Objective:To explore the dosimetric differences of different dose accumulation method for brachytherapy combined with external beam radiation therapy (EBRT) of cervical cancer and establish clinical prediction models for radiation-induced late rectal injury (RLRI) after radiotherapy.Methods:A retrospective analysis was conducted for the clinical data of patients who received radical concurrent chemoradiotherapy (CCRT) for cervical cancer in the Department of Oncology of the Affiliated Hospital of North Sichuan Medical College from January 1, 2020 to November 30, 2021. EBRT combined with brachytherapy was employed for the patients, and dose assessment was performed in two means: the direct accumulation using equivalent dose in 2-Gy fractions (EQD2) and deformable image registration (DIR)-based dose accumulation of 3D planning images. The toxicity criteria of the Radiation Therapy Oncology Group were adopted as the RLRI grading criteria. The prediction models of RLRI using both dose assessment method were constructed. The areas under the receiver operating characteristic (ROC) curves were calculated to assess the predictive accuracy of the different dose assessment method.Results:In the case of brachytherapy, the D95% and D90% EQD2 doses to high-risk clinical target volumes (HR-CTVs) were 2.18 and 2.92 Gy higher respectively and the D2 cm 3, D1 cm 3, and D0.1 cm 3 EQD2 doses to the rectal were 1.74, 2.28, and 2.26 Gy higher, respectively compared to DIR-based dose accumulation ( t = 3.82, 5.21, 4.58, 5.17, 2.05, P < 0.05). For EBRT combined with brachytherapy, the D2 cm 3, D1 cm 3, and D0.1 cm 3 EQD2 doses to the rectal were 6.22, 7.61, 9.56 Gy higher than DIR-based doses, respectively, and the dosimetric differences were statistically significant ( t = 9.40, 10.59, 7.87, P < 0.001). The joint prediction model yielded an area under the ROC curve of 0.788. The sensitivity and specificity of the optimal cut-off value were 0.850 and 0.660, respectively. Furthermore, the Hosmer-Lemeshow goodness-of-fit tests indicated high goodness-of-fit ( P > 0.05). The prediction model for DIR-based dose accumulation of traditional predictors yielded areas under the ROC curves for D2 cm 3 and D1 cm 3 to the rectal of 0.784 and 0.763, respectively. The sensitivities of the optimal cut-off values were 0.850 and 0.750, respectively, and the specificities were 0.679 and 0.717, respectively. Conclusions:There are dosimetric differences between the direct dose accumulation using EQD2 and DIR-based dose accumulation of 3D planning images for brachytherapy combined with EBRT. Both the joint prediction model and the DIR-based dose accumulation of D2 cm 3 and D1 cm 3 to the rectal are effective in predicting RLRI. Given the complex calculation of the joint prediction model, it is recommended that RLRI should be predicted through DIR-based dose accumulation of D2 cm 3 and D1 cm 3 to the rectal clinically.

Objective:To investigate the efficacy of staged treatment of infectious femoral defects of Cierny-Mader type Ⅳ using bone transport combined with locking plating after En-Bloc resection debridement.Methods:A retrospective analysis was conducted of the 10 patients with distal femoral traumatic bone infection who had been treated at Department of Orthopedics, The People's Hospital of Weifang from January 2020 to January 2023. There were 8 males and 2 females with an age of (48.5±11.4) years. All cases were classified as Cierny-Mader type Ⅳ. At the first stage, En-Bloc resection debridement was performed in all cases to remove previous internal fixation devices and fill the defects with antibiotic bone cement. After infection control, the second stage involved removal of bone cement, re-fixation with internal devices, and external fixation support for bone transport. After the bone segments met, freshening of the bone ends, minor bone grafting, and screw locking of the transported bone segments were performed. Outcomes observed included bone defect length, frame carrying time and index, bone healing time, limb function, and complications.Results:After the first stage of debridement, a bone defect of (9.1±2.1) cm was created in 10 patients. All patients were followed up for (19.8±6.6) months. The duration for carrying external fixation frame was (107.2±25.1) days, and the frame index (11.8±0.5) d/cm. No recurrence was observed postoperatively. Bone union was achieved in 9 patients within 8 months, but in 1 patient only after secondary bone grafting due to poor healing at the meeting ends. All patients returned to their previous life or physical labor with no complications like pain or re-fracture. Three patients experienced varying degrees of knee joint stiffness, but were able to meet needs of daily life; one requested joint release surgery which resulted in satisfactory therapeutic efficacy.Conclusion:Staged treatment of infectious femoral defects of Cierny-Mader type Ⅳ using bone transport combined with locking plating after En-Bloc resection debridement is simple and effective.

Objective To investigate the impacts of drug administration processes on comfort, tolerability and adverse events in patients with chemotherapy for multiple myeloma. Methods A total of 113 patients with chemotherapy for multiple myeloma were randomly divided into control group (n=56) and observation group (n=57). The control group was treated with conventional drug administration procedures, while the observation group was treated with bortezomib subcutaneously by an optimized drug administration process. Comfort level, tolerability, adverse events and satisfaction rate for injection were compared between the two groups before and after intervention. Results After intervention, the observation group scored higher on the General Comfort Questionnaire (GCQ) for physiological dimension of (24.59±2.73), psychological dimension of (25.64±2.29), sociocultural dimension of (22.64±2.05), environmental of (11.79±1.37), and total score of (79.21±6.81) than (21.68±2.67), (22.05±2.16), (18.11±1.74), (9.42±1.46) and (63.52±6.34) respectively in the control group. Total chemotherapy course was (6.02±1.08) cycles in the observation group, which was less than (7.86±1.59) cycles in the control group, with a chemotherapy discontinuation rate of 8.77% versus 37.5%, and the full-dose and full-schedule chemotherapy completion rate of 96.49% versus to 82.14% between observation group and control group, and all the differences were statistical significant (P < 0.05). The overall incidence of liver-kidney function damage, thrombocytopenia, and peripheral neuropathy during medication administration was 3.51% in the observation group, which was significantly lower than 16.07% in the control group (P < 0.05). The satisfaction rate for injection in the observation group was 94.74%, which was significantly higher than 78.57% in the control group (P < 0.05). Conclusion Optimizing the drug administration process can improve patient's comfort and tolerability during chemotherapy for multiple myeloma, reduce the incidence rate of adverse reactions, and has a high satisfaction rate for injection.

OBJECTIVE To explore the material basis and mechanism of expectorant and cough relief effects of the fruits of Phellodendron chinense var. glabriusulum Schneid. METHODS The expectorant and cough relief effects of volatile oil and water decoction of the fruits of P. chinense var. glabriusulum Schneid. were studied by ammonia water cough induction and drug expectorant model mice experiments； GC-MS and UPLC-MS technologies were used to identify its volatile oils and non-volatile components of the fruits of P. chinense var. glabriusulum Schneid. The active ingredients， core targets and pathways of expectoration and cough relief were analyzed by network pharmacology. RESULTS The volatile oil （0.8， 0.2 g/kg， calculated by volatile oil） and water decoction （12， 3 g/kg， calculated by crude drug） of the fruits of P. chinense var. glabriusulum Schneid. both had obvious expectorant and cough relief effects， and showed obvious dose-dependent relationship. A total of 38 volatile oil components were identified from the medicinal herbs， and the relative percentage contents of 8 components were greater than 1%， such as α -pinene， myrcene， β -caryophyllene， germanene D， isospathulenol； a total of 69 non-volatile oil components were identified， mainly including phenolic compounds， alkaloids， and flavonoids. The active ingredients screened from the identified components included 13 compounds such as α-pinene， myrcene， chlorogenic acid， luteolin， berberine. There were a total of 55 intersection targets with diseases， and the core targets were tumor necrosis factor （TNF）， epidermal growth factor receptor （EGFR）， vascular endothelial growth factor A （VEGFA）， serine/threonine kinase proteins （AKT1） and Toll-like receptor 4 （TLR4）. The molecular docking results showed that the active ingredients and the core targets had good binding ability. GO functional analysis found that the targets were significantly enriched in biological processes such as the reaction affecting lipopolysaccharides， the positive regulation of peptidyl serine phosphorylation， and the positive regulation of the biosynthesis process of nitric oxide. KEGG pathway enrichment analysis found that the targets were significantly enriched in the signaling pathways such as cancer， non-small cell lung cancer， proteoglycans in cancer. CONCLUSIONS Fruits of P. chinense var. glabriusulum Schneid. have obvious expectorant and cough relief effects， and its material basis may be α-pinene， myrcene， chlorogenic acid， luteolin， berberine， etc.， and mainly act on TNF， EGFR， VEGFA， AKT1， TLR4 and its significantly enriched signaling pathway.

Objective:To investigate the effect of pretreatment with butorphanol on perineal discomfort caused by intravenous injection of dexamethasone sodium phosphate.Methods:Using the method of prospective study, ninety patients undergoing elective gynecological surgery in Dalian Women And Children′s Medical Group from June to December 2021 were randomly divided into three groups: butorphanol 0.5 mg pretreatment group (group B1), butorphanol 1.0 mg pretreatment group (group B2) and normal saline control group (group C), with 30 cases in each group. Patients in groups B1 and B2 were given butorphanol 0.5 mg and 1.0 mg intravenously, respectively, prior to induction of anesthesia, while those in group C were given 0.9% sodium chloride injection. 3 minutes later, all patients in the three groups were given dexamethasone sodium phosphate injection 10 mg, and the incidence, grade and adverse reactions of their perineal discomfort symptoms were recorded.Results:The incidence of perineal discomfort and moderate perineal discomfort of patients in group B1 and group B2 was lower than that in group C: 20.00%(6/30)and 10.00%(3/30)vs. 60.00%(18/30), 3.33%(1/30)and 3.33(1/30)vs. 30.00%(10/30), with a statistically significant differences ( P<0.05). The incidence of adverse reactions such as dizziness was increased in the group B2:26.67%(8/30)and 10.00%(3/30)vs. 40.00%(12/30), with a statistically significant difference ( χ2 = 7.13, P = 0.028). Conclusions:Butorphanol 0.5 mg and 1.0 mg pretreatments are touted as effective in inhibiting perineal discomfort caused by intravenous injection of dexamethasone sodium phosphate. However, the butorphanol 0.5 mg pretreatment group have fewer adverse reactions.

At present, hepatic resection (HR) and radiofrequency ablation of (RFA) are the main radical treatment methods for small hepatocellular carcinoma (sHCC), while stereotactic body radiotherapy (SBRT) is developing rapidly and there is an increasing number of reports on the effective treatment of sHCC with SBRT. This article introduces the technical advantages, therapeutic dose, and fractionation scheme of SBRT in the treatment of sHCC, as well as the limit of normal liver tissue and the protection of surrounding organs at risk. This article also compares the efficacy of SBRT versus HR and RFA in the treatment of sHCC and briefly describes the adverse reactions of SBRT in the treatment of sHCC. Previous studies have shown that for some sHCC cases, SBRT has an equal or even better clinical effect than HR and RFA, with controllable toxicity. Therefore, SBRT is expected to become another radical treatment method for sHCC.

Objective In this study,a multiplex PCR amplification system was constructed based on fluorescent labeling PCR and LDR,to provide a new strategy for analyzing severely degraded DNA.Methods Eight SNP loci (rs10802248,rs10516197,rs10488372,rs2278945,rs4757318,rs4887255,rs4889002,and rs9304473) were selected.Their LDR probes and PCR primers of linked products were designed and synthesized.Ligase detection reaction,PCR amplification,and capillary gel electrophoresis (CEG) were performed to establish the multiplex LDR-PCR amplification system.Results The genotypes of these 8 loci were obtained simultaneously by the fluorescence-labeled multiplex LDR-PCR amplification method.The loci profiles obtained by fluorescence-labeled multiplex LDR-PCR amplification were in accordance with those obtained by direct sequencing of the polymorphic regions in samples from all individuals.By fluorescence-labeled multiplex LDR-PCR amplification,the 8 SNP loci were efficiently amplified from the severely degraded FFPET DNA.Conclusion Eight SNP loci results could be obtained simultaneously by using the multiplex LDR-PCR amplification system,which is a simple,efficient,and practical SNP genotyping method with accurate and reliable results for highly degraded samples.

Objective To investigate the association between donor complement factor component 7 (C7) rs6876739 gene polymorphisms and risk of early bacterial infection following orthotopic liver transplantation (OLT).Methods A total of 113 patients who had undergone OLT in Shanghai General Hospital between July 2007 and January 2011 were included.A single nucleotide polymorphism (SNP),donor C7 rs6876739 was genotyped and analyzed together with clinical data.Results We demortstrated that donor C7 rs6876739 CC genotype had higher risk of early bacterial infection than TT genotype following OLT (55.6％ vs.26.5％,P =0.021).The multivariate logistic regression analysis revealed that gender (P =0.018),biliary complications (P =0.018),ICU stay after LT (P＜0.001) and donor C7 rs6876739 genotype (P =0.001) were identified as independent factors of early bacterial infection.Conclusion Donor C7 rs6876739 genotype polymorphism is associated with early bacterial infection following OLT and may be a new marker of risk for the development of potentially serious bacterial infection after liver transplantation.

Objective To explore the clinicopathological significance of the presence of lymphovascular invasion (LVI) in the high-grade stage pT1 bladder cancer (BC) after first transurethral resection of bladder tumor (TURBT).Methods The retrospective study was performed with 27 patients of high-grade stage pT1 BC after first TURBT from January 2006 to December 2011,and another 54 patients were matched as negative control in terms of gender,age,pathological pattern,grading and staging.All the data were calculated by using SPSS17.0 software.Qualitative variables were compared by using chi-square test.The Kaplan-Meier method was used to calculate total survival and cancer-specific survival and differences were assessed with the Log-rank statistic.Results Twenty-four patients (89％) experienced cancer recurrence in LVI group,while 19 cases (35％) experienced recurrence in control group.Progress developed in 56％ (15/27) and 24％ (13/54) in the 2 groups respectively.LVI was detected to be a prognostic factor for overall recurrence (x2 =20.845,P＜0.001) and progress (x2 =7.887,P =0.005) in patients with high-grade T1 stage BC.Furthermore,overall survival and recurrence-free survival according to the presence or absence of LVI was 54±6 months and 84±3 months,17±5 months and 67±5 months,respectively.LVI was proved to be associated with worse overall survival (x2=13.443,P＜0.001) and recurrence free survival (x2=33.094,P＜0.001).Conclusion In patients with high-grade T1 stage BC,LVI in first TURBT specimens predicts disease recurrence,progression and overall recurrence and recurrence free survival.

ObjectiveTo explore the change of renal cortical perfusion in rabbits by microbubbles-enhanced ultrasound cavitation.MethodsTotally 20 New Zealand rabbits were randomly divided into four groups, 5 rabbits in each group. SonoVue was injected via the ear vein at a dose of 0.1 ml/kg. The renal perfusion imaging 30 s modeling was made. Under the mode of contrast enhancement, the rabbit kidneys irradiated with different mechanical indexs (MI) were 0.6 (MI 0.6 group) , 0.75 (MI 0.75 group) , 1.1 (MI 1.1 group) and 1.3 (MI 1.3 group) for 60 s, 15 min respectively. After the irradiation and conventional ultrasound contrast was made again, the renal perfusion imaging was mad. The time-intensity curves (TIC) were analyzed obtained from the following parameters: the slope rate of ascending curve (A) , the slope rate of descending curve (α) , area under the curve (AUC) , time to peak (TTP) , and derived peak intensity (DPI) . One-way ANOVA and LSD-t were used to analyze all experimental data.ResultsCompared with the MI 0.6 group, the MI 1.1 group and the MI1.3 group, the A, α were less than MI 0.6 group, the AUC, DPI, TTP were greater than MI 0.6 group, and the differences were statistically signiifcant (MI 1.1 groupvs MI 0.6 group:t=3.13, 5.31, 4.25, 4.53, 5.72, allP<0.05; MI 1.3 groupvs MI 0.6 group:t=3.67, 6.23, 4.47, 5.48, 6.86, allP<0.05). Compared with the MI 0.75 group, the MI 1.1 group and the MI 1.3 group, the α were less than MI 0.75 group, the AUC, DPI, TTP were greater than MI 0.75 group, and the differences were statistically signiifcant (MI 1.1 groupvs MI 0.75 group:t=6.02, 4.36, 4.85, 5.83, allP<0.05; MI 1.3 groupvs MI 0.75 group:t=6.19, 4.51, 5.73, 6.97, allP<0.05); the MI 1.1 group and the MI 1.3 group, the A were less than MI 0.75 group, and the difference were not statistically signiifcant. The MI 1.1 group and the MI 1.3 group, the MI 0.6 and the MI 0.75 group, and the difference were not statistically signiifcant.ConclusionsTo the change of hemodynamic of the rabbits renal cortical perfusion in the microbubbles-enhanced ultrasound cavitation contrast agent can be observed. Along with the mechanical index increased renal cortical perfusion flow stasis and the perfusion on of slowed in rabbit, may cause renal damage, the TIC curve displayed further changes.