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Deep Learning Automated Patient-Specific Quality Assurance (PSQA) aims to reduce clinical resource requirements. It is vital to ensure the safety and effectiveness of radiation therapy by predicting the dose difference metric (Gamma passing rate) and its distribution. However, current research overlooks uncertainty quantification in model predictions, limiting their trustworthiness in real clinical environments. This paper proposes a Multi-granularity Uncertainty Quantification (MGUQ) framework. A Bayesian framework that quantifies uncertainties at multiple granularities for multi-task PSQA, specifically Gamma Passing Rate (GPR) prediction and Dose Difference Prediction (DDP), integrates visualization-based interactive components. Using Bayesian theory, we derive a comprehensive multi-granularity loss function that comprises granularity-specific loss and coherence loss components. Additionally, we proposed Multi-granularity Prior Networks, a dual-stream network architecture, to infer the distributions of DDP (modeled as t-distributions) and GPR (modeled as Gaussian distributions) under specific statistical assumptions. Comprehensive evaluations are conducted on a dataset from ''Peeking Union Medical College Hospital'', and results show that our proposed method achieves a minimum MAE loss of 0.864 with a 2%/3 mm criterion and realizes the uncertainty visualization of dose difference. Further, it also achieves 100% Clinical Accuracy (CA) with a workload of 67.2%. Experiments demonstrate that the proposed framework can enhance the trustworthiness of deep learning applications in PSQA.

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Objective:To investigate the dosimetry effect of rotational errors of multi-channel cylinder vaginal applicator of intravaginal irradiation after surgery of endometrial cancer.Methods:A total of 18 patients who underwent surgery of endometrial cancer at Peking Union Medical College Hospital from June to December 2022 were selected.The plans of patients who adopted the treatment of multi-channel cylinder applicator of vagina were retrospectively analyzed,which maintained the same retained mode with clinical plan.The applicator was rotated clockwise by 22.5? and 45.0?,respectively,simulating the rotational errors that occurred in placing the applicator among clinical inter-fractions.And then,the changes of dosimetry of target area and organs at risk(OAR)under two kinds of rotation amplitudes were further analyzed.Results:When the applicator was rotated as 22.5?,the minimum doses to 90%volumes of CTV by 2.03%than that of clinical plan,which was significantly different(t=5.86,P<0.05),and the maximal doses to 2cc of OARs of bladder and rectum respectively increased 2.35%and 2.71%,and the differences of them were statistically significant(t=-3.49,-2.40,P<0.05),respectively.When the applicator was rotated as 45?,the D90 of the target area decreased by 5.75%than that of clinical plan,which was statistically significant(t=14.07,P<0.05).The D2cc values of the bladder and rectum increased respectively by 6.50%and 9.49%than that of clinical plan,which were statistically significant(t=-7.72,-6.9,P<0.05).The differences of the exposed doses of sigmoid colon and small intestine after the applicator was rotated by 22.5? and 45.0? between the plan and original plan were respectively less,which were not statistical significance.Conclusion:The multi-channel cylinder applicator can provide individualized dose distribution in intravaginal irradiation.However,attention should be paid to the placement of the applicator when patients undergo inter-fractional treatment,in order to avoid deviations in the angular alignment from the original plan.This can impact the dosages of the target area and OARs.

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Objective:To investigate the risk factors and their warning effectiveness for postoperative intestinal barrier dysfunction (IBD) in patients with severe traumatic brain injury (sTBI).Methods:A retrospective cohort study was conducted to analyze the clinical data of 101 patients with sTBI admitted to Wuxi Branch of Zhongda Hospital Affiliated to Southeast University from May 2020 to February 2023, including 63 males and 38 females, aged 21-81 years [(53.4±14.2)years]. All the patients underwent emergency surgery. The patients were divided into IBD group ( n=67) and non-IBD group ( n=34) according to whether or not they had IBD after surgery. The gender, age, basic diseases (hypertension and diabetes), types of intracranial hematoma (subdural, epidural, and intracerebral hematoma), preoperative Glasgow Coma Scale (GCS), cerebral hernia, intraoperative initial intracranial pressure (iICP), operation time, removal of bone flap, treatment time in ICU, initiation time of enteral nutrition, and use of broad-spectrum antibiotics were recorded in the two groups. Univariate and multivariate binary Logistic regression analyses were conducted to assess the correlations between above-mentioned indicators and incidence of postoperative IBD in sTBI patients and determine the independent risk factors for sTBI. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the warning effectiveness of each risk factor for IBD. Results:The results of the univariate analysis showed that preoperative GCS, cerebral hernia, intraoperative iICP, removal of bone flap, treatment time in ICU, initiation time of enteral nutrition, and use of broad-spectrum antibiotics were significantly correlated with the incidence of IBD in sTBI patients ( P<0.05 or 0.01), while there were no correlations of IBD with gender, age, basic diseases, types of intracranial hematoma and operation time ( P>0.05). The results of the multivariate binary Logistic regression analysis showed that preoperative GCS≤5 points ( OR=2.49, 95% CI 1.17, 5.32, P<0.05), intraoperative iICP>23 mmHg (1 mmHg=0.133 kPa)( OR=1.20, 95% CI 1.03, 1.39, P<0.05), and initiation time of enteral nutrition>24 hours ( OR=10.03, 95% CI 1.26, 80.21, P<0.05) were highly correlated with postoperative IBD in sTBI patients. The results of the ROC curve analysis showed that intraoperative iICP had the highest warning value (AUC=0.91, 95% CI 0.85, 0.96), followed by preoperative GCS (AUC=0.88, 95% CI 0.82, 0.95), and initiation time of enteral nutrition had the lowest warning value (AUC=0.78, 95% CI 0.69, 0.87). Conclusions:Preoperative GCS≤5 points, intraoperative iICP>23 mmHg, and initiation time of enteral nutrition>24 hours are independent risk factors for postoperative IBD in sTBI patients. The warning value of intraoperative iICP ranks the highest for postoperative IBD in sTBI patients, followed by preoperative GCS, with initiation time of enteral nutrition having the lowest warning value.

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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.

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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<IMRT-9F<Manual-4Arc<IMRT-7F<VMAT-3Arc<VMAT-2Arc. There were significant statistical differences in V 30 Gy and D mean for the rectum, and the dose ranking was generally consistent with that of the bladder, except for a switch between the IMRT-7F and Manual-4Arc plans. There were no significant differences in rectal V 40 Gy, small intestine D max, and D mean among the 6 groups of plans. For OAR distant from the target, such as the left and right femoral heads, spinal cord, and bone marrow, the dose ranking was generally as follows: IMRT-12F<IMRT-9F<IMRT-7F<VMAT-2Arc<VMAT-3Arc<Manual-4Arc. Conclusion:The plans automatically generated by Ethos IOE in postoperative patients with cervical cancer can achieve similar performance to manual plans, and the automatically generated IMRT-12F and IMRT-9F plans are recommended for clinical use.

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BACKGROUND@#As the efficacy of programmed cell death-1/programmed death-ligand 1 (PD-1/PD-L1) inhibitors combined with chemotherapy in curing breast cancer is still controversial, this meta-analysis compares the efficacy and safety of PD-1/PD-L1 inhibitors combined with chemotherapy and chemotherapy alone in the treatment of breast cancer, which provides guidance for the clinical treatment.@*METHODS@#Relevant studies published as of April 2022 in the various databases including EMBASE, PubMed, and Cochrane Library were selected. Randomized controlled trials (RCTs) in which control patients underwent chemotherapy alone and experimental group patients underwent combination chemotherapy and PD-1/PD-L1 inhibitor treatment were included in this investigation. Investigations without complete information, researches from which information could not be extracted, duplicate articles, animal studies, review articles, and systematic reviews were excluded. STATA 15.1 was employed for all statistical analyses.@*RESULTS@#In total, eight eligible studies were identified, revealing that combination chemotherapy and PD-1/PD-L1 inhibitor treatment was linked to significant increases in progression-free survival (PFS) relative to chemotherapy alone (hazard ratio [HR] = 0.83, 95% confidence interval [CI]: 0.70-0.99, P = 0.032) but not overall survival (HR = 0.92, 95% CI: 0.80-1.06, P = 0.273). Pooled adverse event rates were also increased within the group of combination treatment relative to the chemotherapy group (risk ratio [RR] = 1.08, 95% CI: 1.03-1.14, P = 0.002). Specifically, nausea rates were lesser within the group of combination treatment relative to the group of chemotherapy (RR = 0.48, 95% CI: 0.25-0.92, P = 0.026). Subgroup analyses indicated that the PFS of patients who underwent combination atezolizumab or pembrolizumab and chemotherapy treatment were substantially longer than those of patients who underwent chemotherapy alone (HR = 0.79, 95% CI: 0.69-0.89, P ≤0.001; HR = 0.79, 95% CI: 0.67-0.92, P = 0.002).@*CONCLUSIONS@#The pooled results suggest that combination chemotherapy and PD-1/PD-L1 inhibitor treatment approaches help prolong PFS in breast cancer patients, but have no statistically significant effect on overall survival (OS). Additionally, combination therapy can significantly improve complete response rate (CRR) compared with chemotherapy alone. However, combination therapy was associated with greater rates of adverse events.

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Objective:To study the role of a novel brain-derived peptide hypoxic-ischemic brain damage associated peptide (HIBDAP) in regulating pyroptosis of oxygen-glucose deprived (OGD) microglia.Methods:The sequence of HIBDAP was coupled with the sequence of cell-penetrating peptide transactivator of transcription (TAT) to form TAT-HIBDAP. Fluorescein isothiocyanate (FITC) labeled TAT-HIBDAP was added to microglia cells and observed under fluorescence microscope. Microglia cells were treated with different concentrations of TAT-HIBDAP (1, 5, 10, 20 μmol/L) and then OGD process. Cell pyroptosis was analyzed using lactate dehydrogenase (LDH) assay. The concentration of TAT-HIBDAP with the most prominent inhibiting effects was determined and selected for subsequent experiments. The pyroptosis morphology of the control group, the OGD group and the HIBDAP group (5 μmol/L TAT-HIBDAP+OGD) was observed using transmission electron microscope. The mRNA and protein expression of NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasomes were examined using real-time quantitative PCR and Western Blot analysis.Results:Fluorescence microscope showed FITC-labeled TAT-HIBDAP could successfully enter microglia cells. Compared with the OGD group, low concentrations of TAT-HIBDAP (1, 5, 10 μmol/L) could significantly reduce microglia pyroptosis and the concentration of 5 μmol/L showed the most prominent effects. Compared with the control group, OGD group showed typical pyroptosis morphology and HIBDAP group showed significantly improved morphology. The mRNA and protein expression of NLRP3 inflammasomes in the OGD group were significantly higher than the control group and also the HIBDAP group.Conclusions:The novel brain-derived peptide HIBDAP may reduce the expression of NLRP3 inflammasomes and inhibit the pyroptosis of OGD microglia.

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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.

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Neonatal hypoxic ischemic encephalopathy(HIE)is a hypoxic ischemic brain injury caused by perinatal asphyxia.It is the major cause of neonatal death and neurological damage of infant and children, and its characteristic pathophysiological alteration is massive neuronal apoptosis.Microglia, one of the central nervous system phagocytes, play an important role in development of neonatal HIE.In recent years, efferocytosis has been discovered to be a specific phagocytosis of phagocytes.In neonatal HIE, microglia are able to remove apoptotic cells through efferocytosis, preventing further necrosis of apoptotic cells, which can trigger inflammatory responses and brain damage.Understanding the role of microglial efferocytosis in neonatal HIE may aid in elucidating its pathogenesis and exploring potential therapeutic approaches.This article is a review of the progress of microglial efferocytosis in neonatal HIE.

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Obesity has been identified as a chronic low-grade systemic inflammation and a key risk factor for diseases such as diabetes, hypertension, and malignancies, and has become an urgent global health burden. Adipose tissue macrophages play a significant role in adipose immune homeostasis and inflammatory responses. Under different conditions, they can be polarized into pro-inflammatory M1 phenotype or anti-inflammatory M2 phenotype. In obese individuals, there is abnormal polarization of macrophages in adipose tissue, leading to an imbalance in the M1/M2 phenotype dynamic equilibrium and the development of pathological inflammation. Therefore, restoring the balance of M1/M2 macrophage polarization is an important potential target for the treatment of chronic inflammation in obesity. Studies have shown that traditional Chinese medicine(TCM) can positively modulate macrophage polarization and produce beneficial effects on obesity. Based on existing evidence, this paper systematically reviewed the potential mechanisms of TCM in improving chronic inflammation in obesity from the perspective of macrophage polarization, in order to provide evidence for the clinical diagnosis and treatment of chronic inflammation in obesity with TCM and offer new insights for related research design and the development of new TCM.

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Objective:To formulate clinical commissioning procedures, items, and testing method for Flexitron afterloader hardware and software and establish relevant quality control procedures in order to meet national standards and clinical requirements.Methods:Clinical commissioning included hardware, treatment planning system (TPS), and end-to-end (ETE) full-process testing. The radioactive source positioning accuracy was measured using a source position check ruler. The accuracy and linearity of dwell time were evaluated using three method: stopwatch timing, ion chamber measurement, and video analysis. The accuracy of source position simulator, connecting tubes, source position check ruler, and other measuring tools was tested using a high-precision ruler. Films were used for calibration of marker lines and applicators. The electrometer and well chamber were used to calibrate the radioactive source activity. The display and reconstruction accuracies of the TPS were evaluated using physical image data. ETE testing was conducted using a custom-made phantom for scanning, planning, and dose measurement.Results:The accuracy testing result of the commissioning items were within acceptable limits. The deviation in source activity measurements was 0.21%, and the ETE point dose measurement deviation was 2.32%, both of which met the clinical requirements. However, there was a 2 mm difference between the nominal and measured values of the magnetic resonance marker line in the accuracy testing items. Therefore, adjustments were required when using marker line for catheter reconstruction based on magnetic resonance images.Conclusions:By summarizing the clinical commissioning experience of the Flexitron afterloader, this study has developed quality control method and baseline levels of result of afterloader and TPS items, which provides a reference for the commissioning before clinical use.

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Objective:To explore the feasibility of StereoPhan (SP) phantoms and SRS MapCHECK (SMC) semiconductor matrices in the dose verification of HyperArc (HA) plans for patients with brain metastases (BM).Methods:A total of 16 BM patients who received HA radiotherapy in the Peking Union Medical College Hospital were enrolled in this study. The ion chamber and the SMC semiconductor matrix were inserted into SP phantoms, respectively. The point and planar doses in HA verification plans were measured and compared with the calculated data of the treatment planning system (TPS). The criteria for planar dose γ analysis were set at 2 mm/3%, 2 mm/2%, 1 mm/3%, and 1 mm/2%.Results:The mean deviation of point doses in 16 patients was 1.33%±0.84%. Based on the above criteria, the γ pass rates of planar doses were 99.72%±0.46%, 98.93%±1.32%, 98.85%±1.79%, and 97.13%±3.19%, respectively.Conclusions:SP phantoms and SMC semiconductor matrices are applicable to the dose verification of HA plans for BM patients. The analytical criteria of 3% and 1 mm/2% can be used for verifying point and planar doses, respectively.

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Brachytherapy (BT) provides the opportunity to deliver highly potent radiation doses to the tumor, while more effectively sparing the surrounding organs at risk (OAR) due to the proximity of radiation sources to the tumor target and rapid fall-off of the source dose profile. As an important part of radiotherapy for cervical cancer, BT plays an irreplaceable role. The BT process is complex and can be divided into a series of steps. Long time waiting for patients in the state of implantation of the applicator may cause changes in the position of the applicator relative to the tumor and the movement of the OAR. In recent years, artificial intelligence (AI) has made great progress in the medical field. Machine learning and neural network have been widely applied in all aspects of BT, such as implantation of the applicator, image acquisition, segmentation of target area and OAR, reconstruction of the applicator, plan optimization, and treatment delivery, etc. In addition, BT significantly reduces the overall time, improves the homogeneity of operation, and enhances the accuracy of treatment. In this article, the application, development prospects, and challenges of AI in the BT of cervical cancer in recent years were reviewed, aiming to provide novel ideas for the application of AI in BT.

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BACKGROUND: Congenital anomalies of the kidney and urinary tracts (CAKUT) are the leading cause of kidney failure in children with phenotypic and genotypic heterogeneity. Our objective was to describe the genetic spectrum and identify the risk factors for kidney failure in children with CAKUT. METHODS: Clinical and genetic data were derived from a multicenter network (Chinese Children Genetic Kidney Disease Database, CCGKDD) and the Chigene database. A total of 925 children with CAKUT who underwent genetic testing from 2014 to 2020 across China were studied. Data for a total of 584 children wereobtained from the CCGKDD, including longitudinal data regarding kidney function. The risk factors for kidney failure were determined by the Kaplan-Meier method and Cox proportional hazards models. RESULTS: A genetic diagnosis was established in 96 out of 925 (10.3%) children, including 72 (8%) with monogenic variants, 20 (2%) with copy number variants (CNVs), and 4 (0.4%)with major chromosomal anomalies. Patients with skeletal abnormalities were more likely to have large CNVs or abnormal karyotypes than monogenic variants. Eighty-two patients from the CCGKDD progressed to kidney failure at a median age of 13.0 (95% confidence interval, 12.4-13.6) years, and twenty-four were genetically diagnosed with variants of PAX2, TNXB, EYA1, HNF1B and GATA3 or the 48, XXYY karyotype. The multivariate analysis indicated that solitary kidney, posterior urethral valves, bilateral hypodysplasia, the presence of certain variants and premature birth were independent prognostic factors. CONCLUSIONS: The genetic spectrum of CAKUT varies among different subphenotypes. The identified factors indicate areas that require special attention.

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BACKGROUND: The data in the real-world setting on breast pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) for hormone receptor-positive, human epidermal growth factor receptor-2-negative (HR+, HER2-) breast cancer (BC) is limited. The present study aims to screen for some predictors and investigate the prognostic significance of breast pCR after NAC in HR+, HER2- BC in China. METHODS: This was a multicenter, retrospective study. In this study, three hundred eighty-four HR+, HER2- BC patients who received NAC were enrolled between 2010 and 2016 from Shanghai Jiaotong University Breast Cancer Database (SJTU-BCDB). These patients were dichotomized according to the presence of breast pCR after NAC. Logistic analysis was used to screen for predictors associated with breast pCR. Kaplan-Meier (K-M) curve and a propensity score matching (PSM) analysis were performed to compare the disease-free survival (DFS) between the two groups. Cox regression was used to analyze the prognostic significance of breast pCR on DFS in HR+, HER2- BC. A nomogram model was established to predict the probability of DFS at 1, 3, and 5 years after NAC. RESULTS: Fifty-seven patients (14.8%) achieved breast pCR. Univariate analysis showed that tumor size, estrogen receptor (ER), progesterone receptor (PR), and Ki67 were associated with breast pCR. Further, multivariate analysis showed that tumor size, PR, and Ki67 remained statistically significant. K-M curves showed a statistical difference between the breast pCR and non-pCR groups before PSM (p = 0.047), and a more significant difference was shown after PSM (p = 0.033). Cox regression after PSM suggested that breast pCR, adjuvant ET, clinical T stage, and Ki67 status were the significant predictive factors for DFS in HR+, HER2- BC patients. The adjusted hazards ratio (aHR) for breast pCR was 0.228 (95% CI, 0.070~0.739; p = 0.014), for adjuvant endocrine therapy was 0.217 (95% CI, 0.059~0.801; p = 0.022), for Ki67 was 1.027 (95% CI, 1.003~1.052; p = 0.027), for cT stages 2 and 3 compared with 1, the values were 1.331 (95% CI, 0.170~10.389), and 4.699 (95% CI, 0.537~41.142), respectively (p = 0.043). A nomogram was built based on these significant predictors, providing an integrated probability of DFS at 1, 3, and 5 years. The values of area under the receiver operating characteristic (ROC) curve (AUC) were 0.967, 0.991, and 0.787, at 1 year, 3 years, and 5 years, respectively, demonstrating the ability of the nomogram to predict the DFS. CONCLUSIONS: This real-world study demonstrates that tumor size, PR, and Ki67 were independent predictive factors for breast pCR in HR+, HER2- BC. Breast pCR after NAC was an independent predictor for DFS in HR+, HER2- patients, regardless of a change in nodes. Furthermore, the nomogram built in our study could predict the probability of individualized DFS in HR+, HER2- BC patients.

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Objective:To evaluate and summarize the teaching effect of" New Technology of Radiotherapy and Oncology" in the form of questionnaire, understand the degree of demand for the course of all kinds of medical students and improve the teaching contents and methods.Methods:The course of" New Technology of Radiotherapy and Oncology" was a specialized elective course in Peking Union Medical College. After two rounds of teaching practices, we evaluated the students participating in the course or non-course participants by anonymous questionnaire. The questionnaire items include the course content, setting, teachers and improvement suggestions.Results:A total of 73 questionnaires were sent out, and the recovery rate was 100%. Among them, 52(71%) were from students who chose the courses. 83% of the students" strongly agree" that the teaching content of this course is the latest development, the latest achievement or the problem to be solved, 94% were" satisfied" or" very satisfied" with their learning effect, and 92% and 83% were satisfied with the teachers and teaching plan, respectively. After taking the course, students rated" broadening of mind" (96%) as the biggest gain, followed by" facilitating interdisciplinary collaboration" (79%). 86% of the non-course participants felt the need to supplement the existing curriculum with new techniques in oncology radiotherapy, hoping that the curriculum would" broaden the mind" (76%), improve clinical application (81%) and facilitate interdisciplinary collaboration (71%).Conclusion:The questionnaire results show that the teaching practice of this course covers the different needs of all kinds of students, which is worthy of implementation and further improvement.

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Objective:To investigate the current status of radiotherapy personnel and equipment in China, and to provide data basis for scientific allocation and effective use of radiotherapy equipment during the 14 th Five-year Plan period. Methods:From October to December 2020, a group of experts from China Association of Medical Equipment carried out an online questionnaire investigating the basic situation of radiotherapy in China, and the contents of the survey include radiotherapy centers, professional personnel, equipment, technology, equipment utilization rate, forecast of personnel and equipment in the next five years, etc. The data were reviewed by provincial medical societies/associations.Results:There were 1538 radiotherapy centers and 32978 radiotherapy professionals in Mainland China, including 18966 radiotherapy physicians, 4475 physicists and 9537 technicians. There were 2139 linear accelerators, 57 cobalt 60 accelerators, 457 afterloaders, 6 proton/heavy ion machines, 1034 conventional 2D simulators, 1208 CT simulators, and 89 MR simulators. 1459 centers can provide 3D conformal radiotherapy, 1256 centers can deliver intensity-modulated radiotherapy, 514 centers can offer volumetric modulated arc therapy, 422 centers can provide brachytherapy. According to the estimated data reported by the participating centers, in the next five years, the demand of professionals and machines will be increased by 4868 radiotherapy physicians, 2078 physicists and 3796 technicians, and 994 linacs, 896 CT simulators, 313 MR simulators and 54 proton heavy ions.Conclusions:The radiotherapy industry in China grows fast. During the 14 th Five-Year Plan period, the radiotherapy industry still has strong market demand as well as increase demand of personnel and equipment. Strengthening the market competitiveness of domestic radiotherapy enterprises, improving the equipment utilization rate in primary hospitals, providing comprehensive and systematic training and promoting standardized clinical application can resolve the issues of the lack and unbalanced distribution of radiotherapy resources, and maintain the fast and sustainable development of radiotherapy in China.

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Objective:To compare the effectiveness and safety of laparoscopic hepatectomy (LH) versus radiofrequency ablation (RFA) in treatment of hepatocellular carcinoma (HCC).Methods:The medical literatures on LH and RFA for HCC were searched in PubMed, Web of Science, Embase, VIP, Wanfang, CNKI and other electronic databases. The retrieval date was from database construction to June 7, 2021. According to the inclusion and exclusion criteria, studies were extracted by two authors, and Revman 5.3 software was used to conduct a meta-analysis to compare differences in operation time, blood loss, length of hospital stay, total complications, overall survival and disease-free survival outcomes between the LH group and the RFA group.Results:Of 3 690 patients who were included in 32 studies, there were 1 708 patients in the LH group and 1982 patients in the RFA group. Meta-analysis showed that compared with the LH group, the RFA group had significantly shorter surgical duration ( MD=-86.41, 95% CI: -116.21--56.60), less blood loss ( MD=-213.22, 95% CI: -273.43--153.00), shorter hospital stay ( MD=-3.23, 95% CI: -4.13--2.32), and lower incidence of complications ( OR=0.33, 95% CI: 0.26-0.43). However, local recurrence rate was significantly higher ( OR=1.83, 95% CI: 1.38-2.41). (All P<0.05). The 5-year survival rate of the LH group was significantly better than the RFA group ( OR=0.68, 95% CI: 0.51-0.90, P=0.008). Conclusion:LH provided better overall survival outcomes and lower local recurrence rates than RFA in HCC patients.

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Objective:To study the clinical feasibility and advantages of the RapidPlan module based on Halcyon 2.0 ring medical linear accelerator in the design of volumetric modulated arc therapy (VMAT) plans after cervical cancer surgery.Methods:The data of 98 clinical cervical cancer cases were selected from the database, and VMAT artificial radiotherapy plans were designed based on Halcyon 2.0. Then, the designed plans were imported into the RapidPlan module to train the module for a prediction model with high goodness of fit. Another 20 patients after cervical cancer surgery were selected as the validation set to compare the differences in dosimetry, plan consistency, and plan execution efficiency between the manual plans and RapidPlan automatic plans.Results:The RapidPlan automatic plans could obtain dose distribution of target volume and organs at risk with the same quality as the manual plans. The RapidPlan automatic plans provided slightly inferior protection of the femoral head but superior protection of the spinal cord compared to the manual plans, and the difference was statistically significant ( t = 4.71, P<0.001). The average MU of the RapidPlan automatic plans was 687.46, which was lower than that of the manual plan (815.34), and the difference was statistically significant ( t = 6.09, P < 0.05). The portal dosimetry (PD) verification revealed that the average γ passing rate (1 mm/1%) of the RapidPlan automatic plans was 89.48%and that of the manual plans was 88.22%, and the difference was statistically significant ( t = 3.35, P < 0.05). Conclusion:RapidPlan automatic plans based on the Halcyon 2.0 platform can meet the clinical needs of the VMAT program for cervical cancer and has certain advantages.

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Objective: To analyze the classification and functions of cell subsets in laryngeal carcinoma and metastatic lymph nodes, and to explore the evolution trajectory of epithelial cells to tumor cells. Methods: Single-cell RNA sequencing was performed on 5 cases of laryngeal cancer, matched metastatic lymph nodes and 3 normal tissues. Patients were admitted to Ningbo Medical Center Lihuili Hospital from October 22, 2019 to December 16, all patients were male, aged 53-70 years old. Cell subsets of the above-mentioned tissues were analyzed by the Seurat, and the biological functions of cell subpopulation were investigated by functional enrichment analysis. Malignant epithelial cells were identified using copy number variation (CNV). The evolutionary trajectory of epithelial cells to cancer cells was analyzed by cell trajectory analysis, and cancerous transitional cells were identified. The highly expressed genes in transitional cells were analyzed by the FindAllMarker of the Seurat and verified by immunohistochemistry. Results: A total of 66 969 high-quality cells were obtained in 9 major clusters: epithelial cells, T cells, B cells, fibroblasts, endothelial cells, myeloid cells, mast cells, plasmacytoid dendritic cells and nerve cells. The first 5 cell clusters were divided into 8, 6, 4, 3 and 2 subgroups, respectively. Four epithelial cell subsets (C0, C1, C2 and C5) were derived from tumor tissues and metastatic lymph nodes, and had high levels of CNV and tumor cell content. Cell trajectory analysis showed that the evolution trajectory of epithelial cells was from normal epithelial subpopulation C4 to early cancerous cell population C0, which differentiated into three major malignant cell subsets C1, C3, and C5. Epithelial cell C0 may represent the transitional cell population of carcinogenesis, and were enriched in biological processes such as epithelial-mesenchymal transformation and angiogenesis. C0 highly expressed sulforaphane (SFN) which may be related to the occurrence and development of cancer. Immunohistochemistry confirmed that SFN was highly expressed in tumor tissues and metastatic lymph nodes compared with paracancerous tissues. Conclusion: Single-cell sequencing may be used to elucidate the diversity of cells and functions in laryngeal carcinoma tissues and metastatic lymph nodes, and cell population C0 plays a key role in the evolution of cells.

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