Objective To investigate the effect of field angle on the results of in vivo dose validation of electronic portal imaging device(EPID)in patients.Methods Design the mold test and analyze the influence of different mold thicknesses and different frame angles on the 2D γ pass rate.Twenty-three patients who un-derwent radiotherapy in the Department of Radiotherapy of Jinhua Municipal Central Hospital from January to June 2023 were selected as the research object.In vivo dose verification was carried out during treatment to obtain 2D γ pass rate using same-day sector beam CT(FBCT)of planned CT and executive image guided(IG-RT)as reference images,and the influence of field angle on pass rate was analyzed.Results When the frame angle was unchanged,the area of the shooting field was larger than 17 cm×17 cm,and the 2D γ passing rate decreased with the increase of the thickness.The frame angle had no effect on the 2D γ pass rate when the mold thickness was constant.In clinical treatment data,the passage rate of 2D γ near 0°/180° was higher than that near 90°/270°(P＜0.05),and the passage rate near 90°/270° in the FBCT group was higher than that in the IGRT group(P＜0.05).The median passing rate of 3 mm 2D γ was 97.97％in 3％of the 23 patients.The non-IGRT group was 96.81％,the IGRT group was 97.89％,the FBCT group was 98.94％.There was a statistically significant difference in 2D γ passing rate between the non-IGRT group and the IGRT group(Z=-5.083,P＜0.05),and there was a statistically significant difference in 2D γ passing rate between the IGRT group and the FBCT group(Z=-10.657,P＜0.05).Conclusion Clinically,the difference of pass rate in vi-vo dose verification at different rack angles is mainly due to the difference of images within and between ses-sions.Using same-day FBCT as the reference image for in-vivo dose verification can improve the accuracy of pass rate and eliminate the influence of image difference between sessions.

Objective To analyze the mutation status of Kirsten rat sarcoma viral oncogene homolog(KRAS),phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha(PIK3CA),v-raf murine sarcoma viral oncogene homolog B1(BRAF)genes,and the expression of mismatch repair(MMR)and human epidermal growth factor receptor 2(HER-2)proteins in tumor tissues of patients with colorectal cancer(CRC)harboring neuroblastoma rat sarcoma viral oncogene homolog(NRAS)gene mutations,and explore their relationships with the clinicopathological characteristics of CRC patients.Methods The clinicopathological data of 546 patients with NRAS mutation CRC were retrospectively analyzed.The mutation status of NRAS,KRAS,PIK3CA,and BRAF genes was detected by AmoyDx amplification refractory mutation system(ARMS)-polymerase chain reaction(PCR)kit(fluorescent PCR method),the expression levels of MMR and HER-2 proteins were detected by immunohistochemical staining EnVision method,and the relationship between them and the clinicopathological characteristics of patients were analyzed.Results The mutation rate of single-point mutations in the NRAS gene was 98.35%(537/546),double-point mutations in the NRAS gene were 1.65%(9/546),and double mutations in the NRAS and KRAS genes were 1.47%(8/546).No patients were found to harbor mutations in the PIK3CA or BRAF genes.The types of NRAS mutations included Q61R(or Q61K,Q61L,Q61H)mutations(266/546,48.72%),G12D(or G12S)mutations(154/546,28.21%),G13R(or G12C,G12V,G12A,G13V)mutations(134/546,24.54%),and A146T mutation(1/546,0.18%).G13R(or G12C,G12V,G12A,G13V)mutations in the NRAS gene were more likely to occur in the rectum cancer patients(P=0.035);although the tumors had a larger diameter(P=0.029),the patients had a longer progression-free survival after surgery(P=0.028).Among patients with NRAS gene mutations,HER-2 positive expression was associated with perineural invasion(P=0.003),and the patients with deficient MMR were younger on average(P=0.041)and were associated with double-point mutations in the NRAS gene(P=0.018).Conclusion CRC harboring NRAS mutations may have unique clinicopathological characteristics and molecular phenotypes,providing possibilities for individualized treatment and prognosis evaluation of CRC.

Objective To analyze the quantity,quality,and research layout of medical scientific papers(in Chinese)published by various regions,hospitals,and institutions in Inner Mongolia Autonomous Region from 2018 to 2022,in order to understand the overall scientific and technological level of our region,providing an overview of support for medical scientific research in the entire region and provi-ding references for the rational layout of medical scientific and technological development.Methods From July to August 2023,Chinese National Knowledge Infrastructure(CNKI)was used as the data source to systematically retrieve Chinese medical literature related to Inner Mongolia Autonomous Region from 2018 to 2022.Bibliometric methods were applied to analyze the quantity and quality of literature,as well as regional and institutional distribution.Results From 2018 to 2022,there were 5 273 articles published in core journals in Inner Mongo-lia,accounting for 30.96%of the total.Among them,1095 articles(20.77%)were indexed in CSCD,1 567 articles(29.72%)in Peking University Core Journals,and5164 articles(97.93%)in Science and Technology Core Journals.The journal with the highest publication volume among the top10 core journals was"Journal of Inner Mongolia Medical University,"accounting for20.77%.The top three regions in terms of total output of core journal articles were Hohhot,Baotou,and Chifeng,while Xing'an League and Alxa League had very few pub-lications.Among different levels of hospitals,tertiary hospitals had much higher publication volumes than primary and secondary hospitals.Among different types of institutions,medical institutions had higher publication volumes than higher education institutions.The top three in-stitutions in terms of publication volumes in core journals were Affiliated Hospital of Inner Mongolia Medical University,Inner Mongolia Med-ical University,and Inner Mongolia People's Hospital.Conclusion The number of core journals in Inner Mongolia needs to be increased,and the quantity of research output varies among regions.It is necessary to strengthen scientific research management systems,improve the level of research achievements,and promote scientific and technological innovation in Inner Mongolia.

Objective:To investigate the association of malnutrition based on Global Leadership Initiative on Malnutrition (GLIM) criteria with the disease activity and clinical outcomes in hospitalized ulcerative colitis (UC) patients.Methods:Clinical data of 115 patients with UC hospitalized in the Affiliated Hospital of Qingdao University from September 2019 to March 2023 were prospectively analyzed. GLIM and European Society for Clinical Nutrition and Metabolism (ESPEN) 2015 criteria were used for the diagnosis of malnutrition, allowing the analysis of consistency between two diagnostic criteria for malnutrition. The relationship between malnutrition based on GLIM criteria and disease activity and clinical outcome was further investigated. The risk factors of adverse clinical outcomes in UC patients were analyzed using binary logistic regression.Results:GLIM and ESPEN 2015 diagnostic criteria showed high correlation and consistency (AUC=0.875, P<0.001; K=0.809, P<0.001). According to GLIM criteria, the prevalence of malnutrition among hospitalized UC patients was 32.17% (37 cases). Compared with non-malnourished UC patients, the modified Mayo score and C-reactive protein level of malnutrition patients were higher ( P<0.005), and the proportion of patients with severe disease activity was higher ( P=0.005). UC patients in the malnourished group had longer hospital stay ( P<0.001), higher hospitalization costs ( P<0.001), and higher rates of drug escalation/conversion therapy, re-admission and surgery at 12 weeks and 54 weeks ( P<0.05). Binary logistic regression analysis showed that a high Mayo score ( OR=3.606, P=0.016), a high modified Mayo score ( OR=1.346, P=0.009) and malnutrition ( OR=1.430, P=0.012) were independent risk factors for adverse clinical outcomes of hospitalized UC patients at 12 weeks. A high modified Mayo score ( OR=6.491, P=0.011) and malnutrition as per GLIM criteria ( OR=6.693, P=0.033) were independent risk factors for adverse clinical outcomes of hospitalized UC patients at 54 weeks. Conclusions:GLIM and ESPEN 2015 diagnostic criteria show high consistency in the diagnosis of malnutrition in hospitalized UC inpatients. Malnutrition may imply adverse clinical outcomes of hospitalized UC patients, which is an independent risk factor for the adverse clinical outcome of hospitalized UC patients.

Objective:To investigate the factors affecting the accuracy of electronic portal imaging device (EPID)-based in vivo dose verification in radiotherapy for patients with lung and esophageal cancers, and to recommend the workflow and specifications for the application of the in vivo dose verification. Methods:This study randomly selected 32 patients who received radiotherapy for esophageal and lung cancers at the Department of Radiation Oncology, Jinhua Municipal Central Hospital from May to August 2022, including 14 lung cancer cases and 18 esophageal cancer cases. Using a uRT-linac 506c linear accelerator, these patients were treated according to the dynamic intensity-modulated radiotherapy (dIMRT) and EPID-based In vivo dose verification ( In vivo EPID) plans developed with the uRT-TPOIS planning system. The In vivo dose verification performed during the treatment included 238 fractions of In vivo EPID and 80 fractions of image-guided radiotherapy (IGRT) for the lung cancer cases, as well as 414 fractions of In vivo EPID and 105 fractions of IGRT for the esophageal cancer cases. The 2D γ passing rate for each irradiation field was obtained according to the set threshold value. Furthermore, fractioned irradiation fields with γ-passing rates below the threshold value were analyzed, and primary factors decreasing the γ-passing rate were further analyzed by combining the online CT images and 3D reconstruction-derived dose. Results:For lung and esophageal cancers, the mean γ-passing rates were 95.1% ± 5.7% and 96.5% ± 4.5%, respectively at 3 mm/5%; 91.5% ± 8.4% and 92.2% ± 4.9%, respectively at 3 mm/3%, and 79.1% ± 14.7% and 83.7% ± 8.2%, respectively at 2 mm/2%, indicating no statistically significant differences between two cancers ( P > 0.05). The average γ passing rate for beam orientations near 0°/180° (Group A) was higher than those near 90°/270° (Group B) 3 mm/5%: Z = -25.4, P < 0.05; 3 mm/3%: Z = -26.8, P < 0.05). The IGRT correction of setup errors significantly improved the γ passing rates (96.3% ± 5.1% and 96.4% ± 4.9%, respectively at 3 mm/5%, Z = -5.50, P < 0.05; 92.3% ± 8.0% and 91.3% ± 7.7%, respectively at 3 mm/3%, Z = -9.54, P < 0.05). The results of In vivo dose verification were affected by changes in the volumes and motion of tumors and normal tissues, radiotherapy positioning, and adequacy of pre-treatment preparation. Conclusions:EPID-based In vivo dose verification during radiotherapy can avoid incorrect irradiation. However, it is necessary to standardize the workflow of the EPID-based In vivo dose verification to avoid the decrease in the γ passing rate caused by artificial factors.

Objective:To investigate the value of a nomogram predicting the outcome of intracerebral hemorrhage (ICH) based on clinical characteristics and diffusion-weighted imaging (DWI) of hyperintense lesions.Methods:A case-control study. Consecutive patients, aged 30-88(59±13) years old, with ICH were recruited at the Stroke Center of Zhengzhou People′s Hospital from January 2018 to August 2021. Patients were divided into a group with DWI lesions and a group without DWI lesions depending on whether there were DWI hyperintense lesions distant from the hematoma. Prognosis was evaluated at 90 days via the modified Rankin Scale (mRS). Univariate and multivariable logistic regression models were used to identify independent predictors of a poor ICH outcome (mRS score≥4), and a nomogram model was developed. The performance of the nomogram was validated via the area under the receiver operating characteristic curve (AUC) and a calibration chart.Results:Of the 303 patients included in the study, 24.8% presented with DWI lesions; 17.5% with asymptomatic DWI lesions and 7.3% with symptomatic DWI lesions. Poor outcomes were significantly more frequent in the group with DWI lesions than in the group without DWI lesions ( χ2=21.32, P<0.001). In multivariable regression analysis, age [odds ratio ( OR)=1.032, 95% confidence interval ( CI) 1.002-1.063, P=0.035], hematoma volume ( OR=1.050, 95% CI 1.011-1.090, P=0.012), hematoma location ( OR=3.839, 95% CI 1.248-11.805, P=0.019), DWI lesions ( OR=3.955, 95% CI 1.906-8.206, P<0.001), and baseline NIHSS scores ( OR=1.102, 95% CI 1.038-1.170, P=0.001) were independent predictors of a poor outcome. In subgroup analysis patients with asymptomatic DWI lesions had a 3-fold greater risk of a poor outcome compared to those without DWI lesions ( OR=3.135, 95% CI 1.382-7.112, P=0.006), and patients with symptomatic DWI lesions had a 7-fold greater risk of a poor outcome compared to those without DWI lesions ( OR=7.126, 95% CI 2.279-22.277, P=0.001). A nomogram model was established based on the independent predictors for a poor outcome. The AUC of the nomogram was 0.846 (95% CI 0.795-0.898), and a calibration chart indicated good consistency between values predicted by the nomogram and actual observed values. Conclusions:DWI lesions are an independent risk factor for a poor outcome in patients with ICH-particularly symptomatic DWI lesions. A nomogram model based on clinical characteristics and DWI lesions exhibited good efficacy when predicting the outcome of ICH.

With the development of medical technology, the fixation method of the oral duct is constantly updated, and the selection of a relatively safe, effective, simple and fast fixation method of the oral duct has been widely concerned. However, the use of traditional 3M I-shaped tape fixation needs to be cut, which wastes time and easily leads to the outward displacement of the tracheal tube, and is easy to be soaked by oral secretions, resulting in facial skin damage. Therefore, the medical staffs of the department of critical care medicine of Hengshui People's Hospital designed a self-made tracheal catheter fixing band (composed of the main structure, the fixed band, the internal adjusting structure and the internal structure of the fixed block), and obtained the national utility model patent (ZL 2018 2 0508681.6). The inner side of the fixing band is fixed with a spongy body, which can absorb the secretions around the mouth to avoid the moist condition around the mouth and cheek skin. Meanwhile, the endotracheal catheter is fixed with the help of the card slot, hinge and other structures, which can fully ensure the fixation effect. A total of 80 patients undergoing airway intubation were admitted to the department of critical care medicine of our hospital from October 2020 to September 2021. They were divided into observation group and control group according to intubation time (single number and double number), with 40 patients in each group. The observation group was fixed with self-made tracheal catheter fixation band. Through evidence-based practice path, relevant literatures at home and abroad were searched for clinical practice basis, and the practice plan was formulated and implemented. The control group was fixed with 3M tape + inch tape according to the traditional method. The fixation of tracheal tube and the degree of facial skin injury were compared between the two groups. All patients were included in the final analysis without shedding cases. Severe catheter displacement occurred in 3 patients (7.5%) in the control group, and no severe catheter displacement occurred in the observation group. The incidence of facial skin injury in the observation group was significantly lower than that in the control group [25.0% (10/40) vs. 55.0% (22/40), P < 0.05]. Moreover, the fixation time of the observation group was significantly shorter than that of the control group (minute: 12.11±1.69 vs 17.59±1.27, P < 0.05). The application of self-made tracheal catheter fixation band can shorten the fixation time of tracheal catheter and reduce the incidence of unplanned endotracheal extubation (UEE) and facial skin injury, which is worthy of clinical promotion and application.

Objective:To explore the mechanism underlying microRNA (miR) -125a-mediated inhibition of proliferation of keratinocytes.Methods:After 24-hour pretreatment with interleukin (IL) -23, human HaCaT keratinocytes were divided into miR-125a group and miR-NC group transfected with a miR-125a overexpression plasmid and a control plasmid, respectively. Cell counting kit-8 (CCK8) assay was performed to evaluate the proliferative ability of HaCaT cells in the two groups at 0, 24, 48 and 72 hours after transfection, real-time fluorescence-based quantitative PCR to determine the mRNA expression of miR-125a and IL-23 receptors (IL-23R) in the two groups 24 hours after transfection, and Western blot analysis to determine the protein expression of IL-23R, Janus kinase 2 (JAK2) , protein kinase B (AKT) and phosphorylated AKT (p-AKT) in the two groups 48 hours after transfection. Dual-luciferase reporter assay was performed to verify the targeting relationship between miR-125a and IL-23R. Comparison of means between two groups was carried out by using t test, and changes in the proliferative ability of HaCaT cells over time were evaluated by using repeated measures analysis of variance. Results:After plasmid transfection, the relative expression of miR-125a was significantly higher in the miR-125a group (6.377 ± 0.745) than in the miR-NC group (0.700 ± 0.222; t=7.305, P=0.002) . At 0, 24 and 48 hours after transfection, there was no significant difference in cellular proliferative ability between the miR-125a group and the miR-NC group ( t=0.663, 0.623 and 1.930, respectively, all P > 0.05) ; at 72 hours after transfection, the cellular proliferative ability was significantly lower in the miR-125a group than in the miR-NC group ( t=4.407, P < 0.05) . The IL-23R mRNA expression was significantly lower in the miR-125a group than in the miR-NC group ( t=3.082, P < 0.05) . Compared with the miR-NC group, the miR-125a group showed significantly decreased protein expression of IL-23R, JAK2 and p-AKT ( t=11.715, 6.996, 12.424, P < 0.001,=0.002, < 0.001, respectively) . Dual-luciferase reporter assay showed targeted binding of miR-125a to IL-23R. Conclusion:MiR-125a may inhibit the proliferation of keratinocytes by negatively regulating the IL-23R/JAK2/AKT signaling pathway.

Objective:To explore the enhancement effect of different concentrations of contrast media on blood vessels and hollow organs in CT enterography.Methods:Sixty patients with CT enterography were enrolled from January to August 2019 at Shanghai Ninth People's Hospital, and were prospectively randomly divided into three groups (group A: 90 ml 400 mg/ml contrast media, group B: 90 ml 350 mg/ml contrast media, and group C: 79 ml 400 mg/ml contrast media). Evaluation parameters included CT value, signal noise ratio (SNR) and contrast noise ratio (CNR) of main abdominal vessels (abdominal aorta, superior and inferior mesenteric atery, jejunal artery, ileum artery, superior and inferior mesenteric vein), jejunum, ileum and inflammatory bowel disease. The overall image quality and direct jejunum ileum artery quality scores were evaluated. One-way ANOVA was used to compare the parameters among the three groups.Results:There was no statistical difference in CT value, SNR and CNR of each measurement index among the three groups in plain scan ( P>0.05). The CT value, SNR and CNR of abdominal aorta, superior mesenteric artery, inferior mesenteric artery, jejunal artery and ileal artery in group A and C were higher than those in group B in arterial phase ( P<0.05), but there was no significant difference between group A and group C ( P>0.05). The CT value, SNR and CNR of superior mesenteric vein, inferior mesenteric vein, normal jejunum, ileum and inflammatory lesions in group A were higher than those in group B and C in venous phase ( P<0.05), but there was no significant difference between group B and group C ( P>0.05). The overall image quality scores of group A, B and C were (3.8±0.7), (3.4±0.6), (3.4±0.6), respectively, with no significant difference ( F=3.075, P=0.054). The direct jejunum ileum artery scores of the three groups were (3.5±0.5), (3.1±0.5), (3.4±0.5), respectively, the difference was statistically significant ( F=3.684, P=0.031). Conclusion:At the same injection rate and scanning parameters, contrast media at 400 mg/ml can provide better vessel and hollow organ enhancement.

Objective:To explore the exfoliative value of multi-slice CT (MSCT) on conversion therapy of gastric cancer patients with positive evaluation cytology (P 0CY 1) . Methods:A total of 36 P 0CY 1 gastric cancer patients receiving conversion therapy in a prospective, single-center, phase Ⅱ clinical trial were enrolled. MSCT examinations were performed before and after conversion therapy. Its solid tumor efficacy evaluation criteria (response evaluation criteria in solid tumors, Recist) 1.1 score and tumor volume reduction rate were evaluated. The Spearman correlation test was used to analyze the correlation between Recist 1.1 score and tumor volume reduction rate and the results of conversion therapy. The ROC curve was used to determine the defined value of the volume reduction rate to identify the effectiveness of conversion therapy, and formulate new grading standards. Results:According to the conversion of free cancer cells in the abdominal cavity , 15 of 36 patients had successful conversion therapy and 21 had failed. The rate of tumor volume reduction in the successful and failed conversion groups was 44.38%±37.86% and -54.96%±156.92%, respectively( P=0.016). The Recist 1.1 score was moderate correlated with the results of conversion therapy ( R=0.540, P=0.001), and the rate of tumor volume reduction was significantly correlated with the results of conversion therapy ( R=0.657, P<0.001). When the tumor volume reduction rate of 26.27% was used as the effective threshold for evaluating conversion therapy, the AUC under the ROC curve was the largest, and the sensitivity and specificity were 80.0% and 85.7%, respectively. Conclusion:Both the MSCT-measured Recist 1.1 score and the tumor volume reduction rate can be used to evaluate the efficacy of conversion therapy in patients with pure exfoliated cytology-positive gastric cancer, and CT tumor volume measurement significantly correlates with conversion therapy results.