Objective:To explore the movement patterns and factors influencing lung tumors tracked using the M6 cyberknife stereotactic radiotherapy(SRT)system and to provide a reference for the implementation of precise stereotactic radiotherapy for lung tumors.Method:A retrospective analysis was conducted on 29 patients with lung tumors who were treated using x-sight lung tracking technology and the M6 cyberknife SRT system at Tianjin Medical University Cancer Institute&Hospital,from January 2022 to August 2024.The tumor location and volume,irradiation dose,isodose line,and number of divisions were recorded.Lung tumor location and SPSS 26.0 software were used to analyze the movement amplitude of tumors in the left and right(LFT/RGT,LR)directions,the anterior-posterior(ANT/POS,AP)direction,and the superior-inferior(SUP/INF,SI)direction.The results are expressed as the mean±standard deviation((x)±s)mm,and a t-test was used for inter-group comparisons.Multiple linear regression was used to analyze the effects of factors such as age,gender,tumor location(upper and lower lungs),and tumor volume on the amplitudes of the lung tumor movements.Result:The average motion amplitudes in the LR direc-tions,AP direction,and SI direction of the tumor target areas were(3.5±1.8)mm,(5.3±1.7)mm,and(7.3±5.4)mm for the upper lung,based on 19 cases,and(3.1±1.6)mm,(4.5±2.2)mm,and(12.2±4.4)mm for the lower lung,based on 10 cases,respectively.There was a statistic-ally significant difference(P=0.015 3)in the amplitude of movements between the lower and upper lung tumors in the SI direction.The lung tumor movement amplitude in the SI direction was influenced by tumor location(P=0.035),and the movement amplitudes in the LR direc-tions and the AP direction were not related to factors such as gender,age,tumor location,and tumor volume.Conclusions:The lung tumor movement amplitudes for the different locations varied depending on the respiratory movement shown by the patient.In the SI direction,the movement amplitude of the lower lung tumors was greater than that of upper lung tumors,and this was due to tumor location effects.The movement amplitudes of the lower and upper lung tumors were similar in the LR directions and AP directions.Furthermore,movement amplitude was not affected by gender,age,tumor location,and tumor volume.

Objective:To investigate the impact of delayed ileostomy closure (>6 months) on postoperative complications in patients with ulcerative colitis (UC) undergoing ileal pouch-anal anastomosis (IPAA) .Methods:Using propensity score matching. Clinical data of UC patients who underwent IPAA and subsequent ileostomy closure at Jinling Hospital from January 2014 to December 2021 were retrospectively analyzed. Patients were categorized into a routine group (2 to ≤6 months) and a delayed group (>6 months) based on the timing of ileostomy closure. A 1∶1 propensity score matching analysis was performed to compare early (≤30 days) and late (>30 days) postoperative complications between the two groups.Results:A total of 225 UC patients who underwent IPAA and ileostomy closure were included, comprising 129 males (57.3%) and 96 females (42.7%). After propensity score matching, 88 patients were included in the analysis, with 44 patients in each group. There was no significant difference in the overall incidence of early postoperative complications (11.4% vs. 15.9%, P = 0.534) or late postoperative complications (43.2% vs. 43.2%, P = 1.000) between the delayed and routine groups. Additionally, no significant differences were observed in other postoperative complications (all P > 0.05) . Conclusion:Delayed ileostomy closure following IPAA does not significantly increase the risk of postoperative complications in UC patients.

Objective:To investigate the impact of delayed ileostomy closure (>6 months) on postoperative complications in patients with ulcerative colitis (UC) undergoing ileal pouch-anal anastomosis (IPAA) .Methods:Using propensity score matching. Clinical data of UC patients who underwent IPAA and subsequent ileostomy closure at Jinling Hospital from January 2014 to December 2021 were retrospectively analyzed. Patients were categorized into a routine group (2 to ≤6 months) and a delayed group (>6 months) based on the timing of ileostomy closure. A 1∶1 propensity score matching analysis was performed to compare early (≤30 days) and late (>30 days) postoperative complications between the two groups.Results:A total of 225 UC patients who underwent IPAA and ileostomy closure were included, comprising 129 males (57.3%) and 96 females (42.7%). After propensity score matching, 88 patients were included in the analysis, with 44 patients in each group. There was no significant difference in the overall incidence of early postoperative complications (11.4% vs. 15.9%, P = 0.534) or late postoperative complications (43.2% vs. 43.2%, P = 1.000) between the delayed and routine groups. Additionally, no significant differences were observed in other postoperative complications (all P > 0.05) . Conclusion:Delayed ileostomy closure following IPAA does not significantly increase the risk of postoperative complications in UC patients.

Objective:To explore the movement patterns and factors influencing lung tumors tracked using the M6 cyberknife stereotactic radiotherapy(SRT)system and to provide a reference for the implementation of precise stereotactic radiotherapy for lung tumors.Method:A retrospective analysis was conducted on 29 patients with lung tumors who were treated using x-sight lung tracking technology and the M6 cyberknife SRT system at Tianjin Medical University Cancer Institute&Hospital,from January 2022 to August 2024.The tumor location and volume,irradiation dose,isodose line,and number of divisions were recorded.Lung tumor location and SPSS 26.0 software were used to analyze the movement amplitude of tumors in the left and right(LFT/RGT,LR)directions,the anterior-posterior(ANT/POS,AP)direction,and the superior-inferior(SUP/INF,SI)direction.The results are expressed as the mean±standard deviation((x)±s)mm,and a t-test was used for inter-group comparisons.Multiple linear regression was used to analyze the effects of factors such as age,gender,tumor location(upper and lower lungs),and tumor volume on the amplitudes of the lung tumor movements.Result:The average motion amplitudes in the LR direc-tions,AP direction,and SI direction of the tumor target areas were(3.5±1.8)mm,(5.3±1.7)mm,and(7.3±5.4)mm for the upper lung,based on 19 cases,and(3.1±1.6)mm,(4.5±2.2)mm,and(12.2±4.4)mm for the lower lung,based on 10 cases,respectively.There was a statistic-ally significant difference(P=0.015 3)in the amplitude of movements between the lower and upper lung tumors in the SI direction.The lung tumor movement amplitude in the SI direction was influenced by tumor location(P=0.035),and the movement amplitudes in the LR direc-tions and the AP direction were not related to factors such as gender,age,tumor location,and tumor volume.Conclusions:The lung tumor movement amplitudes for the different locations varied depending on the respiratory movement shown by the patient.In the SI direction,the movement amplitude of the lower lung tumors was greater than that of upper lung tumors,and this was due to tumor location effects.The movement amplitudes of the lower and upper lung tumors were similar in the LR directions and AP directions.Furthermore,movement amplitude was not affected by gender,age,tumor location,and tumor volume.

Objective:To analyze the risk factors leading to the failure of enhanced recovery after surgery (ERAS) in inflammatory bowel disease (IBD) patients with colorectal resection.Methods:A retrospective case-control study was conducted. Clinical data of consecutive IBD patients who received colorectal resection under ERAS protocol in Jingling Hospital from January 2019 to February 2021 were analyzed. ERAS failure was defined as prolonged postoperative length of hospital stay, or unplanned reoperation, accidental readmission or death within 30 days after operation. The patients were divided into failed ERAS group and successful ERAS group according to whether the ERAS failed. Univariate and Logistic multivariate analyses were performed to identify the risk factors of ERAS failure in IBD patients with colorectal resection.Results:A total of 216 patients were enrolled. There were 65 patients in failed ERAS group and 151 in successful ERAS group. Univariate analysis showed that compared with successful ERAS group, the ratio of body mass index (BMI) <18.5 kg/m 2 (61.5% vs.46.4%, P = 0.041) , the ratio of preoperative nutritional risk screening tools 2002 (NRS-2002) score ≥3 points (69.2% vs. 48.3%, P = 0.005) , the ratio of preoperative modified Glasgow prognostic score (mGPS) = 2 points (30.8% vs. 10.6%, P<0.001) , the ratio of preoperative steroids use within 4 weeks before operation (44.6% vs. 23.8%, P<0.001) , the ratio of neostomy (63.1% vs. 46.4%, P = 0.024) , the ratio of intraoperative infusion volume>3 L (44.6% vs. 21.9%, P = 0.038) were higher in failed ERAS group, while the the ratio of preoperative enteral nutrition was lower (53.8% vs. 68.2%, P = 0.044) . Multivariate analysis showed that preoperative NRS-2002 score ≥3 points ( OR = 2.212, 95% CI: 1.133-4.321, P = 0.020) , mGPS = 2 points ( OR = 3.510, 95% CI: 1.555-7.926, P = 0.003) and preoperative steroids use within 4 weeks before operation ( OR = 2.600, 95% CI: 1.313-5.146, P = 0.006) were the independent risk factors of ERAS failure in IBD patients with colorectal resection. Conclusions:ERAS failure is more likely to occur in IBD patients after colorectal resection with charactertics including preoperative NRS-2002 score ≥3 points, mGPS=2 points, and preoperative steroids use within 4 weeks before operation. Preoperative nutritional preconditioning, perioperative hormone discontinuation, and control of preoperative inflammatory response may promote the successful implementation of ERAS in IBD patients with surgery.

Objective:To analyze the risk factors leading to the failure of enhanced recovery after surgery (ERAS) in inflammatory bowel disease (IBD) patients with colorectal resection.Methods:A retrospective case-control study was conducted. Clinical data of consecutive IBD patients who received colorectal resection under ERAS protocol in Jingling Hospital from January 2019 to February 2021 were analyzed. ERAS failure was defined as prolonged postoperative length of hospital stay, or unplanned reoperation, accidental readmission or death within 30 days after operation. The patients were divided into failed ERAS group and successful ERAS group according to whether the ERAS failed. Univariate and Logistic multivariate analyses were performed to identify the risk factors of ERAS failure in IBD patients with colorectal resection.Results:A total of 216 patients were enrolled. There were 65 patients in failed ERAS group and 151 in successful ERAS group. Univariate analysis showed that compared with successful ERAS group, the ratio of body mass index (BMI) <18.5 kg/m 2 (61.5% vs.46.4%, P = 0.041) , the ratio of preoperative nutritional risk screening tools 2002 (NRS-2002) score ≥3 points (69.2% vs. 48.3%, P = 0.005) , the ratio of preoperative modified Glasgow prognostic score (mGPS) = 2 points (30.8% vs. 10.6%, P<0.001) , the ratio of preoperative steroids use within 4 weeks before operation (44.6% vs. 23.8%, P<0.001) , the ratio of neostomy (63.1% vs. 46.4%, P = 0.024) , the ratio of intraoperative infusion volume>3 L (44.6% vs. 21.9%, P = 0.038) were higher in failed ERAS group, while the the ratio of preoperative enteral nutrition was lower (53.8% vs. 68.2%, P = 0.044) . Multivariate analysis showed that preoperative NRS-2002 score ≥3 points ( OR = 2.212, 95% CI: 1.133-4.321, P = 0.020) , mGPS = 2 points ( OR = 3.510, 95% CI: 1.555-7.926, P = 0.003) and preoperative steroids use within 4 weeks before operation ( OR = 2.600, 95% CI: 1.313-5.146, P = 0.006) were the independent risk factors of ERAS failure in IBD patients with colorectal resection. Conclusions:ERAS failure is more likely to occur in IBD patients after colorectal resection with charactertics including preoperative NRS-2002 score ≥3 points, mGPS=2 points, and preoperative steroids use within 4 weeks before operation. Preoperative nutritional preconditioning, perioperative hormone discontinuation, and control of preoperative inflammatory response may promote the successful implementation of ERAS in IBD patients with surgery.

Objective:To provide a new morning check method for the output dose stability of the multileaf collimator (MLC) of the CyberKnife M6 (CK-M6) system.Methods:The CT images of a verification phantom with a size of 20 cm × 20 cm × 10 cm were transmitted into the Precision Treatment Plan ning System (ver. 1.1.1.1). The high-precision alignment between the accelerator output front and the fixed position of the phantom surface was achieved using the fiducial tracking method. A 10 cm × 10 cm radiation field was formed by the MLC and a DailyCheck plan with an output of 200 MU was designed. The repeatability, sensitivity, and accuracy of the DailyCheck plan were measured, and the CK-M6 system was continuously tested for one month using the artificial fixed method and the DailyCheck plan designed in this study. Results:The average and the standard deviation of 10 repeated measurements by the DailyCheck plan were 492.28 pC and 0.09, respectively, indicating good stability. There was a linear correlation between the measured values and the output dose, with a correlation coefficient of R2 > 0.999. Moreover, there was a position deviation of 2 mm between the phantom and the accelerator output front, and the result ant effect on the measured values was equivalent to a dose deviation caused by an output of 1.24 MU. The result from the continuous measurement of both the artificial fixed method and the DailyCheck plan fell within permissible limits, showing high consistency. Conclusions:The DailyCheck plan established through the fiducial tracking of a verification phantom can achieve the convenient, quick, and accurate daily detection of the output dose stability of the MLC of CK-M6. Therefore, this method can be widely applied in the clinical quality control of the CK-M6 system.

Objective:To investigate pouch function, quality of life, and their influencing factors after ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) .Methods:Clinical data of 111 patients undergoing IPAA in the UC database at Department of General Surgery, Jinling Hospital from 2014 to 2020 were retrospectively analyzed. Through the questionnaire, pouch functional score (PFS) and Cleveland global quality of life (CGQL) were obtained. These patients were diveided into two groups according to the PFS score. Univariate and multivariate analysis were used to compare the clinical features and reveal the risk factors of PFS.Results:A total of 111 patients were enrolled in this study, including 65 males and 38 females. 63 patients were in the good pouch function group, and 48 in the poor pouch function group. The median score of PFS was 7 (3.0-10.0) . Univariate analysis showed that compared with the good pouch function group, the poor pouch function group had a longer duration of disease before operation[44.5 (21.0-86.0) months vs. 14.0 (5.0-70.0) months, P = 0.005], a shorter follow-up time[16.0 (7.0-28.8) months vs. 26.0 (15.0-39.0) months, P = 0.020], and a higher proportion of pouchitis (29.1% vs. 12.9%, P = 0. 031) . The multivariate logistic regression analysis showed duration of disease before operation ( OR = 0.974, 95% CI: 0.951-0.997, P = 0.030) and pouchitis ( OR = 3.251, 95% CI: 1.168-9.045, P = 0.024) were the independent risk factor of PFS in UC patients.The median CGQL was 0.77 (0.67-0.87) . The median surgical satisfaction score was 9.0 (8.0-10.0) . There was a correlation between CGQL and PFS ( rs = -0.376, P<0.001) . Conclusions:Most patients recover well after IPAA, and are highly satisfied with the operation. A good pouch function has a positive influence on the quality of life.

Objective:To investigate pouch function, quality of life, and their influencing factors after ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) .Methods:Clinical data of 111 patients undergoing IPAA in the UC database at Department of General Surgery, Jinling Hospital from 2014 to 2020 were retrospectively analyzed. Through the questionnaire, pouch functional score (PFS) and Cleveland global quality of life (CGQL) were obtained. These patients were diveided into two groups according to the PFS score. Univariate and multivariate analysis were used to compare the clinical features and reveal the risk factors of PFS.Results:A total of 111 patients were enrolled in this study, including 65 males and 38 females. 63 patients were in the good pouch function group, and 48 in the poor pouch function group. The median score of PFS was 7 (3.0-10.0) . Univariate analysis showed that compared with the good pouch function group, the poor pouch function group had a longer duration of disease before operation[44.5 (21.0-86.0) months vs. 14.0 (5.0-70.0) months, P = 0.005], a shorter follow-up time[16.0 (7.0-28.8) months vs. 26.0 (15.0-39.0) months, P = 0.020], and a higher proportion of pouchitis (29.1% vs. 12.9%, P = 0. 031) . The multivariate logistic regression analysis showed duration of disease before operation ( OR = 0.974, 95% CI: 0.951-0.997, P = 0.030) and pouchitis ( OR = 3.251, 95% CI: 1.168-9.045, P = 0.024) were the independent risk factor of PFS in UC patients.The median CGQL was 0.77 (0.67-0.87) . The median surgical satisfaction score was 9.0 (8.0-10.0) . There was a correlation between CGQL and PFS ( rs = -0.376, P<0.001) . Conclusions:Most patients recover well after IPAA, and are highly satisfied with the operation. A good pouch function has a positive influence on the quality of life.

The tumor microenvironment is a special environment including tumor cells,stromal cells and extracellular matrix.The notion that the tumor microenvironment is a necessary functional unit to support cancer progression,metastasis and recurrence has been accepted by more and more scholars.Studies have shown that exosomes may play a pivotal role in tumor progression that involved in cell-cell communication in the tumor microenvironment.Here,we summarize the recent publications on the characteristics of exosomes,its biological effects and the potential roles as an important part of the tumor microenvironment during tumor progression.