Objective:To monitor intra-fractional set-up errors in tumor radiotherapy using a real-time intelligent capture system for precision displacement.Methods:A simulated radiotherapy environment was created in both the laboratory and the treatment room. A three-axis ( xyz) displacement platform (LD60-LM) and dial gauges were used as displacement measurement tools. Moreover, a real-time intelligent capture system for precision displacement was developed for displacement monitoring. With 23 patients treated with radiotherapy enrolled in this study, the above system was employed to monitor their intra-fractional set-up errors in fractionated radiotherapy. Descriptive analyses were conducted on the deviations between the data captured by cameras and the actual displacement, obtaining the mean values and standard deviation. Results:The monitoring calibration data from the laboratory revealed displacement differences of ≤ 0.5 mm within 20 mm and a maximum displacement difference of 1.47 mm for 50 mm. In contrast, the calibration result from the treatment room exhibited deviations of ± 0.2 mm on the y- z axes, as displayed by both the left and right cameras, and ± 0.31 mm on the x- z axes, as displayed by the middle camera. During 37 radiotherapy sessions in 23 patients, the monitoring result from the middle camera revealed five deviations exceeding the threshold of 5 mm, with the maximum deviation duration and displacement of 57.2 s and 9.24 mm, respectively. Conclusions:The real-time intelligent capture system for precision displacement based on machine vision can achieve real-time monitoring of set-up errors during tumor radiotherapy. Nevertheless, further improvements and service testing are necessary for this system.

Objective:To compare the short-term efficacy and the safety of microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of benign thyroid nodules (BTNs).Methods:This prospective randomized controlled trial, performed from December 2019 to September 2021, included 36 patients with solid or predominantly solid BTNs who met the eligibility criteria and provided written informed consent at the Nanjing sub-center (Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine). Patients were assigned to either the MWA group or the RFA group (18 patients in each group) at a ratio of 1∶1 using a block randomization design and allocation concealment using sealed envelope randomization. The independent-sample t-test and χ2 test were used to compare the volume reduction rates (VRRs), effective rates (VRRs≥50%), cosmetic scores, and complication rates at 1, 3, and 6 months after treatment between the two groups. Results:The clinical characteristics of the two groups of patients were comparable. After ablation, the nodule volume was significantly reduced in both groups. At 1, 3, and 6 months, there was no significant difference in the volume between the two groups (all P>0.05). At 3 months, the RFA group had a larger VRRs than that in the MWA group (62.08%±12.46% vs. 46.90%±23.16%, t=-2.45, P=0.021). However, at 1 and 6 months, no statistical significance was observed (both P>0.05). No significant difference was observed in the effective rates at the last follow-up (14/18 vs. 18/18, P=0.104). However, the RFA group had a lower cosmetic score than that in the MWA group (1.78±0.43 vs. 2.17±0.51, t=-2.47, P=0.019). There was no statistically significant difference in the complication rates between the two groups (all P>0.05). Conclusions:Both MWA and RFA were effective and safe treatments for BTNs, with no significant differences in short-term efficacy and safety. In addition, the RFA group showed slightly more favorable outcomes than the MWA group in terms of cosmetic improvement.

Objective The goals of this study were to identify early warning markers of severe dengue based on bioinformatics com-bined with machine learning,and explore the evaluation system of the risk of occurrence of severe dengue.Methods Based on the Gene Expression Omnibus database,the differentially expressed genes between dengue and severe dengue were analyzed,and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were conducted.Early warning genes of severe dengue were screened using a random forest model,and the accuracy of the genes was verified using receiver operating characteristic(ROC)curves.Finally,nomograms were constructed to quantify the warning genes and predict the risk of progression from dengue to severe dengue based on the expression level of these genes.Results A total of 817 differentially expressed genes were identified,along with the associated biolo-gical processes that may be closely related to the occurrence and development of severe dengue,namely,antimicrobial humoral response,humoral immune response,serine hydrolase activity,and arachidonic acid metabolism.Based on this analysis,five early warning genes were isolated:AZU1,PDCD4,COL4A3BP,TRPM4,and ATP4A.Among these,ATP4A,COL4A3BP,and TRPM4 showed low expression levels,whereas AZU1and PDCD4were highly expressed.The ROC curves indicated that these genes were accurate pre-dictors of severe dengue.The nomograms indicated good predictive accuracy,clinical benefit rate,and clinical effectiveness of the model.Conclusion Measuring the expression levels of five warning genes(AZU1,PDCD4,COL4A3BP,TRPM4,and ATP4A)may help to evaluate the risk of severe dengue.

Pancytopenia is one of the serious complications of Graves disease, and its clinical treatment is quite challenging. Based on traditional Chinese medicine theory and combining with literature reports and clinical practice in China, we discuss the etiology, pathogenesis, and syndromes-based treatment of pancytopenia, hoping to open up new treatment approaches, guide clinical practice, and improve treatment effectiveness.

Objective:To develop an automated landmark location system applicable to the case of landmark missing.Methods:Four and eighty-one lateral cephalograms, which contained 240 males and 241 females, with an average age of (24.5±5.6) years, taken from January 2015 to January 2021 in the Department of Orthodontics, Capital Medical University School of Stomatology, and met the inclusion criteria were collected. Five postgraduate orthodontic students were the annotators to manually locate 61 possible landmarks in 481 lateral cephalograms. Two assistant professors in the department as reviewers performed calibration. Two professors as arbitrators, made final decision. Data sets were established (341 were used as training set, 40 as validation set, and 100 as test set). In this paper, an automatic landmarks identification and location model based on convolutional neural networks (CNN), CephaNET, was developed. The model was trained by feeding the original image into the feature extraction module and convolutional pose machine (CPM) module to locate landmarks with high accuracy using deep supervision. Training set was enhanced to 1 684 images by histogram equalization, cropping, and adjustment of brightness. The model was trained to compare the Gaussian heat maps output from the network with the set threshold to identify landmark missing cases. Test set of 100 lateral cephalograms was used to test the accuracy of the model. The evaluation criteria used were success detection rate of missing landmark, mean radial error (MRE) and success detection rate (SDR) in the range of 2.0, 2.5, 3.0, 3.5 and 4.0 mm.Results:The model identified and located 61 commonly used landmarks in 0.13 seconds on average. It had an average accuracy of 93.5% in identifying missing landmarks. The MRE of our testing set was (1.19±0.91) mm. SDR of 2.0, 2.5, 3.0, 3.5 and 4.0 mm were 85.4%, 90.2%, 93.5%, 95.4%, 97.0% respectively.Conclusions:The model proposed in this paper could adapt to the absence of landmark in lateral cephalograms and locate 61 commonly used landmarks with high accuracy to meet the requirements of different cephalometric analysis methods.

Type 2 diabetes mellitus （T2DM），as a chronic disease with an increasing prevalence，has greatly affected the quality of life of patients， and aroused widespread concern in society. Previous studies have shown that inflammation is closely related to the occurrence and development of T2DM. The role of inflammatory response and its signaling pathway in the pathogenesis of T2DM has become a research hotspot，and the intervention of inflammatory response to control the progression of T2DM has become a new approach for treatment. With the deepening in the research field of traditional Chinese medicine （TCM），the generation of inflammation is attributed to turbid phlegm and blood stasis， whose mutual transformation results in the impairment of body functions. However，the monomers and compounds of Chinese medicine in the treatment of T2DM based on inflammatory signaling pathways are advantageous in multiple targets，multiple pathways， and few side effects，which can significantly relieve the symptoms of T2DM. In recent years，there has been an increasing number of studies on TCM intervention in T2DM. The present article elaborated the understanding of the relationship between T2DM and inflammation in TCM and the seven signaling pathways related to the regulation of inflammation in T2DM by TCM， including nuclear transcription factor-κB （NF-κB） signaling pathway，mitogen-activated protein kinase （MAPK）-dependent signaling pathway，phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway，protein kinase C （PKC） signaling pathway，adenosine 5′-monophosphate （AMP）-activated kinase （AMPK） signaling pathway，Wnt signaling pathway，and transforming growth factor-β （TGF-β） signaling pathway.

Objective:To evaluate the effect of short-term very low-calorie restriction(VLCR) on glycemic control in overweight/obese patients with type 2 diabetes, and to explore mechanisms through identifying markers of gut microbiota.Methods:This trial was conducted in 14 adult overweight/obese patients with type 2 diabetes. They received VLCR for 9 days in the hospital(calorie intake 300-600 kcal/d). Before and after VLCR, body weight(BW), waist circumference(WC), blood pressure(BP), and heart rate(HR) were measured, and body mass index(BMI) was calculated according to their height and weight. Fasting blood glucose(FBG), 2 h postprandial blood glucose(2hPBG), fasting insulin(FINS), triglycerides(TG), total cholesterol(TC), high-density lipoprotein-cholesterol(HDL-C), and low-density lipoprotein-cholesterol(LDL-C) were determined, and yielded the homeostasis model assessment for insulin resistance(HOMA-IR). Additional lab tests such as liver and kidney function and electrolytes were performed. The estimated glomerular filtration rate(eGFR) was calculated to evaluate renal function. All data were analyzed using the SPSS Sample Power software. Feces samples were collected before and after VLCR. Fecal samples were tested for microbial diversity using 16S rDNA technology. Professional software was used to analyze the differences of gut microbiota in feces before and after VLCR.Results:After 9 days of VLCR, BW, BMI, WC, BP, HR, FBG, 2hPBG, FINS, HOMA-IR, alkaline phosphatase, TG, and blood urea nitrogen of 14 overweight/obese patients with type 2 diabetes were significantly reduced( P<0.05). No effect was seen on serum alanine aminotransferase, aspartate amino transferase, gamma glutamyl transferase, TC, HDL-C, LDL-C, creatinine, eGFR, uric acid, albumin, calcium, and phosphorus( P>0.05). The gut microbiota diversity did not differ before and after VLCR. The abundance of Bacteroidetes increased significantly, and the Firmicutes/Bacteroidetes ratio decreased from 11.79 to 4.20. Between groups analysis showed the abundance of Parabacteroides distasonis increased significantly after VLCR. Conclusion:VLCR can improve body weight and glucose and lipid metabolism in overweight/obese patients with type 2 diabetes, with no serious adverse events. Parabacteroides distasonis may be a marker of VLCR.

Objective:To study the safety and efficacy of laparoscopic subtotal distal pancreatectomy using the arterial first approach in treatment of patients with pancreatic neck-body cancer after neoadjuvant chemotherapy.Methods:The clinical data of patients who underwent laparoscopic subtotal distal pancreatectomy after neoadjuvant chemotherapy at the Department of Pancreatic Surgery, Hunan Provincial People's Hospital from January 2019 to June 2021 were analyzed retrospectively. Seven patients were included in this study. There were 3 males and 4 females, aged 55(46, 67) years old. The clinical data analysed included chemotherapy, preoperative, intraoperative, postoperative and follow-up data. Follow up was done by outpatient visits, or contact using wechat or telephone.Results:Five borderline staged patients were treated with the AG chemotherapy regimen (gemcitabine+ albumin-bound paclitaxel), and two patients with locally advanced stage were treated with the mFOLFIRINOX chemotherapy regimen (oxaliplatin+ irinotecan+ calcium folate+ fluorouracil). All the 7 patients underwent portal vein/superior mesenteric vein resection and reconstruction using the superior mesenteric artery priority approach. The operation time was 400(350, 440) min, and the intraoperative blood loss was 300(150, 400) ml. Postoperative complications occurred in 2 patients with grade B pancreatic fistula and refractory ascites in 1 patient each. The postoperative hospital stay was 11(10, 14) days. All 7 patients underwent R 0 resection. During a follow-up period of 9 to 33 months, 5 patients were still alive without tumor, 1 patient survived with tumor, and 1 patient had died of recurrence. Conclusion:In selected cases, laparoscopic subtotal distal pancreatectomy for pancreatic neck-body cancer after neoadjuvant chemotherapy was safe and feasible.

Objective:To understand the epidemiological characteristics and trends of syphilis in Kashgar area of Xinjiang Uygur Autonomous Region and provide a basis for formulating syphilis control measures.Methods:A descriptive epidemiological method was used to analyze the epidemiological characteristics of syphilis cases reported in Kashgar from 2005 to 2020, and the Joinpoint 4.8.0.1 software was used to calculate the annual percent change (APC) and perform trend testing.Results:From 2005 to 2020, 75 331 syphilis cases were reported in Kashgar. The number of syphilis cases increased from 720 in 2005 to 4 275 in 2020. The reported incidence increased from 19.57/100 000 in 2005 to 93.86/100 000 in 2020 in two stages. From 2005 to 2014, the reported incidence increased from 19.57/100 000 to 188.17/100 000, with an average annual increase of 28.24%. From 2014 to 2020, the reported incidence decreased from 188.17/100 000 to 93.86/100 000, with an average annual decrease of 12.58%. The reported incidence of primary syphilis, secondary syphilis, tertiary syphilis and fetal-transmitted syphilis increased first and then decreased with time. However, the reported incidence of recessive syphilis has been on the rise. Since 2018, the ratio of recessive syphilis has exceeded that of primary syphilis, becoming the main epidemic type. The incidence ratio of male to female was 0.97∶1 (37 097∶38 234); all age groups had reported cases, with 20-49-year-old group the most, accounting for 55.65% (41 921/75 331) of the total number of reported cases; occupational distribution was dominated by farmers, accounting for 71.15% (53 595/75 331) of all reported cases, and the proportion of farmers was increasing year by year, from 35.00% in 2005 to 79.04% in 2020.Conclusions:The situation of syphilis in Kashgar was serious in 2005-2020. We should strengthen the publicity of health knowledge and health education,especially strengthen the health education and prevention of young and middle-aged people, farmers, women of childbearing age and other key groups. Additional, the screening that raises syphilis ceaselessly even and detects level, accomplish early discovery, standard report and cure, in order to curb the popularity of syphilis.

Objective: To investigate the effect of obstructive sleep apnoea-hypoapnoea syndrome(OSAHS)on diabetic retinopathy(DR)in elderly patients with type 2 diabetes mellitus(T2DM)and analyze risk factors for DR process. Methods: Data of elderly diabetic patients without DR admitted into our hospital from January 2012 to December 2014 were retrospectively analyzed.Based on whether or not to combine OSAHS, patients were divided into the OSAHS group(n=42)and the control group(n=85). After 36 months' follow-up, the incidence and progression of DR were compared, and the effect of different degree of OSAHS on DR was analyzed.Multivariate logistic regression analysis was used to analyze the risk factors for DR. Results: The systolic pressure, diastolic pressure and Epworth sleepiness scores were higher in the OSAHS group than in the control group(P<0.05). At the(34.5±6.7)months of follow-up versus baseline, body mass index, renal function and cardiac function were markedly decreased in both groups(P<0.05). The systolic pressure, diastolic pressure, 2-h postprandial blood glucose and Epworth sleepiness scores were higher in the OSAHS group than in the control group; and the glomerular filtration rate(GFR)and left ventricular ejection fraction were lower in the OSAHS group than in the control group(P<0.05). The incidences of mild, moderate and severe non-proliferative DR were higher in the OSAHS group than in the control group(P<0.05). The results of subgroup analysis showed that the incidence of DR was higher in patients with moderate to severe OSAHS than in controls(OR=4.57, 95%CI: 1.24~13.78, P=0.002), while the incidence of DR in patients with mild OSAHS was similar to that in the controls(OR=2.33, 95%CI: 0.66~12.56, P=0.29). Multivariate logistic regression analysis showed that T2DM duration ≥7 years(OR=3.24, 95%CI: 1.80-9.59, P<0.05), haemoglobin A1c(HbA1c)≥7.5%(OR=2.07, 95%CI: 1.41-8.52, P<0.05), GFR<60 ml/min(OR=4.52, 95%CI: 1.75-14.26, P<0.05)and apnea/hyponea index ≥15/h(OR=2.03, 95%CI: 1.37-11.24, P<0.05)were independent risk factors for DR. Conclusions OSAHS patients tend to have hypertension and high glucose level, and are more prone to cardiac and renal dysfunction and DR.T2DM duration ≥7 years, HbA1c ≥7.5%, GFR<60 ml/min and AHI ≥15/h are independent risk factors for DR progression.And more studies are needed to confirm the independent risk factors.