Objective To evaluate the quality of treatment planning(TP)and re-optimization planning(RP)of radiotherapy for rectal cancer using PlanIQ software,thereby providing methods and tools for the screening and optimization of radiotherapy plans.Methods Twenty patients with rectal cancer who received radiotherapy were selected retrospectively,with 10 cases of intensity-modulated radiotherapy(IMRT)and 10 of volumetric modulated arc therapy(VMAT).(1)TP:IMRT plan involved 5-field irradiation,and VMAT plan involved two 360°arcs.The prescription doses were 50 Gy/25 f for PTV1 and 45 Gy/25 f for PTV2.All plans underwent direct machine parameter optimization and required 95%isodose lines to cover 100%of the target volume.Organs-at-risk(OAR)were limited by reference to tolerated dose standards.After the planning was completed,the plans were reviewed and confirmed by a physician,and the treatment was implemented after dose verification.(2)RP:a physicist with 10 years of experience re-optimized the 20 TP plans,with the irradiation technique and field setting unchanged.The re-optimization involved adjusting planning conditions and parameters based on individual experience until the dose to OAR was minimized while without affecting PTV coverage.The quality of TP plans and RP plans were quantitatively evaluated using PlanIQ software.Non-parametric Wilcoxon signed rank test was performed for dose-volume histogram parameters and plan quality index between two groups.Results The dose-volume histogram parameters in RP plans were superior to those in TP plans,and the differences in the Dmax of PTV1,the V45 Gy and Dmax of small intestine,and the V45 Gy of colon were statistically significant(P<0.05).The quality scores of RP plans for IMRT group,VMAT group and all patients were significantly higher than those of TP plans(P<0.05),with plan quality index of 88.55±3.35 vs 86.61±4.63(P=0.005),89.72±3.15 vs 87.21±3.04(P=0.028),and 89.14±3.22 vs 86.91±3.22(P=0.001),respectively.Conclusion RP can further improve the quality of radiotherapy plan for rectal cancer.PlanIQ software serves as an effective tool for quality control and screening of radiotherapy planning.

Objective To assess inter-observer variations(IOV)in the delineation of target volumes and organs-at-risk(OAR)for intensity-modulated radiotherapy(IMRT)of nasopharyngeal carcinoma(NPC)among physicians from different levels of cancer centers,thereby providing a reference for quality control in multi-center clinical trials.Methods Twelve patients with NPC of different TMN stages were randomly selected.Three physicians from the same municipal cancer center manually delineated the target volume(GTVnx)and OAR for each patient.The manually modified and confirmed target volume(GTVnx)and OAR delineation structures by radiotherapy experts from the regional cancer center were used as the standard delineation.The absolute volume difference ratio(△V_diff),maximum/minimum volume ratio(MMR),coefficient of variation(CV),and Dice similarity coefficient(DSC)were used to compare the differences in organ delineation among physicians from different levels of cancer centers and among the 3 physicians from the same municipal cancer center.Furthermore,the IOV of GTVnx and OAR among physicians from different levels cancer centers were compared across different TMN stages.Results Significant differences in the delineation of GTVnx were observed among physicians from different levels of cancer centers.Among the 3 physicians,the maximum values of △V_diff,MMR,and CV were 97.23%±83.45%,2.19±0.75,and 0.31±0.14,respectively,with an average DSC of less than 0.7.Additionally,there were considerable differences in the delineation of small-volume OAR such as the left and right optic nerves,chiasm,and pituitary,with average MMR>2.8,CV>0.37,and DSC<0.51.However,relatively smaller differences were observed in the delineation of large-volume OAR such as the brainstem,spinal cord,left and right eyeballs,and left and right mandible,with average△V_diff<42%,MMR<1.55,and DSC>0.7.Compared with the differences among physicians from different levels cancer centers,the differences among the 3 physicians from the municipal cancer center were slightly reduced.Furthermore,there were also differences in the delineation of target volumes for NPC among physicians from different levels cancer centers,depending on the staging of the disease.Compared with the delineation of target volumes for earlier stage patients(stages I or II),the differences among physicians in the delineation of target volumes for advanced stage patients(stages III or IV)were smaller,with average △V_diff and DSC of 98.31%±67.36%vs 69.38%±72.61%(P<0.05)and 0.55±0.08 vs 0.72±0.12(P<0.05),respectively.Conclusion There are differences in the delineation of GTVnx and OAR in radiation therapy for NPC among physicians from different levels of cancer centers,especially in the delineation of target volume(GTVnx)and small-volume OAR for early-stage patients.To ensure the accuracy of multicenter clinical trials,it is recommended to provide unified training to physicians from different levels of cancer centers and review their delineation results to reduce the effect of differences on treatment outcomes.

Purpose: This study was aimed to investigate long-term survivals and toxicities of early-stage nasopharyngeal carcinoma (NPC) in endemic area, evaluating the role of chemotherapy in stage II patients. Materials and Methods: Totally 187 patients with newly diagnosed NPC and restaged American Joint Committee on Cancer/ International Union Against Cancer 8th T1-2N0-1M0 were retrospectively recruited. All received intensity-modulated radiotherapy (IMRT)±chemotherapy (CT) from 2001 to 2010. Results: With 15.7-year median follow-up, 10-year locoregional recurrence-free survival, distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were 93.3%, 93.5%, 92.9% and 88.2%, respectively. Multivariable analyses showed cervical lymph nodes positive and pre-treatment prognostic nutritional index ≥ 52.0 could independently predict DMFS (p=0.036 and p=0.011), DSS (p=0.014 and p=0.026), and OS (p=0.002 and p < 0.001); Charlson comorbidity index < 3 points could predict DSS (p=0.011); age > 45 years (p=0.002) and pre-treatment lactate dehydrogenase ≥ 240 U/L (p < 0.001) predicted OS. No grade 4 late toxicity happened; grade 3 late toxicities included subcutaneous fibrosis (4.3%), deafness or otitis (4.8%), skin dystrophy (2.1%), and xerostomia (1.1%). No differences on survivals were shown between IMRT+CT vs. IMRT alone in stage II patients, even in T2N1M0 (p > 0.05). Unsurprising, patients in IMRT+CT had more acute gastrointestinal reaction, myelosuppression, mucositis, late ear toxicity, and cranial nerve injury (all p < 0.05) than IMRT alone group. Conclusion Superior tumor control and satisfying long-term outcomes could be achieved with IMRT in early-stage NPC with mild late toxicities. As CT would bring more toxicities, it should be carefully performed to stage II patients.

Dendritic cell-based cancer vaccines (DC vaccines) have been proved efficient and safe in immunotherapy of various cancers, including melanoma, ovarian and prostate cancer. However, the clinical responses were not always satisfied. Here we proposed a novel strategy to prepare DC vaccines. In the present study, a fusion protein SNU containing a secretin-penetratin (SecPen) peptide, NY-ESO-1 and ubiquitin was designed and expressed. To establish the DC vaccine (DC-SNU), the mouse bone marrow-derived DCs (BMDCs) were isolated, pulsed with SNU and maturated with cytokine cocktail. Then peripheral blood mononuclear cells (PBMCs) from C57BL/6 mice inoculated intraperitoneally with DC-SNU were separated and cocultured with MC38/MC38

In recent years, many researchs have found that microRNA (miRNAs) has differential expression in pancreatic tissues, pancreatic cancer cells and drug-resistant pancreatic cancer cells, and miRNAs can change the sensitivity of pancreatic cancer cells to chemotherapy drugs by acting on downstream target genes.The molecular mechanism of drug resistance in tumors is complex. In the drug-resistance of pancreatic cancer, miRNAs can mediate drug resistance in pancreatic cancer cells by affecting epithelial-mesenchymal transformation, DNA damage and repair, downstream signaling pathways, non-coding RNA, related coding genes, pancreatic cancer stem cells and other mechanisms. Therefore, the investigation of drug resistance mechanism and related miRNAs in pancreatic cancer will help to find new anti-drug resistance treatment methods. The authors summarize exosome miRNAs invloved in regulating chemoresistance in pancreatic cancer, in order to provide theoretical support for clinical treatment and find new targeted therapy of pancreatic cancer.

Objective To analyze the death characteristics and disease burden of the labor force in Jingzhou City from 2015 to 2018, and to provide a basis for formulating policies to protect the labor force population and propose effective prevention and control measures to reduce the death level and disease burden. Methods The death data of the labor force in Jingzhou City from 2015 to 2018 was collected and statistically analyzed. The death levels, causes of death, and disease burden of the labor force in different years, sexes, ages, and regions were analyzed. Results From 2015 to 2018, the death toll of the labor force accounted for 24.79% of total deaths in Jingzhou City, with a mortality rate of 219.61/100 000 and a standardized mortality rate of 192.17/100 000. There was no significant difference in the mortality rate in different years (P=0.34). The male and female mortality rates were 297.77/100 000 and 139.63/100 000, and the standardized mortality rates were 257.36/100 000 and 119.57/100 000, respectively. The male and female YLL rates were 9.55% and 4.47%, and the standardized YLL rates were 6.75% and 3.12%, respectively. The male mortality and YLL rates were higher than those of the female (P<0.01). The mortality and YLL rate of different age groups increased with age (P<0.01). The mortality rates of urban and rural population were 187.37/100 000 and 229.07/100 000, respectively, the standardized mortality rates were 141.87/100 000 and 208.58/100 000, respectively, the YLL rates were 5.90% and 7.37% respectively, and the standardized YLL rates were 4.13% and 5.20%, respectively. The mortality rate and YLL rate of rural population were higher than those of urban population (P<0.01). The first cause of death in the labor force population was malignant tumor, with the mortality and YLL rate being 87.19/100 000 and 2.90%, respectively. The second cause was injury, with the mortality and YLL rate of 42.60/100 000 and 1.56%, respectively. The leading cause of death was injury in the 15 and 25 years old groups, and malignant tumor in the 35, 45 and 55 years old groups. Lung cancer and liver cancer were the main types of lethal cancers. Transportation accidents and suicide were the main types of lethal injuries. Conclusion The disease burden of the rural labor force was heavy. It is important to strengthen health education for the rural labor force, especially male laborers over the age of 45, and to implement early cancer diagnosis and treatment and injury intervention programs to effectively improve the health of the labor population.

Objective To explore the clinical value of laparoscopic totally extraperitoneal herniorrhaphy (LTEP) and open to tally extraperitoneal (OTEP) for bilateral inguinal hernias.Methods From January 2015 to December 2017,61 male patients with bilateral inguinal hernias,who were in accordance with the inclusion criteria,were prospectively randomized into laparoscopic totally extraperitoneal herniorrhaphy group (LTEP group,n =31)or totally extraperitoneal herniorrhaphy via hypogastric midline incision group(OTEP group,n =30).Operative outcomes,postoperative complications,recurrence,the levels of C-reactive protein (CRP) were analyzed.The data were analyzed by statistical software.Results The operative baselines of patients in two groups were equivalent.In patients who received laparoscopic totally extraperitoneal herniorrhaphy,decreased levels of CRP on the 1th day after operation,postoperative ambulation and hospital stay [(88.7 ± 18.5) mg/L vs (102.0 ±25.1) mg/L,P=0.022];[(5.6±2.2) h vs (20.0±5.5) h,P＜0.001;(3.0±0.6) dvs (4.5±1.0) d,P ＜ 0.001],were found compared with the OTEP group significantly,LTEP group had more hospitalization expense than OTEP group [(14 779.3 ± 1450.1) yuan vs (13 650.0 ± 1 787.3) yuan,P ＜ 0.001].There were no mesh infection,chronic pain,scrotal edema and recurrence of inguinal hernia in two groups.No difference was found between the two groups in the other operative outcomes and postoperative complications.Conclusion Both laparoscopic totally extraperitoneal herniorrhaphy and totally extraperitoneal herniorrhaphy via hypogastric midline incision are effective and safe in the treatment of bilateral inguinal hernias,each has both advantages and disadvantages,and complement each other.

Objective: To investigate the expression and significance of NF-κB in oral squamous cell carcinoma and paracancerous tissues. Methods: Cancerous and paracancerous tissues about 5 mm outside the tumor boundary were cut from 47 patients with OSCC. NF-κB expression in these tissues were detected by the immunohistochemical SP method and compared with that in 32 normal oral mucosa tissues. Results : The average optical density (OD value) of immunohistochemical-positive cells in cancer tissues and paracancerous tissues was higher than that in normal tissues, and the difference was statistically significant (P < 0.001). There was no significant difference in the OD values between cancer tissues and paracancerous tissues (P=0.356). The rate of NF-κB positive expression in cancer tissue and paracancerous tissue was significantly higher than that in normal mucosa tissue, and the difference was statistically significant (P < 0.001). There was no significant difference in the rate of NF-κB positive expression between cancer tissues and paracancerous tissues (P=0.117), but the rate of moderate-to-strong positive expression in cancer tissues was significantly higher than that in paracancerous tissues (P < 0.001). Conclusion NF-κB may be involved in the development of OSCC.

Objective: To assess the interobserver variations in delineating the planning target volume (PTV) and organs at risk (OAR) using different contouring methods during intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), aiming to provide references for the quality control of multi-center clinical trials. Methods: The PTV and OAR of CT image of 1 NPC patient manually delineated by 10 physicians from 8 different radiation centers were defined as the " manual contour group" , and the OAR auto-contoured using the ABAS software and modified by the physicians were defined as the " auto+ manual contour group" . The maximum/minimum ratio (MMR) of the PTV and OAR volumes, and the coefficient of variation (CV) for different delineated contours were comparatively evaluated. Results: Large variation was observed in the PTV and OAR volumes in the manual contour group. The MMR and CV of the PTV were 1.72-3.41 and 0.16-0.39, with the most significant variation in the PTV_nd (MMR=3.41 and CV=0.39 for the PTV_nd-L). The MMR and CV of the manually contoured OAR were 1.30-7.89 and 0.07-0.67. The MMR of the temporal lobe, spinal cord, temporomandibular joint, optic nerve and pituitary gland exceeded 2.0. Compared with the manual contour group, the average contouring time in the auto+ manual group was shortened by 68% and the interobserver variation of the OAR volume was reduced with an MMR of 1.04-2.44 and CV of 0.01-0.37. Conclusions Large variation may occur in the PTV and OAR contours during IMRT plans for NPC delineated by different clinicians from multiple medical centers. Auto-contouring+ manually modification can reduce the interobserver variation of OAR delineation, whereas the variation in the delineation of small organs remains above 1.5 times. The consistency of the PTV and OAR delineation and the possible impact upon clinical outcomes should be reviewed and evaluated in multi-center clinical trials.

Objective To analyze the results of assessment of malaria elimination in 9 counties (districts) of Nanchang City, and explore suitable monitoring methods for malaria after elimination of the disease in this region. Methods In 2016, the data from the network reports of malaria epidemic situation, blood examinations of febrile patients, epidemiological questionnaires of local malaria cases, investigation of epidemic focuses and disposal tables were collected and analyzed in Nanchang City from 2010 to 2015. The data of malaria elimination assessment at county ( district ) level of Donghu District , Xihu District , Qingshanhu District and Wanli District in 2013 , Nanchang County and Anyi County in 2014, Jinxian County, Qingyunpu District and Xinjian District in 2015 were collected. At same time, the data of ability of the diagnosis and treatment of malaria in clinicians, the microscopical examinations of Plasmodium in the inspection personnel were collected . Totally 30 negative blood slides and all positive blood slides since 2010 were reviewed. Results From 2010 to 2015, 93 local malaria cases were reported in Nanchang City, the majority of malaria cases were imported except 2 local malaria infection cases in 2010. Totally 64027 febrile patients received blood detections for malaria, of which 101 cases were positive and the positive rate was 0.16％. The positive blood slides review rate was 100.00％ (101/101), the negative blood slides review rate was 9.69％ (6195/63926). 9 counties (districts) all passed the malaria elimination assessment at county ( district ) level . The malaria elimination assessment scores of the 9 counties (districts) were all higher than 90 points. The correct rate of inspection personnel of microscopical examinations of Plasmodium was 91.58％ (174/190), the correct rate of knowledge of the diagnosis and treatment of malaria was 95.00％ (1710/1800), the coincidence rate of blood slides review was 100 . 00％( 304/304 ) in Nanchang , the qualified rate of slides production and dyeing was 88.16％ (268/304). Conclusions All the 9 counties (districts) of Nanchang City have passed the malaria elimination assessment with high scores. After malaria elimination, the monitoring should continue to consolidate the achievements.