Objective:To explore the dosimetry difference between intensity-modulated radiotherapy (IMRT) and volumetric intensity modulated arc therapy (VMAT) based on the inner edge tangent field (IETF) after left-sided breast conserving surgery.Methods:The localization CT and target organ at risk (OAR) data of 35 patients with left-sided breast cancer treated with IMRT after breast conserving surgery at Department of Radiotherapy in Yunnan Cancer Hospital from June 2022 to June 2023 were selected. The IETF-IMRT and the IETF-VMAT plans were designed for the same patient based on IETF, the dosimetry differences of target areas and OAR, as well as the planned execution time were compared between the two groups.Results:Dosimetry of target areas: for IETF-IMRT and IETF-VMAT, the D 98% of the planning target volume were (47.92±0.51) and (48.21±0.33) Gy, respectively, while the D 50% were (52.04±0.22) and (51.91±0.26) Gy, respectively, and the D 2% were (53.93±0.36) and (53.62±0.41) Gy, respectively, the conformity index were 0.84±0.03 and 0.87±0.02, respectively, while the homogeneity index were 0.12±0.01 and 0.10±0.01, respectively, with statistically significant differences ( t=-3.87, P<0.001; t=3.53, P=0.001; t=5.30, P<0.001; t=-13.60, P<0.001; t=6.24, P<0.001). Dosimetry of OAR: for IETF-IMRT and IETF-VMAT, the left lung V 5 were (31.91±6.28) % and (33.99±6.31) %, respectively, and the V 20 were (11.71±2.06) % and (9.73±2.12) %, respectively, with statistically significant differences ( t=-4.18, P<0.001; t=12.40, P<0.001). The right lung V 5 were (0.11±0.08) % and (7.13±3.12) %, respectively, and the D mean were (1.05±0.12) and (2.71±0.27) Gy, respectively, with statistically significant differences ( t=-33.62, P<0.001; t=-13.30, P<0.001). The spinal cord D 2% were (1.08±0.11) and (4.83±1.40) Gy, respectively, with a statistically significant difference ( t=-15.99, P<0.001). The left lung D mean were (7.45±1.08) and (7.37±1.03) Gy, the heart D mean were (4.21±0.96) and (4.41±0.48) Gy, and the right-sided breast D mean were (3.74±1.52) and (3.48±1.11) Gy, respectively, with no statistically significant difference ( t=1.16, P=0.253; t=-1.76, P=0.088; t=1.41, P=0.169). Planned execution time: the execution time of IETF-IMRT and IETF-VMAT was (10.73±1.21) and (2.18±0.17) min, respectively, with a statistically significant difference ( t=44.71, P<0.001) . Conclusion:Both IETF-IMRT and IETF-VMAT can meet clinical requirements, however the two techniques have their own characteristics. IETF-VMAT has better conformity and homogeneity of target region. The planned OAR dosimetry in both plans are significantly lower than the dose limit of postoperative radiotherapy for breast cancer, among which the left lung V 5, the right lung V 5, D mean and spinal cord D 2% of IETF-IMRT are slightly lower, the left lung V 20 of IETF-VMAT is slightly lower. IETF-VMAT significantly reduces the planned execution time compared with IETF-IMRT, thus can greatly reduce the dose deviation caused by patient position change, and significantly improve patients experience and comfort of radiotherapy. Taken together, IETF-VMAT has advantages over IETF-IMRT in radiotherapy after breast conserving surgery of left-sided breast cancer.

Systemic treatment, including molecular targeted therapy, immunotherapy, and chemotherapy, is an important means of achieving long-term survival in patients with intermediate-and advanced-stage liver cancer. However, some patients are insensitive to treatment and even develop drug resistance. Mitochondria are the center of cellular energy metabolism and, at the same time, are the priority targets for systemic therapy. Mitochondrial homeostasis plays an important role in the treatment of liver cancer. The relationship between the two advances is elucidated so as to provide better ideas for the clinical treatment of liver cancer.

Objective:To survey and update the epidemiological data of chronic obstructive pulmonary disease (COPD) in people≥40 years old in Yinchuan City in the last 10 years.Methods:This was a cross-sectional study in which questionnaires and physical measurements were taken from April 2019 to December 2022 using multi-stage stratified whole population sampling of residents≥40 years in three districts, two counties, and one city in Yinchuan City. In this survey, 14 666 cases were extracted, and finally 11 547 cases with qualified lung function measurements and complete questionnaires were included in the analysis to obtain the basic information of the respondents, exposure to disease-related factors, symptoms related to COPD, disease awareness and lung function test rate, and logistic regression was used to analyze the risk factors of COPD.Results:A total of 11 547 cases were included in the study, and 1 841 patients with COPD were detected, giving an overall prevalence of COPD of 15.9%. The prevalence was higher in men (18.6%) than in women (12.9%); it was higher in urban areas (17.3%) than in rural areas (14.7%); and it was statistically significant that the prevalence of current smokers (24.4%) and ex-smokers (24.6%) was higher than the prevalence of non-smokers (13.0%) (all P<0.001) in those COPD patients. The prevalence rates of COPD in people aged 40-49, 50-59, 60-69, and ≥70 years were 11.7%, 12.9%, 16.9%, and 24.6%, respectively, which tended to increase gradually with age ( P<0.001). 10.5% of patients with COPD said they were aware of the disease and 17.4% received a pulmonary function test. The results of logistic regression analyses showed that the risk factors for COPD included male, advanced age, living in an urban area, low literacy, current smoking, former smoking, history of secondhand smoke exposure, low body weight, history of biomass fuel use, and family history of respiratory disease. Conclusions:The prevalence of COPD among people≥40 years in Yinchuan City is significantly higher than 10 years ago and is higher than the national data. However, the disease awareness rate is low, and active intervention of risk factors and enhancement of publicity are important measures to prevent and control the disease.

Novel coronavirus Omicron variant infection can cause severe illness and even death in certain populations. Omicron variant infection may lead to systemic inflammatory response, coagulation disorder, multi-organ dysfunction and other pathophysiological changes, which are different from other Novel coronavirus variants to a certain extent, so therapeutic strategies should not be the same. The National Medical Center for Major Public Health Events invited experts in fields of infectious diseases, respiratory medicine, intensive care, pediatrics and fever clinic to develop this quick guideline based on the current best evidence and extensive clinical practices. This quick guideline aims to standardize the diagnosis and treatment of novel coronavirus Omicron infection, and to improve the disease management abilities of clinicians.

Molecular targeted drugs are one of the treatments for hepatocellular carcinoma (HCC), the primary factor influencing their therapeutic efficacy is drug resistance. Diminished drug intake, greater efflux, improved DNA damage repair capacity, aberrant signal pathways, hypoxia, epithelial-mesenchymal cell transition, and the cellular autophagy system are summarized herein as aspects of the drug resistance mechanism. Simultaneously, effective strategies for addressing drug resistance are elaborated, providing ideas for better clinical treatment of HCC.

Since 2010, the incidence of severe fever with thrombocytopenia syndrome (SFTS) has been increased. Owing the progress in diagnosis and treatment, the overall mortality of SFTS in China has decreased, while the mortality in critical SFTS patients is still high. In order to provide guidance and working procedures for clinicians to diagnose and treat critical SFTS, the National Medical Center for Major Public Health Events invited experts to discuss and formulate this consensus based on their experience and up-to-date knowledge on SFTS.

Objective:To explore the dosimetry difference between volumetric modulated arc therapy (VMAT) and tomo direct (TD) in tumor bed simultaneous push radiotherapy after left breast-conserving surgery, and to provide more dosimetry reference for clinic.Methods:A total of 22 patients with left breast cancer who underwent simultaneous quantitative radiotherapy after breast-conserving surgery were selected from the Department of Radiation Oncology, Yunnan Cancer Hospital from December 2018 to June 2020. The localized CT images and target organs at risk and other structural data were collected. Two radiotherapy plans, VMAT and TD, were designed for the same patient, and the dosimetry differences of target areas and organs at risk were compared and analyzed between the two groups.Results:In terms of target dosimetry, there were statistically significant differences in the D 2% [ (59.99±0.19) Gy vs. (59.55±0.51) Gy, t=4.09, P<0.001], D 98% [ (57.19±0.08) Gy vs. (57.46±0.22) Gy, t=-5.10, P<0.001], conformal index (CI) (0.76±0.05 vs. 0.58±0.13, t=8.19, P<0.001) and homogeneity index (HI) (0.05±0.00 vs. 0.04±0.01, t=4.89, P<0.001) of the planning gross tumor volume (PGTV) between VMAT and TD plans. However, there was no statistically significant difference in the D 50% [ (58.73±0.10) Gy vs. (58.73±0.24) Gy, t=-0.03, P=0.974]. There were statistically significant differences in the D 50% [ (52.21±0.33) Gy vs. (53.00±0.72) Gy, t=-4.81, P<0.001], D 98% [ (48.44±0.43) Gy vs. (49.09±0.21) Gy, t=-6.80, P<0.001], CI (0.83±0.06 vs. 0.67±0.06, t=10.52, P<0.001) and HI (0.20±0.01 vs. 0.19±0.01, t=8.75, P<0.001) of the planned target volume (PTV) between the two plans. However, there was no statistically significant difference in the D 2% [ (59.01±0.45) Gy vs. (59.00±0.48) Gy, t=0.22, P=0.830]. In terms of organs at risk, there were statistically significant differences in the V 20 [ (18.81±2.86) % vs. (22.03±1.91) %, t=-5.36, P<0.001] and D mean [ (11.66±1.32) Gy vs. (12.85±1.46) Gy, t=-4.10, P=0.007] of left lung, V 5 [ (5.70±2.90) % vs. (0.30±0.13) %, t=16.44, P<0.001] and D mean [ (2.45±0.29) Gy vs. (0.43±0.14) Gy, t=9.09, P<0.001] of right lung, D mean [ (3.22±0.72) Gy vs. (1.69±0.80) Gy, t=5.41, P<0.001] of right breast, D 2% [ (5.37±1.97) Gy vs. (0.46±0.09) Gy, t=11.75, P<0.001] of cord between VMAT and TD plans. There were no significant differences in the V 5 of left lung [ (53.00±5.99) % vs. (50.00±7.69) %, t=1.91, P=0.061], V 5 of right breast [ (11.51±4.60) % vs. (8.06±3.49) %, t=1.59, P=0.120], V 30 [ (1.49±0.69) % vs. (1.51±0.71) %, t=-0.06, P=0.952] and D mean [ (3.99±0.97) Gy vs. (3.90±1.03) Gy, t=0.56, P=0.581] of heart between the two plans. Conclusion:TD and VMAT can meet the clinical dosimetry requirements for patients with left breast cancer after breast-conserving surgery. However, the two techniques have their own characteristics. VMAT has better conformity and TD has better uniformity. TD is significantly better than VMAT in protecting the right lung, right breast and spinal cord of healthy organs at risk. VMAT is better in protecting the left lung. Both VMAT and TD basically achieve the same protection for heart.

Objective:To investigate the pathogen distribution and antimicrobial resistance among lower respiratory tract infections in patients with hematological malignancies.Methods:Sputum samples were collected from 967 patients with hematological malignancies and lower respiratory tract infections in Department of Hematology,the Second Hospital of Shanxi Medical University from January 2017 to July 2020. The pathogens and drug sensitivity reports were carried out by automatic bacterial identification instruments. WHONET 5.6 and SPSS 20.0 softwares were used for statistical analysis.Results:A total of 961 strains of pathogens were isolated, 516 (53.7%) pathogens were Gram-negative bacteria, mainly 118 strains of Klebsiella pneumonia (12.3%), 68 strains of Pseudomonas aeruginosa (7.1%), 67 strains of Acinetobacter baumannii (7.0%),52 strains of Stenotrophomonas maltophilia (5.4%), 43 strains of Escherichia coli (4.5%), and 42 strains of Enterbacter cloacae (4.4%). There were 171 (17.8%) strains of Gram-positive bacteria and 274 (28.5%) fungi. The drug resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenem were 22.1%-31.3%. Stenotrophomonas maltophilia was sensitive to levofloxacin, compound sulfamethoxazole and minocycline. The antimicrobial resistance rates of these three enterobacteria to carbapenems, cefoperazone/sulbactam, piperacillin/tazobactam were low (<10%). The resistant Gram-positive bacteria to ticoplanin, vancomycin and linazolamide were not detected.Conclusion:The major pathogens related to lower respiratory tract infections in patients with hematological malignancies are gram-negative bacteria in our centre. Different pathogens appear different characteristics of antimicrobial resistance.

Objective:To explore the application value of soluble tumor suppressor 2 (SST2), galectin-3 combined with magnetic resonance multimodality in the diagnosis of myocardial fibrosis.Methods:The clinical data of 88 patients with cardiomyopathy from January 2017 to December 2019 in Handan Central Hospital of Hebei Province were retrospectively analyzed as the experimental group, and 100 healthy people in the same period were selected as the control group. According to the results of cardiac magnetic resonance imaging (CMRI)-late gadolinium enhanced (LGE), the patients with cardiomyopathy were divided into LGE positive and LGE negative. The arrhythmia rate was evaluated by ambulatory electrocardiogram. The New York Heart Association (NYHA) cardiac function grade was recorded. The left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD) were detected by echocardiography. The SST2, galectin-3 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were detected by enzyme-linked immunosorbent assay (ELISA). The receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of SST2 and Galectin-3 in predicting myocardial fibrosis in patients with cardiomyopathy.Results:CMRI-LGE results of 88 patients with cardiomyopathy showed that LGE was positive in 42 cases and negative in 46 cases. The arrhythmia rate, LVEDD, SST2 and galectin-3 in experimental group were significantly higher than those in control group: 67.05% (59/88) vs. 2.00% (2/100), (46.55 ± 5.99) mm vs. (27.92 ± 2.05) mm, (61.83 ± 10.57) μg/L vs. (24.99 ± 7.69) μg/L and (18.65 ± 3.39) μg/L vs. (7.12 ± 1.33) μg/L, the LVEF was significantly lower than that in control group: (55.11 ± 8.36)% vs. (68.83 ± 9.45)%, and there were statistical differences ( P<0.01). The arrhythmia rate, NYHA cardiac function grade, LVEDD, SST2 and galectin-3 in patients with LGE positive were significantly higher than those in patients with LGE negative: 88.10% (37/42) vs. 47.83% (22/46), (3.10 ± 0.53) grade vs. (2.11 ± 0.61) grade, (48.88 ± 5.95) mm vs. (44.41 ± 5.24) mm, (65.58 ± 11.73) μg/L vs. (58.40 ± 8.10) μg/L and (21.00 ± 2.72) μg/L vs. (16.51 ± 2.39) μg/L, the LVEF was significantly lower than that in patients with LGE negative: (52.15 ± 8.23)% vs. (57.82 ± 7.60)%, and there were statistical differences ( P<0.01). ROC curve analysis result showed that the optimal critical values of serum SST2 and galectin-3 for predicting myocardial fibrosis in patients with cardiomyopathy were 65.07 μg/L and 18.46 μg/L, the area under the curve was 0.714 (95% CI 0.604 to 0.825, P = 0.001) and 0.894 (95% CI 0.828 to 0.960, P = 0.001), the sensitivity was 61.9% and 85.7%, and the specificity was 80.4% and 82.6%. Conclusions:Magnetic resonance multimodality has a good ability in detecting myocardial fibrosis, and serum SST2 and galectin-3 have good predictive value for myocardial fibrosis. SST2 and galectin-3 combined with magnetic resonance multimodality has important clinical significance in the diagnosis of myocardial fibrosis.

In December 2019, the 2019 novel coronavirus pneumonia (NCP, officially named Coronavirus Disease 2019(COVID-19) by the World Health Organization) broke out in Wuhan, Hubei, and it quickly spread to the whole country and abroad. The situation was at stake. The sudden and serious COVID-19 epidemic has brought us a lot of urgent problems. How to effectively control the spread of COVID-19? When does the population infection rate rise to its peak? What will eventually be the number of infected patients? How to make early diagnosis? What effective antiviral drugs are available? How to effectively treat with existing drugs? Can it successfully improve the survival rate of critically patients? In response to the above questions, we put forward corresponding suggestions and reflections from the perspective of the infectious clinician.