At present, pancreatic cancer is a solid tumor with the worst prognosis. Compared with surgery and chemotherapy, radiotherapy plays an auxiliary role in the treatment of pancreatic cancer. In recent years, significant advances have been achieved in radiotherapy technology, which have been gradually applied in the diagnosis and treatment of pancreatic cancer. In this article, the progress in radiation therapy in the treatment of pancreatic cancer was reviewed, especially the clinical application of magnetic resonance imaging-guided radiation therapy in the treatment of pancreatic cancer, aiming to deepen the understand of the progress in radiation therapy for pancreatic cancer, and providing reference for improving the survival rate of pancreatic cancer patients.

Objective To evaluate the feasibility of 4-channel functional electrical stimulation(FES)in the treatment of cerebral ischemic stroke sequelae using 3.0T magnetic resonance diffusion tensor imaging(DTI).Methods Patients with the sequelae of cerebral ischemic stroke who were admitted to Shandong Provincial Third Hospital from February 2020 to November 2022(n=100)were enrolled and divided into two groups at a ratio of 1:1 according to random numbers generated by Excel.Besides routine rehabilitation training,observation group was given 4-channel FES to stimulate the quadriceps muscle,tibialis anterior muscle,gastrocnemius muscle and hamstring muscle of the affected lower extremity by simulating the time series of muscle contraction of normal subjects when walking;while control group was treated with dual-channel FES,with electrodes placed on the muscle points of the tibialis anterior muscle and peroneus longus and brevis muscles of the affected lower extremity for stimulation.All patients received 3.0T MRI before and after treatment,and the relevant DTI parameters were recorded and compared.Meanwhile,Berg balance scale(BBS)and Fugl-Meyer assessment scale for lower extremity(FMA-LE)were used to evaluate the therapeutic efficacies in two groups of patients with the sequelae of cerebral ischemic stroke.The correlation of BBS/FMA-LE score with DTI parameters in observation group was also discussed.Results After treatment,both FMA-LE and BBS scores of control group and observation group showed increasing trends,and the increases in observation group were more obvious(P<0.05).After 2 weeks of treatment,compared with control group,observation group had higher FMA-LE score,BBS score,fractional anisotropy(FA),average diffusion coefficient(DCavg)and volume ratio anisotropy(VRA),but lower exponential attenuation(Exat)(all P<0.05).In observation group,FMA-LE score was positively correlated with FA,DCavg and VRA,but negatively correlated with Exat;while BBS score was positively correlated with FA and VRA,but negatively correlated with Exat,and had no significant correlation with DCavg.Conclusion DTI can be used to evaluate the therapeutic efficacy of 4-channel FES on the sequelae of cerebral ischemic stroke,and its parameters are significantly correlated with BBS score and FMA-LE score,suggesting that MRI can assist doctors in understanding the correlation between neurological impairments and neuropathological changes,and provide reference for accurate assessment of prognosis and formulation of individualized rehabilitation program.

OBJECTIVES: The automatic delineation of organs at risk (OARs) can help doctors make radiotherapy plans efficiently and accurately, and effectively improve the accuracy of radiotherapy and the therapeutic effect. Therefore, this study aims to propose an automatic delineation method for OARs in cervical cancer scenarios of both after-loading and external irradiation. At the same time, the similarity of OARs structure between different scenes is used to improve the segmentation accuracy of OARs in difficult segmentations. METHODS: Our ensemble model adopted the strategy of ensemble learning. The model obtained from the pre-training based on the after-loading and external irradiation was introduced into the integrated model as a feature extraction module. The data in different scenes were trained alternately, and the personalized features of the OARs within the model and the common features of the OARs between scenes were introduced. Computer tomography (CT) images for 84 cases of after-loading and 46 cases of external irradiation were collected as the train data set. Five-fold cross-validation was adopted to split training sets and test sets. The five-fold average dice similarity coefficient (DSC) served as the figure-of-merit in evaluating the segmentation model. RESULTS: The DSCs of the OARs (the rectum and bladder in the after-loading images and the bladder in the external irradiation images) were higher than 0.7. Compared with using an independent residual U-net (convolutional networks for biomedical image segmentation) model [residual U-net (Res-Unet)] delineate OARs, the proposed model can effectively improve the segmentation performance of difficult OARs (the sigmoid in the after-loading CT images and the rectum in the external irradiation images), and the DSCs were increased by more than 3%. CONCLUSIONS Comparing to the dedicated models, our ensemble model achieves the comparable result in segmentation of OARs for different treatment options in cervical cancer radiotherapy, which may be shorten time for doctors to sketch OARs and improve doctor's work efficiency.
Female ; Humans ; Image Processing, Computer-Assisted/methods* ; Machine Learning ; Organs at Risk/radiation effects* ; Radiotherapy Planning, Computer-Assisted/methods* ; Uterine Cervical Neoplasms/radiotherapy*

Objective To explore the feasibility and efficacy of endoscopic balloon dilation in treatment of esophageal stenosis caused by operation of congenital esophageal atresia. Methods A retrospective analysis was performed on data of 218 children with type Ⅲ esophageal atresia, who underwent surgery in Zhengzhou Children' s Hospital from January 2009 to December 2017. The occurrence of postoperative complications and efficacy of endoscopic balloon dilation in treatment of esophageal stenosis was analyzed. Results Among the 218 patients with congenital esophageal atresia, 92 were type Ⅲa and 126 were type Ⅲb. Postoperative anastomotic leakage occurred in 46 cases (21. 1％), including 29 (31. 5％) of type Ⅲa and 17 (13. 5％) of type Ⅲb. Postoperative anastomotic stenosis occurred in 53 cases (24. 3％), including 29 ( 31. 5％) of type Ⅲa and 24 ( 19. 0％) of typeⅢb. The incidence of anastomotic leakage and anastomotic stenosis in different types was significantly different (χ2=10. 383, P=0. 001; χ2=4. 497, P=0. 034). The 53 cases of anastomotic stenosis underwent 123 times of endoscopic balloon dilation, with mean time of 3. 5±1. 6, and were finally clinically recovery. No esophagus perforation occurred. Among them, 29 cases of type Ⅲa underwent 73 times with mean of 4. 0±1. 8, and 24 cases of type Ⅲb underwent 50 times with mean of 2. 5±0. 7. The difference between the two types was statistically significant (t=-4. 053, P=0. 027). Conclusion Children with type Ⅲa esophageal atresia has a higher incidence of anastomotic stenosis and leakage, and more times of esophageal dilation. Endoscopic balloon dilation is safe and effective in treatment of esophageal stenosis after surgery for patients with congenital esophageal atresia.

Objective To study the relationship between bronchial asthma and smoking status in Chinese people.Methods Asthma epidemiological survey and stratified-cluster-random method survey were performed in residents over 14 years in 8 provinces (cities) of China from February 2010 to August 2012.Asthma was diagnosed based upon case history,clinical signs and lung function test.Smoking status was investigated by questionnaire.Results Sampling population was 180 099 and 164 215 were valid.A total of 2 034 subjects were diagnosed as asthma including 79 692 men and 84 523 women.The overall prevalence rate of asthma was 1.24％ (2 034/164 215).Smokers were 23.8％ (39 137/164 215) in the whole population.Smokers were 34.5％ (702/2 034) in asthmatic patients,compared with 23.7％ (38 435/ 162 181) in no-asthmatic population.The incidence of asthma was 1.79％ and 1.06％ in smokers and nonsmokers respectively (P ＜0.001),suggesting that OR of smoking was 1.70 (95％ CI 1.55-1.86,P ＜ 0.001).According to asthma control test (ACT) score,the level of asthma control in non smoking group was higher than that in smoking group(43.2％ vs 35.3％).The times of hospitalization due to acute exacerbations (0.51 vs 0.41 events/person/year),total hospitalization rate (27.35 ％ vs 20.12％),annual emergency room visits (0.80 vs 0.60 events/person/year) and emergency room visit rate (31.77％ vs 24.47％) were all much higher in smoking asthmatic patients than those in non smoking asthmatic patients,indicating that the level of asthma control in smoking patients was significantly worse than in non smoking patients.Conclusions The smoking rate in Chinese people over 14 years is still high.The prevalence rate of asthma in smokers is significantly higher than that of non-smokers.The level of asthma control in smokers is significantly worse than that in non smokers.

Objective To investigate the infection characteristics and drug resistance of methicillin resistant Staphylococcus aureus after liver transplantation.Methods Retrospectively analyzed the clinical data of 170 patients who underwent liver transplantation in Beijing Chaoyang Hospital,Capital Medical University between January 2011 and April 2016.The incidence,pathogenic characteristics,distribution and drug resistance of methicillin resistant Staphylococcus aureus were analyzed.Results In this research,the methicillin resistant Staphylococcus aureus infection occurred in 23 cases after liver transplantation,and the incidence rate was 13.53％ (23/170).There were 27 strains of pathogens had been isolated,and 74.07％ (20/27) of pathogens were isolated from peritoneal drainage fluid.The most common methicillin resistant Staphylococcus aureus were Staphylococcus haemolyticus,Staphylococcus epidermidis and Staphylococcus hominis,accounting for 29.63％ (8/27),22.22％ (6/27) and 14.81％ (4/27).Drug sensitivity results indicated that the methicillin resistant Staphylococcus aureus were completely resistant to Penicillin,Oxacillin and Methicillin antibiotics.And the pathogens were extensively drug-resistant to Ciprofloxacin,Levofloxacin and Moxifloxacin,the resistance rates were 63％ (15/24),63％ (15/24) and 58％ (14/24).But the pathogens were sensitive to Teicoplanin,Vancomycin and Linezolid,and there have not been detected drug-resistant bacteria.Conclusions The infection of methicillin resistant Staphylococcus aureus is one of the most common pathogens after liver transplantation.Routine prophylactic antibiotics are not useful for the treatment,however,Teicoplanin,Vancomycin and Linezolid can be used as the first choice of treatment.

BACKGROUNDNeutrophil/lymphocyte ratio (NLR) has been proposed as a novel marker of systemic inflammation and oxidative stress. The objective of this study was to ascertain the relationship between levels of NLR and recurrence of lone atrial fibrillation (AF) after catheter ablation.

METHODSA total of 379 lone AF patients who underwent catheter ablation were enrolled in the study. The NLR before and after catheter ablation was determined. Cox regression analyses were used to estimate the relationship between NLR and the recurrence of lone AF.

RESULTSAfter a mean follow-up of (30.5 ± 5.3) months, 124 (32.7%) patients had AF recurrences. The patients who developed AF recurrence had a higher postablation NLR (post-NLR) than patients with no recurrence (5.74 ± 1.55 vs. 4.66 ± 1.27, P < 0.001). Multivariate Cox regression analysis revealed that post-NLR (hazard ratio (HR) 1.514, 95% confidence interval (CI) 1.364-1.680, P < 0.001), left atrium diameter (HR 1.035, 95% CI 1.001-1.071, P = 0.04) and body mass index (HR 1.028, 95% CI 1.002-1.054, P = 0.03) were independent predictors of AF recurrence. Using a cut-off level of 5.15, post-NLR predicted AF recurrence with a sensitivity of 73% and specificity of 67%.

CONCLUSIONSOur results indicate that an elevated post-NLR is associated with a high rate of lone AF recurrence. A simple measurement of NLR may help us to identify high-risk patients who need pharmacologic intervention to prevent recurrence.

Adult ; Atrial Fibrillation ; surgery ; Catheter Ablation ; Female ; Humans ; Lymphocytes ; immunology ; Male ; Middle Aged ; Neutrophils ; immunology ; Proportional Hazards Models

Objective To evaluate the clinical value of laparoscopic cystogastrostomy for retrogastric pancreatic pseudocysts.Methods Five patients suffering from retrogastric pancreatic pseudocysts caused by severe acute biliary pancreatitis received conservative management for 2 ～ 6 months,and the sizes of pseudocysts were 8,10,12,14,15 cm.All the 5 patients received laparoscopic cystogastrostomy,and 4 ports methods was applied,through anterior gastric wall,the posterior gastric wall and pancreatic pseudocysts were incised by using harmonic scalpel,then cystogastrostomy was performed to drain the pseudocysts.Results Laparoscopic cystogastrostomy for retrogastric pancreatic pseudocysts was successful in all patients,theoperation time was 90,105,115,120,150 minutes.The blood loss was 100,150,150,200,300 ml.No intra-gastric bleeding occurred.After 1 month follow-up,all the pseudocysts disappeared,and there was no acute pancreatitis and local infection recurrence.Gastric leakage occurred 7 d after operation in one patient,and was healed after one month of conservative management.Conclusions Laparoscopic cystogastrostomy through gastric cavity for retrogastric pancreatic pseudocysts is simple and effective,mini-invasive,and it can be an alternative therapeutic method for pancreatic pseudocysts.

According to the characteristics of general surgery class teaching,methods and experiences of the application of associative approach to general surgery class teaching were analyzed,such as word,picture,contrast,comprehensive,analogical and association,which is advantageous to the improvement of class teaching methods,effects and students' study interests and ideation.

ObjectiveTo determine the risk factors and the optimal management of hepatic artery complications (HAC) after orthotopic liver transplantation.MethodsThe clinical data of 180 orthotopic liver transplantation patients performed between January 2005 and September 2007 was reviewed.The incidence of HAC between primary liver carcinoma and benign diseases of liver was compared.ResultsTwelve (6.7％) episodes of HAC were identified.3 were hepatic artery thrombosis (HAT) and 9 were hepatic artery stenosis (HAS).The incidence of HAC in patients with primary liver carcinoma (6/39) was higher than benign disease (6/141)(P＜0.05).ConclusionsThe keys to management of HAC after orthotopic liver transplantation are to diagnose the complication in time and to select the proper treatment based on the type of HAC.