigation-assisted group was 99.2% (119/120), significantly higher than 86.7% (104/120) in the conventional surgery group ( P<0.01). Before operation and at 2 weeks, 6 months postoperatively, and at the last follow-up, the VAS scores for neck and shoulder pain and JOA scores in the navigation-assisted group were 5.0(4.0, 7.0)points and (8.7±2.8)points, 3.0(2.0, 4.0)points and (10.2±2.5)points, 2.0(1.0, 2.0)points and (1 3.0±1.8)points, and 1.0(1.0, 2.0)points and (13.9±1.5)points respectively, while in the conventional surgery group, the VAS scores and JOA scores were 5.5(5.0, 6.3)points and (8.8±2.6)points, 4.0(3.0, 4.0)points and (10.4±2.5)points, 2.0(1.0, 3.0)points and (12.9±2.2)points, and 2.0(1.0, 2.0)points and (13.8±2.0)points ( P>0.05). Both groups showed improvement in neck and shoulder VAS scores and JOA scores at 2 weeks, 6 months postoperatively, and at the last follow-up, compared to preoperative scores ( P<0.05); further improvement was observed at 6 months postoperatively and at the last follow-up compared to that at 2 weeks postoperatively ( P<0.05). There were no significant differences between neck and shoulder VAS scores or JOA scores at 6 months postoperatively and at the last follow-up ( P>0.05). In the navigation-assisted group, 2 patients had axial neck-shoulder pain postoperatively, with a complication rate of 7% (2/30); while in the conventional surgery group, 7 patients had axial neck-shoulder pain and one patient developed cerebrospinal fluid leakage and low-pressure headache, with a complication rate of 27% (8/30) ( P<0.05). Conclusion:Compared to the conventional intermuscular approach, O-arm navigation-assisted intermuscular approach CEOL for CSCIWFD reduces surgical duration and intraoperative blood loss, improves the accuracy of hinge and open-door position preparation, and lowers complication rates.

OBJECTIVE To investigate the expression levels of nucleotide-binding oligomerization domain-like recep-tor pyrin domain-associated protein 3(NLRP3)inflammasome pathway and toll-like receptors(TLRs)pathway in serofast patients with syphilis infection,and their correlation with helper T lymphocytes(Th)1/Th2.METHODS A total of 549 patients with syphilis admitted to Tianjin Chest Hospital and Tianjin Medical University General Hospital from Jan.2021 to Dec.2022 were selected.Among them,62 patients who had not received anti-syphilis treatment were assigned to the syphilis group,238 patients whose serum remained positive after anti-syphilis treatment were selected as the fixed group,249 patients whose serum turned negative after anti-syphilis treatment were selected as the negative conversion group,and another 565 healthy people who underwent medical examina-tion in the hospital during the same period were selected as the control group.TLR2,TLR4,nuclear factor(NF)-κB,NLRP3,apoptosis-associated speck-like protein(ASC),cysteinyl aspartate proteolytic enzyme 1(Caspase-1),in-terleukin(IL)-1β mRNA and interferon-γ(IFN-γ),IL-12,IL-13 and IL-10 levels were compared between each group.Pearson's analysis was used to analyze the correlation between the mRNA expression of TLR2,TLR4,NF-κB,NLRP3,ASC,Caspase-1,and IL-1β and the levels of IFN-γ,IL-12,IL-13,and IL-10 in serologically fixed patients with syphilis.RESULTS Compared with the control group,the mRNA expression of TLR2,TLR4,NF-κB,NLRP3,ASC,Caspase-1 and IL-1β was elevated in the negative conversion and the syphilis groups,and the expres-sion of the above indicators was decreased in the fixed group(P＜0.05).Compared with negative conversion group,mR-NA expressions of TLR2,TLR4,NF-κB,NLRP3,ASC,Caspase-1 and IL-1β were increased in syphilis group,while the expression of the above indicators was decreased in fixed group(P＜0.05).Compared with fixed group,mRNA ex-pressions of TLR2,TLR4,NF-κB,NLRP3,ASC,Caspase-1 and IL-1β in syphilis group were increased in the syphilis group(P＜0.05).Compared with the control group,IFN-γ and IL-12 levels were decreased in the negative conversion group,syphilis group and fixed group,and IL-13 and IL-10 levels were increased(P＜0.05).Compared with the nega-tive conversion group,IFN-γ and IL-12 levels in the syphilis group and fixed group were decreased,while IL-13 and IL-10 levels were increased(P＜0.05).Compared with the fixed group,the levels of IFN-γ and IL-12 in syphilis group were increased,while the levels of IL-13 and IL-10 were decreased(P＜0.05).The mRNA levels of TLR2,TLR4,NF-κB,NLRP3,ASC,Caspase-1 and IL-1β were positively correlated with the levels of IFN-γ and IL-12 in serum fixed patients with syphilis infection(r=0.698,0.602,0.636,0.702,0.645,0.617,0.583 and 0.669,and 0.693,0.641,0.702,0.623,0.618 and 0.647,respectively,all P＜0.05),and negatively correlated with the levels of IL-13 and IL-10(r=-0.639,-0.705,-0.614,-0.590,-0.598,-0.651 and-0.628,and-0.704,-0.649,-0.606,-0.655,-0.650,-0.641 and-0.539,respectively,all P＜0.05).CONCLUSION The NLRP3 inflammasome pathway and TLRs pathway are abnormally expressed in sero-fast patients with syphilis infection,positively correlated with the expression of Th1 cytokines IFN-γ and IL-12,and negatively correlated with the expression of Th2 cytokines IL-13 and IL-10.

Background and purpose:In recent years,deep inspiration breath hold(DIBH)based on surface-guided radiation therapy(SGRT)has emerged as one of the most promising techniques in breast cancer radiotherapy.Conventionally,cone-beam CT(CBCT)is used before treatment to verify and correct patient positioning deviations.However,patient position may change during treatment,and pre-fraction CBCT cannot fully reflect real-time positional deviations.Therefore,this study aimed to introduce intra-fraction CBCT into left-sided breast DIBH radiotherapy to monitor and correct real-time deviations,verify whether patients achieve the desired position during treatment,and evaluate the clinical value of intra-fraction CBCT in left-breast radiotherapy.Methods:Clinical data from postoperative left-sided breast cancer patients treated at Fudan University Shanghai Cancer Center between June 2023 and January 2024 were collected.Patients with satisfactory cardiopulmonary function and stable DIBH compliance were included.Pre-fraction CBCT scans were performed before treatment,and data were recorded.During treatment,the gantry was rotated to-180° to trigger kV-level intra-fraction CBCT scanning.After gantry repositioning to the starting angle of the tangential field,MV beam delivery commenced.Intra-fraction CBCT scans were acquired for positional registration,and deviations were compared with pre-fraction CBCT results.Results:A total of 30 eligible patients were included,with 150 pairs of pre-fraction and intra-fraction CBCT images analyzed per patient.The mean registration deviations for intra-fraction CBCT were 26%,52%,and 51%lower than pre-fraction CBCT in the X,Y,and Z axes,respectively(P＜0.05),demonstrating significantly reduced real-time deviations.The probability of intra-fraction deviations being＜6 mm was 100.0%,100.0%,and 99.3%for the X,Y,and Z axes,respectively.Correlation analysis revealed a weak correlation between intra-fraction and pre-fraction deviations in the X-axis(P＜0.05),while no significant correlation was observed for the Y and Z axes(P＞0.05).Conclusion:Intra-fraction CBCT effectively monitors and corrects real-time positional deviations in left-sided breast DIBH radiotherapy,serving as a valuable supplement to conventional pre-fraction CBCT.It minimally impacts treatment efficiency while significantly improving positional accuracy,offering clinical and practical benefits for left-breast cancer radiotherapy.