Objective:To evaluate the robustness of fully automated adaptive planning for Ethos online adaptive radiotherapy (ART) based on the intelligent optimization engine (IOE).Methods:Clinical data of 11 stage ⅠB cervical cancer patients admitted to Peking Union Medical College Hospital between June 2021 and June 2022 were retrospectively analyzed. Original planning images and iterative cone-beam computed tomography (iCBCT) images of each radiotherapy treatment were acquired, and all patient data were imported into the Ethos simulator. IOE-based 9-field automatic plan generation was performed for 11 patients using Ethos, and the generated plans were sent to online adaptive radiotherapy simulation to obtain each online adaptive radiotherapy plan (273 fractions in total) and complete the simulated treatment. For comparison, manual plan design was performed based on the images and contoured structures used for online adaptive radiotherapy planning, and the manually plans created with evenly divided 9 fields. Dosimetric parameters, plan complexity parameters, and Mobius quality assurance (QA) pass rates were collected to compare and evaluate the robustness of the online adaptive radiotherapy plan in terms of organs at risk (OAR), target volume dosimetric parameters, and plan complexity by using paired t-test or rank sum test. Results:The online adaptive plan of cervical cancer had comparable planning target volume (PTV) coverage compared to the manual plan. For the clinical target volume (CTV) D 99%, online adaptive plan was significantly higher than the manual plan [(45.93±0.36) vs. (45.32±0.31) Gy, P<0.001]. For hot dose area, the maximum point dose (PTV D max) of adaptive plan was significantly higher than the manual plan [(49.89±1.25) vs. (48.48±0.77) Gy, P<0.001], but the PTV D 1% of adaptive plan was significantly lower than the manual plan [(47.22±0.29) vs. (47.59±0.48) Gy, P<0.001]. There was no statistical difference in the conformal index ( P=0.967). And there was significant difference in the homogeneity index, with same medians and less dispersion in adaptive plan ( P<0.001). For OAR dose, bladder D mean, rectal V 40 Gy, small intestine D mean of adaptive plan was slightly higher than that of the manual plan; the rectal D mean, small intestine D 2 cm3 of the adaptive plan was slightly lower than that of manual plan; dosimetric parameters of right and left femoral heads, spinal cord and bone marrow of the adaptive plan were better than those of manual plan. The adaptive plan had more monitor units (MU) than the manual plan, but the complexity of the adaptive plan was significantly lower than that of the manual plan (0.135±0.012 vs. 0.151±0.015, P<0.001). For Mobius γ pass rate (5%/3 mm), both adaptive and manual plans met clinical requirements. Conclusion:Ethos cervical cancer online adaptive plan, which is based on the IOE engine, demonstrates good robustness and ensures the quality of online adaptive plans generated for each treatment fraction.

Objective:To evaluate the automatic optimization performance and clinical feasibility of the intelligent optimization engine (IOE) in the Ethos online adaptive radiotherapy platform.Methods:Clinical data of 11 patients with postoperative cervical cancer treated with Halcyon accelerator were retrospectively analyzed. Manual planning was performed for all patients using the 4 full arc volumetric modulated arc therapy (VMAT) (Manual-4Arc) in Eclipse, with a prescription dose of 45 Gy/25F. Patient images and structures were imported into the Ethos simulator, and appropriate clinical goals were added based on clinical requirements. The target coverage was normalized to 95%. Automatic plan generation was conducted using IOE, resulting in 7, 9, and 12 field intensity modulated radiotherapy (IMRT) plans (IMRT-7F、IMRT-9F、IMRT-12F), as well as 2 and 3 arc VMAT plans (VMAT-2Arc、VMAT-3Arc). Dosimetric index comparisons were made between the Manual-4Arc plans and the 5 groups of IOE-generated plans through one-way analysis of variance. Based on the analysis results, Turky post hoc multiple comparisons were performed to evaluate the automatic optimization performance of IOE.Results:In terms of the high dose area, the IMRT-12F plans showed the lowest D 1% for the planning target volume (PTV), and there were significant differences compared to the Manual-4Arc plans ( P=0.004). Regarding target coverage, all groups produced clinical target volume (CTV) plans that met the clinical requirements. Although the Ethos online adaptive plans were normalized during planning, the PTV coverage was slightly insufficient. For organs at risk (OAR) close to the target, such as the bladder, there were significant differences in V 30 Gy, V 40 Gy, and D mean among the 6 groups of plans. The dose ranking for the bladder was generally as follows: IMRT-12F

A case of cirrhosis with spontaneous spinal cord hemorrhage is reported. The patient was a 57-year-old male, whose main clinical symptoms were acute onset, sudden progressive decline of lower limb muscle strength, and incontinence. Magnetic resonance imaging+magnetic resonance angiography+susceptibility-weighted imaging of thoracic spinal cord showed that thin strip like equal and slightly high signal could be seen in the spinal cord of T 1WI sequence, a few low signal foci could be seen in the corresponding part of T 2WI sequence, and there was no obvious change in enhanced scanning. Obvious long strip like low signal foci were shown in the spinal cord of susceptibility-weighted imaging, and the range was significantly larger than that of T 2WI sequence. Spinal cord hemorrhage was diagnosed before operation, and no obvious improvement was found after drug treatment. Spontaneous spinal cord hemorrhage was diagnosed after surgical incision.

Objective:To analyze the differences in dosimetric quality and plan complexity of volumetric modulated arc therapy (VMAT) plans based on Halcyon 2.0 and Truebeam for different treatment sites of the patients.Methods:Halcyon 2.0 VMAT plans in head & neck, chest, abdomen, and pelvis treatment sites of 49 cases were retrospectively selected and the VMAT plans were re-designed based on Truebeam with the same optimization parameters. The differences in dosimetric metrics and plan complexity between the two types of plans were compared and analyzed. P<0.05 was considered as statistically significant. Results:In terms of PTV, Halcyon 2.0 plans showed better homogeneity index (HI), conformal index (CI) in the head & neck and chest. Besides, Halcyon 2.0 plans yielded better D 98% and CI in the abdomen and better D 2% in the pelvis. For organs at risk (OAR), the D 20% and D mean of bilateral lungs, and D meanof heart for Halcyon 2.0 plans in the chest were lower than those for Truebeam plans (all P<0.05). For the complexity metrics, the median average aperture area variability (AAV) of Halcyon 2.0 plans in the head & neck, abdomen and pelvis were 0.414, 0.425 and 0.432, which were better than 0.385, 0.368 and 0.361 of Truebeam plans in the corresponding sites, respectively. In the abdomen and pelvis, Halcyon 2.0 plans showed better median modulation complexity score (MCS) than Truebeam plans (0.320 vs. 0.268, 0.303 vs. 0.282; both P<0.05). The median small aperture score (SAS) for all plans of Halcyon 2.0 were better than that of Truebeam plans (all P<0.05), and the median plan average beam area (PA) of all plans of Halcyon 2.0 were larger than that of Truebeam plans (all P<0.05). Conclusions:Compared with conventional fractionated VMAT plans based on Halcyon 2.0 and Truebeam, Halcyon 2.0 plans have similar or even better dosimetric quality. However, Halcyon 2.0 plans have lower plan complexity, which makes it an advantage in clinical application.

Periodontitis is a common infectious disease that is harmful to human oral health and is the main cause of tooth loss. Periodontal inflammation can damage the integrity of the epithelium, causing periodontal pathogens to spread to the systemic circulation, and the periodontal pocket contains a large number of inflammatory mediators, especially those related to chronic inflammation, such as tumor necrosis factor-α, interleukins and prostaglandins, which will enter the blood circulation system from periodontal pocket and cause systemic inflammatory response. Periodontitis is closely related to the occurrence and development of systemic diseases, including cardiovascular, endocrine, respiratory, immune, and nervous systems. Inflammatory responses and inflammatory factors may be the mechanism of the association between periodontitis and multiple systemic diseases. This article reviews the current research on the relationship between periodontitis and systemic disease.

Objective To revise looming maladaptive style questionnaire(LMSQ-R) and examine its reliability and validity.Methods 284 undergraduates were measured preparedly with LMSQ-R,281 university students participated in a retest,using LMSQ-R,fear of negative evaluation scale (FNE),Beck anxiety inventory (BAI),Beck depression inventory (BDI).Results ①The item distinguish analysis was acceptable.②Reliability analysis confirmed that Cronbach α coefficient of LMSQ-R was 0.736,Cronbach α coefficient of the two subscales were 0.593 and 0.636.The test-retest reliability of LMSQ-R ranged from 0.564 to 0.700.③Confirmatory factor analysis suggested that the first order six factor-second order two factor model was perfect according to the evaluation criteria.The correlation coefficient between the two subscales was 0.527,the correlation coefficients among the two subscales and the total score ranged from 0.872 to 0.875.The correlation coefficients among the LMSQ-R and FNE,BAI,BDI ranged from 0.872 to 0.875,the results had statistical significance.Conclusion The revised LMSQ-R shows the satisfactory reliability and validity in university students.It can be used as a useful testing tool of LCS in psychological research.

Background Staphylococcus aureus,Staphylococcus epidermidis and Pseudomonas aeruginosa are common pathogenic bacteria in ophthalmology.To seek an optimal antimicrobial method is critical for the prevention of infection.Objective This study was to investigate the antimicrobial efficacy of riboflavin-ultraviolet A (UVA) on Staphylococcus aureus,Staphylococcus epidermidis and Pseudomonas aeruginosa.Methods Ten strains of frozen Staphylococcus aureus,Staphylococcus epidermidis and Pseudomonas aeruginosa were incubated to culture dishes and resuscitated for 2 times.The bacteria were put into bacterial dilution to prepare the suspension of 0.5 Mclntosh concentration and then the suspension was diluted 10-folds.UVA was used to irradiate the culture dishes added 0,0.1％,0.5％ riboflavin for 10,20,30 minutes with the exposure intensities of 1,2,3 mW/cm2,and the optimal bacteriostatic condition was evaluated by measuring the diameters of inhibition zone.Staphylococcus aureus,Staphylococcus epidermidis and Pseudomonas aeruginosa were divided into normal control group,riboflavin group,UVA group and photodynamic therapy (PDT) group (riboflavin+UVA),and colony forming unit was compared among the groups.Results The optional experimental conditions of PDT inactivating microorganisms were determined as UVA wavelength 370 nm,UVA exposure rate 3 mW/cn2,UVA exposure time 30 minutes and riboflavin 0.1％.The colony forming units were decreased in turn in the normal control group,riboflavin group,UVA group and PDT group (F =110.990,190.841,118.197,all at P =0.000).Compared with the normal control group,the colony forming units were significantly decreased in the UVA group (t =14.640,7.550,5.320,all at P＜0.05),and the colony forming units were significantly decreased in the PDT group (t =25.480,14.750,12.920,all at P＜0.05).The colony forming units decreased by 46.4％-50.2％ in the UVA group and 91.6％-96.7％ in the PDT group.There was no significant difference in colony forming units between the normal control group and the riboflavin group(t =0.660,0.470,0.510,all at P＞0.05).Conclusions PDT can effectively inactivate common bacteria in ophthalmology.This result suggests that PDT has a potential in the treatment of microbial keratitis.

Objective To identify the risk factors for early postoperative cognitive dysfunction (POCD) in the elderly patients undergoing spinal surgery.Methods One hundred and fifty ASA Ⅱ or Ⅲ patients,aged ≥65 yr,undergoing elective spinal surgery under general anesthesia,were studied.Venous blood samples were taken at 1 day before operation and 7 days after operation to determine the concentration of serum S-100B protein.Cognitive function was assessed by Mini-Mental State Examination (MMSE) at 1 day before operation and 7 days after operation.The patients were diagnosed as having POCD if MMSEpre-MMSEpost ≥ 3.The patients were divided into POCD group and non-POCD group.Age,body weight,sex,education,type of operations,complications,preoperative TCM syndrome type,MMSE score at 1 day before operation and 7 days after operation,duration of operation,emergence time,and intraoperative blood loss,cardiovascular events,and amount of fluid infused per hour were recorded.The risk factors for POCD were analyzed using multivariate logistic regression analysis.Results Thirty-eight patients developed early POCD (25.3％).The resuhs of logistic regression analysis showed that age ≥ 70 yr,elementary education or below,duration of operation ≥5 b,and the number of hypotension occurred during operation≥3 were the risk factors for early POCD.Conclusion Age≥70 yr,elementary education or below,duration of operation ≥ 5 h,and the number of hypotension occurred during operation ≥ 3 are the risk factors for early POCD in the elderly patients undergoing spinal surgery.

Background The study on the classification of fungi is very important for the diagnosis and treatment of fungal keratitis.Identifying the different species of filamentous fungi is a critical factor for the application of anti-fungal drug in treating keratitis.ObjectiveThis report studies the relationship between the genotype of filamentous fungi and the clinical factors.MethodsFifty-two patients with filamentous fungal keratitis determined by clinical and laboratory examination were recruited in Tongren Hospital from January 2006-December 2006.The lesions were graded on the severity of the corneal ulcer and the presence of hypopyon.The filamentous fungal keratitis was treated with topical and systemic administration of anti-fungal drugs or corneal transplantation.The isolates were cultured in potato culture and identified by morphological characteristics based on the Nelson criterion and genotyped by the rDNA ITS method.The clinical data was retrospectively analyzed.ResultsForty-eight species (eubacteria are bacteria,not fungi)of fungus were identified by morphological characteristics,and the filamentous fungi were divided into 4 types based on the phylogenetic relationships within the rDNA ITS of the 52 filamentous fungi.The morphological characteristics and genotype were confirmed in 48 strains of eubacteria and 31 strains of 52 filamentous fungi (90.3%).The 4 groups of fungi were classified by genotype as follows:group 1 represents 22 strains including 20 strains of Fusarium solani and 2 strains of Fusarium oxysporum;group 2 represents 12 strains including 8 strains of Fusarium moniliformis,3 strains of Fusarium proliferatum and 1 strain of Fusarium incarnatum;group 3 represents 5 strains including 1 strain of Fusarium moniliformis and 4 unknown strains;group 4 represents 13 strains including 10 strains of Aspergillus spp.and 3 strains of Alternaria spp.Significant differences were found in the disease duration (P=0.00),inducing cause (P=0.03),ulcer grade (P=0.01)and outcome of the anti-fungal treatment (P=0.035)when compared between group 1 and 2 with group 3 and 4.Conclusion Filamentous fungi that cause keratitis could be correctly identified by sequencing the internal tanscribed spacer of rDNA.There are significant clinical differences among the groups classified by genotype.

ACEI and Xyr1 are two regulators that potentially involve in regulation of cellulases and xylanases formation in Trichoderma reesei, they compete for a binding site in the xyn1 (Xylanase1-encoding) gene promoter. To further investigate the mechanism for the transcriptional regulation of cellulases, DNA-binding domains of both ACEI and Xyr1 in T. Koningii were expressed from E. coli. They both showed bindings to the cbh1 promoter fragment (-304 bp to -18 bp) by electrophoresis mobility shift assays, suggesting ACEI and Xyr1 not only compete for binding to xyn1 promoter but also to cbh1 promoter.
Binding Sites ; Cellulase ; biosynthesis ; Endo-1,4-beta Xylanases ; genetics ; metabolism ; Escherichia coli ; genetics ; metabolism ; Gene Expression Regulation, Enzymologic ; Gene Expression Regulation, Fungal ; Promoter Regions, Genetic ; Trans-Activators ; genetics ; metabolism ; Trichoderma ; enzymology ; genetics