Objective:To evaluate the effect of different reconstruction points of intrauterine applicator on the source dwell positions and plan dosimetry in intracavitary brachytherapy for cervical cancer.Methods:Clinical data of 43 patients with cervical cancer who had completed radical radiotherapy in Liuzhou Workers' Hospital from May 2020 to October 2022 were retrospectively analyzed. Among 43 patients, aged 32-79 years, 40 cases were diagnosed with squamous carcinoma and 3 cases of adenocarcinoma. All patients received external irradiation for 50.4 Gy / 28 fractions and CT-guided intracavitary brachytherapy (45° intrauterine applicator) was 36 Gy / 6 fractions. Brachytherapy was performed by using Fletcher applicator, the curvature of intrauterine applicator were 15°, 30°and45°. Two sets of brachytherapy plans were simulated for each patient. One set of plans extracted the simulated CT positioning images and the original plan of the patient's brachytherapy. The reconstruction point of the curved part of the 45° intrauterine applicator was adjusted to slice-by-slice reconstruction. The plan was optimized to meet clinical requirements according to the prescription, which was called the slice-by-slice group. In the other set of plans, slice-by-slice group was used as a template. The reconstruction points of the curved section of the 45° intrauterine applicator were adjusted to 1, 3, 5, and 7, without modifying the applicator weights and other parameters, which was called the average group 1, 3, 5 and 7. The deviation analysis of 15°, 30° and 45° intrauterine applicator with different number of reconstruction points was carried out, the reconstruction deviation of 45°, 30° and 15° intrauterine applicator at different reconstruction points was compared. Paired-sample t-test or Wilcoxon signed rank test were used to compare the differences in high-risk clinical target volume (HR-CTV) D 50%, D 90%, D 100%, V 100%, V 150%, V 200% and conformity index (CI) as well as D 2 cm3, D 1 cm3 and D 0.1 cm3 in bladder, rectum, and small intestine between two groups of 45° intrauterine applicator. Results:The reconstruction deviation in the average group was mainly from the vertical direction of the 45° intrauterine applicator. The mean reconstruction deviations of 45° (1, 3, 5, 7 reconstruction points), 30° (1, 3, 5 reconstruction points) and 15° (1, 2 reconstruction points) were 1.30 mm, 0.32 mm, 0.14 mm and 0.08 mm; 0.57 mm, 0.14 mm and 0.06 mm; 0.14 mm and 0.06 mm, respectively. There was no significant difference in the parameters of high-risk clinical target volume (HR-CTV) in the slice-by-slice group compared with the average group 5 and 7 (all P>0.005), and no significant difference was found between the average group 5 and 7 (all P>0.005). There were no statistically significant differences in bladder and rectum doses between the slice-by-slice group and the average groups or within the average groups (all P>0.005). The parameters of small intestine in the slice-by-slice group were higher than those of the average group 1, the difference was statistically significant ( P=0.002,<0.001,<0.001). The dose of small intestine in the slice-by-slice group was not statistically significant compared with those in the average group 5 and 7 (both P>0.005). The dose of small intestine in the average group 5 was not statistically significant compared with that in the average group 7 ( P>0.005). The small intestine dose deviations of D 0.1 cm3, D 1 cm3 and D 2 cm3 in the average groups at 1 reconstruction point were 2.41%±1.70%, 1.95%±1.27% and 1.71%±1.10%, respectively. Conclusion:The number of reconstruction points is recommended to be no less than 1, 3 and 5 of the curved part of the 15°, 30°and 45° Fletcher intrauterine applicator, respectively, during intracavitary brachytherapy for cervical cancer.

Objective:To analyze the correlation between the monitor units and pass rate of plan dose verification in the volumetric intensity modulated arc therapy (VMAT) plan.Methods:VMAT plans for 20 patients with nasopharyngeal carcinoma (NPC) and 30 patients with cervical cancer who underwent radiotherapy at Liuzhou Workers' Hospital from January to October 2020 were retrospectively chosen. The Detector 1500 array and Octavius 4D phantom from German PTW company were used for dose measurement. The pass rates of dose verification of relevant plans were analyzed under the conditions of 3%/2 mm and 2%/2 mm. The correlation between the monitor units and pass rate of plan dose verification in VMAT plans was assessed by Pearson's bivariate correlation analysis.Results:Under the condition of 3%/2 mm, the correlation coefficients between the monitor units and gamma pass rate were -0.873 ( P<0.001), -0.800 ( P<0.001), -0.781 ( P<0.001), -0.493 ( P=0.006) for NPC_1Arc, NPC_2Arc, NPC_1Arc+NPC_2Arc and Cervix_2Arc, respectively. Under the condition of 2%/2 mm, the correlation coefficients between the monitor units and gamma pass rate were -0.842 ( P<0.001), -0.770 ( P<0.001), -0.748 ( P<0.001) and -0.531 ( P=0.003) for NPC_1Arc, NPC_2Arc, NPC_1Arc+NPC_2Arc and Cervix_2Arc, respectively. Conclusion:Significant negative correlation can be observed between the monitor units and plan dose verification pass rate in VMAT plan.

Objective:To investigate the species types and phylogenetic relationship of canine Leishmania in Diebu County, Gansu Province, so as to provide a basis for exploring new methods of prevention and control of canine visceral leishmaniasis. Methods:DNA was extracted from blood samples of eight asymptomatic Leishmania-infected dogs in Luoda administrative village in Diebu County, Gansu Province. Ribosomal internal transcribed spacer 1 (ITS-1) gene fragments were amplified and isolated by PCR, and then the amplified target fragments were sequenced. The MEGA 7.0 software was used for multiple sequence alignment, and a phylogenetic tree was constructed by neighbor-joining method to analyze the phylogenetic relationship of canine Leishmania in Diebu County, Gansu Province. Results:Fragments of about 320 bp corresponding in size to the target sequence ITS-1 were isolated from all of the eight asymptomatic Leishmania-infected dogs blood samples. ITS-1 sequence alignment showed that the sequence homology between 8 samples and Leishmania infantum MG969403, MN648755 strains was 99.1% - 100.0%; phylogenetic tree showed that all 8 samples were clustered into one branch with Leishmania infantum. Conclusion:Leishmania infantum is identified from all of the eight asymptomatic Leishmania-infected dogs blood samples in Diebu County, Gansu Province.

Objective:To study the differences in the dosimetry and delivery time between helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) in postoperative radiotherapy of synchronous bilateral breast cancer (SBBC) and to explore the feasibility of clinical application of the HT technology.Methods:A retrospective analysis was conducted for nine SBBC patients who underwent modified radical postoperative radiotherapy in the Fourth Affiliated Hospital of Guangxi Medical University from February 2017 to May 2022. For each patient, the Precision planning system was used to formulate the HT plan, and the RayStation planning system was employed to develop the VMAT plan. All plans obtained were divided into HT group and VMAT group according to plan type. The paired sample t-test was used to compare the dosimetric parameters of the target volume and organ at risk (OAR) and delivery time between the two radiotherapy technologies. Results:The plans of both groups could meet the clinical treatment requirements. The coverage ( D95% and V100%), conformity index (CI), average dose ( Dmean), and median dose ( D50%) of the target volumes in the HT group were better than those in the VMAT group, and the differences were statistically significant ( t=-3.21, -3.39, -5.03, 3.76, 4.97, P < 0.05). The differences in the maximum dose ( D2%), minimum dose ( D98%), high dose volumes ( V107% and V110%), and homogeneity index (HI) of the target volumes between the two groups were not statistically significant ( P > 0.05). Regarding the OAR, the V20 and Dmean of both lungs in the HT group were significantly lower than those in the VMAT group, but the irradiation volume V5 of both lungs in the HT group was significantly higher than that in the VMAT group ( t=-3.01, 3.83, -2.81, P < 0.05). Moreover, V20, V30, V40, and Dmean of heart and the V20 and Dmean of liver in the HT group were significantly lower than those in the VMAT group, with statistically significant differences ( t=3.76, -2.83, -2.74, 5.93, 4.57, 4.48, P < 0.05). There was no significant difference in the radiation doses to other OARs (spinal cord, thyroid gland, and humerus head, P > 0.05). The delivery time of the HT group was significantly higher than that of the VMAT group ( t = 11.32, P < 0.05). Conclusions:Compared with VMAT, HT has greater dosimetric advantages, and can provide higher target coverage, conformability and average dose, and significantly reduce the overall radiation doses to both lungs, heart, and liver in OARs. However, the irradiation volume V5 at low-dose areas of both lungs and the delivery time in the HT group are higher than those in the VMAT group, but still meet the clinical treatment requirements. Therefore, it is feasible to apply the HT technology to the modified radical postoperative radiotherapy of SBBC.

Objective:To compare the safety and efficacy of laparoscopic and open hepatectomy for hepatolithiasis.Methods:Between January 2014 and May 2020, the clinicopathological data of 254 patients with hepatolithiasis who underwent laparoscopic or open hepatectomy at the First Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College were collected retrospectively. There were 74 males and 180 females with age of (56±8) years (range: 38 to 77 years). Of the 254 patients, 162 underwent laparoscopic surgery (laparoscopic group) and 92 underwent open surgery (open group). Propensity score matching(PSM) was performed to match baseline characteristics of the two groups,and then the perioperative results and follow-up efficacy were compared between the two groups. The t-test, Mann-Whitney U test, χ 2 test or Fisher′s exact probability method was used to compare the perioperative data and follow-up results of the two groups after matching, respectively. Results:Each group had 63 patients after PSM with well-balanced baseline characteristics. There was no statistic difference in the type of hepatectomy,combined common bile duct exploration rate,T tube drainage placement rate,operation time,intraoperative transfusion rate,intraoperative accidental injury rate,initial and final stone clearance rate,and stone recurrence rate between the two groups. However,compared with the open hepatectomy group, the laparoscopic group had significantly lower intraoperative blood loss ( M(IQR))(300(175)ml vs. 350(145)ml, Z=3.227, P=0.001),shorter postoperative hospital stay((10.6±4.1)days vs. (14.0±4.0)days, t=4.634, P<0.01),shorter time to postoperative oral intake ((1.8±1.1)days vs. (2.9±1.6)days, t=4.556, P<0.01), and lower postoperative complication rate (25.4%(16/63) vs. 49.2%(31/63), χ2=7.635, P=0.006). Conclusion:Laparoscopic hepatectomy is safe and effective for hepatolithiasis with the advantages of less intraoperative blood loss,lower postoperative complications and faster postoperative recovery.

Objective:To compare the safety and efficacy of laparoscopic and open hepatectomy for hepatolithiasis.Methods:Between January 2014 and May 2020, the clinicopathological data of 254 patients with hepatolithiasis who underwent laparoscopic or open hepatectomy at the First Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College were collected retrospectively. There were 74 males and 180 females with age of (56±8) years (range: 38 to 77 years). Of the 254 patients, 162 underwent laparoscopic surgery (laparoscopic group) and 92 underwent open surgery (open group). Propensity score matching(PSM) was performed to match baseline characteristics of the two groups,and then the perioperative results and follow-up efficacy were compared between the two groups. The t-test, Mann-Whitney U test, χ 2 test or Fisher′s exact probability method was used to compare the perioperative data and follow-up results of the two groups after matching, respectively. Results:Each group had 63 patients after PSM with well-balanced baseline characteristics. There was no statistic difference in the type of hepatectomy,combined common bile duct exploration rate,T tube drainage placement rate,operation time,intraoperative transfusion rate,intraoperative accidental injury rate,initial and final stone clearance rate,and stone recurrence rate between the two groups. However,compared with the open hepatectomy group, the laparoscopic group had significantly lower intraoperative blood loss ( M(IQR))(300(175)ml vs. 350(145)ml, Z=3.227, P=0.001),shorter postoperative hospital stay((10.6±4.1)days vs. (14.0±4.0)days, t=4.634, P<0.01),shorter time to postoperative oral intake ((1.8±1.1)days vs. (2.9±1.6)days, t=4.556, P<0.01), and lower postoperative complication rate (25.4%(16/63) vs. 49.2%(31/63), χ2=7.635, P=0.006). Conclusion:Laparoscopic hepatectomy is safe and effective for hepatolithiasis with the advantages of less intraoperative blood loss,lower postoperative complications and faster postoperative recovery.

Objective:To analyze the spatial distribution characteristics of dogs infected with Leishmania in Wenxian and Diebu counties of Gansu Province, and provide a scientific basis for implementation of precise prevention and control measures. Methods:In 2019, blood samples were collected from all dogs in visceral leishmaniasis endemic areas Xinglong Village, Wenxian County and Luoda Village, Diebu County, Gansu Province, by cluster sampling method. The primer RV1-RV2 which was commonly used to diagnose visceral leishmaniasis, was used for PCR amplification of dog blood samples. SaTScan V9.5 software was used to analyze the spatial clustering of dogs infected with Leishmania. Results:A total of 537 dogs were investigated, and the number of positive infection was 221, with a positive rate of 41.2%. Among them, the positive rates of dogs infected with Leishmania in Wenxian and Diebu counties were 64.6% (95/147) and 32.3% (126/390), respectively. The results of SaTScan analysis showed that the spatial clustering of dogs infected with Leishmania in Wenxian and Diebu counties were not statistically significant ( P > 0.05). Conclusions:There are no spatial clustering of dogs infected with Leishmania in Wenxian and Diebu counties, but the positive rate of dogs infected with Leishmania is higher, and there is a higher risk of epidemic. It is recommended to strengthen health education in local area, strictly drive out lacewings, detect and kill diseased dogs, and reduce the risk of visceral leishmaniasis transmission.

Objective:To investigate the Leishmania infection status in dogs in canine-derived visceral leishmaniasis endemic areas in Wenxian County and Diebu County of Gansu Province, to provide basis for formulating effective prevention and treatment measures for visceral leishmaniasis. Methods:In 2019, household survey method was used to collect dog basic information (such as gender and age) in villages with higher incidence of previous cases in Wenxian County and Diebu County of Gansu Province; and venous blood of dog was collected, PCR method was used to detect microloop DNA of Leishmania. Results:A total of 537 dogs were investigated, the positive rate of Leishmania detected by PCR was 41.15% (221/537); the positive rates of PCR detection were 64.63% (95/147) and 32.31% (126/390) in Wenxian County and Diebu County, respectively, and the positive rate in Wenxian County was higher than that in Diebu County (χ 2=46.044, P < 0.05). In 35 dogs with clinical symptoms of visceral leishmaniasis, the positive rate of PCR detection was 74.29% (26/35); the positive rates of PCR detection in symptomatically infected dogs were 84.62% (22/26) and 4/9 in Wenxian County and Diebu County, respectively, the positive rate in Wenxian County was higher than that in Diebu County ( P < 0.05). The positive rate of PCR detection was 38.84% (195/502) in 502 asymptomatic dogs; the positive rates of PCR detection were 60.33% (73/121) and 32.02% (122/381) in Wenxian County and Diebu County, respectively, the positive rate in Wenxian County was higher than that in Diebu County (χ 2=39.982, P < 0.05). Conclusions:The infection rates of Leishmania in dogs are high in Wenxian County and Diebu County of Gansu Province, the positive rate of PCR detection in asymptomatic dogs infected with Leishmania is high. This indicates that local residents and dogs are at high risk of infection with Leishmania. It is recommended that relevant departments should enhance residents' awareness of active protection and strengthen efforts to control the Leishmania infection of dogs.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

BACKGROUND: How to locate pulmonary ground-glass nodules in thoracoscopic surgery is an important clinical topic in minimally invasive thoracic surgery. There is no unified localization method at present. This study intends to investigate the accuracy and security of body surface theodolitic puncture localization method in video-assisted thoracoscopic surgery for pulmonary ground-glass nodules. METHODS: The clinical data of 41 patients from August 2018 to December 2019 were analyzed retrospectively, including 28 males and 13 females. After anesthesia, the patient was located by body surface theodolitic puncture, and then partial lobectomy was performed under video-assisted thoracoscopy. The distance from the nodule to the marked suture and the distance from the nodule to the incisal margin were measured, and the accuracy of localization, the rate of complication and the success rate of surgical resection were calculated. RESULTS: A total of 51 nodules in 41 patients were located by body surface theodolitic puncture localization method. The accuracy rate was 96.1%, and the average location time was 8.3 min. Puncture bleeding occurred in 5 cases (12.2%), all of which were successfully stopped by video-assisted thoracoscopy, and there were no other complications. All patients underwent thoracoscopic partial lobectomy, including 33 cases of anatomical segmentectomy and 8 cases of wedge lobectomy. All the patients in operation process smoothly. The distance between nodule and incisal margin was measured, and all specimens were more than 2 cm, reaching a safe distance. The success rate of surgical resection was 100.0%. CONCLUSIONS In video-assisted thoracoscopic surgery for ground glass nodules of lung, the body surface theodolitic puncture localization method can be accurate, safe and simple.