Objective To compare the dosimetric differences in the heart and its substructures between two hybrid plans for hypofractionated whole-breast radiotherapy after breast-conserving surgery in patients with early-stage left-sided breast cancer. Methods A total of 46 patients with early-stage left-sided breast cancer who underwent hypofractionated whole-breast radiotherapy were randomly selected. Two hybrid radiotherapy plans were used, including hybrid intensity-modulated radiotherapy (H_IMRT) and hybrid volumetric-modulated arc therapy (H_VMAT). The heart and its substructures were contoured, including left anterior descending (LAD), left ventricle (LV), right coronary artery (RCA), and right ventricle (RV). The heart and substructure doses, as well as monitor units, were compared between H_IMRT and H_VMAT. Results Both hybrid plans met the clinical requirements. H_IMRT significantly outperformed H_VMAT for the heart (V₁₀, V₃₀, and D_mean), LAD (V₃₀, V₄₀, D_max and D_mean), LV (V₁₀, V₂₀ and D_mean), RCA (D_max, D_mean), and RV (V₅, V₁₀, D_mean) (P < 0.001). Additionally, H_IMRT was significantly superior to H_VMAT for heart V₅, LAD V₂₀, and RV V₂₀ (P = 0.005, 0.035 and 0.037). For LAD (V₁₅, V₄₀) and LV (V₅, V₂₅), H_IMRT was slightly better than H_VMAT, and the difference was not statistically significant. Conclusion Both H_IMRT and H_VMAT hybrid radiotherapy plans are suitable for hypofractionated whole-breast radiotherapy after breast-conserving surgery in patients with early-stage left-sided breast cancer. H_IMRT is slightly better than H_VMAT in dose sparing for the heart and its substructures.

Objective To explore the radiosensitizing effect of arsenic trioxide (ATO) in cervical cancer, and to further explore the underlying mechanism related to DNA damage repair. Methods Human cervical cancer cells (Siha and Hela cells) were cultured in vitro, treated with different concentrations of ATO, and the cell proliferation was detected by CCK-8 assay. The cells were divided into four groups: control group, radiotherapy (IR) group, ATO group, and radiotherapy + ATO (IR + ATO) group. Radiosensitization ratio was determined by plate cloning assay, cell cycle and apoptosis by flow cytometry, the expression of γH2AX by immunofluorescence, the expression of Cyclin B1, PTEN, and RAD51 by Western blot, and the expression of RAD51 mRNA by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Results CCK-8 showed that ATO at concentrations of 1 μM and higher could significantly inhibit the proliferation of Siha and HeLa cells. Plate cloning showed that ATO had a radiosensitizing effect on cervical cancer, and the radiosensitization ratios were 1.37 and 1.30, respectively. Flow cytometry showed that the proportion of cell cycle arrest was significantly higher in the IR + ATO group than that in the control group (P < 0.001). The apoptosis rate was significantly higher in the IR + ATO group than that in the control group (P < 0.01). Western blotting showed that the expression levels of PTEN and RAD51 proteins significantly decreased (P < 0.05) and the expression level of Cyclin B1 protein significantly increased (P < 0.05) in the IR + ATO group. Conclusion ATO achieves radiosensitization in cervical cancer through blocking the DNA homologous recombination repair pathway by consuming PTEN.

OBJECTIVE To investigate the reasons for interrupting menopausal hormone therapy in patients with menopausal syndrome and analyze the influencing factors that may lead to treatment interruption. METHODS The patients who visited our menopause medicine clinic from March 2022 to November 2023 and established a menopausal health manual were collected retrospectively. The case data were collected through the medical history registered in the manual and the outpatient medical record system. Telephone follow-up was conducted among the patients who had received menopausal hormone therapy to know about whether they were taking medication and to record the reasons for treatment interruption. Univariate analysis and multivariate Logistic regression analysis were adopted to investigate the influencing factors of discontinuing menopausal hormone therapy in patients with menopausal syndrome. RESULTS A total of 183 patients receiving menopause hormone therapy were enrolled. They were divided into interruption group （78 cases） and continuation group （105 cases） according to whether the treatment was interrupted. The results of telephone follow-up showed that the reasons in turn for interruption were perceiving ineffectiveness （16.67%）， concerning about medication risk（15.38%）， the existence of caution case（12.82%） and adverse reactions（10.26%）. The results of univariate analysis showed that there were statistically significant differences in occupation， complications， medication regimen， bone condition and blood viscosity between the two groups （P＜0.05）. Multivariate Logistic regression analysis showed that the absence of complications， osteopenia and osteoporosis， working in public institution and retirement， and the continuous sequential medication regimen favored continuation of menopausal hormone therapy （P＜0.05）. CONCLUSIONS The interruption rate of menopausal hormone therapy is relatively high， and patients are greatly affected by perceiving ineffectiveness and concerning about medication risks， the existence of caution case， and adverse reactions. Complications can cause patients to interrupt treatment， while factors such as osteopenia and osteoporosis， working in public institutions and retirement， and continuous sequential medication regimens make patients more inclined to choose to continue menopausal hormone therapy.

Objective:The objective of this study is to sequence whole genome of the rabies virus in the saliva specimen of a suspected rabies case with onset of rabies from a wildlife (hog badger) bite wound in Sichuan province, where the genetic variation characteristics of the virus was analyzed at the molecular level, so as to understand the prevalence and mutation of wildlife rabies virus in Sichuan province.Methods:Total viral RNA was extracted from the saliva specimen of the suspected rabies case. Then, rabies virus sequences were amplified using PCR with specific primers; the gene fragments obtained were sequenced, and the sequences obtained were spliced using biological software to obtain the whole genome sequence of the rabies virus strain. The genetic variation characteristics of the whole genome were analyzed.Results:The whole genome nucleotide sequence of a strain of rabies virus of hog badger origin (hereinafter referred to as SCR23-052) was obtained by sequencing, and NCBI online BLAST and comparison with several reference sequences showed that the composition and structure of the whole genome sequence of SCR23-052 conformed to the characteristics of the Lyssavirus under the Rhabdoviridae; the highest similarity in nucleotide and amino acid sequences in various gene regions was observed between SCR23-052 and the strains of Ningxia (J) and Chongqing (CQ92, 02050CHI). The sequence variability of SCR23-052 genome was significantly lower at the amino acid level than that at the nucleotide level, which indicated that most of the nucleotide variants in the protein-coding genes belonged to synonymous mutations. Phylogenetic analysis showed that SCR23-052 belonged to genotype V, which did not show any obvious mutation in the major antigenic site of the glycoprotein, underwent amino acid glycosylation at positions 56 and 338 by the online site prediction, and showed the least amino acid difference compared with the signal peptide sequence of the vaccine strain CTN181. The virus in this study has an A→T mutation at position 332 in the nucleoprotein major antigenic site with all reference vaccine strains, and an L→V mutation at position 379 in the B-cell epitope with the CTN181 vaccine strain. SCR23-052 was consistent with both genotype V reference strains at the nucleoprotein study site.Conclusions:The whole genome sequence of a wildlife strain of genotype V rabies virus of hog badger origin was obtained, which was different from that of the genotype I strain of rabies virus of dog origin that previously reported to be prevalent in Sichuan. The genome sequence of SCR23-052 differed from that of the reference vaccine strains to a varying degree, but the main virulence characteristics remained unaltered.

Objective To preliminarily study the effectiveness and safety of stereotactic ablative brachytherapy (SABT) for lung metastases from cervical cancer. Methods We analyzed the clinical data of 18 patients with cervical cancer with lung metastasis treated with SABT to compare gross tumor volume (V_GTV) and squamous cell carcinoma (SCC) antigen before and after SABT. The clinical benefit rate (CBR) and adverse reactions were recorded. Results After SABT treatment, there were significant decreases in V_GTV (t=1.708, P<0.05) and the SCC antigen level (t=1.704, P<0.05). CBR reached 94.4%. Adverse reactions of grades 3-4 did not occur in any patient. Fourteen patients had mild complications, including 1 case of bloody sputum and 1 case of a small pneumothorax. Ten cases developed mild radiation-induced lung injury, with grade 2 radiation pneumonitis in 4 cases. The Karnofsky performance status score and needle depth were not associated with the occurrence of adverse reactions, while the radius of GTV and interstitial lung disease were associated with the occurrence of adverse reactions. Conclusion SABT is a safe and effective alternative to the treatment of lung metastases from cervical cancer.

Objective To investigate the effect of different fractionated radiotherapy of hypofractionated radiotherapy (HFRT) and conventional fractionated radiotherapy (CFRT) on peripheral blood lymphocytes in patients with breast cancer. Methods This retrospective analysis enrolled 40 patients with early breast cancer who underwent radiotherapy post breast conserving surgery in Xuzhou Central Hospital from November 2019 to August 2021. The patients were randomly divided into the observation group (HFRT, n = 20) and the control group (CFRT, n = 20). Changes in peripheral blood lymphocyte count (PLC) before and during radiotherapy were compared between the two groups. Results The baseline PLC was comparable between the observation group and the control group (1.53 ± 0.54 vs 1.64 ± 0.56, P > 0.05). In both groups, the PLC declined steadily during radiotherapy, and the incidence of lymphopenia in the observation group was lower than that in the control group (32.5% vs 50.0%, P > 0.05); the PLC nadir was higher in the observation group than in the control group (0.91 ± 0.28 vs 0.55 ± 0.22, P < 0.001). The ratio of the PLC nadir during treatment to baseline was significantly higher in the observation group than in the control group (0.64 ± 0.24 vs 0.38 ± 0.21, P < 0.05). Conclusion Patients with breast cancer receiving HFRT show a lower risk of radiation-induced lymphopenia versus those receiving CFRT.

Background::To date, there is no effective medicine to treat coronavirus disease 2019 (COVID-19), and the antiviral efficacy of arbidol in the treatment for COVID-19 remained equivocal and controversial. The purpose of this study was to evaluate the efficacy and safety of arbidol tablets in the treatment of COVID-19.Methods::This was a prospective, open-label, controlled and multicenter investigator-initiated trial involving adult patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Patients were stratified 1:2 to either standard-of-care (SOC) or SOC plus arbidol tablets (oral administration of 200 mg per time, three times a day for 14 days). The primary endpoint was negative conversion of SARS-CoV-2 within the first week. The rates and 95% confidential intervals were calculated for each variable.Results::A total of 99 patients with laboratory-confirmed SARS-CoV-2 infection were enrolled; 66 were assigned to the SOC plus arbidol tablets group, and 33 to the SOC group. The negative conversion rate of SARS-CoV-2 within the first week in patients receiving arbidol tablets was significantly higher than that of the SOC group (70.3% [45/64] vs. 42.4% [14/33]; difference of conversion rate 27.9%; 95% confidence interval [CI], 7.7%-48.1%; P = 0.008). Compared to those in the SOC group, patients receiving arbidol tablets had a shorter duration of clinical recovery (median 7.0 days vs. 12.0 days; hazard ratio [HR]: 1.877, 95% CI: 1.151-3.060, P = 0.006), symptom of fever (median 3.0 days vs. 12.0 days; HR: 18.990, 95% CI: 5.350-67.410, P < 0.001), as well as hospitalization (median 12.5 days vs. 20.0 days; P < 0.001). Moreover, the addition of arbidol tablets to SOC led to more rapid normalization of declined blood lymphocytes (median 10.0 days vs. 14.5 days; P > 0.05). The most common adverse event in the arbidol tablets group was the elevation of transaminase (5/200, 2.5%), and no one withdrew from the study due to adverse events or disease progression. Conclusions::SOC plus arbidol tablets significantly increase the negative conversion rate of SARS-CoV-2 within the first week and accelerate the recovery of COVID-19 patients. During the treatment with arbidol tablets, we find no significant serious adverse events.Trial registration::Chinese Clinical Trial Registry, NCT04260594, www.clinicaltrials.gov/ct2/show/NCT04260594?term= NCT04260594&draw=2&rank=1

Objective To compare the dosimetric difference between the biological function based on equivalent uniform dose (EUD) and the physical function based on dose volume (DV) in the intensity modulated radiotherapy for stage Ⅲ non-small cell lung cancer. Methods Four different radiotherapy plans were designed for 15 stage Ⅲ non-small cell lung cancer patients: Group A, physical function optimization (DV + DV) was used for target area and organs at risk; GroupB, in the target region, biological function optimization conditions were added on the basis of physical function optimization, and physical function optimization of organs at risk (DV－EUD + DV) was added. Group C, biological function optimization (EUD + EUD) was used for target area and organs at risk. Group D, in the target area, physical function optimization conditions were added on the basis of biological function optimization, and biological function optimization of organs at risk (EUD－DV + DV) was added. The differences in dosimetric parameters of the four plans were compared. Results Target area: PTV: D_2%, D_98%, D_50%, D_105% and D_max values of group C (P < 0.05) is the highest while group B and group D were relatively small (P > 0.05); The homogeneity index: the results of the group B and the group D were better than those of the other two groups (P < 0.05). conformity index: The results of the four groups were similar (P>0.05). Organ at risk: lung tissue mean dose (MLD), V₅, V₁₀, V₂₀, V₃₀ and heart V₃₀, V₄₀, D_mean dose parameters were similar (P > 0.05). Spinalcord: Group C and group D D_1% were better than the other two groups (P < 0.05). There was no statistical difference in the number ofmonitor unit (MU) among the four groups (P > 0.05). Conclusion The optimization method combining physical and biological function optimization in the target area can improve the conformity of the target area on the premise of ensuring the treatment. The Spinalcord load would be significantly reduced when using biological function optimization or the combination of biological function and physical function optimization.

Objective To explore the optimal radiotherapy method by comparing the dosimetric differences of target and organs at risk of four radiotherapy plans for left sided breast cancerafter breast-conserving surgery. Methods Twenty-three patients with left breast cancer were randomly selected and given PTV 25 fractions, 50 Gy prescription dose.TheHybrid_IMRT, rj_IMRT, VMAT and t_VMAT plans were designed for each patients. Dosimetric differences were compared, including dose volume histograms of target and OARs, target homogeneity indexes (HI), conformal indexes (CI) and the machine MUs. Results Target Dosimetric comparison, HI: t_VMAT plan target has highest HI and had significant difference (P ≤ 0.001); The target CI of VMAT plans were 0.967 ± 0.016, had significant difference compared with the other 3 plans (P < 0.05). The CI of rj_ IMRT were 0.942 ± 0.018 better than that of IMRT and t_VMATs. Dosimetric comparison of OARs, left_lung mean dose (MLD_L): rj_IMRT were （8.76 ± 1.52） Gy which were best of 4 plans, and had statistical significance (P < 0.05). Heart mean dose: rj_IMRT were （4.68 ± 0.87） Gy were better than that of VMAT (P < 0.05). Conclusion All of these four plans could be applied in clinical treatments, while the limitations of treatment equipment, patients’ physical conditions and some other factors should be considered before selecting an appropriate one.