Objective To evaluate the application of three deep learning algorithms in automatic segmentation of clinical target volumes (CTVs) in high-dose-rate brachytherapy after surgery for endometrial carcinoma. Methods A dataset comprising computed tomography scans from 306 post-surgery patients with endometrial carcinoma was divided into three subsets: 246 cases for training, 30 cases for validation, and 30 cases for testing. Three deep convolutional neural network models, 3D U-Net, 3D Res U-Net, and V-Net, were compared for CTV segmentation. Several commonly used quantitative metrics were employed, i.e., Dice similarity coefficient, Hausdorff distance, 95th percentile of Hausdorff distance, and Intersection over Union. Results During the testing phase, CTV segmentation with 3D U-Net, 3D Res U-Net, and V-Net showed a mean Dice similarity coefficient of 0.90 ± 0.07, 0.95 ± 0.06, and 0.95 ± 0.06, a mean Hausdorff distance of 2.51 ± 1.70, 0.96 ± 1.01, and 0.98 ± 0.95 mm, a mean 95th percentile of Hausdorff distance of 1.33 ± 1.02, 0.65 ± 0.91, and 0.40 ± 0.72 mm, and a mean Intersection over Union of 0.85 ± 0.11, 0.91 ± 0.09, and 0.92 ± 0.09, respectively. Segmentation based on V-Net was similarly to that performed by experienced radiation oncologists. The CTV segmentation time was < 3.2 s, which could save the work time of clinicians. Conclusion V-Net is better than other models in CTV segmentation as indicated by quantitative metrics and clinician assessment. Additionally, the method is highly consistent with the ground truth, reducing inter-doctor variability and treatment time.

Concurrent chemoradiotherapy (CCRT) refers to the simultaneous treatment of chemotherapy and radiotherapy, and the effect of radiotherapy is enhanced with low-dose chemotherapy, which can reduce tumor recurrence and metastasis and improve clinical prognosis of patients. At present, the main factors for the increase of radiosensitivity of concurrent chemotherapy is that concurrent chemotherapy prevents the repair of tumor cells, and chemotherapy and radiotherapy act on different cell cycles and have synergistic effects. However, even for patients with locally advanced cervical cancer (LACC) who have undergone CCRT, the 5-year survival rate is only 60%, which is still not ideal. In order to improve the efficacy, researchers have conducted a series of exploratory studies, which consist of the combination of targeted drugs and immunodrugs, and neoadjuvant regimens before CCRT, etc. Although targeted or immunologic drugs are effective treatment of LACC, in view of the lack of large-scale evidence-based medical evidence, multi-center prospective and randomized phase III clinical trials and high-level articles are needed to improve the level of evidence-based medicine. This consensus summarizes several key evidence-based medical studies published recently, especially the clinical research progress in targeted and immunological therapies, providing reference for domestic peers.

Objective:To explore the effect of artificial dermis combined with autogenous thin skin graft on the survival rate of compound skin graft and the scar state of joints in burn patients.Methods:94 burned patients treated in Baoding Fifth Hospital from August 2017 to August 2019 were prospectively selected as the research objects. They were randomly divided into two groups with 47 cases in each group. The control group was treated with simple medium thick skin transplantation, and the observation group was treated with artificial dermis combined with autologous thin skin grafting. The recovery of the two groups (healing time of skin donor area, healing time of skin graft area, healing time under scab of burn area and hospitalization time) were compared. The survival rate of composite skin transplantation, wound healing, Vancouver Scar Scale (VSS) score, joint range of motion (shoulder abduction, knee flexion, knee extension), Burn Specific Health Scale-Brief (BSHS-B), Profile of Mood States-Short Form (POMS-SF) score and complications were compared.Results:The healing time of donor area, skin graft area, subeschar healing time and hospital stay in the observation group were shorter than those in the control group ( P<0.05). The wound healing in the observation group was better than that in the control group, and the survival rate of composite skin transplantation was higher than that in the control group ( P<0.05). After treatment, the scar state of the joint in the two groups was improved compared with that before treatment ( P<0.05); The scar thickness, vascular distribution score and total score of VSS in the observation group were lower than those in the control group ( P<0.05). After treatment, the joint range of motion in the two groups was improved compared with that before treatment ( P<0.05); The shoulder abduction, knee flexion and knee extension in the observation group were higher than those in the control group ( P<0.05). After treatment, the quality of life and psychological status of the two groups were improved compared with those before treatment ( P<0.05); The BSHS-B score of the observation group was higher than that of the control group, and the POMS-SF score was lower than that of the control group ( P<0.05); The incidence of complications in the observation group (4.26%) was lower than that in the control group (21.28%) ( P<0.05). Conclusions:Artificial dermis combined with autologous thin skin graft can significantly improve the survival rate of compound skin graft in burned patients, and can further reduce the scar condition of the joints of patients, reduce the incidence of complications, and effectively improve the prognosis of patients.

We use a dense and fully connected convolutional network with good feature learning in small samples, to automatically pre-deline CTV of cervical cancer patients based on CT images and evaluate the effect. The CT data of stage IB and IIA postoperative cervical cancer with similar delineation scope were selected to be used to evaluate the pre-sketching accuracy from three aspects:sketching similarity, sketching offset and sketching volume difference. It has been proved that the 8 most representative parameters are superior to those with single network and reported internationally before. Dense V-Net can accurately predict CTV pre-delineation of cervical cancer patients, which can be used clinically after simple modification by doctors.
Automation ; Female ; Humans ; Machine Learning ; Patients ; Tomography, X-Ray Computed ; Uterine Cervical Neoplasms/diagnostic imaging*

Objective:To explore clustered epidemic of COVID-19 in Liaocheng city and analyze infection status and chain of transmission of the cases.Methods:A joint investigation team of emergency response for COVID-19 epidemic by CDC professional workers of Liaocheng city and district at two levels on January 30, 2020. According to a indicator case from ZH supermarkets, close contacts and related subjects were tracked and screened on February 1, including ZH supermarket employees, family members having contact history with related cases during January 13-26, supermarket clients during January 16-30 and family members of related cases. an epidemiological investigation was carried on and their swab of nose/throat were collected and were sent to Liaocheng CDC laboratory, real-time fluorescence quantitative RT-PCR was used to detect nucleic acids of SARS-CoV-2.Results:a total of 8 437 people were screened during January 30 to February 9, 2020 (120 employees of supermarket, 93 family members, and 8224 clients of supermarket). The epidemic was caused by ZH cases and brought clustered cases in four families. A total 25 cases of SARS-CoV-2 infection, the total infection rate of subjects was 0.30% (25/8 437) with 22 confirmed cases (0.26%, 22/8 437) and 3 asymptomatic patients (0.04%, 3/8 437), asymptomatic patients accounted for 12.00% (3/25) of all infection cases. The infection rates of supermarket employees, family members of confirmed cases and supermarket clients were 9.17% (11/120), 12.90% (12/93) and 0.02% (2/8 224).Conclusions:This was a cluster epidemic caused by one imported case of COVID-19 in a supermarket of Liaocheng city. Prevention and control of cluster epidemic should be focused on chain of community transmission and family cluster cases. It must also be an attention for transmission risk of asymptomatic patients.

Objective To analyze the correlation between serum leptin and osteoprotegerin with IL-6 and TNF-α in the pa-tients with gout arthritis osteoporosis .Methods Forty-eight cases of gout arthritis were selected as the research subjects (GA group) ,including 19 cases of complicating osteoporosis(OP group) and 29 cases of non-complicating osteoporosis(non-OP group) . Other 45 individuals undergoing healthy physical examination were selected as the control group .The bone mineral density (BMD) was measured by dual energy X-ray BMD absorptionmetry instrument and the levels of serum LEP ,OPG ,IL-6 and TNF-αwere de-tected by ELISA .Results The incidence rate of osteoporosis in the GA group was significantly higher than that in the control group (39 .6% vs .13 .3% ,P=0 .004) ,and BMD in various sites was significantly lower than that of the control group (P<0 .05) . The serum LEP level in the OP group was significantly increased compared with that in the non-OP group and control group(P<0 .05) ,and the OPG level was significantly decreased ,the difference was statistically significant (P<0 .05) .The serum LEP level in the non-OP group was significantly higher than that in the control group (P<0 .05) ,but the OPG level had no statistical difference between non-OP group and control group(P>0 .05) .The serum IL-6 and TNF-αlevels in the OP group were significantly higher than those in the non-OP group and control group(P<0 .05) ,and the non-OP group was significantly higher than the control group (P<0 .05) .The serum LEP level in the OP group was positively correlated with IL-6 and TNF-α(P<0 .05) ,and the serum OPG level was negatively correlated with IL-6 and TNF-α(P<0 .05) .Conclusion The serum LEP and OPG levels have abnormal change in the patients with gout arthritis osteoporosis ,which has a certain correlation with IL-6 and TNF-α.

OBJECTIVETo understand the prevalence of myopia in primary and middle school students in 6 provinces and the possible influencing factors.

METHODSPrimary and middle school students were selected through multistage cluster sampling in 60 primary and middle schools in 6 provinces in China. The questionnaire survey and eyesight test were conducted among all the students selected according to the national student's physique and health survey protocol. Pearson chi-square test and binary multivariate logistic regression analysis were done to identify the influencing factors for myopia in students.

RESULTSThe prevalence of myopia among primary and middle school students surveyed was 55.7%, the gender specific difference was statistically significant (59.7% for girls, 51.9% for boys) (P<0.01). The prevalence of myopia increased with age obviously. The prevalence was 35.8% in age group 6-8 years, 58.9% in age group 10-12 years, 73.4% in age group 13-15 years and 81.2% in age group 16-18 years, the differences were statistically significant (P<0.001). Single factor and multivariate analysis showed that parents' myopia, distance between computer screen and eyes, distance less than 30 cm between eyes and book while reading, distance less than 10 cm between chest and the table edge while studying, distance less than 3 cm between fingers and pen tip, sleep time, average outdoor activity time during last week, school sport activities in the afternoon, the size of television set at home, time spent on watching TV and playing computer were the influencing factors for myopia.

CONCLUSIONSThe prevalence of myopia is till high in primary and middle school students. Myopia is associated with both genetic factors and individual eye health related behaviors.

Adolescent ; Child ; China ; epidemiology ; Female ; Health Behavior ; Health Surveys ; Humans ; Logistic Models ; Male ; Multivariate Analysis ; Myopia ; epidemiology ; Parents ; Prevalence ; Schools ; Sleep ; Students ; Surveys and Questionnaires

OBJECTIVE:To discuss the effect and safety of dezocine on hemodynamics and inflammatory cytokines in esoph-ageal cancer patients with one-lung ventilation(OLV). METHODS:80 esophageal cancer patients were randomly divided into ob-servation group and control group,40 cases in each group. All patients received 0.5 mg penehyclidine hydrochloride+0.1 mg/kg midazolam+4 μg/kg fentanyl+2 mg/kg propofol+0.15 mg/kg cisatracurium for anesthesia induction,propofol 4-10 mg/(kg·h)+remifentanil 0.1 μg/(kg·min)were pumped after double-lumen endobronchial catheter. Observation group received 1 mg dezocine by Intravenous injection in surgical skin incision,control group received the same amount of normal saline. Hemodynamic parame-ters [heart rate (HR),mean arterial pressure (MAP)] and inflammatory cytokine levels in 2 groups before anesthesia induction (T1),when skin incision(T2),5 min after dezocine/normal saline(T3),OLV 30 min(T4),recovery two-lung ventilation 10 min (T5)and end of the operation(T6)were compared,and the incidence of adverse reactions was observed. RESULTS:There was no significant difference in HR and MAP in 2 groups at T1,T5 and T6(P>0.05);HR and MAP in observation group at T2,T3 and T4 were significantly lower than control group,the difference was statistically significant(P<0.05). There were no significant differ-ences in TNF-α and IL-8 at T1,T2 and T3 and IL-6 at T1,T2,T3 and T4 between 2 groups(P>0.05);TNF-α and IL-8 at T4,T5 and T6 and IL-6 at T5 and T6 in observation group were significantly lower than control group,the differences were statistically signifi-cant(P<0.05). And there was no obvious adverse reactions during treatment. CONCLUSIONS:Dezocine shows more stable hemo-dynamics and lower expression level of inflammatory cytokines in esophageal cancer patients with OLV,with good safety.

Objective To compare the dosimetric characteristics of helical tomotherapy(HT)and step-and-shoot intensity modulated radiotherapy(IMRT)for post-operative cervix cancer patients. Methods Ten patients with post-operative cervix cancer were enrolled in this study.HT and IMRT plans were developed for each patient.The dose distributions of the targets,organs at risk(OARs),CI and HI were analyzed and compared.The prescribed dose was 60 Gy/25 f for CTV1,50 Gy/25 f for CTV2.The iso-dose line of 50 Gy was used.Results The homogeneity indexes(HI)(0.94±0.03),conformity index(C1)(1.28±0.02)in HT group were better than in IMRT group(0.85±0.01 and 1.36±0.03),respectively(t=5.12,-6.34,P<0.001).The Dmean of PTV in HT group(51.77 Gy)was lower than that in IMRT group(54.53 Gy)(t=-8.01,P<0.05).The Dmax ,Dmean,V30,V40 and V50 of bladder、rectum and small bowel were lower in HT group than those in IM RT group.The Dmax,Dmean,V30 and V40 of right and left femoral head were lower in HT group than those in IMRT group.Conclusion Helical tomotherapy treatment plan has a better homogeneity,steeper dose gradient,and a better protection for organs at risk.

Objective To investigate the dosimetric characteristics of helical tomotherapy(HT),intensity-modulated radiation therapy(IMRT)and three.dimensional conformal radiation therapy(3D-CRT)for the post-operative breast cancer as well as their comparison in protecting the normal tissues.Methods The CT images of 10 postoperative patients with early stage breast cancer were transferRed into HT and IMRT and 3D- CRT planning system respectively after the target region and normal tissues were drawn out with the same doctor.Each prescribed dose for three kinds of plans was 50 Gy/25 fractions.Inrradiation doses and volume at heart and double lungs as well as conformity index(CI)and homogeneity index(HI)were evaluated.Results The PTV volume of prescribed target dose of 95% and 100%in HT, IMRT and 3D-CRT groups were 99.13%and 95.87%,97.80%and 94.05%,96.37%and 87.29%.respectively.The CI and HI in HT.IMRT and 3D-CRT groups were 0.80±0.10 and 1.09 ±0.03,0.65±0.07 and 1.14±0.02,0.40±0.08 and 1.17±0.04,respectively V5,V10 and V20 of the heart were the lowest at 3D-CRT than HT and lM RT.V5 of the diseased lung was the lowest at 3D-CRT compared to HT and IMRT.V5 and V10 of the healthy lung were the lowest at 3 D-CRT compared to other groups.Conclusions Compared with IMRT and 3D-CRT.HT technique in treating breast cancer had the best conformity index and homogeneity index as well as steeper dose gradient.Irradiated doses and volume at the heart was the lowest at 3D- CRT and the highest at IMRT.Irradiated doses and volume of the heart and healthy lung as well as the diseased lung were the lowest at 3D-CRT compared to HT and IMRT groups.