Radiochemotherapy-induced oral mucositis (OM) is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy. Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment. To date, differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties, which has increased the uncertainty of treatment effects. On the basis of current research evidence, this expert consensus outlines risk factors, clinical manifestations, clinical grading, ancillary examinations, diagnostic basis, prevention and treatment strategies and efficacy indicators for OM. In addition to strategies such as basic oral care, anti-inflammatory and analgesic agents, anti-infective agents, pro-healing agents, and photobiotherapy recommended in previous guidelines, we also emphasize the role of traditional Chinese medicine in OM prevention and treatment. This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention, diagnosis, and treatment, standardizing clinical practice, reducing OM occurrence, promoting healing, and improving the quality of life of patients.
Humans ; Chemoradiotherapy/adverse effects* ; Consensus ; Risk Factors ; Stomatitis/etiology*

OBJECTIVE: This study aimed to explore the association between humidity exposure and the risk of cardiovascular disease (CVD), utilizing follow-up data and relative humidity (RH) metric assessments. METHODS: We extracted the baseline data from the China Hypertension Survey (CHS) of 24,510 enrolled participants aged ≥ 35 years without a history of CVD between 2012 and 2015 and followed them up from 2018 to 2019. The National Meteorological Information Center (NMIC) of the China Meteorological Administration (CMA) provided the quality-controlled relative humidity (RH) datasets. Cox proportional hazards models were used to estimate hazard ratios ( HRs) for CVD in relation to RH. RESULTS: During the follow-up period (2018-2019), 973 patients with CVD were identified. The HR of CVD risk was 1.17 (95% CI: 1.04-1.31) per 10% increase in summer mean RH. Compared with participants in the 3 ^rd quintile group, those in the 1 ^st and 5 ^th quintiles of RH had a higher risk of CVD. For summer mean RH, the HRs (95% CIs) for the 1 ^st and 5 ^th quintiles were 1.34 (1.04-1.71) and 1.44 (1.14-1.83), respectively. The relationship ("U" shape) between summer mean RH and the risk of CVD was nonlinear. Stratified analyses indicated that the risk of CVD was substantially influenced by the summer mean RH in female, older individuals, and those in southern China. CONCLUSION Unsuitable (too high or low) humidity environments affect the risk of CVD. Our study highlights those future policies for adapting to climate change should consider the humidity-CVD relationship.
Humans ; Humidity/adverse effects* ; Cardiovascular Diseases/etiology* ; Female ; Male ; Middle Aged ; Prospective Studies ; China/epidemiology* ; Adult ; Aged ; Risk Factors ; Proportional Hazards Models ; Seasons

Objective:To reconstruct the dose of nasopharyngeal carcinoma and verify the results of the whole-process radiotherapy plan based on log files and cone beam CT (CBCT).Methods:A total of 15 patients with nasopharyngeal carcinoma who received volumetric modulated arc therapy (VMAT) with Halcyon accelerator in the Cancer Center of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from February to September 2022 were retrospectively selected. Log files and CBCT for all fractionated radiotherapy were recorded. The errors of monitor unit (MU), gantry angle, and multi-leaf collimator (MLC) leaf position per control point were analyzed. The adaptive CT (aCT) were generated according to CBCT and planned CT (pCT) using a commercial software Velocity TM, and the similarities among aCT, pCT and CBCT were analyzed. The original plan was modified from the log files and imported into the treatment planning system to calculate the delivered dose on the corresponding fractionated aCT to reconstruct the fractionated dose. And all the reconstructed doses were mapped back to pCT to obtain the cumulative dose. Theγpass ratios with criteria of 2 mm/2% and 2 mm/3% and the dose differences between the planned dose and the cumulative dose in the planning target volume (PTV) and organs at risk (OAR) were compared. Results:The root mean square (RMS) and the 95th percentile of the errors of MU, gantry angle and MLC leaf position errors were within an acceptable range. The aCT generated by Velocity TM had the anatomical structure of CBCT and the resolution, contrast, noise characteristics of pCT, which could be directly used for dose calculation. Compared with the planned dose, the changes of V 70 Gy of nasopharyngeal primary tumor (PTV nx), V 68 Gy of cervical glands (PTV nd) and V 60 Gy of planning target volume (PTV1) were -0.88%±1.91%, -2.99%±2.99% and -0.63%±0.93%, respectively, and V 40 Gy of parotid gland was increased to 2.65%±2.63%. Cumulative dose showed different degrees of PTV dose decrease ( P<0.05) and parotid dose was increased ( P<0.05). The γ pass ratio (2 mm/3%) between the cumulative dose and planned dose was 97.3%±2.7% and >95.0% in 86.7% of patients. Conclusions:Based on the log files and CBCT, the whole-process dose reconstruction of nasopharyngeal carcinoma patients can be carried out. According to the results of dose reconstruction, the radiotherapy effect of the target area and OAR can be quantitatively evaluated. In the case of high dose coverage and conformity of the original plan, the reconstruction results show that the cumulative dose coverage of the target area is decreased, whereas that of the parotid gland is increased.

A 70﹣year﹣old female patient received chemotherapy regimen of pemetrexed combined with cisplatin for metastatic non﹣small﹣cell lung cancer. After 2 cycles of chemotherapy,the tumor partly relieved,but the patient developed grade II leukopenia and serum creatinine elevation. Renal injury was considered to be caused by cisplatin. Therefore,cisplatin was discontinued in the third cycle and pemetrexed monotherapy was given. On day 10 of the chemotherapy,the patient developed fever and laboratory tests revealed pancytopenia,white blood cell count( WBC)1. 1 ×109/L,neutrophil count 0. 54 ×109/L, platelet count(PLT)63×109/L,hemoglobin(Hb)72 g/L,and red blood cell count(RBC)2. 23×1012/L. The patient received symptomatic and supportive treatments such as platelet and erythrocyte suspension infusion,and granulocyte colony stimulating factor subcutaneous injection,but her complete blood count continued to decline,with WBC 0. 2×109/L,neutrophil 0. 13×109/L,PLT 0×109/L,Hb 59 g/L,and RBC 1. 88×1012/L. Ⅳmyelosuppression induced by pemetrexed was diagnosed. Calcium folinate was given for rescue therapy(the first dose was 100 mg/m2 ,then 50 mg/m2 every 6 hours for 4 days). After 23 days of calcium folinate treatment,the laboratory tests showed WBC 6. 8×109/L,neutrophil 3. 84×109/L,PLT 169×109/L,Hb 95 g/L,and RBC 2. 99×1012/L.

A 70﹣year﹣old female patient received chemotherapy regimen of pemetrexed combined with cisplatin for metastatic non﹣small﹣cell lung cancer. After 2 cycles of chemotherapy,the tumor partly relieved,but the patient developed grade II leukopenia and serum creatinine elevation. Renal injury was considered to be caused by cisplatin. Therefore,cisplatin was discontinued in the third cycle and pemetrexed monotherapy was given. On day 10 of the chemotherapy,the patient developed fever and laboratory tests revealed pancytopenia,white blood cell count( WBC)1. 1 ×109/L,neutrophil count 0. 54 ×109/L, platelet count(PLT)63×109/L,hemoglobin(Hb)72 g/L,and red blood cell count(RBC)2. 23×1012/L. The patient received symptomatic and supportive treatments such as platelet and erythrocyte suspension infusion,and granulocyte colony stimulating factor subcutaneous injection,but her complete blood count continued to decline,with WBC 0. 2×109/L,neutrophil 0. 13×109/L,PLT 0×109/L,Hb 59 g/L,and RBC 1. 88×1012/L. Ⅳmyelosuppression induced by pemetrexed was diagnosed. Calcium folinate was given for rescue therapy(the first dose was 100 mg/m2 ,then 50 mg/m2 every 6 hours for 4 days). After 23 days of calcium folinate treatment,the laboratory tests showed WBC 6. 8×109/L,neutrophil 3. 84×109/L,PLT 169×109/L,Hb 95 g/L,and RBC 2. 99×1012/L.

Objective To evaluate the effect of the discrepancy of the dose calculation results of different algorithms upon the CyberKnife lung tumor treatment plan,and assess the impact of tumor volume and location on the dose calculation results. Methods Thirty-two cases of lung tumors were treated with MultiPlan 5.2.1 planning system of CyberKnife VSI.Ray Tracing and Monte Carlo algorithms were adopted to calculate the dose distribution, and then the calculation results were statistically compared between two algorithms. Results For the enrolled cases,the calculation results of these two algorithms demonstrated that the deviation range of prescription dose coverage of planning target volume (PTV),conformal index,new conformal index and uniformity index were 0.93%~68. 80%, 0.87%~17. 21%,-212.38%~8. 27% and 0%~15. 17%, respectively. Conclusions In the CyberKnife treatment of lung tumors, the volume and location of tumors exert significant impact on the discrepancies of the dose calculation results of different algorithms. The smaller tumor volume and longer beam heterogeneity path are likely to generate a greater discrepancy. It is recommended to adopt or refer to the calculation results of Monte Carlo algorithm to deliver corresponding treatment.

AIM: To investigate the changes of corneal biomechanical indexes after femtosecond laser-assisted in situ keratomileusis ( LASIK ) , so as to provide theoretical basis for the safety study of femtosecond laser LASIK.?METHODS: Totally 85 myopia patients ( 170 eyes ) treated in our hospital from June 2014 to June 2016 were selected and underwent femtosecond laser LASIK surgery. The medical records of patients met the inclusion criteria were retrospectively analyzed. Corneal compensated intraocular pressure ( IOPcc ) and corneal resistance factor ( CRF ) , corneal hysteresis ( CH ) and Goldmann correlated to IOP value ( IOPg ) before operation, and at 3 and 6mo after surgery were measured by the ocular response analyzer, and central corneal thickness was measured by A type ultrasonic measuring instrument.?RESULTS:At postoperative 3 and 6mo, central corneal thickness was sharply lower than that before surgery, with a statistical significance ( P<0. 05 ); postoperative IOPcc, CRF, CH, IOPg and other corneal biomechanical parameters decreased distinctively, with statistical meaning ( P<0. 05 ); data at postoperative 3 and 6mo showed no evident differences ( P>0. 05 ); the cornea cutting thickness was 98. 67 ± 7. 56μm, CH and CRF variation were 3. 40 ± 0. 34mmHg, 3. 55 ± 0. 43mmHg respectively, the cornea cutting thickness was positively correlated with CH, CRF variation ( r=0. 232, 0. 254; P<0. 001).? CONCLUSION: Femtosecond laser LASIK can apparently reduce corneal thickness as well as the corneal biomechanical indexes, the data at postoperative 3mo tends to be stable.

·AIM:To investigate the therapeutic effect of intravitreal injection of Ranibizumab combined with laser for diabetic macular edema (DME). ·METHODS: Totally 60 cases (60 eyes) of DME patients treated in ophthalmology department of our hospital from June 2014 to June 2016 were selected and divided into the observation group and the control group. The control group were treated with laser therapy, and the observation group received intravitreal injection of ranibizumab on the basis of the treatment of the control group. Comparison between two groups on the best corrected visual acuity before operation and at 1wk,1,3, 6mo after operation was taken. The non - contact tonometer was used to measure intraocular pressure before and after treatment. The optical coherence tomography(OCT) was conducted to assess preoperative and postoperative central macular thickness (CMT).The postoperative complications of two groups were recorded subsequently. ·RESULTS: The two groups' postoperative visual acuity was significantly improved,data of the observation group at 1,3mo after operation was sharply higher than that of the control group, there was statistical significance (P<0.05), and data at 1wk, 6mo after operation had no evident difference (P>0.05). After 1wk of treatment, the two groups'intraocular pressure increased,with statistical significance (P<0.05);there was no significant difference between the two groups on intraocular pressure before treatment and at 1,3,6mo after treatment(P>0.05). The postoperative CMT of two groups significantly decreased, data of the observation group at 1, 3mo after treatment was evidently lower than that of the control group, there was statistical significance (P<0. 05), and data before treatment, at 1wk, 6mo after treatment showed no significant difference(P>0.05). In the observation group, 5 cases (5 eyes) recurred within 6mo,the recurrence rate was 17%. In the control group, 10 cases (10 eyes) relapsed,the recurrence rate was 33%,the difference was statistically significant (P<0.05). At postoperatively 2d, 2 cases(2 eyes) of the observation group and 3 cases (3 eyes) of the control group had high intraocular pressure, and then returned to normal by given the carteolol eye drops. ·CONCLUSION: Compared with laser therapy alone, intravitreal injection of ranibizumab combined with laser therapy has a significant and safe short-term treatment effective for DME patients with a fast visual acuity recovery.

Objective To conduct a computer simulation to evaluate the discrepancy between the cumulative doses calculated by four-dimensional computed tomography (4DCT) images and 4DCT scans (for real-time respiratory motions) due to the patient's irregular breathing.Methods A series of digital phantoms were generated from a patient's 4DCT images to simulate 4DCT images and 4DCT scans (for real-time respiratory motions) resulting from various irregular breathing curves.A six-field intensity-modulated radiotherapy plan was generated.Two cumulative doses in the target were calculated.The first one, named Dall, was calculated by tracking the point displacements in the target manifested on the 4DCT images;the second one, named D4D, was calculated based on the point displacements along the whole breathing motion during 4DCT scanning.Dose discrepancy between D4D and Dall was calculated to evaluate the correlation between breathing pattern and dose discrepancy in the target.Results The dose discrepancy in the target was correlated with mean motion excursion and the standard deviation of motion excursion.ΔDmin(ΔD99) in the target increased from 2.39%(2.04%) to 11.91%(5.24%) as the mean motion excursion increased from 5 mm to 15 mm, and increased from 5.93%(2.15%) to 14.65%(5.01%) as the standard deviation of motion excursion increased from 15% to 45% of the mean motion excursion.When the mean period increased from 3 s to 5 s or the standard deviation of period increased from 10% to 40% of the mean period,ΔDmin(ΔD99) in the target was greater than 6.0%(2.0%), but less than 9.0%(3.0%).When the target diameter was 2 cm, 3 cm, and 4 cm,ΔDminΔD99) in the target was 11.88%(5.50%), 6.91%(2.42%), and 7.53%(3.62%), respectively.Conclusions There is a large discrepancy between the cumulative doses calculated using 4DCT images and 4DCT scans (for real-time respiratory motions) when the patient has irregular breathing.This dose discrepancy depends on mean motion excursion and the standard deviation of motion excursion, but has little relationship with mean period, the standard deviation of period, and tumor volume.

AIM: To investigate curative effects of excimer laser corneal refractive surgery for adults or older adolescent with hyperopic anisometropic amblyopia.METHODS: From March 2014 to March 2016, we selected 26 cases 26 eyes of adults or older adolescent with hyperopic anisometropic amblyopia in our hospital.All eyes underwent laser in situ keratomileusis, observed for the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), diopter and stereopsis.RESULTS: At the end of the follow-up, the patient`s spherical equivalent and anisometropia were 1.47±0.51D and 1.15±0.22D, were significantly lower than that before operation (P<0.05).At the end of the follow-up, the distance and near UCVA and BCVA were 0.26±0.13 and 0.23±0.09, 0.42±0.09 and 0.31±0.16, which were significantly higher than those before operation (P<0.05).At the end of follow-up, the visual function of the patients was significantly improved (P<0.05), the rate of postoperative visual function < 100 eyes was 23%.CONCLUSION: In adult or older adolescent with hyperopic anisometropic amblyopia, excimer laser corneal refractive surgery has a certain effect.